经曰∶丹田隐隐痛者三焦疽，其上肉微起者三焦痈。
王肯堂曰∶三焦痈石门穴（又名三焦募，在脐下二寸。）必隐痛微肿，令人寒热往来，二便
秘涩，由湿热遇寒凝结而成，治法与大小肠痈同。
书云∶积聚大小一辙，但人大气壮无积，人小气弱积多，故积论偏重哑科。
夫不言痢、泻、疳三者，而仅言积，治未病之源也。更不言六聚，而先言五积，从
其难者而言之也。聚与积总因食物不化，阴血凝聚，源同而名异。经曰∶积者五脏所
生，聚者六腑所成，气之所积名曰积，气之所聚名曰聚。聚者，阳气也，故阳浮而
动，其气运转不定，遇滞即止，发无本根，痛无常处，气旺渐消，不治自己。积者，阴
气也，故阴沉而伏，蓄积一处而不行，发有常处，其痛不离其部，阴属里，治之为
难。积有常所，有形之血也，聚无定部，无形之气也。积块者痰与食，积，死血也。凡
面黄浮肿，腹胀虚鸣，小便如油，毛发焦黄，下痢赤白，目珠黄赤，遍体虚肿，当
腹倍热，遇食肚疼，昏困多睡者，皆是积候，宜急治之。若至面白喘急，或面黑眼
直，干呕不食，泻住又泻，腹急如鼓，项软口噤，手足俱细者，并为不治。然有五
脏为积之名， 、瘕、痞、癖四证之别；食、乳、气三积之分，虚、实、惊，诸积之异。
先举五脏之积而详之。肝之积名曰肥气，在左胁下，形如覆杯，有头有足，如龟鳖状。
心之积名曰伏梁，起于脐上，大如手臂，上至心下。脾之积名曰痞气，在于胃脘，覆
大如盘。肺之积名曰息贲，在右胁下，覆如大杯。肾之积名曰奔豚，发于少腹，上
至心下，如豚奔走之状，或上或下，亦无定时，此五积之候也。 者，按之应手，亦
如五积之不移，瘕者，假物成形，如鱼鳖石瘕之类。 者，皮浓也，在肌肉之门而
可见者也。癖者，僻也，内结于隐僻，外不可见也。乳积者，吐泻兼作，气息酸臭，
因乳哺失调所致也。食积者，腹坚热渴，或泻或呕，肠鸣腹痛，因饮食过餐而得也。气
积者，腹痛啼叫，痢如蟹渤，因物触忤儿，或食母气乳而得也。虚积者，乳食不化，一
身浮肿，虚中受积也。实积者，肚热粪硬，身热而渴，嗜食善饥，实热蕴积也。惊积
者，因惊时与食，口秽而黄，当腹疼痛也。治之之法，寒者温之，热者清之，实者行
之，虚者调之，惊者和之。治积惟有挨积、磨积、消积、化积，而无迅下之理。
丹溪曰∶凡积不可用下药，徒损真气，病亦不去，况积之成也，正气不足，而后
邪气踞之，如小人在朝，由君子之衰也。正气与邪势不两立，一胜则一负，邪气日昌，
正气日削，不攻去之，危亡从及，然攻之太急，正气转伤。国中末之三法，不可不
明也。初者病邪初起，正气尚强，邪气尚浅，则任受攻；中者受病渐久，邪气较深，
正气较弱，任受且攻且补；末者病魔经久，邪气侵凌，正气消残，则任受补。盖积之
为义，匪朝伊芳夕所以去之，亦当有渐，攻之愈亟，则伤正气，正伤则不能运化而邪
愈固矣。更宜审明何经受病，受伤何物，从其因以治之。
昔张子和动辄言下，下之当也。仲景三承气汤审之详密，可下不可下，急下何
积何药，分毫不爽。寒积巴豆感应丸，热积大黄承气汤，血积桃仁、红花，下水牵
牛、甘遂，水中之血虻虫、水蛭，虫积槟榔、雷丸。今人畏而不敢下者，不明之罪；
无忌而妄用者，杀人之罪；消虚者当扶助正气，消息推荡之，慎勿孟浪戕人天年。
五积当从郁论，《难经》所谓因受胜己之邪，传于己之所胜，适当旺时，拒而不
受，因留为积，此皆抑郁不伸而受其邪，故五积六聚，治同郁断。伏梁者心之郁，肥
气者木之郁，痞气者土之郁，息贲者金之郁，奔豚者水之郁，郁者气不舒而抑郁成
积，不独聚可以气言也。故治积之法，以理气为先，则津液流行，积聚何由而成，然
更不可不兼以补也。盖壮者气行则已，怯者着而成病。故积之为积，本于气虚血弱
之人，故曰壮人无积，虚则有之。善治积者，不必问其何经何脏，必先调其中气，使
能饮食，气血即旺，积滞自消，即壮实而宜消者，亦当以补血补气之药兼服。经曰∶
大积大聚，其可犯也，衰其半而已。故消积及半，纯与甘温调养，使脾血健运，则
余积不攻自退，所谓养正则邪自除，犹满座皆君子，则一二小人，自无容身之地；若
欲积尽而后止胃气之存也，无几矣。
积聚痞块之证，皆内为喜、怒、忧、思、悲、恐、惊七情所致，若以五脏传克成积，
不亦求之太过乎！盖气血荣卫一身，上下周流，无时少息，一旦七情感动五志之火，
火性炎上，有升无降，以致气液水谷不能顺序，稽留为积也必矣。丹溪曰∶气不能
成块成聚，夫块乃有形之物，乃痰与食积死血而成。凡在中为痰饮，在右为食积，在
左为血块，何以明之？夫左关肝胆之位，藏血液，右关脾胃之位，藏饮食，所以左边
有积则为血块，右边有积则为食积，而其
中间则为水谷出入之道路，五志之火熏蒸水谷而为痰饮，所以中间有积，则为痰饮
也。治法因所因从其类以治之。大抵积之初多属寒，而积之久则为热矣。宜知新久
之异，以分辛温、辛平、辛凉三者之宜。然人之积块疝气心腹等，痛本多属热，而方
中又多用桂附热药，却又不发药毒者，盖因诸积、诸痛喜温而恶寒，热药与病情相
和，况积久成郁而火邪深矣，若见寒愈逆，见热愈喜，两热相从，是即所谓亢则害承
乃制，从治法也。世人见其投热不为热误，遂以是寒为属沉寒痼冷，恣投热剂，以致
真气被蚀，阴血干枯，不可为矣。抑尝论之，医为病所困者，惟阴虚之难补，久积
之难除，故玉山自倒，阴虚之谓也，养虎遗患，久积之谓也。人之罹此二者，须节
欲以养性，内观以养神，淡泊自如，从容自得，然后委之于医，方能为尔保也。
者，是因饮食得之。痛刺胁肋，心胸烦闷，饮食不下，吐逆恶心，日久不治，
渐成 结。又曰∶食结其证属阴，阴主静，故 定于一处而不移。
瘕者，是因伤血得之。其状胸膈烦闷，痛引少腹，时或攻筑上抢心胸，虽不阻食，
渐成瘕结，又曰血结。然此与 ，总因荣卫俱虚，风寒袭于外，饮食滞于中，久而
不化则邪并于阴而为 ；邪并于阳则为瘕。瘕者假物象形，动而不息，去来无常，或
两胁间有块如石，按之则痛，不按则轻，久而不已，面黄肌瘦，肚硬而胀，腹现青筋，
昼凉夜热，食减飧泥，成为疳积。治宜调脾养胃，磨积消疳，非一日一夕可愈也。
痞者，是因伤气得之。其候心腹膨胀，肚大胁满，痛刺往来，住在左肋，面黄肌
瘦，倦怠无力，久而不治渐成痞块。痞者，寒也。结者，实也。凡热气蕴于胸膈之间，
停饮聚于腹胁之内，于是荣卫不得流行，腑脏不得宣通，而乃成结也，不可迅下，否
则邪反坚结，经所谓着而不去，其病为实矣。惟宜安胃理脾，佐以顺气化滞。若胸
中气不通泰而如痞者，乃正气不运所致，不可作有形攻治。盖胸为受气之所，虚则受
而不能行，实非物也，故曰∶痞者否也。
癖者，是因积得之。其证如肠癖之疾，便利无度，似痢非痢，似虫非虫，或下鲜
血，肚腹干痛，心胸满闷，久久不治，则顽结不散，有类痞状。盖由乳哺失调，停
滞为积，久则血膜并聚，胁旁结癖，时时作痛，或发潮热，又有食癖乳癖，疳癖惊
癖，虚癖痰癖之分，其伤气血一也。若至面色紫黑，肚胀如鼓，凑心刺痛，忽泻鲜
血，唇舌皆黑，干呕气促，皮焦斑紫，吐泻出虫，肠鸣自利，体虚发搐，面青流涎，
手足心肿，面黑泻黑者，并皆不治。
钱仲阳曰∶癖块者，僻于两胁；痞结者，居于中脘。此因乳哺失调，饮食停滞，
邪气相搏而成。医者多用克伐，脾胃必虚，久而不愈，必先以固胃气为主，使养正则
结自除。若欲直攻其结，不但不消，抑亦损其脾土，脾土亏损，必变证百出矣。宜
朝服补中益气汤，夕服千金消癖丸，间服治之获效多矣。（《幼科痞块论》）
酒积 轻者葛根、神曲、黄连，白豆蔻。甚者甘遂、牵牛。
气积 轻者木香、枳壳、浓朴、橘红。甚者枳实、牵牛。
蟹积 紫苏。
痰积 轻者半夏、栝蒌。甚者滚痰丸。老痰海石、瓦楞子。皮里膜外芥子。
水积 轻者五苓散。甚者商陆、甘遂、芫花。
茶积 轻者姜黄、芝麻。甚者茱萸、椒姜。
谷积 轻者麦芽、神曲、砂仁。甚者鸡内金。
肉积 轻者山楂、阿魏。甚者 砂、硝石。
蛋积 白豆蔻、橘红、豆豉、姜汁。
鱼鳖积 紫苏、橘红、木香、姜汁，白马尿专治鳖瘕。
虫积 雄黄、锡灰、槟榔、雷丸、芜荑、榧子、使君子、川楝子。
狗肉积 杏仁、山楂。
血积 轻者干漆、桃仁、丹皮、归尾、赤芍、红花。甚者大黄、虻虫、水蛭、穿山甲、花蕊石。
果积 丁香、肉桂、麝香。
麦积 萝卜子、姜，酒煎。
《黄帝内经》说：丹田部位隐隐作痛的是三焦疽，该处肌肉微微隆起的是三焦痈。
王肯堂说：治疗三焦痈要针刺石门穴（又名三焦募穴，位于脐下二寸）。此病必然表现为隐痛微肿，使人出现寒热往来的症状，大小便秘涩不通。这是由湿热之邪遇寒凝结而成的，治疗方法与大肠痈、小肠痈相同。
医书说：积聚的大小治法大体一致，但人体气壮者不易产生积聚，人气弱则积聚多生，所以论述积聚的书籍往往偏重于儿科（哑科，指不能言语的小儿）。这里不讲痢疾、腹泻、疳证这三种病，而只讲积，是为了探究未病的根源。又不讲六聚，而先讲五积，是因为从难治的角度来论述。聚和积总因食物不消化，阴血凝聚而成，源头相同而名称不同。《内经》说：积是由五脏产生的，聚是由六腑形成的。气所积聚的地方叫作“积”，气所聚集的地方叫作“聚”。聚属于阳气，所以阳气浮越而动，其气运转不定，遇到阻滞就停止，发作没有固定的根本，疼痛没有固定的位置，正气旺盛时逐渐消散，即使不治疗也会自愈。积属于阴气，所以阴沉伏藏，蓄积在一处而不运行，发作有固定的部位，疼痛不离其所在部位，阴属里证，治疗起来比较困难。积有固定的处所，是有形的血瘀；聚没有固定的部位，是无形的氣滞。积块是痰与食积、死血凝结而成。凡是面色黄而浮肿，腹胀虚鸣，小便如油状，毛发焦黄，下痢赤白相间，眼珠黄赤，全身虚肿，腹部特别发热，进食后肚子疼，昏沉困倦多睡的人，都是积证的候象，应当紧急治疗。如果发展到面色苍白气喘急促，或者面色发黑眼睛直视，干呕不能进食，腹泻停止后又腹泻，腹部急胀像鼓一样，颈部软弱口噤不开，手足都细瘦的人，都属于无法治疗的绝症。然而有五积的名称，以及癥、瘕、痞、癖四种证候的区别；还有食积、乳积、气积的分类，以及虚积、实积、惊积等不同。先列举五脏之积并详细说明。肝的积名叫肥气，在左胁下，形状像倒扣的杯子，有头有足，像龟鳖的形状。心的积名叫伏梁，起于脐上，大如手臂，向上延伸至心下。脾的积名叫痞气，位于胃脘部，覆盖面积大如盘子。肺的积名叫息贲，在右胁下，覆盖形状像大杯子。肾的积名叫奔豚，发于小腹，向上至心下，像小猪奔跑的样子，或上或下，也没有固定时间，这就是五积的候象。癥，用手按压能感觉到，也像五积那样位置固定不移；瘕，是假借物象成形，如鱼瘕、鳖瘕、石瘕之类。痞，是指皮厚，在肌肉表层而可见到的。癖，是指僻侧，内结于隐蔽偏僻之处，外表不可见。乳积，表现为呕吐腹泻同时发生，气息酸臭，是由于哺乳失调所致。食积，表现为腹部坚硬发热口渴，或者腹泻或者呕吐，肠鸣腹痛，是由于饮食过量而得。气积，表现为腹痛啼哭呼叫，痢疾状如蟹渤，是由于受惊吓触犯小儿，或者母亲情绪波动通过乳汁传给孩子而得。虚积，表现为乳食不化，全身浮肿，是虚中受积。实积，表现为肚热大便硬，身体发热而口渴，嗜食且容易饥饿，是实热蕴积。惊积，是由于受惊时进食，口臭且黄，腹部疼痛。治疗的方法，寒证用温法，热证用清法，实证用行气攻逐法，虚证用调理法，惊证用安抚和解法。治疗积证只有挨积、磨积、消积、化积的方法，而没有迅速攻下的道理。
朱丹溪说：凡是有积证不可使用泻下药，只会损伤真气，病也不会去除。况且积的形成，是因为正气不足，然后邪气占据它，就像小人在朝廷当道，是因为君子的衰败。正气与邪势不相容，一胜则一负，邪气日益昌盛，正气日益削弱，如果不攻除它，危亡随即到来，然而攻伐太急，正气反而受伤。初、中、末三法，不可以不明白。初期病邪刚起，正气尚强，邪气尚浅，则可以承受攻伐；中期患病渐久，邪气较深，正气较弱，可以承受边攻边补；末期病魔经久，邪气侵凌，正气消残，则可以承受补益。大概积的含义，不是朝夕之间形成的，所以去除它，也应当循序渐进，攻伐越急切，就越伤正气，正气受伤就不能运化，邪气反而更牢固了。更应审明是哪条经络生病，受伤的是什么物质，顺着病因来治疗。
过去张子和动不动就言下法，认为下法是恰当的。张仲景的三承气汤审查得详细周密，可下不可下，急下何种积、用何药，分毫不差。寒积用巴豆感应丸，热积用大黄承气汤，血积用桃仁、红花，下水饮用牵牛子、甘遂，水中之血用虻虫、水蛭，虫积用槟榔、雷丸。现在的人畏惧而不敢用下法，是不明白医理的罪过；无忌惮而妄用下法的，是杀人的罪过；对于虚证积滞应当扶助正气，慢慢推荡消除，千万不要鲁莽地戕害人的寿命。
五积应当从郁证来论治，《难经》所谓因为受到克己之邪，传到自己所能克的脏腑，正当旺时，拒绝而不接受，因而停留成为积，这都是抑郁不伸而受邪，所以五积六聚，治疗同于郁证的断治。伏梁是心的郁结，肥气是肝（木）的郁结，痞气是脾（土）的郁结，息贲是肺（金）的郁结，奔豚是肾（水）的郁结，郁结是气不舒展而抑郁成积，不只是聚可以用气来解释。所以治疗积的方法，以理气为先，那么津液流行，积聚从何而生？然而更不可不兼用补法。大概强壮的人气行则病已，怯弱的人着而成病。所以积之所以成为积，本于气虚血弱的人，所以说壮人无积，虚人则有之。善于治疗积证的人，不必问它是哪条经络哪个脏腑的病，必须先调和中气，使它能饮食，气血就会旺盛，积滞自然消除，即使是壮实之人适宜消积的，也应当兼服补血补气的药物。《内经》说：大积大聚，可以攻伐，但衰减到一半就要停止。所以消积用到一半，纯用甘温调养，使脾血健运，那么剩余的积不攻自退，所谓养护正气则邪气自除，就像满座都是君子，那么一两个小人，自然没有容身之地；如果想要积尽而后止，胃气也就所剩无几了。
积聚痞块的证候，都是内部由喜、怒、忧、思、悲、恐、惊七情所致，如果认为是五脏传克形成积，不也是求之太过吗？大概气血营卫遍布一身，上下周流，无时稍停，一旦七情感动五志之火，火性炎上，有升无降，以致气液水谷不能顺序运行，稽留成为积是必然的。朱丹溪说：气不能成块成聚，块乃是有形的物体，是痰与食积死血而成。凡是在中间的是痰饮，在右边的是食积，在左边的是血块，怎么说明呢？左关是肝胆之位，藏血液，右关是脾胃之位，藏饮食，所以左边有积就是血块，右边有积就是食积，而其中间是水谷出入的道路，五志之火熏蒸水谷而为痰饮，所以中间有积，就是痰饮。治疗法则根据病因顺从其类来治疗。大概积之初多属寒，而积之久则为热了。应当知道新久之异，以区分辛温、辛平、辛凉三者的适宜用法。然而人的积块、疝气、心腹等痛，本质多属热，而方剂中又多用桂枝、附子等热药，却不引发药毒的原因，大概因为诸积、诸痛喜温而恶寒，热药与病情相合，况且积久成郁而火邪深重了，若见寒愈逆，见热愈喜，两热相从，这就是所谓的亢则害承乃制，从治法（反治法）啊。世人见到投用热药不为热误，于是认为寒证属于沉寒痼冷，肆意投用热剂，以致真气被侵蚀，阴血干枯，不可救治了。我曾论述过，医生被病情困扰的，只有阴虚难以补益，久积难以根除，所以玉山自倒是阴虚的说法，养虎遗患是久积的说法。人遭受这两种病，必须节制欲望以养性，内观以养神，淡泊自如，从容自得，然后把病情委托给医生，才能为你保全。
食结，是因饮食得之。疼痛刺及胁肋，心胸烦闷，饮食不下，吐逆恶心，日久不治，渐渐结成食结。又说：食结其证属阴，阴主静，所以食结定于一处而不移。
瘕，是因伤血得之。其状胸膈烦闷，疼痛牵引少腹，有时攻筑向上抢犯心胸，虽然不阻碍进食，渐渐结成瘕结，又叫血结。然而这与食结，总因荣卫俱虚，风寒侵袭于外，饮食停滞于中，久而不化则邪并于阴而为食结；邪并于阳则为瘕。瘕是假借物象成形，动而不息，去来无常，有时在两胁间有块如石头，按压则痛，不按则轻，久而不已，面黄肌瘦，肚子硬而胀，腹部现青筋，昼凉夜热，食减泄泻不成形，成为疳积。治疗宜调脾养胃，磨积消疳，不是一天一夕可以痊愈的。
痞，是因伤气得之。其候心腹膨胀，肚子大胁肋满，疼痛刺感往来，住在左肋，面黄肌瘦，倦怠无力，久而不治渐渐成痞块。痞，是寒的意思。结，是实的意思。凡热气蕴于胸膈之间，停饮聚于腹胁之内，于是营卫不得流行，腑脏不得宣通，从而结成，不可迅速攻下，否则邪气反而坚结，经书所说着而不去，其病为实了。只宜安胃理脾，佐以顺气化滞。如果胸中气不通泰而感觉像痞，乃是正气不运所致，不可当作有形之物攻治。盖胸是受气之所，虚则受而不能行，实非物也，所以说：痞者否也（不通之意）。
癖，是因积得之。其证如肠癖之疾，便利无度，似痢非痢，似虫非虫，或者下鲜血，肚腹干痛，心胸满闷，久久不治，则顽结不散，有类似痞状。大概由于乳哺失调，停滞为积，久则血膜并聚，胁旁结癖，时时作痛，或者发潮热，又有食癖、乳癖、疳癖、惊癖、虚癖、痰癖之分，其伤气血是一样的。如果到面色紫黑，肚胀如鼓，凑心刺痛，忽泻鲜血，唇舌皆黑，干呕气促，皮焦斑紫，吐泻出虫，肠鸣自利，体虚发搐，面青流涎，手足心肿，面黑泻黑的人，都属于无法治疗的。
钱仲阳说：癖块，是僻在于两胁；痞结，是居于中脘。这是因为乳哺失调，饮食停滞，邪气相搏而成。医生多用克伐药物，脾胃必虚，久而不愈，必先以固护胃气为主，使养护正气则结自除。如果想要直接攻其结，不仅不消，而且损害脾土，脾土亏损，必然变证百出。宜早晨服用补中益气汤，晚上服用千金消癖丸，间歇服用，获效很多。（《幼科痞块论》）
酒积：轻者用葛根、神曲、黄连、白豆蔻。重者用甘遂、牵牛。
气积：轻者用木香、枳壳、浓朴、橘红。重者用枳实、牵牛。
蟹积：紫苏。
痰积：轻者用半夏、栝蒌。重者用滚痰丸。老痰用海浮石、瓦楞子。皮里膜外用白芥子。
水积：轻者用五苓散。重者用商陆、甘遂、芫花。
茶积：轻者用姜黄、芝麻。重者用吴茱萸、椒姜。
谷积：轻者用麦芽、神曲、砂仁。重者用鸡内金。
肉积：轻者用山楂、阿魏。重者用硇砂、硝石。
蛋积：白豆蔻、橘红、豆豉、姜汁。
鱼鳖积：紫苏、橘红、木香、姜汁，白马尿专治鳖瘕。
虫积：雄黄、锡灰、槟榔、雷丸、芜荑、榧子、使君子、川楝子。
狗肉积：杏仁、山楂。
血积：轻者用干漆、桃仁、丹皮、归尾、赤芍、红花。重者用大黄、虻虫、水蛭、穿山甲、花蕊石。
果积：丁香、肉桂、麝香。
麦积：萝卜子、姜，酒煎。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Dull pain in the Dantian (Lower Abdomen) indicates Sanjiao Ju (Gangrene of the Sanjiao), while slight swelling of the flesh in that area indicates Sanjiao Yong (Abscess of the Sanjiao).
Wang Kentang stated: For treating Sanjiao Yong, one must needle the Shimen point (also known as the Mu-Point of the Sanjiao, located 2 cun below the umbilicus). This condition inevitably presents with dull pain and slight swelling, causing alternating chills and fever, and constipation of both urine and stool. It is caused by damp-heat condensing due to cold. The treatment method is the same as for Large Intestine Abscess and Small Intestine Abscess.
Medical texts state: The treatment principles for accumulation (Ji) and gathering (Ju) are largely identical. However, individuals with robust Qi rarely develop accumulations, whereas those with weak Qi often do; thus, discussions on accumulation tend to focus on pediatrics (referred to as "mute department," referring to infants who cannot speak). Here, dysentery, diarrhea, and malnutrition syndromes (Gan Zheng) are not discussed, but only accumulation, to address the root of disease before it manifests. Furthermore, rather than discussing all six types of gathering, five types of accumulation are prioritized because they are more difficult to treat. Both gathering and accumulation result from undigested food and congealed Yin blood; they share the same origin but have different names. The *Neijing* states: Accumulation arises from the Five Zang organs, while gathering forms from the Six Fu organs. Where Qi accumulates, it is called "Accumulation"; where Qi gathers, it is called "Gathering." Gathering belongs to Yang Qi; therefore, it floats and moves, its movement is unpredictable, it stops when obstructed, has no fixed root, and pain occurs in varying locations. When Qi is strong, it gradually dissipates and may resolve without treatment. Accumulation belongs to Yin Qi; therefore, it sinks and hides, accumulating in one place without moving. It has a fixed location, pain remains in that area, and since Yin pertains to the interior, it is difficult to treat. Accumulation has a fixed site and consists of tangible blood stasis; gathering has no fixed site and consists of intangible Qi stagnation. Accumulation masses are formed by phlegm, food retention, and dead blood. Symptoms such as sallow and edematous complexion, abdominal distension with hollow sounds, oily urine, scorched yellow hair, dysentery with red and white discharge, yellow-red sclera, generalized edema, excessive heat in the abdomen, abdominal pain after eating, lethargy, and hypersomnia indicate accumulation syndromes, which require urgent treatment. If the condition progresses to pale complexion with rapid breathing, black complexion with staring eyes, dry retching with inability to eat, cessation of diarrhea followed by recurrence, drum-like abdominal tension, neck flaccidity with jaw lock, and thin extremities, these are untreatable terminal conditions. However, there are names for accumulations of the five Zang organs, and distinctions among four syndromes: Zheng (firm mass), Jia (shifting mass), Pi (stuffiness), and Pi (hidden mass). There are also classifications into food accumulation, milk accumulation, and Qi accumulation, as well as differences between deficiency accumulation, excess accumulation, and fright accumulation. We first detail the five Zang accumulations. The liver's accumulation is named Feiqi (Fat Qi), located under the left hypochondrium, shaped like an inverted cup, with head and feet resembling a turtle or tortoise. The heart's accumulation is named Fuliang (Hidden Beam), starting above the umbilicus, as large as an arm, extending up to the epigastrium. The spleen's accumulation is named Piqi (Pi Qi), located in the stomach region, covering an area as large as a plate. The lung's accumulation is named Xiben (Suffocating Rush), located under the right hypochondrium, covered like a large cup. The kidney's accumulation is named Bentun (Running Piglet), originating in the lower abdomen and extending up to the epigastrium, resembling a running piglet, moving up and down without a fixed schedule. These are the manifestations of the five accumulations. Zheng refers to masses felt upon palpation, fixed in place like the five accumulations. Jia refers to masses taking shape from假 (false/imitated) objects, such as fish jia, turtle jia, or stone jia. Pi refers to thickened skin visible on the muscle surface. Pi (hidden mass) refers to something hidden in obscure internal areas, invisible externally. Milk accumulation presents with simultaneous vomiting and diarrhea, sour-smelling breath, caused by improper breastfeeding. Food accumulation presents with hard, hot, thirsty abdomen, diarrhea or vomiting, borborygmi, and abdominal pain, caused by overeating. Qi accumulation presents with abdominal pain, crying, and dysentery-like stools resembling crab roe, caused by fright or maternal emotional disturbances transmitted via breast milk. Deficiency accumulation presents with indigestion of milk/food and generalized edema, resulting from deficiency complicated by accumulation. Excess accumulation presents with hot abdomen, hard stool, fever, thirst, craving food, and easy hunger, resulting from excess heat accumulation. Fright accumulation results from eating during fright, foul mouth with yellow coating, and abdominal pain. Treatment methods include warming for cold syndromes, clearing for heat syndromes, promoting circulation for excess syndromes, regulating for deficiency syndromes, and harmonizing for fright syndromes. Treating accumulation involves only methods of approaching, grinding, dissolving, and transforming accumulation; there is no rationale for rapid purgation.
Zhu Danxi stated: Accumulations should never be treated with purgatives, as this only damages True Qi without removing the disease. Moreover, accumulation forms because of deficient Righteous Qi, allowing Pathogenic Qi to occupy the space, similar to villains dominating the court due to the decline of virtuous officials. Righteous Qi and Pathogenic Qi are incompatible; as one wins, the other loses. As pathogenic Qi flourishes daily and righteous Qi wanes daily, failure to attack leads to imminent danger. However, attacking too hastily further injures righteous Qi. The three stages—initial, middle, and terminal—must be understood. In the initial stage, pathogen is new, righteous Qi is strong, and pathogen is shallow; aggressive treatment is tolerated. In the middle stage, illness persists, pathogen is deeper, and righteous Qi is weaker; combined attack and tonification are tolerated. In the terminal stage, disease is chronic, pathogen invades deeply, and righteous Qi is depleted; only tonification is tolerated. Accumulation does not form overnight; thus, eliminating it requires gradual progress. Hasty attack damages righteous Qi; once damaged, transformation fails, and pathogen becomes more entrenched. One must determine which meridian is affected and what substance caused injury, treating according to the etiology.
In the past, Zhang Zihe frequently advocated purgation, considering it appropriate. Zhang Zhongjing’s Three Chengqi Decoctions were meticulously examined regarding when to purge, which accumulation to target, and which herbs to use, with precision. For cold accumulation, use Radix Euphorbiae Pekingensis (Badou) Yinggan Wan; for heat accumulation, use Da Huang Chengqi Tang; for blood accumulation, use Tao Ren and Hong Hua; for water retention, use Qian Niu and Gan Sui; for blood in water, use Meng Chong and Shui Zhi; for worm accumulation, use Bing Lang and Lei Wan. Today, those who fear purgation and dare not use it commit the sin of ignorance; those who use it recklessly commit the sin of murder. For deficiency accumulation, one must support righteous Qi and gently push out stagnation; do not rashly harm natural lifespan.
The five accumulations should be treated based on stagnation (Yu). The *Nan Jing* states that when one receives a pathogen that conquers oneself, transmitting it to what one conquers, at the peak of strength, refusing acceptance causes it to remain as accumulation. This is all due to depression and obstruction leading to pathogenic invasion. Thus, the treatment for five accumulations and six gatherings is similar to treating stagnation. Fuliang is heart stagnation; Feiqi is wood (liver) stagnation; Piqi is earth (spleen) stagnation; Xiben is metal (lung) stagnation; Bentun is water (kidney) stagnation. Stagnation is Qi failing to flow freely, leading to accumulation. It is not only gathering that can be described by Qi. Therefore, the primary method for treating accumulation is regulating Qi, so that body fluids circulate, preventing accumulation formation. However, tonification must not be neglected. Generally, robust individuals recover as Qi moves; frail individuals develop disease. Accumulation originates in those with Qi deficiency and Blood weakness; hence, robust people rarely have accumulation, while deficient people do. A skilled practitioner need not ask which meridian or Zang organ is involved but must first regulate Middle Qi to restore appetite. Once Qi and Blood are robust, stagnation resolves naturally. Even for robust individuals suitable for resolving accumulation, one should concurrently administer herbs to tonify Blood and Qi. The *Neijing* states: For major accumulations and gatherings, one may attack, but stop when half is resolved. Thus, when resolving accumulation reaches halfway, switch purely to sweet-warm nourishment to strengthen Spleen Blood and transport. The remaining accumulation will recede without direct attack. Nourishing righteousness removes evil, just as if the room were full of gentlemen, there would be no place for villains. If one waits until accumulation is completely gone before preserving Stomach Qi, little will remain.
Syndromes of accumulation, gathering, and stuffy masses are internally caused by the seven emotions: joy, anger, worry, thought, sorrow, fear, and fright. Attributing them solely to Zang organ conquest is overly complex. Qi, Blood, Ying, and Wei circulate throughout the body without pause. Once the seven emotions stir the fire of the five wills, fire nature flares upward, rising without descending, causing Qi, fluids, and food to fail to follow their order, inevitably stalling into accumulation. Zhu Danxi said: Qi alone cannot form masses or gatherings; masses are tangible objects formed by phlegm, food retention, and dead blood. In the center is phlegm-fluid; on the right is food retention; on the left is blood mass. Why? The left Guan position corresponds to Liver and Gallbladder, storing Blood; the right Guan position corresponds to Spleen and Stomach, storing food. Thus, accumulation on the left is blood mass; on the right is food retention. The center is the pathway for food and fluid entry/exit. Fire from the five wills steams food/fluids into phlegm-fluid, so accumulation in the center is phlegm-fluid. Treatment follows the cause and category. Generally, early accumulation is cold, but long-standing accumulation becomes heat. One must distinguish new from old to choose between acrid-warm, acrid-neutral, and acrid-cool methods. However, pain from accumulation, hernia, and epigastric/cardiac issues is often heat-based, yet formulas often use warm/hot herbs like Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) without causing toxicity. This is because various accumulations and pains prefer warmth and dislike cold. Hot herbs harmonize with the condition. Moreover, long-standing accumulation leads to stagnation and deep fire. If cold aggravates and heat pleases, two heats combine, following the principle "Excess brings harm, control follows," known as contrary treatment (Fan Zhi). People see hot herbs working without error and assume cold syndromes are deep-seated cold, indiscriminately using hot agents, eroding True Qi and drying Yin Blood, rendering it incurable. I have argued that physicians are troubled by the difficulty of tonifying Yin deficiency and removing long-standing accumulation. "Jade mountain collapsing" refers to Yin deficiency; "nurturing the tiger leaves trouble" refers to long-standing accumulation. Those suffering these must restrain desires to nourish nature, practice introspection to nourish spirit, remain indifferent and calm, then entrust care to the physician for preservation.
Shi Jie (Food Knot) arises from diet. Pain pierces hypochondrium and chest, mental restlessness, inability to eat, retching and nausea. Untreated long-term, it gradually forms Shi Jie. Shi Jie belongs to Yin; Yin is static, so Shi Jie stays in one place and does not move.
Jia (Shifting Mass) arises from blood injury. Symptoms include chest oppression, pain radiating to lower abdomen, occasional attacking sensation rushing to chest. Though eating is not blocked, it gradually forms Jie, also called Blood Knot. Both Shi Jie and Jia arise from dual deficiency of Ying and Wei, external wind-cold invasion, and internal food stagnation. Long-term non-digestion causes pathogen to merge with Yin forming Shi Jie; merging with Yang forms Jia. Jia takes shape from imitated objects, moves ceaselessly, comes and goes unpredictably. Sometimes a stone-like mass appears in hypochondrium, painful on pressure, light otherwise. Long-term untreated leads to sallow face, emaciation, hard/distended abdomen, visible blue veins, cool days/hot nights, reduced appetite, loose stools, becoming Gan Ji (Malnutrition Accumulation). Treatment should regulate Spleen and nourish Stomach, grind accumulation and resolve Gan Ji; it cannot be cured in a day or night.
Pi (Stuffiness) arises from Qi injury. Symptoms include epigastric/abdominal distension, large belly, full hypochondrium, piercing pain moving around, located in left hypochondrium, sallow face, emaciation, fatigue. Untreated long-term, it becomes Pi Mass. Pi means cold; Jie means excess. Heat stifling in chest/diaphragm and retained fluid gathering in abdomen/hypochondrium prevent Ying/Wei circulation and Fu/Zang unblocking, forming knot. Do not purge rapidly, or pathogen becomes firmly knotted. As the Classic says: Lingering without removal makes the disease excess. Only soothe Stomach and regulate Spleen, assisting with smoothing Qi and resolving stagnation. If chest Qi is unsmooth feeling like Pi, it is due to failed movement of Righteous Qi, not a tangible object; do not treat as tangible mass. Chest is where Qi resides; deficiency prevents movement, excess is not a physical object. Hence: Pi means blockage (Pi).
Pi (Hidden Mass) arises from accumulation. Symptoms resemble intestinal dysentery, frequent loose stools,似痢非痢 (like dysentery but not),似虫非虫 (like worms but not), possibly fresh blood, dry abdominal pain, chest fullness. Untreated long-term, stubborn knots persist, resembling Pi. Caused by improper breastfeeding, stagnation becomes accumulation, long-term blood membranes gather, forming Pi beside hypochondrium, causing intermittent pain or tidal fever. Classifications include Food Pi, Milk Pi, Gan Pi, Fright Pi, Deficiency Pi, Phlegm Pi; all damage Qi and Blood similarly. If face turns purple-black, abdomen drum-like, stabbing heart pain, sudden fresh blood diarrhea, black lips/tongue, dry retching, shortness of breath, scorched skin with purple spots, vomiting/diarrhea with worms, borborygmi with spontaneous diarrhea, convulsions in deficiency, cyanotic face with drooling, swollen palms/soles, black face with black diarrhea—all are untreatable.
Qian Zhongyang stated: Pi Ku (Hidden Mass) is僻 (obscure) in hypochondria; Pi Jie (Stuffiness Knot) resides in Zhongwan. Caused by improper breastfeeding, food stagnation, and pathogenic conflict. Physicians often use harsh draining herbs, weakening Spleen/Stomach. If unresolved long-term, prioritize securing Stomach Qi; nourishing righteousness removes knots. Directly attacking knots fails to dissolve them and damages Spleen Earth, leading to myriad complications. Recommend Buzhong Yiqi Tang in morning, Qianjin Xiaopi Wan in evening, taken intermittently for good effect. (*Pediatric Stuffiness and Mass Discussion*)
Alcohol Accumulation: Mild cases use Ge Gen, Shen Qu, Huang Lian, Bai Dou Kou. Severe cases use Gan Sui, Qian Niu.
Qi Accumulation: Mild cases use Mu Xiang, Zhi Ke, Hou Po, Ju Hong. Severe cases use Zhi Shi, Qian Niu.
Crab Accumulation: Zi Su.
Phlegm Accumulation: Mild cases use Ban Xia, Gua Lou. Severe cases use Gun Tan Wan. Old phlegm uses Hai Shi, Wa Leng Zi. Intracellular/phlegm uses Bai Jie Zi.
Water Accumulation: Mild cases use Wu Ling San. Severe cases use Shang Lu, Gan Sui, Yuan Hua.
Tea Accumulation: Mild cases use Jiang Huang, Zhi Ma. Severe cases use Zhu Yu, Jiao Jiang.
Grain Accumulation: Mild cases use Mai Ya, Shen Qu, Sha Ren. Severe cases use Ji Nei Jin.
Meat Accumulation: Mild cases use Shan Zha, A Wei. Severe cases use Nao Sha, Xiao Shi.
Egg Accumulation: Bai Dou Kou, Ju Hong, Dou Chi, Jiang Zhi.
Fish/Turtle Accumulation: Zi Su, Ju Hong, Mu Xiang, Jiang Zhi. White horse urine specifically treats Turtle Jia.
Worm Accumulation: Xiong Huang, Xi Hui, Bing Lang, Lei Wan, Wu Yi, Fei Zi, Shi Jun Zi, Chuan Lian Zi.
Dog Meat Accumulation: Xing Ren, Shan Zha.
Blood Accumulation: Mild cases use Gan Qi, Tao Ren, Dan Pi, Gui Wei, Chi Shao, Hong Hua. Severe cases use Da Huang, Meng Chong, Shui Zhi, Chuan Shan Jia, Hua Rui Shi.
Fruit Accumulation: Ding Xiang, Rou Gui, She Xiang.
Wheat Accumulation: Luo Bo Zi, Jiang, decocted in wine.