五十五难曰。病有积有聚。何以别之。然。积者、阴气也。聚者、阳气也。故阴沉而伏。阳浮而动。气之所积。名
曰积。气之所聚。名曰聚。故积者、五脏所生。聚者、六腑所成也。积者、阴气也。其始发有常处。其痛不离其部。上
下有所终始。左右有所穷处。聚者、阳气也。其始发无根本。上下无所留止。其痛无常处。谓之聚。故以是别知积聚也。
丁曰。积者、阴气所积。是五脏传其所胜。当王时不受邪。故留结为积。所以止而不移也。聚者、六腑之为病。阳
也。所传其子。以回转不定。又阳主动。故无常处。吕曰。诸阴证病常在一处牢强。有头足。止不移者。脏气所作。死
不治。故言脏、病难治。所以证病上下左右无常处者。此所谓阳证。虽困可治。本不死也。
故当经岁月。故经言腑病易治。
五十六难曰。五脏之积。各有名乎。以何月何日得之。然。肝之积名曰肥气。在左胁下。如覆杯。有头足。久不愈。
令人发咳逆 疟。连岁不已。以季夏戊己日得之。何以言之。肺病传于肝。肝当传脾。脾季夏适王。王者不受邪。肝复
欲还肺。肺不肯受。故留结为积。故知肥气以季夏戊己日得之。
杨曰。积、蓄也。言血脉不行。积蓄成病也。凡积者、五脏所生也。荣气常行。不失节度。谓之平人。平人者、不
病也。一脏受病。则荣气壅塞。故病焉。然五脏受病者。则传其所胜。所胜适王。则不肯受传。既不肯受。则反传所胜。
所胜复不为纳。于是则留结成积。渐以长大。病因成矣。肥气者、肥盛也。言肥气聚于左胁之下。如覆杯突出。如肉肥
盛之状也。小儿多有此病。按前章有积有聚。此章唯出五积之名状。不言诸聚。聚者。六腑之病。亦相传行。还如五脏。
以胜相加。故不重言。从省约也。
心之积名曰伏梁。起齐上。大如臂。上至心下。久不愈。令人病烦心。以秋庚辛日得之。何以言之。肾病传心。心
当传肺。肺以秋适王。王者不受邪。心复欲还肾。肾不肯受。故留结为积。故知伏梁以秋庚辛日得之。
杨曰。伏梁者、言积自齐上。至心下。其大如臂。状似屋舍栋梁也。
脾之积名曰痞气。在胃脘。覆大如盘。久不愈。令人四肢不收。发黄胆。饮食不为肌肤。以冬壬癸日得之。何以言
之。肝病传脾。脾当传肾。肾以冬适王。王者不受邪。脾复欲还肝。肝不肯受。故留结为积。故知痞气以冬壬癸日得之。
杨曰。痞、否也。言痞结成积也。脾气虚。则胃中热而引食焉。脾病不能通气。行津液。故虽食多而羸瘦也。
肺之积名曰息贲。在右胁下。覆大如杯。久不已。令人洒淅寒热。喘咳。发肺壅。以春甲乙日得之。何以言之。心
病传肺。肺当传肝。肝以春适王。王者不受邪。肺复欲还心。心不肯受。故留结为积。故知息贲以春甲乙日得之。
杨曰。息、长也。贲、膈也。言肺在膈上。其气不行。渐长而逼于膈。故曰息贲。一曰贲、聚也。言其渐长而聚蓄。
肺为上盖。脏中阳也。阳气盛。故令人发肺壅也。
肾之积名曰贲豚。发于少腹。上至心下。若豚状。或上或下无时。久不已。令人喘逆骨痿。少气。以夏丙丁日得之。
何以言之。脾病传肾。肾当传心。心以夏适王。王者不受邪。肾复欲还脾。脾不肯受。故留结为积。故知贲豚以夏丙丁
日得之。此是五积之要法也。
丁曰。人之五脏本和。谓恣欲五情。所以有增损。故蕴积生其病也。故有积有聚。积病为阴。聚病为阳。王时即安。
失时即病也。旧经文注皆明矣。杨曰。此病状似豚而上冲心。又有奔豚之气。非此积病也。名同而疾异焉。
第五十五难说：疾病有积证和聚证两种，如何区分它们呢？回答说：积证属于阴气，聚证属于阳气。所以阴气沉潜而潜伏，阳气轻浮而变动。气机积聚的地方，称为积；气机聚散无常的地方，称为聚。因此，积证是由五脏产生的，聚证是由六腑形成的。积证是阴气所致，它发作时有固定的部位，疼痛不离开其所在区域，向上向下有起止点，向左向右有尽头。聚证是阳气所致，它发作时没有根本固定的位置，上下没有停留止息之处，疼痛没有固定的地方，这就叫做聚。因此根据这些特点来辨别积证和聚证。
丁氏说：积证是阴气积聚而成，这是五脏之间相互传变，克制其所胜之脏（即相克关系）。当被克之脏当令旺盛时，不受邪气侵犯，所以邪气停留结聚形成积证。因此积证静止而不移动。聚证是六腑的疾病，属阳。邪气传变给所生之脏（即相生关系），因为回转不定，加上阳气主动，所以疼痛没有固定地方。
吕氏说：各种阴证疾病常固定在一处，坚硬强实，有头足形状，停止不移，这是脏气病变所致，预后不良，难以治愈。所以说脏病难治。那些症状在上下左右没有固定地方的，这叫阳证，虽然病情严重但可治疗，本来不会致死。所以经过长时间，经文说腑病容易治疗。
第五十六难说：五脏的积证，各有名称吗？是在哪个月、哪一天得的呢？回答说：肝的积证名叫肥气，位于左胁下，像倒扣的杯子，有头有脚，久治不愈，使人发生咳嗽气逆、疟疾，连年不断。这是在季夏（夏季最后一个月）戊己日得的。为什么这样说呢？因为肺病传变给肝，肝应当再传变给脾，但脾在季夏正当旺盛之时，旺盛之脏不受邪气，肝想再把邪气返还给肺，肺不肯接受，所以邪气留结成为积证。因此知道肥气是在季夏戊己日得的。
杨氏说：积，就是蓄积的意思，指血脉运行不畅，积蓄而成病。凡是积证，都是由五脏产生的。营气正常循行，不失节度，称为平人。平人就是不生病的人。一旦一脏受病，则营气壅塞阻滞，所以发病。然而五脏受病后，会传变给其所胜之脏。如果所胜之脏正值旺盛，就不肯接受传变。既然不肯接受，就反向传回给原本克它的脏（此处原文逻辑为反侮或还归，结合上下文意指无法传变而留结）。原本克它的脏也不接纳，于是邪气留结成为积证，逐渐长大，病因由此形成。所谓肥气，是指肥盛的样子。说肥气聚积在左胁之下，像倒扣的杯子突出，像肉块肥盛的样子。小儿多有此病。按前章所说有积有聚，此章只列出五积的名称和形态，没有提及诸聚。聚证是六腑的病，也是相互传变，如同五脏一样，以相克关系相加，所以不再重复说明，是为了简省文字。
心的积证名叫伏梁，起于脐上，大如手臂，向上延伸至心下，久治不愈，使人患心烦病。这是在秋季庚辛日得的。为什么这样说呢？因为肾病传变给心，心应当再传变给肺，但肺在秋季正当旺盛之时，旺盛之脏不受邪气，心想再把邪气返还给肾，肾不肯接受，所以邪气留结成为积证。因此知道伏梁是在秋季庚辛日得的。
杨氏说：伏梁，是说积证从脐上开始，直到心下，大小如手臂，形状像房屋的栋梁。
脾的积证名叫痞气，位于胃脘部，覆盖面积大如盘子，久治不愈，使人四肢无力收持，发黄疸病，饮食不能转化为肌肤营养。这是在冬季壬癸日得的。为什么这样说呢？因为肝病传变给脾，脾应当再传变给肾，但肾在冬季正当旺盛之时，旺盛之脏不受邪气，脾想再把邪气返还给肝，肝不肯接受，所以邪气留结成为积证。因此知道痞气是在冬季壬癸日得的。
杨氏说：痞，同“否”，指痞结成为积证。脾气虚弱，则胃中热盛而引动食欲。脾病不能通调气机，运行津液，所以虽然吃得很多却身体消瘦。
肺的积证名叫息贲，位于右胁下，覆盖面积大如杯子，久治不愈，使人出现忽冷忽热的寒热症状，气喘咳嗽，引发肺气壅滞。这是在春季甲乙日得的。为什么这样说呢？因为心病传变给肺，肺应当再传变给肝，但肝在春季正当旺盛之时，旺盛之脏不受邪气，肺想再把邪气返还给心，心不肯接受，所以邪气留结成为积证。因此知道息贲是在春季甲乙日得的。
杨氏说：息，指长；贲，指膈膜。说肺位于膈膜之上，其气不行，逐渐增长而逼近膈膜，所以叫息贲。另一种说法：贲，指聚积。说其逐渐增长而聚积。肺为上盖，属脏中之阳。阳气盛，所以使人发生肺气壅滞。
肾的积证名叫贲豚，发于少腹，向上延伸至心下，形状像小猪，有时上行有时下行，没有定时，久治不愈，使人气喘逆乱、骨痿、气短。这是在夏季丙丁日得的。为什么这样说呢？因为脾病传变给肾，肾应当再传变给心，但心在夏季正当旺盛之时，旺盛之脏不受邪气，肾想再把邪气返还给脾，脾不肯接受，所以邪气留结成为积证。因此知道贲豚是在夏季丙丁日得的。这是五积证的关键法则。
丁氏说：人的五脏本应调和，如果放纵欲望和情志，就会导致增减失衡，从而蕴积产生疾病。所以有积证和聚证。积证属于阴病，聚证属于阳病。在当令之时病情安定，失令之时则发病。旧有的经文注释都已阐明。
Chapter 55 states: Diseases include "Ji" (accumulation/mass) and "Ju" (gathering/flux). How can they be distinguished? The answer is: Ji belongs to Yin Qi (Yin energy), while Ju belongs to Yang Qi (Yang energy). Therefore, Yin is deep and latent, whereas Yang is floating and active. Where Qi accumulates, it is called Ji; where Qi gathers intermittently, it is called Ju. Thus, Ji originates from the Zang organs (solid organs), and Ju is formed by the Fu organs (hollow organs). Ji is caused by Yin Qi; its onset has a fixed location, pain remains within that area, moving up or down has definite limits, and extending left or right has boundaries. Ju is caused by Yang Qi; its onset lacks a fixed root, with no specific stopping point up or down, and the pain has no fixed location. This is what is meant by Ju. Therefore, one distinguishes between Ji and Ju based on these characteristics.
Ding said: Ji is accumulated by Yin Qi, resulting from the transmission of disease among the Zang organs according to the cycle of overcoming (Wood overcomes Earth, etc.). When the target organ is in its season of prosperity, it does not accept the pathogenic factor, so the pathogen stays and knots to form Ji. Hence, it remains stationary and does not move. Ju is a disease of the Fu organs, which are Yang. The pathogen transmits to the organ it generates (Wood generates Fire, etc.), moving back and forth不定ly. Furthermore, Yang is characterized by movement, so there is no fixed location for the pain.
Lü said: Various Yin-pattern diseases often remain fixed in one place, hard and strong, with distinct upper and lower bounds, stopping and not moving; this is caused by Zang Qi dysfunction, leading to death and being difficult to treat. Thus, it is said that Zang diseases are hard to treat. Those symptoms that have no fixed location up, down, left, or right are called Yang patterns. Although severe, they are treatable and not necessarily fatal. Therefore, after a long period, the classic text states that Fu diseases are easier to treat.
Chapter 56 asks: Do the accumulations of the five Zang organs each have specific names? On which month and day are they acquired? The answer is: The accumulation of the Liver is named Feiqi (Fatty Qi/Mass), located under the left hypochondrium, resembling an inverted cup, with a head and feet. If not cured for a long time, it causes cough, counterflow qi, and malaria, persisting for years. It is acquired on Wu and Ji days during the late summer (the last month of summer). Why is this so? Because Lung disease transmits to the Liver. The Liver should transmit to the Spleen. However, the Spleen is prosperous in late summer, and a prosperous organ does not accept pathogens. The Liver attempts to return the pathogen to the Lung, but the Lung refuses to accept it. Thus, the pathogen stays and knots to form an accumulation. Therefore, we know Feiqi is acquired on Wu and Ji days in late summer.
Yang said: "Ji" means accumulation, referring to blood vessels failing to circulate properly, leading to pathological buildup. All Ji formations originate from the Zang organs. Ying Qi (Nutritive Qi) normally circulates without losing its rhythm, which defines a healthy person (Ping Ren). A healthy person is free from disease. Once one Zang organ becomes diseased, Ying Qi becomes obstructed, leading to illness. When a Zang organ is diseased, it transmits to the organ it overcomes. If that organ is currently prosperous, it refuses the transmission. Since it refuses, the pathogen may rebound to the organ that originally overcame it (or fail to transmit further). If that organ also rejects it, the pathogen stays and knots to form Ji, gradually enlarging until the pathology is established. "Feiqi" refers to a state of flabid abundance. It describes Feiqi gathering under the left hypochondrium, protruding like an inverted cup, resembling fleshy abundance. This condition is common in children. As mentioned in the previous chapter regarding Ji and Ju, this chapter only lists the names and forms of the five Jis, omitting the Jus. Ju is a disease of the Fu organs, involving mutual transmission similar to the Zang organs, governed by the cycle of overcoming. Thus, it is not repeated here for brevity.
The accumulation of the Heart is named Fuliang (Hidden Beam), starting above the umbilicus, as large as an arm, extending upward to below the heart. If untreated for a long time, it causes mental restlessness and anxiety. It is acquired on Geng and Xin days in autumn. Why? Because Kidney disease transmits to the Heart. The Heart should transmit to the Lung. However, the Lung is prosperous in autumn, and a prosperous organ does not accept pathogens. The Heart attempts to return the pathogen to the Kidney, but the Kidney refuses. Thus, the pathogen stays and knots to form an accumulation. Therefore, we know Fuliang is acquired on Geng and Xin days in autumn.
Yang said: Fuliang refers to the accumulation starting above the umbilicus and reaching below the heart, as large as an arm, resembling the beam of a house.
The accumulation of the Spleen is named Piqi (Stagnant Qi/Mass), located in the epigastrium, covering an area as large as a plate. If untreated for a long time, it causes inability to control the limbs, jaundice, and failure of food to nourish the muscles. It is acquired on Ren and Gui days in winter. Why? Because Liver disease transmits to the Spleen. The Spleen should transmit to the Kidney. However, the Kidney is prosperous in winter, and a prosperous organ does not accept pathogens. The Spleen attempts to return the pathogen to the Liver, but the Liver refuses. Thus, the pathogen stays and knots to form an accumulation. Therefore, we know Piqi is acquired on Ren and Gui days in winter.
Yang said: "Pi" is synonymous with "Pi" (blockage/stagnation), indicating stagnation forming an accumulation. When Spleen Qi is deficient, heat arises in the Stomach, stimulating appetite. However, due to Spleen disease, Qi cannot flow freely, and fluids cannot be distributed. Thus, although the patient eats much, they become emaciated.
The accumulation of the Lung is named Xiben (Gasping Accumulation), located under the right hypochondrium, covering an area as large as a cup. If untreated for a long time, it causes chills and fever, wheezing, cough, and Lung obstruction. It is acquired on Jia and Yi days in spring. Why? Because Heart disease transmits to the Lung. The Lung should transmit to the Liver. However, the Liver is prosperous in spring, and a prosperous organ does not accept pathogens. The Lung attempts to return the pathogen to the Heart, but the Heart refuses. Thus, the pathogen stays and knots to form an accumulation. Therefore, we know Xiben is acquired on Jia and Yi days in spring.
Yang said: "Xi" means long/growing; "Ben" refers to the diaphragm. The Lung sits above the diaphragm. Its Qi fails to descend, gradually growing and pressing against the diaphragm, hence named Xiben. Another interpretation: "Ben" means gathering. It grows gradually and gathers. The Lung is the upper cover, belonging to Yang within the Zang organs. Excess Yang Qi causes Lung obstruction.
The accumulation of the Kidney is named Benteng (Rushing Pig), originating in the lower abdomen and extending upward to below the heart, resembling a pig. It moves up or down at irregular times. If untreated for a long time, it causes wheezing, counterflow qi, bone weakness, and shortness of breath. It is acquired on Bing and Ding days in summer. Why? because Spleen disease transmits to the Kidney. The Kidney should transmit to the Heart. However, the Heart is prosperous in summer, and a prosperous organ does not accept pathogens. The Kidney attempts to return the pathogen to the Spleen, but the Spleen refuses. Thus, the pathogen stays and knots to form an accumulation. Therefore, we know Benteng is acquired on Bing and Ding days in summer. This is the essential method for the five accumulations.
Ding said: The five Zang organs of humans are originally harmonious. Indulgence in desires and emotions causes imbalance, leading to accumulation and disease. Thus, there are Ji and Ju. Ji diseases are Yin-type, and Ju diseases are Yang-type. The disease subsides when in season and manifests when out of season. Old textual annotations have clarified this.
Yang said: This symptom resembles a pig rushing upward toward the heart, accompanied by the sensation of Ben Teng Qi (Rushing Pig Qi). This is not the Ji accumulation described here. Although the name is the same, the disease is different.