天津于氏妇，年过三旬，于产后得四肢抽掣病。
病因 产时所下恶露甚少，至两日又分毫恶露不见，迟半日遂发抽掣。
证候 心中发热，有时觉气血上涌，即昏然身驱后挺，四肢抽掣。其腹中有时作疼，令人揉之则
少瘥，其脉左部沉弦，右部沉涩，一息四至强。
诊断 此乃肝气胆火，挟败血上冲以瘀塞经络，而其气火相并上冲不已，兼能妨碍神经，是以昏
然后挺而四肢作抽掣也。当降其败血，使之还为恶露泻出，其病自愈。
处方 怀牛膝（一两） 生杭芍（六钱） 丹参（五钱） 玄参（五钱）
苏木（三钱） 桃仁（三钱去皮） 红花（二钱） 土鳖虫（五大个捣） 红娘虫（即樗鸡，六大个捣）
共煎汤一盅，温服。
效果 此药煎服两剂，败血尽下，病若失。
邑城西韩氏妇，年三十六岁，得产后 瘕证。
病因 生产时恶露所下甚少，未尝介意，迟至半年遂成 瘕。
证候 初因恶露下少，弥月之后渐觉少腹胀满。因系农家，时当麦秋忙甚，未暇延医服药。又
迟月余则胀而且疼，始服便方数次皆无效。后则疼处按之觉硬，始延医服药，延医月余，其疼似减轻
而硬处转见增大，月信自产后未见。诊其脉左部沉弦，右部沉涩，一息近五至。
诊断 按生理正则，产后两月，月信当见；有孩吃乳，至四月亦当见矣。今则已半载月信未见，因其
产后未下之恶露，结 瘕于冲任之间，后生之血遂不能下为月信，而尽附益于其上，俾其日有增长，是
以积久而其硬处益大也。是当以消 瘕之药消之，又当与补益之药并用，使之消 瘕而不至有伤气化。
处方 生箭 （五钱） 天花粉（五钱） 生怀山药（五钱） 三棱（三钱）
莪术（三钱） 当归（三钱） 白术（二钱） 知母（二钱）
生鸡内金（二钱黄色的捣） 桃仁（二钱去皮）
共煎汤一大盅，温服。
复诊 将药连服六剂，腹已不疼，其硬处未消，按之觉软，且从前食量减少，至斯已复其旧。
其脉亦较前舒畅，遂即原方为之加减俾再服之。
处方 生箭 （五钱） 天花粉（五钱） 生怀山药（四钱） 三棱（三钱）
莪术（三钱） 怀牛膝（三钱） 野党参（三钱） 知母（三钱）
生鸡内金（二钱黄色的捣） 生水蛭（二钱捣碎）
共煎汤一大盅，温服。
效果 将药连服十五六剂（随时略有加减），忽下紫黑血块若干，病遂全愈。
帮助 妇女 瘕治愈者甚少，非其病之果难治也。《金匮》下瘀血汤，原可为治妇女 瘕之主方。
特其药性猛烈，原非长服之方。于 瘕初结未坚硬者，服此药两三次或可将病消除。若至累月累年，
瘕结如铁石，必须久服，方能奏效者，下瘀血汤原不能用。乃医者亦知下瘀血汤不可治坚结之 瘕，
遂改用桃仁，红花、丹参、赤芍诸平和之品；见其 瘕处作疼，或更加香附、延胡、青皮、木香诸
理气之品，如此等药用之以治坚结之 瘕，可决其虽服至百剂，亦不能奏效。然仗之奏效则不足，
伤人气化则有余。若视为平和而连次服之，十余剂外人身之气化即暗耗矣。此所以治 瘕者十中难
愈二三也。若拙拟之方其三棱、莪术、水蛭，皆为消 瘕专药。即鸡内金人皆用以消食，而以消
瘕亦甚有力。更佐以参、 、术诸补益之品，则消 瘕诸药不虑其因猛烈而伤人。且又用花粉、知
母以调剂补药之热，牛膝引药下行以直达病所，是以其方可久服无弊。而坚结之 瘕即可徐徐消除
也。至于水蛭必生用者，理冲丸后论之最详。且其性并不猛烈过甚，治此证者，宜放胆用之以挽救人命。
Tianjin, a woman surnamed Yu, aged over thirty, developed convulsions and spasms of the four limbs after childbirth.
Etiology: The lochia discharged during delivery was scanty. By the second day, not a trace of lochia could be seen. Half a day later, convulsions and spasms ensued.
Symptoms: There was heat in the heart region, accompanied by occasional sensations of Qi and Blood rushing upward. This would lead to sudden unconsciousness, opisthotonos (backward arching of the body), and convulsions of the four limbs. Her abdomen sometimes hurt; rubbing it provided slight relief. Her pulse was deep and wiry on the left side, deep and choppy on the right side, with four beats per breath and strong force.
Diagnosis: This condition is caused by Liver Qi and Gallbladder Fire carrying retained blood (lochiostasis) upward, causing obstruction in the meridians. The continuous upward rush of Qi and Fire also interferes with nerve function, resulting in unconsciousness, opisthotonos, and limb convulsions. Treatment should focus on descending and expelling the retained blood, allowing it to discharge as lochia, which will lead to spontaneous recovery.
Prescription: Huai Niuxi (Radix Achyranthis Bidentatae, 1 liang), Sheng Hangshao (Radix Paeoniae Albae, 6 qian), Danshen (Radix Salviae Miltiorrhizae, 5 qian), Xuanshen (Radix Scrophulariae, 5 qian), Sumu (Lignum Sappan, 3 qian), Taoren (Semen Persicae, 3 qian, peeled), Honghua (Flos Carthami, 2 qian), Tubiechong (Asio, five large specimens, crushed), Hongniangchong (i.e., Chuji, six large specimens, crushed). Decoct together in one cup of water, take warm.
Outcome: After taking two doses, the retained blood was completely discharged, and the illness vanished as if it had never existed.
In the west of the county, a woman surnamed Han, aged thirty-six, suffered from postpartum Zha syndrome (abdominal masses).
Etiology: Lochia discharge was scanty during delivery. She paid no attention to it. Six months later, a Zha mass formed.
Symptoms: Initially, due to scanty lochia, she gradually felt distension in the lower abdomen after one month. Being a farmer's wife, she was busy with the wheat harvest and had no time to consult a doctor or take medicine. A month later, distension turned into pain. She tried several folk prescriptions without effect. Later, the painful area felt hard upon pressure, prompting her to seek medical treatment. After a month of treatment, the pain seemed reduced, but the hard mass enlarged. Menstruation had not returned since childbirth. Her pulse was deep and wiry on the left, deep and choppy on the right, with nearly five beats per breath.
Diagnosis: According to physiological norms, menstruation should return two months postpartum, or four months if breastfeeding. Since it has been half a year without menstruation, the undischarged postpartum lochia has condensed into a Zha mass between the Chong and Ren vessels. Consequently, newly generated blood cannot descend to become menstruation but instead attaches to and nourishes the Zha mass, causing it to grow daily. Thus, the longer it persists, the harder the mass becomes. Treatment requires herbs that dissolve Zha masses, combined with tonifying herbs to prevent damage to Qi transformation while resolving the mass.
Prescription: Sheng Huangqi (Radix Astragali Membranacei, 5 qian), Tianhuafen (Radix Trichosanthis, 5 qian), Sheng Huaishanyao (Rhizoma Dioscoreae Hypoglaucae, 5 qian), Sanleng (Rhizoma Sparganii, 3 qian), Ezhu (Rhizoma Curcumae, 3 qian), Danggui (Radix Angelicae Sinensis, 3 qian), Baizhu (Rhizoma Atractylodis Macrocephalae, 2 qian), Zhimu (Cortex Phellodendri, 2 qian), Sheng Jineijin (Endothelium Corneum Gigeriae Galli, 2 qian, yellow variety, crushed), Taoren (Semen Persicae, 2 qian, peeled). Decoct together in a large cup of water, take warm.
Follow-up Visit: After six doses, abdominal pain ceased, and although the hard mass remained, it felt softer upon pressure. Her appetite, which had decreased previously, had returned to normal. Her pulse was smoother than before. The original prescription was modified slightly for continued use.
Prescription: Sheng Huangqi (Radix Astragali Membranacei, 5 qian), Tianhuafen (Radix Trichosanthis, 5 qian), Sheng Huaishanyao (Rhizoma Dioscoreae Hypoglaucae, 4 qian), Sanleng (Rhizoma Sparganii, 3 qian), Ezhu (Rhizoma Curcumae, 3 qian), Huai Niuxi (Radix Achyranthis Bidentatae, 3 qian), Ye Dangshen (Radix Codonopsis Pilosulae, 3 qian), Zhimu (Cortex Phellodendri, 3 qian), Sheng Jineijin (Endothelium Corneum Gigeriae Galli, 2 qian, yellow variety, crushed), Sheng Shizhi (Hirudo, 2 qian, crushed). Decoct together in a large cup of water, take warm.
Outcome: After taking fifteen to sixteen doses (with minor adjustments as needed), numerous purple-black blood clots were discharged, and the disease was completely cured.
Commentary: Few women with Zha syndrome recover. This is not because the disease is inherently incurable. The Xiayuxue Tang (Blood-Expelling Decoction) from *Jin Gui Yao Lue* is originally the principal formula for treating female Zha. However, its properties are fierce and unsuitable for long-term use. For early-stage Zha that is not yet hard, two or three doses may resolve it. But for cases persisting for months or years where the Zha is hard as ironstone, requiring long-term medication, Xiayuxue Tang is inappropriate. Doctors know this and switch to milder herbs like Taoren, Honghua, Danshen, and Chishao. If pain is present, they add Qi-regulating herbs like Xiangfu, Yanhusuo, Qingpi, and Muxiang. Using such mild herbs for hard Zha masses guarantees failure even after a hundred doses. Moreover, their efficacy is insufficient, while their potential to damage Qi transformation is excessive. If taken continuously under the guise of being "mild," Qi transformation is secretly depleted after ten doses. This explains why only two or three out of ten patients recover. In my proposed formula, Sanleng, Ezhu, and Shizhi are specific herbs for dissolving Zha. Even Jineijin, commonly used for digestion, is powerful against Zha. Combined with tonics like Renshen, Huangqi, and Baizhu, the risk of damaging the body from harsh herbs is mitigated. Tianhuafen and Zhimu balance the heat of tonics, while Niuxi guides the herbs downward to the disease site. Thus, the formula can be taken long-term without harm, slowly dissolving hard Zha masses. Shizhi must be used raw; the rationale is detailed in the commentary on Lizhong Wan. Its properties are not excessively fierce. Practitioners should dare to use it to save lives.