邻庄刘氏妇，年二十五岁，经血不行，结成 瘕。
病因 处境不顺，心多抑郁，以致月信渐闭，结成 瘕。
证候 瘕初结时，大如核桃，屡治不消，渐至经闭后则 瘕浸长。三年之后大如复盂，按之
甚硬。渐至饮食减少，寒热往来，咳嗽吐痰，身体羸弱，亦以为无可医治待时而已。后忽闻
愚善治此证，求为诊视。其脉左右皆弦细无力，一息近六至。
诊断 此乃由经闭而积成 瘕，由 瘕而浸成虚劳之证也。此宜先注意治其虚劳，而以消 瘕之品辅之。
处方 生怀山药（一两） 大甘枸杞（一两） 生怀地黄（五钱） 玄参（四钱）
沙参（四钱） 生箭 （三钱） 天冬（三钱） 三棱（钱半）
莪术（钱半） 生鸡内金（钱半黄色的捣）
共煎汤一大盅，温服。
方解 方中用三棱、莪术，非但以之消 瘕也。诚以此证廉于饮食，方中鸡内金固能消食，而
三棱、莪术与黄 并用，更有开胃健脾之功。脾胃健壮，不但善消饮食，兼能运化药力使病速愈也。
复诊 将药连服六剂，寒热已愈，饮食加多，咳嗽吐痰亦大轻减。 瘕虽未见消，然从前时或
作疼今则不复疼矣。其脉亦较前颇有起色。拟再治以半补虚劳半消 瘕之方。
处方 生怀山药（一两） 大甘枸杞（一两） 生怀地黄（八钱） 生箭 （四钱）
沙参（四钱） 生杭芍（四钱） 天冬（四钱） 三棱（二钱）
莪术（二钱） 桃仁（二钱去皮） 生鸡内金（钱半黄色的捣）
共煎一大盅，温服。
三诊 将药连服六剂，咳嗽吐痰皆愈。身形已渐强壮，脉象又较前有力，至数复常。至此虚劳
已愈，无庸再治。其 瘕虽未见消，而较前颇软。拟再专用药消之。
处方 生箭 （六钱） 天花粉（五钱） 生怀山药（五钱） 三棱（三钱）
莪术（三钱） 怀牛膝（三钱） 潞党参（三钱） 知母（三钱）
桃仁（二钱去皮） 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 将药连服十二剂，其瘀血忽然降下若干，紫黑成块，杂以脂膜， 瘕全消。为其病积
太久，恐未除根，俾日用山楂片两许，煮汤冲红蔗糖，当茶饮之以善其后。
The wife of a family surnamed Liu in the neighboring village, aged twenty-five, suffered from amenorrhea (absence of menstruation), with blood stasis accumulating to form a mass (Jia).
Etiology Due to unfavorable circumstances and prolonged mental depression, her menstrual cycle gradually ceased, eventually leading to the formation of a mass.
Clinical Manifestations When the mass first formed, it was as large as a walnut. Despite repeated treatments, it did not dissipate. As amenorrhea persisted, the mass gradually enlarged. After three years, it became as large as an inverted bowl and felt very hard upon palpation. Subsequently, she experienced reduced appetite, alternating chills and fever, cough with expectoration, and emaciation. Her family believed the condition was incurable and could only await its natural course. Later, they heard that I specialized in treating such conditions and requested my consultation. Her pulse was wiry, thin, and weak on both sides, with nearly six beats per respiration cycle.
Diagnosis This is a case where amenorrhea led to the accumulation of blood stasis forming a mass, which, over time, consumed healthy qi and evolved into consumptive disease (Xu Lao). The treatment should prioritize addressing the consumptive disease, assisted by herbs that dissipate masses.
Prescription Raw Huai Yam (Shan Yao) - 1 liang; Large Sweet Goji Berry (Gou Qi Zi) - 1 liang; Raw Huai Di Huang (Rehmanniae Radix Recens) - 5 qian; Xuan Shen (Scrophulariae Radix) - 4 qian; Sha Shen (Glehniae Radix or Adenophorae Radix) - 4 qian; Raw Huang Qi (Astragali Radix) - 3 qian; Tian Dong (Asparagi Radix) - 3 qian; San Leng (Curcumae Rhizoma) - 1.5 qian; E Zhu (Zedoariae Rhizoma) - 1.5 qian; Raw Ji Nei Jin (Galli Gigerii Endothelium Corneum, yellow part, crushed) - 1.5 qian.
Decoct together in a large cup of water, take warm.
Formula Analysis San Leng and E Zhu are used not only to dissipate the mass. Indeed, given the patient's poor appetite, while Ji Nei Jin effectively promotes digestion, the combination of San Leng and E Zhu with Huang Qi further enhances the function of opening the stomach and strengthening the spleen. A robust spleen and stomach not only digest food efficiently but also facilitate the transformation and transportation of medicinal efficacy, accelerating recovery.
Follow-up Visit 1 After taking the prescription for six doses, the alternating chills and fever resolved, appetite increased, and cough with expectoration significantly decreased. Although the mass had not visibly diminished, the intermittent pain previously experienced had ceased. The pulse showed considerable improvement compared to before. It was decided to prescribe a formula half aimed at tonifying consumptive disease and half at dissipating the mass.
Prescription Raw Huai Yam (Shan Yao) - 1 liang; Large Sweet Goji Berry (Gou Qi Zi) - 1 liang; Raw Huai Di Huang (Rehmanniae Radix Recens) - 8 qian; Raw Huang Qi (Astragali Radix) - 4 qian; Sha Shen (Glehniae Radix or Adenophorae Radix) - 4 qian; Raw Bai Shao (Paeoniae Radix Alba) - 4 qian; Tian Dong (Asparagi Radix) - 4 qian; San Leng (Curcumae Rhizoma) - 2 qian; E Zhu (Zedoariae Rhizoma) - 2 qian; Tao Ren (Persicae Semen, peeled) - 2 qian; Raw Ji Nei Jin (Galli Gigerii Endothelium Corneum, yellow part, crushed) - 1.5 qian.
Decoct in a large cup, take warm.
Follow-up Visit 2 After taking the prescription for six doses, the cough and expectoration completely resolved. Her physical strength gradually improved, and her pulse became stronger than before, returning to a normal rate. At this point, the consumptive disease was cured and required no further treatment. Although the mass had not fully disappeared, it had become considerably softer than before. It was decided to use a formula specifically designed to eliminate the mass.
Prescription Raw Huang Qi (Astragali Radix) - 6 qian; Tian Hua Fen (Trichosanthis Radix) - 5 qian; Raw Huai Yam (Shan Yao) - 5 qian; San Leng (Curcumae Rhizoma) - 3 qian; E Zhu (Zedoariae Rhizoma) - 3 qian; Huai Niu Xi (Achyranthis Bidentatae Radix) - 3 qian; Lu Dang Shen (Codonopsis Radix) - 3 qian; Zhi Mu (Anemarrhenae Rhizoma) - 3 qian; Tao Ren (Persicae Semen, peeled) - 2 qian; Raw Ji Nei Jin (Galli Gigerii Endothelium Corneum, yellow part, crushed) - 2 qian; Raw Shui Zhi (Hirudo, crushed) - 2 qian.
Decoct together in a large cup of water, take warm.
Outcome After taking the prescription for twelve doses, a significant amount of dark purple, clotted blood mixed with fatty membranes was discharged, and the mass completely disappeared. Given the long duration of the pathology, there was concern about residual root causes. She was advised to consume approximately two liang of dried Hawthorn Fruit (Shan Zha) daily, decocted in water with brown sugar, as a tea to consolidate the recovery.