Library

(Attachment: Huayu Tongjing San [Blood-Activating and Menstruation-Unblocking Powder])

Women suffering from *zheng* (masses with fixed location) and *jia* (masses with mobile location) often do so because lochia remains uncleaned after childbirth, coagulating within the Chong (Penetrating Vessel) and Ren (Conception Vessel). As new blood flows daily, it stagnates upon this coagulation, adding to it, until gradually accumulating into a mass. The term *zheng* refers to a condition with tangible evidence, fixed in one place without moving. The term *jia* refers to something that can still move; upon palpation, a mass may appear or disappear, as if falsely attributed. By this reasoning, *zheng* is indeed more severe than *jia*. If this condition occurs within several months, and the patient's body remains strong, and the formed mass is not yet very hard, one may use the Xiayuxue Tang (Downward-Purging Blood Decoction) from the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) to purge the blood stasis. However, one must strictly follow the administration method recorded in the *Jingui Yaolue*: first prepare it as pills, then decoct them into a soup, and consume it together with the dregs for efficacy.

If the illness has persisted for over a year, or even several years, and the *zheng* and *jia* accumulation nearly fills the abdomen, becoming hard as iron or stone, with amenorrhea (absence of menstruation), reduced appetite, and gradually developing into consumptive disease (Laozai), when the pathological trend reaches this stage, administering Xiayuxue Tang again will certainly be intolerable for the patient; even if tolerated, it cannot effectively purge the blood stasis. Only by using my formulated Lizhong Tang (Regulate the Middle Vessel Decoction), which combines tonifying and breaking agents, can patients with weak constitutions transform weakness into strength. Even for masses accumulated over ten years, hard as iron and stone, long-term consumption can slowly and completely eliminate them. Several cured cases are attached behind this formula for reference. Recently in Tianjin, I used this formula with modifications based on symptoms and cured several patients with *zheng* and *jia*. Therefore, I record one case below as a rough guideline for treating this disease.

A woman surnamed Zhang in Tianjin, nearing forty years of age, stated: "Five years ago, due to uncleaned lochia after childbirth, a hard mass accumulated, initially the size of an orange, which gradually enlarged over time. It was originally located below the umbilicus, but now extends three to four cun above it. The part that accumulated later and enlarged is still soft to the touch. However, the initial mass is hard as iron and stone, and feels very cold. Initially, there was no pain, but since this year, I have gradually felt pain. I have taken various medicines before with no effect whatsoever, leading to reduced diet and physical weakness. I wonder if it can still be treated?" She spoke with evident fear. I said, "Do not worry; it is guaranteed to heal." I then asked if her menstruation was still regular. She replied that previously it flowed monthly, but now although some flow persists, it is no longer monthly, and the volume is decreasing; she has not seen it for two months. Palpating her pulse, it was choppy (Se) and powerless, especially weak at both Chi (Cun) positions. Thus, I prescribed: Sheng Huangqi (Raw Radix Astragali) 4 qian, Dangshen (Radix Codonopsis), Baizhu (Rhizoma Atractylodis Macrocephalae), Danggui (Radix Angelicae Sinensis), Sheng Shanyao (Raw Rhizoma Dioscoreae), Sanleng (Tuber Sparganii), Ezhu (Rhizoma Curcumae), and Sheng Jineijin (Endothelium Corneum Gigeriae Galli) each 3 qian, Taoren (Semen Persicae), Honghua (Flos Carthami), and Sheng Shizhi (Hirudo) each 2 qian, E chong (Ground Beetle) 5 pieces, and Xiaohuixiang (Fructus Foeniculi) 1.5 qian. Decoct in a large cup of water, take warm. After taking four doses continuously, abdominal pain ceased, the affected area no longer felt cold, appetite increased, and the pulse showed slight improvement. Immediately, I removed Xiaohuixiang from the original prescription and administered five more doses. Although the mass had not disappeared, the surrounding area had gradually softened. However, the upper jiao felt slightly hot. Therefore, I added Xuanshen (Radix Scrophulariae) 3 qian and Chuji (Pollen Platycladi) 8 pieces to the formula. After taking more than ten doses continuously, the *zheng* and *jia* completely disappeared.

However, *zheng* and *jia* do not necessarily all belong to blood stasis. Generally speaking, those whose *zheng* and *jia* are formed from blood stasis must suffer from infertility, and their menstruation is frequently closed. If the patient does not suffer from infertility and menstruation occurs frequently, their *zheng* and *jia* are mostly due to cold accumulation. For those with robust constitutions, one can use 3 qian of powder from the first and second crushings of roasted Qian Niu Zi (Semen Pharbitidis) to purge the accumulation. The discharged accumulation is usually semi-transparent white, resembling paste made from mung bean flour. For those with slightly weaker constitutions, one can also use decoctions of tonifying Qi herbs such as Huangqi (Radix Astragali) and Renshen (Radix Ginseng) to deliver the Qian Niu Zi powder. For those who fear taking such harsh purgatives, one can slowly take pill medicine to resolve it. The formula uses 2 liang of Hujiao (Fructus Piperis Nigris) and Bai Fan (Alumen), mixed with roasted wheat flour to form pills the size of Torreya seeds. Take 1.5 qian per dose, twice daily. After taking for over a month, the *zheng* and *jia* will naturally dissipate.

If the affected area feels cold, taking more warming and circulating medications can also help discharge the accumulation. I once treated a case of cold accumulation in a woman surnamed Zhang, heavily using Fuzi (Radix Aconiti Lateralis Preparata); details are provided in the explanation of Fuzi for reference. Regardless of whether it is blood stasis or cold accumulation, taking 4-5 qian of real Lu Jiao Jiao (Colla Cornus Cervi) daily (divided into two doses, stewed until melted) can also slowly eliminate it over time. This is because Lu Jiao Jiao naturally enters the Chong and Ren vessels to unblock blood vessels, and also enters the Du (Governor Vessel) to assist Yuan Yang (Primordial Yang). Therefore, it can slowly digest both blood stasis and cold accumulation.

Recently, I formulated another prescription to eliminate *zheng* and *jia* while unblocking amenorrhea. It uses equal parts of Chao Baizhu (Stir-fried Rhizoma Atractylodis Macrocephalae), Tiandong (Radix Asparagi), and Sheng Jineijin (Endothelium Corneum Gigeriae Galli), ground into fine powder. To treat firm *zheng* and *jia* and menstrual obstruction, take 3 qian per dose, delivered with boiled water, twice daily. If taken with a decoction of 3 qian Shanzha (Fructus Crataegi) mixed with 3 qian dissolved red sugar, it is even better. Due to its frequent efficacy, I named it Huayu Tongjing San (Blood-Activating and Menstruation-Unblocking Powder).

Jineijin inherently possesses strong blood-activating power; being able to activate blood means it is good at eliminating *zheng* and *jia*. However, it has never been used alone to achieve efficacy. In my formulated Lizhong Tang, there is originally 3 qian of Sheng Jineijin. The note behind the formula states: for those who are weak, remove Sanleng and Ezhu, and increase Jineijin to 4 qian. The ability of Jineijin to eliminate *zheng* and *jia* is indeed not inferior to Sanleng and Ezhu. Being able to eliminate *zheng* and *jia* implies the ability to regulate menstruation; this is a definite principle. However, without clinical verification, I dare not determine it solely based on theory. Later, I treated a young woman surnamed Yang in Tianjin. She had suffered from scrofula (Luoli) and had taken excessive cold and dispersing medicines, damaging her Spleen and Stomach, resulting in postprandial fullness and indigestion. I heavily used warming and tonifying formulas for the Spleen and Stomach, adding 2 qian of Sheng Jineijin to facilitate the transformation of medicinal power. After taking several doses, she returned for a consultation, stating that her illness had greatly improved, but on the night she first took the medicine, her menstruation started, less than ten days before her previous cycle. Since her illness had improved, I did not pay much attention to this statement, and the revised prescription still contained 2 qian of Sheng Jineijin. After taking several more doses, she returned seeking a revision, stating that her illness was completely cured, except that she had menstruated three times within a month. The latter two occurrences were after taking the medicine, with scant flow, and she requested further regulation. I suddenly realized this was indeed due to the use of Jineijin. From this, I could definitely know the menstruation-unblocking power of Jineijin. I recalled that when I was in Fengtian (now Shenyang), I treated a young woman surnamed Song who had stomach pain due to blood stasis accumulation. I heavily used Sheng Jineijin in the formula. After taking several doses, she passed blood in stool and urine and was cured. This not only demonstrated Jineijin's power to eliminate stasis but also its power to unblock menstruation. Reviewing these cases collectively, Jineijin's power to eliminate stasis and unblock menstruation is indeed exceptional. The inclusion of Baizhu in this formula is to prevent the Spleen and Stomach from being too weak to bear the opening power of Jineijin. The addition of Tiandong is to prevent Yin deficiency with heat from tolerating the warming and drying nature of Baizhu. However, Jineijin must be used raw to be effective; if stir-fried, it loses its efficacy.