《金匮》曰∶妇人咽中,有如炙脔,半夏浓朴汤主之,炙脔干肉也。咽中贴贴,如有炙肉,吐之不出,吞之不下,
此病不因肠胃,故不碍饮食;二便不因表邪,故无骨痛寒热,乃气为积寒所伤,不与血和,血中之气,溢而浮于咽中,
得水湿之气,凝结难移,男子亦间有之。药用半夏浓朴汤,乃二陈去陈皮、甘草,加浓朴、紫苏、生姜也。专治妇人
七情之气,郁滞不散,结成痰涎,或如梅核,在咽咯咽不下,或中脘痞满,气不舒畅,或痰饮中滞,呕逆恶上,并可
取效。盖半夏降逆,浓朴散结,生姜、茯苓宜至高之滞,而下其湿,苏叶味辛气香,色紫性温,能入阴和血,则气与
血和,即不复上浮也。
者,近脐左右,各有一条,筋脉急痛,大者如臂,次者如拳,因气而成,如弦之状,故名曰 。癖者,僻在两肋
之间,有时而痛,故名曰 。癖者,僻在两肋之间,有时而痛,故名曰癖。疝者,痛也。瘕者,假也,假物成形,推
移乃动也。若伤食成块坚而不移,名曰食 。瘀血成块,坚牢不移,名曰血 。积在肠胃之间与脏气结搏坚牢,虽推之
不移,名曰 ,言其病形可征验也。气壅塞而为痞,言其气痞塞不宣畅也。大抵推之不动为 ,推之动为瘕也。
至疝与 癖则与痛俱,痛即现,不痛即隐,在脐左右为 ,在两肋间为癖,在小腹牵引腰胁为疝,总因妇人脏腑虚弱,
经行不忌生冷,痰血饮食,结聚成块,与脏气相持,日渐生长,牢固不安,得冷则发,大痛欲死,然有异于丈夫者,
非因产后血虚受寒,或因经来取冷过度,不独饮食失节,多挟血气所成。其脉弦急者生,虚弱微细者危。善治者,
调补脾胃为主,佐以消导。若形气充实者,调其气而破其血,消其食而豁其痰,衰其大半而止,不可猛攻,以伤
元气,病重则病受之,病轻则胃气受伤矣。或云,待块消尽而后补养,则胃气之存也。几希不惟不胜治。终亦不可治也。
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: "In women, there is a sensation in the throat as if a piece of roasted meat were stuck; Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction) is indicated." 'Zhilian' refers to dried, roasted meat. The throat feels sticky and obstructed, as if a piece of roasted meat were lodged there; it cannot be spat out, nor can it be swallowed. This condition does not originate from the stomach or intestines, so it does not hinder eating and drinking; the urination and defecation are not affected by exterior pathogens, so there are no symptoms such as bone pain, aversion to cold, or fever. It arises because Qi is injured by accumulated cold and fails to harmonize with Blood. The Qi within the Blood overflows and floats upward to the throat. Upon encountering dampness and water fluids, it coagulates and becomes difficult to move. Men occasionally suffer from this as well. The prescribed medicine is Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction), which is Erchen Tang (Two-Aged Phlegm Decoction) minus Chenpi (Dried Tangerine Peel) and Gancao (Licorice Root), plus Houpo (Magnolia Bark), Zisu (Perilla Leaf), and Shengjiang (Fresh Ginger). It specifically treats Qi stagnation in women caused by the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) that fails to disperse, condensing into phlegm-fluids. Patients may feel as if a plum pit is stuck in the throat, impossible to cough up or swallow down; or experience epigastric fullness and distension with unsmooth Qi flow; or have phlegm-fluids stagnating in the middle jiao causing vomiting, regurgitation, and anorexia. All these conditions can be effectively treated. This is because Banxia (Pinelliae Rhizoma) descends rebellious Qi, Houpo (Magnoliae Officinalis Cortex) dissipates nodulation, Shengjiang (Zingiberis Rhizoma Recens) and Fuling (Poria) promote the dispersion of stagnation at the upper levels and drain downward dampness, while Zisu Ye (Perillae Folium), being pungent in flavor and aromatic in qi, purple in color and warm in nature, enters the Yin to harmonize Blood. When Qi and Blood harmonize, the Qi ceases to float upward.
"Jia" (False mass) refers to tendons and vessels on either side of the navel that are tight and painful. The larger masses are as thick as an arm, and the smaller ones as large as a fist. They form due to Qi stagnation and resemble the shape of a string, hence the name "Jia". "Pi" (Hidden mass) refers to masses located obliquely between the two hypochondria, which cause intermittent pain, hence the name "Pi". "Shan" (Hernia/Colic) means pain. "Jia" (False mass) implies something false or temporary taking shape; it moves when pushed. If a hard mass formed by food injury does not move when pushed, it is called "Shi Jia" (Food Mass); if a mass formed by static Blood is hard, firm, and immovable, it is called "Xue Jia" (Blood Mass); if accumulation occurs between the stomach and intestines, knotting firmly with the Qi of the zang-organs, remaining immovable even when pushed, it is called "Ji" (Fixed Accumulation), indicating that its pathological form can be verified. Obstruction of Qi leading to blockage is called "Pi" (Stagnant Fullness), signifying that Qi is stagnant and not flowing smoothly. Generally, masses that do not move when pushed are "Ji", while those that move are "Jia". As for Shan and Pi, they present with pain; symptoms appear when painful and hide when painless. Located on the left and right of the navel is "Jia"; located between the hypochondria is "Pi"; radiating from the lower abdomen to the waist and flanks is "Shan". These generally result from weakness of the zang-organs and bowels in women, failure to avoid raw and cold foods during menstruation, leading to the aggregation of phlegm, blood, and food residues into masses. These masses contend with the Qi of the zang-organs, growing day by day, becoming firm and unstable. They flare up upon exposure to cold, causing severe pain nearly unto death. However, this differs from men; women's conditions are rarely due to cold invasion following postpartum blood deficiency, but rather often stem from excessive exposure to cold during menstruation combined with irregular diet, mostly involving both blood and Qi. If the pulse is wiry and rapid, the prognosis is good; if the pulse is weak, thready, and fine, the condition is critical. Skilled practitioners prioritize tonifying and regulating the Spleen and Stomach, assisting with methods to resolve stagnation. For patients with robust constitution and abundant Qi, one may regulate Qi and break Blood, resolve Food, and clear Phlegm, but treatment should cease when the pathogen has diminished by more than half. One must not use harsh attacking methods to damage Yuan Qi (Primal Qi); otherwise, severely ill patients will not withstand it, and mildly ill patients will suffer damage to Stomach Qi. Some argue that one should wait until the masses are completely eliminated before beginning tonic nourishment to preserve Stomach Qi. This is incorrect; not only will it fail to achieve therapeutic success, but ultimately, the disease will remain incurable.