Library

Luo Qianfu stated: The *Huangdi Neijing* (Yellow Emperor's Inner Canon) records that Shijia (a disease characterized by abdominal masses hard as stone) originates in the Baozhong (uterus). Cold pathogenic factors invade the Zimen (cervical os), causing obstruction of the Zimen, preventing the smooth flow of Qi. Evil blood should be discharged but fails to do so, remaining stagnant and gradually enlarging, resembling pregnancy, with menstruation not occurring on time. This condition occurs only in women and can be treated by guiding and purging downward. The Bladder is the mansion of body fluids; it functions through Qi transformation to allow excretion. Now, cold pathogens lodge in the Zimen, causing Qi obstruction and stagnation, leading to blood stasis and retention, which condenses into a hardness like stone, named Shijia. This begins as a Qi disorder followed by a Blood disorder, hence amenorrhea; it can be treated by promoting circulation and guiding downward. Only potent acrid-hot formulas can cure it; one may take Jianhou Wan or Hexue Tongjing Tang.

*Zegong Manlu* (Random Records from Broken Bones) states: My daughter-in-law, Shen Shi, was prone to depression and anger. She suddenly developed amenorrhea, and her abdomen gradually enlarged. Suspecting pregnancy, physicians examined her and also concluded she was pregnant. After more than ten months without delivery, various symptoms emerged, raising doubts. Physicians suspected blood accumulation and desired to purge, but due to her weak constitution unable to withstand harsh treatment, they opted for gradual resolution, using blood-invigorating and regulating herbs for a long time, daring not to use strong blood-purging drugs. Consequently, she died. Later, I read a case treated by Shengqidong regarding the Crown Princess Consort and felt deep regret and sorrow. During the Yongle era, Crown Princess Consort Zhang suffered from amenorrhea for over ten months. Most physicians believed it was pregnancy. Her abdominal distension worsened significantly. The Emperor ordered Shengqidong to diagnose her. His diagnosis aligned with previous observations; he prescribed blood-breaking formulas. After taking the medicine, several dou of blood were discharged, and the illness subsided. My daughter-in-law’s condition matched this exactly. Had we boldly purged after the tenth month, once pregnancy was definitively ruled out, she might have survived. Alas, the physicians lacked courage; is this not lamentable?

Shen Zhai commented: The above three passages outline differential diagnoses between pregnancy and conditions mimicking it, such as Changqin (intestinal polyp/mass), Shijia, and Xuxue (blood accumulation). The previously mentioned Guotai (ghost fetus) stems from deficiency of Ying and Wei (nutritive and defensive Qi) and mental instability, allowing demonic influences to invade the organs and bowels upon deficiency. Therefore, Xue Lizhai emphasized tonifying Yuanqi (primordial Qi). Regarding Changqin and Shijia from the *Neijing*, one involves the Large Intestine and is a Qi disorder, while the other involves the Zimen and is a Blood disorder; both closely resemble Guotai. Guotai and normal pregnancy are ambiguous; without clairvoyant diagnostic insight, physicians often misdiagnose. Thus, the case of Xuxue is appended to illustrate the indication for purging methods. However, purging methods should only be discussed when the syndrome is clearly identified without doubt.