（血瘕，即儿枕，宜参看。）
〔大〕夫积者，阴气也，五脏所生。聚者，阳气也，六脏所成。皆由饮食不节，寒
热不调，致五脏之气积，六腑之气聚，积者痛不离其部。聚者其痛无有常处。所以然者，
积为阴气，阴性沉伏，故痛不离其部。聚为
阳气，阳性浮动，故痛无常处，产后血气伤于脏腑，脏腑虚弱，为风冷所乘，搏于脏腑，
与血气相结，故成积聚 块也。
〔薛〕前证乃真气亏损，邪气乘之，况产后得之，尤当固真气为主。若求旦夕之效，
而攻其邪，则速其危矣。当参前杂证积聚诸方论治之。一产妇腹中似有一块，或时作
痛而转动，按之不痛，面色痿黄，痛则 白，脉浮而涩，余谓此肝气虚而血弱也，不信，乃
用破血行气，痛益甚，转动无常。又认以为血鳖，专用破血驱逐之药，痛攻两胁，肚腹
尤甚，益信为鳖确。服下虫等药，去血甚多，形气愈虚，肢节间各结小核，隐于肉里，以
为鳖子畏药而走于外。余曰∶肝藏血而养诸筋，此因肝血复损，筋涸而挛结耳。盖肢节
胸项，皆属肝胆部分，养其脾土，补金水，以滋肝血，则筋自舒。遂用八珍汤、逍遥散、归
脾汤加减，调治而愈。一妇月经不调，两拗肿胀，小便涩滞，腹中一块作痛，或上攻
胁腹，或下攻小腹，发热晡热，恶寒，肌肤消瘦，饮食无味，殊类瘵证，久而不愈。余
谓肝脾血气亏损，用八珍汤、逍遥散、归脾汤，随证互服而愈。
〔大〕新产后有血与气相搏而痛者，谓之瘕。瘕之言假也，谓其痛浮假无定处也。此
由夙有风冷血气，不治，至产血下则少，故致此病也。不急治，则多成积结，妨害月水，
轻则痞涩，重则不通也。
〔薛〕前证乃寒邪乘客，气血壅结，此因气病而血病也。当补养胃气，调和月经，宽
缓静养为善。《难经》云∶任脉之病，男子为七疝，女子为瘕聚。当参前后各论治之。
〔丹〕南山妇人年三十八，于九月二十三日月经行，比前过后十日，得草药以败血
海，为下胎之谋，有数滴血下，因此腹痛，在小腹下有块如碗大，不可按，汤熨则痛稍定，
大小便抽痛，小便涩，大便略下少赤积垢，食不进，口略渴发热，此胃气为草药所败，加
以受伤之血妄行而不得泄，所以为病也。
砂仁 甘草（炙） 川芎 黄芩（各三分） 滑石（一钱半） 牛膝（二钱） 桃仁（七粒）
上水、酒煎服。
芍药汤 （《保命》）治产后诸积不可攻，宜养阴去热，其病自安。
芍药（一斤） 黄芩 茯苓（各六两）
上锉散，每以半两，水煎温服，日三。
〔丹〕产后消血块。
滑石（三钱） 没药 血竭（各二钱）
上为细末，醋糊丸。如恶露不下，以五灵脂为细末，面糊丸，白术汤、陈皮汤任下。
又方 消血块。
香附（童便浸） 桃仁（去皮留尖，等分）
为末，醋糊丸。
治血瘕作痛，脐下胀满，或月经不行，发热体倦。
当归（二两） 桂心 芍药 血竭 蒲黄（炒，各一两半） 延胡索（炒，一两）
上为末，每服二钱，空心热酒调下。
葛氏方（治证同前。）桂心为末，每服一钱，空心酒调下。
《产宝》疗血瘕，痛无定处。
童便（三升） 生地黄汁 生藕汁（各一升） 生姜汁（三升）
上先煎前三味，约三分减二，次下姜汁，慢火煎如稀饧，每服取一合，暖酒调下。
《千金》疗血瘕。
先干地黄（一两） 乌贼鱼骨（二两）
上为细末，空心温酒调服二钱匕。
四神散 治产后瘀血不消，积聚作块，心腹切痛。
川芎 当归（去芦） 干姜（炮） 赤芍药（各等分）
上为细末，每服二钱，食远用温酒调服。
桂心丸 治产后血气不散，积聚成块，上攻心腹，或成寒热，四肢羸瘦烦疼。
桂心 当归 赤芍药 牡丹皮 没药 槟榔（各半两） 青皮 干漆（炒烟尽，各七钱半）
大黄 桃仁（去皮尖） 三棱（煨） 玄胡索 鳖甲（酥
炙） 浓朴（制，各一两）
上为细末，炼蜜和丸梧子大。每服三四十丸，食前用温酒送下。
(Blood Jia, also known as Erzhen [afterbirth mass], see reference.)
[Xue Ji] The aforementioned syndrome is caused by the deficiency of True Qi (Zhen Qi), allowing pathogenic factors to invade. In particular, when occurring postpartum, the primary treatment should focus on consolidating True Qi. If one seeks immediate effects and attacks the pathogens, it will hasten the danger. One should refer to the previous discussions on various miscellaneous syndromes involving accumulation and gathering for treatment methods. A postpartum woman had a lump in her abdomen that occasionally hurt and moved; pressing on it did not cause pain. Her complexion was sallow, and she turned pale when in pain. Her pulse was floating and choppy. I stated that this was due to Liver Qi deficiency and weak Blood. She did not believe me, so she used blood-breaking and Qi-moving herbs, which intensified the pain and made its movement unpredictable. It was then diagnosed as "Blood Bi" (a type of abdominal mass), and specific blood-breaking and expelling drugs were used exclusively. The pain attacked both hypochondriac regions and the abdomen severely, reinforcing the belief that it was indeed a "Bi". After taking vermifuge-like medicines, she lost a large amount of blood, becoming increasingly deficient in form and Qi. Small nodules formed in the joints, hidden within the flesh, which were believed to be "Bi seeds" fleeing outward due to fear of the medicine. I said: The Liver stores Blood and nourishes all sinews. This condition arose because Liver Blood was further damaged, causing sinews to dry up and contract. Since joints, chest, and neck all belong to the Liver and Gallbladder areas, nourishing Spleen Earth, tonifying Metal and Water to moisten Liver Blood would allow sinews to relax naturally. Thus, using modified Bazhen Tang (Eight Treasures Decoction), Xiaoyao San (Free and Easy Wanderer Powder), and Guipi Tang (Restore the Spleen Decoction), she was treated and recovered. Another woman with irregular menstruation had swollen ankles, dysuria, and a painful lump in the abdomen that sometimes attacked upward to the hypochondriac/abdominal area or downward to the lower abdomen. She had fever, afternoon tidal fever, aversion to cold, emaciation, loss of appetite, resembling Tuberculosis Syndrome (Zhai Zheng) but persisting without cure. I attributed this to Liver and Spleen Blood and Qi deficiency, treating her with alternating doses of Bazhen Tang, Xiaoyao San, and Guipi Tang according to symptoms, resulting in recovery.
[Zhang Jiebin] Accumulation (Ji) belongs to Yin Qi and originates from the Five Zang Organs. Gathering (Ju) belongs to Yang Qi and is formed by the Six Fu Organs. Both result from irregular diet and imbalance of Cold and Heat, leading to the accumulation of Qi in the Five Zang and gathering of Qi in the Six Fu. Pain from Accumulation remains fixed in its location. Pain from Gathering has no constant location. The reason is that Accumulation is Yin Qi; Yin nature is deep and latent, so pain does not leave its site. Gathering is Yang Qi; Yang nature is floating and active, so pain has no fixed place. Postpartum, Blood and Qi injure the Zang-Fu organs, making them weak. They are invaded by Wind-Cold, which clashes with the Zang-Fu, knotting with Blood and Qi, thus forming Accumulation and Gathering masses.
[Zhang Jiebin] Immediately after childbirth, if Blood and Qi clash causing pain, it is called Jia. "Jia" implies false/transient, meaning the pain is floating, false, and has no fixed location. This occurs because there was pre-existing Wind-Cold affecting Blood and Qi. Without prior treatment, during childbirth, Blood loss reduces volume, leading to this disease. If not treated urgently, it often becomes accumulated knots, interfering with Menstrual Water (Yue Shui). Mild cases cause stagnation and obstruction; severe cases lead to complete blockage.
[Xue Ji] The aforementioned syndrome is caused by Cold Pathogens invading guests, resulting in congestion and knotting of Qi and Blood. This is a case where Qi pathology leads to Blood pathology. One should supplement and warm Stomach Qi, regulate menstruation, and adopt a relaxed, quiet rest approach. The *Nan Jing* states: Diseases of the Ren Mai (Conception Vessel) manifest as Seven Types of Hernia in men and Jia Ju (Gathering Masses) in women. Refer to previous and subsequent discussions for treatment.
[Zhu Danxi] A woman from Nanshan, aged thirty-eight, began her menstruation on September 23rd, ten days later than usual. She obtained herbal medicine intended to ruin the Blood Sea to induce abortion. A few drops of blood were discharged, followed by abdominal pain. A lump the size of a bowl appeared in the lower abdomen, which could not be pressed. Hot compresses slightly alleviated the pain. There was pulling pain in urination and defecation, dysuria, slight passage of red turbid fecal matter, anorexia, slight thirst, and fever. This occurred because Stomach Qi was ruined by the herbs, compounded by injured Blood moving recklessly without discharge, hence the illness.
Amomum fruit (Sharen), Licorice root (Gancao, roasted), Ligusticum rhizome (Chuanxiong), Scutellaria root (Huangqin) (each 3 fen), Talcum (Huashi, 1.5 qian), Achyranthes root (Niuxi, 2 qian), Peach kernel (Taoren, 7 grains).
Decoct in water and wine, take orally.
Shaoyao Tang (*Bao Ming Fang*) treats various postpartum accumulations that cannot be aggressively attacked. It is suitable to nourish Yin and clear Heat; the disease will resolve itself.
Peony root (Shaoyao, 1 jin), Scutellaria root (Huangqin), Poria sclerotium (Fuling) (each 6 liang).
Crush into coarse powder. Take 0.5 liang each time, decoct in water, take warm, three times daily.
[Zhu Danxi] Eliminate blood clumps postpartum.
Talcum (Huashi, 3 qian), Myrrh (Moyao), Dragon's blood (Xuejie) (each 2 qian).
Grind into fine powder, make pills with vinegar paste. If lochia does not descend, grind Drynaria rhizome (Wulingzhi) into fine powder, make pills with flour paste, administer freely with Atractylodes macrocephala decoction (Baizhu Tang) or Tangerine peel decoction (Chenpi Tang).
Another prescription for eliminating blood clumps.
Cyperus rhizome (Xiangfu, soaked in child's urine), Peach kernel (Taoren, peeled leaving tips, equal parts).
Grind into powder, make pills with vinegar paste.
Treats pain from Blood Jia, fullness below the umbilicus, or amenorrhea, with fever and body fatigue.
Angelica sinensis (Danggui, 2 liang), Cinnamon twig (Guixin), Peony root (Shaoyao), Dragon's blood (Xuejie), Coptis pollen (Puhuang, stir-fried, each 1.5 liang), Corydalis rhizome (Yanhusuo, stir-fried, 1 liang).
Grind into powder. Take 2 qian each time, mix with hot wine on an empty stomach and swallow.
Ge Shi Formula (treats same conditions as above). Cinnamon twig (Guixin) ground into powder. Take 1 qian each time, mix with wine on an empty stomach and swallow.
*Chan Bao* treats Blood Jia with pain having no fixed location.
Child's urine (Tongbian, 3 sheng), Fresh Rehmannia juice (Sheng Dihuang Zhi), Fresh Lotus rhizome juice (Sheng Ou Zhi) (each 1 sheng), Fresh Ginger juice (Sheng Jiang Zhi, 3 sheng).
First decoct the first three ingredients until reduced by two-thirds. Then add Ginger juice, simmer slowly over low heat until like thin syrup. Take 1 he each time, mix with warm wine and swallow.
*Qian Jin* treats Blood Jia.
Pre-dried Rehmannia root (Xian Gan Dihuang, 1 liang), Cuttlefish bone (Wuzhe Yu Gu, 2 liang).
Grind into fine powder. Take 2 qian each time, mix with warm wine on an empty stomach and swallow.
Sishen San treats postpartum stasis blood not resolving, accumulating into masses, with cutting pain in heart and abdomen.
Ligusticum rhizome (Chuanxiong), Angelica sinensis (Danggui, remove radicles), Dried ginger (Ganjiang, processed), Red Peony root (Chishaoyao) (equal parts).
Grind into fine powder. Take 2 qian each time, take with warm wine long after meals.
Guixin Wan treats postpartum Blood and Qi not dispersing, accumulating into masses, attacking upward to heart and abdomen, or causing alternating chills and fever, emaciation and painful discomfort in four limbs.
Cinnamon twig (Guixin), Angelica sinensis (Danggui), Red Peony root (Chishaoyao), Moutan bark (Mudanpi), Myrrh (Moyao), Areca seed (Binglang) (each 0.5 liang), Green tangerine peel (Qingpi), Processed Dry lacquer (Ganqi, stir-fried until smoke ceases, each 0.75 liang), Rhubarb (Dahuang), Peach kernel (Taoren, remove skin and tips), Burreed rhizome (Sanleng, baked), Corydalis rhizome (Yanhusuo), Softshell turtle shell (Biejia, fried with butter), Magnolia bark (Houpo, processed) (each 1 liang).
Grind into fine powder, mix with refined honey to make pills the size of wutong seeds. Take 30-40 pills each time before meals, send down with warm wine.