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Xue Xinpu stated: In women, *jia pi* (abdominal masses) are generally caused by improper diet, daily routine, and emotional imbalance, leading to the depletion of Zang-Fu organs, disharmony of Qi and Blood, injury to Yin collaterals, and loss of normal circulation.

Luo Qianfu said: Nourishing the righteous Qi causes accumulation to eliminate itself. One must first regulate and nourish, ensuring that Ying and Wei (nutritive and defensive Qi) are sufficient. Only if the accumulation does not dissipate should one consider purgative methods. However, removing it cannot be done abruptly (purgatives should not be used lightly; the character "gradually" is extremely profound), otherwise, there will inevitably be catastrophic harm. If one does not observe dietary and lifestyle taboos and indulges in desires, few will survive.

A woman suffered from internal heat and thirst, poor appetite, and an abdominal mass that initially resembled an egg and gradually enlarged to about four cun (is this a symptom of stagnation rather than a pulse indicating stagnation?). Her menstruation occurred once every three months, her limbs were emaciated, her teeth and cheeks appeared ulcerated, and her pulse was surging, rapid, and deficient, especially at the left Guan position. This was a syndrome of Liver and Spleen stagnation. External application of Awei Plaster was used. In the morning, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was administered; in the afternoon, Jiawei Guipi Tang (Modified Restore the Spleen Decoction). After about two months, Liver fire subsided slightly, and Spleen Earth function improved somewhat. In the morning, Liuwei Wan (Six-Ingredient Pill with Rehmannia) was added to Buzhong Yiqi Tang; in the afternoon, Xiaoyao San (Free and Easy Wanderer Powder) was taken with Guipi Wan. For another month or so, Lu Hui Wan (Aloe Pill) was taken twice daily (used for Gallbladder-Liver knots); taken on an empty stomach with Xiaoyao San in the morning, and with Guipi Tang in the late afternoon. Fortunately, she was diligent in her treatment, and after more than a year of regulation, she recovered.

Another woman had a lump in her abdomen that occasionally surged upward, sometimes causing pain with audible sounds, acid regurgitation, chest fullness, irregular menstruation, and difficult urination, persisting for over two years. Her complexion was greenish-yellow. I diagnosed it as Liver and Spleen Qi stagnation. I prescribed Liujun Zi Tang (Six-Gentlemen Decoction) with minor amounts of Chuanxiong, Danggui, Chaihu, fried Huanglian, Muxiang, and Wuzhuyu for two doses. Then, Lu Hui Wan was taken with Guipi Tang. After more than three months, the Liver and Spleen harmonized, and all symptoms receded. Subsequently, Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction) with Fuling and Mudanpi was given. As the Middle Qi strengthened, menstruation regulated itself.

A woman with a depressive and irritable temperament, diligent in needlework, had a knot in her lower abdomen causing pain or fullness, and irregular menstruation. She strictly took herbs to subdue the Liver, resulting in internal heat, alternating chills and fever, chest diaphragm discomfort, loss of taste, progressive emaciation, and gum erosion. This indicated that Spleen Earth could not generate Lung Metal, Lung Metal could not generate Kidney Water, and Kidney Water could not nourish Liver Wood. The source of transformation should be nourished using Buzhong Yiqi Tang and Liuwei Wan. She recovered by mid-spring.

A woman had delayed menstruation, fever, and fatigue. Someone used Siwu Tang (Four-Substance Decoction) and Huanglian, which resulted in menstruation occurring only once every two months, scanty flow, and clots. Harsh purgatives were then used to unblock the menses, leading to vision obscured as if by white silk. I said: The Spleen is the head of all Yin, and the eyes are the congregation of blood vessels. This indicates Spleen injury, causing all five Zang organs to lose their proper function and fail to nourish the eyes. Therefore, Buzhong Yiqi Tang and Jisheng Guipi Tang (Sustaining Life Restore the Spleen Decoction) were used, focusing specifically on the Spleen and Stomach. She recovered after more than a year.

He Gongren, the wife of the Prefect of Songjiang, was prone to anger. She had an abdominal knot for over a year, with upper body erosion and penetration, and extreme deficiency of Qi and Blood. It was deep winter. Her Liver pulse was surging, rapid, and wiry-tight upon pressure. Some suggested herbs to subdue Liver Wood and clear Stomach Fire. I said: This is deficiency of True Qi and excess of Pathogenic Qi. Subduing Liver Wood might prevent the generation of life force in spring. Bazhen Tang (Eight-Treasure Decoction) was used to generate Qi and Blood, and Dihuang Wan (Rehmannia Pill) to nourish Kidney Water (Observing these cases, they were cured primarily through regulating Liver, Spleen, and Kidney; this approach suits Liza [Xue Ji], but may not suit other physicians). The Liver pulse suddenly subsided. Due to severe anger, bleeding occurred from the ear, and the Liver pulse remained large, accompanied by irritability, heat, and thirst. This was rootless fire. The previous prescription with Rougui (Cinnamon Bark) was continued for two doses. The pulse constricted, and heat receded. However, due to further anger, she unfortunately died on the Xin-Si day of late winter, due to Metal overcoming Wood.

Li stated: Those skilled in treating *jia* masses regulate Qi to break Blood, digest Food to resolve Phlegm, and stop treatment when the pathogen has diminished by more than half. One must not attack fiercely or use harsh methods to avoid damaging Yuan Qi (this is a supreme principle). It is better to support the righteous Qi of the Spleen and Stomach and wait for self-resolution; this is the origin of the name "Kaiyu Zhengyuan San" (Open Stagnation and Rectify Origin Powder). After recovery, Daxiao Wuji Wan (Large and Small Black Chicken Pills), Bazhen Tang, Jiajiao San (Intersecting Additions Powder), and Jiajiao Dihuang Wan should be used for regulation. All attacking drugs burden the disease in severe cases, but in mild cases, they injure the Stomach Qi. Some say to wait until the mass completely disappears before tonifying; however, the remaining Stomach Qi would be negligible.