立斋治黄恭人，腹内一块，不时作痛，痛则人事不知，良久方苏，诸药不应。诊其脉沉细，则非疮毒。河
间云∶失笑散，（五灵脂、蒲黄等分为末，醋汤调，每服二钱。）治疝气及妇人血气痛欲死并效。与一服，
痛去六七，再服而平。此药治产后心腹绞痛，及儿枕痛尤妙。
钱国宾治陈小山妻，年三十二岁，痞成形，状宛如鲫鱼，长五寸，阔寸许，头尾口牙悉具，渐渐游行穿肠
透膜，上近喉边，下近谷道，饮血咬肝，声呼痛楚，形神野狼狈。其脉强牵，尚有胃气，可治。先以古方五味紫
金锭磨服止痛，次以 刀豆壳一两为君，以此豆能杀痞也。乳香、没药定痛活血，麝香通窍，木香顺气，调以
砂糖作饵。痞受毒药，旬日内伏不动，月余而化，便出如蚬肉一堆。以四物、参、术、枸杞、香附，调理百日全安。
张文潜药戒云∶张子病痞，积于中者，伏而不能下，自外至者，捍而不能纳。从医而问之，曰∶非下之不
可。归而饮其药，既饮而暴下。不终日，而向之伏者，散而无余；向之捍者，柔而又不支。焦膈导达，呼吸开
利，快然若未始疾者。不数日，痞复作，以故药，其快然也亦如初。自是逾月，而痞五作五下，辄下每愈。然
张子之气，一语而三引，体不劳而汗，股不步而栗，肤革无所耗于外，而其中 然，莫知所自来。闻楚之南，
有良医焉，往而问之。医叹曰∶子无叹是 然者也。天下之理，其甚快于余心者，其未必有所伤。求无伤于终
身者，则初无快于吾心。痞横于胸中，其累大矣，击而去之，不须臾而除甚大之累，和平之物，不能为也，必
将击搏震挠而后可。其攻未成，而和平已病，则子之痞，凡一快者，子之和一伤矣。不终日而快者五，则和平
之气，不既索乎？且将去子之痞，而无害其和乎？子归燕居三月，而后予之药，可为也。张子归，三月而后请
之。医曰∶子之气少全矣。取药而授之，三日而疾少平，又三日而少康，终年而复常，且饮药不得亟进。张子
归而行其说，其初使人懑然迟之，盖三投其药，而三反之也。然日不见其所攻，久较则月异而时不同，盖终岁
而疾平。（《容斋五笔》。）
张子和治息城司侯，闻父死于贼，乃大悲，哭之罢，便觉心痛，日增不已，月余成块，状若杯覆而大，痛
不住，药无功。议用燔针炷艾，病患患之，乃求于张。张至，适巫者坐其旁，乃学巫者，杂以狂言以谑疾者。
至是大笑不可忍，回面向壁，一二日，心下结块皆散。张曰∶《内经》言忧则气结，喜则百脉舒。又曰∶喜胜悲。
《内经》亦有此法，治之不知，何用针灸哉？适足增其痛耳。（妙人妙想，触机即应，故古今真能治疾者，
子和一人而已。）
刘子平妻，腹中有块如瓢，十八年矣，经水断绝，诸法无措。张令一月之内，涌四次，下六次，所去痰约
一二桶，其中不化之物，有如葵菜烂鱼肠之状。涌时以木如意 之，觉病稍如刮，渐渐如平。及积之尽，块反
洼如臼，略无少损。至是面有童色，经水既行，若当年少，可以有子。
张主簿妻，病肥气，初如酒杯大，发寒热，十五年余。后因性急悲盛，病益甚，惟心下三指许无病，满腹
如石片，不能坐卧，针灸匝矣，徒劳力耳。张曰∶此肥气也，得之季夏戊己日，在左胁下，如覆杯，久不愈，
令人发 疟。 疟者，寒热也。以瓜蒂散吐之，如鱼腥黄涎，约一二缶。至夜，令用舟车丸、通经散投之，五
更，黄涎浓水相半，五六行，凡有积处皆觉痛。后用白术散、当归散，和血流经之药，如斯涌泄，凡三四次方愈。
山东颜先生，有积二十年，目视物不真，细字不睹，当心如顽石，每发痛不可忍，食减肉消，黑 满面，
腰不能直。因遇张，令涌寒痰一大盆如片粉。夜以舟车丸、通经散，下烂鱼肠葵菜汁七八行。病十去三四，以
热浆粥投之，复去痰一盆。次日又以舟车丸、通经散，前后约一百余行，略无少困。不五六日面红 去，食进
目明，心中空旷，遂失顽石所在。旬日外来谢。
杜弓匠子妇，年三十，有孕已岁半矣，每发痛则召侍媪侍之，以为将产也。一二日复故，凡数次。张诊其
脉涩而小，断之曰∶块病也，非孕也。《脉诀》所谓涩脉如刀刮竹形，主丈夫伤精，女人败血，治法有病当泻
之。先以舟车丸百余粒，后以调胃承气汤加当归、桃仁，用河水煎，乘热投之。三日后，又以舟车丸、桃仁承
气汤，泻出脓血杂然而下。每更衣，以手向下推之揉之则出。后三二日，又用舟车丸，以猪肾散佐之。一二日，
又以舟车丸、通经散，如前数服，病去十九。俟晴明，当未食时，以针泻三阴交穴，不再旬，已消矣。
孙主簿季述之母，久患胸中痞急，不得喘息，按之则脉数且涩，曰∶胸痹也。因与仲景三物小陷胸汤，一
剂知，三剂愈。（《医学纲目》。）
龚子才治吴仰泉坚，年五旬，患腹中积块如盘大，年余渐卧不倒，腹响如雷，嗳气不透，口干，吐白沫，
下气通则少宽，五心烦热，不思饮食，肌瘦如柴，屡治无效。诊之，六脉涩乱数，气口紧盛，知为寒凉克伐之
过，使真气不运，而瘀血不行。与八珍汤加半夏、陈皮、木香、浓朴、莱菔子、大腹皮、海金沙，三剂，小
便下血如鸡肝状。至十二剂，下黑血块盆许。腹中仍有数块，仍以八珍汤加枳实、香附，五剂而痊。
一妇人年近三十，患腹左胁有一大块，坚硬如石，有时痛，肚腹膨胀，经水不调，白带频下，夜热，脉急
数，以千金化铁丸一料，块消即孕，生一女。（此方疑龚杜撰，四物之外，一派破血行气而已。）
李河山患腹左一块，数年不愈，后食柿饼过多，腹胀满闷。诊之，六脉洪数，气口紧盛，以藿香正气丸加
山楂、神曲，二剂而愈。逾月，又因饮食失节，腹胀如初，用前药勿效，与行湿补气养血汤，二十余剂始安。
因嘱曰∶病虽愈，体未复元，务宜谨守，勿犯禁忌。后数月，过龚曰∶凡有病者，皆天与也，不在服药谨守，
若颜子亚圣，岂不能保养，何短命死矣？我今保养半年，未见何如，从可知也。龚不能对，遂复恣纵无忌。未
旬日，忽患痢赤白，里急后重，痛不可忍，日夜无度，乃自置大黄一剂，数下无效。复求诊，六脉洪数，先与
调中益气汤二剂，又以补中益气汤加白芍、黄连微效。彼欲速愈，易医，不审其夙有痞满之病，复下之，不愈。
又易一医，再与下药，遂肛门下脱，痛如刀割。腹胀如鼓。此元气下陷也，当大补升提而反泻之，不亡何待？
（此症湿热内蕴，兼有积滞，因柿饼之寒滞，故为胀满。藿香正气能燥湿行气，故遂愈。然病根未拔，故伤食而
复病。继用汤药，想即藿香正气之类，去湿而不能去热，故不效。行湿补气养血汤，又加以血药益湿之品，
虽迁延而愈，非真愈也。始终治法，均未中肯。若早以黄连理中，枳实理中，更互治之，病必速愈，何至
有变痢之患乎？）
陆养愚治茅鹿门三夫人，经期参前，腹中有块升动，有时作痛作胀，大便不实，脾胃不和，其脉人迎大于
气口二倍。（以此断为血有余。）茅问曰∶此症屡服消导及养血之药，轻则枳实、枳壳、木香、豆仁，重则槟榔、
棱、莪，俱以养血佐之，药颇中和，而病反增剧何也？曰∶据脉左盛于右，气不足而血有余，今所服不惟诛伐无过，
且损不足而益有余，欲其病之不剧得乎？用人参、白术、陈皮、干姜、大枣，以益其气，用消痞丸以去其血之
瘀。其方用香附醋炒四两，元胡索醋炒一两五钱，归尾二两，川芎、红花、桃仁、海石、瓦楞子火 醋淬各一
两。醋打面糊为丸，与煎剂相间服，未半料而块已失，大便结实，经水如期。
李士材治于郡守，在白下时，每酒后腹痛，渐至坚硬，得食辄痛。得食反痛，实症无疑。脉之，浮大而长，
脾有大积矣。然两尺按之软，不可峻攻，令服四君子汤七日，投以自制攻积丸三钱。但微下，更与四钱与服，
下积十余次，皆黑而韧者。察其形不倦，又进四钱，于是腹大痛，而所下甚多。服四君子汤十日，又进丸药四
钱，去积三次。又进二钱，而积下遂至六七碗许。脉大而虚，按至关部豁如矣，乃以补中益气调补，一月全愈。
攻补互施法。
王工部郁结成痞，形坚而痛甚，攻之太多，遂泄泻不止，一昼夜计下二百余次，一月之间，肌体骨立，神
气昏乱，舌不能言，已治木待毙。李诊之曰∶在症虽无活理，在脉犹有生机。以真脏脉不见也，大虚之后，法
当大温大补。一面用枯矾、龙骨、粟壳、樗根之类，以固其肠；一面用人参二两，熟附五钱，以救其气。三日
之间，服参半斤，进附二两，泻遂减半，舌转能言。更以补中益气加生附、生干姜，并五帖为一剂，一日饮尽。
（就进药而论，则胃能纳受可知。）如是者一百日，精旺食进，泻减十九。然每日夜犹下四五行，两足痿
废，用仙茅、巴戟、丁、附等为丸。参附汤并进，计一百四十日而步履如常，痞泻悉愈。（枯矾虽敛而苦寒，
何不用禹粮、石脂？）
姚氏妇久患痞积，两年之间，攻击之剂，无遗用矣，而积未尽除，形体 羸。李曰∶积消其半，不可伐矣，
但用补剂，元气一复，病自祛耳。遂作补丸，服毕而痞果全消。逾三年，调理失宜，胸腹痛甚，医以痛无用补
法，用理气化痰之剂，痛不减。脉之大而无力，此气虚也，投以归脾汤加人参二钱，其痛乃止。
喻嘉言治袁聚东，年二十岁，生痞块，卧床数月，进化坚消痞之药，渐至毛瘁肉脱，面黧发卷，殊无生理。
其块自少腹脐旁，分为三岐，皆硬如石，按之痛不可忍。脉只两尺洪盛，余俱微细。谓初时块必不坚，以峻猛
之药攻，至真气内乱，转获邪气为害，其实全是空气聚成，非如女子月经凝而不行，即成血块之比。观两尺洪
盛，明是肾气传于膀胱，误施攻击，其气不运，结为坚块，故按之则愈痛也。虚症亦有按之而愈痛者，姑用大
补中药一剂，以通中下之气，然后用大剂药内收肾气，外散膀胱之气，约三剂，可全愈矣。先以理中汤加附子
五分，一剂，块减十之三。再用桂、附一大剂，肠中气向甚喧，顷之，三块一时顿没。再服一剂，果全愈。更
用补肾药加桂、附，多用河车为丸以善后，取其以胞补胞，而助膀胱之化源也。（俞东扶曰∶此人攻伐太过，
易以温补，未足为奇。惟两尺洪盛，非此诠解，谁不面墙？至于桂、附、河车，同补肾药为善后计，则与肾
气传膀胱之论，紧切不泛，非通套治痞成法可比。）
冯楚瞻治戚氏妇，腹中有块作痛，发则攻心欲死，上则不进饮食，下则泄泻无度，医药三百余剂不效。脉
之，六部沉细已极，右关尺似有似无，明系火衰土弱，肾家虚气上凌于心，脾土不能按纳奔豚之气，非温补不
可。用炒干熟地八钱，补水以滋土；炒黄白术六钱，补土以固中；炮姜、熟附各二钱，补火以生土；更入五味
子一钱以敛之，俾祖气有归，脏得其藏，而肾气纳而不出也。数剂而安，一月全愈。
按∶冯公此案，前人所未发，字字如良玉精金，后贤宜三复之。
吴孚先治一人患痞，前医用攻药已去六七。适前医他往，吴与汤丸，俱系参、术补剂。病者云∶去疾莫如
尽，奈何留之？吴曰∶正所以尽去其疾也。经曰大积大聚，衰其半而止。此前医之用攻也。又曰∶补正则邪自
除，此余之用补也。若必尽攻，则痞去而鼓胀成，是欲尽去其疾，而反益其疾矣。乃遵服不间而痊。
张路玉曰∶顾晋封室，患痞在胁下，或令用膏药加阿魏一分，麝香半分贴之。五六日间，遂下鲜血，血块
甚多，一二日方止。是后每岁当贴膏时必发。近邻妪亦用阿魏膏贴痞，下血如前。世以阿魏、麝香为痞块必用
之药，外用为患若此，况服食乎！为拈出以为虚弱人漫用攻击之戒。
韩贻丰治昝中翰如颖，病数日，二旬不食矣，已治木。韩视之，病色如灰，声低喉涩，瞳神黯然无光。私
语其子曰∶此甚难治。病者觉之，乃哀恳曰∶我今年六十七矣，即死不为夭，但遇神针而不一用而死，死且不
瞑目。我生平好酒而不好色，幸为我下一针。于是乃勉为用针，令卧床坦腹，拊其脐下有一痞，周遭径七寸，
坚硬如石。乃以梅花针法，重重针之。又针其三脘，又针其百劳、百会，皆二十一针。针毕，令饮醇酒一杯。
乃摇手曰∶恶闻酒气，以两月矣。强之，初攒眉，既而满引如初。
顾鸣仲有腹疾，近三十年，朝宽暮急，每发腹胀，十余日方减。食面及房劳，其应如响。腹左隐隐微高鼓，
呼吸触之， 有声。以痞块法治之，内攻外贴，究莫能疗。喻嘉言议之曰∶人身五积六聚，心肝脾肺肾之邪，
结于腹之上下左右，及当脐之中者，皆高如覆盂者也。胆胃大小肠膀胱命门之邪，各结于其本位，不甚形见者
也。此症乃肾脏之阴气，聚于膀胱之阳经，有似于痞块耳。肾有两窍，左从前通膀胱，右从后通命门，邪结于
腹之左畔，即左肾与膀胱为之主也。六腑惟胆无输泻，其五腑受五脏浊气，不能久留，即为输泻者也。今肾邪
Xu Mingyi Leian (Continued Cases of Famous Physicians) on "Pi Masses" (Group 1):
Xue Lizhai treated Lady Huang, who had a mass in her abdomen that caused intermittent pain. During episodes of pain, she would lose consciousness and only regain it after a long time. Various medications were ineffective. Her pulse was deep and fine, indicating it was not due to sores or toxins. Liu Hejian stated: Shixiao San (Pain-Absent Powder, made from equal parts Trogopterus Dung [Wulingzhi] and Lygodium Spore [Puhuang], taken with vinegar water, two qian per dose) is highly effective for treating hernia qi and severe blood-related pain in women. One dose was administered, reducing the pain by sixty to seventy percent; a second dose resolved the pain completely. This medicine is particularly wonderful for treating postpartum cramping abdominal pain and "child pillow" pain (postpartum uterine lochia retention).
Qian Guobin treated the wife of Chen Xiaoshan, aged thirty-two. She had a formed pi mass resembling a crucian carp, five cun long and about one cun wide, with distinct head, tail, mouth, and teeth. It gradually migrated through the intestines and penetrated the membranes, moving upwards near the throat and downwards near the anus. It consumed blood and bit into the liver, causing loud cries of pain and leaving her spirit and form in a wretched state. Her pulse was strong and taut but still retained Stomach Qi, indicating treatability. First, an ancient formula, Wuwei Zijin Ding (Five-Ingredient Purple Gold Pellet), was ground and taken to relieve pain. Then, Dou Dou Qiao (Shell of Dolichos Lablab) at one liang was used as the sovereign herb, as this bean can kill pi masses. Frankincense (Ruxiang) and Myrrh (Moyao) were added to stabilize pain and invigorate blood; Musk (Shexiang) to unblock orifices; and Costus Root (Muxiang) to regulate Qi. These were mixed with brown sugar to form pills. The pi mass, affected by the toxic drugs, remained dormant within ten days and dissolved after more than a month, being excreted as a pile of flesh resembling clam meat. Subsequently, Siwu Tang (Four-Substance Decoction) combined with Ginseng (Renshen), Atractylodes Macrocephala (Baizhu), Goji Berry (Gouqi), and Cyperus Rotundus (Xiangfu) was used to regulate her constitution for one hundred days, resulting in full recovery.
Zhang Wenqian's "Yao Jie" (Warnings on Medicine) records: Zhang Zi suffered from a pi disease. Accumulations within lay dormant and could not descend; external pathogens invaded but could not be admitted. Consulting a physician, he was told, "It cannot be cured without purgation." Upon returning home and taking the medicine, he experienced sudden, violent diarrhea. Within less than a day, the previously dormant accumulations scattered completely; the previously resistant pathogens became weak and unable to withstand. His chest and diaphragm felt clear, his breathing was smooth, and he felt as if he had never been ill. However, within a few days, the pi disease recurred. Taking the same medicine again produced the same feeling of relief. Over the next month, the disease manifested five times and was purged five times, each purge bringing improvement. Yet, Zhang Zi's vital energy was depleted; a single sentence drew three sighs, his body sweated without exertion, his thighs trembled without walking, his skin showed no external damage, but his interior was hollow, and he did not know the source. Hearing of a skilled physician in southern Chu, he went to consult him. The physician sighed, "Do not sigh over this hollow state. In the world, what brings great pleasure to the heart does not necessarily go unharmed. To seek lifelong harmlessness, one must not initially seek great pleasure. The pi mass obstructing the chest causes great harm. Striking it away removes a huge burden in an instant; peaceful substances cannot achieve this. It requires violent attack and shock. If the attack fails while the peaceful Qi becomes diseased, then every 'pleasure' you experience damages your peaceful Qi. If you experience pleasure five times in a day, has not your peaceful Qi been exhausted? Can you remove your pi mass without harming your harmony? Return home and live in seclusion for three months, then I will give you medicine." Zhang Zi returned, waited three months, and then requested treatment. The physician said, "Your Qi has slightly recovered." He provided the medicine. After three days, the illness subsided slightly; after another three days, it improved further; by year-end, he was fully restored. He was advised not to take medicine hastily. Zhang Zi followed this advice. Initially, it caused frustration and delay; there were three administrations of medicine and three relapses. However, daily observation showed no aggressive attack, yet month by month and season by season, changes occurred. Finally, after a year, the disease was pacified. (From *Rongzhai Wubi*.)
Zhang Hezi treated the Magistrate of Xicheng. Upon hearing his father died at the hands of bandits, he was filled with extreme grief. After crying, he felt heart pain, which increased daily. After more than a month, a mass formed, shaped like an inverted cup, causing constant pain unresponsive to medication. They considered using burning needles and moxibustion, but the patient feared them and sought Zhang Hezi. Upon arrival, Zhang saw a shaman sitting nearby. He imitated the shaman, mixing wild words to mock the patient. The patient laughed uncontrollably, turned his face to the wall, and within one or two days, the knot under the heart dispersed. Zhang Hezi said: *Neijing* states that sorrow causes Qi stagnation, while joy relaxes all vessels. It also says: Joy overcomes sorrow. *Neijing* contains this method. If one does not know how to treat diseases using it, what use are acupuncture and moxibustion? They only serve to increase pain. (A brilliant mind responding instantly to triggers; thus, among ancients and moderns, only Zhang Hezi truly excels in curing diseases.)
The wife of Liu Ziping had a mass in her abdomen like a ladle for eighteen years, with amenorrhea. All methods failed. Zhang Hezi induced vomiting four times and purging six times within one month. The expelled phlegm amounted to about one or two buckets, containing undigested matter resembling rotten okra and fish intestines. During emesis, he tapped her chest with a wooden ruyi; she felt the pathogen scraping off, gradually flattening. Once the accumulation was exhausted, the mass concaved like a mortar, without any damage. Her face regained a youthful color, menstruation resumed, resembling her youth, and she could conceive.
The wife of Magistrate Zhang suffered from Feiqi (Fatty Qi) for over fifteen years. It began the size of a wine cup, accompanied by alternating chills and fever. Later, due to irritability and excessive sadness, the condition worsened. Only the area three fingers below the heart was unaffected; the rest of the abdomen was hard as a stone slab, preventing sitting or lying down. Acupuncture and moxibustion were tried extensively but were futile. Zhang Hezi said: This is Feiqi, acquired on a Wu-Ji day in late summer, located under the left hypochondrium, like an inverted cup. If untreated, it causes malaria (alternating chills and fever). He used Genti San (Melon Peduncle Powder) to induce vomiting, expelling yellow saliva smelling of fish, about one or two jars. At night, he administered Zhouche Wan (Boat Cart Pills) and Tongjing San (Meridian-Unblocking Powder). At dawn, half yellow saliva and half thick fluid were excreted five or six times. Pain was felt wherever accumulation existed. Afterwards, Baizhu San (Atractylodes Macrocephala Powder) and Danggui San (Angelica Sinensis Powder) were used to harmonize blood and flow through meridians. After three or four rounds of emesis and purging, she recovered.
Mr. Yan from Shandong had accumulated pathology for twenty years. Vision was blurred, unable to see small print. The epigastrium felt like a stubborn stone, with unbearable pain upon attacks. Food intake decreased, flesh wasted, black discoloration covered the face, and the waist could not straighten. Meeting Zhang Hezi, he underwent emesis of a large basin of cold phlegm, like sliced powder. At night, Zhouche Wan and Tongjing San were given, resulting in seven or eight stools of liquid resembling rotten fish intestines and okra juice. The illness improved by three-tenths. Hot grain porridge was used to nourish, leading to another basin of phlegm expulsion. The next day, Zhouche Wan and Tongjing San were repeated. In total, over one hundred bowel movements occurred with little fatigue. Within five or six days, facial redness and black discoloration vanished, appetite increased, vision cleared, the heart felt empty, and the "stone" disappeared. He thanked Zhang after ten days.
The daughter-in-law of Du Gongjiang, aged thirty, had been pregnant for a year and a half. Each time pain attacked, she summoned attendants, believing labor was imminent. It would resolve after one or two days, repeating several times. Zhang Hezi diagnosed her pulse as choppy and small, stating: "This is a mass disease, not pregnancy." *Maijue* states: A choppy pulse resembles a knife scraping bamboo, indicating seminal injury in men and ruined blood in women. The treatment principle is to purge when disease exists. First, over one hundred Zhouche Wan pills were given. Then, Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) plus Dang Gui (Angelica Sinensis) and Tao Ren (Peach Kernel) was decocted in river water and taken hot. Three days later, Zhouche Wan and Taoren Chengqi Tang were given, expelling pus and blood mixed together. During defecation, pushing and rubbing downwards helped expulsion. Two or three days later, Zhouche Wan was used again, assisted by Zhushen San (Pig Kidney Powder). One or two days later, Zhouche Wan and Tongjing San were repeated as before. Ninety percent of the disease was removed. When the weather cleared, before meals, the Sanyinjiao acupoint was needled to drain. Within ten days, it had disappeared.
Mother of Sun Zhubu's youngest son suffered from chronic chest pi urgency, inability to breathe, with a rapid and choppy pulse upon palpation. Diagnosis: Xiongbi (Chest Bi/Obstruction). Zhang Zhongjing's Sanwu Xiaoxiongtang (Three-Ingredient Small Heart-Piercing Decoction) was prescribed. One dose brought improvement, three doses cured. (From *Yixue Gangmu*.)
Gong Zicai treated Wu Yangquan Jian, aged fifty. He had an abdominal mass the size of a plate. For over a year, he gradually became bedridden. Abdomen roared like thunder, belching was blocked, mouth dry, spitting white foam. Relief came only when lower Qi moved. Five centers felt hot, no appetite, emaciated as firewood. Previous treatments failed. Pulse: choppy, chaotic, rapid in all six positions; Qi Kou (Lung position) tight and full. Cause identified as excessive cooling and attacking herbs damaging true Qi, preventing movement and causing blood stasis. Eightzhen Tang (Eight-Treasure Decoction) plus Banxia (Pinellia), Chenpi (Tangerine Peel), Muxiang (Costus Root), Houpo (Magnolia Bark), Laifuzi (Radish Seed), Dafupi (Areca Peel), and Haijinsha (Lygodium Spore) was given. After three doses, bloody urine resembling chicken liver appeared. By twelve doses, a basin of black blood clots was passed. Several masses remained. Eightzhen Tang plus Zhishi (Immature Bitter Orange) and Xiangfu (Cyperus) was given for five doses, resulting in cure.
A woman near thirty had a large, rock-hard mass in the left hypochondrium. Intermittent pain, abdominal distension, irregular menstruation, frequent leukorrhea, night fever, urgent and rapid pulse. One course of Qianjin Huatie Wan (Thousand-Gold Iron-Melting Pill) dissolved the mass, leading to pregnancy and birth of a daughter. (This formula is suspected to be fabricated by Gong; aside from Siwu, it consists entirely of blood-breaking and Qi-moving herbs.)
Li Heshan had a mass in the left abdomen for years. After eating too many persimmon cakes, he developed abdominal distension and fullness. Pulse: flooding and rapid in all six positions; Qi Kou tight and full. Huoxiang Zhengqi Wan (Agaricus Rectifying Qi Pill) plus Shanzha (Hawthorn) and Shenqu (Medicated Leaven) was given. Two doses cured. A month later, due to dietary indiscretion, distension returned. Previous medicine failed. Xingshi Buqi Yangxue Tang (Dampness-Removing, Qi-Nourishing, Blood-Supplementing Decoction) was given for over twenty doses until stable. Advice: Although cured, constitution not restored. Strictly observe taboos. Months later, he visited Gong saying: Illness is heaven-sent. Recovery depends not on medicine but on preservation. Even Yan Hui, the Virtuous Sage, could not preserve himself and died young. I preserved myself for half a year, seeing nothing special. Gong could not reply, so he indulged recklessly. Within ten days, he suddenly developed dysentery with red and white discharge, tenesmus, unbearable pain, day and night without limit. He self-administered Rhubarb (Dahuang), but multiple doses failed. Seeking diagnosis again, pulse was flooding and rapid. Tiaozhong Yiqi Tang (Regulate Middle and Boost Qi Decoction) for two doses, then Buzhong Yiqi Tang (Middle-Boosting and Qi-Supplementing Decoction) plus Baishao (White Peony) and Huanglian (Coptis) gave slight effect. Desiring quick cure, he changed doctors. Unaware of his chronic pi-fullness, they purged again, failing. Another doctor purged again, causing rectal prolapse, cutting pain, and drum-like distension. This is sinking of Yuan Qi. It should have been greatly supplemented and lifted, but was purged instead. Death was inevitable. (Note: This case involved internal damp-heat with stagnation, exacerbated by the cold-stagnation of persimmons. Huoxiang Zhengqi dried dampness and moved Qi, hence initial cure. But root cause remained, so food injury caused recurrence. Subsequent decoctions likely resembled Huoxiang Zhengqi, removing dampness but not heat, hence failure. Xingshi Buqi Yangxue Tang added blood tonics that may have increased dampness. Though prolonged recovery occurred, it was not true cure. Treatment missed the key. Early alternating use of Huanglian Lizhong or Zhishi Lizhong would have cured quickly, avoiding dysentery complications.)
Lu Yangyu treated Third Madam of Mao Lumen. Menstruation preceded schedule. Mass rose and moved in abdomen, causing occasional pain and distension. Loose stools, spleen-stomach disharmony. Renying pulse twice larger than Qikou pulse. (Diagnosed as excess blood.) Mao asked: Why did previous treatments with digestion-promoting and blood-nourishing herbs (light: Zhishi, Zhike, Muxiang, Doren; heavy: Binglang, Sanleng, E Zhu, aided by blood tonics) make the condition worse? Lu replied: Left pulse stronger than right indicates insufficient Qi and excess blood. Current medicines not only punish the innocent but damage insufficiency and augment excess. How can the disease not worsen? Renshen (Ginseng), Baizhu (Atractylodes), Chenpi (Tangerine Peel), Ganjiang (Dried Ginger), and Dazao (Jujube) were used to boost Qi. Xiaopi Wan (Pi-Dissolving Pill) was used to remove blood stasis. Formula: Vinegar-fried Xiangfu (Cyperus) four liang, Vinegar-fried Yuanhusuo (Corydalis) one liang five qian, Guiwei (Angelica Tail) two liang, Chuanxiong (Sichuan Lovage), Honghua (Safflower), Taoren (Peach Kernel), Haishi (Fossil Shell), and Lewangzi (Arca Shell) calcined and vinegar-quenched, one liang each. Dough paste made with vinegar formed pills, alternated with decoctions. Before half a dose was finished, the mass disappeared, stools solidified, and menstruation returned on schedule.
Li Shicai treated Prefect Yu. While in Baixia, he suffered abdominal pain after drinking, gradually becoming hard. Eating aggravated pain. Clearly an excess syndrome. Pulse: floating, large, and long. Large accumulation in Spleen. However, both Chi (Kidney) positions were soft upon pressure; harsh purging was contraindicated. Four Junzi Tang (Four Gentlemen Decoction) was given for seven days, followed by three qian of homemade Gongji Wan (Accumulation-Attacking Pills). Mild purging occurred. Another four qian given, resulting in over ten evacuations of black, tough material. Observing he was not fatigued, another four qian were given, causing severe abdominal pain and massive evacuation. Ten days of Four Junzi Tang, then another four qian of pills, removing accumulation three times. Another two qian led to six or seven bowls of accumulation expelled. Pulse became large and deficient; Guan position felt empty. Buzhong Yiqi Tang (Middle-Boosting and Qi-Supplementing Decoction) was used to regulate and tonify. Full recovery in one month. Method of alternating attack and tonification.
Minister Wang developed pi from depression. Mass was hard and painful. Excessive attacking led to continuous diarrhea, over two hundred times a day. Within a month, muscles wasted to bone, spirit confused, tongue unable to speak. Treated as dead wood awaiting death. Li diagnosed: No hope in symptoms, but pulse shows vitality because True Organ pulses are absent. After severe deficiency, major warming and tonification is indicated. On one hand, Kubai (Alum), Longgu (Dragon Bone), Susuke (Poppy Shell), and Chugen (Bark of Chinese Toona) were used to secure the intestines. On the other hand, Renshen (Ginseng) two liang and Shufu (Prepared Aconite) five qian were used to save Qi. Within three days, half a jin of Ginseng and two liang of Aconite were taken. Diarrhea halved, tongue could speak. Buzhong Yiqi Tang plus raw Fuzi (Aconite) and raw Ganjiang (Dried Ginger) was prepared, five doses combined into one, consumed in one day. (Regarding administration, stomach acceptance is evident.) For one hundred days, essence flourished, appetite increased, diarrhea reduced by ninety percent. Still four or five stools day and night. Legs flaccid. Xianmao (Curculigo), Bajitian (Morinda), Dingxiang (Clove), and Fuzi formed pills. Shenfu Tang (Ginseng and Aconite Decoction) administered concurrently. After one hundred and forty days, walking normal, pi and diarrhea cured. (Note: Alum is astringent but bitter-cold. Why not Yuliangshi (Kaolin) or Shizhi (Hematite)?)
Madam Yao suffered from chronic pi accumulation for two years. Attacking agents were exhausted, yet accumulation not fully removed, body emaciated. Li said: Accumulation reduced by half, do not attack further. Use only tonics. Once Yuan Qi recovers, disease will dispel itself. Tonifying pills were made. Upon finishing, pi completely disappeared. Three years later, improper regulation caused severe chest and abdominal pain. Physician rejected tonification for pain, using Qi-regulating and phlegm-resolving agents. Pain persisted. Pulse large and powerless, indicating Qi deficiency. Guipi Tang (Restore the Spleen Decoction) plus two qian Renshen stopped the pain.
Yu Jiayan treated Yuan Judong, aged twenty. Pi mass formed, bedridden for months. Hardening and dissolving medicines progressed to hair loss, muscle wasting, dark face, curled hair, no sign of life. Mass divided into three branches from lower abdomen beside navel, hard as stone, unbearable pain on pressure. Pulse: only Chi positions flooding and full, others micro and fine. Yu stated: Initially, the mass was not hard. Harsh medicines attacked, causing internal disorder of true Qi, allowing pathogenic Qi to harm. It is actually air accumulation, unlike women's menstrual blood stasis forming clots. Flooding Chi positions indicate Kidney Qi transmitting to Bladder. Misapplied attack prevented Qi movement, knotting into hard mass, hence pain on pressure. Deficiency syndromes also hurt on pressure. Tentatively, one dose of major middle-tonifying medicine to open middle and lower Qi. Then, large dose to gather Kidney Qi internally and disperse Bladder Qi externally. About three doses for full cure. First, Lizhong Tang (Middle-Warming Decoction) plus five fen Fuzi. One dose reduced mass by three-tenths. Then, a large dose of Guizhi (Cinnamon Twig) and Fuzi. Intestinal Qi became noisy. Soon, three masses disappeared simultaneously. One more dose confirmed full cure. Follow-up with Kidney-tonifying medicine plus Guizhi and Fuzi, using Heche (Placenta) in pills to benefit the uterus and assist Bladder transformation source. (Yu Dongfu comments: This patient was over-attacked; switching to warm tonification is not surprising. Only the explanation of flooding Chi positions is unique. Guizhi, Fuzi, and Heche with Kidney tonics for follow-up closely align with the theory of Kidney Qi transmitting to Bladder, not a generic pi treatment.)
Feng Chuzhan treated Madam Qi. Abdominal mass causing pain. Attacks struck heart, nearly fatal. Upper: no food intake. Lower: profuse diarrhea. Over three hundred doses of medicine failed. Pulse: Six positions extremely deep and fine. Right Guan and Chi positions faint. Clearly Fire decline and Earth weakness. Kidney deficient Qi rushed up to harass Heart. Spleen Earth could not anchor Ben Tun (Running Piglet) Qi. Warm tonification required. Chao Shudi (Stir-fried Rehmannia) eight qian to tonify Water to nourish Earth. Chao Baizhu (Stir-fried Atractylodes) six qian to tonify Earth to secure Middle. Paojiang (Roasted Ginger) and Shufu (Prepared Aconite) two qian each to tonify Fire to generate Earth. Plus Wuweizi (Schisandra) one qian to astringe, giving Ancestral Qi a return, organs their storage, and Kidney Qi contained. Several doses brought peace, full recovery in one month.
Commentary: Master Feng's case is unprecedented. Every word is like fine jade and gold. Later scholars should reflect deeply.
Wu Fuxian treated a man with pi. Previous doctor used attacking medicine, removing six or seven parts. While previous doctor was away, Wu prescribed decoctions and pills consisting of Renshen and Baizhu tonics. Patient asked: Removing disease should be complete. Why leave it? Wu said: This is precisely how to remove it completely. Classic states: For large accumulations, stop when half is reduced. This is what the previous doctor did regarding attack. Also states: Supplementing righteousness causes evil to self-remove. This is my use of tonification. If insisted on complete attack, pi would go but鼓胀 (drum distension) would form. Wanting to remove disease completely反而 increases disease. Patient followed continuously and recovered.
Zhang Luyu said: Gu Jinfeng's wife had pi under hypochondrium. Some advised applying plaster with one fen Asarum (Awei) and half fen Musk (Shexiang). Within five or six days, bright blood and many blood clots were passed, stopping after one or two days. Since then, every year when plaster application was due, bleeding occurred. Neighbor old woman also used Asarum plaster for pi, passing blood similarly. World considers Asarum and Musk essential for pi masses. External harm is如此, let alone ingestion! Pointed out as a warning against weak people casually using attacking medicines.
Han Yifeng treated Zan Ru Ying. Ill for several days, not eating for twenty days, treated as dead wood. Han observed: Complexion ash-gray, voice low, throat dry, pupils dull without light. Whispered to son: Very difficult to treat. Patient heard, pleaded: I am sixty-seven. Dying is not untimely. But if I meet divine needle and die without using it, I will not close my eyes in death. I love wine, not lust. Please give me one needle. Han reluctantly used needle. Ordered patient lie supine, expose abdomen. Palpated pi below navel, seven cun diameter, hard as stone. Used Plum Blossom Needle method, needling heavily. Needled Sanwan (Three Transports), Bailao, Baihui, totaling twenty-one needles. After needling, ordered drink a cup of pure wine. Patient waved hand: Hate smell of wine, haven't smelled it in two months. Forced to drink, frowned initially, then drank fully as before.
Gu Mingzhong had abdominal disease for nearly thirty years. Morning宽松, evening urgent. Each attack caused distension, reducing after ten-plus days. Eating noodles and sexual exhaustion triggered immediate response. Left abdomen slightly high and鼓, sound upon breathing touch. Treated as pi mass, internal attack and external plaster, ultimately incurable. Yu Jiayan discussed: Human body Five Accumulations and Six Gatherings. Pathogens of Heart, Liver, Spleen, Lung, Kidney knotting above/below/left/right of abdomen and center of navel, all rise like inverted bowl. Pathogens of Gallbladder, Stomach, Small/Large Intestine, Bladder, Mingmen knotting in their original positions, not very visible. This case is Kidney Yin Qi gathering in Bladder Yang meridian, resembling pi mass. Kidney has two orifices: Left connects forward to Bladder, Right connects backward to Mingmen. Pathogen knots on left side of abdomen, dominated by Left Kidney and Bladder. Among Six Fu organs, only Gallbladder has no output/drainage. Its five Fu organs receive turbid Qi from Five Zang, cannot stay long, thus drain. Now Kidney pathogen...