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Blood Accumulation Syndrome is caused by pathogenic factors from the transmission of cold damage (Shanghan) or epidemic warm diseases (Wenyi), entering the Blood Chamber (referring to areas closely related to blood circulation such as the Liver and Chong Mai). This attracts the blood of the entire body, causing it to accumulate in the Bao Zhong (here referring generally to the Lower Jiao Sea of Blood), resulting in distension and pain in the lower abdomen. The patient may experience chills or fever; consciousness is clear during the day but delirious at night. In severe cases, madness occurs, with shouting, beating, and scolding. As stated in the *Neijing*: "Blood accumulating above leads to forgetfulness; blood accumulating below resembles madness." This refers to this condition. When bitten by a mad dog, toxic pathogens gather in the Bao Zhong, also leading to madness. All these belong to Blood Accumulation Syndrome. Zhang Zhongjing treats this with Didang Tang (Eaglewing Decoction), and Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) can also be used. If the physician's courage and discernment are insufficient, Gexia Zhuyu Tang (Decoction for Expelling Stasis Below the Diaphragm) can be used, with added Dahuang (Rhubarb Root and Rhizome). If the blood has not yet coagulated into masses, but only heat has entered the Blood Chamber causing nighttime delirium, Xiaochaihu Tang (Minor Bupleurum Decoction) with added Taoren (Peach Seed) and Danpi (Moutan Bark) should be used.

(Attached: Blood Swelling)
The symptoms of Xuegu (Blood Drum, a syndrome characterized by abdominal distension like a drum and purplish skin discoloration) include: fullness and distension in the hypochondrium and lower abdomen, thread-like red streaks on the body, irritability, a desire to rinse the mouth without swallowing water, dark red urine, black stools, and visible blue veins on the abdominal surface. Medical texts claim this is a disease exclusive to women, but Yu Jiayan argued that men also frequently suffer from it. The complexion is sallow, with crab-claw-like patterns on the skin. Although the pulse is extremely deficient, walking ability remains normal. The patient is prone to anger and forgetfulness, suffers from dry mouth and constipation, and experiences hypochondriac distension and abdominal pain. Once the distension is fully formed, the abdomen becomes as large as a winnowing basket, making it incurable. This disease is most common in the southeast. The reason is that the East China Sea abounds in fish and salt. Fish are sweet and delicious; excessive consumption causes heat to accumulate in the middle. Salt is salty and bitter; its nature tends to disperse into the blood. Blood belongs to Yin. Initially combining with heat, no illness is felt. Over time, the harmonious Qi of the Middle Jiao gradually transforms into heat. Heat causes Qi to coagulate, and blood flow stagnates. Thus, Qi resides within the blood, and blood wraps around the Qi externally, resembling pregnancy. By the time of delivery, the abdomen is as large as a jar. Extending this logic, any rich and fatty foods, or pungent herbs like pepper, ginger, and cinnamon consumed in various regions that cause heat accumulation in the middle, fall into this category. The treatment method involves using Liujunzi Tang (Six Gentlemen Decoction) with added Ganjiang (Dried Ginger), Chuanxiong (Sichuan Lovage Rhizome), and Fangji (Stephania Root) ground into powder. These are made into pills using decoctions of aged rice and lotus leaves, taken with plain boiled water. This employs the method of controlling the Central Jiao (Spleen/Stomach) to regulate the four peripheries.

Respectfully noted: Yu's discussion on the origin of Blood Drum is the most detailed and accurate. However, his prescribed formula does not align with the theory that "heat causes Qi to coagulate and blood to stagnate." Liujunzi Tang and its added herbs are more suitable for treating Phlegm Drum, especially when combined with cold fluids. As mentioned in the text, one should use clearing and harmonizing Qi-regulating agents. For attacking methods, Daididang Wan (Great Eaglewing Pill) should be the main prescription. For harmonizing methods, Danzhi Xiaoyao San (Moutan and Gardenia Free and Easy Wanderer Powder) with added Jianghuang (Turmeric Rhizome) and Xiangfu (Cyperus Rhizome) should be used. Various books recommend Taonusan (Peach Bud Powder) or Huposan (Amber Powder). However, both formulas use warming herbs, treating stasis due to cold coagulation, which differs from Yu's discussion. Physicians should examine the syndrome and choose appropriately.

There are also Shijia (Stone Mass) and Changtan (Intestinal Polyp/Tumor), which resemble pregnancy with progressively enlarging abdomens. If menstruation occurs on time, it is Changtan, caused by cold pathogens lodging outside the intestines, affecting Qi but not Blood. Juhe Wan (Tangerine Seed Pill) is indicated. If menstruation is irregular, it is Shijia, caused by cold pathogens lodging in the Zimen (uterine opening), blocking it so that evil blood cannot discharge and accumulates, forming Shijia. This affects both Qi and Blood. Huposan and Taonusan are indicated, followed by Wenjing Tang (Warm the Menses Decoction).

Abdominal distension alone is Blood Drum. If all four limbs swell, or swelling starts in the limbs with red discoloration, it is called Blood Swelling. There are cases without redness because blood transforms into water, thus appearing non-red. Some cases arise after hematemesis or epistaxis, where blood stasis transforms into water causing edema. Others result from amenorrhea in women, where blood transforms into water causing edema. Once transformed into water, water-draining treatments must be combined. Wupi Yin (Five-Bark Decoction) with added Danggui (Angelica Sinensis), Baishao (White Peony Root), Puhuang (Pollen Typhae), Danpi, and Taoren is indicated. Alternatively, Ganqi (Drynaria Rhizome) and Xionghuang (Realgar) made into pills with vinegar, taken with malt decoction, is also acceptable.

Furthermore, all drum-like distensions and edemas must be distinguished between Yin and Yang syndromes. Yin syndromes present with deep, choppy, wiry, or tight pulses and symptoms of cold-phlegm. Zhongman Fenxiao Tang (Middle Fullness Resolving Decoction) with added Taoren is indicated. Yang syndromes present with rapid pulses, thirst, scanty urine, and qi rebellion. Xiaochaihu Tang with added Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum), Fangji, Danpi, Taoren, Zhuling (Polyporus), Fuling (Poria), and Cheqianzi (Plantago Seed) is indicated. See Volume 6, Chapter on Distension and Edema for details.