天津于氏妇，年过三旬，于产后得四肢抽掣病。
病因 产时所下恶露甚少，至两日又分毫恶露不见，迟半日遂发抽掣。
证候 心中发热，有时觉气血上涌，即昏然身驱后挺，四肢抽掣。其腹中有时作疼，令人揉之则
少瘥，其脉左部沉弦，右部沉涩，一息四至强。
诊断 此乃肝气胆火，挟败血上冲以瘀塞经络，而其气火相并上冲不已，兼能妨碍神经，是以昏
然后挺而四肢作抽掣也。当降其败血，使之还为恶露泻出，其病自愈。
处方 怀牛膝（一两） 生杭芍（六钱） 丹参（五钱） 玄参（五钱）
苏木（三钱） 桃仁（三钱去皮） 红花（二钱） 土鳖虫（五大个捣） 红娘虫（即樗鸡，六大个捣）
共煎汤一盅，温服。
效果 此药煎服两剂，败血尽下，病若失。
邑城西韩氏妇，年三十六岁，得产后 瘕证。
病因 生产时恶露所下甚少，未尝介意，迟至半年遂成 瘕。
证候 初因恶露下少，弥月之后渐觉少腹胀满。因系农家，时当麦秋忙甚，未暇延医服药。又
迟月余则胀而且疼，始服便方数次皆无效。后则疼处按之觉硬，始延医服药，延医月余，其疼似减轻
而硬处转见增大，月信自产后未见。诊其脉左部沉弦，右部沉涩，一息近五至。
诊断 按生理正则，产后两月，月信当见；有孩吃乳，至四月亦当见矣。今则已半载月信未见，因其
产后未下之恶露，结 瘕于冲任之间，后生之血遂不能下为月信，而尽附益于其上，俾其日有增长，是
以积久而其硬处益大也。是当以消 瘕之药消之，又当与补益之药并用，使之消 瘕而不至有伤气化。
处方 生箭 （五钱） 天花粉（五钱） 生怀山药（五钱） 三棱（三钱）
莪术（三钱） 当归（三钱） 白术（二钱） 知母（二钱）
生鸡内金（二钱黄色的捣） 桃仁（二钱去皮）
共煎汤一大盅，温服。
复诊 将药连服六剂，腹已不疼，其硬处未消，按之觉软，且从前食量减少，至斯已复其旧。
其脉亦较前舒畅，遂即原方为之加减俾再服之。
处方 生箭 （五钱） 天花粉（五钱） 生怀山药（四钱） 三棱（三钱）
莪术（三钱） 怀牛膝（三钱） 野党参（三钱） 知母（三钱）
生鸡内金（二钱黄色的捣） 生水蛭（二钱捣碎）
共煎汤一大盅，温服。
效果 将药连服十五六剂（随时略有加减），忽下紫黑血块若干，病遂全愈。
帮助 妇女 瘕治愈者甚少，非其病之果难治也。《金匮》下瘀血汤，原可为治妇女 瘕之主方。
特其药性猛烈，原非长服之方。于 瘕初结未坚硬者，服此药两三次或可将病消除。若至累月累年，
瘕结如铁石，必须久服，方能奏效者，下瘀血汤原不能用。乃医者亦知下瘀血汤不可治坚结之 瘕，
遂改用桃仁，红花、丹参、赤芍诸平和之品；见其 瘕处作疼，或更加香附、延胡、青皮、木香诸
理气之品，如此等药用之以治坚结之 瘕，可决其虽服至百剂，亦不能奏效。然仗之奏效则不足，
伤人气化则有余。若视为平和而连次服之，十余剂外人身之气化即暗耗矣。此所以治 瘕者十中难
愈二三也。若拙拟之方其三棱、莪术、水蛭，皆为消 瘕专药。即鸡内金人皆用以消食，而以消
瘕亦甚有力。更佐以参、 、术诸补益之品，则消 瘕诸药不虑其因猛烈而伤人。且又用花粉、知
母以调剂补药之热，牛膝引药下行以直达病所，是以其方可久服无弊。而坚结之 瘕即可徐徐消除
也。至于水蛭必生用者，理冲丸后论之最详。且其性并不猛烈过甚，治此证者，宜放胆用之以挽救人命。
天津于姓妇女，年龄超过三十岁，在产后患上了四肢抽搐痉挛的病。
病因 分娩时排出的恶露很少，到了两天后连一丝恶露都看不见了，过了半天便发作了抽搐痉挛。
证候 心中发热，有时感觉气血向上冲涌，随即神志昏迷、身体向后挺僵，四肢发生抽搐痉挛。她的腹部有时疼痛，让人揉按后会稍微缓解；其脉象左部沉弦，右部沉涩，每呼吸一次脉搏跳动四次且有力。
诊断 这是肝气与胆火，挟带败血（产后残留的瘀血）上冲，导致经络瘀塞；而且气火相并持续上冲，兼能妨碍神经功能，所以出现昏迷、身体后挺以及四肢抽搐痉挛的症状。应当降低并排出败血，使其重新变为恶露泻出，疾病自然痊愈。
处方 怀牛膝（一两） 生杭芍（六钱） 丹参（五钱） 玄参（五钱）
苏木（三钱） 桃仁（三钱，去皮） 红花（二钱） 土鳖虫（五个大的，捣碎） 红娘虫（即樗鸡，六个大的，捣碎）
共煎煮成一盅汤剂，温服。
效果 此药煎服两剂后，败血全部排出，病如消失一般痊愈。
邑城西韩姓妇女，三十六岁，得了产后的瘕证（腹内结块）。
病因 生产时恶露排出很少，当时并未在意，拖延到半年便形成了瘕块。
证候 起初因为恶露排出少，满月之后逐渐觉得小腹胀满。因为是农家妇女，正值麦收农忙时节，无暇延医服药。又拖延了一个多月，则胀而且痛，才开始服用偏方数次但都没有效果。后来疼痛部位按压感觉坚硬，才请医生服药，看医生一个多月，疼痛似乎减轻了，但硬块反而增大，月经从产后至今未见。诊察其脉象左部沉弦，右部沉涩，每呼吸一次脉搏跳动接近五次。
诊断 按照生理常规，产后两个月，月经应当来潮；如果有孩子吃奶，到四个月也应当来潮了。如今已经半年月经未见，是因为产后未排下的恶露，凝结成瘕于冲任二脉之间，新产生的血液就不能下行成为月经，而全都依附增益于瘕块之上，使得它日益增长，因此积久之后硬块更加增大。这应当用消除瘕块的药物治疗，同时配合补益药物一起使用，使之消除瘕块而不致损伤气化功能。
处方 生黄芪（五钱） 天花粉（五钱） 生怀山药（五钱） 三棱（三钱）
莪术（三钱） 当归（三钱） 白术（二钱） 知母（二钱）
生鸡内金（二钱，黄色的，捣碎） 桃仁（二钱，去皮）
共煎煮成一大盅汤剂，温服。
复诊 将药连续服用六剂，腹部已不疼痛，硬块尚未消除，但按压感觉变软，而且从前食量减少的情况，至此已恢复旧观。
脉象也比之前舒畅，于是就在原方基础上进行加减，让其继续服用。
处方 生黄芪（五钱） 天花粉（五钱） 生怀山药（四钱） 三棱（三钱）
莪术（三钱） 怀牛膝（三钱） 野党参（三钱） 知母（三钱）
生鸡内金（二钱，黄色的，捣碎） 生水蛭（二钱，捣碎）
共煎煮成一大盅汤剂，温服。
效果 将药连续服用十五六剂（随时略有加减），忽然排出若干紫黑色血块，疾病完全痊愈。
帮助说明 妇女瘕证治愈者很少，并非这个病确实难治。《金匮要略》中的下瘀血汤，原本可以作为治疗妇女瘕证的主方。
只是它的药性猛烈，原本不是可以长期服用的方子。对于瘕证初结、尚未坚硬的情况，服用此药两三次或许可以将病消除。如果到了累月累年，
瘕结像铁石一样坚硬，必须长期服用才能见效的情况，下瘀血汤原本就不能使用。然而医生也知道下瘀血汤不能治疗坚结的瘕，
于是改用桃仁、红花、丹参、赤芍等平和的药物；见到瘕处疼痛，或者再加上香附、延胡索、青皮、木香等
调理气机的药物，像这样用药去治疗坚结的瘕，可以断定即使服用到一百剂，也不能见效。然而依靠这些药奏效是不足的，
损伤人气化却是有余的。如果把它们视为平和之药而连续服用，十余剂之外人身的气化就会暗中耗损。这就是为什么治疗瘕证的人中十人难得治愈二三人的原因。至于我拟定的方子，其中三棱、莪术、水蛭，都是专门消除瘕块的药物。就连鸡内金人们都用来消食，但以消除
瘕块也非常有力。再辅以人参、黄芪、白术等补益药物，那么消除瘕块的诸药就不必担心因药性猛烈而伤人。并且又用花粉、知母来调剂补药的燥热，牛膝引药下行以直达病所，所以这个方子可以久服而无弊端。而坚结的瘕块就可以慢慢消除了。至于水蛭必须生用，道理在《理冲丸》后的论述中最详细。而且它的药性并不猛烈过分，治疗这种病症的人，应该大胆使用它以挽救人命。
Tianjin, a woman surnamed Yu, aged over thirty, developed convulsions and spasms of the four limbs after childbirth.
Etiology: The lochia discharged during delivery was scanty. By the second day, not a trace of lochia could be seen. Half a day later, convulsions and spasms ensued.
Symptoms: There was heat in the heart region, accompanied by occasional sensations of Qi and Blood rushing upward. This would lead to sudden unconsciousness, opisthotonos (backward arching of the body), and convulsions of the four limbs. Her abdomen sometimes hurt; rubbing it provided slight relief. Her pulse was deep and wiry on the left side, deep and choppy on the right side, with four beats per breath and strong force.
Diagnosis: This condition is caused by Liver Qi and Gallbladder Fire carrying retained blood (lochiostasis) upward, causing obstruction in the meridians. The continuous upward rush of Qi and Fire also interferes with nerve function, resulting in unconsciousness, opisthotonos, and limb convulsions. Treatment should focus on descending and expelling the retained blood, allowing it to discharge as lochia, which will lead to spontaneous recovery.
Prescription: Huai Niuxi (Radix Achyranthis Bidentatae, 1 liang), Sheng Hangshao (Radix Paeoniae Albae, 6 qian), Danshen (Radix Salviae Miltiorrhizae, 5 qian), Xuanshen (Radix Scrophulariae, 5 qian), Sumu (Lignum Sappan, 3 qian), Taoren (Semen Persicae, 3 qian, peeled), Honghua (Flos Carthami, 2 qian), Tubiechong (Asio, five large specimens, crushed), Hongniangchong (i.e., Chuji, six large specimens, crushed). Decoct together in one cup of water, take warm.
Outcome: After taking two doses, the retained blood was completely discharged, and the illness vanished as if it had never existed.
In the west of the county, a woman surnamed Han, aged thirty-six, suffered from postpartum Zha syndrome (abdominal masses).
Etiology: Lochia discharge was scanty during delivery. She paid no attention to it. Six months later, a Zha mass formed.
Symptoms: Initially, due to scanty lochia, she gradually felt distension in the lower abdomen after one month. Being a farmer's wife, she was busy with the wheat harvest and had no time to consult a doctor or take medicine. A month later, distension turned into pain. She tried several folk prescriptions without effect. Later, the painful area felt hard upon pressure, prompting her to seek medical treatment. After a month of treatment, the pain seemed reduced, but the hard mass enlarged. Menstruation had not returned since childbirth. Her pulse was deep and wiry on the left, deep and choppy on the right, with nearly five beats per breath.
Diagnosis: According to physiological norms, menstruation should return two months postpartum, or four months if breastfeeding. Since it has been half a year without menstruation, the undischarged postpartum lochia has condensed into a Zha mass between the Chong and Ren vessels. Consequently, newly generated blood cannot descend to become menstruation but instead attaches to and nourishes the Zha mass, causing it to grow daily. Thus, the longer it persists, the harder the mass becomes. Treatment requires herbs that dissolve Zha masses, combined with tonifying herbs to prevent damage to Qi transformation while resolving the mass.
Prescription: Sheng Huangqi (Radix Astragali Membranacei, 5 qian), Tianhuafen (Radix Trichosanthis, 5 qian), Sheng Huaishanyao (Rhizoma Dioscoreae Hypoglaucae, 5 qian), Sanleng (Rhizoma Sparganii, 3 qian), Ezhu (Rhizoma Curcumae, 3 qian), Danggui (Radix Angelicae Sinensis, 3 qian), Baizhu (Rhizoma Atractylodis Macrocephalae, 2 qian), Zhimu (Cortex Phellodendri, 2 qian), Sheng Jineijin (Endothelium Corneum Gigeriae Galli, 2 qian, yellow variety, crushed), Taoren (Semen Persicae, 2 qian, peeled). Decoct together in a large cup of water, take warm.
Follow-up Visit: After six doses, abdominal pain ceased, and although the hard mass remained, it felt softer upon pressure. Her appetite, which had decreased previously, had returned to normal. Her pulse was smoother than before. The original prescription was modified slightly for continued use.
Prescription: Sheng Huangqi (Radix Astragali Membranacei, 5 qian), Tianhuafen (Radix Trichosanthis, 5 qian), Sheng Huaishanyao (Rhizoma Dioscoreae Hypoglaucae, 4 qian), Sanleng (Rhizoma Sparganii, 3 qian), Ezhu (Rhizoma Curcumae, 3 qian), Huai Niuxi (Radix Achyranthis Bidentatae, 3 qian), Ye Dangshen (Radix Codonopsis Pilosulae, 3 qian), Zhimu (Cortex Phellodendri, 3 qian), Sheng Jineijin (Endothelium Corneum Gigeriae Galli, 2 qian, yellow variety, crushed), Sheng Shizhi (Hirudo, 2 qian, crushed). Decoct together in a large cup of water, take warm.
Outcome: After taking fifteen to sixteen doses (with minor adjustments as needed), numerous purple-black blood clots were discharged, and the disease was completely cured.
Commentary: Few women with Zha syndrome recover. This is not because the disease is inherently incurable. The Xiayuxue Tang (Blood-Expelling Decoction) from *Jin Gui Yao Lue* is originally the principal formula for treating female Zha. However, its properties are fierce and unsuitable for long-term use. For early-stage Zha that is not yet hard, two or three doses may resolve it. But for cases persisting for months or years where the Zha is hard as ironstone, requiring long-term medication, Xiayuxue Tang is inappropriate. Doctors know this and switch to milder herbs like Taoren, Honghua, Danshen, and Chishao. If pain is present, they add Qi-regulating herbs like Xiangfu, Yanhusuo, Qingpi, and Muxiang. Using such mild herbs for hard Zha masses guarantees failure even after a hundred doses. Moreover, their efficacy is insufficient, while their potential to damage Qi transformation is excessive. If taken continuously under the guise of being "mild," Qi transformation is secretly depleted after ten doses. This explains why only two or three out of ten patients recover. In my proposed formula, Sanleng, Ezhu, and Shizhi are specific herbs for dissolving Zha. Even Jineijin, commonly used for digestion, is powerful against Zha. Combined with tonics like Renshen, Huangqi, and Baizhu, the risk of damaging the body from harsh herbs is mitigated. Tianhuafen and Zhimu balance the heat of tonics, while Niuxi guides the herbs downward to the disease site. Thus, the formula can be taken long-term without harm, slowly dissolving hard Zha masses. Shizhi must be used raw; the rationale is detailed in the commentary on Lizhong Wan. Its properties are not excessively fierce. Practitioners should dare to use it to save lives.