罗谦甫曰∶经云石瘕生于胞中，寒气客于子门，子门闭塞，气不得通，恶血当泻不泻， 以留止，日以益大，
状如怀子，月事不以时下，皆生于女子，可导而下。夫膀胱为津液之府，气化则能出。今寒客子门，则气塞不通，
血壅不流， 以留止，结硬如石，是名石瘕。此先气病而后血病，故月事不来，可宣导而下，非大辛热之剂不
能已，可服见 丸、和血通经汤。
《折肱漫录》曰，予媳申氏，多郁怒，忽患不月，腹渐大，疑有妊，医视之，亦以为妊也。十余月勿产，
诸证渐见，疑之。医者
亦疑为蓄血，欲下之，以体弱不胜，可暗消，久用行血调血药，不敢用下血药，竟至不起。后阅盛启东治东宫
妃一案，大悔悼。永乐中，东宫妃张氏，经不通者十余月，众医以为胎也。胀愈甚，上命启东诊，一一如见方，
皆破血之剂，服药下血数斗而疾平。予媳病正与此合。当十月外，既确知非妊，宜大胆下之，可得生，惜医无胆，
不亦伤乎。
慎斋按∶以上三条，序胎孕有肠覃、石瘕、蓄血之疑证也。前条鬼胎，本之荣卫虚弱，精神恍惚，则妖魅鬼
邪，得乘虚感人脏腑。故立斋一以补元气为主。若《内经》肠覃、石瘕，一犯大肠为气病，一犯子门为血病，
几与鬼胎相似。鬼胎与妊孕，在疑似间，非医者有洞垣之见，往往误治。故附蓄血一案，以为宜下之法。但下
法必见证不疑者始可与议此也。
罗谦甫说：《黄帝内经》记载，石瘕（一种腹部结块如石的疾病）生于胞宫之中，寒气侵入子门（子宫口），导致子门闭塞，气机无法通畅运行，恶血应当排出却未能排出，因而滞留体内，日渐增大，形状如同怀孕，月经不能按时来潮。这类病症只发生于女性，可以通过导引通下的方法治疗。膀胱是津液汇聚的府库，依靠气化作用才能使尿液排出。如今寒气客居于子门，导致气机壅塞不通，血液瘀滞不流，因而滞留体内，凝结坚硬如石，这就叫做石瘕。这是先有气病而后发展为血病，所以月经不来，可以采用宣通导下的方法治疗，如果不是大辛大热的药物就不能治愈，可以服用见睺丸、和血通经汤。
《折肱漫录》记载：我的儿媳申氏，平时多郁怒，忽然出现闭经，腹部逐渐增大，怀疑是怀孕，医生诊察后也认为是怀孕。过了十几个月没有分娩，各种症状逐渐显现，开始产生怀疑。医生也怀疑是蓄血证，想要用攻下法治疗，但因为患者体质虚弱承受不住，只能采用暗中消散的方法，长期服用行血调血的药物，不敢使用峻烈的下血药，最终导致病情恶化死亡。后来我阅读了盛启东治疗东宫妃的案例，感到十分后悔和悲痛。永乐年间，东宫妃张氏，月经不通已有十几个月，众医都认为是胎孕。腹胀越来越严重，皇上命令盛启东诊治，他诊断结果与之前所见方剂一致，都是破血逐瘀的药物，服药后排出数斗瘀血，疾病得以平复。我儿媳的病与此完全吻合。如果在十月之后，已经确切知道不是怀孕，应该大胆地使用攻下法，或许还能保住性命，可惜医生缺乏胆识，这不是很令人伤心吗？
慎斋按语：以上三条内容，叙述了胎孕疑似肠覃、石瘕、蓄血等疑难证候的情况。前一条提到的鬼胎，源于荣卫虚弱，精神恍惚，致使妖魅鬼邪乘虚侵入人体脏腑。因此，薛立斋主张以补益元气为主。至于《黄帝内经》中的肠覃、石瘕，一个是侵犯大肠属于气病，一个是侵犯子门属于血病，几乎与鬼胎相似。鬼胎与正常妊娠处于似是而非的状态，如果医生没有洞察秋毫的本领，往往会导致误治。所以附上蓄血一案，作为应当使用攻下法的参考。但是，攻下法必须在确认证候无疑的情况下才可以讨论使用。
Luo Qianfu stated: The *Huangdi Neijing* (Yellow Emperor's Inner Canon) records that Shijia (a disease characterized by abdominal masses hard as stone) originates in the Baozhong (uterus). Cold pathogenic factors invade the Zimen (cervical os), causing obstruction of the Zimen, preventing the smooth flow of Qi. Evil blood should be discharged but fails to do so, remaining stagnant and gradually enlarging, resembling pregnancy, with menstruation not occurring on time. This condition occurs only in women and can be treated by guiding and purging downward. The Bladder is the mansion of body fluids; it functions through Qi transformation to allow excretion. Now, cold pathogens lodge in the Zimen, causing Qi obstruction and stagnation, leading to blood stasis and retention, which condenses into a hardness like stone, named Shijia. This begins as a Qi disorder followed by a Blood disorder, hence amenorrhea; it can be treated by promoting circulation and guiding downward. Only potent acrid-hot formulas can cure it; one may take Jianhou Wan or Hexue Tongjing Tang.
*Zegong Manlu* (Random Records from Broken Bones) states: My daughter-in-law, Shen Shi, was prone to depression and anger. She suddenly developed amenorrhea, and her abdomen gradually enlarged. Suspecting pregnancy, physicians examined her and also concluded she was pregnant. After more than ten months without delivery, various symptoms emerged, raising doubts. Physicians suspected blood accumulation and desired to purge, but due to her weak constitution unable to withstand harsh treatment, they opted for gradual resolution, using blood-invigorating and regulating herbs for a long time, daring not to use strong blood-purging drugs. Consequently, she died. Later, I read a case treated by Shengqidong regarding the Crown Princess Consort and felt deep regret and sorrow. During the Yongle era, Crown Princess Consort Zhang suffered from amenorrhea for over ten months. Most physicians believed it was pregnancy. Her abdominal distension worsened significantly. The Emperor ordered Shengqidong to diagnose her. His diagnosis aligned with previous observations; he prescribed blood-breaking formulas. After taking the medicine, several dou of blood were discharged, and the illness subsided. My daughter-in-law’s condition matched this exactly. Had we boldly purged after the tenth month, once pregnancy was definitively ruled out, she might have survived. Alas, the physicians lacked courage; is this not lamentable?
Shen Zhai commented: The above three passages outline differential diagnoses between pregnancy and conditions mimicking it, such as Changqin (intestinal polyp/mass), Shijia, and Xuxue (blood accumulation). The previously mentioned Guotai (ghost fetus) stems from deficiency of Ying and Wei (nutritive and defensive Qi) and mental instability, allowing demonic influences to invade the organs and bowels upon deficiency. Therefore, Xue Lizhai emphasized tonifying Yuanqi (primordial Qi). Regarding Changqin and Shijia from the *Neijing*, one involves the Large Intestine and is a Qi disorder, while the other involves the Zimen and is a Blood disorder; both closely resemble Guotai. Guotai and normal pregnancy are ambiguous; without clairvoyant diagnostic insight, physicians often misdiagnose. Thus, the case of Xuxue is appended to illustrate the indication for purging methods. However, purging methods should only be discussed when the syndrome is clearly identified without doubt.