《褚氏遗书》曰∶建平孝王妃姬皆丽无子,择民家未笄女子入御,又无子,问曰∶求男
有道乎?澄对曰∶合男女必当其年,男虽十六而精通,必三十而娶;女虽十四而天癸至,必
二十而嫁。皆欲阴阳完实,然后交而孕,孕而育,育而子坚壮强寿。今未笄之女,天癸始至
,已近男色,阴气早泄,未完而伤,未实而动,是以交而不孕,孕而不育,而子脆不寿,此
王之所以无子也。然妇人有所产皆女者,有所产皆男者,大王诚能访求多男妇人至宫府,有
男之道也。王曰∶善。未再期生六男。夫老阳遇少阴,老阴遇少阳,亦有子之道也。
毓麟珠(新因十四) 左归丸(新补四) 右归丸(新补五) 赞育丹(新因又十四) 还少丹
(补一三五) 全鹿丸(补一二七) 无比山药丸(补一三六) 延年益嗣丹(妇一三五) 大补阴
丸(寒一五七) 八珍益母丸(妇一三八) 续嗣降生丹(妇一三六) 女金丹(妇一三三) 四制
香附丸(妇一三二) 河车种玉丸(妇一三七) 乌鸡丸四方(妇一三九后) 黑锡丹(热一八九)
瘕之病,即积聚之别名。《内经》止有积聚疝瘕,并无证字之名,此后世之所增
设者。盖 者征也;瘕者,假也。征者成形而坚硬不移者是也,假者无形而可聚可散者
是也。成形者,或由血结,谓之血 ,或由食结,谓之食 。无形者惟在气分,气
滞则聚而见形,气行则散而无迹。此 瘕之辨也。然又有痛者,有不痛者。痛者联于气
血,所以有知,气血行则愈,故痛者易治;不痛者不通气血,别结窠囊,药食难及,故不痛
者难治,此又治之有辨也。其他如肺之积曰息奔,心之积曰伏梁,脾之积曰痞气,肝之积曰
肥气,肾之积曰奔豚,以至后世有曰 癖、曰痞块之属,亦不过以形见之处有不同,故名亦
因之而异耳。总之非在气分,则在血分。知斯二者,则 瘕二字已尽之矣。但血
气瘕,各有虚实,而宜攻宜补,当审之真而用之确也。诸经义另详积聚门,所当参阅。
《骨空论》曰∶任脉为病,男子内结七疝,女子带下瘕聚。张子和曰∶遗溺闭癃,阴痿
脬痹,精滑白淫,皆男子之疝也。若血涸、月事不行,行后小腹有块,或时动移,前阴突出
,后阴痔核,皆女子之疝也。但女子不谓之疝,而谓之瘕。
《褚氏遗书》记载:建平孝王的妃子和姬妾都容貌美丽但没有生育,挑选民间未行成人礼的女子纳入后宫侍奉,依然没有子嗣。孝王问道:“求取男婴有方法吗?”褚澄回答说:“男女结合必须年龄相当,男子虽然十六岁精气已通,但一定要等到三十岁才娶妻;女子虽然十四岁天癸(月经)初至,但一定要等到二十岁才出嫁。这都是希望阴阳之气完备充实,然后交合才能受孕,受孕后能顺利孕育,出生后孩子才能坚固强壮、长寿。如今那些未行成人礼的女子,天癸刚刚到来,就接近男子,导致阴气过早泄漏,身体尚未发育完全就已受损,元气尚未充实就已妄动,因此交合不能受孕,即使受孕也不能顺利生产,生下的孩子脆弱且不长寿,这就是君王没有子嗣的原因。然而妇女中有的只生女孩,有的只生男孩,大王如果能访求多生男孩的妇女到宫中府邸,就有得到男丁的方法了。”孝王说:“好。”不到一年便生了六个男孩。所谓老阳遇到少阴,老阴遇到少阳,也是得子的道理。
毓麟珠(新因篇第十四方)、左归丸(新补篇第四方)、右归丸(新补篇第五方)、赞育丹(新因篇又第十四方)、还少丹(补益篇一三五方)、全鹿丸(补益篇一二七方)、无比山药丸(补益篇一三六方)、延年益嗣丹(妇科篇一三五方)、大补阴丸(寒病篇一五七方)、八珍益母丸(妇科篇一三八方)、续嗣降生丹(妇科篇一三六方)、女金丹(妇科篇一三三方)、四制香附丸(妇科篇一三二方)、河车种玉丸(妇科篇一三七方)、乌鸡丸四方(妇科篇一三九方之后)、黑锡丹(热病篇一八九方)。
瘕(jiǎ,腹内结块)这种病,就是积聚的别名。《内经》中只有积聚和疝瘕的说法,并没有“证”这个字的名目,这是后世增设的。大概“征”是征兆的意思;“瘕”是假借的意思。征者,是指形态固定、坚硬不移的肿块;假者,是指无形态、可以聚散变化的肿块。有形体的肿块,有的是由血结而成,称为血瘕;有的是由食积而成,称为食瘕。无形体的只在气分存在,气机阻滞则聚集成形可见,气机通畅则消散无迹可寻。这就是征与瘕的区别。然而又有疼痛和不疼痛的区别。疼痛的关联于气血,所以患者有感觉,气血运行通畅则痊愈,所以疼痛的容易治疗;不疼痛的是气血不通,另外结成窠囊,药物和食物难以到达,所以不疼痛的难治,这又是治疗上的区别。其他的如肺部的积块叫息贲,心部的积块叫伏梁,脾部的积块叫痞气,肝部的积块叫肥气,肾部的积块叫奔豚,以至于后世所说的癖积、痞块之类,也不过是因为显现的部位不同,所以名称也因此而异罢了。总之,不是在气分,就是在血分。懂得这两点,那么“征”和“瘕”两个字的含义就全部概括了。但是血气和瘕各有虚实之分,适宜攻伐还是适宜补益,应当仔细审察真实情况并准确使用。各经文的义理另在积聚门中详细记载,应当参考阅读。
《骨空论》说:任脉发病,男子内部结为七种疝气,女子带下及瘕聚。张子和说:遗尿、小便闭塞不通、阳痿、膀胱痹阻、精液滑泄、白带过多,都是男子的疝病。如果血液枯竭、月经不行,月经结束后小腹有肿块,有时移动,前阴突出,后阴痔核,都是女子的疝病。只是女子不称之为疝,而称之为瘕。
According to *Chu Shi Yi Shu* (Remnant Books of Master Chu): The consorts and concubines of the Prince Xiaowang of Jianping were all beautiful but childless. He selected young women from common families who had not yet undergone the capping ceremony (coming-of-age ritual for men) or hairpin ceremony (for women) to serve in his harem, yet still had no offspring. The Prince asked, "Is there a method to obtain male heirs?" Cheng replied, "The union of man and woman must be at appropriate ages. Although a man's essence may become clear at sixteen, he should only marry at thirty; although a woman's Tian Gui (menstruation) may arrive at fourteen, she should only marry at twenty. This is to ensure that both Yin and Yang are complete and solid before intercourse, so that conception occurs, gestation proceeds smoothly, and the offspring is born robust, strong, and long-lived. Nowadays, girls who have not come of age have just begun their Tian Gui; if they approach men prematurely, their Yin Qi leaks early, damaging them before they are fully developed and agitating them before they are solid. Thus, intercourse fails to result in pregnancy, or if pregnant, fails to sustain it, resulting in fragile and short-lived children. This is why the Prince has no offspring. However, some women only bear daughters, while others only bear sons. If Your Highness could seek out women who frequently bear sons into your palace, there would be a way to obtain male heirs." The Prince said, "Very well." Within one year, six sons were born. The principle that Old Yang meets Young Yin, and Old Yin meets Young Yang, is also a way to conceive.
Yu Lin Zhu (New Causes, Formula 14), Zuo Gui Wan (Left Restoring Pill, New Supplement, Formula 4), You Gui Wan (Right Restoring Pill, New Supplement, Formula 5), Zan Yu Dan (Zan Yu Decoction, New Causes, Formula 14 again), Hai Shao Dan (Hai Shao Pill, Tonification 135), Quan Lu Wan (Whole Deer Pill, Tonification 127), Wu Bi Shan Yao Wan (Wu Bi Yam Pill, Tonification 136), Yan Nian Yi Si Dan (Yan Nian Yi Si Decoction, Gynecology 135), Da Bu Yin Wan (Da Bu Yin Pill, Cold Pathology 157), Ba Zhen Yi Mu Wan (Ba Zhen Motherwort Pill, Gynecology 138), Xu Si Jiang Sheng Dan (Xu Si Jiang Sheng Decoction, Gynecology 136), Nu Jin Dan (Nu Jin Decoction, Gynecology 133), Si Zhi Xiang Fu Wan (Si Zhi Cyperus Pill, Gynecology 132), He Che Zhong Yu Wan (He Che Jade-Planting Pill, Gynecology 137), Wu Ji Wan Si Fang (Black Chicken Pill Four Formulas, Gynecology 139 onwards), Hei Xi Dan (Hei Xi Pill, Heat Pathology 189).
Jia (abdominal mass) is another name for Ji Ju (accumulations and masses). *Nei Jing* (Inner Canon) only mentions Ji Ju and Shan Jia, without using the character "Zheng" (manifestation/syndrome); this was added by later generations. Generally, "Zheng" refers to signs; "Jia" refers to falsehood. Zheng denotes a mass with fixed shape, hardness, and immobility; Jia denotes a mass without fixed shape, which can gather and disperse. A formed mass may arise from blood stagnation, called Blood Jia, or from food retention, called Food Jia. An unformed mass exists only in the Qi level; when Qi stagnates, it gathers to form a visible shape, and when Qi moves, it disperses without a trace. This is the distinction between Zheng and Jia. Furthermore, there are those that are painful and those that are painless. Painful masses involve Qi and Blood, so the patient feels sensation; when Qi and Blood flow freely, the condition heals, making painful masses easier to treat. Painless masses indicate blocked Qi and Blood, forming separate sacs or pockets where medicines and foods cannot reach, making painless masses difficult to treat. This is another distinction in treatment. Others include: accumulation in the Lung called Xi Ben, accumulation in the Heart called Fu Liang, accumulation in the Spleen called Pi Qi, accumulation in the Liver called Fei Qi, and accumulation in the Kidney called Ben Tun. Later generations also mentioned Pi Pi and Pi Kuai, which differ only in location, hence different names. In summary, these are either in the Qi level or the Blood level. Understanding these two aspects covers the meanings of Zheng and Jia completely. However, Blood, Qi, and Jia each have deficiency and excess patterns; whether to use attacking or tonifying methods must be carefully examined and applied accurately. The principles of various classics are detailed separately in the Ji Ju section and should be consulted.
*Gu Kong Lun* states: Disease of the Ren Mai (Conception Vessel) causes seven types of Shan (hernia/genital disorders) in men and Dai Xia (leukorrhea) and Jia Ju (masses) in women. Zhang Zihe said: Enuresis, strangury, impotence, bladder bi, seminal emission, and leukorrhea are all Shan diseases in men. If blood is depleted, menstruation stops, or after menstruation a mass appears in the lower abdomen, sometimes moving, with protrusion of the anterior yin and hemorrhoidal nodules at the posterior yin, these are Shan diseases in women. However, in women, these are not called Shan but Jia.