大全云∶夫积者，阴气也，五脏所生；聚者，阳气也，六腑所成。皆由饮食不节，寒热不
调，致五脏之气积，六腑之气聚。积者，痛不离其部；聚者，其痛无有常处。所以然者，积为阴
气，阴性沉伏，故痛不离其部；聚兼阳气，阳性浮动，故痛无常处。产后血气伤于脏腑，脏腑
虚弱，为风冷所乘，搏于脏腑，与血气相结，故成积聚 块也。
薛氏曰∶前证乃真气亏损，邪气乘之，况产后得之，尤当固真气为主，若求旦夕之效而
攻其邪，则速其危矣，当参前杂证积聚诸方论治之。
一产妇腹中似有一块，或时作痛而转动，按之不痛，面色萎黄，痛则皎白（似字是眼。按
不痛是虚，萎黄皎白浮涩为血虚），脉浮而涩。余谓∶此肝气虚而血弱也。不信，乃用破
血行气，痛益甚，转动无常，又认以为血鳖，专用破血驰逐之药，痛攻两胁，肚腹尤甚，益信
为血鳖（妄言妄听，可笑），确服下血等药，去血甚多，形气愈虚，肢节间各结小核，隐于肉
里，以为鳖子畏药而走于外。余曰∶肝藏血而养诸筋，此因肝血复损，筋涸而挛结耳（血涸
筋挛之说，自立斋始，大概发在肝胆部分者当补金水，然而难愈，惟善守者得效）。盖肢节胸
项皆属肝胆部分，养其脾土，补金水以滋肝血，则筋自舒。遂用八珍汤逍遥散归脾汤，加
减调治而愈。
一妇月经不调，两拗肿胀，小便涩滞，腹中一块作痛，或上攻胁腹，或下攻小腹，发热
晡热，恶寒，肌肤消瘦，饮食无味（两拗即髀厌，属肝经，小便小腹寒热等症皆肝所主，而
饮食无味则脾也，故须肝脾兼治），殊类废症，久而不愈，余谓肝脾血气亏损，用八珍汤、逍
遥散、归脾汤，随症互服而愈。
大全云∶新产后有血与气相搏而痛者，谓之瘕，瘕之言假也，谓其痛浮假无定处也，此
由夙有风冷，血气不治（虽以风冷为因，总是血气不治），至产血下则少，故致此病，不急治
则多成积结，妨害月水，轻则痞涩，重则不通也。
薛氏曰∶前证乃寒邪乘客，气血壅结，此因气病而血病也，当补养胃气，调和月经，宽
缓静养为善（此亦大概言耳，至于治法，非行气破结不可，而养正邪自除之说，于胃气不
足，攻伐太过者，切有补焉）。《难经》云∶任脉之病，男子为七疝，女子为瘕聚。当参前后各论治之。
河间芍药汤 治产后诸积不可攻，宜养阴去热，其病自安。（此方若为风冷所致，与夫
瘀血所积者，当以别治之）
芍药（一斤） 黄芩 茯苓（各六两）
上锉散，每服半两，水煎，温服，日三。
四神散 治产后瘀血不消，积聚作块，心腹切痛。（此以佛手散温行）
当归（去芦） 川芎 赤芍药 干姜（炮，各等分）
上为细末，每服二钱，食前同温酒调服。
一方 治血瘕作痛，脐下胀满，或月经不行，发热体倦。
当归（二两） 芍药（炒） 桂心 血竭 蒲黄（炒，各一两半） 玄胡索（炒，一两）
上为末，每服二钱，空心热酒调下。
桂心丸 治产后血气不散，积聚成块，上攻心腹，或成寒热，四肢羸瘦烦疼。（此三方皆
以消瘀为主，而此兼行气，然有轻重之分，在人因病采择）
桂心 当归 赤芍 牡丹皮 没药 槟榔 干漆（炒烟尽） 青皮（各七钱半） 浓朴（制） 三
棱（煨） 玄胡索 大黄 桃仁（去皮尖） 鳖甲（酥炙，各一两）
上为细末，炼蜜丸如桐子大，每服三四十丸，食前温酒下。
产宝方 疗血瘕痛无定处。
童便（三升） 生地黄汁 生藕汁（各一升） 生姜汁（三升）
上先煎前三味，约三分减二，次下姜汁，慢火煎如稀饧，每服取一合，暖酒调下。（按
有形，瘕无形，有形者血病，无形者气病，故血病则着，气病则行。今以血瘕而痛无定所
者，乃气血俱病也，气为瘕郁，郁则生火，火载瘕行，故痛无定所。方以童便生地藕汁者，养
血清火破瘀也，盖火清则不痛，瘀破则瘕消，佐以姜汁，调以暖酒，以热则行，寒则凝，故用
之以从治耳。此方平顺中有奇处，可法之）
千金方 疗血瘕。
生干地黄（一两） 乌贼鱼骨（二两）
上为细末，空心温酒调服二钱匕。
《大全》说：所谓“积”，属于阴气，由五脏产生；所谓“聚”，属于阳气，由六腑形成。这都是由于饮食没有节制，寒热失调，导致五脏之气郁结为积，六腑之气壅滞为聚。“积”的特点是疼痛部位固定不移；“聚”的特点是疼痛位置不固定。之所以这样，是因为“积”属于阴气，阴性沉伏潜藏，所以疼痛不离其原发部位；“聚”兼有阳气，阳性浮动游走，所以疼痛没有固定处。产后血气损伤脏腑，脏腑虚弱，被风冷邪气侵袭，邪气搏结于脏腑，与血气相互纠结，从而形成积聚肿块。
薛己（薛氏）说：上述证候是由于真气亏损，邪气乘虚而入。特别是产后出现这种情况，更应当以固护真气为主。如果追求立竿见影的效果而攻伐邪气，就会加速危重情况的发生。应当参考前文杂病中关于积聚的各种方论进行治疗。
有一位产妇腹中似乎有一块东西，有时发作疼痛且位置转动，按压时不痛，面色萎黄，疼痛发作时面色苍白（注：“似”字应为“眼”之误？此处依原文意译，指症状描述；按之不痛属虚证，萎黄、苍白、脉浮涩均为血虚之象），脉象浮而涩。我说：这是肝气虚而血弱。患者不信，使用了破血行气的药物，疼痛更加严重，肿块转动无常。后来又误认为是“血鳖”（一种瘀血结块），专门使用破血逐瘀的药物，疼痛攻冲两胁，腹部尤其严重，更加确信是“血鳖”。确实服用了下血等药物，导致失血很多，形体和气更加虚弱，四肢关节间各结成小核，隐伏在肌肉里面，认为这是“鳖子”害怕药物而逃跑到体表去了。我说：肝藏血而滋养全身筋脉，这是因为肝血再次受损，筋脉干枯而痉挛结聚（“血涸筋挛”的说法，始于李东垣，大概指出病变在肝胆部分时应当补益肺金和肾水，然而难以治愈，只有善于守正调理的人才能见效）。因为四肢、关节、胸部、颈部都属于肝胆经脉所过之处，通过滋养脾土，补益肺金和肾水以滋助肝血，筋脉自然舒展。于是使用八珍汤、逍遥散、归脾汤，根据病情加减调治而痊愈。
另一位妇女月经不调，大腿根部肿胀，小便涩滞不畅，腹中有一块作痛，有时向上攻冲胁腹，有时向下攻冲小腹，发热，午后潮热，怕冷，肌肤消瘦，饮食无味（注：“两拗”即髀厌，属于肝经，小便和小腹的寒热等症状皆由肝所主，而饮食无味则关乎脾，所以需要肝脾同治），症状极像“废症”（指重症或难治之症），久治不愈。我说这是肝脾气血亏损，使用八珍汤、逍遥散、归脾汤，根据症状交替服用而痊愈。
《大全》说：新近产后的妇女，如果有血与气相互搏结而疼痛的，称为“瘕”。“瘕”的意思是假，是指疼痛虚假不定、没有固定位置。这是由于素来有风冷之邪，血气不调（虽然以风冷为病因，但根本在于血气不调），到了生产时血液下行减少，因此导致此病。如果不及时治疗，大多会形成积结，妨害月经，轻则痞塞涩滞，重则完全不通。
薛己说：上述证候是寒邪客居体内，气血壅结，这是因气病而导致血病。应当补养胃气，调和月经，保持心情宽缓、安静休养为好（这也是一般性的说法，至于具体治法，非行气破结不可，而“养正气则邪气自除”的说法，对于胃气不足、攻伐太过者，确实有补充作用）。《难经》说：任脉的疾病，男子表现为七疝，女子表现为瘕聚。应当参考前后的各种论述进行治疗。
河间芍药汤：治疗产后各种积聚不可攻伐，宜养阴清热，病自然安宁。（注：此方若是由风冷所致，或由瘀血积聚引起，应当另外治疗）
芍药（一斤）、黄芩、茯苓（各六两）。
以上切碎成散剂，每次服用半两，用水煎煮，温服，每日三次。
四神散：治疗产后瘀血不消，积聚成块，心腹剧烈疼痛。（注：此方以佛手散为基础温通运行）
当归（去芦头）、川芎、赤芍药、干姜（炮制，各等分）。
以上研为细末，每次服用二钱，饭前用温酒调服。
一方：治疗血瘕作痛，脐下胀满，或月经不行，发热体倦。
当归（二两）、芍药（炒）、桂心、血竭、蒲黄（炒，各一两半）、玄胡索（炒，一两）。
以上研为末，每次服用二钱，空腹时用热酒送服。
桂心丸：治疗产后血气不散，积聚成块，向上攻冲心腹，或形成寒热往来，四肢消瘦烦疼。（注：这三个方子都以消除瘀血为主，而这个方子兼有行气作用，但有轻重之分，应根据病情选择采用）
桂心、当归、赤芍、牡丹皮、没药、槟榔、干漆（炒至烟尽）、青皮（各七钱半）、浓朴（炮制）、三棱（煨）、玄胡索、大黄、桃仁（去皮尖）、鳖甲（酥炙，各一两）。
以上研为细末，用炼蜜制成梧桐子大小的丸药，每次服用三四十丸，饭前用温酒送下。
产宝方：治疗血瘕疼痛无定处。
童便（三升）、生地黄汁、生藕汁（各一升）、生姜汁（三升）。
以上先煎前三味药，约减少三分之二，然后加入姜汁，用慢火煎至如稀糖状，每次取一合，用暖酒调服。（注：有形者为实，瘕为无形，有形者是血病，无形者是气病，所以血病则固定，气病则游走。现在以血瘕而疼痛无定处的，是气血俱病，气为瘕所郁结，郁结则生火，火推动瘕移动，所以疼痛无定所。方中使用童便、生地、藕汁，是为了养血、清火、破瘀，盖因火清则不痛，瘀破则瘕消，佐以姜汁，用暖酒调服，是因为热则流通，寒则凝滞，所以用它们来顺从病势而治。此方在平顺中有奇特之处，值得效法）
Quan Da (General Collection) states: "Ji" (accumulation) belongs to Yin Qi and is generated by the five Zang organs; "Ju" (gathering) belongs to Yang Qi and is formed by the six Fu organs. Both arise from irregular diet and imbalance of cold and heat, leading to the stagnation of Qi in the five Zang organs forming "Ji", and the congestion of Qi in the six Fu organs forming "Ju". The characteristic of "Ji" is that pain remains fixed in its location; the characteristic of "Ju" is that the location of pain is not constant. This is because "Ji" involves Yin Qi, whose nature is deep and latent, so pain does not leave its original site; "Ju" involves Yang Qi, whose nature is floating and wandering, so pain has no fixed place. After childbirth, blood and Qi injure the Zang-Fu organs, causing them to become deficient. They are invaded by Wind-Cold pathogens, which contend with the Zang-Fu organs and knot together with blood and Qi, thus forming accumulations and masses.
Xue Ji (Mr. Xue) said: The aforementioned syndrome results from the depletion of True Qi, allowing pathogenic factors to take advantage of the deficiency. Especially when this occurs postpartum, one must prioritize consolidating True Qi. If one seeks immediate effects by attacking the pathogens, it will hasten the danger. One should refer to the various formulas and discussions on accumulation and gathering in miscellaneous diseases mentioned earlier for treatment.
A postpartum woman had a mass seemingly in her abdomen, which sometimes caused pain and moved around; pressing on it did not cause pain. Her complexion was sallow, and during pain episodes, her face turned pale (Note: 'Si' character might be an error; pressing without pain indicates deficiency; sallow, pale complexion, and floating/rough pulse all indicate Blood deficiency). Her pulse was floating and rough. I stated: This is Liver Qi deficiency and weak Blood. She did not believe this and used blood-breaking and Qi-moving herbs, which exacerbated the pain. The mass moved unpredictably. Later, she mistakenly identified it as "Blood Biē" (a type of blood stasis mass) and exclusively used blood-breaking and purging drugs. The pain attacked both hypochondriac regions, especially the abdomen, reinforcing her belief in "Blood Biē". She indeed took blood-expelling medicines, resulting in significant blood loss, further depleting her form and Qi. Small nodules formed in her limbs and joints, hidden within the muscles, which she believed were "Biē offspring" fleeing the medicine to the exterior. I said: The Liver stores Blood and nourishes the sinews. This condition arises because Liver Blood was further damaged, leading to dry sinews and spasmodic knotting (The concept of 'Blood exhaustion and sinew spasm' originated with Li Dongyuan; generally, lesions in the Liver-Gallbladder sectors require tonifying Lung Metal and Kidney Water, but these are difficult to cure; only those who adhere strictly to proper regulation achieve success). Since limbs, joints, chest, and neck belong to the Liver-Gallbladder meridians, by nourishing Spleen Earth, tonifying Lung Metal and Kidney Water to nourish Liver Blood, the sinews will naturally relax. Thus, using Bazhen Tang (Eight Treasures Decoction), Xiaoyao San (Free and Easy Wanderer Powder), and Guipi Tang (Restore the Spleen Decoction), adjusted according to symptoms, she recovered.
Another woman suffered from irregular menstruation, swelling at the root of the thighs (Note: 'Liang Ao' refers to the hip crease, belonging to the Liver meridian; urinary and lower abdominal cold-heat symptoms are governed by the Liver, while lack of taste in food relates to the Spleen, hence simultaneous treatment of Liver and Spleen is necessary), dysuria, and a painful mass in the abdomen that sometimes attacked upward to the hypochondrium and abdomen, or downward to the lower abdomen. She experienced fever, afternoon tidal fever, aversion to cold, emaciation, and loss of appetite. The symptoms closely resembled severe chronic illness ("Fei Zheng"). Despite prolonged treatment without success, I diagnosed it as Liver-Spleen Qi and Blood deficiency. Using Bazhen Tang, Xiaoyao San, and Guipi Tang, alternating based on symptoms, she recovered.
Quan Da states: In newly postpartum women, if pain occurs due to the contending of Blood and Qi, it is called "Jia" (false/mass). "Jia" implies falsity, meaning the pain is fleeting and lacks a fixed location. This is due to pre-existing Wind-Cold and disordered Blood and Qi (Although Wind-Cold is the cause, the root is always the disorder of Blood and Qi). During childbirth, blood flow decreases, leading to this disease. If not treated promptly, it often becomes an accumulation, interfering with menstruation; mildly causing distension and obstruction, severely causing complete blockage.
Xue Ji said: The aforementioned syndrome is caused by Cold pathogens lodging in the body, resulting in Qi and Blood congestion. This is a case where Qi pathology leads to Blood pathology. One should tonify Stomach Qi, regulate menstruation, and maintain a relaxed and quiet rest (This is a general statement; regarding specific treatment methods, moving Qi and breaking knots is indispensable, yet the theory that 'tonifying righteousness eliminates evil' is particularly beneficial for those with insufficient Stomach Qi and excessive attack). The Nan Jing states: Diseases of the Ren Mai (Conception Vessel) manifest as Seven Hernias in men and Jia-Ju (gathering masses) in women. Refer to previous and subsequent discussions for treatment.
Hejian Shaoyao Tang (Peony Decoction): Treats various postpartum accumulations; do not use purgatives. Instead, nourish Yin and clear Heat, and the disease will settle itself. (Note: If this formula is used for cases caused by Wind-Cold or Blood stasis accumulation, different treatments are required.)
Shaoyao (one jin), Huangqin (Scutellariae Radix), Fuling (Poria) (each six liang).
Crush into coarse powder. Take half a liang per dose, decoct in water, and take warm. Three times daily.
Sishen San (Four Spirits Powder): Treats postpartum unresolved blood stasis, formation of accumulations and masses, and severe cutting pain in the heart and abdomen. (Note: This formula uses Foshou San as a base for warming and moving.)
Danggui (Angelicae Sinensis Radix, remove radicle), Chuanxiong (Chuanxiong Rhizoma), Chi Shaoyao (Red Peony Root), Ganjiang (Zingiberis Rhizoma, processed) (equal parts).
Grind into fine powder. Take two qian per dose, mix with warm wine before meals.
Another Formula: Treats pain from Blood Jia, fullness below the umbilicus, amenorrhea, fever, and fatigue.
Danggui (two liang), Shaoyao (fried), Guixin (Cinnamomi Cortex), Xuexie (Sanguis Draconis), Puhuang (Typhae Pollen, fried, each one and a half liang), Yanhusuo (Corydalis Rhizoma, fried, one liang).
Grind into powder. Take two qian per dose, swallow with hot wine on an empty stomach.
Guixin Wan (Cinnamon Heart Pill): Treats postpartum stagnant Blood and Qi forming masses, attacking upward to the heart and abdomen, or causing alternating chills and fever, emaciation, and painful limbs. (Note: All three formulas primarily focus on eliminating blood stasis, but this one also moves Qi. There are differences in intensity; choose according to the condition.)
Guixin, Danggui, Chi Shao, Mudanpi (Moutan Cortex), Moyao (Myrrha), Binglang (Arecae Semen), Ganqi (Drynariae Rhizoma? No, Ganqi here likely refers to Drynaria or similar, but text says 'Ganqi' fried until smoke ceases - usually implies toxic herb processing, possibly Ganqi 干漆 - Drynariae Rhizoma or Canna Indica Rhizome? Context suggests blood breaking, likely Ganqi 干漆 - Dried Resin of Rhus chinensis), Qingpi (Citri Reticulatae Pericarpium Viride, each seven and a half qian), Houpo (Magnoliae Officinalis Cortex, processed), Sanleng (Sparganii Rhizoma, roasted), Yanhusuo, Dahuang (Rhei Radix et Rhizoma), Taoren (Persicae Semen, skin and tip removed), Biejia (Testudinis Carapax et Plastrum, prepared with butter, each one liang).
Grind into fine powder, make pills with refined honey the size of tung seeds. Take 30-40 pills per dose, swallow with warm wine before meals.
Chanbao Fang (Child Treasure Prescription): Treats Blood Jia pain with no fixed location.
Tongbian (Infant Urine, three sheng), Sheng Dihuangzhi (Fresh Rehmanniae Radix Juice), Sheng Ouzhi (Fresh Lotus Rhizome Juice, each one sheng), Sheng Jiangzhi (Fresh Ginger Juice, three sheng).
First decoct the first three ingredients until reduced by two-thirds. Then add Ginger Juice. Simmer slowly over low heat until thick like syrup. Take one he per dose, mix with warm wine. (Note:有形 (有形) refers to tangible forms, Jia is intangible. Tangible issues are Blood disorders, intangible are Qi disorders. Thus, Blood disorders are fixed, Qi disorders move. Here, Blood Jia pain with no fixed location indicates both Qi and Blood disorders. Qi is constrained by Jia, constraint generates Fire, Fire drives Jia to move, hence pain is unfixed. The formula uses infant urine, Rehmannia, and lotus juice to nourish Blood, clear Fire, and break stasis. Clearing Fire stops pain; breaking stasis resolves Jia. Ginger juice and warm wine are added because heat promotes circulation while cold causes stagnation, thus using them to treat the condition by following its nature. This formula has unique efficacy within its mild approach and is worth emulating.)
Qianjin Fang (Thousand Gold Prescription): Treats Blood Jia.
Sheng Gan Dihuang (Dried Fresh Rehmanniae Radix, one liang), Wouyu Gu (Sepiae Endoconcha, two liang).
Grind into fine powder. Take two qian bishi (small scoops) per dose, mix with warm wine on an empty stomach.