脉弱质亏，操持多劳，昔年产后少腹起有痞块，不时作痛，迩来痛于早晨，日日如是。
经云
∶任脉起于中极之下，循腹里。任之为病，其内若结，男子七疝，女子瘕聚。再考古人论积
聚，分 瘕两端。 者征也，有块可征，其病在血。瘕者假也。聚则有形，散则无迹，其病
在气。良由新产之后，或因寒侵，或因气滞，以致循经之血，凝结成形，胶粘牢固，长大则
易，铲削则难。须待本身元气充旺，始能消磨。倘务急攻，非但积不可消，反伤正气。内
经有大积大聚，其可犯也之戒。旨可见矣。现
在痛势攻冲较甚，滋腻之补，似非所宜。思久痛在络，冲为血海，先商煎剂，调和冲任，使
其脉络流通，气机条畅，痛势稍缓，再议丸药，图刈病根。
安波按∶煎剂议通瘀煎法丸，以回生丹攻补兼用。
时疫十朝，正虚挟邪，证见神卷耳聋，热发不退，脉息沉细无力。凭脉用药，理应壮中
温托
，阅方曾服理阴煎三剂，病样日增，前法似难再进。夫阳证阴脉，原属不宜，方书有时疫，
邪伏于里，脉多沉细，不同伤寒邪自外来，脉多浮大，语属可参。仿赵氏六味汤加柴胡一法
。复诊脉仍虚细，神形倦怠，唇齿干枯，舌苔黄燥变黑。夫邪热最为真阴之贼，高年肾阴本
亏，热甚津液更耗。《己任编》所谓感证始终以存津液为第一义，盖阳明燥土，全赖少阴肾
水以滋养之。如旱田侧有井泉，犹可供其灌溉之资，倘并井泉干涸，燥土炎蒸，则苗槁矣，
宗甘露饮。
脉象虚弱，体质亏损，操劳过度。早年产后少腹部出现痞块，时常疼痛，近来早晨疼痛加剧，每日如此。
《内经》说：任脉起于中极穴之下，沿腹部内侧上行。任脉发生病变，感觉体内如有结块，男子患七疝，女子患瘕聚（妇女下腹结块，聚散无常的病证）。再考证古人关于积聚的论述，分为“寢”和“瘕”两端。“寢”是征验的意思，有块状物可以验证，病在血分；“瘕”是假的意思，聚时有形，散时无迹，病在气分。这大多是因为新产之后，或因寒邪侵袭，或因气机阻滞，导致循经运行的血液凝结成形，胶粘牢固，想要长大容易，想要铲除则很难。必须等待身体元气充盛旺盛，才能慢慢消磨。如果一味追求急攻，不仅积块不能消除，反而会损伤正气。《内经》有“大积大聚，其可犯也”的告诫，旨意已经很明白了。现在疼痛势头攻冲较甚，滋腻的补益药似乎不太适宜。考虑到久痛多在络脉，冲脉为血海，先商量用煎剂，调和冲脉和任脉，使脉络流通，气机条畅，疼痛势头稍缓后，再讨论服用丸药，以图根除病根。
安波按语：煎剂建议采用通瘀煎的方法制成丸药，配合回生丹攻补兼施。
时疫（流行性疫病）十天，正气虚弱夹杂邪气，症状表现为精神萎靡、耳聋，发热不退，脉象沉细无力。根据脉象用药，理应温补中气、托毒外出，查看处方曾服用理阴煎三剂，病情反而日益加重，前法似乎难以继续进用。阳证见阴脉，原本就不适宜，方书中有时疫邪气伏于体内，脉象多沉细，不同于伤寒邪气从外来，脉象多浮大，此语可以参考。仿照赵氏六味汤加柴胡的方法。复诊时脉象仍然虚细，精神和形体倦怠，嘴唇和牙齿干枯，舌苔黄燥变黑。邪热是最伤害真阴的贼寇，高龄者肾阴本已亏损，热势严重则津液更加耗损。《己任编》所说感证始终以保存津液为第一要义，大概因为阳明燥土，全赖少阴肾水来滋养它。就像旱田旁边有井泉，还可以供其灌溉之需，倘若连井泉都干涸了，燥土炎热蒸腾，那么禾苗就会枯槁了。宗法甘露饮（清热养阴方剂）。
Weak pulse, deficient constitution, and excessive mental and physical labor. In previous years, after childbirth, a mass formed in the lower abdomen, causing intermittent pain. Recently, the pain has intensified in the morning, occurring daily.
The *Classic of Internal Medicine* states: "The Ren Mai (Conception Vessel) originates below Zhongji (CV3), running along the interior of the abdomen. When the Ren Mai is diseased, there is a sensation of internal knotting; men suffer from seven types of hernia, while women suffer from Jia Ju (masses that gather and disperse)." Further examining ancient discussions on Ji Ju (accumulations and masses), they are divided into two categories: Pin and Jia. "Pin" refers to tangible evidence; there is a palpable mass, indicating the disease is in the Blood aspect. "Jia" means false or temporary; it appears有形 (form) when gathered and leaves no trace when dispersed, indicating the disease is in the Qi aspect. This is largely due to postpartum conditions where cold invasion or Qi stagnation causes blood circulating along the meridians to coagulate and form shapes. These become firmly adhered and difficult to dissolve once enlarged. It requires the body's Yuan Qi (Original Qi) to be robust before gradual resolution can occur. If one pursues aggressive attack methods hastily, not only will the accumulation fail to dissipate, but the healthy Qi will also be damaged. The *Inner Canon* warns against attacking large accumulations and masses indiscriminately, which clearly illustrates this principle. Currently, the pain is severe and surging; rich, cloying tonics seem inappropriate. Considering that chronic pain often resides in the collaterals, and the Chong Mai (Penetrating Vessel) is the Sea of Blood, we first propose a decoction to harmonize the Chong and Ren vessels, ensuring smooth flow through the collaterals and free movement of Qi mechanisms. Once the pain subsides slightly, we will discuss pill preparations to eradicate the root cause.
An Bo’s Note: For the decoction, it is proposed to use the method of Tong Yu Jian (Unblocking Stasis Decoction) to make pills, combined with Hui Sheng Dan (Revive Life Pill) for simultaneous purgative and tonic effects.
After ten days of Yi Zheng (epidemic febrile disease), there is deficiency of healthy Qi mixed with pathogenic factors. Symptoms include listlessness, deafness, and persistent fever. The pulse is deep, fine, and powerless. Based on the pulse, the treatment should theoretically involve strengthening the Middle Jiao and warming to support expulsion. However, reviewing the prescription, three doses of Li Yin Jian (Regulating Yin Decoction) were taken, yet the condition worsened daily, suggesting the previous method is difficult to continue. Yang syndrome presenting with Yin pulse is generally inadvisable. Medical texts note that in epidemic diseases, pathogens may lie hidden internally, resulting in a deep and fine pulse, unlike Shang Han (Cold Damage) where pathogens come from outside, typically presenting with a floating and large pulse. This statement is worth considering. We imitate Zhao’s method of Liu Wei Tang (Six-Ingredient Decoction) adding Chai Hu (Bupleurum). On follow-up, the pulse remains deficient and fine; spirit and form are exhausted; lips and teeth are dry; tongue coating is yellow, dry, and turning black. Pathogenic heat is the greatest thief of True Yin. In elderly patients with inherent Kidney Yin deficiency, severe heat further consumes fluids. As stated in *Ji Ren Bian*, managing infectious syndromes always prioritizes preserving fluids. This is because the Dry Earth of the Yangming channel relies entirely on the Kidney Water of Shaoyin for nourishment. Like a dry field next to a wellspring, irrigation is possible if the spring exists; but if the spring dries up, the dry earth steams, and seedlings wither. Therefore, we adopt Gan Lu Yin (Sweet Dew Decoction).