蓄血者。或伤寒传经之邪。或温疫时气之邪。传于血室之中。致周身之血。皆为邪所招致。而蓄聚胞中。小
腹胀痛。其人或寒或热。昼日明了。夜则谵语。甚则发狂。呼叫打骂。内经所谓血在上喜忘。血在下如狂是
也。癫犬咬伤。毒聚胞中。故令发狂。皆属蓄血之证。仲景抵当汤治之。桃仁承气汤亦治之。若胆识不及。可
用膈下逐瘀汤。加大黄。若血犹未结。但是热入血室。夜则谵语。用小柴胡汤。加桃仁丹皮治之。
（附血肿）
血臌之证。胁满小腹胀。满身上有血丝缕。烦躁漱水。小便赤。大便黑。腹上青筋是也。医书俱云是妇人之
病。唯喻嘉言谓男子恒有之。面色萎黄。有蟹爪纹路。脉虽虚极。而步履如故。多怒善忘。口燥便秘。胁胀腹
疼。迨胀之既成。腹大如箕。遂不可救。东南最多。所以然者。东海饶鱼盐。鱼者甘美之味。多食令人热中。盐
者咸苦之味。其性偏于走血。血为阴象。初与热合。不觉其病。日久月增。中焦冲和之气。亦渐为热矣。气热
则结。而血不流矣。于是气居血中。血裹气外。一似妇人受孕者然。至弥月时。腹如抱瓮。推而言之。凡五方
之膏粱浓味。椒姜桂糈。成热中者。皆其类也。治之之法。以六君子汤。加干姜川芎防己为末。陈米荷叶煎
汤泛丸。白汤下。执中央以运四旁法也。
谨按喻氏之论。其言血臌之原。最为详确。惟所主之方。与气热则结。而血不流之说。未能吻合。盖六君子
与所加之药。于治痰臌为宜。且须寒饮。方为切合。如论所谓。宜用清和理气之品。攻剂代抵当丸主之。和
剂丹栀逍遥散。加姜黄香附治之。诸书皆用桃奴散。或琥珀散治之。第两方用温药。亦血因寒凝之剂。与
喻氏所论。又有不同。医者审证择用可也。
又有石瘕肠覃。状如怀子。腹日以大。月事以时下者为肠覃。以寒客于肠外。气病而血不病也。宜橘核丸
主之。月事不以时下者为石瘕。乃寒气客于子门。子门闭塞。恶血当下不下。 以留止。故成石瘕。是气病
而血亦病也。宜琥珀散桃奴散治之。后服温经汤。
单腹胀者为血臌。若四肢皆胀。或先从四肢肿起。其色红者。谓之血肿。亦有不红者。血从水化而为水。故
不红也。或得于吐衄之后。瘀血化水而肿。或得于妇人经水不行。血化为水而肿。既化为水。则兼治水。五
皮饮。加当归白芍蒲黄丹皮桃仁治之。或用干漆雄黄。醋丸麦芽汤下亦可。
又凡臌胀浮肿。俱要分阴证阳证。阴证脉沉涩弦紧。必有寒痰诸证。宜中满分消汤加桃仁。阳证脉数口
渴。便短气逆等证。宜小柴胡汤。加知母石膏防己丹皮桃仁猪苓茯苓车前子治之。另详六卷肿胀门。
蓄血证，是由伤寒传经之邪，或温疫时气之邪，传入血室（指肝脏及冲脉等与血液运行密切相关的部位）所致。这导致全身之血被邪气吸引，而蓄积在胞中（此处泛指下焦血海），出现小腹胀痛。患者有时恶寒，有时发热，白天神志清醒，夜间则胡言乱语，严重时会发狂，呼叫打骂。《内经》所说的“血在上则健忘，血在下则如狂”正是此意。被疯狗咬伤后，毒邪聚于胞中，也会导致发狂，这些都归属于蓄血证。张仲景用抵当汤治疗此证，桃仁承气汤也可以治疗。如果医者胆识不足，可以使用膈下逐瘀汤，并加大黄。如果血尚未凝结成块，仅仅是热邪进入血室，夜间出现胡言乱语，可用小柴胡汤，加入桃仁、丹皮治疗。
（附：血肿）
血臌（以腹部胀大如鼓、肤色青紫为特征的病证）的症状是：胁肋部胀满，小腹胀满，身上有血丝缕状纹路，烦躁不安，想漱口但不欲咽水，小便颜色深红，大便黑色，腹部表面有青色筋脉显露。医书都说是妇女的病，只有喻嘉言认为男子也常有此病。面色萎黄，皮肤上有蟹爪状的纹路，脉象虽然极度虚弱，但行走如常。患者容易发怒，善忘，口燥便秘，胁肋胀满腹痛。等到胀满形成之后，腹部大得像簸箕一样，就不可救治了。这种病在东南地区最多。之所以如此，是因为东海一带盛产鱼盐。鱼是甘美之味，多吃使人热蕴于中；盐是咸苦之味，其性偏于走散入血。血属阴象，起初与热邪结合，不觉得有病，日久月增，中焦冲和之气也逐渐变为热邪。气热则凝结，而血行不畅。于是气居于血中，血包裹着气外，就像妇人怀孕一样。到了临产时，腹部像抱着瓮一样大。推而言之，凡是五方之地食用膏粱厚味、椒姜桂辛等能导致热蕴于中的食物，都属于此类。治疗的方法，是用六君子汤，加入干姜、川芎、防己研为细末，用陈米、荷叶煎汤泛丸，白开水送服。这是执掌中焦脾胃之气以运化四旁的方法。
谨按：喻氏关于血臌起源的论述，最为详细确切。只是他所主张的方剂，与“气热则结，而血不流”的说法不能吻合。因为六君子汤及其所加的药物，治疗痰臌较为适宜，且须配合寒饮，才更为切合。如文中所说，宜用清和理气的药物，攻伐之剂可用代抵当丸为主，调和之剂可用丹栀逍遥散，加入姜黄、香附治疗。各书多用桃奴散，或用琥珀散治疗。但这两个方子使用温药，也是治疗因寒凝血的药剂，与喻氏的论述又有不同。医者审察证候选择使用即可。
又有石瘕、肠覃，形状如同怀孕，腹部日渐增大。月经按时来潮的是肠覃，是因为寒气客居在肠外，气分有病而血分无病，宜用橘核丸主治。月经不按时来潮的是石瘕，乃是寒气客居在子门（子宫口），子门闭塞，恶血当下不下，因而留止，所以形成石瘕。这是气分有病而血分也有病，宜用琥珀散、桃奴散治疗，随后服用温经汤。
单见腹部胀大的是血臌。如果四肢都肿胀，或者先从四肢肿起，颜色发红者，称为血肿。也有不发红的，是因为血转化为水而为水湿，所以不红。有的是由于吐血、衄血之后，瘀血化为水而肿胀；有的是由于妇人月经不行，血化为水而肿胀。既然已经化为水，就要兼治水肿。可用五皮饮，加入当归、白芍、蒲黄、丹皮、桃仁治疗。或用干漆、雄黄，醋制为丸，麦芽汤送下也可以。
另外，凡臌胀浮肿，都要区分阴证和阳证。阴证脉象沉涩弦紧，必有寒痰等各种证候，宜用中满分消汤加入桃仁。阳证脉数、口渴，伴有小便短少、气逆等证候，宜用小柴胡汤，加入知母、石膏、防己、丹皮、桃仁、猪苓、茯苓、车前子治疗。另详第六卷肿胀门。
Blood Accumulation Syndrome is caused by pathogenic factors from the transmission of cold damage (Shanghan) or epidemic warm diseases (Wenyi), entering the Blood Chamber (referring to areas closely related to blood circulation such as the Liver and Chong Mai). This attracts the blood of the entire body, causing it to accumulate in the Bao Zhong (here referring generally to the Lower Jiao Sea of Blood), resulting in distension and pain in the lower abdomen. The patient may experience chills or fever; consciousness is clear during the day but delirious at night. In severe cases, madness occurs, with shouting, beating, and scolding. As stated in the *Neijing*: "Blood accumulating above leads to forgetfulness; blood accumulating below resembles madness." This refers to this condition. When bitten by a mad dog, toxic pathogens gather in the Bao Zhong, also leading to madness. All these belong to Blood Accumulation Syndrome. Zhang Zhongjing treats this with Didang Tang (Eaglewing Decoction), and Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) can also be used. If the physician's courage and discernment are insufficient, Gexia Zhuyu Tang (Decoction for Expelling Stasis Below the Diaphragm) can be used, with added Dahuang (Rhubarb Root and Rhizome). If the blood has not yet coagulated into masses, but only heat has entered the Blood Chamber causing nighttime delirium, Xiaochaihu Tang (Minor Bupleurum Decoction) with added Taoren (Peach Seed) and Danpi (Moutan Bark) should be used.
(Attached: Blood Swelling)
The symptoms of Xuegu (Blood Drum, a syndrome characterized by abdominal distension like a drum and purplish skin discoloration) include: fullness and distension in the hypochondrium and lower abdomen, thread-like red streaks on the body, irritability, a desire to rinse the mouth without swallowing water, dark red urine, black stools, and visible blue veins on the abdominal surface. Medical texts claim this is a disease exclusive to women, but Yu Jiayan argued that men also frequently suffer from it. The complexion is sallow, with crab-claw-like patterns on the skin. Although the pulse is extremely deficient, walking ability remains normal. The patient is prone to anger and forgetfulness, suffers from dry mouth and constipation, and experiences hypochondriac distension and abdominal pain. Once the distension is fully formed, the abdomen becomes as large as a winnowing basket, making it incurable. This disease is most common in the southeast. The reason is that the East China Sea abounds in fish and salt. Fish are sweet and delicious; excessive consumption causes heat to accumulate in the middle. Salt is salty and bitter; its nature tends to disperse into the blood. Blood belongs to Yin. Initially combining with heat, no illness is felt. Over time, the harmonious Qi of the Middle Jiao gradually transforms into heat. Heat causes Qi to coagulate, and blood flow stagnates. Thus, Qi resides within the blood, and blood wraps around the Qi externally, resembling pregnancy. By the time of delivery, the abdomen is as large as a jar. Extending this logic, any rich and fatty foods, or pungent herbs like pepper, ginger, and cinnamon consumed in various regions that cause heat accumulation in the middle, fall into this category. The treatment method involves using Liujunzi Tang (Six Gentlemen Decoction) with added Ganjiang (Dried Ginger), Chuanxiong (Sichuan Lovage Rhizome), and Fangji (Stephania Root) ground into powder. These are made into pills using decoctions of aged rice and lotus leaves, taken with plain boiled water. This employs the method of controlling the Central Jiao (Spleen/Stomach) to regulate the four peripheries.
Respectfully noted: Yu's discussion on the origin of Blood Drum is the most detailed and accurate. However, his prescribed formula does not align with the theory that "heat causes Qi to coagulate and blood to stagnate." Liujunzi Tang and its added herbs are more suitable for treating Phlegm Drum, especially when combined with cold fluids. As mentioned in the text, one should use clearing and harmonizing Qi-regulating agents. For attacking methods, Daididang Wan (Great Eaglewing Pill) should be the main prescription. For harmonizing methods, Danzhi Xiaoyao San (Moutan and Gardenia Free and Easy Wanderer Powder) with added Jianghuang (Turmeric Rhizome) and Xiangfu (Cyperus Rhizome) should be used. Various books recommend Taonusan (Peach Bud Powder) or Huposan (Amber Powder). However, both formulas use warming herbs, treating stasis due to cold coagulation, which differs from Yu's discussion. Physicians should examine the syndrome and choose appropriately.
There are also Shijia (Stone Mass) and Changtan (Intestinal Polyp/Tumor), which resemble pregnancy with progressively enlarging abdomens. If menstruation occurs on time, it is Changtan, caused by cold pathogens lodging outside the intestines, affecting Qi but not Blood. Juhe Wan (Tangerine Seed Pill) is indicated. If menstruation is irregular, it is Shijia, caused by cold pathogens lodging in the Zimen (uterine opening), blocking it so that evil blood cannot discharge and accumulates, forming Shijia. This affects both Qi and Blood. Huposan and Taonusan are indicated, followed by Wenjing Tang (Warm the Menses Decoction).
Abdominal distension alone is Blood Drum. If all four limbs swell, or swelling starts in the limbs with red discoloration, it is called Blood Swelling. There are cases without redness because blood transforms into water, thus appearing non-red. Some cases arise after hematemesis or epistaxis, where blood stasis transforms into water causing edema. Others result from amenorrhea in women, where blood transforms into water causing edema. Once transformed into water, water-draining treatments must be combined. Wupi Yin (Five-Bark Decoction) with added Danggui (Angelica Sinensis), Baishao (White Peony Root), Puhuang (Pollen Typhae), Danpi, and Taoren is indicated. Alternatively, Ganqi (Drynaria Rhizome) and Xionghuang (Realgar) made into pills with vinegar, taken with malt decoction, is also acceptable.
Furthermore, all drum-like distensions and edemas must be distinguished between Yin and Yang syndromes. Yin syndromes present with deep, choppy, wiry, or tight pulses and symptoms of cold-phlegm. Zhongman Fenxiao Tang (Middle Fullness Resolving Decoction) with added Taoren is indicated. Yang syndromes present with rapid pulses, thirst, scanty urine, and qi rebellion. Xiaochaihu Tang with added Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum), Fangji, Danpi, Taoren, Zhuling (Polyporus), Fuling (Poria), and Cheqianzi (Plantago Seed) is indicated. See Volume 6, Chapter on Distension and Edema for details.