（血瘕，即儿枕，宜参看。）
〔大〕夫积者，阴气也，五脏所生。聚者，阳气也，六脏所成。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。聚为
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〕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，面色痿黄，痛则 白，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，专用破血驱逐之药，痛攻两胁，肚腹
尤甚，益信为鳖确。服下虫等药，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。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，殊类瘵证，久而不愈。余
谓肝脾血气亏损，用八珍汤、逍遥散、归脾汤，随证互服而愈。
〔大〕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，至产血下则少，故致此病也。不急治，则多成积结，妨害月水，
轻则痞涩，重则不通也。
〔薛〕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。《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。
〔丹〕南山妇人年三十八，于九月二十三日月经行，比前过后十日，得草药以败血
海，为下胎之谋，有数滴血下，因此腹痛，在小腹下有块如碗大，不可按，汤熨则痛稍定，
大小便抽痛，小便涩，大便略下少赤积垢，食不进，口略渴发热，此胃气为草药所败，加
以受伤之血妄行而不得泄，所以为病也。
砂仁 甘草（炙） 川芎 黄芩（各三分） 滑石（一钱半） 牛膝（二钱） 桃仁（七粒）
上水、酒煎服。
芍药汤 （《保命》）治产后诸积不可攻，宜养阴去热，其病自安。
芍药（一斤） 黄芩 茯苓（各六两）
上锉散，每以半两，水煎温服，日三。
〔丹〕产后消血块。
滑石（三钱） 没药 血竭（各二钱）
上为细末，醋糊丸。如恶露不下，以五灵脂为细末，面糊丸，白术汤、陈皮汤任下。
又方 消血块。
香附（童便浸） 桃仁（去皮留尖，等分）
为末，醋糊丸。
治血瘕作痛，脐下胀满，或月经不行，发热体倦。
当归（二两） 桂心 芍药 血竭 蒲黄（炒，各一两半） 延胡索（炒，一两）
上为末，每服二钱，空心热酒调下。
葛氏方（治证同前。）桂心为末，每服一钱，空心酒调下。
《产宝》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。
《千金》疗血瘕。
先干地黄（一两） 乌贼鱼骨（二两）
上为细末，空心温酒调服二钱匕。
四神散 治产后瘀血不消，积聚作块，心腹切痛。
川芎 当归（去芦） 干姜（炮） 赤芍药（各等分）
上为细末，每服二钱，食远用温酒调服。
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。
桂心 当归 赤芍药 牡丹皮 没药 槟榔（各半两） 青皮 干漆（炒烟尽，各七钱半）
大黄 桃仁（去皮尖） 三棱（煨） 玄胡索 鳖甲（酥
炙） 浓朴（制，各一两）
上为细末，炼蜜和丸梧子大。每服三四十丸，食前用温酒送下。
〔大〕所谓“积”，属于阴气，由五脏产生；所谓“聚”，属于阳气，由六腑形成。这都是由于饮食不节制，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”的特点是疼痛位置没有定处。之所以如此，是因为“积”属阴气，阴性沉伏潜藏，所以疼痛不离其部；“聚”属阳气，阳性浮动游走，所以疼痛无常处。产后气血损伤脏腑，导致脏腑虚弱，风冷之邪乘虚而入，与脏腑搏结，并与气血相互纠缠，从而形成积聚肿块。
〔薛〕上述证候乃是真气亏损，邪气趁虚侵袭所致。况且是在产后发生，更应当以固护真气为主要治疗原则。如果追求立竿见影的效果而采用攻伐邪气的方法，则会加速病情的危重。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肿块，有时疼痛且位置转动不定，按压时不痛，面色萎黄，疼痛时脸色发白，脉象浮而涩。我认为这是肝气虚而血弱的表现，但患者不信，反而使用破血行气的药物，导致疼痛更加剧烈，肿块转动无常。后来又误认为是“血鳖”（一种瘀血形成的硬块），专门使用破血驱逐的药物，疼痛攻冲两胁，肚腹尤其严重，这更加确信是“鳖”作祟。服用下虫等药物后，出血很多，形体和气更加虚弱，四肢关节间各结成小核，隐于肌肉之中，认为这是“鳖子”畏惧药物而逃窜到体表。我说：肝藏血而滋养全身筋脉，这是因为肝血再次受损，筋脉干枯而挛缩结聚。因为四肢关节、胸部和颈部都属于肝胆所主的部位，应当补益脾土，补益肺金和水液（肾水），以滋养肝血，那么筋脉自然舒展。于是使用八珍汤、逍遥散、归脾汤加减，调理治疗后痊愈。另一位妇女月经不调，两胁肿胀，小便涩滞不畅，腹中有一块肿块作痛，有时向上攻冲胁腹，有时向下攻冲小腹，伴有发热、午后潮热、恶寒、肌肤消瘦、饮食无味，症状极似虚劳痨病（瘵证），久治不愈。我认为这是肝脾血气亏损，使用八珍汤、逍遥散、归脾汤，根据症状交替服用而痊愈。
〔大〕新近分娩后，有因血与气相互搏结而疼痛的，称为“瘕”。“瘕”字意为假，指其疼痛虚假无定处。这是由于素来有风冷血气停滞，未加治疗，到了生产时血液下行减少，从而导致此病。如果不及时治愈，大多会形成积结，妨害月经，轻则痞塞涩滞，重则完全不通。
〔薛〕上述证候乃是寒邪客居体内，气血壅结所致，这是因气病而导致血病。应当补养胃气，调和月经，以宽缓静养为宜。《难经》说：任脉的病，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。
〔丹〕南山的一位妇人，三十八岁，在九月二十三日月经来潮，比平时晚了十天。她服用草药试图败坏血海，作为堕胎的手段，只有几滴血流出，因此出现腹痛，在小腹下有碗大的肿块，不可按压，热敷后疼痛稍定，大小便时有抽掣样疼痛，小便涩滞，大便略排出少量赤色积垢，进食困难，口微渴，发热。这是胃气被草药败坏，加上受伤的血妄行而不能泄出，所以致病。
砂仁 甘草（炙） 川芎 黄芩（各三分） 滑石（一钱半） 牛膝（二钱） 桃仁（七粒）
以上药材用水、酒煎服。
芍药汤（出自《保命集》）：治疗产后各种积聚不可攻伐，宜养阴清热，病自然安宁。
芍药（一斤） 黄芩 茯苓（各六两）
以上锉成散剂，每次取半两，水煎温服，每日三次。
〔丹〕治疗产后消除血块。
滑石（三钱） 没药 血竭（各二钱）
以上研为细末，用醋糊制成丸药。如果恶露不下，可用五灵脂研为细末，面糊制丸，用白术汤或陈皮汤送服均可。
又一方：消除血块。
香附（童便浸泡） 桃仁（去皮留尖，等分）
研为细末，醋糊制丸。
治疗血瘕作痛，脐下胀满，或月经不行，发热体倦。
当归（二两） 桂心 芍药 血竭 蒲黄（炒，各一两半） 延胡索（炒，一两）
以上研为细末，每次服二钱，空腹时用热酒调服。
葛氏方（主治证候同前）：桂心研为细末，每次服一钱，空腹时用酒调服。
《产宝》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，约减去三分之二，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。
《千金方》治疗血瘕。
先干地黄（一两） 乌贼鱼骨（二两）
以上研为细末，空腹时用温酒调服二钱匕。
四神散：治疗产后瘀血不消，积聚成块，心腹剧烈疼痛。
川芎 当归（去芦） 干姜（炮） 赤芍药（各等分）
以上研为细末，每次服二钱，饭后较远时用温酒调服。
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，四肢羸瘦烦疼。
桂心 当归 赤芍药 牡丹皮 没药 槟榔（各半两） 青皮 干漆（炒至烟尽，各七钱半） 大黄 桃仁（去皮尖） 三棱（煨） 玄胡索 鳖甲（酥炙） 浓朴（制，各一两）
以上研为细末，炼蜜和丸，如梧桐子大。每次服三四十丸，饭前用温酒送下。
(Blood Jia, also known as Erzhen [postpartum lochia retention], is suitable for reference to relevant discussions.)
[Da] The so-called "Ji" (accumulation) belongs to Yin Qi and is generated by the Five Zang organs; the so-called "Ju" (gathering) belongs to Yang Qi and is formed by the Six Fu organs. These are all caused by irregular diet and disharmony of cold and heat, leading to the stagnation of Qi in the Five Zang organs forming "Ji", and the obstruction of Qi in the Six Fu organs forming "Ju". The characteristic of "Ji" is that the pain remains fixed in its location; the characteristic of "Ju" is that the pain has no fixed location. The reason for this is that "Ji" belongs to Yin Qi, whose nature is sinking and latent, so the pain does not leave its location; "Ju" belongs to Yang Qi, whose nature is floating and wandering, so the pain has no constant place. After childbirth, Qi and Blood damage the Zang-Fu organs, causing them to become weak. Wind-Cold pathogens take advantage of this weakness to invade, combing with the Zang-Fu organs and entangling with Qi and Blood, thereby forming accumulations and masses.
[Xue] The aforementioned syndrome is due to the depletion of True Qi, allowing pathogenic factors to invade when the body's resistance is low. Moreover, since it occurs postpartum, the primary treatment principle should be to consolidate True Qi. If one seeks immediate effects by using methods to attack and eliminate pathogens, it will accelerate the danger of the condition. One should refer to the various formulas and discussions on "Ji-Ju" in miscellaneous diseases mentioned earlier for treatment. A certain postpartum woman had a lump in her abdomen that sometimes hurt and moved around; pressing it did not cause pain. Her complexion was sallow, and she turned pale when in pain. Her pulse was floating and choppy. I considered this to be Liver Qi deficiency and Blood weakness. However, she did not believe this and instead used blood-breaking and Qi-moving drugs, which made the pain more severe and the lump movement erratic. Later, it was mistaken for "Xue Die" (a hard mass formed by blood stasis), and drugs specifically for breaking blood and expelling were used exclusively. The pain attacked both hypochondriac regions, with the abdomen being particularly severe, further convincing her that it was indeed a "Die". After taking drugs to expel parasites, she lost a lot of blood, becoming even more deficient in form and Qi. Small nodules formed in the joints, hidden within the muscles, which was thought to be "Die offspring" fleeing outward due to fear of the medicine. I said: The Liver stores Blood and nourishes the sinews throughout the body. This is because Liver Blood was damaged again, causing the sinews to dry up and contract into knots. Since the limbs, joints, chest, and neck all belong to the areas governed by the Liver and Gallbladder, one should tonify Spleen Earth, supplement Lung Metal and Kidney Water to nourish Liver Blood, so that the sinews will naturally relax. Thus, Ba Zhen Tang, Xiao Yao San, and Gui Pi Tang were modified and used for regulation, resulting in recovery. Another woman had irregular menstruation, swelling in both hypochondriac regions, dysuria, and a painful mass in the abdomen that sometimes attacked upward to the hypochondrium and abdomen or downward to the lower abdomen. She had fever, afternoon tidal fever, aversion to cold, emaciation, and loss of appetite. Her symptoms closely resembled consumptive disease (Zhai Syndrome), but it persisted without cure. I considered this to be a deficiency of Liver and Spleen Qi and Blood. Using Ba Zhen Tang, Xiao Yao San, and Gui Pi Tang, alternating according to symptoms, led to recovery.
[Da] In the immediate postpartum period, pain caused by the combat between Blood and Qi is called "Jia". The character "Jia" means false, indicating that the pain is fleeting and has no fixed location. This is due to pre-existing stagnation of Wind-Cold and Blood-Qi that was not treated. During childbirth, blood flow decreases, leading to this disease. If not treated urgently, it often becomes an accumulation, interfering with menstruation. Mild cases present with stuffiness and sluggishness, while severe cases result in complete obstruction.
[Xue] The aforementioned syndrome is caused by Cold Pathogens lodging in the body, leading to Qi and Blood congestion and knotting. This is a case where Qi pathology leads to Blood pathology. One should tonify Stomach Qi, regulate menstruation, and adopt a relaxed and quiet rest approach. The *Nan Jing* states: Diseases of the Ren Mai manifest as Seven Types of Hernia in men and Jia-Ju in women. Refer to the discussions before and after for treatment.
[Dan] A woman from Nanshan, aged thirty-eight, had her menstrual period on September 23rd, ten days later than usual. She took herbal medicine intended to ruin the Blood Sea for the purpose of abortion. Only a few drops of blood came out, after which she suffered from abdominal pain. There was a bowl-sized mass in the lower abdomen that could not be pressed; hot compresses slightly relieved the pain. There was pulling pain during urination and defecation, urinary difficulty, and only a small amount of reddish fecal debris passed. She could not eat and had slight thirst and fever. This was because Stomach Qi was ruined by the herbs, compounded by injured Blood flowing recklessly without being able to discharge, thus causing illness.
Sha Ren (Amomi Fructus), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Huang Qin (Scutellariae Radix) (each 3 fen), Hua Shi (Talcum, 1.5 qian), Niu Xi (Achyranthis Bidentatae Radix, 2 qian), Tao Ren (Persicae Semen, 7 grains).
Decoct these with water and wine for oral administration.
Shaoyao Tang (from *Baoming Ji*): Treats various postpartum accumulations that must not be attacked aggressively. It is appropriate to nourish Yin and clear Heat, after which the condition will naturally settle.
Shaoyao (Paeoniae Radix Alba, 1 jin), Huang Qin (Scutellariae Radix), Fu Ling (Poria) (each 6 liang).
Crush into powder. Take half a liang each time, decoct with water, and take warm. Three times daily.
[Dan] To eliminate blood clots postpartum.
Hua Shi (Talcum, 3 qian), Moyao (Myrrha), Xuexie (Dracaenae Sangue) (each 2 qian).
Grind into fine powder and make pills with vinegar paste. If lochia does not descend, grind Wulingzhi (Trogopterori Faeces) into fine powder, make pills with flour paste, and administer with Baizhu Tang or Chenpi Tang at discretion.
Another formula: Eliminate blood clots.
Xiangfu (Cyperi Rhizoma, soaked in child's urine), Tao Ren (Persicae Semen, peeled leaving the tip, equal parts).
Grind into powder and make pills with vinegar paste.
Treats pain from Blood Jia, fullness below the umbilicus, amenorrhea, fever, and fatigue.
Danggui (Angelicae Sinensis Radix, 2 liang), Guixin (Cinnamomi Cortex), Shaoyao (Paeoniae Radix), Xuexie (Dracaenae Sangue), Puhuang (Typhae Pollen, stir-fried) (each 1.5 liang), Yanhusuo (Corydalis Rhizoma, stir-fried, 1 liang).
Grind into powder. Take 2 qian each time, mixed with hot wine on an empty stomach.
Ge Shi Fang (Treatment indications same as above): Guixin (Cinnamomi Cortex) ground into powder. Take 1 qian each time, mixed with wine on an empty stomach.
*Chan Bao* treats Blood Jia with pain having no fixed location.
Tongbian (Child's Urine, 3 sheng), Sheng Dihuang Zhi (Fresh Rehmanniae Radix Juice), Sheng Ou Zhi (Fresh Nelumbinis Nuciferae Rhizome Juice) (each 1 sheng), Sheng Jiang Zhi (Fresh Zingiberis Rhizome Juice, 3 sheng).
First decoct the first three ingredients until reduced by two-thirds. Then add Ginger Juice and simmer slowly over low heat until thick like syrup. Take 1 he each time, mixed with warm wine.
*Qian Jin* treats Blood Jia.
Xian Gan Dihuang (Dried Rehmanniae Radix, 1 liang), Wuzeiyu Gu (Sepiae Endoconcha, 2 liang).
Grind into fine powder. Take 2 qian bich (approx. 2-3 grams) with warm wine on an empty stomach.
Si Shen San: Treats postpartum unresolved blood stasis, accumulation forming masses, and cutting pain in the heart and abdomen.
Chuan Xiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix, de-gorged), Ganjiang (Zingiberis Rhizoma, processed), Chi Shaoyao (Paeoniae Radix Rubra) (equal parts).
Grind into fine powder. Take 2 qian each time, taken with warm wine well after meals.
Guixin Wan: Treats postpartum un-dispersed Blood and Qi, accumulation forming masses, attacking upward to the heart and abdomen, or causing alternating chills and fever, emaciation of limbs, and vexatious pain.
Guixin (Cinnamomi Cortex), Danggui (Angelicae Sinensis Radix), Chi Shaoyao (Paeoniae Radix Rubra), Mudanpi (Moutan Cortex), Moyao (Myrrha), Binglang (Arecae Semen) (each 0.5 liang), Qingpi (Citri Reticulatae Pericarpium Viride), Ganqi (Crotonis Fructus, stir-fried until smoke ceases) (each 0.75 liang), Dahuang (Rhei Radix et Rhizoma), Tao Ren (Persicae Semen, peeled and de-pipined), Sanleng (Sparganii Rhizoma, roasted), Xuansu (Corydalidis Rhizoma), Biejia (Testudinis Carapax et Plastrum, fried with butter), Houpo (Magnoliae Officinalis Cortex, processed) (each 1 liang).
Grind into fine powder, mix with refined honey, and make pills the size of wutong seeds. Take 30-40 pills each time before meals, delivered with warm wine.