（附∶化瘀通经散）
女子 瘕，多因产后恶露未净，凝结于冲任之中，而流走之新血，又日凝滞其上以附益之，遂渐积
而为 瘕矣。 者，有实可征，在一处不移。瘕者，犹可移动，按之或有或无，若有所假托。由斯而论，
固甚于瘕矣。此证若在数月以里，其身体犹强壮，所结之 瘕犹未甚坚，可用《金匮》下瘀血汤下之。然必如
《金匮》所载服法，先制为丸，再煎为汤，连渣服之方效。
若其病已逾年，或至数年， 瘕积将满腹，硬如铁石，月信闭塞，饮食减少，浸成痨瘵，病势至此，再
投以下瘀血汤，必不能任受；即能任受，亦不能将瘀血通下。惟治以拙拟理冲汤补破之药并用，其身形弱者
服之，更可转弱为强。即十余年久积之 瘕，硬如铁石，久久服之，亦可徐徐尽消。本方后附载有治愈之
案若干，可参观也。近在津门，用其方因证加减，治愈 瘕数人。爰录一案于下，以为治斯病之粗规。
天津张氏妇，年近四旬，自言∶“五年之前，因产后恶露未净，积为硬块，其大如橘，积久渐大。
初在脐下，今则过脐已三四寸矣。其后积而渐大者，按之犹软。其初积之块，则硬如铁石，且觉其处甚凉。初
犹不疼，自今年来渐觉疼痛。从前服药若干，分毫无效，转致饮食减少，身体软弱，不知还可治否？”言
之似甚惧者。愚曰∶“此勿忧，保必愈。”因问其月信犹通否。言从前犹按月通行，今虽些许通行，已不
按月，且其来浸少，今已两月未见矣。诊其脉，涩而无力，两尺尤弱。爰为疏方∶生黄
四钱，党参、白术、当归、生山药、三棱、莪术、生鸡内金各
三钱，桃仁、红花、生水蛭各二钱， 虫五个，小茴香钱半。煎汤一大盅，温服。将药连服四剂，腹已不疼，
病处已不觉凉，饮食加多，脉亦略有起色。遂即原方去小茴香，又服五剂，病虽未消而周遭已渐软。惟上
焦觉微热。因于方中加玄参三钱，樗鸡八枚。又连服十余剂，其 瘕全消。
然 瘕不必尽属瘀血也。大抵瘀血结为 瘕者，其人必碍生育，月信恒闭。若其人不碍生育，月信亦屡
见者，其 瘕多系冷积。其身形壮实者，可用炒熟牵牛头次所轧之末三钱下之。所下之积恒为半透明白色，状
若绿豆粉所熬之糊。若其身形稍弱者，亦可用黄 、人参诸补气之药煎汤，送服牵牛末。若畏服此峻攻
之药者，亦可徐服丸药化之。方用胡椒、白矾各二两，再用炒熟
麦面和之为丸，桐子大。每服钱半，日两次。服至月余，其 瘕自消。
若其处觉凉者，多服温暖宣通之药，其积亦可下。曾治张氏妇寒积，重用附子一案，详附子解后，可参阅。
无论血瘀冷积，日服真鹿角胶四五钱（分两次炖化服之），日久亦可徐消。盖鹿角胶原能入冲任以
通血脉，又能入督脉以助元阳，是以无论瘀血冷积，皆能徐为消化也。
近又拟一消 瘕兼通经闭方。用炒白术、天冬、生鸡内金等分，为细末。以治 瘕坚结及月事不通，
每服三钱，开水送下，日再服。若用山楂片三钱煎汤，冲化红蔗糖三钱，以之送药，更佳。因用之屡有效验，爰
名为化瘀通经散。
鸡内金原饶有化瘀之力，能化瘀当即善消 瘕。然向未尝单用之以奏效也。因所拟理冲汤中原有生鸡内
金三钱，方后注云∶若虚弱者，宜去三棱、莪术，将鸡内金改用四钱。鸡内金之消 瘕，诚不让三棱、莪
术矣。夫能消 瘕，即能通月信，此原一定之理，然未经临证实验，不敢但凭理想确定也，后来津治杨氏女，
因患瘰 过服寒凉开散之药，伤其脾胃，以致食后胀满，不能消化，重用温补脾胃之剂，加生鸡内金二钱，
以运化药力。后服数剂来更方，言病甚见愈，惟初服此药之夜，经即通下，隔前经期未旬日耳。因其病已
见愈，闻此言未尝注意，更方中仍有生鸡内金二钱。又服数剂，来求更方，言病已全愈，唯一月之内，行经
三次，后二次在服药之后，所来甚少，仍乞再为调治。愚恍悟此诚因用鸡内金之故。由此可确知鸡内金通经之
力。因忆在奉时，曾治宋氏女，胃有瘀积作疼，方中重用生鸡内金，服数剂后，二便下血而愈。此固见
鸡内金消瘀之力，实并见鸡内金通经之力也。总前后数案参观，鸡内金消瘀通经之力，洵兼擅其长矣。此
方中伍以白术者，恐脾胃虚弱，不任鸡内金之开通也。更辅以天冬者，恐阴虚有热，不受白术之温燥也。然
鸡内金必须生用，方有效验，若炒熟用之则无效矣。
（附：化瘀通经散）
女子患有癥瘕，多是因为产后恶露没有排净，凝结在冲脉和任脉之中，而流动的新血又每天凝滞在上面以助长它，于是逐渐积聚而形成癥瘕。所谓“癥”，是有实质可查的，固定在一个地方不移动；所谓“瘕”，还可以移动，按压时有时有肿块有时没有，像是假借什么东西存在一样。由此而论，癥病比瘕病更严重。这个病症如果在几个月以内，患者身体还强壮，所结成的癥块还不算坚硬，可以使用《金匮要略》中的下瘀血汤来攻下瘀血。但是必须按照《金匮要略》记载的服用方法，先制成丸药，再煎煮成汤剂，连同药渣一起服用才有效。
如果病情已经超过一年，甚至几年，癥瘕积聚几乎填满腹部，坚硬得像铁石一样，月经闭止，饮食减少，逐渐发展成虚劳痨病，病势到了这种地步，再投用下瘀血汤，患者一定承受不住；即使能承受，也不能将瘀血通下排出。只有用我拟定的理冲汤，补益药和破瘀药并用，对于身形瘦弱的患者服用，更能使虚弱转为强壮。即使是十多年的久积之癥，坚硬如铁石，长期服用，也可以慢慢完全消除。本方后面附有若干治愈的案例，可以参考。最近在天津，我用这个方子根据症状加减，治愈了几位癥瘕患者。于是记录一个案例在下面，作为治疗这种病的粗略规范。
天津张姓妇女，年龄接近四十岁，自己说：“五年前，因为产后恶露未净，积聚成硬块，大小像橘子，时间久了逐渐变大。起初在肚脐下方，现在则超过肚脐三四寸了。后来积聚逐渐变大的部分，按下去还是软的。最初积聚的那个块，则硬得像铁石，而且感觉那个部位很凉。起初还不疼，从今年开始渐渐觉得疼痛。以前吃过不少药，分毫无效，反而导致饮食减少，身体软弱，不知道还能不能治？”说话时显得很恐惧。我说：“不要担心，保证一定能治好。”于是问她的月经是否还通畅。她说以前还能按月通行，现在虽然还有一点通行，但已经不按月份了，而且量逐渐减少，现在已经两个月没来了。诊察她的脉搏，涩而无力，两尺脉尤其弱。于是为她开方：生黄芪四钱，党参、白术、当归、生山药、三棱、莪术、生鸡内金各三钱，桃仁、红花、生水蛭各二钱，䗪虫五个，小茴香一钱半。煎一大盅汤，温服。连续服药四剂后，肚子已经不疼了，患处也不觉得凉了，饮食增多，脉搏也略有起色。随即在原方中去掉小茴香，又服五剂，病虽未消除，但周围已渐渐变软。只是上焦觉得微热。于是在方中加入玄参三钱，樗鸡八枚。又连续服用十余剂，癥瘕全部消除。
然而，癥瘕不一定都属于瘀血。大致来说，瘀血结成癥瘕的患者，必定妨碍生育，月经经常闭止。如果患者不妨碍生育，月经也经常来的，其癥瘕多属于冷积。身形壮实的患者，可以用炒熟牵牛子头道和二道碾压后的粉末三钱来攻下。排出的积滞通常是半透明白色的，形状像绿豆粉熬成的糊状。如果身形稍弱的患者，也可以用黄芪、人参等补气药物煎汤，送服牵牛子粉末。如果畏惧服用这种峻猛攻下的药物，也可以慢慢服用丸药来化解。方子用胡椒、白矾各二两，再用炒熟的麦面和在一起做成丸药，大小如梧桐子。每次服用一钱半，每天两次。服用一个多月，癥瘕自然消除。
如果患处感觉凉的，多服用温暖宣通的药物，积滞也可以下行。曾经治疗过张姓妇女的寒积病例，重用附子，详见附子解说之后，可以参阅。无论是血瘀还是冷积，每天服用真鹿角胶四五钱（分两次炖化服用），日久也可以慢慢消除。因为鹿角胶本来就能进入冲任二脉以疏通血脉，又能进入督脉以辅助元阳，所以无论是瘀血还是冷积，都能慢慢消化。
最近又拟定了一个消除癥瘕兼通月经闭止的方子。用炒白术、天冬、生鸡内金等量，研成细末。用来治疗坚结的癥瘕及月经不通，每次服用三钱，开水送下，每天两次。如果用山楂片三钱煎汤，冲化红糖三钱，用它来送药，效果更好。因为使用多次都有疗效，所以命名为化瘀通经散。
鸡内金原本就很有化瘀的力量，能化瘀自然就善于消除癥瘕。然而过去从未单独使用它而奏效。因为我拟定的理冲汤中原有生鸡内金三钱，方后注释说：如果体质虚弱者，宜去掉三棱、莪术，将鸡内金改用四钱。鸡内金消除癥瘕的能力，确实不亚于三棱、莪术。能够消除癥瘕，就能通调月经，这原本是确定的道理，但是没有经过临床实验，不敢仅凭理想确定。后来在天津治疗杨姓女子，因为患瘰疬过量服用寒凉发散的药物，损伤了脾胃，导致饭后胀满，不能消化，重用温补脾胃的药剂，加入生鸡内金二钱，以运化药力。后来服药几剂来复诊，说病大有好转，只是初次服药的那晚，月经就通下了，距离前次经期不到十天。因为病已经好转，听到这话没有在意，复诊方中仍有生鸡内金二钱。又服几剂，来求换方，说病已经完全好了，唯一月之内，行经三次，后两次是在服药之后，量很少，仍然请求再调理。我突然领悟到这确实是因为用了鸡内金的缘故。由此可以确切知道鸡内金通经的力量。想起在奉天（今沈阳）时，曾治疗宋姓女子，胃中有瘀积作痛，方中重用生鸡内金，服几剂后，大小便下血而痊愈。这固然显示了鸡内金消瘀的力量，实际上也显示了鸡内金通经的力量。综合前后几个案例观察，鸡内金消瘀通经的力量，确实兼擅其长。这个方子中配伍白术，是担心脾胃虚弱，不能承受鸡内金的开通之力。更辅以天冬，是担心阴虚有热，不能耐受白术的温燥。然而鸡内金必须生用，才有效验，如果炒熟使用则无效了。
(Attachment: Huayu Tongjing San [Blood-Activating and Menstruation-Unblocking Powder])
Women suffering from *zheng* (masses with fixed location) and *jia* (masses with mobile location) often do so because lochia remains uncleaned after childbirth, coagulating within the Chong (Penetrating Vessel) and Ren (Conception Vessel). As new blood flows daily, it stagnates upon this coagulation, adding to it, until gradually accumulating into a mass. The term *zheng* refers to a condition with tangible evidence, fixed in one place without moving. The term *jia* refers to something that can still move; upon palpation, a mass may appear or disappear, as if falsely attributed. By this reasoning, *zheng* is indeed more severe than *jia*. If this condition occurs within several months, and the patient's body remains strong, and the formed mass is not yet very hard, one may use the Xiayuxue Tang (Downward-Purging Blood Decoction) from the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) to purge the blood stasis. However, one must strictly follow the administration method recorded in the *Jingui Yaolue*: first prepare it as pills, then decoct them into a soup, and consume it together with the dregs for efficacy.
If the illness has persisted for over a year, or even several years, and the *zheng* and *jia* accumulation nearly fills the abdomen, becoming hard as iron or stone, with amenorrhea (absence of menstruation), reduced appetite, and gradually developing into consumptive disease (Laozai), when the pathological trend reaches this stage, administering Xiayuxue Tang again will certainly be intolerable for the patient; even if tolerated, it cannot effectively purge the blood stasis. Only by using my formulated Lizhong Tang (Regulate the Middle Vessel Decoction), which combines tonifying and breaking agents, can patients with weak constitutions transform weakness into strength. Even for masses accumulated over ten years, hard as iron and stone, long-term consumption can slowly and completely eliminate them. Several cured cases are attached behind this formula for reference. Recently in Tianjin, I used this formula with modifications based on symptoms and cured several patients with *zheng* and *jia*. Therefore, I record one case below as a rough guideline for treating this disease.
A woman surnamed Zhang in Tianjin, nearing forty years of age, stated: "Five years ago, due to uncleaned lochia after childbirth, a hard mass accumulated, initially the size of an orange, which gradually enlarged over time. It was originally located below the umbilicus, but now extends three to four cun above it. The part that accumulated later and enlarged is still soft to the touch. However, the initial mass is hard as iron and stone, and feels very cold. Initially, there was no pain, but since this year, I have gradually felt pain. I have taken various medicines before with no effect whatsoever, leading to reduced diet and physical weakness. I wonder if it can still be treated?" She spoke with evident fear. I said, "Do not worry; it is guaranteed to heal." I then asked if her menstruation was still regular. She replied that previously it flowed monthly, but now although some flow persists, it is no longer monthly, and the volume is decreasing; she has not seen it for two months. Palpating her pulse, it was choppy (Se) and powerless, especially weak at both Chi (Cun) positions. Thus, I prescribed: Sheng Huangqi (Raw Radix Astragali) 4 qian, Dangshen (Radix Codonopsis), Baizhu (Rhizoma Atractylodis Macrocephalae), Danggui (Radix Angelicae Sinensis), Sheng Shanyao (Raw Rhizoma Dioscoreae), Sanleng (Tuber Sparganii), Ezhu (Rhizoma Curcumae), and Sheng Jineijin (Endothelium Corneum Gigeriae Galli) each 3 qian, Taoren (Semen Persicae), Honghua (Flos Carthami), and Sheng Shizhi (Hirudo) each 2 qian, E chong (Ground Beetle) 5 pieces, and Xiaohuixiang (Fructus Foeniculi) 1.5 qian. Decoct in a large cup of water, take warm. After taking four doses continuously, abdominal pain ceased, the affected area no longer felt cold, appetite increased, and the pulse showed slight improvement. Immediately, I removed Xiaohuixiang from the original prescription and administered five more doses. Although the mass had not disappeared, the surrounding area had gradually softened. However, the upper jiao felt slightly hot. Therefore, I added Xuanshen (Radix Scrophulariae) 3 qian and Chuji (Pollen Platycladi) 8 pieces to the formula. After taking more than ten doses continuously, the *zheng* and *jia* completely disappeared.
However, *zheng* and *jia* do not necessarily all belong to blood stasis. Generally speaking, those whose *zheng* and *jia* are formed from blood stasis must suffer from infertility, and their menstruation is frequently closed. If the patient does not suffer from infertility and menstruation occurs frequently, their *zheng* and *jia* are mostly due to cold accumulation. For those with robust constitutions, one can use 3 qian of powder from the first and second crushings of roasted Qian Niu Zi (Semen Pharbitidis) to purge the accumulation. The discharged accumulation is usually semi-transparent white, resembling paste made from mung bean flour. For those with slightly weaker constitutions, one can also use decoctions of tonifying Qi herbs such as Huangqi (Radix Astragali) and Renshen (Radix Ginseng) to deliver the Qian Niu Zi powder. For those who fear taking such harsh purgatives, one can slowly take pill medicine to resolve it. The formula uses 2 liang of Hujiao (Fructus Piperis Nigris) and Bai Fan (Alumen), mixed with roasted wheat flour to form pills the size of Torreya seeds. Take 1.5 qian per dose, twice daily. After taking for over a month, the *zheng* and *jia* will naturally dissipate.
If the affected area feels cold, taking more warming and circulating medications can also help discharge the accumulation. I once treated a case of cold accumulation in a woman surnamed Zhang, heavily using Fuzi (Radix Aconiti Lateralis Preparata); details are provided in the explanation of Fuzi for reference. Regardless of whether it is blood stasis or cold accumulation, taking 4-5 qian of real Lu Jiao Jiao (Colla Cornus Cervi) daily (divided into two doses, stewed until melted) can also slowly eliminate it over time. This is because Lu Jiao Jiao naturally enters the Chong and Ren vessels to unblock blood vessels, and also enters the Du (Governor Vessel) to assist Yuan Yang (Primordial Yang). Therefore, it can slowly digest both blood stasis and cold accumulation.
Recently, I formulated another prescription to eliminate *zheng* and *jia* while unblocking amenorrhea. It uses equal parts of Chao Baizhu (Stir-fried Rhizoma Atractylodis Macrocephalae), Tiandong (Radix Asparagi), and Sheng Jineijin (Endothelium Corneum Gigeriae Galli), ground into fine powder. To treat firm *zheng* and *jia* and menstrual obstruction, take 3 qian per dose, delivered with boiled water, twice daily. If taken with a decoction of 3 qian Shanzha (Fructus Crataegi) mixed with 3 qian dissolved red sugar, it is even better. Due to its frequent efficacy, I named it Huayu Tongjing San (Blood-Activating and Menstruation-Unblocking Powder).
Jineijin inherently possesses strong blood-activating power; being able to activate blood means it is good at eliminating *zheng* and *jia*. However, it has never been used alone to achieve efficacy. In my formulated Lizhong Tang, there is originally 3 qian of Sheng Jineijin. The note behind the formula states: for those who are weak, remove Sanleng and Ezhu, and increase Jineijin to 4 qian. The ability of Jineijin to eliminate *zheng* and *jia* is indeed not inferior to Sanleng and Ezhu. Being able to eliminate *zheng* and *jia* implies the ability to regulate menstruation; this is a definite principle. However, without clinical verification, I dare not determine it solely based on theory. Later, I treated a young woman surnamed Yang in Tianjin. She had suffered from scrofula (Luoli) and had taken excessive cold and dispersing medicines, damaging her Spleen and Stomach, resulting in postprandial fullness and indigestion. I heavily used warming and tonifying formulas for the Spleen and Stomach, adding 2 qian of Sheng Jineijin to facilitate the transformation of medicinal power. After taking several doses, she returned for a consultation, stating that her illness had greatly improved, but on the night she first took the medicine, her menstruation started, less than ten days before her previous cycle. Since her illness had improved, I did not pay much attention to this statement, and the revised prescription still contained 2 qian of Sheng Jineijin. After taking several more doses, she returned seeking a revision, stating that her illness was completely cured, except that she had menstruated three times within a month. The latter two occurrences were after taking the medicine, with scant flow, and she requested further regulation. I suddenly realized this was indeed due to the use of Jineijin. From this, I could definitely know the menstruation-unblocking power of Jineijin. I recalled that when I was in Fengtian (now Shenyang), I treated a young woman surnamed Song who had stomach pain due to blood stasis accumulation. I heavily used Sheng Jineijin in the formula. After taking several doses, she passed blood in stool and urine and was cured. This not only demonstrated Jineijin's power to eliminate stasis but also its power to unblock menstruation. Reviewing these cases collectively, Jineijin's power to eliminate stasis and unblock menstruation is indeed exceptional. The inclusion of Baizhu in this formula is to prevent the Spleen and Stomach from being too weak to bear the opening power of Jineijin. The addition of Tiandong is to prevent Yin deficiency with heat from tolerating the warming and drying nature of Baizhu. However, Jineijin must be used raw to be effective; if stir-fried, it loses its efficacy.