《大全》曰∶妇人 痞，由饮食失节，脾胃亏损，邪正相抟，积于腹中，牢固不动，有可征验，故名曰症 。
气道壅塞，故名曰痞。得冷则发，冷入子脏则不孕，入胞络则月水不通。
薛立斋按∶此证若脾胃虚弱，六君子加芎、归。若肝脾虚弱，补中汤及归脾汤。若肝火郁滞，佐以芦荟、
地黄二丸，外贴阿魏膏。患者须慎七情六淫，饮食起居。治者不时审察病机而药之，庶几有效。
《大全》曰∶妇人食 ，由脏腑虚弱，经行不忌生冷之物，不能消化，与脏气相持，结聚成块，日渐生长，
牢固不安，谓之 症，或劳伤元气所致。陈无择云∶经不行者，宜先导之，然后固元气为主。
薛立斋曰∶证若形气虚弱，须先调补脾胃为主，佐以消导。若形气充实，当先疏导为主，佐以补脾胃。若
气壅血滞而不行者，宜乌药散散而行之。若脾气虚而血不行者，四君子、芎、归，补而行之。若脾气郁而血不
行者，归脾汤解而行之。若肝脾血燥而血不行者，加味逍遥散，清而行之。大抵食积痞块证为有形。邪气胜则
实，真气夺则虚，当
养正避邪，而积自除。虽云坚者削之，客者除之，胃气未虚，或可少用，若病久虚乏，不宜轻用。
《大全》曰∶妇人寒热失节，脏腑气虚，风冷在内，饮食不消，与血气相结，渐生块，不移动，皆因血气
劳伤，月水往来，经络痞塞，恶血不除，久而不瘥，心腹两胁苦痛，碍于饮食，肌肤消瘦。问∶ 一也。何以
知是血 ？曰∶血外证瞀闷、烦躁、惊狂、痰呕、汗多、骨蒸、肢冷。其蓄在下焦者，必脐下结急，外热内痛，
尺脉洪而数，桃仁、灵脂、生地、牛膝、大黄、甘草去之。
薛立斋按∶此证多兼七情亏损，五脏气血乖违而致。气主煦之，血主濡之。脾统血，肝藏血。故郁结伤脾，
恚怒伤肝者多患之。腹胁作痛，正肝脾二经证。洁古云∶养正积自除。东垣云∶人以胃气为本，治法当主固元
气，佐以攻伐之剂，必需之岁月。若期速效，投以峻剂反致有误也。
《女科大全》说：妇人症瘕痞块，是由于饮食不节制，导致脾胃亏损，邪气与正气相互搏结，积聚在腹中，牢固不动，有可征验的症状，所以称为“症”。
气道壅塞不通，所以称为“痞”。遇到寒冷就会发作，寒气侵入子宫则导致不孕，侵入胞络则导致月经不通。
薛立斋按语：此证如果脾胃虚弱，用六君子汤加川芎、当归。如果肝脾虚弱，用补中益气汤及归脾汤。如果肝火郁滞，配合使用芦荟丸、地黄丸，外用阿魏膏贴敷。患者必须谨慎对待七情（喜、怒、忧、思、悲、恐、惊）和六淫（风、寒、暑、湿、燥、火），注意饮食起居。治疗者要不时审察病机并用药，才可能有效。
《女科大全》说：妇人食积痞块，是由于脏腑虚弱，经期不注意忌口生冷之物，食物不能消化，与脏气相持，结聚成块，日渐生长，牢固不安，称为“症”，或者是劳伤元气所致。陈无择说：月经不行的，应当先疏导通经，然后以固护元气为主。
薛立斋说：如果形体气息虚弱，必须先以调补脾胃为主，辅以消食导滞。如果形体气息充实，应当先以疏导为主，辅以补益脾胃。如果气壅血滞而不行，宜用乌药散疏散而行气。如果脾气虚而血不行，用四君子汤加川芎、当归，补益而行之。如果脾气郁结而血不行，用归脾汤解郁而行之。如果肝脾血燥而血不行，用加味逍遥散清热而行之。大抵食积痞块证属于有形之邪。邪气盛则为实证，真气耗夺则为虚证，应当养正避邪，积块自然消除。虽然常说坚硬的要用削法，外来的邪气要用除法，但如果胃气未虚，或许可以少量使用；如果病久体虚乏力，不宜轻易使用。
《女科大全》说：妇人寒热失调，脏腑气虚，风冷内侵，饮食不消化，与血气相结，渐渐生块，不移动，都是因为血气劳伤，月经往来之间，经络痞塞，恶血不去，日久不愈，心腹两胁剧烈疼痛，妨碍饮食，肌肤消瘦。问：症和瘕是一回事吗？怎么知道是血瘀形成的症呢？回答说：血瘀的外证表现为头晕目眩、烦躁、惊狂、痰呕、汗多、骨蒸潮热、四肢冰冷。蓄积在下焦的，必然脐下结急，外热内痛，尺脉洪大而数，可用桃仁、五灵脂、生地、牛膝、大黄、甘草等药去除瘀血。
薛立斋按语：此证多兼有七情亏损，五脏气血乖违而导致。气主温煦，血主濡润。脾统血，肝藏血。所以郁结伤脾，愤怒伤肝的人多患此病。腹胁作痛，正是肝脾二经的证候。洁古说：养正积自除。东垣说：人以胃气为本，治法应当以固护元气为主，辅以攻伐的药物，需要一定的时间。如果期望速效，投以峻猛的药物反而会导致失误。
The *Daquan* (Complete Collection) states: In women, the formation of masses (*zheng*) and stagnation (*pi*) arises from irregular diet causing damage to the Spleen and Stomach. Pathogenic factors and healthy Qi contend with each other, accumulating in the abdomen, remaining fixed and immobile, presenting observable signs; hence it is named "Zheng" (mass).
When the flow of Qi is obstructed, it is named "Pi" (stagnation/blockage). It manifests upon exposure to cold; if cold enters the uterus (*Zang*), infertility results; if it enters the uterine collaterals (*Bao Luo*), amenorrhea occurs.
Xue Lizhai's commentary: For this condition, if the Spleen and Stomach are weak, use Liu Jun Zi Tang (Six Gentlemen Decoction) added with Chuanxiong Rhizome (*Chuanxiong*) and Angelica Sinensis Root (*Danggui*). If the Liver and Spleen are weak, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Gui Pi Tang (Restore the Spleen Decoction). If Liver Fire is stagnant, administer Lu Hui Wan (Aloe Pill) and Di Huang Wan (Rehmannia Pill), and apply A Wei Gao (Asafoetida Plaster) externally. The patient must be cautious regarding the Seven Emotions and Six Exogenous Factors, as well as diet and daily routine. The practitioner must frequently examine the pathogenesis and prescribe medication accordingly for efficacy.
The *Daquan* states: Food stagnation masses in women arise from weakness of the Zang-Fu organs. During menstruation, failure to avoid raw and cold foods leads to indigestion. The food residue contends with the organ Qi, knotting into a mass that grows day by day, becoming fixed and uncomfortable. This is called "Zheng," or it may result from exhaustion of Yuan Qi due to overwork. Chen Wuyue said: For those with amenorrhea, one should first promote circulation, then focus on consolidating Yuan Qi.
Xue Lizhai said: If the physical constitution and Qi are weak, one must first regulate and tonify the Spleen and Stomach, assisting with digestion-promoting herbs. If the physical constitution and Qi are robust, one should first promote unblocking, assisting with Spleen and Stomach tonification. If Qi stagnation and Blood stasis prevent flow, use Wu Yao San (Lindera Powder) to disperse and move Qi. If Spleen Qi deficiency prevents Blood flow, use Si Jun Zi Tang (Four Gentlemen Decoction) with Chuanxiong and Danggui to tonify and move. If Spleen Qi depression prevents Blood flow, use Gui Pi Tang to resolve depression and move. If Liver and Spleen Blood dryness prevents Blood flow, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) to clear heat and move. Generally, food stagnation and mass formations are tangible pathogens. When pathogenic factors prevail, it is an Excess pattern; when Healthy Qi is depleted, it is a Deficiency pattern. One should nourish the righteous Qi and avoid pathogenic factors, so the accumulation will naturally dissipate. Although it is said that hard masses should be pared down and external pathogens eliminated, if the Stomach Qi is not yet deficient, these methods might be used sparingly. However, if the disease has been prolonged leading to deficiency and fatigue, such methods should not be used lightly.
The *Daquan* states: Women with irregular chills and fever, visceral Qi deficiency, internal invasion of wind-cold, and undigested food, where food knots with Qi and Blood, gradually forming a non-migratory mass, are all caused by labor and injury to Qi and Blood. During menstrual cycles, meridian blockage occurs, evil blood remains, and if left untreated for a long time, it causes severe pain in the heart, abdomen, and hypochondrium, hinders eating, and leads to emaciation. Question: Are Zheng and Jia the same? How do we know it is a blood-induced Zheng? Answer: External signs of blood stasis include dizziness, irritability, mania, phlegm vomiting, excessive sweating, bone-steaming fever, and cold limbs. If accumulation is in the Lower Jiao, there will be tightness below the umbilicus, external heat with internal pain, and a surging, rapid Chi pulse. Use Tao Ren (Peach Seed), Ling Zhi (Tremella/Polyporus - *Note: Context implies Wu Ling Zhi/Pantoloba for blood stasis*), Sheng Di Huang (Rehmannia Root), Niu Xi (Achyranthes Root), Da Huang (Rhubarb Root), and Gan Cao (Licorice Root) to eliminate the blood stasis.
Xue Lizhai's commentary: This condition often involves damage from the Seven Emotions, causing disharmony of Qi and Blood in the Five Zang organs. Qi provides warmth; Blood provides nourishment. The Spleen controls Blood; the Liver stores Blood. Therefore, those whose Spleen is injured by emotional constraint and Liver by anger are prone to this. Pain in the abdomen and hypochondrium is precisely the manifestation of the Liver and Spleen meridians. Jiegu said: Nourish the righteous Qi, and the accumulation will remove itself. Dongyuan said: Humans rely on Stomach Qi as their foundation. Treatment should primarily consolidate Yuan Qi, assisted by attacking agents, requiring patience. If one seeks rapid effects and administers harsh medicines, it will likely lead to error.