薛新甫曰∶妇人 癖 瘕，大抵因饮食、起居、七情失宜，亏损脏腑，气血乖违，阴络受
伤，循行失度所致。
罗谦甫云∶养正积自除，必先调养，使荣卫充实，若不消散，方可议下，但除之不以渐
（下不可轻，渐字极妙），则必有颠覆之害。若不守禁忌，纵情嗜欲，其有不丧者鲜矣。
一妇人内热作渴，饮食少思，腹内初如鸡卵，渐大四寸许（非郁结之脉，而谓郁之症何
软），经水三月一至，肢体消瘦，齿颊似疮，脉洪数而虚，左关尤甚，此肝脾郁结之证，外贴
阿魏膏，午前用补中益气汤（补中益气，何以能治郁结？意取积气外散也），午后用加味归
脾汤。两月许，肝火稍退，脾土少健，午前补中益气下六味丸，午后逍遥散下归脾丸，又月
余，日用芦荟丸二服（芦荟丸治肝胆之结），空心以逍遥散下，日晡以归脾汤下，喜其谨疾，
调理年余而愈。
一妇人腹内一块，不时上攻，或作痛有声，或吞酸痞闷，月经不调，小便不利，二年余
矣。面色青黄，余以为肝脾气滞，以六君加芎、归、柴胡、炒连、木香、吴茱各少许二剂，却与
归脾汤送下芦荟丸，三月余，肝脾和而诸症退，又与调中益气汤加茯苓、牡丹皮，中气健而经自调。
一妇人性多郁善怒，勤于女工，小腹内结一块，或作痛，或痞闷，月经不调，恪服伐肝之
剂，内热寒热，胸膈不利，饮食不甘，形体日瘦，牙龈蚀烂，此脾土不能生肺金，肺金不能
生肾水，肾水不能生肝木，当滋化源，用补中益气汤、六味丸，至仲春而愈。
一妇人经候过期，发热倦怠，或用四物、黄连之类，反两月一度，且少而成块，又用峻
药通之，两目如帛所蔽。余曰∶脾为诸阴之首，目为血脉之宗，此脾伤五脏皆为失所，不能归
于目也。遂用补中益气、济生归脾二汤，专主
脾胃，年余而愈。
松江太守何恭人，性善怒，腹结一块年余，上 蚀透，血气虚极，时季冬，肝脉洪数，
按之弦紧，或用伐肝木、清胃火之药。余曰∶真气虚而邪气实也，恐伐肝木，至春不能发生
耳。用八珍汤以生气血，用地黄丸以滋肾水（历观数案，皆以肝脾肾为主而愈者，在立斋
则可，在他医则不可）。肝脉顿退，因大怒，耳内出血，肝脉仍大，烦热作渴，此无根之火也，
仍以前药加肉桂二剂，脉敛热退，复因大怒，果卒于季冬辛巳日，乃金克木故也。
李氏曰∶善治 瘕者，调其气而破其血，消其食而豁其痰，衰其大半而止，不可猛攻峻
施，以伤元气（至论）。宁扶脾胃正气，待其自化，此开郁正元散之由名也。愈后宜大小乌鸡
丸、八珍汤、交加散、交加地黄丸调之。凡攻击之药，病重病受，病轻胃气受之而伤矣。或云
待块消尽而后补养，则胃气之存也几希。
薛新甫说：妇女的瘕癖（腹内结块），大抵是因为饮食、起居、七情（喜、怒、忧、思、悲、恐、惊）失调，导致脏腑亏损，气血运行逆乱，阴络（分布于体内的深层脉络）受伤，循行失去常度所致。
罗谦甫说：扶助正气，积滞自然消除。必须先进行调养，使营卫（营气与卫气，泛指人体正气）充实。如果积滞不消散，才可以考虑使用攻下法。但是，去除积滞不能过于急骤（攻下法不可轻易使用，“渐”字极为精妙），否则必然会有危及生命的危害。如果不遵守禁忌，放纵情欲，能保全性命的就很少了。
有一位妇人，体内发热且口渴，饮食减少不想进食，腹部起初像鸡蛋大小，逐渐增大到四寸左右（并非郁结导致的脉象，却说是郁结的症状，对吗？），月经三个月来一次，肢体消瘦，牙齿和脸颊部位像生疮一样，脉象洪大而数且虚弱，左关脉尤其明显。这是肝脾郁结的证候。外部贴敷阿魏膏，午前服用补中益气汤（补中益气为何能治疗郁结？意在取积聚之气向外发散的作用），午后服用加味归脾汤。两个月左右，肝火稍微减退，脾土功能稍见强健，午前在补中益气汤中加入六味丸，午后服用逍遥散配合归脾丸。又过了一个多月，每天早晚各服两服芦荟丸（芦荟丸用于治疗肝胆之结），空腹时用逍遥散送服，傍晚时用归脾汤送服。庆幸她谨慎治病，经过一年多的调理而痊愈。
另一位妇人，腹内有肿块，不时向上冲逆，有时疼痛并伴有声响，有时吞酸、痞闷不适，月经不调，小便不通利，这种情况持续两年多了。面色青黄，我认为这是肝脾气机阻滞，给予六君子汤加入川芎、当归、柴胡、炒黄连、木香、吴茱萸各少许，服用两剂后，再用归脾汤送服芦荟丸。三月多后，肝脾调和，各种症状消退，接着给予调中益气汤加入茯苓、牡丹皮，中气健旺而月经自然调顺。
一位妇人性格多抑郁且易怒，勤于女红工作，小腹内结成一团，有时疼痛，有时痞闷，月经不调。严格服用疏伐肝脏的药物后，出现内部发热、寒热往来，胸膈部不利，饮食无味，形体日益消瘦，牙龈腐蚀溃烂。这是脾土不能生肺金，肺金不能生肾水，肾水不能生肝木的表现。应当滋生化之源，使用补中益气汤、六味丸，到了仲春时节痊愈。
一位妇人月经过期不来，发热倦怠，有人使用四物汤、黄连之类的药物，反而导致月经两个月来一次，而且量少且成块状。又使用峻猛的药物通经，导致两眼像被白布遮蔽一样模糊。我说：脾是诸阴之首，目是血脉之宗，这是脾受伤，五脏都失去了所依，不能上注于目的缘故。于是使用补中益气汤、济生归脾汤二方，专门主治脾胃，一年多后痊愈。
松江太守何恭人，性格易怒，腹内结块一年多，上部腐蚀穿透，血气极度虚弱。当时正值深冬，肝脉洪大数急，按之弦紧，有人建议使用伐肝木、清胃火的药物。我说：这是真气虚弱而邪气实盛，恐怕伐肝木，到了春季就不能发生生机了。使用八珍汤以生气血，用地黄丸以滋肾水（纵观这几个医案，都是以肝脾肾为主而治愈的，这在立斋[薛己]是可以的，在其他医生则不行）。肝脉顿时减退，因为大怒，耳内出血，肝脉仍然盛大，烦热口渴，这是无根之火，仍然用前面的药加入肉桂，服用两剂，脉象收敛热退。又因为大怒，果然在季冬辛巳日去世，这是因为金克木的缘故。
李氏说：善于治疗瘕块的，要调畅其气而破其血，消导其食而豁除其痰，病势衰退大半时就停止，不可猛烈攻击峻施，以免损伤元气（这是至理名言）。宁可扶持脾胃正气，等待其自行化解，这就是“开郁正元散”命名的由来。痊愈后宜用大小乌鸡丸、八珍汤、交加散、交加地黄丸进行调理。凡是攻击性的药物，重病时由病邪承受，轻病时则由胃气承受而受伤。有人说等块完全消除后再补养，那么存留的胃气就寥寥无几了。
Xue Xinpu stated: In women, *jia pi* (abdominal masses) are generally caused by improper diet, daily routine, and emotional imbalance, leading to the depletion of Zang-Fu organs, disharmony of Qi and Blood, injury to Yin collaterals, and loss of normal circulation.
Luo Qianfu said: Nourishing the righteous Qi causes accumulation to eliminate itself. One must first regulate and nourish, ensuring that Ying and Wei (nutritive and defensive Qi) are sufficient. Only if the accumulation does not dissipate should one consider purgative methods. However, removing it cannot be done abruptly (purgatives should not be used lightly; the character "gradually" is extremely profound), otherwise, there will inevitably be catastrophic harm. If one does not observe dietary and lifestyle taboos and indulges in desires, few will survive.
A woman suffered from internal heat and thirst, poor appetite, and an abdominal mass that initially resembled an egg and gradually enlarged to about four cun (is this a symptom of stagnation rather than a pulse indicating stagnation?). Her menstruation occurred once every three months, her limbs were emaciated, her teeth and cheeks appeared ulcerated, and her pulse was surging, rapid, and deficient, especially at the left Guan position. This was a syndrome of Liver and Spleen stagnation. External application of Awei Plaster was used. In the morning, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was administered; in the afternoon, Jiawei Guipi Tang (Modified Restore the Spleen Decoction). After about two months, Liver fire subsided slightly, and Spleen Earth function improved somewhat. In the morning, Liuwei Wan (Six-Ingredient Pill with Rehmannia) was added to Buzhong Yiqi Tang; in the afternoon, Xiaoyao San (Free and Easy Wanderer Powder) was taken with Guipi Wan. For another month or so, Lu Hui Wan (Aloe Pill) was taken twice daily (used for Gallbladder-Liver knots); taken on an empty stomach with Xiaoyao San in the morning, and with Guipi Tang in the late afternoon. Fortunately, she was diligent in her treatment, and after more than a year of regulation, she recovered.
Another woman had a lump in her abdomen that occasionally surged upward, sometimes causing pain with audible sounds, acid regurgitation, chest fullness, irregular menstruation, and difficult urination, persisting for over two years. Her complexion was greenish-yellow. I diagnosed it as Liver and Spleen Qi stagnation. I prescribed Liujun Zi Tang (Six-Gentlemen Decoction) with minor amounts of Chuanxiong, Danggui, Chaihu, fried Huanglian, Muxiang, and Wuzhuyu for two doses. Then, Lu Hui Wan was taken with Guipi Tang. After more than three months, the Liver and Spleen harmonized, and all symptoms receded. Subsequently, Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction) with Fuling and Mudanpi was given. As the Middle Qi strengthened, menstruation regulated itself.
A woman with a depressive and irritable temperament, diligent in needlework, had a knot in her lower abdomen causing pain or fullness, and irregular menstruation. She strictly took herbs to subdue the Liver, resulting in internal heat, alternating chills and fever, chest diaphragm discomfort, loss of taste, progressive emaciation, and gum erosion. This indicated that Spleen Earth could not generate Lung Metal, Lung Metal could not generate Kidney Water, and Kidney Water could not nourish Liver Wood. The source of transformation should be nourished using Buzhong Yiqi Tang and Liuwei Wan. She recovered by mid-spring.
A woman had delayed menstruation, fever, and fatigue. Someone used Siwu Tang (Four-Substance Decoction) and Huanglian, which resulted in menstruation occurring only once every two months, scanty flow, and clots. Harsh purgatives were then used to unblock the menses, leading to vision obscured as if by white silk. I said: The Spleen is the head of all Yin, and the eyes are the congregation of blood vessels. This indicates Spleen injury, causing all five Zang organs to lose their proper function and fail to nourish the eyes. Therefore, Buzhong Yiqi Tang and Jisheng Guipi Tang (Sustaining Life Restore the Spleen Decoction) were used, focusing specifically on the Spleen and Stomach. She recovered after more than a year.
He Gongren, the wife of the Prefect of Songjiang, was prone to anger. She had an abdominal knot for over a year, with upper body erosion and penetration, and extreme deficiency of Qi and Blood. It was deep winter. Her Liver pulse was surging, rapid, and wiry-tight upon pressure. Some suggested herbs to subdue Liver Wood and clear Stomach Fire. I said: This is deficiency of True Qi and excess of Pathogenic Qi. Subduing Liver Wood might prevent the generation of life force in spring. Bazhen Tang (Eight-Treasure Decoction) was used to generate Qi and Blood, and Dihuang Wan (Rehmannia Pill) to nourish Kidney Water (Observing these cases, they were cured primarily through regulating Liver, Spleen, and Kidney; this approach suits Liza [Xue Ji], but may not suit other physicians). The Liver pulse suddenly subsided. Due to severe anger, bleeding occurred from the ear, and the Liver pulse remained large, accompanied by irritability, heat, and thirst. This was rootless fire. The previous prescription with Rougui (Cinnamon Bark) was continued for two doses. The pulse constricted, and heat receded. However, due to further anger, she unfortunately died on the Xin-Si day of late winter, due to Metal overcoming Wood.
Li stated: Those skilled in treating *jia* masses regulate Qi to break Blood, digest Food to resolve Phlegm, and stop treatment when the pathogen has diminished by more than half. One must not attack fiercely or use harsh methods to avoid damaging Yuan Qi (this is a supreme principle). It is better to support the righteous Qi of the Spleen and Stomach and wait for self-resolution; this is the origin of the name "Kaiyu Zhengyuan San" (Open Stagnation and Rectify Origin Powder). After recovery, Daxiao Wuji Wan (Large and Small Black Chicken Pills), Bazhen Tang, Jiajiao San (Intersecting Additions Powder), and Jiajiao Dihuang Wan should be used for regulation. All attacking drugs burden the disease in severe cases, but in mild cases, they injure the Stomach Qi. Some say to wait until the mass completely disappears before tonifying; however, the remaining Stomach Qi would be negligible.