大全云∶妇人寒热失节，脏腑气虚，风冷在内，饮食不消，与血气相结，渐生颗块，盘牢
不移动者是也。皆因血气劳伤，月水往来，经络痞塞，恶血不除，结聚所生，久而不瘥，则心
腹两胁苦痛，害于饮食，肌肤羸瘦。
问 一也。何以知是血 ？曰∶血外之证（有以左畔为血 者，凡肝之部，皆可为血
病），瞀闷烦躁，迷忘惊狂，痰呕汗多，骨热肢冷，其蓄在下焦者，必脐下结急，外热内痛，
尺脉洪而数也。桃仁、灵脂、生地黄、牛膝、大黄、甘草祛逐之。薛氏曰∶前证多兼七情，亏损
五脏，气血乖达而致。（此说甚佳）盖气主嘘之，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，正属肝脾二经证也。洁古曰∶养正积自除。东垣云∶人以
胃气为主，治法当主于固元气，而佐以攻伐之剂，必需之岁月，若期速效，投以峻剂，反致有误。
大全云∶妇人月经痞塞不通，或产后余秽未尽，因而乘风取凉，为风冷所乘，血得冷则
成瘀血也，血瘀在内，则时时体热面黄，瘀久不消，则为积聚 癖矣。
薛氏曰∶前证若郁结伤脾，用加味归脾汤；若恚怒伤肝，用加味逍遥散；若产后恶露，
用失笑散；若肝脾虚损，用六君子加柴胡以补元气为主；胃气虚弱，用补中益气汤加茯苓、
半夏为主。大凡腹中作痛畏手按者，此内有瘀血。若形体如常，属病气元气俱实，用桃仁承
气汤直下之；若痛而肢体倦怠，饮食少思，此脾胃受伤，属病气有余，元气不足，用当归散
调和之（立斋专重脾胃，故其言如此，然亦一偏之见。但攻削之药，不得其窍，反致伤气，以
致不救，故不如善守之为愈矣）。若痛而喜手按腹，形体倦怠，饮食少思，此形气病气俱不
足，用六君、炮姜、芎、归纯补之；若痛而大便不实，饮食难化，此脾肾虚寒，用六君、炮姜、
肉果温补之；若痛而作呕少食，此脾胃虚弱，用六君、炮姜、藿香；若痛而呕吐不食泄泻，用
六君、姜、桂；若兼手足逆冷自汗，更加附子，此证多有因攻伐而致者。
《女科证治准绳》（简称“大全”）中说：妇女寒热失调，脏腑气虚，风冷邪气滞留体内，饮食无法消化，与气血相互搏结，逐渐形成块状物，坚硬固定不移的，就是这种情况。这都是因为气血劳损，月经周期紊乱，经络阻滞，恶血未能清除，凝结积聚而生成的。如果日久不愈，就会导致心腹及两胁剧烈疼痛，影响饮食，肌肉消瘦。
问：如何判断这是瘀血病？答：瘀血的体表症状（有人以左侧为瘀血部位，凡属肝经所主区域，均可出现瘀血病变），表现为头晕目眩、胸闷烦躁、神志恍惚、惊悸狂乱、呕吐痰涎、多汗、骨蒸潮热而四肢发冷。若瘀血蓄积在下焦，必然脐下拘急硬满，外部发热内部疼痛，尺脉洪大而数。可用桃仁、五灵脂、生地黄、牛膝、大黄、甘草来祛除瘀血。薛己说：上述症状多兼有情志内伤，导致五脏亏损，气血运行失常所致。（这种说法很好）大概气主要起温煦作用，血主要起濡养作用，脾统摄血液，肝贮藏血液，所以情志抑郁损伤脾气，愤怒损伤肝气的患者，容易患此病。腹部和胁部疼痛，正是肝脾两经病变的表现。张元素（洁古）说：扶助正气，积滞自然消除。李东垣说：人应以胃气为本，治疗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，投用峻猛药物，反而会导致误治。
《女科证治准绳》又说：妇女月经阻滞不通，或产后余血污秽未尽，此时乘凉受风，被风冷邪气侵袭，血液遇冷则凝结成瘀血。瘀血在体内，就会时常身体发热、面色萎黄，瘀血日久不消，就会形成积聚癖块。
薛己说：上述症状如果是因情志抑郁损伤脾气所致，使用加味归脾汤；如果是因愤怒损伤肝气所致，使用加味逍遥散；如果是产后恶露不尽，使用失笑散；如果是肝脾虚损，使用六君子汤加柴胡，以补益元气为主；如果是胃气虚弱，使用补中益气汤加茯苓、半夏为主。大凡腹部疼痛且害怕用手按压的，这是内有瘀血。如果形体如常，属于病气和元气都实证，用桃仁承气汤直接攻下；如果疼痛且肢体倦怠，食欲不振，这是脾胃受伤，属于病气有余，元气不足，用当归散调和（薛己特别重视脾胃，所以这样说，但这也是一种片面的观点。然而攻削类药物，如果不得法，反而会损伤正气，导致不可挽救的后果，所以不如善于保守正气更为优越）。如果疼痛且喜欢用手按压腹部，形体倦怠，食欲不振，这是形气、病气都不足，用六君子汤、炮姜、川芎、当归纯补；如果疼痛且大便不成形，饮食难消化，这是脾肾虚寒，用六君子汤、炮姜、肉豆蔻温补；如果疼痛且作呕、食少，这是脾胃虚弱，用六君子汤、炮姜、藿香；如果疼痛、呕吐、不食、泄泻，用六君子汤、干姜、肉桂；如果兼有手足逆冷、自汗，再加附子，这种病症多是因为误用攻伐药物导致的。
The *Daquan* (Compendium) states: When women suffer from irregular chills and fever, deficiency of zang-fu qi, retention of wind-cold pathogens inside the body, and indigestion of food, these factors bind with qi and blood, gradually forming nodules that are hard and fixed in place. This is the condition described. All such cases arise from labor and injury to qi and blood, irregular menstruation, obstruction of meridians and collaterals, failure to eliminate evil blood, and subsequent condensation and accumulation. If left untreated for a long time, it causes severe pain in the heart, abdomen, and hypochondrium, impairs digestion, and leads to emaciation of the skin and muscles.
Question: How can one know this is blood stasis? Answer: The external manifestations of blood stasis (some consider the left side as the site of blood stasis; generally, any area governed by the Liver channel may present with blood stasis pathology), including dizziness and mental confusion, chest tightness, irritability, amnesia,惊狂 (fright and mania), vomiting of phlegm, excessive sweating, bone-steaming fever with cold limbs. If blood stasis accumulates in the Lower Jiao (Lower Burner), there will inevitably be tension and hardness below the umbilicus, external heat with internal pain, and a chi pulse that is surging and rapid. These can be dispelled using Tao Ren (Persicae Semen), Ling Zhi (Trogopterori Faeces), Sheng Di Huang (Rehmanniae Radix), Niu Xi (Achyranthis Bidentatae Radix), Da Huang (Rhei Radix et Rhizoma), and Gan Cao (Glycyrrhizae Radix et Rhizoma). Xue Ji stated: The aforementioned symptoms often accompany emotional injuries, leading to damage of the five zang organs and disordered flow of qi and blood. (This view is excellent.) Generally, qi provides warming functions, while blood provides nourishing functions. The Spleen controls blood, and the Liver stores blood. Therefore, those whose spleen is injured by depression or whose liver is injured by anger are prone to this disease. Pain in the abdomen and hypochondrium belongs precisely to pathologies of the Liver and Spleen channels. Zhang Yuansu (Jiegu) said: Nourish the righteous qi, and the accumulation will naturally dissipate. Li Dongyuan said: Humans rely on Stomach Qi as their foundation. Treatment should focus on consolidating Yuan Qi (Original Qi), assisted by attacking agents. Patience is required; if speed is sought by administering harsh medicines, errors may result.
The *Daquan* further states: When women experience obstructed menstruation or incomplete expulsion of lochia postpartum, and they subsequently seek coolness or are exposed to wind, the wind-cold pathogens invade. Blood congeals into blood stasis due to cold. Internal blood stasis causes frequent low-grade fever and sallow complexion. If the stasis persists without resolving, it forms accumulations and masses (ji ju pi).
Xue Ji stated: For the aforementioned conditions, if caused by emotional depression injuring the Spleen, use Jiawei Guipi Tang (Modified Gui Pi Decoction); if caused by anger injuring the Liver, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); if due to postpartum lochia retention, use Shixiao San (Pain-Relieving Powder); if due to Liver and Spleen deficiency, use Liujunzi Tang (Six Gentlemen Decoction) added with Chai Hu (Bupleuri Radix), focusing on tonifying Yuan Qi; if due to weak Stomach Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fu Ling (Poria) and Banxia (Pinelliae Rhizoma). Generally, abdominal pain that worsens with pressure indicates internal blood stasis. If the physical constitution remains normal, it indicates excess in both pathogenic qi and righteous qi; treat directly with Taoren Chengqi Tang (Persicae and Rheum Decoction) to purge downward. If pain is accompanied by limb fatigue and poor appetite, this indicates Spleen-Stomach injury, where pathogenic qi is excessive but righteous qi is deficient; harmonize with Danggui San (Angelica Powder) (Xue Ji emphasized the Spleen and Stomach heavily, hence his words, though this is somewhat one-sided. However, purgative drugs, if not used correctly, can damage qi and lead to untreatable conditions; thus, preserving righteousness is superior). If pain is relieved by pressure, accompanied by physical fatigue and poor appetite, this indicates deficiency in both form/qi and pathogenic qi; tonify purely with Liujunzi Tang, Pao Jiang (Prepared Ginger), Xiong (Chuanxiong Rhizome), and Dang Gui (Angelicae Sinensis Radix). If pain is accompanied by loose stools and difficulty digesting food, this indicates Spleen-Kidney Yang Deficiency with Cold; warm and tonify with Liujunzi Tang, Pao Jiang, and Rou Dou Kou (Myristicae Semen). If pain is accompanied by nausea and reduced intake, this indicates Spleen-Stomach weakness; use Liujunzi Tang, Pao Jiang, and Huo Xiang (Agastaches Herba). If pain is accompanied by vomiting, anorexia, and diarrhea, use Liujunzi Tang, Gan Jiang (Zingiberis Rhizoma), and Rou Gui (Cinnamomi Cortex). If accompanied by cold extremities and spontaneous sweating, add Fu Zi (Aconiti Lateralis Radix Praeparata). Such conditions often arise from improper use of attacking/purgative therapies.