滑伯仁治一产妇恶露不行。脐腹痛。头疼身寒热。众皆以为感寒。温以姜、附。益大热
手足搐搦。谵语目窜。诊其脉弦而洪数。面赤目闭。语喃喃不可辨。舌黑如炱。燥无津润
胸腹按之不胜手。盖燥剂搏其血。内热而风生。血蓄而为痛也。曰。此产后热入血室。因
而生风。即先为清热降火。治风凉血。两服颇爽。继以琥珀、牛黄等。稍解人事。从以张从
政三和散。行血破瘀。三四服。恶露大下如初。时产已十日矣。于是诸证悉平。
魏云。投姜、附后始搐搦。由燥剂搏血而风生。故此等案宜细心熟玩。若是虚寒。手足
岂不厥冷。况证有舌黑腹不胜按。在三四日者耶。又况面赤洪数之脉耶。
一妇产后。时发昏瞀。身热汗多。眩晕口渴。或时头痛恶心。医用四物凉血之剂。病不
减。复用小柴胡。病益甚。汪诊之。脉皆浮洪搏指。汪曰。产后而得是脉。又且汗多而脉不
为汗衰。法在不治。所幸者气不喘。不作泄耳。其脉如是。恐为凉药所激也。用人参三钱。
黄二钱。甘草、当归各七分。白术、麦冬各一钱。干姜、陈皮、黄芩各五分。煎服五剂。
脉敛而病渐安。
震按浮洪搏指之脉。产后所大忌。合以身热口渴。时发昏瞀。头痛恶心。几与伤寒证相
似。用小柴胡汤未为大谬。以方中原有人参也。但汗多眩晕。柴胡不宜。汪公之论。明白切
当。非大剂人参。岂能挽回。至云其脉如是。恐为凉药所激。后学安知有此道理。服五剂而
脉敛。言更验矣。
王佥宪公宜人。产后因沐浴。发热呕恶。渴欲饮冷水瓜果。谵语若狂。饮食不进。体素
丰浓不受补。医用清凉。热增剧。石山诊之。六脉浮大洪数。曰。产后暴损气血。孤阳外浮
内真寒而外假热。宜大补气血。与八珍汤加炮姜八分。热减大半。病患自知素不宜参、
不肯再服。过一日。复大热如火。复与前剂。潜加参、 、炮姜。连进二三服。热退身凉
而愈。
震按病由沐浴而发热呕恶。渴欲饮冷。狂谵不食。人必以伤寒视之。及用清凉而热增剧
茫无把握矣。况脉洪数。用滋阴易。用参、姜难也。乃投八珍热减大半。停参、 一日。
复大热如火。则病宜温补。不宜凉散。始得显然耳。
孙东宿治武进邑宰孙康宇媳。年十六。初产女艰苦。二日偶感风邪。继食面饼。时师不
察。竟以参、术投之。即大热。谵语口渴。汗出如洗。气喘泄泻。泻皆黄水无粪。一日夜不
计遍数。小水短少。饮食不进。证甚危恶。时当暑月。女科见热不除。用芩、连等药。证益
甚。乃重用参、术、肉果、干姜等止泻。泻不减。热反剧。喘汗转加。谵语不辍。医悉辞去
孙往诊之。六脉乱而无绪。七八至。独右关坚硬。踌躇久之。因思暑月汗出乃常事。但风
邪面食瘀血。皆未消熔。补剂太骤。书云。蓄血如见鬼。治当消其瘀食。解其暑气。犹可图
生。勿遽弃也。乃用益元散六钱。解暑清热为君。仲景云。渴而小便不利者。当先利其小便
况水泻犹当用之为君也。以楂肉三钱为臣。红曲、泽兰叶各一钱五分。消瘀血。安魂为佐
香附、橘红、半夏、茯苓以统理脾气为使。京三棱五分。消前参、术。决其壅滞为先锋。
水煎。服后即稍睡。计两日。连进四剂。热减泻止。恶露略行。脉始有绪。前方去三棱、红
曲。加扁豆。而热全退。便亦实。改用四君子汤加益元散、青蒿、香附、扁豆、白芍。调理
而平。
震按前二案虚证似实。此案实证似虚。病之能惑人也如此。但用芩、连而证益甚。用参
术兼温药而更加剧。亦将束手无策。孙公之得间处。在右关独坚硬。信乎善治病者。必善
辨脉也。若粗工见其证极沉重。脉又七八至。乱而无绪。不遑细辨。此女何由得生。今从辨
脉得病情。用药自游刃有余。而药之得力处。又在京三棱五分也。
别驾沈石山夫人。产三日而腹不宽畅。一女科为下之。大泻五六次。遂发热恶心。又用
温胆
汤止吐。小柴胡退热。服四日。吐与热不止。粒米不进。又用八珍汤加童便。服后昏愦。耳
聋眼合。口渴肠鸣。眼胞及手足背皆虚浮。因逆孙诊。六脉皆数。时五月初二日也。东宿曰
脉书云。数脉所主。其邪为热。其正为虚。以十全大补汤加炮姜进之。夜半稍清爽。进粥
一盂。始开目言语。次日以多言语。复昏昧。又以参、术各三钱。炮姜、茯苓、陈皮各一钱
甘草五分。煎服。体微汗。遍身痱痤。热退而神爽。下午药不接。且动怒。昏昧复如前。
六脉散乱无伦。状如解索。痱痤没而虚极矣。亟以参、术各五钱。炙草、炮姜、附子各一钱
连进二帖。是夜熟寝。唯呼吸之息尚促。初六日脉又数。下午发热不退。环跳穴边发一毒
如碗大。红肿微痛。前医者遂归咎姜、附。拟用寒凉解毒药。孙曰。此乃胃中虚火游行无制
大虚之证。非毒也。内经云。壮者气行则愈。怯者着而成病。惟大补庶可万全。用寒凉。
速其死矣。乃煎附子理中汤进之。日夕两帖。参、术皆用七钱。服后痱痤复出。毒散无踪。
热亦退矣。再以参苓白术散。调理而全安。皆由产后误下。致变百出。可不畏哉。
震按八珍与十全大补。相去不远。乃一则服之而加重。一则服之而遽轻。其义何居。盖
得力在肉桂及加炮姜也。而敢于用姜、桂。由于数脉之义。参得透耳。其邪为热。其正为虚
二语。与景岳恰合。英雄所见略同也。今人一见数脉。只知为热。断不敢用姜、附、桂。夭
枉者多矣。但温补既投。亦须数脉渐退。仲景云。数脉不时。则生恶疮。故后有发毒之变。
孙公能认定为虚。故终以大剂温补收功。较之胸无主见。随境游移者。自是仙凡迥别。
程石洲乃眷因产难子死。忧闷。小腹有块作痛。下午发热。不思饮食。东宿诊之。脉右
大于左者三倍。且数。与芎归汤加山楂、泽兰、肉桂。次日下午。腰腹胀痛。诘之。晌午食
圆眼一斤矣。从此小腹渐胀。大便三日未行。早晨鼻衄。夜间极热。口渴。脉大无绪。势甚
危急。用芎、归、红花、桃仁、青皮、槟榔、莪术、山楂。水煎。调元明粉二钱。服后。下
结粪二枚。安而就寝。醒后。进粥稍多。又复胀痛。腹大如斗。坚如石。气促不安。势危之
至。乃与五灵脂、山楂各四钱。凌霄花二钱。赤芍一钱。服后大便通。腹软气定。始可进粥
渐有生气。但脉仍鼓指。此腹中积滞尚多。不可不因其时而驱去也。用山楂、大黄各三钱
桃仁二钱。桂心、红花各五分。炙甘草七分。煎冲元明粉一钱五分。其夜下黑粪四次。热始
退。上腹虽消。脐下仍大。仍以桃仁承气加山楂、滑石、红花。煎饮之。五更大便行。脐腹
胀又减。后与积块丸调理全消。是役也。女科于初起发热腹痛之时。即以常套十全大补汤投
之。讵如圆眼肉入腹。渐渐胀开。故腹亦因之大胀。且其味甘。尤能作滞。复加地黄、参、
术。宁不塞其塞哉。由是而成大坚之证。内经谓中满者。泻之于内。良以此夫。彼亦泥乎丹
溪产后须大补气血之误也。
震按此案与前案截然不同。数脉大脉。均为产后所忌。而彼用温补。此用攻消。俱获全
安。自非名手不能。观石山论浮洪搏指之脉曰。恐为凉药所激。此则认为积滞尚多。可见临
证者全在圆通活变。断无一定之法可守也。
马元仪治苏州藩司王管家之妻。产后一月。神气昏倦。胸满中痛。咳嗽喘促发热。服药
反渐加重。势将治木。马诊之。两手脉沉涩兼结。马曰。此证胎前已有伏邪。产后气血既虚
邪益内结。法宜表里两和。使邪从外达。气从内泄。病自愈矣。用桂枝、柴胡、苏梗、枳
壳、半曲、菔子、杏仁、广皮透邪达滞之剂。服后病势偏安。脉亦稍舒。前医尚以气血两虚
遽投参、地、归、芍敛滞之品。遂致彻夜靡宁。如丧神守。不知邪结于中。反行补法。如
欲盗之出而反闭其门也。急改透邪散结法。用桂枝、炮姜、黄连、枳实、浓朴、广皮等。一
剂而胸满中痛之证释。复用栝蒌实、柴胡、桂枝、半夏、枳实、杏仁、苏子、桔梗等。再剂
而表热喘嗽之证平。但大便不行。此久病伤津液。肠胃失养之所致也。加生首乌一两。大便
得解。余邪尽去。然正气大亏。继进滋补气血之剂而安。盖病有虚邪内结。而正气积亏者。
当补正以托邪。而不知者反治邪而伤正。有正气未伤。而邪势方张者。当去邪以安正。而不
知者反用补以滞邪。虚实莫辨。多致冤沉无诉。而尚不觉也。岂不谬哉。
震按产后病因。果系外邪者。定当祛邪。不可泥于丹溪之说。曾见胎前受暑湿致痢。痢
未几而产。产后仍痢。腹痛胸满。后重口渴。脉数大者。竟用芩、连、槟、朴、滑石、木香
甚则加大黄殊效。与此案治法。病异而理同也。
俞伯仁治疗一位产妇，恶露排出不畅。脐腹部疼痛，头痛，身体忽冷忽热。大家都认为是受寒所致，用干姜、附子等温热药物治疗，结果导致患者更加发热，手足抽搐，胡言乱语，眼球上翻。诊察其脉象弦而洪大数急，面色红赤，眼睛紧闭，说话喃喃自语无法辨清，舌苔黑如烟灰，干燥无津液滋润，胸腹部按压时患者不能忍受（拒按）。这是因为燥热药物搏结血液，导致内热生风，血液瘀滞而产生疼痛。俞伯仁说：“这是产后热邪陷入血室，因而产生肝风。”随即先用清热降火、治风凉血的方药，服用两剂后症状明显缓解。接着使用琥珀、牛黄等药物，使神志稍见清醒。随后采用张从正的三和散，行血破瘀。服用三四剂后，恶露大量排出，如同产前一样。此时分娩已过十天，于是各种病症全部平息。
魏云说：患者在投用干姜、附子后才出现抽搐，这是由于燥热药物搏结血液而生风。因此这类医案应当细心研读玩味。如果是虚寒证，手足怎么会不厥冷呢？况且还有舌苔黑、腹部拒按的症状，出现在发病三四天的时候？更何况还有面赤、脉象洪数的表现呢？
另一位产妇在产后，时常发生昏厥迷蒙，身体发热，出汗多，眩晕口渴，有时头痛恶心。医生使用四物汤等凉血药物，病情没有减轻，又改用小柴胡汤，病情反而加重。汪机诊察后，发现脉象都浮大搏指有力。汪机说：“产后出现这种脉象，而且出汗多但脉象不因汗出而减弱，按照医理属于难治之症。所幸的是气息不喘，也没有腹泻。脉象如此，恐怕是被寒凉药物激惹所致。”于是用人参三钱，黄芪二钱，甘草、当归各七分，白术、麦冬各一钱，干姜、陈皮、黄芩各五分，煎服五剂。脉象收敛，病情逐渐安定。
俞震按语：浮大搏指有力的脉象，是产后最忌讳的。结合身体发热、口渴、时常昏厥迷蒙、头痛恶心等症状，几乎与伤寒证相似，使用小柴胡汤也不算大错，因为方中原有人参。但是出汗多且眩晕，就不宜使用柴胡。汪机的论述，明白恰当，如果不是大剂量的人参，怎么能挽回危局？至于说脉象如此，恐怕是被寒凉药物激惹，后辈学者怎么知道这个道理呢？服用五剂后脉象收敛，说明言辞更加应验。
王佥宪公的宜人（妻子），产后因沐浴，出现发热、呕吐恶心，想喝冷水瓜果，胡言乱语像发狂一样，饮食不进。患者体质本来丰腴肥胖，不耐受补益。医生使用清凉药物，热势加剧。石山诊察后，六脉浮大洪数，说：“产后气血突然亏损，孤阳外浮，内部真寒而外部假热，应当大补气血。”给予八珍汤加炮姜八分，热势减少大半。病患自己知道素来不宜服用人参，不肯再服用。过了一天，再次出现大热如火的症状，再次给予前面的药方，暗中增加人参、肉桂、炮姜，连续服用二三剂，热退身凉而痊愈。
俞震按语：病由沐浴后发热、呕吐恶心，想喝冷水，狂躁谵语不进食，人们必定将其视为伤寒。等到使用清凉药物后热势反而加剧，便茫然无把握了。况且脉象洪数，使用滋阴药容易，使用人参、干姜难。然而投用八珍汤后热势减少大半，停用人参、肉桂一天，再次大热如火，那么病情适宜温补，不适宜凉散，这一点才变得显然。
孙东宿治疗武进县令孙康宇的儿媳，十六岁。初次生产女孩很辛苦，两天后偶然感受风邪，接着吃了面饼。当时的医生不加审察，竟然用人参、白术投予。随即出现大热、胡言乱语、口渴、汗出如洗、气喘、腹泻，泻下全是黄色水样便而无粪便，一天一夜不计其数，小便短少，饮食不进，病情非常危重恶劣。当时正值暑月，妇科医生见热不退，使用黄芩、黄连等药物，病情更加严重。于是重用参、术、肉豆蔻、干姜等止泻，腹泻不减，热势反而加剧，喘息出汗加重，胡言乱语不停。其他医生都辞别离去。孙东宿前往诊察，六脉紊乱而没有头绪，每息七八至，唯独右关脉坚硬。犹豫良久，想到暑月出汗本是常事，但风邪、面食积滞、瘀血都没有消除，补益药太急骤。书上说：“蓄血证如见鬼怪”，治疗应当消除瘀食，解除暑气，还可以图谋生机，不要急于放弃。”于是使用益元散六钱，作为君药以解暑清热。仲景说：“口渴而小便不利的，应当先利小便”，何况是水样腹泻，更应当用它作为君药。以山楂肉三钱为臣药，红曲、泽兰叶各一钱五分，作为佐药以消瘀血、安神魂；香附、橘红、半夏、茯苓作为使药以统理脾气；京三棱五分，作为先锋以消除之前人参、白术造成的壅滞。用水煎服，服药后即能稍睡。共计两天，连续进服四剂，热减泻止，恶露略行，脉象始有头绪。前方去掉三棱、红曲，加入扁豆，而热全退，大便也成形。改用四君子汤加益元散、青蒿、香附、扁豆、白芍，调理而平复。
俞震按语：前两个医案是虚证似实证，此案是实证似虚证。病情迷惑人就是这样。但是使用黄芩、黄连而病情加重，使用参、术兼温热药而更加剧烈，也将束手无策。孙公能够找到间隙处理，关键在于右关脉独硬。确实善于治病的人，一定善于辨脉。如果粗疏的医生见到症状极其沉重，脉象又是七八至，混乱没有头绪，来不及细细辨别，这个女子怎么能活下来？现在通过辨脉得知病情，用药自然游刃有余，而药物得力的关键，又在京三棱五分上。
别驾沈石山的夫人，产后三天腹部不宽畅。一位妇科医生给她攻下，大泻五六次。随即发热恶心，又用温胆汤止吐，小柴胡汤退热。服用四天，呕吐与热势不止，粒米不进。又用八珍汤加童便，服用后昏愦，耳聋眼合，口渴肠鸣，眼睑及手背足背皆虚浮。于是请孙东宿诊察，六脉皆数，时间是五月初二日。孙东宿说：“脉书云：数脉所主，邪为热，正为虚。”给予十全大补汤加炮姜进服。半夜稍清爽，进粥一碗，才开始睁眼说话。第二天因为多说话，再次昏昧。又以人参、白术各三钱，炮姜、茯苓、陈皮各一钱，甘草五分，煎服。身体微汗，遍身出痱子痤疮，热退而神志清爽。下午药力接续不上，且动怒，昏昧又恢复从前。六脉散乱无伦，状如解索，痱子痤疮消退而极度虚弱。紧急用人参、白术各五钱，炙甘草、炮姜、附子各一钱，连续进服两帖。当晚熟睡，只有呼吸之气尚急促。初六日脉又数，下午热势不退，环跳穴边发一个毒疮如碗大，红肿微痛。之前的医生于是归咎于干姜、附子，打算用寒凉解毒药。孙东宿说：“这是胃中虚火游行无制，是大虚之证，不是毒疮。《内经》说：‘壮者气行则愈，怯者着而成病。’只有大补才能万全。使用寒凉药，会加速死亡。”于是煎附子理中汤进服，日夜两帖，人参、白术都用七钱。服用后痱子痤疮复出，毒疮消散无踪，热势也退了。再用参苓白术散，调理而完全安康。这都是由于产后误用攻下，导致变证百出，能不敬畏吗？
俞震按语：八珍汤与十全大补汤，相去不远，却一则服用后加重，一则服用后迅速减轻，其中的道理何在？大概得力于肉桂以及加炮姜。而敢于使用姜、桂，是由于透彻理解了数脉的含义。“其邪为热，其正为虚”这两句话，与张景岳的观点恰好吻合，英雄所见略同。现在的人一见数脉，只知道是热证，断然不敢使用干姜、附子、肉桂，夭折枉死者很多。但是温补既已投用，也必须数脉逐渐消退。仲景说：“数脉不时，则生恶疮。”所以后来有发毒的变化。孙公能认定为虚证，故最终以大剂温补收功，比起那些胸无主见、随境游移的人，自然是仙凡迥别。
程石洲的妻子因产难子死，忧闷，小腹有块作痛，下午发热，不思饮食。孙东宿诊察，脉象右边比左边大三倍，且数。给予芎归汤加山楂、泽兰、肉桂。次日下午，腰腹胀痛。追问原因，说是中午吃了一斤桂圆肉。从此小腹渐渐胀大，大便三日未行，早晨鼻出血，夜间极热，口渴，脉大无绪，形势非常危急。使用川芎、当归、红花、桃仁、青皮、槟榔、莪术、山楂，水煎，调元明粉二钱冲服。服后，排出结粪两枚，安静入睡。醒来后，进粥稍多，又复胀痛，腹大如斗，坚如石头，气促不安，形势危急至极。于是给予五灵脂、山楂各四钱，凌霄花二钱，赤芍一钱，服后大便通，腹软气定，才可以进粥，渐渐有生气。但脉仍鼓指，这说明腹中积滞还多，不可不趁时而驱除。使用山楂、大黄各三钱，桃仁二钱，桂心、红花各五分，炙甘草七分，煎服冲元明粉一钱五分。当夜下黑粪四次，热势才退。上腹虽消，脐下仍大，仍以桃仁承气汤加山楂、滑石、红花，煎饮之。五更大便行，脐腹胀又减。后与积块丸调理，全消。这次诊疗中，妇科医生在初起发热腹痛之时，就以常套的十全大补汤投予。哪里想到桂圆肉入腹，渐渐胀开，所以腹部也因此大胀。而且其味甘，尤能导致停滞，再加上地黄、人参、白术，难道不是堵塞其塞吗？由此而成大坚之证。《内经》说“中满者，泻之于内”，确实是因为这个缘故。他们也拘泥于丹溪“产后须大补气血”的错误观点。
俞震按语：此案与前案截然不同。数脉、大脉，均为产后所忌，而彼处用温补，此处用攻消，都获得全安，自非名医不能做到。看石山论浮洪搏指的脉象说：“恐怕是被凉药激惹”，这里则认为积滞尚多，可见临证者全在圆通活变，断无一定之法可守。
马元仪治疗苏州藩司王管家之妻，产后一个月，神气昏倦，胸满中痛，咳嗽喘促发热，服药反而渐加重，形势将危及生命。马元仪诊察，两手脉沉涩兼结。马元仪说：“此证胎前已有伏邪，产后气血既虚，邪气更加内结，法宜表里两和，使邪气从外达，气机从内泄，病自愈矣。”使用桂枝、柴胡、苏梗、枳壳、半曲、菔子、杏仁、广皮等透邪达滞的药物。服用后病势偏安，脉象也稍舒。前医还以为气血两虚，遽然投予人参、地黄、当归、芍药等敛滞之品，遂致彻夜不宁，如丧神守。不知道邪气结于中焦，反而行补法，就像想要让盗贼出去却反把门关上一样。紧急改为透邪散结法，使用桂枝、炮姜、黄连、枳实、浓朴、广皮等。一剂后胸满中痛的病症解除。复用栝蒌实、柴胡、桂枝、半夏、枳实、杏仁、苏子、桔梗等，再剂后表热喘嗽的病症平息。只是大便不行，这是久病伤津液，肠胃失养所致。加生首乌一两，大便得解，余邪尽去。然而正气大亏，继进滋补气血之剂而安。盖病有虚邪内结，而正气积亏者，当补正以托邪，而不知者反治邪而伤正；有正气未伤，而邪势方张者，当去邪以安正，而不知者反用补以滞邪。虚实莫辨，多致冤沉无诉，而尚不觉也。岂不谬哉！
俞震按语：产后病因，果系外邪者，定当祛邪，不可拘泥于丹溪之说。曾见胎前受暑湿致痢，痢疾未几而产，产后仍痢，腹痛胸满，后重口渴，脉数大者，竟用黄芩、黄连、槟榔、厚朴、滑石、木香，甚则加大黄，殊效。与此案治法，病异而理同也。
Bo Ren Hua treated a postpartum woman whose lochia was not discharging smoothly. She experienced pain in the umbilical and abdominal region, headache, and alternating chills and fever. Everyone believed it was caused by cold invasion and prescribed warming agents such as Shengjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata). This resulted in intensified heat, spasms of the hands and feet, delirium, and upward deviation of the eyes. Upon palpation, her pulse was wiry, surging, and rapid. Her face was red, eyes closed, and she murmured unintelligibly. Her tongue was black like soot, dry without moisture. Palpation of the chest and abdomen revealed tenderness that she could not bear. This was due to drying agents clashing with the blood, generating internal heat and wind, causing blood stasis and pain. Bo said, "This is heat entering the Blood Chamber (Xue Shi) after childbirth, thereby generating wind." He first employed clearing heat and reducing fire, treating wind and cooling blood. After two doses, there was significant relief. Subsequently, he used Hupo (Ambar) and Niuhuang (Calculus Bovis), which slightly restored her consciousness. Then he administered Zhang Congzheng's Sanhe San (Three Harmonies Powder) to promote blood circulation and break stasis. After three or four doses, lochia discharged profusely as before. It had been ten days since delivery, and all symptoms subsided.
Wei Yun commented: The spasms appeared only after administering Shengjiang and Fuzi, indicating that wind was generated by drying agents clashing with blood. Therefore, such cases should be studied carefully. If it were deficiency-cold, would not the extremities be cold? Moreover, how could there be a black tongue and abdominal rejection of pressure on the third or fourth day? Furthermore, how could there be a red face and surging pulse?
Another postpartum woman frequently suffered from fainting and confusion, fever with profuse sweating, dizziness, thirst, occasional headache, and nausea. Physicians used Siwu Tang (Four Substance Decoction) and other blood-cooling formulas without improvement. They then switched to Xiaochaihu Tang (Minor Chest Pivot Decoction), but the condition worsened. Wang Ji diagnosed her pulses as floating, surging, and beating against the finger. Wang said, "Pulses appearing thus after childbirth, especially with profuse sweating where the pulse does not weaken accordingly, are difficult to treat according to medical principles. Fortunately, there is no panting or diarrhea. Such a pulse suggests irritation by cold medicines." He prescribed Renshen (Ginseng Radix) 3 qian, Huangqi (Astragali Radix) 2 qian, Gancao (Glycyrrhizae Radix) and Danggui (Angelicae Sinensis Radix) each 7 fen, Baizhu (Atractylodis Macrocephalae Rhizoma) and Maidong (Ophiopogonis Tuber) each 1 qian, Ganjiang (Zingiberis Rhizoma) and Chenpi (Citri Reticulatae Pericarpium) and Huangqin (Scutellariae Radix) each 5 fen. After five doses, the pulse became contained and the condition gradually stabilized.
Yu Zhen noted: Floating, surging, and beating pulses are highly contraindicated postpartum. Combined with fever, thirst, frequent fainting, headache, and nausea, the presentation closely resembled Shaoyang syndrome (Lesser Yang Syndrome). Using Xiaochaihu Tang was not entirely wrong, as it contains Renshen. However, given the profuse sweating and dizziness, Chaihu (Bupleuri Radix) was unsuitable. Wang's analysis was clear and appropriate. Without large doses of Renshen, how could the situation have been reversed? Regarding his comment that the pulse suggested irritation by cold medicines, how would junior physicians know such reasoning? The fact that the pulse contained after five doses validated his statement.
The wife of Vice Commissioner Wang, following childbirth and bathing, developed fever, vomiting, nausea, and a craving for cold water and fruits. She exhibited delirium resembling mania and refused food. Her constitution was robust and intolerant of tonification. Physicians used cooling agents, which exacerbated the heat. Shishan diagnosed the six pulses as floating, large, surging, and rapid. He stated, "Postpartum sudden loss of Qi and Blood causes solitary Yang to float outward; internally there is true cold while externally there is false heat." He recommended massive tonification of Qi and Blood, prescribing Bazhen Tang (Eight Treasure Decoction) with Paojiang (Prepared Zingiberis Rhizoma) 8 fen. The heat decreased significantly. The patient, knowing she usually did not tolerate Renshen, refused further doses. A day later, she experienced intense heat again. The same formula was repeated with increased amounts of Renshen, Rougui (Cinnamomi Cortex) and Paojiang. After two or three doses, the heat subsided, and she recovered.
Yu Zhen noted: The illness originated from bathing leading to fever, vomiting, craving for cold drinks, mania, delirium, and anorexia. People would naturally view this as Shanghan (Cold Damage). When cooling agents failed and heat increased, one would feel lost. Given the surging and rapid pulse, using Yin-nourishing agents is easier than using Renshen and Ganjiang. Yet, after Bazhen Tang reduced the heat significantly, stopping Renshen and Rougui for a day led to a recurrence of intense heat. Thus, the disease required warming and tonification rather than cooling and dispersing, which became evident.
Sun Dongsu treated the daughter-in-law of Sun Kangyu, magistrate of Wujin, aged sixteen. After a difficult first delivery, she caught a wind pathogen two days later and ate wheat cakes. The attending physician, failing to examine properly, administered Renshen and Baizhu. This immediately caused high fever, delirium, thirst, profuse sweating, asthma, and diarrhea consisting of yellow watery stool without feces, occurring countless times in a day and night. Urine output was scant, and she refused food. The condition was critical during the summer month. Gynecologists, seeing persistent heat, used Huangqin (Scutellariae Radix) and Lianzi (Nelumbinis Semen) or similar herbs, worsening the condition. They then heavily used Renshen, Baizhu, Rouguo (Myristicae Semen), and Ganjiang to stop diarrhea, but diarrhea persisted, heat intensified, and asthma and sweating worsened. Delirium continued. Other physicians withdrew. Sun examined her, finding chaotic pulses without order, rate of seven to eight breaths per pulse beat, with the right Guan position being particularly hard. Hesitating for a long time, he reasoned that sweating is common in summer, but wind pathogen, food stagnation, and blood stasis remained unresolved. The tonics were too abrupt. As the classics state, "Blood accumulation manifests as seeing ghosts," treatment should eliminate stasis and food stagnation and resolve summer heat. Survival was still possible. He prescribed Yiyuan San (Benefit Origin Powder) 6 qian as the sovereign herb to resolve summer heat and clear heat. Following Jingue's principle, "Thirst with difficulty in urination requires promoting urination first," and certainly for watery diarrhea, it serves as the sovereign. Hawthorn fruit (Shanzha) 3 qian served as the minister. Hongqu (Red Yeast Rice) and Zelan Ye (Lycopus Herba) each 1.5 qian served as assistants to eliminate blood stasis and calm the spirit. Xiangfu (Cyperi Rhizoma), Juhong (Tangerine Pith), Banxia (Pinelliae Rhizoma), and Fuling (Poria) served as guides to regulate Spleen Qi. Sanleng (Sparganii Rhizoma) 5 fen acted as the vanguard to break the congestion caused by previous Renshen and Baizhu. Taken with water, she slept slightly after the first dose. Over two days, four doses were taken. Heat decreased, diarrhea stopped, lochia began to flow slightly, and pulses became orderly. Sanleng and Hongqu were removed from the previous formula, and Doukou (Amomi Fructus Rotundus) was added. Heat completely subsided, and stools solidified. He then switched to Sijunzi Tang (Four Gentlemen Decoction) plus Yiyuan San, Qinghao (Artemisiae Annuae Herba), Xiangfu, Doukou, and Baishao (Paeoniae Radix Alba) for regulation and recovery.
Yu Zhen noted: The previous two cases presented deficiency mimicking excess; this case presented excess mimicking deficiency. Diseases confuse people thus. Using Huangqin and Lianlian worsened the condition; using Renshen and Baizhu with warming agents aggravated it further, leaving one helpless. Sun's success lay in identifying the hardness at the right Guan position. Indeed, a good healer must be skilled in pulse diagnosis. A crude physician seeing severe symptoms and chaotic, rapid pulses might fail to differentiate carefully, leading to death. By differentiating the pulse, Sun understood the pathology, allowing flexible medication. The efficacy relied partly on the small dose of Sanleng.
Madam Shen Shishan, wife of Biejia, three days postpartum, felt abdominal distension. A gynecologist purged her, causing five or six large bowel movements. She developed fever and nausea. Wendan Tang (Warm Gallbladder Decoction) was used for vomiting, and Xiaochaihu Tang for fever. After four days, vomiting and fever persisted, and she ate nothing. Bazhen Tang with Tongbian (Child's Urine) was tried, resulting in coma, deafness, closed eyes, thirst, borborygmus, and edema of eyelids and dorsum of hands/feet. Sun Dongsu was consulted. Pulses were rapid. Date: May 2nd. Sun said, "Pulse books state: Rapid pulse indicates Heat pathogen and Deficiency Zheng." He prescribed Shiquan Dabu Tang (Ten Significant Tonifying Decoction) with Paojing. By midnight, she felt clearer, drank porridge, opened her eyes, and spoke. The next day, excessive talking caused relapse into confusion. He prescribed Renshen and Baizhu each 3 qian, Paojing, Fuling, and Chenpi each 1 qian, Gancao 5 fen. She sweated slightly, developed miliaria (heat rash), heat subsided, and spirit cleared. In the afternoon, medication gap and anger caused relapse. Pulses became scattered and chaotic, like untying a rope. Miliaria disappeared, indicating extreme deficiency. Urgently, he gave Renshen and Baizhu each 5 qian, Zhigancao (Honey-fried Glycyrrhizae Radix), Paojing, and Fuzi each 1 qian. Two doses taken overnight led to deep sleep, though breathing remained rapid. On the 6th, pulses were rapid again, afternoon fever persisted, and a boil like a bowl appeared near the Huantiao (GB30) acupoint, red, swollen, and slightly painful. Previous physicians blamed Jiang and Fu, planning cold-clearing detoxifiers. Sun said, "This is wandering deficient fire from the Stomach due to extreme deficiency, not a toxin. The Neijing states: 'The strong recover as Qi moves; the weak develop disease as Qi stagnates.' Only massive tonification ensures safety. Cold agents will hasten death." He prescribed Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction), two doses day and night, with Renshen and Baizhu each 7 qian. Miliaria reappeared, the boil dissipated, and heat subsided. Shenling Baizhu San (Poria, Atractylodes, and Gastrodia Powder) was used for final recovery. All complications arose from incorrect purgation postpartum. One must fear such errors.
Yu Zhen noted: Bazhen Tang and Shiquan Dabu Tang are similar. One worsened the condition; the other rapidly improved it. Why? The difference lies in Rougui (Cinnamon Bark) and the addition of Paojing. Courage to use Jiang and Gui stems from understanding the meaning of rapid pulses. "Pathogen is Heat, Zheng is Deficiency" aligns with Zhang Jingyue. Heroes think alike. Modern physicians see rapid pulses and assume Heat, fearing Jiang, Fu, and Gui, causing many deaths. However, after warming tonification, rapid pulses must subside. Jingue said, "If rapid pulses persist, malignant sores arise," explaining the subsequent boil. Sun identified deficiency and concluded with massive warming tonification, vastly superior to those with no conviction who drift with circumstances.
Cheng Shizhou's wife, due to difficult labor and fetal death, suffered worry and depression, lower abdominal mass pain, afternoon fever, and anorexia. Sun diagnosed the right pulse larger than the left by three times and rapid. He prescribed Xionggui Tang (Ligusticum and Angelica Decoction) plus Shanzha, Zelan, and Rougui. The next afternoon, waist and abdominal pain occurred. Inquiry revealed she ate one jin (approx. 500g) of Longyanrou (Longan Aril) at noon. Thereafter, lower abdomen swelled, no bowel movement for three days, morning epistaxis, night fever, thirst, large chaotic pulses, critical condition. He used Xiongui, Honghua (Carthami Flos), Taoren (Pruni Semen), Qingpi (Citri Reticulatae Pericarpium Viride), Binglang (Arecae Semen), Ezhu (Curcumae Rhizoma), Shanzha. Water decoction with Yuánmíngfěn (Natrii Sulfas) 2 qian mixed. She passed two hard stools, rested peacefully, ate more porridge, then bloating recurred. Abdomen enlarged like a bucket, hard as stone, shortness of breath, critical. He prescribed Wulingzhi (Trogopteri Dung) and Shanzha each 4 qian, Lingxiaohua (Campsis Grandiflorae Flos) 2 qian, Chishao (Paeoniae Radix Rubra) 1 qian. Bowel movement ensued, abdomen softened, breathing stabilized, porridge intake resumed, vitality returned. Pulse remained bounding, indicating remaining stagnation. He used Shanzha and Dahuang (Rhei Radix et Rhizoma) each 3 qian, Taoren 2 qian, Guixin (Cinnamomi Ramulus) and Honghua each 5 fen, Zhigancao 7 fen, decocted with Yuánmíngfěn 1.5 qian. Four black stools passed that night, heat subsided. Upper abdomen reduced, but lower abdomen remained large. TaoRen Chengqi Tang (Peach Kernel Decoctio ad Order the Qi) plus Shanzha, Huashi (Kaolin), and Honghua was decocted. Large bowel movement at dawn, abdominal distension reduced. Finally, Jikuai Wan (Mass Dissolving Pill) regulated and resolved the mass. The gynecologist initially used Shiquan Dabu Tang for fever and pain. Unbeknownst to them, the sweet Longyanrou caused expansion and stagnation. Adding Dihuang (Rehmanniae Radix), Renshen, and Baizhu sealed the blockage, creating a hard mass. The Neijing states, "Fullness in the middle should be drained internally." They were misled by Danxi's error that postpartum requires massive tonification.
Yu Zhen noted: This case differs sharply from the previous one. Both rapid and large pulses are contraindicated postpartum. Yet, warming tonification worked in one, and attacking/dispersing in the other, both achieving full recovery. Only a master can do this. Shishan argued that floating/surging pulses suggest irritation by cold meds; here, stagnation was identified. Clinical practice requires flexibility; no fixed rules apply.
Ma Yuanyi treated the wife of the steward of the Suzhou Provincial Administration, one month postpartum. She had dull spirit, fatigue, chest fullness, mid-abdominal pain, cough, asthma, and fever. Medications worsened the condition, nearing untreatability. Ma diagnosed sinking, choppy, and knotted pulses in both hands. Ma said, "Latent pathogens existed prenatally. Postpartum Qi/Blood deficiency allows pathogens to knot internally. Treatment should harmonize exterior and interior, expelling pathogens outward and venting Qi inward." He used Guizhi (Cinnamomi Ramulus), Chaihu, Sugen (Perillae Caulis), Zhike (Aurantii Fructus), Banqu (Medicated Leaven), Fuzi (Radish Seed), Xingren (Armeniacae Semen Amarum), Guangpi (Tangerine Peel) to penetrate pathogens and move stagnation. Condition stabilized, pulses relaxed. Previous physicians, assuming Qi/Blood deficiency, abruptly used Renshen, Dihuang, Danggui, and Baishao (Paeoniae Radix Alba), causing insomnia and distress. Not realizing pathogens were knotted internally, they used tonics, akin to locking doors to let thieves out. Ma urgently changed to penetrating pathogens and resolving knots: Guizhi, Paojing, Huanglian (Coptidis Rhizoma), Zhishi (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex), Guangpi. One dose resolved chest/mid-abdominal fullness/pain. Next, Gualou Shi (Trichosanthis Fructus), Chaihu, Guizhi, Banxia, Zhishi, Xingren, Su Zi (Perillae Fructus), Jiegeng (Platycodonis Radix) resolved exterior heat, asthma, and cough. Constipation remained due to fluid injury from chronic illness. Shouwu (Polygoni Multiflori Radix Preparata) 1 liang was added, resolving constipation. Remaining pathogens cleared. Due to severe Qi/Blood deficiency, tonics were given for recovery. Some diseases involve internal knotting of deficiency pathogens with accumulated deficiency Zheng; one must tonify Zheng to support expulsion of pathogens. Ignorant physicians attack pathogens, harming Zheng. Some involve intact Zheng with flourishing pathogens; one must remove pathogens to pacify Zheng. Ignorant physicians use tonics, stagnating pathogens. Failure to distinguish deficiency/excess leads to unjust suffering unnoticed. How absurd!
Yu Zhen noted: If postpartum illness is due to external pathogens, they must be expelled. Do not blindly follow Danxi. I have seen cases of dysentery caused by summer-heat-dampness prenatally, continuing postpartum with abdominal pain, chest fullness, tenesmus, thirst, and rapid/large pulses. Using Huangqin, Lianlian, Binglang, Houpo, Huashi, Muxiang (Aucklandiae Radix), even Dahuang, yielded excellent results. Different disease, same principle as this case.