叶杏林指掌赋曰。医学之传。首自黄农。女科之始。则由扁鹊。邯郸为带下之医。史迁
所载。产宝着愈风之散。华佗所传。病机不等。巢元方之立论最详。精血攸关。褚侍中之遗
书甚善。热入血室。脏燥悲伤。胃气下泄而阴吹。非张长沙孰能辨此。三十六病。转女为男
巧夺造化之枢机。舍孙真人其谁与归。唐白敏中。访昝殷备集验方三百七十八首而为产宝
宋郭稽中。补濮阳李师圣产论二十一篇以为产方。作大全陈自明之勋最。补医按薛立斋之
功多。高宾刻便产须知。杜 着产育宝庆。朱丹溪之百问可传。陈无择之三因宜读。搜罗众
善。王宇泰之女科准绳。分晰群方。武叔卿之济阴纲目。议论具备于经纶。方法谨承夫家秘
东垣河间。各有名言。春甫养葵。亦多妙义。诸书悉当诵习。临证自探渊微。学问思辨。
不辞人十而己千。补泻寒温。可即一隅而反四。功行满则青城有望。怠惰久则白首无成。
东垣治一妇。年三十余。每洗浴后。必用冷水淋身。又尝大惊。遂患经来时。必先小腹
大痛。口吐涎水。经行后。又吐水三日。其痛又倍。至六七日。经水止时方住。百药不效。
诊其脉。寸滑大而弦。关尺皆弦大急。尺小于关。关小于寸。所谓前大后小也。遂用香附三
两。半夏二两。茯苓、黄芩各一两五钱。枳实、延胡、丹皮、人参、当归、白术、桃
仁各一两。黄连七钱。川楝、远志、甘草各五钱。桂三钱。吴茱萸一钱五分。分十五帖。
入姜汁两蚬壳。热服之。后用热汤洗浴。得微汗乃已。忌当风坐卧。手足见水。并忌吃生冷
服三十帖全愈。半年后。因惊忧。其病复举。腰腹时痛。小便淋痛。心惕惕惊悸。意其表
已解。病独在里。先为灸少冲、劳宫、昆仑、三阴交。止悸定痛。次用桃仁承气汤大下之。
下后用醋香附三两。醋蓬术、当归身各一两五钱。醋三棱、延胡索、醋大黄、醋青皮、青木
香、茴香、滑石、木通、桃仁各一两。乌药、甘草、砂仁、槟榔、苦楝各五钱。木香、吴茱
萸各二钱。分作二十帖。入新取牛膝湿者二钱。生姜五片。用荷叶汤煎服愈。
震按冷水淋身致病。似宜温经散寒。后因惊忧复病。似宜调气安神。乃前则寒药多于热
药。继则灸心与心胞络膀胱及脾之穴。即能止悸定痛。痛已定而复用桃仁承气大下之。立法
甚奇。且前用参。后不用参。而大下之后又用棱、术、桃、黄、青、槟等二十帖。几如国手
下子。不可思议。诚非明季清初诸医所能及也。
丹溪治一妇。年四十八岁。因有白带。口渴。月经多。初来血黑色。后来血淡。倦怠食
少。脐上急。以白术一钱五分。红花、豆大陈皮、白芍各一钱。木通、枳壳各五分。黄芩、
砂仁、炙甘草各三分。煎汤下保和丸三十粒。抑青丸三十粒。
震按初来血黑。后来血淡。是本虚而标热也。来既多。又倦怠食少。虚象显然。何以不
用补药。试观第四条女年十五之案。则此案治法似未尽善。或者此妇之脉弦大而数耶。下二
案如黄浆。如黑豆汁。制方极当。
一妇行经色淡若黄浆。心腹嘈杂。此脾胃湿痰故也。以二陈汤合四物入细辛、苍术。数
服即止。
一妇子经水下如黑豆汁。此络中风热也。以四物加黄芩、川连、荆芥穗、蔓荆子。数服
血清色转。
一女年十五。脉弦而大。不数。形肥。初夏时。倦怠。月经来时多。此禀受弱。气不足
摄血也。以白术一钱五分。生 、陈皮各一钱。人参五钱。炒柏三分。
一妇年四十余。月经不调。行时腹疼。行后又有三四日淋沥。皆秽水。口渴面黄。倦怠
无力。以白术一两。归身尾、陈皮各七钱。黄连三钱。木通二钱。生 、黄芩各二钱。炙甘
草一钱。分作八帖。下五灵脂丸四十粒。食前服。
震按此案用药。白术、黄连、归身、归尾用得最好。 、芩嫌其太轻。更好在五灵脂丸
一妇年二十余。形肥。痞塞不食。每日卧至未。饮薄粥一盏。粥后必吐水半碗。仍复卧
经不通三月矣。前番通时黑色。脉辰时寸关滑有力。午后关滑。寸则否。询之因乘怒饮食
而然。遂以白术一两五钱。浓朴、黄连、枳实各一两。半夏、茯苓、陈皮、山楂、人参、
滑
石各八钱。砂仁、香附、桃仁各五钱。红花二钱。分作十帖。每日服一帖。各入姜汁二蚬壳
间三日。以神佑丸、神秘沉香丸微下之。至十二日。吐止食渐进。四十日平复如故。
震按饮薄粥一碗。必吐水半碗。卧不能起。将认作大虚证矣。其辨在于痞塞。及经停之
前虽通而黑色也。此内火食积。郁成湿热。上则饮停。下则瘀阻。实证似虚耳。辰时寸关脉
滑有力者。辰为气血注胃之时。胃满甚而连及上焦。午后惟关滑。独显胃实之象矣。方主消
痰消食破气活血。加黄连、滑石以清湿热。仍兼人参以鼓舞胃气。使诸药得行其疏通之力。
再佐姜汁之辛以开道路。又治呕吐。此真纪律之师。有胜无败者也。然犹有病深药浅之虑。
隔三日。以二丸微下。则直捣贼巢。病根可拔矣。
吕沧洲治一女。在室病不月。诸医疗皆不得其状。视之腹大如娠。求其色脉即怪。语之
曰。汝病非有异梦。则鬼灵所凭耳。女不答。趋入卧内。密语其侍妪曰。我去夏追凉庙庑下
薄暮过木神心动。是夕梦一男子。如暮间所见者。即我寝亲狎。由是感病。我惭赧不敢以
告人。医言是也。妪以告吕。吕曰。女面色乍赤乍白者。愧也。脉乍大乍小者。祟也。病因
与色脉符。虽剧无苦。乃以桃仁煎下血类豚肝者六七枚。俱有窍如鱼目。病已。
震按此即鬼胎。亦易识别。惟云。病因与色脉符。虽剧无苦。一秘诀也。桃仁煎颇狠。
然非此药。不能去此病。
俞子容治一妇寡居。郁结成疾。经事不行。体热如炙。忽吐血若泉涌。医用止血药。不
效。愈以茅草根捣汁。浓磨沉香。服至五钱许。日以酽醋贮瓶内。火上炙热。气冲两鼻孔。
血始得降下。遂不复吐。经事乃行。
震按此是倒经。故降其气而血自降。茅根汁磨最妙。尤妙在热醋熏鼻。但经倒犹可生。
经枯则必死耳。
石山治一妇。瘦小。年二十余。经水紫色。或前或后。临行腹痛。恶寒喜热。或时感寒
腹亦作痛。脉皆细濡近滑。两尺重按略洪而滑。汪曰。血热也。或谓恶寒如此。何谓为热
曰。热极似寒也。遂用酒煮黄连四两。香附、归身尾各二两。五灵脂一两。为末粥丸。空
腹吞之而愈。
震按脉细濡近滑。两尺亦于重按略洪而滑。又不兼数。殊难认为大热。乃重用黄连而愈
汪公指下真有得心应手之乐。
一妇年二十一岁。六月。经行腹痛如刮。难忍求死。脉得细软而快。尺则沉弱而近快。
汪曰。细软属湿。数则为热。尺沉属郁滞也。以酒煮黄连八两。炒香附六两。五灵脂半炒半
生三两。归身尾二两。为末粥丸。空心汤下三四钱。服至五六料。越九年。得一子。又越四
年。经行两月不断。腹中微痛。又服前丸而愈。续后经行六七日。经止则流清水。腹中微痛
又服前丸而痛亦止。又经住只有七八日。若至行时。或大行五六日。续则适来适断。或微
红。或淡红。红后常流清水。小腹大痛。渐连遍身。胸背腰腿骨里皆痛。自巳至酉乃止。痛
则遍身冷热。汗大出。汗止痛减。尚能饮食。自始痛至今。历十五年。前药屡服屡效。今罔
效者何也。汪复诊之。脉皆洪滑无力。幸其尚有精神。汪曰。此非旧日比矣。旧乃郁热。今
则虚寒。东垣曰。始为热中。终为寒中是也。经曰。脉至而从。按之不鼓。乃阴盛格阳。当
作寒治。且始病时形敛小。今则形肥大矣。医书曰。瘦人血热。肥人气虚。岂可同一治耶。
所可虑者。汗大泄而脉不为汗衰。血大崩而脉不为血减耳。其痛日重夜轻。知由阳虚不能健
运。故亦凝滞而作痛。以证参脉。宜用助阳。若得脉减痛轻。方为佳兆。遂投参、 、归、
术大剂加桂、附。一帖。来早再诊。脉皆稍宁。服至二三十帖。时当二月。至五月病愈。盖
病有始终寒热之异。药有前后用舍不同。形有肥瘦壮少不等。岂可以一方而通治哉。
震按细软而数。为湿热。洪滑无力。为虚寒。的系辨脉要旨。汪公自跋数语。尤属治病
要诀。然前之黄连。终嫌太过。久服不换。亦恐非宜。
一妇经行。必泻三日。然后行。诊其脉皆濡弱。曰。此脾虚也。脾属血。属湿。经水将
动。脾血已先流注血海。然后下流为经。脾血既亏。则虚而不能营运其湿。令作参苓白术散
每服二钱。一日米饮调下二三次。月余。经行不泻矣。
一妇年逾四十。形长色脆。病经不调。右脉浮软而大。左脉虚软而小。近快。常时经前
作泄。今年四月。感风咳嗽。用汤洗浴汗多。因泄一月。六月。复因洗浴。发疟六七次。疟
虽止而神思不爽。至八月尽。而经水过多。白带时下。泻泄。遂觉右脚疼痛。旧曾闪挫脚跟
今则假此延痛。臀腿腰胁尻骨胫项左边筋皆掣痛。或咳嗽一声。则腰眼痛如刀扎。日轻夜
重。叫号不已。幸痛稍止。饮食如常。因思月水过多。白带时下。日轻夜重。泄泻无时。亦
属下多亡阴。宜作血虚治。然服四物止痛之剂益甚。九月。汪复诊视。始
悟此病乃合仲景所谓阳生则阴长之法矣。夫经水多。白带下。常泄泻。皆由阳虚陷下而然。
脱是也。日轻夜重。盖日阳旺而得健运之职。故血亦无凝滞之患而日轻也。夜则阴旺而阳不
得其任。失其健运之常。血亦随滞。故夜重也。遂以参、术助阳之药。煎服六七帖。痛减。
此亦病证之变。治法殊常。故记之。
震按前案之理易明。此案之脉亦易认为虚。惟近快而合以足之延痛。颇似湿热耳。然久
泻复疟。经水过多。白带时下。显系参、术对证。何云治法殊常耶。
一妇人年逾四十。形色颇实。常患产难倒生。经水不调。或时遍身骨节疼痛。食少倦怠
自汗。汪诊之。两手脉皆不应。而右关轻按。隐隐然微觉动也。疑脉出部。以指寻按经渠
列缺穴分。亦不应。甚怪之。乃叩其夫。曰。有孕时。医诊亦言无脉。后服八物汤。幸而易
产。得一子。汪曰。此由禀赋本来脉不应也。无足怪。可见天下事变无穷。果难一一以常理
测也。如脉经所谓。但道其常而已。两手无脉。不伤其生。又不妨于胎孕。岂脉经所能尽耶
震按人有一手无脉者颇多。若两手无脉者则少。此乃母胎中。或襁褓时。蹙锉其经隧。
致脉不通。原非病也。石山又诊一妇左手无脉。而动于腕臂外廉阳溪偏历之分。是即今所谓
反关脉耳。汪乃曰。左脉离其部位。其病难以脉知。诚然反关脉多洪大。且可推展。果不足
以审病情。又按丹溪治一妇久疟。食少经闭。两手无脉。每日与三花神佑丸十余粒。津咽之
月余食进。脉出。又半月脉愈。又一月经行。此则因病而无脉。非向来无脉也。
一妇产后。经行不止。或红或白或淡。病逾八月。面色黄白。性躁。头眩脚软。医用参
补药。病益加。用止涩药不效。汪诊之。右脉濡弱无力。左脉略洪而快。曰。右脉弱者。
非病也。左脉偏盛。遂觉右脉弱耳。宜主左脉。治以凉血之剂。遂以生地、白芍、白术各一
钱。黄芩、阿胶、归身各八分。陈皮、香附、川芎、椿根皮、茯苓各六分。柴胡、甘草各五
分。煎服二十余剂而愈。
震按右脉濡弱无力。而汪公乃以左脉偏盛为主。其取舍异矣。且曰。右脉弱非病。则经
水之或白或淡。及面色黄白头眩脚软。非右脉弱之为病。汪公盖因曾用参 而病益加。则右
脉不足凭。常以凉血之剂专主左脉为治耳。
又治一妇。年逾三十无子。汪诊其脉近和。惟尺部洪滑。曰。子宫有热。血海不固也。
其夫曰然。每行人道。经水即来。乃以丹溪大补丸加山茱萸、白龙骨止涩之药以治其内。再
以乱发灰、白矾灰、黄连、五倍子为末。以治其隐处。果愈且孕。
立斋治一妇人。每交接则出血作痛。敷服皆凉血止痛之剂。不时出血甚多。此肝伤不能
藏血。脾伤不能摄血也。用补中益气归脾二汤而愈。外亦以乱发、青布。烧灰敷之。
又一外家证同前。按其脉。两尺沉迟而涩。用补血散寒之剂不愈。偶检千金方。以蛇床子
散绵裹纳其中。二次遂愈。
震按以上三案。病同而治法各异。可见病以脉为断也。立斋首案不载脉。然敷服皆凉血
止痛之剂不效。则舍补无他法矣。此又可以意会也。
又一妇人。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。薛曰。脾为诸阴之首。目为血脉之宗。此脾伤五脏皆为失所。
不能归于目矣。遂用补中益气、济生归脾二汤。专主脾胃。年余寻愈。
震按此案可比人天法眼。若不补脾胃而用血药凉药以治目。亡无日矣。
一妇人年四十。劳则足跟热痛。薛以阴血虚极。急用圣愈汤而痊。后遍身瘙痒。误服风
药。发热抽搐。肝脉洪数。此乃肝家血虚火盛而生风。以天竺胆星为丸。用四物、麦冬、五
味、芩、连、炙草、山栀、柴胡煎送而愈。
叶天士在《指掌赋》中说：医学的传承，最早追溯到黄帝和神农。妇科的开端，则始于扁鹊。他在邯郸担任治疗妇女带下病的医生，这是司马迁在《史记》中记载的。华佗所著的《产宝》，记录了愈风散等方剂。病机理论虽然繁杂，但巢元方的立论最为详尽，因为这与精血密切相关。褚遂良（褚侍中）留下的医书也非常好。像热入血室、脏躁悲伤、胃气下泄导致的阴吹等症状，如果不是张仲景（长沙太守），谁能辨别清楚呢？关于三十六种妇科病证，以及转女为男这样巧夺天工的枢机变化，除了孙思邈（真人），还有谁能够胜任呢？唐代的白敏中，拜访昝殷，收集了三百七十八首验方，编成《产宝》。宋代的郭稽中，补充了濮阳李师圣的二十一篇产论，编成《产方》。陈自明编纂《妇人大全良方》，功勋最大；薛立斋编写《内科摘要》，功劳很多。高宾刻印了《便产须知》，杜本著有《产育宝庆》。朱丹溪的《百问》值得流传，陈无择的《三因极一病证方论》应当阅读。搜罗各家之长，王宇泰的《女科准绳》将各种方剂分析得清清楚楚，武叔卿的《济阴纲目》议论完备于经纶之中，方法严谨地继承了家传秘方。东垣和河间两位大家，各有名言；春甫养葵，也多有妙义。这些书籍都应当诵读学习，临证时自然能探求到深奥微妙的道理。学问需要思考辨析，不怕别人做十遍，自己要做千遍；通过补泻寒温的一隅之知，可以推知其他方面。功行圆满，就有望达到青城仙人的境界；如果怠惰长久，则白发苍苍却一事无成。
李东垣治疗一位三十多岁的妇人。每次洗澡后，她一定用冷水淋身，又曾受大惊吓，于是患上月经来时必先小腹剧烈疼痛，口吐涎水，月经结束后，又吐水三天，疼痛加倍。直到六七天，月经停止时才缓解。服用各种药物都不见效。诊察她的脉象，寸部滑大而弦，关部和尺部都是弦大急，尺部小于关部，关部小于寸部。这就是所谓的“前大后小”。于是使用香附三两，半夏二两，茯苓、黄芩各一两五钱，枳实、延胡索、牡丹皮、人参、当归、白术、桃仁各一两，黄连七钱，川楝子、远志、甘草各五钱，桂枝三钱，吴茱萸一钱五分。分为十五帖，加入姜汁两蚬壳量，热服。之后用热水洗澡，微微出汗才停止。忌避当风坐卧，手足接触冷水，并忌吃生冷食物。服用三十帖后完全痊愈。半年后，因为惊恐忧虑，病情复发，出现腰腹时常疼痛，小便淋漓刺痛，心中惕惕不安惊悸。推测表证已解，病独在里。先艾灸少冲、劳宫、昆仑、三阴交穴，以止住惊悸定住疼痛。接着使用桃仁承气汤猛烈攻下。攻下后，使用醋制香附三两，醋制蓬莪术、当归身各一两五钱，醋制三棱、延胡索、醋大黄、醋青皮、青木香、茴香、滑石、木通、桃仁各一两，乌药、甘草、砂仁、槟榔、苦楝各五钱，木香、吴茱萸各二钱。分为二十帖，加入新取的湿牛膝二钱，生姜五片，用荷叶汤煎服而愈。
俞震按语：用冷水淋身致病，似乎适宜温经散寒。后来因惊恐忧虑复发，似乎适宜调气安神。然而前面用的寒药多于热药，随后灸心包络、膀胱及脾的穴位，就能止悸定痛。疼痛稳定后又用桃仁承气汤猛烈攻下。立法非常奇特。而且前面用人参，后面不用人参，而在大下之后又用三棱、莪术、桃仁、大黄、青皮、槟榔等二十帖，简直如同国手下棋，不可思议。这确实不是明清之际那些医生所能达到的水平。
朱丹溪治疗一位四十八岁的妇人。因为有白带，口渴，月经量多，初来血色黑，后来血色淡，倦怠食少，脐上紧迫。用白术一钱五分，红花、豆大的陈皮、白芍各一钱，木通、枳壳各五分，黄芩、砂仁、炙甘草各三分，煎汤送服保和丸三十粒，抑青丸三十粒。
俞震按语：初来血黑，后来血淡，是本虚而标热。既然量多，又倦怠食少，虚象明显。为什么不用补药？试看第四条女性年十五岁的医案，那么这个案例的治疗方法似乎不够完善。或许这位妇人的脉象是弦大而数吧？下面两个医案，一个如黄浆，一个如黑豆汁，制方非常恰当。
一位妇人经期血色淡如黄浆，心腹嘈杂，这是脾胃湿痰的缘故。用二陈汤合四物汤，加入细辛、苍术，服用几剂就停止了。
一位妇人经期血流如黑豆汁，这是经络中风热的缘故。用四物汤加黄芩、黄连、荆芥穗、蔓荆子，服用几剂后血清色转。
一位女性十五岁，脉弦大但不数，形体肥胖，初夏时倦怠，月经来时量多，这是禀赋弱，气不足不能摄血。用白术一钱五分，生黄芪、陈皮各一钱，人参五钱，炒黄柏三分。
一位四十多岁的妇人，月经不调，行经时腹痛，行经后又有三四日淋漓不尽，都是秽水，口渴面黄，倦怠无力。用白术一两，当归身尾、陈皮各七钱，黄连三钱，木通二钱，生黄芪、黄芩各二钱，炙甘草一钱。分为八帖，送服五灵脂丸四十粒，饭前服用。
俞震按语：这个案例用药，白术、黄连、当归身、当归尾用得最好。黄芪、黄芺嫌其太轻，好在有五灵脂丸。
一位二十多岁的妇人，形体肥胖，痞塞不进食，每天躺到未时，喝一盏薄粥，饭后必吐半碗水，仍然继续躺卧。月经三个月没来了。上次通经时血色黑。辰时寸关脉滑有力，午后关脉滑，寸脉则否。询问得知是因为发怒后进食所致。于是用白术一两五钱，厚朴、黄连、枳实各一两，半夏、茯苓、陈皮、山楂、人参、滑石各八钱，砂仁、香附、桃仁各五钱，红花二钱。分为十帖，每日服一帖，每帖加入姜汁两蚬壳量。隔三日，用神佑丸、神秘沉香丸轻微攻下。到第十二天，呕吐停止，饮食逐渐增加，四十天后平复如初。
俞震按语：喝一碗薄粥，必吐半碗水，躺卧不能起身，几乎要认作大虚证了。辨证的要点在于痞塞，以及停经之前虽通经但血色黑。这是内火食积，郁结成湿热，上则饮水停留，下则瘀血阻滞，实证看起来像虚证。辰时寸关脉滑有力，辰时是气血灌注胃的时候，胃满甚而连及上焦，午后只有关脉滑，独显胃实之象。方子主要消痰消食破气活血，加黄连、滑石以清湿热，仍兼用人参以鼓舞胃气，使诸药得以发挥疏通之力。再佐以姜汁的辛味以开通道路，又能治呕吐。这真是纪律严明的军队，有胜无败啊。然而仍有病深药浅的顾虑。隔三日用两丸轻微攻下，则直捣贼巢，病根可拔除。
吕沧洲治疗一位未婚女子，患闭经，众医诊治都不能得其状貌。看她腹部大如怀孕。询问其神色脉象即觉奇怪。对她说：“你的病不是做了异梦，就是鬼神凭依。”女子不回答，快步进入卧室，悄悄告诉侍女说：“我去年夏天在庙廊下乘凉，傍晚经过木神祠心动。那天晚上梦见一男子，就像傍晚所见的那样，就在我的寝室内亲近狎昵。因此感病，我羞愧不敢告诉人。医生说对了。”侍女把这话告诉吕沧洲。吕沧洲说：“女子面色忽红忽白，是羞愧的表现。脉象忽大忽小，是鬼祟的表现。病因与色脉相符，虽然严重但没有痛苦。”于是用桃仁煎送下类似猪肝的血块六七枚，都有孔窍像鱼眼一样。病就好了。
俞震按语：这就是鬼胎，也容易识别。只说“病因与色脉相符，虽然严重但没有痛苦”，这是一个秘诀。桃仁煎很猛烈，但不用此药，不能去除这个病。
俞子容治疗一位寡居的妇人，因忧郁结成疾病，月经不行，身体发热如火烤，忽然吐血如泉涌。医生用止血药，无效。改用茅草根捣汁，浓磨沉香，服用至五钱左右，每天用浓醋贮存在瓶内，火上加热，让热气冲入两个鼻孔，血才开始降下，于是不再吐血，月经也就行了。
俞震按语：这是倒经，所以降其气而血自降。茅根汁磨沉香最妙。尤其妙在用热醋熏鼻。但经血倒行还可以生存，经血枯竭则必死。
石山治疗一位瘦小的妇人，二十多岁，经血色紫，或提前或错后，临行经时腹痛，恶寒喜热，有时感受寒冷腹部也作痛。脉皆细濡近滑，两尺重按略洪而滑。汪机说：“这是血热。”有人说是恶寒如此，怎么能说是热？回答说：“热极似寒。”于是用酒煮黄连四两，香附、当归身尾各二两，五灵脂一两，研末，用米粥做成丸药，空腹吞服而愈。
俞震按语：脉细濡近滑，两尺重按略洪而滑，又不兼数，很难认为是大热。乃重用黄连而痊愈。汪公指下真有得心应手的乐趣。
一位二十一岁的妇人，六月，行经腹痛如刮，难忍求死。脉得细软而快，尺部沉弱而近快。汪机说：“细软属湿，数则为热，尺沉属郁滞。”用酒煮黄连八两，炒香附六两，五灵脂半炒半生三两，当归身尾二两，研末，用米粥做成丸药，空腹汤送下三四钱。服用至五六料，过了九年，生得一子。又过四年，行经两个月不断，腹中微痛，又服前丸而愈。续后经行六七日，经止则流清水，腹中微痛，又服前丸而痛亦止。又经住只有七八日，若至行经时，或大行五六日，续则适来适断，或微红，或淡红，红后常流清水，小腹大痛，渐连遍身，胸背腰腿骨里皆痛，从巳时至酉时乃止。痛则遍身冷热，汗大出，汗止痛减，尚能饮食。自始痛至今，历经十五年，前药屡服屡效，现在无效是什么原因？汪机再次诊视，脉皆洪滑无力。幸好她尚有精神。汪机说：“这已经不是旧日的情况了。旧日是郁热，现在是虚寒。李东垣说：‘始为热中，终为寒中’。《内经》说：‘脉至而从，按之不鼓，乃阴盛格阳’，应当作寒治。而且始病时形体收敛细小，现在则形体肥大了。医书说：‘瘦人血热，肥人气虚’，怎么可以用同一方法治疗呢？所担心的是，汗大泄而脉不为汗衰，血大崩而脉不为血减罢了。其痛日重夜轻，知道是由阳虚不能健运，所以凝滞而作痛。以证参脉，宜用助阳。如果得到脉减痛轻，才是佳兆。”于是投予人参、黄芪、当归、白术大剂，加肉桂、附子。一帖，第二天早晨再诊，脉皆稍宁。服用至二三十帖，时当二月，到五月病愈。盖病有始终寒热之异，药有前后用舍不同，形有肥瘦壮少不等，岂可以用一方而通治哉？
俞震按语：细软而数，为湿热；洪滑无力，为虚寒。确实是辨脉的要旨。汪公自跋数语，尤属治病要诀。然而前面的黄连，终究嫌太过，久服不换，也恐怕不宜。
一位妇人行经，必腹泻三日，然后行经。诊其脉皆濡弱。说：“这是脾虚。脾属血，属湿。经水将动，脾血已先流注血海，然后下流为经。脾血既亏，则虚而不能营运其湿。”令作参苓白术散，每服二钱，一日用米饮调下二三次。月余，行经不泻了。
一位四十多岁的妇人，形体长脸色脆，病经不调，右脉浮软而大，左脉虚软而小，近快。常时经前作泄，今年四月，感风咳嗽，用汤洗浴汗多，因泄一月。六月，复因洗浴，发疟疾六七次。疟虽止而神思不爽，至八月尽，而经水过多，白带时下，泻泄，遂觉右脚疼痛。旧曾闪挫脚跟，今则假此延痛，臀腿腰胁尻骨胫项左边筋皆掣痛。或咳嗽一声，则腰眼痛如刀扎，日轻夜重，叫号不已。幸痛稍止，饮食如常。因思月水过多，白带时下，日轻夜重，泄泻无时，亦属下多亡阴，宜作血虚治。然服四物止痛之剂益甚。九月，汪机复诊视，始悟此病乃合仲景所谓阳生则阴长之法矣。夫经水多，白带下，常泄泻，皆由阳虚陷下而然。脱是也。日轻夜重，盖日阳旺而得健运之职，故血亦无凝滞之患而日轻也。夜则阴旺而阳不得其任，失其健运之常，血亦随滞，故夜重也。遂以参、术助阳之药，煎服六七帖，痛减。此亦病证之变，治法殊常，故记之。
俞震按语：前案的理容易明白，此案的脉也容易认为虚。惟独近快而合以足之延痛，颇似湿热耳。然而久泻复疟，经水过多，白带时下，显系参、术对证，何云治法殊常耶？
一位四十多岁的妇人，形色颇实，常患产难倒生，经水不调，或时遍身骨节疼痛，食少倦怠自汗。汪机诊之，两手脉皆不应，而右关轻按，隐隐然微觉动也。疑脉出部，以指寻按经渠列缺穴分，亦不应，甚怪之。乃叩其夫，曰：“有孕时，医诊亦言无脉，后服八物汤，幸而易产，得一子。”汪机曰：“此由禀赋本来脉不应也，无足怪。可见天下事变无穷，果难一一以常理测也。如脉经所谓，但道其常而已。两手无脉，不伤其生，又不妨于胎孕，岂脉经所能尽耶？”
俞震按语：人有一手无脉者颇多，若两手无脉者则少。此乃母胎中，或襁褓时，蹙锉其经隧，致脉不通，原非病也。石山又诊一妇左手无脉，而动于腕臂外廉阳溪偏历之分，是即今所谓反关脉耳。汪机乃曰：“左脉离其部位，其病难以脉知。”诚然反关脉多洪大，且可推展，果不足以审病情。又按丹溪治一妇久疟，食少经闭，两手无脉，每日与三花神佑丸十余粒，津咽之，月余食进，脉出，又半月脉愈，又一月经行。此则因病而无脉，非向来无脉也。
一位妇人产后，经行不止，或红或白或淡，病逾八月，面色黄白，性躁，头眩脚软。医用参补药，病益加，用止涩药不效。汪机诊之，右脉濡弱无力，左脉略洪而快。曰：“右脉弱者，非病也，左脉偏盛，遂觉右脉弱耳。宜主左脉，治以凉血之剂。”遂以生地、白芍、白术各一钱，黄芩、阿胶、归身各八分，陈皮、香附、川芎、椿根皮、茯苓各六分，柴胡、甘草各五分，煎服二十余剂而愈。
俞震按语：右脉濡弱无力，而汪公乃以左脉偏盛为主，其取舍异矣。且曰：“右脉弱非病”，则经水之或白或淡，及面色黄白头眩脚软，非右脉弱之为病。汪公盖因曾用参芪而病益加，则右脉不足凭，常以凉血之剂专主左脉为治耳。
又治一妇人，年逾三十无子。汪机诊其脉近和，惟尺部洪滑。曰：“子宫有热，血海不固也。”其夫曰：“然，每行人道，经水即来。”乃以丹溪大补丸加山茱萸、白龙骨止涩之药以治其内，再以乱发灰、白矾灰、黄连、五倍子为末，以治其隐处，果愈且孕。
薛立斋治疗一妇人，每交接则出血作痛，敷服皆凉血止痛之剂，不时出血甚多。此肝伤不能藏血，脾伤不能摄血也。用补中益气归脾二汤而愈。外亦以乱发、青布，烧灰敷之。
又一外家证同前，按其脉，两尺沉迟而涩，用补血散寒之剂不愈。偶检千金方，以蛇床子散绵裹纳其中，二次遂愈。
俞震按语：以上三案，病同而治法各异，可见病以脉为断也。立斋首案不载脉，然敷服皆凉血止痛之剂不效，则舍补无他法矣。此又可以意会也。
又一妇人，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。薛立斋曰：“脾为诸阴之首，目为血脉之宗，此脾伤五脏皆为失所，不能归于目矣。”遂用补中益气、济生归脾二汤，专主脾胃，年余寻愈。
俞震按语：此案可比人天法眼。若不补脾胃而用血药凉药以治目，亡无日矣。
一妇人年四十，劳则足跟热痛。薛立斋以阴血虚极，急用圣愈汤而痊。后遍身瘙痒，误服风药，发热抽搐，肝脉洪数，此乃肝家血虚火盛而生风，以天竺胆星为丸，用四物、麦冬、五味、芩、连、炙草、山栀、柴胡煎送而愈。
Ye Xilin's *Zhang Fu* (Palm Manual) states: The transmission of medicine originates from Huangdi (Yellow Emperor) and Shennong (Divine Farmer). The beginning of gynecology starts with Bian Que. He served as a doctor for women's leukorrhea in Handan, as recorded by Sima Qian. Hua Tuo transmitted the *Chan Bao* (Precious Prescriptions for Childbirth), which includes the Yufeng San (Wind-Relieving Powder). Although pathological mechanisms are diverse, Chao Yuanfang's theoretical discussions are the most detailed, as they concern essential blood and essence. Chu Shizhong's (Chu Suiliang) surviving writings are also excellent. Conditions such as heat entering the Blood Chamber (Xue Shi), Zang Zao (Organ Dryness with sorrowful mood), and Yin Chui (vaginal flatulence caused by downward leakage of Stomach Qi) could only be distinguished by Zhang Zhongjing (the Grandee of Changsha). Regarding thirty-six types of gynecological diseases, and the miraculous pivot of transforming female to male, who else but Sun Simiao (the True Man) could achieve this? In the Tang Dynasty, Bai Minzhong visited Zan Yin, collected 378 verified prescriptions, and compiled them into *Chan Bao*. In the Song Dynasty, Guo Jizhong supplemented Li Shisheng of Puyang's twenty-one treatises on childbirth to create *Chan Fang*. Chen Ziming's compilation of *Da Quan* (Complete Works) holds the greatest merit; Xue Lizhai's contributions to *Yi An* (Medical Records) are substantial. Gao Bin engraved *Bian Chan Xu Zhi* (Necessary Knowledge for Easy Childbirth), and Du Ben authored *Chan Yu Bao Qing* (Precious Celebration of Childbearing). Zhu Danxi's *Bai Wen* (Hundred Questions) is worth transmitting, and Chen Wuyi's *San Yin* (Three Causes) should be read. Collecting all merits, Wang Yutai's *Nu Ke Zhun Sheng* (Standard for Gynecology) analyzes various formulas clearly, while Wu Shuqing's *Ji Yin Gang Mu* (Outline of Women's Medicine) has complete discussions on classics and methods, strictly inheriting family secrets. Dongyuan (Li Dongyuan) and Hejian (Liu Wansu) each have famous sayings; Chunfu Yangkui also has many profound meanings. All these books should be recited and studied; when treating clinically, one will naturally explore the profound mysteries. Learning requires thinking and discrimination; do not refuse to work ten times harder than others. From understanding one corner of tonifying, purging, cooling, and warming, one can infer the rest. When merit and practice are full, one may hope to reach Mount Qingcheng (immortality); if lazy for too long, one will grow old white-haired without achievement.
Li Dongyuan treated a woman over thirty years old. After every bath, she would splash cold water on her body. She had also suffered a great fright. Consequently, whenever her menstruation arrived, she experienced severe lower abdominal pain first, followed by vomiting saliva. After menstruation ceased, she vomited water for three days, and the pain doubled. It did not stop until six or seven days later when menstruation ended. Various medicines were ineffective. Her pulse was slippery, large, and wiry at the Cun (inch) position, and wiry, large, and urgent at the Guan (bar) and Chi (cubit) positions. The Chi position was smaller than Guan, and Guan smaller than Cun. This is what is called "large in front, small in back." He prescribed Xiang Fu (Cyperus Rhizome) 3 liang, Ban Xia (Pinellia Tuber) 2 liang, Fu Ling (Poria) and Huang Qin (Scutellaria Root) 1.5 liang each, Zhi Shi (Immature Bitter Orange), Yan Hu Suo (Corydalis Rhizome), Dan Pi (Moutan Cortex), Ren Shen (Ginseng Root), Dang Gui (Angelica Sinensis Root), Bai Zhu (Atractylodes Rhizome), and Tao Ren (Peach Seed) 1 liang each, Huang Lian (Coptis Rhizome) 7 qian, Chuan Lian Zi (Sichuan Chinaberry Seed), Yuan Zhi (Polygala Root), and Gan Cao (Licorice Root) 5 qian each, Gui Zhi (Cinnamon Twig) 3 qian, Wu Zhu Yu (Evodia Fruit) 1.5 qian. Divided into fifteen doses, taken hot with ginger juice (two clam shells). Afterwards, she bathed in hot water until slight sweating occurred. She was advised to avoid sitting or lying in drafts, letting hands and feet touch water, and eating raw/cold foods. After taking thirty doses, she was completely cured. Half a year later, due to fright and worry, the disease relapsed with occasional waist and abdominal pain, dysuria, and palpitations/fearfulness. Inferring that the exterior syndrome was resolved and the disease was solely in the interior, he first moxa-ed Shaochong (HT9), Laogong (PC8), Kunlun (BL60), and Sanyinjiao (SP6) to stop palpitations and pain. Then he used Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) to purge vigorously. After purging, he used Cu Xiang Fu (Vinegar-processed Cyperus) 3 liang, Cu Peng Zhu (Vinegar-processed Curcuma Zedoaria Rhizome) and Dang Gui Shen (Angelica Sinensis Root Head) 1.5 liang each, Cu San Leng (Vinegar-processed Burreed Tuber), Yan Hu Suo, Cu Da Huang (Vinegar-processed Rheum Rhizome), Cu Qing Pi (Vinegar-processed Tangerine Peel), Qing Mu Xiang (Aucklandiae Radix), Hui Xiang (Fennel Fruit), Hua Shi (Talcum), Mu Tong (Akebia Caulis), and Tao Ren 1 liang each, Wu Yao (Lindera Root), Gan Cao, Sha Ren (Amomum Fruit), Bing Lang (Areca Seed), and Ku Lian (Chinaberry Root Bark) 5 qian each, Mu Xiang (Costus Root) and Wu Zhu Yu 2 qian each. Divided into twenty doses, taken with fresh wet Niu Xi (Achyranthes Root) 2 qian and five slices of Sheng Jiang (Fresh Ginger), decocted in Lotus Leaf Soup. She was cured.
Yu Zhen commented: Illness caused by splashing cold water seems suitable for warming meridians and dispersing cold. Relapse due to fright and worry seems suitable for regulating qi and calming the spirit. Yet previously, cold herbs outweighed hot ones. Subsequently, moxa-ing heart, pericardium, bladder, and spleen acupoints stopped palpitations and pain. After pain stabilized, using Tao Ren Cheng Qi Tang to purge vigorously is very unusual legislation. Moreover, Ren Shen was used before but not after, and after vigorous purging, twenty doses of San Leng, E Zhu, Tao Ren, Da Huang, Qing Pi, Bing Lang, etc., were used. It is like a grandmaster playing chess, unimaginable. This is indeed beyond the reach of physicians in the late Ming and early Qing dynasties.
Zhu Danxi treated a forty-eight-year-old woman. She had leukorrhea, thirst, heavy menstruation. Initially, the blood was black, later pale. She felt fatigued with poor appetite and tightness above the umbilicus. He prescribed Bai Zhu (Atractylodes Macrocephala Rhizome) 1.5 qian, Hong Hua (Carthamus Flower), Chen Pi (Tangerine Peel) the size of a bean, Bai Shao (White Peony Root) 1 qian each, Mu Tong (Akebia Caulis), Zhi Ke (Bitter Orange) 0.5 qian each, Huang Qin (Scutellaria Root), Sha Ren (Amomum Fruit), Zhi Gan Cao (Prepared Licorice Root) 0.3 qian each. Decocted in soup to take with Bao He Wan (Preserve Harmony Pill) 30 pills and Yi Qing Wan (Suppress Green Pill) 30 pills.
Yu Zhen commented: Black blood initially, pale later indicates root deficiency with branch heat. Heavy flow plus fatigue and poor appetite clearly shows deficiency. Why no tonics? Referring to the case of the fifteen-year-old girl below, this treatment method seems imperfect. Perhaps her pulse was wiry, large, and rapid? The following two cases, one like yellow paste, one like black bean juice, were formulated very appropriately.
A woman had pale menstrual blood like yellow paste, with stomach and abdomen discomfort (tsao za). This was due to Spleen-Stomach damp-phlegm. Er Chen Tang (Two-Cured Decoction) combined with Si Wu Tang (Four Substance Decoction), added with Xi Xin (Asarum Root) and Cang Zhu (Atractylodes Rhizome). A few doses stopped it.
A woman had menstrual blood flowing like black bean juice. This was wind-heat in the collaterals. Si Wu Tang added with Huang Qin, Huang Lian (Coptis Rhizome), Jing Jie Sui (Schizonepeta Spike), and Man Jing Zi (Vernonia Fruit). A few doses cleared the blood and changed the color.
A fifteen-year-old girl had a wiry and large pulse, not rapid. She was obese, fatigued in early summer, with heavy menstruation. This was weak constitution and insufficient Qi failing to control blood. Bai Zhu 1.5 qian, Sheng Huang Qi (Raw Astragalus Root), Chen Pi 1 qian each, Ren Shen 5 qian, Chao Huang Bo (Stir-fried Phellodendron Bark) 0.3 qian.
A woman over forty had irregular menstruation, abdominal pain during flow, and dripping discharge for three to four days after flow, consisting of foul fluid. She had thirst, sallow complexion, fatigue, and weakness. Bai Zhu 1 liang, Dang Gui Shen Wei (Angelica Root Head and Tail), Chen Pi 0.7 liang each, Huang Lian 3 qian, Mu Tong 2 qian, Sheng Huang Qi, Huang Qin 2 qian each, Zhi Gan Cao 1 qian. Divided into eight doses, taken with Wu Ling Zhi Wan (Trogopterus Dung Pill) 40 pills before meals.
Yu Zhen commented: In this case, Bai Zhu, Huang Lian, Dang Gui Shen, and Dang Gui Wei were used best. Huang Qi and Huang Qin were too light; the use of Wu Ling Zhi Pill was good.
A woman in her twenties was obese, with chest fullness and anorexia. She lay down until Wei hour (1-3 PM), drank a bowl of thin porridge, then vomited half a bowl of water, and continued lying down. Menstruation had stopped for three months. Previous flow was black. At Chen hour (7-9 AM), Cun and Guan pulses were slippery and forceful; at afternoon, Guan was slippery, Cun was not. Inquiry revealed it resulted from eating while angry. Bai Zhu 1.5 liang, Hou Po (Magnolia Bark), Huang Lian, Zhi Shi 1 liang each, Ban Xia, Fu Ling, Chen Pi, Shan Zha (Hawthorn Fruit), Ren Shen, Hua Shi 0.8 liang each, Sha Ren, Xiang Fu, Tao Ren 0.5 liang each, Hong Hua 2 qian. Divided into ten doses, one dose daily, each with ginger juice (two clam shells). Every three days, slightly purge with Shen You Wan (Divine Protection Pill) and Shen Mi Chen Xiang Wan (Mysterious Musk Agarwood Pill). By the twelfth day, vomiting stopped, diet gradually increased, and by the fortieth day, she recovered fully.
Yu Zhen commented: Vomiting half a bowl of water after one bowl of porridge, unable to rise, almost mistaken for severe deficiency. The differentiation lies in chest fullness and previous black menstrual blood. This is internal fire and food stagnation,郁结 (stagnating) into damp-heat. Upper: fluid retention; Lower: blood stasis. Excess syndrome resembling deficiency. Slippery and forceful Cun/Guan at Chen hour: Chen is when Qi and Blood enter the Stomach; Stomach fullness extends to Upper Jiao. Afternoon only Guan slippery shows Stomach excess. The formula mainly eliminates phlegm, food, breaks Qi, and invigorates blood, adding Huang Lian and Hua Shi to clear damp-heat, still combining Ren Shen to boost Stomach Qi so drugs can circulate. Ginger juice opens pathways and treats vomiting. This is a disciplined army, undefeated. However, there was concern that the disease was deep and medicine shallow. Purging lightly every three days strikes the enemy's nest, uprooting the disease.
Lu Cangzhou treated an unmarried girl with amenorrhea. Physicians could not diagnose her. Her abdomen was large as if pregnant. Her complexion and pulse were strange. He said, "Your illness is not from strange dreams, but possessed by spirits." She did not answer, went to her room, and whispered to her maid, "Last summer I cooled off under a temple corridor. At dusk, passing the Wood God shrine, my heart moved. That night I dreamed of a man like the one I saw at dusk, who intimately approached me in my bedroom. Thus I became ill. I am ashamed to tell anyone. The doctor is right." The maid told Lu. Lu said, "Her face turns red and white alternately due to shame. Pulse changes large and small due to spiritual influence. The cause matches complexion and pulse. Though severe, it causes no suffering." He used Tao Ren Jian (Peach Kernel Decoction) to expel blood clots resembling pig liver, about six or seven pieces, each with holes like fish eyes. The disease was cured.
Yu Zhen commented: This is Ghost Fetus (Gui Tai), easy to identify. Only saying "cause matches pulse/complexion, though severe, no suffering" is a secret technique. Tao Ren Jian is harsh, but necessary to cure this disease.
Yu Zirong treated a widow whose depression formed illness, stopping menstruation. Her body felt hot as if roasting. Suddenly she vomited blood like a spring. Doctors used hemostatics without effect. They switched to grinding fresh Mao Gen Cao (Imperata Rhizome) juice, thickly ground Chen Xiang (Agarwood), taken up to 5 qian. Daily, strong vinegar was stored in a bottle, heated on fire, and the vapor inhaled through both nostrils. Blood then descended, vomiting stopped, and menstruation resumed.
Yu Zhen commented: This is Reverse Menstruation (Dao Jing). Descending Qi makes blood descend. Mao Gen juice is excellent. Especially clever is steaming nose with hot vinegar. If menstruation reverses, life is possible; if menstruation dries up, death is certain.
Shi Shan treated a thin woman in her twenties. Menstrual blood was purple, early or late. Abdominal pain before flow, aversion to cold, preference for warmth. Sometimes catching cold causes abdominal pain. Pulse was fine, soggy, near slippery. Both Chi positions slightly large and slippery upon heavy pressure. Wang Ji said, "Blood heat." Some asked, "How can it be heat with such aversion to cold?" Answered, "Extreme heat resembles cold." He used wine-boiled Huang Lian 4 liang, Xiang Fu, Dang Gui Shen Wei 2 liang each, Wu Ling Zhi 1 liang, powdered, made into pills with congee, taken on empty stomach. Cured.
Yu Zhen commented: Pulse fine/soggy/near slippery, Chi slightly large/slippery without rapidity, hard to recognize as major heat. Yet heavy Huang Lian cured it. Master Wang truly has mastery over his fingers.
A twenty-one-year-old woman in June had menstrual pain like scraping, unbearable. Pulse was fine, soft, and rapid. Chi was deep, weak, and near rapid. Wang Ji said, "Fine/soft indicates dampness, rapid indicates heat, deep Chi indicates stagnation." Wine-boiled Huang Lian 8 liang, stir-fried Xiang Fu 6 liang, Wu Ling Zhi (half fried, half raw) 3 liang, Dang Gui Shen Wei 2 liang, powdered, pill with congee, taken on empty stomach with warm water, 3-4 qian. After 5-6 courses, nine years later, she bore a son. Four years later, menstruation lasted two months continuously with mild abdominal pain, cured by previous pills. Later, menstruation lasted 6-7 days, then clear fluid flowed with mild pain, cured again. Then menstruation lasted only 7-8 days. When flow came, sometimes heavy for 5-6 days, then intermittent, slightly red or pale red, often followed by clear fluid. Severe lower abdominal pain radiating to whole body, chest, back, waist, legs, bones all hurt, from Si hour to You hour. Pain caused whole-body cold/heat, profuse sweating, pain relieved by sweat, yet able to eat. Over fifteen years, previous pills worked repeatedly, now ineffective. Why? Wang re-examined: Pulse all large, slippery, and powerless. Fortunately, she still had spirit. Wang said, "This is different from before. Previously depression-heat, now deficiency-cold. Dongyuan said: 'Starts as Heat Middle, ends as Cold Middle.' Classic says: 'Pulse follows but does not drum when pressed, indicating Yin excess repelling Yang,' treat as cold. Also, originally thin/small, now fat/large. Medical books say: 'Thin people have blood heat, fat people have Qi deficiency.' How can same treatment apply? Worrisome is profuse sweating/pulse not declining, massive bleeding/pulse not decreasing. Pain heavier by day/lighter by night indicates Yang deficiency failing to transport, causing stagnation pain. Combining symptom and pulse, tonify Yang. If pulse decreases and pain lightens, it is auspicious." He prescribed large dose of Ren Shen, Huang Qi, Dang Gui, Bai Zhu, added Gui Zhi and Fu Zi. One dose, re-examined next morning, pulse calmed. After 20-30 doses, in February, cured by May. Disease changes from heat to cold; medicine usage differs; body types vary. One formula cannot treat all.
Yu Zhen commented: Fine/soft/rapid is damp-heat; Large/slippowerless is deficiency-cold. Key to pulse diagnosis. Wang's postscript is crucial for treatment. However, previous Huang Lian was excessive; long-term use without change is inadvisable.
A woman always had diarrhea for three days before menstruation. Pulse was soggy and weak. "Spleen deficiency. Spleen governs blood and dampness. Before menstruation moves, Spleen blood flows to Sea of Blood, then downflows as menses. Spleen blood deficient, fails to transport dampness." Made Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Powder), 2 qian per dose, mixed with rice drink 2-3 times daily. Over a month, menstruation stopped accompanying diarrhea.
A woman over forty, tall and frail, irregular menstruation. Right pulse floating, soft, large; Left pulse deficient, soft, small, near rapid. Usually diarrhea before menstruation. April: caught wind cough, bathed with herbal soup, sweated heavily, diarrhea for one month. June: bathed again, malaria 6-7 times. Malaria stopped but mind unclear. End of August: heavy menstruation, leukorrhea, diarrhea, right foot pain. Old ankle sprain pain extended to buttocks, legs, waist, ribs, sacrum, calf, neck, left tendons pulling pain. Coughing caused waist pain like knife stabbing. Lighter by day, heavier by night, crying out. Fortunately pain subsided slightly, diet normal. Heavy menstruation, leukorrhea, day-light/night-heavy diarrhea suggests Lower Loss leading to Yin exhaustion, treat as Blood deficiency. But Si Wu Tang (Four Substance Decoction) for pain worsened it. September, Wang re-examined, realized this fits Zhongjing's principle "Yang generates, Yin grows." Heavy menstruation, leukorrhea, diarrhea all due to Yang deficiency sinking. Day-light/night-heavy: Day Yang strong, transports well, blood not stagnant, lighter by day. Night Yin strong, Yang fails to transport, blood stagnates, heavier by night. Used Ren Shen and Bai Zhu to tonify Yang, 6-7 doses, pain decreased. This is a variation of disease/treatment, recorded thus.
Yu Zhen commented: Previous case logic easy to understand, this case pulse easily seen as deficiency. Near rapid plus leg pain resembles damp-heat. But chronic diarrhea/malaria/heavy menses/leukorrhea clearly suits Ren/Bai Zhu. Why call treatment unusual?
A woman over forty, solid appearance, often difficult breech birth, irregular menstruation, occasional whole-body joint pain, poor appetite, fatigue, spontaneous sweating. Wang diagnosed: Both hands pulse non-responsive, but Right Guan faintly moving upon light pressure. Suspected pulse out of position, checked Jing Qu and Lie Que acupoints, still non-responsive, very strange. Asked husband: "During pregnancy, doctors said no pulse. Took Ba Wu Tang (Eight Substance Decoction), luckily easy birth, got one son." Wang said, "Constitutional non-responsive pulse, nothing strange. World events infinite, hard to measure by common rules. Mai Jing says only describes norms. No pulse in both hands doesn't harm life or pregnancy. Can Mai Jing cover all?"
Yu Zhen commented: Many have one hand no pulse, few have both. This is likely meridian constriction in womb/swaddling, not disease. Shi Shan diagnosed another woman with no Left pulse, moving at Yang Xi/Pian Li points, i.e., Reversed Guan Pulse (Fan Guan Mai). Wang said, "Left pulse out of position, disease hard to know by pulse." Indeed Fan Guan usually large/sliding, extendable, insufficient for diagnosis. Zhu Danxi treated a woman with chronic malaria, poor appetite, amenorrhea, no pulse in both hands. Gave San Hua Shen You Wan (Three-Flower Divine Protection Pill) 10+ pills daily, swallowed with saliva. Over a month, appetite returned, pulse appeared. Half month later pulse healthy, one month later menstruation started. This is disease-caused no pulse, not congenital.
A woman postpartum had continuous menstruation, red/white/pale, over eight months. Sallow-white face, irritable, dizzy, weak legs. Doctors used Ren Shen tonics, condition worsened. Astringents ineffective. Wang diagnosed: Right pulse soggy/weak/powerless, Left slightly large/rapid. "Right weakness not disease, Left excess makes Right seem weak. Focus on Left, treat with Cooling Blood agents." Sheng Di (Rehmannia Root), Bai Shao, Bai Zhu 1 qian each, Huang Qin, E Jiao (Donkey-hide Gelatin), Dang Gui 0.8 fen each, Chen Pi, Xiang Fu, Chuan Xiong (Sichuan Lovage Rhizome), Chun Gen Pi (Toona Bark), Fu Ling 0.6 fen each, Chai Hu (Bupleurum Root), Gan Cao 0.5 fen each. Decocted, 20+ doses cured.
Yu Zhen commented: Right pulse weak, Wang focused on Left excess, different selection. Said "Right weakness not disease," meaning pale/dripping menses, sallow face/dizziness/weak legs not caused by Right weakness. Wang likely because Ren/Shen worsened condition, Right pulse unreliable, usually focuses on Left with Cooling Blood agents.
Also treated a woman over thirty, childless. Wang diagnosed: Pulse nearly harmonious, Chi large/slippery. "Uterine heat, Blood Sea unstable." Husband confirmed: "Menstruation comes immediately after intercourse." Prescribed Danxi Da Bu Wan (Danxi Great Tonification Pill) added Shan Zhu Yu (Cornus Fruit), Bai Long Gu (Fossilized Bone) to astringe internally. External: Hair ash, Bai Fan (Alum), Huang Lian, Wu Bei Zi (Gallnut) powdered, applied to private parts. Cured and conceived.
Xue Lizhai treated a woman bleeding and painful during intercourse. Applied/took Cooling Blood/Pain-relieving agents, frequent heavy bleeding. Liver injured failing to store blood, Spleen injured failing to control blood. Bu Zhong Yi Qi Tang (Tonify Middle Augment Qi Decoction) and Gui Pi Tang (Restore the Spleen Decoction) cured. Externally: Hair ash, green cloth, burnt to ash, applied.
Another relative similar symptoms. Pulse both Chi deep/slow/choppy. Tonify Blood/Disperse Cold agents failed. Checked Qian Jin Fang (Thousand Golden Prescriptions), used She Chuang Zi San (Cnidarius Powder) wrapped in silk, inserted twice. Cured.
Yu Zhen commented: Three cases, same disease, different treatments. Disease judged by pulse. First case no pulse recorded, but Cooling agents failed, so Tonification was only option. Understood by intuition.
Another woman delayed menstruation, fever, fatigue. Used Si Wu, Huang Lian, etc.,反而 (instead) menstruated once every two months, scanty/clotted. Used harsh purgatives, eyes covered like silk. Xue said, "Spleen is head of all Yin, Eyes are gathering of blood vessels. Spleen injured, Five Organs lose their place, cannot return to eyes." Used Bu Zhong Yi Qi and Ji Sheng Gui Pi Decoctions, focusing on Spleen/Stomach. Cured in over a year.
Yu Zhen commented: This case has heavenly insight. Not tonifying Spleen/Stomach but using Blood/Cooling drugs for eyes would lead to death soon.
A forty-year-old woman, labor caused heel heat/pain. Xue identified extreme Yin-Blood deficiency, urgently used Sheng Yu Tang (Holy Rescue Decoction), cured. Later whole-body itching, mistakenly took Wind-dispelling drugs, fever, convulsions, Liver pulse large/rapid. Liver Blood deficiency with Fire excess generating Wind. Tian Zhu Dan Xing (Buddha's Hand Star) pills, taken with Si Wu, Mai Dong (Ophiopogon Root), Wu Wei Zi (Schisandra Berry), Qin, Lian, Zhi Gan Cao, Shan Zhi Zi (Gardenia Fruit), Chai Hu decoction. Cured.