乐元忠妻。产后病惊。身飘飘如在浮云中。举目则旋转。持身不定。四肢酸软。皆以安
神补虚治之。前证转甚。载原礼独曰。左脉芤且涩。神色不变。是因惊致心胞络积血耳。乃
下血如漆者一斗。遂愈。古人云。大实似羸者此也。
震按此证必共认为虚矣。苟不辨其左脉之芤涩。岂能测其心胞之积血耶。人只知惊是病
不知因惊而又致病。则治惊无益也。可举此案以例其余。
汪石山治一妇。产后未经盈月。怒气。血流如水。三日方止。随又劳苦。四肢无力。睡
而汗出。日晡潮热。口干。五心如炙。诸医皆用柴、芩、薄荷之类。其热愈炽。诊其脉弦大
无力。此蓐劳也。以四物汤一两。入胡黄连、秦艽、青蒿各五分。数服热退身凉。后以黄连
八珍丸一料而安。
震按此用二连、艽、蒿。可见薛氏之八珍十全。原非成例定局。
一妇产后。血逆上行。鼻衄。口干心燥舌黑。盖因瘀血上升。遂用益母丸。童便化下数
丸。后鼻衄渐止。下血渐通。
震按女科诸书。咸以产后鼻衄为险证。此用益母丸童便化下数丸。是仿倒经治法。亦有
愈者。然未可奉为胜算也。
立斋治大尹俞君之内。产后发热晡热。吐血便血。兼盗汗。小便频数。胸胁胀痛。肚腹
痞闷。薛曰。此诸脏虚损也。治当固本为善。自恃知医。用降火之剂。更加泻痢肠鸣。呕吐
不食。腹痛足冷。始信薛言求诊。其脉或浮洪。或沉细。或如无。其面或青黄。或赤白。此
虚寒假热之状。时值仲夏。当舍时从证。先用六君子汤加炮姜、肉桂。数剂胃气渐复。诸证
渐退。更佐以十全大补汤。半载全愈。
震按此条脉法。可为大虚之据。
一产妇咳嗽痰盛。面赤口干。内热晡热。撤作无时。此阴火上炎。当补脾肾。遂用补中
益气汤、六味地黄丸。而愈。
一产妇泻痢年余。形体骨立。内热晡热。自汗盗汗。口舌糜烂。曰吐痰三碗许。脉洪大
重按全无。此命门火衰。脾土虚寒而假热。吐痰者。乃脾虚不能统摄归源也。用八味丸补
火以生土。用补中益气兼补肺金而脾胃健。
震按此二案。乃薛氏治法正宗。能熟志之。自不流入清解滋阴一路。
乐元忠的妻子。产后患惊悸证。身体飘忽不定，如同在浮云之中。睁眼则感觉天旋地转。站立不稳。四肢酸软无力。众医都以安神补虚的方法治疗。前面的症状反而加重。只有载原礼说。左脉芤且涩。神色没有改变。这是因为受惊导致心包络积血所致。于是排出如漆般黑稠的瘀血一斗。病随即痊愈。古人说。大实之证似羸弱之状，指的就是这种情况。
俞震按语：这个病症大家必定都认为是虚证了。如果不辨别其左脉的芤涩之象，怎么能推测出是心包络有积血呢？人们只知道惊是病因，不知道因惊而导致的病理产物（如瘀血）又成为致病因素，那么单纯治惊就没有效果了。可以列举这个案例来类推其他情况。
汪石山治疗一位妇人。产后未满一个月。因发怒。血流如水样。三天才停止。随后又过度劳累。四肢无力。睡觉时出汗。下午申酉时分出现潮热。口干。五心烦热如被炙烤。众医都用柴胡、黄芩、薄荷之类药物。其发热更加严重。诊察其脉弦大而无力。这是蓐劳（产后虚劳）。用四物汤一两，加入胡黄连、秦艽、青蒿各五分。服用几剂后热退身凉。后来服用一料黄连八珍丸而安定康复。
俞震按语：这里使用黄连、胡黄连、秦艽、青蒿，可见薛己氏的八珍汤、十全大补汤，原本就不是固定不变的成例。
一位产妇产后。血逆上行。鼻衄（鼻出血）。口干心燥舌苔黑。大概是因为瘀血上升。于是使用益母丸。用童便化开送服数丸。之后鼻衄逐渐停止。下血（恶露）逐渐通畅。
俞震按语：妇科各类书籍，都认为产后鼻衄是险证。这里使用益母丸配合童便化开送服数丸，是仿效倒经的治疗方法。也有治愈的案例。然而不可将其奉为万全之策。
立斋（薛己）治疗大尹俞君的妻子。产后发热及傍晚发热。吐血便血。兼有盗汗。小便频数。胸胁胀痛。肚腹痞闷。薛己说。这是各个脏腑虚损所致。治疗应当以固本培元为好。患者自恃懂医。使用降火药剂。更加出现泻痢肠鸣。呕吐不食。腹痛足冷。这才相信薛己的话求诊。其脉或浮洪。或沉细。或微弱如无。面色或青黄。或赤白。这是虚寒假热的征象。当时正值仲夏。应当舍去时令禁忌而从证候治疗。先用六君子汤加炮姜、肉桂。服用数剂后胃气逐渐恢复。各种症状逐渐消退。再辅以十全大补汤。半年后完全痊愈。
一位产妇咳嗽痰多。面赤口干。内热傍晚发热。发作无定时。这是阴火上炎。应当补脾肾。于是使用补中益气汤、六味地黄丸。而痊愈。
一位产妇腹泻痢疾一年多。形体消瘦如骨立。内热傍晚发热。自汗盗汗。口舌糜烂。每天吐痰约三碗。脉洪大但重按全无。这是命门火衰。脾土虚寒而表现为假热。吐痰的原因，乃是脾虚不能统摄津液归源。使用八味丸补火以生土。使用补中益气汤兼补肺金从而使脾胃健运。
Wu Yuanzhong's wife. After childbirth, she suffered from a condition of fright (Jing). Her body felt floating and unstable, as if in the clouds. Upon opening her eyes, she experienced vertigo. She was unable to stand steadily. Her four limbs were sore and weak. All physicians treated it with methods to calm the spirit and tonify deficiency. Consequently, the preceding symptoms worsened. Only Zai Yuanli stated: "The left pulse is Kou (hollow) and Se (choppy), yet her expression remains unchanged. This is due to fright causing blood stasis accumulation in the Pericardium Collateral." Subsequently, one dou (a unit of volume) of dark, lacquer-like blood was discharged, and she recovered. The ancients said, "A great excess condition may resemble a debilitated state," which refers to this case.
Zhen's commentary: This syndrome must be universally considered as a deficiency pattern. If one does not distinguish the Kou and Se qualities of the left pulse, how could one deduce the blood stasis in the Pericardium? People only know that fright is the cause; they do not realize that pathological products resulting from fright can become new pathogenic factors. In such cases, treating only the fright is futile. This case can be cited to illustrate others.
Wang Shishan treated a woman who had not yet reached one month postpartum. Due to anger, she experienced bleeding flowing like water, which stopped after three days. Subsequently, due to overexertion, she suffered from weakness in the four limbs, sweating during sleep, tidal fever in the afternoon (Shen-You hours), dry mouth, and five-palm heat (burning sensation in palms, soles, and chest). All physicians used herbs such as Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), and Bo He (Menthae Haplocalycis Herba), but the fever intensified. Palpation revealed a Xian (wiry) and Da (large) pulse that was empty upon pressure. This was identified as Ru Lao (postpartum consumptive disease). A decoction of Si Wu Tang (Four Substances Decoction) 1 liang, with Hu Huang Lian (Picrorhizae Rhizoma), Qin Jiao (Gentianae Macrophyllae Radix), and Qing Hao (Artemisiae Annuae Herba) each added at 5 fen, was administered. After several doses, the fever subsided and the body cooled. Later, she took one dose of Huang Lian Ba Zhen Wan (Coptis Eight Treasure Pill) and stabilized.
Zhen's commentary: The use here of Huang Lian, Hu Huang Lian, Qin Jiao, and Qing Hao demonstrates that Xue Ji’s formulas, Ba Zhen Tang (Eight Treasure Decoction) and Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction), are not rigid, fixed protocols.
A puerperal woman suffered from upward reversal of blood flow, leading to Bi Xu (epistaxis/nosebleed). She had a dry mouth, restless heart, and black tongue coating. This was likely due to ascending blood stasis. Yi Mu Wan (Motherwort Pill) was prescribed, taken with child's urine (Tong Bian) to dissolve and administer several pills. Subsequently, the nosebleed gradually ceased, and lochia discharge became smooth.
Zhen's commentary: Various gynecological texts consider postpartum epistaxis a critical/dangerous syndrome. Using Yi Mu Wan dissolved in child's urine imitates the treatment method for Dao Jing (retrograde menstruation). There are cases of recovery, but this should not be regarded as a guaranteed cure.
Lizhai (Xue Ji) treated the wife of Grand Secretary Yu. Postpartum, she had fever and evening tidal fever, hematemesis (vomiting blood), hematochezia (blood in stool), accompanied by night sweats, frequent urination, distending pain in the chest and hypochondrium, and abdominal fullness/stuffiness. Xue Ji said: "This is damage and deficiency of various zang organs. Treatment should prioritize securing the root." Relying on her own medical knowledge, she used fire-descending agents, which exacerbated her condition with diarrhea, borborygmus, vomiting, anorexia, abdominal pain, and cold feet. Only then did she believe Xue Ji and seek consultation. Her pulse was either Fu Hong (floating and flooding), Chen Xi (deep and fine), or nearly imperceptible. Her complexion was either cyan-yellow or red-white. These are signs of false heat due to deficiency. It was midsummer, so the season should be disregarded in favor of the syndrome. Initially, Liu Jun Zi Tang (Six Gentlemen Decoction) with Pao Jiang (Prepared Ginger) and Rou Gui (Cinnamon Bark) was given. After several doses, stomach qi gradually recovered, and symptoms subsided. This was supplemented with Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction). Half a year later, she fully recovered.
Zhen's commentary: The pulse findings in this case serve as strong evidence for a major deficiency pattern.
A puerperal woman suffered from cough with profuse sputum, flushed face, dry mouth, internal heat, and evening tidal fever, occurring intermittently. This was Fire of Yin flaring upward. Spleen and Kidney should be tonified. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia) were used, resulting in recovery.
A puerperal woman suffered from diarrhea and dysentery for over a year. Her body was emaciated, with bones prominent. She had internal heat, evening tidal fever, spontaneous sweating, and night sweats. Her mouth and tongue were ulcerated. She vomited approximately three bowls of sputum daily. Her pulse was Hong Da (flooding and large) but completely absent upon deep pressure. This indicated decline of Ming Men (Gate of Life) fire, deficiency-cold of Spleen Earth manifesting as false heat. The vomiting of sputum resulted from Spleen deficiency failing to control and return fluids to their source. Ba Wei Wan (Eight-Ingredient Pill) was used to tonify fire to generate earth. Bu Zhong Yi Qi Tang was used to tonify Lung Metal, thereby strengthening the Spleen and Stomach.
Zhen's commentary: These two cases represent the orthodox treatment methods of Xue Ji. If memorized thoroughly, one will naturally avoid deviating into paths of merely clearing heat/resolving exterior or nourishing yin/draining fire.