夷坚志曰。杜壬治郝质子妇。产四日。螈 戴眼。弓背反张。壬以为痉病。与大豆紫汤
独活汤而愈。政和间。予妻房分娩。犹在蓐中忽作此证。头足反接。相去几二尺。家人惊
骇。以数婢强拗之不直。适记所云。而药囊有独活。乃急为之。召医未至。连进三剂。遂能
直。医至即愈矣。更不须用大豆紫汤。古人处方。神验屡矣。
一产妇牙关紧急。腰背反张。四肢抽搐。两目连札。立斋以为去血过多。元气亏损。阴
火炽盛。用十全大补加炮姜。一剂而苏。又数剂而安。
魏云。立斋治螈 以大温补。前条治风。想螈 有微甚之不同耳。
震按不必分微甚。但须审地方及时令。若薛案明云去血过多。必无用独活之理矣。
丹溪治一产妇。年三十余。正月间。新产十余日。左脚左手发搐。气喘不眠。面起黑色
口臭。脉浮弦而沉涩。右为甚。意其受湿。询之。产前三月。时常喜羹汤茶水。以黄 、
荆芥、木香、滑石、苍白术、槟榔、陈皮、川芎、甘草、芍药。四服后加桃仁。又四服而漉
漉有声。大下水晶块。大小如鸡子黄与蝌蚪者数十枚。而愈。乃去荆芥、槟榔、滑石。加当
归、茯苓。调理其血。四十帖而安。
震按左脚左手发搐。似肝经血燥生风。气喘不眠。面起黑色。口臭。似瘀血入肺死证。
脉象浮弦易辨。沉涩难辨。身临其局。彷徨无措者多矣。非丹溪岂能认为湿而用此等药乎。
若下条薛案。稍有墙壁可循耳。
一妇人发螈遗尿。自汗面赤。或时面青。饮食如故。肝脉弦紧。立斋曰。此肝经血燥。
风热螈 也。肝主小便。肝色青。入心则赤。法当滋阴血。清肝火。遂用加味逍遥散。不数
剂诸证悉退。
孙东宿治潘大司马媳。年二十五。体素弱。语言端谨。因难产伤力。继以生女拂意。后
又女死悲戚。实时晕厥。醒而神思眯昧。手足螈 。不可诊脉。目上视。细询之。自女落地
恶露绝无。有女医时与人参干嚼。及独参汤并粥乱进。参与粥皆壅塞膈上不下。以故神昏
螈不已也。孙教以手于喉中探而吐之。喜其随手吐出痰饮粥药盈盆。螈 方定。乃与川芎
山楂、泽兰叶、陈皮、半夏、茯苓、香附进之。稍得睡。不虞女医又私与补药二帖。
子丑
时陡然狂乱。如降神之状。汉声官话。问答如流。其声壮厉。迥异平时。其家咸谓神附。祈
祷百般。孙曰。此恶露不尽。乃蓄血如见鬼之证。非真有神佛相附也。以归尾四钱。川芎一
钱五分。泽兰叶、益母草、滑石等。煎冲热童便。连饮二帖。狂乱少定而未除。意其胸中必
有余痰作滞。前方中无佐使之品。故药力不行也。大加山楂为引。恶露稍行。神思即静。嗣
后稍睡少时。手足微动。或自以手掌其面。或自以手捶其胸。昏乱不息。诊其脉近虚。早间
面红而光。申酉时面色白。此血行火退。故脉虚而当补矣。与人参、川芎、泽兰叶各一钱。
当归、山楂各二钱。茯苓、陈皮各八分。卷荷叶一片。煎冲琥珀末五分。服后嗳气二声。孙
喜曰。此清阳升而浊阴降矣。自兹安静。恶露行。大便通。而索粥饮矣。
震按此案前半段治法不难。盖得其参粥杂进之病情。自有消瘀及消痰食之方药。但探吐
法尤捷耳。蓄血如见众。知者亦多。难于后半段恶露稍行。神思即静。略睡片时。昏乱不息
仍是蓄血形状。乃于轻剂消瘀之中。复用人参。并不以前曾误用而畏蹈故辙。此为高手。
其讲脉与面色极是。但产后谵语昏狂。有纯因于痰者。又不可不知。
《夷坚志》记载：杜壬治疗郝质的儿媳妇。她产后四天，出现抽搐、两眼上视、背部弓起反张的症状。杜壬认为是痉病，给予大豆紫汤和独活汤，病情痊愈。政和年间，我妻子的房室分娩，还在产床上忽然发作这种病症，头脚向后弯曲对接，相距近两尺。家人惊恐害怕，叫几个婢女强行掰直身体却未能成功。恰好想起之前读过的医案，药囊里又有独活，于是急忙为她煎服。请来的医生还没到，连续服用三剂后，身体就能伸直了。医生到达时，病也就好了，不再需要使用大豆紫汤。古人开方，神奇灵验的情况屡见不鲜。
一位产妇牙关紧闭，腰背反张，四肢抽搐，双眼连眨。薛立斋认为这是失血过多，元气亏损，阴火炽盛所致。使用十全大补汤加炮姜，一剂后苏醒，又服几剂后安稳。
魏云说：薛立斋治疗抽搐多用大温补法，前一条案例治风，想来抽搐有轻重程度的不同罢了。
俞震按语：不必区分轻重，只需审察地域和时令。如果像薛立斋的医案明确说是失血过多，那一定没有使用独活的道理。
朱丹溪治疗一位产妇，三十多岁。正月间，新产十多天。左脚左手发生抽搐，气喘失眠，面部呈现黑色，口臭，脉象浮弦而沉涩，右侧更为明显。推测是受湿邪侵袭。询问得知，产前三个月，时常喜欢喝羹汤茶水。用黄芪、荆芥、木香、滑石、苍术、白术、槟榔、陈皮、川芎、甘草、芍药。服用四剂后加入桃仁。又服四剂后，肠鸣漉漉有声，排出大量如水晶块状的大便，大小如鸡蛋黄和蝌蚪的数十枚，病愈。于是去掉荆芥、槟榔、滑石，加入当归、茯苓，调理其血。服用四十帖后安稳。
俞震按语：左脚左手抽搐，像是肝经血燥生风；气喘失眠，面部发黑，口臭，像是瘀血入肺的死证。脉象浮弦容易辨别，沉涩难以辨别。身临其境，彷徨无措的人很多啊。如果不是朱丹溪，谁能认为是湿邪而使用这些药物呢？至于下一条薛立斋的医案，尚且有理路可循。
一位妇人发作抽搐并遗尿，自汗面赤，有时面色青，饮食正常。肝脉弦紧。薛立斋说：这是肝经血燥，风热引起的抽搐。肝主小便，肝色青，入心则赤。治法应当滋阴血，清肝火。于是使用加味逍遥散，没几剂各种症状都消退了。
孙东宿治疗潘大司马的儿媳，二十五岁。体质素来虚弱，言语端庄谨慎。因为难产用力过度，接着因生下女儿不如意，后来女儿又去世感到悲伤悲痛，当时突然晕厥。醒来后神思迷糊，手足抽搐，无法诊脉，眼睛向上看。仔细询问得知，自从女儿落地，恶露完全没有排出。有位女医时常让人嚼服人参，以及独参汤和粥乱进。人参和粥都壅塞在膈上不能下行，因此神昏抽搐不止。孙东宿教她用手指在喉咙中探吐，幸好随手吐出痰饮粥药盈满一盆，抽搐才停止。于是给予川芎、山楂、泽兰叶、陈皮、半夏、茯苓、香附给她服用。稍微能睡一会儿。没想到女医又私自给她补药两帖。子丑时（夜间11点至凌晨3点）突然狂乱，像降神附体一样，说着官话，问答流利，声音壮厉，与平时完全不同。家人都认为是神灵附体，祈祷百般。孙东宿说：这是恶露不尽，属于蓄血如见鬼的证候，并非真有神佛附体。用当归尾四钱，川芎一钱五分，泽兰叶、益母草、滑石等，煎煮冲入热童便。连续饮用两帖，狂乱稍定但未消除。推测胸中必定有余痰阻滞，前方中没有佐使之品，所以药力不行。大量增加山楂作为引经药，恶露稍行，神思即静。此后稍微睡了一会儿，手足微动，或者自己用手摸脸，或者自己用手捶胸，昏乱不停。诊脉接近虚象，早上面色红亮，申酉时（下午3点至7点）面色白。这是血行火退，所以脉虚而应当补益。给予人参、川芎、泽兰叶各一钱，当归、山楂各二钱，茯苓、陈皮各八分，卷荷叶一片，煎煮冲入琥珀末五分。服用后嗳气两声。孙东宿高兴地说：这是清阳升而浊阴降了。从此安静，恶露行，大便通，要喝粥了。
俞震按语：这个案例前半段的治法不难，因为得到了人参和粥杂进的病情，自然有消瘀及消痰食的药物。但探吐法尤其快捷。蓄血如见鬼，知道的人也多。难点在于后半段恶露稍行，神思即静，略睡片刻，昏乱不息，仍然是蓄血的表现。却在轻剂消瘀之中，又用人参，并不因为以前误用而害怕重蹈覆辙。这才是高手。他对脉象和面色的讲解非常正确。但产后谵语昏狂，有纯因于痰的，也不可不知道。
*Yijian Zhi* records: Du Ren treated the daughter-in-law of Hao Zhi. Four days after childbirth, she experienced convulsions (Chou Xu), upward staring of the eyes, and opisthotonos (back arching). Du Ren diagnosed it as Spasm Disease (Jing Bing) and prescribed Doudaizi Tang (Purple Soybean Decoction) and Duhuo Tang (Angelica Pubescens Decoction), resulting in a cure. During the Zhenghe era, my wife’s chamber gave birth. While still in bed, she suddenly suffered this condition; her head and feet bent backward to meet, nearly two chi apart. Her family was terrified. Several maids tried forcibly to straighten her body but failed. Recalling the previous case I had read, and finding Duhuo (Radix Angelicae Pubescentis) in my medicine pouch, I hastily prepared it for her. Before the doctor arrived, three doses were administered consecutively, allowing her body to straighten. By the time the doctor arrived, she had recovered, and there was no need to use Doudaizi Tang. Ancient physicians’ prescriptions were often miraculously effective.
A postpartum woman presented with lockjaw (trismus), opisthotonos, limb convulsions, and continuous blinking of the eyes. Xue Lizhai attributed this to excessive blood loss, deficiency of Yuan Qi (Original Qi), and flourishing Yin Fire (Yin Huo). He used Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) with Pao Jiang (Prepared Ginger). After one dose, she regained consciousness; after several more doses, she stabilized.
Wei Yun stated: Xue Lizhai treats convulsions mainly with strong warming and tonifying methods. The previous case treated Wind. It seems convulsions vary in severity.
Yu Zhen commented: There is no need to distinguish severity; one must examine the locality and season. If Xue’s case clearly states excessive blood loss, there would be no reason to use Duhuo.
Zhu Danxi treated a postpartum woman, over thirty years old. In January, more than ten days after delivery, her left foot and left hand twitched. She suffered from asthma-like breathing, insomnia, a blackish complexion, and foul breath. Her pulse was floating and wiry yet deep and choppy, more pronounced on the right side. Suspecting dampness invasion, he asked and learned that for three months before delivery, she frequently enjoyed soups and tea. He prescribed Huangqi (Radix Astragali), Jingjie (Herba Schizonepetae), Muxiang (Radix Aucklandiae), Huashi (Talcum), Cangzhu (Rhizoma Atractylodis), Baizhu (Rhizoma Atractylodis Macrocephalae), Binglang (Semen Arecae), Chenpi (Pericarpium Citri Reticulatae), Chuanxiong (Rhizoma Chuanxiong), Gancao (Radix Glycyrrhizae), and Shaoyao (Radix Paeoniae Alba/Rubra). After four doses, Taoren (Semen Persicae) was added. After another four doses, borborygmus was heard, and numerous large stools resembling crystal blocks, sized like chicken egg yolks or tadpoles, were discharged, curing the illness. Then, Jingjie, Binglang, and Huashi were removed, and Danggui (Radix Angelicae Sinensis) and Fuling (Poria) were added to regulate the blood. After forty doses, she stabilized.
Yu Zhen commented: Twitching of the left foot and hand suggests Liver Meridian Blood Dryness generating Wind. Asthma, insomnia, blackish face, and foul breath suggest Blood Stasis entering the Lung, a critical condition. Floating and wiry pulses are easy to identify, but deep and choppy ones are difficult. Many find themselves at a loss in such situations. Only Zhu Danxi could diagnose dampness and prescribe such herbs. In contrast, the following Xue Lizhai case has some logical basis to follow.
A woman presented with convulsions and urinary incontinence, spontaneous sweating, flushed face, and occasionally a bluish complexion. Her diet remained normal. Her Liver pulse was wiry and tight. Xue Lizhai said: This is Liver Meridian Blood Dryness causing Wind-Heat Convulsions. The Liver governs urination, its color is green, and if it enters the Heart, the face turns red. The treatment should nourish Yin and Blood and clear Liver Fire. He used Jiawei Xiaoyao San (Modified Free Wanderer Powder). Within a few doses, all symptoms subsided.
Sun Dongsu treated the daughter-in-law of Grand Marshal Pan, aged twenty-five. She was constitutionally weak and spoke with dignity and caution. Due to difficult labor and exertion, followed by disappointment over giving birth to a girl, and later grief over the girl's death, she suddenly fainted. Upon waking, her mind was confused, limbs convulsed, making pulse diagnosis impossible, and her eyes stared upward. Detailed inquiry revealed that since the baby was born, lochia had completely ceased. A female physician had been indiscriminately administering chewed Ginseng, Dushen Tang (Single Ginseng Decoction), and porridge. The Ginseng and porridge caused stagnation above the diaphragm, leading to unconsciousness and persistent convulsions. Sun instructed her to induce vomiting by probing the throat with her fingers. Fortunately, phlegm, fluids, porridge, and medicine were vomited out, filling a basin, and the convulsions stopped. He then prescribed Chuanxiong, Shanzha (Fructus Crataegi), Zelan Ye (Herba Lycopi), Chenpi, Banxia (Rhizoma Pinelliae), Fuling, and Xiangfu (Rhizoma Cyperi) for her to take. She slept slightly. Unexpectedly, the female physician privately gave her two doses of tonics. Between Zi and Chou hours (11 PM - 3 AM), she suddenly became manic, acting as if possessed, speaking official Mandarin fluently, with a loud voice, very different from usual. Her family believed spirits had possessed her and prayed extensively. Sun said: This is incomplete expulsion of lochia, a condition of Blood Stasis resembling seeing ghosts, not actual possession. He prescribed Danggui Wei (Tail of Radix Angelicae Sinensis) 4 qian, Chuanxiong 1.5 qian, Zelan Ye, Yimucao (Herba Leonuri), and Huashi, decocted and mixed with hot Tongbian (Child Urine). After drinking two doses, the mania subsided slightly but did not disappear. He surmised there must be residual Phlegm causing stagnation in the chest, and the previous prescription lacked guiding or assisting herbs, so the medicinal power did not act effectively. He greatly increased Shanzha as a guide. As lochia began to flow, her mind quieted. Later, she slept briefly, moved her limbs slightly, touched her face with her hands, or pounded her chest, remaining confused. Her pulse was near-deficient. Her face was red and bright in the morning, but white during Shen and You hours (3 PM - 7 PM). This indicated Blood movement and Fire retreat, so the deficient pulse warranted tonification. He prescribed Ginseng, Chuanxiong, and Zelan Ye each 1 qian, Danggui and Shanzha each 2 qian, Fuling and Chenpi each 0.8 fen, and a piece of Juan Heye (Rolled Lotus Leaf), decocted and mixed with Hupo Mo (Powder of Amber) 0.5 fen. After taking it, she belched twice. Sun rejoiced, saying: This indicates Clear Yang ascending and Turbid Yin descending. From then on, she was calm, lochia flowed, bowels moved, and she requested porridge.
Yu Zhen commented: The treatment in the first half of this case is not difficult because the history of mixed Ginseng and porridge intake naturally calls for formulas resolving stasis and digesting food/phlegm. However, the induced vomiting method is particularly swift. "Blood Stasis resembling seeing ghosts" is known to many. The difficulty lies in the second half: after slight lochia flow and mental quieting, brief sleep leads to persistent confusion, still showing signs of Blood Stasis. Yet, within a mild formula resolving stasis, Ginseng is used again, without fear of repeating past errors due to previous misuse. This demonstrates high skill. His analysis of pulse and facial color is excellent. However, one must know that postpartum delirium and mania can also be purely caused by Phlegm.