喻嘉言治顾季掖室人。仲夏时。孕已五月。偶尔下血。医以人参、阿胶。勉固其胎。又
经一月。身肿气胀。血逆上奔。结聚于会厌胸膈间。食饮才入。触之痛楚。转下甚艰。稍急
即连粒呕出。全如噎证。更医数手。咸以为胎气上逆。脾虚作肿而成膈噎也。用人参之补
五味之收为治。延至白露节。计孕期已八月。而病势危极。呼吸将绝。始邀喻诊。其脉尺
部微涩艰推。独肺部洪大无伦。其喘声如曳锯。其手臂青紫肿亮如殴伤色。喻骇曰。似此凶
证。何不相商。幸余尚有善药。可以通其下闭上壅。季掖必求病名。喻曰。上壅者。以肺脉
之洪大。合于会厌之结塞。知其肺当生痈也。下闭者。以尺脉之微涩。合于肉色之青肿。知
其胎已久坏也。善药者。泻白散加芩、桔之苦以开之。不用硝、黄等疠药也。服二大剂。腹
即弩痛。下白污如脓者数斗。裹朽胎而出。胸膈即开。连连进粥。但寒热咳嗽未除。旬余白
污既尽。忽大肿大喘可畏。一以清肺为主。竟获全痊。
震按此案从吕沧洲得来。沧洲治经历哈散侍人。病喘不得卧。众作肺受风邪治。吕诊气
口独盛。厥阴弦动而疾。两尺俱短而离经。乃曰。此得之毒药动血。以致胎死不下。奔逆而
上冲。非风寒作喘也。用催生汤加芎、归。煮大剂服之。夜半果下一死胎。喘即止。哈散因
告外家诚有孕。以室人见嫉。故药去之。众所不知也。
喻嘉言治疗顾季掖的妻子。正值仲夏时节，她怀孕已五个月。偶然出现阴道出血，医生用人参、阿胶勉强固护胎元。又过一个月，身体浮肿，气机胀满，血气逆乱上冲，结聚在会厌和胸膈之间。饮食刚入口，触碰就感到疼痛，向下排泄非常困难，稍微用力就会连颗粒食物一起呕吐出来，完全像噎证一样。经过多位医生诊治，都认为这是胎气上逆，脾虚导致浮肿进而形成膈噎症。采用人参的补益作用和五味子的收敛作用进行治疗。拖延到白露节气时，计算孕期已达八个月，而病情危急到了极点，呼吸即将停止，这才邀请喻嘉言诊察。他的脉象尺部微弱涩滞且难以推求，唯独肺部脉象洪大无比。他的喘息声像拉锯一样，手臂青紫肿胀发亮，如同被打伤的颜色。喻嘉言惊骇地说：“像这样凶险的病症，为什么不早点商量？幸好我还有好药，可以通利下部的闭塞和上部的壅塞。”顾季掖一定要问病名，喻嘉言说：“所谓的上壅，是因为肺脉洪大，结合会厌部位的结塞，知道是肺将要生痈脓；所谓的下闭，是因为尺脉微涩，结合肌肉颜色青肿，知道胎儿已经死亡很久。所谓的好药，是用泻白散加上黄芩、桔梗的苦味药物来开通，不用硝石、大黄等峻烈攻下的药物。”服用两副大剂量的药后，腹部立即剧烈疼痛，排出像脓一样的白色污物几斗，包裹着腐烂的胎儿排出，胸膈随即通畅，能够连续喝粥。只是寒热咳嗽症状未除。十几天后白色污物排尽，突然发生严重的大肿大喘，令人畏惧。以清肺为主进行治疗，最终获得痊愈。
俞震按语：这个医案是从吕沧洲那里得来的。吕沧洲治疗经历哈散的侍妾，患病气喘不能平卧。众人当作肺受风邪来治疗。吕沧洲诊察发现气口脉独盛，厥阴脉弦动而疾速，两尺脉都短促且偏离正常经候（离经之脉）。于是说：“这是因服用毒药扰动血液，导致胎儿死亡无法排出，气血奔逆向上冲撞所致，不是风寒引起的喘息。”使用催生汤加川芎、当归，煮成大剂量服用。半夜果然排下一个死胎，喘息随即停止。哈散因此告诉岳母家确实有孕，因为妻子嫉妒，所以用药害掉了胎儿。这是众人所不知道的。
Yu Jiayan treated the wife of Gu Yiye. It was midsummer, and she had been pregnant for five months. She occasionally experienced vaginal bleeding. Physicians used Ren Shen (Ginseng Radix) and E Jiao (Donkey-hide Gelatin) to tentatively secure the fetus. A month later, her body became swollen and distended with Qi, blood rushed upward in rebellion, and stagnation gathered between the epiglottis and the chest-diaphragm region. As soon as food or drink entered, it caused pain upon contact; defecation became extremely difficult, and any slight effort resulted in vomiting out every grain of food, resembling a complete case of dysphagia (Yi Zheng). Several other physicians were consulted, all believing this was fetal Qi rebelling upward, spleen deficiency causing edema, which evolved into Ge Ye (diaphragmatic obstruction). They treated it using the tonifying properties of Ren Shen (Ginseng Radix) and the astringent properties of Wu Wei Zi (Schisandrae Fructus). By the time of the White Dew solar term, the pregnancy had reached eight months, yet the condition became critically dangerous, with breathing nearly ceasing. Only then was Yu Jiayan invited to diagnose. Her pulse at the Chi position was faint, choppy, and difficult to palpate, while the Lung pulse alone was excessively flooding and boundless. Her wheezing sound resembled sawing wood; her arms were cyanotic, swollen, shiny, and discolored like bruises. Yu Jiayan exclaimed in shock, "Such a ominous syndrome—why did you not consult earlier? Fortunately, I still have effective medicines that can unblock the lower closure and upper congestion." Jiye insisted on knowing the disease name. Yu said, "The 'upper congestion' is indicated by the flooding Lung pulse combined with the blockage at the epiglottis, suggesting the lungs are developing an abscess. The 'lower closure' is indicated by the faint and choppy Chi pulse combined with the cyanotic and swollen skin color, indicating the fetus has been dead for a long time. The 'effective medicine' refers to Xie Bai San (White-Draining Powder) added with Ku (bitter) herbs like Huang Qin (Scutellariae Radix) and Jie Geng (Platycodonis Radix) to open the blockage, without using harsh purgatives like Xiao Shi (Natrii Sulfas) or Da Huang (Rhei Radix et Rhizoma)." After taking two large doses, abdominal pain immediately intensified, and several dou of white, pus-like discharge were passed, expelling the putrefied fetus. The chest-diaphragm region immediately opened up, allowing continuous consumption of congee. However, chills, fever, and cough persisted. More than ten days later, after the white discharge ceased, sudden severe generalized edema and terrifying wheezing occurred. Treatment focused primarily on clearing the Lungs, resulting in complete recovery.
Zhen's commentary: This case originated from Lv Cangzhou. Lv Cangzhou treated a concubine of Jingli Hasan, who suffered from asthma so severe she could not lie flat. The majority treated it as Wind-Evil invading the Lungs. Lv diagnosed that the Qi Kou pulse was exclusively strong, the Jue Yin pulse was wiry, rapid, and quick, while both Chi pulses were short and deviated from the normal meridian pattern (Li Jing Mai). He stated, "This results from toxic drugs disturbing the blood, causing fetal death and retention, with Qi and Blood rushing upward in rebellion. It is not asthma caused by Wind-Cold." He used Cui Sheng Tang (Labor-Delivery Decoction) added with Xiong Duan (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix), prepared as a large dose. At midnight, a dead fetus was indeed expelled, and the asthma stopped immediately. Hasan subsequently informed his mother-in-law that there had indeed been a pregnancy; jealous of the main wife, the concubine had been administered drugs to terminate it. This fact was unknown to the public.