李思萱室人有孕。冬日感寒。至春而发。初不觉也。连食鸡
面鸡子。遂成夹食伤寒。一月才愈。又伤食物。吐泻交作。前后七十日。共反五次。遂成膈症。滴饮不入。
延诊时。其脉上涌而乱。重按全无。呕哕连绵不绝。声细如虫鸣。久久方大呕一声。余曰。病者胃中全无水谷。
已翻空向外。此不可救之症也。思萱必求良治。以免余憾。余筹画良久。因曰。万不得已。必多用人
参。但才入胃中。即从肠出。有日费斗金。不勾西风一浪之譬。奈何。渠曰。尽在十日之内。尚可勉备。
余曰。足矣。乃煎人参汤。调赤石脂末。以坠安其翻出之胃。病者气若稍回。少顷大
便。气即脱去。凡三日服过人参五两。赤石脂末一斤。俱从大便泻出。得食仍呕。但不呕药耳。因思必以药之渣
滓。如粞粥之类与服。方可望其少停胃中。顷之传下。又可望其少停肠中。于是以人参陈橘皮二味。剪如芥
子大。和粟米同煎作粥。与服半盏。不呕。良久又与半盏。如是再三日。始得胃舍稍安。但大肠之
空。尚未填实。复以赤石脂末为丸。每用人参汤吞两许。如是再三日。大便亦稀。此三日参橘粥内。已加入
陈仓米。每进一盏。日进十余次。人事遂大安矣。仍用四君子汤丸调理。通共享人参九两全愈。然此亦因
其胎尚未堕。有一线生气可续。故为此法以续其生耳。不然者用参虽多。安能回元气于无何有之乡哉。
后生一子。小甚。缘母疾百日失荫之故。
附叶氏妇治验 叶氏妇。亦伤寒将发。误食鸡面鸡子。大热喘胀。余怜其贫。乘病正传阳明胃经。日
间与彼双表去邪。夜间即以酒大黄玄明粉。连下三次。大便凡十六行。胎仍不动。次早即轻安。薄粥将养。
数日全愈。此盖乘其一日骤病。元气大旺。尽驱宿物以免缠绵也。设泥有孕。而用四物药和合下之。则
滞药反为食积树党矣
胡卣臣先生曰。前治神矣。后治复不减。盖前治明。后治良也。行所明以持危扶颠。藉有天幸者多矣。此嘉言所以
昭述其事。亦曰不得已欤。
李思萱的妻子怀有身孕。冬季感受寒邪，至春季发作，起初并未察觉。连续食用鸡肉、面条和鸡蛋后，遂形成夹食伤寒（外感风寒兼有饮食积滞的病证）。一个月后才痊愈。又因伤食，出现呕吐与腹泻交替发作的症状，前后历时七十天，共发生反胃五次，最终演变为膈症（指吞咽困难或饮食格拒不入的病症），滴水不进。
请我诊治时，其脉象浮越于上且杂乱无章，重按则完全无力。呕逆之声连绵不绝，声音细微如同虫鸣，许久才剧烈地呕吐一声。我说：“病人胃中已无水谷存留，胃气已经翻空向外脱出，这是不可救治的病症。”李思萱必定要求良好的治疗，以消除心中的遗憾。我筹划良久，说道：“万不得已，必须大量使用人参。但药液刚进入胃中，就会从肠道排出，这好比每天耗费斗金，却抵不过西风掀起的一阵波浪，该怎么办呢？”他回答说：“全部在十天之内，还可以勉强备齐。”我说：“足够了。”于是煎煮人参汤，调入赤石脂粉末，用以镇坠并安定翻出的胃气。病人气息略微恢复，不久后大便通畅，气息随即脱失。三天内服用人参五两、赤石脂末一斤，均从大便泻出。进食仍会呕吐，但不再呕吐药物。我想必须将药物的渣滓处理得像碎米粥那样细小再给病人服用，才有望让药液在胃中稍作停留，片刻之后传入肠道，又可望其在肠中稍作停留。于是将人参和陈橘皮两味药剪成芥子大小的颗粒，与粟米同煎做成粥，给病人服用半盏，没有呕吐。过了很久又给予半盏。如此持续三天，胃舍才稍微安宁。但是大肠的空虚尚未填补充实，又用赤石脂末制成丸剂，每次用人参汤送服约一两。如此又过三天，大便也变得稀薄。在这三天的人参橘皮粥内，已经加入了陈仓米，每进饮一盏，每日进十余次，人事便大大安稳了。随后仍用四君子汤（补气健脾的基础方剂）制成丸剂进行调理，总共享用人参九两，完全痊愈。然而这也是因为胎儿尚未流产，尚有一线生气可以接续，所以才采用这种方法来延续生命。否则的话，即使使用大量人参，又怎能从无何有之乡（指元气极度虚弱、近乎虚无的状态）挽回元气呢？后来生下一个儿子，非常瘦小，是因为母亲患病百日失去母体荫庇的缘故。
附叶氏妇女治验：叶氏的妇女，也是伤寒即将发作，误食鸡肉、面条和鸡蛋，导致大热、气喘、腹胀。我怜悯她贫穷，趁病邪正传阳明胃经之时，白天用双解表法祛除邪气，夜间即用酒大黄、玄明粉，连续攻下三次，大便共十六行，胎元仍然未动。次日清晨即感轻快安适，喝薄粥调养，数日后完全痊愈。这大概是趁着她一日之间突发急病，元气依然旺盛，尽力驱除宿积之物以避免病情缠绵。假如拘泥于怀孕的事实，而使用四物汤（补血调血方剂）配合泻下药，那么滞涩的药物反而会为食积树立党羽（助长病势）。
胡卣臣先生说：“前面的治疗神妙，后面的治疗也不逊色。这是因为前面的治疗思路明晰，后面的治疗方案优良。运用明晰的思路来处理危急局面，借助天幸成功的情况有很多。这就是嘉言（喻昌号）所以详细记述此事的原因，也说这是不得已而为之吧。”
Li Sixuan's wife was pregnant. In winter, she contracted cold pathogens, which manifested in spring, though initially unnoticed. After continuously consuming chicken, noodles, and eggs, she developed Shanghan with food retention (a condition of exterior cold invasion complicated by dietary stagnation). It took a month to recover. Subsequently, due to further dietary injury, vomiting and diarrhea occurred alternately. This persisted for seventy days, with five episodes of regurgitation, eventually evolving into Ge disease (a syndrome characterized by difficulty swallowing or rejection of food and fluids), where not even a drop of liquid could be retained.
When I was consulted, her pulse surged superficially and was chaotic, while deep pressure revealed complete emptiness. Her retching and hiccups were continuous, with sounds as faint as insect chirping, followed by a violent vomit only after a long interval. I stated, "The patient's stomach is completely devoid of food and fluids; the Stomach Qi has inverted and is protruding outward. This is an incurable condition." Li Sixuan insisted on seeking effective treatment to avoid regret. After much deliberation, I said, "If there is no other choice, we must use large doses of Renshen (Ginseng Root). However, once it enters the stomach, it will pass directly through the intestines. This is like spending a peck of gold daily yet failing to withstand a single wave of the west wind. What can be done?" He replied, "I can prepare it within ten days." I said, "That is sufficient." Thus, I decocted Renshen soup and mixed it with powder of Chishizhi (Halloysitum Rubrum) to anchor and stabilize the inverted Stomach Qi. The patient's Qi slightly recovered, and shortly after, she had a bowel movement, after which her Qi immediately collapsed. Over three days, she consumed five taels of Renshen and one jin of Chishizhi powder, all excreted via stool. She still vomited upon eating but did not vomit the medicine. I reasoned that the medicinal dregs must be processed into something resembling broken rice porridge before administration, so that the medicine might stay in the stomach briefly, then move to the intestines and stay there temporarily. Therefore, I cut Renshen and Chenjupi (Citrus Reticulatae Pericarpium) into particles the size of mustard seeds, cooked them together with millet into porridge, and administered half a cup. There was no vomiting. After a while, another half cup was given. This continued for three days, until the Stomach house finally settled somewhat. However, the emptiness of the Large Intestine was not yet filled. I then made pills from Chishizhi powder, administering each pill with about one tael of Renshen soup. After another three days, her stool became loose. During these three days, Chen Cangmi (aged Coix Seed) was added to the Renshen and Chenjupi porridge. Each intake was one cup, taken more than ten times a day, after which her general condition stabilized significantly. Subsequently, Sijunzi Tang (Four Gentlemen Decoction) was used in pill form for regulation. In total, nine taels of Renshen were consumed, leading to full recovery. However, this success was possible because the fetus had not miscarried, leaving a thread of vital Qi to sustain life. Hence, this method was employed to prolong life. Otherwise, even with massive doses of Renshen, how could Yuan Qi (Original Qi) be restored from the state of non-existence? Later, she gave birth to a son who was very small, due to the loss of maternal nourishment during her hundred-day illness.
Supplementary Case: Treatment of Mrs. Ye
Mrs. Ye also suffered from impending Shanghan. Mistakenly consuming chicken, noodles, and eggs, she developed high fever, panting, and abdominal distension. Pitying her poverty, I treated her while the pathogen was transmitting to the Yangming Stomach channel. During the day, I used dual-releasing methods to expel pathogens; at night, I administered Jiuhuangqi (Rhubarb prepared with wine) and Xuanmingfen (Mirabilite) for purgation, three times consecutively. She had sixteen bowel movements, yet the fetus remained unaffected. By the next morning, she felt relieved and comfortable. She was nourished with thin congee and fully recovered in a few days. This worked because her sudden acute illness left her Yuan Qi still robust, allowing us to drive out accumulated pathogens and prevent lingering disease. If we had adhered strictly to the pregnancy and used Siwu Tang (Four Substances Decoction) combined with purgatives, the stagnant herbs would have merely allied with the food stagnation.
Mr. Hu Youchen commented: "The previous treatment was divine, and the latter was no less excellent. The former was clear-minded, and the latter was well-executed. Applying clarity to manage critical situations often relies on heavenly fortune. This is why Jiayan (Yu Chang's courtesy name) recorded these events in detail, stating it was a measure of last resort."