顾季掖乃室。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
上逼。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。而病造极
中之极。呼吸将绝。始请余诊。毫不泄露病状。其脉尺部微涩难推。独肺部洪大无伦。其喘声如曳锯。其手臂
青紫肿亮。如殴伤色。余骇曰。似此凶证。何不早商。季掖曰。昨闻黄咫旭乃室。有
孕而膈噎。得遇良治而愈。是以请救。但内子身肿气急。不识亦可疗否。余曰。此证吾视若悬鉴。不必明言以
滋惊恐。姑以善药一二剂投之。通其下闭上壅可也。季掖必求病名。余曰。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。不用硝黄等厉药也。服一大剂。腹即努痛。如欲产状。季掖曰。产乎。余曰。
肺气开而下行。数时闭拒。恶秽得出可也。奚产之云。再进一剂。身肿稍退。上气稍平。下白污如脓者数斗。
裹朽胎而出。旬余尚去白污。并无点血相间。可知胎朽腹中。已近百日。荫胎之血。和胎俱化为脓也。
病者当时。胸膈即开。连连进粥。神思清爽。然朽胎虽去。而秽气充斥周身。为青肿者未去也。胸厌虽宽。而
肺气壅遏。为寒热咳嗽者未除也。余认真一以清肺为主。旬余果获全痊。
顾生升恒曰。先生议内子病。余甚骇为不然。及投剂如匙开钥。其言果验。朽物既去。忽大肿大喘可畏。
先生一以清肺药。批 导 。病邪旋即解散。不二旬体复康平。抑何神耶。内子全而老母不至尸饔。幼子不至
啼饥。此身不至只影。浓德固难为报耳。因思谭医如先生。真为轩岐继后。世俗之知先生者。即谓之谤先生可
也。然而百世之下。犹当有闻风与起者矣。昆庠晚学顾升恒季掖甫谨识于案末
顾季掖的妻子。在仲夏时节。怀孕已经五个月。偶尔出现阴道出血。医生用人参和阿胶勉强固护胎元。又过一个月。身体浮肿、气机胀满。血气逆乱向上冲涌。
结聚在会厌和胸膈之间。饮食刚入口。触碰就感到疼痛。排便非常困难。稍微用力就会连食物一起呕吐出来。完全像噎证一样。换了好几位医生诊治。都认为是胎气上逼。脾虚导致肿胀。从而形成膈噎病。采用人参的补益作用。五味子的收敛作用来治疗。拖延到白露节气。计算孕期已经八个月。而病情发展到极致的极致。呼吸即将断绝。这才请我诊察。我没有泄露病情状况。她的脉象尺部微弱涩滞难以推究。唯独肺部脉象洪大无比。喘息声像拉锯一样。手臂呈现青紫色。肿胀发亮。像被打伤后的颜色。我惊讶地说。像这样凶险的病症。为什么不早点商量。季掖说。昨天听说黄咫旭的妻子。怀孕时患膈噎。遇到良医治愈了。所以来求救。只是内人身体肿胀气急。不知道也可以治疗吗。我说。这个病症我看清楚得像照镜子一样。不必明说以增添惊恐。暂且用几剂好药投下。疏通下面的闭塞和上面的壅塞就可以了。季掖一定要知道病名。我说。上面的壅塞。是因为肺脉的洪大。与会厌处的结塞相合。知道肺将要生痈脓。下面的闭塞。是因为尺脉的微涩。与肌肉颜色的青肿相合。知道胎儿已经很久坏死了。所谓好药。是用泻白散加上黄芩、桔梗的苦味药物来开泄。不用硝石、大黄等猛烈药物。服用一大剂后。腹部立即阵痛。像要生产的样子。季掖问。是要生产了吗。我说。肺气开通而下行。刚才数小时的闭拒。恶露秽物排出就可以了。哪里谈得上是生产。再进一剂药。身体肿胀稍退。上逆之气稍平。排出白色污浊如脓样的东西几斗。包裹着腐烂的胎儿排出。十多天后还在排白色污浊物。并没有一点血液夹杂其中。可知胎儿在腹中腐烂。已经将近一百天。滋养胎儿的血。随着胎儿一起化为脓液了。
病人当时。胸膈立刻开阔。连续喝粥。神志清爽。然而腐烂的胎儿虽然去除了。但秽气充斥全身。所以青肿没有消退。胸膈虽然宽畅。但肺气壅遏。所以寒热咳嗽的症状还没有去除。我坚持以清肺为主进行治疗。十多天后果然获得全愈。
顾生升恒说。先生议论内人的病。我非常惊骇认为不对。等到用药像钥匙开锁一样。先生的话果然应验。腐烂之物既然去除。忽然出现巨大的肿胀和喘促。令人畏惧。先生只用清肺药。疏导。病邪随即解散。不到十天身体恢复健康。多么神奇啊。内人保全了。老母亲不至于吃尸祭之食。幼子不至于因饥饿啼哭。我自己不至于形单影只。深厚的恩德实在难以报答。因此想到谭论医术像先生这样的人。真是轩辕、岐伯的后继者。世俗之人了解先生。即使诽谤先生也是可以的。然而在百世之后。仍然会有闻风而起的人。昆山县庠生晚辈顾升恒字季掖谨识于案末
The wife of Gu Jiye. During the mid-summer season, she had been pregnant for five months and occasionally experienced vaginal bleeding. The physician used Ren Shen (Ginseng Radix) and E Jiao (Donkey-hide Gelatin) to tentatively secure the fetus. After another month, her body became swollen and distended with Qi, and blood Qi rebelled upward, rushing up. It accumulated in the area between the epiglottis and the chest-diaphragm. As soon as food or drink entered, it caused pain upon contact. Defecation was extremely difficult; any slight urgency resulted in vomiting out everything, resembling a complete case of Ye Zheng (Dysphagia/Choking Syndrome). Several other physicians treated her, all believing that fetal Qi was pressing upward, causing swelling due to Spleen deficiency, thus forming Ge Ye (Diaphragmatic Dysphagia). They used the tonifying properties of Ren Shen and the astringent properties of Wu Wei Zi (Schisandrae Fructus) for treatment. This continued until the Bai Lu (White Dew) solar term, when the pregnancy had reached eight months, and the illness had reached its extreme extremity. Her breathing was nearly cut off, and only then did they invite me to examine her. I did not reveal the nature of the disease. Her pulse at the Chi position (Cun-kuan-chi, specifically Chi) was faint, choppy, and difficult to palpate, while the Lung pulse alone was excessively surging and vast. Her panting sound resembled sawing wood. Her arms were cyanotic, purple, swollen, and shiny, resembling the color of bruised skin from beating. I exclaimed in shock, "Such a ominous syndrome, why was not consulted earlier?" Jiye said, "Yesterday I heard that Huang Zhixu's wife, while pregnant, suffered from dysphagia and was cured by a good physician. Hence I came for rescue. However, my wife has body swelling and rapid breathing; I wonder if this can also be treated?" I said, "I see this syndrome clearly as if looking into a mirror. There is no need to state it explicitly to cause panic. Let us administer a few doses of effective medicine to unblock the lower closure and upper congestion." Jiye insisted on knowing the disease name. I said, "The upper congestion is indicated by the surging Lung pulse combined with the blockage at the epiglottis, suggesting that the Lung is about to develop an abscess (Fei Yong). The lower closure is indicated by the faint and choppy Chi pulse combined with the cyanotic and swollen flesh color, suggesting that the fetus has been dead for a long time." The 'effective medicine' refers to Xie Bai San (Drain the White Powder) added with the bitter properties of Huang Qin (Scutellariae Radix) and Jie Geng (Platycodonis Radix) to open the blockage, without using harsh medicines like Xiao Shi (Natrii Sulfas) or Da Huang (Rhei Radix et Rhizoma). After taking one large dose, abdominal cramping pain immediately occurred, resembling labor pains. Jiye asked, "Is it childbirth?" I said, "The Lung Qi opens and descends. After several hours of closure and rejection, the foul waste will be expelled. How could this be called childbirth?" After administering another dose, the body swelling receded slightly, and the rebellious Qi calmed down somewhat. Several dou of white, turbid, pus-like discharge were expelled, wrapping the putrid fetus. For more than ten days, white turbid matter continued to be discharged, with not a single drop of blood mixed in. This indicates that the fetus had been rotting in the abdomen for nearly one hundred days. The blood nourishing the fetus had turned into pus along with the fetus itself. At that moment, the patient's chest and diaphragm instantly opened, allowing her to consume porridge continuously, and her mental clarity was restored. However, although the putrid fetus was removed, foul qi filled the whole body, so the cyanotic swelling had not yet disappeared. Although the chest-diaphragm was wide, the Lung Qi was still congested, so the symptoms of chills, fever, and cough had not been eliminated. I adhered strictly to clearing the Lung as the main treatment. More than ten days later, full recovery was indeed achieved.
Gu Sheng Heng said, "When Mr. discussed my wife's illness, I was greatly shocked and disagreed. However, when the medicine was administered, it was like a key opening a lock, and his words proved accurate. Once the putrid matter was removed, sudden severe swelling and asthma appeared, which were terrifying. Mr. used only Lung-clearing medicines to guide and drain, and the pathogenic factors were quickly dispersed. Within less than ten days, her body recovered health. How miraculous! My wife is preserved, my elderly mother does not have to eat sacrificial food [implying widowhood/mourning], my young son does not cry from hunger, and I am not left alone. Such profound virtue is hard to repay. Therefore, thinking of someone who discusses medicine like Mr., he is truly the successor of Xuanyuan and Qibo. Those in the secular world who know Mr. may slander him, but even after a hundred generations, there will surely be those who hear his fame and rise up." Gu Sheng Heng, courtesy name Jiye, a junior scholar of the Kunshan county school, respectfully recorded this at the end of the case.