质亏，生育多胎，此番重身三月，又复半产，气随血脱，昏晕频发，幸赖独参汤挽回。
日来
热发不退，时时怯寒，舌白，喜饮热汤，头痛形倦，脉急无力，合参脉证，明是气血两虚，
即有外邪，投鼠忌器。丹溪云∶产后当以大补气血为主，他证从末治之。仿甘温除大热之旨
。下午复诊，脉象仿佛，早间服药，安眠片时，顷复寒热交作，此属阴阳两虚，正气不胜，
非疟证也。原方更进一渣，明日再议。两进甘温，昨午寒后热甚，扶掖下床，小溲遗出，直
至半夜，热始渐缓。切恐今午寒热复来，撑持不住，揣其寒热之故，非阴阳两亏，即正虚邪
陷，当此危迫，不问有邪无邪，一意扶元固本。盖辅正即所以祛邪也。本草谓人参能回元气
于无何有之乡，古人治气随血脱之候，悉仗参力斡旋，昨药分两固虽加重，惜乏参力，故难
奏效耳。昨午寒热仍来，神形益倦，二更后热势渐平，然起床劳顿，即作昏晕，顷进诊间，
晕又复发，连服温补大剂，尚未见功，即云寒热由于外因，睹此野狼狈情形，焉可再从标治。
仍守原制，佐以河车，亟挽真元。医当医人，不当医病。昨夕昏晕频作，顷诊右脉虚要，左
犹带数，体倦无力，气怯懒言，虚象无疑。病缘质亏半产，加之寒热纠缠，波涛汹涌。现下
热退神清，固见小效，奈病来势暴，大厦摇摇，前议补元归脾，更从养营进步。两日未诊，
脉象依然，在前发热之际，脉由热搏而数，今外热既退，理当和缓，何至数犹未平。口不干
渴，并无火象。无非产时血去过多，营阴受亏，脉乃血派，是以急数不平耳，但诸药皆是草
木根 ，人身真元耗伤，仓卒焉能挽转。参力既艰，他策又无可画，前方减去辛温，稍佐柔
和之品。产后崩晕，血气大亏，阴阳枢纽不固，见出种种疲惫之候，赖诸温补药饵，竭力挽
回。寒热已除，胃安谷纳，无如事多磨折，臀生疡毒。痛楚不安，疡甫溃脓，痛势稍定，又
加时感湿邪，腹痛便泻，节外生枝。暂与香砂六君，俟其痛泻愈后，仍须峻补真元，冀图恢
复。
安波按∶先生方必中肯，剂不虚投。但此妇真元已败，冥游已近，不过聊尽人事矣。
体质虚弱，生育过多，此次怀孕三个月，又发生半产（小产），气随血脱，频繁出现昏晕，幸亏依靠独参汤才挽回生命。
近日发热不退，时常怕冷，舌苔白，喜欢喝热汤，头痛且身体疲倦，脉象急而无力，综合参看脉象和症状，明显是气血两虚，即使有外邪侵袭，也因顾虑正气虚弱而不敢轻易攻邪。丹溪说：产后应当以大补气血为主，其他病症从属次要治疗。仿照甘温除大热的旨意。下午复诊，脉象大致相同，早上服药后，安静睡眠片刻，不久又寒热交替发作，这属于阴阳两虚，正气不能胜任，不是疟疾。原方再进一剂药渣，明天再商议。两次服用甘温药物后，昨天中午在发冷之后发热严重，扶掖下床时，小便失禁，直到半夜，发热才逐渐缓解。深切担心今天中午寒热再次发作，身体支撑不住，推测其寒热的原因，不是阴阳两亏，就是正虚邪陷，在此危急紧迫之际，不问是否有外邪，一心扶助元气、固护根本。因为辅助正气就是祛除邪气的方法。本草记载人参能在虚无缥缈之处挽回元气，古人治疗气随血脱的证候，完全依赖人参之力来斡旋，昨天的药分量虽然加重，可惜缺乏人参的药力，所以难以见效。昨天中午寒热仍然发作，神志和形体更加疲倦，二更天后热势逐渐平息，然而起床劳累，就出现昏晕，刚才进入诊室，晕厥又复发，连续服用温补大剂量的药物，尚未见到功效，如果说寒热是由于外因引起的，看到这种狼狈的情形，怎么还能再从标症治疗？仍遵守原方制度，佐以紫河车，亟需挽回真元。医生应当医治人，不应当只医治病。昨晚昏晕频繁发作，刚才诊察右脉虚软，左脉还带有数象，身体疲倦无力，气怯懒言，虚象毫无疑问。病因体质虚弱加上半产，加之寒热纠缠，病情如波涛汹涌。现在热退神清，确实见到小效，无奈病势凶猛，大厦摇摇欲坠，前议补元归脾，更进一步从养营方面着手。两天未诊，脉象依然如此，在前发热的时候，脉由热搏动而数，现在外热既然已退，理当和缓，为何至数脉仍未平复。口不干渴，并没有火象。无非是产时血去过多，营阴受亏，脉乃血之派生，所以急数不平罢了，只是诸药皆是草木根茎，人身真元耗伤，仓促之间怎么能挽回？人参药力既难达到，其他策略又无可谋划，前方减去辛温药物，稍加柔和之品。产后崩漏昏晕，血气大亏，阴阳枢纽不稳固，出现种种疲惫的症状，依靠各种温补药物，竭力挽回。寒热已经消除，胃气和顺能进食，无奈事情多磨折，臀部生疡毒。疼痛不安，疮疡刚溃脓，痛势稍微安定，又加上感受湿邪，腹痛便泻，节外生枝。暂时给予香砂六君子汤，等待其痛泻痊愈后，仍需峻补真元，希望图谋恢复。安波按语：先生的方子必定切中肯綮，剂量不虚投。但这名妇女真元已败坏，冥游（死亡）已接近，不过是聊尽人事罢了。
Constitution is deficient, with multiple births; this time, after being pregnant for three months, she suffered a miscarriage (half-birth). Qi followed the blood in its loss, leading to frequent syncope. Fortunately, life was saved by Dushen Tang (Single Ginseng Decoction).
Recently, fever persists without abating, accompanied by occasional aversion to cold, a white tongue coating, and a preference for hot drinks. There is headache and physical fatigue. The pulse is rapid yet forceless. Synthesizing the pulse and symptoms, it is clearly a deficiency of both Qi and Blood. Even if there are external pathogens, one must hesitate to attack them due to the fragile state of the vital organs (fear of harming the host while trying to eliminate the pest). Danxi stated: "Postpartum treatment should primarily focus on greatly tonifying Qi and Blood, treating other conditions as secondary." Following the principle of using sweet-warm methods to eliminate great heat.
In the afternoon follow-up consultation, the pulse appeared similar. After taking medicine in the morning, she slept peacefully for a while, but soon experienced alternating chills and fever. This belongs to dual deficiency of Yin and Yang, where Zheng Qi (Upright Qi) is insufficient to resist; it is not malaria. Administer another dose of the residue from the original prescription, and discuss further tomorrow. After two administrations of sweet-warm formulas, yesterday at noon, severe fever followed chills. While being supported out of bed, urinary incontinence occurred. Fever did not gradually subside until midnight. I deeply fear that chills and fever will recur this afternoon, overwhelming her strength. Speculating on the cause of these chills and fevers, it is either a dual deficiency of Yin and Yang, or Zheng Qi deficiency allowing pathogenic invasion. In this critical situation, regardless of the presence of pathogens, the sole focus is on supporting Yuan Qi (Primordial Qi) and consolidating the root. Assisting Zheng Qi is indeed the way to dispel pathogens. Materia Medica states that Ren Shen (Ginseng Radix) can restore Yuan Qi from the realm of nothingness. Ancients relied entirely on the power of Ren Shen to manage cases of Qi following blood loss. Although the dosage of yesterday's medicine was increased, it lacked the potency of Ren Shen, hence the lack of efficacy. Yesterday at noon, chills and fever returned, and mental and physical exhaustion worsened. After the second watch (10 PM - 2 AM), the fever gradually subsided. However, rising from bed and exertion immediately triggered syncope. Upon entering the consulting room just now, syncope recurred. Continuous administration of large doses of warm-tonic medicines has yet to show results. If one claims the chills and fever are due to external factors, seeing such a wretched condition, how can one continue to treat only the branch manifestations? Still adhering to the original prescription, supplemented with He Che (Placenta Hominis), urgently to salvage Zhen Yuan (True Primordial Qi). Physicians should treat the person, not just the disease.
Last night, syncope occurred frequently. Just now, upon examination, the Right pulse was weak and soft, while the Left still showed a rapid rate. The body is fatigued and weak, Qi is timid, and speech is reluctant. The signs of deficiency are undeniable. The illness stems from constitutional deficiency and miscarriage, compounded by entangled chills and fever, creating turbulent waves. Currently, fever has subsided and consciousness is clear, showing minor efficacy. However, the onset of the disease was violent; the house of health is shaking. The previous discussion of tonifying Yuan Qi and Guipi Tang (Restore the Spleen Decoction) has progressed further to nourishing Ying (Nutritive) Qi.
Two days have passed without consultation, and the pulse remains unchanged. During the previous fever, the pulse became rapid due to heat agitation. Now that external heat has subsided, it should theoretically be缓和 (moderate/soothing). Why has the rapidity not yet normalized? The mouth is not dry or thirsty, indicating no fire signs. It is simply that excessive blood loss during childbirth caused a deficiency of Ying Yin (Nutritive Yin). Since the pulse is a derivative of blood, it remains rapid and irregular. However, all medicines are herbal roots; when True Primordial Qi is depleted, how can it be swiftly restored? With Ren Shen's potency difficult to achieve and no other strategies available, the previous formula had pungent-warm substances removed, slightly supplemented with gentle-moistening items.
Postpartum metrorrhagia and syncope involve a great deficit of Qi and Blood, with an unstable pivot of Yin and Yang, presenting various signs of exhaustion. Relying on various warm-tonic medications, efforts were made to salvage the patient. Chills and fever have been eliminated, stomach Qi is harmonious, and appetite has returned. Unfortunately, events are full of setbacks; a carbuncle developed on the buttocks. Pain and discomfort persisted. After the abscess ruptured and pus drained, pain slightly stabilized. Then, damp-pathogen invasion occurred, causing abdominal pain and diarrhea—complications arising unexpectedly. Temporarily administered Xiangsha Liujun Zi Tang (Aucklandia and Amomum Six Gentlemen Decoction). After pain and diarrhea resolve, vigorous tonification of True Primordial Qi is still required, hoping for recovery.
An Bo's commentary: The Master's prescriptions are invariably accurate, and dosages are never wasted. However, this woman's True Primordial Qi is already ruined, and death is imminent. We are merely doing our human best.