孙文垣治一妇人，年十六，初产女，艰苦二日，偶感暑邪，继食面饼，时师不察，竟以参、术投之，即大
热谵语，口渴，汗出如洗，（暑症多汗。）气喘，（暑伤气。）泄泻，泻皆黄水、无屎，（协热下利。）日夜无度，小水短少，
饮食不进，症甚危恶。时六月初旬，女科见热不退，乃投黄连、黄芩、白芍之剂，诸症更甚。又以参、术大剂，肉
果、干姜等止泻，一日计用参二两四钱，泻益频，热益剧，喘汗转加，谵语不彻口。医各束手，谢曰∶汗出如
油，喘而不休，死症也。又汗出而热不退，泻而热不止，谵语神昏，产后脉洪，大法皆犯逆，无生路矣，惟附
子理中汤，庶侥幸万一。孙诊之，六脉乱而无绪，七八至，独右关坚硬。（食积。）因思暑月汗出乃常事，但暑邪面
食瘀血，皆未销熔，补剂太骤，致蓄血如见鬼，若消瘀去积解暑，犹可生也。用益元散六钱，解暑清热，止泻
利水为君，糖球子（即山楂。）三钱为臣，红曲、泽兰各一钱五分消瘀安魂为佐，橘红、半夏曲、茯苓理脾为使，三
棱五分，消前参、术，决其壅滞为先锋。饮下即略睡，谵语竟止。连进二剂，泻半减。次日仍用前方，其下渐
减，大便止二次，有黄屎矣，恶露行黑血数枚。次日诊之，脉始有绪，神亦收敛，进粥一盏。前方去三棱、红
曲，加扁豆，大便一次，所下皆黑屎，热尽退。改用六君子加益元散、青蒿、扁豆、香附、酒芍、炮姜，调理
而安。（三棱亦消瘀之品耳，略消参、术之壅滞，则山楂已足矣，非三棱事也。雄按∶炮姜是蛇足矣。）
易思兰治石城王福谦之妃，癸酉年六月受孕，偶患泄泻。医用淡渗之药止之，自后每月泻三五日。有作脾
泻者，用参苓白术散之类，二三服亦止，然每月必泻五七次。至次年三月生产后，连泻半月，日夜八九次，诸
药不效。惊惶无措，召易诊之，两寸尺俱平和，惟两关洪大有力。曰∶此暑病也。以黄连香薷饮治之，一剂
减半，再剂全愈。惟肝脉未退，又用通元二八丹调理，半月后平复。
陆祖愚治李丹山子室，自来元气不足，产后六七日，正当酷暑，而卧房在楼，忽头疼气喘，昏闷，体若燔
炭，沉沉昏去。或以为伤寒，令门窗尽闭，帐幔重围，用二陈、羌活、防、芎、苏，一剂口干唇裂，喘急欲绝。
诊之，六脉浮洪而散，乃冒暑而非感寒，宜凉解而不宜温散。令取井水洒地，铺以芦席，移病患卧其上，饮以
香薷饮，遂微汗而苏。再用清暑益元汤，四剂而起。（雄按∶论证甚超，用药可议，何不用益元散、西瓜汁等物？）
沈明生治刘舜泉孙媳，夏月产后，晕厥不知人事。或谓恶露上攻所致，投去瘀清魂等剂，瘀不行，晕厥益
甚。又作痰治食治，皆不效。沈至，回翔谛审，笑曰∶吾得之矣，此暑热乘虚而入，急宜清暑，非黄连不可。
或谓血得冷则凝，今恶露未去，若投寒凉，是速其毙也。沈笑曰∶有不讳，吾任之。药甫入口，厥苏晕止，再
进而恶露行。盖产时楼小人多，炎敲之际，益助其热，乍虚之体触之，岂能不病？经云∶暑伤心。又云∶心主
血。为热冒而晕厥，此中暑而非恶露明矣。或曰∶舍症从时，理固然矣。然血热则行，冷则凝，亦古训也。今
用寒凉而恶露反去何也？曰∶热行冷瘀，以血喻水，道其常耳。子独不观失血者，有用温缓药而得止，则瘀血
者，岂无用苦寒而得行，岂造化之微，权逆从之妙理也，安可执乎？（雄按∶病虽因暑，而恶露不行，必佐清
痰之品，断非单以黄连治之也，诸读者须默会之。）
孙文垣治疗一位十六岁的妇人，刚生下女儿，因分娩艰难持续了两天，偶然感受暑邪，随后又吃了面饼。当时的医生没有仔细诊察，竟然给她投用参、术（人参、白术）等补益药，结果导致她出现大热、胡言乱语、口渴、汗出如洗（暑症多表现为多汗）、气喘（暑邪损伤元气）、泄泻，泻下皆为黄水、无粪便（协热下利），日夜无度，小便短少，饮食不进，病情非常危重。当时正值六月初旬，妇科医生见热势不退，便投用黄连、黄芩、白芍的方剂，各种症状反而加重。后来又用大剂量的参、术，以及肉果、干姜等药物来止泻，一天内服用人参达二两四钱，结果腹泻更加频繁，热势更加剧烈，气喘和出汗加剧，胡言乱语整日不停。各位医生都束手无策，叹息说：“汗出如油，气喘不止，这是死症。”又说：“汗出而热不退，腹泻而热不止，胡言乱语神志昏迷，产后脉象洪大，大法上都犯了逆证，没有生路了，只有附子理中汤，或许还能侥幸有一线生机。”孙文垣诊察后，发现六脉混乱无绪，一息七八至，唯独右关脉坚硬（提示食积）。他想到暑月出汗本是常事，但暑邪、面食停滞及瘀血都未消除，补药太过急骤，导致蓄血如见鬼魅，若能消瘀去积、解暑，还可以存活。于是用益元散六钱为君药，以解暑清热、止泻利水；糖球子（即山楂）三钱为臣药；红曲、泽兰各一钱五分为佐药，以消瘀安魂；橘红、半夏曲、茯苓为使药，以理脾；三棱五分为先锋，以消除之前参、术造成的壅滞。服药后患者略睡片刻，胡言乱语竟停止。连续服用两剂，腹泻减半。第二天仍用前方，腹泻逐渐减少，大便仅两次，且有黄色粪便排出，恶露排出黑血数枚。次日诊察，脉象始有秩序，神志亦收敛，给予一盏粥。前方去掉三棱、红曲，加入扁豆，大便一次，所下皆黑屎，热势尽退。改用六君子汤加益元散、青蒿、扁豆、香附、酒芍、炮姜，调理后痊愈。（按：三棱也是消瘀之品，只需略微消除参、术的壅滞，则山楂已足够，并非一定要用三棱。徐灵胎按语：炮姜是画蛇添足。）
易思兰治疗石城县王福谦的妃子，癸酉年六月受孕，偶然患泄泻。医生用淡渗利尿的药物来止泻，从此之后每月腹泻三五天。有人认为是脾泻，用参苓白术散之类的药物，服二三剂也止住了，然而每月必定腹泻五七次。到了次年三月生产后，连续腹泻半个月，日夜八九次，各种药物无效。病人惊慌失措，召请易思兰诊治。易思兰诊得两寸尺脉俱平和，唯独两关脉洪大有力。他说：“这是暑病。”用黄连香薷饮治疗，一剂减半，再剂全愈。只是肝脉未退，又用通元二八丹调理，半月后平复。
陆祖愚治疗李丹山的儿媳，素来元气不足，产后六七天，正当酷暑，而卧房在楼上，忽然头疼气喘，昏闷，身体像燃烧的炭火一样烫，沉沉昏过去。有人以为是伤寒，让人把门窗紧闭，帐幔重重围住，用二陈汤加羌活、防风、川芎、苏叶，一剂后口干唇裂，喘急欲绝。陆祖愚诊察，六脉浮洪而散，认为是冒暑而非感寒，宜凉解而不宜温散。让人取井水洒地，铺上芦席，将病患移到上面躺着，饮用香薷饮，于是微汗而苏醒。再用清暑益元汤，四剂而起。（徐灵胎按语：论证甚超，用药可议，为何不用益元散、西瓜汁等物？）
沈明生治疗刘舜泉的孙媳，夏月产后，晕厥不知人事。有人说是恶露上攻所致，投用去瘀清魂等药剂，瘀血不行，晕厥更甚。又当作痰治、食治，都不见效。沈明生到后，来回仔细审视，笑着说：“我明白了，这是暑热乘虚而入，急宜清暑，非黄连不可。”有人说：“血得冷则凝，现在恶露未去，若投寒凉，是加速其死亡。”沈明生笑着说：“若有不测，我承担责任。”药甫入口，厥苏晕止，再进而恶露行。因为产时楼小人多，炎热之际，更助其热，乍虚之体触之，岂能不病？《内经》云：“暑伤心。”又云：“心主血。”因热冒而晕厥，此中暑而非恶露明矣。有人说：“舍症从时，道理固然如此。然而血热则行，冷则凝，也是古训。现在用寒凉而恶露反去何也？”回答说：“热行冷瘀，以血喻水，道其常耳。你难道没看过失血者，有用温缓药而得止，那么瘀血者，岂无用苦寒而得行，这难道是造化之微，权逆从之妙理吗？怎么可以固执己见呢？”（徐灵胎按语：病虽因暑，而恶露不行，必佐清痰之品，断非单以黄连治之也，诸读者须默会之。）
Sun Wenyuan treated a sixteen-year-old woman who had just given birth to a daughter. After enduring the hardship of labor for two days, she accidentally contracted summer-heat pathogen (Shu Xie, 暑邪). Subsequently, she ate wheat cakes. The attending physicians failed to examine her carefully and administered tonics such as Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome). This immediately caused high fever, delirium, thirst, profuse sweating resembling washing (summer-heat syndromes often present with sweating), panting (summer-heat damages Qi), diarrhea consisting of yellow water without feces (diarrhea with heat binding), occurring incessantly day and night, scanty urination, and inability to eat. The condition was extremely critical. It was early June. The gynecologist, seeing that the fever did not subside, prescribed a formula containing Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), and Shaoyao (Peony Root). All symptoms worsened. They then used large doses of Renshen and Baizhu, along with Rouguo (Myristica Seed) and Ganjiang (Dried Ginger) to stop diarrhea. In one day, they administered four taels and four qian of Renshen. Consequently, diarrhea became more frequent, fever more intense, panting and sweating increased, and delirium persisted throughout the day. The doctors were at a loss and sighed, "Sweating like oil, continuous panting; this is a fatal syndrome." They added, "Sweating with unsubsided fever, diarrhea with unceasing fever, delirium and coma, and a surging pulse after childbirth; all major treatment principles have been violated. There is no way out. Only Fuzi Lizhong Tang (Aconite Decoction for Warmng the Middle) might offer a slim chance." Sun examined her and found the six pulses chaotic and disordered, beating seven or eight times per breath, with only the Right Guan position being hard (indicating food stagnation). He reasoned that sweating in summer months is common, but the summer-heat pathogen, retained food from the wheat cakes, and blood stasis had not been resolved. The sudden and heavy use of tonics led to blood accumulation manifesting as hallucinations ("seeing ghosts"). If he could resolve stasis, remove stagnation, and clear summer-heat, she could survive. He used Liuyuan San (Six-Yuan Powder) at 6 qian as the sovereign herb to clear summer-heat, clear heat, stop diarrhea, and promote urination; Tangqiuzi (Hawthorn Fruit) at 3 qian as the minister herb; Hongqu (Red Yeast Rice) and Zelan (Prunella Vulgaris Herba) each at 1.5 qian as the assistant herbs to resolve stasis and calm the spirit; Juhong (Tangerine Peel) and Banxia Qu (Pinellia Fermented Paste) and Fuling (Poria) as the envoy herbs to regulate the Spleen; and Sanleng (Sparganium Rhizome) at 0.5 qian as the vanguard to eliminate the congestion caused by the previous Renshen and Baizhu. After drinking the medicine, she slept briefly, and the delirium stopped completely. After two consecutive doses, diarrhea reduced by half. The next day, he continued with the same formula. Diarrhea gradually decreased, bowel movements occurred only twice, and yellow feces appeared. Dark blood clots from lochia were discharged. On the following day, the pulse regained order, and her spirit became calm. She was given a bowl of rice gruel. The previous formula was modified by removing Sanleng and Hongqu, and adding Bidou (Lablab Bean). She had one bowel movement, passing black stool, and the fever completely subsided. He then switched to Liu Junzi Tang (Six-Gentlemen Decoction) plus Liuyuan San, Qinghao (Artemisia Annua Herb), Bidou, Xiangfu (Cyperus Rhizome), Jiushaoyao (Wine-processed Peony Root), and Paojiang (Charred Ginger). She recovered after regulation. (Note: Sanleng is also a blood-resolving agent. To slightly relieve the congestion of Renshen and Baizhu, Hawthorn is sufficient; Sanleng is not strictly necessary. Xu Lingtai's note: Paojiang is superfluous.)
Yi Silan treated the consort of Wang Fuqian in Shicheng County. In the sixth lunar month of the Guiyou year, while pregnant, she accidentally suffered from diarrhea. Physicians used diaphoretic and leeching drugs to stop it, resulting in diarrhea occurring three to five days every month thereafter. Some diagnosed it as Spleen diarrhea and prescribed formulas similar to Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). After two or three doses, it stopped, yet she still experienced diarrhea five to seven times monthly. By the third month of the following year, after giving birth, she suffered continuous diarrhea for half a month, eight to nine times day and night, with all medications ineffective. Panicked and helpless, she summoned Yi Silan. Yi palpated the pulses: both Cun and Chi positions on the left and right were peaceful, but the Guan positions on both sides were surging, large, and forceful. He said, "This is a summer-heat disease." He treated her with Huanglian Xiangru Yin (Coptis and Mosla Decoction). After one dose, symptoms halved; after two doses, she was fully cured. However, the Liver pulse remained unsubsided, so he prescribed Tongyuan Erba Dan (Unblocking Origin Two-Eight Pill) for regulation. She recovered completely after half a month.
Lu Zuyu treated the daughter-in-law of Li Danshan. She had always lacked primordial Qi. Seven or eight days postpartum, during the peak of summer heat, while resting in an upper-story room, she suddenly developed headache, panting, dizziness, and oppression. Her body felt as hot as burning charcoal, and she fell into a deep coma. Someone diagnosed it as Cold Damage (Shanghan) and ordered windows and doors closed tightly, with curtains heavily drawn. They prescribed Erchen Tang (Two-Aged Decoction) plus Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Chuanxiong (Ligusticum Chuanxiong Rhizome), and Suzye (Perilla Leaf). After one dose, her mouth and lips cracked dry, and she gasped for breath, nearing death. Lu palpated the pulses: all six were floating, surging, and scattered. He determined it was exposure to summer-heat rather than cold contraction, requiring cooling resolution rather than warming dispersion. He ordered well water to be sprinkled on the floor, reed mats laid down, and the patient moved onto them. She was given Xiangru Yin (Mosla Decoction), and subsequently sweated slightly and regained consciousness. He then prescribed Qingshu Yiyuan Tang (Clear Summer-heat and Benefit Origin Decoction). After four doses, she rose from bed. (Xu Lingtai's note: The argument is excellent, but the medication is debatable. Why not use Liuyuan San and Watermelon Juice?)
Shen Mingsheng treated the granddaughter-in-law of Liu Shunquan. During summer, postpartum, she fainted and lost consciousness. Someone attributed it to lochia attacking upward and administered formulas to remove stasis and clear the soul. The stasis did not move, and the fainting worsened. Others treated it as phlegm or food stagnation, with no effect. Upon arrival, Shen paced back and forth, examining carefully, and smiled, saying, "I understand now. This is summer-heat invading due to deficiency. Urgent clearing of summer-heat is required, and only Huanglian will suffice." Someone argued, "Blood coagulates when cold. Since lochia has not been expelled, administering cold-natured herbs will hasten death." Shen smiled, "If there is any mishap, I take responsibility." As soon as the medicine entered her mouth, the syncope ceased, and upon further administration, lochia began to flow. This occurred because the room was small and crowded during childbirth, and the intense heat exacerbated the internal heat. A body newly deficient encountering such conditions inevitably becomes ill. The Classics state: "Summer-heat injures the Heart." And again: "The Heart governs Blood." Fainting due to heat oppression indicates summer-heat stroke, not lochia issues, clearly. Someone asked, "Abandoning symptoms for the season, the logic holds. But 'blood flows when hot, coagulates when cold' is also ancient wisdom. Why does lochia flow when using cold-natured herbs?" The answer is: "Heat promotes flow, cold causes stasis. Comparing blood to water describes the norm. Have you not seen cases of hemorrhage where warm and mild herbs stopped bleeding? Similarly, can't bitter-cold herbs cause stasis to flow? Is this not the subtle principle of creation, the profound logic of adapting to reversals? How can one be rigid?" (Xu Lingtai's note: Although the disease is caused by summer-heat, if lochia does not flow, one must assist with phlegm-clearing agents. It is definitely not treatable solely with Huanglian. Readers should comprehend this silently.)