薛立斋治一产妇,阴脱,便闭下坠,形气倦甚,用十全大补汤而上。因怒仍脱,重坠,寒热,小便淋沥,
用补中益气汤加山栀、龙胆草,一剂,重坠减,而小便利。仍用前汤,去二味,倍加升麻、参、 而愈。
一产妇阴脱重痛,小便淋漓,此因元气甚虚,而肝火旺也。用补中益气汤加山栀、车前子,四剂而肝症悉
退。仍用前药,去二味,加茯苓,小便利。又用十全大补汤,而肿痛坠渐消。
一产妇元气充实,初产,玉门不闭,肿 作痛,小便不利。薛谓肝经湿热壅滞,欲以加味逍遥散加车前子、
牛膝治之。不信,乃服十全大补汤,肿痛益甚。仍用前药,更加泽泻,一剂而安。
一产妇阴脱肿痛,脉又滑数,欲作脓也。薛用十全大补汤,四剂脓成,又数剂而脓溃。但小便频数,而患
处重坠痛盛,此因元气虚弱而下陷也,又用补中益气汤,数剂而安。
一产妇素有肝火,患阴蚀疳疮内溃,痒痛如虫行状,食少热渴,小水淋沥,用加味逍遥散、加味归脾汤兼
服,间以芦荟丸,外以鹤虱草煎洗而愈。
龚子材治一产妇,阴门痛极不可忍,教用桃仁去皮尖,研如泥,涂之即已。(散其瘀也。)一妇产后,阴户极痒,
令以食盐一两涂之即瘳。(去风热也。)一妇产后,阴肿大,用吴茱萸煎汤洗立愈。(辛以散之也。)
薛立斋治一妇,胞衣不下,努力太过,致子宫脱出如猪肚状,令用温汤治之,即以手捺子宫,去其恶露,
仰卧徐徐推入而安。
一妇脱肛,用补中益气加归脾各百余剂而愈。后因分娩后复脱,仍以前药各二百余剂始愈。(拙哉!)
李时珍治一妇,产后子肠不收,用蓖麻仁捣膏贴其丹田,一夜而上。但用此膏,病愈即宜揭去,其提拔之
力最猛也。又用催生下胎,用涂脚底,亦宜实时洗去。
孙文垣治一仆妇,因产难,子宫坠出户外,半月不收,艰于坐卧。有医令服补中益气百帖,需参二斤可愈,
乃听之。孙谓此必产时受寒,血凝滞不能收敛,虽名阴脱,未必尽由气虚下陷也。观其善饭、大小便如常,可
知矣。授以一法,价廉功省,三五日可愈。用未经水锻石干一块,重二三斤者,又以韭菜二三斤煎汤,置盆中,
将干灰投入,灰开汤沸,俟沸声尽,乃滤去灰,乘热坐盆上,先熏后洗,即以热韭于患处揉挪。盖锻石能散寒
消瘀,韭菜亦行气消瘀。一日洗一次,三日果消软收入。
按∶子宫、子肠有坠下损伤者,有终身不能上如带绶者,要皆初时治之不得其法耳。
薛立斋治疗一位产妇,出现阴道脱垂(子宫或阴道壁向外脱出),伴有排便困难及下坠感,身体气息极度疲倦。使用十全大补汤后症状缓解。后因发怒导致再次脱垂,且下坠感加重,出现寒热往来、小便淋漓不尽的症状。薛立斋使用补中益气汤加入山栀、龙胆草,服用一剂后,下坠感减轻,小便通畅。随后继续使用该方,去掉山栀和龙胆草两味药,加倍增加升麻、人参的用量,最终痊愈。
另一位产妇阴道脱垂且疼痛严重,小便淋漓不尽。这是因为元气非常虚弱,而肝火旺盛所致。薛立斋使用补中益气汤加入山栀、车前子,服用四剂后,肝经症状全部消退。接着继续使用原方,去掉山栀和车前子两味药,加入茯苓,使小便通畅。之后又使用十全大补汤,肿痛和下坠感逐渐消除。
还有一位产妇元气充足,刚生产完,阴道口不能闭合,肿胀作痛,小便不利。薛立斋认为是肝经湿热壅滞,打算用加味逍遥散加入车前子、牛膝来治疗。患者不信,反而服用了十全大补汤,导致肿痛更加严重。最终还是使用了薛立斋之前的方药,并增加了泽泻,服用一剂后病情安定。
又一位产妇阴道脱垂且肿痛,脉象滑数,似乎要化脓了。薛立斋使用十全大补汤,服用四剂后脓液形成,又服用数剂后脓液溃破。但此时小便频数,患处重坠疼痛剧烈,这是因为元气虚弱而下陷所致,于是又使用补中益气汤,服用数剂后病情安定。
还有一位产妇素有肝火,患阴部蚀烂疳疮并内溃,瘙痒疼痛感觉像虫子爬行,食欲减退,发热口渴,小便淋漓不尽。薛立斋让患者兼服加味逍遥散、加味归脾汤,间歇服用芦荟丸,外用鹤虱草煎水清洗,最终痊愈。
龚子材治疗一位产妇,阴门疼痛极其剧烈难以忍受,教她使用桃仁去皮尖,研磨成泥状,涂抹患处即愈。(这是为了消散瘀血。)另一位产妇产后,阴户极度瘙痒,让她用食盐一两涂抹,即刻痊愈。(这是为了去除风热。)还有一位产妇产后阴部肿大,用吴茱萸煎汤清洗,立即痊愈。(这是利用辛味药物发散邪气。)
薛立斋治疗一位妇女,胎盘不下,因用力过猛,导致子宫脱出如猪肚状。他让人用温水治疗,随即用手按压子宫,排出恶露,让患者仰卧,慢慢将子宫推回原位,从而安定下来。
还有一位妇女脱肛,使用补中益气汤和归脾汤各一百多剂后痊愈。后来因分娩后再次脱出,仍然使用这两种药各二百多剂才治愈。(真是笨拙啊!)
李时珍治疗一位妇女,产后子宫下垂不收,用蓖麻仁捣成膏贴敷在丹田穴,一夜之间就收回了。但使用此膏,病愈后即应揭去,因为其提拔之力最猛烈。另外,若用于催生下胎,涂于脚底,也应及时洗去。
孙文垣治疗一位女仆,因难产,子宫坠出体外,半个月无法收回,坐卧困难。有医生让她服用补中益气汤一百帖,需要人参二斤才能痊愈,她便听从了。孙文垣认为这必定是生产时受寒,血液凝滞不能收敛,虽然名为阴脱,未必全是由气虚下陷引起。观察她胃口好、大小便正常,就可以知道了。于是传授给她一种方法,价格便宜且功效显著,三五天即可痊愈。使用未经水洗过的锻石干块一块,重二三斤,再用韭菜二三斤煎汤,放入盆中,将干灰投入,灰散汤沸,等到沸腾声停止,滤去灰渣,趁热坐在盆上,先熏后洗,并用热的韭菜在患处揉搓。因为锻石能散寒消瘀,韭菜也能行气消瘀。每天洗一次,三天后果然消肿变软并收入体内。
Xue Lizhai treated a postpartum woman who suffered from vaginal prolapse (prolapse of the uterus or vaginal walls), accompanied by constipation and a bearing-down sensation, with extreme fatigue in both form and qi. After administering Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction), her condition improved. However, due to anger, the prolapse recurred with severe bearing-down sensations, alternating chills and fever, and dribbling urination. Xue prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Gardenia Fruit (Shanzhi) and Gentian Root (Longdancao). After one dose, the bearing-down sensation decreased, and urination became smooth. He continued with the same formula, removing Shanzhi and Longdancao, and doubled the dosage of Cimicifugae Rhizoma (Shengma) and Codonopsis Radix (Renshen), leading to recovery.
In another case, a postpartum woman presented with severe vaginal prolapse and pain, along with dribbling urination. This was attributed to severe deficiency of primordial qi and hyperactive liver fire. Xue used Buzhong Yiqi Tang added with Gardenia Fruit (Shanzhi) and Plantago Seed (Cheqianzi). After four doses, the liver-related symptoms subsided completely. He then continued with the previous prescription, removing Shanzhi and Cheqianzi, and adding Poria Cocos (Fuling), which facilitated urination. Subsequently, he administered Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction), and the swelling, pain, and bearing-down sensation gradually diminished.
Regarding a third postpartum woman with sufficient primordial qi, whose vulva failed to close after initial delivery, accompanied by swelling and pain, and difficult urination, Xue diagnosed it as damp-heat stagnation in the Liver channel. He intended to treat her with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Plantago Seed (Cheqianzi) and Achyranthes Bidentatae Radix (Niuxi). The patient did not believe this and instead took Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction), which exacerbated the swelling and pain. Eventually, she accepted Xue's original prescription with the addition of Alisma Orientale Rhizoma (Zexie). One dose brought relief.
In another instance, a postpartum woman had vaginal prolapse with swelling and pain, and her pulse was slippery and rapid, suggesting impending suppuration. Xue prescribed Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction). After four doses, pus formed; after several more doses, it ruptured. However, she experienced frequent urination and severe bearing-down pain at the lesion site, indicating sinking of deficient primordial qi. Thus, he again used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and she recovered after several doses.
Another postpartum woman, who had a history of liver fire, suffered from erosive ulcers in the vagina that ulcerated internally, causing itching and pain resembling insect crawling, poor appetite, fever, thirst, and dribbling urination. Xue prescribed Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Jiawei Guipi Tang (Modified Restore the Spleen Decoction) concurrently, interspersed with Aloe Pill (Lushui Wan), and externally washed with a decoction of Chrysanthemum Carancanthoides Herb (Heshicao), resulting in recovery.
Gong Zicai treated a postpartum woman with unbearable pain in the vulva. He instructed her to apply peeled and crushed Peach Kernel (Taoren) paste to the area, which provided immediate relief (to dissipate blood stasis). For another postpartum woman with intense itching in the vaginal opening, he advised applying one liang of salt, which cured her immediately (to dispel wind-heat). For a third postpartum woman with swollen vulva, he recommended washing with a decoction of Evodiae Fructus (Wuzhuyu), which cured her instantly (using acrid properties to disperse pathogenic factors).
Xue Lizhai treated a woman whose placenta failed to descend. Due to excessive straining, her uterus prolapsed outside, resembling a pig's stomach. He instructed her to use warm water treatment, manually press the uterus to expel lochia, lie supine, and gently push the uterus back into place, thereby stabilizing the condition.
He also treated a woman with rectal prolapse using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Guipi Tang (Restore the Spleen Decoction) for over a hundred doses each, achieving cure. Later, after childbirth, the prolapse recurred. She required over two hundred doses of each medicine to recover again. (This approach was considered inept.)
Li Shizhen treated a woman with uterine prolapse after delivery. He applied a paste made from Castor Seed (Bimaren) to the Dantian point, which resulted in retraction overnight. He noted that once the disease is cured, the paste should be removed immediately because its lifting power is very potent. Additionally, if used to induce labor, it should be applied to the soles of the feet and washed off promptly.
Sun Wen Yuan treated a female servant who suffered from uterine prolapse outside the body for half a month due to difficult labor, making sitting and lying down difficult. A physician advised taking one hundred doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) requiring two jin of Codonopsis Radix (Renshen) for a cure, which she followed. Sun argued that this was likely caused by cold invasion during childbirth, leading to blood stagnation preventing retraction. Although named "yin prolapse," it was not necessarily solely due to qi deficiency and sinking. Observing her good appetite and normal bowel/bladder movements confirmed this. He taught her a cost-effective method that could cure her in three to five days. He used a piece of unrefined calcined stone (Duanshi) weighing two to three jin, boiled it with two to three jin of Chinese Chives (Jiucai) in a basin, added the dry ash until boiling ceased, filtered out the ash, and instructed her to sit on the hot basin, fumigating and then washing the area. He also rubbed the heated chives on the affected part. Since Duanshi can disperse cold and resolve stasis, and Jiuqi promotes qi movement and resolves stasis, washing once daily led to resolution and retraction within three days.
Commentary: Cases of uterine or intestinal prolapse involving injury from falling or lifelong inability to retract (resembling a hanging ribbon) are all due to improper treatment methods initially.