(十五）产后晕厥金姓，女。屡以产后失调，伤血太过，十余日前又患流产，肝家失养，邪遂乘虚，曾发晕厥数次，眠食均差，舌苔白腻，脉象弦而濡。治宜从本滋益以抑肝邪，兼和中，并交心肾。生龙齿(包，先煎）12克芥穗炭1．5克代赭石9干百合18克磁朱粉(包，先煎）9克桑上寄生24克火麻仁9克石决明(生研，先煎）30克旋覆花(包煎）9克清半夏9克朱茯神9克土炒杭芍(焦）9克广陈皮6克当归9克荷叶一张局方至宝丹1粒(研服，每次四分之一）服2剂。复诊：药后未发晕厥，夜寐能至六小时，食纳稍增，脉仍弦濡，宜稍事加味。原方加栝萎15克、百合、牡蛎各增6克，火麻仁加3克，服3剂。三诊：脉濡象已无，左关尚属弦大，精力、寝、食俱有好转，惟肝阳未敢，仍上犯头晕，再尊原方酌情变通之。原方加真玳瑁(布包，先煎）6克橹豆衣(包煎）12克鳖血青蒿12克局方至宝丹改服半粒，去当归、茯神、芥穗炭、广陈皮，嘱服4剂。
(孔嗣伯整理：孔伯华医案，《中医杂志》8：547．1958）
【评按】此例前曾屡有产后失血，近又罹流产，邪遂乘肝之虚而为晕厥，病理表现以阴虚阳亢较为突出。孔氏治以平肝潜阳、和中安神为大法，配合少量至宝丹，功能逐邪清热开窍，复诊仍宗前法，以其肝阳未戢，故以变通治之，方治随病机而酌变，虽以补法为主，药物配伍精当而无温燥之弊。
(十六）产后狂躁石某，35岁。分娩后一日，忽发高热，面赤目直，脱衣揭被，狂躁妄言，时欲起床奔走，口渴不欲多饮，恶露未净，腹中作痛。医者数辈，议论下一，有断为阳热实邪,用白虎汤加生地、麦冬、花粉之类，狂越更甚；有认为产后血舍空虚，浮阳上越，用桂附八味引火归元,服后稍能安睡，醒后仍然惊狂幻见，全家惶惑。诊见脉沉弦细数，舌质暗赤。溲清便秘，躁热汗出，必因恶露不净，蓄血如狂。傅青主有“败血攻心”之论，遂仿其和血逐瘀法，用安心汤加味。全当归30克正川芎15克生地黄10克苏方木10克牡丹皮10克生蒲黄6克青荷叶1块1剂而狂躁定，身热退；再剂而恶露下，人事清、
(《李聪甫医案》）
【评按】此案由于产后恶露不净，败血攻心所致，患者虽有狂躁见症，然小便清长，口渴又不欲多饮，则非阳明热证可知。李氏用和血逐瘀法，辨证明晰，用方果断，1剂而狂躁定。如为轻证，则可用生化汤治之。
(十七）产后发痉秦××，女，20岁。1948年秋，因产后七八日，头晕眼花，不能坐起，临诊时忽见患者手指抽掣，相继呵欠，张大其口，越张越大，竟至口角裂破流血，急令人以手按合，亦竟不止。复现面色淡白，目瞪流涎，冷汗时出，神识昏迷。脉弦缓无力。辨证：新产亡血伤阴，汗多伤阳，复受外感，风入经俞而发痉，势有阴竭阳脱之象。治法：回阳固脱、法风镇痉。方药:急煎高丽参15克与服，半小时后稍有好转，续用栝蒌桂枝汤加味。高丽参9克炙黄芪30克桂枝6克杭芍9克附片4石克：栝蒌根12克炙甘草9克生姜9克大枣5个2剂，水煎服。二诊：服：剂后，汗出渐少，2剂服完，抽搐亦缓解，惟感眩晕疲乏，乃表固阳回，阴血仍亏。拟以养血镇痉，气血并补之剂。方药：栝蒌桂枝汤合四物汤加减：炙黄芪30克当归9克桂枝4．5克杭芍9克栝萎根9克生地15克川芎4.5克钩藤9克炙甘草6克高丽参9克人一连服之剂后，眩晕减轻，精神日趋恢复。
(《席梁丞治验录》）
【评按】此案新产后亡血兼汗多，阴阳俱伤，复受外感。风入经俞而发痉。煎高丽参以大补元气、回阳固脱，使阳生阴长，并用括蒌桂枝汤以扶元益气、祛风镇痉；复诊时参入气血并补法，取得良效。这种以补法为主、祛邪为辅的治法,是产后发痉治疗的重要手段。
(十八）产后发热
例一玉姓妇人，年20余岁，小产后发热，诊治半年之久，服药注射皆无效力，且增心慌盗汗，卧床不起，日渐消瘦，脉弦浮无力，此证因小产后感受风寒，失于治疗，迁延至此，欲表则恐盗汗不止，不表则表证仍在，只用和解一法，于不表之中，寓达肌腠，以透其邪，兼清里热。方用：银柴胡
(醋炒）9克酒秦艽6克杭白芍4．5克粉丹皮6克地骨皮6克酒芩3克龙骨3克牡蛎3克甘草3克醋青蒿1．5克服1剂热退大半，2剂痊愈。
(梁赐明整理：蒋王伯医案，《广东医学》3：36，1964）
例二陈某，产后发热恶寒，头晕汗多，口渴，眉骨痛，心悸，胸痞不思食，食则干呕，吐白沫，苔白厚，右脉弦紧，左脉微浮。此新感风寒，因产后百脉空虚，故宗丹溪“产后当大补气血，即有杂证，以末治之”之论。处方：秦当归15克炒白芍15克川芎3克茯神9克煨生姜9克枣仁12克鲜藕60克橘饼30克天麻9克杜仲12克补骨脂12克再诊：仍寒热汗多，于前方加黄芪9克，白术6克、炮干姜9克，去川芎、天麻、煨生姜。连服2剂，寒热不作，汗止，惟脐周微痛，加小茴香3克，炙甘草3克，服后痛除。
(《沈绍九医话》）
例三钟××，女，24岁，于1977年6月30日足月平产第一胎。产后三天，过食肥甘厚味，当日下午又洗头洗澡，入夜突然发热，但不畏寒，未予介意。次日，意识昏沉，高热谵语，体温41．7℃，持续不降。遂于7月5日住院治疗。入院时体温41．8℃，脉搏140次／分，呼吸40次／分。血压100／70毫米汞柱。神志昏沉，呈急性重病容。内、妇科检查无阳性发现，恶露致病菌、血培养
(一），血白细胞18，500／立方毫米。印象：发烧待查。从7月5日～7月23日采用多种抗菌素、激素、物理降温措施，以及中药麻杏石甘、白虎、犀角、鳖甲、青蒿之辈，体温始终持续在40～41℃之间，会诊时症见发热口渴，脘腹胀痛、呕吐厌食，暧腐吞酸，不能安卧。触其院腹疼痛拒按，观其舌，质红苔黄，脉弦滑有力。辨证：食湿交阻中焦，郁而发热。治法：越鞠丸合枳实芍药散，重用六曲：忌肥甘生冷。方药：香附10克苍术10克栀仁10克六曲18克川芎5克枳实6克白芍10克陈皮5克生姜3片3剂。7月26日复诊：服上方后，体温降至38℃，脘腹胀痛大减，能进少量食物，但脘腹仍拒按，口渴未已，舌质淡红，脉弦有力，前方去苍术、栀仁，加党参12克、白术10克、山楂10克，大黄6克，厚朴10克，3剂。7月28日三诊，服上方体温下降为37℃，上述症状基本消失，食欲增进，二便如常。《湖南省老中医医案》廖仲颐医案）
例四孙××，女，35岁。因妊娠9个月感冒、发烧，头晕，肝区痛，大使呈陶土色，巩膜、皮肤黄染。干1972年1i月27日引产一男婴，死胎。产后黄疸加重，四肢躯干发现少数出血点，曾疑为“亚急性肝坏死”。经中西药抢救，病情危重，井出现狂闹哭笑等精神症状。体温在38～39℃之间，心率120次／分。患者呈半昏迷状，口噤抽搐，两目上吊，大小便失禁，面目发黄，腹部膨起，胸腹颈满布白痦，舌苔白嫩如腐，不见舌质，齿燥，脉左细数，右弦大数无力。辨证：妊娠湿温(产后气血大虚，内外合邪）治法：辛凉清热，淡渗利湿。薏苡竹叶散(汤）加味。方药：苡仁24克茯苓块15克白寇仁9克淡竹叶9克陈皮9克金银花15克净连翘15克石菖蒲18克双钩藤9克合欢皮30克首乌藤30克甘草3克12月14日二诊：服药6剂后，神志较前清楚，但仍有神昏谵语，体温37～38℃之间。产后阴亏，湿热伤阴，而致水不涵木，故呈肝风内动之象。方药：西洋参4．5克
(男煎）白芍9克龟板12克鳖甲12克真阿胶9克苡仁24克麦冬9克竹茹9克生牡蛎12克
(打碎）五味子4．5克沙参21克炙草4．5克12月］6日三诊：患者意识渐渐清楚，黄疸减轻，痦疹减少，体温38℃左右，皮肤灼热，上方去西洋参，加金银花、连翘、茯芩。以后曾加减使用过健脾的山药、莲子，以及养阴清热药首乌、地骨皮，或加扁豆甘淡健脾。1月11日，体温已恢复正常，食欲、二便恢复正常，整个治疗期间采取中西医结合，二月后痊愈出院。
(《席梁丞治验录》）
例五邓君之妻，年24岁。小产后患伏热，杂洽不痊，检阅前方，皆与症反，势已濒，其夫仓皇乞诊。其脉弦数，舌色红而苔白。辨证：瘀血停蓄为患。治法：本宜桃仁承气汤，以病久人困，虑其难于胜受，乃变通用四物汤去地黄，加桃仁、红花、肉桂、醋炒大黄以缓通之。方药：归尾4．5克赤芍9克川芎3克桃仁6克片红花3克紫瑶桂1．5克醋炒生川军1．5克1剂下黑粪甚多，痛减七八，再剂而愈。
(《重印全国名医验案类编》萧琢如医案）
例六韩某，女，28岁。初诊日期1975年4月19日。患者于1974年12月10日产后，曾患外感高烧，经中药治疗烧退后，经常失眠，心烦意乱，自觉有时发寒热。近一周来夜寐不实，梦乱纷纭，有幻视，眼前似有二人，一黑一白，夜见昼消，故夜间不敢关灯睡觉，自觉头痛头晕，心烦急躁，时觉身热汗出，心跳，惊悸，胆怯，恶心，胸胁胀满，小腹发胀，小便黄短，月经未至。舌质红，脉弦。辨证：产后外感，余邪未尽，热入血室，扰于神明。治法：和解肝胆，清热安神。方药：柴胡6克党参6克黄芩9克半夏9克甘草6克枳壳6克栀子9克连翘9克白芍9克生姜3片大枣3枚生龙齿30克丹皮6克治疗经过，4月24日，上方3剂后，诸证减轻，寒热已退，能够关灯入睡，幻视消失，仍有头晕，恶心，纳差，胸胁胀。继服3剂，诸症皆愈。
(《刘奉五妇科经验》）
【评按】产后由于阴血虚耗，百脉空虚，阳易浮散不收，而致发热。起因比较复杂，但以产后外感、产后中风、热入血室、血虚等较为多见。清·沈尧封认为：“新产发热，血虚而阳浮于外者居多，亦有头痛。此是虚阳升腾，不可误为胃寒，妄投发散以煽其焰，此惟潜阳摄纳，则气火平而热自己。”并进一步指出产后感冒亦不当妄事疏散，“……惟和其营卫，慎其起居，而感邪亦能自解”
(见《沈氏女科辑要笺正》）。此属经验之谈，对临床颇有参考价值。
例一为小产后感受风寒，蒋氏用和解法，但全方寓有疏透清里之义。
例二虽为产后感冒风寒，然方中并无疏解清热之品，沈氏以患者气血两虚的见证明显，先以补气血，和中为治：后以甘温除热、温中法寒法奏效。审因结合辨证，方药契。
例三为妊娠湿温，由于产后气血大虚，内外合邪，症势颇笃，初用辛凉清热、淡渗利湿法，后因湿热伤阴，水不涵木，呈肝风内动之象，故改用养阴清热、扶正柔肝之剂。俟体温减、黄疸轻、痦疹少，终以健脾和胃、养阴清热法善其后。全案用方的转换变化，恰合病机。
例四、例五均为产后热入血室。例四为小产后伏热，势已濒危，此案本属桃仁承气汤证，萧氏考虑到患者“病久人困”，师桃仁承气意而变其方，以四物汤去地黄，另加温经通瘀之品，着重解决患者瘀热互结的矛盾。方药组合严密，体现了祖国医药“因人制宜”的特点。
例五为产后外感余邪未尽，热入血室、扰于神明。由于此案瘀血见症不明显，故刘氏治以和解肝胆、清热安神法，实为小柴胡汤加减法，其药味斟酌损益与病证相合，而无浮泛之弊。
(十九）产后血痹方××，女，37岁，工人。四年来时感心跳气短，二年来症状加重，曾有四次咯血，这次发病在产后第十天，突觉右下肢发凉、发胀，伴有阵发性疼痛，日轻夜重，不能行动。检查：右腿自膝以下发凉，未触到股及腘动脉搏动。脉弦细、时有结代，唇微紫，舌边缘有紫色瘀斑，舌苔薄白。诊断为股动脉栓塞。辨证：气血瘀滞，经络闭塞。治法：补气活血，法瘀通络。方药：黄芪60克桃仁、红花、地龙、川牛膝、元参各15克归尾、川芎各12克蒲黄、五灵脂、乳香、没药、菖蒲各9克甘草3克苏合香0．9克(冲服）针刺穴位：委中承山阳陵泉足三里(灸）二诊：前方服5剂，症状逐渐减轻，右下肢自觉温暖，疼痛次数减少，时间缩短。前方黄芪加至90克。治疗一个月后疼痛消失，可触及股动脉搏动，能下地活动。五周后出院，继服中药调养。
(《邢锡波医案选》）
【评按】血痹的病名，原见于《灵枢经·九针》。产生此病的内因由于气血虚弱，外因则以感受风寒较为常见；或因劳汗出、风邪乘虚袭人、气血闭阻所致。此案发生于产后，气血虚弱自不待言。洽以补气活血、祛瘀通络法。方中重用黄芪以加强补气，配合法瘀定痛诸品，亦具有温通的效能，方治外复配合针灸，针药并用，效验更著。
(二十）产后瘫闭患者房××，女，成人，已婚。病历号为20745
（十五）产后晕厥
金姓女子，因多次产后调养不当，导致失血过多。十余日前又遭遇流产，致使肝脏失去血液滋养，邪气便趁虚而入，曾发作过数次晕厥。目前睡眠和饮食状况都很差，舌苔白腻，脉象弦而濡软。治疗应当从根本入手，通过滋补来抑制肝邪，同时调和脾胃，并交通心肾。处方：生龙齿（包煎，先煎）12克，荆芥穗炭1.5克，代赭石9克，干百合18克，磁朱粉（包煎，先煎）9克，桑寄生24克，火麻仁9克，石决明（生研，先煎）30克，旋覆花（包煎）9克，清半夏9克，朱茯神9克，土炒杭芍（炒焦）9克，广陈皮6克，当归9克，荷叶一张，局方至宝丹1粒（研末服用，每次四分之一粒）。服用2剂后复诊：服药后未再发生晕厥，夜间能睡眠六小时，食欲稍增，脉象仍呈弦濡之象，适宜在原方基础上稍作加减。原方加入栝萎15克，百合和牡蛎各增加6克，火麻仁增加3克，服用3剂。三诊时：脉象中的濡象已消失，左关脉仍显弦大，精力、睡眠、饮食均有好转，只是肝阳仍未平息，依然上犯导致头晕，仍遵循原方酌情调整。原方加入真玳瑁（布包，先煎）6克，橹豆衣（包煎）12克，鳖血青蒿12克，局方至宝丹改为服用半粒，去掉当归、茯神、芥穗炭、广陈皮，嘱咐服用4剂。
（孔嗣伯整理：孔伯华医案，《中医杂志》8：547．1958）
【评按】此病例此前曾多次出现产后失血，近期又遭受流产，邪气乘肝血之虚而导致晕厥，病理表现以阴虚阳亢较为突出。孔氏采用平肝潜阳、调和脾胃、安神的大法，配合少量至宝丹，起到驱除邪气、清热开窍的作用。复诊时仍沿用前法，因为其肝阳尚未平息，故进行变通治疗，方药随病机变化而调整，虽然以补法为主，但药物配伍精当，没有温燥的弊端。
（十六）产后狂躁
石某，35岁。分娩后一天，突然发高热，面色红赤，两眼直视，脱去衣服掀开被子，狂躁妄言，时常想要起床奔走，口渴但不想多喝水，恶露未净，腹部疼痛。多位医生讨论，意见倾向于使用攻下法，有的判断为阳热实邪，用白虎汤加生地、麦冬、花粉等药，结果狂躁更加严重；有的认为产后血室空虚，浮阳上越，用桂附八味丸引火归元，服药后稍微能安睡，醒来后仍然惊狂幻视，全家惶恐困惑。诊见脉沉弦细数，舌质暗红。小便清长，便秘，躁热汗出，必定是因为恶露不净，蓄血如狂。傅青主有“败血攻心”的理论，于是模仿其和血逐瘀法，用安心汤加味。全当归30克，正川芎15克，生地黄10克，苏方木10克，牡丹皮10克，生蒲黄6克，青荷叶1块。服1剂后狂躁停止，身热退去；再服1剂后恶露下行，人事清醒。
（《李聪甫医案》）
【评按】此案由于产后恶露不净，败血攻心所致，患者虽有狂躁症状，但小便清长，口渴又不想多喝，可知不是阳明热证。李氏运用和血逐瘀法，辨证明晰，用方果断，1剂后狂躁即定。如果是轻证，则可用生化汤治疗。
（十七）产后发痉
秦××，女，20岁。1948年秋，因产后七八天，头晕眼花，不能坐起，就诊时忽然看见患者手指抽搐，接连打哈欠，张大嘴巴，越张越大，竟至口角裂破流血，急忙让人用手按住合拢，却怎么也止不住。随后出现面色淡白，眼睛瞪直流涎，冷汗不时流出，神识昏迷。脉象弦缓无力。辨证：新产亡血伤阴，汗多伤阳，又感受外邪，风邪侵入经络俞穴而引发痉挛，有阴竭阳脱的迹象。治法：回阳固脱，祛风镇痉。方药：急煎高丽参15克给患者服用，半小时后稍有转机，续用栝蒌桂枝汤加味。高丽参9克，炙黄芪30克，桂枝6克，杭芍9克，附片4.5克，栝蒌根12克，炙甘草9克，生姜9克，大枣5个。水煎服，2剂。二诊：服完2剂后，出汗逐渐减少，抽搐也缓解，只感到眩晕疲乏，这是表固阳回，但阴血仍亏。拟定养血镇痉、气血并补的方剂。方药：栝蒌桂枝汤合四物汤加减：炙黄芪30克，当归9克，桂枝4.5克，杭芍9克，栝蒌根9克，生地15克，川芎4.5克，钩藤9克，炙甘草6克，高丽参9克。连续服用几剂后，眩晕减轻，精神日趋恢复。
（《席梁丞治验录》）
【评按】此案新产后亡血兼汗多，阴阳俱伤，又感受外邪，风邪侵入经络俞穴而引发痉挛。煎服高丽参以大补元气、回阳固脱，使阳生阴长，并用栝蒌桂枝汤以扶元益气、祛风镇痉；复诊时加入气血并补法，取得良效。这种以补法为主、祛邪为辅的治法，是产后发痉治疗的重要手段。
（十八）产后发热
例一 玉姓妇人，20多岁，小产后发热，诊治半年之久，服药注射均无效，且增加了心慌盗汗，卧床不起，日渐消瘦，脉弦浮无力。此证因小产后感受风寒，失于治疗，拖延至此，欲解表则恐盗汗不止，不解表则表证仍在，只用和解一法，在不解表中寓含通达肌腠之意，以透发邪气，兼清里热。方用：银柴胡（醋炒）9克，酒秦艽6克，杭白芍4.5克，粉丹皮6克，地骨皮6克，酒黄芩3克，龙骨3克，牡蛎3克，甘草3克，醋青蒿1.5克。服1剂热退大半，2剂痊愈。
（梁赐明整理：蒋王伯医案，《广东医学》3：36，1964）
例二 陈某，产后发热恶寒，头晕汗多，口渴，眉骨痛，心悸，胸痞不思食，食则干呕，吐白沫，苔白厚，右脉弦紧，左脉微浮。此为感受风寒，因产后百脉空虚，故宗丹溪“产后当大补气血，即使有杂证，也以次要处理”的理论。处方：秦当归15克，炒白芍15克，川芎3克，茯神9克，煨生姜9克，枣仁12克，鲜藕60克，橘饼30克，天麻9克，杜仲12克，补骨脂12克。再诊：仍寒热汗多，于前方加黄芪9克，白术6克、炮干姜9克，去川芎、天麻、煨生姜。连服2剂，寒热不作，汗止，惟脐周微痛，加小茴香3克，炙甘草3克，服后痛除。
（《沈绍九医话》）
例三 钟××，女，24岁，于1977年6月30日足月平产第一胎。产后三天，过食肥甘厚味，当日下午又洗头洗澡，入夜突然发热，但不畏寒，未予介意。次日，意识昏沉，高热谵语，体温41.7℃，持续不降。遂于7月5日住院治疗。入院时体温41.8℃，脉搏140次/分，呼吸40次/分。血压100/70毫米汞柱。神志昏沉，呈急性重病容。内、妇科检查无阳性发现，恶露致病菌、血培养（阴性），血白细胞18,500/立方毫米。印象：发烧待查。从7月5日～7月23日采用多种抗菌素、激素、物理降温措施，以及中药麻杏石甘、白虎、犀角、鳖甲、青蒿之类，体温始终持续在40～41℃之间，会诊时症见发热口渴，脘腹胀痛、呕吐厌食，嗳腐吞酸，不能安卧。触其腹部疼痛拒按，观其舌，质红苔黄，脉弦滑有力。辨证：食湿交阻中焦，郁而发热。治法：越鞠丸合枳实芍药散，重用六曲：忌肥甘生冷。方药：香附10克，苍术10克，栀仁10克，六曲18克，川芎5克，枳实6克，白芍10克，陈皮5克，生姜3片。3剂。7月26日复诊：服上方后，体温降至38℃，脘腹胀痛大减，能进少量食物，但脘腹仍拒按，口渴未已，舌质淡红，脉弦有力，前方去苍术、栀仁，加党参12克、白术10克、山楂10克，大黄6克，厚朴10克，3剂。7月28日三诊，服上方体温下降为37℃，上述症状基本消失，食欲增进，二便如常。（《湖南省老中医医案》廖仲颐医案）
例四 孙××，女，35岁。因妊娠9个月感冒、发烧，头晕，肝区痛，大便呈陶土色，巩膜、皮肤黄染。于1972年11月27日引产一男婴，死胎。产后黄疸加重，四肢躯干发现少数出血点，曾疑为“亚急性肝坏死”。经中西药抢救，病情危重，并出现狂闹哭笑等精神症状。体温在38～39℃之间，心率120次/分。患者呈半昏迷状，口噤抽搐，两目上吊，大小便失禁，面目发黄，腹部膨起，胸腹颈满布白痦，舌苔白嫩如腐，不见舌质，齿燥，脉左细数，右弦大数无力。辨证：妊娠湿温（产后气血大虚，内外合邪）。治法：辛凉清热，淡渗利湿。薏苡竹叶散（汤）加味。方药：苡仁24克，茯苓块15克，白寇仁9克，淡竹叶9克，陈皮9克，金银花15克，净连翘15克，石菖蒲18克，双钩藤9克，合欢皮30克，首乌藤30克，甘草3克。12月14日二诊：服药6剂后，神志较前清楚，但仍有神昏谵语，体温37～38℃之间。产后阴亏，湿热伤阴，而致水不涵木，故呈肝风内动之象。方药：西洋参4.5克（另煎），白芍9克，龟板12克，鳖甲12克，真阿胶9克，苡仁24克，麦冬9克，竹茹9克，生牡蛎12克（打碎），五味子4.5克，沙参21克，炙草4.5克。12月16日三诊：患者意识渐渐清楚，黄疸减轻，痦疹减少，体温38℃左右，皮肤灼热，上方去西洋参，加金银花、连翘、茯苓。以后曾加减使用过健脾的山药、莲子，以及养阴清热药首乌、地骨皮，或加扁豆甘淡健脾。1月11日，体温已恢复正常，食欲、二便恢复正常，整个治疗期间采取中西医结合，二月后痊愈出院。
（《席梁丞治验录》）
例五 邓君之妻，年24岁。小产后患伏热，杂治不痊，检阅前方，皆与症反，势已濒危，其夫仓皇乞诊。其脉弦数，舌色红而苔白。辨证：瘀血停蓄为患。治法：本宜桃仁承气汤，以病久人困，虑其难于胜受，乃变通用四物汤去地黄，加桃仁、红花、肉桂、醋炒大黄以缓通之。方药：归尾4.5克，赤芍9克，川芎3克，桃仁6克，片红花3克，紫瑶桂1.5克，醋炒生川军1.5克。1剂下黑粪甚多，痛减七八，再剂而愈。
（《重印全国名医验案类编》萧琢如医案）
例六 韩某，女，28岁。初诊日期1975年4月19日。患者于1974年12月10日产后，曾患外感高烧，经中药治疗烧退后，经常失眠，心烦意乱，自觉有时发寒热。近一周来夜寐不实，梦乱纷纭，有幻视，眼前似有二人，一黑一白，夜见昼消，故夜间不敢关灯睡觉，自觉头痛头晕，心烦急躁，时觉身热汗出，心跳，惊悸，胆怯，恶心，胸胁胀满，小腹发胀，小便黄短，月经未至。舌质红，脉弦。辨证：产后外感，余邪未尽，热入血室，扰于神明。治法：和解肝胆，清热安神。方药：柴胡6克，党参6克，黄芩9克，半夏9克，甘草6克，枳壳6克，栀子9克，连翘9克，白芍9克，生姜3片，大枣3枚，生龙齿30克，丹皮6克。治疗经过，4月24日，上方3剂后，诸证减轻，寒热已退，能够关灯入睡，幻视消失，仍有头晕，恶心，纳差，胸胁胀。继服3剂，诸症皆愈。
（《刘奉五妇科经验》）
【评按】产后由于阴血虚耗，百脉空虚，阳气易浮散不收，而致发热。起因比较复杂，但以产后外感、产后中风、热入血室、血虚等较为多见。清代·沈尧封认为：“新产发热，血虚而阳浮于外者居多，亦有头痛。此是虚阳升腾，不可误为胃寒，妄投发散以煽其焰，此惟潜阳摄纳，则气火平而热自己。”并进一步指出产后感冒亦不当妄事疏散，“……惟和其营卫，慎其起居，而感邪亦能自解”（见《沈氏女科辑要笺正》）。此属经验之谈，对临床颇有参考价值。
例一为小产后感受风寒，蒋氏用和解法，但全方寓有疏透清里之义。
例二虽为产后感冒风寒，然方中并无疏解清热之品，沈氏以患者气血两虚的见证明显，先以补气血，和中为治；后以甘温除热、温中散寒法奏效。审因结合辨证，方药契合。
例三为妊娠湿温，由于产后气血大虚，内外合邪，症势颇笃，初用辛凉清热、淡渗利湿法，后因湿热伤阴，水不涵木，呈肝风内动之象，故改用养阴清热、扶正柔肝之剂。俟体温减、黄疸轻、痦疹少，终以健脾和胃、养阴清热法善其后。全案用方的转换变化，恰合病机。
例四、例五均为产后热入血室。例四为小产后伏热，势已濒危，此案本属桃仁承气汤证，萧氏考虑到患者“病久人困”，师桃仁承气意而变其方，以四物汤去地黄，另加温经通瘀之品，着重解决患者瘀热互结的矛盾。方药组合严密，体现了祖国医药“因人制宜”的特点。
例六为产后外感余邪未尽，热入血室、扰于神明。由于此案瘀血见症不明显，故刘氏治以和解肝胆、清热安神法，实为小柴胡汤加减法，其药味斟酌损益与病证相合，而无浮泛之弊。
（十九）产后血痹
方××，女，37岁，工人。四年来时感心跳气短，二年来症状加重，曾有四次咯血，这次发病在产后第十天，突觉右下肢发凉、发胀，伴有阵发性疼痛，日轻夜重，不能行动。检查：右腿自膝以下发凉，未触到股及腘动脉搏动。脉弦细、时有结代，唇微紫，舌边缘有紫色瘀斑，舌苔薄白。诊断为股动脉栓塞。辨证：气血瘀滞，经络闭塞。治法：补气活血，祛瘀通络。方药：黄芪60克，桃仁、红花、地龙、川牛膝、元参各15克，归尾、川芎各12克，蒲黄、五灵脂、乳香、没药、菖蒲各9克，甘草3克，苏合香0.9克（冲服）。针刺穴位：委中、承山、阳陵泉、足三里（灸）。二诊：前方服5剂，症状逐渐减轻，右下肢自觉温暖，疼痛次数减少，时间缩短。前方黄芪加至90克。治疗一个月后疼痛消失，可触及股动脉搏动，能下地活动。五周后出院，继服中药调养。
（《邢锡波医案选》）
【评按】血痹的病名，原见于《灵枢经·九针》。产生此病的内因由于气血虚弱，外因则以感受风寒较为常见；或因劳汗出、风邪乘虚袭人、气血闭阻所致。此案发生于产后，气血虚弱自不待言。洽以补气活血、祛瘀通络法。方中重用黄芪以加强补气，配合祛瘀定痛诸品，亦具有温通的效能，方治之外配合针灸，针药并用，效验更著。
（二十）产后瘫闭
患者房××，女，成人，已婚。病历号为20745
(XV) Postpartum Syncope
Patient Jin, female. Due to repeated postpartum maladjustment and excessive blood loss, she suffered a miscarriage more than ten days ago. This caused the Liver to lose nourishment, allowing pathogenic factors to take advantage of the deficiency. She had experienced several episodes of syncope. Her sleep and appetite were poor. The tongue coating was white and greasy, and the pulse was wiry and soggy (Ruo). Treatment should focus on nourishing from the root to suppress Liver pathogenic factors, while harmonizing the Middle Jiao (Spleen and Stomach) and connecting the Heart and Kidney. Prescription: Sheng Long Chi (Calcitrum, wrapped, decocted first) 12g, Jingjie Sui Tan (Charred Schizonepeta Spike) 1.5g, Dai Zhe Shi (Hematitum) 9g, Gan Baihe (Lilii Bulbus) 18g, Ci Zhu Fen (Magnetitum cum Magnetite, wrapped, decocted first) 9g, Sang Shang Ji Sheng (Taxilli Cacuminis Mori) 24g, Huo Ma Ren (Cannabis Fructus) 9g, Shi Jue Ming (Haliotidis Concha, raw ground, decocted first) 30g, Xuan Fu Hua (Inulae Flos, wrapped) 9g, Qing Ban Xia (Pinelliae Rhizoma Preparatum) 9g, Zhu Fu Shen (Poria with Pulsatillae Radix) 9g, Tu Chao Hang Shao (Jiao) (Soil-fried Paeoniae Radix Alba, charred) 9g, Guang Chen Pi (Citri Reticulatae Pericarpium) 6g, Dang Gui (Angelicae Sinensis Radix) 9g, one Lotus Leaf (He Ye), and one pill of Ju Fang Zhi Bao Dan (Prescribed Formula Treasure-Protecting Pill, powdered for administration, one-quarter pill per dose). Take 2 doses.
Follow-up visit: After taking the medicine, no further syncope occurred. Nighttime sleep lasted up to six hours, and appetite slightly increased. The pulse remained wiry and soggy. It is appropriate to make slight modifications to the original prescription. Add Gua Lou (Trichosanthis Fructus) 15g; increase Bai He (Lilii Bulbus) and Mu Li (Ostreae Concha) by 6g each; increase Huo Ma Ren (Cannabis Fructus) by 3g. Take 3 doses.
Third visit: The soggy quality of the pulse has disappeared, but the left Guan position remains wiry and large. Energy, sleep, and diet have all improved. However, Liver Yang has not yet subsided and continues to harass upwards, causing dizziness. Continue to follow the original prescription with appropriate adjustments. Add Zhen Dai Mao (Eretmochelys Carapax) 6g (wrapped, decocted first), Lu Dou Yi (Glycine Soja Seed Coat, wrapped) 12g, Bie Xue Qing Hao (Artemisiae Annuae Herba soaked in Turtle Blood) 12g. Change Ju Fang Zhi Bao Dan dosage to half a pill. Remove Dang Gui (Angelicae Sinensis Radix), Fu Shen (Poria with Pulsatillae Radix), Jingjie Sui Tan (Charred Schizonepeta Spike), and Guang Chen Pi (Citri Reticulatae Pericarpium). Instruct to take 4 doses.
(Compiled by Kong Sibai: Medical Cases of Kong Bohua, *Journal of Traditional Chinese Medicine* 8:547, 1958)
[Commentary] This case involved repeated postpartum blood loss previously, followed by a recent miscarriage. Pathogenic factors took advantage of the Liver deficiency to cause syncope. The pathological presentation was prominently characterized by Yin deficiency and Yang hyperactivity. Dr. Kong adopted the major principle of pacifying the Liver, subduing Yang, harmonizing the Middle Jiao, and calming the spirit, combined with a small amount of Zhi Bao Dan to expel pathogens, clear heat, and open the orifices. At the follow-up, the previous method was still followed because the Liver Yang had not yet subsided, so treatment was modified accordingly. The prescription varied according to the pathogenesis. Although primarily using tonification methods, the herb combination was precise and avoided the drawbacks of being too warming and drying.
(XVI) Postpartum Mania
Patient Shi, 35 years old. One day after delivery, she suddenly developed high fever, flushed face, fixed gaze, removed clothes and kicked off blankets, spoke wildly and maniacally, and frequently attempted to get up and run around. She felt thirsty but did not want to drink much. Lochia was not yet clean, and she had abdominal pain. Several physicians discussed the case, leaning towards purgative methods. Some diagnosed it as Excess Heat-Yang and prescribed Bai Hu Tang (White Tiger Decoction) plus Sheng Di Huang (Rehmanniae Radix), Mai Dong (Ophiopogonis Radix), and Hua Fen (Trichosanthis Radix); however, her mania worsened. Others believed that the Blood Chamber was empty postpartum, causing floating Yang to rise upwards, and prescribed Gui Fu Ba Wei Wan (Eight-Ingredient Pill with Cinnamon and Aconite) to guide fire back to its source. After taking this, she could sleep slightly, but upon waking, she remained startled, manic, and hallucinating, causing family panic. Examination revealed a deep, wiry, fine, and rapid pulse, and a dark-red tongue body. Urine was clear, stool was constipated, and there was restlessness, heat, and sweating. This was certainly due to retained lochia causing blood stasis leading to mania-like symptoms. Following Fu Qingzhu’s theory of "Defective Blood Attacking the Heart," I imitated his method of harmonizing blood and purging stasis, using An Xin Tang (Heart-Calming Decoction) with modifications. Quan Dang Gui (Angelicae Sinensis Radix) 30g, Zheng Chuan Xiong (Ligusticum Chuanxiong Rhizoma) 15g, Sheng Di Huang (Rehmanniae Radix) 10g, Su Fang Mu (Dalbergiae Odoriferae Lignum) 10g, Mu Dan Pi (Moutan Cortex) 10g, Sheng Pu Huang (Typhae Pollen) 6g, Qing He Ye (Nelumbinis Nymphaeae Folium) 1 piece. After 1 dose, mania ceased and fever subsided; after another dose, lochia flowed, and consciousness cleared.
(Medical Cases of Li Congfu)
[Commentary] This case was caused by retained lochia postpartum, where defective blood attacked the heart. Although the patient exhibited manic symptoms, the clear urine and thirst without desire to drink indicated this was not a Yangming Heat syndrome. Dr. Li used the method of harmonizing blood and purging stasis, with clear differentiation and decisive prescribing, resolving the mania in one dose. For milder cases, Sheng Hua Tang (Transformation and Production Decoction) could be used.
(XVII) Postpartum Tetany
Patient Qin XX, female, 20 years old. In autumn 1948, seven to eight days postpartum, she suffered from dizziness and blurred vision, unable to sit up. During the consultation, her fingers were observed twitching, followed by yawning, and her mouth opening wider and wider until the corners cracked and bled. Despite manual pressure to close it, it would not stop. Subsequently, her complexion became pale, eyes stared fixedly with saliva flowing, cold sweat appeared intermittently, and consciousness was clouded. The pulse was wiry, slow, and weak. Differentiation: New birth resulted in blood loss and Yin injury; excessive sweating injured Yang. Combined with external contraction, Wind entered the meridians and acupoints, triggering tetany, with signs of Yin exhaustion and Yang collapse. Therapeutic Method: Restore Yang and secure collapse, dispel Wind and calm spasms. Prescription: Decoct Gao Li Shen (Korean Ginseng Radix et Rhizoma) 15g urgently for administration. Half an hour later, there was slight improvement. Continue with Gua Lou Gui Zhi Tang (Trichosanthes and Cinnamon Twig Decoction) with modifications. Gao Li Shen 9g, Zhi Huang Qi (Astragali Radix, honey-fried) 30g, Gui Zhi (Cinnamomi Ramulus) 6g, Hang Shao (Paeoniae Radix Alba) 9g, Fu Pian (Aconiti Lateralis Radix Praeparata) 4.5g, Gua Lou Gen (Trichosanthis Radix) 12g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) 9g, Sheng Jiang (Zingiberis Rhizoma Recens) 9g, Da Zao (Jujubae Fructus) 5 pieces. Decoct in water, take 2 doses.
Second visit: After taking 2 doses, sweating gradually decreased, and after finishing 2 doses, convulsions alleviated. Only dizziness and fatigue remained, indicating that the exterior is secured and Yang has returned, but Yin-blood is still deficient. Prescribe a formula to nourish blood, calm spasms, and tonify both Qi and Blood. Prescription: Gua Lou Gui Zhi Tang combined with Si Wu Tang (Four Substances Decoction) with modifications: Zhi Huang Qi 30g, Dang Gui 9g, Gui Zhi 4.5g, Hang Shao 9g, Gua Lou Gen 9g, Sheng Di Huang 15g, Chuan Xiong 4.5g, Gou Teng (Uncariae Ramulus cum Uncis) 9g, Zhi Gan Cao 6g, Gao Li Shen 9g. After continuously taking several doses, dizziness lessened, and spirit gradually recovered.
(Medical Records of Xi Liangcheng)
[Commentary] This case involved new postpartum blood loss combined with excessive sweating, injuring both Yin and Yang, followed by external contraction. Wind entered the meridians and acupoints, causing tetany. Decocting Gao Li Shen greatly tonifies Yuan Qi, restores Yang, and secures collapse, promoting Yang generation and Yin growth. Gua Lou Gui Zhi Tang supports Yuan Qi, benefits Qi, dispels Wind, and calms spasms. At the second visit, the method of tonifying both Qi and Blood was incorporated, achieving good results. This treatment approach, prioritizing tonification with auxiliary expulsion of pathogens, is an important method for treating postpartum tetany.
(XVIII) Postpartum Fever
Case 1: Mrs. Yu, over 20 years old. Suffered from fever after a minor abortion. Diagnosis and treatment lasted half a year, with no effect from medication or injections. Symptoms worsened to include palpitations, night sweats, inability to get out of bed, and gradual emaciation. The pulse was wiry, floating, and weak. This condition resulted from contracting Wind-Cold after a minor abortion and neglecting treatment, dragging on to this state. Wanting to release the exterior risks endless night sweats; failing to release the exterior leaves the exterior syndrome unresolved. Use only the Harmonizing method, embedding the meaning of venting muscle-layer pathogens within non-releasing strategies to excrete pathogens, while clearing interior heat. Prescription: Yin Chai Hu (Stellariae Radix, vinegar-fried) 9g, Jiu Qin Jiao (Kadsurae Caulis, wine-processed) 6g, Hang Bai Shao (Paeoniae Radix Alba) 4.5g, Fen Dan Pi (Moutan Cortex) 6g, Di Gu Pi (Lycii Cortex) 6g, Jiu Huang Qin (Scutellariae Radix, wine-processed) 3g, Long Gu (Fossilia Ossis Mastodi) 3g, Mu Li (Ostreae Concha) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Cu Qing Hao (Artemisiae Annuae Herba, vinegar-fried) 1.5g. After 1 dose, fever reduced significantly; after 2 doses, cured.
(Compiled by Liang CIMing: Medical Cases of Jiang Wangbo, *Guangdong Medical Journal* 3:36, 1964)
Case 2: Patient Chen, postpartum fever with aversion to cold, dizziness, profuse sweating, thirst, supraorbital pain, palpitations, chest fullness, loss of appetite, dry retching with white foam upon eating. Tongue coating was thick and white. Right pulse was wiry and tight; left pulse was slightly floating. This was a new contraction of Wind-Cold. Because all vessels are empty postpartum, following Danxi’s theory that "postpartum requires major tonification of Qi and Blood; even if other syndromes exist, they are treated secondarily." Prescription: Dang Gui 15g, Chao Bai Shao (Paeoniae Radix Alba, stir-fried) 15g, Chuan Xiong 3g, Fu Shen 9g, Wei Sheng Jiang (Zingiberis Rhizoma Recens, baked) 9g, Zao Ren (Ziziphi Spinosae Semen) 12g, Xian Ou (Nelumbinis Rhizoma Recens) 60g, Ju Bing (Citri Reticulatae Pericarpium Conservatum) 30g, Tian Ma (Gastrodiae Rhizoma) 9g, Du Zhong (Eucommiae Cortex) 12g, Bu Gu Zhi (Psoraleae Fructus) 12g.
Second visit: Still experiencing chills, fever, and profuse sweating. Add Huang Qi (Astragali Radix) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 6g, Pao Gan Jiang (Zingiberis Rhizoma Preparatum) 9g to the previous formula. Remove Chuan Xiong, Tian Ma, and Wei Sheng Jiang. Take 2 consecutive doses. Chills and fever ceased, sweating stopped. Only mild pain around the umbilicus remained. Add Xiao Hui Xiang (Foeniculi Fructus) 3g, Zhi Gan Cao 3g. Pain resolved after taking.
(Medical Conversations of Shen Shaojiu)
Case 3: Patient Zhong XX, female, 24 years old. Delivered her first child normally at term on June 30, 1977. Three days postpartum, she consumed rich, fatty, and sweet foods excessively. That afternoon, she washed her hair and bathed. Suddenly, at night, she developed fever without aversion to cold, which she initially ignored. The next day, consciousness became dull, with high fever and delirium. Temperature reached 41.7°C and persisted. Hospitalized on July 5. Upon admission, temperature was 41.8°C, pulse 140 bpm, respiration 40 breaths/min. Blood pressure 100/70 mmHg. Consciousness was dull, presenting acute severe illness appearance. Internal and gynecological examinations showed no positive findings. Lochia pathogen culture and blood culture were negative. White blood cell count 18,500/mm³. Impression: Fever of unknown origin. From July 5 to July 23, multiple antibiotics, hormones, physical cooling measures, and TCM herbs such as Ma Xing Shi Gan Tang, Bai Hu Tang, Xi Jiao (Rhinocerotis Cornu), Bie Jia (Testudinis Carapax et Plastrum), and Qing Hao were used. Temperature remained between 40–41°C. At consultation, symptoms included fever, thirst, epigastric and abdominal distension and pain, vomiting, anorexia, belching with acid regurgitation, and inability to lie comfortably. Palpation revealed abdominal pain and tenderness (refusal to press). Tongue body was red with yellow coating. Pulse was wiry, slippery, and forceful. Differentiation: Food and Dampness obstructing the Middle Jiao, stagnating and generating heat. Therapeutic Method: Yue Ju Wan (Regulating Pills) combined with Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder), heavily using Liu Qu (Medicated Leaven). Avoid rich, sweet, raw, and cold foods. Prescription: Xiang Fu (Cyperi Rhizoma) 10g, Cang Zhu (Atractylodis Rhizoma) 10g, Zhi Ren (Gardeniae Fructus) 10g, Liu Qu 18g, Chuan Xiong 5g, Zhi Shi (Aurantii Fructus Immaturus) 6g, Bai Shao 10g, Chen Pi 5g, Sheng Jiang 3 slices. 3 doses.
July 26 Follow-up: After taking the above prescription, temperature dropped to 38°C, epigastric and abdominal distension/pain significantly reduced, able to eat small amounts. However, abdomen still tender to pressure, thirst persists. Tongue body pale red, pulse wiry and forceful. Remove Cang Zhu and Zhi Ren from previous formula. Add Dang Shen (Codonopsis Radix) 12g, Bai Zhu 10g, Shan Zha (Crataegi Fructus) 10g, Da Huang (Rhei Radix et Rhizoma) 6g, Hou Po (Magnoliae Officinalis Cortex) 10g. 3 doses.
July 28 Third visit: After taking the above prescription, temperature dropped to 37°C. Above symptoms basically disappeared, appetite increased, urination and defecation normal. (Medical Cases of Old TCM Physicians of Hunan Province, Medical Cases of Liao Zhongyi)
Case 4: Patient Sun XX, female, 35 years old. Due to cold and fever at 9 months of pregnancy, dizziness, liver area pain, clay-colored stools, scleral and skin jaundice. Induced labor on November 27, 1972, resulting in a stillborn male infant. Jaundice worsened postpartum. Few hemorrhagic spots appeared on limbs and trunk. Suspected "Subacute Hepatic Necrosis." Resuscitated with Chinese and Western medicines, condition critical. Developed psychiatric symptoms like manic laughter and crying. Temperature between 38–39°C, heart rate 120 bpm. Patient semi-comatose, jaw locked, convulsing, eyes rolled up, incontinence of urine and feces, yellow face and eyes, distended abdomen, white miliary rash covering chest, abdomen, and neck. Tongue coating white, tender, rotting-like, obscuring tongue body. Teeth dry. Left pulse fine and rapid; right pulse wiry, large, rapid, and weak. Differentiation: Pregnancy Damp-Warmth (Postpartum severe Qi and Blood deficiency, internal and external pathogens combining). Therapeutic Method: Acrid-cool clearing heat, bland-leaching draining dampness. Yi Yi Zhu Ye San (Coix and Lysimachia Powder) with modifications. Prescription: Yi Yi Ren (Coicis Semen) 24g, Fu Ling Kuai (Poria) 15g, Bai Kou Ren (Amomi Fructus Rotundus) 9g, Dan Zhu Ye (Lophatheri Herba) 9g, Chen Pi 9g, Jin Yin Hua (Lonicerae Japonicae Flos) 15g, Jing Lian Qiao (Forsythiae Fructus) 15g, Shi Chang Pu (Acori Tatarinowii Rhizoma) 18g, Shuang Gou Teng (Uncariae Ramulus cum Uncis) 9g, He Huan Pi (Albiziae Cortex) 30g, Shou Wu Teng (Polygoni Multiflori Caulis) 30g, Gan Cao 3g.
December 14 Second visit: After 6 doses, consciousness clearer, but still delirious. Temperature between 37–38°C. Postpartum Yin deficiency, Damp-Heat injuring Yin, leading to Water not nourishing Wood, presenting signs of Internal Stirring of Liver Wind. Prescription: Xi Yang Shen (Panacis Quinquefolii Radix) 4.5g (decocted separately), Bai Shao 9g, Gui Ban (Testudinis Carapax) 12g, Bie Jia 12g, Zhen E Jiao (Asini Corii Colla) 9g, Yi Yi Ren 24g, Mai Dong 9g, Zhu Ru (Bambusae Caulis in Taenia) 9g, Sheng Mu Li (Ostreae Concha, crushed) 12g, Wu Wei Zi (Schisandrae Chinensis Fructus) 4.5g, Sha Shen (Glehniae Radix seu Linderae Radix) 21g, Zhi Cao 4.5g.
December 16 Third visit: Patient's consciousness gradually cleared, jaundice lightened, rashes decreased. Temperature around 38°C, skin burning hot. Remove Xi Yang Shen from previous formula, add Jin Yin Hua, Lian Qiao, Fu Ling. Later, modifications included spleen-tonifying Shan Yao (Dioscoreae Rhizoma), Lian Zi (Nelumbinis Semen), and Yin-nourishing heat-clearing Shou Wu, Di Gu Pi, or adding Bian Dou (Dolichi Lablab Semen) for bland spleen-tonification. January 11, temperature normalized, appetite and bowel/bladder functions normal. Integrated Chinese and Western medicine throughout treatment. Discharged cured after two months.
(Medical Records of Xi Liangcheng)
Case 5: Wife of Mr. Deng, 24 years old. Suffered from latent heat after a minor abortion. Various treatments failed. Reviewing previous prescriptions, they contradicted the symptoms. Condition was critical. Husband sought emergency consultation. Pulse wiry and rapid, tongue red with white coating. Differentiation: Blood stasis accumulation causing pathology. Therapeutic Method: Originally suitable for Tao Ren Cheng Qi Tang (Persicae Semen and Magnolia Bark Decoction), but due to prolonged illness and patient weakness, fearing intolerance, modified to use Si Wu Tang (Four Substances Decoction) removing Di Huang, adding Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Rou Gui (Cinnamomi Cortex), and Vinegar-fried Da Huang (Rhei Radix et Rhizoma) for gentle purgation. Prescription: Gui Wei (Angelicae Sinensis Radix Tail) 4.5g, Chi Shao (Paeoniae Radix Rubra) 9g, Chuan Xiong 3g, Tao Ren 6g, Pian Hong Hua 3g, Zi Yao Gui (Cinnamomi Cortex) 1.5g, Cu Chao Sheng Chuan Jun (Vinegar-fried Raw Rheum) 1.5g. After 1 dose, passed large amount of black stool, pain reduced by 70-80%. After another dose, cured.
(Reprinted National Famous Doctors' Medical Cases Compilation, Medical Cases of Xiao Zhuoru)
Case 6: Patient Han, female, 28 years old. First visit date: April 19, 1975. Patient delivered on December 10, 1974. Previously suffered from external contraction with high fever. After fever subsided with TCM treatment, she frequently suffered insomnia, mental agitation, and perceived alternating chills and fever. For the past week, sleep was restless with chaotic dreams and visual hallucinations (seeing two figures, one black, one white, appearing at night and disappearing by day), hence afraid to turn off lights at night. Complained of headache, dizziness, irritability, occasional body heat and sweating, palpitations, timidity, nausea, chest and hypochondriac fullness, lower abdominal distension, short yellow urine, and amenorrhea. Tongue body red, pulse wiry. Differentiation: Postpartum external contraction, residual pathogens not fully cleared, Heat entering the Blood Chamber, disturbing the Spirit. Therapeutic Method: Harmonize Liver and Gallbladder, clear heat and calm spirit. Prescription: Chai Hu (Bupleuri Radix) 6g, Dang Shen 6g, Huang Qin 9g, Ban Xia 9g, Gan Cao 6g, Zhi Ke (Aurantii Fructus) 6g, Zhi Zi (Gardeniae Fructus) 9g, Lian Qiao 9g, Bai Shao 9g, Sheng Jiang 3 slices, Da Zao 3 pieces, Sheng Long Chi 30g, Dan Pi 6g.
Treatment Course: April 24, after 3 doses of the above prescription, symptoms alleviated, chills and fever subsided, able to sleep with lights off, hallucinations disappeared. Still had dizziness, nausea, poor appetite, chest/hypochondriac distension. Continued taking 3 doses. All symptoms resolved.
(Gynecological Experience of Liu Fengwu)
[Commentary] Postpartum fever occurs due to consumption of Yin-blood, emptiness of all vessels, and floating/scattering of Yang Qi. Causes are complex, but common ones include postpartum external contraction, postpartum Wind-stroke, Heat entering the Blood Chamber, and Blood deficiency. Qing Dynasty Shen Yaofeng stated: "Most postpartum fevers are due to Blood deficiency with Yang floating outward; some also have headaches. This is rising deficient Yang, cannot be mistaken for Stomach Cold, nor wrongly given dispersing agents to fan the flames. Only by subduing Yang and gathering Qi will Fire settle and heat resolve." He further pointed out that postpartum colds should not be treated with reckless dispersing: "...only harmonize Ying and Wei, be cautious with daily life, and contracted pathogens can resolve themselves" (see *Shen Shi Nu Ke Ji Yao Jian Zheng*). This is experiential wisdom with significant clinical reference value.
Case 1: Minor abortion complicated by Wind-Cold contraction. Jiang used the Harmonizing method, but the entire formula contained meanings of venting and clearing interior heat.
Case 2: Although postpartum cold with Wind-Cold, the formula lacked dispersing and clearing heat herbs. Shen recognized obvious Qi and Blood deficiency, treating first with tonifying Qi/Blood and harmonizing the Middle. Later, Sweet-Warm eliminating heat and Warming-Middle dispelling cold methods proved effective. Etiology combined with differentiation made the prescription fit perfectly.
Case 3: Pregnancy Damp-Warmth. Due to severe postpartum Qi/Blood deficiency, internal and external pathogens combined, severity was high. Initially used Acrid-Cool clearing heat and Bland-Leaching draining dampness. Later, Damp-Heat injured Yin, Water failed to nourish Wood, presenting Internal Liver Wind stirring. Changed to Yin-nourishing heat-clearing and Supporting Upright Softening Liver formula. Once temperature dropped, jaundice lightened, rashes decreased, finally concluded with Spleen-Stomach harmonizing and Yin-nourishing heat-clearing. The transformation of formulas throughout the case matched the pathogenesis precisely.
Cases 4 and 5: Both postpartum Heat entering the Blood Chamber. Case 4: Latent heat after minor abortion, critical condition. Originally a Tao Ren Cheng Qi Tang pattern. Xiao considered the patient "prolonged illness and weakness," adapted the intent of Tao Ren Cheng Qi Tang, using Si Wu Tang removing Di Huang, adding Warm-Meridian unblocking stasis herbs, focusing on resolving the conflict of Stasis-Heat binding. Herb combination was rigorous, reflecting the characteristic of "treating individuals according to their constitution" in Chinese medicine.
Case 6: Postpartum external contraction with residual pathogens, Heat entering Blood Chamber disturbing Spirit. Since stasis symptoms were not obvious, Liu used Harmonizing Liver/Gallbladder, Clearing Heat, Calming Spirit method, essentially a modification of Xiao Chai Hu Tang. Herb selection and modification matched the syndrome without superficiality.
(XIX) Postpartum Blood Bi
Patient Fang XX, female, 37 years old, worker. For four years, occasionally felt palpitations and shortness of breath. Symptoms worsened over two years, with four episodes of hemoptysis. This episode began on the tenth day postpartum. Suddenly felt right lower limb cold and swollen, with paroxysmal pain, lighter during day, heavier at night, unable to move. Examination: Right leg below knee felt cold, femoral and popliteal artery pulses not palpable. Pulse wiry, fine, with intermittent arrests (Jie Dai). Lips slightly purple, tongue edges had purple stasis spots, coating thin white. Diagnosed as Femoral Artery Embolism. Differentiation: Qi and Blood stasis, meridian blockage. Therapeutic Method: Tonify Qi and invigorate Blood, remove stasis and unblock collaterals. Prescription: Huang Qi 60g, Tao Ren, Hong Hua, Di Long, Chuan Niu Xi, Yuan Shen each 15g, Gui Wei, Chuan Xiong each 12g, Pu Huang, Wu Ling Zhi, Ru Xiang, Mo Yao, Shi Chang Pu each 9g, Gan Cao 3g, Su He Xiang 0.9g (dissolved and taken). Acupuncture Points: Wei Zhong, Cheng Shan, Yang Ling Quan, Zu San Li (Moxibustion).
Second visit: After taking 5 doses of previous formula, symptoms gradually reduced. Right lower limb felt warm, pain frequency and duration decreased. Increase Huang Qi in previous formula to 90g. After one month of treatment, pain disappeared, femoral artery pulse palpable, able to walk. Discharged after five weeks, continued TCM for recovery.
(Selected Medical Cases of Xing Xibo)
[Commentary] The disease name Blood Bi originally appears in *Ling Shu · Nine Needles*. The internal cause is Qi and Blood deficiency; external causes are commonly contracting Wind-Cold, or sweating from labor allowing Wind to invade deficiency, blocking Qi and Blood. This case occurred postpartum, where Qi and Blood deficiency is self-evident. Treated with Tonify Qi Invigorate Blood, Remove St Unblock Collateral method. Heavy use of Huang Qi strengthens Qi tonification, combined with stasis-removing pain-relieving herbs, possessing warming-unblocking efficacy. External to the prescription, acupuncture was combined, needle-drug integration yielded better results.
(XX) Postpartum Paralysis and Retention
Patient Fang XX, female, adult, married. Medical Record No. 20745