天津董姓妇，年三十四岁，怀妊，感受温病兼有痰作喘。
病因 受妊已逾八月，心中常常发热。时当季春，喜在院中乘凉，为风袭遂成此证。
证候 喘息有声，呼吸迫促异常，昼夜不能少卧，心中烦躁。舌苔白浓欲黄。左右寸脉皆洪
实异常，两尺则按之不实，其数八至。大便干燥，小便赤涩。
诊断 此证前因医者欲治其喘，屡次用麻黄发之。致其元气将脱，又兼外感之热已入阳明。其
实热与外感之气相并上冲，是以其脉上盛下虚，喘逆若斯迫促，脉七至即为绝脉，今竟
八至恐难挽回。欲辞不治而病家再三恳求，遂勉为拟方。以清其热，止其喘，挽救其气化之将脱。
处方 净萸肉（一两） 生怀地黄（一两） 生龙骨（一两捣碎） 生牡蛎（一两捣碎）
将四味煎汤，送服生石膏细末三钱，迟五点钟若热犹不退。
煎渣再服，仍送服生石膏细末三钱。
复诊 服药头煎次煎后，喘愈强半，遂能卧眠，迨至黎明胎忽滑下，且系死胎。再诊其脉较前
更数，一息九至，然不若从前之滑实，而尺脉则按之即无。其喘似又稍剧，其心中烦躁依旧，且觉
怔忡，不能支持。此乃肝肾阴分大亏，不能维系阳分而气化欲涣散也。当峻补肝肾之阴兼清外感未尽之余热。
处方 生怀山药（六两） 玄参（两半） 熟鸡子黄（六个捻碎） 真西洋参（二钱捣为粗末）
先将山药煎十余沸，再入玄参、鸡子黄煎汤一大碗，分多次徐徐温饮下。每饮一次，送服洋参
末少许，饮完再煎渣取汤接续饮之，洋参末亦分多次送服，勿令余剩。
三诊 翌日又为诊视，其脉已减去三至为六至，尺脉按之有根，知其病已回生。问其心中已不
怔忡，惟其心中犹觉发热，此非外感之热，乃真阴未复之热也。当纯用大滋真阴之品以复其阴。
处方 玄参（三两） 生怀山药（两半） 当归（四钱） 真西洋参（二钱捣为粗末）
将前三味共煎汤一大碗，分多次温饮下。每饮一次送服洋参末少许。
四诊 前方服一剂，心中已不觉热，惟腹中作疼，问其恶露所下甚少，当系瘀血作疼。治以化瘀
血之品，其疼当自愈。
处方 生怀山药（一两） 当归（五钱） 怀牛膝（五钱） 生鸡内金（二钱黄色的捣）
桃仁（二钱） 红花（钱半） 真西洋参（二钱捣为粗末）
将前六味共煎汤一大盅，送服洋参末一半，至煎渣服时再送服余一半。
效果 前方日服一剂，服两日病遂全愈。
或问 他方用石膏皆与诸药同煎，此证何以独将石膏为末送服？答曰∶石膏原为石质重坠之品，
此证之喘息迫促，呼吸惟在喉间，分毫不能下达，几有将脱之势。石膏为末服之，欲借其重坠之力以
引气下达也。且石膏末服，其退热之力一钱可抵半两，此乃屡经自服以试验之。而确能知其如斯，此证一
日服石膏末至六钱，大热始退。若用生石膏三两，同诸药煎汤，病家将不敢服，此为救人计，不
得不委曲以行其术也。
或问 产后忌用寒凉，第三方用于流产之后，方中玄参重用三两，独不虑其过于苦寒乎？答曰∶玄
参细嚼之其味甘而微苦，原甘凉滋阴之品，实非苦寒之药。是以《神农本草经》谓其微寒，善治产乳
余疾，故产后忌用凉药而玄参则毫无所忌也。且后世本草谓大便滑泻者忌之，因误认其为苦寒也。而
此证服过三两玄参之后，大便仍然干燥，则玄参之性可知矣。
或问 此证之胎已逾八月，即系流产，其胎应活，何以产下竟为死胎？答曰∶胎在腹中，原有
脐呼吸，实借母之呼吸以为呼吸，是以凡受妊者其吸入之气，可由任脉以达于胎儿脐中。此证因吸入
之气分毫不能下达，则胎失所荫，所以不能资生也。为其不能资生，所以下降，此非因服药而下降也。
A woman surnamed Dong from Tianjin, aged thirty-four, was pregnant and contracted a warm disease (Wen Bing) accompanied by phlegm-induced wheezing.
Etiology She had been pregnant for over eight months and frequently experienced heat in the heart region. It was late spring, and she liked to enjoy the cool air in the courtyard. An invasion of wind pathogen led to this condition.
Symptoms Wheezing with audible sounds, extremely rapid and forced breathing, unable to lie down even slightly during day or night, irritability and restlessness in the heart region. The tongue coating is white, thick, and turning yellow. Both cun positions of the left and right pulses are excessively surging and full. The chi positions feel empty upon pressure, with a rate of eight beats per respiration. Dry stool, red and difficult urination.
Diagnosis Previously, physicians attempted to treat her wheezing by repeatedly using Ephedrae Herba (Mahuang, 麻黄) to induce sweating. This caused her primordial qi to be on the verge of collapse, and the external heat had entered the Yangming channel. The internal excess heat combined with the external pathogenic qi to rush upward, resulting in an upper-excess and lower-deficient pulse pattern. Consequently, the wheezing and rebellious qi were so rapid and forced. A pulse rate of seven beats per respiration is considered a terminal pulse; now reaching eight beats, it is feared that recovery may be difficult. Intending to decline treatment due to the poor prognosis, but urged by the family's repeated pleas, I reluctantly prescribed a formula to clear heat, stop wheezing, and salvage the collapsing qi transformation.
Prescription Clean Corni Fructus (Yurou, 山茱萸) 1 liang, Raw Rehmanniae Radix Preparata (Sheng Huai Dihuang, 生怀地黄) 1 liang, Raw Longgu (Longgu, 龙骨) 1 liang (crushed), Raw Muli (Muli, 牡蛎) 1 liang (crushed). Decoct these four herbs and take the decoction while swallowing 3 qian of fine powder of Raw Gypsum Fibrosum (Sheng Shigao, 生石膏). If the heat persists after five hours, decoct the dregs again and take them, still swallowing 3 qian of Raw Gypsum Fibrosum powder.
Second Visit After taking the first and second decoctions, the wheezing improved by more than half, allowing her to lie down and sleep. At dawn, the fetus slipped out spontaneously, but it was a dead fetus. Re-palpation showed the pulse was faster than before, nine beats per respiration, but no longer slippery and full as before; the chi pulse vanished upon pressure. The wheezing seemed slightly worse, irritability persisted, and she felt palpitations and exhaustion. This indicates severe deficiency of Liver and Kidney Yin, failing to anchor Yang, leading to impending dispersion of qi transformation. Treatment should vigorously tonify Liver and Kidney Yin while clearing residual external heat.
Prescription Raw Dioscoreae Rhizome (Sheng Huai Shanyao, 生怀山药) 6 liang, Scrophulariae Radix (Xuanshen, 玄参) 1.5 liang, Cooked Egg Yolk (Shu Jizi Huang, 熟鸡子黄) 6 pieces (mashed), Genuine American Ginseng (Zhen Xiyangshen, 真西洋参) 2 qian (coarsely powdered). First, decoct the Yam for about ten boils, then add Scrophulariae Radix and Egg Yolk to decoct into one large bowl. Drink slowly and warmly in multiple doses. Each time drinking, swallow a small amount of American Ginseng powder. After finishing, decoct the dregs again to continue drinking, dividing the American Ginseng powder into multiple doses to ensure none remains.
Third Visit The next day, the pulse rate decreased by three beats to six per respiration, and the chi pulse had root upon pressure, indicating recovery. She reported no more palpitations, only feeling heat in the heart region. This is not external heat, but heat from unrecovered True Yin. Treatment should purely use substances that greatly nourish True Yin to restore Yin.
Prescription Scrophulariae Radix (Xuanshen, 玄参) 3 liang, Raw Dioscoreae Rhizome (Sheng Huai Shanyao, 生怀山药) 1.5 liang, Angelicae Sinensis Radix (Danggui, 当归) 4 qian, Genuine American Ginseng (Zhen Xiyangshen, 真西洋参) 2 qian (coarsely powdered). Decoct the first three herbs into one large bowl, drink warmly in multiple doses. Swallow a small amount of American Ginseng powder with each dose.
Fourth Visit After one dose of the previous prescription, the heart heat subsided, but abdominal pain occurred. Lochia discharge was scant, suggesting pain due to blood stasis. Treatment should focus on resolving blood stasis, which should alleviate the pain.
Prescription Raw Dioscoreae Rhizome (Sheng Huai Shanyao, 生怀山药) 1 liang, Angelicae Sinensis Radix (Danggui, 当归) 5 qian, Achyranthis Bidentatae Radix (Huai Niuxi, 怀牛膝) 5 qian, Raw Endothelium Corneum Gigeriae Galli (Sheng Jineijin, 生鸡内金) 2 qian (yellow part crushed), Persicamiae Semen (Taoren, 桃仁) 2 qian, Carthami Flos (Honghua, 红花) 1.5 qian, Genuine American Ginseng (Zhen Xiyangshen, 真西洋参) 2 qian (coarsely powdered). Decoct the first six herbs into one large cup. Take half the American Ginseng powder with the initial decoction, and the remaining half with the dregs decoction.
Outcome Taking one dose daily, the disease was completely cured after two days.
Interrogation: In other prescriptions, Gypsum Fibrosum is decocted with other herbs. Why was it used as a powder for this case? Response: Gypsum Fibrosum is naturally heavy and sinking. In this case, the wheezing was so forced that respiration remained only in the throat, unable to descend, nearing collapse. Using it as a powder aims to utilize its heavy, sinking property to guide Qi downward. Moreover, powdered Gypsum Fibrosum is potent; one qian is equivalent to half a liang in heat-clearing effect, verified by my own trials. In this case, up to 6 qian of powder were taken daily before the high fever subsided. If 3 liang of raw Gypsum Fibrosum were decocted, the family might refuse to administer it. To save the patient, compromise in method was necessary.
Interrogation: Cold and cooling herbs are contraindicated postpartum. The third prescription used 3 liang of Scrophulariae Radix after miscarriage. Is there no concern regarding its excessive bitter-cold nature? Response: Scrophulariae Radix tastes sweet and slightly bitter when chewed; it is inherently sweet-cool and Yin-nourishing, not truly bitter-cold. Thus, *Shennong Bencao Jing* states it is slightly cold and effective for postpartum disorders. While cold herbs are generally avoided postpartum, Scrophulariae Radix is an exception. Later materia medica warns against its use in loose stools due to mistaken belief in its bitter-cold nature. However, in this case, after taking 3 liang, the stool remained dry, confirming its nature.
Interrogation: The fetus was over eight months old; even if miscarried, it should have survived. Why was it dead? Response: The fetus breathes via the umbilicus, relying on the mother's respiration. In pregnancy, inhaled Qi reaches the fetal umbilicus through the Ren Mai. In this case, inhaled Qi could not descend, depriving the fetus of nourishment and protection, leading to death. The descent was due to lack of nourishment, not caused by the medication.