天津李氏妇，年近四旬，得产后下血证。
病因 身形素弱，临盆时又劳碌过甚，遂得斯证。
证候 产后未见恶露，纯下鲜血。屡次延医服药血终不止。及愚诊视，已二十八日矣。其
精神衰惫，身体羸弱，周身时或发灼，自觉心中怔忡莫支。其下血剧时腰际疼甚，呼吸常觉短
气，其脉左部弦细，右部沉虚，一分钟八十二至。
诊断 即此脉证细参，当系血下陷气亦下陷。从前所服之药，但知治血，不知治气，是以屡次
服药无效。此当培补其气血，而以收敛固涩之药佐之。
处方 生箭 （一两） 当归身（一两） 生怀地黄（一两） 净萸肉（八钱）
生龙骨（八钱捣碎） 桑叶（十四片） 广三七（三钱细末）
药共七味，将前六味煎汤一大盅，送服三七末一半，至煎渣再服时，仍送服其余一半。
方解 此乃傅青主治老妇血崩之方。愚又为之加生地黄、萸肉、龙骨也。其方不但善治老妇血
崩，即用以治少年者亦效。初但用其原方，后因治一壮年妇人患血崩甚剧，投以原方不效，
且服药后心中觉热，遂即原方为加生地黄一两则效。从此，愚再用其方时，必加生地黄一两，
以济黄 之热，皆可随手奏效。今此方中又加萸肉、龙骨者，因其下血既久，下焦之气化不能
固摄，加萸肉、龙骨所以固摄下焦之气化也。
复诊 服药两剂，下血与短气皆愈强半，诸病亦皆见愈，脉象亦有起色。而起坐片时自觉筋骨
酸软，此仍宜治以培补气血，固摄下焦气化，兼壮筋骨之剂。
处方 生箭 （一两） 龙眼肉（八钱） 生怀地黄（八钱） 净萸肉（八钱）
胡桃肉（五钱） 北沙参（五钱） 升麻（一钱） 鹿角胶（三钱）
药共八味，将前七味煎汤一大盅，鹿角胶另炖化兑服。方中加升麻者，欲以助黄 升补气分使之
上达，兼以升提血分使不下陷也。
三诊 将药连服三剂，呼吸已不短气，而血分则犹见少许，然非鲜血而为从前未下之恶露，此吉兆也。若
此恶露不下，后必为恙。且又必须下净方妥，此当兼用化瘀之药以催之速下。
处方 生箭 （一两） 龙眼肉（八钱） 生怀地黄（八钱） 生怀山药（六钱）
胡桃肉（五钱） 当归（四钱） 北沙参（三钱） 鹿角胶（四钱）
广三七（三钱细末）
药共九味，先将前七味煎汤一大盅，鹿角胶另炖化兑汤药中，送服三七末一半，至煎渣再服时，仍将
所余之鹿角胶炖化兑汤药中，送服所余之三七末。
方解 按此方欲用以化瘀血，而不用桃仁、红花诸药者，恐有妨于从前之下血也。且此方中原有
善化瘀血之品，鹿角胶、三七是也。盖鹿角之性原善化瘀生新，熬之成胶其性仍在。前此之恶露
自下，实多赖鹿角胶之力，今又助之以三七，亦化瘀血不伤新血之品。连服数剂，自不难将恶露尽化也。
效果 将药连服五剂，恶露下尽，病遂全愈。
A woman surnamed Li from Tianjin, approaching forty years of age, suffered from postpartum bleeding.
Etiology Her physique was inherently weak, and she exerted herself excessively during labor, thus contracting this syndrome.
Symptoms After childbirth, lochia (postpartum vaginal discharge) did not appear; instead, pure bright red blood was discharged continuously. Multiple physicians were consulted and medicines administered, yet the bleeding persisted. When I examined her, twenty-eight days had passed. Her spirit was exhausted and depleted, her body emaciated and weak, with occasional sensations of burning heat throughout the body, and palpitations that felt unbearable. During severe episodes of bleeding, she experienced intense pain in the waist region, and frequently complained of shortness of breath. Her pulse was wiry and fine on the left side, and deep and deficient on the right side, beating eighty-two times per minute.
Diagnosis Based on a careful analysis of these pulses and symptoms, it appears that the downward flow of blood has caused Qi to sink as well. The medicines previously taken only addressed the blood without treating Qi deficiency, which is why repeated treatments failed. At this stage, it is necessary to tonify Qi and Blood, assisted by herbs that astringe and consolidate.
Prescription Raw Astragali Radix (Sheng Huangqi) [Astragali Radix] (1 liang), Dang Gui Shen (Radix Angelicae Sinensis) (1 liang), Raw Rehmanniae Radix (Sheng Huai Dihuang) [Rehmanniae Radix] (1 liang), Clean Corni Fructus (Jing Yurou) [Corni Fructus] (8 qian), Raw Ossa Dragonis (Sheng Longgu) [Ossum Draconis] (8 qian, crushed), Mulbai Folium (Sangye) [Folium Mori] (14 leaves), Guang Sanqi (Rhizoma Notoginseng) (3 qian, finely powdered).
There are seven ingredients in total. Decoct the first six ingredients in a large cup of water. Take half of the Sanqi powder with the decoction. When decocting the dregs for the second dose, take the remaining half of the Sanqi powder with the liquid.
Formula Analysis This formula originates from Fu Qingzhu’s prescription for treating metrorrhagia in elderly women. I added Raw Rehmanniae Radix, Corni Fructus, and Ossum Draconis to it. This formula is effective not only for elderly women with metrorrhagia but also for younger patients. Initially, I used only the original formula. Later, when treating a robust middle-aged woman with severe metrorrhagia, the original formula proved ineffective and caused a sensation of heat in the heart after ingestion. Consequently, I added one liang of Raw Rehmanniae Radix to the original formula, which yielded results. Since then, whenever I use this formula, I invariably add one liang of Raw Rehmanniae Radix to counteract the heat of Astragali Radix, achieving immediate efficacy. In the current prescription, I further added Corni Fructus and Ossum Draconis because prolonged bleeding indicates that the Qi transformation in the Lower Jiao cannot be consolidated. These herbs are added to secure and consolidate the Qi transformation of the Lower Jiao.
Second Visit After two doses, both the bleeding and shortness of breath improved by more than half, other symptoms showed improvement, and the pulse condition began to recover. However, she felt soreness and weakness in the tendons and bones after sitting or standing for a short while. This still requires treatment with agents that tonify Qi and Blood, consolidate the Qi transformation of the Lower Jiao, and strengthen the tendons and bones.
Prescription Raw Astragali Radix (Sheng Huangqi) [Astragali Radix] (1 liang), Longan Arillus (Longyan Rou) [Arillus Longan] (8 qian), Raw Rehmanniae Radix (Sheng Huai Dihuang) [Rehmanniae Radix] (8 qian), Clean Corni Fructus (Jing Yurou) [Corni Fructus] (8 qian), Juglans Semen (Hutao Rou) [Semen Juglandis] (5 qian), Glehniae Radix (Beishashen) [Glehniae Radix] (5 qian), Cimicifugae Rhizoma (Shengma) [Rhizoma Cimicifugae] (1 qian), Cornu Cervi Gelatinum (Lujiaojiao) [Cornu Cervi Gelatinum] (3 qian).
There are eight ingredients in total. Decoct the first seven ingredients in a large cup of water. Melt the Cornu Cervi Gelatinum separately and mix it into the decoction before taking. Cimicifugae Rhizoma is added to assist Astragali Radix in ascending and uplifting Qi to the upper regions, and to lift Blood preventing it from sinking.
Third Visit After three consecutive doses, breathing was no longer short of breath, though slight bleeding remained. However, it was no longer bright red blood but rather the lochia that had not been discharged previously, which is an auspicious sign. If this lochia is not expelled, complications will likely arise later. It must be completely cleared to ensure safety. Therefore, blood-invigorating and stasis-resolving herbs should be used concurrently to accelerate its expulsion.
Prescription Raw Astragali Radix (Sheng Huangqi) [Astragali Radix] (1 liang), Longan Arillus (Longyan Rou) [Arillus Longan] (8 qian), Raw Rehmanniae Radix (Sheng Huai Dihuang) [Rehmanniae Radix] (8 qian), Raw Dioscoreae Rhizome (Sheng Huai Shanyao) [Dioscoreae Rhizoma] (6 qian), Juglans Semen (Hutao Rou) [Semen Juglandis] (5 qian), Angelicae Sinensis Radix (Dang Gui) [Radix Angelicae Sinensis] (4 qian), Glehniae Radix (Beishashen) [Glehniae Radix] (3 qian), Cornu Cervi Gelatinum (Lujiaojiao) [Cornu Cervi Gelatinum] (4 qian), Guang Sanqi (Rhizoma Notoginseng) (3 qian, finely powdered).
There are nine ingredients in total. First, decoct the initial seven ingredients in a large cup of water. Melt the Cornu Cervi Gelatinum separately and mix it into the herbal decoction. Take half of the Sanqi powder with this mixture. When decocting the dregs for the second dose, melt the remaining Cornu Cervi Gelatinum separately, mix it into the decoction, and take the remaining Sanqi powder with it.
Formula Analysis This formula aims to resolve blood stasis without using Tao Ren (Persicae Semen) or Hong Hua (Carthami Flos), fearing they might aggravate the previous bleeding. Moreover, the formula already contains herbs proficient at resolving stasis: Cornu Cervi Gelatinum and Sanqi. The nature of deer horn is inherently capable of resolving stasis and generating new tissue; this property remains even after being boiled into gelatin. The prior spontaneous discharge of lochia relied largely on the power of Cornu Cervi Gelatinum. Now, assisting it with Sanqi, another herb that resolves stasis without damaging new blood, several doses should suffice to completely dissolve the lochia.
Outcome After five consecutive doses, the lochia was completely discharged, and the illness was entirely cured.