吴茭山治一少妇。初产四日。食冷物。觉身分不快。呕逆。饮食少思。心腹满闷。时或
腹胁刺痛。晨恶寒。晚潮热。夜则恍惚谵语。昼则抽搐。颇类风状。变异多端。诸医莫测。
或作虚风。或云血凝实热。用甘温行血。以寒凉退热。如此半月不效。吴至。见医满座。亦
局。诊其脉弦而紧。遂令按之。小腹急痛。知瘀血未尽也。思患者大势恶露已下。未必还
有余血。偶因寒凉所伤。瘀血停滞下焦。日久客于经络。所以变生诸证。须得大调经散。倍
入琥珀化诸恶血成水。其患方愈。遂合前药服之。五日后。行恶水斗许。臭不可近。患人觉
倦。病势渐减。然后以人参养荣汤数十帖。月余如初。
一妇产后恶露未尽。因起抹身。寒气客于经络。乍寒乍热。脉紧而弦。以葱白散。二帖
而安。
立斋治一产妇。恶寒发热。欲以八珍加炮姜治之。其家知医。以为风寒。用小柴胡汤。
薛曰。寒热不时。乃气血虚。不信。仍服一剂。汗出不止。谵语不绝。烦热作渴。肢体抽搐
薛用十全大补二剂。益甚。脉洪大。重按如无。仍以前汤加附子数剂。稍缓。再服而安。
震按前二案。以脉弦而紧知为瘀血。此案以脉洪大。重按如无。知为气血两虚。是真临
证指南也。但首案必须大调经散。次案必须葱白散。决非通套行血消瘀所能治。此案必须桂
附。亦非平补气血所能治。
Wu Jiaoshan treated a young woman. Four days after her first childbirth, she consumed cold food and felt unwell, experiencing nausea, vomiting, loss of appetite, fullness and distension in the heart and abdomen, and occasional stabbing pain in the abdomen and hypochondrium. She experienced chills in the morning and tidal fever in the evening, with delirium at night and convulsions during the day, resembling wind-stroke (Zheng Feng) with varied manifestations. Other physicians were unable to diagnose the condition accurately. Some attributed it to deficiency-wind (Xu Feng), while others claimed it was blood stasis with excess heat, using sweet-warm herbs to move blood and cold-cool herbs to clear heat. After half a month of such treatment, there was no effect.
When Wu arrived, he found the consulting room crowded with doctors, feeling somewhat constrained. He palpated her pulse, which was wiry (Xian) and tight (Jin). He instructed her to press on her lower abdomen, revealing acute tenderness, and concluded that lochia (E Lu) stasis remained incomplete. Considering that the main flow of lochia had already been discharged, residual blood might not be significant; however, due to injury from cold-cool substances, blood stasis had stagnated in the Lower Jiao (Lower Burner) and lingered in the meridians over time, generating various symptoms. He prescribed Da Tiao Jing San (Great Menstruation Regulating Powder), doubling the dosage of Hupo (Amber) to transform the pathological blood into fluid, so that the patient could recover. The prescribed medicine was taken together. Five days later, the patient passed about one dou (a unit of volume) of foul-smelling dark fluid. Feeling fatigued, her condition gradually improved. Subsequently, she took dozens of doses of Renshen Yang Rong Tang (Ginseng Nourishing Qi and Blood Decoction), and within more than a month, she returned to normal health.
Another postpartum woman had incomplete lochia discharge. Due to getting up to wipe her body, cold pathogenic factors invaded the meridians, causing alternating chills and fever with a tight and wiry pulse. She was treated with Cong Bai San (Scallion White Powder), and recovered after two doses.
Xue Lizhai treated a postpartum woman suffering from aversion to cold and fever. He initially intended to treat her with Bazhen Tang (Eight Treasures Decoction) plus Pao Jiang (Prepared Ginger). However, her family, who understood medicine, believed it was Wind-Cold (Feng Han) and administered Xiao Chai Hu Tang (Minor Bupleurum Decoction). Xue stated, "Irregular chills and fever indicate deficiency of Qi and Blood." The family did not believe him and continued with one dose of Xiao Chai Hu Tang. Consequently, she suffered from profuse sweating, continuous delirium, irritability, fever, thirst, and limb convulsions.
Xue then used Shiquan Dabu Tang (Ten Significant Tonifying Decoction) for two doses, but the condition worsened. Her pulse became surging (Hong Da) yet empty upon heavy pressure. He reverted to the previous formula (implied context suggests modification or specific application, though text says 'previous soup') adding Fuzi (Aconite Root) for several doses. Her condition slightly stabilized, and she recovered after further administration.
Zhen noted: In the first two cases, the wiry and tight pulse indicated blood stasis; in this case, the surging pulse that feels empty upon deep pressure indicated dual deficiency of Qi and Blood. This serves as a true guide for clinical practice. However, the first case required Da Tiao Jing San, and the second required Cong Bai San; neither could be treated by generic blood-moving and stasis-resolving methods. This case required Guizhi (Cinnamon Twig) and Fuzi; it could not be treated by mild Qi and Blood tonification.