Library

*Yijian Zhi* records: Du Ren treated the daughter-in-law of Hao Zhi. Four days after childbirth, she experienced convulsions (Chou Xu), upward staring of the eyes, and opisthotonos (back arching). Du Ren diagnosed it as Spasm Disease (Jing Bing) and prescribed Doudaizi Tang (Purple Soybean Decoction) and Duhuo Tang (Angelica Pubescens Decoction), resulting in a cure. During the Zhenghe era, my wife’s chamber gave birth. While still in bed, she suddenly suffered this condition; her head and feet bent backward to meet, nearly two chi apart. Her family was terrified. Several maids tried forcibly to straighten her body but failed. Recalling the previous case I had read, and finding Duhuo (Radix Angelicae Pubescentis) in my medicine pouch, I hastily prepared it for her. Before the doctor arrived, three doses were administered consecutively, allowing her body to straighten. By the time the doctor arrived, she had recovered, and there was no need to use Doudaizi Tang. Ancient physicians’ prescriptions were often miraculously effective.

A postpartum woman presented with lockjaw (trismus), opisthotonos, limb convulsions, and continuous blinking of the eyes. Xue Lizhai attributed this to excessive blood loss, deficiency of Yuan Qi (Original Qi), and flourishing Yin Fire (Yin Huo). He used Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) with Pao Jiang (Prepared Ginger). After one dose, she regained consciousness; after several more doses, she stabilized.

Wei Yun stated: Xue Lizhai treats convulsions mainly with strong warming and tonifying methods. The previous case treated Wind. It seems convulsions vary in severity.

Yu Zhen commented: There is no need to distinguish severity; one must examine the locality and season. If Xue’s case clearly states excessive blood loss, there would be no reason to use Duhuo.

Zhu Danxi treated a postpartum woman, over thirty years old. In January, more than ten days after delivery, her left foot and left hand twitched. She suffered from asthma-like breathing, insomnia, a blackish complexion, and foul breath. Her pulse was floating and wiry yet deep and choppy, more pronounced on the right side. Suspecting dampness invasion, he asked and learned that for three months before delivery, she frequently enjoyed soups and tea. He prescribed Huangqi (Radix Astragali), Jingjie (Herba Schizonepetae), Muxiang (Radix Aucklandiae), Huashi (Talcum), Cangzhu (Rhizoma Atractylodis), Baizhu (Rhizoma Atractylodis Macrocephalae), Binglang (Semen Arecae), Chenpi (Pericarpium Citri Reticulatae), Chuanxiong (Rhizoma Chuanxiong), Gancao (Radix Glycyrrhizae), and Shaoyao (Radix Paeoniae Alba/Rubra). After four doses, Taoren (Semen Persicae) was added. After another four doses, borborygmus was heard, and numerous large stools resembling crystal blocks, sized like chicken egg yolks or tadpoles, were discharged, curing the illness. Then, Jingjie, Binglang, and Huashi were removed, and Danggui (Radix Angelicae Sinensis) and Fuling (Poria) were added to regulate the blood. After forty doses, she stabilized.

Yu Zhen commented: Twitching of the left foot and hand suggests Liver Meridian Blood Dryness generating Wind. Asthma, insomnia, blackish face, and foul breath suggest Blood Stasis entering the Lung, a critical condition. Floating and wiry pulses are easy to identify, but deep and choppy ones are difficult. Many find themselves at a loss in such situations. Only Zhu Danxi could diagnose dampness and prescribe such herbs. In contrast, the following Xue Lizhai case has some logical basis to follow.

A woman presented with convulsions and urinary incontinence, spontaneous sweating, flushed face, and occasionally a bluish complexion. Her diet remained normal. Her Liver pulse was wiry and tight. Xue Lizhai said: This is Liver Meridian Blood Dryness causing Wind-Heat Convulsions. The Liver governs urination, its color is green, and if it enters the Heart, the face turns red. The treatment should nourish Yin and Blood and clear Liver Fire. He used Jiawei Xiaoyao San (Modified Free Wanderer Powder). Within a few doses, all symptoms subsided.

Sun Dongsu treated the daughter-in-law of Grand Marshal Pan, aged twenty-five. She was constitutionally weak and spoke with dignity and caution. Due to difficult labor and exertion, followed by disappointment over giving birth to a girl, and later grief over the girl's death, she suddenly fainted. Upon waking, her mind was confused, limbs convulsed, making pulse diagnosis impossible, and her eyes stared upward. Detailed inquiry revealed that since the baby was born, lochia had completely ceased. A female physician had been indiscriminately administering chewed Ginseng, Dushen Tang (Single Ginseng Decoction), and porridge. The Ginseng and porridge caused stagnation above the diaphragm, leading to unconsciousness and persistent convulsions. Sun instructed her to induce vomiting by probing the throat with her fingers. Fortunately, phlegm, fluids, porridge, and medicine were vomited out, filling a basin, and the convulsions stopped. He then prescribed Chuanxiong, Shanzha (Fructus Crataegi), Zelan Ye (Herba Lycopi), Chenpi, Banxia (Rhizoma Pinelliae), Fuling, and Xiangfu (Rhizoma Cyperi) for her to take. She slept slightly. Unexpectedly, the female physician privately gave her two doses of tonics. Between Zi and Chou hours (11 PM - 3 AM), she suddenly became manic, acting as if possessed, speaking official Mandarin fluently, with a loud voice, very different from usual. Her family believed spirits had possessed her and prayed extensively. Sun said: This is incomplete expulsion of lochia, a condition of Blood Stasis resembling seeing ghosts, not actual possession. He prescribed Danggui Wei (Tail of Radix Angelicae Sinensis) 4 qian, Chuanxiong 1.5 qian, Zelan Ye, Yimucao (Herba Leonuri), and Huashi, decocted and mixed with hot Tongbian (Child Urine). After drinking two doses, the mania subsided slightly but did not disappear. He surmised there must be residual Phlegm causing stagnation in the chest, and the previous prescription lacked guiding or assisting herbs, so the medicinal power did not act effectively. He greatly increased Shanzha as a guide. As lochia began to flow, her mind quieted. Later, she slept briefly, moved her limbs slightly, touched her face with her hands, or pounded her chest, remaining confused. Her pulse was near-deficient. Her face was red and bright in the morning, but white during Shen and You hours (3 PM - 7 PM). This indicated Blood movement and Fire retreat, so the deficient pulse warranted tonification. He prescribed Ginseng, Chuanxiong, and Zelan Ye each 1 qian, Danggui and Shanzha each 2 qian, Fuling and Chenpi each 0.8 fen, and a piece of Juan Heye (Rolled Lotus Leaf), decocted and mixed with Hupo Mo (Powder of Amber) 0.5 fen. After taking it, she belched twice. Sun rejoiced, saying: This indicates Clear Yang ascending and Turbid Yin descending. From then on, she was calm, lochia flowed, bowels moved, and she requested porridge.

Yu Zhen commented: The treatment in the first half of this case is not difficult because the history of mixed Ginseng and porridge intake naturally calls for formulas resolving stasis and digesting food/phlegm. However, the induced vomiting method is particularly swift. "Blood Stasis resembling seeing ghosts" is known to many. The difficulty lies in the second half: after slight lochia flow and mental quieting, brief sleep leads to persistent confusion, still showing signs of Blood Stasis. Yet, within a mild formula resolving stasis, Ginseng is used again, without fear of repeating past errors due to previous misuse. This demonstrates high skill. His analysis of pulse and facial color is excellent. However, one must know that postpartum delirium and mania can also be purely caused by Phlegm.