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Yu Jiayan treated the wife of Gu Yiye. It was midsummer, and she had been pregnant for five months. She occasionally experienced vaginal bleeding. Physicians used Ren Shen (Ginseng Radix) and E Jiao (Donkey-hide Gelatin) to tentatively secure the fetus. A month later, her body became swollen and distended with Qi, blood rushed upward in rebellion, and stagnation gathered between the epiglottis and the chest-diaphragm region. As soon as food or drink entered, it caused pain upon contact; defecation became extremely difficult, and any slight effort resulted in vomiting out every grain of food, resembling a complete case of dysphagia (Yi Zheng). Several other physicians were consulted, all believing this was fetal Qi rebelling upward, spleen deficiency causing edema, which evolved into Ge Ye (diaphragmatic obstruction). They treated it using the tonifying properties of Ren Shen (Ginseng Radix) and the astringent properties of Wu Wei Zi (Schisandrae Fructus). By the time of the White Dew solar term, the pregnancy had reached eight months, yet the condition became critically dangerous, with breathing nearly ceasing. Only then was Yu Jiayan invited to diagnose. Her pulse at the Chi position was faint, choppy, and difficult to palpate, while the Lung pulse alone was excessively flooding and boundless. Her wheezing sound resembled sawing wood; her arms were cyanotic, swollen, shiny, and discolored like bruises. Yu Jiayan exclaimed in shock, "Such a ominous syndrome—why did you not consult earlier? Fortunately, I still have effective medicines that can unblock the lower closure and upper congestion." Jiye insisted on knowing the disease name. Yu said, "The 'upper congestion' is indicated by the flooding Lung pulse combined with the blockage at the epiglottis, suggesting the lungs are developing an abscess. The 'lower closure' is indicated by the faint and choppy Chi pulse combined with the cyanotic and swollen skin color, indicating the fetus has been dead for a long time. The 'effective medicine' refers to Xie Bai San (White-Draining Powder) added with Ku (bitter) herbs like Huang Qin (Scutellariae Radix) and Jie Geng (Platycodonis Radix) to open the blockage, without using harsh purgatives like Xiao Shi (Natrii Sulfas) or Da Huang (Rhei Radix et Rhizoma)." After taking two large doses, abdominal pain immediately intensified, and several dou of white, pus-like discharge were passed, expelling the putrefied fetus. The chest-diaphragm region immediately opened up, allowing continuous consumption of congee. However, chills, fever, and cough persisted. More than ten days later, after the white discharge ceased, sudden severe generalized edema and terrifying wheezing occurred. Treatment focused primarily on clearing the Lungs, resulting in complete recovery.

Zhen's commentary: This case originated from Lv Cangzhou. Lv Cangzhou treated a concubine of Jingli Hasan, who suffered from asthma so severe she could not lie flat. The majority treated it as Wind-Evil invading the Lungs. Lv diagnosed that the Qi Kou pulse was exclusively strong, the Jue Yin pulse was wiry, rapid, and quick, while both Chi pulses were short and deviated from the normal meridian pattern (Li Jing Mai). He stated, "This results from toxic drugs disturbing the blood, causing fetal death and retention, with Qi and Blood rushing upward in rebellion. It is not asthma caused by Wind-Cold." He used Cui Sheng Tang (Labor-Delivery Decoction) added with Xiong Duan (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix), prepared as a large dose. At midnight, a dead fetus was indeed expelled, and the asthma stopped immediately. Hasan subsequently informed his mother-in-law that there had indeed been a pregnancy; jealous of the main wife, the concubine had been administered drugs to terminate it. This fact was unknown to the public.