子 肿
杨××,女,廿八岁,干部。1971年10月。
初诊:妊娠产期已过旬日,夜间烦躁,胎动不安,小便短少,体重骤增,血压高达200/100毫米汞柱,行动迟缓笨拙。近一周来,更觉头眩、眼花、面足浮肿,腰楚腹坠。已住某医院用催产、利尿、降压等药物,症状未减。脉息轻按滑数,重取弱,舌苔薄白有津。此属子肿,系由妊娠血虚,胞脉气滞,水湿遏阻。法当利水消肿,松气滑胎为治。处方:
带皮茯苓24克 大腹皮9克 广陈皮6克 炒枳壳6克 老
苏梗9克 木通9克 当归15克 川芎6克 白通草3克
柞枝木15克 生龟板15克
二诊:上方连用二剂,小便转频,量多,胎动加剧,至第三日清晨,即顺产一孩。产后浮肿减退,血压降至150/90毫米汞柱。自觉头昏神倦,少腹时痛,恶露量少、有块,色暗红。脉弦缓,舌白润。续拟下方清理:
当归15克 川芎6克 茯苓15克 桃仁4.5克 川红花3克
益母草9克 桑寄生12克黑荆芥4.5克 生甘草3克 红
糖炒山楂9克
三诊:上方服三剂,浮肿全消,恶露已尽,腹痛止,血压稳在130/90毫米汞柱。食眠.二便正常,只精神未复,脉缓和,舌润。再拟下方调理数剂而愈。处方;
生口芪12克 全当归12克 漂白术9克 茯苓15克 广陈
皮6克西砂仁6克淮山药12克生甘草3克小红枣11枚
炒苡仁15克 桑寄生12克
[按]妊娠血虚,水湿遏阻,胞脉气滞,致过期不产,变症丛生。法拟利水消肿,松气滑胎,中加养血之品,为因势利导,标本兼顾,深见气血互用之要领。
滑 胎
苏××,女,二十九岁,某厂职工。1963年。
初诊:患者结婚八年,曾怀孕三次均先期流产。现又妊娠五月,因恶阻,脾胃失调,食少神倦。一日劳累,发生腰楚腹坠,漏红色鲜,胎动不安。且气短,心悸,头晕,泛恶,动则汗出,思睡而不能入寐,小便频数。诊脉寸滑无力,关濡,尺部细微,舌自少津。此因气血两亏,肝肾冲任不固,有滑胎之兆。宜温固气血,调摄冲任。处方:
生口芪24克 当归15克 阿胶珠15克 炒艾炭6克 菟丝
子15克千张纸9克炙甘草3克炮姜炭6克炙升麻2.4克
小红枣11个 煅龙骨12克
二诊:上方服二剂,漏红渐少,夜能安卧,腰楚腹坠已减。胎动未安,气短溺频,自汗眩晕。脉象较前稍起,舌淡润。仍以固气养血,安胎为法。拟方;
苏条参15克 生口芪24克当归15克茯神15克炒白术12克
广陈皮6克炒艾炭6克阿胶珠15克桑寄生15克菟丝
子15克炮姜6克 小红枣11个 枯芩炭2.4克 炙甘草3克
三诊:上方连进五剂,漏红已止,胎动渐安。余症均减,饮食增加。舌红润,脉滑缓。此冲任胎元调固。续以滋养培补之剂。处方:
黄芪15克 当归身15克炒杭芍9克茯神15克桑寄生15克
菟丝子12克 枯芩2.4克 炒白术9克 炙甘草3克 莲
子15克 桂圆11枚 小红枣11枚
常服上方,病痊愈,足月后,产一女。
[按]肝肾素虚,封藏失职,冲任损伤,致累孕累坠。此乃劳逸失常,且恶阻伤脾,中阳不举。恐胎元所系,复致流产,故玄法重在补气固摄,充实内脏,达安胎之的。
产后胞衣不下
杨××,女,三十岁,昆明市郊区。1941年3月。
初诊:因分娩第六胎时间过长,胎儿下后,流血过多,胞衣留滞,急延余往诊。症见少腹剧痛,面色灰白,汗出淋漓,呼吸迫促。脉芤,舌淡红,苔薄白而腻。此属冲任虚损,气滞血瘀所致。病情危急,速拟下方:
当归30克川芎9克怀牛夕9克瞿麦12克芒硝6克通草6克
浮麦12克 小枣10枚 王不留行9克 点童便一小杯为引
药后一时许,患者自觉腹中绞痛阵作,顷刻,胞衣即下,恶露畅行,腹痛顿减,汗出渐收。得安卧,思饮食。脉仍芤,舌转红润。得宜调理气血,温经化瘀。处方:
当归24克 川芎6克 益母草9克 红糖炒山查9克 桃仁
泥4.5克藏红花3克炒续断9克 生炒蒲黄各4.5克 炮
姜6克小枣10枚
上方服二剂,腹痛渐止,恶露已少,面色转润。脉和缓,舌粉红,再拟调理冲任气血。
生口芪15克全当归15克炒杭芍9克茯神15克淮药12克
益母草6克 炒续断9克 桑寄生12克 生甘草3克 炒蒲
黄6克炮姜4.5克小枣10枚
[按]胞衣留滞,症情危急,在黑暗的旧社会,对妇女威胁尤甚。此案冲任既亏,血瘀胞阻,本内经:“留者攻之”,然若纯用攻破,必致气血重伤。因以通导活血、养血,治之获效。此遵经而不泥古也。
产后血瘀腹痛
王××,女,二十四岁。1939年。
初诊:产后旬余,少腹剧痛阵作,拒按,恶露不净,且时下紫黑瘀块。寒热往来,腰楚神倦,自汗头眩,食少,乳汁不下。脉沉细而紧,尺涪,舌淡,苔白腻。证属产后血瘀气滞,冲任受损。法当活血化瘀,舒通经脉,调达肝脾。处方;
当归18克 川芎9克 藏红花2.4克 桃仁泥6克 炙香
附6克生蒲黄6克五灵脂6克炒荆芥6克竹柴胡9克
红糖炒山楂9克 点童便(每次一酒杯为引)
二诊:上方服一剂,下紫黑色瘀块甚多,腹中疼痛轻减,寒热渐平。脉细而涩,苔自腻较退。余症同前。此瘀滞渐化,惟肝脾络脉未调。续以下方治之:
竹柴胡6克 当归18克炒杭芍9克川芎6克益母草9克
炒山查9克炙香附6克 茯神12克 藏红花2.4克 生蒲
黄6克炒艾叶6克点童便(为引)
三诊:上方服二剂,寒热全退,恶露将尽,血块已无,腹痛止。思饮食,大便通畅。仍感头眩神倦,腰楚肢软,乳汁未下。脉细缓,舌薄腻,此瘀滞化除后,气弱血虚,冲任未足。拟方:
口芪15克 当归15克炒杭芍9克 川芎6克 炙香附6克
淮山药15克(炒) 甘草3克炒续断9克桑寄生12克浮
小麦12克 小红枣10枚 生炒蒲黄各4.5克 包谷须一束煎
汤代水煨药
四诊:上方服三剂后,恶露已净。腹痛腰楚全止。乳汁已行,精神渐佳。脉现缓和,舌转红润。但因产后气血冲任尚虚,再拟下方调和滋养:
炙口芪15克 当归15克 党参15克 炒杭芍9克 白术12克
炒淮药12克陈皮6克桑寄生12克西砂仁6克(冲) 炙
甘草3克 烧生姜2片 小枣9枚
[按]此属产后瘀阻胞络又兼寒热之血痛症。治从瘀血着手,投加味失笑散;而于行气活血及消瘀导滞方中引入疏肝和解,使气机枢转,瘀消而病除。
产后血晕
张××,女,三十五岁,家住昆明市。1946年。
初诊:产后三日,恶露不畅,头眩晕,起则欲仆。少腹拘痛,面色苍白夹青。舌淡苔白少津,脉象濡弱无力。此产后血亏肝虚,瘀郁不化,风热上越,发为眩晕。治法如下:
先用打醋汤熏法:用栗炭和铁器烧红,置于盆中,淬好醋,使冒烟,令患者吸入。
内服方:
当归15克 川芎6克 苏木6克 红花2.4克 川续断9克
醋炒荆芥6克 茯神15克黑芝麻15克香白芷6克 荷叶
顶2个 点童便黄酒各半酒杯为引
二诊:上方服一剂,恶露畅行,并下紫黑色瘀块,腹痛渐止,眩晕轻减,夜能安卧。脉转细弦,苔薄白腻。续用下方,清化调理:
醋炒荆芥6克 当归15克川芎6克益母草9克茯神15克
黑芝麻15克 炒杭芍9克 法半夏9克 荷叶顶2个 苏
木6克生炒蒲黄各6克 点黄酒(一小匙为引)
三诊:上方服二剂后,眩晕已止,恶露干净,食眠均佳,可哺乳,唯觉身困肢软。脉转平和,舌红润。症属肝虚风热渐化,瘀郁已去,气血不足。续用下方加减调治:
干地黄12克 当归15克炒杭芍9克淮山药12克茯神15克
桑寄生12克炙口芪12克白术12克甘草3克广陈皮6克
荷叶顶2个醋炒荆芥6克
[按]产后亏虚瘀郁而为眩晕,不可骤补。此例以养血活血,清化瘀郁风热之品;先用打醋汤熏法,以其酸辛之气味,疏达旰经,肝气得舒,清升浊降,眩晕立除。
又,姚老医师认为醋炒荆芥具有醒脑、散血分风热,止眩晕之功效。用量可由2.4克至30克据病情酌定。
乳 结
钱××,女,廿四岁,某厂职工。1973年9月。
初诊:患者初产七日,恶露已净,因无哺乳经验,遂致乳汁留滞,乳房胀痛,渐发红肿,右侧硬结有块,昼夜呼痛,手不能触。发寒热,夜烦,口干,便秘,溺短黄。经注射青、链霉素,外敷中草药,效果不显。就诊时,呈痛苦病容,自诉:“右乳部疼痛如鸡啄。”诊脉弦滑而数,舌边、尖俱红,苔薄黄。证属:产后郁热,厥阴,少阳别络不通,发为乳结。治宜疏肝理气,化热,散结,通络。处方:
炒柴胡9克 醋郁金9克(冲) 老川芎6克 天花粉9克
全瓜萎1个(打碎) 吴芷9克 炒桔核9克(冲) 浙贝
母6克(冲)醋煅牡蛎12克蒲公英9克 炒黄芩4.5克 自
通草3克甘草梢3克藕节3个
上方以包谷须煎水煨药。外用芙蓉叶捣汁,加酸醋调匀,外敷乳部。
二诊:上方服二剂,右乳硬结变软,尚感隐痛,可挤出少量乳汁。寒热及烦躁轻减,仍便秘溺短。不思饮食。脉转细弦,舌红苔黄。除外敷乳部外,续以清肝散结,化热润燥为治。处方:
炒柴胡9克 紫苏叶6克 赤芍药9克 吴白芷9克 焦山
查9克 天花粉9克 醋郁金9克(冲) 郁李仁9克(冲)
蒲公英9克炒桔核9克(冲)通草3克全瓜萎1个(打碎)
上方服三剂,便秘已通,烦躁全退,乳部红肿胀痛及硬结消失。乳汁已下,而神疲食少。证属乳结散后,血弱阴虚,肝脾不调,脉象细弦,舌红苔薄。
当归12克 自元参9克寸冬9克炒杭芍9克广陈皮6克
醋炒柴胡4.5克茯神12克 天花粉9克 广木香3克生
甘草3克小红枣11个藕节3个
[按]内经云:“厥阴之脉其支者,复从肝剐贯膈,少阳之脉其支者,以下胸中贯膈。”恶者产后畏惧哺乳,肝气不舒,热滞厥阴、少阳之别络,乳汁停留,硬结红肿。对证用药,以柴胡、苏叶、郁金和芍药,疏肝理气定痛,以吴芷、牡蛎、桔核散结软坚,以浙贝、黄芩、郁李、瓜蒌、山查和通草,清润通导。再以归、芍、元、麦滋血养阴。
[Sub-swelling (Zi Zhong)]
Yang XX, female, 28 years old, cadre. October 1971.
First visit: Pregnancy has exceeded the due date by ten days. Restlessness at night, restless fetal movement, scanty urine, sudden weight gain, blood pressure as high as 200/100 mmHg, slow and clumsy movements. For the past week, dizziness, blurred vision, edema of the face and feet, soreness in the lower back, and a bearing-down sensation in the abdomen have become more pronounced. She had been admitted to a certain hospital for treatment with oxytocics, diuretics, and antihypertensives, but symptoms did not subside. The pulse is slippery and rapid on light palpation, weak on heavy palpation; the tongue coating is thin, white, and moist. This belongs to Zi Zhong (pregnancy-related edema), caused by blood deficiency during pregnancy, qi stagnation in the uterine vessels, and obstruction by dampness-water. The treatment method should be to promote urination to reduce swelling, regulate qi to facilitate delivery. Prescription:
Poria with Skin (Fu Ling Pi) 24g, Areca Peel (Da Fu Pi) 9g, Broad-leaved Tangerine Peel (Chen Pi) 6g, Fried Aurantium (Zhi Ke) 6g, Old Perilla Stem (Su Geng) 9g, Akebia Stem (Mu Tong) 9g, Angelica Sinensis (Dang Gui) 15g, Ligusticum Chuanxiong (Chuan Xiong) 6g, White Tong Cao 3g, Ziziphus Branch Wood (Zuo Zhi Mu) 15g, Raw Tortoise Shell (Gui Ban) 15g.
Second visit: After taking the above prescription for two doses, urination frequency increased, volume was large, and fetal movement intensified. On the morning of the third day, a healthy infant was delivered smoothly. Postpartum edema subsided, blood pressure dropped to 150/90 mmHg. She felt dizzy and fatigued, occasional pain in the lower abdomen, scanty lochia with clots, dark red in color. The pulse is wiry and moderate; the tongue coating is white and moist. Continue with the following prescription for clearance:
Angelica Sinensis (Dang Gui) 15g, Ligusticum Chuanxiong (Chuan Xiong) 6g, Poria (Fu Ling) 15g, Peach Kernel (Tao Ren) 4.5g, Safflower (Hong Hua) 3g, Motherwort (Yi Mu Cao) 9g, Eucommia Bark (Du Zhong/Sang Ji Sheng - Note: Sang Ji Sheng is Euodia/Dogwood fruit context usually, here Sang Ji Sheng) 12g, Black Schizonepeta (Hei Jing Jie) 4.5g, Raw Licorice (Sheng Gan Cao) 3g, Brown Sugar-fried Hawthorn (Hong Tang Chao Shan Zha) 9g.
Third visit: After taking the above prescription for three doses, edema completely disappeared, lochia cleared, abdominal pain stopped, blood pressure stabilized at 130/90 mmHg. Diet, sleep, and bowel/bladder functions were normal, only spirit had not recovered. The pulse is moderate, tongue moist. Prescribe the following for regulation and recovery:
Raw Astragalus (Sheng Huang Qi) 12g, Whole Angelica Sinensis (Quan Dang Gui) 12g, Bleached Atractylodes (Bai Zhu) 9g, Poria (Fu Ling) 15g, Broad-leaved Tangerine Peel (Chen Pi) 6g, Amomum Fruit (Sha Ren) 6g, Chinese Yam (Huai Shan Yao) 12g, Raw Licorice (Sheng Gan Cao) 3g, Small Red Dates (Xiao Hong Zao) 11 pieces, Fried Coix Seed (Chao Yi Yi Ren) 15g, Eucommia Bark (Sang Ji Sheng) 12g.
[Commentary] Blood deficiency during pregnancy, obstruction by dampness-water, and qi stagnation in the uterine vessels lead to post-term non-delivery and various complications. The treatment method proposes promoting urination to reduce swelling and regulating qi to facilitate delivery, adding blood-nourishing herbs in between. This is guiding according to the trend, addressing both root and branch, deeply reflecting the essential principle of mutual use of qi and blood.
[Slippery Fetus / Habitual Abortion]
Su XX, female, 29 years old, factory worker. 1963.
First visit: Married for eight years, had three pregnancies ending in premature abortion. Currently pregnant for five months. Due to hyperemesis gravidarum (E Zu), spleen and stomach dysfunction, poor appetite, and fatigue. After one day of labor, she experienced lower back soreness, abdominal bearing-down sensation, leakage of bright red blood, and restless fetal movement. Accompanied by shortness of breath, palpitations, dizziness, nausea, sweating upon exertion, desire to sleep but inability to fall asleep, and frequent urination. Pulse: Cun position slippery and weak, Guan position soggy, Chi position minute. Tongue: Pale, dry. This is due to dual deficiency of qi and blood, insecurity of Liver-Kidney and Chong-Ren meridians, indicating signs of Slippery Fetus (habitual abortion). Treatment should warm and secure qi and blood, regulate Chong and Ren. Prescription:
Raw Astragalus (Sheng Huang Qi) 24g, Angelica Sinensis (Dang Gui) 15g, Prepared Donkey-hide Gelatin (E Jiao Zhu) 15g, Fried Mugwort Leaf (Ai Tan) 6g, Dodder Seed (Tu Si Zi) 15g, Platycodon Root (Qian Zhang Zhi) 9g, Honey-fried Licorice (Zhi Gan Cao) 3g, Roasted Ginger Charcoal (Pao Jiang Tan) 6g, Honey-fried Cimicifuga (Zhi Sheng Ma) 2.4g, Small Red Dates (Xiao Hong Zao) 11 pieces, Calcined Dragon Bone (Duan Long Gu) 12g.
Second visit: After taking the above prescription for two doses, bleeding gradually decreased, able to sleep peacefully at night, lower back soreness and abdominal bearing-down reduced. Fetal movement still unsettled, shortness of breath, frequent urination, spontaneous sweating, dizziness persist. Pulse slightly stronger than before, tongue pale and moist. Continue with securing qi, nourishing blood, and calming the fetus. Prescription:
Codonopsis (Su Tiao Shen) 15g, Raw Astragalus (Sheng Huang Qi) 24g, Angelica Sinensis (Dang Gui) 15g, Poria Spirit (Fu Shen) 15g, Fried Atractylodes (Chao Bai Zhu) 12g, Broad-leaved Tangerine Peel (Chen Pi) 6g, Fried Mugwort Leaf (Ai Tan) 6g, Prepared Donkey-hide Gelatin (E Jiao Zhu) 15g, Eucommia Bark (Sang Ji Sheng) 15g, Dodder Seed (Tu Si Zi) 15g, Roasted Ginger (Pao Jiang) 6g, Small Red Dates (Xiao Hong Zao) 11 pieces, Scorched Scutellaria (Ku Qin Tan) 2.4g, Honey-fried Licorice (Zhi Gan Cao) 3g.
Third visit: After continuously taking the above prescription for five doses, bleeding stopped, fetal movement gradually settled. Other symptoms reduced, diet increased. Tongue reddish and moist, pulse slippery and moderate. This indicates Chong and Ren meridians and fetal origin are regulated and secured. Continue with nourishing and tonifying agents. Prescription:
Astragalus (Huang Qi) 15g, Angelica Sinensis Body (Dang Gui Shen) 15g, Fried White Peony Root (Chao Bai Shao) 9g, Poria Spirit (Fu Shen) 15g, Eucommia Bark (Sang Ji Sheng) 15g, Dodder Seed (Tu Si Zi) 12g, Scorched Scutellaria (Ku Qin) 2.4g, Fried Atractylodes (Chao Bai Zhu) 9g, Honey-fried Licorice (Zhi Gan Cao) 3g, Lotus Seed (Lian Zi) 15g, Longan Aril (Gui Yuan) 11 pieces, Small Red Dates (Xiao Hong Zao) 11 pieces.
Regularly taking the above prescription cured the disease. After full term, a daughter was born.
[Commentary] Liver and Kidney have always been deficient, failing in their storing function, damaging Chong and Ren meridians, leading to repeated abortions. This is due to irregular work and rest, and hyperemesis damaging the spleen, causing middle jiao yang to fail to rise. Fearing the fetal origin will be affected again leading to abortion, the profound method focuses on tonifying qi and securing retention, filling the internal organs, to achieve the goal of calming the fetus.
[Postpartum Retained Placenta]
Yang XX, female, 30 years old, suburban Kunming. March 1941.
First visit: Due to prolonged delivery of the sixth child, after the fetus was expelled, excessive bleeding occurred, and the placenta remained retained. Urgently summoned me for consultation. Symptoms: severe pain in the lower abdomen, grayish-white complexion, profuse sweating, rapid breathing. Pulse: Kou (hollow), tongue pale red, coating thin white and greasy. This belongs to deficiency and damage of Chong and Ren meridians, caused by qi stagnation and blood stasis. The condition is critical. Quickly prescribe the following:
Angelica Sinensis (Dang Gui) 30g, Ligusticum Chuanxiong (Chuan Xiong) 9g, Achyranthes Bidentata (Huai Niu Xi) 9g, Dianthus Superbus (Qu Mai) 12g, Mirabilite (Mang Xiao) 6g, Tetrapanax Papyriferus (Tong Cao) 6g, Floating Wheat (Fu Mai) 12g, Small Dates (Xiao Zao) 10 pieces, Imperata Cylindrica Rhizome (Wang Bu Liu Xing) 9g, Use a small cup of Fresh Human Urine (Tong Bian) as a guide.
About an hour after taking the medicine, the patient felt intermittent colicky pain in the abdomen. In an instant, the placenta was expelled, lochia flowed freely, abdominal pain suddenly decreased, and sweating gradually stopped. Able to lie down peacefully, craving food. Pulse still Kou, tongue turned reddish and moist. Appropriate to regulate qi and blood, warm meridians and resolve stasis. Prescription:
Angelica Sinensis (Dang Gui) 24g, Ligusticum Chuanxiong (Chuan Xiong) 6g, Motherwort (Yi Mu Cao) 9g, Brown Sugar-fried Hawthorn (Hong Tang Chao Shan Zha) 9g, Peach Kernel Paste (Tao Ren Ni) 4.5g, Saffron (Zang Hong Hua) 3g, Fried Drynaria (Chao Xu Duan) 9g, Raw and Fried Lygodium Spore (Sheng Chao Pu Huang) 4.5g each, Roasted Ginger (Pao Jiang) 6g, Small Dates (Xiao Zao) 10 pieces.
After taking the above prescription for two doses, abdominal pain gradually stopped, lochia became scanty, complexion turned lustrous. Pulse moderate, tongue pink. Further prescribe to regulate Chong, Ren, qi, and blood.
Raw Astragalus (Sheng Huang Qi) 15g, Whole Angelica Sinensis (Quan Dang Gui) 15g, Fried White Peony Root (Chao Bai Shao) 9g, Poria Spirit (Fu Shen) 15g, Chinese Yam (Huai Yao) 12g, Motherwort (Yi Mu Cao) 6g, Fried Drynaria (Chao Xu Duan) 9g, Eucommia Bark (Sang Ji Sheng) 12g, Raw Licorice (Sheng Gan Cao) 3g, Fried Lygodium Spore (Chao Pu Huang) 6g, Roasted Ginger (Pao Jiang) 4.5g, Small Dates (Xiao Zao) 10 pieces.
[Commentary] Retained placenta presents a critical condition, posing a severe threat to women in the dark old society. In this case, Chong and Ren are depleted, and blood stasis obstructs the uterus. Based on the *Neijing*: "Those that remain, attack them." However, if purely using attacking methods, it would severely damage qi and blood. Therefore, treating with promoting circulation, resolving stasis, and nourishing blood achieved efficacy. This follows the classics without being bound by ancient dogma.
[Postpartum Blood Stasis Abdominal Pain]
Wang XX, female, 24 years old. 1939.
First visit: More than ten days postpartum, severe intermittent pain in the lower abdomen, tenderness to pressure, lochia not clear, passing purple-black clots intermittently. Alternating chills and fever, lower back soreness, fatigue, spontaneous sweating, dizziness, poor appetite, no lactation. Pulse: deep, fine, tight, Chi position choppy. Tongue pale, coating white and greasy. Syndrome belongs to postpartum blood stasis and qi stagnation, damaging Chong and Ren meridians. Treatment method: invigorate blood and resolve stasis, soothe and unblock meridians, harmonize Liver and Spleen. Prescription:
Angelica Sinensis (Dang Gui) 18g, Ligusticum Chuanxiong (Chuan Xiong) 9g, Saffron (Zang Hong Hua) 2.4g, Peach Kernel Paste (Tao Ren Ni) 6g, Honey-fried Cyperus (Zhi Xiang Fu) 6g, Raw Lygodium Spore (Sheng Pu Huang) 6g, Trogopterus Dung (Wu Ling Zhi) 6g, Fried Schizonepeta (Chao Jing Jie) 6g, Bamboo Bupleurum (Zhu Chai Hu) 9g, Brown Sugar-fried Hawthorn (Hong Tang Chao Shan Zha) 9g, Use Fresh Human Urine (Tong Bian) (one wine glass each time) as a guide.
Second visit: After taking the above prescription for one dose, passed many purple-black clots, abdominal pain relieved, chills and fever subsided. Pulse fine and choppy, white greasy coating receded. Other symptoms same as before. Stasis is gradually resolving, but Liver and Spleen collaterals are not yet harmonized. Continue with the following prescription:
Bamboo Bupleurum (Zhu Chai Hu) 6g, Angelica Sinensis (Dang Gui) 18g, Fried White Peony Root (Chao Bai Shao) 9g, Ligusticum Chuanxiong (Chuan Xiong) 6g, Motherwort (Yi Mu Cao) 9g, Fried Hawthorn (Chao Shan Zha) 9g, Honey-fried Cyperus (Zhi Xiang Fu) 6g, Poria Spirit (Fu Shen) 12g, Saffron (Zang Hong Hua) 2.4g, Raw Lygodium Spore (Sheng Pu Huang) 6g, Fried Artemisia Leaf (Chao Ai Ye) 6g, Use Fresh Human Urine (Tong Bian) as a guide.
Third visit: After taking the above prescription for two doses, chills and fever completely subsided, lochia almost finished, blood clots gone, abdominal pain stopped. Craving food, bowel movement smooth. Still feels dizzy, fatigued, lower back soreness, limb weakness, no lactation. Pulse fine and moderate, tongue thin greasy coating. After stasis resolves, qi is weak and blood is deficient, Chong and Ren are insufficient. Prescribe:
Astragalus (Huang Qi) 15g, Angelica Sinensis (Dang Gui) 15g, Fried White Peony Root (Chao Bai Shao) 9g, Ligusticum Chuanxiong (Chuan Xiong) 6g, Honey-fried Cyperus (Zhi Xiang Fu) 6g, Chinese Yam (Huai Shan Yao) 15g (fried), Licorice (Gan Cao) 3g, Fried Drynaria (Chao Xu Duan) 9g, Eucommia Bark (Sang Ji Sheng) 12g, Floating Wheat (Fu Xiao Mai) 12g, Small Red Dates (Xiao Hong Zao) 10 pieces, Raw and Fried Lygodium Spore (Sheng Chao Pu Huang) 4.5g each, Bundle of Corn Silk (Bao Gu Xu) decocted to replace water for simmering herbs.
Fourth visit: After taking the above prescription for three doses, lochia cleared. Abdominal pain and lower back soreness completely stopped. Lactation started, spirit gradually improved. Pulse moderate, tongue reddish and moist. But since postpartum qi, blood, Chong, and Ren are still deficient, further prescribe for harmonizing and nourishing:
Honey-fried Astragalus (Zhi Huang Qi) 15g, Angelica Sinensis (Dang Gui) 15g, Codonopsis (Dang Shen) 15g, Fried White Peony Root (Chao Bai Shao) 9g, Atractylodes (Bai Zhu) 12g, Fried Chinese Yam (Chao Huai Yao) 12g, Tangerine Peel (Chen Pi) 6g, Eucommia Bark (Sang Ji Sheng) 12g, Amomum Fruit (Xi Sha Ren) 6g (dissolved), Honey-fried Licorice (Zhi Gan Cao) 3g, Burnt Ginger (Shao Sheng Jiang) 2 slices, Small Dates (Xiao Zao) 9 pieces.
[Commentary] This belongs to postpartum blood stasis obstructing uterine collaterals combined with alternating chills and fever blood pain syndrome. Treatment starts from blood stasis, administering Modified Shixiao San; while in the formula for moving qi, invigorating blood, and eliminating stasis, introducing soothing Liver and harmonizing methods, allowing qi mechanism to pivot, stasis to dissipate, and disease to be eliminated.
[Postpartum Blood Fainting]
Zhang XX, female, 35 years old, resident of Kunming City. 1946.
First visit: Three days postpartum, lochia not flowing smoothly, dizziness, feeling like falling when standing up. Lower abdomen tense and painful, complexion pale with bluish tint. Tongue pale, coating white and dry, pulse soggy, weak, and powerless. This is postpartum blood deficiency and Liver deficiency, stasis and depression not resolving, wind-heat rising upward, causing dizziness. Treatment method as follows:
First use Vine Smelling Therapy (Da Cu Tang Xun Fa): Heat chestnut charcoal and ironware until red, place in a basin, quench with good vinegar to produce smoke, let the patient inhale.
Internal Prescription:
Angelica Sinensis (Dang Gui) 15g, Ligusticum Chuanxiong (Chuan Xiong) 6g, Sappan Wood (Su Mu) 6g, Safflower (Hong Hua) 2.4g, Sichuan Drynaria (Chuan Xu Duan) 9g, Vine-fried Schizonepeta (Cu Chao Jing Jie) 6g, Poria Spirit (Fu Shen) 15g, Black Sesame (Hei Zhi Ma) 15g, Angelica Dahurica (Xiang Bai Zhi) 6g, Lotus Leaf Tip (He Ye Ding) 2 pieces, Use half a wine glass each of Fresh Human Urine (Tong Bian) and Yellow Wine (Huang Jiu) as a guide.
Second visit: After taking the above prescription for one dose, lochia flowed freely, passing purple-black clots, abdominal pain gradually stopped, dizziness relieved, able to sleep peacefully at night. Pulse turned fine and wiry, coating thin white and greasy. Continue with the following prescription for clearing and transforming regulation:
Vine-fried Schizonepeta (Cu Chao Jing Jie) 6g, Angelica Sinensis (Dang Gui) 15g, Ligusticum Chuanxiong (Chuan Xiong) 6g, Motherwort (Yi Mu Cao) 9g, Poria Spirit (Fu Shen) 15g, Black Sesame (Hei Zhi Ma) 15g, Fried White Peony Root (Chao Bai Shao) 9g, Processed Pinellia (Fa Ban Xia) 9g, Lotus Leaf Tip (He Ye Ding) 2 pieces, Sappan Wood (Su Mu) 6g, Raw and Fried Lygodium Spore (Sheng Chao Pu Huang) 6g each, Use a small spoon of Yellow Wine (Huang Jiu) as a guide.
Third visit: After taking the above prescription for two doses, dizziness stopped, lochia clean, diet and sleep excellent, able to breastfeed, only feeling body fatigue and limb weakness. Pulse turned peaceful, tongue reddish and moist. Syndrome belongs to Liver deficiency and wind-heat gradually resolving, stasis and depression gone, qi and blood insufficient. Continue with the following prescription for modification and treatment:
Rehmannia Glutinosa (Gan Di Huang) 12g, Angelica Sinensis (Dang Gui) 15g, Fried White Peony Root (Chao Bai Shao) 9g, Chinese Yam (Huai Shan Yao) 12g, Poria Spirit (Fu Shen) 15g, Eucommia Bark (Sang Ji Sheng) 12g, Honey-fried Astragalus (Zhi Huang Qi) 12g, Atractylodes (Bai Zhu) 12g, Licorice (Gan Cao) 3g, Broad-leaved Tangerine Peel (Chen Pi) 6g, Lotus Leaf Tip (He Ye Ding) 2 pieces, Vine-fried Schizonepeta (Cu Chao Jing Jie) 6g.
[Commentary] Postpartum deficiency and stasis-depression causing dizziness should not be supplemented abruptly. This case uses blood-nourishing and blood-invigorating herbs, along with those clearing stasis-depression and wind-heat; first using Vine Smelling Therapy, using its sour and pungent aroma to soothe and reach the Liver Meridian, allowing Liver qi to relax, clear ascending and turbid descending, dizziness immediately removed.
Additionally, Dr. Yao believes that Vine-fried Schizonepeta has the effects of awakening the brain, dispersing wind-heat in the blood level, and stopping dizziness. Dosage can range from 2.4g to 30g depending on the condition.
[Milk Knot / Breast Abscess]
Qian XX, female, 24 years old, factory worker. September 1973.
First visit: Patient gave birth seven days ago, lochia cleared. Due to lack of breastfeeding experience, milk stagnated, causing breast distension and pain, gradually developing redness and swelling. Right side hard knot with mass, crying out in pain day and night, unable to touch. Developed chills and fever, nighttime restlessness, dry mouth, constipation, scanty yellow urine. Injected with Penicillin and Streptomycin, applied external Chinese herbal medicine, effect not obvious. At consultation, presented with painful expression, self-reported: "Right breast pain like a chicken pecking." Pulse wiry, slippery, and rapid; tongue edges and tip all red, coating thin yellow. Syndrome belongs to: postpartum stagnant heat, obstruction of collateral branches of Jueyin and Shaoyang, causing Milk Knot. Treatment should soothe Liver and regulate qi, clear heat, dissipate knots, and unblock collaterals. Prescription:
Fried Bupleurum (Chao Chai Hu) 9g, Vine-processed Curcuma (Cu Yu Jin) 9g (dissolved), Old Ligusticum Chuanxiong (Lao Chuan Xiong) 6g, Trichosanthes Root (Tian Hua Fen) 9g, Whole Trichosanthes Fruit (Quan Gua Lou) 1 piece (crushed), Evodia Fruit (Wu Zhu Yu) 9g, Fried Apricot Kernel (Chao Ju He) 9g (dissolved), Zhejiang Fritillaria (Zhe Bei Mu) 6g (dissolved), Vine-calcined Oyster Shell (Cu Duan Mu Li) 12g, Dandelion (Pu Gong Ying) 9g, Fried Scutellaria (Chao Huang Qin) 4.5g, White Tong Cao 3g, Licorice Tip (Gan Cao Shao) 3g, Lotus Node (Ou Jie) 3 pieces.
Simmer the above prescription in water decocted from Corn Silk (Bao Gu Xu). Externally, crush Hibiscus Leaf (Fu Rong Ye) to extract juice, mix evenly with vinegar, apply externally to the breast.
Second visit: After taking the above prescription for two doses, right breast hard knot softened, still feeling dull pain, able to squeeze out small amount of milk. Chills, fever, and restlessness reduced, still constipated and scanty urine. No appetite. Pulse turned fine and wiry, tongue red, coating yellow. Besides external application to breast, continue with clearing Liver, dissipating knots, clearing heat, and moistening dryness. Prescription:
Fried Bupleurum (Chao Chai Hu) 9g, Perilla Leaf (Zi Su Ye) 6g, Red Peony Root (Chi Shao Yao) 9g, Angelica Dahurica (Wu Bai Zhi) 9g, Scorched Hawthorn (Jiao Shan Zha) 9g, Trichosanthes Root (Tian Hua Fen) 9g, Vine-processed Curcuma (Cu Yu Jin) 9g (dissolved), Prunus Armeniaca Seed (Yu Li Ren) 9g (dissolved), Dandelion (Pu Gong Ying) 9g, Fried Apricot Kernel (Chao Ju He) 9g (dissolved), Tetrapanax Papyriferus (Tong Cao) 3g, Whole Trichosanthes Fruit (Quan Gua Lou) 1 piece (crushed).
After taking the above prescription for three doses, constipation resolved, restlessness completely retreated, redness, swelling, pain, and hard knot in breast disappeared. Milk flow started, but spirit fatigued and poor appetite. Syndrome belongs to after Milk Knot dissipation, blood weak and yin deficient, Liver-Spleen disharmony, pulse fine and wiry, tongue red, thin coating.
Angelica Sinensis (Dang Gui) 12g, Scrophularia (Xuan Shen) 9g, Ophiopogon (Cun Dong) 9g, Fried White Peony Root (Chao Bai Shao) 9g, Broad-leaved Tangerine Peel (Chen Pi) 6g, Vine-fried Bupleurum (Cu Chao Chai Hu) 4.5g, Poria Spirit (Fu Shen) 12g, Trichosanthes Root (Tian Hua Fen) 9g, Aucklandia (Guang Mu Xiang) 3g, Raw Licorice (Sheng Gan Cao) 3g, Small Red Dates (Xiao Hong Zao) 11 pieces, Lotus Node (Ou Jie) 3 pieces.
[Commentary] The *Neijing* states: "The branch of the Jueyin meridian returns from the liver side, piercing through the diaphragm; the branch of the Shaoyang meridian goes below the chest, piercing through the diaphragm." Due to fear of breastfeeding, Liver qi is not free, heat stagnates in the collateral branches of Jueyin and Shaoyang, milk stays, causing hard knots, redness, and swelling. Medicating according to the syndrome, using Bupleurum, Perilla Leaf, Curcuma, and Peony to soothe Liver, regulate qi, and stop pain; using Evodia, Oyster Shell, and Apricot Kernel to dissipate knots and soften hardness; using Fritillaria, Scutellaria, Prunus, Trichosanthes, Hawthorn, and Tong Cao to clear, moisten, and unblock. Then using Angelica, Peony, Scrophularia, and Ophiopogon to nourish blood and yin.