杭垣凌木梳巷高姓妇。年四十七岁。患血崩两月余。淋漓不断。其血初起鲜赤、久则渐淡。若一起坐。骤下如倾。
往来寒热。下体如废。床上不能转动。面色 白如纸。唇舌皆无血色。常觉目暗脑空。自起病以来。更医数手。服药七
十余剂。如水投石。乃延余治。诊其脉两关尺皆浮虚芤大。重按软弱无神。寸口涩涩不调。余曰。妇人七七。天癸将竭。
其血较衰于壮年。今病已日久。下崩若倾。所去之血。已不啻数斗。所谓奇经血海之血。盖皆下脱。急当大补气血。症
虽危险。若照余方服之。不得稍有增减。尚可转危为安。与补血汤合胶艾汤法。更加介类潜阳止血之品。方用黄 一两。
当归四钱。党参、白芍、阿胶、荆芥炭、贯众炭血余炭各三钱。姜炭一钱五分。陈艾叶七片。杜仲、川断、桑寄生各二
钱五分。牡蛎八钱。水煎加童便半茶钟。服二剂而血减。下体稍能转动。乃去寄生、川断、血余、黄 。用六钱。党参、
高丽参，加熟地一两。鹿角胶、龙骨各三钱。附子一钱。又二剂血止而能起坐。唇面稍转红活。脉象有根。而白带时下。
又服五剂。诸症悉愈。按血脱补气。古法可循。原非难治。而数手久治。迄无一效。岂非可笑。
定海巡捕魏小隐夫人。年三十余。前曾有孕四月。因腰痛腹疼。误认血积。破血陨胎。年余原医复用前药致陨。丙
戌秋停经四月。腰腹如旧疼痛。乃邀余诊。脉弦虚滑数。尺脉躁动不安。余曰。此胎脉也。问几月矣。曰将及四月。余
曰脉已离经。胎将堕矣。伊芳备述前因。余曰。前堕两胎。皆在四月。今届其时。瓜弱蒂脆。又欲堕也。曰腰腹虽痛。血
尚未下。余曰。脉象如此。势必漏下。姑用安胎之法。以四物汤加桑寄生、杜仲、川断、胶艾、砂仁。药未服而血已下。
持方
来问。余曰。此方正治胎漏。然胎之能保与否。难以预决。而又不得不服。次日下血更多。余复诊之。脉数已减。尺脉
稍安。余曰。脉似有根。胎可保矣。渠曰。胎既可保。何以下血反多。腰腹仍痛。余曰。此凭脉不凭症也。昨血未下
。余断必下。盖离经之血。自然当下。若止涩之。将来瘀血为患。变症百出矣。已离之血。必当尽下。则未离之血自止。
但产期须补一两月耳。复于前方参、 、白术又服二剂。而血始止。胎卒不堕。噫嘻。天下之误药而郧胎者。不知凡几。
岂非医之造孽耶。
杭州凌木梳巷高姓妇女，四十七岁。患血崩症两个多月，淋漓不断。其血起初颜色鲜红，久了则逐渐变淡。只要一起身或坐起，血液便骤然大量涌出，如倾倒一般。
伴有寒热往来症状，下肢如同瘫痪，在床上无法转动。面色苍白如纸，嘴唇和舌头都没有血色，经常觉得眼睛昏暗、头脑空虚。从发病以来，更换了好几位医生，服用了七十多剂药，效果如同水浇石头（毫无反应），于是请我来诊治。诊察其脉象，两关尺三部皆浮虚芤大，重按软弱无神；寸口脉涩滞不调。我说：女子到了四十九岁（七七之年），天癸（指与月经有关的精微物质）将竭尽，气血较壮年时已衰退。如今患病日久，下焦崩漏如倾泻，所流失的血液，已超过数斗之多。所谓奇经八脉中的血海之血，大概都已下脱。急需大补气血。病症虽然危险，但如果照我的方子服用，不得稍有增减，还可以转危为安。给予补血汤合胶艾汤的方法，再加上介类潜阳止血的药物。方用黄芪一两，当归四钱，党参、白芍、阿胶、荆芥炭、贯众炭、血余炭各三钱，姜炭一钱五分，陈艾叶七片，杜仲、川断、桑寄生各二钱五分，牡蛎八钱。水煎，加入童便（儿童尿液）半茶钟。服用两剂后，出血减少，下肢稍能转动。于是去掉桑寄生、川断、血余、黄芪，改用黄芪六钱，党参、高丽参，加熟地黄一两，鹿角胶、龙骨各三钱，附子一钱。又服两剂，血止并能坐起，嘴唇和面部稍微转为红润有光泽，脉象有了根基，但白带时下。又服五剂，所有症状全部痊愈。按语：血脱证补气，是古代遵循的法度，原本并非难治之症，但经过多位医生长久治疗，竟然无一见效，难道不可笑吗？
定海巡捕魏小隐夫人，三十多岁。此前曾怀孕四个月，因腰痛腹痛，误认为是瘀血积聚，使用破血药导致流产。一年多后，原医生再次使用前药致其流产。丙戌年秋季停经四个月，腰腹疼痛如旧，于是邀请我诊治。脉象弦虚滑数，尺脉躁动不安。我说：这是胎脉。问怀孕几个月了？回答说将近四个月。我说：脉象已经离开正常经脉规律，胎儿将要堕落了。她详细陈述了前因后果。我说：之前两次流产都在四个月时，现在又到了这个时期，瓜弱蒂脆，又要流产了。她说腰腹虽然痛，但血还没有下来。我说：脉象如此，势必会有漏下出血。暂且用安胎的方法，以四物汤加桑寄生、杜仲、川断、胶艾、砂仁。药还没吃下去，血就已经下来了。拿着方子来问我。我说：这个方子正是治疗胎漏（妊娠期阴道少量出血）的正法，但是胎儿能否保住，难以预先决定，但又不得不服用。第二天流血更多。我再行诊察，脉数已减，尺脉稍安。我说：脉象似乎有了根基，胎儿可以保住了。他说：既然胎儿可以保住，为什么流血反而更多？腰腹仍然疼痛？我说：这是凭脉象诊断而不凭症状判断。昨天血未下，我断定必然要下。因为离经之血，自然应当排出。如果强行止涩，将来瘀血为患，变化出的病症就会层出不穷。已经离经的血，必须排尽，那么未离经的血自然会停止。只是产期需要补养一两个月罢了。又在前方中加入人参、茯苓、白术，又服两剂，血才停止，胎儿最终没有堕落。唉！天下因误药而损伤胎儿的，不知有多少，这难道是医生的罪孽吗？
The woman of the Gao family in Lingmushu Alley, Hangzhou, was forty-seven years old. She suffered from metrorrhagia (uterine bleeding) for over two months, with continuous dripping. Initially, the blood was bright red; later, it gradually became pale. Whenever she sat up or stood, the blood would suddenly gush out profusely as if pouring.
She experienced alternating chills and fever (alternating cold and heat sensations), her lower limbs felt paralyzed, and she could not turn over in bed. Her complexion was as white as paper, and her lips and tongue lacked color. She often felt dim vision and emptiness in her head. Since the onset of the illness, she had consulted several physicians and taken more than seventy doses of medicine, but to no effect (like water thrown on a stone). She then invited me to treat her. Her pulse at both Guan (middle) and Chi (cinnabar) positions was floating, deficient, hollow (Kou), and large; upon heavy pressure, it was weak and spiritless. The Cun (inch) position was choppy and irregular. I said: "At forty-nine (seven times seven), women's Tian Gui (menstrual essence) is about to exhaust, and their Qi and Blood are weaker than in their prime. Now that the disease has persisted for a long time, with severe lower jiao bleeding like a pour, the amount of blood lost exceeds several dou. The blood of the Chong and Ren vessels (the Sea of Blood) has likely all descended. Urgent supplementation of Qi and Blood is required. Although the condition is critical, if you take my prescription without any modification, you can still turn danger into safety." I prescribed a combination of Bu Xue Tang (Blood-Nourishing Decoction) and Jiao Ai Tang (Colla Corii Asini and Mugwort Leaf Decoction), adding shell-type minerals to anchor Yang and stop bleeding. The formula consisted of Huang Qi (Astragali Radix) 1 liang, Dang Gui (Angelicae Sinensis Radix) 4 qian, Dang Shen (Codonopsis Radix), Bai Shao (Paeoniae Radix Alba), E Jiao (Colla Corii Asini), Jing Jie Tan (Scutellariae Barbatae Carbo), Guan Zhong Tan (Cyathiophyllae Spora Carbo), and Xue Yu Tan (Carbo Hominis) each 3 qian, Jiang Tan (Zingiberis Rhizoma Carbo) 1.5 qian, Chen Ai Ye (Artemisiae Argyi Folium) 7 slices, Du Zhong (Eucommiae Cortex), Chuan Duan (Dipsaci Radix), and Sang Ji Sheng (Taxilli Herba) each 2.5 qian, Mu Li (Concha Ostreae) 8 qian. Decoct in water, add half a teacup of Tong Bian (child's urine). After two doses, the bleeding decreased, and her lower limbs could move slightly. Then, Sang Ji Sheng, Chuan Duan, Xue Yu Tan, and Huang Qi were removed; Huang Qi was reduced to 6 qian. Dang Shen was replaced with Gao Li Shen (Ginseng Radix et Rhizoma Koreanum), and Shu Di Huang (Rehmanniae Radix Praeparata) 1 liang was added, along with Lu Jiao Jiao (Corvi Cornu Colla) and Long Gu (Os Draconis) each 3 qian, and Fu Zi (Aconiti Lateralis Radix Praeparata) 1 qian. After another two doses, the bleeding stopped, she could sit up, her lips and face turned slightly rosy, and her pulse gained root. However, leukorrhea continued. After five more doses, all symptoms resolved. Note: Tonifying Qi for blood loss is an ancient method that should be followed; originally, this was not a difficult case. Yet, after prolonged treatment by several doctors with no effect, is it not laughable?
The wife of Wei Xiaoyin, a patrol officer from Dinghai, was in her thirties. Previously, she had been pregnant for four months. Due to lower back pain and abdominal pain, she was misdiagnosed with blood stasis and administered blood-breaking herbs, resulting in miscarriage. Over a year later, the original physician used the same drugs again, causing another miscarriage. In the autumn of the Bingxu year, she missed her period for four months, with recurring lower back and abdominal pain. She invited me to diagnose her. Her pulse was wiry, deficient, slippery, and rapid, with the Chi position restless and unstable. I said: "This is a fetal pulse." I asked how many months pregnant she was. She replied nearly four months. I said: "The pulse has deviated from the normal meridian pattern; the fetus is about to miscarry." She recounted the previous history in detail. I said: "Your previous two miscarriages occurred at four months. Now that you have reached that time again, like a weak melon on a fragile stem, another miscarriage is imminent." She said, "Although my waist and abdomen hurt, there is no bleeding yet." I said: "Given the pulse, spotting will inevitably occur. For now, use a fetal-calming method: Si Wu Tang (Four Substances Decoction) plus Sang Ji Sheng, Du Zhong, Chuan Duan, Jiao Ai, and Sha Ren. Before taking the medicine, bleeding started." She brought the prescription to ask me. I said: "This formula correctly treats Tai Lou (threatened abortion with spotting). However, whether the fetus can be saved cannot be predetermined, yet it must be taken." The next day, bleeding increased. I examined her again; the rapid pulse had slowed, and the Chi position had calmed slightly. I said: "The pulse seems to have gained root; the fetus can be saved." He asked, "If the fetus can be saved, why did the bleeding increase? Why do the waist and abdomen still hurt?" I said: "This diagnosis relies on the pulse, not just symptoms. Yesterday, before the bleeding started, I predicted it would happen. Blood that has left the meridians naturally needs to be expelled. If we forcibly stop it, blood stasis will cause complications, leading to various pathological changes. The blood that has already left the meridians must be completely expelled, so the remaining blood within the meridians will naturally stop. However, postpartum recovery requires one to two months of tonification." I added Ren Shen (Ginseng Radix), Fu Ling (Poria), and Bai Zhu (Atractylodis Macrocephalae Rhizoma) to the previous formula. After two more doses, the bleeding stopped, and the fetus was ultimately preserved. Alas! How many cases of fetal damage due to medical error exist in the world? Is this not the sin of physicians?