天津董姓妇，年三十四岁，怀妊，感受温病兼有痰作喘。
病因 受妊已逾八月，心中常常发热。时当季春，喜在院中乘凉，为风袭遂成此证。
证候 喘息有声，呼吸迫促异常，昼夜不能少卧，心中烦躁。舌苔白浓欲黄。左右寸脉皆洪
实异常，两尺则按之不实，其数八至。大便干燥，小便赤涩。
诊断 此证前因医者欲治其喘，屡次用麻黄发之。致其元气将脱，又兼外感之热已入阳明。其
实热与外感之气相并上冲，是以其脉上盛下虚，喘逆若斯迫促，脉七至即为绝脉，今竟
八至恐难挽回。欲辞不治而病家再三恳求，遂勉为拟方。以清其热，止其喘，挽救其气化之将脱。
处方 净萸肉（一两） 生怀地黄（一两） 生龙骨（一两捣碎） 生牡蛎（一两捣碎）
将四味煎汤，送服生石膏细末三钱，迟五点钟若热犹不退。
煎渣再服，仍送服生石膏细末三钱。
复诊 服药头煎次煎后，喘愈强半，遂能卧眠，迨至黎明胎忽滑下，且系死胎。再诊其脉较前
更数，一息九至，然不若从前之滑实，而尺脉则按之即无。其喘似又稍剧，其心中烦躁依旧，且觉
怔忡，不能支持。此乃肝肾阴分大亏，不能维系阳分而气化欲涣散也。当峻补肝肾之阴兼清外感未尽之余热。
处方 生怀山药（六两） 玄参（两半） 熟鸡子黄（六个捻碎） 真西洋参（二钱捣为粗末）
先将山药煎十余沸，再入玄参、鸡子黄煎汤一大碗，分多次徐徐温饮下。每饮一次，送服洋参
末少许，饮完再煎渣取汤接续饮之，洋参末亦分多次送服，勿令余剩。
三诊 翌日又为诊视，其脉已减去三至为六至，尺脉按之有根，知其病已回生。问其心中已不
怔忡，惟其心中犹觉发热，此非外感之热，乃真阴未复之热也。当纯用大滋真阴之品以复其阴。
处方 玄参（三两） 生怀山药（两半） 当归（四钱） 真西洋参（二钱捣为粗末）
将前三味共煎汤一大碗，分多次温饮下。每饮一次送服洋参末少许。
四诊 前方服一剂，心中已不觉热，惟腹中作疼，问其恶露所下甚少，当系瘀血作疼。治以化瘀
血之品，其疼当自愈。
处方 生怀山药（一两） 当归（五钱） 怀牛膝（五钱） 生鸡内金（二钱黄色的捣）
桃仁（二钱） 红花（钱半） 真西洋参（二钱捣为粗末）
将前六味共煎汤一大盅，送服洋参末一半，至煎渣服时再送服余一半。
效果 前方日服一剂，服两日病遂全愈。
或问 他方用石膏皆与诸药同煎，此证何以独将石膏为末送服？答曰∶石膏原为石质重坠之品，
此证之喘息迫促，呼吸惟在喉间，分毫不能下达，几有将脱之势。石膏为末服之，欲借其重坠之力以
引气下达也。且石膏末服，其退热之力一钱可抵半两，此乃屡经自服以试验之。而确能知其如斯，此证一
日服石膏末至六钱，大热始退。若用生石膏三两，同诸药煎汤，病家将不敢服，此为救人计，不
得不委曲以行其术也。
或问 产后忌用寒凉，第三方用于流产之后，方中玄参重用三两，独不虑其过于苦寒乎？答曰∶玄
参细嚼之其味甘而微苦，原甘凉滋阴之品，实非苦寒之药。是以《神农本草经》谓其微寒，善治产乳
余疾，故产后忌用凉药而玄参则毫无所忌也。且后世本草谓大便滑泻者忌之，因误认其为苦寒也。而
此证服过三两玄参之后，大便仍然干燥，则玄参之性可知矣。
或问 此证之胎已逾八月，即系流产，其胎应活，何以产下竟为死胎？答曰∶胎在腹中，原有
脐呼吸，实借母之呼吸以为呼吸，是以凡受妊者其吸入之气，可由任脉以达于胎儿脐中。此证因吸入
之气分毫不能下达，则胎失所荫，所以不能资生也。为其不能资生，所以下降，此非因服药而下降也。
天津董姓妇女，三十四岁，怀孕期间，感染温病并伴有痰饮引发的喘息。
病因 怀孕已超过八个月，心中经常发热。正值春季末，喜欢在庭院中乘凉，被风邪侵袭从而形成此病证。
证候 喘息时发出声音，呼吸极度急促，白天黑夜都不能稍微躺卧，心中烦躁不安。舌苔白厚且即将转黄。左右手寸脉都洪大有力异常，两尺脉按下去感觉不实，脉搏频率极快，一息跳动八次。大便干燥，小便赤红且排尿涩痛。
诊断 此病之前因为医生想要治疗她的喘息，屡次使用麻黄来发汗解表。导致她的元气即将耗脱，再加上外感的热邪已经传入阳明经。体内的实热与外感之气相互结合向上冲逆，所以出现上盛下虚的脉象，喘息逆乱如此急促。脉搏一息七至已经是绝脉，现在竟然达到八至，恐怕难以挽回。本想推辞不治疗，但病人家属再三恳求，于是勉强为她拟定处方。旨在清除热邪，止住喘息，挽救即将耗散的气化功能。
处方 净山茱萸（一两） 生怀地黄（一两） 生龙骨（一两，捣碎） 生牡蛎（一两，捣碎）
将这四味药煎汤，送服生石膏细末三钱。如果过五个小时热势仍然不退。
再煎药渣服用，依然送服生石膏细末三钱。
复诊 服用头煎和次煎后，喘息症状减轻了一半多，于是能够躺卧睡眠。等到黎明时分，胎儿突然滑出，而且是死胎。再次诊察脉象比之前更加快速，一息九至，但不像从前那样滑实，而尺脉按下去就感觉不到了。喘息似乎又稍微加重，心中烦躁依旧，并且感到心悸怔忡，身体无法支撑。这是肝肾阴分严重亏损，不能维系阳分，导致气化功能即将涣散。应当峻补肝肾之阴，兼清外感未尽的余热。
处方 生怀山药（六两） 玄参（一两半） 熟鸡蛋黄（六个，捻碎） 真西洋参（二钱，捣为粗末）
先将山药煎煮十余沸，再加入玄参、鸡蛋黄煎取一大碗汤，分多次慢慢温服。每次饮用时，送服少许西洋参末，喝完后再煎药渣取汤接续饮用，西洋参末也分多次送服，不要剩下。
三诊 第二天再次诊视，脉象已经减少三次，变为六至，尺脉按之有根，知道病情已经好转回生。询问她心中已经不感到心悸怔忡，只是心中仍然觉得发热，这不是外感的发热，而是真阴尚未恢复产生的虚热。应当纯用大滋真阴的药物来恢复其阴液。
处方 玄参（三两） 生怀山药（一两半） 当归（四钱） 真西洋参（二钱，捣为粗末）
将前三味药共同煎取一大碗汤，分多次温服。每次饮用时送服少许西洋参末。
四诊 前方服用一剂后，心中已经不觉得发热，只是腹部疼痛，询问恶露排出很少，应当是瘀血引起的疼痛。治疗以化瘀血的药物，疼痛应当自愈。
处方 生怀山药（一两） 当归（五钱） 怀牛膝（五钱） 生鸡内金（二钱，黄色的捣碎）
桃仁（二钱） 红花（一两半） 真西洋参（二钱，捣为粗末）
将前六味药共同煎取一大盅汤，送服一半西洋参末，等到煎药渣服用时再送服剩余的一半。
效果 前方每天服用一剂，服用两天后疾病完全痊愈。
有人问 其他方子使用石膏都是与其他药物一起煎煮，此病证为何唯独将石膏磨成粉末送服？回答说：石膏原本是质地沉重下沉的药物，此病证的喘息急促，呼吸只在喉间，丝毫不能下达，几乎有气脱之势。将石膏磨成粉末服用，是想借助其沉重下沉的力量来引导气机下行。而且石膏粉末服用，其退热的力量一钱可抵半两，这是我多次亲自试验验证过的。确实能知道是这样，此病证一天服用石膏末多达六钱，大热才消退。如果使用生石膏三两，与其他药物一起煎汤，病人家属将不敢服用，这是为了救人的打算，不得不委婉地施行这种方法。
有人问 产后忌讳使用寒凉药物，第三个方子在流产之后使用，方中重用玄参三两，难道不担心它过于苦寒吗？回答说：玄参细细咀嚼味道甘甜而微苦，原本是甘凉滋阴的药物，实在不是苦寒的药。因此《神农本草经》说它微寒，善于治疗产后余疾，所以产后忌讳使用凉药，而玄参则毫无禁忌。而且后世本草书籍说大便滑泻的人忌用，是因为误认为它是苦寒的。而此病证服用过三两玄参之后，大便仍然干燥，那么玄参的性质就可以知道了。
有人问 此病证的胎儿已经超过八个月，即使是流产，胎儿应该存活，为什么产下来竟然是死胎？回答说：胎儿在腹中，本来就有脐带呼吸，实际上是借助母亲的呼吸来进行呼吸，所以凡是怀孕的人，吸入的气可以通过任脉到达胎儿的脐中。此病证因为吸入的气丝毫不能下达，导致胎儿失去荫庇，所以不能得到滋养。因为不能得到滋养，所以下降，这并不是因为服药而导致下降。
A woman surnamed Dong from Tianjin, aged thirty-four, was pregnant and contracted a warm disease (Wen Bing) accompanied by phlegm-induced wheezing.
Etiology She had been pregnant for over eight months and frequently experienced heat in the heart region. It was late spring, and she liked to enjoy the cool air in the courtyard. An invasion of wind pathogen led to this condition.
Symptoms Wheezing with audible sounds, extremely rapid and forced breathing, unable to lie down even slightly during day or night, irritability and restlessness in the heart region. The tongue coating is white, thick, and turning yellow. Both cun positions of the left and right pulses are excessively surging and full. The chi positions feel empty upon pressure, with a rate of eight beats per respiration. Dry stool, red and difficult urination.
Diagnosis Previously, physicians attempted to treat her wheezing by repeatedly using Ephedrae Herba (Mahuang, 麻黄) to induce sweating. This caused her primordial qi to be on the verge of collapse, and the external heat had entered the Yangming channel. The internal excess heat combined with the external pathogenic qi to rush upward, resulting in an upper-excess and lower-deficient pulse pattern. Consequently, the wheezing and rebellious qi were so rapid and forced. A pulse rate of seven beats per respiration is considered a terminal pulse; now reaching eight beats, it is feared that recovery may be difficult. Intending to decline treatment due to the poor prognosis, but urged by the family's repeated pleas, I reluctantly prescribed a formula to clear heat, stop wheezing, and salvage the collapsing qi transformation.
Prescription Clean Corni Fructus (Yurou, 山茱萸) 1 liang, Raw Rehmanniae Radix Preparata (Sheng Huai Dihuang, 生怀地黄) 1 liang, Raw Longgu (Longgu, 龙骨) 1 liang (crushed), Raw Muli (Muli, 牡蛎) 1 liang (crushed). Decoct these four herbs and take the decoction while swallowing 3 qian of fine powder of Raw Gypsum Fibrosum (Sheng Shigao, 生石膏). If the heat persists after five hours, decoct the dregs again and take them, still swallowing 3 qian of Raw Gypsum Fibrosum powder.
Second Visit After taking the first and second decoctions, the wheezing improved by more than half, allowing her to lie down and sleep. At dawn, the fetus slipped out spontaneously, but it was a dead fetus. Re-palpation showed the pulse was faster than before, nine beats per respiration, but no longer slippery and full as before; the chi pulse vanished upon pressure. The wheezing seemed slightly worse, irritability persisted, and she felt palpitations and exhaustion. This indicates severe deficiency of Liver and Kidney Yin, failing to anchor Yang, leading to impending dispersion of qi transformation. Treatment should vigorously tonify Liver and Kidney Yin while clearing residual external heat.
Prescription Raw Dioscoreae Rhizome (Sheng Huai Shanyao, 生怀山药) 6 liang, Scrophulariae Radix (Xuanshen, 玄参) 1.5 liang, Cooked Egg Yolk (Shu Jizi Huang, 熟鸡子黄) 6 pieces (mashed), Genuine American Ginseng (Zhen Xiyangshen, 真西洋参) 2 qian (coarsely powdered). First, decoct the Yam for about ten boils, then add Scrophulariae Radix and Egg Yolk to decoct into one large bowl. Drink slowly and warmly in multiple doses. Each time drinking, swallow a small amount of American Ginseng powder. After finishing, decoct the dregs again to continue drinking, dividing the American Ginseng powder into multiple doses to ensure none remains.
Third Visit The next day, the pulse rate decreased by three beats to six per respiration, and the chi pulse had root upon pressure, indicating recovery. She reported no more palpitations, only feeling heat in the heart region. This is not external heat, but heat from unrecovered True Yin. Treatment should purely use substances that greatly nourish True Yin to restore Yin.
Prescription Scrophulariae Radix (Xuanshen, 玄参) 3 liang, Raw Dioscoreae Rhizome (Sheng Huai Shanyao, 生怀山药) 1.5 liang, Angelicae Sinensis Radix (Danggui, 当归) 4 qian, Genuine American Ginseng (Zhen Xiyangshen, 真西洋参) 2 qian (coarsely powdered). Decoct the first three herbs into one large bowl, drink warmly in multiple doses. Swallow a small amount of American Ginseng powder with each dose.
Fourth Visit After one dose of the previous prescription, the heart heat subsided, but abdominal pain occurred. Lochia discharge was scant, suggesting pain due to blood stasis. Treatment should focus on resolving blood stasis, which should alleviate the pain.
Prescription Raw Dioscoreae Rhizome (Sheng Huai Shanyao, 生怀山药) 1 liang, Angelicae Sinensis Radix (Danggui, 当归) 5 qian, Achyranthis Bidentatae Radix (Huai Niuxi, 怀牛膝) 5 qian, Raw Endothelium Corneum Gigeriae Galli (Sheng Jineijin, 生鸡内金) 2 qian (yellow part crushed), Persicamiae Semen (Taoren, 桃仁) 2 qian, Carthami Flos (Honghua, 红花) 1.5 qian, Genuine American Ginseng (Zhen Xiyangshen, 真西洋参) 2 qian (coarsely powdered). Decoct the first six herbs into one large cup. Take half the American Ginseng powder with the initial decoction, and the remaining half with the dregs decoction.
Outcome Taking one dose daily, the disease was completely cured after two days.
Interrogation: In other prescriptions, Gypsum Fibrosum is decocted with other herbs. Why was it used as a powder for this case? Response: Gypsum Fibrosum is naturally heavy and sinking. In this case, the wheezing was so forced that respiration remained only in the throat, unable to descend, nearing collapse. Using it as a powder aims to utilize its heavy, sinking property to guide Qi downward. Moreover, powdered Gypsum Fibrosum is potent; one qian is equivalent to half a liang in heat-clearing effect, verified by my own trials. In this case, up to 6 qian of powder were taken daily before the high fever subsided. If 3 liang of raw Gypsum Fibrosum were decocted, the family might refuse to administer it. To save the patient, compromise in method was necessary.
Interrogation: Cold and cooling herbs are contraindicated postpartum. The third prescription used 3 liang of Scrophulariae Radix after miscarriage. Is there no concern regarding its excessive bitter-cold nature? Response: Scrophulariae Radix tastes sweet and slightly bitter when chewed; it is inherently sweet-cool and Yin-nourishing, not truly bitter-cold. Thus, *Shennong Bencao Jing* states it is slightly cold and effective for postpartum disorders. While cold herbs are generally avoided postpartum, Scrophulariae Radix is an exception. Later materia medica warns against its use in loose stools due to mistaken belief in its bitter-cold nature. However, in this case, after taking 3 liang, the stool remained dry, confirming its nature.
Interrogation: The fetus was over eight months old; even if miscarried, it should have survived. Why was it dead? Response: The fetus breathes via the umbilicus, relying on the mother's respiration. In pregnancy, inhaled Qi reaches the fetal umbilicus through the Ren Mai. In this case, inhaled Qi could not descend, depriving the fetus of nourishment and protection, leading to death. The descent was due to lack of nourishment, not caused by the medication.