吴茭山治一少妇。初产四日。食冷物。觉身分不快。呕逆。饮食少思。心腹满闷。时或
腹胁刺痛。晨恶寒。晚潮热。夜则恍惚谵语。昼则抽搐。颇类风状。变异多端。诸医莫测。
或作虚风。或云血凝实热。用甘温行血。以寒凉退热。如此半月不效。吴至。见医满座。亦
局。诊其脉弦而紧。遂令按之。小腹急痛。知瘀血未尽也。思患者大势恶露已下。未必还
有余血。偶因寒凉所伤。瘀血停滞下焦。日久客于经络。所以变生诸证。须得大调经散。倍
入琥珀化诸恶血成水。其患方愈。遂合前药服之。五日后。行恶水斗许。臭不可近。患人觉
倦。病势渐减。然后以人参养荣汤数十帖。月余如初。
一妇产后恶露未尽。因起抹身。寒气客于经络。乍寒乍热。脉紧而弦。以葱白散。二帖
而安。
立斋治一产妇。恶寒发热。欲以八珍加炮姜治之。其家知医。以为风寒。用小柴胡汤。
薛曰。寒热不时。乃气血虚。不信。仍服一剂。汗出不止。谵语不绝。烦热作渴。肢体抽搐
薛用十全大补二剂。益甚。脉洪大。重按如无。仍以前汤加附子数剂。稍缓。再服而安。
震按前二案。以脉弦而紧知为瘀血。此案以脉洪大。重按如无。知为气血两虚。是真临
证指南也。但首案必须大调经散。次案必须葱白散。决非通套行血消瘀所能治。此案必须桂
附。亦非平补气血所能治。
吴茭山治疗一位年轻妇女。她刚生产四天，吃了生冷食物后，感觉身体不舒服，出现呕吐逆气、食欲不振、心腹部胀满闷痛的症状，有时腹胁部有针刺样的疼痛。早晨怕冷，傍晚像潮水一样定时发热，夜间神志恍惚说胡话，白天则发生抽搐，症状很像中风，变化多端，其他医生无法诊断清楚。有的认为是虚风内动，有的说是血凝实热，使用甘温药行血，用寒凉药退热，这样治疗半个月没有效果。
吴茭山到达时，看到诊室里坐满了医生，他也感到为难。他诊察病人的脉象弦而紧，于是让病人按压腹部，发现小腹部急迫疼痛，判断是瘀血未尽。考虑到患者大势下的恶露已经排出，未必还有余血残留，可能是偶然因寒凉所伤，导致瘀血停滞在下焦，日久客居在经络中，所以变生出各种证候。必须使用大调经散，加倍加入琥珀，将各种恶血化为水液，病患才能痊愈。于是配合前面的药物一起服用。五天后，排出了约一斗多的臭秽恶水，气味难闻，病人感到疲倦，病情逐渐减轻。然后用人参养荣汤几十帖，一个多月后恢复如初。
另一位产妇产后恶露未尽，因为起身擦拭身体，寒气侵入经络，出现忽冷忽热的症状，脉象紧而弦。使用葱白散，两帖后病情安定。
薛立斋治疗一位产妇，出现怕冷发热的症状，原本打算用八珍汤加炮姜来治疗。但这家人懂医理，认为是风寒，使用了小柴胡汤。薛立斋说：“寒热不时发作，是因为气血虚弱。”但家属不信，仍然服用了小柴胡汤一剂，结果汗出不止，胡话不停，烦躁发热口渴，肢体抽搐。
薛立斋改用十全大补汤两剂，病情反而加重，脉象洪大，重按却感觉空虚无力。于是还是用小柴胡汤（注：此处原文逻辑可能有误或指代前文语境，通常此类危重症应转为补益回阳，但依原文翻译）加上附子几剂，病情稍缓，再服用后安定。
俞震按语：前两个案例，通过脉象弦而紧判断为瘀血；这个案例通过脉象洪大、重按如无，判断为气血两虚，这是真正的临证指南。但是第一个案例必须用大调经散，第二个案例必须用葱白散，绝不是通用的行血消瘀法所能治疗的。这个案例必须用桂枝、附子，也不是平和地补益气血所能治疗的。
Wu Jiaoshan treated a young woman. Four days after her first childbirth, she consumed cold food and felt unwell, experiencing nausea, vomiting, loss of appetite, fullness and distension in the heart and abdomen, and occasional stabbing pain in the abdomen and hypochondrium. She experienced chills in the morning and tidal fever in the evening, with delirium at night and convulsions during the day, resembling wind-stroke (Zheng Feng) with varied manifestations. Other physicians were unable to diagnose the condition accurately. Some attributed it to deficiency-wind (Xu Feng), while others claimed it was blood stasis with excess heat, using sweet-warm herbs to move blood and cold-cool herbs to clear heat. After half a month of such treatment, there was no effect.
When Wu arrived, he found the consulting room crowded with doctors, feeling somewhat constrained. He palpated her pulse, which was wiry (Xian) and tight (Jin). He instructed her to press on her lower abdomen, revealing acute tenderness, and concluded that lochia (E Lu) stasis remained incomplete. Considering that the main flow of lochia had already been discharged, residual blood might not be significant; however, due to injury from cold-cool substances, blood stasis had stagnated in the Lower Jiao (Lower Burner) and lingered in the meridians over time, generating various symptoms. He prescribed Da Tiao Jing San (Great Menstruation Regulating Powder), doubling the dosage of Hupo (Amber) to transform the pathological blood into fluid, so that the patient could recover. The prescribed medicine was taken together. Five days later, the patient passed about one dou (a unit of volume) of foul-smelling dark fluid. Feeling fatigued, her condition gradually improved. Subsequently, she took dozens of doses of Renshen Yang Rong Tang (Ginseng Nourishing Qi and Blood Decoction), and within more than a month, she returned to normal health.
Another postpartum woman had incomplete lochia discharge. Due to getting up to wipe her body, cold pathogenic factors invaded the meridians, causing alternating chills and fever with a tight and wiry pulse. She was treated with Cong Bai San (Scallion White Powder), and recovered after two doses.
Xue Lizhai treated a postpartum woman suffering from aversion to cold and fever. He initially intended to treat her with Bazhen Tang (Eight Treasures Decoction) plus Pao Jiang (Prepared Ginger). However, her family, who understood medicine, believed it was Wind-Cold (Feng Han) and administered Xiao Chai Hu Tang (Minor Bupleurum Decoction). Xue stated, "Irregular chills and fever indicate deficiency of Qi and Blood." The family did not believe him and continued with one dose of Xiao Chai Hu Tang. Consequently, she suffered from profuse sweating, continuous delirium, irritability, fever, thirst, and limb convulsions.
Xue then used Shiquan Dabu Tang (Ten Significant Tonifying Decoction) for two doses, but the condition worsened. Her pulse became surging (Hong Da) yet empty upon heavy pressure. He reverted to the previous formula (implied context suggests modification or specific application, though text says 'previous soup') adding Fuzi (Aconite Root) for several doses. Her condition slightly stabilized, and she recovered after further administration.
Zhen noted: In the first two cases, the wiry and tight pulse indicated blood stasis; in this case, the surging pulse that feels empty upon deep pressure indicated dual deficiency of Qi and Blood. This serves as a true guide for clinical practice. However, the first case required Da Tiao Jing San, and the second required Cong Bai San; neither could be treated by generic blood-moving and stasis-resolving methods. This case required Guizhi (Cinnamon Twig) and Fuzi; it could not be treated by mild Qi and Blood tonification.