丹溪治一妇产后。四肢浮肿。寒热往来。盖因败血流入经络。渗入四肢。气喘咳嗽。胸
膈不利。口吐酸水。两胁疼痛。遂用旋复花汤。微汗渐解。频服小调经。用泽兰梗煎汤调下
肿气渐消。
震按此系败血流经之肿。乃产后浮肿之一端耳。其不因败血而肿者。又当另法以治。但
产后浮肿。亦是险证。此二方未必能效。
汪石山曰。余一日庄居。一乡人踵门哀恳。道其妻产后。数喘促不能卧。痰与血交涌而
上。日夜两人扶坐。才侧身壅绝。乞救疗之。余以意度。新产后。血气脾胃。大虚顿损。故
虚痰壅盛。而败血乘之。犀角六君子加失笑散。一服痰血俱下。喘亦立止。次日来谢云。诸
病皆去。止不能食耳。与参苓白术散调理全愈。
震按此证甚危。此方甚巧。若用六君而不加犀角失笑散。则不应。用犀角失笑散而不合
六君。亦不应。但以意度之。不凭脉象。固由汪公熟能生巧。而其病机。在乎痰与血交涌而
上。才侧身。便壅绝。显系败血随痰上升。然非血气脾胃之大虚。败血何由随痰上升耶。此
方所以恰对也。闭门造车。出门合辙。先生之谓欤。
一产妇因收生者不谨。损破尿胞。而致淋沥不禁。丹溪曰。肌肉破伤。在外者。尚可完
补。胞虽在腹。恐亦可治。诊其脉虚甚。盖难产。因气血虚。故产后尤虚。试与峻补。以参
术为君。芎、归为臣。桃仁、陈皮、黄 、茯苓为佐。以猪羊胞煎汤熬药汁。极饥饮之。
一月而安。盖气而骤长。其脬即完。恐稍迟即难成功也。
一妇产后。阴户下一物如合钵状。有二岐。此子宫也。气血弱。故随子而下。用升麻、
当归、黄 大剂。服二次。仍用皮工之法。以五倍子作汤洗濯。皴其皮。后觉一响而收入。
但经宿着席。破落一片如掌大。心甚恐。朱曰。非肠胃比也。肌肉破尚可复完。以四物加人
参数十帖。三年后。复生一子。
震按难产因气血虚。故产后尤虚。此是至言。然以论损破尿胞。脱下子宫者。尤为确切
不移。他证又当活看。
朱丹溪治疗一位产后妇女。四肢浮肿，寒热交替发作。这是因为恶露（产后残留的瘀血）流入经络，渗入四肢，导致气喘咳嗽，胸膈部气机不畅，口吐酸水，两胁疼痛。于是使用旋复花汤，通过微微出汗使症状逐渐缓解。频繁服用小调经散，用泽兰梗煎汤送服，肿胀之气逐渐消退。
俞震按语：这属于恶露流注经络引起的浮肿，只是产后浮肿的一种情况罢了。那些不是因为恶露而导致的浮肿，又应当用其他方法治疗。但是，产后浮肿也是一种危险的证候，这两个方子未必都能见效。
汪石山说：我有一天住在乡间庄园，一位乡亲登门哀求救助，说他妻子产后，多次出现气喘急促、不能平卧的症状，痰液与血液交涌而上，日夜需要两个人扶着坐起，稍微侧身就会感到气息阻塞不通。请求救治。我凭经验推测，新近产后，气血和脾胃都极度虚弱受损，所以虚痰壅盛，败血趁机上逆。使用犀角六君子汤加入失笑散，服用一次后，痰和血都排下了，气喘也立刻停止。第二天来道谢说，各种病症都去除了，只有不能进食。给予参苓白术散调理，完全痊愈。
俞震按语：这个病证非常危险，这个方子非常巧妙。如果只用六君子汤而不加犀角和失笑散，就不会有效；如果用犀角和失笑散而不配合六君子汤，也不会有效。只是凭主观推测，不依赖脉象，固然因为汪医生熟能生巧，但其病机在于痰与血交涌而上，稍微侧身就导致气机阻塞，明显是败血随着痰液上升。然而，如果不是气血脾胃的大虚，败血怎么会随着痰液上升呢？这个方子之所以恰好对症，正是如此。“闭门造车，出门合辙”，说的就是先生您吧。
一位产妇因为接生者不慎，损伤破裂了膀胱，导致尿液淋漓不尽。朱丹溪说：肌肉破损受伤，在体表的还可以修补完整，膀胱虽然在腹腔内，恐怕也可以治疗。诊察她的脉象非常虚弱，这是由于难产，因为气血虚弱，所以产后更加虚弱。尝试给予峻补，以人参、白术为君药，川芎、当归为臣药，桃仁、陈皮、黄芪、茯苓为佐药，用猪羊膀胱煎汤熬制药汁，在极度饥饿时饮用。一个月后病情安定。因为气迅速生长，膀胱就能恢复完整，恐怕稍晚一点就难以成功了。
一位妇女产后，阴户下方有一个物体像倒扣的钵状，有两个分叉，这是子宫。因为气血虚弱，所以随胎儿一起脱出。使用升麻、当归、黄芪大剂量服用两次，随后仍用皮匠的方法，用五倍子煎汤清洗，使其皮肤皱缩，后来听到一声响便收入体内。但经过一夜躺在席子上，破落了一片手掌大小的皮，心里非常恐惧。朱丹溪说：这不是肠胃相连的部分。肌肉破损还可以重新愈合。用四物汤加入人参几十帖，三年后，又生了一个孩子。
俞震按语：难产因为气血虚弱，所以产后更加虚弱，这是至理名言。然而用来论述损伤破裂膀胱、子宫脱垂的情况，尤为确切不移。其他病症又应当灵活看待。
Zhu Danxi treated a postpartum woman presenting with edema of the four limbs and alternating chills and fever. This was due to lochia (residual blood after childbirth) flowing into the meridians and infiltrating the limbs, resulting in panting, coughing, chest and diaphragm discomfort, vomiting of sour fluid, and pain in both hypochondria. He then prescribed Xuanfu Hua Tang (Inula Flower Decoction), which gradually resolved the symptoms through mild sweating. She frequently took Xiaotiaojing San (Minor Regulating Menses Powder), administered with decoction of Zelan Geng (Eclipta Stem) to help dissipate the swelling.
Yu Zhen’s commentary: This type of edema is caused by lochia flowing into the meridians and represents only one aspect of postpartum edema. Edema not caused by lochia requires different treatment methods. However, postpartum edema is also a critical condition, and these two formulas may not necessarily be effective.
Wang Shishan stated: One day, while residing in my country estate, a villager came to my door begging for help, saying his wife had recently given birth and was suffering from frequent panting and shortness of breath, unable to lie flat. Phlegm and blood surged upward together, requiring two people to support her sitting upright day and night; any slight change in position caused airway obstruction. I requested treatment. Based on my clinical judgment, immediately after childbirth, Qi, Blood, Spleen, and Stomach are severely deficient and damaged. Thus, deficiency-phlegm becomes abundant, and lochia takes advantage of this weakness to ascend. I prescribed Xijiao Liujunzi Tang (Rhinoceros Horn Six Gentlemen Decoction) combined with Shixiao San (Instant Success Powder). After one dose, phlegm and blood were expelled, and the pantting stopped immediately. The next day, he returned to thank me, stating that all other symptoms had resolved, except for an inability to eat. I prescribed Shenling Baizhu San (Ginseng and Poria Powder to Strengthen the Spleen) for regulation, leading to complete recovery.
Yu Zhen’s commentary: This condition is very critical, and this formula is quite ingenious. If one used only Liujunzi Tang without adding Xijiao (Rhinoceros Horn) and Shixiao San, it would not have worked. Conversely, using Xijiao and Shixiao San without combining them with Liujunzi Tang would also have failed. Relying solely on subjective judgment without pulse diagnosis demonstrates Dr. Wang’s skill derived from experience. The pathogenesis lies in the simultaneous surging of phlegm and blood upwards, causing obstruction upon slight movement, clearly indicating that lochia ascends following the phlegm. However, without severe deficiency of Qi, Blood, Spleen, and Stomach, how could lochia ascend with the phlegm? This formula is precisely targeted. "Building a cart behind closed doors that fits the ruts outside" perfectly describes your approach, Sir.
A parturient woman suffered from continuous urinary leakage because the midwife was negligent and ruptured the bladder (Niaopao). Zhu Danxi said: When muscles are injured externally, they can still be repaired. Although the bladder is located within the abdomen, it is likely treatable as well. Her pulse was extremely deficient, indicating that difficult labor resulted from Qi and Blood deficiency, making the postpartum state even more depleted. I attempted vigorous tonification, using Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala Rhizome) as sovereign herbs, Chuan Xiong (Szechwan Lovage Rhizome) and Dang Gui (Angelica Sinensis Root) as minister herbs, Tao Ren (Peach Kernel), Chen Pi (Tangerine Peel), Huang Qi (Astragalus Root), and Fu Ling (Poria) as assistant herbs. The medicine was decocted in a broth made from pig or sheep bladders and consumed when extremely hungry. Within one month, she stabilized. Rapid regeneration of Qi allows the bladder to heal completely; delay might hinder success.
Another postpartum woman presented with a mass protruding from the vagina resembling an inverted bowl with two branches, which was the uterus (Zigong). Due to weak Qi and Blood, the uterus descended along with the fetus. She received large doses of Sheng Ma (Cimicifuga Rhizome), Dang Gui, and Huang Qi twice. Subsequently, a tanner’s method was employed: washing the area with Wu Bei Zi (Galla Chinensis) decoction to induce skin contraction. Afterward, a snapping sound was heard, and the organ retracted. However, lying on the mat overnight caused a palm-sized piece of tissue to slough off, causing great fear. Zhu Danxi said: This is not connected to the intestines or stomach. Muscle injuries can still heal. She took dozens of doses of Siwu Tang (Four Substance Decoction) added with Ren Shen. Three years later, she gave birth to another child.
Yu Zhen’s commentary: Difficult labor due to Qi and Blood deficiency leads to an even more deficient postpartum state; this is a profound truth. However, regarding the discussion of ruptured bladder and uterine prolapse, the analysis is particularly accurate and unshakable. Other conditions should be viewed flexibly.