经不止。是血分有热。脾气尚虚。以逍遥散倍用白术、茯苓、陈皮。又以补中益气加酒炒芍
药。兼服而安。
一妇人月经不调。晡热内热。饮食少思。肌体消瘦。小便频数。服济阴丸。月经不行。
四肢浮肿。小便不通。曰。此血分也。朝用椒仁丸。夕用归脾汤。渐愈。乃以人参丸代椒仁
丸。两月余将愈。专用归脾汤五十余剂而痊。
一 妇月经不调。小便短少。或用清热分利之剂。小便不利。三月余。身面浮肿。月经
不通。曰。此水分也。遂朝用葶苈丸。夕用归脾汤。渐愈。乃用人参丸间服而愈。以上二证
作脾虚水气。用分利等药而没者。多矣。
震按立斋治病。善于温补。若攻伐之药。非其所长。今此三案。首案是其本色。后二案
全宗陈氏良方治法。其椒仁丸中有芫花、 青、斑蝥、信砒峻毒之品。竟毅然用之。虽兼佐
归脾汤。而毒药力猛。甚为担险。即葶苈人参二丸。亦非轻剂。乃二病皆痊。譬之名将。或
攻或守。或奇或正。总操必胜之着。虽履险而如夷也。
一妇内热作渴。饮食少思。腹内近左。初如鸡卵。渐大四寸许。经水三月一至。肢体消
瘦。齿颊似疮。脉洪数而虚。左关尤甚。此肝脾郁结之证。外贴阿魏膏。午前用补中益气汤
午后以加味归脾汤。两月许。肝火少退。脾土少健。仍与前汤送下六味地黄丸。午后又用
逍遥散送归脾丸。又月余。日用芦荟丸。以大皂角、青黛、芦荟、朱砂、麝香各一钱。另以
干虾蟆用皂角等分烧存性。为末一两。入前项药。同为末。蒸饼丸如麻子大。每日二服。空
腹以逍遥散下。日晡以归脾汤下。喜其谨疾。调理年余而愈。
震按古方治 瘕。有芦荟丸。用芦荟、黄连、胡黄连、木香、芜荑、青皮各五钱。当归
茯苓、陈皮各一两五钱。炙草七钱。米糊丸云。治疳瘕。肌肉消瘦。发热。饮食少思。口
干作渴。齿颊生疮等证。与此方大同小异。而叙证悉同。济阴纲目注。谓小儿疳积腹胀者宜
用。疑与妇人非宜。意其误收。今观此案。而后知集书者之不误收也。
孙东宿治马二尹媳。每月汛行。子户旁辄生一肿毒。胀而不痛。过三五日。以银簪针破
出白脓盏许而消。不必贴膏药而生肉。无疤痕。但汛行即发。或上下左右无定所。第不离
子户也。内外科历治数年不效。且致不孕。因询于孙。沉思两日而悟曰。此中焦湿痰。
随经水下
流。壅于子户也。经下而痰凝。故化为脓。原非毒。故不痛。用白螺蛳壳火 存性为君。南
星、半夏为臣。柴胡
甘草为佐。面糊丸。早晚服之。遂愈。
震按孙公颖悟。殊不可及。原非毒。故不痛。亦格致名言。
〔附〕一寡妇体弱。每逢月事声哑。沈尧封曰。肝肾之络。俱上连肺。精血下注。肺中
必枯。故哑。用地黄、天冬、肉苁蓉、归身等大补精血。病反甚。加细辛五分。通厥少之络
才入口。声即出。后用八味丸调理。经来不哑。
震按今人称月事为天癸者。谬也。经云。女子二七而天癸至。任脉通。太冲脉盛。月事
以时下。又云。男子二八而肾气盛。天癸至。精气溢泻。若天癸即月事。丈夫有之乎。顾名
思义。谓是天一之真水。乃精血之源头也。盖男女皆有精。易云。男妇媾精。可据。然指天
癸为精。亦不妥。天癸为精。不该又云。精气溢泻矣。后贤讲受孕之道。有阳精阴血。先至
后冲等说。亦谬。夫男女交接。曾见女人有血出耶。交接出血是病。岂能裹精。及为精所裹
哉。大约两情欢畅。百脉齐到。天癸与男女之精偕至。斯入任脉而成胎耳。男胎女胎则由夫
妇之天癸。有强弱盈虚之不同也。任脉督脉。皆起于前后两阴交之会阴穴。督总诸阳。任总
诸阴。任脉隶足少阴。冲脉隶足阳明。所谓冲为血海。任主胞胎也。经云。前阴总宗筋之所
会会于气街。而阳明为之长。阳明水谷之精华。变化成血以灌输太冲。太冲脉盛。月事以时
下矣。既孕则血聚以养胎。不能输入太冲。故月事不下。由此辨之。任脉通而天癸至。冲脉
盛而月事下。明系两项矣。
月经淋漓不止。这是血分有热。脾气尚且虚弱。使用逍遥散并加倍白术、茯苓、陈皮用量。同时服用补中益气汤加入酒炒芍药。两方兼服而病愈。
一位妇人月经不调。傍晚发热及内热。饮食减少不想进食。身体消瘦。小便频数。服用济阴丸后。月经停止不行。四肢浮肿。小便不通畅。我说。这是血分病。早晨服用椒仁丸。晚上服用归脾汤。逐渐痊愈。后来用人参丸代替椒仁丸。两个多月快要痊愈时。专门使用归脾汤五十多剂而完全康复。
一位妇人月经不调。小便短少。有人使用清热利湿的药物。导致小便更加不利。三个多月后。全身和面部浮肿。月经不通畅。我说。这是水分病。于是早晨服用葶苈丸。晚上服用归脾汤。逐渐痊愈。后来用人参丸交替服用而治愈。以上两种证候。因为脾虚水气。使用分利等药物而死亡的。已经很多了。
俞震按语：薛立斋治病。善于温补。对于攻伐类药物。不是他的专长。现在这三则医案。第一案是他的本色风格。后两案完全遵循陈氏良方的治法。其中的椒仁丸含有芫花、青黛、斑蝥、信砒等峻烈有毒的药物。竟然毅然使用。虽然兼用归脾汤佐助。但毒药药力猛烈。非常冒险。即使是葶苈丸和人参丸。也不是轻缓的药剂。然而这两种病都痊愈了。好比名将。或进攻或防守。或出奇兵或正兵。总是掌握必胜的策略。虽然经历险境却如履平地。
一位妇人内热口渴。饮食减少不想进食。腹部左侧近处。起初像鸡蛋大小。逐渐增大到四寸左右。月经三个月来一次。肢体消瘦。牙齿和脸颊似有疮疡。脉象洪大而数且虚。左关脉尤其明显。这是肝脾郁结的证候。外部贴敷阿魏膏。午前服用补中益气汤。午后服用加味归脾汤。两个多月后。肝火稍微减退。脾土稍微强健。仍然用前面的汤药送服六味地黄丸。午后又用逍遥散送服归脾丸。又过了一个多月。每天服用芦荟丸。以大皂角、青黛、芦荟、朱砂、麝香各一钱。另外取干蟾蜍与大皂角等量烧存性。研为末一两。加入前面的药物。共同研为细末。用蒸饼做丸如麻子大。每天服用两次。空腹时用逍遥散送下。傍晚时用归脾汤送下。庆幸她谨慎调养。调理一年多而痊愈。
俞震按语：古方治疗瘕积。有芦荟丸。使用芦荟、黄连、胡黄连、木香、芜荑、青皮各五钱。当归、茯苓、陈皮各一两五钱。炙甘草七钱。米糊为丸。说能治疗疳积瘕块。肌肉消瘦。发热。饮食减少不想进食。口干口渴。牙齿脸颊生疮等证候。与此方大同小异。而且叙述的证候完全相同。《济阴纲目》注解说。小儿疳积腹胀者适宜使用。怀疑不适合妇人。认为是误收。现在看了这个医案。才知道编书的人没有误收。
孙东宿治疗马二尹的儿媳。每月月经来潮时。子宫旁边就会生出一个肿毒。肿胀但不疼痛。过三五天。用银簪针刺破流出约一盏白脓后消退。不需要贴膏药就能长肉。没有疤痕。只是月经来潮就发作。位置上下左右不定。只是不离开子宫部位。内外科治疗数年无效。并且导致不孕。于是向孙东宿咨询。沉思两天后领悟说。这是中焦湿痰。随着经水下流。壅塞在子宫部位。经血下行而痰凝滞。所以化为脓液。原本不是毒邪。所以不痛。用白螺蛳壳煅烧存性作为君药。南星、半夏作为臣药。柴胡、甘草作为佐使药。面糊为丸。早晚服用。于是痊愈。
俞震按语：孙公聪慧悟性。实在不可企及。原本不是毒邪。所以不痛。也是格物致知的名言。
〔附〕一位寡妇身体虚弱。每逢月经来潮声音嘶哑。沈尧封说。肝肾的络脉。都向上连接肺部。精血向下注注。肺中必然枯槁。所以声音嘶哑。用地黄、天冬、肉苁蓉、当归身等大补精血。病情反而加重。加入细辛五分。疏通厥阴、少阴的络脉。药才入口。声音立即恢复。后来用八味丸调理。月经来潮时不再嘶哑。
俞震按语：现在人称月经为天癸。是错误的。《内经》说。女子十四岁天癸至。任脉通畅。太冲脉盛。月经按时来潮。又说。男子十六岁肾气盛。天癸至。精气满溢泻出。如果天癸就是月经。男子也有吗？顾名思义。说是天一之真水。是精血的源头。大概男女都有精。《易经》说。男女媾精。可以依据。然而指天癸为精。也不妥当。如果说天癸是精。就不该又说精气溢泻了。后世贤人讲解受孕之道。有阳精阴血。先至后冲等说法。也是错误的。男女交合。曾见过女人出血吗？交合出血是病。怎么能裹挟精液。以及被精液所裹挟呢？大约两情欢畅。百脉齐至。天癸与男女之精一同到达。这才进入任脉而成胎。男胎女胎则由夫妇的天癸。有强弱盈虚的不同。任脉督脉。都起于前后二阴交汇的会阴穴。督脉总领诸阳。任脉总领诸阴。任脉隶属于足少阴。冲脉隶属于足阳明。所谓冲为血海。任主胞胎。《内经》说。前阴是宗筋汇聚之处。汇聚于气街。而阳明为之统领。阳明水谷的精华。变化成血以灌输太冲。太冲脉盛。月经按时来潮了。既然怀孕则血液聚集以养胎。不能输入太冲。所以月经不来。由此辨析。任脉通而天癸至。冲脉盛而月经下。明显是两回事了。
Menstruation flows incessantly. This is due to heat in the blood level (Xue Fen). The Spleen Qi is still deficient. Use Xiaoyao San (Free and Easy Wanderer Powder) with doubled doses of Baizhu (Atractylodis Rhizoma), Fuling (Poria), and Chenpi (Citri Reticulatae Pericarpium). Concurrently administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Jiu Chao Shaoyao (Wine-fried Paeoniae Radix Alba). Both taken together, the condition resolved.
A woman suffered from irregular menstruation, afternoon fever (Bure Re), internal heat, reduced appetite, emaciation, frequent urination. After taking Ji Yin Wan (Nourish Yin Pill), her menstruation ceased. She developed edema of the four limbs and urinary retention. I said, "This is a disorder of the Blood Level." In the morning, use Jiaoren Wan (Pepper Kernel Pill); in the evening, use Guipi Tang (Restore the Spleen Decoction). Gradually improved. Later, replace Jiaoren Ren with Renshen Wan (Ginseng Pill). After more than two months, nearly cured. Specifically using Guipi Tang for over fifty doses resulted in full recovery.
Another woman had irregular menstruation and scanty urine. Someone used clearing-heat and separating-turbidity agents, leading to difficult urination. After more than three months, she developed generalized and facial edema and amenorrhea. I said, "This is a disorder of the Water Level." Thus, in the morning use Tingli Wan (Descurainiae Semen Pill); in the evening, Guipi Tang. Gradually improved. Then use Renshen Wan intermittently until cured. Regarding the above two cases, many have died from using diuretic agents for Spleen deficiency with water qi accumulation.
Yu Zhen's commentary: Xue Lizhai was skilled in warm tonification. Aggressive draining methods were not his strength. In these three cases, the first reflects his characteristic style. The latter two fully follow the treatment methods of Chen's Liang Fang. The Jiaoren Wan contains harsh and toxic substances such as Yuanhua (Kadupul Flower), Qingdai (Indigo Naturalis), Banmao (Mylabris), and Xinbi (Arsenic Trioxide). He boldly used them. Although assisted by Guipi Tang, the toxicity was potent and highly risky. Even Tingli Wan and Renshen Wan are not mild formulas. Yet both illnesses were cured. It is like a famous general who knows when to attack or defend, use unorthodox or orthodox tactics, always holding the winning strategy, navigating danger as if it were flat ground.
A woman suffered from internal heat and thirst, reduced appetite. Near the left side of her abdomen, a mass initially like an egg gradually grew to about four cun. Menstruation occurred once every three months. Her limbs were emaciated, and her teeth and cheeks resembled sores. The pulse was surging, rapid, and deficient, especially at the Left Guan position. This is a pattern of Liver and Spleen Qi stagnation and knotting. Apply Awei Gao (Asafoetida Plaster) externally. In the forenoon, use Buzhong Yiqi Tang; in the afternoon, Jiawei Guipi Tang (Modified Restore the Spleen Decoction). After about two months, Liver fire slightly subsided, and Spleen Earth slightly strengthened. Continue with the previous decoction to deliver Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). In the afternoon, use Xiaoyao San to deliver Guipi Wan. Another month later, daily use Lulu Wan (Aloe Pill) made of Dagongcao (Terminalia Chebula Retusa Fruit), Qingdai, Lulu (Aloe), Zhusha (Cinnabar), and Shexiang (Moschus), each one qian. Separately, dry Bu (Toad) and Dagongcao in equal proportions, calcined to preserve nature, ground into powder, one liang. Mix with the aforementioned drugs, grind together, make pills with steamed dough the size of hemp seeds. Take twice daily. In the empty stomach, take with Xiaoyao San; in the late afternoon, take with Guipi Tang. Fortunately, she was diligent in avoiding illness. After more than a year of regulation, she recovered.
Yu Zhen's commentary: Ancient formulas for treating abdominal masses include Lulu Wan, using Lulu, Huanglian (Coptidis Rhizoma), Huhuanglian (Coptidis Rhizoma var. chinensis), Muxiang (Aucklandiae Radix), Wuyi (Chrysanthemi Indici Flos), and Qingpi (Citri Reticulatae Pericarpium Viride), each five qian. Danggui (Angelicae Sinensis Radix), Fuling, and Chenpi, each one liang five qian. Zhi Gancao (Prepared Licorice Root), seven qian. Made into pills with rice paste. It treats infantile malnutrition with abdominal masses, emaciation, fever, reduced appetite, dry mouth and thirst, sores on teeth and cheeks. This formula is largely similar to the one above, and the symptoms described are identical. *Ji Yin Gang Mu* notes that it is suitable for children with infantile malnutrition and abdominal distension, doubting its suitability for women, suggesting it was erroneously included. Now, seeing this case, we know the compiler did not err.
Sun Dongsu treated the daughter-in-law of Magistrate Ma. Every time her menstrual period arrived, a swelling would appear beside the uterus (Zihu). It was swollen but painless. After three to five days, punctured with a silver hairpin, releasing about a cup of white pus, after which it subsided. Flesh regenerated without plasters, leaving no scar. It flared up only during menstruation, located variably above, below, left, or right, but never far from the uterus. Treated by internal and external medicine specialists for years without effect, leading to infertility. She consulted Sun. After pondering for two days, he realized: "This is damp-phlegm from the Middle Jiao flowing down with the menstrual blood, obstructing the uterus. As the blood flows, phlegm coagulates, transforming into pus. Originally not toxin, hence painless." Use Bai Luosi Ke (White Conch Shell) calcined as the sovereign herb. Nanxing (Arisaematis Rhizoma Preparatum) and Banxia (Pinelliae Rhizoma Preparatum) as ministers. Chaihu (Bupleuri Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) as assistants. Make pills with flour paste. Take morning and evening. Cured.
Yu Zhen's commentary: Master Sun's insight is unsurpassable. "Originally not toxin, hence painless" is also a profound statement derived from investigating things.
[Appendix] A widow was weak. Every time her menses arrived, her voice became hoarse. Shen Yaofeng said: "The collaterals of the Liver and Kidney connect upwards to the Lung. When essence and blood flow downward, the Lung becomes dry, causing hoarseness." Used Dihuang (Rehmanniae Radix), Tiandong (Asparagi Rhizoma), Roucongrong (Cynomorii Herba), and Danggui Shen (Angelicae Sinensis Radix Radix) to greatly tonify essence and blood. The condition worsened. Added Xixin (Asari Radix et Rhizoma), five fen. To unblock the Jueyin and Shaoyin collaterals. Upon entering the mouth, the voice immediately returned. Later regulated with Bawei Wan (Eight-Ingredient Pill). Menstruation arrived without hoarseness.
Yu Zhen's commentary: People today call menstruation Tian Gui (Heavenly Water). This is incorrect. The *Classic of Internal Medicine* states: "At fourteen, a girl's Tian Gui arrives, the Ren Mai becomes patent, and the Chong Mai becomes abundant, so menstruation occurs on time." It also says: "At sixteen, a boy's Kidney Qi becomes abundant, Tian Gui arrives, and essence overflows and ejaculates." If Tian Gui were menstruation, do men have it? By its name, it refers to the True Water of Heaven Yi, the source of essence and blood. Generally, both men and women possess essence. The *I Ching* says: "Male and female unite their essence," which is credible. However, identifying Tian Gui as essence is also inappropriate. If Tian Gui were essence, it should not say "essence overflows and ejaculates." Later scholars discussing conception proposed theories like "Yang essence and Yin blood, arriving first and second," which are also erroneous. Have you ever seen a woman bleed during sexual intercourse? Bleeding during intercourse is a pathology. How can it wrap essence, or be wrapped by essence? Roughly speaking, when mutual passion is high and all pulses converge, Tian Gui and the essence of man and woman arrive together. Only then does it enter the Ren Mai to form a fetus. Male or female fetuses depend on the strength, weakness, fullness, or emptiness of the couple's Tian Gui. The Ren Mai and Du Mai both originate from the Huiyin point where the anterior and posterior orifices meet. The Du Mai governs all Yang meridians; the Ren Mai governs all Yin meridians. The Ren Mai belongs to the Foot Shaoyin; the Chong Mai belongs to the Foot Yangming. It is said that the Chong is the Sea of Blood, and the Ren governs the womb. The *Classic* states: "The anterior orifice is the convergence of the Zong Jin (General Tendons), converging at Qichong, with Yangming as its leader. The essence of water and grain from Yangming transforms into blood to irrigate the Taichong. When the Taichong Mai is abundant, menstruation occurs on time." Once pregnant, blood gathers to nourish the fetus and cannot irrigate the Taichong, so menstruation stops. From this analysis, "Ren Mai becomes patent and Tian Gui arrives" versus "Chong Mai becomes abundant and menstruation flows" are clearly two distinct phenomena.