奉化陆严治新昌徐氏妇。病产后暴死。但胸膈微热。陆诊之曰。此血闷也。用红花数十
斤。以大锅煮之。候汤沸。以木桶盛汤。将病者寝其上熏之。汤气微。复进之。有顷。妇人
指动。半日遂醒。此法与许允宗治王太后之意同。
立斋治一妇产后。小腹作痛。忽牙关紧急。灌以失笑散。良久而苏。又用四物加炮姜、
白术、陈皮而愈。
震按血晕皆因恶血冲心。当于纲目中选择验过之方。如上二条。乃正治法。而丹溪治一
妇。面白形长。心郁。半夜生产。清晨晕厥。急灸气海十五壮而苏。后以参、术等药。服两
月而安。此阳虚也。乃变法也。
一产妇因产饮酒。恶露甚多。患血晕。口出酒气。此血得酒热而妄行。虚而作晕也。以
佛手散加干葛二钱。一剂而痊。
立斋云。产后饮酒能致晕。产室人众。喧嚷气热。亦能致晕。
立斋治一产妇。腹痛发热。气口脉大。薛以为饮食停滞。不信。乃破血补虚。反发热头
痛。呕吐涎沫。又用降火化痰理气。四肢逆冷。泄泻下坠。始悔。问曰。何也。薛曰。此脾
胃虚之变证也。法当温补。遂用六君子加炮姜二钱。肉桂、木香各一钱。四剂。诸证悉退。
再用补中益气之剂。元气遂复。
震按气口脉大。故认停食。后以误药而变四肢逆冷。泄泻下坠。诚变为虚寒证矣。但不
知脉象若何。若脉亦变为细软。则温补得效。设脉仍大。则非所宜。或大而软。犹可用温补
以望其敛小。倘脉大且数。按之有力。其死可必。温补无益也。
一妇产后。腹痛后重。下痢无度。形体倦怠。饮食不甘。怀抱久郁。患茧唇。寐而盗汗
如雨。竟夜不敢寐。神思消烁。薛曰。气血虚而有热。用当归六黄汤。纳黄芩、连、柏炒黑
一剂汗顿止。再剂全止。乃用归脾汤、八珍散兼服。元气渐复而愈。
震按此证不难于用归脾八珍。而难于用当归六黄。恨不载脉。然留此案以见古人有是病
即用是药。勿拘定产后必当大补也。但苦寒之药。中病即止耳。
一产妇小腹作痛。有块。脉芤而涩。以四物加延胡、红花、桃仁、牛膝、木香治之而愈
一产妇小腹痛甚。牙关紧急。此瘀血内停。灌以失笑散。下血而苏。又用四物加炮姜、
白术、陈皮而愈。
震按此二案。乃恶露作痛之正法也。
一产妇小腹作痛。服行气破血之药。不效。其脉洪数。此瘀血内溃为脓也。以瓜子仁汤
二剂痛止。更以太乙膏下脓而愈。产后多有此病。纵非痈患。用之亦效。
一产妇小腹疼痛。小便不利。用薏苡仁汤。二剂痛止。更以四物加桃仁、红花。下瘀血
而愈。大抵此证。皆因荣卫不调。或瘀血停滞所致。若脉洪数。已有脓。脉但数。微有脓。
脉迟紧。乃瘀血。下之即愈。若腹胀大。转侧作水声。或脓从脐出。或从大便出。宜用蜡矾
丸、太乙膏。及托里药。
一妇人寒月中。产后腹大痛。觉有块。百方不治。一人教以羊肉四两。熟地黄二两。生
姜一两。水煎服之。二三次愈。
震按 漪子曰。觉有块。想是寒气乘虚而聚。非真实证也。不然。何以羊肉熟地能愈哉
此说可谓善于读书。至其所引衍义云。一妇人产当寒月。寒气入产门。脐下胀痛。手不得
犯。此寒疝也。医欲治之以抵当汤。谓其有瘀血耳。予教之曰。非其治也。可服仲景羊肉汤
少减作二服。愈。方即元方多川芎。以酒水同煎。或加葱盐。较之用熟地者。略为辛温。
然总治虚寒腹痛也。设于寒月血因寒凝。结瘀 痛。又当用琥珀丸、香桂散、及姜、桂、吴
茱、桃仁、蓬术、五灵脂等药。非仲景方均能见效也。且善悟者更当反是以观焉。寒之反为
热。如金匮下瘀血汤、河间玉烛散等方。又一例也。畏其峻者。回生丹亦妙。叶案谓取乎醋
煮大黄一味。药入病所。不碍无病之所。斯真妙解。想先生或从夺命丹。用醋水同煎法悟入
耶。
奉化人陆严治疗新昌县徐姓人家的妇女。该产妇在分娩后突然死亡（意识丧失），但胸部和膈部仍有微热。陆严诊察后说：“这是血闷证。”于是使用几十斤红花，用大锅煮水，待汤水沸腾后，用木桶盛装药汤，让患者躺在桶上熏蒸。当药气变淡时，再补充新的药汤。过了一会儿，产妇的手指开始活动，半天后便苏醒过来。这种方法与许允宗治疗王太后的意图相同。
立斋治疗一位产后妇女，小腹部疼痛，突然牙关紧闭（痉挛）。灌服失笑散后，过了很久才苏醒。随后又使用四物汤加入炮姜、白术、陈皮，病情痊愈。
俞震按语：血晕都是因为恶露（产后余血浊液）冲心所致，应当在《本草纲目》等典籍中选择经过验证的方剂。如上两条案例，属于正治法。而丹溪治疗一位妇女，面色苍白，身形瘦长，心中郁结，半夜生产，清晨出现晕厥。紧急灸气海穴十五壮后苏醒，后来用人参、白术等药物，服用两个月后才安稳。这属于阳虚证，是变法。
另一位产妇因产后饮酒，恶露量非常多，患血晕症，口中呼出酒气。这是因为血液受酒热影响而妄行，因虚而致晕。使用佛手散加入干葛二钱，一剂药后痊愈。
立斋说：产后饮酒能导致晕厥，产房内人员众多，喧闹且热气重，也能导致晕厥。
立斋治疗一位产妇，腹痛发热，气口脉象盛大。薛己认为是饮食停滞所致，但家属不信。于是采用破血补虚的方法，反而导致发热、头痛、呕吐涎沫。后来又用降火化痰理气的药物，导致四肢逆冷、泄泻且有下坠感。此时才开始后悔，问道：“为什么会这样？”薛己说：“这是脾胃虚弱产生的变证。治疗方法应当温补。”于是使用六君子汤加入炮姜二钱、肉桂一钱、木香一钱，服用四剂后，所有症状全部消退。随后再用补中益气的药剂，元气得以恢复。
俞震按语：因为气口脉大，所以认定为停食。后因误用药物导致四肢逆冷、泄泻下坠，确实变成了虚寒证。只是不知道当时的脉象如何。如果脉象也变为细软，那么温补就会见效；假如脉象仍然盛大，就不适宜使用温补；或者脉象大而软，还可以用温补来期望其收敛变小。倘若脉象大且数，按之有力，那么死亡是必然的，温补就没有益处了。
一位产妇产后，腹痛伴有里急后重，痢疾无度，形体倦怠，饮食无味，怀抱长期抑郁，患上茧唇（嘴唇生疮如蚕茧），睡觉时盗汗如雨，整夜不敢入睡，神思消烁。薛己说：“这是气血虚弱而有热。”使用当归六黄汤，将黄芩、黄连、黄柏炒黑后加入，一剂后汗顿止，两剂后完全停止。随后使用归脾汤、八珍散兼服，元气逐渐恢复而痊愈。
俞震按语：这个病例不难于使用归脾汤和八珍散，而难于使用当归六黄汤。遗憾的是没有记载脉象。然而保留这个案例是为了展示古人有病即用相应的药，不要拘泥于产后必定要大补的观念。只是苦寒的药物，中病即止即可。
一位产妇小腹部疼痛，有肿块，脉象芤而涩。使用四物汤加入延胡索、红花、桃仁、牛膝、木香治疗而痊愈。
一位产妇小腹痛甚，牙关紧闭。这是瘀血内停，灌服失笑散，排出瘀血后苏醒。随后使用四物汤加入炮姜、白术、陈皮而痊愈。
一位产妇小腹部疼痛，服用行气破血的药物无效。其脉象洪数，这是瘀血内溃化为脓。使用瓜子仁汤，两剂后疼痛停止，再用太乙膏排出脓液而痊愈。产后多有此病，即使不是痈患，使用此法也有效。
一位产妇小腹疼痛，小便不利。使用薏苡仁汤，两剂后疼痛停止，再用四物汤加入桃仁、红花，排出瘀血而痊愈。大抵这类病症，都是由于营卫不调，或瘀血停滞所致。如果脉象洪数，说明已有脓；脉象仅数，说明微有脓；脉象迟紧，乃是瘀血，攻下瘀血即愈。如果腹胀大，转动身体时有水声，或者脓从脐部流出，或从大便流出，宜使用蜡矾丸、太乙膏及托里药。
一位妇人在寒冷的月份，产后腹部剧痛，感觉有肿块，用各种方法治疗无效。有人教她用羊肉四两、熟地黄二两、生姜一两，水煎服，两三次后痊愈。
俞震按语：漪子说：感觉有肿块，想是寒气乘虚而聚积，并非真实的实证。不然，为什么羊肉和熟地能治愈呢？这种说法可以说是善于读书。至于他所引用的《衍义》中说：一位妇人在寒冷的月份生产，寒气侵入产门，脐下胀痛，手不能触碰，这是寒疝。医生想用抵当汤治疗，认为是有瘀血。我教导他说：“这不是正确的治法。可以服用张仲景的羊肉汤，稍微减少分量分为两次服用，即可痊愈。”方子就是原方多加川芎，用酒和水同煎，或者加葱盐，比使用熟地的略为辛温。但这总归是治疗虚寒腹痛的。如果在寒冷月份，血液因寒凝滞，结成瘀血疼痛，又应当使用琥珀丸、香桂散，以及姜、桂、吴茱萸、桃仁、蓬术、五灵脂等药物，如果不是张仲景的方子均能见效。而且善于领悟的人更应当反过来观察。寒的反面转化为热，如《金匮要略》的下瘀血汤、河间玉烛散等方剂，也是一例。害怕药性峻猛的，回生丹也很妙。叶天士医案中提到取醋煮大黄一味药，药入病所，不伤害无病之处，这真是精妙的解释。想先生或许是从夺命丹用醋水同煎的方法悟入的吧。
Lu Yan from Fenghua treated a woman of the Xu family in Xinchang. The patient suffered sudden death (loss of consciousness) after childbirth, but there was slight heat in the chest and diaphragm. Upon diagnosis, Lu Yan said, "This is Blood Stagnation (Xue Men)." He used dozens of jin of Hong Hua (Carthamus tinctorius), boiled it in a large pot. When the decoction boiled, he filled a wooden bucket with the liquid and had the patient lie on top to fumigate. As the medicinal vapor faded, more was added. After a while, the woman's fingers began to move, and she woke up half a day later. This method aligns with the intent of Xu Yuzong when treating Empress Dowager Wang.
Lizhai treated a postpartum woman who experienced lower abdominal pain followed by sudden trismus (lockjaw). She was administered Shixiao San (Pain-Relieving Powder), and after a long time, she regained consciousness. Subsequently, she was treated with Si Wu Tang (Four Substance Decoction) modified with Pao Jiang (Charred Ginger), Bai Zhu (Atractylodes macrocephala Rhizome), and Chen Pi (Tangerine Peel), resulting in recovery.
Yu Zhen commented: Blood晕 (Xue Yun, fainting due to blood disorders) is all caused by E Lu (lochia) rushing to the heart. One should select verified prescriptions from texts like Ben Cao Gang Mu (Compendium of Materia Medica). The above two cases represent standard treatment methods. However, Danxi treated a woman who was pale and slender, with mental depression, who gave birth at midnight and fainted in the early morning. Urgent moxibustion was applied to Qihai (CV6) for fifteen moxa cones, after which she recovered. Later, she took herbs such as Ren Shen (Ginseng) and Bai Zhu for two months before stabilizing. This is Yang Deficiency (Yang Xu), representing an alternative treatment method.
Another postpartum patient drank alcohol after delivery, resulting in excessive lochia and Xue Yun. Her breath smelled of alcohol. This occurred because the blood moved recklessly due to the heat of alcohol, causing faintness due to deficiency. She was treated with Fo Shou San (Buddha's Hand Powder) modified with Gan Ge (Kudzu Root) 2 qian, recovering after one dose.
Lizhai stated: Drinking alcohol postpartum can cause fainting; furthermore, a crowded delivery room with noise and heat can also cause fainting.
Lizhai treated a postpartum woman with abdominal pain and fever. The Qi Kou pulse (radial artery pulse at the cun position) was large. Xue Ji attributed this to food stagnation, but the family did not believe him. Instead, they used blood-breaking and tonifying methods, which aggravated the condition, leading to fever, headache, and vomiting of saliva/phlegm. They then used herbs to clear fire, resolve phlegm, and regulate qi, resulting in cold limbs, diarrhea, and a sensation of bearing down. Only then did they regret their actions and ask, "Why?" Xue Ji replied, "This is a complication of Spleen and Stomach Deficiency (Pi Wei Xu). The method should be warming and tonifying." Thus, Liu Jun Zi Tang (Six Gentlemen Decoction) was modified with Pao Jiang 2 qian, Rou Gui (Cinnamon Bark) 1 qian, and Mu Xiang (Aucklandia Root) 1 qian. After four doses, all symptoms subsided. Subsequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used, restoring the Yuan Qi (Original Qi).
Yu Zhen commented: Because the Qi Kou pulse was large, food stagnation was diagnosed. Due to erroneous medication, the condition changed to cold limbs and diarrhea with bearing down, truly becoming a Deficient-Cold syndrome. However, the pulse characteristics were unknown. If the pulse had become fine and soft, warming and tonifying would have been effective. If the pulse remained large, warming and tonifying would not have been appropriate. If the pulse was large and soft, warming and tonifying could still be used hoping for the pulse to contract. If the pulse was large and rapid, and forceful upon pressure, death would be inevitable, and warming and tonifying would be useless.
A postpartum woman suffered from abdominal pain with tenesmus, severe dysentery, physical fatigue, poor appetite, long-term emotional depression, and developed Jian Chun (silkworm lip, a type of lip lesion). She sweated profusely during sleep (night sweats) like rain, dared not sleep all night, and her spirit was emaciated. Xue Ji said, "This is Qi and Blood deficiency with internal heat." Dang Gui Liu Huang Tang (Angelica Six-Yellow Decoction) was used, with Huang Qin (Scutellaria Root), Lian Zi (Lotus Seed Plumule/often refers to Lian Xin or similar bitter cold herbs in context, here likely Lian Xin or Huang Lian based on context of 'Lian'), and Huang Bo (Phellodendron Bark) stir-fried until black. Added to the formula, sweating stopped immediately after one dose and completely after two doses. Then, Gui Pi Tang (Restore the Spleen Decoction) and Ba Zhen San (Eight Treasures Powder) were taken concurrently, gradually restoring Yuan Qi and achieving recovery.
Yu Zhen commented: This case was not difficult regarding the use of Gui Pi Tang and Ba Zhen San, but difficult regarding the use of Dang Gui Liu Huang Tang. It is regrettable that the pulse was not recorded. However, preserving this case shows that ancient physicians used specific medicines for specific diseases, without rigidly adhering to the notion that postpartum conditions must always be heavily tonified. Bitter-cold herbs should be stopped once the disease is addressed.
A postpartum woman had lower abdominal pain and a palpable mass. The pulse was Kou (hollow) and Se (choppy). She was treated with Si Wu Tang modified with Yan Hu Suo (Corydalis Rhizome), Hong Hua (Safflower), Tao Ren (Peach Kernel), Niu Xi (Achyranthes Root), and Mu Xiang, resulting in recovery.
A postpartum woman suffered severe lower abdominal pain and trismus. This was due to internal retention of Blood Stasis (Yu Xue). She was administered Shixiao San, expelled blood, and regained consciousness. She was subsequently treated with Si Wu Tang modified with Pao Jiang, Bai Zhu, and Chen Pi, resulting in recovery.
Yu Zhen commented: These two cases represent the standard treatment for pain caused by lochia.
A postpartum woman had lower abdominal pain. Administration of Qi-regulating and blood-breaking herbs was ineffective. Her pulse was Hong (surging) and Shu (rapid). This indicated that the blood stasis had ulcerated internally into pus. Gua Zi Ren Tang (Melon Seed Decoction) was used for two doses, stopping the pain. Tai Yi Gao (Great One Ointment) was then used to drain the pus, resulting in recovery. This condition is common postpartum; even if not an abscess, this method is effective.
A postpartum woman had lower abdominal pain and difficulty urinating. Yi Yi Ren Tang (Coix Seed Decoction) was used. Pain stopped after two doses. Si Wu Tang modified with Tao Ren and Hong Hua was then used to expel blood stasis, resulting in recovery. Generally, these conditions are caused by disharmony of Ying and Wei (Nutritive and Defensive Qi) or retention of blood stasis. If the pulse is Hong and Shu, pus has formed; if only Shu, slight pus exists; if Chi Jin (slow and tight), it is blood stasis, which resolves with purgation. If the abdomen is distended and large, with water sounds upon turning, or if pus discharges from the umbilicus or stool, La Fan Wan (Beeswax Alum Pill), Tai Yi Gao, and interior-supporting herbs should be used.
A woman in the cold midwinter suffered severe postpartum abdominal pain and felt a mass. Various treatments failed. Someone advised boiling Lamb Meat 4 liang, Shu Di Huang (Prepared Rehmannia Root) 2 liang, and Sheng Jiang (Fresh Ginger) 1 liang in water. After two or three doses, she recovered.
Yu Zhen commented: Yizi said: Feeling a mass suggests cold pathogen gathering due to deficiency, rather than a true solid excess. Otherwise, how could lamb meat and prepared rehmannia cure it? This demonstrates skillful reading. Regarding the citation from Yan Yi: A woman gave birth in the cold month; cold pathogen entered the birth canal, causing distending pain below the navel, intolerant to touch. This is Han Shan (Cold Hernia). The physician wanted to treat with Di Dang Tang (Di Dang Decoction), believing it was blood stasis. I instructed him: "This is not the correct treatment. Administer Zhang Zhongjing's Lamb Meat Decoction, slightly reduced in dosage, divided into two servings." The formula is the original one plus Chuan Xiong (Sichuan Lovage Rhizome), decocted with wine and water, or with green onion and salt. It is slightly more acrid-warm compared to using prepared rehmannia. However, it generally treats deficient-cold abdominal pain. If in the cold month, blood coagulates due to cold, forming stasis and pain, one should use Hu Po Wan (Amber Pill), Xiang Gui San, and herbs such as Jiang (Ginger), Gui (Cinnamon), Wu Zhu Yu (Evodia Fruit), Tao Ren, Peng Ze (Curcuma), and Wu Ling Zhi (Trogopterus Dung). Not all formulas by Zhang Zhongjing would be effective in such cases. Moreover, those adept at understanding should view it inversely. Cold transforming into heat, such as Xia Yu Xue Tang (Drain Blood Stasis Decoction) from Jin Gui Yao Lue and Yu Zhu San (Jade Candle Powder) from He Jian, are examples. For those fearing harsh drugs, Hui Sheng Dan (Life-Restoring Pill) is excellent. Ye Tianshi's medical records mention taking Da Huang (Rhubarb Root and Rhizome) boiled in vinegar as a single ingredient, so the medicine enters the diseased area without affecting healthy areas. This is a truly brilliant interpretation. Perhaps Mr. [the author/patient] derived this insight from the method of decocting Duo Ming Dan (Life-Taking Pill) with vinegar and water.