丹溪治一妇。年四旬。孕九月。转胞。小便闭三日矣。脚肿形瘁。左脉稍和。而右涩。
此必饱食气伤。胎系弱。不能自举而下堕。压膀胱。偏在一边。气急为其所闭。所以水窍不
能出也。当补血养气。血气一正。胎系自举。以参、术、归尾、芍药、带白陈皮、炙甘草、
半夏、生姜浓煎四帖。任其叫号。次早以四帖渣作一服煎。顿饮探吐之。小便大通。皆黑水
后遂就此方加大腹皮、炒枳壳、青葱叶、砂仁。作二十帖与之。以防产前后之虚。果得平
安。产后亦健。
一孕妇七月。小便不通。百医不得利。转加急胀。脉细弱。乃气血虚不能乘载其胎。故
胎压膀胱下口。所以溺不能出。用补药升起。恐迟。反加急满。遂令稳婆以香油抹手入产户
托起其胎。溺出如注。胀急顿解。却以参、 、升麻大剂服之。或少有急满。再托如前。
江云。不如将孕妇眠于榻上。将榻倒竖起。胎自坠转。其溺溅出。胜于手托多矣。
震按二案皆用补药。则可知利水破气药之谬。观前案任其叫号。四日方用探吐。后学宜
借以壮胆。毋事纷更自误。
丹溪治一妇。有胎至三个月左右即堕。其脉左大无力。重取则涩。乃血少也。以其妙年
只补中气。使血自荣。时正初夏。浓煎白术汤。调黄芩末一钱。服之至三四两。得保全而
生。
一妇年三十余。或经住。或成形未具。其胎必堕。察其性急多怒。色黑气实。此相火太
盛。不能生气化胎。反食气伤精故也。因令住经第二月。用黄芩、白术、当归、甘草。服至
三月尽。止药。后生一子。
震按前案补气以生血。此案清热以养气。不过芩、术二味。服又甚少。竟得保全。今恐
不能也。然今有煎苎麻汤日服。间佐以二蚕绵灰。或南瓜蒂灰。或黄楝头。亦有验者。
一妇经住三月后。尺脉或涩。或微弱。其妇却无病。知是子宫真气不全。故阳不施。阴
不化。精血虽凝。终不成形。至产血块。或产血胞。惟脉洪盛者。胞不堕。
震按尺脉或涩或微弱。与尺脉微滑按之不绝者。其是胎非胎。从此分别。必于指下辨得
清。方于腹中决得定。下案神色甚困。难与之药。其尺脉必不滑。必按之无根也。后石山案
两尺浮弱。不任寻按。几与此案脉同。竟以大补得保其胎。此又事之变者矣。
一妇腹渐大如怀子。至十月。求易产药。察其神色甚困。难与之药。不数日。生白虫半
桶。盖由妇之元气太虚。精血虽凝。不能成胎。而为秽腐蕴积之久湿化为热。湿热生虫。理
之所有。亦须周十月之气。发动而产。终非佳兆。其妇不及月死。湿热生虫。譬之沟渠污浊
积久不流。则诸虫生于其间矣。
石山治一妇。长瘦。色黄白。性躁急。年三十余。常患堕胎。已七八见矣。诊其脉皆柔
软无力。两尺虽浮而弱不任寻按。曰。此因堕胎太多。气血耗甚。胎无滋养。故频堕。譬之
水涸而禾枯。土削而木倒也。况三月五月。正属少阳火动之时。加以性躁而激发之。故堕多
在三五七月也。宜用大补汤去桂。加黄柏、黄芩煎服。仍用研末。蜜丸服之。庶可保生。服
半年。胎固而生二子。
陈斗岩治一妇。有胎四月。堕下逾旬。腹肿。发热。气喘。脉洪盛。面赤口臭。舌青黑
陈诊之曰。脉洪盛者。胎未堕也。面赤。心火盛而血干也。舌青口臭。肝既绝而胎死矣。
内外皆曰。胎堕久矣。复诊色脉如前。以蛇蜕煎汤下平胃散加芒硝、归尾一倍服之。须臾腹
鸣如雷。腰腹阵痛。复一死胎堕下。病亦愈。
魏云。产后气喘脉洪。法在不治。此所以得生者。全在逾旬二字。若非胎未堕。决不能
至逾旬。
陈仁甫治一妇。年近四十。禀气素弱。自去其胎。五日内。渐渐腹胀如鼓。至心前。吐
不能食。用补药不效。诊六脉微弱。但只叫胀死。此乃损伤脾气而作胀。虽然当急则治其标
也。若泥用丹溪方法。恐缓不及事矣。用桃仁承气加朴、实。倍硝、黄煎。服四分。吐去其
一。至次日早。仍不通。事急。又服琥珀丸三钱。至申时大通。胀减。但体倦四肢无力。口
不知味。发热。再用参、 、归、芍、术、陈、楂煎服。八剂而安。
魏云。此用补不效。后案用破血益甚。宜参看。
薛立斋治一妊娠五月。服剪红丸而堕。腹中胀痛。服破血之剂。益甚。以手按之。益痛
薛曰。此峻药重伤。脾胃受患。用八珍倍人参、黄 、半夏、乳香、没药。二剂而痛止。
数剂全愈。
魏云。痛以手按之痛不痛分虚实。立斋以按之痛甚。竟作大虚治。非明眼不能。
震按此案是正法。上案是死证。急则治标。亦侥幸于万一。
一妇素怯弱。四月生女。自乳。患疥疮年余不愈。遂至羸困。五月勉强执姑丧礼旬月。
每欲眩卧。一日感气。忽患心脾高肿作痛。手不可按。而呕吐不止。六脉微细之极。医以为
脉虽虚而病形则实。误认诸痛不可补气。乃用青皮、香附、吴茱萸等药而愈。继复患疟。且
堕胎。又投理气行气之剂。病去。元气转脱。再投参、 补剂。不应矣。六脉如丝欲绝。薛
诊云。皆理气之剂。损真之误也。连投参、 、归、术、附子、姜、桂六剂。间用八味丸。
五日眠食渐甘。六脉全复。薛云。心脾疼痛时。即当服此等药。疟亦不作矣。
震按先前之痛已医好。继后患疟半产。亦云病去。乃追咎先前之不用温补。此岂人所能
及。余因是言而追思生平所见心脾痛证。有屡治屡愈。屡愈屡发。数年之间发渐频。以至危
殆者。安知不犯薛公所责耶。然屡发者。脉必弦小而坚。或更带数。必非微细之极。若至如
丝欲绝。亦谁不能温补哉。
江应宿治汪镐妻。三十五岁。厌产。服打胎药。下血如崩。旬余不止。或时鼻衄。诸药
不效。江诊得六脉数而微弦。乃厥阳之火泛逆。投四物换生地。加阿胶、炒黑山栀、薄黄。
一剂而愈。
江云。内热而虚。致堕者居多。盖孕至三五月上。属少阳相火。所以易堕。不然。何以
黄芩、白术、阿胶等。为安胎之圣药。
孙东宿曰。侄妇戴氏。孕已五月。忽血大下。午后发战。六脉俱数。左寸滑大。右关搏
指。左关软弱。予以白芍二钱。生地、阿胶、人参、蒲黄各一钱。柴胡、香附、地榆、荆芥
各七分。甘草五分煎服。午后发寒热。每夜凡三次。头痛恶心。腹中块硬。所下血块甚多。
心下怯力。此虚无疑也。以补中益气加阿胶、炮姜、白芍、乌梅。下午。右眼白珠发一白泡
光肿下垂。而面亦肿。此虚火游行无制之证。其夜大发寒热。指爪皆黑。唇白。汗大出。
腹中作痛。牵引两乳皆痛。仍以补中益气加阿胶、白芍、桂枝、五味、麦冬。服后热退汗止
渴除。神气少定。乃有生意。次日。咳嗽而胎堕。即以独参汤继服。其夜肠鸣。泻二次。以
参、术各三钱。炙草一钱五分。炮姜一钱。桂心、茯苓各五分。陈皮七分。莲子、大枣煎服
后因咳嗽。以四君加炮姜、五味、紫菀。调理而愈。
震按胎甫堕而即进独参汤。一见泻即用参术至三钱。盖缘未堕之前已是虚证。虽新堕之
后。何妨骤补。若庸流必主停参。且与消瘀矣。
张路玉治一妇。怀孕六月。因丧子悲哭动胎。医用芩、术安胎药二服。不应。改用枳壳
香附、紫苏、砂仁理气一服。胎遂上逼心下。胀闷喘急。口鼻出血。第三日薄暮诊之。其
脉急疾如狂风骤雨。十余至则不至。顷之复至如前。因谕之曰。此孕本非好胎。安之无益。
不若去之以存母命。因思此胎必感震气所结。震属木。惟金可制。令以铁斧。烈火烧红醋淬
乘热调芒硝末一两灌之。夜半。果下异胎。下后脉息微和。神思恍惚。所去恶露甚多。又
与安神调血之剂。数服而安。
许裕卿治邵涵贞内子。孕十七月不产。不敢执意凭脉。问诸情况。果孕非病。但云孕五
月以后不动。心窃讶之。为主丹参一味。令日服七钱。两旬余胎下。已死而枯。其胎之死。
料在五月不动时。经十三月在腹。不腐而枯。如果实在树。败则必腐。然亦有不腐者。则枯
胎之理可推也。张石顽曰。余昔治马云生妇。孕十三月不产。脉来微结。为处十全大补汤。
服至二十余剂。而下枯胎色白。所治虽异。而胎枯则一也。
震按异胎如夜叉胎及蝌蚪蜥蜴之类。古书多有。若枯胎则向来未说。果瘪在树。其喻极
是。曾阅后汉书载宝武之母产武。并产一蛇。送之林中。后母死。蛇亦来至柩前。盘绕俯仰
涕血皆流。因想未产时。其胎之异若何。恐非望闻问切所能知也。又医林史传载潘 治二
妇。一孕二岁。一孕十四月。诊之曰。非孕也。疾也。作剂饮之。孕二岁者下肉块百余。孕
十四月者下大蛇。二妇俱得活。此可谓善诊者矣。
朱丹溪治疗一位妇女，四十岁，怀孕九个月，出现转胞（妊娠期间因胎气压迫导致的小便不通），小便闭塞已有三天。脚部肿胀，形体憔悴，左脉稍显和缓，而右脉涩滞。
这一定是因为饱食损伤了气机，胎系虚弱，不能自行举起胎儿而下坠，压迫膀胱，使其偏向一侧，气机急迫而被闭塞，所以水道不能排出。应当补血养气，血气一旦调正，胎系自然能举起胎儿。用党参、白术、当归尾、芍药、带白皮的陈皮、炙甘草、半夏、生姜浓煎四帖。任凭她大声呼叫号痛。第二天早晨将这四帖的药渣合在一起煎煮，一次性服用以探吐。小便随即通畅排出，都是黑水，随后就在原方基础上加大腹皮、炒枳壳、青葱叶、砂仁，共二十帖给她服用，以防备产前产后气血虚弱。果然平安无事，产后身体也很健康。
另一位孕妇七个月时，小便不通，众多医生用药未能通利，反而更加急胀。脉象细弱，这是气血虚弱不能承载胎儿，所以胎儿压迫膀胱下口，导致尿液无法排出。如果用补药升起胎气，恐怕迟缓反而加重急满症状。于是让稳婆用香油涂抹手，进入产户托起胎儿，尿液如注般流出，胀急顿时缓解。随后用党参、[人参]、升麻大剂量服用。如果稍有急满，再像之前那样托举。
江云说：不如让孕妇躺在床上，将床倒竖起，胎儿自然会坠落转动，尿液就会溅出，比用手托举效果好得多。
俞震按语：这两个案例都使用了补药，由此可知利水破气药物的谬误。看前案任凭患者叫号，四天之后才用探吐法，后学者应当借此壮胆，不要随意更改方法而自误。
朱丹溪治疗一位妇女，怀孕到三个月左右就流产。其脉象左手大而无力，重按时则涩，这是血少的表现。因为她正值妙龄，只补中气，使血液自然充盈。当时正值初夏，浓煎白术汤，调入黄芩末一钱，服至三四两，得以保全并顺利生产。
一位三十多岁的妇女，有时月经停闭，有时胎儿成形但未发育完全就必然流产。观察她性情急躁易怒，面色黑而气实，这是相火太盛，不能化生元气以孕育胎儿，反而消耗元气损伤精血所致。因此让她在停经的第二个月开始，用黄芩、白术、当归、甘草，服用至第三个月结束停药。后来生下一个儿子。
俞震按语：前案通过补气来生血，此案通过清热来养气，不过是黄芩、白术两味药，服用量又很少，竟然得以保全。现在恐怕很难做到了。然而现在有每日服用苎麻汤，偶尔辅以二蚕绵灰，或南瓜蒂灰，或黄楝头，也有验证有效的。
一位妇女停经三个月后，尺脉或涩，或微弱。这位妇女却没有生病，知道是子宫真气不全，所以阳气不施布，阴气不化生，虽然精血凝结，最终也不能成形。到了分娩时排出血块，或排出血胞。只有脉象洪盛的，胞衣才不会脱落。
俞震按语：尺脉或涩或微弱，与尺脉微滑且按之不绝的，以此区分是有胎还是无胎。必须在指下辨别清楚，才能在腹中确定诊断。下案中患者神色非常困顿，难以给予药物。其尺脉必然不滑，按之必然无根。后来石山案的案例，两尺脉浮弱，不耐寻按，几乎与此案脉象相同，竟然用大补之法保住了胎儿，这又是情况的变化。
一位妇女腹部逐渐增大像怀孕一样，到了十个月，求易产的药物。观察她神色非常困顿，难以给予药物。没过几天，生出了半桶白虫。大概是因为妇人元气太虚，虽然精血凝结，但不能成胎，而是秽浊腐败之物蕴积日久，湿气化为热，湿热生虫，这是情理之中的事。也必须经过十月的气运发动才能产出，终究不是好兆头。这位妇女不到一个月就死了。湿热生虫，就像沟渠污浊积聚久了不流动，各种虫子就会生在其中一样。
石山治疗一位妇女，身材长瘦，面色黄白，性情急躁，三十多岁，经常患流产，已经发生过七八次了。诊察她的脉象都柔软无力，两尺脉虽然浮但弱，不耐寻按。说：这是因为流产太多，气血耗损严重，胎儿缺乏滋养，所以频繁流产。就像水干涸禾苗枯死，土壤削薄树木倒下一样。况且三月、五月，正是少阳火动的时候，加上她性情急躁加以激发，所以多在三月、五月、七月流产。宜用大补汤去掉桂枝，加入黄柏、黄芩煎服，仍然研磨成粉，用蜜做成丸剂服用，才可以保全生育。服用半年，胎气稳固并生了两个儿子。
陈斗岩治疗一位妇女，怀孕四个月，流产超过十天，腹部肿胀，发热，气喘，脉象洪盛，面赤口臭，舌质青黑。
陈诊察后说：脉象洪盛，说明胎儿未堕。面赤，是心火盛而血干。舌青口臭，是肝气已绝而胎儿死亡。
内外人都说：胎儿已经流产很久了。复诊时神色脉象如前。用蛇蜕煎汤送服平胃散加芒硝、归尾一倍服用。片刻后腹鸣如雷，腰腹阵痛，又排下一个死胎，病也好了。
魏云：产后气喘脉洪，按理属于不治之症。这里之所以能生存，全在于“超过十天”这几个字。如果不是胎儿未堕，决不能拖延到超过十天。
陈仁甫治疗一位妇女，年近四十，禀赋素来虚弱，自行打胎。五天内，渐渐腹胀如鼓，直到心前区，呕吐不能进食，用补药无效。诊察六脉微弱，只是喊叫胀死。这是损伤脾气而导致胀满。虽然应当急则治其标。如果拘泥于使用丹溪的方法，恐怕迟缓来不及处理。用桃仁承气汤加厚朴、枳实，倍用芒硝、大黄煎煮。服用四分之一的量，吐出三分之一。到第二天早上，仍然不通。情况紧急，又服用琥珀丸三钱。到申时大便大通，胀减，但身体疲倦四肢无力，口不知味，发热。再用党参、[人参]、当归、芍药、白术、陈皮、山楂煎服，八剂后安愈。
魏云：此案先用补药无效，后用破血药益甚，应当参考查看。
薛立斋治疗一位妊娠五个月的妇女，服用剪红丸后流产。腹中胀痛，服用破血药剂后，疼痛更甚。用手按压，疼痛加剧。
薛说：这是峻烈药物重伤，脾胃受损。用八珍汤倍用人参、黄芪、半夏、乳香、没药，两剂后疼痛停止。数剂后痊愈。
魏云：疼痛用手按压，痛与不痛可以分辨虚实。立斋根据按压后痛甚，竟当作大虚证治疗，不是明眼人不能做到。
俞震按语：此案是正法，上案是死证。急则治标，也是侥幸万一。
一位妇女素来怯弱，四月生下女儿，亲自哺乳，患疥疮一年多不愈，遂至消瘦困顿。五月勉强操持婆婆丧礼一个月，常常想眩晕卧床。一天感受外气，忽然患心脾部位高肿作痛，手不可按压，而且呕吐不止。六脉微细至极。医生认为脉虽虚但病形则实，误认诸痛不可补气，于是用青皮、香附、吴茱萸等药而治愈。接着又患疟疾，并且流产，又投理气行气的药剂，病去，元气转脱。再投党参、[人参]补剂，不应验了。六脉如丝欲绝。薛诊察说：这都是理气药剂损伤真元的错误。连续投用党参、[人参]、当归、白术、附子、生姜、肉桂六剂，间用八味丸。五日眠食渐佳，六脉全复。薛说：心脾疼痛时，就应当服用这些药，疟疾也不会发作了。
俞震按语：先前的疼痛已经医好，继后患疟疾半产，也说病去，于是追究先前不用温补的错误。这哪里是人所能预料的。我因此言而追思生平所见的心脾痛证，有屡治屡愈，屡愈屡发，数年之间发作渐频，以至危殆的，怎知不犯薛公所指责的错误呢？然而屡发者，脉必弦小而坚，或更带数，必非微细至极。若至如丝欲绝，谁不能温补呢？
江应宿治疗汪镐的妻子，三十五岁，厌恶生产，服用打胎药，下血如崩漏，旬余不止，有时鼻出血，诸药无效。江诊得六脉数而微弦，这是厥阳之火泛逆，投用四物汤换生地，加阿胶、炒黑山栀、薄荷黄，一剂而愈。
江云：内热而虚，导致流产的居多。大概怀孕到三五月，属少阳相火，所以容易流产。不然，为什么黄芩、白术、阿胶等，是安胎的圣药。
孙东宿说：侄妇戴氏，怀孕已五月，忽然血大下，午后发战栗，六脉俱数，左寸滑大，右关搏指，左关软弱。予以白芍二钱，生地、阿胶、人参、蒲黄各一钱，柴胡、香附、地榆、荆芥各七分，甘草五分煎服。午后发寒热，每夜凡三次，头痛恶心，腹中块硬，所下血块甚多，心下怯力，这是虚无疑也。用补中益气汤加阿胶、炮姜、白芍、乌梅。下午，右眼白珠发一白泡光肿下垂，而面亦肿，这是虚火游行无制之证。其夜大发寒热，指爪皆黑，唇白，汗大出，腹中作痛，牵引两乳皆痛。仍以补中益气汤加阿胶、白芍、桂枝、五味子、麦冬。服后热退汗止渴除，神气少定，乃有生机。次日，咳嗽而胎堕。即以独参汤继服。其夜肠鸣，泻二次，以党参、白术各三钱，炙草一钱五分，炮姜一钱，桂心、茯苓各五分，陈皮七分，莲子、大枣煎服。后因咳嗽，用四君子汤加炮姜、五味子、紫菀，调理而愈。
俞震按语：胎儿刚堕即进独参汤，一见泻即用参术至三钱。大概因为未堕之前已是虚证，虽新堕之后，何妨骤补。若庸流必主张停参，且给予消瘀药。
张路玉治疗一位妇女，怀孕六月，因丧子悲哭动胎。医生用黄芩、白术安胎药二服，不应。改用枳壳、香附、紫苏、砂仁理气一服，胎遂上逼心下，胀闷喘急，口鼻出血。第三日薄暮诊之，其脉急疾如狂风骤雨，十余至则不至，顷之复至如前。因而告诉她说：此孕本非好胎，安之无益，不如去之以存母命。因而想此胎必感震气所结，震属木，惟金可制。令以铁斧，烈火烧红醋淬乘热调芒硝末一两灌之。夜半，果下异胎。下后脉息微和，神思恍惚，所去恶露甚多。又与安神调血之剂，数服而安。
许裕卿治疗邵涵贞的内子，怀孕十七月不产。不敢执意凭脉，问诸情况，果孕非病。但云孕五月以后不动，心窃讶之。为主丹参一味，令日服七钱，两旬余胎下，已死而枯。其胎之死，料在五月不动时。经十三月在腹，不腐而枯。如果实在树，败则必腐。然亦有不腐者，则枯胎之理可推也。张石顽曰：余昔治马云生妇，孕十三月不产，脉来微结，为处十全大补汤，服至二十余剂，而下枯胎色白。所治虽异，而胎枯则一也。
俞震按语：异胎如夜叉胎及蝌蚪蜥蜴之类，古书多有记载。若枯胎则向来未说。果瘪在树，其喻极是。曾阅后汉书载宝武之母产武，并产一蛇，送之林中，后母死，蛇亦来至柩前，盘绕俯仰涕血皆流。因想未产时，其胎之异若何，恐非望闻问切所能知也。又医林史传载潘 治二妇，一孕二岁，一孕十四月。诊之曰：非孕也，疾也。作剂饮之，孕二岁者下肉块百余，孕十四月者下大蛇。二妇俱得活。此可谓善诊者矣。
Zhu Danxi treated a woman, aged forty, who was nine months pregnant and suffering from *Zhuanbao* (a condition in pregnancy characterized by urinary retention due to fetal pressure). She had been unable to urinate for three days. Her feet were swollen, her physique emaciated, her left pulse slightly harmonious, and her right pulse choppy.
This must be caused by overeating damaging the Qi mechanism. The fetal ligament is weak and cannot support the fetus, causing it to descend and compress the bladder, shifting it to one side. The Qi mechanism becomes urgent and blocked, preventing the water passages from draining. Treatment should focus on nourishing blood and tonifying Qi. Once blood and Qi are regulated, the fetal ligament will naturally lift the fetus. A decoction was prepared with Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix Tail (Guangui), Paeoniae Radix (Shaoyao), Tangerine Peel with White Pith (Dairchenpi), Prepared Licorice Root (Zhigancao), Pinelliae Tuber (Banxia), and Fresh Ginger (Shengjiang), boiled strongly into four doses. The patient was allowed to cry out freely. The next morning, the dregs of these four doses were combined and decocted as a single serving to induce vomiting. Urination immediately flowed freely, discharging dark fluid. Subsequently, the original formula was modified by adding Areca Seed (Dafupi), Stir-fried Bitter Orange (Chao Zhiqiao), Green Onion Leaf (Qingcong Ye), and Amomum Fruit (Sharen), administered as twenty doses to prevent deficiency before and after delivery. She delivered safely and remained healthy postpartum.
Another pregnant woman at seven months experienced urinary retention. Numerous physicians failed to promote diuresis, and her abdominal distension and urgency worsened. Her pulse was fine and weak, indicating that deficiency of Qi and Blood could not support the fetus, causing the fetus to press upon the lower outlet of the bladder, thus preventing urine excretion. Using tonic herbs to lift the Qi might be too slow and exacerbate the fullness. Therefore, a midwife was instructed to apply sesame oil to her hands and manually lift the fetus through the vagina. Urine gushed forth, and the distension and urgency instantly resolved. Thereafter, large doses of Ginseng Radix et Rhizoma (Renshen), [Ginseng Radix et Rhizoma], and Cimicifugae Rhizoma (Shengma) were administered orally. If slight fullness recurred, manual lifting was repeated as before.
Jiang Yun stated: It would be better to have the pregnant woman lie on a bed and tilt the bed vertically so that the fetus naturally shifts downward, allowing urine to spray out, which is far superior to manual lifting.
Yu Zhen commented: Both cases utilized tonic herbs, demonstrating the fallacy of using diuretic and Qi-breaking drugs. In the first case, the patient cried out for four days before inducing vomiting; students of medicine should draw courage from this and avoid arbitrary changes that lead to self-harm.
Zhu Danxi treated a woman who miscarried around the third month of pregnancy. Her pulse was large and powerless on the left, and choppy upon heavy pressure, indicating Blood deficiency. Since she was young, treatment focused solely on tonifying Middle Qi to allow Blood to flourish naturally. It was early summer, so a strong decoction of Atractylodis Macrocephalae Rhizoma (Baizhu) was prepared, mixed with one qian of Scutellariae Radix (Huangqin) powder. After consuming three to four liang, the pregnancy was preserved and she delivered successfully.
A woman in her thirties experienced amenorrhea or incomplete fetal development leading to inevitable miscarriage. Observing her irritable and angry temperament, dark complexion, and robust Qi, Zhu identified excessive Ministerial Fire failing to generate Yuan Qi for conception, instead consuming Qi and damaging Essence. He prescribed Scutellariae Radix (Huangqin), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), and Glycyrrhizae Radix et Rhizoma (Gancao) starting from the second month of missed menses, stopping at the end of the third month. She subsequently gave birth to a son.
Yu Zhen commented: The previous case generated Blood by tonifying Qi; this case nourished Qi by clearing Heat. Only two herbs, Huangqin and Baizhu, were used in small quantities, yet success was achieved. Such outcomes are rare today. However, daily decoctions of Ramie Root Decoction (Zhuma Tang), occasionally supplemented with ashes of silkworm cocoons, pumpkin peduncles, or Melia Toosendan seeds, have also proven effective.
In a woman whose menses had ceased for three months, the Chi pulse was either choppy or faint. Although she reported no illness, this indicated incomplete True Qi in the uterus, resulting in Yang failing to distribute and Yin failing to transform. Although Essence and Blood coagulated, they failed to form a viable fetus. At delivery, blood clots or placental membranes were expelled. Only when the pulse was vigorous did the placenta remain intact.
Yu Zhen commented: Distinguishing between a viable fetus and non-pregnancy relies on differentiating between a Choppy/Faint Chi pulse and a Fine-Slippery Chi pulse that does not vanish upon pressure. One must discern this clearly under the fingers to confirm the diagnosis. In the following case, the patient’s spirit was exhausted, making medication difficult. Her Chi pulse was certainly not slippery and lacked root upon pressure. Later, in Shi Shan’s case, both Chi pulses were floating and weak, barely tolerating palpation, similar to this case, yet a major tonic regimen saved the fetus, illustrating variability in clinical presentations.
A woman’s abdomen enlarged progressively like pregnancy. By the tenth month, she sought herbs for easy delivery. Her spirit was exhausted, making medication inadvisable. Shortly after, she delivered half a bucket of white worms. This occurred because extreme deficiency of Yuan Qi prevented the coagulated Essence and Blood from forming a fetus; instead, turbid decay accumulated over time, transforming dampness into Heat, which generated worms. This is consistent with natural principles. Delivery required the completion of the ten-month cycle but was an ominous sign. The woman died within a month. Worms generated by Damp-Heat are akin to insects breeding in stagnant, polluted ditches.
Shi Shan treated a tall, thin woman with a sallow-white complexion and irritable temperament, aged thirty-something, who suffered recurrent miscarriages (seven or eight times). Her pulses were soft and powerless throughout; the two Chi pulses were floating but weak and intolerant of deep palpation. He stated: Frequent miscarriages deplete Qi and Blood, leaving the fetus without nourishment, much like crops dying when water dries up or trees falling when soil erodes. Furthermore, the third and fifth months correspond to the activation of Shaoyang Fire; her irritability exacerbates this, explaining why miscarriages often occur in the third, fifth, and seventh months. He prescribed a Major Tonic Decoction minus Cinnamon Twig (Guizhi), added with Phellodendri Cortex (Huangbai) and Scutellariae Radix (Huangqin), taken as a decoction and later as honey pills. After six months of treatment, her pregnancy stabilized, and she bore two sons.
Chen Douyan treated a woman who miscarried at four months. More than ten days later, her abdomen swelled, accompanied by fever, asthma, a vigorous pulse, red face, foul breath, and a bluish-black tongue.
Chen diagnosed: A vigorous pulse indicates the fetus has not yet passed. Red face signifies Heart Fire excess and dry Blood. Bluish tongue and foul breath indicate Liver failure and fetal death.
Everyone claimed the fetus had passed long ago. Upon re-examination, the signs remained unchanged. Chen administered Pingwei San plus Magnesium Sulfate (Mangxiao) and double the dose of Angelicae Sinensis Radix Tail (Guangui), washed down with a decoction of Snake Slough (Shetui). Soon, borborygmus sounded like thunder, and waves of pain struck the waist and abdomen. A dead fetus was expelled, and the illness resolved.
Wei Yun noted: Postpartum asthma with a vigorous pulse is typically incurable. Survival here depended entirely on the "ten days" interval. Had the fetus not been retained, such delay would be impossible.
Chen Renfu treated a woman near forty, constitutionally weak, who induced abortion herself. Within five days, her abdomen distended like a drum up to the heart region, causing vomiting and inability to eat. Tonics failed. Her six pulses were faint; she complained only of fatal distension. This was Spleen Qi injury causing distension. Although acute symptoms require treating the branch, adhering strictly to Danxi’s methods might be too slow. Chen used Tao Ren Cheng Qi Tang plus Magnolia Bark (Houpo) and Immature Bitter Orange (Zhishi), doubling Magnesium Sulfate (Mangxiao) and Rhubarb (Dahuang). One-quarter of the dose was taken, resulting in vomiting one-third of the content. The next morning, bowel movement remained obstructed. Urgency prompted administration of 3 qian of Amber Pill (Hupo Wan). By Shen hour, significant defecation occurred, reducing distension but leaving fatigue, limb weakness, loss of taste, and fever. Subsequently, Ginseng Radix et Rhizoma (Renshen), [Ginseng Radix et Rhizoma], Angelicae Sinensis Radix (Danggui), Paeoniae Radix (Shaoyao), Atractylodis Macrocephalae Rhizoma (Baizhu), Citrus Reticulatae Pericarpium (Chenpi), and Crataegi Fructus (Shanzha) were decocted. Eight doses brought stability.
Wei Yun noted: This case shows failure of tonics followed by worsening with blood-breaking herbs; readers should compare carefully.
Xue Lizhai treated a pregnant woman at five months who miscarried after taking Jianhong Pill. Abdominal distension and pain ensued, worsening with blood-breaking agents. Palpation increased pain.
Xue stated: Harsh medicines severely injured the Spleen and Stomach. He prescribed Bazhen Tang with doubled Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Pinelliae Tuber (Banxia), Frankincense (Ruxiang), and Myrrh (Moyao). Pain ceased after two doses; full recovery followed after several doses.
Wei Yun noted: Palpation distinguishes Deficiency from Excess in pain. Lizhai correctly treated severe pain on pressure as major Deficiency, requiring keen insight.
Yu Zhen commented: This case represents standard practice; the previous case was terminal. Treating the branch in emergencies is a last resort.
A constitutionally timid woman delivered a daughter at four months and breastfed. She suffered from scabies for over a year, becoming emaciated. In the fifth month, she endured her mother-in-law’s funeral rites for a month, frequently feeling dizzy and wanting to lie down. One day, catching a pathogen, she suddenly developed high swelling and pain in the Heart and Spleen regions, untouchable, with incessant vomiting. Her six pulses were extremely faint and fine. Physicians, seeing a deficient pulse but substantial pathology, mistakenly believed pain should not be treated with Qi tonics. They used Tangerine Peel (Qingpi), Cyperi Rhizoma (Xiangfu), and Evodiae Fructus (Wuzhuyu), achieving cure. Later, she contracted malaria and miscarried, receiving Qi-regulating agents. Although symptoms subsided, her Yuan Qi collapsed. Further tonics with Ginseng Radix et Rhizoma (Renshen), [Ginseng Radix et Rhizoma], failed. Pulses became thread-like and nearly absent. Xue diagnosed: All prior Qi-regulating herbs damaged True Yuan. He consecutively administered Ginseng Radix et Rhizoma (Renshen), [Ginseng Radix et Rhizoma], Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu), Aconiti Lateralis Radix Preparata (Fuzi), Ginger (Shengjiang), and Cinnamomi Cortex (Guizhi) for six doses, interspersed with Bawei Wan. Within five days, sleep and appetite improved, and pulses recovered. Xue remarked: These tonics should have been given during the initial pain; malaria would not have occurred.
Yu Zhen commented: The initial pain was cured, then malaria and miscarriage occurred, attributed to "symptom resolution." Blaming the earlier lack of warming tonics seems retrospective. Reflecting on my own experience with Heart/Spleen pain cases that recur frequently until critical, one wonders if they violated Xue’s principle. However, recurring cases typically show wiry, small, firm, or rapid pulses, not extremely faint ones. When pulses are thread-like, warming tonics are universally applicable.
Jiang Yingsu treated Wang Hao’s wife, thirty-five, who took abortifacients due to fear of childbirth, resulting in profuse bleeding lasting over ten days, with occasional epistaxis. Medications failed. Jiang found rapid and slightly wiry pulses in all six positions, diagnosing rebellious Jueyang Fire. He prescribed Siwu Tang substituting Rehmanniae Radix (Shengdi), adding Oviductus Bufonis (Ejiao), stir-fired Gardeniae Fructus (Chao Zhizi), and Mint (Bohe). One dose cured her.
Jiang Yun stated: Internal Heat with Deficiency causes most miscarriages. Around the third to fifth months, Shaoyang Ministerial Fire is active, increasing miscarriage risk. Hence, Scutellariae Radix (Huangqin), Atractylodis Macrocephalae Rhizoma (Baizhu), and Oviductus Bufonis (Ejiao) are sacred herbs for stabilizing pregnancy.
Sun Dongsu stated: His niece, Dai Shi, at five months pregnant, suffered sudden heavy bleeding and afternoon chills. All pulses were rapid; Left Cun was slippery and large, Right Guan beat against the finger, Left Guan was weak. He prescribed Paeoniae Radix Alba (Baishao) 2 qian, Rehmanniae Radix (Shengdi), Oviductus Bufonis (Ejiao), Ginseng Radix et Rhizoma (Renshen), and Polygoni Multiflori Caulis (Puhuang) 1 qian each, Bupleuri Radix (Chaihu), Cyperi Rhizoma (Xiangfu), Sanguisorbae Radix (Diyu), and Schizonepetae Spica (Jingjie) 0.7 fen each, Licorice Root (Gancao) 0.5 fen. Afternoon chills and fevers occurred three times nightly, with headache, nausea, abdominal hardness, and many blood clots. Mental fatigue confirmed Deficiency. He used Buzhong Yiqi Tang plus Ejiao, Prepared Ginger (Paojiang), Baishao, and Mume Fructus (Wumei). That afternoon, a white blister appeared on the sclera of the right eye, swelling and drooping, with facial edema, indicating uncontrolled wandering Deficient Fire. That night, severe chills/fever, black fingernails, pale lips, profuse sweating, abdominal pain radiating to breasts occurred. He continued Buzhong Yiqi Tang plus Ejiao, Baishao, Cinnamomi Ramulus (Guizhi), Schisandrae Fructus (Wuweizi), and Ophiopogonis Tuber (Maidong). Fever, sweat, and thirst ceased; spirit stabilized, indicating life returned. The next day, coughing led to fetal expulsion. Dushen Tang followed. That night, borborygmus and two diarrheal episodes occurred. He prescribed Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) 3 qian each, Prepared Licorice Root (Zhigancao) 1.5 qian, Prepared Ginger (Paojiang) 1 qian, Cinnamon Heart (Guixin) and Poria (Fuling) 0.5 fen each, Citrus Reticulatae Pericarpium (Chenpi) 0.7 fen, Lotus Seed (Lianzi), and Jujube (Dazao). Later, cough was treated with Six Gentlemen Decoction (Sijunzi Tang) plus Paojiang, Wuweizi, and Asteris Flos (Ziwan), leading to recovery.
Yu Zhen commented: Administering Dushen Tang immediately after miscarriage and heavy doses of Renshen/Baizhu upon diarrhea reflects pre-existing Deficiency. Acute tonification is justified. Quacks would withhold tonics and use blood-resolving herbs.
Zhang Luyu treated a woman at six months pregnant who miscarried due to grief-induced fetal agitation. Two doses of Huangqin and Baizhu failed. Switching to Zhiqiao, Xiangfu, Perillae Folium (Zisu), and Amomum Fruit (Sharen) to regulate Qi caused the fetus to press upward against the heart, causing distension, asthma, and epistaxis. On the third evening, the pulse was frantic like a storm, skipping beats. Zhang advised: This is not a viable fetus; preserving it is futile. Removing it saves the mother. Believing the fetus was affected by Wood energy (Zhen trigram), he used Metal to control it. A red-hot iron axe quenched in vinegar was used to mix 1 liang of Magnesium Sulfate (Mangxiao) powder, administered hot. At midnight, an abnormal fetus was passed. Pulse and spirit stabilized afterward, though lochia was heavy. Calming and blood-nourishing agents restored peace.
Xu Yuqing treated Shao Hanzhen’s wife, pregnant for seventeen months without delivery. Relying on history rather than pulse alone, he confirmed pregnancy but noted no fetal movement since five months. He prescribed solely Salviae Miltiorrhizae Radix (Danshen) 7 qian daily. Over two weeks, a dead, shriveled fetus was passed. Death likely occurred at five months. Thirteen months in utero, it dried without rotting, unlike fruit which rots. Zhang Shiwen recalled treating a woman pregnant thirteen months; Ten Great Tonics Decoction yielded a white, shriveled fetus. Though treatments differed, the result—shriveling—was the same.
Yu Zhen commented: Abnormal fetuses (like yak fetuses or tadpole/lizard forms) are recorded in ancient texts, but shriveled fetuses are rarely mentioned. The analogy of a shriveled fruit is apt. The Book of Later Han records Bao Wu’s mother delivering a snake alongside Wu, which later wept blood at her coffin. The nature of such anomalies defies standard diagnostic methods. Medical histories record Pan treating two women: one "pregnant" two years, the other fourteen months. Diagnosis revealed disease, not pregnancy. Administration of a decoction resulted in passing over a hundred flesh blocks and a large snake, respectively. Both survived, demonstrating excellent diagnostic skill.