吴静山（敬权）孝廉令正钱夫人，时邪后遂发黄肿，日嗜干茶无度，苏太诸医，皆用气血并补，久而不愈。延余诊之。脉两手俱洪数之甚，询得腹中攻痛无常，夜则身热如烙，此由阴液不充，瘀滞干粘所致。宿血不去，则肢体浮肿。新血不生，则肌肉消瘦。一切补脾刚药，未可施于此证。考仲景治黄，有猪膏发煎润燥之法，爰仿其义，专用滋润之品，调养肾肝而愈。
前营游击温公（大勇）夏月自浦口来松，途中冒暑，到署后请医调治，初用清暑利湿不效，改用参术归地，转增脘痛。自后朝暮更医，佥言误补留邪，治难有效。遂延余诊。余见其身面发黄，总是胃腑结聚不行所致，用连理汤辛开苦降法，授方不服，遂就诊于青浦医家，方用茵陈五苓散等，服之亦不效。遂以绝证为辞，归至署中，计无复出，始委命以听余焉。予仍用前法，服参些少，是夜即得安寝，改用理中汤调理半月而愈。后以礼貌之衰，坚辞不往，升金山参将后，重发旧恙，遂成不治之证矣。
浊证医案
浊证湿滞为多，而亦有宜于温固者。上海徐德音浊下如涕，医不辨其为精浊，概以利湿
头痛医案
嘉定陈妪年五十有七，病头痛数年，额上为甚，额属阳明部分，久痛必虚，须填补阳明，之法治之，久不见效。渐至食则易饥，心火上亢，肾水下趋，形消腰折，寒热频频，督脉阳维交病。余谓此系精浊。非便浊也。用鹿角菟丝骨脂等温补下焦，兼服威喜丸而愈。
提宪稿房陈寿昌病浊，医者疑其肾阴亏损而致此疾，早投补肾药，少腹胀痛欲死。余用左金清火，合雄鼠粪汤攻浊而愈。兼鼓舞胃中清阳之气，用玉屏风散加炙草葛根，二剂全愈。推此而太阳头顶痛，少阳头角痛，厥阴头巅痛，皆可按法而治矣。
高桥镇曹连珍室，操持家事颇劳，兼多暴怒，孟夏得疾，自天柱至头巅，忽然强痛，坚重难移，两耳赤肿，胃中嘈杂，脉象洪数。宗喻氏治吴添官母例而愈。
腹痛医案
枫泾镇宋元英境享安闲，恣情房帏，患腹痛二年，医药不效，遂就诊于吴郡极时之医，以绝证为辞。宋即归家，料理后事，深信医言为不谬。余适过枫，晤宋氏西席程永孚，谈及医理，遂为知己。遂同元英来寓就诊，细按其脉，细询其证，总是阴阳悖逆，升降不利使然。问曰：曾服泻心汤，进退黄连汤否？曰未也。因酌一方以授，投一剂而稍平，数剂而全愈。
前余在嘉定，有乡人王四九官病膈，向服和中药，据述投三四剂辄效，逾时复然。就诊于予。投进退黄连汤不应，改用丹溪韭汁牛乳饮而愈。因知古人因证立方，不相假也。
胎前医案
胎前宜凉，人人知之。而亦有宜于温者，胎前宜补血，不宜破血，而亦有转用破血而得安者，总在临证时之细心体会也。郡城孙锦章室，怀胎五月，病转胞不溺，医用清利水道，并不究及转胞由于下焦虚寒，由于中焦气弱，由于肝家血滞，猪苓、泽泻、车前等药，徒伤胃气，故饮食减少，夜不得寐，诸恙渐臻，而胞系之缭戾者如故也。日请稳婆抬起，始得溺出。究之元气不支，日甚一日，因而延余诊治。余诊其脉，缓大有力，许以可救。遵《金匮》成例，投肾气汤一剂，是夜稍得安寝，盖利水之药，足以泻肾。投桂附而命门温暖，故稍得安寝耳。再遵丹溪补气成例，投参术汤一剂，饮食渐能知味，惟病者大便不行已数日，腹中至此更觉不安，改用茱连汤一剂，大便得解，小便虽仍稳婆伺候。病者因诸恙悉减，深信不疑，再求良治，余为沉思者久之，脉象比前益见有力，元气已复而胎气未举，必有瘀血阻塞其间，遂用大剂破血之药，一剂而胀遂消，三剂而胎气未举，凡破血之药，最足碍胎，今破血而胎反固，妙在先用补药以助其元气也。
产后医案
产后感冒时邪，宜温散，不宜凉散，人人知之。而亦有不宜于温而宜于凉者，误用温则不得不用大寒矣。归鞠氏侄女，冬月初产无恙，至六日头痛身热，凛凛畏寒，予用栀豉汤，夜半热退，逾日复热，更医用产后逐瘀成法，遂加烦躁。余谓冬温为病，清之可安。通评虚实论曰：乳子而病热，脉悬小者，手足温则生，仍依时邪治例，用白虎汤而愈。凡产后无产证而染他证者，即当以他证治之，而丹溪大补气血之言，却不可拘。仲景云：病解能食，七八日更发热者，此为胃实，大承气汤主之。夫阳明经中，仲景尚再三戒人不可轻下，而产后亡血既多，仍云承气主之，盖既为胃实自有不得不用之理，举一证而产后之挟实者可类推也。仲景云：产后下利虚极，白头翁加甘草阿胶汤主之。夫既曰虚极，仍用白头翁汤者，下痢中既有渴欲饮水热而下重之证，则白头翁汤自有不得不用之理。惟其虚极，故加甘草、阿胶以养其正，举一证而产后之挟虚者可类推也。
产后恶露不行，胸腹饱胀，温之通之，人人知之。而亦有不宜于温而宜于凉，不宜于通而宜于和者。东门鞠上玉室初产患此，其脉数大而疾，上兼鼻衄，余用当归二两煎汤，冲热童便与服，稍稍安稳，但恶露止有点滴耳。更医用炮姜等温通套剂，遂至胸腹增胀，恶露点滴不行，有欲依产后春温治例，大进苦寒之品，余曰：又非稳治。坚用归地丹芍等凉血和血之剂，十余日，恶露大行而全愈。凡产后病解能食，七八日更发热者，当作别病治。初产后即发热者，则仍作产后治。但各有寒热，两途不可不条分缕析。
郡城侯姓妇年三下有八，因元霄夜游，行走太劳，归即小产。医者皆以其胸腹有块，用逐瘀成法，每剂必加炮姜，俱未有效。后虽停药，而骨节如焚，积块愈大，小便艰涩，热痛异常。至三月初始延余诊，已奄奄一息。诊其脉沉伏之极，隐隐难寻，予固知其阴虚阳盛，但日期多延，宜用缓治。初投复脉减去姜桂，神气稍安，继投丹溪大补阴丸，诸恙悉减，终投本事虎杖汤，积块平复，淋痛皆除，不及一月，饮食大增而全愈。
得胜渡卫姓妇初产恶露不行，发热疼痛，中挟冬温伏气，医用逐瘀温经套剂，遂至热邪流注左腿，日夜难安，饮多食少，至冬至朝延予诊治。予变产后宜温之说，用凉血大剂，加通瘀解毒，四服全愈。
郡城张六老室，产后月余，崩中不止，时当暑月，医用和中养血，俱不能止，病已三日夜，视为必死。余诊其脉，浮大欲脱，连声索救，神气尚清，急令煎黄芪一两，当归一两，服之顷刻立止。古方当归补血汤，黄芪多于当归五倍，今加当归与黄芪等分者，时当暑月。恐黄芪之过亢也。
血厥医案
郡城七星桥翁氏女经前发厥，厥必数日不醒人事，医用朱、黄、胆星之属，经年不效。己卯六月，延予诊治。脉象搏指，余谓此系经血内瘀，久而发厥，非痰迷心窍也。朱、黄、胆星，焉能破瘀生新耶。乃合《内经》乌鲗骨丸，仲景旋复花汤，河间金铃子散为一方，数剂全痊，竟不再发。
吴静山（敬权）孝廉的夫人钱氏，在感受时邪之后出现发黄、浮肿的症状，每天无节制地嗜饮干茶。苏州太仓地区的各位医生，都采用气血双补的方法治疗，但久治不愈。后来请我诊治。诊得两手脉象都非常洪大且数，询问得知患者腹中攻痛无常，夜间身体发热如烙铁般烫手。这是由于阴液不足，瘀血阻滞、黏腻所致。宿血不去，则肢体浮肿；新血不生，则肌肉消瘦。一切刚燥的补脾药物，都不适用于此证。考察张仲景治疗黄疸，有用猪膏发煎润燥的方法，于是仿效其意，专门使用滋润的药物，调养肾肝而痊愈。
前营游击温公（大勇）夏季从浦口来到松江，途中冒犯暑气，到官署后请医生调治。起初用清暑利湿法无效，改用参术归地等药，反而增加了脘腹疼痛。此后早晚更换医生，大家都说是误补导致邪气留滞，治疗难以见效。于是请我诊治。我见他身面发黄，总是胃腑结聚不通所致，便用了连理汤辛开苦降的法子，授方后患者不服，转而就诊于青浦的医生，方剂用了茵陈五苓散等，服用后也不见效。于是以绝症为由推辞，回到官署中，计谋已尽，才把性命托付听任我处置。我仍然沿用前面的方法，只加入少量的参药，当晚即能安睡，随后改用理中汤调理半个月而痊愈。后来因为礼节疏慢，坚决辞谢不再前往，升任金山参将后，旧病复发，最终成了不治之症。
浊证医案
浊证多由湿滞引起，但也有适宜温固的情况。上海徐德音下焦流出浊物如鼻涕状，医生不辨别这是精浊，一概用利湿法治疗。
头痛医案
嘉定一位五十多岁的老妇人，患头痛数年，额头部位尤为严重。额头属于阳明经循行部位，久痛必然虚损，需要用填补阳明经的方法治疗，但长期不见效。逐渐发展到进食后容易饥饿，心火上亢，肾水下趋，形体消瘦，腰部弯曲，寒热交替频繁，督脉与阳维脉同时发病。我认为这属于精浊，不是便浊。于是用鹿角、菟丝子、骨脂等药物温补下焦，兼服威喜丸而痊愈。
提宪稿房陈寿昌患浊证，医生怀疑是肾阴亏损导致此疾，早上投用补肾药，导致小腹胀痛难忍。我用左金丸清火，合雄鼠粪汤攻逐浊邪而痊愈。同时鼓舞胃中清阳之气，用玉屏风散加炙甘草、葛根，两剂药全部痊愈。由此类推，太阳经头顶痛、少阳经头角痛、厥阴经头巅痛，都可以按照这种方法治疗。
高桥镇曹连珍的妻子，操持家务颇为劳累，加上经常暴怒，孟夏时节患病，从天柱穴至头顶忽然强痛，坚硬沉重难以移动，两耳红肿，胃中嘈杂，脉象洪数。遵循喻嘉言治疗吴添官母亲的先例而痊愈。
腹痛医案
枫泾镇宋元英生活安逸，纵情房事，患腹痛两年，医药无效，于是就诊于吴郡极负盛名的医生，对方以绝症为由推辞。宋元英随即回家料理后事，深信医生的话没有错。我恰好路过枫泾，遇到宋家的西席老师程永孚，谈论医理，遂成知己。于是同宋元英来寓所就诊，仔细按摸他的脉象，详细询问他的症状，总是阴阳逆乱，升降不利所致。我问：曾经服用过泻心汤或进退黄连汤吗？回答说没有。于是斟酌一方授予他，服用一剂后病情稍平，数剂后完全痊愈。
此前我在嘉定时，有个乡人王四九患膈证，向来服用调和中药，据他说服用三四剂就有效，过段时间又发作。就诊于我。投用进退黄连汤无效，改用丹溪的韭汁牛乳饮而痊愈。因此知道古人因证立方，不相假借。
胎前医案
胎前宜凉，人人皆知。但也有适宜温养的；胎前宜补血，不宜破血，但也有转用破血药而获得安胎效果的，关键在于临证时的细心体会。郡城孙锦章的妻子，怀孕五月，患转胞证不能排尿，医生用清利水道的方法，并不探究转胞是由于下焦虚寒、中焦气弱、肝家血滞所致。猪苓、泽泻、车前等药，徒然损伤胃气，所以饮食减少，夜间无法入睡，各种病症逐渐加重，而胞系的缠绕扭转依然如故。每天请稳婆抬起身体，才能排出尿液。究其原因是元气不支，一天比一天虚弱，因而延请我诊治。我诊得她的脉象缓大有力，许诺可以救治。遵循《金匮要略》的成例，投用肾气汤一剂，当晚稍微能安睡，这是因为利水药足以泻肾，投用桂枝、附子使命门温暖，所以稍微能安睡。再遵循朱丹溪补气成例，投用参术汤一剂，饮食逐渐能知味道，只是病人几天没有大便，腹部到这里更觉得不安，改用茱连汤一剂，大便得解，小便虽然仍需要稳婆协助。病人因为各种病症都减轻，深信不疑，再次请求良好治疗，我为此沉思良久，脉象比以前更加有力，元气已恢复但胎气未举，必有瘀血阻塞其间，于是用大剂量破血药，一剂后胀气消除，三剂后胎气未举（注：此处原文可能有误或指胎气稳固/未动），凡破血药最碍胎，现在破血而胎反固，妙在先用补药以助其元气。
产后医案
产后感冒时邪，宜温散，不宜凉散，人人皆知。但也有不适宜温而适宜凉的，误用温法则不得不用大寒药了。归鞠氏侄女，冬月初生产无恙，到第六天头痛身热，凛凛畏寒，我用栀豉汤，半夜热退，第二天又发热，换用医生按产后逐瘀成法治疗，于是增加烦躁。我认为这是冬温病，清解即可安宁。《通评虚实论》说：哺乳期间生病发热，脉象悬小的，手足温暖则生，仍依时邪治例，用白虎汤而痊愈。凡是产后没有产后证而感染其他病的，就应当按其他病治疗，而朱丹溪“大补气血”的说法，却不可拘泥。张仲景说：病解能食，七八日更发热者，此为胃实，大承气汤主之。在阳明经中，张仲景尚且再三告诫人不可轻下，而产后亡血既多，仍说用承气汤主治，大概既然为胃实自有不得不用的道理，举一例而产后挟实证者可类推。张仲景说：产后下利虚极，白头翁加甘草阿胶汤主之。既然说虚极，仍用白头翁汤，是因为下痢中既有渴欲饮水、热而下重的证候，则白头翁汤自有不得不用的道理。正因为虚极，所以加甘草、阿胶以养护正气，举一例而产后挟虚证者可类推。
产后恶露不行，胸腹饱胀，温之通之，人人皆知。但也有不适宜温而适宜凉，不适宜通而适宜和的情况。东门鞠上玉的妻子初产后患此，脉象数大而疾，上部兼有鼻衄，我用当归二两煎汤，冲热童便服用，稍稍安稳，但恶露仅有点滴。换用医生用炮姜等温通套方，导致胸腹增加胀满，恶露点滴不行。有人想依产后春温治例，大进苦寒之品，我说：这又不是稳妥的治疗。坚持用归地丹芍等凉血和血的药剂，十余日后，恶露大行而痊愈。凡是产后病解能食，七八日更发热者，当作别病治。初产后即发热者，则仍作产后治。但各有寒热，两途不可不条分缕析。
郡城侯姓妇女三十多岁，因为元宵夜出游，行走太劳，回家后即小产。医生都认为她胸腹有块，用逐瘀成法，每剂必加炮姜，都没有效果。后来虽停药，但骨节如焚，积块更大，小便艰涩，热痛异常。到三月才延请我诊治，已经奄奄一息。诊得她的脉象沉伏至极，隐隐难寻，我固然知道她是阴虚阳盛，但日期拖延已久，宜用缓治。初投复脉汤减去姜桂，神气稍安，继投朱丹溪大补阴丸，各种病症都减轻，最后投用本事虎杖汤，积块平复，淋痛皆除，不到一个月，饮食大增而痊愈。
得胜渡卫姓妇女初产恶露不行，发热疼痛，中挟冬温伏气，医生用逐瘀温经套方，导致热邪流注左腿，日夜难安，饮多食少，到冬至早晨延请我诊治。我改变产后宜温的说法，用凉血大剂，加通瘀解毒，四服全愈。
郡城张六老妻子，产后月余，崩中不止，当时正值暑月，医生用和中养血法，都不能止住，病已三日夜，视为必死。我诊得她的脉象浮大欲脱，连声求救，神气尚清，急令煎黄芪一两，当归一两，服用后顷刻立止。古方当归补血汤，黄芪多于当归五倍，现在加当归与黄芪等分，是因为正值暑月，恐怕黄芪过于亢盛。
血厥医案
郡城七星桥翁氏女儿经前发厥，厥必数日不醒人事，医生用朱砂、黄芩、胆星之类，经年无效。己卯年六月，延请我诊治。脉象搏指，我认为这是经血内瘀，久而发厥，不是痰迷心窍。朱砂、黄芩、胆星，怎么能破瘀生新呢？于是合《内经》乌鲗骨丸、张仲景旋复花汤、刘河间金铃子散为一方的方剂，数剂后完全康复，竟不再发作。
Wu Jingshan (Jingquan), a Xiucai, presented with his wife, Madam Qian. After contracting an epidemic pathogen, she developed jaundice and edema. She had an uncontrolled craving for dry tea daily. Various physicians in Suzhou and Taicang treated her with methods tonifying both Qi and Blood, but the condition persisted without improvement. I was then invited to examine her. The pulse on both hands was extremely surging and rapid. Upon inquiry, it was found that she suffered from unpredictable abdominal pain, and her body felt hot as if branded at night. This was caused by insufficient Yin fluids and stagnation of blood causing stickiness. When old blood remains, limbs swell; when new blood is not generated, muscles emaciate. All rigid and drying spleen-tonifying herbs are unsuitable for this syndrome. Studying Zhang Zhongjing’s treatment of jaundice, there is the method of using Pig Fat and Hair Decoction (Zhigao Fa Jian) to moisten dryness. Therefore, imitating its principle, I exclusively used moistening agents to nourish the Kidney and Liver, resulting in recovery.
General Wen Dayong (Dayong) of the Former Camp arrived in Songjiang from Pukou in summer. He was exposed to summer heat during the journey. After arriving at the office, he sought medical treatment. Initially, clearing summer heat and promoting diuresis failed. Switching to Ginseng, Atractylodes, Angelica, and Rehmannia aggravated epigastric pain. Physicians changed frequently thereafter, all agreeing that mistaken tonification had retained the pathogen, making cure difficult. I was then consulted. I observed yellowing of the body and face, which I attributed to accumulation and obstruction in the Stomach organ. I prescribed Lianli Tang (Coptis and Gastrodia Decoction) using the method of acrid opening and bitter descending. The patient refused it and consulted a physician in Qingpu, who prescribed Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Decoction) among others, which also failed. Declaring it a terminal case, he returned to the office, having exhausted all strategies, and finally entrusted his life to my care. I continued with the previous method, adding a small amount of Ginseng. That night, he slept peacefully. Subsequently, Lizhong Tang (Regulate the Middle Decoction) was used for half a month until recovery. Later, due to perceived discourtesy, I firmly declined further visits. After his promotion to Senior General of Jinshan, his old illness recurred, becoming incurable.
Case of Turbid Urine Syndrome
Turbid urine syndrome is mostly due to dampness stagnation, but warming and consolidating methods are sometimes appropriate. Xu Deyin from Shanghai had turbid discharge resembling mucus from the lower jiao. Physicians did not distinguish whether it was essence turbidity or urinary turbidity, generally treating it with damp-draining methods.
Case of Headache
An elderly woman in Jiading, aged fifty-seven, suffered from headache for several years, most severe on the forehead. The forehead belongs to the Yangming region. Chronic pain implies deficiency, requiring supplementation of the Yangming channel. However, long-term treatment showed no effect. Gradually, she developed easy hunger after eating, hyperactive Heart Fire, sinking Kidney Water, emaciation, lumbar curvature, frequent alternating chills and fever, involving both the Du vessel and Yangwei vessel. I determined this was essence turbidity, not urinary turbidity. I used Deer Antler, Cuscuta, and Dogwood Cortex to warm and tonify the Lower Jiao, combined with Weixi Pill, resulting in recovery.
Chen Shouchang, clerk to the Provincial Surveillance Commissioner, suffered from turbid urine. Physicians suspected Kidney Yin deficiency and administered kidney-tonifying drugs in the morning, causing severe lower abdominal distension and pain. I used Zuojin Wan (Left Metal Pill) to clear fire, combined with Male Rat Feces Decoction to attack turbidity, resulting in recovery. To stimulate clear Yang Qi in the Stomach, I used Yupingfeng San (Jade Windscreen Powder) with roasted Licorice and Kudzu Root. Two doses led to complete recovery. From this, one can infer that Taiyang vertex headache, Shaoyang temporal headache, and Jueyin vertex headache can all be treated according to their respective methods.
The wife of Cao Lianzhen from Gaoqiao Town managed household affairs with great exertion and suffered from frequent anger. In early summer, she fell ill with sudden, stiff, heavy pain from Tianzhu to the vertex, difficult to move. Her ears were red and swollen, stomach嘈杂 (discomfort/burning), and pulse surging and rapid. Following Yu Jia Yan’s precedent for treating Wu Tianguan’s mother, she recovered.
Case of Abdominal Pain
Song Yuanying from Fengjing Town lived comfortably but indulged in sexual activity. He suffered from abdominal pain for two years with no effect from medicine. He consulted a renowned physician in Wu Commandery, who declared it a terminal case. Song returned home to arrange his affairs, believing the diagnosis correct. I happened to pass through Fengjing and met Cheng Yongfu, Song’s tutor, discussing medical principles, becoming close friends. Accompanying Song to my residence, I carefully palpated his pulse and inquired about his symptoms. It was clearly due to rebellion of Yin and Yang and unfavorable ascending and descending. I asked: Have you taken Xiexin Tang or Jintui Huanglian Tang? He replied no. I formulated a prescription. One dose brought slight relief; several doses led to complete recovery.
Previously in Jiading, a villager named Wang Sijiu suffered from Ge syndrome (obstruction). He usually took harmonizing Chinese medicines, reporting efficacy after three or four doses, only for recurrence later. Consulting me, Jintui Huanglian Tang was ineffective. Switching to Danxi’s Leek Juice and Cow Milk Drink resulted in recovery. Thus, I know ancients formed prescriptions based on syndromes, without arbitrary application.
Case of Prenatal Care
It is known that prenatal care should favor cooling, though warming is sometimes appropriate. It is known that prenatal care should tonify blood and avoid breaking blood, yet breaking blood agents have been used successfully for peace of fetus. This depends on careful clinical discernment. Sun Jinzhhang’s wife in the prefectural city, five months pregnant, suffered from Zhuanbao (bladder displacement) with inability to urinate. Physicians used diuretics, ignoring that Zhuanbao could stem from Lower Jiao deficiency-cold, Middle Jiao Qi weakness, or Liver blood stagnation. Polyporus, Alisma, and Plantago seeds merely damaged Stomach Qi, reducing appetite and causing insomnia, worsening conditions while the bladder ligament remained twisted. Daily lifting by midwives allowed urination. Ultimately, Yuanqi (Original Qi) failed, worsening daily. I was consulted. Pulse was slow, large, and forceful. I promised salvation. Following the Golden Chamber precedent, I administered Shenqi Tang (Kidney Qi Decoction). One dose allowed slight sleep, as water-draining herbs drain Kidney, while Cinnamon Twig and Aconite warm Mingmen (Gate of Life), facilitating sleep. Following Danxi’s Qi-tonifying precedent, I administered Renshen Baizhu Tang (Ginseng and Atractylodes Decoction). Appetite improved. However, constipation for several days caused abdominal discomfort. Switching to Zhulian Tang (Evodia and Coptis Decoction) resolved stool. Urination still required midwife assistance. Seeing improvement, she trusted me completely and sought further treatment. Contemplating her pulse, which became more forceful, Yuanqi had recovered but fetal Qi was not yet established. Blood stasis likely blocked the area. I used a large dose of blood-breaking herbs. One dose reduced distension; three doses stabilized fetal Qi. Although blood-breaking herbs usually harm the fetus, here they strengthened it, thanks to prior tonification supporting Yuanqi.
Case of Postpartum Care
Postpartum exposure to epidemic pathogens requires warming dispersal, not cooling dispersal, which is common knowledge. Yet, cooling is sometimes appropriate; mistaken warming necessitates major cold herbs. The niece of Gui Ju gave birth safely in winter. On the sixth day, she had headache, fever, and aversion to cold. I used Zhichi Tang (Gardenia and Soybean Decoction). Fever subsided by midnight but returned next day. Other physicians applied postpartum blood-stasis removal methods, increasing irritability. I diagnosed Winter Warmth disease, treatable by clearing. Tongping Xu Shi Lun states: If a nursing woman has fever and suspended-small pulse, survival is indicated if hands and feet are warm. Following epidemic pathogen protocols, I used Baihu Tang (White Tiger Decoction), resulting in recovery. For postpartum patients with non-obstetric diseases, treat the specific disease; do not rigidly adhere to Danxi’s “major tonification of Qi and Blood.” Zhang Zhongjing stated: If after resolution of disease, appetite returns, but fever recurs after seven to eight days, this is Stomach excess, treated with Dachengqi Tang. Even in Yangming channel, Zhang warned against purgatives, yet prescribed them for postpartum blood loss cases where Stomach excess exists. This illustrates postpartum excess syndromes. Zhang also stated: Postpartum diarrhea with extreme deficiency is treated with Baitouweng Tang plus Licorice and Donkey-hide Gelatin. Despite extreme deficiency, Baitouweng Tang is used due to thirst and heaviness indicating heat. Licorice and Gelatin protect healthy Qi. This illustrates postpartum deficiency syndromes.
Postpartum lochia retention with chest/abdominal distension is typically treated with warming and moving methods. However, cooling and harmonizing are sometimes appropriate. The wife of Ju Shangyu from East Gate suffered this after first childbirth. Pulse was rapid, large, and swift, with epistaxis. I used two taels of Angelica decocted in water, mixed with hot child’s urine. She stabilized slightly, but lochia remained scant. Other physicians used dried Ginger for warming/moving, worsening distension and stopping lochia. Some suggested major bitter-cold herbs for Spring Warmth protocol. I rejected this as unstable. Persisting with Danggui, Rehmannia, Moutan, and Peony for cooling/harmonizing blood, lochia flowed heavily after ten days, leading to recovery. Generally, postpartum fever after seven-eight days with appetite return is treated as separate disease. Immediate postpartum fever is treated as postpartum condition. Cold and heat must be distinguished carefully.
A woman surnamed Hou in the prefectural city, in her thirties, miscarried after excessive walking during Lantern Festival. Physicians saw abdominal masses and used blood-moving methods with dried Ginger, ineffective. Stopping medication, bone joints burned, mass enlarged, dysuria with painful heat occurred. Consulted in the third month, she was near death. Pulse was deep, hidden, faint. I knew it was Yin deficiency with Yang hyperactivity, but chronicity required slow treatment. Initial Fu Mai Tang minus Cinnamon/Aconge calmed spirit. Then Danxi’s Dabu Yin Wan reduced symptoms. Finally, Bencao Huazhang Tang flattened the mass and removed dysuria/pain. Within a month, appetite increased, and she recovered.
A woman surnamed Wei from Deshengdu had postpartum lochia retention, fever, and pain, complicated by latent Winter Warmth qi. Physicians used blood-moving/warming meridians methods, causing heat to flow into the left leg, restlessness, polydipsia, poor appetite. Consulted on Winter Solstice morning, I abandoned postpartum warming dogma, using major blood-cooling herbs with blood-moving/antitoxic agents. Four doses cured her.
Madam Zhang, wife of Zhang Liulao in the prefectural city, suffered metrorrhagia for over a month postpartum during summer. Harmonizing/tonifying blood failed. After three days/nights, deemed fatal. Pulse was floating, large, nearly collapsing. She cried for help, spirit clear. I urgently ordered one liang of Astragalus and one liang of Angelica decocted. Bleeding stopped instantly. Ancient Danggui Buxue Tang uses five times more Astragalus than Angelica. Here, equal parts were used due to summer heat, fearing Astragalus’ excessive rising nature.
Case of Blood Syncope
Miss Weng from Qixing Bridge, prefectural city, experienced syncope before menstruation, unconscious for days. Physicians used Cinnabar, Scutellaria, and Pinellia preparations annually without effect. In June of Ji Mao year, I was consulted. Pulse was striking. I diagnosed internal menstrual blood stasis causing syncope, not phlegm confusing the heart orifice. Cinnabar, Scutellaria, and Pinellia cannot break stasis and generate new blood. Combining Eupolyphaga Pill from Neijing, Xin Yi Hua Tang from Zhang Zhongjing, and Jinlingzi San from Liu Hejian into one formula, several doses led to full recovery with no recurrence.