包氏 严寒坐蓐,肠出不收,身热面赤。思被冷无温,肠必干涩难上,如蓖麻子捣涂发顶,法必不验。
即冷水 面,亦虑滋病。令煎芎归汤入净桶,着人扶坐桶上,以旧绢托肠,乘热熏之。肠得热气,自润而升,
且托且送,待其将尽,趁手托入。如法而收,再服补剂热退。
陈氏 产数日,浮肿身重,不能转侧,不食不语,脉虚缓。当由产后浴早,水湿乘虚袭入子宫,下
部先肿,渐至通体重着,殆伤湿之见症也。开发腠理,逐去湿邪。宜羌活渗湿汤加陈皮、半夏、防己、茯苓皮。
一啜湿从汗解,身可转侧,浮肿渐退。再为健脾利湿,饮食亦进。以妇体素肥,气郁生涎,时或昏冒,用温
胆汤调理而痊。
某氏 露产冒暑,烦热汗出,直视不语,脉软数。医谓恶露未行,治宜逐瘀。予曰∶直视者足太阳经血
虚,筋急牵引直上也。不语者暑先入心,手少阴脉系舌本,络舌旁,邪入营分,舌系缩
也。烦热则易郁冒,汗多亦虑液亡,失治必变昏痉危 。用生脉散加生地、当归、石斛、连翘、丹皮、木瓜、
甘草、藕汁冲服。诸症退能言,又加减前方,数十服得安。
张氏 中年产育,旬日外鲜红下注,自汗身热,此阴虚阳无所附也。用十全大补汤去桂,加炮姜、小
麦煎汤,二服汗收血止。是症血去则亡阴,汗多则亡阳,产后危症也。
徐氏 产后夜热烦渴,脉促数。因决其胎必下,当夜遂产,恶露甚少,逾日鲜血暴注,晕绝。用潞参、
茯神、熟地、炮姜、荆芥(醋炒)、山栀、甘草(俱炒黑)、石斛、阿胶,神苏血止。
杨氏 产后鲜血,足膝热,乳少,脉芤,宜摄固下元,兼升举中气。桑螵蛸(炙研)、熟地、杞子、杜
仲(盐水炒)、黄 (蜜炙)、升麻。二服血止。去桑螵蛸,加生黄 、甘草、当归、红枣,而乳倍常。
李氏 产后郁冒,昏睡不语,虑其痉厥。用鲜石菖蒲根汁热服,渐次苏醒能言。询所苦,但云目暗咽塞,
心系下引,遂闷绝不知人,此为风火,痰阻窍也。因用桔梗、荆芥、甘菊(炒)、连翘、贝母、茯神、山栀、
菖蒲汁冲,二服而安。
张氏 官署坐蓐,辄动乡思,经旬宵热如烙,脉虚疾,插髻银簪,一夕色黑,以纸拭去,明晨如漆,骇
极。予云∶此产后血虚火炎,汗泽所蒸耳。宜滋阴退热。以熟地、白芍、丹皮、当归、丹参、石斛、茯神、
杞子、甘草,四服热退,簪色不变矣。去丹皮、丹参,加枣仁、山药、莲子,蜜丸服,愈。此前取甘凉除热,
后取酸涩安神。
吴氏 蓐损不复,寒热往来,自汗,咳呕吐沫,心悸耳鸣,脉虚数。经言∶阳维为病苦寒热。阳失维护,
奇脉已损,况中宫小镇,致咳呕悸眩,肝阳升逆,面色忽青忽赤,延为难治。惟大便未溏,肾关未撤,尚堪借
箸。拟晨服黄 建中汤,去姜,加参、苓、山药,橘白,卫外扶中。晚服熟地、杞子(俱炒)、牡蛎(醋 )、
枣仁、白芍、茯神、五味、莲子、小麦煎服,摄阴敛阳。症减,背时凛寒,晨服方中再加鹿角胶,外以白胡
椒末掺布膏药贴背脊第三椎至第七节,仍照前分早晚各服五七剂乃安。
巢氏 初春小产,寒热头痛烦呕,汗后复热,血下如豆汁,
篡间糜损,脉右洪大,左沉数。此温邪化热,乘虚袭入下焦也。以豆豉、山栀、蒌仁、鲜生地、石斛、知母、
麦冬、丹参、阿胶,血稀热减。去知母、阿胶,加丹皮,竹叶心,元参,汗透身凉而脉和。
邹氏 冬寒当产,艰难损动元气,嗣以月内便泄。交春寒热往来,痰嗽汗泄,晡时火升,颊红唇燥,
食入呕满,小腹痛坠,泻利稀白无度,支离委顿。所服丸剂,一味混补,罔顾滋腻,岂胃弱火衰,食已不化,
小腹重坠,气更下陷,尚堪滑腻增泻,浸至蓐劳莫挽矣。急用温中运脾,痛利可减,呕满可除。炮姜、小茴、
益智仁、茯苓、白术、半夏曲、谷芽(俱炒)、橘白,数剂利止,寒热减,食亦知味。去炮姜、小茴、谷芽、
半夏曲、白术、橘白等,加砂仁、熟地(炭)、潞参、五味、丹皮、山药、莲子、钗斛,虚阳渐退,并去益智、
茯苓,加甜杏仁、茯神、白芍、百合,嗽止调理而康。
包氏 在严寒中分娩,子宫脱垂无法回纳,身体发热,面色发红。考虑到被褥寒冷且无温暖之物,子宫必然干涩难以复位,如果使用蓖麻子捣碎涂抹头顶的方法,必定无效。
即使使用冷水洗脸,也担心加重病情。于是让人煎煮芎归汤倒入干净的桶中,让人扶着坐在桶上,用旧丝绢托住脱出的子宫,利用热气熏蒸。子宫得到热气滋润后,自然润滑并上升,一边托举一边送入,待即将完全纳入时,顺势用手推入。按照这个方法成功复位,随后服用补益药物,热退病愈。
陈氏 产后数日,出现浮肿、身体沉重,不能翻身转动,不进食也不说话,脉象虚缓。这应当是由于产后过早洗浴,水湿之邪乘虚侵入子宫,下部先肿,逐渐发展到全身沉重,大概是伤湿的表现症状。治疗应开发腠理,驱逐湿邪。适宜使用羌活渗湿汤加入陈皮、半夏、防己、茯苓皮。喝一剂后湿气随汗液排出,身体可以转动,浮肿逐渐消退。再采用健脾利湿的方法,饮食也能进用。因为该妇人平时体胖,气机郁滞生痰涎,时常昏闷眩晕,使用温胆汤调理而痊愈。
某氏 露天生产感受暑邪,烦躁发热出汗,两眼直视不语,脉象软数。医生认为恶露未行,治疗应当逐瘀。我说:直视是因为足太阳经血虚,筋脉拘急牵引向上所致。不语是因为暑邪先入心,手少阴心经的脉络系于舌根,联络舌旁,邪气进入营分,导致舌根收缩。烦躁发热容易引发郁冒,出汗多也担心津液耗亡,如果失治必然变为昏厥痉病的危症。使用生脉散加生地、当归、石斛、连翘、丹皮、木瓜、甘草,用藕汁冲服。各种症状消退能说话后,又加减前方,服用几十剂得以安宁。
张氏 中年生育,十几天后阴道鲜红出血不止,自汗身热,这是阴虚阳气无所依附的表现。使用十全大补汤去掉桂枝,加入炮姜、小麦煎汤,服用两剂后汗止血停。这种病症血液流失则亡阴,汗出过多则亡阳,是产后的危重病症。
徐氏 产后夜间发热烦渴,脉象急促数。因此推断其胎儿必将产出,当夜果然生产,但恶露很少,过了一天鲜血暴注,晕厥过去。使用潞参、茯神、熟地、炮姜、荆芥(醋炒)、山栀、甘草(全部炒黑)、石斛、阿胶,神识清醒血止。
杨氏 产后流血,足膝发热,乳汁少,脉象芤,应当固摄下元,兼以升举中气。使用桑螵蛸(炙研)、熟地、枸杞子、杜仲(盐水炒)、黄芪(蜜炙)、升麻。服用两剂血止。去掉桑螵蛸,加入生黄芪、甘草、当归、红枣,乳汁加倍。
李氏 产后郁冒,昏睡不语,担心发生痉厥。使用鲜石菖蒲根汁热服,逐渐苏醒能说话。询问痛苦所在,只说眼睛昏暗咽喉堵塞,心部向下牵引,随即闷绝不知人事,这是风火痰阻窍所致。因此使用桔梗、荆芥、甘菊(炒)、连翘、贝母、茯神、山栀、菖蒲汁冲服,服用两剂而安。
张氏 在官府住所分娩,动不动就思念家乡,经过十天夜间发热如火烧,脉象虚疾,插戴银簪,一夜之间变黑,用纸擦拭去除,第二天早晨像漆一样黑,惊恐万分。我说:这是产后血虚火炎,被汗水浸润蒸发所致。适宜滋阴退热。使用熟地、白芍、丹皮、当归、丹参、石斛、茯神、枸杞子、甘草,服用四剂热退,簪子颜色不再变化。去掉丹皮、丹参,加入枣仁、山药、莲子,制成蜜丸服用,痊愈。这是前期取甘凉除热,后期取酸涩安神。
吴氏 产后身体亏损未复,寒热往来,自汗,咳嗽呕吐泡沫,心悸耳鸣,脉象虚数。经文说:阳维脉生病苦于寒热。阳气失去维护,奇经八脉已受损,何况中焦脾胃虚弱,导致咳嗽呕吐心悸眩晕,肝阳升逆,面色忽青忽赤,拖延下去难治。只有大便尚未溏泄,肾关未撤,还可以借助药力。拟定早晨服用黄芪建中汤,去掉生姜,加入人参、茯苓、山药、橘白,护卫体表扶助中焦。晚上服用熟地、枸杞子(全部炒)、牡蛎(醋煅)、枣仁、白芍、茯神、五味子、莲子、小麦煎服,摄阴敛阳。症状减轻,背部定时发冷,早晨方中再加鹿角胶,外用白胡椒末掺入布膏药贴在背脊第三椎至第七节,仍然照前分早晚各服五到七剂才安宁。
巢氏 初春小产,寒热头痛烦躁呕吐,出汗后再次发热,阴道出血如豆汁,肛门糜烂损伤,脉象右洪大,左沉数。这是温邪化热,乘虚侵入下焦。使用豆豉、山栀、瓜蒌仁、鲜生地、石斛、知母、麦冬、丹参、阿胶,血稀热减。去掉知母、阿胶,加入丹皮、竹叶心、玄参,汗透身凉而脉象平和。
邹氏 冬季寒冷时分娩,艰难损伤元气,随后一个月内腹泻。交春后寒热往来,痰嗽汗出,傍晚时分火气上升,脸颊红嘴唇干燥,进食后呕吐胀满,小腹痛坠,泻利稀白无度,精神萎靡疲惫。所服的丸剂,一味混补,不顾滋腻,难道胃弱火衰,食物已经吃下却不消化,小腹重坠,气更下陷,还能承受滑腻增加腹泻吗?这将导致蓐劳无法挽救。紧急使用温中运脾的方法,疼痛和腹泻可减,呕吐胀满可除。使用炮姜、小茴香、益智仁、茯苓、白术、半夏曲、谷芽(全部炒)、橘白,几剂后腹泻停止,寒热减少,饮食也知道味道。去掉炮姜、小茴香、谷芽、半夏曲、白术、橘白等,加入砂仁、熟地(炭)、潞参、五味子、丹皮、山药、莲子、钗斛,虚阳逐渐消退,并去掉益智、茯苓,加入甜杏仁、茯神、白芍、百合,咳嗽停止调理而康复。
Bao Shi (Patient Bao) gave birth during severe cold, with uterine prolapse unable to retract, accompanied by fever and flushed face. Considering the bedding was cold and lacked warmth, the uterus must be dry and difficult to return; using the method of applying crushed castor bean paste to the crown would certainly be ineffective. Even washing the face with cold water might exacerbate the condition. Therefore, decoct Xiong Gui Tang (Szechwan Lovage and Angelica Decoction) in a clean tub, have the patient sit on the tub supported by others, use old silk cloth to support the prolapsed uterus, and fumigate it with the hot steam. Upon receiving the heat, the uterus becomes moist and rises naturally. While supporting and pushing, wait until it is almost fully reduced, then manually push it in. Following this method, reduction was successful; subsequently, tonifying medicines were administered, fever subsided, and the patient recovered.
Chen Shi (Patient Chen) presented several days postpartum with edema, heavy body sensation, inability to turn over, anorexia, mutism, and a deficient, slow pulse. This likely resulted from bathing too early after childbirth, allowing water-dampness to invade the uterus via deficiency. Swelling started in the lower part and gradually spread to cause whole-body heaviness, indicative of injury by dampness. The treatment should open the cou li (pores and interstices) and expel dampness. Qiang Huo Shen Shi Tang (Notopterygium Damp-Expelling Decoction) added with Chen Pi (Tangerine Peel), Ban Xia (Pinellia), Fang Ji (Stephania), and Fu Ling Pi (Poria Skin) was appropriate. After one dose, dampness was resolved through sweating, mobility returned, and edema gradually receded. Subsequently, spleen-fortifying and damp-draining methods were used, allowing food intake to resume. As the patient was constitutionally obese with qi stagnation generating phlegm-saliva, occasional dizziness and faintness occurred; Wen Dan Tang (Warm Gallbladder Decoction) was used for regulation, leading to recovery.
A certain woman gave birth outdoors, contracting summerheat. She presented with irritability, fever, sweating, fixed gaze, mutism, and a soft, rapid pulse. The physician believed lochia had not yet flowed and advocated blood-stasis removal. I stated: Fixed gaze results from blood deficiency in the Foot-Taiyang Bladder channel, causing tendon tension pulling upward. Mutism occurs because summerheat first enters the Heart; the Hand-Shaoyin Heart channel connects to the root of the tongue and links to its sides; when pathogenic factors enter the Ying (Nutritive) level, the tongue root contracts. Irritability and fever predispose to yu mao (depressive vertigo); excessive sweating risks fluid depletion. Without proper treatment, this will likely transform into coma and convulsions. Sheng Mai San (Generate the Pulse Powder) added with Sheng Di Huang (Rehmannia Root), Dang Gui (Angelica Sinensis), Shi Hu (Dendrobium Stem), Lian Qiao (Forsythia Fruit), Mu Dan Pi (Moutan Bark), Mu Gua (Chaenomeles Fruit), and Gan Cao (Licorice Root), taken with lotus root juice, was prescribed. Symptoms subsided, speech returned, and after several modifications of the previous formula over dozens of doses, she stabilized.
Zhang Shi (Patient Zhang), giving birth at middle age, presented ten days later with continuous bright red vaginal bleeding, spontaneous sweating, and fever. This indicates Yin deficiency with Yang having no anchor. Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) without Gui Zhi (Cinnamon Twig), added with Pao Jiang (Prepared Ginger) and Xiao Mai (Wheat), was decocted and taken. After two doses, sweating stopped and bleeding ceased. In this condition, blood loss leads to Yin collapse, and excessive sweating leads to Yang collapse; this is a critical postpartum syndrome.
Xu Shi (Patient Xu) presented postpartum with night fever, irritability, thirst, and a hurried, rapid pulse. It was predicted that the fetus would be delivered, which indeed happened that night. However, lochia was scanty. The next day, massive fresh blood flow occurred, leading to syncope. Lu Shen (Codonopsis Radix), Fu Shen (Poria with Hostwood), Shu Di Huang (Prepared Rehmannia Root), Pao Jiang (Prepared Ginger), Jing Jie (Schizonepeta, stir-fried with vinegar), Shan Zhi (Gardenia Fruit), Gan Cao (Licorice, all charred), Shi Hu (Dendrobium Stem), and E Jiao (Donkey-hide Gelatin) were used. Consciousness was restored, and bleeding stopped.
Yang Shi (Patient Yang) presented postpartum with vaginal bleeding, heat in feet and knees, scanty lactation, and a knifelike (Kou) pulse. Treatment should secure the Lower Origin and simultaneously raise Middle Qi. Sang Piao Xiao (Mantis Egg-case, roasted and ground), Shu Di Huang (Prepared Rehmannia Root), Gou Qi Zi (Goji Berry), Du Zhong (Eucommia Bark, stir-fried with salt water), Huang Qi (Astragalus Root, honey-roasted), and Sheng Ma (Cimicifuga Rhizome) were used. Bleeding stopped after two doses. Sang Piao Xiao was removed, and Sheng Huang Qi (Raw Astragalus), Gan Cao (Licorice), Dang Gui (Angelica Sinensis), and Hong Zao (Jujube) were added, resulting in doubled milk production.
Li Shi (Patient Li) presented postpartum with yu mao (depressive vertigo), lethargy, mutism, raising concern for convulsions. Fresh Shi Chang Pu (Acorus Rhizome) root juice was taken hot, leading to gradual awakening and speech resumption. Inquiry revealed dim vision, throat obstruction, and a pulling sensation from the heart downward, followed by sudden fainting and unconsciousness. This was identified as Wind-Fire and Phlegm obstructing the orifices. Jie Geng (Platycodon Root), Jing Jie (Schizonepeta), Gan Ju (Chrysanthemum Flower, stir-fried), Lian Qiao (Forsythia Fruit), Bei Mu (Fritillaria Bulb), Fu Shen (Poria with Hostwood), Shan Zhi (Gardenia Fruit), and Shi Chang Pu juice were used. Stability was achieved after two doses.
Zhang Shi (Patient Zhang) gave birth in an official residence, frequently experiencing homesickness. For ten days, she suffered nightly fever feeling like burning, with a deficient, rapid pulse. A silver hairpin inserted into her hair turned black overnight; wiping it off revealed it black as lacquer the next morning, causing great alarm. I stated: This is postpartum blood deficiency with flaming fire, steamed by sweat moisture. Nourishing Yin and reducing fever was indicated. Shu Di Huang (Prepared Rehmannia Root), Bai Shao (White Peony Root), Mu Dan Pi (Moutan Bark), Dang Gui (Angelica Sinensis), Dan Shen (Salvia Root), Shi Hu (Dendrobium Stem), Fu Shen (Poria with Hostwood), Gou Qi Zi (Goji Berry), and Gan Cao (Licorice Root) were used. Fever subsided after four doses, and the hairpin color remained unchanged. Mu Dan Pi and Dan Shen were removed, and Suan Zao Ren (Ziziphus Seed), Shan Yao (Chinese Yam), and Lian Zi (Lotus Seed) were added, made into honey pills, leading to cure. Initially, sweet-cool herbs were used to clear heat; subsequently, sour-astringent herbs were used to calm the spirit.
Wu Shi (Patient Wu) presented with postpartum physical depletion, alternating chills and fever, spontaneous sweating, cough with vomiting of foam, palpitations, tinnitus, and a deficient, rapid pulse. The classics state: Disease of the Yang Wei vessel causes aversion to cold and fever. Yang lacks maintenance, and the extraordinary vessels are damaged. Moreover, the Middle Jiao is weak, causing cough, vomiting, palpitations, and vertigo; Liver Yang rises rebelliously, causing facial color to fluctuate between green and red. Prognosis is poor if delayed. Since stool was not loose and the Kidney gate was not collapsed, treatment was still possible. Morning: Huang Qi Jian Zhong Tang (Astragalus Build the Middle Decoction) without Sheng Jiang (Fresh Ginger), added with Ren Shen (Ginseng), Fu Ling (Poria), Shan Yao (Chinese Yam), and Ju Bai (Citrus Albedo), to protect the exterior and support the Middle. Evening: Shu Di Huang (Prepared Rehmannia Root), Gou Qi Zi (Goji Berry, both stir-fried), Mu Li (Oyster Shell, calcined with vinegar), Suan Zao Ren (Ziziphus Seed), Bai Shao (White Peony Root), Fu Shen (Poria with Hostwood), Wu Wei Zi (Schisandra Fruit), Lian Zi (Lotus Seed), and Xiao Mai (Wheat) decocted, to gather Yin and contain Yang. Symptoms improved, but back chills occurred periodically. Deer Antler Glue (Lu Jiao Jiao) was added to the morning formula. Externally, Bai Hu Jiao (White Pepper) powder mixed into plaster was applied to the back spine from the third to seventh thoracic vertebrae. Taking both formulas morning and evening for five to seven doses each led to stability.
Chao Shi (Patient Chao) had a miscarriage in early spring, presenting with chills, fever, headache, irritability, vomiting, recurrent fever after sweating, bloody discharge resembling bean curd residue, anal erosion, right pulse large and flooding, left pulse deep and rapid. This indicates Warm Pathogen transforming into heat, invading the Lower Jiao via deficiency. Dou Chi (Fermented Soybean), Shan Zhi (Gardenia Fruit), Lou Ren (Trichosanthes Seed), Xian Sheng Di Huang (Fresh Rehmannia Root), Shi Hu (Dendrobium Stem), Zhi Mu (Anemarrhena Rhizome), Mai Dong (Ophiopogon Tuber), Dan Shen (Salvia Root), and E Jiao (Donkey-hide Gelatin) were used. Blood became thinner, heat decreased. Zhi Mu and E Jiao were removed, and Mu Dan Pi (Moutan Bark), Zhu Ye Xin (Bamboo Leaf Tip), and Yuan Shen (Scrophularia Root) were added. Sweating ensued, body cooled, and pulse normalized.
Zou Shi (Patient Zou) gave birth in winter cold, damaging Yuan Qi due to difficulty. Subsequently experienced diarrhea within the month. Entering spring, alternating chills and fever, phlegmy cough, sweating, rising fire in the late afternoon, red cheeks, dry lips, postprandial vomiting and fullness, lower abdominal pain and bearing-down sensation, profuse watery white diarrhea, and extreme debility. Previous pill medications consisted of indiscriminate tonification, ignoring cloying nature. With weak Stomach Fire and impaired digestion, food not transforming, lower abdominal heaviness, sinking Qi, how could slippery/cloying substances be tolerated, worsening diarrhea? This risked untreatable postpartum consumption. Urgently, warm the Middle and transport the Spleen. Pao Jiang (Prepared Ginger), Xiao Hui Xiang (Fennel Fruit), Yi Zhi Ren (Alpinia Fruit), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome), Ban Xia Qu (Pinellia Fermented Paste), Gu Ya (Sprouted Grain, all stir-fried), and Ju Bai (Citrus Albedo) were used. Diarrhea stopped, chills/fever reduced, appetite returned after several doses. Pao Jiang, Xiao Hui Xiang, Gu Ya, Ban Xia Qu, Bai Zhu, and Ju Bai were removed. Sha Ren (Amomum Fruit), Shu Di Huang (Prepared Rehmannia Root, charred), Lu Shen (Codonopsis Radix), Wu Wei Zi (Schisandra Fruit), Mu Dan Pi (Moutan Bark), Shan Yao (Chinese Yam), Lian Zi (Lotus Seed), and Cha Hu (Dendrobium Stem) were added. Deficient Yang gradually receded. Yi Zhi Ren and Fu Ling were removed. Tian Xing Ren (Sweet Almond), Fu Shen (Poria with Hostwood), Bai Shao (White Peony Root), and Bai He (Lily Bulb) were added. Cough stopped, and regulation led to health.