薛立斋治一产妇,饮食少思,服消导之剂,四肢浮肿。薛谓中气不足,朝用补中益气汤,夕用六君子汤而
愈。后因怒腹胀,误服沉香化气丸,吐泻不止,饮食不进,小便不利,肚腹四肢浮肿,用《金匮》加减肾气丸
而愈。
一产妇泄泻,四肢面目浮肿,喘促恶寒,此脾气虚寒,用六君子加姜而泄泻愈。又用补中益气而脾胃健。
杜壬治一妇,产后,忽患浮肿,众作水气治不效。曰∶水气必咳嗽,小便不利,今便利而不作嗽,独手足
寒,乃血脏虚寒,气塞不通,故生浮肿也。治宜益和血气,后服丹皮散愈。
张子和治曹典史妻,产后,忧恚抱气,浑身肿,绕阴器皆肿,(肝经所络。)大小便如常,其脉浮而大,此风水
肿也。先以齑水潦其痰,以火助之发汗。次以舟车丸、浚川散泻数行。后四五日,方用苦剂涌讫,用舟车丸、
通经散行十余行。又六日,舟车、浚川复下之。末后用水煮桃红丸四十余丸,不一月如故。前后涌者二,泻凡
四,约百余行。当时议者以为倒布袋法耳,病再来则必死,不知此乃《内经》治郁之玄旨,但愈后慎房室等事。
况风水不同水,无复来之理。
薛立斋治一产妇,略闻音响,其汗如水而昏愦,诸药到口即呕。薛以为脾气虚败,用参、附末为细丸,时
噙三五粒,随液咽下,乃渐加至钱许,却服参附汤而安。
一产妇盗汗不止,遂至废寐,神思疲甚,口干引饮。薛谓血虚有热,用当归补血汤以代茶。又以当归六黄
汤,内黄芩、连、柏炒黑,倍加人参、五味子,二剂而愈。
缪仲淳治于中甫夫人,产后气喘,投以人参、苏木、麦冬各五钱,一剂愈。五日后,忽自汗,无间昼夜,
畏闻响声,饮热茶汤即汗遍体,投以人参、黄 各五钱,加归身、生地,二剂不效,即令停药。金坛俗忌未弥
月不得诊视,乃遍检方书,至《证治要诀》治汗门内,有凡服固表药不效者,法当补心。汗者,心之液也。洒
然曰∶是矣。病患素禀有火气,非不足也。产后阴血暴亡,故心无所养而病汗。亟以枣仁一两炒为君,生地、
白芍、麦冬、五味、枸杞、牛膝、杜仲、归身、阿胶、牡蛎、龙眼肉,大剂与之。至三十二剂,罔效。于惧曰∶
得无不起乎?曰∶非也,前投参、 不应,而遽止之者,以参、 为气分药,剂且大。其不应者,必与症不合
也。兹得其症,复可惑乎。盖阴,血也,难成易亏者也,不可责效旦夕。乃投前剂,至四十二帖,忽得睡,汗
渐收,睡愈熟。至四日夜,醒而霍然,颜色逾常,血足则色华也。
谓能于方中加炒焦黄连三五分,则数剂可愈。(雄按∶还须去归身,效始速。)
冯楚瞻治一产妇,因头汗甚多延诊,余无他苦。诊之,虽洪而缓,曰∶头汗过多,诸症谓之亡阳,然产后
阴气太虚,正喜其亡阳与阴齐等,此薛氏之谓可勿药而愈也。病家疑之,别延一医,峻用参、 温补,遂暴注
下泻,完谷不化。益认阳虚,重用参、附、炮姜,其泻愈甚。不数日,其肉尽削,精神困顿。复延诊,六脉洪
弦甚数,此真阴竭矣,何能挽救?盖产后头汗乃阴虚,虚火上蒸,孤阳上迫,津液不能闭藏,误作阳虚,重加
温补燥热之气,暴注下趋,而为完谷不化,乃火性急速,不及变化而出也。重以温热焚灼,势必穷极,尚何药
之可救哉。(雄按∶薛氏此言,不通已极。魏氏谓其不能养阴,余谓良由泥于产后宜温补,故不敢用壮水养
阴之法也。)
案中正喜亡阳,与阴齐等,薛氏谓可勿药而愈,此正薛氏生平不能峻用养阴之缺处也。予尝过此症,以
重剂生熟地、白芍、杞子、麦冬、枣仁,察其有火则少加芩、连,不过二三剂愈矣。冯君论此症虽了了而
不与药,使病家属之庸手而败,亦守而未化之过也。(何尝了了,不过习于温补,遇此等症便茫然无所措手耳。)
薛立斋治疗一位产妇,患者饮食减少且缺乏食欲,服用消食导滞的药物后,出现四肢浮肿。薛立斋认为这是中气不足所致,早晨服用补中益气汤,晚上服用六君子汤,病情痊愈。后来因为发怒导致腹部胀满,误服沉香化气丸,引起呕吐腹泻不止,无法进食,小便不通利,肚腹及四肢浮肿,使用《金匮要略》中的加减肾气丸而治愈。
另一位产妇患泄泻,四肢和面目浮肿,呼吸急促且怕冷,这是脾气虚寒所致,使用六君子汤加生姜治疗后泄泻痊愈。随后又用补中益气汤调理,使脾胃功能恢复健康。
杜壬治疗一位妇人,产后突然患上浮肿,众人将其作为水气病治疗但无效。杜壬说:“水气病必然伴有咳嗽、小便不利,现在患者小便通利且不咳嗽,只有手足寒冷,这是血脏(肝)虚寒,气机阻塞不通,所以产生浮肿。”治疗应当调和气血,后来服用丹皮散而痊愈。
张子和治疗曹典史的妻子,产后因忧愤郁结,浑身肿胀,阴器周围皆肿(足厥阴肝经所络属之处),大小便正常,脉象浮大,这是风水肿。先用齑水(醋浆)催吐以排出痰涎,并用火法辅助发汗。接着用舟车丸、浚川散泻下数次。之后四五天,再用苦剂涌吐完毕,使用舟车丸、通经散行气泻下十余次。又过了六天,再次用舟车丸、浚川散攻下。最后用水煮桃红丸四十多丸,不到一个月身体恢复如初。前后涌吐两次,泻下共四次,约一百多次排泄。当时议论的人认为是“倒布袋法”(一种极端的攻邪疗法),如果病复发则必死无疑,却不知道这是《内经》中治疗郁证的深奥旨意,只是愈后要谨慎房事等事宜。况且风水不同于普通的水气病,没有复发的道理。
薛立斋治疗一位产妇,稍微听到声响,就出汗如水并神志昏乱,各种药物入口即呕吐。薛立斋认为是脾气虚败,用人参、附子末制成细丸,时常含服三五粒,随津液咽下,逐渐增加至一钱左右,然后改服参附汤而安定下来。
另一位产妇盗汗不止,导致无法入睡,精神极度疲乏,口干想喝水。薛立斋认为是血虚有热,用当归补血汤代替茶饮。又用当归六黄汤,将方中的黄芩、黄连、黄柏炒黑,倍加人参、五味子,两剂药后痊愈。
缪仲淳治疗于中甫的夫人,产后气喘,投以人参、苏木、麦冬各五钱,一剂药后痊愈。五日后,突然自汗,不分昼夜,害怕听到响声,喝热茶汤即全身出汗,投以人参、黄芪各五钱,加当归身、生地黄,两剂药无效,随即令停药。金坛当地习俗忌讳未满月不得诊视,于是遍查方书,在《证治要诀》治汗门内,记载凡是服用固表药无效的,治法应当补心。汗是心的体液。缪氏恍然大悟说:“对了。”病人素体有火气,并非正气不足。产后阴血暴亡,所以心无所养而患病汗出。急忙用酸枣仁一两炒制为君药,配伍生地黄、白芍、麦冬、五味子、枸杞子、牛膝、杜仲、当归身、阿胶、牡蛎、龙眼肉,大剂量给予。服至三十二剂,毫无效果。家属恐惧地说:“难道治不好吗?”缪氏说:“不是的,之前投用参、芪不应效,而立即停止,是因为参、芪属于气分药,剂量大。其不应效,一定是与病症不合。现在找到了病因,还有什么可困惑的呢?阴血,是难成易亏的物质,不能指望朝夕见效。”于是继续投用前剂,服至四十二帖,忽然能睡觉,汗逐渐收敛,睡得越熟越好。到了第四天夜里,醒来后霍然痊愈,面色超过平常,这是因为血足则面色光华。
有人建议在方中加入炒焦的黄连三五分,则数剂可愈。(徐灵胎按:还须去掉当归身,疗效才会迅速。)
冯楚瞻治疗一位产妇,因头部出汗过多延请诊治,没有其他痛苦。诊察时,脉象虽洪大但缓,冯氏说:“头汗过多,诸症称为亡阳,然而产后阴气太虚,正希望亡阳与阴气达到平衡,这就是薛氏所说的可以不药而愈的情况。”病家怀疑此说法,另外聘请一位医生,峻烈地使用人参、黄芪温补,结果导致暴注下泻,完谷不化。医生更加认定是阳虚,重用参、附、炮姜,腹泻反而更严重。没过几天,肌肉消瘦殆尽,精神困顿。再次延请诊治,六脉洪弦且非常数急,这是真阴枯竭了,怎么能挽救呢?大概产后头汗乃是阴虚,虚火上蒸,孤阳上迫,津液不能闭藏,误作阳虚,重加温补燥热之气,导致暴注下趋,而为完谷不化,这是火性急速,来不及变化而出。再加以温热之药焚烧灼烧,势必穷极,还有什么药可以救呢?(徐灵胎按:薛氏此言,不通已极。魏氏认为他不能养阴,我认为良由拘泥于产后宜温补,所以不敢用壮水养阴之法。)
案中称“正喜亡阳与阴齐等”,薛氏谓可勿药而愈,这正是薛氏生平不能峻用养阴法的缺憾之处。我曾经过往诊治此类病症,用重剂的生地黄、熟地黄、白芍、枸杞子、麦冬、酸枣仁,观察到有火则少加黄芩、黄连,不过二三剂就痊愈了。冯君论述此症虽然清楚明白,却不予用药,致使病家托付给庸医而搞坏病情,这也是墨守成规不知变通的过错。(何尝清楚明白,不过是习惯于温补,遇到这类病症便茫然不知所措罢了。)
Xue Lizhai treated a postpartum woman who had poor appetite and lack of desire for food. After taking digestive-promoting agents, she developed edema in the four limbs. Xue stated that this was due to deficiency of Middle Qi (Middle Jiao Qi). He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) in the morning and Liujunzi Tang (Six Gentlemen Decoction) in the evening, resulting in recovery. Later, due to anger causing abdominal distension, she mistakenly took Chenxiang Huqi Wan (Agarwood Regulating Qi Pill), leading to incessant vomiting and diarrhea, inability to eat, difficulty in urination, and edema of the abdomen and four limbs. She was cured using Jiajian Shenqi Wan (Modified Kidney Qi Pill) from *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet).
Another postpartum woman suffered from diarrhea, with edema of the four limbs and face, panting, and aversion to cold. This was identified as deficiency-cold of Spleen Qi. Using Liujunzi Tang added with fresh ginger, the diarrhea ceased. Subsequently, Buzhong Yiqi Tang was used to strengthen the Spleen and Stomach functions.
Du Ren treated a woman who suddenly developed edema after childbirth. Others treated it as Water-Qi disease without effect. Du Ren said: "Water-Qi disease must involve coughing and difficulty in urination. Now her urination is unobstructed and she does not cough; only her hands and feet are cold. This is deficiency-cold of the Blood Organ (Liver), with Qi obstruction preventing free flow, thus generating edema." The treatment should harmonize and tonify Blood and Qi. She later recovered after taking Danpi San (Moutan Powder).
Zihe Zheng treated the wife of Official Cao. After childbirth, due to worry and indignation causing Qi stagnation, her whole body swelled, including the area around the external genitalia (the pathway of the Foot-Jueyin Liver Meridian). Her urination and defecation were normal, and her pulse was floating and large. This was diagnosed as Fengshui Edema (Wind-Edema). First, he induced vomiting using vinegar water to expel phlegm, assisted by fire therapy to induce sweating. Next, he administered Zhouche Wan (Boat Cart Pill) and Junchuan San (Clearing River Powder) to purge several times. Four or five days later, after completing emesis with bitter agents, he used Zhouche Wan and Tongjing San to promote circulation and purging over ten times. Six days later, he purged again with Zhouche Wan and Junchuan San. Finally, he administered forty-plus pills of Shuizhu Taohong Wan (Water-Boiled Peach Red Pill). Within less than a month, she returned to normal. In total, there were two episodes of emesis and four episodes of purging, totaling about one hundred evacuations. Contemporaries discussed this as the "Emptying the Bag" method (a radical purgative technique), believing that if the disease recurred, death would be inevitable. However, they did not understand that this was the profound principle of treating stagnation according to *Neijing* (The Inner Canon); one only needed to avoid sexual intercourse and similar activities after recovery. Moreover, Fengshui differs from ordinary Water-Qi disease and has no tendency to recur.
Xue Lizhai treated another postpartum woman who, upon hearing any sound, sweated profusely like water and became confused. All medicines taken orally caused immediate vomiting. Xue attributed this to failure of Spleen Qi. He made fine pills from powder of Renshen (Ginseng Root) and Fuzi (Aconite Lateral Root), which she held in her mouth, swallowing three to five pills at a time with saliva, gradually increasing to one qian (approx. 3-5 grams). Then she took Shenfutang (Ginseng and Aconite Decoction) and stabilized.
Another postpartum woman suffered from continuous night sweats, leading to insomnia and extreme mental fatigue, with dry mouth and desire to drink. Xue considered this Heat due to Blood deficiency. He used Danggui Buxue Tang (Danggui Tonifies the Blood Decoction) as a tea substitute. He also prescribed Danggui Liu Huang Tang (Danggui Six Yellow Decoction), where Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Huangbai (Phellodendron Bark) were stir-fried until black, with doubled amounts of Renshen (Ginseng Root) and Wuweizi (Schisandra Fruit). She recovered after two doses.
Miao Zhongchun treated the wife of Yu Zhongfu, who suffered from asthma after childbirth. He prescribed Renshen (Ginseng Root), Sumu (Sappan Wood), and Maidong (Ophiopogon Tuber), each five qian, curing her after one dose. Five days later, she suddenly experienced spontaneous sweating day and night, feared loud noises, and sweated all over upon drinking hot tea. He prescribed Renshen (Ginseng Root) and Huangqi (Astragalus Root), each five qian, plus Dangguishen (Angelica Sinensis Root Heart) and Shengdihuang (Rehmannia Root), but there was no effect after two doses, so he stopped the medication. In Jintan, local custom forbade medical consultation within the first month postpartum. He searched through medical texts and found in *Zhengzhi Yaojue* (Key to Diagnosis and Treatment) under the section on sweating: for cases where surface-consolidating drugs fail, the method should be to tonify the Heart. Sweat is the fluid of the Heart. Miao exclaimed: "Correct!" The patient naturally had a fiery constitution, not a deficiency. Postpartum sudden loss of Yin Blood meant the Heart lacked nourishment, causing sweating. He urgently prescribed a large dose with Zaoren (Bitter Apricot Seed) stir-fried to one liang (approx. 30-50 grams) as the sovereign herb, combined with Shengdihuang (Rehmannia Root), Baishao (White Peony Root), Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Fruit), Gouqi (Goji Berry), Niuxi (Achyranthes Root), Duzhong (Eucommia Bark), Dangguishen (Angelica Sinensis Root Heart), Ejiao (Donkey-Hide Gelatin), Muli (Oyster Shell), and Longyanrou (Longan Aril). After thirty-two doses, there was no effect. The family feared: "Is it incurable?" Miao replied: "No. The previous use of Renshen and Huangqi failed because they are Qi-class herbs, and the dose was large. Their failure indicates mismatch with the syndrome. Now that I have identified the syndrome, what is there to doubt? Yin/Blood is hard to form and easy to deplete; one cannot expect effects overnight." He continued the same prescription. At forty-two doses, she suddenly slept, and the sweating gradually stopped; the deeper the sleep, the better. On the fourth night, she woke up completely cured, with a complexion better than usual, because sufficient Blood manifests as luster.
It was suggested that adding three to five fen (approx. 1-2 grams) of stir-fried Huanglian (Coptis Rhizome) to the formula would cure it in a few doses. (Xu Lingtai notes: One must also remove Dangguishen for faster efficacy.)
Feng Chuzhan treated a postpartum woman who complained of excessive head sweating, with no other discomfort. His pulse diagnosis revealed a洪 (Surging) yet slow quality. He said: "Excessive head sweating is termed Wangyang (Loss of Yang). However, postpartum Yin Qi is too deficient; it is fortunate that the Loss of Yang balances the Yin deficiency. This is what Xue referred to as recoverable without medication." The family doubted this and hired another doctor who aggressively used Renshen (Ginseng Root) and Huangqi (Astragalus Root) for warm tonification. This resulted in violent watery diarrhea with undigested food. The doctor further confirmed Yang deficiency and heavily used Renshen, Fuzi (Aconite Lateral Root), and Paojiang (Prepared Ginger), which worsened the diarrhea. Within a few days, her muscles wasted away, and she was mentally exhausted. Upon re-examination, the six pulses were surging, wiry, and very rapid. This indicated exhaustion of True Yin; how could it be saved? Generally, postpartum head sweating is due to Yin deficiency, with deficient Fire steaming upward, solitary Yang pressing up, and fluids failing to consolidate. Mistaking this for Yang deficiency and adding heavy warm-tonifying and drying-hot qi led to violent downward flow and undigested food excretion. This is because Fire nature is rapid, leaving no time for transformation. Further burning with warm-hot substances leads to ultimate depletion. What medicine can save her now? (Xu Lingtai notes: Xue's statement here is extremely illogical. Wei attributes his failure to nourish Yin to his adherence to the notion that postpartum requires warm tonification, thus daring not to use methods that enrich Water and nourish Yin.)
The case states "fortunate that Loss of Yang balances Yin," and Xue claimed recovery without medication. This highlights Xue's lifelong shortcoming in not boldly using Yin-nourishing methods. I have treated such cases using heavy doses of Shengdihuang (Raw Rehmannia Root), Shudihuang (Prepared Rehmannia Root), Baishao (White Peony Root), Gouqi (Goji Berry), Maidong (Ophiopogon Tuber), and Zaoren (Bitter Apricot Seed). If Heat signs were present, I added small amounts of Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome). Recovery occurred in two or three doses. Although Feng's discussion of this case was clear, his refusal to prescribe allowed quacks to ruin the condition, which is an error of rigid adherence without flexibility. (How was it clear? He was merely accustomed to warm tonification and became bewildered when encountering such cases.)