易思兰治一妇，产后半月余，胃中有清水，作逆而吐，以为胃寒，令煮鸡，倍用椒、姜，初觉相宜。（凡内热
虚火之人，初服辛热之药，亦有小效。）至三五日，清水愈多，以姜、椒煎汤，时时饮之。近一月，口气渐冷，
四肢发厥，昼夜作逆，腹中冷气难堪，有时战栗，用四君子汤，人参一钱至二钱，初服少安，久则不应。又加炮姜，
亦不效。众议用附子理中汤。（庸俗必趋之道。）易诊之，六脉俱无，以食指复按尺部，中指无名指之后，（诊法妙。）
脉来实数有力，左右皆同，发言壮厉，一气可说三五句，唇焦颊赤，大便五六日一次，小便赤少，此实热症也。询之，
其俗产后以食胡椒炒鸡为补，此妇日食三次，半月后，遂得此疾。乃用三黄汤治之，连进四盏，六脉俱现，姜
椒汤不欲食矣。又进四盏，身不战栗，清水减半。服四日，口中热气上升，满口舌尖俱发黄小粟疮，大便八日
不通，以四苓合凉膈散，空心一服。至午不动，又以甘草煎汤，调元明粉五钱热服。一时许，腹中微鸣，吐出
酸水一二碗，大便连去二次。又复元明粉五钱，下燥矢十数枚。后以四苓、三黄、山栀、枳壳，调理全愈。主
人曰∶荆人之病，医皆以为虚，而用姜、附，先生一诊而遂用大剂三黄汤，更加元明粉寒凉之剂以通之，不以
产为掣肘，公何见也？易曰∶脉症明显，不详察耳。《脉法》云∶极大极微，最宜斟酌。凡诊脉遇极大无力者，
须防阳气浮散于外。若极微之脉，久久寻而得之，手指稍稍加力，按之至骨，愈坚牢者，不可认作虚寒。今脉
左右三部，初按悉无，再以食指按其尺部，中指无名指按其尺后，脉来实数有力，所谓伏匿脉是也。此乃阳匿
于下，亢之极矣。又大便秘结，小便赤少，唇焦颊赤，气壮言高，自脉与症视之，其为实热明矣。若果虚寒，
脉当浮大无力，何以实数有力？症当气息微弱，何以言貌壮强？其口气冷，吐清水，四肢厥，时战栗者，正热
极似水，阳遏阴浮之义也。战栗则热入血室，热极则生风矣。热在肝肾，不在心经，故言语真诚，而不妄也。
其致病之由，本于食椒鸡过多，胡椒性味辛热，能散寒逐败，鸡属巽而入肝，性温能活滞血而养新血。鸡可常
食，椒性大热有毒，不可过多，多则热毒积于肠胃，而诸怪症作矣。至于服姜、椒而反现寒症者，正古云∶服
黄连多而反热者，服姜、附多而反寒之谓也。用三黄者，黄连味苦入心，苦能下泄，如天气下降，自能引地气
上升。黄芩利大肠之热毒，黄柏生肾水以制火，甘草稍解诸药之毒，元明粉软坚，四苓散合凉膈散清利大小便。
此药一服，故口舌生疮，其毒自口而出，虽不补产后之虚，然内邪既去，则正气自昌，而虚弱者充实矣。是不
补之中，而有大补者在也。
按∶此为火极似水，乃物极必反之候。凡患此，为燥热温补所杀者多矣，哀哉！
许学士云∶记一妇人产后，护密阁内，更生火，睡久及醒，则昏昏如醉，不省人事，其家惊惶。许用荆芥，
佐以交解散。云∶服之即睡，睡之必以左手搔头，觉必醒矣。（盖为火所逼也。）
魏玉横曰∶沈协兰室人善病，自颇知医，最重《景岳全书》。数年来，所服多温补之剂，约桂、附几各半
斤。近以产后恶露淋漓，赤白时下，咳嗽日甚，小便自遗。脉之，右手鼓指，两关弦数，右尺弱，面有红光，
舌当中无胎，胸多冷气，喜热饮，稍凉则不快。所服乃寿脾煎加姜、桂等。乃列案与之，曰∶病本三阴不足，
久服温补，则气分偏胜，遂至绵延不已，其误在便溏气冷，又喜热饮，认为脾胃虚寒，不知火盛下迫则作泻，
上冲则反冷，郁于中则得辛热而暂散，此理方书多未论及。今以产后去血，血益虚则火益盛。面有红光，火炎
上也。恶露赤白，肝脾热也。咳嗽便遗，肺虚肝盛，肾不秘密也。辛温燥烈，宜急远之。方用生熟地、杞子、
沙参、麦冬、钗斛。初犹畏麦冬之寒，以二钱太重，只用六分。数剂后，觉相宜，渐加至一钱五分。十余剂，
便不喜热饮，症渐平，又加蒌仁。二十余剂，每日大便下青黑杂物，而辛气满房户。盖桂、姜之热，久迫回肠，
因荣气渐充，乃势不能容而下出也。若再投温补，其害可胜言哉。书此以为偏服温补者戒。
杨氏二妇，妯娌也，其姒新产，发热头晕，不能起坐，坐则欲仆，恶露红白，两乳壅肿，子户旁肿如鸡卵，
痛甚，势将成痈。专科与炮姜、白术、荆芥、桂枝等，更呕恶不寐。脉之，弦数六至有余。乃与生地、杞子、
地丁、麦冬、当归、银花、甘草、黄连、蒌仁，六剂全愈。其娣产弥月，耳聋，头及乳腹常痛，带下绵绵，每
浴汤中，摇漾如线，子户亦肿痛，医与香燥转甚，亦用前方加减而愈。又朱朗斋之妹，产后赤白淋沥，口干咽
痛，前方去地丁、当归，加白芍，四帖全安。其初，杨姒所生儿，食乳即吐，自母服药后，亦不呕矣。凡此，
皆少厥二阴阴虚火盛之病，若谓产后而用辛温，是杀之也。
易思兰治疗一位妇人，产后半个多月，胃中有清水上逆而呕吐，医生认为是胃寒，让她煮鸡肉吃，并加倍使用花椒、生姜。起初觉得适宜。（凡是体内有内热、虚火的人，刚开始服用辛热药物时，也会有轻微的效果。）到了三五天，清水更多了，便用姜、椒煎汤，时时饮用。接近一个月时，口气逐渐变冷，四肢发凉厥逆，昼夜不停地上逆呕吐，腹中冷气难以忍受，有时出现战栗，使用四君子汤，人参用量从一钱到二钱，刚服用时稍感安宁，久了就不见效了。又加入炮姜，也不见效。众人商议使用附子理中汤。（这是庸俗医生必然趋向的治疗道路。）易思兰诊察她，六脉都摸不到，他用食指重新按压尺部，中指和无名指按在尺部之后，（诊法精妙。）脉搏来势实数有力，左右手都一样，说话声音壮厉，一口气可以说三五句话，嘴唇焦干，脸颊发红，大便五六天一次，小便赤少，这是实热证。询问得知，当地习俗认为产后吃胡椒炒鸡是补益，这位妇人每天吃三次，半个月后，就得了这个病。于是使用三黄汤治疗，连续服下四碗，六脉全部显现，不再想喝姜椒汤了。又服下四碗，身体不再战栗，清水减少了一半。服药四天，口中热气上升，满口舌尖都长出黄色的小粟疮，大便八天不通，用四苓散合凉膈散，空腹服下一剂。到了中午仍未排便，又用甘草煎汤，调元明粉五钱热服。大约一个时辰后，腹中微微鸣响，吐出酸水一二碗，大便连续排出两次。再服用元明粉五钱，排出干燥粪便十多个。后来用四苓散、三黄汤、山栀、枳壳调理，完全痊愈。主人说：“我们这里人的病，医生都认为是虚证，而使用姜、附，先生一诊脉就使用大剂量三黄汤，再加上元明粉等寒凉药剂来通泄，不因产后的情况而有所顾忌，您的见解如何？”易思兰说：“脉象和症状明显，只是没有详细考察罢了。《脉法》说：‘脉象极大或极微，最应该仔细斟酌。’凡是诊脉遇到极大但无力的，必须防备阳气浮散于外。如果是极微的脉，久久寻找才能摸到，手指稍微加力，按到骨头，感觉更加坚牢的，不能认作虚寒。现在脉象左右三部，初按时全都摸不到，再用食指按其尺部，中指无名指按其尺后，脉搏来势实数有力，这就是所谓的伏匿脉。这是阳气隐匿在下，亢盛到了极点。而且大便秘结，小便赤少，嘴唇焦干脸颊发红，气壮言高，从脉象与症状来看，这显然是实热证。如果是真正的虚寒，脉应当浮大无力，为什么实数有力？症状应当气息微弱，为什么言语面貌壮强？那些口气冷、吐清水、四肢厥冷、时常战栗的情况，正是热极似水，阳气被遏制、阴气浮越的道理。战栗则是热入血室，热极则生风。热在肝肾，不在心经，所以言语真诚，而不胡言乱语。导致疾病的原因，本在于吃椒炒鸡过多，胡椒性味辛热，能散寒逐瘀，鸡属巽卦而入肝，性温能活血滞而生新血。鸡可以常食，但椒性大热有毒，不可过多，多了则热毒积聚在肠胃，各种怪症就会发作。至于服用姜、椒反而出现寒症，正是古话所说的：‘服用黄连多反而发热，服用姜、附多反而发寒’的意思。使用三黄汤，是因为黄连味苦入心，苦能下泄，如同天气下降，自然能引地气上升。黄芩清利大肠的热毒，黄柏滋生肾水以制约火势，甘草稍微解除诸药的毒性，元明粉软坚散结，四苓散合凉膈散清利大小便。这药服下后，所以口舌生疮，毒邪从口而出，虽然不补产后的虚弱，但内邪既然去除，正气自然昌盛，虚弱者也就充实了。这不补之中，就有大补的作用存在。”
按语：这是火极似水的表现，是物极必反的征候。凡是患此病，被燥热温补疗法害死的很多，可悲啊！
许学士说：“记得有一位妇人产后，在密闭阁楼内，又生了火，睡很久及醒来时，昏昏沉沉像醉酒一样，不省人事，家人惊慌失措。许学士用荆芥，佐以交解散。说：‘服用后即入睡，睡着时必定用左手搔头，醒来后就痊愈了。（这是因为被火邪逼迫所致。）’”
魏玉横说：“沈协兰的妻子善于生病，自己颇懂医术，最重视《景岳全书》。几年来，所服的药多为温补之剂，大约桂枝、附子各用了半斤。最近因产后恶露淋漓不尽，赤白时下，咳嗽日益加重，小便失禁。诊脉，右手鼓指，两关脉弦数，右尺脉弱，面部有红光，舌中部无苔，胸中多有冷气，喜欢热饮，稍凉就不舒服。所服用的乃是寿脾煎加姜、桂等药。于是列出医案给她看，说：‘病本是三阴不足，久服温补，则气分偏胜，遂至绵延不已，其错误在于便溏气冷，又喜热饮，被认为是脾胃虚寒，不知道火盛下迫则作泻，上冲则反冷，郁结在中焦则得辛热而暂时消散，这个道理方书大多未论及。现在因为产后失血，血越虚则火越盛。面部有红光，是火炎上的表现。恶露赤白，是肝脾热盛。咳嗽遗尿，是肺虚肝盛，肾气不固。辛温燥烈的药物，应当立即远离。方药用生熟地黄、枸杞子、沙参、麦冬、石斛。起初还畏惧麦冬的寒性，认为二钱太重，只用六分。几剂后，觉得适宜，逐渐加到一钱五分。十余剂后，不再喜欢热饮，症状逐渐平稳，又加入瓜蒌仁。二十余剂后，每日大便排出青黑杂物，且充满辛辣气味。这是因为桂枝、生姜的热性，长久逼迫回肠，随着营气逐渐充盈，便势不能容纳而下出。如果再投以温补之药，其危害怎能说得尽呢？写下这些作为偏服温补者的警戒。”
杨氏两位媳妇，是妯娌关系，其中嫂子刚生产完，发热头晕，不能起坐，坐下就想跌倒，恶露红白相间，两乳壅肿，阴户旁肿胀如鸡蛋大，疼痛剧烈，形势即将成痈。专科医生给予炮姜、白术、荆芥、桂枝等药，反而呕吐恶心无法入睡。诊脉，脉弦数，每息六至以上。于是给予生地、枸杞子、地丁、麦冬、当归、银花、甘草、黄连、瓜蒌仁，六剂全愈。另一位弟媳产后满月，耳聋，头部及乳房腹部常痛，带下绵绵不断，每次洗澡时，身体摇荡如线一般，阴户也肿痛，医生给予香燥药物治疗反而加重，也用前方加减而痊愈。还有朱朗斋的妹妹，产后赤白淋沥不尽，口干咽痛，前方去掉地丁、当归，加白芍，四帖完全安好。起初，杨嫂所生的孩子，吃奶就吐，自从母亲服药后，也不再呕吐了。凡此种种，都是少阳、厥阴二经阴虚火盛的病证，如果说产后就用辛温药物，那是害死病人啊。
Yi Silan treated a woman who, more than half a month after childbirth, experienced regurgitation and vomiting of clear fluid from the stomach. The physician diagnosed it as Stomach Cold (Wei Han) and prescribed boiled chicken with extra Zanthoxylum (Jiaojiao, 花椒) and Ginger (Shengjiang, 生姜). Initially, she felt relief. (However, for individuals with internal heat or deficient fire, initial administration of acrid-warm herbs may yield minor effects.) By the third to fifth day, the amount of clear fluid increased further, leading her to drink decoctions of ginger and zanthoxylum frequently. Approaching one month, her breath became cold, limbs turned cold and inverted (Si Zhi Fa Jue), she suffered from continuous upward rebellion of qi day and night, unbearable cold sensation in the abdomen, and occasional shivering. She was administered Sijunzi Tang (Four Gentlemen Decoction) with Ren Shen (Ginseng Root) ranging from 1 qian to 2 qian. There was slight relief initially, but no effect over time. Pao Jiang (Prepared Ginger) was added, yet still ineffective. The consensus was to use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). (This is the path inevitably taken by mediocre physicians.) Yi examined her pulse; all six pulses were imperceptible at first. Using his index finger to re-examine the Chi position (Cun-Kou pulse position corresponding to Kidney/Lower Burner), and placing his middle and ring fingers behind the Chi position, (a subtle diagnostic method), he found the pulse to be solid, rapid, and forceful, identical on both sides. Her voice was loud and vigorous, able to speak three to five sentences in one breath. Her lips were dry, cheeks red, bowel movements occurred once every five to six days, and urine was scanty and dark red. This indicated a Excess-Heat syndrome. Upon inquiry, he learned that local custom considered pepper-fried chicken as a tonic postpartum. This woman ate it three times daily, resulting in this illness after half a month. He then prescribed Sanhuang Tang (Three Yellows Decoction). After consuming four bowls continuously, all six pulses became palpable, and she lost the desire for ginger-pepper decoction. After another four bowls, her shivering ceased, and the clear fluid reduced by half. After four days of medication, heat rose in her mouth, and small yellow millet-like sores appeared all over her tongue and lips. Bowel movement had been absent for eight days. He administered Siling San (Four Poria Powder) combined with Liangge San (Cool the Diaphragm Powder) on an empty stomach. By noon, there was no movement. He then prepared a decoction of Gan Cao (Licorice Root), mixed with 5 qian of Yuanming Fen (Natrii Sulfas, Mirabilite), and administered it hot. Within about one shichen (two hours), mild borborygmus occurred in the abdomen, followed by vomiting of one to two bowls of sour fluid and two episodes of defecation. Another 5 qian of Yuanming Fen was given, resulting in the passage of more than ten hard fecal pellets. Subsequently, she was regulated with Siling San, Sanhuang Tang, Zhi Zi (Gardenia Fruit), and Zhi Ke (Aurantium Fructus), achieving full recovery. The host remarked: "In our region, physicians always consider such cases as deficiency and use Ginger and Aconite. You, Sir, upon a single examination, prescribed a large dose of Sanhuang Tang and used cold-natured agents like Mirabilite to purge, without being hindered by the postpartum state. What is your insight?" Yi replied: "The pulse and symptoms are obvious; it is merely a lack of detailed observation. The *Pulse Methods* state: 'Extremely large or extremely minute pulses require careful deliberation.' When encountering a pulse that is extremely large but weak, one must guard against floating and scattering Yang Qi. If a pulse is extremely minute and only found after prolonged searching, becoming firmer when pressed to the bone with slight additional pressure, it should not be mistaken for Deficiency-Cold. In this case, the three positions on both sides were imperceptible initially. Re-examining the Chi position with the index finger, and the area behind it with the middle and ring fingers, revealed a solid, rapid, and forceful pulse. This is what is called a Hidden Pulse (Fu Ni Mai). It indicates Yang Qi hidden in the lower jiao, reaching extreme hyperactivity. Furthermore, constipation, scanty dark urine, dry lips, red cheeks, vigorous qi, and loud speech clearly indicate Excess-Heat from both pulse and symptom perspectives. If it were true Deficiency-Cold, the pulse would be floating, large, and weak, not solid and rapid. Symptoms would show faint breathing, not strong demeanor. The cold breath, vomiting of clear fluid, cold limbs, and shivering are precisely manifestations of 'Extreme Heat resembling Water' and the principle of Yang being restrained while Yin floats. Shivering indicates heat entering the Blood Chamber (Xue Shi); extreme heat generates wind. The heat resides in the Liver and Kidney, not the Heart Meridian, hence her speech is sincere and not delirious. The cause lies in excessive consumption of pepper and chicken. Pepper is acrid and hot, capable of dispersing cold and driving out stasis; chicken belongs to Xun (Wind/Wood) and enters the Liver, its warm nature activating stagnant blood and nourishing new blood. Chicken can be eaten regularly, but pepper is extremely hot and toxic; excess leads to accumulation of heat-toxin in the intestines and stomach, causing various strange syndromes. As for developing cold symptoms after taking ginger and pepper, this aligns with the ancient saying: 'Taking too much Huang Lian (Coptis Rhizome) causes heat; taking too much Ginger and Aconite causes cold.' Using Sanhuang Tang works because Huang Lian is bitter and enters the Heart; bitterness drains downward, like heaven's qi descending, naturally drawing earth's qi up. Huang Qin (Scutellaria Root) clears heat-toxin from the Large Intestine; Huang Bai (Phellodendron Bark) generates Kidney Water to control Fire; Gan Cao slightly detoxifies the other herbs; Yuanming Fen softens hardness. Siling San combined with Liangge San clears and promotes urination and defecation. Thus, after taking this medicine, sores appeared on the mouth and tongue, allowing toxins to exit via the mouth. Although it does not tonify postpartum deficiency, removing internal pathogens allows Righteous Qi to flourish, thereby filling the weakness. Thus, within non-tonification lies great tonification."
Commentary: This is a presentation of Extreme Fire resembling Water, a sign of reversal when things reach their extreme. Many have died from this condition due to treatment with drying-heat and warming-tonifying methods. Alas!
Scholar Xu stated: "I recall a woman who, after childbirth, stayed in a sealed pavilion where a fire was lit. After sleeping for a long time or upon waking, she was dazed as if drunk and unconscious, causing panic among her family. Xu used Jing Jie (Schizonepeta Spike) assisted by Jiaojie San (Intersecting Dissolution Powder). He said: 'After ingestion, she sleeps; while sleeping, she scratches her head with her left hand; upon waking, she recovers.' (This is because she was oppressed by Fire Evil.)"
Wei Yuheng stated: "Shi Helan's wife was prone to illness and knowledgeable in medicine, highly valuing *Jingyue Quanshu*. For years, she took mostly warming and tonifying formulas, consuming approximately half a jin each of Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root). Recently, due to prolonged postpartum lochia discharge, intermittent red and white discharge, worsening cough, and urinary incontinence. Pulse diagnosis showed a beating sensation on the right hand, wiry and rapid pulses at both Guan positions (Liver/Spleen), and a weak pulse at the right Chi position. Her face had a reddish glow, the center of her tongue lacked coating, she felt cold air in the chest, preferred hot drinks, and disliked coolness. She had been taking Shoupi Jian (Spleen Longevity Decoction) plus Ginger and Cinnamon. I presented a case analysis to her, stating: 'The root disease is insufficiency of the Three Yin meridians. Long-term use of warming tonics has caused Qi aspects to become excessive, leading to chronic persistence. The error lies in mistaking loose stools, cold sensations, and preference for hot drinks for Spleen-Stomach Deficiency-Cold. One fails to realize that excessive Fire forcing downward causes diarrhea, rising upward causes cold sensations, and stagnation in the middle jiao temporarily dissipates with acrid-warm herbs. This principle is rarely discussed in medical texts. Now, due to blood loss postpartum, blood deficiency exacerbates Fire. Facial redness indicates Fire flaming upward. Red and white lochia indicates Liver-Spleen Heat. Cough and incontinence indicate Lung Deficiency, Liver Excess, and Kidney failing to secure. Acrid-warm desiccating herbs should be avoided immediately. The prescription uses Raw and Prepared Rehmannia Root (Shu Di Huang, Sheng Di Huang), Goji Berry (Gou Qi Zi), Glehnia Root (Sha Shen), Ophiopogon Tuber (Mai Dong), and Dendrobium Stem (Dai Du Hu). Initially, she feared the cold nature of Ophiopogon, considering 2 qian too heavy, using only 6 fen. After several doses, she felt comfortable, gradually increasing to 1.5 qian. After more than ten doses, she no longer desired hot drinks, and symptoms stabilized. Melon Seed (Lou Ren) was added. After twenty-plus doses, she passed green-black debris in stool daily, filling the room with pungent odor. This is because the heat of Cinnamon and Ginger had long oppressed the colon; as Ying Qi (Nutritive Qi) replenished, it could no longer contain the pathogenic factors, which were expelled downward. If warming tonics were continued, the harm would be incalculable. I record this as a warning against biased use of warming tonics."
Two sisters-in-law from the Yang family: The elder sister had just given birth, suffering from fever, dizziness, inability to sit or stand, falling when sitting, red and white lochia, swollen breasts, and swelling beside the vulva the size of a chicken egg, with severe pain threatening abscess formation. Specialists prescribed Pao Jiang, Bai Zhu (Atractylodes Macrocephala Rhizome), Jing Jie, and Guizhi, which worsened vomiting, nausea, and insomnia. Pulse was wiry and rapid, exceeding six beats per respiration. Prescribed Raw Rehmannia Root, Goji Berry, Vincenteae Herba (Di Ding), Ophiopogon Tuber, Angelica Sinensis Radix (Dang Gui), Honeysuckle Flower (Jin Yin Hua), Licorice Root, Coptis Rhizome, and Melon Seed. Fully recovered in six doses. The younger sister, one month postpartum, suffered from deafness, frequent pain in the head, breasts, and abdomen, continuous leukorrhea, and swaying like a thread during bathing, with painful and swollen vulva. Physicians used aromatic-drying herbs, worsening the condition. She also recovered with modifications of the previous formula. Additionally, Zhu Langzhai's sister had prolonged red and white discharge postpartum, dry mouth, and sore throat. The previous formula had Di Ding and Dang Gui removed, and Bai Shao (White Peony Root) added. Fully healed in four prescriptions. Initially, the infant born to the elder Yang sister vomited immediately upon breastfeeding. After the mother took medicine, the infant stopped vomiting. All these cases represent Yin Deficiency with Hyperactive Fire in the Shaoyang and Jueyin meridians. To treat postpartum conditions with acrid-warm herbs is to kill the patient.