一妇产后，水道中下肉线一条，长三四尺，动之则痛欲绝。先服失笑散数帖，次以带皮姜三斤研烂，入清
油二斤，煎油干为度，用绢兜起肉线，屈曲于水道边，以前姜熏之，冷则熨之。六日夜，缩其大半，二六日，
即尽入。再服失笑散、芎归汤调理之。如肉线断，则不可治矣。
产后恶露过多不止，用伏龙肝二两，煎汤澄清，烊入阿胶一两服之。如不应，加人参。方出沈尧封《女科
辑要》。
陆肖愚治吴敬之室，年二十余，产前已有感冒，分娩三日后，因责婢离床，时正冬月，觉身上懔栗，遂身
热头痛。或用参苏饮发其汗，头痛止而身热不除。遂以产后当大补气血，数剂而烦热日甚，又拟用补中益气汤。
脉之，两手虽弱，而左犹带浮，右已见数，曰∶脉虚，正产后之平脉，但左手犹浮，知表邪未散，右手见数，
欲传里之候也。宜急解其表，微通其里，少缓则有承气之患矣。用柴、葛、桔梗、黄芩、花粉、甘草、山楂，
一剂而烦热减，二剂而身凉，以清气养荣汤调之。（雄按∶左手带浮，是产后血虚，右手数，是为客邪未解。）
马元仪治陆氏妇，产后恶寒，虽重茵浓被不除，屡补不效，将行桂、附矣。诊之，两手脉沉伏，面赤，口
燥胸满，此非产后新虚，乃胎前伏邪也。屡用参、术，则邪愈结而正愈阻。肌表恶寒者，邪热内郁，逼阴于外
也；口干面赤胸满者，邪气挟火挟食，上凌清道也。仍宜一表一里治之。用葛根、防风、苏梗、枳壳、桔梗、
杏仁、苏子、薄荷，一服而表症已，右关尺转见滑实。随用大黄五钱，元明粉三钱，甘草一钱，一服下积秽甚
多，复发疹发颐，此表里两和，余邪毕达之征也。再与辛凉解之透之剂而安。此症邪伏于内，久而不宣，用清
阳泄表，苦寒达下两泄之，犹发疹发颐，而乃妄行温补，将谓脉伏恶寒为阳虚之候耶？其亦不审病机甚矣。（雄
按∶在产后能知伏邪，而用一表一里之治，洵是高手，更能不犯苏、防、葛、桔，可免后来发颐之患矣。）
王氏妇，产后一月，神气昏倦，上气喘促，胸中满痛，咳嗽发热，百治无效。诊之，两脉沉涩兼结。此胎
前已有伏邪，兼产后气血两虚，邪益内结。法宜表里两和，使邪从外达，气从内泄，病自愈矣。以桂枝、柴胡、
苏梗、枳壳、半夏曲、萝卜子、杏仁、广皮，透邪达滞之剂顿安。脉已稍舒，或投参、地、归、芍、敛滞之品，
遂彻夜靡宁，如丧神守。此邪结于中，补之生变也。乃用桂枝、炮姜、黄连、枳实、浓朴、广皮等，一剂而胸
满中痛除。复用蒌仁、柴胡、桂枝、半夏、枳壳、杏仁、苏子、桔梗，再剂而表热喘咳平，但大便不行，此久
病津液失养也。加生首乌一两，便行，余邪尽去。然正气大亏，再与滋补气血之剂而安。
李季虬治魏季尝令正，产后饮食不节，复感风寒，遂致发热谵语，喘咳气逆，恶露绝不至，势甚急迫。谓
症皆系外来客邪尚属可救，设正气虚脱，现诸症者，必无幸矣。何以见之？以脉气浮大有力故也。用大剂疏风
消食之剂，二剂便霍然。先是有用白术、芎、归等补药者，几为所误。（《广笔记》。）
张意田治一妇，产后，患病已及半载，咸作劳损治，且云阴亏已极，势难痊愈。张连诊五次，确知此症服
小柴胡汤，法必当应。奈群议纷纭，以参、柴非治阴亏之药，又言肺热咳嗽，大忌人参，因立案争之。幸病家
见信，一服而寒热大作，三服之后，寒热退而咳嗽平，十服全愈。案云∶诊得六脉皆数，右寸脉大而软，关尺
两部沉候弦急，左寸洪数，关部三候皆虚数，尺中空大。夫右寸软大，肺气虚也。关尺沉候弦急，关主中州，
尺司火位，沉里也，弦肝脉也，此因中气虚而木邪犯位，木气动而火从之也。左寸洪数，心经虚火也。关中虚
数，肝无血养也。尺中空大，肾水虚也。是脉本属阴虚，而寒邪乘之，留连不已，以至于此。今所见症，五更
发热者，寅卯木旺之时，肝火挟邪，随时而动也。上午寒热，得汗热减者，邪稍泄而势稍缓也。咳嗽之声，结
而不畅，此久嗽伤肺，肺气虚而邪不得越也。胸腹时胀而微鸣，此肝木犯脾，肝主胀者也。合脉与症，是为虚
中挟实，不得枢转外出之候也。《大全》曰∶产后血气虚弱，饮食未平，不满百日，将养失所，风冷客于气血，
颜容憔悴，饮食难消，感于肺，故咳嗽口干，遂觉头昏，百节疼痛。荣卫受邪，气通于肝，流注脏腑，须臾频
发，咳嗽无汗，寒热如疟，蓐劳之候，往往如此。景岳云∶虚弱之人，外邪初感，不为解散，而作内伤，或用
清凉，或用滋补，以致寒邪郁伏，久留不解，而寒热往来，或为咳嗽，其症全似劳损。欲辨之者，察其表里病
情，或身有疼痛，而微汗则热退，无汗则复热。或大声咳嗽，脉虽弦紧，而不甚数，即病至一两月，而邪犹未
解，此似损非损症，毋再误也。今此症实类此，当用小柴胡汤，转动枢机，藉少阳之生气，由内而外，自下而
上，则阴阳和而伏邪解散矣。去半夏加牛膝。半夏能启阴气，产后阴亏而兼口燥，故去之。胸腹时胀，脾阴
多郁，宜加牛膝以导之。药病相当，自应如桴鼓也。（雄按∶今春余荆人，娩子颇艰，至三朝，忽浑身麻冷，
俄即壮热大渴，汗出不解，耳鸣目泪，舌绛无津，胎色黄燥，腹痛拒按，脘闷不饥，恶露仍行，小溲极热，按
脉弦滑，右甚，是胎前吸受温邪，而痰热素盛，气机窒滞，血去阴伤，故见证如是之剧也。予元参、丹参、白
薇、知母、花粉、竹茹、豆卷、旋复、桑叶等服之，热即退而脉不减，且不饥，仍予是药。越二日后，麻冷而复
热，舌较润，胎稍薄，知治已中 ，尚嫌力薄也，前方加石菖蒲、枳实、楝实、蒌仁投之，热亦退；即退，并
吐胶痰数碗，略进稀糜。间一日，又发寒热，或
疑为疟，或云产时用力劳伤，或虑将成蓐损，议论纷纷。予置若罔闻，仍主前药，热果渐短，渴亦甚减。逾日，
寒热犹来，确守原方，至十一朝，始解黑燥矢，而诸恙悉解，且渐进谷，计服此方已十大剂矣。继惟粥食调养，
竟不与药。戚友闻之，莫不骇异。然非独断独行，断艰奏续。设泥初产而用生化行瘀，或视为疟，而以柴胡桂温
散，则必骤变。即知为阴虚热感，而与四物等养血，亦必邪气纠缠，延为蓐损。季冬，孙昼三仲媳，因儿女过
多，不欲产乳，胎前屡用下胎药，不应。娩后三朝，亦发寒热，兼以痛泻无溺，泻出者皆黑色，医视为瘀，予回
生丹等药，已渐愈。惟寒热间作未已，至八朝，延余诊之，右寸关大而乏韵，且有静中一跃之象，及视其神气颇
安，胎色薄黄，略思粥食。诊视甫毕，前医适来，余谓脉甚不佳，恐有猝变。彼诊之云∶较昨已大和矣，必无害
也。余唯唯而退，主人似讶余之太无能也，勉强送余出门。余复谓曰∶元气太伤，不可再服峻药也。闻夜间寒热
复来，腹痛又作，仍以回生丹下之，越日而殒。）
来天培治潘氏妇，季夏，产后二十余日，患寒热便血，恶露未净。而专科与香薷饮四剂，服后反呕吐头眩，
腹痛自汗，恶心发热，气促发斑，色微红，两颊淡红。诊之，左脉如丝，右脉沉细，此虚而兼感，呕吐伤胃，
肝木乘相火刑金，肺气受伤，上下拒格之症也。治宜活血滋阴，行气舒脾，散气降逆，托里化斑之剂。用牛膝、
茯苓、杞子、当归、红花、黄 、川芎、木香、香附、广皮、半夏曲、生姜，一剂诸症大减，六脉和缓。但微
嗽眩晕，心跳，胸膈不舒，此邪去正虚所致也。前方去川芎、木香、牛膝，加茯神、丹参、杏仁、贝母，二剂
前症尽除。惟心跳头晕，改用归脾汤去人参、木香，加防党参、杞子、白芍，调理而愈。
一位产妇在分娩后，从尿道（水道）排出一条肉质条状物，长达三四尺，触动它时疼痛难忍。先服用失笑散几帖，接着用带皮的生姜三斤捣烂，加入清油二斤，煎至油干为止，用绢布兜住那条肉线，弯曲放置在尿道口旁，用之前的姜渣熏蒸患处，凉了就用热敷熨烫。经过六天六个夜晚，肉线缩回了大半；再过两天（十二日），便完全缩回体内。随后再服用失笑散和芎归汤进行调理。如果肉线断裂，就无法治愈了。
产后恶露过多且不止，使用伏龙肝二两，煎汤澄清，溶入阿胶一两服用。如果无效，加入人参。此方出自沈尧封的《女科辑要》。
陆肖愚治疗吴敬之的妻子，年龄二十多岁，产前已有感冒症状，分娩三天后，因责备婢女离开床铺照顾，当时正值冬季，感到身上战栗，随即出现身体发热、头痛。有人用参苏饮让她发汗，头痛停止但身体发热未除。于是认为产后应当大补气血，服用数剂后烦热日益加重，又打算使用补中益气汤。诊脉发现，两手脉象虽然虚弱，但左手脉仍带浮象，右手脉已现数象。他说：脉虚是产后正常的平脉，但左手脉仍浮，说明表邪未散；右手脉见数，是病邪欲传入里的征兆。应当紧急解除表邪，轻微通利里实，稍一迟缓就会有承气汤证（阳明腑实证）的危险。使用柴胡、葛根、桔梗、黄芩、天花粉、甘草、山楂，服用一剂后烦热减轻，两剂后身体凉爽，再用清气养荣汤调理。（徐灵胎按语：左手脉带浮，是因为产后血虚；右手脉数，是因为外感客邪未解。）
马元仪治疗陆氏妇人，产后怕冷，即使盖着厚褥子、裹着浓被也无法缓解，多次进补无效，几乎要用到桂枝、附子等温热药。诊脉发现，两手脉象沉伏，面色红赤，口干燥，胸中胀满。这不是产后新近的气血虚弱，而是怀孕期间潜伏的病邪。多次用人参、白术等补气药，导致邪气更加结聚，正气更加受阻。肌表怕冷，是因为邪热内郁，逼迫阴气外越；口干、面赤、胸满，是因为邪气挟带火气和食积，上犯清窍。仍然应该采用表里双解的方法治疗。使用葛根、防风、苏梗、枳壳、桔梗、杏仁、苏子、薄荷，服用一剂后表症消除，右关尺脉转为滑实。随即使用大黄五钱、元明粉三钱、甘草一钱，服用一剂后排出大量积滞秽物，随后又发出皮疹和颐部疮疡，这是表里调和、余邪全部透发的征象。再用辛凉解表透邪的药剂而痊愈。此症邪气潜伏在内，日久不宣发，用清阳泄表、苦寒通下的方法两路夹击，竟然还发出皮疹和颐部疮疡，如果此时妄行温补，难道会把脉伏、恶寒当作阳虚的征兆吗？这真是没有审察病机啊！（徐灵胎按语：在产后能知道是伏邪，并采用表里双解的治疗，确实是高手，如果能不用苏叶、防风、葛根、桔梗，就可以避免后来颐部生疮的祸患了。）
王氏妇人，产后一个月，神志昏沉疲倦，上气喘促，胸中满痛，咳嗽发热，各种治疗都无效。诊脉发现，两脉沉涩兼有结象。这是产前已有潜伏病邪，加上产后气血两虚，邪气更加内结。治法应当表里双和，使邪气从外透出，气机从内宣泄，病自然痊愈。使用桂枝、柴胡、苏梗、枳壳、半夏曲、萝卜子、杏仁、广皮，作为透邪达滞的药剂，顿然安适。脉象已稍舒缓，有人投予人参、地黄、当归、芍药等收敛阻滞的药物，结果整夜无法安宁，如同丢了魂魄。这是因为邪气结在中焦，补益会导致变证。于是改用桂枝、炮姜、黄连、枳实、厚朴、广皮等，一剂后胸满和中痛消除。再用瓜蒌仁、柴胡、桂枝、半夏、枳壳、杏仁、苏子、桔梗，两剂后表热、喘咳平息，只是大便不通，这是久病津液失于滋养所致。加入生首乌一两，大便通畅，其余邪气尽去。然而正气大亏，再用滋补气血的药剂而痊愈。
李季虬治疗魏季尝的正室，产后饮食不节制，又感受风寒，导致发热谵语，喘咳气逆，恶露完全不来，病情非常急迫。他说：症状都是由外来客邪引起，尚属可救；如果是正气虚脱，出现这些症状，必定无救了。凭什么这样判断？因为脉气浮大有力。使用大剂量的疏风消食药，两剂便霍然痊愈。先前有用白术、川芎、当归等补药治疗的，差点被误导。（出自《广笔记》）
张意田治疗一位妇人，产后患病已半年，大家都当作劳损治疗，并且说阴液亏损已到极点，难以痊愈。张意田连续诊治五次，确信此症服用小柴胡汤必然有效。无奈众人议论纷纷，认为人参、柴胡不是治疗阴亏的药，又说肺热咳嗽，严禁用人参，因此立案争辩。幸好病人家属信任他，服用一剂后寒热大作，三剂之后，寒热退去，咳嗽平息，十剂后完全痊愈。案中说：诊得六脉皆数，右寸脉大而软，关尺两部沉取弦急，左寸洪数，关部三部皆虚数，尺部中空大。右寸软大，是肺气虚。关尺沉取弦急，关主中州（脾胃），尺司火位（肾/命门），沉取属里，弦为肝脉，这是因为中气虚而肝木邪气侵犯本位，肝气动而火随之而起。左寸洪数，是心经虚火。关中虚数，是肝血不足无法滋养。尺中空大，是肾水虚。这个脉象本来属于阴虚，但寒邪乘虚而入，留连不去，以至于如此。现在所见症状，五更发热，是因为寅卯时（凌晨3-7点）木气旺盛之时，肝火挟带邪气，随时间而动。上午寒热，出汗后热减，是因为邪气稍泄，势头稍缓。咳嗽声音，结滞不畅，这是久嗽伤肺，肺气虚而邪气不得发散。胸腹时常胀满微鸣，这是肝木侵犯脾土，肝主胀。综合脉象与症状，这是虚中挟实，枢机不能转动外出的证候。《大全》说：产后血气虚弱，饮食未平复，不满百日，调养失当，风冷客于气血，容颜憔悴，饮食难消，感于肺，所以咳嗽口干，觉得头晕，全身关节疼痛。营卫受邪，气通于肝，流注脏腑，须臾间频繁发作，咳嗽无汗，寒热如疟，这是蓐劳的证候，往往如此。景岳说：虚弱之人，外邪初感，不为解散，而作内伤，或用清凉药，或用滋补药，导致寒邪郁伏，久留不解，而寒热往来，或为咳嗽，其症状全似劳损。想要辨别的人，观察其表里病情，或者身体有疼痛，微汗则热退，无汗则复热。或者大声咳嗽，脉虽弦紧，但不甚数，即使病至一两个月，而邪气仍未解，这是似损非损症，不要再误诊。如今此症确实类似于此，应当用小柴胡汤，转动枢机，借助少阳的生气，由内而外，自下而上，则阴阳调和而伏邪解散。去掉半夏，加牛膝。半夏能启阴气，产后阴亏兼口燥，所以去掉它。胸腹时常胀满，脾阴多郁结，宜加牛膝以引导。药病相当，自然应验如桴鼓。（徐灵胎按语：今年春天我的妻子，分娩颇艰难，到了第三天，忽然浑身麻木冰冷，随即壮热大渴，汗出不解，耳鸣目泪，舌绛无津，胎色黄燥，腹痛拒按，胃脘闷不想吃东西，恶露仍在行，小便极热，按脉弦滑，右侧更甚，这是产前吸受温邪，而痰热素盛，气机窒滞，血去阴伤，所以见证如此剧烈。我用玄参、丹参、白薇、知母、天花粉、竹茹、豆卷、旋覆花、桑叶等服用，热即退而脉不减，且仍不饥，继续给这些药。过了两天，麻木冰冷后又发热，舌较润，胎稍薄，知道治疗已中肯，但仍嫌药力薄弱，前方加石菖蒲、枳实、楝实、瓜蒌仁投服，热也退了；退后，并吐出胶痰数碗，略进稀粥。隔一天，又发寒热，有人怀疑是疟疾，有人说产时用力劳伤，有人担心将成蓐损，议论纷纷。我置若罔闻，仍主前药，热果渐短，渴亦甚减。过几天，寒热犹来，确守原方，到第十一朝，才解黑燥屎，而诸恙悉解，且渐进谷，计服此方已十大剂了。继后惟以粥食调养，竟不与药。亲戚朋友听说，无不惊异。然而若非独断独行，断难奏效续命。如果拘泥于初产而用生化汤行瘀，或视为疟疾，而以柴胡桂枝汤温散，则必骤变。即使知道是阴虚热感，而与四物汤等养血，也必邪气纠缠，延为蓐损。季冬，孙昼三的次媳，因为儿女过多，不想哺乳，产前屡用下胎药，不应。娩后三天，也发寒热，兼以痛泻无尿，泻出者皆黑色，医生视为瘀血，我给回生丹等药，已渐愈。惟寒热间作未已，到第八朝，延我诊治，右寸关大而乏韵，且有静中一跃之象，及视其神气颇安，胎色薄黄，略思粥食。诊视刚结束，前医恰好来了，我说脉很不好，恐怕有猝变。他诊后说：比昨天已大和矣，必无害也。我唯唯而退，主人似乎惊讶我太无能，勉强送我出门。我又说：元气太伤，不可再服峻药也。听说夜间寒热复来，腹痛又作，仍以回生丹下之，越日而殒。）
来天培治疗潘氏妇人，季夏（夏季末），产后二十多天，患寒热便血，恶露未净。而专科医生给予香薷饮四剂，服用后反而呕吐头眩，腹痛自汗，恶心发热，气促发斑，色微红，两颊淡红。诊脉发现，左脉如丝，右脉沉细，这是虚而兼感，呕吐伤胃，肝木乘相火刑金，肺气受伤，上下拒格之症。治宜活血滋阴，行气舒脾，散气降逆，托里化斑的药剂。使用牛膝、茯苓、杞子、当归、红花、黄芪、川芎、木香、香附、广皮、半夏曲、生姜，一剂后诸症大减，六脉和缓。但微嗽眩晕，心跳，胸膈不舒，这是邪去正虚所致。前方去掉川芎、木香、牛膝，加茯神、丹参、杏仁、贝母，两剂前症尽除。惟心跳头晕，改用归脾汤去人参、木香，加防党参、杞子、白芍，调理而愈。
A woman, after childbirth, expelled a strip of fleshy tissue from the urinary tract (Shuidao), three to four chi in length. Touching it caused excruciating pain. She first took Shixiao San (Pain-Stopping Powder) for several doses. Then, three jin of ginger with skin were pounded into a paste, mixed with two jin of refined sesame oil, and boiled until the oil was dry. The fleshy strip was gathered in silk gauze, bent, and placed beside the urethral opening, then fumigated with the residual ginger. When cool, it was applied as a warm compress. After six days and nights, it retracted by more than half; within another twelve days, it completely retracted inside. Subsequently, she took Shixiao San and Xionggui Tang (Safflower and Angelica Decoction) for regulation. If the fleshy strip had ruptured, it would have been incurable.
For excessive postpartum lochia that does not stop, use 2 liang of Fulonggan (Dragon's House Earth), decocted in water, clarified, and dissolved with 1 liang of Ejiao (Donkey-hide Gelatin). If ineffective, add Renshen (Ginseng). This formula is from Shen Yaofeng's *Nuke Jiyao* (Essentials of Gynecology).
Lu Xiaoyu treated the wife of Wu Jingzhi, who was in her twenties. Before delivery, she already had symptoms of a cold. Three days after giving birth, while scolding a maid for leaving the bed, during the winter season, she felt chills, followed by fever and headache. Someone administered Shen Su Yin (Ginseng and Perilla Decoction) to induce sweating. The headache ceased, but the fever persisted. It was then assumed that postpartum conditions require substantial tonification of Qi and Blood. After several doses, irritability and heat intensified. A decision was made to use Buzhong Yiqi Tang (Decoction for Boosting the Middle and Augmenting Qi). Upon pulse diagnosis, both wrists showed weak pulses, but the left still carried a floating quality, and the right showed rapidness. He stated: "A weak pulse is a normal postpartum pulse. However, the left floating indicates that exterior pathogenic factors have not dispersed. The right rapidness suggests the pathogen is about to transmit inward. We must urgently release the exterior and mildly unblock the interior. Delaying this risks developing Chengqi Syndrome (Yangming Fu-organ excess syndrome)." He used Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Jiegeng (Platycodonis Radix), Huangqin (Scutellariae Radix), Huafen (Trichosanthis Radix), Gancao (Glycyrrhizae Radix), and Shanzha (Crataegi Fructus). After one dose, irritability decreased; after two doses, body temperature normalized. She was then regulated with Qingqi Yangying Tang (Decoction for Clearing Heat and Nourishing Ying). (Xu Lingtai's note: Left floating indicates postpartum blood deficiency; right rapidness indicates unresolved external pathogens.)
Ma Yuanyi treated a Lady Lu, who suffered from aversion to cold after childbirth. Even with thick mattresses and heavy quilts, the sensation did not subside. Multiple attempts at tonification failed, and Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) were nearly prescribed. Pulse diagnosis revealed deep and hidden pulses in both wrists, flushed face, dry mouth, and chest fullness. This was not new postpartum deficiency, but latent pathogens from pregnancy. Repeated use of Renshen (Ginseng) and Baizhu (Atractylodis Macrocephalae Rhizoma) caused further pathogen consolidation and obstruction of healthy Qi. The surface aversion to cold resulted from internal pathogenic heat forcing Yin outward. Dry mouth, flushed face, and chest fullness indicated pathogens carrying fire and food stagnation attacking the clear orifices. Treatment should address both exterior and interior. He used Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Sugen (Perillae Caulis), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), Suzi (Perillae Fructus), and Bohe (Menthae Haplocalycis Herba). After one dose, exterior symptoms resolved, and the right Guan and Chi positions became slippery and solid. He then used Dahuang (Rhei Radix et Rhizoma) 5 qian, Yuanmingfen (Mirabilite) 3 qian, and Gancao (Glycyrrhizae Radix) 1 qian. One dose expelled significant fecal impaction. Subsequently, rashes appeared on the body and parotid swelling occurred, signs of harmonized interior/exterior and complete expulsion of residual pathogens. She recovered with acrid-cool releasing and penetrating agents. This case involved latent pathogens lingering internally. Using clearing yang to release the exterior and bitter-cold to drain downward, even with rash and parotid swelling, if one blindly uses warm tonification, mistaking deep pulse and aversion to cold for Yang deficiency, it shows a profound failure to examine the disease mechanism. (Xu Lingtai's note: Recognizing latent pathogens postpartum and using exterior-interior dual treatment is indeed expert skill. Avoiding Suye, Fangfeng, Gegen, and Jiegeng could have prevented the later parotid swelling.)
Lady Wang, one month postpartum, presented with mental fatigue, shortness of breath, chest fullness and pain, cough, and fever. All treatments failed. Pulse diagnosis showed deep, choppy, and knotted pulses in both wrists. Latent pathogens existed before delivery, compounded by postpartum Qi and Blood deficiency, leading to deeper pathogen consolidation. The method should harmonize interior and exterior, allowing pathogens to exit outward and Qi to vent inward. She used Guizhi (Cinnamon Twig), Chaihu (Bupleuri Radix), Sugen (Perillae Caulis), Zhike (Aurantii Fructus), Banxiaqu (Pinelliae Fermentatum), Luoboziren (Raphani Semen), Xingren (Armeniacae Semen Amarum), and Guangpi (Citri Reticulatae Pericarpium). As an agent to penetrate pathogens and resolve stagnation, she was instantly relieved. Pulses relaxed slightly. Someone administered Renshen (Ginseng), Dihuang (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), and Shaoyao (Paeoniae Radix Alba)—astringent and stagnating herbs—causing all-night restlessness and loss of spirit. This was because tonifying when pathogens are consolidated causes complications. Instead, Guizhi (Cinnamon Twig), Paojiang (Prepared Ginger Rhizome), Huanglian (Coptidis Rhizoma), Zhishi (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex), and Guangpi (Citri Reticulatae Pericarpium) were used. One dose relieved chest fullness and mid-abdominal pain. Then, Louren (Fructus Trichosanthis), Chaihu (Bupleuri Radix), Guizhi (Cinnamon Twig), Banxia (Pinelliae Rhizoma), Zhike (Aurantii Fructus), Xingren (Armeniacae Semen Amarum), Suzi (Perillae Fructus), and Jiegeng (Platycodonis Radix) were used. Two doses resolved exterior heat, wheezing, and cough. Only constipation remained due to fluid depletion from chronic illness. Adding 1 liang of Sheng Shouwu (Polygoni Multiflori Radix) induced bowel movement, removing residual pathogens. With severe Qi and Blood deficiency, she was finally stabilized with tonifying agents.
Li Jiu treated the principal wife of Wei Jichang. Postpartum dietary irregularity combined with wind-cold invasion led to fever, delirium, wheezing, cough, and cessation of lochia. The condition was urgent. He stated: Symptoms caused by external pathogens are salvageable; if they result from collapse of healthy Qi, there is no hope. Why? Because the pulse was floating, large, and forceful. Large doses of wind-dispersing and food-resolving agents cured her in two doses. Previously, tonics like Baizhu (Atractylodis Macrocephalae Rhizoma), Xiong (Ligustici Chuanxiong Rhizoma), and Danggui (Angelicae Sinensis Radix) nearly misled the treatment. (From *Guang Biji*)
Zhang Yitian treated a woman ill for half a year postpartum. Others treated it as consumptive disease, claiming extreme Yin deficiency and poor prognosis. Zhang diagnosed five times and determined Xiao Chaihu Tang (Minor Bupleurum Decoction) was indicated. Despite objections that Renshen (Ginseng) and Chaihu (Bupleuri Radix) are unsuitable for Yin deficiency and lung heat cough, he insisted. The family trusted him. One dose caused intense chills and fever; three doses resolved them and stopped cough; ten doses cured her. Case record: Six pulses were rapid. Right Cun was large and soft; Guan and Chi were wiry and urgent upon deep pressure. Left Cun was flooding and rapid; Guan was deficient and rapid across three positions; Chi was hollow and large. Right Cun soft/large indicates Lung Qi deficiency. Deep Guan/Chi wiry/urgent indicates Liver Wood invading the center (Spleen/Stomach) and Fire following Wood movement. Left Cun flooding/rapid indicates Heart deficient fire. Guan deficient/rapid indicates Liver blood deficiency. Chi hollow/large indicates Kidney Water deficiency. Although the pulse suggests Yin deficiency, cold pathogens invaded and lingered. Symptoms: Fever at dawn (Yin-Mao hours, Wood peak) indicates Liver fire carrying pathogens. Morning chills/fever resolving with sweat indicates slight pathogen release. Stagnant cough indicates Lung damage and inability to disperse pathogens. Abdominal distension/borborygmus indicates Liver Wood invading Spleen Earth. Combined, this is deficiency with excess, where pivot mechanism fails to expel pathogens. *Daquan* states: Postpartum Qi/Blood weakness, improper diet/care within 100 days allows wind-cold to invade, causing emaciation, indigestion, cough, dizziness, joint pain. Ying/Wei pathogens affect Liver, flow to organs, causing frequent cough, no sweat, malaria-like chills/fever—signs of *Rulao* (Childbed Consumption). Jingyue states: Weak persons with initial external pathogens, if not released but treated with cooling or tonics, trap cold pathogens, causing alternating chills/fever or cough, mimicking consumption. Differentiate by checking if pain resolves with slight sweat or recurs without sweat; or if loud cough has wiry-tight but not rapid pulse despite long duration. This is "apparent consumption, not actual." Do not misdiagnose. This case fits. Use Xiao Chaihu Tang to rotate the pivot, utilizing Shaoyang's generating Qi to move from inside-out, bottom-up, harmonizing Yin/Yang and dispersing latent pathogens. Remove Banxia (Pinelliae Rhizoma), add Niuxi (Achyranthis Bidentatae Radix). Banxia raises Yin Qi, contraindicated here due to postpartum Yin deficiency and dry mouth. Abdominal distension requires Niuxi to guide downward. Medicine matches pathology, ensuring efficacy. (Xu Lingtai's note: My wife had difficult labor. On day 3, sudden numbness/cold, then high fever/thirst, unremitting sweat, tinnitus, tearing, crimson tongue without fluids, yellow-dry coating, abdominal pain refusing pressure, epigastric fullness/anorexia, ongoing lochia, hot urine. Pulse wiry-slippery, stronger on right. Prenatal warm pathogen absorption with phlegm-heat stasis and Yin injury. I used Xuanshen (Scrophulariae Radix), Danshen (Salviae Miltiorrhizae Radix), Baiwei (Cynanchi Atrati Radix), Zhimu (Anemarrhenae Rhizoma), Huafen (Trichosanthis Radix), Zhuru (Bambusae Caulis in Taenia), Doujuan (Sojae Semen Praeparatum), Xuanfu (Inulae Flos), Sangye (Mori Folium). Heat subsided, pulse unchanged, anorexia persisted. Continued same prescription. Two days later, numbness/cold returned with fever, tongue moister, coating thinner. Treatment correct but weak. Added Shichangpu (Acori Tatarinowii Rhizoma), Zhishi (Aurantii Fructus Immaturus), Lianshi (Meliae Fructus), Louren (Fructus Trichosanthis). Heat subsided; expelled viscous phlegm; tolerated gruel. Next day, chills/fever recurred. Suspected malaria or labor injury. I ignored doubts, kept original formula. Heat shortened, thirst reduced. Days passed, chills/fever continued. Adhered strictly. On day 11, passed black dry stool, all symptoms resolved, appetite returned. Total 10 doses. Thereafter, only gruel, no medicine. Relatives amazed. Without determination, success would be hard. If I used Shenghua Tang (Life-Restoring Decoction) for blood stasis, or Chaihu Guizhi Tang for malaria, or Siwu Tang for Yin deficiency, pathogens would entangle, leading to *Rulao*. In late winter, Sun Zhou's daughter-in-law, having many children, refused nursing, used abortifacients prenatally. Failed. Day 3 postpartum, chills/fever, painful diarrhea, anuria, black stool. Doctor saw stasis, gave Huisheng Dan (Life-Returning Pill). Improved. Chills/fever persisted. Day 8, I examined. Right Cun/Guan large, lacking resonance, with a jumping sensation. Spirit calm, coating thin-yellow, desired gruel. Just finished, previous doctor arrived. I said pulse bad, risk of sudden change. He said: Much better than yesterday, harmless. I withdrew politely. Host seemed disappointed. I added: Vital Qi too damaged, harsh drugs forbidden. Heard night chills/fever and abdominal pain returned. Doctor again used Huisheng Dan. Died next day.)
Lai Tianpei treated Lady Pan. Late summer, 20+ days postpartum, chills/fever, bloody stool, incomplete lochia. Specialist gave Xiangru Yin (Elsholtzia Decoction) for four doses. Result: vomiting, vertigo, abdominal pain, spontaneous sweating, nausea, fever, shortness of breath, macules (light red), pale-red cheeks. Pulse: Left thread-thin, Right deep-fine. Deficiency with infection. Vomiting injured Stomach. Liver Wood overacting on Ministerial Fire insulting Metal (Lung). Upper/Lower rejection syndrome. Treatment: Invigorate blood, nourish Yin, move Qi, soothe Spleen, scatter Qi, direct rebellion, support interior, resolve macules. Used Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria), Qizi (Lycii Fructus), Danggui (Angelicae Sinensis Radix), Honghua (Carthami Flos), Huangqi (Astragali Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Muxiang (Aucklandiae Radix), Xiangfu (Cyperi Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Banxiaqu (Pinelliae Fermentatum), Shengjiang (Zingiberis Rhizoma Recens). One dose greatly reduced symptoms, pulses harmonious. Mild cough, vertigo, palpitations, chest discomfort remained due to pathogen departure and Zheng deficiency. Removed Chuanxiong, Muxiang, Niuxi; added Fushen (Poria cum Pinodia), Danshen (Salviae Miltiorrhizae Radix), Xingren (Armeniacae Semen Amarum), Beimu (Fritillariae Thunbergii Bulbus). Two doses cleared prior symptoms. Palpitations/dizziness remained. Switched to Guipi Tang (Restore the Spleen Decoction) minus Renshen, Muxiang; added Fangdangshen (Codonopsis Radix), Qizi (Lycii Fructus), Shaoyao (Paeoniae Radix Alba). Regulated and cured.