薛立斋治一妇人，堕胎昏愦，不时吐痰。自用养血化痰之剂，昏愦不省，自汗发搐，痰涎涌出。彼以为中
风，欲用祛风化痰之剂。薛曰∶此属脾气虚寒所致。遂用十全大补汤加炮姜，二十余剂寻愈。
一妇人年二十余，疫疾堕胎，时咳，服清肺解表，喘急不寐。薛谓脾土虚，不能生肺金，药损益甚。先与
补中益气加茯苓、半夏、五味、炮姜，四剂渐愈。又与八珍加五味，及十全大补汤全愈。
龚子才治一妇人，每怀孕至三个月必堕，不肯服药。教以四五年老母鸡煮汤，入红壳小黄米煮粥食之，不
数服而胎固，至足月生男。
方节庵之夫人朱氏，屡受产难，因就医乞堕胎方，服之无效，复求方于郑氏。郑云∶堕胎不下，必贵儿也，
今后宜服安胎药矣。一日，方闲步阡陌间，见一道人手携竹筐，坐于桥下，与之语，道气盎然，因设斋留之。
到家问筐中何物，曰∶此济瘳病患丹药也。因授一方，名曰回生救产丹，并劝修合普施。朱夫人诞弥厥月，时
服一丸，则果如达矣。遂连生二子，长名鹏，字矫亭；次名凤，字改亭。后一为宫詹，一为御史。（《张氏卮言》。）
薛立斋治一妇，苦于生育。孕及三月，以面粉烧酒调服堕胎，胎去，下血不止，呕吐，汤药不纳，六脉细
小欲绝。作毒药伤胃气，胃气虚不能司纳。以人参二钱，甘草五分，水煎徐徐与服，呕止。用八珍汤调理而安。
又治一孕妇，用前药患前症，胸腹饱满，呕吐不止，用绿豆甘草汤饮之而安。
一妇怀孕三月而堕，堕后发热自汗，四肢软弱。曰∶气血虚，不能荣养其胎故堕。堕后益虚，阴虚则发热，
阳虚则自汗。以十全大补汤去桂，加五味子而安。
吴桥治程应兆妻，故多病，三月不月，已忽微行。诸医以为积血而力导之，恶乃大至，举身汗溢，垂绝而
苏。则又为虚极，而重剂补之，上视反张，惊搐昏冒，饰巾待尽。桥诊之，脉虽离经，按之不绝，曰∶此妊脉
也。误谓积血，迫之大行，胎离经而欲下，则血竭而途穷，阳气无阴血可根据，则浮腾而上越，胎堕阳上逆而触
心，故上视反张，惊搐昏瞀，法不当死。乃予顺胎散，始进甚艰，既及半而药力行，嗒焉而寐。诸医目桥曰∶
死矣。桥曰∶药中病乃寐，诸公待之。顷之呻吟，始云头痛。诸医以为余烬也，夜分乃终。桥曰∶中夜阳生，
比当来复。时至而圉圉乃少舒，诘朝爽然。俄仆卧内，诸医目慑桥曰∶真死矣。桥曰∶胎欲下而血垂尽，壅
阏不得行。寻以顺胎散下之，则血块大如拱。诸医慑桥曰∶吾侪固以为积血，果然。桥徐应曰∶非积血也，胎
也。立引水激而濯之，外紫而中白，具人形，病者渐安，诸医乃服。（《太函集》。）
徐灵胎曰∶妇科之最重者二端，堕胎与难产耳。世之治堕胎者，往往纯用滋补，治难产者，往往专于攻下，
二者皆非也。盖半产之故非一端，由于虚滑者，十之一二，由于内热者，十之八九。盖胎惟赖血以养，故得胎
之后，经事不行者，因冲任之血，皆为胎所吸，无余血下行也。苟血或不足，则胎枯竭而下堕矣。其血所以不
足之故，皆由内热火盛，阳旺而阴亏也。故古人养胎之方，专以黄芩为主。又血之生，必由于脾胃。经云荣卫
之道，纳谷为宝，故又以白术佐之。乃世之人专以参、 补气，熟地滞胃，气旺则火盛，胃湿则不运，生化之
源衰而血益少矣。至于产育之事，乃天地化育之常，本无危险之理，险者千不得一，世之遭厄难者，乃人事之
未工也。其法在乎产妇，不可令早用力。盖胎必转而后下，早用力则胎先下坠，断难舒转，于是横生倒产之害
生。又用力则胞浆骤下，胎已枯涩，何由能产？此病不但产子之家不知，即收生稳妇，亦有不知者。至于用药
之法，则交骨不开，胎元不转，种种诸症，各有专方。其外或宜润，或宜降，或宜温，或宜凉，亦当随症施治。
其大端以养血为主，盖血足则诸症自退也。至于易产强健之产妇，最多卒死。盖大脱血之后，冲任空虚，经脉
娇脆，健妇不以为意，轻举妄动，用力稍重，冲脉断裂，气脱血崩，死在顷刻。尤忌举手上头，如是死者，吾
见极多。不知者，以为奇异，实理之常。生产之家，不可不知也。
薛立斋治疗一位妇人，因流产导致神志昏迷、意识模糊，且不时呕吐痰涎。患者自行服用养血化痰的药物后，病情加重，出现昏睡不醒、自汗以及抽搐症状，痰涎涌出更多。家属误认为是中风，打算使用祛风化痰的药物。薛立斋说：“这是属于脾气虚寒所致。”于是使用十全大补汤加入炮姜，服用二十多剂后很快痊愈。
另一位二十多岁的妇人，因患疟疾（疫疾）而流产，伴有咳嗽，之前服用了清肺解表的药物，导致气喘急促、无法入睡。薛立斋认为脾土虚弱，不能生养肺金，之前的用药反而使病情加重。先给予补中益气汤加入茯苓、半夏、五味子、炮姜，服用四剂后逐渐好转。随后又给予八珍汤加入五味子，最后用十全大补汤完全治愈。
龚子才治疗一位妇人，每次怀孕到三个月必定流产，但她不肯服药。龚子才教她用四五年的老母鸡煮汤，加入红壳小黄米煮粥食用，没过几服胎气就稳固了，直到足月生下男孩。
方节庵的夫人朱氏，多次遭遇难产，因此就医请求堕胎方，服用后无效，又向郑氏求方。郑氏说：“堕胎药下不来，一定是因为胎儿珍贵（或指胎儿稳固），今后应当服用安胎药了。”有一天，方节庵在田间小路上闲逛，看见一位道士手提竹筐，坐在桥下，便与他交谈，觉得他道气盎然，于是设斋饭留他在家里住宿。到家后问筐里装的是什么，道士说：“这是救济治愈病患的丹药。”于是传授了一个方子，名叫“回生救产丹”，并劝他配制后普遍施舍。朱夫人在预产期时，按时服用一丸，果然顺利分娩。于是接连生了两个儿子，长子名鹏，字矫亭；次子名凤，字改亭。后来一个做了宫詹（太子宾客或类似官职），一个做了御史。（出自《张氏卮言》。）
薛立斋治疗一位妇女，苦于生育问题。怀孕到三个月时，她服用面粉和烧酒调制的堕胎药，胎虽去但阴道出血不止，伴有呕吐，连汤药都吃不下去，六脉细微欲绝。薛立斋判断是毒药损伤了胃气，胃气虚弱无法受纳食物。用人参二钱、甘草五分，水煎后慢慢喂服，呕吐停止。再用八珍汤调理而安定下来。
又治疗一位孕妇，服用前文提到的堕胎药后出现上述症状，胸腹饱满，呕吐不止，用绿豆甘草汤饮用后得以安宁。
一位妇人怀孕三个月流产，流产后发热、自汗，四肢软弱无力。薛立斋说：“这是因为气血虚弱，不能滋养胎儿所以流产。流产后更加虚弱，阴虚则发热，阳虚则自汗。”使用十全大补汤去掉桂枝，加入五味子而痊愈。
吴桥治疗程应兆的妻子，她平时多病，月经三个月没来，突然有轻微出血迹象。各位医生认为是瘀血积滞，用力导引攻下，结果恶露大量涌出，全身大汗淋漓，几乎断气才苏醒。此时身体极度虚弱，医生又用重剂补益，患者出现眼球上翻、角弓反张、惊厥抽搐、昏迷不省人事，盖上头巾等待死亡。吴桥诊察发现，脉搏虽然偏离正常妊娠脉象，但按之不绝，说：“这是妊娠脉。”误认为是瘀血积滞，强行攻下导致经血大行，胎元脱离经脉想要下行，导致血液枯竭、无路可走，阳气没有阴血作为依托，于是浮腾而上越，胎堕后阳气上逆冲击心脏，所以出现眼球上翻、角弓反张、惊厥昏迷等症状，按照医理本不该死。于是给予顺胎散，刚开始很难喂进去，等到喝了一半药效发挥，患者安静地睡着了。其他医生看着吴桥说：“死了。”吴桥说：“药力击中病灶所以睡着，各位等着看吧。”过了一会儿，患者呻吟，开始说头痛。其他医生以为是余毒未清，到了半夜就会去世。吴桥说：“半夜阳气生发，届时应该会恢复。”时间到了，患者稍微舒展一些，早晨醒来精神清爽。不久患者倒在床上，其他医生惊恐地看着吴桥说：“真的死了。”吴桥说：“胎儿想要下行但血液几乎耗尽，壅塞阻滞不能运行。”随即用顺胎散排出，结果排出一大块如拱手大小的血块。其他医生敬畏吴桥说：“我们原本以为是瘀血积滞，果然如此。”吴桥从容回答说：“不是瘀血，是胎儿。”立刻让人取水冲洗，外面紫里面白，具备人形，病人逐渐安稳，其他医生这才信服。（出自《太函集》。）
徐灵胎说：妇科中最重要的是两个方面，堕胎和难产。世上治疗堕胎的人，往往纯用滋补法；治疗难产的人，往往专于攻下法，这两种做法都不对。半产（流产）的原因不只一种，由于虚滑导致的，占十分之一二；由于内热导致的，占十分之八九。因为胎儿只依靠血液来滋养，所以受孕之后，月经停止，是因为冲任之血都被胎儿吸收，没有多余的血液下行。如果血液不足，胎儿就会干枯而下坠流产。血液之所以不足的原因，都是由内热火盛，阳气旺盛而阴液亏损造成的。所以古人养胎的方子，专门以黄芩为主药。另外，血液的生成，必然依赖于脾胃。《内经》说营卫之道，以饮食为宝，所以又用白术辅助它。然而世人专门用人参、黄芪补气，熟地黄滋腻碍胃，气旺则火盛，胃湿则运化失常，生化之源衰败，血液反而更少。至于生产这件事，是天地化育的正常规律，本来没有危险的道理，危险的千中无一，世上的厄难，是因为人为处理不当。方法在于产妇，不可以过早用力。因为胎儿必须转动后才能产出，过早用力则胎儿先下坠，难以舒展转动，于是产生横生倒产的祸害。而且用力会导致胞浆骤下，胎儿已经干枯涩滞，怎么能产出来？这种病不仅生孩子的人家不知道，就连接生的稳婆，也有不知道的。至于用药的方法，对于交骨不开、胎元不转等各种症状，各有专门的方子。或者适宜润燥，或者适宜降逆，或者适宜温补，或者适宜清凉，也应当随症施治。其大原则是以养血为主，因为血充足则各种症状自然消退。至于那些容易生产、身体强健的产妇，最多会发生猝死。因为在大量失血之后，冲任空虚，经脉娇嫩脆弱，健壮的产妇不在意，轻举妄动，用力稍重，导致冲脉断裂，气脱血崩，顷刻间死亡。尤其忌讳举手过头顶，像这样死亡的，我见过非常多。不知道的人以为奇异，其实是常理。生产之家，不可不知道这些道理。
Xue Lizhai treated a woman who, after a miscarriage, suffered from coma and confusion, along with intermittent expectoration of phlegm. She had self-administered blood-nourishing and phlegm-resolving agents, which worsened her condition, leading to unconsciousness, spontaneous sweating, convulsions, and profuse salivation. Her family mistook this for wind-stroke (Zhong Feng) and intended to use wind-dispelling and phlegm-resolving formulas. Xue said, "This is caused by deficiency-cold of the Spleen Qi." He prescribed Shiquan Dabu Tang (Complete Great Tonifying Decoction) with processed ginger (Pao Jiang). After more than twenty doses, she recovered quickly.
Another woman in her twenties suffered a miscarriage due to malaria (Yi Ji) and coughing. Having taken lung-clearing and exterior-releasing medicines, she developed wheezing, urgency of breath, and insomnia. Xue diagnosed that the Spleen Earth was deficient and failed to generate Lung Metal, meaning the previous medications aggravated the condition. He first prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Poria (Fu Ling), Pinellia (Ban Xia), Schisandra (Wu Wei Zi), and processed ginger. After four doses, she gradually improved. Subsequently, she took Bazhen Tang (Eight Treasures Decoction) with Schisandra, and finally recovered completely with Shiquan Dabu Tang.
Gong Zicai treated a woman who invariably miscarried at three months of pregnancy but refused medication. He advised her to boil soups from old hens aged four or five years, adding red-shelled small yellow millet to make porridge. After just a few servings, her fetus stabilized, and she delivered a healthy boy at full term.
Mrs. Zhu, wife of Fang Jie'an, experienced repeated difficult labors. Seeking medical help, she requested an abortifacient formula, which proved ineffective. She then sought advice from Zheng Shi. Zheng said, "If the abortifacient fails to expel the fetus, it indicates the fetus is precious/stable; you should now take fetal-securing medicines." One day, while strolling in the fields, Fang saw a Daoist priest carrying a bamboo basket sitting under a bridge. Upon conversation, he found the priest's aura profound and invited him home for a meal. When asked about the contents of the basket, the priest replied, "These are miraculous pills to heal patients." He then imparted a formula named Huisheng Jiuchan Dan (Life-Restoring and Labor-Saving Pill) and encouraged its widespread distribution. During Mrs. Zhu's confinement month, taking one pill daily ensured a smooth delivery. She subsequently gave birth to two sons: the eldest, Peng, courtesy name Jiaoting; and the second, Feng, courtesy name Gaiting. Later, one became a Gongzhan (Imperial Tutor/Advisor) and the other a Censor (Yushi). (From *Zhangshi Zhiyan*.)
Xue Lizhai treated another woman suffering from reproductive issues. At three months of pregnancy, she ingested a mixture of flour and rice wine intended to induce abortion. Although the fetus was expelled, she suffered continuous bleeding, vomiting, and inability to retain any food or medicine. Her six pulses were minute and nearly imperceptible. Xue determined that the toxic substance had damaged Stomach Qi, leaving it too weak to receive nourishment. He administered Ren Shen (Ginseng Root) 2 qian and Gan Cao (Licorice Root) 5 fen, decocted in water and given slowly. The vomiting ceased. She was then regulated with Bazhen Tang and stabilized.
He also treated a pregnant woman who, after taking the aforementioned abortifacient, presented with chest and abdominal distension and incessant vomiting. She was soothed by drinking Mung Bean and Licorice Decoction (Lvdou Gancao Tang).
A woman miscarried at three months, followed by fever, spontaneous sweating, and weakness in the four limbs. Xue stated, "This is due to Qi and Blood deficiency failing to nourish the fetus, causing the miscarriage. Post-miscarriage, the deficiency increases; Yin deficiency causes fever, and Yang deficiency causes spontaneous sweating." He used Shiquan Dabu Tang minus Gui Zhi (Cinnamon Twig), adding Wu Wei Zi (Schisandra Berry), resulting in recovery.
Wu Qiao treated the wife of Cheng Yingzhao, who was chronically ill. Her menstruation had stopped for three months, and she suddenly exhibited slight vaginal bleeding. Various physicians assumed it was blood stasis and forcefully attempted to purge it. This resulted in massive lochia discharge, profuse whole-body sweating, and near-death collapse before she revived. The patient was extremely deficient, yet doctors administered heavy tonics. She then developed upward-gazing eyes, opisthotonos (back arching), convulsions, and coma, with a towel placed over her head as she awaited death. Wu Qiao palpated the pulse, finding it deviated from the normal pregnancy pulse but remained unbroken upon pressure. He said, "This is a pregnancy pulse." Mistaking it for blood stasis and forcing purgation caused excessive bleeding. The fetus detached from the meridian and attempted to descend, leading to blood exhaustion and stagnation. Without Yin-blood to anchor it, Yang Qi floated upward. The expelled fetus allowed Yang to rebel upward and strike the Heart, causing upward gazing, opisthotonos, convulsions, and coma. According to medical principles, death was not inevitable. He prescribed Shuntai San (Fetus-Pacifying Powder). Initially, administration was difficult, but halfway through, the medicinal action took effect, and she fell into a deep sleep. Other physicians looked at Wu Qiao and said, "She has died." Wu Qiao replied, "The medicine hit the disease site, hence the sleep. Wait and see." Soon, she groaned and complained of headache. Others thought it was residual heat and predicted death by midnight. Wu Qiao said, "At midnight, Yang Qi generates, and recovery should follow." As time passed, she relaxed slightly and woke up refreshed in the morning. Suddenly, she collapsed on the bed. Terrified, the other physicians said, "Truly dead." Wu Qiao explained, "The fetus wanted to descend, but blood was nearly exhausted, causing obstruction. I will now use Shuntai San to expel it." A large blood clot, size of a cupped hand, was expelled. The physicians, awed, admitted, "We indeed thought it was blood stasis, and it turned out to be so." Wu Qiao calmly responded, "It was not stasis, but the fetus." He ordered water to wash the mass; it was purple outside and white inside, possessing human form. The patient gradually stabilized, and the other physicians submitted. (From *Taihan Ji*.)
Xu Lingtai commented: In gynecology, the two most critical aspects are miscarriage and dystocia (difficult labor). Those treating miscarriage often rely solely on tonification, while those treating dystocia focus exclusively on purgation; both approaches are incorrect. The causes of premature birth (half-birth/miscarriage) vary. Cases due to deficiency and slipping account for only 10-20%, whereas cases due to internal heat account for 80-90%. The fetus relies on blood for nourishment; thus, after conception, menstruation ceases because the blood of the Chong and Ren meridians is absorbed by the fetus, leaving no surplus to flow downward. If blood is insufficient, the fetus withers and miscarries. The reason for insufficiency lies in internal fire and excess heat, where Yang is vigorous and Yin is deficient. Therefore, ancient fetal-nourishing formulas primarily use Huang Qin (Scutellaria Root). Furthermore, blood generation depends on the Spleen and Stomach. The *Classic of Internal Medicine* states that Ying and Wei pathways value grain intake; thus, Bai Zhu (Atractylodes Macrocephala Rhizome) is used to assist. However, modern practitioners often indiscriminately use Ren Shen (Ginseng) and Huang Qi (Astragalus Root) to boost Qi. Shu Di Huang (Prepared Rehmannia Root) can cloy the Stomach. Excess Qi leads to excess fire, and Stomach dampness impairs transformation. Consequently, the source of bio-transformation declines, and blood becomes even scarcer. Regarding childbirth, it is a natural process of Heaven and Earth's creation and inherently carries no danger; dangerous outcomes occur in less than 1 in 1,000 cases. Adversities arise from improper human management. The key lies with the parturient: she must not exert force early. The fetus must rotate before descending; early exertion causes the fetus to drop prematurely, making rotation difficult, leading to malpresentations like transverse or breech births. Moreover, exertion causes amniotic fluid to rush out, leaving the fetus dry and stuck, hindering delivery. This ignorance exists not only among families but also among midwives. Regarding medication, specific formulas exist for conditions such as non-opening of the pubic symphysis (Jiao Gu) or failure of fetal rotation. Treatments may involve moistening, descending, warming, or cooling, depending on symptoms. The general principle is to nourish Blood, as sufficient Blood resolves various symptoms. Conversely, robust women prone to easy labor sometimes suffer sudden death. After massive hemorrhage, the Chong and Ren meridians are empty, and vessels are fragile. Healthy women may underestimate this, moving lightly or exerting themselves heavily, potentially rupturing the Chong Mai (Penetrating Vessel), leading to Qi collapse and blood flooding, causing instant death. Particularly, raising hands above the head is forbidden. I have witnessed many such deaths. Laypeople find this strange, but it is common logic. Families involved in childbirth must understand this.