杨乘六治许氏妇，产后动怒，寒热往来，胁痛口苦，（肝火病，其状如疟。盖胆为肝腑，肝病则胆亦病矣。）
渐次发热晡热。医云风证，混加表散，腹左忽增一块，匾大如掌，日夜作痛。或疑寒凝，或疑食滞，或疑瘀蓄，
或疑痞积，杂治之，病益甚，食减肌瘦。脉之，右关弦洪，左关弦数，面色黑瘦，舌色淡黄而干，症乃怒气伤肝经，
血少而燥痛也。盖肝居胃左，本藏血者也，血足则其叶软而下垂，血亏则其叶硬而横举，内与胃相磨，外与肌相逼，
能不隐而痛乎？凡性躁多怒者，往往患此，而妇女尤多。庸妄不知，误用香燥削克之剂，枉杀者不知凡几，良
可叹也！以滋水清肝饮，四剂块消痛止。继用归脾汤去木香，加白芍、丹皮、山栀，间服十余剂而痊。（必用归脾
收场，吾知其守而未化也。）
许氏妇，产后发热，或时作寒，头痛体倦，医与疏邪降火，烦渴不食。杨诊之，其脉浮取似数，重按则芤，
左手尤甚，唇舌皆白，面无血色，用十全大补汤加炮姜。或曰∶如此大热而用姜、桂，何也？曰∶阳在外，为
阴之卫，阴在内，为阳之守，两相根据附者也。今产后阴血大亏，虚阳无附，浮散于外而为热，非引浮散之阳，
归于柔阴，其热不退，（却不尽然。）故用温补血气之剂，欲其补以收之也。又曰∶姜、桂味辛而散，何云补以收之
耶？曰∶桂逢阳药，固能汗散，若逢血药，即为温行。姜之为用，生则开肌发汗，熟则温中散寒，至炮黑则入
血，且能引气药以入血分而生新血，故以大补为主，以之为佐使，阴得阳生，则热自除耳。四剂，果热退身凉。
十余剂，诸症悉愈。
凡产后症，多属阴虚血少，第以二地、二冬、杞子，一切养荣之剂，无不立愈。若气血兼补，杂以姜、
附刚剂，非担延时日，即贻病者后患，临症者宜审之。（雄按∶魏氏独擅此长，至论产后，却是最为贴切。）
柴屿青治钱屿沙官侍御时，其夫人产后三日，恶露甚少，面色唇燥，口干身热，（与前案唇舌皆白，面无
血色同。）拟用参。屿沙以产后不宜用补为疑。柴曰∶果有外感，自别有治法，今症属不足，舍此必致贻患，
不可用参之说，此不知医者及女流之说也。遂投人参当归散，加好桂一钱，次日口润生津，调理半月而痊。
陆祖愚治聂巡司子妇，产后百余日，大肠燥结，虚火上冲，便血肠鸣，腹满短气，内外皆热，半月不能进
饮食，或与养血清火，愈甚。诊得两脉浮洪而数，按之无神，脾肾两脉更觉空虚，乃产后元气耗散，真阴不足，
而非实热也。用八味丸，清晨淡盐汤送下三钱，用四君加归、芍、麦冬、知母、莲肉，作煎剂，数服，诸症少
缓。后以补中益气加白芍、麦冬，一月瘳。
马元仪治陆氏妇，产未一月，因起居微触，便血三日，遂彻夜不寐，此新产去血过多，虚而益虚也。凡有
所触，必伤其肝，肝伤而血溢，则气亦不守矣。气虚血弱，心神无养，故目为之不瞑。又与归脾大剂，用参至
一两，加鹿茸三钱，两月而愈。（论是，而方未尽协。）
魏玉横曰∶许竹溪室人，产后数日，发热自汗，面赤头痛，恶食不眠，恶露虽极少而淡，腹时胀痛，脉则
洪大而数。曰∶此血虚也，腹胀面赤，其势欲崩，宜峻补。或问故，曰∶面赤者，阳上越也；腹胀者，阴下陷
也。阳上飞则阴下走，势所必然。以熟地一两，杞子、枣仁各五钱，一剂。次日，小腹之右，忽有一块，如
且硬，按之痛甚，于是疑为瘀而误补，欲更张。幸病患素服予药，姑再延诊。曰∶其块骤起，即大如 ，虽瘀
滞亦无如是之甚也，此正肝脾失血，燥而怒张，得补犹然，否则厥而崩矣。今脉大渐敛，面赤渐退，非药之误，
乃药之轻也。令前方加倍，再入炒白芍五钱，炙甘草一钱，一服，块渐平，再服，块如失。前方减半，数剂，
诸症全安。此症若作瘀治，断无幸矣。
杨乘六治疗许氏妇人，产后因动怒，出现寒热往来、胁痛口苦的症状。（这是肝火病，症状类似疟疾。因为胆是肝的腑，肝病则胆也会受累。）随后逐渐发展为午后发热。医生诊断为风证，胡乱使用解表发散的药物，导致腹部左侧突然增生一块肿块，大小如手掌，日夜疼痛。有人怀疑是寒凝，有人怀疑是食滞，有人怀疑是瘀血蓄积，有人怀疑是痞积，采用多种方法杂治，病情反而加重，食欲减退，肌肉消瘦。诊脉时，右关脉弦而洪大，左关脉弦而数，面色黑且瘦削，舌色淡黄而干燥，病症乃是怒气损伤肝经，血少而导致燥痛。肝脏位于胃的左侧，本是藏血的脏器，血液充足时，其叶柔软而下垂；血液亏虚时，其叶变硬而横举，内部与胃相互摩擦，外部与肌肉相互逼迫，怎能不隐隐作痛呢？凡是性情急躁易怒的人，往往患此病，妇女尤其多见。庸医妄自不知，误用香燥克伐的药物，枉死之人不知有多少，实在令人叹息！给予滋水清肝饮，服用四剂后肿块消除、疼痛停止。继而又用归脾汤去掉木香，加入白芍、丹皮、山栀，间隔服用十余剂后痊愈。（必定要用归脾汤收尾，我知道他守方而未灵活变化。）
许氏妇人，产后发热，有时发冷，头痛体倦，医生给予疏邪降火的药物，导致烦渴、不能进食。杨乘六诊察她的脉象，轻取似乎数脉，重按则呈芤脉，左手尤为明显，嘴唇和舌头皆白，面无血色，使用十全大补汤加炮姜。有人问：“如此大热却用姜、桂，为什么呢？”回答说：“阳气在外，作为阴气的卫护；阴气在内，作为阳气的守持，两者互相依附。现在产后阴血大亏，虚阳无所依附，浮散于外而表现为发热，如果不引导浮散的阳气回归到柔阴之中，发热就不会消退。（这种说法并不完全正确。）所以使用温补血气的药物，希望依靠补益来收敛阳气。”又问：“姜、桂味道辛散，为什么说能补益收敛呢？”回答说：“桂枝遇到阳药，固然能发汗散邪，但如果遇到血药，就起到温通运行的作用。生姜的作用，生用时开腠理发汗，熟用时温中散寒，至于炮黑后则入血分，并且能引气药进入血分以生新血，所以以大补为主，将其作为佐使药，阴得阳助而生化，那么热自然消除。”服用四剂后，果然热退身凉。服用十余剂后，各种症状全部痊愈。
凡是产后病症，多属于阴虚血少，只用生地、熟地、天冬、麦冬、枸杞子等一切养荣的药物，没有不立即痊愈的。如果气血兼补，混杂使用姜、附等刚烈药物，不是拖延时日，就是给患者留下后患，临症诊治时应当审慎考察。（徐灵胎按语：魏之琇独自擅长于此，但论述产后病症，却是最为贴切的。）
柴屿青治疗钱屿沙官侍御的妻子，产后三天，恶露很少，面色唇燥，口干身热。（与前一案中唇舌皆白、面无血色的情况相同。）打算使用人参。钱屿沙认为产后不宜使用补药而感到怀疑。柴屿青说：“果真有外感，自然有别的治疗方法，现在的症状属于不足，舍弃人参必然导致遗留祸患，‘产后不可用人参’的说法，是不懂医术的人和妇女们的言论。”于是投予人参当归散，加入好桂枝一钱，第二天口润生津，调理半月后痊愈。
陆祖愚治疗聂巡司的儿子媳妇，产后一百多天，大肠燥结，虚火上冲，便血肠鸣，腹满短气，内外皆热，半个月不能进食。有人给予养血清火的药物，病情反而加重。诊得两脉浮洪而数，重按无神，脾肾两脉更觉空虚，这是产后元气耗散，真阴不足，而不是实热。使用八味丸，清晨用淡盐汤送服三钱；用四君子汤加当归、白芍、麦冬、知母、莲肉，煎成汤剂，服用数次后，各种症状稍微缓解。后来改用补中益气汤加白芍、麦冬，一个月后病愈。
马元仪治疗陆氏妇人，生产未满一个月，因为起居稍有触动，便血三天，随即彻夜不眠，这是新产失血过多，虚上加虚。凡是有触动，必伤及其肝，肝受伤而血溢，则气也不能固守。气虚血弱，心神得不到滋养，所以眼睛无法闭合。又给予大剂量的归脾汤，用人参至一两，加入鹿茸三钱，两个月后痊愈。（议论是正确的，但方药未尽协调。）
魏玉横说：许竹溪的妻子，产后数日，发热自汗，面赤头痛，厌恶饮食、不能安睡，恶露虽然极少且颜色淡，腹部时常胀痛，脉象洪大而数。他说：“这是血虚，腹胀面赤，有血崩的趋势，应当峻补。”有人询问原因，回答说：“面赤，是阳气上越；腹胀，是阴气下陷。阳气上飞则阴气下走，这是势所必然的。”给予熟地黄一两，枸杞子、酸枣仁各五钱，服用一剂。第二天，小腹右侧忽然出现一块肿块，像块石头一样硬，按压时非常疼痛，于是怀疑是瘀血而误用补法，想要更改方案。幸好病人平时服用我的药，姑且再延请诊治。我说：“这块肿块骤然兴起，即使很大如盘，即使是瘀滞也不会有如此严重，这正是肝脾失血，干燥而怒张，得到补益尚且如此，否则就会厥逆而崩漏了。现在脉象大者逐渐收敛，面赤逐渐消退，这不是药物的错误，而是药力太轻。令前方剂量加倍，再加入炒白芍五钱，炙甘草一钱，服用一次后，肿块逐渐平复，再服用后，肿块消失。前方剂量减半，服用数剂后，各种症状全部安定。这个病症如果当作瘀血治疗，绝对没有幸免的道理。”
Yang Chengliu treated a woman of the Xu family who, after childbirth, became angry and developed alternating chills and fever, hypochondriac pain, and bitter taste in the mouth. (This is Liver Fire disease, with symptoms resembling malaria. Since the Gallbladder is the Fu organ of the Liver, Liver disease affects the Gallbladder as well.) Subsequently, she gradually developed afternoon fever. Physicians diagnosed it as Wind syndrome and indiscriminately used exterior-releasing and dispersing methods. Suddenly, a mass appeared on the left side of her abdomen, palm-sized, causing day-and-night pain. Some suspected Cold coagulation, some suspected Food stagnation, some suspected Blood stasis accumulation, and some suspected Pi accumulation. Various treatments were applied, but the condition worsened, with reduced appetite and emaciation. Pulse diagnosis revealed a wiry and surging Right Guan pulse, and a wiry and rapid Left Guan pulse. Her complexion was dark and thin, and her tongue was pale yellow and dry. The pathology was anger injuring the Liver meridian, leading to deficiency of Blood and dryness-pain. The Liver resides to the left of the Stomach and is the zang organ that stores Blood. When Blood is sufficient, its lobes are soft and hang down; when Blood is deficient, its lobes become hard and protrude horizontally. Internally, they rub against the Stomach; externally, they press against the muscles. How could there be no dull pain? Those with irritable temperaments often suffer from this, especially women. Quack doctors, ignorant of the true nature, mistakenly used aromatic, drying, and attacking agents, causing countless unnecessary deaths, which is truly lamentable! He prescribed Zishui Qinggan Yin (Nourishing Water to Clear Liver Heat Decoction). After four doses, the mass disappeared and pain ceased. Subsequently, Guipi Tang (Restore the Spleen Decoction) was used without Xiangxiang (Aucklandiae Radix), adding Baishao (Radix Paeoniae Alba), Danpi (Cortex Moutan), and Shanzhi (Fructus Gardeniae). Taken intermittently for over ten doses, she recovered. (Insisting on using Guipi Tang to conclude treatment shows he adhered rigidly to the formula without flexibility.)
Another case involved a woman of the Xu family who had postpartum fever, occasional chills, headache, and fatigue. Physicians administered herbs to disperse pathogens and clear fire, resulting in irritability, thirst, and anorexia. Yang examined her pulse: superficially it seemed rapid, but deep pressure revealed a Kou (hollow) pulse, more pronounced on the left hand. Her lips and tongue were white, and her face lacked color. He prescribed Shiquan Dabu Tang (Ten Significant Tonifying Decoction) with Paojiang (Prepared Ginger Rhizome). Someone asked, "Why use Ginger and Cinnamon Twig for such intense heat?" Yang replied, "Yang Qi outside guards Yin; Yin inside anchors Yang. They rely on each other. Now, postpartum Blood and Yin are severely depleted, leaving Deficient Yang unanchored, floating outward and manifesting as heat. Unless we guide this floating Yang back to nourish the Yin, the heat will not subside. (This explanation is not entirely accurate.) Therefore, I use warming agents to tonify Blood and Qi, hoping that tonification will help consolidate and anchor." The questioner asked, "Ginger and Cinnamon Twig are pungent and dispersing; how can they tonify and consolidate?" Yang answered, "Guizhi (Cinnamomi Ramulus) combined with Yang-tonifying herbs induces sweating, but combined with Blood-nourishing herbs, it warms and promotes circulation. Raw Shengjiang (Fresh Ginger Rhizome) opens the pores and induces sweating; cooked Jiang warms the Middle and dispels Cold. However, charred Paojiang enters the Blood level and guides Qi-herbs into the Blood level to generate new Blood. Thus, the main strategy is massive tonification, using these herbs as assistants. When Yin receives Yang's assistance to generate, the heat naturally resolves." After four doses, the fever subsided and the body cooled. After ten doses, all symptoms resolved.
Generally, postpartum conditions mostly belong to Yin deficiency and Blood depletion. Using only Shengdi Huang (Rehmanniae Radix), Shudi Huang (Prepared Rehmanniae Radix), Tandong (Asparagi Radix), Maidong (Ophiopogonis Radix), and Gouqi Zi (Lycii Fructus)—all Nutritive and Nourishing agents—usually results in immediate recovery. If one tonifies both Qi and Blood while mixing in harsh agents like Jiang (Ginger) and Fuzi (Aconiti Lateralis Radix Praeparata), it either prolongs the illness or causes sequelae. Clinicians must examine this carefully. (Xu Lingtai noted: Wei Zhixiu excelled in this area, but his discussion on postpartum conditions was particularly apt.)
Chai Yuqing treated the wife of Qian Yusha, an official attendant. Three days postpartum, she had scant lochia, dry complexion and lips, dry mouth, and body heat. (Similar to the previous case where lips and tongue were white and the face lacked color.) Chai intended to use Renshen (Ginseng Radix). Qian doubted this, believing tonics should not be used postpartum. Chai said, "If there were an external pathogen, there would be a specific treatment method. Now the condition belongs to deficiency. Abandoning Renshen will surely lead to complications. The saying 'Renshen cannot be used postpartum' is the view of those who do not understand medicine and of women." He then administered Renshen Danggui San (Ginseng and Angelica Powder) plus 1 qian of high-quality Guizhi (Cinnamomi Ramulus). The next day, her mouth felt moist and saliva flowed. After half a month of regulation, she recovered.
Lu Zuyu treated the daughter-in-law of Patrol Officer Nie. More than 100 days postpartum, she suffered from dry intestinal constipation, defluxion of Deficient Fire upward, hematochezia, borborygmus, abdominal fullness, shortness of breath, and internal/external heat. She could not eat for half a month. Treatments aimed at nourishing Blood and clearing fire aggravated the condition. Pulses were floating, surging, and rapid, but empty upon deep pressure. Spleen and Kidney pulses felt even more hollow. This indicated consumption of Yuan Qi postpartum and insufficiency of True Yin, rather than Excess Heat. He prescribed Bawei Wan (Eight-Ingredient Pill), taken with light salt water in the morning, 3 qian per dose. He also prepared a decoction of Sijunzi Tang (Four Gentlemen Decoction) added with Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Maidong (Ophiopogonis Radix), Zhimu (Anemarrhenae Rhizoma), and Lianrou (Lotus Seed Endosperm). After several doses, symptoms eased slightly. Later, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Baishao and Maidong was used, and she recovered after one month.
Ma Yuanyi treated a woman of the Lu family. Less than a month postpartum, due to slight disturbance in daily routine, she experienced hematochezia for three days and subsequently insomnia all night. This was excessive blood loss after childbirth, compounding deficiency with deficiency. Any disturbance injures the Liver; Liver injury causes blood to overflow, and Qi fails to remain secure. Qi deficiency and Blood weakness mean the Heart Spirit lacks nourishment, hence the eyes cannot close. He prescribed a large dose of Guipi Tang (Restore the Spleen Decoction), using up to 1 liang of Renshen (Ginseng Radix) and adding 3 qian of Lurong (Cervi Cornus Pantotrichum). She recovered after two months. (The reasoning was correct, but the prescription was not fully appropriate.)
Wei Yuheng stated: The wife of Xu Zhuxi, several days postpartum, had fever, spontaneous sweating, red face, headache, aversion to food, and insomnia. Lochia was extremely scant and pale. Her abdomen was distended and painful at times. Her pulse was surging, large, and rapid. He said, "This is Blood deficiency. Abdominal distension and red face indicate a tendency toward Bing (hemorrhage). Severe tonification is required." When asked why, he replied, "Red face indicates Yang floating upward; abdominal distension indicates Yin sinking downward. When Yang flies upward, Yin must sink downward; this is inevitable." He prescribed Shudi Huang (Prepared Rehmanniae Radix) 1 liang, plus Gouqi Zi (Lycii Fructus) and Zaoren (Ziziphi Spinosae Semen) 5 qian each. One dose later, a hard mass suddenly appeared on the right lower abdomen, very tender to touch. Suspecting Blood stasis caused by mistaken tonification, they wanted to change the plan. Fortunately, the patient usually took his medicines, so he continued. He said, "This mass arose suddenly. Even if it were Blood stasis, it would not be this severe. This is exactly Liver and Spleen losing Blood, becoming dry and distended. With tonification, it is still manageable; otherwise, Jue (cold extremities/collapse) and Bing (hemorrhage) would occur. Now the large pulse is converging, and the red face is receding. This is not a medication error, but insufficient dosage. Double the previous prescription, add 5 qian of fried Baishao (Paeoniae Radix Alba) and 1 qian of Zhi Gancao (Prepared Licorice Root). After one dose, the mass flattened; after another, it vanished. Reduce the dosage by half and take several doses; all symptoms resolved. If this case were treated as Blood stasis, survival would be impossible."