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, outpatient basic history. First visit 4/6/1974, 主诉:刮宫术后2 天，剧烈腹痛l 天。 CC: 2 days after D&C procedure, patient experienced intense abdominal pain for 1 day. 现病史:4 月4 日因不全流产行刮宫术。 Current medical presentation: on 4/4 underwent D&C due to a partial abortion. 5 日夜 , 突然下腹部阵发性剧痛，腰痛。 After 5 days and nights, suddenly there was lower abdominal pain, as well as low back pain. 曾服止痛片及四环素, 痛未 ，腰腹酸痛，恶露不多，头晕纳差，腿软无力，痛时出 冷汗，面色苍白。 She previously took a painkiller and tetracycline, the pain did not decrease, the low back and abdomen were aching, the lochia was very little, there was dizziness and decreased food intake, leg weakness, cold sweating with the pain, and her face was pale. 舌象:舌质黯淡。脉象:弦缓。 Tongue: tongue body was dusky and pale. Pulse: wiry and slow. 西医诊断:①不全流产术后。②刮宫术后腹痛待查。 Basis of medical diagnosis: 1. post partial abortion procedure. 2. abdominal pain following D&C needs investigation. 中医辨证: 瘀血内停，兼感寒凉。 TCM doctor's diagnosis : Blood stasis collected interiorly, concurrently affected by cold. 治法:活血化瘀， 血暖宫。 Treatment: Invogorate blood to transform stasis, nourish blood and warm the uterus. 方药: Formula 当归三钱 川芎一钱 红花一钱 益母草一钱 泽兰一 钱 桃仁五分 炙甘草五分 炮姜五分 南山植二钱 蒲黄 三钱 五 脂三钱 dang gui 3 qian, chaun xiong 1 qian, hong hua 1 qian, yi mu cao 1 qian, ze lān qian, tao ran 5 fen, zhi gan cao 5 fen, pao jiang 5 fen, nan shan zhi 2 qian, pu huang 3 qian, wu ling zhi 3 qian 治疗经过: 4 月8 日，服上方2 剂后, 腹痛 轻，流出黑色血块两块，下腹仍有坠感，大 便(漉)稀，日解2次。 Treatment course: 4/8, after 2 bags of the above formula, the abdominal pain eased, discharged two black blood clots, the lower abdomen still had a feeling of being weighed down, bowel movements were scarce and watery, and there were
现病史:因早孕合并风心病，于1974 年4 月18日，行人工流产术。 Current symptoms: Early in her pregnancy there were complications from rheumatic heart disease. she went into shock and was hospitalized for observation. BP110/70 (google says mm soft column?) 4 月20 日血查白细胞7 ， I ~400/立方毫米，中性粒细胞61% 。 4/20 blood leukocytes 7 I-400 cubic mm. bowel movements were dry. the lower abdomen was suddenly severly painful for one week. damp heat pouring downward . and the pain was ﬁxed in location. Rheumatic heart disease. pao jiang was removed and 2 qian gan jiang. Following the administration of herbs the lochia cleared. 3 qian of bai zhu were added.. heart rate 80BPM. (something about a heart murmur). neutrophils 61% 舌象:舌质黯淡，苔黄腻。脉象:弦滑。 Tongue: tongue body is dusky. pulse: wiry and slippery. she had dizziness and decreased appetite. coat is yellow and greasy. clear lower abdominal pain with pressure. 41yo.. Waiyuan consultation case history 会诊日期1975 年4 月22 日。 Consultation date 4/22/1975.two bowel movements per day. 上方去炮姜加干姜二钱，白术三钱，再服3 剂。 From the previous formula. female. (unknown? she underwent a D&C!!) 2. vaginal bleeding. and [the patient] was given another 3 bags 4 月13 日，药后恶露已净，下腹已不痛，大便次数正常，症状缓解。 4/13. 例二:李菜，女， 41 岁，外院会诊病历。 Case 2: Li Cai. bowel movements regulated. on 4/18/1975 .3 . 2"<:: ) ，大便干燥.①自宫后腹痛待查。②风湿性心脏病。 Western dx: spontaneous post uterine abdominal pain of unknown origin.2 degrees C). the lower abdomen was not painful. 西医诊断. 头晕纳差，腹痛，阴道流血，近2 日 来血量增多(如月经量)色红有块，小腹阵发性剧痛，痛有定处。 After the procedure she had a fever (37.3-38. it was red and had clots. 主诉:人流术后，小腹阵发性剧痛已1 周。 Chief complaint: Following an abortion. 因手术过程中发生休克而收入院观察。 Because of the surgery. soft abdomen.3"<:: ，脉搏80 次/分，、面色一般，咽部充血，心尖部可l商及双期杂 音，腹软，小腹部压痛明显，血压110/70 毫米柔柱。 On exam: Temperature 37. 38. for nearly two days the bleeding increased (it was the same amount as her menstrual ﬂow). she underwent an induced abortion procedure.3. throat is bloodshot (google says throat congestion). abdominal pain. facial color is normal. the lower abdomen had sudden severe pain. 中医辨证:瘀血内结，湿热下注。 TCM dx: interior blood stasis binding. and the symptoms alleviated. 术后开始发热(体温37. 检查:体温37.
yi mu cao 1 qian 治疗经过:，4 月29 日，服上方3 剂后，排出膜样物一块及小血块。 Course of treatment:4/29. the abdominal pain eased. mo yao 2qian. the abdominal pain ceased. 5/2 subsequent medical visit: After the above formula. 【按语】人工流产后腹痛，多因部分胎盘绒毛组织残留宫腔，或术后感染所致。 (Commentary) Abortion and post-partum abdominal pain. pu gong ying 5 qian. Cold lodged in the uterus: during the process of surgery the patient catches cold. mu tong 1 qian. vaginal bleeding. invigorate the blood to transform stasis. and the body temperature normalized. dispelled a membranous thing (?) and a clot as well as small blood clots. Liu believes: This condition is more often seen in the following three situations: ①瘀血内停:由于部分胚胎组织未被清除，或术后血流不畅，属于中医所谓疲瘀血停子 胞宫，故而作痛。 1. da huang one qian. 上方继服。5 月2 日 诊时称:服上药后，于4月30 日流血已止，腹痛已止，体温正常 己3 天，于5月2 日出院。 She continued with the above dose. and the body temperature was normal for the last 3 days. ②寒客胞宫:在手术过程中受寒凉，多见有小腹绞痛，发凉，面色青白，脉象弦紧。 2. wu ling zhi 3 qian. dark purple complexion. in TCM this is known as blood stasis settling in the uterus. from 4/30 onward the bleeding stopped. The blood stasis has collected interiorly: Part of the embryological tissue was not eliminated. therefore there is pain. in most cases there you will see gripping pain in the lower abdomen.治法:清热除湿，活血化瘾。 Tx strategy: clear heat and drain damp. 刘老医生认为:本病多见有以下三种情况: Dr. chills. tao ran 5 fen. sometimes accompanied by lower back pain. took (more than?) 3 doses. bai jiang cao ﬁve qian. on 5/2 she was released from the hospital. hua shi 5 qian. pu huang 3 qian. 方药: Formula 瞿麦四钱木通一钱车前子三钱滑石五钱大黄一 钱败酱草五钱蒲公英五钱延胡索三钱五灵脂三钱 蒲黄三钱没药二钱桃仁五分益母草一钱 qu mai 4 qian. in most cases is caused by placental tissue that remains in the womb. or following the procedure the blood ﬂow was poor. a . or there is infection following the procedure. 症见痛有定处而拒按，阴道出血、色紫黑，有时伴有腰痛。 In this condition you see ﬁxed pain that resists pressure. che qian zi 3 qian. 治疗应以活血化为瘀主，多选用生化汤加减。 One should treat this by means of invigorating the blood and transforming stasis. 以后流血 少，腹痛 轻，体温恢复正常。 Afterward the bleeding decreased. yan hu suo 3 qian. many choose Sheng Hua Tang with modiﬁcation.
舌质黯，苔黄，脉弦滑。 3. poor food intake. nourishing blood and warming the channels. red face. many use Wen Jing Tang with modiﬁcation. low back pain. with a yellow coat. 例二，术中并发休克，术后小腹剧痛，且有定处，持续阴道流血，舌质偏黯是由于内 有瘀血之故。 In case 2. pulse is wiry and tight. 故而出现头 晕、纳差、腿软元力。 The complexion was pale and there was twisting pain in the abdomen due to blood deﬁciency and cold. yellow greasy tongue fur. 气血虚衰. leg weakness with diminished force. 舌黯淡是血虚而有瘀滞。脉弦主痛、缓主虚。证属瘀血凝滞，血虚兼感寒凉。 The dusky tongue is from blood deﬁciency and blood stasis. The wiry pulse indicates pain. Use Chan Hou Sheng Hua Tang to treat this efffectively. tongue body is dusky. the procedure was complicated by shock. and invigorating blood to transform stasis. and the wiry slippery pulse. use Ba Zheng San with modiﬁcation. connected to interior blood stasis. slowness indicates deﬁciency. 治疗应以暖宫散寒为主，多选用温经汤加减。 One should treat this by warming the uterus to dispel the cold. 以清热利湿为主，少佐活血化瘀之品。 . these symptoms are due to interior blood stasis. 例一，因刮宫术后，出血不多，小腹剧痛，腰痛，系因内有瘀血。 In the ﬁrst example. and therefore there is dizziness rising. Concurrently there are signs of damp heat. abdominal pain that refuses pressure. post D&C. There are symptoms of interior blood stasis binding. 由于流产后又行刮宫. and damp heat pouring downward. there was severe postoperative abdominal pain.pale complexion. Blood stasis collecting internally together with damp heat: In addition to abdominal pain that refuses pressure of the interior blood stasis type. These symptoms belong to blood stasis solidifying. uterine bleeding. the tongue was inclined toward duskiness. ③瘀血内停兼有湿热: 除腹痛拒按等瘀血内停见证外，因兼见湿热多伴有发热，子宫出 血，色红，腹痛拒按. 所以治疗土以活血化瘀，养血温经为法。以产后生化汤治疗而收效。 Therefore treat the earth by the method of invigorating blood and transforming stasis. 治疗以八正散为主，酌加清热解毒、活血化瘀等药物。 Treat this with Ba Zheng San. qi and blood deﬁciency failing ensues. persistant vaginal bleeding. Due to the post-abortion D&C. blood deﬁciency affected by cold. are all signs of damp heat. 低烧，舌苔黄腻，脉弦滑乃湿热之象。证属瘀血内结，湿热下注。故选用八正散加 减。 The slight fever. one would also see symptoms on the exterior. Therefore. the bleeding was not much. 面色苍白，腹部绞疼为血虚兼有寒象. often accompanied by heat effusion. consider adding medicinals from the category of clearing heat and resolving toxicity. the pulse is wiry and slippery. there was severe lower abdominal pain.
药后排出膜样物后，腹痛缓解，阴道出血停止，避免了再次刮宫的痛苦。 After taking the medicinals. there was a membranous discharge. the vaginal bleeding ceased. 以上 例同为刮宫后腹部剧痛，基本病理均为瘀血内停。 The above are two similar cases of post D&C abdominal pain. and these should serve as a detailed differential diagnosis. 但是，例一兼虚寒，例二兼湿热，应当详细辨识.Use this primarily from the category to clear heat and drain dampness. avoiding pain during a second D&C (?). Yet the ﬁrst example is one of simultaneous deﬁciency cold. the abdominal pain was eased. . the fundamental pathology of both being blood stasis collecting interiorly. and secondarily to assist in invigorating blood to transform stasis. and the second example is one of simultaneous damp heat.