泽兰叶(一分) 人参(一分) 荆芥穗(一两) 川芎(半两)
上为末。温酒热汤各半盏,调一钱,急灌之,下咽即开眼气定,省人事。
评曰∶产后眩晕,顷刻害人,须量虚实为治。若胸中宿有痰饮阻病不除,产后多致眩晕
,又血盛气弱,气不使血,逆而上攻,此等皆非清魄可疗。瘀晕,仍用半夏茯苓汤;血壅,
须用牡丹散。但快药尤难辄用,当识轻重,所谓扰乎可扰,扰亦无扰。若气血平人,因去血
多致晕者,芎 汤尤佳。
半夏茯苓汤(方见恶阻门)
治产后血晕,闷绝野狼狈。若口噤,则拗开灌之必效。
牡丹皮 大黄(蒸) 芒硝(各一两) 冬瓜子(半合) 桃仁(三七粒,去皮尖)
上为锉散。每服五钱,水三盏,煎至盏半,去滓,入芒硝又煎,分二服。欲产,先煎下
以备缓急。《金匮》以此治肠痈,但分两少异。
芎 汤 方见眩晕门
第五论曰∶产后口干痞闷者何?答曰∶产后荣卫大虚,血气未定,食面太早,胃不能消
化,面毒结聚于胃脘,上熏胸中,是以口干燥渴,心下痞闷。医者不识,认为胸膈壅滞,以
药下之,万不得一,但服见 丸。
姜黄 京三棱(炮) 荜澄茄 陈皮 人参 高良姜 蓬术(炮,各一两)
上为末,用萝卜慢火煮烂,研细,将汁煮面糊丸,如梧子大。用萝卜汤下三十丸。
评曰∶产后口干痞闷,未必止因食面。或产母内积忧烦,外伤燥热,饮食甘辛,使口干
痞闷,当随其所因调之可也。烦心,宜四物汤去地黄,加人参、乌梅煎;若外伤燥热,看属
何经,当随经为治,难以备举。饮食所伤,见 丸却能作效。
增损四物汤 (方见下第六论)
第六论曰∶产后乍寒乍热者何?答曰∶阴阳不和,败血不散,能令乍寒乍热。产后血气
虚损,阴阳不和,阴胜则乍寒,阳胜则乍热,阴阳相乘,则或寒或热。若因产劳,脏腑血弱
,不得宣越,故令败血不散,入于肺则热,入于脾则寒,医人若误作疟疾治之,则谬矣。阴
阳不和,宜增损四物汤;败血不散,宜夺命丹。又问∶二者何以别之,答曰∶时有刺痛者,
败血;但寒热无他证者,阴阳不和,增损四物汤不一,皆随病加减。
泽兰叶(一分) 人参(一分) 荆芥穗(一两) 川芎(半两)
以上药物研为细末。用温酒和热汤各半盏,调和一钱药末,迅速灌服,药液咽下后眼睛即能睁开,气息平稳,神志恢复清醒。
评论说:产后眩晕,顷刻间即可危及生命,必须根据虚实情况进行治疗。如果胸中素有痰饮阻碍病情不除,产后多导致眩晕;另外血盛气弱,气不能推动血液运行,逆而上攻,这些情况都不是清魄散所能治疗的。瘀血引起的眩晕,仍应使用半夏茯苓汤;血壅滞,须用牡丹散。但是峻猛的药物尤其难以轻易使用,应当识别病情的轻重,所谓“扰乱那些可以扰乱的,即使扰乱了也如同没有扰乱一样”。如果是气血平和之人,因失血过多导致眩晕的,芎劳汤尤为适宜。
半夏茯苓汤(方剂见恶阻门)
治疗产后血晕,昏迷不醒,神情狼狈。如果牙关紧闭,则掰开嘴巴灌药,必定有效。
牡丹皮 大黄(蒸制) 芒硝(各一两) 冬瓜子(半合) 桃仁(三七粒,去皮尖)
以上药物切碎成散剂。每次服用五钱,加水三盏,煎煮至一盏半,滤去药渣,加入芒硝再煎煮,分两次服用。临产前,先煎好备用,以应对紧急情况。《金匮要略》用此方治疗肠痈,只是分量略有不同。
芎劳汤(方剂见眩晕门)
第五论说:产后口干、胸脘痞闷是什么原因?回答说:产后营卫之气大虚,血气尚未安定,过早食用面食,胃无法消化,面毒结聚于胃脘,向上熏蒸胸中,因此口干燥渴,心下痞闷。医生不认识这种情况,误认为是胸膈壅滞,用泻下药治疗,十次中难有一效,只应服用见丸。
姜黄 京三棱(炮制) 荜澄茄 陈皮 人参 高良姜 蓬术(炮制,各一两)
以上药物研为细末,用萝卜慢火煮烂,研磨成细粉,将萝卜汁煮面糊制成丸药,如梧桐子大小。用萝卜汤送服三十丸。
评论说:产后口干痞闷,未必仅仅是因为吃面食。或者是产母内心积聚忧烦,外受燥热侵袭,饮食甘辛,导致口干痞闷,应当根据病因进行调理即可。心烦意乱,宜用四物汤去掉地黄,加入人参、乌梅煎服;如果外受燥热,要看属于哪一经,应当随经治疗,难以一一列举。饮食所伤,服用见丸能够见效。
增损四物汤(方剂见下第六论)
第六论说:产后忽冷忽热是什么原因?回答说:阴阳不和,败血不散,会导致忽冷忽热。产后血气虚损,阴阳不和,阴偏胜则突然发冷,阳偏胜则突然发热,阴阳相互乘袭,所以或寒或热。如果是因为分娩劳累,脏腑血弱,气血不得宣通发散,导致败血不散,进入肺脏则发热,进入脾脏则发冷,医生如果误当作疟疾治疗,那就错了。阴阳不和,宜用增损四物汤;败血不散,宜用夺命丹。又问:二者如何区别?回答说:如果有刺痛感的,是败血;只有寒热而没有其他症状的,是阴阳不和。增损四物汤有多种变方,都应根据病情加减。
Radix Agrimoniae (Zelan Ye, 泽兰叶) [1 fen], Radix Ginseng (Renshen, 人参) [1 fen], Flos Schizonepetae (Jingjie Sui, 荆芥穗) [1 liang], Rhizoma Chuanxiong (Chuanxiong, 川芎) [0.5 liang].
The above are ground into powder. Mix with half a cup of warm wine and half a cup of hot water, combine with one qian of the powder, and administer rapidly. Upon swallowing, the eyes will open, breathing will stabilize, and consciousness will return.
Comment: Postpartum vertigo can be fatal in an instant; treatment must be based on deficiency or excess. If phlegm-fluid retention has long obstructed the chest without being resolved, postpartum vertigo is often caused by this. Additionally, if blood is abundant but qi is weak, causing qi to fail to move blood, leading to rebellious upward attack, such cases cannot be treated with Qingpo San. For vertigo due to blood stasis, Banxia Fuling Tang should still be used; for blood congestion, Mudan San is required. However, harsh medicines are particularly difficult to use casually; one must discern the severity. As stated, "disturb what can be disturbed; even if disturbed, it is as if not disturbed." For individuals with balanced qi and blood who experience vertigo due to excessive blood loss, Xiongtang is especially suitable.
Banxia Fuling Tang (Formula seen in the section on Nausea during Pregnancy).
Treats postpartum blood syncope, characterized by coma and distress. If the jaw is clenched, pry it open and administer the medicine; it will surely be effective.
Cortex Moutan (Mudan Pi), Rhizoma Rhei (Dahuang, 大黄) (steamed), Natrii Sulfas (Mangxiao, 芒硝) (each 1 liang), Semen Benincasae (Dongguazi, 冬瓜子) (0.5 he), Semen Persicae (Taoren, 桃仁) (37 grains, skin and tip removed).
The above are cut into pieces and made into a powder. Each dose is five qian, boiled with three cups of water until reduced to one and a half cups. Strain the dregs, add Mangxiao, and boil again. Divide into two doses. Before delivery, decoct in advance for emergency use. The *Jinkui Yaolue* uses this formula to treat intestinal abscess, with slight differences in dosage.
Xiongtang (Formula seen in the section on Vertigo).
Discussion Five: What causes dry mouth and epigastric fullness after childbirth? The answer is: After childbirth, Ying and Wei qi are greatly deficient, and blood and qi are unsettled. Eating noodles too early prevents the stomach from digesting them. The toxicity of noodles accumulates in the epigastrium, steaming upwards into the chest, resulting in dry mouth, thirst, and subcardiac fullness. Physicians who do not recognize this condition mistake it for chest and diaphragm congestion and use purgatives; this succeeds in less than one out of ten cases. One should only feed Jian Wan.
Rhizoma Curcumae Longae (Jianghuang), Rhizoma Sparganii (Jingsanleng, 京三棱) (processed), Fructus Tetradii (Bichengqie, 荜澄茄), Pericarpium Citri Reticulatae (Chenpi, 陈皮), Radix Ginseng (Renshen, 人参), Rhizoma Zingiberis Officinalis Recens (Gaoliangjiang, 高良姜), Rhizoma Curcumae Phaeocaulis (Pengzhu, 蓬术) (processed, each 1 liang).
The above are ground into powder. Boil radish slowly until soft, grind finely, and use the radish juice to make a paste with flour to form pills the size of a wutong seed. Administer thirty pills with radish soup.
Comment: Dry mouth and epigastric fullness after childbirth are not necessarily solely due to eating noodles. It may also result from internal accumulation of worry and vexation, external invasion of dry-heat, or consumption of sweet and pungent foods, leading to dry mouth and fullness. Treatment should follow the specific cause. For mental vexation, Siwu Tang minus Rehmanniae Radix (Dihuang), plus Ginseng Radix (Renshen) and Fructus Mumei (Wumei, 乌梅) decocted is suitable; for external dry-heat invasion, treatment should follow the affected meridian, which is difficult to list exhaustively. For injury due to diet, Jian Wan can be effective.
Zengsun Siwu Tang (Formula seen in Discussion Six below).
Discussion Six: What causes alternating chills and fever after childbirth? The answer is: Disharmony of Yin and Yang, combined with un-dispersed failed blood, causes alternating chills and fever. After childbirth, blood and qi are deficient and damaged, leading to disharmony of Yin and Yang. If Yin prevails, there are sudden chills; if Yang prevails, there are sudden fevers. When Yin and Yang mutually invade, either chills or fever occur. If caused by labor during delivery, weakening the zang-fu organs and blood, preventing free circulation and diffusion, failed blood fails to disperse. Entering the Lung causes heat; entering the Spleen causes cold. If physicians mistakenly treat this as malaria, they are erroneous. For disharmony of Yin and Yang, Zengsun Siwu Tang is indicated; for un-dispersed failed blood, Mingdan is indicated. Another question asks: How to distinguish between the two? The answer is: Stabbing pain indicates failed blood; chills and fever without other symptoms indicate disharmony of Yin and Yang. There are various modifications of Zengsun Siwu Tang, all adjusted according to the disease.