妇人伤寒同一治,胎产经来热入室,昼日明了夜谵妄,小柴生地牡丹皮,无汗加麻
有汗桂,汗后不解再加枝。寒热如疟加麻桂,中寒姜附不须疑,渴热白虎花粉葛,瘀血桃
仁承气俱。产后胎前虽多证,不外阴阳表里医。
【注】妇人伤寒,与男子治法同也。惟产后经来,邪热乘虚而入血室,另有治法。热
入血室之证,昼日明了,夜则谵语妄见鬼状,宜小柴胡汤加生地、丹皮。若无汗则为表实,
加麻黄汗之。有汗则为表虚,加桂枝解之。若有发热恶寒之表,已经发汗,虽无汗不加麻
黄,再加桂枝以解之,不可复用麻黄也,若有如疟之寒热,加麻黄、桂枝两解之。若厥
而下利,则为中寒,去黄芩加姜、附,不须疑也。若发热烦渴,则为里热,去半夏合白
虎,或加花粉。葛根。胸胁少腹或满硬、或作痛,则为瘀血,宜合桃仁承气汤攻之。产
后胎前虽有多证,不能尽述,总不外阴阳表里之治,在临证者以意消息之耳。
新愈脏腑皆不足,营卫肠胃未通和,多食过劳复生热,枳实栀子大黄瘥。浮汗沉下
小柴解,燥呕竹叶石膏合,气虚补中益气主,阴亏六味倍参多。
【注】新愈之后,脏腑气血皆不足,营卫未通,肠胃未和,惟宜白粥静养。若过食,胃
弱难消,因复烦热,名曰食复。若过劳役复生热烦,名曰劳复。劳复者,宜枳实栀子豉
汤汗之。食复者,宜枳实栀子豉加大黄汤下之。脉浮有表者,宜枳实栀子豉汤以汗解之。
脉沉有里者,宜枳实栀子豉加大黄汤以下解之。若无表里证者,宜小柴胡汤以和解之。口
燥烦渴喜呕者,宜竹叶石膏汤主之。若内伤气虚劳复者,宜补中益气汤主之。若犯内事
阴亏者,宜六味生干地黄汤,气少者,倍加人参汤主之。
妇女患伤寒,治疗原则与男子相同;但若处于胎产或月经期间,邪热乘虚侵入血室,则有另外的治疗方法。热入血室的症状表现为白天神志清醒,夜间胡言乱语、出现幻觉,治疗宜用小柴胡汤加生地、牡丹皮。若无汗,则加麻黄发汗;若有汗,则加桂枝解表;若发汗后病仍未解,再加桂枝(指桂枝汤之意)。若寒热往来如疟疾状,加麻黄和桂枝同用;若中寒导致四肢厥冷且下利,则加干姜、附子,无需迟疑;若发热烦渴,则用白虎汤加天花粉、葛根;若有瘀血,则用桃仁承气汤攻逐瘀血。产后及孕前的病症虽多,但总不离阴阳表里的辨证治疗。
【注】妇女患伤寒,治疗方法与男子相同。只有产后或经期时,邪热乘虚进入血室,另有治法。热入血室的证候,白天神志清楚,夜间则谵语妄见鬼怪之状,适宜用小柴胡汤加生地黄、牡丹皮。若无汗,属于表实证,加麻黄以发汗。有汗,属于表虚证,加桂枝以解表。若已有发热恶寒的表证,已经发过汗,即使无汗也不再加麻黄,而是再加桂枝(桂枝汤)来解表,不可重复使用麻黄。若有如疟疾般的寒热交替,加麻黄、桂枝两者兼用以解表。若四肢厥冷且下利,则是中寒证,去掉黄芩,加干姜、附子,无需怀疑。若发热烦躁口渴,则是里热证,去掉半夏,合用白虎汤,或加天花粉、葛根。若胸胁或少腹部胀满硬痛,则是瘀血证,适宜合用桃仁承气汤攻下。产后和产前虽有多种证候,不能一一列举,总之不外乎阴阳表里的治疗,在于临证医生根据具体情况灵活变通。
疾病初愈时,脏腑气血皆虚弱,营卫之气未通畅,肠胃功能未调和,此时若多食或过度劳累,会再次引发发热,可用枳实栀子大黄汤治愈。脉浮有表证者,宜用微汗法或小柴胡汤和解;脉沉有里证者,宜用泻下法。若伴有燥热呕吐,宜用竹叶石膏汤。若属气虚劳复,主方为补中益气汤;若属阴亏劳复,主方为六味地黄汤,若气少者,倍加人参。
【注】大病初愈之后,脏腑气血都不足,营卫之气未通,肠胃未和,只宜喝白粥静养。如果饮食过量,胃弱难以消化,因而再次出现烦热,称为“食复”。如果过度劳累再次引发热烦,称为“劳复”。对于劳复,适宜用枳实栀子豉汤发汗解之。对于食复,适宜用枳实栀子豉汤加大黄汤泻下之。脉浮且有表证的,适宜用枳实栀子豉汤以汗法解之。脉沉且有里证的,适宜用枳实栀子豉汤加大黄汤以下法解之。若无表里证候的,适宜用小柴胡汤以和解法解之。若口燥、烦渴、喜欢呕吐的,适宜用竹叶石膏汤主治。若因内伤气虚导致的劳复,适宜用补中益气汤主治。若因房事不节导致阴精亏损的,适宜用六味生干地黄汤主治,若气虚者,加倍加入人参。
Women suffering from Cold Damage (Shanghan) are treated with the same principles as men; however, if they are in the state of pregnancy, postpartum, or menstruation, and pathogenic heat enters the Blood Chamber (Xueshi) due to deficiency, there are separate treatment methods. The syndrome of Heat Entering the Blood Chamber is characterized by clear consciousness during the day and delirium with hallucinations at night. The treatment should utilize Xiaochaihu Tang (Minor Bupleurum Decoction) added with Shengdi Huang (Rehmanniae Radix) and Mudan Pi (Moutan Cortex). If there is no sweating, it indicates exterior excess, so add Mahuang (Ephedrae Herba) to induce sweating. If there is sweating, it indicates exterior deficiency, so add Guizhi (Cinnamomi Ramulus) to resolve the exterior. If the disease persists after inducing sweat, add Guizhi (referring to Guizhi Tang/Cinnamon Twig Decoction). If chills and fever alternate like malaria, add both Mahuang and Guizhi. If cold damage leads to cold extremities and diarrhea, add Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata), without hesitation. If there is fever, irritability, and thirst, use Baihu Tang (White Tiger Decoction) added with Huafen (Trichosanthis Radix) and Gegen (Puerariae Lobatae Radix). If there is blood stasis, use Tao Ren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) to purge the stasis. Although there are many syndromes in postpartum and prenatal states, they all fall under the treatment of Yin-Yang and Exterior-Interior.
[Note] Women suffering from Cold Damage are treated similarly to men. Only when pathogenic heat enters the Blood Chamber due to deficiency after childbirth or during menstruation are there separate treatments. The syndrome of Heat Entering the Blood Chamber presents with clear consciousness during the day and delirium with hallucinations of seeing ghosts at night. It is suitable to use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Shengdi Huang (Rehmanniae Radix) and Mudan Pi (Moutan Cortex). If there is no sweating, it is an exterior excess pattern; add Mahuang (Ephedrae Herba) to induce sweating. If there is sweating, it is an exterior deficiency pattern; add Guizhi (Cinnamomi Ramulus) to resolve the exterior. If there is already an exterior pattern of fever and aversion to cold, and sweating has already been induced, even if there is no sweating now, do not add Mahuang again; instead, add Guizhi (Guizhi Tang/Cinnamon Twig Decoction) to resolve the exterior, and do not reuse Mahuang. If there are chills and fever alternating like malaria, add both Mahuang and Guizhi to resolve the exterior simultaneously. If there are cold extremities and diarrhea, it is a middle-cold pattern; remove Huangqin (Scutellariae Radix) and add Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata), without doubt. If there is fever, irritability, and thirst, it is an interior-heat pattern; remove Banxia (Pinelliae Rhizoma), combine with Baihu Tang (White Tiger Decoction), or add Huafen (Trichosanthis Radix) and Gegen (Puerariae Lobatae Radix). If there is fullness, hardness, or pain in the chest, hypochondrium, or lower abdomen, it is a blood-stasis pattern; it is suitable to combine with Tao Ren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) to purge. Although there are many syndromes in postpartum and prenatal states that cannot be fully listed, they ultimately do not exceed the treatments of Yin-Yang and Exterior-Interior. It is up to the clinician to apply them flexibly based on specific circumstances.
After recovery, the Zang-Fu organs and Qi-Blood are deficient, Ying-Wei (Nutritive and Defensive Qi) are not yet smooth, and the intestines and stomach are not yet harmonious. Overeating or overexertion can cause recurrent heat, which can be cured with Zhishi Zhizi Dahuang Tang (Immature Bitter Orange, Gardenia, and Rhubarb Decoction). If the pulse is floating indicating an exterior pattern, mild sweating or Xiaochaihu Tang (Minor Bupleurum Decoction) for harmonizing is appropriate. If the pulse is sunken indicating an interior pattern, purgation is appropriate. If accompanied by dryness, vomiting, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is used. If it is labor recurrence due to Qi deficiency, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is the main formula. If it is labor recurrence due to Yin deficiency, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) is the main formula; if Qi is also deficient, double the amount of Renshen (Ginseng Radix et Rhizoma).
[Note] After the recent cure, the Zang-Fu organs and Qi-Blood are all deficient, Ying-Wei (Nutritive and Defensive Qi) are not yet unblocked, and the intestines and stomach are not yet harmonized. One should only consume plain rice porridge and rest quietly. If one overeats, the weak stomach cannot digest it, leading to recurrent irritability and heat, known as "Food Recurrence" (Shifu). If one overexerts oneself, leading to recurrent heat and irritability, it is known as "Labor Recurrence" (Laofu). For Labor Recurrence, Zhishi Zhizi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) is suitable to induce sweating. For Food Recurrence, Zhishi Zhizi Chi Tang added with Dahuang (Rhei Radix et Rhizoma) is suitable to induce purgation. If the pulse is floating with an exterior pattern, Zhishi Zhizi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) is suitable to resolve via sweating. If the pulse is sunken with an interior pattern, Zhishi Zhizi Chi Tang added with Dahuang (Rhei Radix et Rhizoma) is suitable to resolve via purgation. If there are no exterior or interior patterns, Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable to resolve via harmonizing. If there is dry mouth, irritability, thirst, and a desire to vomit, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is the main treatment. If Labor Recurrence is caused by internal injury and Qi deficiency, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is the main treatment. If Yin deficiency is caused by sexual indiscretion, Liuwei Shenggan Dihuang Tang (Six-Ingredient Raw and Dried Rehmannia Decoction) is the main treatment; if Qi is deficient, double the addition of Renshen (Ginseng Radix et Rhizoma).