由气血虚,神魂无根据也,治当论块痛有无缓急。若块痛未除,先服生化汤二、三帖,痛止;继服加参生化汤,或补
中益气汤,加安神定志丸调服之。若产日久,形气俱不足,即当大充气血,安神定志,服至药力充足,其病自愈。勿谓
邪祟,若喷以法水惊之,每至不救。屡治此症,服药至十数帖方效。病虚似邪,欲除其邪,先补其虚,先调其气,次论
诸病,此古人治产后虚症,及年老虚喘,弱人妄言,所当用心也。
安神生化汤 治产后块痛未止,妄言妄见症,未可用 、术。
川芎(一钱) 柏子仁(一钱) 人参(一、二钱) 当归(二、三钱) 茯神(二钱) 桃仁(十二粒) 黑姜
(四分) 炙草(四分) 益智(八分,炒) 陈皮(三分)
枣,水煎。
滋荣益气复神汤 块痛已止,妄言妄见,服此方即愈。
黄 白术 麦冬 川芎 柏子仁 茯神 益智(各一钱) 陈皮(三分) 人参 熟地(各二钱) 炙草(四分)
五味子(十粒) 枣仁(十粒,一钱) 莲子(八枚) 元肉(八个)
枣,水煎服。
产后血崩、血脱、气喘、气脱、神脱妄言,虽有血气阴阳之分,其精散神去一也。比晕后少缓,亦危症也。若非浓
药频服,失之者多矣。误论气实痰火者,非也。新产有血块痛,并用加参生化汤,行中有补,斯免滞血血晕之失也。其
块痛止,有宜用升举大补汤,少佐黄连,坠火以治血脱,安血归经也;有宜用倍参补中益气汤,少佐附子,助参以治气
脱,摄气归渊也;有宜用滋荣益气复神汤,少佐痰剂,以清心火,安君主之官也。
歌括∶产后日久气血虚,妄见妄言神无根据。
虚病似邪欲除之,先补其虚调其气。
安神生化柏子仁,当归川芎与人参。
桃仁黑姜陈皮草,茯神益智枣水吞。
滋荣益气复神汤,参 术芎麦地黄。
茯神益智柏枣仁,陈草五味萸莲尝。
由于气血虚弱,导致神魂失去依附的根本,治疗时应当根据是否有血块疼痛以及疼痛的缓急情况来制定方案。如果血块疼痛尚未消除,先服用生化汤两到三帖,待疼痛停止后;接着服用加参生化汤,或者补中益气汤,配合安神定志丸调服。如果产后时间已久,形体和正气都显得不足,就应当大力充补气血,安定神志,服药直到药力充足,病症自然痊愈。不要误认为是邪祟作怪,如果用符水喷溅惊吓患者,往往会导致无法救治的后果。我多次治疗这类病症,发现服药十几帖后才见效。病情虚弱看似邪祟,想要祛除所谓的“邪”,必须先补益虚损,先调理气机,然后再讨论其他病症。这是古人治疗产后虚证、年老体弱导致的虚喘,以及身体虚弱之人出现胡言乱语时所必须用心掌握的法则。
安神生化汤:治疗产后血块疼痛未止,出现胡言乱语、幻视幻听症状,此时不可使用白术、苍术等燥烈之品。
川芎(一钱) 柏子仁(一钱) 人参(一至二钱) 当归(二至三钱) 茯神(二钱) 桃仁(十二粒) 黑姜(四分) 炙甘草(四分) 益智仁(八分,炒制) 陈皮(三分)
加入大枣,用水煎煮。
滋荣益气复神汤:血块疼痛已经停止,仍有胡言乱语、幻视幻听症状,服用此方即可痊愈。
黄芪 白术 麦冬 川芎 柏子仁 茯神 益智仁(各一钱) 陈皮(三分) 人参 熟地黄(各二钱) 炙甘草(四分) 五味子(十粒) 酸枣仁(十粒,或一钱) 莲子(八枚) 龙眼肉(八个)
加入大枣,用水煎服。
产后出现血崩、血脱、气喘、气脱、神散妄言等症状,虽然涉及血气阴阳的不同区分,但其精髓涣散、神气离去的本质是一样的。如果在晕厥后稍微缓解,也属于危重病症。如果不是浓药频繁服用,失治的患者很多。错误地将其论述为气实痰火者,是不对的。新产之后若有血块疼痛,应同时使用加参生化汤,在行血中兼顾补益,从而避免瘀血停滞导致血晕的错误。当血块疼痛停止后,有的适宜使用升举大补汤,少量佐以黄连,降火以治疗血脱,使血液安归经脉;有的适宜使用加倍人参量的补中益气汤,少量佐以附子,助人参以治疗气脱,摄纳气机回归本源;有的适宜使用滋荣益气复神汤,少量佐以化痰药物,以清心火,安定君主之官(心脏)。
歌诀:
产后日久气血虚,妄见妄言神无根据。
虚病似邪欲除之,先补其虚调其气。
安神生化柏子仁,当归川芎与人参。
桃仁黑姜陈皮草,茯神益智枣水吞。
滋荣益气复神汤,参术芎麦地黄。
茯神益智柏枣仁,陈草五味萸莲尝。
Due to the deficiency of Qi and Blood, the Shen (Spirit) and Hun (Ethereal Soul) lack a foundation. Treatment should be determined by assessing the presence or absence of abdominal masses/pain and its urgency. If the pain from blood stasis has not been resolved, first administer Shenghua Tang (Life-Begotten Decoction) for two to three doses until the pain ceases; subsequently, administer Jiashen Shenghua Tang (Shenghua Tang with Ginseng) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), taken in conjunction with Anshen Dingzhi Wan (Calming the Spirit and Stabilizing Will Pill). If a considerable time has passed since childbirth and both physical form and Zheng Qi (Upright Qi) are insufficient, one must vigorously tonify Qi and Blood and calm the Spirit. Continue medication until the therapeutic force is sufficient, at which point the disease will resolve spontaneously. Do not attribute this to evil spirits; spraying the patient with talismanic water to startle them often leads to untreatable conditions. Having treated this syndrome repeatedly, I have found that efficacy usually appears after more than ten doses. The condition is deficient yet resembles an exogenous pathogen; to eliminate the so-called "pathogen," one must first tonify the deficiency and regulate Qi, before addressing other symptoms. This is the principle that ancient physicians applied when treating postpartum deficiency syndromes, deficiency-type asthma in the elderly, and delirium in weak individuals.
Anshen Shenghua Tang: Treats postpartum persistent abdominal mass pain accompanied by delirium and visual/auditory hallucinations. At this stage, Bai Zhu (Atractylodis Rhizoma) and Cang Zhu (Atractylodis Lanceae Rhizoma) should not be used.
Chuan Xiong (Ligustici Chuanxiong Rhizoma) (1 qian), Baizi Ren (Biota Seed) (1 qian), Renshen (Ginseng Radix et Rhizoma) (1-2 qian), Dang Gui (Angelicae Sinensis Radix) (2-3 qian), Fushen (Poria with Hostwood) (2 qian), Taoren (Persicae Semen) (12 grains), Hei Jiang (Zingiberis Rhizoma Carbonisatum) (4 fen), Zhi Cao (Prepared Licorice Root) (4 fen), Yizhi Ren (Alpiniae Oxyphyllae Fructus) (8 fen, stir-fried), Chen Pi (Citri Reticulatae Pericarpium) (3 fen).
Add Da Zao (Jujubae Fructus), decoct in water.
Zirong Yiqi Fushen Tang: For cases where abdominal mass pain has ceased but delirium and hallucinations persist; taking this formula leads to recovery.
Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Mai Dong (Ophiopogonis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Baizi Ren (Biota Seed), Fushen (Poria with Hostwood), Yizhi Ren (Alpiniae Oxyphyllae Fructus) (each 1 qian), Chen Pi (Citri Reticulatae Pericarpium) (3 fen), Renshen (Ginseng Radix et Rhizoma), Shu Di Huang (Rehmanniae Radix Praeparata) (each 2 qian), Zhi Cao (Prepared Licorice Root) (4 fen), Wu Wei Zi (Schisandrae Chinensis Fructus) (10 grains), Suan Zao Ren (Ziziphi Spinosae Semen) (10 grains or 1 qian), Lian Zi (Nelumbinis Semen) (8 pieces), Yuan Rou (Longan Aril) (8 pieces).
Add Da Zao (Jujubae Fructus), decoct in water and take orally.
Postpartum hemorrhage (Xue Beng), blood collapse (Xue Tuo), panting (Qi Chuang), Qi collapse (Qi Tuo), and Shen dispersion with delirium: Although these involve distinctions among Blood, Qi, Yin, and Yang, their essence lies in the scattering of Jing (Essence) and departure of Shen. Even if there is slight relief after fainting, it remains a critical condition. Without frequent administration of concentrated decoctions, many patients would die. It is incorrect to diagnose this as excess Qi and Phlegm-Fire. In new postpartum cases with abdominal mass pain, Jiashen Shenghua Tang should be used simultaneously; this promotes blood circulation while tonifying, thereby avoiding errors such as blood stasis retention leading to blood syncope. Once the mass pain stops, some cases suit Shengju Dabu Tang (Ascending and Greatly Tonifying Decoction) with a small addition of Huang Lian (Coptidis Rhizoma) to descend fire and treat blood collapse, stabilizing blood within the vessels; some cases suit Buzhong Yiqi Tang with double the dose of Renshen and a small addition of Fu Zi (Aconiti Lateralis Radix Praeparata) to assist Renshen in treating Qi collapse and drawing Qi back to its source; some cases suit Zirong Yiqi Fushen Tang with a small addition of phlegm-resolving agents to clear Heart Fire and stabilize the Monarch Organ (Heart).
Verse:
Postpartum long duration, Qi and Blood deficient,
Delusions and speech, Shen lacks foundation.
Deficiency mimics pathogen, to remove it,
First tonify deficiency, then regulate Qi.
Anshen Shenghua contains Baizi Ren,
Dang Gui, Chuan Xiong, and Renshen.
Taoren, Hei Jiang, Chen Pi, and Cao,
Fushen, Yizhi Ren, swallowed with Jujube water.
Zirong Yiqi Fushen Tang,
Contains Renshen, Bai Zhu, Chuan Xiong, Mai Dong, Di Huang.
Fushen, Yizhi Ren, Biota and Jujube seeds,
Chen Pi, Cao, Wu Wei Zi, Cornus, Lotus seeds.