凡发热乃气虚甚,非有实热也。有内伤发热,有外感发热恶寒者,亦血气虚甚,有瘀血作者。
【主意】
产后发热又增寒,中感须知有几般。外邪身热脉浮紧,五积交加病自安。右寸脉大头不痛,发热皆由
宿食存,香砂二陈加麦用,内伤莫作外伤看。小腹满疼有瘀血、增寒壮热掌心温、弦紧脉宜五积散,延胡葱
白散为尊。日晡潮热宜八物,脉虚弦大补中论。医临药脉如临陈,虚实分明仔细参。
五积交加散
浓朴(姜汁炒) 陈皮 桔梗 苍术(米泔水浸) 川芎 白芷 白茯 川归 香附(制) 半夏 枳
壳(炒) 干姜(炙黑) 肉桂 甘草(炙) 麻黄 白芍(酒炒) 青皮 羌活 独活 柴胡 前胡 人参(邪
胜不可用参) 水(二钟) 姜(三片) 葱(一根)
煎至八分,温服。
五积散(其方见二十三内)
八物汤
人参 白术(炒) 茯苓 甘草(减半,炙) 归身(酒洗) 熟地 芍药(酒炒) 川芎(各等分)
他本有砂仁。水二盅、姜三片、枣一枚,煎服。
宜用生化汤。有血多去而晕,宜大补血。有气虚而晕,宜大补
气。有痰火泛上而晕,宜清痰降火。有瘀血不行而晕,消瘀血为主。
【主意】
血晕皆由血去多,血虚痰动耳鸣锣,脉息沉微加冷厥,若然不治渐成瘕。
凡是产后发热,是由于气虚严重所致,并非体内有实热。其中有的属于内伤引起的发热,有的属于外感风寒引起的发热并伴有恶寒,这些也都是因为气血极度虚弱;还有的情况是由瘀血停滞引起的发热。
【主旨歌诀】
产后出现发热又增加怕冷症状,心中需知病因有好几种类型。若是外邪侵袭导致身体发热且脉象浮紧,使用五积交加散可使病体自安。若右寸脉象异常而头部不痛,这种发热皆因宿食停滞引起,可用香砂二陈汤加入麦芽治疗,切勿将内伤误当作外伤看待。若小腹胀满疼痛且有瘀血,伴随怕冷、高热且手心温热,脉象弦紧,适宜用五积散,或以延胡索葱白散为尊选方。若是日晡时分(下午3-5点)出现的潮热,适宜用八物汤;若脉象虚弦大,则依据补中益气论治。医生面对药物和脉象要如同面对战场一样谨慎,必须仔细辨析虚实分明。
五积交加散
浓朴(用姜汁炒制) 陈皮 桔梗 苍术(用米泔水浸泡) 川芎 白芷 白茯苓 当归 香附(炮制) 半夏 枳壳(炒制) 干姜(炙至黑) 肉桂 甘草(炙制) 麻黄 白芍(酒炒) 青皮 羌活 独活 柴胡 前胡 人参(若邪气盛不可用人参) 水(两钟) 生姜(三片) 葱(一根)
煎煮至剩余八分药液,温服。
五积散(其方剂见本书第二十三卷内)
八物汤
人参 白术(炒制) 茯苓 甘草(减半,炙制) 当归身(酒洗) 熟地黄 芍药(酒炒) 川芎(各等分)
其他版本中有砂仁。用水两盅、生姜三片、大枣一枚,煎煮后服用。
(针对产后血晕)适宜使用生化汤。如果是因失血过多导致的头晕,宜大补血液。如果是因气虚导致的头晕,宜大补气机。如果是痰火上升导致的头晕,宜清化痰热、降泻火邪。如果是因瘀血阻滞不行导致的头晕,以消除瘀血为主。
【主旨歌诀】
血晕都是因为失血过多,血虚导致痰动如耳鸣锣响,脉象沉微并伴有四肢冷厥,如果不予治疗,逐渐会形成瘕积(腹内结块)。
Whenever fever occurs postpartum, it is due to severe Qi deficiency, not the presence of excess heat. Some cases involve fever caused by internal injury; others involve fever accompanied by aversion to cold due to external contraction, which are also caused by extreme deficiency of Blood and Qi. Additionally, some fevers arise from retained Blood stasis.
[Main Principle Verse]
Postpartum fever with added chills requires understanding several etiologies. If external pathogens cause body heat with a floating and tight pulse, Wuji Jiaojia San (Five Accumulations Combined Powder) will bring about recovery. If the Right Cun (Cun position on the right wrist) pulse is abnormal but the head does not hurt, the fever stems from retained food stagnation; Xiangsha Erchen Tang (Aucklandia and Amomum Two-Chen Decoction) with added Maiya (Hordeum Vulgare Sprout) should be used; do not mistake internal injury for external trauma. If there is fullness and pain in the lower abdomen indicating Blood stasis, accompanied by chills, high fever, warm palms, and a wiry-tight pulse, Wuji San (Five Accumulations Powder) is appropriate, or Yanyu Congbai San (Cyathula and Scallow White Decoction) is preferred. For tidal fever occurring at Dibu (the hours of the Horse and Goat, 11 AM–5 PM), Bawu Tang (Eight-Ingredient Decoction) is suitable; if the pulse is deficient, wiry, and large, treatment should follow the principles of tonifying the Middle (Bu Zhong Yi Qi). When facing medicines and pulses, physicians must be as cautious as on a battlefield, carefully analyzing the distinction between deficiency and excess.
Wuji Jiaojia San (Five Accumulations Combined Powder)
Houpo (Magnolia Bark, stir-fried with ginger juice) Chenpi (Citrus Reticulatae Pericarpium) Jiegeng (Platycodon Root) Cangzhu (Atractylodis Rhizoma, soaked in rice water) Chuanxiong (Ligusticum Chuanxiong Baishao (White Peony Root, stir-fried with wine) Qingpi (Green Citrus Peel) Qianghuo (Notopterygii Rhizoma et Radix) Duhuo (Angelicae Pubescentis Radix) Chaihu (Bupleuri Radix) Qianhu (Peucedani Radix) Renshen (Ginseng Radix et Rhizoma - *Do not use Renshen if pathogenic factors are strong*) Water (2 zhong) Ginger (3 slices) Scallion (1 root)
Decoct until eight-tenths remains, take warm.
Wuji San (See Formula in Volume 23)
Bawu Tang (Eight-Ingredient Decoction)
Renshen (Ginseng Radix et Rhizoma) Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried) Fuling (Poria) Gancao (Licorice Root, halved, roasted) Danggui Shenyang (Angelica Sinensis Radix, washed with wine) Shudi (Rehmanniae Radix Preparata) Shaoyao (Paeoniae Radix Alba, stir-fried with wine) Chuanxiong (Ligusticum Chuanxiong, equal parts)
Other editions include Sharen (Amomi Fructus). Use 2 zhong of water, 3 slices of ginger, and 1 jujube; decoct and take.
(For Postpartum Syncope/Xue Yun) Huasheng Tang (Transformation of Stasis Decoction) is appropriate. If syncope results from excessive blood loss, strongly tonify Blood. If syncope results from Qi deficiency, strongly tonify Qi. If syncope is caused by Phlegm-Fire rising, clear Phlegm and descend Fire. If syncope is caused by uneliminated Blood stasis, focus on eliminating Blood stasis.
[Main Principle Verse]
Blood syncope is all due to excessive blood loss; Blood deficiency causes Phlegm agitation like the ringing of an ear trumpet. The pulse is deep and faint, accompanied by cold extremities; if untreated, it gradually develops into a Jia mass (abdominal lump).