产后咳嗽,悉属胃气不足,胃为五脏之本,胃气一虚,五脏失所,百病生焉。虽谓
肺主皮毛,腠理不密所致,不知肺属辛金,生于已土,亦因土虚不能生金,所以腠理不
密,外邪易感,其阴火上炎者,宜壮土以生金,滋肾水以制火。前论肺病而责及胃者,
以上不能生金也。何独不思子能令母虚,而责及肾乎?况肺主出气,肾主纳气,咳嗽
者,气不能纳,虽肺病而实肾病也。
产后半月内外,寒热往来,或日哺夜间发热,或一日二三度,其发有期,其证类
疟,由气血并竭,阳虚作寒,阴虚发热也。毋以疟治,柴胡汤不可轻用,惟调补气血,
寒热自除,欲阳藏纳,浮越自己。
产后腹痛泻痢者,由产后肠胃虚怯,寒邪易侵,故腹痛如刺,水谷不化,洞泻肠
鸣,或下赤白,急服调中汤立愈。若非外因所伤,乃属肾气亏损,阳虚不能生土,阴虚
不能闭藏耳。必用四神八味补肾,倘误投分利导水之剂,是益虚其虚也。
产后蓐劳,由生产日浅,血气虚弱,将养失所,致使虚乏劳倦,乍卧乍起,容颜憔
悴,饮食不甘,咳嗽口干,头昏目眩,百节疼痛,时有盗汗,寒热如疟,四肢不举,沉
重着床,此皆蓐劳之候也。毋论日期,必须调养平复,方可动作,否则气血复伤,终成
痨瘵。其治当补脾胃为主,佐以调和气血。盖饮食一进,精气生化,诸脏有所赖矣。
产后咳嗽,全部属于胃气不足。胃是五脏的根本,胃气一旦虚弱,五脏就会失去滋养,各种疾病便会由此产生。虽然常说肺主皮毛,是因为腠理(皮肤纹理及汗孔)不致密所致,但不知肺属辛金,源于脾胃之土,也是因为土虚不能生金,所以导致腠理不密,外邪容易侵袭。如果是阴火上炎的情况,应当通过补益脾胃(壮土)来生养肺气(生金),并滋补肾水以制约虚火。前文论述肺病而责怪到胃的原因,是因为上焦之气不能生金。为何只想到子能令母虚,而责怪到肾呢?况且肺主呼气,肾主纳气,咳嗽是因为气不能下纳,虽然是肺的病,但实际上是肾的病。
产后半个月左右,出现寒热往来,或者在傍晚夜间发热,或者一天发作两三次,发作有定时,症状类似疟疾,这是由于气血同时衰竭,阳虚则发冷,阴虚则发热。不要当作疟疾来治疗,柴胡汤不可轻易使用,只有调补气血,寒热症状自然消除,阳气得以潜藏收纳,浮越的阳气自然回归。
产后出现腹痛、腹泻和痢疾,是由于产后肠胃虚弱怯弱,寒邪容易侵入,所以腹痛如针刺,水谷无法消化,呈水样泄泻且肠鸣,或者排出赤白粘液,应立即服用调中汤,可立刻痊愈。如果不是外因所伤,那就属于肾气亏损,阳虚不能生脾土,阴虚不能固摄闭藏。必须使用四神丸合八味地黄丸(即金匮肾气丸)来补肾,如果误用分利导水的药物,这是使虚者更虚。
产后蓐劳,是由于生产时间尚短,血气虚弱,调养不当,致使身体虚乏劳倦,时而躺卧时而起身,容颜憔悴,饮食无味,咳嗽口干,头晕目眩,全身关节疼痛,时常盗汗,寒热像疟疾一样,四肢无力抬举,身体沉重卧床不起,这些都是蓐劳的症状表现。不论病程多久,必须经过调养使身体平复,才可以进行活动,否则气血再次受伤,最终会发展成痨瘵(慢性消耗性疾病)。其治疗应当以补益脾胃为主,辅以调和气血。因为饮食一旦进入体内,精气就能化生,五脏六腑也就有所依赖了。
Postpartum cough is entirely attributed to insufficiency of Stomach Qi (Wei Qi). The Stomach is the root of the five Zang organs; once Stomach Qi becomes deficient, the five Zang organs lose their nourishment, and myriad diseases arise. Although it is said that the Lung governs the skin and hair, and that this condition results from loose interstices (Cou Li), one must not forget that the Lung belongs to Metal of the Acrid flavor and is born from Earth (Spleen/Stomach). It is precisely because Earth deficiency fails to generate Metal that the interstices become loose, making the body susceptible to external pathogens. In cases where Yin fire flares upward, one should strengthen Earth to generate Metal and nourish Kidney Water to control the fire. The previous discussion blamed the Lung disease on the Stomach because the Upper Jiao failed to generate Metal. Why does one only consider that "the child can cause the mother to become deficient" and blame the Kidney? Furthermore, the Lung governs exhalation, while the Kidney governs inhalation. Coughing occurs because Qi cannot be grasped and retained; although it is a Lung disease, it is essentially a Kidney disease.
Around half a month postpartum, alternating chills and fever may occur, or fever may manifest in the late afternoon or at night, occurring two or three times a day with a regular pattern. The symptoms resemble Malaria (Nue), resulting from the exhaustion of both Qi and Blood: Yang deficiency causes coldness, while Yin deficiency causes fever. Do not treat this as Malaria; Chai Hu Tang (Bupleurum Decoction) should not be used lightly. Only by regulating and tonifying Qi and Blood will the chills and fever naturally subside, allowing the floating Yang to return and be stored properly.
Postpartum abdominal pain accompanied by diarrhea and dysentery arises from the weakness and timidity of the intestines and stomach after childbirth, allowing Cold pathogens to easily invade. Consequently, there is stabbing abdominal pain, inability to digest food and water, watery diarrhea with borborygmus, or passage of red and white mucus. One should immediately administer Tiao Zhong Tang (Regulate the Middle Decoction) for immediate relief. If not caused by external factors, it belongs to Kidney Qi deficiency, where Yang deficiency fails to generate Spleen Earth, and Yin deficiency fails to secure and store. One must use Si Shen Wan (Four Spirits Pill) combined with Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Root Pill) to tonify the Kidney. If diuretic and draining agents are mistakenly administered, this further depletes the already deficient state.
Postpartum Ru Lao (Childbed Consumption) results from the short time since delivery, weak Qi and Blood, and improper nursing, leading to physical debility and fatigue, alternating between lying down and rising, haggard appearance, lack of appetite, cough with dry mouth, dizziness, pain in all joints, occasional night sweats, chills and fever resembling malaria, inability to lift the limbs, and heaviness causing the patient to remain in bed. These are all signs of Ru Lao. Regardless of the duration, one must ensure the body recovers through proper care before engaging in activity; otherwise, Qi and Blood will be injured again, eventually developing into Lao Zhai (Consumption Disease). Treatment should primarily focus on tonifying the Spleen and Stomach, assisted by harmonizing Qi and Blood. Once diet enters the body, Essence and Qi are generated, providing reliance for all Zang organs.