〔《大》〕凡生产毕,令饮童便一盏,不得便卧,且宜闭目而坐。须臾上床仰卧,不宜侧卧,宜竖
膝,未可伸足,高倚床头,浓铺茵褥,遮围四壁,使无孔隙,免致贼风。兼时时令人以物从心捍至脐,使
恶露不滞,更三日内令产妇常闻醋炭气,或烧干漆烟。若无干漆,以旧漆器烧之,以防血晕。不问腹痛
不痛,有病无病,以童便和酒半盏,温服五七服,妙。(陈藏器云∶渍苎汁与产妇服之,将苎麻与产妇
枕之,止血晕。产妇腹痛,以苎安腹上则止。)
〔丹〕产后当大补血气为先,虽有杂症,以末治之。
〔《大》〕地黄丸 治产后腹痛,眼见黑花,或发狂如见鬼状,或胎衣不下,失音不语,心胸胀满,水谷
不化,口干烦渴,寒热往来,口内生疮,咽喉肿毒,心中忪悸,夜不得睡,产后中风,角弓反张,面
赤,牙关紧急,或崩中如豚肝,脐腹 痛,烦躁恍惚,四肢肿满,及受胎不稳,唇口指甲青黑。
生地(研,取汁留渣) 生姜(各二斤。研,取汁,留渣) 蒲黄 当归(各四两)
上于银石器内取生地黄汁炒生姜滓,以生姜汁炒地黄渣,各令干,四味同焙,研为细末,醋煮面糊,
为丸如弹子大,每服一丸,食前,当归酒化下,神妙。一方,只用生姜、生地,无蒲黄、当归,根据交
加法制之,为末,每服三钱,温酒调下。
〔丹〕黑神丸 产后服之,能生新血,去旧血。用白汤送下,虚者参、术、陈皮汤送下。(方见
催生门。)
益母膏治产妇一切伤损,一切血病。(方见调经门。)
〔《大》〕凡妇人因暑月产乳取凉,大多得风冷,腹中积聚,百病竞起,迄至于死,百方不瘥,桃仁煎
主之。出蓐后服之。
桃仁(一千二百枚,去皮尖及双仁,熬令黄色)
上一味,捣令极细熟,以上等酒一斗五升,研三四遍,如作麦粥法,以极细为佳。纳小长项瓷瓮中,
密塞,以糊封之,纳汤中,煮一伏时,不停火,亦不令火猛,使瓶口常出在汤上,勿令没之,熟极,温
酒服一合,日再服。
黑神散 治妇人产后恶露不尽,胞衣不下,攻冲心腹痞满,或脐腹坚胀撮痛,及血晕神昏,眼黑口噤,
产后瘀血诸疾。
熟地 蒲黄(炒) 当归 干姜(炮) 桂心 芍药 甘草(各四两) 黑豆(炒,去皮,半升)
上为细末,每服二钱,酒半盏,童便半盏,同煎调服。
上黑神散,寒多及秋冬者宜之,若性急形瘦及夏月,宜审之。
〔丹〕胎前母滞,产后母虚,产后一切皆不可发表。产后不可用芍药,以酸寒伐生发之气故也。
〔《大》〕不可吃物过多,恐成积滞。若未盈月,不宜多语,喜笑惊恐,忧惶哭泣,思虑急怒,强起离床,
坐久行动,或作针工,恣食生冷粘硬油腻鱼肉之物,及不避风寒。当时未觉,盈月之后,即成蓐劳。凡
产后满百日,乃可交合。不尔,至死虚羸,百病滋长,慎之。凡妇人患风气,脐下虚冷,莫不由早行房也。
〔丹〕或曰∶初产之妇,好血已亏,污血或留,彼黑神散非要药乎?答曰∶至哉干元,万物资生,
理之常也。初产之妇,好血未必亏,污血未必积,脏腑未必寒,何以药为?饮食起居,勤加调护,何病
之有?诚有污血,体怯而寒,与之数帖,亦自简便。或有他病,当求病起何因,病在何经,气病治气,
血病治血,何用海制此方?例令服饵。设有性急者,形瘦者,本有怒火者,夏月坐蓐者,时有火令,
姜桂皆为禁药。至于将护之法,尤为悖理。肉汁发阴经之火,易成内伤之病也。先哲具有训戒,胡为
以羊鸡浓汁作糜,而又常服当归丸、当归
建中汤、四顺理中丸,虽是补剂,并是偏热。脏腑无寒,何处消受!若夫儿之初生,母腹顿宽,便啖鸡子,且
吃伙盐。不思鸡子难化,伙盐发热,展转生证,不知所困,率尔用药,宁不误人。予每见产妇之无疾者,必教
之以却去黑神散与夫鸡子伙盐诸品肉食,且与白粥将理,间以些少鲞鱼煮令淡食之,半月后,方与少肉。若鸡
于亦须豁开淡煮,大能养胃却疾。彼富贵之家,骄恣之妇,卒有白带、头风、气痛、膈满、痰逆、口干、经事
不调、发秃体倦,皆是阳盛阴虚之病,天生血气,本自和平,曰胜曰虚,又乌知非此等缪迷有以兆之耶?
〔《脉》〕诊妇人生产之后,寸口脉洪疾不调者死,沉微附骨不绝者生。诊妇人新生乳子,脉沉小滑者生,
实大坚弦急者死。
【《大观本草》】凡是分娩结束后,让产妇喝一盏童便(小儿尿),不要立刻躺下,应当闭着眼睛坐着。过了一会儿再上床仰卧,不宜侧卧,应当竖起膝盖,暂时不要伸直腿,高高倚靠在床头,厚铺褥子,遮挡四周墙壁,使没有缝隙,以免贼风(外邪之风)侵入。同时让人时时用物品从心口推至肚脐,使恶露(产后排出的余血浊液)不滞留,另外三天内让产妇经常闻醋炭的气味,或者烧干漆的烟。如果没有干漆,就烧旧的漆器,以防血晕(产后因失血或瘀血引起的头晕目眩甚至昏厥)。不管腹痛不痛,有病没病,用童便和酒半盏,温服五到七次,效果奇妙。(陈藏器说:浸泡苎麻汁给产妇服用,将苎麻给产妇枕着,可以止血晕。产妇腹痛,把苎麻放在腹部上就能停止。)
【朱丹溪】产后应当以大补气血为优先,虽然有其他的杂症,也要作为次要问题来处理。
【《大观本草》】地黄丸 治疗产后腹痛,眼前出现黑花,或者发狂像看见鬼怪一样,或者胎衣不下,失音不能说话,心胸胀满,水谷不消化,口干烦渴,寒热往来,口内生疮,咽喉肿毒,心中悸动不安,夜里不能睡觉,产后中风,角弓反张(身体向后弯曲如弓状),面红,牙关紧闭,或者崩中出血像猪肝色,脐腹疼痛,烦躁恍惚,四肢肿胀,以及受孕不稳,嘴唇、口唇、指甲青黑。
生地黄(研磨,取汁保留药渣) 生姜(各二斤。研磨,取汁,保留药渣) 蒲黄 当归(各四两)
以上药物在银器或石器中,用生地黄汁炒生姜的药渣,用生姜汁炒生地黄的药渣,各自炒干,四种药一起焙干,研成细末,用醋煮面糊,做成如弹子大小的丸药,每次服用一丸,饭前,用当归酒化开送下,效果神妙。另一方法,只用生姜、生地,没有蒲黄、当归,按照上述交互制法处理,研成末,每次服用三钱,用温酒调服。
【朱丹溪】黑神丸 产后服用,能生成新血,去除旧血。用白开水送下,体虚者用人参、白术、陈皮汤送下。(方剂见催生门。)
益母膏 治疗产妇一切损伤,一切血病。(方剂见调经门。)
【《大观本草】凡是妇人因为暑天生产后贪凉,大多感受风冷,导致腹中积聚,百病竞起,直至死亡,各种方法都不见效,桃仁煎主治。出月子后服用。
桃仁(一千二百枚,去皮尖及双仁,炒至黄色)
以上一味药,捣至极细熟,用上等酒一斗五升,研磨三四遍,像做麦粥的方法一样,以极细为佳。放入小长颈瓷瓮中,严密塞住,用米糊封口,放入汤锅中,煮一个时辰(两小时),不停火,也不让火太猛,使瓶口常露在汤面上,不要让瓶子淹没,煮熟后,用温酒服一合(约20毫升),每天服两次。
黑神散 治疗妇人产后恶露不尽,胞衣不下,攻冲心腹痞满,或者脐腹坚硬胀痛撮痛,以及血晕神昏,眼黑口噤,产后瘀血诸疾。
熟地黄 蒲黄(炒) 当归 干姜(炮制) 桂心 芍药 甘草(各四两) 黑豆(炒,去皮,半升)
以上研成细末,每次服用二钱,酒半盏,童便半盏,同煎调服。
上面的黑神散,寒气多及秋冬季节适宜使用,如果性情急躁形体消瘦及夏季,应当审慎使用。
【朱丹溪】胎前母亲气血滞涩,产后母亲气血虚弱,产后一切情况都不可使用发表(发汗解表)的药物。产后不可用芍药,因为酸寒会伐伤生发之气。
【《大观本草】不可吃太多东西,恐怕形成积滞。如果未满一个月,不宜多说话,喜欢笑、惊恐、忧愁惶恐哭泣、思虑、急怒,勉强起床离开床铺,久坐行动,或者做针线活,放纵食用生冷粘硬油腻鱼肉之物,以及不避风寒。当时没感觉,满月之后,就会成为蓐劳(产后虚损劳倦之证)。凡是产后满一百天,才可以同房。不然的话,直到死都会虚弱消瘦,百病滋生,务必谨慎。凡是妇人患风气病,脐下虚冷,无不都是由于过早行房所致。
【朱丹溪】有人说:刚生产的妇女,好血已亏,污血或许残留,那黑神散不是必要的药吗?回答说:天地元阳之气,万物赖以生存,这是常理。刚生产的妇女,好血未必亏损,污血未必积聚,脏腑未必寒冷,为什么要用药呢?饮食起居,勤加调护,有什么病呢?确实有污血,体质怯弱而寒,给她几帖药,也自然简便。如果有其他病,应当探究病因,病在何经,气病治气,血病治血,何必拘泥于这个方子?一律令其服用。假设有性情急躁的人,形体消瘦的人,本来就有怒火的人,夏天坐月子的人,常有火令之时,姜、桂都是禁药。至于护理的方法,更是违背常理。肉汁会引发阴经之火,容易形成内伤之病。先哲都有训诫,为什么还要用羊肉鸡肉浓汁做粥,又常服当归丸、当归建中汤、四顺理中丸,虽然是补剂,但都是偏热的。脏腑没有寒,哪里受得了!至于婴儿刚出生,母亲腹部顿时变宽,就吃鸡子,还吃咸盐。不考虑鸡子难消化,咸盐发热,辗转产生病症,不知道困顿所在,仓促用药,难道不误人吗?我常见产妇无病的,一定教她们去掉黑神散以及鸡子、咸盐等各种肉食,且给予白粥调理,偶尔给少许鲞鱼煮淡了吃,半个月后,才给少量肉。如果鸡子也必须敲开淡煮,大能养胃祛病。那些富贵之家,骄纵的妇人,突然有白带、头风、气痛、膈满、痰逆、口干、月经不调、脱发体倦,这些都是阳盛阴虚的病,天生血气,本自和平,说是胜、说是虚,又怎么知道不是这些谬误迷惑导致的征兆呢?
【《脉诀】诊察妇人生产之后,寸口脉洪大急促不调的预后不良(死),沉微按之不绝的预后良好(生)。诊察妇人刚生产哺乳,脉象沉小滑的预后良好(生),实大坚弦急的预后不良(死)。
[Da Guan Ben Cao] After delivery is completed, allow the parturient to drink a cup of Tongbian (pediatric urine). She must not lie down immediately but should sit with eyes closed. After a short while, she may lie supine on the bed; lateral recumbency is inadvisable. The knees should be kept erect and the legs extended only later. She should lean high against the headboard, with thick padding on the mattress, and the four walls should be shielded without gaps to prevent Zefeng (pathogenic wind) from invading. Meanwhile, someone should frequently use an object to press from the heart region down to the umbilicus, ensuring that Elu (lochia) does not stagnate. Additionally, for three days, the parturient should frequently smell the vapor of vinegar and charcoal, or smoke from dried Qixi (dried lacquer). If dried lacquer is unavailable, old lacquerware should be burned to prevent Xueyun (blood fainting/syncope due to blood loss or stasis). Regardless of whether there is abdominal pain or illness, mix half a cup of Tongbian with wine, warm it, and take it five to seven times; this is excellent. (Chen Cangqi stated: Soaking Ramie juice and giving it to the parturient, or using Ramie as a pillow, can stop bleeding and fainting. For postpartum abdominal pain, placing Ramie on the abdomen stops the pain.)
[Zhu Danxi] Postpartum treatment should prioritize tonifying Qi and Blood first. Even if other miscellaneous symptoms exist, they should be treated secondarily.
[Da Guan Ben Cao] Dihuang Wan (Rehmannia Pill) treats postpartum abdominal pain, visual disturbances such as seeing black spots, mania resembling possession by spirits, retention of the placenta, aphonia, chest and epigastric fullness, indigestion of food and water, dry mouth with irritability and thirst, alternating chills and fever, oral ulcers, sore throat with swelling and toxicity, palpitations, insomnia, postpartum wind-stroke with opisthotonos, facial redness, trismus, menorrhagia resembling pig liver, umbilical and abdominal pain, restlessness and confusion, edema of the four limbs, unstable conception, and cyanosis of lips, mouth, and nails.
Shengdi Huang (Fresh Rehmanniae Radix, ground to extract juice, retaining dregs) and Sheng Jiang (Fresh Zingiberis Rhizoma, each two jin/500g, ground to extract juice, retaining dregs); Puhuang (Typhae Pollen) and Dang Gui (Angelicae Sinensis Radix), each four liang/120g.
Place the above in a silver or ceramic vessel. Stir-fry the Sheng Jiang dregs with Sheng Di Huang juice, and stir-fry the Sheng Di Huang dregs with Sheng Jiang juice, until dry. Roast all four ingredients together, grind into fine powder, and make pills using vinegar-cooked wheat paste, sized like large marbles. Take one pill before meals, dissolved in Dang Gui-infused wine. This is miraculous. Another method uses only Sheng Jiang and Sheng Di Huang, without Puhuang or Dang Gui, processed via the aforementioned intermixed frying method, ground into powder. Take three qian/9g per dose, mixed with warm wine.
[Zhu Danxi] Heishen Wan (Black Divine Pill) taken postpartum generates new blood and eliminates old blood. Swallow with plain boiled water; for deficient patients, swallow with a decoction of Renshen (Ginseng), Baizhu (Atractylodis Macrocephalae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium). (Formula see Cui Sheng Men/Delivery Promotion Section.)
Yimu Gao (Motherwort Paste) treats all injuries and blood disorders in parturients. (Formula see Tiao Jing Men/Menstruation Regulation Section.)
[Da Guan Ben Cao] Women who seek coolness during summer childbirth often contract Wind-Cold, leading to abdominal accumulations, onset of myriad diseases, and eventually death, unresponsive to various treatments. Taoren Jian (Peach Kernel Decoction/Paste) is the primary remedy, taken after confinement.
Taoren (Peach Kernels, 1200 pieces, peeled of skin and tips, double-kernels removed, roasted until yellow).
Grind this single ingredient extremely finely. Mix with 1 dou 5 sheng/6 liters of premium wine, grinding repeatedly three or four times, similar to making oatmeal porridge, aiming for extreme fineness. Place in a small long-necked porcelain jar, seal tightly, and seal the lid with rice paste. Boil in a water bath for one fu shi/2 hours, maintaining heat but not too fierce, keeping the jar mouth above the water level. When fully cooked, take one ge/20ml with warm wine, twice daily.
Heishen San (Black Divine Powder) treats incomplete expulsion of lochia, retained placenta, attacking pain and fullness in the heart and abdomen, hard and painful distension of the umbilical and abdominal regions, syncope with unconsciousness, vision blacking out, and trismus, as well as various postpartum blood stasis disorders.
Shu Di Huang (Prepared Rehmanniae Radix), Puhuang (Typhae Pollen, stir-fried), Dang Gui (Angelicae Sinensis Radix), Gan Jiang (Zingiberis Rhizoma Recens, processed), Guixin (Cinnamomi Cortex), Shaoyao (Paeoniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), each four liang/120g; Heidou (Soybean, roasted, peeled, half sheng/60g).
Grind into fine powder. Take two qian/6g per dose, decocted with half a cup of wine and half a cup of Tongbian (pediatric urine), then mixed and taken.
The aforementioned Heishen San is suitable for cases with abundant cold or during autumn and winter. For those with irritable temperaments, emaciated bodies, or during summer, caution is advised.
[Zhu Danxi] During pregnancy, the mother's Qi and Blood may be stagnant; postpartum, the mother is deficient. Therefore, postpartum conditions generally contraindicate Fa Biao (releasing the exterior/sweating methods). Shaoyao (Paeoniae Radix) should not be used postpartum because its sour and cold nature damages the generating Qi.
[Da Guan Ben Cao] Do not overeat, lest accumulation form. Within the first month, avoid excessive talking, laughing, fright, worry, weeping, rumination, anger, rising forcibly from bed, prolonged sitting or walking, needlework, indulging in raw, cold, sticky, hard, greasy foods, fish, meat, and exposure to Wind-Cold. Symptoms may not appear immediately, but after one month, Ru Lao (postpartum consumptive fatigue) may develop. Intercourse is permitted only after one hundred days postpartum. Otherwise, chronic debility and myriad diseases will arise until death; be cautious. All women suffering from Wind disorders and cold deficiency below the umbilicus likely did so due to early sexual activity.
[Zhu Danxi] Someone asked: "In newly delivered women, good blood is depleted, and foul blood may remain; is Heishen San not an essential medicine?" I replied: "The Great Origin generates all things; this is the constant principle. In newly delivered women, good blood is not necessarily depleted, foul blood not necessarily accumulated, and viscera not necessarily cold. Why use medicine? Diligent care of diet and起居 (daily life) prevents disease. If foul blood truly exists and the body is weak and cold, a few doses are simple and effective. If other diseases exist, investigate the cause and meridian involvement; treat Qi disorders by regulating Qi, and Blood disorders by regulating Blood. Why rigidly adhere to this formula and order everyone to take it? Consider those with irritable temperaments, emaciation, internal fire, or confinement in summer; Ginger and Cinnamon are contraindicated when Fire is prevalent. Furthermore, nursing practices contradict reason. Meat broths ignite Fire in Yin meridians, easily causing internal injury. Ancients provided warnings; why consume rich mutton and chicken broths, and constantly administer Dang Gui Wan (Angelica Pill), Dang Gui Jian Zhong Tang (Angelica Decoction for Building the Middle), and Si Shun Li Zhong Wan (Four Smooths Regulating the Middle Pills)? Although these are tonics, they are excessively hot. How can non-cold viscera tolerate them? When a baby is born, the mother's abdomen suddenly expands; eating eggs and salty food immediately is unwise. Eggs are hard to digest, and salt generates heat, leading to complications. Rushing to medicate harms people. I often advise healthy parturients to reject Heishen San, eggs, salty food, and heavy meats, relying instead on white rice gruel for nourishment, occasionally adding lightly boiled dried fish. After half a month, introduce small amounts of meat. Eggs should also be cracked and boiled lightly to benefit the Stomach and dispel disease. Wealthy, indulgent women who suddenly present with leukorrhea, headache, Qi pain, chest fullness, rebellious Phlegm, dry mouth, irregular menstruation, hair loss, and fatigue suffer from Excess Yang and Deficient Yin. Their innate Qi and Blood are naturally balanced. Claims of excess or deficiency are often caused by such erroneous misconceptions."
[Mai Jue] Diagnosing women after childbirth: If the Cun Kou (inch position at radial artery) pulse is Hong (surging), rapid, and irregular, prognosis is poor (death). If the pulse is Chen (deep), Wei (minute), and continuous upon deep pressure, prognosis is good (life). Diagnosing women who have just given birth and are nursing: If the pulse is Chen (deep), Xiao (small), and Hua (slippery), prognosis is good (life). If the pulse is Shi (excess), Da (large), Jian (firm), Xian (wiry), and Ji (rapid), prognosis is poor (death).