加味八珍汤
38.新产血虚多汗出, 易中风邪痉病成, 口噤项强身反折, 八珍耆附
桂防风, 摇头气促寒不止, 两手撮空莫望生.
【注】产后血气不足, 脏腑皆虚多汗出, 腠理不密, 风邪乘虚袭入,
遂成痉证. 手三阳之筋结于颔颊, 风入颔颊则口噤. 阴阳经络周环于
身,风中经络, 则头项, 肩背强直, 如角弓反张之状, 产后患此, 皆
属虚象. 惟宜用八珍汤加黄耆, 附子, 肉桂, 大补其阴阳, 少佐防风
以治之. 若见头摇喘促汗出不止, 两手撮空者, 则为真气去, 邪气独
留,必死之候, 故曰莫望生也.
八珍汤 方见首卷
加味八珍汤
39.阴血去多阳气炽, 筋无所养致抽搐, 发热恶寒烦又渴, 八珍丹地
钩藤钩, 抽搐无力戴眼折, 大汗不止命将休.
【注】产后血去太多, 阳气炽盛, 筋无所养, 必致瘛瘲抽搐, 发热恶
寒,心烦口渴, 不宜作风治, 惟当气血兼补, 用八珍汤加丹皮, 生地
,钩藤钩治之. 若无力抽搐, 戴眼反折, 大汗不止者, 则为不治之证
,故曰命将休也.
八珍汤 方见首卷
加味八珍汤 星连二陈汤 七珍散
40.产后不语分虚实, 痰热乘心败血冲, 气血两虚神郁冒, 实少虚多
要辨明. 虚用八珍藤菖志, 痰热星连入二陈, 败血冲心七珍散, 芎地
辛防朱蒲参.
【注】产后不语, 须分虚实治之. 有痰热乘心者; 有败血冲心者; 有
气血两虚而郁冒神昏者. 大抵产后属虚者多, 而实者少也. 虚宜八珍
汤加钩藤, 菖蒲, 远志; 痰热宜二陈汤加胆星, 黄连; 败血冲心宜七
珍散, 即川芎, 生地, 细辛, 防风, 朱砂, 菖蒲, 人参也.
八珍汤方 见首卷 二陈汤 方见三卷
医宗金鉴 四十八卷
加味八珍汤
38. 新近分娩后,因血液亏虚且多汗,容易感受风邪而发展为痉病(以项背强直、四肢抽搐为主要表现的病证)。症状表现为牙关紧闭、颈项僵硬、身体向后反折如弓状。治疗应使用八珍汤(由人参、白术、茯苓、甘草、当归、川芎、白芍、熟地黄组成)加入黄芪、附子、肉桂、防风。若出现头部摇动、气促喘息、寒战不止,以及双手无意识地抓空,则预后不良,难以救治。
【注】产后气血不足,脏腑功能虚弱,导致多汗,腠理(皮肤毛孔及其附属结构)不致密,风邪乘虚侵袭,从而形成痉证。手三阳经的筋脉结聚于下颌和面颊部位,风邪侵入此处则导致牙关紧闭。阴阳经络环绕全身,风邪中伤经络,则头项、肩背部强直僵硬,呈现如同角弓反张的状态。产后患此病,均属于虚损的表现。适宜使用八珍汤加入黄芪、附子、肉桂,以大补阴阳之气,稍加防风以祛风治标。如果见到头摇、喘促、汗出不止、两手撮空的症状,则是真气耗散、邪气独留的征象,属于必死的征兆,所以说没有生还的希望。
八珍汤方剂见本书首卷
加味八珍汤
39. 阴血流失过多,导致阳气炽盛,筋脉失去滋养而引起抽搐(瘛瘲,指筋脉拘急与弛缓交替出现的症状)。伴有发热、恶寒、心烦和口渴等症状。治疗不应按外感风邪处理,只应当气血双补,使用八珍汤加入牡丹皮、生地黄、钩藤钩进行治疗。若抽搐无力、两眼上视(戴眼)、身体反折、大汗淋漓不止,则属于无法治疗的证候,所以说生命即将终结。
【注】产后失血过多,阳气相对炽盛,筋脉得不到血液的滋养,必然导致瘛瘲抽搐,出现发热恶寒、心烦口渴的症状,不宜当作风邪致病来治疗,只应当兼顾补气养血,使用八珍汤加入丹皮、生地、钩藤钩来治疗。如果出现抽搐无力、戴眼反折、大汗不止的情况,则属于不治之症,所以说生命即将休亡。
八珍汤方剂见本书首卷
40. 产后不语(不能说话)需要区分实证和虚证进行治疗。有的因痰热乘袭心窍所致;有的因败血(瘀血)冲犯心脏所致;有的因气血两虚导致神志郁闭昏冒。大抵产后病症多为虚证,实证较少,必须仔细辨别。虚证使用八珍汤加钩藤、石菖蒲、远志;痰热证使用二陈汤加胆南星、黄连;败血冲心证使用七珍散,即由川芎、生地黄、细辛、防风、朱砂、石菖蒲、人参组成。
【注】产后不语,必须分虚实进行治疗。有痰热乘袭心窍的;有败血冲犯心神的;有气血两虚而导致神志郁闭昏蒙的。大体上产后病症属虚的多,属实的少。虚证适宜用八珍汤加钩藤、菖蒲、远志;痰热适宜用二陈汤加胆星、黄连;败血冲心适宜用七珍散,也就是川芎、生地、细辛、防风、朱砂、菖蒲、人参这七味药。
八珍汤方剂见首卷 二陈汤方剂见第三卷
《医宗金鉴》第四十八卷
Modified Bazhen Decoction (Eight-Treasure Decoction)
38. Following recent childbirth, blood deficiency and excessive sweating predispose the body to wind-pathogen invasion, leading to the formation of Jing Disease (Spasm disease, characterized by stiffness of the neck and back and convulsions). Symptoms include lockjaw (trismus), stiff neck, and opisthotonos (arching of the back like a bow). The treatment should employ Bazhen Tang (Eight-Treasure Decoction, composed of Ginseng, Atractylodes Macrocephala Rhizome, Poria, Licorice Root, Angelica Sinensis Radix, Ligusticum Chuanxiong Rhizome, White Peony Root, and Prepared Rehmannia Root) supplemented with Astragalus Root, Aconite Lateralis Radix Praeparata, Cinnamon Twig, and Saposhnikovia Root. If symptoms such as head tremors, shortness of breath, unceasing chills, and involuntary grasping movements of both hands appear, the prognosis is poor and recovery is unlikely.
[Annotation] Postpartum qi and blood are insufficient, causing weakness in the zang-fu organs. Excessive sweating leads to loose couli (pores and interstices), allowing wind-pathogens to invade due to deficiency, thereby forming Jing Disease. The sinews of the three hand-yang meridians converge at the mandible and cheeks; when wind enters these areas, lockjaw occurs. The yin and yang meridians encircle the body; when wind strikes the meridians, the head, neck, shoulders, and back become stiff and rigid, resembling opisthotonos. Conditions arising postpartum are generally manifestations of deficiency. It is appropriate to use Bazhen Tang added with Astragalus Root, Aconite Lateralis Radix Praeparata, and Cinnamon Twig to greatly tonify yin and yang, with a small amount of Saposhnikovia Root to treat the pathogen. If head tremors, panting, unceasing sweating, and grasping at empty air are observed, it indicates the departure of true qi and the retention of pathogenic factors alone, which is a sign of inevitable death; hence, it is said that there is no hope for survival.
Bazhen Tang formula is found in the first volume.
Modified Bazhen Decoction
39. Excessive loss of yin-blood leads to blazing yang-fire, causing the sinews to lose nourishment and resulting in Ji Zhuo (spasms and flaccidity) and convulsions. Accompanying symptoms include fever, aversion to cold, irritability, and thirst. Treatment should not focus on expelling wind; rather, it should tonify both qi and blood simultaneously using Bazhen Tang added with Moutan Cortex, Rehmanniae Radix Recens, and Uncaria Ramulus cum Uncis. If convulsions are weak, accompanied by fixed upward gaze (dai yan), opisthotonos, and unceasing profuse sweating, it constitutes an untreatable condition, indicating imminent death.
[Annotation] Excessive blood loss postpartum causes relative excess of yang-fire. Without blood nourishment, the sinews inevitably suffer from Ji Zhuo and convulsions, presenting with fever, aversion to cold, irritability, and thirst. This should not be treated as a wind-pathogen disorder; instead, one must tonify qi and blood together using Bazhen Tang added with Moutan Cortex, Rehmanniae Radix Recens, and Uncaria Ramulus cum Uncis. If convulsions are weak, with fixed upward gaze, opisthotonos, and unceasing sweating, it is an incurable syndrome, thus implying impending demise.
Bazhen Tang formula is found in the first volume.
Modified Bazhen Decoction, Xinglian Erchen Tang (Pinellia and Citrus Decoction with Arisaema and Coptis), Qizhen San (Seven-Treasure Powder)
40. Postpartum aphasia (inability to speak) must be differentiated into excess and deficiency patterns for treatment. Some cases arise from phlegm-heat invading the heart orifice; others from failed blood (blood stasis) rushing to the heart; still others from dual deficiency of qi and blood leading to mental depression and confusion. Generally, postpartum conditions are predominantly deficiency, with fewer excess cases, so careful differentiation is required. For deficiency, use Bazhen Tang added with Uncaria Ramulus cum Uncis, Acorus Tatarinowii Rhizome, and Polygala Root. For phlegm-heat, use Erchen Tang (Two-Aged Decoction) added with Pinelliae Rhizoma Preparatum (Arisaema cum Bile) and Coptidis Rhizoma. For failed blood rushing to the heart, use Qizhen San, composed of Ligusticum Chuanxiong Rhizome, Rehmanniae Radix Recens, Asarum Root, Saposhnikovia Root, Cinnabaris, Acorus Tatarinowii Rhizome, and Ginseng Radix et Rhizoma.
[Annotation] Postpartum aphasia requires differentiation between excess and deficiency. There are cases of phlegm-heat invading the heart; cases of blood stasis assaulting the heart spirit; and cases of qi and blood dual deficiency causing mental clouding. Broadly speaking, postpartum disorders are mostly deficiency, with few excesses. Deficiency is suitable for Bazhen Tang added with Uncaria Ramulus cum Uncis, Acorus Tatarinowii Rhizome, and Polygala Root; phlegm-heat is suitable for Erchen Tang added with Pinelliae Rhizoma Preparatum and Coptidis Rhizoma; failed blood rushing to the heart is suitable for Qizhen San, consisting of Ligusticum Chuanxiong Rhizome, Rehmanniae Radix Recens, Asarum Root, Saposhnikovia Root, Cinnabaris, Acorus Tatarinowii Rhizome, and Ginseng Radix et Rhizoma.
Bazhen Tang formula is found in the first volume. Erchen Tang formula is found in the third volume.
*Yi Zong Jin Jian* (Golden Mirror of Medicine), Volume 48.