初产有作乳者,有产下而不育乳汁者,膨上俱致发热,但此症与恶露未净停胞络而发热者相
似而实不同,宜细细辨之。小腹痛者,恶露停蓄也,不宜服加减四物汤。若小腹不痛者,阴
阳不和也,宜服之。若往来寒热,小柴胡汤主之。寒热而盗汗如雨者,麦煎散主之。
皇甫中曰∶产后血虚发热,头痛自汗,心烦气短者,人参当归散。产后阴虚气血不足而发热
,日轻夜重而恶寒者,四物汤加炮姜。微热,加茯苓。产后蒸乳发热者,用四物加黄 、人
参、白术、花粉。
人参当归汤
熟地(一两) 人参(一两) 当归(一两) 麦冬(一两) 肉桂(一两) 白芍(一钱,炒)
每服五钱,加姜、竹叶煎服。
产后诸风,痿弱筋挛无力者,血风汤。产后气弱汗多,风搏之而成 ,口噤,角弓反张,
脊强,汗出不止者,难治,大圣散加川芎、黄 。
血风汤
秦艽(一钱) 羌活(一钱) 防风(七分) 白芍(一钱,酒炒) 大熟地(二钱) 白芷(八分)
川芎(一钱) 白术(一钱,炒) 归身(一钱半) 炙黄 (钱半) 茯苓(一钱) 半夏(一钱)
水煎服。
大圣散 治产后因惊而发心神不定,怔忡恍惚。
川芎(一两) 黄 (一两,蜜炙) 当归(一两) 木香(一两) 人参(一两) 甘草(一两) 茯
神(一两) 麦冬(一两)
上药锉为末,每服七钱,姜三片,水二盏,煎至八分,空心服。
产后血少,怔忡恍惚惊悸,睡不安宁者,益荣汤,或养心汤、宁志丸。产后心恍惚者,茯苓
散。
益荣汤
当归(钱半) 黄 (一钱,炙) 远志(一钱) 枣仁(一钱,炒) 柏子仁(一钱,炒) 茯神(
一钱) 人参(一钱) 白芍(八分,炒) 甘草(三分,炒) 紫石英(八分) 姜三片,水煎服
养心汤 治产后心虚血少,恍惚惊悸不安。
黄 (五钱) 茯神(五钱) 远志肉(五钱) 当归(五钱) 人参(二钱) 半夏曲 川芎(各五
钱) 枣仁(二钱半,炒) 肉桂(二钱半) 五味(三钱) 柏子仁(二钱) 甘草(四钱,炙)
上为粗末,每服三钱,加姜三片,水煎服。
茯苓散
人参(一钱) 甘草(一钱) 山药(一钱) 当归(一钱) 远志肉(一钱) 茯苓(一钱) 桂心(
一钱) 麦冬(一钱)
大枣三枚,水煎服。
初产妇出现乳房胀痛(作乳)的情况,也有产后乳汁分泌不足的,这两种情况都会导致发热。但是这种病症与恶露未排净、瘀血停滞在胞宫络脉而导致的发热相似,但实质不同,需要仔细辨别。如果小腹部疼痛,说明是恶露停滞蓄积,此时不宜服用加减四物汤。如果小腹部不痛,则是阴阳不和所致,适宜服用加减四物汤。如果出现忽冷忽热的症状,以小柴胡汤为主治方剂。如果既有寒热往来又伴有盗汗如雨的症状,以麦煎散为主治方剂。
皇甫中说:产后因血虚导致发热,伴有头痛、自汗、心烦、气短症状的,用人参当归散。产后因阴虚、气血不足导致发热,表现为白天轻晚上重且伴有恶寒症状的,用四物汤加炮姜。如果有轻微发热,再加茯苓。产后因蒸乳(乳汁郁积化热)导致发热的,用四物汤加黄芪、人参、白术、天花粉。
人参当归汤
熟地黄(一两) 人参(一两) 当归(一两) 麦冬(一两) 肉桂(一两) 白芍(一钱,炒制)
每次服用五钱,加入生姜、淡竹叶煎服。
产后各种风邪致病,出现肢体痿软无力、筋脉拘挛的症状,用血风汤。产后气虚多汗,风邪侵袭搏结而成痉病,出现牙关紧闭、角弓反张、脊柱强直、出汗不止的症状,属于难治之症,用大圣散加川芎、黄芪。
血风汤
秦艽(一钱) 羌活(一钱) 防风(七分) 白芍(一钱,酒炒) 大熟地黄(二钱) 白芷(八分)
川芎(一钱) 白术(一钱,炒制) 当归身(一钱半) 炙黄芪(钱半) 茯苓(一钱) 半夏(一钱)
用水煎服。
大圣散 治疗产后因受惊吓而导致心神不定、怔忡恍惚。
川芎(一两) 黄芪(一两,蜜炙) 当归(一两) 木香(一两) 人参(一两) 甘草(一两) 茯神(一两) 麦冬(一两)
以上药物捣碎成粗末,每次服用七钱,加生姜三片,水两盏,煎至八分满,空腹服用。
产后血少,出现怔忡、恍惚、惊悸,睡眠不安宁的,用益荣汤,或者养心汤、宁志丸。产后心气恍惚的,用茯苓散。
益荣汤
当归(钱半) 黄芪(一钱,炙制) 远志(一钱) 酸枣仁(一钱,炒制) 柏子仁(一钱,炒制) 茯神(一钱)
人参(一钱) 白芍(八分,炒制) 甘草(三分,炒制) 紫石英(八分) 生姜三片,用水煎服。
养心汤 治疗产后心虚血少,出现恍惚、惊悸、不安的症状。
黄芪(五钱) 茯神(五钱) 远志肉(五钱) 当归(五钱) 人参(二钱) 半夏曲 川芎(各五钱)
酸枣仁(二钱半,炒制) 肉桂(二钱半) 五味子(三钱) 柏子仁(二钱) 甘草(四钱,炙制)
以上药物制成粗末,每次服用三钱,加生姜三片,用水煎服。
茯苓散
人参(一钱) 甘草(一钱) 山药(一钱) 当归(一钱) 远志肉(一钱) 茯苓(一钱) 桂心(一钱) 麦冬(一钱)
大枣三枚,用水煎服。
For primiparas, breast engorgement (breast milk stasis) may occur, or there may be insufficient lactation after childbirth. Both conditions can lead to fever. However, this condition is similar to but fundamentally different from fever caused by lochia not being fully expelled and blood stasis remaining in the uterine collaterals; careful differentiation is required. If lower abdominal pain is present, it indicates lochia retention and accumulation; Jiawei Siwu Tang (Modified Four Substances Decoction) should not be administered. If there is no lower abdominal pain, it is due to disharmony between Yin and Yang, and Jiawei Siwu Tang is appropriate. In cases of alternating chills and fever, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary formula. For chills and fever accompanied by profuse night sweats like rain, Maijian San (Wheat Cooling Powder) is indicated.
Huangfu Zhong stated: For postpartum fever due to blood deficiency, accompanied by headache, spontaneous sweating, mental restlessness, and shortness of breath, Renshen Danggui San (Ginseng and Angelica Powder) is used. For postpartum fever due to Yin deficiency and insufficiency of Qi and Blood, characterized by symptoms that are milder during the day and heavier at night with aversion to cold, Siwu Tang (Four Substances Decoction) with Pao Jiang (Prepared Ginger) is prescribed. For slight fever, add Fuling (Poria). For fever caused by "steaming breasts" (lactational heat), Siwu Tang (Four Substances Decoction) with Huangqi (Astragalus), Renshen (Ginseng), Baizhu (Atractylodes Macrocephala), and Huafen (Trichosanthes Root) is used.
Renshen Danggui Tang (Ginseng and Angelica Decoction)
Shudi (Prepared Rehmannia Root, 1 liang) Renshen (Ginseng, 1 liang) Danggui (Angelica Sinensis, 1 liang) Maidong (Ophiopogon Tuber, 1 liang) Rougui (Cinnamon Twig, 1 liang) Baishao (White Peony Root, 1 qian, stir-fried)
Take 5 qian per dose, decoct with Shengjiang (Fresh Ginger) and Zhuyeqian (Bamboo Leaf) and drink.
For various wind-pathogens affecting the postpartum period, resulting in flaccidity, weak sinews, convulsions, and lack of strength, Xuefeng Tang (Blood Wind Decoction) is used. For postpartum Qi deficiency with excessive sweating, where wind pathogens invade and bind, leading to spasm (Jing Bing), trismus (lockjaw), opisthotonos (arched back), rigidity of the spine, and continuous sweating, the prognosis is difficult. Dasheng San (Great Sage Powder) with Chuanxiong (Ligusticum Wallichii) and Huangqi (Astragalus) is indicated.
Xuefeng Tang (Blood Wind Decoction)
Qinjiao (Gentiana Macrophylla Root, 1 qian) Qianghuo (Notopterygium Rhizome, 1 qian) Fangfeng (Saposhnikovia Root, 7 fen) Baishao (White Peony Root, 1 qian, wine-fried) Dushudi (Large Prepared Rehmannia Root, 2 qian) Baizhi (Angelica Dahurica, 8 fen)
Chuanxiong (Ligusticum Wallichii, 1 qian) Baizhu (Atractylodes Macrocephala, 1 qian, stir-fried) Guishen (Angelica Sinensis Stem, 1.5 qian) Zhi Huangqi (Honey-fried Astragalus, 0.5-1 qian) Fuling (Poria, 1 qian) Banxia (Pinellia Tuber, 1 qian)
Decoct in water and take orally.
Dasheng San (Great Sage Powder) treats postpartum mental instability, palpitations (Zhengchong), and trance-like states caused by fright.
Chuanxiong (Ligusticum Wallichii, 1 liang) Huangqi (Astragalus, 1 liang, honey-fried) Danggui (Angelica Sinensis, 1 liang) Muxiang (Aucklandia Root, 1 liang) Renshen (Ginseng, 1 liang) Gancao (Licorice Root, 1 liang) Fushen (Poria with Hostwood, 1 liang) Maidong (Ophiopogon Tuber, 1 liang)
Grind the above herbs into coarse powder. Take 7 qian per dose, add 3 slices of Shengjiang (Fresh Ginger), decoct in 2 cups of water until reduced to 0.8 cup, and take on an empty stomach.
For postpartum blood deficiency causing Zhengchong (palpitations), trance, palpitation (Jingji), and restless sleep, Yirong Tang (Benefit Nourishment Decoction), or Yangxin Tang (Nourish Heart Decoction) and Ningzhi Wan (Calming Spirit Pill) are used. For postpartum mental vagueness, Fuling San (Poria Powder) is indicated.
Yirong Tang (Benefit Nourishment Decoction)
Danggui (Angelica Sinensis, 0.5-1 qian) Huangqi (Astragalus, 1 qian, roasted) Yuanzhi (Polygala Root, 1 qian) Zaoren (Sour Jujube Seed, 1 qian, stir-fried) Baiziren (Biota Seed, 1 qian, stir-fried) Fushen (Poria with Hostwood, 1 qian)
Renshen (Ginseng, 1 qian) Baishao (White Peony Root, 0.8 qian, stir-fried) Gancao (Licorice Root, 0.3 qian, stir-fried) Zi Shiyin (Purple Quartz, 0.8 qian) Shengjiang (Fresh Ginger, 3 slices)
Decoct in water and take orally.
Yangxin Tang (Nourish Heart Decoction) treats postpartum heart deficiency and blood insufficiency, manifesting as mental vagueness, palpitations, and unrest.
Huangqi (Astragalus, 5 qian) Fushen (Poria with Hostwood, 5 qian) Yuanzhi Rou (Polygala Root Flesh, 5 qian) Danggui (Angelica Sinensis, 5 qian) Renshen (Ginseng, 2 qian) Banxia Qu (Pinellia Fermented Paste) Chuanxiong (Ligusticum Wallichii, each 5 qian)
Zaoren (Sour Jujube Seed, 2.5 qian, stir-fried) Rougui (Cinnamon Twig, 2.5 qian) Wuwei Zi (Schisandra Berry, 3 qian) Baiziren (Biota Seed, 2 qian) Gancao (Licorice Root, 4 qian, roasted)
Grind the above into a coarse powder. Take 3 qian per dose, add 3 slices of Shengjiang (Fresh Ginger), decoct in water, and take orally.
Fuling San (Poria Powder)
Renshen (Ginseng, 1 qian) Gancao (Licorice Root, 1 qian) Shanyao (Chinese Yam, 1 qian) Danggui (Angelica Sinensis, 1 qian) Yuanzhi Rou (Polygala Root Flesh, 1 qian) Fuling (Poria, 1 qian) Guixin (Cinnamon Bark, 1 qian) Maidong (Ophiopogon Tuber, 1 qian)
Da Zao (Jujube, 3 pieces)
Decoct in water and take orally.