《大全》云∶产后因惊,败血冲心,昏闷发狂,如有鬼祟,乃血虚而神不守舍,非补养
元气不可。《局方》用大圣泽兰散加辰砂一字煎,枣仁汤下,一服可安。
《大全》云∶心主一身之血脉,因产伤血,心气虚耗,败血停积,上干于心,心受触遂
致心
中烦躁,起卧不安,乍见鬼神,言语颠错。大抵此症皆心脾血少所致,但调补胃气则痰清而
神自安矣(前论止言瘀血而不言痰此言痰而又不治痰,但调胃气,设果有痰,亦须观人勇怯
为之)。其或不起,多因豁痰降火,攻伐之过也。
《大全》云∶产后脏虚,心神惊悸者,由体虚心气不足之经为风邪所乘也。或恐惧忧迫
,令心
气受于风邪,邪搏于心则惊不自安。若惊不已,则悸动不定,其状目睛不转而不能动。诊其
脉动而弱者,惊悸也,动则为惊,弱则为悸也。治法补气血为主。
《大全》云∶人之血气通于荣卫脏腑,遍循经络,产则血气俱伤,五脏皆虚,荣卫不足
,即
为风邪所乘,则令心神恍惚。盖风为虚极之假象,当大补气血为主,以固其本源,诸病自退
。
若专治风则误矣(自不语至恍惚等症,有谓气血虚,有谓败血入心,有谓风所乘,一皆名为
心气。然此风从何来?当从何治?前人亦未知悉,但言治痰治风,而丹溪立斋则以大补气血为
主,若有所见,在临症酌用之)。
《产宝备录》记载:产后因受惊扰,导致败血(瘀滞之恶露)上冲于心,出现神志昏闷、发狂,仿佛见到鬼怪祟害的症状。这属于血虚而心神不能内守的证候,必须通过补养元气才能治愈。《太平惠民和剂局方》使用大圣泽兰散加辰砂一钱煎服,并用枣仁汤送下,服用一次即可安定。
《产宝备录》又记载:心主宰全身的血脉。由于分娩损伤血液,导致心气虚弱耗损,败血停滞积聚,向上干扰心脏,心脏受到触动,从而导致心中烦躁,坐卧不安,偶尔看见鬼神,言语错乱颠倒。大致这类病症都是由心脾两脏血少引起的。只要调理补益胃气,那么痰浊自清,心神自然安宁。(前面的论述只提到瘀血而没有提到痰,这里提到痰却没有直接治疗痰,而是仅仅调理胃气;如果确实有痰,也必须观察患者的体质强弱来制定治疗方案)。如果病情没有好转,大多是因为过度使用豁痰降火、攻伐邪气的药物所致。
《产宝备录》记载:产后脏腑虚弱,心神出现惊悸症状,是由于身体虚弱,心气不足,经脉被风邪乘虚侵袭所致。或者因为恐惧、忧愁逼迫,使心气遭受风邪,邪气与心相搏结,就会导致惊恐不安。如果惊恐不止,就会发展为悸动不定,表现为眼睛呆滞不转动、身体不能活动。诊察其脉搏跳动且微弱无力,这就是惊悸症;脉动主惊,脉弱主悸。治疗方法以补益气血为主。
《产宝备录》又记载:人的血气贯通于营卫和脏腑,遍行于经络之中。分娩时血和气都会受伤,五脏都处于虚弱状态,营卫之气不足,就会被风邪乘虚侵袭,从而导致心神恍惚。风邪是极度虚弱所呈现出的假象,应当以大补气血为主,以巩固根本,各种病症自然会消退。如果专门治疗风邪就错了。(从不言语到心神恍惚等症状,有的说是气血虚,有的说是败血入心,有的说是风邪侵袭,这些都统称为心气病。然而,这个风邪从何而来?应当如何治疗?前人也不清楚,只是说治疗痰和风,而朱丹溪和李东垣则主张以大补气血为主,这种见解很有见地,在临证时应酌情采用)。
*Daquan* states: Postpartum, due to fright,敗血 (stagnant lochia) rushes to the heart, causing unconsciousness, mania, and hallucinations of demonic influence. This is a syndrome of blood deficiency where the Shen (Spirit) fails to reside within its abode; it cannot be cured without tonifying and nourishing Yuan Qi (Primordial Qi). *Ju Fang* (Tai Ping Hui Min He Ji Ju Fang) prescribes Da Sheng Ze Lan San (Great Sage Blumea Decoction) with one qian of Chen Sha (Cinnabar), decocted and administered with Zao Ren Tang (Zizyphus Seed Decoction); a single dose can bring relief.
*Daquan* also states: The Heart governs the blood vessels of the entire body. Due to blood loss during childbirth, Heart Qi becomes deficient and depleted. Stagnant lochia accumulates and interferes with the Heart from above. Upon being disturbed by this pathogen, the Heart manifests as inner restlessness, inability to sit or lie comfortably, intermittent visions of spirits, and disordered speech. Generally, these syndromes are caused by insufficient blood in the Heart and Spleen. By regulating and tonifying Stomach Qi, phlegm will clear naturally, and the Shen will become tranquil. (Previous discussions mentioned only blood stasis and not phlegm; here, phlegm is mentioned but not directly treated; instead, Stomach Qi is regulated. If phlegm is indeed present, treatment must be adjusted according to the patient's constitutional strength). If the condition does not improve, it is often due to excessive use of herbs that resolve phlegm, descend fire, and attack pathogens.
*Daquan* states: Postpartum visceral weakness leading to mental fright and palpitations arises because the body is deficient, Heart Qi is insufficient, and the meridians are invaded by Wind Pathogens. Alternatively, fear and anxiety may cause Heart Qi to be affected by Wind Pathogens. When the pathogen clashes with the Heart, it results in uncontrollable fright. If fright persists, it develops into restless palpitations, characterized by fixed eyes that do not move and an immobile body. Palpation reveals a pulsating yet weak pulse; a pulsating quality indicates Fright, while a weak quality indicates Palpitations. The treatment principle is primarily to tonify Qi and Blood.
*Daquan* further states: Human Qi and Blood circulate through Ying-Wei (Nutritive and Defensive systems) and viscera, traversing all meridians. Childbirth injures both Qi and Blood, leaving the Five Viscera deficient. Insufficient Ying-Wei Qi allows Wind Pathogens to invade, resulting in mental vagueness and恍惚 (fluctuating spirit). Wind is merely a false manifestation of extreme deficiency. Treatment should focus on major tonification of Qi and Blood to consolidate the root, after which various diseases will recede. Specializing in treating Wind would be erroneous. (Symptoms ranging from muteness to mental vagueness are attributed variously to Qi-Blood deficiency, stagnant blood entering the Heart, or Wind invasion, collectively termed Heart Qi disorders. However, where does this Wind come from, and how should it be treated? Predecessors were uncertain, merely advocating treatment for Phlegm and Wind. Zhu Danxi and Li Dongyuan, however, advocated major tonification of Qi and Blood as the primary approach. This insight is valuable and should be applied judiciously in clinical practice).