丹溪曰∶产后当大补气血为主,虽有杂症,以末治之(产后虽当大补,亦须审恶露有无
,内
外感虚实何如,庶为合理)。产后补虚用参、术、黄 、陈皮、归身、川芎、炙草。如发热
轻则加茯苓渗之,其热自除,重则加干姜。
凡产后有病,先固气血,产后一切病多是血虚,皆不可发表。新产后不可用芍药,以其
酸寒伐生发之气故也。大抵胎前毋滞,产后毋虚(法言)。
仲景云∶问新产妇人有三病,一者病痉,二者病郁冒,三者大便难,何谓也?师曰∶新
产血
虚多汗出,喜中风,故令病痉(读此则知痉症亦有外来,不可专主气血不足而骤用补剂,反
致不救也)。亡血复汗寒多,故令郁冒。亡津液,胃燥,故大便难(产妇郁冒即血晕也)。
《脉经》曰∶诊妇人生产之后,寸口脉洪疾不调者死(不调者并附骨不绝者重看,洪数
中得
胃气者亦生,坚强者死。亦须审原禀脉如何,方能断定),沉微附骨不绝者生。妇人新生,
乳子脉沉小滑者生,实大坚弦急者死。丹溪曰∶产前脉细小,产后脉洪大者多死。又曰∶产
前脉当洪数,既产而洪数如故者,多主死(此亦大概言之,今见产妇脉洪数而生者多矣)。
郭稽中论曰∶胞衣不下者何?答曰∶母生子讫,血流入衣中,衣为血所胀,故不得下。
治之
稍缓,胀满腹中,以次上冲心胸,疼痛喘急者难治。但服夺命丹(黑附子五钱,丹皮一两,
干漆炒烟尽二钱五分,用米醋一斤,大黄末一两,煮膏为丸)以逐去衣中之恶血,血散胀消
,胎衣自下。若外冷乘之,则血道涩而胞亦难下,不可不知(豆淋酒用黑豆炒二合,将铁秤
锤烧红,同豆淬酒)。
薛氏曰∶有因恶露入衣,胀而不能出,有因元气亏损而不能送出,其恶露流入衣中者,
腹中
胀痛,用夺命丹、失笑散以消瘀血则不缓救。其元气不能送出者腹中不胀痛,用保生无忧散
以补固元气(法以产妇头发入口作呕,胎衣自出,其不出者必死)。
朱丹溪说:产后应当以大补气血为主要治疗原则,即使伴有其他杂症,也应将其作为次要问题来处理(产后虽然需要大补,但也必须审察恶露是否有残留,以及外感内伤、虚证实证的具体情况,这样才合理)。产后补虚使用人参、白术、黄芪、陈皮、当归身、川芎、炙甘草。如果发热轻微,则加入茯苓以渗湿利水,热自会消除;如果发热严重,则加入干姜。
凡是产后患病,首先要稳固气血,产后的一切疾病大多属于血虚,都不可使用发汗解表的方法。新近生产后不可使用芍药,因为芍药性味酸寒,会损伤人体生发之气。大概而言,怀孕期间不要使气血壅滞,产后不要使身体虚弱(这是医家的法度之言)。
张仲景说:询问新产妇人常见的三种病,一种是痉病,一种是郁冒,一种是大便难,这是什么原因呢?老师说:新产之后血虚且多汗出,容易感受风邪,所以导致痉病(读到此处就知道痉症也有由外邪引起的,不能专门主张是气血不足而贸然使用补剂,否则反而会导致无法救治)。失血后又出汗,寒气较多,所以导致郁冒。津液耗损,胃中干燥,所以导致大便难(产妇的郁冒就是血晕)。
《脉经》说:诊察妇女生产之后,如果寸口脉象洪大而急疾且不调和,预后不良(如果不调和且按至骨部仍无脉气者情况更重,若在洪数之中能触及胃气者尚可生存,脉象坚强无柔润之意的则死亡。也必须审察患者原本的体质脉象如何,才能做出断定),如果脉象沉微但按至骨部仍有脉气不绝者,预后良好。妇女刚生产完,哺乳期的母亲如果脉象沉小滑者,预后良好;如果脉象实大坚弦急者,预后不良。朱丹溪说:产前脉象细小,产后脉象洪大的,大多预后不良。又说:产前脉象应当洪数,分娩后洪数脉象依然如故的,大多主死(这也是一般性的说法,现在见到产妇脉象洪数而生存的也有很多了)。
郭稽中论述说:胞衣不下的原因是什么?回答说:母亲生下婴儿后,血液流入胞衣中,胞衣被血液胀满,所以不能排出。如果治疗稍微迟缓,胀满之气在腹中积聚,依次向上冲撞心胸,出现疼痛、气喘急促等症状的就难以治疗。只需服用夺命丹(黑附子五钱,牡丹皮一两,干漆炒至烟尽二钱五分,用米醋一斤,大黄末一两,煮成膏状制成丸药)以驱逐胞衣中的瘀血,血散胀消,胎衣自然脱落。如果外来的寒气侵袭,则血脉涩滞而胞衣也难以排出,这一点不可忽视(豆淋酒的制作方法是用黑豆炒二合,将铁秤锤烧红,同豆子一起淬入酒中)。
薛氏说:有的因为恶露进入胞衣,导致胞衣胀满而不能排出;有的因为元气亏损而不能将胞衣送出。那些恶露流入胞衣中的,腹部胀痛,使用夺命丹、失笑散来消除瘀血,就不能拖延急救的时间。那些因为元气不能送出的,腹部不胀痛,使用保生无忧散来补固元气(治疗方法是让产妇的头发入口引起呕吐,胎衣就会自行排出,如果不排出的必定死亡)。
Zhu Danxi stated: Postpartum treatment should primarily focus on greatly tonifying Qi and Blood. Even if there are other miscellaneous symptoms, they should be treated as secondary (Although postpartum requires great tonification, one must also examine whether lochia is retained, and assess the nature of external or internal pathogens, as well as deficiency or excess conditions, to ensure rational treatment). For postpartum deficiency, use Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Qi (Astragali Radix), Chen Pi (Citri Reticulatae Pericarpium), Dang Gui Shen (Angelicae Sinensis Radix - root body), Chuan Xiong (Chuanxiong Rhizoma), and Zhi Gan Cao (Prepared Licorice Root). If fever is mild, add Fu Ling (Poria) to promote diuresis and leach out dampness, and the heat will naturally subside; if fever is severe, add Gan Jiang (Zingiberis Rhizoma).
Generally, when illness occurs postpartum, one must first secure Qi and Blood. Most postpartum diseases are due to Blood deficiency, and thus, methods that induce sweating to release the exterior should not be used. In the immediate postpartum period, Shao Yao (Paeoniae Radix Alba/Rubra) should not be used because its sour and cold nature damages the body's generating and ascending Qi. Generally speaking, during pregnancy, avoid stagnation; postpartum, avoid deficiency (This is a principle from medical classics).
Zhang Zhongjing said: Regarding new mothers, there are three common illnesses: one is Jing disease (spasm/tetanus), the second is Yu Mao (depression and dizziness), and the third is difficult defecation. What does this mean? The Master said: After childbirth, Blood is deficient and sweating is profuse, making the patient prone to Wind invasion, which leads to Jing disease (Reading this reveals that Jing disease can also be caused by external pathogens; it cannot be assumed solely to be due to Qi and Blood deficiency with hasty use of tonics, which could lead to fatal consequences). Loss of Blood combined with sweating and excessive Cold leads to Yu Mao. Loss of Body Fluids and dryness in the Stomach lead to difficult defecation (Yu Mao in postpartum women is equivalent to Xue Yun/Blood Syncope).
The Mai Jing (Pulse Classic) states: When examining women after childbirth, if the Cun Kou (radial artery at the wrist) pulse is Hong Da (surging and large) and rapid but irregular, the prognosis is poor (If irregular and lacking pulse sensation even when pressed deeply to the bone, the condition is critical; however, if a Wei Qi [Stomach Qi] is felt within the surging and rapid pulse, survival is possible; a rigid and unyielding pulse indicates death. One must also consider the patient's constitutional pulse pattern to make a definitive judgment). If the pulse is Chen Wei (deep and faint) but persists when pressed to the bone, the prognosis is good. For women who have just given birth, if the pulse during lactation is Chen Xiao Hua (deep, small, and slippery), the prognosis is good; if it is Shi Da Jian Xian Ji (full, large, firm, wiry, and rapid), the prognosis is poor. Zhu Danxi said: If the pulse is Xi Xiao (fine and small) before delivery but becomes Hong Da (surging and large) after delivery, mortality is high. He also said: Before delivery, the pulse should be Hong Shuo (surging and rapid); if it remains surging and rapid after delivery, death is likely (This is a general rule; nowadays, many postpartum women with surging and rapid pulses survive).
Guo Jizhong discussed: What causes Bao Yi Bu Xia (retained placenta)? The answer is: After the mother delivers the baby, blood flows into the placenta. The placenta becomes distended by the blood, preventing its expulsion. If treatment is delayed, the distension accumulates in the abdomen and rises sequentially to the chest and heart, causing pain, panting, and urgency, which is difficult to treat. One should administer Duo Ming Dan (Life-Extending Pill: Hei Fu Zi [Aconiti Lateralis Radix Praeparata], 5 qian; Mu Dan Pi [Moutan Cortex], 1 liang; Gan Xi [Caulis Kadsurae], stir-fried until smoke ceases, 2.5 qian; cooked with 1 jin of rice vinegar and Da Huang [Rhei Radix et Rhizoma] powder, 1 liang, into a paste for pills) to expel the stasis from the placenta. Once the blood disperses and distension subsides, the placenta will naturally descend. If external Cold invades, the blood vessels become obstructed, making placental expulsion difficult; this must be noted (Dou Lin Jiu [Bean-Dripping Wine]: Stir-fry 2 he of black beans, heat an iron scale weight until red-hot, and quench it in the wine with the beans).
Xue Yue stated: Some cases of retained placenta occur because lochia enters the placenta, causing distension that prevents expulsion. Others occur because Yuan Qi (Primordial Qi) is deficient and unable to push the placenta out. In cases where lochia enters the placenta, there is abdominal distension and pain; Duo Ming Dan and Shi Xiao San (Sorrow-Dispelling Powder) should be used to eliminate blood stasis without delay. In cases where Yuan Qi is insufficient to expel it, there is no abdominal distension or pain; Bao Sheng Wu You San (Life-Preserving Worry-Free Powder) should be used to tonify and secure Yuan Qi (One treatment method involves placing the mother's hair in her mouth to induce vomiting, which causes the placenta to expel spontaneously; if it does not expel, death is inevitable).