产后发热。恶寒。头痛。毋认为伤寒太阳症。发热头痛。乍寒乍冷。或兼腹痛。毋认为少
阳症。
皆由气血两虚。阴阳不和。而类外感。切不可用麻黄柴胡等发汗。重亡阴血。即明知虚中真
感风寒。口伤冷物。若用药能调和营卫。诸症自退矣。
当归(四钱) 川芎(二钱) 姜皮(四分) 桃仁(十粒) 枣(二枚) 煎温服。速服二帖。若诸
症未退。加羌活。防风。(各四分) 服之后。病又不减。加连根葱(四根) 如呕吐。加藿香
(三分) 姜(一片)
凡产妇素弱。临产又劳。气血不足。胸膈不舒。胃虽纳谷。脾难转舒。若产后即服生化汤
满。其产后或中满膨胀者。大率因伤食而误用消导。因气郁而误用
顺散。又因多食冷物而停恶露。又因血虚大便燥结误下而愈胀。殊不知产后血气两虚。血块
消后。盒饭大补气血。以补中虚。治者但知伤食当消。气郁当顺。恶露当攻。便秘当下。投
药一帖不效。又投一帖。病者医者。不知新产妇服消耗药多。满闷益增。气不升降。温热
助邪。积郁之久。遂成膨胀。医工以为尽技。病家咎于时气。又有喜食橘饼、橙丁。中满助
成。岂知消导佐于补中汤。则脾强而所伤之物自消。则气亦散。助泻兼行。大便自通。而恶
露即行矣。每见误用消导、耗气、攻下之药。以致绝谷食久者。用长生活命丹而更生者。百
试百验。又误用而致膨胀者。仍用大补益气之剂。而不至夭折者。十救八九。治者毋以予言
为过。予盖先用人参送锅焦粉。试引加之。以救绝谷。再遵丹溪医案。以救绝谷。产后中气
不足中满。或嗳气虚饱。及误用耗气顺气药。致膨胀危症。
产后出现发热、恶寒(怕冷)、头痛等症状,不要将其误认为是伤寒病的太阳经证。若出现发热、头痛,忽冷忽热,或者兼有腹痛,也不要将其误认为是少阳经证。
这些症状都是由气血两虚、阴阳失调引起的类外感病证,切不可使用麻黄、柴胡等药物进行发汗治疗,否则会进一步耗伤阴血。即使明知是正气虚弱中又真受了风寒,或食用了生冷食物,只要用药调和营卫(调节体表防御机能),各种症状自然就会消退。
处方:当归(四钱)、川芎(二钱)、姜皮(四分)、桃仁(十粒)、大枣(二枚)。煎煮后温服,迅速服用两帖。如果诸症未退,加入羌活、防风(各四分)。服药后病情仍未减轻,加入带根的葱白(四根)。如果出现呕吐,加入藿香(三分)、生姜(一片)。
凡是产妇平时体质虚弱,临产时又过度劳累,导致气血不足,胸膈部感觉不舒畅。虽然胃能接受食物,但脾脏难以运化舒展。如果在产后立即服用生化汤(注:此处原文语境似指误用或过量服用补益或消导药,结合下文“满闷”及“消耗药”,此处应理解为产后脾胃虚弱时不当用药导致胀满,原文“服生化汤满”疑为笔误或特指某种情况下的副作用,但根据上下文“凡产妇素弱...若产后即服...满”,更倾向于指产后脾胃虚弱时服用某些药物导致胀满,结合标题“产后服消耗药增满闷积久成胀”,此处重点在于批评误用消耗药。然而原文确实写了“服生化汤满”,考虑到生化汤本身是补血化瘀之剂,通常用于产后,但若患者脾虚极甚,滋腻或活血过猛也可能致胀,或者原文意指“服[某]药满”,但既然原文写生化汤,暂按原文翻译,并在实体提取中标注)。*修正理解*:细读原文,“若产后即服生化汤满”这一句在逻辑上与前文“加味生化汤”章节标题呼应,但后文大篇幅论述的是“消耗药”导致的胀满。实际上,这段文字是在讨论产后胀满的成因,其中提到一种情况是误治。让我们再仔细看:“若产后即服生化汤满”可能是指如果产后就服用(导致)胀满的药物?不,原文是“若产后即服生化汤满”。这在中医古籍中有时指“如果产后就服用(导致)满闷的药”,或者是指“生化汤”在某些情况下也可能导致满闷?不,结合下文“其产后或中满膨胀者...大率因伤食而误用消导...”,这一段主要是在讲**误用消耗药**的危害。原文第一句“若产后即服生化汤满”可能存在传抄错误,或者意指“若产后即服[导致]满[闷之]药”。但为了忠实于原文,我将直译。不过,注意到标题是“产后服消耗药增满闷积久成胀”,正文开头是“加味生化汤”,然后突然跳到“产后发热...”,这似乎是两个不同的条目混在一起了?
再看结构:
1. 【背景信息】提到章节:产后类外感 / 加味生化汤 / 产后服消耗药增满闷积久成胀。
2. 原文第一段:“产后发热...速服二帖...”这是“加味生化汤”的内容。
3. 原文第二段:“凡产妇素弱...遂成膨胀...”这是“产后服消耗药增满闷积久成胀”的内容。
所以,第一段是加味生化汤的主治和用法。第二段是另一种病症(产后胀满)的病机和误治分析。
重新梳理翻译逻辑:
第一段:描述产后类外感的症状,鉴别诊断(非太阳、非少阳),病因(气血两虚,阴阳不和),禁忌(不可发汗),治疗原则(调和营卫)。给出加味生化汤方剂及加减法。
第二段:描述产后因体弱劳倦致气血不足,脾胃虚弱。指出产后胀满多因误用消导、顺散、攻下等消耗药所致。强调产后本虚,应大补气血。批评医者不知新产妇气血两虚,滥用消耗药,导致气机升降失常,邪热助势,积郁成胀。提出正确治法(补中益气佐以消导/泻下),并列举误治后果及补救措施(长生活命丹、大补益气剂)。最后提到作者的经验(人参送锅焦粉救绝谷,遵丹溪医案)。
翻译修正:
第一段:
产后出现发热、恶寒、头痛,不要认为这是伤寒病的太阳经证。出现发热、头痛,忽冷忽热,或者兼有腹痛,不要认为这是少阳经证。
这些都是由于气血两虚、阴阳不和而引起的类似外感的病证,千万不能用麻黄、柴胡等药物发汗,以免再次严重耗伤阴血。即使是明知是虚人感受风寒,或吃了生冷食物,只要用药调和营卫,各种症状自然会消退。
【方剂】当归(四钱)、川芎(二钱)、姜皮(四分)、桃仁(十粒)、大枣(二枚)。煎好后温服,尽快服用两帖。如果症状没有消退,加入羌活、防风(各四分)。服药后病情仍不减轻,加入带根的葱白(四根)。如果有呕吐,加入藿香(三分)、生姜(一片)。
第二段:
凡是产妇平时体质虚弱,临产时又劳累,导致气血不足,胸膈部憋闷不舒。虽然胃能进食,但脾脏难以运化舒展。如果产后就服用(导致)胀满的药物(注:此处原文“服生化汤满”语意稍显突兀,结合上下文“产后服消耗药...”,可能意指产后脾胃虚弱时服用不当药物如生化汤若不对证或叠加其他消耗药会导致满闷,或者原文有误,但依字面译),或者产后出现脘腹胀满膨胀的情况,大多是因为饮食停滞却误用了消导药,因为气机郁滞却误用了顺气散结药,又因为多吃生冷食物导致恶露停滞,还因为血虚大便燥结却误用泻下药而导致更加胀满。殊不知产后气血两虚,在血块消散后,应当大补气血以填补中焦之虚。治病的人只知道伤食需要消导,气郁需要顺气,恶露需要攻逐,便秘需要泻下,投下一帖药无效,又投一帖,病人和医生都不知道新产妇服用过多消耗正气的药物,会使胀满憋闷日益加重,导致气机不能升降,温热之邪助长病势,积郁日久,最终形成膨胀病。医生自以为用尽了办法,病人家属则归咎于时行疫病。又有喜欢食用橘饼、橙丁等助湿碍气之物,加重中满的。哪里知道在补中益气汤的基础上佐以消导药,就能使脾气强健,所伤的食物自然消化,气机也就疏散;配合泻下药同时施行,大便自然通畅,恶露也就随之排行了。经常见到误用消导、耗气、攻下药物,导致长期无法进食的人,使用长生活命丹而恢复生命的,百试百灵。又有误用这些药物导致膨胀的,仍然使用大补益气的药剂,而没有早逝的,十个能救活八九个。治病的人不要认为我的话过分,我曾用参汤送服锅焦粉,尝试引用这种方法来救治长期无法进食的患者,再遵循朱丹溪的医案,来救治产后中气不足导致的脘腹胀满,或者嗳气虚饱,以及误用耗气、顺气药物导致的膨胀危重症。
Postpartum fever, aversion to cold (Ehan), and headache should not be mistaken for the Taiyang syndrome of Shanghan (Cold Damage). Fever and headache accompanied by alternating chills and fever, or abdominal pain, should not be mistaken for Shaoyang syndrome.
All these conditions arise from deficiency of both Qi and Blood, and disharmony of Yin and Yang, presenting as exogenous-like syndromes. One must absolutely avoid using diaphoretic herbs such as Ephedrae Herba (Mahuang) or Bupleuri Radix (Chaihu), as this would cause further severe depletion of Yin and Blood. Even if it is known that there is a true contraction of Wind-Cold due to underlying deficiency, or ingestion of cold substances, symptoms will subside spontaneously once the Ying and Wei (Nutritive and Defensive) levels are harmonized through appropriate medication.
Prescription: Dang Gui (Radix Angelicae Sinensis, 4 qian), Chuan Xiong (Rhizoma Chuanxiong, 2 qian), Jiang Pi (Pericarpium Zingiberis Recens Cutis, 4 fen), Tao Ren (Semen Persicae, 10 grains), Da Zao (Fructus Jujubae, 2 pieces). Decoct and take warm. Take two doses promptly. If symptoms persist, add Qiang Huo (Rhizoma et Radix Notopterygii, 4 fen) and Fang Feng (Radix Saposhnikoviae, 4 fen). If the condition does not improve after taking the medicine, add Cong Bai (Caulis Allii Cepae cum Radice, 4 roots). If vomiting occurs, add Huo Xiang (Herba Pogostemonis, 3 fen) and Sheng Jiang (Rhizoma Zingiberis Recens, 1 slice).
For women who are constitutionally weak and exhausted during labor, resulting in insufficiency of Qi and Blood, chest and diaphragmatic discomfort, where the Stomach can accept food but the Spleen fails to transform and transport smoothly: If postpartum medications lead to fullness, or if postpartum epigastric distension and bloating occur, this is generally due to misusing digestive-promoting herbs for food stagnation, using qi-regulating dispersants for Qi depression, consuming excessive cold foods causing lochia retention, or using purgatives for constipation caused by Blood deficiency, thereby worsening the bloating. They fail to realize that postpartum Qi and Blood are doubly deficient; after blood clots dissipate, one should strongly tonify Qi and Blood to supplement the Middle Jiao deficiency. Physicians only know that food stagnation requires digestion, Qi depression requires regulation, lochia requires expulsion, and constipation requires purging. When one dose is ineffective, they administer another. Neither patient nor physician realizes that new mothers have taken too many herbs that consume Qi and Blood, increasing fullness and oppression, preventing the ascending and descending of Qi, allowing Heat pathogens to assist the evil, and leading to chronic accumulation and distension over time. Physicians think they have done their utmost, while families blame seasonal pathogens. Some enjoy eating tangerine peel candies or orange segments, which aggravate middle-jiao fullness. How could they know that adding digestive aids to Bu Zhong Yi Qi Tang strengthens the Spleen, allowing damaged food to digest naturally, dispersing Qi, and combining with mild purgatives to unblock the bowels and promote lochia flow? I often see cases where misuse of digestive, Qi-consuming, and purgative herbs leads to long-term anorexia; using Chang Sheng Huo Ming Dan saves lives, with hundred percent efficacy. For those whose distension was caused by such misuse, administering strong Qi-tonifying formulas saves eight or nine out of ten. Physicians should not consider my words excessive. I have previously used Ginseng decoction to deliver roasted rice powder, attempting to apply this method to save patients with anorexia, and followed Zhu Danxi’s medical cases to treat postpartum Middle Qi deficiency causing distension, false satiety with belching, and critical distension caused by misuse of Qi-consuming and Qi-regulating herbs.