恶露不下,由产后脏腑劳伤,气血虚损,或胞络挟于宿冷,或当风取凉,风冷乘虚而搏于血,壅滞不宣,积蓄在内,
故不下也。宜温暖活血,则血自行。更有服燥血枯不能宣滞者,惟为温补气血自通也,不可攻之,反增别病。
产后恶露不绝,由产时伤其经血虚损不足,不能收敛;或恶血不尽则好血难安;或阴虚内热,热搏血分;或挟于宿
冷致气血不调,并宜脉候参详。虚极者,但温补生新而瘀自化;虚不甚者,则为去瘀生新可也。
产后恶露不绝,若肝气热,不能生血,六味丸;若肝气虚,不能藏血,逍遥散;若脾气虚,不能摄血,六君子汤;
胃气下陷,不能统血,补中汤;若脾经郁热,血不归源,加味归脾汤;若肝经怒火,荣血妄行,加味四物汤;若气血两
虚,十全大补汤;若肝经风邪,其血沸腾,一味防风丸;若淫欲怒气,有伤冲任,血久不止者,六味地黄汤加阿胶、麦
冬、五味子。
头者,诸阳之会也。产后五脏皆虚,胃气亏弱,饮食不充,而虚阳失守,上凑于头,阳实阴虚,则令头痛。间有败
血头痛者,总浊气在上也。虽有身热、恶寒之候,只宜生化汤加减,慎不可用羌独等药。盖此由真阳亏损,浊阴得以犯
上,陷入髓海,为胀为痛,是非清阳升复,则浊阴不降,在里内起之邪为病,非若外入之邪可表而愈也。
恶露不下,是因为产后脏腑受到劳损伤害,气血虚弱亏损,或者胞络夹杂有宿存的寒气,或者在产后吹风受凉,风冷之邪乘虚侵入并与血液搏结,导致血液壅滞不能宣通,积蓄在体内,所以恶露排不出来。适宜采用温暖血脉、活血散瘀的方法,血液自然能够运行通畅。更有因为服用燥血药物导致血液枯涸、无法宣通瘀滞的情况,只需用温补气血的方法,气血自然通畅,不可使用攻下之法,否则会反而增加其他疾病。
产后恶露不绝(产后阴道出血持续不止),是因为分娩时损伤了经血,导致血虚不足,不能收敛;或者恶露(残留的瘀血)没有排尽,则新血难以安宁;或者阴虚导致内热,热邪搏结于血分;或者夹杂宿存寒气导致气血不调,这些都应当结合脉象进行详细诊察。如果虚损极其严重的,只需温补以生新血,瘀血自然化解;如果虚损不严重的,可以采用去除瘀血、生成新血的方法。
产后恶露不绝,如果是肝气热,不能生血,用六味丸;如果是肝气虚,不能藏血,用逍遥散;如果是脾气虚,不能统摄血液,用六君子汤;胃气下陷,不能统领血液,用补中汤;如果是脾经郁积热气,血液不能归源,用加味归脾汤;如果是肝经怒火,营血妄行,用加味四物汤;如果是气血两虚,用十全大补汤;如果是肝经受风邪侵袭,血液沸腾,用一味防风丸;如果是因纵欲或怒气损伤冲任二脉,导致出血长久不止的,用六味地黄汤加入阿胶、麦冬、五味子。
头部是诸阳经汇聚的地方。产后五脏都虚弱,胃气亏弱,饮食营养供给不足,导致虚阳失去固守,向上冲逆至头部,造成阳实阴虚的状况,从而引起头痛。间或有因败血(瘀血)引起的头痛,总归是浊气停留在上部的原因。虽然伴有身体发热、怕冷的症状,只适宜用生化汤加减治疗,千万不可使用羌活、独活等发散药。这是因为真阳亏损,浊阴之气得以侵犯上部,陷入髓海,导致胀满疼痛,这不是清阳之气升发恢复,浊阴之气就不能下降,这是由体内产生的邪气致病,不像外感入侵的邪气可以通过发汗解表而痊愈。
Lochia retention is caused by the damage to the Zang-Fu organs due to overwork after childbirth, leading to deficiency and depletion of Qi and Blood. It may also result from cold pathogens lingering in the uterine collaterals, or from exposure to wind and cold after delivery. The wind-cold pathogen takes advantage of the deficiency to contend with the blood, causing stagnation and obstruction, preventing its free flow, and accumulating inside the body, thus resulting in the retention of lochia. It is appropriate to employ methods that warm the vessels and invigorate blood circulation, so that the blood flows freely. In cases where dryness-inducing medicines have been taken, causing blood exhaustion and inability to resolve stagnation, only warming and tonifying Qi and Blood will restore free flow; attacking purgatives must be avoided, as they will only induce other diseases.
Postpartum lochia non-stop (prolonged postpartum bleeding) is caused by injury to the meridians and blood during delivery, leading to insufficiency and inability to consolidate; or if lochia (residual stasis) is not completely expelled, new blood cannot settle; or due to Yin deficiency generating internal heat, where heat contends with the blood level; or due to lingering cold causing disharmony of Qi and Blood. All these conditions should be carefully diagnosed by correlating pulse findings. In cases of extreme deficiency, only warming and tonifying to generate new blood will allow stasis to dissolve naturally; in cases of mild deficiency, methods to remove stasis and generate new blood are suitable.
For postpartum lochia non-stop: If Liver Qi is hot and unable to generate blood, use Liuwei Wan (Six-Ingredient Pill); if Liver Qi is deficient and unable to store blood, use Xiaoyao San (Free and Easy Wanderer Powder); if Spleen Qi is deficient and unable to control blood, use Liujunzi Tang (Six-Gentleman Decoction); if Stomach Qi sinks and fails to command blood, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if Spleen channel has stagnant heat causing blood to fail to return to its source, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction); if Liver channel fire causes Ying Blood to move recklessly, use Jiawei Siwu Tang (Modified Four-Substance Decoction); if both Qi and Blood are deficient, use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction); if Liver channel is invaded by Wind Pathogen causing blood to boil, use Yiwai Fangfeng Wan (Single Ingredient Saposhnikovia Pill); if excessive sexual activity or anger damages the Chong and Ren vessels, causing prolonged bleeding, use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) added with Ejiao (Donkey-hide Gelatin), Maidong (Ophiopogon Tuber), and Wuweizi (Schisandra Fruit).
The head is the convergence point of all Yang channels. After childbirth, the Five Zang organs are all deficient, Stomach Qi is weak, and dietary nourishment is insufficient, causing Deficient Yang to lose its anchor and rush upward to the head. This results in a state of Excess Yang and Deficient Yin, leading to headache. Occasionally, headaches are caused by stale blood (stasis), which is essentially turbid Qi residing in the upper part. Although symptoms such as fever and aversion to wind may appear, only Shenghua Tang (Generate the New Decoction) with modifications should be used; one must strictly avoid using Qianghuo (Notopterygium Rhizome) and Duhuo (Angelica Pubescens Root). This is because True Yang is damaged, allowing Turbid Yin to invade the upper region and sink into the Marrow Sea, causing distension and pain. Without the restoration of Clear Yang ascending, Turbid Yin cannot descend. This pathology arises from internal pathogens, unlike external pathogens which can be resolved through sweating and releasing the exterior.