薛立斋曰∶前证属胃气虚寒之恶候。如用丁香散未应,急投参附汤,亦有生者。若产后呃逆,有寒热虚实
之不同。如寒者,丁香、姜、桂。热者,宜干柿、竹茹。虚者,宜人参、附子。实者,宜香附、橘皮。误施则
有噬脐之悔。
慎斋按∶以上二条,序产后有呃逆之证也。经云∶病深者,其声哕。哕即呃逆也。诸病见之为恶候,况产后
犯此。有虚无实,有寒无热矣。立斋必兼热实论,殊谬。若古方治产后呃逆,又兼败血瘀停胃逆,用丁香豆蔻
散,煎桃仁、吴茱汤下之。病机又不可不知。
郭稽中曰∶产后恶露不快,败血停凝,上熏于肺,亦令喘急,但服夺命丹,血去而喘自定。又产后败血冲
心,胸满上喘,命在须臾,服血竭散,或参苏饮。治产后血入于肺,面黑发喘欲死,人参一两,苏木二两。
娄全善曰∶产后喘者多死,有产二月,洗浴即气喘,坐不得卧者,五月恶风,得暖稍缓,用丹皮、桃仁、
桂枝、茯苓、干姜、枳实、浓朴、桑皮、紫苏、五味、栝蒌煎服,即卧,其痰如失,作污血感寒治也。
郭稽中曰∶产后喉中气急喘促者何?答曰∶荣者,血也;卫者,气也。荣行脉中,卫行脉外,相随上下,
谓之荣卫。因产所下过多,荣血暴竭,卫气无主,独聚肺中,故令喘。此名孤阳绝阴,为难治。
薛立斋说:上述证候属于胃气虚寒的危重恶候。如果服用丁香散后没有见效,应立即投用参附汤,也有治愈的案例。如果是产后呃逆,有寒、热、虚、实的不同区别。如果是寒证,宜用丁香、生姜、桂枝。如果是热证,宜用干柿、竹茹。如果是虚证,宜用人参、附子。如果是实证,宜用香附、橘皮。误用治疗方法则会有追悔莫及的后果。
慎斋按语:以上两条,叙述了产后出现呃逆的证候。《内经》说:病邪深入的人,会出现哕(呃逆)的声音。哕就是呃逆。各种疾病中出现这种症状都是恶候,更何况是产后发生这种情况。产后只有虚无实,只有寒而无热。薛立斋必定兼论热证和实证,这是极大的谬误。至于古方治疗产后呃逆,又兼有败血瘀滞停于胃中导致气逆的情况,使用丁香豆蔻散,煎煮桃仁、吴茱萸汤送服。疾病的机理又是不可不知的。
郭稽中说:产后恶露排出不畅,败血停滞凝结,向上熏蒸于肺,也会导致喘急,只需服用夺命丹,血液去除了而喘息自然平定。另外,产后败血冲心,胸部胀满并向上喘息,性命在顷刻之间危险,服用血竭散,或者参苏饮。治疗产后血液进入肺部,面色发黑且喘息欲死的情况,用人参一两,苏木二两。
娄全善说:产后气喘的多为死证,有产妇在产后两个月,洗浴后即出现气喘,无法坐卧的,五月时怕风,得到温暖稍缓解,使用丹皮、桃仁、桂枝、茯苓、干姜、枳实、厚朴、桑白皮、紫苏、五味子、栝蒌煎服,就能躺下休息,其痰液如同消失一样,这是作为污血感寒来治疗的。
郭稽中说:产后喉中气息急促、喘息迫促是什么原因?回答说:荣(营气),是血;卫(卫气),是气。荣行于脉中,卫行于脉外,相随上下运行,称为荣卫。因为生产时失血过多,荣血突然枯竭,卫气失去了主宰,独自聚集在肺中,所以导致气喘。这名叫孤阳绝阴,属于难治之症。
Xue Lizhai stated: The aforementioned syndrome belongs to the ominous prognosis of deficiency-cold in Stomach Qi (Stomach Qi). If Dingxiang San (Clove Powder) yields no effect, Shenfu Tang (Ginseng and Aconite Decoction) should be administered urgently; there are cases of survival. Regarding postpartum hiccups (epigastric reflux), there are differences between cold, heat, deficiency, and excess patterns. For cold patterns, Dingxiang (Clove), Shengjiang (Fresh Ginger), and Guizhi (Cinnamon Twig) are indicated. For heat patterns, Qianshi (Dried Persimmon) and Zhuru (Bamboo Shavings) are indicated. For deficiency patterns, Renshen (Ginseng Root) and Fuzi (Prepared Aconite Lateral Root) are indicated. For excess patterns, Xiangfu (Cyperi Rhizome) and Jupi (Tangerine Peel) are indicated. Misapplication of treatment will lead to regret that cannot be remedied.
Shenzhen's commentary: The above two passages describe the syndrome of postpartum hiccups (epigastric reflux). The Classic states: "In severe diseases, the sound is yue (hiccups/epigastric reflux)." Yue refers to hiccups (epigastric reflux). Its appearance in various diseases is an ominous sign, let alone occurring after childbirth. Postpartum conditions involve only deficiency, not excess; only cold, not heat. Xue Lizhai's insistence on discussing heat and excess patterns is fundamentally erroneous. As for ancient formulas treating postpartum hiccups (epigastric reflux) complicated by stagnant blood obstructing the Stomach causing rebellious Qi, Dingxiang Doukou San (Clove and Cardamom Powder) is used, decocted with Taoren (Peach Seed) and Wuzhuyu (Evodia Fruit) soup for administration. The pathogenesis must also be understood.
Guo Jizhong stated: When lochia discharge is unsmooth after childbirth, and敗血 (dead blood/stagnant blood) stagnates and coagulates, ascending to fumigate the Lung, it causes panting and urgency. Simply administering Duoming Dan (Life-Snatching Pill) will remove the blood, and the panting will settle naturally. Furthermore, if postpartum stagnant blood rushes to the Heart, causing chest fullness and upward panting, with life hanging in the balance, Xuexie San (Dragon's Blood Powder) or Sushen Yin (Perilla and Ginseng Infusion) should be taken. To treat postpartum blood entering the Lung, presenting with black complexion and fatal panting, use one liang of Renshen (Ginseng Root) and two liang of Sumu (Sappan Wood).
Lou Quanshan stated: Most cases of postpartum panting result in death. There was a case of a woman who, two months after delivery, developed panting immediately after bathing, unable to sit or lie down. In the fifth month, she feared wind, but felt slightly relieved by warmth. She was treated with a decoction of Danpi (Moutan Bark), Taoren (Peach Seed), Guizhi (Cinnamon Twig), Fuling (Poria), Ganjiang (Dried Ginger), Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Sangbai Pi (Mulberry Root Bark), Zisu (Perilla Leaf), Wuweizi (Schisandra Berry), and Gualou (Trichosanthes Fruit). After taking it, she could lie down, and her phlegm seemed to vanish. This was treated as stagnant blood affected by cold.
Guo Jizhong asked: What is the cause of urgent breathing and panting from the throat after childbirth? The answer is: Ying (Nutritive Qi) is blood; Wei (Defensive Qi) is Qi. Ying circulates within the vessels, while Wei circulates outside the vessels, moving up and down together, referred to as Ying-Wei. Because excessive blood loss occurs during childbirth, Ying blood suddenly exhausts, leaving Wei Qi without a master. It gathers exclusively in the Lung, thus causing panting. This is named Gu Yang Jue Yin (Solitary Yang and Absolute Yin), which is difficult to treat.