《产孕集》曰∶产后小便不通,腹胀如鼓,闷乱不醒。盖缘未产前,内积冷气,遂致产时尿胞运动,用盐于
脐中填平,用葱白捣一指浓,安盐上,以艾柱饼上灸之,觉热气入腹内,实时便通,神验。
《大全》曰∶产后诸淋,因产有热气客脬中。内虚则频数,热则小便涩痛,故谓之淋。
《大全》曰∶有因产损,气虚挟热,热邪搏血,流渗胞中,血流小便而出,则为血淋。
陈无择曰∶治诸产前后淋,其法不同,产前当安胎,产后当去血。如冷、热、膏、石、气淋等,为治则一,
但量虚实用之。瞿麦、蒲黄是产后要药,唯当寻究所因,则不失机要矣。
慎斋按∶以上四条,序产后有小便不通,淋秘之证也。《三因》云∶产前当安胎,产后当去血。此二语为
吃紧。如产前淋,或由气虚不化,当用参、 补气安胎,不可过用渗利。产后淋,或由污血阻滞,当以瞿麦、
蒲黄为要药。若血虚热郁,当用六味丸、逍遥散,补阴养血,滋其化源,佐以导血药可也。
《大全》曰∶产后大小便不通,肠胃本挟热,因产水血俱下,津液燥竭,肠胃痞涩,热气结于肠胃,故令
大小便不通。有妇产下,患二便不通,饮牛乳而通,人乳尤善。
《大全》曰∶产后小便数者,气虚不能制也。
薛立斋曰∶产后遗尿,肾气不固也,五味子丸主之。若脾肾虚弱,用还少丹,仍以补中汤为主。虚寒加肉
果、补骨,或四神丸。若脾肾虚寒,用八味丸、四神丸佐之。
《产孕集》记载:产后小便不通,腹部胀大如鼓,神志昏乱不醒。这是因为产前体内积聚寒气,导致分娩时膀胱功能失调,可用盐填满脐中,将葱白捣成厚约一指,置于盐上,再用艾柱在葱上灸治,待感觉热气进入腹内,小便即刻通畅,效果神奇。
《妇人大全良方》记载:产后各种淋证,是因为分娩时热气侵入膀胱。体内虚弱则小便频数,有热则小便涩痛,所以称为淋。
《妇人大全良方》记载:有的因分娩损伤,气虚兼夹热邪,热邪与血相搏,渗入膀胱,血液随小便排出,就形成血淋。
陈无择说:治疗产前产后各种淋证,方法不同,产前应当安胎,产后应当祛瘀。如冷淋、热淋、膏淋、石淋、气淋等,治疗原则一致,只需根据虚实情况酌情使用。瞿麦、蒲黄是产后常用要药,只要探究病因,就不会错过关键。
慎斋按语:以上四条,叙述了产后有小便不通、淋证闭塞的症状。《三因方》说:产前当安胎,产后当去瘀。这两句话是关键。如产前淋证,或因气虚不能气化,当用人参、黄芪补气安胎,不可过度使用渗利药物。产后淋证,或因污血阻滞,当以瞿麦、蒲黄为要药。若血虚热郁,当用六味丸、逍遥散,补阴养血,滋生化之源,辅以导血药即可。
《妇人大全良方》记载:产后大小便不通,肠胃本挟热,因分娩时水血俱下,津液燥竭,肠胃痞塞涩滞,热气结于肠胃,所以导致大小便不通。有产妇分娩后患二便不通,饮用牛乳而通,人乳尤其好。
薛立斋说:产后遗尿,是肾气不固,用五味子丸主治。若脾肾虚弱,用还少丹,仍以补中益气汤为主。虚寒加肉果、补骨脂,或四神丸。若脾肾虚寒,用八味丸、四神丸辅助治疗。
*Chan Yun Ji* states: Postpartum urinary retention, with the abdomen distended like a drum, accompanied by mental confusion and unconsciousness. This is due to cold qi accumulating internally before delivery, causing dysfunction of the bladder during childbirth. Salt can be used to fill the umbilicus, green onion white parts pounded to a thickness of one finger placed on the salt, and moxa cones applied for moxibustion. When warmth is felt entering the abdomen, urination will immediately resume, which is highly effective.
*Da Quan* states: Various strangury syndromes after childbirth are caused by heat qi invading the bladder during delivery. Internal deficiency leads to frequent urination, while heat causes painful and difficult urination, hence termed strangury.
*Da Quan* states: Some cases result from injury during delivery, where Qi deficiency accompanies heat. Heat pathogen clashes with blood, seeping into the bladder, causing blood to flow out with urine, forming bloody strangury.
Chen Wuyue says: The treatment methods for strangury before and after childbirth differ. Before childbirth, the fetus should be stabilized; after childbirth, blood stasis should be removed. For cold, heat, paste, stone, and Qi strangury, the treatment principles are the same, but dosage should be adjusted according to deficiency or excess. Qumai (Dianthus Herba) and Puhuang (Typhae Pollen) are essential herbs for postpartum conditions. Investigating the cause ensures not missing the key points.
Shen Zhai's commentary: The above four items describe postpartum urinary retention and strangury obstruction. *San Yin Fang* states: "Before childbirth, stabilize the fetus; after childbirth, remove blood stasis." These two sentences are crucial. For prepartum strangury, if caused by Qi deficiency failing to transform fluids, use Renshen (Ginseng Radix) and Huangqi (Astragali Radix) to tonify Qi and stabilize the fetus; avoid excessive use of diuretics. For postpartum strangury, if caused by foul blood obstruction, Qumai and Puhuang are essential. If there is Blood deficiency with heat stagnation, use Liuwei Wan (Six-Ingredient Rehmannia Pill) and Xiaoyao San (Free and Easy Wanderer Powder) to tonify Yin and nourish Blood, supplementing with blood-guiding herbs.
*Da Quan* states: Postpartum retention of both urine and feces occurs because the intestines and stomach originally harbor heat. During delivery, fluids and blood descend together, leading to dryness and exhaustion of body fluids. Intestinal and gastric blockage and涩 (astringency/stagnation) occur, with heat qi knotting in the intestines and stomach, causing retention of both urine and feces. A woman who suffered from retention of both urine and feces after delivery was cured by drinking cow's milk; human milk is even better.
*Da Quan* states: Frequent urination after childbirth is due to Qi deficiency failing to control urination.
Xue Lizhai says: Postpartum enuresis is due to insecure Kidney Qi, treated with Wuweizi Wan (Schisandra Berry Pill). If Spleen and Kidney are weak, use Huanshao Dan (Return to Youth Elixir), primarily relying on Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For deficiency-cold, add Rouguo (Myristica Seed) and Buguzhi (Alpiniae Oxyphyllae Fructus), or Shenshen Wan (Four Gods Pill). For Spleen and Kidney deficiency-cold, use Bawei Wan (Eight-Ingredient Pill) and Shenshen Wan as adjuncts.