(微)风,(亡血之后,阳邪客入,则)四肢苦烦热。(然此症,当其头痛之与不痛。若)头痛者,(是风未全变为热,)
与小柴胡汤;(以解之。若)头不痛但烦者,(则已全变为热,热盛则虫生,势所必至,以)此汤主之。
(长孙心典禀)按∶附方者《金匮》本书阙载,而《千金》、《外台》等书载之,其云出自《金匮》,后人别之曰附方。
附方∶《千金》内补当归建中汤,治妇人产后虚羸不足,腹中刺痛不止,吸吸少气;或苦少腹中急,摩痛引腰背,不
能食饮。产后一月,日得服四、五剂为善,令人强壮宜。
徐忠可云∶产后虚羸不足,先因阴虚,后并阳虚。补阴则寒凝,补阳则气壅。盖后天以中气为主,故治法亦出于建
中,但加当归即偏于内,故曰内补当归建中汤。谓腹中刺痛不止,血少也;吸吸少气,阳弱也;故将桂枝、生姜、当归
之辛温,以行其荣卫之气;甘草、白芍,以养其脾阴之血;而以饴糖、大枣峻补中气,则元气自复,而羸者丰,痛者止
也。然桂枝于阴阳内外,无所不通,犹恃当归善入阴分治带下之病,故又主少腹急,摩痛引腰背,不能饮食者。盖带下
病去,而中气自强也。曰产后一月,日得服四五剂为善;谓宜急于此调之,庶无后时之叹!然药味和平,可以治疾,可
以调补,故又曰∶令人强壮宜。其云大虚加饴糖,以虚极无可支撑,惟大甘专于补脾,脾为五脏六腑之母,止此一条,
可以得其生路也。其去血过多,崩伤内衄,方加干地黄、
阿胶,以其所伤原偏于阴,故特多加阴药,非产后必宜用地黄、阿胶也。
微风(侵袭),在亡血之后,阳邪客入体内,则四肢感到烦热。(然而此症,需根据头痛与否来辨别。如果)头痛的,(说明风邪尚未完全转化为热邪,)给予小柴胡汤;(以解除病邪。如果)头不痛但心烦的,(则说明已完全转化为热邪,热盛则生虫,这是必然的趋势,用)此方主治。
(长孙心典禀)按语:附方在《金匮》原书中缺失记载,而《千金方》、《外台秘要》等书中有所记载,声称出自《金匮》,后人将其单独列为“附方”。
附方:《千金方》内补当归建中汤,治疗妇人产后身体虚弱消瘦、气血不足,腹中刺痛不止,呼吸短促气少;或者苦于小腹拘急疼痛,牵引腰背作痛,不能进食饮水。产后一个月内,每天服用四到五剂为宜,能使人强壮适宜。
徐忠可说:产后虚弱消瘦不足,起初是因为阴虚,后来导致阳虚。单纯补阴会导致寒凝,单纯补阳会导致气机壅滞。大概后天之本以中气为主,所以治法也出于建中汤,但加入当归就偏向于内部调理,所以称为内补当归建中汤。说腹中刺痛不止,是因为血少;呼吸短促气少,是因为阳气虚弱;所以用桂枝、生姜、当归的辛温之性,来运行营卫之气;甘草、白芍,来滋养脾阴之血;并用饴糖、大枣峻补中气,那么元气自然恢复,瘦弱者变得丰满,疼痛者停止。然而桂枝在阴阳内外无所不通,仍然依赖当归善于进入阴分治疗带下病,所以又主治小腹拘急,疼痛牵引腰背,不能饮食的情况。大概带下病去除,中气自然强盛。说产后一个月,每天服用四五剂为宜;意思是应当在此时紧急调理,以免有后悔莫及的叹息!然而药味平和,可以治病,可以调补,所以又说:使人强壮适宜。文中说大虚加饴糖,因为虚极到了无法支撑的地步,只有大甘之品专门补脾,脾是五脏六腑的母亲,仅这一条,就可以找到生机。如果失血过多,崩漏或内衄,方中加干地黄、阿胶,因为所伤原本偏于阴分,所以特意多加滋阴药物,并非产后必定适合用地黄、阿胶。
(With) slight wind (invasion), after loss of blood, when pathogenic Yang qi invades the interior, the four limbs suffer from vexation and heat. (However, for this syndrome, one must distinguish based on the presence or absence of headache. If there is a headache,) it indicates that the Wind pathogen has not fully transformed into Heat; administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) to resolve it. (If there is no headache but only vexation,) it indicates that the condition has fully transformed into Heat; excessive Heat inevitably leads to the generation of parasites, which is an inevitable trend; treat with this formula.
(Changsun Xindian's) Commentary: The "Attached Formulas" are missing from the original text of *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), but are recorded in books such as *Qianjin Yaofang* (Prescriptions Worth a Thousand Gold) and *Waitai Miyao* (Secret Essentials of the Outer Cabinet). They claim origin from *Jingui*, and later scholars categorized them separately as "Attached Formulas."
Attached Formula: Neibu Danggui Jianzhong Tang (Internal Nourishing Angelica Decoction to Establish the Middle) from *Qianjin Yaofang*. It treats women postpartum with deficiency, emaciation, and insufficiency, unceasing stabbing pain in the abdomen, shortness of breath with shallow breathing; or suffering from urgency and pain in the lower abdomen, pain radiating to the back, and inability to eat or drink. Within one month postpartum, taking four to five doses per day is advisable, as it promotes strength and suitability.
Xu Zhongke stated: Postpartum deficiency and emaciation initially stem from Yin deficiency, which subsequently leads to Yang deficiency. Tonifying Yin alone causes Cold coagulation, while tonifying Yang alone causes Qi stagnation. Generally, the acquired constitution relies primarily on Middle Qi; thus, the treatment method derives from Jianzhong Tang. However, adding Dang Gui shifts the focus inward, hence the name Internal Nourishing Angelica Decoction to Establish the Middle. The unceasing stabbing pain in the abdomen indicates Blood deficiency; shallow breathing and shortness of breath indicate weak Yang Qi. Therefore, the acrid-warm properties of Guizhi (Cinnamon Twig), Shengjiang (Fresh Ginger), and Dang Gui (Angelica Root) are used to circulate Ying and Wei Qi; Gancao (Licorice Root) and Baishao (White Peony Root) nourish the Spleen Yin and Blood; while Yitang (Maltose) and Dazao (Jujube) vigorously tonify Middle Qi. Consequently, Yuan Qi recovers naturally, the emaciated become robust, and the pain ceases. Although Guizhi penetrates both Yin and Yang internally and externally, it still relies on Dang Gui’s ability to enter the Yin aspect to treat leukorrhea; thus, it also treats urgency in the lower abdomen, pain radiating to the back, and inability to eat. Once leukorrhea is resolved, Middle Qi becomes strong. The statement "within one month postpartum, taking four to five doses per day is advisable" implies urgent regulation at this time to avoid future regret. Since the herbs are mild, they can treat disease and regulate/tonify, hence it is said to promote strength and suitability. Regarding "for severe deficiency, add Yitang," this is because extreme deficiency leaves no support; only sweet flavors specifically tonify the Spleen. As the Spleen is the mother of the five Zang and six Fu organs, this single principle provides a path to life. For excessive blood loss, metrorrhagia, or internal epistaxis, add Dihuang (Rehmannia Root) and Ejiao (Donkey-hide Gelatin) because the injury primarily affects the Yin aspect; thus, Yin-nourishing herbs are specifically increased. This does not mean Dihuang and Ejiao are necessarily suitable for all postpartum cases.