〔大〕心主身之血脉,因产伤耗血脉,心气虚则败血停积,上干于心,心不受触,遂
致心中烦躁,卧起不安,乍见鬼神,言语颠错,医人不识,呼为风邪,如此治疾,必不
得愈,但服调经散,每服加龙脑一捻,得睡即安。
〔薛〕前证若败血停滞,用调经散。若血虚发热,用八珍加炮姜。若心血虚损,用
柏子仁散。大抵此证皆心脾血少所致,但调补胃气,则痰清而神自安矣。若果系鬼祟所
附,即灸鬼哭可愈。其或不起者,多因豁痰降火,攻伐之过也。一产妇患前证,或用
调经散,愈而复作,仍服前药,益甚,痰涎上涌,朝寒暮热。余朝用八珍散,夕用加味
归脾汤,各五十余剂而愈。
云岐治产后发热狂言奔走,脉虚大者,四物汤加柴胡;如不愈,加甘草、柴胡、生地
黄等分煎服亦可。
《广济》治产后血晕,心闷不识人,神言鬼语,气急欲绝。(见血晕。)
调经散
没药 琥珀(并细研) 桂心(各一钱) 芍药 当归(各二钱半) 麝香(研) 细辛(各半钱)
上为末,每服半钱,生姜汁、温酒各少许调服。
茯神散 治产后血邪,心神恍惚,言语失度,睡卧不安。
茯神(一两,去皮木) 人参 龙齿(研) 虎珀(研) 赤芍药 黄 牛膝(各七钱半)
生地黄(一两半) 桂心(半两)
上为末,每服三钱,水一盏,煎至七分,不拘时,去渣温服。
治方产一日,言语颠倒,用苏合香丸一钱,以童便调服即苏。
柏子仁散 治产后狂言乱语,皆因内虚,败血挟邪气攻心。
柏子仁 远志(去心) 人参 桑寄生 防风 琥珀(别研) 当归(焙) 生地黄(焙)
甘草(各等分)
上为粗末,先用白羊心一个切片,以水一大盏半,先煮至九分,去羊心,入药末五
钱,煎至六分,去渣无时服。
与前颠狂谵语门参看。
【大】心主宰身体的血脉。因为分娩损伤耗伤了血脉,心气虚弱导致败血(产后瘀血)停积,上扰于心,心脏不能承受这种干扰,从而导致心中烦躁,坐卧不安,突然看见鬼神,言语错乱颠倒。医生如果不认识这是病机,误称为风邪,这样治疗疾病,必定无法痊愈。只需服用调经散,每次服药时加入一捻龙脑(冰片),能够入睡即能安宁。
【薛】上述证候如果是败血停滞,使用调经散。如果是血虚发热,使用八珍汤加炮姜。如果是心血虚损,使用柏子仁散。大抵这类证候都是由于心脾血少所致,只要调理补益胃气,那么痰浊自清而神志自然安定。如果确实是鬼祟附体,即可灸治鬼哭穴可愈。那些不能治愈的,多是因为过度使用豁痰降火、攻伐的药物所致。有一位产妇患上述证候,有人用调经散治疗,好了之后又复发,仍然服用前药,病情更加严重,痰涎上涌,早晨恶寒傍晚发热。我早上用八珍散,晚上用加味归脾汤,各服用五十余剂而痊愈。
云岐治疗产后发热、胡言乱语、奔走狂躁,脉象虚大的患者,用四物汤加柴胡;如果无效,加甘草、柴胡、生地黄等分煎服也可以。
《广济》方治疗产后血晕,心胸闷塞不认识人,说神说鬼的话,气息急促快要断绝。(详见“血晕”条。)
调经散
没药、琥珀(都细细研磨)、桂心(各一钱)、芍药、当归(各二钱半)、麝香(研磨)、细辛(各半钱)。
以上药物研为末,每次服用半钱,用生姜汁、温酒各少许调和服用。
茯神散 治疗产后血邪,心神恍惚,言语失去法度,睡卧不安。
茯神(一两,去皮木)、人参、龙齿(研磨)、虎珀(研磨)、赤芍药、黄芩、牛膝(各七钱半)、生地黄(一两半)、桂心(半两)。
以上药物研为末,每次服用三钱,用水一盏,煎至七分,不拘时间,去渣温服。
治疗方:产后第一天,言语颠倒,用苏合香丸一钱,用童子尿调和服用即苏醒。
柏子仁散 治疗产后胡言乱语,都是因为内里虚弱,败血挟带邪气攻心。
柏子仁、远志(去心)、人参、桑寄生、防风、琥珀(另外研磨)、当归(焙干)、生地黄(焙干)、甘草(各等分)。
以上药物制成粗末,先用一个白羊心切片,用水一大盏半,先煮至九分,去掉羊心,放入药末五钱,煎至六分,去渣随时服用。
与前文“颠狂谵语”门参看。
[Da] The Heart governs the blood vessels of the body. Due to childbirth injury and depletion of blood vessels, Heart Qi deficiency causes "Bai Xue" (postpartum stagnant blood) to accumulate and ascend to disturb the Heart. The Heart cannot tolerate this disturbance, resulting in mental restlessness, inability to lie down or sit still comfortably, sudden hallucinations of seeing ghosts and spirits, and disordered speech. If physicians do not recognize the pathology and mistakenly attribute it to Wind Evil, treating the disease in this manner will certainly fail to cure it. One should simply administer Tiao Jing San (Regulate Menstruation Powder), adding a pinch of Long Nao (Borneol) to each dose; sleep indicates peace and recovery.
[Xue] For the aforementioned syndrome caused by stagnant "Bai Xue", use Tiao Jing San. For fever due to Blood deficiency, use Ba Zhen Tang (Eight Treasures Decoction) with Pao Jiang (Charred Ginger). For Heart Blood deficiency and damage, use Bai Zi Ren San (Biota Seed Powder). Generally, these syndromes are caused by insufficient Blood in the Heart and Spleen. By regulating and tonifying Stomach Qi, phlegm will clear and the Spirit (Shen) will naturally settle. If it is indeed possession by evil spirits, moxibustion on the Guiku acupoint can cure it. Cases that do not recover are often due to excessive use of herbs that resolve phlegm, descend fire, and attack/evacuate. A postpartum patient suffered from the aforementioned syndrome; after using Tiao Jing San, she recovered but relapsed. Continuing the previous medication worsened her condition, with phlegm-saliva surging upward, chills in the morning, and heat in the evening. I administered Ba Zhen San (Eight Treasures Powder) in the morning and Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) in the evening, each for over fifty doses, until she recovered.
Yun Qi treated postpartum fever with delirious speech and running about wildly, where the pulse was deficient and large, using Si Wu Tang (Four Substances Decoction) plus Chai Hu (Bupleurum); if ineffective, adding Gan Cao (Licorice), Chai Hu, and Sheng Di Huang (Rehmannia Root) in equal parts and decocting for administration is also acceptable.
Guang Ji Fang treats postpartum Xue Yun (Blood Fainting), chest oppression, inability to recognize people, speaking as if possessed by spirits, and rapid breathing nearing cessation. (See entry on Xue Yun.)
Tiao Jing San (Regulate Menstruation Powder)
Moyao (Myrrha Resina), Hupo (Succinitum) (both finely ground), Guixin (Cinnamomi Cortex), Shaoyao (Paeoniae Radix), Danggui (Angelicae Sinensis Radix) (each 1 qian), Shexiang (Moschus), Xixin (Asari Radix et Rhizoma) (each 0.5 qian).
Grind the above into powder. Each dose is 0.5 qian, mixed with a small amount of fresh ginger juice and warm wine for administration.
Fushen San (Poria Cocos Powder)
Treats postpartum Blood-Evil causing vague spirit, loss of verbal propriety, and restless sleep.
Fushen (Poria Cum Radice Xylomi, 1 liang, peeled), Renshen (Ginseng Radix), Longchi (Draconis Os), Hupo (Succinitum), Chishao Yao (Paeoniae Radix Rubra), Huang Qin (Scutellariae Radix), Niuxi (Achyranthis Bidentatae Radix) (each 7.5 qian), Sheng Di Huang (Rehmanniae Radix, 1.5 liang), Guixin (Cinnamomi Cortex, 0.5 liang).
Grind the above into powder. Each dose is 3 qian, decocted with one lamp of water until reduced to 0.7 parts. Take warm at any time, straining the dregs.
Treatment Formula: On the first day postpartum, if speech is inverted/disordered, use Su He Xiang Wan (Styrax Pill) 1 qian, mixed with Tong Bian (Child's Urine) for administration to restore consciousness.
Bai Zi Ren San (Biota Seed Powder)
Treats postpartum delirious speech, all caused by internal deficiency where "Bai Xue" carries pathogenic factors to attack the Heart.
Bai Zi Ren (Biota Semen), Yuanzhi (Polygalae Radix, heart removed), Renshen (Ginseng Radix), Sangjisheng (Taxilli Herba), Fangfeng (Saposhnikoviae Radix), Hupo (Succinitum, separately ground), Danggui (Angelicae Sinensis Radix, roasted), Sheng Di Huang (Rehmanniae Radix, roasted), Gancao (Glycyrrhizae Radix et Rhizoma) (equal parts).
Grind the above into coarse powder. First, slice one white sheep heart. Boil in one and a half lamps of water until reduced to 0.9 parts. Remove the sheep heart, add five qian of the herbal powder, and decoct until reduced to 0.6 parts. Strain and take at any time.
Refer to the section on Dian Kuang Chan Yu (Manic Delirium) for comparison.