〔大〕产后中风恍惚者,由心主血,血气通于荣卫脏腑,遍循经络,产则血气俱伤,
五脏皆虚,荣卫不足,即为风邪所乘,则令心神恍惚不定也。
〔薛〕前证当大补血气为主,而佐以后方为善。盖风为虚极之假象也,固其本源,诸
病自退。若专治风,则速其危矣。一产妇患前证,盗汗自汗,发热晡热,面色黄白,四
肢畏冷,此气血俱虚,用八珍汤不应,更用十全大补、加味归脾二汤始应。后因劳怒,发
厥昏愦,左目牵紧,两唇抽动,小便自遗。余谓肝火炽盛,用十全大补加钓藤、山栀而安,
再用十全大补汤、辰砂远志丸而愈。
《千金》疗产后暴苦,心悸不定,言语错乱恍惚,皆因心虚所致。
茯苓(三两) 芍药(二两) 甘草 桂心 当归(各一两) 生姜(一两半) 麦门冬(去心,一升)
大枣(三十枚)
上为散,水三升,煎取一升,去渣分作两服。
《经效》疗产后心虚忪悸,志意不定,烦躁恍惚。
茯神 当归 黄芩 麦门冬(去心) 甘草 人参 芍药 酸枣仁 白鲜皮(各三两) 大
枣(七枚)
上为粗末,水二升,煮取七合,去渣温服。
琥珀散 治产后中风,恍惚语涩,心神烦闷,四肢不随。
琥珀(另研) 茯神(去木,各一两) 远志(去心) 石菖蒲 黄 防风 独活
人参(各去芦) 麦门冬(去心) 芎 桑寄生 赤芍药 羚羊角屑(各半两) 甘草(二钱半,炙)
上为 咀,每服五钱,水一中盏半,煎至一大盏,去渣温服,不拘时。
远志散 治产后中风,心神恍惚,言语错乱,烦闷,睡卧不安。
远志(去心) 防风(去芦,各一两) 麦门冬(去心) 酸枣仁(炒) 桑寄生 独活(去芦)
桂心 当归(去芦,炒) 茯神(去木) 羚羊角屑(各七钱半) 甘草(炙,半两)
上为 咀,每服五钱,煎服法同前。
天麻丸 疗产后中风,恍惚语涩,四肢不随。
天麻 朱砂(水飞) 防风 羌活(去芦,各一两) 僵蚕(炒,七钱半) 干蝎(炒) 白附子(炮)
五灵脂(炒,各半两) 雄雀粪(炒) 牛黄(另研,各二钱半)
上为细末,糯米饭为丸,如梧子大。每服二三十丸,薄荷酒送下,日进二服。
辰砂远志丸 主产后中风,消风化痰,安神镇心。
石菖蒲 远志肉(甘草煮) 人参 茯神(去木) 辰砂(各五钱) 川芎 山药 铁粉 麦门
冬(去心) 细辛 天麻 半夏(汤泡) 南星 白附子(各一两)
上为末,姜汁煮,糊丸如绿豆大。别以朱砂为衣。每服三十丸,夜卧生姜汤吞下。
【大论】产后出现中风且神志恍惚的症状,是因为心主血脉,气血通过荣卫运行于脏腑,并遍循经络。分娩时气血俱伤,导致五脏皆虚,荣卫不足,风邪便乘虚而入,致使心神不宁、神志恍惚不定。
【薛己按语】上述证候应当以大补气血为主,并辅以相应的方剂治疗为妙。因为风象往往是极度虚弱所呈现的假象,固护其本源(气血),各种病症自然消退。如果专门针对“风”进行治疗,反而会加速危重情况的发生。曾有一位产妇患此证,表现为盗汗、自汗、发热及午后潮热,面色黄白,四肢畏冷,这是气血俱虚的表现。起初使用八珍汤无效,后来改用十全大补汤和加味归脾汤才见效。之后因劳累和愤怒,出现昏厥、神志不清,左眼牵引紧绷,双唇抽动,小便失禁。我认为是肝火炽盛,使用十全大补汤加入钩藤、山栀后病情安定,再服用十全大补汤和辰砂远志丸而痊愈。
《千金方》治疗产后突然悲伤哭泣,心悸不安,言语错乱恍惚,这些都是因心气虚弱所致。
茯苓(三两) 芍药(二两) 甘草 桂心 当归(各一两) 生姜(一两半) 麦门冬(去心,一升)
大枣(三十枚)
以上药物研为散剂,用水三升,煎取一升,去渣后分两次温服。
《经效方》治疗产后心气虚弱导致的惊悸,意志不定,烦躁恍惚。
茯神 当归 黄芩 麦门冬(去心) 甘草 人参 芍药 酸枣仁 白鲜皮(各三两)
大枣(七枚)
以上药物捣成粗末,用水二升,煮取七合,去渣后温服。
琥珀散:治疗产后中风,神志恍惚,言语涩滞,心神烦闷,四肢不能随意运动。
琥珀(另研细) 茯神(去木心,各一两) 远志(去心) 石菖蒲 黄芪 防风 独活
人参(各去芦头) 麦门冬(去心) 川芎 桑寄生 赤芍药 羚羊角屑(各半两) 甘草(二钱半,炙烤)
以上药物切碎,每次服用五钱,用水一中盏半,煎至一大盏,去渣后温服,不拘泥于固定时间。
远志散:治疗产后中风,心神恍惚,言语错乱,烦闷,睡眠卧息不安。
远志(去心) 防风(去芦头,各一两) 麦门冬(去心) 酸枣仁(炒制) 桑寄生 独活(去芦头)
桂心 当归(去芦头,炒制) 茯神(去木心) 羚羊角屑(各七钱半) 甘草(炙烤,半两)
以上药物切碎,每次服用五钱,煎服方法同前。
天麻丸:治疗产后中风,神志恍惚,言语涩滞,四肢不能随意运动。
天麻 朱砂(水飞法研磨) 防风 羌活(去芦头,各一两) 僵蚕(炒制,七钱半) 干蝎(炒制) 白附子(炮制)
五灵脂(炒制,各半两) 雄雀粪(炒制) 牛黄(另研细,各二钱半)
以上药物研为细末,用糯米饭做丸,如梧桐子大小。每次服用二三十丸,用薄荷酒送下,每日服用两次。
辰砂远志丸:主治产后中风,祛风化痰,安神镇心。
石菖蒲 远志肉(甘草水煮) 人参 茯神(去木心) 辰砂(各五钱) 川芎 山药 铁粉 麦门
冬(去心) 细辛 天麻 半夏(汤泡) 南星 白附子(各一两)
以上药物研为末,用姜汁煮糊做丸,如绿豆大小。另外以朱砂为衣。每次服用三十丸,夜间卧床时用生姜汤吞服。
[Da Lun] Postpartum wind-stroke accompanied by mental confusion arises because the Heart governs blood vessels, and Qi and Blood circulate through Ying-Wei (Nutritive and Defensive systems) to the Zang-Fu organs, traversing all meridians. Childbirth injures both Qi and Blood, leading to deficiency in all five Zang organs and insufficiency of Ying-Wei. Consequently, Wind pathogen takes advantage of this deficiency, causing the Heart Spirit to become unsettled and resulting in mental confusion and instability.
[Xue Ji's Commentary] For the aforementioned syndrome, the primary treatment should be greatly tonifying Qi and Blood, assisted by the following prescriptions. This is because the manifestation of "Wind" is often a false image of extreme deficiency; securing the root source (Qi and Blood) allows various diseases to recede spontaneously. If one treats solely for "Wind," it will hasten the danger. A certain puerpera suffered from this syndrome, presenting with night sweats, spontaneous sweating, fever, afternoon tidal fever, yellowish-white complexion, and cold intolerance in the four limbs. This indicated joint deficiency of Qi and Blood. The initial use of Bazhen Tang (Eight-Treasure Decoction) was ineffective; subsequently, Shiquan Dabu Tang (Ten-Ingredient Great Supplement Decoction) and Jiawei Guipi Tang (Modified Spleen-Restoring Decoction) were employed, yielding results. Later, due to labor and anger, she experienced syncope and unconsciousness, left eye traction and tightness, twitching of both lips, and urinary incontinence. I diagnosed it as blazing Liver Fire, and used Shiquan Dabu Tang added with Gouteng (Uncaria Ramulus) and Zhizi (Gardeniae Fructus), which stabilized her condition. She was then cured by continuing with Shiquan Dabu Tang and Chensha Yuanzhi Wan (Cinnabar Polygalae Pill).
Qianjin Fang treats sudden sorrow and weeping after childbirth, palpitations with instability, disordered speech, and mental confusion, all caused by Heart deficiency.
Fuling (Poria, 3 liang) Shaoyao (Peony Root, 2 liang) Gancao (Licorice Root) Guixin (Cinnamon Twig) Danggui (Angelicae Sinensis Radix) (each 1 liang) Shengjiang (Fresh Ginger, 1.5 liang) Maimendong (Ophiopogonis Radix, heart removed, 1 sheng)
Dazao (Jujubae Fructus, 30 pieces)
Grind the above into powder. Add 3 sheng of water, decoct to obtain 1 sheng, remove dregs, and divide into two doses.
Jingxiao Fang treats postpartum Heart deficiency causing palpitations (Songji), indecisiveness, irritability, and mental confusion.
Fushen (Poria with Hostwood) Danggui Huangqin (Scutellariae Radix) Maimendong (heart removed) Gancao Renshen (Ginseng Radix) Shaoyao Suanzaoren (Ziziphi Spinosae Semen) Baixianpi (Dictamni Cortex) (each 3 liang)
Dazao (7 pieces)
Grind the above into coarse powder. Add 2 sheng of water, boil to obtain 7 he, remove dregs, and take warm.
Hupo San (Amber Powder): Treats postpartum wind-stroke, mental confusion, slurred speech, mental restlessness, and immobility of the four limbs.
Hupo (Amber, ground separately) Fushen (Poria with Hostwood, heart removed, each 1 liang) Yuanzhi (Polygalae Radix, heart removed) Shichangpu (Acori Tatarinowii Rhizoma) Huangqi (Astragali Radix) Fangfeng (Saposhnikoviae Radix) Duhuo (Angelicae Pubescentis Radix)
Renshen (Ginseng Radix, each de-gorged) Maimendong (Ophiopogonis Radix, heart removed) Xiong (Ligustici Rhizoma et Radix) Sangjisheng (Taxilli Herba) Chi Shaoyao (Red Peony Root) Lingyangjiaoxie (Saiga Tataricae Cornu) (each half liang) Gancao (Licorice Root, 2.5 qian, roasted)
Cut the above into small pieces. Each dose is 5 qian, decocted with 1.5 zhans of water until reduced to 1 zhan. Remove dregs and take warm, without restriction on time.
Yuanzhi San (Polygalae Powder): Treats postpartum wind-stroke, mental confusion, disordered speech, restlessness, and restless sleep.
Yuanzhi (Polygalae Radix, heart removed) Fangfeng (Saposhnikoviae Radix, de-gorged, each 1 liang) Maimendong (Ophiopogonis Radix, heart removed) Suanzaoren (Ziziphi Spinosae Semen, stir-fried) Sangjisheng (Taxilli Herba) Duhuo (Angelicae Pubescentis Radix, de-gorged)
Guixin (Cinnamon Twig) Danggui (Angelicae Sinensis Radix, de-gorged, stir-fried) Fushen (Poria with Hostwood, heart removed) Lingyangjiaoxie (Saiga Tataricae Cornu) (each 7.5 qian) Gancao (Licorice Root, roasted, half liang)
Cut the above into small pieces. Each dose is 5 qian. Decocting method is the same as above.
Tianma Wan (Gastrodia Pill): Treats postpartum wind-stroke, mental confusion, slurred speech, and immobility of the four limbs.
Tianma (Gastrodiae Rhizoma) Zhusha (Cinnabaris, water-ground) Fangfeng (Saposhnikoviae Radix) Qianghuo (Notopterygii Rhizoma et Radix, de-gorged, each 1 liang) Jiangcan (Bombyx Batryticatus, stir-fried, 7.5 qian) Ganxie (Scorpio, stir-fried) Baifuzi (Typhonii Rhizoma, processed)
Wulingzhi (Trogopterori Faeces, stir-fried, each half liang) Xiongquefen (Excrement of Male Sparrow, stir-fried) Niuhuang (Bovis Calculus, ground separately, each 2.5 qian)
Grind the above into fine powder. Form pills using glutinous rice paste, sized like wutong seeds. Each dose is 20-30 pills, taken with Bohe Jiu (Mint Wine), twice daily.
Chensha Yuanzhi Wan (Cinnabar Polygalae Pill): Primarily treats postpartum wind-stroke, dispels wind and resolves phlegm, calms the spirit and anchors the Heart.
Shichangpu (Acori Tatarinowii Rhizoma) Yuanzhi Rou (Polygalae Radix flesh, boiled with Gancao) Renshen (Ginseng Radix) Fushen (Poria with Hostwood, heart removed) Chensha (Cinnabaris) (each 5 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma) Shanyao (Dioscoreae Rhizoma) Tie Fen (Ferrum) Maimendong (Ophiopogonis Radix, heart removed) Xixin (Asari Radix et Rhizoma) Tianma (Gastrodiae Rhizoma) Banxia (Pinelliae Rhizoma, soaked in boiling water) Nanxing (Arisaematis Rhizoma) Baifuzi (Typhonii Rhizoma, each 1 liang)
Grind the above into powder. Cook with Jiangzhi (Ginger Juice) and form pills using paste, sized like mung beans. Coat separately with Zhusha (Cinnabaris). Each dose is 30 pills, swallowed with Shengjiang Tang (Ginger Decoction) before sleep.