夫产后霍乱,气血俱伤,脏腑虚损;或饮食不消、触冒风冷所致。阴阳不顺,清浊相干
,气乱于肠胃之间,真邪相搏,冷热不调,上吐下痢,故曰霍乱也。经曰∶渴而饮水者,五
苓散;寒而不饮水者,理中丸。大段虚冷者,加附子。来复丹亦妙。(见《局方》)
治产后霍乱,吐利腹痛,烦渴,手足逆冷。
白术 橘红 麦门冬 人参 干姜(各一两) 甘草(半两)
上为粗末,每服四钱。生姜五片,水一盏,煎至七分,去滓温服。
疗产后霍乱,吐利不止,手足逆冷。附子散。
附子 白术 当归 吴茱萸 桂心 人参 丁香 橘红 甘草(各半两)
上为细末,粥饮调下二钱,无时候。
治产后霍乱,吐泻不止。温中散。
人参 白术 当归 草豆蔻仁 干姜(各一两) 浓朴(二两)
上为粗末,每服三钱,水煎服。
治产后霍乱吐利,腹中 痛。高良姜散。
良姜 当归 草豆蔻仁
上等分为细末,每服二钱,粥饮调下
诃子散、胡椒汤亦妙。(方见第七卷第二论)
凡产后发热,头痛身疼,不可便作感冒治之。此等疾证,多是血虚或败血作梗。血虚
者,阴虚也;阴虚者,阳必凑之,故发热。且以平和之剂与服必效。如玉露散(方见十八卷
第三论)或四物汤以生地黄易熟地黄,加北柴胡等分煎服;或人参当归散、秦艽鳖甲散、
人参轻骨散、人参百解散、逍遥散,皆可选用。不学无闻,才见产后发热不退,便以为热
入血室,便以小柴胡汤,竟不可救者。亦有用竹叶石膏汤而死者;亦有见前失而投以温剂,
其热愈炽者。诸如此等,非不知罪福,皆是不观古典,杜撰臆度,枉伤人命。殊不知此等疾
状,是产后去血过多而阴虚发热,亦有寒极生热。但以上件之药,以脉证选用,无不获安。
若是阴阳不和,乍寒乍热,宜增损四物汤;如败血不散者,宜夺命丹、大调经散、五积散,
加醋煎却效。(详见二十卷第三论)
王子亨云∶妇人新产,去血过多,津液燥少。(阴阳俱虚,大凡有疾。)如中风、伤寒、
时气之类,虽当发汗,如麻黄,谨不可用。取汗毋令过多,以意斟酌。
夫人触冒寒气而为病者,谓之伤寒。产妇血气俱虚,日月未满而起早劳勤,为寒所伤,
则淅淅恶寒。翕翕发热,头项、肩背、骨节皆痛,至七、八日乃差也。
妇人产后,亡血汗多,故令郁冒。其脉微弱,不能食,大便反坚,但头汗出。所以然者
,血虚而厥,厥而必冒,冒家欲解必大汗出。以血虚下厥,孤阳上出,故但头汗出。所以为
产妇无汗出者,亡阴血,阳气独盛,故当汗出,阴阳乃复。所以便坚者,呕不能食也。方可
用小柴胡汤加生干地黄主之。秦艽鳖甲散、人参轻骨散、神仙百解散。(并见《和剂局方》)
产后霍乱,是由于气血两伤、脏腑虚损;或因饮食不消化、感受风冷所致。阴阳之气不相顺接,清浊之气相互干扰,气机在肠胃之间紊乱,正气与邪气相搏结,寒热失调,出现上吐下泻的症状,所以称为霍乱。医经中说:口渴想喝水的,用五苓散(Wuling San, Five-Ling Powder);怕冷不想喝水的,用理中丸(Lizhong Wan, Regulate the Middle Pill)。如果是严重的虚寒证,加用附子(Aconiti Lateralis Radix Praeparata, Prepared Root of Side-son of Aconite)。来复丹(Laifu Dan, Laifu Pill)也很好。(见《太平惠民和剂局方》)
治疗产后霍乱,呕吐腹泻、腹痛、心烦口渴、手足逆冷。
白术(Atractylodis Macrocephalae Rhizoma)、橘红(Citri Reticulatae Pericarpium Rubrum)、麦门冬(Ophiopogonis Radix)、人参(Ginseng Radix)、干姜(Zingiberis Rhizoma),各一两;甘草(Glycyrrhizae Radix et Rhizoma),半两。
以上药物研成粗末,每次服用四钱。加入生姜五片,水一盏,煎煮至七分满,去渣,温服。
治疗产后霍乱,呕吐腹泻不止,手足逆冷。附子散(Fuzi San, Aconite Powder)。
附子(Aconiti Lateralis Radix Praeparata)、白术(Atractylodis Macrocephalae Rhizoma)、当归(Angelicae Sinensis Radix)、吴茱萸(Evodiae Fructus)、桂心(Cinnamomi Cortex)、人参(Ginseng Radix)、丁香(Eugeniae Flos)、橘红(Citri Reticulatae Pericarpium Rubrum)、甘草(Glycyrrhizae Radix et Rhizoma),各半两。
以上药物研成细末,用米汤调服二钱,不拘时候。
治疗产后霍乱,呕吐腹泻不止。温中散(Wenzhong San, Warm the Middle Powder)。
人参(Ginseng Radix)、白术(Atractylodis Macrocephalae Rhizoma)、当归(Angelicae Sinensis Radix)、草豆蔻仁(Alpiniae Katsumadai Semen)、干姜(Zingiberis Rhizoma),各一两;浓朴(Magnoliae Officinalis Cortex),二两。
以上药物研成粗末,每次服用三钱,用水煎服。
治疗产后霍乱吐利,腹中疼痛。高良姜散(Gaoliangjiang San, Galangal Powder)。
良姜(Alpiniae Officinarum Rhizoma)、当归(Angelicae Sinensis Radix)、草豆蔻仁(Alpiniae Katsumadai Semen)。
以上药物等分研成细末,每次服用二钱,用米汤调服。
诃子散(Hezi San, Chebula Powder)、胡椒汤(Hujiao Tang, Pepper Decoction)也很好。(方剂见第七卷第二论)
凡是产后发热、头痛、身体疼痛,不可以简单地当作感冒来治疗。这类疾病,多是血虚或败血(瘀血)阻滞所致。血虚属于阴虚;阴虚则阳气必会凑集于内,所以导致发热。此时给予平和的药物服用必定有效。如玉露散(Yulu San, Jade Dew Powder)(方见十八卷第三论);或者使用四物汤(Siwu Tang, Four Substances Decoction),以生地黄(Rehmanniae Radix)代替熟地黄(Rehmanniae Radix Praeparata),加入北柴胡(Bupleuri Radix)等量煎服;或者人参当归散(Renshen Danggui San)、秦艽鳖甲散(Qinjiao Biejia San)、人参轻骨散(Renshen Qinggu San)、人参百解散(Renshen Baijie San)、逍遥散(Xiaoyao San),都可以选用。那些没有学问的人,一见到产后发热不退,就认为是热入血室(Heat entering the Blood Chamber),便用小柴胡汤(Xiaochaihu Tang, Minor Bupleurum Decoction),结果往往无法挽救。也有使用竹叶石膏汤(Zhuye Shigao Tang, Bamboo Leaf and Gypsum Decoction)而导致死亡的;也有见到前阴出血就投以温补药物,致使热势更炽盛的。诸如此类情况,并非他们不知道罪福因果,都是因为没有研读古典医籍,凭空臆测,枉害人命。殊不知这些症状,是因为产后失血过多导致阴虚发热,也有因寒极而生热的。只要根据脉象和证候,选用上述药物,无不获得安宁。如果是阴阳不和,忽冷忽热,宜用增损四物汤(Zengsun Siwu Tang, Modified Four Substances Decoction);如果是败血(瘀血)不散,宜用夺命丹(Duoming Dan)、大调经散(Da Tiaojing San)、五积散(Wuji San),加醋煎煮则有效。(详见二十卷第三论)
王子亨说:妇女刚生产后,失血过多,津液干燥减少。(阴阳俱虚,大凡有疾。)如中风、伤寒、时气等病,虽然应当发汗,但像麻黄(Ephedrae Herba)这样峻烈的发汗药,千万不可使用。取汗不要令其过多,要根据具体情况斟酌。
夫人感受寒气而生病的,称为伤寒。产妇气血都虚弱,未满月就起床劳作,被寒气所伤,就会感到淅淅恶寒(瑟瑟发抖地怕冷),翕翕发热(微微发热),头项、肩背、骨节都疼痛,到七八天才能痊愈。
妇人产后,亡血且汗多,所以导致郁冒(头晕目眩,意识模糊)。其脉象微弱,不能进食,大便反而坚硬,只有头部出汗。之所以这样,是因为血虚导致厥逆,厥逆必然导致郁冒,郁冒的患者想要解除病症,必须全身大汗出。因为血虚导致下部厥逆,孤阳上浮外越,所以只有头部出汗。之所以说产妇无汗出的情况,是因为亡失阴血,阳气独盛,所以应当汗出,阴阳才能恢复平衡。之所以大便坚硬,是因为呕吐不能进食的缘故。这时方可用小柴胡汤(Xiaochaihu Tang)加生干地黄(Sheng Gan Dihuang, Dried Raw Rehmannia Root)为主治之。秦艽鳖甲散(Qinjiao Biejia San)、人参轻骨散(Renshen Qinggu San)、神仙百解散(Shenxian Baijie San)。(均见《太平惠民和剂局方》)
Postpartile Huoluan (Acute Gastroenteritis with Vomiting and Diarrhea) is caused by injury to both Qi and Blood, and deficiency and damage of the Zang-Fu organs; or it results from indigestion of food and exposure to wind-cold. The Yin and Yang fail to harmonize, clear and turbid energies interfere with each other, Qi becomes chaotic between the intestines and stomach, Zheng Qi (Upright Qi) and Xie Qi (Pathogenic factors) contend, cold and heat are unbalanced, leading to vomiting above and diarrhea below, hence it is called Huoluan. The Classics state: For those who are thirsty and desire water, use Wuling San (Five-Ling Powder); for those who feel cold and do not desire water, use Lizhong Wan (Regulate the Middle Pill). In cases of severe deficiency-cold, add Fu Zi (Prepared Root of Side-son of Aconite). Laifu Dan (Laifu Pill) is also excellent. (See *Tai Ping Hui Min He Ji Ju Fang*)
To treat postpartile Huoluan with vomiting, diarrhea, abdominal pain, restlessness, thirst, and cold limbs:
Bai Zhu (Rhizoma Atractylodis Macrocephalae), Ju Hong (Pericarpium Citri Reticulatae Rubrum), Mai Men Dong (Radix Ophiopogonis), Ren Shen (Radix Ginseng), Gan Jiang (Rhizoma Zingiberis), each 1 liang; Gan Cao (Radix et Rhizoma Glycyrrhizae), 0.5 liang.
Grind the above into coarse powder. Each dose is 4 qian. Add 5 slices of Sheng Jiang (Rhizoma Zingiberis Recens), 1 cup of water, decoct until 0.7 cup remains, remove dregs, and take warm.
To treat postpartile Huoluan with incessant vomiting and diarrhea, and cold limbs: Fuzi San (Aconite Powder).
Fu Zi (Radix Aconiti Lateralis Praeparata), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Dang Gui (Radix Angelicae Sinensis), Wu Zhu Yu (Fructus Evodiae), Gui Xin (Cortex Cinnamomi), Ren Shen (Radix Ginseng), Ding Xiang (Flos Eugeniae), Ju Hong (Pericarpium Citri Reticulatae Rubrum), Gan Cao (Radix et Rhizoma Glycyrrhizae), each 0.5 liang.
Grind the above into fine powder. Take 2 qian mixed with rice broth, at any time.
To treat postpartile Huoluan with incessant vomiting and diarrhea: Wenzhong San (Warm the Middle Powder).
Ren Shen (Radix Ginseng), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Dang Gui (Radix Angelicae Sinensis), Cao Dou Kou Ren (Semen Alpiniae Katsumadai), Gan Jiang (Rhizoma Zingiberis), each 1 liang; Hou Po (Cortex Magnoliae Officinalis), 2 liang.
Grind the above into coarse powder. Each dose is 3 qian, decoct in water and take.
To treat postpartile Huoluan with vomiting, diarrhea, and abdominal pain: Gaoliangjiang San (Galangal Powder).
Liang Jiang (Rhizoma Alpiniae Officinarum), Dang Gui (Radix Angelicae Sinensis), Cao Dou Kou Ren (Semen Alpiniae Katsumadai).
Grind the above equal parts into fine powder. Take 2 qian mixed with rice broth.
Hezi San (Fructus Terminaliae Chebulae Powder) and Hu Jiao Tang (Decoctio Piperis Nigris) are also excellent. (Formulas see Vol. 7, Treatise 2)
In all cases of postpartile fever, headache, and body ache, one must not simply treat it as a common cold (Gan Mao). Such conditions are mostly due to Blood deficiency or stagnation of Bi Xue (Stagnant Blood). Blood deficiency constitutes Yin deficiency; when Yin is deficient, Yang inevitably congregates within, thus causing fever. Administering mild and balanced formulas will be effective. For example, Yulu San (Jade Dew Powder) (see Vol. 18, Treatise 3); or Siwu Tang (Four Substances Decoction) using Sheng Di Huang (Radix Rehmanniae Preparata) instead of Shu Di Huang (Radix Rehmanniae Praeparata), added with Bei Chai Hu (Radix Bupleuri) in equal proportions and decocted; or Renshen Danggui San (Ginseng and Angelica Powder), Qinjiao Biejia San (Gentian and Turtle Shell Powder), Renshen Qinggu San (Ginseng and Light Bone Powder), Renshen Baijie San (Ginseng and Hundred-Resolve Powder), Xiaoyao San (Free and Easy Wanderer Powder), all can be selected. Ignorant practitioners, upon seeing persistent postpartile fever, immediately assume it is Re Ru Xue Shi (Heat Entering the Blood Chamber) and prescribe Xiaochaihu Tang (Minor Bupleurum Decoction), often resulting in untreatable conditions. Some have died after using Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction); some, seeing vaginal bleeding, administered warming agents, causing the heat to flare up even more. Such instances, though practitioners may know right from wrong, stem from a failure to study classical texts and reliance on speculation, unjustly taking lives. They do not realize that these symptoms arise from Yin-deficiency fever due to excessive blood loss postpartum, or from extreme cold generating false heat. By selecting the aforementioned medicines according to pulse and syndrome, peace is invariably restored. If there is disharmony of Yin and Yang with alternating chills and fever, use Zengsun Siwu Tang (Modified Four Substances Decoction); if Bi Xue (Stagnant Blood) has not dispersed, use Duoming Dan (Life-Restoring Pill), Da Tiaojing San (Great Menstruation-Regulating Powder), Wuji San (Five Accumulations Powder), decocted with vinegar for efficacy. (See Vol. 20, Treatise 3)
Wang Ziheng stated: After childbirth, women lose excessive blood, leading to dryness and scarcity of Jin Ye (Body Fluids). (Both Yin and Yang are deficient; generally, disease arises.) For conditions such as Feng Zhong (Wind Strike), Shang Han (Cold Damage), or Shi Qi (Seasonal Epidemic), although sweating methods are indicated, harsh diaphoretics like Ma Huang (Herba Ephedrae) must strictly be avoided. Induce sweating moderately, exercising judgment.
When a woman is afflicted by pathogenic cold, it is called Shang Han (Cold Damage). Postpartile women have deficient Qi and Blood. If they rise and labor early before the confinement period ends, and are injured by cold, they experience Xi Xi E Han (shivering aversion to cold), Xi Xi Fa Re (mild fever), pain in the head, neck, shoulders, back, and joints, which resolves after seven or eight days.
Postpartile women, having lost blood and sweated excessively, suffer from Yu Mao (Depression and Vertigo). Their pulse is weak, they cannot eat, their stool is hard, yet only the head sweats. This occurs because Blood deficiency leads to Jue (Rebellious Qi/Cold extremities), and Jue necessarily leads to Mao (Vertigo/Clouding of consciousness). For a patient with Mao to resolve, profuse sweating must occur. Due to Blood deficiency causing lower Jue, isolated Yang floats upward, hence only the head sweats. Regarding the statement that postpartile women do not sweat: when Yin Blood is lost, Yang Qi stands alone in excess, so sweating should occur to restore Yin-Yang balance. The hardness of stool is due to vomiting and inability to eat. At this point, Xiaochaihu Tang (Minor Bupleurum Decoction) added with Sheng Gan Di Huang (Dried Raw Rehmannia Root) can be used as the main treatment. Qinjiao Biejia San (Gentian and Turtle Shell Powder), Renshen Qinggu San (Ginseng and Light Bone Powder), Shenxian Baijie San (Immortal Hundred-Resolve Powder). (All see *Tai Ping Hui Min He Ji Ju Fang*)