二味参苏饮
产后气喘为危候,血脱气散参附煎;败血上攻面紫黑,二味参苏夺命痊。
【注】产后气喘,极危证也。因下血过多,荣血暴竭,卫气无倚,孤阳上越。宜骤补其
气,用参、附煎汤,不时饮之。若因恶露不行,败血上攻于肺而喘者,必面色紫黑,宜
夺命散下瘀,瘀去喘自定。虚者参苏饮,即人参一两为末,苏木二两煎汤冲服也。
枳术汤 小调中汤
产后肿分气水血,轻浮胀满气之形,水肿喘嗽小便涩,皮如熟李血之情。气肿枳术汤最效,水肿茯
苓导水灵,血肿调中归芍木,茯陈煎冲小调经,归芍珀麝辛桂没,理气调荣瘀血行。
【注】产后浮肿,由于败血乘虚流入经络,血化为水,故令浮肿。然有气肿、水肿之别,
不可不辨也。若轻虚浮肿,心胸胀满者,原素有水所作,名曰气分也。宜用枳术汤,即
枳实、白术煎汤服之。若喘嗽小便不利者,则为水肿,宜茯苓导水汤利之。若皮如熟李,或
遍身青肿者,则为血分,宜小调中汤治之。其方即当归、白芍药、白术、茯苓、陈皮煎汤,
冲小调经散服之,即当归、赤芍、琥珀、麝香、细辛、肉桂心、没药也。
茯苓导水汤(方见三卷)
加味四物汤 加味异功散 生化汤
产后发热不一端,内伤饮食外风寒,瘀血血虚与劳力,三朝蒸乳亦当然,阴虚血脱阳外散,攻补温凉细细参。
【注】产后发热之故,非止一端。如食饮太过,胸满呕吐恶食者,则为伤食发热;若
早起劳动,感受风寒,则为外感发热;若恶露不去,瘀血停留,则为瘀血发热;若去血
过多,阴血不足,则为血虚发热。亦有因产时伤力劳乏发热者,三日蒸乳发热者。当详
其有余不足,或攻或补,或用凉药正治,或用温热反治,要在临证细细参考也。
产后出现气喘属于危重证候,若因失血过多导致气随血脱,宜用红参与附子煎汤服用;若因败血上冲面部呈现紫黑色,宜用二味参苏饮以挽救生命。
【注】产后气喘是极危重的证候。由于下血过多,营血突然枯竭,卫气失去依附,孤阳上浮外越。应当紧急补气,使用人参、附子煎汤,随时饮用。如果是由于恶露排出不畅,败血上攻于肺而导致气喘的,必然面色紫黑,宜用夺命散攻下瘀血,瘀血去除后气喘自然平息。属于虚证的,使用参苏饮,即取人参一两研为细末,用苏木二两煎汤送服。
产后浮肿分为气肿、水肿和血肿三种,轻浮胀满是气肿的表现,伴有气喘咳嗽且小便涩滞的是水肿,皮肤像熟李子一样或遍身青肿的是血肿。气肿用枳术汤效果最好,水肿用茯苓导水汤疗效显著,血肿用小调中汤配合当归、白芍药、木香、陈皮煎汤冲服小调经散(方中含有当归、白芍、琥珀、麝香、细辛、肉桂心、没药),能理气调荣,使瘀血运行通畅。
【注】产后浮肿,是因为败血乘虚流入经络,血液化为水液,所以导致浮肿。然而有气肿和水肿的区别,不可不加以辨别。如果是轻微虚浮浮肿,心胸胀满的,原本就是由水湿所致,名叫气分病。宜用枳术汤,即枳实、白术煎汤服用。如果气喘咳嗽且小便不利的,则是水肿,宜用茯苓导水汤利水消肿。如果皮肤像熟李子一样,或者遍身青肿的,则是血分病,宜用小调中汤治疗。该方即当归、白芍药、白术、茯苓、陈皮煎汤,冲服小调经散,小调经散由当归、赤芍、琥珀、麝香、细辛、肉桂心、没药组成。
茯苓导水汤(方剂见第三卷)
产后发热原因不一,可能是内伤饮食或外感风寒,也可能是瘀血阻滞、血虚或劳力过度,产后第三天乳汁分泌旺盛引起的蒸乳发热也是正常现象,还有阴虚血脱导致阳气外散的发热,需要根据具体情况仔细斟酌采用攻法或补法,凉药正治或温热反治。
【注】产后发热的原因不止一端。如饮食过量,出现胸满呕吐、厌恶食物的,则是伤食发热;如果早起劳动,感受风寒,则是外感发热;如果恶露不尽,瘀血停留体内,则是瘀血发热;如果失血过多,阴血不足,则是血虚发热。也有因产时用力过度、疲劳乏力的发热,以及产后三日乳汁分泌旺盛引起的发热。应当详细分辨邪气的有余与正气的不足,决定采用攻法还是补法,或使用凉药进行正治,或使用温热药进行反治,关键在于临证时仔细参考辨证。
Erwei Rensu Yin (Two-Ingredient Ginseng and Liquidambar Decoction)
Postpartum panting is a critical condition. If caused by blood loss leading to Qi collapse, Shenfu Jian (Ginseng and Aconite Decoction) should be used. If caused by retained blood attacking upward, resulting in a purple-black complexion, Erwei Rensu Yin can save life.
[Note] Postpartum panting is an extremely critical syndrome. Due to excessive bleeding, Ying Blood (nutritive blood) is suddenly depleted, causing Wei Qi (defensive Qi) to lose its foundation, with lone Yang floating upward and outward. Urgent tonification of Qi is required; use Shen (Ren Shen, Ginseng Root) and Fu Zi (Prepared Aconite Lateral Root) decocted in water, taken frequently. If the panting is due to lochia retention, with retained blood attacking the lungs, the complexion will inevitably be purple-black. Du Ming San (Life-Restoring Powder) should be used to purge stasis; once the stasis is removed, the panting will subside spontaneously. For deficiency patterns, Rensu Yin is indicated: take Ren Shen (Ginseng Root) one liang ground into powder, and Su Mu (Sappan Wood) two liang decocted in water, taken together.
Zhizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction) Xiaodiao Zhong Tang (Minor Regulating Middle Jiao Decoction)
Postpartum edema is categorized into Qi edema, Water edema, and Blood edema. Mild swelling and distension indicate Qi edema. Edema accompanied by panting, coughing, and scanty/difficult urination indicates Water edema. Skin resembling that of a ripe plum or generalized cyanotic swelling indicates Blood edema. Zhizhu Tang is most effective for Qi edema; Fuling Daoshui Tang (Poria Water-Draining Decoction) is efficacious for Water edema; Xiaodiao Zhong Tang combined with Dang Gui (Angelica Sinensis Root), Bai Shao (White Peony Root), Mu Xiang (Aucklandia Root), and Chen Pi (Tangerine Peel) decocted to flush Xiao Tiaojing San (Minor Regulating Menstruation Powder)—which contains Dang Gui, Chi Shao (Red Peony Root), Hu Po (Amber), She Xiang (Musk), Xi Xin (Asarum), Rou Gui Xin (Cinnamon Bark Heart), and Mo Yao (Myrrh)—regulates Qi and nourishes Ying, promoting the circulation of blood stasis.
[Note] Postpartum edema occurs when retained blood enters the collaterals due to deficiency, transforming into fluid, thus causing swelling. However, distinctions must be made between Qi edema and Water edema. If there is mild, puffy edema with chest and epigastric fullness, it originates from water-dampness and is termed "Qi Fen" (Qi Division). Zhizhu Tang, consisting of Zhi Shi (Immature Bitter Orange) and Bai Zhu (Atractylodes Macrocephala Rhizome) decocted in water, is indicated. If accompanied by panting, coughing, and difficult urination, it is Water edema, treated with Fuling Daoshui Tang to promote diuresis. If the skin resembles a ripe plum or there is generalized cyanotic swelling, it is Blood edema, treated with Xiaodiao Zhong Tang. This formula consists of Dang Gui, Bai Shao Yao (White Peony Root), Bai Zhu, Fu Ling (Poria), and Chen Pi decocted in water, taken with Xiao Tiaojing San. Xiao Tiaojing San comprises Dang Gui, Chi Shao, Hu Po, She Xiang, Xi Xin, Rou Gui Xin, and Mo Yao.
Fuling Daoshui Tang (Formula see Volume III)
Jiawei Siwu Tang (Modified Four Substances Decoction) Jiawei Yigong San (Modified Yi Gong Powder) Shenghua Tang (Transform and Generate Decoction)
Postpartum fever has various causes, including internal injury from diet, external contraction of wind-cold, blood stasis, blood deficiency, labor fatigue, lactation fever on the third day, and Yang escaping outward due to Yin deficiency and blood depletion. One must carefully consider whether to use attack or tonification methods, cooling drugs for direct treatment, or warming drugs for reverse treatment.
[Note] The causes of postpartum fever are manifold. Excessive food intake leading to chest fullness, vomiting, and aversion to food indicates fever from food stagnation. Rising early to work and contracting wind-cold indicates fever from external contraction. Retained lochia and lingering blood stasis indicate fever from blood stasis. Excessive blood loss leading to insufficient Yin blood indicates fever from blood deficiency. There is also fever from physical exertion during childbirth and fever from milk production on the third day. One must carefully distinguish between excess and deficiency, deciding whether to attack or tonify, use cooling drugs for direct treatment, or use warming drugs for reverse treatment. The key lies in careful clinical differentiation.