产后 疟,在初产时绝少,即胎前久疟淹缠,产后里气通达,无不霍然。即有半月内外,寒
热往来,每日应期而发,或一日二三度,其症类疟,皆由产后气血虚损,阳虚作寒,阴虚发热,或昼
轻夜重,或日晡发热,或有汗,或头有汗而不及身足。此乃元气虚弱,孤阳绝阴之症。俱宜滋荣益
气扶正汤,间服六味丸,以退寒热,如寒热往来,头痛无汗,加减养胃汤治之;若寒热已久,无
汗者,兼煎参术膏,以助养胃汤药力。慎不可作疟治,而用柴胡汤及芩、连、栀、柏以退热,草果、
槟,常以绝疟而误人也。至于阴阳不和,乍寒乍热,参归汤治之。《全书》云∶阴胜寒多,理阴煎;
阳胜热多,三阴煎;阳气陷入阴中,补阴益气煎,阴阳俱虚,八珍、十全∶败血不散,流入阴中而
作寒热,决阴煎、殿胞煎。
滋荣益气扶正汤 治产后寒热往来,有汗,每午后应期而发。
人参 熟地(各二钱) 川芎 黄 (蜜炙) 麦冬(去心各一钱) 当归(三钱) 白术(钱半
土炒) 陈皮(四分) 炙草(五分)
加减养胃汤 治产后以及一月类疟,并治寒热往来,头痛无汗。
人参(钱半) 川芎 茯苓 苍术(米泔水制,炒,各一钱) 当归(三钱,酒浸) 藿香 炙草(四
分) 橘红(四分) 制夏(八分) 姜(一片) 枣(三枚)
参归汤 治产后阴阳不和,乍寒乍热。
当归(酒洗) 炮姜(一钱) 人参 白芍(炒) 川芎 炙草(各八分)
理阴煎
熟地 当归 干姜 炙草
三阴煎 治肝脾虚损,精血不足,及营虚失血等病。凡中风血不养筋,及疟症汗多,邪散而
寒热犹不止者。
人参 当归(二三钱) 熟地(三五钱) 酒炒芍药 枣仁(各二钱) 炙草(一钱)
补阴益气煎 人参(一二钱) 当归 山药(酒炒,各二三钱) 熟地(三五钱) 陈皮
炙草(各一钱) 升麻(三五分,若火浮于上者,去此不用) 柴胡(一二钱,如无外邪不用) 姜(三片)
煎服。此补中益气汤之变方,治劳倦伤阴,精不化气,阴虚外感 疟,并便结不通,凡属阴气不足,
而虚邪外侵者,用此升散,无不神效。
产后疟疾,在刚生产时极少发生。即使是产前长期缠绵难愈的疟疾,到了产后随着体内气机通畅,没有不立刻痊愈的。如果有在半个月内,出现寒热往来,每天定时发作,或者一天发作两三次,症状类似疟疾,这都是因为产后气血虚弱亏损,阳气虚则生寒,阴血虚则发热,有的白天轻晚上重,有的在下午申时发热,有的全身出汗,有的只有头部出汗而不到身体和足部。这是元气虚弱、孤阳独存而阴气断绝的症状。都适宜服用滋荣益气扶正汤,间歇服用六味丸,以退去寒热;如果寒热往来,头痛无汗,用加减养胃汤治疗;如果寒热已久且无汗,同时煎煮参术膏,以增强养胃汤的药力。千万不要当作疟疾来治,而使用柴胡汤以及黄芩、黄连、栀子、黄柏来退热,草果、槟榔来截断疟疾,这样会误人性命。至于阴阳不和,忽冷忽热,用参归汤治疗。《全书》说:阴偏胜则寒多,用理阴煎;阳偏胜则热多,用三阴煎;阳气陷入阴中,用补阴益气煎;阴阳都虚,用八珍汤、十全大补汤;败血不散,流入阴中导致寒热,用决阴煎、殿胞煎。
滋荣益气扶正汤 治疗产后寒热往来,有汗,每天午后定时发作。
人参、熟地黄(各二钱),川芎、黄芪(蜜炙)、麦冬(去心,各一钱),当归(三钱),白术(一钱半,土炒),陈皮(四分),炙甘草(五分)。
加减养胃汤 治疗产后及产后一个月内类似疟疾,并治疗寒热往来,头痛无汗。
人参(一钱半),川芎、茯苓、苍术(米泔水制,炒,各一钱),当归(三钱,酒浸),藿香、炙甘草(四分),橘红(四分),制半夏(八分),生姜(一片),大枣(三枚)。
参归汤 治疗产后阴阳不和,忽冷忽热。
当归(酒洗),炮姜(一钱),人参、白芍(炒)、川芎、炙甘草(各八分)。
三阴煎 治疗肝脾虚损,精血不足,以及营血虚失血等疾病。凡是中风后血不能养筋,以及疟疾汗多,邪气已散但寒热仍不止的情况。
人参、当归(二三钱)、熟地黄(三五钱)、酒炒芍药、酸枣仁(各二钱)、炙甘草(一钱)。
补阴益气煎 人参(一二钱)、当归、山药(酒炒,各二三钱)、熟地黄(三五钱)、陈皮、炙甘草(各一钱)、升麻(三五分,如果火气浮于上部,去掉此药不用)、柴胡(一二钱,如果没有外邪则不用)、生姜(三片)。煎服。这是补中益气汤的变方,治疗劳累倦怠损伤阴气,精气不能化为气,阴虚兼感外邪引起的疟疾,以及大便干结不通,凡是属于阴气不足,而虚邪外侵的,用此方升散,无不神效。
Postpartum malaria is extremely rare immediately after childbirth. Even if the patient suffered from chronic malaria during pregnancy, once in the postpartum period, as the internal qi becomes unobstructed, recovery is invariably swift and complete. However, within half a month after delivery, some women may experience alternating chills and fever (alternating cold and heat), occurring daily at specific times, or two to three times a day, with symptoms resembling malaria. These conditions are all caused by deficiency and depletion of qi and blood after childbirth: yang deficiency generates cold, while yin deficiency generates heat. Symptoms may be lighter during the day and heavier at night, or feature fever in the afternoon (specifically around the Shen hour). There may be generalized sweating, or sweating only on the head without extending to the body or feet. This constitutes a syndrome of weak primordial qi, characterized by isolated yang and absent yin. All such cases should be treated with Zirong Yiqi Fuzheng Decoction (Nourishing Blood and Replenishing Qi to Support Uprightness Decoction), taken intermittently alongside Liuwei Wan (Six-Ingredient Rehmannia Pill) to resolve the alternating chills and fever. If accompanied by headache and absence of sweating, Jiajian Yangwei Tang (Modified Stomach-Nourishing Decoction) should be used. If the alternating chills and fever have persisted for a long time and there is no sweating, Shenzhu Gao (Ginseng and Atractylodes Paste) should be decocted concurrently to enhance the efficacy of the Yangwei Tang. One must strictly avoid treating this as malaria; using Chaihu Tang (Bupleurum Decoction) along with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Huangbai (Phellodendri Cortex) to reduce heat, or Caoguo (Tsaoko Fructus) and Binglang (Arecae Semen) to arrest malaria, will lead to fatal errors. For cases of yin-yang disharmony presenting with intermittent chills and fever, Shengu Tang (Ginseng and Angelica Decoction) is indicated. The *Quan Shu* states: When yin predominates, resulting in more cold, Liyin Jian (Yin-Nourishing Decoction) is used; when yang predominates, resulting in more heat, Sanyin Jian (Three Yin Decoction) is used; when yang qi sinks into the yin, Buyin Yiqi Jian (Tonifying Yin and Replenishing Qi Decoction) is used; when both yin and yang are deficient, Bazhen Tang (Eight-Treasure Decoction) or Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) are used. If stagnant blood fails to disperse and flows into the yin causing chills and fever, Jueyin Jian (Yin-Resolving Decoction) or Dianbao Jian (Uterine-Pacifying Decoction) are indicated.
Zirong Yiqi Fuzheng Decoction (Nourishing Blood and Replenishing Qi to Support Uprightness Decoction): Treats postpartum alternating chills and fever with sweating, occurring daily at a fixed time in the afternoon.
Ren Shen (Panax Ginseng Radix et Rhizoma), Shu Di Huang (Rehmanniae Radix Praeparata) (each 2 qian); Chuan Xiong (Ligustici Chuanxiong Rhizoma), Huang Qi (Astragali Radix, honey-fried), Mai Dong (Ophiopogonis Tuber, core removed) (each 1 qian); Dang Gui (Angelicae Sinensis Radix) (3 qian); Bai Zhu (Atractylodis Macrocephalae Rhizoma, earth-fried) (1.5 qian); Chen Pi (Citri Reticulatae Pericarpium) (4 fen); Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata) (5 fen).
Jiajian Yangwei Tang (Modified Stomach-Nourishing Decoction): Treats malaria-like symptoms within one month postpartum, as well as alternating chills and fever with headache and absence of sweating.
Ren Shen (Panax Ginseng Radix et Rhizoma) (1.5 qian); Chuan Xiong (Ligustici Chuanxiong Rhizoma), Fu Ling (Poria), Cang Zhu (Atractylodis Rhizoma, processed with rice water, fried) (each 1 qian); Dang Gui (Angelicae Sinensis Radix, wine-soaked) (3 qian); Huo Xiang (Agastaches Herba), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata) (4 fen); Ju Hong (Citri Reticulatae Pericarpium Rubrum) (4 fen); Zhi Ban Xia (Pinelliae Tuber Preparatum) (8 fen); Sheng Jiang (Zingiberis Rhizoma Recens) (1 slice); Da Zao (Ziziphi Jujubae Fructus) (3 pieces).
Shengu Tang (Ginseng and Angelica Decoction): Treats postpartum yin-yang disharmony presenting with intermittent chills and fever.
Dang Gui (Angelicae Sinensis Radix, wine-rinsed); Pao Jiang (Zingiberis Rhizoma Preparatum) (1 qian); Ren Shen (Panax Ginseng Radix et Rhizoma), Bai Shao (Paeoniae Radix Alba, fried), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata) (each 8 fen).
Liyin Jian (Yin-Nourishing Decoction)
Shu Di Huang (Rehmanniae Radix Praeparata), Dang Gui (Angelicae Sinensis Radix), Gan Jiang (Zingiberis Rhizoma), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata).
Sanyin Jian (Three Yin Decoction): Treats liver and spleen deficiency with insufficient essence and blood, as well as disorders such as loss of blood due to nutritive qi deficiency. It is also indicated for wind-stroke where blood fails to nourish the tendons, and for malaria with excessive sweating where pathogenic factors have dispersed but alternating chills and fever persist.
Ren Shen (Panax Ginseng Radix et Rhizoma); Dang Gui (Angelicae Sinensis Radix) (2-3 qian); Shu Di Huang (Rehmanniae Radix Praeparata) (3-5 qian); Jiu Chao Shao Yao (Paeoniae Radix, wine-fried); Suan Zao Ren (Ziziphi Spinosae Semen) (each 2 qian); Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata) (1 qian).
Buyin Yiqi Jian (Tonifying Yin and Replenishing Qi Decoction): Ren Shen (Panax Ginseng Radix et Rhizoma) (1-2 qian); Dang Gui (Angelicae Sinensis Radix), Shan Yao (Dioscoreae Rhizoma, wine-fried) (each 2-3 qian); Shu Di Huang (Rehmanniae Radix Praeparata) (3-5 qian); Chen Pi (Citri Reticulatae Pericarpium), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata) (each 1 qian); Sheng Ma (Cimicifugae Rhizoma) (3-5 fen; omit if fire floats upward); Chai Hu (Bupleuri Radix) (1-2 qian; omit if no external pathogen); Sheng Jiang (Zingiberis Rhizoma Recens) (3 slices). Decoct and take orally. This is a modification of Buzhong Yiqi Tang (Center-Boosting Qi-Replenishing Decoction), used for fatigue-induced yin injury, failure of essence to transform into qi, yin deficiency with external contraction leading to malaria, and constipation. It is effective for ascending and dispersing in cases of insufficient yin qi and invasion by deficient pathogens.