凡产后因忿怒气逆,胸膈不舒,血块大痛,宜用生化汤,临服时磨木香一分在内服之,则血块
自化,怒气自散,并治而不悖也。若轻重气,偏用木香、香砂、乌药、枳壳、砂仁之剂,以散气行
块,则元气反损,而满闷反增,是重虚之,非善治产者也。又如怒后即食,胃弱停闷,当审何物所
伤。如肉物伤,加砂仁、神曲消之;如面饭伤,加神曲、麦芽消之。若伤物作痛,涩滞胁腹,宜加桂
枝、吴茱萸在生化汤中,以逐寒定痛,无有不安,慎勿用木香槟榔丸、顺气饮之方,以散气化食。
不然,则虚弱产妇,重虚之祸,有不可胜言者矣。
大抵产后患崩,血脱;短气似喘,气脱;妄言妄见,神脱。三症虽有血阴气阳之分,其精散神
去之促无异,此亦危症也。若非能浓药急方频服,失之者多矣。妄论气实痰火皆非也。如新产为块
痛,并用加参生化汤,行中当补之方,斯免血滞血虚之失也。其块痛止,宜用升举大补汤,少佐黄连
坠火,以治崩脱、宁血归经也。宜用倍参补中益气汤,少佐附子助参以治气脱,摄气归源也。宜用
滋荣益气复神汤,少佐痰剂以清心火,宁君主之官也。因人妄论气脱妄言之症,误用气实痰火之方药,
屡夭人年,故重复录告。倘执论气痰而愈重,必当识补救,方可活也。
凡是产后因愤怒导致气机逆乱,胸膈部感觉不舒畅,血块引起剧烈疼痛的情况,适宜使用生化汤。在服用前,将一分木香磨入药液中同服,这样血块自然化解,怒气自然消散,两者同时治疗而互不冲突。如果病情较轻,仅偏重于气滞,单独使用木香、香砂、乌药、枳壳、砂仁等药物来行气散块,反而会损伤元气,使胀闷感加重,这是使虚证更虚的做法,不是善于治疗产后病的方法。
又如发怒后立即进食,导致胃气虚弱、停滞胀闷,应当仔细审查是哪种食物造成的损伤。如果是肉食损伤,加入砂仁、神曲来消化;如果是面食或米饭损伤,加入神曲、麦芽来消化。如果因伤食引起疼痛,伴有胁腹部的涩滞感,适宜在生化汤中加入桂枝、吴茱萸,以驱除寒邪、安定止痛,没有不安稳的道理。务必不要使用木香槟榔丸、顺气饮这类方剂来行气化食。否则,对于虚弱的产妇来说,会造成更加严重的虚损,其祸害不可胜言。
大抵上,产后出现崩漏(大量出血),属于血脱;呼吸短促类似喘息,属于气脱;胡言乱语、幻觉妄见,属于神脱。这三种症状虽然分别涉及血阴、气阳的不同方面,但其精气涣散、神明离去的危急程度并无二致,这也属于危重病症。如果不是能够用浓稠的药液、紧急的方剂频繁服用,失误的情况就很多了。胡乱议论认为是气实痰火所致都是错误的。例如新近生产后出现血块疼痛,应当统一使用加参生化汤,这是在行血中兼以补益的方子,这样可以避免血滞和血虚的过失。
当血块疼痛停止后,适宜使用升举大补汤,稍加黄连以降火,用来治疗崩漏脱血、使血液回归经脉。适宜使用加倍人参量的补中益气汤,稍加附子辅助人参以治疗气脱,收敛气机使其归源。适宜使用滋荣益气复神汤,稍加化痰药物以清心火,安宁君主之官(心脏)。因为有人胡乱议论气脱导致的胡言乱语症状,误用了针对气实痰火的方药,屡次折损人的寿命,所以再次记录并告诫后人。如果固执于气痰的理论而使病情加重,必须认识到补救措施,才可以挽救生命。
In cases where postpartum anger causes qi rebellion, leading to discomfort in the chest and diaphragm, and severe pain from blood stasis (blood clots), Shenghua Tang (Life Generating Decoction) is appropriate. Before administration, grind one fen of Muxiang (Aucklandiae Radix) into the decoction for ingestion; this will naturally resolve the blood stasis and dissipate the anger, allowing both conditions to be treated simultaneously without conflict. If the condition is mild and primarily involves qi stagnation, using only agents such as Muxiang (Aucklandiae Radix), Xiangsha (Amomi Fructus with Aucklandiae Radix), Wuyao (Linderae Radix), Zhike (Aurantii Fructus), and Sharen (Amomi Fructus Rotundus) to move qi and disperse clots will反而 damage the Yuan Qi (Primary Qi), thereby increasing distension and fullness. This constitutes a "double deficiency" error and is not a skillful approach to treating postpartum disorders.
Furthermore, if eating immediately after an outburst of anger leads to weak stomach qi and food stagnation causing fullness, one must determine the specific offending food. For meat injury, add Sharen (Amomi Fructus Rotundus) and Shenqu (Massa Medicata Fermentata) to aid digestion; for grain or rice injury, add Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus). If food injury causes pain accompanied by astringency and stagnation in the hypochondrium and abdomen, it is appropriate to add Guizhi (Cinnamomi Ramulus) and Wuzhuyu (Evodiae Fructus) to Shenghua Tang (Life Generating Decoction) to dispel cold and alleviate pain, ensuring stability. One must strictly avoid using formulas like Muxiang Binglang Wan (Aucklandia and Areca Nut Pill) or Shunqi Yin (Qi-Pacifying Drink) to move qi and digest food. Otherwise, applying these draining methods to a debilitated postpartum woman will cause severe additional deficiency, with consequences that are beyond description.
Generally speaking, postpartum metrorrhagia (flooding) indicates Blood Exhaustion; shortness of breath resembling asthma indicates Qi Exhaustion; delirious speech and visual hallucinations indicate Spirit Exhaustion. Although these three syndromes differ in their association with Yin/Blood and Yang/Qi, the urgency of essence scattering and spirit departing is identical, making them critical conditions. Unless thick medicinal preparations and urgent prescriptions are administered frequently, many errors occur. It is erroneous to attribute these symptoms to excess qi or phlegm-fire. For instance, in recent childbirth presenting with pain from blood clots, Jia Shen Shenghua Tang (Shenghua Tang with Added Ginseng) should be used uniformly. This formula moves blood while tonifying, thereby avoiding the pitfalls of blood stasis and blood deficiency.
Once the pain from blood clots subsides, Shengju Dabu Tang (Raising and Great Tonification Decoction) is appropriate, with a small addition of Huanglian (Coptidis Rhizoma) to descend fire, treating flooding and exhaustion while calming blood and guiding it back to its vessels. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Renshen (Ginseng Radix et Rhizoma) is appropriate, with a small addition of Fuzi (Aconiti Lateralis Radix Praeparata) to assist Renshen in treating Qi Exhaustion and gathering qi to its source. Zirong Yiqi Fushen Tang (Nourish Glory, Tonify Qi, and Restore Spirit Decoction) is appropriate, with a small addition of phlegm-resolving agents to clear Heart Fire and pacify the Monarch Organ (Heart). Because some erroneously interpret delirious speech caused by Qi Exhaustion as symptoms of excess qi and phlegm-fire, leading to the misuse of corresponding prescriptions and repeatedly shortening lives, this warning is recorded again. If one adheres rigidly to theories of qi and phlegm, worsening the condition, one must recognize the need for remedial measures to save the patient's life.