楼氏曰∶产后喘极危,多死也。(此真实话也,临症者慎之)
郭稽中曰∶产后喉中气急喘促者何。答曰∶荣者血也,卫者气也,荣行脉中,卫行脉
外,相随上下,谓之荣卫。因产所下过多,荣血暴竭,卫气无主,独聚肺中,故令喘也。此名孤
阳绝阴,为难治,若恶露不快,败血停凝,上熏于肺,亦令喘急,但服夺命丹(见胞衣不下),
血去喘自定。
陈无择评曰∶产后喘急固可畏,若是败血上熏于肺,犹可责效夺命丹,若感风寒,或因
忧思饮食咸冷等致病者,夺命丹未可均济,况孤阳绝阴乎。若荣血暴绝,宜大料煮散,川芎
汤亦可救;伤风寒,宜旋复花汤;性理郁发,宜小调经散,用桑白皮杏仁煎汤调下;伤食,宜
服见 丸、五积散、川芎汤。
薛氏曰∶前证若脾肺气虚弱,用六君桔梗,若兼外邪,更加紫苏;若中气虚寒,用补中
益气加炮姜、肉桂(专益补,似太泥);若阳气虚脱,更加附子;若瘀血入肺,急用二味参苏饮。
一产妇喘促自汗,手足俱冷,常以手护脐腹;此阳气虚脱,用参附汤四剂而愈。
浦江吴辉妻孕时足肿,七月初旬产后,二月洗浴即气喘,但坐不得卧者五个月,恶风,
得暖稍宽,两关脉动,尺寸皆虚,百药不效,用牡丹皮、桃仁、桂枝、茯苓、干姜、枳实、浓朴、
桑白皮、紫苏、五味、栝蒌仁煎汤服之即宽,三服得卧,其痰如失,盖作污血感寒治之也。(以
洗浴气喘,及得暖稍宽之症审之,自宜发散,而百药不效,乃更用破血温消之剂愈之者,是
当责在产后有余邪也,关动脉尺寸虚者,邪郁在中,不得出也,故当温散而愈,可为学人法)
夺命散 治产后败血冲心,胸满上喘,命在须臾。(此治败血)
方见前血晕。
二味参苏饮 治产后血入于肺,面黑发喘欲死者。(此保肺逐瘀)
人参(二两,为末) 苏木(二两,槌碎)
上用水二碗煮苏木,取汁一碗,调人参末,随时加减服。
旋复花汤 治产后伤风寒喘嗽,痰涎壅盛。(此治风寒)
方见前咳嗽。
见 丸 治产后伤咸冷冻饮料食而喘者。(此治饮食)
方见前痞闷。
五味子汤 治产后喘促,脉浮而厥。(此单补虚,此补肺法,果虚者宜之)
五味子(麸炒) 人参 杏仁(各二钱) 麦门冬(去心) 陈皮(各一钱)
上加生姜三片,枣二枚,水煎服。
六君加失笑散 治产后喘急不能卧,痰与血杂涌而上,此脾胃气虚而败血乘之也,服
此立止。
六君子料六钱,加生姜三片,水煎服,调入蒲黄、五灵脂,各炒五分,搅匀温服,少顷滓
再煎,再入蒲、灵末服,神效。(据此法,亦二味参苏与之变,设非究理为治,即败乃事矣,妙
在佐以失笑散。余一日庄居,一乡人踵门哀恳,道其妻产后数喘促不能卧,痰与血交涌而
上,日夜两人扶坐,才侧身壅绝,乞救疗之。无暇检方书,以意度之,新产后血气脾胃大虚顿
损,故虚痰壅盛,而败血乘之,犀角六君子加失笑散一服,痰血俱下,喘亦立止。次日来谢
云∶诸病皆去,止不能食。再与参苓白术散,二帖痊愈。对症之药,神效如此,故特附于此)
大补汤 治产后百日外面青浮肿,唇口气急,有汗,乃大虚之证,急宜服此。(要诀在
面青自汗上审,此大方也,宜知之)
当归头 大川芎 大白术 白芍药 白茯苓 人参(多) 黄 (多) 五味子 熟地黄 干姜
(上上) 甘草(少)
上锉散,水煎服,此帖不退,即加川乌木香,另磨入服(即十全大补去桂加干姜、五味
子,盖非有真见者不能用。川乌木香丸良)。有泻,加诃子肉、豆蔻、粟壳。
楼氏说:产后出现极度喘息,病情非常危险,多数会导致死亡。(这是真实的情况,临床医生务必谨慎对待)
郭稽中说:产后喉咙中气息急促、喘息迫促的原因是什么?回答说:荣气就是血,卫气就是气,荣气在脉管中运行,卫气在脉管外运行,它们相随上下流动,称为荣卫。因为分娩时失血过多,荣血突然枯竭,卫气失去了主宰,独自聚集在肺中,所以导致喘息。这种情况名为“孤阳绝阴”,属于难治之症;如果是恶露排出不畅,败血停滞凝结,向上熏蒸于肺,也会导致喘息急促,只需服用夺命丹(见胞衣不下篇),血去则喘息自然平息。
陈无择评论说:产后喘急固然令人畏惧,如果是败血上熏于肺,还可以指望夺命丹见效;但如果是感受风寒,或者因为忧思、饮食咸冷等因素致病,夺命丹就不一定能起作用了,更何况是“孤阳绝阴”的情况呢?如果是荣血暴绝,应该用大剂量的煮散,川芎汤也可以救治;伤于风寒,适宜用旋复花汤;情志郁结发作,适宜用小调经散,用桑白皮和杏仁煎汤送服;伤食,适宜服用见嗢丸、五积散、川芎汤。
薛氏说:上述病症如果是因为脾肺气虚弱,使用六君子汤加桔梗;如果兼有外邪,再加紫苏;如果中气虚寒,使用补中益气汤加炮姜、肉桂(专门用于补益,似乎过于滞腻);如果阳气虚脱,再加附子;如果瘀血进入肺中,紧急使用二味参苏饮。有一位产妇喘息急促、自汗,手足都冰冷,经常用手护住脐腹部;这是阳气虚脱的表现,服用四剂参附汤后痊愈。
浦江吴辉的妻子怀孕时脚肿,七月下旬产后,二月时洗浴后就气喘,只能坐着不能躺卧长达五个月,怕风,得到温暖症状稍缓解,两手关脉跳动,寸尺脉皆虚,各种药物都不见效,用牡丹皮、桃仁、桂枝、茯苓、干姜、枳实、厚朴、桑白皮、紫苏、五味子、瓜蒌仁煎汤服用后症状立即缓解,服用三剂后能躺下睡觉,痰液消失,这被当作污血感寒来治疗。(根据洗浴后气喘,以及得暖稍缓解的症状仔细审视,本来应该发散解表,但百药无效,反而用破血温消的药剂治愈,这说明责任在于产后有余留的病邪,关脉动而寸尺虚,说明邪气郁结在中焦,无法排出,所以应当温散而愈,可以作为学习者的典范)
夺命散 治疗产后败血冲心,胸满上喘,性命垂危。(这是治疗败血的方剂)
方剂见前文血晕篇。
二味参苏饮 治疗产后血入于肺,面色发黑、喘息欲死。(这是保肺逐瘀的方剂)
人参(二两,研为粉末) 苏木(二两,捶碎)
以上用水两碗煮苏木,取汁一碗,调用人参粉末,根据情况随时加减服用。
旋复花汤 治疗产后伤风寒引起的喘息咳嗽,痰涎壅盛。(这是治疗风寒的方剂)
方剂见前文咳嗽篇。
见嗢丸 治疗产后因食用咸冷冻饮料食物而喘息者。(这是治疗饮食所伤的方剂)
方剂见前文痞闷篇。
五味子汤 治疗产后喘息急促,脉浮且四肢厥冷。(这是单纯补虚的方剂,此乃补肺之法,确属虚证者适宜)
五味子(麸炒) 人参 杏仁(各二钱) 麦门冬(去心) 陈皮(各一钱)
以上加生姜三片,大枣二枚,水煎服。
六君加失笑散 治疗产后喘急不能平卧,痰与血混杂涌上,这是脾胃气虚而败血乘虚侵袭所致,服用此方立即停止。
六君子汤料六钱,加生姜三片,水煎服,调入蒲黄、五灵脂,各炒五分,搅匀温服,片刻后将药渣再煎,再次加入蒲黄、五灵脂粉末服用,效果神奇。(根据这种方法,也是二味参苏饮的变方,如果不是探究原理进行治疗,就会失败,妙处在于佐以失笑散。我有一天住在乡下,一位乡人登门哀求,说他妻子产后几次喘息急促不能平卧,痰与血交杂涌上,日夜需要两人扶着坐,刚侧身就窒息,请求救治。我没时间检查医书,凭推测判断,新产后气血脾胃大虚顿损,所以虚痰壅盛,而败血乘虚侵袭,用犀角六君子汤加失笑散,一服药后,痰血俱下,喘息也立即停止。第二天来道谢说:各种病都好了,只是不能吃。再给予参苓白术散,两帖后痊愈。对症的药物,效果如此神奇,所以特别附记于此)
大补汤 治疗产后百日之外,面色青紫浮肿,嘴唇口气急促,有汗,这是大虚的证候,紧急适宜服用此方。(关键要点在于面色青紫和自汗的判断,这是一个大方剂,应当知晓)
当归头 大川芎 大白术 白芍药 白茯苓 人参(多用) 黄芪(多用) 五味子 熟地黄 干姜(上等用量) 甘草(少用)
以上锉成散剂,水煎服,这一帖不退症,就加川乌、木香,另外磨粉冲服(即十全大补汤去掉桂枝,加上干姜、五味子,没有真知灼见的人不能用。川乌木香丸也很好)。如果有腹泻,加诃子肉、豆蔻、罂粟壳。
Lou said: Postpartum extreme panting is extremely critical, and death often ensues. (This is a true statement; clinicians must exercise caution.)
Guo Jizhong asked: What is the cause of rapid breathing and panting in the throat after childbirth? He answered: Ying (Nutritive Qi) is blood, Wei (Defensive Qi) is qi. Ying circulates within the vessels, while Wei circulates outside the vessels. They move up and down together, which is called Ying-Wei. Due to excessive blood loss during delivery, Ying blood suddenly exhausts, leaving Wei qi without a master. It gathers exclusively in the lungs, causing panting. This condition is named "Lone Yang and Absolute Yin" and is difficult to treat. If lochia (postpartum discharge) does not flow smoothly, and stagnant blood coagulates and steams upward to the lungs, it also causes urgent panting. In such cases, administering Duoming Dan (see section on Retained Placenta) will resolve the blood stasis, and the panting will subside naturally.
Chen Wuyue commented: Although postpartum urgent panting is indeed frightening, if it is caused by stagnant blood steaming upward to the lungs, one may still expect efficacy from Duoming Dan. However, if the condition arises from contracting wind-cold, or from emotional distress, or from consuming salty, cold foods and drinks, Duoming Dan may not be effective. How much less so for "Lone Yang and Absolute Yin"? If Ying blood is suddenly exhausted, a large dose of decoction powder should be used; Chuanxiong Tang can also rescue the patient. For wind-cold injury, Xuanfuhua Tang is appropriate. For emotional depression manifesting as disease, Xiaotiaojing San is suitable, taken with a decoction of Sangbaipi (Morus Alba Root Bark) and Xingren (Apricot Seed). For food injury, Jianwa Wan, Wuji San, and Chuanxiong Tang are appropriate.
Xue noted: For the aforementioned conditions, if Spleen and Lung Qi are deficient, use Liujunzi Tang (Six Gentlemen Decoction) with Jiegeng (Platycodon Root); if accompanied by external pathogens, add Zisu (Perilla Leaf). If Middle Qi is deficient and cold, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Paojiang (Prepared Ginger) and Rougui (Cinnamon Bark) (this is purely tonifying, perhaps too cloying). If Yang Qi is deficient and collapsing, add Fuzi (Aconite Lateral Root). If blood stasis enters the lungs, urgently use Erwei Rensu Yin (Two-Ingredient Ginseng and Tallowwood Decoction). One parturient presented with urgent panting, spontaneous sweating, and cold hands and feet, frequently holding her hands over her umbilical and abdominal regions; this indicated Yang Qi deficiency and collapse. She was cured after taking four doses of Shenfu Tang (Ginseng and Aconite Decoction).
The wife of Wu Hui from Pujiang had swollen feet during pregnancy. After giving birth in early July, she experienced panting after bathing in early September. She could only sit, unable to lie down, for five months. She feared wind, and warmth provided slight relief. Her Guan pulses were active, while Cun and Chi pulses were both deficient. Various medicines failed. She was prescribed a decoction of Mudanpi (Tree Peony Root Bark), Taoren (Peach Kernel), Guizhi (Cinnamon Twig), Fuling (Poria), Ganjiang (Dried Ginger), Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Sangbaipi (Morus Alba Root Bark), Zisu (Perilla Leaf), Wuweizi (Schisandra Berry), and Gualou Ren (Trichosanthes Seed). After taking it, she felt immediate relief. After three doses, she could lie down, and her phlegm disappeared. This was treated as cold invading stagnant blood. (Based on the symptoms of panting after bathing and slight relief with warmth, dispersing methods should have been used initially. The failure of various medicines followed by success with blood-breaking and warming-resolving agents indicates that residual pathogens remained postpartum. The active Guan pulse with deficient Cun/Chi pulses suggests pathogens stagnating in the middle, unable to exit. Therefore, warming dispersion was curative. This serves as a model for students.)
Duoming San (Life-Saving Powder) treats postpartum stagnant blood rushing to the heart, chest fullness, upper panting, and imminent death. (This treats stagnant blood.)
Formula see previous Blood Syncope section.
Erwei Rensu Yin (Two-Ingredient Ginseng and Tallowwood Decoction) treats postpartum blood entering the lungs, black complexion, and fatal panting. (This protects the lungs and expels stasis.)
Renshen (Ginseng Root) (2 liang, powdered) Sumu (Tallowwood Stem) (2 liang, crushed)
Boil Sumu in two bowls of water, take one bowl of juice, and mix with Renshen powder. Adjust dosage as needed.
Xuanfuhua Tang (Inula Flower Decoction) treats postpartum panting and cough due to wind-cold injury, with abundant phlegm-saliva. (This treats wind-cold.)
Formula see previous Cough section.
Jianwa Wan (See-Omega Pill) treats postpartum panting caused by consuming salty, frozen beverages and foods. (This treats dietary injury.)
Formula see previous Chest Oppression section.
Wuweizi Tang (Schisandra Berry Decoction) treats postpartum urgent panting with floating pulse and cold extremities. (This solely tonifies deficiency; it is a Lung-tonifying method, suitable for true deficiency.)
Wuweizi (Schisandra Berry) (bran-fried) Renshen (Ginseng Root) Xingren (Apricot Seed) (2 qian each) Maidong (Ophiopogon Tuber) Chenpi (Citrus Peel) (1 qian each)
Add three slices of Shengjiang (Fresh Ginger) and two dates. Decoct in water and take orally.
Liujunzi plus Shixiao San (Six Gentlemen plus Stop Pain Powder) treats postpartum urgent panting preventing lying flat, with phlegm and blood mixing and surging upward. This is due to Spleen-Stomach Qi deficiency allowing stagnant blood to invade. Taking this stops it immediately.
Use six qian of Liujunzi Tang ingredients, add three slices of Shengjiang, decoct in water. Mix in Huangbo (Polygonum Multiflorum Root? Note: Text says Pu Huang - Cattail Pollen) and Wulingzhi (Trogopterus Dung), each stir-fried 5 fen. Stir well and take warm. After a short while, decoct the dregs again, add more Huangbo and Wulingzhi powder, and take. Divine effect. (According to this method, it is a variation of Erwei Rensu Yin. Without investigating principles, treatment would fail. The brilliance lies in adding Shixiao San. One day I resided in the countryside when a villager begged for help, saying his wife suffered several episodes of postpartum panting unable to lie flat, with phlegm and blood surging upward. Two people had to support her sitting all day and night; turning sideways caused suffocation. I had no time to check books and guessed: newly postpartum, Qi, Blood, Spleen, and Stomach are greatly deficient and damaged, leading to abundant deficient phlegm and invasion by stagnant blood. I used Xijiao Liujunzi Tang (Rhino Horn Six Gentlemen Decoction) plus Shixiao San. One dose cleared phlegm and blood, stopping panting immediately. The next day he thanked me, saying all diseases were gone except inability to eat. I then gave Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for two doses, resulting in recovery. Symptomatic medicine works divinely thus; hence attached here.)
Dabu Tang (Great Tonification Decoction) treats postpartum beyond 100 days with bluish-green facial swelling, urgent breath at lips/mouth, and sweating. This is a severe deficiency syndrome; urgent administration is required. (Key points are bluish-green face and spontaneous sweating. This is a major formula; it should be known.)
Danggui Tou (Angelica Sinensis Root Head) Dachuanyu (Large Sichuan Lovage Rhizome) Dabai Zhu (Large Atractylodes Macrocephala Rhizome) Baishao Yao (White Peony Root) Bai Fuling (White Poria) Renshen (Ginseng Root) (large dose) Huangqi (Astragalus Root) (large dose) Wuweizi (Schisandra Berry) Shudihuang (Prepared Rehmannia Root) Ganjiang (Dried Ginger) (high grade) Gancao (Licorice Root) (small dose)
Cut into pieces, decoct in water, and take orally. If this dose does not resolve symptoms, add Chuanwu (Aconite Root) and Muxiang (Vladimiria Root), separately ground and mixed in. (This is Shiquan Dabu Tang minus Guizhi, plus Ganjiang and Wuweizi. Only those with true insight can use it. Chuanwu Muxiang Wan is also good.) If diarrhea occurs, add Hezi Rou (Chebulic Myrobalan Flesh), Doukou (Cardamom Seed), and Susuke (Poppy Shell).