李氏曰∶产后外感,离床太早,或换衣袭风,冷入下部,令人寒热似疟,头疼不歇(寒热
似疟,头疼不歇,是冒下数项,又消息酌用)。血虚者,芎归汤加人参紫苏干葛;血气虚者,
补虚汤加陈皮干姜;寒热甚者,熟料五积散;热不止者,黄龙汤主之。如体盛发热恶寒及疟
痢者,小柴胡汤合四君子四物汤加黄 ,名三分散,切不可以伤寒治法。若误服热药过多,
热证大见,久而便闭者,柴胡破瘀汤,或四物汤加大黄芒硝暂服,即调补之。
良方曰∶产后外感风寒,发热头痛身疼,虽如伤寒时气,当用麻黄,亦不可轻易(吃紧
语)。如早起劳动,为寒所伤,则淅淅恶寒,翕翕发热,头项肩背骨节皆痛,至七八日乃瘥。
若大便坚,作呕不能食,用小柴胡汤加生姜地黄。(以呕加地黄,宜酌用)
吴氏曰∶新产后患伤寒,不可轻易发汗。盖有产时伤力发热,去血过多发热,恶露不去
发热,三日蒸乳发热,或有早起劳动,饮食停滞,一皆发热,状类伤寒,要在仔细详辨,切不
可辄便发汗。大抵产后大血空虚(大虚变症),若汗之则变筋惕肉 ,或郁冒昏迷而不省,或
风搐搦而不定,或大便闭涩而难去,其害非轻,切宜详审。凡有发热,且与四物汤,以川芎
当归为君最多,白芍药须炒过,酒蒸熟地黄佐之,如发热,加软苗柴胡、人参、干姜炮之最
效,盖干姜之辛热,能引血药入血分,气药入气分也,且能去恶养新,有阳生阴长之道,以
热治热,深合《内经》之旨,予尝用之,取效如神,故录以劝。如有恶露未尽者,益母丸、黑神
散必兼用之,若胃虚少食者,必加白术、茯苓,有痰呕逆者,必加陈皮、半夏,其余六经各条
治例皆同,但药中必加四物汤为主,乃养血务本之要也。
大全云∶凡产后发热,头痛身疼,不可便作感冒治之,此等多是血虚,或败血作梗,宜
以和平之剂与服,必效,如玉露散,或四物汤加北柴胡等分煎服(等分法,乃善守法)。若便
以小柴胡汤及竹叶石膏汤之类,竟不救者多矣。
产后中风,数十日不解,头微痛,恶寒,时时有热,心下闷,干呕,汗出虽多,阳旦证耳,
可与阳旦汤。(即桂枝汤,方见伤寒。仲景所谓中风,即今人所谓伤风,阳旦汤者,从仲景方也)
加味芎归汤 治产后血气虚,外感风寒,头痛,憎寒壮热。
当归 川芎(各二钱) 人参 紫苏 干葛(各一钱)
上锉,加生姜三片,水煎服。
竹叶汤 治产后中风,发热面赤,喘而头痛。
竹叶(一把) 葛根(三两) 防风 桔梗 桂枝 人参 甘草(炙,各一两)
上 咀,每服五钱,枣一枚,姜五片,水一盏半煎一盏,去滓服,温覆使汗出,若头项强,
用大附子五分,煎药扬去沫,呕者加半夏一钱。(以竹叶干葛为君,为面赤而喘也,然不用
血药而用参桂,从中风也。此虽大法,用须斟酌。附子亦须善用)
李氏说:产后外感风寒,是因为下床过早,或者换衣服时受风,寒气侵入下部,导致出现像疟疾一样的寒热交替、头痛不止的症状(这种寒热似疟、头痛不止的情况,涵盖了上述几种情形,需根据具体情况斟酌选用方药)。血虚者,用芎归汤加入人参、紫苏、干葛;气血两虚者,用补虚汤加入陈皮、干姜;寒热症状严重者,用熟料五积散;发热不止者,以黄龙汤为主治。如果体质壮实,出现发热恶寒以及疟疾或痢疾症状的,用小柴胡汤合四君子汤、四物汤,加入黄芩,名为三分散,切记不能用治疗伤寒的方法。如果误服过多热性药物,热证明显显现,时间久了导致便秘的,用柴胡破瘀汤,或者四物汤加大黄、芒硝暂时服用,随后再调理补益。
《良方》说:产后外感风寒,出现发热、头痛、身体疼痛,虽然像伤寒或时行疫病,即使需要使用麻黄发汗,也不可轻易使用(这是关键的话)。如果是早起劳作,被寒气所伤,就会感到瑟瑟恶寒,微微发热,头项肩背及骨节都疼痛,到七八天才会痊愈。如果大便坚硬,呕吐不能进食,用小柴胡汤加入生姜、地黄。(因为呕吐而加地黄,应当酌情使用)
吴氏说:新产后患伤寒,不可轻易发汗。因为产时用力过度会发热,失血过多会发热,恶露不尽会发热,产后三天蒸乳会发热,或者有早起劳作、饮食停滞等情况,都会引起发热,症状类似伤寒,关键在于仔细详细辨别,切不可随意发汗。大抵产后血液空虚(这是大虚导致的变症),如果发汗,则会导致筋脉跳动、肌肉抽搐,或者郁冒昏迷不省人事,或者风搐搦动不定,或者大便闭塞难解,其危害不轻,务必详细审慎。凡是有发热的,先给予四物汤,以川芎、当归为君药用量最多,白芍药必须炒过,酒蒸熟地黄作为佐药。如果有发热,加入软苗柴胡、人参、炮干姜最为有效,因为干姜的辛热之性,能引导血药进入血分,气药进入气分,而且能去除恶露、滋养新血,符合阳生阴长的道理,以热治热,深合《内经》的宗旨,我曾经使用它,取效如神,所以记录下来以此劝勉大家。如果有恶露未尽的,益母丸、黑神散必须兼用;如果胃虚食少,必须加入白术、茯苓;有痰呕逆的,必须加入陈皮、半夏。其余六经各条的治疗案例都相同,但药物中必须加入四物汤为主,这是养血固本的要诀。
《大全》说:凡是产后发热、头痛、身体疼痛,不可立刻当作感冒治疗,这大多多是血虚,或者是败血阻滞所致,宜用平和的药剂服用,必定有效,如玉露散,或者四物汤加北柴胡等量煎服(等量服用法,是善于遵守法则的做法)。如果直接用小柴胡汤及竹叶石膏汤之类的,往往不能治愈的情况很多。
产后中风,几十天不愈,头部轻微疼痛,恶寒,时不时有发热,心下闷堵,干呕,出汗虽多,这只是阳旦证罢了,可以与阳旦汤。(即桂枝汤,方剂见伤寒论。张仲景所说的中风,就是今人所说的伤风,阳旦汤,是沿用张仲景的方子)
加味芎归汤:治疗产后气血虚弱,外感风寒,头痛,怕冷且高热。
当归、川芎(各二钱)、人参、紫苏、干葛(各一钱)
以上药材切碎,加入生姜三片,水煎服。
竹叶汤:治疗产后中风,发热面赤,气喘且头痛。
竹叶(一把)、葛根(三两)、防风、桔梗、桂枝、人参、甘草(炙,各一两)
以上药材捣碎,每次服用五钱,大枣一枚,生姜五片,水一盏半煎至一盏,去渣服用,温覆使身体出汗。如果头项强直,用大附子五分,煎药时扬去沫,呕吐者加半夏一钱。(以竹叶、干葛为君药,是因为面赤而喘,然而不用血药而用人参、桂枝,是针对中风而言。这虽然是大法,使用时须斟酌。附子也必须善用)
Li stated: Postpartum exterior contraction of wind-cold occurs due to getting out of bed too early, or being exposed to wind when changing clothes, allowing cold to enter the lower part. This causes chills and fever resembling malaria, and unremitting headache (The symptoms of chills and fever resembling malaria and unremitting headache cover several of the aforementioned conditions; formulas should be selected with discretion). For blood deficiency, use Xionggui Tang (Cnidium and Angelica Decoction) added with Renshen (Ginseng), Zisu (Perilla Leaf), and Gange (Kudzu Root); for qi and blood deficiency, use Buxu Tang (Deficiency-Supplementing Decoction) added with Chenpi (Tangerine Peel) and Ganjiang (Dried Ginger); for severe chills and fever, use Shuliao Wuji San (Five Accumulations Powder with Cooked Ingredients); for persistent fever, Huanglong Tang (Yellow Dragon Decoction) is the primary treatment. If the constitution is robust, presenting with fever, aversion to cold, as well as malaria or dysentery, use Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Sijunzi Tang (Four Gentlemen Decoction) and Siwu Tang (Four Substance Decoction), added with Huangqin (Scutellaria Root), named Sanfen San (Three-Parts Powder). It is crucial not to treat this using methods for Shanghan (Cold Damage). If too many hot-natured medicines are mistakenly taken, leading to prominent heat syndromes and subsequent constipation after a long time, Chaihu Poyu Tang (Bupleurum Stasis-Breaking Decoction) may be used, or Siwu Tang added with Dahuang (Rhubarb Root) and Mangxiao (Mirabilite) for temporary use, followed by regulation and supplementation.
Liangfang states: Postpartum exterior contraction of wind-cold presents with fever, headache, and body pain. Although it resembles Shanghan or seasonal epidemics, even if Mahuang (Ephedra Herb) is needed for sweating, it must not be used lightly (This is a critical point). If injury from cold occurs due to early rising and labor, one will feel chilly aversion to cold, mild fever, and pain in the head, neck, shoulders, back, and joints, which resolves after seven to eight days. If the stool is hard, vomiting occurs, and eating is impossible, use Xiaochaihu Tang added with Shengjiang (Fresh Ginger) and Dihuang (Rehmannia Root). (Adding Dihuang for vomiting should be used with discretion).
Wu stated: In the immediate postpartum period, contracting Shanghan should not lead to hasty sweating therapy. Fever can result from exertion during childbirth, excessive blood loss, retention of lochia, milk engorgement on the third day, or early labor and food stagnation. All these cause fever resembling Shanghan. The key lies in careful and detailed differentiation; one must not rashly induce sweating. Generally, postpartum blood is empty (a major deficiency leading to variations). If sweating is induced, it may cause twitching of sinews and muscles, or depression and dizziness with coma and loss of consciousness, or convulsive movements that are unstable, or constipation and difficulty defecating. The harm is not slight; thorough examination is essential. For any fever, initially administer Siwu Tang (Four Substance Decoction), with Chuanxiong (Szechwan Lovage Rhizome) and Danggui (Angelica Sinensis) as the sovereign herbs in the largest doses. Baishao (White Peony Root) must be stir-fried, and Jiuhuang (Wine-processed Rehmannia Root) serves as an assistant herb. If fever persists, adding Ruanmiao Chaihu (Soft-stemmed Bupleurum Root), Renshen (Ginseng), and Paoganjiang (Stir-fried Dried Ginger) is most effective. The pungent and hot nature of Ganjiang guides blood-invigorating herbs into the blood level and qi-regulating herbs into the qi level. Moreover, it eliminates lochia and nourishes new blood, following the principle of "yang generates yin." Treating heat with heat aligns deeply with the principles of Neijing (Inner Canon). I have used it with miraculous efficacy, so I record it to encourage others. If lochia is not fully expelled, Yimu Wan (Motherwort Pill) and Heishen San (Black Divine Powder) must be used concurrently. If there is stomach deficiency and poor appetite, Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria) must be added. If there is phlegm, vomiting, and counterflow, Chenpi (Tangerine Peel) and Banxia (Pinellia Tuber) must be added. The treatment examples for the other six meridians remain the same, but Siwu Tang must be included as the main component in all prescriptions, as this is the essential method for nourishing blood and securing the root.
Daquan states: Whenever postpartum fever, headache, and body pain occur, do not immediately treat them as a common cold. These cases are mostly due to blood deficiency or obstruction by stagnant blood. Mild and harmonizing formulas should be administered, which will surely be effective, such as Yulu San (Jade Dew Powder) or Siwu Tang added with Beichaihu (Northern Bupleurum Root) in equal parts (Equal-part dosage is a prudent adherence to rules). Many cases fail to respond if Xiaochaihu Tang or Zhuyegao Tang (Bamboo Leaf and Ophiopogon Decoction) are used directly.
Postpartum wind-stroke lasting dozens of days without resolution, with mild headache, aversion to cold, intermittent fever, chest oppression, dry retching, and profuse sweating, is merely the Yangdan syndrome. Yangdan Tang (Yangdan Decoction) may be given. (This is Guizhi Tang (Cinnamon Twig Decoction), see Shanghan Lun. Zhang Zhongjing's term "wind-stroke" refers to what modern people call "wind-cold"; Yangdan Tang follows Zhang Zhongjing's formula.)
Jiawei Xionggui Tang (Modified Cnidium and Angelica Decoction): Treats postpartum qi and blood deficiency with exterior contraction of wind-cold, headache, aversion to cold, and high fever.
Danggui (Angelica Sinensis Root), Chuanxiong (Szechwan Lovage Rhizome) (each 2 qian), Renshen (Ginseng), Zisu (Perilla Leaf), Gange (Kudzu Root) (each 1 qian).
Crush the herbs, add three slices of Shengjiang (Fresh Ginger), decoct in water, and take orally.
Zhuye Tang (Bamboo Leaf Decoction): Treats postpartum wind-stroke with fever, flushed face, wheezing, and headache.
Zhuye (Bamboo Leaf) (one handful), Gegen (Kudzu Root) (3 liang), Fangfeng (Saposhnikovia Root), Jiegeng (Platycodon Root), Guizhi (Cinnamon Twig), Renshen (Ginseng), Gancao (Licorice Root, honey-fried) (each 1 liang).
Chop the herbs. Take 5 qian per dose, with one jujube and five slices of ginger. Decoct in 1.5 sheng of water until 1 sheng remains, strain, and take warm. Cover warmly to induce sweating. If there is stiffness in the head and neck, use Dafuzi (Aconite Lateral Root) 5 fen; decoct the medicine, skim off the foam, and add Banxia (Pinellia Tuber) 1 qian if vomiting occurs. (Using Zhuye and Gegen as sovereign herbs addresses the flushed face and wheezing. However, avoiding blood-invigorating herbs and using Renshen and Guizhi targets wind-stroke. While this is the general principle, application requires discretion. Dafuzi must also be used skillfully.)