郭稽中曰∶问产后口干痞闷者何。答曰∶产后荣卫大虚,血气未定,食面太早,胃不能
消化,面毒结聚于胃脘,上熏胸中,是以口干燥渴,心下痞闷,医者不识,认为胸膈壅滞,以
药下之,万不得一,但服见 丸则愈。
释曰∶为食面者之戒,南人甚少,于诸饮食皆能致疾,不必拘于一面也。
陈无择评曰∶产后口干痞闷,未必只因食面,或产母内积忧烦,外伤燥热,饮食甘肥,使
口干痞闷,当随其所因调之可也,心烦宜四物汤去地黄加人参、乌梅煎(随因调治极是,但
治烦以四物去地黄,尤不如去川芎也),若外伤燥热者,属何经,当随经焉治,难以备举,饮
食所伤,见 丸却能作汤。
薛氏曰∶前证若宿食停滞。用六君枳实神曲;若因肉食所致,更加山楂;若因鱼 之类,
再加陈皮。其物既消而仍痞,或反作痛作呕,此脾胃受伤,用六君子汤。或咽酸嗳腐,加炮
姜,作泻,更加升麻,如不应,佐以四神丸,或间用补中益气汤。
一妇人食角黍,烦渴痞闷,腹痛,大便欲去不去,服消导之药不应,饮食日减,肌体日
瘦,半年矣。余谓此食积为患,用大酒曲炒为末,温酒调服二钱,俄而腹鸣,良久仍下粽而
愈。一妇人食鱼胙,腹痛患痢,诸药不应,用陈皮白术等分为末,以陈皮汤送下,数剂而愈。
见 丸 治产后血气虚弱,饮食停积,口干烦闷,心下痞痛。
姜黄(炒) 荜澄茄 良姜 三棱(醋煨) 蓬术(醋煨) 人参 陈皮(去白,各等分)
上为细末,用萝卜(按见 丸有三棱莪术良姜温滑之味,加以人参,丸以萝卜汁,亦巧
于治面矣。而立斋纯于用补,亦为膏梁久用消导者设也,如藜藿新病,未曾用消导而气实
者,岂可泥于立斋之说乎,法当临时消息。萝卜汤为治面也)慢火煮令极熟,研烂取余汁煮
面,糊丸如桐子大,每服三五十丸,萝卜汤或白汤下。
郭稽中说:问产后出现口干、胸脘痞闷的症状是什么原因?回答说:产后营卫之气极度虚弱,血气尚未稳定,过早食用面食,胃无法消化,面毒结聚在胃脘部,向上熏蒸胸中,因此导致口干燥渴、心下痞闷。医生如果不了解这种情况,误认为是胸膈部的壅滞堵塞,使用泻下药治疗,几乎无一生还;只要服用见睨丸就能痊愈。
注释说:这是为了告诫那些吃面食的人,南方人很少吃面食,但各种饮食不当都能致病,不必局限于面食这一种情况。
陈无择评论说:产后口干痞闷,未必仅仅因为吃了面食。或者是产母内心积聚了忧烦,外受燥热之邪侵袭,加上饮食甘腻肥厚,从而导致口干痞闷。应当根据病因进行调理即可。心烦适宜用四物汤去掉地黄,加入人参、乌梅煎服(根据病因调理非常正确,但治疗心烦以四物汤去掉地黄,还不如去掉川芎更好)。如果是外受燥热所致,属于哪一经的病变,就应当顺着该经的规律治疗,难以一一列举。饮食所伤的情况,见睨丸不仅能做成丸剂,也能煮成汤剂。
薛氏说:上述症状如果是宿食停滞,使用六君子汤加枳实、神曲;如果是因肉食引起,再加山楂;如果是因鱼类之类引起,再加陈皮。如果食物已经消化但仍然痞闷,或者反而出现疼痛、呕吐,这是脾胃受伤,使用六君子汤。如果出现咽酸、嗳出腐臭气味,加炮姜;出现腹泻,再加升麻;如果不见效,辅助使用四神丸,或者交替使用补中益气汤。
有一位妇人吃了角黍(粽子),感到烦渴、痞闷、腹痛,大便想排却排不出,服用消导药物无效,饮食日渐减少,身体日渐消瘦,持续了半年。我认为这是食积引起的危害,用大酒曲炒成粉末,温酒调服二钱,不久后腹中鸣响,过了很久仍然排出粽子样粪便而痊愈。另一位妇人吃了鱼干,腹痛患痢疾,各种药物无效,用陈皮、白术等分为末,用陈皮汤送服,几剂药后痊愈。
处方组成:姜黄(炒)、荜澄茄、良姜、三棱(醋煨)、蓬术(即莪术,醋煨)、人参、陈皮(去白),以上各等分。
制作与服用方法:将上述药材研成细末,用萝卜(按语:见睨丸含有三棱、莪术、良姜等温滑性质的药物,加入人参,并用萝卜汁制丸,也是巧妙治疗面食积滞的方法。而立斋先生纯粹使用补益法,也是为长期膏粱厚味、久用消导药的人设立的。如果是体质虚弱的普通人新病,未曾用过消导药且正气充实者,怎么能拘泥于立斋的说法呢?方法应当根据实际情况灵活变通。萝卜汤用于治面食积滞)慢火煮至极熟,捣烂取剩余汁液来煮面糊,制成如梧桐子大小的丸药。每次服用三五十丸,用萝卜汤或白开水送服。
Guo Jizhong said: "Inquiring about the cause of dry mouth and epigastric fullness after childbirth. The answer is: After childbirth, Ying and Wei (nutritive and defensive qi) are severely deficient, and blood and qi have not yet stabilized. Consuming wheat noodles too early overwhelms the stomach's digestive capacity. The 'toxicity' of noodles accumulates in the epigastrium, steaming upward into the chest. Consequently, there is dry mouth with thirst and subcardiac fullness. If physicians fail to recognize this condition and mistakenly diagnose it as chest and diaphragm congestion/stagnation, using purgative drugs will result in failure in almost all cases. However, taking Jian Ni Wan (See-Ni Pill) will lead to recovery."
Annotation: This serves as a warning for those who consume noodles. People in the South rarely eat noodles, but improper consumption of any diet can cause disease; one should not restrict the etiology solely to noodles.
Chen Wuyue commented: "Postpartum dry mouth and epigastric fullness are not necessarily caused only by eating noodles. It may be due to the mother accumulating internal worry and vexation, suffering external invasion of dry-heat pathogenic factors, or consuming sweet, greasy, and rich foods, leading to dry mouth and fullness. Treatment should follow the specific cause. For vexation, Si Wu Tang (Four Substances Decoction) minus Rehmanniae Radix (Shu Di Huang), plus Ginseng Radix et Rhizoma (Ren Shen) and Mume Fructus (Wu Mei) decocted is suitable. (Treating based on the cause is very correct; however, for treating vexation, removing Chuanxiong Rhizoma (Chuan Xiong) from Si Wu Tang is even better than removing Rehmanniae Radix). If caused by external dry-heat, determine which meridian is affected and treat accordingly according to the meridian patterns; it is difficult to list all possibilities. For injuries caused by diet, Jian Ni Wan can be prepared as either pills or decoction."
Xue noted: "If the aforementioned symptoms are due to retained food stagnation, use Liu Jun Zi Tang (Six Gentlemen Decoction) added with Atractylodis Macrocephalae Rhizoma (Bai Zhu), Zhi Shi (Immature Bitter Orange), and Medicated Leaven (Shen Qu). If caused by meat consumption, add Crataegi Fructus (Shan Zha). If caused by fish, add Tangerine Peel (Chen Pi). If the food has digested but fullness persists, or if pain and vomiting occur instead, this indicates injury to the Spleen and Stomach; use Liu Jun Zi Tang (Six Gentlemen Decoction). If there is acid regurgitation and belching of rotten smells, add Roasted Ginger (Pao Jiang); if diarrhea occurs, add Cimicifugae Rhizoma (Sheng Ma). If there is no response, assist with Si Shen Wan (Four Spirits Pill), or alternatively use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)."
A woman consumed Jiao Shu (Zongzi/Sticky Rice Dumplings), experiencing vexation, thirst, fullness, abdominal pain, and tenesmus (urge to defecate without success). Purgative/digestive medications were ineffective. Her diet decreased daily, and her body emaciated over half a year. I considered this a disorder caused by food accumulation. I used Da Jiu Qu (Large Yeast) stir-fried into powder, taken with warm wine, two qian per dose. Soon after, borborygmus occurred, and after a long while, undigested Zongzi was passed, leading to recovery. Another woman consumed dried fish, developing abdominal pain and dysentery. Various medications failed. Equal parts Chen Pi (Tangerine Peel) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) were powdered and administered with Chen Pi decoction, resulting in recovery after several doses.
Jian Ni Wan (See-Ni Pill) treats postpartum deficiency of blood and qi, retention of food and fluid, dry mouth with vexation, and subcardiac painful fullness.
Ingredients: Curcuma Longa Rhizome (Jiang Huang, stir-fried), Galangal Fruit (Bi Cheng Qie), Alpinia Officinarum Rhizome (Liang Jiang), Sparganium Tuber (San Leng, stir-baked with vinegar), Curcuma Zedoaria Rhizome (E Zhu/Peng Zhen, stir-baked with vinegar), Ginseng Radix et Rhizoma (Ren Shen), Citrus Reticulata Pericarpium (Chen Pi, white pith removed). All in equal proportions.
Preparation and Administration: Grind the above ingredients into fine powder. Use Radish (Note: Jian Ni Wan contains warming and slippery herbs like San Leng, E Zhu, and Liang Jiang, combined with Ren Shen. Using radish juice to make pills is also a clever method for treating noodle accumulation. However, Li Zhai [Xue Ji] purely uses tonification methods, designed for those accustomed to rich diets and long-term use of digestive aids. For common people with new illnesses, who have not used digestive aids and have excess qi, how can one rigidly adhere to Li Zhai's theory? Methods should be adjusted flexibly according to circumstances. Radish soup is used here to treat noodle accumulation.) Slowly boil until extremely soft, mash thoroughly, extract the remaining juice, and use this juice to cook flour paste. Form pills the size of paulownia seeds. Take 30-50 pills per dose, washed down with radish soup or plain water.