羊肉汤 治产妇脾虚,为寒邪所乘,以致腹痛,及寒月生产,寒气入于产门,脐下胀满,
手不可犯。
精羯羊肉(四两) 当归 川芎(各半两) 生姜(一两)
上以水十盏、酒三盏煎至四盏,分四次空心服,加葱盐亦可。
衍义云∶一妇人产当寒月,寒气入于产门,脐下胀痛,手不可犯,此寒疝也,医当治之
以抵当汤,谓其有瘀血耳。予教之曰∶非其治也,可服张仲景羊肉汤少减,作二服愈。
千金方 治产后余疾,腹中绞痛,瘦乏,不下食。(与前增损四物汤相上下,用者当合观之)
当归 黄 芍药(各六钱) 干地黄 白术(各八分) 桂心 甘草(各四分) 大枣(十四枚)
上 咀,水二升煮八合,空心服,忌生冷。
以上治虚寒腹痛之剂。
生料五积散 治产后内有余血,外感寒邪,相搏而腹痛。
苍术(二钱四分) 麻黄(去根节) 橘红 枳壳(各六钱) 桔梗(一钱二分) 浓朴 干姜(炮,
各四钱) 当归 白芍 川芎 白茯苓 半夏 白芷 肉桂 甘草(炙,各三分)
上加姜葱,水煎服。
上方治寒邪腹痛之剂。(非真受寒气者不可轻用)
大全云∶产后两胁胀满气痛,由膀胱宿有停水,因产后恶露下不尽,水壅痞与气相搏,
积在膀胱,故令胁肋胀满,气与水相激,故令痛也。(胁胀痛,由膀胱停水所致,是何见解,
用何汤药,宜考之)
薛氏曰∶前症若肝经血瘀,用玄胡索散(玄胡索散见前腹痛条)。若肝经气滞,用四君青皮柴胡。若肝经血虚,
用四物参术柴胡(俱属肝经,而有胜克乘制之异,故治不同)。气血俱虚,用八珍柴胡。若肾水不足,不能生肝,用六味
丸。若肺金势盛,克制肝木,用泻白汤,仍参前论主之。
一产妇因怒,两胁胀痛,吐血甚多,发热恶寒,胸腹胀痛,余以为气血俱虚,用八珍加柴胡丹皮炮姜,而血顿止,
又用十全大补汤,而寒热渐退。此症苟非用姜桂辛温,助脾肺以行药势,不惟无以施功,而反助其胀矣。
干地黄汤 治产后两胁满胀,兼除百病。
干地黄 芍药(各三两) 当归 蒲黄(各二两) 桂心(六两)(世谓木得桂而枯,故用之以治胁痛,然不可不审
寒热虚实也。此方以桂心为君,而以血药为铺,用之以温肝家血寒之痛则可,用之以治肝火作痛则不可,须详辨之,生
姜亦然) 甘草(一两) 生姜(五两) 大枣(二十枚)
上 咀,以水一斗煮取二分半,分服,日三。
经效方 治产后肝经气滞(气滞二字尽之)不平,胁肋胀痛,或寒热往来, 内热晡热。
当归(一钱半) 芍药(炒) 苦梗 槟榔 枳壳(麸炒,各八分) 桂心 青木香 柴胡(各六分)
上锉,水煎服。
苏葛汤 疗产后恶露不下,血气壅痞,胁胀痛,不下食。
苏木 柴葛(各十二分) 芍药 当归(各八分) 桂心 蒲黄(各六分) 生地黄汁(三合)
上 咀,以水二升煎七合,下蒲黄,分两服。
经效方 理血气烦闷,胁肋胀满及痛。(行血为主)
芍药(八分) 当归(六分) 玄胡索 蒲黄(各四分) 荷叶蒡(炙,三枚)
上水二升煎取七合,后入蒲黄,空心分二服。
当归散 治产后腹痛,胁肋胀满。
当归 干姜(各等分)
上为末,酒服三钱,水煎,入盐醋少许,食前热服。(一方酒煎)
广济方 疗产后腹痛气胀,胁下闷,不下食,兼微利。(此方治气血虚滞,脾胃不足者尤宜)
浓朴(八分) 人参 当归 茯苓 甘草(各六分) 陈皮 生姜(各四分)
上 咀,以水二升煎取八合,去滓,分温服。
抵圣汤 治产后腹胁闷满,或呕吐者。
赤芍 半夏 泽兰叶 陈皮 人参 甘草(各等分)
上 咀,每服四钱,姜五片,水煎,温服。(以上七方并无川芎,岂胁痛者不宜欤,要知
此窍此理)
羊肉汤:治疗产妇因脾气虚弱,遭受寒邪侵袭,从而导致腹痛;以及寒冷月份生产时,寒气侵入产门,引起脐下胀满,疼痛剧烈到用手触碰都不可忍受。
配方:精羯羊肉(四两)、当归、川芎(各半两)、生姜(一两)。
煎服法:以上药材用水十盏、酒三盏,煎煮至剩余四盏药液,分四次空腹服用,加入葱和盐也可以。
《衍义》记载:有一位妇人在寒冷的月份生产,寒气侵入产门,导致脐下胀痛,手不可触碰,这是寒疝病,医生应当用抵当汤治疗,认为其中有瘀血。我教导她说:这不是正确的治法,可以服用张仲景的羊肉汤,剂量稍减,分两次服用即可痊愈。
千金方:治疗产后余疾,腹中绞痛,身体消瘦乏力,无法进食。(此方与前文增损四物汤相似,使用者应当结合参考)
配方:当归、黄芪、芍药(各六钱)、干地黄、白术(各八分)、桂心、甘草(各四分)、大枣(十四枚)。
煎服法:以上药材切碎,用水二升煮取八合,空腹服用,忌食生冷食物。
以上均为治疗虚寒性腹痛的方剂。
生料五积散:治疗产后体内有余血未清,外部感受寒邪,内外相搏而导致腹痛。
配方:苍术(二钱四分)、麻黄(去除根节)、橘红、枳壳(各六钱)、桔梗(一钱二分)、浓朴、干姜(炮制,各四钱)、当归、白芍、川芎、白茯苓、半夏、白芷、肉桂、甘草(炙,各三分)。
煎服法:以上药材加生姜、葱白,用水煎服。
上方为治疗寒邪所致腹痛的方剂。(如果不是真正受寒气的患者,不可轻易使用)
《大全》记载:产后两胁胀满气痛,是由于膀胱素有停水,因产后恶露排不尽,水湿壅滞痞塞与气相互搏结,积聚在膀胱,所以导致胁肋胀满,气与水相互激荡,所以产生疼痛。(关于胁胀痛由膀胱停水所致的见解,以及使用何种汤药,值得考证)
薛氏说:前述症状如果是肝经血瘀,使用玄胡索散(玄胡索散见前腹痛条)。如果是肝经气滞,使用四君子汤加青皮、柴胡。如果是肝经血虚,使用四物汤加人参、白术、柴胡(均属于肝经病变,但有胜克乘制的不同,所以治疗方法不同)。如果气血俱虚,使用八珍汤加柴胡。如果肾水不足,不能滋养肝木,使用六味丸。如果肺金气势过盛,克制肝木,使用泻白汤,并参照前面的论述主治。
一位产妇因发怒,导致两胁胀痛,吐血很多,发热恶寒,胸腹胀痛,我认为这是气血俱虚,使用八珍汤加柴胡、丹皮、炮姜,血液顿时停止出血,又使用十全大补汤,寒热症状逐渐消退。此症如果不使用姜、桂等辛温药物,辅助脾肺以推动药势,不仅无法见效,反而会加重胀满。
干地黄汤:治疗产后两胁满胀,兼除百病。
配方:干地黄、芍药(各三两)、当归、蒲黄(各二两)、桂心(六两)(世人说木头遇到桂就会枯死,所以用它来治疗胁痛,然而不可不仔细辨别寒热虚实。此方以桂心为君药,而以补血药为辅佐,用来温补肝家血寒之痛是可以的,用来治疗肝火作痛则不可以,必须详细辨别,生姜也是如此)、甘草(一两)、生姜(五两)、大枣(二十枚)。
煎服法:以上药材切碎,用水一斗煮取二分半,分次服用,每日三次。
经效方:治疗产后肝经气滞(仅“气滞”二字便概括了病情),不平顺,胁肋胀痛,或寒热往来,内热及傍晚发热。
配方:当归(一钱半)、芍药(炒)、苦梗、槟榔、枳壳(麸炒,各八分)、桂心、青木香、柴胡(各六分)。
煎服法:以上药材锉碎,用水煎服。
苏葛汤:治疗产后恶露不下,血气壅滞痞塞,胁胀痛,无法进食。
配方:苏木、柴葛(各十二分)、芍药、当归(各八分)、桂心、蒲黄(各六分)、生地黄汁(三合)。
煎服法:以上药材切碎,用水二升煎取七合,加入蒲黄,分两次服用。
经效方:调理血气烦闷,胁肋胀满及疼痛。(以行血为主)
配方:芍药(八分)、当归(六分)、玄胡索、蒲黄(各四分)、荷叶蒡(炙,三枚)。
煎服法:以上用水二升煎取七合,后加入蒲黄,空腹分两次服用。
当归散:治疗产后腹痛,胁肋胀满。
配方:当归、干姜(各等分)。
煎服法:以上研为末,用酒送服三钱,也可用水煎,加入少许盐和醋,饭前热服。(另一方法是用酒煎)
广济方:治疗产后腹痛气胀,胁下闷堵,无法进食,兼有轻微腹泻。(此方治疗气血虚滞、脾胃不足者尤为适宜)
配方:浓朴(八分)、人参、当归、茯苓、甘草(各六分)、陈皮、生姜(各四分)。
煎服法:以上药材切碎,用水二升煎取八合,去渣滓,分次温服。
抵圣汤:治疗产后腹胁闷满,或呕吐者。
配方:赤芍、半夏、泽兰叶、陈皮、人参、甘草(各等分)。
煎服法:以上药材切碎,每次服用四钱,加生姜五片,用水煎,温服。(以上七个方子都没有川芎,难道胁痛者不宜使用吗?要知道其中的窍妙和道理)
Mutton Decoction: Treats postpartum abdominal pain caused by Spleen Qi deficiency and invasion of Cold pathogen; as well as when production occurs in cold months, allowing Cold to enter the birth canal, resulting in distension and fullness below the umbilicus, with pain so severe that it cannot be touched by hand.
Ingredients: Lean ram mutton (4 liang), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 0.5 liang), Shengjiang (Zingiberis Rhizoma Recens) (1 liang).
Preparation and Administration: Decoct the above ingredients in 10 cups of water and 3 cups of wine until reduced to 4 cups. Divide into four doses and take on an empty stomach. Adding scallion and salt is also acceptable.
*Yanyi* records: A woman gave birth during a cold month, and Cold entered the birth canal, causing distending pain below the umbilicus that could not be touched. This is Han Shan (Cold Hernia). The physician should treat it with Didang Tang (Turdus Decoction), assuming there is Blood stasis. I advised her: This is not the correct treatment. She may consume Zhang Zhongjing's Mutton Decoction, with a slightly reduced dosage, divided into two doses, which will cure her.
Qianjin Fang: Treats residual diseases after childbirth, including colicky abdominal pain, emaciation and weakness, and loss of appetite. (This formula is similar to Zengsun Siwu Tang mentioned earlier; users should consult both.)
Ingredients: Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Membranacei Radix), Shaoyao (Paeoniae Radix Alba) (each 6 qian), Dihuang (Rehmanniae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 8 fen), Guixin (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma) (each 4 fen), Dazao (Ziziphi Jujubae Fructus) (14 pieces).
Preparation and Administration: Coarsely crush the above ingredients. Decoct in 2 sheng of water to obtain 8 he. Take on an empty stomach. Avoid raw and cold foods.
The above are formulas for treating Deficiency-Cold abdominal pain.
Shengliao Wuji San: Treats postpartum abdominal pain caused by internal residual Blood and external invasion of Cold pathogen, where they clash and interact.
Ingredients: Cangzhu (Atractylodis Rhizoma) (2.4 qian), Mahuang (Ephedrae Herba) (roots and joints removed), Juhong (Citri Reticulatae Pericarpium Rubrum), Zhike (Aurantii Fructus Immaturus) (each 6 qian), Jiegeng (Platycodonis Radix) (1.2 qian), Houpo (Magnoliae Officinalis Cortex), Ganjiang (Zingiberis Rhizoma) (prepared, each 4 qian), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baifuling (Poria), Banxia (Pinelliae Rhizoma), Baizhi (Angelicae Dahuricae Radix), Rougui (Cinnamomi Cortex), Gancao (Glycyrrhizae Radix et Rhizoma) (prepared, each 3 fen).
Preparation and Administration: Add fresh ginger and scallion to the above ingredients, decoct in water, and take orally.
The above is a formula for treating abdominal pain due to Cold pathogen. (Do not use lightly if the patient has not truly contracted Cold.)
*Daquan* records: Postpartum distension, fullness, and Qi pain in the bilateral hypochondrium are caused by retained fluid previously present in the Bladder. Because lochia is not fully discharged after childbirth, water stagnates and obstructs, clashing with Qi, accumulating in the Bladder, thus causing distension and fullness in the hypochondrium. The agitation between Qi and Water causes pain. (The theory that hypochondriac distension and pain are caused by retained fluid in the Bladder requires further investigation regarding the appropriate herbal prescriptions.)
Xue says: If the aforementioned symptoms are due to Blood stasis in the Liver Meridian, use Xuanhusuo San (see Abdominal Pain section). If due to Qi stagnation in the Liver Meridian, use Sijunzi Tang (Four Gentlemen Decoction) added with Qingpi (Tangerine Peel) and Chaihu (Bupleuri Radix). If due to Blood deficiency in the Liver Meridian, use Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Chaihu (Bupleuri Radix). (All belong to Liver Meridian disorders but differ in their pathological mechanisms of overacting or subduing, hence different treatments.) If both Qi and Blood are deficient, use Bazhen Tang (Eight Treasures Decoction) added with Chaihu (Bupleuri Radix). If Kidney Water is insufficient and fails to nourish Liver Wood, use Liuwei Wan (Six-Ingredient Pill with Rehmannia). If Lung Metal is excessive and suppresses Liver Wood, use Xiebai Tang (Drain White Decoction), referring to the previous discussion for primary treatment.
A puerperal woman, due to anger, suffered from distending pain in the bilateral hypochondrium, profuse hematemesis, fever and aversion to cold, and chest/abdominal distension and pain. I considered this a case of Qi and Blood deficiency. I used Bazhen Tang (Eight Treasures Decoction) added with Chaihu (Bupleuri Radix), Danpi (Moutan Cortex), and Paojiang (Prepared Ginger). The bleeding stopped immediately. Then I used Shiquan Dabu Tang (Ten Significant Tonifying Decoction), and the chills and fever gradually subsided. In this case, if Jiang (Ginger) and Gui (Cinnamon) had not been used for their acrid-warm properties to assist the Spleen and Lung in promoting the action of the herbs, not only would there be no therapeutic effect, but the distension would have been exacerbated.
Dihuang Tang: Treats postpartum fullness and distension in the bilateral hypochondrium, and generally eliminates various diseases.
Ingredients: Dihuang (Rehmanniae Radix), Shaoyao (Paeoniae Radix Alba) (each 3 liang), Danggui (Angelicae Sinensis Radix), Puhuang (Typhae Pollen) (each 2 liang), Guixin (Cinnamomi Ramulus) (6 liang) (It is said in the world that wood withers when encountering Cinnamon, so it is used to treat hypochondriac pain. However, one must carefully distinguish between Cold, Heat, Deficiency, and Excess. In this formula, Guixin is the Sovereign herb, supported by Blood-nourishing herbs. It can be used to treat pain due to Blood-Cold in the Liver, but not for pain caused by Liver Fire. Detailed differentiation is required. The same applies to Shengjiang/Fresh Ginger), Gancao (Glycyrrhizae Radix et Rhizoma) (1 liang), Shengjiang (Zingiberis Rhizoma Recens) (5 liang), Dazao (Ziziphi Jujubae Fructus) (20 pieces).
Preparation and Administration: Coarsely crush the above ingredients. Decoct in 1 dou of water until reduced to half of the original volume. Divide into doses and take three times daily.
Jingxiao Fang: Treats postpartime Liver Meridian Qi stagnation (the term "Qi stagnation" summarizes the condition), leading to disharmony, distending pain in the hypochondrium, alternating chills and fever, internal heat, and afternoon tidal fever.
Ingredients: Danggui (Angelicae Sinensis Radix) (1.5 qian), Shaoyao (Paeoniae Radix Alba) (stir-fried), Kugeng (Platycodonis Radix), Binglang (Arecae Semen), Zhike (Aurantii Fructus Immaturus) (stir-fried with bran, each 8 fen), Guixin (Cinnamomi Ramulus), Qingmuxiang (Tasmanniæ Spicatae Fructus), Chaihu (Bupleuri Radix) (each 6 fen).
Preparation and Administration: Coarsely chop the above ingredients, decoct in water, and take orally.
Suge Tang: Treats postpartum retention of lochia, stagnation and obstruction of Blood and Qi, distending pain in the hypochondrium, and inability to eat.
Ingredients: Sumu (Sappan Lignum), Chage (Bupleuri Radix and Puerariae Radix) (each 12 fen), Shaoyao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix) (each 8 fen), Guixin (Cinnamomi Ramulus), Puhuang (Typhae Pollen) (each 6 fen), Shengdihuang Zhi (Fresh Juice of Rehmanniae Radix) (3 he).
Preparation and Administration: Coarsely crush the above ingredients. Decoct in 2 sheng of water to obtain 7 he. Add Puhuang (Typhae Pollen), divide into two doses.
Jingxiao Fang: Regulates Qi and Blood vexation and oppression, distension, fullness, and pain in the hypochondrium. (Primary focus on moving Blood.)
Ingredients: Shaoyao (Paeoniae Radix Alba) (8 fen), Danggui (Angelicae Sinensis Radix) (6 fen), Xuanhusuo (Corydalis Rhizoma), Puhuang (Typhae Pollen) (each 4 fen), Heyebang (Nelumbinis Nymphaeae Folium) (roasted, 3 pieces).
Preparation and Administration: Decoct in 2 sheng of water to obtain 7 he. Add Puhuang (Typhae Pollen) afterwards. Divide into two doses and take on an empty stomach.
Danggui San: Treats postpartum abdominal pain and distension/fullness in the hypochondrium.
Ingredients: Danggui (Angelicae Sinensis Radix), Ganjiang (Zingiberis Rhizoma) (equal parts).
Preparation and Administration: Grind into powder. Take 3 qian with wine. Alternatively, decoct in water with a little salt and vinegar. Take hot before meals. (Another method is decocting with wine.)
Guangji Fang: Treats postpartum abdominal pain and Qi distension, stuffiness under the hypochondrium, inability to eat, accompanied by mild diarrhea. (This formula is particularly suitable for cases of Qi and Blood deficiency with stagnation and Spleen/Stomach insufficiency.)
Ingredients: Houpo (Magnoliae Officinalis Cortex) (8 fen), Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma) (each 6 fen), Chenpi (Citri Reticulatae Pericarpium), Shengjiang (Zingiberis Rhizoma Recens) (each 4 fen).
Preparation and Administration: Coarsely crush the above ingredients. Decoct in 2 sheng of water to obtain 8 he. Strain the dregs. Divide into doses and take warm.
Disheng Tang: Treats postpartum stuffiness and fullness in the abdomen and hypochondrium, or vomiting.
Ingredients: Chishao (Paeoniae Radix Rubra), Banxia (Pinelliae Rhizoma), Zelan Ye (Leonuri Herba), Chenpi (Citri Reticulatae Pericarpium), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma) (equal parts).
Preparation and Administration: Coarsely crush the above ingredients. For each dose, use 4 qian of herbs, add 5 slices of ginger, decoct in water, and take warm. (None of the above seven formulas contain Chuanxiong. Is it inappropriate for hypochondriac pain? One must understand the underlying principles and nuances.)