大全云∶产后热闷气上,转为香港脚者何。答曰∶产卧血虚生热,复因春夏取凉过多,地
之蒸湿,因足履之;所以着为香港脚,其状热闷掣 ,惊悸心烦,呕吐气上,皆其候也,可服小
续命汤(方见后中风条)两三剂必愈,若医者误以逐败血药攻之,则血去而疾愈增矣。
陈无择评曰∶香港脚固是常病,未闻产后能转为者。往读《千金》,见产妇多有此疾之语,
便出是证,文辞害意,盖可见矣。设是热闷气上,如何便服续命汤,此药本主少阳经中风,
非均治诸经香港脚,要须根据香港脚方论,阴阳经络调之,此涉专门,未易轻论,既非产后要病,更不繁引。
准绳云∶陈无择虽有此论,然小续命汤加减与之,用无不效。故《百问》云∶寒中三阳,
所患必冷,小续命汤主之(加生姜汁更快)。暑中三阴,所患必热。小续命汤(去附子,减桂一
半)。大烦躁者,紫雪最良(予取《百问》中加减法,庶使后人均得治疗)。如无紫雪,用真薄荷
煎冷水嚼下。(楼云∶诸方必与四物汤各半服之)
薛氏曰∶前证当补气血为主,佐以小续命汤寄生汤,如不应,用大防风汤。
一产妇患前证,或用独活寄生汤而痊。后复作,服前汤,其汗如水,更加口噤吐痰。余用
十全大补汤,倍养血气渐愈,后饮食日少,肌体日瘦,吐痰如涌,此命门火衰,脾土虚寒,用
八味丸及加味归脾汤,诸症渐退,肌肉渐生。
独活寄生汤 治肝肾虚弱,或久履湿冷之地,或洗足当风,湿毒内攻,两胫缓纵,挛痛
痹弱,或皮肉紫破,足膝挛重,又专治产后香港脚。
川独活(三两) 桑寄生(如无以续断代) 杜仲(炒) 牛膝(去芦,酒浸) 细辛 官桂(不见火)
白茯苓 防风 川芎 当归 人参 熟地黄(酒洗) 芍药 秦艽(各二两) 甘草(炙,一两)
上 咀,每服四钱,姜五片,水煎,温服。
大防风汤 治阴虚邪袭,腿膝肿痛等证。(按二方俱小续命汤变法,但去麻黄而佐四
物,是不舍产后二字)
防风 附子(炮) 牛膝(酒浸) 白术(炒) 羌活 人参 肉桂 黄 (炒,各一钱) 川芎 熟
地(各一钱) 芍药(炒) 杜仲(姜汁炒) 甘草(炙,各五分)
上锉,水煎服。
《大全》记载:产后出现烦热闷乱、气逆上冲,进而转为香港脚(一种以足胫肿重疼痛为主要表现的疾病)的原因是什么?回答说:分娩后卧床休息导致血虚生热,又因在春夏季节贪凉过度,地面的蒸腾湿气通过脚底侵入人体;因此湿气附着于下肢形成香港脚。其症状表现为烦热闷乱、肢体抽搐牵引、惊悸心烦、呕吐及气逆上冲,这些都是该病的征候,可以服用小续命汤(方剂见后文中风条)两三剂即可痊愈。如果医生错误地使用逐瘀败血的药物进行攻伐,那么血液耗损而疾病反而会加重。
陈无择评论说:香港脚固然是常见病症,但未曾听说产后会转变为这种病。以前阅读《千金方》,看到关于产妇多有此疾的记载,便列出这一证型,可见原文的文辞损害了医理。假设确实是烦热闷乱、气逆上冲,怎么能直接服用小续命汤呢?此药原本主治少阳经中风,并非通用治疗各经香港脚的药物,必须依据香港脚的方论,根据阴阳经络进行调理。这涉及专门领域,不容易轻易议论。既然不是产后的主要病症,更不必繁琐引用。
《准绳》记载:虽然陈无择有上述言论,然而对小续命汤进行加减使用,应用没有不有效的。所以《百问》中说:寒邪侵袭三阳经,所患之病必定偏冷,用小续命汤主治(加入生姜汁效果更快)。暑邪侵袭三阴经,所患之病必定偏热,用小续命汤(去掉附子,减少桂枝用量的一半)。若出现极度烦躁者,紫雪最为适宜(我选取《百问》中的加减法,以便使后人都能得到治疗)。如果没有紫雪,可用真薄荷煎煮冷水送服。(楼全善按语:各方剂必与四物汤各半合用服用)
薛己说:前述证候应当以补益气血为主,佐以小续命汤和独活寄生汤,如果无效,则使用大防风汤。
有一位产妇患有前述证候,有人使用独活寄生汤而痊愈。后来复发,服用前一方,结果出汗如水,更加出现牙关紧闭、吐痰的症状。我用十全大补汤,加倍补养气血,逐渐好转。后来饮食日渐减少,身体日渐消瘦,吐痰如涌,这是命门火衰、脾土虚寒所致,于是使用八味丸及加味归脾汤,诸症逐渐消退,肌肉逐渐生长。
独活寄生汤:治疗肝肾虚弱,或久处湿冷之地,或洗脚时当风受邪,湿毒内攻,导致两小腿松弛无力、挛缩疼痛、麻木虚弱,或皮肉紫暗破损、足膝拘挛沉重,又专门治疗产后香港脚。
药材组成:川独活(三两)、桑寄生(若无可用续断代替)、杜仲(炒制)、牛膝(去芦头,酒浸)、细辛、官桂(不经过火烤)、白茯苓、防风、川芎、当归、人参、熟地黄(酒洗)、芍药、秦艽(各二两)、甘草(炙,一两)。
用法:将药材切碎,每次服用四钱,加生姜五片,水煎,温服。
大防风汤:治疗阴虚外邪侵袭,腿膝肿痛等证候。(按:这两个方剂都是小续命汤的变法,只是去掉了麻黄而辅以四物汤,是不舍弃“产后”这一特点的意思)
药材组成:防风、附子(炮制)、牛膝(酒浸)、白术(炒制)、羌活、人参、肉桂、黄芪(炒制,各一钱)、川芎、熟地黄(各一钱)、芍药(炒制)、杜仲(姜汁炒制)、甘草(炙,各五分)。
用法:将药材锉碎,水煎服。
Quan Shu records: What is the reason for postpartum heat, oppression, and rising qi transforming into Hongxiangjiao (a disease characterized by swelling and pain in the lower legs)? The answer is: After childbirth, lying in bed causes blood deficiency generating heat. Furthermore, due to excessive cooling during spring and summer, the steaming dampness of the ground enters through the feet; thus, dampness adheres to the lower limbs forming Hongxiangjiao. Its manifestations include heat, oppression, muscle twitching and pulling, palpitations, irritability, vomiting, and rising qi; these are all its signs. One may take Xiao Xuming Tang (Formula see later Stroke section) for two or three doses to be cured. If a doctor mistakenly uses drugs that expel stasis and败血 (destroy blood) to attack it, the blood will be depleted and the disease will worsen.
Chen Wuyue commented: Hongxiangjiao is indeed a common disease, but I have never heard of it transforming from postpartum conditions. Previously reading Qianjin Fang, I saw statements about many puerperae having this disease, so this syndrome was listed; it can be seen that the text's wording harms the meaning. Suppose there is heat, oppression, and rising qi, how can one directly take Xiao Xuming Tang? This medicine originally treats Shaoyang channel wind-stroke, not uniformly treating all channels' Hongxiangjiao. It is necessary to follow Hongxiangjiao formula theories and regulate according to Yin-Yang meridians. This involves specialized knowledge and is not easy to discuss lightly. Since it is not a major postpartum disease, there is no need to cite it extensively.
Zhunsheng records: Although Chen Wuyue has this argument, adding or subtracting ingredients from Xiao Xuming Tang yields effective results every time. Therefore, Baiwen states: When cold invades the Three Yang channels, the illness must be cold; treat with Xiao Xuming Tang (adding ginger juice works faster). When summer-heat invades the Three Yin channels, the illness must be hot; treat with Xiao Xuming Tang (remove Fuzi, reduce Guizhi by half). For severe restlessness, Zixue is best (I selected the modification methods from Baiwen so that later generations can receive treatment). If Zixue is unavailable, use genuine Bohe decocted in cold water to chew and swallow. (Lou Quanshan notes: All formulas must be taken half-dose combined with Siwu Tang)
Xue Ji said: The aforementioned syndromes should primarily be treated by tonifying Qi and Blood, assisted by Xiao Xuming Tang and Duhuo Jisheng Tang. If ineffective, use Dafangfeng Tang.
A puerpera suffered from the aforementioned syndrome. Someone used Duhuo Jisheng Tang and she recovered. Later it recurred; after taking the previous formula, her sweat flowed like water, and she developed trismus (lockjaw) and expectoration. I used Shiquan Dabu Tang, doubling the dosage to nourish Qi and Blood, leading to gradual improvement. Later, her food intake decreased daily, her body became thinner, and she vomited phlegm profusely. This indicated decline of Mingmen fire and deficiency-cold of Spleen Earth. I used Bawei Wan and Jiawei Guipi Tang, after which various symptoms gradually subsided and muscle mass gradually increased.
Duhuo Jisheng Tang: Treats Liver and Kidney deficiency, or prolonged exposure to damp-cold places, or washing feet while exposed to wind, causing damp-toxin to attack internally. Symptoms include flaccidity and weakness in both calves, cramping pain, numbness, weakness, purple and broken skin/flesh, and heavy, contracted feet and knees. It also specifically treats postpartum Hongxiangjiao.
Ingredients: Chuan Duhuo (3 liang), Sangjisheng (substitute with Xuduan if unavailable), Duzhong (stir-fried), Niuxi (remove radicle, soak in wine), Xixin, Guanzi Gui (not roasted over fire), Baifuling, Fangfeng, Chuanxiong, Danggui, Renshen, Shudihuang (wash with wine), Shaoyao, Qinjiao (each 2 liang), Gancao (honey-fried, 1 liang).
Usage: Cut the herbs coarsely. Take 4 qian per dose, add 5 slices of fresh ginger, decoct in water, and take warm.
Dafangfeng Tang: Treats deficiency of Yin with external pathogen invasion, presenting with swelling and pain in legs and knees, etc. (Note: Both formulas are variations of Xiao Xuming Tang, merely removing Mahuang and assisting with Siwu Tang, preserving the essence of "postpartum" conditions.)
Ingredients: Fangfeng, Fuzi (processed), Niuxi (soak in wine), Baizhu (stir-fried), Qianghuo, Renshen, Rougui, Huangqi (stir-fried, each 1 qian), Chuanxiong, Shudi (each 1 qian), Shaoyao (stir-fried), Duzhong (stir-fry with ginger juice), Gancao (honey-fried, each 0.5 fen).
Usage: Coarsely crush the herbs, decoct in water, and take orally.