产后六气为病,除伤寒遵仲景师外(孕妇伤寒,后人有六合汤法),当于前三焦篇中求之。斟
酌轻重,或速去其邪,所谓无粮之师,贵在速战者是也。或兼护其虚,一面扶正,一面驱邪。大抵初
起以速清为要,重证亦必用攻。余治黄氏温热,妊娠七月,胎已欲动,大实大热,目突舌烂,乃前医过
于瞻顾所致,用大承气一服,热退胎安,今所生子
二十一岁矣。如果六气与痉螈之因,暾然心目,俗传产后惊风之说可息矣。
朱丹溪谓产后不可用白芍,恐伐生生之气,则大谬不然,但视其为虚寒虚热耳。若系虚寒,虽非
产后,亦不可用;如仲景有桂枝汤去芍药法,小青龙去芍药法。若系虚热,必宜用之收阴。后世不
善读书者,古人良法不知守,此等偏谬处,偏牢记在心,误尽大事,可发一叹。按白芍花开春末夏
初,禀厥阴风木之全体,得少阴君火之气化,炎上作苦,故气味苦平(《本经》芍药并无酸字,但云苦
平无毒,酸字后世妄加者也)。主治邪气腹痛,除血痹,破坚积,寒热疝瘕,止痛,利小便,益气,岂伐
生生之气者乎?使伐生气,仲景小建中汤,补诸虚不足而以之为君乎?张隐庵《本草崇原》中论之
最详。
当归、川芎,为产后要药,然惟血寒而滞者为宜,若血虚而热者断不可用。盖当归秋分始开花,
得燥金辛烈之气,香窜异常,甚于麻、辛,不过麻、辛无汁而味薄,当归多汁而味浓耳。用之得当,功
力最速,用之不当,为害亦不浅。如亡血液亏,孤阳上冒等证,而欲望其补血,不亦愚哉!盖当归止
能运血,裒多益寡,急走善窜,不能静守,误服致螈,螈甚则脱。川芎有车轮纹,其性更急于当归,
盖物性之偏长于通者,必不长于守也。世人不改用白芍,而恣用当归、川芎,何其颠倒哉!
产后因六淫邪气致病,除了伤寒证遵循张仲景医师的治法外(孕妇患伤寒,后世有六合汤的治疗方法),应当在《温病条辨》的前三焦篇中寻求诊治依据。斟酌病情的轻重,要么迅速祛除邪气,这正如没有粮草补给的军队,贵在速战速决;要么兼顾保护正气之虚损,一面扶助正气,一面驱除邪气。大抵疾病初起以迅速清热为关键,重症也必然使用攻下法。我曾治疗黄氏温热病,患者妊娠七月,胎动不安,表现为大实大热之证,眼球突出,舌体溃烂,这是前一位医生过于瞻前顾后、犹豫不决所致。我使用大承气汤一剂服用后,热退胎安,如今所生的孩子已经二十一岁了。如果对于六淫致痉、抽搐的原因能像太阳一样明朗于心,那么民间流传的“产后惊风”的说法就可以停止了。
朱丹溪认为产后不可使用白芍,担心会损伤生生不息的生命之气,这种观点是大错特错的,关键在于辨别是虚寒还是虚热。如果是虚寒证,即使不是产后,也不可使用白芍;如张仲景有桂枝汤去芍药的方法,小青龙汤去芍药的方法。如果是虚热证,则必须使用白芍来收敛阴液。后世不善于读书的人,不知遵守古人的良法,却偏偏将这些偏颇谬误之处牢记在心,耽误了大事,令人叹息。按:白芍在春末夏初开花,禀受厥阴风木的完整性质,得到少阴君火的气化作用,炎上而呈现苦味,所以气味苦平(《神农本草经》中记载芍药并无酸字,只说苦平无毒,酸字是后世妄加的)。主治邪气引起的腹痛,去除血痹,破除坚积,治疗寒热疝瘕,止痛,利小便,益气,哪里是损伤生命之气呢?如果说是损伤生气,那么张仲景的小建中汤,以它作为君药来补益各种虚损不足吗?张隐庵在《本草崇原》中对此论述得最为详细。
当归、川芎,虽然是产后的要药,但只适合血寒且瘀滞的情况,如果是血虚而有热的情况绝对不可使用。因为当归在秋分开始开花,禀受燥金辛烈之气,香气窜透异常,比麻黄、细辛更甚,只不过麻黄、细辛无汁液而味道淡薄,当归多汁液而味道浓厚罢了。使用得当,功效最快;使用不当,危害也不浅。如出现亡血液亏、孤阳上冒等证候,却希望它能补血,难道不愚蠢吗!盖当归只能运行血液,削多补少,急走善窜,不能静守,误服会导致抽搐,抽搐严重则导致脱证。川芎有车轮纹,其性质比当归更急迫,大概物性偏向于通利的,一定不偏向于固守的。世人不敢改用白芍,却肆意使用当归、川芎,这是多么颠倒啊!
Postpartum diseases caused by the six qi (Six Excesses: wind, cold, summer-heat, dampness, dryness, fire), except for Taiyang Cold Damage (Taiyang Cold Damage) which follows Master Zhang Zhongjing's methods (for pregnant women with Taiyang Cold Damage, later generations have the Liuhe Tang method), should be sought in the first three chapters of the Sanjiao (Triple Burner) section. Weighing the severity, one should either rapidly eliminate the pathogenic factor, as a troop without provisions values swift battle; or simultaneously protect against deficiency, supporting the righteous qi while driving out the pathogen. Generally, at the onset, rapid clearing is essential, and even in severe cases, purgative methods must be used. I once treated Huang's warm-heat disease during the seventh month of pregnancy, where the fetus was about to move, presenting with excessive excess and excessive heat, protruding eyes, and ulcerated tongue, caused by the previous physician's excessive hesitation. Using Da Chengqi Tang (Major Order the Qi Decoction) once resulted in the subsidence of heat and stabilization of the fetus; the child born from this pregnancy is now twenty-one years old. If the causes of spasm and convulsions due to the six qi are clear as the sun in one's mind, the folk saying of "postpartum convulsive disease" can be dismissed.
Zhu Danxi stated that Baishao (Radix Paeoniae Alba) should not be used postpartum, fearing it would attack the vital energy of life, which is greatly erroneous; it depends on whether it is deficiency-cold or deficiency-heat. If it is deficiency-cold, even if not postpartum, it should not be used; for example, Zhang Zhongjing has the method of removing Baishao from Guizhi Tang (Cinnamon Twig Decoction) and Xiao Qinglong Tang (Minor Blue Dragon Decoction). If it is deficiency-heat, it must be used to gather and nourish Yin. Later generations who are not good at reading books do not know to adhere to the beneficial methods of the ancients but instead memorize these biased errors, causing great harm, which is worth a sigh. Note: Baishao blooms in late spring and early summer, inheriting the complete nature of Jueyin Wind-Wood, and obtaining the qi transformation of Shaoyin Ministerial Fire, rising upward to produce bitterness, thus its flavor is bitter and neutral (Shennong Bencao Jing does not mention sour for Shaoyao, only stating bitter, neutral, and non-toxic; the sour character was added erroneously by later generations). It treats abdominal pain caused by pathogens, removes blood obstruction, breaks firm accumulations, treats cold-hot hernia and masses, stops pain, promotes urination, and benefits qi. How could it be said to attack the vital energy of life? If it attacks shengqi (vital energy), how could Zhang Zhongjing use it as the sovereign herb in Xiaojianzhong Tang (Minor Construct the Middle Decoction) to supplement various deficiencies and insufficiencies? Zhang Yinan discusses this most detailedly in Bencao Chongyuan (Revered Source of Materia Medica).
Danggui (Radix Angelicae Sinensis) and Chuanxiong (Rhizoma Chuanxiong) are important herbs for postpartum conditions, but they are suitable only for blood-cold with stagnation. For blood-deficiency with heat, they must absolutely not be used. Danggui begins to bloom after the Autumnal Equinox, inheriting the pungent and fierce qi of Dry Metal, with an aroma that penetrates exceptionally, surpassing Mahuang (Ephedrae Herba) and Xixin (Asari Radix et Rhizoma); it is just that Mahuang and Xixin lack juice and have thin flavors, whereas Danggui is juicy and rich in flavor. Used appropriately, its efficacy is fastest; used inappropriately, the harm is also profound. In cases of blood loss and deficiency, or floating of lone Yang upwards, hoping for it to tonify blood is foolish! Danggui can only circulate blood, reducing excess and benefiting scarcity, moving quickly and penetrating well, but cannot remain static. Misuse leads to convulsions (spasms/convulsions), and severe convulsions lead to collapse (deviation/collapse). Chuanxiong has wheel-like patterns, and its nature is more urgent than Danggui. Generally, substances whose nature favors unblocking do not favor retaining. People dare not change to using Baishao but recklessly use Danggui and Chuanxiong; how inverted this is!