朱丹溪云∶“产后当大补气血,即有杂病,从末治之;一切病多是血虚,皆不可发表。”张景岳
云∶“产后既有表邪,不得不解;既有火邪,不得不清,既有内伤停滞,不得不开通消导;不可偏执。
如产后外感风寒,头痛身热,便实中满,脉紧数洪大有力,此表邪实病也。又火盛者,必热渴躁烦,
或便结腹胀,口鼻舌焦黑,酷喜冷冻饮料,眼眵尿痛,溺赤,脉洪滑,此内热实病也。又或因产过食,致停
蓄不散,此内伤实病也。又或郁怒动肝,胸胁胀痛,大便不利,脉弦滑,此气逆实病也。又或恶露
未尽,瘀血上冲,心腹胀满,疼痛拒按,大便难,小便利,此血逆实证也。遇此等实证,若用大补,是
养虎为患,误矣”。愚按二子之说,各有见地,不可偏废,亦不可偏听。如丹溪谓产后不可发表,仲景
先师原有亡血禁汗之条,盖汗之则痉也。产后气血诚虚,不可不补,然杂证一概置之不问,则亦不
可,张氏驳之,诚是。但治产后之实证,自有妙法,
妙法为何?手挥目送是也。手下所治系实证,目中心中意中注定是产后。识证真,对病确,一击而
罢;治上不犯中,治中不犯下,目中清楚,指下清楚,笔下再清楚,治产后之能事毕矣。如外感自上
焦而来,固云治上不犯中,然药反不可过轻,须用多备少服法,中病即已,外感已即复其虚,所谓无
粮之兵,贵在速战;若畏产后虚怯,用药过轻,延至三、四日后,反不能胜药矣。余治产后温暑,每用
此法。如腹痛拒按则化瘀,喜按即补络,快如转丸,总要医者平日用功参悟古书,临证不可有丝毫
成见而已。
朱丹溪说:“产后应当大补气血,即使有其他杂病,也要从属地位进行治疗;一切疾病大多是因为血虚,都不可使用发汗解表的方法。”张景岳说:“产后如果有表邪,不得不解除;如果有火邪,不得不清泄;如果有内伤停滞,不得不疏通消导;不可偏执一端。比如产后外感风寒,出现头痛身热、大便实满、脉象紧数洪大有力,这是表邪实证。又有火热炽盛的,必然出现热渴烦躁,或者大便干结腹胀、口鼻舌焦黑、极度喜欢冷冻饮料、眼屎多尿痛、小便赤红、脉象洪滑,这是内热实证。又或者是因生产后饮食过量,导致食物停滞不散,这是内伤实证。又或者是因郁怒触动肝气,胸胁胀痛、大便不利、脉象弦滑,这是气逆实证。又或者是恶露未尽,瘀血上冲,心腹胀满、疼痛拒按、大便困难、小便通畅,这是血逆实证。遇到这些实证,如果使用大补之法,是养虎为患,是错误的。”我认为这两位先生的说法,各有见地,不可偏废,也不可偏听。比如丹溪说产后不可发汗,仲景先师原本就有亡血禁汗的条文,大概是因为发汗会导致痉病。产后气血确实虚弱,不可不补,然而对杂证一概置之不问,也是不对的,张氏驳斥这一点,确实是正确的。但是治疗产后的实证,自有妙法,妙法是什么?就是“手挥目送”。手下所治的是实证,但心中意念中注定是针对产后这一特殊生理状态。辨证准确,对病确切,一击而愈;治疗上部不侵犯中部,治疗中部不侵犯下部,眼中清楚,指下清楚,笔下再清楚,治疗产后的能事就完备了。比如外感病从上焦而来,固然说治上不犯中,然而药力反而不可过轻,必须采用多备少服的方法,中病即止,外感一好就恢复其虚损,所谓没有粮草的军队,贵在速战速决;如果畏惧产后体虚怯弱,用药过轻,拖延到三四日后,反而不能胜任药力了。我治疗产后温暑病,经常使用这种方法。比如腹痛拒按就化瘀,喜按就补络,见效快如转丸,总要医生平日用功参悟古书,临证时不可有丝毫成见罢了。
Zhu Danxi stated: "After childbirth, one should strongly tonify Qi and Blood. Even if there are other miscellaneous diseases, they should be treated as secondary; most illnesses are due to Blood deficiency, and thus, diaphoresis (releasing the exterior through sweating) is contraindicated." Zhang Jingyue stated: "If there is an exterior pathogen after childbirth, it must be resolved; if there is Fire pathogen, it must be cleared; if there is internal injury with stagnation, it must be unblocked and digested. One cannot adhere to a single bias. For instance, if postpartum exterior cold-wind invasion occurs, presenting with headache, fever, solid stool, abdominal fullness, and a tight, rapid, surging, large, and forceful pulse, this is an exterior excess syndrome. If Fire is flourishing, there will inevitably be heat, thirst, restlessness, and irritability, or dry constipation with abdominal distension, scorched black tongue and lips, a strong desire for cold drinks, eye discharge, painful urination, red urine, and a surging and slippery pulse; this is an interior heat excess syndrome. Or, excessive eating after delivery may cause food stagnation that does not dissipate; this is an internal injury excess syndrome. Or, depression and anger moving Liver Qi may cause chest and hypochondriac distending pain, difficult defecation, and a string-taut and slippery pulse; this is a Qi rebellion excess syndrome. Or, if lochia is not fully expelled, blood stasis rushes upward, causing heart and abdominal distension, pain that refuses pressure, difficult defecation, but free urination; this is a Blood rebellion excess syndrome. In encountering such excess syndromes, if strong tonification is used, it is nurturing the tiger to create disaster, which is erroneous." I observe that both gentlemen's theories have their merits and should not be discarded or listened to exclusively. Zhu Danxi's assertion that postpartum patients should not undergo diaphoresis aligns with Master Zhongjing's original principle of prohibiting sweating in cases of blood loss, as sweating can lead to spasm (Jing). Postpartum Qi and Blood are indeed deficient, and tonification is indispensable; however, ignoring miscellaneous conditions entirely is also incorrect, so Zhang's refutation is indeed valid. Nevertheless, treating postpartum excess syndromes has its own ingenious method. What is this ingenious method? It is "hand waving while eyes follow" (a metaphor for precise, decisive action guided by clear intent). The treatment applied by the hands addresses the excess syndrome, while the mind and intention remain fixed on the postpartum state. Accurate pattern differentiation, precise disease identification, and a single decisive strike ensure cure; treating the upper jiao without offending the middle, and the middle without offending the lower, with clarity in vision, palpation, and prescription, completes the art of postpartum treatment. For example, if an external contraction originates from the Upper Jiao, although the principle is "treating the upper without offending the middle," the medicinal potency should not be too light. One must use the method of preparing ample doses but administering small amounts frequently. Stop when the medicine takes effect; once the external contraction is resolved, restore the deficiency. This is like an army without provisions, where speed in battle is prized; if one fears postpartum deficiency and uses overly mild medication, delaying for three or four days, the patient may eventually be unable to tolerate the medicine. When treating postpartum warm-heat and summer-heat diseases, I often employ this method. For instance, if abdominal pain refuses pressure, resolve blood stasis; if it welcomes pressure, tonify collaterals. Efficacy should be swift as a turning pill. Ultimately, physicians must diligently study ancient texts in their daily practice and hold no preconceived notions during clinical consultation.