元气不足,劳动伤经血也,或恶血未尽,适挟风冷,而致气血不调;或过服固胎药,产虽下而恶露不去,竟至二三
月而点滴不已,皆宜补血顺血,调气通气为主。济阴丹可加味用之。(和二十七)
气血俱虚而淡红不已,十全大补汤。(补三十九)
怒火伤肝而血不藏,加味四物汤。(补二十八)
胃气下陷,不能统血,补中益气汤。(补六)
脾经郁热,血不归源,加味逍遥散。(补二十二)
肝气热不能生血,六味丸。(补二)
脾虚不能摄血,六君子汤。(补一)
伤冲任之络而不止,加味固阴煎。(补二)六味丸(补二)加阿胶、麦冬、北五味。
产妇耗伤气血,经脉未得平复,而或惊忧恚怒;或劳役损动;或咸酸不节,伤于营冲;或气衰血弱,不能固摄,皆
成崩中。若小腹满痛,肝经已坏,为难治也。其余郁热气陷,以致血崩,与恶露不绝同治。
血多色紫,败血也,当去之,留之反作痛,不可以作崩论,生化汤加五灵脂、生蒲黄以破之。(和二十四)
形脱而汗不止,加参生化汤;渴,加麦冬;泻,加茯苓;两手脉伏,或右手脉绝,加北五味、麦冬;痰,加竹沥、
姜汁;惊,加枣仁;食不可进,闻药即吐,胃虚也,宜用参汤送饭锅焦粉,渐渐引开胃口,然后服药。
崩下如牛膜,昏迷倒地,乃受惊而然,朱雄丸。(和二十九)
恶血重来,如流水不止,昏迷不知人事,此因未满一月,妄行交媾,以致血不归经也。
急用金狗脊散。(和三十)
日久不止,宜升举大补汤。(补四十)
血脱妄言妄见,宜升举大补汤,加辰砂少许,以坠其心火。(补四十)
血崩如涌,口噤目斜,手足搐搦,肝经血耗,风生也。六味丸加荆芥穗。(补二)
血来紫黑如豆汁色,怒伤肝也。宜加味四物汤。(和二十八)
血来鲜红,是惊伤心,怒伤肝,劳伤脾,致血不归经也。生化汤和。(二十四。)加味治之,鲜血来多,再加升麻、
白芷各四分。
元气不足,因劳累损伤了经血;或者恶露未尽,恰好又感受风冷之邪,导致气血不调;或者过服固胎的药物,虽然胎儿已产出但恶露未去,竟然持续两三个月点滴不断,这些情况都应当以补血顺血、调气通气为主要治法。济阴丹可以加味后使用。(和二十七)
脾经有郁热,导致血液不能回归本源(正常循行)的,用加味逍遥散。(补二十二)
损伤冲任二脉的络脉而致出血不止的,用加味固阴煎。(补二)六味丸(补二)加阿胶、麦冬、北五味子。
产妇耗伤气血,经脉尚未平复,此时若受惊忧或愤怒;或过度劳累;或饮食咸酸不节制,损伤营卫与冲脉;或气衰血弱,不能固摄血液,都会形成崩中(急性大量子宫出血)。如果小腹胀满疼痛,说明肝经已经败坏,属于难治之症。其余因郁热气陷导致的血崩,治疗原则与恶露不绝相同。
血色紫暗,是败血(瘀血),应当祛除它,留着它反而会引起疼痛,不可以当作崩中论治,应用生化汤加五灵脂、生蒲黄来破除瘀血。(和二十四)
形体脱失且汗出不止的,用加参生化汤;口渴的,加麦冬;腹泻的,加茯苓;两手脉象伏匿,或右手脉绝,加北五味子、麦冬;有痰的,加竹沥、姜汁;受惊的,加枣仁;食物无法进食,闻到药味就呕吐,这是胃虚的表现,宜用人参汤送服饭锅焦粉,慢慢引导开胃,然后再服药。
崩漏下血如牛膜状,昏迷倒地,这是受惊所致,用朱雄丸。(和二十九)
恶血再次涌出,如流水般不止,昏迷不知人事,这是因为产后未满一个月,妄行房事,导致血液不能归经。
血脱导致胡言乱语、幻觉妄见的,宜用升举大补汤,加少许辰砂,以镇坠心火。(补四十)
血崩如涌,口噤目斜,手足抽搐,这是肝经血耗,风气内生的表现。用六味丸加荆芥穗。(补二)
血色紫黑如豆汁色,是怒伤肝所致。宜用加味四物汤。(和二十八)
血色鲜红,是惊伤心、怒伤肝、劳伤脾,导致血液不能归经。用生化汤调和。(二十四)加味治疗,若鲜血来得多,再加升麻、白芷各四分。
Insufficient Yuan Qi (Primordial Qi), caused by labor damaging the Jing blood (menstrual/uterine blood); or lochia (postpartum discharge) not yet exhausted, concurrently affected by wind-cold pathogen, resulting in disharmony of Qi and Blood; or excessive consumption of fetal-stabilizing medicines, although delivery has occurred, lochia remains, persisting as spotting for two to three months. All such cases should be treated primarily by tonifying blood, regulating blood flow, harmonizing Qi, and unblocking Qi circulation. Ji Yin Dan (Womb-Nourishing Pill) may be used with modifications. (He 27)
For deficiency of both Qi and Blood presenting with persistent pale-red bleeding, use Shiquan Dabu Tang (Decoction of Ten Substances for Great Tonification). (Bu 39)
For liver injury due to furious anger causing failure of blood storage, use Jiawei Siwu Tang (Modified Four Substance Decoction). (Bu 28)
For sinking of Stomach Qi failing to control blood, use Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). (Bu 6)
For stagnant heat in the Spleen channel causing blood to fail to return to its source, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). (Bu 22)
For heat in Liver Qi failing to generate blood, use Liuwei Wan (Six-Ingredient Pill with Rehmannia). (Bu 2)
For Spleen deficiency failing to grasp blood, use Liujunzi Tang (Six Gentlemen Decoction). (Bu 1)
For bleeding due to damage to the collaterals of the Chong and Ren vessels, use Jiawei Guyin Jian (Modified Firm Yin Decoction). (Bu 2) Liuwei Wan (Six-Ingredient Pill with Rehmannia) (Bu 2) plus Ejiao (Donkey-hide Gelatin), Maidong (Ophiopogon Tuber), and Bei Wuwei Zi (Schisandra Berry).
Postpartum women suffer depletion of Qi and Blood, and the meridians have not yet recovered. If they experience fright, worry, or anger; or overwork and physical strain; or irregular consumption of salty and sour foods damaging Ying (Nutritive) Qi and the Chong vessel; or if Qi is weak and Blood is deficient failing to secure and hold, all these result in Bengzhong (Sudden Profuse Uterine Bleeding). If there is fullness and pain in the lower abdomen, it indicates the Liver channel is already damaged, which is difficult to treat. Other cases of Bengzhong caused by stagnant heat and Qi sinking are treated similarly to Bu Luan Bu Jue (Persistent Lochia).
If the blood is dark purple, it is Bai Xue (Dead/Bad Blood/Stasis); it must be expelled. Retaining it will cause pain and should not be treated as Bengzhong. Use Shenghua Tang (Life Production Decoction) plus Wulingzhi (Trogopterus Dung) and Sheng Puhuang (Fresh Lygodium Spore) to break up the stasis. (He 24)
For collapse of form with incessant sweating, use Jiashen Shenghua Tang (Shenghua Tang with Ginseng); for thirst, add Maidong; for diarrhea, add Fuling; for submerged pulses in both hands, or absent pulse in the right hand, add Bei Wuwei Zi and Maidong; for phlegm, add Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice); for fright, add Zaoren (Ziziphus Seed); for inability to eat and vomiting upon smelling medicine, indicating Stomach deficiency, use Renshen Tang (Ginseng Decoction) to swallow Fan Guojiao Fen (Scorched Rice Pot Crust Powder), gradually opening the appetite before administering other medicines.
Profuse bleeding resembling cow membrane with coma and falling to the ground is due to fright; use Zhu Xiong Wan (Cinnabar Male Pill). (He 29)
Recurrence of bad blood flowing continuously like water, accompanied by coma and loss of consciousness, is caused by illicit sexual intercourse within one month postpartum, leading to blood failing to return to its channels. Urgently use Jin Gouji San (Golden Dogspine Powder). (He 30)
For prolonged cessation of treatment, use Shengju Dabu Tang (Great Tonification for Ascending and Raising). (Bu 40)
For blood depletion causing delirium and hallucinations, use Shengju Dabu Tang with a small amount of Chen Sha (Cinnabar) to anchor descending Heart Fire. (Bu 40)
Profuse bleeding like a gush, with locked jaw, deviated eyes, and convulsions of limbs indicates exhaustion of Liver Blood generating internal Wind. Use Liuwei Wan plus Jingjie Sui (Schizonepeta Spikelet). (Bu 2)
Blood coming out purple-black like bean juice color is due to anger injuring the Liver. Use Jiawei Siwu Tang. (He 28)
Bright red blood indicates fright injuring the Heart, anger injuring the Liver, and labor injuring the Spleen, causing blood to fail to return to its channels. Use Shenghua Tang harmonized. (24.) Treat with modifications. If bright red blood is profuse, add Shengma (Cimicifuga Rhizome) and Baizhi (Angelica Dahurica Root), each 4 fen.