产后有外感发热者,盖临盆之际,露体用力,无暇他顾,此时或遇寒邪乘虚而入,感之最易。若见头痛、身
痛、憎寒、壮热,或腰背拘急,脉见紧数,外感证也。然此外感随感随病,与正伤寒不同。故宜略加解散即痊。
勿谓新产之后,不宜表散,但当酌其虚实而分治之。如感邪气不甚虚者,宜三柴胡饮。若气虚脾弱者,宜四柴胡饮,
或五柴胡饮。若肝脾肾三阴不足者,宜补阴益气煎。若虚寒之甚者,宜理阴煎。若强壮气实者,宜正柴胡饮。
若兼火盛而邪不解者,宜一柴胡饮。若风寒俱感,表里俱滞者,宜五积散。
三柴胡饮
柴胡(二三钱) 白芍(一钱五分) 炙甘草 陈皮(各一钱) 生姜(三五片) 当归(二钱,溏泄者,
易熟地黄)
水煎,温服。
如微寒咳嗽者,加半夏(制)一钱。
四柴胡饮
柴胡(一二钱) 炙甘草(一钱) 生姜(三五片) 当归(二三钱) 人参(二三钱)
水煎,温服。
如胸膈滞闷者,加陈皮一钱。
五柴胡饮
柴胡(一二钱) 白术(蜜炙) 当归(各二三钱) 熟地黄(三五钱) 白芍(炒,一钱五分)
炙甘草(一钱) 陈皮(酌用或不必用)
水煎,温服。
寒胜无火者,减白芍,加生姜三五片,或炮姜一二钱,或再加桂枝一二钱;脾滞者,减白术;气虚者,加
人参二三钱;腰痛加杜仲(炒)一钱;头痛加川芎一钱;劳倦伤脾阳虚者,加升麻一钱。
补阴益气煎
人参 当归 山药(酒炒,各二三钱) 熟地黄(三五钱) 炙甘草 陈皮(各一钱) 柴胡(一二钱)
升麻(三五分) 生姜(三五片)
水煎,温服。
如火浮于上,去升麻。无外邪,去柴胡。
理阴煎
熟地黄(三五钱) 当归(二三钱) 炙甘草 干姜(炒黄,各一钱)
水煎,热服。或加肉桂一钱。
若风寒外感,邪不深者,加柴胡一钱五分;若寒凝阴盛者,加麻黄(去沫)一钱;若外感寒邪,脉细,恶
寒或背畏寒者,加细辛一钱,甚者再加附子一钱;腰腹疼痛,加杜仲(炒)、枸杞;腹胀滞痛,加陈皮、木香。
正柴胡饮
柴胡(一二钱) 防风 甘草(各一钱) 陈皮(一钱五分) 白芍(二钱) 生姜(三五片)
水煎,热服。
头痛加川芎一钱;热渴加葛根一二钱;呕恶加半夏(制)一钱五分;湿胜加苍术(制)一钱;胸腹微滞加
浓朴一钱;寒盛加苏叶一钱。
一柴胡饮
柴胡(二三钱) 黄芩 生地黄 陈皮(各一钱五分) 白芍(二钱) 甘草(八分)
水煎,温服。
内热甚者,加连翘(去心)一钱;外邪甚者,加防风一钱;邪结在胸而痞满者,去生地加枳实(麸炒)
一钱;热渴加天花粉一钱,或葛根一钱;热甚加知母、石膏。
五积散
当归 麻黄(去节) 苍术(泔制) 陈皮(各一钱) 浓朴(姜制) 干姜(炮) 白芍 枳壳(麸炒,
各八分) 半夏(炮) 白芷(各七分) 桔梗 炙甘草 茯苓 肉桂 人参(各五分) 川芎(四分)
姜(三片) 葱白(三茎)
水煎服。
产后出现外感发热症状,大概是因为分娩之际,身体暴露且用力过度,无暇顾及保暖,此时若遇寒邪乘虚而入,最容易受到感染。如果见到头痛、身体疼痛、怕冷、高热,或者腰背部拘挛紧急,脉象表现为紧而数,这是外感证候。然而这种外感是随感受随即发病,与典型的伤寒不同。因此适宜稍微加以发散解表即可痊愈。不要认为新产之后,就不宜使用发汗解表的方法,只应当斟酌其虚实情况而分别治疗。如感受邪气不重且体质不虚者,适宜用三柴胡饮。若气虚脾弱者,适宜用四柴胡饮,或五柴胡饮。若肝、脾、肾三阴不足者,适宜用补阴益气煎。若虚寒严重的,适宜用理阴煎。若体质强壮、正气充足者,适宜用正柴胡饮。若兼有火盛而邪气不解者,适宜用一柴胡饮。若风寒同时感受,表里俱有阻滞者,适宜用五积散。
三柴胡饮
柴胡(二三钱) 白芍(一钱五分) 炙甘草 陈皮(各一钱) 生姜(三五片) 当归(二钱,大便溏泄者,改用熟地黄)
加水煎煮,温服。
若有轻微恶寒咳嗽者,加制半夏一钱。
四柴胡饮
柴胡(一二钱) 炙甘草(一钱) 生姜(三五片) 当归(二三钱) 人参(二三钱)
加水煎煮,温服。
若胸膈部滞闷者,加陈皮一钱。
五柴胡饮
柴胡(一二钱) 白术(蜜炙) 当归(各二三钱) 熟地黄(三五钱) 白芍(炒,一钱五分)
炙甘草(一钱) 陈皮(酌情使用或不必用)
加水煎煮,温服。
寒邪偏胜而无火热者,减少白芍用量,加生姜三五片,或炮姜一二钱,或再加桂枝一二钱;脾气滞涩者,减少白术用量;气虚者,加人参二三钱;腰痛加炒杜仲一钱;头痛加川芎一钱;因劳倦损伤脾阳导致气虚者,加升麻一钱。
补阴益气煎
人参 当归 山药(酒炒,各二三钱) 熟地黄(三五钱) 炙甘草 陈皮(各一钱) 柴胡(一二钱)
升麻(三五分) 生姜(三五片)
加水煎煮,温服。
若虚火浮越于上部,去掉升麻。若无外邪,去掉柴胡。
理阴煎
熟地黄(三五钱) 当归(二三钱) 炙甘草 干姜(炒至黄,各一钱)
加水煎煮,热服。或加肉桂一钱。
若是风寒外感,邪气不深的,加柴胡一钱五分;若是寒凝阴盛者,加去沫的麻黄一钱;若是外感寒邪,脉细,怕冷或背部畏寒者,加细辛一钱,严重者再加附子一钱;腰腹疼痛,加炒杜仲、枸杞;腹胀滞痛,加陈皮、木香。
正柴胡饮
柴胡(一二钱) 防风 甘草(各一钱) 陈皮(一钱五分) 白芍(二钱) 生姜(三五片)
加水煎煮,热服。
头痛加川芎一钱;热渴加葛根一二钱;呕吐恶心加制半夏一钱五分;湿邪偏胜加制苍术一钱;胸腹部轻微阻滞加浓朴一钱;寒邪盛加苏叶一钱。
一柴胡饮
柴胡(二三钱) 黄芩 生地黄 陈皮(各一钱五分) 白芍(二钱) 甘草(八分)
加水煎煮,温服。
内热严重,加去心的连翘一钱;外邪严重,加防风一钱;邪气结聚在胸部导致痞满者,去掉生地黄加麸炒枳实一钱;热渴加天花粉一钱,或葛根一钱;热势甚加知母、石膏。
五积散
当归 麻黄(去节) 苍术(泔水制) 陈皮(各一钱) 浓朴(姜制) 干姜(炮制) 白芍 枳壳(麸炒,各八分) 半夏(炮制) 白芷(各七分) 桔梗 炙甘草 茯苓 肉桂 人参(各五分) 川芎(四分)
生姜(三片) 葱白(三茎)
加水煎煮服用。
Postpartum exogenous fever generally occurs because during childbirth, the body is exposed and exertion is heavy, leaving no time to attend to warmth. At this time, if cold pathogenic factors enter due to deficiency, infection is most likely. If headache, body ache, aversion to cold, and high fever are observed, or if there is stiffness and tension in the waist and back, with a tight and rapid pulse, it is an exogenous syndrome. However, this type of exogenous condition manifests immediately upon exposure, differing from typical Shanghan (Cold Damage). Therefore, slight dispersing and resolving measures are suitable for recovery. One should not assume that after recent childbirth, diaphoretic methods (sweating therapies) are contraindicated; rather, treatment should be differentiated based on deficiency and excess. For those with mild pathogenic invasion and sufficient constitution, Sanchaihu Yin (Three Bupleurum Decoction) is appropriate. For those with Qi deficiency and weak spleen, Sichaihu Yin (Four Bupleurum Decoction) or Wuchaihu Yin (Five Bupleurum Decoction) is suitable. For insufficiency of the Liver, Spleen, and Kidney Yin, Buyin Yiqi Jian (Nourish Yin and Boost Qi Decoction) is indicated. For severe deficiency-cold, Liyin Jian (Regulate Yin Decoction) is recommended. For strong constitutions with abundant Zhengqi (Upright Qi), Zhengchaihu Yin (Standard Bupleurum Decoction) is used. For cases with excessive fire and unresolved pathogens, Yichaihu Yin (One Bupleurum Decoction) is prescribed. For simultaneous contraction of wind-cold with stagnation in both exterior and interior, Wuji San (Five Accumulations Powder) is applied.
Sanchaihu Yin (Three Bupleurum Decoction):
Chai Hu (Bupleuri Radix) (2-3 qian), Bai Shao (Paeoniae Radix Alba) (1.5 qian), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium) (each 1 qian), Sheng Jiang (Zingiberis Rhizoma Recens) (3-5 slices), Dang Gui (Angelicae Sinensis Radix) (2 qian; replace with Shu Di Huang (Rehmanniae Radix Praeparata) if loose stools occur).
Decoct in water, take warm.
For mild aversion to cold and cough, add Ban Xia (Pinelliae Rhizoma Preparatum) (1 qian).
Sichaihu Yin (Four Bupleurum Decoction):
Chai Hu (Bupleuri Radix) (1-2 qian), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) (1 qian), Sheng Jiang (Zingiberis Rhizoma Recens) (3-5 slices), Dang Gui (Angelicae Sinensis Radix) (2-3 qian), Ren Shen (Ginseng Radix et Rhizoma) (2-3 qian).
Decoct in water, take warm.
For chest and epigastric fullness/stagnation, add Chen Pi (Citri Reticulatae Pericarpium) (1 qian).
Wuchaihu Yin (Five Bupleurum Decoction):
Chai Hu (Bupleuri Radix) (1-2 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma Honey-fried), Dang Gui (Angelicae Sinensis Radix) (each 2-3 qian), Shu Di Huang (Rehmanniae Radix Praeparata) (3-5 qian), Bai Shao (Paeoniae Radix Alba Stir-fried) (1.5 qian), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) (1 qian), Chen Pi (Citri Reticulatae Pericarpium) (use as needed or omit).
Decoct in water, take warm.
For predominance of cold without fire, reduce Bai Shao, add Sheng Jiang (Zingiberis Rhizoma Recens) (3-5 slices) or Pao Jiang (Zingiberis Rhizoma Preparatum) (1-2 qian), or additionally Gui Zhi (Cinnamomi Ramulus) (1-2 qian); for Spleen stagnation, reduce Bai Zhu; for Qi deficiency, add Ren Shen (Ginseng Radix et Rhizoma) (2-3 qian); for lower back pain, add Du Zhong (Eucommiae Cortex Preparatum) (1 qian); for headache, add Chuan Xiong (Ligustici Chuanxiong Rhizoma) (1 qian); for fatigue damaging Spleen Yang leading to Qi deficiency, add Sheng Ma (Ephedrae Herba? No, Cimicifugae Rhizoma) (1 qian). *Correction: Sheng Ma is Cimicifugae Rhizoma.*
Buyin Yiqi Jian (Nourish Yin and Boost Qi Decoction):
Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Shan Yao (Dioscoreae Rhizoma Wine-fried) (each 2-3 qian), Shu Di Huang (Rehmanniae Radix Praeparata) (3-5 qian), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium) (each 1 qian), Chai Hu (Bupleuri Radix) (1-2 qian), Sheng Ma (Cimicifugae Rhizoma) (0.3-0.5 qian), Sheng Jiang (Zingiberis Rhizoma Recens) (3-5 slices).
Decoct in water, take warm.
If deficient fire floats upward, remove Sheng Ma. If no exogenous pathogen, remove Chai Hu.
Liyin Jian (Regulate Yin Decoction):
Shu Di Huang (Rehmanniae Radix Praeparata) (3-5 qian), Dang Gui (Angelicae Sinensis Radix) (2-3 qian), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Gan Jiang (Zingiberis Rhizoma Preparatum Stir-fried Yellow) (each 1 qian).
Decoct in water, take hot. Or add Rou Gui (Cinnamomi Cortex) (1 qian).
For mild exogenous wind-cold, add Chai Hu (Bupleuri Radix) (1.5 qian); for cold coagulation and Yin excess, add Ma Huang (Ephedrae Herba Devoid of Foam) (1 qian); for exogenous cold with fine pulse, aversion to cold or fear of cold in the back, add Xi Xin (Asari Radix et Rhizoma) (1 qian), and Fu Zi (Aconiti Lateralis Radix Preparata) (1 qian) for severe cases; for waist and abdominal pain, add Du Zhong (Eucommiae Cortex Preparatum) and Gou Qi (Lycii Fructus); for abdominal distension and painful stagnation, add Chen Pi (Citri Reticulatae Pericarpium) and Mu Xiang (Aucklandiae Radix).
Zhengchaihu Yin (Standard Bupleurum Decoction):
Chai Hu (Bupleuri Radix) (1-2 qian), Fang Feng (Saposhnikoviae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) (each 1 qian), Chen Pi (Citri Reticulatae Pericarpium) (1.5 qian), Bai Shao (Paeoniae Radix Alba) (2 qian), Sheng Jiang (Zingiberis Rhizoma Recens) (3-5 slices).
Decoct in water, take hot.
For headache, add Chuan Xiong (Ligustici Chuanxiong Rhizoma) (1 qian); for heat and thirst, add Ge Gen (Puerariae Lobatae Radix) (1-2 qian); for vomiting and nausea, add Ban Xia (Pinelliae Rhizoma Preparatum) (1.5 qian); for dampness predominance, add Cang Zhu (Atractylodis Rhizoma Preparatum) (1 qian); for slight chest/abdominal stagnation, add Hou Po (Magnoliae Officinalis Cortex Ginger-prepared) (1 qian); for severe cold, add Su Ye (Perillae Folium) (1 qian).
Yichaihu Yin (One Bupleurum Decoction):
Chai Hu (Bupleuri Radix) (2-3 qian), Huang Qin (Scutellariae Radix), Sheng Di Huang (Rehmanniae Radix), Chen Pi (Citri Reticulatae Pericarpium) (each 1.5 qian), Bai Shao (Paeoniae Radix Alba) (2 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (0.8 fen).
Decoct in water, take warm.
For severe internal heat, add Lian Qiao (Forsythiae Fructus Devoid of Heart) (1 qian); for severe external pathogen, add Fang Feng (Saposhnikoviae Radix) (1 qian); for pathogen knotting in the chest causing fullness/stiffness, remove Sheng Di Huang and add Zhi Shi (Aurantii Fructus Immaturus Bran-fried) (1 qian); for heat and thirst, add Tian Hua Fen (Trichosanthis Radix) (1 qian) or Ge Gen (Puerariae Lobatae Radix) (1 qian); for severe heat, add Zhi Mu (Anemarrhenae Rhizoma) and Shi Gao (Gypsum Fibrosum).
Wuji San (Five Accumulations Powder):
Dang Gui (Angelicae Sinensis Radix), Ma Huang (Ephedrae Herba Devoid of Nodes), Cang Zhu (Atractylodis Rhizoma Rice-water Prepared), Chen Pi (Citri Reticulatae Pericarpium) (each 1 qian), Hou Po (Magnoliae Officinalis Cortex Ginger-prepared), Gan Jiang (Zingiberis Rhizoma Preparatum), Bai Shao (Paeoniae Radix Alba), Zhi Ke (Aurantii Fructus Immaturus Bran-fried) (each 0.8 fen), Ban Xia (Pinelliae Rhizoma Preparatum), Bai Zhi (Angelicae Dahuricae Radix) (each 0.7 fen), Jie Geng (Platycodonis Radix), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Fu Ling (Poria), Rou Gui (Cinnamomi Cortex), Ren Shen (Ginseng Radix et Rhizoma) (each 0.5 fen), Chuan Xiong (Ligustici Chuanxiong Rhizoma) (0.4 fen), Sheng Jiang (Zingiberis Rhizoma Recens) (3 slices), Cong Bai (Allii Fistulosi Bulbus) (3 stems).
Decoct in water and take.