产后有阴虚发热者,必素禀脾肾不足,及产后气血俱虚,故多有之。其热则倏忽往来,时作时止,或昼或夜
进退无常,或精神困倦,怔忡恍惚。但察其外无表证而脉见弦数,或浮弦豁大,或微细无力,其来也渐。非若他
证之暴至者,是即阴虚之候。治当专补真阴,宜小营煎。若阴虚兼火而微热者,宜一阴煎。若阴虚火甚而大热
者,宜加减一阴煎。若阴虚火盛而多汗者,宜当归六黄汤。若阴中阳虚火不归源者,宜大营煎。若血虚阳不附
阴,烦热作渴者,宜人参当归汤。若气血俱虚,发热烦躁,面赤作渴,宜八珍汤。
小营煎
当归 白芍(酒炒) 山药(炒) 枸杞(各二钱) 熟地黄(二三钱) 炙甘草(一钱)
水煎,食远温服。
营虚而惊恐、怔忡、不眠、多汗者,加枣仁、茯神各二钱;营虚兼寒者,去白芍,加生姜;气滞有痛者,加
香附(制)一钱。
一阴煎
生地黄 熟地黄 白芍 麦冬(去心) 丹参(各二钱)
牛膝(一钱五分) 甘草(一钱)
水煎温服。
火盛烦躁,加龟胶二三钱;气虚加人参二钱;心虚不眠多汗者,加枣仁、当归各一二钱;汗多烦躁,加
五味子十粒;如见微火者,加女贞子一二钱;虚火上浮或吐血衄血,加泽泻一二钱,茜根二钱,或加川
续断一钱。
加减一阴煎
生地黄 白芍 麦冬(去心,各二钱) 熟地黄(三五钱) 炙甘草(五七分) 知母 地骨皮(各一钱)
水煎服。
躁烦热甚便结者,加石膏二钱;小便热涩者,加栀子一钱;火浮于上者,加泽泻一二钱,或黄芩一钱;血
燥血少者,加当归一二钱。
当归六黄汤
当归 黄 (蜜炙,各二钱) 生地黄 熟地黄 黄连 黄芩 黄柏(各一钱)
水煎服。
大营煎
当归(二三钱) 熟地黄(三五钱) 牛膝(一钱五分) 枸杞 杜仲(炒,各二钱) 炙甘草 肉桂(各一钱)
水煎温服。
寒滞在经,气血不能流通,筋骨疼痛之甚者,必加制附子一钱;带浊腹痛,加破故纸(炒)一钱;脾虚加人参、
白术(蜜炙);中气虚寒呕恶,加干姜(炒)一钱。
人参当归汤
人参 当归 生地黄 桂心 麦冬(去心) 白芍(各等
分) 粳米(一合) 竹叶(十片)
水煎去米,入药五钱,枣二枚,煎服。
八珍汤
人参 白术(蜜炙) 茯苓 炙甘草 熟地黄 当归 白芍 川芎(各一钱)
上加姜、枣水煎服。
若热甚脉微者,急加附子、肉桂。
产后出现阴虚发热的情况,必定是因为患者平素脾肾亏虚,加上产后气血两虚,所以这种情况很常见。这种发热忽来忽去,时作时止,或在白天或在夜间发作,进退没有规律;或者伴有精神困倦、心悸恍惚的症状。只要检查发现体表没有表证(外感病初期症状),而脉象呈现弦数,或浮弦且宽大中空,或微细无力,且发病过程是逐渐形成的,而不是像其他病证那样突然发作的,这就是阴虚的表现。治疗应当专门滋补真阴,适宜使用小营煎。如果阴虚兼有火邪且只有轻微发热的,适宜使用一阴煎。如果阴虚火旺且高热严重的,适宜使用加减一阴煎。如果阴虚火盛且多汗的,适宜使用当归六黄汤。如果阴中阳虚导致火不归原(虚火上浮)的,适宜使用大营煎。如果血虚导致阳气不能依附于阴,出现烦热口渴的,适宜使用人参当归汤。如果气血都虚弱,出现发热烦躁、面色发红、口渴的,适宜使用八珍汤。
小营煎
当归、白芍(酒炒)、山药(炒)、枸杞(以上各二钱)、熟地黄(二三钱)、炙甘草(一钱)。
用水煎煮,在饭后较长时间温服。
如果是营血虚并伴有惊恐、心悸、失眠、多汗的,加酸枣仁、茯神各二钱;如果是营血虚兼有寒邪的,去掉白芍,加生姜;如果有气滞疼痛的,加制香附一钱。
一阴煎
生地黄、熟地黄、白芍、麦冬(去心)、丹参(以上各二钱)、牛膝(一钱五分)、甘草(一钱)。
用水煎煮后温服。
如果火盛烦躁,加龟胶二三钱;气虚加人参二钱;心虚导致失眠多汗的,加酸枣仁、当归各一二钱;出汗多且烦躁的,加五味子十粒;如果见到轻微虚火的,加女贞子一二钱;如果是虚火上浮或出现吐血、鼻出血的,加泽泻一二钱、茜草根二钱,或者加川续断一钱。
加减一阴煎
生地黄、白芍、麦冬(去心,以上各二钱)、熟地黄(三五钱)、炙甘草(五七分)、知母、地骨皮(以上各一钱)。
用水煎煮服用。
如果躁动烦热严重且大便干结的,加石膏二钱;小便热涩的,加栀子一钱;火气浮越于上部的,加泽泻一二钱,或者黄芩一钱;血燥血少的,加当归一二钱。
当归六黄汤
当归、黄芪(蜜炙,以上各二钱)、生地黄、熟地黄、黄连、黄芩、黄柏(以上各一钱)。
用水煎煮服用。
大营煎
当归(二三钱)、熟地黄(三五钱)、牛膝(一钱五分)、枸杞、杜仲(炒,以上各二钱)、炙甘草、肉桂(以上各一钱)。
用水煎煮后温服。
如果有寒邪停滞在经络,气血不能流通,导致筋骨剧烈疼痛的,必须加制附子一钱;如果有白带浑浊腹痛的,加炒破故纸(补骨脂)一钱;脾虚的加人参、白术(蜜炙);中气虚寒导致呕吐恶心的,加炒干姜一钱。
人参当归汤
人参、当归、生地黄、桂心、麦冬(去心)、白芍(以上各等分)、粳米(一合)、竹叶(十片)。
用水煎煮去掉米粒,取药液五钱,加入大枣两枚,煎煮后服用。
八珍汤
人参、白术(蜜炙)、茯苓、炙甘草、熟地黄、当归、白芍、川芎(以上各一钱)。
上面药物加生姜、大枣,用水煎煮服用。
如果热势严重但脉象微弱的,紧急加入附子、肉桂。
Postpartum yin deficiency with fever must stem from a constitutional insufficiency of the Spleen and Kidney, compounded by the dual deficiency of Qi and Blood after childbirth; hence, it is common. The fever comes and goes suddenly, occurring intermittently, either during the day or night, without regularity. It may be accompanied by mental fatigue, palpitations (Xin Jing), and a trance-like state. Provided there are no exterior syndromes (Biao Zheng) externally, but the pulse is wiry and rapid (Xuan Shu), or floating, wiry, and large and hollow (Fu Xuan Huo Da), or faint, fine, and powerless (Wei Xi Wu Li), and the onset is gradual rather than sudden like other conditions, this indicates a pattern of Yin deficiency. Treatment should focus exclusively on tonifying True Yin, using Xiao Ying Decoction (Little Nourishing Decoction). If Yin deficiency is accompanied by Fire causing mild heat, Yi Yin Decoction (One Yin Decoction) is suitable. If Yin deficiency with vigorous Fire causes high fever, Jia Jian Yi Yin Decoction (Modified One Yin Decoction) is suitable. If Yin deficiency with excessive Fire leads to profuse sweating, Dang Gui Liu Huang Tang (Angelica Sinensis and Six Yellow Decoction) is suitable. If Yang deficiency within Yin causes Fire to fail to return to its source (Huo Bu Gui Yuan), Da Ying Decoction (Great Nourishing Decoction) is suitable. If Blood deficiency prevents Yang from attaching to Yin, causing vexatious heat and thirst, Ren Shen Dang Gui Tang (Ginseng and Angelica Decoction) is suitable. If both Qi and Blood are deficient, causing fever, restlessness, flushed face, and thirst, Ba Zhen Tang (Eight Treasure Decoction) is suitable.
Xiao Ying Decoction (Little Nourishing Decoction)
Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba, stir-fried with wine), Shan Yao (Dioscoreae Rhizoma, stir-fried), Gou Qi (Lycii Fructus) [each 2 qian], Shu Di Huang (Rehmanniae Radix Praeparata) [2-3 qian], Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata cum Melle) [1 qian].
Decoct in water, take warm long after meals.
For Ying (Nutritive) deficiency with fright, palpitations, insomnia, and hyperhidrosis, add Zao Ren (Ziziphi Spinosae Semen) and Fu Shen (Poria Cum Radix) [each 2 qian]; for Ying deficiency with cold, remove Bai Shao and add Sheng Jiang (Zingiberis Rhizoma Recens); for Qi stagnation with pain, add Zhi Xiang Fu (Cyperi Rhizoma Preparatum) [1 qian].
Yi Yin Decoction (One Yin Decoction)
Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Rehmanniae Radix Praeparata), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Tuber, heart removed), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) [each 2 qian], Niu Xi (Achyranthis Bidentatae Radix) [1.5 qian], Gan Cao (Glycyrrhizae Radix et Rhizoma) [1 qian].
Decoct in water, take warm.
For excessive Fire with restlessness, add Gui Jiao (Asini Corii Colla) [2-3 qian]; for Qi deficiency, add Ren Shen (Ginseng Radix et Rhizoma) [2 qian]; for Heart deficiency with insomnia and hyperhidrosis, add Zao Ren (Ziziphi Spinosae Semen) and Dang Gui (Angelicae Sinensis Radix) [1-2 qian each]; for profuse sweating with restlessness, add Wu Wei Zi (Schisandrae Chinensis Fructus) [10 grains]; for slight Fire, add Nu Zhen Zi (Ligustri Lucidi Fructus) [1-2 qian]; for defascinating Fire floating upward or hematemesis/epistaxis, add Ze Xie (Alismatis Rhizoma) [1-2 qian], Qian Gen (Rubiae Cordifoliae Radix) [2 qian], or Chuan Xu Duan (Dipsaci Radix) [1 qian].
Jia Jian Yi Yin Decoction (Modified One Yin Decoction)
Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Tuber, heart removed) [each 2 qian], Shu Di Huang (Rehmanniae Radix Praeparata) [3-5 qian], Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata cum Melle) [0.5-0.7 qian], Zhi Mu (Anemarrhenae Rhizoma), Gu Pi (Phellodendri Cortex) [each 1 qian].
Decoct in water and take.
For severe restlessness, heat, and constipation, add Shi Gao (Gypsum Fibrosum) [2 qian]; for hot and difficult urination, add Zhi Zi (Gardeniae Fructus) [1 qian]; for Fire floating upward, add Ze Xie (Alismatis Rhizoma) [1-2 qian] or Huang Qin (Scutellariae Radix) [1 qian]; for Blood dryness and scarcity, add Dang Gui (Angelicae Sinensis Radix) [1-2 qian].
Dang Gui Liu Huang Tang (Angelica Sinensis and Six Yellow Decoction)
Dang Gui (Angelicae Sinensis Radix), Huang Qi (Astragali Membranacei Radix, honey-fried) [each 2 qian], Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Rehmanniae Radix Praeparata), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex) [each 1 qian].
Decoct in water and take.
Da Ying Decoction (Great Nourishing Decoction)
Dang Gui (Angelicae Sinensis Radix) [2-3 qian], Shu Di Huang (Rehmanniae Radix Praeparata) [3-5 qian], Niu Xi (Achyranthis Bidentatae Radix) [1.5 qian], Gou Qi (Lycii Fructus), Du Zhong (Eucommiae Cortex, stir-fried) [each 2 qian], Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata cum Melle), Rou Gui (Cinnamomi Cortex) [each 1 qian].
Decoct in water, take warm.
For Cold stagnation in the meridians preventing Qi and Blood circulation, causing severe bone and joint pain, add Zhi Fu Zi (Aconiti Lateralis Radix Preparata) [1 qian]; for leukorrhea and abdominal pain, add Po Gu Zhi (Psoraleae Fructus, stir-fried) [1 qian]; for Spleen deficiency, add Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma, honey-fried); for Middle Qi deficiency-cold with vomiting and nausea, add Gan Jiang (Zingiberis Rhizoma, stir-fried) [1 qian].
Ren Shen Dang Gui Tang (Ginseng and Angelica Decoction)
Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Sheng Di Huang (Rehmanniae Radix), Gui Xin (Cinnamomi Ramulus), Mai Dong (Ophiopogonis Tuber, heart removed), Bai Shao (Paeoniae Radix Alba) [equal parts], Jing Mi (Oryza Sativa Germen) [1 he], Zhu Ye (Bambusae Folium) [10 leaves].
Decoct in water, remove the rice, take 5 qian of the decoction, add two Jujubes (Ziziphi Jujubae Fructus), decoct again, and take.
Ba Zhen Tang (Eight Treasure Decoction)
Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma, honey-fried), Fu Ling (Poria), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata cum Melle), Shu Di Huang (Rehmanniae Radix Praeparata), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Chuan Xiong (Ligustici Chuanxiong Rhizoma) [each 1 qian].
Add Sheng Jiang (Zingiberis Rhizoma Recens) and Jujube (Ziziphi Jujubae Fructus), decoct in water, and take.
If heat is severe but the pulse is faint, urgently add Fu Zi (Aconiti Lateralis Radix Preparata) and Rou Gui (Cinnamomi Cortex).