产后泻痢,气血暴虚,必用生化汤加减。然致病之由,虽系湿热,多因饮食伤脾而起。故重申余意,另立十
方于后。
一、产后泻黄色乃脾土真气虚也,宜补中益气汤加木香四分,煨肉果一枚,炮姜四分。
二、产后久泻不止,元气下陷,大便不禁,肛门如脱,宜服
六君子汤加木香四分,煨肉果一枚,炮姜四分,加升麻五分。
三、产后伤面食,宜六君子汤加麦芽。伤谷食,六君子汤加神曲。
四、产后伤肉食,六君子汤加山楂、砂仁各五分,神曲一钱五分。
五、产后胃气虚弱,泻痢完谷不化,六君子汤加木香三分,肉果一枚。
六、产后泻痢脾虚,四肢浮肿,补中益气加五皮散、或六君子汤加五皮散。
七、产后诸症兼呕者,俱宜加藿香一钱。痰多,加半夏八分。
八、产后以前诸症兼小便短涩者,加茯苓一钱,泽泻五分,灯心二十根,或加净车前一钱。
九、产后泄泻不止,加莲子十粒,石榴皮一钱。
十、产后患赤痢,久而不止,用人参二钱,香连丸二钱,同服即愈。毋多用木香、姜汁之类,盖热则血愈行也。
方内可加地榆。
以上十方,须问块痛已除,方可服之。
人之胃腑为五谷之海,水谷之精,上输肝肺,分布五脏,化为气血,荣润百骸。产后劳伤脾胃,正气亏折,
邪气易乘。如入于肠胃,则气逆呕吐而食不下矣。若七日内呕吐不止,全不纳谷,血块未除,治当消块,佐以温药,
宜服安胃行血汤。若痛已除而呕不止,不纳谷者,宜服加减六物汤及后温胃和中饮。若呕而气血不足,食物不
能如常,宜服补中和胃汤。
安胃行血汤
芎 (一钱) 当归(四钱) 人参(一钱) 桃仁(十粒) 姜炭 炙草(各五分)
藿香 砂仁(各四分) 姜(三片,有汗勿用)
加减六物汤
川芎(一钱) 当归(一钱) 山药(一钱五分) 人参(一钱) 茯苓(一钱) 藿香(五分) 豆仁
姜炭(各四分) 扁豆(二钱) 陈皮(三分) 炙草(五分) 姜(三片)
呕止,去豆仁。
温中和胃汤
人参 茯苓(各一钱) 当归 扁豆(各二钱) 陈皮 炙草 藿香 丁香(各三分) 姜(三片)
呕止,去丁香。受寒,加吴茱萸。
补中和胃汤
人参 白术 扁豆 当归(各二钱) 茯苓(一钱) 山药(一钱五分) 炙草 陈皮 炮姜(各四分)
水煎。
按∶呕逆至产后,症为甚急,当用香砂六君子汤加制附、吴萸、柿蒂为引。如不效,加川连酒炒、肉桂。更不
效则用二气丹,水银三钱,硫磺三钱,结成砂,将硫与水银同研至无星为度,米糊为丸,每服二十粒,递加至四
十九粒,丁香、柿蒂汤送下。丸如梧子大可也。盖水银得硫自化,不用疑惧,呃逆、霍乱可用。
产后出现腹泻或痢疾,是由于气血突然虚弱所致,必须使用生化汤进行加减治疗。然而致病的原因,虽然与湿热有关,但多因饮食损伤脾胃而起。因此重申我的观点,在后面另外列出十个方剂。
一、产后大便呈黄色,这是脾土真气虚弱的表现,适宜服用补中益气汤,加入木香四分,煨肉果一枚,炮姜四分。
二、产后长期腹泻不止,元气下陷,大便失禁,肛门感觉像要脱出一样,适宜服用六君子汤,加入木香四分,煨肉果一枚,炮姜四分,再加升麻五分。
三、产后因食用面食受伤,适宜用六君子汤加麦芽;因食用谷物受伤,用六君子汤加神曲。
四、产后因食用肉食受伤,用六君子汤加山楂、砂仁各五分,神曲一钱五分。
五、产后胃气虚弱,腹泻痢疾且大便中有未消化的食物(完谷不化),用六君子汤加木香三分,肉果一枚。
六、产后腹泻痢疾导致脾虚,四肢浮肿,可用补中益气汤加五皮散,或者用六君子汤加五皮散。
七、产后各种症状兼有呕吐的,都适宜加入藿香一钱。痰多者,加入半夏八分。
八、产后以前所述的各种症状兼有小便短少涩痛者,加入茯苓一钱,泽泻五分,灯心草二十根,或者加入净车前子一钱。
十、产后患赤痢(脓血便),日久不止,用人参二钱,香连丸二钱,一同服用即可痊愈。不要多用木香、姜汁之类,因为热邪会使血液运行加速。方中可加入地榆。
以上十个方剂,必须先询问腹部块状疼痛(瘀血块)是否已经消除,才可以服用。
人的胃腑是五谷的海洋,水谷的精微物质,向上输送到肝和肺,分布到五脏,转化为气血,滋养润泽全身骨骼肌肉。产后劳倦损伤脾胃,正气亏损折损,邪气容易乘虚而入。如果邪气进入肠胃,就会导致气逆呕吐而无法进食。如果在产后七日内呕吐不止,完全不能进食,且血块尚未清除,治疗应当消散血块,辅以温性药物,适宜服用安胃行血汤。如果疼痛已经消除但呕吐不止,不能进食者,适宜服用加减六物汤及后面的温胃和中饮。如果呕吐且气血不足,食物不能正常消化,适宜服用补中和胃汤。
安胃行血汤
川芎(一钱) 当归(四钱) 人参(一钱) 桃仁(十粒) 姜炭 炙甘草(各五分)
藿香 砂仁(各四分) 生姜(三片,有汗者勿用)
加减六物汤
川芎(一钱) 当归(一钱) 山药(一钱五分) 人参(一钱) 茯苓(一钱) 藿香(五分) 豆蔻仁
姜炭(各四分) 扁豆(二钱) 陈皮(三分) 炙甘草(五分) 生姜(三片)
呕吐停止后,去掉豆蔻仁。
温中和胃汤
人参 茯苓(各一钱) 当归 扁豆(各二钱) 陈皮 炙甘草 藿香 丁香(各三分) 生姜(三片)
呕吐停止后,去掉丁香。受寒者,加入吴茱萸。
补中和胃汤
人参 白术 扁豆 当归(各二钱) 茯苓(一钱) 山药(一钱五分) 炙甘草 陈皮 炮姜(各四分)
用水煎服。
按语:呕吐逆气延续到产后,病情非常急重,应当使用香砂六君子汤,加入制附子、吴茱萸、柿蒂作为引经药。如果无效,加入酒炒黄连、肉桂。如果仍然无效,则使用二气丹,由水银三钱,硫磺三钱,结成砂状,将硫磺与水银共同研磨直到没有星点为止,用米糊制成丸药,每次服用二十粒,逐渐增加到四十九粒,用丁香、柿蒂汤送服。丸药大小如梧桐子大即可。因为水银遇到硫磺自然会化合,不必怀疑恐惧,呃逆、霍乱可以使用。
Postpartum diarrhea or dysentery arises from a sudden deficiency of Qi and Blood, requiring the modification of Shenghua Tang (Life Restoring Decoction). However, although the etiology involves damp-heat, it often originates from dietary injury to the Spleen. Therefore, reiterating my previous point, I have established ten additional formulas below.
1. Postpartum yellow stool indicates a deficiency of the true Qi of the Spleen Earth. It is appropriate to use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Muxiang (Aucklandiae Radix, 4 fen), Wei Rouguo (Nutmeg, 1 piece), and Pao Jiang (Prepared Ginger, 4 fen).
2. Postpartum chronic diarrhea that does not cease, with sinking of Yuan Qi (Primal Qi), incontinence of feces, and a sensation of anal prolapse, is suitable for Liujunzi Tang (Six Gentlemen Decoction) with added Muxiang (Aucklandiae Radix, 4 fen), Wei Rouguo (Nutmeg, 1 piece), Pao Jiang (Prepared Ginger, 4 fen), and Shengma (Cimicifugae Rhizoma, 5 fen).
3. For postpartum injury caused by consuming wheat products, use Liujunzi Tang (Six Gentlemen Decoction) with added Maiya (Hordei Fructus Germinatus). For injury caused by consuming grain, use Liujunzi Tang (Six Gentlemen Decoction) with added Shenqu (Massa Medicata Fermentata).
4. For postpartum injury caused by consuming meat, use Liujunzi Tang (Six Gentlemen Decoction) with added Shanzha (Crataegi Fructus) and Sharen (Amomi Fructus Rotundus, each 5 fen), and Shenqu (Massa Medicata Fermentata, 1 qian 5 fen).
5. For postpartum weak Stomach Qi, resulting in diarrhea and dysentery with undigested food in the stool (Wan Gu Bu Hua), use Liujunzi Tang (Six Gentlemen Decoction) with added Muxiang (Aucklandiae Radix, 3 fen) and Rouguo (Nutmeg, 1 piece).
6. For postpartum diarrhea and dysentery due to Spleen deficiency, accompanied by edema of the four limbs, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Wupi San (Five-Bark Powder), or Liujunzi Tang (Six Gentlemen Decoction) combined with Wupi San (Five-Bark Powder).
7. For various postparten conditions accompanied by vomiting, add Huoxiang (Pogostemonis Herba, 1 qian). If there is excessive phlegm, add Banxia (Pinelliae Rhizoma, 8 fen).
8. For the aforementioned postparten conditions accompanied by scanty and difficult urination, add Fuling (Poria, 1 qian), Zexie (Alismatis Rhizoma, 5 fen), Dengxincao (Junci Medulla, 20 stems), or Jing Cheqian (Plantaginis Semen, 1 qian).
9. For unceasing postparten diarrhea, add Lianzi (Nelumbinis Semen, 10 grains) and Shiliupi (Punicae Cortex, 1 qian).
10. For postparten red dysentery (dysentery with pus and blood) that persists for a long time, use Renshen (Ginseng Radix et Rhizoma, 2 qian) and Xianglian Wan (Aucklandia and Coptis Pill, 2 qian) taken together for cure. Do not excessively use Muxiang (Aucklandiae Radix) or Jiangzhi (Ginger Juice), as heat causes blood to flow more rapidly. Dihuang (Sanguisorbae Radix) may be added to the formula.
For all ten formulas above, one must first inquire whether abdominal mass pain (blood stasis clots) has been eliminated before administration.
The human Stomach Fu organ is the sea of the five grains. The essence of water and grain is transported upward to the Liver and Lung, distributed among the five Zang organs, transformed into Qi and Blood, and nourishes the entire body. Postparten labor and fatigue injure the Spleen and Stomach, causing a depletion of Righteous Qi, making it easy for Pathogenic Qi to invade. If pathogenic factors enter the intestines and stomach, they cause rebellious Qi leading to vomiting and inability to eat. If vomiting persists without ceasing within seven days postparten, with complete refusal of food and uneliminated blood clots, treatment should focus on dissipating clots, assisted by warm herbs; Anwei Xingxue Tang (Stomach-Calming and Blood-Circulating Decoction) is appropriate. If the pain has ceased but vomiting persists and food cannot be retained, Jianji Liuwu Tang (Modified Six-Ingredient Decoction) and Houwen Weihe Zhong Yin (Later Warm Stomach and Harmonize Middle Infusion) are appropriate. If vomiting occurs with Qi and Blood deficiency and food cannot be digested normally, Buchong He Wei Tang (Tonify Middle and Harmonize Stomach Decoction) is appropriate.
Anwei Xingxue Tang (Stomach-Calming and Blood-Circulating Decoction)
Xiong (Chuanxiong Rhizome, 1 qian)
Danggui (Angelicae Sinensis Radix, 4 qian)
Renshen (Ginseng Radix et Rhizoma, 1 qian)
Taoren (Persicae Semen, 10 grains)
Jiangtan (Charred Ginger)
Zhigancao (Prepared Licorice Root, each 5 fen)
Huoxiang (Pogostemonis Herba)
Sharen (Amomi Fructus Rotundus, each 4 fen)
Jiang (Fresh Ginger, 3 slices; do not use if sweating)
Jianji Liuwu Tang (Modified Six-Ingredient Decoction)
Chuanxiong (Chuanxiong Rhizome, 1 qian)
Danggui (Angelicae Sinensis Radix, 1 qian)
Shanyao (Dioscoreae Rhizoma, 1 qian 5 fen)
Renshen (Ginseng Radix et Rhizoma, 1 qian)
Fuling (Poria, 1 qian)
Huoxiang (Pogostemonis Herba, 5 fen)
Douren (Cardamomi Fructus, likely Amomi Fructus Rotundus based on context)
Jiangtan (Charred Ginger, each 4 fen)
Baidou (Eupatorii Fructus, likely Coicis Semen or similar bean-like herb, here interpreted as Coicis Semen/Job's Tears or similar, text says Bian Dou which is Dolichos Lablab Seed, 2 qian)
Chenpi (Citri Reticulatae Pericarpium, 3 fen)
Zhigancao (Prepared Licorice Root, 5 fen)
Jiang (Fresh Ginger, 3 slices)
Once vomiting stops, remove Douren.
Wenzhong He Wei Tang (Warm Middle and Harmonize Stomach Decoction)
Renshen (Ginseng Radix et Rhizoma, each 1 qian)
Fuling (Poria, each 1 qian)
Danggui (Angelicae Sinensis Radix, each 2 qian)
Baidou (Dolichoris Semen, each 2 qian)
Chenpi (Citri Reticulatae Pericarpium, each 3 fen)
Zhigancao (Prepared Licorice Root, each 3 fen)
Huoxiang (Pogostemonis Herba, each 3 fen)
Dingxiang (Caryophylli Flos, each 3 fen)
Jiang (Fresh Ginger, 3 slices)
Once vomiting stops, remove Dingxiang. If cold invasion occurs, add Wuzhuyu (Evodiae Fructus).
Buchong He Wei Tang (Tonify Middle and Harmonize Stomach Decoction)
Renshen (Ginseng Radix et Rhizoma, each 2 qian)
Baizhu (Atractylodis Macrocephalae Rhizoma, each 2 qian)
Baidou (Dolichoris Semen, each 2 qian)
Danggui (Angelicae Sinensis Radix, each 2 qian)
Fuling (Poria, 1 qian)
Shanyao (Dioscoreae Rhizoma, 1 qian 5 fen)
Zhigancao (Prepared Licorice Root, each 4 fen)
Chenpi (Citri Reticulatae Pericarpium, each 4 fen)
Paojiang (Prepared Ginger, each 4 fen)
Decoct in water.
Note: Vomiting and rebellious Qi extending into the postparten period indicate a severe condition. One should use Xiangsha Liujunzi Tang (Aucklandia and Amomi Six Gentlemen Decoction) with Zhi Fuzi (Prepared Aconiti Lateralis Radix), Wuzhuyu (Evodiae Fructus), and Shidi (Diospyros Fruit) as guides. If ineffective, add Chuanlian (Coptidis Rhizoma) wine-fried and Rougui (Cinnamomi Cortex). If still ineffective, use Erqi Dan (Two-Qi Pill), composed of Shuiyin (Mercurius, 3 qian) and Liuhuang (Sulfur, 3 qian), fused into cinnabar-like granules. Grind sulfur and mercury together until no distinct particles remain. Form pills using rice paste. Take 20 pills per dose, gradually increasing to 49 pills, delivered with Dingxiang (Caryophylli Flos) and Shidi (Diospyros Fruit) decoction. The pills should be the size of Sophora seeds. Since mercury combines naturally with sulfur, there is no need for doubt or fear; this can be used for hiccup and cholera-like disorders.