一月如露珠,二月如桃花,三月分男女,四月形象具,五月骨节成,六月毛发生,七月动右手(是男于母左,
是女于母右,)八月动左手(是男于母右,是女于母左,)九月三转身,十月始满足。
凡病起于血气之衰,脾胃之虚。况产妇气血脾胃之虚弱,殆有甚焉。丹溪论∶产后当以大补气血为主,虽有他
症,以末治之。故治法∶有气毋专耗气,有食毋专消食,热不用芩连,寒不用附桂。如中虚外感,见三阳表证之多,
似可汗也,在产后而用麻黄则重伤其阳。见三阴里症之多,似宜下也,在产后而用承气则重亡其阴。至若耳聋、
胁痛、肾虚、恶露之停,休用柴胡。谵语、汗出、中风恶寒之症,莫作风治。其由阳气之衰,非大补不能回阳
而起弱。即如因阴血之涸,非滋补不能舒筋而活络。又乍寒乍热,发作有期,症类疟也,若以疟治,淹滞难痊。神
不守舍,言语无伦,病似邪也,若以邪治,危亡可待。去血而大便闭结,苁蓉加于生化。汗多而小便短涩,六君
倍用参 。肛脱、茄症,俱是气虚下陷,补中益气是良方也。口禁、拳握,无非血燥类风,加参生化,十有益焉。
产户入风,服以养荣、羌、独。玉门伤冷,洗须床、兔、萸、硫。怔忡惊悸,生化汤加以远志。似邪恍惚,安
神丸兼服。脾气因喘咳而满闷、虚烦,生化汤加木香为佐。因过食而呕吐、呃逆、六君子加神曲为良。苏木、棱、
蓬,大能破血。青皮、枳实,最消膨胀。一应耗气破血之药,汗出泄下之方,只可施于强壮,不宜用于虚弱。大抵
新产之后,先问恶露何如,块痛何如,参术不可遽加。至若亡阳汗脱,气虚喘促,加参生化是从权也。如亡阴太
热,晕厥血崩,升举大补乃急救耳。王太仆云∶
治下补下,制以缓急,制缓以滋道路,制急乃气味俱薄,力与缓同。是治法当遵丹溪,服法须效太仆。虽未尽产
症之详,已统括治疗之要,敢曰济阴之指南,其于女科不无小补云。
第一个月胎儿像露珠一样微小,第二个月像桃花一样初具形态,第三个月开始分男女,第四个月五官形体具备,第五个月骨节形成,第六个月毛发长出,第七个月胎儿右手活动(如果是男孩在母亲左侧胎动,女孩在母亲右侧胎动),第八个月左手活动(如果是男孩在母亲右侧胎动,女孩在母亲左侧胎动),第九个月胎儿转身三次,第十个月才完全成熟足月。
凡是疾病都起因于血气的衰弱和脾胃的虚弱。何况产妇的气血脾胃更加虚弱,甚至更为严重。朱丹溪论述说:产后应当以大补气血为主,即使有其他症状,也作为次要问题来处理。所以治疗方法是:如果有气虚不要专门耗气,如果有食积不要专门消食,有热证不用黄芩、黄连,有寒证不用附子、肉桂。如果中焦虚弱又外感邪气,出现很多三阳经表证的症状,似乎可以用发汗法,但在产后如果用麻黄则会严重损伤阳气。如果出现很多三阴经里证的症状,似乎应该用泻下法,但在产后如果用承气汤则会严重耗伤阴液。至于耳聋、胁痛、肾虚、恶露停滞的情况,不要用柴胡。谵语、出汗、中风恶寒等症状,不要当作风邪来治疗。如果是由于阳气衰微,不大力补益就不能回阳救逆并改善虚弱状态。如果是由于阴血枯竭,不滋补就不能舒缓筋脉并通利经络。又有忽冷忽热、发作有定时的情况,症状类似疟疾,如果按疟疾治疗,病情会拖延难以痊愈。神志不守舍、言语错乱,病状似邪祟干扰,如果按邪祟治疗,危亡就在眼前。因失血导致大便闭结,在生化汤中加入肉苁蓉。出汗多而小便短少涩滞,六君子汤加倍用人参。子宫脱垂、阴道肿物突出,都是气虚下陷所致,补中益气汤是良方。牙关紧闭、手握拳,无非是血燥引起的类似风证的病症,在生化汤中加入人参,十次会有九次有效。产道受风,服用养荣汤加羌活、独活。阴门受寒,需用蛇床子、兔丝子、山茱萸、硫磺煎水清洗。心悸怔忡、惊悸不安,在生化汤中加入远志。神志恍惚似邪祟作怪,兼服安神丸。脾气虚弱因喘咳导致胸脘满闷、虚烦,在生化汤中加入木香作为佐药。因过食导致呕吐、呃逆,六君子汤加入神曲为良方。苏木、三棱、蓬莪术,大能破血行瘀。青皮、枳实,最能消除胀满。一切耗气破血的药物,以及发汗泄下的方剂,只可施用于身体强壮者,不宜用于虚弱之人。大抵新产之后,先询问恶露情况如何,腹痛块痛情况如何,人参、白术不可急于添加。至于亡阳汗出欲脱,气虚喘促,在生化汤中加入人参是从权变通的做法。如果亡阴内热太盛,晕厥血崩,升举大补汤才是急救之法。王冰说:治疗下部疾病,用药制法要根据缓急而定,制法缓和是为了滋润道路(指药力缓慢到达病所),制法急峻则是气味淡薄,但效力与缓剂相同。因此治法应当遵循朱丹溪的观点,服药方法须效法王冰。虽然未能详尽列举所有产后病症,但已概括了治疗的要点,敢说这是救治妇女病的指南,对于妇科而言不无小补。
In the first month, the fetus is like a dewdrop; in the second month, like a peach blossom; in the third month, male and female distinctions appear; in the fourth month, features and form are complete; in the fifth month, bone joints are formed; in the sixth month, hair grows; in the seventh month, movement of the right hand occurs (if male, movement is on the mother's left side; if female, on the mother's right side); in the eighth month, movement of the left hand occurs (if male, movement is on the mother's right side; if female, on the mother's left side); in the ninth month, the fetus turns three times; in the tenth month, it is fully mature.
All diseases arise from the decline of Xue Qi (Blood and Qi) and the deficiency of Pi Wei (Spleen and Stomach). How much more so for postpartum women, whose Xue Qi and Pi Wei are even more deficient. Zhu Danxi stated: Postpartum treatment should primarily focus on greatly tonifying Xue Qi. Even if other symptoms exist, they should be treated as secondary. Therefore, the therapeutic principles are: if there is Qi deficiency, do not specifically deplete Qi; if there is food stagnation, do not specifically reduce food accumulation; for heat patterns, do not use Huang Qin (Scutellariae Radix) or Lian Zi (Nelumbinis Semen); for cold patterns, do not use Fu Zi (Aconiti Lateralis Radix Praeparata) or Rou Gui (Cinnamomi Cortex). If there is middle Jiao deficiency with external pathogenic invasion, presenting with many Tai Yang (Greater Yang), Yang Ming (Yang Brightness), or Shao Yang (Lesser Yang) exterior syndrome signs, sweating might seem appropriate, but using Ma Huang (Ephedrae Herba) in the postpartum period would severely damage Yang Qi. If there are many Tai Yin (Lesser Yin), Shao Yin (Lesser Yin), or Jue Yin (Terminal Yin) interior syndrome signs, purgation might seem suitable, but using Cheng Qi Tang (Ordering the Qi Decoction) in the postpartum period would severely consume Yin fluids. As for tinnitus, hypochondriac pain, Shen Jing (Kidney Deficiency), and retention of E Lu (Lochia), Chai Hu (Bupleuri Radix) should not be used. For delirium, sweating, and aversion to wind/cold resembling Zhong Feng (Wind Stroke), these should not be treated as Wind pathogens. If the condition stems from the decline of Yang Qi, only great tonification can restore Yang and alleviate weakness. If it stems from the exhaustion of Yin Blood, only nourishing tonification can relax sinews and unblock collaterals. Sudden chills and fever occurring at regular intervals resemble Nue (Malaria); treating it as Malaria will lead to lingering and difficult recovery. Restlessness of the Shen (Spirit) and incoherent speech resemble possession by evil spirits; treating it as such portends imminent danger. Constipation due to blood loss requires adding Rong Ren (Cistancheae Caulis) to Sheng Hua Tang (Transform the Stasis Decoction). Excessive sweating with scanty, dysuric urine requires doubling the dose of Ren Shen (Ginseng Radix) in Liu Jun Zi Tang (Six Gentlemen Decoction). Uterine prolapse and vaginal protrusions are caused by Qi deficiency sinking; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is an excellent formula. Trismus and clenched fists are essentially dry-blood patterns resembling Wind; adding Ren Shen to Sheng Hua Tang yields ten benefits out of ten cases. Wind entering the birth canal should be treated with Yang Rong Tang (Nourish the Ying Decoction) plus Qiang Huo (Notopterygii Rhizoma et Radix) and Du Huo (Angelicae Pubescentis Radix). Cold injuring the vulva requires washing with Chuang Xin (Cnidii Fructus), Tu Si Zi (Cuscutae Semen), Shan Yu Rou (Corni Fructus), and Liu Huang (Sulfur). Palpitations and fright require adding Yuan Zhi (Polygalae Radix) to Sheng Hua Tang. Delirious trance resembling spirit possession requires concurrent administration of An Shen Wan (Calming the Spirit Pill). Fullness, distension, and empty irritability due to Spleen Qi deficiency exacerbated by coughing and panting require adding Mu Xiang (Aucklandiae Radix) as an assistant herb to Sheng Hua Tang. Vomiting and hiccups due to overeating are best treated with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Shen Qu (Massa Medicata Fermentata). Su Mu (Sappan Lignum), San Leng (Sparganii Rhizoma), and E Zhu (Curcumae Rhizoma) strongly break blood stasis. Qing Pi (Citri Reticulatae Pericarpium Viride) and Zhi Shi (Aurantii Fructus Immaturus) most effectively reduce distension. All herbs that deplete Qi and break blood, and all formulas that induce sweating or purgation, are only applicable to robust individuals and unsuitable for the weak. Generally, after recent childbirth, one must first inquire about the state of E Lu (Lochia) and abdominal mass pain; Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) should not be added hastily. In cases of Yang collapse with sweating and impending collapse, or Qi deficiency with panting, adding Ren Shen to Sheng Hua Tang (Transform the Stasis Decoction) is a flexible adaptation. In cases of severe Yin collapse with intense heat, syncope, or metrorrhagia, Sheng Ju Da Bu Tang (Lifting and Great Tonification Decoction) is for emergency rescue. Wang Bing stated: "Treating lower jiao disorders, the preparation method depends on urgency. Gentle preparation moistens the pathway; urgent preparation results in thin flavor and aroma, yet efficacy matches gentle preparations." Thus, treatment methods should follow Zhu Danxi, and administration methods should emulate Wang Bing. Although this does not detail every postpartum disorder, it summarizes the essentials of treatment. It may be called a guide for saving women, offering no small benefit to Gynecology.