张仲景先生云∶产后郁冒,为血虚而厥也。其脉微弱,呕不食,大便坚,头汗出,此血虚于下,孤阳上冒,
防其脱也,宜大补之。李东垣曰∶阴血暴亡,心神无根据,致昏冒。朱丹溪曰∶气血俱虚,痰火泛上而晕。吾师
钟龄先生,
曾用人参两许,加炮姜、附子以救之。予亦救多人,用参 归地并进而起,附案于尾卷。
大抵脾虚痰厥,头眩而呕者,用六君子汤加炮姜。若瘀血不行,腹痛拒按者,服佛手散下失笑丸。此为半
虚,余皆太虚。如面白眼合,口张手撒,足冷鼻寒,皆宜十全大补。若一味退缩,不急峻补,则人已去远矣,
后悔何及?
六君子汤
人参(一钱) 白术(土炒,一钱五分) 茯苓(二钱,茯神亦可) 甘草(五分,炙) 陈皮(七分)
半夏(一钱,姜制)
加姜枣煎服。
十全大补汤 佛手散 失笑丸(俱见前)。
产后诊视,必先问临产瘀血多与少,有与无。此物关系不少,眼前则防发热也,腹痛也,小便被阻也。甚有
积成内痈之患,久后变成 块,积致血臌,岂不大有干系焉?如瘀血不行,必以生化汤多服,自然流通。如兼腹
胀,佐以失笑丸。如感冒,下部受寒,加肉桂(生化汤见前)。
其恶露不可不行,又不可多行。崩者,乃如水之流,此症最重。总属荣气空虚,不能摄血归经,以归脾汤主
之,为正治也。然又有怒伤肝者,于归脾汤加炒黑山栀(一钱),阿胶(二钱),艾叶(酒炒,五分),柴胡(二分),
或服补中益气汤。又方有瑞莲散,止崩妙剂。重者,参附汤加阿茯地补之。
瑞莲散
湖莲子(百粒) 棕榈灰 当归(各一两) 川芎(五钱) 鲤鱼麟(烧灰七钱) 炮姜炭(五钱)
共为末,酒调二钱,二服自止。
归脾汤
人参(一钱,虚人三五钱) 炙黄 (二钱) 甘草(五分) 归身(一钱五分) 茯神(三钱) 枣仁
(二钱,炒) 白
术(二钱,土炒),桂圆肉(五枚)
加姜枣煎服。
补中益气汤
黄 (二钱五分,蜜炙) 白术(一钱,土炒) 归身(一钱五分) 人参(一钱) 柴胡(三分,蜜炙)
升麻(三分蜜炙) 炙草(五分) 陈皮(七分)
加姜枣煎服。
参附汤(平时崩症,亦当参以此理)
人参(三钱) 熟附子(一钱)
水煎服。体虚之甚者,加熟地(一两),茯神(二钱),阿胶(三钱),艾叶(五分),大剂补之,方能成
功,迟则防脱。贫者以黄 两许代参。
张仲景先生说:产后郁冒,是由于血虚导致阳气厥逆。其脉象微弱,呕吐不能进食,大便干结,头部出汗,这是因为下部血虚,孤阳上冲,需防止阳气外脱,应当用大补之法。李东垣说:阴血突然大量亡失,心神失去依托,导致昏晕。朱丹溪说:气血都虚弱,痰火上升而致眩晕。我的老师钟龄先生,曾用过一两多的人参,加入炮姜、附子来救治。我也救活过许多人,用人参、当归、地黄同时进补而起死回生,相关医案附在卷末。
大体上,如果是脾虚导致的痰厥,出现头晕目眩且呕吐的,使用六君子汤加炮姜。如果是瘀血阻滞不行,腹部疼痛且拒绝按压的,服用佛手散并配合下失笑丸。这属于半虚证,其余情况都属于极度虚弱。如果面色苍白、眼睛闭合、口张手松、脚冷鼻寒,都适宜使用十全大补汤。如果一味退缩犹豫,不急于峻猛大补,那么病人就已经离死亡不远了,到时候后悔又有什么用呢?
六君子汤
人参(一钱) 白术(土炒,一钱五分) 茯苓(二钱,茯神也可以) 甘草(五分,炙) 陈皮(七分)
半夏(一钱,姜制)
加入生姜、大枣煎服。
产后诊视,必须先询问临产时瘀血的多少以及有无。这个因素关系重大,眼前要预防发热、腹痛、小便受阻等情况。甚至有积滞形成内痈的隐患,日久变成癥块,积聚导致血臌病,难道不是大有关系吗?如果瘀血不行,必须多服生化汤,自然就会流通。如果兼有腹胀,辅助使用失笑丸。如果感冒,或下部受寒,加入肉桂(生化汤见前文)。
恶露不可不行,但也不可过多流出。崩漏,像水一样流淌不止,此症最重。总归是营气空虚,不能统摄血液回归经脉,以归脾汤为主治方剂,这是正治法。然而又有因愤怒伤肝的情况,在归脾汤中加入炒黑山栀(一钱),阿胶(二钱),艾叶(酒炒,五分),柴胡(二分),或者服用补中益气汤。另有瑞莲散,是止崩漏的妙方。重症者,用参附汤加入阿胶、茯苓、地黄来补益。
瑞莲散
湖莲子(一百粒) 棕榈灰 当归(各一两) 川芎(五钱) 鲤鱼鳞(烧成灰七钱) 炮姜炭(五钱)
共研为细末,用酒调服二钱,服两次后自能止血。
归脾汤
人参(一钱,体虚者可三五钱) 炙黄芪(二钱) 甘草(五分) 归身(一钱五分) 茯神(三钱) 枣仁
(二钱,炒) 白
术(二钱,土炒),桂圆肉(五枚)
加入生姜、大枣煎服。
补中益气汤
黄芪(二钱五分,蜜炙) 白术(一钱,土炒) 归身(一钱五分) 人参(一钱) 柴胡(三分,蜜炙)
升麻(三分蜜炙) 炙甘草(五分) 陈皮(七分)
加入生姜、大枣煎服。
参附汤(平时崩漏病症,也应当参考这个道理)
人参(三钱) 熟附子(一钱)
水煎服。身体极度虚弱的,加入熟地黄(一两),茯神(二钱),阿胶(三钱),艾叶(五分),用大剂量补益,才能成功,迟缓则担心阳气外脱。贫穷者可用一两黄芪代替人参。
Mr. Zhang Zhongjing stated: Postpartual Yu Mao (dizziness and fainting due to blood deficiency and yang collapse) is caused by blood deficiency leading to Yang Qi reversal. The pulse is weak, there is vomiting with inability to eat, dry stool, and sweating on the head. This indicates blood deficiency in the lower body and solitary Yang floating upward; one must guard against Yang collapse, so a major tonification method is appropriate. Li Dongyuan said: Sudden massive loss of Yin Blood causes the Heart Spirit to lose its foundation, resulting in dizziness and fainting. Zhu Danxi said: Both Qi and Blood are deficient, and Phlegm-Fire floats upward causing dizziness. My teacher, Mr. Zhong Ling, once used over one tael of Ren Shen (Ginseng Root), adding Pao Jiang (Prepared Ginger Rhizome) and Fu Zi (Prepared Aconite Root) to save them. I have also saved many people using Ren Shen (Ginseng Root), Dang Gui (Angelica Sinensis Root), and Di Huang (Rehmannia Root) simultaneously, with relevant cases appended at the end of the volume.
Generally speaking, for Pi Xu (Spleen Deficiency) leading to Tan Jue (Phlegm-induced collapse) with dizziness and vomiting, use Liu Jun Zi Tang (Six Gentlemen Decoction) added with Pao Jiang (Prepared Ginger Rhizome). If Yu Xue (Blood Stasis) fails to move, accompanied by abdominal pain and tenderness upon pressure, take Fo Shou San (Buddha's Hand Powder) combined with Shi Xiao Wan (Laughing Off Pill). This belongs to half-deficiency; all other cases belong to extreme deficiency. If the face is pale, eyes closed, mouth open, hands relaxed, feet cold, and nose cold, Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) is suitable. If one hesitates and does not urgently apply strong tonification, the patient will be far gone, and regret will be useless.
Liu Jun Zi Tang (Six Gentlemen Decoction)
Ren Shen (Ginseng Root) (1 qian) Bai Zhu (Atractylodes Macrocephala Rhizome, soil-fried, 1.5 qian) Fu Ling (Poria, 2 qian, Fu Shen [Poria with Hostwood] is also acceptable) Gan Cao (Licorice Root, roasted, 0.5 qian) Chen Pi (Tangerine Peel, 0.7 qian) Ban Xia (Pinellia Tuber, ginger-processed, 1 qian)
Decoct with Sheng Jiang (Fresh Ginger) and Da Zao (Jujube Fruit).
Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), Fo Shou San (Buddha's Hand Powder), Shi Xiao Wan (Laughing Off Pill) (all see previous sections).
During postpartum examination, one must first ask about the amount and presence of Chan Hou Yu Xue (Postpartum Lochial Stasis). This factor is significant; immediately, one must guard against Fa Re (Fever), Fu Tong (Abdominal Pain), and Xiao Bian Bei Zu (Obstructed Urination). There are even cases where accumulation leads to Nei Yong (Internal Abscess), and later transforms into Zheng Kuai (Masses), accumulating to cause Xue Gu (Blood Distension), which is certainly of great consequence. If Yu Xue (Blood Stasis) does not move, one must administer Sheng Hua Tang (Generation and Transformation Decoction) frequently to ensure natural circulation. If accompanied by abdominal distension, assist with Shi Xiao Wan (Laughing Off Pill). If there is Gan Mao (Common Cold) or lower body exposure to Cold, add Rou Gui (Cinnamon Bark) (see Sheng Hua Tang previously).
E Lu (Lochia) must flow but not excessively. Beng (Flooding/Profuse Bleeding) flows like water and is the most severe condition. It generally belongs to Rong Qi Kong Xu (Deficiency of Nutritive Qi), unable to control Blood returning to the vessels; Gui Pi Tang (Restore the Spleen Decoction) is the primary treatment, which is the orthodox method. However, there are cases where anger injures the Liver; in Gui Pi Tang (Restore the Spleen Decoction), add Chao Hei Shan Zhi (Stir-fried Black Gardenia Fruit) (1 qian), E Jiao (Donkey-hide Gelatin) (2 qian), Ai Ye (Mugwort Leaf, wine-fried) (0.5 qian), Chai Hu (Bupleurum Root) (0.2 fen), or alternatively,服用 Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Another prescription is Rui Lian San (Lotus Seed Powder), a miraculous agent for stopping flooding. For severe cases, Shen Fu Tang (Ginseng and Aconite Decoction) added with E Jiao (Donkey-hide Gelatin), Fu Ling (Poria), and Di Huang (Rehmannia Root) is used for tonification.
Rui Lian San (Lotus Seed Powder)
Hu Lian Zi (Lake Lotus Seeds) (100 grains) Zong Lv Hui (Ash of Palm Frond) Dang Gui (Angelica Sinensis Root) (each 1 liang) Chuan Xiong (Ligusticum Chuanxiong Rhizome) (5 qian) Li Yu Lin (Carp Scales, burnt to ash) (7 qian) Pao Jiang Tan (Charred Prepared Ginger Rhizome) (5 qian)
Grind together into powder, mix with wine, take 2 qian per dose; two doses will naturally stop the bleeding.
Gui Pi Tang (Restore the Spleen Decoction)
Ren Shen (Ginseng Root) (1 qian, 3-5 qian for deficient persons) Zhi Huang Qi (Honey-roasted Astragalus Root) (2 qian) Gan Cao (Licorice Root, roasted) (0.5 qian) Gui Shen (Angelica Sinensis Root Head) (1.5 qian) Fu Shen (Poria with Hostwood) (3 qian) Zao Ren (Ziziphus Seed, stir-fried) (2 qian) Bai Zhu (Atractylodes Macrocephala Rhizome, soil-fried) (2 qian), Gui Yuan Rou (Longan Aril) (5 pieces)
Decoct with Sheng Jiang (Fresh Ginger) and Da Zao (Jujube Fruit).
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Huang Qi (Astragalus Root) (2.5 qian, honey-roasted) Bai Zhu (Atractylodes Macrocephala Rhizome, soil-fried) (1 qian) Gui Shen (Angelica Sinensis Root Head) (1.5 qian) Ren Shen (Ginseng Root) (1 qian) Chai Hu (Bupleurum Root, honey-roasted) (3 fen) Sheng Ma (Cimicifuga Rhizome, honey-roasted) (3 fen) Zhi Cao (Roasted Licorice Root) (0.5 qian) Chen Pi (Tangerine Peel) (0.7 qian)
Decoct with Sheng Jiang (Fresh Ginger) and Da Zao (Jujube Fruit).
Shen Fu Tang (Ginseng and Aconite Decoction) (For ordinary flooding conditions, this principle should also be referenced)
Ren Shen (Ginseng Root) (3 qian) Shu Fu Zi (Prepared Aconite Root) (1 qian)
Decoct in water. For those with extreme physical weakness, add Shu Di Huang (Prepared Rehmannia Root) (1 liang), Fu Shen (Poria with Hostwood) (2 qian), E Jiao (Donkey-hide Gelatin) (3 qian), Ai Ye (Mugwort Leaf) (0.5 qian); a large dose is required for success, otherwise delay risks Yang collapse. For the poor, replace Ren Shen (Ginseng Root) with approximately one liang of Huang Qi (Astragalus Root).