艾叶 赤石脂( ) 补骨脂(炒) 木贼(各半两) 附子(一个,炮去皮脐)
上为末,陈米饮和丸,梧子大。食前温酒、米汤下二十丸。
评曰∶血崩不是轻病,况产后有此,是谓重伤,恐不止咸酸不节而能致之。多因忧惊恚
怒,脏气不平;或产后服断血药早,致恶血不消,郁满作坚,亦成崩中,固经丸似难责效,
不若大料煮芎 当归加芍药汤,候定,续次随证合诸药治之为得。
芎 当归加芍药汤方 方见眩晕门,加芍药等分
第十四论曰∶产后腹胀闷、呕吐不定者何?答曰∶败血散于脾胃,脾受之,不能运化精
微而成腹胀;胃受之,则不得受纳水谷而生吐逆。医者不识,若以寻常治胀止吐药疗之,病
与药不相干,转更伤动正气,疾愈难治,但服抵圣汤。
赤芍药 半夏(汤洗七次) 泽兰叶 人参 陈皮(各二钱) 甘草(炙,一钱)
上为锉散。每作一剂,用水二碗,生姜半两,煎至二盏,去滓,分三次热服。
第十五论曰∶产后口鼻黑气起及鼻衄者何?答曰∶阳明者经脉之海,起于鼻,交
中,还出挟口,交人中,左之右,右之左。产后气消血散,荣卫不理,散乱入于诸经,却还
不得,故令口鼻黑起及变鼻衄。此缘产后虚热变生此证,其疾不可治,名胃绝肺败。此证不可治,不出方。
第十六论曰∶产后喉中气急喘者何?答曰∶荣者血也,卫者气也,荣行脉中,卫行脉外
,相随上下,谓之荣卫。因产所下过多,荣血暴竭,卫气无主,独聚肺中,故令喘也,此名
孤阳绝阴,为难治。若恶露不快,败血停凝,上熏于肺,亦令喘急,但服夺命丹,血去喘息自定。
夺命丹 方见第二论
评曰∶产后喘急固可畏,若是败血上熏于肺,犹可责效夺命丹。若感风寒,或因忧怒,
饮食咸冷等,夺命丹末可均济,况孤阳绝阴乎?若荣血暴绝,宜大料煮芎 汤亦自可救;伤
风寒,宜旋复花汤;性理郁发,宜大调经散,用桑白皮杏仁煎汤调下;伤食,宜见 丸、五积散。
芎 汤 方见眩晕门
Ai Ye (Artemisiae Argyi Folium), Chishi Zhi (Halloysit Rubrum, red halloysite), Buguzhi (Psoraleae Fructus, Psoralea fruit, stir-fried), Mu Zei (Equiseti Herba, Horsetail herb) [each half liang], Fuzi (Aconiti Lateralis Radix Praeparata, prepared lateral root of aconite, one piece, processed, skin and umbilicus removed).
The above ingredients are ground into powder. Mix with aged rice water to form pills the size of a Chinese quince seed (Wu Zi). Take twenty pills before meals, washed down with warm wine or rice soup.
Comment: Hemorrhage (Xue Beng, severe uterine bleeding) is not a mild disease. Moreover, occurring postpartum, it constitutes a severe injury. It is likely caused not merely by irregular consumption of salty and sour foods. It often results from sorrow, fright, and anger, leading to imbalance in the Qi of the Zang organs; or from taking blood-stopping medications too early postpartum, causing lochia (E Xue, retained blood) to fail to dissipate, becoming stagnant, distended, and hardened, thus also forming Bing Zhong (sudden heavy vaginal bleeding). Gu Jing Wan (Solidify the Menses Pill) seems unlikely to be effective. It would be better to use a large dose of Zhu Xiong Gui Jia Shao Yao Tang (Decoction of Ligusticum and Angelica with Added Peony), and after the condition stabilizes, subsequently combine various herbs according to the specific symptoms for treatment. This is the proper approach.
Formula for Xiong Gui Jia Shao Yao Tang (Ligusticum and Angelica Decoction with Added Peony): See section on Vertigo/Dizziness; add Shao Yao (Paeoniae Radix Alba/Rubra, white/red peony root) in equal proportion.
Chapter Fourteen states: What causes abdominal distension, fullness, and uncertain vomiting postpartum? The answer is: Failed blood (Bai Xue, necrotic blood/lochia) scatters into the Spleen and Stomach. When the Spleen is affected, it cannot transform and transport essence and micro-nutrients, resulting in abdominal distension; when the Stomach is affected, it cannot receive and digest food and fluids, generating vomiting and regurgitation. If physicians do not recognize this, and treat with ordinary medicines for distension and vomiting, the disease and medicine will be unrelated, further damaging the Righteous Qi (Zheng Qi), making the illness harder to cure. One should simply take Di Sheng Tang (Support the Sage Decoction).
Chi Shao Yao (Paeoniae Radix Rubra, red peony root), Ban Xia (Pinelliae Rhizoma, Pinellia rhizome, washed seven times with hot water), Ze Lan Ye (Leonuri Herba, Houttuynia leaf/herb), Ren Shen (Ginseng Radix et Rhizoma, Ginseng root and rhizome), Chen Pi (Citri Reticulatae Pericarpium, tangerine peel) [each two qian], Gan Cao (Glycyrrhizae Radix et Rhizoma, licorice root, honey-fried) [one qian].
The above ingredients are cut into coarse fragments to make a powder. For each dose, use two bowls of water and half a liang of fresh ginger. Decoct until two bowls remain. Remove the dregs. Divide into three doses and take hot.
Chapter Fifteen states: What causes black qi to rise around the mouth and nose, along with epistaxis (Bi Nu, nosebleed), postpartum? The answer is: The Yangming Meridian is the sea of the meridians. It originates at the nose, crosses at the nasolabial fold (E), emerges again flanking the mouth, and crosses at the philtrum (Ren Zhong). The left side connects to the right, and the right to the left. Postpartum, Qi is depleted and Blood is scattered. Ying and Wei (Nutritive and Defensive Qi) lose their orderly regulation. They scatter into the various meridians but cannot return to their original paths. Therefore, black qi appears around the mouth and nose, and epistaxis occurs. This arises because deficiency-heat generated postpartum transforms into this syndrome. This illness is incurable, named Wei Jue Fei Bai (Exhaustion of Stomach and Failure of Lung). Since this syndrome is incurable, no formula is provided.
Chapter Sixteen states: What causes rapid breathing and wheezing in the throat postpartum? The answer is: Ying refers to Blood, and Wei refers to Qi. Ying circulates within the vessels, while Wei circulates outside the vessels, moving up and down together, known as Ying and Wei. Due to excessive blood loss during childbirth, Ying Blood suddenly exhausts. Wei Qi loses its master and gathers exclusively in the Lungs, thus causing wheezing. This is named Gu Yang Jue Yin (Solitary Yang and Absolute Yin), which is difficult to treat. If lochia flows poorly and failed blood stagnates and coagulates, steaming upward to the Lungs, it also causes rapid breathing. In such cases, simply take Duo Ming Dan (Snatch Life Pill); once the blood is expelled, the breathing will naturally settle.
Duo Ming Dan (Snatch Life Pill): See Chapter Two.
Comment: Postpartum rapid breathing and wheezing are indeed frightening. If caused by failed blood steaming upward to the Lungs, one can still expect efficacy from Duo Ming Dan. However, if caused by contraction of Wind-Cold, or by emotional distress (worry/anger), or by consuming salty/cold foods, the powder of Duo Ming Dan is insufficient to remedy the situation, let alone in cases of Solitary Yang and Absolute Yin. If Ying Blood is suddenly exhausted, a large dose of Zhu Xiong Gui Tang (Decoction of Ligusticum and Angelica) can also save the patient; if injured by Wind-Cold, Xuan Fu Hua Tang (Inula Flower Decoction) is suitable; if due to emotional stagnation and eruption, Da Tiao Jing San (Great Regulation of Menses Powder) is suitable, taken mixed with decoction of Sang Bai Pi (Mori Cortex, mulberry bark) and Xing Ren (Armeniacae Semen, apricot seed); if due to food injury, Jian Yuan Wan (See Circle Pill) and Wu Ji San (Five Accumulations Powder) are suitable.
Xiong Gui Tang (Ligusticum and Angelica Decoction): See section on Vertigo/Dizziness.