娠妊既产之后。脏腑受伤。血气俱积。为病甚多。不可不审。条列于后。
妇人新产。忽觉昏晕。口噤眼合。面如土色。欲倒者。乃恶血冲心也。名曰血运。令人
持住。勿使卧下。即以热醋向鼻喷之。即醒。
产后恍惚谵语。舞手掉头。口流涎沫。少醒又发。有似败血冲心。其实因痰犯心胞络也
。盖败血冲心。昏迷不能少醒而痰犯心胞。但昏迷有时而醒觉耳。
产后发狂。跳跃罔顾羞耻。欲上屋者。非颠也。乃各经之血。一齐乘虚上升。迷其心窍
。而下部恶血又相奔腾。其势上而不下。故发狂跳跃。不能自禁也。
产后腹痛。不可尽作恶血不行。须看新久。若初产腹中有痛阵。如将产之状。腹皮又宽
软。
又若运转不宁。乃是双胎。若经一二日腹痛者。恶血停滞。而未尽去也。名曰儿枕块。若恶
血已收。而腹中如芒刺者。翕翕无力。乃空痛也。不可复以行血之剂治。惟养血而已。
产后腰痛。多是恶血停积于两肾空隙之处。其痛重急。不能转侧。得热物熨之则缓者是
也。若两肾疼痛翕翕然如不能呻气者。虚也。
产后下血不止者。看其血之红紫。紫为旧血。任其下。红为新血。宜止之再补。然紫者
既尽。必继之以红。红者既尽。必继之以淡。此必然之势也。宜斟酌治之。
产后疟疾。适值秋七八月间发者。方可以疟治。若春夏。及冬时而发者。非其时而有其
气。谓之非疟而似疟。必是产后风食所伤。气血两虚也。
产后伤寒。决不可用汗下之剂。以其气血俱虚。汗则亡阳。而伤气。下则亡阴而伤血
。若犯麻黄。大黄。多致不救。惟以和解为主治。而以血药佐之。
产后中风。危疾也。若外有六经之形症。内有便溺之阻塞。皆难治之症。唯口眼 斜者
无事
耳。若忽然角弓反张。目定项强者。必平素有痰。风邪乘虚而入。风痰交作壅塞经络。致使
荣卫不通。痰气上逆。似中而非中也。若又汗出不止或遗尿不禁。其死必矣。
产后泻痢甚者。死多生少。不甚犹可施治。然泻比于痢则痢为犹难而泻全在调理。大抵
泻者以补脾为主。而以消食药佐之。痢则以扶脾消食为主。而以血药佐之。
产后身热不止。口干烦渴。日晡尤甚者。血虚也。宜大补其血。不宜寒凉之剂。反佐以
温热。则热自除矣。
乍寒乍热。不可便作外感治。先审其乳房胀痛。乳汁行否。乳汁不行。发寒热者。气滞
也。
乳汁行过而发寒热者。必审其小腹痛否。痛若手不可近。必败血不散。入于肺则热。入于脾
则寒。腹不作痛。而发寒热者。实是气血虚。气虚则寒。血虚则热也。若心胸饱闷。发寒热
者。非饮食所伤。必切其脉。若浮数者。方是感冒寒热也。
四肢浮肿者。因败血停滞不行。流入四肢。日久化血为水。若作水气治。而用导水之剂
。则
虚而愈虚矣。或血停脾胃。必致腹胁胀闷。呕逆恶心。或血入肺经。必致面黑。欲喘欲死。或
血闷心窍。必致神志恍惚。语言不明。舌根强硬。
心痛。此因产后气虚。偶为外寒所侵。搏于血分。凝滞不得消散。其气逆上。冲击于心
经也。
遍身痛。腰背不得转侧。手足不能动摇。此败血流凝不散。以致腹痛。若饮食停滞者。
必恶
食吞酸。瘀血痛。必手不可按。虚寒痛。必四肢厥冷。小腹痛。瘀血不尽。大便不通枯涩。
因去血太多。大肠干涸。小便不通。因津液燥竭也。
喘有二。有气血暴绝。有瘀血凝滞。
咳嗽有血虚。有肺气虚。有风寒。有瘀血。
产门不闭。生肠不收。阴户及子宫脱下。皆由气血虚弱也。
After pregnancy and childbirth, the Zang-Fu organs are injured, and Qi and Blood accumulate and become disordered, leading to many diseases. This must be carefully examined. The conditions are listed below:
When a woman has just given birth, if she suddenly feels faint, with clenched jaws, closed eyes, and a sallow complexion resembling earth, appearing as if she is about to collapse, this is caused by Evil Blood rushing to the Heart. It is named "Blood Syncope" (Xue Yun). Hold the patient upright; do not let her lie down. Immediately spray hot vinegar into her nostrils, and she will awaken.
Postpartum mental confusion, delirium, waving hands, shaking the head, and drooling saliva, which recurs after brief periods of lucidity, resembles Evil Blood rushing to the Heart. However, it is actually due to Phlegm invading the Pericardium Collateral (Xin Bao Luo). This is because Evil Blood rushing to the Heart causes coma without brief lucidity, whereas Phlegm invading the Pericardium allows for intermittent awakening.
Postpartum mania, characterized by jumping around disregarding shame, even attempting to climb onto roofs, is not Epilepsy (Dian). It occurs when Blood from various meridians rises together due to deficiency, confusing the orifices of the Heart. Meanwhile, Evil Blood in the lower body surges violently, its momentum rising rather than descending, causing uncontrollable manic jumping.
Postpartum abdominal pain should not all be attributed to stagnation of Evil Blood. One must distinguish between recent and long-standing cases. If there are paroxysmal pains shortly after delivery, resembling labor pains, with a soft and loose abdominal wall, this may indicate twins. If abdominal pain persists for one or two days, it is due to stagnation of Evil Blood that has not yet been fully expelled, known as "Child's Pillow Mass" (Er Zhen Kuai). If the Evil Blood has been retracted but the abdomen feels like it contains thorns, accompanied by weakness and lack of strength, this is Empty Pain (Xu Tong). It should not be treated with blood-invigorating agents, but only with blood-nourishing methods.
Postpartum lower back pain is mostly caused by Evil Blood accumulating in the spaces between the two Kidneys. The pain is heavy and urgent, preventing turning or side-lying, and is relieved by applying heat. If the Kidney regions ache faintly, as if unable to sigh, this indicates Deficiency.
For postpartum continuous bleeding, observe the color of the blood. Purple indicates old blood, which should be allowed to discharge naturally. Red indicates new blood, which should be stopped and subsequently supplemented. Once the purple old blood is exhausted, red new blood will inevitably follow. Once the red blood is exhausted, pale blood will follow. This is an inevitable trend, and treatment should be adjusted accordingly.
Postpartum Malaria occurring in the seventh or eighth lunar months can be treated as Malaria. However, if it occurs in spring, summer, or winter, it is not the proper season for such symptoms, termed "Non-Malaria resembling Malaria." This is likely due to injury from Wind and Food retention following childbirth, resulting in dual deficiency of Qi and Blood.
Postpartum Cold Damage (Shang Han) must absolutely not be treated with sweating or purging agents. Since Qi and Blood are both deficient, sweating leads to loss of Yang and injury to Qi, while purging leads to loss of Yin and injury to Blood. Misuse of Ephedrae Herba (Mahuang) or Rheomi Radix et Rhizoma (Dahuang) often leads to untreatable conditions. Treatment should primarily focus on harmonizing, assisted by blood-tonifying herbs.
Postpartum Wind Stroke is a critical condition. If there are exterior manifestations of the Six Meridians combined with interior obstruction of urination and defecation, it is difficult to treat. Only facial paralysis (deviation of mouth and eyes) is manageable. If there is sudden opisthotonos, fixed gaze, and neck stiffness, it indicates pre-existing Phlegm. Wind Pathogen enters due to deficiency, causing Wind and Phlegm to interact and block the collaterals, obstructing Ying and Wei circulation. Phlegm-Qi rebels upward. It resembles stroke but is not true stroke. If accompanied by incessant sweating or incontinence of urine, death is certain.
Severe postpartum diarrhea and dysentery have high mortality. Mild cases are treatable. Dysentery is more difficult to treat than diarrhea, which relies mainly on regulation. Diarrhea is primarily treated by tonifying the Spleen, assisted by food-digesting herbs. Dysentery focuses on supporting the Spleen and digesting food, assisted by blood-modulating herbs.
Persistent postpartum fever with dry mouth and irritability, worsening in the afternoon (Shen hour), indicates Blood Deficiency. One should strongly tonify Blood. Cold-cooling agents should be avoided; instead, warm-hot herbs should be added as assistants, and the fever will resolve spontaneously.
Alternating chills and fever should not immediately be treated as Exterior Syndrome. First, examine whether the breasts are distended and painful, and whether lactation is flowing. If lactation is blocked and chills/fever occur, it is due to Qi Stagnation.
If chills/fever occur after lactation has flowed, examine whether there is lower abdominal pain. If the pain is severe and intolerable to touch, it is due to un-dispersed Evil Blood. Evil Blood entering the Lung causes fever; entering the Spleen causes chills. If there is no abdominal pain but chills/fever occur, it is truly Qi and Blood Deficiency. Qi deficiency causes chills; Blood deficiency causes fever. If chest fullness and oppression accompany chills/fever, it is not due to food injury. Pulse diagnosis is required; if the pulse is floating and rapid, it is indeed a Cold-Heat Exterior Syndrome.
Edema of the four limbs is caused by stagnant Evil Blood flowing into the limbs, transforming into fluid over time. Treating this as Water-Qi disease using diuretic agents will further deplete the already deficient body. If Blood stagnates in the Spleen and Stomach, it causes abdominal and hypochondriac distension, vomiting, and nausea. If Blood enters the Lung Meridian, it causes blackening of the face and severe asthma approaching death. If Blood blocks the Heart Orifices, it causes mental confusion, unclear speech, and a stiff tongue root.
Heart pain in this context is caused by Postpartum Qi Deficiency allowing external Cold to invade, binding with the Blood aspect, stagnating without dissipating. The rebellious Qi rushes upward, striking the Heart Meridian.
Generalized body pain, inability to turn the waist and back, and immobility of hands and feet are caused by stagnant and coagulated Evil Blood failing to disperse, leading to abdominal pain. If caused by food stagnation, there is aversion to food and acid regurgitation. If caused by Blood stasis, the area is tender to touch. If caused by Empty Cold, there is cold extremities. Lower abdominal pain with incomplete expulsion of Blood leads to dry, hard stools due to excessive blood loss drying the Large Intestine. Urinary obstruction is due to exhaustion of body fluids.
There are two types of panting/dyspnea: one due to sudden exhaustion of Qi and Blood, and the other due to Blood stasis stagnation.
Cough can result from Blood Deficiency, Lung Qi Deficiency, Wind-Cold, or Blood stasis.
Failure of the vaginal opening to close, prolapse of the rectum, and descent of the vagina and uterus are all caused by Qi and Blood deficiency.