潮热有汗,大便不通,毋专论为阳明症;口燥咽干而渴,毋专论为少阴症;腹满液干,大便实,毋专论为太阳症;
又汗出谵语便闭,毋专论为肠胃中燥粪宜下症。数症多由劳倦伤脾,运化稽迟,气血枯槁,肠腑燥涸,乃虚症类实,当
补之症,治者勿执偏门轻产,而妄议三承气汤,以治类三阴之症也。间有少壮产后妄下,幸而无妨;虚弱产妇亦复妄下,
多致不救。屡见妄下成膨,误导反结。又有血少,数日不通,而即下致泻不止者,危哉!《妇人良方》云∶产后大便秘,
若计其日期,饭食数多,即用药通之,祸在反掌。必待腹满觉胀,欲去不能者,反结在直肠,宜用猪胆汁润之。若日期
虽久,饮食如常,腹中如故,只用补剂而已。若服苦寒疏通,反伤中气、通而不止,或成痞满,误矣!
养正通幽汤 治产后大便秘结类伤寒三阴症。
川芎(二钱半) 当归(六钱) 炙草(五分) 桃仁(十五粒) 麻仁(二钱,炒) 肉苁蓉(酒洗去甲,一钱)
汗多便实,加黄 一钱,麻黄根一钱,人参二钱;口燥渴,加人参、麦冬各一钱;腹满溢便实,加麦冬一钱,枳壳
六分,人参二钱,苁蓉一钱;汗出谵语便实,乃气血虚竭,精神失守,宜养荣安神,加茯神、远志、苁蓉各一钱,人参、
白术各二钱,黄 、白芷各一钱,柏子仁一钱。
以上数等大便燥结症,非用当归、人参至斤数,难取功效。大抵产后虚中伤寒,口伤食物,外症虽见头痛发热,或
胁痛腰痛,是外感宜汗,犹当重产亡血禁汗。惟宜生化汤,量为加减,调理无失。又如大便秘结,犹当重产亡血禁下,
宜养正助血通滞,则稳当矣。
又润肠粥 治产后日久大便不通。
芝麻一升研末,和米二合,煮粥食,肠润即通。
歌括∶劳倦伤脾运化慢,气血枯槁肠腑干。
虚症类实宜用补,治者处方勿执偏。
养正通幽肠可润,川芎当归麻桃仁。
苁蓉炙草同煎服,汗多参 麻黄根。
产后大便久不通,润肠粥服最灵应。
芝麻一升研成末,和米煮粥树奇功。
Tidal fever with sweating and unsmooth defecation should not be exclusively diagnosed as Yangming disease; dry mouth and throat with thirst should not be exclusively diagnosed as Shaoyin disease; abdominal fullness, dried fluids, and solid stool should not be exclusively diagnosed as Taiyang disease (Note: In the context of "Three Yin diseases" and symptoms like abdominal fullness, this often refers to a misdiagnosis of Taoyin or Yangming excess, but here translated literally as Taiyang per source); sweating, delirium, and constipation should not be exclusively diagnosed as a syndrome of dry feces in the stomach and intestines suitable for purgation. These numerous symptoms mostly arise from fatigue damaging the Spleen Qi, leading to sluggish transformation and transportation, exhaustion of Qi and Blood, and drying up of the Intestines and Bowels. This is a deficiency syndrome presenting as an excess syndrome, requiring tonification. Physicians must not adhere to biased approaches and rashly prescribe San Chengqi Tang (Three Decoctions for Receiving Qi) to treat such conditions resembling Three Yin diseases. Occasionally, young and robust postpartum women subjected to erroneous purgation may escape harm; however, weak postpartum women subjected to erroneous purgation often become incurable. It is frequently seen that erroneous purgation leads to abdominal distension, and misleading treatments result in stagnation. Furthermore, due to blood deficiency, if one does not defecate for several days and immediately uses purgatives, it can cause incessant diarrhea, which is critical! *Furen Liangfang* states: For postpartum severe constipation, if one calculates the days and notes increased food intake, using medicine to promote bowel movement brings disaster in the blink of an eye. One must wait until there is abdominal fullness and a sensation of bloating, wanting to pass stool but unable to do so, indicating dry stool stuck in the rectum, in which case pig bile should be used to moisten the intestines. If the duration is long but diet is normal and the abdomen feels unchanged, only tonifying agents are needed. Using bitter-cold purgatives damages Middle Qi, causing unceasing discharge or forming epigastric fullness, which is an error!
Yangzheng Tongyou Tang (Nourish Righteousness and Unblock the Deep Decoction) treats postpartum severe constipation resembling Three Yin diseases of Cold Damage.
Chuanxiong Rhizome (2.5 qian) Angelicae Sinensis Radix (6 qian) Prepared Licorice Root (0.5 qian) Peach Kernel (15 grains) Hemp Seed (2 qian, stir-fried) Cistanche Stem (washed in wine to remove scales, 1 qian).
For excessive sweating and solid stool, add Astragali Radix (1 qian), Ephedrae Herba Root (1 qian), Ginseng Radix et Rhizoma (2 qian); for dry mouth and thirst, add Ginseng Radix et Rhizoma and Ophiopogonis Tuber (1 qian each); for abdominal fullness and solid stool, add Ophiopogonis Tuber (1 qian), Aurantii Fructus (0.6 fen), Ginseng Radix et Rhizoma (2 qian), Cistanche Stem (1 qian); for sweating, delirium, and solid stool, indicating exhaustion of Qi and Blood and loss of Spirit, nourish Blood, enrich Ying, and calm the Spirit by adding Poria (1 qian), Polygalae Radix (1 qian), Cistanche Stem (1 qian), Ginseng Radix et Rhizoma (2 qian), Atractylodis Macrocephalae Rhizoma (2 qian), Astragali Radix (1 qian), Angelicae Dahuricae Radix (1 qian), and Biota Seed (1 qian).
For the aforementioned types of dry stool constipation, it is difficult to achieve efficacy without using large doses (up to jin/liang) of Angelicae Sinensis Radix and Ginseng Radix et Rhizoma. Generally, postpartum weakness combined with cold invasion, or dietary injury, may present external symptoms such as headache, fever, hypochondriac pain, or lower back pain. Although these suggest exterior syndromes suitable for diaphoresis, one must strictly observe the contraindication of diaphoresis in postpartum blood loss. Only Shenghua Tang (Generate New Decoction) should be used with appropriate modifications for regulation without error. Similarly, for severe constipation, one must strictly observe the contraindication of purgation in postpartum blood loss. It is advisable to support Righteousness, assist Blood, and resolve stagnation, which ensures safety.
Also, Runchang Porridge (Moisten Intestines Porridge) treats postpartum prolonged constipation.
Sesame seed (1 sheng, ground into powder), mixed with Rice (2 he), cooked into porridge and eaten; when the intestines are moistened, passage becomes smooth.
Rhyme: Fatigue damages Spleen, transformation slows down; Qi and Blood exhaust, Intestines dry out.
Deficiency mimicking Excess requires tonification; physicians' prescriptions must not be biased.
Yangzheng Tongyou moistens the intestines; Chuanxiong, Danggui, Hemp Seed, and Peach Kernel join.
Cistanche and Prepared Licorice decoct together; for sweating, add Ginseng, Astragalus, and Ephedra Root.
Postpartum constipation lasting long; Runchang Porridge is most effective.
One sheng of sesame ground fine; mixed with rice, it performs miraculous work.