川芎(一钱五分) 当归(三钱) 甘草 姜炭 羌活 防风(各四分) 桃仁(十粒) 服二帖。
如无块痛。去桃仁。若二帖后。头疼。身热不除。加白芷(八分) 细辛(二分) 若发热不止
。头疼如破。加莲须。葱头(五个) 若虚甚加人参(二三钱)
产后潮热。有汗。大便不通。毋专论为伤寒阳明症。口燥咽干而渴。毋专论为伤寒少阴症。
腹满。咽干。大便实。毋专论为伤寒太阴症。又汗出。谵语。便闭。毋专论为胃中燥屎宜下
。此数症多由劳倦伤脾。运化稽迟。气血枯竭。肠腑燥涸。乃虚症类实。当补之症。治者毋
执偏门。轻产后妄议三承气汤。以治类三阴症。间有少壮产妇。患此症而误下。幸而无妨。
若虚弱产妇。亦复误下。多致不救者。或因气血虚胀。误下反结。又有血少数日。大便不通
。误服攻下。而泄不止者。危哉。
(〔吴按〕六经病症当查究伤寒论。则表里分明。所以学人博览群书。一以贯之。)
人参(二钱五分) 当归(六钱) 炙草(五分) 桃仁(十五粒) 苁蓉(酒洗去甲) 麻仁(炒各
一钱) 陈皮(四分)
如汗多便实。加黄 。麻黄根。人参。(各一钱) 口燥渴。加麦冬。人参(各一钱) 腹满。
嗌干。便实。加麦冬(一钱) 枳壳(六分) 人参(二钱) 汗出。谵语。便实。乃气血并竭。
精神失守。宜养荣安神。加茯苓。枣仁。远志(各一钱) 人参。白术。(各二钱) 黄 。柏
子仁。(各一钱) 以上大便燥结症。非用芎、归、人参至数斤。难见全效。
大抵产后。虚中伤寒。口伤寒物。外症虽见。头痛。发热。或胁痛。腰疼。是外感。宜汗。
犹宜重产。亡血。禁汗。仲景伤寒论。亡血家禁汗。禁下。岂产后而可汗下乎。惟宜生化汤
量为加减。调理方谓无失。又如大便秘结。犹当重产亡血。禁下。长沙论伤寒之不可汗。不
可下者。非谓不当汗不当下。无奈脱血后。万万不敢耳。
Chuanxiong Rhizoma (1.5 qian), Danggui Radix (3 qian), Gancao Radix et Rhizoma, Jiangtan Charred Zingiberis Rhizoma, Qianghuo Notopterygii Rhizoma, Fangfeng Saposhnikoviae Radix (each 0.4 qian), Taoren Persicae Semen (10 grains). Take two doses.
If there is no pain from blood stasis masses, remove Taoren Persicae Semen. If after two doses, headache and body heat persist, add Baizhi Angelicae Dahuricae Radix (0.8 fen) and Xixin Asari Radix et Rhizoma (0.2 fen). If fever does not cease and headache is severe as if breaking, add Lianxu Nelumbinis Stamen and Congtou Allii Cepae Bulbus (five pieces). If deficiency is severe, add Renshen Ginseng Radix et Rhizoma (2-3 qian).
Postpartum tidal fever with sweating and constipation should not be exclusively diagnosed as Yangming disease (a syndrome caused by pathogenic factors affecting the Yangming meridians). Dry mouth, dry throat, and thirst should not be exclusively diagnosed as Shaoyin disease (a syndrome caused by pathogenic factors affecting the Shaoyin meridians). Abdominal fullness, dry throat, and solid stool should not be exclusively diagnosed as Taiyin disease (a syndrome caused by pathogenic factors affecting the Taiyin meridians). Sweating, delirium, and constipation should not be exclusively diagnosed as dry feces in the stomach requiring purgation. These symptoms are mostly caused by fatigue damaging the Spleen Qi, leading to sluggish transformation and transportation, depletion of Qi and Blood, and dryness of the Intestines. This is a deficiency syndrome presenting as excess, and treatment should employ tonification. Physicians must not adhere to biased approaches or lightly prescribe the Three Chengqi Decoctions (Tiaowei Chengqi Tang, Xiao Chengqi Tang, Da Chengqi Tang) for conditions resembling the Three Yin diseases. Occasionally, young and strong postpartum women who suffer from these symptoms and are mistakenly treated with purgatives may escape harm. However, if weak postpartum women are mistakenly treated with purgatives, it often leads to untreatable conditions. Some cases involve abdominal distension due to Qi and Blood deficiency, where mistaken purgation causes further stagnation; others involve scant blood and constipation over several days, where mistaken use of purgatives leads to unceasing diarrhea, which is critical.
([Wu's Note] The Six Meridian syndromes should be investigated through the Shanghan Lun so that exterior and interior distinctions are clear. Therefore, students who read extensively should be able to integrate knowledge comprehensively.)
Renshen Ginseng Radix et Rhizoma (2.5 qian), Danggui Radix (6 qian), Zhigancao Honey-fried Glycyrrhizae Radix et Rhizoma (0.5 fen), Taoren Persicae Semen (15 grains), Rongcong Cistanche Stem, Haren Hemp Seed (fried, each 1 qian), Chenpi Citri Reticulatae Pericarpium (0.4 qian).
If sweating is excessive and stool is solid, add Huangqi Astragali Radix, Mahuanggen Ephedrae Herba Caulis, and Renshen Ginseng Radix et Rhizoma (each 1 qian). Dry mouth and thirst, add Maidong Ophiopogonis Tuber and Renshen Ginseng Radix et Rhizoma (each 1 qian). Abdominal fullness, dry throat, and solid stool, add Maidong Ophiopogonis Tuber (1 qian), Zhike Aurantii Fructus (0.6 fen), and Renshen Ginseng Radix et Rhizoma (2 qian). Sweating, delirium, and solid stool indicate simultaneous depletion of Qi and Blood and loss of spiritual control; nourish Ying and calm the Spirit, add Fuling Poria, Zaoren Ziziphi Spinosae Semen, Yuanzhi Polygalae Radix (each 1 qian), Renshen Ginseng Radix et Rhizoma, Baizhu Atractylodis Macrocephalae Rhizoma (each 2 qian), Huangqi Astragali Radix, and Bairen Platycladi Semen (each 1 qian). For the above symptoms of dry and hard stool, unless Chuanxiong Rhizoma, Danggui Radix, and Renshen Ginseng Radix et Rhizoma are used in quantities reaching several jin, complete efficacy is difficult to achieve.
Generally, postpartum conditions involve deficiency complicated by cold damage. Patients dislike cold substances. Although external symptoms such as headache, fever, hypochondriac pain, or lower back pain appear indicating external contraction suitable for diaphoresis, one must still prioritize the postpartum state of blood loss and prohibit diaphoresis. Zhang Zhongjing stated in the Shanghan Lun that those with blood loss should not undergo diaphoresis or purgation; how much less should this apply to postpartum women? One should only adjust Shenghua Tang (Cinnamon Twig and Motherwort Decoction) according to circumstances for regulation to ensure no errors. Similarly, for severe constipation, one must emphasize postpartum blood loss and prohibit purgation. Zhang Zhongjing’s discussion on the prohibition of diaphoresis and purgation in cold damage does not mean that diaphoresis and purgation are never appropriate, but rather that after massive blood loss, they are absolutely contraindicated.