张仲景曰∶问,新产妇人有三病,一者病痉,二者病郁冒,三者大便难,何谓也?师曰∶新产血虚,多汗
出,喜中风,故令病痉。亡血复汗,寒多,故令郁冒。亡津液,胃燥,故大便难。
《千金方》曰∶妇人产后十二 病。带下无子,皆是风冷寒气,或产后未满百日,胞络恶血未尽,便利于悬
圊,及久坐寒湿入胞里,结在小腹,牢痛积聚,小如鸡子,大者如拳,按之跳手隐隐然,或如虫啮,或如针刺,
气时抢心,两胁支满,不能食,食饮不消。
《大全》曰∶产后十八证。一曰因热病胎死腹中。二曰难产。三曰胞衣不下。四曰血晕。五曰口干心闷。
六曰乍寒乍热。七曰虚痛。八曰乍见鬼神。九曰月内不语。十曰腹痛泄泻。十一曰遍身疼痛。十二曰血崩。十
三曰血气不通、咳嗽。十四曰寒热心痛、月候不来。十五曰腹胀满,呕逆。十六曰口鼻黑气及鼻衄。十七曰喉
中气喘急。(上二证俱不治。)十八曰中风。
张飞畴曰∶产后诸证,非行血则邪不去。即诸虚证,亦须血行,其气乃复。第行之有
方,不可过峻。凡产后危证,莫如三冲三急。三冲者,败血冲肺、冲心、冲胃也。三急者,新产之呕吐、泄泻、
多汗也。其用药则有三禁,禁佛手散,以川芎能发汗也;禁四物汤,以地黄能作泻也;禁小柴胡汤,以黄芩能阻
恶露也。然皆产后常法,没有风寒发热喘胀,下痢,危急证候,亦将守此,致令坐毙乎?古人未尝不用汗下,
不用寒凉。而暴病势紧,不得不猛治者,下手稍软,畏缩逡巡,去生便远。唯病气久衰者,非但不可峻攻,亦
不可峻补,必缓剂轻剂,以俟胃气之复耳。
Zhang Zhongjing said: "Inquiry: A woman who has just given birth suffers from three diseases: one is Jing (spasm and convulsion), the second is Yumao (dizziness, vertigo, and confusion of consciousness), and the third is difficulty in defecation. What does this mean?" The Master said: "After childbirth, blood deficiency occurs, accompanied by excessive sweating, making the body susceptible to wind pathogenic factors; thus, Jing (spasm and convulsion) arises. Loss of blood followed by sweating leads to an excess of cold; thus, Yumao (dizziness, vertigo, and confusion of consciousness) arises. Depletion of body fluids results in dryness of the Stomach; thus, difficulty in defecation arises."
Qianjin Fang states: "Twelve postpartum diseases in women. Leukorrhea and infertility are all caused by wind-cold pathogenic factors. If within one hundred days after childbirth, when lochia remains in the uterine collaterals and has not been fully expelled, the patient uses a high toilet (xuan qing), or sits for long periods allowing cold-dampness to enter the interior of the uterus, stagnation forms in the lower abdomen. This presents as firm, painful masses. Small masses are like chicken eggs, large ones like fists. Upon palpation, they throb faintly; the sensation may feel like insect bites or needle pricks. Qi occasionally rushes to the heart region, causing distension and fullness in both hypochondria, inability to eat, and indigestion."
Daquan states: "Eighteen postpartum syndromes. One: fetal death in the womb due to febrile disease. Two: difficult labor. Three: retention of the placenta. Four: blood syncope. Five: dry mouth and chest oppression. Six: alternating chills and fever. Seven: deficiency pain. Eight: hallucinations of seeing ghosts and spirits. Nine: muteness within the first month. Ten: abdominal pain with diarrhea. Eleven: generalized body pain. Twelve: metrorrhagia (profuse uterine bleeding). Thirteen: obstruction of blood and qi with cough. Fourteen: alternating chills and fever, heart pain, and amenorrhea. Fifteen: abdominal distension and fullness with vomiting and regurgitation. Sixteen: black aura around the mouth and nose, and epistaxis. Seventeen: wheezing and急促 breathing in the throat. (The last two syndromes are considered untreatable.) Eighteen: wind-stroke."
Zhang Feichou said: "For various postpartum syndromes, if blood circulation is not promoted, pathogenic factors will not be eliminated. Even in cases of various deficiency syndromes, blood must circulate for Qi to recover. However, promoting blood circulation must be done with proper method and should not be overly harsh. Among all postpartum critical conditions, none are more severe than 'Three Rushes' (San Chong) and 'Three Urgencies' (San Ji). The Three Rushes refer to敗血 (stagnant blood) rushing to the Lung, Heart, and Stomach. The Three Urgencies refer to vomiting, diarrhea, and excessive sweating immediately after childbirth. There are three prohibitions in medication: Banish Foshou San because Chuanxiong Radix (Chuanxiong) can induce sweating; banish Siwu Tang because Rehmanniae Radix Preparata (Shudi) can cause diarrhea; banish Xiaochaihu Tang because Scutellariae Radix (Huangqin) can obstruct the expulsion of lochia. However, these are merely standard methods for postpartum care. If there were no wind-cold, fever, wheezing, distension, dysentery, or other critical conditions, would one strictly adhere to these rules and sit waiting for death? Did ancients never use diaphoretic and purgative methods, nor cold-natured herbs? When acute diseases present with rapid progression, drastic treatment is necessary. If the physician hesitates, acts timidly, or delays, the patient's chance of survival diminishes. Only in cases where the pathogenic factor has been depleted over a long period should one avoid both drastic attack and drastic tonification; instead, mild and gentle formulas should be used to await the recovery of Stomach Qi."