产前有病,以安胎为第一义,人尽知之。不知胎之所以不安者,病为之耳。病不去,则
胎不
安,虽日用安胎之药无效也。然则欲安胎者,必先审病之所由来而攻去之,病去胎安,其效
甚捷。并非安胎之药,却是安胎之方;竟有碍胎之味,反收安胎之功者,此岂肤浅者所能识
哉?即如浓朴、枳壳、半夏,皆为孕妇所忌。然湿满气逆者,舍此不为功。甚至大黄、芒硝
、枳实、干姜、桂、附,更非孕妇所宜,然热闭寒滞者,非此不能治。昔黄帝问于岐伯曰∶
妇人重身,毒之如何?岐伯对曰∶有故无殒,亦无殒也。大积大聚,其可犯也。衰其大半而
止。有故无殒者,言有病者无损乎胎也。亦无殒者,言于产母亦无损也。盖有病者病能当药
,药虽有毒,无损乎胎,亦无损于母。然必大积大聚,乃可投之,又宜得半而止,不宜过剂
,以伤其正气也。用药者奈何不师轩岐大法,而根据违顾忌,俟病日深,致不可救,以卒殒其
胎耶!
产后之有寒热,因于感冒风寒者十之二三,因于气血两虚,气虚则阳衰而外生寒,血虚
则阴
竭而内生热,寒热交作,虚风自动,而痉厥不止者十之七八。果系风寒外感,则必头疼脑胀
,项背牵强,畏风无汗,食物变味,当于四物汤中,量加荆、苏等味,以散寒祛风,不可重
剂表散。若系气血两虚,误认为风寒而表散之,未有不汗出心悸不寐,而病日益深者。盖汗
为心之液,心为血所生,汗愈出则血愈亏,心无血心养,安得不惊悸不寐乎?此百病之所以
丛生也。然则将奈何?曰∶恶露未清,腹中结痛,按之有块者,治宜去瘀生新,生化汤、佛
手散、加味芎归汤,其主方也。恶露既清,时寒时热,腹中安舒,口和知味,舌苔淡白,脉
象沉细,面白如纸,唇无血色,自汗盗汗,头晕耳鸣,心悸不寐,皆属虚象,非大补气血,
未易挽回。八珍汤、十全大补汤,加龙、蛎、枣、茯,其主方也。总之,瘀未净,则以行瘀
为主;瘀已净,则以补血为要。补血之方,必兼补气者,盖气为血之帅,古人谓治风先治血
,补血先补气,补血汤之所以重用黄 也。气行血行而瘀亦行,故虚体之行瘀,亦必先补气
血,丹溪为产后无得令虚,当大补气血为先。虽有杂症,以末治之。知其要矣。
炳按∶吴鞠通云∶老人、产后、小儿、虚人,如兵家无粮之师,利速战。然眼明手快,
谈何容易耶?
When a pregnant woman is ill, the primary principle is to stabilize the fetus; this is known to all. However, people do not realize that the reason for fetal instability is the disease itself. If the pathogenic factor is not eliminated, the fetus will remain unstable, and even daily use of fetal-stabilizing medicines will be ineffective. Therefore, those who wish to stabilize the fetus must first examine the origin of the disease and eliminate it. Once the disease is gone, the fetus becomes stable, with very rapid results. These are not merely "fetal-stabilizing" drugs, but rather formulas that stabilize the fetus; some substances considered harmful to the fetus may actually achieve the effect of stabilizing it. Can such insights be understood by those with superficial knowledge? For instance, Magnoliae Officinalis Cortex (Houpo), Aurantii Fructus Immaturus (Zhiqiao), and Pinelliae Rhizoma Preparatum (Banxia) are all contraindicated for pregnant women. Yet, for patients with dampness obstruction and rebellious Qi, there is no alternative but to use these herbs. Even more so, Radix Rhei Preparata (Dahuang), Natrii Sulfas (Mangxiao), Aurantii Fructus (Zhishi), Zingiberis Rhizoma (Ganjiang), Cinnamomi Ramulus (Guizhi), and Aconiti Lateralis Radix Praeparata (Fuzi) are generally unsuitable for pregnancy. However, for conditions involving heat closure and cold stagnation, treatment is impossible without them. In the past, the Yellow Emperor asked Qibo: "How should toxic medicines be used in pregnant women?" Qibo replied: "If there is a cause (pathology), there will be no destruction (to the mother or fetus)." Large accumulations and masses can be treated with aggressive methods. Stop when the pathology has diminished by more than half. "If there is a cause, there is no destruction" means that because there is an existing pathology, the medicine does not harm the fetus. "Nor is there destruction" means it does not harm the mother either. Generally, because there is pathology, the pathology absorbs the drug's force; although the drug may have toxicity, it does not damage the fetus nor the mother. However, these should only be administered for large accumulations and masses, and one should stop when half the effect is achieved, avoiding overdose which would damage healthy Qi. Why do practitioners not follow the great principles of Xuanyuan (Yellow Emperor) and Qibo, but instead hesitate due to fear of contraindications, waiting until the disease deepens beyond cure, ultimately resulting in fetal death!
Postpartum chills and fever occur in 20-30% of cases due to exogenous wind-cold invasion, and in 70-80% due to deficiency of both Qi and Blood. Qi deficiency leads to Yang decline and external cold; Blood deficiency leads to Yin exhaustion and internal heat. Alternating chills and fever, spontaneous movement of deficient Wind, and continuous spasms or convulsions characterize the latter group. If it is indeed exogenous wind-cold, symptoms must include headache, distending brain pain, stiffness in the neck and back, aversion to wind, absence of sweating, and altered taste perception. One should add Herba Schizonepetae (Jingshen) and Folium Perillae (Zisu) to Siwu Tang (Four Substances Decoction) in appropriate doses to dispel cold and expel wind, avoiding heavy diaphoretic agents. If it is Qi and Blood deficiency mistakenly diagnosed as wind-cold and treated with diaphoresis, the patient will inevitably suffer from sweating, palpitations, insomnia, and worsening condition. Sweat is the fluid of the Heart, and the Heart is generated by Blood. The more sweat is lost, the more Blood is depleted. Without sufficient Blood to nourish the Heart, how can one avoid palpitations and insomnia? This is why myriad diseases arise. So what should be done? If lochia is not clear, abdominal pain with palpable masses upon pressure, the treatment should focus on removing stasis and generating new blood. Shenghua Tang, Foshou San, and Jiawei Xionggui Tang are the principal formulas. Once lochia is cleared, and if the patient experiences alternating chills and fever, abdominal comfort, normal taste, pale white tongue coating, deep and fine pulse, pale face like paper, colorless lips, spontaneous and night sweats, dizziness, tinnitus, palpitations, and insomnia, these are all signs of deficiency. Without substantial tonification of Qi and Blood, recovery is difficult. Bazhen Tang (Eight Treasures Decoction) and Shiquan Dabu Tang (Ten Significant Tonifying Decoction), supplemented with Os Draconis (Longgu), Concha Ostreae (Muli), Jujubae Fructus (Dazao), and Poria (Fuling), are the principal formulas. In summary, if stasis remains, the priority is to move stasis; if stasis is cleared, the priority is to tonify Blood. Formulas for tonifying Blood must also tonify Qi, because Qi is the commander of Blood. Ancients stated: "To treat Wind, first treat Blood; to tonify Blood, first tonify Qi." This explains why Huangqi (Astragali Radix) is heavily used in Buxue Tang (Blood-Tonifying Decoction). When Qi moves, Blood moves, and stasis is resolved. Therefore, for deficient constitutions requiring stasis removal, one must first tonify Qi and Blood. Danxi argued that postpartum women should not be allowed to remain deficient; tonifying Qi and Blood should be the priority. Even if other complications exist, they should be treated secondarily. This grasps the essential principle.
Bing notes: Wu Jutong said: "The elderly, postpartum women, infants, and deficient persons are like an army without provisions; speed in battle is advantageous." However, having sharp eyes and quick hands—how easy is that to achieve?