产后治法,前人颇多,非如温病混入伤寒论
中,毫无尺度者也。奈前人亦不无间有偏见,且散见于诸书之中,今人读书不能搜求拣择,以致因陋
就简,相习成风。兹特指出路头,学人随其所指而进步焉,当不岐于路矣。本论不及备录,古法之阙
略者补之,偏胜者论之,流俗之坏乱者正之,治验之可者表之。
产后惊风之说,由来已久,方中行先生驳之最详,兹不复议。《金匮》谓新产妇人有三病∶一者病
痉,二者病郁冒,三者大便难。新产血虚,多汗出,喜中风,故令人病痉;亡血复汗,故令郁冒,亡津液
胃燥,故大便难。产妇郁冒,其脉微弱,呕不能食,大便反坚,但头汗出,所以然者,血虚而厥,厥而必
冒,冒家欲解,必大汗出,以血虚下厥,孤阳上出,故头汗出。所以产妇喜汗出者,亡阴血虚,阳气独
盛,故当汗出,阴阳乃复。大便坚,呕不能食,小柴胡汤主之。病解能食,七、八日复发热者,此为胃
实,大承气汤主之。按此论乃产后大势之全体也,而方则为汗出中风一偏之证而设。故沈目南谓仲
景本意,发明产后气血虽虚,然有实证,即当治实,不可顾虑其虚,反致病剧也。
按产后亦有不因中风,而本脏自病郁冒、痉厥、大便难三大证者。盖血虚则厥,阳孤则冒,液
短则大便难。冒者汗者,脉多洪大而芤;痉者厥者,脉则弦数,叶氏谓之肝风内动,余每用三甲复
脉,大小定风珠及专翕大生膏而愈(方法注论悉载下焦篇),浅深次第,临时斟酌。
The treatment principles for postpartum diseases have been discussed extensively by predecessors, unlike warm diseases which are mixed into the *Treatise on Cold Damage* (*Shanghan Lun*) without clear standards. However, predecessors' views also occasionally contained biases, and they were scattered among various books. Modern readers fail to collect and select carefully from their studies, resulting in adhering to outdated practices and taking shortcuts, which has become a custom. Here, I specifically point out the correct path; learners who follow this guidance will progress and not deviate from the right way. This treatise does not record everything; it supplements missing ancient methods, discusses biased ones, rectifies chaotic folk practices, and highlights effective clinical experiences.
The theory of "postpartum convulsions" (Jingfeng) has existed for a long time. Mr. Fang Zhongxing refuted it most thoroughly, so I will not discuss it further here. The *Jin Gui Yao Lue* states that new mothers suffer from three diseases: one is Jing disease (Spasm), characterized by stiffness of the neck and back and opisthotonos; two is Yumao (Depressed Dizziness/Vertigo), characterized by dizziness and blurred consciousness; and three is difficulty in defecation. After childbirth, blood deficiency leads to excessive sweating and susceptibility to wind pathogens, thus causing Spasm; loss of blood followed by sweating leads to Depressed Dizziness; depletion of body fluids and dryness of the stomach lead to difficulty in defecation. When a postpartum woman suffers from Depressed Dizziness, her pulse is weak and faint, she vomits and cannot eat, her stool becomes hard, and only her head sweats. The reason for this is that blood deficiency causes Qi rebellion upward (Jue), and Qi rebellion necessarily causes dizziness. For a patient with Depressed Dizziness to recover, there must be profuse sweating throughout the body. Because blood deficiency causes Yin collapse at the lower jiao, solitary Yang floats upward and outward, hence only the head sweats. Therefore, it is said that postpartum women tend to sweat because Yin blood is depleted and deficient, while Yang qi is relatively excessive; thus, sweating should occur to restore the balance of Yin and Yang. If the stool is hard, vomiting prevents eating, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary formula. If the illness resolves and appetite returns, but fever recurs after seven or eight days, this indicates excess heat in the stomach, and Da Cheng Qi Tang (Major Order the Qi Decoction) is the primary formula. According to this discussion, the general trend of postpartum diseases is comprehensively covered, while the formulas mentioned are designed for the specific syndrome of wind-strike following sweating. Therefore, Shen Munan stated that Zhang Zhongjing's original intent was to clarify that although postpartum Qi and Blood are deficient, if excess syndromes exist, they should be treated as excess; one should not hesitate due to deficiency, lest the condition worsen.
However, there are cases where postpartum women do not contract wind but suffer from the three major syndromes of Depressed Dizziness, Spasm/Jue, and difficulty in defecation due to internal organ dysfunction. Generally, blood deficiency leads to Qi rebellion (Jue), isolated Yang leads to dizziness (Yumao), and shortness of body fluids leads to difficulty in defecation. In cases of Depressed Dizziness and sweating, the pulse is often surging and hollow (Kou pulse); in cases of Spasm and Jue, the pulse is wiry and rapid. Ye Tianshi referred to this as "internal stirring of Liver Wind" (Ganfeng Neidong). I frequently cure these conditions using Sanjia Fumai Tang (Three-Shells Pulse-Restoring Decoction), Da Ding Feng Zhu (Great Wind-Calming Pearl) and Xiao Ding Feng Zhu (Small Wind-Calming Pearl), as well as Zhuanxi Dasheng Gao (Special Absorption Life-Nourishing Paste) (specific methods and notes are recorded in the Lower Jiao Chapter). The depth and sequence of treatment are adjusted according to the situation.