干熟地黄 当归 独活 吴茱萸(汤) 干姜(炮) 芍药 桂心 甘草(炙) 小草(各一两)
细辛(半两)
上锉散。每服半两,用水三大盏,煎至一盏,去滓,微热服。
评曰∶产后心痛,虽非产蓐常病,庸或有之,九痛未必便是血痛,设是,岩蜜汤岂可用
熟地黄?熟地黄泥血,安能去痛?此方本出《千金》,用生干地黄耳。茱萸一升合准五两,干
姜三两,细辛治陈寒在下焦,方本一两,却减作半两,制奇制耦,量病浅深,自有品数,不
可妄意加减。然以岩蜜汤治血痛,不若失笑散用之有效。
治心腹痛欲死,百药不效,服此顿愈。
五灵脂 蒲黄(微炒,各等分)
上末。先用酽醋调二钱,熬成膏,入水一盏,煎七分,食前热服。
第十九论曰∶产后热闷气上,转为香港脚若何?答曰∶产卧血虚生热,复因春夏取凉过多
,地之蒸湿,因足履之,所以着而为香港脚,其状热闷掣 ,惊悸心烦,呕吐气上,皆其候也
,可服小续命汤两三剂必愈。若医者误以逐败血药攻之,则血去而疾益增剧。
小续命汤 方见中风门
评曰∶香港脚固是常病,未闻产后能转为者。往往读《千金》见有产妇多此疾之语,便出
是证,文辞害意,可慨见矣。设是热闷气上,如何令服续命汤?此药本主少阳经中风,非均
治诸经香港脚,要须根据香港脚方论阴阳经络调之。此涉专门,未易轻论,既非产后要病,更不繁引。
第二十论曰∶产后汗出多而变 者何,答曰,产后血虚,肉理不密,故多汗,因遇
风邪搏之,则变 也, 者,口噤不开,背强而直,如发痫状,摇头马鸣,身反折,
须臾十发,气息如绝,宜速斡口灌小续命汤,稍缓即汗出如雨,手拭不及者,不可治。
小续命汤 方见中风门
评曰∶产后汗出多变 ,亦令服续命汤,此又难信。既汗多,如何更服麻黄、官桂、防
己、黄芩辈,不若大豆紫汤为佳,《太医局方》大圣散亦良药也。
大豆紫汤 方见眩晕门
第二十一论曰∶产后所下过多,虚极生风若何?答曰∶妇人以荣血为主,因产血下太多
,气无所主,唇青肉冷,汗出,目暝神昏,命在须臾,此但虚极生风也,如此则急服济危上
丹。若以风药治之则误矣。
干熟地黄、当归、独活、吴茱萸(经汤洗)、干姜(炮制)、芍药、桂心、甘草(炙烤)、小草(以上各一两)
细辛(半两)
将上述药材切碎成散剂。每次服用半两,用三大盏水,煎煮至一盏水的量,滤去药渣,趁微温时服用。
评论说:产后心痛,虽然并非产褥期的常见病症,但偶尔也会有发生。九种疼痛未必就是血瘀引起的疼痛,假设是血痛,岩蜜汤怎么能使用熟地黄呢?熟地黄性质滋腻碍血,怎能起到止痛作用?此方原本出自《千金方》,使用的是生干地黄罢了。吴茱萸一升折算为五两,干姜三两,细辛用于治疗下焦的陈寒,原方用量为一两,这里却减少为半两。制定奇数或偶数的配伍比例,根据病情的深浅来衡量,自有其法度,不可随意妄加增减。然而用岩蜜汤治疗血瘀疼痛,不如使用失笑散那样有效。
治疗心腹剧烈疼痛欲死,各种药物无效,服用此方立刻痊愈。
五灵脂、蒲黄(微炒,各等分)
将上述药材研成粉末。先用浓醋调和二钱药粉,熬制成膏状,加入一盏水,煎煮至七分水量,饭前热服。
第十九篇论述说:产后因热闷气逆上冲,转变为香港脚(脚气病)该怎么办?回答说:产后卧床导致血虚而生内热,又因为春夏季节贪凉过多,地面的蒸腾湿气,通过足部接触侵入人体,所以附着而成为香港脚。其症状表现为热闷抽搐、惊悸心烦、呕吐气逆上冲,这些都是其征候,可以服用小续命汤两三剂必定痊愈。如果医生错误地使用逐除败血的药物来攻伐,那么血液耗损后疾病会更加加剧。
小续命汤 方剂见中风门
评论说:香港脚固然是常见病,但未听说产后能转变为香港脚的。往往有人读《千金方》看到有产妇多患此疾的说法,就得出这种证候的结论,这是文辞损害了医理,令人感慨。假设真是热闷气逆上冲,怎么会让患者服用续命汤呢?此药原本主治少阳经中风,并非普遍治疗各经香港脚,必须要依据香港脚方论中的阴阳经络理论来调理。这涉及专门领域,不容易轻易议论,既然不是产后的主要病症,就不再繁琐引用。
第二十篇论述说:产后出汗多而变为痉病(角弓反张、口噤不开等症)是怎么回事?回答说,产后血虚,腠理不致密,所以容易多汗,如果遇到风邪搏结,就会变成痉病。所谓痉病,是指口噤不能张开,背部僵硬挺直,像发作癫痫的样子,摇头马嘶鸣叫,身体向后反折,片刻之间发作十次,气息微弱如同断绝,应当迅速撬开嘴巴灌服小续命汤,如果稍微迟缓,就会汗出如雨,手擦拭不及者,就无法治愈了。
小续命汤 方剂见中风门
评论说:产后出汗多而变发为痉病,也让人服用续命汤,这又难以令人相信。既然已经汗出很多,怎么还要服用麻黄、官桂、防己、黄芩这类发散或苦寒的药物呢?不如使用大豆紫汤为佳,《太医局方》中的大圣散也是良药。
大豆紫汤 方剂见眩晕门
第二十一篇论述说:产后恶露排出过多,极度虚弱而生风该怎么办?回答说:妇女以营血为主,因为生产时血液流失太多,气无所依附,出现嘴唇青紫、肌肉冰冷、出汗、眼睛闭合神志昏迷,生命在顷刻间危殆,这只是因为极度虚弱而生风。遇到这种情况则应立即服用济危上丹。如果用治风的药物治疗则是错误的。
Dried Shu Di Huang (Rehmanniae Radix Praeparata), Dang Gui (Angelicae Sinensis Radix), Du Huo (Angelicae Pubescentis Radix), Wu Zhu Yu (Evodiae Fructus) (rinsed with water), Gan Jiang (Zingiberis Rhizoma Preparatum) (prepared by stir-frying), Shao Yao (Paeoniae Radix), Gui Xin (Cinnamomi Cortex), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) (prepared by honey-frying), Xiao Cao (Lycopii Herba) (each one tael).
Xi Xin (Asari Radix et Rhizoma) (half a tael).
Crush the above herbs into a coarse powder. For each dose, take half a tael, add three large bowls of water, and decoct until one bowl remains. Remove the dregs and take while slightly warm.
Comment: Postpartum heart pain is not a common disease of the lying-in period, though it may occasionally occur. The "Nine Kinds of Pain" are not necessarily blood stasis pain. If it were blood stasis pain, how could Yan Mi Tang use Shu Di Huang? Shu Di Huang is cloying and impedes blood circulation; how can it relieve pain? This formula originally comes from *Qian Jin Fang*, which uses Sheng Gan Di Huang (Dried Raw Rehmanniae Radix). One sheng of Wu Zhu Yu equals five taels; Gan Jiang is three taels; Xi Xin treats chronic cold in the lower jiao; the original formula dosage is one tael, but here it is reduced to half a tael. Formulating odd or even combinations depends on measuring the depth of the disease; there are inherent standards, and one must not arbitrarily add or subtract ingredients. However, using Yan Mi Tang to treat blood stasis pain is less effective than using Shi Xiao San.
Treats severe heart and abdominal pain that feels like death, unresponsive to various medicines; taking this formula brings immediate relief.
Wu Ling Zhi (Trogopteri Dung) and Pu Huang (Typhae Pollen) (lightly stir-fried, equal parts).
Grind into powder. First, mix two qian of powder with strong vinegar, boil into a paste, add one bowl of water, and decoct until seven-tenths remain. Take hot before meals.
Chapter 19 states: What if postpartum heat oppression and qi rebellion transform into Hong Jiao Jiao (Jiaqi/Foot Qi)? Answer: Postpartum bed rest causes blood deficiency generating internal heat. Combined with excessive cooling during spring and summer, and stepping on ground moisture causing dampness to invade via the feet, it attaches and becomes Hong Jiao Jiao. Symptoms include heat oppression, convulsions, palpitations, irritability, vomiting, and rebellious qi. These are its signs. Taking Xiao Xu Ming Tang for two to three doses will surely cure it. If physicians mistakenly use drugs to purge failed blood, the loss of blood will exacerbate the disease.
Xiao Xu Ming Tang see Stroke Chapter.
Comment: Hong Jiao Jiao is indeed a common disease, but it is unheard of for postpartum conditions to transform into it. Often, reading *Qian Jin Fang* reveals statements about many puerperal women suffering from this disease, leading to such diagnoses. This is where literary phrasing harms medical meaning, which is lamentable. If it were truly heat oppression and qi rebellion, why prescribe Xu Ming Tang? This medicine primarily treats Shaoyang channel wind-stroke, not all channels of Hong Jiao Jiao. One must regulate according to the yin-yang and meridians discussed in Hong Jiao Jiao formulas. This involves specialized knowledge and is not easy to discuss lightly. Since it is not a critical postpartum disease, further citation is omitted.
Chapter 20 states: Why does excessive sweating after childbirth lead to Jing Bing (Spasm/Opisthotonos)? Answer: Postpartum blood deficiency leads to loose interstices (cou li), causing excessive sweating. When attacked by wind pathogen, it transforms into Jing Bing. Jing Bing refers to locked jaw, stiff and straight back, resembling epilepsy, head shaking, horse-like neighing, body opisthotonos, occurring ten times in a short while, with breath nearly stopping. One must quickly pry open the mouth and administer Xiao Xu Ming Tang. If delayed, sweating will be profuse like rain, and if hands cannot keep up wiping it, it is incurable.
Xiao Xu Ming Tang see Stroke Chapter.
Comment: It is hard to believe that postpartum excessive sweating transforming into Jing Bing should be treated with Xu Ming Tang. Given the profuse sweating, how can one administer Ma Huang (Ephedrae Herba), Guan Gui (Cinnamomi Ramulus), Fang Ji (Stephaniae Tetrandrae Radix), Huang Qin (Scutellariae Radix) and similar dispersing or bitter-cold herbs? Da Dou Zi Tang (Purple Soybean Decoction) is better. Da Sheng San from *Tai Yi Ju Fang* is also a good medicine.
Da Dou Zi Tang see Vertigo Chapter.
Chapter 21 states: What if excessive lochia discharge leads to extreme deficiency generating wind? Answer: Women rely on Ying Blood. Excessive blood loss during childbirth leaves Qi without mastery. Symptoms include cyanotic lips, cold flesh, sweating, closed eyes, and coma, with life hanging in the balance. This is merely wind generated by extreme deficiency. In such cases, urgently administer Ji Wei Shang Dan. Treating with wind-dispelling drugs would be a mistake.