产后大便不通,由去血过多,大肠干涸,或血虚火燥,以致秘涩,不可计其日期,及饮食数多,用药通之
润之,必待腹满觉胀,自欲去而不能者,乃结在直肠,宜用猪胆导之。若误以为有热,用苦寒之剂通之,反伤
中焦元气,或愈加难通,或通而泻不能止,必成败证。若属血虚火燥,用加味逍遥散,气血俱虚用八珍汤。一
产妇大便不通七日矣,饮食如常,腹中如故,用八珍汤加桃仁、杏仁,至二十一日腹满欲去,用猪胆汁润之,
先去干粪数块,后皆常粪而安。一产妇大便秘涩,诸药不应。苦不可言,令饮人乳而愈,牛乳亦可,大小便不
通者俱宜。陈无择曰∶产后不得利,利者百无一生,去血过多,脏燥,大便闭涩,宜用葱涎调腊茶为丸,复以
腊茶下之必通,大黄决不可用。
丹溪治产后秘结不通、膨满气急、坐卧俱难,用大麦 炒黄为末,酒下一合,神效,又麻子、苏子粥最为
稳妥,用紫苏子、火麻子二味各半合,洗净研极细,用水再研,取汁一盏,分二次煮粥啜下,此粥不惟产后可
服,大抵老人诸虚风秘,皆宜服之。有一媪年八十四,忽而腹痛、头疼、恶心、不食,召医数人,用补脾及清
利头目等,全不入食,此正是老人风秘,脏腑壅滞,聚于胸中,则腹胀恶心,上至于巅,则头痛神不清,令作
此粥,两啜而气泄,先下结粪,后渐得通利,不用药而自愈矣。
桃花散
治产后气滞血涩,大小便秘。
桃仁 葵子 滑石 槟榔(各等分)
上为细末,每服二钱,空心葱白汤调下。
产后大便不通,是由于失血过多,导致大肠干涸,或者是血虚火燥,致使大便秘结涩滞。这种情况不能单纯计算天数,也不能因为饮食较多就用药物强行通便或润肠。必须等到腹部胀满、自觉有便意但排不出时,这才说明粪便结在直肠,此时适宜使用猪胆汁进行导引通便。如果错误地认为是有热邪,使用苦寒性质的药物来通便,反而会损伤中焦的元气,导致更加难以排便,或者虽然通了但腹泻不止,最终必然演变成败证(危重难治之证)。如果是属于血虚火燥引起的,可以使用加味逍遥散;如果是气血都虚弱,则使用八珍汤。
有一位产妇大便不通已经七天了,饮食正常,腹部也没有不适感,医生给她服用八珍汤,并加入桃仁、杏仁。到了第二十天,她感到腹部胀满想要排便,于是用猪胆汁润肠导便,先排出几块干硬的粪便,随后大便恢复正常,身体也就安稳了。
还有一位产妇大便秘结涩滞,各种药物都不见效,痛苦不堪。医生让她喝人乳而痊愈,牛乳也可以,无论是大便还是小便不通,都适宜使用这种方法。陈无择说:产后不得随意使用泻下法,如果误用泻下药,患者百无一活。因为产后去血过多,脏腑干燥,大便闭涩,适宜用葱汁调和腊茶制成丸药,再用腊茶送服,必定能通畅,大黄绝对不可使用。
朱丹溪治疗产后秘结不通、腹部膨满气急、坐卧都困难的情况,使用大麦炒黄研成末,用酒送服一合,效果神奇。另外,麻子粥、苏子粥最为稳妥。取紫苏子、火麻子各半合,洗净后研磨得极细,再加水研磨,取汁一盏,分两次煮粥喝下。这种粥不仅产后可以服用,大致上老年人各种虚证引起的风秘,也都适宜服用。有一位八十四岁的老妇人,突然腹痛、头疼、恶心、不想吃东西,请了好几位医生,用了补脾和清利头目等药物,完全吃不下饭。这正是老人的风秘,脏腑壅滞,积聚在胸中,就会腹胀恶心,向上影响到头顶,就会头痛神志不清。让人制作这种粥,喝两碗后气机泄降,先排出结聚的粪便,随后逐渐通畅,没有用药而自愈了。
桃花散
治疗产后气滞血涩,大小便便秘。
桃仁 葵子 滑石 槟榔(各等分)
以上药材研成细末,每次服用二钱,空腹时用葱白汤调服。
Postpartum constipation is caused by excessive blood loss, leading to dryness of the Large Intestine (大肠), or by Blood Deficiency with Fire Dryness (血虚火燥), resulting in constipation and difficulty in defecation. One should not merely count the days, nor should one use laxatives or moistening agents simply because food intake has increased. It is necessary to wait until the abdomen feels full and distended, and there is an urge to defecate but it cannot be expelled; only then can it be determined that the stool is impacted in the rectum. In such cases, it is appropriate to use Pig Gallbladder Juice (猪胆) for enema-guided evacuation. If mistakenly treated as having Heat (热), using Bitter-Cold (苦寒) purgatives will instead damage the Yuan Qi (元气) of the Middle Jiao (中焦). This may lead to even greater difficulty in defecation, or if defecation occurs, diarrhea may become uncontrollable, inevitably progressing to a critical condition (败证). If the cause is Blood Deficiency with Fire Dryness, Jiawei Xiaoyao San (加味逍遥散, Modified Free and Easy Wanderer Powder) should be used; if both Qi and Blood are deficient, Bazhen Tang (八珍汤, Eight-Treasure Decoction) is indicated.
A postpartum woman suffered from constipation for seven days, yet her diet remained normal and she had no abdominal discomfort. She was administered Bazhen Tang (Eight-Treasure Decoction) supplemented with Tao Ren (Peach Kernel) and Xing Ren (Apricot Kernel). On the twenty-first day, she experienced abdominal fullness and an urge to defecate. A pig gallbladder juice enema was used to moisten the intestines. Several hard fecal masses were expelled first, after which normal bowel movements resumed, and she recovered.
Another postpartum woman suffered from severe constipation and dryness, to which various medications proved ineffective, causing unbearable suffering. The physician prescribed human milk, which cured her; cow's milk is also acceptable. This method is suitable for both urinary and fecal retention. Chen Wuyue stated: "After childbirth, purgatives must not be used lightly; if misused, mortality approaches 100%." Since excessive blood loss leads to dryness of the Zang-Fu organs and constipation, it is appropriate to mix scallion juice with aged tea (腊茶) to form pills, taken with aged tea decoction, which will ensure passage. Da Huang (Rhubarb Root) must absolutely not be used.
Zhu Danxi treated postpartum constipation accompanied by abdominal distension, shortness of breath, and inability to sit or lie comfortably, using roasted barley powder mixed with wine (one he), yielding miraculous results. Furthermore, Hemp Seed Porridge (麻子粥) and Perilla Seed Porridge (苏子粥) are particularly safe and effective. Take equal parts of Zi Su Zi (Perilla Fruit) and Huo Ma Zi (Hemp Seed), wash them, grind them into an extremely fine powder, add water, grind again, and extract one cup of juice. Use this juice to cook porridge and consume it in two doses. This porridge is not only suitable for postpartum women but also generally appropriate for elderly patients suffering from Wind Constipation (风秘) due to various deficiencies. An eighty-four-year-old woman suddenly suffered from abdominal pain, headache, nausea, and anorexia. Several physicians were consulted, and treatments involving Spleen tonification and clearing the head and eyes were attempted, but she could not tolerate any food. This was indeed Wind Constipation in the elderly, characterized by stagnation of the Zang-Fu organs accumulating in the chest, causing abdominal distension and nausea. When the stagnation rises to the vertex, it causes headache and mental cloudiness. The aforementioned porridge was prepared; after two servings, the stagnant Qi dissipated, impacted stool was passed first, followed by gradual normalization of bowel movements, and she recovered without further medication.
Taohua San (Peach Blossom Powder)
Indicated for postpartum Qi Stagnation and Blood Sluggishness, causing constipation of both large and small bowels.
Tao Ren (Peach Kernel), Kui Zi (Abelmoschus Seed), Hua Shi (Talcum), Bing Lang (Areca Seed) (in equal proportions).
Grind the above ingredients into a fine powder. Take two qian per dose, mixed with Scallion White Decoction on an empty stomach.