产后虚烦不止者,由阴气虚,阳无所附,阳气独发于外,故汗出也。阴气虚弱不复,故汗出不止。因之遇风则变成
痉。纵不成痉,亦虚乏短气,身体柴瘦,唇口干燥,久则经水短绝,由津液竭故也。薛立斋曰∶前证属血气俱虚,急用
十全大补汤。如不应,用参附、 附等汤,若汗多亡阳发痉,尤当用前药。
一产妇,略闻音响,其汗如水而昏愦,诸药到口即呕。余以为脾气虚败,用参附末为细丸,时含三五粒,随液咽下,
乃渐加之,至钱许,却服参附汤而痊。
一产妇,盗汗不止,遂至废寐,神思疲甚,口干引饮,余谓血虚有热,用当归补血汤以代茶,又以当归六黄汤内芩
连柏炒黑,倍人参五味子,二剂而愈。凡产后忽冒闷,汗出不识人,属大虚,宜固元气为主,其汗不止,必变柔痉。
麻黄根汤
治产后虚汗不止。
当归 黄 麻黄根 牡蛎( 成粉) 人参 粉草(各等分)
上水一盏,每服四钱,煎七分,温服。
经效方
治汗出不止。
黄芩(一钱半) 白术 牡蛎( ) 茯苓 防风 麦冬 生地(各八分) 大枣(七枚)
上用水二钟,煎至七分,空心温服。
止汗散
治产后盗汗不止,一应,汗多者皆可服。
牡蛎( 成粉) 小麦麸(炒黄,碾成粉)
上等分和匀,猪肉煮汤,调服二钱。
人参汤
治产后诸虚不足,发热、盗汗。
人参 当归(各等分)
上为末,以猪腰子一只,去脂膜,切小片子,水三钟,糯米半合,葱白两条,煮米熟,取清汁一盏,入药二钱,煎
至八分,温服,不拘时。
当归六黄汤
治虚热盗汗不止,不应,加人参,白术,不寐加酸枣仁。
当归 熟地 黄 (各二钱) 生地 黄柏(炒黑) 黄芩(炒黑) 黄连(炒黑。各一钱)
上水煎服。
参附汤
治阳气虚寒,自汗恶寒,或手足逆冷,大便自利,或脐腹疼痛,呃逆不食,或汗多发痉。
人参(一两) 附子(炮,五钱)
上作一服,姜枣煎,徐徐温服。
附汤
治阳气虚脱,恶寒自汗,或口噤痰涌,四肢逆冷,或吐泻腹痛,饮食不入,一切虚寒等证。
黄 (一两) 附子(炮,五钱)
上水一大碗,姜枣煎服,如不应,倍加附子,方得全济。
产后出现持续虚烦不安的症状,是由于阴气虚弱,阳气失去依附,导致阳气独自发散于体表,从而引起出汗。若阴气虚弱无法恢复,就会导致汗出不止。因此,如果此时感受风邪,就会转变为痉病(以项背强直、角弓反张为特征的疾病)。即使不发展为痉病,也会出现身体虚弱乏力、呼吸短促、形体消瘦干枯、嘴唇和口腔干燥等症状;日久则会导致月经量少甚至闭经,这是因为津液枯竭的缘故。薛立斋说:上述症状属于气血俱虚,应立即使用十全大补汤。如果无效,使用参附汤或附子等温阳药物;如果是因汗出过多导致亡阳并引发痉病,更应当使用前面的药物。
有一位产妇,稍微听到一点声响,就大汗淋漓如水,并且神志昏沉迷糊,各种药物入口即呕吐。我认为这是脾气虚败所致,于是将人参、附子研成细末制成小丸,让她每次含服三五粒,随唾液慢慢咽下,逐渐增加剂量,直到服用约一钱重量的药丸后,再改服参附汤而痊愈。
另一位产妇,夜间盗汗不止,导致无法入睡,精神极度疲乏,口干想喝水。我认为是血虚有热,便用当归补血汤代替茶饮,又用当归六黄汤,并将其中的黄芩、黄连、黄柏炒黑,加倍使用人参和五味子,服用两剂后痊愈。凡是产后突然发生晕厥闷乱、出汗且不认识人的情况,属于大虚证,应以固护元气为主;如果汗出不止,必然会演变为柔痉(以汗出、恶风、项强为特征的痉病)。
麻黄根汤
治疗产后虚汗不止。
药材包括:当归、黄芪、麻黄根、牡蛎(煅成粉)、人参、甘草(各等分)。
用法:用水一盏,每次服用四钱,煎至七分,温服。
经效方
治疗汗出不止。
药材包括:黄芩(一钱半)、白术、牡蛎(煅)、茯苓、防风、麦冬、生地(各八分)、大枣(七枚)。
用法:用水二钟,煎至七分,空腹时温服。
止汗散
治疗产后盗汗不止,以及一般汗多者皆可服用。
药材包括:牡蛎(煅成粉)、小麦麸(炒黄,碾成粉)。
用法:上等分和匀,用猪肉煮汤,调服二钱。
人参汤
治疗产后各种虚损不足,发热、盗汗。
药材包括:人参、当归(各等分)。
用法:研成末,取猪腰子一只,去除脂膜,切成小片,加水三钟,糯米半合,葱白两条,煮至米熟,取清汁一盏,加入药末二钱,煎至八分,温服,不拘时间。
当归六黄汤
治疗虚热导致的盗汗不止,如果效果不明显,加人参、白术;失眠加酸枣仁。
药材包括:当归、熟地黄(各二钱)、生地黄、黄柏(炒黑)、黄芩(炒黑)、黄连(炒黑,各一钱)。
用法:用水煎服。
参附汤
治疗阳气虚寒,自汗恶寒,或者手足逆冷,大便自利,或者脐腹疼痛,呃逆不食,或者汗多发痉。
药材包括:人参(一两)、附子(炮制,五钱)。
用法:作一服,加生姜、大枣煎煮,徐徐温服。
芪附汤
治疗阳气虚脱,恶寒自汗,或者口噤痰涌,四肢逆冷,或者吐泻腹痛,饮食不入,一切虚寒等证候。
药材包括:黄芪(一两)、附子(炮制,五钱)。
用法:用水一大碗,加生姜、大枣煎服,如果无效,加倍增加附子的用量,才能完全治愈。
Postpartum persistent deficiency-related restlessness is caused by the deficiency of Yin Qi, leaving Yang Qi without attachment. Consequently, Yang Qi alone disperses outward, resulting in sweating. If the deficiency of Yin Qi fails to recover, sweating will persist incessantly. Therefore, if exposed to wind pathogens during this state, it may transform into Jing disease (a condition characterized by stiffness of the neck and back, and opisthotonos). Even if Jing disease does not develop, the patient will suffer from physical weakness, shortness of breath, emaciation, dry lips and mouth; prolonged duration leads to scanty menstruation or amenorrhea due to the exhaustion of body fluids. Xue Lizhai stated: The aforementioned symptoms belong to a dual deficiency of Blood and Qi. One should urgently use Shiquan Dabu Tang (Ten Agents Great Tonifying Decoction). If there is no response, use Shenfu Tang (Ginseng and Aconite Decoction) or other warming Yang formulas. In cases where excessive sweating leads to the collapse of Yang and triggers Jing disease, the aforementioned medicines are even more indicated.
A postpartum woman, upon hearing slight noises, sweated profusely like water and became unconscious and confused. All administered medicines were vomited immediately upon ingestion. I diagnosed this as failure of Spleen Qi. I prepared fine pills made from Ginseng and Aconite powder, advising her to hold three to five pills in her mouth at a time and swallow them slowly with saliva. Gradually increasing the dose to approximately one qian, she subsequently took Shenfu Tang and recovered.
Another postpartum woman suffered from incessant night sweats, leading to insomnia and extreme mental fatigue, accompanied by dry mouth and thirst. I diagnosed this as Blood deficiency with internal heat. I prescribed Danggui Buxue Tang (Dong Quai Decoction for Replenishing Blood) to be taken as tea. Additionally, I used Danggui Liuhuang Tang (Dong Quai and Six Huangs Decoction), modifying it by stir-frying Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Phellodendri Cortex (Huangbai) until blackened, and doubling the dosage of Ginseng and Schisandrae Fructus (Wuweizi). She recovered after two doses. Generally, sudden fainting and confusion with sweating and loss of recognition in postpartum women indicate severe deficiency; the primary treatment should focus on consolidating Yuan Qi. If sweating persists, it must transform into Rou Jing (Soft Spasm, characterized by sweating, aversion to wind, and neck stiffness).
Mahuanggen Tang (Ephedrae Caulis Radix Decoction)
Treats persistent deficiency sweating after childbirth.
Ingredients: Angelicae Sinensis Radix (Danggui), Astragali Membranacei Radix (Huangqi), Ephedrae Caulis Radix (Mahuanggen), Ostreae Concha (Muli, calcined to powder), Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao) (equal parts).
Preparation: Use one cup of water. For each dose of four qian, decoct until seven-tenths remain. Take warm.
Jingxiao Fang (Effective Formula)
Treats incessant sweating.
Ingredients: Scutellariae Radix (Huangqin, 1.5 qian), Atractylodis Macrocephalae Rhizoma (Baizhu), Ostreae Concha (Muli, calcined), Poria (Fuling), Saposhnikoviae Radix (Fangfeng), Ophiopogonis Tuber (Maidong), Rehmanniae Radix (Shengdi) (each 0.8 fen), Ziziphi Jujubae Fructus (Dazao, 7 pieces).
Preparation: Use two zhong of water. Decoct until seven-tenths remain. Take warm on an empty stomach.
Zhihan San (Sweat-Stop Powder)
Treats persistent night sweats after childbirth; suitable for general cases of excessive sweating.
Ingredients: Ostreae Concha (Muli, calcined to powder), Triticum Vulgare Bran (Xiaomai Fu, stir-fried yellow, ground to powder).
Preparation: Mix equal parts evenly. Prepare soup with pork meat, mix with two qian of the powder, and take orally.
Renshen Tang (Ginseng Decoction)
Treats various deficiencies after childbirth, fever, and night sweats.
Ingredients: Ginseng Radix et Rhizoma (Renshen), Angelicae Sinensis Radix (Danggui) (equal parts).
Preparation: Grind into powder. Take one pig kidney, remove the fat membrane, slice thinly. Add three zhong of water, half he of glutinous rice, and two stalks of scallion white. Boil until the rice is cooked, strain to obtain one cup of clear juice. Add two qian of the medicine powder, decoct until eight-tenths remain. Take warm, at any time.
Danggui Liuhuang Tang (Dong Quai and Six Huangs Decoction)
Treats persistent night sweats due to deficiency-heat. If ineffective, add Ginseng and Atractylodes. For insomnia, add Ziziphi Spinosae Semen (Suanzaoren).
Ingredients: Angelicae Sinensis Radix (Danggui), Prepared Rehmanniae Radix (Shu Dihuang) (each 2 qian), Raw Rehmanniae Radix (Sheng Dihuang), Phellodendri Cortex (Huangbai, stir-fried black), Scutellariae Radix (Huangqin, stir-fried black), Coptidis Rhizoma (Huanglian, stir-fried black) (each 1 qian).
Preparation: Decoct in water and take.
Shenfu Tang (Ginseng and Aconite Decoction)
Treats deficiency-cold of Yang Qi, spontaneous sweating with aversion to cold, cold limbs, loose stools, umbilical or abdominal pain, hiccups and anorexia, or sweating leading to spasm.
Ingredients: Ginseng Radix et Rhizoma (Renshen, 1 liang), Prepared Aconiti Lateralis Radix (Fuzi, processed, 5 qian).
Preparation: Prepare as one dose. Decoct with ginger and jujube. Take warm slowly.
Qifu Tang (Astragalus and Aconite Decoction)
Treats collapse of Yang Qi, aversion to cold with spontaneous sweating, locked jaw with phlegm rushing, cold limbs, vomiting and diarrhea with abdominal pain, inability to eat, and all deficiency-cold syndromes.
Ingredients: Astragali Membranacei Radix (Huangqi, 1 liang), Prepared Aconiti Lateralis Radix (Fuzi, processed, 5 qian).
Preparation: Decoct in one large bowl of water with ginger and jujube. If there is no response, double the dosage of Fuzi to ensure complete recovery.