产后四肢浮肿者,败血乘虚停积,循经流入四肢,留淫日深,不能复还,腐坏如水,故令面黄,四肢浮肿。
医人不识,便作水气治之,多用导水之药,极能虚人,产后既虚,又以药虚之,是谓虚虚,多致夭枉。丹溪曰∶
产后肿,必用大补气血为主,少佐以苍术、茯苓使水自利。薛立斋曰∶前证若寒水侮土,宜养脾肺,若气虚浮
肿,宜益脾胃,若水气浮肿,宜补中气,当参杂证本门。
白术汤
治心腹坚大如盘,名曰气分。
枳实(一两半) 白术(三两)
上 咀,每服四钱,水一盏半,煎至七分,去滓温服,腹中软即愈。
干漆散
治产后遍身浮肿疼痛及产后血水诸证。
干漆 大麦 (等分)
上各为细末,以新瓦罐子中铺一重麦 ,一重干漆,填满用盐泥固济,火 通赤,放冷,研为细末,但是
产后诸疾,热酒调下二钱。
丹溪方
治产后浮肿,小便少、口渴、恶寒、无力、脉沉,此体虚而湿热,宜补中导水行气可也。
白术(二两半) 陈皮(一两) 川芎(半两) 木通(五钱) 茯苓(三钱)
上水煎,下与点丸二十五丸炒。按与点丸,用黄芩炒为末粥糊丸,亦名清金丸。
夺魂散
治产后虚肿喘促,利小便则愈。
生姜(三两,取汁) 白面(三两) 大半夏(七枚)
上用生姜汁和面,裹半夏为七饼子,煨焦熟为末,水调一盏,小便利为效。
加味八物汤
治产后遍身浮肿,气急潮热。
人参 白茯苓 熟地黄 小茴香(各三钱) 白术 川芎 当归 白芍 香附子(各五钱) 甘草
黄芩 柴胡(各一钱)
上 分五服,每服水一钟半,生姜三片,煎至七分,空心热服。若腹痛加延胡索、枳壳、倍芍药;呕吐恶
心加藿香、砂仁;咳嗽加五味子、款冬花。
加减济生肾气丸
治产后及一切脾胃虚损、腰重脚肿、小便不利,或肚腹膨胀、四肢浮肿,或喘急痰盛,已成蛊证,其效如神。
白茯苓(二两) 附子(半两) 车前子 山茱萸 川牛膝 肉桂(去皮) 泽泻 山药 牡丹皮(各一
两) 怀地黄(四两,酒拌蒸熟杵膏)
上为末,加蜜炼为丸,如梧桐子大,每服七八十丸,空心白汤下。
产后出现四肢浮肿的,是因为败血趁着虚损停滞积聚,顺着经络流入四肢,停留浸淫日久,无法回流消散,腐败变质如同水液一般,所以导致面色发黄,四肢浮肿。
医生如果不认识这种病机,就当作普通的水气病来治疗,大多使用通利导水的药物,这些药极其容易损伤人体正气。产妇本身已经虚弱,再用药物进一步耗损其正气,这就叫做“虚虚”(使虚者更虚),往往导致早逝或死亡。朱丹溪说:产后的浮肿,必须以大补气血作为主要治法,稍微佐以苍术、茯苓,使水湿自然通过小便排出。薛立斋说:前述证候如果是寒水反侮脾土,应当滋养脾肺;如果是气虚导致的浮肿,应当补益脾胃;如果是水气导致的浮肿,应当补益中气,具体应当参考杂病各门类的相关论述。
白术汤
治疗心腹部坚硬胀大如盘状,名为气分病。
枳实(一两半) 白术(三两)
将药材切碎,每次服用四钱,加水一盏半,煎煮至七分水量,滤去药渣,温服,腹部变软即为痊愈。
干漆散
治疗产后全身浮肿疼痛以及产后血水混杂的各种证候。
干漆 大麦 (等量)
将两味药分别研为细末,在新瓦罐中铺一层大麦,再铺一层干漆,填满后用盐泥密封加固,用火煅烧至通红,放凉后,研磨成细末,凡是产后各种疾病,用热酒调服二钱。
丹溪方
治疗产后浮肿,小便量少、口渴、恶寒、无力、脉沉,这是体质虚弱兼有湿热,适宜采用补中益气、通利水湿、行气的方法。
白术(二两半) 陈皮(一两) 川芎(半两) 木通(五钱) 茯苓(三钱)
用水煎煮,送服点丸二十五丸(炒制)。其中点丸,是用黄芩炒成粉末,用米粥糊制作成丸剂,也名叫清金丸。
夺魂散
治疗产后虚肿伴有气喘急促,小便通畅则痊愈。
生姜(三两,取汁) 白面(三两) 大半夏(七枚)
用生姜汁调和面粉,包裹半夏做成七个饼子,在火中煨烤至焦熟,研磨成粉末,用水调服一盏,以小便利为见效标志。
加味八物汤
治疗产后全身浮肿,气急、潮热。
人参 白茯苓 熟地黄 小茴香(各三钱) 白术 川芎 当归 白芍 香附子(各五钱) 甘草 黄芩 柴胡(各一钱)
将药材分为五服,每服用清水一钟半,生姜三片,煎煮至七分水量,空腹热服。如果腹痛,加入延胡索、枳壳,加倍使用白芍;如果呕吐恶心,加入藿香、砂仁;如果咳嗽,加入五味子、款冬花。
加减济生肾气丸
治疗产后及一切脾胃虚损、腰部沉重脚部浮肿、小便不利,或者肚腹膨胀、四肢浮肿,或者气喘急促痰多,已经形成蛊胀证的,效果神奇。
白茯苓(二两) 附子(半两) 车前子 山茱萸 川牛膝 肉桂(去皮) 泽泻 山药 牡丹皮(各一两) 怀地黄(四两,用酒拌蒸熟捣成膏)
将药材研为粉末,加入蜂蜜炼制成丸剂,大小如梧桐子,每次服用七八十丸,空腹用白开水送下。
Postpartum edema of the four limbs occurs when retained blood (retained blood) stagnates due to deficiency, flows along the meridians into the limbs, and remains there for a long time without returning. It decomposes like water, causing yellowish complexion and edema of the limbs.
If physicians fail to recognize this pathology and treat it as ordinary water qi disease (water retention), they often use diuretic drugs that severely weaken the body. Since postpartum women are already deficient, using such drugs further depletes their qi, which is termed "deficiency inducing deficiency" (making the deficient more deficient), often leading to premature death. Zhu Danxi stated: For postpartum edema, the primary treatment must be greatly tonifying qi and blood, with minor additions of Atractylodis Rhizoma (Cangzhu) and Poria (Fuling) to allow water to pass naturally through urination. Xue Lizhai stated: If the aforementioned syndrome involves cold water insulting the spleen earth, one should nourish the spleen and lungs; if it is edema due to qi deficiency, one should benefit the spleen and stomach; if it is edema due to water qi, one should tonify middle qi. Specific treatments should refer to the relevant sections in miscellaneous diseases.
Baizhu Tang (Atractylodes Decoction)
Treats hardness and distension in the heart and abdomen resembling a plate, named Qi Fen (Qi compartment).
Zhi Shi (Immature Bitter Orange, 1.5 liang) Baizhu (White Atractylodes Rhizome, 3 liang)
Crush the herbs. Take 4 qian per dose, add 1.5 zhan of water, decoct until 0.7 zhan remains, strain, and take warm. Recovery is indicated by softening of the abdomen.
Ganxi San (Dry Lacquer Powder)
Treats generalized edema and pain after childbirth, as well as various syndromes involving blood and water postpartum.
Ganxi (Dried Lacquer, equal amount) Damai (Great Barley, equal amount)
Grind each into fine powder. Layer barley and Ganxi alternately in a new clay pot, fill tightly, seal with salt mud, calcine over fire until red hot, cool, and grind into fine powder. For any postpartum disorder, mix 2 qian with hot wine and ingest.
Danxi Fang (Formula of Danxi)
Treats postpartum edema with scanty urine, thirst, aversion to cold, weakness, and deep pulse. This indicates constitutionally weak with damp-heat; the method should involve tonifying the middle, guiding out water, and moving qi.
Baizhu (White Atractylodes Rhizome, 2.5 liang) Chenpi (Aged Tangerine Peel, 1 liang) Chuanxiong (Sichuan Lovage Rhizome, 0.5 liang) Mutong (Akebia Stem, 5 qian) Fuling (Poria, 3 qian)
Decoct in water. Administer with Dian Wan (Point Pill) 25 pills (stir-fried). Dian Wan is made from stir-fried Scutellariae Radix (Huangqin) powder bound with rice paste, also known as Qingjin Wan (Clear Metal Pill).
Duohun San (Soul-Seizing Powder)
Treats postpartum deficiency edema with panting and urgency; recovery occurs when urination becomes smooth.
Shengjiang (Fresh Ginger Juice, 3 liang) Baifan (White Flour, 3 liang) Banxia (Pinellia Tuber, 7 large pieces)
Mix flour with ginger juice, wrap Banxia inside to form seven cakes. Roast until charred and cooked, grind into powder. Mix with water to drink one zhan. Effectiveness is confirmed by free urination.
Jiawei Bawu Tang (Modified Eight-Ingredient Decoction)
Treats postpartum generalized edema, rapid breathing, and tidal fever.
Renshen (Ginseng Root) Fuling (Poria) Shudihuang (Prepared Rehmannia Root) Xiaohuixiang (Fennel Fruit, 3 qian each) Baizhu (White Atractylodes Rhizome) Chuanxiong (Sichuan Lovage Rhizome) Danggui (Angelica Sinensis Root) Baishao (White Peony Root) Xiangfuzi (Cyperi Rhizome, 5 qian each) Gancao (Licorice Root) Huangqin (Scutellaria Root) Chaihu (Bupleurum Root, 1 qian each)
Divide into five doses. For each dose, add 1.5 zhong of water and three slices of fresh ginger. Decoct until 0.7 zhong remains. Take warm on an empty stomach. If abdominal pain occurs, add Yanshusuo (Corydalis Rhizome) and Zhike (Bitter Orange), and double the dosage of Baishao. If vomiting or nausea occurs, add Huoxiang (Patchouli) and Sharen (Amomum Fruit). If cough occurs, add Wuweizi (Schisandra Berry) and Kuandonghua (Farflo Flower).
Jiajian Jisheng Shenqi Wan (Modified Jisheng Kidney Qi Pill)
Treats postpartum conditions and all disorders of spleen-stomach deficiency damage, heavy waist and swollen legs, difficult urination, abdominal distension, edema of the four limbs, panting with profuse phlegm, or advanced Gu Zheng (abdominal swelling/ascites). The effect is miraculous.
Fuling (Poria, 2 liang) Fuzi (Prepared Aconite Root, 0.5 liang) Cheqianzi (Plantago Seed) Shanzhuyu (Cornus Fruit) Chuan Niuxi (Cyathula Root) Rougui (Cinnamon Bark, peeled) Zexie (Alisma Rhizome) Shanyao (Dioscorea Rhizome) Mudanpi (Moutan Cortex, 1 liang each) Huaidihuang (Rehmannia Root, 4 liang, steamed with wine and pounded into paste)
Grind into powder, add honey to refine into pills the size of paulownia seeds. Take 70–80 pills per dose on an empty stomach with plain boiled water.