妇人产后恶寒恶心,身体颤,发热作渴,人以为产后伤寒也,谁知是气血两虚,正不敌邪而然乎!大凡人之气
不虚,则邪断难入。产妇失血既多,则气必大虚,气虚则皮毛无卫,邪原易入,正不必户外之风来袭体也,即一举
一动,风即可乘虚而入之。然产后之妇,风易入而亦易出,凡有外邪之感,俱不必祛风,况产妇之恶寒者,寒由
内生也。发热者,热由内弱也;身颤者,颤由气虚也。治其内寒,而外寒自散;治其内弱,而外热自解;壮其元
阳,而身颤自除。
方用十全大补汤。
人参(三钱) 白术(三钱,土炒) 茯苓(三钱,去皮) 甘草(一钱,炙) 川芎(一钱,酒洗) 当归(三
钱,酒洗) 熟地(五钱,九蒸) 白芍(二钱,酒炒) 黄 (一两,生用) 肉桂(一钱,去粗,研)
水煎服。一剂而诸病悉愈。此方但补气与血之虚,而不去散风与邪之实,正以正足而邪自除也,况原无邪气
乎!所以奏功之捷也。
眉批∶宜连服数剂,不可只服一剂。
歌括∶产后恶寒身振颤,发热作渴是何缘。
气血两虚邪入侵,认作伤寒错决断。
十全大补参 草,术苓当归与白芍。
川芎肉桂熟地黄,连服数剂奏捷效。
妇人产后恶心欲吐,时而呕吐,人皆曰胃气之寒也,谁知是肾气之寒乎!夫胃为肾之关,胃之气寒,则胃气不
能行于肾之中;肾之气寒,则肾气亦不能行于胃之内,是肾与胃不可分而两之也。惟是产后失血过多,必致肾水干
涸,肾水涸应肾火上炎,当不至胃有寒冷之虞,何故肾寒而胃亦寒乎?盖新产之余,水乃遽然涸去,虚火尚不能
生,火既不生,而寒之象自现。治法宜补其肾中之火,然火无水济,则火在水上,未必不成火动阴虚之症,必须于
水中补火,肾中温胃,而后肾无太热之患,胃有既济之欢也。
方用温肾止呕汤。
熟地(五钱,九蒸) 巴戟(一两,盐水浸) 人参(三钱) 白术(一两,土炒) 山萸(五钱,蒸,去核) 炮
姜(一钱) 茯苓(二钱,去皮) 橘红(五分,姜汁洗) 白蔻(一粒,研)
水煎服。一剂而呕吐止,二剂而不再发,四剂而全愈矣。此方补肾之药,多于治胃之品,然而治肾仍是治胃
也。所以肾气升腾,而胃寒自解,不必用大热之剂,温胃而祛寒也。
眉批∶服此方必待恶露尽后,若初产一、二日之内恶心欲呕,乃恶露上冲,宜服加味生化汤∶全当归一两(酒
洗)、川芎二钱、炮姜一钱、东查炭二钱、桃仁一钱(研,用无灰黄酒一钟,水三钟同煎)。
歌括∶产后恶心呕吐现,胃气寒因肾气寒。
失血过多肾水涸,火既不生寒自现。
温肾止呕白术丸,巴戟山萸熟地团。
参苓炮姜橘白蔻,肾气升腾驱胃寒。
【产后恶寒身颤(第六十九首)】
妇女在分娩后出现怕冷、恶心、身体颤抖、发热并感到口渴,人们通常认为是产后感受了伤寒邪气,但这哪里知道是因为气血两虚,正气无法抵御邪气所导致的呢!大凡人的正气不虚,那么邪气就极难侵入。产妇因为失血过多,正气必然严重亏虚;正气虚弱则皮毛失去卫外功能,邪气原本就容易侵入,甚至不必是户外的风邪来袭扰身体,就是日常的一举一动,风邪也可以乘虚而入。然而对于产后的妇女来说,风邪容易侵入也容易被排出,凡是受到外邪感应的情况,都不必使用祛风的方法,更何况产妇的怕冷,寒气是由内部产生的。发热,是因为体内虚弱所致;身体颤抖,是因为气虚所致。治疗内部的寒邪,外部的寒冷自然消散;治疗内部的虚弱,外部的发热自然解除;补壮元阳,身体的颤抖自然消除。
方剂选用十全大补汤。
人参(三钱) 白术(三钱,土炒) 茯苓(三钱,去皮) 甘草(一钱,炙) 川芎(一钱,酒洗) 当归(三钱,酒洗) 熟地黄(五钱,九蒸) 白芍(二钱,酒炒) 黄芪(一两,生用) 肉桂(一钱,去粗皮,研碎)
用水煎服。服用一剂后各种病症全部痊愈。这个方子只补益气血的虚弱,而不发散风邪和实邪,正是因为正气充足而邪气自然被清除,况且原本就没有邪气存在!所以见效迅速。
眉批:应该连续服用几剂,不可只服用一剂。
歌诀:产后恶寒身体震颤,发热口渴是什么原因。气血两虚邪气入侵,误认为伤寒是错误的判断。十全大补汤含参草,白术茯苓当归与白芍。川芎肉桂熟地黄,连续服用几剂奏效快。
妇女在分娩后出现恶心想要呕吐,时而发生呕吐,人们都说这是胃气寒冷,但这哪里知道是肾气寒冷呢!胃是肾的关隘,胃的气寒冷,则胃气不能运行到肾中;肾的气寒冷,则肾气也不能运行到胃内,这说明肾与胃是不可分割且相互关联的。只是产后失血过多,必然导致肾水干涸,肾水干涸应当引起肾火上炎,按理说不应该有胃寒冷的担忧,为什么会出现肾寒而胃也寒的情况呢?大概是因为刚生产完毕,阴液突然枯竭,虚火还来不及产生,火既然没有产生,寒象自然就显现出来。治疗方法应当补益肾中的阳气(命门之火),然而如果火没有水的济助,则火在水上,未必不会形成火动阴虚的症状,必须在水中补火,使肾温暖胃,这样肾就不会有过热之患,胃也能得到既济(阴阳调和)的喜悦。
方剂选用温肾止呕汤。
熟地黄(五钱,九蒸) 巴戟天(一两,盐水浸泡) 人参(三钱) 白术(一两,土炒) 山茱萸(五钱,蒸,去核) 炮姜(一钱) 茯苓(二钱,去皮) 橘红(五分,姜汁洗) 白豆蔻(一粒,研碎)
用水煎服。服用一剂后呕吐停止,服用两剂后不再发作,服用四剂后完全痊愈。这个方子补肾的药物多于治胃的药,然而治肾也就是治胃。所以肾气升腾,胃寒自然解除,不必使用大热的药剂来温胃祛寒。
眉批:服用此方必须等到恶露排尽之后,如果在初产一两天之内出现恶心欲呕,那是恶露上冲所致,适宜服用加味生化汤:全当归一两(酒洗)、川芎二钱、炮姜一钱、东查炭二钱、桃仁一钱(研碎,用无灰黄酒一杯,水三杯同煎)。
歌诀:产后恶心呕吐出现,胃气寒因肾气寒。失血过多肾水干涸,火不生则寒象现。温肾止呕汤含白术丸,巴戟天山茱萸熟地黄团。人参茯苓炮姜橘皮白豆蔻,肾气升腾驱散胃寒。
[Postpartum Aversion to Cold and Trembling (Verse 69)]
When a woman experiences aversion to cold, nausea, trembling of the body, fever, and thirst after childbirth, people often attribute it to postpartum Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian). However, this is actually due to deficiency of both Qi and Blood, where the Healthy Qi (Zheng Qi) is insufficient to resist the pathogen. Generally, if a person's Qi is not deficient, pathogens find it extremely difficult to invade. Since a parturient has lost a significant amount of blood, her Qi must be severely deficient. When Qi is deficient, the skin and hair lose their defensive function (Wei Qi), making it easy for pathogens to enter; indeed, external wind does not necessarily need to attack from outside. Even during ordinary movements, wind can take advantage of the deficiency to enter. However, for postpartum women, although wind enters easily, it also exits easily. For any sensation of external pathogens, there is no need to use methods to dispel wind. Moreover, the aversion to cold in parturients arises from internal cold. The fever arises from internal weakness; the trembling arises from Qi deficiency. By treating the internal cold, the external cold will naturally dissipate; by treating the internal weakness, the external fever will naturally resolve; by strengthening the Primordial Yang, the bodily trembling will naturally cease.
The formula used is Shiquan Dabu Tang (Ten Significant Tonifying Decoction).
Ren Shen (Ginseng Radix et Rhizoma, 3 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 qian, stir-fried with soil), Fu Ling (Poria, 3 qian, peeled), Gan Cao (Licorice Root, 1 qian, honey-fried), Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 1 qian, washed with wine), Dang Gui (Angelica Sinensis Radix, 3 qian, washed with wine), Shu Di Huang (Rehmanniae Radix Praeparata, 5 qian, steamed nine times), Bai Shao (Paeoniae Radix Alba, 2 qian, stir-fried with wine), Huang Qi (Astragali Membranacei Radix, 1 liang, raw), Rou Gui (Cinnamomi Cortex, 1 qian, coarse bark removed, crushed).
Decoct in water and take orally. After one dose, all symptoms are cured. This formula only tonifies the deficiency of Qi and Blood without dispersing wind or eliminating excess pathogens, precisely because when Healthy Qi is sufficient, pathogens are naturally expelled. Furthermore, there were no pathogenic factors present originally! Hence, the rapid efficacy.
Marginal Note: It is advisable to take several doses consecutively, not just one.
Rhyme Verse: Postpartum aversion to cold and body trembling, what is the reason for fever and thirst? Deficiency of Qi and Blood allows pathogens to invade; mistaking this for Taiyang disease leads to wrong judgment. Shiquan Dabu contains Ren Shen and Gan Cao, along with Bai Zhu, Fu Ling, Dang Gui, and Bai Shao. Chuan Xiong, Rou Gui, and Shu Di Huang, taking several doses consecutively yields swift results.
[Postpartum Nausea and Vomiting (Verse 70)]
When a woman experiences nausea and the urge to vomit after childbirth, occasionally vomiting, people generally say it is due to Cold in the Stomach Qi. However, this is actually due to Cold in the Kidney Qi! The Stomach serves as the gate for the Kidneys. If the Stomach's Qi is cold, Stomach Qi cannot circulate into the Kidneys; if the Kidney's Qi is cold, Kidney Qi cannot circulate into the Stomach. Thus, the Kidneys and Stomach are inseparable and mutually related. Since postpartum blood loss is excessive, it inevitably leads to the drying up of Kidney Water. When Kidney Water is dry, it should cause Kidney Fire to flare upward, so there should theoretically be no concern about Cold in the Stomach. Why then do we see Cold in the Kidneys leading to Cold in the Stomach? It is because immediately after delivery, Yin fluids are suddenly depleted. At this stage, Deficient Fire has not yet generated; since Fire has not generated, the image of Cold naturally appears. The treatment method should tonify the Fire within the Kidneys (Mingmen Fire). However, if Fire exists without Water to balance it, Fire remains above Water, which may lead to symptoms of Fire stirring and Yin deficiency. Therefore, one must tonify Fire within Water, warming the Stomach via the Kidneys. In this way, the Kidneys will not suffer from excessive heat, and the Stomach will enjoy the harmony of Ji Ji (successful interaction between Water and Fire).
The formula used is Wen Shen Zhi Ou Tang (Warm the Kidneys and Stop Vomiting Decoction).
Shu Di Huang (Rehmanniae Radix Praeparata, 5 qian, steamed nine times), Ba Ji Tian (Morinda Officinalis Radix, 1 liang, soaked in salt water), Ren Shen (Ginseng Radix et Rhizoma, 3 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 liang, stir-fried with soil), Shan Yu Rou (Corni Fructus, 5 qian, steamed, pips removed), Pao Jiang (Zingiberis Rhizoma Preparatum, 1 qian), Fu Ling (Poria, 2 qian, peeled), Ju Hong (Citri Reticulatae Pericarpium Rubrum, 5 fen, washed with ginger juice), Bai Dou Kou (Amomi Fructus Rotundus, 1 grain, crushed).
Decoct in water and take orally. After one dose, vomiting stops; after two doses, it does not recur; after four doses, full recovery is achieved. This formula contains more herbs that tonify the Kidneys than those that treat the Stomach, yet treating the Kidneys is effectively treating the Stomach. Thus, as Kidney Qi rises, Stomach Cold resolves naturally, without needing strongly hot agents to warm the Stomach and dispel Cold.
Marginal Note: This formula should only be taken after the Lochia (postpartum discharge) has completely cleared. If nausea and the urge to vomit occur within the first one or two days after delivery, it is caused by Lochia rushing upward. In such cases, Jia Wei Sheng Hua Tang (Modified Birth-Generating Decoction) is appropriate: Quan Dang Gui (Angelica Sinensis Radix, 1 liang, washed with wine), Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 2 qian), Pao Jiang (Zingiberis Rhizoma Preparatum, 1 qian), Dong Cha Tan (Charred Tea Leaves, 2 qian), Tao Ren (Persicae Semen, 1 qian, crushed, decocted with one cup of unadulterated yellow rice wine and three cups of water).
Rhyme Verse: Postpartum nausea and vomiting appear; Stomach Cold stems from Kidney Cold. Excessive blood loss dries Kidney Water; without Fire generation, Cold manifests. Wen Shen Zhi Ou Tang includes Bai Zhu pills, Ba Ji Tian, Shan Yu Rou, and Shu Di Huang. Ren Shen, Fu Ling, Pao Jiang, Ju Hong, and Bai Dou Kou help Kidney Qi rise to drive away Stomach Cold.