产妇肠下,亦危症也,人以为儿门不关之故,谁知是气虚下陷而不能收乎!夫气虚下陷,自宜用升提之药,以
提其气。然新产之妇,恐有瘀血在腹,一旦提气,并瘀血升腾于上,则冲心之患,又恐变出非常,是气又不可竟提
也。气既不可竟提,而气又下陷,将用何法以治之哉?盖气之下陷者,因气之虚也,但补其气,则气旺而肠自升举
矣。惟是补气之药少,则气力薄而难以上升,必须以多为贵,则阳旺力强,断不能降而不升矣。
方用补气升肠饮。
人参(一两,去芦) 生黄 (一两) 当归(一两,酒洗) 白术(五钱,土炒) 川芎(三钱,酒洗) 升麻
(一分)
水煎服。一剂而肠升矣。此方纯于补气,全不去升肠,即如用升麻一分,亦不过引气而升耳。盖升麻之为
用,少则气升,多则血升也,不可不知。又方用蓖麻仁四十九粒捣涂顶心以提之,肠升即刻洗去,时久则恐吐血,
此亦升肠之一法也。
眉批∶生产有子未下肠先下者,名盘肠生。勿遽服此方,
急取一净盆,用开水洗热,将肠置于盆内,静待勿惧,子下后肠即徐徐收回。若时久,盆与肠俱冷,不能速收,急
用开水一盆待温,以入得手为度。将温水倾于置肠盆内,肠热气充,即可收起矣。若子先下,急服此方,少迟恐气脱不
救。
歌括∶产妇肠下亦危症,气虚下陷收不能。
升提之药宜慎用,补气气旺肠自升。
补气升肠饮川芎,当归一两酒洗用。
人参白术生黄 ,少佐升麻引气升。
产妇出现直肠脱垂(肠下),也是一种危急的病症。人们通常认为是产门未闭合的缘故,但谁知道这是因为气虚下陷而无法收摄呢!既然属于气虚下陷,自然应当使用具有升提作用的药物,来提升下陷之气。然而,刚分娩后的妇女,腹部恐怕仍有瘀血滞留,如果突然使用升提之法,可能会导致瘀血随气上逆冲心,从而引发严重的变证,因此气又不可以完全强行升提。既然气不能强行升提,而气又处于下陷状态,那么该用什么方法来治疗呢?大概气的下陷,是因为气的虚弱所致,只要补充其气,使气旺盛,直肠自然会自行升举复位。只是补气药物的剂量如果太少,则药力薄弱难以使气上升,必须以大剂量为贵,这样阳气旺盛、力量强劲,断然不会下降而只会上升了。
方剂用补气升肠饮。
人参(一两,去芦头) 生黄芪(一两) 当归(一两,酒洗) 白术(五钱,土炒) 川芎(三钱,酒洗) 升麻(一分)
水煎服。服用一剂后,直肠即可升举复位。此方纯粹在于补气,并没有直接针对升提直肠的药物,即使使用了少量升麻,也不过是作为引经药引导气机上升罢了。要知道升麻的作用,用量少时能升气,用量多时则能升血,这一点不可不知道。另一个方法是使用四十九粒蓖麻仁捣烂后涂抹在头顶百会穴处以起到提举作用,一旦直肠复位即刻洗去药膏,若停留时间过长,恐怕会导致吐血,这也是升提直肠的一种方法。
眉批:生产时有胎儿未娩出而直肠先脱出的情况,称为“盘肠生”。不要急于服用上述汤药,应迅速取一个干净的盆,用开水烫热,将脱出的直肠置于盆内,保持安静等待,不要恐惧。待胎儿娩出后,直肠便会徐徐收回体内。如果放置时间过久,盆与直肠都会变冷,就不能快速收回,此时应紧急准备一盆待温的开水,以手感觉适宜的温度为准。将温水倒入放置直肠的盆中,直肠受热后气机充盈,即可自行收起。若是胎儿已经先娩出,则应立即服用此方,稍迟恐因气脱而无法救治。
歌诀:产妇直肠脱垂也是危急症,气虚下陷导致无法收摄。
升提类药物应当谨慎使用,补益正气气旺则直肠自升。
补气升肠饮中含有川芎,当归一两需用酒洗。
人参、白术、生黄芪为主,少量佐以升麻引导气机上升。
Chorea recti prolapse (rectal prolapse) in postpartum women is also a critical condition. People generally attribute it to the failure of the vaginal opening to close, but who would know that this is actually due to Qi deficiency with sinking, resulting in an inability to retain? Since it is Qi deficiency with sinking, it is appropriate to use herbs with ascending properties to lift the Qi. However, in newly delivered women, there may be lochia stasis remaining in the abdomen. If one suddenly employs ascending methods, the stasis might rise along with the Qi and attack the Heart, leading to severe complications; therefore, Qi should not be forcibly lifted entirely. Since Qi cannot be forcibly lifted, yet it is sinking, what method should be used for treatment? Generally, the sinking of Qi is caused by Qi deficiency. By tonifying the Qi, making it robust, the rectum will naturally ascend and reduce on its own. The key is that if the dosage of Qi-tonifying herbs is too small, the therapeutic force will be weak and difficult to ascend; thus, large dosages are essential. When Yang Qi is abundant and strong, it certainly will not sink but will ascend.
The formula used is Buqi Shengchang Yin (Qi-Tonifying and Rectum-Lifting Decoction).
Ren Shen (Ginseng Radix et Rhizoma, 1 liang, remove rhizome), Sheng Huang Qi (Astragali Radix, 1 liang), Dang Gui (Angelicae Sinensis Radix, 1 liang, washed with wine), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 5 qian, stir-fried with soil), Chuan Xiong (Ligustici Chuanxiong Rhizoma, 3 qian, washed with wine), Sheng Ma (Cimicifugae Rhizoma, 1 fen).
Decoct in water and take orally. After one dose, the rectum will ascend. This formula focuses purely on tonifying Qi, without directly targeting the lifting of the rectum. Even the use of a small amount of Sheng Ma serves merely as a guiding herb to direct Qi upwards. It must be known that Sheng Ma, in small doses, ascends Qi, while in large doses, it ascends Blood; this distinction is crucial. Another method involves applying forty-nine crushed seeds of Ricinus Communis (Ricini Semen) to the Baihui acupoint (DU20) on the vertex to promote lifting. Once the rectum reduces, the paste must be washed off immediately; otherwise, prolonged contact may cause hematemesis. This is another method for reducing rectal prolapse.
Marginal Note: In cases where the rectum prolapses before the fetus is delivered, it is called "Pan Chang Sheng" (Coiled Intestine Birth). Do not hastily administer this decoction. Instead, quickly obtain a clean basin, rinse it with boiling water to heat it, place the prolapsed rectum inside, wait calmly without fear, and after the fetus is delivered, the rectum will slowly retract into the body. If left for too long, both the basin and the rectum will become cold, preventing rapid retraction. In such cases, urgently prepare a basin of warm water (comfortable to the touch). Pour the warm water into the basin containing the rectum; the heat will充盈 (fill) the area with Qi, allowing it to retract. If the fetus has already been delivered, administer this decoction immediately; any delay may result in Qi collapse that cannot be saved.
Song Verse:
Rectal prolapse in childbirth is also a critical condition,
Caused by Qi deficiency and sinking, unable to retain.
Ascending herbs should be used with caution,
Tonify Qi so that when Qi is robust, the rectum ascends naturally.
Buqi Shengchang Yin contains Chuan Xiong,
Dang Gui at 1 liang, washed with wine.
Ren Shen, Bai Zhu, and Sheng Huang Qi are primary,
With a small addition of Sheng Ma to guide Qi upward.