产后血大来,审血色之红紫,视形色之虚实。如血紫有块,乃当去其败血也,止留作痛,不可论崩。如鲜红之血,
乃是惊伤心不能生血,怒伤肝不能藏血,劳伤脾不能统血,俱不能归经耳,当以崩治,先服生化汤几帖,则行中自有补。
若形脱汗多气促,宜服倍参生化汤几帖以益气,非棕灰之可以止。如产后半月外崩,又宜升举大补汤治之,此症虚极,
服药平稳,未见速效,须二十帖后,诸症顿除。
生血止崩汤 治产后血崩。
川芎(一钱) 当归(四钱) 黑姜(四分) 炙草(五分) 桃仁(十粒) 荆芥(五分,炒黑) 乌梅(五分,
灰) 蒲黄(五分,炒)
枣,水煎。忌姜、椒、热物、生冷。
凡止崩用荆芥,俱宜炒黑。
鲜红血大来,荆芥穗炒黑、白芷各五分。血竭形败,加参三、四钱。汗多气促,亦加参三、四钱;无汗,形不
脱,气促,只服生化汤,多服则血自平。有言归、芎但能活血,甚误!
歌括∶产后血崩不归经,惊伤心而血不生,
怒伤肝而血不藏,劳伤脾而血不统。
生血止崩芎归姜,炙草桃仁炒蒲黄。
荆芥炒黑乌梅 ,枣水煎服获效良。
升举大补汤 滋荣益气。如有块动,只服前方, 、术勿用。
黄 白术 陈皮(各四分) 人参(二钱) 炙草 升麻(各四分) 当归 熟地(各二钱) 麦冬(一钱) 川
芎(一钱) 白芷(四分) 黄连(三分,炒) 荆芥穗(四分,炒黑)
汗多,加麻黄根一钱,浮麦炒一小撮;大便不通,加肉苁蓉一钱,禁用大黄。气滞,磨木香三分;痰,加贝母六分,
竹沥姜汁少许;寒嗽,加杏仁十粒,桔梗五分,知母一钱;惊,加枣仁、柏子仁各一钱;伤饭,加神曲、麦芽各一钱;
伤肉食,加山楂、砂仁各八分,俱加枣、水煎。身热不可加连、柏;伤食怒气,均不可专用耗散无补药。凡年老虚人患
崩,宜升举大补汤。
眉批,按症虚极,注中有“身热不可加连、柏”云云。后复神汤项下注,有宜用此汤“少佐黄连坠火”云云。设无
火可坠,此方内并无热药,无须反佐,恐黄连未可轻用,此处最宜详慎。又注中寒嗽、加有知母,既系寒嗽,知母亦未
可擅用。此条疑原刊“寒”字有误。
歌括∶产后半月发血崩,滋荣益气法最灵。
此症极虚难速效,二十帖后方见功。
升举大补术 参,炙草升芷当归陈。
熟地麦芎连芥穗,汗多宜加麻黄根。
产后恶露大量出血,需审视血液颜色的红紫,观察患者形色的虚实。如果血色紫暗且有血块,这是应当去除瘀败之血的情况,若将其当作崩漏来治疗导致疼痛,则不可取。如果是鲜红色的血,这是由于惊恐伤心导致不能生血,愤怒伤肝导致不能藏血,劳累伤脾导致不能统血,最终都导致血液不能回归经脉,应当按照崩漏治疗,先服用生化汤几剂,则在行血中自然包含补益的作用。
如果出现形体脱失、汗多、气短急促的症状,适宜服用加倍人参的生化汤几剂以益气,这不是棕榈灰这类药物可以止住的。如果在产后半个月以后发生崩漏,又适宜用升举大补汤治疗,这种病症虚损到了极点,服药后效果平稳,不会立即见效,必须服用二十剂之后,各种症状才能突然消除。
生血止崩汤:治疗产后血崩。
川芎(一钱) 当归(四钱) 黑姜(四分) 炙甘草(五分) 桃仁(十粒) 荆芥(五分,炒黑) 乌梅(五分,制成炭) 蒲黄(五分,炒)
加红枣,水煎服。忌食姜、花椒、热性食物及生冷食物。
凡是使用荆芥来止血崩,都适宜炒黑使用。
如果是鲜红色血液大量涌出,可用荆芥穗炒黑、白芷各五分。如果血竭且形体衰败,加入人参三至四钱。如果汗多气促,也加入人参三至四钱;如果没有汗,形体未脱,只是气促,只服用生化汤,多服几次血液自然平复。有人说当归、川芎只能活血,这是很大的错误!
歌诀:产后血崩血液不归经,惊恐伤心而血不生,
愤怒伤肝而血不藏,劳累伤脾而血不统。
生血止崩汤用川芎、当归、干姜,炙草、桃仁、炒蒲黄。
荆芥炒黑、乌梅炭,加枣水煎服疗效好。
升举大补汤:滋养营血,益气。如果有血块活动,只服用前面的方子,不要使用白术。
黄芪 白术 陈皮(各四分) 人参(二钱) 炙甘草 升麻(各四分) 当归 熟地黄(各二钱) 麦冬(一钱) 川芎(一钱) 白芷(四分) 黄连(三分,炒) 荆芥穗(四分,炒黑)
汗多,加麻黄根一钱,浮小麦炒一小撮;大便不通,加肉苁蓉一钱,禁用大黄。气滞,磨木香三分;有痰,加贝母六分,竹沥和姜汁少许;寒性咳嗽,加杏仁十粒,桔梗五分,知母一钱;受惊,加酸枣仁、柏子仁各一钱;饮食积滞于饭食,加神曲、麦芽各一钱;饮食积滞于肉食,加山楂、砂仁各八分,均加红枣、水煎服。身体发热不可加黄连、黄柏;因饮食积滞或怒气导致的病证,均不可专用耗散而无补益作用的药物。凡是年老体虚之人患崩漏,适宜用升举大补汤。
眉批按语:针对此症极度虚损,注文中有“身体发热不可加黄连、黄柏”的说法。在后文“复神汤”条目下的注文中,提到适宜用此汤“少佐黄连以坠火”。如果没有火可降,此方内并没有热药,不需要反佐,恐怕黄连不可轻易使用,此处最应详细审慎。另外注文中寒性咳嗽加了知母,既然是寒性咳嗽,知母也不可以擅自使用。这一条怀疑原刊本中的“寒”字有误。
歌诀:产后半月发血崩,滋养营血益气法最灵验。
此症极虚难以快速见效,服用二十剂后方见功效。
升举大补汤用白术、人参,炙草、升麻、白芷、当归、陈皮。
熟地、麦冬、川芎、黄连、荆芥穗,汗多适宜加麻黄根。
After childbirth, if there is heavy bleeding, one must examine whether the blood color is red or purplish, and observe the patient's physical constitution to determine deficiency or excess. If the blood is purplish with clots, it indicates the need to expel stagnant blood; treating this as metrorrhagia (abnormal uterine bleeding) would cause pain and is incorrect. If the blood is bright red, it results from fright injuring the Heart (Zang organ), preventing blood generation; anger injuring the Liver (Zang organ), preventing blood storage; or overwork injuring the Spleen (Zang organ), preventing blood control. In all these cases, the blood fails to return to its vessels. It should be treated as metrorrhagia. First, administer Shenghua Tang (Life-Birth Decoction) for a few doses, so that within the action of moving blood, tonification is naturally included.
If there is collapse of form, excessive sweating, and shortness of breath, it is appropriate to administer Shenghua Tang with doubled Ginseng for a few doses to benefit Qi. This cannot be stopped by Cinnabar Ash (Luzhu Hui). If metrorrhagia occurs more than half a month after childbirth, Shengju Dabu Tang (Ascending and Great Tonifying Decoction) should be used. This condition involves extreme deficiency; although the medication acts steadily, quick effects are not seen. Only after taking twenty doses will all symptoms suddenly disappear.
Shengxue Zhibeng Tang (Blood-Generating Metrorrhagia-Stopping Decoction): Treats postpartum metrorrhagia.
Chuanxiong Rhizome (1 qian) Angelicae Sinensis Radix (4 qian) Charred Ginger (4 fen) Honey-fried Licorice Root (5 fen) Peach Kernel (10 grains) Schizonepeta Spike (5 fen, stir-fried until black) Mume Fruit (5 fen, charred) Polygoni Orientalis Herba (5 fen, stir-fried)
Add Jujube, decoct in water. Avoid ginger, pepper, hot-natured foods, and raw/cold foods.
Whenever Schizonepeta Spike is used to stop metrorrhagia, it should preferably be stir-fried until black.
If bright red blood flows heavily, use stir-fried black Schizonepeta Spike Achenes and Angelica Dahurica Radix, each 5 fen. If blood is exhausted and the physical form is ruined, add Ginseng 3–4 qian. If there is excessive sweating and shortness of breath, also add Ginseng 3–4 qian; if there is no sweating, the form is not collapsed, but there is shortness of breath, only Shenghua Tang should be taken; taking it frequently will naturally calm the blood. Some say Angelicae Sinensis Radix and Chuanxiong Rhizome can only move blood, which is a great error!
Verse: Postpartum metrorrhagia, blood fails to return to its vessels;
Fright injures the Heart, so blood is not generated;
Anger injures the Liver, so blood is not stored;
Overwork injures the Spleen, so blood is not controlled.
Shengxue Zhibeng uses Chuanxiong, Danggui, Ganjiang, Honey-fried Licorice Root, Peach Kernels, and stir-fried Polygoni Orientalis Herba.
Stir-fried black Schizonepeta Spike, Charred Mume Fruit, added with Jujubes, decocted in water for good effect.
Shengju Dabu Tang (Ascending and Great Tonifying Decoction): Nourishes Ying (Nutritive) Qi and benefits Qi. If there are moving clots, only take the previous formula; do not use Atractylodis Macrocephalae Rhizoma.
Astragali Membranacei Radix (Huangqi) Atractylodis Macrocephalae Rhizoma (Baizhu) Citri Reticulatae Pericarpium (Chenpi, each 4 fen) Ginseng Radix et Rhizoma (2 qian) Honey-fried Licorice Root (Zhigancao) Cimicifugae Rhizoma (Shengma, each 4 fen) Angelicae Sinensis Radix (Danggui) Prepared Rehmanniae Radix (Shudihuang, each 2 qian) Ophiopogonis Radix (Maidong, 1 qian) Chuanxiong Rhizome (1 qian) Angelica Dahurica Radix (Baizhi, 4 fen) Coptidis Rhizoma (Huanglian, 3 fen, stir-fried) Stir-fried Black Schizonepeta Spike Achenes (Jingjie Sui, 4 fen)
For excessive sweating, add Ephedrae Radix et Rhizoma Root (Mahuang Gen) 1 qian, and stir-fried Floating Wheat (Fumai) a small pinch; for constipation, add Cistanche Deserticola (Roucongrong) 1 qian, strictly avoid Rheum Palmatum Radix et Rhizoma (Dahuang). For Qi stagnation, grind Muskostelea Fructus (Muxiang) 3 fen; for Phlegm, add Fritillariae Thunbergii Bulbus (Beimu) 6 fen, and a little Bamboo Sap (Zhuli) and Ginger Juice (Jiangzhi); for cold cough, add Prunus Armeniaca Semen (Xingren) 10 grains, Platycodonis Radix (Jiegeng) 5 fen, and Anemarrhenae Rhizoma (Zhimu) 1 qian; for fright, add Ziziphus Jujuba Seed (Zaoren) and Biota Orientalis Seed (Baiziren), each 1 qian; for rice food retention, add Massae Fermentata Medicinalis (Shenqu) and Hordeum Vulgare Sprout (Maiya), each 1 qian; for meat food retention, add Crataegi Fructus (Shanzha) and Amomi Fructus Rotundus (Sharen), each 8 fen. All are decocted with Jujubes and water. If the body is hot, do not add Coptidis Rhizoma (Huanglian) and Phellodendri Chinensis Cortex (Huangbai); for conditions caused by food retention or anger, do not exclusively use dispersing herbs without tonifying properties. For elderly patients with deficiency suffering from metrorrhagia, Shengju Dabu Tang is appropriate.
Marginal Note: Regarding this condition of extreme deficiency, the annotation states "do not add Huanglian and Huangbai if the body is hot." Later, under the entry for Fushen Tang, the note mentions it is appropriate to use this decoction with "a small amount of Huanglian to descend fire." If there is no fire to descend, and this formula contains no heat-inducing herbs, there is no need for counter-assistance; thus, Huanglian should probably not be used lightly. This part requires careful consideration. Additionally, the annotation adds Zhimu for cold coughs; since it is a cold cough, Zhimu should not be used arbitrarily. It is suspected that the character "cold" (Han) in the original printed text may be an error.
Verse: Postpartum metrorrhagia occurring half a month later, the method of nourishing Ying and benefiting Qi is most effective.
This condition is extremely deficient and difficult to cure quickly; efficacy is seen only after twenty doses.
Shengju Dabu Tang uses Baizhu and Renshen, Zhigancao, Shengma, Baizhi, Danggui, and Chenpi.
Shudihuang, Maidong, Chuanxiong, Huanglian, Jingjie Sui; for excessive sweating, Mahuang Gen is suitable.