产后小腹痛,由恶露凝结,或外寒搏之久而不散,必成血瘕,月水不调。然有肾阳、肾阴不足者,并宜按脉别治。
儿枕痛者,儿在胎中,宿有血块,产时其血破败,与儿俱下,则无是患矣。若产妇脏腑风冷,则血凝小腹,结聚疼
痛,右曰儿枕痛,宜芎、归、益母、山楂、香附、陈皮,煎服。甚者加炒五灵脂,或六味加益母草、炒黑干姜,煎服尤
佳。凡儿在胎,食母之血,十月满足,余血成块,俗呼为儿HT 。有产时血块中动,败血裹其子,则令难产也。
有产妇小腹作痛,服行气破血药不效,其脉洪数,此瘀血内溃成脓也。是因营卫不调,瘀血停滞,宜急治之,缓则
腐化为脓,最难治疗。若流注关节,则患骨疽。失治多为败证,脉数而洪,已有脓,迟紧乃瘀血也,下之愈。若腹胀大,
转侧作水声,或脓从脐出,或从大便出,宜蜡矾丸、太乙膏,下脓而愈。
产后恶露方行,忽断绝不来,腰中重痛下注两股,痛如锥刺入骨,此血滞经络,不即通之,必作痈疽,宜桃仁汤、
五香连翘汤。
产后腰痛者,肾为胞胎所系,产则劳伤肾气,损动胞络,虚未平复,风冷客之,冷气乘腰,故令腰痛。或寒冷邪气
连滞背脊,痛久未已,后忽有娠,必致损动。盖胞络属肾,肾主腰故也。
产后胁痛,若肝经血瘀,玄胡索散;若肝经气虚,四君子加柴胡、薄、桂;若肝经血虚,四物加参、术、柴胡;若
月水不足下能生肝,六味丸;若肺金势盛,克制肝木,泻白散,然若不用姜、桂,辛温助脾肺,以行药力,不惟无以施
力,反助其胀矣。
产后小腹部疼痛,是由于恶露凝结,或者外感寒邪侵袭,日久不散,必然形成血瘕(体内形成的肿块),导致月经不调。然而也有因肾阳不足或肾阴不足引起的,应当通过诊脉来辨别并分别治疗。
所谓“儿枕痛”,是指胎儿在母体中时,宿存有血块,分娩时这些败血与胎儿一同排出,就不会有这种病患了。如果产妇脏腑受风冷侵袭,血液凝滞于小腹,结聚而疼痛,右侧称为儿枕痛,适宜用川芎、当归、益母草、山楂、香附、陈皮煎服。病情严重的可加入炒五灵脂,或者在六味地黄丸基础上加益母草、炒黑干姜煎服,效果更佳。凡是胎儿在胎中,摄取母体的血液,十月怀胎期满,剩余的血液结成块状,俗称“儿HT”(此处原文疑为“儿枕”之误或特定称谓)。如果在分娩时血块扰动,败血包裹住胎儿,就会导致难产。
有的产妇小腹部疼痛,服用行气破血的药物无效,其脉象洪大且数,这是瘀血在内溃烂成脓的表现。这是因为营卫不调,瘀血停滞所致,应当紧急治疗,若拖延则腐败化为脓液,最难治疗。如果脓毒流注到关节,就会患骨疽(骨骼部位的化脓性感染)。失治往往成为败证,脉象数而洪大说明已有脓液,脉象迟紧则是瘀血,使用攻下法可以痊愈。如果腹部胀大,转动身体时有水声,或者脓液从肚脐流出,或从大便排出,适宜服用蜡矾丸、外用太乙膏,排出脓液后即可痊愈。
产后恶露刚刚正常排出,忽然断绝不来,腰部沉重疼痛并向两腿放射,疼痛如锥刺入骨,这是血滞经络所致,如果不立即疏通,必然发生痈疽(体表化脓性感染),适宜用桃仁汤、五香连翘汤。
产后腰痛,是因为肾系连着胞胎,分娩时劳伤肾气,损伤胞络,虚损尚未平复,风冷之邪客居其中,冷气乘袭腰部,所以导致腰痛。或者是寒冷邪气连滞于背脊,疼痛长久不愈,后来再次怀孕,必然导致损伤。因为胞络属于肾,肾主司腰部,所以如此。
产后胁肋部疼痛,如果是肝经血瘀,用玄胡索散;如果是肝经气虚,用四君子汤加柴胡、薄荷、肉桂;如果是肝经血虚,用四物汤加人参、白术、柴胡;如果是月经量少导致不能滋养肝木,用六味地黄丸;如果是肺金之气过盛,克制肝木,用泻白散。但是如果不使用生姜、肉桂等辛温药物来辅助脾肺,以推动药力运行,不仅无法发挥药效,反而会增加胀满。
Postpartum lower abdominal pain is caused by the coagulation of lochia (postpartum uterine discharge) or invasion by external cold pathogens that persist for a long time, inevitably forming blood masses (blood stasis masses), leading to irregular menstruation. However, there are cases due to insufficiency of Kidney Yang or Kidney Yin; these should be differentiated and treated according to pulse diagnosis.
The so-called "child pillow pain" refers to the condition where, during fetal development, residual blood clumps exist in the womb. At delivery, if this degenerated blood is expelled along with the fetus, this ailment does not occur. If the mother's Zang-Fu organs are invaded by wind-cold, blood stagnates in the lower abdomen, condenses, and causes pain. Pain on the right side is called "child pillow pain." It is suitable to decoct and take Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Motherwort Herba (Yimucao), Hawthorn Fruit (Shanzha), Cyperi Rhizoma (Xiangfu), and Tangerine Peel (Chenpi). For severe cases, add Stir-fried Trogopterus Dung (Wulingzhi), or add Motherwort Herba (Yimucao) and Charred Dried Ginger (Ganjiang) to Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill); decocting and taking this is particularly effective. Whenever a fetus is in the womb, it feeds on maternal blood. After ten months of gestation, remaining blood forms clumps, commonly referred to as "child pillow" (Eren). If during delivery these blood clumps move restlessly, and degenerated blood wraps around the fetus, it causes difficult labor.
Some postpartum women experience lower abdominal pain that does not respond to Qi-moving and blood-breaking herbs. Their pulse is surging and rapid, indicating that stagnant blood has ulcerated internally into pus. This is due to disharmony of Ying and Wei (nutritive and defensive qi) and stagnation of blood. Urgent treatment is required; delay will lead to putrefaction into pus, which is extremely difficult to treat. If the toxin flows into the joints, bone abscesses may develop. Failure to treat properly often results in critical conditions. A rapid and surging pulse indicates existing pus, while a slow and tight pulse indicates blood stasis; purgative methods can bring about recovery. If the abdomen is distended and large, with sounds of fluid shifting when turning, or if pus discharges from the umbilicus or through the stool, Laifan Wan (Beeswax and Alum Pill) and Taiyi Gao (Taiyi Plaster) should be used to drain the pus, after which recovery ensues.
If postpartum lochia, having just flowed normally, suddenly stops, accompanied by heavy pain in the lower back radiating down both thighs, with pain piercing like an awl into the bone, this is blood stagnation in the meridians. If not unblocked immediately, carbuncles and sores (abscesses) will likely develop. Tao Ren Tang (Peach Kernel Decoction) and Wuxiang Lianqiao Tang (Five-Aromatic Forsythia Decoction) are indicated.
Postpartum low back pain occurs because the Kidneys connect to the Chong and Ren vessels (uterus). Childbirth exhausts Kidney Qi and damages the uterine collaterals. Before the deficiency recovers, wind-cold pathogens invade. Cold qi attacks the waist, causing pain. Alternatively, cold pathogenic factors may linger in the spine, causing chronic pain. Subsequent pregnancy would further damage these structures. Since the uterine collaterals belong to the Kidneys, and the Kidneys govern the waist, this pathology arises.
Postpartum hypochondriac pain: If due to blood stasis in the Liver Meridian, use Xuanhusuo San (Corydalis Powder); if due to Qi deficiency in the Liver Meridian, use Sijunzi Tang (Four Gentlemen Decoction) added with Bupleuri Radix (Chaihu), Menthae Haplocalycis Herba (Bohe), and Cinnamomi Ramulus (Guizhi); if due to Blood deficiency in the Liver Meridian, use Siwu Tang (Four Substance Decoction) added with Ginseng Radix (Renshen), Atractodis Macrocephalae Rhizoma (Baizhu), and Bupleuri Radix (Chaihu); if due to insufficient menstrual blood failing to nourish Liver Wood, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill); if Lung Metal energy is excessive and overacts on Liver Wood, use Xiebai San (Drain White Powder). However, without using pungent-warm herbs like Ginger Rhizome (Shengjiang) and Cinnamon Twig (Guizhi) to assist Spleen and Lung Qi and facilitate drug action, the medication will not exert its effect and may instead exacerbate distension.