产后积聚瘕疝,多属气血为风冷所搏而成。积者,阴气也,五脏所生。聚者,阳气也,六腑所成。阴性沉伏,故痛
不离其部;阳性浮动,故痛无常处。瘕者,假也,谓其痛浮假成形,无定处也,皆由产后气血虚弱,风冷所乘,搏于脏
腑,与血气相结而成也,若不急治,多成积结,妨害月水。
有产妇腹中一物时痛不止,以为血瘕,用行血破气药,两胁肚腹尤甚,肢节间各结小核,隐于肉里,以为鳖子,治
亦不效。殊不知肝血而养诸筋,何处之骨不属于肾,何处之筋不属于肝,此肝血虚损,筋涸而挛结耳。养其脾土,补水
以滋肝血,则筋自舒,八珍汤、逍遥散、归脾汤加减治之。甚者,温补肾元,则真阳得而气行乃健,何有假物成形之患,
真阴得而血分不枯,自无筋挛、胁痛之虞矣。
产后呕吐,因饮食过多者,六君子加楂、曲。兼劳役者,补中汤。饮食停滞者,
人参养胃汤。脾胃气虚者,六君子,胃气虚寒者,加炮姜。煨木香。寒水侮土者,益黄
散。肝木侮土者,六君子加升柴。命门火衰,不能升土者,八味丸。呕吐泄泻,手足
俱冷,肚腹作痛者,乃阳气虚寒也,急用附子理中汤。
产后呃逆,属脾虚聚冷,胃中伏寒也。夫肺主气,五脏六腑俱禀之,产后气血并
伤,脏腑皆损,风冷搏于气,则气逆上,又脾虚聚冷,胃中伏寒,因食热物,冷热之气
相为冲击,使气逆不顺,则为呃逆,脾主中焦,为三焦之关,五脏之仓禀。若阴阳气
虚,使荣卫之气厥逆,致生斯病。《经》云∶呃,噫者,胃寒所生。然亦有中气大虚,下
焦阴火上冲而致者,当用桂、附、干姜之类。
产后出现积聚、瘕疝(腹内结块,推之可移或痛有定处),多属于气血被风冷邪气搏结而形成的。积证,属于阴气,由五脏产生;聚证,属于阳气,由六腑形成。阴性的病邪性质沉伏,所以疼痛部位固定不移;阳性的病邪性质浮动,所以疼痛没有固定位置。瘕证,意为假象,指其疼痛浮游不定、似有形质却无固定位置,这都是因为产后气血虚弱,风冷邪气乘虚而入,搏结于脏腑,与血气相互纠结而成的。如果不及时救治,多会形成积结,妨害月经来潮。
有一位产妇腹中有一物,时时疼痛不止,旁人以为是血瘕(瘀血凝结成的包块),使用行血破气的药物,结果两胁及肚腹疼痛更加严重,四肢关节间各结成小核,隐没在肌肉里面,以为是“鳖子”(一种寄生虫或病理产物),治疗也没有效果。殊不知肝主藏血并滋养全身筋脉,哪里的骨骼不属于肾所主?哪里的筋脉不属于肝所主?这是肝血虚损,导致筋脉干枯而挛缩结聚。应当补养脾土,滋补水液以滋生肝血,那么筋脉自然舒展。可用八珍汤、逍遥散、归脾汤加减治疗。病情严重的,温补肾元,使真阳得以恢复,气机运行强健,哪里还会有假物成形的祸患?真阴得以充盈,血分就不会枯竭,自然就没有筋脉挛缩、胁肋疼痛的忧虑了。
产后呕吐,如果是因饮食过多引起的,用六君子汤加山楂、神曲。兼有劳累过度损伤中气的,用补中益气汤。饮食停滞不化的,用人参养胃汤。脾胃气虚的,用六君子汤;胃气虚寒的,加炮姜、煨木香。寒水之气反侮脾土(肾寒犯脾)的,用益黄散。肝木之气反侮脾土(肝气犯脾)的,用六君子汤加升麻、柴胡。命门火衰,不能温煦脾土的,用八味丸(金匮肾气丸)。如果呕吐伴有泄泻,手足冰冷,肚腹作痛的,这是阳气虚寒的表现,急需使用附子理中汤。
产后呃逆(打嗝),属于脾虚导致寒气聚集,胃中有潜伏的寒邪。肺主一身之气,五脏六腑都禀受于肺气。产后气血同时受伤,脏腑皆受损,风冷邪气搏结于气机,导致气机上逆;再加上脾虚寒气聚集,胃中潜伏寒邪,此时若进食热物,冷热之气相互冲击,使得气机逆乱不顺,从而产生呃逆。脾居中焦,是三焦的关隘,也是五脏的营养仓库。如果阴阳之气虚弱,导致营卫之气厥逆,因而产生此病。《黄帝内经》说:“呃、噫,是胃寒所产生的。”然而也有因中气大虚,下焦阴火上冲而导致的情况,应当使用肉桂、附子、干姜之类的药物。
Postpartum accumulation (Ji, a fixed mass), gathering (Ju, a mobile mass), jia masses (soft, movable lumps), and hernias are mostly formed by the binding of Qi and Blood with Wind-Cold pathogens. The Ji syndrome belongs to Yin Qi and is generated by the Zang organs; the Ju syndrome belongs to Yang Qi and is formed by the Fu organs. Since Yin pathogens are deep and static, the pain remains in its specific location; since Yang pathogens are floating and dynamic, the pain has no fixed location. "Jia" implies falsity or illusion, referring to lumps that appear to have form but lack a fixed position, often associated with shifting pain. These conditions all arise from postpartum deficiency of Qi and Blood, allowing Wind-Cold to invade, bind within the Zang-Fu organs, and knot together with Qi and Blood. If not treated urgently, they tend to solidify into accumulations, obstructing menstruation.
There was a parturient who had a mass in her abdomen causing continuous intermittent pain. It was mistaken for a blood jia (blood stasis mass), and blood-invigorating and Qi-breaking herbs were administered. Consequently, pain in the hypochondrium and abdomen worsened, and small nodules formed in the joints, hidden within the muscles, which were erroneously identified as "turtle eggs" (parasitic larvae). Treatment proved ineffective. The practitioner failed to realize that the Liver stores Blood and nourishes the sinews; where is bone not governed by the Kidney? Where is a tendon not governed by the Liver? This case resulted from Liver Blood deficiency, leading to dryness and contraction of the sinews. By nourishing Spleen Earth and tonifying Water to generate Liver Blood, the sinews would naturally relax. Treatment should involve modifications of Bazhen Tang (Eight-Treasure Decoction), Xiaoyao San (Free and Easy Wanderer Powder), or Guipi Tang (Restore the Spleen Decoction). In severe cases, warming and tonifying the Kidney Yuan (Primordial Qi) allows True Yang to restore vigorous Qi movement, eliminating the risk of phantom masses forming; nourishing True Yin prevents depletion of the Blood aspect, thereby removing the danger of tendon contraction and hypochondriac pain.
Postpartum vomiting caused by excessive food intake is treated with Liujunzi Tang (Six-Gentleman Decoction) plus Shan Zha (Hawthorn Fruit) and Shen Qu (Medicated Leaven). When complicated by overexertion damaging the Middle Jiao, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used. For food stagnation, Renshen Yangwei Tang (Ginseng Stomach-Nourishing Decoction) is indicated. For Spleen and Stomach Qi deficiency, Liujunzi Tang is prescribed; for Stomach Qi deficiency with Cold, Pao Jiang (Prepared Ginger) and Wei Muxiang (Baked Aucklandiae Root) are added. When Cold Water insults Spleen Earth (Kidney Cold invading the Spleen), Yihuang San (Yellow-Protecting Powder) is used. When Liver Wood insults Spleen Earth (Liver Qi invading the Spleen), Sheng Ma (Cimicifugae Rhizome) and Chai Hu (Bupleuri Radix) are added to Liujunzi Tang. For Mingmen Fire (Gate of Life Fire) deficiency failing to warm Spleen Earth, Bawei Wan (Eight-Ingredient Pill) is employed. If vomiting is accompanied by diarrhea, cold extremities, and abdominal pain, this indicates Yang Qi deficiency and Cold; Fuzi Lizhong Tang (Aconite Regulate-the-Middle Decoction) must be used urgently.
Postpartum hiccups belong to Spleen deficiency with accumulated Cold and latent Cold in the Stomach. The Lung governs Qi, and all Zang-Fu organs receive their Qi from it. Postpartum injury to both Qi and Blood damages the Zang-Fu organs. When Wind-Cold binds with Qi, Qi rebels upward. Additionally, due to Spleen deficiency with Cold accumulation and latent Stomach Cold, if hot food is ingested, the conflict between Cold and Hot Qi causes rebellious and unsmooth Qi flow, resulting in hiccups. The Spleen resides in the Middle Jiao, serving as the gate of the Triple Burner and the granary of the Five Zang organs. If Yin and Yang Qi are deficient, causing rebellion of Ying and Wei (Nutritive and Defensive) Qi, this disease arises. The Classics state: "Hiccups and belching are generated by Stomach Cold." However, there are also cases caused by severe deficiency of Middle Qi, with Yin Fire from the Lower Jiao rushing upward; such cases require herbs like Rou Gui (Cinnamon Bark), Fu Zi (Aconite Lateral Root), and Gan Jiang (Dried Ginger).