产后血崩者,因所下过多,血气大虚,未得平复,或因劳役,或因惊恐而致也。宜
补心脾以统之。若小腹满痛不已,为脉实大紧数者,此肝阴已竭,肝气随败矣,难治。
若小腹胀满,按之而痛者,此内有瘀血,未可遽止,否则必致淋漓。
产后便难者,由肠胃无血也。大肠为传导之官,变化出焉。产后津液耗损,胃中枯
燥,而精微不及下输,是以糟粕壅滞,故令便难,由气血过多,内亡津液也,然大肠主
津,小肠主液,其大肠小肠,更必受胃之阳气,乃能行津液于上焦,今产后大虚,胃中
原气已亏,二肠津液并损,故便难者,此其
宜也,惟宜调中养血,切不可单用麻仁、枳壳,徒耗肠胃中生养之气也。
产后小便淋秘之证,《三因》云∶产前当安胎,产后当去血,此二语最为吃紧。如
产前淋,或由气虚不化,当用参 补气安
胎,不可过用渗利。产后淋,或由污血阻滞,当以瞿麦、蒲黄为要药。若血虚热郁,
当用六味丸、逍遥散补阴养血,滋其化源,佐以导血药可也。更有收生不谨,以致损胞
而得淋沥者。丹溪曰∶有徐氏妇壮年患此。因思肌肉破伤,在外者且可补完,虽在内恐亦可
治,诊其脉虚甚,因悟凡难产之人,多是气虚,既产之后,血气尤虚,应用峻补,以参术膏煎,
以猪羊胞汤,极饥时饮之,一月而安,令气血骤长,其胞可完,稍缓亦难成功也。
产后血崩,是因为阴道出血量过多,导致气血严重亏虚,身体尚未恢复平静,又因过度劳累或受到惊恐刺激而引发。治疗应当补益心脾以统摄血液。如果小腹部胀满疼痛持续不止,且脉象表现为实、大、紧、数,这是肝阴已经枯竭,肝气随之败坏的表现,属于难治之症。如果小腹胀满,按压时感到疼痛,这是体内有瘀血阻滞,此时不可急于止血,否则必然会导致淋漓不尽的出血。
产后大便困难,是由于肠道缺乏血液濡养所致。大肠是负责传导糟粕的器官,负责排出变化后的废物。产后津液耗损,胃中干燥,精微物质无法向下输送,因此糟粕壅滞,导致大便困难。这是因为气血大量流失,体内津液亡失的缘故。然而,大肠主司津液,小肠主司液体,大肠和小肠必须依赖胃的阳气,才能将津液输布至上焦。现在产后身体极度虚弱,胃中原有的元气已经亏损,大肠和小肠的津液同时受损,所以出现大便困难是必然的。治疗只宜调理中焦、养血润燥,切不可单独使用火麻仁、枳壳等药物,以免徒然耗伤肠胃中正在生长的正气。
产后小便淋沥闭塞的病证,《三因极一病证方论》中说:产前应当安胎,产后应当祛除瘀血,这两句话最为关键。如果是产前出现淋证,可能由于气虚不能气化水液,应当用人参补气以安胎,不可过度使用渗湿利水的药物。产后出现淋证,可能由于污血阻滞尿道,应当以瞿麦、蒲黄为主要药物。如果是血虚伴有热郁,应当使用六味地黄丸、逍遥散来补阴养血,滋养化生之源,并辅以引导瘀血排出的药物即可。更有因为接生不慎,导致胞宫受损而出现淋沥不尽的情况。朱丹溪说:有一位徐姓妇女在壮年时患此病。他认为肌肉破损在外尚且可以修补完整,虽然在内脏恐怕也可以治愈。诊察其脉象非常虚弱,于是领悟到凡是难产的人,大多是因为气虚,生产之后,气血更加虚弱,应当应用峻猛的补益法,用参术膏煎汤,配合猪羊胞汤,在极度饥饿时饮用,一个月后病情安定,使气血迅速增长,受损的胞宫得以修复,如果治疗稍慢也难以成功。
Postpartum metrorrhagia (postpartum heavy bleeding) is caused by excessive vaginal discharge, leading to severe deficiency of blood and qi. If the body has not yet recovered its equilibrium, it may be triggered by overexertion or fright. Treatment should focus on tonifying the Heart and Spleen to control the blood. If there is persistent fullness and pain in the lower abdomen accompanied by a pulse that is excess, large, tight, and rapid, this indicates exhaustion of Liver Yin and collapse of Liver Qi, which is difficult to treat. If the lower abdomen is distended and painful upon palpation, this signifies the presence of intra-abdominal blood stasis; one must not hastily stop the bleeding, otherwise it will inevitably lead to prolonged dripping.
Postpartum difficulty in defecation arises from a lack of blood nourishing the intestines. The Large Intestine is the official responsible for conduction, where transformation and excretion occur. Postpartum consumption of fluids leads to dryness in the Stomach, preventing the downward transmission of essence and nutrients, causing accumulation of waste and resulting in difficult defecation. This is due to the excessive loss of blood and qi, leading to the depletion of internal fluids. However, the Large Intestine governs fluids (Jin), and the Small Intestine governs liquids (Ye). Both intestines rely on the Yang Qi of the Stomach to transport fluids to the Upper Jiao. Now, following postpartum extreme deficiency, the original Qi of the Stomach is already depleted, and the fluids of both intestines are damaged; thus, difficulty in defecation is inevitable. Treatment should only regulate the Middle Jiao and nourish blood; one must absolutely avoid using solely Semen Cannabis (Hemp Seed) and Fructus Aurantii (Bitter Orange), as this would merely consume the vital energy generating within the intestines and stomach.
Regarding postpartum strangury and urinary retention, *San Yin Fang* states: "During pregnancy, one should stabilize the fetus; after delivery, one should eliminate blood stasis." These two statements are most critical. If strangury occurs during pregnancy, it may be due to Qi deficiency failing to transform fluids; Ginseng Radix et Rhizoma (Ren Shen) should be used to tonify Qi and stabilize the fetus, avoiding excessive use of diuretic herbs. If strangury occurs postpartum, it may be due to obstruction by foul blood; Epilobii Herba (Epilobium) and Polygoni Multiflori Caulis (Qumai) along with Paeoniae Radix Rubra (Mudanpi) or more commonly here referring to Polygoni Multiflori Caulis? No, Qumai is Epilobii Herba, Puhuang is Spora Typhae (Pollen Typhae) should be used as key herbs. If there is Blood deficiency with heat stagnation, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Xiaoyao San (Free and Easy Wanderer Powder) should be used to tonify Yin and nourish Blood, nourishing the source of transformation, assisted by herbs that guide out blood stasis. Furthermore, some cases arise from careless midwifery causing damage to the uterus, leading to dripping strangury. Zhu Danxi stated: A Mrs. Xu suffered from this condition in her prime. He reasoned that if external muscle tears can be repaired, internal injuries might also be treatable. Upon palpating a very deficient pulse, he realized that those with difficult labor are mostly Qi deficient. After delivery, blood and Qi are even more deficient, requiring vigorous tonification. He prescribed Shen Shu Gao (Ginseng and Atractylodes Paste) decocted with Pig or Sheep Uterus Soup, to be drunk when extremely hungry. Within one month, the patient stabilized, allowing blood and Qi to grow rapidly so the uterus could repair itself; delaying treatment would make success difficult.