产后血虚气惫,诸病丛生。盖妊娠之时,胎成一分,则母气盗泄一分,胎气渐成,母气渐泄
,十月胎完,而母气耗损,十倍寻常,不过数胎,而人已衰矣。母气传子,子壮则母虚,自然
之理也。但十月之内,形体虽分,而呼吸关通,子母同气,胎未离腹,不觉其虚。及乎产后,胎妊已
去,气血未复,空洞虚豁,不得充灌,动即感伤,最易为病。胎时气滞血凝,积瘀未尽, 瘕续成者,
事之常也。气血亏乏,脾虚肝燥,郁而克土,腹痛食减者,亦复不少。而痉冒便难,尤为易致,是为产后
三病。血弱经虚,表疏汗泄,感袭风寒,是以病痉。痉者,筋脉挛缩,头摇口噤项强而背折也。气损
阳亏,凝郁内陷,群阴闭束,是以病冒。冒者,清气幽埋,不得透发,昏愦而迷罔也。津枯肠燥,阴
凝气结,关窍闭结,是以便难。便难者,糟粕艰阻,不得顺下,原于道路之梗塞,非关阳旺而火盛也。
总之,胎气生长,盗泄肝脾,土虚木贼,为诸病之本,土气不亏,不成大病也。如瘀血蓄积,木郁腹痛
者,以桃仁鳖甲汤主之。如脾虚肝燥,木郁克土,腹痛食减,渴欲饮水者,以桂枝丹皮地黄汤主之。
如风伤卫气,而病柔痉,发热汗出者,以桂枝栝蒌首乌汤主之。如寒伤营血,而病刚痉,发热无汗者,
以葛根首乌汤主之。如阳虚郁冒者,以桂枝茯苓人参汤主之。如津亏木燥,大便艰难者,以苁蓉杏仁汤主
之。如饮食不消者,以姜桂苓砂汤主之。如血崩气虚者,以艾叶姜苓阿胶汤主之。如产后血晕,缘血热
乘虚,逆上凌心,以致昏迷不省,气闭欲绝者,以童便一钟,乘热服之。如产后阴血暴脱,因阴虚发热
者,以当归补血汤主之。如产后胎衣不下,腹中胀急者,以牛膝散主之。如产妇乳少者,以猪蹄汤主之。
桃仁鳖甲汤
桃仁(三钱) 鳖甲(三钱) 丹皮(三钱) 丹参(三钱) 桂枝(三钱) 甘草(二钱)
水煎大半杯,温服。治瘀血蓄积,木郁腹痛者,内热加生地、内寒加干姜。
桂枝丹皮地黄汤
桂枝(三钱) 芍药(三钱) 甘草(二钱) 丹皮(三钱) 地黄(三钱) 当归(三钱)
水煎大半杯,温服。治脾虚肝燥,木郁克土,腹痛食减,渴欲饮水者,气虚加人参,水寒土湿加干姜、茯苓。
桂枝栝蒌首乌汤
桂枝(三钱) 芍药(二钱) 甘草(二钱) 栝蒌根(三钱) 首乌(三钱) 生姜(三
钱)
大枣(三枚) 水煎大半杯,温服。治风伤卫气,而病柔痉,发热汗出者。
葛根首乌汤
桂枝(三钱) 芍药(三钱) 甘草(二钱) 葛根(三钱) 麻黄(二钱) 首乌(三钱) 生
姜
(三钱) 大枣(三枚) 水煎大半杯,温服。治寒伤营血,而病刚痉,发热无汗者。
桂枝茯苓人参汤
人参(三钱) 甘草(二钱) 茯苓(三钱) 桂枝(三钱) 生姜(三钱) 大枣(三枚)
水煎大半杯,温服。治阳虚郁冒。
苁蓉杏仁汤
甘草(二钱) 杏仁(二钱) 白蜜(一两) 肉苁蓉(三钱) 水煎大半杯,入白蜜,温服。
治津亏木燥,大便艰难。
姜桂苓砂汤
茯苓(三钱) 甘草(二钱) 生姜(三钱) 桂枝(三钱) 芍药(三钱) 砂仁(一钱研) 水
煎大半杯,入砂仁末,温服。治饮食不消。
艾叶姜苓阿胶汤
甘草(二钱) 茯苓(三钱) 芍药(三钱) 生姜(三钱) 丹皮(三钱) 首乌(三钱)
阿胶(三钱) 艾叶(三钱) 水煎大半杯,温服。治血崩。如气虚,加人参。
当归补血汤
(方见头痛)
牛膝散
牛膝 川芎 蒲黄(炒) 丹皮(各二两) 桂心(四钱) 当归(一两半) 共为末,每服
五钱,水煎服。治胎衣不下,
腹中胀急者。
猪蹄汤
生黄 (一两) 当归(五钱) 白芷(三钱) 木通(一钱) 以猪前蹄二只,煮汁五碗,以二
碗半煎药,至八分碗服,偃面卧一时,其乳擦一晌,令人吮之。渣再用猪蹄汁煎服。治产妇乳少者。
(按∶“乳擦一晌”,疑有讹误。服药后自觉乳房有异,似应揉按片刻,再令儿吮之。)
产后因血虚气弱,各种疾病容易丛生。大概妊娠期间,胎儿每长一分,母体的气就盗泄一分;随着胎气逐渐形成,母气也逐渐耗泄。到十月胎儿成形时,母气的耗损是平常的十倍,不过生育几胎,人就已经衰老了。母气传给子,子壮则母虚,这是自然的道理。但在十月怀胎期间,虽然形体已分,但呼吸相通,子母同气,胎儿未离腹中,尚不觉其虚弱。等到产后,胎妊已去,气血尚未恢复,体内空洞虚豁,得不到充灌,稍微活动就会感伤,最容易生病。胎时气滞血凝,积瘀未尽,癥瘕续成者,是常有的事。气血亏乏,脾虚肝燥,郁结而克伐脾土,出现腹痛、食欲减退的情况,也不在少数。而痉病(抽搐)、冒证(昏晕)、大便困难,尤为容易发生,这被称为“产后三病”。
血弱经虚,表疏汗泄,感受风寒侵袭,因此发生痉病。所谓痉,是指筋脉挛缩,头摇、口噤、项强且背部反折。气损阳亏,凝郁内陷,群阴闭束,因此发生冒证。所谓冒,是指清气幽埋,不得透发,导致昏愦迷罔。津枯肠燥,阴凝气结,关窍闭结,因此导致大便困难。大便困难,是指糟粕艰阻,不能顺下,源于道路梗塞,并非因为阳气旺盛而火盛。总之,胎气生长,盗泄肝脾之气,导致土虚木贼,这是诸病的根本;只要土气不亏,就不会形成大病。
如果瘀血蓄积,木郁导致腹痛,用桃仁鳖甲汤主治。如果脾虚肝燥,木郁克土,腹痛食减,渴欲饮水,用桂枝丹皮地黄汤主治。如果风伤卫气,而患柔痉,发热汗出,用桂枝栝蒌首乌汤主治。如果寒伤营血,而患刚痉,发热无汗,用葛根首乌汤主治。如果阳虚导致郁冒,用桂枝茯苓人参汤主治。如果津亏木燥,大便艰难,用苁蓉杏仁汤主治。如果饮食不消,用姜桂苓砂汤主治。如果血崩气虚,用艾叶姜苓阿胶汤主治。如果产后血晕,缘于血热乘虚逆上凌心,以致昏迷不省人事,气闭欲绝,用童便一钟,乘热服用。如果产后阴血暴脱,因阴虚发热,用当归补血汤主治。如果产后胎衣不下,腹中胀急,用牛膝散主治。如果产妇乳少,用猪蹄汤主治。
桃仁鳖甲汤
桃仁(三钱) 鳖甲(三钱) 丹皮(三钱) 丹参(三钱) 桂枝(三钱) 甘草(二钱)
水煎大半杯,温服。治疗瘀血蓄积,木郁腹痛者,内有热加生地,内有寒加干姜。
桂枝丹皮地黄汤
桂枝(三钱) 芍药(三钱) 甘草(二钱) 丹皮(三钱) 地黄(三钱) 当归(三钱)
水煎大半杯,温服。治疗脾虚肝燥,木郁克土,腹痛食减,渴欲饮水者,气虚加人参,水寒土湿加干姜、茯苓。
桂枝栝蒌首乌汤
桂枝(三钱) 芍药(二钱) 甘草(二钱) 栝蒌根(三钱) 首乌(三钱) 生姜(三钱)
大枣(三枚) 水煎大半杯,温服。治疗风伤卫气,而患柔痉,发热汗出者。
葛根首乌汤
桂枝(三钱) 芍药(三钱) 甘草(二钱) 葛根(三钱) 麻黄(二钱) 首乌(三钱) 生姜(三钱) 大枣(三枚)
水煎大半杯,温服。治疗寒伤营血,而患刚痉,发热无汗者。
桂枝茯苓人参汤
人参(三钱) 甘草(二钱) 茯苓(三钱) 桂枝(三钱) 生姜(三钱) 大枣(三枚)
水煎大半杯,温服。治疗阳虚郁冒。
苁蓉杏仁汤
甘草(二钱) 杏仁(二钱) 白蜜(一两) 肉苁蓉(三钱)
水煎大半杯,加入白蜜,温服。治疗津亏木燥,大便艰难。
姜桂苓砂汤
茯苓(三钱) 甘草(二钱) 生姜(三钱) 桂枝(三钱) 芍药(三钱) 砂仁(一钱研)
水煎大半杯,加入砂仁末,温服。治疗饮食不消。
艾叶姜苓阿胶汤
甘草(二钱) 茯苓(三钱) 芍药(三钱) 生姜(三钱) 丹皮(三钱) 首乌(三钱)
阿胶(三钱) 艾叶(三钱)
水煎大半杯,温服。治疗血崩。如气虚,加人参。
当归补血汤
(方见头痛章节)
牛膝散
牛膝 川芎 蒲黄(炒) 丹皮(各二两) 桂心(四钱) 当归(一两半)
共为末,每次服用五钱,水煎服。治疗胎衣不下,腹中胀急者。
猪蹄汤
生黄耆(一两) 当归(五钱) 白芷(三钱) 木通(一钱)
以猪前蹄二只,煮汁五碗,用二碗半煎药,至八分碗服用,俯卧一时辰,乳房有异感片刻,让人吮吸。药渣再用猪蹄汁煎服。治疗产妇乳少者。
(按:原文“乳擦一晌”,疑有讹误。服药后自觉乳房有异,似应揉按片刻,再令儿吮之。)
Postpartum, due to blood deficiency and qi exhaustion, various diseases tend to emerge. Generally, during pregnancy, for every unit of fetus formed, a corresponding unit of the mother's qi is drained. As fetal qi gradually develops, maternal qi gradually depletes. By the tenth month when the fetus is fully formed, the depletion of maternal qi is ten times that of normal circumstances; after merely a few pregnancies, one may appear aged. Maternal qi transmits to the offspring; as the child grows strong, the mother becomes weak, which is the natural order. However, within the ten months, although forms are distinct, respiration is connected, and mother and child share the same qi; while the fetus remains in the abdomen, its deficiency is not felt. After delivery, once the pregnancy is gone, qi and blood have not yet recovered, leaving the interior empty and hollow, unable to be filled and nourished. Any movement invites injury, making it highly susceptible to disease. During gestation, qi stagnation and blood coagulation occur; if residual stasis is not fully resolved, masses (zheng) may continue to form, which is common. Deficiency of qi and blood, spleen deficiency with liver dryness, depression leading to the overacting on earth (spleen), resulting in abdominal pain and reduced appetite, is also frequent. Spasm (jing), dizziness/fainting (mao), and difficult defecation are particularly prone to occur, known collectively as the "Three Postpartum Diseases."
Weak blood and depleted menses, with porous exterior and sweating, allow wind-cold invasion, thus causing spasm. Spasm refers to the contraction of sinews and vessels, characterized by head shaking, locked jaw, stiff neck, and opisthotonos (back bending). Qi damage and yang deficiency lead to internal entrapment and depression, with yin paths closing tightly, thus causing dizziness/fainting. Dizziness/fainting refers to the obscuring of clear qi, preventing its emergence, resulting in confusion and mental clouding. Dryness of fluids and intestines, with yin condensation and qi knotting, closes the orifices, thus causing difficult defecation. Difficult defecation implies that waste is obstructed and cannot descend smoothly, due to blockage of the pathways, not because of excessive yang or fire. In summary, fetal growth drains liver and spleen qi, causing earth deficiency and wood overacting, which is the root of all diseases; as long as earth qi is not deficient, severe illness will not develop.
If blood stasis accumulates and wood depression causes abdominal pain, treat with Tao Ren Bie Jia Tang (Peach Kernel and Turtle Shell Decoction). If spleen deficiency and liver dryness cause wood overacting on earth, with abdominal pain, reduced appetite, and thirst, treat with Gui Zhi Dan Pi Di Huang Tang (Cinnamon Twig, Moutan Cortex, and Rehmannia Decoction). If wind injures defensive qi, causing soft spasm (Rou Jing) with fever and sweating, treat with Gui Zhi Gua Lou Shou Wu Tang (Cinnamon Twig, Trichosanthes Root, and Polygonum Multiflorum Decoction). If cold injures nutritive blood, causing hard spasm (Gang Jing) with fever and no sweating, treat with Ge Gen Shou Wu Tang (Kudzu Root and Polygonum Multiflorum Decoction). If yang deficiency causes depressive dizziness, treat with Gui Zhi Fu Ling Ren Shen Tang (Cinnamon Twig, Poria, and Ginseng Decoction). If fluid deficiency and wood dryness cause difficult defecation, treat with Cong Rong Xing Ren Tang (Cistanche and Apricot Seed Decoction). If food stagnation occurs, treat with Jiang Gui Ling Sha Tang (Ginger, Cinnamon Twig, Poria, and Amomum Decoction). If uterine bleeding with qi deficiency occurs, treat with Ai Ye Jiang Ling E Jiao Tang (Mugwort Leaf, Ginger, Poria, and Donkey-Hide Gelatin Decoction). If postpartum blood fainting occurs, due to blood heat riding on deficiency to reverse upward and harass the heart, causing coma and near-death closure of qi, drink one cup of fresh human urine (Tong Bian) while hot. If postpartum sudden loss of yin blood causes fever due to yin deficiency, treat with Dang Gui Bu Xue Tang (Angelica Sinensis and Astragalus Decoction). If postpartum retained placenta causes abdominal distension and urgency, treat with Niu Xi San (Achyranthes Powder). If the nursing mother has insufficient milk, treat with Zhu Ti Tang (Pig Trotter Decoction).
Tao Ren Bie Jia Tang (Peach Kernel and Turtle Shell Decoction)
Tao Ren (Peach Kernel) (3 qian) Bie Jia (Turtle Shell) (3 qian) Dan Pi (Moutan Cortex) (3 qian) Dan Shen (Salvia Miltiorrhiza) (3 qian) Gui Zhi (Cinnamon Twig) (3 qian) Gan Cao (Licorice Root) (2 qian)
Decoct in water to obtain half a cup, take warm. Treats blood stasis accumulation and wood-depression abdominal pain. Add Sheng Di (Rehmannia Root) if internal heat is present; add Gan Jiang (Dried Ginger) if internal cold is present.
Gui Zhi Dan Pi Di Huang Tang (Cinnamon Twig, Moutan Cortex, and Rehmannia Decoction)
Gui Zhi (Cinnamon Twig) (3 qian) Shao Yao (White Peony Root) (3 qian) Gan Cao (Licorice Root) (2 qian) Dan Pi (Moutan Cortex) (3 qian) Di Huang (Rehmannia Root) (3 qian) Dang Gui (Angelica Sinensis) (3 qian)
Decoct in water to obtain half a cup, take warm. Treats spleen deficiency with liver dryness, wood overacting on earth, abdominal pain, reduced appetite, and thirst. Add Ren Shen (Ginseng) for qi deficiency; add Gan Jiang (Dried Ginger) and Fu Ling (Poria) for water-cold and damp earth.
Gui Zhi Gua Lou Shou Wu Tang (Cinnamon Twig, Trichosanthes Root, and Polygonum Multiflorum Decoction)
Gui Zhi (Cinnamon Twig) (3 qian) Shao Yao (White Peony Root) (2 qian) Gan Cao (Licorice Root) (2 qian) Gua Lou Gen (Trichosanthes Root) (3 qian) Shou Wu (Polygonum Multiflorum) (3 qian) Sheng Jiang (Fresh Ginger) (3 qian) Da Zao (Jujube) (3 pieces)
Decoct in water to obtain half a cup, take warm. Treats wind injuring defensive qi, causing soft spasm with fever and sweating.
Ge Gen Shou Wu Tang (Kudzu Root and Polygonum Multiflorum Decoction)
Gui Zhi (Cinnamon Twig) (3 qian) Shao Yao (White Peony Root) (3 qian) Gan Cao (Licorice Root) (2 qian) Ge Gen (Kudzu Root) (3 qian) Ma Huang (Ephedra) (2 qian) Shou Wu (Polygonum Multiflorum) (3 qian) Sheng Jiang (Fresh Ginger) (3 qian) Da Zao (Jujube) (3 pieces)
Decoct in water to obtain half a cup, take warm. Treats cold injuring nutritive blood, causing hard spasm with fever and no sweating.
Gui Zhi Fu Ling Ren Shen Tang (Cinnamon Twig, Poria, and Ginseng Decoction)
Ren Shen (Ginseng) (3 qian) Gan Cao (Licorice Root) (2 qian) Fu Ling (Poria) (3 qian) Gui Zhi (Cinnamon Twig) (3 qian) Sheng Jiang (Fresh Ginger) (3 qian) Da Zao (Jujube) (3 pieces)
Decoct in water to obtain half a cup, take warm. Treats yang deficiency with depressive dizziness.
Cong Rong Xing Ren Tang (Cistanche and Apricot Seed Decoction)
Gan Cao (Licorice Root) (2 qian) Xing Ren (Apricot Seed) (2 qian) Bai Mi (White Honey) (1 liang) Rou Cong Rong (Cistanche) (3 qian)
Decoct in water to obtain half a cup, add White Honey, take warm. Treats fluid deficiency and wood dryness causing difficult defecation.
Jiang Gui Ling Sha Tang (Ginger, Cinnamon Twig, Poria, and Amomum Decoction)
Fu Ling (Poria) (3 qian) Gan Cao (Licorice Root) (2 qian) Sheng Jiang (Fresh Ginger) (3 qian) Gui Zhi (Cinnamon Twig) (3 qian) Shao Yao (White Peony Root) (3 qian) Sha Ren (Amomum Fruit) (1 qian, ground)
Decoct in water to obtain half a cup, add Sha Ren powder, take warm. Treats food stagnation.
Ai Ye Jiang Ling E Jiao Tang (Mugwort Leaf, Ginger, Poria, and Donkey-Hide Gelatin Decoction)
Gan Cao (Licorice Root) (2 qian) Fu Ling (Poria) (3 qian) Shao Yao (White Peony Root) (3 qian) Sheng Jiang (Fresh Ginger) (3 qian) Dan Pi (Moutan Cortex) (3 qian) Shou Wu (Polygonum Multiflorum) (3 qian) E Jiao (Donkey-Hide Gelatin) (3 qian) Ai Ye (Mugwort Leaf) (3 qian)
Decoct in water to obtain half a cup, take warm. Treats uterine bleeding. Add Ren Shen (Ginseng) if qi is deficient.
Dang Gui Bu Xue Tang (Angelica Sinensis and Astragalus Decoction)
(See formula under Headache)
Niu Xi San (Achyranthes Powder)
Niu Xi (Achyranthes Root) Chuan Xiong (Ligusticum Rhizome) Pu Huang (Typha Pollen, stir-fried) Dan Pi (Moutan Cortex) (2 liang each) Gui Xin (Cinnamon Heart) (4 qian) Dang Gui (Angelica Sinensis) (1.5 liang)
Grind into powder. Take 5 qian per dose, decoct in water and take. Treats retained placenta with abdominal distension and urgency.
Zhu Ti Tang (Pig Trotter Decoction)
Sheng Huang Qi (Astragalus Root) (1 liang) Dang Gui (Angelica Sinensis) (5 qian) Bai Zhi (Angelica Dahurica) (3 qian) Mu Tong (Akebia Stem) (1 qian)
Boil two front pig trotters to obtain five bowls of broth. Use two and a half bowls to decoct the herbs until reduced to 0.8 bowl. Take orally. Lie face down for one shichen (two hours). When breasts feel abnormal/tight, massage briefly and let the infant suckle. Boil the dregs again in pig trotter broth. Treats insufficient lactation in nursing mothers.
(Note: The phrase "rub breasts for a moment" in the original text is suspected to be an error. It likely means that after taking the medicine, upon feeling breast fullness/discomfort, one should massage briefly before letting the infant suckle.)