15.恶露不绝伤任冲, 不固时时淋漓行, 或因虚损血不摄, 或因瘀血
腹中停. 审色污淡臭腥秽, 虚补实攻要辨明, 虚用十全加胶续, 瘀宜
佛手补而行.
【注】产后恶露, 乃裹儿污血, 产时当随胎而下. 若日久不断, 时时
淋漓者, 或因冲任虚损, 血不收摄; 或因瘀行不尽, 停留腹内, 随化
随行者. 当审其血之色, 或污浊不明, 或浅淡不鲜, 或臭, 或腥, 或
秽,辨其为实, 为虚, 而攻补之. 虚宜十全大补汤加阿胶, 续断, 以
补而固之. 瘀宜佛手散, 以补而行之.
十全大补汤 佛手散 方俱见首卷
16.产后头疼面黄白, 无表无里血虚疼, 恶露不行兼腹痛, 必因瘀血
上攻冲, 逐瘀芎归汤最效, 虚用八珍加蔓荆.
【注】产后头痛, 若面色黄白, 无寒热身痛之表证, 又无便秘之里证
,则是因产后去血过多, 血虚头痛也. 若恶露不行, 兼腹痛者, 乃属
瘀血上攻之痛也. 去瘀以芎归汤, 补虚以八珍汤加蔓荆子.
八珍汤 方见首卷
大岩蜜汤
17.心痛厥逆爪青白, 寒凝大岩蜜温行, 四物去芎加独活, 姜桂茱萸
草远辛. 因食恶食多呕吐, 麴麦香砂入二陈, 大便燥结小便赤, 兼热
饮冷玉烛冷攻.
【注】产后心胃痛, 若四肢厥逆, 爪甲青白, 乃风冷寒凝, 气血滞涩
,宜用大岩蜜汤温以行之, 即生地, 当归, 赤芍, 独活, 干姜, 桂心
,吴茱萸, 甘草, 远志, 细辛也. 若因饮食停滞, 中脘作痛, 必恶食
呕吐, 宜二陈汤加神麴, 麦芽, 木香, 砂仁. 若大便结硬, 小便赤涩
,渴欲饮冷者, 乃内有实热也, 宜玉烛散攻之.
玉烛散 方见首卷
15. 恶露不绝损伤任脉和冲脉,导致固摄无力,时常淋漓不尽。这可能是因为虚损导致血液无法被统摄,也可能是因为瘀血停滞在腹中。需要仔细辨别血液的颜色、气味:若污浊、色淡、有腥臭味,则需明确区分虚实,虚证用补法,实证用攻法。虚证使用十全大补汤加阿胶、续断;瘀血证宜用佛手散以补益兼行血。
【注】产后恶露,是包裹胎儿的污血,分娩时应当随着胎儿排出。如果日久不断,时时淋漓不止,可能是因为冲任二脉虚损,血液不能收摄;也可能是因为瘀血排不干净,停留在腹内,随着化生而随血流走。应当审视血液的颜色,或污浊不清,或浅淡不鲜亮,或有臭味,或有腥味,或有秽气,辨别其属于实证还是虚证,从而采用攻邪或补虚的方法。虚证适宜用十全大补汤加阿胶、续断,以补益并固摄。瘀血证适宜用佛手散,以补益兼行血。
十全大补汤、佛手散的方剂均见本书首卷。
16. 产后头痛且面色黄白,若无表证也无里证,则是血虚引起的头痛;若恶露不行且伴有腹痛,必定是因为瘀血上冲所致。逐瘀首选芎归汤最为有效,虚证则用八珍汤加蔓荆子。
【注】产后头痛,如果面色黄白,没有寒热、身体疼痛等表证,也没有便秘等里证,这就是因为产后失血过多,血虚导致的头痛。如果恶露不下,兼有腹痛,那属于瘀血上攻引起的疼痛。祛除瘀血用芎归汤,补益虚损用八珍汤加蔓荆子。
八珍汤的方剂见本书首卷。
大岩蜜汤(方剂名)
17. 心痛伴四肢厥冷、指甲青白,这是寒凝所致,宜用大岩蜜汤温通行血。该方由四物汤去掉川芎,加入独活、干姜、肉桂、吴茱萸、甘草、远志、细辛组成。若因饮食停滞导致厌恶进食、频繁呕吐,应在二陈汤中加入神曲、麦芽、木香、砂仁。若大便干燥结硬、小便赤涩,兼有内热想喝冷饮,则宜用玉烛散进行寒下攻积。
【注】产后心胃痛,如果出现四肢厥冷逆乱、爪甲青白,这是风冷寒邪凝滞,气血运行滞涩,适宜用大岩蜜汤温通以行血,即由生地、当归、赤芍、独活、干姜、桂心、吴茱萸、甘草、远志、细辛组成。若因饮食停滞,中脘部作痛,必然厌恶食物并呕吐,适宜用二陈汤加神曲、麦芽、木香、砂仁。若大便结硬,小便赤涩,口渴想喝冷饮,这是内有实热,适宜用玉烛散攻下。
玉烛散的方剂见本书首卷。
15. Failure of lochia to cease damages the Ren and Chong vessels, leading to instability and continuous dripping. This may be due to deficiency and damage causing blood loss without retention, or due to blood stasis stagnating in the abdomen. One must carefully examine the color, turbidity, lightness, odor, and foulness of the discharge to clearly distinguish between deficiency and excess; apply tonification for deficiency and purgation for excess. For deficiency, use Shiquan Dabu Tang (Ten Significant Decoction) plus Ejiao (Donkey-hide Gelatin) and Xuduan (Dipsacus Root); for stasis, use Foshou San (Buddha's Hand Powder) to tonify while promoting circulation.
[Note] Postpartum lochia is the dirty blood that wrapped the fetus; it should descend with the delivery of the fetus. If it continues for a long time without stopping, dripping intermittently, it may be due to deficiency and damage of the Chong and Ren vessels, where blood cannot be retained; or it may be due to incomplete expulsion of blood stasis, which remains in the abdomen and flows out as it transforms. One should observe the color of the blood: whether it is turbid and unclear, pale and dull, odorous, fishy-smelling, or foul. Differentiate whether it is excess or deficiency, and apply purgation or tonification accordingly. For deficiency, Shiquan Dabu Tang (Ten Significant Decoction) added with Ejiao (Donkey-hide Gelatin) and Xuduan (Dipsacus Root) is suitable to tonify and secure. For stasis, Foshou San (Buddha's Hand Powder) is suitable to tonify and promote movement.
The formulas for Shiquan Dabu Tang and Foshou San are both found in the first volume.
16. Postpartum headache with a sallow or pale complexion indicates headache due to blood deficiency when there are no exterior or interior syndromes. If lochia fails to flow accompanied by abdominal pain, it is definitely due to blood stasis attacking upward. Xiongui Tang (Ligusticum and Angelica Decoction) is most effective for expelling stasis; for deficiency, Bazhen Tang (Eight Treasures Decoction) added with Manjingzi (Vitex Fruit) should be used.
[Note] Postpartum headache, if accompanied by a sallow or pale complexion, without exterior symptoms such as aversion to cold, fever, or body ache, nor interior symptoms such as constipation, is caused by excessive blood loss during childbirth, resulting in headache due to blood deficiency. If lochia does not flow and is accompanied by abdominal pain, it belongs to pain caused by blood stasis attacking upward. To remove stasis, use Xiongui Tang (Ligusticum and Angelica Decoction); to tonify deficiency, use Bazhen Tang (Eight Treasures Decoction) added with Manjingzi (Vitex Fruit).
The formula for Bazhen Tang is found in the first volume.
Dayanmi Tang (Great Rock Honey Decoction)
17. Heart pain with cold extremities and cyanotic/white nails indicates cold coagulation; Dayanmi Tang (Great Rock Honey Decoction) should be used to warm and move. This formula consists of Siwu Tang (Four Substances Decoction) minus Chuanxiong (Sichuan Lovage Rhizome), plus Duhuo (Angelica Pubescens Root), Ganjiang (Dried Ginger), Guixin (Cinnamon Twig), Wuzhuyu (Evodia Fruit), Gancao (Licorice Root), Yuanzhi (Polygala Root), and Xixin (Asarum). If caused by food stagnation leading to anorexia and frequent vomiting, Shenqu (Medicated Leaven), Maiya (Sprouted Barley), Muxiang (Aucklandia Root), and Sharen (Amomum Fruit) should be added to Erchen Tang (Two Aged Decoction). If accompanied by dry, hard stools, red and scanty urine, and a desire to drink cold fluids due to internal heat, Yuzhu San (Jade Candle Powder) should be used for cold purgation.
[Note] Postpartum heart and stomach pain, if accompanied by cold extremities and cyanotic/white nails, indicates wind-cold coagulation and stagnant qi and blood; Dayanmi Tang (Great Rock Honey Decoction) should be used to warm and move, composed of Dihuang (Rehmannia Root), Danggui (Angelica Sinensis Root), Chishao (Red Peony Root), Duhuo (Angelica Pubescens Root), Ganjiang (Dried Ginger), Guixin (Cinnamon Twig), Wuzhuyu (Evodia Fruit), Gancao (Licorice Root), Yuanzhi (Polygala Root), and Xixin (Asarum). If caused by food stagnation with pain in the middle jiao, necessarily accompanied by anorexia and vomiting, Erchen Tang (Two Aged Decoction) added with Shenqu (Medicated Leaven), Maiya (Sprouted Barley), Muxiang (Aucklandia Root), and Sharen (Amomum Fruit) is suitable. If stools are hard and dry, urine is red and difficult, and there is thirst with a desire for cold drinks, this indicates internal excess heat; Yuzhu San (Jade Candle Powder) should be used for purgation.
The formula for Yuzhu San is found in the first volume.