产后百脉皆空,不宜发表。并大寒大热之剂,伤败气血,再虚其虚。虽有他症,皆
以调血为主。若恶露未尽腹痛者,以当归炭、五灵脂、桃仁、泥炮姜,血虚晕脱者,以当
归炭、白芍炭、杞子、川断、阿胶珠、淡苁蓉、丹参、香附、太子参、茺蔚子。有风者,
加荆芥炭、桔梗、川芎。有寒者,加肉桂。发热口渴舌燥者,加黄芩、麦冬、丹皮。不思
食者,加石斛、谷芽、炒苡仁。凡有杂症临时斟酌,参以妇科书诸法,始无差误矣。
温邪方发,两三日舌便燥裂而缩,言语呢喃,神识半明半昧,饮不解渴,或渴不欲
饮,即投育阴清热之药,病势全然不退。此肾气将绝,水枯无以上潮,心阳散越不敛,难
过一候之期。
温邪一见舌燥,大渴引饮,皆知进清热养阴法。烦渴虽暂解,移时仍渴,舌虽回润,
随复燥裂,止壮热不见汗出,脉象躁疾不静。此生化之源已竭,不能引邪外出,百无一生。
温病初起,舌苔白滑如粉,至六七日,虽烦躁神昏,渴不思饮,而舌苔不见干燥,此
邪直犯心胞,不干阳明之腑,十中难救一二,惟以参麦散(方见后),以希万一。
初病,舌遂黄白相兼而滑,或止黄而不燥,或边白中黄,或中白边黄,皆不干裂。此
乃脾湿与秽浊上蒙胞络,其人多时明时昏,渴不多饮,多凶少吉。
温邪至五六日,舌苔见灰白而润,或灰黑夹黄而不燥,神志模糊。此肾气败绝,上
凌心君,水极似火之象。非津液枯耗,无以上濡。若用苦寒济阴,是促其危,勉与炙甘
草汤(方见后),聊尽人事而已。
病至数日,舌苔乍黄乍灰黑,为值邪盛之时,舌又忽转白润,乃值邪退之顷,一日
迭变。此由正气本虚,邪来与之交战,故舌亦现幻象。人事皆沉不醒,虽烦不渴,姑以
辅正清邪一法,以俟天命何如?
有种时邪并病,久之,人神气清爽,尚能起动,口又不作渴,舌苔忽现嫩黄光润色。
此胃气欲绝,以胃属中央,黄乃土之正色,中气外泄,真色不能内藏,不出四五日当死。
产后妇女全身经脉气血空虚,不宜使用发汗解表的药物。以及大寒、大热的药方,会损伤败坏气血,使原本虚弱的身体更加虚弱。即使有其他病症,也都以调理血液为主要原则。如果恶露排出不尽且伴有腹痛的,用当归炭、五灵脂、桃仁、泥炮姜(煅烧过的干姜);血虚导致头晕昏厥脱证的,用当归炭、白芍炭、枸杞子、川断(续断)、阿胶珠、淡苁蓉(肉苁蓉)、丹参、香附、太子参、茺蔚子。兼有风邪的,加荆芥炭、桔梗、川芎。兼有寒邪的,加肉桂。出现发热、口渴、舌燥的,加黄芩、麦冬、丹皮。食欲不振的,加石斛、谷芽、炒薏苡仁。凡是遇到其他杂症,需临时斟酌处理,参考妇科书籍中的各种方法,才能避免差错失误。
温病邪气刚刚发作,两三天后舌头便干燥开裂并缩短,言语含糊不清,神志半清醒半昏迷,喝水不能解渴,或者口渴但不想喝水,此时立即投用滋阴清热的药物,病情完全不退。这是肾气即将衰竭,阴水枯竭无法上承滋润,心阳散乱外越不能收敛,很难熬过一周的时间。
温病邪气一见舌头干燥,大渴引水而饮,都知道采用清热养阴的方法。烦渴虽然暂时缓解,过了一会儿仍然口渴,舌头虽然恢复润泽,随即又干燥开裂,只见高热不退且没有汗出,脉象躁动急疾不平静。这是生化之源已经枯竭,不能引导邪气排出体外,百无一活。
温病初起,舌苔白滑像粉一样,到了六七天,虽然烦躁神志昏迷,口渴但不想喝水,而舌苔不见干燥,这是邪气直接侵犯心包络,不波及阳明腑,十个人中难救一二,只能用参麦散(方剂见后),以求万分之一的希望。
刚发病时,舌头便呈现黄白相间且滑润,或者只是黄色而不干燥,或者边缘白中间黄,或者中间白边缘黄,都不干燥开裂。这是脾湿与秽浊之气上蒙蔽心包络,这种人大多时间清醒时间昏迷,口渴但饮水不多,预后多凶少吉。
温病邪气到五六天,舌苔呈现灰白色且湿润,或者灰黑色夹杂黄色而不干燥,神志模糊。这是肾气败绝,寒气上凌犯心君,是水极似火的征象。并非津液枯耗无法上濡。如果使用苦寒药物来济助阴液,是加速其危亡,勉强给予炙甘草汤(方剂见后),聊尽人事罢了。
患病几天后,舌苔忽黄忽灰黑,正值邪气盛行的时候,舌头忽然转为白润,正值邪气退去的时候,一天之内多次变化。这是因为正气本来虚弱,邪气来袭与之交战,所以舌头也显现出虚幻的现象。人事皆沉溺不醒,虽然烦躁但不口渴,姑且采用扶助正气、清除邪气的方法,以听任天命如何?
有种时行邪气合并病症,时间久了,人的神气清爽,还能活动,口又不觉得渴,舌苔忽然呈现嫩黄色且光润。这是胃气将要断绝,因为胃属中央土,黄色是土的正色,中气外泄,真色不能内藏,不出四五天就会死亡。
Postpartum women have empty meridians and blood and qi throughout the body; it is inappropriate to use diaphoretic (sweat-inducing) treatments. Furthermore, remedies that are excessively cold or hot will damage and deplete blood and qi, further weakening an already deficient constitution. Even if other symptoms exist, the primary treatment principle should be regulating blood. If lochia remains incomplete accompanied by abdominal pain, use Danggui Tan (Charred Radix Angelicae Sinensis), Wulingzhi (Trogopterus Dung), Taoren (Peach Kernel), and Nipaojiang (Charred Dried Ginger). For dizziness, fainting, or collapse due to blood deficiency, use Danggui Tan, Baishao Tan (Charred Radix Paeoniae Alba), Qizi (Goji Berry), Chuanduan (Radix Dipsaci), Ejiao Zhu (Glue Ball of Donkey-hide Gelatin), Dancongroung (Cistanche), Danshen (Salvia Root), Xiangfu (Cyperus Rhizome), Taizishen (Pseudostellaria Root), and Chongweizi (Herba Leonuri). If wind pathogen is present, add Jingjie Tan (Charred Herba Schizonepetae), Jiegeng (Platycodon Root), and Chuanxiong (Ligusticum Rhizome). If cold pathogen is present, add Rougui (Cinnamon Bark). In cases of fever, thirst, and dry tongue, add Huangqin (Scutellaria Root), Maidong (Ophiopogon Tuber), and Danpi (Moutan Cortex). For loss of appetite, add Shihu (Dendrobium Stem), Guya (Sprouted Grain), and Chao Yiren (Stir-fried Coix Seed). Whenever miscellaneous conditions arise, one must exercise discretion, referring to various methods in gynecological texts to avoid errors.
When warm-heat pathogen first emerges, within two to three days the tongue becomes dry, cracked, and shrunk; speech is muttering and indistinct; consciousness is half-clear and half-obscured; drinking does not quench thirst, or there is thirst without desire to drink. Immediately administering Yin-nourishing and heat-clearing herbs fails to reduce the disease severity. This indicates impending exhaustion of Kidney Qi, with枯竭 (dryness) of Water failing to ascend moistening the upper jiao, and Heart Yang scattering outward without converging. Survival beyond one week (hou) is unlikely.
Upon observing a dry tongue with great thirst and desire to drink water, clinicians typically employ heat-clearing and Yin-nourishing methods. Although vexatious thirst may temporarily resolve, it returns shortly after; although the tongue momentarily regains moisture, it soon cracks and dries again; only high fever persists without sweating; and the pulse is restless and rapid. This signifies the exhaustion of the source of transformation and production, inability to guide pathogens outward, and virtually no chance of survival.
In the early stage of warm disease, the tongue coating is white, slippery, and resembles powder. By the sixth or seventh day, despite restlessness and coma, and thirst without desire to drink, the tongue coating remains non-dry. This indicates the pathogen directly invading the Pericardium (Xinbao) without affecting the Fu organs of the Yangming channel. Fewer than one or two out of ten patients can be saved. Only Shenmai San (Formula follows) may be used to seek a slim hope.
At the onset of illness, the tongue shows a mixture of yellow and white coatings that are slippery, or purely yellow but not dry, or white edges with a yellow center, or a white center with yellow edges, all without cracking or dryness. This represents Spleen dampness and turbid pathogens obscuring the Pericardium. The patient exhibits alternating periods of clarity and confusion, thirst with little intake of fluids, and carries a poor prognosis with more bad outcomes than good.
By the fifth or sixth day of warm disease, the tongue coating appears gray-white and moist, or gray-black mixed with yellow but not dry, accompanied by blurred consciousness. This indicates failure and exhaustion of Kidney Qi, with cold water overwhelming the Heart Monarch, presenting as "water extreme resembling fire." It is not merely fluid depletion failing to moisten. Using bitter-cold herbs to nourish Yin would hasten death. One might tentatively administer Zhigancao Tang (Formula follows) to do what is humanly possible.
After several days of illness, the tongue coating fluctuates between yellow and gray-black during peak pathogenic strength, then suddenly turns white and moist as the pathogen retreats, changing multiple times within a day. This occurs because righteous Qi is originally deficient, clashing with incoming pathogens, causing illusory manifestations on the tongue. The patient is comatose and unresponsive; although restless, there is no thirst. One may tentatively adopt a method of supporting righteous Qi and clearing pathogens, leaving the outcome to Heaven's will.
In certain epidemic diseases combined with other conditions, after a long duration, the patient’s spirit becomes clear, movement is possible, and there is no thirst. Suddenly, the tongue coating presents as tender yellow and glossy. This indicates impending exhaustion of Stomach Qi. Since the Stomach belongs to Central Earth, and yellow is the true color of Earth, the leakage of Middle Qi causes the true color to fail to remain internal. Death will occur within four to five days.