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(腹中结块,时聚时散),多是因为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。阴性的特点是沉伏不动,所以疼痛位置固定,不离其部位;阳性的特点是浮动不定,所以疼痛没有固定的地方。瘕证,意思是“假”,指其疼痛浮泛、似有成形但无定处,这都是因为产后气血虚弱,风冷邪气乘虚而入,搏结于脏腑,与血气相互凝结而成。如果不紧急治疗,多会形成积结,妨害月经来潮。
曾有一位产妇腹中有肿块,时时疼痛不止,被误认为是血瘕(瘀血结块),使用行血破气的药物后,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,被认为是“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,哪里的骨头不属于肾呢?哪里的筋脉不属于肝呢?这是肝血虚损,导致筋脉干枯而挛缩结聚。应当补养脾土,通过补水(滋肾阴)来滋养肝血,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呢?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。兼有劳累过度引起的,用补中益气汤。饮食停滞引起的,用人参养胃汤。脾胃气虚引起的,用六君子汤;胃气虚寒引起的,加炮姜、煨木香。寒水之气反侮脾土(肾寒犯脾)引起的,用益黄散。肝木之气反侮脾土(肝气犯脾)引起的,用六君子汤加升麻、柴胡。命门火衰,不能温煦脾土引起的,用八味丸(金匮肾气丸)。如果呕吐泄泻,手足都冰冷,肚腹作痛,这是阳气虚寒的表现,急需使用附子理中汤。
产后呃逆(打嗝),属于脾虚聚冷,胃中有潜伏的寒气。肺主一身之气,五脏六腑都禀受于肺气。产后气血同时受损,脏腑皆受损伤,风冷邪气搏结于气机,导致气机上逆;加上脾虚聚冷,胃中潜伏寒气,此时若进食热物,冷热之气相互冲击,使气机逆乱不顺,从而产生呃逆。脾位于中焦,是三焦的关口,也是五脏六腑的仓库。如果阴阳之气虚弱,导致营卫之气厥逆,就会引发此病。《内经》说:“呃,噫”,是胃寒所生。然而也有因中气大虚,下焦阴火上冲而导致的,这种情况应当使用肉桂、附子、干姜之类的药物。
Postpartum accumulation (Ji, fixed masses), mass (Jia, mobile masses), and hernia are mostly caused by Qi and Blood being constrained by 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. Yin nature is deep and static, so pain remains in its specific location; Yang nature is floating and dynamic, so pain has no fixed location. Jia means "false," referring to pain that appears and disappears with a semblance of form but no fixed position. All these conditions arise from postpartum deficiency of Qi and Blood, allowing Wind-Cold to invade, constrain the Zang-Fu organs, and knot with Qi and Blood. If not treated urgently, they often develop into solid accumulations, obstructing menstruation.
There was a parturient who had a mass in her abdomen causing continuous intermittent pain, which was mistaken for blood Jia (blood stasis mass). After using herbs that invigorate blood and break Qi stagnation, her hypochondriac and abdominal pain worsened significantly, and small nodules appeared in her limbs and joints, hidden within the muscles, suspected to be "biē zǐ" (a type of parasite or pathological entity), yet treatment was ineffective. She did not realize that the Liver stores Blood and nourishes all sinews. Which bone does not belong to the Kidney? Which sinew does not belong to the Liver? This case was due to Liver Blood deficiency, leading to dryness and contraction of the sinews. By nourishing Spleen Earth and supplementing Water (Kidney Yin) to moisten Liver Blood, the sinews would naturally relax. It should be treated with modifications of Bā Zhēn Tāng (Eight Treasures Decoction), Xiāo Yáo Sǎn (Free and Easy Wanderer Powder), or Guī Pí Tāng (Restore the Spleen Decoction). In severe cases, warming and tonifying the Kidney Yuan (Source Qi) allows True Yang to recover, making Qi movement robust, thus eliminating the risk of false masses forming. When True Yin is sufficient, the Blood aspect will not be depleted, naturally avoiding risks of sinew contraction and hypochondriac pain.
Postpartum vomiting caused by excessive food intake is treated with Liù Jūn Zǐ Tāng (Six Gentlemen Decoction) added with Shān Zhā (Hawthorn Fruit) and Qū (Medicated Leaven). Vomiting caused by overwork is treated with Bǔ Zhōng Yì Qì Tāng (Tonify the Middle and Augment the Qi Decoction). Vomiting due to food stagnation is treated with Rén Shēn Yǎng Wèi Tāng (Ginseng Stomach-Nourishing Decoction). Vomiting due to Spleen and Stomach Qi deficiency is treated with Liù Jūn Zǐ Tāng; if due to Stomach Qi deficiency and Cold, Pào Jiāng (Prepared Ginger) and Wéi Mù Xiāng (Baked Aucklandia Root) are added. Vomiting due to Cold Water insulting Spleen Earth (Kidney Cold invading Spleen) is treated with Yì Huáng Sǎn (Yellow Child Powder). Vomiting due to Liver Wood insulting Spleen Earth (Liver Qi invading Spleen) is treated with Liù Jūn Zǐ Tāng added with Shēng Má (Cimicifuga Rhizome) and Chái Hú (Bupleurum Root). Vomiting due to Ming Men Fire Decline failing to warm Spleen Earth is treated with Bā Wèi Wán (Eight-Ingredient Pill). For vomiting and diarrhea accompanied by cold hands and feet and abdominal pain, indicating Yang Qi deficiency and Cold, Fù Zǐ Lǐ Zhōng Tāng (Aconite Regulate the Middle Decoction) should 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 all Zang-Fu organs. When Wind-Cold constrains the Qi, Qi rebels upward. Additionally, Spleen deficiency with accumulated Cold and latent Stomach Cold, combined with eating hot foods, causes Cold and Heat energies to clash, disrupting smooth Qi flow and resulting in hiccups. The Spleen resides in the Middle Jiao, serving as the gate of the Three Jiao and the granary of the Five Zang organs. If Yin and Yang Qi are deficient, causing rebellion of Ying (Nutritive) and Wei (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 and upward rushing of Yin Fire from the Lower Jiao; such cases should be treated with herbs like Guì (Cinnamon Twig), Fù Zǐ (Aconite Root), and Gān Jiāng (Dried Ginger).