《大全》曰∶产后中风,由产时伤动血气,劳损脏腑,未曾平复,起早劳动,致气虚而风邪乘之,冷气客
于皮肤经络,但疼痹羸乏不任,少气。大凡筋脉挟寒则挛急, 僻,挟温则纵缓虚弱。若入诸脏,恍惚惊悸,
随其所伤脏腑经络,而生病焉。
郭稽中曰∶产后中风者何?答曰∶产后五七日内,强力下床,或一月之内,伤于房室,或怀忧怒,扰荡冲
和,或因食生硬,伤动脏腑。得病之初,眼涩口噤,肌肉 搐,渐至腰脊,筋急强直者,不可治。此乃人作,
非偶尔中风所得也。
《大全》曰∶产后下血过多,虚极生风者何?答曰∶妇人以荣血为主,因产血下太多,气无所主,唇青肉冷,
汗出,目眩神昏,命在须臾,此虚极生风也。若以风药治之,则误矣。
朱丹溪曰∶产后中风,口眼 斜,必用大补气血,然后治痰。当以左右手脉,分气血多少以治,切不可作
中风治,用小续命汤,发表治风之药。
薛立斋曰∶产后中风,果外邪所属,形气不足,病气有余,当补元气为主,稍佐治病之药。若强力不休,月
内入房,形气俱不足,当纯补元气,多有复苏者。若误投风药,是促其危也。前证若心脾血气俱虚,十全汤,
不应,加附子、钩藤。若肝经血虚,逍遥散加钩藤。经云∶脾之荣在唇,心之液为汗。若心脾二脏虚极,急用
参附救之。
慎斋按∶以上六条,序产后有中风之证也。中风有真中、类中,有火有气有痰,中脏中腑中血脉之不一。若
产后中风,总属血虚而动伤脏腑所致。即有外邪,以大补为主。遵丹溪、立斋之法,为不易也。若舍此而以
中风为治,用愈风、续命之类,速之毙矣。戒之。
《妇人大全良方》说:产后中风,是因为分娩时损伤了气血,劳损了脏腑,尚未恢复平静,就过早起床劳作,导致气虚而风邪趁机侵入。冷气客居在皮肤经络中,只表现为疼痛、痹阻、消瘦乏力难以支撑,以及气短。大凡筋脉夹杂寒邪就会痉挛拘急,夹杂温邪就会松弛软弱。如果病邪进入各个脏腑,就会出现神志恍惚、惊悸等症状,根据所伤害的脏腑经络不同,而产生相应的疾病。
郭稽中说:什么是产后中风?回答说:产后五到七天内,勉强下床活动,或者一个月内因房事受损,或者怀着忧愁愤怒的情绪,扰乱冲任二脉的和顺之气,或者因为吃了生冷坚硬的食物,损伤了脏腑。刚得病时,眼睛干涩、牙关紧闭、肌肉抽搐,逐渐发展到腰脊部位,筋脉紧急强直,这就不可治愈了。这是人为造成的,不是偶然的中风所致。
《妇人大全良方》说:产后恶露过多,极度虚弱而生内风的道理是什么?回答说:妇女以营血为本,因为生产时失血太多,气失去了依附的主宰,出现嘴唇发青、肌肉冰冷、出汗、头晕眼花、神志昏迷,生命危在旦夕,这就是极度虚弱而生内风。如果用治外风的风药来治疗,那就错了。
朱丹溪说:产后中风,出现口眼歪斜,必须先用大剂量的药物补益气血,然后再治疗痰浊。应当通过诊察左右手的脉象,分辨气血的多少来进行治疗,切不可当作外感中风来治,使用小续命汤等发表祛风的药物。
薛立斋说:产后中风,如果是属于外邪引起的,且形体元气不足但病邪亢盛,应当以补益元气为主,稍微佐以治疗疾病的药物。如果勉强劳作不停止,或一个月内行房事,导致形气和元气都不足,应当纯粹地补益元气,很多患者都能苏醒过来。如果误用风药,就是加速其死亡。上述病症如果是心脾两脏的气血俱虚,可用十全汤;若无效,加附子、钩藤。如果是肝经血虚,用逍遥散加钩藤。医经说:脾的外华表现在嘴唇,心的液为汗。如果心脾两脏极度虚弱,急需用人参、附子来急救。
慎斋按语:以上六条,叙述了产后出现中风证候的情况。中风有真中风和类中风之分,病因有火、气、痰的不同,病位有中脏、中腑、中血脉的差异。但产后的中风,总归是血虚而动伤脏腑所致。即使有外邪,也应以大补为主。遵循朱丹溪、薛立斋的治疗方法,是不变的准则。如果舍弃这种方法而按普通中风治疗,使用愈风丹、小续命汤之类的药物,会加速病人的死亡。务必警惕。
The *Daquan* (Compendium of Great Importance) states: Postpartum wind-stroke arises from the injury to blood and qi during childbirth, damaging the zang-fu organs. If one rises early and engages in labor before recovery is complete, qi deficiency allows wind-pathogens to take advantage. Cold qi lodges in the skin and meridians, causing only pain, bi-syndrome (obstruction syndrome), emaciation, weakness, inability to bear weight, and shortness of breath. Generally, when sinews and vessels are combined with cold, they become spasmodic and contracted; when combined with warmth, they become flaccid and weak. If the pathogen enters the various zang-fu organs, it causes mental confusion and palpitations. Diseases arise according to the specific zang-fu or meridians injured.
Guo Jizhong asks: What is postpartum wind-stroke? He answers: Within five to seven days after childbirth, if one forces oneself out of bed, or within a month engages in sexual intercourse, or harbors worry and anger which disturbs the harmony of the Chong and Ren vessels, or consumes raw and hard foods that damage the zang-fu organs. At the onset of illness, there is dryness in the eyes, lockjaw, muscle twitching, gradually progressing to stiffness and rigidity of the waist and spine. This condition is incurable. This is caused by human error, not by an accidental external wind-stroke.
The *Daquan* asks: What is the mechanism of internal wind generated by extreme deficiency due to excessive postpartum bleeding? It answers: Women rely on Ying-blood (Nutritive Blood) as their foundation. Due to excessive blood loss during childbirth, Qi loses its master anchor. Symptoms include cyanosis of the lips, cold flesh, sweating, dizziness, and coma, with life hanging in the balance. This is internal wind generated by extreme deficiency. Treating this with wind-dispelling herbs would be a mistake.
Zhu Danxi states: For postpartum wind-stroke presenting with deviation of the mouth and eye, one must first vigorously tonify Qi and Blood, and only then treat Phlegm. Treatment should be guided by assessing the abundance or scarcity of Qi and Blood through the pulse at the left and right wrists. One must absolutely not treat it as external wind-stroke using Xiao Xuming Tang (Minor Continuation of Life Decoction) or other diaphoretic wind-dispelling herbs.
Xue Lizhai states: Regarding postpartum wind-stroke, if it belongs to external pathogens and the patient has insufficient form and Qi but excess pathogenic factors, the primary treatment should be tonifying Yuan-Qi (Original Qi), with a slight adjuvant of herbs treating the disease. If the patient exerts themselves without rest or engages in intercourse within a month, resulting in insufficiency of both form and Qi, pure tonification of Yuan-Qi should be used, and many patients will recover. Misusing wind-dispelling herbs accelerates danger. If the aforementioned symptoms indicate dual deficiency of Heart and Spleen Qi and Blood, use Shiquan Tang (Ten Complete Decoction); if ineffective, add Fuzi (Aconite Lateral Root) and Gouteng (Uncaria Rhynchophylla). If Liver Meridian Blood is deficient, use Xiaoyao San (Free and Easy Wanderer Powder) with added Gouteng. The Classics state: The flourishing aspect of the Spleen manifests in the lips, and the fluid of the Heart is sweat. If the Heart and Spleen are extremely deficient, urgently use Renshen (Ginseng Root) and Fuzi for rescue.
Shenzhai’s Commentary: The above six passages describe the presentation of wind-stroke syndromes in the postpartum period. Wind-stroke includes true wind-stroke and stroke-like syndromes, with etiologies involving Fire, Qi, and Phlegm, and locations involving the Zang organs, Fu organs, and collaterals/vessels. However, postpartum wind-stroke is fundamentally caused by Blood deficiency leading to disturbance and injury of the zang-fu organs. Even if external pathogens are present, the primary approach must be vigorous tonification. Following the methods of Danxi and Lizhai is an unchangeable principle. Abandoning this approach to treat it as ordinary wind-stroke using formulas like Yufeng Dan (Wind-Dispelling Pill) or Xuming Tang would hasten death. Beware of this.