《大全》曰∶肺主气,因产后血虚,肺经一感微邪,便成咳嗽。或风热,或寒湿,皆令人咳嗽。若产后吃
盐太早,咳嗽者难治。
郭稽中曰∶产后血气不通,咳嗽者何?答曰∶产后咳嗽,多因食热面壅纳,或热病,或有气块,发时冲心痛,
气急咳嗽,四肢寒热。
陈良甫曰∶产后伤风咳嗽,是恶露上攻,流入肺经,或面赤,发喘欲死,急用二味参苏饮。又,李氏曰∶产
后咳嗽,多是瘀血入肺。知母饮治产后恶露流入肺经,咳嗽。
《济阴》按∶知母、贝母,凉药也,岂可治恶露上攻。人参补气药也,岂可治流入肺经之嗽。即加桃仁、杏
仁以泻肺导瘀,亦不可妄用。
薛立斋曰∶产后咳嗽,悉胃气不足。胃为五脏之本,胃气一虚,五脏失所,百病生焉。患者多谓腠理不密
所致,不知肺属辛金,生于己土,亦因土虚不能生金,腠理不密,外邪所感,其阴火上炎,宜壮土金生肾水,
制火为善,若径治咳嗽则误矣。
薛立斋曰∶产后咳嗽,或因阴血耗损,或因肺气亏伤,或阴火上炎,或风寒所感,治法不一。若阴血虚者,
芎、归、熟地、参、术。肺气伤者,四君子加芎、归、桔梗。阴火上炎者,六味地黄加参、术。风寒感者,补
中汤加桔梗、紫苏。
慎斋按∶以上五条,序产后有咳嗽之证也。产后咳嗽,有外邪,有内伤,有瘀血,不
外三因之感。其本则以气血虚,而胃气不足所致。夫咳嗽为肺金病,土虚不能生金,致有咳嗽之患。虽有外邪、
伤食、恶露诸证,必顾母为要。此立斋之论,为知本也。
《大全》说:肺主司气,因为产后血虚,肺经一旦感受轻微邪气,就会形成咳嗽。或是风热,或是寒湿,都会导致人咳嗽。如果产后过早吃盐,出现咳嗽症状的难以治疗。
郭稽中说:产后气血不通畅,为什么会咳嗽?回答说:产后咳嗽,多因食用热性面食导致饮食积滞,或因热病,或有气块,发作时冲击心痛,气急咳嗽,四肢忽冷忽热。
陈良甫说:产后伤风咳嗽,是恶露上逆攻冲,流入肺经,或者见面部发红,气喘欲死,紧急时用二味参苏饮。另外,李氏说:产后咳嗽,多是瘀血进入肺脏。知母饮治疗产后恶露流入肺经引起的咳嗽。
《济阴》按语:知母、贝母,是凉性药物,怎么能治疗恶露上逆攻冲?人参是补气药物,怎么能治疗流入肺经的咳嗽?即使加入桃仁、杏仁来泻肺导瘀,也不可以妄加使用。
薛立斋说:产后咳嗽,都是胃气不足所致。胃是五脏的根本,胃气一虚,五脏失去滋养,百病由此产生。患者多认为是腠理不致密所致,不知道肺属辛金,生于己土,也是因为土虚不能生金,导致腠理不致密,外邪所感,其阴火上炎,应当壮土以生金,进而生肾水,制约火邪为善,如果直接治疗咳嗽就错了。
薛立斋说:产后咳嗽,或因阴血耗损,或因肺气亏伤,或阴火上炎,或风寒所感,治疗方法各不相同。如果是阴血虚者,用川芎、当归、熟地黄、人参、白术。肺气伤者,用四君子汤加川芎、当归、桔梗。阴火上炎者,用六味地黄丸加人参、白术。风寒感者,用补中益气汤加桔梗、紫苏。
慎斋按语:以上五条,叙述了产后有咳嗽证候的情况。产后咳嗽,有外邪,有内伤,有瘀血,不外乎三因之感。其根本在于气血虚弱,而胃气不足所致。咳嗽属于肺金病,土虚不能生金,导致有咳嗽的祸患。虽然有外邪、伤食、恶露等各种证候,必须以顾护产妇为本。这是立斋的论述,是抓住了根本。
The *Daquan* states: The Lung governs Qi. Due to blood deficiency after childbirth, if the Lung meridian is once exposed to slight pathogenic factors, coughing ensues. Whether it is wind-heat or cold-dampness, all can cause people to cough. If salt is consumed too early after childbirth and coughing occurs, it is difficult to treat.
Guo Jizhong said: Why does coughing occur when postpartum Qi and Blood are not flowing smoothly? The answer is: Postpartum coughing is mostly due to consuming hot noodles leading to food stagnation, or due to heat diseases, or having a Qi mass; when it attacks, it causes heart pain, urgent breathing and coughing, and alternating cold and heat in the four limbs.
Chen Liangfu said: Postpartum wind-stroke coughing is caused by lochia attacking upwards and flowing into the Lung meridian, or presenting with a red face and panting as if dying; urgently use Erwei Rensu Yin (Two-Ingredient Ginseng and Perilla Decoction). Furthermore, Li Shi said: Postpartum coughing is mostly due to stasis-blood entering the Lung. Zhi Mu Yin (Anemarrhena Decoction) treats postpartum coughing caused by lochia flowing into the Lung meridian.
The commentary in *Jiyin* notes: Zhi Mu (Anemarrhenae Rhizoma) and Bei Mu (Fritillariae Bulbus) are cooling herbs; how can they treat lochia attacking upwards? Renshen (Ginseng Radix) is a Qi-tonifying herb; how can it treat coughing from lochia flowing into the Lung meridian? Even adding Tao Ren (Persicae Semen) and Xing Ren (Armeniacae Semen) to drain the Lung and guide out stasis, one should not recklessly use them.
Xue Lizhai said: Postpartum coughing is entirely due to insufficient Stomach Qi. The Stomach is the root of the five Zang organs; once Stomach Qi is deficient, the five Zang organs lose their nourishment, and hundreds of diseases arise. Patients often attribute this to loose interstices (Couli), not knowing that the Lung belongs to Xin Metal, born from Ji Earth; it is also because Earth deficiency fails to generate Metal, causing loose interstices and susceptibility to external pathogens, with Yin Fire flaring upward. It is advisable to strengthen Earth to generate Metal, thereby generating Kidney Water, and restrain Fire. Treating the cough directly would be a mistake.
Xue Lizhai said: Postpartum coughing may be due to consumption of Yin Blood, damage to Lung Qi, flaring of Yin Fire, or contraction of wind-cold; the treatment methods vary. For Yin Blood deficiency, use Xiong (Chuanxiong Rhizome), Gui (Angelicae Sinensis Radix), Shudi (Rehmanniae Radix Preparata), Renshen (Ginseng Radix), and Zhu (Atractylodis Macrocephalae Rhizoma). For Lung Qi damage, use Sijunzi Tang (Four Gentlemen Decoction) plus Xiong, Gui, and Jiegeng (Platycodonis Radix). For flaring Yin Fire, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Renshen and Zhu. For wind-cold contraction, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Jiegeng and Zisu (Perillae Folium).
Shenzhai commented: The above five items describe the syndrome of coughing after childbirth. Postpartum coughing involves external pathogens, internal injury, or stasis-blood, falling under the influence of the three categories of causes. Its root lies in Qi and Blood deficiency, resulting from insufficient Stomach Qi. Coughing is a disease of Lung Metal; Earth deficiency fails to generate Metal, leading to coughing. Although there are syndromes such as external pathogens, food injury, and lochia, protecting the mother must be the priority. This discussion by Lizhai grasps the essence.