《大全》曰∶头者,诸阳之会也。产后五脏皆虚,胃气亏弱,饮食不充,谷气尚乏,令虚热;阳气不守,上
凑于头,阳实阴虚,则令头痛。又有产后败血头痛,不可不知。
薛立斋曰∶前证若中气虚,补中汤加蔓荆。若血虚,四物加参、术。气血俱虚,八珍汤。若风寒所伤,补
中汤倍加川芎。
单养贤曰∶产后头痛,身热恶寒,虽是感冒风寒,只宜服生化汤一二服,慎不可用柴胡、麻黄等药,以表虚。
其汗剂中川芎、干姜,其味辛温,亦能散邪退热。如头痛不解,加连须、葱白三枚。
慎斋按∶以上二条,序产后有头痛之证也。头痛有三阳三阴经之分,属风寒外感者居多。若产后头痛,虽
有风寒,而本之血虚者,其病源也。唯大剂芎、归养血,血行则风自灭。若立斋以补中汤倍川芎,此是治气
虚头痛为宜。至污血头痛,产后恒有,若用黑龙丹下蝗虫子,此又病机之不可测者矣。
《产宝百问》曰∶心者血之主,产后虚寒,血凝不散,气逆上冲于心,以温热治之,寒去则血脉温而经脉
通,大岩蜜汤主之,四物去川芎,加独活、吴茱、干姜、细辛、桂心、甘草。
《大全》曰∶产后心痛,为阴血亏损,随火上冲心络,名曰心包络痛,宜大岩蜜汤治之。若寒伤心经,名
曰真心痛,无药可救。
单养贤曰∶产后寒气上攻则心痛,下攻则腹痛,兼血块者,宜服生化汤加桂。未止,加吴茱、姜三片助血。
若独用诸热药攻寒,其痛难止,其血未免来多,以虚产母也。
《妇人大全良方》说:头部是诸阳经交汇的地方。产后五脏都处于虚弱状态,胃气亏损衰弱,饮食摄入不足,水谷精气尚且匮乏,导致产生虚热;阳气不能固守,向上冲凑到头部,造成阳实阴虚的状况,从而引发头痛。又有产后因败血(瘀血)引起的头痛,不可不加以知晓。
薛立斋说:上述证候如果是中气虚弱,用补中益气汤加入蔓荆子。如果是血虚,用四物汤加入人参、白术。如果气血都虚弱,用八珍汤。如果是被风寒邪气所伤,用补中益气汤加倍加入川芎。
单养贤说:产后头痛,伴有身体发热、怕冷,虽然像是感冒风寒,只适宜服用生化汤一两剂,千万不可使用柴胡、麻黄等发汗药,因为产后表虚。在发汗药剂中的川芎、干姜,味道辛温,也能疏散邪气退去热势。如果头痛不缓解,加上带须的葱白三根。
慎斋按语:以上两条,叙述了产后有头痛这种病症。头痛有分属三阳经和三阴经的区别,属于风寒外感的情况居多。如果是产后头痛,虽然有风寒邪气,但根本原因在于血虚,这才是病源。只有用大剂量的川芎、当归来养血,血液运行通畅则风邪自然消除。如果像薛立斋那样用补中益气汤加倍川芎,这是治疗气虚头痛比较适宜的方法。至于污血(瘀血)引起的头痛,产后经常发生,如果使用黑龙丹攻下瘀血虫积,这又是病情机理难以预测的情况了。
《产宝百问》说:心是血液的主宰,产后出现虚寒,血液凝滞不散,气机逆乱向上冲撞心脏,用温热的方法来治疗,寒气去除则血脉温暖而经脉通畅,以大岩蜜汤为主治方剂,该方由四物汤去掉川芎,加入独活、吴茱萸、干姜、细辛、桂心、甘草组成。
《妇人大全良方》说:产后心痛,是因为阴血亏损,随着火气上冲心包络,名叫心包络痛,适宜用大岩蜜汤治疗。如果是寒气伤害心经,名叫真心痛,没有药物可以救治。
单养贤说:产后寒气向上攻冲则引起心痛,向下攻冲则引起腹痛,兼有血块的,适宜服用生化汤加入肉桂。如果疼痛不止,加入吴茱萸、生姜三片以助血行。如果单独使用各种热性药物来攻逐寒气,疼痛难以停止,出血难免增多,这是因为产妇体质虚弱所致。
*Daquan* states: The head is the convergence point of all Yang meridians. After childbirth, the five Zang organs are all deficient; the Stomach Qi is depleted and weak, dietary intake is insufficient, and grain Qi is still lacking, leading to deficiency heat. Yang Qi fails to remain in its proper place, rushing upward to the head, resulting in a state of excess Yang and deficiency Yin, which causes headache. One must also be aware of headaches caused by retained blood (stasis) after childbirth.
Xue Lizhai stated: If the aforementioned syndrome is due to deficiency of Middle Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Jingjie Caoying (Vitex Fruit). If it is due to Blood deficiency, use Siwu Tang (Four Substances Decoction) with added Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome). If both Qi and Blood are deficient, use Bazhen Tang (Eight Treasures Decoction). If injured by Wind-Cold pathogens, use Buzhong Yiqi Tang with doubled amounts of Chuanxiong Rhizoma.
Shan Yanxian stated: For postpartum headache accompanied by fever and aversion to cold, although it resembles a Wind-Cold common cold, one should only administer Shenghua Tang (Generate the New Decoction) for one or two doses. One must strictly avoid using herbs such as Chaihu (Bupleuri Radix) and Mahuang (Ephedrae Herba), as the exterior is deficient. In sweating agents, Chuanxiong Rhizoma and Ganjiang (Zingiberis Rhizoma) have pungent and warm flavors, which can also disperse pathogens and reduce fever. If the headache does not resolve, add three stalks of Congbai (Allii Fistulosae Bulbus) with roots.
Shen Zhai commented: The above two passages describe the syndrome of headache occurring after childbirth. Headaches are differentiated according to the Three Yang and Three Yin meridians, with cases caused by external Wind-Cold being the most common. In postpartum headaches, although Wind-Cold may be present, the root cause lies in Blood deficiency. Only by using large doses of Chuanxiong Rhizoma and Danggui (Angelicae Sinensis Radix) to nourish the Blood, will the Blood flow smoothly and the Wind pathogen extinguish itself. Using Buzhong Yiqi Tang with doubled Chuanxiong, as Xue Lizhai suggested, is suitable for treating headaches due to Qi deficiency. As for headaches caused by turbid blood (stasis), these are common after childbirth; however, using Heilong Dan (Black Dragon Pill) to purge stasis represents a pathology that is difficult to predict.
*Chanbao Baiwen* states: The Heart is the master of Blood. Postpartum deficiency-cold causes Blood to coagulate and fail to disperse, while Qi rebels and rushes upward to strike the Heart. Treatment should employ warming methods; once the Cold is eliminated, the Blood vessels become warm and the meridians unobstructed. Da Yanmi Tang (Great Rock Honey Decoction) is the primary formula. This formula consists of Siwu Tang (Four Substances Decoction) minus Chuanxiong Rhizoma, plus Duhuo (Angelicae Pubescentis Radix), Wuzhuyu (Evodiae Fructus), Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix et Rhizoma), Guixin (Cinnamomi Cortex), and Gancao (Glycyrrhizae Radix et Rhizoma).
*Daquan* states: Postpartum heart pain is caused by the depletion of Yin Blood, which follows Fire upward to assault the Pericardium Collateral, named Pericardium Collateral Pain. It should be treated with Da Yanmi Tang (Great Rock Honey Decoction). If Cold damages the Heart Meridian, it is named True Heart Pain, for which there is no curative medicine.
Shan Yanxian stated: When postpartum Cold Qi attacks upward, it causes heart pain; when it attacks downward, it causes abdominal pain. If accompanied by blood clots, one should take Shenghua Tang (Generate the New Decoction) with Rougui (Cinnamomi Cortex) added. If the pain persists, add Wuzhuyu (Evodiae Fructus) and three slices of Shengjiang (Zingiberis Rhizoma Recens) to assist Blood circulation. If one uses only various hot-natured drugs to attack Cold, the pain will be difficult to stop, and bleeding will inevitably increase, due to the deficiency of the parturient woman.