朱丹溪曰∶初产之妇,将护之法,不可失宜。肉汁发阴经之火,易成内伤,先哲具有训戒,何以羊鸡浓汁
作糜服之乎?若儿初产,母腹顿宽,便啖鸡子,且吃伙盐,不思鸡子难化,伙盐发热。必须却去伙盐诸肉食,
与白粥将理,以鲞鱼淡者食之,半月后,方与少肉,鸡子豁开淡煮,大能养胃却疾也。
孙千金曰∶凡产后满百日,乃可会合,不尔至死,虚羸百疾滋长,慎之。凡妇人患风气,脐下虚冷,莫不
由早行房故也。
慎斋按∶以上五条,序产后有饮食起居之戒也。新产调理,已载《大全》一条之内,而饮食之不节,起居
之不慎,此五者犹所易犯,故再序以示人节戒之意。
朱丹溪曰∶产后一切病,皆不可发表。产后病多是血虚,故不可用风药发表出汗。
张子和曰∶妇人产余之疾,皆是败血恶物,发作寒热,脐腹撮痛,食饮稍减,医者
不察,谓产后气血俱虚,便用温热之剂,养血补虚,止作寒治,举世皆然。岂知妇人之孕,如天地孕物,物以
阴阳和合而后生,人亦阴阳和合而后孕。偏阴偏阳,岂有孕乎?此与禾黍瓜果之属何异?水旱不时,则华之与
实俱萎落矣。此又与孕而不育者何异?七月立秋后十八日,寸草不结者,天寒故也。妇人妊娠终十月,无难而
生,反谓之寒,何不察理之甚也。窃譬之治砖者,炎火在下,以水沃窑之巅,遂成砖矣。砖既出窑,窑顿寒
耶。世俗竟传黑神散治产后十八证,非徒不愈,经脉闭涸,前后淋闭,呕吐痰嗽,凡百热证生矣。若此误死者,
不可胜计。曷若四物与凉膈散对停,大作汤剂下之,利以数行,恶物俱尽,后服甘淡之剂自愈。
慎斋按∶子和以产后不可服热药,而以治砖为喻。夫砖未出窑,其热为实热,砖既出窑,则热为虚热矣。
胎在腹,当用清热养血。胎既产,恶露行而气血虚。虚则生寒,黑神散固不可多服久服,而任以凉膈散大黄、
连翘之苦寒,则误矣。矫枉之论,殊未尽善。
朱丹溪说:刚分娩的妇女,护理方法不可失当。肉汤会激发阴经的火气,容易形成内伤,先前的贤哲都有训诫,为什么还要用羊肉、鸡肉熬成的浓汁煮粥来服用呢?如果婴儿刚出生,母亲腹部突然变宽松,就吃鸡蛋,并且食用加盐的食物,却不考虑鸡蛋难以消化,加盐的食物容易生热。必须去掉加盐的各种肉食,用白粥进行调养,以清淡的咸鱼作为食物,半个月后,才给予少量的肉,鸡蛋敲开淡煮,非常能够养胃并祛除疾病。
孙思邈(孙千金)说:凡是产后满一百天,才可以同房,否则直到死亡,身体虚弱消瘦,各种疾病滋生,务必谨慎。凡是妇人患有风气病,脐下虚冷,没有不是因为过早行房造成的。
慎斋按语:以上五条,叙述了产后在饮食起居方面的禁忌。新产后的调理,已经记载在《大全》的一条内容之内,而饮食不节制,起居不谨慎,这五种情况仍然容易犯到,所以再次叙述以示人节制的戒意。
朱丹溪说:产后的一切病症,都不可使用发汗解表的方法。产后病症多是血虚,所以不可使用风药来发汗解表。
张子和说:妇人产后遗留的疾病,都是败血和恶露等污物,发作时出现寒热交替,脐腹拘急疼痛,饮食稍微减少,医生不仔细考察,认为产后气血都虚弱,便使用温热的药剂,养血补虚,只当作寒证治疗,举世皆然。哪里知道妇人的怀孕,就像天地孕育万物,万物经过阴阳和合之后才能产生,人也经过阴阳和合之后才能受孕。偏于阴或偏于阳,怎么会有孕呢?这与禾黍瓜果之类有什么不同?水旱灾害不时发生,那么花与果实都会枯萎掉落。这又与怀孕而不能生育的人有什么不同?七月立秋后十八天,寸草不结果实的,是因为天气寒冷的缘故。妇人妊娠终十月,没有困难而生子,反而被说是寒证,这是不考察事理的严重错误啊。我私下比喻烧砖的人,底下的火很旺,用水浇在窑顶,于是就成了砖。砖既已出窑,窑顿时变冷了吗?世俗竟然流传黑神散治疗产后十八种病症,不仅不能痊愈,反而导致经脉闭涩枯竭,大小便淋沥闭塞,呕吐痰嗽,各种热证都产生了。像这样因误治而死的人,数不胜数。不如将四物汤与凉膈散配合使用,大量煎成汤剂服用,通过几次通便,败血恶物全部排尽,之后再服用甘淡的药剂自然痊愈。
慎斋按语:张子和认为产后不可服用热药,并用烧砖做比喻。砖未出窑时,其热是实热;砖既已出窑,则热变为虚热了。胎在腹中,应当用清热养血的方法。胎既已产出,恶露排出而气血虚弱。虚则生寒,黑神散固然不可多服久服,但如果任由医生使用凉膈散中大黄、连翘的苦寒之品,那就错了。这种矫枉过正的言论,并没有完全妥善。
Zhu Danxi said: For women who have just given birth, the method of care must not be inappropriate. Meat broth can stimulate fire in the Yin meridians, easily leading to internal injury. Former sages have issued warnings; why then consume porridge made from rich broths of mutton and chicken? If a child has just been born and the mother's abdomen suddenly feels loose, eating eggs and consuming salted food without considering that eggs are hard to digest and salted food generates heat is unwise. One must eliminate salted meats, nourish with white rice gruel, and eat bland dried fish. After half a month, small amounts of meat may be introduced. Eggs should be cracked and boiled plainly, which greatly benefits the stomach and dispels disease.
Sun Simiao (Sun Qianjin) said: Generally, after childbirth, one may resume sexual intercourse only after one hundred days have passed. Otherwise, it may lead to death, with the body becoming weak and emaciated, and various diseases proliferating. This must be handled with caution. Any woman suffering from wind disorders or cold deficiency in the lower abdomen invariably does so because of engaging in sexual activity too early.
Shenzhai commented: The above five points outline the prohibitions regarding diet and daily life after childbirth. The regulation for postpartum recovery has already been recorded in one section of *Daquan* [Complete Essentials]. However, since immoderate diet and imprudent daily habits are still easily committed, these five points are reiterated to demonstrate the intent of warning and restraint.
Zhu Danxi said: All conditions occurring after childbirth must not be treated with methods that induce sweating to release the exterior. Postpartum conditions are mostly due to blood deficiency; therefore, acrid-warm herbs that disperse wind and induce sweating should not be used.
Zhang Zihe said: Diseases remaining after childbirth in women are all caused by retained evil blood and foul matter. These manifest as alternating chills and fever, cramping pain in the umbilical and abdominal regions, and slightly reduced appetite. Physicians, failing to examine carefully, assume that both qi and blood are deficient after childbirth. They then use warm-tonic formulas to nourish blood and tonify deficiency, treating the condition solely as a cold pattern. This is common throughout the world. Do they not know that a woman's pregnancy is like heaven and earth nurturing things? Things are born only after the harmonization of yin and yang; humans conceive only after the harmonization of yin and yang. How can conception occur if there is an excess of either yin or yang? What difference is there between this and grains such as millet or fruits? When water and drought occur out of season, both flowers and fruits wither and fall. Is this not similar to pregnancy that fails to result in viable offspring? On the eighteenth day after the Start of Autumn in the seventh lunar month, no grass bears fruit because the weather is cold. A woman carries a fetus for ten full months and gives birth without difficulty, yet this is mistakenly labeled as a "cold" condition. How profound is the failure to investigate reason! I privately compare this to brickmakers: with intense fire below and water poured on top of the kiln, bricks are formed. Once the bricks leave the kiln, does the kiln instantly become cold? The secular world blindly spreads the notion that Heishen San (Black Divine Powder) treats eighteen postpartum syndromes. Not only does it fail to cure, but it also causes the meridians to close and dry up, leading to strangury and urinary retention, vomiting, phlegm, and coughing, generating all sorts of heat patterns. The number of deaths resulting from such errors is countless. It would be better to combine Siwu Tang (Four Substance Decoction) with Liangge San (Cool the Upper Jiao Powder), prepare them as a large decoction, and administer them to induce defecation several times until all the foul matter is expelled. Subsequently, administering sweet-and-bland formulas will lead to natural recovery.
Shenzhai commented: Zhang Zihe argues against taking hot medicines after childbirth and uses the analogy of brickmaking. Before leaving the kiln, the heat of the brick is excess heat (shi re); once out of the kiln, the heat becomes deficiency heat (xu re). While the fetus is in the abdomen, clearing heat and nourishing blood is appropriate. After delivery, when lochia flows and qi and blood become deficient, deficiency generates cold. While Heishen San (Black Divine Powder) certainly should not be taken in large doses or for long periods, allowing physicians to arbitrarily use the bitter-cold herbs Dahuang (Rhubarb Rhizome) and Lianqiao (Forsythia Fruit) from Liangge San (Cool the Upper Jiao Powder) is also a mistake. Such arguments aimed at correcting extremes are not entirely sound.