妇人乳汁乃冲任气血所化,故下则为经,上则为乳。若产后乳迟乳少者,由气血之不足,而犹或无乳
者,其为冲任之虚弱无疑也。治当补化源而兼通利,宜猪蹄汤。若乳将至而未得通畅者,宜涌泉散。
猪蹄汤(见《妇人规古方》)治气血不足,乳汁不下。
用八物汤(即八珍汤)加黄 、漏芦、陈皮、木通。先以猪蹄煮汁二碗,煎药服之。或加天花粉。
又方∶用猪蹄一副,通草二两、甘草一钱、穿山甲十四片炒,将猪蹄洗切,入水六碗,同药煎煮约至三碗,
加葱、姜、盐料,取汁饮之,忌冷物,要吃羹汤,助其气血,乳汁自下。夏月不可失,盖时用葱汤洗乳为佳。
《良方》涌泉散(见《妇人规古方》)下乳。忌食姜、椒、辛辣饮食。
王不留行 瞿麦 麦门冬 龙骨(各二钱)
上用猪蹄汁一碗,酒一杯,煎服,以木梳于乳上梳下。
产妇乳汁不来,其原有二∶盖一因气血不足,故乳汁不来,宜用猪蹄汤,是即虚者补之也;一因肥胖妇人
痰气壅盛,乳滞不来者,宜用漏芦汤之类,是壅者行之也。
《良方》漏芦汤(见《妇人规古方》)治妇人肥盛,脉气壅结,乳少。
漏芦(二两) 蛇蜕(一条) 土瓜根
上共为末,酒调下二钱。
产后乳自出乃阳明胃气之不固,当分有火、无火而
治之。无火而泄不止,由气虚也,宜八珍汤、十全大补汤;若阳明血热而溢者,宜保阴煎或四君子汤加栀子;
若肝经怒火上冲,乳胀而溢者,宜加减一阴煎;若乳多胀满而溢者,宜温帛熨而散之;若未产而乳自出者,
以胎元薄弱,滋溉不全而然,谓之乳泣,生子多不育。
八珍汤(见经不调)
十全大补汤(见调经论外备用方)
保阴煎(见血热经早)
四君子汤(见血虚经乱)
加减一阴煎(见血热经迟)
妇女的乳汁是由冲脉和任脉的气血所化生,因此下行则成为月经,上行则成为乳汁。如果产后出现乳汁来得晚或乳汁少的情况,是由于气血不足造成的;而完全无乳的情况,毫无疑问是冲脉和任脉虚弱所致。治疗应当补益化源(指脾胃为气血生化之源)并兼以通利,适宜使用猪蹄汤。如果乳汁将下但尚未通畅,适宜使用涌泉散。
猪蹄汤(见《妇人规古方》)用于治疗气血不足导致的乳汁不下。
用法:用八物汤(即八珍汤)加入黄芪、漏芦、陈皮、木通。先用猪蹄煮出两碗汁液,再用此汁煎药服用。也可以加入天花粉。
另一个方子:用一副猪蹄,通草二两、甘草一钱、炒穿山甲十四片,将猪蹄洗净切块,放入六碗水中,与药物同煎至约三碗,加入葱、姜、盐等调料,取汁饮用。忌食生冷食物,要吃羹汤以助气血,乳汁自然就会下来。夏季不可疏忽,此时用葱汤清洗乳房为佳。
《良方》涌泉散(见《妇人规古方》)用于下乳。忌食姜、花椒及辛辣饮食。
药材:王不留行、瞿麦、麦门冬、龙骨(各二钱)。
用法:以上药材用一碗猪蹄汁、一杯酒煎服,并用木梳在乳房上向下梳理。
产妇乳汁不来,原因主要有两种:一是因气血不足,导致乳汁不来,适宜用猪蹄汤,这是虚证用补法;二是因肥胖妇人痰气壅盛,导致乳汁阻滞不来,适宜用漏芦汤之类,这是实证用通法。
《良方》漏芦汤(见《妇人规古方》)用于治疗妇人形体肥盛,脉气壅结,乳汁少。
药材:漏芦(二两)、蛇蜕(一条)、土瓜根。
用法:以上共研为末,用酒调服二钱。
产后乳汁自行流出,是因为阳明胃气不固,应当区分有火和无火进行治疗。无火而泄不止,是由于气虚,适宜用八珍汤、十全大补汤;若是阳明血热而溢出者,适宜用保阴煎或四君子汤加栀子;若是肝经怒火上冲,乳房胀满而溢出者,适宜用加减一阴煎;若是乳汁过多胀满而溢出者,适宜用温热的布巾熨敷以消散之;若未生产而乳汁自行流出者,是因为胎元薄弱,滋养灌溉不全所致,称为“乳泣”,所生子女大多不能存活。
Women's milk is transformed from the Qi and Blood of the Chong (Penetrating) and Ren (Conception) vessels; therefore, when it flows downward it becomes menstruation, and when it flows upward it becomes milk. If there is a delay or scarcity of milk postpartum, it is due to deficiency of Qi and Blood; if there is no milk at all, it is undoubtedly due to weakness of the Chong and Ren vessels. Treatment should tonify the source of transformation (referring to the Spleen and Stomach as the source of Qi and Blood production) while promoting circulation and unblocking. The Pig Trotter Decoction (Zhuti Tang) is suitable. If milk is about to come but has not yet flowed smoothly, the Yongquan Powder (Yongquan San) is suitable.
Pig Trotter Decoction (Zhuti Tang) [See "Ancient Prescriptions in Furen Gui"] treats milk non-secretion due to deficiency of Qi and Blood.
Usage: Use Bawu Decoction (Bawu Tang, i.e., Bazhen Decoction) added with Huangqi (Astragali Radix), Loulu (Euphorbiae Humifusae Herba), Chenpi (Citri Reticulatae Pericarpium), and Mutong (Akebiae Caulis). First, boil pig trotters to obtain two bowls of broth, then decoct the herbs in this broth for administration. Tianhuafen (Trichosanthis Radix) may also be added.
Another prescription: Use one pig trotter, Tongcao (Tetrapanacis Medulla) 2 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 1 qian, and Chanshanjia (Manis Squama) 14 slices stir-fried. Wash and chop the pig trotters, place them in six bowls of water, and decoct together with the herbs until reduced to approximately three bowls. Add scallions, ginger, and salt for seasoning, and drink the liquid. Avoid cold foods; consume soups and stews to assist Qi and Blood, and milk will naturally flow. Do not neglect this during summer months; washing the breasts with scallion water is advisable at this time.
Yongquan Powder (Yongquan San) [See "Good Prescriptions" and "Ancient Prescriptions in Furen Gui"] promotes lactation. Avoid consuming ginger, Sichuan pepper, and spicy foods.
Herbs: Wangbuliuxing (Vaccariae Semen), Qumai (Dianthi Herba), Maimendong (Ophiopogonis Radix), Longgu (Fossilia Ossis Mastodi et Scapulae) (each 2 qian).
Usage: Decoct the above herbs in one bowl of pig trotter broth and one cup of wine, and take orally. Comb downwards on the breast with a wooden comb.
There are two primary reasons for milk non-secretion in postpartum women: first, deficiency of Qi and Blood causing milk non-secretion, which is treated with Pig Trotter Decoction, applying the method of tonifying deficiency; second, phlegm-Qi stagnation and excess in obese women causing milk obstruction and non-secretion, which is treated with formulas such as Loulu Tang, applying the method of moving stagnation.
Loulu Tang [See "Good Prescriptions" and "Ancient Prescriptions in Furen Gui"] treats scanty milk in obese women with stagnant Qi and pulse.
Herbs: Loulu (Euphorbiae Humifusae Herba) 2 liang, Shetui (Bombyx Batryticatus) 1 strip, Tuguagen (Cucumeris Radix).
Usage: Grind the above into powder, mix with wine, and take 2 qian per dose.
Spontaneous leakage of milk postpartum is due to insecurity of the Stomach Qi of the Yangming channel. Treatment should distinguish between cases with fire and without fire. If leakage persists without fire, it is due to Qi deficiency, treated with Bazhen Decoction or Shiquan Dabu Decoction. If overflow is due to Heat in the Blood of the Yangming channel, Baoyin Decoction or Sijunzi Decoction added with Zhizi (Gardeniae Fructus) is suitable. If liver-fire surging upward causes breast distension and overflow, Jiajian Yiyin Decoction is suitable. If excessive milk causes distension and overflow, apply warm cloth compresses to dissipate it. If milk leaks spontaneously before delivery, it is due to weak fetal origin and incomplete nourishment, termed "Ruqi" (Milk Weeping); children born under this condition often fail to survive.
Bazhen Decoction [See Jing Bu Diao]
Shiquan Dabu Decoction [See Supplementary Prescriptions in Tiaojing Lun]
Baoyin Decoction [See Xue Re Jing Zao]
Sijunzi Decoction [See Xuexue Jing Luan]
Jiajian Yiyin Decoction [See Xue Re Jing Chi]