往来寒热阴阳格,柴胡四物各半汤。荣卫不和乍寒热,归芍芎参甘草姜;寒热似疟瘀兼食,生化
柴胡楂曲良;憎寒壮热更生散,归地芎参荆穗姜。
【注】产后阴阳不和,往来寒热者,宜柴胡四物汤。若荣卫不调,乍寒乍热者,用增
损四物汤,其方即当归、白芍、川芎、人参、甘草、干姜也。若停瘀兼食,寒热似疟者,用
生化汤加柴胡、山楂、神曲。若感受风寒,憎寒壮热者,宜更生散,即当归、熟地、川芎、
人参、荆芥穗、干姜也。
柴胡四物汤(方见首卷)
产后阴虚阳气盛,微微自汗却无妨。头汗阴虚阳上越,周身大汗是亡阳。
【注】产后血去过多则阴虚,阴虚则阳盛。若微微自汗,是荣卫调和,故虽汗无妨。若
周身无汗,独头汗出者,乃阴虚阳气上越之象也。若头身俱大汗不止,则恐有亡阳之虑
矣。
当归六黄汤 黄 汤
虚热上蒸头汗出,治用当归六黄汤,黄芩连 炒黑用,归 生熟二地黄。自汗黄 汤牡蛎, 术
苓甘麦地防。大汗不止阳外脱,大剂参附可回阳。
【注】产后亡血阴虚,阳热上蒸,头上汗出至颈而还者,宜当归六黄汤。即黄连、黄
芩、黄柏、当归、黄 、生地、熟地也,内芩、连、柏三味俱炒黑用。若自汗太甚,宜
黄汤,即牡蛎粉、黄 、白术、茯苓、甘草、麦冬、熟地、防风也。若阴血大脱,孤
阳外越,大汗不止,非大剂参附不能回阳也。
往来寒热(忽冷忽热)是由于阴阳之气相互格拒所致,治疗宜用柴胡四物汤各半汤。若因营卫不和导致忽冷忽热,宜用归芍芎参甘草姜汤(即由当归、白芍、川芎、人参、甘草、生姜组成的方剂)。若寒热症状类似疟疾,且兼有瘀血和食积,宜用生化汤加柴胡、山楂、神曲。若恶寒壮热(极度怕冷且高热),宜用更生散,该方由当归、熟地黄、川芎、人参、荆芥穗、干姜组成。
【注】产后阴阳不和,出现往来寒热者,适宜使用柴胡四物汤。若是营卫不调,出现忽冷忽热的症状,应使用增损四物汤,其方剂组成即为当归、白芍、川芎、人参、甘草、干姜。若是瘀血停滞兼有饮食积滞,寒热症状类似疟疾者,应使用生化汤加入柴胡、山楂、神曲。若是感受风寒邪气,出现恶寒壮热者,适宜使用更生散,该方即由当归、熟地黄、川芎、人参、荆芥穗、干姜组成。
柴胡四物汤(方剂见本书首卷)
产后阴虚而阳气偏盛,出现微微自汗(白天不因劳累、炎热或服药而自然出汗)并无妨碍。头汗(仅头部出汗)是阴虚导致阳气上越的表现;周身大汗则是亡阳(阳气衰竭脱失)的征象。
【注】产后失血过多则导致阴虚,阴虚则阳气相对偏盛。若是微微自汗,说明营卫调和,因此虽然出汗也无妨。若是周身无汗,唯独头部出汗,这是阴虚阳气上越的现象。若是头身都大汗不止,则恐怕有亡阳的危险了。
虚热上蒸导致头汗出,治疗宜用当归六黄汤,方中黄芩、黄连需炒黑使用,配以当归以及生地黄、熟地黄。自汗严重者可服用黄芪汤加牡蛎,方中含黄芪、白术、茯苓、甘草、麦冬、地黄、防风。若大汗不止,属于阳气外脱,需用大剂量人参、附子方可回阳救逆。
【注】产后亡血导致阴虚,阳热上蒸,头上出汗至颈部而止者,适宜使用当归六黄汤。该方由黄连、黄芩、黄柏、当归、黄芪、生地黄、熟地黄组成,其中黄芩、黄连、黄柏三味药均需炒黑使用。若是自汗过于严重,适宜使用黄芪汤,该方由牡蛎粉、黄芪、白术、茯苓、甘草、麦冬、熟地黄、防风组成。若是阴血大量脱失,孤阳外越,大汗不止,非大剂量的人参、附子不能挽回阳气。
Chills and fever alternating (alternating chills and fever) result from the mutual rejection of Yin and Yang Qi; treatment should employ Chaihu Siwu Tang Ge Ban Tang (Half-and-Half Decoction of Bupleurum and Four Substances). If alternating chills and fever arise from disharmony of Ying and Wei (Nutritive and Defensive levels), use Guishao Xiongshen Gancao Jiang Tang (Decoction of Angelica, White Peony, Ligusticum, Ginseng, Licorice, and Ginger); if chills and fever resemble malaria and are complicated by blood stasis and food retention, use Shenghua Tang (Life-restoring Decoction) added with Chaihu (Bupleuri Radix), Shanzha (Crataegi Fructus), and Shenqu (Massa Medicata Fermentata). If there is aversion to cold with high fever, use Gengsheng San (San for Revitalization), which consists of Danggui (Angelicae Sinensis Radix), Shudi (Rehmanniae Radix Preparata), Chuanxiong (Ligustici Chuanxiong Rhizoma), Renshen (Ginseng Radix et Rhizoma), Jingjie Sui (Schizonepetae Spica), and Ganjiang (Zingiberis Rhizoma).
[Note] Postpartum disharmony of Yin and Yang leading to alternating chills and fever is suitable for treatment with Chaihu Siwu Tang. If disharmony of Ying and Wei leads to intermittent chills and fever, use Zengsun Siwu Tang (Modified Four Substances Decoction), whose composition includes Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Chuanxiong (Ligustici Chuanxiong Rhizoma), Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), and Ganjiang (Zingiberis Rhizoma). If blood stasis stagnates accompanied by food retention, with chills and fever resembling malaria, use Shenghua Tang (Life-restoring Decoction) added with Chaihu (Bupleuri Radix), Shanzha (Crataegi Fructus), and Shenqu (Massa Medicata Fermentata). If affected by wind-cold pathogens, presenting with aversion to cold and high fever, Gengsheng San (San for Revitalization) is appropriate, composed of Danggui (Angelicae Sinensis Radix), Shudi (Rehmanniae Radix Preparata), Chuanxiong (Ligustici Chuanxiong Rhizoma), Renshen (Ginseng Radix et Rhizoma), Jingjie Sui (Schizonepetae Spica), and Ganjiang (Zingiberis Rhizoma).
Chaihu Siwu Tang (Formula seen in the first volume)
Postpartum Yin deficiency with flourishing Yang may cause slight spontaneous sweating (spontaneous sweating during daytime without exertion, heat, or medication), which is harmless. Head sweating (sweating only on the head) indicates Yin deficiency with Yang floating upward; profuse sweating over the entire body signifies collapse of Yang (exhaustion and escape of Yang Qi).
[Note] Excessive blood loss postpartum leads to Yin deficiency, causing relative Yang excess. Slight spontaneous sweating indicates harmony between Ying and Wei, thus posing no harm. If the body has no sweat but only the head sweats, this is a sign of Yin deficiency with Yang floating upward. If both head and body sweat profusely without stopping, there is a danger of Yang collapse.
Deficient heat steaming upward causes head sweating; treatment should employ Danggui Liu Huang Tang (Six Yellow Decoction of Angelica), where Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) are used charred, combined with Danggui (Angelicae Sinensis Radix), Shengdi (Rehmanniae Radix Recens), and Shudi (Rehmanniae Radix Preparata). For severe spontaneous sweating, use Huangqi Tang (Decoction of Astragalus) added with Muli (Ostreae Concha), containing Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Maidong (Ophiopogonis Tuber), Dihuang (Rehmanniae Radix), and Fangfeng (Saposhnikoviae Radix). If profuse sweating persists due to external escape of Yang, large doses of Renshen (Ginseng Radix et Rhizoma) and Fuzi (Aconiti Lateralis Radix Preparata) are required to restore Yang.
[Note] Blood loss postpartum leading to Yin deficiency, with Yang-heat steaming upward, causing sweating on the head up to the neck, is suitable for Danggui Liu Huang Tang (Six Yellow Decoction of Angelica), consisting of Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Huangbai (Phellodendri Cortex), Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Radix), Shengdi (Rehmanniae Radix Recens), and Shudi (Rehmanniae Radix Preparata); Huangqin, Huanglian, and Huangbai must be used charred. If spontaneous sweating is excessive, Huangqi Tang (Decoction of Astragalus) is appropriate, composed of Muli Fen (Concha Ostreae Pulvis), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Maidong (Ophiopogonis Tuber), Shudi (Rehmanniae Radix Preparata), and Fangfeng (Saposhnikoviae Radix). If massive loss of Yin-blood leads to solitary Yang escaping outward with unceasing profuse sweating, only large doses of Renshen (Ginseng Radix et Rhizoma) and Fuzi (Aconiti Lateralis Radix Preparata) can restore Yang.