加味十全大补汤 加味逍遥散
产后亡血更血崩,血脱气陷病非轻,十全大补胶升续,枣仁山萸姜炭寻;若因暴怒伤肝气,逍遥
栀地白茅根;瘀停少腹多胀痛,佛手失笑效如神。
【注】产后阴血已亡,更患崩证,则是血脱气陷,其病非轻,当峻补之。宜用十全大
补汤加阿胶、升麻、续断、枣仁、山萸、炮姜炭,以升补其脱陷可也。若因暴怒伤肝血
妄行者,宜逍遥散加黑栀、生地、白茅根以清之。若因内有停瘀者,必多小腹胀痛,当
用佛手散、失笑散,以补而逐之。
十全大补汤 逍遥散 佛手散 失笑散(方俱见首卷)
产后去血亡津液,胃燥肠枯大便难,饮食如常无所苦,不须妄下损真元,量其虚实通利导,血旺津回听自然。
【注】产后去血过伤其津液,多致胃燥肠枯,故令大便秘结。若饮食如常,无胀满之
苦者,不宜轻下,反伤元气。惟宜量其虚实,用诸导法,待血旺津回,大便自然顺利也。
加味四物汤
产后淋闭腹胀痛,热邪挟血渗胞中,四物蒲瞿桃仁膝,滑石甘草木香通。
【注】产后热邪挟瘀血流渗胞中,多令小便淋闭,宜四物汤加蒲黄、瞿麦、桃仁、牛
膝、滑石、甘草梢、木香、木通治之。
四物汤(方见首卷)
黄 当归散 加味地黄汤
产后小便数且白,肾虚不固自遗尿;因产伤胞多淋沥。频数补中益气宜,胞伤黄 当归治,参 术
芍草当归。不禁六味加桂附,益智螵蛸补骨脂。
【注】产后气虚下陷,多令小便频数而色白。肾虚不固,小便自遗。因产时稳婆不慎,
伤其胞脬,多致小便淋沥。气虚频数者,宜补中益气汤升举之。伤胞淋沥者,宜黄 当
归散补之,其方即黄 、当归、人参、白术、白芍、甘草也,引用猪草胞同煮服。肾虚遗
尿不禁者,宜六味地黄汤加肉桂、附子,名桂附地黄汤,更加益智仁、桑螵蛸、补骨脂
治之。
补中益气汤 六味地黄汤(方俱见首卷)
产后失血过多又患崩漏,属于血脱气陷的病证,病情并不轻微。应使用十全大补汤加入阿胶、升麻、续断,并寻找酸枣仁、山茱萸、炮姜炭(等药);如果是因暴怒损伤肝气所致,可用逍遥散加入栀子、生地、白茅根;如果是瘀血停滞于少腹导致多胀痛,佛手散和失笑散效果如神。
【注】产后阴血已经耗亡,又患崩漏证,这就是血脱气陷,其病势不轻,应当峻猛补益。适宜用十全大补汤加入阿胶、升麻、续断、酸枣仁、山茱萸、炮姜炭,以升提补益其下陷之气即可。如果是因暴怒伤及肝血导致血妄行,适宜用逍遥散加入黑栀子、生地、白茅根以清热凉血。如果是因内有停瘀,必定多有小腹胀痛,当用佛手散、失笑散,以补益兼逐瘀之法治疗。
产后失血导致津液亡失,胃燥肠枯导致大便困难,如果饮食正常没有痛苦,不要妄用攻下法以免损伤真元,应根据虚实情况采用通利导引之法,待气血旺盛、津液恢复,大便自然通畅。
【注】产后失血过度损伤津液,多导致胃燥肠枯,所以引起大便秘结。如果饮食如常,没有胀满痛苦的,不宜轻易使用泻下法,反而损伤元气。只应当衡量其虚实,使用各种导法,等待气血旺盛、津液恢复,大便自然顺利。
产后淋证闭涩、腹部胀痛,是热邪挟带瘀血渗入胞宫,用四物汤加入蒲黄、瞿麦、桃仁、牛膝、滑石、甘草梢、木香、木通来通利。
【注】产后热邪挟带瘀血流渗胞宫,多导致小便淋沥闭塞,适宜用四物汤加入蒲黄、瞿麦、桃仁、牛膝、滑石、甘草梢、木香、木通治疗。
四物汤(方剂见首卷)
产后小便频数且色白,是肾虚不固导致自遗尿;因生产损伤胞宫多致淋沥不尽。频数者宜用补中益气汤治疗,胞宫损伤者用黄芪当归散治疗,该方即黄芪、当归、人参、白术、白芍、甘草。不禁者用六味地黄汤加入肉桂、附子,再加益智仁、桑螵蛸、补骨脂。
【注】产后气虚下陷,多导致小便频数且颜色发白。肾虚不固,小便自行遗出。因分娩时稳婆不慎,损伤其胞脬,多导致小便淋沥不尽。气虚导致频数的,适宜用补中益气汤升举阳气。损伤胞宫导致淋沥的,适宜用黄芪当归散补益,其方即黄芪、当归、人参、白术、白芍、甘草,引用猪膀胱同煮服用。肾虚导致遗尿不禁的,适宜用六味地黄汤加入肉桂、附子,名为桂附地黄汤,更加入益智仁、桑螵蛸、补骨脂治疗。
Jiawei Shiquan Dabu Decoction (Modified Ten-Agent Great Tonifying Decoction), Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder)
Postpartum excessive blood loss followed by metrorrhagia belongs to the syndrome of blood depletion with qi sinking, which is a serious condition. One should use Shiquan Dabu Decoction (Ten-Agent Great Tonifying Decoction) added with Ejiao (Donkey-hide Gelatin), Shengma (Cimicifugae Rhizoma), Xuduan (Dipsaci Radix), and seek Suanzaoren (Ziziphi Spinosae Semen), Shanyuzhu (Corni Fructus), Paojiangtan (Prepared Ginger Charcoal); if caused by sudden anger injuring Liver Qi, Xiaoyao San (Free and Easy Wanderer Powder) added with Zhizi (Gardeniae Fructus), Shengdi (Rehmanniae Radix), and Baimaogen (Imperatae Rhizoma) may be used; if stasis stagnates in the lower abdomen causing distension and pain, Foshou San (Buddha's Hand Powder) and Shixiao San (Pain-Relief Powder) are as effective as divine medicine.
[Note] After childbirth, Yin-blood has already been depleted, and metrorrhagia occurs; this is blood depletion with qi sinking, and the disease is not light. It requires vigorous tonification. It is appropriate to use Shiquan Dabu Decoction added with Ejiao (Donkey-hide Gelatin), Shengma (Cimicifugae Rhizoma), Xuduan (Dipsaci Radix), Suanzaoren (Ziziphi Spinosae Semen), Shanyuzhu (Corni Fructus), and Paojiangtan (Prepared Ginger Charcoal) to lift and tonify the sunken qi. If caused by sudden anger injuring Liver Blood leading to reckless blood flow, it is appropriate to use Xiaoyao San (Free and Easy Wanderer Powder) added with Heizhi (Black Gardeniae Fructus), Shengdi (Rehmanniae Radix), and Baimaogen (Imperatae Rhizoma) to clear heat. If due to internal stasis retention, there will likely be lower abdominal distension and pain; one should use Foshou San (Buddha's Hand Powder) and Shixiao San (Pain-Relief Powder) to tonify while expelling stasis.
Shiquan Dabu Decoction (Ten-Agent Great Tonifying Decoction), Xiaoyao San (Free and Easy Wanderer Powder), Foshou San (Buddha's Hand Powder), Shixiao San (Pain-Relief Powder) (Formulas are all found in Volume 1)
Postpartum blood loss leads to fluid depletion, stomach dryness, and intestinal withering, making defecation difficult. If diet remains normal without discomfort, do not recklessly use purgatives to damage the True Yuan (Original Qi). Assess deficiency and excess, use guiding methods for unblocking, and wait for blood abundance and fluid recovery for natural bowel movement.
[Note] Postpartum excessive blood loss damages fluids, often leading to stomach dryness and intestinal withering, thus causing constipation. If diet is normal without the suffering of fullness, one should not lightly use purgatives, as this would instead damage Yuan Qi (Primal Qi). One should only assess deficiency and excess and use various guiding methods, waiting for blood abundance and fluid recovery so that defecation becomes smooth naturally.
Jiawei Siwu Tang (Modified Four-Substance Decoction)
Postpartum strangury, urinary retention, abdominal distension, and pain are caused by Heat pathogen carrying blood stasis infiltrating the Bao Gong (Uterus). Use Siwu Tang (Four-Substance Decoction) added with Puhuang (Typhonii Pollen), Qumai (Dianthi Herba), Taoren (Persicae Semen), Niuxi (Achyranthis Bidentatae Radix), Huashi (Talcum), Gancao Gao (Licorice Root Tip), Muxiang (Aucklandiae Radix), and Mutong (Akebiae Caulis) to promote urination.
[Note] Postpartum Heat pathogen carrying blood stasis infiltrates the Bao Gong (Uterus), often causing strangury and urinary retention. It is appropriate to treat with Siwu Tang (Four-Substance Decoction) added with Puhuang (Typhonii Pollen), Qumai (Dianthi Herba), Taoren (Persicae Semen), Niuxi (Achyranthis Bidentatae Radix), Huashi (Talcum), Gancao Gao (Licorice Root Tip), Muxiang (Aucklandiae Radix), and Mutong (Akebiae Caulis).
Siwu Tang (Four-Substance Decoction) (Formula is found in Volume 1)
Huangqi Danggui San (Astragalus and Angelica Powder), Jiawei Dihuang Tang (Modified Rehmannia Decoction)
Postpartum frequent urination with white color indicates Kidney Deficiency failing to secure, leading to spontaneous enuresis; injury to the Bao Gong (Uterus) during childbirth often causes dribbling. For frequency, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable; for Bao Gong (Uterus) injury, Huangqi Danggui San (Astragalus and Angelica Powder) is used. The formula consists of Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), and Gancao (Glycyrrhizae Radix et Rhizoma). For incontinence, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill/Decoction) added with Rougui (Cinnamomi Cortex) and Fuzi (Aconiti Lateralis Radix Preparata), plus Yizhiren (Alpiniae Oxyphyllae Fructus), Sangpiaoxiao (Mantis Oviposita), and Buguzhi (Psoraleae Fructus) is used.
[Note] Postpartum Qi deficiency with sinking often causes frequent urination with pale color. Kidney Deficiency failing to secure leads to spontaneous enuresis. Due to carelessness by the midwife during delivery, injury to the Bao Pao (Urinary Bladder/Uterus) often results in urinary dribbling. For Qi deficiency causing frequency, it is appropriate to use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Yang Qi. For Bao Gong (Uterus) injury causing dribbling, it is appropriate to tonify with Huangqi Danggui San (Astragalus and Angelica Powder). The formula is Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), and Gancao (Glycyrrhizae Radix et Rhizoma), taken with Zhu Cao Pao (Porcine Urinary Bladder) boiled together. For Kidney Deficiency causing incontinence, it is appropriate to use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill/Decoction) added with Rougui (Cinnamomi Cortex) and Fuzi (Aconiti Lateralis Radix Preparata), named Guifu Dihuang Tang (Cinnamon and Aconite Rehmannia Decoction), further adding Yizhiren (Alpiniae Oxyphyllae Fructus), Sangpiaoxiao (Mantis Oviposita), and Buguzhi (Psoraleae Fructus) for treatment.
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill/Decoction) (Formulas are all found in Volume 1)