凡妇人冲脉,为血脉之海,若血脉充足,流畅无滞,则关节清利而无病矣。至于产后劳损脏腑,气血暴竭,百骸少
血濡养,多有阴虚内热,热极生风,虽外症如风实,五内阴血不足,气无所主,卒尔口噤牙紧,唇青,肉冷,汗出,或
唇口 斜,手足筋脉挛搐,诸症类于中风者,或因血气耗损,腠理不密,汗出过多,神无所主,致角弓反
张,此乃厥阴虚极,类痉 者。在伤寒之家。虽有刚柔之分,而产后无非血燥、血枯之症,总
宜养阴补血,血长而虚风自灭,任其痰火乘虚泛上,皆当以末治之,毋执偏门而用治风消痰之
方,以重虚产妇也。治初产,当服生化汤,以生旺新血。如见危症三帖后即用人参益气以救之;
如有痰有火,或少佐橘红、竹沥、姜汁,其黄芩、连、柏不可并用,胆星、苏子尤不宜加,慎
之!慎之!如产已数日,腹无块痛,即用滋荣活络汤,如语涩、四肢不利,宜天麻汤。密斋治
语言蹇涩,加味生脉散,治汗多口噤、背反气微、类 ,用止汗生血饮;治无汗筋挛,用芎归
枣仁汤。诸书所用,悉皆参附、十全、理阴、大补元煎之类,温养而峻补之,从来未有以风痰治
者。昔立斋用十全大补治口噤,挖开口灌之,如不得下,令侧其面出之,仍灌热者,又冷又灌,
数次即能下而苏矣。《医通》云∶口噤则抉齿灌之,齿噤则落入鼻中即苏,此古人救急灌法,
不可不知。至于治口噤,不能为语,峻补之中少兼通心气之药治之。故密斋、《尊生》俱用七珍
散,以通心气也。冯氏治产后 ,用八珍加丹皮、钩藤,以生阴血;不应,用四君子、芎、
归、丹皮、钩藤补脾土。盖血生于至阴,至阴者,脾土也,且气有生血之功耳。再此证如伤
寒误汗亡液,误下亡阴,溃疡脓血大下之后,小儿吐泻之后,悉多患之。故在产后,亦惟去血
过多,或大汗、大泻而然,其为元气亏极,血液枯败可知。若肢体恶寒,脉微细
者,此为正状;若脉浮大,发热烦渴,此为假象,惟当固本为善。若至于无力抽搐,戴眼反折,汗
出如珠,两手撮空者,不治。《尊生》治产,久拘挛,不宜补者,用舒筋汤治之。
滋荣活络汤 治产后口噤、项强、筋搐,类中风证。
人参(二钱或三钱) 川芎 茯神(各一钱) 当归(三钱酒浸) 黄 (一二钱,蜜炙)
麦冬(一钱二分或一钱) 天麻(八分或一钱) 熟地(二钱) 陈皮 荆芥 防风 羌活 炙草(各四分)
黄连(三分,姜汁炒)
天麻汤 治产后中风恍惚,语涩,四肢不利。
人参 枣仁(炒) 茯神 远志肉(制) 山药 柏子仁 麦冬(各一钱) 当归(一二钱)
石菖蒲 半夏曲 南星曲(各八分) 川芎 羌活(各七分) 天麻 防风(各五分) 细辛(四分)
加味生脉散 治产后去血太多,心血虚弱,不能上荣于舌,语言蹇涩。
人参 麦冬 归身 生地 炙草 石菖蒲(各一钱) 五味子(十三粒捶碎)
猪心一个,劈开,水二盏,煎至一盏半,去心,入药,煎七分。此方治怔忡甚效。
止汗生血饮 治产后汗出多而口噤,背强而直,气息欲绝,类 症,宜速治。
当归(二钱,酒浸) 川芎 麻黄根(各一钱) 桂枝 羌活 防风 羚羊角 天麻(各六分)
附子(制) 炙草(各四分)
水煎服。
芎归枣仁汤 治产后无汗,筋脉拘挛,类 证。
当归(二钱,酒洗) 川芎 防风(各一钱) 枣仁(五分,去壳,炒用)
一方有羌活七分。
七珍散 治产后败血停积,闭于心窍,神志不明。盖心气通于舌,心气闭,则舌强不语。
人参 石菖蒲(各一钱,为散各一两) 川芎(一钱,为散七钱五分) 生地(一钱,为散,易炙
甘草三钱) 细辛(二分,为散二钱半) 薄荷(一分,为散无此味) 防风(五分) 辰砂(五分,
研细水飞,为散三钱)
《尊生》合生化汤服。
舒筋汤 羌活 姜黄 炙草(各二钱) 海桐皮 当归 赤芍(各一钱) 白术(一钱,土炒)
沉香(少许)
凡是妇女的冲脉,作为血海,如果血脉充足、流畅无阻滞,那么关节就会清利通畅而没有疾病。至于产后因劳损导致脏腑受损,气血突然枯竭,全身骨骼肌肉缺乏血液濡养,多有阴虚内热,热极生风,虽然外在症状像实证中风,但内在阴血不足,气无所依附,突然发生口噤牙紧、嘴唇发青、肌肉冰冷、出汗,或者口角歪斜、手足筋脉痉挛抽搐,这些症状类似于中风;有的因为气血耗损,腠理(皮肤毛孔)不紧密,出汗过多,神志无所主宰,导致角弓反张,这是厥阴经虚极,属于类似痉病的证候。在伤寒病家中,虽然有刚痉和柔痉的区别,但产后无非是血燥、血枯的病证,总宜采用养阴补血的方法,血液生长则虚风自然熄灭,任凭痰火乘虚上泛,都应当作为次要问题处理,不要固执于偏门而使用祛风消痰的方剂,以免使产妇更加虚弱。治疗初产,应当服用生化汤,以生成旺盛的新血。如果见到危重症状,三帖药后即用人参益气来救治;如果有痰有火,可以少量佐加橘红、竹沥、姜汁,黄芩、黄连、黄柏不可同时并用,胆南星、苏子尤其不宜加入,务必谨慎!务必谨慎!如果生产已经几天,腹部没有块状疼痛,就立即使用滋荣活络汤;如果出现语言涩滞、四肢不利,适宜用天麻汤。密斋治疗语言蹇涩,用加味生脉散;治疗出汗多、口噤、背部强直、气息微弱、类似痉病的症状,用止汗生血饮;治疗无汗、筋脉挛急,用芎归枣仁汤。各种医书所用的方法,全都是参附汤、十全大补汤、理阴煎、大补元煎之类,温养并峻补元气,从来没有人用治风痰的方法来治疗。过去立斋用十全大补汤治疗口噤,撬开嘴巴灌药,如果喝不下去,让患者侧脸流出药液,仍然灌热药,又冷又灌,几次之后就能咽下而苏醒。《医通》说:口噤就撬开牙齿灌药,牙齿紧闭就让药液从鼻孔流入即可苏醒,这是古人急救灌药的方法,不可不知道。至于治疗口噤不能说话,在峻补之中稍微兼用通心气的药物来治疗。所以密斋、《尊生》都用七珍散,来通心气。冯氏治疗产后类似痉病,用八珍汤加丹皮、钩藤,以生阴血;如果不效,用四君子汤、川芎、当归、丹皮、钩藤补脾土。因为血生于至阴,至阴就是脾土,而且气有生血的功效。另外此证如伤寒误用发汗亡失津液,误用攻下亡失阴液,溃疡脓血大量流失之后,小儿吐泻之后,都容易患此病。所以在产后,也是因为去血过多,或大汗、大泻所致,可知这是元气极度亏损,血液枯败。如果肢体恶寒,脉象微细,这是正证;如果脉象浮大,发热烦渴,这是假象,只应当固本为善。如果到了无力抽搐、戴眼(眼球固定向上)、角弓反张、出汗如珠、两手抓空的情况,属于不治之症。《尊生》治疗产后久拘挛,不宜补益的,用舒筋汤治疗。
滋荣活络汤 治疗产后口噤、项强、筋脉抽搐,类似中风的证候。
人参(二钱或三钱) 川芎 茯神(各一钱) 当归(三钱酒浸) 黄芪(一二钱,蜜炙)
麦冬(一钱二分或一钱) 天麻(八分或一钱) 熟地黄(二钱) 陈皮 荆芥 防风 羌活 炙甘草(各四分)
黄连(三分,姜汁炒)
天麻汤 治疗产后中风恍惚,语言涩滞,四肢不利。
人参 酸枣仁(炒) 茯神 远志肉(制) 山药 柏子仁 麦冬(各一钱) 当归(一二钱)
石菖蒲 半夏曲 天南星曲(各八分) 川芎 羌活(各七分) 天麻 防风(各五分) 细辛(四分)
加味生脉散 治疗产后失血太多,心血虚弱,不能上荣于舌,语言蹇涩。
人参 麦冬 当归身 生地黄 炙甘草 石菖蒲(各一钱) 五味子(十三粒捶碎)
猪心一个,劈开,水两盏,煎至一盏半,去掉心脏部分,放入药物,煎至七分。此方治疗怔忡非常有效。
止汗生血饮 治疗产后出汗多且口噤,背部强直,气息欲绝,类似痉病的症状,宜速治。
当归(二钱,酒浸) 川芎 麻黄根(各一钱) 桂枝 羌活 防风 羚羊角 天麻(各六分)
附子(制) 炙甘草(各四分)
水煎服。
芎归枣仁汤 治疗产后无汗,筋脉拘挛,类似痉病的症状。
当归(二钱,酒洗) 川芎 防风(各一钱) 酸枣仁(五分,去壳,炒用)
一方中有羌活七分。
七珍散 治疗产后败血停积,闭阻心窍,神志不明。因为心气通于舌,心气闭阻,则舌强不语。
人参 石菖蒲(各一钱,研为散剂各一两) 川芎(一钱,研为散剂七钱五分) 生地黄(一钱,研为散剂,改用炙甘草三钱) 细辛(二分,研为散剂二钱半) 薄荷(一分,研为散剂无此味) 防风(五分) 辰砂(五分,研细水飞,研为散剂三钱)
《尊生》建议配合生化汤服用。
The Chong Mai (Penetrating Vessel) of women is the Sea of Blood. If the blood vessels are sufficient and flow smoothly without stagnation, the joints will be clear and unobstructed, free from disease. However, after childbirth, labor damages the Zang-Fu organs, causing a sudden depletion of Qi and Blood. With insufficient blood to nourish the bones and muscles, there is often Yin deficiency with internal heat. Extreme heat generates Wind. Although external symptoms resemble Excess Wind-Stroke, internally there is a deficiency of Yin and Blood, leaving Qi without a master. Suddenly, one may experience trismus (lockjaw), clenched teeth, cyanotic lips, cold flesh, and sweating, or facial deviation, and spasmodic twitching of the tendons in the hands and feet. These symptoms mimic Wind-Stroke. Alternatively, due to the consumption of Qi and Blood, the Cou Li (pores/skin texture) become loose, leading to excessive sweating where the Shen (Spirit) loses its master, resulting in opisthotonos (arched back). This is due to extreme deficiency of the Jueyin Liver channel, resembling Spasm syndrome. In cases of Shanghan (Cold Damage), although there is a distinction between Gang Jing (Stiff Spasm) and Rou Jing (Soft Spasm), postpartum conditions are invariably related to Blood dryness or Blood exhaustion. The general principle should be to nourish Yin and tonify Blood; as Blood grows, the Deficient Wind extinguishes itself. Even if Phlegm-Fire rises due to deficiency, it should be treated as a secondary issue. One must not adhere to biased approaches using wind-dispelling and phlegm-resolving formulas, which would further weaken the postpartum woman. For initial postpartum care, Shenghua Tang (Life-Birth Decoction) should be taken to generate vigorous new Blood. If critical symptoms appear, Ren Shen (Ginseng Root) should be used after three doses to tonify Qi and rescue the condition. If there is Phlegm and Fire, small amounts of Ju Hong (Tangerine Peel), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice) may be added. Huang Qin (Scutellaria Root), Lian Qiao (Note: Text says Lian, likely Huang Lian based on context of bitter cold), and Huang Bo (Phellodendron Bark) should not be used together; Dan Xing (Arisaema with Bile) and Su Zi (Perilla Seed) are particularly unsuitable. Exercise caution! Caution! If several days have passed since delivery and there is no abdominal mass pain, Zi Rong Huo Luo Tang (Nourish Glory and Unblock Collaterals Decoction) should be used immediately. If speech is slurred and limbs are unresponsive, Tian Ma Tang (Gastrodia Decoction) is appropriate. Mi Zhai treated slurred speech with Jia Wei Sheng Mai San (Modified Generate Pulse Powder); treated excessive sweating, trismus, stiff back, weak breath, and spasm-like symptoms with Zhi Han Sheng Xue Yin (Stop Sweat and Generate Blood Drink); and treated anhidrosis with tendon cramping using Xiong Gui Zao Ren Tang (Ligusticum and Angelica Seed Decoction). Various medical texts use methods such as Can Fu Tang (Ginseng and Aconite Decoction), Shi Quan Da Bu Tang (Complete Ten Tonifying Decoction), Li Yin Jian (Regulate Yin Decoction), and Da Bu Yuan Jian (Great Tonify Origin Decoction), employing warm nourishment and severe tonification. It has never been treated as Wind-Phlegm before. Historically, Li Zhai used Shi Quan Da Bu Tang for trismus, prying open the mouth to administer it. If swallowing was difficult, the patient was turned to the side to let the medicine drain out, while still administering hot medicine, alternating temperature until it could be swallowed and consciousness restored. Yi Tong states: "For trismus, pry the teeth and administer medicine; for clenched jaws, insert via the nose to restore consciousness." This ancient emergency administration method must be known. When treating trismus preventing speech, severe tonification should be slightly combined with herbs that unblock Heart Qi. Therefore, both Mi Zhai and Zun Sheng use Qi Zhen San (Seven Treasures Powder) to unblock Heart Qi. Feng Shi treated postpartum spasm-like symptoms with Ba Zhen Tang (Eight Treasure Decoction) plus Mu Dan Pi (Moutan Cortex) and Gou Teng (Uncaria Rhynchophylla) to generate Yin Blood; if ineffective, Si Jun Zi Tang (Four Gentlemen Decoction) with Chuan Xiong (Szechwan Lovage Rhizome), Dang Gui (Angelica Sinensis), Mu Dan Pi, and Gou Teng were used to tonify Spleen Earth. Since Blood is generated from Supreme Yin, and Supreme Yin refers to Spleen Earth, and Qi has the function of generating Blood. Furthermore, this condition often occurs after Shanghan misdiagnosed with sweating leading to fluid loss, purging leading to Yin loss, extensive pus and blood loss from ulcers, or after pediatric vomiting and diarrhea. Thus, in postpartum cases, it is caused by excessive blood loss, or severe sweating and diarrhea, indicating extreme depletion of Yuan Qi (Original Qi) and exhaustion of Blood. If the limbs feel aversion to cold and the pulse is minute and fine, this is the true presentation; if the pulse is floating and large with fever, irritability, and thirst, this is a false appearance. Only by consolidating the Root is it advisable. If the patient exhibits powerless convulsions, fixed upward gaze (Dai Yan), opisthotonos, sweat like pearls, and grasping at empty air, it is incurable. Zun Sheng treats long-standing postpartum contractures unsuitable for tonification with Shu Jin Tang (Relax Tendons Decoction).
Zi Rong Huo Luo Tang (Nourish Glory and Unblock Collaterals Decoction) treats postpartum trismus, neck stiffness, and tendon spasms, resembling Wind-Stroke.
Ren Shen (Ginseng Root) (2 qian or 3 qian) Chuan Xiong (Szechwan Lovage Rhizome) Fu Shen (Poria with Hostwood) (each 1 qian) Dang Gui (Angelica Sinensis Root) (3 qian, soaked in wine) Huang Qi (Astragalus Root) (1-2 qian, honey-fried)
Mai Dong (Ophiopogon Tuber) (1.2 qian or 1 qian) Tian Ma (Gastrodia Rhizome) (0.8 fen or 1 qian) Shu Di Huang (Prepared Rehmannia Root) (2 qian) Chen Pi (Aged Tangerine Peel) Jing Jie (Schizonepeta Spike) Fang Feng (Saposhnikovia Root) Qiang Huo (Notopterygium Rhizome) Zhi Gan Cao (Honey-fried Licorice Root) (each 0.4 qian)
Huang Lian (Coptis Rhizome) (0.3 fen, stir-fried with ginger juice)
Tian Ma Tang (Gastrodia Decoction) treats postpartum Wind-Stroke with mental confusion, slurred speech, and limb unresponsiveness.
Ren Shen (Ginseng Root) Zao Ren (Semen Ziziphus Jujubae, fried) Fu Shen (Poria with Hostwood) Yuan Zhi Rou (Polygala Root Flesh, processed) Shan Yao (Dioscorea Rhizome) Bai Zi Ren (Biota Seed) Mai Dong (Ophiopogon Tuber) (each 1 qian) Dang Gui (Angelica Sinensis Root) (1-2 qian)
Shi Chang Pu (Acorus Rhizome) Ban Xia Qu (Pinellia Fermented Paste) Nan Xing Qu (Arisaema Fermented Paste) (each 0.8 fen) Chuan Xiong (Szechwan Lovage Rhizome) Qiang Huo (Notopterygium Rhizome) (each 0.7 fen) Tian Ma (Gastrodia Rhizome) Fang Feng (Saposhnikovia Root) (each 0.5 fen) Xi Xin (Asarum Root) (0.4 fen)
Jia Wei Sheng Mai San (Modified Generate Pulse Powder) treats excessive postpartum blood loss, Heart Blood deficiency failing to nourish the tongue, resulting in slurred speech.
Ren Shen (Ginseng Root) Mai Dong (Ophiopogon Tuber) Dang Gui Shen (Angelica Sinensis Root Tip) Sheng Di Huang (Raw Rehmannia Root) Zhi Gan Cao (Honey-fried Licorice Root) Shi Chang Pu (Acorus Rhizome) (each 1 qian) Wu Wei Zi (Schisandra Berry) (13 grains, crushed)
One Pig Heart, split open, boiled in two cups of water until reduced to one and a half cups. Remove the heart tissue, add the herbs, and boil until seven parts remain. This formula is very effective for palpitations (Zheng Tong).
Zhi Han Sheng Xue Yin (Stop Sweat and Generate Blood Drink) treats postpartum excessive sweating with trismus, stiff back, and impending respiratory failure, resembling Spasm syndrome. Urgent treatment is required.
Dang Gui (Angelica Sinensis Root) (2 qian, soaked in wine) Chuan Xiong (Szechwan Lovage Rhizome) Ma Huang Gen (Ephedra Root and Rhizome) (each 1 qian) Gui Zhi (Cinnamon Twig) Qiang Huo (Notopterygium Rhizome) Fang Feng (Saposhnikovia Root) Ling Yang Jiao (Saiga Antelope Horn) Tian Ma (Gastrodia Rhizome) (each 0.6 fen)
Fu Zi (Prepared Aconite Lateral Root) Zhi Gan Cao (Honey-fried Licorice Root) (each 0.4 fen)
Boil in water and take orally.
Xiong Gui Zao Ren Tang (Ligusticum and Angelica Seed Decoction) treats postpartum anhidrosis and tendon contractures, resembling Spasm syndrome.
Dang Gui (Angelica Sinensis Root) (2 qian, washed in wine) Chuan Xiong (Szechwan Lovage Rhizome) Fang Feng (Saposhnikovia Root) (each 1 qian) Zao Ren (Semen Ziziphus Jujubae) (0.5 fen, shelled, fried)
Another prescription includes Qiang Huo (Notopterygium Rhizome) 0.7 fen.
Qi Zhen San (Seven Treasures Powder) treats postpartum stagnant败血 (dead blood) accumulating and closing the Heart Orifice, causing unclear spirit. Since Heart Qi connects to the tongue, closure of Heart Qi results in a stiff tongue and inability to speak.
Ren Shen (Ginseng Root) Shi Chang Pu (Acorus Rhizome) (each 1 qian, ground into powder each 1 liang) Chuan Xiong (Szechwan Lovage Rhizome) (1 qian, ground into powder 0.75 liang) Sheng Di Huang (Raw Rehmannia Root) (1 qian, ground into powder, substitute with Zhi Gan Cao/Honey-fried Licorice Root 3 qian) Xi Xin (Asarum Root) (0.2 fen, ground into powder 0.25 liang) Bo He (Mint Leaf) (0.1 fen, ground into powder - omit this ingredient) Fang Feng (Saposhnikovia Root) (0.5 fen) Chen Sha (Cinnabar) (0.5 fen, finely ground and floated in water, ground into powder 3 qian)
Zun Sheng recommends taking this with Shenghua Tang (Life-Birth Decoction).
Shu Jin Tang (Relax Tendons Decoction) Qiang Huo (Notopterygium Rhizome) Jiang Huang (Curcuma Rhizome) Zhi Gan Cao (Honey-fried Licorice Root) (each 2 qian) Hai Tong Pi (Cryptocarya Cortex) Dang Gui (Angelica Sinensis Root) Chi Shao (Red Peony Root) (each 1 qian) Bai Zhu (Atractylodes Macrocephala Rhizome) (1 qian, stir-fried with earth)
Chen Xiang (Aquilaria Wood) (a small amount)