凡经胎诸症,皆起于气血衰、脾胃虚。而产后之气血至脾胃虚衰尤甚,是以丹溪论产当以大补气
血为主。虽有他症,以末治之。夫产后忧惊劳倦,血气暴虚,诸症乘虚易入。如有气母,专耗散;如
有食母,专消导。热不可用芩、连;寒不可用桂、附。寒则血气停滞,热则新血流崩。至如中外感,
见三阳表症,多似可汗也。在产后而用麻黄,则重竭其阳;见三阴里症,多似可下也,在产后而用
承气,则重竭其阴耳。识胁痛
如肾虚,恶露之停,休用柴胡;谵语汗出乃元弱似邪之症,毋同胃实。厥有阳气之衰,难分寒热,非
大补不能回阳而起弱痊。由阴血之亏,毋论刚柔,非滋荣不能舒筋而活络。又如乍寒乍热,发作有时,
症似疟也,若以疟治,迁延难愈。神不守舍,言论无序,病似邪也,若以邪论,危可立待。去血多
而大便燥结,苁蓉加于生化,非润肠顺气之能通。患汗多而小便短涩,六君倍用参、 ,必生津助液
之可利,加参于生化,频服,救产后之危,长生活命,屡用苏。绝谷之人, 疝、脱肛,多是元虚
下陷,须用补中益气。口噤拳挛,如因血燥类风,还仗生化加参。产户入风而痛甚,宜服羌活养荣。
玉门伤冷而不闭,须选蛇、菟、萸、硫。怔仲惊悸,生化汤堪加定志。似邪恍惚,安神丸助用归脾。
因气而满闷虚损,生化加木香为佐。因食而嗳酸恶食,六君加曲、麦为良。气短者,人参、生化、杏
核。气短而汗出者,再加浮麦、麻根。若内虚弱而外感深,人参宁肺堪用。咳嗽者,生化、杏、桔、
知母。痰嗽而汗出者,还增半、枣、参、 。若干咳嗽而大热甚,加减四物尤宜。泄泻而块痛已无。
酌用参、 、肉果、诃子。痢疾而后重,如甚急,煎木香、白茯苓、陈皮。乳痈肿痛,制立两方。
未脓,栝蒌、乳、没;已脓,大补金花。呕吐绝谷分为两症,气滞,加减六和;血滞,安胃行血。
须知苏木、棱、莪大能破血,青皮、枳实最消胀满。要识耗气破血之剂损伤荣卫,止可施子少壮,岂
宜用于胎产。大抵新产之后,须问恶露何如?块痛未除,不可遽加 、术。腹中痛止,补中益气无疑。
至如阳亡脱汗,气虚喘促,须服加参生化,是从权也。又如阳亡大热,血崩厥晕,速煎生化原方,乃
急救也。治法当遵丹溪而固本,服法宜效太仆而加频。
凡是经血、胎产等病症,都起因于气血衰弱、脾胃虚弱。而产后阶段的气血亏虚和脾胃衰败尤为严重,因此朱丹溪论述分娩时主张以大补气血为主要治疗原则。即使存在其他症状,也应将其作为次要问题来处理。
产后由于忧思、惊恐、劳累和疲倦,导致气血突然极度虚弱,各种病邪容易乘虚而入。如果病因是气滞,治疗应专门采用行气散结的方法;如果病因是食积,治疗应专门采用消食导滞的方法。
热证不可使用黄芩、黄连;寒证不可使用肉桂、附子。若误用寒凉药,会导致气血停滞;若误用温热药,会导致新产生的血液崩漏流失。至于外感风寒或内伤饮食,如果见到三阳经的表证,看起来似乎可以用发汗法治疗。但在产后使用麻黄,会再次耗竭阳气;如果见到三阴经的里证,看起来似乎可以用攻下法治疗,但在产后使用承气汤类方剂,会再次耗竭阴液。
识别胁痛:如果是肾虚引起的恶露停滞,不要使用柴胡(以免进一步耗散肝气);谵语(说胡话)且出汗,这是元气虚弱而非邪气实盛的类似症状,不要当作胃实证来治疗。
厥逆(四肢冰冷)是由于阳气衰微,难以分辨寒热属性,必须大补元气才能回阳救逆并恢复健康。由于阴血亏损,无论表现为筋脉拘急还是弛缓,必须滋养营血才能舒缓筋脉并疏通经络。
又如忽冷忽热,发作有定时,症状类似疟疾,如果按照疟疾治疗,病情会拖延难愈。神志不守舍,言语无序,症状类似邪祟作怪,如果按照邪祟论治,危险立刻就会到来。
失血过多导致大便干燥结滞,在生化汤中加入肉苁蓉,并非仅仅为了润肠顺气,而是为了补血通便。患多汗症导致小便短少涩痛,六君子汤中加倍使用人参、白术,必定能生津助液从而通利小便。在生化汤中加入人参,频繁服用,可以挽救产后的危重情况,延长生命,这种方法屡试不爽。
长期不能进食的人,出现疝气、脱肛等症状,多半是元气虚弱、中气下陷所致,必须使用补中益气汤。牙关紧闭、手足拳挛,如果是因为血燥类似风证,仍然依靠生化汤加入人参来治疗。产道受风侵袭而疼痛剧烈,适宜服用羌活养荣汤。阴道受寒而不能闭合,必须选用蛇床子、菟丝子、山茱萸、硫磺等药物。心悸惊悸不安,生化汤中可以加入定志丸的成分。神志恍惚类似邪祟,可以使用安神丸辅助归脾汤治疗。因气滞导致的胸闷虚损,生化汤中加入木香作为佐药。因食积导致的嗳气反酸、厌恶食物,六君子汤中加入神曲、麦芽效果良好。
呼吸短促者,用人参配合生化汤和杏仁。呼吸短促且出汗者,再加浮小麦、麻根。如果内部虚弱而外部感受邪气深重,用人参宁肺汤。咳嗽者,用生化汤加杏仁、桔梗、知母。痰嗽且出汗者,再增加半夏、大枣、人参、白术。若干咳且大热严重,加减四物汤尤为适宜。泄泻且腹部块状疼痛已消失者,酌情使用人参、白术、肉豆蔻、诃子。痢疾且有里急后重感,如果非常紧急,煎煮木香、白茯苓、陈皮。乳痈(乳腺炎)肿痛,制定两个方剂。未化脓时,用瓜蒌、乳香、没药;已化脓时,用大补金花丸。
呕吐且绝食分为两种症状:气滞型,用加减六和汤;血滞型,用安胃行血汤。须知苏木、三棱、莪术具有强大的破血作用,青皮、枳实最能消除胀满。要认识到耗气破血的药剂会损伤营卫之气,只适用于身体强壮的年轻人,岂能用于胎产妇女?
大体上,新产之后,必须询问恶露情况如何?如果瘀块疼痛未除,不可立即加入白芍、白术。如果腹中疼痛停止,使用补中益气汤无疑是对的。至于阳气亡脱导致的大汗淋漓,气虚导致的喘息急促,必须服用加参生化汤,这是权宜之计。又如阳气亡脱导致的大热,血崩导致的昏厥晕倒,迅速煎煮生化汤原方,这是急救措施。治疗方法应当遵循朱丹溪的主张以固本培元,服药方法应当效法太仆(李中梓)而增加服药频率。
All disorders related to menstruation and pregnancy originate from the deficiency of Qi and Blood, and the weakness of the Spleen and Stomach. In the postpartum period, the depletion of Qi and Blood and the decline of Spleen and Stomach function are even more severe. Therefore, Zhu Danxi argued that the primary treatment for childbirth should be greatly tonifying Qi and Blood. Even if other symptoms exist, they should be treated as secondary issues.
Postpartum, due to worry, fright, fatigue, and overwork, Qi and Blood suddenly become extremely deficient, allowing various pathogens to easily enter through this deficiency. If the cause is Qi stagnation, treatment should specifically employ methods to move Qi and dissipate stagnation; if the cause is food retention, treatment should specifically employ methods to digest food and guide it out.
For heat patterns, Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma) must not be used; for cold patterns, Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata) must not be used. Using cold herbs will cause Qi and Blood stagnation, while using hot herbs will cause fresh blood to hemorrhage. Regarding external contractions or internal injuries, if Yangming/Taiyang/Shaoyang exterior symptoms appear, sweating therapy might seem applicable. However, using Mahuang (Ephedrae Herba) in the postpartum state would severely deplete Yang; if Yin interior symptoms appear, purging therapy might seem applicable, but using Chengqi Tang (Gastrointestinal Purge Decoction) in the postpartum state would severely deplete Yin.
Identifying hypochondriac pain: If caused by Kidney deficiency with lochia stasis, Chaihu (Bupleuri Radix) should not be used; delirium accompanied by sweating is a symptom of Yuan Qi (Original Qi) weakness mimicking pathogenic excess, and should not be treated as Stomach excess.
Jue syndrome (cold extremities) results from the decline of Yang Qi, making it difficult to distinguish between cold and heat patterns; only great tonification can restore Yang and recover health. Due to the deficit of Yin Blood, regardless of whether stiffness or flaccidity occurs, only nourishing Ying Blood can relax sinews and activate collaterals.
Furthermore, alternating chills and fever occurring at regular intervals mimic malaria; treating it as malaria leads to prolonged and difficult recovery. Restlessness of the Shen (Spirit) and disordered speech mimic possession by evil spirits; treating it as such leads to imminent danger.
Excessive blood loss leading to dry, constipated stool requires adding Rongrong (Cistanche Deserticola) to Shenghua Tang (Decoction for Generating New Blood), not merely for moistening intestines and promoting Qi movement, but to tonify blood and unblock bowels. Excessive sweating leading to scanty, dysuric urine requires doubling the dosage of Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) in Liujunzi Tang (Six Gentlemen Decoction) to generate fluids and promote urination. Adding Renshen to Shenghua Tang and administering it frequently can rescue postpartum critical conditions, prolong life, and has been repeatedly proven effective.
Individuals unable to eat for long periods presenting with hernia or rectal prolapse usually suffer from Yuan Qi deficiency and sinking of Middle Qi, requiring Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Trismus and clenched fists, if resembling wind syndrome due to Blood dryness, still rely on Shenghua Tang added with Renshen. Severe pain in the vagina due to wind invasion warrants Qianghuo Yangrong Tang (Notopterygii and Codonopsis Nourishing Ying Decoction). Cold injury to the vulva causing inability to close requires Shechuangzi (Cnidii Fructus), Tusi (Cuscutae Semen), Shanzhuyu (Corni Fructus), and Liuhuang (Sulfur). Palpitations and fright warrant adding Dingzhi Wan (Calming Spirit Pill) components to Shenghua Tang. Mental confusion mimicking spirit possession warrants Anshen Wan (Calming Spirit Pill) assisting Guipi Tang (Restore the Spleen Decoction). Chest fullness and deficiency due to Qi stagnation warrant adding Muxiang (Aucklandiae Radix) as an assistant herb to Shenghua Tang. Belching, sour regurgitation, and food aversion due to food retention warrant adding Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus) to Liujunzi Tang.
Shortness of breath calls for Renshen combined with Shenghua Tang and Xingren (Armeniacae Semen Amarum). Shortness of breath with sweating calls for adding Fumai (Tritici Levis Fructus) and Magen (Hemp Root). If internal deficiency is profound with deep external contraction, Renpi Ningfei Tang (Ginseng Lung-Calming Decoction) is applicable. Cough calls for Shenghua Tang plus Xingren, Jiegeng (Platycodonis Radix), and Zhimu (Anemarrhenae Rhizoma). Phlegm-cough with sweating calls for adding Banxia (Pinelliae Rhizoma), Dazao (Ziziphus Jujubae Fructus), Renshen, and Baizhu. Dry cough with severe heat calls for Jiawei Siwu Tang (Modified Four Substances Decoction). Diarrhea with resolved abdominal mass-pain calls for酌情 (discretionary use of) Renshen, Baizhu, Rougu (Myristicae Semen), and Hezi (Terminalia Chebulae Fructus). Dysentery with tenesmus, if urgent, calls for decocting Muxiang, Baifuling (Poria), and Chenpi (Citri Reticulatae Pericarpium). Mastitis swelling and pain require two formulated prescriptions: before suppuration, Gualou (Trichosanthis Radix), Rushen (Mastix), and Moyao (Myrrha); after suppuration, Dabu Jinhua Wan (Great Tonifying Golden Flower Pill).
Vomiting and anorexia are divided into two syndromes: Qi stagnation uses Jiawei Liuhe Tang (Modified Six Harmonies Decoction); Blood stagnation uses Angwei Xingxue Tang (Stomach-Calming and Blood-Activating Decoction). One must know that Sumu (Sappan Lignum), Sanleng (Sparganii Rhizoma), and E'zhu (Curcumae Rhizoma) strongly break blood stasis, while Qingpi (Citri Reticulatae Pericarpium Viride) and Zhishi (Aurantii Fructus Immaturus) best eliminate distension. One must recognize that formulas consuming Qi and breaking Blood damage Ying and Wei (Defensive) Qi; these are only suitable for robust young adults, never for women during pregnancy or postpartum.
Generally, after recent childbirth, one must inquire about the status of Lochia. If mass-pain from stasis remains, Shaoyao (Paeoniae Radix Alba) and Baizhu should not be abruptly added. If abdominal pain ceases, Buzhong Yiqi Tang is undoubtedly appropriate. For Yang collapse with profuse sweating and Qi deficiency with panting, Jiashen Shenghua Tang (Shenghua Decoction with Added Ginseng) is a provisional measure. For Yang collapse with high fever and bloody flooding with syncope, rapidly decocting the original Shenghua Tang is an emergency rescue. Treatment methods should follow Danxi's principle of consolidating the root, and administration should emulate Taipu (Li Zhongzi) by increasing frequency.