产后乍寒乍热,总由血气虚损,阴阳不和而然。若阳胜则乍热,阴胜则乍寒。凡阴胜而
寒多者,宜增损四物汤、理阴煎。若阳胜而热多者,宜四物汤、三阴煎。若阳气陷入阴中而
乍寒乍热者,宜补中益气汤、补阴益气煎。若阴阳俱虚而寒热者,宜八珍汤、十全大补汤。
若败血不散,流入阴中而作寒热者,宜决津煎、殿胞煎。若血实气壅者,宜夺命丹。陈无择
曰∶败血流闭诸阴则寒,流闭诸阳则热,宜五积散。若有外感者,宜从前产后发热调治。
蓐,草荐也。产妇坐草艰难,以致过劳心力,故曰蓐劳,此即产后劳倦也。其证则或为
寒热如疟,或头疼自汗,或眩晕昏沉,或百节疼痛,或倦怠喘促,饮食不甘,形体虚羸之类
,皆其候也,悉当以培补元气为主。若初产后蓐劳困倦,惟猪腰汤为妙,或用黄雌鸡汤、白
茯苓散。若蓐劳虚汗不止,宜母鸡汤。若兼脏寒者,宜羊肉汤。若气血俱虚者,宜五福饮、
十全大补汤。若兼外邪发热者,宜补阴益气煎、补中益气汤。若兼外邪发热而中寒背恶寒者
,宜理阴煎,详加减法治之。若兼阳虚内寒者,宜五君子煎,或理阴煎。若阳盛阴虚兼内热
者,宜五福饮加芍药、黄芩、地骨皮之类,随宜用之。
产后喘急有二,乃一以阴虚之极,一以寒邪在肺。盖产后既以大虚,焉得气实而喘?若
肺无寒邪而见喘促者,此以血去阴虚,孤阳无主,故气穷短促而浮脱于上,此实肝肾不接,
无根将脱之兆,最为危候。经曰∶肝苦急,急食甘以缓之,正此类也。惟贞元饮为治此之神
剂。若气虚兼寒者,宜大补丸煎,或理阴煎。若风寒外感,邪气入肺而喘急者,此必气粗胸
胀,或多咳嗽,自与气短似喘上下不接者不同,治当以疏散兼补为主,宜金水六君煎,或六
君子汤。若单以寒邪入肺,气实气壅而本无虚者,宜六安煎,或二陈汤加苏叶之类主之。
产后出现忽冷忽热的症状,总归是由于气血虚损,阴阳失调所致。如果阳气偏胜则表现为忽冷忽热中的发热,阴气偏胜则表现为忽冷忽热中的发冷。凡是阴气偏胜而寒冷较多的,适宜使用增损四物汤、理阴煎。如果阳气偏胜而发热较多的,适宜使用四物汤、三阴煎。如果是阳气陷入阴分而导致忽冷忽热的,适宜使用补中益气汤、补阴益气煎。如果阴阳都虚弱而出现寒热往来的,适宜使用八珍汤、十全大补汤。如果是恶露(产后余血)不散,流入阴分而引起寒热的,适宜使用决津煎、殿胞煎。如果是血实气滞的,适宜使用夺命丹。陈无择说:败血阻滞诸阴经则发冷,阻滞诸阳经则发热,适宜使用五积散。如果有外感邪气的,应当按照产后发热的常规方法调治。
“蓐”指草垫。产妇坐草分娩艰难,导致心力过度劳累,所以称为蓐劳,这就是产后的劳倦病。其症状有的像疟疾一样寒热往来,有的头痛自汗,有的眩晕昏沉,有的全身关节疼痛,有的倦怠气喘急促,饮食无味,身体虚弱消瘦等,都是它的证候,都应当以培补元气为主。如果在刚生产后出现蓐劳困倦,用猪腰汤最为巧妙,或者使用黄雌鸡汤、白茯苓散。如果蓐劳导致虚汗不止,适宜喝母鸡汤。如果兼有脏腑寒冷的,适宜喝羊肉汤。如果气血都虚弱的,适宜使用五福饮、十全大补汤。如果兼有外邪发热,适宜使用补阴益气煎、补中益气汤。如果兼有外邪发热且中焦受寒背部怕冷的,适宜使用理阴煎,详细根据加减法治疗。如果兼有阳虚内寒的,适宜使用五君子煎,或者理阴煎。如果阳盛阴虚兼有内热的,适宜在五福饮中加入芍药、黄芩、地骨皮之类,酌情使用。
产后气喘急促有两种情况,一种是因为阴虚到了极点,一种是因为寒邪在肺。因为产后已经是大虚之体,怎么会有气实导致的喘息呢?如果肺部没有寒邪却出现气喘急促,这是因为失血导致阴虚,孤阳失去主宰,所以气息穷尽短促,浮脱于上,这实际上是肝肾之气不相接续,元气无根即将脱失的征兆,是最为危险的证候。《内经》说:肝苦急,急切时吃甘味食物来缓和它,正是这类情况。只有贞元饮是治疗此症的神效方剂。如果气虚兼有寒邪的,适宜使用大补丸煎,或者理阴煎。如果风寒外感,邪气入肺导致气喘急促的,这必然伴有呼吸粗重胸腹胀满,或者多咳嗽,这与气息短促似喘但上下不接的情况不同,治疗应当以疏散外邪兼补益正气为主,适宜使用金水六君煎,或者六君子汤。如果只是单纯寒邪入肺,气实气滞而原本没有虚证的,适宜使用六安煎,或者二陈汤加入苏叶之类为主进行治疗。
Sudden alternation of chills and fever after childbirth is generally caused by deficiency and damage to Qi and Blood, resulting in disharmony between Yin and Yang. If Yang prevails, there will be sudden heat; if Yin prevails, there will be sudden cold. For cases where Yin prevails with more coldness, Zengsun Siwu Tang (Modified Four Substance Decoction) or Liyin Jian (Decoction for Nourishing Yin) are appropriate. For cases where Yang prevails with more heat, Siwu Tang (Four Substance Decoction) or Sanyin Jian (Decoction for Nourishing the Three Yin) are appropriate. For cases where Yang Qi sinks into the Yin causing sudden alternation of chills and fever, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) or Buyin Yiqi Jian (Decoction for Nourishing Yin and Augmenting Qi) are appropriate. For cases where both Yin and Yang are deficient presenting with alternating chills and fever, Bazhen Tang (Eight Treasure Decoction) or Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) are appropriate. For cases where lochia (postpartum residual blood) fails to disperse and flows into the Yin causing chills and fever,iejue Jin Jian (Decoction for Resolving Fluids) or Dianbao Jian (Decoction for Settling the Womb) are appropriate. For cases of excess Blood and stagnant Qi, Mingdan (Life-Saving Pill) is appropriate. Chen Wuzhe stated: When broken blood obstructs the Yin meridians, cold occurs; when it obstructs the Yang meridians, heat occurs; Wuji San (Five Accumulations Powder) is appropriate. If there is an external pathogenic invasion, it should be treated according to the standard protocols for postpartum fever.
"Ru" refers to straw mats. The difficulty of parturition on straw mats leads to excessive mental and physical fatigue, hence the term "Ru Lao" (Childbed Exhaustion), which is essentially postpartum fatigue. Its symptoms may include alternating chills and fever resembling malaria, headache with spontaneous sweating, dizziness and lethargy, pain in all joints, lassitude with rapid breathing, poor appetite, emaciation, etc. All these manifestations should primarily be treated by tonifying Yuan Qi (Primary Qi). For Ru Lao and exhaustion immediately after childbirth, Zhu Yao Tang (Pig Kidney Decoction) is excellent, or Huang Ci Ji Tang (Yellow Hen Soup) and Bai Fuling San (White Poria Powder) can be used. For Ru Lao with incessant deficiency sweating, Mother Chicken Soup is appropriate. If accompanied by internal cold of the Zang organs, Lamb Soup is appropriate. If both Qi and Blood are deficient, Wufu Yin (Five Blessings Drink) or Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) are appropriate. If accompanied by fever from external pathogens, Buyin Yiqi Jian (Decoction for Nourishing Yin and Augmenting Qi) or Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) are appropriate. If accompanied by external fever and middle Jiao cold with aversion to cold on the back, Liyin Jian (Decoction for Nourishing Yin) is appropriate, to be treated with detailed modifications. If accompanied by Yang deficiency and internal cold, Wujunzi Jian (Decoction for Five Gentlemen) or Liyin Jian (Decoction for Nourishing Yin) are appropriate. If Yang is exuberant and Yin is deficient with internal heat, Wufu Yin (Five Blessings Drink) added with Shaoyao (Radix Paeoniae Alba), Huangqin (Scutellaria Root), and Digupi (Cortex Lycii) should be used as indicated.
There are two types of rapid breathing and asthma after childbirth: one is due to extreme Yin deficiency, and the other is due to Cold Pathogen in the Lung. Since the postpartum state is already a great deficiency, how can there be asthma due to Qi excess? If rapid breathing occurs without Cold Pathogen in the Lung, this is because blood loss leads to Yin deficiency, leaving solitary Yang without mastery, causing Qi to become exhausted and short, floating and detaching upwards. This is actually a sign that the Qi of the Liver and Kidney are not connecting, indicating that Root Qi is unrooted and about to detach, which is the most critical condition. The Classic says: "The Liver suffers from tension; eat sweet foods to relieve it." This is exactly such a case. Only Zhenyuan Yin (True Origin Drink) is the miraculous agent for treating this. If Qi deficiency is accompanied by Cold, Dabu Wan Jian (Great Tonifying Pill Decoction) or Liyin Jian (Decoction for Nourishing Yin) are appropriate. If Wind-Cold external invasion causes pathogens to enter the Lung leading to rapid breathing, this must present with coarse respiration, chest distension, or frequent coughing, which differs from the condition of shortness of breath resembling asthma with disconnect between upper and lower parts. Treatment should focus on dispersing pathogens while supplementing, using Jinshui Liujun Jian (Metal-Water Six Gentlemen Decoction) or Liujunzi Tang (Six Gentlemen Decoction). If it is solely Cold Pathogen entering the Lung causing Qi excess and stagnation without underlying deficiency, Liu'an Jian (Six Peaceful Decoction) or Erchen Tang (Two Aged Decoction) added with Ziye (Perilla Leaf) should be used as the main treatment.