薛氏曰∶玉门不闭,气血虚弱也,用十全大补汤;肿胀 痛,肝经虚热也,加味逍遥散;
若因忧怒,肝脾气血伤也,加味归脾汤;若因暴怒,肝火血伤也,龙胆泻肝汤。
一产妇玉门不闭,发热恶寒,用十全大补加五味子数剂,而寒热退,用补中益气加五味
子数剂。而玉门闭。
一妇人脾胃素弱,兼有肝火,产后玉门肿痛,寒热作渴,呕吐不食,外敷大黄等药,内用
驱利之剂,肿及于臂,诸证蜂起,此真气虚而邪气盛也,先用六君子以固肠胃,次用补中益
气以升阳气,下数剂而痊愈。(无肝火则不肿痛,非脾胃弱则不呕吐,故用大黄等药失其治也)
一产妇患此失治,肿溃不已,形体消瘦,饮食少思,(此从饮食少思治)朝寒暮热,自汗
盗汗,半年矣,用补中益气汤加茯苓、半夏,脓水渐少,饮食渐进,又用归脾汤,共五十余剂而愈。
一产妇玉门不闭,小便淋沥,腹内一块,攻走胁下,或胀或痛,(此从胁下胀痛淋沥治)
用加味逍遥散加车前子而愈。
一妇人子宫肿大,二日方入,损落一片,殊类猪肝,面黄体倦,饮食无味,内热晡热,
自汗盗汗,用十全大补汤二十余剂,诸证悉愈,仍复生育。
十全大补汤 治产后血气大虚,阴门不闭,发热恶寒。
本方加五味子,水煎服。
硫黄汤 治产后玉门开而不闭。
硫黄(四两) 吴茱萸 菟丝子(各一两半) 蛇床子
上锉,每服四钱,水一碗煎汤,频洗之,自效。
敛阴法 治新产后阴肿下脱及产门不合。
新锻石半升先放在脚盆内,后以沸汤冲入,乘热于上熏之,俟温,用手掬清者沃淋之。
未效,日再用。(有一妇用此法熏之即死,不可不慎。大抵宜温不宜乘热也,盖以新锻石而加
滚汤,以熏新产之妇,能不伤乎,故尽信书不如无书,又当以己意逆之也)
当归汤 治产后脏中风冷,阴肿痛。(品味俱妙)
当归 独活 白芷 地榆(各三两) 败酱(《千金翼》不用) 矾石(各三两)
上锉碎,以水一斗半煮取五升,适冷暖洗阴,日三。(适冷暖二字妙)
一方 治妇人子宫大痛不可忍,并产后生肠不收。(谓子宫坠下以致大痛也,此子宫
当以玉门为释,观生肠不收可想矣,不然腹中之物岂能泡糁,是玉门,前案可据)
五倍子 白矾(各等分)
上为末,温酒泡洗,干糁亦可。
桃仁膏 治产后阴肿妨闷。(此谓阴肿有瘀血)
桃仁(去皮尖) 五倍子 枯矾(各等分)
上为末,研桃仁膏拌匀敷。
一方 单用桃仁,去皮尖研细,四五次抹之。
万应丸 治产后小户痛不可忍。
知母一味去皮,炒为末,炼蜜丸如弹子大,每服一丸,清酒一盏化下。
一方 治产后阴户两旁肿痛,手足不能舒伸者,用四季葱入乳香。同捣成饼,安于阴
户两旁,良久即愈。(两旁属厥阴,葱涎止痛,以其通也,四季葱通而愈通,况同乳香乎,此
入理之方,请试思之)
薛氏说:玉门(阴道口)不能闭合,是气血虚弱所致,使用十全大补汤;肿胀疼痛,是肝经虚热所致,使用加味逍遥散;如果是因为忧愁愤怒导致肝脾的气血受损,使用加味归脾汤;如果是因为暴怒导致肝火伤及血液,使用龙胆泻肝汤。
有一位产妇玉门不闭,伴有发热恶寒,服用加了五味子的十全大补汤数剂后,寒热症状消退;接着服用加了五味子的补中益气汤数剂,玉门便闭合了。
有一位妇人脾胃向来虚弱,兼有肝火,产后玉门肿痛,出现寒热、口渴、呕吐、不能进食的症状。她外用大黄等药物,内服通利攻下的药剂,结果肿胀蔓延至手臂,各种病症蜂拥而起。这是真气虚弱而邪气盛实的情况,先用六君子汤来巩固肠胃,再用补中益气汤来提升阳气,服用数剂后痊愈。(如果没有肝火就不会肿痛,如果不是脾胃虚弱就不会呕吐,所以使用大黄等药物是错误的治法。)
有一位产妇患此病失治,肿胀溃烂不止,形体消瘦,饮食减少且缺乏食欲(此处应从调理饮食少思入手),早晨怕冷傍晚发热,自汗和盗汗,持续半年之久。使用补中益气汤加入茯苓、半夏,脓水逐渐减少,饮食逐渐增加;又改用归脾汤,共服用五十多剂而痊愈。
有一位产妇玉门不闭,小便淋漓不尽,腹内有肿块,游走至胁下,有时胀有时痛(此处应从胁下胀痛和小便淋漓入手治疗),使用加味逍遥散加入车前子而痊愈。
有一位妇人子宫肿大,两天后才缩回,脱落一片组织,形状极像猪肝,面色萎黄,身体疲倦,饮食无味,体内发热且午后潮热,自汗和盗汗。使用十全大补汤二十多剂,所有症状全部痊愈,后来恢复了生育能力。
十全大补汤:治疗产后气血大虚,阴门不闭,发热恶寒。
本方加入五味子,用水煎服。
硫黄汤:治疗产后玉门张开而不能闭合。
硫黄(四两)、吴茱萸、菟丝子(各一两半)、蛇床子。
以上药材切碎,每次取四钱,用一碗水煎成汤,频繁清洗患处,自然见效。
敛阴法:治疗新产后阴部肿胀下垂以及产门不合。
取半升新锻石先放在脚盆内,然后倒入沸水冲入,趁热气在上面熏蒸,等到水温适宜,用手捧起清水淋洗患处。
如果未见效,第二天再用。(曾有一位妇女用此法熏蒸导致死亡,不可不谨慎。大抵适宜温和而不宜趁热,因为新锻石加上滚水,用来熏蒸刚生产的妇女,能不造成伤害吗?所以尽信书不如无书,还应当用自己的心意去推测验证。)
当归汤:治疗产后脏腑受风冷侵袭,阴部肿痛。(品味都很精妙)
当归、独活、白芷、地榆(各三两)、败酱(《千金翼方》不用)、矾石(各三两)。
以上切碎,用一斗半水煮取五升,调节冷暖清洗阴部,每天三次。(“调节冷暖”二字很精妙。)
另一方:治疗妇人子宫剧烈疼痛难以忍受,以及产后肠脱不收。(所谓子宫坠下导致剧痛,这里的子宫应当解释为玉门,看肠脱不收就可以想象了,否则腹中之物岂能泡在粪水中,这是指玉门,前面的案例可以作为依据。)
五倍子、白矾(各等分)。
以上研为粉末,用温酒浸泡清洗,干燥后撒粉也可以。
桃仁膏:治疗产后阴部肿胀感到烦闷。(这里指阴肿是由于瘀血引起)
桃仁(去皮尖)、五倍子、枯矾(各等分)。
以上研为粉末,研磨桃仁制成膏状拌匀后敷贴。
万应丸:治疗产后小户(指难产或产后恢复期女性)疼痛难以忍受。
知母一味,去皮,炒后研为粉末,炼蜜制成如弹子大小的丸药,每次服用一丸,用一盏清酒化开送服。
另一方:治疗产后阴户两旁肿痛,手足不能伸展的,用四季葱加入乳香,一同捣成饼状,放置在阴户两旁,很久之后即可痊愈。(两旁属于厥阴经,葱汁止痛,因为它具有通达的作用,四季葱通达而更加通达,何况还同乳香一起呢?这是一个合乎医理的方子,请试着思考它。)
Mr. Xue said: The inability of the Yumen (vaginal opening) to close is due to deficiency of Qi and Blood; use Shiquan Dabu Decoction (Ten Complete Tonifying Decoction). Swelling and pain are due to deficient heat in the Liver channel; use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If caused by sorrow and anger damaging the Qi and Blood of the Liver and Spleen, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). If caused by violent anger injuring the Blood with Liver Fire, use Longdan Xiegan Tang (Gentian Decoction to Drain the Liver).
A postpartum woman presented with an unclosed Yumen, accompanied by fever and aversion to cold. After taking several doses of Shiquan Dabu Decoction added with Wuweizi (Schisandrae Fructus), the chills and fever subsided. Subsequently, after taking several doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Wuweizi, the Yumen closed.
A woman with a constitutionally weak Spleen and Stomach, complicated by Liver Fire, experienced swelling and pain of the Yumen postpartum, along with alternating chills and fever, thirst, vomiting, and loss of appetite. She applied external medicines such as Dahuang (Rhei Radix et Rhizoma) and took internal purgatives. Consequently, the swelling spread to her arms, and various symptoms arose. This indicated that True Qi was deficient while Pathogenic factors were excessive. First, Liujunzi Tang (Six Gentlemen Decoction) was used to stabilize the intestines and stomach, followed by Buzhong Yiqi Tang to raise Yang Qi. After several doses, she recovered. (Without Liver Fire, there would be no swelling or pain; without weak Spleen and Stomach, there would be no vomiting. Therefore, using Dahuang and similar drugs was an incorrect treatment.)
A postpartum patient suffered from this condition due to mismanagement, resulting in persistent swelling and ulceration, emaciation, poor appetite, morning chills and evening fevers, spontaneous sweating, and night sweats, lasting for half a year. Bu Zhong Yi Qi Tang added with Fuling (Poria) and Banxia (Pinelliae Rhizoma) was used, gradually reducing the pus and improving dietary intake. Then, Guipi Tang (Restore the Spleen Decoction) was administered. After more than fifty doses, she recovered.
A postpartum woman had an unclosed Yumen, dribbling urination, and a mass in the abdomen that moved to the hypochondrium, causing distension or pain. Treating based on the hypochondriac distension/pain and dribbling urination, Jiawei Xiaoyao San added with Cheqianzi (Plantaginis Semen) cured her.
A woman presented with uterine enlargement that only reduced after two days, shedding a piece of tissue resembling pig liver. She had sallow complexion, fatigue, tasteless food, internal heat, afternoon tidal fever, spontaneous sweating, and night sweats. After more than twenty doses of Shiquan Dabu Decoction, all symptoms resolved, and she regained fertility.
Shiquan Dabu Decoction: Treats severe deficiency of Qi and Blood postpartum, unclosed vaginal opening, fever, and aversion to cold.
Add Wuweizi (Schisandrae Fructus) to this formula, decoct in water, and take orally.
Liu Huang Tang (Sulfur Decoction): Treats Yumen opening and failing to close postpartum.
Liu Huang (Sulfur, 4 liang), Wuzhuyu (Evodiae Fructus), Tusizi (Cuscutae Semen, each 1.5 liang), Chuangzi (Cnidii Fructus).
Crush the herbs. For each dose, take 4 qian, decoct in one bowl of water to make a soup, and wash frequently. It will be effective spontaneously.
Lian Yin Method (Method to Astringe Yin): Treats vulvar swelling and prolapse and unclosed vaginal opening immediately postpartum.
Place half sheng of Xin Duanshi (Newly Calcined Iron Ore/Slag) in a foot basin first, then pour boiling water into it. Steam over the hot vapor while it is still hot. When warm enough, scoop up the clear liquid with hands and wash/sprinkle it on the affected area.
If ineffective, repeat daily. (One woman died after using this steaming method; caution is required. Generally, warmth is suitable, but not scalding heat. Using newly calcined slag with boiling water to steam a postpartum woman can cause injury. Thus, blind faith in books is worse than having no books at all; one must also verify with one's own judgment.)
Danggui Tang (Angelica Decoction): Treats wind-cold invading the viscera postpartum, causing vulvar swelling and pain. (The ingredients are excellent.)
Danggui (Angelicae Sinensis Radix), Duhuo (Angelicae Pubescentis Radix), Baizhi (Angelicae Dahuricae Radix), Diyü (Sanguisorbae Radix, each 3 liang), Baijiang (Patriniae Herba - not used in *Qianjin Yi Fang*), Fanshi (Alumen, each 3 liang).
Crush the herbs. Boil in 1.5 dou of water to obtain 5 sheng. Wash the vulva with appropriate temperature (neither too hot nor too cold), three times a day. (The instruction "appropriate temperature" is exquisite.)
Another Prescription: Treats unbearable severe pain of the uterus and prolapse of the rectum/intestine postpartum. (This refers to uterine prolapse causing severe pain. Here, "uterus" should be interpreted as the Yumen/vaginal opening; considering the prolapse of the intestine, this interpretation is supported by previous cases.)
Wubeizi (Galla Chinensis), Baifan (Alumen, equal parts).
Grind into powder. Soak and wash with warm wine, or apply dry powder.
Taoren Gao (Peach Kernel Paste): Treats vulvar swelling causing stifling sensation postpartum. (This indicates vulvar swelling due to blood stasis.)
Taoren (Persicae Semen, peeled and removed of pits), Wubeizi (Galla Chinensis), Kufan (Calcined Alumen, equal parts).
Grind into powder, mix with paste made from crushed peach kernels, and apply externally.
Another Prescription: Use Taoren (Persicae Semen) alone, peel and remove pits, grind finely, and apply four or five times.
Wanying Wan (Myriad Applications Pill): Treats unbearable pain in the "Xiaohu" (a term referring to difficult childbirth or postpartum recovery period women).
Zhimu (Anemarrhenae Rhizoma) alone, peeled, stir-fried, and ground into powder. Make pills with refined honey the size of a bullet. Take one pill per dose, dissolved in one zhan of clear wine.
Another Prescription: Treats swelling and pain on both sides of the vulva postpartum, where hands and feet cannot extend. Use Sichuan Cong (Allium fistulosum, available in all seasons) mixed with Ruxiang (Olibanum). Pound together into a cake and place on both sides of the vulva. Recovery occurs after a long time. (Both sides belong to the Jueyin channel. Scallion juice relieves pain due to its unblocking properties. Sichuan Cong is unblocking and becomes more so when combined with Olibanum. This is a rational prescription; please ponder it.)