大全云∶产后中风恍惚者,由心主血,血气通于荣卫脏腑,遍行经络,产则血气俱伤,
五脏皆虚,荣卫不足,即为风邪所乘,则令心神恍惚不定也。(自不语至恍惚等症,有谓气
血虚,有谓败血入心,有谓风邪所乘,一皆名为心风。然此风从何来,当从何治,前人亦未
之悉,但言治痰治风,而丹溪立斋则以大补气血为主,各有所见,在临症酌用可也)
薛氏曰∶前证当大补血气为主,而佐以后方为善,盖风为虚极之假象也,固其本源,诸
病自退,若专治风,则速其危矣。
一产妇患前证,盗汗自汗,发热晡热,面色黄白,四肢畏冷,此气血俱虚(以虚中之火,
故用如是耳),用八珍汤不应,更用十全大补加味归脾二汤始应。后因劳怒,发厥昏愦,左
目牵紧,两唇抽动,小便自遗,余谓肝火炽盛,用十全大补加钩藤山栀而安,再用十全大补
汤、辰砂远志丸而愈。
千金方 治产后暴苦心悸不定,言语错
乱恍惚,皆因心虚所致。
茯苓(三两) 芍药(二两) 当归 桂心(盖古方恒以桂为补,今之治者又畏其太热,反以伤
血,遵古法今,所当因病制宜也) 甘草(各一两) 麦冬(去心,一升) 生姜(一两半) 大枣(三十枚)
上为散,用水三升煎取一升,去滓,分作二服。
经效方 疗产后心虚忪悸,志意不定,烦躁恍惚。(此凉心之剂,心热者宜之)
茯神 当归 芍药 人参 麦门冬(去心) 酸枣仁(炒) 黄芩 甘草 白鲜皮(各二两) 大枣(七枚)
上为粗末,水二升煮取七合,去滓,温服。
琥珀散 治产后中风,恍惚语涩,心神烦闷,四肢不随。
琥珀(另研) 茯神(去木,各一两) 远志(去心) 石菖蒲 人参 黄 麦门冬(去心) 川芎
赤芍 防风 独活 桑寄生 羚羊角屑(各半两) 甘草(炙,二钱半)
上 咀,每服五钱,水煎温服,不拘时。(真产后中风者宜之,若曰虚风所为,则不宜用风药)
远志散 治产后中风,心神恍惚,言语错乱,烦闷,睡卧不安。(此与前方不甚远,而且
加桂心,故非真中风者不敢用。丹溪有云∶北方之人,真中风者恒有之,南方之人,皆是痰
生热,热生风,且如恍惚错乱,烦闷不安,皆热也,何敢用焉)
远志(去心) 防风(去芦,各一两) 当归 茯神(去木) 枣仁(炒) 麦冬(去心) 桑寄生
羚羊角屑 独活(去芦) 桂心(各七钱半) 甘草(炙,半两)
上 咀,每服五钱,水煎服。
天麻丸 治产后中风,恍惚语涩,四肢不随。
天麻 防风(去芦) 羌活(去芦) 朱砂(水飞,各一两) 僵蚕(炒,七钱半) 干蝎(炒)
五灵脂(炒) 白附子(炮,各半两) 雄雀粪(炒) 牛黄(另研,各二钱半)
上为细末,糯米饭为丸如桐子大,每服二
三十丸,薄荷酒送下,日进二服。
辰砂远志丸 治产后中风,消风化痰,安神镇心。
辰砂 远志肉(甘草煮) 石菖蒲 人参 茯神(去木,各五分) 川芎 山药 麦门冬(去心)
细辛 天麻 半夏 南星 白附子 铁粉(各一两)
上为末,姜汁煮,糊丸如绿豆大,别以朱砂为衣,每服三十丸,夜卧时生姜汤下。
《大全》记载:产后出现中风且神志恍惚的症状,是因为心主血脉,气血通过营卫运行于脏腑,遍布经络。分娩时气血俱伤,五脏皆虚,营卫不足,因此容易被风邪侵袭,导致心神不宁、神志恍惚不定。(从不能言语到神志恍惚等症状,有的认为是气血虚弱,有的认为是败血进入心脏,有的认为是风邪侵袭,这些都统称为“心风”。然而这种风从何而来,应当如何治疗,前人也没有完全阐明,只是说治疗痰和风,而朱丹溪和李东垣则以大补气血为主,各有见解,临证时酌情选用即可。)
薛己认为:上述症状应当以大补气血为主,并配合后文所列方剂治疗为妙,因为所谓的“风”其实是极度虚弱产生的假象。巩固其本源,各种病症自然消退;如果专门治疗风邪,反而会加速病情恶化危及生命。
有一位产妇患上述病症,伴有盗汗、自汗、发热及傍晚潮热,面色黄白,四肢畏冷,这是气血两虚(由于虚火内扰,所以表现出这些症状),使用八珍汤无效,改用十全大补汤加味归脾汤后才见效。后来因劳累和愤怒,出现昏厥、意识不清,左眼牵扯紧绷,双唇抽动,小便失禁。我认为这是肝火炽盛,使用十全大补汤加钩藤、山栀后病情安定,再用十全大补汤和辰砂远志丸治愈。
《千金方》:治疗产后突然悲伤、心悸不定、言语错乱、神志恍惚,这些都是因心虚所致。
茯苓(三两) 芍药(二两) 当归 桂心(古代方剂常以桂枝作为补益药,现代医者又担心其过于温热,反而损伤阴血,遵循古法还是顺应今俗,都应当根据病情制宜) 甘草(各一两) 麦冬(去心,一升) 生姜(一两半) 大枣(三十枚)
以上药物研为散剂,用水三升煎取一升,去渣,分两次服用。
《经效方》:治疗产后心虚悸动不安,意志不定,烦躁恍惚。(这是清心的方剂,适用于心热者。)
茯神 当归 芍药 人参 麦门冬(去心) 酸枣仁(炒) 黄芩 甘草 白鲜皮(各二两) 大枣(七枚)
以上药物切碎,用水二升煮取七合,去渣,温服。
琥珀散:治疗产后中风,神志恍惚、言语涩滞,心神烦闷,四肢活动不利。
琥珀(另研) 茯神(去木,各一两) 远志(去心) 石菖蒲 人参 黄芪 麦门冬(去心) 川芎 赤芍 防风 独活 桑寄生 羚羊角屑(各半两) 甘草(炙,二钱半)
以上药物切碎,每次服用五钱,水煎温服,不限时间。(适用于真正的产后中风患者,如果是虚风所致,则不宜使用祛风药。)
远志散:治疗产后中风,心神恍惚,言语错乱,烦闷,睡卧不安。(此方与前一方相差不远,但加了桂心,所以不是真正的中风患者不敢使用。朱丹溪曾说:北方人常有真正的中风,南方人多是痰生热,热生风,况且像恍惚错乱、烦闷不安,都属于热证,怎么敢用温燥药呢?)
远志(去心) 防风(去芦,各一两) 当归 茯神(去木) 枣仁(炒) 麦冬(去心) 桑寄生 羚羊角屑 独活(去芦) 桂心(各七钱半) 甘草(炙,半两)
以上药物切碎,每次服用五钱,水煎服。
天麻丸:治疗产后中风,神志恍惚、言语涩滞,四肢活动不利。
天麻 防风(去芦) 羌活(去芦) 朱砂(水飞,各一两) 僵蚕(炒,七钱半) 干蝎(炒) 五灵脂(炒) 白附子(炮,各半两) 雄雀粪(炒) 牛黄(另研,各二钱半)
以上药物研为细末,用糯米饭做丸,如梧桐子大小,每次服用二三十丸,薄荷酒送下,每日两次。
辰砂远志丸:治疗产后中风,祛风化痰,安神镇心。
辰砂 远志肉(甘草煮) 石菖蒲 人参 茯神(去木,各五分) 川芎 山药 麦门冬(去心) 细辛 天麻 半夏 南星 白附子 铁粉(各一两)
以上药物研为末,用姜汁煮糊做丸,如绿豆大小,另外用朱砂为衣,每次服用三十丸,睡前用生姜汤送下。
The *Daquan* records: Postpartum wind-stroke accompanied by mental confusion arises because the Heart governs blood vessels, and Qi and Blood circulate through Ying and Wei (Defensive and Nutritive Qi) to the Zang-Fu organs, traversing all meridians. Childbirth injures both Qi and Blood, leaving the Five Zang organs deficient, with insufficient Ying and Wei, making one susceptible to invasion by Wind pathogen, resulting in unsettled Heart Spirit and mental confusion. (Symptoms ranging from muteness to mental confusion are attributed variously to Qi and Blood deficiency, to stagnant blood entering the Heart, or to Wind pathogen invasion; all are collectively termed "Heart Wind." However, where this Wind originates and how it should be treated was not fully elucidated by predecessors. They merely spoke of treating Phlegm and Wind, whereas Zhu Danxi and Li Dongyuan emphasized major supplementation of Qi and Blood. Each has their own insights, which should be applied judiciously according to clinical presentation.)
Xue Ji stated: For the aforementioned symptoms, treatment should primarily focus on major supplementation of Qi and Blood, supplemented by the formulas listed below. This is because what appears as "Wind" is actually a false manifestation of extreme deficiency. By consolidating the root source, various diseases will recede spontaneously; if one treats only for Wind, it will hasten danger.
A postpartum woman suffered from the aforementioned symptoms, presenting with night sweats, spontaneous sweating, fever, afternoon tidal fever, yellowish-white complexion, and cold intolerance in the four limbs. This indicated dual deficiency of Qi and Blood (the manifestations result from deficient fire). Treatment with Bazhen Tang (Eight-Treasure Decoction) was ineffective. Subsequently, Shiquan Dabu Tang (Ten-Ingredient Decoction for Great Tonification) modified with Guipi Er Tang (Two Formulas for Restoring the Spleen) yielded results. Later, due to exertion and anger, she experienced syncope and unconsciousness, left eye pulling tightness, twitching of both lips, and urinary incontinence. I diagnosed this as blazing Liver Fire, and used Shiquan Dabu Tang plus Gouteng (Uncariae Ramulus Cum Uncis) and Zhizi (Gardeniae Fructus) to stabilize the condition. She was subsequently cured with Shiquan Dabu Tang and Chen Sha Yuanzhi Wan (Cinnabar and Polygala Pill).
*Qianjin Fang*: Treats sudden grief, palpitations, irregular speech, and mental confusion after childbirth, all caused by Heart deficiency.
Fuling (Poria, 3 liang), Shaoyao (Paeoniae Radix Alba, 2 liang), Danggui (Angelicae Sinensis Radix), Guixin (Cinnamomi Cortex), Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang each), Maidong (Ophiopogonis Radix, peeled heart, 1 sheng), Shengjiang (Zingiberis Rhizoma Recens, 1.5 liang), Dazao (Jujubae Fructus, 30 pieces).
Grind into powder. Boil in 3 sheng of water to obtain 1 sheng. Strain and divide into two doses.
*Jingxiao Fang*: Treats postpartum Heart deficiency with palpitations, unstable will/intent, irritability, and mental confusion. (This is a formula to cool the Heart, suitable for those with Heart heat.)
Fushen (Poria cum Radice Xylom), Danggui, Shaoyao, Renshen (Panacis Ginseng Radix), Maimendong (Ophiopogonis Radix, peeled heart), Suanzaoren (Ziziphi Spinosae Semen, stir-fried), Huangqin (Scutellariae Radix), Gancao, Baixianpi (Dictamni Cortex), Dazao (7 pieces, 2 liang each for herbs except Jujube).
Coarsely grind. Boil in 2 sheng of water to obtain 7 he. Strain and take warm.
Hupo San: Treats postpartum wind-stroke with mental confusion, slurred speech, mental restlessness, and immobility of the four limbs.
Hupo (Amber, separately ground), Fushen (Poria cum Radice Xylom, pith removed, 1 liang each), Yuanzhi (Polygalae Radix, peeled heart), Shichangpu (Acori Tatarinowii Rhizoma), Renshen, Huangqi (Astragali Radix), Maimendong (peeled heart), Chuanxiong (Ligustici Chuanxiong Rhizoma), Chishao (Paeoniae Radix Rubra), Fangfeng (Saposhnikoviae Radix), Duhuo (Angelicae Pubescentis Radix), Sangjisheng (Taxilli Caulis), Lingyangjiaoxie (Saigae Tataricae Cornu). Gancao (Licorice Root, honey-fried, 2.5 qian, half liang for others).
Chop ingredients. Take 5 qian per dose, decoct in water and take warm, at any time. (Suitable for true postpartum wind-stroke; if caused by deficient wind, wind-dispelling drugs are inappropriate.)
Yuanzhi San: Treats postpartum wind-stroke with mental confusion, erratic speech, restlessness, and disturbed sleep. (This formula is similar to the previous one but adds Guixin, so it should not be used unless it is true wind-stroke. Zhu Danxi said: True wind-stroke is common in people from the North; in the South, it is mostly Phlegm generating Heat, and Heat generating Wind. Since confusion, erratic speech, and restlessness are Heat patterns, how dare one use warming/drying drugs?)
Yuanzhi (peeled heart), Fangfeng (rhizome removed, 1 liang each), Danggui, Fushen (pith removed), Zaoren (Ziziphi Spinosae Semen, stir-fried), Maidong (peeled heart), Sangjisheng, Lingyangjiaoxie, Duhuo (rhizome removed), Guixin (7.5 qian each), Gancao (honey-fried, 0.5 liang).
Chop ingredients. Take 5 qian per dose, decoct in water and take.
Tianma Wan: Treats postpartum wind-stroke with mental confusion, slurred speech, and immobility of the four limbs.
Tianma (Gastrodiae Rhizoma), Fangfeng (rhizome removed), Qianghuo (Notopterygii Rhizoma et Radix), Zhusha (Cinnabaris, water-ground, 1 liang each), Jiangcan (Bombyx Batryticatus), Ganxie (Scorpio, stir-fried), Wulingzhi (Trogopterori Faeces, stir-fried), Baifuzi (Glehniae Radix, processed, 0.5 liang each), Xiongquefen (Male Sparrow Droppings, stir-fried), Niuhuang (Bovis Calculus, separately ground, 2.5 qian each).
Grind into fine powder. Make pills using glutinous rice paste, size of paulownia seeds. Take 20-30 pills per dose, washed down with mint wine, twice daily.
Chensha Yuanzhi Wan: Treats postpartum wind-stroke, dispels wind and transforms Phlegm, calms the Spirit and settles the Heart.
Chensha (Prepared Cinnabar), Yuanzhi Rou (Polygalae Radix flesh, boiled in Licorice), Shichangpu, Renshen, Fushen (pith removed, 5 fen each), Chuanxiong, Shanyao (Dioscoreae Rhizoma), Maimendong (peeled heart), Xixin (Asari Radix et Rhizoma), Tianma, Banxia (Pinelliae Rhizoma Preparatum), Nanxing (Arisaematis Rhizoma Preparatum), Baifuzi, Tiefen (Ferrum Oxidatum, 1 liang each).
Grind into powder. Cook with Ginger Juice and starch to make pills, size of mung beans. Coat with Zhusha. Take 30 pills per dose, washed down with Ginger Decoction before sleep.