仲景云∶问新产妇人有三病,一者病痉,二者病郁冒,三者大便难,何谓也?师曰∶新产
血虚,多汗出,喜中风,故令病痉(读此则知痉症亦有外来,不可专主气血不足而骤用补剂,
反致不救也)。亡血复汗寒多,故令郁冒。亡津液胃燥,故大便难。(产妇郁冒,即今世所谓血晕也。)
千金云∶凡产后满百日,乃可会合,不尔,至死虚羸,百疾滋长,慎之(至言)!凡妇人患
风气,脐下虚冷,莫不由此早行房故也。产后七日内,恶血未尽,不可服汤,候脐下块散,
乃进羊肉汤(不可服汤,谓不可服补气之剂,故羊肉汤亦俟块散后服)。有痛甚切者,不在
此例,候两三日消息,可服泽兰丸,此至盈月,丸药尽为佳。不尔,虚损不可平复也,至极消
瘦,不可救者,服五石泽兰丸补之,服法必七日之外,不得早服也。凡妇人因暑月产乳,取
凉太多,得风冷,腹中积聚,百疾竞起,迄至于死,百方疗不能瘥,桃仁煎主之,出蓐后服之。
妇人总令无病,每至秋冬,须服一二剂,以至年内,常将服之佳。
脉经云∶诊妇人生产之后,寸口脉洪疾不调者死,沉微附骨不绝者生(不调字并附骨不
绝字,重看)。妇人新生乳子,脉沉小滑者生,实大坚弦急者死。
丹溪曰∶产前脉细小,产后脉洪大者,多死。又曰∶产前脉当洪数,既产而洪数如故
者,多主死。(此亦大概言之,今见产后,岂无脉洪数而生者。)(洪数中得胃气者亦生,坚强
者死,亦须审
原禀脉何如?乃当知)
张仲景说:问新产妇人有三种病,一是痉病,二是郁冒,三是大便难,这是什么原因呢?老师说:新产之后血虚,多汗出,容易感受风邪,所以导致痉病(读到这里就知道痉症也有外感因素,不能专门主张气血不足而急于使用补剂,否则反而会导致无法救治)。失血后又出汗且寒邪多,所以导致郁冒。津液耗伤、胃中干燥,所以导致大便难。(产妇的郁冒,就是当今世面所说的血晕。)
孙思邈《千金方》说:凡是产后满一百天,才可以行房事,不然的话,会导致死亡、身体虚弱消瘦,各种疾病滋生,务必谨慎(这是至理名言)!凡是妇人患有风气,脐下虚冷,没有不是由于过早行房造成的。产后七日内,恶露未尽,不可服用汤药,等到脐下瘀块消散后,再进服羊肉汤(所谓不可服汤,是指不可服用补气之剂,所以羊肉汤也要等瘀块消散后再服用)。如果有疼痛非常剧烈的,不在此例,等到两三天后气息稍定,可以服用泽兰丸,这到满月时,将丸药服完为佳。不然的话,虚损症状无法平复,甚至极度消瘦,无法救治的,服用五石泽兰丸来补益,服药方法必须在七日之后,不得提前服用。凡是妇人因在暑月生产,贪凉太多,感受风冷,导致腹中积聚,各种疾病竞发,直至死亡,用百种方法治疗都不能痊愈,用桃仁煎主治,应在出月子后服用。妇人即使总体无病,每到秋冬季节,也必须服用一二剂,直到年底,经常服用为好。
王叔和《脉经》说:诊察妇人生产之后,寸口脉洪大疾速而不调和的预后不良,沉微但按之至骨仍有根气的预后良好(“不调”二字和“附骨不绝”四字,需重点理解)。妇人刚生产完哺乳婴儿,脉象沉小滑利的预后良好,脉象实大坚弦急的预后不良。
朱丹溪说:产前脉象细小,产后脉象洪大的,大多预后不良。又说:产前脉象应当洪数,分娩后洪数脉象依旧存在的,大多主死。(这也是一般而言,如今见到产后,难道没有脉洪数而存活的情况吗?)(洪数脉中若得胃气者也能存活,脉象坚强者则死,也必须审察其原本禀赋的脉象如何,才能知晓。)
Zhang Zhongjing said: Regarding the three diseases in new postpartum women, one is Jing disease (spasm), the second is Yumao (dizziness and fainting), and the third is difficult defecation. What does this mean? The Master said: After a new delivery, there is blood deficiency, excessive sweating, and susceptibility to wind pathogens, thus causing Jing disease (Reading this reveals that spasm can also be caused by external factors; one should not solely attribute it to Qi and blood deficiency and hastily use tonifying agents, which may lead to untreatable conditions). Loss of blood followed by sweating and abundant cold pathogens causes Yumao. Depletion of body fluids and dryness in the Stomach causes difficult defecation. (Yumao in postpartum women is what is currently known as Xueyun [blood syncope].)
Sun Simiao's *Qianjin Fang* states: Generally, marital intercourse should only resume after one hundred days postpartum; otherwise, it may lead to death, extreme emaciation, and the proliferation of various diseases. This must be strictly observed (this is an ultimate truth)! Any woman suffering from Wind pathogen conditions or cold deficiency in the lower abdomen invariably results from engaging in intercourse too early after childbirth. Within seven days postpartum, when lochia has not yet cleared, decoctions should not be taken. One should wait until the masses in the lower abdomen dissipate before administering Mutton Decoction (The instruction "do not take decoctions" refers to avoiding Qi-tonifying formulas; thus, Mutton Decoction should also be taken only after the masses have dissipated). In cases of severe pain, this rule does not apply. After two or three days when the patient's breath stabilizes, Zeluan Wan (Zeluan Pill) can be administered. It is best to complete the course of pills by the end of the first month. Otherwise, the deficiency damage cannot be resolved, potentially leading to extreme emaciation and untreatable conditions. In such critical cases, Wushi Zeluan Wan (Five-Stone Zeluan Pill) can be used for supplementation. The administration method requires waiting until after the seventh day; it must not be taken early. For women who give birth during the hot summer months, excessive cooling and exposure to wind-cold can lead to abdominal accumulations and the onset of various diseases, potentially resulting in death despite numerous treatments. Taoren Jian (Peach Kernel Decoction) is the primary treatment, to be taken after the confinement period ends. Even if women are generally healthy, they should take one or two doses every autumn and winter until the end of the year, with regular consumption being beneficial.
Wang Shuhe's *Mai Jing* states: When examining women after childbirth, a Cun Kou pulse that is Hong (surging) and rapid but irregular indicates a poor prognosis, whereas a Chen (deep) and Wei (fine) pulse that remains palpable even when pressed to the bone indicates survival (The terms "irregular" and "palpable to the bone" require careful attention). For women who have just given birth and are nursing, a pulse that is Chen, Xiao (small), and Hua (slippery) indicates survival, while a pulse that is Shi (excess), Da (large), Jian (firm), Xian (wiry), and Ji (rapid) indicates a poor prognosis.
Zhu Danxi said: A pulse that is Xi Xiao (fine and small) during pregnancy but becomes Hong (surging) and Da (large) postpartum often indicates a poor prognosis. He also stated: During pregnancy, the pulse should typically be Hong and Shuo (rapid); if the Hong and Shuo pulse persists unchanged after delivery, it often indicates death. (This is a general statement; nowadays, we see cases where women survive despite having a Hong and Shuo pulse postpartum.) (If a Hong and Shuo pulse retains the Stomach Qi, survival is possible; if the pulse is rigid and strong, death ensues. One must also examine the patient's original constitutional pulse to determine the outcome.)