典藏书目

The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: There are three types of postpartum syndromes in women: one is Jing disease (spasm, characterized by muscle stiffness and convulsions), two is Yumao (depression and dizziness, characterized by vertigo and blurred consciousness), and three is difficulty in defecation. The causes of these three syndromes are nothing other than damage to Yin fluids and depletion of blood. People know that Siwu Tang (Four Substances Decoction) can tonify blood, but this only recognizes its superficial efficacy without examining its root source. Blood is generated by the Heart and governed by the Spleen; if one wishes to seek its source, who else but these two? Furthermore, according to TCM theory, the Spleen governs muscles; Spleen deficiency leads to muscle fever. The Heart governs Shen (Spirit); Heart deficiency leads to the loss of Shen's containment. Calculating this, only Hei Guipi Tang (Black Spleen-Tonifying Decoction) can be considered a targeted prescription. Broadly exploring other therapies may lead to many divergent paths without effect. As the saying goes: "It is better to treat ten men than one woman." Generally, gynecological diseases are not difficult to treat; the most difficult aspects are pregnancy and childbirth. For various diseases during pregnancy, cultivating Qi and Blood is still necessary, let alone the emptiness of all vessels after childbirth, which is self-evident.

Mrs. Bao Yuqing, wife of Elder Yu Jing, has been ten days postpartum, presenting with fever, dizziness/fainting, limb convulsions and irritability, and restless sleep at night. Her pulse is rapid and large but powerless. It is determined that this is not due to retained blood stasis or wind pathogen invasion, but clearly belongs to Yin Deficiency with Yang Hyperactivity (Yin deficiency leading to floating Yang). The condition involves the root, not merely branch symptoms. Guipi Tang (Spleen-Tonifying Decoction) can cultivate the Heart and Spleen to generate the source of blood. Fortunately, her deficient constitution can tolerate tonification. However, using tonics for deficiency is like irrigating dry fields; irrigation should be frequent. The patient fears taking medicine. From yesterday morning until now, she has stopped taking medication, resulting in mental restlessness, limb agitation, and impending spasm and syncope. Add E Jiao (Donkey-hide Gelatin), Huang Jing (Polygonatum Rhizome), Da Zao (Jujube Fruit), and Mai Dong (Ophiopogon Tuber) to the original formula, and continue taking it without slackening.

An Bo's Commentary: A major current malpractice is the indiscriminate use of Shenghua Tang (Flower-Generating Decoction) for postpartum cases. Practitioners fail to realize that herbs like Xiong Gui (Ligusticum Chuanxiong and Angelica Sinensis) have wandering properties that can scatter Qi and Blood uncontrollably. Reviewing this case compared to using Guipi Tang with E Jiao and Huang Jing reveals a difference as vast as heaven and earth. Zhu Danxi previously stated that postpartum conditions are mostly due to Blood deficiency, advocating major tonification as the primary approach, treating miscellaneous symptoms secondarily. Zhang Jingyue said: "Postpartum conditions are often not deficient; during pregnancy, Qi and Blood are congested, and deficiency appears only after childbirth." This is a penetrating statement. Carefully pondering these two views requires the physician to be flexible and adaptable, avoiding rigid adherence to a single perspective, thus avoiding being like a fixed zither bridge unable to change.

In the *Shanghan Lun* (Treatise on Cold Damage Disorders), Jue syndrome (syncope/cold extremities) is differentiated into Yin and Yang. Yin Jue belongs to Cold, Yang Jue belongs to Heat; Cold should be treated with warmth, Heat with cooling. In the *Zabing Lun* (Treatise on Miscellaneous Diseases), Jue syndrome is differentiated into Deficiency and Excess. Duo Jue, Jian Jue, and Wei Jue are Deficiency types; Bo Jue, Shi Jue, and Shi Jue are Excess types. Excess can be reduced, and Deficiency can be tonified. This illness arises from unresolved emotions, causing the Liver Qi to lose its free flow. Qi and Blood become biased day by day, and Yin and Yang fail to connect smoothly, thereby causing Jue syndrome. This differs from pure Deficiency or pure Excess. The principle lies in balancing bias towards harmony, suitable for using mild methods. Partial tonification or partial reduction cannot treat diseases caused by emotions. Jue syndrome is common in women, obviously caused by emotional depression and stagnation. However, frequent occurrence day and night injures both Yin and Yang organ Qi, which is concerning. If it occurs occasionally, is mild, and sparse, it causes no harm. The worry is that the disease relates to emotions and is hard to eradicate completely. One must avoid anger, relax the mind, conserve energy, and rest quietly. During winter, the season of storage, extra caution is needed. Only when spring arrives and grasses and trees sprout can recurrence be prevented.

Jue syndrome can be caused by Phlegm or not. When caused by Phlegm, there is always rattling phlegm sound in the throat during the episode. This case is silent during the episode. Also, Phlegm-Jue pulse should be slippery; here the pulse is fine, wiry, and choppy, confirming it is undoubtedly Qi Jue (Qi Syncope). The method of palpating the pulse requires knowing the normal pulse first, then observing the pathological pulse. A fine pulse indicates constitutional deficiency, which is normal. However, the presence of a choppy quality within the fine pulse, along with a wiry image at the Right Cun and Guan positions, indicates pathology. Choppy pulse signifies Blood deficiency and Qi stagnation; Wiry pulse signifies weak Stomach and strong Liver. Fine, small, wiry, and choppy pulses indicate lighter pathology; Firm, large, wiry, and long pulses indicate severe pathology. All Jue syndromes belong to the Liver. Women regard the Liver as their "Heaven" (primary organ). The Liver governs anger; anger causes Qi to rise. The Classic states: "When Blood and Qi rush upward together, it becomes Great Jue." Thus, it is known to be caused by Liver Depression. Examining ancient treatments for Depression syndromes, Yueju Wan (Yueju Pill) and Xiaoyao San (Free and Easy Wanderer Powder) were often used. Yueju Wan is drying and harsh, while Xiaoyao San is moistening and mild. Yueju Wan is峻猛 (vigorous/aggressive), while Xiaoyao San is harmonious. Three methods for treating the Liver: Pungent dispersal, Sour astringency, and Sweet moderation. Xiaoyao San contains all three methods. Wood depression generates Fire; adding Mu Dan Pi (Moutan Cortex) and Zhi Zi (Gardeniae Fructus) creates Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). Nourishing Water to generate Wood by adding Shu Di Huang (Prepared Rehmannia Root) creates Hei Xiaoyao San (Black Free and Easy Wanderer Powder). *Jiren Bian* (Compilation of Self-Reliance) varies this into Shugan Yishen Tang (Liver-Soothing Kidney-Tonifying Decoction) and further into Zishen Shenggan Yin (Kidney-Nourishing Liver-Generating Drink). Previously, using Xiaoyao San minus Chai Hu was to avoid it being too central/stagnant; using Mu Dan Pi instead of Zhi Zi was to avoid its bitter-cold nature damaging the Stomach.

When both Liver and Stomach meridians are involved, one must distinguish whether Liver Yin and Stomach Fluids are already depleted. If fluids are not depleted, Qi-moving herbs can be temporarily used. If fluids are depleted, treatment must focus on nourishing Yin and moistening. The Stomach is Yang Earth, suitable for cooling and moistening; the Liver is a Rigid Organ, suitable for softening and harmonizing. Ye Tianshi discussed treating Depression syndromes, emphasizing not focusing on partial attack or tonification, but rather on using Bitter-Cold to clear Heat without damaging the Stomach, using Pungent herbs to regulate Qi without breaking it, using Slippery/Moist herbs to relieve dryness without clogging Qi mechanism, and using Unblocking methods without forcing growth. These words deeply grasp the principle of treating Depression. For Blood deficiency, one should tonify Blood; Siwu Tang (Four Substances Decoction) is the premier formula. However, one must distinguish Yin and Yang within it. If Blood deficiency leads to Liver Dryness and Wood-Fire boiling, Shao Yao (Peony Root), being slightly sour and cold, is essential. First use Sheng Di Huang (Raw Rehmannia Root) to cool Blood and generate Blood, then use Shu Di Huang (Prepared Rehmannia Root) to nourish Water and contain Wood. Chuan Xiong (Ligusticum Chuanxiong) is pungent and wandering, thus unsuitable; Dang Gui (Angelica Sinensis) should also be steamed to remove its pungent-warm nature. Among Blood-nourishing herbs, besides Siwu Tang, Dan Shen (Salvia Miltiorrhiza) is superior. Materia Medica states its red color enters the Heart, possessing the ability to remove stasis and generate new blood, combining the merits of the Four Substances, making it an important gynecological herb for backup.

Wood depression generates Fire, which should be cooled. However, this Fire does not come from outside but arises because Wood lacks Water nourishment, causing internal Liver Yang blazing. Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Zhi Mu (Anemarrhena Rhizome), and Huang Bai (Phellodendron Bark) are bitter-cold and damage the Stomach, truly unsuitable. Better to use Sheng Di Huang (Raw Rehmannia Root) and Mu Dan Pi (Moutan Cortex) to clear Liver heat and cool Blood steadily. In Five Element theory, Wood inevitably overacts on Earth. Liver Qi rebellious upward strikes the Stomach. Indeed, upon Jue onset, there is a mass in the epigastrium, painful on pressure, and food obstruction after eating. This is Liver invading Stomach, with Rebellant Yang following Yangming. Knowing Qi rebellion is the issue, treatment should first regulate Qi. Unfortunately, Qi-regulating herbs are mostly drying. With depleted Liver Yin and Stomach Fluids, how can drying herbs be used? The Classic says Lan Cao (Orchid Stem) removes stale Qi and awakens the Stomach and soothes the Liver; it can be added as a guiding herb. Sang Ye (Mulberry Leaf) is light and clear, able to drain Liver-Gallbladder depression-heat, often used with Mu Dan Pi in Ye Tianshi's cases with good results. "Tonify the mother when deficient"; treating Liver and Kidney together, Yi Gui Tong Yuan (Water and Wood share the same source) is the first key to treating Liver disease. However, wait until the epigastric fullness subsides and Jue stabilizes before planning follow-up. If using Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), add Dang Gui and Bai Shao, or remove Shan Zhu Yu, fearing its warming effect on the Liver. Chen Pi (Tangerine Peel) is best used, with reduced dosage, stir-fried with salt water.

Limb convulsions are named Liver Wind. This is not external wind but changes in internal Yang Qi, hence "All winds, dizziness, and tremors belong to the Liver." The Liver is a Rigid Organ and must be aided by softening and harmonizing methods. Treatment uses Harmonizing Yang and extinguishing Wind, and Nourishing Yin with Sweet moderation. Gou Teng (Uncaria Ramulus cum Uncis), Ju Hua (Chrysanthemi Flos), and Sang Ji Sheng (Taxilli Caulis et Folium) all have abilities to calm the Liver and extinguish Wind; add them as appropriate during attacks. The *Neijing* states: "The Liver suffers from tension; urgently eat Sweet to moderate it." The *Jingui Yaolue* presents Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction), using only Gan Cao (Licorice Root), Xiao Mai (Wheat Grain), and Zao Rou (Jujube Flesh). Because Wheat grows in Spring, it is the grain of the Liver, best nourishing the Liver. Combined with the sweetness of Licorice and Jujube, it moderates tension. Later experts treating Liver Wind often reference this method. Wood likes moisture and dislikes dryness. In constitutions with Yin deficiency and Blood dryness, encountering weather where Yang Qi leaks out, or touching emotional anger, can agitate Liver Wind, transforming into Spasm and Jue. Lingering for a long time depletes internal Yin fluids. One can borrow Fu Mai Tang (Pulse-Recovering Decoction) from *Qianjin Fang*. Pulse is a branch of Blood; since Blood vessels are deficient, rely on its medicinal power to unblock Ying and Wei, and distribute Jin Ye (Body Fluids). Ye Tianshi removed Jiang (Ginger) and Gui (Cinnamon Twig) from the formula to refine essence.

Although all Jue syndromes belong to the Liver, the Heart is the Sovereign Official. If the Heart is peaceful, the twelve officials perform their duties. Long-standing Jue causes internal Liver Wind to fan inward, shaking the Heart Ying (Nutritive Level). Although there are many Heart-nourishing and Spirit-calming drugs, Bao Mu Fu Shen (Poria with Pine Root) is recommended first. Fu Shen treats the Heart, and the pine root inside it belongs to the Liver, symbolizing using Wood to control Wood. Secondly, Bai Zi Ren (Biota Seed) can nourish the Heart and moisten the Kidney and Liver. Suan Zao Ren (Ziziphus Seed) should be steamed and dried mixed with Pig Heart Blood; Mai Dong (Ophiopogon Tuber) should be dyed with Chen Sha (Cinnabar). Adding Hu Po (Amber), Long Gu (Fossilized Bones), and Mu Li (Oyster Shell) all have sedative effects. For obese patients, fear Yang deficiency; for thin patients, fear Yin deficiency. After Yin deficiency, Yang floats upward, creating Lower Deficiency and Upper Excess, leading to Jue and Dian disorders. Therefore, among Yin-nourishing drugs, one must assist with Yang-subduing agents, like placing shellfish in a pond raising fish. Mu Li (Oyster Shell), Bie Jia (Tartar Carapace), Dan Cai (Edible Sea Squirt), and Gui Ban (Tortoise Plastron) are all shellfish. Using only Mu Li and Bie Jia in the formula takes advantage of Mu Li's Salty flavor to soften hardness, and Bie Jia's Green color entering the Liver, doing more than just subduing Yang.

An Bo's Commentary: Liver Jue is caused by Kidney Yin exhaustion and Liver Yang floating upward. Mild cases cause blockage of orifices and collaterals; severe cases cause twitching, spasms, and syncope. Thus, Jue always accompanies Spasm, often occurring this way.