产后乳自出,乃阳明胃气之不固,当分有火无火而治之。若无火而泄不止,由气虚也。宜八珍汤(方见前滑
胎条中)、十全大补汤(方见前产门不闭条中)。若阳明血热而溢者,宜保阴煎,或四君子汤加栀子。若肝经
怒火上冲,乳胀而溢者,宜加减一阴煎。若乳多胀痛而溢者,宜温帛熨而散之。若未产而乳自出者,以胎元薄
弱,滋溉不全而溢也,谓之乳泣,生子多不育。
保阴煎
生地黄 熟地黄 白芍(各二钱) 山药(姜汁炒) 川续断 黄芩 黄柏(各一钱五分) 生甘草(一钱)
水二钟,煎七分,食远温服。
如小水多热,或兼怒火动血者,加栀子(炒黑)一钱。夜热身热,加地骨皮一钱五分。肺热多汗,加麦冬(去
心)、酸枣仁各一钱。血热甚者,加黄连一钱五分。血虚血滞筋骨疼痛,加当归二三钱。气滞而痛,去熟地黄,
加陈皮、青皮、
丹皮、香附之类。血脱血滑及便血久不止者,加地榆一钱或乌梅一个。少壮强盛者,不必用熟地黄、山药。肢节
筋骨疼痛,或肿胀者,加秦艽、丹皮各一二钱。
加减一阴煎
生地黄 白芍 麦冬(去心,各二钱) 熟地黄(三五钱) 炙甘草(五七分) 知母 地骨皮(各二钱)
水煎温服。如躁烦热甚便结者,加石膏二钱;小儿热涩者,加栀子一二钱;火浮于上者,加泽泻一二钱,或
黄芩一钱;血躁血少者,加当归一二钱。
四君子汤
人参 白术(蜜炙) 茯苓(各二钱) 炙甘草(一钱) 姜(三片) 枣(二枚)
水煎服。
产后乳汁自行流出,是由于阳明胃气固摄无力所致,治疗时应区分体内有火或无火两种情况。如果是因为没有实火而乳汁漏泄不止,这是由于气虚引起的。适宜使用八珍汤(方剂见前文滑胎条中)、十全大补汤(方剂见前文产门不闭条中)。如果是阳明经血分有热导致乳汁溢出,适宜使用保阴煎,或者在四君子汤基础上加入栀子。如果是肝经怒火上冲,导致乳房胀痛且乳汁溢出,适宜使用加减一阴煎。如果乳汁过多且伴有胀痛溢出,适宜用温热的布巾熨敷以消散郁结。如果在未分娩时乳汁就自行流出,这是因为胎元薄弱,滋养灌溉不全导致的溢出,这种情况称为“乳泣”,所生的孩子大多难以养活。
保阴煎
生地黄、熟地黄、白芍(各二钱),山药(用姜汁炒制),川续断,黄芩、黄柏(各一钱五分),生甘草(一钱)。
加水两钟,煎至七分,饭后稍远时温服。
如果小便多且有热感,或者兼有怒火扰动血分的情况,加入炒黑栀子一钱。夜间身体发热,加入地骨皮一钱五分。肺热导致多汗,加入去心的麦冬、酸枣仁各一钱。血热严重的,加入黄连一钱五分。血虚且血行不畅导致筋骨疼痛的,加入当归二三钱。气机阻滞导致疼痛的,去掉熟地黄,加入陈皮、青皮、丹皮、香附等药物。出现血脱、血滑以及便血久治不愈的,加入地榆一钱或乌梅一个。年轻力壮体质强健者,不必使用熟地黄、山药。肢体关节筋骨疼痛,或者出现肿胀的,加入秦艽、丹皮各一二钱。
加减一阴煎
生地黄、白芍、麦冬(去心,各二钱),熟地黄(三到五钱),炙甘草(五到七分),知母、地骨皮(各二钱)。
加水煎煮后温服。如果出现烦躁、热势严重且大便干结的,加入石膏二钱;小儿出现热涩症状的,加入栀子一二钱;火邪浮越于上部的,加入泽泻一二钱,或者黄芩一钱;血躁动且血少的,加入当归一二钱。
Postpartum spontaneous lactation is caused by the failure of Stomach Qi in the Yangming channel to maintain control. Treatment should differentiate between cases with heat-fire and those without. If leakage persists without fire, it is due to Qi deficiency. Ba Zhen Tang (Eight Treasures Decoction) [see formula in previous miscarriage section] or Shi Quan Da Bu Tang (Ten Complete Tonifying Decoction) [see formula in previous uterine closure section] are appropriate. If overflow is caused by blood-heat in the Yangming channel, Bao Yin Jian (Preserve Yin Decoction) or Si Jun Zi Tang (Four Gentlemen Decoction) added with Zhi Zi (Gardeniae Fructus) is suitable. If liver-fire surges upward causing breast distension and overflow, Jia Jian Yi Yin Jian (Modified One-Yin Decoction) is indicated. If there is excessive milk production accompanied by distending pain and overflow, warm cloth compresses should be applied to dissipate the stagnation. If lactation occurs before delivery, it is termed Ru Qi (Milk Weeping), caused by weak fetal origin and insufficient nourishment; children born under this condition often fail to thrive.
Bao Yin Jian (Preserve Yin Decoction)
Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Prepared Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba) (each 2 qian), Shan Yao (Dioscoreae Rhizoma stir-fried with ginger juice), Chuan Xu Duan (Drynariae Rhizoma), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex) (each 1.5 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) (1 qian).
Add two zhong of water, decoct until one-seventh remains, and take warm after meals.
If urine is frequent and hot, or if fire disturbs the blood, add 1 qian of chao hei Zhi Zi (Charred Gardeniae Fructus). For night fever and body heat, add 1.5 qian of Di Gu Pi (Lycii Cortex). For lung-heat with excessive sweating, add 1 qian each of qu xin Mai Dong (Ophiopogonis Tuber, heart removed) and Suan Zao Ren (Ziziphi Spinosae Semen). For severe blood-heat, add 1.5 qian of Huang Lian (Coptidis Rhizoma). For blood-deficiency with blood-stasis causing bone and joint pain, add 2-3 qian of Dang Gui (Angelicae Sinensis Radix). For Qi-stagnation causing pain, remove Shu Di Huang and add Chen Pi (Citri Reticulatae Pericarpium), Qing Pi (Citri Reticulatae Pericarpium Viride), Dan Pi (Moutan Cortex), Xiang Fu (Cyperi Rhizoma), etc. For blood-loss, slippery blood, and persistent hematochezia, add 1 qian of Di Yu (Sanguisorbae Radix) or one Wu Mei (Mume Fructus). Young and robust individuals need not use Shu Di Huang and Shan Yao. For limb, joint, and bone pain or swelling, add 1-2 qian each of Qin Jiao (Gentianae Macrophyllae Radix) and Dan Pi.
Jia Jian Yi Yin Jian (Modified One-Yin Decoction)
Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Tuber, heart removed) (each 2 qian), Shu Di Huang (Prepared Rehmanniae Radix) (3-5 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) (0.5-0.7 qian), Zhi Mu (Anemarrhenae Rhizoma), Di Gu Pi (Lycii Cortex) (each 2 qian).
Decoct in water and take warm. For restlessness, severe heat, and constipation, add 2 qian of Shi Gao (Gypsum Fibrosum). For infants with heat and urinary difficulty, add 1-2 qian of Zhi Zi. For floating fire in the upper jiao, add 1-2 qian of Ze Xie (Alismatis Rhizoma) or 1 qian of Huang Qin. For blood-restlessness and blood-deficiency, add 1-2 qian of Dang Gui.
Si Jun Zi Tang (Four Gentlemen Decoction)
Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma honey-fried), Fu Ling (Poria) (each 2 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) (1 qian), Sheng Jiang (Zingiberis Rhizoma Recens) (3 slices), Da Zao (Jujubae Fructus) (2 pieces).
Decoct in water and take.