产后血晕,因阴血暴虚,孤阳上冒,忽然头旋眼黑,昏闷不醒,急用清魂散,或以童便热服。然有血下
过多而晕者,有血下少而晕者,晕虽同,治法则异。如血下多而晕,神昏烦乱而已,治宜补血清心。如生地、
白芍、当归、茯苓、麦冬、阿胶、人参、龙齿、枣仁等。渴烦汗热,加乌梅、山栀、丹参、浮小麦等。烦热,
去当归,加童便。血下少而晕,乃恶露不下,上抢心,心下满急,神昏口噤,治宜行血破瘀,加生楂肉,桃仁、
牛膝、桂心、归尾、苏木,合失笑散。或用四味散、黑神散、鹿角散、郁金散。若痰火上壅,用导痰汤加朱砂
安神丸。清降治之。有一产妇暴死,但胸微热,陆 诊之曰∶血闷也。以红花煮沸入木桶,寝妇于上
熏之,汤冷加之,遂指动而苏。
一、禁卧。恐气未定,遽卧则恶血上升也。二、禁酒。恐助火升动其阳,致眩晕也。三、禁浴。恐水
湿沁窍,致喘满肿重也。四、禁寒。恐血气凝滞,腹痛吐泻诸变丛生也。五、禁汗。恐风药性升,开泄伤阳也。
六、禁下。恐肠腑津液伤也。七、禁利小便。恐伤肾气蛰藏也。八、禁寒凉药。恐伤胃,或滋瘀痛也。白芍、
地黄、黄芩等皆慎用。九、禁交合早。恐百脉开张,头眩少腹急满也。十、禁起早作劳,不避风寒,不谨食忌,
致滋疾也。
产后血晕,是由于阴血突然大量亏损,导致孤阳上浮冲逆,患者忽然出现头晕目眩、眼前发黑、神志昏闷不醒的症状。此时急需使用清魂散(Qinghun San),或者用童子尿加热后服用。然而,有的产妇是因为恶露排出过多而晕厥,有的是因为恶露排出过少而晕厥。虽然晕厥的表现相同,但治疗法则却不同。
如果是恶露排出过多导致的晕厥,表现为神志昏迷、心烦意乱而已,治疗应当以补血清心为主。可选用药材如生地黄、白芍、当归、茯苓、麦冬、阿胶、人参、龙齿、酸枣仁等。如果伴有口渴、心烦、出汗、发热,可加入乌梅、山栀、丹参、浮小麦等。如果仅有烦热症状,则去掉当归,加入童子尿。
如果是恶露排出过少导致的晕厥,这是因为恶露不下,瘀血上冲于心,导致心下痞满急迫,神志昏迷、牙关紧闭,治疗应当以行血破瘀为主。可加入生山楂肉、桃仁、牛膝、桂心、当归尾、苏木,配合失笑散(Shixiao San)使用。也可以使用四味散、黑神散、鹿角散、郁金散。如果是痰火上壅所致,则使用导痰汤加朱砂安神丸进行清降治疗。
曾有一位产妇突然死亡,只有胸部微微发热,陆氏诊察后说:“这是血闷。”于是用红花煮沸倒入木桶中,让产妇坐在桶上方熏蒸,汤凉了再添加热水,产妇随即手指动弹并苏醒过来。
一、禁止卧床休息。担心气血尚未安定,立即卧床会导致恶血上升。
二、禁止饮酒。担心酒性助火升动阳气,导致眩晕。
三、禁止洗澡。担心水湿侵入孔窍,导致气喘、胸满、浮肿沉重。
四、禁止受寒。担心血气凝滞,引发腹痛、呕吐腹泻等各种变证。
五、禁止发汗。担心风药性质升散,开泄毛孔损伤阳气。
六、禁止泻下。担心损伤肠腑津液。
七、禁止利尿。担心损伤肾气的封藏功能。
八、禁止使用寒凉药物。担心损伤胃气,或滋留瘀血导致疼痛。白芍、地黄、黄芩等都需慎用。
九、禁止过早同房。担心百脉开张,导致头晕、少腹急满。
十、禁止过早起床劳作,不避风寒,不注意饮食禁忌,从而导致疾病滋生。
Postpartum blood syncope is caused by the sudden severe deficiency of Yin-blood, leading to the floating and rushing upward of isolated Yang. The patient suddenly experiences dizziness, blacking out, and unconsciousness with a sense of suffocation. Immediate treatment should involve Qinghun San (Clear Soul Powder) or hot administration of child's urine. However, some women faint due to excessive lochia discharge, while others faint due to insufficient lochia discharge. Although the symptom of syncope is the same, the treatment principles differ.
If the fainting is due to excessive lochia discharge, manifesting as coma and restlessness, the treatment should focus on nourishing blood and clearing the heart. Herbs such as Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Mai Dong (Ophiopogonis Radix), E Jiao (Colla Corii Asini), Ren Shen (Ginseng Radix), Long Gu (Fossilia Ossis Mastodi), and Zao Ren (Ziziphi Spinosae Semen) may be used. If accompanied by thirst, irritability, sweating, and fever, Wu Mei (Mume Fructus), Shan Zhi (Gardeniae Fructus), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), and Fu Xiao Mai (Tritici Levis Fructus) can be added. If only irritability and heat are present, remove Dang Gui and add child's urine.
If the fainting is due to insufficient lochia discharge, it is because lochia fails to descend and turbid blood rushes upward to affect the heart, causing fullness and urgency in the epigastrium, coma, and lockjaw. The treatment should focus on promoting blood circulation and breaking up stasis. Raw Hawthorn Fruit (Shan Zha Rou), Tao Ren (Persicae Semen), Niu Xi (Achyranthis Bidentatae Radix), Gui Xin (Cinnamomi Ramulus Cortex), Dang Gui Wei (Angelicae Sinensis Radix Cauda), and Su Mu (Sappan Lignum) can be added, combined with Shixiao San (Excellent Payment Powder). Alternatively, Siwei San, Heishen San, Lu Jiao San, or Yujin San may be used. If phlegm-fire obstructs upwards, Daotan Tang (Phlegm-Resolving Decoction) plus Zhusha Anshen Wan (Cinnabar Calming Spirit Pill) should be used for clearing and descending.
In one case, a puerpera suddenly died, but her chest was slightly warm. Dr. Lu diagnosed it as "blood obstruction." He boiled Hong Hua (Carthami Flos) in water inside a wooden tub and had the woman sit above it to inhale the steam, adding hot water as it cooled. She soon moved her fingers and regained consciousness.
1. Prohibition of lying down: To prevent rising of turbid blood due to premature recumbency before Qi and Blood have stabilized.
2. Prohibition of alcohol: To prevent alcohol from aiding fire and stirring up Yang, causing dizziness.
3. Prohibition of bathing: To prevent water-dampness from invading orifices, leading to asthma, distension, edema, and heaviness.
4. Prohibition of cold exposure: To prevent stagnation of Qi and Blood, which could generate various complications such as abdominal pain, vomiting, and diarrhea.
5. Prohibition of diaphoresis (sweating): To prevent wind-dispelling herbs from ascending and dispersing, thereby damaging Yang through excessive opening and leakage.
6. Prohibition of purgation: To prevent damage to the fluids of the intestines and bowels.
7. Prohibition of diuresis: To prevent damage to the storing function of Kidney Qi.
8. Prohibition of cold-natured medicines: To prevent damage to Stomach Qi or retention of stasis causing pain. Bai Shao, Di Huang, and Huang Qin should all be used with caution.
9. Prohibition of early sexual intercourse: To prevent the opening of all vessels, leading to dizziness and urgency/fullness in the lower abdomen.
10. Prohibition of early rising and labor: To prevent illness arising from failure to avoid wind-cold and negligence in dietary taboos.