临产之母护痛倾侧,两足不开,扭夹儿头,气不得伸,故儿闷绝,谓之寤生。救法自胎
衣来
,勿断脐带,急用小锅烧水,以胎衣置汤中,频用温水洗带,须臾气暖入腹,儿气即回,啼
声出矣。若仓卒断其肠,不可救也。
产后血气暴虚,欲补之,则恐恶露停滞,欲攻之,又恐元气有亏。惟行中带补,化旧生
新,
方始万全也。世之治产者,往往用四物汤。窍谓地黄性寒滞血,芍药酸寒无补,非治产之良
剂也。惟生化一汤,预时制下,候胎衣一破,速煎,俟儿下即服,相继服二、三帖,使下焦
血块速化,新血骤长,自无厥晕。且产妇服一帖,精神渐增,二帖阴血顿旺,并去宿瘀,所
以有生化之名也。
凡病生于血气之衰、脾胃之虚,而产后气血、脾胃之虚衰尤甚焉。是以丹溪先生论产后
,必
以大补气血为先,虽有他症,以末治之。此三言已尽医之大旨,若能扩充其方,用药可以无
失矣。夫产后忧惊劳倦,气血暴虚,诸症乘虚易入。如有气,无专耗散;有食,无专消导;
热不可用芩、连;寒不可用桂、附。寒则血块凝滞,热则新血流崩。至若虚中外感,见三阳
表症,似可汗也,在产后而用麻黄,虑有亡阳之患;见三阴里证,似可下也,在产后而用承
气,则重亡阴血。耳聋、胁痛,乃肾虚恶露之停,休用柴胡。谵语汗出,乃元弱似邪之症,
毋解胃实。厥逆,阳气之衰,虽分寒热,非大补不能回阳而起弱。 因阴血之亏,毋论刚柔
,非滋荣不能舒筋而活络。又如乍寒乍热,发作有期,症类疟也,若以疟治,迁延难愈。神
不守舍,言语无论,病似邪也,若以邪治,危亡可待。去血多而大便燥热,肉苁蓉加于生化
,非润肠承气之能通。患汗多而小便短涩,六君子倍加参、 ,必生津而津可利。加人参生
化频服,能救产后之危,长生活命,屡用可苏绝谷之人, 疝脱肛,多是气虚下陷,补中益
气之方。口噤拳挛,乃因血燥类风,加参生化之剂。产户入风而痛甚,宜服羌活养荣。产门
伤冷而不闭,五味倍参生化。怔忡惊悸,生化合定志。似邪恍惚,安神助脾归脾。因气而满
闷虚烦,生化汤加木香为佐。因食而嗳酸恶食,六君子入神曲为良。苏木、蓬、棱大能破血
,青皮、枳壳散胀消满。一应耗气破血之剂,汗吐攻下之方,止可施于少壮,岂宜用于胎产
。大抵新产之后,须问恶露如何。若块痛未消,未可遂加 术。腹中痛止,补中益气无疑。
至若亡阳脱肛,气虚喘促,频进加参生化,是从权也。又有阴亡大热,血崩厥晕,速进生化
原方,乃急救也。凡附生死之奇术,须因病以用药。欲俯仰之无愧,用存心以爱物。兹虽未
尽产症之详,皆援近治之验为拘,未必无小补云。
临产时母亲因疼痛而身体倾斜侧卧,双腿无法张开,挤压胎儿头部,导致胎儿气息无法伸展,因而出现窒息昏迷的情况,这被称为“寤生”(指胎儿在母体内窒息死亡或假死状态)。急救方法是在胎盘娩出后,不要剪断脐带,立即用小锅烧水,将胎盘放入水中,频繁用温水冲洗脐带。片刻之后,暖意通过脐带传入胎儿腹部,胎儿气息即可恢复,发出啼哭声。如果仓促间剪断脐带,则无法挽救。
产后血气突然虚弱,想要进补,又担心恶露停滞;想要攻逐瘀血,又担心元气受损。只有采用“行中带补、化旧生新”的方法,才算万全之策。世间的产科医生,往往使用四物汤。我认为地黄性寒且易滞血,芍药酸寒而无补益作用,并非治疗产后病的良方。唯有生化汤这一方剂,预先制备好,等到胎衣破裂后,迅速煎煮,待胎儿娩出后立即服用,连续服用两到三帖,使下焦的血块迅速化解,新血快速生长,自然就不会出现厥逆晕倒的症状。而且产妇服用一帖后,精神逐渐增加,服用两帖后阴血顿时旺盛,并能去除宿存的瘀血,因此得名“生化”。
凡是疾病都产生于血气的衰弱和脾胃的虚弱,而产后的气血、脾胃虚衰尤为严重。因此,朱丹溪先生论述产后病时,必定以大补气血为先务,即使有其他病症,也作为次要问题来处理。这三句话已经概括了医学的大旨,如果能扩充其方义,用药就不会有失误了。产后因忧思、惊恐、劳累、疲倦导致气血突然虚弱,各种病症容易乘虚而入。如果有气滞,不可专门使用耗散气机的药物;如果有食积,不可专门使用消导的药物;有热象不可使用黄芩、黄连;有寒象不可使用桂枝、附子。因为寒凉会导致血块凝滞,温热会导致新血崩漏。至于虚人外感,出现三阳经表证,看似可以用发汗法,但在产后使用麻黄,担心会有亡阳的危险;出现三阴经里证,看似可以用泻下法,但在产后使用承气汤,则会严重损伤阴血。耳聋、胁痛,是肾虚兼恶露停滞所致,不要用柴胡。谵语、出汗,是元气虚弱似有邪气的症状,不要按胃实热证来解表。四肢厥冷,是阳气衰微的表现,虽然要区分寒热,但非大补不能回阳并唤醒虚弱的身体。由于阴血亏损,无论刚痉还是柔痉,非滋养营血不能舒缓筋脉并疏通经络。又如忽冷忽热,发作有定时,症状类似疟疾,如果按疟疾治疗,会拖延难愈。神志不守舍,言语错乱,病状似中邪,如果按邪气治疗,危亡就在眼前。失血过多导致大便干燥发热,在生化汤中加入肉苁蓉,这不是润肠承气汤所能通下的。患汗多而小便短少涩滞,六君子汤加倍人参、白术,必须生津液才能使津液流通。加入人参的生化汤频繁服用,能挽救产后的危重情况,延长生命,多次使用可以救活绝食垂危之人。疝气和脱肛,多是气虚下陷所致,可用补中益气汤。口噤握拳痉挛,是因为血燥类似风证,可用加参生化汤。产户受风而疼痛剧烈,宜服用羌活养荣汤。产门受冷而不闭合,可用五味子加倍人参的生化汤。怔忡惊悸,用生化汤配合定志丸。神志恍惚似中邪,用安神助脾归脾汤。因气机阻滞而胸闷虚烦,用生化汤加木香为佐使。因饮食不当而嗳气反酸厌恶食物,用六君子汤加入神曲为良方。苏木、蓬莪术、三棱大能破血,青皮、枳壳能消散胀满消除痞块。一切耗气破血的药剂,以及汗、吐、攻、下的方剂,只适用于年轻力壮者,岂能用于胎产妇女?大抵新产之后,必须先询问恶露情况。如果血块疼痛未消,不可随意加入白术、苍术。腹中疼痛停止,使用补中益气汤无疑。至于亡阳脱肛、气虚喘促,频繁进服加参生化汤,这是权宜之计。又有阴液枯竭大热、血崩厥晕,速进生化汤原方,这是急救之法。凡是涉及生死的关键医术,必须根据病情来用药。想要仰俯无愧于心,就要用心爱护生命。这里虽然没有详尽列举所有产后病症,但都是引用近期治疗的验证作为依据,未必没有小小的补益作用。
During labor, the mother may lean to one side due to pain, with legs unable to spread, compressing the fetal head. This prevents the fetus from extending its breath, leading to suffocation and coma, a condition known as "Wu Sheng" (fetal suffocation or stillbirth). The rescue method is: after the placenta is delivered, do not cut the umbilical cord. Immediately boil water in a small pot, place the placenta into the water, and frequently wash the umbilical cord with warm water. After a short while, warmth enters the fetus's abdomen through the cord, restoring the infant's breath and causing it to cry. If the cord is cut hastily, it cannot be saved.
Postpartum blood and Qi are suddenly deficient. To tonify them risks stagnation of lochia; to purge them risks damaging Yuan Qi. Only by employing a method that moves while tonifying, transforming the old to generate the new, can one ensure complete safety. Practitioners often use Siwu Tang (Four Substances Decoction). I believe Dihuang (Rehmanniae Radix) is cold and causes blood stasis, and Shaoyao (Paeoniae Radix Alba/Rubra) is sour and cold without tonifying properties; thus, it is not a good formula for postpartum conditions. Only Shenghua Tang (Decoction for Generating New Blood) is suitable. It should be prepared in advance. Once the membranes rupture, decoct it quickly and administer immediately after the baby is born. Continue taking two or three doses to rapidly resolve blood clots in the lower jiao and promote rapid growth of new blood, thereby preventing syncope or fainting. After one dose, the patient's spirit gradually improves; after two doses, Yin blood becomes robust, and old stasis is eliminated. Hence the name "Shenghua" (Generating and Transforming).
Diseases arise from the decline of blood and Qi and the deficiency of Spleen and Stomach. Postpartum deficiency of blood, Qi, Spleen, and Stomach is particularly severe. Therefore, Mr. Zhu Danji argued that treating postpartum conditions must prioritize tonifying blood and Qi above all else. Even if other symptoms exist, they should be treated as secondary matters. These three words summarize the main principles of medicine. If one expands upon this prescription, medication will be error-free. Postpartum anxiety, fright, fatigue, and overwork cause sudden blood and Qi deficiency, allowing various pathogens to invade easily. For Qi stagnation, do not use purely dispersing agents; for food retention, do not use purely digestive agents. For heat, avoid Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma); for cold, avoid Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata). Cold causes blood clots to stagnate; heat causes new blood to hemorrhage. Regarding exterior syndromes in a deficient person presenting with Taiyang syndrome, sweating might seem appropriate, but using Mahuang (Ephedrae Herba) postpartum risks Yang collapse. Regarding interior syndromes presenting with Yin syndrome, purging might seem appropriate, but using Chengqi Tang (Gastrointestinal Decoction) postpartum severely damages Yin blood. Deafness and hypochondriac pain indicate Kidney deficiency with lochia stasis; do not use Chaihu (Bupleuri Radix). Delirium and sweating indicate Yuan Qi weakness mimicking pathogenic invasion; do not treat as Stomach excess. Cold limbs indicate Yang deficiency. Although differentiation between cold and heat is necessary, only major tonification can restore Yang and revive the weak. Due to Yin blood deficiency, regardless of rigid or flaccid spasms, only nourishing Ying blood can relax tendons and unblock collaterals. Alternating chills and fever with periodic attacks resemble malaria; treating it as malaria leads to prolonged illness. Restlessness and incoherent speech resemble possession; treating it as such leads to critical danger. Excessive blood loss causing dry, hot stool requires adding Rongsheng (Cistanches Herba) to Shenghua Tang, as Run Chang Chengqi Tang (Moistening Intestines Gastrointestinal Decoction) alone cannot unblock it. Excessive sweating with scanty, difficult urination requires Liujunzi Tang (Six Gentlemen Decoction) with doubled Ginseng and Baizhu (Atractylodis Macrocephalae Rhizoma) to generate fluids and promote fluid metabolism. Frequent administration of Shenghua Tang with Ginseng can save critical postpartum cases, prolong life, and revive those near death. Hernia and rectal prolapse are mostly due to Qi deficiency sinking; use Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi). Lockjaw and clenched fists indicate blood dryness resembling wind; use Shenghua Tang with Ginseng. Wind entering the vagina causing severe pain suggests Qianghuo Yangrong Tang (Notopterygii Root Nourishing Nutritive Decoction). Cold entering the vulva causing failure to close suggests Shenghua Tang with Wuweizi (Schisandrae Fructus) and doubled Ginseng. Palpitations and fright suggest Shenghua Tang combined with Dingzhi Wan (Calming Spirit Pill). Mental confusion resembling possession suggests Anshen Zhupi Guipi Tang (Spirit-Calming Spleen-Nourishing Decoction). Chest fullness and vexation due to Qi stagnation suggest Shenghua Tang with Muxiang (Aucklandiae Radix) as an assistant. Belching, acid reflux, and aversion to food due to diet suggest Liujunzi Tang with Shenqu (Massa Medicata Fermentata). Sumu (Sappan Lignum), Pengling (Curcumae Phaeocaulis Rhizoma), and Leng (Curcumae Longae Rhizoma) strongly break blood; Qingpi (Citri Reticulatae Pericarpium Viride) and Zhike (Aurantii Fructus) dissipate distension and eliminate fullness. All formulas that consume Qi and break blood, as well as diaphoretic, emetic, and purgative methods, are only suitable for young and strong individuals, never for pregnant or postpartum women. Generally, after delivery, one must ask about lochia. If clots and pain persist, do not arbitrarily add Baizhu or Cangzhu (Atractylodis Rhizoma). If abdominal pain ceases, Buzhong Yiqi Tang is undoubtedly correct. For Yang collapse with rectal prolapse and Qi deficiency with panting, frequent administration of Shenghua Tang with Ginseng is a provisional measure. For Yin exhaustion with high fever, bloody hemorrhage, and syncope, immediate administration of the original Shenghua Tang is emergency treatment. Extraordinary arts concerning life and death must be applied according to the disease. To act without shame, one must care for life with compassion. Although this does not detail all postpartum conditions, it relies on recent clinical experiences, offering perhaps some minor benefit.