〔大〕产后中风,筋脉四肢挛急者,是气血不足,脏腑俱虚,月内未满,起早劳役,
动伤脏腑,虚损未复,为风所乘,风邪冷气。初客于皮肤经络,则令人顽痹不仁,羸乏少
气。风气入于筋脉,挟寒则挛急也。
〔薛〕肝属木而主筋,前证若肝经风热血燥,用加味逍遥散,如不应,当用六味地
黄丸以补肾水。经云∶风客淫气,精乃亡,邪伤肝也。仍参前杂证诸风血方论治之。 一
产妇筋挛臂软,肌肉掣动,此气血俱虚而自热也,用十全大补汤而安。一产妇手麻,服
愈风丹,遍身皆麻,神思倦怠。余谓气血虚弱,用十全大补加炮姜,数剂渐愈,去姜又
数剂,及逍遥散而痊。
芎 散 治产后中风,四肢筋脉挛急疼痛,背项强急。
芎 羌活 当归(各去芦) 酸枣仁(炒) 羚羊角屑(各七钱半) 防风(去芦)
牛蒡子(各一两,炒) 桂心 赤芍药(各半两)
上为 咀,每服八钱,水一大盏半,煎至一大盏,去 温服,不拘时。
〔薛〕前方如未应,当用八珍汤。更不应,用十全大补汤。
防己膏 治产后中风,四肢筋脉挛急,身体麻痹,并宜用之。
汉防已(去皮,半斤) 茵芋(五两)
上为 咀,用酒五升,浸药一宿,取猪肪脂一斤,文武火熬三上三下成膏,摊在纸
花上,贴病患患处,以热手不住摩膏上。
【丹溪】产后感受风邪,导致筋脉及四肢拘挛紧急的,是由于气血不足,脏腑均虚弱。如果在产后一个月内未满时,过早起床劳作,损伤了脏腑,虚损尚未恢复,风邪便乘虚而入,风邪夹带寒气。起初客居于皮肤经络,就会使人出现肌肤麻木不仁、身体消瘦乏力、气短等症状。风气侵入筋脉,挟带寒邪则会导致筋脉拘挛紧急。
【薛己】肝属木,主司筋脉。前述证候若因肝经风热血燥所致,应使用加味逍遥散;如果无效,应当使用六味地黄丸以补肾水。《内经》云:“风邪客居并淫乱正气,精气乃亡,邪气伤害肝脏。”仍需参考前文杂病中诸风血证的方论进行治疗。
有一位产妇出现筋挛、手臂软弱、肌肉抽动,这是气血俱虚且产生内热的表现,使用十全大补汤后痊愈。另一位产妇手部麻木,服用愈风丹后,全身皆麻,精神倦怠。我认为这是气血虚弱所致,使用十全大补汤加入炮姜,数剂后逐渐好转,去掉姜后再服数剂,最后服用逍遥散而痊愈。
芎藭散:治疗产后中风,四肢筋脉拘挛紧急疼痛,背部和颈部僵硬紧急。
川芎、羌活、当归(各去除芦头)、酸枣仁(炒制)、羚羊角屑(各七钱半)、防风(去除芦头)、牛蒡子(各一两,炒制)、桂心、赤芍药(各半两)。
以上药物捣碎成粗末,每次服用八钱,加水一大盏半,煎煮至一大盏,去渣温服,不拘时间。
【薛己】上述方剂如果无效,应当使用八珍汤。如果仍然无效,使用十全大补汤。
防己膏:治疗产后中风,四肢筋脉拘挛紧急,身体麻痹,都适宜使用。
汉防己(去皮,半斤)、茵芋(五两)。
以上药物捣碎成粗末,用酒五升浸泡药物一夜,取猪脂一斤,用文武火交替熬制,经过三次上升三次下降的过程制成膏状,涂抹在纸花上,贴敷于患者患处,用手不断按摩膏体使其发热。
[Danxi] Postpartum wind-stroke characterized by spasmodic tightness of the tendons and limbs is caused by deficiency of Qi and Blood, with all Zang-Fu organs being deficient. If one rises early and engages in labor before the completion of the first month postpartum, the Zang-Fu are damaged, and the deficiency has not yet recovered; thus, Wind pathogen takes advantage of this weakness. The Wind pathogen, accompanied by Cold, initially lodges in the skin and meridians, causing numbness and insensitivity (Wanbi Buren), emaciation, fatigue, and shortness of breath. When Wind enters the tendons and vessels and is coupled with Cold, it leads to spasmodic tightness.
[Xueji] The Liver belongs to Wood and governs the tendons. If the aforementioned symptoms are due to Wind-Heat and dry Blood in the Liver channel, Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) should be used. If ineffective, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) should be employed to tonify Kidney Water. The Classic states: "When Wind lodges and causes abnormal Qi flow, Essence is lost, and the pathogen injures the Liver." Treatment should still refer to the discussions on various Wind and Blood formulas for miscellaneous diseases mentioned previously.
A parturient presented with tendon spasms, soft arms, and muscle twitching; this was due to dual deficiency of Qi and Blood with internal heat, which was resolved using Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). Another parturient suffered from hand numbness; after taking Yu Feng Dan (Wind-Dispelling Pill), she experienced numbness throughout her body and mental fatigue. I diagnosed this as Qi and Blood deficiency, treated with Shi Quan Da Bu Tang plus Pao Jiang (Prepared Ginger), resulting in gradual improvement over several doses. After removing the ginger and continuing for a few more doses, followed by Xiao Yao San (Free and Easy Wanderer Powder), she fully recovered.
Xiong Qiong San (Ligusticum and Ligusticum Chinense Powder): Treats postpartum wind-stroke with spasmodic tightness, pain of tendons and vessels in the four limbs, and stiffness/tightness of the back and neck.
Chuanxiong Rhizoma (Chuanxiong), Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Sinensis Radix (Danggui) [each remove rhizome], Sparganii Semen (Suanzaoren) [stir-fried], Cornu Saigae Tataricae (Lingyangjiao) [each 7.5 qian], Saposhnikoviae Radix (Fangfeng) [remove rhizome], Arctii Fructus (Niubangzi) [each 1 liang, stir-fried], Cinnamomi Cortex (Guixin), Paeoniae Radix Rubra (Chishao) [each 0.5 liang].
Grind the above into coarse powder. Each dose consists of 8 qian, decocted in 1.5 large cups of water until reduced to 1 large cup. Strain and take warm, at any time.
[Xueji] If the above formula is ineffective, Ba Zhen Tang (Eight-Treasure Decoction) should be used. If still ineffective, use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction).
Fang Ji Gao (Stephania Plaster): Treats postpartum wind-stroke with spasmodic tightness of tendons and vessels in the four limbs and body numbness; suitable for all such cases.
Stephaniae Tetrandrae Radix (Han Fangji) [remove bark, 0.5 jin], Ilicis Cornei Fructus (Yinyu) [5 liang].
Grind the above into coarse powder. Soak the herbs in 5 sheng of wine overnight. Take 1 jin of Pig Fat (Zhufangzhi) and simmer over alternating mild and strong fire, undergoing three cycles of rising and falling, to form a plaster. Spread onto paper flowers and apply to the affected area. Continuously massage the plaster with warm hands.