长之妙。○产后发热，治用参、 、芎、归，而以黑姜为佐者，引血药入气分，而生新血耳。○胎前原有阴火，
产后去血过多，见出发热、烦躁、汗出等证，若根据前法，大补气血，其证必甚。当用逍遥以清肝火养肝血。此
因血去多，肝虚血燥，勿泥气血俱虚之论也。（赵养葵）
产后发热，用药专以温补为主，亦非确论。大约产后之热，宜从阳引阴，反佐从治者居多。以阴血骤亏，
狐阳外越，非用温补，则虚火不藏，所谓甘温能除大热者也。倘其人阳有余阴不足之体，泥于甘温退热之法，
姜、桂、参、附多进，阴益亏，火益炽，热愈不退，又宜从阴引阳，壮水正治。古人谓∶芍药酸寒，产后忌用。
景岳谓∶阴气散失，正当用之。此真知阴可维阳，水可制火者也。总之，人生阴阳互根，不可偏胜，一味温热，
知有阳而不知有阴矣。○产后发热，气血两虚者居多，药宜甘温；亦有阴虚生热者，药宜壮水。先君子治产后
壮热发狂，用附子一枚、人参一两、童便一杯，一剂霍然。此甘温能除大热也。余治侄女产后阴虚发热，口渴
面赤，用六味汤加童便，一剂成功。此壮水
之主，以镇阳光也。（《会心录》）
寒热
寒热往来，虽为少阳经病，然于产后见之，则属阴阳两虚，营卫不和。当遵丹溪大补气血为治，非小柴胡
可同例也。（萧慎斋）
产后有因气血虚弱、脾胃亏损而发寒热者，此皆不足之证。《经》云∶阳虚则恶寒，阴虚则发热。若兼大
便不通，尤属气血枯槁，切禁发表降火。若寸口脉微，为阳不足，阴气上入阳中而恶寒，用补中汤加姜、枣发
越之。若尺部脉弦，为阴不足，阳气下陷阴中而发热，用六味丸加肉桂收摄之。（《张氏医通》）
头痛
产后头痛，属气虚者用补中汤；属血虚者用四物汤；气血俱虚者，用八珍汤；风寒所伤者，用补中汤加川
芎、蔓荆子。（《薛氏医案》）
产后头痛，虽有风寒，而本之血虚者，其原也。惟大剂芎、归养血，血行则风自灭。（萧慎斋）
腹痛
产后腹中 痛，当归生姜羊肉汤主之。○产后腹痛，烦满不得卧，枳实芍药散主之；假令不愈者，此为腹
中有干血着脐下，宜下瘀血汤主之。（《金匮》）
产后腹痛，有虚实之分∶实者有恶露不净，有干血瘀滞，有食伤裹血；虚者有气弱寒阻，有血虚空痛。自
当审因施治，虚者固宜补气补血，实者亦未可以峻攻，重虚其虚也。（萧慎斋）
产后腹痛，最当辨察虚实∶血有留瘀而痛者，实痛也；无血而痛者，虚痛也。大都痛而且胀，或上冲胸胁，
或拒按而手不可近者，皆实痛也。宜行之散之。若无胀满，或喜揉按，或喜热烫，或得食稍缓者，皆属虚痛。
不可妄用推逐。○产后多有腹痛，摸之亦有块，按之亦拒手，古谓儿枕，指为胞中之宿血。此大不然。夫胎胞俱
去，其血岂能独留？盖子宫蓄子既久，忽尔相离，血海陡虚，所以作痛；胞门受伤，必致壅肿，所以亦若有块，
而实非真块。
肿既未消，所以亦颇拒按。但宜安养其脏，不久即愈，惟殿胞煎最妙。（张景岳）
腰痛
胞胎系于肾，腰者肾之外候。产后劳伤肾气，损动胞络，属虚者居多。虽有风冷滞血，亦必兼补真气为要。（萧慎斋）
胁痛
产后胁痛，若肝经血瘀，用元胡索散；肝经气虚，用四君汤加柴胡；肝经血虚，用四物汤加柴胡；肾水不
能生肝木，用六味丸；肺金克制肝木，用泻白散。（薛立斋）
疟疾
疟病在夏秋之交，本风、寒、暑、湿四气之感。而产后之疟，虽有外邪，当从虚治。阳虚则外寒，阴虚则
内热，阴阳两虚则寒热交作。治宜大补气血为主，一切治疟诸方，概不可施。立斋以补胃气立论，诚得治疟之
本。若以草果饮为佐，则失矣。（萧慎斋）
痢疾
产后下利虚极，白头翁加甘草阿胶汤主之。（《金匮》）
产后痢疾有三∶一因胎前患痢，产后不止，昔人谓七日必死之候。若产妇壮实，元气未败，脉有胃气，能
饮食者，宜伏龙肝汤随证治之。二因产时脐腹受冷，饮食不化，下痢腹痛，或恶露不行者，宜理中汤。白多加
吴萸、木香，赤多加当归、肉桂。三因产后误吞生冷，或临产饮食过饱，泻痢齐作，亦宜理中汤；间有热痢后
重者，宜白头翁汤加甘草阿胶清理之；如恶露未净，痢久不止，腹痛后重者，宜补中汤升举之。大抵产后下痢，
惟顾元神，调和气血，则积滞自下，恶露自行。不然，较妊娠更难照顾也。（《张氏医通》）
泄泻
产后泄泻，其因有五∶一因胎前泄利未止，产后尤甚；一因临产过伤饮食，产后滑脱；一因新产骤食肥
腻，不能克化；一因
新产烦渴恣饮，水谷混乱；一因新产失护，脏腑受冷。致泻之由虽异，一皆中气虚寒，传化失职，并宜理中汤
为主。（《张氏医通》）
产后泄泻一证，有外因，食滞是也；有内因，脾肾虚是也。夫胎系于脾，脾中之气血，已为胎所耗，产后
脾失健运之常，复又食物不慎，以致中焦不化，而噫气嗳腐，腹中肠鸣，大便下泄矣。体实者，用平胃散加减，
服一、二剂，不可多进；体虚者，用长生活命汤，百试百效。此治外因者也。若内因伤在脾肾，最为恶证。盖
脾司仓廪，为后天之根本。脾中血虚生火，则暴注下迫，疾走大肠；脾中气虚生寒，则营运失职，完谷不化。
产后血气内空，食饮入胃，不能变化精微，升清降浊，而时时频泄，未免下多阴亡，泄久阳亡之患矣。至于肾
为生气之原，火能生土，为人生立命之根蒂。产后去血过多，则伤肾中之阴，气因血耗，则伤肾中之阳。阴虚
者火必刑金，上逆作咳；肺虚者热移大肠，下迫作泄。医家不知有肾阴亏虚泄泻之证，一味补土，未见奏功。
若认夹食，更为庸俗。盖阳虚泄泻，必命火衰微而真气不固，非如阴虚有火者，脉细数，面赤口渴为异也。况阳
虚脉必细迟而微，或空大而虚，面色必惨淡，手足必冷而浮肿，自有脉证虚寒之真象可见也。治脾阴虚而有火
者，嘉禾饮；治脾气虚而无火者，六君汤；治肾虚而有火者，六味加人参汤；治阳虚而无火者，八味加人参汤。
倘服此不应，四神丸用参汤吞下，再用枯矾、附子、五倍子，研末和面，人唾作饼，贴于脐中，无不立验。此
治内因者也。（《会心录》）
产后泄泻，责在脾虚，不可用利水药而致脾肾皆虚。治宜补中益气汤加白芍。如兼发热口渴者，乃阴竭，
也用六味丸，煎六君汤或人参汤下。盖泻多则亡阴，故兼发热口渴。然因泻而热渴，其原由于脾传肾，故用六
君、参汤下六味丸，此标本兼治之义也。（高鼓峰）
呕吐
呕吐有虚实，而产后之呕吐，虚者十居其九。夫产后脾胃必
亏，虚而热者，则食入即吐；虚而寒者，则食久反出。然亦不可拘也。倘其人平素脾胃本虚，加之产伤气血，
脾阴枯而胃阳败，忽然食入即吐，手足冷冷汗出，气促不接，脉细如丝，此乃胃绝之候，可遂谓其暴吐为火乎？
即令吐酸，虽属有火，而产后多责胃寒，必须切脉之迟数，有力无力，然后虚实可分。有火而吐者，宜扁豆、
谷芽、沙参、丹参、石斛、陈壁土之类；无火而吐者，宜人参、白术、茯苓、黑姜、肉桂、炙甘草之类。虽然，
肾者胃之关。脾胃之病，必推原于肾。肾气壮，则水谷入胃，散精于肺，而变化精微；肾气亏，则完谷不化，
阳火衰弱，而不生脾土，幽门少运动之机，下不通而势必上逆矣。又有肾阳无根，内真寒而外假热，虚火上冲
胃口，因而呕吐不休者，使非理中汤、八味汤重加人参引火归原，而吐未必定也。或谓败血阻于脾胃，不能纳
水谷而生吐逆，此说虽亦中病情，第败血之阻，亦由元气之亏，宜用生化汤、二陈汤，加人参、泽兰、丹参之
属，数剂可愈。若用香砂、延胡等药，非其治也。大约吐而轻者救在脾，吐而重者救在肾。舍此他求，岂足谓
之善哉！（《会心录》）
选案
东青巷汪姓妇，产后病呕吐。医初以为食滞也，用消食之药，不应。又以为气滞也，用宽中行气之药，亦
不应。又以为中虚也，用六君、理中之属，俱不应。因请予诊。问其中脘若有阻否？曰∶然。恶露早净否？曰∶
然。予曰∶此蓄瘀为病，故一切止吐之药不效也。先投生化汤倍黑姜，一剂瘀动，吐稍定；再于汤中加入和胃
之品，其吐乃止。（汪广期）
呃逆
产后呃逆，有寒、热、虚、实之不同。寒者宜丁香、姜、桂；热者宜柿蒂、竹茹；虚者宜人参、附子；实
者宜香附、橘皮。误施则有噬脐之悔。（薛立斋）
《经》云∶病深者其声哕。哕，即呃逆也。诸病见之，皆为
恶候。况产后犯此，有虚无实，有寒无热，明矣。立斋必兼热实论，殊谬。然考古方治呃逆，有兼败血蓄瘀，
用丁香豆蔻散，煎桃仁吴茱萸汤下者，病机又不可不知。（萧慎斋）
咳嗽
产后咳嗽，或因阴血被损，或因肺气受伤，或因阴火上炎，或因风寒外感，治法不一。若阴血虚者，用四
物汤加阿胶；肺气伤者，用四君汤加桔梗；阴火上炎者，用六味汤加麦冬、五味；风寒外感者，用补中汤加桔
梗、紫苏。（薛立斋）
喘
产后发喘，最为恶候。盖产后血亡气脱，以致呼吸喘急，气不接续。虽主气之司不敛，实气化之源不纳，
根本动摇，阳孤无偶，非同相火偏胜，销灼肺金之比也。夫肺叶开而生胀，卧则头向后，而肺叶贴背，碍气道
之路，故壅塞难容；坐则头向前，而肺叶离虚，让气道之路，故呼吸稍缓。诚以血海空虚，子午不交，非大补真
阴，填实下元，不能挽回垂绝。第阴血暴脱，真气上越，草木一时难生有形之血，不若重进参、附、归、地，
及鹿茸、河车之属，急生无形之气。且同类有情，血肉为补，庶无根之焰渐渐归原，而相傅之官清肃下行矣。
倘恶露未尽，败血停凝，上熏肺金，亦令人喘者，须进人参生化汤，逐瘀于补元之中，元气回而瘀血自通矣。
若其人平素原有哮喘之疾，因胎下偶受外风，旧疾复作者，宜金水六君煎主之。《难经》曰∶呼出心与肺，吸
入肾与肝。今产后呼出多而吸入少，元气无主，大补犹恐不回，而医家不悟，仍以表散之药投之，是耶非耶？（《会心录》）
烦渴
血乃周身之津液，产妇去血过多，阴虚火旺，因而烦躁发渴者，治宜滋阴降火消瘀，加童便为主。童便味
咸，而性就下，故能降火消瘀，所谓浊阴走下窍是也。（萧慎斋）
前证若去血过多，虚火上炎者，用四物汤，入童便，加麦冬、丹
皮；胃虚有热者，用竹叶黄 汤；血虚发热者，用四物汤加麦冬、五味；血脱烦躁者，用当归补血汤；胃气虚
弱者，用七味白术散。（薛立斋）
痉
螈者，筋脉拘急也； 者，筋脉弛纵也。肝主筋藏血，肝气为阳为火，肝血为阴为水。产后螈 ，由于阴
血去多，阳火独炽，筋失荣养，虚极生风。治用八珍汤，加丹皮、钩藤，以生阴血，则风熄火退而愈。若肝经
血虚者，用逍遥散加钩藤；肝脾两虚者，用四君汤加芎、归、丹皮、钩藤。盖血生于至阴，至阴者脾土也。若
肌体恶寒，脉微细者，此为真状；若脉浮大，发热烦渴者，此为假象。惟当固本为主。如搐搦无力，戴眼反折，
汗出如珠者，不治。《经》云∶脾之荣在唇。心之液为汗。若心脾二脏虚极，而唇白多汗者，急用参附十全大
补汤救之。（薛立斋）
痉分刚柔，虚者十居六、七，而产后之变痉，则无不本于气血大亏者也。当胎下之后，血去过多，阳孤无
根据，斯时有类伤寒三阳、三阴之证，而实不同。医家不察脉辨证，始进表汗，继投攻下，亡阴亡阳，以致气愈
虚而血愈耗，筋脉失于荣养，燥极生风，反张强直，口噤拳挛，险证叠出。血液枯涸，大伤冲、任二脉，而督
脉在背，亦少柔和，因而发痉耳。治法责在肝肾，阴阳两救。阴虚者人参六味汤，阳虚者十全大补汤，大剂投
之。俾真气流转，精血相通，筋脉得以滋润，始克有济。《经》曰∶阳气者，精则养神，柔则养筋。产后既已
亡血，庸工复认作伤寒之证，而误治之，祸可胜言？且伤寒汗下过多而有变痉者，并宜大补气血为主，则产后
之大补气血，更无疑矣！若不因药误，初病即汗出发痉者，此乃阳气顿虚，腠理不密，津液妄泄，急用人参养
营汤加附子主之。丹溪曰∶产后不论脉证，当以大补气血为主。若产后之变痉，空虚极矣，舍大补何所取哉！
（《会心录》）
颤振
产后颤振者，乃气血亏虚，火盛而生风也。治宜十全大补汤。
如产后半身肉颤汗出者，亦宜大补。若不省人事，口吐涎沫，而颤振或螈 者，宜补血汤加荆芥穗、豆淋酒。
（《张氏医通》）
头汗
产后郁冒，脉微弱，但头汗出。所以然者，血虚而厥，厥而必冒，冒家欲解，必大汗出。以血虚下厥，孤
阳上出，故头汗出。所以产妇喜汗出者，亡阴血虚，阳气独盛，故当汗出，阴阳乃复。（《金匮》）
The treatment for postpartum fever involves using Ren Shen (Ginseng Radix), Chuan Xiong (Ligusticum Rhizome), and Dang Gui (Angelica Sinensis), with Hei Jiang (Charred Zingiberis Rhizoma) as an assistant herb, to guide blood-invigorating drugs into the Qi level to generate new blood. ○ Before delivery, there is originally Yin fire. After delivery, due to excessive blood loss, symptoms such as fever, restlessness, and sweating appear. If one follows the previous method of heavily tonifying Qi and Blood, the condition will surely worsen. One should use Xiao Yao San (Free and Easy Wanderer Powder) to clear Liver fire and nourish Liver blood. This is because excessive blood loss leads to Liver deficiency and dryness of Blood; one should not rigidly adhere to the theory that both Qi and Blood are deficient. (Zhao Yangkui)
For postpartum fever, using medication exclusively focused on warming and tonifying is not an accurate theory. Generally, heat syndromes after delivery are best treated by drawing Yin from Yang, employing counter-assistance and following-treatment methods. This is because sudden depletion of Yin Blood causes solitary Yang to float outward; without warming and tonifying, the deficient fire cannot be concealed. This is what is meant by "sweet and warm can eliminate great heat." However, if the patient has a constitution of excess Yang and insufficient Yin, rigidly applying the sweet-and-warm heat-clearing method and administering large doses of Gan Jiang (Dried Zingiberis Rhizoma), Rou Gui (Cinnamon Bark), Ren Shen (Ginseng Radix), and Fu Zi (Aconiti Lateralis Radix Preparata) will further deplete Yin, intensify fire, and fail to reduce fever. In such cases, one should draw Yang from Yin and apply the orthodox treatment of strengthening Water to control Fire. Ancients stated: Shao Yao (Paeoniae Radix Alba) is sour and cold, contraindicated in postpartum. Zhang Jingyue stated: When Yin Qi dissipates, it is precisely when it should be used. This demonstrates true understanding that Yin can sustain Yang, and Water can control Fire. In summary, human life relies on the mutual root of Yin and Yang; neither should predominate. Using only warming and hot herbs implies knowing only Yang and ignoring Yin. ○ Postpartum fever is mostly due to dual deficiency of Qi and Blood, requiring sweet and warm medicines; however, some cases involve heat generated from Yin deficiency, requiring medicines to strengthen Water. My late father treated severe postpartum fever with delirium using one piece of Fu Zi (Aconiti Lateralis Radix Preparata), one liang of Ren Shen (Ginseng Radix), and one cup of Tong Bian (Human Urine), resulting in recovery after one dose. This illustrates that sweet and warm can eliminate great heat. I treated my niece's postpartum Yin-deficiency fever with thirst and red face using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Tong Bian (Human Urine), achieving success in one dose. This exemplifies strengthening the master of Water to suppress solar flare. (Hui Xin Lu)
Chills and Fever
Alternating chills and fever, although characteristic of Shaoyang channel disease, when seen postpartum, belong to dual deficiency of Yin and Yang and disharmony of Ying and Wei. Treatment should follow Zhu Danxi's principle of heavily tonifying Qi and Blood; it cannot be treated similarly to Xiao Chai Hu Tang (Minor Bupleurum Decoction). (Xiao Shenzhai)
Postpartum chills and fever caused by Qi and Blood weakness and Spleen-Stomach damage are all deficiency syndromes. The Classic states: Yang deficiency leads to aversion to cold; Yin deficiency leads to fever. If accompanied by constipation, it particularly indicates exhaustion of Qi and Blood, strictly forbidding releasing exterior or clearing fire. If the Cun (inch) pulse is faint, it indicates Yang insufficiency, where Yin Qi enters Yang causing aversion to cold; treat with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Sheng Jiang (Fresh Zingiberis Rhizoma) and Da Zao (Jujubae Fructus) to disperse. If the Chi (cubit) pulse is wiry, it indicates Yin insufficiency, where Yang Qi sinks into Yin causing fever; treat with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Rou Gui (Cinnamon Bark) to gather and secure. (Zhang Shi Yi Tong)
Headache
Postpartum headache due to Qi deficiency is treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); due to Blood deficiency, with Si Wu Tang (Four Substance Decoction); due to dual Qi and Blood deficiency, with Ba Zhen Tang (Eight Treasure Decoction); due to Wind-Cold invasion, with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Chuan Xiong (Ligusticum Rhizome) and Man Jing Zi (Viticis Fructus). (Xue Shi Yi An)
Postpartum headache, even if caused by Wind-Cold, has Blood deficiency as its root. Only by using large doses of Chuan Xiong (Ligusticum Rhizome) and Dang Gui (Angelica Sinensis) to nourish Blood, will Blood flow and Wind extinguish itself. (Xiao Shenzhai)
Abdominal Pain
Cold pain in the abdomen postpartum is primarily treated with Dang Gui Sheng Jiang Yang Rou Tang (Angelica, Ginger, and Mutton Decoction). ○ Abdominal pain postpartum with irritability, fullness, and inability to lie down is primarily treated with Zhi Shi Shao Yao San (Immature Bitter Orange and Paeonia Powder); if it does not resolve, this indicates dried Blood adhering below the umbilicus, primarily treated with Xia Yu Xue Tang (Drain Stasis Blood Decoction). (Jin Gui Yao Lue)
Postpartum abdominal pain has excess and deficiency distinctions: Excess includes lochia retention, dried Blood stasis, and food injury trapping Blood; deficiency includes weak Qi with Cold obstruction and empty pain from Blood deficiency. One must examine the cause and treat accordingly. Deficiency requires tonifying Qi and Blood; excess should not be treated with harsh purgatives to avoid further weakening the deficient. (Xiao Shenzhai)
Postpartum abdominal pain must distinguish excess from deficiency: Pain due to retained Blood stasis is excess pain; pain without Blood is deficiency pain. Generally, pain accompanied by distension, upward rushing to chest/hypochondrium, or tenderness upon pressure (refusal to touch) indicates excess pain. Treat with moving and dispersing methods. Lack of distension, preference for rubbing/pressing, preference for warmth, or relief after eating indicates deficiency pain. Do not recklessly use pushing/purging methods. ○ Many postpartum women have abdominal pain with palpable masses and tenderness, traditionally called "Er Zhen" (Child Pillow), attributed to residual blood in the uterus. This is incorrect. Once the fetus and placenta are expelled, how can Blood remain alone? The uterus housed the fetus for a long time; sudden separation causes sudden emptiness of the Blood Sea, leading to pain. Injury to the uterine gate causes swelling, creating the illusion of a mass, but it is not a true mass. Since swelling persists, it remains tender. Only nurturing the organs is needed, and it will heal soon; Dian Bao Jian (Placenta-Expelling Decoction) is best. (Zhang Jingyue)
Lower Back Pain
The fetal sac is tied to the Kidney; the lower back is the external manifestation of the Kidney. Postpartum labor injures Kidney Qi and damages the uterine collaterals, mostly belonging to deficiency. Even if Wind-Cold and stagnant Blood exist, tonifying True Qi is essential. (Xiao Shenzhai)
Hypochondriac Pain
Postpartum hypochondriac pain due to Liver channel Blood stasis is treated with Yuan Hu Suo San (Corydalis Powder); due to Liver channel Qi deficiency, with Si Jun Zi Tang (Four Gentlemen Decoction) plus Chai Hu (Bupleuri Radix); due to Liver channel Blood deficiency, with Si Wu Tang (Four Substance Decoction) plus Chai Hu (Bupleuri Radix); due to Kidney Water failing to generate Liver Wood, with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia); due to Lung Metal controlling Liver Wood, with Xie Bai San (Drain White Powder). (Xue Lizhai)
Malaria
Malaria occurs at the transition of summer and autumn, originally caused by Wind, Cold, Summerheat, and Dampness. Postpartum malaria, even with external pathogens, should be treated from a deficiency perspective. Yang deficiency causes external cold; Yin deficiency causes internal heat; dual deficiency causes alternating chills and fever. Treatment should focus on heavily tonifying Qi and Blood; all malaria-specific formulas are contraindicated. Xue Lizhai’s theory of tonifying Stomach Qi hits the root of treating malaria. Using Cao Guo Yin (Areca Seed Decoction) as an assistant is erroneous. (Xiao Shenzhai)
Dysentery
Severe deficiency with diarrhea/dysentery postpartum is primarily treated with Bai Tou Weng Jia Gan Cao E Jiao Tang (Pulsatilla Decoction with Licorice and Donkey-Hide Gelatin). (Jin Gui Yao Lue)
There are three types of postpartum dysentery: First, dysentery starting before pregnancy continuing postpartum, considered fatal within seven days by ancients. If the mother is robust, Yuan Qi intact, pulse has Stomach Qi, and can eat, treat with Fu Long Gan Tang (Dragon House Earth Decoction) according to syndrome. Second, cold invading umbilical/abdominal area during delivery, undigested food, dysentery with abdominal pain, or blocked lochia; treat with Li Zhong Tang (Regulate the Middle Decoction). Add Wu Zhu Yu (Evodiae Fructus) and Mu Xiang (Aucklandiae Radix) for white discharge; add Dang Gui (Angelica Sinensis) and Rou Gui (Cinnamon Bark) for red discharge. Third, accidental ingestion of raw/cold food postpartum or overeating during delivery causing simultaneous diarrhea and dysentery; also treat with Li Zhong Tang (Regulate the Middle Decoction). For occasional heat dysentery with tenesmus, treat with Bai Tou Weng Tang (Pulsatilla Decoction) plus Gan Cao (Licorice Root) and E Jiao (Donkey-Hide Gelatin) to clear and harmonize; if lochia is unclean and dysentery persists with abdominal pain and tenesmus, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to lift. Generally, postpartum dysentery requires protecting Yuan Shen (Original Spirit) and harmonizing Qi and Blood, so that accumulation drains naturally and lochia flows. Otherwise, it is harder to manage than pregnancy. (Zhang Shi Yi Tong)
Diarrhea
Postpartum diarrhea has five causes: First, pre-pregnancy diarrhea worsening postpartum; second, dietary injury during delivery leading to postpartum slipping; third, sudden consumption of rich/greasy food postpartum unable to digest; fourth, excessive drinking due to thirst postpartum causing chaotic water/grain metabolism; fifth, exposure to cold postpartum damaging Zang-Fu. Although causes differ, they all stem from Middle Qi deficiency and Cold, with failed transmission/transformation, primarily treated with Li Zhong Tang (Regulate the Middle Decoction). (Zhang Shi Yi Tong)
Postpartum diarrhea has external causes (food stagnation) and internal causes (Spleen-Kidney deficiency). The fetus ties to the Spleen; Spleen Qi and Blood are consumed by the fetus. Postpartum, Spleen loses normal transportation; combined with careless diet, Middle Jiao fails to transform, causing belching, rotting smells, borborygmus, and diarrhea. For robust bodies, use Ping Wei San (Calm the Stomach Powder) modified, 1-2 doses, no more. For weak bodies, use Chang Sheng Huo Ming Tang (Long Life and Vitality Decoction), effective every time. This treats external causes. If internal causes damage Spleen-Kidney, it is a severe syndrome. Spleen manages granaries, the foundation of acquired constitution. Spleen Blood deficiency generates fire, causing violent watery diarrhea; Spleen Qi deficiency generates cold, causing failed transport and undigested food. Postpartum internal emptiness of Qi and Blood means food entering Stomach cannot transform into essence, ascending clear/descending turbid, leading to frequent diarrhea, risking Yin collapse from excessive loss and Yang collapse from prolonged leakage. Kidney is the source of generating Qi; Fire generates Earth, the root of life. Excessive blood loss damages Kidney Yin; Qi consumption via Blood loss damages Kidney Yang. Yin deficiency causes Fire to punish Metal, leading to cough; Lung deficiency allows heat to shift to Large Intestine, causing diarrhea. Physicians unaware of Kidney Yin deficiency diarrhea blindly tonify Earth without effect. Mistaking it for food stagnation is vulgar. Yang deficiency diarrhea implies Ming Men Fire decline and unstable True Qi, distinct from Yin deficiency with fire (fine-rapid pulse, red face, thirst). Yang deficiency pulses are fine-slow-faint or hollow-large-empty; complexion is pale; hands/feet are cold/swollen, showing true deficiency-cold signs. Treat Spleen Yin deficiency with fire using Jia He Yin (Harmonizing Grain Drink); Spleen Qi deficiency without fire using Liu Jun Zi Tang (Six Gentlemen Decoction); Kidney deficiency with fire using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Ren Shen (Ginseng Radix); Yang deficiency without fire using Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) plus Ren Shen (Ginseng Radix). If ineffective, use Si Shen Wan (Four Spirits Pill) swallowed with Ren Shen (Ginseng Radix) decoction, then apply powder of Ku Fan (Alumen), Fu Zi (Aconiti Lateralis Radix Preparata), Wu Bei Zi (Galla Chinensis) mixed with flour and saliva as a cake on the umbilicus, always effective. This treats internal causes. (Hui Xin Lu)
Postpartum diarrhea stems from Spleen deficiency; do not use diuretics causing Spleen-Kidney dual deficiency. Treat with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Bai Shao (Paeoniae Radix Alba). If accompanied by fever/thirst indicating Yin exhaustion, use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) taken with Liu Jun Zi Tang (Six Gentlemen Decoction) or Ren Shen (Ginseng Radix) decoction. Excessive diarrhea causes Yin loss, hence fever/thirst. Since diarrhea-heat/thirst originates from Spleen transmitting to Kidney, using Liu Jun Zi/Ren Shen decoction to take Liu Wei Di Huang Wan addresses both root and branch. (Gao Gufeng)
Vomiting
Vomiting has excess and deficiency; postpartum vomiting is 90% deficiency. Postpartum Spleen-Stomach must be deficient. Deficiency-Heat causes immediate regurgitation after eating; Deficiency-Cold causes delayed regurgitation. However, do not be rigid. If the person has inherent Spleen-Stomach weakness, compounded by birth trauma to Qi/Blood, with Spleen Yin dried and Stomach Yang ruined, sudden immediate regurgitation, cold limbs/sweating, shortness of breath, thread-like pulse indicates Stomach extinction. Can we call this acute vomiting due to fire? Even acid regurgitation, though involving fire, postpartum is mostly attributed to Stomach Cold. Pulse speed/strength distinguishes excess/deficiency. Vomiting with fire uses Dou Dou (Sojae Semen Praeparatum), Gu Ya (Hordei Fructus Germinatus), Sha Shen (Glehniae Radix), Dan Shen (Salviae Miltiorrhizae Radix), Shi Hu (Dendrobii Caulis), Chen Bi Tu (Old Wall Soil); vomiting without fire uses Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Hei Jiang (Charred Zingiberis Rhizoma), Rou Gui (Cinnamon Bark), Zhi Gan Cao (Honey-fried Licorice Root). Kidney is the gate of Stomach. Spleen-Stomach diseases trace back to Kidney. Strong Kidney Qi transforms water/grain in Stomach, disperses essence to Lung; weak Kidney Qi causes undigested food, weak Yang Fire failing to generate Spleen Earth, pylorus lacking movement, downward blockage forcing upward rebellion. Kidney Yang rootless, internal true cold/external false heat, deficient fire rushing to stomach causing persistent vomiting requires Li Zhong Tang (Regulate the Middle Decoction) or Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) with heavy Ren Shen (Ginseng Radix) to guide fire back to origin. Some say敗血 (stagnant blood) blocking Spleen-Stomach prevents accepting water/grain, causing vomiting. While plausible, stagnant blood obstruction stems from Yuan Qi deficiency. Use Sheng Hua Tang (Generate the New Decoction) and Er Chen Tang (Two Aged Things Decoction) plus Ren Shen (Ginseng Radix), Ze Lan (Lycopus Herba), Dan Shen (Salviae Miltiorrhizae Radix) for several doses. Xiang Sha (Amomi Fructus/Aucklandiae Radix), Yan Hu (Corydzidis Rhizoma) are inappropriate. Mild vomiting saves Spleen; severe vomiting saves Kidney. Seeking otherwise is not skillful. (Hui Xin Lu)
Selected Case
Mrs. Wang from Dongqing Lane suffered postpartum vomiting. Doctors first assumed food stagnation, used digestive meds, ineffective. Then assumed Qi stagnation, used Qi-moving meds, ineffective. Then assumed Middle deficiency, used Liu Jun Zi Tang (Six Gentlemen Decoction)/Li Zhong Tang (Regulate the Middle Decoction), all ineffective. I was consulted. Asked about epigastric obstruction? Yes. Lochia clean? Yes. I said: This is illness due to retained stasis, so all anti-emetics failed. First administered Sheng Hua Tang (Generate the New Decoction) with doubled Hei Jiang (Charred Zingiberis Rhizoma); after one dose, stasis moved, vomiting stabilized. Added stomach-harmonizing herbs to the decoction, vomiting stopped. (Wang Guangqi)
Hiccups
Postpartum hiccups vary by Cold, Heat, Deficiency, Excess. Cold uses Ding Xiang (Caryophylli Flos), Sheng Jiang (Fresh Zingiberis Rhizoma), Rou Gui (Cinnamon Bark); Heat uses Shi Di (Diospyri Fructus), Zhu Ru (Bambusae Caulis in Taenia); Deficiency uses Ren Shen (Ginseng Radix), Fu Zi (Aconiti Lateralis Radix Preparata); Excess uses Xiang Fu (Cyperi Rhizoma), Ju Pi (Citri Reticulatae Pericarpium). Misapplication brings regret. (Xue Lizhai)
The Classic says: Deep disease manifests as hiccups. Hiccups are a bad omen in all diseases. Postpartum occurrence implies deficiency/cold, not excess/heat. Xue Lizhai’s insistence on heat/excess is wrong. However, ancient formulas for hiccups involving stagnant blood use Ding Xiang Dou Kou San (Cardamom Powder) taken with Tao Ren Wu Zhu Yu Tang (Peach Kernel and Evodia Decoction). Pathogenesis must be known. (Xiao Shenzhai)
Cough
Postpartum cough may result from damaged Yin Blood, injured Lung Qi, rising Yin fire, or external Wind-Cold. Treatments vary. Yin Blood deficiency: Si Wu Tang (Four Substance Decoction) plus E Jiao (Donkey-Hide Gelatin). Lung Qi injury: Si Jun Zi Tang (Four Gentlemen Decoction) plus Jie Geng (Platycodonis Radix). Rising Yin fire: Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Mai Dong (Ophiopogonis Tuber), Wu Wei Zi (Schisandrae Fructus). External Wind-Cold: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Jie Geng (Platycodonis Radix), Zi Su (Perillae Folium). (Xue Lizhai)
Panting
Postpartum panting is a severe omen. Blood loss and Qi collapse lead to rapid breathing and disconnected Qi. Although governing Qi fails to consolidate, the root is failure of Qi transformation source to receive. Fundamental shaking, solitary Yang without companion, unlike Minister Fire scorching Lung Metal. Lungs expand when lying back, obstructing airways; sitting forward relieves obstruction. With empty Blood Sea, Ziwu not connecting, only heavy tonification of True Yin and filling Lower Yuan can save impending death. Sudden Yin Blood loss and floating True Qi mean herbs cannot quickly generate substantial Blood; heavy Ren Shen (Ginseng Radix), Fu Zi (Aconiti Lateralis Radix Preparata), Dang Gui (Angelica Sinensis), Di Huang (Rehmanniae Radix), plus Lu Rong (Cervi Cornu Degelatinatum), He Che (Placenta Humanum) are needed to urgently generate formless Qi. Similar有情 (sentient) substances (meat/blood) help rootless flames return to origin, allowing Lung (Minister Official) to descend clearly. If lochia remains, stagnant blood steams Lung, causing panting; use Ren Shen Sheng Hua Tang (Ginseng Generate the New Decoction) to drain stasis while tonifying Yuan, restoring Yuan Qi allows stasis to pass. If pre-existing asthma triggered by external Wind postpartum, use Jin Shui Liu Jun Jian (Metal-Water Six Gentlemen Decoction). Nan Jing says: Exhalation Heart/Lung, inhalation Kidney/Liver. Postpartum exhalation > inhalation indicates Yuan Qi lack. Heavy tonification may still fail; physicians mistakenly using exterior-releasing drugs are wrong/right? (Hui Xin Lu)
Restlessness and Thirst
Blood is body fluid. Excessive postpartum blood loss leads to Yin deficiency and Fire hyperactivity, causing restlessness and thirst. Treat by nourishing Yin, descending Fire, resolving stasis, primarily adding Tong Bian (Human Urine). Tong Bian is salty, directs downward, descends Fire, resolves stasis, embodying "turbid Yin moves to lower orifices." (Xiao Shenzhai)
If previous symptoms involve excessive blood loss and rising deficient fire, use Si Wu Tang (Four Substance Decoction) with Tong Bian (Human Urine), Mai Dong (Ophiopogonis Tuber), Mu Dan Pi (Moutan Cortex); Stomach deficiency with heat, use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction); Blood deficiency with fever, use Si Wu Tang (Four Substance Decoction) plus Mai Dong (Ophiopogonis Tuber), Wu Wei Zi (Schisandrae Fructus); Blood collapse with restlessness, use Dang Gui Bu Xue Tang (Angelica Tonify Qi Decoction); Stomach Qi weakness, use Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Powder). (Xue Lizhai)
Spasm
Chi (clonic) is tendon spasm; Zong (tonic) is tendon relaxation. Liver governs tendons/stores Blood; Liver Qi is Yang/Fire, Liver Blood is Yin/Water. Postpartum Chi-Zong results from excessive Yin Blood loss, solitary Fire blazing, tendons losing nourishment, extreme deficiency generating Wind. Treat with Ba Zhen Tang (Eight Treasure Decoction) plus Mu Dan Pi (Moutan Cortex), Gou Teng (Uncariae Ramulus cum Uncis) to generate Yin Blood, extinguishing Wind/fire heals. Liver channel Blood deficiency: Xiao Yao San (Free and Easy Wanderer Powder) plus Gou Teng (Uncariae Ramulus cum Uncis); Liver-Spleen dual deficiency: Si Jun Zi Tang (Four Gentlemen Decoction) plus Chuan Xiong (Ligusticum Rhizome), Dang Gui (Angelica Sinensis), Mu Dan Pi (Moutan Cortex), Gou Teng (Uncariae Ramulus cum Uncis). Blood born from Extreme Yin (Spleen Earth). Body aversion to cold, fine/faint pulse indicates true state; floating-large pulse, fever/restlessness/thirst indicates false appearance. Focus on consolidating root. Weak spasms, eyes rolling back, pearl-like sweat indicate untreatable. Classic: Spleen glory in lips; Heart fluid is sweat. Extreme Heart-Spleen deficiency with white lips/sweating requires urgent Shen Fu Shi Quan Da Bu Tang (Ginseng and Aconitum Ten-Tonifying Decoction). (Xue Lizhai)
Spasm divides into rigid/flaccid; 60-70% are deficiency. Postpartum convulsive spasm stems from massive Qi-Blood deficit. Post-delivery excessive blood loss leaves Yang unsupported. Symptoms resemble Taiyang/Taiyin Shaoyang/ShaoYin Shaoyang Shaoyin syndromes but differ. Physicians misdiagnosing pulse/syndrome, using sweating/purging, causing Yin/Yang collapse, worsening Qi/Blood deficiency, tendons losing nourishment, extreme dryness generating Wind, opisthotonos, trismus, clenched fists, dangerous signs emerge. Blood exhaustion damages Chong/Ren vessels; Du vessel on back loses flexibility, causing spasm. Treatment targets Liver/Kidney, saving both Yin/Yang. Yin deficiency: Ren Shen Liu Wei Tang (Ginseng Six-Ingredient Decoction); Yang deficiency: Shi Quan Da Bu Tang (Ten-Tonifying Decoction), heavy doses. Ensure True Qi flows, Essence/Blood connects, tendons moisten. Classic: Yang nourishes spirit/mind, softens tendons. Postpartum blood loss mistaken for Cold Damage by quacks causes disaster. Even Cold Damage spasm from excessive sweating/purging requires heavy Qi-Blood tonification; postpartum definitely requires it! If spasm occurs immediately after sweating without drug error, it is sudden Yang deficiency, loose pores, erratic fluid loss; urgently use Ren Shen Yang Ying Tang (Ginseng Nourish Ying Decoction) plus Fu Zi (Aconiti Lateralis Radix Preparata). Danxi said: Postpartum regardless of pulse/syndrome, prioritize heavy Qi-Blood tonification. Postpartum convulsion is extremely empty; what else to rely on but heavy tonification? (Hui Xin Lu)
Tremor
Postpartum tremor is Qi-Blood deficiency, excess Fire generating Wind. Treat with Shi Quan Da Bu Tang (Ten-Tonifying Decoction). Half-body muscle tremor with sweating also needs heavy tonification. Unconsciousness, salivation, tremor/spasm use Bu Xue Tang (Tonify Blood Decoction) plus Jing Jie Sui (Schizonepetae Spica), Dou Lin Jiu (Bean Soaked Wine). (Zhang Shi Yi Tong)
Head Sweat
Postpartum Yu Mao (Depression/Dizziness) with faint pulse, only head sweating. Reason: Blood deficiency leading to Jue (reversal), Jue leading to Mao (dizziness). Resolution requires heavy sweating. Blood deficiency lower reversal, solitary Yang upper exit causes head sweat. Postpartum women prefer sweating because Yin Blood loss, Yang predominance; sweating restores Yin-Yang balance. (Jin Gui Yao Lue)