腹重坠下，元气虚也；胎动不安，内热盛也。遂用补中益气而安，又用六君子汤痊愈。
司徒李杏岗仲子室，孕五月，小便不利，诸药不应。余曰∶非八味不能救。不信，别用分利之药，肚腹肿
胀，以致不起。
一妊妇，饮食后因恼怒寒热呕吐，头痛恶寒，胸腹胀痛，大便不实，其面青色，小便频数，时或有血，服
安胎止血之剂益甚。余曰∶寒热呕吐而腹胀，此肝木克脾土而元气伤也；大便不实而面青，此饮食伤脾兼肝侮
土也；小便频数而有血，此肝热传胞而兼挺痿也。用六君子加枳壳、紫苏、山栀，二剂脾胃顿醒。又用加味逍遥
散加紫苏、枳壳，二剂小便顿清。后节饮食，调理而安。
一妊妇，因怒尿血，内热作渴，寒热往来，胸乳间作胀，饮食少思，肝脉弦弱。此肝经血虚而热也，
用加味逍遥散、八味地黄丸兼服，渐愈。又用八珍汤加柴胡、山栀、丹皮而愈。
一妊娠，每胎至五月，肢体倦怠，饮食无味，先每足肿，渐至遍身，后及头面。此是脾肺气虚，朝
用补中益气，夕用六君子加苏梗而愈。
地官李孟卿，娶三十五岁女为继室，妊娠虑其难产，索加味归芎汤四剂备用。果产门不开，止服一剂，顿然
分娩。
妊娠欲产之时，但觉腹内转动，即当正身仰卧，待儿转身向下时作痛，试捏产母手中指中节，或本节
跳动，方与临盆，即产矣。
若初觉不仰卧以待转胞，或未产而水频下，此胞衣已破，血水先干，必有逆生难产之患。
若横生者，儿先露手臂，令母正卧，以手徐推儿臂下体，令其正直，复以中指摩其肩，勿令脐带攀系即
生。
逆生者，儿先露足，令母正卧，以手按推其足，仍推儿转正即生。
偏生者，儿头偏在一边，亦照前法，徐正其头即生。或儿后头骨偏在谷道边，徐推近上即生。
碍产者，儿头虽正，但不能下。盖因胎转脐带攀肩所致，用中指按儿两肩，理脱脐带即生。
坐产者，儿将欲生，其母疲倦，久坐椅褥，抵其生路，急用巾带高悬，令母以手攀之，轻轻屈足，良久
儿顺即生。
盘肠生者，临产母肠先出，此难以收上，以蓖麻子四十九粒，研烂涂产母头项，待肠收上，急洗去。设为风
吹干不
能收者，以磨刀水少许，温热拭润其肠。再用磁石煎汤服之，即收上。磁石须阴阳家用有验者。俗以水 母面
使惊，而肠亦收之。盖惊则气散，恐反致他证，戒之。
若胞衣破而不得分娩者，用保生无忧散以固其血，自然生息。如血已耗损，用八珍汤料一斤，益母草半
斤，水数碗，煎熟不时饮之，亦有得生者。
大抵难产多患于安逸富贵之家。治法虽云胎前清气，产后补血，不可专执。若脾胃不实，气血不充，宜预
调补。如因难产，或大寒时，急以大油纸捻，徐徐烧断其脐带，虽儿已死，令暖气入腹，多得复生，切不宜用
刀断之。
子死腹中
多因惊动太早，或触犯禁忌，或抱腰太重，或胞衣先破，血水先尽而胎干涸故耳。其候∶产母唇舌皆黑者，
子母俱死；若舌黑或胀闷甚者，其子已死矣。先以平胃散一两，酒水各半煎，却投朴硝半两服。或用硝一两，
以童便调下，亦妙。
胎衣不出
有因恶露入衣，胀而不能出；有因元气亏损，而不能送出。其恶露流入衣中者，胀痛，用夺命丹或失笑
散，以消淤血，缓则不救。其元气不能送者，腹中不胀痛，用保生无忧散一剂，实时而产。
一妇人，分娩最易，至四十妊娠，下血甚多，产门不开，亦与前汤一剂，又用羌忧散斤许一剂，煎，热饮
之，以助其血而产。
一产妇，阴门不闭，发热恶寒，用十全大补加五味子数剂，而寒热悉退。又用补中益气加五味子，数剂
而敛。若初产肿胀。或 痛而不闭者，当用加味逍遥散。若肿既消而不闭者，当用补中益气汤。切忌寒凉之剂。
一产妇，失治肿溃不已，形体消瘦，饮食少思，朝寒暮热，自汗盗汗半年矣。用补中益气加茯苓、半夏
以健脾胃，脓水渐少，饮食渐进。用归脾汤以解脾郁，共五十余剂，元气渐复，而疮亦愈矣。
产后腹痛
产后小腹作痛，俗名儿枕，用失笑散行散之。若恶露已去而仍痛，用四神散调补之；若不应，
用八珍汤。若痛而恶心，或欲作呕，用六君子汤。若痛而泄泻，用六君子送四神丸。若泄泻痛而或后重，用补
中益气送四神丸。若胸膈饱胀，或恶食吐酸，或腹痛手不可按，此是饮食所致，当用二陈加白术，山楂以消
导。若食既消而仍痛，或按之不痛，或更加头疼，烦热作渴，虚寒欲呕等证，此是中气被伤，宜补脾胃
为主。若发热腹痛，按之痛甚，不恶食，不吞酸，此是淤血停滞，用失笑散以消之。若止是发热头痛，或兼腹
痛，按之却不痛，此是血虚，用四物加炮姜、参、术以补之。《病机要》云∶胎产之病，从厥阴经论之
，无犯胃气及上二焦。为之三禁，不可汗，不可下，不可利小便。发汗者同伤寒下早之症，利
大便则脉数而已动于脾，利小便则内亡津液，胃中枯燥，制药之法，能不犯三禁，则营卫自和，而寒热止矣。
如发渴用白虎，气弱用黄 ，血刺痛则用当归，腹中痛则用芍药，宜详察脉证而用之。凡溪先生云∶产后
当大补气血为先，虽有杂证，从未治之。一切病多是血虚，皆不可发表。
医案
一产妇，腹痛发热，气口脉大。余以为饮食停滞、不信，乃破血补虚，反寒热头痛，呕吐涎沫。又用降
火化痰理气，四肢逆冷，泄泻下坠，始信。谓余曰∶何也？余曰∶此脾胃虚之变证也，法当温补。遂用六
君加炮姜二钱，肉桂、木香一
钱，四剂诸证悉退。再用补中益气之剂，元气悉复。
一妇人，产后腹痛后重，去痢无度，形体倦怠，饮食不甘，怀抱久郁，患茧唇，寐而盗汗如雨，竟夜
不寐，神思消烁。余曰∶气血虚而有热。用当归六黄汤内黄芩、连、柏炒黑，一剂汗顿止，再剂全止。乃用
归脾汤、八珍散兼服，元气渐复而愈。
一产妇，小腹疼痛，小便不利，用薏苡仁汤，二剂痛止，更以四物加桃仁、红花，下淤血而愈。大抵
此证皆因营卫不调，或淤血停滞所致。若脉洪数已有脓，但数微有脓，脉迟紧乃淤血，下之即愈。若腹胀大
，转侧作水声，或脓从脐出，或从大便出，宜用蜡矾丸、太乙膏及托里药。凡淤血停滞，宜急治之，缓则腐
化为脓，最难治疗。若流注关节，即患骨疽，失治多为败证。
产后血晕并失血
产后元气亏损，恶露乘虚上攻，眼花头晕，或心下满闷，神昏口噤，或痰壅盛者，急用失笑散主之。
若血下多而晕，或神昏烦乱者，大剂芎归汤补之，或芸台子散，或童子小便，有痰加二陈汤。若因劳心力而
致者，宜补中益气加香附。若因气血虚极，不省人事，用清魂散，继以芎归汤及大补气血之剂。凡产后
口眼 斜等证，当大补气血为主，而兼以治痰。若脾胃虚而不能固者，用六君子汤。
医案
一产妇月余矣，因怒两胁胀痛，忽吐血甚多，发热恶寒，胸腹胀满，用八珍加柴胡、丹皮、炮姜而安，
却用十全大补，仍加炮姜而愈。前症因脾肺气血亏损，而胸腹虚痞，虽投大补，若非姜、桂辛温助其脾肺，
以行药势，亦无以施其功，而反助其胀耳。
一产妇，两手麻木，服愈风丹、天麻丸，遍身皆麻，神思倦怠，晡热作渴，自汗盗汗。此气血俱虚也，
用十全大补加炮姜，数剂诸证悉退。却去炮姜，又数剂而愈。但内热，此血虚也，用逍遥散而痊。
产后发痉
因去血过多，元气亏极；或外邪相搏，其形牙关紧急，四肢劲强；或腰背反张，肢体抽搐。若有汗而不恶
寒者，曰柔痉；无汗而恶寒者，曰刚痉。然产后患之，实由亡血过多，筋无所养而致。故伤寒汗下过多，与溃
疡脓血大泄，多患之，乃败证也。若大补气血，多保无虞。若攻风邪，必死。
医案
一产妇，牙关紧急，腰背反张，四肢抽搐，两目连札。余以为去血过多，元气亏损，阴火炽盛，用十全
大补加炮姜，一剂而苏，又数剂而安。
余在吴江时，定更后，闻喧嚷云∶某家妇忽仆，牙关紧急，已死矣。询云新产妇，余意其劳伤气血而
发痉也，急用十全大补加附子煎滚，令人抬正其身，一人以手夹正其面，却挖开其口，将药灌之，不咽，药已
冷，反侧其面出之，仍正其面，复灌以热药，又冷又灌，如此五次，方咽下，随灌以热药，遂苏。
大凡产后，或病久元气虚弱，见病百端，皆因脾胃亏损，内真寒而外假热，但用六君子或补中益气加炮
姜，温补脾气，诸症悉退。若四肢畏冷，属阳气虚寒，急加附子。病因多端，当临证制宜，庶无误矣。
医案
一产妇，粪后下血，诸药不应，饮食少思，肢体倦怠。此中气虚弱，用补中益气加茱萸炒黄连五分，四剂
顿止。但怔
忡少寐，寝汗未止，用归脾汤治之而愈。
一妇人，但怒便血，寒热口苦，或胸胁胀痛，或小腹痞闷。此木乘土，倍用六君子加柴胡、
山栀而愈，用补中益气、加味逍遥二药，而不复作。
一妇人，久下血在粪前，属脾胃虚寒，元气下陷，用补中益气加连炒茱萸一钱，数剂稍缓，乃加生茱萸
五分，数剂而愈。
一妇人，产后便血，口干饮汤，胸胁膨满，小腹闷坠，内热晡热，饮食不甘，体倦面黄，日晡则赤，洒
淅恶寒。此脾肺气虚，先用六君加炮姜、木香，诸证渐愈，用补中益气将愈，用归脾汤全愈。后饮食失节，
劳役兼怒气，发热血崩，夜间热甚，谵语不绝，此热入血室，用加味柴胡，二剂而热退，
用补中益气而血止，用逍遥、归脾二方，调理而安。
大便不通案
一产妇，大便八日不通，用通利之药，中脘作痛，饮食甚少。或云通则不痛，痛则不通，乃用蜜导之，
大便不禁，呃逆不食。余曰∶此脾肾复伤，用六君子加吴茱萸，肉果、骨脂、五味数剂，喜其年壮，不然多
致不起。
产后寒热
因气血虚弱，或脾胃亏损，乃不足之证。经云∶阴虚则发热，阳虚则恶寒。若大便不通，尤属气血虚
弱，切不可用发表降火药。若寸口脉微，名阳气不足，阴气上入于阳中则恶寒，用补中益气汤。尺部脉弱，
名阴气不足，阳气下陷于阴中则发热，用六味地黄丸。大抵阴不足，阳往从之，则阳内陷而发热；阳不足
，阴往从之，则阴上入而恶寒。此阴阳不归其分，以致寒热交争，故恶寒而发热也，当用八珍汤。若
病后四肢发热，或形体倦怠，此元气未复，湿热乘之故耳，宜
补中益气汤。若肌热大渴引饮，目赤面红，此血虚发热，用当归补血汤。若认为热，则误矣。
医案
一妇人，产后恶寒发热，用十全大补加炮姜治之而愈。但饮食不甘，肢体倦怠，用补中益气而安。又饮
食后犯怒，恶寒发热，抽搐切牙，难候其脉，视其面色，青中隐黄，欲按其腹，以手护之，此肝木侮脾土，
饮食停滞而作，用六君加木香，一剂而安。
一产妇，恶寒发热，余欲用八珍加炮姜治之，其家知医，以为风寒，小柴胡汤。
余曰∶寒热不时，乃气血虚。不信，仍服一剂，汗出不止，谵语不绝，烦热作渴，肢体抽搐。余用
十全大补，二剂益甚，脉洪大，重按如无，仍以前汤加附子，四剂稍缓，数剂而安。
产后咳嗽
或因阴血耗损，或因肺气亏损，或阴火上炎，或风寒所感，主治之法∶若阴血虚者，用芍、归、熟地、
参、术。肺气伤者，用四君、芎、归、桔梗。阴火上炎者，六味加参、术。风寒所感者，补中益气加桔梗、
紫苏。若淤血入肺发喘，急用二味参苏饮，多有得生者，若兼口鼻起黑，或鼻出血，急用前散，亦有得生者。
然而所患悉因胃气不足，盖胃为五脏之根本，人身之根蒂，胃气一虚，五脏失所，百病生焉。但患者多谓腠理
不密所致，殊不知肺属辛金，生于己土，亦因土虚不能生金，而腠理不密，外邪所感。其阴火上炎，亦壮
土金、生肾水以制火为善，若径治其病，则误矣。
医案
一产妇，咳嗽声重，鼻塞流涕。此风寒所感，用参苏饮一钟，顿愈六七。乃与补中益气加桔梗、茯苓、
半夏，一剂
而愈。又与六君加黄 ，以实其腠理而安。
一产妇，朝吐痰，夜发热，兼之无寐，用清痰降火药，肌体日瘦，饮食日少，前证愈甚。
余曰，早间吐痰，脾气虚也。夜间发热，肝血虚也。昼夜无寐，脾血耗也。遂用六君子汤、
加味逍遥散、加味归脾汤，以次补调，不月而痊。
一产妇，咳嗽痰盛，面赤口干，内热晡热，彻作无时。此阴火上炎，当补脾肾，遂用补中益气，
六味地黄丸而愈。
一产妇，咳而腹满，不食涕唾，面肿气逆。此病在胃，关于肺，用异功散而愈。
产后疟
一产妇，患疟久不愈，百病峰起，其脉或洪大，或微细，或弦紧，或沉伏，难以名状。用六君加炮
姜二十余剂，脉证稍得。又用参、术煎膏，佐以归脾汤百余剂而瘥。
产后痢
一产妇，泻痢年余，形体骨立，内热晡热，自汗盗汗，口舌糜烂，日吐痰三碗许，脉洪大，重按全无。
Abdominal heaviness and bearing-down sensation are caused by deficiency of Yuan Qi (Original Qi); restless fetus is caused by excessive internal heat. Therefore, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used to stabilize the fetus, and Liu Jun Zi Tang (Six Gentlemen Decoction) was subsequently used to achieve a complete cure.
The wife of the second son of Situ Li Xinggang experienced difficulty in urination at five months of pregnancy, with no response to various medications. I stated: "Only Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) can save her." The family did not believe this and used diuretic drugs instead, leading to abdominal swelling and ultimately the death of both mother and child.
A pregnant woman developed chills and fever, vomiting, headache, aversion to cold, chest and abdominal distension and pain, loose stools, and a bluish complexion after becoming angry following a meal. She also had frequent urination with occasional blood. Her symptoms worsened after taking fetal-calming and hemostatic agents. I stated: "Chills, fever, vomiting, and abdominal distension indicate that Liver Wood is overacting on Spleen Earth, damaging Yuan Qi; loose stools and bluish complexion indicate dietary injury to the Spleen combined with Liver Qi invading Earth; frequent urination with blood indicates Liver Heat transmitting to the Bao Gong (Uterus) accompanied by prolapse." Liu Jun Zi Tang (Six Gentlemen Decoction) was modified with Zhi Ke (Aurantii Fructus), Zi Su (Perillae Folium), and Shan Zhi (Gardeniae Fructus). After two doses, Spleen and Stomach function recovered abruptly. Then, Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) modified with Zi Su (Perillae Folium) and Zhi Ke (Aurantii Fructus) was administered for two doses, resulting in clear urine. She then regulated her diet and recovered through conditioning.
A pregnant woman presented with hematuria due to anger, internal heat with thirst, alternating chills and fever, distension in the chest and breasts, poor appetite, and a wiry and weak Liver pulse. This indicated Blood deficiency and heat in the Liver Channel. Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) and Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) were taken concurrently, leading to gradual recovery. Subsequently, Ba Zhen Tang (Eight-Treasure Decoction) modified with Chai Hu (Bupleuri Radix), Shan Zhi (Gardeniae Fructus), and Dan Pi (Moutan Cortex) cured the condition.
A pregnant woman experienced limb fatigue and loss of taste for food every time she reached five months of gestation. Initially, her feet swelled, gradually spreading to the whole body and eventually involving the head and face. This was due to Qi deficiency of the Spleen and Lung. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was administered in the morning, and Liu Jun Zi Tang (Six Gentlemen Decoction) modified with Su Geng (Perillae Caulis) in the evening, resulting in a cure.
Di Guan Li Mengqing married a thirty-five-year-old woman as his second wife. Fearing difficult labor, he requested Si Ji Jia Wei Gui Xiong Tang (Four Doses of Modified Angelica and Ligusticum Decoction) for preparation. Indeed, when delivery began, the birth canal failed to open. Only one dose was taken, and she delivered immediately.
When approaching labor during pregnancy, if one feels movement within the abdomen, one should lie supine with the body straight. Wait until the fetus turns downward and pain begins. Test by pinching the middle joint or proximal interphalangeal joint of the mother's middle finger; if it throbs, labor has commenced, and delivery will follow.
If one does not lie supine upon initial pain to wait for fetal rotation, or if amniotic fluid leaks frequently before delivery, this indicates the membranes have ruptured, and blood/fluid has dried up first, inevitably leading to malpresentation and dystocia.
In case of transverse lie, where the arm presents first, let the mother lie supine. Gently push the fetal arm and body back into position using your hand. Then rub the shoulder with your middle finger to ensure the umbilical cord is not entangled, and the baby will be born.
In case of breech presentation, where the foot presents first, let the mother lie supine. Press and push the foot gently, turning the fetus upright, and delivery will occur.
In case of asynclitism (sideways presentation), where the head is tilted to one side, follow the previous method to gently correct the head position, and delivery will occur. If the occiput is tilted towards the anus, gently push it upwards, and delivery will occur.
In case of obstructed labor, where the head is correct but cannot descend, this is often due to the umbilical cord wrapping around the shoulders during fetal rotation. Use your middle finger to press the fetal shoulders, untangle the cord, and delivery will occur.
In case of seated labor, where the mother is exhausted and sits for a long time on a chair or cushion, blocking the birth canal, hang a towel or belt high up. Let the mother hold onto it, bend her knees gently, and after some time, the baby will be born smoothly.
In case of procidentia of the intestine (prolapsed bowel accompanying delivery), where the intestine protrudes before the baby, it is difficult to retract. Grind forty-nine castor beans (Bi Ma Zi) into a paste and apply to the top of the mother's head and nape. Once the intestine retracts, wash it off immediately. If wind dries it preventing retraction, use a small amount of warm water from sharpening a knife to moisten the intestine. Then administer a decoction of Magnetite (Ci Shi) orally to facilitate retraction. Ensure the Magnetite is verified effective by Yin-Yang practitioners. Folk methods involve startling the mother with jellyfish faces to retract the intestine via fright-induced Qi dispersion, but this may cause other disorders; beware.
If membranes rupture but delivery does not proceed, use Bao Sheng Wu You San (Preserve Life and Ensure Safety Powder) to secure the blood, allowing natural delivery. If blood loss is severe, use one jin (approx. 500g) of Ba Zhen Tang (Eight-Treasure Decoction) ingredients, half a jin of Yi Mu Cao (Leonuri Herba), boiled in several bowls of water, and sip intermittently. Survival is possible.
Generally, dystocia occurs more often in wealthy families living in comfort. Although treatment principles state clearing heat before delivery and tonifying blood after, one must not adhere rigidly. If Spleen and Stomach are weak and Qi/Blood insufficient, preventive tonification is necessary. In cases of dystocia or extreme cold, slowly burn the umbilical cord with a large oil-paper wick. Even if the infant is dead, allowing warmth into the abdomen may revive them. Do not cut the cord with a knife.
Dead Fetus in Uterus
This is often due to premature disturbance, violating taboos, holding the waist too tightly, or premature rupture of membranes causing blood/fluid depletion and fetal desiccation. Signs: If the mother's lips and tongue are black, both mother and child die; if the tongue is black or distension/stuffiness is severe, the fetus is dead. First, administer Ping Wei San (Calm the Stomach Powder) one liang (approx. 30g), decocted with equal parts wine and water, then add Po Xiao (Natrii Sulfas) half a liang. Alternatively, use one liang of Po Xiao mixed with child's urine, which is also effective.
Retained Placenta
Caused by lochia entering the placenta causing distension preventing expulsion, or by Yuan Qi deficiency failing to expel it. If lochia enters the placenta, causing pain and distension, use Duo Ming Dan (Life-Restoring Pill) or Shi Xiao San (Sudden Smile Powder) to resolve blood stasis; delay leads to fatality. If Yuan Qi fails to expel it, without pain/distension, use Bao Sheng Wu You San (Preserve Life and Ensure Safety Powder) one dose for immediate delivery.
A woman who usually delivered easily experienced heavy bleeding and cervical dilation failure at her fortieth pregnancy. One dose of the aforementioned decoction was given, along with one dose of Qiang You San (likely referring to a formula for moving Qi/blood, textually ambiguous but contextually therapeutic), approx. one jin, decocted and drunk hot to assist blood flow and facilitate delivery.
A postpartum woman presented with an open vulva, fever, and aversion to cold. Ten Complete Great Tonifying Decoction (Shi Quan Da Bu Tang) plus Wu Wei Zi (Schisandrae Fructus) for several doses resolved the fever and chills. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Wu Wei Zi for several doses closed the vulva. For initial postpartum swelling or pain without closure, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). For closure issues after swelling subsides, use Bu Zhong Yi Qi Tang. Avoid cold-natured medicines.
A postpartum woman suffered from untreated swelling and ulceration, emaciation, poor appetite, morning chills and evening fevers, spontaneous and night sweats for half a year. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fu Ling (Poria) and Ban Xia (Pinelliae Rhizoma) strengthened the Spleen and Stomach; pus decreased, and appetite improved. Gui Pi Tang (Restore the Spleen Decoction) relieved Spleen depression. Over fifty doses restored Yuan Qi and healed the sores.
Postpartum Abdominal Pain
Lower abdominal pain after delivery, commonly called "Child Pillow" pain, is treated with Shi Xiao San (Sudden Smile Powder) to move blood stasis. If pain persists after lochia cessation, use Si Shen San (Four Spirit Powder) for regulation; if ineffective, use Ba Zhen Tang (Eight-Treasure Decoction). If pain accompanies nausea or vomiting tendency, use Liu Jun Zi Tang (Six Gentlemen Decoction). If pain accompanies diarrhea, use Liu Jun Zi Tang (Six Gentlemen Decoction) with Si Shen Wan (Four Spirit Pill). If diarrhea, pain, and tenesmus occur, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Si Shen Wan (Four Spirit Pill). If epigastric fullness, anorexia, acid regurgitation, or tenderness to touch occurs, it is due to food stagnation; use Er Chen Tang (Two-Cured Decoction) plus Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Shan Zha (Crataegi Fructus) to digest. If pain persists after digestion, or is non-tender, or accompanied by headache, irritability, thirst, and cold intolerance, it indicates Middle Qi injury; prioritize tonifying Spleen and Stomach. If fever and abdominal pain are present, with severe tenderness, no food aversion, and no acid regurgitation, it is blood stasis; use Shi Xiao San (Sudden Smile Powder). If only fever and headache, or mild abdominal pain that is non-tender, it is Blood deficiency; use Si Wu Tang (Four Substance Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum), Ren Shen (Ginseng Radix et Rhizoma), and Bai Zhu (Atractylodis Macrocephalae Rhizoma). *Bing Ji Yao* states: "Diseases related to pregnancy and childbirth should be discussed according to the Jueyin Channel; do not harm Stomach Qi and the Upper/Middle Jiao." These are the Three Prohibitions: no sweating, no purging, no promoting urination. Sweating mimics early purging in Cold Damage; purging moves the pulse and disturbs the Spleen; promoting urination depletes fluids and dries the Stomach. Formulations avoiding these three prohibitions harmonize Ying and Wei, stopping chills and fever. For thirst, use Bai Hu Tang (White Tiger Decoction); for Qi weakness, use Huang Qi (Astragali Radix); for stabbing blood pain, use Dang Gui (Angelicae Sinensis Radix); for abdominal pain, use Shao Yao (Paeoniae Radix). Observe pulses and signs carefully. Mr. Fan Xi said: "Postpartum treatment must prioritize massive tonification of Qi and Blood. Even with miscellaneous symptoms, never treat them separately. Most postpartum diseases are due to Blood deficiency; surface-releasing agents are contraindicated."
Medical Case
A postpartum woman presented with abdominal pain and fever, with a large Qi Kou pulse. I diagnosed food stagnation. The family disagreed, using blood-breaking and tonifying herbs, resulting in worsening chills, fever, headache, and vomiting of saliva. They then used fire-clearing, phlegm-resolving, and Qi-regulating herbs, leading to cold limbs, diarrhea, and rectal prolapse. Finally, they believed me. I explained: "This is a transformation of Spleen-Stomach deficiency, requiring warming and tonification." Liu Jun Zi Tang (Six Gentlemen Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum) 2 qian, Rou Gui (Cinnamomi Cortex), and Mu Xiang (Aucklandiae Radix) 1 qian were given for four doses, resolving all symptoms. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) fully restored Yuan Qi.
A woman presented with postpartum abdominal pain, tenesmus, profuse dysentery, fatigue, poor appetite, long-standing emotional depression, cornified lip (Jian Chun), heavy night sweats, insomnia, and mental exhaustion. I diagnosed Qi and Blood deficiency with heat. Dang Gui Liu Huang Tang (Angelica Six Yellow Decoction) with Chao Hei (charred) Huang Qin (Scutellariae Radix), Lian Qiao (Forsythiae Fructus - *Note: Text says Lian, likely Lian Qiao or Lian Zi, but context implies bitter cold herbs like Huang Lian*), and Huang Bo (Phellodendri Cortex) stopped sweating in one dose and completely in two. Gui Pi Tang (Restore the Spleen Decoction) and Ba Zhen San (Eight-Treasure Powder) were then used concurrently, restoring Yuan Qi and curing the condition.
A postpartum woman had lower abdominal pain and difficulty urinating. Yi Yi Ren Tang (Coix Seed Decoction) for two doses stopped the pain. Si Wu Tang (Four Substance Decoction) plus Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos) expelled blood stasis and cured the condition. Generally, this results from disharmony of Ying and Wei or blood stasis. A surging rapid pulse indicates pus; slightly rapid indicates slight pus; slow tight pulse indicates blood stasis, which resolves with purging. Abdominal distension with splashing sounds, pus from the umbilicus or stool, requires La Fan Wan (Wax Honey Pill), Tai Yi Gao (Great One Paste), and interior-supporting herbs. Treat blood stasis urgently; delay leads to suppuration and difficulty. Joint involvement causes bone abscess; neglect leads to critical conditions.
Postpartum Syncope and Hemorrhage
Yuan Qi deficiency allows lochia to attack upward due to emptiness, causing blurred vision, dizziness, chest oppression, coma, locked jaw, or phlegm obstruction. Urgently use Shi Xiao San (Sudden Smile Powder). If syncope follows heavy bleeding or confusion/agitation occurs, use a large dose of Xiong Gui Tang (Ligusticum and Angelica Decoction), Yun Tai Zi San (Brassicae Semen Powder), or child's urine. Add Er Chen Tang (Two-Cured Decoction) if phlegm is present. If caused by mental exertion, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Xiang Fu (Cyperi Rhizoma). If extreme Qi/Blood deficiency causes unconsciousness, use Qing Hun San (Clear Soul Powder), followed by Xiong Gui Tang (Ligusticum and Angelica Decoction) and massive Qi/Blood tonics. For postpartum facial paralysis, prioritize Qi/Blood tonification and address phlegm. If Spleen-Stomach deficiency fails to consolidate, use Liu Jun Zi Tang (Six Gentlemen Decoction).
Medical Case
A postpartum woman, one month out, developed bilateral hypochondriac distension/pain after anger, sudden heavy hematemesis, fever, aversion to cold, and chest/abdominal fullness. Ba Zhen Tang (Eight-Treasure Decoction) plus Chai Hu (Bupleuri Radix), Dan Pi (Moutan Cortex), and Pao Jiang (Zingiberis Rhizoma Preparatum) stabilized her. Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum) cured her. The prior symptoms were due to Spleen-Lung Qi/Blood deficiency causing empty fullness. Without the acrid-warm properties of Ginger and Cinnamon to aid the Spleen-Lung and drive the medicine, the tonic would fail and increase distension.
A postpartum woman had numb hands, which spread to the whole body after taking Yu Feng Dan (Wind-Dispelling Pill) and Tian Ma Wan (Gastrodia Pill). She had mental fatigue, afternoon fever/thirst, and spontaneous/night sweats. This was Qi and Blood deficiency. Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum) for several doses resolved symptoms. Removing Pao Jiang and continuing for several doses cured her. Residual internal heat indicated Blood deficiency, cured by Xiao Yao San (Free and Easy Wanderer Powder).
Postpartum Tetany
Due to excessive blood loss and extreme Yuan Qi deficiency, or external pathogenic conflict, presenting with locked jaw, stiff limbs, opisthotonos, or convulsions. With sweat but no aversion to cold, it is Rou Jing (Soft Tetany); without sweat and with aversion to cold, it is Gang Jing (Hard Tetany). Postpartum tetany is truly due to excessive blood loss leaving sinews un nourished. Thus, excessive sweating/purging in Cold Damage or large drainage of pus/blood in ulcers often causes this critical condition. Massive Qi/Blood tonification usually ensures safety. Attacking wind pathogens is fatal.
Medical Case
A postpartum woman presented with locked jaw, opisthotonos, limb convulsions, and eye twitching. I attributed this to excessive blood loss, Yuan Qi deficiency, and blazing Yin Fire. Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum) revived her in one dose and stabilized her in several.
While in Wujiang, after dusk, I heard commotion: "A woman fell suddenly, locked jaw, and died." Inquiry revealed she was a new postpartum woman. I suspected tetany from Qi/Blood exhaustion. I urgently boiled Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) plus Fu Zi (Aconiti Lateralis Radix Preparata). Assistants straightened her body and face. I opened her mouth to pour medicine. She didn't swallow. When cold, I turned her head to drain it, straightened her face again, and poured hot medicine. Repeated five times until swallowed, followed by continuous hot administration, she revived.
Generally, postpartum or chronic illness with weak Yuan Qi presents myriad symptoms due to Spleen-Stomach damage, true internal cold with false external heat. Use Liu Jun Zi Tang (Six Gentlemen Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum) to warm and tonify Spleen Qi; symptoms retreat. If limbs are cold, indicating Yang deficiency/cold, urgently add Fu Zi (Aconiti Lateralis Radix Preparata). Etiologies vary; adapt to clinical presentation to avoid error.
Medical Case
A postpartum woman had hematochezia after defecation, unresponsive to other drugs, with poor appetite and fatigue. This was Middle Qi weakness. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Chao Huang Lian (Charred Coptidis Rhizoma) 5 fen and Zhu Yu (Evodiae Fructus) stopped bleeding in four doses. Palpitations, insomnia, and persistent night sweats were cured by Gui Pi Tang (Restore the Spleen Decoction).
A woman bled upon anger, with chills/fever, bitter taste, hypochondriac pain, or abdominal stuffiness. This was Liver Wood overacting on Spleen Earth. Doubling Liu Jun Zi Tang (Six Gentlemen Decoction) plus Chai Hu (Bupleuri Radix) and Shan Zhi (Gardeniae Fructus) cured her. Maintenance with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) prevented recurrence.
A woman had prolonged hematochezia preceding stool, due to Spleen-Stomach deficiency-cold and sinking Yuan Qi. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Lian Zhu Yu (Connected Evodiae Fructus) 1 qian provided relief in several doses. Adding raw Zhu Yu (Evodiae Fructus) 5 fen in subsequent doses cured her.
A postpartum woman had hematochezia, dry mouth desiring soup, chest/hypochondriac distension, lower abdominal heaviness, internal heat with afternoon exacerbation, poor appetite, fatigue, sallow complexion, redness at sunset, and aversion to cold. This was Spleen-Lung Qi deficiency. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum) and Mu Xiang (Aucklandiae Radix) gradually improved symptoms. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) nearly cured it; Gui Pi Tang (Restore the Spleen Decoction) completed the cure. Later, irregular diet, overwork, and anger triggered bloody leukorrhea, severe night fever, and delirium. This was Heat entering the Blood Chamber. Jia Wei Chai Hu Tang (Modified Bupleurum Decoction) cleared fever in two doses. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) stopped bleeding. Xiao Yao San (Free and Easy Wanderer Powder) and Gui Pi Tang (Restore the Spleen Decoction) conditioned her to safety.
Case of Constipation
A postpartum woman had no bowel movement for eight days. Laxatives caused epigastric pain and poor intake. Some argued "patency prevents pain, pain prevents patency," and used honey suppositories, leading to incontinence, hiccups, and anorexia. I stated: "This is secondary Spleen-Kidney injury." Liu Jun Zi Tang (Six Gentlemen Decoction) plus Wu Zhu Yu (Evodiae Fructus), Rou Guo (Myristicae Semen), Gu Zhi (Psoraleae Fructus), and Wu Wei Zi (Schisandrae Fructus) for several doses saved her due to her youth; otherwise, it would have been fatal.
Postpartum Chills and Fever
Due to Qi/Blood weakness or Spleen-Stomach damage, this is a deficiency syndrome. Classics state: "Yin deficiency causes fever; Yang deficiency causes aversion to cold." Constipation here indicates severe Qi/Blood weakness; surface-releasing and fire-clearing drugs are strictly contraindicated. Micrococcous pulse at Cun (inch) indicates Yang deficiency; Yin Qi invading Yang causes chills; use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Weak pulse at Chi (cubit) indicates Yin deficiency; Yang Qi sinking into Yin causes fever; use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). Generally, Yin deficiency attracts Yang, causing Yang to sink and fever; Yang deficiency attracts Yin, causing Yin to rise and chills. This misplacement of Yin/Yang leads to alternating chills and fever; use Ba Zhen Tang (Eight-Treasure Decoction). Limb fever or fatigue post-illness indicates incomplete Yuan Qi recovery with damp-heat invasion; use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Skin fever with intense thirst, red eyes/face indicates Blood deficiency fever; use Dang Gui Bu Xue Tang (Angelica Tonify the Qi Decoction). Mistaking this for excess heat is an error.
Medical Case
A woman had postpartum chills/fever, cured by Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum). Poor appetite and fatigue were resolved by Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Anger after eating caused chills/fever, convulsions, and teeth grinding. Pulse was hard to obtain; face showed blue hiding yellow. She protected her abdomen from palpation. This indicated Liver Wood insulting Spleen Earth with food stagnation. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Mu Xiang (Aucklandiae Radix) cured her in one dose.
A postpartum woman had chills/fever. I intended to use Ba Zhen Tang (Eight-Treasure Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum). The knowledgeable family diagnosed Wind-Cold and used Xiao Chai Hu Tang (Minor Bupleurum Decoction). I stated: "Irregular chills/fever indicates Qi/Blood deficiency." They refused, taking one dose. Result: incessant sweating, delirium, irritability, thirst, and convulsions. Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) for two doses worsened it. Pulse was surging-large but empty on deep pressure. Previous decoction plus Fu Zi (Aconiti Lateralis Radix Preparata) for four doses brought relief, and several doses ensured stability.
Postpartum Cough
Due to Yin Blood consumption, Lung Qi damage, flaming Yin Fire, or Wind-Cold invasion. Treatment: For Yin Blood deficiency, use Shao Yao (Paeoniae Radix), Dang Gui (Angelicae Sinensis Radix), Shu Di Huang (Rehmanniae Radix Preparata), Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma). For Lung Qi injury, use Si Jun Zi Tang (Four-Gentlemen Decoction), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), Jie Geng (Platycodonis Radix). For flaming Yin Fire, use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma). For Wind-Cold, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Jie Geng (Platycodonis Radix) and Zi Su (Perillae Folium). If blood stasis enters the Lung causing asthma, urgently use Er Wei Shen Su Yin (Two-Ingredient Ginseng and Perilla Decoction); many survive. If black marks appear on mouth/nose or epistaxis occurs, urgently use the aforementioned powder; survival is possible.
However, all ailments stem from insufficient Stomach Qi. The Stomach is the root of the Five Zang organs and the foundation of the body. If Stomach Qi is weak, the Five Zang lose their source, and hundred diseases arise. Patients often attribute this to loose pores, unaware that the Lung (Metal) is born from Spleen (Earth). Earth deficiency fails to generate Metal, leading to loose pores and external pathogen invasion. For flaming Yin Fire, strengthening Earth/Metal and generating Kidney Water to control Fire is best. Treating the symptom directly is erroneous.
Medical Case
A postpartum woman had heavy coughing, nasal congestion, and runny nose due to Wind-Cold. Shen Su Yin (Ginseng and Perilla Decoction) cured six or seven tenths immediately. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Jie Geng (Platycodonis Radix), Fu Ling (Poria), and Ban Xia (Pinelliae Rhizoma) cured her in one dose. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Huang Qi (Astragali Radix) solidified the pores and ensured stability.
A postpartum woman vomited phlegm in the morning, had fever at night, and insomnia. Phlegm-resolving and fire-clearing drugs caused emaciation, reduced intake, and worsened symptoms. I stated: Morning phlegm indicates Spleen Qi deficiency. Night fever indicates Liver Blood deficiency. Day-night insomnia indicates Spleen Blood consumption. Liu Jun Zi Tang (Six Gentlemen Decoction), Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder), and Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) were used sequentially for conditioning, curing her within a month.
A postpartum woman had heavy cough with phlegm, red face, dry mouth, internal heat with afternoon exacerbation, and constant symptoms. This was flaming Yin Fire. Tonifying Spleen and Kidney with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) cured her.
A postpartum woman had cough with abdominal fullness, anorexia, drooling, facial edema, and rebellious Qi. This disease originated in the Stomach and affected the Lung. Yi Gong San (Extraordinary Ability Powder) cured her.
Postpartum Malaria
A postpartum woman suffered from prolonged malaria with myriad complications. Pulses varied: surging-large, micro-fine, wiry-tight, or deep-hidden. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum) for twenty-plus doses improved pulses and symptoms. Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) paste, assisted by Gui Pi Tang (Restore the Spleen Decoction) for over a hundred doses, achieved recovery.
Postpartum Dysentery
A postpartum woman suffered from diarrhea/dysentery for over a year, became emaciated, had internal heat with afternoon exacerbation, spontaneous/night sweats, oral ulcers, expectoration of three bowls of phlegm daily, and a surging-large pulse empty on deep pressure.