疗产后恶露不多下方。
川牛膝 大黄（各八分） 牡丹皮 当归（各六分） 芍药 蒲黄 桂心（各四分）
上为末，以生地黄汁调，酒服方寸匕。日二服。血下愈。
生料五积散。《局方》治产后恶露不快，腹中疼痛，或腹有块及发寒热，并加醋少许煎
，通口服。亦能疗血崩。（见《易简方》，不复重录）
产后恶露方行而忽然断绝，骤作寒热，脐腹百脉皆痛，如以锥刺非常。此由冷热不调
，或思虑动作，气所壅遏，血蓄经络。宜没药丸。
当归（一两） 桂心 芍药（各半两） 桃仁（去皮、尖炒，碎研） 没药（研，各一
分） 虻虫（去足，翅，炒） 水蛭（炒，各三十个）
上为末，醋糊丸如豌豆大，醋汤下三丸。
论曰∶夫产后血上抢心，由产后气虚挟宿冷，冷搏于血，则凝结不消。气逆上者，则血
随上冲击而心痛也。凡产后余血不尽，得冷则留结，与气相搏则痛、困重，遇寒结血尤甚，
则变成血瘕，亦令月水否涩不通也。
论曰∶产后心痛者何？答曰∶心者血之主。人有伏宿寒，因产大虚，寒搏于血，血凝不
得消散，其气遂上冲击于心之络脉，故心痛。但以大岩蜜汤治之，寒去则血脉温而经络通，
心痛自止。若误以为所伤治之，则虚极寒益甚矣。心络寒甚，传心之正经，则变为真心痛，
朝发夕死，夕发朝死。药不可轻用如此。
Below is the prescription for treating insufficient lochia discharge postpartum.
Radix Cyathulae (Chuan Niuxi) and Radix et Rhizoma Rhei (Dahuang), each 8 fen; Cortex Moutan (Mudanpi) and Radix Angelicae Sinensis (Danggui), each 6 fen; Radix Paeoniae Alba (Shaoyao), Spora Nelumbinis (Puhuang), and Ramulus Cinnamomi (Guixin), each 4 fen.
Grind the above ingredients into powder. Mix with juice of fresh Radix Rehmanniae (Sheng Dihuang) to form a paste, and take one fangcunbi (a square-inch measure) with wine. Take twice daily. The condition resolves when blood stasis is discharged.
Shengliao Wuji San (Five Accumulations Decoction without processing). *Tai Ping Hui Min He Ji Ju Fang* (Formulary of the Public Welfare Bureau) indicates it treats slow or difficult lochia discharge postpartum, abdominal pain, abdominal masses, and alternating chills and fever. Add a small amount of vinegar during decoction and take orally. It can also treat metrorrhagia (blood flooding). (See *Yijian Fang*, not repeated here.)
If lochia, which should normally flow, suddenly stops, accompanied by sudden onset of chills and fever, and severe pain throughout the meridians of the umbilical and abdominal regions, as if pierced by an awl, this is due to imbalance of cold and heat, or excessive worry and physical exertion causing qi stagnation and obstruction, leading to blood accumulation in the meridians. Moyao Wan (Myrrh Pill) is indicated.
Radix Angelicae Sinensis (Danggui), 1 liang; Ramulus Cinnamomi (Guixin) and Radix Paeoniae Alba (Shaoyao), each half liang; Semen Persicae (Taoren), peeled, tips removed, stir-fried, crushed and ground; Myrrha (Moyao), ground, each 1 fen; Larva Blaberae (Mengchong), legs and wings removed, stir-fried; Hirudo (Shuizhi), stir-fried, each 30 individuals.
Grind the above into powder. Use vinegar paste to make pills the size of pea seeds. Take three pills with vinegar-infused water.
Commentary: Postpartum blood rushing upward to the heart occurs because postpartum qi deficiency is compounded by residual cold. Cold combats with blood, causing coagulation that does not dissipate. When qi rebels upward, blood follows and rushes to strike the heart, causing heart pain. Whenever postpartum residual blood remains incomplete, exposure to cold causes it to stagnate and coagulate; combing with qi causes pain and heaviness. Exposure to cold exacerbates blood coagulation, potentially transforming into Xuejia (blood mass), and also causing dysmenorrhea or amenorrhea.
Question: What causes heart pain postpartum? Answer: The Heart is the master of blood. If there is latent residual cold in the body, and childbirth leads to extreme deficiency, cold combats with blood, causing blood coagulation that cannot disperse. The qi then rushes upward to strike the collateral vessels of the Heart, resulting in heart pain. Treat it solely with Dayanmi Tang (Great Rock Honey Decoction); once the cold is eliminated, the blood vessels become warm and the meridians unobstructed, and the heart pain will cease naturally. If mistakenly treated as an injury, it will lead to extreme deficiency and intensified cold. If cold in the Heart collaterals becomes severe and transmits to the primary meridians of the Heart, it transforms into Zhenxintong (True Heart Pain), where morning onset leads to evening death, and evening onset leads to morning death. Medication must not be used so lightly.