观《病机机要》云∶治胎产之病，当从厥阴证论之，宜无犯胃气及上二焦，是为三禁，谓不可
汗，不可下，不可利小便。发其汗则同伤寒下早之证；利大便则脉数而伤脾；利小便则内亡津液，胃中结燥。
但使不犯三禁，则营卫自和而寒热自止矣。凡用治之法，如发渴则白虎，气弱则黄 ，血痛则当归，腹痛则
芍药。大抵产病天行，从加减柴胡；杂证从增损四物。宜察脉证而用之。详此说虽为产育之大法，然病变不
同，倘有是证，则不得不用是药，所谓有病则病受之也。第此经常之法，固不可不知，而应变之权，亦不可
执一也。
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，或喜热熨，或得食稍缓者，皆属
虚痛，不可妄用推逐等剂。
凡新产之后，多有儿枕腹痛者，摸之亦有块，按之亦微拒手，故古方谓之儿枕，皆指为胞中之宿血。此大
不然。夫胞胎俱去，血亦岂能独留？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。治此者，但宜安养其脏，不久即愈。惟殿胞煎为
最妙。其次则四神散、五物煎，皆极佳者。若误认为瘀，而妄用桃仁、红花、玄胡、青皮之属，反损脏气，必
增虚病。有母体本虚而少血者，即于产时亦无多血，此辈尤非血滞。若有疼痛，只宜治以前法，或以大、小营
煎、黄雌鸡汤主之。
殿胞煎（见小产论外方）
四神散（见血寒论外方）
五物煎（见血寒论外方）
大营煎（见血热经早）
小营煎（见血虚经乱）
《良方》黄雌鸡汤（见《妇人规古方》）治产后虚羸腹痛。
当归 白术（炒） 熟地黄 黄 （炒） 桂心（各半两） 小黄雌鸡（一只，去头足肠翅，细切）
上先用水七碗，煮鸡至三碗，每用汁一碗、药四钱煎，日三服。
凡新产之后，其有阳气虚弱，而寒从中生，或寒由外入，以致心腹作痛，呕吐不食，四肢厥冷者，宜九蜜
煎、大岩蜜汤，或理阴煎主之。产当寒月，以致寒气入腹，脐下胀痛，手不可近者，宜羊肉汤主之。若气实寒
甚者，宜蟠葱散。
九蜜煎（见《新方八阵·因阵》）治产后阳气虚寒，或阴邪入脏，心腹疼痛，呕吐不食，四肢厥冷。
此与大岩蜜汤略同而稍胜之。
当归 熟地（各三钱） 芍药（酒炒焦） 茯苓（各钱半） 炙甘草 干姜（炒） 肉桂 北细辛（各一钱）
吴茱萸（制五分）
水二钟，煎服。
大岩蜜汤（见《妇人规古方》）治产后阳气虚寒，心腹作痛，不食呕吐，四肢厥逆。
生地 当归 芍药（炒） 干姜 吴茱萸 桂心 独活 甘草（炒） 小草（各一两） 细辛（半两）
（按∶小草即远志之苗）
上每服半两，水煎服。
理阴煎（见血寒经迟）
《良方》羊肉汤（见《妇人规古方》）治产妇脾虚寒邪内乘，以致腹痛或头眩脐胁急痛。
精羊肉（四两） 当归 川芎（各半两） 生姜（一两）
上以水十盏，煎至四盏，分四次，空心服。
《局方》蟠葱散（见《古方八阵·热阵》）治男妇脾胃虚冷，滞气不行，攻刺心腹，痛连胸胁，
膀胱小肠寒疝、气疝，及妇人血气刺痛。
苍术（米泔浸切） 炙甘草（各八钱） 三棱（煨） 蓬术（煨） 茯苓 青皮（各六钱） 丁皮 砂仁（去壳） 槟
榔（各四钱） 延胡索（三钱） 干姜（炒） 肉桂（各三钱）
（按∶丁皮即丁香树皮）
上每服五钱，水一盏，入连根葱白一茎，煎七分，空心热服，或为末用葱汤调服二三钱。
产后恶露不尽，留滞作痛者，亦常有之。然此与虚痛者不同，必其由渐而甚，或大小便不行，或小腹硬实
作胀，痛极不可近手，或自下上冲心腹，或痛极牙关紧急，有此实证，当速去其血。近上者宜失笑散；近下
者宜通瘀煎、夺命丹、回生丹。或未效，当用决津煎为善。
失笑散（见经期腹痛）
通瘀煎（见经期腹痛）
夺命丹（见鬼胎）
回生丹（见鬼胎）
决津煎（见经期腹痛）
产后有脾虚肾虚而为腹痛者，此不由产，而由脏气之不足。若脾气虚寒，为呕吐、为少食而兼腹痛者，宜
五君子煎、六君子汤、温胃饮之类主之。若肾气虚寒，为泻、为利而兼腹痛者，宜胃关煎、理阴煎之类主之。
五君子煎（见崩淋经漏不止）
六君子汤（见经期腹痛）
温胃饮（见血虚经乱）
胃关煎（见《新方八阵·热阵》）治脾肾虚寒作泻，或甚至久泻腹痛不止，冷痢等证。
焦干姜（一至三钱） 吴茱萸（五七分制） 白术（炒一至三钱） 熟地（三五钱或一两） 山药（炒二钱）
白扁豆（炒二钱） 炙甘草（一、二钱）
水二钟，煎七分，食远温服。泻甚者加肉豆蔻一、二钱，面炒用，或破故纸亦可。气虚势甚者，加人参，
随宜用。阳虚下脱不固者，加制附子一、二、三钱，腹痛甚者，加木香七八分，或加浓朴八分。滞痛不通者，
加当归二、三钱。滑脱不禁者，加乌梅二个，或北五味子
二十粒。若肝邪侮脾者，加肉桂一、二钱。
产后有饮食停滞及气逆作痛，亦当因其类而消去之。如排气饮、大和中饮之类，皆可酌用。
排气饮（见经期腹痛）
大和中饮（见《新方八阵·和阵》）治饮食留滞积聚等证。
陈皮（一、二钱） 枳实（一钱） 砂仁（五分） 山楂（二钱） 麦芽（二钱） 浓朴（一钱半）
泽泻（一钱半）
水一钟半，煎七八分，食远温服。胀甚者加白芥子，胃寒无火或恶心者加炮干姜一、二钱。疼痛者加木
香、乌药、香附之类。多痰者加半夏。
仲景曰∶“产后腹中 痛，当归生姜羊肉汤主之，并治腹中寒疝，虚
劳不足。”
当归生姜羊肉汤（见《妇人规古方》）治产妇腹中 痛、寒痛，血气不足，虚弱甚者，及寒月生产，
寒气入于子门，手不可犯，脐下胀满，此产后之寒证也。并治寒疝腹中痛，及胁痛里急者。
精羯羊肉（一斤） 当归（三两） 生姜（五两）
上用水八升，煮取三升，加葱、椒、盐，温服七合，日三服。若寒多者，加生姜成一斤。痛多而呕者，
加橘皮二两，白术一两。
立斋曰∶前证若因气滞，用延胡索散；若因外寒，用五积散；若因怒气，用四物加木香、柴胡；若因血
虚，用四物、参、术、炮姜。若因阳气虚弱，用四君、当归、炮姜。若因脾虚血弱，用六君、当归、炮姜。
延胡索散（即玄胡当归散。见经痛论外方）
《局方》五积散（见《古方八阵·散阵》）治感冒寒邪，头疼身痛，项背拘急，恶寒呕吐，肚腹疼
痛，及寒湿客于经络，腰脚骨髓酸痛，及痘疮寒胜等证。
当归 麻黄 苍术 陈皮（各一钱） 浓朴（制） 干姜（炮） 芍药 枳壳（各八分） 半夏 白芷
（各七分） 桔梗 炙甘草 茯苓 肉桂 人参（各五分） 川芎（四分）
水二钟，姜三片，葱白三茎，煎八分，不拘时服。
又歌曰∶痢后偏生脚痛风，局方五积自能攻。就中或却麻黄去，酒煮多多服见功。
According to the *Jingyue Quanshu* (Complete Works of Jingyue), when treating diseases related to pregnancy and childbirth, one should discuss them from the perspective of Jueyin syndrome (disease patterns involving the Liver and Pericardium meridians). It is appropriate not to impair the Stomach Qi (Stomach's digestive energy) and the Upper and Middle Jiao (Upper and Middle Burners/energy centers). This constitutes the "Three Prohibitions" (San Jin): do not induce sweating, do not purge downwards, and do not promote urination. Inducing sweating would result in complications similar to those caused by premature purgation in Taiyang cold damage (Taiyang Shanghan); purging would lead to a rapid pulse and damage Spleen Qi; promoting urination would cause the loss of internal body fluids and dryness/stagnation in the Stomach. As long as these three prohibitions are not violated, Ying and Wei (Nutritive and Defensive Qi) will naturally harmonize, and chills and fever will cease. Regarding treatment methods: if thirst occurs, use Baihu Tang (White Tiger Decoction); if Qi is weak, use Huangqi (Astragalus Root); if blood pain occurs, use Danggui (Angelica Sinensis); if abdominal pain occurs, use Shaoyao (Peony Root). Generally, for postpartum diseases caused by epidemic pathogens, use Modified Chaihu Tang (Bupleurum Decoction); for miscellaneous disorders, use Zengsun Siwu Tang (Augmented Four Substances Decoction). One should carefully observe the pulse and symptoms to apply treatments. Although this theory serves as a general principle for postpartum care, disease variations differ. If specific syndromes exist, corresponding medicines must be used, which is known as "when there is disease, the disease bears the medicine." While these standard methods must be known, flexible adaptation must not be rigidly adhered to.
Postpartum abdominal pain requires distinguishing between deficiency and excess. Pain caused by retained blood stasis is excess pain; pain without blood stasis is deficiency pain. Generally, pain accompanied by distension, or radiating upward to the chest and hypochondrium, or characterized by refusal to pressure with hands unable to approach, indicates excess pain. Treatment should involve moving and dispersing [stasis]. If there is no distension, or if the patient prefers rubbing/massage, hot compresses, or relief after eating, it belongs to deficiency pain. Do not recklessly use pushing/purgative agents.
After recent delivery, "Ezhen Abdominal Pain" (Placental Pillow Pain) is common. Palpation reveals a mass, and slight resistance to pressure occurs. Ancient formulas call this "Ezhen," attributing it to residual blood in the Uterus. This is incorrect. Since the placenta has been expelled, how can blood remain alone? The Uterus housed the fetus for a long time; sudden separation causes the Blood Sea (Chong Mai) to become suddenly empty, leading to pain. Injury to the Bao Men (Uterine Gate) causes congestion and swelling, creating the illusion of a mass, though it is not a true mass. Since the swelling has not subsided, there is resistance to pressure. Treatment should focus on nourishing and calming the Zang organs, and recovery will occur soon. Dianbao Jian (Placenta Settling Decoction) is the best choice. Next are Sishen San (Four Spirits Powder) and Wuwu Jian (Five Materials Decoction), both excellent. Mistaking this for blood stasis and recklessly using Taoren (Peach Kernel), Honghua (Safflower), Yanhusuo (Corydalis Rhizome), or Qingpi (Green Tangerina Peel) will damage Zang Qi and worsen deficiency. Mothers with inherent deficiency and low blood volume may have little bleeding during delivery; they certainly do not have blood stasis. For pain, follow previous methods or use Daying Jian (Great Camp Decoction), Xiaoying Jian (Small Camp Decoction), or Huangci Ji Tang (Yellow Hen Chicken Decoction).
Dianbao Jian (See External Formulas for Miscarriage)
Sishen San (See External Formulas for Blood Cold)
Wuwu Jian (See External Formulas for Blood Cold)
Daying Jian (See Early Menstruation due to Blood Heat)
Xiaoying Jian (See Irregular Menstruation due to Blood Deficiency)
"Liangfang" Huangci Ji Tang (See *Furen Gui Ancient Formulas*) treats postpartum emaciation and abdominal pain.
Ingredients: Danggui (Angelica Sinensis), Baizhu (Atractylodes Macrocephala Rhizome, stir-fried), Shudihuang (Rehmannia Glutinosa Root, prepared), Huangqi (Astragalus Membranaceus Root, stir-fried), Guixin (Cinnamon Twig Bark, half tael each); Small yellow hen (one, remove head, feet, intestines, wings, cut finely).
Preparation: Boil chicken in seven bowls of water until reduced to three bowls. Use one bowl of broth with four qian of herbs per dose. Take three times daily.
For recent delivery, if Yang Qi is weak causing internal cold, or external cold invades causing heart/abdominal pain, vomiting, anorexia, and cold limbs, use Jiumi Jian (Nine Honey Decoction), Dayanmi Tang (Great Rock Honey Decoction), or Liyin Jian (Nourishing Yin Decoction). If delivery occurs in cold months causing cold qi to enter the abdomen, resulting in umbilical distension/pain unapproachable by hand, use Yangrou Tang (Mutton Decoction). If Qi is excess and cold is severe, use Pancong San (Coiled Scallion Powder).
Jiumi Jian (See *Xin Fang Ba Zhen · Yin Zhen*) treats postpartum Yang deficiency-cold, or Yin pathogen invading Zang organs, causing heart/abdominal pain, vomiting, anorexia, and cold limbs.
This is slightly superior to Dayanmi Tang.
Ingredients: Danggui (3 qian), Shudi (3 qian), Shaoyao (1.5 qian, wine-fried scorched), Fuling (1.5 qian), Zhigancao (Honey-fried Licorice Root), Ganjiang (Stir-fried Dried Ginger), Rougui (Cinnamon Bark), Beixixin (Northern Asarum Root) (1 qian each), Wuzhuyu (Processed Evodia Fruit) (0.5 fen).
Preparation: Two zhong of water, decoct and take.
Dayanmi Tang (See *Furen Gui Ancient Formulas*) treats postpartum Yang deficiency-cold, heart/abdominal pain, anorexia/vomiting, and cold limbs.
Ingredients: Shengdi (Raw Rehmannia Root), Danggui, Shaoyao (Stir-fried), Ganjiang, Wuzhuyu, Guixin, Duohuo (Angelica Pubescens Root), Gancao (Stir-fried), Xiaocao (Herba Polygalae Tenuifoliae) (1 liang each), Xixin (Asarum Root) (half liang).
(Note: Xiaocao is the sprout of Yuanzhi.)
Preparation: Half liang per dose, decoct in water and take.
Liyin Jian (See Late Menstruation due to Blood Cold)
"Liangfang" Yangrou Tang (See *Furen Gui Ancient Formulas*) treats postpartum Spleen deficiency with internal invasion of cold pathogen, causing abdominal pain, dizziness, or urgent pain in the umbilicus/hypochondrium.
Ingredients: Lean mutton (4 liang), Danggui, Chuanxiong (Ligusticum Wallichii Rhizome) (half liang each), Shengjiang (Fresh Ginger) (1 liang).
Preparation: Ten bowls of water, decoct to four bowls. Divide into four doses, take warm on an empty stomach.
"Jufang" Pancong San (See *Gufang Bazhen · Re Zhen*) treats male/female Spleen/Stomach deficiency-cold, stagnant Qi failing to move, stabbing pain in heart/abdomen radiating to chest/hypochondrium, Bladder/Small Intestine cold hernia, Qi hernia, and women's blood-Qi stabbing pain.
Ingredients: Cangzhu (Atractylodes Lancea Rhizome, soaked in rice wash water and sliced), Zhigancao (8 qian each), Sanleng (Sparganium Rhizome, roasted), Pengze (Curcuma Zedoaria Rhizome, roasted), Fuling, Qingpi (Green Tangerina Peel) (6 qian each), Dingpi (Syzygium Aromaticum Bark), Sharen (Amomum Fructus, shelled), Binglang (Areca Seed) (4 qian each), Yanhusuo (Corydalis Rhizome) (3 qian), Ganjiang (Stir-fried Dried Ginger), Rougui (Cinnamon Bark) (3 qian each).
(Note: Dingpi is Syzygium aromaticum bark.)
Preparation: Five qian per dose, one bowl of water, add one stalk of scallion white with roots. Decoct to 70%, take warm on an empty stomach. Or powder and mix with scallion water (2-3 qian).
Postpartum lochia retention causing pain is common. However, this differs from deficiency pain; it worsens gradually, involves constipation/oliguria, hard/full lower abdomen, extreme pain unapproachable by hand, pain rushing up to the heart/abdomen, or extreme pain causing lockjaw. With these excess signs, rapidly remove the blood. For upper location, use Shixiao San (Laughing No More Powder); for lower location, use Tongyu Jian (Unblocking Stasis Decoction), Mingdan (Life-Saving Pill), Huisheng Dan (Return Life Pill). If ineffective, useiejing Jian (Crossing the Ford Decoction) is better.
Shixiao San (See Dysmenorrhea)
Tongyu Jian (See Dysmenorrhea)
Mingdan (See Ghost Pregnancy)
Huisheng Dan (See Ghost Pregnancy)
Jiejing Jian (See Dysmenorrhea)
Postpartum abdominal pain due to Spleen/Kidney deficiency is not caused by delivery itself but by insufficiency of Zang Qi. If Spleen Qi deficiency-cold causes vomiting, anorexia, and abdominal pain, use Wu Junzi Jian (Five Gentlemen Decoction), Liu Junzi Tang (Six Gentlemen Decoction), or Wenwei Yin (Warm Stomach Drink). If Kidney Qi deficiency-cold causes diarrhea/dysentery and abdominal pain, use Weiguan Jian (Stomach Gate Decoction) or Liyin Jian.
Wu Junzi Jian (See Metrorrhagia/Metrorrhaxis)
Liu Junzi Tang (See Dysmenorrhea)
Wenwei Yin (See Irregular Menstruation due to Blood Deficiency)
Weiguan Jian (See *Xin Fang Ba Zhen · Re Zhen*) treats Spleen/Kidney deficiency-cold diarrhea, even chronic diarrhea with persistent abdominal pain, cold dysentery, etc.
Ingredients: Jiao Ganjiang (Scorched Dried Ginger) (1-3 qian), Wuzhuyu (Processed Evodia) (0.5-0.7 fen), Baizhu (Stir-fried) (1-3 qian), Shudi (3-5 qian or 1 liang), Shanyao (Stir-fried Chinese Yam) (2 qian), Baibian Dou (Stir-fried White Hyacinth Bean) (2 qian), Zhigancao (1-2 qian).
Preparation: Two zhong of water, decoct to 70%, take warm away from meals. For severe diarrhea, add Roudoukou (Nutmeg, flour-roasted) 1-2 qian, or Pugu Zhi (Psoralea Fruit). For severe Qi deficiency, add Renshen (Ginseng Root) as needed. For Yang deficiency with sinking/prolapse, add Zhi Fuzi (Prepared Aconite Root) 1-3 qian. For severe abdominal pain, add Muxiang (Vladimiria Root) 0.7-0.8 fen, or Houpo (Magnolia Bark) 0.8 fen. For stagnation/pain obstruction, add Danggui 2-3 qian. For incontinence/slippery discharge, add Wumei (Mume Fruit) 2 pieces, or Bei Wuweizi (Schisandra Berry) 20 grains. If Liver pathogen insults Spleen, add Rougui 1-2 qian.
Postpartum pain due to food stagnation or rebellious Qi should be treated by resolving the specific category. Examples include Paiqi Yin (Qi Expelling Drink) and Da Hezhong Yin (Great Harmonizing Middle Drink), used as appropriate.
Paiqi Yin (See Dysmenorrhea)
Da Hezhong Yin (See *Xin Fang Ba Zhen · He Zhen*) treats food stagnation and accumulation.
Ingredients: Chenpi (Aged Tangerina Peel) (1-2 qian), Zhishi (Immature Bitter Orange Fruit) (1 qian), Sharen (Amomum Fructus) (0.5 fen), Shanzha (Hawthorn Fruit) (2 qian), Maiya (Sprouted Barley Grain) (2 qian), Houpo (Magnolia Bark) (1.5 qian), Zexie (Alisma Rhizome) (1.5 qian).
Preparation: One and a half zhong of water, decoct to 70-80%, take warm away from meals. For severe distension, add Baijiezi (White Mustard Seed). For Stomach cold/lack of fire or nausea, add Paoganjiang (Roasted Dried Ginger) 1-2 qian. For pain, add Muxiang, Wuyao (Lindera Root), or Xiangfu (Cyperus Rhizome). For excessive phlegm, add Banxia (Pinellia Tuber).
Zhang Zhongjing said: "Postpartum abdominal colic is treated with Danggui Shengjiang Yangrou Tang (Angelica, Ginger, and Mutton Decoction), also treating abdominal cold hernia and deficiency-labor insufficiency."
Danggui Shengjiang Yangrou Tang (See *Furen Gui Ancient Formulas*) treats postpartum abdominal colic/cold pain, insufficient blood-Qi, severe weakness, or cold month delivery where cold enters Zi Men (Uterine Gate), making the area unapproachable, with umbilical distension. This is postpartum cold syndrome. Also treats cold hernia abdominal pain and hypochondriac pain with internal tension.
Ingredients: Lean ram mutton (1 jin), Danggui (3 liang), Shengjiang (Fresh Ginger) (5 liang).
Preparation: Eight sheng of water, boil to three sheng. Add scallion, pepper, salt. Take seven ge warm, three times daily. If cold is heavy, increase Shengjiang to 1 jin. If pain is heavy with vomiting, add Jupi (Orange Peel) 2 liang, Baizhu 1 liang.
Li Zhang (Xue Ji) said: For the above conditions, if due to Qi stagnation, use Yanhusuo San; if due to external cold, use Wuji San; if due to anger, use Siwu Tang plus Muxiang and Chaihu; if due to blood deficiency, use Siwu Tang plus Renshen, Baizhu, Paoganjiang. If due to Yang Qi weakness, use Sijunzi Tang plus Danggui, Paoganjiang. If due to Spleen deficiency/blood weakness, use Liu Junzi Tang plus Danggui, Paoganjiang.
Yanhusuo San (Also known as Xuanhu Danggui San. See External Formulas for Menstrual Pain)
"Jufang" Wuji San (See *Gufang Bazhen · San Zhen*) treats cold pathogen invasion, headache/body ache, neck/back stiffness, aversion to cold/vomiting, abdominal pain, cold-dampness in collaterals causing waist/leg/bone marrow soreness, and measles dominated by cold.
Ingredients: Danggui, Mahuang (Ephedra Herb), Cangzhu, Chenpi (1 qian each), Houpo (Processed Magnolia Bark), Ganjiang (Roasted Dried Ginger), Shaoyao, Zhike (Bitter Orange Fruit) (0.8 fen each), Banxia, Baizhi (Angelica Dahurica Root) (0.7 fen each), Jiegeng (Platycodon Root), Zhigancao, Fuling, Rougui, Renshen (0.5 fen each), Chuanxiong (0.4 fen).
Preparation: Two zhong of water, three slices of ginger, three stalks of scallion white. Decoct to 80%, take anytime.
Another song says: Gout in legs after dysentery, Wuji San from Jufang can attack it. Remove Mahuang within, brew with wine, drink much to see merit.