皮大丸主之。又产后下利。虚极。白头翁加甘草阿胶汤主之。又妇人少腹满如敦状。小便微难而不渴。此为水与血俱结
在血室也。大黄甘遂汤主之。又妇人昼后脏燥喜悲伤。欲哭。象如神灵所作。数欠伸。甘麦大枣汤主之。刘完素曰。产
后经水适断。感于异症。手足牵搐。切牙昏冒。宜增损柴胡汤。前症已去。次服秦艽汤。去其风邪。又产后风气在表。
面目四肢浮肿。宜七圣丸。以利为度。如又喘嗽。加木香、槟榔倍之。谓气多也。如又昏冒。加羌活、川芎。谓多风也。
又产后虚劳。虽日久而脉浮疾者。三元汤。日久虚劳。微有寒热。脉沉面浮。宜柴胡四物汤。日久虚劳。针灸小药俱不
效者。三分散。日久虚劳不能食。十全散。又产后诸积不可攻。当养阴去热。其病自退。芍药汤。又产后冲胀。胸中有
物。状如噎。气不降。紫金丹。又产后头痛。血虚痰癖寒厥。皆令头痛。加减四物汤。如有汗者。是气弱头痛也。加芍
药三两。桂一两五钱。生姜煎。如痰癖头痛。加半夏三两。茯苓一两半。生姜煎。如热厥头痛。加天麻三两。附子一两
半。生姜煎。又产后诸病。但以双解散服之。通身中外血气宣通。病皆除愈。然孕妇。及产后月经过多。并泄泻者。勿
与服之。又俗未知产后亡液。损血疼痛怖惧。以致神狂气乱。则阴气虚损。邪热太甚。而为诸热症。由不读素问。不知
造化。故不识症候阴阳。反妄以为产后诸虚百损。便为虚冷而无热也。遂以热药温补。或见烦渴者。不令饮水。本虽善
心。为害多矣。但以临时审其脏腑。六气虚实。明其标本。如法治之而已。朱震亨曰。产后血晕。因虚火载血上行。渐
渐运来。方用鹿角烧灰。出火毒研极细。酒同童便灌下。一呷即醒。行血极快。大凡产后有病。先固正气。又产后泄泻。
恶露不行。此余血渗入大肠为泻。洞泄不禁。下青白黑色。用荆芥穗炒黑入麝研汤下。药虽微。能治大病。方名的奇散。
又产后才见身热。便不可发表。发热恶寒。皆是气血虚。左手脉不足。补血多于补气药。右手脉不足。补气多于补血药。
恶寒发热腹痛者。当去恶血。腹满者不是。腹痛者是。又尝见尿胞因稳婆不谨。破损而得淋沥。遂为废疾。因思肌肉尚
可完补。胞虽在腹。亦可治。其症血气必虚。必用大补。以参、术为君。芎、归为臣。桃仁、陈皮、茯苓、黄 为佐。
而煎以猪羊胞。极饥时饮之。亦必多服。气血自长。其胞自完。恐稍迟缓。殊难成功。李 曰。产妇体实无病。不药可
也。但难产气衰。瘀血停留。非药不行。古法。产后用古芎归汤加童便一半服之。如无童便。以淡醋磨墨一小盏入煎汤
药亦好。又产后百病。皆血虚火盛。瘀血妄行而已。间有内伤饮食。外感风寒。然亦必先逐瘀补虚为主。又产后瘀消。
方可行补。如左脉弱。加补血药。右脉弱。加补气药。如不兼逐瘀。但服参、 停滞之剂。有瘀血攻心即死者。食肉太
早亦然。又凡产母。但觉小水短少。（此是微旨）即是病生。便须服药。调理脾胃肝肾。如不愈者。必气滞且逆。盖妇人
凡事多忧思恚怒。忧思过。则气结而血亦结。恚怒过。则气逆而血亦逆。甚则乳硬胁痛烦热。要之。女病皆因气血郁结。
所以古方多用行气药。薛己曰。产后发痉。大补气血。可保无虞。但攻风邪。死无疑矣。又产后寒热。因气血虚弱。或
脾胃不足。经云。阴虚则发热。阳虚则恶寒。若兼大便秘。尤属气血虚。切不可发表降火。若寸口脉微阳不足。阴气上
入阳中则恶寒。补中益气汤。尺脉微阴不足。阳气下陷阴中则发热。六味地黄丸。大抵阴不足。阳往乘之。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。故恶寒又发热也。八珍汤。又妇人性情
执着。不能宽解。多被七情所伤。遂遍身痛。肢节肿痛。或气填胸满。或如梅核塞喉。咽吐不出。或涎痰壅盛。上气喘
急。
或呕逆恶心。甚者渴闷欲绝。产妇多成此症。宜四七汤。先调滞气。更用养血。若因忧思致小便白浊者。用此药吞青州
白丸子。屡效。又血出过多。恒病睛珠痛不能视。羞明隐涩。眼睫无力。眉骨太阳酸痛。当归养荣汤。当归补血汤。除
风益损汤。选用。有热。加黄芩。脾胃不和。恶心不进食。加生姜。产漏。加阿胶。复其血。使有所养则愈。然要忌咸
物。经曰。咸走血。血病无多食咸。王肯堂曰。凡妇人患风气。脐下虚冷。皆产后未满百日会合之故。慎之。张介宾曰。
凡产后气血俱去。诚多虚症。然有虚者。有少虚者。有全实者。当随人随症。辨其虚实以治。不得有成心。概行大补。
以致助邪。又产妇虚症。素弱之人多有之。或于产后。气血俱去。而更弱者亦有之。总当因人察脉。因脉察症。若脉气
形气病气俱不足。此当以全虚治之。若形气不足。病气有余。或兼火邪。或兼外邪。或以饮食停滞。此亦虚中有实。不
可不审。此中委曲。未能言尽。惟明者悟之。产后不虚症。或原素日无病。或以年少。或以素耐辛苦贫劳之质。此辈无
不足。一旦受孕。乃于无病腹中参入于此物。故致气血壅塞。为胀为呕。是皆添设有余之病。及其既产。始见通快。所
留得去。仍复故吾。常人之产。此类极多。是何虚之有。然或内伤。或外感。产后之病。难保必无。倘有所犯。去之即
愈。若概行大补。果能堪否。即临盆带去血气未免暂见耗损。然以壅滞之余。不过皆护胎随从之物。去者当去。生者旋
生。不出数日。必已来复。此生化自然之理。何至是产皆虚也。凡遇此类。固当因症用治。产后全实症。有如外感风寒。
头痛身热。便硬中满。脉紧数洪大有力。此表邪之实症也。又火之盛者。必热渴躁烦。或便结腹痛。口臭舌焦黑。酷喜
冷冻饮料。眼眵。尿管痛。脉见洪滑。此内热之实症也。又郁怒动肝。胸胁胀痛。大便不利。脉弦而滑。此气逆之实症也。
又恶露未尽。瘀血上冲。心腹胀满。疼痛拒按。大便难而小便利。此血逆之实症也。又凡富贵家保养太过。或过用人参、
、术。以致血壅盛。过用糖酒炭火。以致内热。或产本不虚。而妄用大补之药。以致增病。此调摄之实症也。又或因
产过食。并其劳困。固令勉强。以致停蓄不散。此内伤之实症也。夫既有表症。则不得不解。既有火邪。则不得不清。
既有内伤停滞。则不得不开通消导。丹溪但补气血之言。岂可偏执。又病机机要云。治胎产之病。当从厥阴症论之。当
无犯胃气及上二焦。是为三禁。谓不可汗。不可下。不可利小便。但使不犯三禁。则营卫自和。而寒热自止。凡治法。
如发渴则白虎。气弱则黄 。血虚则当归。腹痛则白芍。大抵产病天行。从加减柴胡。杂症从增损四物。宜察脉症用之。
按此虽为产育之大法。然病发不同。倘有是症不得不用是药。所谓有病则病受之也。但此经常之法。固不可不知。而应
变之权。亦不可执一。又新产后有阳虚而寒从中生。或寒由外入。致心腹作痛。呕吐不食。四肢厥冷者。大岩蜜汤。或
理阴煎。产后有脾虚肾虚而为腹痛者。此不由产而由脏气不足。若脾气虚寒。为呕吐。为食少。而兼腹痛者。五君子煎、
六君子汤、温胃饮、肾气虚寒。为泻为痢。而兼腹痛者。胃关煎、理阴煎。若饮食停滞。及气逆作痛。亦当因类而消去
之。排气饮、大和中饮。
鳌按。景岳一书。多偏温热。议亦驳杂。无甚特识。独产后一门。则特辟精旨。能发前人之所未发。其酌方治。亦
至当不易。诚妇科之宝 也。
虚极生风 陈自明曰。产后生风。因去血过多。气无所主。以致唇青。冷汗出。目眩神昏。命在须臾。此但虚
极生风也。急服济危上丹。若投风药。误甚。
感冒风邪 陈士铎曰。产后太阳感风。大喘大吐大呕。不治症也。喘则元阳将绝。况大喘乎。吐则胃气将亡。
况大吐乎。呕则脾气将脱。况大呕乎。方用人参、麦冬、白术、当归、川芎、荆芥、桂枝。名转气救产汤。大剂与之。
喘呕止。当有生机。否则仍死。若太阳症。口吐脓血。头痛欲破。心烦不止。腹痛如死。或作结胸。小见症便难救。若
齐见必死。方用佛手散。多加人参。佐以肉桂、荆芥。即见功矣。产后少阳感风。谵语烦躁。更加惊悸者死。盖少阳胆
经也。胆无汁不能润心。心无血不能为养。是以心中恍惚。而谵语烦躁惊悸。相因而生也。夫胆木受邪。不发表。则血
无以生。然徒发表。则血更耗散。方以佛手散加人参、枣仁、麦冬、竹茹、朱砂、熟地治之。产后阳明感风。而大喘大
汗。亦不治。用麦冬、人参、元参、桑叶、苏子。名补虚降火汤。若阳明症发狂亡阳。不救也。狂症多实热。产后则虚
热。实热可泻。虚热不可泻。然正惟兼亡阳。虽实热仍属气虚。方用人参、桑叶、麦冬、元参、青蒿。名收阳汤。一帖
汗止。二帖狂定。不得服三帖。盖此止可救亡阳急症。不可据以治产后。二帖后。即单用人参、麦冬、当归、川芎、五
味。调理自安。产后忽感少阴症。仲景法用参术温之。吾以为倘不应。宜加附子、甘草治之。凡感少阴之邪者。神效。
若少阴症三四日至六七日。忽然手足蜷卧。息高气喘。恶心腹痛。不救。此盖少阴感寒邪。而在内之真阳逼越于上焦。
上假热而下真寒也。方用人参、麦冬、肉桂、白术、吴萸。微冷顿服。名平喘祛寒散。若半月后将至盈月。亦患前症。
又当用人参、茯苓、附子、白术、当归、熟地、山萸、麦冬、牛膝。名护产汤。若少阴症肾水上泛。呕吐下利。真阳飞
越。亦死症。以产后肾火衰微。为寒所祛。水亦随寒而趋也。方用人参、白术、熟地、山萸、茯苓、附子、肉桂、车前。
名补火引水汤。若产妇手足青。一身黑。不救。此阴寒最重。而毒瓦斯之最酷者。原无回生之法。姑以人参、白术、当归、
附子、肉桂。大剂与之。如青黑退。庶有生机。否则仍死。名开青散黑汤。若但足纯青。心下痛。虽较上症少轻。而寒
毒之攻心则一。亦致死。以前方投之。往往多效。盖此症由下而上。一散其下寒。而上寒即解。所以易于奏功。至产后
四五日。忽感风寒发厥。乃阳气既虚。而阴血又耗。外感寒邪以成之者也。方用人参、附子煎服。名转厥安产方。产后
厥阴感邪。呕吐。两胁胀满者。必便血。不治。方用当归、麦冬各一两。川芎五钱。三七末一钱。名平肝救血汤。若厥
阴症下利厥逆。躁不得卧。或厥不止。俱是死症。方用人参、当归、荆芥。名参归汤。
产后用药 孙思邈曰。妇人草蓐中伤风。四肢苦烦热。头疼。与小柴胡。头不疼。但烦。三物黄芩汤。产后虚
羸。发寒热。饮食少。腹胀等疾。增损柴胡汤。张从政曰。产后之疾。皆是败血恶物。发作寒热。脐腹撮痛。乳汁枯涸。
食饮少减。医者不察。便谓气血俱虚。便用温热之剂。养血补虚。止作寒治。举世皆然。竞传黑神散之属。能治产后一
十八症。非徒不愈。而经脉涸闭。前后淋闭。呕吐咳嗽。凡百热症生矣。若此误死。不可胜计。曷若四物汤。与凉膈散。
停对下之。利数行恶物俱尽。后服淡甘之剂自愈。又大产之后。心火未降。肾水未升。如黑神散补之。轻则危。甚则死。
又备急丸。以巴豆、干姜、大黄。三味蜜丸。亦是下药。止可施于平素粗劣之人。若产后胀闷用之。不死则危。李杲曰。
妇人分娩及半产漏下。昏冒不省。瞑目无知。盖因血暴亡。心神无所养。心与包络者。君火相火也。得血则安。亡血则
危。火上炽故令人昏冒。火胜其肺。瞑目不省。是阴血暴去。不能镇抚也。世医多用滑石、甘草、石膏之类。乃辛甘大
寒。能泻气中之热。今血亏泻气。是阴亏泻阳。使二者俱伤。反为不足虚劳之病也。惟当补其血而升降之。则得血而养。
神不昏矣。血暴下。是秋冬之令大旺。今举而升之以助其阳。则目张。神不昏迷矣。其可误用寒凉哉。朱震亨曰。或曰。
初产之妇。好血已亏。瘀血尚留。黑神散非要药欤。余曰。初产之妇。好血未必亏。瘀血未必积。脏腑未必寒。何以药
为。饮食起居。勤加调护。何病之有。诚有汗血。体怯而寒。与之数帖。亦自简便。或有他病。当求病起何因。病在何
经。气病治气。血病治血。寒者温之。热者清之。凝者行之。虚者补之。药多者止之。何用妄制药方。致令无病生病。
彼黑神散者。用干姜、当归之湿热。黑豆之甘。熟地之微寒。以补血之虚。佐以炒蒲黄之苦。以防出血之多。芍药之酸
寒。有收有散。以为四物之助。官桂之大辛热以行滞气。推凝血。和以甘草之缓。其为取用。似乎精密。然驱逐与补益。
似难同方施治。设有性急者。形瘦者。本有怒火者。夏月坐蓐者。时属火令。姜桂皆为禁药。至于将护之法。尤为悖理。
肉汁发阴经之火。易成内伤之病。胡为羊鸡浓汁作糜。而又常服当归丸。当归建中汤。四顺理中丸。虽是滋补。悉犯桂、
Pida Wan (Large Skin Pill) is the primary treatment. Additionally, for postpartum diarrhea with extreme deficiency, Baitouweng Jia Gancao Ejiao Tang (Bupleurum Root Decoction with Licorice and Donkey-hide Gelatin) is indicated. Furthermore, if a woman's lower abdomen is full and distended like a Dun (an ancient vessel), with slight difficulty in urination but no thirst, this indicates that water and blood are both bound in the Blood Chamber (uterus); Dahuang Gansui Tang (Rhubarb and Kansui Decoction) is indicated. Also, if a woman experiences Zangzao (Visceral Dryness characterized by emotional instability) after noon, feeling prone to sadness and crying, as if possessed by spirits, with frequent yawning and stretching, Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) is indicated. Liu Wansu stated that when menstruation has just ceased postpartum, if affected by an abnormal pathogen leading to convulsions of the hands and feet, teeth grinding, and coma, Zengsun Chaihu Tang (Modified Bupleurum Decoction) should be used. After these symptoms subside, Qinjiao Tang (Gentian Decoction) should be taken next to dispel wind pathogens. Additionally, for postpartum wind pathogens on the exterior causing edema of the face, eyes, and limbs, Qisheng Wan (Seven Sages Pill) is indicated, with purgation as the endpoint. If wheezing and coughing occur additionally, increase the dosage of Muxiang (Vladimiria Root) and Binglang (Areca Seed) due to severe Qi stagnation. If dizziness and confusion occur additionally, add Qianghuo (Notopterygium Rhizome) and Chuanxiong (Sichuan Lovage Rhizome) due to heavy wind pathogens. Additionally, for postpartum consumptive disease lasting a long time but with a floating and rapid pulse, Sanyuan Tang (Three Origins Decoction) is used. For prolonged consumptive disease with slight alternating chills and fever, and a deep pulse with a floating facial complexion, Chaihu Siwu Tang (Bupleurum Four Substances Decoction) is indicated. For prolonged consumptive disease unresponsive to acupuncture and minor herbs, Sanfen San (One-Third Powder) is used. For prolonged consumptive disease with inability to eat, Shiquan San (Ten Complete Powder) is used. Additionally, various accumulations postpartum should not be attacked; instead, nourish Yin and clear heat, and the disease will recede naturally; Shaoyao Tang (Peony Decoction) is indicated. Additionally, for postpartum Chong (Penetrating Vessel) distension with a sensation of a foreign body in the chest, resembling dysphagia, and descending Qi failure, Zijin Dan (Purple Gold Pill) is indicated. Additionally, for postpartum headache caused by Blood deficiency, Phlegm-Stasis, or Cold-Jue (Cold Reversal), Jiajian Siwu Tang (Modified Four Substances Decoction) is used. If sweating occurs, it is a headache due to weak Qi; add 3 liang of Shaoyao (White Peony Root), 1.5 liang of Guizhi (Cinnamon Twig), and decoct with Shengjiang (Fresh Ginger). If it is a Phlegm-Stasis headache, add 3 liang of Banxia (Pinellia Tuber) and 1.5 liang of Fuling (Poria), decocted with Shengjiang. If it is a Heat-Jue headache, add 3 liang of Tianma (Gastrodia Rhizome) and 1.5 liang of Fuzi (Aconite Lateralis Radix Praeparata), decocted with Shengjiang. Additionally, for various diseases postpartum, simply administering Shuangjie San (Double Release Powder) can circulate Qi and Blood throughout the interior and exterior, curing all diseases. However, pregnant women, those with excessive menstrual flow postpartum, and those with diarrhea should not take it. Additionally, laypeople do not understand that postpartum loss of fluids and damage to Blood, combined with pain and fear, leads to mental madness and chaotic Qi, resulting in Yin deficiency and excessive pathogenic heat, manifesting as various heat syndromes. This stems from not reading the *Suwen* and not understanding natural transformations, thus failing to recognize the Yin-Yang nature of symptoms. Instead, they wrongly assume that postpartum deficiencies imply only cold without heat, and thus use hot tonics. Or, seeing irritability and thirst, they forbid drinking water. Although well-intentioned, this causes great harm. One must temporarily examine the Zang-Fu organs and the excess/deficiency of the Six Qi, clarify the root and branch, and treat accordingly. Zhu Zhenheng said that postpartum Blood Syncope (Xue Yun) occurs because deficient Fire carries Blood upward. Gradually recovering, use Lu Jiao (Deer Antler) burnt to ash, removed of fire toxicity, ground extremely fine, and administered with Wine and Tongbian (Child's Urine); one sip wakes the patient, rapidly moving Blood. Generally, for postpartum illness, first secure Righteous Qi. Additionally, postpartum diarrhea with retained Lochia occurs when residual Blood seeps into the Large Intestine, causing uncontrollable profuse diarrhea with green, white, or black stools. Use Jingjie Sui (Schizonepeta Spica) charred, mixed with She Xiang (Musk), and taken with decoction. Though mild, it treats major illnesses; the formula is named Deqi San (Miraculous Effect Powder). Additionally, if body heat appears immediately postpartum, exterior-releasing methods must not be used. Fever and aversion to cold are due to Qi and Blood deficiency. If the Left Hand pulse is insufficient, use more Blood-nourishing than Qi-tonifying herbs; if the Right Hand pulse is insufficient, use more Qi-tonifying than Blood-nourishing herbs. For aversion to cold, fever, and abdominal pain, eliminate Evil Blood; abdominal fullness is not the case, but abdominal pain is. I have seen cases where the urinary bladder was damaged by careless midwives, leading to dribbling urine and becoming disabled. Since muscle can be repaired, the bladder within the abdomen can also be treated. The syndrome involves severe Qi and Blood deficiency, requiring major tonification. Use Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) as Sovereign, Xiong (Ligusticum Chuanxiong Rhizome) and Danggui (Angelica Sinensis Radix) as Ministers, Tao Ren (Peach Kernel), Chenpi (Tangerine Peel), Fuling (Poria), and Huangqin (Scutellaria Root) as Assistants, decocted with Pig or Sheep Bladder. Drink when extremely hungry, and take in large quantities so Qi and Blood grow and the bladder restores itself. Delay may hinder success. Li Gao said that if a puerpera is physically strong and free of disease, no medicine is needed. However, in difficult labor with Qi deficiency and stagnant Blood, medicine is necessary. Ancient method: use Gu Xionggui Tang (Ancient Ligusticum and Angelica Decoction) with half Tongbian (Child's Urine). If unavailable, grind a small cup of Ink with light Vinegar and add to the decoction. Generally, postpartum diseases stem from Blood deficiency, Excess Fire, and reckless Blood movement. Occasionally there is internal injury from diet or external contraction of Wind-Cold, but the primary approach must still be eliminating Stasis and tonifying deficiency. Only after Stasis is cleared can tonification proceed. If the Left pulse is weak, add Blood-nourishing herbs; if the Right pulse is weak, add Qi-tonifying herbs. Without eliminating Stasis, merely taking Renshen (Ginseng Root) and Huangqi (Astragalus Root) can cause Stasis to attack the Heart, leading to death. Eating meat too early causes the same. Furthermore, any parturient feeling shortness of urine (a subtle sign) has disease arising and must take medicine to regulate Spleen, Stomach, Liver, and Kidney. If unresolved, it is Qi stagnation and rebellion. Women often suffer from worry, thought, anger, and resentment. Excessive worry knots Qi and Blood; excessive anger reverses Qi and Blood, potentially causing hard breasts, hypochondriac pain, and irritability. Ultimately, female diseases arise from Qi and Blood stagnation, hence ancient formulas often use Qi-moving herbs. Xue Ji said that postpartum Spasm requires major tonification of Qi and Blood to ensure safety; attacking Wind pathogens guarantees death. Additionally, postpartum chills and fever are due to Qi and Blood weakness or Spleen-Stomach insufficiency. The *Classic* states: Yin deficiency causes fever; Yang deficiency causes aversion to cold. If accompanied by constipation, it is especially Qi and Blood deficiency; do not use exterior-releasing or Fire-clearing methods. If Cun Kou (Inch Position) pulse is faint indicating Yang insufficiency, Yin Qi enters Yang causing aversion to cold; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If Chi Position (Cubit Position) pulse is faint indicating Yin insufficiency, Yang Qi sinks into Yin causing fever; use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). Generally, Yin insufficiency allows Yang to invade, causing Yang to sink internally and produce fever; Yang insufficiency allows Yin to follow, causing Yin to rise externally and produce aversion to cold. This misplacement of Yin and Yang leads to clashing chills and fever, hence both occur; use Bazhen Tang (Eight Treasures Decoction). Additionally, women with stubborn temperaments unable to relax are often injured by Seven Emotions, leading to generalized pain, joint swelling, chest fullness, globus hystericus (sensation of a plum pit in the throat), excessive phlegm, asthma, nausea, vomiting, or extreme thirst and suffocation. Puerperae often develop this; use Siqi Tang (Four Seven Decoction) to first regulate stagnant Qi, then nourish Blood. If worry and thought cause turbid urine, swallow Qingzhou Bai Wanzi (Qingzhou White Pills) with this medicine, often effective. Additionally, excessive Blood loss often causes eye pain, blindness, photophobia, heaviness of eyelids, and soreness of the brow bone and Taiyang region. Select Danggui Yangrong Tang (Angelica Nourishing Grace Decoction), Danggui Buxue Tang (Angelica Tonify Blood Decoction), or Chufeng Yisun Tang (Dispel Wind and Benefit Loss Decoction). Add Huangqin (Scutellaria Root) for heat; add Shengjiang (Fresh Ginger) for Spleen-Stomach disharmony, nausea, and poor appetite; add Ejiao (Donkey-hide Gelatin) for postpartum bleeding to restore Blood and allow nourishment, leading to recovery. Avoid salty foods. The *Classic* states: Salty enters Blood; avoid salt in Blood diseases. Wang Kentang said that women suffering from Wind pathogens and cold below the umbilicus are usually due to intercourse before 100 days postpartum; beware. Zhang Jiebin said that postpartum loss of Qi and Blood indeed presents many deficiency syndromes. However, there are pure deficiencies, slight deficiencies, and complete excesses. Treatment must follow the individual and syndrome, distinguishing excess and deficiency, without preconceived notions of universal major tonification, which aids pathogens. Postpartum deficiency syndromes are common in those constitutionally weak, or worsened by postpartum loss. Always examine the pulse according to the person, and symptoms according to the pulse. If Pulse, Form, Qi, and Pathogenic factors are all insufficient, treat as total deficiency. If Form and Qi are insufficient but Pathogenic factors are excessive, or accompanied by Fire, External pathogens, or Food Stagnation, this is deficiency with excess; careful examination is required. These nuances cannot be fully expressed; only the wise understand. Postpartum non-deficiency syndromes occur in those previously healthy, young, or accustomed to hardship. They have no deficiency. Upon pregnancy, the fetus obstructs Qi and Blood in a healthy abdomen, causing distension and vomiting—these are added excess conditions. After birth, relief occurs, remnants pass, and normalcy returns. Many normal births fit this pattern; where is the deficiency? However, internal injuries or external contractions cannot be ruled out. If they occur, removing them cures the disease. Universal major tonification may not be tolerated. Although delivery temporarily consumes Qi and Blood, the remaining stasis consists mainly of placental materials. What leaves should leave; what generates regenerates. Within days, recovery occurs naturally. Why assume all births are deficient? For such cases, treat according to symptoms. Postpartum complete excess syndromes include: external Wind-Cold with headache, fever, hard stool, abdominal fullness, and tight, rapid, surging, forceful pulse (Exterior Excess); intense Fire with fever, thirst, restlessness, constipation, abdominal pain, bad breath, black tongue coating, craving cold drinks, eye discharge, painful urination, and surging-slippery pulse (Interior Heat Excess); Liver depression/anger with chest/hypochondriac distension/pain, bowel obstruction, and string-taut-slippery pulse (Qi Rebellion Excess); retained Lochia with Stasis rushing upward, heart/abdominal fullness, pain refusing pressure, difficult stool but free urination (Blood Rebellion Excess). Over-care by the wealthy, or overuse of Renshen (Ginseng Root), Huangqi (Astragalus Root), Baizhu (Atractylodes Macrocephala Rhizome), causing Blood congestion; overuse of sugar, wine, charcoal fire, causing Interior Heat; or using major tonics unnecessarily in non-deficient births, causing increased disease (Care-taking Excess). Overeating during labor, combined with fatigue and forced effort, causing retention (Internal Injury Excess). If Exterior syndrome exists, it must be released; if Fire exists, it must be cleared; if Internal Injury/Stagnation exists, it must be opened and digested. Danxi’s words on only tonifying Qi and Blood cannot be biased. The *Jingyue Quanshu* states: Treat fetal/postpartum diseases according to Jueyin syndromes. Do not violate Stomach Qi and the Upper/Middle Jiao; this is the Three Prohibitions: no sweating, no purging, no diuresis. Adhering to these harmonizes Ying and Wei, stopping chills and fever. Treatment principles: Thirst uses Baihu Tang (White Tiger Decoction); weak Qi uses Huangqi Tang (Astragalus Decoction); Blood deficiency uses Danggui Tang (Angelica Decoction); abdominal pain uses Shaoyao (White Peony Root). Generally, epidemic postpartum diseases follow Jiajian Chaihu Tang (Modified Bupleurum Decoction); miscellaneous diseases follow Zengsun Siwu Tang (Modified Four Substances Decoction). Observe pulse and symptoms. Although this is a general principle, diseases vary; if symptoms demand specific herbs, "where there is disease, the disease receives the medicine." Constant methods must be known, but adaptive flexibility must not be rigid. Additionally, new postpartum Yang deficiency generating internal Cold, or external Cold entering, causing heart/abdominal pain, vomiting, anorexia, and cold limbs: Dayanmi Tang (Great Rock Honey Decoction) or Liyin Jian (Replenish Yin Decoction). Postpartum Spleen/Kidney deficiency causing abdominal pain (due to organ insufficiency, not birth): Spleen Qi deficiency/Cold with vomiting, poor appetite, abdominal pain: Wu Junzi Jian (Five Gentlemen Decoction), Liujunzi Tang (Six Gentlemen Decoction), Wenwei Yin (Warm Stomach Decoction). Kidney Qi deficiency/Cold with diarrhea/dysentery, abdominal pain: Weiguan Jian (Stomach Gate Decoction), Liyin Jian (Replenish Yin Decoction). Food stagnation or Qi rebellion pain: Paqi Yin (Discharge Qi Decoction), Da Hezhong Yin (Great Harmonize Middle Decoction). Shen Jin'ao commented: Jingyue's book favors warm/hot theories, arguments are mixed, lacking unique insights. Except for the postpartum section, which offers profound principles, revealing what predecessors missed, and its formula selection is impeccable, truly a treasure of Gynecology.
Extreme Deficiency Generating Wind: Chen Ziming said postpartum wind arises from excessive Blood loss, leaving Qi without mastery, causing blue lips, cold sweat, dizziness, and coma, life hanging by a thread. This is wind generated by extreme deficiency. Immediately administer Jiwei Shangdan (Supreme Rescue Golden Pill). Using Wind-dispelling herbs is a grave error.
Contracting Wind Pathogens: Chen Shiduo said postpartum Taiyang Wind contraction with severe panting, vomiting, and retching is untreatable. Panting indicates Yuan Yang (Primordial Yang) about to perish; severe panting accelerates this. Vomiting indicates Stomach Qi about to perish; severe vomiting accelerates this. Retching indicates Spleen Qi about to collapse; severe retching accelerates this. Use Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Radix), Chuanxiong (Sichuan Lovage Rhizome), Jingjie (Schizonepeta Spica), Guizhi (Cinnamon Twig) named Zhuanqi Jiuchan Tang (Turn Qi Save Birth Decoction). Administer in large doses; if panting/retching stop, survival is possible; otherwise, death ensues. If Taiyang syndrome presents with spitting pus/blood, bursting headache, incessant irritability, agonizing abdominal pain, or Jie Xiong (Chest Binding), minor symptoms are hard to save; simultaneous appearance guarantees death. Use Foshou San (Buddha's Hand Powder), adding much Renshen (Ginseng Root), assisted by Rougui (Cinnamon Bark) and Jingjie (Schizonepeta Spica), showing immediate effect. Postpartum Shaoyang Wind contraction with delirium, irritability, plus palpitations/fright is fatal. Shaoyang governs Gallbladder. Gallbladder juice moistens Heart; Heart Blood nourishes Spirit. Lack thereof causes vagueness, delirium, irritability, and palpitations. Gallbladder Wood affected: not releasing exterior prevents Blood generation; solely releasing exterior exhausts Blood further. Use Foshou San (Buddha's Hand Powder) plus Renshen (Ginseng Root), Zaoren (Ziziphus Seed), Maidong (Ophiopogon Tuber), Zhuru (Bamboo Shavings), Zhusha (Cinnabar), Shudi (Prepared Rehmannia Root). Postpartum Yangming Wind contraction with severe panting/sweating is also untreatable. Use Maidong (Ophiopogon Tuber), Renshen (Ginseng Root), Yuanshen (Trichosanthes Root), Sangye (Mulberry Leaf), Suzi (Perilla Fruit) named Bushu Jianghuo Tang (Tonify Deficiency Descend Fire Decoction). Yangming syndrome with mania/Yang collapse is incurable. Mania is typically Excess Heat; postpartum is Deficient Heat. Excess Heat can be purged; Deficient Heat cannot. With Yang collapse, even Excess Heat belongs to Qi deficiency. Use Renshen (Ginseng Root), Sangye (Mulberry Leaf), Maidong (Ophiopogon Tuber), Yuanshen (Trichosanthes Root), Qinghao (Artemisia Annua Herba) named Shouyang Tang (Gather Yang Decoction). One dose stops sweating; two doses calm mania; do not take three doses. This saves acute Yang collapse, not standard postpartum care. After two doses, use Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), Danggui (Angelica Sinensis Radix), Chuanxiong (Sichuan Lovage Rhizome), Wuweizi (Schisandra Berry) for regulation. Sudden Shaoyin syndrome postpartum: Jingyue uses Renshen/Baizhu to warm. I suggest adding Fuzi (Aconite Lateralis Radix Praeparata) and Gancao (Licorice Root) if ineffective. Shaoyin pathogens respond miraculously. If Shaoyin syndrome days 3-6 suddenly presents with curled limbs, high-pitched breathing, asthma, nausea, abdominal pain, it is incurable. True Yang is forced upward by Cold pathogens, creating upper false heat and lower true cold. Use Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), Rougui (Cinnamon Bark), Baizhu (Atractylodes Macrocephala Rhizome), Wuyu (Evodia Fruit), served slightly cool, named Pingchuan Quhan San (Calms Asthma Dispels Cold Powder). Near month-end with similar symptoms: use Renshen (Ginseng Root), Fuling (Poria), Fuzi (Aconite Lateralis Radix Praeparata), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Radix), Shudi (Prepared Rehmannia Root), Shanzhuyu (Cornus Fruit), Maidong (Ophiopogon Tuber), Niuxi (Achyranthes Root) named Huchan Tang (Protect Birth Decoction). Shaoyin syndrome with Kidney Water flooding, vomiting/diarrhea, flying True Yang is also fatal. Postpartum Kidney Fire is weak; Cold expels it, Water follows Cold. Use Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Shudi (Prepared Rehmannia Root), Shanzhuyu (Cornus Fruit), Fuling (Poria), Fuzi (Aconite Lateralis Radix Praeparata), Rougui (Cinnamon Bark), Cheqianzi (Plantago Seed) named Bohuo Yinshui Tang (Tonify Fire Guide Water Decoction). Blue/black hands/feet and body is incurable; most severe Yin Cold/Poison. No revival method. Try large dose Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Radix), Fuzi (Aconite Lateralis Radix Praeparata), Rougui (Cinnamon Bark); if color fades, hope remains; otherwise death. Named Kaiqing Sanhei Tang (Opens Blue Scatters Black Powder). Purely blue feet with epigastric pain is less severe but Heart-attacking Cold is identical, leading to death. Previous formula often effective. Cold disperses downward, resolving upward cold easily. Days 4-5 postpartum sudden Wind-Cold Jue (Reversal): Yang already weak, Yin Blood exhausted, compounded by external Cold. Use Renshen (Ginseng Root), Fuzi (Aconite Lateralis Radix Praeparata) decocted, named Zhuanjue Anchanchang Fang (Turns Reversal Calms Birth Formula). Jueyin pathogen postpartum with vomiting, hypochondriac fullness leads to bloody stool, untreatable. Use Danggui (Angelica Sinensis Radix), Maidong (Ophiopogon Tuber) 1 liang each, Chuanxiong (Sichuan Lovage Rhizome) 5 qian, Sanqi (Notoginseng Root) powder 1 qian, named Pinggan Jiuxue Tang (Calms Liver Saves Blood Decoction). Jueyin syndrome with diarrhea/reversal, restlessness/inability to lie down, or persistent reversal are fatal. Use Renshen (Ginseng Root), Danggui (Angelica Sinensis Radix), Jingjie (Schizonepeta Spica) named Shengu Tang (Ginseng-Angelica Decoction).
Postpartum Medication: Sun Simiao said: Wind contraction in bed with limb heat/headache: Xiao Chaihu Tang (Minor Bupleurum Decoction). Headache absent, only irritability: Sanwu Huangqin Tang (Three Items Scutellaria Decoction). Postpartum emaciation, chills/fever, poor appetite, abdominal distension: Zengsun Chaihu Tang (Modified Bupleurum Decoction). Zhang Congzheng said: Postpartum diseases are敗血 (Defeated Blood/Evil Matter) causing chills/fever, umbilical/abdominal cramping pain, dry milk, reduced appetite. Physicians failing to observe attribute it to Qi/Blood deficiency, using warm/hot tonics, treating only as Cold. The world follows this, spreading Heishen San (Black Divine Powder) claiming to treat 18 postpartum syndromes. Not only ineffective, but causes meridian drying, urinary/fecal retention, vomiting/coughing, and various heat syndromes. Misdeaths are countless. Better to use Siwu Tang (Four Substances Decoction) with Liangge San (Cooling Chest Powder) to purge several times until evil matter clears, then take bland/sweet agents to heal. After major birth, Heart Fire hasn't descended, Kidney Water hasn't risen; tonifying with Heishen San causes danger/death. Beiji Wan (Emergency Aid Pill) with Badou (Croton Seed), Ganjiang (Dried Ginger), Dahuang (Rhubarb Root) is also a purgative, suitable only for rough constitutions. Using for postpartum distension causes death/danger. Li Gao said: Postpartum or miscarriage bleeding with coma/unconsciousness is due to sudden Blood loss leaving Heart Spirit un nourished. Heart/Pericardium are Ministerial/Fire; nourished by Blood, endangered by loss. Fire blazing causes coma; Fire overcoming Lung causes unconsciousness. Yin Blood sudden loss fails to anchor. Physicians using Shihui (Talcum), Gancao (Licorice Root), Shigao (Gypsum) are using acrid-sweet-great-cold agents clearing Qi-heat. Blood deficiency clearing Qi is Yin deficiency clearing Yang, injuring both, causing deficiency consumption. Must tonify Blood and regulate ascending/descending; nourished by Blood, Spirit clears. Sudden Blood loss mimics Autumn/Winter dominance; lifting it aids Yang, opening eyes, clearing spirit. How can cold/cold agents be misused? Zhu Zhenheng said: Some ask if Heishen San is essential for postpartum Blood deficiency/Stasis. I say: Postpartum good Blood may not be deficient, Stasis may not accumulate, Organs may not be cold. Why medicine? Careful diet/lifestyle prevents disease. If sweating/Blood loss with weakness/cold, a few doses suffice. For other diseases, find cause/meridian: Qi disease treats Qi, Blood disease treats Blood, Cold warms, Heat clears, Stasis moves, Deficiency tonifies, Excess stops. Why invent formulas causing disease in the healthy? Heishen San uses Ganjiang (Dried Ginger)/Danggui (Angelica Sinensis Radix) damp-heat, Heidou (Black Soybean) sweet, Shudi (Prepared Rehmannia Root) slight cold to tonify Blood deficiency; assists with Chaopuhuang (Charred Lygodium Spore) bitter to prevent bleeding, Shaoyao (White Peony Root) sour-cold to gather/scatter, aiding Siwu Tang (Four Substances Decoction); Gu Gui (Cinnamon Bark) acrid-hot to move Qi/push Stasis, harmonized with Gancao (Licorice Root). Seems precise. But expelling and tonifying are hard to combine. Impatient, thin, fiery, summer-born women: Ginger/Cinnamon are forbidden in Fire seasons. Care methods are illogical. Meat juices ignite Yin Meridian Fire, causing internal injury. Why consume mutton/chicken broth and constantly take Danggui Wan (Angelica Pill), Danggui Jianzhong Tang (Angelica Build Middle Decoction), Sishun Lizhong Wan (Four Smooth Regulate Middle Pills)? Though tonifying, they violate Cinnamon...