三合济生汤 治临产艰难。虽一日不下者。服此自然转动下生。
当归（三钱） 川芎 枳壳（各一钱） 香附 大腹皮（各一钱半） 苏叶（八分） 甘草（七分）
水煎。必待腰腹痛甚。服之即产。一方。加白芷一钱。此方乃以枳壳芎归达生三方。抽其精粹而成合此汤。
产难方 治产难。累日气力乏尽。不得生。此是宿有病者。宜此方。
阿胶（二两） 赤小豆（二升）
水九升。煮豆令熟。去豆。化胶。每服五合。不觉更服。不过三服。即出。
胜金丹 治难产神效。
败兔毫笔头一枚。烧灰研细。生藕汁一盏下之。立产。若虚弱及素有冷疾者。恐冷动气。即于银器内重汤温过服。
俗云。胎前一团火。产后一盆冰。理固然也。盖以胎前每多邪热。易至气血沸腾。故如火。产后真元大损。气血空
虚。其如冰也必矣。故产后之疾。先以大补气血为主。纵有他疾。亦以末治之。或欲祛邪。必兼补益。此大较也。其间
又当细分气虚血虚。血闷血脱。症候之别。以或补或泄之。盖气虚者当补气。血虚者当补血。血闷者婴儿下盆之后。血
上冲心。以致牙关紧闭面色赤。脉洪数。须问产时去血多少。可以行瘀药导之。血脱者。因儿下之时去血过多。面色白。
唇舌色淡。短气不足以息。脉来或沉或浮。宜用人参。即血脱补气之说也。然亦有血虽脱而瘀血未尽者。其腹内痛。必
攻补兼施。血脱者但骨节痛。以此为辨耳。夫产后气血大亏。固多虚症。然有全虚者。或有虚实兼者。间又有全实者。
亦不可不辨。概作虚治。其说详见于后张氏论中。至月内产母。切不可恃健。不自保重。或劳碌以损荣。或多食以伤胃。
外感六淫之邪。内伤七情之气。倘丝毫犯之。甚至恶露未尽。而作热作疼。真元难复。而为劳为痿。其为患有不可胜言
者。夫力壮易产者。尚不免感疾。况素虚弱。而可不慎乎。盖产后病最重而难治者。莫如蓐劳。蓐劳之由有二。一由内
伤。因产理不顺。调养失宜。或忧劳思虑。伤其脏腑。荣卫不宣。令人寒热如疟。头痛自汗。痰咳气逆。虚羸喘乏。体
倦
肢怠。宜补虚汤。一由外感。不满日月。气血虚耗。风冷乘之。与气血相搏。不能温于肌肤。令人发热憔悴。饮食不消。
肢体烦痛。若风冷之邪。感入于肺。肺受微寒。咳嗽口干。头昏体痛。荣卫受于风邪。流注脏腑。发眩盗汗。寒热如疟。
背烦痛。肢体沉重。此皆蓐劳之所由成也。宜白茯苓散、加味佛手散、人参鳖甲散。其或兼内伤饮食泄泻。与夫瘀
血未尽者。皆有之。不可不别也。产后又有三大病。一病痉。二病郁冒。三病大便难。仲景云。新产血虚。多汗出。
喜中风。故令病痉。亡血复汗。寒多。故令郁冒。亡津液。胃燥。故大便难是也。余每临症。详察病情。三者常相因。
如新产胃虚。不食。往往昏冒而神不清。或厥。是郁冒也。宜白薇汤。郁冒则多汗。必致痉。宜钩藤汤。且多汗。必液
少而大便秘。至五七日七八日之久。宜养荣血。肠自润矣。宜苏麻粥。产后血晕。亦险症也。宜立应四物汤。于产儿下
地时。用荆芥炭五分。童便调服。可预防血晕之患。其或血去过多而晕。宜芎归汤加人参。或为血闭血迷而晕。宜血竭
破棺丹。皆宜详究。产后中风。口噤。牙关紧闭。手足螈 者。以气血大损。经络空虚。劳碌太早。风邪从虚而入。宜
举轻古拜散、小续命汤。故忽然口眼 斜。痰涎潮壅。或角弓反张。宜大豆子汤。产后伤寒。因气血大虚。虽有寒邪。
不可大发散。宜芎归汤加参、苏、葛根微汗之。即或大热不止。宜芎归汤加黄连、知母。亦不可妄投峻剂。以耗元气。
苟非正伤寒。不可绝其饮食。二者皆产后重症。不可轻视。产后发寒热。多因血虚。只宜养血。其外感者十之一二。即
系外感。不可大发散。只宜和解。或阴分不足。憎寒壮热。日轻夜重。宜四物汤加炭姜。微热加茯苓。或血虚发热。而
自汗心烦短气。宜人参当归散。或因乳蒸而发热。宜四物汤加黄 、花粉。或因收束骨节而发热。此不必药。只多服益
母草汤足已。产后儿枕腹痛。宜延胡索散。或身体壮热。小腹有块而痛。亦名儿枕。宜归尾泽兰汤、杏苏散。或不发热。
但腹痛。或有块。时起时没。亦名儿枕。宜延胡索散、归尾泽兰汤。二症皆产后所常患。几于十人而八九。调治之可也。
产后心腹痛。则以败血凝聚。气上冲心之故。宜大岩蜜汤。亦或七情相干。血与气并而心疼。宜延胡索汤。亦或败血攻
刺心腹而疼。宜当归失笑散。亦或寒气相侵而腹疼。宜理中汤。吐加姜。小便不利加茯苓。肾气动去术。产后遍身疼痛。
因气血走动。升降失常。留滞于关节间。筋脉引急。或手足拘挛。不能屈伸。故遍身肢节走痛。宜趁痛散。若瘀血不尽。
流于遍身。则肢节作痛。宜如神汤。产后头痛。有由血虚所致者。其症朝轻暮重。时作时止。虽亦太阳巅顶痛。惟眉棱
骨不痛。不可作外感治。若风寒头痛。则无时间止。并眉棱骨痛耳。然虽属风寒。亦宜以四物加减。或手足搐搦。切牙。
头痛而昏冒者。尤宜急治。宜先用四物汤加减。后用秦艽汤。有头疼作呕不食者。乃血虚火炎也。宜麦冬橘红汤。如呕
止而头痛。加天冬。产后腹痛呕吐。由恶露下少。败血乘虚散入于脾而为胀满。胃受之则呕吐也。宜抵圣汤。或腹胀呕
逆。为胃不和。宜桔梗半夏汤。或干呕不止。不思食。为胃弱不和。宜和胃汤。产后腿痛。不能立久。而不进饮食。此
脾阴不足之候。脾主四肢。故病下体也。宜石斛牛膝汤。甚则连腰脐腿胯俱痛。则又兼肾气之不足矣。宜补骨四物汤。
以上诸痛症。患之者虽不若寒热儿枕痛之多。要皆为产后所常患者。此外则有由内因者。如产后不语。因败血上干于心。
心气闭塞。舌为心苗。故舌强不语。宜逐血补心汤。亦或痰气壅滞。目闭不言。宜白矾汤吐之。亦或恶血攻心。欲死而
不语。宜郁金三钱。烧存性。醋调服之。产后浮肿。有因败血蓄于五脏。循经流入四肢而化为水。因乘虚浮肿者。宜调
经汤。有气血大虚。肢体浮者。不可利水。宜八珍汤。有浮肿而有水气当利者。宜宣气汤。产后怔忡惊悸。心血虚耗也。
必睡不宁。宜养心汤、益荣汤。心气虚耗亦然。宜茯苓汤。产后乍见鬼神。由血虚之极。败血攻冲。邪淫于心。胡言乱
语。如见鬼祟。非风邪也。宜调经散、妙香散。产后气喘急。下血过多。荣血暴竭。气无所主。独发于肺。故令喘。此
孤阳绝阴。难治。若败血停滞。上朝于肺。而亦作喘。宜夺命丹、固血汤。气滞。亦作喘。宜苏木汤。若自汗不止。饮
汤即汗。为气虚。亦作喘。宜苏木汤加归、地、黄 。不效。宜补心。心主血。又汗为心液。故血耗而病汗也。宜白芍、
枣仁、五味子等。痰饮盛。亦作喘。宜润肺汤。产后惊悸。闻声欲死。非他人用力抱持。则虚烦欲死。由心肝脾三经虚
也。宜石斛散。产后五六朝。狂乱胡言。持刀欲杀人。乃阴血暴崩。肝火虚炎也。宜泽兰汤。产后阴虚血弱。有烦闷者。
宜知母汤。亦有因虚耗而血热心烦口渴者。宜凉血饮、生脉散。产后失血。或因去血过多。兼腹疼身热自汗。宜当归黄
汤。或兼眩晕。宜芎归汤。或兼虚热。宜芎归汤加人参、姜炭。或兼腹痛。宜加肉桂。或兼寒热往来。盗汗脉浮。宜
和解四物汤。或兼阴虚内热。而自汗心烦气短。宜当归建中汤。产后诸淋。宜茅根汤。或则败血不止。淋漓不断。宜乌
金散。或则淋久不止。四肢沉困无力。宜牡蛎散。或则小便闭而淋沥。小腹膨胀。宜 元汤。产后口鼻黑而衄。由产时
气消血败。荣卫不理。散乱入于诸经。不得还元。故口鼻黑气而变衄血。此乃产后虚热成为胃绝肺败。皆死症也。宜犀
角地黄汤。若产后即见鼻衄。则由血溢妄行。宜必效四物汤。产后虚渴。必口干少气。足弱。头昏目晕。宜熟地黄汤。
产后消渴。饮水不止。由于液枯火燥已极。宜止渴四物汤。产后小便不利。宜木通散。大便闭结。宜通润四物汤。皆由
火盛。产后小便尿血。宜牛膝一味浓煎。大便下血。宜黄连四物汤。皆由血虚而热。产后恶露不下。有结聚成块。心胸
烦闷。脐下坚痛者。宜当归血竭丸。有恶露不下。兼受冷热劳碌。腰脊骨烦疼者。宜丹参散。有恶露不下。寒热交攻。
心慌昏沉。腹中痛者。宜通瘀饮。有恶露方下。忽然断绝。骤作寒热。脐腹百脉皆痛如锥刺。由冷热不调。或思虑动作
气所壅遏。血蓄经络者。宜没药丸。产后恶露不止。小便急痛。宜磨块四物汤。或血下过多。渐至瘦弱。宜八珍汤去甘
草。加浓朴、黄柏、阿胶、丹皮。或下如豆汁。紫黑过多。宜加味四物汤。或至月余。犹淋沥不止。已为陷下。宜加味
四物汤。或下不止。至于数月及半载之久。宜千金方。或恶血不绝。崩血不可禁。腹中绞痛。气息急。宜牛角腮丸。或
恶露淋沥不断。心闷短气。四肢乏弱。头目昏重。五心烦热。面黄体瘦。宜牡蛎散。以上皆由于内因者。又有由外因者。
如产后下痢腹痛。里急后重。宜香连散加消导药。或痢久不止。宜四君子汤加收敛药。产后疟疾。治与胎前略同。却宜
以虚为主。其或寒热往来。或热多于寒皆是也。宜草果饮。产后泄泻。有挟寒腹痛。肠鸣小水清白。口不渴者。宜君苓
汤加肉果、肉桂、白芍。有热泄肠垢。口渴。痛一阵下一阵者。宜君苓汤加黄连、木通、六一散。有湿胜水泄者。宜胃
苓汤。产后霍乱。或渴而饮水。宜五苓散。或寒多不渴。宜人参理中汤。或吐利厥冷。宜附子理中汤。或腹痛甚而手足
寒。宜高良姜散。或转筋。宜木瓜散。不止。辣蓼煎汤洗之。产后偏正头风。有头疼目眩者。宜愈风四物汤。有风壅目
眩。遍身疼痛者。宜泻肝四物汤。产后四肢麻痹。皮肤搔痒不仁。皆血虚风袭之。宜逐邪四物汤。产后大惊恐而发寒热。
呕吐痰盛。呕即汗出。宜八珍汤加黄 。小腹痛加桂。产后闪伤。腹痛。血崩。宜兼去瘀。宜五灵脂汤。或代赭石汤。
产时稳婆误损其尿胞。每致日夜淋沥。宜参术膏。以上皆由于外因者。而又有兼内外因者。如产后风痿。经云。诸风痿
弱。筋挛无力。血不足以养筋也。宜血风汤。有血弱气虚多汗。风抟而成 者。其症口噤。脊强反张。若汗出不止者死。
宜大圣汤加川芎。产后咳嗽。有因恶露上攻。肺经受邪者。宜二母散。有感风咳嗽。由外邪。恶风寒发热者。宜参苏饮。
有产后血风感寒暑湿气。咳嗽喘满壅甚者。宜旋复散。产后香港脚。热闷气上冲。若因平日感六淫之气。今又因产后血气
不足。遂袭于足经。因乘虚而发也。宜独活寄生汤。以上皆兼内外因者也。产后之病。其繁琐累重若此。丹溪谓宁治十
男子。莫治一妇人。正以此也。至于生子有乳。乃天地化生自然之理。所谓有是子。则有所以养是子者。其或不行。皆
由气血虚弱。经络不调所致。或产后乳胀疼痛。由年少之人。初经产乳。内有风热也。须服清利药则乳行。若累经产而
无
乳。亡津液故也。须服滋阴药。若虽有乳。却苦其少。须服通经药。并引以羹 。盖乳资于冲脉与胃经通也。此其大略
也。其或产后血气盛实而乳汁不通。宜通草散。其或妇人肥盛。气脉壅滞而乳不通。又经络凝滞。乳内胀痛。欲作痈肿。
宜漏芦散、秘传涌泉散。其或乳汁不通。或乳房结硬疼痛。宜皂角散。其或气血虚而乳不通。宜加味四物汤。其或乳脉
不行。身体壮热疼痛。头目昏痛。大便涩滞。宜玉露散。其或气脉不足。经血衰弱。而乳汁涩少。宜通乳汤。皆当随症
而各与以药。乃有乳汁自出者。是胃气虚所致。宜止以补药。若乳多溢满急痛。温帛熨之。但以漏芦散亦可。有未产前
而乳汁自出者。谓之乳泣。生子多不育。此无药可服。至如乳上外症。详杂病中。兹不重载。
脉法 脉经曰。诊妇人新生乳子脉。沉小滑者生。实大坚弦急者死。诊妇人新生乳子。因得热病。其脉。悬小。
四肢温者生。寒清者死。诊妇人生产。因中风伤寒热病。喘鸣而肩息实者。浮缓者生。小急者死。诊妇人生产之后。寸
口脉焱疾不调者死。沉微附骨不绝者生。脉诀曰。产后因得热病临。脉细四肢暖者生。脉大忽然肢逆冷。须知其死不留
停。
陈自明曰。新产之脉缓滑吉。实大弦急死来侵。若得沉重小者吉。忽若坚牢命不停。寸口涩疾不调死。沉细附骨不绝生。
审看此后分明记。长须念此向心经。
产后脉症总论 仲景曰。新产妇人有三病。一者病痉。二者病郁冒。三者大便难。何谓也。师曰。新产血虚。
多汗出。喜中风。故令病痉。亡血复汗寒多。故令郁冒。亡津液胃燥。故大便难。产妇郁冒。其脉微弱。呕不能食。大
便反坚。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。大便坚。呕不能食。小柴胡汤主之。又病解能食。七八日
Sanhe Jisheng Decoction: Treats difficult labor. Even if delivery does not occur after one day, taking this decoction will naturally facilitate rotation and smooth delivery.
Danggui (Radix Angelicae Sinensis) (3 qian), Chuanxiong (Rhizoma Chuanxiong), Zhike (Fructus Aurantii), Xiangfu (Rhizoma Cyperi), Dafupi (Pericarpium Citri Reticulatae) (1.5 qian each), Ziye (Folium Perillae), Gancao (Radix Glycyrrhizae) (0.7 qian).
Decoct in water. It must be taken when lower back and abdominal pain are severe; delivery will follow immediately. Another version adds Baizhi (Radix Angelicae Dahuricae) 1 qian. This formula is synthesized by extracting the essence from Zhike, Chuanxiong, and Danggui Daseng formulas.
Channan Fang: Treats difficult labor. Exhaustion of strength over several days without delivery. This is indicated for patients with pre-existing chronic conditions.
Ejiao (Colla Corii Asini) (2 liang), Chixiaodou (Semen Phaseoli Angularis) (2 sheng).
Boil Chixiaodou in 9 sheng of water until soft. Remove the beans, dissolve Ejiao. Take 5 he per dose. If no effect is felt, take again. Delivery will occur within three doses.
Shengjin Dan: Highly effective for difficult labor.
One piece of the tip of a rabbit hair brush that has lost its efficacy, burnt to ash and ground fine. Take with one zhan of fresh lotus root juice. Delivery occurs immediately. For those with weakness or chronic cold conditions, who may be disturbed by cold qi, warm it in a silver vessel using a double-boiler method before taking.
The common saying goes: "Before birth, a ball of fire; after birth, a basin of ice." The principle is indeed so. Generally, during pregnancy, there is often pathogenic heat, leading to boiling blood and qi, resembling fire. After childbirth, the primordial yuan is greatly damaged, and blood and qi are empty, resembling ice. Therefore, the treatment of postpartum diseases should primarily focus on greatly tonifying blood and qi. Even if there are other ailments, they should be treated as secondary. If one wishes to eliminate pathogens, tonification must be combined. This is the general principle. Among them, one must further distinguish between qi deficiency and blood deficiency, blood stagnation (Xue Men) and blood collapse (Xue Tuo), based on symptom differences, applying either tonification or purgation accordingly. Qi deficiency requires tonifying qi; blood deficiency requires tonifying blood. Blood stagnation refers to the situation after the infant is born where lochia rushes upward to the heart, causing lockjaw, red face, and rapid, surging pulse. One must ask about the amount of blood loss during delivery and use blood-invigorating drugs to guide the expulsion. Blood collapse refers to excessive blood loss during delivery, resulting in pale complexion, pale lips and tongue, shortness of breath, and pulse that is either deep or floating. Ren Shen (Radix Ginseng) is suitable, which is the theory of "tonifying qi for blood collapse." However, there are cases where blood is collapsed but stasis remains, characterized by abdominal pain, requiring both attack and tonification. Blood collapse typically presents only with bone joint pain; this is used for differentiation. Postpartum blood and qi are greatly depleted, mostly presenting as deficiency syndromes, but there are pure deficiencies, mixed excess-deficiency, and even pure excess syndromes, which must be distinguished. Treating all as deficiency is incorrect; detailed explanations are found in Zhang's discussion later. For mothers within the first month postpartum, one must not rely on robust health and neglect self-care, nor engage in labor that damages Ying and Wei, or overeat damaging the stomach. External invasion of the Six Excesses (Liu Yin) or internal injury from the Seven Emotions (Qi Qing), if even slightly triggered, can lead to fever and pain while lochia is not yet cleared, making restoration of primordial yuan difficult, resulting in consumptive fatigue and flaccidity syndromes, with harms beyond count. Those with strong constitutions who deliver easily still do not escape illness; how much more so for those constitutionally weak? The most serious and difficult-to-treat postpartum disease is certainly Rutao (Postpartum Consumptive Fatigue). Rutao arises from two causes: one is internal injury due to difficult labor, improper care, or worry and overthinking damaging the Zang-Fu organs, blocking Ying and Wei circulation, causing chills and fever like malaria, headache, spontaneous sweating, phlegm-cough, rebellious qi, emaciation, panting, and limb fatigue; Buyu Tang (Tonify Deficiency Decoction) is suitable. The second is external contraction; within the first month, when blood and qi are depleted, wind-cold invades and combats with blood and qi, failing to warm the skin and muscles, causing fever, emaciation, indigestion, and limb pain. If wind-cold enters the Lung, causing slight cold in the Lung, symptoms include cough, dry mouth, dizziness, body pain. When Ying and Wei are affected by wind, flowing into the Zang-Fu, it causes vertigo, night sweats, chills and fever like malaria, back pain, and heavy limbs. These are the origins of Rutao. Bai Fuling San (White Poria Powder), Jiawei Foshou San (Modified Buddha's Hand Powder), and Renshen Biejia San (Ginseng and Turtle Shell Powder) are suitable. If accompanied by internal injury from diet causing diarrhea, or residual stasis, these must also be distinguished. There are three major postpartum diseases: Jing (Spasm/Convulsion), Yumao (Depression/Dizziness/Syncope), and Da Bian Nan (Difficulty in Defecation). Zhang Zhongjing said: New postpartum blood deficiency, excessive sweating, prone to wind strike, thus causing Jing. Loss of blood plus sweating, excessive cold, thus causing Yumao. Loss of body fluids, dry Stomach, thus causing difficulty in defecation. In my clinical practice, observing carefully, these three often occur together. For example, new postpartum Stomach deficiency, inability to eat, often leads to dizziness and unclear spirit, or Jue (cold extremities); this is Yumao. Baiwei Tang (Veronicaea Decoction) is suitable. Yumao leads to excessive sweating, inevitably causing Jing; Gouteng Tang (Uncaria Decoction) is suitable. Excessive sweating leads to fluid deficiency and constipation; after five to seven or even eight days, nourishing Ying blood will naturally moisten the intestines; Suma Zhou (Sesame Porridge) is suitable. Postpartum Xueyun (Blood Syncope/Fainting) is also a critical condition. Liying Siwu Tang (Immediate Response Four Substances Decoction) is suitable. At the moment the baby is born, use 5 fen of Jinjie Tan (Charred Schizonepeta) mixed with Tongbian (Child's Urine) to prevent Xueyun. If fainting is due to excessive blood loss, Xiong Gui Tang (Ligusticum and Angelica Decoction) with Ren Shen is suitable. If fainting is due to blood closure or confusion, Xuejie Poguan Dan (Dragon's Blood Coffin-Breaking Pill) is suitable; all require careful investigation. Postpartum Fengzhong (Wind Strike/Stroke), with lockjaw, clenched teeth, and convulsions of hands and feet, is due to great damage to blood and qi, emptiness of meridians, and early labor allowing wind pathogen to enter through deficiency. Juqing Gu Bai San and Xiao Xuming Tang (Minor Continuation of Life Decoction) are suitable. Sudden deviation of mouth and eyes, flooding of phlegm-saliva, or opisthotonos require Dazidzi Tang (Soja Seed Decoction). Postpartum Shanghan (Cold Damage), due to great deficiency of blood and qi, even if cold pathogen is present, cannot be strongly diaphoretic; Xiong Gui Tang with Ren Shen, Zisu (Perilla Leaf), and Gegen (Pueraria Root) to induce mild sweating is suitable. Even if high fever persists, Xiong Gui Tang with Huanglian (Coptis Rhizome) and Zhimu (Anemarrhena Rhizome) is suitable; harsh agents must not be recklessly administered to consume Yuan Qi. If not true Shanghan, diet should not be cut off completely. Both are severe postpartum conditions, not to be underestimated. Postpartum chills and fever are mostly due to blood deficiency; only nourishing blood is suitable. External contraction accounts for only 10-20%; even if external, strong diaphoresis is unsuitable; only harmonization is appropriate. If Yin deficiency causes aversion to cold and high fever, lighter by day and heavier by night, Siwu Tang with Jiangtan (Charred Ginger) is suitable; add Fuling (Poria) for slight heat. If blood deficiency causes fever with spontaneous sweating, irritability, and shortness of breath, Rendang Gui San (Ginseng and Angelica Powder) is suitable. If fever is caused by lactation stimulation, Siwu Tang with Huangqi (Astragalus Root) and Huafen (Trichosanthes Root) is suitable. If fever is due to tightening of bone joints, no medicine is needed; drinking Yi Mucao Tang (Motherwort Decoction) sufficiently is enough. Erzhen Abdominal Pain (Lochia Stagnation Pain) postpartum requires Yanhusuo San (Corydalis Powder). If accompanied by high fever and painful mass in lower abdomen, also called Erzhen, Guiwei Zelane Tang (Angelica Tail and Lycopodium Decoction) or Xingsu San (Apricot and Perilla Powder) is suitable. If no fever, only abdominal pain or intermittent masses, also called Erzhen, Yanhusuo San or Guiwei Zelane Tang is suitable. These two conditions are common postpartum, affecting nearly 80-90% of women; regulation and treatment are possible. Postpartum Heart and Abdominal Pain is due to coagulation of defeated blood and Qi rushing to the heart; Dayanmi Tang (Large Rock Honey Decoction) is suitable. Or emotional interference causing blood and Qi congestion leading to heart pain; Yanhusuo Tang is suitable. Or defeated blood attacking the heart and abdomen causing pain; Danggui Shixiao San (Angelica and Powo Powder) is suitable. Or cold qi invading causing abdominal pain; Lizhong Tang (Regulate the Middle Decoction) is suitable; add Shengjiang (Fresh Ginger) for vomiting, Fuling for difficult urination, remove Baizhu if Kidney Qi moves. Postpartum generalized body pain is due to abnormal movement of blood and qi, failure of ascending and descending, stagnation in joints, pulling and tightening of sinews, or spasms of hands and feet preventing flexion and extension, causing wandering pain in limbs and joints; Chentong San is suitable. If stasis flows throughout the body causing joint pain, Rushen Tang is suitable. Postpartum headache due to blood deficiency presents as lighter in morning, heavier in evening, intermittent. Although it affects the Taiyang vertex, the brow bone is not painful; do not treat as external contraction. Wind-cold headache is continuous and involves brow bone pain. Even if wind-cold, Siwu Tang modifications are suitable. If accompanied by hand/foot spasms, grinding teeth, headache with dizziness, urgent treatment is needed; first Siwu Tang modification, then Qinjiao Tang. Headache with vomiting and anorexia indicates blood deficiency with fire flaming up; Maidong Juhong Tang (Ophiopogon and Tangerina Peel Decoction) is suitable. Add Tiandong if vomiting stops but headache persists. Postpartum abdominal pain and vomiting are due to scant lochia, defeated blood scattering into the Spleen causing distension, and Stomach receiving it causing vomiting; Disheng Tang is suitable. Abdominal distension and vomiting due to Stomach disharmony; Jiegeng Banxia Tang (Platycodon and Pinellia Decoction) is suitable. Persistent dry retching and anorexia due to Stomach weakness; Hewei Tang is suitable. Postpartum leg pain, inability to stand long, and anorexia indicate Spleen Yin deficiency. Spleen governs four limbs, so disease manifests in the lower body; Shihu Niuxi Tang (Dendrobium and Achyranthes Decoction) is suitable. Severe cases involving waist, umbilicus, legs, and hips indicate Kidney Qi deficiency; Bugusi Wu Tang is suitable. Although these pains are less frequent than chills/fever or Erzhen pain, they are common postpartum complaints. Others arise from internal causes, such as Postpartum Aphasia due to defeated blood disturbing the Heart, blocking Heart Qi; since the tongue is the sprout of the Heart, stiffness prevents speech; Zhuxue Buxin Tang is suitable. Or phlegm-Qi obstruction causing closed eyes and silence; Baijian Tang to induce vomiting is suitable. Or evil blood attacking the Heart causing near-death aphasia; Yujin (Curcuma Aromatica Rhizome) 3 qian, burnt to retain nature, mixed with vinegar is suitable. Postpartum Edema due to defeated blood accumulating in Five Zang, flowing into four limbs transforming into water, swelling upon deficiency; Tiaojing Tang is suitable. Great deficiency of blood and qi causing limb swelling; do not promote urination; Bazhen Tang is suitable. Edema with water qi requiring diuresis; Xuanqi Tang is suitable. Postpartum Palpitations and Fright are due to consumption of Heart Blood, causing restless sleep; Yangxin Tang and Yirong Tang are suitable. Heart Qi deficiency similarly requires Fuling Tang. Postpartum hallucinations of ghosts are due to extreme blood deficiency, defeated blood attacking and disturbing the Heart, causing incoherent speech; not wind pathogen; Tiaojing San and Miaoxiang San are suitable. Postpartum急促 Panting/Dyspnea due to excessive bleeding causing sudden exhaustion of Ying blood, Qi having no master, manifesting solely in the Lung; this is isolated Yang and severed Yin, difficult to treat. If defeated blood stagnates and rises to the Lung causing panting, Mingdan and Guxue Tang are suitable. Qi stagnation causing panting requires Sumu Tang. Spontaneous sweating profuse, sweating upon drinking indicates Qi deficiency causing panting; Sumu Tang with Danggui, Dihuang, Huangqi is suitable. If ineffective, tonify the Heart. Heart governs blood, sweat is the fluid of the Heart; blood loss causes sweating disorder; Shaoyao (Peony Root), Suanzaoren (Ziziphus Seed), Wubeizi (Chinese Gooseberry) are suitable. Profuse Phlegm-Fluid causing panting requires Runfei Tang. Postpartum Fright and Palpitations, hearing sound causes fear of death, or irritability from deficiency, due to Heart, Liver, and Spleen meridian deficiency; Shihu San is suitable. Postpartum day five or six, mania and incoherent speech, holding knife wanting to kill, indicates sudden violent bleeding of Yin blood and deficient Liver Fire flaming up; Zelane Tang is suitable. Postpartum Yin deficiency and blood weakness with irritability requires Zhimu Tang. Deficiency causing hot blood, irritability, and thirst requires Liangxue Yin and Shengmai San. Postpartum Hemorrhage due to excessive loss, accompanied by abdominal pain, fever, and sweating; Danggui Huangqi Tang is suitable. Accompanied by dizziness; Xiong Gui Tang. Accompanied by deficient heat; Xiong Gui Tang with Ren Shen and Jiangtan. Accompanied by abdominal pain; add Rougui (Cinnamon Bark). Accompanied by alternating chills/fever, night sweats, floating pulse; Hejie Siwu Tang. Accompanied by Yin deficiency internal heat, sweating, irritability, shortness of breath; Danggui Jianzhong Tang. Postpartum various Lin (Strangury) syndromes require Maogen Tang. Defeated blood not stopping, dripping continuously; Wujin San. Long-standing Lin with heavy limbs and weakness; Muli San. Urinary retention with dribbling and abdominal distension; Yuanyuan Tang. Postpartum black mouth/nose and Epistaxis due to Qi depletion and blood defeat at birth, Ying and Wei disordered, scattering into meridians, unable to return to origin, causing black qi in mouth/nose and epistaxis; this is postpartum deficient heat becoming Stomach extinction and Lung failure, a fatal sign; Xijiao Dihuang Tang is suitable. Immediate epistaxis after birth due to reckless blood overflow; Bixiao Siwu Tang is suitable. Postpartum deficient thirst with dry mouth, shortness of breath, weak legs, dizziness; Shudihuang Tang is suitable. Postpartum Xiao Ke (Wasting-Thirst) with incessant drinking due to extreme fluid depletion and fire dryness; Zhike Siwu Tang is suitable. Postpartum difficult urination requires Mutong San. Constipation requires Tongrun Siwu Tang, both due to excessive fire. Postpartum hematuria requires thick decoction of Nixi (Achyranthes Root). Hematochezia requires Huanglian Siwu Tang, both due to blood deficiency with heat. Postpartum lochia retention with clumps, chest distress, and hard pain below navel; Danggui Xuejie Wan is suitable. Lochia retention with cold/heat/labor injury and back pain; Danshen San is suitable. Lochia retention with alternating chills/fever, palpitations, dizziness, abdominal pain; Tongyu Yin is suitable. Lochia starts then suddenly stops with acute chills/fever and stabbing pain in umbilicus/abdomen due to cold/heat imbalance or Qi blockage from worry/movement trapping blood in meridians; Moyao Wan is suitable. Postpartum lochia non-stop with urgent painful urination; Mobai Siwu Tang is suitable. Excessive bleeding leading to emaciation; Bazhen Tang minus Gancao, adding Houpo, Huangbai, Ejiao, Mudanpi is suitable. Discharge like bean curd juice, excessively purple-black; Jiawei Siwu Tang is suitable. Dribbling continuing for over a month indicating sinking; Jiawei Siwu Tang is suitable. Bleeding continuing for months; Qianjin Fang is suitable. Unceasing evil blood, uncontrollable metrorrhagia, colic, rapid breathing; Niujiaoshai Wan is suitable. Dribbling lochia with chest oppression, shortness of breath, weak limbs, heavy head/eyes, five-palm heat, sallow thin complexion; Muli San is suitable. All above are internal causes. External causes include Postpartum Dysentery with abdominal pain and tenesmus; Xianglian San with digestive herbs is suitable. Long-standing dysentery; Sijunzi Tang with astringents is suitable. Postpartum Malaria treatment is similar to antenatal but focuses on deficiency. Alternating chills/fever or heat exceeding cold; Caoguo Yin is suitable. Postpartum Diarrhea with cold pain, borborygmus, clear urine, no thirst; Junling Tang with Rouguo, Rougui, Shaoyao is suitable. Heat diarrhea with foul stool, thirst, cramping pain preceding stool; Junling Tang with Huanglian, Mutong, Liuyisan is suitable. Dampness dominance causing watery diarrhea; Weiling Tang is suitable. Postpartum Huoluan (Cholera-like syndrome) with thirst requiring water; Wuling San is suitable. Cold predominance without thirst; Renshen Lizhong Tang is suitable. Vomiting/diarrhea with cold extremities; Fuzi Lizhong Tang is suitable. Severe abdominal pain with cold extremities; Gaoliangjiang San is suitable. Muscle cramps; Mugua San is suitable. If uncontrolled, wash with Lapiao decoction. Postpartum Migraine/Tension Headache with dizziness; Yufeng Siwu Tang is suitable. Wind obstruction with dizziness and body pain; Xiegan Siwu Tang is suitable. Postpartum limb numbness and skin itching/anesthesia due to blood deficiency and wind invasion; Zhuxie Siwu Tang is suitable. Postpartum severe fright causing chills/fever, profuse phlegm vomiting, sweating upon vomiting; Bazhen Tang with Huangqi. Add Guizhi for lower abdominal pain. Postpartum sprain, abdominal pain, metrorrhagia; combine blood-breaking; Wulingzhi Tang or Daizheshi Tang is suitable. Midwife injuring bladder causing day/night dribbling; Shenzhu Gao is suitable. All above are external causes. Combined internal/external causes include Postpartum Fengwei (Wind Flaccidity). Classics state: All wind flaccidity, tendon spasms, weakness are due to blood insufficient to nourish tendons; Xuefeng Tang is suitable. Blood/Qi weakness with sweating, wind condensing causing Jing (spasm) with lockjaw and opisthotonos; if sweating does not stop, death ensues; Dasheng Tang with Chuanxiong is suitable. Postpartum Cough due to lochia attacking Lung meridian; Emu San is suitable. Wind-cough with aversion to wind/cold and fever; Renshen Su Yin is suitable. Postpartum blood-wind affected by cold/heat/dampness causing severe cough/wheezing; Xuanfu San is suitable. Postpartum Hongjiao (Beriberi/Leg Swelling) with heat/stuffiness and Qi rushing up, due to prior Six Excesses invasion now exploiting postpartum deficiency in Foot meridians; Duhuo Jisheng Tang is suitable. All above are combined causes. Postpartum diseases are so complex and numerous; Danxi said "Better to treat ten men than one woman," precisely for this reason. Regarding lactation, producing milk is a natural process of Heaven and Earth generation. "If there is a child, there is means to nourish it." Failure to lactate is due to blood/qi weakness and meridian disharmony. Breast distension/pain in young primiparas is due to internal wind-heat; clear/drain herbs allow flow. Multiparas without milk due to fluid loss; nourish Yin herbs. Scanty milk requires promoting meridians and guiding with soup/gruel. Milk relies on Chong Mai and Stomach Meridian connection. General overview: Robust blood/qi with blocked milk requires Tongcao San. Obese women with Qi/blood stagnation and congealed meridians causing breast pain/risk of abscess; Loulu San and Mishuan Yongquan San are suitable. Blocked milk or hard painful breasts; Saojiao San is suitable. Blood/qi deficiency with blocked milk; Jiawei Siwu Tang is suitable. Milk ducts not flowing with high fever/pain, dizziness, constipation; Yulu San is suitable. Insufficient Qi/blood and weak menstruation causing scant milk; Tongru Tang is suitable. Medication should be prescribed according to symptoms. Spontaneous leakage of milk is due to Stomach Qi deficiency; stop with tonics. Full painful leakage; warm compress with cloth, or Loulu San. Premature leakage before birth is called Ruqi (Weeping Milk); offspring often do not survive; no medicine available. External breast conditions are detailed in miscellaneous diseases, not repeated here.
Pulse Methods: Pulse Classic states: Diagnosing pulse of woman newly delivered and nursing: Chen, Xiao, Hua (Deep, Small, Slippery) indicates life; Shi, Da, Jian, Xian, Ji (Full, Large, Firm, String-taut, Rapid) indicates death. Diagnosing woman newly delivered with febrile disease: Pulse Xuan Xiao (Hanging Small), warm limbs indicates life; cold limbs indicates death. Diagnosing woman delivering with wind-strike/cold-damage/febrile disease, panting with shoulder breathing and excess signs: Fu Huan (Floating Slow) indicates life; Xiao Ji (Small Rapid/Urgent) indicates death. Postpartum Cun Kou pulse Yan Ji (Flaring Rapid) and irregular indicates death; Chen Wei (Deep Minute) and unbroken upon pressing to bone indicates life. Pulse Aphorism states: Postpartum febrile disease, fine pulse with warm limbs indicates life; large pulse with sudden cold extremities indicates imminent death.
Chen Ziming states: New postpartum pulse Huan Hua (Slow Slippery) is auspicious; Shi Da Xian Ji (Full Large String-taut Urgent) brings death. Chen Zhong Xiao (Heavy Heavy Small) is auspicious; Hu Ruo Jian Lao (Suddenly Firm Solid) means life does not last. Cun Kou Se Ji (Rough Rapid) irregular indicates death; Chen Xi (Deep Fine) unbroken upon pressing to bone indicates life. Remember clearly thereafter; always keep this in mind.
General Discussion of Postpartum Pulse and Symptoms: Zhang Zhongjing said: New postpartum women have three diseases: Jing (Spasm), Yumao (Depression/Dizziness), and Da Bian Nan (Difficulty in Defecation). Why? Master said: New postpartum blood deficiency, excessive sweating, prone to wind strike, thus causing Jing. Loss of blood plus sweating, excessive cold, thus causing Yumao. Loss of body fluids, dry Stomach, thus causing difficulty in defecation. Postpartum Yumao presents with weak pulse, vomiting, inability to eat, hard stool, only head sweating. This is because blood deficiency leads to Jue (reversal/collapse), and Jue leads to Mao (dizziness/syncope). For Mao to resolve, there must be profuse sweating. Due to blood deficiency and lower reversal, isolated Yang rises out, hence head sweating. Thus, postpartum women favor sweating; loss of Yin blood leaves Yang alone in excess, so sweating restores Yin-Yang balance. Hard stool and vomiting prevented eating are treated with Xiao Chaihu Tang (Minor Bupleurum Decoction). Once illness resolves and appetite returns, after seven to eight days...