（诸禁 血晕 三冲 三急 三审 呕吐 呃逆 饱闷 谵语 如见鬼神 不语 发痉 发热
寒热 中风 咳嗽 发喘 螈 颤振 伤风 伤寒 疟 痢 蓐劳 虚烦 惊悸 多汗 麻木
大小便诸证 诸痛 泄泻 浮肿 诸血 月水不通 诸淋 乳汁）
经曰。乳子而病热。脉悬小。手足温则生。寒则死。
乳子中风热。喘鸣肩息者。脉实大而缓则生。急则死。
上条言产后以乳哺子之时而患热病。其脉只宜悬小。不宜实大者。以产后新虚故也。设脉虽
悬小。而见手足逆冷。又为脾气衰绝。阴气暴逆之候。亦主死也。下条言产后中风热。而至喘鸣
肩息。以风热逆于阳位。其脉必不能悬小。但须实大之中。而往来和缓。则脾胃之气在其中矣。
设见急疾。胃气已绝。安得不死。后世以乳子二字误认为小儿。如张介宾之明。亦不加察。且因
此而谓小儿不当视虎口三关。即宜诊两手六部。非智者之一失欤。
金匮云。问曰。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。善中风。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。所以产妇善汗出者。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。
病解能食。七八日更发热者。此为胃实。大承气汤主之。
产后气血俱虚。汗下皆禁。独此一证用大承气者。乃证治之变。不当以寻常例测也。以其病
解之后。尚有余热在胃。所以能食。食入既多。至七八日更加发热者。此必复伤饮食之故。故知
胃有实结。恐其煎迫津液。故以急下救阴为务。然必年体强旺。脉证俱实。且时日既久。与新产
大便难不同。是可议下。设遇胃虚之人。虽能食而所食不多。即有发热便秘。亦属血虚。急宜调
养气血。断非承气所宜。不可恣行攻击也。
产后腹中 痛。当归生姜羊肉汤主之。并治腹中寒疝。虚劳不足。若寒多者。加生姜成一斤。
痛多而呕者。加橘皮一两。白术一两。
产后腹中 痛。乃寒积厥阴冲脉。故用辛温以散血中之寒。助以血肉之性。大补精血。较诸
补剂。功效悬殊。若腹痛兼呕。而所呕皆是稀痰。是知脾虚浊气上逆。故加橘皮以宣散其气。白
术以固护其脾。倘见血逆而呕。所呕浑是清水。腹胀满急。则加桃仁、肉桂。具见言外矣。至于
寒疝虚劳。少腹结痛。总是下焦寒结。亦不越是方也。
产后腹痛。烦满不得卧。枳实芍药散主之。并主痈脓。以麦粥下之。
仲景凡治腹痛。多用芍药。以其能收阴气之散也。以其能除血痹之痛也。以其能缓中而止急
痛也。本草谓主邪气腹痛。故多用之。盖五气之邪。莫如厥阴肝木之性急暴。一有不平。则曲直
作痛也。此方治 痛。用芍药为主。佐以枳实炒黑。入血破积聚。收阴缓中。逐陈致新。麦粥补
血下气。而壮血脉也。
师曰。产妇腹痛。法当以枳实芍药散。假令不愈者。此为腹中有干血着脐下。宜下瘀血汤主
之。亦主经水不利。顿服之。新血下如豚肝。
血之燥干凝着者。非芍药、枳实可能治。须用大黄、桃仁、 虫。下其血闭。更加蜜以缓大
黄之急也。
产后七八日。无太阳证。少腹坚痛。此恶露未尽。不大便。烦躁发热。切脉微实再倍。发热
日晡时。烦躁者不食。食则谵语。至夜即愈。宜大承气汤主之。热在于里。结在膀胱也。
太阳为表。膀胱为里。七八日表证入里。故曰无太阳证。恶露已为病气所郁。不能尽去。热
因入里。与恶露相搏。结在膀胱。而作少腹坚痛。下焦热证。故不大便。烦躁发热。更切其脉微
实再倍。其发热在日晡时。而烦躁不食。热邪又攻于胃。胃热则不食。食入则谷气之热更助。两
热相并。故谵语。至夜即愈者。产后血虚。热邪易入血室。入血室则夜如见鬼状。言此以明其热
不在血室。而在膀胱与胃。故用大承气汤也。
产后风。续之数十日不解。头微痛恶寒。时时有热。心下闷。干呕。汗出虽久。阳旦证续在
者。可与阳旦汤。
举此与上文承气汤。为表里之例。
产后中风发热。面正赤。喘而头痛。竹叶汤主之。温覆使汗出。颈项强。用大附子一枚。破
之如豆大。入前药扬去沫。呕者。加半夏半升。洗。
此证太阳上行至头表。阳明脉过膈上循于面。二经合病。多加葛根。以葛根为阳明解肌药也。
防风佐桂枝。去二经之风。竹叶、桔梗主气上喘。参、草和中气。姜、枣行营卫。谷气行。则上
下交济而汗出解矣。附子恐是方后所加。治
颈项强者。以邪在太阳。禁固其筋脉。不得屈伸。故用附子温经散寒。扬去沫者。不使辛热上浮
之气。助其虚阳上逆也。若邪在胸而呕。加半夏治之。上言破之如豆入前药。旧本作如豆大。今
如徐忠可驳正。
妇人乳中虚。烦乱呕逆。安中益气。竹皮大丸主之。有热者。倍白薇。烦喘者。加柏实一分。
乳中虚。言乳哺而乳汁去多。则阴血乏而胃中亦虚。阴乏则火挠而神昏乱。胃虚则呕逆。用
甘草泻心火。石膏疗烦乱。竹皮主呕逆。桂枝和营气。又宣导诸药。使无 格之逆。烦喘者。为
心虚火动。故加柏实以安之。
产后下利虚极。白头翁加甘草阿胶汤主之。
伤寒厥阴证。热利下重者。用白头翁汤。苦寒治热。以坚肠胃。此产后气血两虚。故加阿胶、
甘草。然下利血滞也。古人云。血行则利自止。此方岂独治产后哉。
妇人在草蓐。自发露得风。四肢苦烦热。头痛者。与小柴胡汤。头不痛但烦者。千金三物黄芩汤。
自发露。谓自发衣露体得风。非邪外伤者。故不为自汗风病。盖产时天机开发。虽微风亦得
入之。外感之风。内应之火合化。淫于四末。而作四肢苦烦热。上至于头作头痛。病在表里之间。
故用小柴胡汤。主治少阳。若头不痛是无表也。惟肝胆风热内动。上膈作烦。故用黄芩退热。苦
参养肝。熟地补血而益肾水。则肝胆之火宁矣。
妇人产后虚羸不足。腹中刺痛不止。吸吸少气。或苦少腹中急。摩痛引腰背。不能食饮。千
金内补当归建中汤。产后一月日得服四五剂为善。令人强壮。若大虚。加饴糖六两。汤成纳之。
于火上暖令饴消。若去血过多。崩伤内衄不止。加地黄六两。阿胶二两。合八味。汤成纳阿胶。
产后血去。营卫俱虚。内不充于五脏。肝木妄动。作腹中刺痛。上不充于膻中。遂吸吸少气。
下不济于肾。故少腹急引。外连腰脊。六腑不和。则不能食。用此以益营卫。伐肝邪。补中和内。
按此即黄 建中之变法。彼用黄 以助外卫之阳。此用当归以调内营之血。然助外则用桂枝。调
中则宜肉桂。两不移易之定法也。（千金二字义见中风门方千金三黄汤下。）
诸禁 一禁卧。二禁酒。三禁浴。四禁寒。五禁汗。六禁下。七禁利小便。八禁寒凉药。九
禁起动作劳。盖初产血气未定。遽卧则恶血上升。故分娩之后。须高卧仰倚。切不可即卧。三朝
始可稍去其 。尚宜高枕。七日后。如无他病。方可安枕。多有半月后。未能贴席者。酒能助火
乱经。误用不无动血之虞。至如鸡子猪肾。一切滞气坚纫难化物。及生冷腻滑。皆不可食。即砂
仁汤亦能动血。咸在禁例。浴能升动恶露。虽当夏月。亦须禁之。曾有产数日后。因浴瘀血上冲
而毙者。亦有因浴动血。误用寒凉。瘀结不行。血化为水。喘满肿胀而死者。不可不慎也。新产
骤虚。最忌着寒。寒则血气凝滞。诸变冗生。每至饮食不化。腹痛作泻。祸患莫测。欲去其瘀。
则正气并脱。欲止其泻。则瘀结不行。惟姜、桂、参、术辛温峻补。庶几血行泻止。故冬月一产。
即宜重绵兜护其腹。在夏月亦当复巾裹之。机要云。胎产之病。从厥阴。无犯胃气及上中二焦。
为之三禁。不可汗。不可下。不可利小便。制剂之法。能不犯三禁。则营卫自和。而寒热止矣。
故产后虽有表证。一切风药。皆不可用。以其性升。不特载血上行。令人发晕。抑且令人亡阳。
多致汗脱而死。不特风药当禁。即佛手散中芎 皆为散用。恐汤能发汗也。至于下药。尤为切禁。
非特硝、黄难于轻试。即溲便数难者。只宜调养元气。若车前、泽泻之类。咸非所宜。以产后百
脉空疏。自里至表。无一不虚。虚则诸寒皆禁。即芍药亦难轻用。以其酸寒伐生发之气也。地黄
皆当慎用。以纯阴之味。能令作泻也。黄芩能凝滞瘀血。令人恶露不行。为害不浅。然皆产后常
禁。设有表里客邪。又不当拘于上说也。试观金匮产后例中。阳旦汤之用芩、芍。以其中有桂也。
薛按八珍、十全之用熟地、芍药。以其中有参、术及桂也。岂复拘于此例哉。况乎大承气、小柴
胡、三物黄芩、下瘀血等方。皆产后治例。此圣人临证如日。大转回天之力。非寻常下士。可得
而测识也。迨夫早起作劳。不避风寒。不禁饮食。往往致成大病者。皆自作之孽耳。凡产后之脉。
寸口洪疾不调者死。沉微附骨不绝者生。缓滑沉小者吉。实大弦急者危。牢革结代及涩滞不调者不治。
血晕 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。或痰涎壅盛者。
急用热童便主之。若血下多而晕。或神昏烦乱者。芎归汤加人参三五钱。泽兰叶一握。童便半盏。
兼补而散之。痰。合二陈加乌梅、姜汁。并用铁秤锤烧令赤以醋沃之。或烧漆器并乱发以烟熏之。
产后因虚火载血上行而晕。用鹿茸灰为细末。好酒童便灌下。一呷即醒。行血极快。产后昏晕呕
逆。不能饮食。此胃虚挟痰所致。以抵圣散去赤芍加炮姜、茯苓。慎不可用芎、归血药腻膈。其
呕逆愈不能止矣。初产血晕。速与扶起勿卧。用韭叶一握。切碎。入有嘴瓷瓶中。将醋煎滚。浇
入瓶内。急盖瓶口。以嘴向妇鼻孔。令气透入鼻中即苏。若恶露未尽。忽昏闷不省人事。须问先
因感气而下胎者。以二陈加芎、归、香附、桃仁、山楂、姜汁。切不可作中风治。产后口眼 斜
等证。当大补气血。十全大补下黑龙丹。肥人佐以痰药。如星、半、木香之类。若作中风治。而
用小续命必殆。若腹中刺痛者。严氏清魂散。血晕语言颠倒。健忘失志。此血入心包。宜失笑散
加郁金。或用血竭、没药等分为末。热酒和童便调下二钱。良久再服。恶血自下。
三冲 败血上冲有三。或歌舞谈笑。或怒骂坐卧。甚者逾墙上屋。口咬拳打。山腔野调。号
佛名神。此败血冲心。多
死。方书用龙齿清魂散。然用之多不应。不若花芯石散最捷。琥珀黑龙丹亦效。如虽闷乱。不致
颠狂者。失失散加郁金。若饱闷呕恶。腹满胀痛者曰冲胃。古法用五积散。余尝用平胃加姜、桂。
往往获效。不应。送来复丹。呕逆腹胀血化为水者。金匮下瘀血汤。若面赤呕逆欲死曰冲肺。二
味参苏饮。甚则加芒硝荡涤之。大抵冲心者。十难救一。冲胃者。五死五生。冲肺者十全一二。
产后。口鼻起黑色而鼻衄者。是胃气虚败而血滞也。急用二味参苏饮。稍迟不救。
三急 产后诸病。惟呕吐盗汗泄泻为急。三者并见必危。痰闭心窍。抵圣散去芍药加炮姜、
茯苓。多汗。加乌梅。慎不可用浮麦伤胃耗气。枣仁腻滑作泻。芍药、五味酸收。皆能阻滞恶露也。
三审 凡诊新产妇。先审少腹痛与不痛。以征恶露之有无。次审大便通与不通。以征津液之
盛衰。再审乳汁行与不行及乎饮食多少。以征胃气之充馁。必先审此三者。以脉参证。以证合脉。
脉证相符。虽异寻常。治之必愈。脉证相反。纵无危候。必多变端。即如产后恶露。常以弥月为
期。然间有六七朝即净者。又未可一概论也。此虽产母禀质不同。而胎之所禀亦异。如胎息壮盛
则气血尽归其子。瘀血自少。胎息孱弱。则气血涵养有余。瘀血必多。亦有产时去多。产后必少。
产时去少。产后必多。势使然也。曾见一妇。艰产异常。三朝下一血块。大小形色。与茄无异。
此后绝无瘀血。惟小便如皂荚汁。其少腹略无痛楚。良由艰产过伤子宫。关闸废弛。不能收敛。
故其块得下。世俗名儿枕者是也。大抵常产之妇。开阖有权。既产之后。子宫即闭。儿枕随气攻
注。碎作小块。续续而下。所以绵延日期。此则全块顿出。自无淋沥之患。即有余血。尽归溲便
矣。此后屡见数妇。证虽大异寻常。以意逆之。其理自若也。产后血脱津伤。大便自应艰涩。每
至五七日始通。无足怪也。其有发热谵语。脉滑实者。又当急攻以救津液。若兼少腹硬痛。又当破瘀
为先。产后三朝。每有寒热蒸乳。寒热后。乳汁大行。此胃气孚化。虽有余病。必无他虑。如无
寒热而乳汁充然者。血气本旺也。若不寒热。无乳汁。此营卫不调。总无所苦。急宜当归内补建
中汤。频与调之。否则弥月后渐见寒热骨蒸。而为蓐劳之患矣。
[Various Prohibitions, Blood Stasis Fainting, Three Rushes, Three Urgencies, Three Examinations, Vomiting, Hiccups, Fullness and Distension, Delirium, Seeing Ghosts, Mutism, Spasm, Fever, Alternating Chills and Fever, Wind Stroke, Cough, Asthma, Convulsions, Tremors, Common Cold, Cold Damage, Malaria, Dysentery, Puerperal Consumption, Empty Heat with Irritability, Palpitations due to Fear, Hyperhidrosis, Numbness, Various Disorders of Urination and Defecation, Various Pains, Diarrhea, Edema, Various Bleeding Disorders, Amenorrhea, Various Strangury Syndromes, Milk]
The *Neijing* states: When a nursing mother suffers from heat disease, if the pulse is suspended and small (fine and weak), survival is indicated if the hands and feet are warm; death is indicated if they are cold.
If a nursing mother contracts wind-heat, presenting with wheezing and shoulder breathing, survival is indicated if the pulse is substantial, large, and slow; death is indicated if the pulse is rapid and urgent.
The first passage discusses that during the postpartum period while nursing, if heat disease occurs, the pulse should only be suspended and small, not substantial and large, because the body is newly deficient after childbirth. If the pulse is suspended and small but accompanied by cold extremities, this indicates the exhaustion of Spleen Qi and the sudden rebellion of Yin Qi, which also portends death. The second passage discusses that postpartum contraction of wind-heat progressing to wheezing and shoulder breathing occurs because wind-heat rebels in the Yang regions; the pulse cannot be suspended and small, but must be substantial and large yet gentle and harmonious in its movement, indicating that the Qi of the Spleen and Stomach remains. If a rapid and urgent pulse appears, it indicates the exhaustion of Stomach Qi, leading inevitably to death. Later generations mistakenly interpreted "nursing child" as referring to infants. Even someone as learned as Zhang Jiebin failed to examine this carefully, and consequently argued that infants should not have their Tiger Gate three gates examined, but rather only the six positions of both wrists. Is this not a momentary lapse of judgment by a wise man?
The *Jin Gui Yao Lue* asks: What are the three diseases of women immediately after childbirth? One is spasm (*Jing*), one is depression and vertigo (*Yu Mao*), and one is difficulty in defecation. Why is this? The Master said: Immediately after childbirth, blood deficiency and profuse sweating make one susceptible to wind, thus causing spasm. Loss of blood combined with sweating leads to excess cold, thus causing depression and vertigo. Loss of body fluids leads to dryness in the Stomach, thus causing difficulty in defecation.
When a puerpera experiences depression and vertigo, her pulse is faint and weak, she vomits and cannot eat, her stool is hard, and only her head sweats. This is because blood deficiency leads to Yang rebellion (Jue), and Yang rebellion necessarily leads to vertigo. For the vertigo to resolve, there must be profuse sweating throughout the body. Because blood deficiency causes lower Yang rebellion, solitary Yang rises outward, resulting in head sweating. Therefore, puerperae tend to sweat because the loss of Yin blood leads to deficiency, allowing Yang Qi to flourish alone; sweating allows Yin and Yang to restore balance. Hard stool and vomiting with inability to eat are treated with Xiao Chai Hu Tang.
If the condition resolves and she can eat, but fever returns after seven or eight days, this indicates excess heat in the Stomach, treated with Da Cheng Qi Tang.
Although Qi and Blood are deficient after childbirth, making sweating and purging contraindicated, this specific case uses Da Cheng Qi Tang as a variation in treatment, which should not be judged by ordinary standards. After the initial condition resolves, residual heat remains in the Stomach, allowing her to eat. After eating much, fever returns on the seventh or eighth day, likely due to dietary injury. Thus, we know there is excess heat accumulation in the Stomach. We fear it will scorch and deplete body fluids, so urgent purging to preserve Yin is essential. However, this is only suitable for patients who are young and strong, with substantial pulses and symptoms, and where time has passed, distinguishing it from the immediate postpartum difficulty in defecation. If the patient has a deficient Stomach, although she can eat, she eats little. Even with fever and constipation, this belongs to blood deficiency, requiring urgent nourishment of Qi and Blood; Cheng Qi Decoctions are absolutely unsuitable, and aggressive attack must not be indulged.
Abdominal pain after childbirth is treated with Dang Gui Sheng Yang Rou Tang. It also treats abdominal cold hernia and deficiency-wasting. If cold is severe, add fresh ginger to one jin. If pain is severe with vomiting, add Chen Pi (Tangerine Peel) 1 liang and Bai Zhu (Atractylodes Macrocephala Rhizome) 1 liang.
Postpartum abdominal pain is caused by cold accumulation in the Jueyin and Chong vessels. Therefore, acrid-warm herbs are used to disperse cold in the blood, assisted by substances of flesh and blood nature to greatly tonify essence and blood, offering efficacy far superior to general tonics. If abdominal pain is accompanied by vomiting of thin phlegm, it indicates Spleen deficiency with turbid Qi rebelling upward; Chen Pi is added to diffuse Qi, and Bai Zhu to protect the Spleen. If blood rebellion causes vomiting of clear water with abdominal fullness and urgency, Tao Ren (Peach Kernel) and Rou Gui (Cinnamon Bark) should be added, the rationale being implicit. As for cold hernia and deficiency-wasting with knotting pain in the lower abdomen, all stem from lower Jiao cold accumulation and fall within the scope of this formula.
Abdominal pain with irritability, fullness, and inability to lie down after childbirth is treated with Zhi Shi Shao Yao San, taken with wheat gruel. It also treats abscesses and pus.
Zhong Jing often uses Shao Yao (Peony Root) for abdominal pain because it can gather scattered Yin Qi, eliminate pain from blood bi, and relieve interior tension to stop acute pain. Materia Medica states it treats pain caused by pathogenic factors. Among the five qi pathogens, none are more violent than the nature of Jueyin Liver Wood; when unbalanced, it causes pain. This formula uses Shao Yao as the principal herb, assisted by stir-fried black Zhi Shi (Immature Bitter Orange) to enter the blood level, break accumulations, gather Yin, relieve tension, remove old blood, and generate new blood. Wheat gruel tonifies blood, directs Qi downward, and strengthens blood vessels.
The Master said: For postpartum abdominal pain, Zhi Shi Shao Yao San is indicated by law. If it does not cure, it is because dry blood is adhering below the umbilicus; Xia Yu Xue Tang should be used. It also treats irregular menstruation. Take once. Fresh blood resembling pig liver will be discharged.
Dry, coagulated blood cannot be treated by Shao Yao and Zhi Shi alone. Da Huang (Rhubarb Root), Tao Ren, and E Chong (Ground Beetle) are required to purge blood obstruction, with honey added to moderate the harshness of Da Huang.
Seven or eight days after childbirth, without Taiyang syndrome, if the lower abdomen is hard and painful, this is incomplete expulsion of lochia. With constipation, irritability, and fever, and a pulse slightly substantial and doubled in force, with fever occurring at dusk, irritability, anorexia, and delirium upon eating, resolving at night, Da Cheng Qi Tang is indicated. The heat is in the interior, bound in the Bladder.
Taiyang governs the exterior, Bladder governs the interior. After seven or eight days, exterior syndrome enters the interior, hence no Taiyang syndrome. Lochia is constrained by pathogenic Qi and cannot be fully expelled. Heat entering the interior binds with lochia in the Bladder, causing lower abdominal hardness and pain. This lower Jiao heat syndrome causes constipation, irritability, and fever. The pulse is slightly substantial and doubled. Fever at dusk with irritability and anorexia indicates heat attacking the Stomach; Stomach heat causes anorexia, and food intake adds grain-heat, combining with pathogenic heat to cause delirium. Resolution at night occurs because postpartum blood deficiency allows heat to easily enter the Blood Chamber; entering the Blood Chamber causes nocturnal hallucinations. This explanation clarifies that heat is not in the Blood Chamber but in the Bladder and Stomach, hence Da Cheng Qi Tang is used.
Wind after childbirth persisting for dozens of days without resolution, with slight headache, aversion to cold, intermittent fever, chest oppression, dry retching, and prolonged sweating, yet the Yang Dan syndrome persists, may be treated with Yang Dan Tang.
This example serves as a paradigm of exterior and interior syndromes alongside the previous Da Cheng Qi Tang discussion.
Postpartum wind-stroke with fever, bright red face, asthma, and headache is treated with Zhu Ye Tang. Cover with blankets to induce sweating. For neck stiffness, use one large Fu Zi (Aconite Lateralis Radix Praeparata), broken into bean-sized pieces, added to the previous herbs after shaking off the foam. For vomiting, add Ban Xia (Pinellia Tuber) half sheng, washed.
This syndrome involves the Taiyang channel ascending to the head/exterior and the Yangming channel passing through the diaphragm and circling the face; a combined disease of these two channels warrants adding Ge Gen (Kudzu Root), as it is a muscle-releasing herb for the Yangming channel. Fang Feng (Saposhnikovia Root) assists Gui Zhi (Cinnamon Twig) to expel wind from both channels. Zhu Ye (Bamboo Leaf) and Jie Geng (Platycodon Root) address upper Qi asthma. Ren Shen (Ginseng Root) and Gan Cao (Licorice Root) harmonize middle Qi. Jiang (Fresh Ginger) and Zao (Jujube Fruit) circulate Ying and Wei. Once Gu Qi circulates, upper and lower interact, sweating occurs, and the disease resolves. Fu Zi is likely an addition mentioned in the post-formula notes for neck stiffness, as pathogen in Taiyang stiffens sinews preventing flexion/extension; Fu Zi warms meridians and dispels cold. Shaking off the foam prevents acrid-hot floating Qi from assisting rebellious deficient Yang. If pathogen is in the chest causing vomiting, Ban Xia is added. The text notes breaking into bean-sized pieces added to previous herbs; older editions say "bean-sized," corrected here by Xu Zhongke.
Deficiency in a nursing woman causing irritability, confusion, vomiting, and retching is treated with Zhu Pi Da Wan to calm the middle and tonify Qi. If heat is present, double Bai Wei (Cynanchum Atratum Root). If irritability and asthma occur, add Bai Zi Ren (Biota Seed) one fen.
"Ru Zhong Xu" refers to excessive milk loss during nursing, leading to Yin-blood deficiency and Stomach deficiency. Yin deficiency allows fire to disturb spirit causing confusion; Stomach deficiency causes vomiting. Gan Cao clears Heart fire, Shi Gao (Gypsum Fibrosum) treats irritability, Zhu Pi (Bamboo Sheath) treats vomiting/retching, Gui Zhi harmonizes Ying Qi and guides other herbs to prevent rejection. Irritability and asthma stem from Heart deficiency and fire movement, treated with Bai Zi Ren to calm.
Profuse diarrhea with extreme deficiency after childbirth is treated with Bai Tou Weng Tang plus Gan Cao and E Jiao (Donkey-hide Gelatin).
For Shaoyin/Jueyin cold damage with hot dysentery and tenesmus, Bai Tou Weng Tang is used; bitter-cold treats heat and firms intestines. Here, postpartum dual deficiency of Qi and Blood necessitates adding E Jiao and Gan Cao. Since dysentery involves blood stasis, ancients stated "if blood moves, dysentery stops." This formula is not exclusive to postpartum cases.
A woman in confinement, exposing herself to wind, suffering from vexing heat in limbs and headache is given Xiao Chai Hu Tang. If head does not hurt but only feels vexed, Qian Jin San Wu Huang Qin Tang is used.
"Self-exposure" means exposing skin to wind, not external pathogen invasion via pores, hence not spontaneous sweating wind-disease. During birth, physiological openings are open, allowing even slight wind to enter. External wind combines with internal fire, flooding the four limbs causing vexing heat, rising to head causing headache. Disease is between exterior and interior, hence Xiao Chai Hu Tang treating Shaoyang. No headache implies no exterior syndrome; only Liver/Gallbladder wind-heat moving internally causing chest vexation. Huang Qin clears heat, Ku Shen (Sophora Root) nourishes Liver, Shu Di Huang (Rehmannia Root) tonifies blood and benefits Kidney Water, calming Liver/Gallbladder fire.
Weakness and insufficiency after childbirth with continuous stabbing abdominal pain, shortness of breath, lower abdominal urgency, pain radiating to back, and inability to eat/drink is treated with Qian Jin Nei Bu Dang Gui Jian Zhong Tang. Taking 4-5 doses over a month is beneficial for strengthening. For severe deficiency, add Yi Tang (Maltose) 6 liang, dissolved in warm decoction. For excessive blood loss, metrorrhagia, or internal bleeding, add Di Huang (Rehmannia Root) 6 liang and E Jiao 2 liang, adding E Jiao to the finished decoction.
After childbirth, Ying and Wei are deficient, failing to fill the Five Viscera, causing Liver Wood to move wildly and cause stabbing pain. Failure to fill Dan Zhong causes shortness of breath. Failure to assist Kidney causes lower abdominal urgency radiating to waist/spine. Six Fu organs disharmony causes anorexia. This formula benefits Ying/Wei, subdues Liver pathogen, and tonifies middle/internal.
Note: This is a modification of Huang Qi Jian Zhong Tang. That formula uses Huang Qi to assist exterior Wei Yang; this uses Dang Gui to regulate interior Ying Blood. Exterior assistance uses Gui Zhi; middle regulation uses Rou Gui (Cinnamon Bark). These are fixed rules. (See "Qian Jin" meaning under Qian Jin San Huang Tang in Wind Stroke section.)
Various Prohibitions: 1. Prohibit lying flat. 2. Prohibit alcohol. 3. Prohibit bathing. 4. Prohibit cold. 5. Prohibit sweating. 6. Prohibit purging. 7. Prohibit promoting urination. 8. Prohibit cold-cooling herbs. 9. Prohibit rising and labor. Initially, Qi and Blood are unstable; lying flat causes evil blood to rise. After delivery, one must sleep elevated and reclined, never lie flat immediately. After three days, pillows may be lowered slightly but kept high. After seven days, if no other illness, normal pillow may be used. Some do not touch the mat for half a month. Alcohol aids fire and disrupts menses, risking bleeding. Eggs and pork kidneys, anything causing Qi stagnation, hard-to-digest foods, raw/cold/greasy items are forbidden. Sha Ren Tang can also move blood and is prohibited. Bathing raises lochia; forbidden even in summer. Cases exist of death from lochia rushing up after bathing, or from bathing-induced bleeding treated wrongly with cold herbs leading to fluid transformation, asthma, swelling, and death. Caution is vital. Postpartum sudden deficiency fears cold most; cold causes Qi/Blood stagnation and myriad changes like indigestion, abdominal pain, diarrhea, unpredictable disaster. To remove stasis risks Qi collapse; to stop diarrhea risks stasis retention. Only acrid-warm strong tonics like Jiang, Gui, Shen, Zhu can promote blood flow and stop diarrhea. In winter, protect abdomen with thick cotton; in summer, wrap with cloth. *Ji Yao* states: Puerperal diseases follow Jueyin; do not violate Stomach Qi or Upper/Middle Jiao. These are the Three Prohibitions: no sweating, no purging, no promoting urination. Formulation avoiding these harmonizes Ying/Wei and stops chills/fever. Thus, even with exterior syndrome, wind-dispelling herbs are forbidden due to their ascending nature carrying blood upward causing dizziness or Yang collapse/sweating collapse death. Not only wind herbs are forbidden; even Xiong Diao San's Chuan Xiong and Dang Gui as powder are avoided fearing decoction induces sweating. Purging is strictly forbidden. Besides Niuxiao (Niter/Rhubarb) being risky, even difficult urination requires tonifying Yuan Qi; Che Qian Zi (Plantago Seed) and Ze Xie (Alisma Rhizome) are unsuitable. Postpartum vessels are empty from interior to exterior; deficiency forbids all cold, even Shao Yao is hard to use lightly as sour-cold destroys generating Qi. Di Huang is cautious as pure-Yin flavor causes diarrhea. Huang Qin (Scutellaria Root) stagnates lochia, causing harm. These are common prohibitions, but if exterior-interior exogenous pathogens exist, one should not rigidly adhere to these. Observe *Jin Gui*: Yang Dan Tang uses Qin/Shao because it contains Gui Zhi. Xue Ji noted Ba Zhen/Shi Quan Tang use Shu Di/Shao Yao because they contain Shen/Zhu/Gui Zhi. Why rigidly adhere? Moreover, Da Cheng Qi, Xiao Chai Hu, San Wu Huang Qin, Xia Yu Xue etc. are all postpartum treatments. The Sage’s clinical wisdom is like the sun, turning heaven’s power, unfathomable to inferior scholars. Those who rise early, labor, avoid not wind/cold, ignore diet, causing major illness, bring it upon themselves.
Postpartum pulses: Cun Kou surging/rapid/irregular indicates death. Deep/faint/palpable against bone indicates life. Slow/smooth/deep/small indicates auspicious. Substantial/large/wiry/urgent indicates danger. Firm/reversed/knotted/intermittent/rough/irregular indicates untreatable.
Blood Stasis Fainting: Postparture Yuan Qi depletion allows lochia to attack upward vacuously, causing blurred vision, dizziness, chest fullness, coma, locked jaw, or phlegm-saliva abundance. Urgently use hot Tong Bian (Child’s Urine). If fainting from heavy bleeding or confusion, Xiong Gui Tang plus Ren Shen 3-5 qian, Ze Lan Ye (Lycopus Herb) one handful, Tong Bian half zhan, tonifies and disperses simultaneously. For phlegm, combine Er Chen Tang with Wu Mei (Chinese Plum) and Jiang Zhi (Ginger Juice). Use red-hot iron scale weight quenched in vinegar, or burn lacquer ware/hair to smoke the nose.
Fainting from deficient fire carrying blood upward: Lu Rong Hui (Deer Antler Ash) fine powder, good wine and Tong Bian灌下, wakes instantly, moves blood rapidly. Coma/vomiting/anorexia due to Stomach deficiency with phlegm: Di Sheng San minus Chi Shao, add Pao Jiang (Prepared Ginger) and Fu Ling (Poria). Do not use Xiong/Gui greasy blood herbs worsening vomiting. Initial fainting: raise patient, do not let lie flat. Chop 1 handful of Leek leaves, put in spouted porcelain bottle, boil vinegar, pour in, cover tightly, direct vapor to nostrils to revive. If lochia incomplete and sudden coma, ask if fetus was lost due to Qi sensation; use Er Chen plus Xiong, Gui, Xiang Fu, Tao Ren, Shan Zha, Jiang Zhi. Do not treat as Wind Stroke. Postpartum facial deviation: Tonify Qi/Blood greatly, Shi Quan Da Bu Tang with Hei Long Dan. For obese patients, add phlegm-resolving herbs like Tian Nan Xing, Ban Xia, Mu Xiang. Treating as Wind Stroke with Xiao Xu Ming Tang is dangerous. Abdominal stabbing pain: Yan Shi Qing Hun San. Fainting with inverted speech, amnesia: Blood entered Pericardium, use Shi Xiao San plus Yu Jin. Or Xue Jie (Dragon’s Blood) and Mo Yao equal parts powder, mixed with hot wine and Tong Bian, 2 qian, repeat later. Evil blood descends.
Three Rushes: Ruinous blood rushing upward has three types. Singing/talking/laughing, cursing/sitting/lying, even climbing walls/roofs, biting/hitting, wild shouting, calling Buddha/God names: Ruinous blood rushing to Heart, mostly fatal. Formulas use Long Chi Qing Hun San, often ineffective; Hua Xin Shi San is fastest. Hu Po Hei Long Dan is also effective. If confused but not manic, Shi Xiao San plus Yu Jin. If fullness/vomiting/abdominal distension/pain: Rushing to Stomach. Ancient method: Wu Ji San. I use Ping Wei plus Jiang/Gui, often effective. If ineffective, Song Lai Fu Dan. If vomiting/distension/blood transforms to water: Jin Gui Xia Yu Xue Tang. If red face/vomiting wanting to die: Rushing to Lung. Er Wei Shen Su Yin. Severe cases add Mang Xiao (Mirabilite) to cleanse. Generally, Rushing to Heart: 1 in 10 survives. Rushing to Stomach: 50/50. Rushing to Lung: 1-2 in 10 survive.
Black color around mouth/nose with epistaxis after childbirth: Stomach Qi deficiency/exhaustion with blood stasis. Urgently use Er Wei Shen Su Yin. Delay means death.
Three Urgencies: Among postpartum diseases, vomiting, night sweats, and diarrhea are urgent. All three together indicate critical danger. Phlegm closing Heart orifices: Di Sheng San minus Shao Yao, add Pao Jiang/Fu Ling. Profuse sweating: Add Wu Mei. Do not use Fu Mai (Floating Wheat) damaging Stomach/Qi. Zao Ren (Jujube Seed) is greasy causing diarrhea. Shao Yao/Wu Mei are sour-astringent, blocking lochia.
Three Examinations: Examining new puerperae: First, check lower abdominal pain to verify lochia presence. Second, check bowel movement to verify fluid abundance/deficiency. Third, check milk flow and diet amount to verify Stomach Qi sufficiency. Must examine these three, correlate pulse with symptoms, symptoms with pulse. Pulse/symptom match: even if unusual, cure is certain. Pulse/symptom mismatch: even without critical signs, many changes will occur. Lochia usually lasts a month, but sometimes clears in 6-7 days; cannot generalize. Constitution and fetal endowment vary. Strong fetal Qi draws all Qi/Blood to fetus, less stasis. Weak fetal Qi leaves excess Qi/Blood, more stasis. Heavy loss during birth means less postpartum; light loss means more postpartum, natural trend. I saw a woman with difficult labor pass a blood clot size/color like eggplant on day 3, then no more stasis, only urine like soap pod juice, slight lower abdominal pain. Due to uterine injury from difficult labor, closure mechanism relaxed, unable to contract, allowing whole clot to pass, known as "Baby Pillow." Normal births have controlled opening/closing; uterus closes after birth, Baby Pillow breaks into small pieces and passes gradually, prolonging duration. Here, whole clot passed suddenly, no dripping issue, remaining blood goes to urine/stool. I’ve seen several such cases; though symptoms differ, logic holds. Postpartum blood loss/fluid injury causes constipation, usually clearing days 5-7, not strange. Fever/delirium with slippery/substantial pulse requires urgent purging to save fluids. Lower abdominal hardness/pain requires breaking stasis first. Days 3 postpartum often have chills/fever before milk comes; after chills/fever, milk flows abundantly, indicating Stomach Qi transformation; other illnesses pose no threat. No chills/fever but abundant milk indicates strong Qi/Blood. No chills/fever and no milk indicates Ying/Wei disharmony; if no other discomfort, urgently use Dang Gui Nei Bu Jian Zhong Tang, frequent dosing. Otherwise, after a month, chills/fever and bone-steaming heat develop, leading to Puerperal Consumption.