虚火燥。四物加鲜何首乌润下之。气血俱虚之人。虽数日不通。饮食如常。腹中如故者。八珍加
桃仁、苏子、熟蜜。若多日不解。躁闷异常。不得已。用人参、当归、枳壳煎服。亦权宜之术耳。
古人用玉烛散治之。反致危殆者多矣。至治产后日久。病外感热结。有实邪燥屎者。急用承气、
大柴胡下之。又不当拘于此例也。小便不通。腹胀如鼓。用炒盐加麝半字填脐中。外用葱白十余
茎作一束。切如半指浓。置盐、麝上。将艾灸之。觉热气入腹。难忍方止。小便即通。此惟气
闭者宜之。若气虚源涸。与夫热结膀胱者。皆不可用。产母但觉小水少。此即是病。便宜调治。
如大小便俱秘。恶露不行。先通恶露。四乌汤加蓬术、山楂。如恶露不行。大便泄。小便难。五
苓散倍肉桂加桃仁。不可服胃苓汤。以苍术能止血也。产后小便数。乃气虚不能制水。补中益气
加车前、茯苓。若膀胱阴虚而小便淋沥。生料六味合生脉散。滋其化源。须大剂煎成。隔汤炖热。
续续进之。产后遗尿不知。乃气虚不能统血也。补中益气汤。若新产廷孔未敛。溺出不知。此恒
有之。至六七朝自止。不必治也。妇人产后。水道中出肉线一条。长三四尺。动之则痛欲绝。先
服失笑散数服。次用带皮姜三斤研烂。入清油二斤。煎油干为度。用绢兜起肉线。屈曲于水道边。
以前姜熏之。冷则熨之。一日夜即缩。二日即尽。再服芎归汤调理。如肉线断。则不可救矣。产
妇尿胞损破。致病淋沥者。当与峻补。丹溪云。难产多是气虚。产后气血尤虚。当以参、 为君。
芎、归为臣。桃仁、陈皮为佐。同猪羊脬煎汤。时时饮之。勿令间断。使气血骤长。匝月其脬自
完。若稍缓则难成功矣。产间伤动脬破。终日不小便。但淋湿不干。用天然黄丝二两。不用染者。
牡丹皮、白芨、人参各一钱。水煎至丝烂如饧服。服勿作声。作声则泄气无效。名补胞饮。经月
常服有效。产后损尿胞而淋沥。参、 、术、草熬膏。猪羊胞煎汤。饥时调服。月余胞长淋止。
产后阴尸着风痛。四物汤加 本、防风。不应。有瘀
伤也。加血余、龟版灰、肉桂。阴颓脱下。气血俱虚。不能收敛者。八珍加升麻、黄 。阴户肿
痛。湿热也。用枯矾、荆芥、白芷、当归、桃仁、细辛、川椒、五倍子等分。入葱三茎。煎汤熏
洗即愈。
诸痛 产后遍身疼痛。气虚百节开张。恶露乘虚流入经络骨节之间。谓之败血流经。或流于
腰胯。或流入髀股。痛不可拊。痛处热肿。流注日深。渐致身面浮肿。局方调经散最当。琥珀地
黄丸亦宜。若因虚风所侵。以致肢体沉重不利。筋脉引急。发热头痛。局方用五积散去苍术加鲮
鲤甲。用生漆涂 尤良。或四神散加桂枝、姜、枣。和营止痛最捷。若误作伤寒发汗。致经脉抽搐。
手足厥冷而变为痉。又当十全大补为主。若以手按而痛益甚者。是瘀滞也。四乌加鲮鲤甲、桂枝、
姜、枣以散之。按而痛稍缓者。此血虚也。四物加香附、炮姜、人参、白术、甘草以养之。如皮
肉痛者。外感也。如月内恶露未净者。香苏散加肉桂、鲮鲤甲。产后五脏皆虚。胃气亏损。饮食
不充。则令虚热。阳气不守。上凑于头。则令头痛。补中益气加川芎、香附子。不应。加附子一
片。若血虚。四物加参、术。有产后败血上冲头痛。非琥珀黑龙丹不效。又方。治产后败血作梗
头痛。诸药不效。用大附子一枚。酽醋一碗。用火四畔炙透。蘸醋令尽。去皮脐。加川芎等分。
并为末。每服钱半。或二钱。茶清调下。偏正头风作痛。川芎茶调散去白芷加细辛。黑豆淋酒煎。
乘热熏患处。候温服之。如左半边恶寒。脑后掣痛者。本方去白芷加归、芍。右半边畏寒。两太
阳引痛者。本方去白芷加参、 。千金治产后中风头痛。手臂逆冷。白术三两。附子一枚。独活
一两。生姜三两。豆淋酒煎服。妇人患头风者。常居其半。每发必掉眩。如在车船上。皆因血虚。
风邪运动其痰。二陈加当归、黄芩、羌活、防风。不应。加乌头、石膏。挟气虚者。必加黄 。
然崩伤产后。吐血衄血。并令人眩晕。当随所因而治。感气而胃口作痛。养胃汤。因气而心腹痛。
降气散。感寒而痛。甘
草干姜汤加焦白术、桂枝。有食。枳实理中加炮黑山楂。产后恶血上攻心痛。为阴血亏损。随火
上冲心络。名心胞络痛。宜理中加当归。产后恶露未净。胸腹作痛。或小便不利。琥珀地黄丸温
散之。产后心痛。大寒呕逆不食。千金蜀椒汤。产后心痛。干呕吐涎沫。大岩蜜汤。若真心痛。
旦发夕死。夕发旦死。瘀血上冲。用失笑散一钱。童便调下即定。血既散而仍痛。增损四物汤调
补之。胁痛宜分左右。盖左属血。血藏于肝。肝伤有死血。故痛。小柴胡去芩加丹皮、香附、薄
桂、当归、童便。右属脾。脾有痰积于胁则痛。补中益气去升麻加葛根、半夏、茯苓、枳壳、生
姜。左右俱痛者属虚。补中益气加桂。下六味丸。腹痛恶露已净者。下焦虚寒也。六味丸加桂。
如痛定于一边及小腹者。此是侧卧。败血留滞所致。四乌汤加蓬术。有产后腹痛。服上药不应而
喜温喜按者。属虚属寒。寒则理中加肉桂、当归。虚则金匮当归生姜羊肉汤。随证加减神验。产
后三日腹痛。补中益脏。强力消血。羊肉生地黄汤。若腹中 痛。畏寒少食。大剂人参、阿胶、
生姜煎服效。此即仲景当归生姜羊肉汤之变法也。若痛而恶心。或欲作呕。六君子加炮姜。有瘀。
加莪术、桃仁、炮黑山楂。若泄泻腹痛后重。补中益气加木香、炮姜。若胸膈饱胀。或恶食吞酸。
或停恶露。至夜发热。谵语腹痛。手不可按。此是饮食所致。当用二陈加枳、术、楂肉。虚人。
枳实理中加肉桂、炮楂。发热腹痛。按之痛甚。不恶食。不吞酸。此是瘀血停滞。四乌汤加蓬术、
肉桂。若止是发热头痛。或兼腹痛。按之却不痛。此是血虚。四物加艾、附、 、桂。若腹痛胁
胀。此气寒不能温养肝血。当归、干姜、香附、肉桂、丹皮、茯苓。入盐少许热服。产后下血不
尽。腹内坚痛不可忍者。甘草、干姜、当归、芍药、桂心、桃仁、山楂煎服。产后少腹作痛。俗
名儿枕块。古法用失笑散及四物加莪术、山楂。产后崩中去血。赤白相兼。或如豆汁。千金伏龙
肝汤。能温脾胃。凉肝血。其效如神。若恶露既去而仍痛。四神散调补之。小腹痛当
视去血多少。如败血凝滞。有块而痛者。醋煎散。无块者。四乌汤。须看人虚实酌用。产后脐腹
作痛。冷气乘虚也。内补当归建中汤。产后腰痛者。因产劳伤肾所致。十全大补汤加附子。产后
恶露渐少。忽然不来。腰中重痛。下注两股。痛如锥刺入骨。此由败血流滞经络。不即通之。必
发痈疽。局方调经散加鲮鲤甲。水煎日三服。以痛止为度。琥珀地黄丸亦宜。下瘀血汤、代抵当
丸。皆可取用。切勿误用五积散等辛温之药。丹溪云。局方五积散。治产后瘀血作痛。
以苍术为君。麻黄为臣。浓朴、枳壳为使。虽有归、芍之补血。仅及苍术三分之一。不思产后之
妇。有何寒邪。血气未充。似难发汗。不过借药性温和。可以推陈致新。岂可用麻黄之悍。苍术、
浓朴之燥乎虚。而又虚。祸不旋踵矣。
泄泻 产后泄泻。其因有五。一者因胎前泄利未止。产后尤甚。一者因临产过伤饮食。产后
滑脱。一者因新产骤食肥腥。不能克运。一者因新产烦渴恣饮。水谷混乱。一者因新产失护。脐
腹脏腑受冷。其致泻之由虽异。一皆中气虚寒。传化失职之患。并宜理中汤为主。食。加枳实、
山楂。水。加桂心、茯苓。虚。加桂、附倍参。寒。加桂、附倍姜。久泻肾虚。加桂心、熟附。
瘀结不行。加炮楂、归身。若见完谷不化。色白如糜。此脾胃大虚。元气虚脱之候。十有九死。
惟猛进温补之剂。庶可挽回。即有烦躁发热面赤。脉来数大。皆虚火上炎之故。当并进桂、附、
人参、甘、姜、苓、术之类。伏龙肝煮汤代水煎服。仍得收功。若小便混浊如泔。或大便中有白
沫如肠垢者。乃元气下陷之故。并宜补中益气加桂、苓、炮姜升举之。或臭水不止。加蕲艾、香
附、吴茱萸。若兼瘀结不通。腹胀喘急。神丹不能复图也。
浮肿 肿胀腹大筋青。小便不利。必食生冷伤滞瘀血也。若用利水药。病必转剧。理中汤加
木香、肉桂、蓬术。身肿或腹大如鼓。四七汤加木香。嗽者。忌木香用炮姜灰。面肿下不肿。属
风。宜发散。紫苏饮加防风。下肿上不肿。属湿。宜
利小便。紫苏饮加木通。四肢与头面肿甚。气食也。紫苏饮加消导药。有血。兼破血药。停血不
散。腹肿喘满。夜甚于昼。四乌汤加蓬术。若足忽肿者。乃湿热注病。恐成香港脚。当归拈痛汤。
若红肿而痛。恐生肿毒。则以肤热与不热为辨。产后败血乘虚停积。循经流入腿胁。留滞日深。
故令面目四肢浮肿。宜调血为主。医者不识。便作水气。治以道水之药必危。夫产后既虚。又以
药虚之。是谓重虚。往往多致夭枉。但多服局方调经散。或四神散加蓬术、桃仁、肉桂、穿山甲。
血行肿消则愈。陈无择云。若风邪乘于气分。皮肤肿而浮虚。乃邪气有余也。若皮肤肿。其形色
如熟李者。乃水也。水肿者宜利小便。气肿者宜发汗。
诸血 产后鼻衄。乃气血逆行所致。紫苏饮入童便、荆芥灰。如口鼻黑气起而衄者难治。初
产时。口中血溢出暴。或吐血嗽血。名血气冲心。四物加延胡、木香、炮姜。产久恶露已净。吐
咯咳血者。治与平人同。产后血崩。因经脉未复。而劳碌恼怒。或犯房事。多成此候。若小腹满
痛。肝经已伤。最为难治。若血滞小腹胀满。四乌汤加蓬术、肉桂。血少小腹空痛。四物加丁香、
胶、艾。肝火迫血妄行。加味逍遥散。脾郁不能统血。加味归脾汤。脾虚不能摄血。补中益气汤。
浓味积热伤血。清胃散加炮楂。风热相搏伤血。四君子加防风、枳壳。恶寒呕吐。大便频泻。六
君子加炮姜。下焦虚寒。不能统血。漏下色晦。及瘀淡不止。千金芎 汤、鹿茸散选用。
月水不通 乳子周岁而乳母经行。是其常也。若儿半岁而母经行。有血盛血热之分。血热者
宜凉血。四物加续断、条芩。不乳者不在此例。若儿二三岁。其母经不行而无疾。不必服药。若
肢体倦怠。食少内热。是血少也。宜逍遥散加参、 以健脾胃。若以药通之则误矣。若脾胃虚弱。
六君子汤加当归。若兼郁火伤脾。归脾汤加丹皮、山栀。若怒火
伤血。柴胡四物汤。气血俱虚。八珍汤加丹皮。
诸淋淋因热客于脬。虚则频数。热则涩痛。气血兼热。血入胞中。则血随小便出而为血淋也。
若膀胱虚热。六味丸。若阴虚而阳无以化。肾气丸。盖土生金。金生水。当滋化源。若少壮元气
实强者。用滑石、通草、车前、葵子、瞿麦、蒲黄。浆水煎服。
乳汁 产后三朝。五更发寒热。名曰蒸乳。若产后乳虽肿而 作者。须服清利之药。则乳自
行。仍以美 引之。产后乳汁自出不止。乃胃气虚。宜服五味异功散加黄 、五味以摄之。若乳
多满急痛者。用温帛熨之。新产儿未能吮乳。乳汁蓄结。与血气相搏。而壮热大渴。通乳胀硬掣
痛。名曰妒乳。当以手撙去宿乳。或吮去尤妙。并以贝母、栝蒌实、甘草节、木通煎服。初产因
子不育。蒸乳而发寒热作痛者。俗名乳膨。用断乳法。以四乌汤加炒麦芽一两即止。不然。恐内
结成痈。多致溃脓。亦有乳囊溃而成危候者。不可不知。若有子而乳不下者。通草八钱。煮猪蹄
汤饮之。白虾汁亦妙。乳母气血虚而不能蒸乳。八珍汤加黄 、麦冬。肺胃虚寒而乳不通者。千
金钟乳汤。寒热不均。气道阻逆而乳不通者。麦门冬散。有热。去钟乳加漏芦。因怒火者。逍遥
散加参、 、麦冬之类。凡产不蒸乳者。后必有变。须预言之。元气壮实者。不在此例。吹乳肿
痛。速用栝蒌实一枚。连穣捣烂。甘草节一寸。乳香一钱。煎成加温酒服。服后侧卧于床。令药
气行。外以天南星生末醋调敷。以手揉之自散。
Deficient fire causing dryness. Use Siwu Tang (Four Substances Decoction) with fresh He Shou Wu (Polygonum multiflorum) to moisten and purge downward. For individuals with both Qi and Blood deficiency, even if there is no bowel movement for several days, but diet remains normal and the abdomen feels unchanged, use Bazhen Tang (Eight Treasures Decoction) added with Tao Ren (Peach Kernel), Su Zi (Perilla Seed), and ripe honey. If constipation persists for many days accompanied by extreme restlessness and oppression, as a last resort, decoct and administer Ren Shen (Ginseng), Dang Gui (Angelica Sinensis), and Zhi Ke (Aurantium Fructus). This is merely an expedient method. In ancient times, Yu Zhu San (Jade Candle Powder) was used for treatment, but it often led to critical conditions. Regarding postpartum cases after a long duration where external pathogenic heat accumulation occurs with excess evil and dry feces, urgently use Chengqi Tang (Bowel-Regulating Decoction) or Da Chaihu Tang (Major Bupleurum Decoction) to purge downward. This should not be rigidly bound by the previous examples.
For inability to urinate with abdominal distension like a drum, fill the umbilicus with half a 'zi' (a traditional unit of weight) of roasted salt mixed with Moshe Xiang (Musk). Externally, bundle over ten stalks of Cong Bai (Scallion White), cut to the thickness of half a finger, place on top of the salt and musk, and moxa-burn. Stop when heat sensation enters the abdomen and becomes unbearable. Urination will then resume. This is suitable only for Qi obstruction patterns. It must not be used for Qi deficiency with depleted fluids, nor for heat accumulation in the Bladder. If a postpartum woman merely feels reduced urine volume, this constitutes a pathology requiring timely regulation.
If both stool and urine are blocked with lochia retention, first resolve the lochia using Si Wu Tang (Four Substances Decoction - *Note: Text says Si Wu Tang but context implies a formula for lochia, likely referring to a variation or specific local name, translated literally as Four Black/Decoction based on "Si Wu" characters often associated with blood, though standard Siwu is Four Substances. Given "Si Wu Tang" usually means Four Substances, but here paired with E Zhu/Shan Zha for lochia, it might be a typo for "Si Wu" meaning four substances or a specific lochia formula. I will translate as Four Substances Decoction modified*) added with E Zhu (Curcuma Zedoaria) and Shan Zha (Hawthorn Fruit). If lochia fails to pass, accompanied by diarrhea and difficult urination, use Wuling San (Five-Ling Powder) with doubled Rou Gui (Cinnamon Bark) and added Tao Ren (Peach Kernel). Weiping Tang (Stomach-Pacifying Powder) must not be taken because Cang Zhu (Atractylodes Rhizome) can stop bleeding. Postpartum frequent urination results from Qi deficiency failing to control water; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Che Qian Zi (Plantago Seed) and Fu Ling (Poria). If Yin deficiency of the Bladder causes dribbling urination, use Sheng Liao Liuwei Dihuang Wan (Raw Material Six-Ingredient Rehmannia Pill) combined with Shengmai San (Generate the Pulse Powder) to nourish the source of transformation. Decoct in large doses, keep warm in hot water, and take continuously.
Postpartum enuresis with unawareness is due to Qi deficiency failing to govern blood (*Note: Text says "govern blood", likely a textual error for "control urine" or related to Qi/Blood relationship, translating literally*). Use Buzhong Yiqi Tang. If the vaginal opening has not closed after recent delivery and urine leaks out unknowingly, this is common and stops spontaneously around the sixth or seventh day; no treatment is needed.
If a fleshy cord protrudes from the vagina after childbirth, three to four chi long, causing excruciating pain upon touch, first administer Shixiao San (Instant Satisfaction Powder) for several doses. Then, grind three jin of ginger with skin into a paste, add two jin of clear oil, and boil until the oil is absorbed/dry. Use silk cloth to wrap the fleshy cord, bend it aside at the vaginal opening, and fumigate with the prepared ginger. Apply heat if cold. It retracts within one night and disappears completely in two days. Follow up with Xiong Gui Tang (Ligusticum and Angelica Decoction) for regulation. If the fleshy cord breaks, it is incurable.
If the urinary bladder is damaged and ruptured during childbirth causing dribbling, vigorous tonification is required. Danxi stated that dystocia is mostly due to Qi deficiency, and postpartum Qi and Blood are even more deficient. Use Ren Shen (Ginseng) and [Missing Character, likely Huang Qi/Astragalus] as Sovereign herbs, Xiong Gui (Ligusticum and Angelica) as Ministers, Tao Ren (Peach Kernel) and Chen Pi (Citrus Peel) as Assistants. Decoct together with pig or sheep bladder and drink frequently without interruption to rapidly restore Qi and Blood, allowing the bladder to heal naturally within a month. Delay may lead to failure.
If the bladder is ruptured during labor, resulting in no urination for a whole day but constant wetness, use two liang of natural yellow silk (undyed), one qian each of Mu Dan Pi (Moutan Cortex), Bai Ji (Bletilla Rhizome), and Ren Shen (Ginseng). Decoct in water until the silk dissolves like syrup. Do not make noise while taking it, as noise dissipates Qi and renders it ineffective. Named Bubao Yin (Bladder-Replenishing Decoction), effective with regular monthly use. For postpartum bladder damage with dribbling, decoct Ren Shen (Ginseng), [Missing Character], Bai Zhu (Atractylodes Macrocephala Rhizome), and Gan Cao (Licorice Root) into a paste, mix with pig/sheep bladder decoction, and take when hungry. The bladder regenerates and dribbling stops within a month.
Postpartum vulvar pain due to wind invasion: Siwu Tang (Four Substances Decoction) added with Gao Ben (Ligusticum Jichuanjing Rhizome) and Fang Feng (Saposhnikovia Root). If ineffective, consider blood stasis. Add Xu Yu Tan (Hair Charcoal), Gui Ban Hui (Tortoise Shell Ash), and Rou Gui (Cinnamon Bark). Vulvar prolapse due to dual Qi and Blood deficiency failing to consolidate: Bazhen Tang (Eight Treasures Decoction) added with Sheng Ma (Cimicifuga Rhizome) and Huang Qi (Astragalus Root). Vulvar swelling and pain due to damp-heat: Equal parts Ku Fan (Alumen), Jing Jie (Schizonepeta Spike), Bai Zhi (Angelica Dahurica Root), Dang Gui (Angelica Sinensis), Tao Ren (Peach Kernel), Xi Xin (Asarum), Chuan Jiao (Sichuan Pepper), and Wu Bei Zi (Gallnut). Add three stalks of scallion, decoct for fumigation and washing.
[Pain Syndromes] Generalized body pain postpartum is caused by Qi deficiency leading to open joints, allowing lochia to enter meridians and bone joints via deficiency, termed "Blood Stasis Flowing through Meridians." It may flow to the waist/hips or thighs, causing severe tenderness, heat, and swelling. Deepening stagnation leads to facial and bodily edema. Ju Fang Tiao Jing San (Regulate Menstruation Powder from the Formulary) is most appropriate; Hu Po Di Huang Wan (Amber Rehmannia Pill) is also suitable. If caused by deficient wind invasion leading to heavy limbs, stiff sinews, fever, and headache, Ju Fang Wu Ji San (Five Accumulations Powder from the Formulary) minus Cang Zhu (Atractylodes Rhizome) plus Ling Li Jia (Manis Pentadactyla Scale) is used. Applying raw lacquer externally is excellent. Alternatively, Si Shen San (Four Spirits Powder) added with Gui Zhi (Cinnamon Twig), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) harmonizes Ying and Wei to stop pain quickly. Mistakenly treating this as Taiyang disease and inducing sweating leads to spasms, cold extremities, and convulsions; treat primarily with Shiquan Dabu Tang (Ten Great Tonics Decoction). Pain worsening on pressure indicates stasis; use Si Wu Tang (modified contextually as a blood-moving formula here, likely referring to a specific variant or typo for Si Wu Tang acting on blood) plus Ling Li Jia, Gui Zhi, Sheng Jiang, Da Zao to disperse. Pain easing on pressure indicates Blood deficiency; use Siwu Tang (Four Substances Decoction) added with Xiang Fu (Cyperus Rhizome), Pao Jiang (Charred Ginger), Ren Shen (Ginseng), Bai Zhu (Atractylodes Rhizome), and Gan Cao (Licorice Root) to nourish. Skin/muscle pain indicates external contraction. If lochia is incomplete within a month, use Xiang Su San (Elsholtzia and Perilla Powder) added with Rou Gui (Cinnamon Bark) and Ling Li Jia.
Postpartum Five Zang organs are all deficient, Stomach Qi is impaired, and inadequate nutrition generates deficient heat. Yang Qi floats upward to the head causing headache. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Chuan Xiong (Ligusticum Chuanxiong Rhizome) and Xiang Fu (Cyperus Rhizome). If ineffective, add one slice of Fu Zi (Aconite Lateral Root). For Blood deficiency, use Siwu Tang (Four Substances Decoction) added with Ren Shen (Ginseng) and Bai Zhu (Atractylodes Rhizome). Headache due to postpartum blood stasis rushing upward responds only to Hu Po Hei Long Dan (Amber Black Dragon Pill). Another prescription for headache due to blood stasis obstruction unresponsive to other drugs: Roast one large Fu Zi (Aconite Lateral Root) thoroughly in strong vinegar, let it absorb all vinegar, remove skin/navel, mix equally with Chuan Xiong (Ligusticum Rhizome), powderize. Take 1.5–2 qian with tea infusion. For migraines, use Chuan Xiong Cha Tiao San (Ligusticum Tea-Adjusting Powder) minus Bai Zhi (Angelica Dahurica Root) plus Xi Xin (Asarum), decoct with black beans and wine, fumigate the affected area while hot, then drink when warm. Left-sided chills and occipital pulling pain: Remove Bai Zhi, add Dang Gui (Angelica Sinensis) and Bai Shao (White Peony Root). Right-sided chills and bilateral temporal pain: Remove Bai Zhi, add Ren Shen (Ginseng) and [Missing Character, likely Huang Qi]. Qianjin Fang treats postpartum wind-stroke headache with cold arms using Bai Zhu (3 liang), Fu Zi (1 piece), Du Huo (1 liang), Sheng Jiang (3 liang), decocted in bean-wine. Headaches account for half of women's diseases, often with dizziness as if in a vehicle, due to Blood deficiency and wind stirring phlegm; use Er Chen Tang (Two-Chen Decoction) added with Dang Gui (Angelica Sinensis), Huang Qin (Scutellaria Root), Qiang Huo (Notopterygium Rhizome), Fang Feng (Saposhnikovia Root). If ineffective, add Wu Tou (Aconite Root) and Shi Gao (Gypsum). If accompanied by Qi deficiency, add Huang Qi (Astragalus Root). Hemorrhage, trauma, postpartum, hematemesis, and epistaxis cause dizziness; treat according to cause. Qi-stagnation stomach pain: Yang Wei Tang (Stomach-Nourishing Decoction). Qi-stagnation heart/abdominal pain: Jiang Qi San (Descend Qi Powder). Cold-induced pain: Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) plus Jiao Bai Zhu (Charred Atractylodes Rhizome) and Gui Zhi (Cinnamon Twig). Food stagnation: Zhi Shi Li Zhong Tang (Immature Bitter Orange and Middle-Warming Decoction) plus charred Shan Zha (Hawthorn Fruit).
Postpartum blood stasis attacking the heart causing pain is due to Yin Blood depletion and fire rushing up the Heart Collateral, named Xin Bao Luo Tong (Pericardium Collateral Pain). Use Li Zhong Tang (Middle-Warming Decoction) added with Dang Gui (Angelica Sinensis). Postpartum incomplete lochia with chest/abdominal pain or dysuria: Warm and disperse with Hu Po Di Huang Wan (Amber Rehmannia Pill). Severe cold postpartum heart pain with vomiting/refusal to eat: Qianjin Shu Jiao Tang (Qianjin Sichuan Pepper Decoction). Dry heaving with salivary vomit: Da Yan Mi Tang (Large Rock Honey Decoction). True heart pain is fatal (morning onset evening death, etc.). Blood stasis rushing up: Treat with Shixiao San (Instant Satisfaction Powder) 1 qian mixed with child's urine. If pain persists after blood dispersal, regulate and tonify with Zeng Sun Siwu Tang (Modified Four Substances Decoction).
Hypochondriac pain differs by side: Left relates to Blood/Liver; liver injury with static blood causes pain. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) minus Huang Qin (Scutellaria Root) plus Dan Pi (Moutan Cortex), Xiang Fu (Cyperus Rhizome), Hou Gui (Thin Cinnamon), Dang Gui (Angelica Sinensis), and child's urine. Right relates to Spleen; phlegm accumulation in hypochondrium causes pain. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) minus Sheng Ma (Cimicifuga Rhizome) plus Ge Gen (Kudzu Root), Ban Xia (Pinellia Tuber), Fu Ling (Poria), Zhi Ke (Aurantium Fructus), Sheng Jiang (Fresh Ginger). Bilateral pain indicates deficiency: Use Buzhong Yiqi Tang plus Gui (Cinnamon), combined with Xia Liu Wei Wan (Lower Six-Ingredient Pill).
Abdominal pain with resolved lochia indicates Lower Jiao Deficient Cold: Liu Wei Wan (Six-Ingredient Pill) plus Gui (Cinnamon). Localized pain in one side/lower abdomen due to lateral sleeping and blood stasis: Si Wu Tang (modified for lochia/blood stasis context) plus E Zhu (Curcuma Zedoaria). Postpartum abdominal pain unresponsive to above, preferring warmth/pressure, indicates Deficiency-Cold: Cold pattern uses Li Zhong Tang (Middle-Warming Decoction) plus Rou Gui (Cinnamon Bark) and Dang Gui (Angelica Sinensis); Deficiency pattern uses Jin Gui Dang Gui Sheng Yang Rou Tang (Golden Cabinet Angelica Ginger Lamb Decoction). Adjust per symptoms. Day 3 postpartum abdominal pain, tonifying viscera and strongly resolving blood: Yangrou Sheng Dihuang Tang (Lamb and Raw Rehmannia Decoction). Colicky pain with cholesthesia/poor appetite: Large dose Ren Shen (Ginseng), E Jiao (Donkey-Hide Gelatin), Sheng Jiang (Fresh Ginger). This is a variation of Zhang Zhongjing's Dang Gui Sheng Yang Rou Tang. Nausea/vomiting with pain: Liu Jun Zi Tang (Six Gentlemen Decoction) plus Pao Jiang (Charred Ginger). With stasis: Add E Zhu (Curcuma Zedoaria), Tao Ren (Peach Kernel), charred Shan Zha (Hawthorn Fruit). Diarrhea with abdominal pain/tenesmus: Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Mu Xiang (Aucklandia Root), Pao Jiang (Charred Ginger). Chest fullness/anorexia/acid regurgitation or retained lochia with night fever/delirium/unbearable abdominal pain: Caused by food stagnation. Use Er Chen Tang (Two-Chen Decoction) plus Zhi Shi (Immature Bitter Orange), Bai Zhu (Atractylodes Rhizome), Shan Zha (Hawthorn Fruit). For deficient persons: Zhi Shi Li Zhong Tang (Immature Bitter Orange and Middle-Warming Decoction) plus Rou Gui (Cinnamon Bark), charred Shan Zha (Hawthorn Fruit). Fever with abdominal pain, severe on pressure, no anorexia/acid regurgitation: Blood stasis stagnation. Use Si Wu Tang (modified for stasis) plus E Zhu (Curcuma Zedoaria), Rou Gui (Cinnamon Bark). Fever/headache/abdominal pain not painful on pressure: Blood deficiency. Use Siwu Tang (Four Substances Decoction) plus Ai Ye (Mugwort Leaf), Fu Zi (Aconite Lateral Root), [Missing Character], Gui Zhi (Cinnamon Twig). Abdominal pain with hypochondriac distension: Cold Qi failing to warm Liver Blood. Use Dang Gui (Angelica Sinensis), Gan Jiang (Dried Ginger), Xiang Fu (Cyperus Rhizome), Rou Gui (Cinnamon Bark), Dan Pi (Moutan Cortex), Fu Ling (Poria), with a pinch of salt, taken hot.
Incomplete postpartum bleeding with unbearable hard abdominal pain: Gan Cao (Licorice Root), Gan Jiang (Dried Ginger), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Gui Xin (Cinnamon Heart), Tao Ren (Peach Kernel), Shan Zha (Hawthorn Fruit) decocted. Lower abdominal pain, commonly called "Child Pillow Mass": Ancient methods use Shixiao San (Instant Satisfaction Powder) or Siwu Tang (Four Substances Decoction) plus E Zhu (Curcuma Zedoaria), Shan Zha (Hawthorn Fruit). Postpartum metrorrhagia with red/white discharge or bean-jelly appearance: Qianjin Fu Long Gan Tang (Qianjin Dragon Earth Decoction) warms Spleen/Stomach and cools Liver Blood with miraculous effect. If pain persists after lochia clears: Regulate and tonify with Si Shen San (Four Spirits Powder). Lower abdominal pain depends on blood loss amount. Stasis with clots and pain: Cu Jian San (Vinegar-Boiled Powder). No clots: Si Wu Tang (modified for stasis). Adjust based on deficiency/excess. Umbilical/abdominal pain due to cold invading deficiency: Nei Bu Dang Gui Jian Zhong Tang (Internal Replenishing Angelica and Middle-Building Decoction).
Postpartum lower back pain due to kidney injury from labor strain: Shiquan Dabu Tang (Ten Great Tonics Decoction) plus Fu Zi (Aconite Lateral Root). Sudden cessation of lochia with heavy lower back pain radiating to thighs, piercing bone pain: Blood stasis blocking meridians. Failure to clear promptly leads to carbuncles/sores. Ju Fang Tiao Jing San (Regulate Menstruation Powder) plus Ling Li Jia (Manis Pentadactyla Scale), decocted 3 times daily until pain stops. Hu Po Di Huang Wan (Amber Rehmannia Pill) is also suitable. Xia Yu Xue Tang (Eliminate Blood Stasis Decoction) and Dai Dang Wan (Substitute Dang Gui Pill) are usable. Do NOT mistakenly use Wu Ji San (Five Accumulations Powder) or other acrid-warm herbs. Danxi noted that Ju Fang Wu Ji San uses Cang Zhu (Atractylodes Rhizome) as Sovereign, Ma Huang (Ephedra Herb) as Minister, Hou Po (Magnolia Bark) and Zhi Ke (Aurantium Fructus) as Guides. Although it contains Dang Gui/Bai Shao for blood, their effect is less than one-third of Cang Zhu. Postpartum women have little cold evil; Qi/Blood are unfulfilled and cannot tolerate sweating. It relies on mild properties to push out old and generate new. How can one use the harsh Ma Huang (Ephedra) and drying Cang Zhu/Hou Po? Deficiency compounded by deficiency leads to immediate disaster.
[Diarrhea] Postpartum diarrhea has five causes: 1. Pre-natal diarrhea continuing postpartum. 2. Overeating during labor causing postpartum sliding/diarrhea. 3. Sudden consumption of rich/fatty foods postpartum unable to be transported. 4. Thirst leading to excessive drinking, mixing water/grain. 5. Exposure to cold affecting umbilical/abdominal organs. All stem from Middle Qi Deficiency-Cold and failed transportation/transformation. Primary treatment is Lizhong Tang (Middle-Warming Decoction). Food stagnation: Add Zhi Shi (Immature Bitter Orange), Shan Zha (Hawthorn Fruit). Water-dampness: Add Gui Xin (Cinnamon Heart), Fu Ling (Poria). Deficiency: Add Gui (Cinnamon), Fu Zi (Aconite), double Ren Shen (Ginseng). Cold: Add Gui (Cinnamon), Fu Zi (Aconite), double Gan Jiang (Dried Ginger). Chronic diarrhea with Kidney deficiency: Add Gui Xin (Cinnamon Heart), Shu Fu Zi (Prepared Aconite). Stasis obstruction: Add charred Shan Zha (Hawthorn Fruit), Dang Gui (Angelica Sinensis). Undigested food, white porridge-like stool: Spleen/Stomach severe deficiency, Yuan Qi collapse. Nine out of ten die. Vigorously advance warm-tonifying agents to save. Even with irritability, fever, red face, rapid/large pulse, these are deficient fire flaming upward. Advance Gui (Cinnamon), Fu Zi (Aconite), Ren Shen (Ginseng), Gan Cao (Licorice), Gan Jiang (Dried Ginger), Fu Ling (Poria), Bai Zhu (Atractylodes Rhizome). Decoct using Fu Long Gan (Dragon Earth/Vermilion Roof Tile) water. Cloudy urine or white foam in stool: Yuan Qi sinking. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Gui (Cinnamon), Fu Ling (Poria), Pao Jiang (Charred Ginger) to lift. Foul fluid incessant: Add Qi Ai (Artemisia argyi), Xiang Fu (Cyperus Rhizome), Wu Zhu Yu (Evodia Fruit). If accompanied by stasis obstruction, abdominal distension, wheezing: Irretrievable.
[Edema] Abdominal distension with prominent veins and dysuria indicates cold/raw food injury, stagnation, and blood stasis. Diuretics worsen the condition. Use Lizhong Tang (Middle-Warming Decoction) plus Mu Xiang (Aucklandia Root), Rou Gui (Cinnamon Bark), E Zhu (Curcuma Zedoaria). Body swelling or drum-like abdomen: Si Qi Tang (Four-Word Decoction) plus Mu Xiang (Aucklandia Root). Cough: Avoid Mu Xiang, use Pao Jiang Hui (Charred Ginger Ash). Facial swelling only: Wind pattern, release exterior. Zi Su Yin (Perilla Infusion) plus Fang Feng (Saposhnikovia Root). Leg swelling only: Dampness pattern, promote urination. Zi Su Yin (Perilla Infusion) plus Mu Tong (Akebia Stem). Severe swelling of limbs/face: Qi and Food stagnation. Zi Su Yin (Perilla Infusion) plus digestive-resolving herbs. With blood stasis: Add blood-breaking herbs. Retained blood causing abdominal swelling/wheezing worse at night: Si Wu Tang (modified for stasis) plus E Zhu (Curcuma Zedoaria). Sudden foot swelling: Damp-heat pouring down, risk of gouty arthritis. Dang Gui Nian Tong Tang (Angelica Relieving Pain Decoction). Red/swollen/painful swelling: Risk of toxic sores. Differentiate by skin heat. Postpartum blood stasis accumulating and flowing along meridians to legs/hypochondrium causes deep stagnation and facial/limb edema. Primary treatment is regulating blood. Misidentifying as water qi and using diuretics is dangerous. Postpartum deficiency plus draining herbs equals double deficiency, often fatal. Frequent use of Ju Fang Tiao Jing San (Regulate Menstruation Powder) or Si Shen San (Four Spirits Powder) plus E Zhu (Curcuma Zedoaria), Tao Ren (Peach Kernel), Rou Gui (Cinnamon Bark), Chuan Shan Jia (Pangolin Scale) resolves swelling as blood moves. Chen Wuyue stated: Wind-pathogen in Qi level causes floating skin swelling (excess evil). Skin swelling resembling cooked plum is water. Edema requires diuretics; Qi-edema requires sweating.
[Bleeding Syndromes] Postpartum epistaxis due to reverse flow of Qi/Blood: Zi Su Yin (Perilla Infusion) plus Child's Urine, Jing Jie Hui (Schizonepeta Ash). Black gas rising from mouth/nose with epistaxis is difficult to treat. Sudden bleeding/vomiting blood at initial birth: Blood-Qi rushing to Heart. Siwu Tang (Four Substances Decoction) plus Yan Hu Suo (Corydalis Rhizome), Mu Xiang (Aucklandia Root), Pao Jiang (Charred Ginger). Late postpartum with cleared lochia but coughing/vomiting blood: Treat as ordinary person. Postpartum metrorrhagia due to unrepaid meridians, labor, anger, or sexual intercourse. Lower abdominal fullness/pain indicates Liver channel injury, difficult to treat. Blood stasis with lower abdominal fullness: Si Wu Tang (modified for stasis) plus E Zhu (Curcuma Zedoaria), Rou Gui (Cinnamon Bark). Blood deficiency with empty lower abdominal pain: Siwu Tang (Four Substances Decoction) plus Ding Xiang (Clove), E Jiao (Donkey-Hide Gelatin), Ai Ye (Mugwort Leaf). Liver Fire forcing reckless blood: Jiawei Xiaoyao San (Modified Free Wanderer Powder). Spleen Depression failing to control blood: Jiawei Guipi Tang (Modified Restore the Spleen Decoction). Spleen Deficiency failing to hold blood: Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Rich flavors generating heat damaging blood: Qing Wei San (Clear Stomach Powder) plus charred Shan Zha (Hawthorn Fruit). Wind-Heat combusting damaging blood: Sizijun Zi Tang (Four Gentlemen Decoction) plus Fang Feng (Saposhnikovia Root), Zhi Ke (Aurantium Fructus). Chills/vomiting/frequent diarrhea: Liujun Zi Tang (Six Gentlemen Decoction) plus Pao Jiang (Charred Ginger). Lower Jiao Deficient Cold failing to control blood, dark/scanty bleeding: Select Qianjin Xiong [Gui] Tang (Qianjin Ligusticum/Ghost Decoction) or Lu Rong San (Deer Antler Powder).
[Menstrual Absence] Menstruation returning at one year of breastfeeding is normal. At six months, distinguish between abundant blood and hot blood. Hot blood: Cool blood with Siwu Tang (Four Substances Decoction) plus Xu Duan (Dipsacus Root), Tiao Qin (Scutellaria Root). Non-breastfeeding mothers excluded. If child is 2-3 years old and menstruation absent without illness: No medication needed. Fatigue/poor appetite/internal heat indicates Blood deficiency: Xiaoyao San (Free Wanderer Powder) plus Ren Shen (Ginseng) and [Missing Character, likely Huang Qi] to strengthen Spleen/Stomach. Medications to induce menstruation would be erroneous. Spleen/Stomach weakness: Liujun Zi Tang (Six Gentlemen Decoction) plus Dang Gui (Angelica Sinensis). Depression-Fire injuring Spleen: Guipi Tang (Restore the Spleen Decoction) plus Dan Pi (Moutan Cortex), Shan Zhi (Gardenia Fruit). Anger injuring blood: Chai Hu Siwu Tang (Bupleurum Four Substances Decoction). Dual Qi/Blood deficiency: Bazhen Tang (Eight Treasures Decoction) plus Dan Pi (Moutan Cortex).
[Dysuria Syndromes] Lin syndrome due to heat invading the Bladder. Deficiency causes frequency; Heat causes painful difficulty. Qi/Blood combined heat allows blood into the bladder, causing bloody Lin. Bladder deficient heat: Liuwei Wan (Six-Ingredient Pill). Yin deficiency with Yang failing to transform: Shenqi Wan (Kidney Qi Pill). Earth generates Metal, Metal generates Water; nourish the source. Strong youth with solid Yuan Qi: Hua Shi (Talcum), Tong Cao (Akebia Stem), Che Qian Zi (Plantago Seed), Kui Zi (Malva Seed), Qu Mai (Polygala Root), Pu Huang (Typha Pollen), decocted in fermented rice water.
[Milk] Three days postpartum, chills/fever at dawn: Steaming Milk. Breast swelling with [pain/fullness]: Clear and drain with cooling herbs, guide with good food. Postpartum spontaneous milk leakage: Stomach Qi deficiency. Use Wuwei Yigong San (Five-Flavor Meritorious Powder) plus Huang Qi (Astragalus Root), Wu Wei Zi (Schisandra Berry) to secure. Full/urgent painful breasts: Warm compress. Newborn unable to suckle, milk accumulation fighting Qi/Blood causing high fever/thirst/swelling/stiffness/pulling pain: Jealous Milk. Express old milk manually or by infant suction. Decoct Bei Mu (Fritillaria Bulb), Gua Lou Shi (Trichosanthes Fruit), Gan Cao Jie (Licorice Joint), Mu Tong (Akebia Stem). First birth, infant not nursing, steaming milk causing chills/fever/pain: Breast Swelling. Use weaning method: Si Wu Tang (modified for stasis) plus 1 liang fried Mai Ya (Barley Sprout) stops it. Otherwise, internal abscess/ulceration risk. Ulcerated breast cysts are critical. If infant present but no milk: Tong Cao (Akebia Stem) 8 qian, decoct with pig trotter soup. White shrimp juice is also good. Mother Qi/Blood deficiency failing to steam milk: Bazhen Tang (Eight Treasures Decoction) plus Huang Qi (Astragalus Root), Mai Dong (Ophiopogon Tuber). Lung/Stomach deficient cold blocking milk: Qianjin Zhong Ru Tang (Qianjin Milky Decoction). Cold/Heat imbalance blocking Qi channels: Maidong San (Ophiopogon Powder). With heat: Remove Zhong Ru (Galactodendron), add Lou Lu (Rhaponticum Root). Due to anger: Xiaoyao San (Free Wanderer Powder) plus Ren Shen (Ginseng), [Missing Character], Mai Dong (Ophiopogon Tuber). Failure to steam milk postpartum predicts complications, except in robust Yuan Qi cases. Mastitis/Swelling/Pain: One Gua Lou Shi (Trichosanthes Fruit) mashed with pulp, one cun Gan Cao Jie (Licorice Joint), one qian Ru Xiang (Frankincense). Decoct, take with warm wine. Lie on side after taking to circulate Qi. Externally apply Tian Nan Xing (Arisaema Rhizome) raw powder mixed with vinegar, massage to disperse.