《心典》云∶“血虚汗出,筋脉失养,风入而益其劲,此筋病也;亡阴血虚,阳气遂厥,而寒复郁
之,则头眩而目瞀,此神病也;胃藏津液而灌溉诸阳,亡津液胃燥,则大肠失其润而大便难,此液
病也。三者不同,其为亡血伤津则一,故皆为产后所有之病”。即此推之,凡产后血虚诸证,可心领
而神会矣。按以上三大证,皆可用三甲复脉、大小定风珠、专翕膏主之。盖此六方,皆能润筋,皆能
守神,皆能增液故也,但有浅深次第之不同耳。产后无他病,但大便难者,可与增液汤(方注并见中
焦篇温热门)。以上七方,产后血虚液短,虽微有外感,或外感已去大半,邪少虚多者,便可选用,不
必俟外感尽净而后用之也。再产后误用风药,误
用辛温刚燥,致令津液受伤者,并可以前七方斟酌救之。余制此七方,实从《金匮》原文体会而来,用
之无不应手而效,故敢以告来者。
张石顽云∶“产后元气亏损,恶露乘虚上攻,眼花头眩,或心下满闷,神昏口噤,或痰涎壅盛者,急
用热童便主之。或血下多而晕,或神昏烦乱,芎归汤加人参、泽兰、童便,兼补而散之(此条极须斟
酌,血下多而晕,血虚可知,岂有再用芎、归、泽兰辛窜走血中气分之品,以益其虚哉!其方全赖人
参固之,然人参在今日,值重难办,方既不善,人参又不易得,莫若用三甲复脉、大小定风珠之为愈
也,明者悟之)。又败血上冲有三∶或歌舞谈笑,或怒骂坐卧,甚则逾墙上屋,此败血冲心多死,用花
蕊石散,或琥珀黑龙丹,如虽闷乱,不至癫狂者,失笑散加郁金;若饱闷呕恶腹满胀痛者,此败血冲
胃,五积散或平胃加姜、桂、不应,送来复丹,呕逆复胀,血化为水者,《金匮》下瘀血汤;若面赤呕逆
欲死,或喘急者,此败血冲肺,人参、苏木,甚则加芒硝汤荡涤之。大抵冲心者,十难救一,冲胃者五
死五生,冲肺者十全一、二。又产后口鼻起黑色而鼻衄者,是胃气虚败而血滞也,急用人参苏木,稍
迟不救”。愚按产后原有瘀血上冲等证,张氏论之详矣。产后瘀血实证,必有腹痛拒按情形,如果痛
处拒按,轻者用生化汤,重者用回生丹最妙。盖回生丹以醋煮大黄,约入病所而不伤他脏,内多飞走
有情食血之虫,又有人参护正,何瘀不破,何正能伤。近见产妇腹痛,医者并不问拒按喜按,一概以
生化汤从事,甚至病家亦不延医,每至产后,必服生化汤十数帖,成阴虚劳病,可胜悼哉!余见古本
《达生篇》中,生化汤方下注云∶专治产后瘀血腹痛、儿枕痛,能化瘀生新也。方与病对,确有所
据。近日刻本,直云∶“治产后诸病”,甚至有注“产下即服者”,不通已极,可恶可恨。再《达生篇》一
书,大要教人静镇,待造化之自然,妙不可言,而所用方药,则未可尽信,如达生汤下,“怀孕九月后
服,多服尤妙”,所谓天下本无事,庸人自忧之矣。岂有不问孕妇之身体脉象,一概投药之理乎?假
如沉涩之脉,服达生汤则可,若流利洪滑之脉,血中之气本旺,血分温暖,何可再用辛走气乎?必致
产后下血过多而成痉厥矣。如此等不通之语,辨
之不胜其辨,可为长太息也!
The *Xin Dian* states: "Blood deficiency leads to sweating, causing the sinews and vessels to lose nourishment; when wind pathogen invades, it exacerbates stiffness, which is a disease of the sinews. Massive loss of yin blood results in blood deficiency, causing yang qi to rebel (Jue), and cold pathogen to stagnate within, leading to dizziness and blurred vision, which is a disease of the spirit (Shen). The Stomach stores body fluids and irrigates the Yang meridians; loss of body fluids causes Stomach dryness, leading to lack of lubrication in the Large Intestine and difficult defecation, which is a disease of fluids. Although these three conditions differ, they all stem from blood loss and fluid injury, thus they are all diseases that may occur postpartum." From this, one can infer that any syndrome of blood deficiency postpartum can be understood through intuitive comprehension. Regarding the aforementioned three major syndromes, they can all be treated with Sanjia Fumai Decoction (Three-Shell Pulse-Replenishing Decoction), Da Dingfeng Zhu (Great Wind-Calming Pearl) or Xiao Dingfeng Zhu (Small Wind-Calming Pearl), and Zhuanxi Gao (Zhuanxi Paste). This is because these six formulas can all moisten the sinews, calm the spirit, and replenish fluids, differing only in the depth and sequence of their action. If there are no other illnesses postpartum, but only difficulty in defecation, Zengye Tang (Fluid-Increasing Decoction) may be administered (formula notes are found in the Middle Jiao Chapter on Warm Heat). The above seven formulas are suitable for patients with postpartum blood deficiency and shortness of fluids; even if there is a slight exterior contraction, or the exterior contraction has been largely resolved, presenting as less pathogen and more deficiency, they can be selected for use without waiting for the complete resolution of the exterior contraction. Furthermore, if postpartum errors involve the misuse of wind-dispelling herbs or acrid-warm rigid-dry substances, causing injury to body fluids, the aforementioned seven formulas can be used judiciously for rescue. I formulated these seven formulas based on my understanding of the original text of the *Jingui Yaolue*; they have proven effective upon use, so I dare to share them with future practitioners.
Zhang Shiwan stated: "Postpartum primordial qi is depleted, allowing lochia to attack upward due to deficiency. Symptoms include visual disturbances and dizziness, epigastric fullness and oppression, coma with locked jaw, or excessive phlegm-saliva accumulation. In such cases, hot child urine should be urgently administered. For fainting due to excessive bleeding, or coma with restlessness, Xionggui Tang (Peony and Angelica Decoction) added with Renshen (Ginseng), Zelan (Lycopus Herb), and child urine can be used to tonify and dissipate simultaneously (This point requires careful consideration. Fainting due to heavy bleeding indicates blood deficiency; how can one use acrid, dispersing, and moving herbs like Chuanxiong, Danggui, and Zelan that travel through the blood and qi levels, thereby worsening the deficiency? This formula relies entirely on Renshen to secure the upright qi. However, Renshen is currently difficult to obtain, and the formula itself is flawed. It would be better to use Sanjia Fumai Decoction or Da/Xiao Dingfeng Zhu. Wise individuals should realize this). Additionally, there are three types of敗血 (stagnant blood) rushing upward: singing, dancing, talking, and laughing; angry cursing, sitting, and lying restlessly; or even climbing walls and roofs. This is stagnant blood rushing to the Heart, often resulting in death; Huashishi San (Flower Coral Stone Powder) or Hupo Heilong Dan (Amber Black Dragon Pill) should be used. If there is restlessness but not mania, Shixiao San (Instant Success Powder) added with Yujin (Curcuma Rhizome) is indicated. If there is fullness, bloating, nausea, vomiting, abdominal distension, and pain, this is stagnant blood rushing to the Stomach; Wuji San (Five Accumulations Powder) or Pingwei San (Calm the Stomach Powder) added with Shengjiang (Fresh Ginger) and Rougui (Cinnamon Bark) should be used. If ineffective, Songlaifu Dan (Songlaifu Pill) is sent. If vomiting and rebounding distension occur, and blood transforms into water, Xiayuxue Tang (Drain Stagnant Blood Decoction) from the *Jingui Yaolue* is used. If the face is red, vomiting and retching are severe, or breathing is rapid and urgent, this is stagnant blood rushing to the Lung; Renshen (Ginseng) and Sumu (Pterocarpus Wood) are used, and in severe cases, Mangxiao Tang (Mirabilite Decoction) to purge. Generally, those with heart rush have a mortality rate where ten out of ten die; stomach rush has a 50% mortality rate; lung rush has a survival rate of only one or two out of ten. Additionally, if black color appears around the mouth and nose postpartum accompanied by epistaxis, it indicates failure of Stomach qi and blood stasis. Urgent administration of Renshen and Sumu is required; delay means non-survival." I observe that Zhang's discussion on postpartum stagnant blood rushing upward is detailed. Postpartum stagnant blood excess syndromes must present with abdominal pain that refuses pressure. If the painful area refuses pressure, Shenghua Tang (Generate New Decoction) is best for mild cases, and Huisheng Dan (Regenerate Life Pill) for severe cases. Huisheng Dan uses vinegar-boiled Dahuang (Rhubarb Root), which targets the pathology without damaging other organs; it contains many animal-derived blood-resolving ingredients and Ginseng to protect the upright qi. How can such a formula fail to break stasis or harm the upright qi? Recently, I have seen physicians treating postpartum abdominal pain without asking whether the patient prefers pressure or rejects it, uniformly applying Shenghua Tang. Even families do not consult doctors, routinely administering over ten doses of Shenghua Tang after every birth, leading to Yin-deficiency consumptive diseases, which is truly lamentable! I saw in the ancient edition of *Dasheng Pian* that the note under Shenghua Tang states: "Specifically treats postpartum stagnant blood abdominal pain and 'child pillow' pain, capable of resolving stasis and generating new blood." The formula matches the disease, with solid basis. Recent printed editions simply state: "Treats various postpartum diseases," with some annotations saying "take immediately after delivery," which is extremely illogical, detestable, and hateful. Furthermore, while the main theme of *Dasheng Pian* teaches tranquility and reliance on natural processes, which is wonderful, its prescribed formulas cannot be fully trusted. For instance, under Dasheng Tang, it says: "Take after the ninth month of pregnancy; more is better." This is akin to saying "there is no trouble in the world, yet commoners worry themselves." Is there any logic in prescribing medication to pregnant women regardless of their physical condition and pulse? If the pulse is deep and choppy, taking Dasheng Tang might be acceptable. But if the pulse is slippery, forceful, and slippery (Hong-Hua), indicating abundant qi in the blood and warm blood, how can one again use acrid herbs that move qi? This would inevitably lead to excessive postpartum bleeding and convulsions. Such illogical statements are too numerous to refute, leaving only with a long sigh!