产后吐血，诸书皆称难治，以其上下脱也。《医通》云∶产后鼻衄，乃气血逆行所致，用紫苏饮入童便、
荆芥灰治之。《良方》以荆芥焙为末，童便服二钱。与《医通》意同。又《尊生》治产后鼻血不止，用犀
角、生地、赤芍，合二味参苏饮。如口鼻黑气起而衄者，难治。盖五脏之华，皆上注于面。凡色红赤者，阳
热之生气也。青黑者，阴寒之绝气也。况口鼻为阳明多血多气之经，而见阴寒惨杀之气，则胃中阳和之气
衰败可知矣。复至鼻衄，则阳亡阴走也，胃绝肺败，阴阳两亡，故不可治。
但有禳厌一法，或可望生。急取绯线一条，并产妇顶心发两条，紧系中指节上即止。无药可治。立斋云∶
急用三味参苏饮治之，亦有得生者。如前证再兼舌紫黑者，为血先死，不治。盖心主血，少阴气绝则血
不上荫耳。汪石山治一妇，产后血逆上行，鼻衄口干，心躁舌黑，因瘀血上升，遂用益母丸二丸，童
便化下。鼻衄渐止，血渐通。此条当与三冲门参看。
三味参苏饮 治产后瘀血入肺，咳嗽喘急。若口鼻黑气起，急用此药，亦有可望得生者。
人参（一两） 苏木（二两） 制附子（五钱）
上作一剂，水煎服。
紫苏饮（见上卷安胎门） 二味参苏饮（见本卷三冲门。）
产后尿血，小腹痛者，乃败血流入膀胱；小腹不痛，但溺时涩痛者，乃内热也。
并用小蓟汤主之。《尊生》用加味肾气去桂、附，加生地、发灰治之。至于大便便血，或因饮食起居失
宜，或因六淫七情过极，致元气亏损，阴络受伤也，四君子加生地、升麻、归身、白芍、发灰治之。
小蓟汤
小蓟根 生地 赤芍 木通 蒲黄 淡竹叶 甘草梢（生。各一钱） 滑石（二钱）
灯心四十九寸，水煎服。败血，加归尾、红花各一钱。兼内热，加黄芩，去心麦冬各一钱。
加味肾气汤（见上卷诸痛门，附六味汤下。照丸方减分两，作汤剂煎服。） 四君子汤（
见上卷胎逆上逼门。）
Postpartum hematemesis is considered difficult to treat in various medical texts, due to the depletion of Qi and Blood both above and below. *Yi Tong* states that postpartum epistaxis is caused by the retrograde flow of Qi and Blood; it should be treated with Zisu Yin (Perilla Decoction) added with child's urine and carbonized Schizonepetae Herba. *Liang Fang* recommends roasting Schizonepetae Herba into powder and administering two qian with child's urine, which aligns with the intent of *Yi Tong*. Additionally, *Zun Sheng* treats persistent postpartum epistaxis using Rhinocerotis Cornu (Rhinoceros Horn), Rehmanniae Radix Recens (Rehmannia Root), and Paeoniae Radix Rubra (Red Peony Root), combined with Erwei Renshen Suxue Yin (Two-Ingredient Ginseng and Suxue Decoction). If black qi rises from the mouth and nose accompanied by epistaxis, it is difficult to treat. This is because the splendor of the five Zang organs flows upward to the face. Redness indicates the vibrant Qi of Yang heat, whereas cyanosis or blackness indicates the dying Qi of Yin cold. Moreover, the mouth and nose belong to the Yangming meridians, which are rich in both Qi and Blood. The appearance of Yin cold and desolate Qi indicates the decline and failure of the harmonious Yang Qi in the Stomach. With the addition of epistaxis, this signifies the loss of Yang and the escape of Yin, leading to the exhaustion of Stomach Qi and Lung Qi, and the dual loss of Yin and Yang; thus, it is incurable.
However, there is a method of exorcism or apotropaic ritual that might offer a glimmer of hope. Quickly take one red thread and two hairs from the vertex of the mother's head, tie them tightly around the middle joint of the middle finger, and the bleeding will stop. At this stage, no medicine can treat it. Xue Lizhai stated that urgently treating with Sanwei Renshen Suxue Yin (Three-Ingredient Ginseng and Suxue Decoction) has resulted in survival. If the aforementioned symptoms are accompanied by a purple-black tongue, it indicates that the Blood has died first, and it is incurable. This is because the Heart governs the Blood; when the Qi of the Shaoyin meridian exhausts, Blood cannot nourish upwards. Wang Shishan treated a woman who, after childbirth, experienced upward reversal of Blood, epistaxis, dry mouth, mental restlessness, and a black tongue. Due to the ascent of blood stasis, he administered two pills of Yimu Wan (Motherwort Pills), dissolved in child's urine. The epistaxis gradually ceased, and the Blood circulation restored. This section should be cross-referenced with the "San Chong" (Three Flushing) chapter.
Sanwei Renshen Suxue Yin (Three-Ingredient Ginseng and Suxue Decoction): Treats postpartum blood stasis entering the Lungs, causing coughing and urgent panting. If black qi rises from the mouth and nose, use this medicine urgently, and there is still hope for survival.
Renshen (Ginseng Radix et Rhizoma) (1 liang), Suxmu (Sappan Wood) (2 liang), Zhifuzi (Prepared Aconiti Lateralis Radix) (5 qian).
Prepare as one dose, decoct in water, and take orally.
Zisu Yin (Perilla Decoction) (see Volume 1, An Tai Men/Tai Protection Chapter). Erwei Renshen Suxue Yin (Two-Ingredient Ginseng and Suxue Decoction) (see this volume, San Chong Men/Three Flushing Chapter).
Postpartum hematuria with lower abdominal pain is caused by failed blood flowing into the Bladder; if there is no lower abdominal pain but only astringent pain during urination, it is due to internal Heat.
Both conditions are primarily treated with Xiaoji Tang (Small Thistle Decoction). *Zun Sheng* uses Jiawei Shenqi Tang (Modified Kidney Qi Decoction) without Guizhi (Cinnamon Twig) and Fuzi (Aconite Root), adding Dihuang (Rehmannia Root) and cindere Capillorum (Hair Ash). As for hematochezia (blood in stool), it may result from improper diet and lifestyle, or excessive Six Evils and Seven Emotions, leading to the depletion of Yuan Qi (Original Qi) and injury to the Yin collaterals. It is treated with Sijunzi Tang (Four Gentlemen Decoction) added with Dihuang (Rehmannia Root), Shengma (Cimicifugae Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao (White Peony Root), and cindere Capillorum (Hair Ash).
Xiaoji Tang (Small Thistle Decoction)
Xiaoji Gen (Cirsii Japonici Radix), Dihuang (Rehmanniae Radix), Chishao (Paeoniae Radix Rubra), Mutong (Akebiae Caulis), Puhuang (Typhae Pollen), Danzhuye (Lophatheri Herba), Gancao Shao (Glycyrrhizae Radix et Rhizoma - raw, each 1 qian), Huashi (Talcum) (2 qian).
Dengxincao (Junci Medulla) 49 cun, decoct in water and take orally. For failed blood, add Danggui Wei (Angelicae Sinensis Radix Tail) and Honghua (Carthami Flos) each 1 qian. For internal heat, add Huangqin (Scutellariae Radix) and Maidong (Ophiopogonis Radix - heart removed) each 1 qian.
Jiawei Shenqi Tang (Modified Kidney Qi Decoction) (see Volume 1, Zhu Tong Men/Pain Chapter, attached under Liuwei Tang. Reduce dosages according to the pill formula and decoct as a liquid). Sijunzi Tang (Four Gentlemen Decoction) (see Volume 1, Tai Ni Shang Bi Men/Fetal Reversal Upward Compulsion Chapter).