产后腹痛，先问血块。如有血块，只服生化汤，甚则调失笑散，其块消而痛自止。《尊生》亦用
生化汤，稍久始调失笑散，下延胡一钱。若风冷乘虚入腹，或内伤寒凉之物作痛，得人按摩略止，
或热物熨之略止，宜加味生化汤。密斋用当归建中汤治之。冯氏云∶产后恶露，或因外感六淫，内伤七
气，致令斩然而止。瘀血壅滞，所下不尽，故令腹痛，当审因治之。如产后数朝内，饮食如常，忽
作腹痛，六脉沉伏，四肢厥冷，此恶血不尽，伤食裹血而脉不起也，不可误认气血两虚而用大补，
须兼消导行血之药。但产后恶露不尽，留滞作痛亦常有之，然与虚痛不同，必其由渐而甚，或大小便不
行，或小腹硬实作胀痛极，不可近手，或自下上冲心腹，或痛极，牙关紧急。有此实证，当速去之。近
上者，宜失笑散；近下者，宜通瘀煎。未效，用决津煎为善。又有腹痛定于一边及小腹者，此是侧卧败
血留滞所致。《医通》用四乌汤加蓬术，然亦不若决津煎为当也。《金匮》云∶产后腹中 痛，当归
生姜羊肉汤主之。盖 痛者，缓缓痛也，属客寒相阻，故以当归通血分之滞，生姜行气分之寒。君以羊
肉者，所谓形不足补之以味，况羊肉又能补气， 痛属气弱，故宜之。若妇人产当寒月，寒气入产门，
脐下胀痛，手不可犯，此寒疝也。亦宜当归生姜羊肉汤治之。密斋云∶产时寒气客于子门，入于小腹，
或坐卧不谨，使风冷之气乘虚而入，此寒疝，但不作胀，且无形影为异，治以金铃子散。予考《金匮》、
密斋之论寒疝不同。《金匮》云∶脐下胀痛，手不可犯。盖有寒凝瘀滞也。密斋云∶但不作胀，且
无形影。是无瘀滞也。又有产后脾虚、肾虚而为腹痛者，此不由产，而由脏气不足。若脾气虚寒，为
呕吐、为食少而兼腹痛者，宜五君子煎及六君子汤主之。若肾气虚寒，为泻、为痢而兼腹痛者，宜胃关
煎或理阴煎主之。冯氏用六君子汤送
四神丸治之。若胸膈饱闷，或恶食吞酸，腹痛手不可按，此饮食所伤，治法见伤食门。若食既消而仍痛，
按之不痛，更加头痛、烦热作渴、恶寒欲呕等证，此是中气被伤，宜温补脾胃为主。若发热腹痛，按之
痛甚，不恶食吞酸，此是瘀血停滞，失笑散消之。若止发热头痛腹痛，按之却不痛，此是血虚，初产
生化汤，日久用四物加炮姜、参、术以补之。若产后恶露既去而腹仍痛，四神散调补之。不应，八珍汤
治之。《医通》云∶若下焦虚寒，用六味丸加桂。
加味生化汤 治产后风冷，或伤寒物腹痛。
川芎（二钱） 当归（四钱） 炮姜（四分） 桃仁（十粒，去皮尖） 炙草（五分） 桂枝（四五分）
水煎服。伤食，照生化立效方加法。《尊生》于生化汤内加炒白芍五分，桂技五分。痛止减去。
当归建中汤 治风冷乘虚入腹，或伤寒冷物腹痛。
当归（酒洗） 白芍（酒炒） 桂心 炙草（各二钱）
姜五片，枣三枚，水煎。入饴糖三匙，搅匀热服。
金匮当归生姜羊肉汤 治产后腹中 痛，及寒月生产，寒气入于子门，手不可犯，
脐下胀满。并治寒疝，虚劳不足，及胁痛里急者。
当归（一两） 生姜（一两五钱） 羊肉（二斤，生）
先煮羊肉，去滓及沫，取清者，煮当归生姜，温分三服。亦有加入葱、椒、盐以适口者。若寒多者，
倍生姜。痛多而呕者，加橘皮，土炒白术。后人治产后腹中 痛，用大剂人参、阿胶、生姜煎服，
效。此即当归生姜羊肉汤之变法。
金铃子散 治产后寒气入于小腹，而为寒疝，非若血滞之作胀而有形影者。
川楝子（去核） 小茴香（炒） 补骨脂 桂心（各一钱）
姜引，水煎。加木香一钱，水磨汁，和匀，食前热服。予谓木香磨汁二三分，冲服亦足矣。
五君子煎 治脾胃虚寒，呕吐泄泻而兼湿者。
人参（二三钱） 白术（土炒） 茯苓（各二钱） 干姜（一二钱，炒黄） 炙草（一钱）
水煎服。
胃关煎 治脾肾虚寒作泻，或甚至久泻腹痛不止、冷痢等证。
熟地（三五钱） 山药（炒） 白扁豆（炒。各二钱） 吴茱萸（五七分，制） 焦干姜（一
钱） 白术（一、二、三钱，土炒） 炙草（一二钱）
水煎服。泻甚者，加面煨肉豆蔻一二钱，或破故纸亦可。气虚势甚者，加人参随宜用。阳虚下脱不
固者，加制附子一钱。腹痛甚者，加木香七分，或加制浓朴亦可。滞痛不通者，加当归二三钱。滑脱不
禁者，加乌梅二个，或北五味二十粒。若肝邪侮脾者，加肉桂一钱。
四神丸（附二神丸） 治肾虚肝气逆，不能消克，腹胀泄泻，并治五更肾泻神效。
补骨脂（四两，酒浸一宿，炒） 肉豆蔻（二两，面里煨，去面） 吴茱萸（一两，盐汤泡）
五味子（三两或二两，炒）
为末，蒸饼丸。或姜煮枣，取枣肉，去姜，捣为丸，梧子大，每服二钱，米汤温酒任下。一方补
骨脂、肉豆蔻等分，吴茱萸、五味子减半。止用补骨脂、肉豆蔻二味，枣肉为丸，名二神丸，治五
更早泻功同。
四神散 治产后血虚，或瘀血腹痛。
当归（二钱） 川芎 白芍（炒透。各一钱） 炮姜（五分）
水煎服。予谓白芍治血虚腹痛则可，若治瘀血作痛，未必然也。今炒透而与炮姜合用，故血虚瘀痛兼治之。
生化汤（见本卷生化汤论后。） 失笑散（见中卷胞衣不下门。） 通瘀煎决津煎
（俱见上卷鬼胎门。） 四乌汤 六君子汤 八珍汤 六味丸（俱见上卷诸痛门。） 理阴煎
（见上卷恶阻门。） 四物汤（见上卷安胎门。）
Postpartum abdominal pain requires first inquiring about blood clots. If blood clots are present, only Shenghua Tang (Decoction for Generating New Blood) should be taken; if the condition is severe, Shixiao San (Powder of Costing Failure) should be adjusted and administered. Once the clots dissipate, the pain will naturally cease. *Zunsheng Bazhong* also utilizes Shenghua Tang, adjusting to Shixiao San after a slightly longer period, adding Yihusuo (Corydalis Rhizome) one qian. If wind-cold pathogens invade the abdomen due to deficiency, or if internal injury from cold-cool substances causes pain, which is slightly relieved by massage or hot compresses, Jiawei Shenghua Tang (Modified Decoction for Generating New Blood) is appropriate. Mizhai uses Danggui Jianzhong Tang (Decoction that Builds the Middle with Angelica) for treatment. Fengshi states: Postpartum lochia may be caused by external contraction of the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) or internal injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), leading to an abrupt cessation. Stagnant blood obstructs flow, resulting in incomplete discharge, thus causing abdominal pain; one must examine the etiology to treat it. For instance, within several days postpartum, if diet remains normal but sudden abdominal pain occurs, with six pulses being deep and hidden, and limbs cold, this indicates incomplete expulsion of evil blood, where food stagnation wraps around blood, preventing pulse manifestation. One must not mistakenly diagnose Qi and Blood deficiency and use strong tonification; instead, herbs that promote digestion and move blood must be combined. However, incomplete lochia retention causing pain is common, yet distinct from deficiency pain; it typically worsens gradually, or involves constipation or dysuria, or hardness and distending pain in the lower abdomen that cannot bear touch, or pain rushing upward to strike the heart and abdomen, or extreme pain with locked jaw. When such excess signs appear, pathogenic factors must be rapidly expelled. For conditions located superiorly, Shixiao San is suitable; for those located inferiorly, Tongyu Jian (Decoction for Unblocking Stasis) is suitable. If ineffective, Juejin Jian (Decoction for Resolving Obstruction) is preferable. Abdominal pain fixed to one side or the lower abdomen is caused by stagnant敗血 (stagnant blood) from lying on one side. *Yitong* uses Siwu Tang (Four Substances Decoction) plus Pengzhu (Curcuma Zedoaria Rhizome), yet this is less appropriate than Juejin Jian. *Jinkui Yaolue* states: For lingering pain in the abdomen postpartum, Danggui Shengjiang Yangrou Tang (Angelica, Ginger, and Mutton Decoction) is the primary formula. The term "lingering pain" refers to slow, dull pain, attributed to exogenous cold obstruction; thus, Danggui (Angelica Sinensis Root) unblocks blood stasis, while Shengjiang (Fresh Ginger Rhizome) disperses qi-level cold. Mutton serves as the sovereign herb because flavor-rich foods tonify form deficiency, and mutton additionally tonifies Qi; since lingering pain relates to Qi weakness, it is suitable. If a woman gives birth in cold months, allowing cold qi to enter the birth canal, causing distending pain below the umbilicus that cannot be touched, this is Hanhan (Cold Hernia). Danggui Shengjiang Yangrou Tang is also suitable. Mizhai states: Cold pathogens lodge at the Zi Men (Gate of the Uterus) during delivery, entering the lower abdomen, or improper sitting/lying allows wind-cold to invade due to deficiency; this is also Hanhan, distinguished by lack of distension and absence of palpable masses, treated with Jinlingzi San (Powder of Melia Toosendan). I have examined the differing views on Hanhan between *Jinkui* and Mizhai. *Jinkui* describes distending pain below the umbilicus intolerable to touch, indicating cold coagulation and stasis. Mizhai describes lack of distension and no mass, indicating no stasis. Furthermore, postpartum abdominal pain due to Spleen or Kidney deficiency arises not directly from childbirth but from organ Qi insufficiency. If Spleen Qi deficiency-cold presents with vomiting, poor appetite, and abdominal pain, Wujunzi Jian (Decoction of Five Gentlemen) and Liujunzi Tang (Six Gentlemen Decoction) are indicated. If Kidney Qi deficiency-cold presents with diarrhea, dysentery, and abdominal pain, Weiguan Jian (Decoction Guarding the Gate) or Liyin Jian (Decoction Nourishing Yin) are indicated. Fengshi uses Liujunzi Tang administered with Sishen Wan (Four Spirits Pill). If chest and diaphragm fullness, food aversion, or acid regurgitation occur with abdominal pain intolerable to pressure, this is dietary injury; refer to the Dietary Injury section. If pain persists after food digestion, is non-tender on pressure, and accompanied by headache, irritability, fever, thirst, aversion to cold, and nausea, this is damage to Middle Qi; warm tonification of Spleen and Stomach is primary. If fever and abdominal pain occur with increased tenderness on pressure, without food aversion or acid regurgitation, this is blood stasis; Shixiao San resolves it. If only fever, headache, and abdominal pain occur without tenderness on pressure, this is Blood deficiency; initially administer Shenghua Tang, and later use Siwu Tang (Four Substances Decoction) with Paoyang (Prepared Ginger), Renshen (Ginseng Root), and Baizhu (Atractylodes Macrocephala Rhizome) for tonification. If abdominal pain persists after lochia clearance, Sishen San (Four Spirits Powder) regulates and tonifies. If ineffective, Bazhen Tang (Eight Treasures Decoction) treats it. *Yitong* states: For Lower Jiao deficiency-cold, Liuwei Wan (Six-Ingredient Pill with Rehmannia) plus Guizhi (Cinnamon Twig) is used.
Jiawei Shenghua Tang (Modified Decoction for Generating New Blood) treats postpartum wind-cold or abdominal pain from cold-dietary injuries.
Chuanxiong (Ligusticum Chuanxiong Rhizome) (2 qian) Danggui (Angelicae Sinensis Radix) (4 qian) Paoyang (Prepared Ginger Rhizome) (0.4 qian) Taoren (Persicae Semen) (10 grains, skin and tip removed) Zhigancao (Prepared Licorice Root) (0.5 qian) Guizhi (Cinnamomi Ramulus) (0.4-0.5 qian)
Decoct in water and take orally. For dietary injury, modify according to the Shenghua Lixiao Fang method. *Zunsheng* adds Chaobaishao (Stir-fried White Peony Root) 0.5 qian and Guizhi 0.5 qian to Shenghua Tang; remove when pain ceases.
Danggui Jianzhong Tang (Decoction that Builds the Middle with Angelica) treats wind-cold invading the abdomen due to deficiency or abdominal pain from cold dietary injuries.
Danggui (Washed in wine) Baishao (Stir-fried in wine) Guixin (Cinnamomi Cortex) Zhigancao (Each 2 qian)
Five slices of Shengjiang (Fresh Ginger Rhizome), three dates, decoct in water. Add Yitang (Maltose) three spoons, stir well, and take hot.
Jinkui Danggui Shengjiang Yangrou Tang (Angelica, Ginger, and Mutton Decoction from Jinkui) treats lingering abdominal pain postpartum, and cold-month childbirth where cold enters the Zi Men, causing intolerance to touch and lower umbilical distension. Also treats Hanhan (Cold Hernia), Xu Lao (Deficiency Consumption) insufficiency, and hypochondriac pain with tension.
Danggui (1 liang) Shengjiang (1.5 liang) Yangrou (Mutton Meat, 2 jin, raw)
Boil mutton first, remove dregs and foam, take the clear liquid, then decoct Danggui and Shengjiang. Take warm in three divided doses. Some add Congbai (Scallion Stem), Huajiao (Zanthoxylum Pericarpium), and Yan (Salt) for taste. If cold is severe, double Shengjiang. If pain is severe with vomiting, add Chenpi (Citrus Reticulata Pericarpium) and Tu Chao Baizhu (Earth-stir-fried Atractylodes Macrocephala Rhizome). Later practitioners treat postpartum lingering pain with large doses of Renshen, Ejiao (Donkey-hide Gelatin), and Shengjiang decocted, which is effective. This is a variation of Danggui Shengjiang Yangrou Tang.
Jinlingzi San (Powder of Melia Toosendan) treats postpartum cold qi entering the lower abdomen forming Hanhan (Cold Hernia), distinct from blood stasis which causes distension and palpable masses.
Chuanlianzi (Meliae Toosendae Fructus, pitted) Xiaohuixiang (Foeniculi Fructus, stir-fried) Buguzhi (Psoraleae Fructus) Guixin (Cinnamomi Cortex) (Each 1 qian)
Use Shengjiang as guide, decoct in water. Add Muxiang (Aucklandiae Radix) 1 qian, grind in water to extract juice, mix evenly, and take hot before meals. I believe grinding Muxiang to obtain 0.2-0.3 qian of juice and taking it mixed is sufficient.
Wujunzi Jian (Decoction of Five Gentlemen) treats Spleen and Stomach deficiency-cold with vomiting, diarrhea, and dampness.
Renshen (Ginseng Radix et Rhizoma) (2-3 qian) Baizhu (Atractodis Macrocephalae Rhizoma, earth-stir-fried) Fuling (Poria) (Each 2 qian) Ganjiang (Zingiberis Rhizoma, stir-fried yellow) (1-2 qian) Zhigancao (Prepared Licorice Root) (1 qian)
Decoct in water and take orally.
Weiguan Jian (Decoction Guarding the Gate) treats Spleen and Kidney deficiency-cold causing diarrhea, even persistent abdominal pain from chronic diarrhea, or cold dysentery.
Shudihuang (Rehmanniae Radix Praeparata) (3-5 qian) Shanyao (Dioscoreae Rhizoma, stir-fried) Baibiandou (Lablab Album Seed, stir-fried) (Each 2 qian) Wuzhuyu (Evodiae Fructus, processed) (0.5-0.7 qian) Jiao Ganjiang (Charred Dried Ginger Rhizome) (1 qian) Baizhu (Atractodis Macrocephalae Rhizoma, earth-stir-fried) (1-3 qian) Zhigancao (Prepared Licorice Root) (1-2 qian)
Decoct in water and take orally. For severe diarrhea, add Mian Wei Roudoukou (Flour-baked Nutmeg) 1-2 qian, or Poguzhi is acceptable. For severe Qi deficiency, add Renshen as appropriate. For Yang deficiency with sinking and insecurity, add Zhi Fuzi (Processed Aconiti Lateralis Radix) 1 qian. For severe abdominal pain, add Muxiang 0.7 qian, or Zhi Houpo (Processed Magnolia Bark) is acceptable. For stagnation and pain with obstruction, add Danggui 2-3 qian. For incontinence/slippery discharge, add Wumei (Mume Fructus) 2 fruits, or Bei Wuweizi (Schisandrae Chinensis Fructus) 20 grains. If Liver pathogen invades Spleen, add Rougui (Cinnamomi Cortex) 1 qian.
Sishen Wan (Four Spirits Pill) (Attached: Ershen Wan) treats Kidney deficiency with rebellious Liver Qi failing to digest and control, causing abdominal distension and diarrhea; also miraculously treats Wugeng Shenxie (Morning Diarrhea due to Kidney Deficiency).
Buguzhi (Psoraleae Fructus, 4 liang, soaked in wine overnight, stir-fried) Roudoukou (Myristicae Semen, baked in flour, remove flour) (2 liang) Wuzhuyu (Evodiae Fructus, 1 liang, soaked in salt water)
Wuweizi (Schisandrae Chinensis Fructus, 3 liang or 2 liang, stir-fried)
Grind into powder, make pills with steamed wheat cake dough. Alternatively, boil dates in ginger, take date pulp, remove ginger, pound into pills, size of Sophora japonica seeds. Take 2 qian per dose, with rice soup or warm wine. Another prescription uses equal parts Buguzhi and Roudoukou, half dosage of Wuzhuyu and Wuweizi. Using only Buguzhi and Roudoukou with date pulp as pills is named Ershen Wan (Two Gentlemen Pill), with identical efficacy for morning diarrhea.
Sishen San (Four Spirits Powder) treats postpartum Blood deficiency or blood stasis abdominal pain.
Danggui (Angelicae Sinensis Radix) (2 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma) Baishao (Paeoniae Radix Alba, stir-fried thoroughly) (Each 1 qian) Paoyang (Prepared Ginger Rhizome) (0.5 qian)
Decoct in water and take orally. I consider Baishao suitable for Blood deficiency abdominal pain, but not necessarily for blood stasis pain. Now, being stir-fried thoroughly and combined with Paoyang, it treats both Blood deficiency and stasis pain.
Shenghua Tang (See Shenghua Tang discussion at the end of this volume.) Shixiao San (See Placenta Retention section in Middle Volume.) Tongyu Jian Juejin Jian
(All see Ghost Fetus section in Upper Volume.) Siwu Tang Liujunzi Tang Bazhen Tang Liuwei Wan (All see Various Pains section in Upper Volume.) Liyin Jian
(See Morning Sickness section in Upper Volume.) Siwu Tang (See Pregnancy Stabilization section in Upper Volume.)