【因】产妇始生。气血俱虚。外失卫护。内无主持。最宜调养。设受风寒。岂非难治。故产
后伤寒。邪得以深入。非比寻常伤寒。内有郁热。与邪相拒。循经渐入之缓也。产后伤风。腠理空虚。
风邪得以留恋。非若寻常伤风。元气壮盛。邪易解散。自无留邪致损之患者不同。
【证】证状多与妊娠同。兹不复赘。
【脉】伤寒脉紧。产后伤寒脉必紧细。伤风脉浮。产后伤风。脉必空浮。
【治】寒宜温中达邪。俾中气温。而寒自散。风宜扶元托表。俾元气充。而风自解。若血气大虚。
生阳不振。虽大温大补。不能破其范围。大抵产后血亏挟滞。营气不能布护。寒邪得以直入冲任。
恶寒无汗。发热不休。脉紧细涩者。主以建中汤。（当归三钱、赤芍钱半。肉桂一钱。）无汗加炒
黑荆芥。腹痛加炒焦砂糖。产后卫气空虚。腠理不密。风邪得以留恋经中。故恶风无汗。发热不休。
脉浮软者。主以玉屏风散。（炒黄 、炒白术各三两、防风一两五钱、砂糖炒黑为散、水煎五钱服）
产后气血两虚。风寒得以伤之。故发热无汗。而恶风寒。脉浮涩者。主以疏风芎归散。（当归三两、
人参、川芎、紫苏、葛根各一两五钱、砂糖炒黑为散、生姜两片、葱白三枚水煎。）产后冒风。手
足烦热。面赤气喘。脉浮数者。主以人参竹叶汤。（人参钱半、竹叶三钱、防风钱半、甘草、桔梗各八分。）产后冒风
留恋不解。风热陷入少阳。身热烦渴。时作时止。脉弦数者。主以黄龙汤（人参钱半、柴胡八分、
黄芩甘草各钱半）产后伤寒身热。恶露为热搏不下。烦闷胀喘狂言者。抵当汤。及桃仁承气汤主之。
伤寒小产。恶露不行。腹胀烦闷欲死。大黄挑仁汤（朴硝、大黄等分末之、每一钱或二钱、桃仁
去皮尖碎之、浓煎汤调下。）以通为补、此皆庞安常之法也。
【秀按】陶节 治产后伤寒十余日不解。头痛恶寒。时时有热。心下坚。干呕汗出。以阳旦汤。
（即桂枝汤倍桂枝、加附子。）产后亡津液。大便多闭。或谵语烦躁。以神功丸。（麻子仁、人参各
二两、大黄、诃子皮各四两、为末、麻仁研匀蜜丸桐子大。）产后头痛身热。兼腹内拘急疼痛。以桂
心牡蛎汤。（桂心、牡蛎、白芍、地黄、黄芩。）产后伤风发热。面赤而喘。头痛。以竹叶防风汤。
（竹叶一把、防风、桔梗、桂枝、人参、甘草各一两、葛根三两、生姜五两、大枣十五枚。）
【廉勘】周澹然云。若产后受邪。较胎前更难施治。缘气血已亏。温邪直入难化。此时攻之不可。
补之亦不可。惟审明证候。以固本为主。去邪佐之。邪轻宜大复苏饮。（白僵蚕、蝉衣、当归、人参、
生地、茯神、麦冬、天麻、犀角、丹皮、栀子、黄芩、知母、甘草、滑石。）小复苏饮。（白僵蚕、
蝉衣、神曲、生地、木通、车前子、黄芩、黄柏、焦栀子、黄连、知母、桔梗、丹皮、白蜜后入。）或
神解散、合四物汤。（白僵蚕、蝉衣、神曲、金银花、生地、木通、车前子、黄芩、黄柏、黄连、桔梗、
当归、赤芍、川抚芎）邪重以复苏为主。攻里邪如升降散。（白僵蚕、炒蝉衣、广姜黄、生锦纹。）或
太极丸。（白僵蚕、蝉衣、广姜黄、大黄、天竺黄、杜胆星、冰片为丸。）至于放手攻里则不可。若
果邪热深重。舌干黑。神昏。已成燎原之势。非大剂凉下急救。不能有济。或兼扶元。或佐育阴。总须
临证时细心审察。攻补得宜。方治产后温热病之要诀也。
【炳章按】叶天士云。至于产后之法。按方书谓慎用苦寒。恐伤其已亡之阴也。然亦要辨其邪能从上中解
者。稍从证用之。亦无妨也。不果弗犯下焦。且属虚体。当如虚怯人病邪而治。总之毋犯实实虚虚之戒。况产
后当气血沸腾之候。最多空窦。邪势必乘虚内陷。虚处受邪。为难治也。吴鞠通云。无粮之师。利于速战。若
畏产后虚怯。用药过轻。延至三四日后。反不胜药矣。又云。治产后之症。自有妙法。手下所治系实证。目中
心中意中。注定是产后。识证真。对病确。一击而罢。治上不犯中。治中不犯下。目中清楚。指下明了。治产
后之能事毕矣。
【荣斋按】本节治法根据庞安常，规模粗具，足资应付。证状方面，俞氏说∶“多与妊娠同”。但按之实
际，不是这样简单；由于产后伤寒的辨证论治，是一 最复杂、最细致的任务，应加倍详审。王士雄说∶“产
后暴感发热，可以鼻塞验之。苟胎前伏邪，娩后陡发者，惟舌苔颇有可凭；或浓白而腻，或黄腻黄燥，或有赤
点，或微苔舌赤，或口苦，或口渴，或胸闷，或溲热；此皆温湿暑热之邪内蕴之见证。”吴蒙斋更指出类伤寒
的证治，足补俞氏之缺。他说∶“新产后伤寒，不可轻易发汗。产时有伤力发热，有去血过多发热，有恶露不
去发热，有三日蒸乳发热，有饮食停滞发热；状类伤寒。要在仔细详辨，切不可便发汗。大抵产后气血空虚，
汗之则变筋惕肉 ，或郁冒昏迷，或搐搦，或便秘，其害非轻。凡有发热，宜与四物为君，加柴胡、人参、炮
姜最效。盖干姜辛热，能引血药入血分，气药入气分，且能去恶生新，有阳生阴长之道；以热治热，深合内经
之旨。故丹溪见产后阴虚生内热，必以补阴药大剂中加干姜。王节斋亦以产后阴虚阳无所根据、浮散于外、发
热，必用四物补血，以炮姜之苦温从治，收其浮散之阳以归于阴也。若果伤寒，须以伤寒法治之，但兼顾其虚
耳。”这样的分析异同，如王士雄对于外证的观察，吴蒙斋对于类证的辨别；反复考虑，互相参证，在学说方
面自然比较充实。
[Pathogenesis] After childbirth, both Qi and Blood are deficient. The exterior loses the protection of Wei Qi (Defensive Qi), and the interior lacks a sustaining force. Nourishment and regulation are most suitable. If attacked by Wind-Cold, is it not difficult to treat? Therefore, in postpartime Cold Damage, pathogenic factors easily penetrate deeply into the interior. This differs from ordinary Cold Damage, where internal Stagnant Heat resists the pathogen, allowing it to enter gradually along the meridians. In postpartime Wind Strike, the Cou Li (pores) are empty and vacant, allowing Wind pathogens to linger. This differs from ordinary Wind Strike, where Yuan Qi (Primal Qi) is robust, making it easy to dissipate the pathogen without leaving residual pathogens to cause damage.
[Symptoms] The symptoms are mostly similar to those during pregnancy; details are omitted here.
[Pulse] In Cold Damage, the pulse is Tight. In postpartime Cold Damage, the pulse must be Tight and Fine. In Wind Strike, the pulse is Floating. In postpartime Wind Strike, the pulse must be Empty and Floating.
[Treatment] For Cold pathogens, use methods to warm the Middle and expel pathogens, so that when the Middle Jiao becomes warm, the Cold naturally dissipates. For Wind pathogens, use methods to support the Yuan Qi and push out the pathogen via the exterior, so that when the Yuan Qi is sufficient, the Wind naturally resolves. If Qi and Blood are severely deficient and the generating Yang is not vigorous, even strong warming and tonifying methods cannot break through the constraint. Generally, postpartime blood deficiency with stasis prevents Ying Qi (Nutritive Qi) from distributing and protecting, allowing Cold pathogens to directly invade the Chong and Ren vessels. With symptoms of aversion to cold, no sweating, unremitting fever, and a Tight, Fine, and Choppy pulse, the main formula is Jian Zhong Tang (Cinnamon Twig Decoction). Ingredients: Dang Gui (Angelicae Radix) 3 qian, Chi Shao (Paeoniae Radix Rubra) 1.5 qian, Rou Gui (Cinnamomi Cortex) 1 qian. Add Chao Hei Jing Jie (Charred Schizonepetae Spica) if there is no sweat. Add Chao Jiao Sha Tang (Charred Brown Sugar) if there is abdominal pain. Due to postpartime Wei Qi deficiency and loose Cou Li, Wind pathogens linger in the meridians, causing aversion to wind, no sweating, unremitting fever, and a Soft and Floating pulse. The main formula is Yu Ping Feng San (Jade Windscreen Powder). Ingredients: Chao Huang Qi (Astragali Radix), Chao Bai Zhu (Atractylodis Macrocephalae Rhizoma) each 3 liang, Fang Feng (Saposhnikoviae Radix) 1.5 liang, Sha Tang (Brown Sugar) charred black, made into powder, decocted in water, take 5 qian. Postpartime Qi and Blood dual deficiency allows Wind-Cold to attack, causing fever, no sweating, aversion to wind and cold, and a Floating and Choppy pulse. The main formula is Shu Feng Xiong Gui San (Wind-Dispersing Cyperus and Angelica Powder). Ingredients: Dang Gui (Angelicae Radix) 3 liang, Ren Shen (Ginseng Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Zi Su (Perillae Folium), Ge Gen (Puerariae Lobatae Radix) each 1.5 liang, Sha Tang (Brown Sugar) charred black, made into powder, decocted with 2 slices of Sheng Jiang (Zingiberis Rhizoma Recens) and 3 stalks of Cong Bai (Allii Fistulosi Bulbus). Postpartime exposure to Wind with vexing heat in hands and feet, red face, panting, and a Rapid and Floating pulse. The main formula is Ren Shen Zhu Ye Tang (Ginseng and Bamboo Leaf Decoction). Ingredients: Ren Shen (Ginseng Radix) 1.5 qian, Zhu Ye (Bambusae Folium) 3 qian, Fang Feng (Saposhnikoviae Radix) 1.5 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma), Jie Geng (Platycodonis Radix) each 8 fen. Postpartime Wind lingering unresolved, Wind-Heat sinking into the Shaoyang channel, with body heat, vexation and thirst, intermittent onset, and a Wiry and Rapid pulse. The main formula is Huang Long Tang (Yellow Dragon Decoction). Ingredients: Ren Shen (Ginseng Radix) 1.5 qian, Chai Hu (Bupleuri Radix) 8 fen, Huang Qin (Scutellariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) each 1.5 qian. Postpartime Cold Damage with body heat, lochia obstructed by heat and not discharged, leading to vexation, distension, panting, and delirious speech. Treat with Di Dang Tang (Di Dang Decoction) and Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction). Postpartime miscarriage due to Cold Damage, lochia not flowing, abdominal distension, vexation, and severe discomfort. Treat with Da Huang Tao Ren Tang (Rhubarb and Peach Kernel Decoction). Ingredients: Po Xiao (Natrii Sulfas), Da Huang (Rhei Radix et Rhizoma) equal parts, powdered. Take 1 or 2 qian, mixed with Tao Ren (Persicae Semen) peeled, deseeded, and crushed, taken with thick decoction. "Unblocking serves as tonification." These are all methods of Pang Anchang.
[Commentary by Xiu] Tao Ji'an treated postpartime Cold Damage unresolved for over ten days, with headache, aversion to cold, intermittent fever, hardness below the heart, dry retching, and sweating. He used Yang Dan Tang (Yang Dawn Decoction), which is Gui Zhi Tang (Cinnamon Twig Decoction) with doubled Gui Zhi (Cinnamomi Ramulus) plus Fu Zi (Aconiti Lateralis Radix Praeparata). Postpartime loss of Jin Ye (Body Fluids) often leads to constipation, or delirium and restlessness. Treat with Shen Gong Wan (Divine Merit Pill). Ingredients: Ma Zi Ren (Cannabis Fructus), Ren Shen (Ginseng Radix) each 2 liang, Da Huang (Rhei Radix et Rhizoma), He Zi Pi (Terminalia Chebulae Pericarpium) each 4 liang, powdered. Mix with ground Hemp Seed, form pills with honey the size of Sophora seeds. Postpartime headache and body heat, combined with abdominal cramping and pain. Treat with Gui Xin Mu Li Tang (Cinnamon Heart and Oyster Shell Decoction). Ingredients: Gui Xin (Cinnamomi Cortex), Mu Li (Ostreae Concha), Bai Shao (Paeoniae Radix Alba), Di Huang (Rehmanniae Radix), Huang Qin (Scutellariae Radix). Postpartime Wind Strike with fever, red face, panting, and headache. Treat with Zhu Ye Fang Feng Tang (Bamboo Leaf and Saposhnikovia Decoction). Ingredients: Zhu Ye (Bambusae Folium) one handful, Fang Feng (Saposhnikoviae Radix), Jie Geng (Platycodonis Radix), Gui Zhi (Cinnamomi Ramulus), Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) each 1 liang, Ge Gen (Puerariae Lobatae Radix) 3 liang, Sheng Jiang (Zingiberis Rhizoma Recens) 5 liang, Da Zao (Jujubae Fructus) 15 pieces.
[Commentary by Lian] Zhou Danyan said: Pathogens contracted after childbirth are harder to treat than before pregnancy because Qi and Blood are already depleted, and Warm pathogens entering directly are difficult to resolve. At this time, attacking is inadvisable, and tonifying is also inadvisable. One must carefully examine the syndrome pattern, focusing on securing the Root, with expelling pathogens as an adjunct. For mild pathogens, use Da Fu Su Yin (Great Revival Drink): Bai Jiang Can (Bombyx Batryticatus), Chan Yi (Cicadae Periostracum), Dang Gui (Angelicae Radix), Ren Shen (Ginseng Radix), Sheng Di Huang (Rehmanniae Radix), Fu Shen (Poria cum Radix), Mai Dong (Ophiopogonis Tuber), Tian Ma (Gastrodiae Rhizoma), Xi Jiao (Rhinocerotis Cornu), Dan Pi (Moutan Cortex), Zhi Zi (Gardeniae Fructus), Huang Qin (Scutellariae Radix), Zhi Mu (Anemarrhenae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Hua Shi (Talcum). Or Xiao Fu Su Yin (Small Revival Drink): Bai Jiang Can (Bombyx Batryticatus), Chan Yi (Cicadae Periostracum), Shen Qu (Massa Medicata Fermentata), Sheng Di Huang (Rehmanniae Radix), Mu Tong (Akebiae Caulis), Che Qian Zi (Plantaginis Semen), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), Jiao Zhi Zi (Charred Gardeniae Fructus), Huang Lian (Coptidis Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Jie Geng (Platycodonis Radix), Dan Pi (Moutan Cortex), add Bai Mi (White Honey) last. Or Shen Jie San (Spirit Release Powder) combined with Si Wu Tang (Four Substances Decoction): Bai Jiang Can (Bombyx Batryticatus), Chan Yi (Cicadae Periostracum), Shen Qu (Massa Medicata Fermentata), Jin Yin Hua (Lonicerae Japonicae Flos), Sheng Di Huang (Rehmanniae Radix), Mu Tong (Akebiae Caulis), Che Qian Zi (Plantaginis Semen), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), Huang Lian (Coptidis Rhizoma), Jie Geng (Platycodonis Radix), Dang Gui (Angelicae Radix), Chi Shao (Paeoniae Radix Rubra), Chuan Xiong (Ligustici Chuanxiong Rhizoma). For heavy pathogens, focus on Revival formulas. To attack interior pathogens, use Sheng Jiang San (Ascending and Descending Powder): Bai Jiang Can (Bombyx Batryticatus), Chao Chan Yi (Charred Cicadae Periostracum), Guang Jiang Huang (Curcumae Longae Rhizoma), Sheng Jin Wen (Raw Rheum). Or Tai Ji Wan (Supreme Ultimate Pill): Bai Jiang Can (Bombyx Batryticatus), Chan Yi (Cicadae Periostracum), Guang Jiang Huang (Curcumae Longae Rhizoma), Da Huang (Rhei Radix et Rhizoma), Tian Zhu Huang (Bambusae Calamus), Du Dan Xing (Arisaema cum Bile), Bing Pian (Borneolum Syntheticum), formed into pills. However, boldly attacking the interior is forbidden. If pathogenic heat is truly deep and severe, with a dry black tongue, coma, and a situation spreading like a prairie fire, only large doses of Cooling and Purgative herbs for emergency rescue can help. Combine with supporting Yuan Qi or nourishing Yin as needed. Careful examination at the bedside and appropriate balance of attacking and tonifying are the essential principles for treating postpartime Warm-Heat diseases.
[Commentary by Bingzhang] Ye Tianshi said: Regarding postpartime treatment, formularies advise caution with Bitter-Cold herbs to avoid damaging the already lost Yin. However, one must distinguish whether the pathogen can be resolved from the Upper or Middle Jiao; using them slightly according to the syndrome is acceptable. As long as the Lower Jiao is not violated, and considering the patient is in a deficient state, treat as one would for a frail person with pathogenic invasion. Overall, do not violate the prohibition against reinforcing the Excess and depleting the Deficient. Moreover, postpartime is a time when Qi and Blood are surging, with many empty spaces where pathogenic forces inevitably sink inward due to deficiency. Treating pathogens in deficient areas is difficult. Wu Jutong said: An army without supplies benefits from a swift battle. If one fears postpartime deficiency and uses light medication, delaying three or four days may result in the patient being unable to tolerate the medicine. He also said: There are excellent methods for treating postpartime conditions. If the case under hand is an Excess pattern, but mentally noted as postpartime, accurate syndrome identification and precise disease targeting allow for a single decisive strike. Treating the Upper does not affect the Middle; treating the Middle does not affect the Lower. Clarity in vision and precision in pulse diagnosis complete the art of treating postpartime conditions.
[Commentary by Rongzhai] The treatment methods in this section are based on Pang Anchang, providing a basic framework sufficient for application. Regarding symptoms, Yu stated: "Mostly similar to pregnancy." However, practically, it is not that simple. Differentiating and treating postpartime Cold Damage is the most complex and detailed task, requiring double diligence. Wang Shixiong said: "Sudden fever after childbirth can be verified by nasal congestion. If latent pathogens from pregnancy suddenly manifest after delivery, the tongue coating is reliable: it may be thick white and greasy, yellow greasy or dry, have red spots, have slight coating with a red tongue, bitter taste, thirst, chest fullness, or hot urination; these are manifestations of internal accumulation of Warm-Damp or Summerheat-Heat pathogens." Wu Mengzhai further pointed out treatments for Cold Damage-like syndromes, supplementing Yu's omissions. He said: "New postpartime Cold Damage should not be lightly induced to sweat. Fever during childbirth may be due to physical strain, excessive blood loss, retained lochia, milk engorgement on the third day, or food stagnation; these resemble Cold Damage. Careful differentiation is essential; do not induce sweat hastily. Generally, postpartime Qi and Blood are empty. Inducing sweat may lead to muscle twitching, depression/dizziness/coma, convulsions, or constipation, causing serious harm. For any fever, use Si Wu Tang (Four Substances Decoction) as the sovereign herb, adding Chai Hu (Bupleuri Radix), Ren Shen (Ginseng Radix), and Pao Jiang (Prepared Zingiberis Rhizoma) is most effective. Dried Ginger is acrid and hot, guiding blood-invigorating herbs into the Blood level and Qi-moving herbs into the Qi level, removing evil and generating new, following the principle of Yang generating Yin. Using heat to treat heat aligns deeply with the Neijing. Thus, Danxi, seeing postpartime Yin deficiency generating internal heat, always added dried ginger in large doses of Yin-nourishing herbs. Wang Jiezhai also stated that for postpartime Yin deficiency with Yang lacking foundation, floating outward causing fever, one must use Si Wu Tang to tonify Blood, and Pao Jiang's bitter-warm nature to guide and collect the floating Yang back into Yin. If it is truly Cold Damage, treat according to Cold Damage methods, but simultaneously consider the deficiency." Such analysis of similarities and differences, such as Wang Shixiong's observation of external signs and Wu Mengzhai's differentiation of similar syndromes, when considered repeatedly and cross-referenced, naturally enriches the theoretical discourse.