（论一首脉证六条方八首）
问曰。新产妇人。有三病。一者病痉。二者病郁冒。三者大便难。何谓也。师曰。新产血
虚。多汗出。喜中风。故令病痉。亡血复汗。寒多。故令郁冒。亡津液胃燥。故大便难。
〔补注〕阴与阳。固相资者也。故曰阳生阴长。又曰阳根于阴。夫血阴也。汗为血液。
则亦为阴。假如血去多。则汗亦少矣。乃偏易出者何哉。血大虚。则卫外之阳因
而不固。必多汗而腠理疏也。疏则邪易入之。血既不足以养脉。乃风入又足以
燥其血液。故令病痉。若汗多者亡阳。阳亡必畏寒。寒多遂令郁冒。至若阴气既
虚。津液必少。胃中燥结。大便转难。容或有之。然三者总因血虚所至。乃若不明
其理而复出汗下。未有不至于危亡者。故圣人先以新产血虚立言。使后世之
工。即出于中才以下。亦必从养阴起见也已。
产妇郁冒。其脉微弱。不能食。大便反坚。但头汗出。所以然者。血虚而厥。厥而必冒。
冒家欲解。必大汗出。以血虚下厥。孤阳上出。故头汗出。所以产妇喜汗出者。亡阴
血虚。阳气独盛。故当汗出。阴阳乃复。大便坚。呕不能食。小柴胡汤主之。
〔补注〕产妇脉证极虚种种者。其理可得而晰言之也。妇人主血。重在冲脉。冲者。
肝幕也。血去既多。邪中特易。邪入则必逆冷畏寒。由于遏抑。是血气亏于中。阴
邪冒于外。卒难解也。而其所以难解者。正以血虚不能作汗。而非汗复不解。故
欲解者。必大汗出。而后邪始退。正始越也。此言周身之汗者也。亦有血虚下厥。
而阳气孤而无偶。遂上升而汗亦出。则其汗又头以下不得汗也。总由血虚阴
亡。其阳独盛。汗出之后。邪退正和矣。然其津液一伤于血去。复伤于汗多。安得大便
不坚乎。假使大便坚而复有呕不能食之证。仍是表邪未去。抑或血室受邪也。小柴胡汤为正治之法矣。
病解能食。七八日更发热者。此为胃实。大承气汤主之。
〔补注〕邪去则不归于府。自能食也。七八日更发热。明系食滞于胃。脾虚不能运
之。能不急下以救其津液乎。然大虚者。当小作汤。要在临证斟酌尔。
产后腹中 痛。当归生姜羊肉汤主之。并治腹中寒疝。虚劳不足。
〔补注〕产后本虚。则寒易入。今腹中为肝之幕。为脾之统。痛非正虚而邪实耶。此
汤原治寒疝。取以治产后。未常不可。即以治虚劳。又谁曰不宜。
产后腹痛。烦满不得卧。枳实芍药散主之。
枳实芍药散方
枳实（烧令黑勿太过） 芍药（等分）
上二味为散。服方寸匕。日三服。并主痈脓。以麦粥下之。
〔衍义〕仲景凡治腹痛。多用芍药。何也。以其能治气血积聚。宣行腑脏。通则痛止
也。阴气之散乱成痛。用此收之也。以其能治血痹之痛也。以其能缓中而止急
痛也。本草谓主邪气腹痛。故多用之。盖五气之邪。莫如厥逆。肝木之性急暴。一
有不平。则曲直作痛。又肝为藏血之海。瘀积则海不清。而肝木之气塞矣。东方
震木。出于纯阴。则振起发生。若出于散乱之阴。则肝本之气旺矣。木强直。更值
邪气。则肝木与搏击矣。由此三者而言。芍药所治。皆肝木也。虽曰治之而亦补
之。木之味酸。芍药亦酸。故云补也。枳实炒黑。入血破瘀。麦粥补血脉也。
师曰。产妇腹痛。法当以枳实芍药散。假令不愈者。此为腹中有干血着脐下。宜下
瘀血汤主之。亦主经水不利。
下瘀血汤方
大黄（三两） 桃仁（二十枚） 虫（二十熬去足）
上三味末之。炼蜜为四丸。以酒一升。煎一丸。取八合服之。瘀血下如豚肝。
〔衍义〕血之干燥凝着者。非润燥荡涤。不能去也。芍药、枳实不能治。须用大黄荡
逐之。桃仁润燥。缓中破结。 虫下血。用蜜补不足。止痛和药。缓大黄之急。尤为
润也。与抵当同类。但少缓尔。
产后七八日。无太阳证。少腹坚痛。此恶露不尽。不大便。烦燥发热。切脉微实。再倍
发热。日晡时烦躁者。不食。食则谵语。至夜即愈。宜大承气汤主之。热在里。结在膀胱也。
〔衍义〕太阳为表。膀胱为里。七八日表证入里。故曰无太阳证。恶露已为病气所
郁。不能尽去。邪因入里。与恶露相搏击。在膀胱而小腹坚痛。下焦热极。故不大
便。烦躁发热。更切其脉微实。再倍发热。日晡时烦躁。此邪又攻于胃。胃热则不
食。食入则谷气之热更助。两热相并。故谵语。至夜愈。此产后血虚。邪易入血室。
入血室。则夜如见鬼状。言此以明其不在血室。而在膀胱与胃。故用大承气汤。
产后风。续续数十日不解。头微痛。恶寒。时时有热。心下闷。干呕。汗出虽久。阳旦证
续在尔。可与阳旦汤。（即桂枝汤加黄芩）
〔衍义〕伤寒病。太阳证。头痛发热。汗出恶风者。桂枝汤主之。又太阳病。八九日不
解者。表证仍在。当发其汗。此治伤寒法。凡产后感于风寒诸证。皆不越其规矩。
举此条与上文承气为表里之例耳。东垣治劳役饮食所伤挟外感者。亦名两
感。必顾胃气。大全良方。谓新产去血。津液枯竭。如有时气之类。当发其汗。决不
可用麻黄。取汗无取过多。活人书妇人诸病。皆用四物。与所见证如阳旦之类。各随所感而消息之。
产后中风发热。面正赤。喘而头痛。竹叶汤主之。
竹叶汤方
竹叶（一把） 葛根（三两） 防风 桔梗 桂枝 人参 甘草（各一两） 附子（一枚炮）
大枣（十五枚） 生姜（五两）
上十味。以水一斗。煮取二升半。分温三服。温覆使汗出。
颈项强。用大附子一枚。破之如豆大。（该是入字）前药扬去沫。呕者。加半夏半升洗。
〔衍义〕此证太阳上行至头表。阳脉过膈上循于面。二经合病。故如是。竹叶汤亦
桂枝汤变化者。仲景凡治二经合病。多加葛根。为阳明解肌药也。防风佐桂主
二经之风。竹叶主气上喘。桔梗佐竹叶利之。人参亦治喘。甘草和中。生姜、大枣
行谷气。发荣卫。谷气行。荣卫和。则上下交济而汗出解矣。附子恐是后所加。治
头项强耳。颈项强。邪在太阳有禁。固其筋脉不得屈伸。故用附子温经散寒湿。
以佐葛根。若邪在胸中而呕。加半夏治之。
妇人乳中虚。烦乱呕逆。安中益气。竹皮大丸主之。
竹皮大丸方
生竹茹（二分） 石膏（二分） 桂枝（一分） 甘草（七分） 白薇（一分）
上五味。末之。枣肉和丸。如弹子大。饮服一丸。日三。夜二服。有热者倍白薇。烦喘者加柏实一分。
〔衍义〕妇人以阴血上为乳汁。必藉谷气精微以成之。然乳房居胃上。阳明经脉
之所过。乳汁去多。则阴血乏而胃中益虚。阴乏则火挠而神昏乱。胃虚则呕逆。
用甘草泻心火安中益气。石膏疗烦乱。竹皮主呕逆。桂枝利荣气。通血脉。又宣导诸药。使无捍格
之患。柏实。本草主恍惚虚烦。安五脏。益气。烦喘者。为心中虚火动肺。故以柏实两安之。
产后下利虚极。白头翁加甘草阿胶汤主之。
白头翁加甘草阿胶汤方
白头翁（二两） 秦皮（三两） 黄连（三两） 黄柏（三两） 甘草（二两） 阿胶（二两）
上六味。以水七升。煮取二升半。内胶令消尽。分温三服。
〔衍义〕伤寒厥阴证不利重者。白头翁汤。四味尽苦寒以治热。苦以坚肠胃。此产
后气血两虚。因加阿胶补气血而止利。甘草缓中通血脉。然下利。血滞也。夫人
之血行则利自止。甘草尤为要药。此方岂独治产后哉。
(One discussion, six pulse and symptom clauses, eight formulas)
Question: A woman who has just given birth suffers from three diseases. One is Jing disease (spasm), the second is Yu Mao (depression and dizziness), and the third is difficult defecation. What does this mean? The Master said: Postpartum blood deficiency, excessive sweating, and susceptibility to wind pathogen lead to Jing disease (spasm). Loss of blood followed by sweating, with excess cold, leads to Yu Mao (depression and dizziness). Depletion of body fluids and dryness in the Stomach lead to difficult defecation.
[Supplementary Note] Yin and Yang are mutually supportive. Thus it is said that "Yang generates and Yin grows," and also that "Yang is rooted in Yin." Blood belongs to Yin, and sweat is derived from blood, so it also belongs to Yin. If there is significant blood loss, sweat should theoretically be less. Why does it occur easily instead? This is because severe blood deficiency causes the Wei Qi (Defensive Qi) protecting the exterior to become insecure, leading to excessive sweating and loose interstices (pores). Loose interstices allow pathogens to enter easily. Since the blood is insufficient to nourish the vessels, and the invading wind pathogen further dries and damages the blood, Jing disease (spasm) results. If excessive sweating leads to the loss of Yang Qi, the loss of Yang inevitably causes aversion to cold; heavy cold then leads to Yu Mao (depression and dizziness). As for Yin Qi being deficient and body fluids being scarce, resulting in dryness and constipation in the Stomach, this may indeed occur. However, all three conditions are fundamentally caused by blood deficiency. If one fails to understand this principle and employs sweating or purging methods, it will inevitably lead to critical danger. Therefore, the Sage first established the premise of postpartum blood deficiency, ensuring that even physicians of average or lower ability would consider nourishing Yin.
When a postpartum woman presents with Yu Mao (depression and dizziness), her pulse is faint and weak, she cannot eat, her stool is hard, and only her head sweats. The reason is that blood deficiency leads to Jue (reversal/cold extremities), and Jue necessarily leads to Yu Mao (dizziness). For Yu Mao to resolve, profuse sweating over the whole body must occur. Because blood deficiency causes reversal at the lower jiao, the solitary Yang floats upward, causing only head sweating. Therefore, postpartum women tend to sweat because the loss of Yin blood leads to blood deficiency and excessive Yang Qi. Sweating allows the Yin and Yang to restore balance. Hard stool, vomiting, and inability to eat are treated primarily with Xiao Chai Hu Tang (Minor Bupleurum Decoction).
[Supplementary Note] The various extremely deficient pulse and symptom presentations in postpartum women can be explained in detail. Women govern blood, with emphasis on the Chong Mai (Penetrating Vessel). The Chong Mai serves as a barrier for the Liver. Significant blood loss makes it easy for pathogens to invade. Once invaded, cold and aversion to cold occur due to the suppression of Zheng Qi (Upright Qi). This indicates that Qi and Blood are deficient internally, while Yin pathogens overwhelm externally, making sudden resolution difficult. The difficulty lies in the fact that blood deficiency prevents the generation of sweat, rather than the failure of sweat to resolve the condition. Thus, resolution requires profuse sweating, after which the pathogen retreats and Zheng Qi emerges. This refers to whole-body sweating. There is also a case where blood deficiency causes lower Jiao reversal, and solitary Yang rises without a partner, causing sweating only on the head but not below. Fundamentally, this is due to blood deficiency and Yin depletion, leaving Yang excessively strong. After sweating, the pathogen retreats and Zheng Qi harmonizes. However, since body fluids are injured by blood loss and again by excessive sweating, how can the stool not be hard? If hard stool is accompanied by vomiting and inability to eat, it indicates that the exterior pathogen has not yet left, or that the Blood Chamber (Zi Gong/Uterus) is affected. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the correct treatment.
If the patient recovers and can eat, but develops fever again after seven or eight days, this is a Stomach Excess pattern, treated primarily with Da Cheng Qi Tang (Major Order the Qi Decoction).
[Supplementary Note] When the pathogen is eliminated, it does not return to the Fu organs, and appetite returns naturally. Fever appearing seven or eight days later clearly indicates food stagnation in the Stomach, with Spleen deficiency failing to transform it. Urgent purging is needed to save the body fluids. However, for patients with severe deficiency, the decoction should be administered in small doses frequently. Clinical judgment is key.
Postpartum abdominal pain is treated primarily with Dang Gui Sheng Jiang Yang Rou Tang (Angelica, Ginger, and Mutton Decoction). It also treats abdominal cold cramps and deficiency-wasting syndrome.
[Supplementary Note] Postpartum constitution is inherently deficient, making it easy for Cold to invade. The abdomen is the domain of the Liver and the control center of the Spleen. Pain indicates either deficiency of Zheng Qi or excess of Pathogenic factors. This formula originally treats cold cramps and is suitable for postpartum abdominal pain. It is also appropriate for treating deficiency-wasting syndrome.
Postpartum abdominal pain accompanied by irritability, fullness, and inability to lie down is treated primarily with Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder).
Formula for Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder):
Zhi Shi (Immature Bitter Orange) (burned until black but not overly charred)
Shao Yao (Peony Root) (equal parts)
Grind the two ingredients into a powder. Take one cun-bi (square-inch measure) per dose, three times daily. It also treats abscesses and pus, taken with wheat gruel.
[Extended Meaning] Zhang Zhongjing often uses Shao Yao (Peony Root) to treat abdominal pain. Why? Because it resolves Qi and Blood accumulation, promotes the movement of Zang-Fu organs, and stops pain when flow is restored. It收敛 (astringes/collects) pain caused by scattered Yin Qi. It treats pain from Blood Bi (obstruction). It soothes the middle and relieves acute pain. Materia Medica states it treats abdominal pain caused by pathogenic factors. Among the five pathogenic factors, Jue Ni (Reversal) is the most severe. The nature of Liver Wood is urgent and violent; any imbalance causes pain due to its curving and straightening properties. The Liver stores blood; stasis clouds the sea of blood and obstructs Liver Qi. Eastern Zhen Wood arises from pure Yin to generate life; if it arises from scattered Yin, the Liver's own Qi becomes hyperactive. Strong Wood meets pathogenic factors, leading to conflict between Liver Wood and the pathogen. From these three aspects, Shao Yao (Peony Root) treats Liver Wood issues. Although it treats, it also tonifies. Wood tastes sour, and Shao Yao is sour, hence it is considered tonifying. Zhi Shi (Immature Bitter Orange) stir-fried to black enters the Blood level to break stasis; wheat gruel tonifies the Blood vessels.
The Master said: Postpartum abdominal pain should be treated with Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder). If it does not resolve, it indicates dry blood adhering below the umbilicus. Xia Yu Xue Tang (Decoction to Drain Blood Stasis) is indicated. It also treats irregular menstruation.
Formula for Xia Yu Xue Tang (Decoction to Drain Blood Stasis):
Da Huang (Rhubarb Root and Rhizome) (3 liang)
Tao Ren (Peach Seed) (20 seeds)
E Chong (Ground Beetle) (20 specimens, processed, feet removed)
Grind the three ingredients into powder. Form four pills using refined honey. Decoct one pill in one sheng of wine to obtain eight ge. Take orally. The expelled blood stasis resembles pig liver.
[Extended Meaning] Dry and coagulated blood cannot be removed without moistening dryness and purging. Shao Yao (Peony Root) and Zhi Shi (Immature Bitter Orange) are ineffective here; Da Huang (Rhubarb) is required for purging. Tao Ren (Peach Seed) moistens dryness, soothes the middle, and breaks accumulations. E Chong (Ground Beetle) descends blood. Honey tonifies deficiency, stops pain, harmonizes the herbs, and moderates the harshness of Da Huang (Rhubarb), providing additional moistening. This formula is similar to Di Dang Tang (Calculus Decoction) but acts more gently.
Seven or eight days postpartum, with no Tai Yang (Greater Yang) exterior symptoms, but hardness and pain in the lower abdomen, this is incomplete expulsion of lochia. With constipation, irritability, fever, a slightly solid pulse, doubled fever, evening irritability, anorexia, delirium after eating, and improvement at night, Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. The heat is internal, and the knot is in the Bladder.
[Extended Meaning] Tai Yang represents the exterior, and the Bladder represents the interior. After seven or eight days, exterior symptoms have entered the interior, hence "no Tai Yang symptoms." The lochia is constrained by pathogenic Qi and cannot fully exit. The pathogen enters the interior and conflicts with the lochia, causing hardness and pain in the lower abdomen due to extreme heat in the lower Jiao. This leads to constipation, irritability, and fever. A slightly solid pulse and intensified evening irritability indicate the pathogen attacking the Stomach. Stomach heat causes anorexia; eating adds the heat of grain qi, combining with existing heat to cause delirium. Improvement at night occurs because postpartum blood deficiency allows pathogens to easily enter the Blood Chamber. Entry into the Blood Chamber causes hallucinations at night. These descriptions clarify that the pathology is in the Bladder and Stomach, not the Blood Chamber, hence Da Cheng Qi Tang (Major Order the Qi Decoction) is used.
Postpartum wind strike with continuous fever for dozens of days, slight headache, aversion to cold, intermittent fever, chest oppression, dry vomiting, and sweating. Although prolonged, the Yang Dan pattern persists. Yang Dan Tang (which is Gui Zhi Tang plus Huang Qin/Coptis Rhizome) is indicated.
[Extended Meaning] In Shang Han (Cold Damage) disease, Tai Yang patterns with headache, fever, sweating, and aversion to wind are treated with Gui Zhi Tang (Cinnamon Twig Decoction). If Tai Yang disease persists for eight or nine days with remaining exterior symptoms, sweating should be induced. This follows the method for treating Cold Damage. All postpartum conditions caused by wind-cold follow these principles. This clause serves as an example of exterior-interior relationship with the previous Cheng Qi clauses. Dong Yuan treated injuries from labor and diet complicated by exterior pathogens, called "Liang Gan" (Double Contraction), emphasizing protection of Stomach Qi. Da Quan Liang Fang states that postpartum blood loss depletes body fluids; if seasonal pathogens are present, sweating may be induced, but Ma Huang (Ephedra) must never be used. Sweating should not be excessive. *Huo Ren Shu* (Book that Saves Lives) suggests Si Wu Tang (Four Substances Decoction) for various women's diseases, combined with formulas like Yang Dan Tang according to the specific pathogen.
Postpartum wind strike with fever, bright red face, wheezing, and headache is treated with Zhu Ye Tang (Bamboo Leaf Decoction).
Formula for Zhu Ye Tang (Bamboo Leaf Decoction):
Zhu Ye (Bamboo Leaves) (1 bundle)
Ge Gen (Kudzu Root) (3 liang)
Fang Feng (Saposhnikovia Root)
Jie Geng (Platycodon Root)
Gui Zhi (Cinnamon Twig)
Ren Shen (Ginseng Root)
Gan Cao (Licorice Root) (1 liang each)
Fu Zi (Aconite Lateral Root) (1 piece, processed)
Da Zao (Jujube Fruit) (15 pieces)
Sheng Jiang (Fresh Ginger) (5 liang)
Decoct the ten ingredients in one dou of water to obtain two and a half sheng. Divide into three warm doses. Cover warmly to induce sweating.
For stiff neck and nape, use one large Fu Zi (Aconite), broken into bean-sized pieces. (Note: Text likely implies adding this to the decoction). Boil the other ingredients, skimming off the foam. For vomiting, add Ban Xia (Pinellia Tuber), half a sheng, washed.
[Extended Meaning] This condition involves the Tai Yang channel ascending to the head and exterior, and Yang channels passing through the diaphragm to the face, constituting a combination of two channels. Zhu Ye Tang (Bamboo Leaf Decoction) is a variation of Gui Zhi Tang (Cinnamon Twig Decoction). Zhongjing often adds Ge Gen (Kudzu Root) for combinations of two channels, as it releases the muscles of the Yang Ming. Fang Feng (Saposhnikovia) assists Gui Zhi (Cinnamon Twig) to address wind in both channels. Zhu Ye (Bamboo Leaves) addresses wheezing due to rising Qi. Jie Geng (Platycodon) assists Zhu Ye to benefit the throat. Ren Shen (Ginseng) also treats wheezing. Gan Cao (Licorice) harmonizes the middle. Sheng Jiang (Fresh Ginger) and Da Zao (Jujube) promote Grain Qi and stimulate Ying and Wei. When Grain Qi moves and Ying and Wei harmonize, upper and lower interact, sweating occurs, and the condition resolves. Fu Zi (Aconite) was likely added later to treat stiff neck and nape. Stiff neck indicates pathogen in Tai Yang, restricting sinews and vessels. Fu Zi (Aconite) warms the channels and disperses cold-damp, assisting Ge Gen (Kudzu). If pathogen is in the chest causing vomiting, Ban Xia (Pinellia) is added.
During lactation, if Yin Blood is deficient, causing irritability, confusion, vomiting, and regurgitation, An Zhong Yi Qi (Peace the Middle and Tonify Qi) is achieved with Zhu Pi Da Wan (Bamboo Peel Large Pill).
Formula for Zhu Pi Da Wan (Bamboo Peel Large Pill):
Sheng Zhu Ru (Raw Bamboo Shavings) (2 fen)
Shi Gao (Gypsum Fibrosum) (2 fen)
Gui Zhi (Cinnamon Twig) (1 fen)
Gan Cao (Licorice Root) (7 fen)
Bai Wei (Cynanchum Root) (1 fen)
Grind the five ingredients into powder. Mix with date paste to form pills the size of a bullet. Take one pill with water, three times daily, twice at night. Increase Bai Wei (Cynanchum) if there is heat. Add Bai Zi Ren (Biota Seed) if there is irritability and wheezing.
[Extended Meaning] Women convert Yin Blood into milk, relying on essence from Grain Qi. The breasts are located above the Stomach, traversed by the Yang Ming channels. Excessive milk loss depletes Yin Blood and further weakens the Stomach. Yin deficiency allows Fire to disturb, causing mental confusion. Stomach deficiency causes vomiting and regurgitation. Gan Cao (Licorice) clears Heart Fire, pacifies the middle, and tonifies Qi. Shi Gao (Gypsum) treats irritability. Zhu Ru (Bamboo Shavings) treats vomiting. Gui Zhi (Cinnamon Twig) benefits Ying Qi, unites blood vessels, and guides the other herbs to prevent obstruction. Bai Zi Ren (Biota Seed) treats恍惚 (trance/vacuity) and irritability, calms the Five Zang, and tonifies Qi. Irritability and wheezing result from deficient Fire in the Heart disturbing the Lung; Bai Zi Ren (Biota Seed) addresses both.
Postpartum dysentery with extreme deficiency is treated with Bai Tou Weng Jia Gan Cao E Jiao Tang (Baitouweng Decoction plus Licorice and Donkey-Hide Gelatin).
Formula for Bai Tou Weng Jia Gan Cao E Jiao Tang (Baitouweng Decoction plus Licorice and Donkey-Hide Gelatin):
Bai Tou Weng (Pulsatilla Root) (2 liang)
Qin Pi (Ash Bark) (3 liang)
Huang Lian (Coptis Rhizome) (3 liang)
Huang Bai (Phellodendron Bark) (3 liang)
Gan Cao (Licorice Root) (2 liang)
E Jiao (Donkey-Hide Gelatin) (2 liang)
Decoct the six ingredients in seven sheng of water to obtain two and a half sheng. Dissolve the gelatin. Divide into three warm doses.
[Extended Meaning] For severe dysentery in Jue Yin Cold Damage patterns, Bai Tou Weng Tang (Pulsatilla Decoction) is used. The four ingredients are bitter and cold to clear heat, with bitterness strengthening the intestines and stomach. Here, added for postpartum Qi and Blood deficiency, E Jiao (Donkey-Hide Gelatin) tonifies Qi and Blood to stop dysentery. Gan Cao (Licorice) moderates and promotes blood circulation. Dysentery involves blood stasis; when blood flows, dysentery stops naturally. Gan Cao (Licorice) is a crucial herb. Is this formula exclusive to postpartum cases?