问曰。新产妇人有三病。一者病 。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 。亡血复汗。寒多。故令郁冒。亡津液胃燥。故大便难。（案 。沈尤金鉴。作痉为是。详痉病中。）
〔尤〕痉。筋病也。血虚汗出。筋脉失养。风入而益其劲也。郁冒。神病也。亡阴血虚。阳气遂厥而寒。
复郁之。则头眩而目瞀也。大便难者。液病也。胃藏津液。而渗灌诸阳。亡津液胃燥。则大肠失其润。而便难
也。三者不同。其为亡血伤津则一。故皆为产后所有之病。
〔程〕产后血晕者。为郁冒。又名血厥。
产妇郁冒。其脉微弱。呕不能食。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。（〔原注〕方见呕吐中。）
〔尤〕郁冒虽有客邪。而其本则为里虚。故其脉微弱也。呕不能食。大便反坚。但头汗出。津气上行。
而不下逮之象。所以然者。亡阴血虚。孤阳上厥。而津气从之也。厥者必冒。冒家欲解。必大汗出者。阴阳
乍离。故厥而冒。及阴阳复通。汗乃大出而解也。产妇新虚。不宜多汗。而此反善汗出者。
血去阴虚。阳受邪气。而独盛。汗出则邪去。阳弱而后与阴相和。所谓损阳而就阴是也。小柴胡主之者。以邪
气不可不散。而正虚不可罔顾。惟此法为能解散客邪。而和利阴阳耳。
〔鉴〕大便坚。呕不能食。用小柴胡汤。必其人舌有苔。身无汗形气不衰者。始可。故病得解自能食也。若有汗。当减
柴胡。无热当减黄芩。呕则当倍姜半。虚则当倍人参。又在临证之变通也。
案巢源云。运闷之状。心烦气欲绝是也。亦有去血过多。亦有下血极少。皆令运闷。若去血过多。血虚
气极如此而运闷者。但烦闷而已。若下血过少。而气逆者。则血随气上掩于心。亦令运闷。则烦闷而心满急。
二者为异。亦当候其产妇。血下多少。则知其产后应运与不运也。然烦闷不止。则毙人。巢氏所论如此。知
产后血晕。自有两端。其去血过多而晕者。属气脱。其证眼闭口开。手撒手冷。六脉微细或浮
是也。下血极少而晕者属血逆。其证胸腹胀痛气粗。两手握拳。牙关紧闭是也。此二者证治霄壤。服药一差。
生死立判。宜审辨焉。而本条所论。别是一证。活人书妊娠伤寒门。载此条于三物黄芩汤之后。则知是专治
妇人草蓐伤风。呕而不能食者。若以小柴胡汤为产后郁冒之的方。则误人殆多矣。
病解能食。七八日更发热者。此为胃实。大承气汤主之。
（见 病中。○脉经。作此为胃热气实。程金鉴脉经。并接前条为一条。）
〔沈〕此即大便坚呕不能食。用小柴胡汤。而病解能食也。病解者。谓郁冒已解。能食者。乃余邪隐伏
胃中。风热炽盛。而消谷。但食入于胃。助起余邪复盛。所以七八日。而更发热。故为胃实。是当荡涤胃邪为
主。故用大承气。峻攻胃中坚垒。俾无形邪相随有形之滞。一扫尽出则病如失。仲景本意。发明产后气血虽
虚。然有实证。即当治实。不可顾虑其虚。反致病剧也。
产后腹中 痛。当归生姜羊肉汤主之。并治腹中寒疝。虚劳不足。（方见寒疝中。）
〔程〕产后血虚有寒。则腹中急痛。内经曰。味浓者为
阴。当归羊肉味浓者也。用以补产后之阴。佐生姜以散腹中之寒。则 痛自止。夫辛能散寒。补能去弱。
三味辛温补剂也。故并主虚劳寒疝。
〔魏〕妊娠之 痛。胞阻于血寒也。产后腹中 痛者。里虚而血寒也。一阻一虚。而治法异矣。
〔尤〕当归生姜。温血散寒。孙思邈云。羊肉止痛利产妇。
千金当归汤。治妇人寒疝。虚劳不足。若产后腹中绞痛。
即本方加芍药。注云。子母秘录有甘草。
丹溪心要云。当产寒月。脐下胀满。手不可犯。寒入产门故也。服仲景羊肉汤二服愈。
严氏济生当归羊肉汤。治产后发热自汗。肢体痛。名曰蓐劳。
即本方。加人参黄 。
产后腹痛。烦满不得卧。枳实芍药散主之。
〔鉴〕产后腹痛。不烦不满。里虚也。今腹痛烦满。不得卧。里实也。气结血凝而痛。故用枳实破
气结。芍药调腹痛。枳实炒令黑者。盖因产妇气不实也。并主痈脓。亦因血为气凝。久
而腐化者也。佐以麦粥。恐伤产妇之胃也。
〔尤〕产后腹痛。而至烦满不得卧。知血郁而成热。且下病而碍上也。与虚寒 痛不同矣。枳实烧
令黑。能入血行滞。同芍药为和血止痛之剂也。
〔魏〕大麦粥。取其滑润宜血。且有益胃气也。
枳实芍药散方
枳实（烧令黑勿太过） 芍药（等分）
上二味。杵为散。服方寸匕。日三服。并主痈肿。以麦粥下之。
案朱震亨云。芍药产后禁用。程氏辨其误。极是。今不
繁引。又案此前排脓散中。去桔梗。不用鸡子黄。用麦粥。
立方之意稍近。故并治痈肿乎。
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。
〔鉴〕产妇腹痛。属气结血凝者。枳实芍药散以调之。假令服后不愈。此为热灼血干。着于脐下而痛。非
枳实芍药之所能治也。宜下瘀血主之。下瘀血汤。攻热下瘀血也。并主经水不通。亦因热灼血干故也。
下瘀血汤方
大黄（三两○赵本作二两） 桃仁（二十枚） 虫（二十枚熬去足）
上三味。末之。炼蜜和为四丸。以酒一升。煎一丸。取八合。顿服之。新血下如豚肝。
〔程〕 虫。主下血闭。咸能软坚也。大黄。主下瘀血。苦能泄滞也。桃仁。亦下瘀血。滑以去着也。
三味相合。以攻脐下干血。
〔魏〕此类于抵当汤丸之用。亦主经水不利。
无非通幽开积之治也。和酒为丸者。缓从下治也。
〔徐〕既曰新血。又曰如豚肝。骤结之血也。
案徐氏兰台轨范云。新字当作瘀字。此说颇有理。
产后七八日。无太阳证。少腹坚痛。此恶露不尽。不大便。烦躁发热。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。（见 病中。○脉经。烦躁发
热四字。作四五日趺阳脉六字。食则谵语至夜即愈八字。作谵语利之则愈六字。）
〔程〕太阳伤寒。热结膀胱。则蓄血。小腹坚痛。今产后非太阳证。而小腹亦坚痛者。此恶血未尽。
热在里。结在膀胱也。宜下瘀血汤辈。若不大便。烦躁发热。则热不在膀胱。而热在胃。切其脉亦微实也。
日晡时。阳明向王时也。当向王时。是以再倍发热烦躁。则胃中实矣。胃实则不能食。
故食则谵语。转增其实也。宜大承气汤下之。此条前后简错。热在里八字。当在恶露不尽之下。未有大
承气汤。而下膀胱血结也。至夜即愈四字。衍文。脉经无。（金鉴同。但以至夜即愈。不
为衍文。以再倍二字为衍。）
〔鉴〕李 曰。此一节具两证在内。一是太阳蓄血证。一是阳明里实证。因古人
文法错综。故难辨也。无太阳证。谓无表证也。少腹坚痛者。以肝藏血。少腹为肝经部分。故血必结于此。则
坚痛亦在此。此恶露不尽。是为热在里。结在膀胱。此太阳蓄血证也。宜下去瘀血。若不大便烦躁。脉实谵
语者。阳明里实也。再倍发热者。热在里。蒸蒸发于外也。阳明旺于申酉戌。日晡是阳明向旺时。故烦
躁不能食。病在阳而不在阴。故至夜则愈。此阳明腑病也。宜大承气汤以下胃实。
案尤云。盖谓不独血结于下。而亦热聚于中也。若但治其血。而遗其胃。则血虽去而热不除。即血亦
未必能去。而大承气汤中。大黄枳实。均为血药。仲景取之者。盖将一举而两得之欤。此解不可从。李注似允当。
产后风。续之数十日不解。头微痛。恶寒时时有热。心下闷。干呕汗出。虽久阳旦证续在耳。可与阳旦
汤。（〔原注〕即桂枝汤方。见下利中。○脉经作妇人产得风。心下闷。作心下坚。徐沈作产后中风续续。）
〔徐〕此段言产后中风。迁延不愈。而表里杂见者。仍当去其风也。谓中风之轻者。数十日不解。似
乎不可责表。然头疼恶寒汗出。时有热。皆表证也。心下闷干呕。太阳之
邪欲内入。而内不受也。今阳旦证仍在。阳旦汤何不可与。而因循以致误也。
案阳旦汤。徐沈尤金鉴。为桂枝汤加黄芩。而魏则据伤
寒论证象阳旦条。为桂枝加附子。并误。唯程根据原注为是。
张氏医通云。举此与上文承气汤。为表里之例。
产后中风。发热面正赤。喘而头痛。竹叶汤主之。（喘而。千金。作喘气。头痛。圣济。作头目昏痛。）
〔尤〕此产后表有邪。而里适虚之证。若攻其表。则气浮易脱。若补其里。则表多不服。竹叶汤。用竹
叶葛根桂枝防风桔梗。解外之风热。人参附子。固里之脱。甘草姜枣。以调阴阳之气。而使其平。乃表里
兼济之法。凡风热外淫。而里气不固者。宜于此取则焉。
〔沈〕产后最易变为柔痉。故发热头痛。虽属太阳表证。恐隐痉病之机。所以方后云。颈项强。加大附子一枚。
案金鉴云。产后中风之下。当有病痉者之三字。始与方合。若无此三字。则人参附子。施之于中风发
热可乎。而又以竹叶命名者。何所谓也。且方内有颈项强用大附子之文。
本篇有证无方。则可知必有脱简。此注恐非。是方盖防发痉之渐。若至直发痉。则难奏效也。
竹叶汤方
竹叶（一把○千金作一握） 葛根（三两） 防风（案千金用二两） 桔梗 桂枝
人参 甘草（各一两） 大枣（十五枚） 生姜（五两） 附子（一枚炮○活人书不用）
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。前
药扬去沫。呕者。加半夏半升。洗。（千金。分上。有去滓二字。无一枚以下十二字。前。
赵本作煎。徐注豆大下云。该是入字。案据徐则豆下句。）
〔程〕产后血虚。多汗出。喜中风。故令病痉。今证中未至背反张。而发热面赤头痛。亦风痉之渐。故用
竹叶主风痉。防风治内痉。葛根治刚 。桂枝治柔痉。生姜散风邪。桔梗除风痹。辛以散之之剂也。邪之所
凑。其气必虚。佐人参以固卫。附子以温经。甘草以和诸药。大枣以助十二经。
同诸风剂。则发中有补。为产后中风之大剂也。颈项强急。痉病也。加附子以散寒。呕者。风拥气逆也。加半夏以散逆。
张氏医通云。此桂枝汤。去芍药。加竹叶葛防桔梗人参。
因方后所加附子向来混入方内。案医通。载本方。去附子。盖本于活人书。
又云。附子恐是方后所加。治颈项强者。以邪在太阳禁固其筋脉。不得屈伸。故用附子。温经散寒。
扬去沫者。不使辛热上浮之气。助其虚阳上逆也。若邪在胸而呕。加半夏治
之。上言破之如豆。入前药。旧本作如豆大。今如徐忠可驳正。
妇人乳中虚。烦乱呕逆。安中益气。竹皮大丸主之。（乳。脉经。作产。）
〔程〕胃者。水谷气血之海。产后则血气虚。而胃气逆。故烦乱呕逆。
〔尤〕妇人乳中虚。烦乱呕逆者。
乳子之时。气虚火胜。内乱而上逆也。
案乳中。盖在草蓐之谓。故脉经作产中。而沈云。乳者乳子之妇也。魏云。乳即血也。初产血虚。
沈云。乳下。当有闭字。谓乳闭而不通也。金鉴云。此条文义证药未详。张璐云。乳中虚。言乳哺而乳
汁去多。并误。
竹皮大丸方（活人云。治虚烦。载之于丈夫诸方中。）
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。枣肉和丸弹子大。以饮服一丸。日三夜
二服。有热者。倍白薇。烦喘者。加柏实一分。活人书。柏实。作枳实。
〔程〕竹茹甘寒。以除呕 。石膏辛寒。以除烦逆。白薇咸寒。以治狂惑邪气。夫寒则泥膈。佐桂
枝以宣导。寒则伤胃。佐甘草以和中。有热倍白薇。白薇咸寒。能除热也。
烦喘。加柏实。柏实辛平。能治喘也。用枣肉为丸者。统和
诸药。以安中益气也。
武氏济阴纲目云。中虚不可用石膏。烦乱不可用桂枝。此方以甘草七分。配众药六分。又以枣肉为丸。
仍以一丸饮下。可想其立方之微。用药之难。审虚实之不易也。仍饮服者。尤虑夫虚虚之祸耳。用是方者亦
当深省。
产后下利虚极。白头翁加甘草阿胶汤主之。（脉经。作热痢重下新产虚极。千金。利虚间。有兼字。）
〔尤〕伤寒热利下重者。白头翁汤主之。寒以胜热。苦
以燥湿也。此亦热利下重。而当产后虚极则加阿胶救阴。甘草补中生汤。且以缓连柏之苦也。
案金鉴云。此条文义证药不合。不释。盖以其虚极而用苦寒之品也。
白头翁加甘草阿胶汤方（千金。名白头翁汤。）
白头翁 甘草 阿胶（各二两） 秦皮 黄连（案千金各二两） 柏皮（各三两）
上六味。以水七升。煮取二升半。内胶令消尽。分温三服。
Question: There are three diseases in women who have just given birth. One is Jing disease (a syndrome characterized by stiffness of the neck and back, locked jaw, and even opisthotonos). The second is Yumao (a syndrome characterized by dizziness, blurred vision, and confusion). The third is difficulty in defecation. What does this mean?
The Master said: Women who have just given birth suffer from blood deficiency due to blood loss, and perspire excessively, making them prone to contracting wind pathogens, thus leading to Jing disease. Due to blood loss and sweating, there is an excess of cold, thus leading to Yumao. Due to the consumption of body fluids and dryness in the stomach, difficulty in defecation occurs. (Note: Shen Jin'ao's *Jin Jian* considers "Jing" to be correct; see the chapter on Jing disease for details.)
[You Zaijing] Jing is a disorder of the sinews. Blood deficiency and sweating cause the sinews and vessels to lose nourishment; when wind pathogens invade, they exacerbate the stiffness and tension of the sinews. Yumao is a disorder of the spirit. Loss of yin blood leads to blood deficiency, causing yang qi to rebel and generate cold. When this cold is constrained, it results in dizziness and blurred vision. Difficulty in defecation is a disorder of body fluids. The stomach stores body fluids and distributes them to the yang channels. Loss of body fluids causes stomach dryness, and the large intestine loses its lubrication, resulting in difficult defecation. Although these three diseases present differently, they all result from blood loss and injury to body fluids; therefore, they are all diseases common after childbirth.
[Cheng Lin] Postpartum blood syncope is Yumao, also known as Xue Jue (Blood Jue).
When a postpartum woman suffers from Yumao, her pulse is faint, she vomits and cannot eat, her stool is hard, and only her head sweats. This is because blood deficiency leads to qi rebellion, and qi rebellion causes Yumao. For Yumao to resolve, profuse sweating must occur throughout the body. This is because blood deficiency causes cold at the lower jiao, and lone yang floats upward and outward, causing only the head to sweat. Postpartum women tend to sweat because the loss of yin blood leads to blood deficiency and excessive yang. Sweating allows the yin and yang to harmonize. For cases with hard stool, vomiting, and inability to eat, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. ([Original Note]: Formula found in the Vomiting chapter.)
[You Zaijing] Although Yumao involves external pathogenic factors, its root lies in interior deficiency, hence the faint pulse. Vomiting, inability to eat, hard stool, and head-only sweating indicate that fluid and qi ascend but do not reach the lower jiao. This is due to loss of yin blood, blood deficiency, and the rebellion of lone yang carrying fluid and qi upward. Qi rebellion inevitably causes Yumao; for Yumao to resolve, profuse sweating must occur because yin and yang temporarily separate, causing rebellion and Yumao. When yin and yang reconnect, sweating occurs, and the disease resolves. Postpartum women are newly deficient and should not sweat excessively, but here they sweat readily because blood loss causes yin deficiency, and yang, affected by pathogenic factors, becomes excessive. Sweating eliminates the pathogen, allowing weakened yang to harmonize with yin, which is what is meant by "diminishing yang to join yin." Xiao Chai Hu Tang is used because pathogens must be dispersed, yet the deficiency of healthy qi must not be ignored; this method can both disperse external pathogens and harmonize yin and yang.
[Jin Jian] For hard stool, vomiting, and inability to eat, Xiao Chai Hu Tang is used, provided the patient has a coated tongue, no sweating on the body, and robust physical strength. Once the disease resolves, appetite returns naturally. If sweating is present, reduce the dosage of Chai Hu; if there is no heat, reduce Huang Qin; if vomiting occurs, double the dosage of Sheng Jiang and Ban Xia; if deficiency is prominent, double the dosage of Ren Shen. These adjustments depend on clinical flexibility.
Note: Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states that the symptoms of Yun Men (dizziness and oppression) include mental agitation and shortness of breath approaching suffocation. It can be caused by excessive blood loss or insufficient lochia discharge. Excessive blood loss leads to extreme qi deficiency due to blood deficiency, causing mere mental agitation. Insufficient lochia discharge leads to qi rebellion, where blood follows qi upward to obstruct the heart, causing Yun Men accompanied by mental agitation and chest/abdominal fullness and urgency. These two conditions differ. One should observe the amount of lochia discharge to determine if postpartum Yun Men will occur. However, if agitation persists, it can be fatal. Chao's discussion indicates two types of postpartum blood syncope: one due to excessive blood loss, classified as Qi Collapse, with symptoms such as closed eyes, open mouth, relaxed hands, cold extremities, and faint or floating pulses; the other due to minimal lochia discharge, classified as Blood Rebellion, with symptoms such as chest and abdominal distension and pain, coarse breathing, clenched fists, and locked jaws. The treatments for these two conditions are vastly different; a slight error in medication can lead to immediate death or survival, so careful differentiation is essential. The condition discussed in this clause is distinct. The *Huo Ren Shu* (Book of Life) places this clause after San Wu Huang Qin Tang in the Pregnancy Typhoid section, indicating it specifically treats wind-cold contracted during confinement with vomiting and inability to eat. Treating Xiao Chai Hu Tang as the specific formula for postpartum Yumao would mislead many.
If the disease resolves and the patient can eat, but fever recurs after seven or eight days, this indicates Stomach Excess, treated with Da Cheng Qi Tang (Major Order the Qi Decoction).
(See Yangming Disease chapter. ○ *Mai Jing* reads "This is Stomach Heat Qi Excess"; Cheng Lin's *Jin Jian* edition of *Mai Jing* merges this with the previous clause.)
[Shen Mingzong] This refers to the case of hard stool, vomiting, and inability to eat, treated with Xiao Chai Hu Tang, after which the disease resolves and the patient can eat. "Disease resolves" means Yumao has resolved; "can eat" implies residual pathogens lurking in the stomach, where wind-heat is vigorous and promotes digestion. However, food entering the stomach aids the resurgence of residual pathogens, causing fever to recur after seven or eight days, thus diagnosing Stomach Excess. The priority is to purge the Stomach of pathogens using Da Cheng Qi Tang to vigorously attack the solid accumulation in the Stomach, sweeping away both formless pathogens and formed stagnation. Zhang Zhongjing's intent is to illustrate that although postpartum qi and blood are deficient, if excess patterns exist, they must be treated as excess; one must not hesitate due to deficiency, lest the condition worsen.
For postpartum abdominal pain, Dang Gui Sheng Yang Rou Tang (Angelica Ginger Mutton Soup) is the primary treatment. It also treats abdominal Cold Hernia and Deficiency-Laziness. (Formula found in the Cold Hernia chapter.)
[Cheng Lin] Postpartum blood deficiency with cold causes acute abdominal pain. The *Nei Jing* states: flavors that are rich belong to Yin. Dang Gui and mutton have rich flavors and are used to tonify postpartum yin blood, assisted by Sheng Jiang to dispel abdominal cold, stopping the pain. Pungent flavors dispel cold, and tonification removes weakness; these three ingredients form a pungent-warm tonic, treating both Deficiency-Laziness and Cold Hernia.
[Wei Nianting] Abdominal pain during pregnancy is due to uterine obstruction from blood cold. Postpartum abdominal pain is due to interior deficiency and blood cold. One is obstruction, the other is deficiency; their treatments differ.
[You Zaijing] Dang Gui and Sheng Jiang warm the blood and dispel cold. Sun Simiao stated: Mutton stops pain and benefits postpartum women.
Qian Jin Dang Gui Tang treats female Cold Hernia and Deficiency-Laziness. For postpartum abdominal colic, add Bai Shao to this formula. The note says: *Zi Mu Mi Lu* contains Gan Cao.
*Dan Xi Xin Yao* states: In cold months of delivery, subumbilical distension and tenderness occur because cold enters the birth canal. Two doses of Zhongjing's Mutton Soup cure it.
Yan Shi's *Ji Sheng Fang* Dang Gui Mutton Soup treats postpartum fever, spontaneous sweating, and limb pain, named Ru Lao (Confinement Labor).
It adds Ren Shen and Huang Qi to this base formula.
For postpartum abdominal pain with mental agitation, fullness, and inability to lie down, Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) is the primary treatment.
[Jin Jian] Postpartum abdominal pain without agitation or fullness indicates interior deficiency. Current symptoms of abdominal pain, agitation, fullness, and inability to lie down indicate interior excess. Qi stagnation and blood coagulation cause pain; thus, Zhi Shi breaks qi stagnation, and Bai Shao regulates abdominal pain. Zhi Shi is stir-fried until black because postpartum qi is not solid. This formula also treats carbuncles and pus, as blood coagulated by qi decomposes over time. Mai Zhou (Barley Porridge) is added to protect the postpartum woman's stomach.
[You Zaijing] Postpartum abdominal pain progressing to agitation, fullness, and inability to lie down indicates blood stagnation transforming into heat, affecting the upper jiao from the lower, differing from cold-deficiency abdominal pain. Zhi Shi charred to black enters the blood level to move stagnation; combined with Bai Shao, it harmonizes blood and stops pain.
[Wei Nianting] Barley porridge provides slipperiness to benefit blood and supports stomach qi.
Zhi Shi Shao Yao San Formula
Zhi Shi (stir-fried until black, not too much) Bai Shao (equal parts)
Crush these two ingredients into a powder. Take one cun bi (measure) per dose, three times daily. It also treats carbuncles; take with barley porridge.
Note: Zhu Zhenheng stated that Bai Shao is contraindicated postpartum; Cheng Lin refuted this error correctly. Regarding the Pai Nong San mentioned earlier, removing Jie Geng and Ji Zi Huang, and using Mai Zhou, the formulation logic is slightly similar, hence its use for carbuncles?
The Master said: For postpartum abdominal pain, Zhi Shi Shao Yao San is indicated by law. If it does not heal, it is due to dried blood adhering below the umbilicus; Xia Yu Xue Tang (Drain Stasis Blood Decoction) is indicated. It also treats irregular menstruation.
[Jin Jian] Postpartum abdominal pain due to qi stagnation and blood coagulation is treated with Zhi Shi Shao Yao San. If it fails to heal, it is due to heat scorching blood into dryness adhering below the umbilicus, unresponsive to Zhi Shi and Shao Yao. Xia Yu Xue Tang is indicated to attack heat and drain stasis blood. It also treats amenorrhea due to heat-scorched dry blood.
Xia Yu Xue Tang Formula
Da Huang (3 liang ○ Zhao version: 2 liang) Tao Ren (20 kernels) E Chong (20 pieces, roasted, feet removed)
Grind these three ingredients into powder. Mix with refined honey to make four pills. Decoct one pill in one sheng of wine to obtain 8 he. Take in one dose. Fresh blood resembling pig liver will be discharged.
[Cheng Lin] E Chong primarily breaks blood closure; salty flavor softens hardness. Da Huang primarily drains stasis blood; bitter flavor drains stagnation. Tao Ren also drains stasis blood; slippery texture removes adherence. Combined, they attack dried blood below the umbilicus.
[Wei Nianting] This category resembles the use of Di Dang Tang/Wan, also treating irregular menstruation.
It is essentially a treatment to open blockages and accumulate. Using wine to make pills allows for slow action from below.
[Xu Lingtai] Since it says "fresh blood" and "resembling pig liver," this refers to suddenly congealed blood.
Note: Xu's *Lan Tai Gui Fan* suggests "Xin" (new) should be read as "Yu" (stasis); this reasoning is sound.
Seven or eight days postpartum, without Taiyang signs, with firm and painful lower abdomen, this is incomplete expulsion of lochia. Constipation, irritability, fever, faintly solid pulse, doubled fever, irritability at dusk (Shen-You hours), inability to eat, delirium upon eating, resolving at night: Da Cheng Qi Tang is indicated. Heat is in the interior,结 (knotting) is in the Bladder. (See Yangming Disease chapter. ○ *Mai Jing*: "Irritability and fever" reads "Fourth to fifth day, Fu Yang pulse"; "Delirium upon eating, resolving at night" reads "Delirium, purgation leads to resolution".)
[Cheng Lin] Taiyang cold damage with heat knotting in the Bladder causes blood retention and firm lower abdominal pain. Here, postpartum is not Taiyang, yet the lower abdomen is firm and painful, indicating incomplete expulsion of evil blood, heat in the interior, knotting in the Bladder. Formulas like Xia Yu Xue Tang are suitable. If constipation, irritability, and fever occur, heat is not in the Bladder but in the Stomach; the pulse is faintly solid. Dusk is when Yangming qi tends to flourish; thus, fever and irritability double, indicating Stomach excess. Stomach excess prevents eating; eating triggers delirium, increasing excess. Da Cheng Qi Tang is indicated to purge. The text order is scrambled; "Heat in the interior" should follow "incomplete expulsion of lochia." There is no logic in using Da Cheng Qi Tang to purge Bladder blood knots. "Resolving at night" is likely a scribal error, absent in *Mai Jing*. ([Jin Jian] agrees, but considers "resolving at night" valid and "doubled" as erroneous.)
[Jin Jian] Li Dongyuan states: This section contains two syndromes: Taiyang blood retention and Yangming interior excess. Ancient textual complexity makes them hard to distinguish. "No Taiyang signs" means no exterior syndrome. Firm lower abdominal pain occurs because the Liver stores blood, and the lower abdomen is the Liver channel area; thus, blood knots here, causing firmness and pain. This incomplete lochia expulsion indicates heat in the interior, knotting in the Bladder—Taiyang blood retention. Purging stasis blood is indicated. If constipation, irritability, solid pulse, and delirium occur, it is Yangming interior excess. Doubled fever indicates heat steaming outward from the interior. Yangming flourishes at Shen, You, Xu hours; dusk is when Yangming tends to flourish, causing irritability and anorexia. The disease is in Yang, not Yin, hence resolving at night. This is Yangming Fu organ disease; Da Cheng Qi Tang is indicated to purge Stomach excess.
Note: You Zaijing argues: Not only is blood knotted below, but heat gathers in the middle. Treating only blood while neglecting the Stomach means blood may clear but heat remains, and blood clearance may fail. Da Huang and Zhi Shi in Da Cheng Qi Tang act on blood; Zhang Zhongjing uses them to achieve two goals at once. This interpretation is rejected. Li's annotation is more appropriate.
Postpartum wind strike, persisting for dozens of days without resolution, with mild headache, alternating chills and fever, chest oppression, dry retching, and sweating: Although prolonged, the Yang Dan syndrome persists; Yang Dan Tang can be administered. ([Original Note]: Same as Gui Zhi Tang formula, found in the Diarrhea chapter. ○ *Mai Jing* reads "Woman contracts wind after delivery, chest oppression," reading "chest firmness"; Xu/Shen read "Postpartum wind strike continuing.")
[Xu Lingtai] This passage discusses postpartum wind strike lingering unresolved with mixed exterior-interior symptoms, requiring wind dispersion. Mild wind strike persisting for days might seem not to require exterior treatment, but headache, chills, sweating, and intermittent fever are exterior signs. Chest oppression and dry retching indicate Taiyang pathogens attempting to enter internally but being rejected. Since Yang Dan signs persist, why not use Yang Dan Tang? Delay leads to error.
Note: Yang Dan Tang: Xu, Shen, You, and Jin Jian consider it Gui Zhi Tang plus Huang Qin. Wei Nianting, based on *Shang Han Lun* Yang Dan clause, considers it Gui Zhi Jia Fu Zi Tang. Both are incorrect. Only Cheng Lin following the original note is correct.
Zhang Lu's *Zhang Shi Yi Tong* cites this alongside the preceding Cheng Qi Tang as examples of exterior and interior treatments.
Postpartum wind strike with fever, flushed face, wheezing, and headache: Zhu Ye Tang (Bamboo Leaf Decoction) is indicated. ("Wheezing and," *Qian Jin* reads "wheezing breath"; "Headache," *Sheng Ji* reads "dizzy and painful head/eyes".)
[You Zaijing] This is a postpartum pattern with exterior pathogens and interior deficiency. Attacking the exterior risks qi collapse; tonifying the interior rejects exterior pathogens. Zhu Ye Tang uses Zhu Ye, Ge Gen, Gui Zhi, Fang Feng, Jie Geng to resolve exterior wind-heat; Ren Shen and Fu Zi secure interior collapse; Gan Cao, Sheng Jiang, Da Zao harmonize yin and yang. This is a method of simultaneous exterior-interior support. For exterior wind-heat invasion with insecure interior qi, this formula serves as a model.
[Shen Mingzong] Postpartum women are prone to Rou Jing (Soft Spasm). Thus, fever and headache, though Taiyang exterior signs, hint at impending spasm. Hence, the formula note adds: For stiff neck and back, add one Fu Zi.
Note: Jin Jian states: Three characters "those with Jing disease" should follow "Postpartum wind strike" to match the formula. Without them, how can Ren Shen and Fu Zi be used for wind strike with fever? Also, why name it Zhu Ye Tang? The formula note mentions adding Fu Zi for stiff neck. The text has signs but no formula, implying missing pages. This note is likely incorrect. The formula aims to prevent the onset of spasm; if spasm has already fully developed, it may be ineffective.
Zhu Ye Tang Formula
Zhu Ye (1 bundle ○ *Qian Jin*: 1 handful) Ge Gen (3 liang) Fang Feng (*Qian Jin*: 2 liang) Jie Geng Gui Zhi
Ren Shen Gan Cao (1 liang each) Da Zao (15 pieces) Sheng Jiang (5 liang) Fu Zi (1 piece, processed ○ *Huo Ren Shu*: omitted)
Decoct these ten ingredients in 1 dou of water to obtain 2.5 sheng. Divide into three warm doses. Cover warmly to induce sweating. ○ For stiff neck and back, use one large Fu Zi, broken into bean-sized pieces. Skim foam from the decoction. If vomiting, add 0.5 sheng of washed Ban Xia. (*Qian Jin*: Divides text, includes "remove dregs," omits "one piece" and subsequent twelve characters. "Front," Zhao version reads "decoct"; Xu notes "bean-sized" should be "enter." Based on Xu, break after "bean".)
[Cheng Lin] Postpartum blood deficiency and excessive sweating predispose to wind strike, causing Jing disease. Current signs lack opisthotonos but show fever, flushed face, and headache, indicating early wind spasm. Zhu Ye Tang treats wind spasm; Fang Feng treats internal spasm; Ge Gen treats Gang Jing (Hard Spasm); Gui Zhi treats Rou Jing (Soft Spasm); Sheng Jiang disperses wind; Jie Geng removes wind bi. This is a pungent-dispersing formula. Where pathogens gather, qi is deficient; Ren Shen secures defensive qi, Fu Zi warms meridians, Gan Cao harmonizes herbs, Da Zao assists the twelve channels. Compared to other wind formulas, it combines dispersion with tonification, serving as a major formula for postpartum wind strike. Stiff neck and back indicate spasm; add Fu Zi to dispel cold. Vomiting indicates wind-constrained rebellious qi; add Ban Xia to scatter rebellion.
*Zhang Shi Yi Tong* states: This is Gui Zhi Tang minus Bai Shao, plus Zhu Ye, Ge Gen, Fang Feng, Jie Geng, Ren Shen.
Since Fu Zi was historically included in the formula despite being in the notes, *Yi Tong* omits it, likely based on *Huo Ren Shu*.
It further states: Fu Zi was likely added later to treat stiff neck, as pathogen in Taiyang constrains sinews, preventing flexion/extension; Fu Zi warms meridians and dispels cold.
Skimming foam prevents acrid-hot ascending qi from aiding rebellious deficient yang. If pathogen is in the chest causing vomiting, add Ban Xia. "Break into bean size" refers to adding to the decoction. Old texts read "bean-sized"; Xu Zhongke corrected this.
For nursing women with interior deficiency, mental agitation, and vomiting/retching, An Zhong Yi Qi Wan (Stomach-Anchoring Qi-Supporting Pill) is indicated. ("Nursing," *Mai Jing* reads "Delivery".)
[Cheng Lin] The Stomach is the sea of water and grain, qi and blood. Postpartum blood and qi are deficient, causing rebellious stomach qi, leading to agitation and vomiting.
[You Zaijing] Nursing women with interior deficiency, agitation, and vomiting/retching experience qi deficiency and fire excess during lactation, causing internal chaos and upward rebellion.
Note: "Ru Zhong" likely refers to the confinement period, hence *Mai Jing* reads "Chan Zhong" (During Delivery). Shen Mingzong says "Ru" refers to nursing women. Wei Nianting says "Ru" means blood. Initial postpartum blood deficiency. Shen Mingzong suggests "Ru Xia" should have "Bi" (blockage), meaning milk obstruction. Jin Jian states the text, signs, and drugs are unclear. Zhang Lu says "Ru Zhong Xu" means excessive milk loss during nursing; both are errors.
Zhu Pi Da Wan Formula (*Huo Ren Shu*: Treats deficiency agitation, listed among male formulas.)
Sheng Zhu Ru (2 fen) Shi Gao (2 fen) Gui Zhi (1 fen) Gan Cao (7 fen) Bai Wei (1 fen)
Grind these five ingredients into powder. Mix with date paste to make pills the size of quail eggs. Take one pill with water, three times by day, twice by night. If heat is present, double Bai Wei. If agitation and wheezing occur, add 1 fen of Bai Shi. *Huo Ren Shu* reads Bai Shi as Zhi Shi.
[Cheng Lin] Zhu Ru is sweet and cold, stopping vomiting. Shi Gao is acrid and cold, relieving agitation and rebellion. Bai Wei is salty and cold, treating mania and evil qi. Cold agents can obstruct the diaphragm; Gui Zhi guides them. Cold agents harm the stomach; Gan Cao harmonizes it. Double Bai Wei for heat, as its salty-cold nature clears heat. Add Bai Shi for agitation/wheezing; its acrid-pungent nature treats wheezing. Date paste harmonizes herbs to anchor the middle and support qi.
Wu Shi's *Ji Yin Gang Mu* states: Interior deficiency precludes Shi Gao; agitation precludes Gui Zhi. This formula uses 7 fen Gan Cao against 6 fen of other herbs, made into pills taken singly with water, showing subtle formulation and difficult drug selection, emphasizing the challenge of distinguishing deficiency/excess. Taking with water avoids the danger of further weakening deficiency. Users should reflect deeply.
For postpartum diarrhea with extreme deficiency, Bai Tou Weng Jia Gan Cao E Jiao Tang (Bitter Violet Plus Licorice and Donkey-Hide Gelatin Decoction) is indicated. (*Mai Jing*: "Hot dysentery with heavy straining, new postpartum extreme deficiency"; *Qian Jin*: "Diarrhea deficiency" has "jian" [concurrent] character.)
[You Zaijing] For typhoid hot dysentery with heaviness in the rectum, Bai Tou Weng Tang is used. Cold conquers heat; bitter dries dampness. This is also hot dysentery with rectal heaviness, but in extreme postpartum deficiency, E Jiao is added to save yin, and Gan Cao tonifies the middle and generates flesh, while moderating the bitterness of Lian Lian and Huang Bo.
Note: Jin Jian states the text, signs, and drugs do not align and offers no explanation, likely due to the use of bitter-cold herbs in extreme deficiency.
Bai Tou Weng Jia Gan Cao E Jiao Tang Formula (*Qian Jin*: Named Bai Tou Weng Tang.)
Bai Tou Weng Gan Cao E Jiao (2 liang each) Qin Pi Huang Lian (*Qian Jin*: 2 liang each) Bai Pi (3 liang each)
Decoct these six ingredients in 7 sheng of water to obtain 2.5 sheng. Dissolve E Jiao into the liquid. Divide into three warm doses.