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。
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。
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。
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。而此反喜汗出者。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。
小柴胡汤方（见呕吐）
病解能食。七八日更发热者。此为胃实。宜大承气汤主之。
病解能食。谓郁冒解而能受食也。至七八日更发热。此其病不在表而在里。不属虚而属实矣。是
宜大承气以下里实。
大承气汤方（见痉）
产后腹中 痛。当归生姜羊肉汤主之。兼主腹中寒疝。虚劳不足。
产后腹中 痛。与妊娠腹中 痛不同。彼为血虚而湿扰于内。此为血虚而寒动于中也。当归、生
姜温血散寒。孙思邈云。羊肉止痛利产妇。
当归生姜羊肉汤方（见寒疝）
产后腹痛。烦满不得卧。枳实芍药散主之。
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。
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。并主痈脓。大麦粥下之。
师曰。产妇腹痛。法当以枳实芍药散。假令不愈者。此为腹中有瘀血着脐下。宜下瘀血汤主之。
亦主经水不利。
腹痛服枳实芍药而不愈者。以有瘀血在脐下。着而不去。是非攻坚破积之剂。不能除矣。大黄、桃
仁、 虫。下血之力颇猛。用蜜丸者。缓其性不使骤发。恐伤上二焦也。酒煎顿服者。补下治下制以
急。且去疾惟恐不尽也。
下瘀血汤方
大黄（三两） 桃仁（二十个） 虫（二十枚去足熬）
上三味末之。炼蜜和为四丸。以酒一升煮一丸。取八合。顿服之。新血下如豚肝。
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。更倍发热。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。
无太阳证者。无头痛恶寒之表证也。产后七八日。少腹坚痛。恶露不尽。但宜行血去瘀而已。然
不大便。
烦躁。发热。脉实。则胃之实也。日晡为阳明旺时。而烦躁甚于他时。又胃热之验也。食气入胃。
长气于阳。
食入而助胃之热则谵语。至夜阳明气衰而谵语愈。又胃热之验也。故曰热在里。结在膀胱。里即
阳明。
膀胱即少腹。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。
产后风。续续数十日不解。头微疼。恶寒。时时有热。心下闷。干呕汗出。虽久。阳旦证续在者。
可与阳旦汤。
产后中风。至数十日之久。而头疼寒热等证不解。是未可卜度其虚。而不与解之散之也。阳旦汤
治伤寒太阳中风挟热者。此风久而热续在者。亦宜以此治之。夫审证用药。不拘日数。表里既分。汗
下斯判。
上条里热成实。虽产后七八日。与大承气而不伤于峻。此条表邪不解。虽数十日之久。与阳旦汤
而不虑其散。非通于权变者。未足以语此也。
阳旦汤方（即桂枝汤加黄芩）
产后中风。发热面正赤。喘而头痛。竹叶汤主之。
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。
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）
生姜（五两） 大枣（十五枚）
上十味。以水一斗。煮取二升半。分温三服。覆使汗出。头项强。用大附子一枚破之。如豆大。
前药扬去沫。呕者加半夏半升洗。
妇人乳中虚。烦乱呕逆。安中益气。竹皮大丸主之。
妇人乳中虚。烦乱呕逆者。乳子之时。气虚火胜。内乱而上逆也。竹茹、石膏。甘寒清胃。桂枝、
甘草。辛甘化气。白薇性寒入阳明。治狂惑邪气。故曰安中益气。
竹皮大丸方
生竹茹 石膏（各二分） 桂枝 白薇（各一分） 甘草（七分）
上五味末之。枣肉和丸。弹子大。饮服一丸。日三夜二服。有热倍白薇。烦喘者。加柏实一分。
产后下利虚极。白头翁加甘草阿胶汤主之。
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。甘草补中生阳。且以缓连、柏之苦也。
白头翁加甘草阿胶汤方
白头翁 甘草 阿胶（各二两） 秦皮 黄连 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。
附方
千金三物黄芩汤 治妇人在草蓐。自发露得风。四肢苦烦热。头痛者。与小柴胡汤。头不痛。
但烦者。此汤主之。
黄芩（一两） 苦参（二两） 干地黄（四两）
上三味。以水六升。煮取二升。温服一升。多吐下虫。
此产后血虚风入而成热之证。地黄生血。苦参、黄芩除热也。若头痛者。风未全变为热。故宜柴
胡解之。
千金内补当归建中汤 治妇人产后虚羸不足。腹中刺痛不止。吸吸少气。或苦少腹急。痛引
腰背。不能食饮。产后一月。日得服四五剂为善。令人强壮宜。
当归（四两） 桂枝 生姜（各三两） 芍药（六两） 甘草（二两） 大枣（十二枚）
上六味。以水一斗。煮取三升。分温三服。一日令尽。若大虚加饴糖六两。汤成内之。于火上暖
令饴消。若去血过多。崩伤内衄不止。加地黄六两。阿胶二两。合八味汤成。内阿胶。若无当归。以
芎代之。若无生姜。以干姜代之。
Question: A woman who has just given birth may suffer from three types of illness. One is Jing disease (spasm), the second is Yu Mao (depression and dizziness), and the third is difficulty in defecation. What does this mean? The Master said: After childbirth, blood deficiency and excessive sweating make one prone to contracting wind pathogens, thus causing Jing disease (spasm). Loss of blood followed by sweating leads to an excess of cold, thus causing Yu Mao (depression and dizziness). Depletion of body fluids leads to dryness in the stomach, thus causing difficulty in defecation.
Jing disease (spasm) is a disorder of the sinews. Blood deficiency and excessive sweating cause the sinews and vessels to lose nourishment; when wind pathogens invade, they exacerbate the stiffness of the sinews. Yu Mao (depression and dizziness) is a disorder of the spirit. Loss of yin blood leads to blood deficiency, causing yang qi to rebel upward; combined with the constraint of cold pathogens, 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. Depletion of body fluids leads to stomach dryness, causing the large intestine to lose its moisture, resulting in difficult defecation. Although these three illnesses present differently, their root cause is the same: loss of blood and injury to body fluids. Therefore, they are all diseases common after childbirth.
When a postpartum woman suffers from Yu Mao (depression and dizziness), her pulse is faint, she vomits and cannot eat, her stool is hard, and only her head sweats. This occurs because blood deficiency causes qi rebellion, which inevitably leads to dizziness. For Yu Mao (depression and dizziness) to resolve, there must be profuse sweating throughout the body. Due to blood deficiency causing lower jiao qi rebellion, isolated yang qi rushes upward, resulting in sweating only on the head. Therefore, postpartum women tend to sweat because the loss of yin blood leads to blood deficiency, allowing yang qi to become hyperactive. Sweating allows yin and yang to restore balance. For cases involving hard stool, vomiting, and inability to eat, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Although Yu Mao (depression and dizziness) involves external pathogens, its root lies in internal deficiency, hence the faint pulse. Vomiting, inability to eat, hard stool, and sweating only on the head are signs that yin fluids and qi ascend but do not descend. This happens because yin blood is depleted, isolated yang qi rebels upward, and fluids and qi follow. Rebellion inevitably causes dizziness. For those suffering from dizziness to recover, profuse sweating is required because yin and yang have temporarily separated, causing rebellion and dizziness; once yin and yang reconnect, profuse sweating occurs, leading to recovery. Postpartum women are newly deficient and should not sweat excessively, yet here they prefer to sweat because blood loss leads to yin deficiency, and yang qi, affected by pathogens, becomes hyperactive. Sweating expels the pathogens; as yang qi weakens, it can harmonize with yin. This is what is meant by "diminishing yang to accommodate yin." Xiao Chai Hu Tang (Minor Bupleurum Decoction) is used because pathogens must be dispersed, and the deficiency of healthy qi must not be ignored. Only this method can disperse external pathogens and harmonize yin and yang.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) formula (see section on Vomiting).
If the patient recovers and can eat, but develops fever again after seven or eight days, this indicates excess heat in the stomach. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
"Recovery and ability to eat" refers to the resolution of Yu Mao (depression and dizziness) and the return of appetite. Fever developing after seven or eight days indicates that the pathology is no longer in the exterior but in the interior, shifting from deficiency to excess. In such cases, Da Cheng Qi Tang (Major Order the Qi Decoction) should be used to purge interior excess.
Da Cheng Qi Tang (Major Order the Qi Decoction) formula (see section on Spasm).
For abdominal pain after childbirth, Dang Gui Sheng Jiang Yang Rou Tang (Angelica, Ginger, and Mutton Decoction) is indicated. It also treats abdominal cold cramps and deficiency-wasting conditions.
Abdominal pain after childbirth differs from abdominal pain during pregnancy. Pregnancy-related pain is due to blood deficiency and internal dampness disturbance; postpartum pain is due to blood deficiency and internal cold movement. Dang Gui (Angelica Root) and Sheng Jiang (Fresh Ginger) warm the blood and dispel cold. Sun Simiao stated that mutton relieves pain and benefits postpartum women.
Dang Gui Sheng Jiang Yang Rou Tang (Angelica, Ginger, and Mutton Decoction) formula (see section on Cold Cramps).
For postpartum abdominal pain accompanied by irritability, fullness, and inability to lie down, Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) is indicated.
Postpartum abdominal pain progressing to irritability, fullness, and inability to lie down indicates blood stagnation transforming into heat, where lower jiao pathology obstructs the upper jiao. This differs from deficiency-cold abdominal pain. Zhi Shi (Immature Bitter Orange) is charred to enter the blood level and move stagnation; combined with Shao Yao (Peony Root), it harmonizes blood and relieves pain.
Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) formula
Zhi Shi (Immature Bitter Orange) (charred until black, but not overly so) Shao Yao (Peony Root) (equal parts)
Grind the two ingredients into a powder. Take one cun bi (measure) per dose, three times daily. This formula also treats abscesses and pus. Administer with Barley Porridge.
The Master said: For postpartum abdominal pain, Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) is the standard treatment. If it fails to cure, it indicates blood stasis adhering below the navel. Xia Yu Xue Tang (Decoction to Drain Blood Stasis) is indicated. It also treats irregular menstruation.
If abdominal pain persists despite taking Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder), it is because blood stasis is fixed below the navel. Strong agents that break accumulation are required. Da Huang (Rhubarb Root), Tao Ren (Peach Seed), and E Chong (Ground Beetle) have potent blood-draining effects. Forming pills with honey slows their action to prevent sudden onset, protecting the upper and middle jiao. Decocting in wine and taking it at once follows the principle of "urgent preparation for treating the lower jiao," ensuring complete removal of the pathogen.
Xia Yu Xue Tang (Decoction to Drain Blood Stasis) formula
Da Huang (Rhubarb Root) (3 liang) Tao Ren (Peach Seed) (20 seeds) E Chong (Ground Beetle) (20 pieces, feet removed, roasted)
Grind the three ingredients into powder. Mix with refined honey to form four pills. Decoct one pill in one sheng of wine, reduce to eight he, and take at once. Freshly expelled blood will resemble pig liver.
Seven or eight days after childbirth, without Taiyang syndrome symptoms, if there is hardness and pain in the lower abdomen, this is due to incomplete expulsion of lochia. Accompanied by constipation, irritability, fever, and a slightly solid pulse, with worsening fever, evening irritability, anorexia, delirium after eating, and relief at night, Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. The heat is in the interior, and the knot is in the Bladder (referring to the lower abdomen).
"No Taiyang syndrome" means absence of exterior symptoms like headache and aversion to cold. Seven or eight days postpartum, with hardness and pain in the lower abdomen and incomplete lochia, blood-invigorating and stasis-resolving methods are appropriate. However, constipation, irritability, fever, and a solid pulse indicate stomach excess. Shen Wang (Shen hour, 3-5 PM) is the peak time for Yangming meridian activity; severe irritability at this time confirms stomach heat. Food entering the stomach boosts yang qi; food intake aggravating stomach heat causes delirium. Delirium subsiding at night when Yangming qi declines further confirms stomach heat. Thus, "heat in the interior, knot in the Bladder." "Interior" refers to Yangming Stomach; "Bladder" here refers to the lower abdomen. This means not only is blood knotted in the lower jiao, but heat also gathers in the middle jiao. Treating only blood while neglecting the stomach leaves heat unremoved, and blood may not be effectively cleared. In Da Cheng Qi Tang (Major Order the Qi Decoction), Da Huang (Rhubarb Root) and Zhi Shi (Immature Bitter Orange) also act on blood. Zhang Zhongjing likely used them to achieve two goals with one strike.
For postpartum wind-stroke persisting for dozens of days without resolution, with mild headache, aversion to cold, intermittent fever, chest oppression, dry retching, and sweating, even if prolonged, if the Yang Dan syndrome persists, Yang Dan Tang is indicated.
Postpartum wind-stroke lasting dozens of days with unresolved headache, chills, and fever should not be assumed as purely deficiency requiring no dispersal. Yang Dan Tang treats Taiyang wind-stroke complicated by heat. Here, wind lingers with persistent heat, making this formula suitable. Treatment depends on syndrome differentiation, not duration. Once exterior and interior are distinguished, sweating and purging methods are determined.
The previous case involved interior heat becoming excess; even seven or eight days postpartum, Da Cheng Qi Tang (Major Order the Qi Decoction) was not too harsh. This case involves unresolved exterior pathogens; even after dozens of days, Yang Dan Tang is safe from excessive dispersal. Those unfamiliar with flexible application cannot discuss these matters.
Yang Dan Tang formula (Guizhi Tang [Cinnamon Twig Decoction] plus Huang Qin [Scutellaria Root]).
For postpartum wind-stroke with fever, bright red face, wheezing, and headache, Zhu Ye Tang (Bamboo Leaf Decoction) is indicated.
This is a pattern of exterior pathogens with concurrent interior deficiency in postpartum women. Attacking the exterior risks floating qi and collapse; tonifying the interior may fail to address exterior pathogens. Zhu Ye Tang (Bamboo Leaf Decoction) uses Zhu Ye (Bamboo Leaves), Ge Gen (Kudzu Root), Gui Zhi (Cinnamon Twig), Fang Feng (Saposhnikovia Root), and Jie Geng (Platycodon Root) to release exterior wind-heat; Ren Shen (Ginseng Root) and Fu Zi (Aconite Root) secure interior qi against collapse; Gan Cao (Licorice Root), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube Fruit) harmonize yin and yang. This is a method of treating both exterior and interior simultaneously.
For exterior wind-heat invasion with insecure interior qi, this formula serves as a model.
Zhu Ye Tang (Bamboo Leaf Decoction) formula
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) (each 1 liang) Fu Zi (Aconite Root) (1 piece, processed) Sheng Jiang (Fresh Ginger) (5 liang) Da Zao (Jujube Fruit) (15 pieces)
Decoct the ten ingredients in one dou of water, reduce to two and a half sheng, divide into three warm doses. Cover to induce sweating. For stiff neck, use one large Fu Zi (Aconite Root), broken into bean-sized pieces. Boil prior medicines, skimming off foam. Add Ban Xia (Pinellia Tuber), half a sheng, washed, if vomiting occurs.
During lactation, if a woman suffers from deficiency, irritability, restlessness, vomiting, and regurgitation, Zhu Pi Da Wan (Bamboo Peel Large Pill) is used to calm the middle and boost qi.
Irritability, restlessness, vomiting, and regurgitation during lactation result from qi deficiency and fire hyperactivity disturbing internally and ascending. Zhu Ru (Bamboo Shavings) and Shi Gao (Gypsum) are sweet and cold, clearing the stomach; Gui Zhi (Cinnamon Twig) and Gan Cao (Licorice Root) are pungent and sweet, generating qi; Bai Wei (Anemarrhenae Rhizoma) is cold, enters the Yangming channel, and treats mania and evil qi. Hence, it calms the middle and boosts qi.
Zhu Pi Da Wan (Bamboo Peel Large Pill) formula
Sheng Zhu Ru (Fresh Bamboo Shavings) Shi Gao (Gypsum) (each 2 fen) Gui Zhi (Cinnamon Twig) Bai Wei (Anemarrhenae Rhizoma) (each 1 fen) Gan Cao (Licorice Root) (7 fen)
Grind the five ingredients into powder. Mix with date paste to form pills the size of a quail egg. Take one pill with water, three times during the day and twice at night. Increase Bai Wei (Anemarrhenae Rhizoma) if heat is present; add Bai Zi Ren (Biota Seed), 1 fen, if irritability and wheezing occur.
For postpartum diarrhea with extreme deficiency, Bai Tou Weng Jia Gan Cao E Jiao Tang (Baitouweng Decoction with Added Licorice and Donkey-Hide Gelatin) is indicated.
For heat-dysentery with heaviness in the lower rectum caused by cold damage, Bai Tou Weng Tang (Baitouweng Decoction) is used. Cold overcomes heat; bitterness dries dampness. This is also heat-dysentery with heaviness, but occurring in extreme postpartum deficiency. Therefore, E Jiao (Donkey-Hide Gelatin) is added to nourish yin, and Gan Cao (Licorice Root) to tonify the middle and generate yang, while moderating the bitterness of Lian Mu (Coptis Rhizome) and Huang Bo (Phellodendron Bark).
Bai Tou Weng Jia Gan Cao E Jiao Tang (Baitouweng Decoction with Added Licorice and Donkey-Hide Gelatin) formula
Bai Tou Weng (Pulsatilla Root) Gan Cao (Licorice Root) E Jiao (Donkey-Hide Gelatin) (each 2 liang) Qin Pi (Ash Bark) Huang Lian (Coptis Rhizome) Huang Bo (Phellodendron Bark) (each 3 liang)
Decoct the six ingredients in seven sheng of water, reduce to two and a half sheng. Dissolve E Jiao (Donkey-Hide Gelatin) into the decoction. Divide into three warm doses.
Supplementary Formula
Qian Jin San Wu Huang Qin Tang (Three-Ingredient Scutellaria Decoction from Essential Prescriptions Worth a Thousand Gold) treats women in the puerperium who expose themselves to wind. Symptoms include vexed heat in the four limbs and headache. Give Xiao Chai Hu Tang (Minor Bupleurum Decoction); if there is no headache but only vexation, this formula is indicated.
Huang Qin (Scutellaria Root) (1 liang) Ku Shen (Sophora Root) (2 liang) Gan Di Huang (Rehmannia Root Preparata) (4 liang)
Decoct the three ingredients in six sheng of water, reduce to two sheng. Take one sheng warm. Worms may be vomited or excreted.
This is a pattern of heat generated by wind invasion following blood deficiency postpartum. Di Huang (Rehmannia Root) generates blood; Ku Shen (Sophora Root) and Huang Qin (Scutellaria Root) clear heat. If headache is present, wind has not fully transformed into heat, so Chai Hu (Bupleurum Root) is suitable to resolve the exterior.
Qian Jin Nei Bu Dang Gui Jian Zhong Tang (Internal Tonifying Angelica and Middle-Building Decoction from Essential Prescriptions Worth a Thousand Gold) treats postpartum weakness, emaciation, and insufficiency, with unceasing stabbing pain in the abdomen, shortness of breath, or distress from lower abdominal urgency, pain radiating to the back, and inability to eat or drink. During the first month postpartum, taking four or five doses daily is beneficial for strengthening the body.
Dang Gui (Angelica Root) (4 liang) Gui Zhi (Cinnamon Twig) Sheng Jiang (Fresh Ginger) (each 3 liang) Shao Yao (Peony Root) (6 liang) Gan Cao (Licorice Root) (2 liang) Da Zao (Jujube Fruit) (12 pieces)
Decoct the six ingredients in one dou of water, reduce to three sheng. Divide into three warm doses, consuming within one day. If very deficient, add Yi Tang (Maltose), 6 liang, to the finished decoction, warming on fire until dissolved. If blood loss is excessive, with metrorrhagia or internal hemorrhage uncontrolled, add Di Huang (Rehmannia Root), 6 liang, and E Jiao (Donkey-Hide Gelatin), 2 liang, forming an eight-ingredient decoction, adding E Jiao (Donkey-Hide Gelatin) last. If Dang Gui (Angelica Root) is unavailable, use Xiong Duan (Ligusticum Rhizome); if Sheng Jiang (Fresh Ginger) is unavailable, use Gan Jiang (Dried Ginger).