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（之妇。畏其无汗。若无汗。则营卫不和。而为发热无汗等证。似乎伤寒之表病。但
舌无白苔。及无头痛项强。可辨也。然虽欲有汗。又恐其）血虚。（气热。热则腠理开
而）多汗出。（汗出则腠理愈开。而）喜中风。（血不养筋。而风又动火。）故令病痉。
（新产之妇。畏血不行。若不行。则血瘀于内。而为发热腹痛等证。似乎伤寒里病。但
舌无黄苔。又无大烦躁大狂渴之可辨也。然虽欲血下。又恐下过多而）亡血。（血亡。
其气无耦而外泄。则）复汗。（气血两耗。则寒自内生。而）寒多。（血为阴。阴亡
失守。气为阳。阳虚上厥。）故令（头眩目瞀。或不省人事。而）郁冒。（新产之妇。
虽欲其汗出血行。又恐汗与血过多。以致）亡津液胃（干肠）燥。故大便难。（三者不
同。其为亡血伤津。则一也。）
此为产后提出三病以为纲。非谓产后止此三病也。
（上言新产之病。其纲有三。然痉病有竹叶汤之治法。另详于后。试先言郁冒与
大便难相兼之证。）产妇郁冒。（邪少而虚多。故）其脉微弱。（中虚。故）呕（而）不
能食。（胃液干。故）大便反坚。（身无汗。）但头汗出。（此数证。皆郁冒中兼有
之证也。究其郁冒之）所以然者。血虚（则阴虚。阴虚）而（阳气上）厥。厥而必冒。
冒家欲解。必大汗出。（是阳气郁。得以外泄而解也。然其所以头汗奈何。）以血虚（
为）下（之阴气既）厥。（则阳为孤阳。）孤阳上出。故头汗出。（又或不解。其）所以
（然者。请再申之。盖）产妇（头汗既出。又）喜（其通身）汗出（而解）者。亡阴血虚。
阳气独盛。故当（损阳令其）汗出。（损阳就阴。则）阴阳乃（平而）复。（须知其）
大便坚。（不为实热。而为津少也。其）呕（不为胃气寒。而为胆气逆也。其）不能食。
（不为热不杀谷。而为胃气不和也。以）小柴胡汤主之。（此汤为邪少虚多之对症也。）
此为郁冒与大便难之相兼者。详其病因。而出其方治也。
小柴胡汤方（见呕吐）
（郁冒之）病（既）解（而）能食。（至）七八日更发热者。（能发热而不恶寒。
便知其不在表。而在里矣。因能食而更发热。便知其非虚病。而为食复矣。）此为胃实。
宜大承气汤主之。
此言大虚之后有实证。即当以实治之也。若畏承气之峻而不敢用。恐因循致虚。病
变百出。甚矣哉。庸庸者不堪以共事也。若畏承气之峻。而用谷芽麦芽山楂神曲之类。
消耗胃气。亦为害事。
大承气汤方（见痉）
产后（属虚。客寒阻滞气血。则）腹中 痛。（以）当归生姜羊肉汤主之。并治腹
中寒疝。虚劳不足。
参各家说。 痛者。缓缓痛也。概属客寒相阻。故以当归通血分之滞。生姜行气分
之寒。然胎前责实。故当归芍药散内加茯苓泽泻。泻其水湿。此属产后。大概责虚。故
以当归养血而行血滞。生姜散寒而行气滞。又主以羊肉味浓气温。补气而生血。俾气血
得温。则邪自散而痛止矣。此方攻补兼施。故并治寒疝虚损。或疑羊肉太补。而不知孙
真人谓羊肉止痛利产妇。古训凿凿可据。又何疑哉。
当归生姜羊肉汤方（见寒疝）
（然痛亦有不属于虚者。不可不知。）产后腹痛。（若不烦不满。为中虚而寒动也。
今则火上逆而）烦（气壅滞而）满（胃不和而）不得卧。（此热下郁而碍上也。以）枳
实芍药散主之。
此为腹痛而烦满不得卧者。出其方治也。方意是调和气血之滞。所谓通则不痛之轻
剂也。下以大麦粥者。兼和其肝气。而养心脾。故痈脓亦主之。
枳实芍药散方
枳实（烧令黑勿太过） 芍药（各等分）
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（热灼血干。）腹中有瘀
血。（其痛）着（于）脐下。（非枳实芍药所能治也。）宜下瘀血汤主之。亦主经水不
利。
此为痛着脐下。出其方治也。意者病去则虚自回。不必疑其过峻。
下瘀血汤方
大黄（三两） 桃仁（三十个） 虫（二十枚去足熬）
上三味末之。炼蜜和为四丸。以酒一升。煮丸。取八合。顿服之。新血下如豚肝。
（张石顽云。加蜜以缓大黄之急也。）
（然亦有不可专下其瘀者。不可不知。）产后七八日。无（头痛发热恶寒之）太阳
证。少腹坚痛。此恶露不尽。（治者。不外下其瘀血而已。然其）不大便。烦躁发热。
切脉微实。（是胃家之实也。阳明旺于申酉戌。日晡是阳明向旺之时。其）更倍发
热。（至）日晡时烦躁者。（又胃热之验也。食入于胃。长气于阳。若）不食。（则已
而。）食。（入）则（助胃之热为）谵语。（又胃热之验也。然又有最确之辨。昼。阳也。
夜。阴也。若病果在阴。宜昼轻而夜重。今）至夜（间。应阳明气衰之时。而）即（稍
）愈。（其为胃家之实热。更无疑也。）宜大承气汤主之。（盖此汤热与结兼祛。以阳
明之）热在里。（少腹之）结在膀胱也。
此言血虽结于少腹。若胃有实热。当以大承气汤为主。若但治其血而遗其胃。则血
虽去而热不除。即血亦未必能去也。此条至夜即愈四字。为辨证大眼目。盖昼为阳而主
气。暮为阴而主血。观下节妇人伤寒发热。经水适来。昼日明了。暮则谵语。如见鬼状
者。此为热入血室。以此数句而对面寻绎之。便知至夜则愈。知其病不专在血也。
产后（中）风续续。数十日不解。（似不应在桂枝证之例矣。然）头微疼。恶寒。
时时有热。（皆桂枝本证。中唯一证）心下闷。（邪入胸膈。为太阳之里证。其余）干
呕汗出。（俱为桂枝证例中。本有之证。是桂枝证更进一层。即为阳旦证。桂枝汤稍
为加增。即为阳旦汤。病）虽久。（而）阳旦证续在者。可与阳旦汤。
张石顽云、举此与上文承气汤为一表一里之对子。盖不以日数之多。而疑其无表证
也。
愚按、此言产后阳旦证未罢。病虽久而仍用其方也。伤寒论太阳篇。有因加附子参
其间。增桂令汗出之句。言因者。承上病证象桂枝。因取桂枝汤之原方也。言增桂者。
即于桂枝汤原方外。更增桂枝二两。合共五两是也。言加附子参其间者。即于前方间。
参以附子一枚也。孙真人于此数句。未能体认。反以桂枝汤加黄芩为阳旦汤。后人因之。
至今相沿不解。甚哉。读书之难也。然此方伤寒论特笔用令汗出三字。大是眼目。其
与桂枝加附子汤之治遂漏者。为同中之异。而亦异中之同。盖止汗漏者。匡正之功。令
出汗者。驱邪之力。泛应曲当。方之所以入神也。上节里热成实。虽产七八日。与大承
气汤而不伤于峻。此节表邪不解。虽数十日之久。与阳旦汤而不虑其散。此中之奥妙。
难与浅人道也。丹溪谓产后惟大补气血为主。其余以末治之。又云、芍药伐生生之气。
此授庸医藏拙之术以误人。不得不直斥之。头疼恶寒。时时有热。自汗。干呕。俱是桂
枝证。而不用桂枝汤者。以心下闷。当用桂枝去芍药汤之法。今因产后亡血。不可径去
芍药。须当增桂以宣其阳。汗出至数十日之久。虽与发汗遂漏者迥别。亦当借桂枝加附
子汤之法。固少阴之根以止汗。且止汗即在发汗之中。此所以阳旦汤为丝丝入扣也。
阳旦汤方（坊本俱作桂枝汤加黄芩。今因伤寒论悟出。是桂枝汤增桂加附子。）
（前以痉病为产后三大纲之一。然痉病皆由起于中风。今以中风将变痉而言之。）
产后中风发热。面正赤。喘而头痛。（此病在太阳。连及阳明。而产后正气大虚。又不
能以胜邪气。诚恐变为痉证。以）竹叶汤主之。
此为产后中风。正虚邪盛者。而出其补正散邪之方也。方中以竹叶为君者。以风为
阳邪。不解即变为热。热甚则灼筋而成痉。故于温散药中。先以此而折其势。即杜渐防
微之道也。（次男元犀按。太阳之脉。上行至头。阳明脉过膈上复于面。二经合病。
多加葛根。）
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。煎取二升半。分温三服。覆使汗出。颈项强。用大附子一枚。
破之如豆大。（一本作入）前药扬去沫。呕者加半夏半升洗。
张石顽云、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。
妇人乳中虚。烦乱呕逆。安中益气。竹皮大丸主之。
徐忠可云、乳者。乳子之妇也。言乳汁去多。则阴血不足。而胃中亦虚。内经云、
阴者。中之守也。阴虚不能
胜阳。而火上壅则烦。气上越则呕。烦而乱。则烦之甚也。呕而逆。则呕之甚也。病本
全由中虚。然而药止用竹茹桂甘石膏白薇者。盖中虚而至为呕为烦。则胆腑受邪。烦呕
为主病。故以竹茹之除烦止呕者为君。胸中阳气不用。故以桂甘扶阳。而化其逆气者为
臣。以石膏凉上焦气分之虚热为佐。以白薇去表间之浮热为使。要知烦乱呕逆。而无腹
痛下利等证。虽虚。无寒可疑也。妙在加桂于凉剂中。尤妙在甘草独多。意谓散蕴蓄之
邪。复清阳之气。中即自安。气即自益。故无一补剂。而反注其立汤之本意曰安中益气。
竹皮大丸。神哉。喘加柏实。柏每西向。得西方之气最清。故能益金。润肝木而养心。
则肺不受烁。喘自平也。有热倍白薇。盖白薇能去浮热。故短剧桂枝加龙骨牡蛎汤云。
汗多热浮者。去桂加白薇附子各三分。名曰二加龙骨汤。则白薇之能去浮热可知矣。
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。
（凡下利病。多由湿热。白头翁之苦以胜湿。寒以除热。固其宜也。而）产后下利
虚极。（似不可不商及补剂。但参术则恐其壅滞。苓泽则恐其伤液。惟以）白头翁加甘
草阿胶汤主之。（诚为对证。方中甘草之甘凉清中。即所以补中。阿胶之滋润去风。即所
以和血。以此治利。即以此为大补。彼治利而好用参术者。当知所返矣。）
此为产后下利虚极者。而出其方治也。
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。煎取二升半。内胶。令消尽。分温三服。
附方
千金三物黄芩汤 治妇人（未离产所。尚）在（于）草蓐。自发（去衣被）
露（其身体而）得（微）风。（亡血之后。阳邪客入。则）四肢苦烦热。（然此证当
辨其头之痛与不痛。若）头痛者。（是风未全变为热。）与小柴胡汤。（以解之。若）
头不痛但烦者。（则已全变为热矣。热盛则虫生。势所必至。以）此汤主之。
按附方者。金匮本书阙载。而千金外台等书载之。其云出自金匮。后人别之曰附方。
黄芩（一两） 苦参（二两） 干地黄（四两）
上三味。以水六升。煎取二升。温服一升。多吐下虫。
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
少腹中急摩痛引腰背。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。煎取三升。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。
徐忠可云、后虚羸不足。先因阴虚。后并阳虚。补阴则寒凝。补阳则气壅。后天以
中气为主。故治法亦
出于建中。但加当归。即偏于内。故曰内补当归建中汤。谓腹中刺痛不止。血少也。吸
吸少气。阳弱也。故将桂枝生姜当归之辛温。以行其营卫之气。甘草白芍以养其脾阴之
血。而以饴糖大枣峻补中气。则元气自复。而羸者丰。痛者止也。然桂枝于阴阳内外。
无所不通。尤妙得当归善入阴分。治带下之疾。故又主少腹急摩痛引腰背不能饮食者。
盖带下病去。而中气自强也。曰产后一月日得服四五剂为善。谓宜急于此调之。庶无后
时之叹。然药味和平。可以治疾。可以调补。故又曰令人强壮宜。其云大虚加饴糖。以虚
极无可支撑。惟大甘专于补脾。脾为五脏六腑之母。止此一条。可以得其生路也。其去
血过多。崩伤内衄。加干地黄阿胶。以其所伤原偏于阴。故特多加阴药。非产后必宜用
地黄阿胶也。
Question: What are the three diseases commonly suffered by women shortly after childbirth? One is Jing disease (a condition characterized by stiffness of the neck and back, and opisthotonos). The second is Yu Mao (symptoms characterized by dizziness and blurred consciousness). The third is difficulty in defecation. What is the reason for this?
The Master replied: For women who have just given birth, one worries about their lack of sweat. If there is no sweat, it leads to disharmony between Ying (Nutrient) and Wei (Defensive) Qi, resulting in symptoms such as fever and anhidrosis, which resembles a Exterior syndrome of Shang Han (Cold Damage). However, it can be distinguished by observing that the tongue coating is not white, and there is no headache or stiffness of the neck and back. Nevertheless, although sweating is desired, one fears... blood deficiency. (Qi heat causes the pores to open, leading to) excessive sweating. (After sweating, the pores become even more open, making one) prone to wind invasion. (Because blood fails to nourish the tendons, and wind stirs fire.) Thus, Jing disease occurs.
For women who have just given birth, one worries about stagnant blood flow. If blood does not circulate, it stagnates internally, causing symptoms such as fever and abdominal pain, resembling an Interior syndrome of Shang Han. However, it can be distinguished by observing that the tongue coating is not yellow, and there is no severe restlessness, mania, or extreme thirst. Nevertheless, although one desires the expulsion of stagnant blood, one fears that excessive discharge will lead to) loss of blood. (When blood is lost, Qi loses its companion and escapes outward, leading to) recurrent sweating. (When both Qi and Blood are depleted, cold arises from within, leading to) excess of cold. (Blood belongs to Yin; when Yin fluids are lost, they fail to retain. Qi belongs to Yang; when Yang Qi is deficient, it rebels upward.) Thus, Yu Mao occurs (dizziness, visual disturbances, or even loss of consciousness).
For women who have just given birth, although one hopes for the release of sweat and smooth circulation of blood, one fears that excessive loss of sweat and blood will lead to) depletion of body fluids, causing dryness of the stomach (and intestines). Hence, difficulty in defecation occurs. (Although these three diseases are different, their essence is the same: loss of blood and injury to body fluids.)
These three diseases are listed as the outline for postpartum conditions, not implying that these are the only diseases occurring after childbirth.
(Above, it was stated that the outline of postpartum diseases has three aspects. However, Jing disease has its treatment method using Zhuye Tang, which is detailed later. Now, let us first discuss the syndrome where Yu Mao and difficulty in defecation occur together.) When a postpartum woman suffers from Yu Mao. (Since pathogenic factors are few and deficiency is predominant,) her pulse is faint. (Due to Middle Jiao deficiency,) she vomits (and) cannot eat. (Due to dryness of stomach fluids,) her stool becomes hard. (Her body has no sweat.) Only her head sweats. (These several symptoms are all accompanying signs of Yu Mao. The root cause of Yu Mao lies in blood deficiency (leading to Yin deficiency), and (Yang Qi rebelling) upward. Rebellious Qi inevitably causes dizziness. For a patient with Yu Mao to recover, profuse sweating of the whole body must occur. (This allows the constrained Yang Qi to vent outward and resolve. But why is there only head sweating?) It is because blood deficiency (leads to) rebellion of (lower) Yin Qi. (Then Yang becomes isolated Yang.) Isolated Yang floats upward, causing head sweating. (If it still does not resolve, the reason (is as follows. Let me reiterate. Generally,) for a postpartum woman (after head sweating, she also) desires (whole-body) sweating (to resolve) because loss of Yin blood leads to blood deficiency, leaving Yang Qi hyperactive. Therefore, one should (reduce the excess Yang to induce) sweating. (By reducing Yang to align with Yin,) Yin and Yang will (balance and) restore. (Note that her) hard stool (is not due to excess heat, but due to insufficient fluids. Her) vomiting (is not due to Cold in the Stomach, but due to rebellious Gallbladder Qi. Her) inability to eat (is not due to heat failing to digest food, but due to disharmony of Stomach Qi. Use) Xiao Chai Hu Tang (Minor Bupleurum Decoction) as the main treatment. (This formula is appropriate for syndromes with few pathogens and significant deficiency.)
This addresses the co-occurrence of Yu Mao and difficulty in defecation, detailing the etiology and proposing treatment.
Xiao Chai Hu Tang Formula (See Vomiting section)
(When the) Yu Mao (syndrome) resolves (and she) can eat. (If, after) seven or eight days, fever recurs. (Since she can feel fever without aversion to cold, we know the pathogen is not in the Exterior, but in the Interior. Because she can eat yet develops fever, we know this is not a deficiency syndrome, but a recurrence due to food retention [Shi Fu].) This is a Excess syndrome of the Stomach. Da Cheng Qi Tang (Major Order the Qi Decoction) should be used.
This discusses how to treat Excess syndromes arising after severe Deficiency. If one fears the harshness of Cheng Qi formulas and dares not use them, one risks delaying treatment, leading to further deficiency and myriad complications. Alas, mediocre physicians are unequal to this task. If one fears the harshness of Cheng Qi formulas and instead uses herbs like Gu Ya (Sprouted Grain), Mai Ya (Sprouted Barley), Shan Zha (Hawthorn), and Shen Qu (Medicated Leaven), consuming Stomach Qi, this is also harmful.
Da Cheng Qi Tang Formula (See Jing Disease section)
Postpartum (deficiency syndromes; if external Cold obstructs Qi and Blood,) abdominal pain occurs. (Use) Dang Gui Sheng Yang Rou Tang (Angelica Ginger and Mutton Decoction) as the main treatment. It also treats abdominal Cold Hernia and Deficiency-Labor insufficiency.
Referencing various scholars' opinions: "Tong" (pain) here refers to a slow, lingering pain. It is generally attributed to obstruction by external Cold. Therefore, Dang Gui is used to unblock stagnation in the Blood aspect, and Sheng Jiang (Fresh Ginger) to move Cold in the Qi aspect. In pregnancy, emphasis is placed on Excess, so Fu Ling (Poria) and Ze Xie (Alisma) are added to Dang Gui Shao Yao San (Angelica and Peony Powder) to drain dampness. In postpartum cases, emphasis is generally placed on Deficiency. Therefore, Dang Gui is used to nourish blood and move blood stagnation, and Sheng Jiang to disperse Cold and move Qi stagnation. Furthermore, Mutton is used as the principal ingredient for its rich flavor and warm nature to tonify Qi and generate blood. When Qi and Blood are warmed, pathogens dissipate and pain stops. This formula combines attacking and tonifying, thus treating both Cold Hernia and Deficiency. Some doubt that Mutton is too tonifying, not knowing that Sun Simiao stated Mutton relieves pain and benefits postpartum women. Ancient teachings are solid evidence; what is there to doubt?
Dang Gui Sheng Yang Rou Tang Formula (See Cold Hernia section)
(However, pain may also arise from non-deficiency causes, which must be known.) Postpartum abdominal pain. (If there is no irritability or fullness, it is due to Middle Deficiency and internal Cold. Now, however, Fire rebels upward causing) irritability (Qi stagnation causes) fullness (Stomach disharmony causes) inability to lie down. (This is Heat constrained below obstructing above. Use) Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) as the main treatment.
This addresses abdominal pain accompanied by irritability, fullness, and inability to lie down, proposing treatment. The intent of the formula is to harmonize Qi and Blood stagnation, a mild agent of the principle "unblocked means no pain." Subsequently, using Da Mai Zhou (Barley Porridge) to administer it harmonizes Liver Qi and nourishes Heart and Spleen, hence it is also used for carbuncles and pus.
Zhi Shi Shao Yao San Formula
Zhi Shi (Burned until black but not overdone) Shao Yao (Equal parts)
The above two ingredients are pounded into a powder. Take one cun-bi (measure) per dose, three times daily. It also treats carbuncles and pus. Administer with Da Mai Zhou (Barley Porridge).
The Master said: For postpartum abdominal pain, the standard treatment is Zhi Shi Shao Yao San. If it does not heal, this is because (Heat scorching blood causes dryness.) There is static blood in the abdomen. (The pain) is fixed (at) below the umbilicus. (It cannot be treated by Zhi Shi Shao Yao San.) Xia Yu Xue Tang (Decoction to Drain Blood Stasis) should be used. It also treats irregular menstruation.
This addresses pain fixed below the umbilicus, proposing treatment. The idea is that once the pathogen is removed, deficiency naturally returns; there is no need to worry about it being too harsh.
Xia Yu Xue Tang Formula
Da Huang (Rhubarb) (3 liang) Tao Ren (Peach Kernel) (30 pieces) E Chong (Ground Beetle) (20 pieces, feet removed, roasted)
The above three ingredients are powdered. Mix with refined honey to form four pills. Boil the pills in one sheng of wine, reduce to eight ge, and take at once. Fresh blood resembling pig liver will be discharged.
(Zhang Shiweng said: Honey is added to缓 [moderate] the urgency of Da Huang.)
(However, there are cases where blood stasis should not be exclusively purged, which must be known.) Seven or eight days after childbirth, without (Headache, fever, aversion to cold of the) Tai Yang syndrome, the lower abdomen is hard and painful. This is incomplete expulsion of lochia. (Treatment involves nothing more than purging blood stasis. However, she has) constipation, irritability, and fever. Pulse is slightly firm. (This indicates Excess in the Stomach house. Yang Ming channel peaks at Shen, You, Xu hours; Ri Bu [late afternoon] is when Yang Ming is approaching peak activity. Her) fever becomes more intense. (At) Ri Bu time, she feels irritable. (Another sign of Stomach Heat. Food entering the Stomach generates Qi. If she does) not eat. (it stops soon.) If she (eats,) food (enters) (and assists Stomach Heat causing) delirium. (Another sign of Stomach Heat. However, there is a most definitive diagnostic criterion: Day is Yang, Night is Yin. If the disease were truly in Yin, it should be lighter by day and heavier by night. Now, at) night (when Yang Ming Qi should be declining, the condition) immediately (slightly) improves. (That it is Excess Heat in the Stomach house is beyond doubt.) Da Cheng Qi Tang (Major Order the Qi Decoction) should be used. (For this formula clears both Heat and accumulation; the) Heat is in the Interior (of Yang Ming). (The accumulation in the) lower abdomen is in the Bladder region.
This states that although blood is bound in the lower abdomen, if there is Excess Heat in the Stomach, Da Cheng Qi Tang should be the primary treatment. If one treats only the blood and neglects the Stomach, the blood may be cleared but the Heat will remain, and even the blood may not clear. The phrase "improves at night" in this clause is the key to differentiation. Day is Yang and governs Qi; dusk is Yin and governs Blood. Observe the next section: a woman with Shang Han fever, whose menses just started, is lucid by day but delirious at night, seeing ghosts. This is Heat entering the Blood Chamber. By contrasting these sentences, we understand that "improving at night" indicates the disease is not solely in the Blood aspect.
Postpartum (Wind) Strike continues for dozens of days without resolving. (It might seem inappropriate to classify this under Gui Zhi syndrome. However,) slight headache, aversion to cold, and intermittent fever. (All are original signs of Gui Zhi Tang syndrome, except for one sign) stuffiness in the epigastrium. (Pathogen enters chest/diaphragm, an Interior sign of Tai Yang. The remaining) dry retching and sweating. (Are all signs originally present in the Gui Zhi Tang pattern. This shows the Gui Zhi syndrome has progressed, becoming Yang Dan syndrome. Slightly increasing the dosage of Gui Zhi Tang creates Yang Dan Tang. Although the illness is) long-standing, (if the) Yang Dan syndrome persists, Yang Dan Tang may be given.
Zhang Shiweng said: This example is paired with the Da Cheng Qi Tang mentioned earlier as a Exterior-Interior contrast. One should not doubt the presence of an Exterior syndrome merely because many days have passed.
I observe: This states that the Yang Dan syndrome persists postpartum, and the formula is used despite the long duration. In the Tai Yang chapter of Shang Han Lun, there is a sentence: "adding Fuzi among them, increasing Gui Zhi to induce sweating." "Adding" refers to following the preceding symptoms resembling Gui Zhi syndrome, thus taking the original Gui Zhi Tang formula. "Increasing Gui Zhi" means adding two liang of Gui Zhi to the original formula, totaling five liang. "Adding Fuzi among them" means inserting one Pao Fuzi into the previous formula. Sun Simiao failed to comprehend these sentences, mistakenly believing Yang Dan Tang is Gui Zhi Tang plus Huang Qin. Later generations followed this error, perpetuating confusion. Alas, how difficult it is to study texts! However, the specific use of "induce sweating" in Shang Han Lun is the crucial point. Its difference from Gui Zhi Jia Fu Zi Tang (Gui Zhi Decoction with Added Aconite) treating sweat leakage is a difference within similarity, and a similarity within difference. Stopping sweat leakage corrects the pathology; inducing sweating expels the pathogen. Adapting precisely to the situation is why the formula enters the realm of spirit. In the previous section, Interior Heat formed Excess; even seven or eight days postpartum, Da Cheng Qi Tang was used without being overly harsh. In this section, Exterior pathogen remains unresolved; even after dozens of days, Yang Dan Tang is used without worrying about excessive dispersion. The subtlety here is difficult to explain to shallow-minded people. Danxi stated that postpartum treatment focuses primarily on greatly tonifying Qi and Blood, treating other issues secondarily. He also claimed Shao Yao destroys the vital energy. This is teaching mediocre physicians how to hide their incompetence, misleading people. I must directly refute this. Headache, aversion to cold, intermittent fever, spontaneous sweating, and dry retching are all Gui Zhi Tang signs. Why not use Gui Zhi Tang? Because of epigastric stuffiness, one should use the method of Gui Zhi Qu Shao Yao Tang (Gui Zhi Decoction without Peony). However, due to postpartum blood loss, one cannot simply remove Shao Yao. One must increase Gui Zhi to diffuse Yang. Sweating lasting dozens of days, though distinct from sweat leakage after inducing sweating, should borrow the method of Gui Zhi Jia Fu Zi Tang to secure the root of Shao Yin to stop sweating. Moreover, stopping sweating occurs within the process of inducing sweating. This is why Yang Dan Tang fits perfectly.
Yang Dan Tang Formula (Shop editions all make it Gui Zhi Tang plus Huang Qin. Now, enlightened by Shang Han Lun, it is Gui Zhi Tang with increased Gui Zhi and added Fuzi.)
(Jing disease was previously listed as one of the three major outlines for postpartum conditions. However, Jing disease always originates from Wind Strike. Now discussing Wind Strike transforming into Jing.) Postpartum Wind Strike with fever, face turning red, panting, and headache. (This disease is in Tai Yang, involving Yang Ming. Postpartum Zheng Qi is greatly deficient and cannot overcome the pathogen. There is genuine fear of transforming into Jing syndrome. Use) Zhu Ye Tang (Bamboo Leaf Decoction) as the main treatment.
This addresses postpartum Wind Strike with deficient Zheng Qi and strong pathogens, proposing a formula to support Zheng Qi and scatter pathogens. Zhu Ye is used as the sovereign herb because Wind is a Yang pathogen; if unresolved, it transforms into Heat. Severe Heat scorches tendons causing Jing. Thus, among warming-dispersing herbs, this is used first to curb the momentum, a way of preventing disease progression. (Commentator Nan Yuan Xi notes: Tai Yang channels ascend to the head; Yang Ming channels pass through the diaphragm and return to the face. In combined diseases of these two channels, Ge Gen is often added.)
Zhu Ye Tang Formula
Zhu Ye (Bamboo Leaves) (One bunch) Ge Gen (Kudzu Root) (3 liang) Fang Feng (Saposhnikovia) Jie Geng (Platycodon) Gui Zhi (Cinnamon Twig) Ren Shen (Ginseng) Gan Cao (Licorice) (Each 1 liang) Fu Zi (Aconite) (One piece, prepared) Sheng Jiang (Fresh Ginger) (5 liang) Da Zao (Jujube) (15 pieces)
The above ten ingredients are boiled in one dou of water, reduced to two and a half sheng. Divide into three warm doses. Cover to induce sweating. For stiff neck and back, use one large Fu Zi, broken into bean-sized pieces. (Another version says add to) previous medicine, skimming off foam. For vomiting, add Ban Xia (Pinellia) half a sheng, washed.
Zhang Shiweng said: Fu Zi is likely added according to the post-formula instructions for treating stiff neck and back. Since the pathogen is in Tai Yang, it constricts tendons and vessels, preventing flexion and extension. Thus, Fu Zi is used to warm meridians and disperse Cold. Skimming off foam prevents the acrid-hot floating Qi from assisting the rebellious deficient Yang.
Women nursing infants suffer from Middle Jiao deficiency, irritability, restlessness, vomiting, and regurgitation. An Zhong Yi Qi Wan (Peace the Middle and Tonify Qi Pill) is the main treatment.
Xu Zhongke said: "Ru" refers to a nursing woman. Excessive milk loss leads to insufficient Yin Blood and deficiency in the Stomach. Nei Jing states: Yin is the guardian of the interior. Yin deficiency cannot control Yang, causing Fire to congest upward leading to irritability, and Qi to rebel upward leading to vomiting. Irritability with restlessness indicates severe irritability; vomiting with regurgitation indicates severe vomiting. The disease fundamentally stems from Middle Deficiency. However, the herbs used are only Zhu Ru (Bamboo Shavings), Gui Zhi (Cinnamon Twig), Gan Cao (Licorice), Shi Gao (Gypsum), and Bai Wei (Cynanchum). Since Middle Deficiency leads to vomiting and irritability, the Gallbladder organ is affected, with irritability and vomiting as the main symptoms. Thus, Zhu Ru, which clears irritability and stops vomiting, is used as the sovereign herb. Yang Qi in the chest is ineffective, so Gui Zhi and Gan Cao are used to support Yang and transform rebellious Qi as minister herbs. Shi Gao is used to cool deficient Heat in the Upper Jiao Qi aspect as an assistant herb. Bai Wei is used to remove floating Heat on the exterior as an envoy herb. Note that irritability, restlessness, vomiting, and regurgitation, without abdominal pain or diarrhea, indicate Deficiency without Cold suspicion. The brilliance lies in adding Gui Zhi to cooling agents, and especially in using a large amount of Gan Cao. The intent is to scatter accumulated pathogens and restore Clear Yang Qi, thereby calming the Middle and benefiting Qi. Thus, although no tonifying herbs are used, the original intent of the formula is noted as "Peace the Middle and Tonify Qi." Zhu Pi Da Wan, how divine! For panting, add Bai Shi (Biota Seed). Biota trees grow westward, receiving the purest Qi of the West, thus benefiting Metal (Lung), moistening Wood (Liver), and nourishing Heart, so Lung is not scorched, and panting calms. For Heat, double Bai Wei. Since Bai Wei removes floating Heat, Duan Ju's Gui Zhi Jia Long Gu Mu Li Tang states: For excessive sweating and floating Heat, remove Gui Zhi, add Bai Wei and Fu Zi each 3 fen, named Er Jia Long Gu Tang. Thus, Bai Wei's ability to remove floating Heat is evident.
Zhu Pi Da Wan Formula
Sheng Zhu Ru (Raw Bamboo Shavings) Shi Gao (Gypsum) (Each 2 fen) Gui Zhi (Cinnamon Twig) Bai Wei (Cynanchum) (Each 1 fen) Gan Cao (Licorice) (7 fen)
The above five ingredients are powdered. Mix with date paste to form pills the size of a bullet. Take one pill with water, three times daily, twice at night. For Heat, double Bai Wei. For irritability and panting, add 1 fen of Bai Shi.
(Generally, dysentery arises from Damp-Heat. Bai Weng's bitterness conquers Damp, and cold clears Heat, which is appropriate. However,) postpartum dysentery with extreme deficiency. (One might think tonics are necessary. But Ren Shen and Bai Zhu may cause stagnation, and Fu Ling and Ze Xie may injure fluids. Use) Bai Weng Jia Gan Cao E Jiao Tang (Belleric Myrobalan Plus Licorice and Donkey-Hide Gelatin Decoction) as the main treatment. (This is indeed appropriate. The sweet-cool nature of Gan Cao clears and tonifies the Middle; the moistening nature of E Jiao disperses Wind and harmonizes Blood. Using this to treat dysentery is effectively great tonification. Those who treat dysentery using Ren Shen and Bai Zhu should reflect on this.)
This addresses postpartum dysentery with extreme deficiency, proposing treatment.
Bai Weng Jia Gan Cao E Jiao Tang Formula
Bai Weng (Pulsatilla) Gan Cao (Licorice) E Jiao (Donkey-Hide Gelatin) (Each 2 liang) Qin Pi (Ash Bark) Huang Lian (Coptis) Bai Pi (Phellodendron) (Each 3 liang)
The above six ingredients are boiled in seven sheng of water, reduced to two and a half sheng. Add E Jiao and dissolve completely. Divide into three warm doses.
Supplementary Formulas
Qian Jin San Wu Huang Qin Tang (Thousand Gold Three-Ingredient Scutellaria Decoction) Treats women (who have not left the delivery room, still) on the straw mat, spontaneously (removing clothing/bedding) exposing (their bodies to) slight Wind. (After blood loss, Yang pathogens invade,) limbs suffer from vexing heat. (However, this syndrome requires distinguishing whether there is headache or not. If there is) headache. (The Wind has not fully transformed into Heat.) Give Xiao Chai Hu Tang. (To resolve it. If there is) no headache but only vexation. (The Heat has fully transformed. Excessive Heat generates worms, inevitably. Use) this formula as the main treatment.
Note: Supplementary Formulas are not included in the original text of Jin Gui Yao Lue but are recorded in Qian Jin, Wai Tai, etc. They claim origin from Jin Gui, and later scholars labeled them Supplementary Formulas.
Huang Qin (Scutellaria) (1 liang) Ku Shen (Sophora) (2 liang) Gan Di Huang (Rehmannia) (4 liang)
The above three ingredients are boiled in six sheng of water, reduced to two sheng. Take one sheng warm. Often vomits or passes worms.
Qian Jin Nei Bu Dang Gui Jian Zhong Tang (Thousand Gold Internal Tonification Angelica Build the Middle Decoction) Treats women postpartum with emaciation and insufficiency, continuous stabbing pain in the abdomen, shortness of breath, or distress from urgent rubbing pain in the lower abdomen radiating to the back, inability to eat or drink. Within one month postpartum, taking four or five doses daily is beneficial, promoting strength.
Dang Gui (Angelica) (4 liang) Gui Zhi (Cinnamon Twig) Sheng Jiang (Fresh Ginger) (Each 3 liang) Shao Yao (Peony) (6 liang) Gan Cao (Licorice) (2 liang) Da Zao (Jujube) (12 pieces)
The above six ingredients are boiled in one dou of water, reduced to three sheng. Divide into three warm doses. Consume in one day. For severe deficiency, add Liu Liang of Yi Tang (Maltose) to the decoction. Warm on fire to melt the maltose. If blood loss is excessive, with uterine bleeding or internal hemorrhage continuing, add Liu Liang of Di Huang (Rehmannia) and Er Liang of E Jiao (Donkey-Hide Gelatin), totaling eight ingredients. Add E Jiao to the finished decoction. If Dang Gui is unavailable, substitute with Xiong Dui (Ligusticum). If Sheng Jiang is unavailable, substitute with Gan Jiang (Dried Ginger).
Xu Zhongke said: Postpartum emaciation and insufficiency initially stem from Yin deficiency, subsequently involving Yang deficiency. Tonifying Yin causes Cold coagulation; tonifying Yang causes Qi stagnation. The Posterior Heaven relies on Middle Qi, so the treatment method derives from Jian Zhong. Adding Dang Gui makes it偏向 internal, hence named Nei Bu Dang Gui Jian Zhong Tang. Continuous stabbing pain in the abdomen indicates Blood deficiency; shortness of breath indicates Yang weakness. Thus, the acrid-warm properties of Gui Zhi, Sheng Jiang, and Dang Gui are used to move Ying and Wei Qi; Gan Cao and Bai Shao nourish Spleen Yin Blood; and Yi Tang and Da Zao greatly tonify Middle Qi. Thus, Yuan Qi restores, the emaciated become robust, and pain stops. Gui Zhi penetrates Yin-Yang and Interior-Exterior without obstruction. It is particularly brilliant that Dang Gui enters the Yin aspect well, treating leukorrhea. Thus, it also treats urgent rubbing pain in the lower abdomen radiating to the back and inability to eat. Once leukorrhea is resolved, Middle Qi strengthens. Saying "taking four or five doses daily within one month postpartum is beneficial" implies timely regulation to avoid regret later. The herbs are mild, capable of treating disease and regulating/tonifying, hence "promoting strength." Adding Yi Tang for severe deficiency is because when deficiency is extreme, nothing supports the body except sweet herbs specifically tonifying Spleen. Spleen is the mother of the Five Zang and Six Fu organs; this single clause provides a path to life. Adding Gan Di Huang and E Jiao for excessive blood loss, uterine bleeding, and internal hemorrhage is because the injury originally favors Yin, hence extra Yin-nourishing herbs are added. It does not mean Di Huang and E Jiao are mandatory for all postpartum cases.