典藏书目

Baizhu (Atractylodis Macrocephalae Rhizoma), Xiongqiong (Ligusticum Chuanxiong Rhizoma), Shujiao (Zanthoxyli Pericarpium, removed of sweat) each 3 fen, Musli (Ostreae Concha).
The above four ingredients are pounded into a powder. Take one qianbi (a small measure) with wine, three times a day and once at night. If pain is severe, add Shaoyao (Paeoniae Radix Alba); if there is severe pain in the epigastrium, double the dosage of Xiongqiong; if there is irritability, vomiting, pain, and inability to eat or drink, add Yixin (Asari Radix et Rhizoma) 1 liang and Banxia (Pinelliae Rhizoma) twenty large pieces. After taking this, take it again with Cujiangshui (vinegar water). If vomiting occurs, take it with vinegar water; if it does not resolve, take it with Xiaomai Zhi (wheat juice). If thirst develops subsequently, take Damai Zhou (barley porridge). Even if the disease has healed, continue taking it and do not stop.

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When a woman suffers from damaged fetus, she experiences abdominal fullness during pregnancy, inability to urinate, and heaviness from the waist down, resembling edema. At seven months of pregnancy, when the Taiyin meridian should nourish the fetus but fails to do so, this is due to excess Heart Qi. It is indicated to puncture Laogong (PC 8) and Guanyuan (CV 4) using the reducing method. The condition will heal when urination becomes slightly free.
[Commentary]
The meaning of this text is unclear. Puncturing these acupoints may cause abortion; this must be a textual error in the bamboo slips, so it is not explained.

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Question: What are the three diseases affecting women shortly after childbirth? One is Jing illness (spasm), the second is Yumao (depression and vertigo), and the third is difficult defecation. What does this mean?
Master said: Postpartum blood deficiency, excessive sweating, and susceptibility to wind pathogen lead to Jing illness (spasm). Loss of blood combined with sweating leads to excess cold, causing Yumao (depression and vertigo). Depletion of body fluids and dryness of the Stomach lead to difficult defecation.
[Annotation]
For women who have just given birth, lack of sweating is feared because it indicates disharmony between Ying (Nutrient) and Wei (Defensive) qi, presenting with fever and no sweating, resembling Exterior Syndrome of Cold Damage. However, the absence of white coating on the tongue distinguishes it. Therefore, sweating is desired, but excessive sweating is feared as it fails to secure Exterior Yang, allowing Wind pathogen to invade easily, leading to neck stiffness, opisthotonos, and Jing illness (spasm). For postpartum women, stagnation of blood is feared because blood stasis in the interior presents with fever and abdominal pain, resembling Interior Syndrome of Cold Damage. However, the absence of yellow coating on the tongue distinguishes it. Therefore, lochia discharge is desired, but excessive loss is feared as it leads to collapse of Yin blood and failure of Zheng Qi (Upright Qi), causing deficient Yang to rebel upward, leading to coma, unconsciousness, and Xueyun (blood syncope) with closed eyes and sweating. Although postpartum sweating and blood flow are desirable, excessive damage to Yin fluids is feared, leading to dry stomach and intestines, tidal fever, delirious speech, and difficult defecation, resembling Yangming Stomach Excess Syndrome. Thus, Zhang Zhongjing first mentions these three diseases postpartum not only to prevent potential illnesses but also to differentiate suspected existing conditions. Coma termed Yumao refers to depression caused by deficiency and stagnation of Yin and Yang, preventing their communication.
[Collected Notes]
You Yi stated: Jing illness (spasm) is a disorder of the sinews; blood deficiency and sweating cause the sinews and vessels to lose nourishment, and Wind invasion exacerbates stiffness. Yumao (depression and vertigo) is a disorder of the Shen (Spirit); Yin-blood deficiency causes Yang to rebel upward, while Yin stagnates above, leading to dizziness and blurred vision. Difficult defecation is a disorder of fluids; the Stomach stores body fluids and moistens the Yang meridians. Depletion of fluids causes Stomach dryness, leading to lack of lubrication in the Large Intestine and difficult defecation. Although these three diseases differ, they all stem from loss of blood and injury to fluids.

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In postpartum Yumao (depression and vertigo), the pulse is faint and weak, the patient cannot eat, the stool is hard, and only the head sweats. This is because blood deficiency leads to Jue (rebellious Qi), and Jue inevitably leads to Mao (vertigo/coma). For Mao to resolve, profuse sweating must occur. Due to blood deficiency and lower Jue, isolated Yang floats upward, causing only the head to sweat. Therefore, postpartum women benefit from sweating because Yin-blood depletion leaves Yang in excess. Sweating allows Yin and Yang to restore balance. For hard stool, vomiting, and inability to eat, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. If the disease resolves and appetite returns, but fever recurs after seven or eight days, this indicates Stomach Excess, treated with Da Cheng Qi Tang (Major Order the Qi Decoction).
[Annotation]
This paragraph elaborates on the previous one to clarify the treatment. Faint and weak pulse in postpartum coma indicates dual deficiency of Qi and Blood. Inability to eat indicates unharmonized Stomach Qi. Hard stool indicates dryness of the intestines. The cause of Yumao is that blood deficiency leads to Yin deficiency, which causes Yang to rebel upward, resulting in coma. Profuse sweating resolves Yao because it allows stagnant Yang to dissipate outward, hence postpartum women benefit from sweating. By inference, if coma is caused by blood stasis, resolution requires lochia discharge, allowing stagnant Yin to circulate inward. The most dangerous sign is sweating only on the head, indicating Yin collapse and lower Jue with floating isolated Yang. For hard stool, vomiting, and inability to eat, Xiao Chai Hu Tang is used, but only if the patient has tongue coating, no body sweating, and robust constitution. Upon resolution, appetite returns. If sweating is present, reduce Chai Hu (Bupleuri Radix); if no heat, reduce Huang Qin (Scutellariae Radix); for vomiting, increase Jiang (Zingiberis Rhizoma Recens) and Banxia (Pinelliae Rhizoma); for deficiency, increase Renshen (Ginseng Radix et Rhizoma). These require clinical flexibility. For hard stool and recurrent fever after seven or eight days, Da Cheng Qi Tang is used, but only if the patient has robust Qi and form and strong Stomach function. If Qi is weak and fluids dry, causing dryness due to deficiency, which cannot withstand purgation, then Yuan Ming Fen (Natrii Sulfas) should be taken internally to soften hardness, and external enemas/lubricants should be used to moisten the rectum, proceeding slowly.
[Collected Notes]
You Yi stated: Although Yumao involves external pathogens, its root is internal deficiency, hence the faint pulse. Vomiting, inability to eat, hard stool, and head-only sweating indicate fluids rising but failing to reach the lower part. This is because Yin-blood depletion causes isolated Yang to rebel upward, carrying fluids with it. Jue leads to Mao; resolution requires profuse sweating as Yin and Yang temporarily separate, causing Jue and Mao, and upon reconnection, sweating occurs and the disease resolves. Postpartum women are newly deficient and should not sweat excessively. Here, sweating is beneficial because blood loss causes Yin deficiency, leaving Yang dominant due to pathogenic factors. Sweating expels the pathogen, weakening Yang so it can combine with Yin, described as "diminishing Yang to follow Yin."