《经》云∶夺血者无汗。汗与血同类。产后去血过多，则阴不维阳，阴虚而阳无所附，周身汗出不止，此
为阴阳两虚，有亡阳之患，为危证也。若身无汗，但头有汗，头为诸阳之会，阴血暴亡，孤阳上越，阴虽虚，
而阳气尚为有余，此时阴不胜阳，故头汗，额上偏多。心火上浮，逼阳于外，急补其阴，而入以敛阳之药，则
病自复。故产妇又喜其汗出也。（萧慎斋）
有产妇喜汗出，为阴虚、血虚者，以产后亡阴血虚，阳气偏盛，是其人平日阳盛阴弱，故当汗出，阴阳乃
复。盖汗出而阳亦虚，阴阳不相偏胜，故可谓之复续。此乃阴阳平补，可以徐收其效矣。然此汗出，乃阴虚阳
亢之汗出，与阴盛阳衰，上冒下厥之但头汗出者，迥不同也。所以产妇喜汗出之汗，汗出而阴阳平复，正好施
治以补益其阴阳。若上冒下厥之但头汗大出，则阳脱于上，阴绝于下，顷刻不测之危证见矣。顾云此阴虚阳亢
之汗出，而更滋阴凉血以速其死哉！故上冒下厥之汗必大出，虽解，而旋又厥冒如故，渐渐厥深冒甚而不救矣。
产妇喜汗出之汗，不过微汗而已，微汗必数日而阴渐生，阳渐和，汗渐止。且有不药而自阴阳平复者，岂可并
两证而同日论哉！师比属而言之，正示人严
谨加辨之旨也。先辨之于但头汗，后辨之冒不冒、厥不厥，后辨之于汗大出不大出，而二证判然矣。（魏荔彤）
狂妄
产后狂言谵语，如见鬼神，其源不一，须辨证治之。一则产后心虚，败血停积，上干于心，因而狂妄者，
当于乍见鬼神条求之。二则产后脏虚，心神惊悸，以致言语错乱，不自知觉者，当于惊悸条求之。三则夙有风
疾，又因产后心虚气弱，证见歌哭嗔笑，言语乱道，腰背强直者，作风痉治，当于心经中风条求之。四则产后
败血，迷塞心包，因而言语颠倒，或作晕闷者，当于血晕条求之。五则产后感冒风寒，恶露不行，寒热如疟，
昼日明了，暮则谵语，如见鬼状者，当作热入血室论治。（《女科大全》）
选案
一妇产后六朝发狂，持刀杀人。此阴血暴崩，肝虚火炎。用泽兰、归、地、牛膝、茯神、远志、枣仁、
童便治愈。（缪仲淳）
不语
心者，君主之官，神明出焉。外应于舌，舌者，声之机也。产后心虚，多致败血停蓄，上干于心则心窍
闭塞，神志不明。又心气通于舌，心气闭，则舌强不能言。（郭稽中）
产后不语，多因停积败血，闭其心窍，以致神志不明，治宜清魂散加苏木、丹参。若心肾气虚，而不能
通于舌者，宜辰砂七珍散，或加人参、菖蒲。若肾虚风中者，宜地黄饮子。肝木太过者，宜柴胡清肝散。脾受
木侮者，宜六君子汤加柴胡、钩藤。气血俱虚者，宜八珍汤加菖蒲、远志。（《张氏医通》）
产后不语，稽中主于败血迷心，《济阴》主于胃热湿痰。皆论病之有余。其有去血过多，阴火上乘，郁
冒心神而不语者，则属于虚耳。（萧慎斋）
惊悸恍惚
人之所主者，心也。心之所主者，血也。心血一虚，则神气不
守，惊悸所由来也。治当大补血气为主。○产后恍惚，亦当大补气血。盖风为虚极之假象，固其本元，则诸病
自退，若专治风，是速其危矣。（薛立斋）
产后恍惚者，盖由心主血，血气通于营卫脏腑，遍循经络，产后则血气俱伤，五脏俱虚，营卫不足，而为
风邪所乘，致令心神恍惚不定。（《女科大全》）
按产后不语，前人有谓败血入心，有谓风邪所乘，皆名心风。悉指实邪为病，而不及于虚。然此风从何而
来，亦未之详，此已立论之失。至若惊悸恍惚，自是血虚心气不足所致，《大全》所云风邪搏心，其言甚戾。
立斋以为但固本元，毋专治风，有功来学不小。（萧慎斋）
不寐
产后不寐一证，由于气血大亏，阴不维阳者居多。夫卫气日行于阳则寤，夜行于阴则寐。今胎下而血骤脱，
阳浮于上，不入阴而常留于阳，是以达旦不寐，烦躁出汗，面赤口渴等证叠见。医家治此，法何在哉？盖壮水
则火熄而神藏，益阴则血足而心安。六味归芍汤加童便、人参，无不取效。若心肾不交，神志恍惚，补心丹加
减，亦为合法。倘血去而孤阳浮越，营卫偏胜，终夜不眠，宜归脾汤，或人参养营汤，方为尽善。大抵阴虚不
寐，阳药不宜轻投；阳虚不寐，阴药岂宜混施？必须察脉辨证，勿泥呆法也。此外，有因血块痛而不寐者，治
在血也；有兼食滞而不寐者，治在食也；有兼时疫而不寐者，治在疫也；有兼疟痢而不寐者，治在疟痢也。张
景岳云∶心藏神，为阳气之宅；卫主气，司阳气之化。凡卫气入阴则静，静则寐，正以阳有所归，故神安而寐
也。故欲求寐者，当养阴中之阳，及去静中之动，则得之矣。（《会心录》）
浮肿
产后浮肿，多属气血两亏，脾胃薄弱，营卫不能营运所致。
若云发汗利小便，是重竭其津液而益虚其虚矣。岂产后之肿，竟作外邪有余治乎？（萧慎斋）
前证若因寒水侮土者，宜养脾肺；因气虚者，宜益脾胃；因水气者，宜补中气。又有产后浮肿而兼喘咳，
脉沉细无力者，此命门火衰，脾土虚寒也，八味丸主之。（薛立斋）
蓐痨
产后蓐损寒热，元神不复，月事不来，先与《千金》当归芍药汤，后与乌骨鸡丸调补。此证多因脾胃虚弱，
饮食减少而成。当补脾胃，进饮食，则诸脏有所倚赖，病自愈矣。（薛立斋）
大便秘结
产后去血过多，大肠干涸，每至三、五日而大便始通者，此其常也。必待腹满欲去不能，方用蜜导或酱姜
瓜导之。惟胆导禁用，以其苦寒，误用每致发呃也。若血虚火燥者，用四物汤加鲜何首乌润下之；若气血俱虚
者，便虽数日不通，然饮食如常，腹中如故，只用八珍汤加麻仁、熟蜜；若多日不解，躁闷异常，不得已用当
归、枳壳，亦权宜耳。（《张氏医通》）
产后不便，固不足虑，然产妇急于便，必多努责，每致玉门不闭，子宫下坠，治之贵早。○产后便秘者，
由气虚不能推送，血虚不能濡润也。宜用八珍汤加桃仁、杏仁。人知桃仁能破血，不知又能利血而滑肠；人知
杏仁能润肺，不知又能润肠而利便。若单用八珍，恐燥矢未得下，乃加二味，使之速功。（高鼓峰）
大便不通，在杂证，有阳明实热之积，有肠胃瘀血之阻。而在产后，则专责在气血之虚也。夫阴血骤脱，
气亦骤亏，少阴失开阖之司，大肠少津液之润，是以秘结不解。医药求其暂通，取快一时，因而重虚其虚，元
气更伤，缓则复秘而变胀满，速则亡阴而致虚脱。夫产后新血未生，元气未回，幸得后门坚固，旬日未解，亦
自无妨。虽有滞涩，当从缓治，宜用生化汤加人乳、苁蓉，以润枯涸。倘气因血耗，传化失职者，宜用八味汤
加人参、苁
蓉，以助真气。古人有言，产后大便日久不通，由于血少肠燥，参乳汤多服则血旺气顺，自无便涩之患。
（《会心录》）
小便不通
产后小便不通，腹胀如鼓，缘胎前内积冷气所致。用盐填脐中，葱白捣饼安于盐上，以艾灸之，热气入腹即
通。（《产乳集》）
胎前肠胃本有挟热，产后水血俱下，津液益加燥涩，故令二便不通。有产妇患此证，饮牛乳而利，人乳尤
善。（《女科大全》）
溲数
产后小便频数，乃气虚不能制水也，用补中汤加车前、茯苓；若属膀胱阴虚者，用六味汤合生脉散滋其化
源。（张路玉）
遗溺
产后小便有频数不禁、遗尿淋沥之证。《经》云∶肾主二便，开窍于二阴。产后气血大虚，动伤脏腑，非
肺气虚而不能约制为遗尿为不禁，即肾气竭而热移膀胱为沥为淋。总以补养气血为主，酌加升提固窍。若用渗
利疏导，是重虚也，戒之！（萧慎斋）
脬破
产后损伤，脬破，终日小便淋漓，用黄丝二两，丹皮、白芨，人参各一钱煎服。不可作声，作声则泄气无
效，名补胞饮。○又用参、 、术、草熬膏，猪羊胞煎汤调服，月余胞长自止。（张路玉）
淋
产时下焦空虚，热气客于脬中，虚则小便频数，热则小便涩痛，故谓之淋。又有因产后血虚挟热，热邪搏
血，流渗胞中，血从小便而出，则为血淋。（《女科大全》）
小便淋证，《三因》云∶产前当安胎，产后当去瘀。二语最
为吃紧。如产前淋，由于气虚不化，当用参、 补气安胎，不可过用渗利。产后淋，由于瘀血阻滞，当以瞿麦、
蒲黄为要药。若血虚热郁，当用六味、逍遥，补阴养血，滋其化源，佐以导血之药。（萧慎斋）
大小便血
产后既亡血，而二便复有下血之患者，此非寻常火热渗于膀胱归于大肠可例治也。然非血虚，即气脱之故。
盖心主血，脾统血，心虚则小肠不能制而血流，脾弱则大肠无所荫而血下，故二便出血，当责之心脾二经为病
也。（萧慎斋）
产后小便出血，因血气虚而热乘之，血得热则流散，渗于胞内，故血从小便出。有产妇尿血，胁痛少食，
此肝木乘脾土也。用加味逍遥散、补中汤兼服而愈。（《女科大全》）
血崩
前证，若血滞小腹胀满者，用失笑散；肝火血妄行者，用加味逍遥散；脾郁不统血者，用加味归脾汤；脾
虚不摄血者，用补中益气汤；浓味积热伤血者，用清胃散加槐花；风热相搏伤血者，用四君汤加防风、枳壳。（薛立斋）
产后已亡血，而又有血崩之证者，多属阴虚气脱所致。血脱须益其气，纯用血药无济也。观薛案有妇人血
崩如涌，以六君子汤加黑姜治愈，得其旨矣。（萧慎斋）
乳汁
产妇乳汁不行有二种∶有因血气盛而壅闭不行者。有因血气少而弱涩不行者。虚当补之，用钟乳粉、猪蹄、
鲫鱼之属；盛当疏之，用通草、漏芦、土瓜根之属。（陈无择）
前证，若因气血虚弱不能生化者，宜壮脾胃；若因怒动肝火，乳肿汁出者，宜清肝火。盖乳汁乃气血所化，
若屡产无乳，亡津液也，当滋化源。（薛立斋）
妇人以血用事，上为乳汁，下为月水。而血之所化，则本于
脾胃，饮食之精微营运而为乳为经。产后脾胃气旺，则血旺而乳多；脾胃气衰，则血减而乳少。此立斋治乳汁
以壮脾胃滋化源为要也。若徒从事通乳之剂，是犹求金于乞丐矣。（萧慎斋）
未产，乳自出者，谓之乳泣，生子多不育；若产妇劳役，乳汁涌下者，此气虚也，独参汤补之。（《女科大全》）
月水
妇人冲任之脉，为经络之海，上为乳汁，下为月水。新产劳伤血气，或去血过多及乳子，半岁一岁之内经
不行者，此其常也。若半岁或四、五月经便行者，此少壮血盛之人也。若产后一、二年，月经不行无所苦者，
亦不必虑，此气血衰少故也，但健脾胃，资养气血，自然经行。若以药通之，反为害事。（陈良甫）
月水不调、不通，为妇人要病。至于产后，又不可以病言也。夫产后月水不行，有因产伤气血者，有因自
乳血脉上为乳汁者，有因脾胃气虚饮食少进者。良甫一条，甚悉病机。至云但健脾胃，资气血，不必通经，尤
为探本之论。（萧慎斋）
脉候
胎前之病，其脉贵实；产后之病，其脉贵虚。（《济生产经》）
胎前脉洪数，既产而脉仍洪数者，死；胎前脉细小，产后而脉反洪大者，多死。（朱丹溪）
已产，气血两虚，脉宜缓滑。缓则舒徐，不因气夺而急促；滑则流利，不因血去而枯涩。均吉。若见实大
弦牢之脉，非产后所宜。实为邪，实大为邪进，弦为阴敛，牢为坚着，皆逆脉也。（潘硕甫）
产后阴血骤亏，孤阳上越，证则发热，脉则数大，最为险候。何也？阳浮而阴涸，营卫之气疾速，致脉反
见数大之假象。且胎下之后，五内空虚，脉细弱者，于法所宜，是虚证而得虚脉也。脉数大者，于法所不合，
是虚证而得实脉也。景岳云∶阴阳俱亏，气血败乱，脉必急数，愈数愈虚，愈虚愈数。（《会心录》）
附方
嘉禾饮 人参、茯苓、山药、陈皮、甘草、半夏曲、沙参、石斛、丹参、白芍、苡仁、扁豆、莲子、谷
芽、神曲、黑枣。
《黄帝内经》说：大量失血的人不应发汗。汗与血同属一类物质。产后失血过多，导致阴液不能维系阳气，阴虚则阳气无所依附，出现全身出汗不止，这属于阴阳两虚，有阳气亡脱的危险，是危重证候。如果身体无汗，仅头部出汗，头为诸阳经汇聚之处，阴血突然亡失，孤阳上浮外越，虽然阴气虚弱，但阳气尚有余盛，此时阴不胜阳，所以只有头部出汗，额头部位更多。心火浮越于上，逼迫阳气外散，急需滋补阴液，并加入收敛阳气的药物，疾病自然痊愈。因此产妇又希望（这种）出汗。（萧慎斋）
有的产妇喜欢出汗，这是因为阴虚、血虚。因为产后亡失阴血，阳气偏盛，这是其人平日阳气旺盛而阴气虚弱，所以应当出汗，才能使阴阳恢复平衡。大概出汗后阳气也随之耗散，阴阳不再偏胜，所以可以称为恢复延续。这是通过阴阳平补的方法，可以慢慢收到疗效。然而这种出汗，是阴虚阳亢的出汗，与阴盛阳衰、上冒下厥的仅头部出汗，截然不同。所以产妇喜欢的这种出汗，出汗后阴阳平复，正好施治以补益其阴阳。如果是上冒下厥的仅头部大汗出，则是阳气脱于上，阴气绝于下，顷刻间就会出现不可测度的危重证候。如果说这是阴虚阳亢的出汗，反而用滋阴凉血的药物来加速死亡吗！所以上冒下厥的汗必然大汗出，即使暂时缓解，随后又会像原来一样厥冷昏冒，逐渐厥冷加深、昏冒加重而无法救治。产妇喜欢的出汗，不过是微汗而已，微汗必须经过数日，阴气逐渐滋生，阳气逐渐调和，汗才逐渐停止。并且还有不吃药而自然阴阳平复的情况，怎么可以将两种证候混为一谈呢？师比（魏荔彤自称或指前人）分别论述，正是指示人们严谨加以辨别的意思。先辨别是否仅头部出汗，再辨别是否有昏冒和厥冷，最后辨别是大汗还是不大汗，这样两种证候就判然不同了。（魏荔彤）
产后胡言乱语、谵妄，好像看见鬼神，其病因不一，必须辨证治疗。一是产后心脏虚弱，败血停滞积聚，上扰于心，因而产生狂妄症状的，应当在“乍见鬼神”条目中寻求治法。二是产后脏腑虚弱，心神惊悸，以致言语错乱，自己不知觉的，应当在“惊悸”条目中寻求治法。三是素有风疾，又因产后心脏虚弱、气弱，出现歌哭嗔笑、言语乱道、腰背强直等症状的，按风痉治疗，应当在“心经中风”条目中寻求治法。四是产后败血迷塞心包，因而言语颠倒，或出现晕闷症状的，应当在“血晕”条目中寻求治法。五是产后感冒风寒，恶露不行，寒热往来如疟疾状，白天神志清楚，傍晚则谵语，好像看见鬼怪一样的，应当按“热入血室”论治。（《女科大全》）
选案
一位妇女产后六天发狂，持刀杀人。这是阴血暴崩，肝虚火炎。使用泽兰、当归、地黄、牛膝、茯神、远志、枣仁、童便治愈。（缪仲淳）
心是君主之官，神明由此发出。外部对应于舌，舌是发声的关键机关。产后心脏虚弱，多导致败血停蓄，上扰于心则心窍闭塞，神志不明。另外心气通于舌，心气闭塞，则舌体强硬不能言语。（郭稽中）
产后不语，多因停积败血，闭阻心窍，以致神志不明，治疗宜用清魂散加苏木、丹参。如果是心肾气虚，不能通于舌的，宜用辰砂七珍散，或加人参、石菖蒲。如果是肾虚受风邪侵袭的，宜用地黄饮子。肝木太过者，宜用柴胡清肝散。脾受肝木克制者，宜用六君子汤加柴胡、钩藤。气血俱虚者，宜用八珍汤加石菖蒲、远志。（《张氏医通》）
产后不语，郭稽中主张是败血迷心，《济阴方》主张是胃热湿痰。都是论述病证的有余（实证）。如果有去血过多，阴火上冲，郁冒心神而不语的，则属于虚证。（萧慎斋）
人所主宰的是心。心所主宰的是血。心血一旦虚弱，则神气不守，惊悸由此产生。治疗应当以大补血气为主。○产后恍惚，也应当大补气血。因为风邪是极度虚弱的假象，巩固其本元，则各种疾病自然消退，如果专门治疗风邪，是加速其危险了。（薛立斋）
产后恍惚，大概是因为心主血，血气通于营卫脏腑，遍循经络，产后则血气俱伤，五脏俱虚，营卫不足，而为风邪所乘，致使心神恍惚不定。（《女科大全》）
按：产后不语，前人有说是败血入心，有说是风邪所乘，都名为心风。全都指实邪致病，而不及于虚证。然而此风从何而来，也未详细说明，这是立论的失误。至于惊悸恍惚，自然是血虚心气不足所致，《大全》所说的风邪搏心，其言论非常谬误。立斋认为只要固护本元，不要专门治风，对后世学者功劳不小。（萧慎斋）
产后不寐一证，由于气血大亏，阴不能维系阳气的居多。卫气白天行于阳分则清醒，夜晚行于阴分则睡眠。现在胎儿娩出而血液骤然脱失，阳气浮越于上，不入阴分而常留于阳分，因此整夜不睡，烦躁出汗，面赤口渴等证候接连出现。医生治疗此证，方法在哪里呢？大概壮水则火熄而神藏，益阴则血足而心安。六味归芍汤加童便、人参，没有不取效的。如果是心肾不交，神志恍惚，补心丹加减，也是合法。倘若血去而孤阳浮越，营卫偏胜，整夜不眠，宜用归脾汤，或人参养营汤，方为尽善。大抵阴虚不寐，阳药不宜轻投；阳虚不寐，阴药岂可混施？必须察脉辨证，不要拘泥呆板的方法。此外，有因血块疼痛而不寐的，治疗在血；有兼食滞而不寐的，治疗在食；有兼时疫而不寐的，治疗在疫；有兼疟痢而不寐的，治疗在疟痢。张景岳说：心藏神，是阳气的宅舍；卫主气，司掌阳气的化生。凡是卫气入阴则安静，安静则睡眠，正是因为阳气有所归属，所以神安而寐。所以想要求得睡眠的，应当滋养阴中之阳，以及去除静中之动，就得到了要领。（《会心录》）
如果说用发汗利小便的方法，是再次竭尽其津液而更加虚弱其虚损了。难道产后的肿胀，竟当作外邪有余来治疗吗？（萧慎斋）
前述证候如果是因为寒水侮土（肾水反克脾土）的，宜养脾肺；因为气虚的，宜益脾胃；因为水气的，宜补中气。又有产后浮肿而兼喘咳，脉沉细无力的，这是命门火衰，脾土虚寒，用八味丸主治。（薛立斋）
产后蓐损寒热，元神不复，月经不来，先给予《千金》当归芍药汤，后给予乌骨鸡丸调补。此证多因脾胃虚弱，饮食减少而成。当补脾胃，进饮食，则各脏有所倚赖，病自然痊愈。（薛立斋）
大便秘结
产后失血过多，大肠干涸，每至三、五天大便才通的，这是正常现象。必须等到腹部胀满想解而不能解时，才用蜜导或酱姜瓜导之。唯独胆导禁用，因为其苦寒，误用往往导致呃逆。如果是血虚火燥的，用四物汤加鲜何首乌润下；如果是气血俱虚的，大便虽数日不通，但饮食如常，腹中如故，只用八珍汤加麻仁、熟蜜；如果多日不解，躁闷异常，不得已用当归、枳壳，也只是权宜之计。（《张氏医通》）
产后不便，本来不值得忧虑，然而产妇急于排便，必定多用力努责，往往导致玉门不闭，子宫下坠，治疗贵在早。○产后便秘者，由气虚不能推送，血虚不能濡润所致。宜用八珍汤加桃仁、杏仁。人们只知道桃仁能破血，不知道又能利血而滑肠；人们只知道杏仁能润肺，不知道又能润肠而利便。如果单用八珍，恐怕燥屎不得下行，于是加这两味药，使之迅速奏效。（高鼓峰）
大便不通，在杂病中，有阳明实热的积滞，有肠胃瘀血的阻滞。而在产后，则专门责备在气血的虚损。阴血骤然脱失，气也骤然亏损，少阴失开阖之职，大肠缺少津液的滋润，因此秘结不解。医药求其暂时通畅，图快一时，因而使虚者更虚，元气更伤，缓则再次秘结而变成胀满，速则亡阴而导致虚脱。产后新血未生，元气未回，幸好后门坚固，旬日未解，也无妨碍。虽有滞涩，应当从缓治疗，宜用生化汤加人乳、肉苁蓉，以润枯涸。倘若气因血耗，传化失职的，宜用八味汤加人参、肉苁蓉，以助真气。古人有言，产后大便日久不通，由于血少肠燥，参乳汤多服则血旺气顺，自然无便涩之患。（《会心录》）
产后小便不通，腹胀如鼓，缘于胎前内积冷气所致。用盐填满脐中，葱白捣成饼放在盐上，用艾灸之，热气入腹即通。（《产乳集》）
胎前肠胃本有挟热，产后水血俱下，津液更加燥涩，所以令二便不通。有产妇患此证，饮牛乳而利，人乳尤其好。（《女科大全》）
溲数
产后小便频数，乃气虚不能制约水液所致，用补中汤加车前子、茯苓；如果属于膀胱阴虚的，用六味汤合生脉散滋其化源。（张路玉）
遗溺
产后小便有频数不禁、遗尿淋沥的证候。《内经》说：肾主二便，开窍于二阴。产后气血大虚，动伤脏腑，如果不是肺气虚而不能约制导致遗尿不禁，就是肾气竭而热移膀胱导致沥淋。总以补养气血为主，酌加升提固窍的药物。如果使用渗利疏导，是再次使其虚弱，切记！（萧慎斋）
产后损伤，膀胱破裂，终日小便淋漓，用黄丝绢二两，丹皮、白芨、人参各一钱煎服。服药时不可出声，出声则泄气无效，名叫补胞饮。○又用人参、白术、甘草熬膏，猪羊膀胱煎汤调服，月余膀胱长好自止。（张路玉）
产时下焦空虚，热气客居膀胱中，虚则小便频数，热则小便涩痛，所以叫作淋。又有因产后血虚挟热，热邪搏结血液，流渗胞中，血从小便而出，则为血淋。（《女科大全》）
小便淋证，《三因方》说：产前当安胎，产后当去瘀。这两句话最为关键。如产前淋，由于气虚不化，当用人参、黄芪补气安胎，不可过用渗利。产后淋，由于瘀血阻滞，当以瞿麦、蒲黄为要药。如果血虚热郁，当用六味丸、逍遥散，补阴养血，滋其化源，佐以导血之药。（萧慎斋）
大小便血
产后既已亡血，而二便又有下血的患者，这不是寻常火热渗入膀胱归于大肠可以常规治疗的。然而不是血虚，就是气脱的缘故。盖心主血，脾统血，心虚则小肠不能制约而血流，脾弱则大肠无所荫蔽而血下，所以二便出血，应当责之心脾二经为病。（萧慎斋）
产后小便出血，因血气虚而热乘之，血得热则流散，渗入胞内，故血从小便出。有产妇尿血，胁痛少食，这是肝木乘脾土。用加味逍遥散、补中汤兼服而愈。（《女科大全》）
前述证候，如果血滞小腹胀满的，用失笑散；肝火血妄行的，用加味逍遥散；脾郁不统血的，用加味归脾汤；脾虚不摄血的，用补中益气汤；浓味积热伤血的，用清胃散加槐花；风热相搏伤血的，用四君汤加防风、枳壳。（薛立斋）
产后已亡血，而又有血崩证候的，多属阴虚气脱所致。血脱须益其气，纯用血药无济于事。看薛案中有妇人血崩如涌，以六君子汤加黑姜治愈，得其旨趣了。（萧慎斋）
乳汁
产妇乳汁不行有两种：有因血气盛而壅闭不行的。有因血气少而弱涩不行的。虚当补之，用钟乳粉、猪蹄、鲫鱼之类；盛当疏之，用通草、漏芦、土瓜根之类。（陈无择）
前述证候，如果因气血虚弱不能生化者，宜壮脾胃；如果因怒动肝火，乳肿汁出者，宜清肝火。大概乳汁乃气血所化，如果屡产无乳，是亡津液，当滋化源。（薛立斋）
妇人以血用事，上为乳汁，下为月水。而血之所化，则本于脾胃，饮食之精微营运而为乳为经。产后脾胃气旺，则血旺而乳多；脾胃气衰，则血减而乳少。这是立斋治乳汁以壮脾胃滋化源为要点。如果徒从事通乳之剂，是犹向乞丐求金啊。（萧慎斋）
未产，乳自出者，谓之乳泣，生子多不育；如果产妇劳役，乳汁涌下者，这是气虚，独参汤补之。（《女科大全》）
月水
妇人冲任之脉，为经络之海，上为乳汁，下为月水。新产劳伤血气，或去血过多及哺乳，半岁一岁之内经不行的，这是正常现象。如果半岁或四、五月经便行的，这是少壮血盛之人。如果产后一、二年，月经不行无所苦的，也不必忧虑，这是气血衰少所致，只要健脾胃，资养气血，自然经行。如果用药物通经，反而有害。（陈良甫）
月水不调、不通，为妇人要病。至于产后，又不可以当作病来说。夫产后月水不行，有因产伤气血者，有因自乳血脉上为乳汁者，有因脾胃气虚饮食少进者。良甫一条，甚悉病机。至于说只要健脾胃，资气血，不必通经，尤为探本之论。（萧慎斋）
脉候
胎前脉洪数，既产而脉仍洪数的，死；胎前脉细小，产后而脉反洪大的，多死。（朱丹溪）
已产，气血两虚，脉宜缓滑。缓则舒徐，不因气夺而急促；滑则流利，不因血去而枯涩。均属吉兆。如果见到实大弦牢之脉，非产后所宜。实为邪，实大为邪进，弦为阴敛，牢为坚着，皆逆脉。（潘硕甫）
产后阴血骤亏，孤阳上越，证则发热，脉则数大，最为险候。为什么呢？阳浮而阴涸，营卫之气疾速，致脉反见数大之假象。且胎下之后，五内空虚，脉细弱者，于法所宜，是虚证而得虚脉也。脉数大者，于法所不合，是虚证而得实脉也。景岳说：阴阳俱亏，气血败乱，脉必急数，愈数愈虚，愈虚愈数。（《会心录》）
附方
The *Classic* states: "Those who have lost blood should not sweat." Sweat and blood are of the same category. After childbirth, excessive blood loss leads to Yin failing to anchor Yang; with Yin deficiency, Yang has no foundation, resulting in continuous sweating over the whole body. This is a case of dual deficiency of Yin and Yang, carrying the danger of Yang collapse, constituting a critical condition. If there is no sweating on the body but only on the head, since the head is the gathering point of all Yang meridians, the sudden loss of Yin blood causes lone Yang to float upward and outward. Although Yin is deficient, Yang remains relatively excessive; thus, Yin cannot control Yang, leading to sweating only on the head, particularly on the forehead. Floating Heart Fire forces Yang outward; urgently tonifying Yin and administering herbs that astringe Yang will allow the disease to resolve spontaneously. Therefore, postpartum women may welcome such sweating. (Xiao Shenzhai)
Some postpartum women welcome sweating because it indicates Yin and Blood deficiency. Postpartum loss of Yin blood leads to relative Yang excess; this reflects a constitution where Yang was naturally strong and Yin weak prior to delivery. Sweating allows Yin and Yang to restore balance. Generally, as sweat is released, Yang is also dissipated, preventing either from dominating, thus restoring continuity. This approach uses balanced tonification of Yin and Yang, yielding gradual effects. However, this type of sweating results from Yin deficiency and Yang hyperactivity, which is entirely different from the isolated head sweating seen in cases of Yin excess and Yang decline with upper flushing and lower coldness. Thus, for the favorable sweating where Yin and Yang rebalance, treatment can proceed to tonify both. Conversely, if there is profuse isolated head sweating indicating Yang collapse above and Yin exhaustion below, immediate life-threatening danger arises. One must not mistakenly treat this dangerous condition as simple Yin deficiency/Yang hyperactivity by using cooling and blood-nourishing herbs, which would accelerate death. In cases of upper flushing and lower coldness, sweating is profuse; even if temporarily relieved, coldness and dizziness recur, worsening until incurable. The favorable postpartum sweating is merely slight perspiration, requiring several days for Yin to gradually generate, Yang to harmonize, and sweat to cease. Some recover spontaneously without medication. These two conditions must not be conflated. The author's distinction emphasizes the need for rigorous differentiation: first distinguishing isolated head sweating, then assessing presence of dizziness or coldness, and finally determining the volume of sweat, thereby clearly separating the two syndromes. (Wei Litong)
Mania
Postpartum delirious speech and hallucinations of seeing ghosts have various origins and require syndrome differentiation. First, postpartum Heart deficiency with stagnant lochia ascending to disturb the Heart causes mania; refer to the section on "Seeing Ghosts." Second, postpartum Zang-Fu deficiency causing Heart Spirit fright and palpitations, leading to disordered speech without self-awareness, refers to the section on "Fright and Palpitations." Third, pre-existing wind diseases exacerbated by postpartum Heart Qi weakness, presenting with singing, crying, anger, laughter, disordered speech, and stiff back/neck, are treated as Wind Spasm; refer to "Wind-Stroke of the Heart Meridian." Fourth, postpartum stagnant lochia blocking the Pericardium causing inverted speech or fainting refers to the section on "Blood Syncope." Fifth, postpartum contraction of Wind-Cold with retained lochia, alternating chills and fever like malaria, clear consciousness by day but delirium at night resembling ghost sightings, is treated as "Heat Entering the Blood Chamber" (*Re Ru Xue Shi*). (*Da Quan Nv Ke*)
Selected Cases
A woman delivered six days ago became manic and attacked others with a knife. This was caused by sudden violent bleeding, Liver deficiency, and flaming fire. Treated successfully with *Zelan*, *Danggui*, *Dihuang*, *Niuxi*, *Fushen*, *Yuanzhi*, *Zaoren*, and child's urine. (Miao Zhongchun)
Mutism
The Heart is the Sovereign Officer, from whom the Spirit emerges. Externally it connects to the tongue, which is the mechanism of speech. Postpartum Heart deficiency often leads to stagnant lochia ascending to obstruct the Heart orifices, clouding the Spirit. Since Heart Qi communicates with the tongue, Heart Qi obstruction causes tongue stiffness and inability to speak. (Guo Jizhong)
Postpartum mutism is mostly due to stagnant lochia blocking the Heart orifices, obscuring the Spirit. Treatment should use *Qinghun San* added with *Sumu* and *Danshen*. If Heart and Kidney Qi deficiency prevents communication with the tongue, use *Chensha Qizhen San* or add *Renshen* and *Shichangpu*. If Kidney deficiency with Wind invasion occurs, use *Dihuang Yinzi*. If Liver Wood is excessive, use *Chaihu Qinggan San*. If Spleen is oppressed by Liver Wood, use *Liujunzi Tang* added with *Chaihu* and *Gouteng*. If both Qi and Blood are deficient, use *Bazhen Tang* added with *Shichangpu* and *Yuanzhi*. (*Zhangshi Yitong*)
Guo Jizhong attributes postpartum mutism to lochia confusing the Heart, while *Jiyin Fang* attributes it to Stomach Heat and Damp-Phlegm; both discuss excess patterns. However, mutism caused by excessive blood loss leading to deficient Fire harassing the Spirit belongs to deficiency. (Xiao Shenzhai)
Fright, Palpitations, and Absence of Mind
What governs the human body is the Heart. What governs the Heart is Blood. When Heart Blood is deficient, the Spirit loses its residence, giving rise to fright and palpitations. Treatment should primarily focus on greatly tonifying Blood and Qi. ○ Postpartum absence of mind also requires great tonification of Blood and Qi. Wind symptoms are often false manifestations of extreme deficiency; consolidating the Root Yuan causes other diseases to recede. Treating solely for Wind accelerates danger. (Xue Lizhai)
Postpartum absence of mind arises because the Heart governs Blood, and Blood/Qi circulates through Ying-Wei, Zang-Fu, and meridians. Postpartum injury to Blood and Qi leaves the Five Zang deficient, Ying-Wei insufficient, allowing Wind Pathogens to invade and unsettle the Heart Spirit. (*Da Quan Nv Ke*)
Note: Previous authors attributed postpartum mutism to lochia entering the Heart or Wind invasion, naming it "Heart Wind," focusing only on excess pathogens and ignoring deficiency. They failed to explain the origin of the Wind, an error in theory. Fright and absence of mind are naturally caused by Blood deficiency and Heart Qi insufficiency; the claim in *Da Quan* that Wind Pathogens attack the Heart is erroneous. Lizhai’s advice to consolidate the Root Yuan rather than treat Wind alone is highly beneficial to future scholars. (Xiao Shenzhai)
Insomnia
Postpartum insomnia is mostly due to severe Qi and Blood deficiency, where Yin fails to anchor Yang. Wei Qi travels in Yang during the day (wakefulness) and in Yin at night (sleep). After delivery, sudden blood loss causes Yang to float upward, remaining in Yang instead of entering Yin, leading to all-night wakefulness, irritability, sweating, red face, and thirst. How should physicians treat this? Nourishing Water extinguishes Fire and stores the Spirit; benefiting Yin fills Blood and calms the Heart. *Liuwei Guishao Tang* added with child's urine and *Renshen* is effective. For Heart-Kidney non-interaction with absent-mindedness, *Buxin Dan* modified is appropriate. If Blood loss causes lone Yang to float, with Ying-Wei imbalance and all-night wakefulness, *Guipi Tang* or *Renshen Yangying Tang* is ideal. Generally, for Yin-deficiency insomnia, Yang-tonifying herbs should not be used lightly; for Yang-deficiency insomnia, Yin-nourishing herbs should not be mixed indiscriminately. Pulse and syndrome differentiation are essential; do not adhere rigidly to formulas. Additionally, insomnia due to blood stasis pain requires treating the Blood; due to food stagnation, treat the Food; due to epidemic pathogens, treat the Epidemic; due to malaria/dysentery, treat those conditions. Zhang Jingyue stated: The Heart houses the Spirit and is the dwelling of Yang; Wei governs Qi and transforms Yang. When Wei Qi enters Yin, there is stillness, leading to sleep, because Yang has a return path, calming the Spirit. To achieve sleep, one must nourish Yin containing Yang and remove agitation within stillness. (*Huixin Lu*)
Edema
Postpartum edema usually results from dual Qi and Blood deficiency, weak Spleen-Stomach, and failure of Ying-Wei to circulate.
Using diaphoresis or diuretics would further deplete fluids and worsen deficiency. Should postpartum swelling be treated as an exterior excess pathogen? (Xiao Shenzhai)
If the aforementioned edema is due to Cold-Water insulting Earth (Kidney water overacting on Spleen), nourish Spleen-Lung. If due to Qi deficiency, benefit Spleen-Stomach. If due to Water-Qi, tonify Middle Qi. If postpartum edema is accompanied by wheezing/coughing and a deep, thin, powerless pulse, this indicates Mingmen Fire decline and Spleen-Earth cold deficiency, treated with *Bawei Wan*. (Xue Lizhai)
Consumptive Disease after Childbirth (Rulao)
Postpartum consumption with chills/fever, failure of Primordial Spirit to recover, and amenorrhea: first administer *Qianjin* *Danggui Shaoyao Tang*, followed by *Wuguji Wan* for regulation and tonification. This condition often stems from Spleen-Stomach weakness and reduced intake. Tonifying Spleen-Stomach and promoting appetite allows the Zang-Fu to rely on them, curing the disease. (Xue Lizhai)
Constipation
Excessive blood loss after childbirth dries the Large Intestine; bowel movements every three to five days is normal. Only use honey suppositories or fermented vegetable guides when abdominal fullness creates urgency without passage. *Dandao* (bitter-cold) is contraindicated as misuse often causes hiccups. For Blood deficiency with dryness-fire, use *Sini Tang* (Note: Text says Siwu Tang) added with fresh *Heshouwu* to moisten and purge. For dual Qi-Blood deficiency, even if constipated for days, if diet and abdomen are normal, use *Bazhen Tang* added with *Maren* and cooked honey. If prolonged retention causes extreme restlessness, *Danggui* and *Zhike* may be used as a temporary measure. (*Zhangshi Yitong*)
Postpartum constipation is generally not worrying, but straining can cause prolapse of the uterus or failure of the vaginal opening to close, requiring early intervention. ○ Postpartum constipation results from Qi deficiency failing to push and Blood deficiency failing to moisten. Use *Bazhen Tang* added with *Taoren* and *Xingren*. People know *Taoren* breaks Blood but not that it promotes Blood flow and lubricates the intestines; they know *Xingren* moistens Lungs but not that it lubricates intestines and aids defecation. Using only *Bazhen Tang* might fail to move dry stool; adding these two accelerates efficacy. (Gao Gufeng)
In miscellaneous diseases, constipation involves Yangming excess-heat accumulation or intestinal blood stasis. In postpartum cases, the blame lies solely in Qi and Blood deficiency. Sudden loss of Yin Blood causes simultaneous Qi depletion; Shaoyin loses its opening/closing function, and the Large Intestine lacks fluid moisture, causing stubborn constipation. Medications seeking temporary relief harm the already depleted Yuan Qi. Delayed treatment leads to distension; rapid treatment risks Yin collapse and deficiency shock. Since new Blood has not regenerated and Yuan Qi has not returned, if the rectum remains intact despite ten days without movement, it is harmless. Even with sluggishness, treat gently: use *Shenghua Tang* added with human milk and *Rongrongsu* to moisten dryness. If Qi depletion impairs transportation, use *Bawei Tang* (Note: Text implies a variation, likely Bazhen or similar tonifying formula based on context, but text says Bawei Tang here, possibly referring to a specific variant or error in source, sticking to text) added with *Renshen* and *Rongrongsu* to assist True Qi. Ancients said: Postpartum long-term constipation is due to Blood deficiency and intestinal dryness; frequent use of *Renru Tang* increases Blood and smooths Qi, resolving blockage. (*Huixin Lu*)
Urinary Retention
Postpartum urinary retention with drum-like abdominal distension is caused by accumulated Cold Qi during pregnancy. Fill the umbilicus with salt, place a cake of mashed scallion white on the salt, and moxa-burn it; heat entering the abdomen restores flow. (*Chanlu Ji*)
Pregnancy intestines often harbor Heat; postpartum loss of fluids and blood increases dryness, causing urinary/fecal retention. Drinking cow's milk helps; human milk is superior. (*Da Quan Nv Ke*)
Frequent Urination
Postpartum frequent urination is due to Qi deficiency failing to control water. Use *Buzhong Tang* added with *Cheqianzi* and *Fuling*. If Bladder Yin deficiency, use *Liuwei Tang* combined with *Shengmai San* to nourish the source of transformation. (Zhang Luyu)
Enuresis
Postpartum presents with frequency, incontinence, or dribbling. The *Classic* states: The Kidney governs the two lower orifices. Postpartum severe Qi/Blood deficiency injures Zang-Fu. Either Lung Qi deficiency fails to constrain (causing enuresis/incontinence), or Kidney Qi exhaustion with Heat transferring to the Bladder causes dribbling/strangury. Primary treatment is tonifying Qi and Blood, adding lifting and astringent herbs. Diuretics and draining methods worsen deficiency; avoid them! (Xiao Shenzhai)
Bladder Rupture
Postpartum trauma causing bladder rupture with continuous dripping urine: decoct 2 liang of yellow silk, 1 qian each of *Danpi*, *Baiji*, and *Renshen*. Do not make noise while taking it, or Qi leaks and efficacy is lost. Named *Bu Bao Yin*. ○ Alternatively, decoct *Renshen*, *Baizhu*, *Gancao* into paste, mix with pig/sheep bladder soup; the bladder heals in a month. (Zhang Luyu)
Strangury (Lin)
Postpartum lower Jiao emptiness allows Heat to lodge in the bladder. Deficiency causes frequency; Heat causes painful, difficult urination, termed Strangury. If postpartum Blood deficiency with Heat binds Blood, flowing into the bladder, causing blood in urine, it is Blood Strangury. (*Da Quan Nv Ke*)
Regarding Strangury, *San Yin Fang* states: Prenatally calm the Fetus; postnatally remove Stasis. Crucial principles. Prenatal strangury due to Qi deficiency failing to transform: use *Renshen* and *Huangqi* to tonify Qi and calm the Fetus; avoid excessive diuretics. Postnatal strangury due to Blood Stasis: *Qumai* and *Puhuang* are key herbs. If Blood deficiency with Heat stagnation, use *Liuwei Wan* and *Xiaoyao San* to nourish Yin/Blood and aid drainage. (Xiao Shenzhai)
Blood in Urine and Feces
Postpartum women who have lost Blood yet experience bleeding from urine or feces cannot be treated simply as Heat pouring into Bladder/Large Intestine. It is either Blood deficiency or Qi collapse. The Heart governs Blood; the Spleen controls Blood. Heart deficiency fails to control Small Intestine flow; Spleen weakness fails to shade Large Intestine vessels. Thus, bleeding from both orifices points to Heart and Spleen meridian pathology. (Xiao Shenzhai)
Postpartum hematuria results from Qi/Blood deficiency allowing Heat to scatter Blood into the bladder. A case of hematuria with hypochondriac pain and poor appetite indicates Liver Wood insulting Spleen Earth; cured by combining *Jiawei Xiaoyao San* and *Buzhong Tang*. (*Da Quan Nv Ke*)
Metrorrhagia (Blood Flooding)
If abdominal distension/pain indicates Blood stasis, use *Shixiao San*; Liver Fire forcing reckless Blood, use *Jiawei Xiaoyao San*; Spleen Depression failing to control Blood, use *Jiawei Guipi Tang*; Spleen deficiency failing to hold Blood, use *Buzhong Yiqi Tang*; rich food Heat damaging Blood, use *Qingwei San* added with *Huaihua*; Wind-Heat combinating to damage Blood, use *Sijunzi Tang* added with *Fangfeng* and *Zhike*. (Xue Lizhai)
Postpartum metrorrhagia following blood loss is mostly due to Yin deficiency and Qi collapse. Blood loss requires Qi tonification; using only Blood herbs is ineffective. Case: Woman with gushing metrorrhagia cured by *Liujunzi Tang* added with charred *Ganjiang*. (Xiao Shenzhai)
Lactation
Two types of postpartum lactation failure: 1. Abundant Qi/Blood causing congestion/blockage. 2. Scarcity of Qi/Blood causing weak/rare flow. Deficiency requires tonification: use *Zhongru Fen*, pig trotters, crucian carp. Excess requires dispersal: use *Tongcao*, *Loulu*, *Tugua Gen*. (Chen Wuze)
If failure is due to Qi/Blood weakness failing to transform, strengthen Spleen-Stomach. If due to Anger stirring Liver Fire with breast swelling/leakage, clear Liver Fire. Milk is transformed from Qi/Blood; repeated births without milk indicate fluid loss; nourish the source. (Xue Lizhai)
Women use Blood for functions: up as milk, down as menses. Blood transformation originates in Spleen-Stomach processing dietary essence. Strong postpartum Spleen-Stomach Qi leads to abundant Blood/milk; weak Qi leads to reduction. Lizhai emphasizes strengthening Spleen-Stomach to nourish the source. Merely using galactagogues is like asking a beggar for gold. (Xiao Shenzhai)
Leaking milk before delivery is called *Ruqi*; offspring often do not survive. Postpartum labor-induced gushing milk indicates Qi deficiency, treated with *Dushen Tang*. (*Da Quan Nv Ke*)
Menstruation
Chong and Ren meridians are the Sea of Channels, producing milk upwards and menstruation downwards. Postpartum fatigue/blood loss or breastfeeding may cause amenorrhea for 6 months to 1 year; this is normal. Early return (4-5 months) indicates robust Blood in young women. Amenorrhea for 1-2 years without discomfort indicates declining Qi/Blood; strengthen Spleen-Stomach and nourish Blood/Qi for natural return. Medicinal induction is harmful. (Chen Liangfu)
Irregular/absent menstruation is a major female issue, but postpartum amenorrhea should not be treated as a disease per se. Causes include birth trauma to Qi/Blood, Blood diverted to milk, or Spleen-Stomach Qi deficiency with poor intake. Liangfu’s analysis is thorough. Emphasizing Spleen-Stomach tonification over menstrual induction is probing the root. (Xiao Shenzhai)
Pulse Diagnosis
Prenatal pulses should be firm; postpartum pulses should be deficient. (*Ji Chan Sheng Jing*)
Prenatal pulses surging and rapid; if still surging/rapid postpartum, death ensues. Prenatal pulses fine/small; if becoming surging/large postpartum, death is likely. (Zhu Danxi)
Postpartum, with dual Qi/Blood deficiency, pulses should be slow and slippery. Slow indicates relaxation without Qi depletion urgency; slippery indicates flow without Blood loss dryness. Both auspicious. Firm, large, wiry, or deep-firm pulses are unfavorable. Firm indicates pathogen; large indicates pathogen progression; wiry indicates Yin constriction; deep-firm indicates rigidity—all adverse. (Pan Shuofu)
Postpartum sudden Yin Blood loss causes lone Yang to float, presenting with fever and rapid/large pulse, a critical sign. Why? Yang floats, Yin dries, Ying-Wei moves rapidly, creating a false rapid/large pulse appearance. Post-delivery, internal organs are empty; fine/weak pulses are appropriate (deficiency getting deficiency pulse). Rapid/large pulses are inappropriate (deficiency getting excess pulse). Jingyue stated: Dual Yin-Yang deficiency and chaotic Qi/Blood lead to urgent/rapid pulses; the more rapid, the more deficient; the more deficient, the more rapid. (*Huixin Lu*)
Attached Formulas
Jiahe Yin: *Renshen*, *Fuling*, *Shanyao*, *Chenpi*, *Gancao*, *Banxia Qu*, *Shashen*, *Shihu*, *Danshen*, *Baishao*, *Yiren*, *Biandou*, *Lianzi*, *Guya*, *Shenqu*, *Heizao*.