产后之症。变怪百出。要不越乎虚实。实则瘀血凝滞。虚则去血过多。凝滞
者攻之无难。去多者挽之匪易。此人参之可用不可用。判若天渊也。然有
元气大虚。而恶血未尽。则以四君子入芎归肉桂益母。或去术倍参。加二
陈。一以补中气。一以通血脉。庶有当乎。矧且其因多端。不易枚举。有胎前
受病而发。有坐草过艰而致。有杂病相侵而作。有本质柔弱而得。如胎前
饮食停留。而产后不化。或感冒发热。而产后弥甚。或疟痢太乏。而产后益
虚。或祈望得子。而不育滋戚。或产女已多。而中情鲜悦。或茹荤太早。而寒
热顿作。或起居骤聚。而外邪干侵。或惊恐偶得。而心神欠宁。或恼怒不谨。
而肝气怫郁。凡此数者。毋论恶血之凝与不凝。皆足为产后之累。且男性
急速。产母受病恒少。女性阴滞。产母受病恒多。元气强壮。产母受病易愈。
元气素虚。产母受病难疗。如余内子。戊戌年。得双胎。产以前。自五月至弥
月。形体削瘦。日进参三钱。可纳谷半盏。若缺参一日。食便不入。临产旬日。
日进参两许。果易产而安。产后亦经无恙。及甲辰春。复得一子。胎前未曾
服参。产后大虚。二旬外。忽面青多怒。时昏晕不醒。脉得纯弦而细。饮食不
入。余知其真气已衰。心脾既失所养。肝木从而凌肆。即以归脾汤入参五
钱。熟附一钱。投数剂。屡止屡发。益参至一两。附二钱。亦如故。再加参五钱
附三钱。其势犹未定。乃益参至二两。附四钱。怒始解。昏晕不作。以后参附
渐减。调理两月余而愈。余始叹人参之功。回元气于无何有之乡。亦能调
脏气于大不平之日。若使此症临于病家。焉肯亲信而服参不辍有如是
耶。余故论产后。而实举以告云。
一女子产后八朝。医妄以滚痰丸进。遂上呕下泄。昼夜不止。吴门周子云
来疗之。投参八钱加赤石脂禹余粮呕泄俱止。后其家。又有一生产者。
医作外感治。面赤气喘。肢冷脉弱。乃延余诊。云来亦至。余见其中气空
虚。欲以归脾入炮姜与之。云来曰。先补阴后补阳何如。余曰。火气即浮。
敛之有何不可。遂以六味汤入肉桂远志枣仁。气渐平。脉渐出。余辞归。
忽复厥逆。复延余。余以他往不及。云来用人参四钱。附子八分进之。向
安。因托吾友松声唐子。复与云来商温补而愈。但因年少。气血偶衰。病
虽痊。后发痔漏。用滋阴降火。每致缠绵。观此知用药之不可轻也。
一女子胎前发疟。面色痿黄。余以六君子连进。疟未止而产。产而疟愈甚。
恶露少行。一友进以炮姜。腹中大痛。恶血不下。余用延胡芎归益母山
楂陈皮一剂。痛止血行。再以六君子倍白术。不数剂。脾气渐旺。疟乃止。
一女子产后。去血过多。乃发寒热。肢冷脉微。余以八珍汤入姜附。一剂而
寒热止。数剂而食进神旺。遂得霍然。
一女子产后。以不遂愿。兼怒而戚。恶露未透。身发寒热。自汗如雨。时见谵
妄。余以远志茯神枣仁木香杜仲当归益母。连进而汗止。但谵妄未除。
以前药入牛膝炮姜。下积血一块。昆山郑氏至。商加萎蕤四钱。贝母二
钱。车前一钱。又三剂而神安。继以调理而痊。
一女子产后发肿。加之喘满。但恶露绝不下。与消肿药不效。用五灵脂延
胡索桃仁泽兰红花牛膝。恶露大下。喘止肿退。后用调补而愈。
一女子胎前腹痛。坐卧不宁。至夜半。气息淹淹。脉遂歇止。胎亦不动。余虑
其胎气已损。急服无忧散一剂。痛稍止。胎未动。以芎归汤当归一两。川
芎五钱。血余二钱。顿煎饮之。脉遂现。胎遽动。继用独参汤无忧散相间
服之。乃产而安。
一女子素有病。余虑其难产。令预备。加味芎归汤。及产时。胎果下而不遽
下。稳婆告急无措矣。余令急煎前药与之。未及半时。即得产矣。此皆余
所亲验者。先哲立方。抑何神哉。
产后病症，变化多端，但总不离虚实两端。实证为瘀血凝滞，虚证为失血过多。对于瘀血凝滞者，攻逐并不困难；但对于失血过多者，挽回元气并非易事。这就是人参在产后病中可用与不可用的区别，二者相差如天地之远。然而，若有元气极度虚弱而恶露未尽的情况，则可在四君子汤（补气基础方）中加入川芎、当归、肉桂、益母草以补益气血、温通血脉；或者去掉白术，加倍人参用量，再加入二陈汤（燥湿化痰方）以健脾益气、化痰祛湿。这样既能补益中气，又能疏通血脉，才较为妥当。况且产后病因繁多，难以一一列举。有的因胎前患病而在产后发作；有的因分娩艰难所致；有的因杂病侵袭而引发；有的因体质柔弱而得病。例如：胎前饮食停滞，产后消化不良；或感冒发热，产后加重；或疟疾痢疾导致身体极度虚弱，产后更加亏虚；或渴望生子却未能如愿，心情忧郁；或已生育多个女儿，心中不悦；或过早食用荤腥，导致寒热症状突然发作；或起居骤变，外邪乘虚入侵；或偶受惊恐，心神不安；或恼怒不慎，肝气郁结。以上这些情况，无论是否有瘀血凝滞，都足以成为产后病的负担。而且男性急躁，产妇患病较少；女性阴柔迟缓，产妇患病较多。元气强壮者，产后病容易痊愈；元气素虚者，产后病难治。
像我内人，戊戌年怀双胎，从五月到临产，形体消瘦，每天服用人参三钱，才能吃下半盏饭；若缺参一天，便无法进食。临产前十天，每日服用人参一两，果然顺利生产且平安。产后也无恙。到了甲辰年春季，又得一子，胎前未服人参，产后大虚。二十多天后，突然面色发青、易怒，时常昏晕不醒，脉象纯弦而细，饮食不进。我知道她真气已衰，心脾失去滋养，肝木随之亢盛肆虐。于是用归脾汤加入人参五钱、熟附子一钱，服用几剂后，症状屡止屡发。将人参增至一两，附子增至二钱，依然如此。再加人参五钱、附子三钱，病情仍未稳定。于是将人参增至二两，附子增至四钱，怒气才平息，昏晕不再发作。此后逐渐减少人参和附子的用量，调理两个多月才痊愈。我开始感叹人参的功效，能在元气将绝之时挽回生机，也能在脏腑功能严重失调时进行调节。如果此症发生在别人家，谁肯相信并坚持服用如此大量的人参呢？所以我论述产后病，实则以此为例告知世人。
有一女子产后八天，医生误用滚痰丸（泻下通便方），导致上吐下泻，昼夜不止。苏州周云来诊治，投予人参八钱，加赤石脂、禹余粮，呕吐腹泻随即停止。后来这家人又有位产妇，医生按外感治疗，出现面赤气喘、四肢冰冷、脉象微弱。于是请我诊治，周云来也到了。我看其中气空虚，打算用归脾汤加炮姜给她服用。周云来说：“先补阴后补阳如何？”我说：“火气上浮，收敛有何不可？”于是用六味地黄汤（滋阴补肾方）加入肉桂、远志、酸枣仁，气息逐渐平稳，脉象逐渐显现。我告辞回家，病人忽然再次厥逆，再次延请我，但我因外出不及赶到。周云来用人参四钱、附子八分给予服用，病情暂时安定。后来托朋友唐松声与周云来商量，采用温补疗法而痊愈。但因患者年少，气血偶有衰弱，病虽痊愈，后来却发了痔漏，使用滋阴降火法，每每导致病情缠绵难愈。由此可知用药不可轻率。
有一女子胎前患疟疾，面色萎黄。我用六君子汤连续服用，疟疾未止便分娩了。产后疟疾反而加重，恶露量少。一位朋友用炮姜，导致腹中大痛，恶血不下。我用延胡索、川芎、当归、益母草、山楂、陈皮，一剂药后，疼痛停止，恶血下行。再用六君子汤加倍白术，没几剂，脾气渐旺，疟疾才停止。
有一女子产后失血过多，出现寒热交替、四肢冰冷、脉象微弱。我用八珍汤（补血益气方）加入干姜、附子，一剂后寒热停止，数剂后食欲增加、精神旺盛，于是霍然痊愈。
有一女子产后，因心愿未遂兼愤怒忧郁，恶露未排净，身体发寒热，自汗如雨，时而出现谵语妄言。我用远志、茯神、酸枣仁、木香、杜仲、当归、益母草，连续服用后汗止，但谵语未除。在前药基础上加入牛膝、炮姜，排出积血一块。昆山郑氏到来，商量加入玉竹四钱、贝母二钱、车前子一钱，又服三剂后神志安宁，继以调理而痊愈。
有一女子产后浮肿，加上喘满，但恶露完全不下。用消肿药无效，改用五灵脂、延胡索、桃仁、泽兰、红花、牛膝，恶露大量下行，喘息停止，浮肿消退。后用调补之法而痊愈。
有一女子胎前腹痛，坐卧不宁，至半夜气息奄奄，脉象歇止，胎儿也不动。我担心胎气已损，急服无忧散一剂，疼痛稍止，胎儿未动。再用芎归汤，当归一两、川芎五钱、血余炭二钱，顿煎饮下，脉象随即出现，胎儿随即活动。继用独参汤与无忧散交替服用，最终平安分娩。
有一女子素有疾病，我担心难产，令其预备加味芎归汤。及至分娩时，胎儿果欲下而不能遽下，稳婆惊慌无措。我令急煎前药给她服用，不到半小时，即顺利分娩。这些都是我所亲自验证的。先哲创立的方剂，何其神奇啊！
Postpartum diseases present with myriad variations, yet they fundamentally fall into two categories: excess and deficiency. Excess manifests as stagnation of blood stasis; deficiency results from excessive blood loss. For cases of blood stasis stagnation, resolving it is not difficult; however, for those with excessive blood loss, restoring the body's vital energy is far from easy. This distinction determines whether Ginseng Radix et Rhizoma (Renshen) is applicable or contraindicated, a difference as vast as heaven and earth. Nevertheless, in cases where primordial Qi is severely deficient while lochia remains incomplete, one may add Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Cinnamomi Cortex (Rougui), and Motherwort Herba (Yimucao) to Si Jun Zi Tang (Four Gentlemen Decoction) to tonify Qi and Blood and warm the channels. Alternatively, remove Atractylodis Macrocephalae Rhizoma (Baizhu), double the dosage of Renshen, and add Er Chen Tang (Two-Cured Decoction) to strengthen the Middle Jiao and resolve dampness-phlegm. This approach simultaneously tonifies the Spleen-Stomach Qi and unblocks the blood vessels, which is more appropriate. Moreover, the etiologies of postpartum disorders are manifold and difficult to enumerate. Some arise from illnesses contracted during pregnancy that manifest postpartum; some result from difficult labor; some are caused by concurrent miscellaneous diseases; others stem from inherent physical weakness. For instance, food retention during pregnancy leading to indigestion postpartum; or wind-cold invasion causing fever that worsens postpartum; or severe malaria and dysentery causing extreme debility that exacerbates postpartum; or frustration from infertility causing melancholy; or dissatisfaction from bearing multiple daughters causing inner displeasure; or premature consumption of rich foods triggering sudden chills and fever; or abrupt changes in lifestyle allowing external pathogens to invade; or sudden fright disturbing the Heart Spirit; or unchecked anger causing Liver Qi stagnation. Regardless of whether blood stasis is present, all these factors can burden the postpartum state. Furthermore, men tend to be quick-acting, so postpartum illness is less common among them; women tend to be Yin-dominant and sluggish, making postpartum illness more frequent. Those with strong primordial Qi recover easily from postpartum disorders; those with chronic Qi deficiency find treatment difficult.
My wife, in the year Wuxu, carried twins. From the fifth month until term, her physique became emaciated. She required three qian of Renshen daily to consume half a bowl of rice; without it for a day, she could not eat. Ten days before delivery, she took approximately one liang of Renshen daily, resulting in an easy and safe delivery. Postpartum, she remained well. In the spring of Jiachen, she gave birth to another son. Having not taken Renshen during pregnancy, she suffered severe postpartum deficiency. Beyond twenty days, she suddenly developed a greenish complexion, irritability, and recurrent fainting spells. Her pulse was purely wiry and thin, and she refused food. I recognized that her True Qi had declined, the Heart and Spleen were deprived of nourishment, and the Liver Wood became hyperactive and oppressive. I prescribed Gui Pi Tang (Restore the Spleen Decoction) with five qian of Renshen and one qian of Prepared Aconite Root (Shu Fuzi). After several doses, symptoms recurred intermittently. Increasing Renshen to one liang and Fuzi to two qian yielded no change. Adding another five qian of Renshen and three qian of Fuzai still failed to stabilize the condition. Finally, increasing Renshen to two liang and Fuzi to four qian resolved the anger and ceased the fainting. Subsequently, dosages were gradually reduced, and after over two months of regulation, she recovered. I then marveled at the efficacy of Renshen, capable of rescuing vitality from the brink of extinction and regulating organ functions during severe imbalance. If such a case occurred in another household, who would trust and persist with such high doses of Renshen? Thus, in discussing postpartum diseases, I use this case as an illustration.
A woman, eight days postpartum, was mistakenly administered Gun Tan Wan (Rolling Phlegm Pill) by a physician, resulting in incessant vomiting and diarrhea day and night. Zhou Yunlai from Suzhou treated her, administering eight qian of Renshen combined with Lithosi Fragmentum (Chishizhi) and Yuyuliang Fructus (Yuyuliang), which immediately stopped the vomiting and diarrhea. Later, another patient from the same family presented with facial redness, panting, cold limbs, and a weak pulse, having been treated for exterior contraction. I examined her and identified empty deficiency of the Middle Qi, intending to prescribe Gui Pi Tang with Pao Jiang (Prepared Ginger). Zhou Yunlai suggested, "Why not tonify Yin first, then Yang?" I replied, "With floating Fire, astringing is acceptable." Thus, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) was modified with Rougui, Yuanzhi, and Zaoren. Her breathing gradually stabilized, and her pulse became palpable. Upon my departure, she experienced sudden reversal cold syndrome (Jue Ni). I was away and could not arrive in time. Zhou Yunlai administered four qian of Renshen and eight fen of Zhi Fuzi (Processed Aconite Root), temporarily stabilizing her. Later, through our mutual friend Tang Songsheng, consultation with Zhou Yunlai led to a successful outcome using warming and tonifying methods. However, due to her youth and occasional decline in Qi and Blood, although cured, she later developed hemorrhoids and fistulas. Treatment with Yin-nourishing and fire-clearing herbs often resulted in lingering conditions. This demonstrates that medication must not be used lightly.
A woman suffered from malaria during pregnancy, presenting with sallow complexion. I continuously administered Liu Jun Zi Tang (Six-Gentleman Decoction), but she delivered before the malaria ceased. Postpartum, the malaria worsened, and lochia flow was scant. A colleague prescribed Pao Jiang, causing severe abdominal pain and retention of blood stasis. I prescribed Yan Hu Suo, Chuanxiong, Danggui, Yimucao, Shan Zha, and Chen Pi. One dose stopped the pain and promoted lochia discharge. Subsequently, Liu Jun Zi Tang with doubled Baizhu was given. Within a few doses, Spleen Qi strengthened, and the malaria subsided.
A woman suffered from excessive blood loss postpartum, developing chills and fever, cold limbs, and a minute pulse. I administered Ba Zhen Tang (Eight-Treasure Decoction) with Gan Jiang (Dried Ginger) and Fuzi. One dose stopped the chills and fever; several doses improved appetite and spirit, leading to complete recovery.
A woman postpartum, frustrated and angry, retained incomplete lochia, presenting with chills, fever, profuse spontaneous sweating, and intermittent delirium. I prescribed Yuanzhi, Fushen, Zaoren, Muxiang, Duzhong, Danggui, and Yimucao. Continuous administration stopped the sweating, but delirium persisted. I added Niuxi and Pao Jiang to the previous formula, expelling a mass of accumulated blood. Zheng from Kunshan joined the consultation, suggesting adding Yu Zhu (Polygonatum Odoratum Rhizome), Bei Mu, and Che Qian Zi. After three more doses, mental clarity returned, followed by regulatory treatment for full recovery.
A woman postpartum developed edema and distension, with complete cessation of lochia. Diuretic and swelling-reducing herbs were ineffective. I prescribed Wulingzhi, Yanhusuo, Taoren, Zelanyan, Honghua, and Niuxi. This induced massive lochia discharge, stopping the panting and reducing the edema. She subsequently recovered with tonic therapy.
A woman suffered from abdominal pain during pregnancy, restless day and night. By midnight, her breath was faint, pulse intermittent, and fetal movement ceased. Concerned about damaged fetal Qi, I urgently administered Wu You San (Worry-Free Powder). Pain slightly subsided, but the fetus did not move. I then prepared Xiong Gui Tang with one liang of Danggui, five qian of Chuanxiong, and two qian of Xueyu Tan (Charred Human Hair). Decocted and drunk immediately, the pulse reappeared, and fetal movement resumed. Intermittent administration of Du Shen Tang (Single Ginseng Decoction) and Wu You San led to a safe delivery.
A woman with pre-existing chronic disease was at risk of dystocia. I advised preparing Jia Wei Xiong Gui Tang (Modified Chuanxiong-Danggui Decoction). At delivery, the fetus descended but did not exit quickly. The midwife panicked. I ordered immediate decoction and administration of the prepared medicine. Within half an hour, delivery was achieved. These are cases personally verified by me. How miraculous are the formulas established by the sages!