《大全》云∶夫恶露不下，由产后脏腑劳伤，气血虚损，或胞络挟于宿冷，或产后当风
取凉，风凉乘虚而搏于血，则壅滞不宣，积蓄在内，故令恶露不下也。
薛氏曰∶前症当用失笑散。若气滞血凝，用花蕊石散。
《大全》云∶夫产后恶露不绝者，由产后伤于经血，虚损不足，或分娩之时，恶血不尽
在于腹中，而脏腑挟于宿冷，致气血不调，故令恶露淋漓不绝也。
薛氏曰∶前症若肝气热而不能主血，用六味丸。或肝气虚而不能藏血，用逍遥散。若脾
气虚
而不能摄血，用六君子汤。脾胃气下陷而不能统血，用补中益气汤。若脾经郁热而血不归源
，用加味归脾汤。若肝经风邪而血沸腾，用一味防风丸。
陈氏曰∶产后血崩者何?答曰∶产后伤耗经脉，未得平复，劳得损动，致血暴崩淋漓不
止。
或因酸咸不节，伤蠹荣卫衰弱，亦变崩中。若小腹满痛，肝经已坏，为难治。急服固金丸止
之。
薛氏云∶前症若血滞小腹胀满，用失笑散。血少小腹虚痞，芎 汤。余参前。
《大全》云∶产后心痛为阴血亏损，随火上冲心络，名曰心胞络痛。宜大岩蜜汤(一名
桂心
汤，熟地、当归、独活、吴萸、白芍、干姜、桂心、通草各二钱，细辛、甘草各五分)治之
。若寒伤心经，名曰真心痛，无药可救(心痛曰产后则与寻常之病不同矣，当于血分求之)。
薛氏曰∶小腹作痛，俗名儿枕块，用失笑散行散之。若恶露既去而仍痛，用四神散(干
姜、
当归、赤芍、川芎)调之。若不应，用八珍散。若痛而恶心，或欲作呕，用六君子汤。若痛
而泄泻，用六君子汤送四神丸。若泄泻痛而后重，用补中益气汤送四神丸。若胸膈饱胀，或
恶食吞酸，或腹痛手不可按，此是饮食所致，用二陈加山楂、白术以消导。若食既消而仍痛
，或更加头痛烦热作渴，恶寒欲呕等症，此是中气破伤，宜补脾胃为主。若发热腹痛，按之
痛甚，不恶食，不吞酸，此是瘀血停滞，用失笑散消之(按腹痛原文向有数症，曰∶因气滞
用玄胡索散，因外寒用五积散，因怒气用四物加木香、柴胡，因阳气虚弱用四君子、当归、
炮姜，因脾虚血弱用六君、当归、炮姜。大凡心腹作痛，以手按之却不痛者，此血虚也，须
用补食之剂)。若只是头痛发热，或兼头痛，按之却不痛，此属血虚，用四物加炮姜、参、
术以补之。
《大全》云∶儿枕者，由母胎中宿有血块，因产时其血破散，与儿俱下，皆无患也。若
产妇
脏腑风冷，使血凝滞在于小腹，不能流通，则令结聚疼痛，名之曰儿枕。《金匮》云∶产后
七八日，无太阳症，少腹坚痛，此恶露不尽。不大便，烦躁发热，切脉微实，再倍发热，日
晡时烦躁者，不食，食则谵语，至夜即愈，宜大承气主之。热则里结在膀胱也(按《金匮》
所治，重在伤寒里实，不重在恶露，故其脉症皆寒热。一言当以无太阳症句及热结膀胱句玩
之，便得其意。既曰恶露不尽，不大便而躁热矣。然不用桃仁承气，用大承气者何?盖热结
在膀胱，故宜大承气也)。
《大全》云∶产后两胁胀满气痛，由膀胱宿有停水，因产后恶露不尽，水壅与气相搏，
积在
膀胱，故令胁肋胀满。气与水相激，故令痛也(胁胀痛由膀胱停水所致，是何见解?用何汤药
?胜克乘制之并，故治不同)。
薛氏曰∶前痛症若肝经血瘀，用延胡索散。若肝经气滞，用四君、青皮、柴胡。若肝经
血虚
，用四物、参、术、柴胡。气血俱虚，用八珍、柴胡。若肾水不足，不能生肝，用六味丸。
若肺金势盛，克制肝木，用泻白汤，仍参前论主之。
《大全》云∶肾主腰脚，产后腰痛者，为女人肾位系于胞，产则劳伤肾气，损动胞络，
平复而风冷客之，冷气乘腰，故令腰痛也。若寒热邪气连滞背脊，则痛久不已。后急有娠，
必致损动。盖胞络属肾之主腰故也。
薛氏曰∶前症真气虚，邪乘之者，用当归黄 汤或十全大补汤为主，佐以寄生汤。如不
应，用十全大补加附子。
《大全》云∶夫头者诸阳之会也。凡产后五脏皆虚，胃气亏弱，饮食不充，谷气尚乏，
则令
虚热。阳气不守，上凑于头，阳实阴虚，则令头痛也。又有产后败血头痛，不可作不知，黑
龙丹言之甚详。
《大全》云∶产发遍身疼痛者何?答曰∶产后百节开张，血脉流散，遇气弱则经络肉分
之间
血多流滞，累日不散，则骨节不利，筋脉急引，故腰痛不得转侧，手足不能摇动，身热头痛
也。若作伤寒治之，则汗出而经脉动惕，手足厥冷，变生他症，但服趁痛散除之(气弱血滞
之痛不可作伤寒治是矣，而血虚、风寒之痛乃不论及，何耶)。
薛氏曰∶前症若以手按(按法甚妙)而痛甚，是血滞也，用四物、炮姜、红花、桃仁、泽
兰补而散之。若按而痛稍缓，是血虚也，用四物、炮姜、人参、白术补而养之。
《妇人大全良方》说：产后恶露不下，是因为产后脏腑劳损受伤，气血虚弱亏损，或者胞络夹带宿有的寒气，或者是产后受风、贪凉，风邪和凉气乘虚侵入并与血液搏结，导致血液壅滞不能宣通，积蓄在体内，所以导致恶露不下。
薛己（薛氏）说：上述症状应当使用失笑散。如果是气滞血凝，使用花蕊石散。
《妇人大全良方》说：产后恶露不绝，是因为产后损伤了经血，造成虚损不足，或者是分娩时恶血没有排尽留在腹中，加上脏腑夹带宿有的寒气，导致气血不调，所以导致恶露淋漓不断。
薛己说：上述症状如果是肝气热而不能统摄血液，使用六味丸。如果是肝气虚而不能藏血，使用逍遥散。如果是脾气虚而不能摄血，使用六君子汤。如果是脾胃之气下陷而不能统血，使用补中益气汤。如果是脾经郁热而血不归源，使用加味归脾汤。如果是肝经风邪而血沸腾，使用一味防风丸。
陈氏说：产后血崩是怎么回事？回答说：产后经脉耗伤，尚未恢复平静，因劳累而受损触动，导致血液突然暴崩淋漓不止。
或者因为酸咸饮食不节制，损伤荣卫导致衰弱，也会变成崩中病。如果小腹胀满疼痛，说明肝经已经败坏，属于难治之症。应紧急服用固金丸来止血。
薛己说：上述症状如果是血滞导致小腹胀满，使用失笑散。如果是血少导致小腹虚痞，使用芎䓖汤。其余参考前面的论述。
《妇人大全良方》说：产后心痛是由于阴血亏损，随着火气上冲心包络，名叫心胞络痛。适宜用大岩蜜汤（又名桂心汤，由熟地黄、当归、独活、吴茱萸、白芍、干姜、桂心、通草各二钱，细辛、甘草各五分组成）治疗。如果是寒邪伤心经，名叫真心痛，无药可救（心痛称为产后则与寻常疾病不同，应当在血分中寻求病因）。
薛己说：小腹作痛，俗名儿枕块，使用失笑散行气散瘀。如果恶露已去但疼痛仍在，使用四神散调理。如果无效，使用八珍散。如果疼痛伴有恶心，或想要呕吐，使用六君子汤。如果疼痛伴有泄泻，使用六君子汤送服四神丸。如果泄泻疼痛且伴有里急后重，使用补中益气汤送服四神丸。如果胸膈饱胀，或厌恶食物吞酸，或腹痛手不可按压，这是饮食所致，使用二陈汤加山楂、白术以消食导滞。如果食物已消化但疼痛仍在，或更加出现头痛烦热口渴、恶寒想呕吐等症状，这是中气破损，应当以补益脾胃为主。如果发热腹痛，按压时疼痛加剧，不厌恶食物，不吞酸，这是瘀血停滞，使用失笑散消除（按：关于腹痛原文有多种说法，曰：因气滞用玄胡索散，因外寒用五积散，因怒气用四物汤加木香、柴胡，因阳气虚弱用四君子汤、当归、炮姜，因脾虚血弱用六君子汤、当归、炮姜。大凡心腹作痛，用手按压却不痛的，这是血虚，必须使用补益饮食的药剂）。如果只是头痛发热，或兼有头痛，按压却不痛，这属于血虚，使用四物汤加炮姜、人参、白术来补益。
《妇人大全良方》说：儿枕，是由于母体胎中宿有血块，因分娩时其血破散，随胎儿一起排出，都没有危害。如果产妇脏腑受风冷侵袭，使血液凝滞在小腹，不能流通，就会结聚疼痛，名叫儿枕。《金匮要略》说：产后七八天，没有太阳病的症状，小腹部坚硬疼痛，这是恶露不尽。不大便，烦躁发热，切脉微实，加倍发热，傍晚时分烦躁，不吃东西，吃东西就谵语，到了夜晚就好了，适宜用大承气汤主治。热邪则结滞在膀胱（按：《金匮要略》所治疗的，重在伤寒里的实证，不在于恶露，所以其脉症都有寒热。仔细玩味“无太阳症”一句及“热结膀胱”一句，就能得其意旨。既然说是恶露不尽，又不大便且躁热，然而不用桃仁承气汤，而用大承气汤是为什么？因为热结在膀胱，所以适宜用大承气汤）。
《妇人大全良方》说：产后两胁胀满气痛，是由于膀胱宿有停水，因产后恶露不尽，水气壅滞与气相搏，积聚在膀胱，所以导致胁肋胀满。气与水相互激荡，所以导致疼痛（胁肋胀痛由膀胱停水所致，这是什么见解？用什么汤药？胜克乘制之理都具备，所以治疗方法不同）。
薛己说：上述疼痛症状如果是肝经血瘀，使用延胡索散。如果是肝经气滞，使用四君子汤、青皮、柴胡。如果是肝经血虚，使用四物汤、人参、白术、柴胡。气血俱虚，使用八珍汤、柴胡。如果是肾水不足，不能生养肝木，使用六味丸。如果是肺金气势过盛，克制肝木，使用泻白汤，仍参考前面的论述作为主方。
《妇人大全良方》说：肾主管腰脚，产后腰痛，是因为女人的肾脏位置联系于胞宫，生产时劳损了肾气，损伤了胞络，恢复期间风冷客袭，冷气侵袭腰部，所以导致腰痛。如果寒热邪气连滞背脊，则疼痛长久不愈。之后再次怀孕，必定会导致损伤。这是因为胞络属于肾，主管腰部的缘故。
薛己说：上述症状如果是真气虚弱，邪气乘虚而入的，使用当归黄芪汤或十全大补汤为主，佐以寄生汤。如果无效，使用十全大补汤加附子。
《妇人大全良方》说：头是诸阳经会合的地方。凡是产后五脏都虚弱，胃气亏弱，饮食不充足，谷气尚且缺乏，就会导致虚热。阳气不能固守，上凑于头部，阳实阴虚，就会导致头痛。又有产后败血引起的头痛，不可当作不知，黑龙丹对此解释得很详细。
《妇人大全良方》说：产后遍身疼痛是怎么回事？回答说：产后百节开张，血脉流散，遇到气弱则经络肌肉之间血液多流滞，多日不散，则骨节不利，筋脉紧急牵引，所以腰痛不能转侧，手足不能摇动，身体发热头痛。如果当作伤寒治疗，则会汗出而导致经脉跳动惊惕，手足厥冷，变生其他病症，只服用趁痛散来消除（气弱血滞的疼痛不可当作伤寒治疗是对的，但对于血虚、风寒引起的疼痛却不提及，为什么呢）。
薛己说：上述症状如果用手按压（按压法很巧妙）而疼痛加剧，是血滞，使用四物汤、炮姜、红花、桃仁、泽兰，补益并消散它。如果按压而疼痛稍缓，是血虚，使用四物汤、炮姜、人参、白术，补益并滋养它。
*Daquan* (The Great Compendium) states: Postpartum lochia retention occurs due to the exhaustion and injury of the zang-fu organs after childbirth, resulting in deficiency and depletion of Qi and Blood. It may also be caused by cold pathogens lingering in the Bao Luo (uterine collaterals), or by exposure to wind and cooling after childbirth. Wind and cold pathogens invade through the deficiency and contend with the Blood, causing stagnation and obstruction, preventing free flow. The blood accumulates internally, thus leading to postpartum lochia retention.
Xue Ji stated: For the aforementioned symptoms, Shixiao San (Pain-Relieving Powder) should be used. If there is Qi stagnation and Blood coagulation, Huarui Shi San (Flower Ochre Stone Powder) should be used.
*Daquan* states: Postpartum lochia non-stop occurs due to damage to the menstrual blood after childbirth, resulting in deficiency and insufficiency. Or, during delivery, lochia blood was not completely expelled and remained in the abdomen. Coupled with cold pathogens in the zang-fu organs, this leads to disharmony of Qi and Blood, causing lochia to drip continuously without stopping.
Xue Ji stated: For the aforementioned symptoms, if Liver Qi Heat fails to control the Blood, Liuwei Wan (Six-Ingredient Pill with Rehmannia) should be used. If Liver Qi Deficiency fails to store the Blood, Xiaoyao San (Free and Easy Wanderer Powder) should be used. If Spleen Qi Deficiency fails to contain the Blood, Liujunzi Tang (Six-Gentlemen Decoction) should be used. If Spleen and Stomach Qi sinks and fails to command the Blood, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used. If Spleen Meridian Depression Heat causes Blood to fail to return to its source, Jiaweigui Pi Tang (Modified Gui Pi Decoction) should be used. If Liver Meridian Wind Pathogen causes Blood to boil, Yiwei Fangfeng Wan (Single-Ingredient Saposhnikovia Pill) should be used.
Chen Shi asked: What is postpartum metrorrhagia? He answered: After childbirth, the meridians are exhausted and have not yet recovered. Fatigue damages and disturbs them, causing sudden violent bleeding that drips continuously.
Alternatively, immoderate consumption of sour and salty foods damages Ying Wei (Nutritive and Defensive Qi), leading to weakness, which can also transform into Bingzhong (Metrorrhagia). If the lower abdomen is full and painful, it indicates the Liver Meridian is already damaged, making it difficult to treat. One should urgently服用 Guding Wan (Solidify Metal Pill) to stop the bleeding.
Xue Ji stated: For the aforementioned symptoms, if Blood stagnation causes lower abdominal fullness, Shixiao San should be used. If Blood deficiency causes lower abdominal empty distension, Xiong Tang (Ligusticum Decoction) should be used. Refer to previous discussions for other cases.
*Daquan* states: Postpartum heart pain is due to Yin Blood deficiency, allowing Fire to rush upward along the Xinbao Luo (Pericardium Collaterals), named Xinbaoluo Tong (Heart Pericardium Collateral Pain). It is suitable to treat with Dayanmi Tang (Great Rock Honey Decoction, also known as Guixin Tang, composed of Shudi, Danggui, Duhuo, Wuyu, Baishao, Ganjiang, Guixin, Tongcao each 2 qian, and Xixin, Gancao each 5 fen). If Cold Pathogen injures the Heart Meridian, it is named Zhenxintong (True Heart Pain), for which there is no curative medicine (Heart pain occurring postpartum differs from ordinary diseases; one must seek the cause in the Blood aspect).
Xue Ji stated: Lower abdominal pain, commonly known as Erzhen Kuai (Child Pillow Mass), should be treated with Shixiao San to move and dissipate. If the lochia has passed but pain persists, Sishen San (Four-Spirit Powder) should be used to regulate. If ineffective, Bazhen San (Eight-Treasure Powder) should be used. If pain is accompanied by nausea or a desire to vomit, Liujunzi Tang should be used. If pain is accompanied by diarrhea, Sishen Wan should be taken with Liujunzi Tang. If diarrhea, pain, and tenesmus occur, Buzhong Yiqi Tang should be taken with Sishen Wan. If chest and diaphragm feel full and distended, or if there is food aversion and acid regurgitation, or abdominal pain where pressing is intolerable, this is caused by dietary accumulation. Erchen Tang added with Shanzha and Baizhu should be used to digest and guide out the accumulation. If digestion is complete but pain persists, or if headache, irritability, fever, thirst, aversion to cold, and vomiting appear, this indicates damage to Zhong Qi (Middle Qi); treatment should focus on tonifying the Spleen and Stomach. If fever and abdominal pain occur, with severe pain upon pressing, no food aversion, and no acid regurgitation, this is Blood stasis stagnation; Shixiao San should be used to eliminate it. (Note: The original text mentions several types of abdominal pain: use Xuanhusuo San for Qi stagnation, Wuji San for External Cold, Siwu Tang plus Muxiang and Chaihu for Anger, Sizijunzi Tang, Danggui, and Paojiang for Yang Qi deficiency, and Liujunzi Tang, Danggui, and Paojiang for Spleen Deficiency and Blood Weakness. Generally, if abdominal pain does not hurt when pressed, it is Blood Deficiency, requiring tonic dietary remedies.) If there is only headache and fever, or headache combined with other symptoms, but no pain upon pressing, this belongs to Blood Deficiency; Siwu Tang plus Paojiang, Renshen, and Baizhu should be used to tonify.
*Daquan* states: Erzhen (Child Pillow) refers to blood clumps existing in the womb prior to pregnancy. During delivery, these clumps break apart and are expelled with the infant, posing no harm. However, if the parturient's zang-fu organs are affected by Wind-Cold, causing Blood to coagulate and stagnate in the lower abdomen without flowing freely, it will cluster and cause pain, named Erzhen. *Jingui Yaolue* states: Seven or eight days postpartum, without Taiyang symptoms, but with hardness and pain in the lower abdomen, this is incomplete expulsion of lochia. With constipation, irritability, and fever, and a pulse that is slightly solid, with doubled fever, evening irritability, anorexia, delirium upon eating, and relief at night, Da Chengqi Tang should be primarily used. Heat binds internally in the Bladder. (Note: The treatment in *Jingui Yaolue* focuses on interior excess in Shaoyang/Taiyin syndromes rather than lochia, hence the pulse and symptoms involve cold and heat. Reflecting on "without Taiyang symptoms" and "heat binding in the Bladder" reveals the intent. Although it says lochia is incomplete and there is constipation with irritability and heat, why not use Taoren Chengqi Tang but instead Da Chengqi Tang? Because the heat binds in the Bladder, Da Chengqi Tang is appropriate.)
*Daquan* states: Postpartum distension and Qi pain in both hypochondriac regions are caused by retained water in the Bladder. Due to incomplete lochia expulsion postpartum, water stagnates and contends with Qi, accumulating in the Bladder, causing hypochondriac distension. The agitation between Qi and Water causes pain. (The view that hypochondriac distension-pain is caused by retained water in the Bladder—what is the rationale? What decoction is used? The principles of overcoming and restraining are integrated, hence the treatment differs.)
Xue Ji stated: For the aforementioned pain symptoms, if Liver Meridian Blood Stasis is present, Yanhusuo San should be used. If Liver Meridian Qi Stagnation is present, Sizijunzi Tang, Qingpi, and Chaihu should be used. If Liver Meridian Blood Deficiency is present, Siwu Tang, Renshen, Baizhu, and Chaihu should be used. If both Qi and Blood are deficient, Bazhen Tang plus Chaihu should be used. If Kidney Water is insufficient to generate Liver Wood, Liuwei Wan should be used. If Lung Metal energy is excessive and overacts on Liver Wood, Xiebai Tang should be used, referring to previous discussions as the main approach.
*Daquan* states: The Kidney governs the waist and legs. Postpartum lower back pain occurs because the woman's Kidney position is connected to the Bao (uterus). Childbirth exhausts Kidney Qi and damages the Bao Luo. During recovery, Wind-Cold invades; Cold Qi attacks the waist, causing lower back pain. If Cold and Heat pathogenic factors linger in the spine, the pain will persist for a long time. Subsequent pregnancies will inevitably cause further damage. This is because the Bao Luo belongs to the Kidney, which governs the waist.
Xue Ji stated: For the aforementioned symptoms, if True Qi is deficient and pathogens take advantage, Danggui Huangqi Tang or Shiquan Dabu Tang should be used as the main formula, assisted by Jisheng Tang. If ineffective, Shiquan Dabu Tang plus Fuzi should be used.
*Daquan* states: The head is the convergence of all Yang meridians. After childbirth, the five Zang organs are all deficient, Stomach Qi is weak, dietary intake is insufficient, and Grain Qi is lacking, leading to Empty Heat. Yang Qi fails to remain secure and rushes upward to the head. Excess Yang and Deficient Yin result in headache. There is also postpartum headache caused by敗血 (decayed blood), which cannot be ignored; Heilong Dan discusses this in detail.
*Daquan* states: What causes generalized body pain after childbirth? The answer is: After childbirth, the joints open, and blood vessels disperse. When Qi is weak, Blood flows and stagnates between the meridians and muscle layers. If it does not dissipate over several days, the bone joints become stiff, sinews and tendons contract tightly, causing lower back pain preventing turning, inability to move hands and feet, body fever, and headache. If treated as Shanghan (Cold Damage), sweating will occur, causing meridian tremors and palpitations, cold extremities, and transformation into other symptoms. Only Chen Tong San should be taken to eliminate it. (It is correct that pain from Qi weakness and Blood stagnation should not be treated as Shanghan, but why are pain from Blood deficiency and Wind-Cold not discussed?)
Xue Ji stated: For the aforementioned symptoms, if pressing with the hand (the method of pressing is excellent) exacerbates the pain, it is Blood Stasis. Siwu Tang, Paojiang, Honghua, Tao Ren, and Zelan should be used to tonify and dissipate. If pressing alleviates the pain slightly, it is Blood Deficiency. Siwu Tang, Paojiang, Renshen, and Baizhu should be used to tonify and nourish.