产后小腹作痛，俗名儿枕块，用失笑散行散之。若恶露既去而仍痛，用四神散调补之；若不
应，用八珍汤。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。
若泄泻痛而或后重，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，当用二陈加山楂、白术以消导。若食既消而仍痛，或按之不痛，或更加头痛
，烦热作渴，恶寒欲呕等症，此是中气被伤，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，用失笑散以消之。若止是发热头痛，或兼腹痛，按之却不痛，
此是血虚，用四物加炮姜、参、术以补之。《病机要》云∶胎产之病，从厥阴经论之，
无犯胃气及上二焦，为之三禁，不可汗，不可下，不可利小便。发汗者同伤寒下早之症，利大便
则脉数而已动于脾，利小便则内亡津液，胃中枯燥。制药之法，能不犯三禁，则荣卫自和，
而寒热止矣。如发渴用白虎，气弱用黄 ，血刺痛则用当归，腹中痛则加芍药，宜详察脉症
而用之。丹溪先生云∶产后当大补气血为先，虽有杂症，从末治之，一切病多是血虚，皆不
可发表。
治验
一产妇腹痛发热，气口脉大，余以为饮食停滞，不信，乃破血补虚，反寒热头痛，呕吐涎沫
，又用降火化痰理气，四肢逆冷，泄泻下坠，始信，谓余曰∶何也?余曰∶此脾胃虚之变症
也，法当温补。遂用六君加炮姜二钱，肉桂、木香一钱，四剂诸症悉退，再用补中益气之剂，元气悉复。
一妇人产后，腹痛后重，去痢无度，形体倦怠，饮食不甘，怀抱久郁，患茧唇，寐而盗汗如
雨，竟夜不敢寐，神思消烁。余曰∶气血虚而有热。用当归大黄汤，内黄芩、连、柏炒黑，
一剂汗顿止，再剂全止，乃用归脾汤、八珍散兼服，元气渐服而愈。
一产妇小腹作痛，服行气破血之药不效，其脉洪数，此瘀血内溃为脓也，以瓜子仁汤二剂痛
止，更以太乙膏下脓而愈，产后多有此病，纵非痈患，用之更效。
一产妇小腹疼痛，小便不利，用薏苡仁汤，二剂痛止，更以四物加桃仁、红花，下瘀血而愈
。大抵此症，皆因荣卫不调，或瘀血停滞所致，若脉洪数已有，洪脉但数微有脓，脉迟紧乃
瘀血，下之即愈。若腹胀大，转侧作水声，或脓从脐出，或从大便出，宜用蜡矾丸、太乙膏
及托里药。
一产妇小腹作痛有块，脉芤而涩，以四物加玄胡索、红花、桃仁、牛膝、木香，治之而愈。
一妇人产后，小腹患痛，服瓜子仁汤，下瘀血而痊。凡瘀血停滞，宜急治之，缓则腐化为脓
，最难治疗。若流注关节，则患骨疽，失治多为败症。
一妇人因经水多，服涩药止之，致腹作痛，以失笑散二服而瘳。
产后小腹疼痛，俗称“儿枕块”，使用失笑散（Puxiao San）来行气活血、消散瘀血。如果恶露已经排净但腹痛仍然持续，使用四神散（Sishen San）进行调理和补益；如果服用后没有效果，改用八珍汤（Bazhen Tang）。如果腹痛伴有恶心，或者想要呕吐，使用六君子汤（Liujunzi Tang）。如果腹痛伴有腹泻，用六君子汤送服四神丸（Sishen Wan）。如果腹泻、腹痛且伴有肛门坠胀感（里急后重），使用补中益气汤（Buzhong Yiqi Tang）送服四神丸。如果胸膈部饱胀不适，或者厌恶食物、吞酸，或者腹痛剧烈到不能按压，这是由饮食不当引起的，应当使用二陈汤（Erchen Tang）加入山楂和白术来进行消食导滞。如果食物积滞已消除但腹痛仍在，或者按压腹部不痛，或者出现头痛、烦热口渴、怕冷想吐等症状，这是中气受损，治疗应以补益脾胃为主。如果发热且腹痛，按压时疼痛加剧，但不厌恶食物、不吞酸，这是瘀血停滞所致，使用失笑散来消除瘀血。如果只是发热头痛，或者兼有腹痛，但按压腹部却不痛，这是血虚所致，使用四物汤（Siwu Tang）加入炮姜、人参和白术来补益气血。《病机要》中说：胎产类的疾病，应从厥阴经（Liver and Pericardium meridians）的理论来论述，不可损伤胃气及上、中二焦的功能，这被称为“三禁”，即不可发汗、不可攻下、不可利小便。发汗会导致类似伤寒过早使用下法的病症；通利大便会使脉数并扰动脾脏；通利小便会耗伤体内津液，导致胃中干燥。制药的原则是，如果不触犯上述三禁，营卫之气自然调和，寒热症状就会停止。如出现口渴，可使用白虎汤（Baitu Tang）；气弱可使用黄芪（Huangqi, Astragali Radix）；血刺痛则使用当归（Danggui, Angelicae Sinensis Radix）；腹中痛则加入芍药（Shaoyao, Paeoniae Radix），应当详细诊察脉象和症状后使用。丹溪先生（Zhu Danxi）说：产后应当以大补气血为第一要务，即使有其他杂症，也应作为次要问题处理，因为一切疾病多因血虚引起，都不可使用发表（发汗解表）的方法。
医案记录：
一位产妇腹痛发热，气口脉（Radial artery pulse at the Cun position, indicating Stomach Qi）大，我认为是饮食停滞所致，但她不信，反而使用了破血补虚的药物，结果导致寒热交替、头痛、呕吐涎沫。后来又用了降火化痰理气的药物，出现四肢逆冷、泄泻下坠的症状，此时她才相信我的诊断，问我原因。我说：这是脾胃虚弱产生的变症，治法应当温补。于是使用六君子汤加炮姜二钱、肉桂和木香各一钱，服用四剂后所有症状消退，再服用补中益气汤剂，元气完全恢复。
一位妇人产后，腹痛且有肛门坠胀感，痢疾无度，身体倦怠，饮食无味，长期情绪抑郁，患有茧唇（一种唇部病变），睡觉时盗汗如雨，整夜不敢入睡，精神极度消耗。我说：这是气血虚弱而有内热。使用当归大黄汤（Danggui Dahuang Tang），其中黄芩、黄连、黄柏炒黑，服用一剂后汗止，再服用一剂后完全停止，随后使用归脾汤（Guipi Tang）和八珍散（Bazhen San）兼服，元气逐渐恢复而痊愈。
一位产妇小腹疼痛，服用行气破血的药物无效，其脉象洪数，这是瘀血内溃化脓的表现，服用瓜子仁汤（Gua Zi Ren Tang）两剂后疼痛停止，再用太乙膏（Taiyi Gao）排出脓液而痊愈。产后多有此类疾病，即使不是痈肿，使用此法也更为有效。
一位产妇小腹疼痛，小便不利，使用薏苡仁汤（Yiyiren Tang），两剂后疼痛停止，再用四物汤加入桃仁和红花，排出瘀血而痊愈。大抵这类症状，都是因为营卫不调，或瘀血停滞所致。如果脉象洪数，说明已有脓；洪脉但数象轻微，说明微有脓；脉迟紧则是瘀血，使用下法即可痊愈。如果腹胀大，转动身体时有水声，或者脓从脐部流出，或者从大便流出，宜使用蜡矾丸（Lafan Wan）、太乙膏以及托里透脓的药物。
一位产妇小腹作痛且有肿块，脉象芤而涩，使用四物汤加入玄胡索、红花、桃仁、牛膝和木香进行治疗而痊愈。
一位妇人产后，小腹患痛，服用瓜子仁汤，排出瘀血而痊愈。凡是瘀血停滞，应当紧急治疗，拖延则会腐败化为脓，最难治疗。如果流注于关节，则患骨疽（Bone abscess），延误治疗多为败血症等危重症。
一位妇人因月经量多，服用收敛止血的药物止血，导致腹部疼痛，服用两服失笑散而痊愈。
Postpartum lower abdominal pain, commonly known as "childhood pillow mass" (retained lochia), is treated with Puxiao San (Puxiao Powder) to promote blood circulation and dissipate stasis. If the lochia has been expelled but the pain persists, Sishen San (Four Spirits Powder) is used for regulation and tonification; if there is no response, Bazhen Tang (Eight Treasures Decoction) is employed. If the pain is accompanied by nausea or a desire to vomit, Liujunzi Tang (Six Gentlemen Decoction) is indicated. If the pain is accompanied by diarrhea, Liujunzi Tang is administered with Sishen Wan (Four Spirits Pill). If diarrhea, abdominal pain, and tenesmus (feeling of incomplete defecation) occur, Buzhong Yiqi Tang (Decoction to Tonify the Middle and Augment Qi) is given with Sishen Wan. If there is fullness and distension in the chest and diaphragm, aversion to food, acid regurgitation, or severe abdominal pain that cannot be pressed, this is caused by dietary indiscretion; Erchen Tang (Two Aged Substances Decoction) added with Crataegi Fructus (Shanzha) and Atractylodis Macrocephalae Rhizoma (Baizhu) should be used to digest food and guide out stagnation. If the food stagnation has cleared but the pain remains, or if pressing the abdomen does not cause pain, or if symptoms such as headache, irritability, heat, thirst, aversion to cold, and vomiting arise, this indicates damage to the Middle Qi; treatment should focus on tonifying the Spleen and Stomach. If fever and abdominal pain are present, with exacerbation upon pressure, but without aversion to food or acid regurgitation, this is due to blood stasis stagnation; Puxiao San is used to eliminate the stasis. If there is only fever and headache, or accompanied by abdominal pain, but pressing the abdomen causes no pain, this is due to Blood deficiency; Siwu Tang (Four Substances Decoction) added with Prepared Zingiberis Rhizoma (Paojiang), Ginseng Radix et Rhizoma (Renshen), and Atractylodis Macrocephalae Rhizoma (Baizhu) is used for tonification. The *Ji Bing Ji Yao* states: Diseases related to pregnancy and childbirth should be discussed in terms of the Jueyin Meridian (Liver and Pericardium meridians). One must not violate the Stomach Qi and the Upper and Middle Jiao; this constitutes the "Three Prohibitions": do not induce sweating, do not purge downward, and do not promote urination. Inducing sweating leads to conditions similar to premature purging in Cold Damage diseases; promoting bowel movements causes rapid pulse and disturbs the Spleen; promoting urination depletes internal body fluids, leading to dryness in the Stomach. The principle of preparing medicines is that if these three prohibitions are not violated, Ying and Wei (Nutritive and Defensive Qi) will naturally harmonize, and chills and fever will cease. For thirst, Baitu Tang (White Tiger Decoction) may be used; for Qi deficiency, Huangqi (Astragali Radix); for stabbing blood pain, Danggui (Angelicae Sinensis Radix); for abdominal pain, Shaoyao (Paeoniae Radix) should be added. These should be used after careful examination of the pulse and symptoms. Mr. Zhu Danxi said: Postpartum treatment should prioritize major tonification of Qi and Blood. Even if other miscellaneous symptoms exist, they should be treated as secondary issues, as most postpartum illnesses are due to Blood deficiency, and releasing the exterior (inducing sweating) is contraindicated.
Case Records:
A parturient presented with abdominal pain and fever. The pulse at the Cun position (indicating Stomach Qi) was large. I diagnosed it as food stagnation, but she did not believe me. Instead, she used blood-breaking and tonifying herbs, which resulted in alternating chills and fever, headache, and vomiting of saliva. She then took herbs to clear fire, resolve phlegm, and regulate Qi, leading to cold extremities, diarrhea, and a sensation of rectal prolapse. Only then did she believe my diagnosis and asked for an explanation. I replied: This is a complication of Spleen and Stomach deficiency; the method should be warming and tonifying. Thus, Liujunzi Tang was used with 2 qian of Prepared Zingiberis Rhizoma, and 1 qian each of Cinnamon Twig (Rougui) and Aucklandiae Radix (Muxiang). After four doses, all symptoms subsided. Subsequently, Buzhong Yiqi decoction was administered, and the Yuan Qi (Original Qi) fully recovered.
A woman postpartum suffered from abdominal pain with tenesmus, profuse dysentery, physical fatigue, poor appetite, long-term emotional depression, and a condition called "cocoon lip." She sweated profusely during sleep (night sweats), could not sleep all night, and her spirit was severely depleted. I stated: This is Qi and Blood deficiency with internal heat. Danggui Dahuang Tang (Danggui and Rheum Decoction) was used, with Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Phellodendri Cortex (Huangbai) stir-fried until black. After one dose, sweating stopped; after two doses, it ceased completely. Then, Guipi Tang (Restore the Spleen Decoction) and Bazhen San (Eight Treasures Powder) were taken concurrently, and the Yuan Qi gradually recovered, leading to cure.
A parturient had lower abdominal pain unresponsive to Qi-regulating and blood-breaking herbs. Her pulse was surging and rapid, indicating that blood stasis had ulcerated internally into pus. Two doses of Gua Zi Ren Tang (Melon Seed Decoction) stopped the pain, followed by Taiyi Gao (Taiyi Plaster) to drain the pus, resulting in recovery. This disease is common postpartum; even if not an abscess, this treatment is more effective.
A parturient had lower abdominal pain and difficulty urinating. Yiyiren Tang (Coix Seed Decoction) was used; after two doses, the pain stopped. Then, Siwu Tang added with Peach Kernel (Taoren) and Carthami Flos (Honghua) was used to expel blood stasis, leading to recovery. Generally, these symptoms are caused by disharmony of Ying and Wei, or blood stasis stagnation. A surging and rapid pulse indicates pus formation; a surging pulse with slight rapidity indicates slight pus; a slow and tight pulse indicates blood stasis, which resolves with purgation. If the abdomen is distended and large, with water sounds when turning, or if pus discharges from the umbilicus or stool, Lafan Wan (Wax and Alum Pill), Taiyi Gao, and interior-boosting drugs should be used.
A parturient had lower abdominal pain with a palpable mass. The pulse was hollow and choppy. Siwu Tang added with Corydalis Rhizoma (Yanhusuo), Carthami Flos (Honghua), Peach Kernel (Taoren), Achyranthis Bidentatae Radix (Niuxi), and Aucklandiae Radix (Muxiang) was used, resulting in recovery.
A woman postpartum suffered lower abdominal pain. She took Gua Zi Ren Tang, expelled blood stasis, and recovered. Any blood stasis stagnation should be treated urgently; delay leads to putrefaction into pus, which is difficult to treat. If it flows into the joints, bone abscess (Guju) occurs; delayed treatment often leads to sepsis or critical conditions.
A woman, due to menorrhagia, took astringent herbs to stop bleeding, which caused abdominal pain. Two doses of Puxiao San cured her.