《圣济总录》曰∶产后冲任不足，气血俱虚，其热潜行入足阳明之脉。直行者，从缺盆下乳内 ，下挟脐，
入气街中。冲脉者，起于气街。盖足阳明之经，挟脐上行，至胸中而散。其经为邪热攻冲，则血为之击搏，气
为之留滞。击搏则痛作，留滞则肿生。产后多有此疾，由乳汁壅积，与气相击搏故也。
慎斋按∶以上六条，序产妇有乳汁不行之证也。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。产后脾胃之气旺，则血旺而乳多。脾胃之气衰，则血减而乳少。此立斋
治乳汁，以壮脾胃、滋化源为要也。若罔顾脾胃以补气血，徒从事于通乳之剂，是犹求千金于乞丐而不可得矣。
陈《三因》曰∶妇人趣产劳力，努力太过，致阴下脱，及阴下挺出，逼迫肿痛，举重房劳，皆能发作，清
水续续，小便淋漓，硫黄、乌贼骨、五味子为末，掺之。
陈良甫曰∶产门不闭，由元气素弱，胎前失于调养，以致血气不能收摄故也，十全大补汤。有初产阴户肿
胀，或 痛不闭，加味逍遥散。若肿不闭者，补中汤加五味子，切忌寒凉之药。
薛立斋曰∶玉门不闭，气血虚弱也，十全大补汤。肿胀 痛，肝经虚热也，加味逍遥散。
慎斋按∶以上三条，序产后有阴脱、不闭之二证也。产后一切证，总以气血大虚为治，况阴挺下脱，玉门不
闭乎。故丹溪、立斋医案，有产户下一物如手帕者，有下一物如合钵，有二歧者，有出肉线一条者，有子宫损落
一片者。凡此皆气虚血脱，故子户胞门，见证种种。其立方处治，不过参、 、归、地，加以升提收涩，临证之
工，可以神明之矣。
《圣济总录》说：产后冲任二脉（调节月经和孕育的经脉）不足，气血都虚弱，体内的热邪潜行进入足阳明胃经。足阳明胃经直行的一支，从缺盆穴下行至乳房内部，向下挟持肚脐，进入气街穴中。冲脉，起始于气街穴。大概足阳明胃经，挟持肚脐上行，到达胸中而散开。如果这条经脉被邪热攻冲，那么血液就会为之撞击搏动，气机就会为之停留阻滞。撞击搏动则疼痛发作，停留阻滞则肿胀产生。产后多有这种疾病，是因为乳汁壅积，与气机相互撞击搏动所致。
慎斋按语：以上六条，叙述了产妇乳汁不行的证候。妇女以血为主要生理基础，血上行化为乳汁，下行成为月经。而血的化生，根本在于脾胃运化饮食所生成的精微物质，通过营运作用转化为乳汁和经血。产后脾胃之气旺盛，则血旺而乳汁多；脾胃之气衰弱，则血减而乳汁少。这是薛立斋治疗乳汁问题，以强壮脾胃、滋养化源为关键的原因。如果不顾护脾胃而去补益气血，仅仅从事于通乳的药物，这就像向乞丐乞求千金一样，是不可能得到的。
陈氏《三因极一病证方论》说：妇女分娩时用力过度，努力太过，导致阴部下垂脱出，以及阴部挺出，逼迫肿痛，举重或房事劳累，都能诱发此病，伴有清水不断流出，小便淋漓不尽，可用硫黄、乌贼骨、五味子研成末，撒敷患处。
陈良甫说：产门不闭合，是由于元气素来虚弱，怀孕期间失于调养，导致血气不能收摄的缘故，用十全大补汤。有初产妇阴户肿胀，或者疼痛不闭合的，用加味逍遥散。如果是肿胀但不闭合的，用补中益气汤加五味子，切忌使用寒凉的药物。
薛立斋说：玉门（阴道口）不闭合，是气血虚弱的表现，用十全大补汤。肿胀疼痛，是肝经虚热的表现，用加味逍遥散。
慎斋按语：以上三条，叙述了产后有阴脱、不闭两种证候。产后一切证候，总应以气血大虚为治疗原则，何况是阴挺下脱、玉门不闭呢。所以朱丹溪、薛立斋的医案中，有产道下出一物如手帕状的，有下一物如合钵状的，有二歧形的，有出肉线一条的，有子宫损伤脱落一片的。凡此种种，都是气虚血脱，所以子户胞门出现的证候各种各样。他们确立方剂和处理方法，不过是用人参、黄芪、当归、地黄，加上升提和收涩的药物，临证施治的医生，可以由此达到神妙明通的境界了。
According to *Shengji Zonglu* (General Records of the Holy Relief): After childbirth, the Chong and Ren meridians (meridians regulating menstruation and pregnancy) are deficient, and both Qi and Blood are weak. The latent heat enters the Foot-Yangming Stomach Meridian. The straight branch descends from the Quepen point (ST12), down into the interior of the breast, passes below the navel, and enters the Qichuan area. The Chong Mai originates at the Qichuan area. Generally, the Foot-Yangming Meridian ascends along both sides of the navel and disperses in the chest. When this meridian is attacked by pathogenic heat, the blood is stirred and beaten, and the Qi becomes stagnant. Stirring and beating cause pain; stagnation causes swelling. This condition is common after childbirth, caused by the accumulation of milk colliding with the Qi.
Shenzhen's commentary: The above six sections describe syndromes of lactation failure in postpartum women. Women rely on Blood for their physiological functions; Blood transforms upward into milk and downward into menstrual flow. The transformation of Blood originates from the refined essences derived from food and drink processed by the Spleen and Stomach, which are transported and transformed into milk and menses. If the Qi of the Spleen and Stomach is vigorous after childbirth, Blood is abundant and milk production is plentiful. If the Qi of the Spleen and Stomach declines, Blood diminishes and milk production decreases. This explains why Xue Lizhai emphasized strengthening the Spleen and Stomach and nourishing the source of transformation as key treatments for lactation issues. To neglect the Spleen and Stomach and merely attempt to tonify Qi and Blood, or to solely engage in using galactagogues, is like seeking a thousand gold coins from a beggar—it is impossible to achieve.
Chen’s *Sanyin Fanglun* states: During labor, excessive exertion can cause prolapse of the Yin organs or eversion of the vagina, accompanied by pressing pain and swelling. Heavy lifting and sexual fatigue can also trigger these symptoms, often accompanied by continuous discharge of clear fluid and dribbling urination. Powdered sulfur, cuttlefish bone, and Schisandra berry should be applied topically.
Chen Liangfu stated: Failure of the vaginal opening to close is due to inherent weakness of Yuan Qi (Original Qi) and lack of proper care during pregnancy, resulting in an inability of Qi and Blood to consolidate. Use Shiquan Dabu Tang (Ten Significant Decoction for Great Tonification). For initial postpartum vulvar swelling or painful non-closure, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). For swelling without closure, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Schisandra berry. Cold-natured medicines must be strictly avoided.
Xue Lizhai stated: Non-closure of the Yumen (vaginal introitus) indicates deficiency of Qi and Blood; treat with Shiquan Dabu Tang (Ten Significant Decoction for Great Tonification). Swelling and pain indicate deficiency-heat in the Liver Meridian; treat with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).
Shenzhen's commentary: The above three sections describe two postpartum syndromes: organ prolapse and non-closure. All postpartum conditions should generally be treated based on severe deficiency of Qi and Blood, especially cases of uterine prolapse or vaginal laxity. Therefore, in the medical records of Zhu Danxi and Xue Lizhai, there are descriptions of tissue protruding from the vagina resembling a handkerchief, a bowl, a bifurcated shape, a strip of flesh, or a piece of detached uterus. All these manifestations stem from Qi deficiency and Blood collapse affecting the Zi Hu Bao Men (uterine gate). Their prescriptions primarily consist of Ginseng, Astragalus, Angelica sinensis, and Rehmannia root, combined with herbs that lift and astringe. Clinicians can attain profound understanding through such approaches.