薛立斋曰∶前证若由血过多，虚火上炎，用童便入四物，加白术、麦冬、丹皮。若胃气虚有热，竹叶黄 汤。
若血虚发热，八物加麦冬、五味。若血脱烦躁，用当归补血汤。胃气弱，补中汤、七味白术散。
慎斋按∶以上四条，序产后有虚烦血渴之证也。血为周身津液，产后去血过多，阴虚火旺，则有烦躁，有发
渴证，宜大剂滋阴降火消瘀，加童便为主。《济阴纲目》云∶产后血虚，气无所附，逆而为火，火上逆而瘀
血随之，则心烦发躁。童便，浊阴也，味苦寒而咸，性就下，降火消瘀，所谓浊阴出下窍是也。二证并用之为
妙。若仲景二物黄芩汤，有黄芩、苦参，又有竹茹、石膏，治产妇中虚烦乱，四肢苦烦热诸证，未敢信也，当
以《三因》之论为主。
郭稽中曰∶产后口鼻黑气起，及鼻衄者何？答曰∶阳明者，经脉之海，起于鼻，交 中，还出颊口，交人
中，左之右，右之左。产后气血虚散，荣卫不和，散乱入于诸经，却还不得，故令口鼻黑气起，及变鼻衄。此
缘产后虚热，变生此证。胃绝肺败，不可治。《病机》云∶产后见衄者，不可治。
薛立斋曰∶胃脉挟口，绕承浆，鼻准属脾土，鼻孔属肺金，此胃虚肺损，为气脱血死之证，急用二味参苏
饮加附子，亦有得生者。
慎斋按∶以上二条，序产后有鼻衄之证也。鼻衄本非死证，产后犯此，或恶露不下，虚火载血上行，溢出鼻
窍，不循经度，肺胃已受火热，故黑气变现于鼻口，此热极反兼水化也，故曰肺胃败绝，为不可治。立斋参苏饮
加附子，似未稳。莫若大盏童便，加牛
膝、丹皮、泽兰、生熟地，倍人参服之。
薛立斋说：上述证候如果是因为失血过多，导致虚火上炎，可以使用童便加入四物汤中，再加白术、麦冬、牡丹皮。如果是胃气虚弱且有热，使用竹叶石膏汤（原文“竹叶黄”疑为“竹叶石膏”之误或简称，此处依语境及常见方剂补全意译，但严格遵循原文字面则译为“竹叶黄汤”，鉴于中医古籍中“竹叶石膏汤”更为常见且符合“胃气虚有热”病机，此处暂按原文直译并保留原名，若需严谨学术翻译建议核实底本，此处依指令保持原名）[注：根据WHO术语及常规理解，“竹叶黄”极大概率为“竹叶石膏汤”之笔误或简写，但在无更多上下文情况下，严格按原文“竹叶黄汤”处理，并在英文中对应]。
如果血虚发热，使用八珍汤加麦冬、五味子。如果血脱导致烦躁，使用当归补血汤。如果胃气弱，使用补中益气汤、七味白术散。
慎斋按语：以上四条，叙述了产后出现虚烦和血渴的证候。血是周身津液的主要组成部分，产后失血过多，导致阴虚火旺，就会出现烦躁、发渴的症状，适宜用大剂量滋阴降火消瘀的药物，以童便为主药。《济阴纲目》说：产后血虚，气无所依附，逆乱化为火，火气上逆带动瘀血随之上行，就会导致心烦发躁。童便是浊阴之物，味道苦寒而咸，性质趋下，能降火消瘀，这就是所说的“浊阴出下窍”。这两种情况配合使用效果奇妙。至于张仲景的二物黄芩汤，含有黄芩、苦参，还有竹茹、石膏，治疗产妇中焦虚弱导致的心烦意乱、四肢极度烦热等证候，我不敢轻信，应当以《三因极一病证方论》中的论述为主。
郭稽中说：产后口鼻出现黑气，以及发生鼻衄（鼻出血），是什么原因？回答说：阳明经是经脉之海，起始于鼻旁，交会于目中内眦，复出至颊部口角，交会于人中穴，左脉向右行，右脉向左行。产后气血虚弱涣散，营卫不和，气血散乱进入各条经脉，却无法回归原位，所以导致口鼻出现黑气，进而变为鼻衄。这是由于产后虚热，变生此证。这是胃绝肺败的表现，不可治愈。《黄帝内经·病机》说：产后出现鼻衄的，不可治愈。
薛立斋说：胃脉环绕口唇，经过承浆穴；鼻准（鼻尖）属脾土，鼻孔属肺金，这是胃虚肺损，属于气脱血死的危重证候，急需使用二味参苏饮加附子，也有救活的案例。
慎斋按语：以上两条，叙述了产后出现鼻衄的证候。鼻衄本身并非死证，但产后出现这种情况，或者是恶露不下，虚火载着血液上行，溢出鼻窍，不循经络常度，导致肺胃已经受到火热侵袭，所以黑气显现于鼻口，这是热极反兼水化（真寒假热或热极似水色）的表现，所以说肺胃败绝，属于不可治愈。立斋使用的参苏饮加附子，似乎不够稳妥。不如用大碗童便，加上牛膝、牡丹皮、泽兰、生地黄和熟地黄，加倍人参服用。
Xue Lizhai stated: If the aforementioned syndrome is caused by excessive blood loss leading to deficiency fire flaming upward, use Tongbian (Child's urine) added to Siwu Tang (Four Substances Decoction), along with Baizhu (Atractylodis Rhizoma), Maidong (Ophiopogonis Radix), and Danpi (Moutan Cortex). If there is heat due to deficient stomach qi, use Zhuye Huangtang (Bamboo Leaf and Yellow [Gypsum] Decoction) [Note: Likely refers to Zhuye Shigao Tang].
If there is fever due to blood deficiency, use Bawu Tang (Eight Treasures Decoction) added with Maidong (Ophiopogonis Radix) and Wuwei Zi (Schisandrae Fructus). If restlessness occurs due to blood collapse, use Danggui Buxue Tang (Dangui Tonifying Qi and Blood Decoction). If stomach qi is weak, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder).
Shenzhen commented: The above four points describe postpartum syndromes of deficiency irritability and thirst for blood. Blood constitutes the body's fluids; excessive blood loss postpartum leads to yin deficiency and hyperactive fire, resulting in symptoms such as restlessness and thirst. It is appropriate to use large doses of herbs that nourish yin, descend fire, and resolve stasis, with Tongbian (Child's urine) as the principal agent. *Jiyin Gangmu* states: Postpartum blood deficiency leaves qi without attachment, causing it to rebel and transform into fire. As the fire rebels upward, it carries stasis with it, leading to heart irritability and agitation. Tongbian is a turbid yin substance, bitter, cold, and salty in flavor, with a downward nature, capable of descending fire and resolving stasis, which aligns with the principle that "turbid yin exits through the lower orifices." Combining these two approaches is excellent. Regarding Zhang Zhongjing's Erwu Huangqin Tang (Two-Ingredient Scutellaria Decoction), which contains Huangqin (Scutellariae Radix), Kushen (Sophorae Flavescentis Radix), Zhuru (Bambusae Caulis in Taeniam), and Shigao (Gypsum Fibrosum), used to treat postpartum middle jiao deficiency causing mental confusion and extreme heat in the four limbs, I dare not readily accept it; one should primarily rely on the discussion in *Sanyin Fang*.
Guo Jizhong asked: What is the cause of black qi appearing at the mouth and nose, and epistaxis (nosebleed) postpartum? He answered: The Yangming meridian is the sea of the meridians, originating at the nose, intersecting at Jingming (BL1, Inner Canthus), returning to emerge at the cheek and mouth, intersecting at Renzhong (GV26), with the left side connecting to the right and vice versa. Postpartum, qi and blood are deficient and scattered, Ying and Wei (Nutritive and Defensive qi) are disharmonious, and they scatter into the various meridians but cannot return, causing black qi to appear at the mouth and nose, eventually transforming into epistaxis. This arises from postpartum deficiency heat generating this syndrome. It indicates Stomach exhaustion and Lung failure, which is incurable. *Bingji* states: Epistaxis occurring postpartum is incurable.
Xue Lizhai stated: The Stomach meridian encircles the lips and passes through Chengjiang (CV24); the tip of the nose belongs to Spleen Earth, and the nostrils belong to Lung Metal. This represents Stomach deficiency and Lung damage, a critical syndrome of qi collapse and blood death. Urgently use Erwei Rensu Yin (Two-Ingredient Ginseng and Nardus Decoction) added with Fuzi (Aconiti Lateralis Radix Praeparata); some patients have survived.
Shenzhen commented: The above two points describe postpartum epistaxis. Epistaxis itself is not necessarily a fatal syndrome, but when it occurs postpartum, it may be due to lochia not being discharged, with deficiency fire carrying blood upward, overflowing from the nasal cavity, failing to follow the normal meridian pathways. The Lung and Stomach have already been affected by fire-heat, hence black qi manifests at the nose and mouth. This is heat extreme manifesting as water transformation (dark color associated with Water/Kidney in Five Phase theory, indicating severe heat consuming yin/fluids). Thus, it is said that Lung and Stomach failure is incurable. Xue Lizhai's use of Rensu Yin added with Fuzi seems unstable. It would be better to use a large cup of Tongbian (Child's urine) added with Niuxi (Achyranthis Bidentatae Radix), Danpi (Moutan Cortex), Zelan (Leonuri Herba), Shengdihuang (Rehmanniae Radix), Shudihuang (Rehmanniae Radix Preparata), and doubled Ren Shen (Ginseng Radix et Rhizoma).