《大全》曰∶肾主腰脚，产后腰痛者，肾为胞胎所系，产则劳伤肾气，损动胞络，虚未平复，风冷客之，冷
气乘腰，故令腰痛。若寒冷邪气，连滞背脊，痛久未已，后忽有娠，必致损动，盖胞络属肾，肾主腰故也。
薛立斋曰∶前证真气虚，邪乘之，用当归黄 汤，或十全汤为主，佐以寄生汤，不应，十全汤加附子。
慎斋按∶以上三条，序产后有腰痛之证也。胞胎系于肾，腰者肾之外候，产后劳伤肾气，损动胞络，属虚者
居多，虽有风冷滞血，亦必兼补真气为要，立斋一条，抉其旨矣。
《大全》曰∶产后两胁胀满气痛，由膀胱宿有停水，因产后恶露下不尽，水壅，痞与气相抟，积在膀胱，
故令胁肋胀满，气与水相激，故令痛也。
薛立斋云∶此证若肝经血瘀，玄胡索散。若肝经气虚，四君子加柴胡、青皮。若肝经血虚，四物加参、术、
柴胡。若肾水不足，不能生肝，六味丸。若肺金势盛，克制肝木，泻白散，仍参前证治之。此证苟非用姜、桂辛
温，助脾肺以行药，不唯无以施功，而反助其胀矣。
慎斋按∶以上二条，序产后有胁痛之证也。胁者肝之部分，肝藏血，产后恶露不尽，与去血过多，均足以致
胁痛，未必属于水气相激。必参立斋一条，始攸当尔。
郭稽中曰∶产后遍身疼痛者何？曰∶因
产走动气血，升降失其常度，留滞关节，筋脉引急，是以遍身疼痛，甚则腰背强硬，不能俯仰，手足拘挛，不
能屈伸。或身热头痛，不可作他病，但服趁痛散，循流血气，使筋脉舒畅，疼痛自止。
陈无择曰∶趁痛散不特治产后气弱血滞，兼能治太阳经感风头痛，腰背疼，自汗发热。若感寒伤食，忧恐
惊怒，皆致身疼，发热头痛，况有蓐劳，诸证尤甚，趁痛散皆不能疗。不若五积散入醋煎用，却不妨。
立斋按∶五积散治产后身痛，兼感寒伤食。若气虚血弱人，似非所宜。如手按而痛，是血瘀滞也，用四物，
炮姜、桃仁、红花、泽兰，补散之。按而痛稍缓者，血虚也，四物加参、术、炮姜，补养之。
慎斋按∶以上一条，序产后有遍身疼痛证也。产后百节开张，血脉流散。曰遍身，则自筋骨皮肉，手足，
胁腹腰背，无处不痛。《大全》以为血滞经络，似属有余。然去血过多，虚而风寒袭之，亦为疼痛。故趁痛散
为的对药，无择乃云不能疗，不若五积散，殊未确也。
《产宝百问》说：肾主宰腰部和下肢，产后出现腰痛，是因为肾脏与胞胎相连系，分娩时劳损了肾气，损伤了胞络，虚损尚未平复，风冷邪气侵袭，冷气乘袭腰部，所以导致腰痛。如果寒冷邪气连滞于背脊，疼痛日久不愈，后来忽然再次怀孕，必定会导致损伤，这是因为胞络归属于肾，而肾主司腰部的缘故。
薛立斋说：上述病症是真气虚弱，邪气乘虚而入，使用当归黄芪汤，或者十全大补汤作为主方，佐以独活寄生汤；如果无效，在十全大补汤中加入附子。
慎斋按语：以上三条，叙述了产后有腰痛这一证候。胞胎系属于肾，腰部是肾的外在表现，产后劳伤肾气，损伤胞络，属于虚证的居多，即使有风冷和瘀血阻滞，也必须以补益真气为关键，薛立斋的论述揭示了其主旨。
《产宝百问》说：产后两胁胀满且伴有气痛，是由于膀胱素有停水，因为产后恶露排不尽，水液壅滞，痞块与气相互搏结，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。
薛立斋说：此证如果是肝经血瘀，用玄胡索散。如果是肝经气虚，用四君子汤加柴胡、青皮。如果是肝经血虚，用四物汤加人参、白术。如果是肾水不足，不能滋养肝木，用六味地黄丸。如果是肺金气势过盛，克制肝木，用泻白散，并参考前面的证候治疗。此证如果不是用干姜、肉桂等辛温药物，辅助脾肺以推动药力运行，不仅无法发挥功效，反而会加重胀满。
慎斋按语：以上两条，叙述了产后有胁痛这一证候。胁部是肝脏所主的部位，肝藏血，产后恶露不尽，以及失血过多，都足以导致胁痛，未必属于水气相互激荡所致。必须参考薛立斋的论述，才恰当。
郭稽中说：产后遍身疼痛是怎么回事？回答说：因为分娩走动气血，升降失去了正常的规律，留滞于关节，筋脉牵引拘急，所以遍身疼痛，严重时腰背僵硬，不能俯仰，手足拘挛，不能屈伸。或者伴有身热头痛，不可当作其他疾病治疗，只需服用趁痛散，引导血液流通，使筋脉舒畅，疼痛自然停止。
陈无择说：趁痛散不仅治疗产后气弱血滞，还能治疗太阳经受风引起的头痛、腰背痛、自汗发热。如果是感受寒邪或饮食停滞，以及忧恐惊怒，都会导致身疼、发热头痛，况且还有蓐劳（产后虚损），各种症状尤其严重，趁痛散都不能治愈。不如用五积散加入醋煎服，倒也无妨。
薛立斋按语：五积散治疗产后身痛，兼感寒邪和饮食停滞。对于气虚血弱的人，似乎并不适宜。如用手按压则疼痛加剧，这是血瘀阻滞，用四物汤加炮姜、桃仁、红花、泽兰，进行补益和消散。按压后疼痛稍缓解的，是血虚，用四物汤加人参、白术、炮姜，进行补养。
慎斋按语：以上一条，叙述了产后有遍身疼痛这一证候。产后全身关节开张，血脉流散。说“遍身”，则从筋骨皮肉到手足、胁腹腰背，无处不痛。《产宝百问》认为是血滞经络，似乎属于实证有余。然而失血过多，因虚而风寒侵袭，也会引起疼痛。所以趁痛散是对症的良药，陈无择却说不能治愈，不如用五积散，这确实不够准确。
The *Daquan* (Compendium) states: The Kidney governs the waist and legs. Postpartum lower back pain occurs because the Kidney is connected to the uterus; childbirth labors and injures Kidney Qi, damaging the uterine collaterals. Before the deficiency has recovered, wind-cold pathogens invade. Cold qi attacks the waist, causing lower back pain. If cold pathogenic factors linger in the spine, and pain persists for a long time, followed by a subsequent pregnancy, it will inevitably cause damage, as the uterine collaterals belong to the Kidney, and the Kidney governs the waist.
Xue Lizhai stated: In the aforementioned condition, the True Qi is deficient, allowing pathogens to take advantage of this weakness. Use Danggui Huangqi Tang (Astragalus and Angelica Decoction) or Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) as the main formula, assisted by Jisheng Tang (Decoction for Preserving Life); if ineffective, add Fuzi (Prepared Aconite Root) to Shiquan Dabu Tang.
Shen Zhai commented: The above three passages describe the syndrome of postpartum lower back pain. The uterus is tied to the Kidney, and the waist is the external manifestation of the Kidney. Postpartum labor injures Kidney Qi and damages the uterine collaterals; most cases belong to deficiency. Even if there are wind-cold and stagnant blood, the key must be to tonify the True Qi. Xue Lizhai’s commentary reveals the essence of this matter.
The *Daquan* states: Postpartum distension and fullness in the two hypochondriac regions with qi-related pain is caused by retained water previously present in the Bladder. Because lochia is not completely discharged after childbirth, water accumulates, forming a palpable mass that struggles with qi, accumulating in the Bladder. This causes distension and fullness in the hypochondriac regions. The agitation between qi and water causes pain.
Xue Lizhai said: For this condition, if it is blood stasis in the Liver Channel, use Xuanhusuo San (Corydalis Powder). If it is qi deficiency in the Liver Channel, use Sijunzi Tang (Four Gentlemen Decoction) added with Chaihu (Bupleurum Root) and Qingpi (Aged Tangerine Peel). If it is blood deficiency in the Liver Channel, use Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome). If Kidney Water is insufficient and cannot nourish the Liver, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If Lung Metal is overly strong and suppresses Liver Wood, use Xiebai San (White Powder to Drain), treating according to the previous syndromes. Unless ginger and cinnamon (warm and acrid herbs) are used to assist the Spleen and Lung in moving the medicinal action, not only will the treatment fail, but it may also exacerbate the distension.
Shen Zhai commented: The above two passages describe the syndrome of postpartum hypochondriac pain. The hypochondrium is the area governed by the Liver; the Liver stores blood. Both incomplete discharge of lochia and excessive blood loss after childbirth can lead to hypochondriac pain; it does not necessarily belong to the agitation of water and qi. One must refer to Xue Lizhai’s commentary to be appropriate.
Guo Qizhong asked: What causes generalized body pain after childbirth? He answered: It is because childbirth disturbs the movement of qi and blood, causing their ascending and descending to lose their normal rhythm. They stagnate in the joints, drawing the sinews and vessels into spasm, resulting in generalized body pain. In severe cases, the waist and back become stiff, preventing flexion and extension; the hands and feet become cramped, preventing bending and straightening. There may also be fever and headache. These should not be treated as other diseases; one should simply administer Chen Tong San (Pain-Chasing Powder) to guide the flow of blood and qi, soothing the sinews and vessels, so that the pain stops naturally.
Chen Wuze stated: Chen Tong San not only treats postpartum qi deficiency and blood stagnation but also treats headache due to wind affecting the Taiyang Channel, along with lower back pain, spontaneous sweating, and fever. However, if the pain is caused by cold invasion, food stagnation, worry, fear, shock, or anger, leading to body ache, fever, and headache, especially when complicated by postpartum consumptive disease (Rulao), Chen Tong San cannot cure these conditions. It would be better to use Wuji San (Five Accumulations Powder) decocted with vinegar, which is acceptable.
Xue Lizhai commented: Wuji San treats postpartum body pain accompanied by cold invasion and food stagnation. It is not suitable for those with qi deficiency and weak blood. If pressing on the painful area increases the pain, it indicates blood stasis; use Siwu Tang (Four Substances Decoction) added with Paojiang (Fried Ginger), Taoren (Peach Kernel), Honghua (Safflower), and Zelan (Lycopus Herb) to tonify and dissipate. If pressing slightly relieves the pain, it indicates blood deficiency; use Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), and Paojiang (Fried Ginger) to nourish.
Shen Zhai commented: The above passage describes the syndrome of generalized body pain after childbirth. After childbirth, all joints open, and blood vessels disperse. "Generalized" means that from sinews, bones, skin, and flesh to the hands, feet, hypochondrium, abdomen, waist, and back, there is no place without pain. The *Daquan* attributes this to blood stagnation in the meridians, suggesting an excess condition. However, excessive blood loss leads to deficiency, and wind-cold attacking due to this deficiency also causes pain. Therefore, Chen Tong San is the specific remedy. Chen Wuze’s claim that it cannot cure, and his suggestion of Wuji San instead, is indeed inaccurate.