薛立斋曰∶蓐劳当扶养正气为主，多因脾胃虚弱，饮食减少，致诸经疲惫，当补脾胃，饮食一进，精气生
化，诸脏有所赖，其病自愈。
慎斋按∶以上四条，序产后有蓐劳之证也。蓐劳之成，因产后气血虚损，不慎起居，或感风冷外邪，或伤七
情忧虑，以致动作不时，将养失宜，遂成蓐劳之候。此《产宝》以调养为训，立斋以养正为先也。
郭稽中曰∶产后血崩者何？曰∶因产后所下过多，血气暴虚，未得平复，或因劳役，或因惊怒，致血暴崩。
又有荣卫素伤，气衰血弱，亦变崩中。若小腹满痛，此肝经已坏，为难治，俱宜固经丸止之。若小腹胀满，此
为内有瘀血，未可止之，必致淋沥。
陈良甫曰∶产后伤耗经脉。未得平复，劳役损动，致血暴崩。或因酸咸不节，以伤荣卫，亦变崩中。
陈无择曰∶血崩不是轻病，况产后有此，是谓重伤，恐不止酸咸不节所致。多因惊忧恚怒，脏气不平，或
产后服断血药早，致恶血不消，郁满作坚，亦或崩中，固经丸自难责效，不若大料煮芎归汤加芍药，随证治之。
薛立斋曰∶前证若血滞，小腹胀满，用失笑散。肝火血妄行，加味逍遥散。脾郁不统血，加味归脾汤。脾虚
不摄血，补中汤。浓味积热伤血，清胃散加槐花。风热相抟伤血，四君子加防风、枳壳。
慎斋按∶以上四条，序产后有血崩之证也。产后已亡血，而又有崩证，似非轻病，多属阴气脱所致。稽中
主于劳役惊怒，是本内伤七情为病。若良甫以酸咸不节，无择以血药断早，均非病机之要。予谓产后下多亡阴，
须用仲景法。血脱益气，纯用血药无济也。观《薛氏医案》有妇人血崩如涌，以六君子加黑姜而愈，得其旨矣。
薛立斋说：产后蓐劳（因产后体虚、调养不当导致的慢性虚损性疾病）的治疗应当以养护正气为主。这多是因为脾胃虚弱，饮食减少，导致各条经脉疲惫不堪，因此应当补益脾胃。一旦饮食进入体内，精气得以生化，各个脏腑有所依赖，疾病自然痊愈。
慎斋按语：以上四条内容，叙述了产后出现蓐劳证候的情况。蓐劳的形成，是由于产后气血虚损，起居不慎，或者感受风冷等外邪，或者受到七情（喜、怒、忧、思、悲、恐、惊）忧虑的损伤，导致活动作息不规律，调养失当，从而形成了蓐劳的病候。《产宝》主张以调养为准则，而立斋则主张以养护正气为先。
郭稽中说：产后血崩（产后阴道大量出血）是怎么回事？回答说：因为产后恶露排出过多，气血突然虚弱，尚未恢复平静，又因为过度劳累，或者因为惊恐愤怒，导致血液突然暴崩。又有的人原本荣卫（营气与卫气）就受损，气衰血弱，也会转变为崩中（指妇女非经期阴道大量出血或持续不断出血）。如果小腹部胀满疼痛，这是肝经已经败坏，属于难治之症，都适宜用固经丸来止血。如果小腹胀满但不痛，这是因为内有瘀血，不可立即止血，否则必然导致淋漓不尽。
陈良甫说：产后经脉耗伤，尚未恢复平静，若因劳累损伤触动，导致血液暴崩。或者因为酸咸口味摄入不节制，从而损伤荣卫，也会转变为崩中。
陈无择说：血崩不是轻病，何况在产后发生这种情况，称为重伤，恐怕不仅仅是因为酸咸口味不节制所致。多是因为惊恐忧愁愤怒，导致脏气不平，或者产后过早服用断绝恶露的药物，导致恶血不能消散，郁结胀满变得坚硬，也会导致崩中，此时单靠固经丸很难见效，不如用大剂量的煮芎归汤（川芎当归汤）加入芍药，根据具体证候进行治疗。
薛立斋说：上述证候如果血液停滞，小腹胀满，使用失笑散。如果是肝火导致血液妄行，使用加味逍遥散。如果是脾郁导致不能统摄血液，使用加味归脾汤。如果是脾虚不能摄血，使用补中益气汤。如果是浓味积热损伤血液，使用清胃散加入槐花。如果是风热相互搏结损伤血液，使用四君子汤加入防风、枳壳。
慎斋按语：以上四条，叙述了产后出现血崩证候的情况。产后已经亡血，却又出现崩证，似乎不是轻病，大多属于阴气脱失所致。郭稽中主张由于劳累和惊恐愤怒引起，这是认为内伤七情是致病根本。至于陈良甫认为是酸咸口味不节制，陈无择认为是过早使用止血药物，这些都不是病机的关键所在。我认为产后下血过多会亡阴，必须采用张仲景的方法。血脱时应当益气，单纯使用补血药物是没有帮助的。看《薛氏医案》中有妇人血崩如涌泉般，通过六君子汤加入炮姜而痊愈，这就抓住了要领。
Xue Lizhai stated: The treatment of *Rulao* (chronic deficiency syndrome postpartum due to improper care) should primarily focus on nourishing the upright Qi. This is often caused by Spleen and Stomach weakness, leading to reduced food intake, which results in fatigue of all meridians. Therefore, one must tonify the Spleen and Stomach. Once food intake resumes, Jing-Qi (Essence and Qi) will be generated and transformed, providing support for all Zang-Fu organs, and the disease will heal spontaneously.
Shen Zhai commented: The above four passages describe the syndrome of *Rulao* occurring postpartum. The formation of *Rulao* stems from the deficiency and damage of Qi and Blood after childbirth. If daily life is not managed carefully, or if Wind-Cold external pathogens are contracted, or if the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sadness, Fear, Fright) cause emotional distress, leading to irregular activity and improper recuperation, the condition of *Rulao* ensues. *Chanbao* advocates regulation and care as the guideline, while Lizhai prioritizes nourishing the upright Qi.
Guo Jizhong asked: What is postpartum *Benglong* (sudden heavy vaginal bleeding)? He answered: It occurs because excessive lochia discharge causes a sudden deficiency of Qi and Blood, which has not yet recovered. If further aggravated by overexertion or by fright and anger, it leads to sudden violent bleeding. Additionally, those whose Ying-Wei (Nutritive and Defensive Qi) were originally damaged, with weak Qi and Blood, may also develop *Bengzhong* (metrorrhagia). If the lower abdomen is full and painful, this indicates the Liver Meridian is compromised, making it difficult to treat; Gujing Wan (Solidify the Menses Pill) is suitable to stop the bleeding in all such cases. However, if the lower abdomen is distended but not painful, this indicates the presence of stagnant Blood inside. One must not stop the bleeding immediately, otherwise it will result in persistent dripping.
Chen Liangfu stated: Postpartum meridians are depleted. Before they have recovered, overexertion can trigger sudden violent bleeding. Alternatively, immoderate consumption of sour and salty flavors may damage Ying-Wei, also transforming into *Bengzhong*.
Chen Wuzhe stated: *Benglong* is not a mild disease; occurring postpartum, it constitutes severe injury. It is likely not solely caused by immoderate consumption of sour and salty flavors. It is often due to fright, worry, and anger causing disharmony of the Zang-Qi, or taking hemostatic drugs too early after childbirth, preventing the expulsion of lochia. This leads to stagnation, distension, and hardening, resulting in *Bengzhong*. In such cases, relying solely on Gujing Wan is unlikely to be effective. Instead, a large dose of Zhuxiong Gui Tang (Decoction of Chuanxiong and Angelica Sinensis) added with Shaoyao (Paeoniae Radix Alba) should be used, treating according to the specific syndrome.
Xue Lizhai stated: For the aforementioned syndromes, if there is blood stasis with lower abdominal distension, Shixiao San (Smile Powder) should be used. If Liver Fire causes reckless blood flow, Jiawei Xiaoyao San (Modified Free Wanderer Powder) is indicated. If Spleen depression fails to control the blood, Jiawei Guipi Tang (Modified Restore the Spleen Decoction) is appropriate. If Spleen deficiency fails to hold the blood, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used. If rich flavors accumulate heat damaging the blood, Qingwei San (Clear the Stomach Powder) added with Huaihua (Sophorae Flos) is suitable. If Wind-Heat combats each other damaging the blood, Sijunzi Tang (Four Gentlemen Decoction) added with Fangfeng (Saposhnikoviae Radix) and Zhike (Aurantii Fructus Immaturus) should be employed.
Shen Zhai commented: The above four passages describe the syndrome of *Benglong* occurring postpartum. Since the patient has already lost blood during childbirth, the occurrence of *Beng* suggests it is not a mild condition, often belonging to the category of Yin Qi collapse. Jizhong attributes it to exertion and emotional disturbance, viewing internal injury to the Seven Emotions as the root cause. Liangfu’s attribution to dietary imbalance and Wuzhe’s to premature use of hemostatics are not key to the pathogenesis. I believe that excessive postpartum bleeding leads to Yin depletion; thus, Zhang Zhongjing’s methods must be adopted. When blood is lost, Qi must be tonified; using only blood-nourishing herbs is of no help. In *Xue Shi Yi An* (Medical Cases of Xue), a woman with torrential postpartum bleeding was cured using Liujunzi Tang (Six Gentlemen Decoction) added with Paojiang (Prepared Ginger), which grasped the essence of this principle.