门人问曰∶产后症诸家议论不一，治法互异。而吾闽历久相传，俱宗朱丹溪所云∶产后有病，先固气血。故产后以
大补气血为主，虽有杂病，以末治之。薛立斋、汪石山极赞其妙，而陈良甫、单养贤诸论皆不出其范围，虞天民、叶以
潜又以去瘀血为主，二说互参，可以得攻、补两大法，究竟当从与否？
曰∶此皆庸俗之见，亦且一偏之言，不足听也。今节录《内经》二条、《金匮·产后》全册以注之。各家之说一概置
之弗言，所谓群言淆乱衷于圣是也。
《内经》云∶乳子（之时）而（患伤寒）病热，脉（止宜）悬小，（不宜实大，以产后新虚故也。）手足温则生，（若
脉虽悬小，而见手足俱）寒（是脾气衰绝，阴气暴起）则死。
又云∶乳子中风，（而身为大）热、（以至）喘、鸣息粗者。（为风热逆于阳位也。故其脉必不能悬小而实大，但须）
实大（之中，而见往来）而（和）缓（是脾胃之气，尚荣于脉）则生，（设见疾）急则（脾胃已绝，必）死。此二节以脾
胃为主，可知《内经》所独重，彼诸家互相辨驳，终不足言也。昔人云∶“短语会心非是少”，即读书得间之谓也。
门人问曰∶《金匮》较《伤寒论》更为难读，夫子于产后独主之，曷故？
曰∶医，儒者事也。先其事之所难，东鲁明训。而因陋就简，直市医耳。且随症条分各目，胪列方治，不得其头绪，
如治丝而棼之也。今举《金匮》为主，若得其一知半解，便足活人，故全录于下。
尝论历代未立考试医生之制，其失业之辈混充之，以为糊口之术，所以日流日下，而女科其尤甚者。若明理之人，
遇医辈先询之曰∶岐黄后，若仲景可称上医否？不知者曰∶我不知其为何人也。其知者曰∶汉代之医圣，相去久远而难
从耳。夫时有古今之异，岂天之五运六气、入之五脏六腑
亦有颠倒变迁之异乎？知与不知，不过以五十步笑百步耳。设有明理者，楷录此册第一节、第二节原文，今时行之医，
每句浅浅讲得下，则是上好名医；即一时讲不下，肯执所录原文，携回查对各本旧注，略能敷衍讲得去，便知渠家亦藏
有正书，必不至有大支离处，亦是好医；或携其原文，转向心腹之医友处，东摸西捉，约略于皮毛土说得来，便知渠门
尚有一二读书好友，亦不至有大荒唐处，亦是好医。余欲求其数种人，不能旦暮遇之，实为憾事。且可闻其自文曰∶彼
是仲景派，我是刘、张、朱、李前四大家派，我是王肯堂、薛立斋、张景岳、喻嘉言后四大家派。且时行《临症指南》，
其药惯用生姜滓、泡淡附子、地黄炭、泡淡吴萸、漂淡白术，及一切药炭，海中各种干壳，皆无气无味之类。其治法，
开口便云五行三合，双山颠倒，化合之妙，皆渺茫无据之说。虚病则云以人补人，多仗紫河车熬膏（此物大秽、大毒、
大动火，每见百服百死。病患宜存好心行好事，切勿听此忍心害理之言）。久病则云入络，以老丝瓜、鲜竹茹、当归须、
忍冬藤、刺蒺藜之类为秘药；又以西瓜翠皮、鲜荷梗、淡菜肉、海参之类为新奇；不能于《指南》中，择其善而从之，
而惟集其所短。天士有知，当必斥之、谴之。而必张大其说曰∶我是叶天士一派。斯言也，彼妄言之，我妄听之，其为
斯道何哉？
所望行道诸君子，速迸去相沿之病，从事于圣经贤训，亦不失为善改过之君子矣！
《金匮》云∶问曰∶新产妇人有三病，一曰病痉，二曰病郁冒，三曰大便难，何谓也？师曰∶新产（之妇，畏其无
汗。若其无汗，则荣卫不相和，而为发热无汗等症，似乎伤寒之表病，但舌头无白苔，及无头痛项强之可辨也。然而虽
欲有汗，又恐其）血虚，（气热，热则腠理开，而）多汗出，（汗出则腠理愈开，而）喜中风，（血不养筋，而风又动火，）
故令病痉。（新产之妇，畏血不行，若不行，则血瘀于内，而为发热、腹痛等症，似乎伤寒之里病，但舌无黄苔，及无大
烦燥、大狂渴之可辨也。然虽欲血下，又恐过多）而亡血，（血亡，其气无耦而外泄，则）复汗，（血气两耗，则寒自内
生而）寒多，（血为阴，阴亡失守；气为阳，阳虚上厥；）故令（头眩目瞀，或不省人事而）郁冒。（新产之妇，虽欲其汗
出血行，又恐汗与血过多，以致）亡津液，胃（干，肠）燥，故大便难。（三者不同，其为亡血、伤津则一也。）此为产
后提出三病以为纲，非谓产后止此三病也。
（上言新产之病，其提纲有三，然痉病有竹叶汤之治法，另详于后。试先言郁冒与大便难相兼之症。）产妇郁冒，（与
大便难二病，皆因亡血、伤津所致，故）其脉（俱见）微弱，（惟）呕（而）不能食，大便反坚，（是为大便难纲中之兼
症。一身无汗）但头（上）汗出。（为郁冒纲中之专症。）所以然者，血虚（则阴竭于下，）而（为下）厥，（下）厥（则
孤阳上越，）而必冒。（推而言之，凡素患郁冒之人，名曰冒家。吾观其之）冒家欲解，必（令）大汗出。（而始解。）以
血虚（为）下厥，（下厥则）孤阳（无根据，而）上出，故头汗出。（此头汗出，为郁冒病纲中之大眼目也。）所以产妇（头
汗既出。又）喜（其通身）汗出者，（以）亡阴血虚，阳气独盛，故当（损阳，令其）汗出，（损阳就阴，则）阴阳乃（平
而）复。（盖阴阳之枢，操自少阳，非小柴胡汤不能转其枢而使之平。至于产后）大便（难之纲中，其症俱便燥而且）坚，
（由于血行过多，则阳明之血海干枯，而血不濡于下∶不濡于下，则反逆于上而为）呕（失和于中，而为）不能食，（阳
明属胃，为血海，血不自生，生于所纳之水谷。人但知消导为平胃转胃，降逆顺气为安胃，甘寒柔润为补胃，而不知小
柴胡汤为和胃深一层治法。与《伤寒》小柴胡汤方后云∶上焦得通、津液得下、胃气因和三句，移来此一节，堪为此症
之铁板注脚也。故以上二症，而统以）小柴胡汤主之。此为郁冒与大便难之相兼者，详其病因而出其方治也。
（郁冒之）病（既）解（而）能食，（至）七八日更发热者，（然发热而不恶寒，便知其不在表而在里矣。因能食而
更发热，便知其非虚病而为食复症矣。）此为胃实，大承气汤主之。此言大虚之后有实症，即当以实治之也。若畏承气之
峻而不敢用，恐因循致虚，病变百出。甚矣哉！庸庸者不足以共事也。若畏承气之峻，而用谷芽、麦芽、山楂、神曲之
类，消耗胃气，亦为害事。
产后（属虚，客寒阻滞血气，则）腹中 痛，（以）当归生姜羊肉汤主之；并治腹中寒疝，虚劳不足。
参各家说∶ 痛者，缓缓痛也。概属客寒相阻，故以当归通血分之滞，生姜行气分之寒。然胎前责实，故当归白术
散内加茯苓、泽泻，泻其水湿。此属产后，大概责虚，故以当归养血而行血滞；生姜散寒而行气滞；又主以羊肉味浓，
温补气而生血；俾气血得温。则邪自散而痛止矣。此方攻补兼施，故并治寒疝虚损。或疑羊肉太补，而不知孙真人谓∶
羊肉止痛，利产妇。古训凿凿可据，又奚疑哉？
（然痛亦有不属于虚者，不可不知，）产后腹痛，（若不烦不满，为中虚而寒动也。今则火上逆而）烦（气壅滞而）
满（胃不和而）不得卧，（此热下郁而碍上也。以）枳实芍药散主之。此为腹痛而烦满不得卧者，出其方治也。方意是调
和气血之滞，所谓“通则不痛”之轻剂也。下以大麦粥者，并和其肝
气，而养其心脾，故痈脓亦主之。
师曰∶产妇腹痛，法当以枳实芍药散，假令不愈者，此为（热灼血），腹中有干血，其痛着于脐下，（非枳实等药所
能治也，）宜下瘀血汤主之；亦主经水不利。此为痛着脐下，出其方治也。意者病去则虚自回，不必疑其过峻。
（然亦有不可专下其瘀血者，不可不知。）产后七八日，无（头痛、发热、恶寒之）太阳症，少腹坚痛，此恶露不尽；
（治者不过下其瘀血而已，然其）不大便，烦躁发热，切脉微实，（是胃家之实也。阳明旺于申酉戌，日晡是阳明向旺之
时也。而其）再倍发热，（至）日晡时烦躁者，（又胃热之）验也。（食入于胃，长气于阳，若）不食，（则已，而）食入
则（助胃之热为）谵语，（又胃热之验也。然又有最确之辨，昼阳也，夜阴也，若病果在阴，宜昼轻而夜重，今）至夜（间，
应阳明气衰之时，而）即（稍）愈，（其为胃家之实热，更无疑也。）大承气汤主之。（盖此汤热与结兼祛，以阳明之）热
在里，（少腹之）结在膀胱也。此言血虽结于少腹，若胃有实热，当以大承气汤主之。若但治其血而遗其胃，则血虽去而
热不除，即血亦未必能去也。
此条“至夜则愈”四字，为辨症大眼目。盖昼为阳而主气，暮为阴而主血。观上节“妇人伤寒发热，经水适来，昼
日明了，暮则谵语，如见鬼状者，此为热入血室。”以此数语，而对面寻绎之便知，至夜则愈，知其病不专在血也。
产后（中）风，续续数十日不解，（似不应在桂枝症之例矣。然）头微痛恶寒，时时有热，（皆桂枝本症中。惟有）
心下闷，（一症，邪入胸膈为太阳之里症。其余）干呕汗出，（俱为桂枝症例中本有之症，是桂枝症更进一层，即为阳旦
症。桂枝汤稍为增加，即为阳旦汤。其病）虽久，（而）阳旦症续在者，可与阳旦汤。
张石顽云∶举此与上文承气汤，为一表一里之对子，不以日数之多而疑其表症也。
（男元犀）按∶此言产后阳旦症未罢，病虽久而仍用其方也。《伤寒论·太阳篇》有因加附子参其间、增桂令汗出之
句。言因者，承上文病症象桂枝，因取桂枝之原方也；言增桂者，即于桂枝汤原方外，更增桂枝二两，合共五两是也。
孙真人于此数句未能体认，反以桂枝汤加黄芩为阳旦汤，后人因之，至今相沿不解。甚矣读书之难也！然此方《伤寒论》
特笔用“令汗出”三字，大是眼目，其与桂枝加附子之治遂漏者，为同中之异，而亦异中之同。盖止汗漏者，匡正之功；
令汗出者，驱邪之力；泛应曲当，方之所以入神也。上节里热成实，虽产后七八日，与大承气汤而不伤于峻；此节表邪
不解，虽数十日之久，与阳旦汤而不虚其数；此中之奥妙，难与浅人道也。丹溪谓产后惟大补气血为主，其余以末治之。
又云∶芍药伐生生之气。此授庸医藏拙之术以误人，不得不直斥之。
（长孙心典禀）按∶头疼恶寒，时时有热，自汗干呕，俱是桂枝症。而不用桂枝汤者，以心下闷，当用桂枝去芍药
汤之法。今因产后亡血，不可径去芍药，须当增桂以宣其阳，汗出至数十日之久，虽与发汗
遂漏者迥别，亦当借桂枝加附子汤主法，固少阴之根以止汗，且止汗即在发汗之中，此所以阳旦汤为丝丝入扣也。
（前以痉病为产后三大纲之一，然痉病本起于中风，今以中风将变痉病而言之。）产后中风，发热，面正赤，喘而头
痛，（此病在太阳，连及阳明。而产后正气太虚，又不能以胜邪气，诚恐变为痉病，）以竹叶汤主之。此为产后中风，正
虚邪盛者，而出其补正散邪之方也。方中以竹叶为君者，以风为阳邪，不解即变为热，热盛则灼筋而成痉，故以温散药
中，先君以竹叶而折其势，即杜渐防微之道也。（太阳之脉，上行至头；阳明脉过膈上，循于面；二经合病多加葛根。）
妇人乳中虚，烦乱，呕逆，安中益气，竹皮大丸主之。
徐忠可云∶乳者，乳子之妇也。言乳汁去多，则阴血不足而胃中亦虚。《内经》云∶阴者，中之守也。阴虚不能胜阳，
而火上壅则烦，气上越则呕。烦而乱则烦之甚也，呕而逆则呕之甚也。病本全由中虚，然而药止用竹茹、桂、甘、石膏、
白薇者，盖中虚而至为呕为烦，则胆腑受邪，烦呕为主病，故以竹茹之除烦止呕者为君；胸中阳气不用，故以桂、甘扶
阳而化其逆气者为臣；以石膏凉上焦气分之虚热为佐；以白薇去表间之浮热为使。要知烦乱呕逆而无肠痛下痢等证，虽
虚无寒可知也。妙在加桂于凉剂中，尤妙在生甘草独多，意谓散蕴蓄之邪，复清阳之气，中即自安，气即自益，故无一
补剂。而又注其立汤之本意，曰安中益气，竹皮大丸神哉！喘加柏实，柏每西向，得西方之气最深，故能益金气、润肝
木而养心，则肺不受烁，喘自平也。有热倍白薇，盖白薇能去浮热。故《短剧》桂枝加龙骨牡蛎汤云∶汗多热浮者，去
桂加白薇、附子各三分，名曰二加龙骨汤，则白薇之能去浮热可知矣。
（凡下痢病多由湿热，白头翁之苦以胜湿，寒以除热，固其宣也。而）产后下痢虚极，（似不可不商及补剂；但参、
术则恐其壅滞，苓、泽则恐其伤液，惟以）白头翁加甘草阿胶汤主之。（诚为对症。方中甘草之甘凉清中，即所以补中；
阿胶之滋润去风，即所以和血；以此治利，即以此为大补。彼治利而好用参、术者，当知所返矣。）此为产后下痢虚极者，
而出其方治也。
《金匮》附方云∶《千金》三物黄芩汤，治妇人（未离产所，尚）在于草蓐，自发（去衣被，）露（其身体，而）得
学生问道：“产后病症，各家议论不一，治疗方法也各不相同。而我们福建地区长久以来相传，都尊崇朱丹溪所说的：‘产后如果有病，先要固护气血’。因此，产后治疗以大补气血为主，即使有其他杂病，也只作为次要问题来处理。薛立斋、汪石山极力称赞这种方法的妙处，而陈良甫、单养贤等人的论述也都未超出这个范围；虞天民、叶以潜则主张以祛除瘀血为主。这两种说法互相参照，可以得出攻邪和补虚两大法则，究竟应该遵从哪一种呢？”
我说：“这些都是庸俗浅陋的见解，而且都是片面的言论，不值得听取。现在节录《黄帝内经》中的两条内容，以及《金匮要略·产后病》全篇来注释说明。各家之说一概不予置评，这就是所谓的‘众说纷纭时，以圣人的教导为准绳’。”
《黄帝内经》说：“妇女在哺乳期间（乳子之时），如果患伤寒并出现发热，脉象应当是悬细而小的（不宜实大，因为产后身体新近虚弱）。如果手足温暖，说明阳气尚存，预后良好；如果脉象虽然悬细而小，但见手足俱冷，这是脾气衰绝、阴气暴起的征象，预后不良（主死）。”
又说：“妇女在哺乳期感受风邪，如果身体高热，甚至出现喘息、呼吸有声且粗重，这是因为风热之邪逆犯阳位。因此其脉象必然不能是悬细而小，而是实大，但在实大之中必须兼见往来和缓之象，这说明脾胃之气尚能荣养于脉中，预后良好；如果脉象疾速紧急，说明脾胃之气已绝，预后不良（主死）。这两段经文都以脾胃为主，可以看出《黄帝内经》特别重视脾胃，那些各家互相辩驳的观点，终究不足为道。古人说：‘简短的话语若能会心领悟，并不比长篇大论少’，这就是指读书时要领会其中的精义。”
学生又问：“《金匮要略》比《伤寒论》更难读懂，老师您在产后病方面唯独推崇它，这是什么原因？”
我说：“医学，是儒者所从事的事业。先做那些困难的事，这是孔夫子在鲁地的明确教诲。如果只是因循守旧、图省事，那不过是市井医生罢了。况且《金匮要略》随症状分条列目，罗列方药治疗，如果没有头绪，就像理丝一样越理越乱。现在以《金匮要略》为主，如果能得到其中的一知半解，就足以救活人，所以全文抄录在下面。”
我曾经评论过，历代没有设立医生考试制度，导致失业的人混充医生，以此作为谋生的手段，所以医术日益败坏，妇科更是严重。如果有明理的人，遇到医生先询问他：“岐伯、黄帝之后，张仲景可以称为上医吗？”不知道的人会说：‘我不知道他是谁。’知道的人会说：‘他是汉代的医圣，时代久远难以追随。’其实时代虽有古今差异，难道天的五运六气、人的五脏六腑也有颠倒变迁的差异吗？知道与不知道，不过是五十步笑百步罢了。假设有明理之人，将这一册第一节、第二节原文楷书写录下来，让当今流行的医生逐句浅显地讲解，如果能讲得下去，就是上好的名医；如果一时讲不下去，肯拿着抄录的原文，回去查阅各家的旧注，大概能敷衍讲过去，就知道他家也藏有正书，必定不会有太大的支离破碎之处，也是好医生；或者拿着原文，转向知心好友处的医生请教，东摸西捉，大致能从皮毛土法上讲得来，就知道他门下还有一两个读书的好友，也不至于有大荒唐之处，也是好医生。我想寻找这几种人，却不能在短时间内遇到，实在令人遗憾。而且还可以听到他们自我标榜说：‘那是张仲景一派，我是刘完素、张从正、朱震亨、李杲前四大家一派，我是王肯堂、薛立斋、张景岳、喻嘉言后四大家一派。’并且时下流行的《临证指南》，其药物习惯使用生姜渣、炮制淡附子、地黄炭、炮制淡吴茱萸、漂洗淡白术，以及一切药炭，海中各种干壳，都是无气无味之类的东西。其治疗方法，开口便谈五行三合、双山颠倒、化合之妙，都是渺茫无据的说法。对于虚病，就说用‘以人补人’的方法，多依靠紫河车熬膏（此物大秽、大毒、大动火，常见服用百次死百次。病患应存好心行好事，切勿听信这种忍心害理的话）。对于久病，就说‘入络’，以老丝瓜、鲜竹茹、当归须、忍冬藤、刺蒺藜之类为秘药；又以西瓜翠皮、鲜荷梗、淡菜肉、海参之类为新奇；不能在《指南》中选择其优点而遵循，却只聚集其缺点。如果叶天士有知，必定会斥责、谴责他们。而他们必定夸大其词说：‘我是叶天士一派。’这样的话，他们妄言，我们妄听，这对医学大道有什么益处呢？
我希望行道诸君子，迅速摒弃沿袭下来的弊病，致力于圣经贤传的教诲，也不失为善于改过的君子了！”
《金匮要略》说：“问：新产妇人有三种病，一是痉病，二是郁冒，三是大便难，这是什么意思？老师说：新产后的妇女，担心她无汗。如果无汗，则营卫不和，出现发热无汗等症状，似乎像伤寒的表证，但舌头没有白苔，也没有头痛项强可以辨别。然而虽然想出汗，又怕血虚，气热，热则腠理开，而多汗出，汗出则腠理更开，容易中风，血不养筋，风又动火，所以导致痉病。新产后的妇女，担心血行不畅，如果不通，则血瘀于内，出现发热、腹痛等症状，似乎像伤寒的里证，但舌无黄苔，也没有大烦躁、大狂渴可以辨别。然而虽然想下血，又怕过多亡血，血亡，其气无偶而外泄，则复汗，血气两耗，则寒自内生而寒多，血为阴，阴亡失守；气为阳，阳虚上厥，所以导致头眩目昏，或不省人事而郁冒。新产后的妇女，虽然希望汗出血行，又恐汗与血过多，以致亡津液，胃干，肠燥，所以大便难。这三者不同，但其亡血、伤津是一致的。这是产后提出三种病作为纲领，并非说产后只有这三种病。”
（上文说新产之病，其提纲有三，但痉病有竹叶汤的治疗方法，另详于后。试先说郁冒与大便难相兼的症状。）产妇郁冒，与大便难二病，皆因亡血、伤津所致，故其脉俱见微弱，惟呕而不能食，大便反坚，是为大便难纲中之兼症。一身无汗，但头上汗出，为郁冒纲中之专症。之所以这样，是因为血虚则阴竭于下，而为下厥，下厥则孤阳上越，而必冒。推而言之，凡素患郁冒之人，名叫冒家。我看那冒家欲解，必令大汗出才始解。以血虚为下厥，下厥则孤阳无根据而上出，故头汗出。此头汗出，为郁冒病纲中之大眼目也。所以产妇头汗既出，又喜其通身汗出者，以亡阴血虚，阳气独盛，故当损阳，令其汗出，损阳就阴，则阴阳乃平而复。盖阴阳之枢，操自少阳，非小柴胡汤不能转其枢而使之平。至于产后大便难之纲中，其症俱便燥而且坚，由于血行过多，则阳明之血海干枯，而血不濡于下；不濡于下，则反逆于上而为呕，失和于中，而为不能食。阳明属胃，为血海，血不自生，生于所纳之水谷。人但知消导为平胃转胃，降逆顺气为安胃，甘寒柔润为补胃，而不知小柴胡汤为和胃深一层治法。与《伤寒论》小柴胡汤方后云：‘上焦得通、津液得下、胃气因和’三句，移来此一节，堪为此症之铁板注脚也。故以上二症，而统以小柴胡汤主之。此为郁冒与大便难之相兼者，详其病因而出其方治也。
（郁冒之）病（既）解（而）能食，（至）七八日更发热者，然发热而不恶寒，便知其不在表而在里矣。因能食而更发热，便知其非虚病而为食复症矣。此为胃实，大承气汤主之。此言大虚之后有实症，即当以实治之也。若畏承气之峻而不敢用，恐因循致虚，病变百出。甚矣哉！庸庸者不足以共事也。若畏承气之峻，而用谷芽、麦芽、山楂、神曲之类，消耗胃气，亦为害事。
产后（属虚，客寒阻滞血气，则）腹中痛，以当归生姜羊肉汤主之；并治腹中寒疝，虚劳不足。
参各家说：痛者，缓缓痛也。概属客寒相阻，故以当归通血分之滞，生姜行气分之寒。然胎前责实，故当归白术散内加茯苓、泽泻，泻其水湿。此属产后，大概责虚，故以当归养血而行血滞；生姜散寒而行气滞；又主以羊肉味浓，温补气而生血；俾气血得温。则邪自散而痛止矣。此方攻补兼施，故并治寒疝虚损。或疑羊肉太补，而不知孙真人谓：羊肉止痛，利产妇。古训凿凿可据，又奚疑哉？
（然痛亦有不属于虚者，不可不知，）产后腹痛，若不烦不满，为中虚而寒动也。今则火上逆而烦，气壅滞而满，胃不和而不得卧，此热下郁而碍上也。以枳实芍药散主之。此为腹痛而烦满不得卧者，出其方治也。方意是调和气血之滞，所谓“通则不痛”之轻剂也。下以大麦粥者，并和其肝气，而养其心脾，故痈脓亦主之。
老师说：产妇腹痛，法当以枳实芍药散，假令不愈者，此为热灼血，腹中有干血，其痛着于脐下，非枳实等药所能治也，宜下瘀血汤主之；亦主经水不利。此为痛着脐下，出其方治也。意者病去则虚自回，不必疑其过峻。
（然亦有不可专下其瘀血者，不可不知。）产后七八日，无太阳症，少腹坚痛，此恶露不尽；治者不过下其瘀血而已，然其不大便，烦躁发热，切脉微实，是胃家之实也。阳明旺于申酉戌，日晡是阳明向旺之时也。而其再倍发热，至日晡时烦躁者，又胃热之验也。食入于胃，长气于阳，若不食，则已，而食入则助胃之热为谵语，又胃热之验也。然又有最确之辨，昼阳也，夜阴也，若病果在阴，宜昼轻而夜重，今至夜间，应阳明气衰之时，而即稍愈，其为胃家之实热，更无疑也。大承气汤主之。盖此汤热与结兼祛，以阳明之热在里，少腹之结在膀胱也。此言血虽结于少腹，若胃有实热，当以大承气汤主之。若但治其血而遗其胃，则血虽去而热不除，即血亦未必能去也。
此条“至夜则愈”四字，为辨症大眼目。盖昼为阳而主气，暮为阴而主血。观上节“妇人伤寒发热，经水适来，昼日明了，暮则谵语，如见鬼状者，此为热入血室。”以此数语，而对面寻绎之便知，至夜则愈，知其病不专在血也。
产后中风，续续数十日不解，似不应在桂枝症之例矣。然头微痛恶寒，时时有热，皆桂枝本症中。惟有心下闷一症，邪入胸膈为太阳之里症。其余干呕汗出，俱为桂枝症例中本有之症，是桂枝症更进一层，即为阳旦症。桂枝汤稍为增加，即为阳旦汤。其病虽久，而阳旦症续在者，可与阳旦汤。
张石顽说：举此与上文承气汤，为一表一里之对子，不以日数之多而疑其表症也。
（男元犀）按：此言产后阳旦症未罢，病虽久而仍用其方也。《伤寒论·太阳篇》有因加附子参其间、增桂令汗出之句。言因者，承上文病症象桂枝，因取桂枝之原方也；言增桂者，即于桂枝汤原方外，更增桂枝二两，合共五两是也。孙真人于此数句未能体认，反以桂枝汤加黄芩为阳旦汤，后人因之，至今相沿不解。甚矣读书之难也！然此方《伤寒论》特笔用“令汗出”三字，大是眼目，其与桂枝加附子之治遂漏者，为同中之异，而亦异中之同。盖止汗漏者，匡正之功；令汗出者，驱邪之力；泛应曲当，方之所以入神也。上节里热成实，虽产后七八日，与大承气汤而不伤于峻；此节表邪不解，虽数十日之久，与阳旦汤而不虚其数；此中之奥妙，难与浅人道也。丹溪谓产后惟大补气血为主，其余以末治之。又云：芍药伐生生之气。此授庸医藏拙之术以误人，不得不直斥之。
（长孙心典禀）按：头疼恶寒，时时有热，自汗干呕，俱是桂枝症。而不用桂枝汤者，以心下闷，当用桂枝去芍药汤之法。今因产后亡血，不可径去芍药，须当增桂以宣其阳，汗出至数十日之久，虽与发汗遂漏者迥别，亦当借桂枝加附子汤主法，固少阴之根以止汗，且止汗即在发汗之中，此所以阳旦汤为丝丝入扣也。
（前以痉病为产后三大纲之一，然痉病本起于中风，今以中风将变痉病而言之。）产后中风，发热，面正赤，喘而头痛，此病在太阳，连及阳明。而产后正气太虚，又不能以胜邪气，诚恐变为痉病，以竹叶汤主之。此为产后中风，正虚邪盛者，而出其补正散邪之方也。方中以竹叶为君者，以风为阳邪，不解即变为热，热盛则灼筋而成痉，故以温散药中，先君以竹叶而折其势，即杜渐防微之道也。（太阳之脉，上行至头；阳明脉过膈上，循于面；二经合病多加葛根。）
徐忠可说：乳者，乳子之妇也。言乳汁去多，则阴血不足而胃中亦虚。《内经》云：阴者，中之守也。阴虚不能胜阳，而火上壅则烦，气上越则呕。烦而乱则烦之甚也，呕而逆则呕之甚也。病本全由中虚，然而药止用竹茹、桂、甘、石膏、白薇者，盖中虚而至为呕为烦，则胆腑受邪，烦呕为主病，故以竹茹之除烦止呕者为君；胸中阳气不用，故以桂、甘扶阳而化其逆气者为臣；以石膏凉上焦气分之虚热为佐；以白薇去表间之浮热为使。要知烦乱呕逆而无肠痛下痢等证，虽虚无寒可知也。妙在加桂于凉剂中，尤妙在生甘草独多，意谓散蕴蓄之邪，复清阳之气，中即自安，气即自益，故无一补剂。而又注其立汤之本意，曰安中益气，竹皮大丸神哉！喘加柏实，柏每西向，得西方之气最深，故能益金气、润肝木而养心，则肺不受烁，喘自平也。有热倍白薇，盖白薇能去浮热。故《短剧》桂枝加龙骨牡蛎汤云：汗多热浮者，去桂加白薇、附子各三分，名曰二加龙骨汤，则白薇之能去浮热可知矣。
（凡下痢病多由湿热，白头翁之苦以胜湿，寒以除热，固其宣也。而）产后下痢虚极，似不可不商及补剂；但参、术则恐其壅滞，苓、泽则恐其伤液，惟以白头翁加甘草阿胶汤主之。诚为对症。方中甘草之甘凉清中，即所以补中；阿胶之滋润去风，即所以和血；以此治利，即以此为大补。彼治利而好用参、术者，当知所返矣。此为产后下痢虚极者，而出其方治也。
《金匮要略》附方说：《千金方》三物黄芩汤，治妇人未离产所，尚在于草蓐，自发去衣被，露其身体，而得
A student asked, "Regarding postpartum syndromes, various schools of thought offer different discussions and treatment methods. However, in our Fujian region, it has been passed down for a long time to follow Zhu Danxi's saying: 'If there is disease after childbirth, first consolidate Qi and Blood.' Therefore, the main treatment for postpartum conditions is to greatly tonify Qi and Blood; even if there are other miscellaneous diseases, they are treated as secondary issues. Xue Lizhai and Wang Shishan highly praised the efficacy of this method, while the arguments of Chen Liangfu and Shan Yangxian all fell within this scope. Yu Tianmin and Ye Yiqian, on the other hand, advocated removing blood stasis as the primary approach. By referring to these two theories together, one can derive the two major methods of attacking (pathogens) and tonifying (deficiency). Which one should ultimately be followed?"
I said, "These are all vulgar and shallow views, and moreover, they are one-sided statements not worth listening to. Now, I will excerpt two passages from *Huangdi Neijing* (Yellow Emperor's Inner Canon) and the entire chapter on Postpartum Diseases from *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) to annotate them. All other schools' theories will be disregarded, which is what is meant by 'when many voices confuse, rely on the Sages.'"
*Huangdi Neijing* states: "When a woman is nursing (during lactation) and suffers from Shanghan (Cold Damage) with fever, the pulse should be fine and small (it should not be full and large, because the body is newly deficient after childbirth). If the hands and feet are warm, life is possible (prognosis is good); if the pulse is fine and small but the hands and feet are cold, this indicates the exhaustion of Spleen Qi and the sudden rise of Yin pathogenic factors, leading to death."
It also states: "When a nursing woman contracts Wind, and her body becomes extremely hot, leading to wheezing, noisy breathing, and coarse respiration, this is due to Wind-Heat counterflowing to the Yang positions. Therefore, her pulse must not be fine and small, but rather full and large. However, within the fullness and largeness, there must be a sense of coming and going that is harmonious and slow, indicating that the Qi of the Spleen and Stomach is still nourishing the pulse, so life is possible; if the pulse is rapid and urgent, it indicates the exhaustion of Spleen and Stomach Qi, leading to death." These two sections emphasize the Spleen and Stomach, showing that *Huangdi Neijing* places unique importance on them. The mutual refutations among various schools are ultimately insufficient to discuss. An ancient saying goes: 'Short phrases that resonate with the heart are not few,' which refers to grasping the essence while reading.
The student asked again, "*Jingui Yaolue* is more difficult to read than *Shanghan Lun* (Treatise on Cold Damage). Why do you exclusively advocate it for postpartum diseases, Master?"
I said, "Medicine is the undertaking of Confucian scholars. To tackle the difficult tasks first is a clear instruction from Donglu (Confucius in Lu). Merely following old routines and taking shortcuts makes one merely a market doctor. Furthermore, *Jingui Yaolue* categorizes symptoms and lists prescriptions systematically. Without understanding the thread, it is like trying to organize silk threads, resulting in confusion. Now, taking *Jingui Yaolue* as the main text, even gaining a partial understanding is sufficient to save lives, so I have recorded the whole chapter below."
I have often commented that since ancient times, there has been no examination system for doctors, allowing unemployed individuals to pass themselves off as physicians to make a living. Consequently, medical standards have declined daily, especially in gynecology. If a rational person meets a physician and asks, "After Qibo and Huangdi, can Zhang Zhongjing be called a Superior Physician?" Those who do not know will say, "I do not know who he is." Those who know will say, "He was the Medical Sage of the Han Dynasty; the times are too distant to follow." Although times change from ancient to modern, do the Five Movements and Six Qi of Heaven, or the Five Zang and Six Fu organs of humans, undergo inversion and change? Knowing or not knowing is merely fifty steps laughing at a hundred steps. Suppose a rational person copies the original text of the first and second sections of this book and asks current practicing physicians to explain it simply sentence by sentence. If they can explain it well, they are excellent physicians; if they cannot explain it immediately but are willing to take the copied original text back to check against old commentaries and can roughly explain it, we know they possess correct books and their interpretations are not overly fragmented, making them good physicians; or if they take the original text to consult their close physician friends, gathering bits and pieces to explain superficially, we know they have scholarly friends and their views are not absurdly荒唐, making them good physicians. I wish to find such people but cannot meet them soon, which is truly regrettable. Moreover, I hear them boasting: "That belongs to Zhang Zhongjian's school; I belong to the school of Liu Wansu, Zhang Congzheng, Zhu Zhenheng, and Li Dongyuan, the first four great masters; I belong to the school of Wang Kentang, Xue Lizhai, Zhang Jingyue, and Yu Jiayan, the latter four great masters." And the currently popular *Linzheng Zhinan* (Guidelines for Clinical Practice) habitually uses ginger dregs, processed mild Aconite, Rehmannia charred, processed mild Evodia, washed mild Atractylodes, and all kinds of charred medicines, as well as various dried shells from the sea, which are devoid of Qi and flavor. Their treatment methods start by talking about the harmony of Five Elements and Three Combinations, dual mountain inversions, and the subtleties of combination, all vague and baseless claims. For deficiency diseases, they claim to use 'humans supplementing humans,' relying heavily on Placenta humanus boiled into paste (this substance is highly impure, toxic, and inflammatory; I have seen cases where every hundred doses resulted in death. Patients should maintain kindness and perform good deeds, never listening to such cruel and unreasonable advice). For chronic diseases, they speak of 'entering the collaterals,' using old loofah, fresh bamboo shavings, Dang Gui tails, Honeysuckle vine, and Tribulus as secret remedies; they regard watermelon rind, fresh lotus stems, dried mussel meat, and sea cucumber as novel treatments. Instead of selecting the merits from *Zhinan*, they only collect its flaws. If Ye Tianshi were alive, he would surely reprimand and condemn them. Yet they exaggerate, saying, "I am of Ye Tianshi's school." They speak falsely, and we listen falsely; what does this mean for the Dao of Medicine?
I hope all practitioners of the Way will quickly discard these inherited ailments and devote themselves to the teachings of the Sages and Worthies, thereby remaining gentlemen capable of correcting their mistakes!
*Jingui Yaolue* states: "Question: New mothers suffer from three diseases: one is Spasm (Jing), two is Depression and Dizziness (Yumao), and three is Difficulty in Defecation (Dabian Nan). What does this mean? The Master said: New mothers fear lack of sweating. If there is no sweat, Ying and Wei Qi are not harmonious, leading to fever and anhidrosis, resembling exterior Shanghan syndromes. However, the tongue lacks white coating, and there is no headache or stiff neck to distinguish it. Although one might want to sweat, one fears Blood deficiency. Heat causes pores to open, leading to profuse sweating. Sweating opens pores further, making one prone to contracting Wind. Since Blood fails to nourish tendons, and Wind stirs Fire, Spasm results. New mothers fear stagnant blood. If blood does not flow, it stagnates internally, causing fever and abdominal pain, resembling interior Shanghan syndromes. However, the tongue lacks yellow coating, and there is no severe restlessness or extreme thirst to distinguish it. Although one might want blood to flow down, one fears excessive bleeding. Loss of Blood means Qi has no partner and escapes outward, leading to recurrent sweating. Both Blood and Qi are depleted, generating internal Cold, leading to excessive Cold. Blood is Yin; loss of Yin leads to loss of control. Qi is Yang; Yang deficiency leads to counterflow upward. Thus, Dizziness and fainting (Yumao) occur. New mothers, although hoping for sweat and blood flow, fear excessive loss of sweat and blood, leading to depletion of Body Fluids. Dryness of the Stomach and intestines results in difficulty in defecation. Although the three differ, the loss of Blood and injury to Fluids are the same. This presents three diseases as the outline for postpartum conditions, not implying these are the only postpartum diseases."
(Above, it was stated that the outline of new postpartum diseases has three aspects. However, Spasm has the treatment method of Zhuye Tang, detailed later. Let us first discuss the combined symptoms of Yumao and Difficulty in Defecation.) In postpartum Yumao, both Yumao and Difficulty in Defecation are caused by loss of Blood and injury to Fluids. Therefore, the pulse is weak and minute. There is vomiting and inability to eat, and stool is hard, which is a concurrent symptom of the Difficulty in Defecation outline. The body has no sweat, but only the head sweats, which is a specific symptom of the Yumao outline. The reason is that Blood deficiency leads to Yin exhaustion below, causing Cold reversal below (Jue). Cold reversal below causes solitary Yang to float upward, leading to dizziness. Generally speaking, anyone suffering from chronic dizziness is called a 'Majia' (person with dizziness). I observe that for Majia to resolve, heavy sweating must occur. Because Blood deficiency causes Cold reversal below, and Cold reversal below causes solitary Yang to lack foundation and float upward, head sweat occurs. This head sweat is the key point in the Yumao outline. Therefore, for postpartum women, after head sweat occurs, general sweating is welcomed. Because Yin Blood is depleted and Yang Qi is excessively dominant, Yang must be reduced through sweating. Reducing Yang to join Yin allows Yin and Yang to return to balance. The pivot of Yin and Yang is controlled by Shaoyang; only Xiaochaihu Tang can turn this pivot to bring balance. Regarding the outline of postpartum Difficulty in Defecation, the symptoms include dry and hard stools. Due to excessive blood flow, the Sea of Blood in Yangming is dried up, and Blood fails to moisten below. Failure to moisten below causes rebellion upward, leading to vomiting, and disharmony in the middle, leading to inability to eat. Yangming belongs to the Stomach, which is the Sea of Blood. Blood does not generate itself but comes from ingested food and water. People usually know that digestion clears the Stomach, descending rebellious Qi soothes the Stomach, and sweet-cold moistening tonifies the Stomach, but they do not know that Xiaochaihu Tang is a deeper method of harmonizing the Stomach. The phrase in the formula instructions of Xiaochaihu Tang in *Shanghan Lun*: 'When the Upper Jiao is unobstructed, fluids descend, and Stomach Qi harmonizes' serves as an ironclad footnote for this syndrome. Therefore, these two symptoms are collectively treated with Xiaochaihu Tang. This details the etiology and provides the prescription for combined Yumao and Difficulty in Defecation.
(When the) disease (is resolved and the patient can eat,) if fever recurs after seven or eight days, since the fever is without aversion to cold, we know it is not in the exterior but in the interior. Because the patient can eat and then develops fever, we know it is not a deficiency disease but a relapse due to food retention. This is excess in the Stomach, treated primarily with Dachengqi Tang. This states that after severe deficiency, if excess symptoms appear, they should be treated as excess. If one fears the harshness of Chengqi and dares not use it, one risks delaying treatment, leading to worsening deficiency and myriad changes. Alas! Mediocre physicians are unfit for serious matters. If one fears the harshness of Chengqi and uses Barley Sprout, Malt, Hawthorn, and Medicated Leaven instead, consuming Stomach Qi, it is also harmful.
Postpartum (belonging to deficiency, with external Cold obstructing Qi and Blood,) causes abdominal pain, treated primarily with Danggui Shengjiang Yangrou Tang (Dang Gui, Ginger, and Lamb Soup); it also treats abdominal Cold cramps and deficiency fatigue.
Referencing various schools: Pain here refers to lingering pain. It is generally attributed to obstruction by external Cold. Therefore, Dang Gui is used to unblock stagnation in the Blood aspect, and Sheng Jiang (Fresh Ginger) to move Cold in the Qi aspect. During pregnancy, emphasis is placed on excess, so Fuling and Ze Xie are added to Dang Gui Bai Zhu San to drain dampness. In postpartum, emphasis is generally placed on deficiency. Therefore, Dang Gui nourishes Blood and moves Blood stagnation; Sheng Jiang disperses Cold and moves Qi stagnation; and Lamb, being rich in flavor, warms and tonifies Qi and generates Blood. When Qi and Blood are warmed, pathogens disperse and pain stops. This formula combines attack and tonification, thus treating Cold cramps and deficiency. Some doubt that Lamb is too tonifying, not knowing that Sun Simiao said: 'Lamb stops pain and benefits postpartum women.' Ancient teachings are solid evidence, why doubt?
(However, pain may not always belong to deficiency, which must be known.) Postpartum abdominal pain, if accompanied by irritability and fullness without distension, is due to central deficiency and moving Cold. Now, if Fire rebels upward causing irritability, Qi stagnates causing fullness, and Stomach disharmony prevents lying down, this is Heat郁 (stagnating) below and obstructing above. It is treated primarily with Zhishi Shaoyao San (Immature Bitter Orange and Peony Powder). This provides the prescription for abdominal pain with irritability, fullness, and inability to lie down. The formula's intent is to harmonize Qi and Blood stagnation, a mild agent of the principle 'unblocked means no pain.' Following with Barley Porridge harmonizes Liver Qi and nourishes Heart and Spleen, thus also treating abscesses and pus.
The Master said: For postpartum abdominal pain, the method dictates Zhishi Shaoyao San. If it does not heal, this is due to Heat scorching Blood, with dry Blood in the abdomen. The pain is fixed below the umbilicus, beyond the reach of Zhishi and similar herbs. It should be treated primarily with Xiayu Xue Tang (Remove Stagnant Blood Decoction); it also treats irregular menstruation. This provides the prescription for pain fixed below the umbilicus. The idea is that once the pathogen is removed, deficiency naturally returns; there is no need to doubt its harshness.
(However, there are cases where one cannot solely purge Blood stasis, which must be known.) Seven or eight days postpartum, without Taiyang symptoms (headache, fever, aversion to cold), but with firm pain in the lower abdomen, this is incomplete expulsion of Lochia. The practitioner merely purges Blood stasis. However, if there is constipation, irritability, fever, and the pulse is slightly full, this indicates excess in the Stomach house. Yangming is prosperous during Shen, You, and Xu hours (3 PM - 9 PM); dusk is when Yangming tends to prosper. Double fever occurring at dusk with irritability is another verification of Stomach Heat. Food enters the Stomach and augments Yang Qi. If not eating, it stops; but if eating aids Stomach Heat to cause delirium, this is another verification of Stomach Heat. However, there is a most precise differentiation: Day is Yang and Night is Yin. If the disease were truly in Yin, it should be lighter by day and heavier by night. Now, at night, when Yangming Qi should be declining, the condition improves slightly. This leaves no doubt that it is excess Heat in the Stomach house. Dachengqi Tang is used primarily. This soup dispels both Heat and accumulation; the Heat is in the interior of Yangming, and the accumulation is in the Bladder area (lower abdomen). This states that although Blood is accumulated in the lower abdomen, if there is excess Heat in the Stomach, Dachengqi Tang should be used primarily. If one only treats the Blood and neglects the Stomach, although Blood may be removed, Heat will not be eliminated, and Blood removal may not succeed.
The four characters 'improves at night' in this clause are the major eye for syndrome differentiation. Day is Yang and governs Qi; dusk is Yin and governs Blood. Observing the previous section: 'In women with Shanghan fever, whose menses just arrived, clarity during the day and delirium at night, seeing ghosts, this is Heat entering the Blood Chamber.' From these words, reasoning oppositely, we know that 'improves at night' indicates the disease is not solely in the Blood.
Postpartum Wind Strike, persisting for dozens of days without resolution, seemingly not fitting the Guizhi Syndrome example. However, slight headache, aversion to cold, and intermittent fever are all original symptoms of Guizhi. Only the sensation of stuffiness in the epigastrium indicates pathogen entering the chest and diaphragm, an interior syndrome of Taiyang. The remaining symptoms of dry retching and sweating are originally present in the Guizhi syndrome example. Thus, Guizhi syndrome advancing one level becomes Yangdan Syndrome. Slightly increasing Guizhi Tang creates Yangdan Tang. If the disease has lasted long but Yangdan Syndrome persists, Yangdan Tang can be given.
Zhang Shiwan said: Citing this alongside the Dachengqi Tang above forms a pair of Exterior and Interior, not doubting the exterior syndrome due to the number of days.
(Nan Yuanxi) Commentary: This states that postpartum Yangdan Syndrome has not ceased; although the disease is long-standing, its formula is still used. *Shanghan Lun · Taiyang Chapter* has the phrase 'adding Fuzi between them, increasing Gui Zhi to induce sweating.' 'Adding' implies continuing from the preceding symptoms resembling Guizhi, hence taking the original Guizhi formula. 'Increasing Gui Zhi' means adding two liang of Cinnamon Twig to the original Guizhi Tang, totaling five liang. Sun Simiao failed to recognize these sentences, instead claiming Yangdan Tang is Guizhi Tang plus Scutellaria. Later generations followed this, and it remains unresolved to this day. How difficult reading is! However, *Shanghan Lun* specifically uses the three characters 'induce sweating' in this formula, which is a major eye. Its difference from Guizhi Jia Fuzi Tang treating leakage is a difference within similarity, and also a similarity within difference. Stopping leakage is a corrective function; inducing sweating is an expelling force. Adapting appropriately is how formulas enter the divine realm. The previous section had interior Heat forming excess; even seven or eight days postpartum, giving Dachengqi Tang did not harm due to harshness. This section has exterior pathogen unresolved; even after dozens of days, giving Yangdan Tang did not deplete due to duration. The mystery within is hard to explain to shallow people. Danxi said postpartum requires mainly great tonification of Qi and Blood, with others treated as secondary. He also said: 'Shaoyao destroys the energy of life.' This teaches mediocre physicians a way to hide their incompetence, misleading people; I must directly斥 (reprimand) it.
(Zhangsun Xindian Bing) Commentary: Headache, aversion to cold, intermittent fever, spontaneous sweating, and dry retching are all Guizhi symptoms. Not using Guizhi Tang is because of epigastric stuffiness, requiring the method of Guizhi Qu Shaoyao Tang. Now, due to postpartum Blood loss, one cannot directly remove Shaoyao. One must increase Gui Zhi to disseminate Yang. Sweating lasting dozens of days, although distinct from leakage after inducing sweating, should borrow the main method of Guizhi Jia Fuzi Tang to secure the root of Shaoyin to stop sweating. Moreover, stopping sweating is within inducing sweating. This is why Yangdan Tang fits perfectly.
(Prior to this, Spasm was one of the three outlines of postpartum. However, Spasm originates from Wind Strike. Now discussing Wind Strike potentially transforming into Spasm.) Postpartum Wind Strike, fever, red face, wheezing, and headache. This disease is in Taiyang, extending to Yangming. Postpartum Zheng Qi is too deficient to overcome the pathogen, genuinely fearing transformation into Spasm. Zhuye Tang is used primarily. This provides a formula to tonify Zheng and scatter pathogen for postpartum Wind Strike with deficient Zheng and abundant pathogen. Using Zhuye as the sovereign herb in the formula is because Wind is a Yang pathogen; if unresolved, it transforms into Heat. Excessive Heat scorches tendons causing Spasm. Therefore, among warm-dispersing herbs, Zhuye is used first to curb its momentum, which is the way to prevent gradual development. (Taiyang meridian ascends to the head; Yangming meridian passes over the diaphragm and follows the face; combined diseases of these two meridians often add Ge Gen.)
For women nursing who are deficient, experiencing irritability, chaos, retching, and counterflow, Anzhong Yiqi Wan (Peace the Middle and Tonify Qi Pill) is used primarily.
Xu Zhongke said: 'Ru' refers to a nursing woman. It means excessive milk loss leads to insufficient Yin Blood and deficiency in the Stomach. *Neijing* says: 'Yin is the guardian within.' Yin deficiency cannot overcome Yang, so Fire surges upward causing irritability, and Qi surges upward causing retching. Irritability with chaos is severe irritability; retching with counterflow is severe retching. The disease fundamentally arises from central deficiency. However, the medicine only uses Bamboo Shavings, Cinnamon, Licorice, Gypsum, and Anemarrhena. Because central deficiency leads to retching and irritability, the Gallbladder organ receives pathogen, with irritability and retching as main diseases. Therefore, Bamboo Shavings, which clears irritability and stops retching, is the sovereign; Yang Qi in the chest is unused, so Cinnamon and Licorice support Yang and transform counterflow Qi as ministers; Gypsum cools deficiency Heat in the Qi aspect of the Upper Jiao as assistants; Anemarrhena removes floating Heat on the exterior as guides. Know that irritability, chaos, retching, and counterflow without intestinal pain or dysentery indicate deficiency without Cold. The wonder lies in adding Cinnamon to cooling agents, and especially in using raw Licorice in large amounts. The intent is to scatter accumulated pathogen and restore clear Yang Qi; the middle becomes peaceful, Qi self-tonifies, hence no tonifying agents. And noting the original intent of establishing the decoction, it says 'Peace the Middle and Tonify Qi.' How miraculous is Zhupi Da Wan! For wheezing, add Bi Zi (Biota Seed). Biota faces west, receiving Western Qi deeply, thus benefiting Metal Qi, moistening Liver Wood, and nourishing the Heart, so the Lung is not scorched, and wheezing calms. With Heat, double Anemarrhena, as Anemarrhena removes floating Heat. Thus, *Duanju* Guizhi Jia Longgu Muli Tang says: 'For excessive sweating and floating Heat, remove Cinnamon, add Anemarrhena and Aconia each three fen, named Erjia Longgu Tang.' Thus, Anemarrhena's ability to remove floating Heat is known.
(Every dysentery disease is mostly due to Damp-Heat. Qinghao's bitterness defeats Dampness, and Cold eliminates Heat, certainly appropriate. But) postpartum dysentery with extreme deficiency, (seems one must consider tonifying agents; but Renshen and Baizhu may cause stagnation, Fuling and Zexie may injure Fluids. Only Beitouweng Jia Gancao Ejiao Tang is used primarily.) Truly symptomatic. In the formula, Licorice's sweet-coolness clears the middle, which is tonifying the middle; Ejiao's moistening removes Wind, which harmonizes Blood; using this to treat dysentery is using it as great tonification. Those who treat dysentery and favor Renshen and Baizhu should reflect. This provides the prescription for postpartum dysentery with extreme deficiency.
*Jingui Yaolue* Appendix Formula says: *Qianjin Fang* Sanwu Huangqin Tang treats women (who have not yet left the birthing place, still lying on straw mats, spontaneously (removing covers,) exposing (their bodies, and getting