〔郭〕产后腹痛及泻利者何？答曰∶产后肠胃虚怯，寒邪易侵。若未盈月，饮冷当
风，乘虚袭留于肓膜，散于腹胁，故腹痛作阵，或如锥刀所刺，流入大肠，水谷不化，洞
泄肠鸣，或下赤白， 胁填胀，或痛走不定，急服调中汤立愈。若医者以为积滞取之，祸
不旋踵，谨之谨之。
陈无择评曰∶产后下痢，非止一证，当随所因而调之。既云饮冷当风，何所不至，寒
热风湿，本属外因，喜怒忧思，还从内性，况劳逸饥饱，皆能致病。若其洞泄，可服调中
汤。赤白滞下，非此能愈，各随门类，别有正方。
〔薛〕产后泻痢，或因饮食伤损脾土，或脾土虚不能消食，当审而治之。若米食所
伤，用六君加谷 。若面食所伤，用六君加麦 。若肉食所伤，用六君加山楂、神曲。凡
兼呕吐，皆加藿香。若兼咽酸或呕吐，用前药送越鞠丸。若肝木来侮脾土，用六君加柴
胡、炮姜。若寒水反来侮土，用钱氏益黄散。若久泻，或元气下陷，兼补中益气汤以升发
阳气。若泻痢色黄，乃脾土真气，宜加木香、肉果。若脾土虚寒，当用六君子加木香、姜、
桂。若脾肾虚寒，用补中益气及四神丸。若属命门火衰，而脾土虚寒，用八味丸以补土
母。若小便涩滞，肢体渐肿，或兼喘咳，用金匮肾气丸以补脾肾，利水道。若胃气虚弱
而四肢浮肿，治须补胃为主。若久而不愈，或非饮食所伤而致，乃属肾气亏损，盖胞胎主
于任而系于肾，况九月、十月，乃肾与膀胱所养，必用四神、六味、八味三药以补肾。若
用分利导水之剂，是虚其虚也。一产妇泻痢，发热，作渴，吐痰甚多，肌体消瘦，饮
食少思，或胸膈痞满，或小腹胀坠，年余矣。余以为脾胃泻，朝用二神丸，夕用六君子，三
月余而痊。一妇产后泄泻，兼呕吐咽酸，面目浮肿，此脾气虚寒。先用六君加炮姜为主，
佐以越鞠丸而咽酸愈；又用补中益气加茯苓、半夏，而脾胃康。一产妇泻利年余，形体
骨立，内热晡热，自汗盗汗，口舌糜烂，日吐痰三碗许，脉洪大，重按全无，此命门火
衰，脾土虚寒而假热，吐痰者，乃脾虚不能统摄归源也。用八味丸补火以生土，用补中
益气汤兼补肺金而脾胃健。一产妇腹痛后重，去痢无度，形体倦怠，饮食不进。与死
为邻，此脾肾俱虚。用四神丸、十全大补汤而愈。但饮食难化，肢体倦怠，用补中益气
汤而康。一妇人五月患痢，日夜无度，小腹坠痛，发热恶寒，用六君子汤送香连丸，二
服渐愈。仍以前汤送四神丸四服全愈。至七月终，怠惰嗜卧，四肢不收，体重节痛，口
舌干燥，饮食无味，大便不实，小便频数，洒淅恶寒，凄惨不乐，此肺之脾胃俱虚，而阳
气寒不伸也。用升阳益胃汤而痊。
汪石山治一妇产后滑泄，勺水粒米弗容，时即泄下。如此半月余，众皆危之，或用五
苓散、平胃散，病益甚。汪诊之，脉皆濡缓而弱。曰∶此产中劳力以伤其胃也，若用汤
药，愈滋胃湿，非所宜也。令以参苓白术散除砂仁，加陈皮、肉豆蔻，煎姜、枣汤调服，
旬余而安。
〔丹〕治产后泄泻，恶露不行，此余血渗入大肠为泻，洞泄不禁，下青白黑色。用
荆芥大者四五穗，于盏内烧灰，不得犯油火，入麝香研，汤三呷调下。此药虽微，能治大
病。（方名的奇散。）
产后泄方
茯苓 川芎 黄芩 白术 干姜 滑石 陈皮 芍药（炒各）
上水煎服之。
调中汤
高良姜 当归 桂心 芍药 附子（炮） 川芎（各一两） 甘草（半两）
上为粗末，每服三钱匕，水三盏，煎至一盏，去渣热服。
上方惟寒中洞泄者宜之。其肠胃有热者，当服黄连而愈，如如金丸、香连丸之类。若
戊己丸、固肠丸、四神丸、五味子丸之类，皆产后大便不实必用之药，已详载杂病及前泄
泻门中，兹不赘引。
【郭】产后出现腹痛和腹泻的原因是什么？回答说：产后肠胃虚弱，寒邪容易侵袭。如果在未满月时，饮用冷水或当风受凉，寒气乘虚侵入并停留在肓膜（腹腔内脂膜），散布于腹胁部位，所以阵发性腹痛，或者像被锥刀刺割一样疼痛；若寒气流入大肠，导致水谷不消化，出现洞泄（剧烈腹泻）和肠鸣，或者排出赤白黏液，胁肋部胀满，或者疼痛游走不定，此时应紧急服用调中汤，可立即痊愈。如果医生误认为是积滞而使用攻下法，灾祸将立刻降临，务必谨慎，务必谨慎。
陈无择评论说：产后痢疾，不止一种证型，应当根据病因进行调理。既然提到饮冷当风，那么各种外因都可能存在，寒、热、风、湿本属于外因，喜、怒、忧、思则源于内性，况且劳累、安逸、饥饿、饱食，都能导致疾病。如果是洞泄，可以服用调中汤。如果是赤白痢疾，此方不能治愈，应参照其他门类，另有专门的正方。
【薛】产后泻痢，可能是因为饮食损伤了脾土，或者是脾土虚弱不能消化食物，应当仔细审查后治疗。如果是米食所伤，用六君子汤加谷芽。如果是面食所伤，用六君子汤加麦芽。如果是肉食所伤，用六君子汤加山楂、神曲。凡是兼有呕吐的，都加藿香。如果兼有咽酸或呕吐，用前面的药送服越鞠丸。如果是肝木来克制脾土，用六君子汤加柴胡、炮姜。如果是寒水反来克制脾土，用钱氏益黄散。如果是久泻，或者元气下陷，兼用补中益气汤以升发阳气。如果泻痢颜色发黄，这是脾土的真气外露，宜加木香、肉豆蔻。如果脾土虚寒，应当用六君子汤加木香、干姜、桂枝。如果脾肾虚寒，用补中益气汤及四神丸。如果属于命门火衰，而脾土虚寒，用八味丸以补益脾土之母（肾）。如果小便涩滞，肢体逐渐浮肿，或者兼有喘咳，用金匮肾气丸以补脾肾，通利水道。如果胃气虚弱而导致四肢浮肿，治疗必须以补胃为主。如果久而不愈，或者不是由饮食所伤引起的，那属于肾气亏损，因为胞胎主于任脉而系于肾，况且怀孕九月、十月，是由肾与膀胱滋养的，必须用四神丸、六味地黄丸、八味丸这三种药来补肾。如果使用分利导水的药物，是使虚者更虚。有一位产妇患泻痢，发热，口渴，吐痰很多，身体消瘦，食欲减退，有时胸膈痞满，有时小腹胀坠，病程已有一年多。我认为这是脾胃泻，早晨服用二神丸，晚上服用六君子汤，三个多月后痊愈。另一位产妇产后泄泻，兼有呕吐咽酸，面目浮肿，这是脾气虚寒。先用六君子汤加炮姜为主，佐以越鞠丸，咽酸症状痊愈；又用补中益气汤加茯苓、半夏，脾胃康复。还有一位产妇泻痢一年多，形体瘦骨嶙峋，内有虚热，傍晚发热，自汗盗汗，口舌糜烂，每天吐痰约三碗，脉象洪大，重按完全无力，这是命门火衰，脾土虚寒而产生的假热，吐痰是因为脾虚不能统摄归源。用八味丸补火以生土，用补中益气汤兼补肺金，从而使脾胃健运。还有一位产妇腹痛后重，痢疾无度，形体倦怠，饮食不进，濒临死亡，这是脾肾俱虚。用四神丸、十全大补汤而痊愈。但饮食难化，肢体倦怠，用补中益气汤而康复。还有一位妇人五月患痢疾，日夜无度，小腹坠痛，发热恶寒，用六君子汤送服香连丸，两服后逐渐好转。仍以前汤送服四神丸，四服后完全痊愈。到了七月末，怠惰嗜卧，四肢不收，体重节痛，口舌干燥，饮食无味，大便不成形，小便频数，洒淅恶寒，凄惨不乐，这是肺之脾胃俱虚，而阳气寒凝不得伸展。用升阳益胃汤而痊愈。
汪石山治疗一位产妇产后滑泄，连勺水粒米都容纳不下，随即泄下。如此半月多，众人都认为病情危重，有人用五苓散、平胃散，病情反而加重。汪石山诊察，脉象皆濡缓而弱。他说：这是产中劳力损伤了胃气，如果用汤药，会滋助胃湿，不合适。让他用参苓白术散去掉砂仁，加陈皮、肉豆蔻，用姜枣汤煎服，十多天后安定。
【丹】治疗产后泄泻，恶露不行，这是余血渗入大肠导致泄泻，洞泄不禁，排出青白黑色粪便。用大的荆芥穗四五把，在盏内烧成灰，不能接触油火，加入麝香研细，用三杯汤调下。此药虽然轻微，能治大病。（方名奇散。）
产后泄泻方
茯苓 川芎 黄芩 白术 干姜 滑石 陈皮 芍药（炒，各等份）
以上药材用水煎服。
调中汤
高良姜 当归 桂心 芍药 附子（炮制） 川芎（各一两） 甘草（半两）
以上药材制成粗末，每次服用三钱匕，用水三盏，煎至一盏，去渣热服。
上述方剂仅适用于寒邪中脏导致的洞泄。如果肠胃有热，应当服用黄连类药物而愈，如如金丸、香连丸之类。至于戊己丸、固肠丸、四神丸、五味子丸之类，都是产后大便不实必用的药物，已在杂病及前泄泻门中详细记载，此处不再赘引。
[Guo] What is the cause of abdominal pain and diarrhea after childbirth? The answer is: After childbirth, the intestines and stomach are weak, making them susceptible to invasion by cold pathogens. If one drinks cold water or exposes oneself to wind before the completion of one month, the cold pathogen takes advantage of the deficiency to invade and remain in the huangmo (membranous tissue within the abdominal cavity), spreading to the abdomen and hypochondrium. Consequently, paroxysmal abdominal pain occurs, feeling as if pierced by awls or knives; if the cold flows into the large intestine, causing undigested food and water, it leads to profuse watery diarrhea (dongxie) and borborygmus, or passage of red and white mucus, distension in the hypochondrium, or wandering pain. In such cases, one should urgently take Tiaozhong Tang (Regulate the Middle Decoction) for immediate relief. If a physician mistakenly treats it as accumulation and uses purgatives, disaster will follow immediately; one must be cautious, most cautious.
Chen Wuyue commented: Postpartum dysentery presents various syndromes and should be regulated according to the specific etiology. Since drinking cold water and exposure to wind were mentioned, various external factors may be involved. Cold, heat, wind, and dampness belong to external causes, while joy, anger, worry, and thought stem from internal nature. Moreover, exertion, rest, hunger, and satiety can all induce disease. If it is profuse watery diarrhea, Tiaozhong Tang can be taken. However, for red and white dysentery, this formula cannot cure it; one should refer to other categories for specific correct formulas.
[Xue] Postpartum diarrhea and dysentery may result from dietary injury damaging the Spleen Earth, or from Spleen Earth deficiency failing to digest food. Treatment must be carefully assessed. If injured by rice, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Gu Ya (Valley Sprout). If injured by wheat products, use Liu Jun Zi Tang plus Mai Ya (Wheat Sprout). If injured by meat, use Liu Jun Zi Tang plus Shan Zha (Hawthorn) and Shen Qu (Medicated Leaven). For cases accompanied by vomiting, add Huo Xiang (Patchouli). If accompanied by sour regurgitation or vomiting, administer the aforementioned medicines with Yue Ju Wan (Pill to Resolve Depression). If Liver Wood overacts on Spleen Earth, use Liu Jun Zi Tang plus Chai Hu (Bupleurum) and Pao Jiang (Prepared Ginger). If Cold Water overacts on Spleen Earth, use Qian Shi Yi Huang San (Qian's Formula to Strengthen the Yellow/Spleen). For chronic diarrhea or sinking of Yuan Qi (Primal Qi), combine with Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi) to raise Yang Qi. If the stool/dysentery is yellow, indicating the true Qi of Spleen Earth leaking out, add Mu Xiang (Aucklandia) and Rou Dou Kou (Nutmeg). If Spleen Earth is deficient and cold, use Liu Jun Zi Tang plus Mu Xiang, Gan Jiang (Dried Ginger), and Gui Zhi (Cinnamon Twig). If both Spleen and Kidney are deficient and cold, use Bu Zhong Yi Qi Tang and Si Shen Wan (Four Spirits Pill). If Ming Men Fire (Fire of the Gate of Life) is deficient leading to Spleen Earth deficiency and cold, use Ba Wei Wan (Eight-Ingredient Pill) to tonify the mother of Spleen Earth (Kidney). If urination is obstructive, limbs gradually swell, or asthma/cough accompanies, use Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill) to tonify Spleen and Kidney and promote water metabolism. If Stomach Qi deficiency causes limb edema, treatment must focus on tonifying the Stomach. If prolonged without resolution, or not caused by diet, it belongs to Kidney Qi deficiency. Since the conception sac is governed by the Ren Mai (Conception Vessel) and connected to the Kidneys, and months nine and ten of pregnancy are nourished by Kidneys and Bladder, one must use Si Shen Wan, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), and Ba Wei Wan to tonify the Kidneys. Using diuretic and water-draining agents would further deplete deficiency.
Case 1: A postpartum woman suffered diarrhea and dysentery, fever, thirst, excessive phlegm expectoration, emaciation, poor appetite, occasional chest fullness, and lower abdominal bearing-down sensation for over a year. I diagnosed it as Spleen-Stomach diarrhea. She took Er Shen Wan (Two Spirit Pill) in the morning and Liu Jun Zi Tang in the evening, recovering after three months.
Case 2: A postpartum woman had diarrhea with vomiting and sour regurgitation, facial edema, indicating Spleen Qi deficiency and cold. Initially, Liu Jun Zi Tang plus Pao Jiang was used as the main formula, assisted by Yue Ju Wan, resolving the sour regurgitation. Then, Bu Zhong Yi Qi Tang plus Fu Ling (Poria) and Ban Xia (Pinellia) was used, restoring Spleen and Stomach health.
Case 3: A postpartum woman had diarrhea for over a year, appearing skeletal, with internal heat, afternoon fever, spontaneous and night sweats, oral ulcers, expectorating about three bowls of phlegm daily, and a洪大 (surging-large) pulse that vanished upon heavy pressure. This indicated Ming Men Fire deficiency, Spleen Earth deficiency and cold, manifesting as false heat. The phlegm resulted from Spleen deficiency failing to control and return essence to its source. Ba Wei Wan was used to tonify fire to generate earth, and Bu Zhong Yi Qi Tang was combined to tonify Lung Metal, thereby strengthening Spleen and Stomach.
Case 4: A postpartum woman experienced abdominal pain with tenesmus, uncontrolled dysentery, fatigue, and anorexia, nearing death due to dual deficiency of Spleen and Kidney. She recovered using Si Shen Wan and Shi Quan Da Bu Tang (Great Tonifying Decoction for Ten Insufficiencies). Subsequently, for difficulty digesting food and limb fatigue, she recovered using Bu Zhong Yi Qi Tang.
Case 5: A woman developed dysentery in the fifth month, day and night without cessation, lower abdominal bearing-down pain, fever, and aversion to cold. She took Xiang Lian Wan (Pill with Aucklandia and Coptis) delivered by Liu Jun Zi Tang, improving after two doses. Continuing Liu Jun Zi Tang delivering Si Shen Wan, she fully recovered after four doses. By the end of the seventh month, she exhibited lethargy, desire to sleep, inability to move limbs, heavy body and joint pain, dry mouth and tongue, tasteless food, loose stools, frequent urination, chills, and depression. This indicated dual deficiency of Lung and Spleen-Stomach, with Yang Qi constrained by cold. She recovered using Sheng Yang Yi Wei Tang (Decoction to Raise Yang and Benefit the Stomach).
Wang Shishan treated a postpartum woman with slippery diarrhea, unable to retain even a spoonful of water or grain, which was immediately expelled. This persisted for over half a month. Others considered it critical and used Wu Ling San (Five-Ingredient Powder with Poria) and Ping Wei San (Powder to Maintain Equilibrium), worsening the condition. Wang diagnosed a Ru Huan Ruo (soft, slow, weak) pulse. He stated: "This is stomach injury due to labor during childbirth. Decoctions would increase stomach dampness and are unsuitable." He prescribed Shen Ling Bai Zhu San (Powder of Ginseng, Poria, and Atractylodes Macrocephala) minus Sha Ren (Amomum), plus Chen Pi (Tangerine Peel) and Rou Dou Kou (Nutmeg), administered with Ginger and Jujube decoction. She stabilized after more than ten days.
[Dan] Treating postpartum diarrhea with lochia retention: This is residual blood seeping into the large intestine causing diarrhea, uncontrollable profuse discharge of green, white, or black stool. Use four or five large spikes of Jing Jie (Schizonepeta), burn them to ash in a cup without oil or fire contact, mix with Moschus (Shexiang), and take mixed in three cups of water. Though mild, this medicine cures major illness. (Formula name: Qi San / Miracle Powder.)
Postpartum Diarrhea Formula
Fu Ling (Poria), Chuan Xiong (Ligusticum), Huang Qin (Scutellaria), Bai Zhu (Atractylodes Macrocephala), Gan Jiang (Dried Ginger), Hua Shi (Talc), Chen Pi (Tangerine Peel), Shao Yao (Peony Root, stir-fried) [each equal parts].
Boil in water and take.
Tiaozhong Tang (Regulate the Middle Decoction)
Gao Liang Jiang (Galangal), Dang Gui (Angelica Sinensis), Gui Xin (Cinnamon Heart), Shao Yao (Peony Root), Fu Zi (Aconite Root, prepared), Chuan Xiong (Ligusticum) [each 1 liang], Gan Cao (Licorice Root) [0.5 liang].
Grind into coarse powder. Take 3 qian bi per dose, boil in 3 zhan of water until reduced to 1 zhan, remove dregs, and take hot.
The above formula is suitable only for dongxie caused by cold invading the middle. If there is heat in the intestines and stomach, one should take Huang Lian (Coptis) preparations to recover, such as Ru Jin Wan (Like Gold Pill) or Xiang Lian Wan. Formulas like Wu Ji Wan, Gu Chang Wan, Si Shen Wan, and Wu Wei Zi Wan are essential for postpartum loose stools, detailed in miscellaneous diseases and previous diarrhea sections, so they are not repeated here.