论曰∶产后四肢浮肿者何？答曰∶产后败血乘虚停积于五脏，循经流入四肢。留淫日深
，却还不得，腐坏如水，故令面黄，四肢浮肿。医人不识，便作水气治之，凡治水气，多用
导水药，极虚人。夫产后既虚，又以药虚之，是谓重虚，往往因致夭枉。但服小调经散，血
行肿消则愈。
没药 琥珀 桂心 芍药 当归（各一钱） 细辛 麝香（各半钱）
上为细末，每服半钱匕，姜汁、温酒各少许，调停服。
评曰∶产后浮肿多端，有自怀妊肿至产后不退者；亦有产后失于将理，外感寒暑，风湿
内作，喜怒忧惊，血与气搏，留滞经络。气分、血分，不可不辨。要当随所因脉证治之，
宜得其情。小调经散治血分固效，但力浅难凭。不若吴茱萸汤、枳术汤、夺魂散、大调经散
，皆要药也。经云∶产后肌浮，柑皮酒服。
治妇人脏气本虚，宿挟风冷，胸膈满痛，腹胁绞刺，呕吐恶心，饮食减少，身面虚浮，
恶寒战栗。或泄不止，少气羸困；及因生产，脏气暴虚，邪冷内胜，宿疾转增。
吴茱萸（一两半） 苦梗 干姜 甘草 麦门冬 防风 半夏 细辛 当归 赤茯苓 牡
丹皮 桂心（各半两）
上为粗末，每服四钱。水盏半，煎至七分，去滓，食前热服。
治心腹坚大如盘，边如旋盘，水饮所作，名曰气分。
枳实（一两半） 白术（三两）
上 咀，每服四钱。水一盏半，煎至七分，去滓温服。中软即当散也。
论述说：产后四肢浮肿是什么原因呢？回答说：产后败血（产后未能排出的瘀血）乘虚停滞积聚在五脏，顺着经络流入四肢。停留浸淫日久，却无法回流消散，腐败变质如同水液，所以导致面色发黄，四肢浮肿。医生如果不认识这是瘀血所致，便当作水气病来治疗，凡是治疗水气病，多使用导水利尿的药物，这会使得极度虚弱的人更加虚弱。既然产后身体已经虚弱，又用药物进一步耗损其正气，这叫做“重虚”（双重虚弱），往往因此导致死亡。只需服用小调经散，血液运行通畅，肿胀消退即可痊愈。
没药、琥珀、桂心、芍药、当归（各一钱）、细辛、麝香（各半钱）。
以上药材研为细末，每次服用半钱匕，用姜汁和温酒各少许调和后服用。
评论说：产后浮肿原因多样，有的从怀孕时开始浮肿延续到产后不退；也有的是因为产后调养不当，外感寒暑邪气，风湿内生，加上喜怒忧惊等情志因素，导致血与气相互搏结，留滞于经络之中。气分病与血分病，不可不加以辨别。应当根据病因、脉象和症状进行治疗，务必探求疾病的实情。小调经散治疗血分浮肿固然有效，但药力较浅，难以完全依赖。不如吴茱萸汤、枳术汤、夺魂散、大调经散，这些都是关键药物。医经记载：产后肌肤浮肿，用陈皮配酒服用。
治疗妇人脏气原本虚弱，平素夹杂风冷邪气，导致胸膈满闷疼痛，腹部胁肋部绞痛刺痛，呕吐恶心，饮食减少，身体面部虚浮，恶寒战栗。或者腹泻不止，气息微弱，身体瘦弱困倦；以及因为生产，脏气突然虚弱，邪冷之气内盛，使宿疾加重。
吴茱萸（一两半）、桔梗、干姜、甘草、麦门冬、防风、半夏、细辛、当归、赤茯苓、牡丹皮、桂心（各半两）。
以上药材捣成粗末，每次服用四钱。用水一盏半，煎煮至七分，去渣，饭前热服。
治疗心腹坚硬胀大如盘状，边缘像旋转的盘子，由水饮停聚引起，名叫气分病。
枳实（一两半）、白术（三两）。
以上药材切碎，每次服用四钱。用水一盏半，煎煮至七分，去渣温服。如果腹部变软，说明病邪已散。
Translation:
The discussion states: What is the cause of edema in the four limbs after childbirth? The answer is: After childbirth, retained blood (stasis) takes advantage of deficiency to stagnate and accumulate in the five zang organs, flowing along the meridians into the four limbs. Remaining and infiltrating for a long time, it fails to return and dissipate, rotting and transforming like water, thus causing yellowish complexion and edema in the four limbs. If physicians do not recognize this condition, they may treat it as fluid retention disease. Generally, treatments for fluid retention mostly use diuretic drugs, which severely weaken already deficient patients. Since the postpartum state is already deficient, using drugs to further deplete qi constitutes "double deficiency," often leading to premature death. One should simply administer Xiao Tiaojing San (Small Regulating Menses Powder); once blood circulation resumes and swelling subsides, recovery occurs.
Myrrh, Amber, Cinnamon Twig, White Peony Root, Angelica Sinensis (each 1 qian), Asarum, Musk (each 0.5 qian).
Grind the above ingredients into fine powder. Take 0.5 qian per dose, mixed with a small amount of ginger juice and warm wine.
Commentary: Postpartum edema has various causes. Some cases involve swelling starting during pregnancy that persists after childbirth. Others result from improper postpartum care, external contraction of cold or heat pathogens, internal generation of wind-dampness, and emotional disturbances such as anger, joy, worry, or fright, causing qi and blood to clash and stagnate in the meridians. It is crucial to distinguish between Qi-pattern and Blood-pattern. Treatment must be tailored to the specific etiology, pulse, and symptoms to ascertain the true nature of the disease. While Xiao Tiaojing San is effective for Blood-pattern edema, its action is mild and may not suffice. Better alternatives include Wuzhuyu Tang (Evodia Decoction), Zhizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction), Duohun San (Soul-Rescuing Powder), and Da Tiaojing San (Great Regulating Menses Powder), all of which are essential formulas. The classics state: For postpartum skin edema, consume tangerine peel with wine.
This formula treats women with originally weak zang qi and chronic wind-cold pathogenic factors, resulting in chest and diaphragm fullness and pain, twisting and stabbing pain in the abdomen and hypochondrium, vomiting and nausea, reduced appetite, facial and bodily edema, aversion to cold, and shivering. It also addresses persistent diarrhea, shortness of breath, emaciation, and weakness; or sudden zang qi deficiency due to childbirth, where cold pathogens prevail internally, exacerbating chronic conditions.
Evodia Fruit (1.5 liang), Platycodon Root, Dried Ginger, Licorice, Ophiopogon Tuber, Saposhnikovia Root, Pinellia Tuber, Asarum, Angelica Sinensis, Red Poria, Moutan Cortex, Cinnamon Twig (each 0.5 liang).
Grind the above ingredients into coarse powder. Take 4 qian per dose. Add 1.5 bowls of water, decoct until 0.7 bowl remains, strain, and take hot before meals.
This formula treats hardness and distension of the heart and abdomen resembling a plate, with edges like a rotating disk, caused by fluid retention, known as Qi-pattern.
Immature Bitter Orange (1.5 liang), Atractylodes Macrocephala Rhizome (3 liang).
Cut the above ingredients. Take 4 qian per dose. Add 1.5 bowls of water, decoct until 0.7 bowl remains, strain, and take warm. When the abdomen becomes soft, the pathogen will disperse.