（陈无择）
世传产书甚多，《千金》、《外台》、会王《产宝》，马氏、王氏、崔氏皆有产书。巢安世
有《卫生宝集》、《子母秘录》等。备则备矣，但仓猝之间，未易历试。惟李师圣序郭稽中《产
科经验保庆集》二十一篇，凡十八方，用之颇效。但其间序论未为至当，始用料理，简辨于
诸方之下，以备识之者，非敢好辩也。（愚详产后要病，无出于郭稽中二十一论、一十八方，
有益于世多矣。余家三世用之，未有不效。虽陈无择所评或者或否，亦不可不详而究之。且
如产后眩晕以牡丹散，然其中有大黄、芒硝，况新产后气血大虚，岂宜轻服？又云去血过多
而晕者，或有之；若言痰晕者，十无一、二。又如产后热闷，气上转为香港脚，不应用小续命
汤。仆以《百问》中方加减而用之，此活法也。故孟子云∶尽信书则不如无书。此之谓也）
夫有产儿出、胞衣不落者，世谓之息胞。由产初时用力，此产儿出而体已疲惫，不能更
用力产胞；经停之间，而外冷气乘之，则血道涩，故胞衣不出。须急以方药救治，不妨害于
儿。所奈者，胞系连儿脐，胞不出即不得以时断脐、浴洗，冷气伤儿则成病也。旧法胞衣不
出恐损儿者，根据法截脐而已。产处须顺四时方面，并避五行禁忌者。若有触犯，多令产妇难
产。虽腹痛者，未产也。欲腹痛连腰痛甚者，即产也。所以然者，肾候于腰，胞系肾故也。
诊其脉，转急如切绳无殊者，即产也。郭稽中论曰∶胎衣不下者何？答曰∶母生子讫，流血
入衣中，衣为血所胀，是故不得下。治之稍缓，胀满腹中，以次上冲心胸，疼痛喘急者。但
服夺命丹以逐去衣中之血，血散胀消，胎衣自下而无所患。更有牛膝汤等用之甚效，录以附
之。
（陈无择评注）
世间流传的产科书籍非常多，《千金方》、《外台秘要》以及王叔和的《产宝》，马氏、王氏、崔氏都有产科著作。巢元方有《卫生宝集》、《子母秘录》等。内容虽然详尽，但在紧急情况下，难以逐一尝试。只有李师圣为郭稽中的《产科经验保庆集》所作的序言中提到二十一篇内容，共十八个方剂，使用效果颇为显著。但是其中的序言和论述并非完全恰当，我开始在各方剂之下进行整理辨析，以备有识之士参考，并非敢好争辩。（我详细考察产后的重要病症，没有超出郭稽中二十一论、十八方的范围，对世人的益处很多。我家三代人使用这些方剂，没有不有效的。虽然陈无择的评价有时肯定有时否定，但也不可不详加探究。比如产后眩晕用牡丹散，但其中含有大黄、芒硝，况且新产后气血大虚，怎么可以轻易服用？又说因失血过多而眩晕的，或许有这种情况；如果说痰饮致晕的，十人中不到一二人。又如产后热闷，气上逆转为脚气病，不应使用小续命汤。我以《百问》中的方剂加减后使用，这是灵活变通的方法。所以孟子说：完全相信书本不如没有书本。说的就是这个道理。）
凡是胎儿产出后，胎盘不下来的，世人称为“息胞”。由于分娩初期用力过度，此时胎儿已出，产妇身体已经疲惫，无法再用力排出胎盘；在停顿期间，外界的冷气乘虚而入，导致血脉运行涩滞，所以胎盘排不出来。必须紧急用方药救治，这不会伤害婴儿。无奈的是，胎盘系连着婴儿的脐带，胎盘不排出就不能及时剪断脐带、清洗婴儿，冷气伤害婴儿就会致病。旧法认为胎盘不下会损伤婴儿，就按照方法剪断脐带即可。分娩地点必须顺应四季的方向，并避开五行禁忌。如果有触犯，多会导致产妇难产。虽然有腹痛，但尚未临产。如果腹痛连及腰痛且非常严重，就是即将临产了。之所以这样，是因为肾对应腰部，胎盘系属于肾的缘故。诊察其脉象，脉搏变得急促如同切按绳索一样没有区别的，就是即将临产了。郭稽中论述道：胎衣不下的原因是什么？回答说：母亲生下孩子后，血液流入胎衣中，胎衣被血液胀满，因此不能下行。治疗稍微迟缓，胀满感蔓延至腹中，依次向上冲撞心胸，出现疼痛、气喘急促等症状。只需服用夺命丹以驱逐胎衣中的瘀血，血液消散、胀满消除，胎衣自然下降而没有祸患。还有牛膝汤等方剂，使用也非常有效，记录下来附在后面。
(Commentary by Chen Wuyue)
There are many obstetric books circulated in the world, such as *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold), *Waitai Miyao* (Secret Essentials of the Outer Cabinet), and Wang Shuhe's *Chanbao* (Obstetric Precious Record). Ma Shi, Wang Shi, and Cui Shi all have obstetric works. Chao Yuanfang has *Weisheng Baoji* (Precious Collection for Health Preservation) and *Zimu Milu* (Secret Records of Mother and Child), among others. Although they are comprehensive, it is not easy to try them one by one in emergencies. Only Li Shisheng, in his preface to Guo Jizhong's *Chanke Jingyan Baoqing Ji* (Collection of Experienced and Preserved Methods in Obstetrics), mentions twenty-one articles and eighteen formulas, which have been quite effective when used. However, the prefaces and discussions therein are not entirely appropriate. I began to organize and analyze them under each formula for the reference of knowledgeable people, not out of a desire to argue. (I have carefully examined the critical conditions after childbirth, finding that none exceed the scope of Guo Jizhong's twenty-one discussions and eighteen formulas, which benefit the world greatly. My family has used them for three generations without failure. Although Chen Wuyue's evaluations vary between affirmation and negation, they should still be investigated in detail. For instance, using Mudan San (Peony Powder) for postpartum dizziness contains Dahuang (Rhubarb Rhizome) and Mangxiao (Mirabilite Saltpeter); given that qi and blood are severely deficient immediately after childbirth, how can they be taken lightly? Furthermore, while dizziness due to excessive blood loss may occur, dizziness caused by phlegm accounts for less than one or two cases out of ten. Similarly, for postpartum heat and stifling sensation with qi rebelling upward turning into Hongjiaojiao (Gouty Arthritis/Leg Qi), Xiaoxuming Tang (Minor Continuation of Life Decoction) should not be used. I use modified formulas from *Baiwen* (Hundred Questions), which is a method of flexible application. Thus, Mencius said: "To believe everything in books is better than having no books at all." This applies here.)
When the fetus is delivered but the placenta does not come down, it is called "Xibao" (Retained Placenta) in common parlance. This occurs because the mother exerted herself too much during the initial stages of labor; after the baby is born, her body is exhausted and unable to exert further force to expel the placenta. During the pause, external cold qi invades, causing the blood vessels to become sluggish, thus preventing the expulsion of the placenta. It is necessary to urgently treat with herbal medicine; this will not harm the infant. The difficulty lies in the fact that the placenta is connected to the infant's umbilical cord; if the placenta is not expelled, the cord cannot be cut and the infant washed in time, allowing cold qi to injure the infant and cause disease. The old method, fearing injury to the infant if the placenta remains, simply involves cutting the umbilical cord according to protocol. The place of delivery must conform to the directions of the four seasons and avoid taboos of the Five Elements. Violations often lead to difficult labor. Although abdominal pain may occur, it does not necessarily mean labor has started. If abdominal pain extends to severe lower back pain, labor is imminent. This is because the Kidney governs the waist, and the placenta is connected to the Kidney. Upon pulse diagnosis, if the pulse becomes rapid and tight like cutting a rope without difference, labor is imminent. Guo Jizhong discussed: "What is the reason for retained placenta?" He answered: "After the mother gives birth, blood flows into the placenta, distending it, which is why it cannot descend. If treatment is delayed, the distension spreads to the abdomen, rising successively to rush against the heart and chest, causing pain, panting, and urgency. One should only administer Duoming Dan (Life-Seizing Pill) to drive out the blood within the placenta. Once the blood disperses and distension subsides, the placenta will naturally descend without trouble. Other formulas such as Niuxi Tang (Achyranthes Root Decoction) are also very effective; they are recorded and attached here."