产后病治，尝见丹溪云∶“产后当大补气血，即有杂证，以末治之。一切病多是血虚，皆不可发表。”此
其意谓血气随胎而去，必属大虚，故无论诸证，皆当以大补为先，其他皆属可缓。余于初年诚然佩服，及执而
用之，则每为所困。经者数次，始悟其言虽有理而未免言之过也。即今产科所宗，无非此法，余目睹其误，及
亲为解救者，盖不少矣。故敢剖析于后，实有所见，不得不言，非存心自炫，故毁先贤。若然，则徒为笑骂之
招耳。宾虽至愚，必不为也。观者深察此意。
凡产后气血俱去，诚多虚证。然有虚者，有不虚者，有全实者。凡此三者，但当随证、随人，辨其虚
实，以常法治疗，不得执有诚心，概行大补，以致助邪。此辨不可不真也。
产后虚证，无非随人元气，必素弱之人多有之；或于产后血气俱去而更弱者亦有之。此当因人察脉，因脉
察证，若脉气、形气、病气俱不足，此当以全虚治之。若形气不足，病气有余，或兼火邪，或兼外邪，或以饮
食停滞，是亦虚中有实，不得不详审而治。此中委曲，未能言尽，惟明者悟之。
产后不虚证，盖或其素日无病，或以年少当时，或以素耐辛苦贫劳之质，此辈本无不足，及其一旦受
孕，乃于无病腹中参入此物，故致血气壅塞，为胀为呕，是皆添设有余之病。及其既产，始见通快，所留得
去，仍复故。吾常人之产，此类极多，果何虚之有？然或以内伤，或以外感，产后之病，难保必无。倘有所
犯，去之
即愈。若概行大补，果能堪否？即临盆带去血气，未免暂见耗损。然以壅滞之余，不过皆护胎随从之物。
去者当去，生者旋生，不出数日，必已来复，此生化自然之理，何至是产皆虚也？凡治此类，但当因证用治。
若执云“产后必当大补气血”，则实实之病必所不免。而轻者必甚，甚者必危矣。由此观之，则立言者固不
易，而用言者又岂易哉？
产后全实证∶有如外感风寒，头痛身热，便实中满，脉紧数洪大有力者，此表邪之实证也；又火之盛
者，必热渴躁烦，或便结腹胀，口鼻舌焦黑，酷喜冷冻饮料，眼哆尿管痛赤，脉见洪滑，此内热之实证也；又郁
怒动肝，胸胁胀痛，大便不利，脉弦而滑，此气逆之实证也；又恶露未尽，瘀血上冲，心腹胀满，疼痛拒按，
大便难而小便利，此血逆之实证也；又凡富贵之家，保护太过，或过用人参、 、术，以致气壅；或过用糖、
酒、炭火，以致内热；或产本不虚，而妄用大补之药，以致增病，此调摄之实证也；又或因产过食，恐其劳
困，固令勉强，以致停蓄不散，此内伤之实证也。以上诸证，姑举要者，以见其概。然既有表邪，则不得不
解；既有火邪，则不得不清；既有内伤停滞，则不得不开通消导。且人有强弱，产有虚实，病有真假，治有逆
从，固不可以同日语也。观《六元正纪大论》曰∶“妇人重身，毒之何如？曰∶有故无殒，亦无殒也。”此自
经常不易之大法，亦何庸赘辨之。若此第因丹溪之言，人多偏执，故不得不详尽其说，以解后人之惑也。诸虚
实治法，详具后条。
产后疾病的治疗，我曾见朱丹溪说：“产后应当大补气血，即使有其他杂病，也作为次要问题处理。一切疾病多因血虚引起，都不可使用发汗解表的方法。”他的意思是说，气血随着胎儿的娩出而流失，必然属于极度虚弱，所以无论出现什么证候，都应当以大补为先，其他治疗都可以暂缓。我年轻时确实非常佩服这种观点，但当我坚持运用它时，却常常因此陷入困境。经过多次反复，我才领悟到他的话虽然有理，但未免说得过于绝对了。如今产科所推崇的，无非就是这种方法，我亲眼目睹其造成的误治，以及亲自进行解救的案例，实在不少。所以我敢于在后面剖析其中的道理，这确实是出于我的真实见解，不得不说出来，并非存心自我炫耀，故意诋毁先贤。如果那样做，只会招来嘲笑和责骂罢了。我虽然极其愚钝，也绝不会这样做。希望读者能深入体察这番心意。
凡是产后气血俱失，确实多有虚证。然而也有不虚的，有完全实证的。对于这三种情况，只应当根据证候、因人而异，辨别其虚实，按照常规法则治疗，不能固执地认为“产后必虚”而一概施行大补，以致助长邪气。这种辨别是不可不精确的。
产后的虚证，无非是伴随人的元气状况，一定是素体虚弱的人多有此症；或者在产后气血俱去之后更加虚弱的人也有此症。这应当因人观察脉象，因脉象察看病证，如果脉气、形气、病气都不足，这应当按全虚证来治疗。如果形气不足，但病气有余，或者兼有火邪，或者兼有外邪，或者因为饮食停滞，这也是虚中有实，不得不详细审察后进行治疗。其中的复杂微妙之处，难以用言语穷尽，只有明理的人才能领悟。
产后的不虚证，大概是因为她平日没有疾病，或者因为年少当时身体强健，或者因为素来耐受辛苦贫劳的体质，这类人本来就没有不足，等到一旦怀孕，就是在原本无病的腹中加入了胎儿这个负担，导致气血壅塞，出现胀满、呕吐等症状，这些都是增添出来的有余之病。等到分娩之后，才开始感到通畅快适，残留的（瘀滞等）得以去除，身体又恢复原状。我见过的普通人生产，这类情况极多，哪里有什么虚呢？然而如果因为内伤，或者因为外感，产后生病，也不能保证一定没有。倘若有所触犯，祛除病邪即刻痊愈。如果一概施行大补，身体果真能承受吗？即使是临盆时带去了气血，未免暂时见到耗损。但是相对于之前壅滞的状态而言，不过只是护胎随从之物被带走而已。该去的已经去了，新生的随即产生，不出数日，必然已经恢复，这是生化自然的道理，何至于说所有产后都是虚证呢？凡是治疗这类情况，只应当根据证候使用治法。如果固执地说“产后必须大补气血”，那么实证变实证的错误必定不可避免。轻的病一定会加重，重的病一定会危及生命。由此看来，立论的人固然不容易，而运用言论的人难道就轻松了吗？
产后的全实证：比如外感风寒，头痛身热，大便干结腹部胀满，脉象紧数洪大有力者，这是表邪的实证；又有火邪炽盛的，必然热渴烦躁，或者大便干结腹胀，口鼻舌焦黑，酷喜冷冻饮料，眼屎多尿道疼痛色赤，脉象见洪滑，这是内热的实证；又有郁怒触动肝气，胸胁胀痛，大便不通利，脉弦而滑，这是气逆的实证；又有恶露未尽，瘀血上冲，心腹胀满，疼痛拒按，大便困难而小便通利，这是血逆的实证；又有凡是富贵人家，保护太过，或者过用人参、白术，以致气机壅滞；或者过用糖、酒、炭火，以致内热；或者生产本不虚，而妄用大补的药物，以致增加病情，这是调摄不当导致的实证；又有因为生产时进食过多，担心产妇劳累困倦，固令勉强进食，以致停蓄不散，这是内伤的实证。以上诸证，姑且列举重要的，以显示其概况。既然有表邪，就不得不解表；既有火邪，就不得不清热；既有内伤停滞，就不得不疏通消导。况且人有强弱之分，生产有虚实之别，病有真假之异，治有逆从之法，本来不可以同日而语。看《黄帝内经·素问·六元正纪大论》中说：“妇人怀孕，可以用毒药吗？回答说：有病则病受之，不会伤害母体，也不会伤害胎儿。”这是自古不变的大法，又何须多加辩解呢？这里之所以详尽阐述，只是因为丹溪的话，人们大多偏执，所以不得不详细说明，以解除后人的困惑。各种虚实的治疗方法，详见后面的条目。
The treatment of postpartum diseases, I have seen Zhu Danxi say: "Postpartum patients should be greatly tonified in Qi and Blood; even if there are other miscellaneous syndromes, they should be treated as secondary. All diseases are mostly due to Blood deficiency, and none should be treated with diaphoresis (sweating method)." His meaning is that Qi and Blood depart with the fetus, necessarily belonging to extreme deficiency; therefore, regardless of various syndromes, great tonification should take precedence, while others can be deferred. In my early years, I indeed admired this view, but when I adhered to it, I was often trapped by it. After several cycles of experience, I realized that although his words had merit, they were somewhat too absolute. Currently, what obstetrics follows is nothing but this method. I have witnessed its errors and personally rescued cases, quite a number. Thus, I dare to analyze the following, truly having my own insights, and cannot help but speak; it is not out of a desire to show off or deliberately slander sages. If so, it would only invite ridicule and scolding. Although I am extremely foolish, I certainly would not do such a thing. Readers should deeply contemplate this intent.
Whenever Qi and Blood are lost after childbirth, there are indeed many deficiency syndromes. However, there are also non-deficiency cases, and fully excess cases. For these three types, one must differentiate deficiency and excess according to the syndrome and the individual, treating them by standard methods. One must not stubbornly believe that "postpartum is always deficient" and universally apply great tonification, thereby aiding pathogenic factors. This differentiation must be precise.
Postpartum deficiency syndromes are essentially linked to the person's original Qi; those who are constitutionally weak often suffer from this. Or, those whose Qi and Blood become even weaker after childbirth may also have this. Here, one must observe the pulse based on the individual, and examine the syndrome based on the pulse. If the pulse energy, form/energy, and disease energy are all insufficient, it should be treated as a total deficiency. If form/energy is insufficient but disease energy is sufficient, or if accompanied by Fire pathogen, external pathogen, or food stagnation, this is also deficiency with excess, requiring detailed examination and treatment. The complexities here cannot be fully expressed in words; only the enlightened can comprehend.
Postpartum non-deficiency syndromes generally occur because the person was healthy beforehand, or was young and strong at the time, or has a constitution accustomed to hardship and labor. These people originally lack nothing. When they become pregnant, they add the burden of the fetus to an otherwise healthy abdomen, causing Qi and Blood congestion, leading to distension and vomiting. These are all added "excess" conditions. Once delivery occurs, relief begins, the retained elements are expelled, and the body returns to normal. Among ordinary people's deliveries, such cases are very numerous; where is the deficiency? However, internal injury or external contraction can still cause postpartum illness; one cannot guarantee it never happens. If such pathogens are present, removing them leads to immediate recovery. If one universally applies great tonification, can the body truly endure it? Even though Qi and Blood are temporarily depleted during delivery, relative to the previous congestion, only the substances accompanying the fetus are removed. What leaves departs; what generates regenerates. Within a few days, restoration will surely occur. This is the natural law of bio-generation. Why assume all postpartum states are deficient? For treating such cases, one should treat according to the syndrome. If one stubbornly insists "postpartum must be greatly tonified in Qi and Blood," then real-excess conditions will inevitably remain untreated. Mild conditions will worsen, severe conditions will become critical. From this perspective, establishing theories is indeed difficult, but applying them is no easier either.
Fully excess postpartum syndromes: Such as external contraction of Wind-Cold, with headache, fever, constipation, abdominal fullness, and a tight, rapid, surging, large, and forceful pulse—this is an exterior excess syndrome. Another case involves excessive Fire, manifesting as heat, thirst, restlessness, irritability, constipation, abdominal distension, blackened dry mouth/nose/tongue, intense craving for cold drinks, copious eye discharge, painful red urination, and a surging slippery pulse—this is an interior Heat excess syndrome. Another involves Liver Qi rebellion triggered by depression and anger, with chest and hypochondriac pain/distension, difficulty in defecation, and a string-taut slippery pulse—this is a Qi reversal excess syndrome. Another involves incomplete expulsion of lochia, with blood stasis rushing upward, causing heart/abdominal distension/pain, tenderness upon pressure, difficult defecation but free urination—this is a Blood reversal excess syndrome. Another involves wealthy families providing excessive care, or overusing herbs like Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), leading to Qi congestion; or overusing sugar, alcohol, and charcoal fires, leading to interior Heat; or the birth itself was not deficient, but reckless use of great tonics increased the illness—this is an excess syndrome caused by improper nursing/care. Another involves overeating during labor, fearing fatigue, forcing consumption, leading to retention and stagnation—this is an interior injury excess syndrome. The above syndromes are merely key examples to show the general picture. Since there is an exterior pathogen, it must be resolved; since there is Fire pathogen, it must be cleared; since there is interior injury and stagnation, it must be unblocked and digested. Moreover, people vary in strength, births vary in deficiency/excess, diseases vary in true/false, and treatments vary in counteracting/following approaches. They certainly cannot be discussed as if identical. As stated in the *Suwen: Liuyuan Zhengji Dalun* ("Great Treatise on the Six Origins and Correct Ordinances"): "For a pregnant woman, how should toxic drugs be used? It is said: If there is a disease [pathology], the drug attacks the disease without harming [the mother/fetus], thus neither is harmed." This is an eternal, unchanging major principle. Why need further debate? I elaborate here only because people often rigidly adhere to Danxi's words, necessitating a detailed explanation to resolve later generations' confusion. Methods for treating various deficiencies and excesses are detailed in subsequent sections.