产后腹痛，先问血块。如有血块，只服生化汤，甚则调失笑散，其块消而痛自止。若风冷乘虚
入腹，或内伤寒凉之物作痛，得人按摩略止。或热物熨之略止，宜加味生化汤。密斋用当归建中汤治
之。冯氏云∶产后恶露；或因外感六淫，内伤七情，致令斩然而止，瘀血壅滞，所下不尽，故令腹痛，
当审因治之。如产后数朝内，饮食如常，忽作腹痛，六脉沉伏，四肢厥冷，此恶血不尽，伤食裹血，
而脉不起也。不可误认气血两虚，而用大补，须兼消导、血行之药。但产后恶露不尽，留滞作痛，亦
常有之。然与虚痛不同，必其由渐而甚，或大小便不行，或小腹硬实，作胀痛极，不可近手，或自下
上冲心腹，或痛极，牙关紧急，有此实症，当速去之。近上者，宜失笑散；近下者，宜通瘀煎。未效，用
决津煎为善。又有腹痛定于一边及小腹者，此是侧卧，败血留滞所致，亦用决津煎为当也。《金
匮》云∶产后腹中 痛，当归生姜羊肉汤主之。盖 痛者，缓缓痛也，属客寒相阻。故以当归通血
分之滞，生姜行气分之寒。君以羊肉者，所谓“形不足，补之以味”，况羊肉又能补气， 痛属气
弱，故宜之。若妇人产当寒月，寒气入产门，脐下胀痛，手不可犯，此寒疝也，亦宜当归生姜羊肉
汤治之。又有产后脾虚，肾虚而为腹痛者，此不由产，而由脏气不足。若脾气虚寒，为呕吐，为食
少，而兼腹痛者，宜五君子煎及六君子汤。若肾气虚寒，为泻为痢，而兼腹痛者，宜胃关煎或理阴
煎主之。若胸膈饱闷，或恶食吞酸，腹痛手不可按，此饮食所伤，治法见伤食门。若食既消而仍
痛，按之不痛，更加头痛烦热、作渴、恶寒、欲呕等症，此是中气被伤，宜温补脾胃为主。若发热
腹痛，按之痛甚，不恶食吞酸，此是瘀血停滞，失笑散消之。若止发热、头痛、腹痛，按之却不
痛，此是血虚，初产生化汤，日久用四物加炮姜、参、术以补之。
加味生化汤 治产后风冷，或伤寒物腹痛。
川芎（二钱） 当归（四钱） 炮姜（四分） 桃仁（十粒） 炙草（五分） 桂枝（四、五分）
当归建中汤 治风冷乘虚入腹，或伤寒冷物腹痛。
当归（酒洗） 白芍（酒炒） 桂心 炙草（各二钱） 姜（五片） 枣（三枚）
入饴糖三匙，搅匀服。
《金匮》当归生姜羊肉汤 治产后腹中 痛，及寒月生产，寒气入于子门，手不可犯，脐
下胀满，并治寒疝，虚劳不足，及胁痛里急。
当归（一两） 生姜（一两半） 羊肉（二斤，生）
取羊肉清汤煎药，温分三服。
产后腹痛，首先要询问是否有血块。如果存在血块，只需服用生化汤；若病情严重，则使用调失笑散，待血块消散，疼痛自然停止。如果是风冷之邪乘虚侵入腹部，或内伤寒凉食物导致疼痛，通过人工按摩可稍缓解，或用热物熨烫也可稍缓解，适宜使用加味生化汤。密斋（医家）用当归建中汤治疗此症。冯氏说：产后恶露，或因外感六淫（风、寒、暑、湿、燥、火六种外感病邪），或因内伤七情（喜、怒、忧、思、悲、恐、惊七种情志变化），导致恶露突然中断，瘀血壅滞，排出不尽，从而引起腹痛，应当审察病因进行治疗。如在产后数日内，饮食正常，突然发生腹痛，六脉沉伏，四肢厥冷，这是恶血未尽，食积裹挟瘀血，导致脉象不起。不可误认为是气血两虚而使用大补之法，必须兼用消导和行血的药物。但是产后恶露不尽，留滞体内引起疼痛，也常有发生。然而这与虚痛不同，其疼痛必定是逐渐加重，或者大小便不通，或者小腹硬实，胀痛剧烈，不能触碰，或者疼痛向上冲撞心腹，或者疼痛极度剧烈导致牙关紧闭，出现这些实证症状时，应当迅速祛除病邪。病位偏上的，适宜用失笑散；病位偏下的，适宜用通瘀煎。若无效，使用决津煎较好。又有腹痛固定在一侧及小腹部的，这是因为侧卧导致败血留滞所致，也适宜使用决津煎。《金匮要略》说：产后腹中绵绵作痛，用当归生姜羊肉汤主治。所谓“㽲痛”（yuán tòng），是指缓缓作痛，属于客寒相阻。因此用当归疏通血分的瘀滞，生姜运行气分的寒气。以羊肉为君药，即所谓“形不足者，补之以味”，况且羊肉又能补气，㽲痛属于气弱，所以适宜使用。如果妇人在寒冷的月份生产，寒气侵入产门，脐下胀痛，手不可触碰，这是寒疝，也适宜用当归生姜羊肉汤治疗。又有产后因脾虚、肾虚而导致腹痛的，这不由生产直接引起，而是由脏腑之气不足所致。若脾气虚寒，伴有呕吐、食欲不振，并兼有腹痛的，适宜用五君子煎及六君子汤。若肾气虚寒，伴有腹泻、痢疾，并兼有腹痛的，适宜用胃关煎或理阴煎主治。若胸膈饱闷，或厌恶食物、吞酸，腹痛且手不可按压，这是饮食所伤，治疗方法见伤食门。若食积已消但疼痛仍在，按压不痛，更加出现头痛、烦热、口渴、恶寒、想呕吐等症状，这是中气受损，应以温补脾胃为主。若发热且腹痛，按压时疼痛加剧，不厌恶食物、不吞酸，这是瘀血停滞，用失笑散消除。若仅发热、头痛、腹痛，按压却不痛，这是血虚，初产时用生化汤，日久后用四物汤加炮姜、人参、白术来补益。
加味生化汤 治疗产后受风冷，或食用寒凉食物引起的腹痛。
川芎（二钱） 当归（四钱） 炮姜（四分） 桃仁（十粒） 炙甘草（五分） 桂枝（四、五分）
当归建中汤 治疗风冷乘虚入腹，或损伤寒冷食物引起的腹痛。
当归（酒洗） 白芍（酒炒） 桂心 炙甘草（各二钱） 生姜（五片） 大枣（三枚）
加入饴糖三匙，搅匀服用。
《金匮要略》当归生姜羊肉汤 治疗产后腹中绵绵作痛，以及寒冷月份生产，寒气侵入子门（子宫口），手不可触碰，脐下胀满，并治疗寒疝、虚劳不足，以及胁痛里急。
当归（一两） 生姜（一两半） 羊肉（二斤，生）
取羊肉清汤煎煮药物，分三次温服。
Postpartum abdominal pain requires first inquiring about the presence of blood clots. If blood clots are present, only Shenghua Tang (Decoction for Generating New Blood) should be administered; if the condition is severe, Touxiao San (Powder to Make Pain Cease) should be used. Once the clots dissipate, the pain will naturally cease. If wind-cold pathogens invade the abdomen due to deficiency, or if internal injury from cold and raw foods causes pain, slight relief may be obtained through manual massage or application of hot compresses; Jiawei Shenghua Tang (Modified Decoction for Generating New Blood) is appropriate. Mi Zhai (a physician) treats this with Danggui Jianzhong Tang (Cinnamon Twig and Angelica Decoction to Build the Middle). Feng Shi states: Postpartum lochia may be abruptly stopped due to external contraction of the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) or internal injury from the Seven Emotions (Joy, Anger, Worry, Pensive, Sorrow, Fear, Fright), leading to stagnation of retained blood and incomplete discharge, thus causing abdominal pain. The etiology must be investigated for treatment. For instance, within a few days postpartum, if diet remains normal but sudden abdominal pain occurs, with deep and hidden pulses in all six positions and cold extremities, this indicates that evil blood has not been fully expelled, and food stagnation is entangling the blood, preventing the pulse from rising. One must not mistakenly diagnose Qi and Blood deficiency and use heavy tonification; instead, herbs for resolving stagnation and promoting blood circulation must be combined. However, it is also common for lochia to remain unexpelled and cause pain due to stagnation. This differs from deficiency pain; the pain here gradually worsens, accompanied by constipation or urinary retention, hardness and fullness of the lower abdomen, severe distending pain intolerable to touch, or pain rushing upward to the heart and abdomen, or extreme pain causing lockjaw. When such excess symptoms appear, the pathogen must be rapidly eliminated. For pathology located superiorly, Touxiao San (Powder to Make Pain Cease) is suitable; for pathology located inferiorly, Tongyu Jian (Decoction for Unblocking Stasis) is suitable. If ineffective, Juejin Jian (Decoction for Breaking Through the Vessels) is preferable. Abdominal pain fixed on one side or in the lower abdomen is caused by lying on one side leading to stagnation of foul blood; Juejin Jian (Decoction for Breaking Through the Vessels) is also appropriate here. The *Jingui Yaolue* states: For postpartum abdominal cramping pain (*yuan tong*), Danggui Shengyang Roushou Tang (Angelica, Ginger, and Mutton Decoction) is the primary formula. "Cramping pain" refers to slow, lingering pain, attributed to exogenous cold obstruction. Therefore, Dang Gui (Angelica Sinensis Root) is used to unblock stagnation in the blood level, and Sheng Jiang (Fresh Ginger Rhizome) to circulate cold in the Qi level. Mutton is used as the sovereign herb, following the principle "for those deficient in form, nourish with flavor"; moreover, mutton can tonify Qi. Since cramping pain belongs to Qi weakness, this is suitable. If a woman gives birth in cold months, and cold qi enters the uterus (Zimen), causing distending pain below the umbilicus that is intolerable to touch, this is Han Shan (Cold Hernia), which is also treated with Danggui Shengyang Roushen Tang (Angelica, Ginger, and Mutton Decoction). There are also cases of postpartum abdominal pain due to Spleen deficiency and Kidney deficiency, which do not stem directly from childbirth but from insufficiency of Zang-Fu Qi. If Spleen Qi deficiency and cold manifest as vomiting, poor appetite, and concurrent abdominal pain, Wu Junzi Jian (Decoction of Five Gentlemen) and Liujunzi Tang (Six Gentlemen Decoction) are indicated. If Kidney Qi deficiency and cold manifest as diarrhea, dysentery, and concurrent abdominal pain, Weiguan Jian (Decoction for Guarding the Stomach) or Liyin Jian (Decoction for Nourishing Yin) are indicated. If chest and diaphragm fullness, aversion to food, acid regurgitation, and abdominal pain intolerable to pressure occur, this is injury from dietary excess; see the section on Dietary Injury for treatment methods. If food stagnation has resolved but pain persists, and pressing does not aggravate the pain, accompanied by headache, vexatious heat, thirst, aversion to cold, and nausea, this is damage to Middle Qi, requiring warming and tonification of the Spleen and Stomach as the main approach. If fever and abdominal pain occur, with increased pain upon pressure, but no aversion to food or acid regurgitation, this is stagnation of retained blood, treated with Touxiao San (Powder to Make Pain Cease) to resolve it. If there is only fever, headache, and abdominal pain, with no pain upon pressure, this is Blood deficiency. In early postpartum, Shenghua Tang (Decoction for Generating New Blood) is used; after a long duration, Siwu Tang (Four Substances Decoction) plus Pao Jiang (Prepared Ginger Rhizome), Ren Shen (Ginseng Root), and Bai Zhu (Atractylodes Macrocephala Rhizome) are used to tonify.
Jiawei Shenghua Tang (Modified Decoction for Generating New Blood): Treats postpartum abdominal pain due to wind-cold or consumption of cold/raw foods.
Chuan Xiong (Ligusticum Chuanxiong Rhizome) (2 qian)
Dang Gui (Angelicae Sinensis Radix) (4 qian)
Pao Jiang (Prepared Zingiberis Officinalis Rhizome) (0.4 fen)
Tao Ren (Prunus Persica Seed) (10 grains)
Zhi Cao (Prepared Glycyrrhizae Uralensis Radix et Rhizoma) (0.5 fen)
Gui Zhi (Cinnamomi Ramulus) (0.4-0.5 qian)
Danggui Jianzhong Tang (Cinnamon Twig and Angelica Decoction to Build the Middle): Treats abdominal pain caused by wind-cold invading due to deficiency or injury from cold foods.
Dang Gui (Angelicae Sinensis Radix), washed in wine
Bai Shao (Paeoniae Radix Alba), stir-fried in wine
Gui Xin (Cinnamomi Cortex)
Zhi Cao (Prepared Glycyrrhizae Uralensis Radix et Rhizoma) (each 2 qian)
Sheng Jiang (Fresh Zingiberis Officinalis Rhizome) (5 slices)
Da Zao (Ziziphus Jujube Fruit) (3 pieces)
Add Yi Tang (Maltose) 3 spoons, mix well, and take orally.
*Jingui Yaolue* Danggui Shengyang Roushen Tang (Angelica, Ginger, and Mutton Decoction): Treats postpartum cramping abdominal pain, and abdominal distension below the umbilicus intolerable to touch due to cold qi entering the uterus during birth in cold months. Also treats Han Shan (Cold Hernia), deficiency and exhaustion, and hypochondriac pain with tension.
Dang Gui (Angelicae Sinensis Radix) (1 liang)
Sheng Jiang (Fresh Zingiberis Officinalis Rhizome) (1.5 liang)
Yang Rou (Sheep Meat) (2 jin, raw)
Decoct the medicine in clear broth extracted from the mutton. Take warm, divided into three doses.