观《病机机要》云∶治胎产之病，当从厥阴证论之。宜无犯胃气及上二焦，是为三禁，
谓不可汗，不可下，不可利小便。发其汗，则同伤寒下早之证；利大便，则脉数而伤脾；利
小便，则内亡津液，胃中枯燥。但使不犯三禁，则营卫自和，而寒热自止矣。凡用治之法，
如发渴则白虎，气弱则黄 ，血痛则当归，腹痛则芍药。大抵产病，天行从加减柴胡，杂证
从增损四物，宜察脉证而用之。详此说虽为产育之大法，然病变不同，倘有是证，则不得不
用是药，所谓有病则病受之也。第此经常之法，固不可不知，而应变之权，亦不可执一也。
产后腹痛，最当辨察虚实。血有留瘀而痛者，实痛也；无血而痛者，虚痛也。大都痛而
且胀，或上冲胸胁，或拒按而手不可近者，皆实痛也，宜行之散之。若无胀满，或喜揉按，
或喜热熨，或得食稍缓者，皆属虚痛，不可妄用推逐等剂。
凡新产之后，多有儿枕腹痛者，摸之亦有块，按之亦微拒手，故古方谓之儿枕，皆指为
胞中之宿血，此大不然。夫胎胞俱去，血亦岂能独留？盖子宫蓄子既久，忽尔相离，血海陡
虚，所以作痛。胞门受伤，必致壅肿，所以亦若有块，而实非真块。肿既未消，所以亦颇拒
按。治此者，但宜安养其脏，不久即愈，惟殿胞煎为最妙，其次则四神散、五物煎皆极佳者
。若误认为瘀，而妄用桃仁、红花、玄胡、青皮之属，反损脏气，必增虚病。
一、有母体本虚而血少者，即于产时亦无多血，此辈尤非血滞。若有疼痛，只宜治以前
法，或以大、小营煎、黄雌鸡汤主之。
一、凡新产之后，其有阳气虚弱而寒从中生，或寒由外入，以致心腹作痛，呕吐不食，
四肢厥冷者，宜九蜜煎、大严蜜汤，或理阴煎主之。
一、产当寒月，以致寒气入腹，脐下胀痛，手不可近者，宜羊肉汤主之。若气实寒甚者
，宜蟠葱散。
一、产后恶露不尽，留滞作痛者，亦常有之。然此与虚痛者不同，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
实证，当速去其血。近上者，宜失笑散；近下者，宜通瘀煎、夺命丹、回生丹。如或未效，
当用决津煎为善。
一、产后有脾虚、肾虚而为腹痛者，此不由产而由脏气之不足。若脾气虚寒，为呕吐，
为食少，而兼腹痛者，宜五君子煎、六君子汤、温胃饮之类主之。若肾气虚寒，为泻为痢，
而兼腹痛者，宜胃关煎、理阴煎之类主之。
一、产后有饮食停滞及气逆作痛，亦当因其类而消去之，如排气饮、大和中饮之类，皆
可酌用。
仲景曰∶产后腹中 痛，当归生姜羊肉汤主之。并治腹中寒疝，虚劳不足。
立斋曰∶前证若因气滞，用延胡索散。若因外寒，用五积散。若因怒气，用四物加木香
、柴胡。若因血虚，用四物、参、术、炮姜。若因阳气虚弱，用四君、当归、炮姜。若因脾
虚血弱，用六君、当归、炮姜。
查看《病机机要》中说：治疗胎产疾病，应当从厥阴证（足厥阴肝经病变）来论述。适宜不损伤胃气及上、中二焦，这就是“三禁”，指不可发汗，不可攻下，不可通利小便。如果发汗，就会如同伤寒病过早使用下法所导致的变证；如果通利大便，就会导致脉数且损伤脾气；如果通利小便，就会导致体内津液亡失，胃中干燥。只要不触犯这三项禁忌，那么营卫之气自然调和，寒热症状自然停止。凡是用于治疗的方法，如出现口渴则用白虎汤（清热生津），气虚则用黄芪（补气），血痛则用当归（补血活血），腹痛则用芍药（柔肝止痛）。大抵产后疾病，如果是外感时行邪气应从加减柴胡汤（和解少阳）论治，如果是内伤杂证应从增损四物汤（调理气血）论治，应当观察脉象和证候来选用。详细考察这种说法虽然作为生育的大法，然而病情变化不同，如果有相应的证候，就不得不使用相应的药物，这就是所谓有病则病邪承受药力。只是这种常规之法，固然不可不知道，而应变的权宜之计，也不可拘泥固执。
产后腹痛，最应当辨别虚实。血液有瘀滞而疼痛的，是实痛；没有血液滋养而疼痛的，是虚痛。大多疼痛并且伴有胀满，或者向上冲至胸胁，或者拒绝按压且手不能靠近的，都是实痛，适宜用行气散瘀的方法。如果没有胀满，或者喜欢揉按，或者喜欢热敷，或者进食后稍能缓解的，都属于虚痛，不可胡乱使用推逐破血的药剂。
凡是新产之后，多有儿枕腹痛（产后因子宫收缩或瘀血引起的腹痛）者，触摸也有块状物，按压也轻微拒按，所以古方称之为儿枕，都指为胞宫中的陈旧血液，这非常不对。既然胎胞都已排出，血液又怎能单独留下？大概是因为子宫蓄养胎儿已久，忽然分离，血海骤然空虚，所以产生疼痛。胞门受伤，必然导致壅肿，所以也好像有块状物，但实际上并非真正的肿块。肿胀既然未消，所以也颇觉拒按。治疗此症，只适宜安养脏腑，不久即可痊愈，只有殿胞煎最为妙用，其次是四神散、五物煎也都是极佳的选择。如果误认为是瘀血，而胡乱使用桃仁、红花、玄胡索、青皮之类的药物，反而损伤脏气，必定增加虚损病症。
其一，有母体原本虚弱而血少的，即在分娩时也没有多少出血，这类人尤其不是血滞。如果有疼痛，只适宜用上述方法治疗，或者以大营煎、小营煎、黄雌鸡汤为主方。
其一，凡是新产之后，有阳气虚弱而寒气从中而生，或者寒气由外部侵入，以致心腹作痛，呕吐不食，四肢厥冷的，适宜用九蜜煎、大严蜜汤，或者理阴煎为主方。
其一，分娩在寒冷月份，以致寒气进入腹部，脐下胀痛，手不能靠近的，适宜用羊肉汤为主方。如果气实且寒邪严重的，适宜用蟠葱散。
其一，产后恶露不尽，留滞引起疼痛的，也常有发生。然而这与虚痛不同，必定是逐渐加重，或者大小便不通，或者小腹硬实胀满，疼痛剧烈不能用手触碰，或者疼痛向上冲至心腹，或者疼痛剧烈导致牙关紧急，有此实证，应当迅速去除瘀血。病位偏上的，适宜用失笑散；病位偏下的，适宜用通瘀煎、夺命丹、回生丹。如果尚未见效，应当使用决津煎为好。
其一，产后有脾虚、肾虚而导致腹痛的，这不是由生产引起而是由脏腑之气不足引起。如果脾气虚寒，出现呕吐、食少，并兼有腹痛的，适宜用五君子煎、六君子汤、温胃饮之类为主方。如果肾气虚寒，出现腹泻、痢疾，并兼有腹痛的，适宜用胃关煎、理阴煎之类为主方。
其一，产后有饮食停滞以及气逆引起疼痛的，也应当根据其类别进行消导祛除，如排气饮、大和中饮之类，都可以酌情使用。
张仲景说：产后腹中冷痛，用当归生姜羊肉汤主治。同时治疗腹中寒疝，虚劳不足。
薛立斋说：前述证候如果因气滞引起，用延胡索散。如果因外寒引起，用五积散。如果因怒气引起，用四物汤加木香、柴胡。如果因血虚引起，用四物汤加人参、白术、炮姜。如果因阳气虚弱引起，用四君子汤加当归、炮姜。如果因脾虚血弱引起，用六君子汤加当归、炮姜。
According to *Bingji Jiyao* (Essentials of Pathogenesis), the treatment of diseases related to pregnancy and childbirth should be discussed in terms of Jueyin syndrome (diseases of the Foot-Jueyin Liver meridian). It is appropriate not to damage the Stomach Qi (Stomach energy) and the Upper and Middle Jiao (Upper and Middle Burners), which constitutes the "Three Prohibitions" (San Jin): one must not induce sweating, one must not purge downward, and one must not promote urination. Inducing sweating would result in complications similar to those caused by premature purgation in Cold Damage (Shanghan); promoting bowel movements would lead to a rapid pulse and damage Spleen Qi; promoting urination would cause the loss of body fluids internally and dryness in the Stomach. As long as these three prohibitions are not violated, Ying and Wei (Nutritive and Defensive Qi) will naturally harmonize, and chills and fever will cease spontaneously. Regarding therapeutic methods: if thirst occurs, use Baihu Tang (White Tiger Decoction); if Qi is weak, use Huangqi (Astragali Radix); if there is blood-related pain, use Danggui (Angelicae Sinensis Radix); if there is abdominal pain, use Shaoyao (Paeoniae Radix). Generally speaking, for postpartum diseases, if they are due to epidemic pathogens, one should refer to Jiajian Chaihu Tang (Modified Bupleurum Decoction); if they are miscellaneous internal disorders, one should refer to Zengsun Siwu Tang (Augmented and Reduced Four Substances Decoction). One should observe the pulse and symptoms to apply the treatment. Although this theory serves as a general principle for childbirth, pathological changes vary. If specific syndromes exist, corresponding medicines must be used, as the saying goes, "when there is disease, the disease receives the medicine." This routine method must certainly be known, but adaptive flexibility must not be rigidly adhered to.
Postpartum abdominal pain requires careful differentiation between deficiency and excess. Pain caused by blood stasis retention is excess pain; pain caused by lack of blood nourishment is deficiency pain. Generally, pain accompanied by distension, or radiating upward to the chest and hypochondrium, or characterized by tenderness and inability to tolerate touch, are all excess pains, suitable for treatments that promote circulation and dissipate stasis. If there is no distension, or if the patient prefers rubbing and pressing, or prefers hot compresses, or experiences slight relief after eating, these belong to deficiency pains, and one must not recklessly use purgative or blood-breaking agents.
After recent delivery, many cases involve "Ezhen Abdominal Pain" (postpartum abdominal pain often attributed to uterine contraction or residual blood). Palpation may reveal a mass, and mild resistance to pressure is felt. Ancient formulas call this "Ezhen," attributing it to old blood remaining in the uterus. This is largely incorrect. Since the fetus and placenta have been expelled, how can blood remain alone? The uterus has housed the fetus for a long time; upon sudden separation, the Blood Sea (Chong and Ren meridians) becomes suddenly empty, causing pain. Injury to the uterine opening leads to congestion and swelling, creating the illusion of a mass, though it is not a true solid tumor. Because the swelling has not subsided, there is some resistance to pressure. Treatment should focus on nourishing and calming the organs, with recovery expected soon. Dianbao Jian (Palace-Protecting Decoction) is the most excellent choice, followed by Sishen San (Four Spirit Powder) and Wuwu Jian (Five Materials Decoction), which are also excellent. If mistakenly identified as blood stasis and treated recklessly with Taoren (Persicae Semen), Honghua (Carthami Flos), Yuanhusuo (Corydalis Rhizoma), or Qingpi (Aurantii Fructus Immaturus), organ Qi will be damaged, inevitably worsening the deficiency condition.
First, there are cases where the mother's constitution is originally deficient with low blood volume, resulting in little bleeding during delivery. These individuals definitely do not suffer from blood stasis. If pain occurs, the aforementioned methods should be used, or Daying Jian (Great Camp Decoction), Xiaoying Jian (Small Camp Decoction), and Huangci Ji Tang (Yellow Hen Soup) should be prescribed as main formulas.
Second, after recent delivery, some patients have weak Yang Qi leading to internal cold generation, or external cold invasion, resulting in heart and abdominal pain, vomiting, anorexia, and cold limbs. In such cases, Jiumi Jian (Nine Honey Decoction), Dayanmi Tang (Great Sealing Honey Decoction), or Liyin Jian (Regulating Yin Decoction) should be used.
Third, if delivery occurs in cold months, allowing cold qi to enter the abdomen, causing distending pain below the umbilicus that cannot be touched, Yangrou Tang (Mutton Soup) should be used. If the condition involves excess Qi and severe cold, Pansong San (Coiling Scallion Powder) is appropriate.
Fourth, incomplete expulsion of lochia (postpartum discharge) leading to stagnation and pain is common. However, this differs from deficiency pain; it typically worsens gradually, may involve constipation or urinary retention, hard and full lower abdomen, extreme pain intolerable to touch, pain radiating upward to the heart and abdomen, or severe pain causing lockjaw. With such excess signs, blood stasis must be rapidly removed. For lesions located higher up, Shixiao San (Laughing Without Trace Powder) is suitable; for lesions located lower down, Tongyu Jian (Promoting Circulation Decoction), Xueming Dan (Life-Restoring Pill), or Huisheng Dan (Return-to-Life Pill) are suitable. If these are ineffective, Juejin Jian (Striking Waterway Decoction) is advisable.
Fifth, postpartum abdominal pain caused by Spleen deficiency or Kidney deficiency arises not from the delivery itself but from insufficiency of organ Qi. If Spleen Qi is deficient and cold, presenting with vomiting, poor appetite, and abdominal pain, Wujunzi Jian (Five Gentlemen Decoction), Liujunzi Tang (Six Gentlemen Decoction), or Wenwei Yin (Warming the Stomach Drink) should be used. If Kidney Qi is deficient and cold, presenting with diarrhea, dysentery, and abdominal pain, Weiguan Jian (Stomach Gate Decoction) or Liyin Jian (Regulating Yin Decoction) should be used.
Sixth, postpartum pain caused by food stagnation or rebellious Qi should be treated by resolving the specific type of stagnation. Paqi Yin (Dispersing Qi Drink) and Dahezhong Yin (Great Harmonizing the Middle Drink) can be used酌情 (as appropriate).
Zhang Zhongjing stated: For postpartum abdominal cold pain, Danggui Shengjiang Yangrou Tang (Danggui, Ginger, and Mutton Decoction) is the primary treatment. It also treats abdominal cold hernia and deficiency-wasting conditions.
Xue Lizhai stated: For the aforementioned syndromes, if caused by Qi stagnation, use Yanhusuo San (Corydalis Powder); if caused by external cold, use Wuji San (Five Accumulations Powder); if caused by anger, use Siwu Tang (Four Substances Decoction) added with Muxiang (Aucklandiae Radix) and Chaihu (Bupleuri Radix); if caused by blood deficiency, use Siwu Tang added with Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Paojiang (Prepared Ginger); if caused by weak Yang Qi, use Sijunzi Tang (Four Gentlemen Decoction) added with Danggui and Paojiang; if caused by Spleen deficiency and weak blood, use Liujunzi Tang added with Danggui and Paojiang.