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 ，故毁先贤。若然，则徒为笑骂之招耳。宾虽至愚，
必不为也。观者其深察此意。
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，不得执有成心，概行大补以致助邪，此辨之不可不真也。
一、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。
一、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。
一、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，眼眵，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，即使有其他杂证，也作为次要问题处理。一切病证大多属于血虚，都不可使用发汗解表的方法。”他的意思是，气血随着胎儿娩出而流失，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一观点，但当我严格执行并应用时，却常常因此陷入困境，经过多次反复，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。所以我敢于在后方剖析其中的道理，这确实是有所见地，不得不言，并非存心自我标榜，去诋毁先贤。如果那样做，只会招来嘲笑和责骂罢了。我张介宾虽然极其愚钝，也绝不会这样做。希望读者能深入体察此意。
凡是产后气血俱失，确实多属虚证，但也有不虚的情况，甚至有完全实证的情况。对于这三种情况，只应当根据证候和患者体质，辨别其虚实，按照常规方法治疗，不能固执己见，一概使用大补之法而导致助长邪气，这种辨别是不可不精准的。
第一、产后虚证，无非是随人体元气而定，必定是素体虚弱的人多有此情况，或者在产后气血双亏后更加虚弱的人也有此情况。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，这应当当作全虚证来治疗。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。这里面的复杂情况，未能用言语尽述，只有明理者才能领悟。
第二、产后不虚证，大概是因为其平日无病，或者因为年少力壮之时，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，等到一旦受孕，是在原本健康的腹中加入胎儿这个“异物”，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，才开始通畅爽快，留下的瘀滞排出去后，身体又恢复原状。普通人的生产，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，难免没有这种情况，倘若真的犯了这些病，去除病因即可痊愈；如果一概使用大补之法，身体果真能承受吗？即使是临产时带出的气血，未免暂时有所耗损，但以壅滞之余，不过是保护胎儿随从之物，该去的就去，该生的随即再生，不出数日，必然恢复，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，那么实证变实证的病，必然不可避免，轻的病会变重，重的病会危及生命。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？
第三、产后全实证，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，这是表邪的实证。还有火势旺盛的，必然口渴烦躁，或者大便干结腹胀，口鼻舌苔焦黑，酷喜冷冻饮料，眼屎多，尿道疼痛色红，脉象见洪滑，这是内热的实证。还有因郁怒触动肝气，胸胁胀痛，大便不通利，脉象弦而滑，这是气逆的实证。还有恶露未尽，瘀血上冲，心腹胀满，疼痛拒按，大便难而小便通利，这是血逆的实证。还有凡是富贵人家，保护太过，或者过用人参、白术等药，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。还有因为生产后过食，恐怕其劳累困倦，硬令勉强进食，以致停蓄不散，这是内伤的实证。以上各种证候，姑且列举重要的以展示大概。既然有表邪则不得不解表，既有火邪则不得不清热，既有内伤停滞则不得不疏通消导。而且人有强弱之分，生产有虚实之别，病有真假之异，治有逆从之变，固不可以同日而语。看《六元正纪大论》中说：“妇人怀孕，用毒药治疗怎么样？”回答说：“有病则受病，不会伤害母体，也不会伤害胎儿。”这是永恒不变的大法，又何需像这样详尽辨析呢？只是由于朱丹溪的话，人们大多偏执，所以不得不详尽阐述其说，以解除后人的疑惑。各种虚实的治疗方法详见后文条目。
The treatment of postpartum diseases: I have seen Zhu Danxi state, "Postpartum conditions require substantial tonification of Qi and Blood. Even if other miscellaneous symptoms arise, they should be treated as secondary. Most illnesses are due to Blood deficiency, and diaphoretic (sweating) methods for releasing the exterior should not be used." His intent was that since Qi and Blood are lost along with the fetus, there must be a severe deficiency. Therefore, regardless of the presenting syndrome, substantial tonification should take precedence, while other treatments can be deferred. In my early years, I genuinely admired this view. However, when I strictly applied it, I often found myself in difficulty. After several iterations and reflections, I realized that while his words had merit, they were somewhat overly absolute. Currently, the obstetrics field reveres this method. I have witnessed numerous errors caused by this approach and personally intervened to rescue patients affected by it. Thus, I dare to analyze the following points based on my own insights. It is not out of a desire to self-aggrandize or disparage sages; doing so would only invite ridicule and censure. Although I am extremely dull, I would never do such a thing. Readers are urged to deeply contemplate this meaning.
In all cases where Qi and Blood are lost after childbirth, there are indeed many deficiency syndromes. However, there are also non-deficiency cases and even complete excess cases. For these three categories, one must assess the specific syndrome and the patient's constitution to distinguish between deficiency and excess, treating them according to standard methods. One must not hold rigid preconceptions and indiscriminately apply substantial tonification, which may exacerbate pathogenic factors. Such differentiation must be precise.
First, postpartum deficiency syndromes depend on the individual's original Qi. They are common in those who were constitutionally weak prior to pregnancy, or whose condition worsens due to the loss of Qi and Blood during childbirth. Treatment requires observing the pulse in relation to the person, and interpreting symptoms based on the pulse. If the pulse energy, physical constitution, and disease presentation all indicate insufficiency, it should be treated as a total deficiency. If the physical constitution is deficient but the disease manifestation indicates excess—such as accompanying Fire pathogen, external pathogen, or food stagnation—it represents a deficiency mixed with excess. This requires careful examination and treatment. The complexities involved cannot be fully expressed in words; only those with clarity can comprehend them.
Second, postpartum non-deficiency syndromes occur in individuals who were previously healthy, were young and vigorous at the time, or possessed constitutions accustomed to hard labor and poverty. These individuals originally lacked no vitality. Upon conception, the addition of the fetus causes Qi and Blood to become congested, leading to distension and vomiting—symptoms arising from an excess condition added to a previously balanced state. After delivery, relief is felt as stagnation clears, and the body returns to its normal state. This is very common among ordinary births; where is the deficiency? However, internal injury or external contraction can still cause illness postpartum. If such pathogens are present, removing them leads to recovery. Would indiscriminate substantial tonification be bearable? Although some Qi and Blood are inevitably consumed during delivery, what remains is largely protective material associated with the fetus. What needs to go goes, and new generation occurs rapidly. Within a few days, recovery is inevitable due to natural physiological processes. Why assume all postpartum cases are deficient? For such cases, treatment must follow the specific syndrome. Insisting that postpartum always requires substantial tonification will inevitably lead to "excess reinforcing excess," worsening mild conditions and endangering severe ones. Thus, formulating theories is difficult, but applying them correctly is even harder.
Third, postpartum complete excess syndromes include external contraction of Wind-Cold, presenting with headache, fever, constipation, abdominal fullness, and a tight, rapid, surging, large, and forceful pulse—this is an exterior excess syndrome. Severe Fire excess presents with thirst, irritability, constipation, abdominal distension, blackened dry tongue and lips, intense craving for cold drinks, excessive eye discharge, painful red urination, and a surging slippery pulse—this is an interior heat excess syndrome. Liver Qi stagnation due to anger causes chest and hypochondriac distension and pain, difficult bowel movements, and a wiry slippery pulse—this is a Qi reversal excess syndrome. Incomplete expulsion of lochia with blood stasis rushing upward causes cardiac and abdominal distension, pain upon pressure, difficult defecation but free urination—this is a Blood reversal excess syndrome. Over-protection in wealthy families, or excessive use of herbs like Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu), leads to Qi congestion. Excessive consumption of sugar, alcohol, or charcoal fire causes internal heat. Using substantial tonics unnecessarily in non-deficient cases aggravates illness—these are management-induced excess syndromes. Overeating postpartum to prevent fatigue, forcing intake despite lack of appetite, leads to food retention—this is an internal injury excess syndrome. The above are merely representative examples. If there is an exterior pathogen, it must be released; if there is Fire, it must be cleared; if there is internal injury and stagnation, it must be unblocked and digested. People vary in strength, childbirth varies in deficiency/excess, diseases vary in truth/falsehood, and treatments vary in counteracting/following approaches. They cannot be discussed uniformly. As stated in the *Suwen: Liuyuan Zhengji Da Lun* ("Great Treatise on the Six Ordinances and Correct Principles"): "If a pregnant woman takes toxic medicines, what happens?" The answer is: "If there is a disease (pathology), the medicine will harm the disease but not the mother or fetus." This is an immutable principle. Why elaborate so much? It is solely because people tend to be biased by Zhu Danxi's words, necessitating detailed explanation to resolve future confusion. Detailed treatments for various deficiency and excess syndromes are provided in subsequent sections.