脾胃不健而血不生者，不可专主四物，故于此李老以四君子健脾以助生化之源，使气血自生。方中并用菟丝子、桑寄生、续断、杜仲补肾固胎，体现了安胎不离益肾的观点。气充血足，胎得气载血养，并为肾气牢系，则发育成实，顺利渡过妊娠期，足月而娩。
“轻者转动不安，重者必致伤堕”，故论治胎漏、胎动不安必须动态观察腰腹疼痛程度和阴道出血多少而辨其欲堕已堕。李老宗《医宗金鉴．胎前诸门》之法，欲堕者，力挽去势，大补气血，补肾安胎；已堕者，理气活血，固肾止血；出血不止，气血欲脱者，宜峻补气血以独参汤；恶血瘀滞不行，胁腹胀痛，实而急者，用回生丹，虚而缓者，宜益母丸。
产后病
产后病有广义、狭义之分
多数医家认为，产后病为产妇在新产后至产褥期中所发生的与分娩或产褥有关的疾病。李老则认为此义狭窄，尚不能包容临床所见之疾，他认为，凡产后所发生的一切疾病，不论其时间短暂或长久，均为本病范畴，其中包括产后常见病和产后兼见疾病，如产后血崩、产后中风、产后蓐劳等。另外，古有“小产重于大产”之说，临证确有因堕胎、小产后起居不慎或感触外邪而致生诸病者，因其与产后诸病证治、因机相类，故亦将其列入产后病论治。
产后伤寒慎用汗法
太阳病，发热、恶风、汗出、脉缓者，为中风，以桂枝汤调和营血；恶寒、无汗、脉紧者，为伤寒，以麻黄汤解表发汗。然于产后发病伤寒者，汗之宜慎，若汗之无异于伤血。古有“汗血同源”之说，正如《女科经纶》所云： “大抵产后大血空虚，汗之则筋惕肉（目闰）或郁冒昏迷……其害非轻。”故李老治疗产后伤寒不泥其证，必顾护其产后多虚的特点，无犯虚虚之戒。
附案：
武某，女，38岁。门诊号：56032。
1962年7月24日初诊：流产后3个月，正是夏季，但仍身穿棉衣，严守恶寒，少腹凉而不适，饮食无味，喜按，吃热饮食后舒服，苔薄白，脉紧。处方：
桂枝7．5克 生白芍7．5克 生姜3克 附子3克 大枣4个 炙甘草4。5克
二诊：服上药后恶寒大减，将棉衣换成毛衣。上方改附子为4．5克，再服2剂。
三诊：恶寒已除，少腹冷痛亦减大半。上方再服2剂。
按：本病为产后伤寒，表里俱寒之证。方中以桂枝汤调和营卫，解肌发表，附子既助桂枝扶卫阳发表，又温胃阳暖胞宫，达表里同治、药中病的之功。二诊增附子用药量以求药到病除．、本案用药简练而效佳，值得后人借鉴。
产后恶露不绝 治宜养血和血
产后恶露持续20天以上仍淋沥不断者，称恶露不绝．为冲任受病，气血运行失常所致。因恶露为血所化，其为病或虚损或内有瘀血，故治宜养血和血为主。临证李老多据全身症状及脉症辨其虚实寒热，孰轻孰重，或重养血，或重活血，或养血、活血并重，但宜随证随人，灵活应用，使气血调和，冲任得固，旧血祛，新血生，进而病愈。
附案：
郝某，女，30岁。门诊号：30905。
1960年6月15日初诊：患者体质素弱，产后72天，恶露不止，下腹部胀痛，乳房胀痛，苔薄白，脉沉细。处方：
当归9克 川芎6克 炒白芍7．5克 阿胶4。5克 黑艾叶4．5克 香附4．5克 五灵脂4．5克 黑蒲黄4．5克鸡内金4．5克 炙草3克
2剂，水煎服。
按：患者身体素弱，产时产后失血，虚损不足，冲任为病，故恶露不止。辨其全身症状。见下腹、乳房胀痛，为肝脉气滞血瘀．脉沉细为虚候。纵观其证，属虚重于实，故以养血为主，活血为辅。方用胶艾四物汤养血止血，失笑散活血止血，去地黄避其伤胃泥膈之弊，用香附调肝理气，内金消积，为未病先防，防其胃虚将积之虞。全方共奏养血和血之功，药虽简而功效全，有的放矢，重点突出。
产后腹痛 证多夹杂
寓攻于补 寓补于消
产后腹痛，多数医家以小腹疼痛为主症。李老宗《医宗金鉴》所训，认为本病病在上、中、下全腹，非局限于小腹也。证有虚实之分，正如《景岳全书·妇人规》中所论：“产后腹痛，最当辨察虚实……拒按而手不可近者皆实病也，宜行之散之；若喜揉按或得食稍缓者皆属虚病，不可妄用推逐之剂。”然临证纯虚纯实者少，兼寒兼热、虚实夹杂者多。治当勿忘产后，亦勿拘于产后，虚者补之，实者攻之，攻则虑其虚，补则虑其实，当随证随人施治。
附案：
案一 张某，女，38岁。门诊号：35926。
]961年8月22日初诊：产后食欲不振已2个月，胃脘不适，恶心，不欲冷饮，舌苔薄白，脉沉迟缓。处方：
党参7．5克 生白术7．5克 茯苓6克 陈皮7．5克半夏7。5克 砂仁4。5克 草蔻仁4。5克 鸡内金6克 生姜3片 炙草3克 广木香6克
2剂，水煎服。
二诊：上方服后，前症大减，守原方继服2剂，痊愈。
按：患者产后2月，胃脘不适，属产褥期所发生之腹痛证，为产后气血俱耗，复伤于饮食，以致脾虚不运，从不欲冷饮一条可知为里寒，故本病证属虚寒，其病位在脾胃，故治以香砂六君子汤以健脾益气，佐以少量草蔻健脾温脾，生姜温胃止呕，加鸡内金取其既能消食化滞又兼祛瘀除积之功，充分发挥本方无论脏腑何处有积皆能消之之功效，并照顾了产后多瘀之特点。
案二 杨某，女，30岁。门诊号：16246。
1959年4月16日初诊：患者小产后少腹长期隐痛，面色萎黄，自觉下午内热，头痛，头晕，舌苔薄白，脉细弦。处方：
丹参15克 生白芍9克 赤芍9克 归尾6克 柴胡3克 香附4．5克 五灵脂6克 生蒲黄6克 陈皮7．5克半夏7．5克 甘草4．5克
水煎服，4剂。
按：患者因故小产，胞络受损，瘀血内阻，不通则痛，故少腹疼痛；午后内热为久病瘀血已成干血之证；弦脉主肝、主痛；肝主气，血为气母，血瘀则气郁，头为诸阳之会，循经犯上故头晕头疼；面色萎黄一症为虚象，与众脉症不符。观之实证多，故治以活血止痛为主，疏肝理气为辅，待瘀滞祛而新血生，则颜面得荣，而此证尽除。加陈皮、半夏者，用以理气降逆，此所谓见肝之病，知其传脾，当先实脾之意，体现了未病先防的思想。
产后身痛当从虚治本
产后身痛为产后肢体疼痛、麻木、重着之病，因产后气血俱去筋脉，胞脉失于荣养，不荣而痛，或百节空虚之时感触风寒湿邪，留滞于经络关节，虚滞而病，其不论血虚、肾虚、外邪侵袭，皆本于气血不足。治病求于本，故凡治本病皆以补虚为主。正如《沈氏女科辑要笺正》中云： “此证多血虚宜滋养。或有风寒湿三气夹杂之痹，则养血为主，稍参宣络。”李老认为，补虚之法可直补气血或补脾资化源，补肾益精血，可多途径人手，求殊途而同归。如血虚者，以归脾汤加减；风寒者，以四物直补其血，生芪、红花补气活血以生血，并用秦艽、防风、桂枝、桑枝等祛风药，体现了“治风先治血”的思想；肾虚者，肾经虚损，当辨其阴阳，阴虚有热者，六味地黄汤加枸杞、牛膝，肾阳虚者，八味地黄汤加骨碎补、补骨脂、续断、杜仲等。
附案：
案一 王某，女，31岁。门诊号：55054。
1963年4月11日初诊：患者2个月前小产后手足麻木，乏力，少腹痛，食欲不振，夜寐多梦，苔薄，脉沉细。处方：
党参7．5克 白术7．5克 炙黄芪6克 当归7．5克茯神7．5克 远志6克 炒枣仁15克 广木香3克 元肉6克 桂枝4．5克 生白芍7．5克 炙草3克
二诊：服上方2剂后，饮食增加，夜寐改善，手足麻木、腹痛减轻。上方继服。
按：本病因小产失血，筋脉失于濡养，属血虚证。方用养血归脾健脾养血，加桂枝温通经脉，合生白芍，取其养血柔肝、利筋脉之意，又取其制桂之燥性之意。
案二 靳某，女。32岁。门诊号：37682。
1961年12月5日初诊：患者产后40天出汗受风，身痛如针刺3年，舌苔薄白，脉沉无力。处方：
丹参9克 当归9克 川芎6克 白芍7．5克 生芪4．5克 知母4。5克 羌活4．5克 独活4．5克 秦艽4．5克
3剂，水煎服。
二诊：服上方3剂后，身痛减轻。上方继服12剂，基本痊愈。
按：患者于产后40天汗出腠理开时感触风邪。邪伏经络不去，历时3年不愈，李老于此并不搜风剔邪，而以四物之归、芎、芍养血，黄芪益气以助血行，以达“血行风自灭”之功，知母制羌、独之猛，防其燥性伤阴。全方养血为主，稍佐丹参宣络，柔和祛风，顾护了产后的生理特性。
大柴胡汤治疗产褥热一得
．患者产后发烧，西医认为系产褥热，曾用退烧药及抗生素效果不著。诊之为阵发性寒热，舌苔厚黄，腹部拒按，4日未大便，系一典型的大柴胡汤证。因时在数伏之季，用增损大柴胡汤之意，在大柴胡汤原方中加入连翘、蝉蜕、僵蚕，因系产后，再加入当归、台参，1剂即减轻。此证虽为大柴胡汤证无疑，但因病人、季节等特殊原因，故在应用本方时既要考虑到产后体虚的一面，也要考虑胃肠有积滞，须通里攻下的一面，同时还要考虑季节气候的因素，因人(体质)、因季(气候)随症加味，丝丝入扣，所以能够应手而效。诊治疾病，不论哪一种情况，都应这样全面考虑。
中医瑰宝苑 《李翰卿》er
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脾胃功能虚弱导致血液生成不足的患者，不能单纯使用四物汤治疗。因此，李老在此处以四君子汤健脾益气，以助气血生化之源，使气血自然生成。方中同时使用菟丝子、桑寄生、续断、杜仲来补肾固胎，体现了安胎必须注重益肾的观点。气充血足，胎儿得到气的承载和血的滋养，并被肾气牢固系固，则能发育成熟，顺利度过妊娠期，足月分娩。
“症状轻者表现为转动不安，重者必然导致流产”，因此在论治胎漏（妊娠期间阴道少量出血）、胎动不安（妊娠期腰酸腹痛、下坠感）时，必须动态观察腰腹疼痛的程度和阴道出血的多少，以辨别是即将流产还是已经流产。李老遵循《医宗金鉴·胎前诸门》的方法：对于即将流产者，极力挽回颓势，大补气血，补肾安胎；对于已经流产者，理气活血，固肾止血；如果出血不止，气血有脱失之危者，宜用峻补气血的独参汤；如果有恶血瘀滞不行，胁腹胀痛，属于实证且急迫者，用回生丹；属于虚证且缓慢性者，宜用益母丸。
产后病
产后病有广义和狭义之分。
多数医家认为，产后病是指产妇在新产后至产褥期中所发生的与分娩或产褥期有关的疾病。李老则认为此定义狭窄，尚不能包容临床上所见的所有疾病。他认为，凡是在产后发生的一切疾病，不论时间短暂或长久，均属于本病范畴，其中包括产后常见病和产后兼见疾病，如产后血崩、产后中风、产后蓐劳等。另外，古语有“小产重于大产”的说法，临证确实存在因堕胎、小产后起居不慎或感触外邪而引发各种疾病的情况，因其与产后诸病的证治、病因病机相似，故也将其列入产后病进行论治。
产后伤寒慎用发汗法
太阳病中，出现发热、恶风、汗出、脉缓的症状，属于中风证，用桂枝汤调和营卫；出现恶寒、无汗、脉紧的症状，属于伤寒证，用麻黄汤解表发汗。然而，对于产后发病的伤寒患者，发汗法应当谨慎使用，若强行发汗无异于损伤阴血。古语有“汗血同源”之说，正如《女科经纶》所言：“大致产后大血空虚，发汗则会导致筋惕肉瞤（肌肉跳动）或郁冒昏迷……其危害不轻。”因此，李老治疗产后伤寒不拘泥于常规证候，必定顾护产后多虚的特点，不犯“虚虚”（使虚者更虚）的禁忌。
附案：
武某，女，38岁。门诊号：56032。
1962年7月24日初诊：流产后3个月，正值夏季，但仍身穿棉衣，严重畏寒，少腹发凉且不适，饮食无味，喜欢按压腹部，吃热饮食后感觉舒服，舌苔薄白，脉紧。处方：
桂枝7.5克 生白芍7.5克 生姜3克 附子3克 大枣4个 炙甘草4.5克
二诊：服用上述药物后，畏寒症状大幅减轻，将棉衣换成了毛衣。上方将附子改为4.5克，再服2剂。
三诊：畏寒已除，少腹冷痛也减轻了大半。上方再服2剂。
按语：本病为产后伤寒，属表里俱寒之证。方中以桂枝汤调和营卫，解肌发表，附子既帮助桂枝扶助卫阳以发表，又温胃阳暖胞宫，达到表里同治、药证相符的功效。二诊增加附子的用量以求药到病除。本案用药简练而疗效佳，值得后人借鉴。
产后恶露不绝 治宜养血和血
产后恶露持续20天以上仍淋漓不断者，称为恶露不绝。这是冲任二脉受病，气血运行失常所致。因为恶露由血化生，其病因或是虚损，或是内有瘀血，所以治疗应以养血和血为主。临证时李老多根据全身症状及脉象辨别虚实寒热的轻重，或侧重养血，或侧重活血，或养血、活血并重，但宜随证随人灵活应用，使气血调和，冲任得固，旧血祛除，新血生成，进而病愈。
附案：
郝某，女，30岁。门诊号：30905。
1960年6月15日初诊：患者体质素来虚弱，产后72天，恶露不止，下腹部胀痛，乳房胀痛，舌苔薄白，脉沉细。处方：
当归9克 川芎6克 炒白芍7.5克 阿胶4.5克 黑艾叶4.5克 香附4.5克 五灵脂4.5克 黑蒲黄4.5克 鸡内金4.5克 炙甘草3克
2剂，水煎服。
按语：患者身体素弱，产时产后失血，虚损不足，冲任二脉受损，故恶露不止。辨析其全身症状，见下腹、乳房胀痛，为肝脉气滞血瘀；脉沉细为虚候。纵观其证，属虚重于实，故以养血为主，活血为辅。方用胶艾四物汤养血止血，失笑散活血止血，去掉地黄以避免其伤胃碍膈的弊端，用香附调肝理气，鸡内金消积，是为未病先防，防止因胃虚导致积滞的隐患。全方共奏养血和血之功，药虽简而功效全面，有的放矢，重点突出。
产后腹痛 证多夹杂
寓攻于补 寓补于消
产后腹痛，多数医家以小腹疼痛为主症。李老遵循《医宗金鉴》的训示，认为本病病位在上、中、下全腹，并不局限于小腹。证候有虚实之分，正如《景岳全书·妇人规》中所论：“产后腹痛，最应当辨别虚实……拒绝按压且手不可近者皆属实病，宜用行气散结之法；如果喜欢揉按或进食后稍缓解者皆属虚病，不可妄用推逐之剂。”然而临证纯虚纯实者少见，兼寒兼热、虚实夹杂者多见。治疗时当不忘产后特点，也不拘泥于产后特点，虚者补之，实者攻之，攻则顾虑其虚，补则顾虑其实，应当随证随人施治。
附案：
案一 张某，女，38岁。门诊号：35926。
1961年8月22日初诊：产后食欲不振已2个月，胃脘部不适，恶心，不想喝冷饮，舌苔薄白，脉沉迟缓。处方：
党参7.5克 生白术7.5克 茯苓6克 陈皮7.5克 半夏7.5克 砂仁4.5克 草豆蔻仁4.5克 鸡内金6克 生姜3片 炙甘草3克 广木香6克
2剂，水煎服。
二诊：服用上方后，前述症状大幅减轻，守原方继服2剂，痊愈。
按语：患者产后2个月，胃脘不适，属产褥期所发生的腹痛证，为产后气血俱耗，又伤于饮食，以致脾虚不运，从“不欲冷饮”一条可知为里寒，故本病证属虚寒，病位在脾胃，故治以香砂六君子汤健脾益气，佐以少量草豆蔻健脾温脾，生姜温胃止呕，加鸡内金取其既能消食化滞又兼祛瘀除积之功，充分发挥本方无论脏腑何处有积皆能消之的功效，并照顾了产后多瘀的特点。
案二 杨某，女，30岁。门诊号：16246。
1959年4月16日初诊：患者小产后少腹长期隐痛，面色萎黄，自觉下午内热，头痛，头晕，舌苔薄白，脉细弦。处方：
丹参15克 生白芍9克 赤芍9克 归尾6克 柴胡3克 香附4.5克 五灵脂6克 生蒲黄6克 陈皮7.5克 半夏7.5克 甘草4.5克
水煎服，4剂。
按语：患者因故小产，胞络受损，瘀血内阻，不通则痛，故少腹疼痛；午后内热为久病瘀血已成干血之证；弦脉主肝、主痛；肝主气，血为气之母，血瘀则气郁，头为诸阳之会，循经犯上故头晕头疼；面色萎黄一症为虚象，与众脉症不符。观之实证多，故治以活血止痛为主，疏肝理气为辅，待瘀滞祛除而新血生成，则颜面得荣，而此证尽除。加陈皮、半夏者，用以理气降逆，此所谓“见肝之病，知其传脾，当先实脾”之意，体现了未病先防的思想。
产后身痛当从虚治本
产后身痛为产后肢体疼痛、麻木、重着之病，因产后气血俱去，筋脉、胞脉失于荣养，不荣而痛，或在百节空虚之时感触风寒湿邪，留滞于经络关节，虚滞而病，其不论血虚、肾虚、外邪侵袭，皆本于气血不足。治病求于本，故凡治本病皆以补虚为主。正如《沈氏女科辑要笺正》中云：“此证多血虚宜滋养。或有风寒湿三气夹杂之痹，则养血为主，稍参宣络。”李老认为，补虚之法可直补气血或补脾资化源，补肾益精血，可多途径入手，求殊途而同归。如血虚者，以归脾汤加减；风寒者，以四物汤直补其血，生黄芪、红花补气活血以生血，并用秦艽、防风、桂枝、桑枝等祛风药，体现了“治风先治血”的思想；肾虚者，肾经虚损，当辨其阴阳，阴虚有热者，六味地黄汤加枸杞、牛膝，肾阳虚者，八味地黄汤加骨碎补、补骨脂、续断、杜仲等。
附案：
案一 王某，女，31岁。门诊号：55054。
1963年4月11日初诊：患者2个月前小产后手足麻木，乏力，少腹痛，食欲不振，夜寐多梦，舌苔薄，脉沉细。处方：
党参7.5克 白术7.5克 炙黄芪6克 当归7.5克 茯神7.5克 远志6克 炒枣仁15克 广木香3克 元肉6克 桂枝4.5克 生白芍7.5克 炙甘草3克
二诊：服用上方2剂后，饮食增加，夜寐改善，手足麻木、腹痛减轻。上方继服。
按语：本病因小产失血，筋脉失于濡养，属血虚证。方用养血归脾汤健脾养血，加桂枝温通经脉，合生白芍，取其养血柔肝、利筋脉之意，又取其制约桂枝燥性之意。
案二 靳某，女，32岁。门诊号：37682。
1961年12月5日初诊：患者产后40天出汗受风，身痛如针刺3年，舌苔薄白，脉沉无力。处方：
丹参9克 当归9克 川芎6克 白芍7.5克 生黄芪4.5克 知母4.5克 羌活4.5克 独活4.5克 秦艽4.5克
3剂，水煎服。
二诊：服用上方3剂后，身痛减轻。上方继服12剂，基本痊愈。
按语：患者于产后40天汗出腠理开泄时感触风邪。邪伏经络不去，历时3年不愈，李老于此并不搜风剔邪，而以四物汤之当归、川芎、白芍养血，黄芪益气以助血行，以达“血行风自灭”之功，知母制约羌活、独活的猛烈之性，防其燥性伤阴。全方养血为主，稍佐丹参宣络，柔和祛风，顾护了产后的生理特性。
大柴胡汤治疗产褥热一得
患者产后发烧，西医认为系产褥热，曾用退烧药及抗生素效果不著。诊之为阵发性寒热，舌苔厚黄，腹部拒按，4日未大便，系一典型的大柴胡汤证。因时在数伏之季，用增损大柴胡汤之意，在大柴胡汤原方中加入连翘、蝉蜕、僵蚕，因系产后，再加入当归、太子参，1剂即减轻。此证虽为大柴胡汤证无疑，但因病人、季节等特殊原因，故在应用本方时既要考虑到产后体虚的一面，也要考虑胃肠有积滞，须通里攻下的一面，同时还要考虑季节气候的因素，因人（体质）、因季（气候）随症加味，丝丝入扣，所以能够应手而效。诊治疾病，不论哪一种情况，都应这样全面考虑。
For patients whose spleen and stomach are weak and fail to generate blood, one cannot solely rely on Siwu Tang (Four Substances Decoction). Therefore, Dr. Li uses Sijunzi Tang (Four Gentlemen Decoction) here to strengthen the spleen and assist the source of qi and blood generation, allowing qi and blood to generate naturally. The formula simultaneously uses Cuscutae Semen (Tusizi), Taxilli Herba (Sangjisheng), Dipsaci Radix (Xuduan), and Eucommiae Cortex (Duzhong) to tonify the kidney and secure the fetus, reflecting the view that securing the fetus must not be separated from benefiting the kidney. When qi is abundant and blood is sufficient, the fetus receives the bearing of qi and nourishment of blood, and is firmly anchored by kidney qi; thus it develops fully, smoothly passes through the gestation period, and is delivered at term.
"Symptoms that are mild manifest as restlessness during movement, while severe cases inevitably lead to miscarriage." Therefore, in treating Tai Lou (threatened abortion with vaginal bleeding) and Tai Dong Bu An (restless fetus with lower abdominal pain and backache), one must dynamically observe the degree of lower abdominal and lumbar pain and the amount of vaginal bleeding to distinguish between impending miscarriage and completed miscarriage. Dr. Li follows the method from *Yizong Jinjian · Men on Diseases Before Childbirth*: for impending miscarriage, strive to reverse the downward trend, greatly tonify qi and blood, tonify the kidney, and secure the fetus; for completed miscarriage, regulate qi and invigorate blood, secure the kidney, and stop bleeding; if bleeding persists and there is a risk of qi and blood collapse, use Dushen Tang (Single Ginseng Decoction) for vigorous tonification of qi and blood; if evil blood is stagnant and fails to move, causing distending pain in the hypochondrium and abdomen, and the condition is excess and acute, use Huisheng Dan (Revival Pill); if the condition is deficiency and chronic, Yimu Wan (Motherwort Pill) is appropriate.
Postpartum Diseases
Postpartum diseases are divided into broad and narrow senses.
Most physicians believe that postpartum diseases refer to illnesses occurring in the puerperium related to childbirth or the confinement period. Dr. Li considers this definition too narrow, as it does not encompass all clinical presentations. He believes that any disease occurring after childbirth, regardless of whether the duration is short or long, falls under this category, including common postpartum diseases and concurrent postpartum conditions, such as Postpartum Blood Collapse (Chou Beng), Postpartum Wind Stroke (Zhong Feng), and Postpartum Bedridden Asthenia (Ru Lao). Additionally, ancient texts state that "miscarriage is more serious than full-term delivery." Clinically, there are indeed cases where various diseases arise due to careless living habits or exposure to external pathogens after induced abortion or miscarriage. Since their syndrome differentiation, treatment, etiology, and pathogenesis are similar to those of postpartum diseases, they are also included in the discussion of postpartum diseases.
Caution with Diaphoresis in Postpartum Cold Damage
In Taiyang Disease, fever, aversion to wind, sweating, and a moderate pulse indicate Wind Strike (Zhong Feng), treated with Guizhi Tang (Cinnamon Twig Decoction) to harmonize Ying and Wei. Aversion to cold, absence of sweating, and a tight pulse indicate Cold Damage (Shang Han), treated with Mahuang Tang (Ephedra Decoction) to release the exterior and induce sweating. However, for postpartum patients suffering from Cold Damage, diaphoresis should be used with caution; forcing sweat is equivalent to damaging blood. Ancient texts state that "sweat and blood share the same source," just as *Nuke Jinglun* says: "Generally, after childbirth, large amounts of blood are depleted; inducing sweat may cause muscle twitching or depression-induced coma... the harm is not slight." Therefore, when treating postpartum Cold Damage, Dr. Li does not rigidly adhere to standard syndromes but always protects against the characteristic postpartum deficiency, avoiding the taboo of "making the deficient even more deficient."
Attached Case:
Wu, Female, 38 years old. Outpatient No.: 56032.
First visit on July 24, 1962: Three months after abortion, despite being summer, she still wore cotton clothes, severely suffered from aversion to cold, had a cool and uncomfortable lower abdomen, no taste for food, preferred abdominal pressure, felt comfortable after eating hot food, tongue coating was thin and white, and pulse was tight. Prescription:
Guizhi (Cinnamon Twig) 7.5g, Sheng Baishao (Raw White Peony Root) 7.5g, Shengjiang (Fresh Ginger) 3g, Fuzi (Prepared Aconite Root) 3g, Dazao (Jujube Fruit) 4 pieces, Zhigancao (Honey-fried Licorice Root) 4.5g.
Second visit: After taking the above medicine, aversion to cold significantly decreased, and she changed from cotton clothes to wool sweaters. Change Fuzi to 4.5g in the previous prescription, take another 2 doses.
Third visit: Aversion to cold has disappeared, and lower abdominal cold pain has reduced by more than half. Take the previous prescription for another 2 doses.
Commentary: This case is Postpartum Cold Damage, a syndrome of cold in both the exterior and interior. The formula uses Guizhi Tang to harmonize Ying and Wei, release the muscle layer, and expel from the exterior. Fuzi assists Guizhi in supporting Wei Yang to release the exterior, while warming Stomach Yang and warming the Uterus, achieving simultaneous treatment of exterior and interior, and precise medication matching the syndrome. In the second visit, the dosage of Fuzi was increased to ensure the disease is eradicated. The medication in this case is concise yet effective, worthy of reference by later generations.
Postpartum Lochia Discharge Continues Indefinitely: Treatment Should Focus on Nourishing and Harmonizing Blood
When lochia continues dripping for more than 20 days after childbirth, it is called "Lochia Discharge Continues Indefinitely" (Elu Bu Jue). This is caused by pathology in the Chong and Ren meridians and abnormal qi and blood circulation. Since lochia is derived from blood, its pathology involves either deficiency or internal blood stasis. Therefore, treatment should primarily focus on nourishing and harmonizing blood. Clinically, Dr. Li often differentiates the severity of deficiency, excess, cold, and heat based on systemic symptoms and pulse-syndrome combinations. He may emphasize nourishing blood, emphasizing invigorating blood, or balancing both, applying them flexibly according to the syndrome and patient. This ensures harmony of qi and blood, security of the Chong and Ren meridians, expulsion of old blood, generation of new blood, and eventual recovery.
Attached Case:
Hao, Female, 30 years old. Outpatient No.: 30905.
First visit on June 15, 1960: The patient had a constitutionally weak body. At 72 days postpartum, lochia did not stop, accompanied by distending pain in the lower abdomen and breast distension. Tongue coating was thin and white, pulse was deep and fine. Prescription:
Danggui (Angelica Sinensis Root) 9g, Chuanxiong (Ligusticum Rhizome) 6g, Chao Baishao (Stir-fried White Peony Root) 7.5g, Ejiao (Donkey-hide Gelatin) 4.5g, Hei Aiye (Black Mugwort Leaf) 4.5g, Xiangfu (Cyperus Rhizome) 4.5g, Wulingzhi (Trogopterus Dung) 4.5g, Hei Puhuang (Black Typha Pollen) 4.5g, Jineijin (Chicken Gizzard Lining) 4.5g, Zhigancao (Honey-fried Licorice Root) 3g.
2 doses, decocted in water and taken orally.
Commentary: The patient's body was constitutionally weak, and she lost blood during and after childbirth, leading to deficiency and damage to the Chong and Ren meridians, hence the continuous lochia. Analyzing her systemic symptoms, the distending pain in the lower abdomen and breasts indicates Qi stagnation and Blood stasis in the Liver meridian; the deep and fine pulse indicates deficiency. Overall, the syndrome is deficiency predominant over excess. Thus, treatment focuses on nourishing blood primarily and invigorating blood secondarily. The formula uses Jiao'ai Siwu Tang to nourish blood and stop bleeding, and Shixiao San to invigorate blood and stop bleeding. Dihuang is removed to avoid harming the stomach and obstructing the chest. Xiangfu regulates the Liver and moves Qi, and Jineijin eliminates accumulation, serving as preventive treatment for potential gastric weakness and accumulation. The entire formula achieves the effect of nourishing and harmonizing blood; although the herbs are few, the efficacy is comprehensive, targeted, and focused.
Postpartum Abdominal Pain: Syndromes Are Often Mixed
Incorporating Attack within Tonification, Incorporating Tonification within Elimination
Postpartum abdominal pain is mainly characterized by lower abdominal pain by most physicians. Following the teachings of *Yizong Jinjian*, Dr. Li believes the pathology of this disease affects the upper, middle, and lower abdomen, not limited to the lower abdomen. Syndromes are divided into deficiency and excess, as discussed in *Jingyue Quanshu · Regulations for Women*: "Postpartum abdominal pain requires careful differentiation of deficiency and excess... Rejection of pressure and inability to tolerate touch indicate excess diseases, suitable for moving and dispersing methods; preference for rubbing/pressing or relief after eating indicates deficiency diseases, and pushing/purging agents should not be used recklessly." However, purely deficient or purely excess cases are rare in clinical practice; mixed cold and heat, or deficiency-excess complex cases are common. Treatment should not forget the postpartum context nor be constrained by it. Deficiency is tonified, excess is attacked; when attacking, consider deficiency; when tonifying, consider excess. Treatment must be tailored to the syndrome and the individual.
Attached Case:
Case 1 Zhang, Female, 38 years old. Outpatient No.: 35926.
First visit on August 22, 1961: Poor appetite for 2 months postpartum, discomfort in the epigastrium, nausea, aversion to cold drinks, tongue coating thin and white, pulse deep, slow, and sluggish. Prescription:
Dangshen (Codonopsis Root) 7.5g, Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome) 7.5g, Fuling (Poria) 6g, Chenpi (Aged Tangerine Peel) 7.5g, Banxia (Pinellia Tuber) 7.5g, Sharen (Amomum Fruit) 4.5g, Caodouren (Cardamom Seed) 4.5g, Jineijin (Chicken Gizzard Lining) 6g, Shengjiang (Fresh Ginger) 3 slices, Zhigancao (Honey-fried Licorice Root) 3g, Guangmuxiang (Costus Root) 6g.
2 doses, decocted in water and taken orally.
Second visit: Previous symptoms significantly reduced after taking the prescription. Continue with the original prescription for another 2 doses, resulting in recovery.
Commentary: Two months postpartum, epigastric discomfort belongs to abdominal pain occurring during the puerperium. It results from depletion of qi and blood after childbirth, compounded by dietary injury, leading to Spleen deficiency and failure of transportation. The aversion to cold drinks indicates interior cold. Thus, the syndrome is deficiency-cold, located in the Spleen and Stomach. Treatment uses Xiangsha Liujunzi Tang to strengthen the Spleen and benefit Qi, assisted by a small amount of Caodouren to strengthen and warm the Spleen, Shengjiang to warm the Stomach and stop vomiting, and Jineijin to promote digestion, resolve stagnation, remove blood stasis, and eliminate accumulation. This fully utilizes the formula's ability to eliminate accumulation wherever it exists in the organs and tissues, while addressing the postpartum tendency toward blood stasis.
Case 2 Yang, Female, 30 years old. Outpatient No.: 16246.
First visit on April 16, 1959: Long-term dull pain in the lower abdomen after miscarriage, sallow complexion, subjective feeling of internal heat in the afternoon, headache, dizziness, tongue coating thin and white, pulse fine and wiry. Prescription:
Danshen (Salvia Miltiorrhiza Root) 15g, Sheng Baishao (Raw White Peony Root) 9g, Chishao (Red Peony Root) 9g, Guiwei (Tail of Angelica Sinensis Root) 6g, Chaihu (Bupleurum Root) 3g, Xiangfu (Cyperus Rhizome) 4.5g, Wulingzhi (Trogopterus Dung) 6g, Sheng Puhuang (Raw Typha Pollen) 6g, Chenpi (Aged Tangerine Peel) 7.5g, Banxia (Pinellia Tuber) 7.5g, Gancao (Licorice Root) 4.5g.
Decocted in water, 4 doses.
Commentary: Due to miscarriage, the uterine collaterals were damaged, causing internal blood stasis and pain due to obstruction ("blockage causes pain"), hence lower abdominal pain. Internal heat in the afternoon indicates that long-standing blood stasis has become dry blood. The wiry pulse governs the Liver and pain. The Liver governs Qi, and Blood is the mother of Qi; blood stasis leads to Qi stagnation. The head is the meeting place of all Yang meridians; when pathogens ascend along the meridians, dizziness and headache occur. The sallow complexion is a sign of deficiency, inconsistent with other pulse and syndrome signs. Observing that excess signs predominate, treatment focuses primarily on invigorating blood and relieving pain, with secondary emphasis on soothing the Liver and regulating Qi. Once stasis is resolved and new blood is generated, the face will regain luster, and the syndrome will be eliminated. Chenpi and Banxia are added to regulate Qi and descend rebellious Qi, embodying the principle of "seeing Liver disease, knowing it transmits to the Spleen, and fortifying the Spleen first," reflecting the idea of preventing disease before it arises.
Postpartum Body Pain Should Be Treated by Addressing Deficiency at the Root
Postpartum body pain refers to pain, numbness, and heaviness in the limbs after childbirth. Because qi and blood are depleted postpartum, the sinews and vessels, as well as the uterine collaterals, lose nourishment, causing pain due to lack of nourishment ("lack of nourishment causes pain"). Alternatively, during a time of emptiness in the joints, exposure to Wind, Cold, and Damp pathogens causes them to linger in the collaterals and joints, resulting in disease due to deficiency and stagnation. Regardless of whether it is Blood deficiency, Kidney deficiency, or invasion by external pathogens, the root lies in insufficient qi and blood. Seeking the root in treatment means focusing on tonifying deficiency for this disease. As stated in *Shen Shi Nu Ke Ji Yao Jian Zheng*: "This syndrome is mostly due to Blood deficiency and should be nourished. If there is Bi syndrome mixed with Wind, Cold, and Damp, nourishing Blood is primary, with slight addition of methods to unblock collaterals." Dr. Li believes that tonifying deficiency can be achieved by directly tonifying qi and blood, strengthening the Spleen to aid the source of transformation, or tonifying the Kidney to benefit essence and blood. Multiple approaches can be taken to achieve the same goal. For Blood deficiency, modify Guipi Tang (Restore the Spleen Decoction); for Wind-Cold, use Siwu Tang to directly tonify blood, add Sheng Huangqi (Raw Astragalus Root) and Honghua (Carthamus Flower) to tonify Qi and invigorate Blood to generate Blood, and use Qin Jiao (Gentian Root), Fangfeng (Saposhnikovia Root), Guizhi (Cinnamon Twig), Sangzhi (Mulberry Twig) and other Wind-expelling drugs, reflecting the thought of "treating Wind by first treating Blood"; for Kidney deficiency, differentiate Yin and Yang. For Yin deficiency with heat, use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Gouqi (Goji Berry) and Niuxi (Achyranthes Root); for Yang deficiency, use Bawei Dihuang Tang (Eight-Ingredient Rehmannia Pill) plus Gusui Bu (Drynaria Rhizome), Buguzhi (Psoralea Fruit), Xuduan (Dipsacus Root), and Duzhong (Eucommia Bark).
Attached Case:
Case 1 Wang, Female, 31 years old. Outpatient No.: 55054.
First visit on April 11, 1963: Numbness in hands and feet, fatigue, lower abdominal pain, poor appetite, and dream-disturbed sleep for 2 months after miscarriage. Tongue coating thin, pulse deep and fine. Prescription:
Dangshen (Codonopsis Root) 7.5g, Baizhu (Atractylodes Macrocephala Rhizome) 7.5g, Zhi Huangqi (Honey-fried Astragalus Root) 6g, Danggui (Angelica Sinensis Root) 7.5g, Fushen (Poria with Hostwood) 7.5g, Yuanzhi (Polygala Root) 6g, Chao Zaoren (Stir-fried Jujube Seed) 15g, Guangmuxiang (Costus Root) 3g, Yuanrou (Longan Aril) 6g, Guizhi (Cinnamon Twig) 4.5g, Sheng Baishao (Raw White Peony Root) 7.5g, Zhigancao (Honey-fried Licorice Root) 3g.
Second visit: After taking 2 doses of the above prescription, appetite increased, sleep improved, and numbness in hands/feet and abdominal pain decreased. Continue with the previous prescription.
Commentary: This case is due to blood loss from miscarriage, causing sinews and vessels to lose nourishment, belonging to Blood deficiency syndrome. The formula uses Yangxue Guipi Tang to strengthen the Spleen and nourish Blood, adds Guizhi to warm and unblock the collaterals, combined with Sheng Baishao to nourish Blood and soften the Liver, benefiting the sinews and vessels, and to counteract the drying nature of Guizhi.
Case 2 Jin, Female, 32 years old. Outpatient No.: 37682.
First visit on December 5, 1961: Exposed to Wind while sweating 40 days postpartum, experiencing stabbing body pain for 3 years. Tongue coating thin and white, pulse deep and powerless. Prescription:
Danshen (Salvia Miltiorrhiza Root) 9g, Danggui (Angelica Sinensis Root) 9g, Chuanxiong (Ligusticum Rhizome) 6g, Baishao (White Peony Root) 7.5g, Sheng Huangqi (Raw Astragalus Root) 4.5g, Zhimu (Anemarrhena Rhizome) 4.5g, Qianghuo (Notopterygium Rhizome) 4.5g, Duhuo (Angelica Pubescens Root) 4.5g, Qin Jiao (Gentian Root) 4.5g.
3 doses, decocted in water and taken orally.
Second visit: Body pain reduced after taking 3 doses of the above prescription. Continue with the previous prescription for 12 doses, resulting in near recovery.
Commentary: The patient was exposed to Wind pathogens while sweating and pores were open 40 days postpartum. Pathogens lodged in the collaterals and failed to leave, persisting for 3 years without healing. Dr. Li did not use methods to search for and eliminate Wind pathogens here. Instead, he used Danggui, Chuanxiong, and Baishao from Siwu Tang to nourish Blood, and Huangqi to tonify Qi to assist Blood circulation, achieving the effect of "when Blood flows, Wind extinguishes itself." Zhimu controls the fierce nature of Qianghuo and Duhuo, preventing their drying nature from injuring Yin. The entire formula primarily nourishes Blood, slightly assists Danshen to unblock collaterals, gently expels Wind, and protects the physiological characteristics of the postpartum state.
Insight on Using Da Chaihu Tang to Treat Puerperal Fever
The patient had fever after childbirth. Western medicine diagnosed it as Puerperal Fever. Antipyretics and antibiotics had little effect. Diagnosis revealed paroxysmal alternating chills and fever, thick yellow tongue coating, abdominal tenderness upon pressure, and constipation for 4 days. This is a typical Da Chaihu Tang (Major Bupleurum Decoction) syndrome. Since it was during the dog days of summer, the intention of Zengsun Da Chaihu Tang (Modified Major Bupleurum Decoction) was applied. To the original Da Chaihu Tang formula, Lianqiao (Forsythia Fruit), Chan Tui (Cicada Slough), and Jiangcan (Bombyx Batryticatus) were added. Because it was postpartum, Danggui (Angelica Sinensis Root) and Taishen (Pseudoginseng Root) were also added. Symptoms alleviated after just 1 dose. Although this case is undoubtedly a Da Chaihu Tang syndrome, due to special factors like the patient's condition and season, applying this formula required considering both the postpartum deficiency and the gastrointestinal stagnation requiring purgation, as well as seasonal climate factors. By adding herbs according to symptoms based on the individual (constitution) and season (climate), precisely and meticulously, effectiveness was achieved promptly. In diagnosing and treating diseases, regardless of the situation, such comprehensive consideration should always be applied.