大全云∶产后小便出血者，因气血虚而热乘之，血得热则流散，渗于胞内，故血随小便出。
薛氏曰∶一产妇尿血，面黄，胁胀少食，此肝木乘脾土也，用加味逍遥补中益气，兼服而
愈。后为怀抱不乐，食少体倦，惊悸无寐，血仍
作，用加味归脾汤二十余剂，将愈（以归脾而愈，岂尿血亦为脾不摄血欤，临症须酌之），惑
于众论，服犀角地黄汤，诸证复作，仍服前汤而愈。
血余散 治产后小便出血。（即此五方，条理有序，品味合宜，孰能遗之）
乱发不拘多少，汤洗净，烧灰，研为末，米饮调服方寸匕。
滑石散 治产后小便出血。
滑石（研） 发灰（各等分）
上为末，每服一钱，生地黄汁调下。
崔氏方 疗产后血渗入大小肠。
蜜（一大合） 车前草（捣汁，一升）
上相和煎沸，分两服。
补遗方 治产后小便出血。
川牛膝去芦，水煎服。
又方
生地黄汁（半升） 生姜自然汁（半合）
上相和服之。
薛氏曰∶产后便血，或饮食起居，或六淫七情，以致元气亏损，阳络外伤。治法∶若因膏
粱积热，用加味清胃散；若因淳酒湿毒，葛花解酲汤；若因怒动肝火，加味小柴胡汤；若因
郁结伤脾，加味归脾汤；若因思虑伤心，妙香散；若因大肠风热，四物加侧柏、槐花；若因大
肠血热，四物加芩、连、槐花；若因肠胃虚弱，六君加升麻、柴胡；若因肠胃虚寒，六君加肉
蔻、木香；若因元气下陷，补中益气加茯苓、半夏；若因胃气虚弱，用六君、升麻；若因血虚，
用四物、升麻；若因气血俱虚，用八珍、柴胡、升麻。大凡元气虚弱而发热者，皆内真寒而外
假热也，但用六君子或补中益气加炮姜，温补脾气，诸证悉退，若四肢畏冷，属阳气虚寒，急
加附子。病因多端，当临症制宜，庶无误矣。
一产妇粪后下血，诸药不愈，饮食少思，肢体倦怠，此中气虚弱，用补中益气加吴茱
萸、炒黄连五分，四剂顿止，用归脾汤治之而痊。
一妇人怒则便血，寒热口苦，或胸胁胀痛，或小腹痞闷，此肝木乘脾土，用六君子加
山栀、柴胡而愈，又用补中益气加味逍遥二药而不复作。
一妇人久下血在粪前，属脾胃虚寒，用补中益气汤加连炒吴萸一钱，数剂稍效，乃加生
吴萸五分，数剂而愈。
一产妇大便后血，口干饮汤，胸胁膨满，小腹闷坠，内热晡热，食少体倦，日晡面赤，洒
淅恶寒，此脾肺气虚，先用六君加炮姜、木香渐愈，用补中益气将愈，用归脾汤而愈。后因
劳役兼怒气，发热血崩，夜间谵语，此热入血室，用加味小柴胡二剂而热退，用补中益气而
血止，用逍遥散、归脾汤调理而康。
加味清胃散 治因膏粱积热便血。
当归身（酒浸，一钱） 黄连 生地黄（酒洗） 升麻（各二钱） 牡丹皮（一钱半） 石膏（三钱）
上锉，水煎服。
一方无石膏，有犀角、连翘、甘草。
的奇散 治产后恶露不行，余血渗入大肠，洞泻不禁，下青黑物，亦验。
用荆芥大者四五穗，于盏内燃火烧成灰，不得犯油火，入麝香少许，研匀，沸汤一两呷调下。此药虽
微，能愈大病，幸勿忽之。（妙理入神）
《医宗必读》中说：产后出现小便出血，是因为气血虚弱，热邪乘虚而入，血液受热则流动散乱，渗入膀胱内，所以血液随着小便排出。
薛己说：有一位产妇出现尿血，面色萎黄，胁肋胀满，食欲减退，这是肝木克制脾土的表现，使用加味逍遥散和补中益气汤同时服用而痊愈。后来因为心情抑郁不乐，导致食欲不振、身体疲倦、惊悸失眠，尿血再次发作，使用加味归脾汤二十多剂后即将痊愈（既然用归脾汤治愈了，难道尿血也是由于脾不统血吗？临证时需要斟酌），但因受众人言论迷惑，服用了犀角地黄汤，各种症状又复发，仍然服用之前的方剂才痊愈。
血余散：治疗产后小便出血。（即上述五个方子，条理清晰有序，药味搭配适宜，谁能将其遗漏呢？）
取乱发不论多少，用热水洗净，烧成灰，研磨成粉末，用米汤调服一方寸匕的量。
滑石散：治疗产后小便出血。
滑石（研细） 发灰（各等分）
以上药物研为末，每次服用一钱，用生地黄汁送服。
崔氏方：治疗产后血液渗入大小肠。
蜂蜜（一大合） 车前草（捣取汁液，一升）
将两者混合煎至沸腾，分两次服用。
另一个方子：
生地黄汁（半升） 生姜自然汁（半合）
将两者混合服用。
薛己说：产后便血，可能由于饮食起居不当，或六淫七情致病，导致元气亏损，阳络受损。治疗方法：如果是因为膏粱厚味积热，使用加味清胃散；如果是因为醇酒湿毒，使用葛花解酲汤；如果是因为愤怒引动肝火，使用加味小柴胡汤；如果是因为郁结损伤脾脏，使用加味归脾汤；如果是因为思虑损伤心脏，使用妙香散；如果是因为大肠风热，使用四物汤加侧柏叶、槐花；如果是因为大肠血热，使用四物汤加黄芩、黄连、槐花；如果是因为肠胃虚弱，使用六君子汤加升麻、柴胡；如果是因为肠胃虚寒，使用六君子汤加肉豆蔻、木香；如果是因为元气下陷，使用补中益气汤加茯苓、半夏；如果是因为胃气虚弱，使用六君子汤、升麻；如果是因为血虚，使用四物汤、升麻；如果是因为气血俱虚，使用八珍汤、柴胡、升麻。大凡元气虚弱而发热者，都是内真寒而外假热，只需用六君子汤或补中益气汤加炮姜，温补脾气，各种症状都会消退；如果四肢畏冷，属于阳气虚寒，急需加入附子。病因多种多样，应当根据临证情况灵活制宜，这样才不会出错。
一位产妇在排便后下血，服用多种药物无效，饮食减少，肢体倦怠，这是中气虚弱，使用补中益气汤加吴茱萸、炒黄连五分，四剂后血止，再用归脾汤治疗而痊愈。
一位妇人发怒时便血，伴有寒热、口苦，有时胸胁胀痛，有时小腹痞闷，这是肝木克制脾土，使用六君子汤加山栀、柴胡而痊愈，后又服用补中益气汤和加味逍遥散两种药物，病情未再复发。
一位妇人长期在大便前下血，属于脾胃虚寒，使用补中益气汤加连炒吴茱萸一钱，数剂后稍见好转，于是加入生吴茱萸五分，数剂后痊愈。
一位产妇大便后出血，口干想喝汤水，胸胁膨满，小腹闷坠感，内有热感且傍晚发热，食欲减退，身体疲倦，傍晚面部发红，怕冷发抖，这是脾肺气虚，先用六君子汤加炮姜、木香逐渐好转，再用补中益气汤接近痊愈，最后用归脾汤而痊愈。后来因为劳累兼怒气，引发发热和血崩，夜间胡言乱语，这是热入血室，使用加味小柴胡汤两剂后热退，再用补中益气汤使血止，最后用逍遥散、归脾汤调理而康复。
加味清胃散：治疗因膏粱积热导致的便血。
当归身（酒浸，一钱） 黄连 生地黄（酒洗） 升麻（各二钱） 牡丹皮（一钱半） 石膏（三钱）
以上药物切碎，用水煎服。
的奇散：治疗产后恶露不行，余血渗入大肠，腹泻不止，排出青黑色物体，也有效。
取大的荆芥四五穗，在盏中点燃烧成灰，不得沾染油火，加入少许麝香，研磨均匀，用一两沸水调服。此药虽然轻微，能治愈大病，希望不要忽视它。（其中的妙理神妙无比）
The *Yi Zong Bi Du* states: Postpartum hematuria (blood in urine) occurs due to deficiency of Qi and Blood, allowing heat pathogens to invade. When blood is affected by heat, it flows and scatters, seeping into the bladder (uterus/bladder area), causing blood to be discharged with urine.
Xue Ji stated: A postpartum woman presented with hematuria, sallow complexion, distension in the hypochondrium, and poor appetite. This was Liver Wood overacting on Spleen Earth. She was treated with Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) taken concurrently, resulting in a cure. Later, due to emotional depression, she experienced poor appetite, fatigue, palpitations, and insomnia, and the hematuria recurred. She was treated with Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) for more than twenty doses, nearing recovery. (Since Gui Pi Tang cured this, does hematuria also stem from the Spleen's failure to control blood? Clinical judgment is required here.) However, confused by others' opinions, she took Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction), causing all symptoms to recur. She recovered only after resuming the previous prescription.
Xue Yu San (Hair Ash Powder): Treats postpartum hematuria. (These five formulas are well-organized and appropriately composed; who could overlook them?)
Take any amount of loose hair, wash clean with hot water, burn to ash, grind into powder, and take one cun bi (a square-inch measure) mixed with rice water.
Hua Shi San (Talcum Powder): Treats postpartum hematuria.
Hua Shi (Talcum, ground) and Fa Hui (Hair Ash) in equal parts.
Grind into powder. Take one qian per dose, administered with juice of Sheng Di Huang (Fresh Rehmannia Root).
Cui Shi Fang (Dr. Cui's Formula): Treats postpartum blood seeping into the large and small intestines.
Mi (Honey, one da he) and Che Qian Cao (Plantago Leaf/Seed Juice, one sheng).
Mix and boil until bubbling. Divide into two doses.
Bu Yi Fang (Supplementary Formula): Treats postpartum hematuria.
Chuan Niu Xi (Cyathulae Radix, remove rhizome), decoct in water and drink.
Another formula:
Sheng Di Huang Zhi (Juice of Fresh Rehmannia Root, half sheng) and Sheng Jiang Zi Ran Zhi (Natural Juice of Fresh Ginger, half he).
Mix and administer.
Xue Ji stated: Postpartum hematochezia (blood in stool) may result from improper diet or lifestyle, or pathogenic factors of the Six Excesses and Seven Emotions, leading to depletion of Yuan Qi (Original Qi) and injury to Yang collaterals. Treatment methods: If caused by accumulation of heat from rich foods, use Jia Wei Qing Wei San (Modified Stomach-Clearing Powder); if caused by damp-toxin from alcohol, use Ge Hua Jie Cheng Tang (Ardisia Flower Decoction to Resolve Intoxication); if caused by anger stirring Liver Fire, use Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction); if caused by constraint injuring the Spleen, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction); if caused by overthinking injuring the Heart, use Miao Xiang San (Miraculous Incense Powder); if caused by Wind-Heat in the Large Intestine, use Si Wu Tang (Four Substances Decoction) plus Ce Bai Ye (Biota Tops) and Huai Hua (Sophora Flower); if caused by Blood-Heat in the Large Intestine, use Si Wu Tang plus Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), and Huai Hua; if caused by Spleen-Stomach weakness, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix); if caused by Spleen-Stomach deficiency-cold, use Liu Jun Zi Tang plus Rou Dou Kou (Myristica Seed) and Mu Xiang (Aucklandiae Radix); if caused by sinking of Yuan Qi, use Bu Zhong Yi Qi Tang plus Fu Ling (Poria) and Ban Xia (Pinellia Tuber); if caused by weak Stomach Qi, use Liu Jun Zi Tang and Sheng Ma; if caused by Blood deficiency, use Si Wu Tang and Sheng Ma; if caused by dual deficiency of Qi and Blood, use Ba Zhen Tang (Eight Treasures Decoction), Chai Hu, and Sheng Ma. Generally, fever due to weak Yuan Qi indicates true cold inside and false heat outside; treat only with Liu Jun Zi Tang or Bu Zhong Yi Qi Tang plus Pao Jiang (Prepared Ginger) to warm and tonify Spleen Qi, after which all symptoms will subside. If limbs are cold, indicating Yang deficiency-cold, urgently add Fu Zi (Aconite Lateral Root). Etiologies are diverse; clinical flexibility is essential to avoid errors.
A postpartum woman passed blood after defecation; various medicines failed. She had poor appetite and limb fatigue, indicating weak Middle Qi. She was treated with Bu Zhong Yi Qi Tang plus Wu Zhu Yu (Evodiae Fructus) and Chao Huang Lian (Stir-fried Coptis Rhizome, 5 fen). The bleeding stopped abruptly after four doses. She was then treated with Gui Pi Tang and recovered.
A woman experienced hematochezia upon anger, accompanied by alternating chills and fever, bitter taste, sometimes chest/hypochondriac distension/pain, or abdominal fullness. This was Liver Wood overacting on Spleen Earth. She was cured using Liu Jun Zi Tang plus Shan Zhi (Gardeniae Fructus) and Chai Hu. Subsequent treatment with Bu Zhong Yi Qi Tang and Jia Wei Xiao Yao San prevented recurrence.
A woman had long-term bleeding before defecation, attributed to Spleen-Stomach deficiency-cold. She was treated with Bu Zhong Yi Qi Tang plus Lian Chao Wu Zhu Yu (Continuously Stir-fried Evodiae Fructus, 1 qian). After several doses showing slight improvement, raw Wu Zhu Yu (5 fen) was added, curing her after several more doses.
A postpartum woman had bleeding after defecation, dry mouth desiring soup, chest/hypochondriac distension, abdominal heaviness/dragging sensation, internal heat, afternoon fever, poor appetite, fatigue, evening facial redness, and aversion to cold/shivering. This was Spleen-Lung Qi deficiency. Initially treated with Liu Jun Zi Tang plus Pao Jiang and Mu Xiang for gradual improvement, then Bu Zhong Yi Qi Tang for near recovery, and finally Gui Pi Tang for complete cure. Later, due to labor and anger, she developed fever and metrorrhagia (flooding), with nighttime delirium, indicating Heat entering the Blood Chamber. She was treated with Jia Wei Xiao Chai Hu Tang for two doses to resolve fever, followed by Bu Zhong Yi Qi Tang to stop bleeding, and regulated with Xiao Yao San and Gui Pi Tang for recovery.
Jia Wei Qing Wei San (Modified Stomach-Clearing Powder): Treats hematochezia due to accumulation of heat from rich foods.
Dang Gui Shen (Angelicae Sinensis Radix body, wine-soaked, 1 qian), Huang Lian (Coptis Rhizome), Sheng Di Huang (Rehmanniae Radix, wine-rinsed), Sheng Ma (Cimicifugae Rhizoma, each 2 qian), Mu Dan Pi (Moutan Cortex, 1.5 qian), Shi Gao (Gypsum Fibrosum, 3 qian).
Cut into pieces, decoct in water, and drink.
Another version omits Shi Gao but includes Xi Jiao (Rhinoceros Horn - note: now substituted with Water Buffalo Horn in modern practice), Lian Qiao (Forsythiae Fructus), and Gan Cao (Licorice Root).
De Qi San (Unique Miracle Powder): Treats postpartum lochia retention, residual blood seeping into the Large Intestine, incontinence of diarrhea, passing green-black matter. Also effective.
Use 4-5 spikes of large Jing Jie (Schizonepetae Herba), burn to ash in a cup without oil/fire contact. Add a small amount of She Xiang (Moschus), grind evenly, and take with one liang of boiling water. Though this medicine seems minor, it can cure major diseases; do not neglect it. (Its profound principles are divine.)