大全云∶夫恶露不下者，由产后脏腑劳伤，气血虚损，或胞络挟于宿冷，或产后当风
取凉，风冷乘虚而搏于血，则壅滞不宣，积蓄在内，故令恶露不下也。
薛氏曰∶前证若恶露不下，用失笑散，若气滞血凝，用花蕊石散。
一产妇患前证，服峻厉之药，恶露随下，久而昏愦，以手护其腹。余曰∶此脾气复伤作
痛，故用手护也。以人参理中汤加肉桂二剂，补之而愈。
起枕散 治产后恶血不行，心腹及儿枕作痛，甚危。
当归 白芍药（酒炒，各三钱）（此产后温行正药，白芍酒炒亦无妨） 川芎（二钱） 官桂 元
胡索 牡丹皮 蒲黄（炒） 五灵脂（炒） 没药（各一钱） 白芷
上锉，水煎，入童便，空心服。
荷叶散 治产后恶露不下，腹中疼痛，心神烦闷。
干荷叶（二两） 鬼箭羽 桃仁 刘寄奴 蒲黄（各一两）
上为粗末，每服三钱，以童便一大盏（此以心神烦闷，故不用热药，而加童便以引下），
姜二片，生地黄一分，捶碎同煎，至六分热服。
通瘀饮 治产后恶露不通，心慌昏沉，寒热交攻。
归尾 大黄（各三钱） 白术 木通（各一钱） 红花（五分） 桃仁（三十个，捣烂另入）
上用水一碗、酒一小盏煎三沸，入桃仁，再煎一沸，温服。（既用大黄，复用白术，岂得
已之心，加酒同煎，桃仁后入，又治法之妙）
广济方 疗产后恶露不下。
川牛膝 大黄（各一两） 牡丹皮 当归（各一两半） 芍药 蒲黄 桂心（各一两）
上为末，以生地黄汁调，酒服方寸匕，日二服，血下愈。（此方寒热并用，逐瘀而不峻，
妙在为末，调生地黄汁酒服）
保命集方 治妇人恶血不下。
当归 芫花（炒等分）（芫花大毒，用须斟酌）
上为细末，每服三钱，酒调下。
又用好墨醋淬末，童便、酒下。
没药丸 治产后恶露方行，而忽然断绝，骤作寒热，脐腹百脉皆痛，如锥刺非常。此由
冷热不调，或思虑动作，气所壅遏，血蓄经络。
当归（一两） 芍药 桂心（各半两） 桃仁（去皮尖，炒研） 没药（研，各二钱半） 虻虫（去
翅足，炒） 水蛭（炒焦，各三十枚）（虻虫水蛭，非万不得已不敢用）
上为末，醋糊丸，如碗豆大，醋汤下三丸。
黑龙丹
见前胞衣不下。
治恶血不下杂方
一方 用蒲黄三两炒，水三升煮取一升，顿服。
一方 用益母草捣绞汁，每服一小盅，入酒一合，温服。
一方 用麻子五升，酒一升浸一宿，明旦去滓，温服一升，不瘥再服一升。
《大全》说：恶露不下的原因，是由于产后脏腑劳损受伤，气血虚弱亏损，或者胞络夹杂有宿存的寒气，或者是产后吹风受凉，风冷之邪乘虚侵袭并与血液搏结，导致血液壅滞不通，积蓄在体内，所以导致恶露不下。
薛氏（薛己）说：上述病症如果恶露不下，使用失笑散；如果是气滞血凝，使用花蕊石散。
有一位产妇患上述病症，服用峻烈猛烈的药物后，恶露随即排出，但时间久了出现神志昏沉迷糊，用手护住腹部。我说：这是脾气再次受损引起疼痛，所以用手护住腹部。用人参理中汤加入肉桂，服用两剂，补益脾气后痊愈。
起枕散：治疗产后恶血不行，心腹及儿枕（产后子宫收缩痛或瘀血块）作痛，病情严重危急。
当归、白芍药（酒炒，各三钱）（这是产后温通运行的正药，白芍酒炒也无妨）、川芎（二钱）、官桂、元胡索、牡丹皮、蒲黄（炒）、五灵脂（炒）、没药（各一钱）、白芷。
以上药材切碎，用水煎煮，加入童便（儿童尿液），空腹服用。
荷叶散：治疗产后恶露不下，腹中疼痛，心神烦闷。
干荷叶（二两）、鬼箭羽、桃仁、刘寄奴、蒲黄（各一两）。
以上研为粗末，每次服用三钱，用一大盏童便（因为有心神烦闷的症状，所以不用热药，而加童便以引导下行），两片生姜，一分生地黄，捣碎同煎，煎至六分量时热服。
通瘀饮：治疗产后恶露不通，心慌昏沉，寒热交替发作。
归尾、大黄（各三钱）、白术、木通（各一钱）、红花（五分）、桃仁（三十个，捣烂另入）。
以上用水一碗、酒一小盏煎煮三沸，加入桃仁，再煎一沸，温服。（既然用了大黄，又复用白术，这是不得已的苦心；加酒同煎，桃仁后下，又是治法的妙处。）
广济方：治疗产后恶露不下。
川牛膝、大黄（各一两）、牡丹皮、当归（各一两半）、芍药、蒲黄、桂心（各一两）。
以上研为细末，用生地黄汁调服，酒送服一方寸匕，每日两次，血下则愈。（此方寒热并用，逐瘀而不猛烈，妙处在于研为末，调生地黄汁和酒服用。）
保命集方：治疗妇人恶血不下。
当归、芫花（炒，等分）（芫花有大毒，使用时须斟酌）。
以上研为细末，每次服用三钱，酒调服。
另外用好墨醋淬后的粉末，用童便、酒送服。
没药丸：治疗产后恶露刚开始行经，却忽然断绝，突然发生寒热，脐腹及全身经脉都疼痛，如锥刺般非常剧烈。这是由于冷热不调，或者思虑过度、动作劳累，导致气机壅遏，血液蓄积在经络中。
当归（一两）、芍药、桂心（各半两）、桃仁（去皮尖，炒研）、没药（研，各二钱半）、虻虫（去翅足，炒）、水蛭（炒焦，各三十枚）（虻虫和水蛭，除非万不得已不敢使用）。
以上研为末，用醋糊制成丸药，如豌豆大小，醋汤送服三丸。
黑龙丹
见前文“胞衣不下”条。
治疗恶血不下的杂方
一方：用蒲黄三两炒，水三升煮取一升，一次性服下。
一方：用益母草捣碎绞汁，每次服用一小盅，加入酒一合，温服。
一方：用麻子五升，酒一升浸泡一夜，次日清晨去掉渣滓，温服一升，病不好再服一升。
The *Daquan* states: The cause of retained lochia (postpartum vaginal discharge) lies in the fatigue and injury of the Zang-Fu organs after childbirth, leading to deficiency and depletion of Qi and Blood. Alternatively, the uterine collaterals may harbor pre-existing cold pathogens, or the postpartum woman may be exposed to wind and chill. Wind-cold invades through the deficiency and contends with the blood, causing stagnation and obstruction, accumulating within. Thus, lochia fails to discharge.
Xue Shi (Xue Ji) stated: For the aforementioned condition where lochia is not discharged, use Shixiao San (Pain-Stopping Powder). If there is Qi stagnation and Blood coagulation, use Huarui Shi San (Flower-Millet Stone Powder).
A parturient woman suffered from the aforementioned condition. After taking harsh and drastic medicines, her lochia was discharged, but she later became confused and lethargic, holding her abdomen with her hands. I said: "This is pain caused by further injury to the Spleen Qi, which is why she holds her abdomen." She was treated with Renshen Lizhong Tang (Ginseng and Atractylodes Decoction) plus Rougui (Cinnamon Bark), two doses. After tonification, she recovered.
Qizhen San (Pillow-Raising Powder): Treats postpartum failure of evil blood to move, causing pain in the heart/abdomen and the "child pillow" (uterine contraction pain or blood clots), a critical condition.
Danggui (Radix Angelicae Sinensis), Baishao Yao (Radix Paeoniae Alba, stir-fried with wine, 3 qian each) [This is a proper herb for warming and moving after childbirth; stir-frying Baishao with wine is acceptable], Chuanxiong (Rhizoma Chuanxiong, 2 qian), Guanzi Gui (Cortex Cinnamomi, official grade), Yuanhusuo (Rhizoma Corydalis), Mudan Pi (Cortex Moutan), Huyang (Semen Sparganii, stir-fried), Wulingzhi (Faeces Trogopterori, stir-fried), Moyao (Resina Myrrhae, 1 qian each), Baizhi (Radix Angelicae Dahuricae).
Crush these ingredients, decoct in water, add Tongbian (fresh urine of a healthy child), and take on an empty stomach.
Heye San (Lotus Leaf Powder): Treats postpartum retention of lochia, abdominal pain, and mental restlessness/distress.
Gan Heye (Folium Nelumbinis, dried, 2 liang), Guijianyu (Ramulus Corni), Taoren (Semen Persicae), Liujinu (Herba Siegesbeckiae), Huyang (Semen Sparganii, 1 liang each).
Grind into coarse powder. Take 3 qian per dose. Decoct with one large cup of Tongbian (since there is mental distress, hot herbs are avoided; Tongbian is added to guide the pathogen downward), two slices of fresh ginger, and one fen of Shengdihuang (Radix Rehmanniae Recens), crushed and decocted together. Strain and take warm when reduced to six parts.
Tongyu Yin (Blood-Unblocking Drink): Treats postpartum blockage of lochia, palpitations, dizziness/heaviness, and alternating chills and fever.
Guiwei (Radix Angelicae Sinensis tail), Dahuang (Radix et Rhizoma Rhei, 3 qian each), Baizhu (Rhizoma Atractylodis Macrocephalae), Mutong (Caulis Akebiae, 1 qian each), Honghua (Flos Carthami, 5 fen), Taoren (Semen Persicae, 30 seeds, pounded separately).
Decoct in one bowl of water and one small cup of wine for three boils. Add the pounded Taoren, boil once more, and take warm. (Using both Dahuang and Baizhu reflects a necessary compromise; adding wine and adding Taoren late demonstrates the subtlety of treatment.)
Guangji Fang (Guangji Formula): Treats postpartum retention of lochia.
Chuan Niuxi (Radix Achyranthis Bidentatae), Dahuang (Radix et Rhizoma Rhei, 1 liang each), Mudan Pi (Cortex Moutan), Danggui (Radix Angelicae Sinensis, 1.5 liang each), Shaoyao (Radix Paeoniae Alba), Huyang (Semen Sparganii), Guixin (Cortex Cinnamomi, 1 liang each).
Grind into fine powder. Mix with juice of Shengdihuang (Radix Rehmanniae Recens) and take with wine, one fangcunbi (a measure roughly equivalent to a teaspoon) per dose, twice daily. Recovery occurs when the blood is discharged. (This formula combines cold and heat properties, expelling stasis without being overly drastic. Its brilliance lies in using powder mixed with Shengdihuang juice and wine.)
Baoming Ji Fang (Formula from Bao Ming Ji): Treats retention of evil blood in women.
Danggui (Radix Angelicae Sinensis), Yuanhua (Flos Genkwa, stir-fried, equal parts) [Yuanhua is highly toxic; use with caution].
Grind into fine powder. Take 3 qian per dose, mixed with wine.
Alternatively, use high-quality ink quenched in vinegar, powdered, and taken with Tongbian and wine.
Moyao Wan (Myrrh Pill): Treats the sudden cessation of lochia shortly after it begins, accompanied by abrupt chills and fever, and severe pain in the umbilical/abdominal region and all meridians, described as piercing like needles. This is due to imbalance of cold and heat, or excessive thought and physical exertion, causing Qi obstruction and Blood accumulation in the collaterals.
Danggui (Radix Angelicae Sinensis, 1 liang), Shaoyao (Radix Paeoniae Alba), Guixin (Cortex Cinnamomi, half liang each), Taoren (Semen Persicae, skin and tip removed, stir-fried and pounded), Moyao (Resina Myrrhae, pounded, 2.5 qian each), Mengchong (Insectus Blatta, wings and feet removed, stir-fried), Shuizhi (Hirudo, stir-fried until scorched, 30 each) [Mengchong and Shuizhi should not be used unless absolutely necessary].
Grind into powder, make pills with vinegar paste, size of a pea. Take three pills with vinegar-infused water.
Heilong Dan (Black Dragon Pill)
See the section on "Retained Placenta" above.
Miscellaneous Formulas for Treating Retention of Evil Blood
Formula 1: Use 3 liang of stir-fried Huyang (Semen Sparganii). Decoct in 3 sheng of water until reduced to 1 sheng. Take in one dose.
Formula 2: Crush and squeeze the juice of Yimucao (Herba Leonuri). Take one small cup per dose, mixed with one he of wine, taken warm.
Formula 3: Soak 5 sheng of Maziren (Semen Cannabis) in 1 sheng of wine overnight. Next morning, strain the dregs. Take 1 sheng warm. If not cured, take another 1 sheng.