郭稽中曰∶产后四肢浮肿者,败血乘虚停积,循经流入四肢,留淫日深,却还不得,腐坏
如水,故令面黄,四肢浮肿,医人不识,便作水气治之,投以甘遂、大戟等药,以导其水。夫产
后必虚,又以药虚之,是谓重虚,往往多致夭枉,但服小调经散,血行肿消则愈。
陈无择曰∶产后浮肿多端,有自怀妊肿至产后不退者,亦有产后失于将理,外感寒暑风
湿,内则喜怒忧惊,血与气搏,留滞经络。气分血分,不可不辨(气分者,先肿而后经血不行,
血分者,先经血不行而后肿也,故治法不同),要当随所因脉证治之。小调经散治血分固效,
但力浅难凭,不若吴茱萸汤枳术汤夺魂散大调经散,皆要药也。
又论曰∶夫产后劳伤血气,腠理虚,则为风邪所乘,邪搏于气,不得宣越,故令虚肿轻
浮,是邪搏于气,气肿也。若皮肤如熟李状,则变为水肿。气肿者,发汗即愈;水肿者,利小便
瘥也。洁古云∶如产后风寒在表,面目四肢浮肿,宜局方七圣丸,白汤下,日加,以利为度。
如浮肿至膝,喘嗽,加木香,槟榔倍之,谓气多也;如浮肿,又头痛昏冒,加羌活、川芎,谓风
多也;如只浮肿,止七圣丸本方服。
东垣云∶中满分消丸(见肿满门)用四物汤吞之。
丹溪云∶产后肿,必用大补气血为主,少佐以苍术茯苓,使水自利。
薛氏曰∶前证若寒水侮土,宜养脾肺,若气虚浮肿,宜益脾胃,若水气浮肿,宜补中益
气,当参杂证本门主治。
一产妇饮食少思,服消导之剂,四肢浮肿。余谓中气不足,朝用补中益气汤,夕用六
君子汤而愈。后因怒腹胀,误服沉香化气丸,吐泻不止,饮食不进,小便不利,肚腹四肢浮
肿,用金匮加减肾气丸而愈。(以中气虚误服消克药所致,故宜补土为主,金匮丸者,以补
火生土,而有水郁折之之法存焉)
一产妇泄泻,四肢面目浮肿,喘促恶寒。余谓脾肺虚寒,用六君加姜桂而泄泻愈,用补
中益气而脾胃健。
杜氏治张宣徽侍宠产后半月,忽患浮肿,急召产科医治,经半月不瘥,病势转剧,召杜
治之,杜至,曰∶诸医作何病。张曰∶皆云水气浮肿。杜曰∶非也,且水气发咳嗽,小便涩是也
(审水气法,如咳嗽小便涩者,乃因失降下之令)。今爱宠小便不涩,不作咳嗽,惟手足寒,
乃血脏虚,气塞不通流,面生浮肿。遂用益血和气药治之,旬日病去七八,经半月痊愈。所
用之药乃灵苑方牡丹散也,其方云∶治血脏风虚冷。今产科家多用此药治产后诸病如神,更
名捐金汤者是也,(牡丹散见血晕)
一妇产后四肢浮肿,寒热往来,盖因败血流入经络,渗入四肢,气喘咳嗽,胸膈不利,口
吐酸水,两胁疼痛,遂用旋复花汤,微汗渐解,频服小调经散,用泽兰根煎汤调下,肿气渐消。
大调经散 治产后肿满,喘急烦渴,小便不利。
方见前往来寒热。
小调经散 治败血乘虚停积,流入经络,四肢浮肿。
没药 琥珀 桂心 芍药 当归(各一钱) 细辛 麝香(各五分)
上为细末,每服五分,姜汁温酒各少许调服。
经验方 治产后遍身青肿疼痛,及产后血水疾。(青肿者,血瘀也,以血化为水,故用
此,乃简便良法)
干漆 大麦芽(各等分)
上各为细末,以新瓦罐子中铺一重麦 ,一重干漆,如此填满,用盐泥固济,火 通赤,
放冷,研为散,但是产后诸疾,热酒调下二钱。
白术汤 治心腹坚大如盘,边如旋盘,水饮所作,名曰气分。(此仲景方也,易老变而为丸)
枳实(一两半) 白术(三两)
上 咀,每服四钱,水一盏半煎至七分,去滓,温服,腹中软,即当散也。
正脾散 治产后通身浮肿,及治妇人大病后脾气虚弱,中满腹胀等症。(此行气法,谓
之正脾者,气行而脾得运也)
蓬莪术 香附子(童便浸) 茴香 甘草(炙) 陈皮(各等分)
上为细末,每服二钱,灯心草木通汤下。
小调中汤 治产后一切浮肿,但用此药,无不效者。(补脾胃,行瘀血,妙在调服法)
茯苓 当归 白芍药 陈皮(各一钱) 白术(一钱半)
上切作一剂,煎汤调后药未∶
没药 琥珀 桂心(各一钱) 细辛 麝香(各五分)
橘皮酒 治产后肌浮,以此行气。
橘皮为末,每服二钱,酒调服。
丹溪方 妇人产后浮肿,小便少,口渴,恶寒无力,脉皆沉,此体虚而有湿热之积,必
上焦满闷,宜补中导水行气可也。
白术(二两半) 陈皮(一两) 川芎(半两) 木通(六钱) 茯苓(三钱)
上用水煎,下与点丸二十五丸。(黄芩为末糊丸,名与点丸,亦名清金丸。此方以白术
为君,陈皮为佐,川芎调血,通苓利水,与点丸清金)
夺魂散 治产后虚肿满促,利小便则愈。(此方甚奇,大概中宫有湿痰留积,致小便不
利者宜之,犹服二陈汤,能使大便润而小便长也)
生姜(三两,取汁) 白面(三两) 大半夏(七枚)
上以生姜汁溲面,裹半夏为七饼子,煨焦熟为末,水调一盏,小便利为效。
张氏方 治产后血虚,风肿水肿。
泽兰叶 防己(各等分)
上为末,每服二钱,温酒调下,不饮者醋汤调亦可,(泽兰之性,能通瘀血,利水道,同
防己则又为利水绝药矣)
汉防己散 治产后风虚气壅,上攻头面浮肿。(此药虚人戒服,泻肺利水之急剂也)
汉防己 猪苓 枳壳 桑白皮(各一两) 商陆 甘草(各七钱半)
上为粗末,每服四钱,生姜三片,水煎,空心温服。
七圣丸 治产后风气壅盛,面目四肢浮肿,涕唾稠粘,咽干口燥,心胁胀满,大便秘,
小便赤,睡卧不安。(此方为实热者设)
肉桂(去皮) 川芎 大黄(酒蒸) 槟榔 木香(各半两) 羌活 郁李仁(去皮,各一两)
上为末,炼蜜丸如桐子大,每服十五丸。
食后温汤下。山岚瘴地最宜服,量虚实加减。如浮肿,又头痛昏冒,加羌活川芎,谓风多也,
如只浮肿,止用本方。
加味吴茱萸汤 治妇人脏气本虚,宿挟风冷,胸膈满痛,腹胁绞刺,呕吐恶心,饮食减
少,身面虚浮,恶寒战栗,或泄泻不止,少气羸困,及因生产脏气暴虚,邪冷内胜,宿疾转增。
(此治风寒之剂。本虚便是寒气,故用温剂)
吴茱萸(一两半) 干姜 桂心 防风 细辛 当归 牡丹皮 赤茯苓 半夏 桔梗 麦门冬
甘草(各半两)
上为粗末,每服四钱,水煎,食前热服。
加味八物汤 治产后遍身浮肿,气急潮热。
人参 白茯苓 熟地黄 小茴香(各三钱) 白术 川芎(各四钱) 当归 白芍 香附子(各五钱)
柴胡 黄芩 甘草(各一钱)
上锉散,分作六七服,每服加生姜三片,水煎,空心热服,尽此药,方服调经丸。若肚
痛,加玄胡索、干漆、枳壳各三钱;若呕吐恶心,加良姜、砂仁各二钱;若手足麻痹,加肉桂
一钱半;若咳嗽,加五味子、款冬花、杏仁。
加减金匮肾气丸 治肺肾虚,腰重脚肿,小便不利,或肚腹肿胀,四肢浮肿,或喘急痰
盛,已成蛊证,其效如神,此证多因脾胃虚弱,治失其宜,元气复伤而变证者,非此药不能
救。(夫土为防水之堤,肾为置水之器,肾为胃之关,而开窍于二阴,土恶湿,肾恶燥,而命门
之气藏于肾,为生土之母,主化津液以利膀胱,故肾气盛则土旺而水有所堤,自无泛溢之
患,若火衰则气不化而水溢,溢则湿土卑滥而妄行矣,故有水胀之病。此方既能益火以生
土,又能化气以利水,此其所以为治肿之圣药也,若于热胀,又非所宜)
熟地黄(四两,酒拌,捣膏) 白茯苓(三两) 山药 山茱萸 泽泻 牡丹皮 牛膝 车前子
官桂(各一两) 附子(半两)
上为末,和地黄,炼蜜丸如桐子大,每服七八十丸,空心白汤下。
郭稽中说:产后出现四肢浮肿,是因为败血(产后未能排出的瘀血)乘虚停滞积聚,顺着经络流入四肢,停留浸淫日久,无法回流消散,腐败变质如同水液一样,所以导致面色发黄、四肢浮肿。医生如果不认识这是瘀血所致,便当作水气病来治疗,使用甘遂、大戟等药物来导泻水湿。因为产后身体必然虚弱,再用药物攻伐使其更虚,这叫做“重虚”,往往会导致死亡。只要服用小调经散,血液运行通畅,肿胀消退即可痊愈。
陈无择说:产后浮肿原因多样,有的从怀孕时开始肿直到产后也不退;也有的是产后调理不当,外感寒暑风湿,内因喜怒忧惊,导致血与气相互搏结,留滞于经络。气分和血分的浮肿不可不加以辨别(气分浮肿,是先出现肿胀而后月经停止;血分浮肿,是先月经停止而后出现肿胀,所以治疗方法不同),应当根据病因和脉证进行治疗。小调经散治疗血分浮肿固然有效,但药力较浅难以完全依赖,不如吴茱萸汤、枳术汤、夺魂散、大调经散,这些都是关键药物。
又有论述说:产后劳损伤及气血,腠理(皮肤毛孔及其间隙)空虚,则被风邪侵袭,邪气与气相搏,不能宣发透越,所以导致虚肿轻浮,这是邪气搏结于气,属于气肿。如果皮肤像熟李子那样光亮紧绷,则转变为水肿。气肿者,通过发汗即可痊愈;水肿者,通过利小便即可治愈。洁古说:如果是产后风寒在表,导致面目四肢浮肿,适宜服用局方七圣丸,用白开水送服,每日逐渐增加剂量,以大便通利为度。如果浮肿延伸至膝盖,伴有气喘咳嗽,应加倍木香、槟榔,这是因为气滞较多;如果浮肿,又伴有头痛昏沉,应加羌活、川芎,这是因为风邪较多;如果只是浮肿,只服用七圣丸原方即可。
朱丹溪说:产后浮肿,必须以大补气血为主,稍加苍术、茯苓,使水湿自然排出。
薛己说:上述病症,如果是寒水侮土(肾水反克脾土),宜调养脾肺;如果是气虚浮肿,宜补益脾胃;如果是水气浮肿,宜补中益气,应当参考杂病各门类的主治方法。
有一位产妇饮食减少且思食无力,服用消导类药物后,出现四肢浮肿。我认为这是中气不足,早晨服用补中益气汤,晚上服用六君子汤而痊愈。后来因愤怒导致腹胀,误服沉香化气丸,导致呕吐腹泻不止,饮食不进,小便不利,肚腹四肢浮肿,使用金匮加减肾气丸而痊愈。(因为中气虚弱误服消克药物所致,所以应以补脾土为主,金匮丸能补火生土,并含有治水郁的方法)。
另一位产妇泄泻,四肢面目浮肿,气喘怕冷。我认为这是脾肺虚寒,使用六君子汤加生姜、肉桂而泄泻痊愈,使用补中益气汤而脾胃健运。
杜氏治疗张宣徽的宠妾,产后半个月,忽然患浮肿,急忙召产科医生医治,经过半个月未愈,病情加重,召杜氏诊治。杜氏到达后问:“其他医生诊断为什么病?”张氏说:“都说是水气浮肿。”杜氏说:“不对。水气病发作时会咳嗽,小便涩痛(判断水气病的方法,如咳嗽且小便涩痛的,是因为失于降下之令)。现在这位宠妾小便不涩,也不咳嗽,只是手脚寒冷,这是血脏(肝心等藏血之脏)虚弱,气机堵塞不通流,面部产生浮肿。”于是使用益血和气的药物治疗,十天病去七八,半个月痊愈。所用的药是灵苑方的牡丹散,该方记载:治疗血脏风虚冷。现在产科多用此药治疗产后各种疾病,效果神奇,改名为捐金汤(牡丹散见血晕门)。
一位产妇产后四肢浮肿,寒热往来,这是因为败血流入经络,渗入四肢,气喘咳嗽,胸膈不畅,口吐酸水,两胁疼痛,于是使用旋复花汤,微微出汗后逐渐缓解,频繁服用小调经散,用泽兰根煎汤调服,肿气逐渐消退。
大调经散:治疗产后肿满,气喘急促烦渴,小便不利。方剂见前文往来寒热条下。
小调经散:治疗败血乘虚停积,流入经络,四肢浮肿。
药材:没药、琥珀、桂心、芍药、当归(各一钱),细辛、麝香(各五分)。
制法用法:研为细末,每次服用五分,用姜汁和温酒少许调服。
经验方:治疗产后遍身青肿疼痛,以及产后血水疾。(青肿是血瘀的表现,因为血化为水,所以用此方,是简便良法)。
药材:干漆、大麦芽(各等分)。
制法用法:分别研为细末,在新瓦罐中铺一层麦芽,一层干漆,如此填满,用盐泥密封固定,用火煅烧至通红,放冷后研为散剂,凡是产后各种疾病,用热酒调服二钱。
白术汤:治疗心腹坚硬肿大如盘,边缘如旋转之盘,由水饮引起,名叫气分。(这是张仲景的方子,易老将其变为丸剂)。
药材:枳实(一两半)、白术(三两)。
制法用法:切碎,每次服用四钱,用水一盏半煎至七分,去渣,温服,腹部变软,胀满即散。
正脾散:治疗产后全身浮肿,以及妇女大病后脾气虚弱,中满腹胀等症状。(这是行气的方法,称为正脾,是因为气行则脾得运化)。
药材:蓬莪术、香附子(童便浸泡)、茴香、甘草(炙)、陈皮(各等分)。
制法用法:研为细末,每次服用二钱,用灯心草、木通煎汤送服。
小调中汤:治疗产后一切浮肿,只用此药,没有无效的。(补脾胃,行瘀血,妙在调服方法)。
药材:茯苓、当归、白芍药、陈皮(各一钱),白术(一钱半)。
制法用法:切作一剂,煎汤调服以下药物:没药、琥珀、桂心(各一钱),细辛、麝香(各五分)。
橘皮酒:治疗产后肌肤浮肿,以此行气。
药材:橘皮研为末,每次服用二钱,用酒调服。
丹溪方:妇人产后浮肿,小便少,口渴,恶寒无力,脉象皆沉,这是体质虚弱而有湿热积滞,必然上焦满闷,宜补中、导水、行气。
药材:白术(二两半)、陈皮(一两)、川芎(半两)、木通(六钱)、茯苓(三钱)。
制法用法:用水煎煮,送服点丸二十五丸。(黄芩研末糊丸,名叫点丸,也叫清金丸。此方以白术为君药,陈皮为佐药,川芎调血,木通茯苓利水,点丸清金)。
夺魂散:治疗产后虚肿满促,利小便则痊愈。(此方很奇特,大概是因为中宫有湿痰留积,导致小便不利的情况适宜使用,就像服用二陈汤,能使大便润而小便长也)。
药材:生姜(三两,取汁)、白面(三两)、大半夏(七枚)。
制法用法:用生姜汁和面,包裹半夏做成七个饼子,煨烤至焦熟后研为末,用水调服一盏,以小便利为效验。
张氏方:治疗产后血虚,风肿水肿。
药材:泽兰叶、防己(各等分)。
制法用法:研为末,每次服用二钱,用温酒调服,不饮酒的人用醋汤调服也可以。(泽兰的性质,能通瘀血,利水道,同防己一起则是利水的绝妙药物)。
汉防己散:治疗产后风虚气壅,上攻头面浮肿。(此药体虚之人忌服,是泻肺利水的急剂)。
药材:汉防己、猪苓、枳壳、桑白皮(各一两),商陆、甘草(各七钱半)。
制法用法:研为粗末,每次服用四钱,加生姜三片,水煎,空腹温服。
七圣丸:治疗产后风气壅盛,面目四肢浮肿,涕唾稠粘,咽干口燥,心胁胀满,大便秘结,小便赤黄,睡卧不安。(此方是为实热证设立的)。
药材:肉桂(去皮)、川芎、大黄(酒蒸)、槟榔、木香(各半两),羌活、郁李仁(去皮,各一两)。
制法用法:研为末,炼蜜丸如梧桐子大,每次服用十五丸,食后用温开水送服。山岚瘴气之地最适宜服用,根据虚实加减。如果浮肿,又头痛昏沉,加羌活、川芎,这是因为风多;如果只浮肿,只用本方。
加味吴茱萸汤:治疗妇人脏气本虚,宿挟风冷,胸膈满痛,腹胁绞刺,呕吐恶心,饮食减少,身面虚浮,恶寒战栗,或泄泻不止,少气羸困,以及因生产导致脏气暴虚,邪冷内胜,宿疾转增。(这是治疗风寒的方剂。本虚即是寒气,所以用温剂)。
药材:吴茱萸(一两半),干姜、桂心、防风、细辛、当归、牡丹皮、赤茯苓、半夏、桔梗、麦门冬、甘草(各半两)。
制法用法:研为粗末,每次服用四钱,水煎,食前热服。
加味八物汤:治疗产后遍身浮肿,气急潮热。
药材:人参、白茯苓、熟地黄、小茴香(各三钱),白术、川芎(各四钱),当归、白芍、香附子(各五钱),柴胡、黄芩、甘草(各一钱)。
制法用法:锉散,分作六七次服用,每次加生姜三片,水煎,空腹热服,服完此药后,再服用调经丸。如果腹痛,加玄胡索、干漆、枳壳各三钱;如果呕吐恶心,加良姜、砂仁各二钱;如果手足麻痹,加肉桂一钱半;如果咳嗽,加五味子、款冬花、杏仁。
加减金匮肾气丸:治疗肺肾虚,腰重脚肿,小便不利,或肚腹肿胀,四肢浮肿,或喘急痰盛,已成蛊证,效果如神。此证多因脾胃虚弱,治疗失当,元气复伤而变证者,非此药不能救。(土是防水的堤坝,肾是置水的容器,肾是胃的关口,开窍于前后二阴,土厌恶湿,肾厌恶燥,而命门之气藏于肾,是生土的母源,主化津液以利膀胱,所以肾气盛则土旺而水有所堤防,自然没有泛溢之患,如果火衰则气不化而水溢,溢则湿土卑滥而妄行,故有水胀之病。此方既能益火以生土,又能化气以利水,这就是它成为治肿圣药的原因,如果是热胀,又不适宜)。
药材:熟地黄(四两,酒拌,捣膏),白茯苓(三两),山药、山茱萸、泽泻、牡丹皮、牛膝、车前子、官桂(各一两),附子(半两)。
制法用法:研为末,与地黄混合,炼蜜丸如梧桐子大,每次服用七八十丸,空腹用白开水送服。
Guo Jizhong stated: Postpartum edema of the four limbs is caused by retained blood (postpartum stasis) taking advantage of deficiency to stagnate and accumulate, flowing along the meridians into the four limbs. After lingering for a long time, it fails to return and dissipate, rotting and transforming like water, thus causing yellowish complexion and edema of the four limbs. If physicians do not recognize this condition and treat it as fluid retention disease (Shui Qi), administering drugs such as Kansui Root (Gansui) and Great Euphorbia Root (Daji) to drain water, this is detrimental. Since the postpartum state is inherently deficient, using purgative drugs further depletes the body, a condition termed "double deficiency" (Chong Xu), which often leads to premature death. Simply administering Xiao Tiao Jing San (Minor Regulating Menses Powder) allows the blood to circulate and the swelling to subside, resulting in recovery.
Chen Wuzhe stated: Postpartum edema has various causes. Some cases involve swelling that begins during pregnancy and persists after delivery. Others result from improper postpartum care, where external pathogens such as cold, heat, wind, and dampness invade, or internal emotional disturbances such as anger, joy, worry, and fright cause qi and blood to clash and stagnate in the meridians. It is crucial to distinguish between qi-type edema and blood-type edema (Qi-type edema presents with swelling preceding menstrual cessation; blood-type edema presents with menstrual cessation preceding swelling; hence, treatment methods differ). Treatment should be based on the specific etiology, pulse, and symptoms. While Xiao Tiao Jing San is effective for blood-type edema, its action is mild and may not suffice. Better alternatives include Wu Zhu Yu Tang (Evodia Decoction), Zhi Zhu Tang (Aurantii Fructus and Atractylodis Macrocephalae Decoction), Duo Hun San (Soul-Rescuing Powder), and Da Tiao Jing San (Major Regulating Menses Powder), all of which are essential formulas.
Another discussion states: Postpartum labor injury damages qi and blood, leaving the interstices (Cou Li, referring to skin pores and tissue spaces) empty, allowing wind pathogens to invade. When pathogens clash with qi and cannot be dispersed, it results in slight, floating edema due to pathogen-qih interaction, known as qi-edema. If the skin becomes taut and shiny like a ripe plum, it transforms into water-edema. Qi-edema resolves through sweating; water-edema resolves through promoting urination. Jiegu stated: For postpartime wind-cold affecting the exterior, causing facial and limb edema, Ju Fang Qi Sheng Wan (Seven-Sage Pills from the Bureau Formula) is appropriate, taken with warm water, increasing the dose daily until bowel movements become loose. If edema extends to the knees with wheezing and coughing, double the dosage of Costus Root (Muxiang) and Areca Seed (Binglang), indicating excessive qi stagnation. If edema is accompanied by headache and dizziness, add Notopterygium Root (Qianghuo) and Ligusticum Chuanxiong Rhizome (Chuanxiong), indicating excessive wind. If there is only edema, use the original formula alone.
Li Dongyuan stated: Zhong Man Fen Xiao Wan (Middle Distension Dividing and Eliminating Pill, see Edema and Fullness section) should be swallowed with Si Wu Tang (Four Substances Decoction).
Zhu Danxi stated: Postpartum edema must be treated primarily by greatly tonifying qi and blood, with minor additions of Atractylodes Macrocephala Rhizome (Cangzhu) and Poria (Fuling) to allow natural diuresis.
Xue Ji stated: Regarding the aforementioned conditions, if cold water insults earth (Kidney water overacting on Spleen), nourish the Spleen and Lung; if qi-deficiency edema, benefit the Spleen and Stomach; if water-qi edema, tonify the middle and boost qi. Refer to the main treatments in the respective miscellaneous disease sections.
A puerperal woman had poor appetite and took digestive aids, leading to edema of the four limbs. I diagnosed insufficient middle qi. She used Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction) in the morning and Liu Jun Zi Tang (Six Gentlemen Decoction) in the evening, resulting in recovery. Later, anger-induced abdominal distension led to the mistaken use of Chen Xiang Hua Qi Wan (Agarwood Regulating Qi Pills), causing persistent vomiting and diarrhea, anorexia, dysuria, and abdominal and limb edema. She recovered using Jin Gui Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet). (This occurred because middle qi deficiency was aggravated by draining medicines, so the primary treatment should be tonifying earth [Spleen]. The Jin Gui Pill tonifies fire to generate earth and contains methods to resolve water stagnation.)
Another puerperal woman suffered from diarrhea, edema of the four limbs and face, wheezing, and aversion to cold. I diagnosed Spleen-Lung deficiency-cold. She used Liu Jun Zi Tang added with Ginger and Cinnamon Twig, which cured the diarrhea, and Bu Zhong Yi Qi Tang, which strengthened the Spleen and Stomach.
Du Shi treated the favorite concubine of Zhang Xuanhui, who developed sudden edema half a month after childbirth. Obstetricians were summoned but failed to cure her after half a month, and the condition worsened. Du Shi was called. Upon arrival, he asked, "What did other doctors diagnose?" Zhang said, "They all said it was water-qi edema." Du Shi said, "Incorrect. Water-qi disease typically presents with coughing and painful/difficult urination (The method to identify water-qi is: if there is coughing and difficult urination, it is due to failure of descending functions). Now, your concubine does not have difficult urination nor coughing; she only has cold hands and feet. This is deficiency of the Blood Organs (Liver/Heart), with qi blockage preventing flow, causing facial edema." He then treated her with herbs to nourish blood and harmonize qi. After ten days, seven or eight parts of the illness had resolved, and she fully recovered after half a month. The medicine used was Mu Dan San (Moutan Powder) from Ling Yuan Fang, which treats wind-cold deficiency of the Blood Organs. Currently, obstetricians often use this medicine for various postpartum diseases with miraculous effects, renaming it Juan Jin Tang (Donating Gold Soup) (See Mu Dan San under Blood Stasis Dizziness).
A puerperal woman had postpartum edema of the four limbs, alternating chills and fever. This was due to retained blood flowing into the meridians and infiltrating the limbs, causing wheezing, coughing, chest oppression, sour regurgitation, and hypochondriac pain. She was treated with Xuan Fu Hua Tang (Inula Flower Decoction), which gradually resolved with mild sweating. Frequent administration of Xiao Tiao Jing San, mixed with decoction of Ze Lan Gen (Prunella Root), gradually reduced the edema.
Da Tiao Jing San (Major Regulating Menses Powder): Treats postpartum edema and fullness, wheezing, urgency, thirst, and dysuria. See previous section on alternating chills and fever.
Xiao Tiao Jing San (Minor Regulating Menses Powder): Treats retained blood stagnating due to deficiency, flowing into meridians, causing edema of the four limbs.
Ingredients: Myrrh (Moyao), Amber (Hupo), Cassia Twig (Guixin), Peony Root (Shaoyao), Angelica Sinensis Root (Danggui) (each 1 qian); Asarum (Xixin), Musk (Shexiang) (each 0.5 qian).
Preparation and Administration: Grind into fine powder. Take 0.5 qian per dose, mixed with a little ginger juice and warm wine.
Empirical Formula: Treats generalized cyanotic swelling and pain after childbirth, and postpartum blood-water disorders. (Cyanotic swelling indicates blood stasis, as blood transforms into water; thus, this formula is used, representing a simple and effective method).
Ingredients: Dry Resin of Toxicodendron (Ganqi), Large Barley Sprout (Dayamai) (equal parts).
Preparation and Administration: Grind each into fine powder. Layer barley sprouts and Ganqi in a new clay pot, filling it completely. Seal with salt mud and calcine until red hot. Cool and grind into powder. For any postpartum disorder, take 2 qian mixed with hot wine.
Bai Zhu Tang (Atractylodes Macrocephala Decoction): Treats hardness and distension of the heart and abdomen resembling a plate, with edges like a rotating disk, caused by fluid retention, named Qi Fen (Qi Division). (This is a formula from Zhang Zhongjing, later modified into pills by Yi Lao).
Ingredients: Immature Bitter Orange (Zhishi) (1.5 liang), Atractylodes Macrocephala Rhizome (Baizhu) (3 liang).
Preparation and Administration: Cut into pieces. Take 4 qian per dose, decoct in 1.5 cups of water until 0.7 cup remains. Strain and take warm. Abdominal softness indicates resolution of distension.
Zheng Pi San (Spleen-Correcting Powder): Treats generalized postpartum edema, and Spleen qi deficiency with middle fullness and abdominal distension after severe illness in women. (This is a qi-moving method. It is called "Correcting Spleen" because moving qi allows the Spleen to function properly).
Ingredients: Curcuma Zedoaria Rhizome (Peng Ezhu), Cyperus Rotundus Rhizome (Xiangfu) (soaked in child's urine), Fennel Fruit (Huixiang), Licorice Root (Gancao) (roasted), Tangerine Peel (Chenpi) (equal parts).
Preparation and Administration: Grind into fine powder. Take 2 qian per dose, washed down with decoction of Centipede Grass (Dengxin Cao) and Thalia Herb (Mutong).
Xiao Diao Zhong Tang (Minor Regulating Middle Decoction): Treats all types of postpartum edema. Effective when used alone. (Tonifies Spleen/Stomach, moves blood stasis; efficacy lies in the mixing method).
Ingredients: Poria (Fuling), Angelica Sinensis Root (Danggui), White Peony Root (Baishaoyao), Tangerine Peel (Chenpi) (each 1 qian); Atractylodes Macrocephala Rhizome (Baizhu) (1.5 qian).
Preparation and Administration: Cut into one dose, decoct in water to mix with the following powders: Myrrh (Moyao), Amber (Hupo), Cassia Twig (Guixin) (each 1 qian); Asarum (Xixin), Musk (Shexiang) (each 0.5 qian).
Ju Pi Jiu (Tangerine Peel Wine): Treats postpartum superficial edema by moving qi.
Ingredients: Tangerine Peel (Ju Pi) ground into powder. Take 2 qian per dose, mixed with wine.
Danxi Formula: For women with postpartum edema, scanty urine, thirst, aversion to cold, weakness, and deep pulses. This indicates constitutional deficiency with accumulation of damp-heat, likely causing upper jiao oppression. Treatment should involve tonifying the middle, guiding out water, and moving qi.
Ingredients: Atractylodes Macrocephala Rhizome (Baizhu) (2.5 liang), Tangerine Peel (Chenpi) (1 liang), Ligusticum Chuanxiong Rhizome (Chuanxiong) (0.5 liang), Thalia Herb (Mutong) (6 qian), Poria (Fuling) (3 qian).
Preparation and Administration: Decoct in water. Take with 25 pills of Dian Dian Wan. (Huang Qin powder bound with paste, named Dian Dian Wan, also called Qing Jin Wan. This formula uses Baizhu as Sovereign, Chenpi as Assistant, Chuanxiong to regulate blood, Mutong and Fuling to promote urination, and Dian Dian Wan to clear Metal/Lung).
Duo Hun San (Soul-Rescuing Powder): Treats postpartum deficiency edema and fullness with urgency; recovery occurs upon promotion of urination. (This formula is unique, suitable for cases where damp-phlegm accumulates in the Middle Jiao causing dysuria, similar to Er Chen Tang, which moistens bowels and promotes urination).
Ingredients: Fresh Ginger (Shengjiang) (3 liang, juice extracted), Wheat Flour (Baifan) (3 liang), Large Pinellia Tuber (Daxiaren) (7 pieces).
Preparation and Administration: Mix flour with ginger juice, wrap Pinellia in seven cakes. Roast until charred and cooked, then grind into powder. Take 1 cup mixed with water. Effectiveness is indicated by promoted urination.
Zhang Shi Formula: Treats postpartum blood deficiency, wind-edema, and water-edema.
Ingredients: Prunella Spike (Zelan Ye), Stephania Tetrandra Root (Fangji) (equal parts).
Preparation and Administration: Grind into powder. Take 2 qian per dose, mixed with warm wine. Vinegar water can be used if alcohol is not consumed. (Zelan promotes blood circulation and diuresis; combined with Fangji, it is an excellent diuretic).
Han Fang Ji San (Stephania Tetrandra Powder): Treats postpartum wind-deficiency and qi congestion attacking the head and face, causing edema. (Contraindicated in weak patients; it is an urgent formula for draining Lung and promoting urination).
Ingredients: Han Fangji (Stephania Tetrandra), Polyporus (Zhuling), Bitter Orange (Zhike), Mulberry Root Bark (Sangbaipi) (each 1 liang); Phytolacca Root (Shanglu), Licorice Root (Gancao) (each 0.75 liang).
Preparation and Administration: Coarsely grind. Take 4 qian per dose with 3 slices of ginger, decoct in water, take warm on an empty stomach.
Qi Sheng Wan (Seven-Sage Pills): Treats postpartum excess wind-qih, facial and limb edema, thick saliva, dry throat and mouth, chest/hypochondriac fullness, constipation, dark urine, and restlessness. (Designed for excess-heat patterns).
Ingredients: Cinnamon Bark (Rougui) (peeled), Ligusticum Chuanxiong Rhizome (Chuanxiong), Rhubarb (Dahuang) (wine-steamed), Areca Seed (Binglang), Costus Root (Muxiang) (each 0.5 liang); Notopterygium Root (Qianghuo), Apricot Kernel (Yuliren) (peeled, each 1 liang).
Preparation and Administration: Grind into powder, bind with honey into pills the size of paulownia seeds. Take 15 pills per dose with warm water after meals. Most suitable for miasma regions; adjust dosage based on deficiency/excess. If edema with headache/dizziness, add Qianghuo and Chuanxiong (indicating wind); if only edema, use the base formula alone.
Jia Wei Wu Zhu Yu Tang (Modified Evodia Decoction): Treats women with inherent organ deficiency and chronic wind-cold, causing chest/diaphragm fullness and pain, twisting pain in abdomen/hypochondrium, vomiting/nausea, reduced appetite, facial/body puffiness, aversion to cold/shivering, or persistent diarrhea, shortness of breath, emaciation, and exacerbation of old diseases due to sudden postpartum organ deficiency and internal cold pathogens. (A formula for wind-cold. Inherent deficiency implies cold, hence warming agents are used).
Ingredients: Evodia Fruit (Wuzhuyu) (1.5 liang); Dried Ginger (Ganjiang), Cassia Twig (Guixin), Saposhnikovia Root (Fangfeng), Asarum (Xixin), Angelica Sinensis Root (Danggui), Moutan Cortex (Mudanpi), Red Poria (Chifuling), Pinellia Tuber (Banxia), Platycodon Root (Jiegeng), Ophiopogon Tuber (Maidong), Licorice Root (Gancao) (each 0.5 liang).
Preparation and Administration: Coarsely grind. Take 4 qian per dose, decoct in water, take hot before meals.
Jia Wei Ba Wu Tang (Modified Eight-Ingredient Decoction): Treats generalized postpartum edema, rapid breathing, and tidal fever.
Ingredients: Ginseng (Renshen), White Poria (Baifuling), Prepared Rehmannia Root (Shudihuang), Small Fennel Fruit (Xiaohuixiang) (each 3 qian); Atractylodes Macrocephala Rhizome (Baizhu), Ligusticum Chuanxiong Rhizome (Chuanxiong) (each 4 qian); Angelica Sinensis Root (Danggui), White Peony Root (Baishao), Cyperus Rotundus Rhizome (Xiangfu) (each 5 qian); Bupleurum Root (Chaihu), Scutellaria Root (Huangqin), Licorice Root (Gancao) (each 1 qian).
Preparation and Administration: Cut into fragments, divide into six or seven doses. Add 3 slices of ginger per dose, decoct in water, take hot on an empty stomach. After finishing this medicine, take Tiao Jing Wan (Regulating Menses Pills). If abdominal pain, add Corydalis Rhizome (Yanhusuo), Dry Resin of Toxicodendron (Ganqi), Bitter Orange (Zhike) (each 3 qian); if vomiting/nausea, add Galangal (Liangjiang), Amomum Fruit (Sharen) (each 2 qian); if numbness of limbs, add Cinnamon Twig (Rougui) (1.5 qian); if cough, add Schisandra Berry (Wuweizi), Coltsfoot Flower (Kuandonghua), Apricot Kernel (Xingren).
Jian Shen Qi Wan (Modified Kidney Qi Pill): Treats Lung/Kidney deficiency, heavy waist/swollen feet, dysuria, abdominal swelling, limb edema, wheezing/phlegm, or ascites (Gu Zheng). Effects are miraculous. This condition often arises from Spleen/Stomach weakness, improper treatment, and secondary damage to primal qi. Only this formula can save the patient. (Earth acts as a dam against water; Kidney is the vessel for water. Kidney is the gate of the Stomach, opening to the two yins. Earth dislikes dampness; Kidney dislikes dryness. Mingmen Qi resides in the Kidney, serving as the mother of Earth, governing fluid transformation to benefit the Bladder. Thus, strong Kidney qi strengthens Earth and dams water, preventing overflow. If Fire declines, qi fails to transform, water overflows, damp Earth spreads, causing water swelling. This formula tonifies Fire to generate Earth and transforms qi to promote urination, making it a holy medicine for edema. It is unsuitable for heat-distension).
Ingredients: Prepared Rehmannia Root (Shudihuang) (4 liang, soaked in wine, pounded into paste), White Poria (Baifuling) (3 liang); Chinese Yam (Shanyao), Cornus Fruit (Shanzhuyu), Alisma Rhizome (Zexie), Moutan Cortex (Mudanpi), Achyranthes Root (Niuxi), Plantago Seed (Cheqianzi), Official Cinnamon (Guangui) (each 1 liang); Aconite Root (Fuzi) (0.5 liang).
Preparation and Administration: Grind into powder, mix with Rehmannia paste, bind with honey into pills the size of paulownia seeds. Take 70-80 pills per dose with plain warm water on an empty stomach.