（并小腹痛）
薛氏曰∶产后小腹作痛，俗名儿枕块，用失笑散行散之（按腹痛原文尚有数症，曰因气
滞用玄胡索散∶因外寒用五积散；因怒气用四物加木香、柴胡；因阳气虚弱用四君、当归、炮
姜∶因脾虚血弱，用六君、当归、炮姜）。若恶露既去而仍痛，用四神散调之，若不应，用八
珍汤。若痛而恶心，或欲作呕，用六君子汤。
若痛而泄泻，用六君子汤送四神丸。若泄泻痛而后或后重，用补中益气汤送四神丸。
若胸膈饱胀，恶食吞酸，或腹痛手不可按，此
是饮食所致，用二陈加山楂、白术以消导；若食既消而仍痛，或按之不痛，或更加头痛，烦
热作渴，恶寒欲呕等证，此是中气被伤，宜补脾胃为主。若发热腹痛，按之痛甚，不恶食，
不吞酸，此是瘀血停滞，用失笑散消之。若止是发热头痛，或兼腹痛，按之却不痛，此属血
虚，用四物加炮姜、参、术以补之。如发渴用白虎（发渴恐属血虚，用白虎宜慎！东垣云∶血
虚忌白虎）；气弱用黄 ；血刺痛，则用当归；腹中痛，则加芍药。宜详察脉证而用之。
一产妇腹痛发热，气口脉大，余以为饮食停滞，不信，乃破血补虚（因实成虚，因虚投
补，当与勿当，医者病者两责之，幸勿误也），反寒热头痛，呕吐涎沫，又用降火化痰理气，
四肢逆冷，泄泻下坠，始悔，问余曰，何也？余曰∶此脾胃虚之变证也，法当温补，遂用六君
子加炮姜二钱，肉桂、木香各一钱，四剂，诸症悉退，再用补中益气之剂，元气遂复。
一妇人产后腹痛后重，去痢无度，形体倦怠，饮食不甘，怀抱久郁，患茧唇（茧唇因虚，
宜以脉症参之），寐而盗汗如雨，竟夜不敢寐，神思消烁。余曰∶气血虚而有热，用当归六黄
汤纳黄芩、黄柏炒黑一剂，汗顿止，再剂全止，乃用归脾汤、八珍散兼服，元气渐复而愈。
一产妇小腹作痛，服行气破血之药不效，其脉洪数，此瘀血内溃为脓也，以瓜子仁汤二
剂痛止，更以太乙膏下脓而愈。产后多有此病，纵非痈，用之更效。
一产妇小腹痛，小便不利，用薏苡仁汤二剂痛止，更以四物加红花、桃仁下瘀血而愈。
大抵此证皆因荣卫不调，或瘀血停滞所致。若脉洪数，已有脓；脉但数，微有脓；脉迟紧，乃
有瘀血，下之即愈。若腹胀大，转侧作水声，或脓从脐出，或从大便出，宜用蜡矾丸、太乙膏，
及托里散。
一产妇小腹作痛，有块，脉芤而涩，以四
物加玄胡、红花、桃仁、牛膝、木香，治之而愈。
一妇产后小腹患痛，服瓜子仁汤下瘀血而痊。凡瘀血停滞，宜急治之，缓则腐化为脓，
最难治疗。若流注关节，则患骨疽，失治多为败症。
一妇人寒月中，产后腹大痛，觉有块，百方不治。一人教以羊肉四两，熟地二两，生姜
一两，水煎服之，二三次愈。（曰觉有块，想是寒气乘虚而聚，非真实 也，不然，何以羊肉、
熟地愈哉）
大全云∶儿枕者，由母胎中宿有血块，因产时，其血破散，与儿俱下，则无患也。若产妇
脏腑风冷，使血凝滞在于小腹不能流通，则令结聚疼痛，名之曰儿枕。
全匮云∶产后七八日，无太阳证，少腹坚痛，此恶露不尽，不大便，烦躁发热，切脉微
实，再倍发热，日晡时烦躁者，不食，食则谵语，至夜即愈，宜大承气汤主之，热则里结在
膀胱也。（既曰恶露不尽，不大便而躁热矣，然不用桃仁承气，而用大承气者何？盖热结在膀
胱，故宜大承气也）
大全云∶产后恶血，虽常通行，或因外感五邪，内伤七气，致令斩然而止，余血壅滞，所
下不尽，故令腹痛，当审其因而治之。
一产妇小腹痛甚，牙关紧急，此瘀血内停、灌以失笑散，下血而苏，又用四物加炮姜、
白术、陈皮而愈。
一妇人经水来，比常度过多不止，遂用涩药止之，致腹作痛，此乃气血凝滞也，用失笑
散二服而愈。
以上数段，言恶露不尽。
余按《金匮》所治，重在伤寒里实，不重在恶露，故其脉证皆指实热言，当以无太阳证
句，及热结膀胱句玩之，便得其意。后案专主恶露言，故与前方不同，不可一律看也。
大全云∶以恶露不尽腹痛，及儿枕心腹刺痛，小腹疼痛，寒疝分为四门（寒疝，《大全》
云∶产后脐腹痛，乃冷气乘虚，用当归建中汤。
无择曰∶产当寒月，入门脐下痛，手不可近者，羊肉汤。立斋曰∶前症若脾胃虚寒邪侵者，蟠
葱散；若肝经湿热，小便不利者，泻肝汤亦所当知，毋胶一也）。由母胎中宿有血块，产后不
与儿俱下，而仍在腹作痛，谓之儿枕。其恶露下不快而作痛者，胎中原无积聚，不为儿枕
也。若恶露已尽，或由他故腹痛，如仲景枳实芍药散证，或由血虚腹痛，如仲景当归生姜羊
肉汤证，自当别论。故复胪列诸名方于后，若服枳实芍药散不愈，仍当求责瘀血也，故下瘀
血诸方附焉，而补虚诸方终之，不复立寒疝条。
加味四物汤 治产后恶露不尽腹痛。
当归 川芎 芍药 熟地（各一钱） 香附（炒） 五灵脂（炒，二味另为末，各一钱，临服调入）
上锉一服，水煎服。痛甚者，加桃仁泥四分。
海藏方 四物汤加玄胡索、没药、白芷，治产后败血作痛。（此所加几种药，少有差等，
在自择之）
一方四和汤加苦楝。
一方四物汤加玄胡索。
一方四物汤加蒲黄。
当归蒲延散 治产后血瘕作痛，脐下胀满，或月经不行，发热体倦。
当归（八分） 桂心 芍药（炒） 血竭 蒲黄（炒，各六分） 玄胡索（炒，四分）
上为末，每服二钱，空心酒调下。（桂心血竭治血瘕妙）
玄胡索散 治产后恶血攻刺腹痛，及一切血气刺痛，不论新旧虚实，皆可服之。
当归（酒浸） 玄胡索 赤芍 蒲黄（隔纸炒） 桂皮 乳香 没药（各等分）
上研为细末，每服三钱，温酒调，空心服。
延胡散 治产后儿枕腹痛。
玄胡索 当归（各一两） 赤芍（五钱） 肉桂（七钱半） 蒲黄（炒） 琥珀（各二钱半）
红蓝花（二钱）（更加红蓝、琥珀，治儿枕尤妙）
上为末，每服三钱，童便合酒调，食前服。
乌金散 治恶露败血走刺心腹，儿枕痛，坐卧不得，余血不快。
川芎（七钱半，烧燃盖甑中存性） 黑附子（半枚，炮去皮脐）（用烧川芎、黑附者，温血海之里也）
上为细末，每三钱，童便和酒调服，痛止血下，方住服。
地黄散 治产后恶血不尽，腹中绞痛。
生地黄（炒） 当归（炒，各一两） 生姜（五钱，切碎。新瓦上炒令焦黑）
上为细末，姜酒调下二钱，空心服。一方加蒲黄，为丸。
四神散 治产后瘀血不消，积聚不散作块，心腹切痛。
当归 干姜（炮） 川芎 赤芍（炒，各等分）
上为末，每服二钱，温酒调下。
黑神散 治产后血块痛。
熟地黄（一斤） 陈生姜（半斤）
上二味拌匀，同炒干为末，每服二钱，乌梅汤调下，常服酒调。
丹溪方 治产后血块痛，发热。
五灵脂（四钱，炒） 牡丹皮 没药 滑石
上研细，分五帖，豆淋酒下之，食前服。
卷荷散 治产后血上冲心，血刺血晕，血气腹痛，恶露不快，并皆治之。
初出卷荷 红花 当归（各一钱） 蒲黄（纸炒） 牡丹皮（各半两）
上为细末，每服三钱，空心盐酒调下。
荷叶散 治产后恶露不下，腹中疼痛，心神烦闷。
干荷叶（二两） 刘寄奴 蒲黄（各一两） 桃仁（去皮尖，麸炒，半两）
上 咀，每服四钱，童子小便一盏，生姜三片，生地黄一分，煎至六分，热服，不拘时。
（均是破血药，而治烦闷之症，则童便、生地尤佳）一方有鬼箭羽。
隐居泽兰汤 治产后恶露腹痛，或胸满少气。
泽兰（炒）（泽兰理血气圣药） 生地黄 当归 芍药（炒） 生姜（各一钱） 甘草（五分）
大枣（四枚）
上锉，水煎服。
又方 治产后下血不尽，腹内坚痛不可忍。
当归 芍药 桂心（各三两） 桃仁（一百二十粒，制）
上水六升煮二升，温分二服，未瘥加大黄。（妙在加大黄，然以醋制者佳）
又方 治产后恶露不尽，结聚小腹疼痛。
当归（七钱半） 香附子（制，一两） 赤芍 青皮 木香 桂心 琥珀 没药（各半两）
上为细末，以乌豆淋酒，调服二钱。
产宝汤 治产后余血作痛兼块者。
桂心 姜黄（各等分）
上为细末，酒调方寸匕，血下尽妙。
延胡索散（一名三圣散，又名如神汤）治产后脐下痛并腰疼。
玄胡索 桂心（各半两） 当归（一两）
上为细末，热酒调下二钱。
香桂散 治产后脐下疼痛不止。
当归 川芎（各二钱半） 桂心（半两）
上为细末，分为三服，每服酒一盏煎三五沸，更入童便少许，煎至七分，温服，甚者不过
再服，即瘥。
当归血竭丸 治产后恶露不下，结聚成块，心胸痞闷及脐下坚痛。（破血为主）
当归 血竭 芍药 蓬术（炮，各二两） 五灵脂（四两）
上为细末，醋糊和，丸如梧桐子大，每服五十丸，食前温酒送下。
当归养血丸 治产后恶血不散，发渴，心腹疼痛及恶露不快，脐下急痛，连及腰足疼
痛。（凡产后脚腰疼痛，属瘀血流注者多，今人不知，往往误治，而以大补为主，遂至日久不
治，又或有风寒袭之者，亦不可骤补也。此方行瘀最良，去风未善，别宜简择）
当归 赤芍 牡丹皮 玄胡（各二两） 桂心（一两）
上为末，炼蜜丸如桐子大，空心酒下三四十丸，痛甚者细嚼下。
紫金丸 治产后恶露不快，腰腹小腹如刺，时作寒热头痛，不思饮食，亦治久有瘀血，
月水不调，亦可疗心痛。（产后瘀血要药。即失笑散之变）
五灵脂（水淘去土石，焙干，炒为末） 真蒲黄（各等分）
上以好米醋调五灵脂，慢火熬成膏，次以蒲黄末搜和，丸如樱桃大，每服一丸，水与童
便各半盏煎至七分，令药化温服之，少顷再一服，恶露即下，久有瘀血成块，月信不利者，并
用酒磨下。
玉烛散 治产后恶露不尽，脐腹疼痛，大便燥结，时发寒热。
当归 川芎 赤芍 熟地 大黄 朴硝 甘草（各一钱半）
上作一服，水煎，食前温服（此河间法也，四物合大承气主之。盖咸走血之意）。诸方治
败血作痛，皆是温剂，热则流通之理。惟此一方，却是凉剂，盖为败血凝滞发热，大便燥结
者设也，非大便燥结者，慎不可用。
枳实芍药散 《金匮》云∶产后腹痛，烦满不得卧，此方主之。（一贵内产后脉沉小如丝，
腹痛不能食，闻药则呕，以此方三服而愈）
枳实（炒令黑。勿太过） 芍药（各等分）
上杵为散，服方寸匕，日三服，并主痈脓，以麦粥下之。
下瘀血汤 产妇腹痛，法当以枳实芍药散，假令不愈者，此为腹中有干血着脐下，宜
此方。（此仲景方也，又为经水不利要药）
大黄（二两） 桃仁（二十枚） 虫（二十枚，炒，去足）
上三味末，炼蜜和为四丸，以酒一升煎一丸，取八合，顿服之，新血下如豚肝。（豚肝者，
即干血之下也，新血二字非）
保命方 治血晕血结，或聚于胸中，或偏于小腹，或连于胁肋，四物汤四两，倍当归、川
芎，加鬼箭羽、红花、玄胡各一两，同为粗末，加下四味，煎调没药散服。
虻虫（二钱，去翅足，炒） 水蛭（一钱，炒） 麝香（少许） 没药
上为末，入前药调服，血下痛止，则服一服。
千金桃仁芍药汤 治产后腹痛。
桃仁 芍药 川芎 当归 桂心 干漆（碎炒） 甘草（各二两）
上细切，水八升煮二升半，分三服。
以上治瘀血腹痛之剂，皆重剂，宜斟酌用之。
增损四物汤 治产后阴阳不和，乍寒乍热，恶露停滞，亦令寒热，但看小腹急痛为异。
当归（酒浸） 白芍 川芎 人参（各一两） 干姜（一两） 甘草（炙，半两）
上 咀，每服四钱，姜三片，水煎无时，热服。
独圣散 治产后血虚腹痛。
当归一味为细末，每服二钱，水一盏煎七分，温服。（此方简易，自有独见，而当归又能
治洒洒寒热不已）
当归散 治产后阴血虚弱，或气滞血凝，以致发热腹痛，或腹胁胀满。
当归 干姜（各等分）
上锉，每服三钱，水煎服。
定痛散 治产后恶血不止。
当归 芍药（炒，各二钱） 肉桂（一钱）
上切作一服，水酒各一盏半，加生姜五片，煎一盏服。
当归建中汤 治妇人产后虚羸不足，腹中刺痛不止，吸吸少气，或苦少腹中急，痛引
腰背，不能饮食。
当归（四两） 芍药（炒，六两） 桂枝（三两） 甘草（炙，二两） 生姜（三两） 大枣（十二枚）
上六味，以水一斗，煮取三升，分温三服，
一日令尽（内衄不止，加地黄阿胶似矣，但本方有桂枝生姜，得无太热乎，请酌之），若大
虚，加饴糖六两，汤成，纳于火上暖令饴消。若去血过多，崩伤内衄不止，加地黄六两、阿胶
二两，合八味汤，纳阿胶服之。
（包括小腹痛）
薛己说：产后小腹疼痛，俗称“儿枕块”，使用失笑散来行气活血、消散瘀血。（按：在腹痛原文中还有几种情况：因气滞引起的，用玄胡索散；因外感寒邪引起的，用五积散；因愤怒情绪引起的，用四物汤加木香、柴胡；因阳气虚弱引起的，用四君子汤、当归、炮姜；因脾虚血弱引起的，用六君子汤、当归、炮姜）。如果恶露已经排尽但疼痛仍然持续，使用四神散调理；如果无效，使用八珍汤。如果疼痛伴有恶心，或者想要呕吐，使用六君子汤。
如果疼痛伴有腹泻，用六君子汤送服四神丸。如果腹泻后感到腹部疼痛且肛门有下坠感（里急后重），用补中益气汤送服四神丸。
如果胸膈部饱胀，食欲不振，吞酸，或者腹痛剧烈到不能用手按压，这是饮食不当造成的，使用二陈汤加山楂、白术来消食导滞；如果食物已经消化但疼痛仍在，或者按压时不痛，或者出现头痛、烦热口渴、怕冷想吐等症状，这是中气受损，应当以补益脾胃为主。如果发热且腹痛，按压时疼痛加剧，但不厌恶食物，不吞酸，这是瘀血停滞，使用失笑散来消除瘀血。如果只是发热头痛，或者兼有腹痛，但按压时却不痛，这属于血虚，使用四物汤加炮姜、人参、白术来补益。如果出现口渴，可用白虎汤（口渴恐怕属于血虚，使用白虎汤应当谨慎！李东垣说：血虚者忌用白虎汤）；气弱者用黄芪；血刺痛，则用当归；腹中痛，则加芍药。应当详细诊察脉象和症状后再用药。
有一位产妇腹痛发热，气口脉大，我认为这是饮食停滞所致，但她不信，反而使用了破血补虚的药物（因为实证导致虚证，又因虚证投以补药，该用不该用，医生和病人都要承担责任，千万不要误治），结果反而出现寒热交替、头痛、呕吐涎沫的症状，又用了降火化痰理气的药物，导致四肢逆冷、腹泻下坠，这时才后悔，问我为什么？我说：这是脾胃虚损产生的变证，法度上应当温补，于是使用六君子汤加炮姜二钱，肉桂、木香各一钱，服用四剂后，所有症状都消退了，再用补中益气的药剂，元气便恢复了。
一位妇人产后腹痛且有下坠感，痢疾无度，身体倦怠，饮食无味，长期心情抑郁，患了茧唇（茧唇因虚证引起，应当结合脉症参详），睡觉时盗汗如雨，整夜不敢入睡，精神极度消耗。我说：这是气血虚而有热，使用当归六黄汤，将黄芩、黄柏炒黑，服用一剂，汗立刻停止，再服一剂完全停止，然后使用归脾汤、八珍散同时服用，元气逐渐恢复而痊愈。
一位产妇小腹作痛，服用行气破血的药物无效，其脉象洪数，这是瘀血内溃化脓了，用瓜子仁汤服用两剂后疼痛停止，再用太乙膏排出脓液而痊愈。产后多有此病，即使不是痈肿，使用此方效果更好。
一位产妇小腹痛，小便不利，用薏苡仁汤服用两剂后疼痛停止，再用四物汤加红花、桃仁排出瘀血而痊愈。
大体上这种病症都是因为营卫不调，或者瘀血停滞所致。如果脉象洪数，说明已有脓；脉象仅数，说明微有脓；脉象迟紧，说明有瘀血，攻下瘀血即可痊愈。如果腹胀大，翻身时有水声，或者脓从脐部流出，或者从大便流出，宜用蜡矾丸、太乙膏，以及托里散。
一位产妇小腹作痛，有肿块，脉象芤而涩，用四物汤加玄胡索、红花、桃仁、牛膝、木香治疗而痊愈。
一位产妇产后小腹患痛，服用瓜子仁汤排出瘀血而痊愈。凡是瘀血停滞，应当紧急治疗，拖延则会腐化为脓，最难治疗。如果流注于关节，则患骨疽，失治多成为败症。
一位妇人在寒冷的月份，产后腹部剧痛，感觉有肿块，各种方法都不见效。有人教她用羊肉四两，熟地黄二两，生姜一两，水煎服，两三次就痊愈了。（说感觉有肿块，猜想是寒气乘虚聚集而成，并非真实的肿块，否则，为什么羊肉、熟地黄能治愈呢？）
《大全》说：儿枕，是由于母亲胎中素有血块，分娩时，这些血破散，与胎儿一起排出，就不会有祸患。如果产妇脏腑受风冷侵袭，使血液凝滞在于小腹不能流通，就会结聚疼痛，名叫儿枕。
《金匮要略》说：产后七八天，没有太阳病的症状，少腹坚硬疼痛，这是恶露不尽，不大便，烦躁发热，切脉微实，加倍发热，傍晚时分烦躁的，不吃东西，吃东西就谵语，到了夜间就好转，宜用大承气汤主治，这是因为热结在膀胱。（既然说是恶露不尽，不大便而且躁热，然而不用桃仁承气汤，而用大承气汤为什么呢？因为热结在膀胱，所以宜用大承气汤。）
《大全》说：产后恶露，虽然通常通行，但如果因外感五邪，内伤七情，导致突然停止，余血壅滞，所下的血未尽，所以令腹痛，应当审察原因而治疗。
一位产妇小腹痛甚，牙关紧急，这是瘀血内停，灌服失笑散，下血后苏醒，又用四物汤加炮姜、白术、陈皮而痊愈。
一位妇人月经来潮，比平时量多不止，于是用收敛止涩的药止血，导致腹部疼痛，这是气血凝滞，用失笑散服用两服而痊愈。
以上几段，讲的是恶露不尽。
我按语：《金匮要略》所治疗的，重在伤寒里的实证，不重在恶露，所以它的脉证都是指实热而言，应当通过“无太阳证”一句，及“热结膀胱”句来玩味，就能得其意旨。后面的医案专门针对恶露而言，所以与前方的治法不同，不可以一概而论。
《大全》说：将恶露不尽腹痛，及儿枕心腹刺痛，小腹疼痛，寒疝分为四门（寒疝，《大全》说：产后脐腹痛，乃冷气乘虚而入，用当归建中汤。
无择说：生产在寒冷月份，入门后脐下痛，手不可触碰的，用羊肉汤。立斋说：前面的病症如果是脾胃虚寒邪气侵扰的，用蟠葱散；如果是肝经湿热，小便不利的，泻肝汤也应当知晓，不要拘泥于一法）。由母胎中宿有的血块，产后不与胎儿一起排出，而仍在腹部作痛，叫做儿枕。那些恶露下得不快而作痛的，胎中原无积聚，不称为儿枕。如果恶露已尽，或者因其他原因腹痛，如张仲景枳实芍药散的证候，或者因血虚腹痛，如张仲景当归生姜羊肉汤的证候，自然应当另外讨论。所以再次罗列各种名方在后面，如果服用枳实芍药散不愈，仍应当追究是否有瘀血，所以下面附有下瘀血的各种方子，而以补虚的各种方子结束，不再设立寒疝条目。
加味四物汤 治疗产后恶露不尽腹痛。
当归、川芎、芍药、熟地黄（各一钱）、香附（炒）、五灵脂（炒，这两味另研为末，各一钱，临服时调入）
以上锉为一服，水煎服。疼痛严重的，加桃仁泥四分。
海藏方 四物汤加玄胡索、没药、白芷，治疗产后败血作痛。（这里加的几种药，分量少有差异，由医者自行选择）
当归蒲延散 治疗产后血瘕作痛，脐下胀满，或者月经不行，发热体倦。
当归（八分）、桂心、芍药（炒）、血竭、蒲黄（炒，各六分）、玄胡索（炒，四分）
以上研为细末，每服二钱，空腹时用酒调下。（桂心、血竭治疗血瘕很妙）
玄胡索散 治疗产后恶血攻刺腹痛，以及一切血气刺痛，不论新旧虚实，都可以服用。
当归（酒浸）、玄胡索、赤芍、蒲黄（隔纸炒）、桂皮、乳香、没药（各等分）
以上研为细末，每服三钱，温酒调服，空腹服。
延胡散 治疗产后儿枕腹痛。
玄胡索、当归（各一两）、赤芍（五钱）、肉桂（七钱半）、蒲黄（炒）、琥珀（各二钱半）、红蓝花（二钱）（再加红蓝花、琥珀，治疗儿枕尤其妙）
以上研为细末，每服三钱，童便合酒调服，饭前服。
乌金散 治疗恶露败血走窜刺击心腹，儿枕痛，坐卧不安，余血排泄不畅。
川芎（七钱半，烧存性，盖在甑中）、黑附子（半枚，炮制去皮脐）（使用烧过的川芎和黑附子，是为了温补血海的内部）
以上研为细末，每三钱，童便和酒调服，疼痛停止、血下为止，方才停服。
地黄散 治疗产后恶血不尽，腹中绞痛。
生地黄（炒）、当归（炒，各一两）、生姜（五钱，切碎，在新瓦上炒至焦黑）
以上研为细末，姜酒调下二钱，空腹服。一方加蒲黄，制成丸剂。
四神散 治疗产后瘀血不消，积聚不散形成块状，心腹剧烈疼痛。
当归、干姜（炮）、川芎、赤芍（炒，各等分）
以上研为末，每服二钱，温酒调下。
黑神散 治疗产后血块痛。
熟地黄（一斤）、陈生姜（半斤）
以上两味拌匀，同炒干研为末，每服二钱，乌梅汤调下，常服时用酒调。
丹溪方 治疗产后血块痛，发热。
五灵脂（四钱，炒）、牡丹皮、没药、滑石
以上研细，分五帖，豆淋酒送下，饭前服。
卷荷散 治疗产后血上冲心，血刺血晕，血气腹痛，恶露不快，都治疗。
初出卷荷、红花、当归（各一钱）、蒲黄（纸炒）、牡丹皮（各半两）
以上研为细末，每服三钱，空腹盐酒调下。
荷叶散 治疗产后恶露不下，腹中疼痛，心神烦闷。
干荷叶（二两）、刘寄奴、蒲黄（各一两）、桃仁（去皮尖，麸炒，半两）
以上切碎，每服四钱，童子小便一盏，生姜三片，生地黄一分，煎至六分，热服，不拘时间。（都是破血药，而治疗烦闷之症，童便、生地尤其好）一方有鬼箭羽。
隐居泽兰汤 治疗产后恶露腹痛，或者胸满少气。
泽兰（炒）（泽兰是理血气的圣药）、生地黄、当归、芍药（炒）、生姜（各一钱）、甘草（五分）、大枣（四枚）
以上锉，水煎服。
又方 治疗产后下血不尽，腹内坚痛不可忍受。
当归、芍药、桂心（各三两）、桃仁（一百二十粒，制过）
以上用水六升煮取二升，温分两次服，未痊愈加大黄。（妙在加大黄，但以醋制者为佳）
又方 治疗产后恶露不尽，结聚小腹疼痛。
当归（七钱半）、香附子（制，一两）、赤芍、青皮、木香、桂心、琥珀、没药（各半两）
以上研为细末，用乌豆淋酒，调服二钱。
产宝汤 治疗产后余血作痛兼有块状者。
桂心、姜黄（各等分）
以上研为细末，酒调方寸匕，血下尽则妙。
延胡索散（一名三圣散，又名如神汤）治疗产后脐下痛并腰疼。
玄胡索、桂心（各半两）、当归（一两）
以上研为细末，热酒调下二钱。
香桂散 治疗产后脐下疼痛不止。
当归、川芎（各二钱半）、桂心（半两）
以上研为细末，分为三服，每服酒一盏煎三五沸，再加入少许童便，煎至七分，温服，严重的不过再服，即痊愈。
当归血竭丸 治疗产后恶露不下，结聚成块，心胸痞闷及脐下坚痛。（以破血为主）
当归、血竭、芍药、蓬术（炮，各二两）、五灵脂（四两）
以上研为细末，醋糊和，丸如梧桐子大，每服五十丸，食前温酒送下。
当归养血丸 治疗产后恶血不散，发渴，心腹疼痛及恶露不快，脐下急痛，连及腰足疼痛。（凡产后脚腰疼痛，属瘀血流注的多，今人不知，往往误治，而以大补为主，遂致日久不治，又或者有风寒袭之者，也不可骤补。此方行瘀最良，去风未善，别宜简择）
当归、赤芍、牡丹皮、玄胡（各二两）、桂心（一两）
以上研为末，炼蜜丸如桐子大，空腹酒下三四十丸，疼痛严重的细嚼下。
紫金丸 治疗产后恶露不快，腰腹小腹如针刺，时作寒热头痛，不思饮食，也治疗久有瘀血，月水不调，也可疗心痛。（产后瘀血要药。即失笑散的变方）
五灵脂（水淘去土石，焙干，炒为末）、真蒲黄（各等分）
以上用好米醋调五灵脂，慢火熬成膏，次以蒲黄末搜和，丸如樱桃大，每服一丸，水与童便各半盏煎至七分，令药化温服之，稍后再服一次，恶露即下，久有瘀血成块，月信不利者，并用酒磨下。
玉烛散 治疗产后恶露不尽，脐腹疼痛，大便燥结，时发寒热。
当归、川芎、赤芍、熟地、大黄、朴硝、甘草（各一钱半）
以上作一服，水煎，食前温服（这是河间的方法，四物汤合大承气汤主之。盖咸走血之意）。诸方治疗败血作痛，都是温剂，热则流通的道理。只有这一方，却是凉剂，是为败血凝滞发热，大便燥结者设立的，非大便燥结者，千万不可用。
枳实芍药散 《金匮》说：产后腹痛，烦满不得卧，此方主治。（一位贵妇人产后脉沉小如丝，腹痛不能食，闻药则呕，以此方三服而愈）
枳实（炒令黑，勿太过）、芍药（各等分）
以上杵为散，服方寸匕，日三服，并主治痈脓，以麦粥送下。
下瘀血汤 产妇腹痛，法当以枳实芍药散，假如不愈者，此为腹中有干血着脐下，宜此方。（这是仲景的方子，也是经水不利的要药）
大黄（二两）、桃仁（二十枚）、䗪虫（二十枚，炒，去足）
以上三味研末，炼蜜和为四丸，以酒一升煎一丸，取八合，顿服之，新血下如豚肝。（豚肝者，即干血之下也，新血二字非）
保命方 治疗血晕血结，或聚于胸中，或偏于小腹，或连于胁肋，四物汤四两，倍当归、川芎，加鬼箭羽、红花、玄胡各一两，同为粗末，加下四味，煎调没药散服。
虻虫（二钱，去翅足，炒）、水蛭（一钱，炒）、麝香（少许）、没药
以上研为末，入前药调服，血下痛止，则服一服。
千金桃仁芍药汤 治疗产后腹痛。
桃仁、芍药、川芎、当归、桂心、干漆（碎炒）、甘草（各二两）
以上细切，水八升煮二升半，分三服。
增损四物汤 治疗产后阴阳不和，乍寒乍热，恶露停滞，也令寒热，只看小腹急痛为异。
当归（酒浸）、白芍、川芎、人参（各一两）、干姜（一两）、甘草（炙，半两）
以上切碎，每服四钱，姜三片，水煎无时，热服。
独圣散 治疗产后血虚腹痛。
当归一味为细末，每服二钱，水一盏煎七分，温服。（此方简易，自有独见，而当归又能治洒洒寒热不已）
当归散 治疗产后阴血虚弱，或气滞血凝，以致发热腹痛，或腹胁胀满。
当归、干姜（各等分）
以上锉，每服三钱，水煎服。
定痛散 治疗产后恶血不止。
当归、芍药（炒，各二钱）、肉桂（一钱）
以上切作一服，水酒各一盏半，加生姜五片，煎一盏服。
当归建中汤 治疗妇人产后虚羸不足，腹中刺痛不止，吸吸少气，或苦少腹中急，痛引腰背，不能饮食。
当归（四两）、芍药（炒，六两）、桂枝（三两）、甘草（炙，二两）、生姜（三两）、大枣（十二枚）
以上六味，以水一斗，煮取三升，分温三服，一日令尽（内衄不止，加地黄阿胶似矣，但本方有桂枝生姜，得无太热乎，请酌之），若大虚，加饴糖六两，汤成，纳于火上暖令饴消。若去血过多，崩伤内衄不止，加地黄六两、阿胶二两，合八味汤，纳阿胶服之。
(Including lower abdominal pain)
Xue Ji stated: Postpartum lower abdominal pain, commonly known as "child pillow mass" (Erzhen Kuai), is treated with Shixiao San (Pain-Relieving Powder) to promote qi circulation and dissipate blood stasis. (Note: In the original text on abdominal pain, there are several other conditions: those caused by qi stagnation are treated with Xuanhusuo San; those caused by external cold with Wuji San; those caused by anger with Siwu Tang plus Muxiang and Chaihu; those caused by yang qi deficiency with Sijunzi Tang, Danggui, and Paojiang; and those caused by spleen deficiency and blood weakness with Liujunzi Tang, Danggui, and Paojiang). If lochia has been discharged but pain persists, Sishen San is used for regulation; if ineffective, Bazhen Tang is employed. If pain is accompanied by nausea or a desire to vomit, Liujunzi Tang is used.
If pain is accompanied by diarrhea, Liu Junzi Tang is administered with Sishen Wan. If diarrhea is followed by abdominal pain and tenesmus (feeling of incomplete defecation), Buzhong Yiqi Tang is given with Sishen Wan.
If there is fullness in the chest and diaphragm, anorexia, acid regurgitation, or severe abdominal tenderness where pressure is intolerable, this is caused by dietary indiscretion. Erchen Tang plus Shanzha and Baizhu is used to resolve food stagnation. If digestion has occurred but pain remains, or if pressing does not elicit pain, or if symptoms such as headache, irritability, heat sensation, thirst, aversion to cold, and vomiting appear, this indicates damage to middle qi, and treatment should primarily focus on tonifying the spleen and stomach. If fever and abdominal pain occur, with exacerbation upon pressure, but without anorexia or acid regurgitation, this is due to blood stasis stagnation, treated with Shixiao San to eliminate stasis. If there is only fever and headache, or accompanied by abdominal pain that is not tender to pressure, this belongs to blood deficiency, treated with Siwu Tang plus Paojiang, Renshen, and Baizhu to tonify. If thirst occurs, Baihu Tang may be considered (however, thirst may indicate blood deficiency; caution is advised when using Baihu Tang! Li Dongyuan stated: Blood deficiency contraindicates the use of Baihu Tang); for qi weakness, Huangqi is used; for stabbing blood pain, Danggui is used; for abdominal pain, Shaoyao is added. One must carefully observe the pulse and symptoms before prescribing.
A postpartum woman presented with abdominal pain and fever, with a large pulse at the Qi Kou position. I diagnosed it as food stagnation, but she did not believe me. Instead, she used blood-breaking and tonifying herbs (causing deficiency from excess, then tonifying deficiency, both doctor and patient bear responsibility; do not err). This resulted in alternating chills and fever, headache, and vomiting of saliva. She then took herbs to clear fire, resolve phlegm, and regulate qi, leading to cold limbs, diarrhea, and a feeling of heaviness/prolapse. Only then did she regret her actions and ask me why. I said: These are complications of spleen and stomach deficiency. The method requires warming and tonifying. Thus, Liujunzi Tang plus 2 qian of Paojiang, and 1 qian each of Rougui and Muxiang were prescribed. After four doses, all symptoms subsided. Subsequently, Buzhong Yiqi agents were used, and her primal qi was restored.
A woman suffered from postpartum abdominal pain with a sense of heaviness/prolapse, profuse dysentery, physical fatigue, poor appetite, long-term emotional depression, and developed "cocoon lip" (Jianchun, which arises from deficiency and should be evaluated via pulse and symptoms). She experienced night sweats like rain during sleep, insomnia throughout the night, and extreme mental exhaustion. I diagnosed it as deficiency of qi and blood with heat. Danggui Liuhuang Tang was used, with Huangqin and Huangbai stir-fried until black. After one dose, sweating stopped immediately; after two doses, it ceased completely. Then, Guipi Tang and Bazhen San were taken concurrently, gradually restoring primal qi until recovery.
A postpartum woman had lower abdominal pain unresponsive to qi-regulating and blood-breaking herbs. Her pulse was surging and rapid, indicating internal ulceration of blood stasis into pus. Guazi Ren Tang was administered for two doses, stopping the pain. Taiyi Gao was then used to drain the pus, leading to recovery. This condition is common postpartum; even if not an abscess, this formula is effective.
A postpartum woman had lower abdominal pain and difficulty urinating. Yiyiren Tang for two doses stopped the pain, followed by Siwu Tang plus Honghua and Taoren to expel blood stasis, resulting in recovery.
Generally, this syndrome is caused by disharmony of Ying and Wei levels, or stagnation of blood stasis. A surging and rapid pulse indicates pus formation; a merely rapid pulse indicates slight pus; a slow and tight pulse indicates blood stasis, which resolves with purgatives. If abdominal distension is large with splashing sounds upon turning, or if pus discharges from the umbilicus or stool, Lafan Wan, Taiyi Gao, and Tuoli San should be used.
A postpartum woman had lower abdominal pain and a palpable mass, with a knotted and choppy pulse. Siwu Tang plus Xuanhusuo, Honghua, Taoren, Niuxi, and Muxiang cured her.
A postpartum woman suffered lower abdominal pain and recovered after taking Guazi Ren Tang to expel blood stasis. Blood stasis stagnation requires urgent treatment; delay leads to putrefaction into pus, which is difficult to treat. If it flows into joints, bone abscesses (Guju) may occur, and neglect often leads to critical conditions.
A woman in cold weather suffered severe postpartum abdominal pain with a sensation of a mass, unresponsive to various treatments. Someone advised boiling 4 liang of mutton, 2 liang of Shudihuang, and 1 liang of Shengjiang in water. Two or three doses cured her. (The sensation of a mass is likely cold qi gathering due to deficiency, not a true mass; otherwise, how could mutton and Shudihuang cure it?)
*Daquan* states: "Child pillow" (Erzhen) occurs when blood clumps existed in the womb prior to pregnancy. During delivery, if these break up and discharge with the fetus, no harm ensues. If wind-cold affects the maternal viscera, causing blood stagnation in the lower abdomen that cannot circulate, it condenses and causes pain, named "child pillow."
*Jingui Yaolue* states: Seven to eight days postpartum, without Taiyang syndrome symptoms, hardness and pain in the lower abdomen indicate incomplete lochia discharge. Constipation, irritability, and fever with a slightly solid pulse, exacerbated fever, evening irritability, anorexia, delirium upon eating, and improvement at night, are treated with Dachengqi Tang. This is because heat is bound in the Bladder. (Although lochia is incomplete and constipation causes irritability/heat, why use Dachengqi Tang instead of TaoRen Chengqi Tang? Because the heat binding is in the Bladder.)
*Daquan* states: Although postpartum lochia usually flows freely, external invasion of the five pathogens or internal injury from the seven emotions can cause sudden cessation. Residual blood stagnates, and incomplete discharge causes abdominal pain. One must investigate the cause and treat accordingly.
A postpartum woman had severe lower abdominal pain and trismus (lockjaw). This indicated internal blood stasis. Shixiao San was灌 (poured/administered), leading to blood discharge and revival. Siwu Tang plus Paojiang, Baizhu, and Chenpi then cured her.
A woman had menorrhagia exceeding normal duration. Using astringents to stop bleeding caused abdominal pain due to qi and blood stagnation. Shixiao San for two doses cured her.
The above passages discuss incomplete lochia discharge.
My commentary: *Jingui Yaolue* focuses on interior excess syndromes of Cold Damage, not specifically on lochia. Thus, its pulse and symptom descriptions refer to excess-heat. One should ponder the phrases "without Taiyang syndrome" and "heat binding in the Bladder" to grasp the intent. The subsequent case studies focus specifically on lochia, differing from the earlier formulas; they should not be viewed uniformly.
*Daquan* categorizes incomplete lochia abdominal pain, Erzhen stabbing heart/abdominal pain, lower abdominal pain, and cold colic (Hanshan) into four sections. (Cold colic: Postpartum umbilical abdominal pain caused by cold qi invading deficiency, treated with Danggui Jianzhong Tang. Wuzhe stated: For pain below the umbilicus intolerable to touch during production in cold months, use Yangrou Tang. Lizhai stated: For previous symptoms due to spleen/stomach deficiency with cold pathogen invasion, use Pancong San; for liver channel damp-heat with difficulty urinating, Xiegan Tang is also applicable; do not adhere rigidly to one method.) "Child pillow" refers to blood clumps existing in the womb pre-partum that fail to discharge with the infant, remaining in the abdomen to cause pain. Pain from slow lochia discharge is not called "child pillow" if no accumulation existed originally. If lochia is complete but pain persists due to other causes, such as Zhang Zhongjing's Zhishi Shaoyao San syndrome, or blood deficiency abdominal pain like his Danggui Shengyang Roushang Tang syndrome, these require separate discussion. Therefore, various famous formulas are listed below. If Zhishi Shaoyao San fails, one must still seek blood stasis; thus, blood-expelling formulas follow, ending with deficiency-tonifying formulas, omitting a specific section on cold colic.
**Jiawei Siwu Tang**: Treats postpartum abdominal pain due to incomplete lochia.
Danggui, Chuanxiong, Shaoyao, Shudihuang (each 1 qian), Xiangfu (stir-fried), Wulingzhi (stir-fried, these two separately ground into powder, 1 qian each, mixed in just before taking).
Decoct one dose in water. For severe pain, add 0.4 qian of Tao Ren paste.
**Haizang Formula**: Siwu Tang plus Xuanhusuo, Moyao, Baizhi, treats postpartum pain due to敗血 (decayed blood). (The added herbs have slight variations in dosage; choose according to preference.)
**Another Formula**: Sihe Tang plus Kelian.
**Another Formula**: Siwu Tang plus Xuanhusuo.
**Another Formula**: Siwu Tang plus Puhuang.
**Danggui Puyan San**: Treats postpartum blood masses (Xia) causing pain, lower abdominal fullness, amenorrhea, fever, and fatigue.
Danggui (0.8 qian), Guixin, Shaoyao (stir-fried), Xuejie, Puhuang (stir-fried, each 0.6 qian), Xuanhusuo (stir-fried, 0.4 qian).
Grind into fine powder. Take 2 qian per dose, mixed with wine on an empty stomach. (Guixin and Xuejie are excellent for treating blood masses.)
**Xuanhusuo San**: Treats postpartum abdominal pain from attacking evil blood, and all types of stabbing pain from blood/qi, regardless of new/old or excess/deficiency.
Danggui (wine-soaked), Xuanhusuo, Chishao, Puhuang (stir-fried between paper), Guipi, Ruxiang, Moyao (equal parts).
Grind into fine powder. Take 3 qian per dose, mixed with warm wine, on an empty stomach.
**Yanhu San**: Treats postpartum Erzhen abdominal pain.
Xuanhusuo, Danggui (each 1 liang), Chishao (5 qian), Rougui (7.5 qian), Puhuang (stir-fried), Hupo (each 2.5 qian), Honglanhua (2 qian). (Adding Honglanhua and Hupo is especially effective for Erzhen.)
Grind into powder. Take 3 qian per dose, mixed with child's urine and wine, before meals.
**Wujin San**: Treats decaying lochia/blood wandering and stabbing the heart/abdomen, Erzhen pain, restlessness, and sluggish residual blood.
Chuanxiong (7.5 qian, burned and preserved in nature inside a steamer), Heifuzi (half piece, processed, peel and navel removed). (Using burned Chuanxiong and Heifuzi warms the interior of the Blood Sea.)
Grind into fine powder. Take 3 qian per dose, mixed with child's urine and wine. Stop when pain ceases and blood discharges.
**Dihuang San**: Treats postpartum incomplete lochia and severe cramping abdominal pain.
Shengdihuang (stir-fried), Danggui (stir-fried, each 1 liang), Shengjiang (5 qian, chopped, stir-fried on a new tile until charred black).
Grind into powder. Take 2 qian per dose, mixed with ginger and wine, on an empty stomach. Another formula adds Puhuang and makes pills.
**Sishen San**: Treats postpartum undissipated blood stasis, accumulation forming masses, and severe heart/abdominal pain.
Danggui, Ganjiang (processed), Chuanxiong, Chishao (stir-fried, equal parts).
Grind into powder. Take 2 qian per dose, mixed with warm wine.
**Heishen San**: Treats postpartum blood mass pain.
Shudihuang (1 jin), Chen Shengjiang (half jin).
Mix these two, stir-fry together until dry, grind into powder. Take 2 qian per dose, mixed with Wu Mei soup. For regular use, mix with wine.
**Danxi Formula**: Treats postpartum blood mass pain and fever.
Wulingzhi (4 qian, stir-fried), Mudanpi, Moyao, Huashi.
Grind finely. Divide into five doses. Take with Doulin Jiu (bean-dripping wine) before meals.
**Juanhe San**: Treats postpartum blood rushing to the heart, blood stabbing/fainting, blood/qi abdominal pain, and sluggish lochia.
Chu Chu Juanhe (fresh lotus leaf bud), Honghua, Danggui (each 1 qian), Puhuang (paper-stir-fried), Mudanpi (each half liang).
Grind into fine powder. Take 3 qian per dose, mixed with salt wine on an empty stomach.
**Heye San**: Treats postpartum lochia retention, abdominal pain, and mental restlessness.
Gan Heye (2 liang), Liu Jinu, Puhuang (each 1 liang), Taoren (skin/kernel removed, bran-stir-fried, half liang).
Cut into pieces. Take 4 qian per dose, with one cup of child's urine, three slices of fresh ginger, and 0.1 liang of Shengdihuang. Decoct until reduced to 0.6 volume. Drink hot, anytime. (All are blood-breaking herbs; for treating restlessness, child's urine and Shengdihuang are particularly good.) Another formula includes Guijianyu.
**Yinju Zelan Tang**: Treats postpartum lochia abdominal pain or chest fullness with shortness of breath.
Zelan (stir-fried) (Zelan is a holy medicine for regulating blood and qi), Shengdihuang, Danggui, Shaoyao (stir-fried), Shengjiang (each 1 qian), Gancao (0.5 qian), Dazao (four pieces).
Cut and decoct in water.
**Another Formula**: Treats postpartum incomplete vaginal bleeding and unbearable hard abdominal pain.
Danggui, Shaoyao, Guixin (each 3 liang), Taoren (120 grains, processed).
Decoct six sheng of water to two sheng. Take warm in two doses. If not healed, add Dahuang. (The brilliance lies in adding Dahuang, preferably vinegar-processed.)
**Another Formula**: Treats postpartum incomplete lochia, condensed lower abdominal pain.
Danggui (7.5 qian), Xiangfuzi (processed, 1 liang), Chishao, Qingpi, Muxiang, Guixin, Hupo, Moyao (each half liang).
Grind into fine powder. Take 2 qian per dose, mixed with Wudou Lin Jiu (black bean dripping wine).
**Chanbao Tang**: Treats postpartum residual blood pain with masses.
Guixin, Jianghuang (equal parts).
Grind into powder. Take one cun bi (measure) mixed with wine. Ideal when blood discharges completely.
**Yanhusuo San** (also known as Sansheng San or Rusheng Tang): Treats postpartum pain below the umbilicus and lower back pain.
Xuanhusuo, Guixin (each half liang), Danggui (1 liang).
Grind into powder. Take 2 qian per dose, mixed with hot wine.
**Xianggui San**: Treats persistent postpartum pain below the umbilicus.
Danggui, Chuanxiong (each 2.5 qian), Guixin (half liang).
Grind into powder. Divide into three doses. For each dose, boil in one cup of wine for three-five boils, add a little child's urine, decoct to 0.7 volume. Drink warm. Severe cases may need only two doses to heal.
**Danggui Xuejie Wan**: Treats postpartum lochia retention, mass formation, chest/epigastric stuffiness, and hard lower abdominal pain. (Primarily breaks blood.)
Danggui, Xuejie, Shaoyao, Pengzhu (processed, each 2 liang), Wulingzhi (4 liang).
Grind into powder. Mix with vinegar paste to make pills the size of paulownia seeds. Take 50 pills per dose, washed down with warm wine before meals.
**Danggui Yangxue Wan**: Treats postpartum undissipated evil blood, thirst, heart/abdominal pain, sluggish lochia, urgent lower abdominal pain radiating to waist/legs. (Most postpartum leg/waist pain is due to blood stasis flowing into channels; modern practitioners often mistakenly treat with strong tonics, leading to chronic issues. Even with wind-cold, sudden tonification is inadvisable. This formula excels at moving stasis but is less effective for dispelling wind; select carefully.)
Danggui, Chishao, Mudanpi, Xuanhu (each 2 liang), Guixin (1 liang).
Grind into powder. Make honey pills the size of sesame seeds. Take 30-40 pills on an empty stomach with wine. Chew thoroughly for severe pain.
**Zijin Wan**: Treats postpartum sluggish lochia, stabbing pain in waist/abdomen/lower abdomen, intermittent chills/fever/headache, anorexia. Also treats long-standing blood stasis, irregular menstruation, and heart pain. (Essential herb for postpartum blood stasis. A variation of Shixiao San.)
Wulingzhi (washed to remove earth/stones, dried, stir-fried into powder), True Puhuang (equal parts).
Mix Wulingzhi with good rice vinegar, slowly cook into a paste. Add Puhuang powder and mix. Make pills the size of cherries. Take one pill per dose, decocted in half cup water and half cup child's urine until reduced to 0.7 volume. Drink warm when dissolved. Repeat shortly after. Lochia will discharge. For long-standing stasis masses or irregular menstruation, take with wine.
**Yuzhu San**: Treats postpartum incomplete lochia, umbilical/abdominal pain, dry constipation, intermittent chills/fever.
Danggui, Chuanxiong, Chishao, Shudi, Dahuang, Pu Xiao, Gancao (each 1.5 qian).
One dose, decoct in water. Drink warm before meals. (This is He Jian's method: Siwu Tang combined with Dachengqi Tang. Salty flavors enter the blood.) Most formulas for decayed blood pain are warming, based on the principle that heat promotes flow. This formula is cooling, designed for decayed blood stagnation with fever and dry constipation. Do not use if constipation is not present.
**Zhishi Shaoyao San**: *Jingui* states: Postpartum abdominal pain, irritability, fullness, inability to lie down. This formula governs. (A noblewoman postpartum had a deep, small pulse like silk, abdominal pain preventing eating, vomiting at the smell of medicine. Cured in three doses.)
Zhishi (stir-fried until black, not too much), Shaoyao (equal parts).
Pound into powder. Take one cun bi per dose, three times daily. Also governs carbuncles/pus, taken with millet porridge.
**Xiayuxue Tang**: Postpartum abdominal pain should first use Zhishi Shaoyao San. If ineffective, it indicates dry blood adhering below the umbilicus. Use this formula. (Zhongjing's formula, also essential for irregular menstruation.)
Dahuang (2 liang), Taoren (20 kernels), E Chong (20 pieces, stir-fried, feet removed).
Grind three ingredients into powder. Mix with refined honey to make four pills. Decoct one pill in one sheng of wine to obtain 0.8 he. Take in one dose. Fresh blood resembling pig liver will discharge. ("Fresh blood" here refers to the discharge of dry blood; the term "fresh" is misleading.")
**Baoming Fang**: Treats blood fainting and blood knotting, accumulating in the chest, lower abdomen, or flanks. Siwu Tang 4 liang, double Danggui and Chuanxiong, add Guijianyu, Honghua, Xuanhu (each 1 liang). Grind coarsely. Add the following four, decoct and mix with Moyao San.
Meng Chong (2 qian, wings/feet removed, stir-fried), Shuizhi (1 qian, stir-fried), Shexiang (small amount), Moyao.
Grind into powder. Mix with the previous herbs. Take one dose. When blood discharges and pain stops, cease administration.
**Qianjin Tao Ren Shao Yao Tang**: Treats postpartum abdominal pain.
Taoren, Shaoyao, Chuanxiong, Danggui, Guixin, Ganqi (crushed, stir-fried), Gancao (each 2 liang).
Cut finely. Decoct eight sheng of water to 2.5 sheng. Divide into three doses.
The above formulas for blood stasis abdominal pain are heavy-duty; use with discretion.
**Zengsun Siwu Tang**: Treats postpartum yin-yang disharmony, alternating chills/fever, lochia stagnation causing chills/fever. Differentiated by urgent lower abdominal pain.
Danggui (wine-soaked), Baishao, Chuanxiong, Renshen (each 1 liang), Ganjiang (1 liang), Gancao (roasted, half liang).
Cut. Take 4 qian per dose, with three slices of ginger, decoct in water anytime. Drink hot.
**Dusheng San**: Treats postpartum blood deficiency abdominal pain.
Danggui alone, ground into fine powder. Take 2 qian per dose, decocted in one cup of water to 0.7 volume. Drink warm. (Simple formula with unique insight; Danggui also treats persistent chills/fever.)
**Danggui San**: Treats postpartum yin-blood weakness, or qi stagnation/blood coagulation causing fever/abdominal pain or abdominal/flank fullness.
Danggui, Ganjiang (equal parts).
Cut. Take 3 qian per dose, decoct in water.
**Dingtong San**: Treats postpartum continuous evil blood discharge.
Danggui, Shaoyao (stir-fried, each 2 qian), Rougui (1 qian).
Cut into one dose. Decoct in one and a half cups each of water and wine, with five slices of ginger, until one cup remains. Drink.
**Danggui Jianzhong Tang**: Treats postpartum women with emaciation/insufficiency, continuous stabbing abdominal pain, shallow breathing, or painful urgency in lower abdomen radiating to back, unable to eat.
Danggui (4 liang), Shaoyao (stir-fried, 6 liang), Guizhi (3 liang), Gancao (roasted, 2 liang), Shengjiang (3 liang), Dazao (12 pieces).
Six ingredients, decoct in ten dou of water to obtain three sheng. Take warm in three doses, consumed within one day. (For persistent internal epistaxis, adding Dihuang and Ejiao seems appropriate, but Guizhi and Shengjiang in this formula may be too hot; please consider. For severe deficiency, add 6 liang of Yitang; after decoction, melt Yitang over fire. For excessive blood loss, metrorrhagia, or persistent internal epistaxis, add 6 liang Dihuang and 2 liang Ejiao, combining into an eight-ingredient decoction, dissolving Ejiao into it.)