产后恶露不尽，留滞作痛者亦常有之。然此与虚痛者不同，必其由渐而甚，或大小便不行，或小腹鞭实作胀
痛极不可近手，或自下上冲心腹，或痛极牙关紧急，有此实证，当速去其血，近上者宜失笑散。近下者宜通瘀
煎。如或未效，宜决津煎。若母体本虚而血少者，即于产时亦无多血，此非血滞。若有疼痛，宜殿胞煎、四神
散、五物煎。
失笑散
五灵脂净者（一两） 蒲黄（俱炒，五钱为末）
每服二钱，酒煎热服。
通瘀煎
归尾（三钱） 山楂 红花（新者炒黄用） 香附（童便制，各二钱） 乌药（一钱） 青皮 泽泻（各一
钱五分） 木香（七分）
水煎，入酒半钟服。若兼寒滞加肉桂（一钱）。
决津煎
当归（三钱） 熟地黄（二三钱） 肉桂 乌药（各一钱） 牛膝（二钱） 泽泻（一钱五分）
水煎服。
恶呕加炮姜一钱；气滞胀痛加香附一钱；血滞血涩加酒炒红花一钱；小腹冷痛加吴茱萸七分；大便秘结加
肉苁蓉一钱。
殿胞煎
当归（五钱） 川芎 炙甘草 茯苓（各一钱） 肉桂（一钱或五七分）
水煎服。
兼寒而呕加干姜（炒黄）一钱；血热多火去肉桂加白芍（酒炒）一钱；脉弱阴虚加熟地黄三钱；气滞加香
附一钱；腰痛加杜仲（炒）一钱。
四神散
当归（二钱） 川芎 白芍（炒，各一钱） 炮姜（五分）
水煎服。
五物煎
当归 熟地黄（各三钱） 白芍（酒炒，二钱） 川芎（一钱） 肉桂（一钱）
水煎服。胃寒呕恶加干姜（炮）一钱。
产后恶露排出不净，瘀血停滞引起疼痛的情况也很常见。然而这与虚证引起的疼痛不同，其特点是疼痛逐渐加重，或者大小便不通畅，或者小腹坚硬胀满，疼痛剧烈到不能触碰，或者疼痛从下向上冲撞心腹部，或者疼痛剧烈导致牙关紧闭，出现这些实证表现时，应当迅速祛除瘀血。病位偏上的适宜使用失笑散，病位偏下的适宜使用通瘀煎。如果服用后效果不明显，适宜使用决津煎。如果产妇体质本来虚弱且血液不足，即使在分娩时也没有多少瘀血排出，这不属于血瘀阻滞。如果有疼痛症状，适宜使用殿胞煎、四神散、五物煎。
失笑散
由净选的五灵脂（一两）和蒲黄（各五钱，共同炒制后研成粉末）组成。
每次服用二钱，用酒煎煮后热服。
通瘀煎
由归尾（三钱）、山楂、红花（新鲜的炒至微黄使用）、香附（用童子尿炮制，各二钱）、乌药（一钱）、青皮、泽泻（各一钱五分）、木香（七分）组成。
用水煎煮，加入半钟酒服用。如果兼有寒邪停滞，加肉桂（一钱）。
决津煎
由当归（三钱）、熟地黄（二三钱）、肉桂、乌药（各一钱）、牛膝（二钱）、泽泻（一钱五分）组成。
用水煎煮服用。如果伴有恶心呕吐，加炮姜一钱；气滞导致胀痛，加香附一钱；血滞血涩，加酒炒红花一钱；小腹冷痛，加吴茱萸七分；大便秘结，加肉苁蓉一钱。
殿胞煎
由当归（五钱）、川芎、炙甘草、茯苓（各一钱）、肉桂（一钱或五分至七分）组成。
用水煎煮服用。如果兼有寒邪且呕吐，加干姜（炒黄）一钱；血热火旺，去掉肉桂加白芍（酒炒）一钱；脉弱阴虚，加熟地黄三钱；气滞，加香附一钱；腰痛，加杜仲（炒）一钱。
四神散
由当归（二钱）、川芎、白芍（炒，各一钱）、炮姜（五分）组成。
用水煎煮服用。
五物煎
由当归、熟地黄（各三钱）、白芍（酒炒，二钱）、川芎（一钱）、肉桂（一钱）组成。
用水煎煮服用。如果胃寒伴有恶心呕吐，加干姜（炮制）一钱。
Postpartum lochia discharge is incomplete, and pain caused by the stagnation of retained blood is also common. However, this differs from pain due to deficiency; it is characterized by gradually worsening pain, or obstruction of urination and defecation, or hardness and distension in the lower abdomen with severe pain that cannot tolerate touch, or pain rushing upward from below to strike the heart and abdomen, or extreme pain causing lockjaw. When such excess syndrome manifestations occur, blood stasis should be rapidly expelled. For stasis located higher up, Shixiao San (Plea for Mercy Powder) is suitable; for stasis located lower down, Tongyu Jian (Decoction for Promoting Blood Circulation) is suitable. If there is no effect, Juejin Jian (Decoction for Resolving Obstruction) is suitable. If the mother's constitution was originally deficient with insufficient blood, there may not have been much blood to expel even during delivery; this is not blood stasis. If there is pain, Dianbao Jian (Decoction for Protecting the Womb), Sishen San (Four Divine Powder), and Wuwu Jian (Five Substance Decoction) are suitable.
Shixiao San (Plea for Mercy Powder)
Consists of purified Trogopterus Dung (Wulingzhi, 五灵脂) (one tael) and Coptis Rhizome? No, Poria? No, Lygodii Spora (Puhuang, 蒲黄) (five qian each, stir-fried together and ground into powder).
Take two qian per dose, decoct with wine and take hot.
Tongyu Jian (Decoction for Promoting Blood Circulation)
Consists of Angelica Sinensis Root Tip (Guiwei, 归尾) (three qian), Hawthorn Fruit (Shanzha, 山楂), Safflower (Honghua, 红花) (fresh ones stir-fried until yellow), Cyperus Rotundus Rhizome (Xiangfu, 香附) (processed with child's urine, two qian each), Lindera Root (Wuyao, 乌药) (one qian), Tangerine Peel (Qingpi, 青皮), Alisma Rhizome (Zexie, 泽泻) (one qian five fen each), Aucklandia Root (Muxiang, 木香) (seven fen).
Decoct with water, add half a zhong of wine, and take. If accompanied by cold stagnation, add Cinnamon Twig (Rougui, 肉桂) (one qian).
Juejin Jian (Decoction for Resolving Obstruction)
Consists of Angelica Sinensis Root (Danggui, 当归) (three qian), Prepared Rehmannia Root (Shudihuang, 熟地黄) (two to three qian), Cinnamon Twig (Rougui, 肉桂), Lindera Root (Wuyao, 乌药) (one qian each), Achyranthes Bidentata Root (Niuxi, 牛膝) (two qian), Alisma Rhizome (Zexie, 泽泻) (one qian five fen).
Decoct with water and take. If accompanied by nausea and vomiting, add Stir-fried Ginger (Paojiang, 炮姜) (one qian); if qi stagnation causes distension and pain, add Cyperus Rotundus Rhizome (Xiangfu, 香附) (one qian); if blood stagnation and涩 (astringency/stagnation) occur, add Wine-stir-fried Safflower (Honghua, 红花) (one qian); if lower abdominal cold pain occurs, add Evodia Fruit (Wuzhuyu, 吴茱萸) (seven fen); if constipation occurs, add Cistanche Stem (Roucongrong, 肉苁蓉) (one qian).
Dianbao Jian (Decoction for Protecting the Womb)
Consists of Angelica Sinensis Root (Danggui, 当归) (five qian), Szechwan Lovage Rhizome (Chuanxiong, 川芎), Honey-fried Licorice Root (Zhigancao, 炙甘草), Poria (Fuling, 茯苓) (one qian each), Cinnamon Twig (Rougui, 肉桂) (one qian or five to seven fen).
Decoct with water and take. If accompanied by cold and vomiting, add Dried Ginger (Ganjiang, 干姜) (stir-fried until yellow, one qian); if blood heat with excessive fire, remove Cinnamon Twig and add White Peony Root (Baishao, 白芍) (wine-stir-fried, one qian); if weak pulse with yin deficiency, add Prepared Rehmannia Root (Shudihuang, 熟地黄) (three qian); if qi stagnation, add Cyperus Rotundus Rhizome (Xiangfu, 香附) (one qian); if lower back pain, add Eucommia Bark (Duzhong, 杜仲) (stir-fried, one qian).
Sishen San (Four Divine Powder)
Consists of Angelica Sinensis Root (Danggui, 当归) (two qian), Szechwan Lovage Rhizome (Chuanxiong, 川芎), White Peony Root (Baishao, 白芍) (stir-fried, one qian each), Stir-fried Ginger (Paojiang, 炮姜) (five fen).
Decoct with water and take.
Wuwu Jian (Five Substance Decoction)
Consists of Angelica Sinensis Root (Danggui, 当归), Prepared Rehmannia Root (Shudihuang, 熟地黄) (three qian each), White Peony Root (Baishao, 白芍) (wine-stir-fried, two qian), Szechwan Lovage Rhizome (Chuanxiong, 川芎) (one qian), Cinnamon Twig (Rougui, 肉桂) (one qian).
Decoct with water and take. If stomach cold with nausea and vomiting, add Stir-fried Dried Ginger (Ganjiang, 干姜) (one qian).