〔郭〕产后大便秘涩者何？答曰∶产卧水血俱下，肠胃虚竭，津液不足，是以大便
秘涩不通也。若过五六日，腹中闷胀者，此乃燥屎在脏腑，以其干涩未能出耳。宜服麻
仁丸以津润之。若误以为有热，投之寒药，则阳消阴长，变证百出，性命危矣。
〔薛〕产后大便不通，因去血过多，大肠干涸，或血虚火燥干涸，不可计其日期，饮
食数多，用药通之、润之，必待腹满觉胀，自欲去而不能者，乃结在直肠，宜用猪胆汁润
之。若服苦参药润通，反伤中焦元气，或愈加难通，或通而泻不能止，必成败证。若属
血虚火燥，用加味逍遥散。气血俱虚，八珍汤。慎不可用麻子、杏仁、枳壳之类。一
产妇大便不通七日矣，饮食如常，腹中如故。余曰∶饮食所入，虽倍常数，腹不满胀，用
八珍加桃仁、杏仁。至二十一日，腹满欲去，用猪胆汁润之，先去干粪五七块，后皆常粪
而安。一产妇大便八日不通，用通利之药，中脘作痛，饮食甚少，或云通则不痛，痛则
不通。乃用蜜导之，大便不禁，吃逆不食。余曰∶此脾肾复伤，用六君加吴茱、肉果，骨
脂、五味数剂，喜其年壮而愈。不然，多致不起。一产妇大便秘结，小腹胀痛，用大
黄等药，致吐泻不食，腹痛胸痞。余用六君子加木香、炮姜，治之而愈。一妇人大便
秘涩，诸药不应，苦不可言，令饮人乳而愈。
麻仁丸
麻仁（研如泥） 枳壳 人参（各一两） 大黄（半
两）
上为末，炼蜜丸如梧桐子大。空心温酒下二十丸，未通渐加丸数，不可太过。
评曰∶产后不得利，利者百无一生。去血过多，脏燥大便秘涩，则固当滑之，大黄
似难轻用，唯葱涎调腊茶为丸，复以腊茶下之必通。（予常用《局方》四物汤，以生地黄易熟地
黄，加青皮去白煎服，甚效。）
〔本事〕妇人产后有三种疾，郁冒则多汗，汗多则大便秘，故难于用药，惟麻子苏
子粥最为稳当。用紫苏子、大麻子二味，各半合，洗净研极细，用水再研取汁，一盏，分
二次煮粥啜下。此粥不唯产后可服，大抵老人诸虚风秘，皆宜服之。当有一人母年八十
四，忽尔腹满头疼，恶心不食，召医数人，议皆用补脾进食，治风清利头目等药，数日虽
愈，全不入食，其家忧惶。余辨说前药皆误矣，此证正是老人风秘，脏腑壅滞，聚于胸
中则腹胀恶心，不思饮食，又上至于颠则头痛，神不清也。若脏腑流畅，诸疾悉去矣。予
令作此粥，两啜而气泄，先下结粪如胡椒者十余枚，后渐得通利，不用药而自愈矣。
〔丹〕产后秘结不通，膨满者，气急坐卧俱难，用大麦 炒黄为末，酒下一合，神
效。（出《兵部手集》。）
[郭] 产后大便秘结涩滞的原因是什么？回答说：分娩后，水和血一同排出，导致肠胃虚弱枯竭，津液不足，因此大便秘结涩滞不通。如果过了五六天，腹部感到闷胀，这是燥屎停留在脏腑中，因为粪便干燥涩滞所以无法排出。适宜服用麻仁丸来滋润肠道。如果误认为是体内有热，投用寒凉药物，就会导致阳气消减、阴气增长，从而引发各种变证，危及生命。
[薛] 产后大便不通，是因为失血过多，大肠干涸；或者是血虚导致虚火内燥，使肠道干涸。这种情况不能仅凭天数来判断，即使饮食数量较多，用药通便或润肠，必须等到腹部满闷自觉胀急，想排便却排不出的情况，这才是燥屎结在直肠，适宜使用猪胆汁来润通。如果服用苦参等药物来润通，反而会损伤中焦元气，或者更加难以通便，或者通了之后腹泻不止，必然导致败证（难治之症）。如果属于血虚火燥，使用加味逍遥散。如果是气血俱虚，使用八珍汤。千万不要使用麻子、杏仁、枳壳之类的药物。有一位产妇大便不通七天，饮食如常，腹部也没有异常。我说：虽然摄入的饮食量是平时的两倍，但腹部并不满胀，使用八珍汤加入桃仁、杏仁。到了第二十天，腹部满胀想要排便，使用猪胆汁润通，先排出干硬的粪块五七块，随后排出正常粪便而痊愈。另一位产妇大便八天不通，使用通利药物后，中脘穴处疼痛，饮食很少，有人说“通则不痛，痛则不通”。于是使用蜜导法（蜂蜜栓），结果导致大便失禁，呃逆且不能进食。我说：这是脾肾再次受伤，使用六君子汤加入吴茱萸、肉豆蔻、骨脂、五味子，服用数剂，庆幸她年纪轻壮而痊愈。否则，大多会导致死亡。还有一位产妇大便秘结，小腹胀痛，使用大黄等药物，导致呕吐、腹泻、不能进食，腹痛且胸膈痞闷。我使用六君子汤加入木香、炮姜，治疗而痊愈。还有一位妇人便秘涩滞，各种药物无效，痛苦不堪，让她饮用人乳而痊愈。
麻仁丸
麻仁（研磨成泥） 枳壳 人参（各一两） 大黄（半两）
以上药物研为细末，用炼蜜制成梧桐子大小的药丸。空腹时温酒送服二十丸，若未通便可逐渐增加丸数，不可过量。
评述说：产后不宜使用泻下法，使用泻下法的患者百无一活。因去血过多，脏腑干燥导致大便秘涩，确实应当滑润肠道，大黄似乎难以轻易使用，只有用葱汁调和腊月茶做成药丸，再用腊月茶送服，必定能通便。（我常用《局方》的四物汤，以生地黄代替熟地黄，加入青皮去白煎服，效果很好。）
[本事] 妇人产后有三种疾病，郁冒则多汗，汗多则导致大便秘结，因此用药困难，只有麻子苏子粥最为稳妥。使用紫苏子、大麻子两味药，各半合，洗净后研磨极细，用水再次研磨取汁，得一盏，分两次煮粥喝下。此粥不仅产后可以服用，大体上老人各种虚证引起的风秘，都适宜服用。曾经有一位八十多岁的老母亲，忽然腹部满胀、头痛、恶心不想吃饭，召集多位医生，讨论都认为应该用补脾进食、治风清利头目等药物，几天后虽然症状缓解，但完全无法进食，家人非常担忧。我辨析说前面的药都错了，这个病症正是老人的风秘，脏腑壅滞，积聚在胸中则腹胀恶心，不思饮食，又上行至头顶则头痛，神志不清。如果脏腑流畅，各种疾病都会去除。我让他们制作这种粥，喝了两口后气机泄降，先排出像胡椒粒一样的干硬粪便十余枚，随后逐渐通畅，不用药物而自愈了。
[丹] 产后秘结不通，腹部膨满的，呼吸急促，坐卧都困难，使用大麦炒黄研为细末，用酒送服一合，效果神奇。（出自《兵部手集》。）
[Guo] What is the cause of constipation and dryness of stool after childbirth? The answer is: After delivery, water and blood are discharged together, leading to deficiency and exhaustion of the stomach and intestines, and a lack of body fluids (Jin-Ye), thus causing constipation and dryness of stool. If five or six days pass and there is abdominal stuffiness and distension, this indicates dry feces retained in the zang-fu organs; because the feces are dry and astringent, they cannot be expelled. It is appropriate to take Mahuang Wan (Cannabis Seed Pill) to moisten the intestines. If mistakenly treated as having internal heat by administering cold-natured herbs, yang will decline and yin will grow, resulting in various complicated syndromes and endangering life.
[Xue] Postpartum inability to defecate is caused by excessive blood loss, leading to dryness of the large intestine, or by blood deficiency with fire-dryness causing intestinal dehydration. One should not judge solely by the number of days. Even if food intake is high, using purgative or moistening drugs requires waiting until the patient feels fullness and distension in the abdomen, desires to defecate but cannot. This indicates dry feces impacted in the rectum, suitable for treatment with pig bile to moisten and unblock. If bitter herbs like Sophora flavescens root (Kushen) are used to moisten and unblock, it may damage the primordial qi of the middle jiao, making defecation even more difficult, or causing persistent diarrhea after evacuation, inevitably leading to a critical syndrome (Bai Zheng). If the syndrome belongs to blood deficiency with fire-dryness, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If both qi and blood are deficient, use Bazhen Tang (Eight Treasures Decoction). One must strictly avoid using seeds like hemp seed (Mazi), apricot kernel (Xingren), or aurantium peel (Zhiqiao). One postpartum patient had not defecated for seven days, yet her diet was normal and abdomen felt fine. I said: Although food intake was double the usual amount, the abdomen was not distended. Use Bazhen Tang added with Peach Kernel (Taoren) and Apricot Kernel (Xingren). By the twentieth day, when abdominal distension occurred and she desired to defecate, use pig bile to moisten. First, five or seven pieces of hard feces were passed, followed by normal stools, and she recovered. Another postpartum patient had not defecated for eight days. After using purgatives, pain occurred at Zhongwan (CV12), and food intake was scant. Some said "unblocked means no pain, pain means unblocked." Thus, honey suppositories (Mi Dao) were used, resulting in involuntary defecation, hiccups, and inability to eat. I said: This is further injury to the spleen and kidney. Use Liujunzi Tang (Six Gentlemen Decoction) added with Evodia fruit (Wuzhuyu), Myristica seed (Roudoukou), Achyranthes root (Guzhi), and Schisandra berry (Wuweizi). After several doses, fortunately, due to her young age, she recovered. Otherwise, death would likely have ensued. A postpartum patient with constipation and lower abdominal distending pain used Rhubarb (Dahuang) and other drugs, resulting in vomiting, diarrhea, anorexia, abdominal pain, and chest oppression. I treated her with Liujunzi Tang added with Aucklandia root (Muxiang) and roasted ginger (Paojiang), and she recovered. A woman with severe constipation and dryness found all medicines ineffective and suffered greatly. She was instructed to drink human milk and recovered.
Mahuang Wan (Cannabis Seed Pill)
Hemp Seed (Maren, ground into paste), Aurantium Peel (Zhiqiao), Ginseng Root (Renshen) (each 1 liang), Rhubarb Root and Rhizome (Dahuang) (0.5 liang).
Grind the above into powder, mix with refined honey to form pills the size of paulownia seeds. Take 20 pills on an empty stomach with warm wine. If stool does not pass, gradually increase the number of pills, but do not exceed the appropriate dose.
Commentary states: Purging is contraindicated after childbirth; those who undergo purging rarely survive. Due to excessive blood loss and dryness of the viscera causing constipation, lubrication is indeed indicated. However, Rhubarb (Dahuang) should not be used lightly. Only by mixing scallion juice with tea from the twelfth lunar month (Lacha) to form pills, and taking them down with Lacha, can the bowels be unblocked. (I often use Siwu Tang (Four Substances Decoction) from the Bureau of Medical Relief Formulas, substituting Rehmannia Root (Sheng Dihuang) for processed Rehmannia Root (Shu Dihuang), adding peeled Citrus Aurantium Peel (Qingpi), and decocting for administration; this is very effective.)
[Benshi] There are three types of diseases in women after childbirth. Yu Mao (depression and dizziness) leads to profuse sweating; profuse sweating leads to constipation. Therefore, medication is difficult to administer. Only Mazisu Zi Zhou (Hemp Seed and Perilla Seed Porridge) is the safest option. Use Perilla Seed (Zisuzi) and Hemp Seed (Damaizi), half he each, wash clean, grind extremely finely, add water and grind again to extract juice, obtaining one cup. Divide into two portions and cook into porridge to consume. This porridge is not only suitable for postpartum use but also generally appropriate for the elderly suffering from various deficiency-induced wind-constipation. Once, an eighty-four-year-old mother suddenly experienced abdominal distension, headache, nausea, and anorexia. Several doctors were summoned, and all discussed using spleen-tonifying, appetite-stimulating, wind-dispelling, and head-clearing herbs. Although symptoms improved after several days, she could not eat at all, causing great worry to her family. I analyzed that the previous medications were incorrect. This case was precisely wind-constipation in the elderly, with obstruction of the zang-fu organs. Accumulation in the chest causes abdominal distension, nausea, and anorexia; ascending to the vertex causes headache and mental cloudiness. If the zang-fu organs become smooth and flowing, all diseases will disappear. I instructed them to make this porridge. After two sips, qi descended, and first, more than ten pellets of hard feces resembling peppercorns were passed. Subsequently, bowel movements became regular, and she healed without medication.
[Dan] For postpartum constipation with abdominal distension, where breathing is rapid and sitting or lying down is difficult, use barley stir-fried until yellow, ground into powder. Take one he with wine. The effect is miraculous. (From Bingbu Shouji.)