〔郭〕产后腹痛及泻利者何？答曰∶产后肠胃虚怯，寒邪易侵。若未盈月，饮冷当
风，乘虚袭留于肓膜，散于腹胁，故腹痛作阵，或如锥刀所刺，流入大肠，水谷不化，洞
泄肠鸣，或下赤白， 胁填胀，或痛走不定，急服调中汤立愈。若医者以为积滞取之，祸
不旋踵，谨之谨之。
陈无择评曰∶产后下痢，非止一证，当随所因而调之。既云饮冷当风，何所不至，寒
热风湿，本属外因，喜怒忧思，还从内性，况劳逸饥饱，皆能致病。若其洞泄，可服调中
汤。赤白滞下，非此能愈，各随门类，别有正方。
〔薛〕产后泻痢，或因饮食伤损脾土，或脾土虚不能消食，当审而治之。若米食所
伤，用六君加谷 。若面食所伤，用六君加麦 。若肉食所伤，用六君加山楂、神曲。凡
兼呕吐，皆加藿香。若兼咽酸或呕吐，用前药送越鞠丸。若肝木来侮脾土，用六君加柴
胡、炮姜。若寒水反来侮土，用钱氏益黄散。若久泻，或元气下陷，兼补中益气汤以升发
阳气。若泻痢色黄，乃脾土真气，宜加木香、肉果。若脾土虚寒，当用六君子加木香、姜、
桂。若脾肾虚寒，用补中益气及四神丸。若属命门火衰，而脾土虚寒，用八味丸以补土
母。若小便涩滞，肢体渐肿，或兼喘咳，用金匮肾气丸以补脾肾，利水道。若胃气虚弱
而四肢浮肿，治须补胃为主。若久而不愈，或非饮食所伤而致，乃属肾气亏损，盖胞胎主
于任而系于肾，况九月、十月，乃肾与膀胱所养，必用四神、六味、八味三药以补肾。若
用分利导水之剂，是虚其虚也。一产妇泻痢，发热，作渴，吐痰甚多，肌体消瘦，饮
食少思，或胸膈痞满，或小腹胀坠，年余矣。余以为脾胃泻，朝用二神丸，夕用六君子，三
月余而痊。一妇产后泄泻，兼呕吐咽酸，面目浮肿，此脾气虚寒。先用六君加炮姜为主，
佐以越鞠丸而咽酸愈；又用补中益气加茯苓、半夏，而脾胃康。一产妇泻利年余，形体
骨立，内热晡热，自汗盗汗，口舌糜烂，日吐痰三碗许，脉洪大，重按全无，此命门火
衰，脾土虚寒而假热，吐痰者，乃脾虚不能统摄归源也。用八味丸补火以生土，用补中
益气汤兼补肺金而脾胃健。一产妇腹痛后重，去痢无度，形体倦怠，饮食不进。与死
为邻，此脾肾俱虚。用四神丸、十全大补汤而愈。但饮食难化，肢体倦怠，用补中益气
汤而康。一妇人五月患痢，日夜无度，小腹坠痛，发热恶寒，用六君子汤送香连丸，二
服渐愈。仍以前汤送四神丸四服全愈。至七月终，怠惰嗜卧，四肢不收，体重节痛，口
舌干燥，饮食无味，大便不实，小便频数，洒淅恶寒，凄惨不乐，此肺之脾胃俱虚，而阳
气寒不伸也。用升阳益胃汤而痊。
汪石山治一妇产后滑泄，勺水粒米弗容，时即泄下。如此半月余，众皆危之，或用五
苓散、平胃散，病益甚。汪诊之，脉皆濡缓而弱。曰∶此产中劳力以伤其胃也，若用汤
药，愈滋胃湿，非所宜也。令以参苓白术散除砂仁，加陈皮、肉豆蔻，煎姜、枣汤调服，
旬余而安。
〔丹〕治产后泄泻，恶露不行，此余血渗入大肠为泻，洞泄不禁，下青白黑色。用
荆芥大者四五穗，于盏内烧灰，不得犯油火，入麝香研，汤三呷调下。此药虽微，能治大
病。（方名的奇散。）
产后泄方
茯苓 川芎 黄芩 白术 干姜 滑石 陈皮 芍药（炒各）
上水煎服之。
调中汤
高良姜 当归 桂心 芍药 附子（炮） 川芎（各一两） 甘草（半两）
上为粗末，每服三钱匕，水三盏，煎至一盏，去渣热服。
上方惟寒中洞泄者宜之。其肠胃有热者，当服黄连而愈，如如金丸、香连丸之类。若
戊己丸、固肠丸、四神丸、五味子丸之类，皆产后大便不实必用之药，已详载杂病及前泄
泻门中，兹不赘引。
【郭】产后出现腹痛以及腹泻、痢疾的原因是什么？回答说：产妇的肠胃虚弱，寒邪容易侵袭。如果在产后未满一个月时，饮用冷水或迎风受寒，病邪便会乘虚而入，停留在肓膜（心膈之间的脂膜），散布于腹部和胁肋部，因此阵发性腹痛，疼痛感觉如同锥子或刀子刺割一样；如果病邪流入大肠，导致水谷无法消化，就会出现水样直下的泄泻和肠鸣音，或者排出赤白黏液，胁肋部胀满堵塞，或者疼痛游走不定。此时应立即服用调中汤，可迅速痊愈。如果医生误认为是积滞而采用攻下法治疗，灾祸将立刻降临，务必谨慎，务必谨慎。
陈无择评论说：产后下痢，并不止一种证型，应当根据病因进行调理。既然提到了饮冷当风，那么各种外邪都可能侵入，寒、热、风、湿本属于外因，喜、怒、忧、思则源于内性，况且劳累与安逸、饥饿与饱食，都能导致疾病。如果是水样直下的泄泻，可以服用调中汤。如果是赤白相间的滞下（痢疾），单靠此方不能治愈，应参照各类门径，使用专门的方剂。
【薛】产后腹泻和痢疾，可能是因为饮食损伤了脾土，或者是脾土虚弱不能消化食物，应当仔细审查后进行治疗。如果是米食所伤，用六君子汤加谷芽。如果是面食所伤，用六君子汤加麦芽。如果是肉食所伤，用六君子汤加山楂、神曲。凡是兼有呕吐症状的，都加入藿香。如果兼有咽酸或呕吐，用前面的药送服越鞠丸。如果是肝木来克制脾土，用六君子汤加柴胡、炮姜。如果是寒水反来克制脾土，用钱氏益黄散。如果是久泻，或者元气下陷，兼用补中益气汤以升发阳气。如果泻痢颜色发黄，那是脾土的真气外露，宜加木香、肉豆蔻。如果脾土虚寒，应当用六君子汤加木香、生姜、肉桂。如果脾肾两脏虚寒，用补中益气汤及四神丸。如果属于命门火衰，而脾土虚寒，用八味丸以补益脾土之母（肾）。如果小便涩滞不畅，肢体逐渐浮肿，或者兼有喘咳，用金匮肾气丸以补益脾肾，通利水道。如果胃气虚弱而导致四肢浮肿，治疗必须以补胃为主。如果病程长久不愈，或者不是由饮食所伤引起的，那属于肾气亏损，因为胞胎主司于任脉而系属于肾，况且怀孕九月、十月，是由肾与膀胱滋养的，必须用四神丸、六味地黄丸、八味丸这三种药来补肾。如果使用分利导水的药物，这是使虚者更虚。有一位产妇腹泻痢疾，发热，口渴，痰多，身体消瘦，食欲减退，有时胸膈痞闷胀满，有时小腹胀坠，病程已有一年多。我认为这是脾胃泻，早晨服用二神丸，晚上服用六君子汤，三个多月后痊愈。另一位产妇产后泄泻，兼有呕吐咽酸，面目浮肿，这是脾气虚寒。先用六君子汤加炮姜为主，佐以越鞠丸，咽酸症状痊愈；又用补中益气汤加茯苓、半夏，脾胃恢复健康。还有一位产妇腹泻痢疾一年多，形体枯瘦如柴，内有虚热，傍晚发热，自汗盗汗，口舌糜烂，每天吐痰约三碗，脉象洪大但重按完全无力，这是命门火衰，脾土虚寒而产生的假热，吐痰是因为脾虚不能统摄津液归源。用八味丸补火以生土，用补中益气汤兼补肺金，从而使脾胃健运。还有一位产妇腹痛伴有里急后重，拉痢无度，形体倦怠，饮食不进，濒临死亡，这是脾肾俱虚。用四神丸、十全大补汤而痊愈。只是饮食难以消化，肢体倦怠，用补中益气汤而康复。还有一位妇人五月患痢疾，日夜无度，小腹坠痛，发热恶寒，用六君子汤送服香连丸，两服药后逐渐好转。仍然用前汤送服四神丸，四服药后完全痊愈。到了七月末，怠惰嗜睡，四肢不收，身体沉重关节疼痛，口舌干燥，饮食无味，大便不成形，小便频数，怕冷颤抖，心情凄惨不乐，这是肺之脾胃俱虚，而阳气寒冷不能伸展。用升阳益胃汤而痊愈。
汪石山治疗一位产妇产后滑泄，连勺水粒米都无法容纳，随即就排泄下来。如此持续半个月左右，众人都认为病情危重，有人用五苓散、平胃散，病情反而加重。汪石山诊察，脉象皆濡缓而弱。他说：这是产中劳累损伤了胃气，如果用汤药，只会增加胃中湿气，不适合使用。让他用参苓白术散去掉砂仁，加入陈皮、肉豆蔻，用生姜、大枣煎汤调服，十几天后安定。
【丹】治疗产后泄泻，恶露不行，这是余血渗入大肠导致泄泻，洞泄不禁，排出青白黑色粪便。用大的荆芥穗四五把，在盏内烧成灰，不得接触油火，加入麝香研细，用三口水调服。此药虽然轻微，能治大病。（方名奇散。）
产后泄泻方
茯苓 川芎 黄芩 白术 干姜 滑石 陈皮 芍药（炒，各等份）
以上药材用水煎服。
调中汤
高良姜 当归 桂心 芍药 附子（炮制） 川芎（各一两） 甘草（半两）
以上药材制成粗末，每次服用三钱匕，加水三盏，煎至一盏，去渣后热服。
上方仅适用于寒邪中阻导致的洞泄。如果肠胃有热，应当服用黄连类药物即可痊愈，如如金丸、香连丸之类。至于戊己丸、固肠丸、四神丸、五味子丸之类，都是产后大便不实必用的药物，已在杂病及前泄泻门中详细记载，此处不再赘引。
[Guo] What is the cause of abdominal pain and diarrhea/dysentery after childbirth? The answer is: After childbirth, the intestines and stomach are weak and deficient, making them susceptible to invasion by cold pathogens. If one drinks cold water or exposes oneself to wind within a month postpartum, the pathogen will take advantage of the deficiency to invade and remain in the huangmo (the fatty membrane between the heart and diaphragm), spreading to the abdomen and hypochondrium. Consequently, paroxysmal abdominal pain occurs, feeling as if pierced by awls or knives. If the pathogen flows into the large intestine, causing food and fluids to fail to digest, it results in watery diarrhea with borborygmus, or the passage of red and white mucus, fullness and distension in the hypochondrium, or wandering pain. In such cases, one should immediately administer Tiaozhong Tang (Regulate the Middle Decoction) for immediate recovery. If a physician mistakenly treats this as food stagnation and uses purgatives, disaster will follow instantly; caution is paramount.
Chen Wuyue commented: Postpartum dysentery presents various syndromes and must be regulated according to the specific etiology. Since drinking cold water and exposure to wind were mentioned, various external pathogens may invade. Cold, heat, wind, and dampness belong to external causes, while joy, anger, worry, and thought stem from internal nature. Moreover, both overwork and lack of exertion, hunger and satiety can induce disease. For watery diarrhea, Tiaozhong Tang may be used. However, for bloody and purulent dysentery (Chi Bai Zhi Xia), this formula alone is insufficient; one should refer to respective categories for specific formulas.
[Xue] Postpartum diarrhea and dysentery may result from dietary injury damaging the Spleen Earth, or from Spleen Earth deficiency failing to digest food. Treatment must be determined through careful examination. If injured by rice, use Liu Junzi Tang (Six Gentlemen Decoction) plus Gu Ya (Valley Sprout). If injured by wheat products, use Liu Junzi Tang plus Mai Ya (Wheat Sprout). If injured by meat, use Liu Junzi Tang plus Shan Zha (Crataegus) and Shen Qu (Medicated Leaven). For cases accompanied by vomiting, add Huo Xiang (Pogostemon). For cases with acid regurgitation or vomiting, administer the aforementioned herbs with Yueju Wan (Yueju Pill). If Liver Wood insults Spleen Earth, use Liu Junzi Tang plus Chai Hu (Bupleurum) and Pao Jiang (Prepared Ginger). If Cold Water insults Earth, use Qian Shi's Yihuang San (Yellow Protecting Powder). For chronic diarrhea or sinking of Yuan Qi (Primal Qi), combine with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Yang Qi. If the stool is yellow, indicating the true Qi of Spleen Earth leaking out, add Mu Xiang (Aucklandia) and Rou Dou Kou (Myristica). For Spleen Earth deficiency-cold, use Liu Junzi Tang plus Mu Xiang, Sheng Jiang (Fresh Ginger), and Rou Gui (Cinnamon Bark). For Spleen-Kidney deficiency-cold, use Buzhong Yiqi Tang and Sishen Wan (Four Spirits Pill). If Mingmen Fire (Gate of Life Fire) is deficient leading to Spleen Earth deficiency-cold, use Ba Wei Wan (Eight-Ingredient Pill) to tonify the Mother of Spleen Earth (Kidney). If urination is obstructed, limbs gradually swell, or asthma/cough accompanies, use Jin Gui Shenqi Wan (Golden Cabinet Kidney Qi Pill) to tonify Spleen and Kidney and promote water metabolism. If Stomach Qi weakness causes limb edema, treatment must focus on tonifying the Stomach. If prolonged without resolution, or not caused by diet, it belongs to Kidney Qi deficiency. Since the uterus is governed by the Ren Mai (Conception Vessel) and connected to the Kidneys, and months nine and ten of pregnancy are nourished by Kidneys and Bladder, one must use Sishen Wan, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), and Ba Wei Wan to tonify the Kidneys. Using draining and diuretic agents would further deplete the deficiency.
Case 1: A postpartum woman suffered diarrhea/dysentery, fever, thirst, excessive phlegm, emaciation, poor appetite, occasional chest/epigastric fullness, and lower abdominal bearing-down sensation for over a year. I diagnosed this as Spleen-Stomach diarrhea. She tookershenshen Wan in the morning and Liu Junzi Tang in the evening, recovering after three months.
Case 2: A postpartum woman had diarrhea with vomiting, acid regurgitation, and facial edema, indicating Spleen Qi deficiency-cold. Initially treated with Liu Junzi Tang plus Pao Jiang as the main formula, assisted by Yueju Wan, resolving the acid regurgitation. Then treated with Buzhong Yiqi Tang plus Fu Ling (Poria) and Ban Xia (Pinellia), restoring Spleen-Stomach health.
Case 3: A postpartum woman suffered diarrhea/dysentery for a year, becoming emaciated ("bone-standing"), experiencing internal heat, afternoon fever, spontaneous and night sweats, oral ulcers, expectorating about three bowls of phlegm daily, with a洪大 (Surging) pulse that vanished upon heavy pressure. This indicated Mingmen Fire deficiency, Spleen Earth deficiency-cold, and false heat. The phlegm resulted from Spleen deficiency failing to control fluid retention. Treated with Ba Wei Wan to tonify Fire to generate Earth, and Buzhong Yiqi Tang to tonify Lung Metal, thereby strengthening Spleen-Stomach.
Case 4: A postpartum woman had abdominal pain with tenesmus, profuse dysentery, fatigue, and anorexia, nearing death due to Spleen-Kidney dual deficiency. Cured with Sishen Wan and Shiquan Dabu Tang (Ten Great Tonification Decoction). Subsequent indigestion and fatigue resolved with Buzhong Yiqi Tang.
Case 5: A woman developed dysentery in the fifth month, day and night without cessation, lower abdominal bearing-down pain, fever, and aversion to cold. Treated with Liujunzi Tang delivering Xianglian Wan (Aucklandia-Coptis Pill); improved after two doses. Continued with the same decoction delivering Sishen Wan; fully recovered after four doses. By the end of the seventh month, she exhibited lethargy, desire to sleep, inability to move limbs, heavy body and joint pain, dry mouth/tongue, tasteless food, loose stools, frequent urination, chills, and depression. This indicated Lung-Spleen-Stomach deficiency with Yang Qi cold and constrained. Cured with Shengyang Yiewei Tang (Raise Yang and Benefit Stomach Decoction).
Wang Shishan treated a postpartum woman with slippery diarrhea, unable to retain even a spoonful of water or grain, which was immediately expelled. This persisted for over half a month. Others considered it critical and used Wuling San (Five-Ingredient Powder with Poria) and Pingwei San (Level the Stomach Powder), worsening the condition. Wang diagnosed a Ru Huan Ruo (Soggy, Slow, Weak) pulse. He stated: "This is Stomach Qi injured by labor during childbirth. Decoctions would increase Stomach dampness and are unsuitable." He prescribed Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) minus Sha Ren (Amomum), plus Chen Pi (Tangerine Peel) and Rou Dou Kou (Myristica), taken with Ginger-Jujube decoction. She stabilized after ten days.
[Dan] Treating postpartum diarrhea with lochia stasis: This is residual blood seeping into the large intestine causing diarrhea, uncontrollable watery discharge, passing green-white-black stool. Use 4-5 large spikes of Jingjie (Schizonepeta), burn to ash in a cup without oil/fire contact, mix with Shexiang (Musk), and take with three mouthfuls of water. Though mild, this medicine cures major illness. (Formula name: Qisan / Miracle Powder.)
Postpartum Diarrhea Formula
Fuling (Poria), Chuanxiong (Ligusticum), Huangqin (Scutellaria), Baizhu (Atractylodes), Ganjiang (Dried Ginger), Huashi (Talc), Chenpi (Citrus Peel), Shaoyao (Peony Root) [Stir-fried, equal parts].
Decoct in water and take.
Tiaozhong Tang (Regulate the Middle Decoction)
Gaoliangjiang (Galangal), Danggui (Angelica Sinensis), Guixin (Cinnamon Twig/Cortex Cinnamomi), Shaoyao (Peony Root), Fuzi (Aconite Root [Prepared]), Chuanxiong (Ligusticum) [each 1 liang], Gancao (Licorice Root) [0.5 liang].
Grind into coarse powder. Take 3 qianbi per dose, with 3 zhan of water, decoct to 1 zhan, remove dregs, and take hot.
The above formula is suitable only for cold-mid obstruction causing watery diarrhea. For intestinal-stomach heat,黄连 (Coptis) preparations such as Rujin Wan (Like-Gold Pill) or Xianglian Wan should be used. Formulas like Wuji Wan, Guchang Wan, Sishen Wan, and Wuweizi Wan are essential for postpartum loose stools, detailed in miscellaneous diseases and previous diarrhea sections, thus not repeated here.