〔全〕夫恶露不下者，由产后脏腑劳伤，气血虚损，或胞络挟于宿冷，或产后当风取
凉，风冷乘虚而搏于血，血则壅滞不宣，积蓄在内，故令恶露不下也。
〔薛〕前症若恶露不下，用失笑散。（见后心痛。）若气滞血凝，用花蕊石散。（胞衣不下。）
一产妇患前证，服峻厉之剂，恶露随下，久而昏愦，以手护其腹。余曰∶此脾气复伤作
痛，故用手护也。以人参理中汤加肉桂二剂，补之而愈。
《大全》疗产后三四日恶露不下。
芍药（十分） 知母（八分） 生姜 当归 蒲黄（各四分） 红花（二分）
荷叶中心蒂（七枚） 生地黄汁（二合）
上细切，以水二升，煎至七合，去滓服。
荷叶散 疗产后恶露不下，腹中疼痛，心神烦闷。
干荷叶（二两） 鬼箭羽 桃仁 刘寄奴 蒲黄（各一两）
上为粗末，每服三钱，以童便一大盏，姜二片，生地黄一分，捶碎同煎至六分，去滓，
无时热服。
《广济》疗产后恶露不多下方。
川牛膝 大黄（各二两） 牡丹皮 当归（各一两半） 芍药 蒲黄 桂心（各一两）
上为末，以生地黄汁调酒服方寸匕，日二服，血下愈。
没药丸 治产后恶露方行，而忽然断绝，骤作寒热，脐腹百脉，皆痛如锥刺非常，此
由冷热不调，或思虑动作，气所拥遏，血蓄经络。
当归（一两） 桂心 芍药（各半两） 桃仁（去皮尖，炒研） 没药（研，各二钱半） 虻虫（去
足翅，炒） 水蛭（炒焦，各三十枚）
上为末，醋糊丸如豌豆大，醋汤下三丸。
《千金》备急丹（见胞衣不下。）
《保命》治妇人恶血不下。
当归（炒） 芫花（炒等分）
上为细末，每服三钱，酒下。又方，用好墨醋 ，末，以童便酒下妙。
梅师治产后血不下。蒲黄三两，水三升，煮取一升，顿服。
《本事方》治产后血不下。益母草捣绞汁，每服一小盅，入酒一合，搅匀温服。
《千金》治产后血不去。麻子五升，酒一升，浸一宿，明旦去渣温服一升，不瘥再服
一升，不吐不下。不得与男子通，一月将养，如初瘥。
黑龙丸（见通用方内。）
生料五积散 治产后恶露不快，腹中疼痛，或腹内有块及发寒热，并加醋少许煎，通
口服。亦能疗血崩。
【全元起注】恶露不下的原因，是由于产后脏腑受到劳损伤害，气血虚弱亏损；或者胞络中夹杂有宿存的寒气；或者是产后吹风受凉，风冷之邪乘虚侵入并与血相搏结，导致血液壅滞不通，积蓄在体内，因此造成恶露不下。
【薛己医案】上述症状如果表现为恶露不下，使用失笑散。（参见后文心痛条。）如果是气滞血凝，使用花蕊石散。（参见胞衣不下条。）
有一位产妇患有上述病症，服用了药性峻猛的药剂，恶露随即排出，但时间久了出现神志昏乱、意识模糊，并用手护住腹部。我说：这是脾气再次受损引起疼痛，所以用手护住腹部。用人参理中汤加入肉桂，服用两剂，补益脾气后痊愈。
《大全》记载治疗产后三四天恶露不下的方剂。
芍药（十分） 知母（八分） 生姜 当归 蒲黄（各四分） 红花（二分）
荷叶中心蒂（七枚） 生地黄汁（二合）
以上药材细切，用水二升，煎煮至七合，去渣服用。
荷叶散 治疗产后恶露不下，腹中疼痛，心神烦闷。
干荷叶（二两） 鬼箭羽 桃仁 刘寄奴 蒲黄（各一两）
以上药材研为粗末，每次服用三钱，用童子尿一大盏，生姜两片，生地黄一分，捣碎同煎至六分，去渣，随时热服。
《广济方》记载治疗产后恶露不多的下方。
川牛膝 大黄（各二两） 牡丹皮 当归（各一两半） 芍药 蒲黄 桂心（各一两）
以上药材研为末，用生地黄汁调酒送服方寸匕大小的药量，每日两次，待血下则病愈。
没药丸 治疗产后恶露刚开始下行，却突然断绝，骤然出现寒热交替，脐腹及全身血脉疼痛如锥刺般剧烈，这是由于冷热不调，或者思虑过度、劳累动作，导致气机拥塞遏阻，血液蓄积在经络中。
当归（一两） 桂心 芍药（各半两） 桃仁（去皮尖，炒后研碎） 没药（研碎，各二钱半） 虻虫（去足翅，炒） 水蛭（炒焦，各三十枚）
以上药材研为末，用醋糊制成如豌豆大的丸药，用醋汤送服三丸。
《保命集》治疗妇人恶血不下。
当归（炒） 芫花（炒，等分）
以上药材研为细末，每次服用三钱，用酒送下。另一方法，用好墨加醋研磨成末，用童子尿和酒送下效果更佳。
梅师治疗产后血不下。蒲黄三两，水三升，煮取一升，一次性服下。
《本事方》治疗产后血不下。益母草捣烂绞取汁液，每次服用一小盅，加入酒一合，搅匀温服。
《千金方》治疗产后血不去。麻子五升，酒一升，浸泡一夜，次日清晨去渣温服一升，若未痊愈再服一升，以不引起呕吐和下利为度。服药期间不得与男子同房，需调养一个月，如同初愈时一样。
黑龙丸（参见通用方内。）
[Quan Yuanchi's Commentary] The cause of lochia not descending lies in the damage to the Zang-Fu organs and the deficiency and depletion of Qi and Blood after childbirth. Alternatively, it may be due to cold pathogens lingering in the uterine collaterals, or exposure to wind and cold after childbirth, where wind-cold invades the deficiency and clashes with blood. This causes blood stasis and obstruction, accumulating internally, thus resulting in lochia not descending.
[Xue Ji's Case Record] For the aforementioned symptoms if lochia does not descend, use Shixiao San (Pain-Relieving Powder). (See Heart Pain section below.) If there is Qi stagnation and blood coagulation, use Huarui Shi San (Flower Stalactite Powder). (See Retained Placenta section below.)
A puerpera suffered from the aforementioned condition. After taking harsh purgative medicines, her lochia descended immediately, but later she became confused and unconscious, holding her abdomen with her hands. I said: "This is pain caused by further injury to Spleen Qi, hence she holds her abdomen." She was treated with Renshen Lizhong Tang (Ginseng and Atractylodes Macrocephala Decoction) added with Rougui (Cinnamon Twig), two doses were administered. After tonifying, she recovered.
*Daquan* records a prescription for lochia not descending three or four days postpartum.
Shaoyao (Peony Root) (10 fen) Zhimu (Anemarrhena Rhizome) (8 fen) Shengjiang (Fresh Ginger) Danggui (Angelica Sinensis) Puhuang (Lycopodium Spore) (each 4 fen) Honghua (Safflower) (2 fen)
Hetayou Zhongxin Di (Center Stalk of Lotus Leaf) (7 pieces) Shengdihuang Zhi (Juice of Rehmannia Root) (2 he)
Finely cut the herbs, add two sheng of water, decoct until seven he remains, strain, and take orally.
Heteye San (Lotus Leaf Powder) treats postpartum lochia not descending, abdominal pain, and mental restlessness.
Gan Heteye (Dried Lotus Leaf) (2 liang) Guijianyu (Tetramelas Chinensis) Taoren (Peach Kernel) Liujinu (Artemisia Capillaris) Puhuang (Lycopodium Spore) (each 1 liang)
Grind into coarse powder. Each dose is 3 qian, decocted with one large cup of Tongbian (Child Urine), two slices of Shengjiang (Fresh Ginger), and one fen of Shengdihuang (Rehmannia Root), crushed together. Decoct until six fen remains, strain, and take hot at any time.
*Guangji Fang* records a lower prescription for scanty lochia postpartum.
Chuan Niuxi (Achyranthes Bidentata) Dahuang (Rhubarb Rhizome) (each 2 liang) Mudanpi (Moutan Cortex) Danggui (Angelica Sinensis) (each 1.5 liang) Shaoyao (Peony Root) Puhuang (Lycopodium Spore) Guixin (Cinnamon Twig) (each 1 liang)
Grind into powder. Take one fangcunbi (a measure equivalent to a square inch spoonful) mixed with Shengdihuang Zhi (Juice of Rehmannia Root) and wine, twice daily. Treatment is complete when blood descends.
Moyao Wan (Myrrh Pill) treats postpartum lochia that had just started to descend but suddenly stopped, accompanied by sudden chills and fever. The umbilical region, abdomen, and all meridians suffer piercing pain as if stabbed by awls. This is due to imbalance of cold and heat, or excessive thinking and physical exertion, causing Qi obstruction and blood accumulation in the collaterals.
Danggui (Angelica Sinensis) (1 liang) Guixin (Cinnamon Twig) Shaoyao (Peony Root) (each half liang) Taoren (Peach Kernel) (skin and tip removed, stir-fried and ground) Moyao (Myrrha) (ground, each 2.5 qian) Mengchong (Blatta Orientalis) (legs and wings removed, stir-fried) Shuizhi (Hirudo) (stir-fried until scorched, each 30 pieces)
Grind into powder, make pills using vinegar paste the size of peas. Take three pills with vinegar-infused water.
Qianjin Fang Beiji Dan (Emergency Pill from *Essential Prescriptions Worth a Thousand Gold*) (See Retained Placenta section.)
*Baoming Ji* treats retained evil blood in women.
Danggui (Angelica Sinensis) (stir-fried) Yuanhua (Kadsura Longipedunculata Flower Bud) (stir-fried, equal parts)
Grind into fine powder. Take 3 qian per dose with wine. Another method: grind high-quality ink with vinegar into powder, take with child urine and wine for better effect.
Master Mei treats postpartum blood not descending. Use 3 liang of Puhuang (Lycopodium Spore), three sheng of water, boil until one sheng remains, take in one dose.
*Benshi Fang* treats postpartum blood not descending. Crush Leigongcao (Motherwort Herb), squeeze out the juice. Take one small cup per dose, add one he of wine, mix well, and take warm.
*Qianjin Fang* treats postpartum blood retention. Soak five sheng of Mazi (Cannabis Seed) in one sheng of wine overnight. Next morning, remove dregs, take one sheng warm. If not cured, take another sheng. Do not induce vomiting or diarrhea. Abstain from sexual intercourse with men. Nurture oneself for one month as if fully recovered.
Heilong Wan (Black Dragon Pill) (See General Formulas section.)
Shengliao Wuji San (Raw Material Five Accumulations Powder) treats postpartum sluggish lochia, abdominal pain, intra-abdominal masses, and chills/fever. Add a little vinegar when decocting, take orally. It can also treat metrorrhagia (blood flooding).