凡新产妇人，气血大损，诸事必须保重，切不可恃健劳碌，致内伤外感，六淫七情诸症，为患莫
测。故产后症，先以大补气血为主，虽有他症，以末治之。或欲去邪，必兼补剂为当，不宜专用峻厉，再
损血气也。
或问产后症，丹溪云∶当大补气血为主，虽有杂症，以末治之。又云∶产后中风，切不可作中风治，
用风药。然则产后不问诸症，悉宜大补气血乎？曰∶详主末二字，其义自明。虚而无他症者，合宜大补气
血自愈；或阴虚而感冒风寒者，补气血药带驱风之剂；或因脾虚而食伤太阴者，补气血加消导之剂；或
因淤血，恶露未尽而恶寒发热者，必先逐其淤血，然后大补。经曰∶有本而标之者，有标而本之者。又曰∶
急则治标，缓则治本。丹溪之主末二字，即标本之意也。
新产妇脉诀歌∶新产之脉缓滑宁，实大弦急死来侵；俱要沉重小者吉，忽然坚牢命不停；寸口涩疾
不调死，沉细附骨不绝生；审看此疾分明记，方知医者有神灵。
大凡新产之后，血气衰弱，脉必沉细缓滑为正，实大弦牢坚急不调为反。正则吉，反则凶。
产后切勿侧卧，免致败血流经。若流至膝，轻则无妨，重则生痈，其症难愈，岂可不慎也哉！
才生产时，切戒饮酒，脏腑皆虚，不胜酒力，多致眩晕，宜用黑豆炒出烟，同羌活入酒煎饮之，避
风邪、养气血、下恶露、行乳脉也。
产妇胞衣不下，恶露不尽，攻冲心腹刺痛，或血晕神昏，眼黑，口噤，宜服黑神散。若临产难生，及
胞衣不下，血晕不省人事者，败血冲攻，心腹刺痛，语言狂妄，困顿垂死，宜用琥珀黑龙丹。若败血攻心
迷晕，或胞衣不下，胎死腹中，垂危者，但心头暖，急以童便调花蕊石散服之，不能服者灌之。若胞衣不
下，寒热腹痛，以五个散去茯苓、麻、桔主之。
【花蕊石散】花蕊石（一斤， 透，轻者为上） 硫黄（四两）
上二味拌匀，入瓦罐内，将泥固口，候干、放砖上，以炭火 经宿，候冷取出，为末，童便调服。
因堕胎，胞衣不出，及胎死腹中，宜牛膝散，或大黄醋熬成膏，为丸，醋汤下。
凡胞衣不下，稍久困倦，败血流入胞中，因血胀满，冲心喘急，疼痛危笃，先用物系住脐带，然后断
之。否则胞上掩心，危在顷刻。须令产母口衔发尾，得呕哕，实时下矣。或单将蓖麻子捣烂，涂脚底，若
胞下，随即洗去，如迟，恐伤母，肠亦下，慎之！如胞无冲掩等患，虽延数日，亦不害人，止要产妇安
心，终自下也。
产后中风、中气，口噤，汤药不能下者，用旧油篦箕，烧存性，为末，擦其牙根即开，应验，然后主意用药。
妇人分娩，昏冒瞑目，因阴血暴亡，心神无所养。心与包络，君火相火也，得血则安，亡血则危
矣。火上炽，故令人昏冒，火乘肺，令人瞑目不省人事，是阴血暴亡，不能镇抚也。经云∶病气不足，宜
补不宜泻。瞑目合眼，病悉属阴。暴去有形之血，则火上炽，但补其血，则神自安，心得血则能养而神不昏迷矣。
产后满急，神昏口噤，不省人事，宜破血行血，以黑神散、四乌汤、琥珀黑龙丹、花蕊石散择而用之。
产后用心、使力过多，虚晕，宜补气血之药，加香附、姜、枣煎服即愈。
产后子肠不收，急用枳壳煎汤服，即收。若素多风疾，因产乘虚作晕，以四乌汤加羌活、防风。
产后下血过多，虚晕，神昏烦乱，当补其血，服清魂散。
【清魂散】人参 泽兰 荆芥 川芎（各一钱） 甘草（五分）
产后眩晕，卒然间难辨其虚实，但以勿问散治之，如饱闷，加陈皮、苏子。
【勿问散】川芎 荆芥 归尾 延胡索 丹皮 泽兰 山楂 贝母
煎好，冲入童便服。
若血晕昏迷不省，冲心闷绝，此宜行血醒血理之，以荆芥散，或鹿角散，或五灵四物汤主之。
【鹿角散】鹿角四两
烧炭存性为末，童便、酒调下。
【五灵四物汤】五灵脂（半生半炒） 地黄 当归 白芍 川芎
产后血晕，因气暴虚，痰火泛上作晕，以二陈汤加贝母、竹沥、姜汁、童便。凡导痰，随气血加
减，气虚加气药，血虚加血药，或以十全大补汤加橘红、黄芩、黄连。
产后血虚，上攻心腹，刺痛闷乱，宜延胡散加乌、附，或用琥珀散治之。
【延胡散】延胡索 当归 川芎 赤芍 艾叶 枳壳 桃仁 橘红 熟地 肉桂 生姜
【琥珀散】琥珀 蒲黄 赤芍 当归 延胡索
香附 丹皮 没药 木香 蓬术 肉桂 乌药
产后败血冲心，或歌舞，或骂詈，或笑怒，或逾垣咬打，神名佛号，无一不知，似有鬼祟之状，此
病五死五生，宜龙齿清魂散治之。
【龙齿清魂散】龙齿 远志 肉桂 人参 当归 茯神 麦冬 细辛 延胡索 甘草 黄金 纹银 生姜 大
枣
煎汁，调麝香服之。或将金、银、姜、枣先煎百余滚，调入在内，前药煎好，取汁一并服之。
产后败血冲心、冲胃，此是危症。冲胃则饱闷呕逆，冲心者，则癫狂错乱，速急用药，多主不效，不可不知。
产后口中暴溢血者，名曰暴血冲心，宜延胡散治之。若经恶露已尽日久，而呕嗽出血者，治法与常同。
新产禁用芍药，因酸寒能伐生发之气。若腹痛，非芍药不能止，以酒炒用则不妨。若以醋炒，犹
能治儿枕块痛，酸以收之之意也。如补虚时，黄 可代。
产后败血腹痛寒热，名曰儿枕痛也。若无块，轻，以四乌汤治之；若有块，重，则以醋个散治之，
须量人虚实而用，大抵产后禁用棱、术二味，必元气实者方可用之；若瘦弱者，只可服四乌汤；若不咳
嗽，加肉桂些须亦可，以行血。倘饮食不进，而四乌汤不济事，乃用醋个散治之，然亦不宜多服。
【醋个散】三棱 蓬术 肉桂 香附 乌药 甘草 赤芍
醋煎服。
若儿枕块凝滞，小腹刺痛，宜琥珀黑龙丹，或三圣散，或延胡散，或桃仁承气汤，三圣散加青皮、山
楂、五灵脂、蒲黄治之亦可。
【三圣散】肉桂 当归 延胡索
【桃仁承气汤】桃仁 当归 赤芍 甘草 蒲黄 川芎 肉桂
产后恶露不行，小腹刺痛，甚至发热者，用四乌汤。因怒气相搏，刺痛者，枳壳散合五积散，加醋、童便服。
【枳壳散合五积散】枳壳 甘草 陈皮 川芎 干姜 肉桂 白芷 茯苓 麻黄 桔梗 半夏 浓朴 藿香 生
姜
腹脐间急痛不止，因淤血未尽行也，宜归须散、佛手散，加肉桂、丹皮、延胡索、蒲黄、乌药、
香附，童便煎，治之。若恶露不行，腹痛，兼冒风劳碌、寒热者，此症以三元散治之则愈矣。
【三元散】人参 熟地 半夏 川芎 当归 白芍 黄芩 柴胡 茯苓 生姜 大枣
产后月余，因怒气，恶露不止，如有块淡红色似米粒者，以九仙散治之。
【九仙散】当归 川芎 芍药 甘草 丹皮 青皮 蒲黄 黄芩 香附
将青皮、黄芩、蒲黄，炒黑为末，同煎服。
产后恶露不快，小腹急痛有块者，及发热头晕，宜用五积散，加醋（少许），童便服之。
产后二月余，恶露不止，腹痛，宜服加艾汤。
【加艾汤】熟地 艾叶 阿胶 白芍 当归 川芎 香附 青皮 地榆 蒲黄 甘草
产后小腹刺痛不止，以四乌汤加桂心、童便，酒煎。或佛手散加蒲黄、延胡索、肉桂、童便、酒煎；
若小腹攻痛，蒲黄必用；若腹痛，以平胃散去甘草治之。
【平胃散】苍术 浓朴 陈皮 甘草
如胎前原有阴火证，至产后、去血过多，必大发热、烦躁、汗出等症，若以前法大补气血，其症必
甚，当用逍遥散以清肝火、养肝血，因去血既多，肝虚血燥之故，不可泥于气血虚之论也。
产后乍寒乍热有二∶有阴阳不和，有败血不散，寒热相似，虚实不同。但小腹不痛者，是阴阳不
和也，宜用芎归散治之，不可作疟治，又当量其虚实，加减四物治之。若小腹刺痛者，是败血不散，宜
五积散去麻黄，加香附。
产后二三日，觉壮热头痛，胸膈刺痛，不可作伤寒治，此乃乳脉将行，宜服玉露散。
【玉露散】人参 茯苓 甘草 当归 白芷 桔梗 川芎 白芍
产后去血过多，阴虚内热，头痛，晡时尤甚，与大病后虚烦相似，宜服人参当归散。若小腹甚痛，
手足麻木，及遍身麻、晕，为痰与血虚也，宜二四汤加香附治之。盖血虚证亦能作小腹痛，但重按之痛若
缓者，是血虚也。
【人参当归散】人参 当归 丁香 青皮 吴茱萸
果系去血过多，腰腹空痛者，宜用补剂，以止为愈，在于随证用药可也。
产后谵语者，须问其去血多少。产妇虽不能言，然旁观可知去血多少，宜用治血药清魂散、延胡
散，或用四物加易汤亦可。
【四物加易汤】熟地 当归 白芍 川芎 半夏 陈皮 茯苓 甘草 山楂肉 桃仁 薄荷 生姜
产后去血过多，发谵语者，论曰∶心主乎血，因产耗血过多，心神失守，故发谵语。虽宜大补气
血，又不可太峻，必知真正十分虚极，则可补，又必先用活血药，禁用行血药也。若出汗者，宜养荣、麦
煎散，临时酌而用之。
产后狂言谵语，如见鬼神者，其原不一。有因惊风，语言颠倒，心神恍惚不定者，宜用琥珀丸。
有因心虚惊悸，言语错乱，不知人事，目瞪不能叫呼，宜用龙齿清魂散。
有因败血攻心，狂言颠语错乱者，宜用延胡散。
有因风寒，致令恶露不行，憎寒发热，俨如疟状，昼则明，夜则昏者，此乃热入血室，宜用琥珀地
黄丸，或小柴胡汤，或四物汤加柴胡亦可。
【琥珀地黄丸】琥珀（另研） 延胡索（炒） 当归（各二两） 蒲黄（炒，四两） 生地（二两，取汁留
渣） 生姜（二两，取汁留渣）
用姜汁炒地黄渣，地黄汁炒姜渣，互炒汁干为度，共为末，蜜和丸，如弹子大，当归汤送下一丸。
若产后谵语，热盛，脉大而有力者，难治，此症不与之药为妥也。如脉沉细滑小者，尚可图治。
若产后去血过多，因虚而发谵语者，宜以二四汤去地黄，略加山楂、姜汁治之。不可专以痰断，亦不
可为血迷心窍也。
产后心虚，怔忡不定，言语错乱者，宜茯神散。
【茯神散】人参 甘草 山药 当归 茯神 肉桂 远志 麦冬
产后不语者，此乃败血迷心窍，心气不通，气塞于心，舌强不语，不必恐疑，但服七珍散，弥月愈
矣。若发狂者，加辰砂治之。
【七珍散】人参 石菖蒲 生地 川芎 防风 甘草 细辛
加辰砂，即名八珍散。
产后冒风不语者，以小续命加姜汁治之，若痰闭心窍不语者，以二四汤加竹沥、姜汁治之。若舌强
不语，眼花发狂，及胞衣不下，心腹胀满者，宜琥珀地黄丸。
【小续命汤】桂枝 人参 附子 生姜 川芎 甘草 黄芩 麻黄 杏仁 白芍 防风 大枣
产后乍见鬼神，言语颠倒，因产暴虚，败血挟邪气攻心。医者误为风邪，谬矣。以调经散加龙脑服
之，则安矣，或用琥珀地黄丸亦可。
【调经散】麝香（五分） 没药（一钱） 肉桂（一钱） 白芍（二钱五分） 琥珀（一钱）
上为末，每服五分，生姜汁、温酒各少许调服。
产后发热自汗，日久不止，名曰蓐劳，宜服逍遥散。
若蓐劳因虚发热自汗不止，或遇风邪复发，宜黄 汤加麻黄根、浮小麦治之。
【黄 汤】黄 白术 防风 熟地 牡蛎 茯苓 麦冬 甘草 大枣 浮小麦 竹叶
小产后蓐劳，有汗以增减柴胡汤治之，若半身出汗，又宜二四汤。
【增减柴胡汤】柴胡 人参 白芍 川芎 半夏 甘草 陈皮 生姜 大枣
产后盗汗如雨，服多煎剂，血虚生热自汗，不可太补，兼以调理为主，宜服逍遥散；若喜食而痛甚
者，非养荣汤不能治。盖补中益气汤因有升麻、柴胡，不能敛汗，不若逍遥散，又能止汗、治血虚。如
气虚、血虚兼者，必用八物汤、养荣汤并治。
产后不能轻发汗，如已有汗，不可再发汗也。若虚汗两手拭不干者，不可治也。
产后中风，医血为要，不可先治风，败血得行则止也，宜清心牛黄丸。不语者，乃风触阴户也，以
小续命汤治之。若手足瘫痪者，败血入经络也，宜五积散，或二四汤加桔梗，活血入姜汁治之。若谵语，
以二四加消食、活血之药，入薄荷、姜汁少许治之。产后中风，不过痰、气、血虚也，故二四汤不可缺，
若眼合而痰喘者，尤宜服之。
小产后，因受气忽跌，恶露未尽，迷闷不语，人事不知者，以二四汤加红花、山楂、姜汁治之。
产后恶露未尽，而中风口噤、角弓反张者，以荆芥散加豆淋酒、童便治之，口噤者吹鼻中尤妙。
产后中风口噤，角弓反张，以小续命汤或交加散治之，加竹沥。若中风口噤，四肢顽痹不仁，角弓
反张者，宜羌活酒服之，汗出则愈也。
【交加散】生地（五两，取汁留渣） 生姜（五两，取汁留渣）
互相浸一宿，次日各炒干为细末，加竹沥酒调服。
又方加当归、地黄。
【羌活酒】羌活 防风 黑豆（一升，炒黑令烟尽）
入好酒，纳于瓶中，重汤煮半日，候冷开饮。
凡是刚生产完的产妇，气血大量亏损，所有事情都必须小心保重，切不可倚仗身体尚好而过度劳累，导致内伤和外感，以及六淫（风、寒、暑、湿、燥、火）和七情（喜、怒、忧、思、悲、恐、惊）等各种病症，其危害难以预测。因此，产后病症，首先要以大补气血为主，即使有其他症状，也作为次要处理。如果想要祛除邪气，也必须兼用补益药剂才恰当，不宜专门使用猛烈峻厉的药物，以免再次损伤血气。
有人问：关于产后病症，朱丹溪说：“应当以大补气血为主，即使有杂症，也作为次要处理。”又说：“产后中风，切不可当作普通中风治疗，使用祛风药。”那么，对于产后的各种病症，是否都适宜大补气血呢？回答说：详细探究“主”和“末”这两个字，其中的含义自然明了。如果是虚证而没有其他症状的，适合大补气血即可自愈；或者是阴虚又感冒风寒的，在使用补气血药时带上驱风的药剂；或者是因脾虚而导致饮食积滞损伤太阴经的，在补气血的基础上加上消食导滞的药剂；或者是因淤血、恶露未尽而出现恶寒发热的，必须先驱逐其淤血，然后才能大补气血。医经说：“有本而在标之后治疗的，有标急而在本之前治疗的。”又说：“病势急迫时治标，病势缓和时治本。”朱丹溪所说的“主”和“末”，就是“本”和“标”的意思。
新产妇人的脉象诀歌诀：新产之后的脉象以缓滑为安宁之象，实大弦急则死气逼近；脉象都要沉重且小者吉利，忽然变得坚牢则生命难保；寸口脉涩疾不调者死，沉细按至骨部仍有根者生；仔细审视这些疾病并分明记住，才知道医生有神灵般的医术。
大凡新产之后，血气衰弱，脉象必定以沉细缓滑为正常脉象，实大弦牢坚急不调则为反常脉象。正常则吉利，反常则凶险。
产后切勿侧卧，以免败血流入经络。如果流至膝盖，轻则无妨，重则生痈疽，这种病症难以治愈，怎么可以不谨慎呢！
刚生产时，切忌饮酒，因为脏腑都虚弱，承受不住酒力，多会导致眩晕，宜用黑豆炒至冒烟，同羌活一起入酒煎煮饮用，以避风邪、养气血、下恶露、通乳脉。
产妇胞衣不下，恶露不尽，攻冲心腹刺痛，或者血晕神昏，眼黑，牙关紧闭，宜服用黑神散。如果临产难生，以及胞衣不下，血晕不省人事的，是败血冲攻，心腹刺痛，语言狂妄，困顿垂死，宜用琥珀黑龙丹。如果败血攻心迷晕，或者胞衣不下，胎死腹中，处于危重状态的，只要心头还暖，急忙用童便调服花蕊石散，不能服的则灌服。如果胞衣不下，伴有寒热腹痛，以五个散去茯苓、麻黄、桔梗为主方治疗。
【花蕊石散】花蕊石（一斤，需煅透，质地轻的上品） 硫黄（四两）
以上两味药拌匀，放入瓦罐内，用泥封固罐口，待干后，放在砖上，用炭火煅烧过夜，待冷却后取出，研为细末，用童便调服。
因堕胎，胞衣不出，及胎死腹中，宜用牛膝散，或者大黄醋熬成膏，制成丸剂，醋汤送下。
凡是胞衣不下，稍久感到困倦，败血流入胞中，因血胀满，冲心喘急，疼痛危笃，先用物体系住脐带，然后剪断。否则胞衣上掩心脏，危险就在顷刻之间。必须让产母口衔头发末端，使其呕吐，胞衣随即就会下来。或者单将蓖麻子捣烂，涂在脚底，如果胞衣下来了，随即洗去，如果迟了，恐怕伤到母亲，肠子也会脱出，务必谨慎！如果胞衣没有冲掩等祸患，虽然拖延数日，也不会害人，只要产妇安心，最终自然会下来。
产后中风、中气，牙关紧闭，汤药不能下咽的，用旧的油篦箕，烧至存性，研为细末，擦拭其牙根即能张开，应验有效，然后再根据主要病情用药。
妇人分娩，昏冒闭目，是因为阴血突然亡失，心神无所供养。心和心包络，分别是君火和相火，得到血液则安宁，失去血液则危险。火上炽盛，所以令人昏冒，火乘肺，令人闭目不省人事，这是阴血突然亡失，不能镇抚的缘故。医经说：“病气不足，宜补不宜泻。”闭眼合目，病症全属阴。突然去除有形的血液，则火上炽盛，只补其血，则神自安，心得血则能滋养而神不昏迷。
产后腹部胀满急痛，神昏牙关紧闭，不省人事，宜破血行血，以黑神散、四乌汤、琥珀黑龙丹、花蕊石散选择使用。
产后用心、用力过多，导致虚晕，宜补气血的药，加香附、生姜、大枣煎服即愈。
产后子宫下垂不收，急忙用枳壳煎汤服，即可收回。如果素来多有风疾，因生产乘虚作晕，以四乌汤加羌活、防风。
产后眩晕，突然之间难以辨别虚实，只用勿问散治疗，如饱闷，加陈皮、苏子。
【勿问散】川芎 荆芥 归尾 延胡索 丹皮 泽兰 山楂 贝母
煎好后，冲入童便服用。
如果血晕昏迷不省，冲心闷绝，这宜行血醒血理之，以荆芥散，或者鹿角散，或者五灵四物汤主治。
产后血晕，因气暴虚，痰火泛上作晕，以二陈汤加贝母、竹沥、姜汁、童便。凡是导痰，随气血加减，气虚加气药，血虚加血药，或者用十全大补汤加橘红、黄芩、黄连。
产后血虚，上攻心腹，刺痛闷乱，宜延胡散加乌头、附子，或者用琥珀散治疗。
【延胡散】延胡索 当归 川芎 赤芍 艾叶 枳壳 桃仁 橘红 熟地 肉桂 生姜
【琥珀散】琥珀 蒲黄 赤芍 当归 延胡索
香附 丹皮 没药 木香 蓬术 肉桂 乌药
产后败血冲心，或者歌舞，或者骂詈，或者笑怒，或者逾墙咬打，神名佛号，无一不知，似有鬼祟之状，此病五死五生，宜龙齿清魂散治疗。
【龙齿清魂散】龙齿 远志 肉桂 人参 当归 茯神 麦冬 细辛 延胡索 甘草 黄金 纹银 生姜 大枣
煎汁，调麝香服用。或者将金、银、姜、枣先煎百余滚，调入在内，前药煎好，取汁一并服用。
产后败血冲心、冲胃，这是危症。冲胃则饱闷呕逆，冲心的，则癫狂错乱，速急用药，大多主诉无效，不可不知道。
产后口中暴溢血者，名叫暴血冲心，宜延胡散治疗。如果经恶露已尽日久，而呕嗽出血的，治法与常规相同。
新产禁用芍药，因为酸寒能伐生发之气。如果腹痛，非芍药不能止，以酒炒用则不妨。如果用醋炒，还能治儿枕块痛，这是酸以收之的意思。如补虚时，黄芪可代替。
产后败血腹痛寒热，名叫儿枕痛。如果没有块，轻，以四乌汤治疗；如果有块，重，则以醋个散治疗，须衡量人的虚实而用，大抵产后禁用三棱、莪术二味，必须元气实者方可用之；如果瘦弱者，只可服四乌汤；如果不咳嗽，加少许肉桂也可以，以行血。倘若饮食不进，而四乌汤不济事，乃用醋个散治疗，然而也不宜多服。
如果儿枕块凝滞，小腹刺痛，宜琥珀黑龙丹，或者三圣散，或者延胡散，或者桃仁承气汤，三圣散加青皮、山楂、五灵脂、蒲黄治疗也可以。
产后恶露不行，小腹刺痛，甚至发热者，用四乌汤。因怒气相搏，刺痛者，枳壳散合五积散，加醋、童便服。
【枳壳散合五积散】枳壳 甘草 陈皮 川芎 干姜 肉桂 白芷 茯苓 麻黄 桔梗 半夏 浓朴 藿香 生姜
腹脐间急痛不止，因淤血未尽行也，宜归须散、佛手散，加肉桂、丹皮、延胡索、蒲黄、乌药、香附，童便煎，治疗。如果恶露不行，腹痛，兼冒风劳碌、寒热者，此症以三元散治疗则愈矣。
【三元散】人参 熟地 半夏 川芎 当归 白芍 黄芩 柴胡 茯苓 生姜 大枣
产后月余，因怒气，恶露不止，如有块淡红色似米粒者，以九仙散治疗。
【九仙散】当归 川芎 芍药 甘草 丹皮 青皮 蒲黄 黄芩 香附
将青皮、黄芩、蒲黄，炒黑为末，同煎服。
产后恶露不快，小腹急痛有块者，及发热头晕，宜用五积散，加醋（少许），童便服之。
【加艾汤】熟地 艾叶 阿胶 白芍 当归 川芎 香附 青皮 地榆 蒲黄 甘草
产后小腹刺痛不止，以四乌汤加桂心、童便，酒煎。或者佛手散加蒲黄、延胡索、肉桂、童便、酒煎；如果小腹攻痛，蒲黄必用；如果腹痛，以平胃散去甘草治疗。
如果胎前原有阴火证，至产后、去血过多，必大发热、烦躁、汗出等症状，如果以前法大补气血，其症状必加重，当用逍遥散以清肝火、养肝血，因去血既多，肝虚血燥的缘故，不可拘泥于气血虚的理论。
产后乍寒乍热有二种：有阴阳不和，有败血不散，寒热相似，虚实不同。但小腹不痛的，是阴阳不和，宜用芎归散治疗，不可作疟疾治疗，又当衡量其虚实，加减四物汤治疗。如果小腹刺痛，是败血不散，宜五积散去麻黄，加香附。
产后二三日，觉壮热头痛，胸膈刺痛，不可作伤寒治疗，这是乳脉将行，宜服玉露散。
产后去血过多，阴虚内热，头痛，傍晚时尤其严重，与大病后虚烦相似，宜服人参当归散。如果小腹甚痛，手足麻木，及遍身麻、晕，为痰与血虚也，宜二四汤加香附治疗。盖血虚证也能作小腹痛，但重按之痛若缓者，是血虚也。
果系去血过多，腰腹空痛者，宜用补剂，以止为愈，在于随证用药可也。
产后谵语者，须问其去血多少。产妇虽不能言，然旁观可知去血多少，宜用治血药清魂散、延胡散，或者用四物加易汤也可。
【四物加易汤】熟地 当归 白芍 川芎 半夏 陈皮 茯苓 甘草 山楂肉 桃仁 薄荷 生姜
产后去血过多，发谵语者，论曰：心主乎血，因产耗血过多，心神失守，故发谵语。虽宜大补气血，又不可太峻，必知真正十分虚极，则可补，又必先用活血药，禁用行血药也。如果出汗者，宜养荣、麦煎散，临时酌而用之。
产后狂言谵语，如见鬼神者，其原不一。有因惊风，语言颠倒，心神恍惚不定者，宜用琥珀丸。
有因心虚惊悸，言语错乱，不知人事，目瞪不能叫呼，宜用龙齿清魂散。
有因败血攻心，狂言颠语错乱者，宜用延胡散。
有因风寒，致令恶露不行，憎寒发热，俨如疟状，昼则明，夜则昏者，此乃热入血室，宜用琥珀地黄丸，或者小柴胡汤，或者四物汤加柴胡也可。
【琥珀地黄丸】琥珀（另研） 延胡索（炒） 当归（各二两） 蒲黄（炒，四两） 生地（二两，取汁留渣） 生姜（二两，取汁留渣）
用姜汁炒地黄渣，地黄汁炒姜渣，互炒汁干为度，共为末，蜜和丸，如弹子大，当归汤送下一丸。
如果产后谵语，热盛，脉大而有力者，难治，此症不与之药为妥也。如脉沉细滑小者，尚可图治。
如果产后去血过多，因虚而发谵语者，宜以二四汤去地黄，略加山楂、姜汁治疗。不可专以痰断，也不可为血迷心窍也。
产后不语者，这是败血迷心窍，心气不通，气塞于心，舌强不语，不必恐疑，但服七珍散，弥月愈矣。如果发狂者，加辰砂治疗。
【七珍散】人参 石菖蒲 生地 川芎 防风 甘草 细辛
加辰砂，即名八珍散。
产后冒风不语者，以小续命加姜汁治疗，如果痰闭心窍不语者，以二四汤加竹沥、姜汁治疗。如果舌强不语，眼花发狂，及胞衣不下，心腹胀满者，宜琥珀地黄丸。
【小续命汤】桂枝 人参 附子 生姜 川芎 甘草 黄芩 麻黄 杏仁 白芍 防风 大枣
产后乍见鬼神，言语颠倒，因产暴虚，败血挟邪气攻心。医者误为风邪，谬矣。以调经散加龙脑服用，则安矣，或者用琥珀地黄丸也可。
【调经散】麝香（五分） 没药（一钱） 肉桂（一钱） 白芍（二钱五分） 琥珀（一钱）
上为末，每服五分，生姜汁、温酒各少许调服。
如果蓐劳因虚发热自汗不止，或遇风邪复发，宜黄芪汤加麻黄根、浮小麦治疗。
【黄芪汤】黄芪 白术 防风 熟地 牡蛎 茯苓 麦冬 甘草 大枣 浮小麦 竹叶
小产后蓐劳，有汗以增减柴胡汤治疗，如果半身出汗，又宜二四汤。
【增减柴胡汤】柴胡 人参 白芍 川芎 半夏 甘草 陈皮 生姜 大枣
产后盗汗如雨，服多煎剂，血虚生热自汗，不可太补，兼以调理为主，宜服逍遥散；如果喜食而痛甚者，非养荣汤不能治。盖补中益气汤因有升麻、柴胡，不能敛汗，不若逍遥散，又能止汗、治血虚。如气虚、血虚兼者，必用八物汤、养荣汤并治。
产后不能轻发汗，如已有汗，不可再发汗也。如果虚汗两手拭不干者，不可治也。
产后中风，医血为要，不可先治风，败血得行则止也，宜清心牛黄丸。不语者，乃风触阴户也，以小续命汤治疗。如果手足瘫痪者，败血入经络也，宜五积散，或者二四汤加桔梗，活血入姜汁治疗。如果谵语，以二四加消食、活血之药，入薄荷、姜汁少许治疗。产后中风，不过痰、气、血虚也，故二四汤不可缺，如果眼合而痰喘者，尤宜服之。
小产后，因受气忽跌，恶露未尽，迷闷不语，人事不知者，以二四汤加红花、山楂、姜汁治疗。
产后恶露未尽，而中风口噤、角弓反张者，以荆芥散加豆淋酒、童便治疗，口噤者吹鼻中尤妙。
产后中风口噤，角弓反张，以小续命汤或者交加散治疗，加竹沥。如果中风口噤，四肢顽痹不仁，角弓反张者，宜羌活酒服之，汗出则愈也。
For women who have just given birth, Qi and Blood are severely depleted. All matters must be handled with great care. One must not rely on physical strength to overwork, thereby causing internal injury and external contraction, leading to various syndromes caused by the Six Exogenous Pathogens (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Pensiveness, Sadness, Fear, Fright), the consequences of which are unpredictable. Therefore, for postpartum syndromes, the primary treatment must be to greatly tonify Qi and Blood. Even if there are other symptoms, they should be treated as secondary. If one wishes to eliminate pathogenic factors, it is appropriate to combine them with tonifying agents; one should not exclusively use harsh and drastic drugs, so as not to further damage Qi and Blood.
Someone asked: Regarding postpartum syndromes, Danxi said, "One should primarily tonify Qi and Blood greatly; even if there are miscellaneous syndromes, they should be treated secondarily." He also said, "Postpartum wind-stroke should never be treated as ordinary wind-stroke using wind-dispelling drugs." Then, for all kinds of postpartum syndromes, is it always appropriate to greatly tonify Qi and Blood? The answer is: By carefully examining the characters "primary" (Zhu) and "secondary" (Mo), their meaning becomes clear. For deficiency without other symptoms, greatly tonifying Qi and Blood will lead to self-healing; for those with Yin deficiency complicated by Wind-Cold invasion, wind-dispelling agents should be added to the Qi and Blood tonics; for those with Spleen deficiency leading to food stagnation damaging the Taiyin Meridian, digestion-promoting agents should be added to the Qi and Blood tonics; for those with blood stasis and lochia remaining, presenting with aversion to cold and fever, one must first expel the blood stasis before greatly tonifying Qi and Blood. The Classics state: "There are cases where the root is treated after the branch, and cases where the root is treated before the branch." It also states: "In acute conditions, treat the branch; in chronic or mild conditions, treat the root." Danxi's terms "primary" and "secondary" correspond to the concepts of "root" (Ben) and "branch" (Biao).
Song of Pulse Diagnosis for Newborn Mothers: A slow and slippery pulse is auspicious for a new mother; a full, large, wiry, and rapid pulse signals approaching death; a heavy and small pulse is generally lucky; a suddenly hard and firm pulse indicates life cannot be sustained; a choppy and rapid irregular pulse at the Cun position indicates death; a deep and fine pulse that persists when pressed to the bone indicates survival; carefully examine these diseases and remember them clearly, then you will know the physician possesses divine skill.
Generally, after childbirth, Qi and Blood are weak. A deep, fine, slow, and slippery pulse is considered normal (Zheng), while a full, large, wiry, firm, hard, rapid, and irregular pulse is considered abnormal (Fan). Normality brings good fortune; abnormality brings misfortune.
After childbirth, lying on one's side must be avoided to prevent敗血 (decayed blood) from flowing into the meridians. If it flows to the knees, it may be harmless in mild cases, but in severe cases, it can cause carbuncles, which are difficult to cure. How can one not be cautious!
At the time of delivery, alcohol consumption must be strictly prohibited. The Zang-Fu organs are all deficient and cannot withstand the potency of alcohol, often leading to dizziness. It is advisable to stir-fry black soybeans until smoke rises, decoct them with Qianghuo (Notopterygii Rhizoma et Radix) in wine, and drink this mixture to dispel wind pathogens, nourish Qi and Blood, promote the discharge of lochia, and unblock the milk channels.
If the placenta fails to descend, lochia does not stop, attacking the heart and abdomen with stabbing pain, or if there is blood syncope with coma, blacking out of the eyes, and locked jaw, Heishen San (Black Spirit Powder) should be taken. If there is dystocia during labor, failure of the placenta to descend, or blood syncope with loss of consciousness due to decayed blood attacking, causing stabbing pain in the heart and abdomen, delirious speech, exhaustion, and impending death, Hupo Heilong Dan (Amber Black Dragon Pill) should be used. If decayed blood attacks the heart causing fainting, or if the placenta fails to descend, or if the fetus dies in the womb in a critical condition, as long as the heart area remains warm, Huarui Shi San (Ruhui Stone Powder) should be mixed with child's urine (Tongbian) and administered orally or forcibly灌 (dripped) if swallowing is impossible. If the placenta fails to descend accompanied by alternating chills and fever and abdominal pain, modify the Five Herbs Powder (Wuge San) by removing Fuling (Poria), Mahuang (Ephedrae Herba), and Jiegeng (Platycodonis Radix) as the main formula.
[Huarui Shi San] Ruhui Shi (1 jin, calcined thoroughly, light texture is superior); Liuhuang (Sulfur, 4 liang). Mix the two ingredients evenly, place in a clay jar, seal tightly with mud, let dry, place on bricks, and calcine with charcoal fire overnight. After cooling, remove and grind into powder. Take mixed with child's urine.
For miscarriage where the placenta does not come out, or fetal death in utero, Niuxi San (Achyranthis Bidentatae Decoction) is indicated, or Dahuang (Rhei Radix et Rhizoma) boiled in vinegar to form a paste, made into pills, and taken with vinegar water.
For any case of retained placenta, if delayed, fatigue sets in, and decayed blood flows into the uterus causing distension, attacking the heart with panting and urgent breathing, and severe painful danger, first tie the umbilical cord with an object, then cut it. Otherwise, the uterus may ascend to cover the heart, creating immediate peril. Instruct the parturient woman to hold the end of her hair in her mouth to induce vomiting, which will cause the placenta to descend immediately. Alternatively, crush castor seeds (Bimazi) and apply the paste to the soles of the feet. Once the placenta descends, wash it off immediately; delay may injure the mother, potentially causing prolapse of the intestines. Be extremely cautious! If there are no complications like ascending pressure on the heart, even if several days pass, it will not harm the person. As long as the mother remains calm, it will eventually descend naturally.
For postpartum wind-stroke or qi-stagnation presenting with locked jaw where decoctions cannot be swallowed, burn an old oil-comb basket until it retains its nature (charred but not ashed), grind into powder, and rub it on the gums to open the jaw. This is effective. Then, proceed with medication based on the primary diagnosis.
Women experiencing fainting and closed eyes during delivery do so because Yin Blood has been suddenly lost, leaving the Heart Spirit without nourishment. The Heart and Pericardium are associated with Ministerial and Sovereign Fire. They are peaceful when nourished by blood and endangered when blood is lost. The fire blazes upward, causing fainting; fire invading the Lungs causes closed eyes and unconsciousness. This is due to sudden loss of Yin Blood failing to anchor and soothe. The Classics state: "When disease Qi is deficient, tonification is preferred over purgation." Closed eyes indicate Yin pathology. Sudden removal of有形 (substantial) blood allows fire to blaze; only by tonifying blood can the Spirit be pacified. When the Heart receives blood, it is nourished, and the Spirit remains clear.
For postpartum abdominal fullness and urgency, coma, locked jaw, and unconsciousness, blood-breaking and blood-moving methods are indicated. Choose from Heishen San, Siwu Tang (Four Substances Decoction - *Note: Text says Si Wu Tang but context implies a specific postpartum variant or similar formula, usually referring to a blood-moving formula in this context, though standard Siwu is tonifying. Given the context of 'breaking blood', it likely refers to a variation or a specific named formula in this text distinct from the standard tonic*, here translated as Four Substances Decoction as per text), Hupo Heilong Dan, or Huari Shi San.
For excessive mental exertion or physical effort after childbirth leading to vertigo due to deficiency, tonify Qi and Blood with Xiangfu (Cyperi Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Jujubae Fructus) decocted together.
For prolapse of the uterus (Zichang) after childbirth, immediately take Zhike (Aurantii Fructus) decoction to retract it. For those prone to wind disorders who experience vertigo due to deficiency after childbirth, use Siwu Tang (Four Substances Decoction) with Qianghuo and Fangfeng.
For excessive bleeding after childbirth causing vertigo, coma, and restlessness, tonify the blood with Qinghun San (Clear Soul Powder).
[Qinghun Ren] Renshen (Ginseng Radix et Rhizoma), Zelán (Leonuri Herba), Jingjie (Schizonepetae Spica), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 1 qian); Gancao (Glycyrrhizae Radix et Rhizoma) (0.5 qian).
For postpartum vertigo where it is suddenly difficult to distinguish between deficiency and excess, use Wuwen San (Do Not Ask Powder). If there is fullness and oppression, add Chenpi (Citri Reticulatae Pericarpium) and Suzi (Perillae Fructus).
[Wuwen San] Chuanxiong, Jingjie, Guiwei (Tail of Angelicae Sinensis Radix), Yanshusuo (Corydalis Rhizoma), Danpi (Moutan Cortex), Zelán, Shanzha (Crataegi Fructus), Beimu (Fritillariae Thunbergii Bulbus). Decoct well, mix with child's urine, and take.
For blood syncope with coma, unconsciousness, and oppressive suffocation attacking the heart, treat by moving and awakening the blood. Use Jingjie San (Schizonepeta Powder), Luji San (Deer Horn Powder), or Wuling Siwu Tang (Five Spirits Four Substances Decoction).
[Luji San] Luji (Deer Antler, 4 liang). Calcine to charcoal, retain nature, grind to powder. Take mixed with child's urine and wine.
[Wuling Siwu Tang] Wulingzhi (Trogopteri Dung, half raw half stir-fried), Dihuang (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Chuanxiong.
For postpartum blood syncope due to sudden Qi deficiency, with Phlegm-Fire rising causing vertigo, use Erchen Tang (Two Aged Herbs Decoction) plus Beimu, Zhuli (Bambusa Caulis in Taenia Succus), Jiangzhi (Zingiberis Rhizoma Succus), and Tongbian. When resolving phlegm, adjust according to Qi and Blood. Add Qi-tonifying herbs for Qi deficiency, Blood-tonifying herbs for Blood deficiency, or use Shiquan Dabu Tang (Ten Significant Great Tonification Decoction) with Juhong (Citri Reticulatae Pericarpium Flavum), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma).
For postpartum Blood deficiency attacking the heart and abdomen with stabbing pain and confusion, use Yanhu San (Corydalis Powder) plus Wutou (Aconiti Lateralis Radix Praeparata) and Fuzi (Aconiti Radix Praeparata), or use Hupo San (Amber Powder).
[Yanhu San] Yanshusuo, Danggui, Chuanxiong, Chishao (Paeoniae Radix Rubra), Aiye (Artemisiae Argyi Folium), Zhike, Taoren (Persicae Semen), Juhong, Shudi (Rehmanniae Radix Preparata), Rougui (Cinnamomi Cortex), Shengjiang.
[Hupo San] Hupo (Electrum), Huyang (Psoraleae Fructus - *Note: Text says Huyang but standard Hupo San often uses Puhuang. Checking context... Text lists Puhuang separately later. Wait, standard Hupo San contains Puhuang. Let's look at the ingredient list provided: Amber, Puhuang, Chishao, Danggui, Yanshusuo, Xiangfu, Danpi, Moyao, Muxiang, Pengzhu, Rougui, Wuyao.*], Puhuang, Chishao, Danggui, Yanshusuo, Xiangfu (Cyperi Rhizoma), Danpi, Moyao (Myrrhae Resina), Muxiang (Aucklandiae Radix), Pengzhu (Curcumae Longae Rhizoma), Rougui, Wuyao (Linderæ Fructus).
For decayed blood attacking the Heart after childbirth, manifesting as singing, dancing, cursing, laughing, anger, climbing walls, biting, hitting, knowing names of gods and Buddies, resembling possession, this disease has a 50% mortality rate. Use Longchi Qinghun San (Dragon Tooth Clear Soul Powder).
[Longchi Qinghun San] Longchi (Dentis Mammoth Ossis), Yuanzhi (Polygalae Radix), Rougui, Renshen, Danggui, Fushen (Poria cum Radix), Maidong (Ophiopogonis Radix), Xixin (Asari Radix et Rhizoma), Yanshusuo, Gancao, Huangjin (Gold), Wenyin (Silver), Shengjiang, Dazao. Decoct juice, mix with Shexiang (Moschus) and take. Alternatively, decoct Gold, Silver, Ginger, and Dates for over 100 boils, mix in, then add the decocted herbal juice and take together.
Decayed blood attacking the Heart or Stomach after childbirth is a critical syndrome. Attacking the Stomach causes fullness, oppression, nausea, and vomiting; attacking the Heart causes mania, confusion, and delirium. Urgent medication is required, but often proves ineffective. This must be known.
Sudden bleeding from the mouth after childbirth is called "Violent Blood Attacking the Heart." Treat with Yanhu San. If lochia has ceased for a long time and coughing/vomiting blood occurs, treat according to standard methods.
Shaoyao (Paeoniae Radix) is contraindicated in early postpartum because its sour-cold nature destroys the generative Qi. However, if abdominal pain requires Shaoyao, stir-frying it with wine makes it safe. Stir-frying with vinegar treats "Erzhen" (afterbirth mass) pain, utilizing the astringent property. When tonifying deficiency, Huangqi (Astragali Radix) can substitute.
Abdominal pain with chills and fever due to decayed blood after childbirth is called "Erzhen Pain." If there is no mass, it is mild; treat with Siwu Tang (Four Substances Decoction - *Context implies a blood-moving variant here, likely referring to a specific postpartum formula often conflated or distinct in local texts, but literally Siwu Tang*). If there is a mass, it is severe; treat with Cu Ge San (Vinegar Granule Powder). Use depends on assessing the patient's excess or deficiency. Generally, Sanleng (Sparganii Rhizoma) and Ezhu (Curcumae Rhizoma) are contraindicated postpartum unless the Original Qi is strong. For emaciated patients, only Siwu Tang is suitable. If there is no cough, a little Rougui can be added to move blood. If appetite is poor and Siwu Tang is ineffective, use Cu Ge San, but do not take it excessively.
[Cu Ge San] Sanleng, Ezhu, Rougui, Xiangfu, Wuyao, Gancao, Chishao. Decoct with vinegar.
For stagnant Erzhen masses with stabbing lower abdominal pain, use Hupo Heilong Dan, Sansheng San (Three Sages Powder), Yanhu San, or Tao Ren Cheng Qi Tang (Peach Kernel Drain the Intestines Decoction). Sansheng San plus Qingpi (Citri Reticulatae Pericarpium Viride), Shanzha, Wulingzhi, and Puhuang is also effective.
[Sansheng San] Rougui, Danggui, Yanshusuo.
[Tao Ren Cheng Qi Tang] Tao Ren (Persicae Semen), Danggui, Chishao, Gancao, Puhuang, Chuanxiong, Rougui.
For postpartum lochia retention with stabbing lower abdominal pain, even with fever, use Siwu Tang (Four Substances Decoction - *Again, context suggests a blood-moving formula, possibly a typo in original text for a different Siwu variant or specifically referencing a blood-invigorating preparation*). For stabbing pain due to anger, combine Zhike San (Aurantii Powder) with Wuji San (Five Accumulations Powder), adding vinegar and child's urine.
[Zhike San combined with Wuji San] Zhike, Gancao, Chenpi, Chuanxiong, Ganjiang (Zingiberis Rhizoma), Rougui, Baizhi (Angelicae Dahuricae Radix), Fuling, Mahuang (Ephedrae Herba), Jiegeng, Banxia (Pinelliae Rhizoma), Houpo (Magnoliae Officinalis Cortex), Huoxiang (Agastaches Herba), Shengjiang.
For unceasing urgent pain in the abdomen and navel due to incomplete expulsion of blood stasis, use Guixu San (Angelica Caudex Powder) or Foshou San (Buddha's Hand Powder), plus Rougui, Danpi, Yanshusuo, Puhuang, Wuyao, and Xiangfu, decocted with child's urine. If lochia does not flow, abdominal pain, combined with wind exposure, overwork, chills, and fever, treat with Sanyuan San (Three Origins Powder).
[Sanyuan San] Renshen, Shudi, Banxia, Chuanxiong, Danggui, Baishao, Huangqin, Chaihu (Bupleuri Radix), Fuling, Shengjiang, Dazao.
For lochia continuing for over a month after childbirth due to anger, with pale red clumps resembling rice grains, treat with Jiuxian San (Nine Immortals Powder).
[Jiuxian San] Danggui, Chuanxiong, Shaoyao, Gancao, Danpi, Qingpi, Puhuang, Huangqin, Xiangfu. Stir-fry Qingpi, Huangqin, and Puhuang until black, grind to powder, decoct together, and take.
For sluggish lochia, urgent lower abdominal pain with masses, fever, and dizziness after childbirth, use Wuji San, adding a little vinegar and child's urine.
For lochia continuing for over two months with abdominal pain, take Jiai Tang (Add Mugwort Decoction).
[Jiai Tang] Shudi, Aiye, Ejiao (Colla Corii Asini), Baishao, Danggui, Chuanxiong, Xiangfu, Qingpi, Diyü (Sanguisorbae Radix), Puhuang, Gancao.
For unceasing stabbing lower abdominal pain after childbirth, use Siwu Tang plus Guixin (Cinnamon Twig) and child's urine, decocted in wine. Or Foshou San plus Puhuang, Yanshusuo, Rougui, child's urine, and wine. If lower abdominal pain attacks, Puhuang is essential. For general abdominal pain, use Pingwei San (Peaceful Stomach Powder) minus Gancao.
[Pingwei San] Cangzhu (Atractylodis Rhizoma), Houpo, Chenpi, Gancao.
If there was a Yin-Fire syndrome before pregnancy, and after childbirth with excessive blood loss, severe fever, irritability, and sweating occur, using the previous method of greatly tonifying Qi and Blood will worsen the symptoms. Use Xiaoyao San (Free and Easy Wanderer Powder) to clear Liver Fire and nourish Liver Blood, as excessive blood loss leads to Liver deficiency and Blood dryness. Do not rigidly adhere to the theory of simple Qi and Blood deficiency.
There are two types of alternating chills and fever after childbirth: one due to disharmony of Yin and Yang, the other due to unresolved decayed blood. The chills and fevers are similar, but the deficiency/excess patterns differ. If there is no lower abdominal pain, it is Yin-Yang disharmony; treat with Xiong Gui San (Peony and Angelica Powder). Do not treat as malaria. Adjust Siwu Tang based on deficiency/excess. If there is stabbing lower abdominal pain, it is unresolved decayed blood; use Wuji San minus Mahuang, plus Xiangfu.
On the second or third day after childbirth, feeling high fever, headache, and stabbing chest/diaphragm pain, do not treat as Shanghan (Cold Damage). This is when the milk channels are about to flow; take Yulu San (Jade Dew Powder).
[Yulu San] Renshen, Fuling, Gancao, Danggui, Baizhi, Jiegeng, Chuanxiong, Baishao.
For excessive blood loss after childbirth causing Yin deficiency with internal heat, headache (worse in the afternoon), similar to post-illness deficiency vexation, take Renshen Danggui San (Ginseng and Angelica Powder). If lower abdominal pain is severe, limbs are numb, whole body feels numb/vertiginous, it is due to Phlegm and Blood deficiency. Treat with Er Si Tang (Two Four Decoction) plus Xiangfu. Blood deficiency can also cause lower abdominal pain, but pain that eases with firm pressure indicates Blood deficiency.
[Renshen Danggui San] Renshen, Danggui, Dingxiang (Caryophylli Flos), Qingpi, Wuzhuyu (Evodiae Fructus).
If excessive blood loss causes empty pain in the waist and abdomen, use tonifying agents to stop the pain; medication should follow the syndrome.
For postpartum delirium, ask about the amount of blood loss. Although the mother cannot speak, observers can estimate the blood loss. Use blood-treating medicines like Qinghun San or Yanhu San, or Siwu Jia Yi Tang (Four Substances Plus Ease Decoction).
[Siwu Jia Yi Tang] Shudi, Danggui, Baishao, Chuanxiong, Banxia, Chenpi, Fuling, Gancao, Shan Zha Rou (Crataegi Fructus Flesh), Tao Ren, Bohe (Menthae Haplocalycis Herba), Shengjiang.
Regarding postpartum delirium due to excessive blood loss: The Heart governs Blood. Excessive blood loss during childbirth causes the Heart Spirit to lose its residence, resulting in delirium. While Qi and Blood should be greatly tonified, the tonification should not be too drastic. Only if truly extremely deficient should one tonify. First, use blood-moving herbs; blood-activating herbs are contraindicated. If sweating occurs, use Yangrong Tang (Nourish Glory Decoction) or Maijian San (Grass-Joint Powder), choosing appropriately at the time.
For postpartum manic speech and delirium, seeing ghosts and spirits, the causes vary. For fright-wind causing inverted speech and unsettled spirit, use Hupo Wan (Amber Pill). For Heart deficiency with palpitations, confused speech, unconsciousness, staring eyes unable to call out, use Longchi Qinghun San. For decayed blood attacking the Heart causing manic and confused speech, use Yanhu San. For Wind-Cold causing lochia retention, aversion to cold, fever resembling malaria, clear during day and dim at night, this is Heat entering the Blood Chamber. Use Hupo Dihuang Wan (Amber Rehmannia Pill), Xiao Chaihu Tang (Minor Bupleurum Decoction), or Siwu Tang plus Chaihu.
[Hupo Dihuang Wan] Hupo (ground separately), Yanshusuo (stir-fried), Danggui (each 2 liang), Puhuang (stir-fried, 4 liang), Shengdi (Rehmanniae Radix, 2 liang, juice reserved, dregs kept), Shengjiang (2 liang, juice reserved, dregs kept). Stir-fry Shengdi dregs with Ginger juice, and Ginger dregs with Shengdi juice, until juices are dry. Grind to powder, mix with honey to make pills the size of quail eggs. Take one pill with Danggui decoction.
If postpartum delirium presents with intense heat and a large, forceful pulse, it is difficult to treat; withholding medication may be more appropriate. If the pulse is deep, fine, slippery, and small, treatment is still possible.
For postpartum delirium due to deficiency from excessive blood loss, use Er Si Tang minus Dihuang, with a little Shanzha and Jiangzhi. Do not diagnose solely as Phlegm, nor assume Blood confusing the Heart orifices.
For Heart deficiency after childbirth with palpitations, instability, and confused speech, use Fushen San (Poria Spirit Powder).
[Fushen San] Renshen, Gancao, Shanyao (Dioscoreae Rhizoma), Danggui, Fushen, Rougui, Yuanzhi, Maidong.
For postpartum mutism due to decayed blood confusing the Heart orifices, blocking Heart Qi, Qi stagnating in the Heart, and stiff tongue preventing speech, do not worry. Take Zhenzhen San (Seven Treasures Powder), and recovery will occur within a month. If mania occurs, add Chensha (Cinnabar).
[Zhenzhen San] Renshen, Shichangpu (Acori Tatarinowii Rhizoma), Shengdi, Chuanxiong, Fangfeng, Gancao, Xixin. Adding Chensha makes it Bazhen San (Eight Treasures Powder).
For postpartum mutism due to wind exposure, use Xiao Xuming Tang (Minor Rescue Life Decoction) with Jiangzhi. For mutism due to Phlegm closing the Heart orifices, use Er Si Tang with Zhuli and Jiangzhi. For stiff tongue, blurred vision, mania, and retained placenta with abdominal fullness, use Hupo Dihuang Wan.
[Xiao Xuming Tang] Guizhi (Cinnamomi Ramulus), Renshen, Fuzi, Shengjiang, Chuanxiong, Gancao, Huangqin, Mahuang, Xingren (Pruni Semen), Baishao, Fangfeng, Dazao.
Seeing ghosts and inverted speech after childbirth due to sudden deficiency and decayed blood carrying pathogenic Qi attacking the Heart is often mistakenly diagnosed as Wind-Pathogen by physicians. Use Tiaojing San (Regulate Menstruation Powder) with Nao Bing (Borneolum Syntheticum) to settle it, or use Hupo Dihuang Wan.
[Tiaojing San] Shexiang (0.5 qian), Moyao (1 qian), Rougui (1 qian), Baishao (2.5 qian), Hupo (1 qian). Grind to powder. Take 0.5 qian each time, mixed with a little Ginger juice and warm wine.
Postpartum fever with spontaneous sweating persisting for a long time is called Rulao (Childbed Labor). Take Xiaoyao San.
For Rulao due to deficiency with persistent fever and sweating, or recurrence upon wind exposure, use Huangqi Tang (Astragalus Decoction) plus Mahuanggen (Ephedrae Radix et Rhizoma) and Fu Xiaomai (Triticum Levis Fructus).
[Huangqi Tang] Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fangfeng, Shudi, Muli (Concha Ostreae), Fuling, Maidong, Gancao, Dazao, Fu Xiaomai, Zhuye (Phyllostachys Viridis Folium).
For Rulao after minor abortion with sweating, use Zengjian Chaihu Tang (Modified Bupleurum Decoction). For hemihidrosis (sweating on one side), use Er Si Tang.
[Zengjian Chaihu Tang] Chaihu, Renshen, Baishao, Chuanxiong, Banxia, Gancao, Chenpi, Shengjiang, Dazao.
For postpartum night sweats like rain, despite taking many decoctions, if Blood deficiency generates heat causing spontaneous sweating, do not tonify too heavily; focus on regulation. Take Xiaoyao San. If there is hunger with severe pain, only Yangrong Tang can treat it. Buzhong Yiqi Tang contains Shengma and Chaihu, which cannot astringe sweat, unlike Xiaoyao San which stops sweat and treats Blood deficiency. For combined Qi and Blood deficiency, use Bawu Tang (Eight Substances Decoction) and Yangrong Tang together.
Do not lightly induce sweating after childbirth. If sweating already exists, do not induce sweating again. If deficiency sweating cannot be dried by wiping with both hands, it is incurable.
For postpartum wind-stroke, treating Blood is paramount. Do not treat Wind first; once decayed blood moves, the wind stops. Use Qingxin Niuhuang Wan (Clear Heart Calculus Bovis Pill). Mutism is due to wind touching the yin orifice; treat with Xiao Xuming Tang. Paralysis of limbs is due to decayed blood entering the collaterals; use Wuji San or Er Si Tang plus Jiegeng, with blood-activating herbs and Ginger juice. For delirium, use Er Si Tang plus digestive and blood-activating herbs, with a little Bohe and Jiangzhi. Postpartum wind-stroke involves Phlegm, Qi, and Blood deficiency; thus Er Si Tang is indispensable. Especially for those with closed eyes and Phlegm-panting, it is highly suitable.
For minor abortion followed by emotional upset and falling, with incomplete lochia, confusion, mutism, and unconsciousness, treat with Er Si Tang plus Honghua (Carthami Flos), Shanzha, and Jiangzhi.
For incomplete lochia with postpartum wind-stroke presenting with locked jaw and opisthotonos, use Jingjie San with Doulin Jiu (Bean Soaking Wine) and Tongbian. Blowing the powder into the nose for locked jaw is especially effective.
For postpartum wind-stroke with locked jaw and opisthotonos, use Xiao Xuming Tang or Jiajiao San (Cross-Adding Powder) with Zhuli. For locked jaw, limb numbness, and opisthotonos, take Qianghuo Jiu (Notopterygium Wine); sweating indicates recovery.
[Jiajiao San] Shengdi (5 liang, juice reserved, dregs kept), Shengjiang (5 liang, juice reserved, dregs kept). Soak each in the other's juice overnight. Next day, stir-fry each until dry, grind to fine powder. Take mixed with Zhuli wine. Another prescription adds Danggui and Dihuang.
[Qianghuo Jiu] Qianghuo, Fangfeng, Heidou (Black Soybean, 1 sheng, stir-fried black until smoke ceases). Put in good wine, seal in a bottle, boil in a double boiler for half a day. Cool and drink.