问曰。新产妇人有三病。一者病 。二者病郁冒。三者大便难。何谓也。师曰。新产血虚。多汗出。喜
中风。故令病 。亡血复汗。寒多。故令郁冒。亡津液胃燥。故大便难。（案 。沈尤金鉴。作痉为是。详痉病中。）
〔尤〕痉。筋病也。血虚汗出。筋脉失养。风入而益其劲也。郁冒。神病也。亡阴血虚。阳气遂厥而寒。
复郁之。则头眩而目瞀也。大便难者。液病也。胃藏津液。而渗灌诸阳。亡津液胃燥。则大肠失其润。而便难
也。三者不同。其为亡血伤津则一。故皆为产后所有之病。
〔程〕产后血晕者。为郁冒。又名血厥。
产妇郁冒。其脉微弱。呕不能食。大便反坚。但头汗出。所以然者。血虚而厥。厥而必冒。冒家欲解。必
大汗出。以血虚下厥。孤阳上出。故头汗出。所以产妇喜汗出者。亡阴
血虚。阳气独盛。故当汗出。阴阳乃复。大便坚。呕不能食。小柴胡汤主之。（〔原注〕方见呕吐中。）
〔尤〕郁冒虽有客邪。而其本则为里虚。故其脉微弱也。呕不能食。大便反坚。但头汗出。津气上行。
而不下逮之象。所以然者。亡阴血虚。孤阳上厥。而津气从之也。厥者必冒。冒家欲解。必大汗出者。阴阳
乍离。故厥而冒。及阴阳复通。汗乃大出而解也。产妇新虚。不宜多汗。而此反善汗出者。
血去阴虚。阳受邪气。而独盛。汗出则邪去。阳弱而后与阴相和。所谓损阳而就阴是也。小柴胡主之者。以邪
气不可不散。而正虚不可罔顾。惟此法为能解散客邪。而和利阴阳耳。
〔鉴〕大便坚。呕不能食。用小柴胡汤。必其人舌有苔。身无汗形气不衰者。始可。故病得解自能食也。若有汗。当减
柴胡。无热当减黄芩。呕则当倍姜半。虚则当倍人参。又在临证之变通也。
案巢源云。运闷之状。心烦气欲绝是也。亦有去血过多。亦有下血极少。皆令运闷。若去血过多。血虚
气极如此而运闷者。但烦闷而已。若下血过少。而气逆者。则血随气上掩于心。亦令运闷。则烦闷而心满急。
二者为异。亦当候其产妇。血下多少。则知其产后应运与不运也。然烦闷不止。则毙人。巢氏所论如此。知
产后血晕。自有两端。其去血过多而晕者。属气脱。其证眼闭口开。手撒手冷。六脉微细或浮
是也。下血极少而晕者属血逆。其证胸腹胀痛气粗。两手握拳。牙关紧闭是也。此二者证治霄壤。服药一差。
生死立判。宜审辨焉。而本条所论。别是一证。活人书妊娠伤寒门。载此条于三物黄芩汤之后。则知是专治
妇人草蓐伤风。呕而不能食者。若以小柴胡汤为产后郁冒之的方。则误人殆多矣。
病解能食。七八日更发热者。此为胃实。大承气汤主之。
（见 病中。○脉经。作此为胃热气实。程金鉴脉经。并接前条为一条。）
〔沈〕此即大便坚呕不能食。用小柴胡汤。而病解能食也。病解者。谓郁冒已解。能食者。乃余邪隐伏
胃中。风热炽盛。而消谷。但食入于胃。助起余邪复盛。所以七八日。而更发热。故为胃实。是当荡涤胃邪为
主。故用大承气。峻攻胃中坚垒。俾无形邪相随有形之滞。一扫尽出则病如失。仲景本意。发明产后气血虽
虚。然有实证。即当治实。不可顾虑其虚。反致病剧也。
产后腹中 痛。当归生姜羊肉汤主之。并治腹中寒疝。虚劳不足。（方见寒疝中。）
〔程〕产后血虚有寒。则腹中急痛。内经曰。味浓者为
阴。当归羊肉味浓者也。用以补产后之阴。佐生姜以散腹中之寒。则 痛自止。夫辛能散寒。补能去弱。
三味辛温补剂也。故并主虚劳寒疝。
〔魏〕妊娠之 痛。胞阻于血寒也。产后腹中 痛者。里虚而血寒也。一阻一虚。而治法异矣。
〔尤〕当归生姜。温血散寒。孙思邈云。羊肉止痛利产妇。
千金当归汤。治妇人寒疝。虚劳不足。若产后腹中绞痛。
即本方加芍药。注云。子母秘录有甘草。
丹溪心要云。当产寒月。脐下胀满。手不可犯。寒入产门故也。服仲景羊肉汤二服愈。
严氏济生当归羊肉汤。治产后发热自汗。肢体痛。名曰蓐劳。
即本方。加人参黄 。
产后腹痛。烦满不得卧。枳实芍药散主之。
〔鉴〕产后腹痛。不烦不满。里虚也。今腹痛烦满。不得卧。里实也。气结血凝而痛。故用枳实破
气结。芍药调腹痛。枳实炒令黑者。盖因产妇气不实也。并主痈脓。亦因血为气凝。久
而腐化者也。佐以麦粥。恐伤产妇之胃也。
〔尤〕产后腹痛。而至烦满不得卧。知血郁而成热。且下病而碍上也。与虚寒 痛不同矣。枳实烧
令黑。能入血行滞。同芍药为和血止痛之剂也。
〔魏〕大麦粥。取其滑润宜血。且有益胃气也。
枳实芍药散方
枳实（烧令黑勿太过） 芍药（等分）
上二味。杵为散。服方寸匕。日三服。并主痈肿。以麦粥下之。
案朱震亨云。芍药产后禁用。程氏辨其误。极是。今不
繁引。又案此前排脓散中。去桔梗。不用鸡子黄。用麦粥。
立方之意稍近。故并治痈肿乎。
师曰。产妇腹痛。法当以枳实芍药散。假令不愈者。此为腹中有干血着脐下。宜下瘀血汤主之。亦主经水不利。
〔鉴〕产妇腹痛。属气结血凝者。枳实芍药散以调之。假令服后不愈。此为热灼血干。着于脐下而痛。非
枳实芍药之所能治也。宜下瘀血主之。下瘀血汤。攻热下瘀血也。并主经水不通。亦因热灼血干故也。
下瘀血汤方
大黄（三两○赵本作二两） 桃仁（二十枚） 虫（二十枚熬去足）
上三味。末之。炼蜜和为四丸。以酒一升。煎一丸。取八合。顿服之。新血下如豚肝。
〔程〕 虫。主下血闭。咸能软坚也。大黄。主下瘀血。苦能泄滞也。桃仁。亦下瘀血。滑以去着也。
三味相合。以攻脐下干血。
〔魏〕此类于抵当汤丸之用。亦主经水不利。
无非通幽开积之治也。和酒为丸者。缓从下治也。
〔徐〕既曰新血。又曰如豚肝。骤结之血也。
案徐氏兰台轨范云。新字当作瘀字。此说颇有理。
产后七八日。无太阳证。少腹坚痛。此恶露不尽。不大便。烦躁发热。切脉微实。再倍发热。日晡时
烦躁者不食。食则谵语。至夜即愈。宜大承气汤主之。热在里。结在膀胱也。（见 病中。○脉经。烦躁发
热四字。作四五日趺阳脉六字。食则谵语至夜即愈八字。作谵语利之则愈六字。）
〔程〕太阳伤寒。热结膀胱。则蓄血。小腹坚痛。今产后非太阳证。而小腹亦坚痛者。此恶血未尽。
热在里。结在膀胱也。宜下瘀血汤辈。若不大便。烦躁发热。则热不在膀胱。而热在胃。切其脉亦微实也。
日晡时。阳明向王时也。当向王时。是以再倍发热烦躁。则胃中实矣。胃实则不能食。
故食则谵语。转增其实也。宜大承气汤下之。此条前后简错。热在里八字。当在恶露不尽之下。未有大
承气汤。而下膀胱血结也。至夜即愈四字。衍文。脉经无。（金鉴同。但以至夜即愈。不
为衍文。以再倍二字为衍。）
〔鉴〕李 曰。此一节具两证在内。一是太阳蓄血证。一是阳明里实证。因古人
文法错综。故难辨也。无太阳证。谓无表证也。少腹坚痛者。以肝藏血。少腹为肝经部分。故血必结于此。则
坚痛亦在此。此恶露不尽。是为热在里。结在膀胱。此太阳蓄血证也。宜下去瘀血。若不大便烦躁。脉实谵
语者。阳明里实也。再倍发热者。热在里。蒸蒸发于外也。阳明旺于申酉戌。日晡是阳明向旺时。故烦
躁不能食。病在阳而不在阴。故至夜则愈。此阳明腑病也。宜大承气汤以下胃实。
案尤云。盖谓不独血结于下。而亦热聚于中也。若但治其血。而遗其胃。则血虽去而热不除。即血亦
未必能去。而大承气汤中。大黄枳实。均为血药。仲景取之者。盖将一举而两得之欤。此解不可从。李注似允当。
产后风。续之数十日不解。头微痛。恶寒时时有热。心下闷。干呕汗出。虽久阳旦证续在耳。可与阳旦
汤。（〔原注〕即桂枝汤方。见下利中。○脉经作妇人产得风。心下闷。作心下坚。徐沈作产后中风续续。）
〔徐〕此段言产后中风。迁延不愈。而表里杂见者。仍当去其风也。谓中风之轻者。数十日不解。似
乎不可责表。然头疼恶寒汗出。时有热。皆表证也。心下闷干呕。太阳之
邪欲内入。而内不受也。今阳旦证仍在。阳旦汤何不可与。而因循以致误也。
案阳旦汤。徐沈尤金鉴。为桂枝汤加黄芩。而魏则据伤
寒论证象阳旦条。为桂枝加附子。并误。唯程根据原注为是。
张氏医通云。举此与上文承气汤。为表里之例。
产后中风。发热面正赤。喘而头痛。竹叶汤主之。（喘而。千金。作喘气。头痛。圣济。作头目昏痛。）
〔尤〕此产后表有邪。而里适虚之证。若攻其表。则气浮易脱。若补其里。则表多不服。竹叶汤。用竹
叶葛根桂枝防风桔梗。解外之风热。人参附子。固里之脱。甘草姜枣。以调阴阳之气。而使其平。乃表里
兼济之法。凡风热外淫。而里气不固者。宜于此取则焉。
〔沈〕产后最易变为柔痉。故发热头痛。虽属太阳表证。恐隐痉病之机。所以方后云。颈项强。加大附子一枚。
案金鉴云。产后中风之下。当有病痉者之三字。始与方合。若无此三字。则人参附子。施之于中风发
热可乎。而又以竹叶命名者。何所谓也。且方内有颈项强用大附子之文。
本篇有证无方。则可知必有脱简。此注恐非。是方盖防发痉之渐。若至直发痉。则难奏效也。
竹叶汤方
竹叶（一把○千金作一握） 葛根（三两） 防风（案千金用二两） 桔梗 桂枝
人参 甘草（各一两） 大枣（十五枚） 生姜（五两） 附子（一枚炮○活人书不用）
上十味。以水一斗。煮取二升半。分温三服。温覆使汗出。○颈项强。用大附子一枚。破之如豆大。前
药扬去沫。呕者。加半夏半升。洗。（千金。分上。有去滓二字。无一枚以下十二字。前。
赵本作煎。徐注豆大下云。该是入字。案据徐则豆下句。）
〔程〕产后血虚。多汗出。喜中风。故令病痉。今证中未至背反张。而发热面赤头痛。亦风痉之渐。故用
竹叶主风痉。防风治内痉。葛根治刚 。桂枝治柔痉。生姜散风邪。桔梗除风痹。辛以散之之剂也。邪之所
凑。其气必虚。佐人参以固卫。附子以温经。甘草以和诸药。大枣以助十二经。
同诸风剂。则发中有补。为产后中风之大剂也。颈项强急。痉病也。加附子以散寒。呕者。风拥气逆也。加半夏以散逆。
张氏医通云。此桂枝汤。去芍药。加竹叶葛防桔梗人参。
因方后所加附子向来混入方内。案医通。载本方。去附子。盖本于活人书。
又云。附子恐是方后所加。治颈项强者。以邪在太阳禁固其筋脉。不得屈伸。故用附子。温经散寒。
扬去沫者。不使辛热上浮之气。助其虚阳上逆也。若邪在胸而呕。加半夏治
之。上言破之如豆。入前药。旧本作如豆大。今如徐忠可驳正。
妇人乳中虚。烦乱呕逆。安中益气。竹皮大丸主之。（乳。脉经。作产。）
〔程〕胃者。水谷气血之海。产后则血气虚。而胃气逆。故烦乱呕逆。
〔尤〕妇人乳中虚。烦乱呕逆者。
乳子之时。气虚火胜。内乱而上逆也。
案乳中。盖在草蓐之谓。故脉经作产中。而沈云。乳者乳子之妇也。魏云。乳即血也。初产血虚。
沈云。乳下。当有闭字。谓乳闭而不通也。金鉴云。此条文义证药未详。张璐云。乳中虚。言乳哺而乳
汁去多。并误。
竹皮大丸方（活人云。治虚烦。载之于丈夫诸方中。）
生竹茹（二分） 石膏（二分） 桂枝（一分） 甘草（七分） 白薇（一分）
上五味。末之。枣肉和丸弹子大。以饮服一丸。日三夜
二服。有热者。倍白薇。烦喘者。加柏实一分。活人书。柏实。作枳实。
〔程〕竹茹甘寒。以除呕 。石膏辛寒。以除烦逆。白薇咸寒。以治狂惑邪气。夫寒则泥膈。佐桂
枝以宣导。寒则伤胃。佐甘草以和中。有热倍白薇。白薇咸寒。能除热也。
烦喘。加柏实。柏实辛平。能治喘也。用枣肉为丸者。统和
诸药。以安中益气也。
武氏济阴纲目云。中虚不可用石膏。烦乱不可用桂枝。此方以甘草七分。配众药六分。又以枣肉为丸。
仍以一丸饮下。可想其立方之微。用药之难。审虚实之不易也。仍饮服者。尤虑夫虚虚之祸耳。用是方者亦
当深省。
产后下利虚极。白头翁加甘草阿胶汤主之。（脉经。作热痢重下新产虚极。千金。利虚间。有兼字。）
〔尤〕伤寒热利下重者。白头翁汤主之。寒以胜热。苦
以燥湿也。此亦热利下重。而当产后虚极则加阿胶救阴。甘草补中生汤。且以缓连柏之苦也。
案金鉴云。此条文义证药不合。不释。盖以其虚极而用苦寒之品也。
白头翁加甘草阿胶汤方（千金。名白头翁汤。）
白头翁 甘草 阿胶（各二两） 秦皮 黄连（案千金各二两） 柏皮（各三两）
上六味。以水七升。煮取二升半。内胶令消尽。分温三服。
问：刚生产完的妇女有三种病。一种是痉病（以项背强直、口噤不开甚至角弓反张为特征的病证）。第二种是郁冒（头昏目眩、意识模糊的病证）。第三种是大便难。这是什么原因呢？
医生说：新产后的妇女，由于失血导致血虚，加上出汗多，容易感受风邪，所以会患痉病。因为亡血又出汗，寒气偏多，所以会导致郁冒。因为津液耗伤，胃中干燥，所以会出现大便难。（按语：沈金鳌《金鉴》认为“痉”字是正确的，详见痉病篇。）
〔尤在泾〕痉，属于筋脉的病变。血虚且出汗，导致筋脉失去滋养，风邪侵入后更加使筋脉拘急劲强。郁冒，属于神志的病变。阴血亡失而血虚，阳气于是厥逆而生寒，再被郁遏，就会出现头晕眼花的症状。大便难，属于津液的病变。胃贮藏津液，并渗灌输布于诸阳经，津液亡失导致胃燥，大肠失去滋润，所以排便困难。这三种病虽然表现不同，但都是由于亡血伤津造成的，所以都是产后常见的疾病。
产妇出现郁冒，脉象微弱，呕吐不能进食，大便反而干硬，只有头部出汗。之所以这样，是因为血虚导致气机厥逆，气逆则发生郁冒。郁冒想要解除，一定会全身大汗出。这是因为血虚导致下部厥冷，孤阳上浮外越，所以只有头部出汗。之所以产妇容易出汗，是因为亡失阴血导致血虚，阳气独盛，所以应当通过出汗来调和，阴阳才能恢复平衡。对于大便干硬、呕吐不能进食的情况，用小柴胡汤主治。（〔原注〕方剂见呕吐篇中。）
〔尤在泾〕郁冒虽然有外感客邪，但其根本在于里虚，所以脉象微弱。呕吐不能进食，大便反而干硬，只有头部出汗，这是津气上行而不能下达下焦的现象。之所以这样，是因为亡失阴血导致血虚，孤阳上逆，津气随之而上行。气厥必然导致郁冒，郁冒患者想要解除，一定会大汗出，这是因为阴阳暂时分离，所以发生厥逆和郁冒；等到阴阳重新通畅，汗出而后病解。产妇身体新近虚弱，不应当多汗，但这里反而善于出汗，是因为血液流失导致阴虚，阳气受邪气影响而独盛，出汗则邪气去除，阳气减弱后才能与阴气相和谐，这就是所谓“损阳而就阴”。使用小柴胡汤，是因为邪气不可不散，而正气虚弱也不可不顾，只有这种方法能解散客邪，调和阴阳。
〔金鉴〕大便干硬、呕吐不能进食，用小柴胡汤，必须病人舌上有苔，身上无汗，形体气势不衰，才可以服用。所以病解除后自然能进食。如果有汗，应当减少柴胡用量；无热象，应当减少黄芩用量；呕吐，应当加倍生姜和半夏用量；体虚，应当加倍人参用量，这又在于临证时的灵活变通。
按语：巢元方《诸病源候论》说，运闷（即眩晕昏闷）的症状，是心烦气短欲绝。也有的是因去血过多引起的，也有的是因恶露排出极少引起的，都会导致运闷。如果去血过多，血虚气极，像这样出现的运闷，只是感到烦闷而已。如果恶露排出过少，导致气逆，那么血随气上冲掩蔽于心，也会导致运闷，这时不仅烦闷而且心腹胀满急迫。这两种情况是不同的，也应当观察产妇恶露排出的多少，从而知道产后是否会发生运闷。然而，如果烦闷不止，就会致死。巢氏的论述如此，可知产后血晕自有两个方面：其一是去血过多而晕的，属于气脱，症状是眼睛闭合、口张开、手撒开、手脚冰冷、六脉微细或浮大；其二是恶露极少而晕的，属于血逆，症状是胸腹胀痛、呼吸粗重、两手握拳、牙关紧闭。这两者的证治相差悬殊，服药稍有差错，生死立判，应当仔细辨别。而本条所论述的，是另一种证候。《活人书·妊娠伤寒门》将此条记载在三物黄芩汤之后，可知这是专门治疗妇人在产褥期伤风，呕吐而不能进食的方证。如果把小柴胡汤当作治疗产后郁冒的专用方，那就会误人很多了。
病邪解除后能进食，过了七八天又发热的，这是胃中有实热，用大承气汤主治。
（见阳明病篇中。○《脉经》作“此为胃热气实”，程林《金鉴》版《脉经》将此句与前一条合并为一条。）
〔沈明宗〕这就是前面所说的大便坚、呕不能食，用小柴胡汤治疗后，病解除且能进食的情况。病解除，是指郁冒已解；能进食，说明有余邪潜伏在胃中，风热炽盛而消谷善饥。但食物进入胃中，助起余邪使其再次旺盛，所以过了七八天又发热，因此诊断为胃实。此时应当以荡涤胃中邪气为主，所以用大承气汤，峻猛攻下胃中的坚实积滞，使无形的邪气随着有形的积滞，一扫而空，病就好了。仲景的本意，是阐明产后气血虽然虚弱，但如果出现实证，就应当治疗实证，不可以顾虑其虚，反而导致病情加重。
产后腹中疼痛，用当归生姜羊肉汤主治。同时治疗腹中寒疝、虚劳不足。（方剂见寒疝篇中。）
〔程林〕产后血虚且有寒，会导致腹中急痛。《内经》说：味道浓厚的属于阴。当归和羊肉味道浓厚，用来补益产后的阴血，佐以生姜来散除腹中的寒气，那么腹痛自然停止。辛味能散寒，补法能去弱，这三味药是辛温补剂的组合，所以同时主治虚劳和寒疝。
〔魏念庭〕妊娠期间的腹痛，是胞宫阻滞，属于血寒。产后腹中疼痛，是里虚且血寒。一个是阻滞，一个是虚弱，治疗方法不同。
〔尤在泾〕当归和生姜，能温血散寒。孙思邈说：羊肉止痛，利于产妇。
千金当归汤，治疗妇人寒疝、虚劳不足。如果是产后腹中绞痛，
就在本方基础上加芍药。注释说：《子母秘录》中有甘草。
《丹溪心要》说：在寒冷的月份分娩，脐下胀满，手不敢触碰，是因为寒气进入产门所致。服用仲景的羊肉汤两服即可痊愈。
严氏《济生方》当归羊肉汤，治疗产后发热自汗、肢体疼痛，名为蓐劳。
就是在本方基础上，加人参、黄芪。
〔金鉴〕产后腹痛，如果不烦不满，属于里虚。现在腹痛且烦满，不能平卧，属于里实。气结血凝导致疼痛，所以用枳实破气结，用芍药调治腹痛。将枳实炒至黑色，是因为产妇之气不实。此方同时主治痈脓，也是因为血被气凝滞，久而腐化成脓。佐以麦粥，是担心损伤产妇的胃气。
〔尤在泾〕产后腹痛，发展到心烦胀满、不能平卧，可知是血郁化热，且下部的病变影响了上部，这与虚寒性腹痛不同。将枳实烧成黑色，能入血分而行滞，同芍药配合成为和血止痛的药剂。
枳实芍药散方
枳实（烧令黑，不要太过火） 芍药（等分）
以上两味药，捣碎过筛制成散剂。每次服用一方寸匕，每日三次。同时主治痈肿，用麦粥送服。
按语：朱震亨说，芍药产后禁用，程林辨析其错误，非常正确，此处不再繁琐引用。又按语：此前排脓散中，去掉桔梗，不用鸡子黄，改用麦粥，立方之意稍接近，所以也能主治痈肿吗？
医生说：产妇腹痛，按照法则应当用枳实芍药散。假如服药后不愈，这是因为腹中有干血附着在脐下，宜用下瘀血汤主治。同时也主治月经不通利。
〔金鉴〕产妇腹痛，属于气结血凝的，用枳实芍药散调理。假如服药后不愈，这是因为热灼血干，附着于脐下而痛，不是枳实芍药所能治疗的，宜用下瘀血汤主治。下瘀血汤，是攻逐热邪、下行瘀血的方剂。同时主治月经不通，也是因为热灼血干的原因。
下瘀血汤方
大黄（三两○赵本作二两） 桃仁（二十枚） 䗪虫（二十枚，熬，去足）
以上三味药，研成粉末，炼蜜和丸如弹子大小。用酒一升，煎煮一丸，取八合，一次性服用。排出新的瘀血状如猪肝色。
〔程林〕䗪虫，主要破除血闭，咸味能软坚。大黄，主要下瘀血，苦味能泄滞。桃仁，也下瘀血，滑利以去除着滞。三味药相合，以攻逐脐下的干血。
〔魏念庭〕这类方剂类似于抵当汤丸的用法，也主治月经不通利。
无非是通幽开积的治疗方法。用酒和丸，是缓和地从下焦治疗。
〔徐灵胎〕既然说是“新血”，又说“状如豚肝”，这是骤然凝结之血。
按语：徐氏《兰台轨范》说，“新”字应当作“瘀”字，这种说法很有道理。
产后七八天，没有太阳表证，少腹部坚硬疼痛，这是恶露不尽。不大便，烦躁发热，切脉微实，发热加倍，日晡时（下午3-5点）
烦躁，不能进食，进食则谵语，到了夜间就缓解，宜用大承气汤主治。热在里，结在膀胱。（见阳明病篇中。○《脉经》中，“烦躁发热”四字，作“四五日趺阳脉”六字；“食则谵语至夜即愈”八字，作“谵语利之则愈”六字。）
〔程林〕太阳伤寒，热结膀胱，则形成蓄血，小腹坚硬疼痛。现在产后不是太阳证，但小腹也坚硬疼痛，这是恶血未尽，热在里，结在膀胱。宜用下瘀血汤之类的方剂。如果不大便，烦躁发热，那么热不在膀胱，而在胃，切其脉也微实。日晡时，是阳明经气向旺盛的时候，正当向旺之时，所以发热烦躁加倍，这说明胃中实热。胃实则不能进食，
所以进食则谵语，进一步增加其实热。宜用大承气汤攻下。这一条前后文字简略错乱，“热在里”三字，应当在“恶露不尽”之下。没有用大承气汤来下膀胱血结的道理。“至夜即愈”四字，是衍文，《脉经》中没有。（金鉴看法相同，但认为“至夜即愈”不是衍文，认为“再倍”二字是衍文。）
〔金鉴〕李中梓说：这一段包含两个证候。一是太阳蓄血证，一是阳明里实证。因为古人文章写法错综，所以难以分辨。无太阳证，是指没有表证。少腹坚硬疼痛，因为肝藏血，少腹是肝经部位，所以血必结于此，则坚硬疼痛也在此处。这是恶露不尽，是为热在里，结在膀胱，这是太阳蓄血证。宜用下去瘀血的方法。如果不大便、烦躁、脉实、谵语，则是阳明里实证。发热加倍，是热在里，蒸蒸发于体表。阳明旺于申酉戌时，日晡是阳明向旺之时，所以烦躁不能进食。病在阳而不在阴，所以到了夜间就缓解。这是阳明腑病。宜用大承气汤以下胃实。
按语：尤在泾说：大概意思是不仅血结于下，而且热聚于中。如果只治其血，而遗漏治胃，那么血虽去而热不除，即使血也未必能去，而大承气汤中，大黄、枳实，均为血药，仲景选用它们，大概是想要一举两得吧？这种解释不可从。李中梓的注解似乎更允当。
产后中风，持续几十天不解，头部轻微疼痛，恶寒，时不时发热，心下闷，干呕，出汗，虽然时间久，但阳旦证仍在，可与阳旦汤。（〔原注〕即桂枝汤方，见下利篇中。○《脉经》作“妇人产得风，心下闷”，作“心下坚”，徐灵胎、沈明宗作“产后中风续续”。）
〔徐灵胎〕这段文字讲的是产后中风，迁延不愈，而表里症状杂见的，仍然应当祛风。说的是中风轻症，几十天不解，似乎不应该责之于表，然而头痛、恶寒、出汗、时有发热，都是表证。心下闷、干呕，是太阳邪气想要内入，而体内不受纳。现在阳旦证仍在，阳旦汤为什么不可以用？如果因循拖延以致误诊，那就错了。
按语：阳旦汤，徐灵胎、沈明宗、尤在泾、金鉴认为是桂枝汤加黄芩，而魏念庭则根据《伤寒论》辨太阳病脉证并治中阳旦条，认为是桂枝加附子汤，都错了。只有程林根据原注是正确的。
张璐《张氏医通》说：举此例与上文承气汤，作为表里治疗的范例。
产后中风，发热，面色正红，气喘且头痛，用竹叶汤主治。（“喘而”，《千金方》作“喘气”；“头痛”，《圣济总录》作“头目昏痛”。）
〔尤在泾〕这是产后表有邪气，而里气正虚的证候。如果攻其表，则气浮易脱；如果补其里，则表邪多不服。竹叶汤，用竹叶、葛根、桂枝、防风、桔梗，解除外面的风热；用人参、附子，固护里面的防脱；用甘草、姜、枣，来调和阴阳之气，使其平和，这是表里兼济的方法。凡是风热外淫，而里气不固的，应当从这里取法。
〔沈明宗〕产后最容易变为柔痉，所以发热头痛，虽然属于太阳表证，但恐怕隐含痉病的病机，所以方后注说：颈项强直，加大附子一枚。
按语：金鉴说：在“产后中风”之下，应当有“者”字，才与方剂相符。如果没有这三个字，那么人参、附子，施用于中风发热可以吗？而且以竹叶命名方剂，又有什么含义呢？况且方内有“颈项强，用大附子”的文字。
本篇有证无方，可知必有脱简。这个注解恐怕不对。这个方子大概是防止发作痉病的苗头，如果已经直接发作痉病，就难以奏效了。
竹叶汤方
竹叶（一把○《千金方》作一握） 葛根（三两） 防风（按《千金方》用二两） 桔梗 桂枝
人参 甘草（各一两） 大枣（十五枚） 生姜（五两） 附子（一枚，炮○《活人书》不用）
以上十味药，用水一斗，煮取二升半，分三次温服。温覆使汗出。○颈项强直，用大附子一枚，破开如豆大。前药扬去沫。呕吐者，加半夏半升，洗。（《千金方》，分上段，有“去滓”二字，无“一枚”以下十二字。前，赵本作“煎”，徐注在“豆大”下说：该是“入”字。按据徐说，则在“豆”字下断句。）
〔程林〕产后血虚，多汗出，容易中风，所以患痉病。现在的证候中未到背反张的程度，但发热面赤头痛，也是风痉的渐兆，所以用竹叶汤主治风痉。防风治内痉，葛根治刚痉，桂枝治柔痉，生姜散风邪，桔梗除风痹，这是辛以散之的药剂。邪气所凑，其气必虚，佐人参以固卫，附子以温经，甘草以和诸药，大枣以助十二经。
同其他风剂相比，则是发中有补，是治疗产后中风的大剂。颈项强急，是痉病，加附子以散寒。呕吐，是风拥气逆，加半夏以散逆。
张氏医通说：此方是桂枝汤，去芍药，加竹叶、葛根、防风、桔梗、人参。
因为方后所加的附子向来混入方内，案《医通》载本方，去附子，大概是基于《活人书》。
又说：附子恐怕是方后所加，治颈项强直的，因为邪在太阳，禁固其筋脉，不得屈伸，所以用附子，温经散寒。
扬去沫，是不使辛热上浮之气，助其虚阳上逆。如果邪在胸而呕吐，加半夏治疗。上面说“破之如豆”，加入前药。旧本作“如豆大”，现在如徐忠可驳正。
妇人哺乳期间，中气虚，心烦意乱，呕吐逆气，安中益气，用竹皮大丸主治。（“乳”，《脉经》作“产”。）
〔程林〕胃是水谷气血的海，产后则血气虚，而胃气逆，所以烦乱呕逆。
〔尤在泾〕妇人哺乳期间中气虚，心烦乱呕逆，
是在哺乳的时候，气虚火胜，内乱而上逆。
按语：“乳中”，大概是指在产褥期的意思，所以《脉经》作“产中”，而沈明宗说：“乳”是指哺乳的妇女。魏念庭说：“乳”即血也。初产血虚。沈明宗说：“乳下”，应当有“闭”字，谓乳汁闭塞而不通。金鉴说：此条文义、证候、药物未详。张璐说：“乳中虚”，言哺乳而乳汁去多，都错了。
竹皮大丸方（《活人书》说：治虚烦，载之于丈夫诸方中。）
生竹茹（二分） 石膏（二分） 桂枝（一分） 甘草（七分） 白薇（一分）
以上五味药，研成粉末，用枣肉和丸如弹子大小。用饮服用一丸，白天三次，晚上两次。有热者，倍用白薇。烦喘者，加柏实一分。《活人书》中，柏实，作枳实。
〔程林〕竹茹甘寒，以除呕逆。石膏辛寒，以除烦逆。白薇咸寒，以治狂惑邪气。寒则泥膈，佐桂枝以宣导；寒则伤胃，佐甘草以和中。有热倍用白薇，白薇咸寒，能除热。
烦喘，加柏实，柏实辛平，能治喘。用枣肉为丸，统和诸药，以安中益气。
武氏《济阴纲目》说：中虚不可用石膏，烦乱不可用桂枝。此方以甘草七分，配众药六分，又以枣肉为丸，仍以一丸饮服，可以想见其立方之微妙，用药之艰难，审虚实之不易。仍用饮服者，更是忧虑虚虚之祸罢了。使用此方的人也应当深思。
产后下利，虚极，白头翁加甘草阿胶汤主治。（《脉经》作“热痢重下新产虚极”，《千金方》中，“利虚”间，有“兼”字。）
〔尤在泾〕伤寒热利下重者，白头翁汤主治。寒以胜热，苦以燥湿。这也是热利下重，而当产后虚极时，则加阿胶救阴，甘草补中生肌，且以缓和黄连、黄柏之苦。
按语：金鉴说：此条文义、证候、药物不合，不解释。大概是因为其虚极而用苦寒之品。
白头翁加甘草阿胶汤方（《千金方》名白头翁汤。）
白头翁 甘草 阿胶（各二两） 秦皮 黄连（按《千金方》各二两） 柏皮（各三两）
以上六味药，用水七升，煮取二升半，纳入胶令其溶尽，分三次温服。
Question: There are three diseases in women who have just given birth. One is Jing disease (a syndrome characterized by stiffness of the neck and back, locked jaw, and even opisthotonos). The second is Yumao (a syndrome characterized by dizziness, blurred vision, and confusion). The third is difficulty in defecation. What does this mean?
The Master said: Women who have just given birth suffer from blood deficiency due to blood loss, and perspire excessively, making them prone to contracting wind pathogens, thus leading to Jing disease. Due to blood loss and sweating, there is an excess of cold, thus leading to Yumao. Due to the consumption of body fluids and dryness in the stomach, difficulty in defecation occurs. (Note: Shen Jin'ao's *Jin Jian* considers "Jing" to be correct; see the chapter on Jing disease for details.)
[You Zaijing] Jing is a disorder of the sinews. Blood deficiency and sweating cause the sinews and vessels to lose nourishment; when wind pathogens invade, they exacerbate the stiffness and tension of the sinews. Yumao is a disorder of the spirit. Loss of yin blood leads to blood deficiency, causing yang qi to rebel and generate cold. When this cold is constrained, it results in dizziness and blurred vision. Difficulty in defecation is a disorder of body fluids. The stomach stores body fluids and distributes them to the yang channels. Loss of body fluids causes stomach dryness, and the large intestine loses its lubrication, resulting in difficult defecation. Although these three diseases present differently, they all result from blood loss and injury to body fluids; therefore, they are all diseases common after childbirth.
[Cheng Lin] Postpartum blood syncope is Yumao, also known as Xue Jue (Blood Jue).
When a postpartum woman suffers from Yumao, her pulse is faint, she vomits and cannot eat, her stool is hard, and only her head sweats. This is because blood deficiency leads to qi rebellion, and qi rebellion causes Yumao. For Yumao to resolve, profuse sweating must occur throughout the body. This is because blood deficiency causes cold at the lower jiao, and lone yang floats upward and outward, causing only the head to sweat. Postpartum women tend to sweat because the loss of yin blood leads to blood deficiency and excessive yang. Sweating allows the yin and yang to harmonize. For cases with hard stool, vomiting, and inability to eat, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. ([Original Note]: Formula found in the Vomiting chapter.)
[You Zaijing] Although Yumao involves external pathogenic factors, its root lies in interior deficiency, hence the faint pulse. Vomiting, inability to eat, hard stool, and head-only sweating indicate that fluid and qi ascend but do not reach the lower jiao. This is due to loss of yin blood, blood deficiency, and the rebellion of lone yang carrying fluid and qi upward. Qi rebellion inevitably causes Yumao; for Yumao to resolve, profuse sweating must occur because yin and yang temporarily separate, causing rebellion and Yumao. When yin and yang reconnect, sweating occurs, and the disease resolves. Postpartum women are newly deficient and should not sweat excessively, but here they sweat readily because blood loss causes yin deficiency, and yang, affected by pathogenic factors, becomes excessive. Sweating eliminates the pathogen, allowing weakened yang to harmonize with yin, which is what is meant by "diminishing yang to join yin." Xiao Chai Hu Tang is used because pathogens must be dispersed, yet the deficiency of healthy qi must not be ignored; this method can both disperse external pathogens and harmonize yin and yang.
[Jin Jian] For hard stool, vomiting, and inability to eat, Xiao Chai Hu Tang is used, provided the patient has a coated tongue, no sweating on the body, and robust physical strength. Once the disease resolves, appetite returns naturally. If sweating is present, reduce the dosage of Chai Hu; if there is no heat, reduce Huang Qin; if vomiting occurs, double the dosage of Sheng Jiang and Ban Xia; if deficiency is prominent, double the dosage of Ren Shen. These adjustments depend on clinical flexibility.
Note: Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states that the symptoms of Yun Men (dizziness and oppression) include mental agitation and shortness of breath approaching suffocation. It can be caused by excessive blood loss or insufficient lochia discharge. Excessive blood loss leads to extreme qi deficiency due to blood deficiency, causing mere mental agitation. Insufficient lochia discharge leads to qi rebellion, where blood follows qi upward to obstruct the heart, causing Yun Men accompanied by mental agitation and chest/abdominal fullness and urgency. These two conditions differ. One should observe the amount of lochia discharge to determine if postpartum Yun Men will occur. However, if agitation persists, it can be fatal. Chao's discussion indicates two types of postpartum blood syncope: one due to excessive blood loss, classified as Qi Collapse, with symptoms such as closed eyes, open mouth, relaxed hands, cold extremities, and faint or floating pulses; the other due to minimal lochia discharge, classified as Blood Rebellion, with symptoms such as chest and abdominal distension and pain, coarse breathing, clenched fists, and locked jaws. The treatments for these two conditions are vastly different; a slight error in medication can lead to immediate death or survival, so careful differentiation is essential. The condition discussed in this clause is distinct. The *Huo Ren Shu* (Book of Life) places this clause after San Wu Huang Qin Tang in the Pregnancy Typhoid section, indicating it specifically treats wind-cold contracted during confinement with vomiting and inability to eat. Treating Xiao Chai Hu Tang as the specific formula for postpartum Yumao would mislead many.
If the disease resolves and the patient can eat, but fever recurs after seven or eight days, this indicates Stomach Excess, treated with Da Cheng Qi Tang (Major Order the Qi Decoction).
(See Yangming Disease chapter. ○ *Mai Jing* reads "This is Stomach Heat Qi Excess"; Cheng Lin's *Jin Jian* edition of *Mai Jing* merges this with the previous clause.)
[Shen Mingzong] This refers to the case of hard stool, vomiting, and inability to eat, treated with Xiao Chai Hu Tang, after which the disease resolves and the patient can eat. "Disease resolves" means Yumao has resolved; "can eat" implies residual pathogens lurking in the stomach, where wind-heat is vigorous and promotes digestion. However, food entering the stomach aids the resurgence of residual pathogens, causing fever to recur after seven or eight days, thus diagnosing Stomach Excess. The priority is to purge the Stomach of pathogens using Da Cheng Qi Tang to vigorously attack the solid accumulation in the Stomach, sweeping away both formless pathogens and formed stagnation. Zhang Zhongjing's intent is to illustrate that although postpartum qi and blood are deficient, if excess patterns exist, they must be treated as excess; one must not hesitate due to deficiency, lest the condition worsen.
For postpartum abdominal pain, Dang Gui Sheng Yang Rou Tang (Angelica Ginger Mutton Soup) is the primary treatment. It also treats abdominal Cold Hernia and Deficiency-Laziness. (Formula found in the Cold Hernia chapter.)
[Cheng Lin] Postpartum blood deficiency with cold causes acute abdominal pain. The *Nei Jing* states: flavors that are rich belong to Yin. Dang Gui and mutton have rich flavors and are used to tonify postpartum yin blood, assisted by Sheng Jiang to dispel abdominal cold, stopping the pain. Pungent flavors dispel cold, and tonification removes weakness; these three ingredients form a pungent-warm tonic, treating both Deficiency-Laziness and Cold Hernia.
[Wei Nianting] Abdominal pain during pregnancy is due to uterine obstruction from blood cold. Postpartum abdominal pain is due to interior deficiency and blood cold. One is obstruction, the other is deficiency; their treatments differ.
[You Zaijing] Dang Gui and Sheng Jiang warm the blood and dispel cold. Sun Simiao stated: Mutton stops pain and benefits postpartum women.
Qian Jin Dang Gui Tang treats female Cold Hernia and Deficiency-Laziness. For postpartum abdominal colic, add Bai Shao to this formula. The note says: *Zi Mu Mi Lu* contains Gan Cao.
*Dan Xi Xin Yao* states: In cold months of delivery, subumbilical distension and tenderness occur because cold enters the birth canal. Two doses of Zhongjing's Mutton Soup cure it.
Yan Shi's *Ji Sheng Fang* Dang Gui Mutton Soup treats postpartum fever, spontaneous sweating, and limb pain, named Ru Lao (Confinement Labor).
It adds Ren Shen and Huang Qi to this base formula.
For postpartum abdominal pain with mental agitation, fullness, and inability to lie down, Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) is the primary treatment.
[Jin Jian] Postpartum abdominal pain without agitation or fullness indicates interior deficiency. Current symptoms of abdominal pain, agitation, fullness, and inability to lie down indicate interior excess. Qi stagnation and blood coagulation cause pain; thus, Zhi Shi breaks qi stagnation, and Bai Shao regulates abdominal pain. Zhi Shi is stir-fried until black because postpartum qi is not solid. This formula also treats carbuncles and pus, as blood coagulated by qi decomposes over time. Mai Zhou (Barley Porridge) is added to protect the postpartum woman's stomach.
[You Zaijing] Postpartum abdominal pain progressing to agitation, fullness, and inability to lie down indicates blood stagnation transforming into heat, affecting the upper jiao from the lower, differing from cold-deficiency abdominal pain. Zhi Shi charred to black enters the blood level to move stagnation; combined with Bai Shao, it harmonizes blood and stops pain.
[Wei Nianting] Barley porridge provides slipperiness to benefit blood and supports stomach qi.
Zhi Shi Shao Yao San Formula
Zhi Shi (stir-fried until black, not too much) Bai Shao (equal parts)
Crush these two ingredients into a powder. Take one cun bi (measure) per dose, three times daily. It also treats carbuncles; take with barley porridge.
Note: Zhu Zhenheng stated that Bai Shao is contraindicated postpartum; Cheng Lin refuted this error correctly. Regarding the Pai Nong San mentioned earlier, removing Jie Geng and Ji Zi Huang, and using Mai Zhou, the formulation logic is slightly similar, hence its use for carbuncles?
The Master said: For postpartum abdominal pain, Zhi Shi Shao Yao San is indicated by law. If it does not heal, it is due to dried blood adhering below the umbilicus; Xia Yu Xue Tang (Drain Stasis Blood Decoction) is indicated. It also treats irregular menstruation.
[Jin Jian] Postpartum abdominal pain due to qi stagnation and blood coagulation is treated with Zhi Shi Shao Yao San. If it fails to heal, it is due to heat scorching blood into dryness adhering below the umbilicus, unresponsive to Zhi Shi and Shao Yao. Xia Yu Xue Tang is indicated to attack heat and drain stasis blood. It also treats amenorrhea due to heat-scorched dry blood.
Xia Yu Xue Tang Formula
Da Huang (3 liang ○ Zhao version: 2 liang) Tao Ren (20 kernels) E Chong (20 pieces, roasted, feet removed)
Grind these three ingredients into powder. Mix with refined honey to make four pills. Decoct one pill in one sheng of wine to obtain 8 he. Take in one dose. Fresh blood resembling pig liver will be discharged.
[Cheng Lin] E Chong primarily breaks blood closure; salty flavor softens hardness. Da Huang primarily drains stasis blood; bitter flavor drains stagnation. Tao Ren also drains stasis blood; slippery texture removes adherence. Combined, they attack dried blood below the umbilicus.
[Wei Nianting] This category resembles the use of Di Dang Tang/Wan, also treating irregular menstruation.
It is essentially a treatment to open blockages and accumulate. Using wine to make pills allows for slow action from below.
[Xu Lingtai] Since it says "fresh blood" and "resembling pig liver," this refers to suddenly congealed blood.
Note: Xu's *Lan Tai Gui Fan* suggests "Xin" (new) should be read as "Yu" (stasis); this reasoning is sound.
Seven or eight days postpartum, without Taiyang signs, with firm and painful lower abdomen, this is incomplete expulsion of lochia. Constipation, irritability, fever, faintly solid pulse, doubled fever, irritability at dusk (Shen-You hours), inability to eat, delirium upon eating, resolving at night: Da Cheng Qi Tang is indicated. Heat is in the interior,结 (knotting) is in the Bladder. (See Yangming Disease chapter. ○ *Mai Jing*: "Irritability and fever" reads "Fourth to fifth day, Fu Yang pulse"; "Delirium upon eating, resolving at night" reads "Delirium, purgation leads to resolution".)
[Cheng Lin] Taiyang cold damage with heat knotting in the Bladder causes blood retention and firm lower abdominal pain. Here, postpartum is not Taiyang, yet the lower abdomen is firm and painful, indicating incomplete expulsion of evil blood, heat in the interior, knotting in the Bladder. Formulas like Xia Yu Xue Tang are suitable. If constipation, irritability, and fever occur, heat is not in the Bladder but in the Stomach; the pulse is faintly solid. Dusk is when Yangming qi tends to flourish; thus, fever and irritability double, indicating Stomach excess. Stomach excess prevents eating; eating triggers delirium, increasing excess. Da Cheng Qi Tang is indicated to purge. The text order is scrambled; "Heat in the interior" should follow "incomplete expulsion of lochia." There is no logic in using Da Cheng Qi Tang to purge Bladder blood knots. "Resolving at night" is likely a scribal error, absent in *Mai Jing*. ([Jin Jian] agrees, but considers "resolving at night" valid and "doubled" as erroneous.)
[Jin Jian] Li Dongyuan states: This section contains two syndromes: Taiyang blood retention and Yangming interior excess. Ancient textual complexity makes them hard to distinguish. "No Taiyang signs" means no exterior syndrome. Firm lower abdominal pain occurs because the Liver stores blood, and the lower abdomen is the Liver channel area; thus, blood knots here, causing firmness and pain. This incomplete lochia expulsion indicates heat in the interior, knotting in the Bladder—Taiyang blood retention. Purging stasis blood is indicated. If constipation, irritability, solid pulse, and delirium occur, it is Yangming interior excess. Doubled fever indicates heat steaming outward from the interior. Yangming flourishes at Shen, You, Xu hours; dusk is when Yangming tends to flourish, causing irritability and anorexia. The disease is in Yang, not Yin, hence resolving at night. This is Yangming Fu organ disease; Da Cheng Qi Tang is indicated to purge Stomach excess.
Note: You Zaijing argues: Not only is blood knotted below, but heat gathers in the middle. Treating only blood while neglecting the Stomach means blood may clear but heat remains, and blood clearance may fail. Da Huang and Zhi Shi in Da Cheng Qi Tang act on blood; Zhang Zhongjing uses them to achieve two goals at once. This interpretation is rejected. Li's annotation is more appropriate.
Postpartum wind strike, persisting for dozens of days without resolution, with mild headache, alternating chills and fever, chest oppression, dry retching, and sweating: Although prolonged, the Yang Dan syndrome persists; Yang Dan Tang can be administered. ([Original Note]: Same as Gui Zhi Tang formula, found in the Diarrhea chapter. ○ *Mai Jing* reads "Woman contracts wind after delivery, chest oppression," reading "chest firmness"; Xu/Shen read "Postpartum wind strike continuing.")
[Xu Lingtai] This passage discusses postpartum wind strike lingering unresolved with mixed exterior-interior symptoms, requiring wind dispersion. Mild wind strike persisting for days might seem not to require exterior treatment, but headache, chills, sweating, and intermittent fever are exterior signs. Chest oppression and dry retching indicate Taiyang pathogens attempting to enter internally but being rejected. Since Yang Dan signs persist, why not use Yang Dan Tang? Delay leads to error.
Note: Yang Dan Tang: Xu, Shen, You, and Jin Jian consider it Gui Zhi Tang plus Huang Qin. Wei Nianting, based on *Shang Han Lun* Yang Dan clause, considers it Gui Zhi Jia Fu Zi Tang. Both are incorrect. Only Cheng Lin following the original note is correct.
Zhang Lu's *Zhang Shi Yi Tong* cites this alongside the preceding Cheng Qi Tang as examples of exterior and interior treatments.
Postpartum wind strike with fever, flushed face, wheezing, and headache: Zhu Ye Tang (Bamboo Leaf Decoction) is indicated. ("Wheezing and," *Qian Jin* reads "wheezing breath"; "Headache," *Sheng Ji* reads "dizzy and painful head/eyes".)
[You Zaijing] This is a postpartum pattern with exterior pathogens and interior deficiency. Attacking the exterior risks qi collapse; tonifying the interior rejects exterior pathogens. Zhu Ye Tang uses Zhu Ye, Ge Gen, Gui Zhi, Fang Feng, Jie Geng to resolve exterior wind-heat; Ren Shen and Fu Zi secure interior collapse; Gan Cao, Sheng Jiang, Da Zao harmonize yin and yang. This is a method of simultaneous exterior-interior support. For exterior wind-heat invasion with insecure interior qi, this formula serves as a model.
[Shen Mingzong] Postpartum women are prone to Rou Jing (Soft Spasm). Thus, fever and headache, though Taiyang exterior signs, hint at impending spasm. Hence, the formula note adds: For stiff neck and back, add one Fu Zi.
Note: Jin Jian states: Three characters "those with Jing disease" should follow "Postpartum wind strike" to match the formula. Without them, how can Ren Shen and Fu Zi be used for wind strike with fever? Also, why name it Zhu Ye Tang? The formula note mentions adding Fu Zi for stiff neck. The text has signs but no formula, implying missing pages. This note is likely incorrect. The formula aims to prevent the onset of spasm; if spasm has already fully developed, it may be ineffective.
Zhu Ye Tang Formula
Zhu Ye (1 bundle ○ *Qian Jin*: 1 handful) Ge Gen (3 liang) Fang Feng (*Qian Jin*: 2 liang) Jie Geng Gui Zhi
Ren Shen Gan Cao (1 liang each) Da Zao (15 pieces) Sheng Jiang (5 liang) Fu Zi (1 piece, processed ○ *Huo Ren Shu*: omitted)
Decoct these ten ingredients in 1 dou of water to obtain 2.5 sheng. Divide into three warm doses. Cover warmly to induce sweating. ○ For stiff neck and back, use one large Fu Zi, broken into bean-sized pieces. Skim foam from the decoction. If vomiting, add 0.5 sheng of washed Ban Xia. (*Qian Jin*: Divides text, includes "remove dregs," omits "one piece" and subsequent twelve characters. "Front," Zhao version reads "decoct"; Xu notes "bean-sized" should be "enter." Based on Xu, break after "bean".)
[Cheng Lin] Postpartum blood deficiency and excessive sweating predispose to wind strike, causing Jing disease. Current signs lack opisthotonos but show fever, flushed face, and headache, indicating early wind spasm. Zhu Ye Tang treats wind spasm; Fang Feng treats internal spasm; Ge Gen treats Gang Jing (Hard Spasm); Gui Zhi treats Rou Jing (Soft Spasm); Sheng Jiang disperses wind; Jie Geng removes wind bi. This is a pungent-dispersing formula. Where pathogens gather, qi is deficient; Ren Shen secures defensive qi, Fu Zi warms meridians, Gan Cao harmonizes herbs, Da Zao assists the twelve channels. Compared to other wind formulas, it combines dispersion with tonification, serving as a major formula for postpartum wind strike. Stiff neck and back indicate spasm; add Fu Zi to dispel cold. Vomiting indicates wind-constrained rebellious qi; add Ban Xia to scatter rebellion.
*Zhang Shi Yi Tong* states: This is Gui Zhi Tang minus Bai Shao, plus Zhu Ye, Ge Gen, Fang Feng, Jie Geng, Ren Shen.
Since Fu Zi was historically included in the formula despite being in the notes, *Yi Tong* omits it, likely based on *Huo Ren Shu*.
It further states: Fu Zi was likely added later to treat stiff neck, as pathogen in Taiyang constrains sinews, preventing flexion/extension; Fu Zi warms meridians and dispels cold.
Skimming foam prevents acrid-hot ascending qi from aiding rebellious deficient yang. If pathogen is in the chest causing vomiting, add Ban Xia. "Break into bean size" refers to adding to the decoction. Old texts read "bean-sized"; Xu Zhongke corrected this.
For nursing women with interior deficiency, mental agitation, and vomiting/retching, An Zhong Yi Qi Wan (Stomach-Anchoring Qi-Supporting Pill) is indicated. ("Nursing," *Mai Jing* reads "Delivery".)
[Cheng Lin] The Stomach is the sea of water and grain, qi and blood. Postpartum blood and qi are deficient, causing rebellious stomach qi, leading to agitation and vomiting.
[You Zaijing] Nursing women with interior deficiency, agitation, and vomiting/retching experience qi deficiency and fire excess during lactation, causing internal chaos and upward rebellion.
Note: "Ru Zhong" likely refers to the confinement period, hence *Mai Jing* reads "Chan Zhong" (During Delivery). Shen Mingzong says "Ru" refers to nursing women. Wei Nianting says "Ru" means blood. Initial postpartum blood deficiency. Shen Mingzong suggests "Ru Xia" should have "Bi" (blockage), meaning milk obstruction. Jin Jian states the text, signs, and drugs are unclear. Zhang Lu says "Ru Zhong Xu" means excessive milk loss during nursing; both are errors.
Zhu Pi Da Wan Formula (*Huo Ren Shu*: Treats deficiency agitation, listed among male formulas.)
Sheng Zhu Ru (2 fen) Shi Gao (2 fen) Gui Zhi (1 fen) Gan Cao (7 fen) Bai Wei (1 fen)
Grind these five ingredients into powder. Mix with date paste to make pills the size of quail eggs. Take one pill with water, three times by day, twice by night. If heat is present, double Bai Wei. If agitation and wheezing occur, add 1 fen of Bai Shi. *Huo Ren Shu* reads Bai Shi as Zhi Shi.
[Cheng Lin] Zhu Ru is sweet and cold, stopping vomiting. Shi Gao is acrid and cold, relieving agitation and rebellion. Bai Wei is salty and cold, treating mania and evil qi. Cold agents can obstruct the diaphragm; Gui Zhi guides them. Cold agents harm the stomach; Gan Cao harmonizes it. Double Bai Wei for heat, as its salty-cold nature clears heat. Add Bai Shi for agitation/wheezing; its acrid-pungent nature treats wheezing. Date paste harmonizes herbs to anchor the middle and support qi.
Wu Shi's *Ji Yin Gang Mu* states: Interior deficiency precludes Shi Gao; agitation precludes Gui Zhi. This formula uses 7 fen Gan Cao against 6 fen of other herbs, made into pills taken singly with water, showing subtle formulation and difficult drug selection, emphasizing the challenge of distinguishing deficiency/excess. Taking with water avoids the danger of further weakening deficiency. Users should reflect deeply.
For postpartum diarrhea with extreme deficiency, Bai Tou Weng Jia Gan Cao E Jiao Tang (Bitter Violet Plus Licorice and Donkey-Hide Gelatin Decoction) is indicated. (*Mai Jing*: "Hot dysentery with heavy straining, new postpartum extreme deficiency"; *Qian Jin*: "Diarrhea deficiency" has "jian" [concurrent] character.)
[You Zaijing] For typhoid hot dysentery with heaviness in the rectum, Bai Tou Weng Tang is used. Cold conquers heat; bitter dries dampness. This is also hot dysentery with rectal heaviness, but in extreme postpartum deficiency, E Jiao is added to save yin, and Gan Cao tonifies the middle and generates flesh, while moderating the bitterness of Lian Lian and Huang Bo.
Note: Jin Jian states the text, signs, and drugs do not align and offers no explanation, likely due to the use of bitter-cold herbs in extreme deficiency.
Bai Tou Weng Jia Gan Cao E Jiao Tang Formula (*Qian Jin*: Named Bai Tou Weng Tang.)
Bai Tou Weng Gan Cao E Jiao (2 liang each) Qin Pi Huang Lian (*Qian Jin*: 2 liang each) Bai Pi (3 liang each)
Decoct these six ingredients in 7 sheng of water to obtain 2.5 sheng. Dissolve E Jiao into the liquid. Divide into three warm doses.