论一首 证六条（按当五条。） 方八首
问曰。新产妇人有三病。
按产后痉病。其证治。与上经所叙无别。故更不论列。郁冒。开在次条。但大便难。则不出其方。然不出于脾约丸
等润燥手段也。
又按巢源妇人杂病中曰。张仲景云。妇人经水过多。亡津液者。亦大便难也。恐系于错引本条者。
产妇郁冒。其脉微弱。（大便坚呕不能食七字。脉经。作所以便坚者呕不能食也。）
先兄曰。明理论云。郁。为郁结而气不舒也。冒。为昏冒而神不明也。世谓之昏迷者。是也。此条不言发热。然后
条有更发热之语。则其有热者可知。即为草蓐伤风明矣。
按此条文法。稍近倒装。小柴胡汤主之一句。本当在但头汗出下。其以先辨郁冒之理。故更于章末补出三句也。冒
家大汗出。即是小柴胡相适之效。亦犹少阳病振汗之比。且以血虚下厥三句。释头汗出之理。所以产妇喜汗出者四句。
释前条亡血复汗之理。即血虚邪客之候。阴阳乃复一句。与冒家欲解。必大汗出相应。
盖喜汗出。头汗。大汗。三证不同。宜分别看。
又按大便反坚。反字。对呕不能食而言。盖呕不能食。是少阳证。大便宜未至坚。今产后液燥。故大便反坚也。本
事方曰。人平居无苦疾。忽如死人。身不动摇。默默不知人。目闭不能开。口噤不能言。或微知人。恶闻人声。但如眩
冒。移时方寤。此由已汗过多。血少气并于血。阳独上而不下。气壅塞而不行。故身如死。气过血还。阴阳复通。故移
时方寤。名曰郁冒。亦名血厥。妇人多有之。宜白薇汤。仓公散。白薇汤。白薇。当归。各一两。人参半两。甘草一分。
炙。水煎服。仓公散。瓜蒂。藜芦。雄黄。矾石。 。等分。少许吹入鼻中。（按二方。并非本条证所宜。姑附之。）
又曰。妇人产后。有三种疾。郁冒则多汗。多汗则大便秘。故难于用药。唯麻子苏子粥。最佳且稳。（按冒家汗出
乃复。后但肠燥便秘者。此粥为佳。首条所谓大便难者。亦或所宜。）
病解能食。七八日更发热者。
按此条证。徐朱以为食复。魏周意亦然。盖沈氏与此诸家。俱就能食而立说。但尤氏曰。病解能食。谓郁冒解。而
能受食也。至七八日更发热。此其病不在表而在里。不属虚而属实矣。是宜大承气以下里。此其意稍异。存考。
产后腹中 痛。
千金。治产后虚羸喘乏。白汗出。腹中绞痛。羊肉汤方。
于本方。加桂心。芍药。甘草。芎 。干地黄。（圣惠。羊肉地黄汤。更加人参。）
外台。许仁则。产后更无他状。但觉虚弱。欲得补气力。兼腹痛。宜羊肉当归汤方。
于本方。（当归五两。生姜六两。）加黄 四两。若觉恶露下不尽。加桂心三两。恶露下多。觉有风。加芎 三两。
觉有气。加细辛二两。觉有冷。加吴茱萸一两。觉有热。加生地黄汁二合。
圣济。治产后血气不利。心腹急痛。上下攻冲。气逆烦闷。黄 汤方。
于本方。加黄 。白术。甘草。人参。
下瘀血汤方
〔赵〕与抵当同类。但少缓尔。
按此方。犹是抵当丸大陷胸丸之例。宜云下瘀血丸。今作汤字者。盖传写之讹耳。方后煎字。亦宜作煮字。始合古
义。
产后七八日。无太阳证。（脉经。更无切脉二字。再倍下。有其人二字。不食。作不能食。）
按此条。李注极允。且据无太阳证一句考之。则其有里证。可以推知。盖是产后得邪。邪气下陷。与血相搏者。既
有热候。亦有少腹坚痛。与产后得胃家实者。其证相似易错。故对待为辨也。又膀胱。犹言下焦。不须深讲。产后中风。
发热面正赤。
〔徐〕中风发热头痛。表邪也。然面正赤。此非小可淡红。所谓面若妆朱。乃真阳上浮也。加之以喘。气高不下也。
明是产后太虚。元气不能自固。而又杂以表邪。自宜攻补兼施。
产后下利虚极。
〔徐〕凡治痢者。湿热非苦寒不除。故类聚四味之苦寒不为过。若和血安中。只一味甘草及阿胶而有余。治痢好用
参术者。政由未悉此理耳。
按虚极。犹言疲惫。轩村宁熙曰。此证本自热利。故虽至虚极。犹用白头翁汤。其加甘草阿胶者。不啻补血益气。
兼为缓中调肠之用。陶氏云。甘草。通经解毒。东垣云。热药得之缓其热。寒药得之缓其寒。甄氏云。阿胶止痢。杨仁
齐云。痢疾多因伤暑伏热而成。阿胶乃大肠之要药。有热气留滞者。则能疏导。无留滞者。则能平安。据此诸说。则增
加之意可知。虚闭并用阿胶。乃是此意。此说精确。
论一首，证六条（按：实际应为五条），方八首。
问曰：新近分娩的产妇有三种病。
按：产后痉病（产后因津血亏虚、筋脉失养或外感风邪所致的项背强直、角弓反张之病），其证治与上文经典所述没有区别，所以不再另行论述。郁冒（产后因失血伤津、复感寒邪，导致气血逆乱、头昏目眩如物蒙蔽的病证），在下一条中阐述。只是关于大便难（产后津液亏损导致的排便困难），没有列出相应的方剂。然而，不使用脾约丸等润燥通便的方法。
又按：巢元方《诸病源候论·妇人杂病》中说：“张仲景云：妇人经水过多，亡失津液者，也会导致大便难。”恐怕是错误地引用了本条内容。
产妇出现郁冒，脉象微弱。（“大便坚，呕不能食”七字，《脉经》作“所以便坚者，呕不能食也”。）
先兄说：《明理论》云：郁，是指气机郁结而不舒展；冒，是指神志昏蒙而不清醒。世人所说的昏迷，就是这种情况。此条文中没有提到发热，但后文有提到更发热的语句，那么可知其中有热象。这显然是因为产褥期感受风邪所致。
按：此条文的行文法度，稍微接近倒装句法。“小柴胡汤主之”一句，本当在“但头汗出”之下。之所以将辨别郁冒的道理放在前面，所以在章节末尾补出了这三句话。郁冒患者大汗出，正是小柴胡汤相适宜的效果，也如同少阳病战汗而解的情况一样。并且用“血虚下厥”三句，来解释头汗出的道理；用“所以产妇喜汗出者”四句，来解释前条亡血后又出汗的道理。这就是血虚邪气客留的证候，“阴阳乃复”一句，与“郁冒欲解，必大汗出”相应。
大概喜欢汗出、头汗、大汗，这三种证候不同，应当分别看待。
又按：“大便反坚”中的“反”字，是针对“呕不能食”而言的。盖因“呕不能食”是少阳证，大便本来不至于坚硬。如今产后津液干燥，所以大便反而坚硬。《本事方》说：人平时没有痛苦疾病，忽然像死人一样，身体不动摇，沉默不知人事，眼睛闭合不能睁开，口噤不能说话。或者稍微知道人事，厌恶听到人声，只是感到眩晕昏冒，过一段时间才苏醒。这是由于已经出汗过多，血少气并归于血，阳气独上而不能下行，气机壅塞而不运行，所以身体像死了一样。气经过后血液回流，阴阳重新通畅，所以过一段时间才苏醒。名叫郁冒，也叫血厥。妇女中多有此病。宜用白薇汤、仓公散。白薇汤：白薇、当归各一两，人参半两，甘草一分（炙），水煎服。仓公散：瓜蒂、藜芦、雄黄、矾石，等分。少许吹入鼻中。（按：这两个方子，并不适合本条证的病情，姑且附记于此。）
又说：妇人产后，有三种疾。郁冒则多汗，多汗则大便秘结，所以难以用药。唯有麻子苏子粥，最佳且稳妥。（按：郁冒患者汗出后正气恢复，之后只有肠道干燥便秘者，此粥为佳。首条所谓的大便难，或许也适用。）
病解能食，七八日后又发热的，
按：此条证候，徐灵胎、朱丹溪认为是食复（因饮食不当导致的复发），魏荔彤、周学海的意思也是如此。盖沈金鳌与这些医家，都是基于“能食”这一点立论。但尤在泾说：病解能食，是指郁冒解除，而能够接受食物了。到了七八日又发热，这说明病不在表而在里，不属于虚证而属于实证了。这宜用大承气汤来攻下里实。这个意思稍有不同，存疑供考证。
产后腹中疼痛（注：原文此处似缺具体病名或症状描述，结合上下文及方剂推测为血虚寒凝或瘀血阻滞之腹痛），
《千金方》：治疗产后虚弱羸瘦、气喘乏力、自汗出、腹中绞痛。羊肉汤方。
在本方基础上，加桂心、芍药、甘草、川芎、干地黄。（《圣惠方》：羊肉地黄汤，再加人参。）
《外台秘要》：许仁则方。产后没有其他症状，只感觉虚弱，想要补气力，兼有腹痛。宜用羊肉当归汤方。
在本方（当归五两，生姜六两）基础上，加黄芪四两。如果感觉恶露排不尽，加桂心三两。恶露排出过多，感觉有风邪，加川芎三两。感觉有气滞，加细辛二两。感觉有寒冷，加吴茱萸一两。感觉有热，加生地黄汁二合。
《圣济总录》：治疗产后血气不利，心腹急痛，上下攻冲，气逆烦闷。黄芪汤方。
在本方基础上，加黄芪、白术、甘草、人参。
下瘀血汤方
〔赵〕认为与抵当汤同类，但药力较缓和罢了。
按：此方，还是抵当丸、大陷胸丸的体例，应该说叫“下瘀血丸”。现在写作“汤”字，大概是传抄的错误。方后的“煎”字，也宜作“煮”字，才符合古义。
产后七八日，无太阳证。（《脉经》：更无切脉二字，再倍下，有其人二字，不食，作不能食。）
按：此条，李时珍的注解非常允当。且根据“无太阳证”一句考察，那么可知有里证，可以推断出来。大概是产后感受邪气，邪气下陷，与血相搏结。既有热象，又有少腹坚硬疼痛。与产后得胃家实（阳明腑实证）的证候相似，容易混淆，所以对待进行辨析。另外，“膀胱”在这里犹如下焦，不需要深究。产后中风，发热，面色正红。
〔徐〕中风发热头痛，是表邪。然而面色正红，这不是普通的淡红，所谓的“面若妆朱”，是真阳上浮的表现。加上喘息，气高不下。明显是产后极度虚弱，元气不能自我固摄，而又夹杂表邪。自然应该攻补兼施。
产后下利（腹泻/痢疾），极度虚弱。
〔徐〕凡是治疗痢疾的人，湿热非苦寒药不能清除，所以聚集四味苦寒药不算过分。如果要和血安中，只用一味甘草及阿胶就足够了。治疗痢疾喜欢用人参、白术的，正是因为没有通晓这个道理。
按：“虚极”，犹言疲惫不堪。轩村宁熙说：此证原本就是热利，所以虽然至虚极，仍然使用白头翁汤。其中加入甘草、阿胶的，不仅仅是补血益气，兼有缓中调肠的作用。陶氏说：甘草，通经解毒。东垣说：热药得到它则减缓其热性，寒药得到它则减缓其寒性。甄氏说：阿胶止痢。杨仁齐说：痢疾多因伤暑伏热而成，阿胶是大肠的要药，有热气留滞者，则能疏导；无留滞者，则能平安。根据这些说法，增加药物的意图就可以知道了。虚闭并用阿胶，就是这个意思。这种说法精确。
One Treatise, Six Syndromes (Note: Actually five), Eight Formulas.
Question: There are three diseases in women who have recently given birth.
Note: The syndrome and treatment of postpartum convulsion (a condition characterized by stiffness of the neck and back, opisthotonos, caused by deficiency of fluids and blood failing to nourish the sinews or external wind pathogen) are no different from those described in the preceding classics, so it is not discussed separately here. Yu Mao (a condition of dizziness and clouded consciousness resembling being covered by a hat, caused by loss of blood and fluids combined with cold pathogen leading to qi and blood rebellion) is elaborated in the next clause. However, regarding constipation (difficulty in defecation due to fluid depletion postpartum), no formula is provided. Nevertheless, moistening and purgative methods such as Pi Yue Wan are not employed.
Furthermore, according to "General Discussion on Miscellaneous Diseases in Women" in Chao Yuanfang's *Zhu Bing Yuan Hou Lun*: "Zhang Zhongjing said: If a woman has excessive menstrual flow and loses body fluids, she will also suffer from constipation." This is likely an erroneous citation of this clause.
Postpartum Yu Mao presents with a faint pulse. ("Constipation, vomiting, and inability to eat," seven characters, appear in *Mai Jing* as "The reason for constipation is vomiting and inability to eat.")
My elder brother stated: *Ming Li Lun* says: "Yu" refers to stagnation where qi does not circulate freely; "Mao" refers to mental confusion and lack of clarity. What the world calls coma is exactly this. This clause does not mention fever, but subsequent clauses mention further fever, implying the presence of heat. Thus, it is clearly due to catching wind during the puerperal period.
Note: The syntax of this clause is slightly inverted. "Xiao Chai Hu Tang governs it" should originally follow "only sweating on the head." Because the principle of distinguishing Yu Mao is presented first, these three sentences are added at the end of the chapter. Profuse sweating in patients with Yu Mao is the effect appropriate for Xiao Chai Hu Tang, similar to the shaking sweat resolution in Shaoyang disease. Furthermore, the phrase "blood deficiency leading to lower reversal" explains the mechanism of head sweating; the four sentences "Therefore, postpartum women welcome sweating" explain the mechanism of losing blood followed by sweating in the previous clause. This is the manifestation of blood deficiency with pathogenic retention. The phrase "yin and yang then recover" corresponds to "when Yu Mao is about to resolve, there must be profuse sweating."
Generally, welcoming sweating, head sweating, and profuse sweating are three different syndromes and should be viewed separately.
Furthermore, the character "fan" (reversely/unexpectedly) in "constipation reversely becomes hard" contrasts with "vomiting and inability to eat." Since "vomiting and inability to eat" is a Shaoyang syndrome, the stool would not normally be hard. Now, due to dryness of fluids postpartum, the stool becomes unexpectedly hard. *Ben Shi Fang* states: When a person is healthy without illness, suddenly they seem like a corpse, motionless, silent and unaware, eyes closed unable to open, mouth clenched unable to speak. Or slightly aware, hating human voices, only feeling dizzy and confused, waking up after some time. This is because too much sweat has already been lost, blood is scant, qi merges with blood, yang floats alone upward without descending, qi becomes obstructed and fails to circulate, so the body seems dead. After qi passes and blood returns, yin and yang reconnect, so they wake up after some time. It is named Yu Mao, also called Blood Jue (syncope). It is common in women. Bai Wei Tang and Cang Gong San are suitable. Bai Wei Tang: Bai Wei (Anemarrhenae Rhizoma), Dang Gui (Angelicae Sinensis Radix) each 1 liang, Ren Shen (Ginseng Radix) 0.5 liang, Gan Cao (Licorice Radix et Rhizoma) 1 fen (roasted), decocted in water and taken orally. Cang Gong San: Gua Di (Thlapsidis Fructus), Li Lu (Veratri Radix), Xiong Huang (Realgar), Fan Shi (Alumen), equal parts. A small amount insufflated into the nose. (Note: These two formulas are not suitable for the syndrome in this clause, recorded here tentatively.)
It is also said: Women postpartum have three types of ailments. Yu Mao leads to profuse sweating, which leads to severe constipation, making medication difficult. Only Mazi Suzi Zhou (Hemp Seed and Perilla Seed Porridge) is best and safest. (Note: For patients whose Yu Mao resolves with sweating, leaving only intestinal dryness and constipation, this porridge is excellent. The constipation mentioned in the first clause may also be suitable for it.)
After the illness resolves and appetite returns, if fever recurs after seven or eight days,
Note: Regarding this syndrome, Xu Lingtai and Zhu Danxi consider it a recurrence due to diet (Shi Fu). Wei Litong and Zhou Xuehai share this view. Shen Jin'ao and these physicians base their theories on the ability to eat. However, You Zaijing states: "Illness resolves and ability to eat" means Yu Mao has resolved and food can be tolerated. The fever recurring after seven or eight days indicates the pathology is interior rather than exterior, and excess rather than deficiency. Da Cheng Qi Tang should be used to purge interior excess. This interpretation differs slightly and is preserved for study.
Postpartum abdominal pain,
*Qian Jin Fang*: Treats postpartum emaciation, panting and fatigue, spontaneous sweating, and colicky abdominal pain. Mutton Soup Formula.
To this formula, add Gui Xin (Cinnamomi Ramulus), Shao Yao (Paeoniae Radix Alba), Gan Cao (Licorice Radix et Rhizoma), Xiong Diao (Chuanxiong Rhizoma), and Di Huang (Rehmanniae Radix). (*Sheng Hui Fang*: Mutton and Rehmannia Decoction, plus Ren Shen.)
*Wai Tai Mi Yao*, Xu Renze formula: Postpartum, with no other symptoms, only feeling weak, desiring to tonify qi and strength, accompanied by abdominal pain. Mutton and Angelica Soup Formula is suitable.
To this formula (Dang Gui 5 liang, Sheng Jiang 6 liang), add Huang Qi (Astragali Radix) 4 liang. If lochia is not fully discharged, add Gui Xin 3 liang. If lochia discharge is excessive and wind sensation is felt, add Xiong Diao 3 liang. If qi stagnation is felt, add Xi Xin (Asari Radix et Rhizoma) 2 liang. If cold is felt, add Wu Zhu Yu (Evodiae Fructus) 1 liang. If heat is felt, add Sheng Di Huang (Rehmanniae Radix Recens Juice) 2 he.
*Sheng Ji Zong Lu*: Treats postpartum unfavorable flow of blood and qi, acute heart and abdominal pain, attacking sensations moving up and down, rebellious qi causing vexation and oppression. Huang Qi Tang Formula.
To this formula, add Huang Qi, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao, and Ren Shen.
Xia Yu Xue Tang Formula
[Zhao] considers it similar to Di Dang Tang, but milder in action.
Note: This formula follows the pattern of Di Dang Wan and Da Xian Xiong Wan. It should be called "Xia Yu Xue Wan." The current use of "Tang" is likely a transcription error. The word "jian" (decoct) after the formula should also be "zhu" (boil/cook) to conform to ancient meaning.
Seven or eight days postpartum, without Taiyang syndrome. (*Mai Jing*: omits "taking pulse," repeats "there is this person" twice later, changes "bu shi" to "bu neng shi".)
Note: Li Shizhen's annotation is very appropriate. Examining the phrase "without Taiyang syndrome," one can infer the presence of interior syndrome. It is likely that after childbirth, a pathogen entered and sank downward, clashing with blood. There are heat manifestations and hardness/pain in the lower abdomen. This resembles the syndrome of postpartum Wei Jia Shi (Yangming Interior Excess) and is easily confused, hence the need for differential diagnosis. Additionally, "Bladder" here refers to the Lower Jiao, requiring no deep analysis. Postpartum Wind Strike, fever, face bright red.
[Xu] Wind strike with fever and headache is an exterior pathogen. However, a bright red face is not a mild pinkness; it is described as "face painted with vermilion," indicating floating True Yang. Combined with wheezing and high-pitched breathing, it clearly indicates extreme postpartum deficiency where Yuan Qi cannot consolidate itself, compounded by an exterior pathogen. Tonification and purging should be applied simultaneously.
Postpartum dysentery/diarrhea with extreme debility.
[Xu] In treating dysentery, damp-heat cannot be cleared without bitter-cold herbs, so gathering four bitter-cold ingredients is not excessive. To harmonize blood and calm the middle, using just Gan Cao and E Jiao is sufficient. Physicians who prefer using Ren Shen and Bai Zhu for dysentery simply do not understand this principle.
Note: "Extreme debility" implies exhaustion. Xuancun Ningxi says: This syndrome originates from heat dysentery, so even with extreme debility, Bai Tou Weng Tang is still used. The addition of Gan Cao and E Jiao serves not only to tonify blood and qi but also to moderate the middle and regulate the intestines. Tao Shi says: Gan Cao unblocks meridians and detoxifies. Dongyuan says: Bitter-cold herbs become milder with it; hot herbs become less heating with it. Zhen Shi says: E Jiao stops dysentery. Yang Renqi says: Dysentery often results from summerheat and latent heat; E Jiao is a key herb for the Large Intestine. If heat qi is stagnant, it can guide it out; if not stagnant, it maintains peace. Based on these statements, the intent of adding these herbs is clear. Using E Jiao for both deficiency and obstruction aligns with this logic. This explanation is precise.