产后阴血骤下，阳无所附，孤阳外越，每多发热。此乃阴虚生热，切勿作外感而表散。
生化汤善能退热，以其内有姜、草，所谓甘温能除大热也。故产后虽有表证，一切风药性升
不可用，恐载血上行，令人发晕，且虑重竭其阳，必至汗脱而死。即佛手散中川芎辛散能发
汗走泄，亦须临时因证审酌用之。产后阴血既亏，津液自少，况临产劳倦气虚，虚则传化自
迟，二肠枯臊，势所必然，久则自复。或用生化汤养血兼生津助液亦可。故产后虽二便暂有
不甚通利，然于下利等药必须禁用。非特硝、黄、五苓难于轻试，即四物汤中生地、芍药纯
阴而伐生气，且作泻而凝血，五苓利水伤阴，愈通之而愈枯结。若误用而重亡其阴，难免孤
阳无辅而走脱矣。故《机要》有云∶胎产之病从厥阴，无犯胃气及上、下二焦，不可汗、不
可下、不可利小便也！
凡治产后，三审不可缺也，一审少腹痛与不痛，以征恶露之有无；二审大便通与不通，
以征津液之盛衰；三审乳汁行与不行及饮食多少，以征胃气之充馁。审斯三者，以脉参证，
以证合脉，脉证相符，有疾治之即愈。脉证相反，纵无危候，必多变端。即如产后恶露，常
以弥月为期。然间有六七朝即净者，又未可以概论也。此虽产母禀质不同，而因胎之所禀亦
异，如胎息壮盛，则气血尽归其子，瘀血自少；胎息孱弱，则气血涵养有余，瘀血必多。亦
有产时去多，产后必少，产时去少，产后必多，势使然也。大抵常产之妇，开阖有权，产后
子宫即闭，儿枕随气攻注，碎作小块续续而下，所以绵延日期。又有由于艰产过伤子宫，关
闸废弛，不能收敛。或下血块，大小形色与茄无异，此名儿枕是也，全块顿出，自无淋沥之
患。即有余血，尽归溲便，如皂荚汁，少腹略无痛苦，切勿认为产后瘀尚未行，妄用攻下，
误人性命。产后又有似乎儿枕痛者，摸之亦有块，按之亦微拒手，人皆指为儿枕宿血，此大
不然。夫胎胞俱去，血亦岂能独留！盖子宫蓄子既久，忽尔相离，血海陡虚，所以作痛；胞
门受伤，必致壅肿，所以亦若有块而实非正块；肿既未消，所以亦颇拒按。治此者当安养其
脏，不久自愈。若有瘀服药，生化汤为最，殿胞煎或四神散亦可。若误用苏木、红花、元胡
、青皮之属，反损脏气，必增虚病，慎之慎之。予曾见孕妇产后，少腹旁边以手按之，内有
一条形如小黄瓜，斜长而硬，颇以瘀积，然无痛苦，产妇先以为瘀滞，后以为症瘕，每愁成
病，予开导之云∶无痛苦，不拒按，是虚非实，血足自消，不须疑虑，迟数月果渐消没矣。
五分，水一钟，煎八分，热服，如脉细而寒或呕者，加干姜炒黄色一钱。如血热多火者，去
肉桂，加酒炒芍药一钱。如脉弱阴虚者，加熟地三钱。如气滞者，加制香附一钱。腰痛，加
盐水炒断丝杜仲一二钱。
产后阴血突然大量流失，阳气失去依附，导致孤阳向外浮越，因此常常出现发热的症状。这是阴虚产生的内热，千万不要当作外感病邪而使用解表发散的方法治疗。
生化汤善于退热，因为方中含有生姜、甘草，这就是所谓的“甘温能除大热”的道理。所以，即使产后有表证（如恶寒发热等），一切性质升散的风药都不可使用，恐怕会带动血液上行，使人头晕目眩，并且担心进一步耗竭阳气，必然会导致汗出不止而死亡。即使是佛手散中的川芎，因其辛散之性能发汗走泄，也必须根据当时的具体情况审慎斟酌后使用。产后阴血已经亏损，津液自然减少，况且分娩时劳累疲倦导致气虚，气虚则脏腑传化功能自然迟缓，大肠和小肠干燥涩滞，这是势所必然的，时间久了自然会恢复。或者使用生化汤养血兼以生津助液也可以。所以，虽然产后二便暂时有些不畅通利，但是像泻下通便的药物必须禁用。不仅仅是芒硝、大黄、五苓散这些药物难以轻易尝试，就连四物汤中的生地黄、白芍药也是纯阴之品，会损伤生机，且容易导致腹泻并凝固血液；五苓散利水会伤阴，越是通利反而越会使体内枯结。如果误用这些药物导致阴液再次亡失，难免会出现孤阳没有辅佐而脱散的危象。所以《兰室秘藏·机要》中说：胎产方面的疾病多与厥阴经有关，不要损伤胃气以及上、下二焦的功能，不可发汗，不可泻下，不可利小便！
凡是治疗产后病，三审诊法是不可缺少的。一审少腹部疼痛还是不痛，以此来推断恶露（产后余血浊液）是否有无；二审大便通畅还是不通畅，以此来推断津液的盛衰情况；三审乳汁是否下行以及饮食量的多少，以此来推断胃气的充盈或虚弱。审查这三方面，再结合脉象参验证候，以证候合验脉象，如果脉证相符，有病治疗即可痊愈。如果脉证相反，即使没有危急征候，也必定会有很多变化。就像产后恶露，通常以一个月为期限。然而偶尔也有六七天内就干净的，这也不能一概而论。这虽然是因为产妇体质不同，而且因胎儿所禀受的气血也不同，比如胎儿气息壮盛，气血就会全部供给胎儿，瘀血自然就少；胎儿气息孱弱，气血涵养有余，瘀血必然就多。也有生产时出血多，产后必然出血少；生产时出血少，产后必然出血多的，这是形势使然。大致顺产的妇女，子宫开阖有度，产后子宫立即闭合，儿枕（产后子宫内残留的瘀血块）随着气机攻注，碎裂成小块陆续排出，所以持续时间较长。又有的是因为难产过度损伤了子宫，导致关闸松弛，不能收敛。或者排出大小颜色形状与茄子无异的血块，这就名叫儿枕，如果是整块一次性排出，自然就没有淋漓不尽的隐患。即使有余血，也都从小便排出，像皂荚汁一样，小腹部略微没有痛苦，千万不要认为是产后瘀血尚未排尽，妄用攻下药物，这会误人性命。产后又有似乎像儿枕痛的情况，摸上去也有硬块，按压时也有轻微抵抗感，人们都指认为是儿枕宿血，这非常不对。既然胎胞都已经排出，血液怎么可能单独留下呢？大概是因为子宫蓄养胎儿很久，忽然分离，血海骤然空虚，所以产生疼痛；胞门受伤，必然导致壅肿，所以看起来好像有块头但实际上不是真正的肿块；肿胀既然没有消退，所以按压时也很抗拒。治疗这种情况应当安养脏腑，不久自然痊愈。如果有瘀血需要服药，生化汤最好，殿胞煎或四神散也可以。如果误用苏木、红花、元胡、青皮这类药物，反而会损伤脏气，必定增加虚损病症，务必谨慎。我曾经见过一位孕妇产后，用手按少腹旁边，里面有一条形如小黄瓜的东西，斜长而坚硬，很多人以为是瘀积，但没有痛苦，产妇起初以为是瘀滞，后来以为是症瘕（腹内结块），常常愁苦于变成疾病，我开导她说：没有痛苦，也不抗拒按压，这是虚证而非实证，血充足自然会消散，不必疑虑，过了几个月果然逐渐消失不见了。
[此处原文似乎混入了具体方剂加减用法，虽未明确方名，但结合上下文及前文提到的生化汤加减逻辑，推测为生化汤的随证加减法] 取五分（此处单位存疑，通常为钱或克，依古制可能指分量极轻或笔误，暂译原文），加水一钟，煎至八分，热服。如果脉细且有寒象或呕吐的，加炒至黄色的干姜一钱。如果血热火旺的，去掉肉桂，加酒炒白芍药一钱。如果脉弱阴虚的，加熟地黄三钱。如果气滞的，加制香附一钱。腰痛者，加盐水炒杜仲一两到二钱。
After childbirth, Yin blood is suddenly and heavily lost, leaving Yang without attachment. The solitary Yang floats outward, often resulting in fever. This is heat generated by Yin deficiency; one must never treat it as an external contraction and use diaphoretic (sweating) methods to disperse the exterior.
Shenghua Tang (Decoction for Generating New Blood) is effective in reducing fever because it contains Ginger Rhizome (Shengjiang) and Licorice Root (Gancao), illustrating the principle that "sweet and warm substances can eliminate severe heat." Therefore, even if there are exterior symptoms after childbirth, all wind-dispelling herbs with ascending properties must not be used, as they may carry blood upward, causing dizziness, and more importantly, risk further exhausting Yang, which could lead to death from profuse sweating and collapse. Even Chuanxiong Rhizome (Chuanxiong) in Foshou San (Buddha's Hand Powder), due to its acrid and dispersing nature that induces sweating and leakage, must be used only after careful consideration of the specific condition at that moment. Since Yin blood is already deficient after childbirth, body fluids are naturally scant. Moreover, labor fatigue leads to Qi deficiency; when Qi is deficient, the transmission and transformation functions slow down, leading to dryness and astringency in the Large Intestine and Small Intestine, which is inevitable. It will recover naturally over time. Alternatively, Shenghua Tang can nourish blood while simultaneously generating fluids. Thus, although bowel movements and urination may be temporarily difficult after childbirth, purgative or draining herbs must be strictly prohibited. Not only are minerals like Mirabilite (Xiaoshi) and Rhubarb (Dahuang), along with Wuling San (Five-Ingredient Powder with Poria), difficult to trial lightly, but even Rehmannia Root (Shengdihuang) and Peony Root (Shaoyao) in Siwu Tang (Four Substance Decoction) are purely Yin in nature, damaging vital energy, promoting diarrhea, and coagulating blood. Wuling San promotes urination but injures Yin; the more one tries to drain, the more dryness and constipation result. If mistakenly used, causing further loss of Yin, the solitary Yang will lack support and escape, leading to collapse. Therefore, *Jiyao* (Essential Principles) states: Diseases related to pregnancy and childbirth originate from the Jueyin channel; do not violate Stomach Qi or the Upper and Lower Jiao; do not induce sweating, do not purge, and do not promote urination!
In treating postpartum conditions, the "Three Examinations" are indispensable. First examination: Check whether the lower abdomen hurts or not, to determine the presence or absence of lochia (postpartum discharge). Second examination: Check whether defecation is smooth or obstructed, to assess the abundance or depletion of body fluids. Third examination: Check whether lactation occurs and the amount of food intake, to evaluate whether Stomach Qi is robust or deficient. By examining these three aspects and correlating pulse findings with clinical signs—if the pulse and symptoms match, treatment will lead to recovery; if they contradict, even without critical signs, complications will likely arise. For instance, lochia typically lasts about a month. However, some women clear it within six or seven days, so this cannot be generalized. This variation depends on the mother's constitution and the fetal Qi received. If fetal Qi is vigorous, blood and Qi are fully directed to the fetus, resulting in less stasis; if fetal Qi is weak, there is excess nourishment, resulting in more stasis. Also, excessive bleeding during delivery leads to less postpartum bleeding, while minimal bleeding during delivery leads to more postpartum bleeding, which is a natural consequence. Generally, in normal deliveries, the uterus opens and closes appropriately. After birth, the uterus closes immediately, and the "child pillow" (retained blood clots) moves with Qi, breaking into small pieces and passing out gradually, prolonging the duration. In cases of difficult labor, the uterus may be overly injured, causing the closure mechanism to relax and fail to contract. Blood clots resembling eggplants in size, shape, and color may be expelled; this is called the "child pillow." If expelled entirely at once, there is no risk of prolonged dripping. Any remaining blood goes into urine and stool, resembling soap pod juice, with little to no lower abdominal pain. Do not mistake this for retained stasis and blindly use purgatives, as this can be fatal. Sometimes, postpartum pain resembles child pillow pain, with palpable masses and slight resistance to pressure. People often attribute this to residual blood in the child pillow, which is incorrect. Once the placenta and membranes are expelled, how can blood remain alone? The uterus has housed the fetus for a long time; upon separation, the Sea of Blood becomes suddenly empty, causing pain. The uterine opening is injured, leading to swelling, which feels like a mass but is not a true solid tumor. Since the swelling persists, it resists pressure. Treatment should focus on nurturing the organs, and it will heal soon. If stasis requires medication, Shenghua Tang is best; Dianbao Jian (Placenta Expulsion Decoction) or Sishen San (Four Divine Powder) are also acceptable. Mistakenly using drugs like Broom Crape Myrtle Tuber (Sumu), Safflower (Honghua), Corydalis Rhizome (Yanhusuo), or Green Tangerine Peel (Qingpi) will damage organ Qi and exacerbate deficiency. Be extremely cautious. I once saw a woman whose lower abdomen had a hard, cucumber-like structure when pressed. She feared it was stasis or a mass (*zhijia*), but since it was painless and non-tender, I explained it was deficiency, not excess, and would resolve as blood replenished. Months later, it indeed disappeared.
[Fractional dosage instructions follow, likely modifications for Shenghua Tang based on context]: Take [amount unspecified in text, literally '5 fen'], add one cup of water, decoct to eight parts, and take hot. If the pulse is fine and cold, or if vomiting occurs, add roasted Dried Ginger (Ganjiang) of yellow color, 1 qian. If blood heat and fire are prominent, remove Cinnamon Twig (Rougui) and add wine-fried White Peony Root (Baishaoyao), 1 qian. If the pulse is weak indicating Yin deficiency, add Prepared Rehmannia Root (Shudihuang), 3 qian. If there is Qi stagnation, add processed Cyperus Rhizome (Zhi Xiangfu), 1 qian. For lower back pain, add Salt-processed Eucommia Bark (Du Zhong), 1–2 qian.