产后必须先逐瘀，
正产体实无病，不药可也，但难产气衰，瘀血停留，非药不行。古法∶一产后，古芎归汤加童便一半服
之。如无童便，以淡醋磨墨一小盏，入前汤药亦好。服药后，且闭目少坐，然后上床仰卧，不得侧卧，宜立膝，
不可伸足，高枕浓褥，四壁无风，时以人为从心括至脐下，如此三日。又不可太睡熟，宜频唤醒，时置醋炭，
或烧干漆与旧漆器，以防血迷血晕。夏月房中不可太热，亦不可人多气盛，以致热过，则气耗散而不能送血。又
不可太饱，时与白粥饮之，日渐加与。一月之内，针线劳役，当时不觉大害，月后即成褥劳，手脚及腰腿酸痛；亦
不可脱衣洗浴，强起离床太早，以致外感身强，角弓反张，名曰褥风。如交合阴阳，令下部终身虚疾，将息百
日以过乃可。须知产后百病，皆血虚火盛，瘀血妄行而已矣。间有内伤饮食，外感风寒，然亦必先逐瘀补虚为
主。
瘀消然后堪补助∶
瘀消后方可行补，如左脉弱，加补血药；右脉弱，加补气药。如不逐瘀，遽服参、 甘炙停滞之剂，有
瘀血攻心即死者。食肉太早亦然。
瘀冲眩晕腹心疼，
去血过多，眼花头眩，昏闷烦躁，或见头汗者，古芎归汤入童便，甚者加炒干姜、人参；汗多加黄 ，
或八味黑神散、单五灵脂散、返魂丹。胃弱血虚发厥，仓公散、白薇汤。临产用力劳心，气虚而晕者，用人参
一两，苏木五钱，水煎入童便调服。气血俱虚，痰火泛上作晕者，八物汤合二陈汤去白芍。火载血上昏晕，或
挟风邪者，清魂散。被惊者，抱胆丸、朱砂安神丸。腹心疼痛，全是瘀血，八味黑神散、四味散、失笑散；有寒
热者，当归须散。虚寒心痛
者，桂心汤；感寒者，理中汤。七情心痛者，木槟汤。食滞寒热，心腹痛者，熟料五积散加莪术。小腹痛者，名
儿枕痛，单五灵脂散，或加桃仁醋糊为丸。气虚四君子汤下；血虚四物汤下。产门脐下虚痛者，大温经汤、
羊肉汤。通用女金丹、加味益母丸。
血虚火动寒热互。
产后血虚发热，气虚恶寒，气血俱虚，发热恶寒，切不可发表。阴虚血弱者，四物汤，小热加茯苓为君；
热甚加炒干姜为佐；去血过多，外热内烦，短气闷乱者，人参当归散。蒸乳发热者，四物汤加参、 、白术、
天花粉；发热昼静夜剧者，四物汤去芍药，量加柴胡；气血俱虚寒热者，补虚汤。产后真不宜凉也。
内伤劳役渐虚羸，
产后劳役过度，名曰蓐劳。其证虚羸，乍起乍卧，饮食不消，时有咳嗽，头目昏痛，发渴盗汗，寒热如疟，
臂膊拘急。宜十全大补汤去芎，加续断、牛膝、鳖甲、桑寄生、桃仁为末；猪肾一对，去脂膜，姜一片，枣三
枚，水二盏煎至一盏，入前末二钱，葱三寸，乌梅半个，荆芥五穗，同水煎，空心服，身痛寒热者，当归羊肉
汤、腰子汤。
食滞脾家泻且吐；
凡寒热有腹痛者为瘀血，如腹痛胸满呕泻，必兼伤食。食肉太早瘀滞者，熟料五积散，痛甚加莪术，呕加
砂仁，泻加姜、附、人参。泄泻不止，脐腹痛者，理中丸加肉豆蔻。挟寒腹痛肠鸣，小便清白，不渴者，四君子
汤合五苓散，加肉豆蔻、炒白芍。挟热肠垢便涩，痛一阵泻一阵，口渴者，四君子汤合四苓散，加酒炒黄连及
木通少许，或益元散。挟湿身重腹胀者，胃苓汤。呕吐因败血乘虚入胃胀满者，六君子汤加泽兰叶、赤芍、干生
姜；腹胀胃气不和者，桔梗、半夏、陈皮等分，姜煎服；脾脉弦者，三白汤加干姜、陈皮、黄 、滑石、甘草；
饮食成积痞者，内炙散，睹 丸。霍乱吐泻，烦渴肢冷者，理中汤加陈皮，麦门冬，姜煎；厥冷者加附子；渴
者，五苓散；转筋者，木萸散。
外感寒热无时停，补中带表无过度。
产后外感，离床太早，或换衣袭风，冷入于下部，令人寒热似疟，头痛不歇。血虚者，古芎归汤加人参、
紫苏、干葛；血气虚者，补虚汤加陈皮、干姜；寒热甚者，熟料五积散；热不止者，黄龙汤主之。如体盛发热
恶寒及疟痢者，小柴胡汤合四君子、四物汤，加黄 ，名三分散，切不可以伤寒治法。曾误服热药过多，热
证大见，久而便闭者，柴胡破瘀汤，或四物汤加大黄、芒硝，暂服即补之。产后伤寒，详三卷。
身痛筋挛虚渴烦，
四产走动，气血升降失常，留滞关节，筋脉急引，或手足拘挛，遍身肢节走痛者，趁痛散；或余血不尽，流
于遍身，腰脚关节作痛者，五积散去麻黄，加人参、香附、小茴、桃仁、木香等分，姜煎服。产后诸风痿弱，
筋挛无力者，血风丸，或煎服。烦渴气虚者，生脉散；血虚者四物汤加天花粉、麦门冬；气血俱虚，作渴头
眩脚弱，饮食无味者，用人参二钱，麦门冬一钱半，熟地七分，天花粉三钱，甘草五分，糯米、姜，枣煎服。
虚烦者，用人参、麦门冬、小麦、茯苓各一钱，竹茹一弹丸，半夏八分、甘草五分，姜煎服。心虚惊悸者亦宜。
汗多大便偏闭固；
产后发热自汗者，古归 汤；汗甚加白术、防风、牡蛎、麦门冬、熟地、茯苓、甘草，或黄 建中汤。
自汗兼肿满者，大调经散；自汗肢体疼痛者，当归羊肉汤。发热盗汗者，用猪腰子一枚，糯米半合，葱白二茎，
煮米熟取清汁一盏，入人参、当归各一钱煎服。大便闭者，古芎归汤加防风、枳壳、甘草；闭涩者，麻子仁
丸，或苏麻粥。盖产后去血多则郁冒，郁冒则多汗，多汗则大便闭，皆血虚也。郁冒，即血晕。小便不通，腹
胀满者，用盐填脐中，葱白一束，切作一指浓放盐上，以艾炷灸之，热气入腹即通。热者，六一散加槟榔、枳
壳、木通，麻子仁、葵子，水煎服。
不语败血湿痰迷，
产后败血停蓄，上干于心，心气闭涩，舌强不能言语者，七珍散、四味散。有临产服汤药过多，胃湿使然
者，熟料五积散、六君子汤。痰热迷心不语者，导痰汤；或痰气郁滞，闭目不语者，用生白矾末一钱，熟水调
服。
乍见鬼神非邪忤。
产后乍见鬼神者，由血虚劳动肝心，败血攻冲，邪淫于心，胡言乱语，非风寒、非鬼祟也，宜小调经散
加龙脑少许，或妙香散加当归、地黄、黄连。瘀血迷心，妄言妄见，及心虚谵妄昏晕者，八物汤去芍药，加琥珀、
柏子仁、远志、朱砂、金银煎服；甚者，黑龙丹。产后血少，怔忡，睡卧不宁者，十味温胆汤，或宁神膏、定
志丸。
又有恶露常淋淋，或因脬损尤难住；
产后五淋，白茅汤∶败血淋沥不断者，乌余散；淋久不止，四肢乏力沉困者，牡蛎散。有生产时，被洗
母误损尿脬，以致日夜淋沥者，四君子汤加黄 、陈皮、桃仁，用猪尿脬煮清汁煎，温服；血虚者加芎、归。
任是褥风并肿浮，
产后中风，名曰褥风。口噤牙关紧急，手足螈 ，及血晕强直，筑心眼倒，吐泻欲死者，单荆芥散、古
荆归汤；血虚劳碌太早，风邪乘虚而入者，小续命汤、羌活愈风汤。如口噤反张，涎潮多者，交加散，或大黑豆
半升，炒令烟起，以酒二碗沃之，入瓷器内，每用酒半碗，入独活五钱同煎温服。产后汗多，风搏成 者，难治。
产后败血停蓄化水，循经流入，四肢浮肿者，小调经散；血气虚者，四君子加苍术，或女金丹；血虚者，补虚
汤少加苍术、茯苓，使水自利，忌峻剂攻利。
一切杂证补荣卫。
产后杂病与男子一同，但常兼补、兼逐瘀则病无不愈。丹溪云∶大补荣卫为主，虽有杂病，以末治之
是也。假如月里痢疾，恶露未尽者多瘀，凝滞肠胃，与经后血滞作痢一同，四物汤加桃仁、黄连、木香主之；
里急甚者，通玄二八丹。咳嗽多是瘀血入肺，古二母散加桃仁、杏仁，人参，茯苓水煎。其余以意会之可也。
惟有鼻衄黑如煤，
产后气血散乱，入于诸经不得还元，故口鼻黑起，乃变鼻衄，皆因产后虚热所致，胃绝肺败，犀角地黄汤
救之。
发喘声高难救护；
产后气喘，由荣血暴竭，气无所主，独聚于肺喘急，孤阳绝阴，不治之证，单人参汤，或加苏木少许救
之。若败血停滞胀肺喘者，用血竭、没药等分为末，酒入水调服，兼用夺命丹。
阴门肿突肠不收，
产后阴肉两旁肿痛，手足不能舒伸者，用四季葱入乳香末同捣成饼，安于阴户两旁，良久即愈。因产用
力过多，阴门突出者，四物汤加龙骨末少许，连进二服，外用蓖麻子捣烂贴顶，少收即去蓖麻。产后生肠不收，
八物汤加防风、升麻，须用酒炒黄 为君，外以荆芥、藿香、樗皮煎汤熏洗。
子宫脂膜休羞恶。
产后下一物，如合钵状，有二岐者，子宫也，补中益气汤去柴胡，连进二三大剂，一响而收，后以四物
汤加人参调理。产后下一物如帕，约重斤余者，因临产时劳役，或肝痿所致，有粘席不得上者，乃脂膜，无妨，
补中益气汤去柴胡，连进二帖即收。临产惊动，用力太过，以致育膜有伤，垂出肉线一条，约三四尺长，牵引
心腹痛不可忍，以手微动之则痛苦欲绝，先服失笑散数帖，仍用生姜三斤，洗净捣烂，以清油二斤拌匀，炒令
油干焦为度；却用熟绢五尺折作数层，方令稳重妇人轻轻盛起肉线，使之屈曲作一团，纳在水平交道；却用绢袋兜
前油姜稍温，敷在肉在线熏之。觉姜冷，又用熨斗火熨热，常使有姜气，如姜气已过，又用新姜如此熏熨。一
日一夜其肉线已缩入一半，再
用前法，越两日肉线尽入，却再服失笑散、古芎归汤调理。不可使肉线断作两截，则不可治矣。
乳汁不通血气虚，气滞塞者戒郁怒；
产后气血虚弱，乳汁少者，用钟乳粉二钱，漏芦煎浓汤调服；或用猪悬蹄一只，通草五两煮汁食；或鲫鱼、
木通煮汁食亦好。气滞乳少者，漏芦散；气塞乳少者，涌泉散。无子食乳要消者，用麦芽二两，炒为末，四
物汤调服即止。凡乳母但觉小水短少，即是病生，便须服药调理脾胃肝肾，如不愈者，必气滞且逆也。盖妇人
凡事不得专行，多忧思忿怒，忧思过则气结而血亦结；忿怒过则气逆而血亦逆，甚则乳硬胁痛烦热。要之，
女病皆因气血郁结，所以古方多用香附、砂仁、木香、槟榔、青皮、枳壳者，行气故也。
怪疾乳长尺有余，先贤治法仍详具。
产后瘀血上攻，忽两乳伸长，细小如肠，直过小腹，痛不可忍，名曰乳悬，危证。用川芎、当归各一斤，
水煎浓汤，不时温服；再用二斤，逐旋烧烟，安在病患面前桌子下，令病患曲身低头，将口鼻及病乳常吸烟气；未
甚缩，再用一料，则瘀血消而乳头自复矣。若更不复旧，用蓖麻子捣烂贴顶上，片时收，即洗去。
产后治疗必须先祛除瘀血。
正常分娩、体质强壮且无其他疾病者，可以不服药；但难产导致气虚衰弱的，会有瘀血停留，必须用药治疗。古法规定：产后第一天，服用古芎归汤，并加入一半量的童便（儿童尿液）同服。如果没有童便，可以用淡醋磨墨一小杯，加入前面的汤药中一起服用也可以。服药后，闭目静坐片刻，然后上床仰卧，不能侧卧，双腿宜弯曲，不可伸直，枕头要高，褥子要厚，四周墙壁避免有风，时常让人从心口向下推至脐下，这样持续三天。又不可睡得太熟，应频繁唤醒，在室内放置醋炭，或者烧干漆和旧的漆器，以防血液迷乱导致血晕。夏季房中温度不可太高，也不可有太多人导致气息旺盛，致使热气过盛，从而耗散气机而不能推动血液运行。也不可吃得太饱，时常给予白粥饮用，逐渐增加分量。一个月内，若从事针线活或体力劳动，当时可能不觉得有大害，但一个月后会形成“褥劳”，出现手脚及腰腿酸痛；也不可脱衣洗澡，过早起床离开床铺，以致外感风寒导致身体僵硬、角弓反张，这叫做“褥风”。如果进行性生活，会导致下部终身虚弱疾病，调养一百天以后才可以恢复。须知产后各种疾病，都是由于血虚火旺、瘀血妄行造成的。间或有因饮食内伤、外感风寒的，但也必须先以祛除瘀血、补益虚损为主。
瘀血消除后才可进补：
瘀血消除后方可进行补益治疗，如左脉弱，加补血药；右脉弱，加补气药。如果不先祛除瘀血，就急于服用人参、甘草等甘温滋腻停滞的药物，会导致瘀血攻心而死亡。过早吃肉也是如此。
瘀血上冲引起眩晕、腹部心脏疼痛：
失血过多，导致眼花头晕、昏闷烦躁，或者头部出汗的，用古芎归汤加入童便，严重的加炒干姜、人参；汗多者加黄芪，或者使用八味黑神散、单五灵脂散、返魂丹。胃弱血虚导致厥逆的，用仓公散、白薇汤。临产时用力劳心，气虚而晕倒的，用人参一两，苏木五钱，水煎后加入童便调服。气血都虚，痰火上泛导致眩晕的，用八物汤合二陈汤去掉白芍。火热载血上行导致昏晕，或者夹杂风邪的，用清魂散。受惊吓的，用抱胆丸、朱砂安神丸。腹部心脏疼痛，全是瘀血所致，用八味黑神散、四味散、失笑散；伴有寒热的，用当归须散。虚寒性心痛的，用桂心汤；受寒邪侵袭的，用理中汤。七情（喜怒忧思悲恐惊）导致心痛的，用木槟汤。饮食停滞兼有寒热，心腹疼痛的，用熟料五积散加莪术。小腹痛的，名叫儿枕痛，用单五灵脂散，或者加桃仁醋糊做成丸剂。气虚的用四君子汤送服；血虚的用四物汤送服。产门及脐下虚痛的，用大温经汤、羊肉汤。通用的药物有女金丹、加味益母丸。
血虚火动导致寒热交替：
产后血虚发热，气虚恶寒，气血俱虚则发热恶寒并存，切不可使用发汗解表法。阴虚血弱的，用四物汤，轻微发热加茯苓为君药；热甚加炒干姜为佐药；失血过多，外热内烦，短气闷乱的，用人参当归散。蒸乳（乳汁分泌伴随）发热者，用四物汤加人参、黄芪、白术、天花粉；发热白天轻晚上重的，用四物汤去掉芍药，酌情加柴胡；气血俱虚导致寒热往来的，用补虚汤。产后真的不宜使用凉药。
内伤劳役导致逐渐虚弱消瘦：
产后劳役过度，名叫蓐劳。症状是身体虚弱消瘦，时而起身时而躺卧，饮食不消化，时常咳嗽，头目昏痛，口渴盗汗，寒热像疟疾一样，手臂拘急。宜用十全大补汤去掉川芎，加续断、牛膝、鳖甲、桑寄生、桃仁研成末；取猪肾一对，去掉脂膜，一片姜，三枚枣，两盏水煎至一盏，加入前面药末二钱，葱三寸，半个乌梅，五穗荆芥，同水煎，空腹服用。身体疼痛寒热的，用当归羊肉汤、腰子汤。
饮食停滞脾家导致腹泻呕吐：
凡是寒热伴有腹痛的是瘀血，如果腹痛胸满呕吐腹泻，必定兼有伤食。吃肉太早导致瘀滞的，用熟料五积散，痛甚加莪术，呕吐加砂仁，腹泻加姜、附子、人参。泄泻不止，脐腹痛的，用理中丸加肉豆蔻。夹杂寒邪腹痛肠鸣，小便清白，不口渴的，用四君子汤合五苓散，加肉豆蔻、炒白芍。夹杂热邪肠垢便涩，痛一阵泻一阵，口渴的，用四君子汤合四苓散，加酒炒黄连及少许木通，或者益元散。夹杂湿邪身体沉重腹胀的，用胃苓汤。呕吐因败血乘虚进入胃部导致胀满的，用六君子汤加泽兰叶、赤芍、干生姜；腹胀胃气不和的，用桔梗、半夏、陈皮等分，姜煎服；脾脉弦的，用三白汤加干姜、陈皮、黄芪、滑石、甘草；饮食积滞成痞块的，用内炙散、睹 丸。霍乱吐泻，烦渴四肢冷的，用理中汤加陈皮、麦门冬，姜煎服；四肢厥冷的加附子；口渴的，用五苓散；转筋的，用木萸散。
外感寒热无时停止，补益中带解表不可过度：
产后外感，因离床太早，或者换衣服受风，寒气侵入下部，令人寒热像疟疾，头痛不停。血虚的，用古芎归汤加人参、紫苏、干葛；血气虚的，用补虚汤加陈皮、干姜；寒热严重的，用熟料五积散；热不止的，用黄龙汤主治。如果体质壮实发热恶寒及患疟痢的，用小柴胡汤合四君子、四物汤，加黄芪，名叫三分散，切记不可以按伤寒法治。曾误服热药过多，热证明显，久而便秘的，用柴胡破瘀汤，或者四物汤加大黄、芒硝，暂时服用后即予补益。产后伤寒，详见第三卷。
身体疼痛筋挛虚渴心烦：
多次生产走动，气血升降失常，留滞关节，筋脉紧急牵引，或者手足拘挛，遍身肢节游走疼痛的，趁痛散；或者余血未尽，流窜遍身，腰脚关节作痛的，用五积散去麻黄，加人参、香附、小茴、桃仁、木香等分，姜煎服。产后诸风痿弱，筋挛无力的，用血风丸，或者煎服。烦渴气虚的，用生脉散；血虚的用四物汤加天花粉、麦门冬；气血俱虚，口渴头晕脚弱，饮食无味的，用人参二钱，麦门冬一钱半，熟地七分，天花粉三钱，甘草五分，糯米、姜、枣煎服。虚烦的，用人参、麦门冬、小麦、茯苓各一钱，竹茹一弹丸大小，半夏八分、甘草五分，姜煎服。心虚惊悸者也适宜。
汗多大便偏于闭塞固结：
产后发热自汗的，用古归 汤；汗甚加白术、防风、牡蛎、麦门冬、熟地、茯苓、甘草，或者黄芪建中汤。自汗兼肿满的，用大调经散；自汗肢体疼痛的，用当归羊肉汤。发热盗汗的，用猪腰子一枚，糯米半合，葱白二茎，煮米熟取清汁一盏，加入人参、当归各一钱煎服。大便闭结的，用古芎归汤加防风、枳壳、甘草；闭涩的，用麻子仁丸，或者苏麻粥。大概产后去血多则郁冒，郁冒则多汗，多汗则大便闭，都是血虚所致。郁冒，就是血晕。小便不通，腹胀满的，用盐填满脐中，一束葱白，切成一指厚放在盐上，用艾炷灸之，热气入腹即通。热证的，用六一散加槟榔、枳壳、木通、麻子仁、葵子，水煎服。
不语因败血湿痰迷蒙心窍：
产后败血停蓄，上犯于心，心气闭涩，舌强不能言语的，用七珍散、四味散。有临产时服汤药过多，胃湿导致的，用熟料五积散、六君子汤。痰热迷心不语的，用导痰汤；或者痰气郁滞，闭目不语的，用生白矾末一钱，熟水调服。
乍见鬼神并非邪气忤逆：
产后乍见鬼神的，是由于血虚劳动肝心，败血攻冲，邪淫于心，胡言乱语，不是风寒、也不是鬼祟所致，宜用小调经散加龙脑少许，或者妙香散加当归、地黄、黄连。瘀血迷心，妄言妄见，以及心虚谵妄昏晕的，用八物汤去掉芍药，加琥珀、柏子仁、远志、朱砂、金银煎服；严重的，用黑龙丹。产后血少，怔忡，睡卧不宁的，用十味温胆汤，或者宁神膏、定志丸。
又有恶露常淋沥不断，或因膀胱损伤尤其难止住：
产后五淋，用白茅汤；败血淋沥不断的，用乌余散；淋久不止，四肢乏力沉困的，用牡蛎散。有生产时，被接生婆误损尿脬，以致日夜淋沥的，用四君子汤加黄芪、陈皮、桃仁，用猪尿脬煮清汁煎，温服；血虚的加川芎、当归。
无论是褥风还是浮肿：
产后中风，名叫褥风。口噤牙关紧急，手足抽搐，以及血晕强直，瞪眼倒地，吐泻欲死的，用单荆芥散、古荆归汤；血虚劳碌太早，风邪乘虚而入的，用小续命汤、羌活愈风汤。如果口噤反张，涎潮多的，用交加散，或者大黑豆半升，炒令烟起，用酒二碗浇在上面，放入瓷器内，每次用酒半碗，加独活五钱同煎温服。产后汗多，风搏结成瘛疭的，难治。产后败血停蓄化水，循经流入，四肢浮肿的，用小调经散；血气虚的，用四君子加苍术，或者女金丹；血虚的，用补虚汤少加苍术、茯苓，使水自行利出，忌用峻猛攻利之剂。
一切杂证以补益荣卫为主：
产后杂病与男子相同，但常兼补益、兼祛除瘀血则病无不愈。丹溪说：以大补荣卫为主，虽有杂病，作为次要治疗即可。假如一个月内患痢疾，恶露未尽的多有瘀血，凝滞肠胃，与经后血滞作痢相同，用四物汤加桃仁、黄连、木香主治；里急后重严重的，用通玄二八丹。咳嗽多是瘀血入肺，用古二母散加桃仁、杏仁，人参，茯苓水煎。其余的可以意会推断。
惟有鼻衄血色黑如煤：
产后气血散乱，进入诸经不得还元，故口鼻黑起，乃变为鼻衄，皆因产后虚热所致，胃绝肺败，用犀角地黄汤救之。
发喘声高难以救护：
产后气喘，由荣血暴竭，气无所主，独聚于肺喘急，孤阳绝阴，是不治之证，单人参汤，或者加少许苏木救之。若败血停滞胀肺喘的，用血竭、没药等分为末，酒入水调服，兼用夺命丹。
阴门肿突肠不收：
产后阴肉两旁肿痛，手足不能舒伸的，用四季葱入乳香末同捣成饼，安于阴户两旁，良久即愈。因产用力过多，阴门突出的，用四物汤加龙骨末少许，连进二服，外用蓖麻子捣烂贴顶，稍收即去蓖麻。产后生肠不收，用八物汤加防风、升麻，须用酒炒黄芪为君药，外以荆芥、藿香、樗皮煎汤熏洗。
子宫脂膜休要羞恶：
产后下一物，如合钵状，有二岐的，是子宫，用补中益气汤去掉柴胡，连进二三大剂，一响而收，后用四物汤加人参调理。产后下一物如帕，约重斤余的，因临产时劳役，或者肝痿所致，有粘席不得上的，乃是脂膜，无妨，用补中益气汤去掉柴胡，连进二帖即收。临产惊动，用力太过，以致育膜有伤，垂出肉线一条，约三四尺长，牵引心腹痛不可忍，以手微动之则痛苦欲绝，先服失笑散数帖，仍用生姜三斤，洗净捣烂，以清油二斤拌匀，炒令油干焦为度；却用熟绢五尺折作数层，方令稳重妇人轻轻盛起肉线，使之屈曲作一团，纳在水平交道；却用绢袋兜前油姜稍温，敷在肉在线熏之。觉姜冷，又用熨斗火熨热，常使有姜气，如姜气已过，又用新姜如此熏熨。一日一夜其肉线已缩入一半，再用前法，越两日肉线尽入，却再服失笑散、古芎归汤调理。不可使肉线断作两截，则不可治矣。
乳汁不通因血气虚，气滞塞者戒郁怒：
产后气血虚弱，乳汁少的，用钟乳粉二钱，漏芦煎浓汤调服；或者用猪悬蹄一只，通草五两煮汁食；或者鲫鱼、木通煮汁食也好。气滞乳少的，用漏芦散；气塞乳少的，用涌泉散。无子食乳要消的，用麦芽二两，炒为末，四物汤调服即止。凡乳母但觉小水短少，即是病生，便须服药调理脾胃肝肾，如不愈者，必气滞且逆也。盖妇人凡事不得专行，多忧思忿怒，忧思过则气结而血亦结；忿怒过则气逆而血亦逆，甚则乳硬胁痛烦热。要之，女病皆因气血郁结，所以古方多用香附、砂仁、木香、槟榔、青皮、枳壳者，行气故也。
怪疾乳长尺有余，先贤治法仍详具：
产后瘀血上攻，忽两乳伸长，细小如肠，直过小腹，痛不可忍，名叫乳悬，危证。用川芎、当归各一斤，水煎浓汤，不时温服；再用二斤，逐旋烧烟，安在病患面前桌子下，令病患曲身低头，将口鼻及病乳常吸烟气；未甚缩，再用一料，则瘀血消而乳头自复矣。若更不复旧，用蓖麻子捣烂贴顶上，片时收，即洗去。
Postpartum treatment must first eliminate blood stasis.
For normal delivery with a strong constitution and no other diseases, medication is not necessary; however, in difficult labor leading to Qi deficiency, blood stasis remains and medication is required. Ancient method: On the first day postpartum, administer Gu Xiong Gui Tang (Ancient Angelica and Ligusticum Decoction) mixed with half volume of Tong Bian (child's urine). If child's urine is unavailable, grind a small cup of ink with light vinegar and add it to the aforementioned decoction. After taking the medicine, sit quietly with eyes closed for a moment, then lie supine on the bed; side-lying is prohibited. Legs should be flexed, not extended. Use a high pillow and thick bedding, keep drafts away from walls, and frequently push manually from the heart region down to below the umbilicus. Continue this for three days. Do not sleep too deeply; wake frequently. Place charcoal soaked in vinegar or burn dried lacquer and old lacquerware in the room to prevent blood confusion and syncope due to blood stasis. In summer, the room temperature should not be too high, nor should there be too many people causing excessive heat, which dissipates Qi and hinders blood propulsion. Avoid overeating; provide white rice gruel occasionally, increasing the amount gradually. Within one month, engaging in needlework or physical labor may not cause immediate harm but will lead to "Ru Lao" (postpartum exhaustion) after a month, characterized by soreness and pain in limbs and lower back. Avoid bathing without clothes or getting out of bed too early, as this invites external pathogens causing body stiffness and opisthotonos, known as "Ru Feng" (postpartum wind). Sexual intercourse should be avoided until after 100 days of recuperation, otherwise it causes lifelong weakness in the lower jiao. It must be understood that all postpartum diseases stem from Blood deficiency with hyperactive Fire and reckless movement of blood stasis. Occasionally, there are internal injuries from diet or external invasions of Wind-Cold, but the primary approach must still be eliminating stasis and tonifying deficiency.
Tonification can only proceed after stasis is eliminated:
Only after blood stasis is cleared can tonification begin. If the left pulse is weak, add Blood-tonifying herbs; if the right pulse is weak, add Qi-tonifying herbs. If stasis is not removed and Ginseng and Licorice (Gan Cao) are administered prematurely, their cloying nature may cause stasis to attack the Heart, leading to death. Eating meat too early has the same effect.
Stasis rushing upward causing dizziness and abdominal/cardiac pain:
Excessive blood loss leads to blurred vision, dizziness, faintness, irritability, or sweating on the head. Use Gu Xiong Gui Tang with Tong Bian; for severe cases, add Chao Gan Jiang (Fried Dried Ginger) and Ren Shen (Ginseng); for profuse sweating, add Huang Qi (Astragalus), or use Ba Wei Hei Shen San (Eight-Ingredient Black Divine Powder), Dan Wu Ling Zhi San (Single Five-Spirit Powder), or Fan Hun Dan (Soul-Returning Pill). For stomach weakness and Blood deficiency causing Jue (cold extremities/fainting), use Cang Gong San or Bai Wei Tang. For fainting due to exertion and mental strain during labor causing Qi deficiency, use Ren Shen (1 liang) and Su Mu (5 qian), decocted in water and taken with Tong Bian. For both Qi and Blood deficiency with Phlegm-Fire rising causing dizziness, use Ba Wu Tang combined with Er Chen Tang, removing Bai Shao. For dizziness caused by Fire carrying Blood upward, or complicated by Wind pathogen, use Qing Hun San. For shock-induced conditions, use Bao Dan Wan or Zhu Sha An Shen Wan. Abdominal cardiac pain is entirely due to blood stasis; use Ba Wei Hei Shen San, Si Wei San, or Shi Xiao San. If accompanied by chills and fever, use Dang Gui Xu San. For deficiency-cold cardiac pain, use Gui Xin Tang; for Cold invasion, use Li Zhong Tang. For emotional (Seven Emotions) cardiac pain, use Mu Bing Tang. For food stagnation with cold-heat complex causing heart/abdominal pain, use Shu Liao Wu Ji San plus E Zhu. Lower abdominal pain, named "Er Zhen Tong" (baby pillow pain), is treated with Dan Wu Ling Zhi San, or pills made with Tao Ren (Peach Kernel) and vinegar paste. Administer with Si Jun Zi Tang for Qi deficiency, or Si Wu Tang for Blood deficiency. Deficiency-pain at the vaginal opening and below the umbilicus is treated with Da Wen Jing Tang or Lamb Meat Soup. General formulas include Nu Jin Dan and Jia Yi Mu Wan.
Blood deficiency with Fire agitation causing alternating chills and fever:
Postpartum Blood deficiency causes fever; Qi deficiency causes aversion to cold; both Qi and Blood deficiency cause simultaneous fever and aversion to cold. Do not use diaphoretic methods. For Yin deficiency and Blood weakness, use Si Wu Tang; for slight fever, add Fu Ling as the sovereign herb; for intense heat, add Chao Gan Jiang as an assistant. For excessive blood loss with external heat and internal restlessness, shortness of breath, and confusion, use Ren Shen Dang Gui San. For fever associated with lactation ("Zheng Ru"), use Si Wu Tang plus Ren Shen, Huang Qi, Bai Zhu, and Tian Hua Fen. For fever worse at night and quiet during the day, use Si Wu Tang removing Bai Shao, adding Chai Hu as appropriate. For alternating chills and fever due to dual Qi-Blood deficiency, use Bu Xu Tang. Postpartum patients generally should not use cooling medicines.
Internal injury from overexertion leading to gradual emaciation:
Overexertion postpartum is called "Ru Lao". Symptoms include emaciation, alternating standing and lying, indigestion, occasional cough, dizziness/headache, thirst, night sweats, malaria-like chills and fever, and arm spasms. Use Shi Quan Da Bu Tang removing Xiong (Ligusticum), plus Xu Duan, Niu Xi, Bie Jia, Sang Ji Sheng, and Tao Ren powdered. Take one pair of pig kidneys, remove fat membrane, with one slice of ginger and three dates, decoct two cups of water to one cup. Add two qian of the powder, three cun of scallion, half a Chinese plum, and five spikes of Jing Jie. Decoct together and take on an empty stomach. For body pain and chills/fever, use Dang Gui Yang Rou Tang or Kidney Soup.
Food stagnation in Spleen causing diarrhea and vomiting:
Chills and fever with abdominal pain indicate blood stasis; abdominal pain with chest fullness, vomiting, and diarrhea indicates food injury. If stasis is caused by eating meat too early, use Shu Liao Wu Ji San; add E Zhu for severe pain, Sha Ren for vomiting, and Jiang (Ginger), Fu Zi (Aconite), Ren Shen for diarrhea. For persistent diarrhea with umbilical pain, use Li Zhong Wan plus Rou Dou Kou. For Cold-complex abdominal pain with borborygmus, clear urine, and no thirst, use Si Jun Zi Tang combined with Wu Ling San, plus Rou Dou Kou and Chao Bai Shao. For Heat-complex with foul stool, difficulty passing stool, paroxysmal pain/diarrhea, and thirst, use Si Jun Zi Tang combined with Si Ling San, plus wine-fried Huang Lian and a little Mu Tong, or Yi Yuan San. For Dampness-complex with heavy body and abdominal distension, use Wei Ling Tang. For vomiting due to failed blood entering the Stomach causing fullness, use Liu Jun Zi Tang plus Ze Lan Ye, Chi Shao, and Gan Sheng Jiang. For abdominal distension and Stomach Qi disharmony, use Jie Geng, Ban Xia, and Chen Pi in equal parts, decocted with ginger. For wiry Spleen pulse, use San Bai Tang plus Gan Sheng Jiang, Chen Pi, Huang Qi, Hua Shi, and Gan Cao. For food accumulation forming masses, use Nei Zhi San or Du Wan. For cholera-like vomiting/diarrhea with irritability, thirst, and cold limbs, use Li Zhong Tang plus Chen Pi and Mai Men Dong, decocted with ginger; add Fu Zi for cold limbs; use Wu Ling San for thirst; use Mu Yu San for muscle cramps.
External invasion of chills and fever without cessation; tonify while releasing exterior, do not overdo it:
Postpartum external invasion, often due to getting out of bed too early or changing clothes exposing to wind, allows cold to enter the lower part, causing malaria-like chills/fever and incessant headache. For Blood deficiency, use Gu Xiong Gui Tang plus Ren Shen, Zi Su, and Gan Ge. For Qi-Blood deficiency, use Bu Xu Tang plus Chen Pi and Gan Jiang. For severe chills/fever, use Shu Liao Wu Ji San. For unceasing heat, use Huang Long Tang. For robust constitutions with fever, aversion to cold, malaria, or dysentery, use Xiao Chai Hu Tang combined with Si Jun Zi and Si Wu Tang, plus Huang Qi, named San Fen San. Do not treat as Shang Han (Cold Damage). If hot medicines were mistakenly overdosed, leading to prominent heat signs and chronic constipation, use Chai Hu Po Yu Tang, or Si Wu Tang plus Da Huang and Mang Xiao, taken temporarily followed by tonification. See Volume 3 for detailed Shang Han postpartum.
Body pain, tendon spasms, deficiency-thirst, and irritability:
Multiple births and walking disrupt Qi-Blood ascent/descent, causing stagnation in joints, urgent meridians, hand/foot spasms, or wandering pain in limbs. Use Chen Tong San; or if residual blood flows throughout the body causing waist/leg/joint pain, use Wu Ji San removing Ma Huang, plus Ren Shen, Xiang Fu, Xiao Hui, Tao Ren, and Mu Xiang in equal parts, decocted with ginger. For postpartum wind-withered weakness and tendon spasms, use Xue Feng Wan or decoction. For irritability/thirst with Qi deficiency, use Sheng Mai San; for Blood deficiency, Si Wu Tang plus Tian Hua Fen and Mai Men Dong. For dual Qi-Blood deficiency with thirst, dizziness, weak legs, and tasteless appetite, use Ren Shen (2 qian), Mai Men Dong (1.5 qian), Shu Di (7 fen), Tian Hua Fen (3 qian), Gan Cao (5 fen), cooked with Glutinous Rice, Ginger, and Dates. For deficiency-irritability, use Ren Shen, Mai Men Dong, Xiao Mai, Fu Ling (1 qian each), Zhu Ru (one pill size), Ban Xia (8 fen), Gan Cao (5 fen), decocted with ginger. Suitable for Heart-deficiency palpitations.
Profuse sweating and constipation:
Postpartum fever with spontaneous sweating uses Gu Gui Tang; for severe sweating, add Bai Zhu, Fang Feng, Mu Li, Mai Men Dong, Shu Di, Fu Ling, Gan Cao, or Huang Qi Jian Zhong Tang. For spontaneous sweating with edema/fullness, use Da Tiao Jing San; for spontaneous sweating with limb pain, use Dang Gui Yang Rou Tang. For fever with night sweats, boil one pig kidney, half he of glutinous rice, and two stalks of white scallion; take one cup of clear juice, decoct with Ren Shen and Dang Gui (1 qian each). For constipation, use Gu Xiong Gui Tang plus Fang Feng, Zhi Ke, Gan Cao; for dryness/hardness, use Ma Zi Ren Wan or Su Ma Zhou. Generally, excessive blood loss causes Yu Mao (depression/syncope), which causes sweating, which causes constipation; all are due to Blood deficiency. Yu Mao is synonymous with Blood Syncope. For urinary retention with abdominal fullness, fill the umbilicus with salt, place a bundle of chopped white scallion on top, moxibustion penetrates heat to open flow. For heat-type retention, use Liu Yi San plus Bing Lang, Zhi Ke, Mu Tong, Ma Zi Ren, Kui Zi, decocted.
Inability to speak due to failed blood and damp-phlegm confusing the mind:
Failed blood stagnating and attacking the Heart, closing Heart Qi, causing stiff tongue and inability to speak, is treated with Qi Zhen San or Si Wei San. If caused by excessive herbal intake during labor leading to Stomach dampness, use Shu Liao Wu Ji San or Liu Jun Zi Tang. For phlegm-heat confusing the Heart causing muteness, use Dao Tan Tang; for phlegm-Qi stagnation with closed eyes and muteness, take 1 qian of Sheng Bai Fan (Raw Alum) powder mixed with warm water.
Seeing spirits suddenly is not evil intrusion:
Seeing spirits postpartum results from Blood deficiency and labor damaging Liver/Heart, failed blood attacking, and evil influencing the Heart, causing nonsense speech. It is not Wind-Cold or ghosts. Use Xiao Tiao Jing San plus a little Long Nao (Borneol), or Miao Xiang San plus Dang Gui, Di Huang, Huang Lian. For blood stasis confusing the Heart causing delusions, or Heart-deficiency delirium/syncope, use Ba Wu Tang removing Bai Shao, plus Hu Po, Bai Zi Ren, Yuan Zhi, Zhu Sha, and Gold/Silver, decocted. Severe cases use Hei Long Dan. For postpartum Blood deficiency, palpitations, and restless sleep, use Shi Wei Wen Dan Tang, Ning Shen Gao, or Ding Zhi Wan.
Continuous lochia dripping, especially difficult if bladder is damaged:
Postpartum five types of strangury use Bai Mao Tang; for continuous dripping of failed blood, use Yu San; for prolonged dripping with heavy/weak limbs, use Mu Li San. If midwives accidentally damage the bladder during birth causing day/night dripping, use Si Jun Zi Tang plus Huang Qi, Chen Pi, Tao Ren, decocted with clear juice of pig bladder, taken warm; add Xiong and Gui for Blood deficiency.
Whether Ru Feng or edema:
Postpartum wind-stroke is called Ru Feng. Jaw locking, tight jaw, limb spasms, syncope with rigidity, staring eyes, falling, vomiting/diarrhea near death, are treated with Dan Jing Jie San or Gu Jing Gui Tang. For Blood deficiency from early overwork allowing Wind invasion, use Xiao Xu Ming Tang or Qiang Huo Yu Feng Tang. For jaw locking/opisthotonos with profuse saliva, use Jiao Jia San, or stir-fry half sheng of large black beans until smoking, pour two bowls of wine over them, store in porcelain, take half bowl warmed with Du Huo (5 qian). Postpartum profuse sweating with wind-contraction spasms is difficult to treat. Failed blood stagnating and transforming into water, flowing along meridians causing limb edema, is treated with Xiao Tiao Jing San; for Qi-Blood deficiency, Si Jun Zi plus Cang Zhu, or Nu Jin Dan; for Blood deficiency, Bu Xu Tang with little Cang Zhu and Fu Ling to promote urination naturally; avoid harsh purgatives.
All miscellaneous syndromes focus on tonifying Ying and Wei:
Postpartum miscellaneous diseases are similar to men's, but usually require concurrent tonification and stasis elimination for cure. Danxi said: Focus on greatly tonifying Ying and Wei; treat miscellaneous diseases as secondary. For example, dysentery within the first month with incomplete lochia involves stasis stagnating in intestines, similar to post-menstrual blood stagnation dysentery; treat with Si Wu Tang plus Tao Ren, Huang Lian, Mu Xiang. For severe tenesmus, use Tong Xuan Er Ba Dan. Cough is often due to stasis entering Lungs; use Gu Er Mu San plus Tao Ren, Xing Ren, Ren Shen, Fu Ling, decocted. Others can be inferred similarly.
Nasal bleeding black as coal:
Postpartum Qi-Blood disorder prevents return to origin, turning black at mouth/nose, becoming epistaxis, caused by postpartum deficiency-heat, Stomach exhaustion, Lung failure. Save with Xi Jiao Di Huang Tang.
Gasping with loud voice, hard to save:
Postpartum asthma results from sudden depletion of Ying Blood, Qi having no master, gathering solely in Lungs causing urgency, isolated Yang and severed Yin, a hopeless syndrome. Save with single Ren Shen Tang or add little Su Mu. If failed blood stagnates swelling Lungs causing asthma, use Xue Jie and Mo Yao in equal powder, taken with wine/water mixture, combined with Duo Ming Dan.
Vulvar swelling, prolapse, and non-retracting intestine:
Swelling/pain on both sides of vulva with inability to extend limbs: mash four-season scallions with Ru Xiang powder into cakes, apply to sides of vulva, resolves after time. Prolapse due to excessive labor force: Si Wu Tang plus little Long Gu powder, taken twice; externally apply mashed Bi Ma Zi to crown, remove once retracted. Non-retracting rectum/intestine: Ba Wu Tang plus Fang Feng, Sheng Ma, using Jiu Chao Huang Qi as sovereign; externally fumigate/wash with Jing Jie, Huo Xiang, Chu Pi decoction.
Uterus and fatty membrane discharge:
Discharge of an object like a bowl with two horns is the uterus; treat with Bu Zhong Yi Qi Tang removing Chai Hu, take 2-3 doses, retracts quickly, then regulate with Si Wu Tang plus Ren Shen. Discharge of a cloth-like object weighing over a jin, adhering to mat, due to labor or Liver flaccidity, is fatty membrane; harmless. Treat with Bu Zhong Yi Qi Tang removing Chai Hu, 2 doses retract it. If uterine membrane injured by excessive force during labor, protruding a flesh line 3-4 chi long, pulling heart/abdominal pain unbearable, moving it causes extreme pain: first take Shi Xiao San several doses. Then take 3 jin fresh ginger, wash/mash, mix with 2 jin clear oil, fry until oil is dry/scorched. Fold 5 chi of cooked silk into layers, have a steady woman gently lift the flesh line, coil it into a ball, place in level intersection. Wrap warm oil-ginger in silk bag, fumigate the flesh line. When ginger cools, heat iron to warm again, maintain ginger aroma. Repeat with new ginger. After 1-2 days, half retracts; repeat method, fully retracts in 2 days. Then take Shi Xiao San and Gu Xiong Gui Tang to regulate. Do not let the line break, or it becomes incurable.
Galactorrhea obstruction due to Qi-Blood deficiency; Qi stagnation warns against anger:
Postpartum Qi-Blood weakness causing low milk: use Zhong Ru Fen (2 qian) mixed with Lou Lu decoction; or pig trotters (1) with Tong Cao (5 liang) boiled juice; or crucian carp/Mu Tong juice. For Qi stagnation low milk, use Lou Lu San; for Qi blockage low milk, Yong Quan San. For weaning stopping milk, use Mai Ya (2 liang) fried powder, mixed with Si Wu Tang. If nursing mother feels scanty urine, disease arises; must medicate to regulate Spleen/Stomach/Liver/Kidney. If uncured, Qi stagnation and rebellion occur. Women's illnesses stem from Qi-Blood knotting; worry knots Qi/Blood; anger rebels Qi/Blood, causing breast hardness/costal pain/fever. Ancient formulas use Xiang Fu, Sha Ren, Mu Xiang, Bing Lang, Qing Pi, Zhi Ke to move Qi.
Strange disease: breasts elongating over chi, ancient methods detailed:
Postpartum stasis attacking upward, breasts suddenly elongate, thin as intestines, extending over lower abdomen, unbearable pain, named "Ru Xuan" (Breast Suspension), critical condition. Use Chuan Xiong and Dang Gui (1 jin each), decoct thick soup, take warm frequently. Burn 2 jin slowly, smoke under table before patient, patient bends head to inhale smoke from nose/mouth/breasts. If not shrinking much, use another dose; stasis clears, nipples restore. If not restoring, apply mashed Bi Ma Zi to crown briefly, wash off.