（ 当作痉）
产后发 ，因去血过多，元气亏极；或外邪相搏，其形牙关紧急，四肢劲强；或腰背反张，
肢体抽搐。若有汗而不恶寒者，曰柔 。若无汗而恶寒者，曰刚 。然产后患之，实由亡血
过多，筋无所养而致。故伤寒汗下过多，溃疡脓血大泄，多患之，乃败症也。若大补血气，
多保无虞。若攻风邪，死无疑矣。
治验
一产妇牙关紧急，腰背反张，四肢抽搐，两目连札，余以为去血过多，元气亏损，阴火炽盛
，用十全大补加炮姜一剂而苏，又数剂而安。
余在吴江史万湖第，将入更时，闻喧嚷云∶某家人妇，忽仆牙关紧急已死矣。询云是新产妇
出直厨，余意其劳伤血气而发 也。急用十全大补加附子煎滚，令人推正其身，一人以手夹
正其面，却挖开其口，将药灌之，不咽，药已冷，令侧其面出之，仍正其面复灌以热药，又
冷又灌，如此五次，方咽下，随灌以熟药遂苏。
产后便血，或饮食起居，或六淫七情，以致元气亏损，阳络外伤。治法∶若因膏粱积热，用
加味清胃散；若因醇酒湿毒，葛花解酲汤；若因怒动肝火，六君加柴、芍、芎、归；若因郁
结伤脾，加味归脾汤；若因思虑伤心，妙香散；若因大肠风热，四物加侧柏、荆、防、枳壳
、槐花；若因大肠血热，四物加芩、连；若因肠胃虚弱，六君加升麻、柴胡；若因肠胃虚寒
，六君加肉蔻、木香；若因元气下陷，补中益气加茯苓、半夏；若因气虚，用六君、升麻；
若因血虚，用四物；气血俱虚，用八珍，俱加柴胡、升麻。大凡病久，或元气虚弱，见病百
端，皆因脾胃亏损，内真寒而外假热，但用六君子，或补中益气加炮姜温补脾气，诸症悉退
。若四肢畏冷，属阳气虚寒，急加附子。病因多端，当临症制宜，庶无误矣。
治验
一产妇粪后下血，诸药不应，饮食少思，肢体倦怠，此中气虚弱，用补中益气加茱炒黄连五
分，四剂顿止。但怔忡少寐，盗汗未止，用归脾汤治之而痊。
一妇人但怒便血，寒热口苦，或胸胁胀痛，或小腹痞闷，此木乘土，用六君加山栀、柴胡而
愈，用补中益气、加味逍遥二药，而不复作。
一妇人久下血在粪前，属脾胃虚寒，元气下陷。用补中益气加连炒吴茱一钱，数剂稍缓，乃
加生吴茱五分，数剂而愈。
一妇人产后便血，口干饮汤，胸胁膨满，小腹闷坠，内热晡热，饮食不甘，体倦面黄，日晡
则赤，洒淅恶寒，此脾肺气虚，先用六君加炮姜、木香，诸症渐愈；用补中益气将愈；用归
脾汤痊愈。后饮食失节，劳役兼怒气，发热血崩，夜间热甚，谵语不绝，此热入血室，用加
味小柴胡，二剂而热退；用补中益气而血止；用逍遥散、归脾汤，调理而康。
（此处原文“发”字应为“痉”之误）产后出现痉挛症状，是因为失血过多，元气极度亏损；或者是外邪与体内正气相搏结，表现为牙关紧闭、四肢僵硬强直；或者腰背向后反折，肢体抽搐。如果伴有出汗且不恶寒的，称为柔痉。如果没有出汗且恶寒的，称为刚痉。然而产后患此病，实际上是由于亡血过多，筋脉失去滋养所致。所以伤寒病中发汗或攻下过多，以及溃疡病患者脓血大量流失时，多会出现这种病症，属于危重败症。如果能大补气血，大多能保全性命无忧。若用祛风散邪的方法治疗，则必死无疑。
治验记录：
一位产妇出现牙关紧闭、腰背反张、四肢抽搐、两眼频繁眨动，我认为这是因失血过多导致元气亏损，阴火炽盛，于是使用十全大补汤加入炮姜，服用一剂后苏醒，又服数剂后病情安定。
我在吴江史万湖家中时，即将进入更夜时分，听到喧哗声说：某家的媳妇，突然仆倒，牙关紧闭，已经死亡了。询问得知是新产后的妇女走出厨房，我推测她是因劳累损伤气血而引发痉挛。急忙用十全大补汤加入附子煎煮至沸腾，让人将她的身体推正，一人用手夹住并固定她的面部，撬开她的嘴，将药灌入，但药未咽下且已变冷，于是让她侧身排出药液，再扶正面部重新灌入热药，再次变冷后再灌，如此反复五次，才终于咽下，随后灌入熟药便苏醒了。
产后便血，可能由于饮食起居不当，或因六淫（风、寒、暑、湿、燥、火）七情（喜、怒、忧、思、悲、恐、惊）的影响，导致元气亏损，阳络受损出血。治疗方法：如果是因膏粱厚味积热所致，使用加味清胃散；如果是因醇酒湿毒所致，使用葛花解酲汤；如果是因愤怒触动肝火所致，使用六君子汤加柴胡、白芍、川芎、当归；如果是因郁结损伤脾脏所致，使用加味归脾汤；如果是因思虑损伤心脏所致，使用妙香散；如果是因大肠风热所致，使用四物汤加侧柏叶、荆芥、防风、枳壳、槐花；如果是因大肠血热所致，使用四物汤加黄芩、黄连；如果是因肠胃虚弱所致，使用六君子汤加升麻、柴胡；如果是因肠胃虚寒所致，使用六君子汤加肉豆蔻、木香；如果是因元气下陷所致，使用补中益气汤加茯苓、半夏；如果是因气虚所致，使用六君子汤、升麻；如果是因血虚所致，使用四物汤；气血俱虚，使用八珍汤，均加柴胡、升麻。大凡病程长久，或元气虚弱，见到各种病症，都是因为脾胃亏损，内里真寒而外表假热，只需用六君子汤，或补中益气汤加炮姜温补脾气，各种症状都会消退。如果出现四肢畏冷，属于阳气虚寒，急需加入附子。病因多种多样，应当根据具体症状灵活制宜，这样才能没有差错。
治验记录：
一位产妇在排便后下血，服用多种药物无效，饮食减少且食欲不振，肢体倦怠，这是中气虚弱，使用补中益气汤加吴茱萸炒制的黄连五分，服用四剂后出血立即停止。但仍有心悸失眠、盗汗不止的症状，使用归脾汤治疗而痊愈。
一位妇人只要发怒就会便血，伴有寒热往来、口苦，有时胸胁胀痛，有时小腹痞闷，这是肝木乘克脾土，使用六君子汤加山栀、柴胡而痊愈，后续服用补中益气汤、加味逍遥丸，疾病不再复发。
一位妇人长期在大便前下血，属于脾胃虚寒，元气下陷。使用补中益气汤加连翘炒制的吴茱萸一钱，服用数剂后症状稍缓，于是改为加入生吴茱萸五分，服用数剂后痊愈。
一位妇人产后便血，口干想喝汤水，胸胁胀满，小腹闷坠感，内有发热及傍晚发热，饮食无味，身体疲倦面色萎黄，每天下午脸色发红，怕冷发抖，这是脾肺气虚，先用六君子汤加炮姜、木香，各种症状逐渐好转；再用补中益气汤接近痊愈；最后用归脾汤彻底痊愈。后来因饮食不节制，劳累兼生气，引发发热和血崩，夜间发热严重，胡言乱语不停，这是热邪陷入血室，使用加味小柴胡汤，两剂后热退；再用补中益气汤使血止；最后用逍遥散、归脾汤调理而康复。
(Here, the character "Fa" should be read as "Jing", referring to spasms.) Postpartum spasms occur due to excessive blood loss leading to extreme depletion of Yuan Qi (Original Qi); or it may result from the struggle between external pathogens and the body's righteous Qi. The manifestations include tightness of the jaw, stiffness and rigidity of the four limbs; or opisthotonos (backward arching of the back), and convulsions of the limbs. If sweating is present without aversion to cold, it is called Rou Jing (Soft Spasm). If there is no sweating with aversion to cold, it is called Gang Jing (Hard Spasm). However, when this condition occurs postpartum, it is actually caused by excessive blood loss, leaving the sinews without nourishment. Therefore, in Shaoyang disease (Taiyang disease), excessive sweating or purgation, as well as large losses of pus and blood from ulcers, often lead to this condition, which is a critical and deteriorating syndrome. If one greatly tonifies Qi and Blood, life can mostly be preserved safely. If wind-pathogen dispelling methods are used, death is inevitable.
Case Record 1:
A postpartum woman presented with tightness of the jaw, opisthotonos, convulsions of the four limbs, and frequent blinking of the eyes. I considered this to be due to excessive blood loss causing Yuan Qi deficiency and blazing Yin Fire. I prescribed Shiquan Dabu Tang (Ten Significant Tonifying Decoction) with Pao Jiang (Roasted Ginger). After one dose, she regained consciousness; after several more doses, she stabilized.
While at the residence of Shi Wanhu in Wujiang, just as the night watch was beginning, I heard commotion saying that a servant's wife had suddenly collapsed, her jaw locked, and died. Upon inquiry, I learned she was a newly delivered woman who had walked out to the kitchen. I surmised that labor had injured her Qi and Blood, triggering spasms. I urgently prepared Shiquan Dubu Tang with Fuzi (Aconite Root) boiled until bubbling. Someone pushed her body upright, another person held her face steady with their hands, pried open her mouth, and attempted to pour the medicine in. She did not swallow, and the medicine cooled. We turned her to the side to drain it, then straightened her face again to pour hot medicine. This cycle of cooling and repouring was repeated five times before she finally swallowed. Subsequently, warm medicine was administered, and she revived.
Postpartum hematochezia (blood in stool) may result from improper diet or daily activities, or from the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Overthinking, Sorrow, Fear, Fright), leading to Yuan Qi deficiency and injury to the Yang Collaterals. Treatment methods: If caused by accumulated heat from rich and greasy food, use Jiawei Qingwei San (Modified Clear Stomach Powder); if caused by damp-toxin from strong wine, use Ge Hua Jie Cheng Tang (Pueraria Flower Decoction to Resolve Intoxication); if triggered by anger moving Liver Fire, use Liujun Zi Tang (Six Gentlemen Decoction) plus Chai Hu (Bupleurum), Bai Shao (White Peony Root), Chuan Xiong (Sichuan Lovage Rhizome), and Dang Gui (Angelica Sinensis); if caused by constraint injuring the Spleen, use Jiawei Guipi Tang (Modified Heart-Tonifying Decoction); if caused by overthinking injuring the Heart, use Miaoxiang San (Wonderful Incense Powder); if caused by Wind-Heat in the Large Intestine, use Siwu Tang (Four Substance Decoction) plus Ce Bai Ye (Biota Tops), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Zhi Qiao (Immature Bitter Orange), and Huai Hua (Sophora Flower); if caused by Blood-Heat in the Large Intestine, use Siwu Tang plus Huang Qin (Scutellaria) and Lian Lian (Coptis); if caused by Spleen-Stomach weakness, use Liujun Zi Tang plus Sheng Ma (Cimicifuga) and Chai Hu; if caused by Spleen-Stomach deficiency-cold, use Liujun Zi Tang plus Rou Dou Kou (Nutmeg) and Mu Xiang (Aucklandia); if caused by sinking of Yuan Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fu Ling (Poria) and Ban Xia (Pinellia); if caused by Qi deficiency, use Liujun Zi Tang and Sheng Ma; if caused by Blood deficiency, use Siwu Tang; if both Qi and Blood are deficient, use Bazhen Tang (Eight Treasures Decoction), all adding Chai Hu and Sheng Ma. Generally, for long-standing diseases or weak Yuan Qi, presenting with various symptoms, the root cause is often Spleen-Stomach damage, with true cold inside and false heat outside. One should simply use Liujun Zi Tang, or Buzhong Yiqi Tang with Pao Jiang to warm and tonify Spleen Qi, and all symptoms will recede. If the four limbs feel cold, indicating Yang Qi deficiency-cold, Fuzi must be added urgently. Since etiologies are diverse, treatment must be adapted to specific clinical presentations to avoid errors.
Case Record 2:
A postpartum woman experienced bleeding after defecation. Various medicines were ineffective. She had poor appetite and limb fatigue. This indicated Middle Qi weakness. I used Buzhong Yiqi Tang with ZHU Chao Huang Lian (Wu Zhu Yu-fried Coptis) 5 fen. After four doses, the bleeding stopped abruptly. However, she still suffered from palpitations, insomnia, and night sweats. I treated her with Guipi Tang, and she recovered.
A woman experienced bleeding upon anger, accompanied by alternating chills and fever, bitter taste in the mouth, sometimes chest and hypochondriac distending pain, or lower abdominal stuffiness. This indicated Wood overacting on Earth (Liver invading Spleen). I used Liujun Zi Tang plus Shan Zhi (Gardenia) and Chai Hu, resulting in recovery. Subsequent use of Buzhong Yiqi Tang and Jiawei Xiaoyao Wan (Modified Free and Easy Wanderer Pills) prevented recurrence.
A woman had long-term bleeding preceding stool passage, attributed to Spleen-Stomach deficiency-cold and sinking of Yuan Qi. I used Buzhong Yiqi Tang with Lian Chao Wu Zhu Yu (Fritillaria-fried Evodia) 1 qian. After several doses, symptoms eased slightly. Then I added raw Wu Zhu Yu 5 fen. After several doses, she recovered.
A postpartum woman had hematochezia, dry mouth desiring soup, chest and hypochondriac fullness, lower abdominal heaviness and bearing-down sensation, internal heat, afternoon tidal fever, lack of taste for food, body fatigue, sallow complexion, redness of the face in the late afternoon, and aversion to cold with shivering. This indicated Qi deficiency of the Spleen and Lung. Initially, I used Liujun Zi Tang with Pao Jiang and Mu Xiang; symptoms gradually improved. Then I used Buzhong Yiqi Tang; she nearly recovered. Finally, Guipi Tang cured her. Later, due to irregular diet, overwork, and anger, she developed fever and metrorrhagia (uterine bleeding). Nighttime fever was severe, with incessant delirium. This indicated Heat entering the Blood Chamber. I used Jiawei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction). After two doses, the fever subsided. Then I used Buzhong Yiqi Tang to stop the bleeding. Finally, Xiaoyao San (Free and Easy Wanderer Powder) and Guipi Tang were used for regulation, leading to health.