〔郭〕产后大便秘涩者何？答曰∶产卧水血俱下，肠胃虚竭，津液不足，是以大便
秘涩不通也。若过五六日，腹中闷胀者，此乃燥屎在脏腑，以其干涩未能出耳。宜服麻
仁丸以津润之。若误以为有热，投之寒药，则阳消阴长，变证百出，性命危矣。
〔薛〕产后大便不通，因去血过多，大肠干涸，或血虚火燥干涸，不可计其日期，饮
食数多，用药通之、润之，必待腹满觉胀，自欲去而不能者，乃结在直肠，宜用猪胆汁润
之。若服苦参药润通，反伤中焦元气，或愈加难通，或通而泻不能止，必成败证。若属
血虚火燥，用加味逍遥散。气血俱虚，八珍汤。慎不可用麻子、杏仁、枳壳之类。一
产妇大便不通七日矣，饮食如常，腹中如故。余曰∶饮食所入，虽倍常数，腹不满胀，用
八珍加桃仁、杏仁。至二十一日，腹满欲去，用猪胆汁润之，先去干粪五七块，后皆常粪
而安。一产妇大便八日不通，用通利之药，中脘作痛，饮食甚少，或云通则不痛，痛则
不通。乃用蜜导之，大便不禁，吃逆不食。余曰∶此脾肾复伤，用六君加吴茱、肉果，骨
脂、五味数剂，喜其年壮而愈。不然，多致不起。一产妇大便秘结，小腹胀痛，用大
黄等药，致吐泻不食，腹痛胸痞。余用六君子加木香、炮姜，治之而愈。一妇人大便
秘涩，诸药不应，苦不可言，令饮人乳而愈。
麻仁丸
麻仁（研如泥） 枳壳 人参（各一两） 大黄（半
两）
上为末，炼蜜丸如梧桐子大。空心温酒下二十丸，未通渐加丸数，不可太过。
评曰∶产后不得利，利者百无一生。去血过多，脏燥大便秘涩，则固当滑之，大黄
似难轻用，唯葱涎调腊茶为丸，复以腊茶下之必通。（予常用《局方》四物汤，以生地黄易熟地
黄，加青皮去白煎服，甚效。）
〔本事〕妇人产后有三种疾，郁冒则多汗，汗多则大便秘，故难于用药，惟麻子苏
子粥最为稳当。用紫苏子、大麻子二味，各半合，洗净研极细，用水再研取汁，一盏，分
二次煮粥啜下。此粥不唯产后可服，大抵老人诸虚风秘，皆宜服之。当有一人母年八十
四，忽尔腹满头疼，恶心不食，召医数人，议皆用补脾进食，治风清利头目等药，数日虽
愈，全不入食，其家忧惶。余辨说前药皆误矣，此证正是老人风秘，脏腑壅滞，聚于胸
中则腹胀恶心，不思饮食，又上至于颠则头痛，神不清也。若脏腑流畅，诸疾悉去矣。予
令作此粥，两啜而气泄，先下结粪如胡椒者十余枚，后渐得通利，不用药而自愈矣。
〔丹〕产后秘结不通，膨满者，气急坐卧俱难，用大麦 炒黄为末，酒下一合，神
效。（出《兵部手集》。）
〔郭〕产后出现大便秘结涩滞的原因是什么？回答说：分娩后卧床休息，血液与津液随生产而下泄，导致肠胃空虚衰竭，津液不足，因此大便秘结涩滞不通。如果过了五六天，腹部感到闷胀，这是燥屎停留在脏腑中，因为粪便干燥涩滞所以无法排出。适宜服用麻仁丸来滋润肠道。如果错误地认为体内有热，而投用寒凉药物，就会导致阳气消减、阴气增长，从而引发各种变证，危及生命。
〔薛〕产后大便不通，是因为失血过多，导致大肠干涸；或者是血虚生火，火热燥烈导致干涸。这种情况不能单纯计算天数，即使饮食数量较多，用药通下或润下，必须等到腹部满闷自觉胀急，想要排便却排不出来的时候，这才说明燥屎结在直肠部位，适宜使用猪胆汁进行润滑。如果服用苦参等药物来润通，反而会损伤中焦的元气，或者导致更加难以通便，或者虽然通了但腹泻不止，必然会导致败证（危重之证）。如果属于血虚火燥，使用加味逍遥散。如果是气血俱虚，使用八珍汤。千万不要使用麻子、杏仁、枳壳这类药物。有一位产妇大便不通七天了，饮食如常，腹部也没有异常。我说：饮食摄入虽多，但腹部不满胀，使用八珍汤加入桃仁、杏仁。到了第二十天，腹部满胀想排便，使用猪胆汁润滑，先排出干硬粪块五七块，之后都是正常粪便而痊愈。另一位产妇大便八日不通，使用通利药物后，中脘穴处疼痛，饮食很少，有人说通则不痛，痛则不通。于是使用蜜导法（蜂蜜栓），结果大便失禁，呃逆且不能进食。我说：这是脾肾再次受伤，使用六君子汤加入吴茱萸、肉豆蔻、骨脂、五味子，服用数剂，庆幸她年轻力壮而痊愈。否则，大多会导致死亡。还有一位产妇大便秘结，小腹胀痛，使用大黄等药物，导致呕吐、腹泻、不能进食、腹痛胸痞。我使用六君子汤加入木香、炮姜治疗，治愈了她。还有一位妇人大便秘涩，各种药物无效，痛苦不堪，让她喝人乳而痊愈。
麻仁丸
麻仁（研磨成泥） 枳壳 人参（各一两） 大黄（半两）
以上药物研为细末，用炼蜜制成梧桐子大小的丸药。空腹时温酒送服二十丸，若未通便可逐渐增加丸数，但不可过量。
评曰：产后不宜轻易使用泻下法，一旦误用泻下，百无一活。因去血过多，脏腑干燥导致大便秘涩，确实应当采用滑润之法，大黄似乎难以轻易使用，只有用葱汁调和腊月茶做成丸药，再用腊月茶送服，必定能通便。（我常用《局方》的四物汤，以生地黄替换熟地黄，加入去白青皮煎服，效果很好。）
〔本事〕妇人产后有三种疾病，郁冒会导致多汗，汗多则导致大便秘结，因此用药困难，只有麻子苏子粥最为稳妥。使用紫苏子、大麻子两味药，各半合，洗净后研磨极细，用水再次研磨取汁，得一盏，分两次煮粥饮用。这种粥不仅产后可以服用，大致上老人各种虚证引起的风秘，都适宜服用。曾经有一人的母亲八十多岁，忽然腹部满胀、头痛、恶心不想吃饭，召集多位医生，商议都用补脾进食、治风清利头目等药物，几天后虽然病愈，但完全不能进食，家人非常担忧。我辨析说前面的药都错了，这个病症正是老人的风秘，脏腑壅滞，积聚在胸中则腹胀恶心，不思饮食，又上行至头顶则头痛，神志不清。如果脏腑流畅，各种疾病都会去除。我让人制作此粥，喝了两次后气机通畅，先排出像胡椒粒一样的干硬粪块十余枚，之后逐渐通畅，不用药物而自愈了。
〔丹〕产后秘结不通，腹部膨满的，呼吸急促，坐卧都困难，使用大麦炒黄研为细末，用酒送服一合，效果神奇。（出自《兵部手集》。）
[Guo] What is the reason for constipation and dryness of stool after childbirth? The answer is: After delivery, while resting in bed, blood and body fluids are lost along with the birth process, leading to emptiness and exhaustion of the intestines and stomach, and a deficiency of body fluids. Therefore, the stool becomes constipated and difficult to pass. If five or six days pass and there is a feeling of stuffiness and distension in the abdomen, this indicates that dry feces are retained within the zang-fu organs. Because the feces are dry and sticky, they cannot be expelled. It is appropriate to take Mahuang Wan (Cannabis Seed Pill) to moisten the intestines. If mistakenly believed to be due to internal heat, and cold-natured medicines are administered, yang qi will decline and yin will grow, resulting in various complications and endangering life.
[Xue] Constipation after childbirth is caused by excessive blood loss, leading to dryness of the large intestine; or it may be due to blood deficiency generating fire, causing dryness through heat. In such cases, one should not rely solely on counting days. Even if food intake is substantial, using purgative or moistening medicines requires waiting until abdominal fullness and a sensation of urgency arise, where the patient desires to defecate but cannot. This indicates that hardened feces are stuck in the rectum. In this situation, it is appropriate to use pig bile to lubricate. If bitter herbs like Kushen (Sophora Root) are used to moisten and unblock, it will instead damage the yuan qi of the middle jiao. This may lead to even greater difficulty in defecation, or if defecation occurs, diarrhea may become uncontrollable, inevitably resulting in a fatal condition. If the cause is blood deficiency with fire dryness, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) should be used. If both qi and blood are deficient, Bazhen Tang (Eight Treasures Decoction) is indicated. One must strictly avoid using substances like Hemp Seeds (Huo Ren), Apricot Kernels (Xing Ren), and Aurantium Peel (Zhi Qiao).
Case 1: A puerpera had not passed stool for seven days, yet her diet was normal and her abdomen felt fine. I said: Although food intake is high, the abdomen is not distended. Use Bazhen Tang added with Taoren (Peach Kernel) and Xingren (Apricot Kernel). On the twenty-first day, when abdominal distension occurred and she desired to defecate, use pig bile to lubricate. She first passed five or seven pieces of hard feces, followed by normal stools, and recovered.
Case 2: A puerpera had not passed stool for eight days. After using purgative medicines, she experienced pain at Zhongwan (CV12) and had very little appetite. Some argued that "if there is free flow, there is no pain; if there is pain, there is no free flow." I then used honey suppositories (Mi Dao). However, this led to involuntary defecation, hiccups, and an inability to eat. I said: This indicates further injury to the spleen and kidney. Use Liujunzi Tang (Six Gentlemen Decoction) added with Wuzhuyu (Evodia Fruit), Roudoukou (Nutmeg), Gubao Gu (Bone Fat/likely referring to a specific preparation or typo for another herb, contextually warming), and Wuweizi (Schisandra Berry). After several doses, fortunately, because she was young and strong, she recovered. Otherwise, death would likely have ensued.
Case 3: A puerpera suffered from severe constipation and lower abdominal distending pain. After using Dahuang (Rhubarb) and other medicines, she developed vomiting, diarrhea, anorexia, abdominal pain, and chest oppression. I treated her with Liujunzi Tang added with Muxiang (Aucklandia Root) and Paojiang (Prepared Ginger), which cured her.
Case 4: A woman suffered from severe constipation, to which all medicines failed to respond, causing unbearable suffering. I instructed her to drink human milk, which cured her.
Mahuang Wan (Cannabis Seed Pill)
Hemp Seed (Ma Ren, Cannabis Fructus) (ground into paste) - 1 liang
Aurantium Peel (Zhi Qiao, Aurantii Fructus Perfricatus) - 1 liang
Ginseng Root (Ren Shen, Ginseng Radix et Rhizoma) - 1 liang
Rhubarb Root (Da Huang, Rheum Palmati Radix) - 0.5 liang
Grind the above ingredients into fine powder. Mix with refined honey to form pills the size of paulownia seeds. Take 20 pills with warm wine on an empty stomach. If stool does not pass, gradually increase the number of pills, but do not exceed the appropriate dose.
Commentary: Postpartum patients should not be given purgatives lightly; misuse can be fatal. Due to excessive blood loss, the zang-fu organs become dry, leading to constipation. Slipping/moistening methods are indeed appropriate. Dahuang (Rhubarb) should not be used lightly. Instead, mixing scallion juice with tea from the twelfth lunar month to form pills, and taking them down with the same tea, will effectively promote bowel movement. (I often use Siwu Tang (Four Substances Decoction) from the Bureau of Formulas, substituting Sheng Dihuang (Rehmannia Root) for Shu Dihuang, adding Qingpi (Aurantium Peel without white pith), and decocting for administration. This is very effective.)
[Benshi] There are three types of postpartum disorders in women. Yu Mao (depression and dizziness) leads to excessive sweating; excessive sweating leads to constipation. Therefore, medication is difficult to administer. Only Mazisu Zi Zhou (Hemp Seed and Perilla Seed Porridge) is the safest option. Use Zisuzi (Perilla Seed) and Damazi (Hemp Seed), half he each. Wash them and grind them extremely finely. Grind again with water to extract the juice, obtaining one cup. Divide into two portions and cook as porridge to consume. This porridge is suitable not only for postpartum women but also generally for elderly people suffering from various deficiency-induced wind-type constipation.
Case: The mother of one person, aged eighty-four, suddenly experienced abdominal distension, headache, nausea, and anorexia. Several doctors were summoned, who all prescribed medicines to tonify the spleen, promote digestion, treat wind, and clear the head and eyes. Although she recovered after several days, she could not eat at all, causing great worry to her family. I analyzed that the previous prescriptions were incorrect. This case was precisely wind-type constipation in the elderly, characterized by stagnation in the zang-fu organs. Accumulation in the chest causes abdominal distension, nausea, and anorexia; upward movement to the vertex causes headache and mental cloudiness. If the zang-fu organs become smooth and flowing, all diseases will disappear. I ordered the preparation of this porridge. After two servings, qi began to move, and she first passed more than ten pellets of hard feces resembling peppercorns. Subsequently, bowel movements became regular, and she healed without further medication.
[Dan] For postpartum constipation accompanied by abdominal distension, where breathing is rapid and sitting or lying down is difficult, use Da Mai (Barley) stir-fried until yellow, ground into powder. Take one he with wine. The effect is miraculous. (From Bingbu Shouji).