妇人之病,莫重于产后,因气血大亏,内而七情,外而六气,稍有感触,即足致病。且
多疑
似之症,毋徒以逐瘀为事,以致变端百出。读《金匮》书中,有用大黄等峻剂者,非古人立
法之不善也,盖以古时禀气之足,或西北地土坚浓,人亦强壮,用之良善。至于吾地,体质
柔弱,深闺娇养,岂能受此侵克,此看病之不可泥于古也。时人每谓产后不可补,恐其瘀阻
,往往用苏木、红花等,行瘀为先务。设或血行不止,立见厥脱,急难措手,可不惧哉。丹
溪云∶产后以大补气血为主,虽有他症以末治之。王肯堂云∶产后用下药者,百无一生。诚
哉是言也。
《金匮要略》云∶新产妇人有三病∶一病痉,二病郁冒,三病大便难。新产血虚,多汗
出,
善中风,故令病痉;亡血复汗,寒多故令郁冒;亡津液胃燥,故大便难。《心典》云∶血虚
汗出,筋脉失养,风入而益其劲,此筋病也。亡阴血虚,阳气逆厥,而寒复郁之,则头眩而
目瞀,此神病也。胃藏津液,而渗灌诸阳,亡津液胃燥,则大肠失其润,而大便难,此液病
也。三者不同,其为亡血伤津则一,故产后血虚诸症,由此而类推之。则不致误治矣。
产后诸病,总宜以生化汤为主,随症加味可也。《竹林寺世传秘本》生化汤论云∶产后
血气
暴虚,理当大补,但恶露未尽,用补须知毋滞。血能化,又能生,无损元虚,行中带补,方
为万全。世以回生丹,治以下胞胎,攻血块,虽见速效,未免亏损元气,非良剂也。不得已
而用之,只可服一丸,以参汤下之,庶无虞耳。夫生化汤以药性功用而立名也,夫产后瘀固
当消,新血宜生,若专消则新血不宁,专生则旧血反滞。考药性芎、归、桃仁,善破恶血,
骤生新血,佐以炮姜、甘草,引三品入肺肝,生血理气,五味共方,则行中有补,化中有生
,实产后之要药也。加减得宜,是在临证者之善悟可耳。又论产后治法云∶夫产后忧惊劳倦
,血气暴虚诸症,乘虚易起,如有气勿专耗散,有食勿专消导,热不可用芩、连,寒不可用
桂、附。用寒则血块停结,用热则新血崩流。至若虚中外感,见三阳表症似可汗也,在产后
而用麻黄,则重竭其阳。见三阴里症似可下也,在产后而用承气,则重亡其阴。耳聋胁痛,
乃肝肾恶血之停,休用柴胡。谵语汗出,乃元弱似邪之症,毋同胃实。厥由阳气血衰,无分
寒弱,非大补不能回阳而起弱。痹因阴血之亏,不论刚柔,非滋荣不能舒筋而活络。乍寒乍
热,发作有期,类疟也。若以疟治,则迁延难愈,神不守舍,言语无伦,似邪也。若以邪论
,危亡可待。去血多而大便燥结,苁蓉可加于生化汤中,非润肠承气之为患,汗多而小溲短
涩,六君子倍多参、 ,必生津助液之可利。加参生化频服,能救垂绝之危,长生活络能用
,可苏绝谷之人。颓疝脱肛多是气虚下陷,生化可参用补中益气。口噤拳挛,乃因血燥类疯
,加参生化宜服。产户入风而痛甚,服宜羌活养荣。玉门寒冷而不闭,洗宜床、菟、萸、硫
。类怔忡惊悸,生化加定志之品。似邪恍惚,生化加安神之法。因气而虚烦满闷,生化加木
香为佐。因食而酸嗳恶食,合六君加神曲、麦芽为良。不可用苏木、 蓬以破血,不可用枳
实、青皮以消胀。血崩血晕之危,汗脱气脱之急,连煎加参生化汤为最要务也。王太仆云∶
治下补下,制以缓急,缓则道路远而力微,急则气味浓而力重。丹溪云∶产后切不可发表。
故治产固本,当遵丹溪;服法宜效太仆。
生化汤原方
(分两斟酌在临用变通也)
川芎(二钱) 白当归(四钱) 炙甘草(五分) 炒黑干姜(四分) 单桃仁(十粒,去皮尖)
水二盅,陈酒半小杯,冲服。
产后血晕,因劳倦去血过多气竭神昏而晕。不可误认为恶血冲心,投散血之剂;不可误
认为痰火郁冒,用消降之方,宜服加味生化汤。
归身(三钱) 川芎(一钱五分) 炮姜(四分) 桃仁(十粒,去皮尖) 炙草(四分) 荆芥
炭(五分)
如汗多加人参一钱。
产后厥逆,因劳伤脾,孤脏不能注于四旁,故足冷而厥气上行。经云∶阳气衰于下,则
为寒厥是也。宜加参生化汤、滋荣复神汤。
加参生化汤
人参(一钱) 川芎(一钱五分) 归身(四钱) 桃仁(十粒) 炙甘草(五分) 炮姜(五分)
橘红(四分,盐水炒)
滋荣复神汤
川芎(一钱) 白术(一钱制) 黄 (二钱,炙) 人参(一钱五分) 当归(三钱) 熟地(
三钱
,炒) 麦冬(一钱) 炙甘草(三分) 五味子(十粒) 茯神(二钱) 熟附子(四分) 陈皮(四
分,炒)
如大便不通加苁蓉一钱五分。
产后血崩如紫色有块,是败血未尽,当用原方生化汤,加泽兰叶一钱五分。如血鲜红色
大来
,或因惊伤心,怒伤肝,劳肠脾,血则不能主,不能藏,不能统,阴络大伤矣,症甚急,当
用升举生化汤。
人参(一钱五分) 制白术(一钱五分) 归身(二钱,炒焦) 炙黄 (一钱) 熟地炭(三
钱)
荆芥炭(四分) 陈皮(四分,炒) 升麻(三分,蜜炙) 白芷(三分,炒炭) 川芎(六分,盐
水炒焦) 淡附子(二分) 炙甘草(四分)
如汗多加淮小麦四钱焙。
产后气短似喘,因血既暴去,气必上窜,脾失健运,不能上输于肺,所以呼吸短促,言
语不
相接续,急服加参生化汤、续气养荣汤。若认为痰火,而妄议散气化痰之方,误事多矣。
续气养荣汤
归身(四钱) 川芎(一钱) 炙甘草(四分) 炮姜(四分) 人参(一钱五分) 炙黄 (一
钱) 制白术(一钱) 熟地炭(三钱) 陈皮(四分,炒)
如烦渴加麦冬一钱五分,五味子十粒炒;如大便闭加淡苁蓉二钱;伤食加神曲八分炒,
楂炭一钱,砂仁三分;汗多加浮小麦四钱炒;如手足冷加淡附子三分。
产后妄言妄见,由气血两虚,魂魄无根据也。不可误认为邪祟,喷以符水,惊以法尺,多
致不救。丹溪云∶虚病似邪祟是也。又云∶欲泄其邪,当补其虚。宜服安神定志生化汤。
枣仁(一钱五分,炒熟) 远志(四分,炒) 柏子仁(一钱五分,勿研) 麦冬(一钱五分
,炒
)归身(三钱) 川芎(一钱) 桃仁(七粒,去皮尖) 炙甘草(四分) 炮姜炭(四分) 人参(
五分) 加龙眼肉(五个)
产后去血过多,防血脱;气短如喘,防气脱;汗多妄言妄见,防神脱。虽有血阴气阳之
分,而精散魂去之促无异,若非浓药急方,浓煎频服,奚能有救?宜服大补生化汤。
人参(一钱五分) 熟地(四钱) 炙黄 (一钱五分) 淡附子(三分) 五味子(十粒) 制
冬术
(一钱) 麦冬(一钱五分) 白桃仁(八粒) 归身(三钱) 川芎(八分) 炮姜(四分) 炙甘草
(三分)
产后伤食,因形体劳倦,脾胃俱虚,不思食而强与之,胃虽勉受,脾难转运,食停痞满
,嗳
腐吞酸,必须健脾助胃,加以轻品消导之药,则食化胀平。断不可用峻剂消之,致伤元气,
宜服健脾消食生化汤。
归身(三钱) 川芎(一钱) 焦白术(一钱) 焦神曲(一钱) 焦麦芽(一钱) 陈皮(五分
,炒) 炙甘草(四分)
如伤肉食加焦山楂一钱,砂仁四分,或以绢包炒熟麸皮,加芒硝少许,揉熨更稳。
产后因忿怒气逆,胸痞不舒,宜用木香生化汤。
煨木香(二分) 归身(三钱) 川芎(一钱) 炮姜(四分) 陈皮(四分,炒)
产后类疟,寒热往来,应期而发,此元虚而外邪易侵,不可作泛常疟治。有汗宜用滋荣
扶正化邪生化汤;无汗头痛,加减养胃汤。
归身(三钱) 川芎(一钱) 人参(一钱) 炙甘草(四分) 麦冬(一钱五分) 陈皮(四分
,炒) 炙黄 (八分) 藿香(三分) 荆芥炭(六分) 生姜(四分)
河井水煎服。
加减养胃汤
当归(三钱) 川芎(一钱二分) 藿香梗(四分) 炙甘草(四分) 人参(一钱) 焦白术(
一钱) 茯苓(一钱五分) 制半夏(八分) 橘皮(四分) 姜皮(二分) 酒炒柴胡(三分)
产后七日,内外发头痛,恶寒类太阳症;潮热自汗,大便不通,类阳明症;往来寒热,
口苦
胁痛,类少阳症,皆由气血两虚,阴阳不和,类外感伤寒治者,慎勿轻产而重伤寒,以麻黄
柴胡等汤治之也。盖产妇血脱之后,而重发汗,虚虚之祸,不可胜言。仲景有云∶亡血家不
可发汗。丹溪云∶产后切不可发表。古贤立说,皆具至理,即使真感伤寒,生化汤内芎、姜
亦能散邪。且《内经》云∶西北之气,散而寒之;东南之气,温而收之。即病同而治亦异。
至如产后属虚,无分南北,当于温补中少佐辛散可也,宜祛邪生化汤。
归身(三钱) 川芎(一钱五分) 炙甘草(四分) 炮姜(四分) 羌活(四分) 桃仁(十粒
,去皮尖) 防风(四分) 葱白(七寸)
如虚者加人参五分。
产后头痛,口燥咽干而渴,类少阴症;腹痛液干,大便实,类太阴症;汗出谵语,便闭
痉厥
,类厥阴症。多由劳倦伤脾,运化稽迟,气血枯竭,肠腑燥涸,乃虚证类实,承气诸汤断不
可施,宜养正通幽汤。
当归(四钱) 川芎(一钱五分) 炙甘草(四分) 陈皮(四分) 桃仁(十粒,去皮尖) 肉
苁蓉(一钱) 麻仁(一钱)
如汗多加人参一钱,黄 一钱;口渴加人参一钱,麦冬一钱五分;腹满液干加人参一钱
,大
腹皮一钱;汗出谵语便闭加人参一钱,熟枣仁二钱,柏子仁二钱,茯神二钱,远志肉四分,
麦冬一钱五分。
产后血气暴竭,百骸无以涵濡,卒尔口噤,牙关紧闭,手足挛急,症类中风,不可任用
中风
剂也。盖冲为血脉之海,血脉空虚,关节不能流利。治当先服生化汤,以生旺新血,如危极
,即服滋荣活络汤救之。
熟地(三钱) 人参(一钱) 炙黄 (一钱) 归身(四钱) 川芎(一钱) 茯神(一钱五分)
天
麻(六分,煨) 麦冬(一钱) 荆芥(四分) 防风(四分) 羌活(三分) 陈皮(四分) 炙甘草
(四分)
如有痰加制半夏一钱,姜汁一匙,竹沥一匙;有食加山楂炭一钱五分,焦神曲一钱;大
便闭
加柏子仁二钱,苁蓉一钱五分;惊悸加熟枣仁二钱;言语恍惚,加远志肉四分炒,石菖蒲四
分炒,枣仁二钱炒。
产后汗出不止,亡阳之征也。盖汗为心之液,又肾十五液,血去而心肾大亏,必须急补
心肾。益荣卫而嘘血归源,则汗自止。宜补阳益阴生化汤以救之。
人参(一钱五分) 熟地(三钱,炒) 炙黄 (二钱) 炙甘草(四分) 归身(三钱) 川芎
(一
钱) 炮姜(四分) 牡蛎(二钱) 制白术(一钱) 桃仁(六粒,去皮尖) 浮小麦(一撮)
如渴加麦冬一钱五分,五味子十粒。
产后舌燥口渴,兼小便不利,由产后失血,或汗多所致。治当助脾益肺,调养气血,则
津液
生而小便自利矣。断不可用芩、连、知、柏以降之,五苓等剂以通之,宜服生津止渴益水散
。
炙黄 (一钱五分) 人参(一钱五分) 熟地(三钱,炒) 五味子(十粒) 麦冬(二钱)
归身(三钱) 川芎(一钱) 茯苓(一钱五分) 生甘草(三分) 炙升麻(三分)
产后小便不禁,是气血虚不能收摄肾气,宜加味生化汤。
盐水炒益智仁(四分) 牡蛎(三钱) 北五味(十粒) 归身(二钱) 炙黄 (一钱) 川
芎(
一钱) 桃仁(十粒,去皮尖) 炮姜(四分) 熟地(三钱) 覆盆子(八分) 菟丝子(一钱,炒
)炙甘草(四分)
产后泄泻,非杂症餐泄洞泻,水谷下注之比,大率气血虚,易于食积伤湿所致,宜消补
兼施,加味参苓生化汤。
白术(一钱土炒) 人参(一钱) 茯苓(二钱) 川芎(一钱) 当归(二钱,土炒) 炮姜(
四分) 炙甘草(四分) 焦神曲(五分) 焦麦芽(八分) 广皮(四分) 泽兰(一钱)
如有寒加生姜一片,大枣二枚;如热去炮姜加金石斛三钱;如痛加煨木香四分;如至五
更而甚者,加煨肉果四分。
产后完谷不化,因劳倦伤脾,而转输稽迟也。又有饮食太过,脾胃受伤,当血块未散之
时,患此脾败胃弱之症,宜先服香砂生化汤,继服加味参苓白术散,乃可无虞。
香砂生化汤
砂仁(三分,炒研) 益智仁(三分,炒) 归身(三钱,土炒焦) 川芎(一钱) 炙甘草(
四分) 炮姜炭(四分) 泽兰(一钱五分) 焦锅粑(五钱)
加味参苓白术散
人参(一钱) 白术(一钱五分,土炒) 茯苓(二钱) 归身(三钱,土炒) 川芎(一钱)
炮姜
(四分) 炙甘草(四分) 益智仁(三分,炒) 泽兰(一钱五分) 白芍药(八分,酒炒炭) 广
妇女的疾病中,没有比产后病更严重的了。因为产后气血大量亏损,内受七情(喜、怒、忧、思、悲、恐、惊)影响,外感六气(风、寒、暑、湿、燥、火),稍有感触,就足以导致疾病。而且产后症状多与瘀血阻滞相似,不能仅仅把活血化瘀作为治疗手段,否则会导致各种变证出现。读《金匮要略》一书,发现有使用大黄等峻猛药物的情况,这并不是古人立法不好,而是因为古时候人们先天禀赋充足,或者西北地区土地坚实厚重,人体质强壮,所以使用这些药物效果良好。至于我们这里(指东南地区),人体质柔弱,多在深闺娇生惯养,怎么能承受这种攻伐损伤呢?这是看病不可拘泥于古人的原因。当时的人常说产后不可进补,怕引起瘀血阻滞,往往使用苏木、红花等药物,以行血化瘀为当务之急。如果导致出血不止,立刻会出现厥脱(四肢冰冷、意识丧失的危重状态),急救都难以措手,这难道不令人恐惧吗?朱丹溪说:产后以大补气血为主,即使有其他症状,也作为次要处理。王肯堂说:产后使用泻下药物的,百无一活。这话确实正确啊。
《金匮要略》说:刚生产完的产妇有三种病:一是痉病(筋脉拘急、角弓反张),二是郁冒(头晕目眩、昏闷),三是大便难。新产之后血虚,出汗多,容易感受风邪,所以导致痉病;失血又出汗,寒气多,所以导致郁冒;津液耗伤,胃中干燥,所以导致大便难。《医宗必读》解释说:血虚汗出,筋脉失去滋养,风邪侵入使筋脉更加僵硬,这是筋的病。阴血亡失,血虚,阳气逆乱厥冷,而寒气又郁结其中,就会头晕眼花,这是神的病。胃贮藏津液,并渗灌输布到各阳经,津液亡失导致胃燥,大肠失去滋润,所以大便困难,这是津液的病。这三种病不同,但都是亡血伤津造成的,所以产后血虚的各种症状,都可以由此类推,这样就不会误治了。
产后各种疾病,总宜以生化汤为主方,根据症状加减即可。《竹林寺世传秘本》生化汤论说:产后气血突然虚弱,理应当大补,但恶露未尽,用补法必须知道不要滞碍留邪。血能化旧,又能生新,不损伤元气,在行血中带补益,才是万全之策。世人用回生丹来治疗胎盘不下,攻逐血块,虽然见效快,未免亏损元气,不是良剂。不得已而使用时,只可服一丸,用人参汤送下,才无危险。生化汤是根据药性功用而立名的。产后瘀血固然应当消除,新血应当生成,如果专事消瘀,则新血不得安宁;如果专事补血,则旧血反而停滞。考察药性,川芎、当归、桃仁善于破除恶血,迅速生成新血,佐以炮姜、甘草,引导这三味药入肺肝二经,生血理气,五味药组成一方,则在行血中有补益,化瘀中有新生,确实是产后的要药。加减得当,在于临证医生的善于领悟。又论产后治法说:产后因忧惊劳倦导致气血暴虚等各种症状,乘虚容易发作,如果有气滞不要专事耗散,有食积不要专事消导,热证不可用黄芩、黄连,寒证不可用肉桂、附子。用寒凉药则血块停结,用温热药则新血崩漏流出。至于虚人外感,出现三阳表证似乎可以发汗,但在产后如果用麻黄,则会双重耗竭阳气。出现三阴里证似乎可以攻下,但在产后如果用承气汤,则会双重亡失阴液。耳聋胁痛,是肝肾恶血停滞,不要用柴胡。谵语汗出,是元气虚弱似有邪气,不要当作胃实热证。厥逆是由于阳气气血衰败,不分寒热虚弱,非大补不能回阳救逆。痹症是因为阴血亏虚,不论刚痹柔痹,非滋养荣血不能舒筋活络。乍寒乍热,发作有定时,类似疟疾。如果按疟疾治疗,则迁延难愈。神不守舍,言语无序,类似邪祟。如果按邪祟论治,危亡立待。去血多导致大便燥结,可在生化汤中加入肉苁蓉,而不是用润肠承气汤造成祸患。汗多导致小便短涩,可用六君子汤倍加人参、白术,必定能生津助液从而通利。频服加参生化汤,能救垂危之症;长生活络汤能用,可苏醒绝食之人。颓疝脱肛多是气虚下陷,生化汤可参考配合补中益气汤。口噤拳挛,是因为血燥类似疯病,宜服用加参生化汤。产户受风疼痛剧烈,宜服用羌活养荣汤。玉门寒冷而不闭合,宜用床根、菟丝子、山茱萸、硫磺洗剂。类似怔忡惊悸,生化汤加定志之品。类似邪祟恍惚,生化汤加安神之法。因气虚导致的烦满闷胀,生化汤加木香为佐。因食积导致的酸嗳恶食,合用六君子汤加神曲、麦芽为好。不可用苏木、蓬莪茂破血,不可用枳实、青皮消胀。血崩血晕的危症,汗脱气脱的急症,连煎加参生化汤是最紧要的。王冰说:治下焦补下焦,制方讲究缓急,缓则药力微弱且路程远,急则气味浓厚且力量重。朱丹溪说:产后切不可发表。所以治疗产后固本,应当遵循朱丹溪的说法;服药方法宜效法王冰的理论。
生化汤原方
(分量斟酌,临用时变通)
川芎(二钱) 白当归(四钱) 炙甘草(五分) 炒黑干姜(四分) 单桃仁(十粒,去皮尖)
水两盅,陈酒半小杯,冲服。
产后血晕,因劳倦去血过多,气竭神昏而晕倒。不可误认为是恶血冲心,投用散血药剂;不可误认为是痰火郁冒,用消降方剂,宜服用加味生化汤。
归身(三钱) 川芎(一钱五分) 炮姜(四分) 桃仁(十粒,去皮尖) 炙草(四分) 荆芥炭(五分)
如汗多加人参一钱。
产后厥逆,因劳伤脾,孤脏之气不能注于四肢,所以脚冷且厥气上行。经书说:阳气衰于下,则为寒厥。宜服用加参生化汤、滋荣复神汤。
加参生化汤
人参(一钱) 川芎(一钱五分) 归身(四钱) 桃仁(十粒) 炙甘草(五分) 炮姜(五分) 橘红(四分,盐水炒)
滋荣复神汤
川芎(一钱) 白术(一钱,制过) 黄芪(二钱,炙) 人参(一钱五分) 当归(三钱) 熟地(三钱,炒) 麦冬(一钱) 炙甘草(三分) 五味子(十粒) 茯神(二钱) 熟附子(四分) 陈皮(四分,炒)
如大便不通加肉苁蓉一钱五分。
产后血崩如紫色有块,是败血未尽,应当用原方生化汤,加泽兰叶一钱五分。如血色鲜红量大,或因惊吓伤心,愤怒伤肝,劳累伤脾,血则不能主司、不能藏摄、不能统摄,阴络大伤了,症状很急,应当用升举生化汤。
人参(一钱五分) 制白术(一钱五分) 归身(二钱,炒焦) 炙黄芪(一钱) 熟地炭(三钱) 荆芥炭(四分) 陈皮(四分,炒) 升麻(三分,蜜炙) 白芷(三分,炒炭) 川芎(六分,盐水炒焦) 淡附子(二分) 炙甘草(四分)
如汗多加淮小麦四钱焙干。
产后气短似喘,因血突然大量流失,气必上窜,脾失健运,不能上输于肺,所以呼吸短促,言语不相接续,急服加参生化汤、续气养荣汤。若认为是痰火,而妄议散气化痰的方剂,误事很多。
续气养荣汤
归身(四钱) 川芎(一钱) 炙甘草(四分) 炮姜(四分) 人参(一钱五分) 炙黄芪(一钱) 制白术(一钱) 熟地炭(三钱) 陈皮(四分,炒)
如烦渴加麦冬一钱五分,五味子十粒炒;如大便闭加肉苁蓉二钱;伤食加神曲八分炒,山楂炭一钱,砂仁三分;汗多加浮小麦四钱炒;如手足冷加淡附子三分。
产后妄言妄见,由气血两虚,魂魄无所依托所致。不可误认为是邪祟,喷符水,用法尺惊吓,多导致无法救治。朱丹溪说:虚病似邪祟。又说:想要泄除邪气,应当补其虚损。宜服用安神定志生化汤。
枣仁(一钱五分,炒熟) 远志(四分,炒) 柏子仁(一钱五分,勿研碎) 麦冬(一钱五分,炒) 归身(三钱) 川芎(一钱) 桃仁(七粒,去皮尖) 炙甘草(四分) 炮姜炭(四分) 人参(五分) 加龙眼肉(五个)
产后去血过多,防血脱;气短如喘,防气脱;汗多妄言妄见,防神脱。虽然有血属阴、气属阳的区别,但精散魂去的危急程度无异,如果不是浓药急方,浓煎频服,怎么能有救?宜服用大补生化汤。
人参(一钱五分) 熟地(四钱) 炙黄芪(一钱五分) 淡附子(三分) 五味子(十粒) 制冬术(一钱) 麦冬(一钱五分) 白桃仁(八粒) 归身(三钱) 川芎(八分) 炮姜(四分) 炙甘草(三分)
产后伤食,因形体劳倦,脾胃俱虚,不思饮食却强行喂食,胃虽勉强接受,脾难转运,食物停聚痞满,嗳腐吞酸,必须健脾助胃,加以轻品消导的药物,则食化胀平。断不可用峻剂消导,以致损伤元气,宜服用健脾消食生化汤。
归身(三钱) 川芎(一钱) 焦白术(一钱) 焦神曲(一钱) 焦麦芽(一钱) 陈皮(五分,炒) 炙甘草(四分)
如伤肉食加焦山楂一钱,砂仁四分,或用绢包炒熟麸皮,加芒硝少许,揉熨更稳妥。
产后因忿怒气逆,胸痞不舒,宜用木香生化汤。
煨木香(二分) 归身(三钱) 川芎(一钱) 炮姜(四分) 陈皮(四分,炒)
产后类疟,寒热往来,应期而发,这是元气虚弱而外邪易侵,不可作一般疟疾治疗。有汗宜用滋荣扶正化邪生化汤;无汗头痛,用加减养胃汤。
归身(三钱) 川芎(一钱) 人参(一钱) 炙甘草(四分) 麦冬(一钱五分) 陈皮(四分,炒) 炙黄芪(八分) 藿香(三分) 荆芥炭(六分) 生姜(四分)
河井水煎服。
加减养胃汤
当归(三钱) 川芎(一钱二分) 藿香梗(四分) 炙甘草(四分) 人参(一钱) 焦白术(一钱) 茯苓(一钱五分) 制半夏(八分) 橘皮(四分) 姜皮(二分) 酒炒柴胡(三分)
产后七日,内外发头痛,恶寒类似太阳病;潮热自汗,大便不通,类似阳明病;往来寒热,口苦胁痛,类似少阳病,皆由气血两虚,阴阳不和,类似外感伤寒治疗者,千万不要轻视产后的虚弱而重伤寒,用麻黄、柴胡等汤剂治疗。大概产妇血脱之后,再重发汗,虚上加虚的祸害,不可胜言。张仲景说:亡血家不可发汗。朱丹溪说:产后切不可发表。古贤立论,皆具至理,即使真感伤寒,生化汤内川芎、干姜也能散邪。且《内经》说:西北之气,散而寒之;东南之气,温而收之。即病相同而治法也不同。至于产后属虚,不分南北,应当在温补中少佐辛散药物即可,宜用祛邪生化汤。
归身(三钱) 川芎(一钱五分) 炙甘草(四分) 炮姜(四分) 羌活(四分) 桃仁(十粒,去皮尖) 防风(四分) 葱白(七寸)
如虚者加人参五分。
产后头痛,口燥咽干而渴,类似少阴病;腹痛液干,大便实,类似太阴病;汗出谵语,便闭痉厥,类似厥阴病。多由劳倦伤脾,运化稽迟,气血枯竭,肠腑燥涸,乃虚证类实证,承气诸汤断不可施,宜用养正通幽汤。
当归(四钱) 川芎(一钱五分) 炙甘草(四分) 陈皮(四分) 桃仁(十粒,去皮尖) 肉苁蓉(一钱) 麻仁(一钱)
如汗多加人参一钱,黄芪一钱;口渴加人参一钱,麦冬一钱五分;腹满液干加人参一钱,大腹皮一钱;汗出谵语便闭加人参一钱,熟枣仁二钱,柏子仁二钱,茯神二钱,远志肉四分,麦冬一钱五分。
产后血气暴竭,百骸无以涵濡,突然口噤,牙关紧闭,手足挛急,症状类似中风,不可任用中风药剂。盖冲脉为血脉之海,血脉空虚,关节不能流利。治当先服生化汤,以生旺新血,如病情危极,即服滋荣活络汤救之。
熟地(三钱) 人参(一钱) 炙黄芪(一钱) 归身(四钱) 川芎(一钱) 茯神(一钱五分) 天麻(六分,煨) 麦冬(一钱) 荆芥(四分) 防风(四分) 羌活(三分) 陈皮(四分) 炙甘草(四分)
如有痰加制半夏一钱,姜汁一匙,竹沥一匙;有食加山楂炭一钱五分,焦神曲一钱;大便闭加柏子仁二钱,肉苁蓉一钱五分;惊悸加熟枣仁二钱;言语恍惚,加远志肉四分炒,石菖蒲四分炒,枣仁二钱炒。
产后汗出不止,是亡阳的征象。盖汗为心之液,又是肾之液,血去而心肾大亏,必须急补心肾。益荣卫而嘘血归源,则汗自止。宜用补阳益阴生化汤来救治。
人参(一钱五分) 熟地(三钱,炒) 炙黄芪(二钱) 炙甘草(四分) 归身(三钱) 川芎(一钱) 炮姜(四分) 牡蛎(二钱) 制白术(一钱) 桃仁(六粒,去皮尖) 浮小麦(一撮)
如渴加麦冬一钱五分,五味子十粒。
产后舌燥口渴,兼小便不利,由产后失血,或汗多所致。治当助脾益肺,调养气血,则津液生而小便自利矣。断不可用黄芩、黄连、知母、黄柏以降之,五苓散等剂以通之,宜服生津止渴益水散。
炙黄芪(一钱五分) 人参(一钱五分) 熟地(三钱,炒) 五味子(十粒) 麦冬(二钱) 归身(三钱) 川芎(一钱) 茯苓(一钱五分) 生甘草(三分) 炙升麻(三分)
产后小便不禁,是气血虚不能收摄肾气,宜用加味生化汤。
盐水炒益智仁(四分) 牡蛎(三钱) 北五味(十粒) 归身(二钱) 炙黄芪(一钱) 川芎(一钱) 桃仁(十粒,去皮尖) 炮姜(四分) 熟地(三钱) 覆盆子(八分) 菟丝子(一钱,炒) 炙甘草(四分)
产后泄泻,不是杂症餐泄洞泻,水谷下注之比,大率气血虚,易于食积伤湿所致,宜消补兼施,用加味参苓生化汤。
白术(一钱土炒) 人参(一钱) 茯苓(二钱) 川芎(一钱) 当归(二钱,土炒) 炮姜(四分) 炙甘草(四分) 焦神曲(五分) 焦麦芽(八分) 广皮(四分) 泽兰(一钱)
如有寒加生姜一片,大枣二枚;如热去炮姜加金石斛三钱;如痛加煨木香四分;如至五更而甚者,加煨肉果四分。
产后完谷不化,因劳倦伤脾,而转输稽迟也。又有饮食太过,脾胃受伤,当血块未散之时,患此脾败胃弱之症,宜先服香砂生化汤,继服加味参苓白术散,乃可无虞。
香砂生化汤
砂仁(三分,炒研) 益智仁(三分,炒) 归身(三钱,土炒焦) 川芎(一钱) 炙甘草(四分) 炮姜炭(四分) 泽兰(一钱五分) 焦锅粑(五钱)
加味参苓白术散
人参(一钱) 白术(一钱五分,土炒) 茯苓(二钱) 归身(三钱,土炒) 川芎(一钱) 炮姜(四分) 炙甘草(四分) 益智仁(三分,炒) 泽兰(一钱五分) 白芍药(八分,酒炒炭) 广
Among women's diseases, none is more serious than postpartum disorders. This is because after childbirth, Qi and Blood are severely depleted. Internally affected by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), and externally exposed to the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), even slight contact can lead to disease. Moreover, symptoms often resemble those of blood stasis; one should not merely focus on expelling stasis, lest various complications arise. Reading the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), one finds cases where harsh agents like Rhubarb were used. This does not imply that ancient physicians' legislation was flawed; rather, it is because in ancient times, people had sufficient congenital constitution, or lived in the northwest where the soil is firm and rich, making them robust, thus allowing for such treatments. However, in our region (referring to the southeast), people have delicate constitutions and are pampered in deep courtyards; how could they withstand such invasive and draining therapies? This illustrates why medical practice must not be rigidly bound by ancient precedents. Contemporary people often claim that tonification is contraindicated postpartum, fearing blood stasis, and frequently employ drugs like Sappan Wood (*Caesalpinia sappan*) and Safflower (*Carthamus tinctorius*), prioritizing blood circulation. If this leads to unceasing bleeding, syncope and collapse may occur instantly, making emergency treatment difficult. Is this not a cause for fear? Zhu Danxi stated: "Postpartum treatment should primarily focus on greatly tonifying Qi and Blood; even if other symptoms exist, they should be treated secondarily." Wang Kentang stated: "Those who use purgatives postpartum rarely survive." These words are indeed true.
The *Jin Gui Yao Lue* states: "Newly delivered women suffer from three diseases: first, Spasm (Jing); second, Depression and Vertigo (Yu Mao); third, Difficulty in Defecation. New postpartum blood deficiency with excessive sweating makes one susceptible to Wind, leading to Spasm; loss of blood combined with sweating and excess Cold leads to Yu Mao; loss of body fluids causing Stomach dryness leads to difficulty in defecation." The *Yi Zong Bi Du* explains: "Blood deficiency and sweating cause the sinews and vessels to lose nourishment; Wind invasion exacerbates stiffness, which is a disorder of the sinews. Loss of Yin and blood deficiency cause Yang Qi to reverse and collapse, compounded by Cold stagnation, resulting in dizziness and blurred vision, which is a disorder of the Spirit. The Stomach stores body fluids and distributes them to the Yang meridians; loss of fluids causes Stomach dryness, leading to lack of lubrication in the Large Intestine and difficulty in defecation, which is a disorder of fluids. Although these three diseases differ, they all stem from loss of blood and injury to fluids. Therefore, various postpartum blood-deficiency symptoms can be inferred from this principle, preventing misdiagnosis."
For various postpartum diseases, the primary formula should always be *Shenghua Tang* (Decoction for Generating New Blood), modified according to symptoms. The *Zhulin Temple Secret Manual* commentary on *Shenghua Tang* states: "Postpartum Qi and Blood are suddenly deficient, requiring great tonification. However, since lochia has not yet cleared, tonification must not cause stagnation. Blood can transform old stasis and generate new blood without damaging the original deficiency; combining movement with tonification is the perfect approach." People commonly use *Huisheng Dan* (Life-Returning Pill) to expel the placenta and attack blood masses. Although it shows rapid effects, it inevitably damages Yuan Qi and is not a fine preparation. If used out of necessity, only one pill should be taken, washed down with Ginseng Decoction, to avoid danger. *Shenghua Tang* is named for its medicinal properties and functions. Postpartum stasis must be eliminated, and new blood must be generated. If one focuses solely on eliminating stasis, new blood will not settle; if one focuses solely on generating blood, old stasis will stagnate. Examining the properties: Chuanxiong (*Ligusticum chuanxiong*), Angelica (*Angelica sinensis*), and Peach Kernel (*Prunus persica*) excel at breaking bad blood and rapidly generating new blood. Assisted by Roasted Ginger (*Zingiberis rhizoma preparatum*) and Licorice (*Glycyrrhiza uralensis*), guiding these three into the Lung and Liver meridians to generate blood and regulate Qi, the five ingredients together create a formula where tonification accompanies movement, and generation accompanies transformation. It is truly an essential medicine for postpartum care. Proper modification depends on the clinician's insight.
Regarding postpartum treatment methods: Postpartum conditions caused by worry, fright, fatigue, and overwork lead to sudden Qi and Blood deficiency. If there is Qi stagnation, do not solely use dispersing agents; if there is food retention, do not solely use digestive agents. For Heat, do not use Scutellaria (*Scutellaria baicalensis*) and Coptis (*Coptis chinensis*); for Cold, do not use Cinnamon Twig (*Cinnamomi ramulus*) and Aconite (*Aconiti lateralis radix preparata*). Using cold herbs causes blood masses to bind; using hot herbs causes new blood to flood. Regarding deficiency with external contraction, if Yang-Ming exterior symptoms appear suggesting diaphoresis, using Ephedra (*Ephedrae herba*) postpartum would doubly exhaust Yang. If Yin interior symptoms suggest purgation, using Chengqi Decoctions postpartum would doubly deplete Yin. Deafness and hypochondriac pain indicate stagnant evil blood in the Liver and Kidney; do not use Bupleurum (*Bupleuri radix*). Delirium and sweating indicate Yuan Qi weakness resembling pathogenic factors; do not treat as Stomach excess. Syncope results from decline in Yang Qi and Blood; regardless of cold or heat deficiency, only great tonification can restore Yang and revive weakness. Bi syndrome is due to Yin and Blood deficiency; whether rigid or flexible, only nourishing Ying and relaxing sinews can activate collaterals. Alternating chills and fever with periodic onset resembles Malaria. Treating it as malaria prolongs recovery. Disordered spirit and speech resemble possession; treating it as such invites imminent death. Excessive blood loss causing dry stool can be treated by adding Cistanche (*Cistanches deserticola*) to *Shenghua Tang*, avoiding the harm of Runchang Chengqi Decoction. Excessive sweating causing scanty, painful urination can be treated by doubling Ginseng and Atractylodes (*Atractylodis macrocephalae rhizoma*) in Liujunzi Decoction to generate fluids and promote urination. Frequent administration of Ginseng-added *Shenghua Tang* can save critical cases; Changsheng Huoluo Decoction can revive those who have stopped eating. Genital prolapse and rectal prolapse are mostly due to Qi deficiency sinking; *Shenghua Tang* can be combined with Buzhong Yiqi Decoction. Trismus and clenched fists result from blood dryness resembling convulsions; Ginseng-added *Shenghua Tang* is suitable. Severe pain from wind entering the vagina requires Qianghuo Yangrong Decoction. Coldness and laxity of the vulva require washing with Bedroot (*Dioscorea nipponica*), Dodder Seed (*Cuscutae semen*), Cornus (*Corni fructus*), and Sulfur. Palpitations resembling Zenithong require *Shenghua Tang* added with calming agents. Hallucinations resembling possession require *Shenghua Tang* added with spirit-calming methods. Qi-deficiency irritability and fullness require *Shenghua Tang* assisted by Costus (*Saussureae radix*). Food-induced acid belching and aversion to food require Liujunzi Decoction assisted by Medicated Leaven (*Medicatis fermentatum*) and Barley Sprout (*Hordei fructus germinatus*). Do not use Sappan Wood or Curcuma (*Curcumae longae rhizoma*) to break blood; do not use Immature Bitter Orange (*Aurantii fructus immaturus*) or Green Tangerine Peel (*Citri reticulatae pericarpium*) to reduce distension. In critical cases of flooding and fainting, or urgent sweat and Qi collapse, continuously decocted Ginseng-added *Shenghua Tang* is paramount. Wang Bing stated: "Treating the lower jiao requires balancing urgency and slowness; slow action yields weak force over long distances, while urgent action yields strong force through concentrated flavors." Zhu Danxi stated: "Postpartum treatment must absolutely avoid releasing the exterior." Thus, for postpartum root-fortification, follow Zhu Danxi; for administration methods, emulate Wang Bing.
**Shenghua Tang Original Formula**
(Proportions adjusted as needed during use)
Chuanxiong (2 qian), White Angelica (4 qian), Honey-fried Licorice (5 fen), Stir-fried Black Dried Ginger (4 fen), Single Peach Kernel (10 grains, skin and tip removed).
Decoct in two cups of water, add half a small cup of aged wine, and take.
**Postpartum Blood Faintness**
Caused by excessive blood loss due to fatigue, leading to Qi exhaustion and spirit confusion. Do not mistake it for evil blood rushing to the heart and administer blood-dispersing agents; do not mistake it for Phlegm-Fire depression and administer descending agents. Use Modified *Shenghua Tang*.
Angelica Root (3 qian), Chuanxiong (1.5 qian), Roasted Ginger (4 fen), Peach Kernel (10 grains, skin and tip removed), Honey-fried Licorice (4 fen), Charred Schizonepeta (5 fen).
If sweating is excessive, add Ginseng (1 qian).
**Postpartum Cold Extremities (Jue Ni)**
Caused by spleen injury from overwork, where the isolated organ cannot distribute Qi to the four limbs, causing cold feet and upward-rising Jue Qi. The Classics state: "Yang Qi declining below leads to Cold Jue." Use Ginseng-added *Shenghua Tang* and Zirong Fushen Decoction.
**Ginseng-added Shenghua Tang**
Ginseng (1 qian), Chuanxiong (1.5 qian), Angelica Root (4 qian), Peach Kernel (10 grains), Honey-fried Licorice (5 fen), Roasted Ginger (5 fen), Tanged Red Peel (4 fen, stir-fried with salt water).
**Zirong Fushen Decoction**
Chuanxiong (1 qian), Atractylodes Macrocephala (1 qian, processed), Astragalus (2 qian, honey-fried), Ginseng (1.5 qian), Danggui (3 qian), Prepared Rehmannia (3 qian, stir-fried), Ophiopogon (1 qian), Honey-fried Licorice (3 fen), Schisandra (10 grains), Poria with Hostwood (2 qian), Prepared Aconite (4 fen), Tangerine Peel (4 fen, stir-fried).
If constipation occurs, add Cistanche (1.5 qian).
**Postpartum Flooding**
If blood is purple with clots, indicating residual bad blood, use original *Shenghua Tang* plus Lycopodium Leaf (Ze Lan Ye, 1.5 qian). If blood is bright red and heavy, possibly due to heart injury from fright, liver injury from anger, or spleen injury from labor, causing failure to govern, store, or control blood, with severe damage to Yin collaterals, use Shengju *Shenghua Tang*.
Ginseng (1.5 qian), Processed Atractylodes Macrocephala (1.5 qian), Angelica Root (2 qian, stir-fried until charred), Honey-fried Astragalus (1 qian), Prepared Rehmannia Char (3 qian), Charred Schizonepeta (4 fen), Tangerine Peel (4 fen, stir-fried), Cimicifuga (3 fen, honey-fried), Angelica Dahurica (3 fen, stir-fried until charred), Chuanxiong (6 fen, stir-fried in salt water), Light Aconite (2 fen), Honey-fried Licorice (4 fen).
If sweating is excessive, add Huai Wheat (4 qian, roasted).
**Postpartum Shortness of Breath Resembling Asthma**
Caused by sudden massive blood loss, causing Qi to rush upward. Spleen fails in transportation, unable to send essence to the Lungs, resulting in short breathing and disjointed speech. Urgently administer Ginseng-added *Shenghua Tang* and Xuqi Yangrong Decoction. Mistaking this for Phlegm-Fire and prescribing Qi-scattering or Phlegm-resolving formulas causes much error.
**Xuqi Yangrong Decoction**
Angelica Root (4 qian), Chuanxiong (1 qian), Honey-fried Licorice (4 fen), Roasted Ginger (4 fen), Ginseng (1.5 qian), Honey-fried Astragalus (1 qian), Processed Atractylodes Macrocephala (1 qian), Prepared Rehmannia Char (3 qian), Tangerine Peel (4 fen, stir-fried).
If irritability and thirst occur, add Ophiopogon (1.5 qian) and stir-fried Schisandra (10 grains). If constipation, add Cistanche (2 qian). If food stagnation, add stir-fried Medicated Leaven (8 fen), Charred Hawthorn (1 qian), and Amomum (3 fen). If sweating is excessive, add stir-fried Floating Wheat (4 qian). If hands and feet are cold, add Light Aconite (3 fen).
**Postpartum Delirium and Hallucinations**
Caused by dual deficiency of Qi and Blood, leaving the Hun and Po without foundation. Do not mistake this for demonic possession, spray talisman water, or use ritual rulers to frighten, as this often leads to untreatable conditions. Zhu Danxi said: "Deficiency diseases resemble possession." He also said: "To drain the pathogen, one must tonify the deficiency." Use Anshen Dingzhi *Shenghua Tang*.
Stir-fried Sour Date Kernel (1.5 qian), Polygala (4 fen, stir-fried), Biota Seed (1.5 qian, do not crush), Stir-fried Ophiopogon (1.5 qian), Angelica Root (3 qian), Chuanxiong (1 qian), Peach Kernels (7 grains, skin and tip removed), Honey-fried Licorice (4 fen), Charred Roasted Ginger (4 fen), Ginseng (5 fen), add Longan Aril (5 pieces).
Excessive blood loss risks Blood Collapse; shortness of breath risks Qi Collapse; excessive sweating with delirium risks Spirit Collapse. Although Blood is Yin and Qi is Yang, the urgency of scattering Essence and departing Hun is no different. Unless thick medicines and urgent prescriptions are decocted strongly and taken frequently, rescue is impossible. Use Dabu *Shenghua Tang*.
Ginseng (1.5 qian), Prepared Rehmannia (4 qian), Honey-fried Astragalus (1.5 qian), Light Aconite (3 fen), Schisandra (10 grains), Processed Winter Atractylodes (1 qian), Ophiopogon (1.5 qian), White Peach Kernel (8 grains), Angelica Root (3 qian), Chuanxiong (8 fen), Roasted Ginger (4 fen), Honey-fried Licorice (3 fen).
**Postpartum Food Stagnation**
Caused by physical fatigue and dual deficiency of Spleen and Stomach. Lack of appetite but forced feeding leads to Stomach accepting reluctantly and Spleen failing to transport. Food stagnates causing fullness, belching of rotten smells, and acid regurgitation. Must strengthen Spleen and assist Stomach with mild digestive herbs to resolve food and relieve distension. Never use harsh purgatives that damage Yuan Qi. Use Jianpi Xiaoshi *Shenghua Tang*.
Angelica Root (3 qian), Chuanxiong (1 qian), Charred Atractylodes Macrocephala (1 qian), Charred Medicated Leaven (1 qian), Charred Barley Sprout (1 qian), Tangerine Peel (5 fen, stir-fried), Honey-fried Licorice (4 fen).
If meat consumption caused it, add Charred Hawthorn (1 qian) and Amomum (4 fen), or rub with flour fried in silk bag with a little Mirabilite for better stability.
**Postpartum Anger and Qi Reversal**
Chest fullness and discomfort due to anger and Qi reversal. Use Muxiang *Shenghua Tang*.
Roasted Costus (2 fen), Angelica Root (3 qian), Chuanxiong (1 qian), Roasted Ginger (4 fen), Tangerine Peel (4 fen, stir-fried).
**Postpartum Malaria-like Symptoms**
Alternating chills and fever, occurring periodically. This is Yuan Qi deficiency allowing easy invasion of external pathogens; do not treat as ordinary malaria. With sweating, use Zirong Fuzheng Huaxie *Shenghua Tang*; without sweating and with headache, use Jiawei Yangwei Decoction.
Angelica Root (3 qian), Chuanxiong (1 qian), Ginseng (1 qian), Honey-fried Licorice (4 fen), Ophiopogon (1.5 qian), Tangerine Peel (4 fen, stir-fried), Honey-fried Astragalus (8 fen), Agastache (3 fen), Charred Schizonepeta (6 fen), Fresh Ginger (4 fen).
Decoct in river or well water.
**Modified Yangwei Decoction**
Danggui (3 qian), Chuanxiong (1.2 qian), Agastache Stem (4 fen), Honey-fried Licorice (4 fen), Ginseng (1 qian), Charred Atractylodes Macrocephala (1 qian), Poria (1.5 qian), Processed Pinellia (8 fen), Tangerine Peel (4 fen), Ginger Peel (2 fen), Wine-stir-fried Bupleurum (3 fen).
**Postpartum Headache on the Seventh Day**
Internal and external headache with aversion to cold resembles Taiyang syndrome; tidal fever and spontaneous sweating with constipation resembles Yangming syndrome; alternating chills and fever with bitter taste and hypochondriac pain resembles Shaoyang syndrome. All result from dual Qi and Blood deficiency and Yin-Yang disharmony. Those treating it like external contraction Cold Damage must not lightly assume postpartum weakness allows for heavy Cold Damage treatment with Mahuang or Chaihu decoctions. After blood loss, heavy diaphoresis causes irreversible double deficiency. Zhang Zhongjing said: "One who has lost blood must not be sweated." Zhu Danxi said: "Postpartum treatment must absolutely avoid releasing the exterior." Ancient sages' theories are profound. Even if genuine Cold Damage exists, Chuanxiong and Ginger in *Shenghua Tang* can disperse pathogens. The *Neijing* states: "Northwest Qi is scattered and cooled; Southeast Qi is warmed and gathered." Same disease, different treatment. Postpartum is always deficiency; regardless of north or south, warm tonification with slight acrid dispersion is appropriate. Use Quxie *Shenghua Tang*.
Angelica Root (3 qian), Chuanxiong (1.5 qian), Honey-fried Licorice (4 fen), Roasted Ginger (4 fen), Notopterygium (4 fen), Peach Kernel (10 grains, skin and tip removed), Saposhnikovia (4 fen), Scallion White (7 cun).
If deficient, add Ginseng (5 fen).
**Postpartum Headache with Dry Mouth**
Headache, dry mouth and throat with thirst resembles Shaoyin syndrome; abdominal pain with fluid dryness and solid stool resembles Taiyin syndrome; sweating, delirium, constipation, and spasms resemble Jueyin syndrome. Mostly caused by fatigue injuring Spleen, delayed transformation, exhaustion of Qi and Blood, and dry intestines. This is deficiency mimicking excess; Chengqi Decoctions must absolutely not be used. Use Yangzheng Tongyou Decoction.
Danggui (4 qian), Chuanxiong (1.5 qian), Honey-fried Licorice (4 fen), Tangerine Peel (4 fen), Peach Kernel (10 grains, skin and tip removed), Cistanche (1 qian), Hemp Seed (1 qian).
If sweating is excessive, add Ginseng (1 qian) and Astragalus (1 qian). If thirsty, add Ginseng (1 qian) and Ophiopogon (1.5 qian). If abdominal fullness and fluid dryness, add Ginseng (1 qian) and Areca Peel (1 qian). If sweating, delirium, and constipation, add Ginseng (1 qian), Prepared Sour Date Kernel (2 qian), Biota Seed (2 qian), Poria with Hostwood (2 qian), Polygala Meat (4 fen), Ophiopogon (1.5 qian).
**Postpartum Blood and Qi Exhaustion**
Sudden depletion leaves bones unmourned, causing sudden trismus, locked jaw, and limb spasms, resembling Stroke. Do not use Stroke formulas. The Chong Mai is the Sea of Blood and Vessels; when empty, joints cannot move smoothly. Treat first with *Shenghua Tang* to generate new blood. If critical, use Zirong Huoluo Decoction.
Prepared Rehmannia (3 qian), Ginseng (1 qian), Honey-fried Astragalus (1 qian), Angelica Root (4 qian), Chuanxiong (1 qian), Poria with Hostwood (1.5 qian), Gastrodia (6 fen, roasted), Ophiopogon (1 qian), Schizonepeta (4 fen), Saposhnikovia (4 fen), Notopterygium (3 fen), Tangerine Peel (4 fen), Honey-fried Licorice (4 fen).
If phlegm, add Processed Pinellia (1 qian), Ginger Juice (1 spoon), Bamboo Sap (1 spoon). If food stagnation, add Charred Hawthorn (1.5 qian), Charred Medicated Leaven (1 qian). If constipation, add Biota Seed (2 qian), Cistanche (1.5 qian). If palpitations, add Prepared Sour Date Kernel (2 qian). If confused speech, add stir-fried Polygala Meat (4 fen), Stir-fried Acorus (4 fen), Stir-fried Sour Date Kernel (2 qian).
**Postpartum Unremitting Sweating**
Sign of Yang Collapse. Sweat is the Fluid of the Heart and Kidney. Blood loss causes great Heart-Kidney deficiency; urgently tonify Heart and Kidney. Benefit Ying and Wei, guide blood back to source, and sweating will stop. Use Buyang Yiyin *Shenghua Tang*.
Ginseng (1.5 qian), Prepared Rehmannia (3 qian, stir-fried), Honey-fried Astragalus (2 qian), Honey-fried Licorice (4 fen), Angelica Root (3 qian), Chuanxiong (1 qian), Roasted Ginger (4 fen), Oyster Shell (2 qian), Processed Atractylodes Macrocephala (1 qian), Peach Kernel (6 grains, skin and tip removed), Floating Wheat (a pinch).
If thirsty, add Ophiopogon (1.5 qian) and Schisandra (10 grains).
**Postpartum Dry Tongue and Thirst with Dysuria**
Caused by blood loss or excessive sweating. Treat by assisting Spleen and benefiting Lungs, regulating Qi and Blood, so fluids generate and urination becomes free. Never use Scutellaria, Coptis, Anemarrhena, or Phellodendron to descend, or Wuling San to promote urination. Use Shengjin Zhike Yishui San.
Honey-fried Astragalus (1.5 qian), Ginseng (1.5 qian), Prepared Rehmannia (3 qian, stir-fried), Schisandra (10 grains), Ophiopogon (2 qian), Angelica Root (3 qian), Chuanxiong (1 qian), Poria (1.5 qian), Raw Licorice (3 fen), Honey-fried Cimicifuga (3 fen).
**Postpartum Urinary Incontinence**
Due to Qi and Blood deficiency failing to secure Kidney Qi. Use Jiawei *Shenghua Tang*.
Salt-water stir-fried Alpinia Oxyphylla (4 fen), Oyster Shell (3 qian), Northern Schisandra (10 grains), Angelica Root (2 qian), Honey-fried Astragalus (1 qian), Chuanxiong (1 qian), Peach Kernel (10 grains, skin and tip removed), Roasted Ginger (4 fen), Prepared Rehmannia (3 qian), Raspberry (8 fen), Dodder Seed (1 qian, stir-fried), Honey-fried Licorice (4 fen).
**Postpartum Diarrhea**
Not like general diarrhea with undigested food and water. Mostly due to Qi and Blood deficiency leading to food accumulation and dampness injury. Combine elimination and tonification. Use Jiawei Shenling *Shenghua Tang*.
Earth-stir-fried Atractylodes Macrocephala (1 qian), Ginseng (1 qian), Poria (2 qian), Chuanxiong (1 qian), Danggui (2 qian, earth-stir-fried), Roasted Ginger (4 fen), Honey-fried Licorice (4 fen), Charred Medicated Leaven (5 fen), Charred Barley Sprout (8 fen), Guangpi (4 fen), Lycopodium (1 qian).
If cold, add Fresh Ginger (1 slice) and Jujube (2 pieces). If heat, remove Roasted Ginger, add Dendrobium Officinale (3 qian). If pain, add Roasted Costus (4 fen). If worse at dawn, add Roasted Nutmeg (4 fen).
**Postpartum Undigested Food**
Caused by fatigue injuring Spleen and delayed transport. Or excessive eating injuring Spleen and Stomach while blood clots remain unresolved. This is Spleen failure and Stomach weakness. First take Xiangsha *Shenghua Tang*, then Jiawei Shenling Baizhu San.
**Xiangsha Shenghua Tang**
Amomum (3 fen, stir-fried and ground), Alpinia Oxyphylla (3 fen, stir-fried), Earth-stir-fried Angelica Root (3 qian, stir-fried until charred), Chuanxiong (1 qian), Honey-fried Licorice (4 fen), Charred Roasted Ginger (4 fen), Lycopodium (1.5 qian), Charred Rice Crust (5 qian).
**Jiawei Shenling Baizhu San**
Ginseng (1 qian), Earth-stir-fried Atractylodes Macrocephala (1.5 qian), Poria (2 qian), Earth-stir-fried Angelica Root (3 qian), Chuanxiong (1 qian), Roasted Ginger (4 fen), Honey-fried Licorice (4 fen), Stir-fried Alpinia Oxyphylla (3 fen), Lycopodium (1.5 qian), Wine-stir-fried Charred White Peony Root (8 fen), Guang...