产后心虚一证，最为吃紧。盖小儿禀父之肾
气、母之心气而成，胞宫之脉，上系心包，产后心气十有九虚，故产后补心气亦大扼要。再水火各自
为用，互相为体，产后肾液虚，则心体亦虚，补肾阴以配心阳，取坎填离法也。余每于产后惊悸脉芤
者，用加味大定风珠，获效多矣（方见温热下焦篇，即大定风珠，加人参、龙骨、浮小麦、茯神者）。产
后一切外感。当于本论三焦篇中求之，再细参叶案则备矣。
产后虚热，前则有三甲复脉三方，大小定风珠二方，专翕膏一方，增液汤一方。三甲、增液，原为
温病善后而设；定风珠、专翕膏，则为产后虚损，无力服人参而设者也。古人谓产后不怕虚寒，单怕
虚热。盖温经之药，多能补虚，而补虚之品，难以清热也。故本论详立补阴七法，所以补丹溪之未
备。又立通补奇经丸，为下焦虚寒而设。又立天根月窟膏，为产后及劳伤下焦阴阳两伤而设也，乃
从阳补阴，从阴补阳互法，所谓天根月窟间来往，三十六宫都是春也。
每殒胎五、六月者，责之中焦不能荫胎，宜平
日常服小建中汤。下焦不足者，天根月窟膏，蒸动命门真火，上蒸脾阳，下固八脉，真精充足，自能固胎矣。
每殒胎必三月者，肝虚而热，古人主以桑寄生汤。夫寄生临时保胎，多有鞭长莫及之患，且方中
重用人参合天冬，岂尽人而能用者哉！莫若平时长服二十四味专翕膏（方见下焦篇秋燥门），轻者
一料，即能大生，重者两料（滑过三、四次者），永不堕胎。每一料得干丸药二十斤，每日早中晚服三
次，每次三钱，约服一年。必须戒房事。毋令速速成胎方妙。盖肝热者成胎甚易，虚者又不能保，速
成速堕，速堕速成，尝见一年内二、三次堕者，不死不休，仍未曾育一子也。专翕纯静，翕摄阳动之太
过（肝虚热易成易堕，岂非动之太过乎），药用有情者半，以补下焦精血之损；以洋参数斤代人参，九
制以去其苦寒之性，炼九日以合其纯一之体，约费不过三、四钱人参之价可办矣。愚制二十一味专
翕膏，原为产后亡血过多，虚不肯复，痉厥心悸等证而设，后加鹿茸、桑寄生、天冬三味，保三月殒胎
三、四次者，获效多矣，故敢以告来者。
通补奇经丸方（甘咸微辛法）
鹿茸（八两，力不能者以嫩毛角代之） 紫石英（生研极细，二两） 龟板（炙，四两） 枸杞子
四两） 当归（炒黑，四两） 肉苁蓉（六两） 小茴香（炒黑，四两） 鹿角胶（六两） 沙苑蒺黎（二
两） 补骨脂（四两） 人参（力绵者以九制洋参代之，人参用二两，洋参用四两） 杜仲（二两）
上为极细末，炼蜜为丸，小梧子大，每服二钱渐加至三钱。大便溏者加莲子、芡实、牡蛎各四
两，以蒺藜、洋参熬膏法丸。淋带者加桑螵蛸、菟丝子各四两。 瘕久聚少腹痛者，去补骨、蒺藜、
杜仲，加肉桂、丁香各二两。
天根月窟膏方（酸苦咸微辛法，阴阳两补、通守兼施复法也）
鹿茸（一斤） 乌骨鸡（一对） 鲍鱼（二斤） 鹿角胶（一斤） 鸡子黄（十六枚） 海参（二斤）
龟板（二斤） 羊腰子（十六枚） 桑螵蛸（一斤） 乌贼骨（一斤） 茯苓（二斤） 牡蛎（二斤）
洋参（三斤） 菟丝子（一斤） 龙骨（二斤） 莲子（三斤） 桂元肉（一斤） 熟地（四斤） 沙苑蒺
藜（二斤） 白芍（二斤） 芡实（二斤） 归身（一斤） 小茴香（一斤） 补骨脂（二斤） 拘杞子（二
斤） 肉苁蓉（二斤） 萸肉（一斤） 紫石英（一斤） 生杜仲（一斤） 牛膝（一斤） 萆 （一斤） 白
蜜（三斤）
上三十二味，熬如专翕膏法。用铜锅四口，以有情归有情者二，无情归无情者二，文火次第煎炼
取汁，另入一净锅内，细炼九昼夜成膏；后下胶、蜜，以方中有粉无汁之茯苓、莲子、芡实、牡蛎、龙
骨、鹿茸、白芍、乌贼骨八味为极细末，和前膏为丸梧子大。每服三钱，日三服。
此方治下焦阴阳两伤，八脉告损，急不能复，胃气尚健（胃弱者不可与，恐不能传化重浊之药
也），无湿热证者；男子遗精滑泄，精寒无子，腰膝酸痛之属肾虚者（以上数条，有湿热皆不可服也）；
老年体瘦痱中，头晕耳鸣，左肢麻痹，缓纵不收，属下焦阴阳两虚者（以上诸证有单属下焦阴虚者，宜
专翕膏，不宜此方）；妇人产后下亏，淋带 瘕，胞宫虚寒无子，数数殒胎，或少年生育过多，年老腰
膝尻胯酸痛者。
产后心气虚弱这一证候，是最为关键的。因为胎儿禀受父亲的肾气和母亲的心气而构成，胞宫的脉络向上连接心包络，产后心气十有八九处于虚弱状态，所以产后补益心气也是极为重要的环节。再者，水（肾阴）与火（心阳）各自发挥功能，又互为体用，产后肾阴液亏虚，则心之形体亦随之虚弱，通过补肾阴来配合制约心阳，这是取坎填离的治法。我每当遇到产后出现惊悸、脉象芤大的患者，使用加味大定风珠，获得疗效的情况很多（该方见《温热篇》下焦篇，即在大定风珠基础上，加入人参、龙骨、浮小麦、茯神）。产后所有的外感病证，应当在本论《三焦篇》中寻求治疗方法，再仔细参详叶天士的医案，就完备了。
产后虚热证，此前已有三甲复脉汤三方、大小定风珠二方、专翕膏一方、增液汤一方。其中，三甲和增液汤，原本是为温病后期的善后调理而设立；而定风珠和专翕膏，则是为产后虚损、无力服用参类补气药的患者所设立的。古人说，产后不怕虚寒，只怕虚热。因为温经的药物，大多能补虚，而补虚的药物，却难以清除热邪。因此本论详细确立了补阴七法，以补充朱丹溪理论的不足。又创立通补奇经丸，是为下焦虚寒而设。又创立天根月窟膏，是为产后及劳伤导致下焦阴阳两伤而设的，这是从阳补阴、从阴补阳的互用之法，也就是所谓“在天根月窟间来往，三十六宫都是春”的境界。
凡是怀孕五、六个月时流产的，责任在于中焦不能滋养胎元，适宜平时日常服用小建中汤。如果是下焦不足的，服用天根月窟膏，可以蒸动命门的真火，向上蒸腾脾阳，向下固摄奇经八脉，真精充足，自然能够稳固胎元。
凡是每次都在怀孕三个月时流产的，属于肝虚而有热，古人主张使用桑寄生汤。然而，依靠临时的药物保胎，多有力量达不到患处的担忧，且方中重用人参合天门冬，难道人人都能适用吗？不如平时长期服用二十四味专翕膏（方剂见下焦篇秋燥门），轻症服一料，就能顺利生育；重症（滑胎三、四次者）服两料，永不堕胎。每一料可制成干丸药二十斤，每日早、中、晚各服一次，每次三钱，大约服用一年。必须禁止房事。不要急于求成尽快受孕才妙。因为肝热者受孕很容易，但身体虚弱又不能保住，往往是快速受孕又快速流产，快速流产又快速受孕，我曾见过一年内流产二、三次，不死不休，最终未曾育有一子的情况。专翕膏性质纯静，旨在收敛摄纳阳气动的太过（肝虚热容易受孕也容易流产，难道不是动得太过吗？），药方中一半使用血肉有情之品，以补益下焦精血的亏损；用洋参数斤代替人参，经过九次炮制以去除其苦寒之性，炼制九日以符合纯一的体质，费用不过相当于三四钱人参的价格就可以办到了。我最初制作二十一味的专翕膏，原本是为产后失血过多、虚损难以恢复、出现痉厥心悸等证候而设，后来加入鹿茸、桑寄生、天门冬三味药，对于怀孕三个月左右流产三、四次的情况，获得疗效很多，所以敢以此告知后来者。
通补奇经丸方（采用甘咸微辛的法度）
鹿茸（八两，力弱无法获取者可用嫩毛角替代） 紫石英（生研极细，二两） 龟板（炙，四两） 枸杞子（四两） 当归（炒黑，四两） 肉苁蓉（六两） 小茴香（炒黑，四两） 鹿角胶（六两） 沙苑蒺藜（二两） 补骨脂（四两） 人参（力气微弱者可用九制西洋参替代，人参用二两，西洋参用四两） 杜仲（二两）
以上药材研成极细末，用炼蜜制成丸药，大小如梧桐子，每次服用二钱，逐渐增加至三钱。大便溏泄者，加莲子、芡实、牡蛎各四两，用蒺藜和西洋参熬膏来泛丸。淋证带下者，加桑螵蛸、菟丝子各四两。瘕积久聚少腹痛者，去掉补骨脂、蒺藜、杜仲，加入肉桂、丁香各二两。
天根月窟膏方（采用酸苦咸微辛的法度，是阴阳双补、通守兼施的复法）
鹿茸（一斤） 乌骨鸡（一对） 鲍鱼（二斤） 鹿角胶（一斤） 鸡蛋黄（十六枚） 海参（二斤） 龟板（二斤） 羊腰子（十六枚） 桑螵蛸（一斤） 海螵蛸（一斤） 茯苓（二斤） 牡蛎（二斤） 西洋参（三斤） 菟丝子（一斤） 龙骨（二斤） 莲子（三斤） 桂圆肉（一斤） 熟地黄（四斤） 沙苑蒺藜（二斤） 白芍（二斤） 芡实（二斤） 当归身（一斤） 小茴香（一斤） 补骨脂（二斤） 枸杞子（二斤） 肉苁蓉（二斤） 山茱萸（一斤） 紫石英（一斤） 生杜仲（一斤） 牛膝（一斤） 萆薢（一斤） 白蜜（三斤）
以上三十二味药，按照专翕膏的方法熬制。使用四口铜锅，将有情之品归为一类用两口锅，无情之品归为一类用两口锅，用文火依次煎炼取汁，另外倒入一个干净的锅内，细细炼制九个昼夜成为膏状；之后加入胶类和蜂蜜，将方中有粉无汁的茯苓、莲子、芡实、牡蛎、龙骨、鹿茸、白芍、海螵蛸这八味药研成极细末，与前面的膏混合制成梧桐子大小的丸药。每次服用三钱，每日三次。
此方治疗下焦阴阳两伤，奇经八脉告急受损，急需恢复但不能立即见效，且胃气尚健（胃弱者不可服用，恐怕不能运化传导这些重浊的药物）；没有湿热证候的人；男子遗精滑泄，精寒无子，腰膝酸痛属于肾虚者（以上几条，若有湿热都不可服用）；老年人体瘦中风痱，头晕耳鸣，左肢麻痹，松弛不收，属于下焦阴阳两虚者（以上诸证，若单独属于下焦阴虚者，宜用专翕膏，不宜用此方）；妇人产后下元亏虚，淋证带下，瘕积，胞宫虚寒不孕，多次流产，或少年生育过多，年老腰膝尻胯酸痛者。
The syndrome of Heart Qi deficiency after childbirth is the most critical. This is because the fetus is formed by inheriting the Kidney Qi from the father and the Heart Qi from the mother; the vessels of the uterus connect upward to the Pericardium. After childbirth, Heart Qi is deficient in nine out of ten cases, thus tonifying Heart Qi postpartum is also a major key point. Furthermore, Water (Kidney Yin) and Fire (Heart Yang) function independently yet serve as each other's substance. When Kidney fluid is deficient after childbirth, the substance of the Heart also becomes deficient. Tonifying Kidney Yin to coordinate with Heart Yang is the method of "extracting Kan to fill Li" (drawing water to control fire). Whenever I encounter patients with palpitations and a knotted pulse after childbirth, I use Modified Da Ding Feng Zhu San (Great Calming Wind Pearl Powder), achieving many effective results (the formula is seen in the Lower Jiao chapter of the Warm Disease Treatise, which is Da Ding Feng Zhu San added with Ren Shen [Ginseng], Long Gu [Dragon Bone], Fu Xiao Mai [Floating Wheat], and Fu Shen [Poria with Hostwood]). All exterior contractions after childbirth should be sought in the San Jiao chapter of this treatise; further detailed reference to Ye Tianshi's medical cases will make it complete.
For postpartum deficiency-heat, previously there were three formulas of San Jia Fu Mai Tang (Three Shells Pulse-Nourishing Decoction), two formulas of Da/Xiao Ding Feng Zhu San (Great/Small Calming Wind Pearl Powders), one formula of Zhuan Xi Gao (Concentrating Nourishment Paste), and one formula of Zeng Ye Tang (Fluid-Increasing Decoction). Among them, San Jia and Zeng Ye were originally established for the convalescence of warm diseases; Ding Feng Zhu and Zhuan Xi Gao were established for postpartum deficiency where the patient is too weak to take Ginseng. The ancients said that postpartum women do not fear deficiency-cold but only fear deficiency-heat. This is because warming meridians drugs can mostly tonify deficiency, whereas tonifying substances are difficult to clear heat. Therefore, this treatise details seven methods of tonifying Yin, supplementing the incompleteness of Zhu Danxi's theories. It also establishes Tong Bu Qi Jing Wan (Unblocking and Tonifying Extraordinary Vessels Pill) for lower Jiao deficiency-cold. It also establishes Tian Gen Yue Ku Gao (Heavenly Root and Lunar Cave Paste) for postpartum conditions and injuries from overwork causing dual injury of Yin and Yang in the lower Jiao. This is the mutual method of tonifying Yin from Yang and tonifying Yang from Yin, described as "moving between the Heavenly Root and Lunar Cave, making all thirty-six palaces spring-like."
For those who miscarry at five or six months of pregnancy, the responsibility lies in the Middle Jiao's inability to nourish the fetus; it is suitable to take Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) daily for routine maintenance. For those with lower Jiao insufficiency, taking Tian Gen Yue Ku Gao can stimulate the True Fire of the Gate of Vitality (Ming Men), steaming upward to warm Spleen Yang and securing downward the Eight Extraordinary Vessels. With sufficient true essence, the fetus will naturally be secured.
For those who always miscarry at three months of pregnancy, it belongs to Liver deficiency with heat; the ancients advocated using Sang Ji Sheng Tang (Taxillus Decoction). However, relying on temporary herbs to secure the fetus often suffers from insufficient strength reaching the target, and the formula heavily uses Ren Shen combined with Tian Dong (Asparagus Root); is this applicable to everyone? It is better to take Si Shi Er Wei Zhuan Xi Gao (Twenty-Four Ingredient Concentrating Nourishment Paste) long-term during routine times (formula seen in the Autumn Dryness section of the Lower Jiao chapter). Mild cases require one dose to achieve successful birth; severe cases (those with three or four miscarriages) require two doses to prevent future miscarriages permanently. One dose yields twenty jin of dry pills. Taken three times daily (morning, noon, evening), three qian each time, for approximately one year. Sexual intercourse must be abstained from. It is best not to rush conception. Because Liver heat makes conception easy, but deficiency prevents retention, leading to rapid conception and rapid miscarriage. I have seen cases of two or three miscarriages within a year, continuing until death, never having raised a child. Zhuan Xi Gao is purely quiet, aiming to collect and restrain excessive Yang movement (Liver deficiency-heat leads to easy conception and miscarriage, isn't this excessive movement?). Half of the medicinal ingredients are "sentient" (animal-derived) to tonify the loss of essence and blood in the lower Jiao. Several jin of Western Ginseng (Yang Shen) replace Ren Shen, processed nine times to remove its bitter-cold nature, and refined for nine days to align with a pure unity. The cost is no more than that of three or four qian of Ren Shen. I originally formulated Twenty-One Ingredient Zhuan Xi Gao for postpartum excessive blood loss, failure to recover from deficiency, spasms, syncope, and palpitations. Later, adding Lu Rong (Deer Antler), Sang Ji Sheng (Taxillus), and Tian Dong (Asparagus Root) proved highly effective for miscarriages occurring three to four times around the third month. Thus, I dare to share this with successors.
**Tong Bu Qi Jing Wan Formula (Method of Sweet, Salty, and slightly Pungent)**
Lu Rong (Deer Antler, 8 liang; if unavailable, tender hairy horn may substitute) Zi Shi Ying (Purple Quartz, raw and ground extremely fine, 2 liang) Gui Ban (Tortoise Shell, roasted, 4 liang) Gou Qi Zi (Goji Berry, 4 liang) Dang Gui (Angelica Sinensis, stir-fried black, 4 liang) Rou Cong Rong (Cistanche, 6 liang) Xiao Hui Xiang (Fennel, stir-fried black, 4 liang) Lu Jiao Jiao (Deer Horn Gelatin, 6 liang) Sha Yuan Ji Li (Astragalus Complanatus Seed, 2 liang) Bu Gu Zhi (Psoralea Fruit, 4 liang) Ren Shen (Ginseng; for weak constitution, Nine-Processed Western Ginseng substitutes: 2 liang Ren Shen, 4 liang Western Ginseng) Du Zhong (Eucommia Bark, 2 liang)
Grind all into an extremely fine powder. Form pills with refined honey, size of Sophora seeds. Take 2 qian per dose, gradually increasing to 3 qian. For loose stools, add Lian Zi (Lotus Seed), Qian Shi (Euryale Seed), and Mu Li (Oyster Shell), each 4 liang; use Ji Li and Western Ginseng paste to coat the pills. For leukorrhea and stranguria, add Sang Piao Xiao (Mantis Egg Case) and Tu Si Zi (Cuscuta Seed), each 4 liang. For abdominal pain due to long-standing masses (Jia), remove Bu Gu Zhi, Ji Li, and Du Zhong; add Rou Gui (Cinnamon Bark) and Ding Xiang (Clove), each 2 liang.
**Tian Gen Yue Ku Gao Formula (Method of Sour, Bitter, Salty, and slightly Pungent; a complex method of dual tonification of Yin and Yang, combining unblocking and retaining)**
Lu Rong (Deer Antler, 1 jin) Wu Gu Ji (Black-bone Chicken, 1 pair) Bao Yu (Abalone, 2 jin) Lu Jiao Jiao (Deer Horn Gelatin, 1 jin) Ji Zi Huang (Egg Yolk, 16 pieces) Hai Shen (Sea Cucumber, 2 jin) Gui Ban (Tortoise Shell, 2 jin) Yang Yao Zi (Sheep Kidney, 16 pieces) Sang Piao Xiao (Mantis Egg Case, 1 jin) Wu Zei Gu (Cuttlefish Bone, 1 jin) Fu Ling (Poria, 2 jin) Mu Li (Oyster Shell, 2 jin) Yang Shen (Western Ginseng, 3 jin) Tu Si Zi (Cuscuta Seed, 1 jin) Long Gu (Dragon Bone/Fossilized Bone, 2 jin) Lian Zi (Lotus Seed, 3 jin) Gui Yuan Rou (Longan Aril, 1 jin) Shu Di (Prepared Rehmannia Root, 4 jin) Sha Yuan Ji Li (Astragalus Complanatus Seed, 2 jin) Bai Shao (White Peony Root, 2 jin) Qian Shi (Euryale Seed, 2 jin) Gui Shen (Dang Gui Body, 1 jin) Xiao Hui Xiang (Fennel, 1 jin) Bu Gu Zhi (Psoralea Fruit, 2 jin) Gou Qi Zi (Goji Berry, 2 jin) Rou Cong Rong (Cistanche, 2 jin) Yu Rou (Cornus Fruit, 1 jin) Zi Shi Ying (Purple Quartz, 1 jin) Sheng Du Zhong (Raw Eucommia Bark, 1 jin) Niu Xi (Achyranthes Root, 1 jin) Bi Xie (Dioscorea Hypoglauca Rhizome, 1 jin) Bai Mi (White Honey, 3 jin)
Process these thirty-two ingredients according to the method of Zhuan Xi Gao. Use four copper pots: group sentient ingredients into two pots and non-sentient ingredients into two pots. Decoct slowly over low heat to extract juices. Combine juices in a clean pot and refine finely for nine days and nights to form paste. Then add gelatins and honey. Grind the eight powdery/no-juice ingredients (Fu Ling, Lian Zi, Qian Shi, Mu Li, Long Gu, Lu Rong, Bai Shao, Wu Zei Gu) into an extremely fine powder and mix with the paste to form pills the size of Sophora seeds. Take 3 qian per dose, three times daily.
This formula treats dual injury of Yin and Yang in the lower Jiao, damage to the Eight Extraordinary Vessels requiring urgent recovery but unable to restore immediately, provided Stomach Qi is still robust (do not give to those with weak Stomach Qi, as they cannot transport and transform these heavy/turbid medicines); without damp-heat syndromes; for men with seminal emission, slippery discharge, cold sperm, infertility, soreness/weakness of waist and knees belonging to Kidney deficiency (note: none of the above should be taken if damp-heat is present); for elderly individuals with emaciation and wind-stroke flaccidity, dizziness, tinnitus, left limb numbness, and flaccid paralysis belonging to dual deficiency of Yin and Yang in the lower Jiao (for cases solely of lower Jiao Yin deficiency, Zhuan Xi Gao is suitable, not this formula); for women with postpartum lower deficiency, stranguria, leukorrhea, masses, uterine cold sterility, frequent miscarriages, or those who had excessive childbirth in youth and now suffer waist/knee/buttock/hip soreness in old age.