胎前痧痛，毒瓦斯攻胎，尚惧胎孕绞动，伤胎殒命。况痧有毒血攻冲，胎孕娇嫩，决难安静，至如安胎，用白术、当
归、茯苓之类，痧所大禁，若一误用，立时痧胀凶危。其痧胀所宜，惟是破血破气之剂，又胎孕所忌。愚尝斟酌其间，
若刮痧放痧不愈，必欲活血解毒，用金银花、丹参、益母草、红花、桑寄生消瘀而不损胎元；顺气用香附、陈皮、紫朴、
砂仁、乌药行气而不伤胎气；散痧用荆芥、防风、独活、细辛透窍而不动胎孕；消食积用山楂、卜子、神曲、麦芽宽中
而不伐胎性；采择于中，最为稳当。然痧毒势盛，此等之药，难于速效，或权用一二味克伐，又恐于胎有害，此予所以
反复而不敢轻任也。
产后用药，必须温暖；痧胀用药，惟重清凉；此症属相反。处治之方，毋执产后，一于温暖，亦毋执痧胀，一于清
凉也。愚尝遇此等症，窃以为消瘀破血之药虽同，其余有不可通用者，是以制就一方，为临症之法。散痧用独活、细辛；
破血用桃仁、红花；顺气用香附、乌药、陈皮；解毒用金银花、紫花地丁；消食用山楂、卜子、神曲、麦芽。如产后
用姜炭，肉桂以温血，痧症所大禁。痧症利用荆芥、防风以散痧，连翘、薄荷以清热，产后所不宜。况痧症胀极，尤重
大黄，枳实、槟榔以通其积滞，而产后之药，更不可不禁，恐用此伤产后之气分也。且产妇服药宜温，痧症服药宜冷。
若痧而用温，胀者益胀；产而用冷，瘀者益瘀。故予临症，惟取微温之气，则既无害产后，而亦无助痧祸。若痧更凶极，
微温之气，难于制治，加童便以清热消瘀，产后、痧症，俱得其宜矣。
治验∶
一顾月溪内室，产后三日，腹中绞痛，胀大如臌，恶露不通。延余诊之，余思产妇腹痛，当在小腹，大腹胀痛，亦
仅微疼。今产妇大腹绞痛异常，非产妇本症。及按脉，洪数有力，余曰∶“此产后兼痧胀也，当取痧筋验之”。不信，漫
服产后药，益觉昏迷不醒。复求余治，势已危极，痧筋不现，先取童便一杯饮之，少苏。阅十指筋，刺出紫黑毒血二十
一针，然后扶起，放腿弯痧六针，绞痛稍定。用独活红花汤微温服之，迨痧毒消尽，胀痛尽止，恶露俱通后，调补乃痊。
一蒋南轩内室，产后八日，恶露去血过多，忽恶寒发热，胸中胀闷垂危。延余，脉洪大无伦。余思恶露不尽尤可，
今恶露去尽，何以骤得此脉，因语之曰∶“脉甚凶，若兼痧可救”。南轩善放痧，信余言，入视痧筋紫红色者二条，放毒
血。余复诊之，不复洪大，又刺指臂出紫黑毒血三十余针。用独活、细辛、柴胡、金银花、丹参、益母草、牛膝、石斛、
乌药、山楂、陈皮四剂，微温服之，寒热胀闷具除，后调补而愈。
一单公廉内室，产后六日，遍体疼痛，寒热如疟，昏闷异常。延余，六脉时有歇指，阅左中指、右无名指，微带黑
色，乃知兼痧之症。刺指上紫黑毒血七针，臂上毒血一针，舌底下紫黑毒血一针，昏闷疼痛稍缓。用独活、桃仁、苍术、
香附、童便、姜黄、山楂，微温服二剂，疼痛昏闷具除。但寒热未已，用金银花、丹参、益母草、艾、柴胡、独活、姜
灰、牛膝、山楂，温服四剂，寒热乃瘳，调补月余而健。
胎前患痧痛，毒气攻冲胎儿，令人担忧胎孕受惊扰动，导致伤胎或丧命。况且痧症有毒血攻冲，胎孕娇嫩，决难保持安静。至于安胎，使用白术、当归、茯苓等药物，是治疗痧症的大禁忌，如果一旦误用，立刻会导致痧胀凶险危急。对于痧胀适宜的治疗，只有破血破气的方剂，但这又是胎孕所忌讳的。我曾在两者之间斟酌考量，如果刮痧放痧后病情未愈，必须活血解毒，选用金银花、丹参、益母草、红花、桑寄生来消除瘀血而不损伤胎元；顺气用香附、陈皮、紫朴（厚朴）、砂仁、乌药来行气而不伤害胎气；散痧用荆芥、防风、独活、细辛来透窍而不动摇胎孕；消食积用山楂、卜子（莱菔子）、神曲、麦芽来宽中而不伐害胎性；从中采择，最为稳妥。然而痧毒势盛，这些药物难以迅速见效，或者权且使用一两味克伐之药，又恐怕对胎儿有害，这就是我反复斟酌而不敢轻易处方的原因。
产后用药，必须温暖；痧胀用药，重在清凉；此症属于性质相反。处理治疗的方剂，不要固执于产后一味的温暖，也不要固执于痧胀一味的清凉。我曾遇到此类病症，私下认为虽然消瘀破血的药物相同，其余部分有不可通用的地方，因此制定了一个方子，作为临证的方法。散痧用独活、细辛；破血用桃仁、红花；顺气用香附、乌药、陈皮；解毒用金银花、紫花地丁；消食用山楂、卜子、神曲、麦芽。如产后使用姜炭、肉桂来温血，这是痧症的大禁忌。痧症利用荆芥、防风来散痧，连翘、薄荷来清热，这是产后不适宜的。况且痧症胀极，尤其重用大黄、枳实、槟榔来通其积滞，而产后的药物更不可不禁用，恐怕使用这些会伤害产后之气分。而且产妇服药宜温，痧症服药宜冷。如果痧症用温药，胀者会更胀；产后用冷药，瘀者会更瘀。所以我临证时，只取微温之气，这样既不对产后造成伤害，也不会助长痧祸。如果痧症更加凶险极端，微温之气难以控制治疗，加入童便（童子尿）来清热消瘀，产后和痧症都能得到适宜的处理了。
治验：
一位顾月溪的内室（妻子），产后三天，腹中绞痛，腹部胀大如鼓，恶露不通。请我诊治，我思考产妇腹痛，应当在小腹，大腹胀痛，也只是轻微疼痛。如今产妇大腹绞痛异常，不是产妇的本症。等到诊脉，脉象洪数有力，我说：“这是产后兼患痧胀，应当查看痧筋以验证。”家属不信，随意服用产后药，越发觉得昏迷不醒。再次请求我诊治，病势已经极其危重，痧筋不现，先取一杯童便让她饮下，稍苏醒。查看十指筋，针刺放出紫黑毒血二十一针，然后扶起患者，在腿弯处放痧六针，绞痛稍微安定。用独活红花汤微温服下，等到痧毒消尽，胀痛全止，恶露全部通畅后，进行调补才痊愈。
一位蒋南轩的内室，产后八天，恶露去血过多，忽然恶寒发热，胸中胀闷垂危。请我诊治，脉象洪大无比。我思考恶露不尽还可以理解，如今恶露去尽，为何突然出现这种脉象，于是告诉他说：“脉象很凶险，如果兼患痧症还可以救治。”南轩擅长放痧，相信我的话，入内查看发现有两条紫红色的痧筋，放出毒血。我再诊脉，脉象不再洪大，又刺手指手臂放出紫黑毒血三十多针。用独活、细辛、柴胡、金银花、丹参、益母草、牛膝、石斛、乌药、山楂、陈皮四剂，微温服下，寒热胀闷全部去除，后来调补而痊愈。
一位单公廉的内室，产后六天，遍体疼痛，寒热如疟疾，昏闷异常。请我诊治，六脉时有歇止，查看左中指、右无名指，微带黑色，才知道是兼患痧症的病状。刺手指上紫黑毒血七针，手臂上毒血一针，舌底下紫黑毒血一针，昏闷疼痛稍微缓解。用独活、桃仁、苍术、香附、童便、姜黄、山楂，微温服两剂，疼痛昏闷全部去除。但寒热未停，用金银花、丹参、益母草、艾、柴胡、独活、姜灰、牛膝、山楂，温服四剂，寒热才痊愈，调补一个多月后恢复健康。
Painful Sha (Sha syndrome characterized by pain) during pregnancy involves toxic qi attacking the fetus, causing fear that the fetal movement will be disturbed, leading to injury or loss of the fetus. Moreover, since Sha syndrome involves toxic blood rushing forward, and the fetus is delicate, it is impossible for the fetus to remain calm. Regarding methods to stabilize the fetus, using herbs such as Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), and Poria (Fuling) is strictly contraindicated in Sha syndrome; if mistakenly used, it will immediately lead to critical and dangerous Sha distension. The treatments suitable for Sha distension are primarily decoctions that break blood and move qi, which are also contraindicated for pregnancy. I have carefully considered this dilemma. If scraping and bloodletting do not resolve the condition, and blood-activating and detoxifying measures are necessary, one may use Lonicerae Japonicae Flos (Jinyinhua), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Leonuri Herba (Yimucao), Carthami Flos (Honghua), and Eucommiae Cortex (Sangjisheng) to eliminate stasis without damaging the fetal foundation; for regulating qi, Cyperi Rhizoma (Xiangfu), Citri Reticulatae Pericarpium (Chenpi), Magnoliae Officinalis Cortex (Zhipu), Amomi Fructus Rotundus (Sharen), and Linderæ Fructus (Wuyao) can be used to promote qi movement without harming fetal qi; for dispersing Sha, Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Angelicae Pubescentis Radix (Duhuo), Asari Radix et Rhizoma (Xixin) can be used to open orifices without disturbing the fetus; for resolving food stagnation, Crataegi Fructus (Shanzha), Raphani Semen (Buzi), Medicated Leaven (Shenqu), and Malty (Maiya) can be used to broaden the middle jiao without impairing fetal nature. Selecting from these options is the most prudent approach. However, when Sha toxicity is severe, these herbs may not act quickly; alternatively, using one or two harsh purgative herbs might harm the fetus. This is why I deliberate repeatedly and dare not prescribe lightly.
Medication for postpartum conditions must be warming; medication for Sha distension emphasizes cooling; these two conditions are contrary in nature. In treating this syndrome, one should not rigidly adhere to warming solely for postpartum conditions, nor to cooling solely for Sha distension. I have encountered such cases and believed that although blood-breaking and stasis-resolving herbs are similar, other aspects cannot be universally applied. Therefore, I formulated a specific prescription for clinical practice. For dispersing Sha, use Duhuo and Xixin; for breaking blood, use Persicae Semen (Taoren) and Honghua; for regulating qi, use Xiangfu, Wuyao, and Chenpi; for detoxification, use Jinyinhua and Violae Herba (Zihuadiding); for resolving food stagnation, use Shanzha, Buzi, Shenqu, and Maiya. Using Carbonized Zingiberis Rhizoma (Jiantan) and Cinnamomi Cortex (Rougui) to warm blood is strictly contraindicated in Sha syndrome. Conversely, using Jingjie and Fangfeng to disperse Sha, and Forsythiae Fructum (Lianqiao) and Menthae Haplocalycis Herba (Bohe) to clear heat, are unsuitable for postpartum conditions. Furthermore, in cases of extreme Sha distension, Rheum Palmatum Radix et Rhizoma (Dahuang), Aurantii Fructus Immaturus (Zhishi), and Arecae Semen (Binglang) are heavily relied upon to unblock stagnation, whereas postpartum medications must be avoided to prevent damaging the qi aspect after childbirth. Additionally, postpartum patients should take warm medicines, while Sha patients should take cold medicines. If warm medicines are used for Sha, distension will worsen; if cold medicines are used postpartum, stasis will deepen. Therefore, in my clinical practice, I only utilize mildly warm properties, which neither harm the postpartum state nor exacerbate Sha disasters. If Sha is extremely severe and mild warmth is insufficient, adding Humanis Urine (Tongbian) to clear heat and resolve stasis provides appropriate treatment for both postpartum and Sha conditions.
Clinical Cases:
1. The wife of Gu Yuexi, three days postpartum, suffered from severe abdominal cramping and distension resembling drum-tightness, with no lochia discharge. Upon consultation, I reasoned that postpartum abdominal pain should occur in the lower abdomen, and distension in the large abdomen would only cause slight pain. The patient’s severe large abdominal cramping was not typical of postpartum conditions. Pulse diagnosis revealed a surging, rapid, and forceful pulse. I stated, "This is postpartum complicated by Sha distension; we must examine the Sha veins." The family did not believe me and administered postpartum remedies indiscriminately, resulting in increased coma. Seeking further treatment, the condition became critical with no visible Sha veins. I first had her drink a cup of Tongbian, after which she slightly revived. Examining the veins on the fingertips, I performed acupuncture to release twenty-one needles' worth of purple-black toxic blood. Then, supporting the patient, I performed bloodletting at the popliteal fossa (leg bend) with six needles, which slightly stabilized the cramping. She took Duhuo Honghua Decoction (Angelica Pubescentis and Carthamus Decoction) while lukewarm. Once the Sha toxicity was eliminated and distension/pain ceased, and lochia flowed freely, she recovered after tonic supplementation.
2. The wife of Jiang Nanxuan, eight days postpartum, experienced excessive lochia loss, followed suddenly by aversion to cold, fever, chest distension, and impending danger. Upon consultation, the pulse was overwhelmingly surging and large. I reasoned that incomplete lochia discharge is understandable, but complete discharge followed by such a pulse is abnormal. I told him, "The pulse is ominous; if complicated by Sha, there is hope for rescue." Nanxuan, skilled in bloodletting, examined the patient and found two purple-red Sha veins, from which toxic blood was released. On re-examination, the pulse was no longer surging and large. I then punctured the fingers and arms to release over thirty needles' worth of purple-black toxic blood. She took four doses of a decoction containing Duhuo, Xixin, Bupleuri Radix (Chaihu), Jinyinhua, Danshen, Yimcao, Achyranthis Bidentatae Radix (Niuxi), Dendrobii Caulis (Shihu), Wuyao, Shanzha, and Chenpi, taken lukewarm. The chills, fever, distension, and oppression were completely resolved, and she recovered after tonic supplementation.
3. The wife of Shan Gonglian, six days postpartum, suffered from generalized body pain, chills and fever resembling malaria, and extreme drowsiness and oppression. Upon consultation, the six pulses showed intermittent stopping. Examination of the left middle finger and right ring finger revealed a slight black discoloration, indicating a complication with Sha. I punctured seven needles on the fingers to release purple-black toxic blood, one needle on the arm, and one under the tongue, which slightly alleviated the drowsiness and pain. She took two doses of a decoction containing Duhuo, Taoren, Atractylodis Rhizoma (Cangzhu), Xiangfu, Tongbian, Curcumae Longae Rhizoma (Jianghuang), and Shanzha, taken lukewarm, which resolved the pain and drowsiness. However, chills and fever persisted. She then took four doses of a decoction containing Jinyinhua, Danshen, Yimcao, Artemisiae Argyi Folium (Ai), Chaihu, Duhuo, Ginger Ash (Jianghui), Niuxi, and Shanzha, taken warm. The chills and fever subsided, and she regained health after one month of tonic supplementation.