本文："妇人妊娠，宜常服当归散主之。""妊娠养胎，白术散主之。"此二条，言胎前通用养胎之法也。当归散用归、芍和营，川芎行气，黄芩清热，白术安胎，乃胎前体热者之法也。芩、术为安胎之药，人多知之，以胎前多热，热则伤胎元，胞系于脾，虚则胎坠。故用黄芩清其热以保胎，白术健其脾以举胎也。但胎前虽属热者多，亦有寒湿之证，如第二条白术散，用白术、牡蛎以燥湿，川芎温血，蜀椒去寒，则胎前寒湿者之方治也。仲景列此养胎二方，极有深意，恐后人之偏凉畏热，故出一当归散以清热，即出一白术散以治寒水，以示无偏之意。而识医之用药，有经有权，不能以一言蔽之也。二方之中，同用川芎，川芎温行，后人忌用，不知补中无行，便成呆补，且平时不疏利气机，临产必多窒碍，故二方均用川芎，以示行动之药，不必尽忌。用之有法，碍而不碍也。仲景著书时，一若预知后人有胎前忌热，忌通行之陋习，而先为此以矫正之，不亦异哉。妊娠门中，共文十一条，方十首，丸散居七，汤居三。盖汤者荡也，妊娠当以安胎为主，攻补皆不宜骤，缓以图之耳。
尚有一条在妇人杂病门中，亦当移入胎前，即转胞之证是也。本文："问曰：妇人病饮食如故，烦热不得卧，而反倚息者，何也？师曰：此名转胞不得溺也。以胞系了戾，故致此病。当利小便则愈。宜肾气丸主之。"此言胎前转胞之证治也。下不得通，则反上逆，因不得溺而见烦热，不得卧，倚息，则病在上而本在下。其病因盖由胎重压胞。胞者，脬也。胞系了戾不顺，胞为之转，胞转则膀胱宣化不利，故不得溲溺。水气无有出路，反从上逆也。肾气丸化气通阳，气壮举胎，胎举则膀胱宣化得行，小便通利，下通则上病自愈。此以肾气丸利小便之意，非谓但利小便即可以治转胞也。其证少腹必坠胀难忍，小溲点滴。其病因亦不止胎重压胞一源，惟胎前者居多数耳。《甲乙经》云："转胞不得溺，少腹满，关元主之。"明言转胞有少腹满之形，且当从肾脏主治。关元肾穴，仲景肾气丸有本矣。后人论此证，则有虚实之分。如饱食疾走，忍尿入房，忍精不泄脬热闭塞，均实证也。血少气虚，胎气不举，下压膀胱，则为虚证。治法除肾气丸外，有以沉香、木香利气者，有以盐汤探吐开上，上窍开则下窍利者。而丹溪以补气开举之品为君，佐以探吐。惟上举各法，尤为虚人所宜，故学者每多取用，实能补前人所不及，至足法也。
妊娠篇
胎前之病甚多，然以大要分之，有二大别：一为因胎以成病者，一为因病而碍胎者。因病碍胎，无论外感内伤，均能致此，当于杂病门中求之。惟未伤胎时，以去病为主，安胎为佐；既伤胎后，以安胎为主，去病为佐，为不同耳。因胎而成病者，以其必有胎，然后有此病，故为胎前专侯。今就此论之，以免滋蔓。一曰验胎。何以知其有身？曰：当于脉中验之。书中言胎脉甚夥，而各不同，有谓寸口脉动甚为有子者，有谓有胎之脉，当阴搏阳别者，有谓脉滑大为有胎者，又有谓当脉动如珠者，左大为男，右大为女者，然诸说有验有不验，未能确定一是，故医者每以验胎为难事。实则诸说之真谛不过形容有胎之脉当生机流动，无涩滞而已。以余考之，验胎之法，当以"身有病而无邪脉"一语为最佳。何谓身有病？月事不行是也。月事不行，乃不通之象，当见涩滞之脉，今无邪脉，是不见涩滞而反见滑利，滑利则生机流动，与病不符，则知其经停非病，而有胎矣。以此消息，验胎之脉，无有善于此者。若初次有娠者，可于乳头验之。有娠三月，乳房发胀，乳头变黑，不如此不成胎也。怀胎六月，腹中必动，间有不动者，必有漏红之急。漏红太甚，血不养胎，胎萎不长，故不动。但能漏止血足，其胎自动。当以法治之。至于验腹分男女之法，当于五月以后行之，男胎背朝外，故形如釜，女胎足朝外，故形如箕。此法甚验，以其从实践而来，非虚语也。二曰恶阻。普通有胎者必见之病状也。其期每在受孕二三月中，轻者不治自愈，重者非药不除。其因有数：一为肝胆之气上逆。以一二月中，肝胆养胎，受胎之后，血尽养胎，不能兼养肝胆，肝胆无制，胆火上逆，胃亦随之，呕恶酸苦，喜食酸物，木之味酸，虚而求助于食，故喜酸也。宜养肝体以柔肝用，泄胆火而平胃逆。养肝滋血，如白芍、乌梅、石斛、木瓜、元参、阿胶、橹豆、胡麻、女贞之类，清泄胆胃，如金铃、姜山栀、川连、黄芩、黛蛤散、橘皮、竹茹之类。甘酸、酸苦最为要要，甘酸化阴，酸苦泄热，且酸能补助肝体也。如呕吐痰水甚多者，胃有痰湿，宜复以二陈、温胆之类。如呕恶昼夜不止，势甚剧者，上逆甚则防其下脱，急宜降逆平和，当辨其舌苔脉象，以定治法。如苔黄腻，底尖绛，脉弦数者，胆火上炎，前方不应，可用黄连解毒、龙胆泻肝诸法。大便闭者，幽门不通，上冲吸门，非通下不可，当归龙荟丸。不能以有胎忌攻，当从有故无殒之例。此症此治，曾经验过。如舌光绛无苔，脉细数者，阴虚肝阳化风，气火上逆，洋参温胆加黄连，或十味温胆汤亦可。如再不应，则以大剂育阴增液之品煎汤，以苏梗、香附、乌药、陈皮等行气降逆之品磨冲或研末冲服。育阴而不碍气，顺气而不伤阴，亦良法也。一为浊气上冲。女子受胎，则月事不行。月事者，血之余也。平时有余则闰，而月一下，既已有孕，则下以养胎，上为乳汁，无余故不下。故有胎则经停，乳子则经少，其明证也。惟其中有精有浊，其停也，不能专取其精华而遗其糟粕。其精者以养胎，以化乳，其浊者停而不出，无所发泄，反从上逆。胞胎系胃，胃脉通心，由脉上冲，则为呕恶，故俗名恶心，良有以也。惟其上冲之路，必由胃逆，胃气强者，冲不上至，故恶轻，或并不恶。曾见有一生受孕，从无恶阻者，即是胃气强之故。亦有体虚甚而无恶阻者，则以其血质甚清，浊气不多也。此系体质之故，无关病理。若胃弱而浊气重者，则断无不恶之理。其治以芳香化浊为唯一之法，故藿、佩、砂、蔻在所必用。夹热加茹、连，夹湿加吴萸、丁香。而和胃健中，亦不可少，以浊之上逆，必由胃虚，故四君、异功等汤亦当合用也。
产后篇
《金匮》产后病，首标三证，即病痉、病郁冒，病大便难也。产后不止三证，而独以此三证为言者，以其每易相因同见，而为产后病之大纲也。后人不察三证为三大法，如太阳之麻桂、青龙焉，实为错误。盖三证之本固同，唯兼见不同，知其本则其末自明，纵有变幻，亦能指挥若定，故仲景特提出常见之三证本末同异，以为标准，庶乎有所取法耳。新产之后，血去太多，血虚乃必然之理，血为阴，血虚则亡其阴。亡阴血虚，阳气独盛，热逼汗泄，故喜汗出，汗多亦必然之理也。血虚亡阴，阳盛多汗八字则为新产三证之本。熟此八字，然后再观其流变。如汗出表虚，腠理不固，风邪乘虚入中，血虚阴亏，不能荣养筋骨，汗出津亡，不能润泽关节。阴亏阳盛，阳盛则生热，热盛则津液愈亏，风邪鼓动，风火交扇，筋骨不荣，则背反强，脚挛急，手搐搦，而为痉病。若亡血之后，复得多汗，血去阴伤，汗多津竭。胃为阳土，肠为燥金，津液即亡，肠胃益燥，肠无津润，宿垢无以下达，传导之令不行，水涸舟胶，则为大便难。血虚于下，则为下厥，阴厥于下，不能配阳，孤阳无依，独越于上，则为冒。阴弱于内，阳浮于外，逼汗外泄，汗出孔疏，外寒易袭，则为郁。寒束于外，阳无所泄，独冒于上，则头眩晕，独头汗出，则为郁冒。阴涸于下，则便坚。气冲于上，则呕逆。便难呕逆，而与头晕头汗出同见，是大便难而兼郁冒矣。头晕汗出，而见肢搐背张，是郁冒而兼痉厥矣。大便难最轻，郁冒次之，痉厥最重。三证可以同见，可以依稀而见。以其标虽不同，其本则同，同者何？即血虚阴亏、阳盛汗出八字是也。至言治法，经未出方，然可以意想得之。痉为血液不足，汗出受风，宜养血祛风而柔筋脉，借用桂枝加栝楼根汤合四物汤颇合病症。后人清魂散、古拜散用黑芥穗祛营分之风，甚妙。再参养营舒筋，治无不效也。大便难，经方可用脾约麻仁丸，时方若吴氏《条辨》增液汤、增液承气，陶氏黄龙汤、玉烛散等，亦佳。惟纯虚者，用养营润燥，少佐行气通幽，如苏子、麻仁之类。虚中夹实，则朴、枳、硝、黄亦可合补药用。仲景治产后便坚用大承气者有二方，虽非常法，聊备一格，非绝对不可用也。当以证为辨，痞满坚拒作痛方可用之。但硬不痛，惟有滋润一法，不能攻下。《伤寒》谓苔滑者不可攻。滑字极有经验，一切病症，应行攻下，均当于此致意，不独伤寒一门也。郁冒，经出小柴胡一方，先疏其郁，郁去则冒亦减，意良美也。惟阳升而冒，柴胡究不相宜。南人体虚，尤为枘凿。冒宜养阴潜阳，郁宜疏解辛散。求其疏郁而不升阳增冒者，其唯黑芥、焦防之属欤。以言时方，似以清魂散合养血柔肝、潜阳为当。总之三证之治，虽有差池，而养血补虚，终为要著。丹溪谓产后无论何证，总以补血为主，不为无见。但当察其兼证，以定制方之法耳。新产之病，除三证外，次则腹痛。以新产之时，恶露未净，血滞气凝，最易腹痛，故生化汤为产后必服之剂。仲景则出枳实芍药散一方，枳实炒黑入血，祛血中之结滞，芍药和肝调营佐之，下以大麦粥。大麦和肝养心脾，心生血，脾统血，肝藏血，产后血虚正虚，故用之以扶正补虚，虚实并治，为产后恶露未净、血瘀腹痛之正方。后人妄言产后忌芍药，真不读仲景书者也。方仅三味，虚实均以照顾，较之后世女科产后腹痛祛瘀之方，药多意少，高明多矣。枳实、芍药和肝祛瘀，和剂也。仲景既定为产后血虚，肝木侮土，恶瘀未楚之正方，又从本方之偏胜极则而分攻补两法。本文："产后腹中痛，当归生姜羊肉汤主之。并治腹中寒疝，虚劳不足"一条，是则产后腹痛，偏于虚寒者之治也。痛者，旧释为缓痛，缓痛固属虚，然不必虚痛尽缓，缓痛二字，不能尽虚寒之象也。无论缓痛、急痛、大痛，大抵以喜按、喜热、喜踡伏为辨。若见其证，更参色脉，毫无热症实象，方可断为虚寒。则痛二字，当指虚寒之各证而言，非可一也。当归温血，羊肉补虚，生姜散寒，为血海虚寒之圣剂。产后气血大伤，胞室空虚，客寒内犯，寒搏血虚，血得寒则血凝而不流，血不行则气停而作痛。其喜热者，寒得热则行也；其喜按者，虚则喜实也；其喜踡伏者，寒则收引，踡则阳气团聚，令暖内温，欲以胜其寒也。用当归生姜羊肉汤无一不切。或谓羊肉太补，非痛所宜，不知羊肉气温味厚，味厚能补，气温能通，是通补，非呆补也。加以当归温行，生姜辛散，系一完全通补奇脉之方。痛虽属虚，寒则宜散；虚虽当补，滞则宜行。昔人谓痛无补法，非真谓绝对不能用补药，惟纯补、呆补则终非合法耳。此方治虚痛，其妙在能用补药，而尤妙在选药制方。通补之方，固无出此三味右者，用之屡屡，验亦屡屡。若胃虚不能受羊肉者，服之恐吐，不得已而思其次，胶姜饮，胶艾汤亦可代之，惟功力稍逊耳。
本文："师曰：产妇腹痛，法当以枳实芍药散，假令不愈者，此为腹中有瘀血著脐下，宜下瘀血汤主之，亦主经水不利。"此则产后腹痛，偏于瘀实之主方也。设用而不应，或见虚象，当从虚治。假令不愈，非不合也，乃方轻不能胜病，病症仍在，反见纯实之象，自当更进一步论治。瘀血著于脐下，桃仁攻瘀，蟅虫破络，方极重峻。以产后体虚而有实邪，急祛其实，免致迁延伤正。炼蜜和丸，甘缓以和药性；以酒煮服，温行以助药力也。其证必见脐下坚结，拒按大痛，便黑目黯诸瘀结状，方可用此，非投枳实芍药散不应即攻也。产后腹痛，分此三法，而以枳实芍药和肝祛瘀为主。偏虚、纯虚者，当归生姜羊肉汤温之补之；偏实、纯实者，下瘀血汤攻之荡之。若嫌过峻，则生化加参汤，生化汤加五灵脂、百草霜等，均可代用，是在临证之权衡矣。
【背景信息】
书名：程门雪遗稿 章节：正文(4/4) 类别：综合
本文引用：“妇人妊娠，宜常服当归散主之。”“妊娠养胎，白术散主之。”这两条经文，讲的是胎前通用的安胎方法。当归散（Angelica Decoction）使用当归、白芍调和营血，川芎行气，黄芩清热，白术安胎，这是针对胎前体质偏热者的治法。黄芩和白术是安胎的药物，人们大多知道，因为胎前多热证，热邪会损伤胎元；胞宫系于脾，脾气虚弱则会导致胎坠。所以用黄芩清其热以保胎，用白术健运脾胃以举胎固胎。但是胎前虽然属热证的多，也有寒湿的证候，如第二条提到的白术散（Atractylodes Macrocephala Decoction），使用白术、牡蛎来燥湿，川芎温通血脉，蜀椒去除寒邪，这就是治疗胎前寒湿证的方剂。张仲景列出这两个安胎方，极有深意，恐怕后人偏执于凉药而畏惧热药，所以出一个当归散以清热，又出一个白术散以治寒湿，以此显示没有偏颇之意。而高明的医生用药，懂得原则与权变，不能用一句话概括。这两个方子中都用了川芎，川芎性温而行散，后人忌讳使用，却不知道补益之中若无行散之品，就会变成呆补；况且平时不疏利气机，临产时必然多有阻碍，所以两个方子均用川芎，以此说明行散的药物不必完全禁忌。用法得当，虽有碍滞之嫌实则无碍。张仲景著书时，似乎预知后人会有胎前忌热、忌通行药物的陋习，而预先为此进行矫正，不也很奇妙吗。妊娠门中，共有文章十一条，方剂十首，丸剂和散剂占七首，汤剂占三首。大概汤剂的作用荡涤猛烈，妊娠期应当以安胎为主，攻邪和补益都不宜骤用，应缓图之。
还有一条在妇人杂病门中，也应当移入胎前篇，即转胞（Urinary Retention due to Pregnancy）这个证候。原文说：“问曰：妇人病饮食如故，烦热不得卧，而反倚息者，何也？师曰：此名转胞不得溺也。以胞系了戾，故致此病。当利小便则愈。宜肾气丸主之。”这是在讲胎前转胞的证治。下窍不通，则气机上逆，因为不能排尿而出现烦热、不能平卧、倚靠呼吸等症状，这是病象表现在上而病根在下。其病因大概是由于胎儿沉重压迫膀胱。胞，就是脬（膀胱）。胞系扭转不顺，导致膀胱翻转，膀胱翻转则宣发气化功能不利，所以不能排尿。水气没有出路，反而从上逆冲。肾气丸（Kidney Qi Pill）能化气通阳，气壮则能举胎，胎举则膀胱宣化功能得以恢复，小便通利，下窍通则上部的病症自然痊愈。这里用肾气丸利小便的意思，并不是说只要利小便就可以治疗转胞。这个证候少腹部必然坠胀难忍，小便点滴而出。其病因也不止是胎重压胞这一种原因，只是胎前这种情况居多而已。《甲乙经》说：“转胞不得溺，少腹满，关元主之。”明确说明转胞有少腹胀满的症状，且应当从肾脏主治。关元穴是肾经穴位，张仲景的肾气丸正是基于此理。后人论述这个证候，有虚证和实证的区分。如饱食后疾走，忍尿行房，忍精不泄导致膀胱热闭塞，都属于实证。血少气虚，胎气不能上举，下压膀胱，则为虚证。治疗方法除肾气丸外，有用沉香、木香利气的，有用盐汤探吐开通上窍，上窍开则下窍利的。而朱丹溪以补气升举的药物为君药，佐以探吐法。以上各法，尤其适合虚证患者，所以学者们多采用，确实能弥补前人的不足，是非常好的方法。
妊娠篇
胎前的病很多，但大致分类，有两个大别：一是因怀孕而引发的疾病，二是因病而影响胎儿。因病碍胎，无论是外感还是内伤，都能导致这种情况，应当在杂病门中寻找治疗方法。只是在未伤胎时，以祛除疾病为主，安胎为辅；既已伤胎后，以安胎为主，祛病为辅，这是不同的。因胎而成病者，是因为必须有胎，然后才有此病，所以属于胎前特有的候症。现在就此进行讨论，以免滋蔓复杂。一曰验胎（Diagnosis of Pregnancy）。怎么知道怀孕了？回答说：应当在脉象中验证。书中关于胎脉的说法很多，而且各不相同，有的说寸口脉动甚是有孕，有的说有胎之脉应当阴搏阳别，有的说脉滑大是有胎，还有的说应当脉动如珠，左大为男，右大为女。然而这些说法有的灵验有的不灵验，未能确定哪一个是正确的，所以医生每觉得验胎很难。实际上这些说法的真谛不过是形容有胎之脉应当生机流动，没有涩滞而已。据我考证，验胎的方法，以“身有病而无邪脉”这句话最为恰当。什么叫身有病？月经停止就是。月经停止，是不通的征象，应当见到涩滞的脉象，现在没有邪脉，是不见涩滞反而见滑利，滑利则生机流动，与病态不符，就知道月经停闭不是病，而是有胎了。据此斟酌，验胎的脉象，没有比这更好的了。如果是初次怀孕的人，可以从乳头验证。怀孕三个月，乳房发胀，乳头变黑，不像这样就不是怀孕。怀孕六个月，腹中必定有胎动，间或有不动的，一定有漏红（阴道出血）的急症。漏红太甚，血不养胎，胎萎不长，所以不动。但只要止血足血，胎儿自然会动。应当用法治疗。至于通过验腹分辨男女的方法，应当在五月以后进行，男胎背朝外，所以腹部形状像釜，女胎足朝外，所以腹部形状像箕。这个方法很灵验，因为它是从实践中得来的，不是空话。二曰恶阻（Morning Sickness）。这是普通孕妇必见的症状。其时期多在受孕后的两三个月中，轻者不治自愈，重者非药物不能消除。其原因有几个：一是肝胆之气上逆。在一两个月时，肝胆负责养胎，受孕之后，血液都用来养胎，不能兼养肝胆，肝胆失去制约，胆火上逆，胃气也随之上逆，出现呕吐酸苦，喜欢食用酸物，木的味道是酸，肝虚而求助于食物，所以喜酸。适宜滋养肝体以柔顺肝用，清泄胆火而平降胃逆。滋养肝滋血的药物，如白芍、乌梅、石斛、木瓜、玄参、阿胶、橹豆、胡麻、女贞子之类；清泄胆胃的药物，如金铃子、姜山栀、黄连、黄芩、黛蛤散、橘皮、竹茹之类。甘酸、酸苦最为重要，甘酸化阴，酸苦泄热，且酸能补助肝体。如果呕吐痰水很多，说明胃有痰湿，适宜配合二陈汤、温胆汤之类。如果呕恶昼夜不止，病情严重，上逆太甚则防止下脱，急需降逆平和，应当辨别舌苔脉象，以确定治法。如苔黄腻，舌底尖绛，脉弦数，是胆火上炎，前方无效，可用黄连解毒汤、龙胆泻肝汤诸法。大便闭结者，幽门不通，气机上冲吸门，非通下不可，用当归龙荟丸。不能因为有胎就忌讳攻下，应当遵循“有故无殒”的原则。这种病症这种治法，我曾经验证过。如果舌光绛无苔，脉细数，是阴虚肝阳化风，气火上逆，可用西洋参温胆汤加黄连，或十味温胆汤也可以。如果再无效，就用大剂育阴增液的药物煎汤，以苏梗、香附、乌药、陈皮等行气降逆的药物磨冲或研末冲服。育阴而不碍气，顺气而不伤阴，也是好方法。二是浊气上冲。女子受孕，则月经停止。月经是血的剩余部分。平时有余则闰月而下，既然已有孕，则下以养胎，上化为乳汁，没有剩余所以不下。所以有胎则经停，哺乳则经少，这是明显的证据。其中既有精华又有糟粕，经血停止时，不能只取精华而遗留糟粕。精华用来养胎、化乳，糟粕停滞不出，无处发泄，反而从上逆冲。胞胎系于胃，胃脉通心，由脉上冲，则为呕恶，所以俗名恶心，确实有其道理。只是其上冲之路，必然由胃气上逆引起，胃气强盛，冲不上去，所以恶心轻，或者根本不恶心。曾见过有人受孕，从无恶阻的，就是胃气强的缘故。也有体质非常虚弱而没有恶阻的，则是因其血质很清，浊气不多。这是体质的原因，无关病理。如果胃弱而浊气重，则断然不会有不恶心的道理。治疗以芳香化浊为唯一的方法，所以藿香、佩兰、砂仁、蔻仁在所必用。夹热加竹茹、黄连，夹湿加吴茱萸、丁香。而和胃健中，也不可缺少，因为浊气上逆，必然由于胃虚，所以四君子汤、异功散等汤剂也应当合用。
产后篇
《金匮要略》产后病，首先标出三个证候，即病痉（Spasm）、病郁冒（Depression and Vertigo）、病大便难（Difficulty in Defecation）。产后不止这三个证候，而独以此三证来说明，是因为它们容易相互关联同时出现，作为产后病的纲领。后人不明这三证是三大法则，就像太阳病的麻黄汤、桂枝汤、小青龙汤一样，这实际上是错误的。因为三证的本质相同，只是兼见不同，知道了本质，末节自然明了，即使有变化，也能指挥若定，所以张仲景特别提出常见的三证的本末同异，作为标准，以便有所取法。新产之后，失血太多，血虚是必然的道理，血属阴，血虚则亡阴。亡阴血虚，阳气独盛，热逼汗泄，所以喜欢出汗，汗多也是必然的道理。血虚亡阴，阳盛多汗这八个字是新产三证的根本。熟记这八个字，然后再观察其流变。如汗出表虚，腠理不固，风邪乘虚而入，血虚阴亏，不能荣养筋骨，汗出津亡，不能润泽关节。阴亏阳盛，阳盛则生热，热盛则津液愈亏，风邪鼓动，风火交扇，筋骨不荣，则出现角弓反张，脚挛急，手搐搦，而为痉病。如果在亡血之后，又得多汗，血去阴伤，汗多津竭。胃为阳土，肠为燥金，津液即亡，肠胃更加干燥，肠无津润，宿垢无法下行，传导功能不行，水涸舟胶，则为大便难。血虚于下，则为下厥，阴厥于下，不能配阳，孤阳无依，独越于上，则为冒。阴弱于内，阳浮于外，逼汗外泄，汗出孔疏，外寒易袭，则为郁。寒束于外，阳无所泄，独冒于上，则头眩晕，独头汗出，则为郁冒。阴涸于下，则便坚。气冲于上，则呕逆。便难呕逆，而与头晕头汗出同见，是大便难而兼郁冒。头晕汗出，而见肢搐背张，是郁冒而兼痉厥。大便难最轻，郁冒次之，痉厥最重。三证可以同见，也可以依稀而见。因为其标虽不同，其本则同，同的是什么？即血虚阴亏、阳盛汗出这八个字。至于治法，经典中没有出方，但可以意想得知。痉为血液不足，汗出受风，宜养血祛风而柔筋脉，借用桂枝加栝楼根汤合四物汤颇合病症。后人清魂散、古拜散用黑芥穗祛营分之风，甚妙。再参养营舒筋，治无不效。大便难，经典方可用脾约麻仁丸，时方如吴氏《温病条辨》增液汤、增液承气汤，陶氏黄龙汤、玉烛散等，也很好。如果是纯虚者，用养营润燥，少佐行气通幽的药物，如苏子、麻仁之类。虚中夹实，则厚朴、枳实、芒硝、大黄也可以配合补药用。张仲景治产后便坚用大承气汤的有两个方子，虽然不是常规方法，姑且备一格，并非绝对不可用。应当以证候为辨别，痞满坚拒作痛方可用之。但如果硬而不痛，惟有滋润一法，不能攻下。《伤寒论》说苔滑者不可攻。滑字极有经验，一切病症，应行攻下的，都应当在此处留意，不独伤寒一门。郁冒，经典出小柴胡汤一方，先疏其郁，郁去则冒亦减，用意良美。只是阳升而冒，柴胡终究不相宜。南方人体虚，更为格格不入。冒宜养阴潜阳，郁宜疏解辛散。求其疏郁而不升阳增冒的，大概是黑芥、焦防风之类的吧。以言时方，似乎以清魂散合养血柔肝、潜阳为当。总之三证的治疗，虽有差池，而养血补虚，终为要著。朱丹溪说产后无论何证，总以补血为主，不为没有见解。但应当察其兼证，以定制方的方法。新产之病，除三证外，其次则是腹痛。因为新产之时，恶露未净，血滞气凝，最容易腹痛，所以生化汤是产后必服的药剂。张仲景则出枳实芍药散一方，枳实炒黑入血分，祛血中之结滞，芍药和肝调营佐之，下以大麦粥。大麦和肝养心脾，心生血，脾统血，肝藏血，产后血虚正虚，所以用之以扶正补虚，虚实并治，为产后恶露未净、血瘀腹痛的正方。后人妄言产后忌芍药，真是没读仲景书的人啊。方仅三味，虚实均以照顾，较之后世女科产后腹痛祛瘀之方，药多意少，高明多了。枳实、芍药和肝祛瘀，是和剂。张仲景既定为产后血虚，肝木侮土，恶瘀未楚的正方，又从本方之偏胜极则而分攻补两法。原文：“产后腹中痛，当归生姜羊肉汤主之。并治腹中寒疝，虚劳不足”一条，这是产后腹痛，偏于虚寒者的治法。痛者，旧释为缓痛，缓痛固属虚，但不必虚痛尽缓，缓痛二字，不能尽虚寒之象。无论缓痛、急痛、大痛，大抵以喜按、喜热、喜踡伏为辨别。如果见到这些证候，更参色脉，毫无热症实象，方可断为虚寒。则痛二字，应当指虚寒的各证而言，不可一概而论。当归温血，羊肉补虚，生姜散寒，为血海虚寒的圣剂。产后气血大伤，胞室空虚，客寒内犯，寒搏血虚，血得寒则血凝而不流，血不行则气停而作痛。其喜热者，寒得热则行也；其喜按者，虚则喜实也；其喜踡伏者，寒则收引，踡则阳气团聚，令暖内温，欲以胜其寒也。用当归生姜羊肉汤无一不切。有人说羊肉太补，不适合疼痛，不知道羊肉气温味厚，味厚能补，气温能通，是通补，不是呆补。加上当归温行，生姜辛散，是一个完全通补奇经的方子。痛虽属虚，寒则宜散；虚虽当补，滞则宜行。昔人谓痛无补法，并非真谓绝对不能用补药，只是纯补、呆补则终非合法。此方治虚痛，其妙在能用补药，而尤妙在选药制方。通补之方，固无出此三味之右者，我用之屡屡，验亦屡屡。如果胃虚不能受羊肉者，服之恐吐，不得已而思其次，胶姜饮、胶艾汤也可替代，只是功力稍逊。
原文：“师曰：产妇腹痛，法当以枳实芍药散，假令不愈者，此为腹中有瘀血著脐下，宜下瘀血汤主之，亦主经水不利。”这是产后腹痛，偏于瘀实的主方。假设用了而无效，或见虚象，应当从虚治。假如不愈，不是不合，而是方轻不能胜病，病症仍在，反见纯实之象，自当更进一步论治。瘀血著于脐下，桃仁攻瘀，蟅虫破络，方极重峻。因为产后体虚而有实邪，急祛其实，免致迁延伤正。炼蜜和丸，甘缓以和药性；以酒煮服，温行以助药力。其证必见脐下坚结，拒按大痛，便黑目黯诸瘀结状，方可用此，不是投枳实芍药散不应即攻也。产后腹痛，分此三法，而以枳实芍药和肝祛瘀为主。偏虚、纯虚者，当归生姜羊肉汤温之补之；偏实、纯实者，下瘀血汤攻之荡之。如果觉得过峻，则生化加参汤，生化汤加五灵脂、百草霜等，均可代用，是在临证之权衡矣。
Background Information: Book: Cheng Menxue's Manuscripts; Chapter: Main Text (4/4); Category: Comprehensive
The text states: "For pregnant women, it is advisable to regularly take Danggui San (Angelica Decoction)." And: "To nourish the fetus during pregnancy, Baizhu San (Atractylodes Macrocephala Decoction) should be used." These two passages discuss the general methods for fetal maintenance before delivery. Danggui San uses Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix) to harmonize Ying (Nutritive Qi), Chuanxiong (Ligustici Chuanxiong Rhizoma) to move Qi, Huangqin (Scutellariae Radix) to clear Heat, and Baizhu (Atractylodis Macrocephalae Rhizoma) to stabilize the fetus; this is a method for those with a heat constitution during pregnancy. Huangqin and Baizhu are known as herbs for stabilizing the fetus by many people, because there is often Heat during pregnancy, and Heat damages the fetal origin; the Bao (Uterus) is connected to the Pi (Spleen), and when the Spleen is deficient, the fetus may fall. Therefore, Huangqin is used to clear its Heat to protect the fetus, and Baizhu is used to strengthen the Spleen to support the fetus. However, although most cases during pregnancy belong to Heat, there are also Cold-Damp syndromes. For example, the second passage mentions Baizhu San, which uses Baizhu and Muli (Concha Ostreae) to dry Dampness, Chuanxiong to warm the blood, and Shujiao (Zanthoxyli Pericarpium) to remove Cold; this is the formula for treating Cold-Damp conditions during pregnancy. Zhang Zhongjing listed these two formulas for fetal maintenance with profound meaning, fearing that later generations would be biased towards cooling medicines and fearful of warming ones. Thus, he presented Danggui San to clear Heat, and Baizhu San to treat Cold-Damp, showing an intention of non-bias. Wise physicians understand principles and flexibility in medication usage and cannot summarize it with a single statement. Both formulas use Chuanxiong; Chuanxiong is warm and moving, yet later generations avoided using it, not realizing that tonification without movement becomes stagnant tonification. Moreover, if Qi mechanism is not unblocked normally, there will likely be obstructions at delivery. Therefore, both formulas use Chuanxiong to demonstrate that moving medications need not be entirely taboo. When used correctly, potential hindrances become harmless. Zhang Zhongjing, when writing his book, seemed to anticipate the later bad habit of avoiding warmth and moving agents during pregnancy, and pre-emptively corrected this, which is indeed remarkable. In the Pregnancy Section, there are eleven articles and ten formulas in total; seven are pills or powders, and three are decoctions. Generally, decoctions have a sweeping and vigorous action; pregnancy treatment should focus on stabilizing the fetus, and neither purging nor tonifying should be abrupt but rather gradual.
There is one more case in the Women's Miscellaneous Diseases section that should be moved to the Prenatal section, namely the syndrome of Zhuanbao (Urinary Retention due to Pregnancy). The text says: "Asked: A woman suffers from illness where her diet remains normal, she feels vexed and hot, cannot lie flat, and instead leans forward to breathe. Why? The Master said: This is called Zhuanbao, inability to urinate. Because the Bao system is twisted, this disease arises. Promoting urination will lead to recovery. Shengqi Wan (Kidney Qi Pill) is indicated." This discusses the diagnosis and treatment of Zhuanbao during pregnancy. Obstruction below leads to rebellion above; inability to urinate causes vexation, heat, inability to lie flat, and leaning to breathe, indicating the pathology manifests above but originates below. The etiology is likely due to the heavy fetus compressing the Bao (Bladder/Uterus). Bao refers to the Paob (Bladder). If the Bao system twists and fails to flow smoothly, the Bao turns, leading to impaired宣化 (transformation and transportation) of the Bladder, resulting in inability to void. Water Qi has no outlet and rebels upwards. Shengqi Wan transforms Qi and unblocks Yang; strong Qi lifts the fetus, and once lifted, the Bladder's transformation function resumes, urination becomes smooth, and upper symptoms resolve upon lower clearance. The intent here is not merely to say that promoting urination cures Zhuanbao. This syndrome must present with unbearable distending pain in the lower abdomen and scanty urination. Etiology is not solely fetal compression, though it is common in pregnancy. The *Jia Yi Jing* states: "Zhuanbao with inability to urinate and lower abdominal fullness, Guanyuan (CV4) is indicated." This explicitly states Zhuanbao presents with lower abdominal fullness and should be treated via the Kidney channel. Guanyuan is a Kidney point, providing the basis for Zhang Zhongjing's Shengqi Wan. Later discussions distinguish between deficiency and excess syndromes. For instance, walking rapidly after a full meal, holding urine during intercourse, or retaining semen causing bladder Heat obstruction are all Excess syndromes. Blood deficiency and Qi deficiency, where fetal Qi fails to lift and presses down on the Bladder, constitute a Deficiency syndrome. Treatment methods, besides Shengqi Wan, include using Chenxiang (Aquilariae Lignum Resinatum) and Muxiang (Vladimiriae Root) to promote Qi flow, or using salt water to induce vomiting to open the upper orifice, thereby benefiting the lower orifice. Zhu Danxi used Qi-tonifying and lifting herbs as sovereign drugs, assisted by inducing vomiting. The aforementioned methods are particularly suitable for deficiency patients, hence widely adopted by scholars, effectively supplementing previous limitations and serving as excellent models.
Pregnancy Section
Diseases during pregnancy are numerous, but broadly categorized into two types: those caused by pregnancy itself, and those affecting the fetus due to other diseases. Diseases affecting the fetus, whether external contraction or internal injury, can all cause this, and should be sought in the Miscellaneous Diseases section. Before damaging the fetus, the primary goal is removing the disease, with fetal stabilization as secondary; after damaging the fetus, the primary goal is stabilizing the fetus, with disease removal as secondary. This distinction is crucial. Diseases caused specifically by pregnancy exist only because the fetus is present, thus belonging to specific prenatal conditions. We discuss them here to avoid complexity. First is diagnosing pregnancy. How do we know one is pregnant? By examining the pulse. There are many descriptions of pregnancy pulses in texts, varying significantly. Some say vigorous pulsation at Cun Kou indicates pregnancy; some say Yin pulses beat distinctly while Yang pulses differ; some say slippery and large pulses indicate pregnancy; others say pulses move like pearls, with left dominance indicating male and right female. However, these methods vary in accuracy, making definitive diagnosis difficult for physicians. Essentially, the core truth of these descriptions is that a pregnancy pulse should exhibit flowing vitality without stagnation. Based on my research, the best method for diagnosing pregnancy is the phrase "symptoms of illness but absence of pathological pulse." What constitutes "symptoms of illness"? Amenorrhea. Amenorrhea suggests obstruction, typically associated with choppy/stagnant pulses. However, in pregnancy, there is no pathological pulse; instead, we see slippery and smooth pulses. Slippery and smooth indicate flowing vitality, inconsistent with disease, suggesting amenorrhea is not pathological but due to pregnancy. Considering this, no pulse diagnosis for pregnancy is superior. For first-time pregnancies, verification can be done via nipples. At three months, breasts swell and nipples darken; absence of these signs suggests no pregnancy. At six months, fetal movement is usually felt; if absent, urgent vaginal bleeding (Louhong) may be occurring. Severe bleeding fails to nourish the fetus, leading to fetal wasting and lack of movement. If bleeding stops and blood volume recovers, movement resumes. Treatment is required. Methods for determining fetal gender by abdominal shape should be applied after five months. Male fetuses face outward with their backs, creating a cauldron-like shape; female fetuses face outward with their feet, creating a basket-like shape. This method is highly accurate as it derives from practice, not speculation. Second is Ezuzu (Morning Sickness/Nausea of Pregnancy). This is a common symptom in pregnancy, typically occurring in the second or third month. Mild cases resolve spontaneously; severe cases require medication. Causes include: First, rebellious Qi of Liver and Gallbladder. During the first two months, Liver and Gallbladder nourish the fetus. After conception, blood is fully utilized for the fetus and cannot simultaneously nourish Liver and Gallbladder. Unchecked, Gallbladder Fire rebels upward, dragging Stomach Qi with it, causing vomiting of sour/bitter fluids and craving for sour foods. Wood flavor is sour; liver deficiency seeks aid from food, hence the craving. Treatment should nourish Liver substance to soften Liver function, drain Gallbladder Fire, and calm Stomach rebellion. Herbs to nourish Liver and tonify blood include Shaoyao (Paeoniae Radix), Wumei (Mume Fructus), Shihu (Dendrobii Caulis), Mugua (Chaenomelis Fructus), Xuanshen (Scrophulariae Radix), Ejiao (Colla Corii Asini), Ludou (Sojae Semen Praeparatum), Huma (Sesami Fructus), and Nuzhenzi (Ligustri Lucidi Fructus). Herbs to clear/drain Gallbladder and Stomach include Jinlingzi (Meliae Toosendan Fructus), Jiang Shanzhi (Gardeniae Fructus processed with Ginger), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Daige San (Murex and Indigo Powder), Jupi (Citri Reticulatae Pericarpium), and Zhuru (Bambusae Caulis in Taenia). Sweet-sour and sour-bitter combinations are crucial: sweet-sour generates Yin, sour-bitter drains Heat, and sour supplements Liver substance. If profuse phlegm-fluid vomiting occurs, indicating Phlegm-Damp in Stomach, combine with Erchen Tang (Two-Cured Decoction) or Wendan Tang (Warm Gallbladder Decoction). If vomiting persists day and night severely, preventing downward collapse due to extreme upward rebellion, urgently calm rebellion moderately. Differentiate based on tongue coating and pulse. Yellow greasy coating, red tip, wiry rapid pulse indicates Gallbladder Fire flaming upward; if previous formulas fail, use Huanglian Jiedu Tang (Coptis Decoction for Detoxification) or Longdan Xiegan Tang (Gentian Liver-Draining Decoction). Constipation implies blockage at the pylorus, with Qi rushing up to the glottis; purgation is necessary, using Danggui Longhui Wan (Angelica and Gardenia Pills). Do not fear purgatives due to pregnancy; follow the principle "having the pathogen allows for no harm." I have verified this treatment. If the tongue is bare and crimson with fine rapid pulse, indicating Yin deficiency with Liver Yang transforming into Wind and Qi/Fire rebelling, use Yangshen Wendan Tang (American Ginseng Warm Gallbladder Decoction) plus Huanglian, or Shiwei Wendan Tang (Ten-Ingredient Warm Gallbladder Decoction). If still ineffective, use large doses of Yin-nourishing and fluid-generating herbs decocted, mixed with powder of Sugen (Perillae Caulis), Xiangfu (Cyperi Rhizoma), Wuyao (Linderae Radix), and Chenpi (Citri Reticulatae Pericarpium) to move Qi and calm rebellion. Nourishing Yin does not obstruct Qi; moving Qi does not damage Yin, which is also a good method. Second cause: Turbid Qi rushing upward. Upon conception, menstruation stops. Menstruation is surplus blood. Normally surplus leads to monthly shedding. With pregnancy, blood nourishes the fetus below and transforms into milk above; no surplus remains to shed. Hence, pregnancy stops menses, lactation reduces them. Essence nourishes fetus/milk; turbidity remains trapped, having no outlet, and rebels upward. The Bao is connected to Stomach, Stomach meridian connects to Heart; rising via meridians causes nausea/vomiting, hence the term "nausea." The path of rebellion goes through Stomach. Strong Stomach Qi prevents rebellion, resulting in mild or no nausea. I have seen women conceive without any nausea due to strong Stomach Qi. Some very weak constitutions also lack nausea because their blood quality is clear with little turbidity. This is constitutional, not pathological. Weak Stomach with heavy turbidity inevitably causes nausea. Treatment relies solely on aromatic transformation of turbidity; Huoxiang (Agastaches Herba), Peilan (Plagiosci Herba), Sharen (Amomi Fructus), and Kouren (Cardamomi Fructus) are essential. Add Ruyu (Bambusae Caulis in Taenia) and Huanglian for Heat; add Wuzhuyu (Evodiae Fructus) and Dingxiang (Caryophylli Flos) for Damp. Harmonizing Stomach and strengthening Middle is indispensable because turbid rebellion stems from Stomach deficiency; thus, Sijunzi Tang (Four-Gentlemen Decoction) and Yigong San (Extra-Efficacy Powder) should be combined.
Postpartum Section
*Jinkui Yaolue* lists three primary postpartum syndromes: Jing (Spasm), Yumao (Depression and Vertigo), and Bian Nan (Difficulty in Defecation). Postpartum disorders are not limited to these three, but they are highlighted because they often occur together, forming the outline of postpartum diseases. Later physicians mistakenly viewed these three as distinct major laws, akin to Mahuang Tang, Guizhi Tang, and Xiao Qinglong Tang for Taiyang disease, which is erroneous. The root of the three syndromes is identical; only accompanying symptoms differ. Understanding the root clarifies the branches. Even with variations, one can manage them confidently. Thus, Zhang Zhongjing highlighted these three common syndromes' similarities and differences as standards for reference. After childbirth, excessive blood loss makes blood deficiency inevitable. Blood is Yin; blood deficiency leads to Yin depletion. Depleted Yin and deficient blood allow Yang to flourish alone. Heat forces sweat secretion, hence sweating is common and expected. "Blood deficiency, Yin depletion, Yang flourishing, excessive sweating" are the eight characters defining the root of the three postpartum syndromes. Master these eight characters, then observe variations. Sweating depletes Wei Qi, leaving pores unsecured, allowing Wind pathogens to enter. Blood deficiency and Yin decline fail to nourish sinews and bones. Sweat loss depletes fluids, failing to lubricate joints. Yin decline and Yang flourishing generate Heat, further depleting fluids. Wind agitates, Wind-Fire interact, sinews/bones lose nourishment, causing opisthotonos, leg cramps, and hand spasms—this is Jing disease. If excessive sweating follows blood loss, Yin injury and fluid exhaustion occur. Stomach is Yang Earth, Intestines are Dry Metal. Fluid loss dries intestines further. Without fluid lubrication, retained waste cannot descend, transmission fails, water dries and boat sticks—this is Bian Nan. Blood deficiency below causes Lower Jue (Cold extremities due to Yin collapse). Yin collapse below fails to anchor Yang; lone Yang floats upward—this is Mao (Vertigo/Dizziness). Yin weak internally, Yang floats externally, forcing sweat out, pores open, exterior Cold easily invades—this is Yu (Stagnation/Depression). Exterior Cold binds, Yang has no outlet, floats exclusively upward, causing dizziness and isolated head sweating—this is Yumao. Yin dried below causes hard stool. Qi rushes above causing vomiting/reversal. Hard stool and vomiting with dizziness/head sweating indicate Bian Nan combined with Yumao. Dizziness/sweating with limb spasms/back stiffness indicate Yumao combined with Jing/Jue. Bian Nan is mildest, Yumao moderate, Jing/Jue severest. These three can appear together or vaguely. Though manifestations differ, roots are same: blood deficiency, Yin depletion, Yang flourishing, sweating. Regarding treatment, classics provide no specific formulas, but can be inferred. Jing results from blood insufficiency and wind invasion after sweating; treat by nourishing blood, dispelling wind, and softening sinews. Borrow Guizhi Jia Guilou Gen Tang (Guizhi Decoction plus Trichosanthes Root) combined with Siwu Tang (Four-Substance Decoction), which fits well. Later Qinghun San and Gubai San use Hei Jiesui (Charred Sheathed Seedhead of Mustard) to dispel Wind in Ying level, which is ingenious. Combine with Yangying Shujin (Nourish Ying and Relax Sinews) treatments for efficacy. For Bian Nan, Jingfang uses Miyue Maren Wan (Hemp Seed Pill for Confinement). Time formulas like Wu's *Tiaobian* Zengye Tang (Increase Fluids Decoction), Zengye Chengqi Tang, Tao's Huanglong Tang, and Yuzhu San are also good. For pure deficiency, use Yangying Rundao (Nourish Ying and Moisten Dryness) with minor Qi-moving/unblocking agents like Suzi (Perillae Fructus) and Maren (Cannabis Fructus). For deficiency with excess, Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus), Xiaoshao (Miris Natrii Sulfas), and Dahuang (Rhei Radix et Rhizoma) can be combined with tonics. Zhang Zhongjing used Dachengqi Tang (Major Order the Qi Decoction) for postpartum hard stool in two formulas; though not routine, they serve as alternatives, not absolutely contraindicated. Use only if bloating, fullness, hardness, resistance, and pain are present. If hard but painless, only moistening is applicable, not purgation. *Shanghan Lun* states slippery coating contraindicates purgation. "Slippery" is empirically valuable; for all diseases requiring purgation, attention to this sign is crucial, not just in Shanghan. For Yumao, Jing provides Xiao Chaihu Tang (Minor Bupleurum Decoction) to first disperse stagnation; reducing stagnation reduces vertigo, a good intention. However, for Yang rising causing vertigo, Chaihu is unsuitable. Southern constitutions are particularly vulnerable. Vertigo requires nourishing Yin and subduing Yang; stagnation requires dispersing and resolving with acrid-warmth. To disperse stagnation without raising Yang and worsening vertigo, Hei Jie (Charred Mustard Seed) and Jiao Fangfeng (Charred Saposhnikoviae Radix) seem appropriate. For time formulas, combining Qinghun San with blood-nourishing, liver-softening, and Yang-subduing methods seems proper. In summary, despite variations in treating the three syndromes, nourishing blood and tonifying deficiency remain key. Zhu Danxi stated postpartum treatment always prioritizes blood tonification, which is insightful. One must examine accompanying syndromes to customize formulas. Besides the three main syndromes, abdominal pain is next. Postpartum, lochia is not cleared; blood stasis and Qi stagnation easily cause abdominal pain. Hence, Shenghua Tang (Life Generation Decoction) is a mandatory postpartum medicine. Zhang Zhongjing provided Zhishi Shaoyao San (Immature Bitter Orange and Peony Powder). Zhishi charred enters blood level to remove blood stasis; Shaoyao harmonizes Liver and regulates Ying as assistant. Followed by Damai Zhou (Barley Porridge). Damai harmonizes Liver, nourishes Heart and Spleen. Heart generates blood, Spleen controls blood, Liver stores blood. Postpartum blood and Zheng Qi deficiency require this to support righteousness and tonify deficiency, treating both deficiency and excess. It is the correct formula for postpartum lochia retention and blood-stasis abdominal pain. Later claims that postpartum contraindicates Shaoyao show ignorance of Zhang Zhongjing's works. This simple three-ingredient formula covers both deficiency and excess, far superior to later gynecological formulas for postpartum abdominal pain which use many herbs with shallow intent. Zhishi and Shaoyao harmonize Liver and remove stasis, acting as a harmonizing agent. Zhang Zhongjing defined this as the standard for postpartum blood deficiency, Liver Wood insulting Earth, and lingering evil lochia. From this base, he derived attack and tonification methods based on extreme bias. Text: "Postpartum abdominal pain, Danggui Shengyang Roushou Tang (Angelica, Ginger, and Lamb Meat Decoction) is indicated. Also treats cold hernia in abdomen and deficiency-labor insufficiency." This addresses postpartum abdominal pain偏向虚寒 (leaning towards deficiency-cold). Pain was traditionally interpreted as slow/gnawing pain. While slow pain belongs to deficiency, not all deficiency pain is slow, and "slow pain" doesn't capture all deficiency-cold aspects. Whether slow, acute, or severe pain, differentiation relies on preference for pressure, warmth, and curling up. If these signs appear, combined with color/pulse lacking Heat/excess features, diagnose as deficiency-cold. "Tongue pain" here refers to various deficiency-cold syndromes, not a single type. Danggui warms blood, Roushou (Lamb Meat) tonifies deficiency, Shengjiang (Fresh Ginger) scatters Cold; this is a sacred remedy for Blood Sea deficiency-cold. Postpartum Qi and Blood severely damaged, Uterus empty, external Cold invades internally. Cold clashes with deficient blood; blood congeals and stagnates due to Cold. Stagnant blood causes Qi stoppage and pain. Preference for warmth: Cold moves with Heat. Preference for pressure: Deficiency welcomes solidity. Preference for curling: Cold contracts; curling gathers Yang Qi, warming interior to overcome Cold. Danggui Shengyang Roushou Tang fits perfectly. Some argue Lamb Meat is too tonifying for pain, not knowing Lamb Meat is warm in nature and thick in flavor; thick flavor tonifies, warm nature moves—it is moving tonification, not stagnant tonification. Added Danggui's warm movement and Shengjiang's acrid dispersion, it forms a complete moving-tonification formula for extraordinary vessels. Pain belongs to deficiency, but Cold requires scattering; Deficiency requires tonification, but stagnation requires movement. Ancients said "pain has no tonification method," meaning absolute prohibition of tonics is false; rather, pure or stagnant tonification is incorrect. This formula's brilliance in treating deficiency pain lies in using tonics wisely, especially in herb selection and formulation. No moving-tonification formula surpasses these three ingredients; repeated use yields consistent results. If Stomach deficiency cannot tolerate Lamb Meat, risking vomiting, consider secondary options: Jiao Jiang Yin (Gelatin and Ginger Drink) or Jiao Ai Tang (Gelatin and Artemisia Decoction), though slightly less potent.
Text: "Master said: Postpartum abdominal pain should be treated with Zhishi Shaoyao San. If it does not heal, this indicates blood stasis adhering below the umbilicus; Xiayuxue Tang (Downward Expelling Blood Stasis Decoction) is indicated, also treating irregular menstruation." This is the main formula for postpartum abdominal pain leaning towards Excess-Stasis. If used ineffectively or deficiency signs appear, treat as deficiency. "If not healed" implies the formula was too weak for the severity, symptoms persist, revealing pure Excess, necessitating stronger treatment. Blood stasis below umbilicus: Taoren (Pruni Persicae Semen) attacks stasis, Zhechong (Eupolyphaga/Steleophaga) breaks collaterals; the formula is potent. Postpartum body is deficient with Excess pathogen; urgently remove Excess to prevent prolonged damage to Zheng Qi. Honey-pilled for gentle sweetness moderating herb properties; decocted in wine for warmth aiding medicinal power. Symptoms must include firmness/tenderness below umbilicus, severe pain resisting pressure, black stool, dark eyes—all stasis signs—before using this. Do not jump to this immediately after Zhishi Shaoyao San fails. Postpartum abdominal pain is divided into these three methods, with Zhishi Shaoyao San harmonizing Liver and removing stasis as primary. For deficiency-leaning or pure deficiency, Danggui Shengyang Roushou Tang warms and tonifies. For excess-leaning or pure excess, Xiayuxue Tang attacks and sweeps. If considered too harsh, Shenghua Tang plus Renshen (Ginseng Radix et Rhizoma), or Shenghua Tang plus Wulingzhi (Trogopterori Faeces) and Baicaoshuang (Carbonized Herb Ash) can substitute, depending on clinical judgment.