南濠陈鳌妻，新产五六日，患腹痛，恶寒发热。医曰∶此元气太虚，正合丹溪云，产后当大补气血。遂用
人参大剂，入口痛剧，面黑发喘而死。殊不知丹溪以产后当以大补气血为主治，有杂症以末治之。今陈氏之妻，
因瘀血未尽，而恶寒发热，不先去其瘀血，骤施大补，是失丹溪主末二字之意矣。主末者，即标本之谓也。（《续
医说》。丹溪之言，本有语病，不须与之回护。）
吴孚先治杨氏妇，产后一月，半身以下忽肿胀脐突，小便不通。或以五皮饮加车前、牛膝治之，不效。吴
曰∶先经断而后肿胀，名曰血分。（分去声。）且按小腹有块如拳，知败血尚结于胞门，非温无以化之。以姜、桂佐
行瘀之剂，下血如黑漆数升，便利肿消。
孙文垣治温氏妇，产后五十余日，右胁胀痛，手不可近，（非虚痛可知。）赤白带下多如脓，发热便秘。
诊之曰∶此恶露未尽，血化为脓，宜急治之也。常见数妇病此，治之不善，积久为毒，有成肠痈者，有内成毒从腰俞出
者，皆瘀血为患也。急用泽兰叶、山楂、五灵脂，消恶露为君、川芎、当归、茯苓、白芍为臣，益母为佐，香
附、青皮为使。外与当归龙荟丸，润大便，使热从之去。服后，次日腹胁皆宽，痛亦止。又食荤与鸡子，复作
痛，但不如前之盛，与保和丸，用山楂煎汤，送下三钱，遂愈。（若用行气等药则引恶血入四肢，发为痈毒，
故产后以去恶露为要着。）
潘印川子室，年二十五，因难产伤力，继以生女拂意，后又女死悲戚，实时晕厥。洎醒，神思眯 ，手
足螈 ，目上视。孙至，因螈 ，不能诊脉，细询之，自产后，恶露绝无，时有女医在傍，与人参大嚼，及独
参汤，并粥杂进。盖参与粥，皆壅塞膈上，故神昏螈 不已也。教以手探喉中，乃随手吐出痰饮粥食盈盆，螈
方定。以川芎、山楂、泽兰叶、陈皮、半夏、茯苓、香附进之，稍得睡。不虞女医又私与补药，子丑时，陡
然狂乱，人皆异之，目为神附，祷禳无已。曰∶此恶露不尽，乃蓄血如见鬼之症，非真有神物相附也。（此时何不
明言女医之失？）徐以正言叱之，即缄默。继以清魂散加滑石、童便与之，天明小便乃行，狂乱皆定。既而女医欲要
功，又以药进，则狂乱如前，再与川芎一钱五分，当归四钱，泽兰、益母各一钱，临服，加童便，连进二帖不
效。此必胸中有痰作滞，故药力不行。即用前剂，大加山楂，恶露稍行，神思即清，静睡片时，手足微动，或
以掌批其面，或以手捶其胸，昏乱不息。诊其脉近虚，早间面红而光，申酉时面白，此血行火退，当补矣，与
人参、川芎、泽兰各一钱，当归、山楂各二钱，茯苓、陈皮各八分，卷荷叶一片，煎熟，调琥珀末五分。服半
时许，嗳气二声，此清阳升而浊阴降矣。自是恶露微行，大便亦利，饮食渐进而安。
细阅是案，其得肯綮处，全在知恶露未行，及误服人参两着。至其用药，亦只见症治症而已。雄按∶此证总
不宜用川芎，而方方用之，是白璧之瑕也。至于嗳气，谓为清阳升而浊阴降则误矣。其症既因痰阻瘀滞，气窒不行，
故用多方通降而得愈，则是浊阴降而清阳始升也，何可颠倒其词哉。）
俞东扶曰∶此条前半段法治不难，盖得其参粥杂进之病情，自有消瘀及消痰食之方法，但探吐法尤捷耳。
蓄血如见鬼，知者亦多。后半段恶露稍行，神思即静，略睡片时，昏乱不息，仍是蓄血形状。乃于轻剂消
瘀之中，复用人参，并不以前会误用而畏蹈故辙，此为高手。其讲脉与面色极是，但产后谵语昏狂，有纯
因于痰者，又不可不知。
高鼓峰治一妇人，产后恶露不尽，至六七日，鲜血奔注，发热口渴，胁痛狂叫，饮食不进。或用四物汤调
理，或用山楂、青皮、延胡、黄芩等药，卒无一效。脉之，洪大而数，此恶露未尽，留泊血海，凡新化之血，
皆迷失故道，不去蓄血，瘀则以妄为常，曷以御之？遂以醋制大黄一两，生地黄一两，桃仁泥五钱，干漆三钱，
浓煎饮之。或曰∶产后大虚，药毋过峻否？曰∶生者自生，去者自去，何虚之有？第急饮之，果熟寐半夜。次
早下黑血块数升，诸症如失矣，复用补中益气而安。（雄按∶此鼓峰杰出之案，然干漆可删，愈后亦不宜遽投
补中益气汤。）
薛立斋治一产妇，患恶露不下，服峻犷之剂，恶露随下，久而昏愦，以手护其腹。薛曰∶此脾气复伤作痛。
故用手护也。（虚痛喜按。）以人参理中汤加肉桂，二剂，补之而愈。
按∶产后恶露不下有二，一则瘀滞宜行，一则血虚宜补。予常治数人，皆二三日而止。察其人果虚，一
以大剂养荣而愈。
陆肖愚治谢四府如夫人，分娩旬余，忽臂下微微作痛。或谓血虚，用大料芎、归，十剂而痛不减。又谓血
当补气，阳生则阴长，加参、 ，五六剂而痛益剧。脉之，六部沉弦，而左关尺更紧。询之，止左边近肛门一
点痛耳。问痛处热否？曰∶极热。曰∶此气血不足而痛也，乃产后败血凝滞于肝经，臀乃肝经所络之地，凝而
注之，不急治，久必成毒，当行血海之瘀滞，解经络之蕴结，庶可消耳。不信，更医，仍以八物汤投之。一日，
痛处顿肿，又与寒凉解毒之品，致疮口不收，大便作滞，饮食不进，肌肉半削。再诊，脉微细如蛛丝，按之犹
觉有神。曰∶今宜大补矣。乃用四君子加 、桂、附，数剂泻止食进。又加当归、熟地，约十剂，成痂而愈。
一产妇患恶露不行，瘀塞溺道，小便不利，遍身浮肿，喘急不得卧，用牛膝膏治之愈。丹皮、大黄、当归、
桂心、桃仁、蒲黄、元胡、香附、瞿麦、川芎、麝香。先用土牛膝三两，水五碗，煎减半，入上药煎。
孙文垣治陈达庵之媳，产半月而腿疼。专科曰虚，与八珍汤，十日疼益盛，疼处益热。（非虚可知。）谓曰∶慎
勿认虚认风，此产后败血凝滞血海，流于经络，不急治，则瘀无从出，久必化脓成毒，或为肠痈。今腿疼，是
其候也。不信，复延专科。曰∶风也。但丹溪云，产后当大补气血，虽有它症，从末治。投十全大补，痛转剧，
大发寒热，小腹近胯红肿出脓。外科又与收口太早，腰俞复发一毒，痛肿寒热如初。十日后，大溃脓而不收口，
精神萎顿，肌肉陡削，饮食不进，恶心恶寒，奄奄一息。诊之，六脉濡大无力，清水无脓，曰∶势亟矣，速为保
脾，与人参、白术各五钱，甘草、干姜、附子各一钱，黄 三钱，白芷、桂心各五分。外科曰∶白术作脓，恐不
可服。曰∶脓不死人，饮食不进，则死人也。四帖神气回，饮食进，症减脓成。改用参苓白术散，调理一月而安。
朱丹溪治一妇人，年十八，难产七日，产后，大便泻，口渴气喘，面红有紫斑，小腹胀痛，小便不通，用
牛膝、桃仁、当归、红花、木通、滑石、甘草、白术、陈皮、茯苓煎汤，调益母膏。不减，后以杜牛膝煎浓汁
一碗饮之，至一更许，大利，下血一桶，小便通而愈。（《心法》。雄按∶此症余每以当归龙荟丸投之，立效。）
缪仲淳治庄敛之次女，产后恶露未净，至夜发热，脾胃却弱，腰腹大痛。时师谓产后气血俱虚，投以人参、
当归诸补剂转剧，咸虑其成蓐劳也。诊之，谓不数帖即痊矣。用白芍、扁豆、杜仲各三钱，红曲、苏子、车前
各二钱，萸肉、麦冬、青蒿各四钱，橘红、干葛各钱半，炙草八分，牛膝五钱，黑豆八钱，泽兰一钱，十剂而
恶露净，发热已，腹痛亦止。但腰痛未尽除，脾胃尚未健，改用白芍、山楂、橘红、麦芽、石斛、扁豆、沙参
各三钱，砂仁、杜仲、萸肉各一钱，五味一钱，炙草五分，牛膝五钱，莲肉四十粒，十余剂，脾胃亦健而全愈。
李天培治王正权室人，产后十余日，患寒热腹痛，目赤而涩，羞明疼痛。诊之，脉沉而涩，询其恶露未尽，
知停瘀为患。以当归、川芎、桃仁、红花、甘菊、生地、丹皮、银花、连翘、蝉蜕，清火行瘀驱风等剂，六帖而痊。
薛立斋治一妇，产后四肢浮肿，寒热往来。盖因败血流入经络，渗入四肢，气喘咳嗽，胸膈不利，口吐酸
水，两胁疼痛，遂用旋复花汤，微汗，渐解。频服小调经散，用泽兰根煎汤调下，肿气渐消。（未选入。）
一产妇腹痛，或用抵当汤，败血已下，前症益甚，小腹重坠，似欲去后，此脾气虚而下陷。用补中益气加
炮姜，温补脾气，重坠如失。又用六君子汤而安，归脾汤调理而愈。（同上。）
南濠陈鳌的妻子，在分娩后五六天，出现腹痛、怕冷并伴有发热的症状。医生认为：这是元气过于虚弱，正符合丹溪所说的，产后应当大补气血。于是使用了大剂量的人参，药入口后疼痛剧烈，患者面色发黑并气喘，最终死亡。殊不知丹溪的意思是，产后虽然以补益气血为主要治疗原则，但若夹杂其他病症，则应次要处理那些杂症。如今陈氏的妻子，是因为瘀血尚未排尽，才导致恶寒发热，如果不先去除瘀血，就突然施用大补之法，这就违背了丹溪关于“主次”二字的意思。“主”与“末”，指的就是“本”与“标”。（出自《续医说》。丹溪的话本身有语病，不必为他辩解。）
吴孚先治疗杨氏的妇人，产后一个月，下半身突然肿胀且肚脐突出，小便不通畅。有人用五皮饮加车前子、牛膝治疗，无效。吴孚先说：先是月经停止而后出现肿胀，这叫做“血分”（此处“分”读去声）。并且按压小腹有像拳头大小的硬块，可知败血仍然凝结在胞宫门口，不用温性药物无法化解它。于是用干姜、肉桂辅助行瘀的药物，排出如黑漆般的血液数升，大小便通畅，肿胀消退。
孙文垣治疗温氏的妇人，产后五十多天，右胁部胀痛，手不能触碰（显然不是虚痛），赤白带下量多如脓液，发热便秘。诊察后说：这是恶露未尽，血液化为脓液，应当紧急治疗。常见几位妇女患此病，治疗不当，积久成毒，有的发展成肠痈，有的在体内成毒从腰俞穴排出，这都是瘀血为害所致。紧急使用泽兰叶、山楂、五灵脂作为君药以消除恶露，川芎、当归、茯苓、白芍作为臣药，益母草作为佐药，香附、青皮作为使药。外用当归龙荟丸，润通大便，使热邪随之而去。服药后，第二天腹胁部感到宽松，疼痛也停止了。后来吃了荤腥和鸡蛋，疼痛复发，但不比之前严重，给予保和丸，用山楂煎汤送服三钱，于是痊愈。（如果使用行气等药物，会将恶血引向四肢，引发痈毒，所以产后以去除恶露为关键要点。）
潘印川的儿子媳妇，年龄二十五岁，因难产耗伤体力，接着因生下女儿不如意，后来又因女儿去世而悲伤，当时突然晕厥。醒来后，神志恍惚迷糊，手足抽搐，眼睛上翻。孙文垣赶到时，因为患者抽搐，无法诊脉，仔细询问得知，自产后恶露完全没有排出，旁边有时常有一位女医，让人大量吃人参，以及独参汤，并混杂着粥一起进食。大概人参和粥都壅塞在膈上，所以神志昏迷、抽搐不止。教她用手指探入喉咙催吐，随即吐出痰饮、粥食满满一盆，抽搐才停止。给予川芎、山楂、泽兰叶、陈皮、半夏、茯苓、香附服用，稍能入睡。没想到女医又私自给予补药，在子丑时（夜间11点至凌晨3点），突然狂乱，人们都很惊奇，认为是神灵附体，不停地祈祷驱邪。孙文垣说：这是恶露不尽，是蓄血证出现的如见鬼的症状，并非真有神灵附体。（此时为什么不明确指责女医的错误？）慢慢用严肃的话语斥责她，她就沉默了。接着给予清魂散加滑石、童便给她服用，天亮时小便得以排出，狂乱全部安定。随后女医想要邀功，又进献药物，则狂乱再次发作，再给予川芎一钱五分，当归四钱，泽兰、益母草各一钱，临服用时加入童便，连续服用两帖无效。这一定是胸中有痰阻滞，所以药力无法运行。就用前面的方剂，大量增加山楂，恶露稍微通行，神志立即清醒，安静睡了一会儿，手脚轻微动一下。有人用手掌打她的脸，或用手捶打她的胸部，昏乱仍不停止。诊察其脉象近于虚弱，早晨面色红亮，申酉时（下午3点至7点）面色苍白，这是血行火退，应当进补了，给予人参、川芎、泽兰各一钱，当归、山楂各二钱，茯苓、陈皮各八分，卷荷叶一片，煎熟后，调入琥珀末五分。服用约半小时，打了两个嗝，这是清阳上升而浊阴下降的表现。从此恶露微微通行，大便也通畅，饮食逐渐恢复而安宁。
仔细审阅这个医案，其抓住关键之处，全在于知道恶露未行，以及误服人参这两点。至于用药，也只是见症治症罢了。按语：此证总不宜用川芎，但各方都用到了，这是美中不足的地方。至于说打嗝是清阳升而浊阴降，则是错误的。既然病症是因为痰阻瘀滞，气机窒塞不行，所以用多种方法通降而痊愈，那是浊阴降而清阳才升，怎么能颠倒说法呢？
俞东扶说：这条医案的前半段治疗方法不难，因为掌握了人参、粥混杂进食的病情，自然有消瘀及消痰食的方法，但探喉催吐法尤其快捷。蓄血如见鬼，懂的人也不少。后半段恶露稍行，神思即静，略睡一会儿，昏乱不息，仍是蓄血的表现。于是在轻剂消瘀之中，又用人参，并不因为以前误用而害怕重蹈覆辙，这算是高手。他对脉象与面色的讲解非常正确，但产后谵语昏狂，有纯因于痰引起的，也不可不知道。
高鼓峰治疗一位妇人，产后恶露不尽，到六七天，鲜血奔注，发热口渴，胁痛狂叫，饮食不进。有人用四物汤调理，或用山楂、青皮、延胡索、黄芩等药，始终无效。诊脉，洪大而数，这是恶露未尽，留滞于血海，凡是新化的血液，都迷失了原来的道路，不除去蓄血，瘀血就会妄行成为常态，怎么抵御它呢？于是用醋制大黄一两，生地黄一两，桃仁泥五钱，干漆三钱，浓煎饮用。有人说：产后大虚，药性不要太峻猛吗？回答说：该生的自然生，该去的自然去，有什么虚的？只是赶紧喝下去，果然熟睡半夜。次日早上排出黑血块数升，各种症状消失，再用补中益气汤而安宁。（按语：这是高鼓峰杰出的医案，然而干漆可以删除，愈后也不宜急于投用补中益气汤。）
薛立斋治疗一位产妇，患恶露不下，服用峻烈之剂，恶露随即下来，久了却昏愦，用手护住腹部。薛立斋说：这是脾气再次受伤作痛。所以用手护住。（虚痛喜欢按压。）用人参理中汤加肉桂，两剂，补益而痊愈。
按语：产后恶露不下有两种情况，一种是瘀滞应当疏通，一种是血虚应当补益。我常治疗几个人，都是两三天就停止了。观察其人确实虚弱，用大剂量的养荣汤而痊愈。
陆肖愚治疗谢四府的侍妾，分娩十几天后，突然腋下微微作痛。有人说血虚，用大剂量的川芎、当归，十剂后疼痛不减。又说血当补气，阳生则阴长，加入人参、黄芪，五六剂后疼痛更剧。诊脉，六部沉弦，而左关尺更紧。询问得知，只有左边靠近肛门一点痛。问痛处是否发热？回答说：极热。说：这是气血不足而痛，乃是产后败血凝滞于肝经，臀部是肝经所络属的地方，凝滞而注于此，不紧急治疗，久必成毒，应当行血海的瘀滞，解经络的蕴结，才可以消除。不信，换医生，仍以八物汤投用。一天后，痛处突然肿胀，又给予寒凉解毒之品，导致疮口不收，大便滞涩，饮食不进，肌肉消瘦一半。再诊，脉微细如蛛丝，按之犹觉有神。说：现在应当大补了。于是用四君子汤加黄芪、肉桂、附子，数剂后泻止食进。又加当归、熟地黄，约十剂，结成痂而痊愈。
一位产妇患恶露不行，瘀塞溺道，小便不利，遍身浮肿，喘急不得卧，用牛膝膏治疗而愈。配方：丹皮、大黄、当归、桂心、桃仁、蒲黄、元胡、香附、瞿麦、川芎、麝香。先用土牛膝三两，水五碗，煎至减半，加入上述药物煎煮。
孙文垣治疗陈达庵的儿媳，产后半个月腿疼。专科医生说是虚，给予八珍汤，十天疼痛更盛，痛处更热。（显然不是虚痛。）对她说：千万不要认作虚或风，这是产后败血凝滞血海，流于经络，不紧急治疗，则瘀无从出，久必化脓成毒，或为肠痈。现在腿疼，就是它的征兆。不信，又请专科医生。说是风邪。但丹溪说，产后应当大补气血，虽有其它病症，从次要处理。投用十全大补汤，疼痛转剧，大发寒热，小腹近胯部红肿出脓。外科医生又过早收口，腰俞处复发一个毒疮，痛肿寒热如初。十日后，大溃脓而不收口，精神萎顿，肌肉陡削，饮食不进，恶心恶寒，奄奄一息。诊察，六脉濡大无力，清水无脓，说：形势危急了，速为保脾，给予人参、白术各五钱，甘草、干姜、附子各一钱，黄芪三钱，白芷、桂心各五分。外科医生说：白术助脓，恐怕不可服。说：脓不死人，饮食不进，则死人。四帖后神气回，饮食进，症状减轻脓成。改用参苓白术散，调理一月而安。
朱丹溪治疗一位妇人，年龄十八岁，难产七日，产后，大便泻，口渴气喘，面红有紫斑，小腹胀痛，小便不通，用牛膝、桃仁、当归、红花、木通、滑石、甘草、白术、陈皮、茯苓煎汤，调益母膏。不减，后来用杜牛膝煎浓汁一碗饮之，到一个时辰左右，大利，下血一桶，小便通而愈。（出自《心法》。按语：此症我常用当归龙荟丸投用，立效。）
缪仲淳治疗庄敛之次女，产后恶露未净，至夜发热，脾胃却弱，腰腹大痛。当时的医生认为产后气血俱虚，投以人参、当归诸补剂反而加重，大家都担心她形成蓐劳。诊察后，说不需几帖即可痊愈。用白芍、扁豆、杜仲各三钱，红曲、苏子、车前子各二钱，山茱萸、麦冬、青蒿各四钱，橘红、干葛各钱半，炙甘草八分，牛膝五钱，黑豆八钱，泽兰一钱，十剂后恶露净，发热已，腹痛亦止。但腰痛未尽除，脾胃尚未健，改用白芍、山楂、橘红、麦芽、石斛、扁豆、沙参各三钱，砂仁、杜仲、山茱萸各一钱，五味子一钱，炙甘草五分，牛膝五钱，莲肉四十粒，十余剂，脾胃亦健而全愈。
李天培治疗王正权的妻子，产后十余日，患寒热腹痛，目赤而涩，羞明疼痛。诊察，脉沉而涩，询问得知恶露未尽，知是停瘀为患。用当归、川芎、桃仁、红花、甘菊、生地、丹皮、银花、连翘、蝉蜕，清火行瘀驱风等剂，六帖而痊愈。
薛立斋治疗一位妇人，产后四肢浮肿，寒热往来。盖因败血流入经络，渗入四肢，气喘咳嗽，胸膈不利，口吐酸水，两胁疼痛，遂用旋复花汤，微汗，渐解。频服小调经散，用泽兰根煎汤调下，肿气渐消。（未选入。）
一位产妇腹痛，或用抵当汤，败血已下，前症益甚，小腹重坠，似欲去后，此脾气虚而下陷。用补中益气加炮姜，温补脾气，重坠如失。又用六君子汤而安，归脾汤调理而愈。（同上。）
Chen Ao's wife from Nan Hao, five or six days after childbirth, suffered from abdominal pain, aversion to cold, and fever. The physician stated: "This is due to excessive deficiency of Yuan Qi (Original Qi), which aligns with Danxi's saying that postpartum women should receive substantial tonification of Qi and Blood." Consequently, a large dose of Renshen (Ginseng Radix et Rhizoma) was administered. Upon ingestion, the pain intensified severely; her complexion turned dark, she developed asthma (wheezing/dyspnea), and died. Little did they know that Danxi's principle was that while tonifying Qi and Blood is the primary treatment for postpartum conditions, any concurrent miscellaneous symptoms should be treated secondarily. In this case, Chen's wife suffered from aversion to cold and fever because blood stasis had not yet been fully expelled. By failing to remove the blood stasis first and suddenly applying strong tonification, they violated the meaning of Danxi's distinction between "primary" and "secondary" treatments. "Primary" and "secondary" refer to "Root" (Ben) and "Branch" (Biao). (From *Xu Yi Shuo*. Danxi's statement itself contains logical flaws and does not require defense.)
Wu Fuxian treated a woman surnamed Yang, one month postpartum, who suddenly developed swelling in the lower half of her body with protrusion of the umbilicus and inability to urinate. Someone treated her with Wupi Yin (Five-Bark Decoction) added with Cheqianzi (Plantago Seed) and Niuxi (Achyranthes Root), but it was ineffective. Wu said: "Menstruation ceased before the swelling appeared, which is named 'Blood Partition' (Xue Fen - note: 'Fen' is pronounced with the departing tone). Furthermore, pressing the lower abdomen revealed a mass the size of a fist, indicating that failed blood remains congealed at the uterine gate. Without warm-natured herbs, it cannot be transformed." He used Ganjiang (Zingiberis Rhizoma) and Rougui (Cinnamon Twig) to assist blood-activating agents. She passed several sheng (a unit of volume) of black, lacquer-like blood; bowel movements and urination became smooth, and the swelling subsided.
Sun Wen Yuan treated a woman surnamed Wen, fifty-plus days postpartum, suffering from distending pain in the right hypochondrium, intolerable to touch (indicating it was clearly not deficiency pain), profuse red-and-white leukorrhea resembling pus, fever, and constipation. On examination, he said: "This is residual lochia not yet expelled, where blood has transformed into pus. It requires urgent treatment." He often saw several women suffer from this condition; if treated poorly, toxins would accumulate over time, leading to intestinal abscesses or internal toxins emerging from the Yaoshu acupoint. All were caused by blood stasis. He urgently prescribed Zelan Ye (Lycopus Herba), Shanzha (Crataegi Fructus), and Wulingzhi (Trogopteri Dung) as Sovereign herbs to eliminate lochia; Chuanxiong (Ligustici Rhizoma et Radix), Danggui (Angelicae Sinensis Radix), Fuling (Poria), and Baishao (Paeoniae Radix Alba) as Minister herbs; Yimucao (Leonuri Herba) as Assistant herbs; Xiangfu (Cyperi Rhizoma) and Qingpi (Citri Reticulatae Pericarpium Viride) as Envoy herbs. Externally, he administered Danggui Longhui Wan (Angelica Dragon Gallbladder Pill) to moisten the bowels, allowing heat to exit through them. After taking the medicine, her abdomen and hypochondrium felt relaxed the next day, and the pain stopped. Later, she consumed meat and eggs, causing the pain to recur, though less severely than before. He gave Baohe Wan (Harmonize the Stomach Pill), taken with Shanzha decoction, three qian, and she recovered. (Note: Using Qi-moving herbs would draw bad blood into the four limbs, causing carbuncles and sores; thus, eliminating lochia is the crucial step postpartum.)
The daughter-in-law of Pan Yinchuan, aged twenty-five, exhausted herself during difficult labor. Subsequently, she was distressed by giving birth to a girl, and later grief-stricken by the girl's death, causing immediate syncope. Upon waking, she exhibited mental confusion, convulsions of the hands and feet, and upward deviation of the eyes. When Sun arrived, he could not take her pulse due to the convulsions. After careful inquiry, he learned that since childbirth, there had been absolutely no lochia discharge. A female doctor nearby had fed her large amounts of Renshen (Ginseng Radix et Rhizoma), Dushen Tang (Single Ginseng Decoction), and porridge mixed together. Likely, both Renshen and porridge obstructed the diaphragm, causing continuous coma and convulsions. Sun instructed her to stimulate her throat with her finger to induce vomiting, resulting in the expulsion of phlegm-fluid, porridge, and food filling a basin; only then did the convulsions cease. He prescribed Chuanxiong (Ligustici Rhizoma et Radix), Shanzha (Crataegi Fructus), Zelan Ye (Lycopus Herba), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Fuling (Poria), and Xiangfu (Cyperi Rhizoma). She slept slightly. Unexpectedly, the female doctor secretly gave her tonic medicines. During the Zi-Chou hours (11 PM to 3 AM), she suddenly became manic and chaotic. People were astonished, believing it was spirit possession, and prayed incessantly. Sun said: "This is incomplete lochia expulsion, a symptom of accumulated blood manifesting as seeing ghosts; it is not truly spirit possession." (Why not explicitly blame the female doctor here?) He sternly reprimanded her, and she fell silent. He then administered Qinghun San (Clear Soul Powder) added with Huashi (Talcum) and Tongbian (Child's Urine). By dawn, urination occurred, and the mania resolved. Later, the female doctor sought credit and administered more medicine, causing the mania to return. He again prescribed Chuanxiong (Ligustici Rhizoma et Radix) 1.5 qian, Danggui (Angelicae Sinensis Radix) 4 qian, Zelan (Lycopus Herba) and Yimucao (Leonuri Herba) 1 qian each, with Tongbian (Child's Urine) added before administration. Two doses were ineffective. This must be due to phlegm stagnation in the chest preventing drug efficacy. He used the previous formula with significantly increased Shanzha (Crataegi Fructus). As lochia began to flow slightly, her mind cleared, and she slept quietly for a while. Her limbs moved slightly. Someone slapped her face or punched her chest, but the confusion persisted. Her pulse was near-deficient. Her face was red and shiny in the morning but pale in the Shen-You hours (3 PM to 7 PM). This indicated blood circulation improved and fire receded; tonification was now needed. He prescribed Renshen (Ginseng Radix et Rhizoma), Chuanxiong (Ligustici Rhizoma et Radix), and Zelan (Lycopus Herba) 1 qian each; Danggui (Angelicae Sinensis Radix) and Shanzha (Crataegi Fructus) 2 qian each; Fuling (Poria) and Chenpi (Citri Reticulatae Pericarpium) 0.8 qian each; one piece of Juanheyeye (Rolled Lotus Leaf). After decocting, he mixed in Hupo Moxi (Succini Pulvis) 0.5 qian. After about half an hour, she belched twice. This indicated Clear Yang ascending and Turbid Yin descending. From then on, lochia flowed slightly, bowels moved freely, diet gradually improved, and she stabilized.
Reviewing this case, its key success lay in recognizing the unexpelled lochia and the error of administering Renshen (Ginseng Radix et Rhizoma). The medication merely addressed symptoms. Commentary: This condition generally should not use Chuanxiong (Ligustici Rhizoma et Radix), yet it appears in every prescription, which is a flaw in an otherwise excellent case. Regarding the belching, claiming it represents Clear Yang ascending and Turbid Yin descending is incorrect. Since the condition resulted from phlegm obstruction and blood stasis blocking Qi mechanism, recovery came from multiple methods promoting descent; thus, Turbid Yin descended first, allowing Clear Yang to ascend. How can the terms be reversed?
Yu Dongfu stated: The first half of this case is not difficult to treat; once the condition of mixed Renshen (Ginseng Radix et Rhizoma) and porridge intake is understood, methods for resolving stasis, phlegm, and food stagnation are evident, with induced vomiting being particularly swift. Accumulated blood causing ghost-like visions is well-known. In the second half, although lochia flowed slightly and the mind quieted, brief sleep was followed by persistent confusion, still reflecting accumulated blood. Yet, within a mild blood-resolving formula, Renshen (Ginseng Radix et Rhizoma) was used again, without fear of repeating past errors, demonstrating high skill. His analysis of pulse and facial color was very accurate. However, one must know that postpartum delirium and madness can be purely caused by phlegm.
Gao Gufeng treated a woman whose lochia had not ceased. By the sixth or seventh day, fresh blood gushed forth, accompanied by fever, thirst, hypochondriac pain, screaming, and loss of appetite. Treatments with Siwu Tang (Four-Substance Decoction) or herbs like Shanzha (Crataegi Fructus), Qingpi (Citri Reticulatae Pericarpium Viride), Yanhusuo (Corydalis Rhizoma), and Huangqin (Scutellariae Radix) failed. Her pulse was surging and rapid. This indicated unexpelled lochia lingering in the Sea of Blood; newly formed blood lost its proper path. Without removing the accumulated blood, stasis would become habitual, making resistance impossible. He prescribed Cu Zhi Dahuang (Vinegar-processed Rheum Palmatum Radix et Rhizoma) 1 liang, Shengdihuang (Rehmanniae Radix Preparata) 1 liang, Taoren (Prunus Persica Semen) paste 5 qian, and Ganqi (Drywood) 3 qian, decocted strongly for drinking. Someone asked: "Postpartum is a state of great deficiency; is the medicine too harsh?" He replied: "What needs to live will live; what needs to go will go. Where is the deficiency?" She drank it quickly and slept soundly for half the night. The next morning, she passed several sheng of black blood clots, and all symptoms vanished. She was then stabilized with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). (Commentary: This is an outstanding case by Gufeng, but Ganqi (Drywood) could be omitted, and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should not be administered immediately after recovery.)
Xue Lizhai treated a parturient woman suffering from non-expulsion of lochia. After taking harsh purgatives, lochia discharged, but she later became confused and held her abdomen with her hands. Xue said: "This is pain caused by further injury to Spleen Qi. Hence, she holds her abdomen." (Deficiency pain prefers pressure.) He prescribed Renshen Lizhong Tang (Ginseng and Magnolia Bark Decoction for the Middle Jiao) added with Rougui (Cinnamon Twig), two doses, and she recovered through tonification.
Commentary: There are two types of postpartum lochia non-expulsion: one due to stasis requiring promotion, and one due to blood deficiency requiring tonification. I often treated several cases where it stopped within two or three days. Observing that the patients were indeed deficient, I cured them with large doses of Yangrong Tang (Nourish the Nutritive Decoction).
Lu Xiaoyu treated the concubine of Prefect Xie Si. More than ten days after delivery, she suddenly experienced slight pain under her arm. Someone attributed it to blood deficiency and prescribed large doses of Xiong Gui (Chuanxiong and Danggui), ten doses, but the pain persisted. Another suggested tonifying Qi for Blood, stating "Yang generates Yin," adding Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), five to six doses, but the pain worsened. Her pulse was deep and wiry in all six positions, tighter in the left Guan and Chi positions. Inquiry revealed pain only at one point on the left side near the anus. Asked if the painful area was hot, she replied: "Extremely hot." He said: "This is pain due to insufficiency of Qi and Blood, caused by postpartum failed blood stagnating in the Liver Meridian. The buttocks are areas connected to the Liver Meridian; stagnation flows there. If not treated urgently, it will become toxic. One must resolve stasis in the Sea of Blood and untie knotting in the collaterals to eliminate it." Disbelieving, she changed doctors and received Bawu Tang (Eight-Ingredient Decoction). One day later, the painful area swelled suddenly. Cold-natured detoxifying herbs were given, causing the sore to fail to heal, stool stagnation, loss of appetite, and significant muscle wasting. Re-examination showed a pulse faint and thin as a spider thread, yet possessing spirit upon pressure. He said: "Now major tonification is required." He prescribed Sijunzi Tang (Four Gentlemen Decoction) added with Huangqi (Astragali Radix), Rougui (Cinnamon Twig), and Fuzi (Aconiti Lateralis Radix Praeparata). After several doses, diarrhea stopped, and appetite returned. He added Danggui (Angelicae Sinensis Radix) and Shudi (Rehmanniae Radix Preparata); after about ten doses, a scab formed, and she healed.
A parturient woman suffered from non-expulsion of lochia, which blocked the urinary tract, causing difficulty urinating, generalized edema, wheezing, and inability to lie flat. She was cured using Niuxi Gao (Achyranthes Paste). Formula: Mudanpi (Moutan Cortex), Dahuang (Rhei Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Guixin (Cinnamomi Cortex), Taoren (Prunus Persica Semen), Puhuang (Typhae Pollen), Yuanshu (Curcumae Radix), Xiangfu (Cyperi Rhizoma), Qumai (Dianthi Herba), Chuanxiong (Ligustici Rhizoma et Radix), and Shexiang (Moschus). First, decoct Tuniuxi (Achyranthis Bidentatae Radix) 3 liang in five bowls of water until reduced by half, then add the above herbs and decoct.
Sun Wen Yuan treated the daughter-in-law of Chen Da'an, who suffered leg pain half a month postpartum. Specialist doctors claimed it was deficiency and prescribed Bazhen Tang (Eight-Treasure Decoction). After ten days, the pain intensified, and the painful area became hotter. (Clearly not deficiency.) He told her: "Do not mistake this for deficiency or wind. This is postpartum failed blood stagnating in the Sea of Blood, flowing into the collaterals. If not treated urgently, the stasis cannot exit, will eventually transform into pus and toxin, or cause intestinal abscess. Current leg pain is a sign of this." Disbelieving, she consulted another specialist who diagnosed wind. Citing Danxi's rule that postpartum women need substantial Qi and Blood tonification, treating other symptoms secondarily, he administered Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction). Pain worsened, severe chills and fever erupted, and redness and swelling with pus appeared near the groin in the lower abdomen. The surgeon closed the wound too early, causing a new boil to erupt at the Yaoshu acupoint, with initial pain, swelling, chills, and fever. Ten days later, it ulcerated heavily without healing. Spirit was listless, muscles wasted rapidly, no appetite, nausea, aversion to cold, barely alive. Pulse was soggy, large, and powerless; discharge was clear fluid without pus. He said: "The situation is critical. Quickly protect the Spleen." He prescribed Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) 5 qian each; Gancao (Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata) 1 qian each; Huangqi (Astragali Radix) 3 qian; Baizhi (Angelicae Dahuricae Radix) and Guixin (Cinnamomi Cortex) 0.5 fen each. The surgeon said: "Baizhu (Atractylodis Macrocephalae Rhizoma) promotes pus formation; perhaps it should not be taken." He replied: "Pus does not kill; lack of food intake kills." After four doses, spirit returned, appetite improved, symptoms decreased, and pus formed. He switched to Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) and regulated her for a month until stable.
Zhu Danxi treated an eighteen-year-old woman who endured seven days of difficult labor. Postpartum, she had diarrhea, thirst, asthma (wheezing), red face with purple spots, lower abdominal distending pain, and inability to urinate. He prescribed Niuxi (Achyranthes Root), Taoren (Prunus Persica Semen), Danggui (Angelicae Sinensis Radix), Honghua (Carthami Flos), Mutong (Akebiae Caulis), Huashi (Talcum), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Fuling (Poria) decocted, mixed with Yimu Gao (Leonurus Paste). Symptoms did not subside. Later, he gave her a bowl of concentrated Du Niuxi (Cyathulae Radix) decoction. After about one geng (two hours), she had severe diarrhea, passed a bucket of blood, urination resumed, and she recovered. (From *Xin Fa*. Commentary: I often treat this condition with Danggui Longhui Wan (Angelica Dragon Gallbladder Pill) with immediate effect.)
Miu Zhongchun treated Zhuang Lianzhi's second daughter. Postpartum, lochia was not clean; she had nighttime fever, weak Spleen and Stomach, and severe waist and abdominal pain. Contemporary physicians believed postpartum Qi and Blood were both deficient and administered tonics like Renshen (Ginseng Radix et Rhizoma) and Danggui (Angelicae Sinensis Radix), worsening the condition. Everyone feared she would develop puerperal consumption. On examination, he predicted recovery in a few doses. He prescribed Baishao (Paeoniae Radix Alba), Bidou (Dolichoris Lablab Semen), and Duzhong (Eucommiae Cortex) 3 qian each; Hongqu (Levisticum Fermented Rice), Suzi (Perillae Fructus), and Cheqianzi (Plantago Seed) 2 qian each; Yurou (Corni Fructus), Maidong (Ophiopogonis Radix), and Qinghao (Artemisiae Annuae Herba) 4 qian each; Juhong (Citri Reticulatae Pericarpium Rubrum), Gegen (Puerariae Lobatae Radix) 1.5 qian each; Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 0.8 fen; Niuxi (Achyranthes Root) 5 qian; Heidou (Sojae Semen Nigrum) 8 qian; Zelan (Lycopus Herba) 1 qian. After ten doses, lochia was clean, fever ceased, and abdominal pain stopped. However, waist pain remained, and Spleen/Stomach function was not yet robust. He switched to Baishao (Paeoniae Radix Alba), Shanzha (Crataegi Fructus), Juhong (Citri Reticulatae Pericarpium Rubrum), Maiya (Hordei Fructus Germinatus), Shihu (Dendrobii Caulis), Bidou (Dolichoris Lablab Semen), and Shashen (Glehniae Radix) 3 qian each; Sharen (Amomi Fructus), Duzhong (Eucommiae Cortex), and Yurou (Corni Fructus) 1 qian each; Wuwei Zi (Schisandrae Chinensis Fructus) 1 qian; Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 0.5 fen; Niuxi (Achyranthes Root) 5 qian; Lianrou (Nelumbinis Semen) 40 grains. After more than ten doses, Spleen and Stomach function recovered completely.
Li Tianpei treated Wang Zhengquan's wife. More than ten days postpartum, she suffered from alternating chills and fever, abdominal pain, red and dry eyes, photophobia, and pain. Pulse was deep and choppy. Inquiry revealed unexpelled lochia, indicating stagnation of stasis as the cause. He prescribed Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Rhizoma et Radix), Taoren (Prunus Persica Semen), Honghua (Carthami Flos), Ganju (Chrysanthemi Flos), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Yinhua (Lonicerae Japonicae Flos), Lianqiao (Forsythiae Fructus), and Chantui (Cicadae Periostracum) to clear fire, move stasis, and expel wind. After six doses, she recovered.
Xue Lizhai treated a woman with postpartum generalized limb edema and alternating chills and fever. This was due to failed blood flowing into collaterals and infiltrating the limbs, causing asthma (wheezing), cough, chest oppression, sour regurgitation, and bilateral hypochondriac pain. He used Xuanfuhua Tang (Inula Flower Decoction) to induce slight sweating, leading to gradual resolution. He frequently administered Xiao Tiaojing San (Minor Regulating Menstruation Powder), taken with Zelan Gen (Lycopus Root) decoction, and the edema gradually subsided. (Not selected.)
A parturient woman suffered abdominal pain. Someone used Didang Tang (Severe Stasis-Deciding Decoction). Although failed blood was expelled, previous symptoms worsened, with heavy bearing sensation in the lower abdomen, as if defecation were needed. This indicated Spleen Qi deficiency with sinking. He used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Paojiang (Prepared Zingiberis Rhizoma) to warm and tonify Spleen Qi; the bearing sensation disappeared. He then used Liujunzi Tang (Six Gentlemen Decoction) for stability and Guipi Tang (Restore the Spleen Decoction) for regulation until recovery. (Ibid.)