产后阴血骤下，阳无所附，孤阳外越，每多发热，此乃阴虚生热，切勿作外感而表散。生化汤善能退
热，以其内有姜、草，所谓甘温能除大热也。故产后虽有表证，一切风药性升，不可用，恐载血上行，
令人发晕，且虑重竭其阳，必至汗脱而死。即佛手散中川芎辛散，能发汗走泄，亦须临时因证审酌用之。
产后阴血既亏，津液自少，况临产劳倦气虚，虚则传化自迟，二肠枯燥，势所必然，久则自复。或
用生化汤养血，兼生津助液亦可。故产后虽二便暂有不甚通利，然于下利等药，必须禁用。非特硝、黄、
五苓难于轻试，即四物汤中生地、芍药，纯阴而伐生气，且作泻而凝血。五苓利水伤阴，愈通之而愈枯
结。若误用而重亡其阴，难免孤阳无辅而走脱矣。故《机要》有云∶胎产之病从厥阴，无犯胃气及上下
二焦，不可汗，不可下，不可利小便也。
生化汤（见本卷生化汤论后。）
凡治产后，三审不可缺一也。一审少腹痛与不痛，以征恶露之有无。二审大便通与不通，以征津液之
盛衰。三审乳汁行与不行及饮食多少，以征胃气之充馁。审斯三者，以脉参证，以证合脉，脉证相符，
有疾治之即愈。脉证相反，纵无危候必多变端。即如产后恶露，常以弥月为期，然间有六七朝即净者，
又未可以概论也。此虽产母禀质不同，而因胎之所禀亦异，如胎息壮盛，则气血尽归其子，瘀血自少。
胎息孱弱，则气血涵养有余，瘀血必多。亦有产时去多，产后必少；产时去少，产后必多，势使然也。
大抵常产之妇，开阖有权，产后子宫即闭，儿枕随气攻注，碎作小块，续续而下，所以延绵日期。又有
由于艰产过伤子宫，关闸废弛不能收敛，或下血块，大小形色与茄无异，此名儿枕是也，全块顿出，自
无淋沥之患。即有余血尽归溲便，如皂荚汁，少腹略无痛苦，切勿认为产后瘀尚未行，妄行攻下，误人
性命。产后又有似乎儿枕痛者，摸之亦有块，按之亦微拒手，人皆指为儿枕宿血，
此大不然。夫胎胞俱去，血亦岂能独留？盖子宫蓄子既久，忽尔相离，血海陡虚，所以作痛。胞门受
伤，必致壅肿，所以亦若有块，而实非真块。肿既未消，所以亦颇拒按。治此者，当安养其脏，不久自
愈。若有瘀服药，生化汤为最，殿胞煎或四神散亦可。若误用苏木、红花、元胡、青皮之属，反损脏气，
必增虚病，慎之慎之。予曾见孕妇产后，少腹旁边以手按之，内有一条形如小黄瓜，斜长而硬，颇似瘀积，
然无痛苦。产妇先以为瘀滞，后以为 瘕，每愁成病。予开导之云∶无痛苦，不拒按，是虚非实，血足
自消，不须疑虑。迟数月，果渐消没也。
殿胞煎 治产后儿枕疼痛等证如神。
当归（五钱） 川芎（一钱） 茯苓（一钱） 炙草（一钱） 肉桂（五分）
水一钟，煎八分，热服。如脉细而寒或呕者，加干姜炒黄色一钱。如血热多火者，去肉桂，加酒炒
芍药一钱。如脉弱阴虚者，加熟地三钱。如气滞者。加制香附一钱。腰痛，加盐水炒断丝杜仲一二钱。
生化汤（见本卷生化汤论后。） 四神散（见本卷腹痛门。）
产后阴血突然大量流失，阳气失去依附，导致孤阳外越，常常出现发热的症状，这是阴虚生内热所致，千万不要当作外感表证而使用解表发散的方法。生化汤善于退热，因为方中含有生姜、甘草，这就是所谓的“甘温能除大热”的道理。因此，产后即使有表证，一切性质升散的风药都不可使用，恐怕会载着血液上行，使人头晕目眩，并且担心进一步耗竭阳气，必然导致汗出亡阳而死。即使是佛手散中的川芎，其性辛散，能发汗走泄，也必须根据当时的具体情况审慎斟酌后使用。
产后阴血已经亏损，津液自然减少，况且分娩时劳累疲倦导致气虚，气虚则脏腑传化功能自然迟缓，大肠和小肠干燥枯竭，这是必然的趋势，时间久了自然会恢复。或者使用生化汤养血，兼以生津助液也是可以的。所以产后虽然大小便暂时不太通利，但是像泻下通便之类的药物必须禁用。不仅仅是芒硝、大黄、五苓散等难以轻易尝试，就连四物汤中的生地、芍药，因其纯阴之性会损伤生机，且会导致腹泻并凝固血液。五苓散利水伤阴，越是通利小便，肠道和身体反而越发干枯结滞。如果误用这些药物再次耗伤阴液，难免导致孤阳无依而脱散死亡。所以《医学机要》中说：胎产疾病多从厥阴经论治，不要损伤胃气以及上、中、下三焦，不可发汗，不可攻下，不可利小便。
凡是治疗产后病，三审法缺一不可。一审少腹部疼痛还是不痛，以此推断恶露是否有残留。二审大便通畅还是不通畅，以此推断津液的盛衰情况。三审乳汁是否下行以及饮食量的多少，以此推断胃气的充盈或虚弱程度。审查这三方面，结合脉象参验证候，结合证候印证脉象，如果脉证相符，有病及时治疗即可痊愈。如果脉证相反，即使没有危急征象也必然会出现多变的情况。就像产后恶露，通常以满月为期，但间或有六七天就干净的，也不能一概而论。这虽然是因为产妇体质不同，而且因胎儿禀受的气血也不同，如胎儿气息壮盛，则气血尽归于胎儿，瘀血自然较少。胎儿气息孱弱，则气血涵养有余，瘀血必然较多。也有生产时出血多，产后必然少；生产时出血少，产后必然多的，这是形势使然。
大致顺产的妇女，子宫开阖有度，产后子宫即闭合，儿枕（产后留在子宫内的瘀血块）随气攻注，碎裂成小块，陆续排出，所以持续时间较长。又有由于难产过度损伤子宫，关闸废弛不能收敛，或者排出血块，大小形状与茄子无异，这就叫儿枕，如果是整块一次性排出，自然就没有淋漓不尽的忧患。即使有余血全部从小便排出，如皂荚汁般，少腹略无痛苦，千万不要认为是产后瘀血未行，妄用攻下药物，这会误人性命。产后又有似乎儿枕痛的情况，摸上去也有块状物，按压时也有轻微抵抗感，人们都指为儿枕宿血，这完全不对。既然胎胞都已排出，血又怎能单独留下？大概是因为子宫蓄养胎儿已久，忽然分离，血海骤然空虚，所以产生疼痛。胞门受伤，必然导致壅肿，所以看起来也像有块状物，但实际上并非真正的肿块。肿胀既然没有消退，所以按压时也很抗拒。治疗这种情况，应当安养脏腑，不久自然痊愈。如果有瘀血需要服药，生化汤最为适宜，殿胞煎或四神散也可以。如果误用苏木、红花、元胡、青皮这类药物，反而损伤脏气，必定增加虚损病症，务必谨慎。我曾见过一位孕妇产后，用手按少腹旁边，里面有一条形如小黄瓜的东西，斜长而硬，颇似瘀积，但没有痛苦。产妇起初以为是瘀滞，后来以为是瘕聚，每愁发展成疾病。我开导她说：没有痛苦，不抗拒按压，这是虚证而非实证，血充足自然会消散，不必疑虑。过了几个月，果然逐渐消失不见了。
殿胞煎 治疗产后儿枕疼痛等证效果神奇。
当归（五钱） 川芎（一钱） 茯苓（一钱） 炙甘草（一钱） 肉桂（五分）
用水一钟，煎至八分，热服。如果脉细而寒或呕吐的，加干姜炒至黄色一钱。如果血热火旺的，去掉肉桂，加酒炒芍药一钱。如果脉弱阴虚的，加熟地黄三钱。如果气滞的，加制香附一钱。腰痛，加盐水炒杜仲一二钱。
After childbirth, Yin blood is suddenly and heavily lost, leaving Yang without attachment. This causes solitary Yang to float outward, often resulting in fever. This is heat generated by Yin deficiency; it must not be mistaken for an external contraction treated with diaphoretic (sweating) methods. Shenghua Tang (Postpartum Transformation Decoction) is effective in reducing fever because it contains Ginger Rhizome (Shengjiang) and Licorice Root (Gancao), illustrating the principle that "sweet and warm herbs can eliminate severe heat." Therefore, even if there are exterior symptoms after childbirth, all wind-dispelling drugs with ascending properties should not be used, as they may carry blood upward, causing dizziness, and risk further exhausting Yang, which could lead to death from sweating collapse. Even Chuanxiong Rhizome (Chuanxiong) in Foshou San (Buddha's Hand Powder), which has a pungent and dispersing nature capable of inducing sweating and leaking Qi, must be used cautiously based on the specific condition at the time.
Since Yin blood is already deficient postpartum, body fluids are naturally scant. Moreover, labor fatigue leads to Qi deficiency; deficiency slows down the transmission and transformation functions of the Zang-Fu organs, inevitably leading to dryness and depletion of the Large Intestine and Small Intestine. This will recover naturally over time. Alternatively, using Shenghua Tang to nourish blood and assist in generating fluids is also appropriate. Thus, although urination and defecation may be temporarily difficult postpartum, purgative or diarrhea-inducing drugs must be strictly prohibited. Not only are drugs like Mirabilite (Xiaoshi), Rhubarb (Dahuang), and Wuling San (Five-Ingredient Powder with Poria) difficult to use lightly, but also Rehmannia Root (Shengdi) and Peony Root (Shaoyao) in Siwu Tang (Four-Substance Decoction), being purely Yin in nature, damage the vital Qi, cause diarrhea, and congeal blood. Wuling San promotes urination but injures Yin; the more one promotes urination, the more dry and constipated the body becomes. Misuse would cause a second loss of Yin, making it inevitable for solitary Yang to detach and collapse. Therefore, *Jiyao* (Essentials of Medicine) states: Diseases related to pregnancy and childbirth originate from the Jueyin Liver channel; one must not violate the Stomach Qi or the Upper, Middle, and Lower Jiao. One must not induce sweating, purge, or promote urination.
Shenghua Tang (See discussion on Shenghua Tang later in this volume.)
In treating postpartum conditions, the "Three Examinations" are indispensable. The first examination checks for pain or absence of pain in the lower abdomen to determine the presence or absence of lochia discharge. The second examination assesses whether bowel movements are unobstructed or obstructed to gauge the abundance or depletion of body fluids. The third examination evaluates whether lactation is established and the amount of food intake to determine whether the Stomach Qi is robust or deficient. By examining these three aspects and correlating pulse findings with clinical manifestations, if the pulse and symptoms match, treatment will lead to recovery. If the pulse and symptoms contradict each other, even without critical signs, complications are likely. For instance, lochia discharge usually lasts until one month postpartum, but sometimes clears up in six or seven days; this cannot be generalized. Although maternal constitution varies, the Qi and Blood allocated to the fetus also differ. If fetal vitality is strong, Qi and Blood are fully directed to the fetus, resulting in less stasis. If fetal vitality is weak, there is excess Qi and Blood nourishment, resulting in more stasis. Also, excessive bleeding during delivery leads to less postpartum bleeding, while minimal bleeding during delivery leads to more postpartum bleeding; this is due to natural circumstances.
Generally, women who deliver normally have regulated opening and closing of the uterus. Postpartum, the uterus closes immediately. The "Erzhen" (fetal pillow, referring to retained blood clots) moves with Qi, breaks into small pieces, and is discharged continuously, hence the prolonged duration. In cases of difficult labor causing excessive uterine injury, the closure mechanism relaxes and fails to contract, potentially expelling large blood clots resembling eggplants. This is called Erzhen. If expelled entirely at once, there is no risk of lingering discharge. Even if residual blood exits via urine like soap pod juice, with slight abdominal discomfort, one must not mistake this for unexpelled stasis and blindly administer purgatives, which could be fatal. Sometimes postpartum patients experience pain resembling Erzhen pain, where palpation reveals a mass and mild resistance upon pressure. People often attribute this to retained blood in the Erzhen, but this is incorrect. Since the placenta and fetus have been expelled, how can blood remain alone? The uterus, having housed the fetus for a long time, suddenly separates, causing sudden emptiness in the Sea of Blood, resulting in pain. Injury to the cervical os causes congestion and swelling, creating the illusion of a mass, though it is not a true solid mass. Since the swelling has not subsided, it resists pressure. Treatment should focus on nurturing the organs, and recovery will occur naturally. If blood stasis requires medication, Shenghua Tang is best; Dianbao Jian (Placenta-Clearing Decoction) or Sishen San (Four-God Powder) are also suitable. Misusing drugs like Broomrape Root (Sumu), Safflower (Honghua), Corydalis Rhizome (Yanhusuo), or Green Tangerine Peel (Qingpi) damages organ Qi and exacerbates deficiency; caution is essential. I once observed a postpartum woman who felt a hard, oblong, cucumber-like structure in her lower abdomen upon palpation, resembling stasis, but without pain. She worried it was stasis or a mass (*jia*). I reassured her: "No pain and no resistance indicate deficiency rather than excess; sufficient blood will resolve it naturally; do not worry." Months later, it indeed gradually disappeared.
Dianbao Jian (Placenta-Clearing Decoction) is miraculous for treating postpartum Erzhen pain and related conditions.
Angelica Sinensis Root (Danggui) (5 qian), Ligusticum Wallichii Rhizome (Chuanxiong) (1 qian), Poria Cocos (Fuling) (1 qian), Roasted Licorice Root (Zhigancao) (1 qian), Cinnamon Bark (Rougui) (0.5 qian).
Boil with one zhong of water until reduced to eight fen; take hot. If the pulse is fine and cold, or vomiting occurs, add roasted Dried Ginger (Ganjiang) (1 qian). If there is abundant blood heat and fire, remove Rougui and add wine-fried Peony Root (Shaoyao) (1 qian). If the pulse is weak indicating Yin deficiency, add Prepared Rehmannia Root (Shudihuang) (3 qian). If there is Qi stagnation, add processed Cyperus Rhizome (Zhi Xiangfu) (1 qian). For lower back pain, add Salt-water fried Eucommia Bark (Du Zhong) (1-2 qian).
Shenghua Tang (See discussion on Shenghua Tang later in this volume.) Sishen San (See Abdominal Pain section in this volume.)