产后大便燥秘，由于去血过多，胃中枯燥，精微不及下输，以至糟粕壅滞不通。况大肠主津，产妇内
亡津液，则干涸失其传导变化之权，故令便难。多服生化汤，则血旺气顺，自润而通。或服养正通幽汤
亦可。倘不大便，而无所苦，即勿药亦可。所以产后，每至三五日之久，甚至八九日而大便始通者，皆
其常也。即有似伤寒三阴证，潮热汗出，或口燥腹满，或谵语便秘，燥粪宜下等证，乃气血枯竭，虚证类
实，慎勿执偏门而轻产，妄议三承气汤以下之。或有血虚火燥不便者，不可计其日数，必待腹满觉胀，
欲自去而不能，此乃结在直肠，用润肠粥润之自通，《全书》用
济川煎主之，慎不可用导法。倘润之不通，势急有无可如何者，用蜜煎导之，将蜜煎褐色成膏，入水捏
成枣样，纳入肛门，其结粪自化而出。或削酱瓜、酱姜如蜜枣导法。此亦权宜之计耳。惟猪胆汁导切记禁
用，以其苦寒误用，每至发呃。倘服苦寒药攻通，反伤中焦元气，或愈结难通，或通泄不止，斯成败证矣。
《医通》云∶血虚火燥，用四物汤加何首乌润下之。立斋云∶若去血过多，十全大补汤。气血俱虚，
用八珍汤。如数日不通，饮食如常，腹中如故者，八珍加桃仁、杏仁治之。冯氏云∶大便难，惟宜调中养
血，切不可单用麻仁、枳壳，徒耗肠胃中生养之气而无功也。有治大便日久不通，大料芎、归，服至
斤数，方得取效，仍兼服润肠粥。如大小便俱秘，恶露不行，方论俱见恶露不下门。
养正通幽汤 治产后大便燥秘。
川芎（一钱或一钱五分，或二钱） 当归（四钱或六钱） 桃仁（十粒，去皮尖） 炙草（五分）
陈皮（四分） 麻仁（一钱或一钱五分，炒） 肉苁蓉（一钱或二钱，酒洗去泥甲）
水煎服。一方无苁蓉。如有血块痛，加肉桂、炒延胡索各五分，不用苁蓉。如气虚多汗，加蜜炙
黄一钱，人参一二钱。一方再加麻黄根一钱。燥渴，加去心
麦冬一钱五分，人参一二钱。一方再加五味子七粒。腹满便实，加去心麦冬一钱，麸炒枳壳六分。汗出
谵语便实，乃气血并竭神衰，心主失守，宜养气安神，加茯神、炒枣仁、制远志肉、炙黄 、柏仁、
苁蓉各一钱，人参、土炒白术各二钱。更须与妄言妄见门参治。
润肠粥 治产后日久，便秘不通。
芝麻（一升）
研为末，和粳米二合煮食，肠润即通。
济川煎 凡病涉虚损而大便闭结不通，其攻击等药万不可用。若势有不得不用通者，此方主之。
此用通于补之剂也，最妙。
当归（三五钱） 牛膝（二钱，蒸） 肉苁蓉（二三钱，酒洗去卤） 泽泻（一钱五分） 升麻（
五七分） 枳壳（一钱，麸炒。虚甚者不用）
水一钟半，煎七分，食前服。如气虚，但加人参无碍。如有火，加酒炒黄芩。如肾虚，加熟地。
生化汤（见本卷生化汤论后。） 十全大补汤（见上卷胎不长养门。） 四物汤（
见上卷安胎门。） 八珍汤（见上卷诸痛门。）
产后大便干燥秘结，是由于分娩时失血过多，导致胃中津液枯竭，精微物质无法向下输布，致使糟粕堆积阻滞不通。况且大肠主管津液，产妇体内津液大量亡失，肠道干涸，失去了传导和变化粪便的功能，因此导致排便困难。多服用生化汤，可以使血液充盈、气机顺畅，大便自然滋润通畅。或者服用养正通幽汤也可以。如果虽然不大便，但身体没有痛苦不适，即使不服药也是可以的。所以产后，往往经过三五天之久，甚至八九天后大便才通畅的，都属于正常现象。即使出现类似伤寒三阴证的症状，如潮热汗出，或者口燥腹满，或者谵语便秘，以及燥屎内结需要攻下的等证候，这实际上是气血枯竭导致的虚证表现出类似实证的样子（真虚假实），务必谨慎，不要固执于偏激的方法而轻视产后的特殊性，胡乱议论使用三承气汤来攻下。如果有因血虚火燥导致不便者，不能计算天数，必须等到腹部胀满自觉憋胀，想要排便却排不出来，这是燥屎结在直肠，用润肠粥滋润它，大便自然会通畅，《全书》主张用济川煎主治，务必不可使用导法（灌肠）。如果滋润后仍不通，情况紧急别无他法时，可用蜜煎导法，将蜂蜜煎熬成褐色膏状，入水捏成枣子形状，纳入肛门，其中的结粪自然会化解排出。或者削酱瓜、酱姜做成类似蜜枣的形状，采用蜜煎导法的方式使用。这也是权宜之计罢了。唯独猪胆汁导法切记禁用，因为苦寒之药误用，常常导致呃逆。如果服用苦寒药物攻通，反而损伤中焦元气，或者更加结滞难以通畅，或者通泄不止，这就变成了败坏难治的证候了。《医通》说：血虚火燥，用四物汤加何首乌来滋润下行。立斋说：如果失血过多，用十全大补汤。气血都虚弱，用八珍汤。如果几天不通，饮食如常，腹中没有异常感觉的，用八珍汤加桃仁、杏仁治疗。冯氏说：大便困难，只适宜调理中焦、滋养血液，切不可单独使用麻仁、枳壳，白白耗损肠胃中生发养育之气而没有功效。有人治疗大便日久不通，大量使用川芎、当归，服至几斤重，才取得效果，同时兼服润肠粥。如果大小便都秘结，恶露不行，方论都在恶露不下门中记载。
养正通幽汤 治疗产后大便干燥秘结。
川芎（一钱或一钱五分，或二钱） 当归（四钱或六钱） 桃仁（十粒，去皮尖） 炙甘草（五分）
陈皮（四分） 麻仁（一钱或一钱五分，炒） 肉苁蓉（一钱或二钱，酒洗去泥甲）
用水煎服。一方没有肉苁蓉。如果有血块疼痛，加肉桂、炒延胡索各五分，不用肉苁蓉。如果气虚多汗，加蜜炙黄芪一钱，人参一二钱。一方再加麻黄根一钱。燥渴，加去心麦冬一钱五分，人参一二钱。一方再加五味子七粒。腹满便实，加去心麦冬一钱，麸炒枳壳六分。汗出谵语便实，这是气血并竭、神气衰败、心主失守，应当养气安神，加茯神、炒枣仁、制远志肉、炙黄芪、柏子仁、肉苁蓉各一钱，人参、土炒白术各二钱。更须参考妄言妄见门进行参治。
润肠粥 治疗产后日久，便秘不通。
芝麻（一升）
研为粉末，与粳米二合一起煮食，肠道滋润即可通畅。
济川煎 凡是疾病涉及虚损而导致大便闭结不通的，其攻逐泻下等药物万万不可使用。如果形势有不得不使用通利药物的情况，此方主治。
这是寓通于补的药剂，最为巧妙。
当归（三五钱） 牛膝（二钱，蒸） 肉苁蓉（二三钱，酒洗去卤） 泽泻（一钱五分） 升麻（五七分） 枳壳（一钱，麸炒。虚甚者不用）
用水一钟半，煎至七分，饭前服用。如果气虚，只加人参无妨碍。如果有火，加酒炒黄芩。如果肾虚，加熟地黄。
Postpartum dryness and constipation of the stool result from excessive blood loss during childbirth, leading to dryness in the Stomach (Stomach organ). The essence and nutrients fail to descend and distribute downward, causing food residue to accumulate and obstruct the bowels. Furthermore, the Large Intestine (Large Intestine organ) governs fluids. When a postpartum woman suffers from a massive loss of body fluids internally, the intestines become dry and lose their function of conduction and transformation, thus making defecation difficult. Frequent administration of Shenghua Tang (Decoction for Generating New Blood) will promote blood generation and smooth Qi flow, allowing the stool to naturally become moist and pass. Alternatively, Yangzheng Tongyou Tang (Decoction for Nourishing Righteousness and Unblocking the Obstruction) may also be taken. If there is no bowel movement but no discomfort or suffering, medication may not be necessary. Therefore, it is common for postpartum women to go three to five days, or even eight to nine days, before having a bowel movement; this is considered normal. Even if symptoms resembling Shaoyin (Lesser Yin) or Taiyin (Greater Yin) patterns of Cold Damage (Shanghan) appear—such as tidal fever with sweating, dry mouth with abdominal fullness, delirium with constipation, or indications that dry feces need to be purged—these are actually manifestations of deficiency due to exhaustion of Qi and Blood, presenting as false excess. One must be cautious not to adhere to biased methods or underestimate the postpartum state, nor should one recklessly prescribe the Three Chengqi Decoctions (San Chengqi Tang) for purging. In cases of difficulty due to Blood deficiency and Fire dryness, one should not wait based on the number of days passed. One must wait until there is abdominal fullness and a sensation of distension, where the patient desires to defecate but cannot. This indicates impaction in the rectum. It should be treated by moistening with Runchang Zhou (Moistening Intestines Porridge), which will allow natural passage. The *Quan Shu* advocates using Jichuan Jian (Jichuan Decoction) as the primary treatment. Caution: do not use enema methods (Daofa). If moistening fails to resolve the issue and the situation is urgent with no other options, use Mi Jian Dao (Honey Suppository Method). Boil honey until it becomes a brown paste, shape it into a date-like form after dipping in water, and insert it into the anus; the impacted stool will naturally dissolve and exit. Alternatively, sliced preserved melon or ginger can be shaped like honey dates and used similarly. This is merely an expedient measure. The Zhu Danzhi Bilian Dao (Pig Bile Enema) method must strictly be avoided; misusing bitter-cold substances often leads to hiccups. If bitter-cold purgatives are taken, they may damage the Yuan Qi (Original Qi) of the Middle Jiao (Middle Burner), resulting in either worsened impaction or unceasing diarrhea, turning the condition into a critical failure. *Yi Tong* states: For Blood deficiency with Fire dryness, use Siwu Tang (Four Substances Decoction) plus He Shou Wu (Polygoni Multiflori Radix Praeparata) to moisten and purge. Lizhai states: If blood loss was excessive, use Shiquan Dabu Tang (Ten Significant Tonifying Decoction). If both Qi and Blood are deficient, use Bazhen Tang (Eight Treasures Decoction). If there has been no bowel movement for several days, but diet remains normal and the abdomen feels unchanged, treat with Bazhen Tang plus Tao Ren (Persicae Semen) and Xing Ren (Armeniacae Semen). Feng Shi states: For difficult defecation, only regulating the Middle Jiao and nourishing Blood is appropriate. One must not solely use Huo Ma Ren (Cannabis Seed) and Zhi Ke (Aurantii Fructus), as this vainly depletes the generating Qi of the intestines and stomach without effect. Some practitioners have successfully treated long-standing constipation by administering large doses of Xiong Gui (Chuanxiong and Angelicae Sinensis Radix), totaling several jin, while concurrently taking Runchang Zhou. If both urine and stool are retained and lochia does not discharge, the formulas and discussions are found in the chapter on "Lochia Not Discharging."
Yangzheng Tongyou Tang treats postpartum dryness and constipation.
Chuanxiong (1 qian, or 1.5 qian, or 2 qian) Danggui (4 qian or 6 qian) Taoren (10 grains, skin and tip removed) Zhigancao (0.5 qian)
Chenpi (0.4 qian) Huorenm (1 qian or 1.5 qian, stir-fried) Rongshongrong (1 qian or 2 qian, washed with wine to remove mud and scales)
Decoct in water and take orally. One variation excludes Rongshongrong. If there is pain due to blood stasis masses, add Rougui (Cinnamomi Cortex) and Chao Yanhusuo (Stir-fried Corydalis Rhizoma) each 0.5 qian, and exclude Rongshongrong. If Qi deficiency with profuse sweating occurs, add Mi Zhi Huangqi (Honey-fried Astragali Radix) 1 qian and Renshen (Ginseng Radix et Rhizoma) 1-2 qian. One variation adds Mahuanggen (Ephedrae Radix et Rhizoma) 1 qian. For dryness and thirst, add Qu Xin Maidong (Ophiopogonis Radix with heart removed) 1.5 qian and Renshen 1-2 qian. One variation adds Wubeizi (Schisandrae Fructus) 7 grains. For abdominal fullness and solid stool, add Qu Xin Maidong 1 qian and Fu Chao Zhike (Bran-stir-fried Aurantii Fructus) 0.6 qian. For sweating, delirium, and solid stool, this indicates exhaustion of both Qi and Blood, decline of Shen (Spirit), and loss of control by the Heart (Heart organ). One should nourish Qi and calm the Spirit, adding Fushen (Poria with Wood), Chao Zaoren (Stir-fried Ziziphi Spinosomi Semen), Zhi Yuanzhi Rou (Prepared Polygalae Radix flesh), Zhi Huangqi, Baoren (Platycladi Semen), and Rongshongrong each 1 qian, and Renshen and Tu Chao Baizhu (Earth-stir-fried Atractylodis Macrocephalae Rhizoma) each 2 qian. Further consultation with the chapter on "Delirium and Hallucinations" is required.
Runchang Zhou treats long-standing postpartum constipation.
Zhima (Sesame seed, 1 sheng)
Grind into powder, mix with Jingmi (Oryza Sativa Var. Glutinosa, 2 he), cook and eat. Once the intestines are moistened, passage will occur.
Jichuan Jian is indicated for constipation due to deficiency and damage. Purgative drugs must absolutely not be used. If circumstances necessitate the use of unblocking agents, this decoction is primary.
This is a formula that achieves unblocking through tonification, which is most excellent.
Danggui (3-5 qian) Niuxi (2 qian, steamed) Rongshongrong (2-3 qian, washed with wine) Zexie (1.5 qian) Shengma (0.5-0.7 qian) Zhike (1 qian, bran-stir-fried. Exclude if deficiency is severe)
Decoct in 1.5 zhong of water until 0.7 zhong remains. Take before meals. If Qi deficient, adding Renshen is harmless. If Heat/Fire is present, add Jiu Chao Huangqin (Wine-stir-fried Scutellariae Radix). If Kidney (Kidney organ) deficient, add Shudi (Rehmanniae Radix Praeparata).
Shenghua Tang (See discussion on Shenghua Tang later in this volume.) Shiquan Dabu Tang (See chapter on "Fetal Malnutrition" in the previous volume.) Siwu Tang (See chapter on "Fetal Protection" in the previous volume.) Bazhen Tang (See chapter on "Various Pains" in the previous volume.)