《脉经》云∶产后之脉，寸口洪疾不调者死，沉微附骨不绝者生。又曰∶沉小缓滑者吉，实大坚弦
疾者凶，牢革结代及涩滞不调者不治。丹溪曰∶胎前脉当洪数，既产而脉仍洪数者死。又曰∶胎前脉细小，
产后脉洪大者多死。予见产后多有洪数而生者，要知血虚之脉浮洪而数者居多，产后血虚，故现此脉。若
不明以告医，俗医多误认为外感，虚虚之祸在于顷刻。然此洪数之中，自有和滑之
象，非如牢疾而少胃气之谓，故多死也。《产经》曰∶胎前之病，其脉贵实，产后之病，其脉贵虚。胎
前则顺气安胎，产后则补虚消瘀，此其要也。大凡孕妇临产，气血动荡，胞胎迸裂，与常经离异，必有水
先下，俗谓之胞浆，即养胎之液也。水下则胞裂而产，既产则气血两虚，脉宜缓滑。缓则舒徐，不因气
夺而急促，滑则流利，不因血去而枯涩，均吉兆也。若实大弦牢，非产后气血两虚所宜。实则邪实，大为
邪进，弦为阴敛宣布不能，牢为坚着近乎无胃，皆相逆之脉，故凶。
《全书》云∶丹溪曰，产后当大补气血，即有杂证，以末治之。此其意谓血气随胎而去，必属大虚，
故无论诸证当以大补为先，其他皆可缓也。今产科所宗，无非此法。但产后气血俱去，诚多虚证，然有虚者，
有不虚者，有全实者，当随证随人辨其虚实治疗，不得执有诚心概行大补，以致助邪，此辨之不可不慎
也。今予遵生化汤加减兼治之法，未尝敢大补，而置诸证于缓治。观晕厥总论中，块痛未除，未可遽
加木之语，概可知矣。又云∶产后虚证，无非随人元气，必素弱之人多有之。或于产后血气既去而更弱
者，亦有之。此当因人察脉，因脉察证。若脉气、形气、病气俱不足，此当以全虚治之。若形气不足，病
气有余，或兼火邪，或兼外感，或以饮食停滞，是亦虚中有实，不得不详审而治。今予治全虚者，后立
有加参、从权生化汤等方。治虚中有实，亦立有随证加减生化汤等方，随其虚实以投之，是皆重产而兼治者
也。又云∶产后不虚证，或素日无病，或年少当时，或素耐辛苦贫劳之质。此辈本无不足，及其一旦受孕，
乃于腹中添入此物，故至气血壅塞，为胀为呕，是皆添设有余之病。及其既产，始见通快，所留得去，
仍复故吾。常人之产，此类极多，果何虚之有。或因内伤外感，难保必无，倘有所患，去之即愈。若概行
大补，果能堪否？即临盆带去血气，未免暂见耗损，然以壅滞之余，不过皆护胎随从之物，去者当去，生
者旋生，不出数日必已来复。此生化自然之理，何至是产皆虚也。若执云产后必当大补，则实实之病，必
所不免，致轻者甚，甚者危矣。予谓
少壮妇人产后不虚，只用黑糖水汤，或少加以酒去瘀可耳。原可不必服药，即服生化汤一、二剂，亦非
大补实实之药，有益无损者也。倘有内伤外感，生化汤因证加减用之。又云∶产后全实证，如外感风寒，
头痛身热，便实中满，脉紧实洪大有力，此表邪之实证也。又火之盛者，必热渴躁烦，或便结腹胀，口
鼻舌焦黑，酷喜冷冻饮料，眼眵，尿管痛赤，脉见洪滑，此内热之实证也。又郁怒动肝，胸胁胀痛，大
便不利，脉弦而滑，此气逆之实证也。又恶露未尽，瘀血上冲，心腹胀满，疼痛拒按，大便难而小便利，
此血逆之实证也。又凡富贵之家，保护太过，或过用人参、 、术以致气壅；或过用糖、酒、炭火，以
致内热；或产本不虚，而妄用大补之药，以致增病。此调摄之实证也。又或因产过食，恐其劳困，固令
勉强，以致停蓄不散，此内伤之实证也。以上诸证，姑举要者，以见其概。然既有表邪不得不解，既有
火邪不得不清，既有内伤停滞不得不开通、消导也。今予治各证，后开生化汤中俱有随证加减。一以
重产，一以兼治。所谓道并行而不相悖，可保万全者矣。
《脉经》说：产后脉象，如果寸口部脉来洪大急疾且不调和的，预后不良；如果沉取微弱但按至骨部仍有根气的，预后良好。又说：脉象沉小、缓滑的是吉兆；脉象实大、坚弦、急疾的是凶兆；脉象牢革、结代以及涩滞不调的，难以治愈。朱丹溪说：妊娠期间脉象应当洪数，分娩后脉象仍然洪数的会死亡。又说：妊娠期间脉象细小，分娩后脉象反而洪大的多数会死亡。我见到产后有很多脉象洪数却存活下来的，要知道血虚导致的脉象浮洪而数者居多，因为产后血虚，所以出现这种脉象。如果不明确告知医生，庸医多误认为是外感病，导致“虚虚”（使虚证更虚）的祸患就在顷刻之间。然而在这种洪数之中，自然带有和缓滑利之象，不像那种牢疾而缺乏胃气的脉象，所以才会导致死亡。《产经》说：妊娠期间的疾病，脉象贵在充实；产后期间的疾病，脉象贵在虚弱。妊娠期应当顺气安胎，产后应当补虚消瘀，这是关键所在。
大凡孕妇临产时，气血动荡，胞胎破裂，与常经不同，必然有羊水先下，俗称胞浆，就是滋养胎儿的液体。羊水流出则胞胎破裂而分娩，分娩后气血两虚，脉象宜见缓滑。缓代表舒徐从容，不因气被夺而急促；滑代表流利通畅，不因血流失而枯涩，这都是吉兆。如果脉象实大、弦紧、牢硬，就不适合产后气血两虚的情况。实代表邪气盛，大代表邪气进犯，弦代表阴气收敛宣发受阻，牢代表坚硬附着近乎没有胃气，这些都是相逆的脉象，所以主凶。
《全书》引用丹溪的话说：产后应当大补气血，即使有其他杂症，也要作为次要问题处理。这意思是说气血随着胎儿而去，必然属于大虚，所以无论有什么症状都应当以大补为先，其他都可以暂缓。现在产科所遵循的，无非是这种方法。但是产后气血俱去，确实多为虚证，然而有的虚，有的不虚，有的全实，应当根据症状和体质辨别虚实进行治疗，不能固执地认为必须大补而一概进行大补，以致助长邪气，这一点辨别不可不谨慎。现在我遵循生化汤加减兼治的方法，不敢轻易大补，而将其他病症放在次要位置处理。看晕厥总论中提到的“块痛未除，不可遽加木（指人参等补气药）”的话，大概就可以知道了。又说：产后的虚证，无非是随人的元气而定，必定是素体虚弱的人多有此情况。或者在产后气血既去之后更加虚弱的，也有这种情况。这应当因人察脉，因脉察证。如果脉气、形气、病气都不足，这应当当作全虚来治疗。如果形气不足，病气有余，或者兼有火邪，或者兼有外感，或者因为饮食停滞，这也是虚中有实，不得不详细审察而治疗。现在我治疗全虚者，在后面列出了加参、从权生化汤等方子。治疗虚中有实，也列出了随证加减生化汤等方子，根据其虚实情况投药，这些都是重视产后调理而兼顾治疗的。
又说：产后不虚的情况，或者平时无病，或者年少当时，或者素来能忍受辛苦贫劳体质的人。这些人本来就没有不足，等到一旦受孕，便在腹中加入这个胎儿，所以导致气血壅塞，出现胀满呕吐，这些都是添设出来的有余之病。等到分娩后，才开始感到通快，留下的去除掉，身体恢复原状。普通人的生产，这类情况极多，哪里有什么虚呢？或者因为内伤外感，难免没有，如果有患病，去除病邪即愈。如果一概进行大补，真的能承受吗？即使临盆时带走气血，未免暂时有所耗损，但以壅滞之余，不过是保护胎儿随从之物，该去的就去，该生的随即产生，不出几天必然恢复。这是生化自然的道理，何至于所有生产都是虚证呢？如果固执地说产后必须大补，那么实实之病（实证用补法导致邪气更实），必然不可避免，导致轻病加重，重病危险。我认为少壮妇人产后不虚，只用黑糖水汤，或少加一些酒以祛瘀即可。原本可以不必服药，即使服用一、二剂生化汤，也不是大补导致实实的药物，是有益无害的。如果有内伤外感，生化汤根据症状加减使用。
又说：产后全实证，如外感风寒，头痛身热，大便实、腹部胀满，脉紧实洪大有力，这是表邪的实证。还有火邪旺盛的，必然热渴躁烦，或者大便干结腹胀，口鼻舌焦黑，酷喜冷冻饮料，眼屎多，尿道疼痛赤红，脉见洪滑，这是内热的实证。还有郁怒动肝，胸胁胀痛，大便不利，脉弦而滑，这是气逆的实证。还有恶露未尽，瘀血上冲，心腹胀满，疼痛拒按，大便难而小便通利，这是血逆的实证。还有凡是富贵人家，保护太过，或者过用人参、白术等导致气机壅塞；或者过用糖、酒、炭火，导致内热；或者生产本不虚，而妄用大补的药物，导致增加病情。这是调摄不当导致的实证。还有因为生产后吃得过多，恐怕其劳累困倦，故意令其勉强进食，导致停蓄不散，这是内伤的实证。以上各种症状，姑且列举重要的，以见其概略。然而既然有表邪不得不解表，既有火邪不得不清热，既有内伤停滞不得不疏通、消导。现在我治疗各种症状，后面列出生化汤中都有随证加减。一方面重视产后，一方面兼顾治疗。所谓道并行而不相悖，可以保证万无一失。
The *Mai Jing* (Pulse Classic) states: Regarding the pulse after childbirth, if the Cun (inch) position at the wrist is Hong (surging), Ji (rapid), and irregular, the prognosis is poor; if it is Chen (deep) and Wei (minute) but remains rooted when pressed to the bone, the prognosis is good. It further states: A pulse that is Chen (deep), Xiao (small), Huan (relaxed), or Hua (slippery) indicates a favorable outcome; one that is Shi (excess), Da (large), Jian (firm), Xian (wiry), or Ji (rapid) indicates an unfavorable outcome; one that is Lao (solid), Ge (leather-like), Jie (knotted), Dai (intermittent), or Se (choppy) and irregular is difficult to treat. Zhu Danxi stated: During pregnancy, the pulse should be Hong (surging) and Shuo (rapid); if the pulse remains Hong and Shuo after delivery, death may occur. He also stated: If the pulse is Xi (fine) and Xiao (small) during pregnancy but becomes Hong (surging) and Da (large) after delivery, death is likely. I have observed many cases where patients with a Hong (surging) and Shuo (rapid) pulse survived after childbirth. One must understand that pulses appearing Fu (floating), Hong (surging), and Shuo (rapid) are mostly due to Blood deficiency (Blood Deficiency). Since postpartum Blood deficiency is common, this pulse presentation occurs. If this is not clearly communicated to physicians, quacks often misdiagnose it as an External Contraction (Exogenous Pathogen invasion), leading to the disaster of "deficientifying the deficient" within moments. However, within this Hong (surging) and Shuo (rapid) presentation, there is naturally a He (harmonious) and Hua (slippery) quality. It is not like the Lao (solid) and Ji (rapid) pulse which lacks Stomach Qi (Vital Energy of the Spleen and Stomach), which leads to death. The *Chan Jing* (Obstetrics Classic) states: For diseases during pregnancy, the pulse should ideally be Shi (full/excess); for diseases after childbirth, the pulse should ideally be Xu (empty/deficient). During pregnancy, the principle is to soothe Qi and calm the fetus; after childbirth, the principle is to tonify deficiency and resolve stasis. This is the key.
Generally, when a pregnant woman approaches labor, Qi and Blood become turbulent, the Bao Tai (fetal sac) ruptures, deviating from normal physiology. There must be water (amniotic fluid) descending first, commonly called Bao Jiang (placental fluid), which is the fluid nourishing the fetus. When the fluid descends, the sac ruptures and birth occurs. After childbirth, both Qi and Blood are deficient, so the pulse should appear Huan (relaxed/slow) and Hua (slippery). Huan indicates relaxation and slowness, not急促 (urgent/rushed) due to Qi depletion; Hua indicates smoothness and flow, not Ku (withered) and Se (choppy) due to Blood loss. Both are auspicious signs. Conversely, a pulse that is Shi (excess), Da (large), Xian (wiry), or Lao (solid) is unsuitable for the postpartum state of Qi and Blood deficiency. Shi indicates Excess pathogen; Da indicates pathogenic progression; Xian indicates Yin constriction and failure of distribution; Lao indicates firmness attached deeply, nearing the absence of Stomach Qi. These are contrary pulses, hence ominous.
The *Quan Shu* quotes Danxi: "After childbirth, one should greatly tonify Qi and Blood; even if other miscellaneous syndromes exist, they should be treated secondarily." The intent is that Qi and Blood depart with the fetus, resulting in severe deficiency. Therefore, regardless of various symptoms, great tonification should take precedence, while others can be delayed. This method is currently followed by obstetricians. However, although postpartum Qi and Blood loss indeed often results in deficiency syndromes, there are cases of deficiency, non-deficiency, and pure excess. Treatment must distinguish between deficiency and excess based on symptoms and individual constitution. One must not rigidly adhere to the belief that great tonification is always necessary, as this may aid the pathogen. This distinction requires extreme caution. I follow the method of modifying and treating concurrently with Shenghua Tang (Life-Restoring Decoction), daring not to use heavy tonics immediately, thereby placing other syndromes in a secondary position. As seen in the General Discussion on Syncope, "if blood stasis pain is not resolved, one should not hastily add [tonic herbs]," which illustrates this point. Furthermore, postpartum deficiency syndromes depend on the person's Yuan Qi (Original Qi); those with a constitution of inherent weakness are prone to this. Some may become weaker after Qi and Blood loss. In such cases, one must examine the pulse according to the person, and the syndrome according to the pulse. If Pulse Qi, Form Qi, and Disease Qi are all insufficient, it should be treated as total deficiency. If Form Qi is insufficient but Disease Qi is sufficient, or if accompanied by Fire pathogen, external contraction, or food stagnation, this is "deficiency with excess," requiring careful examination and treatment. For total deficiency, I later prescribe formulas such as Ginseng-Added Shenghua Tang or Emergency Shenghua Tang. For deficiency with excess, I prescribe Modified Shenghua Tang according to the syndrome, administering them based on their deficiency or excess status. These are methods that prioritize postpartum care while addressing concurrent issues.
Regarding postpartum non-deficiency: some women had no prior illness, were young and strong, or had constitutions accustomed to hardship and poverty. These individuals originally had no deficiency. Upon conception, the fetus adds a burden, causing Qi and Blood congestion, leading to distension and vomiting. These are "excess" conditions created by the addition of the fetus. After delivery, relief is felt, the retained matter is expelled, and the body returns to its original state. Such cases are very common among ordinary births; where is the deficiency? Although internal injury or external contraction cannot be ruled out, if illness occurs, removing the cause leads to recovery. If one universally applies heavy tonification, can the body bear it? Even though labor consumes Qi and Blood temporarily, the remaining congested state consists mainly of substances supporting the fetus. What needs to go goes; what needs to be generated regenerates. Within a few days, recovery is inevitable. This is the natural law of Shenghua (generation and transformation). Why assume all postpartum states are deficient? If one rigidly insists on heavy tonification for all postpartum cases, "excess reinforcing excess" syndromes will inevitably occur, turning mild conditions severe and severe ones critical. I believe that for young and vigorous women with no postpartum deficiency, using only dark brown sugar water soup, or adding a little wine to resolve stasis, is sufficient. Medication is not strictly necessary. Even taking one or two doses of Shenghua Tang is not a heavy tonic that causes excess; it is beneficial and harmless. If there is internal injury or external contraction, Shenghua Tang should be modified according to the syndrome.
Regarding postpartum pure excess syndromes: External contraction of Wind-Cold presents with headache, fever, constipation, abdominal fullness, and a tight, solid, surging, large, and forceful pulse; this is an Excess syndrome of exterior pathogens. Severe Fire excess presents with heat, thirst, restlessness, irritability, constipation, abdominal distension, blackened mouth/nose/tongue, craving for cold drinks, excessive eye discharge, painful red urination, and a surging-slippery pulse; this is an Excess syndrome of internal heat. Liver qi stagnation due to anger presents with chest and hypochondriac distension/pain, difficulty in defecation, and a wiry-slippery pulse; this is an Excess syndrome of rebellious Qi. Incomplete expulsion of Lochia (postpartum discharge) with blood stasis rushing upward presents with heart/abdominal distension/fullness, pain refusing pressure, difficult defecation but free urination; this is an Excess syndrome of rebellious Blood. Additionally, wealthy families who overprotect, or overuse Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), causing Qi congestion; or overuse sugar, wine, charcoal fire, causing internal heat; or where childbirth was not deficient but heavy tonics were wrongly used, increasing illness—this is an Excess syndrome of improper nursing/care. Also, overeating after childbirth to prevent fatigue, forcing consumption, leading to retention and stagnation—this is an Excess syndrome of internal injury. These are merely important examples to illustrate the general picture. However, if there is an exterior pathogen, it must be released; if there is Fire pathogen, it must be cleared; if there is internal injury/stagnation, it must be unblocked and digested. In my treatment of these syndromes, I list modifications to Shenghua Tang accordingly. This prioritizes postpartum care while simultaneously treating the specific syndrome. As the saying goes, "The Way proceeds without contradiction," ensuring complete safety.