产后如患三阴伤寒，大便不通，其人谵语发热，脉沉实者，大柴胡汤，三承气亦宜还用
，从
权治救。或其人如狂，不至发狂者，蓄血症也。桃仁承气汤主之。因秘本无此二症，故详录
之，以为后学之津梁也。
大柴胡汤 治身热不恶寒，反恶热，大便秘。
柴胡（一钱五分） 黄芩（一钱） 芍药（一钱） 半夏（八分） 大黄（七分） 枳壳（四分）
姜枣引。
调胃承气汤 治病患邪在中焦，不恶寒反恶热，谵语便秘呕逆。
大黄（六钱，酒洗） 芒硝（四钱） 甘草（一钱）
水盅半，煎八分，去渣，入硝一沸服。
此下剂稍重者，不用枳朴，恐伤上焦氤氲之气也。用∶
大黄（六钱，炒） 浓朴（六钱，炒） 枳实（二钱，炒）
水二盅服。
此下剂之稍重者，不用芒硝，恐伤下焦之血也。
小承气汤 治病患六七日不大便，腹胀满，潮热，狂言而喘，是汤专泻上焦之痞
热。
大黄 浓朴 枳实
桃仁承气汤 治病患小腹急，大便秘或黑，小便不利，中焦积血也。
桃仁（十粒） 肉桂（一钱，去皮） 甘草（一钱） 大黄（一钱五分） 芒硝（一钱五分）
水二盅，煎一盅，入硝一沸服。
大承气汤 治五六日不大便，腹痛烦渴，少阴口燥，咽干潮热，脉沉实，三焦俱
有邪。
大黄（五钱） 芒硝（四钱） 浓朴（二钱，炒）
水二盅，先煎枳，朴至一盅，去渣，入硝煎一沸服。
此下剂之最重者，不可轻用。
产后有恶露久滞，遂化为水，以致发肿，皮肤作光莹色，指捺成窠，宜服五皮饮，并健
脾利
水，已见前二十一产后水肿中。但下部大肿者，药力率不能到，用银针刺足跗足面孤拐小腿
，十数处，流出蓄水，令产妇下部旧棉衣铺垫，时时换易，亦水甚则决之之义。愚以意消息
经治有验，故书此以告后学人。
产后如果患上三阴伤寒，导致大便不通，患者出现胡言乱语、发热，脉象沉而有力的情况，可以使用大柴胡汤，三承气汤（调胃承气汤、小承气汤、大承气汤）也适宜使用，这是权宜的救治方法。或者患者表现为似狂非狂的状态，尚未发展到完全发狂的程度，这是蓄血症（瘀血内停），以桃仁承气汤为主治方剂。因为原本的本篇没有收录这两个病症，所以详细记录它们，作为后学者的入门指引。
大柴胡汤：治疗身体发热但不怕冷，反而怕热，大便秘结的症状。
组成：柴胡（一钱五分）、黄芩（一钱）、芍药（一钱）、半夏（八分）、大黄（七分）、枳壳（四分）。
用法：用生姜和大枣作为引子煎服。
调胃承气汤：治疗病邪位于中焦，不怕冷反而怕热，伴有胡言乱语、便秘、呕吐逆气的症状。
组成：大黄（六钱，酒洗）、芒硝（四钱）、甘草（一钱）。
用法：用水半盅，煎至八分，去渣，加入芒硝煮沸一次后服用。
这是泻下剂中稍重的一种，不用枳实和厚朴，是担心损伤上焦弥漫之气。改用：
大黄（六钱，炒）、浓朴（六钱，炒）、枳实（二钱，炒）。
用法：用水二盅煎服。
这是泻下剂中稍重的一种（指比调胃承气汤重但比大承气汤轻），不用芒硝，是担心损伤下焦的血分。
小承气汤：治疗患病六七天不大便，腹部胀满，潮热，胡言乱语且气喘，此汤专门泻除上焦的痞塞热邪。
组成：大黄、浓朴、枳实。
桃仁承气汤：治疗患者小腹拘急，大便秘结或颜色发黑，小便不利，这是中焦有积血的症状。
组成：桃仁（十粒）、肉桂（一钱，去皮）、甘草（一钱）、大黄（一钱五分）、芒硝（一钱五分）。
用法：用水二盅，煎至一盅，加入芒硝煮沸一次后服用。
大承气汤：治疗五六天不大便，腹痛烦躁口渴，少阴经口燥咽干，潮热，脉象沉实，三焦都有邪气侵袭。
组成：大黄（五钱）、芒硝（四钱）、浓朴（二钱，炒）。
用法：用水二盅，先煎枳实和浓朴至一盅，去渣，加入芒硝煮沸一次后服用。
这是泻下剂中最重的，不可轻易使用。
产后如果有恶露长期停滞，进而化为水湿，导致身体浮肿，皮肤光亮莹润，按压手指留下凹陷，适宜服用五皮饮，并配合健脾利水的药物，这在前文第二十一节“产后水肿”中已有记载。但是，如果是下部严重肿胀，药力通常难以到达，可以用银针刺破足背、足面、脚踝及小腿部位，选择十余处穴位，放出积聚的水液，让产妇在下部铺垫旧棉衣，经常更换，这也符合“水势盛大则决堤疏导”的道理。我根据经验斟酌经络治疗有效，所以写下这些来告知后学者。
If a postpartum woman contracts Shaoyin, Jueyin, and Taiyin cold damage (San Yin Shang Han), resulting in constipation, delirium, fever, and a deep, solid pulse, Da Chai Hu Tang (Greater Bupleurum Decoction) may be used. The Three Chengqi Decoctions (Tiao Wei Cheng Qi Tang, Xiao Cheng Qi Tang, Da Cheng Qi Tang) are also appropriate; this is a pragmatic rescue method. If the patient exhibits a state resembling mania but not full-blown madness, it indicates Blood Stasis Syndrome (accumulation of blood), which should be treated primarily with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi). Since these two conditions were omitted from the original text, they are recorded in detail here as a guide for future students.
Da Chai Hu Tang (Greater Bupleurum Decoction): Treats body heat without aversion to cold, but with aversion to heat, and constipation.
Ingredients: Chai Hu (Bupleuri Radix, 1.5 qian), Huang Qin (Scutellariae Radix, 1 qian), Shao Yao (Paeoniae Radix Alba, 1 qian), Ban Xia (Pinelliae Rhizoma Preparatum, 0.8 fen), Da Huang (Rhei Radix et Rhizoma, 0.7 fen), Zhi Qiao (Aurantii Fructus Immaturus, 0.4 fen).
Usage: Use Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus) as guides for decoction.
Tiao Wei Cheng Qi Tang (Regulate the Stomach Decoction to Order the Qi): Treats pathogenic factors located in the Middle Jiao, characterized by aversion to heat rather than cold, delirium, constipation, and vomiting/rebellious qi.
Ingredients: Da Huang (Rhei Radix et Rhizoma, 6 qian, washed with wine), Mang Xiao (Natrii Sulfas, 4 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian).
Usage: Decoct half a zhong of water until reduced to eight parts, remove the dregs, add Mang Xiao, boil once, and take.
This is a slightly heavier purgative formula; it does not use Zhi Shi or Hou Po to avoid damaging the ethereal qi of the Upper Jiao. Instead, use:
Da Huang (Rhei Radix et Rhizoma, 6 qian, stir-fried), Nong Po (Magnoliae Officinalis Cortex, 6 qian, stir-fried), Zhi Shi (Aurantii Fructus Immaturus, 2 qian, stir-fried).
Usage: Decoct with two zhongs of water and take.
This is a slightly heavier purgative formula (heavier than Tiao Wei Cheng Qi Tang but lighter than Da Cheng Qi Tang); it does not use Mang Xiao to avoid damaging the blood of the Lower Jiao.
Xiao Cheng Qi Tang (Minor Decoction to Order the Qi): Treats cases where there has been no bowel movement for six or seven days, abdominal distension and fullness, tidal fever, delirium, and wheezing. This decoction specifically drains the stagnation-heat of the Upper Jiao.
Ingredients: Da Huang (Rhei Radix et Rhizoma), Nong Po (Magnoliae Officinalis Cortex), Zhi Shi (Aurantii Fructus Immaturus).
Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi): Treats urgency and pain in the lower abdomen, constipation with black stool, and difficult urination, indicating accumulated blood in the Middle Jiao.
Ingredients: Tao Ren (Persicae Semen, 10 grains), Rou Gui (Cinnamomi Cortex, 1 qian, peeled), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian), Da Huang (Rhei Radix et Rhizoma, 1.5 qian), Mang Xiao (Natrii Sulfas, 1.5 qian).
Usage: Decoct with two zhongs of water until reduced to one zhong, add Mang Xiao, boil once, and take.
Da Cheng Qi Tang (Greater Decoction to Order the Qi): Treats cases of no bowel movement for five or six days, abdominal pain, restlessness, thirst, dry mouth and throat due to Shaoyin involvement, tidal fever, deep and solid pulse, indicating pathogenic factors in all three Jiaos.
Ingredients: Da Huang (Rhei Radix et Rhizoma, 5 qian), Mang Xiao (Natrii Sulfas, 4 qian), Nong Po (Magnoliae Officinalis Cortex, 2 qian, stir-fried).
Usage: Decoct with two zhongs of water, first decoct Zhi Shi and Nong Po until reduced to one zhong, remove dregs, add Mang Xiao, boil once, and take.
This is the heaviest of the purgative formulas and must not be used lightly.
In postpartum cases, if lochia remains stagnant for a long time and transforms into water-dampness, causing edema where the skin is shiny and pitting upon pressure, Wu Pi Yin (Five Peel Decoction) should be taken, along with strategies to strengthen the Spleen and promote diuresis, as detailed in Section 21 "Postpartum Edema" above. However, when severe swelling occurs in the lower part of the body, medicinal efficacy often fails to reach the area. In such cases, silver needles can be used to puncture more than ten points on the dorsum of the foot, the instep, the malleolus, and the calf to drain the accumulated fluid. The patient should place old cotton clothes under the swollen area and change them frequently. This aligns with the principle of "draining the waters when they are abundant." I have verified the efficacy of this method through empirical adjustment of meridian treatments and record it here to inform future practitioners.