问曰∶新产妇人有三病∶一者病痉，二者病郁冒，三者大便难，何谓也？师曰∶新
产血虚，多汗出，喜中风，故令病痉。亡血复汗，寒多，故令郁冒。亡津液，胃燥，故
大便难。
【注】新产之妇，畏其无汗，若无汗则荣卫不和。而有发热无汗，似乎伤寒表病者，但
舌无白苔可辨也。故喜其有汗，而又恐汗出过多，表阳不固，风邪易入，而为项强腰背反张之痉
病也。新产之妇，畏血不行，若不行则血瘀于里。而有发热腹痛，似乎伤寒里病者，但以舌无黄苔可
辨也。故喜其血下，而又恐血下过多，阴亡失守，虚阳上厥，而为昏冒不省，合目汗出之血晕也。
新产虽喜其出汗，喜其血行，又恐不免过伤阴液，致令胃干肠燥，而有潮热谵语，大便硬难，似乎
阳明胃家实者。故仲景于产后首出三病，不只为防未然之病，而更为辨已然之疑也。昏冒而曰郁冒
者，谓阴阳虚郁，不相交通而致冒也。
【集注】尤怡曰∶痉，筋病也，血虚汗出，筋脉失养，风入而益其劲也。郁冒，神病也，
亡阴血虚，阳气遂厥，而阴复郁之，则头眩而目瞀。大便难者，液病也，胃脏津液，渗
灌诸阳，亡津液胃燥，则大肠失其润而便难也。三者不同，其为亡血伤津则一也。
产妇郁冒，其脉微弱，不能食，大便反坚，但头汗出。所以然者，血虚而厥，厥而
必冒。冒家欲解，必大汗出。以血虚下厥，孤阳上出，故头汗出。所以产妇喜汗出者，亡
阴血虚，阳气独盛，故当汗出，阴阳乃复。大便坚，呕不能食，小柴胡汤主之。病解能食，
七八日更发热者，此为胃实，大承气汤主之。
【注】此承上条互详其义，以明其治也。产妇昏冒，脉微弱者，是气血俱虚应得之诊
也。不能食者，是胃气未和应得之侯也。大便反坚者，是肠胃枯干应得之病也。究之郁
冒所以然者，由血虚则阴虚，阴虚则阳气上厥而必冒也。冒家欲解，必大汗出者，是阳
气郁得以外泄而解也，故产妇喜汗出也。由此推之，血瘀致冒，解必当血下，是阴气郁
得以内输而解也。最忌者，但头汗出，则为阴亡下厥，孤阳上出也。大便坚，呕不能食，
用小柴胡汤，必其人舌有苔身无汗，形气不衰者始可，故病得解，自能食也。若有汗当
减柴胡，无热当减黄芩，呕则当倍姜、半，虚则当倍人参，又在临证之变通也。大便坚，七
八日更发热，用大承气汤，亦必其人形气俱实，胃强能食者始可也。若气弱液干，因虚
致燥，难堪攻下者，则又当内用元明粉以软坚燥，外用诸导法以润广肠，缓缓图之也。
【集注】尤怡曰∶郁冒虽有客邪，而其本则为里虚，故其脉微弱也。呕不能食，大便反
坚，但头汗出，津液上行不下逮之象。所以然者，亡阴血虚，孤阳上厥，而津液从之也。厥者
必冒，冒家欲解，必大汗出者，阴阳乍离，故厥而冒，及阴阳复通，汗乃大出而解也。产妇新
虚，不宜多汗，而此反喜汗出者，血去阴虚，阳受邪气而独盛，汗出则邪去，阳弱而后与阴相
和，所谓损阳而就阴是也。
小柴胡汤（见呕吐中）
大承气汤（见痉病中）
产妇腹中 痛，当归生姜羊肉汤主之，并治腹中寒疝，虚劳不足。
【注】产后暴然腹中急痛，产后虚寒痛也。主之当归生姜羊肉汤者，补虚散寒止痛也。并
治虚劳不足，寒疝腹痛者，亦以其虚而寒也。
【集注】程林曰∶产后血虚有寒，则腹中急痛。《内经》曰∶味浓者为阴。当归、羊肉
味浓者也，用以补产后之阴，佐生姜以散腹中之寒，则 痛自止。夫辛能散寒，补能去
弱，三味辛温补剂也，故并主虚劳寒疝。
魏荔彤曰∶妊娠之 痛，胞阻于血寒也。产后腹中 痛者，里虚而血寒也。一阻一虚，
而治法异矣。
当归生姜羊肉汤方（见寒疝中）
产后腹痛，烦满不得卧，枳实芍药散主之。
【注】产后腹痛，不烦不满，里虚也；今腹痛，烦满不得卧，里实也。气结血凝而痛，
故用枳实破气结，芍药调腹痛。枳实炒令黑者，盖因产妇气不实也。并主痈脓，亦因血
为气凝，久而腐化者也。佐以麦粥，恐伤产妇之胃也。
【集注】尤怡曰∶产后腹痛而至烦满不得卧，知血郁而成热，且下病而碍上也，与虚
寒痛不同矣。
枳实芍药散方
枳实（烧令黑，勿太过） 芍药（等分）
上二味，杵为散，服方寸匕，日三服。并主痈脓，以麦粥下之。
师曰∶产妇腹痛，法当以枳实芍药散。假令不愈者，此为腹中有干血着脐下，宜下瘀
血汤主之。亦主经水不利。
【注】产妇腹痛，属气结血凝者，枳实芍药散以调之。假令服后不愈，此为热灼血干
着于脐下而痛，非枳实、芍药之所能治也，宜下瘀血，主之下瘀血汤，攻热下瘀血也。并
主经水不通，亦因热灼血干故也。
下瘀血汤方
大黄（三两） 桃仁（二十枚） 虫（熬，去足，二十枚）
上三味，末之，炼蜜和为四丸，以酒一升，煎一丸，取八合，顿服之，新血下如豚
肝。
【集注】程林曰∶ 虫主开血闭，大黄主攻瘀血，桃仁主破死血。
产后七八日，无太阳证，少腹坚痛，此恶露不尽。不大便，烦躁发热，切脉微实，再
倍发热，日晡时烦躁者不食，食则谵语，至夜即愈，宜大承气汤主之。热在里，结在膀
胱也。
【按】“热在里结在膀胱也”之八字，当在本条上文恶露不尽之下，未有大承气汤下
膀胱血之理，必是传写之讹。“再倍”二字，当是衍文。
【注】无太阳证，无表证也；少腹坚痛，有里证也。因其产后七八日，有蓄血里证，而
无太阳表证，则可知非伤寒太阳随经瘀热在里之病，乃产后恶露未尽，热结膀胱之病，当
主以下瘀血可也。若不大便，不食、谵语、烦躁、发热，日晡更甚，至夜即愈，此为胃实
之病，非恶露不尽之病。以其日晡更甚，至夜即愈，则可知病不在血分而在胃也，故以
大承气汤下之。
【集注】李 曰∶此一节具两证在内∶一是太阳蓄血证，一是阳明里实证。因古人文
法错综，故难辨也。无太阳证，谓无表证也。少腹坚痛者，以肝藏血，少腹为肝经部分，故血
必结于此，则坚痛亦在此，此恶露不尽，是为热在里，结在膀胱，此太阳蓄血证也，宜下
去瘀血。若不大便，烦躁，脉实，谵语者，阳明里实也，再倍发热者，热在里，蒸蒸发于外也。
阳明旺于申、酉、戌，日晡是阳明向旺时，故烦躁不能食，病在阳而不在阴，故至夜则愈，此
阳明腑病也，宜大承气汤以下胃实。
【按】《伤寒论》曰∶阳明病不能食，攻其热必哕，以胃中虚冷故也。又云∶发热者，
尤当先解表，乃可攻之。况在产后，岂可妄议攻下哉？必认证果真，方可用此。
产后风续之，数十日不解，头微痛，恶寒，时时有热，心下闷，干呕，汗出，虽久，
阳旦证续在耳，可与阳旦汤。
【注】产后续感风邪，数十日不解，头微痛，恶寒，时热汗出，表未解也，虽有心下
闷、干呕之里，但有桂枝证在，可与阳旦汤解表可也。阳旦汤，即桂枝汤加黄芩。阳旦
证，即桂枝证也。
【集注】沈明宗曰∶上下三条，乃产后感冒证也。世谓产后气血两虚，不论外感内伤，
皆以补虚为主，而仲景拈伤寒中之风伤卫发热，仍以表里阴阳去邪为训。故云∶产后中
风，数十日不解，头微痛，恶寒，时时有热，汗出，乃太阳表未解也，但心下闷干呕，是
外邪入于胸中之里。太阳表里有邪，谓之阳旦证，故以桂枝汤加黄芩而为阳旦汤。以风
邪在表，故用桂枝解肌，邪入胸膈之间，当以清凉解其内热，故加黄芩，正谓不犯其虚，
是益其余，不补正而正自补，不驱邪而邪自散，斯为产后感冒入神之妙方也。奈后人不
察其理，反谓芍药酸寒，能伐生生之气，桂枝辛热，恐伤其血，弃而不用，以致病剧不
解，只因未窥仲景门墙耳！故《千金方》以此加饴糖、当归，为当归建中汤，治产后诸
虚或外感病。推仲景之意，尝以此汤加减出入，治产后诸病，屡获神效，故表出之。
尤怡曰∶夫审证用药，不拘日数，表里既分，汗下斯判。上条里热成实，虽产后七
八日，与大承气而不伤于峻；此条表不解，虽数十日之久，与阳旦汤而不虑其散，非通于
权变者，未足语此也。
阳旦汤方
即桂枝汤内加黄芩（桂枝汤方见下利中）
产后中风，发热面正赤，喘而头痛，竹叶汤主之。
【按】“产后中风”之下，当有“病痉者”之三字，始与方合。若无此三字，则人
参、附子施之于中风发热可乎？而又以竹叶命名者，何所谓也？且方内有“颈项强用大
附子”之文，本篇有证无方，则可知必有脱简。
【注】产后汗多，表虚而中风邪病痉者，主之竹叶汤，发散太阳、阳明两经风邪。用
竹叶为君者，以发热，面正赤，有热也；用人参为臣者，以产后而喘，不足也；颈项强
急，风邪之甚，故佐附子；呕者气逆，故加半夏也。
【集注】程林曰∶产后血虚多汗出，喜中风，故令病痉，今证中未至背反张，而发热
面赤头痛，亦风痉之渐也。
竹叶汤方
竹叶（一把） 葛根（三两） 防风（一两） 桔梗 桂枝 人参 甘草（各一两） 附
子（炮，一枚） 大枣（十五枚） 生姜（三两）
上十味，以水一斗，煮取二升半，分温三服，温覆使汗出。颈项强，用大附子一枚，
破之如豆大，前药扬去沫。呕者，加大半夏半升洗。
妇人乳中虚，烦乱，呕逆，安中益气，竹皮大丸主之。
【按】此条文义，证药未详。
竹皮大丸方
生竹茹（二分） 石膏（二分） 桂枝（一分） 甘草（七分） 白薇（一分）
上五味，末之，枣肉和丸，弹子大，以饮服一丸，日二夜二服。有热者，倍白薇。喘
者，加柏实一分。
【集解】《济阴纲目》云∶中虚不可用石膏，烦乱不可用桂枝，此方以甘草七分，配
众药六分，又以枣肉为丸，仍以一丸饮下，可
想其立方之微，用药之难，审虚实之不易也。仍饮服者，尤虑夫虚虚之祸耳！用是方者，亦
当深省。
产后下利及虚极，白头翁加甘草阿胶汤主之。
【按】此条文义、证药不合，不释。
白头翁加甘草阿胶汤方
白头翁 甘草 阿胶（各二两） 秦皮 黄连 柏皮（各三两）
上六味，以水七升，煮取二升半，内胶，令消尽，分温三服。
问：新生产妇有三种病：一种是痉病，一种是郁冒，一种是大便难，这是什么意思呢？老师说：新产之后血虚，出汗多，容易感受风邪，所以导致痉病。失血后又出汗，寒气重，所以导致郁冒。津液耗伤，胃中干燥，所以导致大便难。
【注】新生产的妇女，担心她不出汗，如果不出汗则营卫不和。如果有发热但无汗，似乎像伤寒表证，但可以通过舌苔没有白苔来辨别。所以希望她有汗，但又怕出汗过多，表阳不固，风邪容易侵入，从而引起项强、腰背反张的痉病。新生产的妇女，担心血行不畅，如果不通畅则血瘀在体内。如果有发热腹痛，似乎像伤寒里证，但可以通过舌苔没有黄苔来辨别。所以希望她恶露下行，但又怕下血过多，阴血亡失守持不住，虚阳上逆，从而引起昏冒不省人事、闭目出汗的血晕。新产后虽然希望出汗，希望血行通畅，但又恐怕难免过度损伤阴液，导致胃干肠燥，出现潮热谵语、大便硬结难解，似乎像阳明胃家实证。所以张仲景在产后首先提出这三种病，不仅是为了预防未发生的病，更是为了辨析已发生且令人疑惑的病。昏冒称为郁冒，是说阴阳虚弱郁滞，不能相互交通而导致昏冒。
【集注】尤怡说：痉，是筋脉的病变，血虚汗出，筋脉失去滋养，风邪侵入使其更加僵硬。郁冒，是神志的病变，亡阴血虚，阳气于是上逆，而阴气又郁滞于内，导致头晕眼花。大便难，是津液的病变，胃脏的津液渗灌到各阳经，津液亡失胃燥，则大肠失去滋润而大便困难。这三种病不同，但它们都是由于亡血伤津造成的。
产妇郁冒，脉搏微弱，不能进食，大便反而坚硬，只有头部出汗。之所以这样，是因为血虚导致气逆，气逆必然导致昏冒。郁冒想要解除，必须全身大汗出。因为血虚下部气逆，孤阳向上外出，所以只有头部出汗。所以产妇喜欢出汗，是因为亡阴血虚，阳气独盛，应当通过出汗，使阴阳恢复平衡。大便坚硬，呕吐不能进食，用小柴胡汤主治。病解后能进食，过了七八天又发热的，这是胃实，用大承气汤主治。
【注】这一段承接上一条详细阐述其含义，以说明治疗方法。产妇昏冒，脉搏微弱的，是气血俱虚应有的脉象。不能进食的，是胃气未调和应有的征候。大便反而坚硬的，是肠胃枯干应有的病症。究其郁冒的原因，是由于血虚则阴虚，阴虚则阳气上逆而必然昏冒。郁冒患者想要解除，必须大汗出的，是阳气郁滞得以向外宣泄而解除，所以产妇喜欢出汗。由此推断，如果是血瘀导致的昏冒，解除时必然有瘀血下行，这是阴气郁滞得以向内输布而解除。最忌讳的是只有头部出汗，这是阴亡下部气逆，孤阳上出的表现。大便坚硬，呕吐不能进食，用小柴胡汤，必须是其人舌上有苔、身上无汗、形体气息不衰者才可以，所以病得解后自然能进食。如果有汗应当减少柴胡用量，无热应当减少黄芩用量，呕吐则应当加倍生姜和半夏，虚则应当加倍人参，这又在于临证时的变通。大便坚硬，七八天后又发热，用大承气汤，也必须是其人形气都充实，胃强能进食者才可以。如果气弱液干，因虚导致燥，难以承受攻下的，则又应当内服元明粉以软化坚结，外用各种导法以润滑直肠，慢慢图谋治疗。
【集注】尤怡说：郁冒虽然有外感客邪，但其根本则是里虚，所以脉搏微弱。呕吐不能进食，大便反而坚硬，只有头部出汗，是津液上行不能下达的现象。之所以这样，是因为亡阴血虚，孤阳上逆，津液随之而上行。气逆必然昏冒，郁冒患者想要解除，必须大汗出的，是阴阳暂时分离，所以气逆而昏冒，等到阴阳重新贯通，汗才大量排出而病解。产妇新近体虚，不宜多汗，而这里反而喜欢出汗，是因为失血阴虚，阳气受邪气影响而独盛，出汗则邪气去除，阳气减弱后才能与阴气相和，这就是所谓“损阳而就阴”。
产妇腹中疼痛，用当归生姜羊肉汤主治，同时治疗腹中寒疝，虚劳不足。
【注】产后突然腹中急痛，是产后虚寒引起的疼痛。主治用当归生姜羊肉汤，是为了补虚散寒止痛。同时治疗虚劳不足、寒疝腹痛，也是因为其属于虚寒所致。
【集注】程林说：产后血虚有寒，则腹中急痛。《内经》说：味道浓厚的属于阴。当归、羊肉味道浓厚，用来补充产后的阴血，佐以生姜来疏散腹中的寒邪，则疼痛自然停止。辛味能散寒，补性能去弱，这三味药是辛温补剂，所以同时主治虚劳寒疝。
魏荔彤说：妊娠期间的腹痛，是胞宫阻滞因血寒所致。产后腹中疼痛，是里虚而血寒所致。一个是阻滞，一个是虚损，治疗方法就不同了。
【注】产后腹痛，如果不烦不满，是里虚；现在腹痛，烦满不能卧，是里实。气结血凝导致疼痛，所以用枳实破气结，芍药调治腹痛。枳实炒至黑色，是因为产妇气不实。同时也主治痈脓，也是因为血被气凝滞，久而腐化所致。佐以麦粥，是担心损伤产妇的胃气。
【集注】尤怡说：产后腹痛发展到烦满不能卧，知道是血郁而成热，且下部的病影响到上部，与虚寒痛不同。
枳实芍药散方
枳实（烧至黑色，不要太过） 芍药（等分）
以上两味药，捣碎成散剂，每次服用一方寸匕，每日三次。同时也主治痈脓，用麦粥送服。
老师说：产妇腹痛，按理应使用枳实芍药散。假如服药后不愈，这是因为腹中有干血附着在脐下，宜用下瘀血汤主治。也主治月经不通利。
【注】产妇腹痛，属于气结血凝的，用枳实芍药散调理。假如服药后不愈，这是因为热灼血液干枯附着在脐下而疼痛，不是枳实、芍药所能治疗的，宜用下瘀血的方法，主方用下瘀血汤，攻逐热结下的瘀血。也主治月经不通，也是因为热灼血液干枯的缘故。
下瘀血汤方
大黄（三两） 桃仁（二十枚） 䗪虫（熬，去足，二十枚）
以上三味药，研成末，炼蜜和制成四丸，用酒一升，煎煮一丸，取八合，一次性服用，会排出像猪肝一样的新血。
【集注】程林说：䗪虫主要开通血闭，大黄主攻逐瘀血，桃仁主要破除死血。
产后七八天，没有太阳表证，少腹坚硬疼痛，这是恶露不尽。不大便，烦躁发热，切脉微实，加倍发热，日晡时分烦躁不进食，进食则谵语，到了夜间就痊愈，宜用大承气汤主治。热在里，结在膀胱。
【按】“热在里结在膀胱也”这八个字，应当在上一条文中“恶露不尽”之下，没有用大承气汤下膀胱血的道理，必定是传写错误。“再倍”二字，应当是衍文。
【注】没有太阳证，就是没有表证；少腹坚硬疼痛，是有里证。因为产后七八天，有蓄血里证，而没有太阳表证，则可以知道这不是伤寒太阳随经瘀热在里的病，而是产后恶露未尽，热结膀胱的病，应当主方以下瘀血为主。如果不大便，不进食、谵语、烦躁、发热，日晡时分更严重，到了夜间就痊愈，这是胃实的病，不是恶露不尽的病。因为日晡时分更严重，到了夜间就痊愈，则可以知道病不在血分而在胃，所以用大承气汤攻下。
【集注】李说：这一节包含两个证候：一是太阳蓄血证，一是阳明里实证。因为古文写法错综，所以难以辨别。没有太阳证，是指没有表证。少腹坚硬疼痛，因为肝藏血，少腹是肝经部位，所以血必结于此，则坚硬疼痛也在此，这是恶露不尽，是为热在里，结在膀胱，这是太阳蓄血证，宜用下去瘀血。如果不大便，烦躁，脉实，谵语，是阳明里实。加倍发热，是热在里，蒸蒸发于外。阳明旺于申、酉、戌时，日晡是阳明向旺的时候，所以烦躁不能进食，病在阳而不在阴，所以到了夜间就痊愈，这是阳明腑病，宜用大承气汤以下胃实。
【按】《伤寒论》说：阳明病不能进食，攻其热必呃逆，因为胃中虚冷。又说：发热者，尤其应当先解表，然后才可攻下。何况在产后，岂可妄议攻下？必须认证确切，方可使用此方。
产后中风持续数十日不解，头微痛，恶寒，时不时有热，心下闷，干呕，出汗，虽然时间久，阳旦证依然存在，可与阳旦汤。
【注】产后续感风邪，数十日不解，头微痛，恶寒，时热汗出，表证未解，虽然有心下闷、干呕的里证，但有桂枝证存在，可与阳旦汤解表。阳旦汤，即桂枝汤加黄芩。阳旦证，即桂枝证。
【集注】沈明宗说：上下三条，是产后感冒证。世人认为产后气血两虚，不论外感内伤，都以补虚为主，而张仲景选取伤寒中风伤卫发热，仍以表里阴阳祛邪为训诫。所以说：产后中风，数十日不解，头微痛，恶寒，时时有热，汗出，乃太阳表未解，但心下闷干呕，是外邪入于胸中之里。太阳表里有邪，称为阳旦证，所以用桂枝汤加黄芩成为阳旦汤。因为风邪在表，所以用桂枝解肌，邪入胸膈之间，当用清凉解其内热，所以加黄芩，正是所谓不犯其虚，是益其余，不补正气而正气自补，不驱邪而邪自散，这才是产后感冒入神的妙方。无奈后人不明其理，反而认为芍药酸寒，能伐生生之气，桂枝辛热，恐伤其血，弃而不用，以致病情加重不解，只因未窥探张仲景门径罢了！所以《千金方》以此方加饴糖、当归，成为当归建中汤，治疗产后诸虚或外感病。推究张仲景的本意，曾以此汤加减出入，治疗产后诸病，屡获神效，所以列出此方。
尤怡说：审证用药，不拘泥于日数，表里既已分清，汗下之法随即判定。上一条里热成实，虽然是产后七八天，与大承气汤而不伤于峻烈；这一条表证未解，虽然时间长达数十日，与阳旦汤而不虑其发散太过，不通晓权变的人，不足以谈论此道。
【按】“产后中风”之下，应当有“病痉者”这三个字，才与方子相符。如果没有这三个字，那么人参、附子施用于中风发热可以吗？而又以竹叶命名，有什么说法呢？且方内有“颈项强用大附子”的文字，本篇有证无方，则可以知道必有脱简。
【注】产后汗多，表虚而中风邪病痉者，主方用竹叶汤，发散太阳、阳明两经风邪。用竹叶为君药，是因为发热、面正赤，有热；用人参为臣药，是因为产后而喘，正气不足；颈项强急，是风邪甚重，所以佐以附子；呕者是气逆，所以加半夏。
【集注】程林说：产后血虚多汗出，喜中风，所以导致痉病，现在证候中未到背反张的程度，而发热面赤头痛，也是风痉的渐进阶段。
竹叶汤方
竹叶（一把） 葛根（三两） 防风（一两） 桔梗 桂枝 人参 甘草（各一两） 附子（炮，一枚） 大枣（十五枚） 生姜（三两）
以上十味药，用水一斗，煮取二升半，分三次温服，温覆使汗出。颈项强，用大附子一枚，破开如豆大，前药扬去沫。呕者，加大半夏半升洗净。
妇人哺乳期中气虚，烦乱，呕逆，安中益气，用竹皮大丸主治。
【按】此条文义，证候药物不详。
竹皮大丸方
生竹茹（二分） 石膏（二分） 桂枝（一分） 甘草（七分） 白薇（一分）
以上五味药，研成末，枣肉和丸，弹子大小，用饮服一丸，每日两次，夜间两次。有热者，加倍白薇。喘者，加柏实一分。
【集解】《济阴纲目》说：中虚不可用石膏，烦乱不可用桂枝，此方以甘草七分，配众药六分，又以枣肉为丸，仍以一丸饮服，可以想见其立方之微妙，用药之艰难，审虚实之不易。仍用饮服者，更是担心虚虚之祸啊！使用此方的人，也应当深思。
产后下利及虚极，白头翁加甘草阿胶汤主治。
【按】此条文义、证候药物不合，不解释。
白头翁加甘草阿胶汤方
白头翁 甘草 阿胶（各二两） 秦皮 黄连 柏皮（各三两）
以上六味药，用水七升，煮取二升半，纳入胶，令其消尽，分三次温服。
Question: There are three diseases in new postpartum women: one is Jing disease (spasm), the second is Yumao (dizziness and confusion), and the third is difficult defecation. What does this mean? The Master said: After childbirth, there is blood deficiency and excessive sweating, making one prone to wind invasion, thus causing Jing disease (spasm). Loss of blood followed by sweating, with much cold, causes Yumao (dizziness and confusion). Loss of body fluids and dryness of the stomach cause difficult defecation.
[Annotation] For a woman who has just given birth, one fears lack of sweating; if there is no sweat, Ying and Wei (nutritive and defensive qi) will not harmonize. If there is fever without sweat, it resembles exterior syndrome of Cold Damage (Shanghan), but this can be distinguished by the absence of white coating on the tongue. Therefore, one hopes for sweating, yet fears excessive sweating which fails to secure exterior Yang, allowing wind pathogen to easily enter and cause Jing disease (spasm) characterized by stiff neck and opisthotonos. One fears stagnation of blood flow; if it does not flow, blood stasis occurs internally. If there is fever and abdominal pain, it resembles interior syndrome of Cold Damage, but this can be distinguished by the absence of yellow coating on the tongue. Therefore, one hopes for the discharge of lochia, yet fears excessive bleeding leading to loss of Yin and failure of retention, causing floating deficient Yang to rebel upward, resulting in Xueyun (blood fainting) characterized by dizziness, unconsciousness, and sweating with eyes closed. Although postpartum sweating and blood flow are desirable, one must fear excessive damage to Yin fluids, leading to dry stomach and intestines, tidal fever, delirium, and hard, difficult defecation, resembling Yangming Stomach excess syndrome. Thus, Zhang Zhongjing first presents these three diseases postpartum not only to prevent potential illnesses but also to differentiate existing ambiguous conditions. Dizziness and confusion are called Yumao, meaning that deficiency and stagnation of Yin and Yang fail to communicate, leading to dizziness.
[Collected Annotations] You Yi stated: Jing disease (spasm) is a disorder of sinews; blood deficiency and sweating cause sinews and vessels to lose nourishment, and wind invasion exacerbates stiffness. Yumao (dizziness and confusion) is a disorder of the spirit; loss of Yin and blood deficiency cause Yang to rebel upward, while Yin stagnates internally, leading to vertigo and blurred vision. Difficult defecation is a disorder of fluids; stomach fluids fail to moisten the Yang channels; loss of fluids and dry stomach cause the large intestine to lose moisture, resulting in difficult defecation. Although these three diseases differ, they all stem from loss of blood and injury to fluids.
In postpartum Yumao (dizziness and confusion), the pulse is weak and thready, the patient cannot eat, stool is hard, and only the head sweats. This is because blood deficiency leads to Qi rebellion, and Qi rebellion inevitably causes dizziness. For Yumao to resolve, profuse sweating must occur. Due to blood deficiency and lower Qi rebellion, isolated Yang floats upward, hence only the head sweats. Therefore, postpartum women welcome sweating because loss of Yin and blood deficiency lead to excessive Yang; sweating allows Yin and Yang to restore balance. Hard stool, vomiting, and inability to eat are treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). If the illness resolves and eating resumes, but fever returns after seven or eight days, this indicates Stomach excess, treated with Da Cheng Qi Tang (Major Order the Qi Decoction).
[Annotation] This passage elaborates on the previous clause to clarify treatment. Postpartum dizziness with a weak pulse reflects the expected diagnosis of combined Qi and blood deficiency. Inability to eat reflects the expected sign of unharmonized Stomach Qi. Hard stool reflects the expected pathology of dry intestines and stomach. The cause of Yumao is that blood deficiency leads to Yin deficiency, and Yin deficiency causes Yang to rebel upward, resulting in dizziness. Profuse sweating resolves Yumao by allowing stagnant Yang to vent outward, hence postpartum women welcome sweating. By inference, if dizziness is caused by blood stasis, resolution requires blood discharge, allowing stagnant Yin to circulate inward. The most dangerous sign is sweating only on the head, indicating loss of Yin, lower Qi rebellion, and floating isolated Yang. Hard stool, vomiting, and inability to eat are treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction), applicable only if the patient has tongue coating, no body sweat, robust form and Qi. Upon resolution, appetite returns. If sweating occurs, reduce Guizhi (Cinnamon Twig); if no heat, reduce Huangqin (Scutellaria Root); if vomiting, increase Shengjiang (Fresh Ginger) and Banxia (Pinellia Tuber); if deficiency, increase Renshen (Ginseng Root). These require clinical flexibility. Hard stool and fever returning after seven or eight days are treated with Da Cheng Qi Tang (Major Order the Qi Decoction), applicable only if the patient has robust form and Qi and strong stomach function. If Qi is weak and fluids dry, causing dryness due to deficiency, harsh purgation is intolerable; instead, use Yuan Ming Fen (Mirabilite) internally to soften hardness and external suppositories to lubricate the rectum, proceeding gradually.
[Collected Annotations] You Yi stated: Although Yumao (dizziness and confusion) involves external pathogens, its root is interior deficiency, hence the weak pulse. Vomiting, inability to eat, hard stool, and head-only sweating indicate fluids rising but failing to descend. This is due to loss of Yin and blood deficiency causing isolated Yang to rebel upward, carrying fluids with it. Qi rebellion causes dizziness; resolution requires profuse sweating as Yin and Yang temporarily separate and then reconnect. Postpartum women are newly deficient and should not sweat excessively, yet here sweating is welcomed because blood loss causes Yin deficiency and Yang becomes excessive due to pathogens; sweating expels pathogens, weakening Yang so it can harmonize with Yin, termed "reducing Yang to accommodate Yin."
Xiao Chai Hu Tang (Minor Bupleurum Decoction) (see Vomiting section)
Da Cheng Qi Tang (Major Order the Qi Decoction) (see Jing Disease section)
Postpartum abdominal pain is treated with Dang Gui Sheng Jiang Yang Rou Tang (Angelica Sinensis, Fresh Ginger, and Mutton Decoction), which also treats abdominal cold cramps and deficiency-wasting insufficiency.
[Annotation] Sudden acute abdominal pain postpartum is caused by deficiency-cold. Dang Gui Sheng Jiang Yang Rou Tang (Angelica Sinensis, Fresh Ginger, and Mutton Decoction) tonifies deficiency, dispels cold, and stops pain. It also treats deficiency-wasting and cold cramps due to their deficiency-cold nature.
[Collected Annotations] Cheng Lin stated: Postpartum blood deficiency with cold causes acute abdominal pain. The Neijing states: Strong flavors belong to Yin. Dang Gui (Angelica Sinensis Root) and mutton have strong flavors, tonifying postpartum Yin, assisted by Sheng Jiang (Fresh Ginger) to disperse abdominal cold, stopping pain. Pungent flavors disperse cold, tonification removes weakness; these three are pungent-warm tonics, treating deficiency-wasting and cold cramps.
Wei Litong stated: Abdominal pain during pregnancy is due to uterine obstruction from blood cold. Postpartum abdominal pain is due to interior deficiency and blood cold. One is obstruction, the other deficiency; treatments differ.
Dang Gui Sheng Jiang Yang Rou Tang (Angelica Sinensis, Fresh Ginger, and Mutton Decoction) (see Cold Cramps section)
Postpartum abdominal pain with irritability, fullness, and inability to lie down is treated with Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder).
[Annotation] Postpartum abdominal pain without irritability or fullness indicates interior deficiency; current symptoms of pain, irritability, fullness, and inability to lie down indicate interior excess. Qi stagnation and blood coagulation cause pain; Zhi Shi (Immature Bitter Orange) breaks Qi stagnation, and Shaoyao (Peony Root) regulates abdominal pain. Zhi Shi (Immature Bitter Orange) is charred black because postpartum Qi is not solid. It also treats carbuncles and pus due to blood coagulation from Qi stagnation over time. Mai Zhou (Wheat Gruel) is added to protect the Stomach.
[Collected Annotations] You Yi stated: Postpartum abdominal pain progressing to irritability, fullness, and inability to lie down indicates blood stagnation generating heat and lower pathology affecting the upper, differing from deficiency-cold pain.
Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder)
Zhi Shi (Immature Bitter Orange) (charred black, not too much) Shaoyao (Peony Root) (equal parts)
Crush the two ingredients into powder. Take one cun-bi (measure) three times daily. Also treats carbuncles and pus, taken with wheat gruel.
The Master said: Postpartum abdominal pain should be treated with Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder). If it does not resolve, it indicates dry blood adhering below the umbilicus; Xia Yu Xue Tang (Drain Blood Decoction) is indicated. It also treats irregular menstruation.
[Annotation] Postpartum abdominal pain due to Qi stagnation and blood coagulation is regulated by Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder). If unresolved, heat scorches blood into dryness adhering below the umbilicus, unresponsive to Zhi Shi (Immature Bitter Orange) and Shaoyao (Peony Root); Xia Yu Xue Tang (Drain Blood Decoction) is used to purge heat and drain blood stasis. It also treats amenorrhea due to heat-scorched dry blood.
Xia Yu Xue Tang (Drain Blood Decoction)
Da Huang (Rhubarb Root) (3 liang) Tao Ren (Peach Seed) (20 seeds) E Chong (Ground Beetle) (roasted, feet removed, 20 insects)
Grind the three ingredients into powder. Mix with refined honey to make four pills. Decoct one pill in 1 sheng of wine to obtain 8 ge. Take at once. Fresh blood resembling pig liver will be discharged.
[Collected Annotations] Cheng Lin stated: E Chong (Ground Beetle) opens blood closure; Da Huang (Rhubarb Root) attacks blood stasis; Tao Ren (Peach Seed) breaks dead blood.
Seven or eight days postpartum, without Taiyang syndrome, with hard and painful lower abdomen, this is incomplete expulsion of lochia. Constipation, irritability, fever, weakly solid pulse, doubled fever, evening irritability, anorexia, and delirium upon eating, resolving at night, are treated with Da Cheng Qi Tang (Major Order the Qi Decoction). Heat is in the interior,结 (knotting) in the Bladder.
[Note] The phrase "Heat is in the interior, knotting in the Bladder" should follow "incomplete expulsion of lochia" in the preceding text; there is no logic for Da Cheng Qi Tang (Major Order the Qi Decoction) to purge blood from the Bladder, indicating a transcription error. "Doubled" is likely a superfluous character.
[Annotation] No Taiyang syndrome means no exterior syndrome; hard/painful lower abdomen indicates interior syndrome. Given postpartum day seven or eight, interior blood accumulation exists without Taiyang exterior syndrome, ruling out Cold Damage with interior-stagnant heat following the meridians. Instead, it is incomplete lochia expulsion with heat knotting in the Bladder, initially treated with blood-draining methods. However, constipation, anorexia, delirium, irritability, fever worsening in the afternoon/evening, and resolving at night indicate Stomach excess, not incomplete lochia. Since symptoms worsen in the afternoon/evening and resolve at night, the pathology is in the Stomach, not blood; thus, Da Cheng Qi Tang (Major Order the Qi Decoction) is used to purge.
[Collected Annotations] Li Zhongyan stated: This section contains two syndromes: Taiyang blood accumulation and Yangming interior excess. Ancient texts are complex, making differentiation difficult. No Taiyang syndrome means no exterior syndrome. Hard/painful lower abdomen occurs because the Liver stores blood and the lower abdomen is the Liver meridian area; blood knots here, causing hardness/pain. This is incomplete lochia, heat in the interior, knotting in the Bladder (Taiyang blood accumulation), treated with blood-draining methods. Constipation, irritability, solid pulse, and delirium indicate Yangming interior excess. Doubled fever indicates interior heat steaming outward. Yangming peaks at Shen, You, Xu hours; afternoon/evening is when Yangming strengthens, causing irritability/anorexia. Pathology is in Yang, not Yin, resolving at night. This is Yangming Fu-organ disease, treated with Da Cheng Qi Tang (Major Order the Qi Decoction) to purge Stomach excess.
[Note] Shanghan Lun states: Yangming disease with anorexia, attacking heat causes hiccups due to cold Stomach. Also: With fever, resolve exterior first before purging. Especially postpartum, purging must not be reckless; confirm diagnosis precisely before use.
Postpartum wind syndrome persists for dozens of days unresolved, with mild headache, aversion to cold, intermittent fever, chest oppression, dry retching, and sweating. Although long-standing, Yang Dan syndrome persists; Yang Dan Tang is indicated.
[Annotation] Postpartum wind pathogen infection persisting for dozens of days with mild headache, aversion to cold, intermittent fever, and sweating indicates unresolved exterior syndrome. Despite chest oppression and dry retching (interior signs), Guizhi syndrome (Cinnamon Twig Syndrome) exists; Yang Dan Tang resolves the exterior. Yang Dan Tang is Guizhi Tang (Cinnamon Twig Decoction) plus Huangqin (Scutellaria Root). Yang Dan syndrome is Guizhi syndrome (Cinnamon Twig Syndrome).
[Collected Annotations] Shen Mingzong stated: The preceding three clauses describe postpartum colds. People believe postpartum Qi/blood deficiency requires tonification regardless of external/internal causes, but Zhang Zhongjing focuses on Wind injuring Wei (Defensive) qi with fever, using exterior/interior Yin-Yang to expel pathogens. Postpartum wind, persistent for dozens of days, with mild headache, aversion to cold, intermittent fever, and sweating indicates unresolved Taiyang exterior. Chest oppression/dry retching indicates pathogen entering chest interior. Exterior/interior Taiyang pathogens constitute Yang Dan syndrome, treated with Guizhi Tang (Cinnamon Twig Decoction) plus Huangqin (Scutellaria Root). Wind in exterior uses Guizhi (Cinnamon Twig) to release muscle layer; pathogen in chest/diaphragm uses cooling to clear internal heat (Huangqin). This avoids harming deficiency, benefiting residual health, tonifying Zheng Qi (Upright Qi) without explicit tonification, and dispersing pathogens without explicit expulsion—a miraculous formula for postpartum colds. Later practitioners, misunderstanding, rejected Shaoyao (Peony Root) as sour-cold damaging life force, and Guizhi (Cinnamon Twig) as pungent-hot damaging blood, worsening illness due to ignorance of Zhang's principles. Qianjin Fang adds Yitang (Maltose) and Dang Gui (Angelica Sinensis Root) to create Dang Gui Jian Zhong Tang (Angelica Sinensis Build the Middle Decoction) for postpartum deficiency/colds. Zhang's intent was to modify this formula for various postpartum diseases with great efficacy.
You Yi stated: Treatment depends on syndrome differentiation, not duration. Once exterior/interior are distinguished, sweating/purging methods are decided. Previous clause: Interior heat excess postpartum day seven/eight uses Da Cheng Qi Tang (Major Order the Qi Decoction) without being overly harsh. Current clause: Unresolved exterior after dozens of days uses Yang Dan Tang without fearing excessive dispersion. Only those mastering flexibility can discuss this.
Yang Dan Tang (Yang Dan Decoction)
Guizhi Tang (Cinnamon Twig Decoction) plus Huangqin (Scutellaria Root) (Guizhi Tang [Cinnamon Twig Decoction] see Diarrhea section)
Postpartum wind strike with fever, flushed face, wheezing, and headache is treated with Zhu Ye Tang (Bamboo Leaf Decoction).
[Note] "Postpartum wind strike" should include "Jing disease (spasm)" to match the formula. Using Renshen (Ginseng Root) and Fuzi (Aconite Root) for wind strike with fever seems inappropriate. Naming it Zhu Ye Tang (Bamboo Leaf Decoction) lacks explanation. The note "stiff neck uses large Fuzi (Aconite Root)" suggests missing text/formula.
[Annotation] Postpartum excessive sweating, exterior deficiency with wind strike causing Jing disease (spasm) is treated with Zhu Ye Tang (Bamboo Leaf Decoction) to disperse wind pathogen from Taiyang and Yangming meridians. Zhu Ye (Bamboo Leaf) is monarch for fever/flushed face (heat); Renshen (Ginseng Root) is minister for postpartum wheezing (deficiency); stiff neck indicates severe wind, assisted by Fuzi (Aconite Root); retching indicates rebellious Qi, assisted by Banxia (Pinellia Tuber).
[Collected Annotations] Cheng Lin stated: Postpartum blood deficiency with sweating invites wind, causing Jing disease (spasm). Current symptoms (fever, flushed face, headache) without opisthotonos are early stages of wind-Jing.
Zhu Ye Tang (Bamboo Leaf Decoction)
Zhu Ye (Bamboo Leaf) (1 bundle) Ge Gen (Kudzu Root) (3 liang) Fang Feng (Saposhnikovia Root) (1 liang) Jie Geng (Platycodon Root) Guizhi (Cinnamon Twig) Renshen (Ginseng Root) Gan Cao (Licorice Root) (each 1 liang) Fuzi (Aconite Root) (prepared, 1 piece) Da Zao (Jujube) (15 pieces) Sheng Jiang (Fresh Ginger) (3 liang)
Decoct ten ingredients in 1 dou water to obtain 2.5 sheng. Divide into three warm doses. Cover warmly to induce sweating. For stiff neck, use large Fuzi (Aconite Root, 1 piece), crushed bean-sized, remove foam from decoction. For retching, add Banxia (Pinellia Tuber, half sheng, washed).
During lactation, middle Jiao deficiency with irritability and retching is treated with Zhu Pi Da Wan (Bamboo Peel Large Pill) to calm the middle and tonify Qi.
[Note] Textual meaning, syndrome, and medication are unclear.
Zhu Pi Da Wan (Bamboo Peel Large Pill)
Sheng Zhu Ru (Raw Bamboo Shavings) (2 fen) Shi Gao (Gypsum Fibrosum) (2 fen) Guizhi (Cinnamon Twig) (1 fen) Gan Cao (Licorice Root) (7 fen) Bai Wei (Cynanchum Root) (1 fen)
Grind five ingredients into powder. Mix with jujube flesh to make pills the size of a bullet. Take one pill with water twice daily and twice nightly. If heat, double Bai Wei (Cynanchum Root). If wheezing, add Bai Zi Ren (Biota Seed) 1 fen.
[Collected Annotations] Ji Yin Gang Mu states: Middle deficiency should not use Shi Gao (Gypsum Fibrosum); irritability should not use Guizhi (Cinnamon Twig). This formula uses Gan Cao (Licorice Root) 7 fen against six fen of other herbs, formed into pills with jujube flesh, taken singly. This reveals subtle formulation and difficult herb selection, emphasizing difficulty in assessing deficiency/excess. Taking with water prevents further weakening. Practitioners must reflect deeply.
Postpartum diarrhea and extreme deficiency are treated with Bai Tou Weng Jia Gan Cao E Jiao Tang (Baitouweng Decoction plus Licorice and Donkey-Hide Gelatin).
[Note] Textual meaning, syndrome, and medication do not align; not explained.
Bai Tou Weng Jia Gan Cao E Jiao Tang (Baitouweng Decoction plus Licorice and Donkey-Hide Gelatin)
Bai Tou Weng (Pulsatilla Root) Gan Cao (Licorice Root) E Jiao (Donkey-Hide Gelatin) (each 2 liang) Qin Pi (Ash Bark) Huang Lian (Coptis Rhizome) Bo Gu Pi (Phellodendron Bark) (each 3 liang)
Decoct six ingredients in 7 sheng water to obtain 2.5 sheng. Add gelatin and dissolve. Divide into three warm doses.