〔郭〕产后口鼻黑气起及鼻衄者何？答曰∶阳明者，经脉之海，起于鼻，交 中，还
出颊口，交人中，左之右，右之左。产后气虚血散，荣卫不理，散乱入于诸经，却还不
得，故令口鼻气起及变鼻衄，此缘产后虚热，变生此证，胃绝肺败，不可治。
《经验方》云∶急取绯线一条，并产妇顶心发两条，紧扎中指节上即止。无药可治，亦
禳厌之一端也。
〔薛〕按胃脉侠口绕承浆，盖鼻准属脾土，鼻孔属肺金。诚胃虚肺损，气脱血死之
证，急用二味参苏饮加附子五钱，亦有得生者。
〔汪〕一妇产后，血逆上行，鼻衄口干，心躁舌黑，盖因瘀血上升，遂用益母丸二丸，
童便化下，鼻衄渐止，下血渐通。
〔陈〕产后血崩者何？答曰∶产卧伤耗经脉，未得平复，劳役损动，致血暴崩，淋
沥不止。或因酸咸不节，伤蠹荣卫衰弱，亦变崩中。若小腹满痛，肝经已坏为难治，急
服固经丸以止之。
陈无择评曰∶血崩不是轻病，况产后有此，是谓重伤。恐不止咸酸不节而能致之，多
因惊忧恚怒，脏气不平，或产后服断血药早，致恶血不消，郁满作坚，亦成崩中。固经丸
自难责效。不若大料煮芎 汤加芍药，候定，续次随证诸药治之为得。
〔薛〕前证若血滞小腹胀满，用失笑散。血少小腹虚痞，芎 汤。肝火血妄行，加味
逍遥散。脾郁不统血，加味归脾汤。脾气虚不摄血，补中益气汤。浓味积热伤血，清胃
散加槐花。风热相搏伤血，四君子、防风、枳壳。一产妇血崩，小腹胀痛，用破气行血
之剂，其崩如涌，四肢不收，恶寒呕吐，大便频泻。余用六君加炮黑干姜，四剂稍愈，又
以十全大补三十余剂而痊。一产妇血崩，因怒其血如涌，仆地口噤目斜，手足抽搐，此
肝经血耗生风。余用六味丸料一剂，诸证悉退，但食少晡热，佐以四君、柴胡、牡丹皮
而愈。
固经丸
艾叶 赤石脂（ ） 补骨脂（炒） 木贼（各半两） 附子（一枚炮）
上为末，陈米饭和丸如梧子大。每服二十丸，食前温酒下，米饮亦可。
芎 汤加芍药方
芎 当归 芍药（各等分）
上 咀，每服四钱，水一盏半，煎至七分，去渣热服，无时。
熟干地黄散 治产后崩中，头目旋运，神思昏迷，四肢烦乱，不知人事。
熟干地黄 伏龙肝 黄 赤石脂（各一两） 阿胶 甘草 白术 艾叶（炒） 川芎 人
参（各半两） 当归（七钱半）
上 咀，每服四钱，水一盏半，姜三片，煎至七分，去渣温服。
白芍药散 治产后崩中下血，淋沥不绝，黄瘦虚损。
白芍药 牡蛎 干姜 熟干地黄 桂心 黄 乌贼鱼骨 鹿角胶 龙骨（各一两）
上为末，每服二钱，食前温酒下。
又方
赤石脂 熟地黄（各一两） 鹿茸 牡蛎 当归（各半两）
上为细末，食前以粥饮调下二钱。
阿胶丸 治产后崩中下血不止，虚羸无力。
阿胶 赤石脂（各一两半） 续断 川芎 当归 甘草 丹参（各一两） 龙骨
鹿茸（酥炙） 乌贼鱼骨 鳖甲（炙，各二两，共为细末）
上炼蜜丸如梧桐子大，空心温酒下二、三十丸。
菖蒲酒 治产后崩中下血不止。
菖蒲（一两半细锉，）以酒二盏，煮取一盏，去渣，分温三服，食前。
瑞莲散 治产后恶血崩漏，状如泉水。
瑞莲（百枚，烧存性） 棕榈（烧存性） 当归 桂心（各一两） 鲤鱼鳞（烧） 川芎（各七钱半）
槟榔（二枚）
上为细末，每服三钱，煨姜酒调下。如未止，更进一服。或非时血崩，无药可治，但
进三服即止。
《补遗》治产后血崩。
香附子（炒赤，二两） 莲蓬壳（五枚，烧存性）
上为末，米饮调下二钱、
产后血崩，素有热者，奇效四物汤良。（方见血崩。）
【郭】产后口鼻出现黑气以及发生鼻衄（鼻出血）的原因是什么？回答说：阳明经是十二经脉之海，其经脉起始于鼻旁，在鼻根部相交，然后返回经过脸颊和口部，在人中穴处左右交叉。产后气血虚弱，血液散乱，营卫之气运行失调，气血散乱进入各条经脉，却无法回归本位，因此导致口鼻出现黑气并引发鼻衄。这是由于产后虚热，变生此证，若发展到胃气绝、肺气败的地步，则不可治愈。
《经验方》记载：紧急取一根红线，以及产妇头顶心头发两根，紧紧扎在中指节上，出血即可停止。虽然没有药物可治，但这也是一种禳解厌胜的方法。
【薛】按：胃脉夹口环绕承浆穴，鼻尖属脾土，鼻孔属肺金。如果是胃虚肺损，属于气脱血死的重证，紧急使用二味参苏饮加五钱附子，也有救活的案例。
【汪】一位产妇产后，血逆上行，出现鼻衄、口干、心烦、舌苔发黑的症状，这是因为瘀血上升所致，于是服用益母丸两丸，用童子小便送服，鼻衄逐渐停止，恶露也逐渐通畅。
【陈】产后血崩是什么原因？回答说：分娩时耗伤经脉，尚未恢复平静，因劳累损伤，导致血液突然大量崩漏，淋漓不止。或者因为饮食酸咸不节制，损伤荣卫，导致荣卫衰弱，也变为崩中。如果小腹胀满疼痛，说明肝经已坏，难以治疗，应紧急服用固经丸以止血。
陈无择评论说：血崩不是轻病，何况发生在产后，这称为重伤。恐怕不仅仅是因为咸酸饮食不节制导致的，多因惊恐、忧愁、愤怒，导致脏气不平；或者是产后过早服用断血药，导致恶血不能消除，郁结胀满变硬，也形成崩中。固经丸很难指望见效。不如用大剂量的芎劳汤加芍药，待病情稳定后，再根据症状依次用药治疗更为妥当。
【薛】上述证候，如果是血滞导致小腹胀满，使用失笑散。血少导致小腹虚痞，使用芎劳汤。肝火导致血妄行，使用加味逍遥散。脾郁不能统摄血液，使用加味归脾汤。脾气虚不能摄血，使用补中益气汤。厚味积热伤血，使用清胃散加槐花。风热相搏伤血，使用四君子汤加防风、枳壳。
一位产妇血崩，小腹胀痛，使用了破气行血的药剂，结果出血如涌，四肢无力收持，恶寒呕吐，大便频繁腹泻。我使用六君子汤加炮干姜，四剂后稍有好转，又用十全大补汤三十余剂而痊愈。
另一位产妇血崩，因发怒导致血如涌出，倒地口噤目斜，手足抽搐，这是肝经血耗生风。我使用六味地黄丸料一剂，诸证悉退，但食少且午后发热，辅以四君子汤、柴胡、牡丹皮而愈。
固经丸
艾叶、赤石脂（煅）、补骨脂（炒）、木贼（各半两）、附子（一枚，炮制）。
以上研为细末，用陈米饭和丸，如梧桐子大。每次服用二十丸，饭前温酒送下，米汤亦可。
芎劳汤加芍药方
川芎、当归、芍药（各等分）。
以上锉碎，每次服用四钱，水一盏半，煎至七分，去渣热服，不拘时候。
熟干地黄散 治疗产后崩中，头目眩晕，神思昏迷，四肢烦乱，不知人事。
熟干地黄、伏龙肝、黄芪、赤石脂（各一两）、阿胶、甘草、白术、艾叶（炒）、川芎、人参（各半两）、当归（七钱半）。
以上锉碎，每次服用四钱，水一盏半，生姜三片，煎至七分，去渣温服。
白芍药散 治疗产后崩中下血，淋漓不绝，面色黄瘦，身体虚损。
白芍药、牡蛎、干姜、熟干地黄、桂心、黄芪、乌贼鱼骨、鹿角胶、龙骨（各一两）。
以上研为细末，每次服用二钱，饭前温酒送下。
又方
赤石脂、熟地黄（各一两）、鹿茸、牡蛎、当归（各半两）。
以上研为细末，饭前用粥饮调服二钱。
阿胶丸 治疗产后崩中下血不止，身体虚弱羸弱无力。
阿胶、赤石脂（各一两半）、续断、川芎、当归、甘草、丹参（各一两）、龙骨、鹿茸（酥炙）、乌贼鱼骨、鳖甲（炙，各二两，共为细末）。
以上炼蜜为丸，如梧桐子大，空腹时温酒送服二三十丸。
菖蒲酒 治疗产后崩中下血不止。
菖蒲（一两半，细切），用酒二盏，煮取一盏，去渣，分三次温服，饭前服用。
瑞莲散 治疗产后恶血崩漏，状如泉水流出。
瑞莲（百枚，烧存性）、棕榈（烧存性）、当归、桂心（各一两）、鲤鱼鳞（烧）、川芎（各七钱半）、槟榔（二枚）。
以上研为细末，每次服用三钱，用煨姜酒调服。如果未止，再进一服。或者非经期血崩，无药可治时，只要服用三服即可停止。
[Guo] What is the cause of black qi appearing at the mouth and nose, as well as epistaxis (nosebleed), postpartum? The answer is: The Yangming meridian is the sea of the twelve meridians. It originates beside the nose, intersects at the root of the nose, returns to pass through the cheeks and mouth, and crosses at the Renzhong point. Postpartum, Qi and Blood are deficient and scattered; Ying and Wei (Nutritive and Defensive Qi) fail to circulate properly. Qi and Blood scatter into the various meridians but cannot return to their proper positions, thus causing black qi to appear at the mouth and nose and triggering epistaxis. This arises from postpartum deficiency-heat generating this syndrome. If it progresses to the exhaustion of Stomach Qi and failure of Lung Qi, it is incurable.
The *Experience Formulas* records: Urgently take one red thread and two hairs from the vertex of the parturient woman's head, tie them tightly around the middle finger joint, and the bleeding will stop immediately. Although there is no medicinal treatment, this is also a form of apotropaic ritual.
[Xue] According to my analysis: The Stomach meridian flanks the mouth and surrounds the Chengjiang point. The tip of the nose belongs to Spleen Earth, and the nostrils belong to Lung Metal. If it is indeed Stomach deficiency and Lung damage, it constitutes a critical syndrome of Qi collapse and Blood death. Urgently using Erwei Rensu Yin (Two-Ingredient Ginseng and Asarum Decoction) with five qian of Fuzi (Prepared Aconite Root) has resulted in survival.
[Wang] A postpartum patient experienced upward reversal of blood, presenting with epistaxis, dry mouth, mental restlessness, and a black tongue coating. This was due to the ascent of stagnant blood. Therefore, Yi Mu Wan (Motherwort Pills) were administered, two pills dissolved and taken with child's urine. The epistaxis gradually ceased, and lochia flow became smooth.
[Chen] What is the cause of metrorrhagia (uterine bleeding) postpartum? The answer is: Childbirth injures and depletes the meridians. If they have not yet recovered and are subjected to physical exertion, it causes sudden violent bleeding, dripping continuously. Alternatively, immoderate consumption of sour and salty foods damages Ying and Wei, leading to weakness, which also transforms into metrorrhagia. If there is fullness and pain in the lower abdomen, it indicates that the Liver meridian is damaged and difficult to treat; urgently administer Gujing Wan (Solidify the Menses Pill) to stop the bleeding.
Chen Wuze commented: Metrorrhagia is not a mild disease, especially when occurring postpartum, which is termed severe injury. It is likely caused not only by immoderate intake of salty and sour foods but often by fright, worry, or anger, leading to disharmony of Zang organ Qi. Or, if hemostatic drugs are taken too early postpartum, preventing the expulsion of lochia, the stagnant blood accumulates, becomes distended and hard, also resulting in metrorrhagia. Gujing Wan alone is unlikely to be effective. It is better to use a large dose of Xiong Gui Tang (Ligusticum and Angelica Decoction) added with Shaoyao (Peony Root). Once stabilized, subsequent treatment should follow the specific symptoms.
[Xue] Regarding the aforementioned syndromes: If blood stagnation causes lower abdominal fullness, use Shixiao San (Pain-Relieving Powder). If blood deficiency causes lower abdominal empty bloating, use Xiong Gui Tang. If Liver fire causes reckless blood movement, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If Spleen depression fails to control blood, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). If Spleen Qi deficiency fails to hold blood, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If rich flavors accumulate heat damaging blood, use Qingwei San (Clear the Stomach Powder) added with Huaihua (Sophora Flower). If wind-heat struggle damages blood, use Sixia Junzi Tang (Four Gentlemen Decoction) added with Fangfeng (Saposhnikovia Root) and Zhike (Aurantium Fructus).
One postpartum patient suffered metrorrhagia with lower abdominal distension and pain. After using formulas that break Qi and move blood, the bleeding surged like a fountain, limbs became flaccid, accompanied by aversion to cold, vomiting, and frequent diarrhea. I used Liujun Zi Tang (Six Gentlemen Decoction) added with Pao Ganjiang (Prepared Dried Ginger). After four doses, there was slight improvement, followed by thirty-plus doses of Shiquan Dabu Tang (Ten Complete Tonifying Decoction) for recovery.
Another postpartum patient suffered metrorrhagia; due to anger, blood surged like a fountain, she collapsed with locked jaw and deviated eyes, and convulsions of hands and feet. This was Wind generated from Liver Blood depletion. I administered one dose of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) ingredients, after which all symptoms receded. However, she had poor appetite and afternoon fever, so Si Jun Zi Tang (Four Gentlemen Decoction), Chaihu (Bupleurum Root), and Mudanpi (Moutan Bark) were added to achieve cure.
Gujing Wan (Solidify the Menses Pill)
Aiye (Mugwort Leaf), Chishizhi (Red Halloysite, calcined), Buguzhi (Psoralea Fruit, stir-fried), Muzei (Equisetum Herba) (each half liang), Fuzi (Prepared Aconite Root, one piece, processed).
Grind into powder, mix with aged rice paste to make pills the size of wutong seeds. Take twenty pills before meals with warm wine; rice water is also acceptable.
Xiong Gui Tang Jia Shaoyao Formula (Ligusticum and Angelica Decoction Added with Peony Root)
Xionggui (Ligusticum Chuanxiong Rhizome), Danggui (Angelica Sinensis Radix), Shaoyao (Paeonia Lactiflora Radix) (equal parts).
Cut into pieces. Take four qian per dose, add one and a half cups of water, decoct until seven-tenths remain, remove dregs, and drink hot. Take at any time.
Shugen Dihuang San (Cooked Rehmannia Powder)
Treats postpartum metrorrhagia, vertigo, coma, limb restlessness, and loss of consciousness.
Shu Dihuang (Prepared Rehmanniae Radix), Fulonggan (Dragon's House Soil), Huangqi (Astragali Radix), Chishizhi (Red Halloysite) (each one liang), Ejiao (Donkey-hide Gelatin), Gancao (Licorice Root), Baizhu (Atractylodis Macrocephalae Rhizoma), Aiye (Mugwort Leaf, stir-fried), Chuanxiong (Ligusticum Chuanxiong Rhizome), Renshen (Ginseng Radix) (each half liang), Danggui (Angelicae Sinensis Radix) (seven qian and half).
Cut into pieces. Take four qian per dose, add one and a half cups of water and three slices of ginger, decoct until seven-tenths remain, remove dregs, and drink warm.
Baishaoyao San (White Peony Powder)
Treats postpartum metrorrhagia with continuous dripping, sallow complexion, and deficiency wasting.
Baishaoyao (White Peony Root), Muli (Ostrea Shell), Ganjiang (Dried Ginger), Shu Dihuang (Prepared Rehmanniae Radix), Guixin (Cinnamon Twig), Huangqi (Astragali Radix), Wuzheiyugu (Sepiae Endoconcha), Lu Jiaojiao (Deer Antler Glue), Longgu (Fossilized Mammoth Teeth/Bones) (each one liang).
Grind into powder. Take two qian per dose before meals with warm wine.
Another Formula
Chishizhi (Red Halloysite), Shu Dihuang (Prepared Rehmanniae Radix) (each one liang), Lurong (Deer Antler), Muli (Ostrea Shell), Danggui (Angelicae Sinensis Radix) (each half liang).
Grind into fine powder. Take two qian before meals mixed with porridge water.
Ejiao Wan (Donkey-hide Gelatin Pills)
Treats persistent postpartum metrorrhagia with emaciation and weakness.
Ejiao (Donkey-hide Gelatin), Chishizhi (Red Halloysite) (each one and a half liang), Xuduan (Dipsaci Radix), Chuanxiong (Ligusticum Chuanxiong Rhizome), Danggui (Angelicae Sinensis Radix), Gancao (Licorice Root), Danshen (Salviae Miltiorrhizae Radix et Rhizoma) (each one liang), Longgu (Fossilized Mammoth Teeth/Bones), Lurong (Deer Antler, baked with rice wine), Wuzheiyugu (Sepiae Endoconcha), Biejia (Testudinis Carapax et Plastrum, roasted) (each two liang, ground together into fine powder).
Make pills with refined honey, size of wutong seeds. Take twenty to thirty pills on an empty stomach with warm wine.
Changpu Jiu (Acorus Wine)
Treats persistent postpartum metrorrhagia.
Changpu (Acori Tatarinowii Rhizoma, one and a half liang, finely cut). Boil in two cups of wine until one cup remains, remove dregs, divide into three warm doses, taken before meals.
Ruilian San (Auspicious Lotus Powder)
Treats postpartum lochia metrorrhagia resembling flowing spring water.
Ruilian (Nelumbinis Plumula, one hundred pieces, burned to retain properties), Zonglv (Palmae Folium, burned to retain properties), Danggui (Angelicae Sinensis Radix), Guixin (Cinnamon Twig) (each one liang), Liyu Lin (Cyprini Carpio Squama, burned), Chuanxiong (Ligusticum Chuanxiong Rhizoma) (each seven qian and half), Binglang (Arecae Semen) (two pieces).
Grind into fine powder. Take three qian before meals mixed with roasted ginger wine. If bleeding does not stop, take another dose. For irregular metrorrhagia where no medicine is available, taking three doses will stop it.
*Supplement* treats postpartum metrorrhagia.
Xiangfu (Cyperi Rhizoma, stir-fried until red, two liang), Lianpeng Ke (Nelumbinis Calyx Shell, five pieces, burned to retain properties).
Grind into powder. Take two qian mixed with rice water.
For postpartum metrorrhagia in patients with pre-existing heat, Qixiao Siwu Tang (Miraculous Efficacy Four Substances Decoction) is excellent. (Formula see section on Metrorrhagia.)