张氏医通云。伤寒厥阴证。热利下重者。用白头翁汤。苦寒治热。以坚肠胃。此产后气血两虚。故加
阿胶甘草。然下利血滞也。古人云。血行则利自止。此方岂独治产后哉。
附方
千金三物黄芩汤 治妇人在草蓐。自发露得风。四肢苦
烦热。头痛者。与小柴胡汤。头不痛但烦者。此汤主之。（千金。烦者。作烦热。）
黄芩（一两） 苦参（二两） 干地黄（四两 千金。二两上。有各字。）
上三味。以水六升。煮取二升。温服一升。多吐下虫。（千金。六升下有去滓二字。）
〔徐〕在草蓐。是未离产所也。自发露得风。是揭盖衣被。稍有不慎而暂感也。产后阴虚。四肢在
亡血之后。阳气独盛。又得微风。则苦烦热。然表多则上入而头痛。当以上焦为重。故主小柴胡和解。若从
下受之。而湿热结于下。则必生虫。头不痛。故以黄芩消热为君。苦参去风杀虫为臣。
而以地黄补其元阴为佐。曰多吐下虫。谓虫得苦参。必不安。其上出下出。故未可知也。
案别录云。苦参除伏热。本方所用。盖不在杀虫。当考千金伤寒杂治门。
千金内补当归建中汤治妇人产后虚羸不足。腹中刺痛不止。吸吸少气。或苦少腹中急摩痛引腰背。不能
食饮。产后一月。日得服四五剂为善。令人强壮。宜（千金。刺作 。中急作拘急。无摩字。宜作方。）
当归（四两） 桂枝（三两） 芍药（六两○千金作五两） 生姜（三两○千金作
六两） 甘草（五两） 大枣（十二枚○千金作十八枚）
上六味。以水一斗。煮取三升。分温三服。一日令尽。若大虚加饴糖六两。汤成内之于火上。暖令饴消。
若去血过多。崩伤内衄不止。加地黄六两。阿胶二两。合八味。汤成内阿胶。若无当归。以芎 代之。若
无生姜。以干姜代之。（案内衄。千金作内竭。非也。千金翼。与本条同。巢源云。吐血有三种。一日内衄。
出血如鼻衄。但不从鼻孔出。或去数升。乃至斛。是也。若无生姜以下。千金无。）
〔沈〕产后体虽无病。血海必虚。若中气充实。气血虽虚。易能恢复。或后天不能生血。充于血海。
则见虚羸不足。但血海虚。而经络之虚。是不待言。因气血不利。而瘀则腹中刺痛不止。冲任督带内虚。则
少腹中急摩痛。引腰背。脾冒气虚。则吸吸少气。不能食饮。故用桂枝汤。调和营卫。
加当归欲补血之功居多。若大虚加胶饴。峻补脾胃。而生气血。若去血过多。崩伤内衄。乃血海真阴大亏。故加地黄阿
胶以培之。方后云。无生姜。以干姜代之。乃温补之中。兼引血药入血分生血。其义更妙。
张氏医通云。按此即黄 建中之变法。彼用黄 。以助
外卫之阳。此用当归。以调内营之血。两不移易之定法也。
千金芍药汤。治产后苦腹少痛方。
即小建中汤。用胶饴八两。
《张氏医通》记载：伤寒厥阴病证中，若出现热性腹泻且伴有肛门重坠感（热利下重），应使用白头翁汤。该方以苦寒之药清解热邪，从而坚固肠胃功能。这是针对产后气血两虚的情况，所以在原方基础上加入阿胶和甘草。然而，腹泻往往伴随血行不畅（下利血滞）。古人说：“血液运行通畅，则腹泻自然停止。”此方难道仅仅用于治疗产后疾病吗？
附方
千金三物黄芩汤：治疗妇女在产褥期，因自行掀开衣被而受风邪侵袭，导致四肢烦闷燥热、头痛者，给予小柴胡汤；若头不痛但仅感烦热者，以此方主治。（出自《千金方》，注：原文中的“烦”字，意指烦热。）
药材及用量：黄芩（一两）、苦参（二两）、干地黄（四两，《千金方》注：此处为二两，上方各药名后均有“各”字）。
以上三味药，用水六升，煎煮至取汁二升，分次温服，每次一升。服药后可能会吐出或排出虫体。（《千金方》注：六升之下有“去滓”二字。）
〔徐灵胎评注〕“在草蓐”，是指尚未离开分娩场所。“自发露得风”，是指掀开盖在身上的衣被，稍有不慎便暂时感受了风邪。产后阴液亏虚，四肢在大量失血之后，阳气相对独盛，再加上受到微风侵袭，所以感到四肢烦闷燥热。如果表证较重，邪气上逆则引起头痛，此时应当重视上焦病变，故主治用小柴胡汤来和解少阳。如果是从下部受邪，湿热结聚于下焦，则必然生虫，且头不痛，因此以黄芩清热为君药，苦参祛风杀虫为臣药，而以地黄滋补元阴为佐药。文中说“多吐下虫”，意思是虫子遇到苦参必然不安稳，向上吐出或向下排出，情况难以预料。
案语：据《别录》记载，苦参能清除伏热。本方所用之苦参，大概不在于杀虫，这一点值得考证。参见《千金方·伤寒杂治门》。
千金内补当归建中汤：治疗妇人产后身体虚弱消瘦、元气不足，腹部刺痛不止，呼吸短促，或者感觉小腹拘急疼痛并牵引腰背，无法进食饮水。产后一个月内，每天服用四五剂效果较好，能使人体强壮。（《千金方》注：“刺”字作“绞”意，“中急”作“拘急”解，无“摩”字，“宜”字作“方”解。）
药材及用量：当归（四两）、桂枝（三两）、芍药（六两，《千金方》作五两）、生姜（三两，《千金方》作六两）、甘草（五两）、大枣（十二枚，《千金方》作十八枚）。
以上六味药，用水一斗，煎煮至取汁三升，分三次温服，一天内服完。如果体质非常虚弱，加入饴糖六两，待汤药煎成后放入火上加热，使饴糖融化。如果失血过多，或有崩漏、外伤及体内出血不止的情况，加入地黄六两、阿胶二两，共八味药，待汤药煎成后放入阿胶。如果没有当归，可以用川芎代替。如果没有生姜，可以用干姜代替。（关于“内衄”，《千金方》作“内竭”，这是不对的。《千金翼方》与本条相同。巢元方《诸病源候论》云：吐血有三种，一是内衄，出血像鼻衄一样，只是不从鼻孔流出，有时出血数升甚至数斛，就是这种情况。若无当归以下加减法，《千金方》中没有。）
〔沈明宗评注〕产后虽然体表看似无病，但血海必然空虚。如果中气充实，即使气血虚弱，也容易恢复。如果后天脾胃不能生化血液以充盈血海，就会出现虚弱消瘦、元气不足的症状。仅仅是血海空虚，那么经络的虚弱就不言而喻了。因为气血运行不利，瘀滞则导致腹部刺痛不止；冲脉、任脉、督脉、带脉内部空虚，则导致小腹拘急疼痛，牵引腰背；脾肺气虚，则呼吸短促，无法进食饮水。因此使用桂枝汤调和营卫。加入当归，主要为了增强补血的功效。如果极度虚弱，加入胶饴，可以峻补脾胃，从而化生气血。如果失血过多，出现崩漏、外伤及体内出血，这是血海真阴严重亏损，所以加入地黄和阿胶来培补根本。方后注说，没有生姜用干姜代替，这是在温补之中，兼引血药进入血分以生血，其中的义理更为精妙。
《张氏医通》记载：按此方即是黄芪建中汤的变法。彼方使用黄芪，以助卫外之阳气；此方使用当归，以调内在营分之血。这是两种不可移易的定法。
千金芍药汤：治疗产后苦于小腹轻微疼痛的方剂。
即小建中汤，使用胶饴八两。
*Zhang's Medical Treatise* records: In the Jueyin syndrome of Cold Damage, if there is a hot dysentery accompanied by a sensation of heaviness in the anus (hot diarrhea with tenesmus), Baitouweng Decoction should be used. This formula employs bitter-cold herbs to clear heat and thereby strengthen the intestines and stomach. This modification adds Ejiao (Donkey-hide Gelatin) and Gancao (Licorice Root) to address the dual deficiency of Qi and Blood postpartum. However, diarrhea often involves blood stasis. The ancients said: "When blood flows smoothly, diarrhea stops naturally." Is this formula exclusively for treating postpartum conditions?
Supplementary Formulas
Qianjin Sanwu Huangqin Decoction: Treats women during the puerperium who, by inadvertently exposing themselves to wind after lifting covers, suffer from vexation and heat in the four limbs and headache. For those with headache, Xiaochaihu Tang (Minor Chest Guardian Decoction) is given; for those without headache but only experiencing vexation and heat, this decoction is the primary treatment. (From *Qianjin Fang*: "Vexation" here refers to vexatious heat.)
Herbs and Dosages: Huangqin (Scutellariae Radix, 1 liang), Kushen (Sophorae Flavescentis Radix, 2 liang), Gadihuang (Rehmanniae Radix Preparata, 4 liang). (*Qianjin Fang* note: Here it is 2 liang; the word "each" follows the names of the above herbs.)
The above three herbs are boiled in 6 sheng of water until reduced to 2 sheng. Take 1 sheng warm per dose. It may cause vomiting or expulsion of parasites. (*Qianjin Fang* note: The words "remove dregs" appear after "6 sheng".)
[Commentary by Xu Lingtai] "In the grass mat" means not yet having left the delivery place. "Self-exposure to wind" means lifting the bedding and inadvertently catching a slight wind. Postpartum Yin fluid is deficient; after significant blood loss, Yang qi stands alone and becomes relatively excessive. Combined with exposure to slight wind, this causes vexation and heat in the four limbs. If the exterior syndrome is prominent, pathogenic factors move upward causing headache; thus, priority should be given to the Upper Jiao, and Xiaochaihu Tang is used to harmonize Shaoyang. If pathogens enter from below, damp-heat accumulates in the Lower Jiao, leading to parasite generation, and there is no headache. Therefore, Huangqin (Scutellariae Radix) clears heat as the Sovereign herb, Kushen (Sophorae Flavescentis Radix) dispels wind and kills parasites as the Minister herb, and Dihuang (Rehmanniae Radix Preparata) tonifies primordial Yin as the Assistant herb. The text states "many parasites vomited or expelled," meaning that upon encountering Kushen, parasites become restless and may exit via vomiting or defecation, making the outcome unpredictable.
Case Note: According to *Bielu*, Kushen eliminates latent heat. The use of Kushen in this formula likely aims not at killing parasites, which warrants further examination. See *Qianjin Fang, Section on Cold Damage and Miscellaneous Diseases*.
Qianjin Neibu Danggui Jianzhong Decoction: Treats women postpartum suffering from emaciation and insufficiency, unceasing stabbing pain in the abdomen, shortness of breath, or urgency and pain in the lower abdomen radiating to the back, accompanied by inability to eat or drink. During the first month postpartum, taking 4-5 doses daily is beneficial and strengthens the body. (*Qianjin Fang* notes: "Stabbing" implies twisting/cramping; "Zhongji" means cramping/spasm; there is no character "Mo"; "Yi" should be read as "Formula".)
Herbs and Dosages: Danggui (Angelicae Sinensis Radix, 4 liang), Guizhi (Cinnamomi Ramulus, 3 liang), Shaoyao (Paeoniae Radix Alba, 6 liang; *Qianjin Fang* uses 5 liang), Shengjiang (Zingiberis Rhizoma Recens, 3 liang; *Qianjin Fang* uses 6 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 5 liang), Dazao (Jujubae Fructus, 12 pieces; *Qianjin Fang* uses 18 pieces).
The above six herbs are boiled in 1 dou of water until reduced to 3 sheng. Divide into three warm doses, consumed within one day. If severely deficient, add Yitang (Malt Sugar) 6 liang. After decoction, add Yitang and warm over fire until dissolved. If blood loss is excessive, or if there is metrorrhagia, trauma, or internal bleeding that does not stop, add Dihuang (Rehmanniae Radix Preparata) 6 liang and Ejiao (Colla Corii Asini) 2 liang, totaling eight herbs. Add Ejiao after decoction. If Danggui is unavailable, replace with Xiong (Ligustici Chuanxiong Rhizoma). If Shengjiang is unavailable, replace with Ganjiang (Zingiberis Rhizoma). (Regarding "internal nasal hemorrhage," *Qianjin Fang* reads "internal depletion," which is incorrect. *Qianjin Yi Fang* agrees with this clause. Chao Yuanfang's *Zhubing Yuanhou Lun* states: There are three types of hematemesis. One is internal nasal hemorrhage, where bleeding resembles epistaxis but does not flow from the nostrils; sometimes several sheng or even several hu are lost. The substitution instructions following "If no Shengjiang..." are absent in *Qianjin Fang*.)
[Commentary by Shen Mingzong] Although the postpartum body may appear free of disease, the Sea of Blood must be empty. If Middle Qi is substantial, recovery from Qi and Blood deficiency is easy. If the Spleen and Stomach fail to generate blood to fill the Sea of Blood, emaciation and insufficiency result. Mere emptiness of the Sea of Blood implies emptiness of the collaterals and vessels. Due to impaired Qi and Blood circulation, stasis causes unceasing stabbing abdominal pain. Emptiness in the Chong, Ren, Du, and Dai meridians causes urgency and pain in the lower abdomen radiating to the back. Deficiency of Spleen and Lung Qi causes shortness of breath and anorexia. Therefore, Guizhi Tang (Cinnamon Twig Decoction) is used to harmonize Ying and Wei. Adding Danggui primarily enhances blood tonification. For severe deficiency, adding Jiaoyi (Malt Sugar) vigorously tonifies the Spleen and Stomach to generate Qi and Blood. For excessive blood loss, metrorrhagia, trauma, or internal bleeding, this represents a severe deficit of True Yin in the Sea of Blood; thus, Dihuang and Ejiao are added to nourish the root. The post-formula note says to substitute Ganjiang for Shengjiang; this cleverly combines warming tonification with guiding blood-invigorating herbs into the Blood level to generate blood.
*Zhang's Medical Treatise* records: This formula is a variation of Huangqi Jianzhong Decoction. That formula uses Huangqi (Astragali Radix) to assist defensive Yang outside; this formula uses Danggui to regulate nutritive Blood inside. These are two immutable standard methods.
Qianjin Shaoyao Decoction: A formula for treating mild abdominal pain postpartum.
This is simply Jianzhong Decoction using 8 liang of Jiaoyi (Malt Sugar).