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。
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
寒复郁之。则头眩而目瞀也。大便难者。液病也。胃藏津液而渗灌诸阳。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。故皆为产后所有之病。
产妇郁冒。其脉微弱。呕不能食。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。
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。津气上行而
不下逮之象。所以然者。亡阴血虚。孤阳上厥。而津气从之也。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。小柴胡主之者。以
邪气不可不散。而正虚不可罔顾。惟此法为能解散客邪。而和利阴阳耳。
小柴胡汤方（见呕吐）
病解能食。七八日更发热者。此为胃实。宜大承气汤主之。
病解能食。谓郁冒解而能受食也。至七八日更发热。此其病不在表而在里。不属虚而属实矣。是
宜大承气以下里实。
大承气汤方（见痉）
产后腹中 痛。当归生姜羊肉汤主之。兼主腹中寒疝。虚劳不足。
产后腹中 痛。与妊娠腹中 痛不同。彼为血虚而湿扰于内。此为血虚而寒动于中也。当归、生
姜温血散寒。孙思邈云。羊肉止痛利产妇。
当归生姜羊肉汤方（见寒疝）
产后腹痛。烦满不得卧。枳实芍药散主之。
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。枳实烧令黑。
能入血行滞。同芍药为和血止痛之剂也。
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。大麦粥下之。
师曰。产妇腹痛。法当以枳实芍药散。假令不愈者。此为腹中有瘀血着脐下。宜下瘀血汤主之。
亦主经水不利。
腹痛服枳实芍药而不愈者。以有瘀血在脐下。着而不去。是非攻坚破积之剂。不能除矣。大黄、桃
仁、 虫。下血之力颇猛。用蜜丸者。缓其性不使骤发。恐伤上二焦也。酒煎顿服者。补下治下制以
急。且去疾惟恐不尽也。
下瘀血汤方
大黄（三两） 桃仁（二十个） 虫（二十枚去足熬）
上三味末之。炼蜜和为四丸。以酒一升煮一丸。取八合。顿服之。新血下如豚肝。
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。更倍发热。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。
无太阳证者。无头痛恶寒之表证也。产后七八日。少腹坚痛。恶露不尽。但宜行血去瘀而已。然
不大便。
烦躁。发热。脉实。则胃之实也。日晡为阳明旺时。而烦躁甚于他时。又胃热之验也。食气入胃。
长气于阳。
食入而助胃之热则谵语。至夜阳明气衰而谵语愈。又胃热之验也。故曰热在里。结在膀胱。里即
阳明。
膀胱即少腹。盖谓不独血结于下。而亦热聚于中也。若但治其血而遗其胃。则血虽去而热不除。
即血亦未必能去。而大承气汤中。大黄、枳实。均为血药。仲景取之者。盖将一举而两得之欤。
产后风。续续数十日不解。头微疼。恶寒。时时有热。心下闷。干呕汗出。虽久。阳旦证续在者。
可与阳旦汤。
产后中风。至数十日之久。而头疼寒热等证不解。是未可卜度其虚。而不与解之散之也。阳旦汤
治伤寒太阳中风挟热者。此风久而热续在者。亦宜以此治之。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。此条表邪不解。虽数十日之久。与阳旦汤
而不虑其散。非通于权变者。未足以语此也。
阳旦汤方（即桂枝汤加黄芩）
产后中风。发热面正赤。喘而头痛。竹叶汤主之。
此产后表有邪而里适虚之证。若攻其表。则气浮易脱。若补其里。则表多不服。竹叶汤。用竹叶、
葛根、桂枝、防风、桔梗。解外之风热。人参、附子。固里之脱。甘草、姜、枣。以调阴阳之气。而
使其平。乃表里兼济之法。
凡风热外淫。而里气不固者。宜于此取则焉。
竹叶汤方
竹叶（一把） 葛根（三两） 防风 桔梗 桂枝 人参 甘草（各一两） 附子（一枚炮）
生姜（五两） 大枣（十五枚）
上十味。以水一斗。煮取二升半。分温三服。覆使汗出。头项强。用大附子一枚破之。如豆大。
前药扬去沫。呕者加半夏半升洗。
妇人乳中虚。烦乱呕逆。安中益气。竹皮大丸主之。
妇人乳中虚。烦乱呕逆者。乳子之时。气虚火胜。内乱而上逆也。竹茹、石膏。甘寒清胃。桂枝、
甘草。辛甘化气。白薇性寒入阳明。治狂惑邪气。故曰安中益气。
竹皮大丸方
生竹茹 石膏（各二分） 桂枝 白薇（各一分） 甘草（七分）
上五味末之。枣肉和丸。弹子大。饮服一丸。日三夜二服。有热倍白薇。烦喘者。加柏实一分。
产后下利虚极。白头翁加甘草阿胶汤主之。
伤寒热利下重者。白头翁汤主之。寒以胜热。苦以燥湿也。此亦热利下重。而当产后虚极。则加
阿胶救阴。甘草补中生阳。且以缓连、柏之苦也。
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。
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。
黄芩（一两） 苦参（二两） 干地黄（四两）
上三味。以水六升。煮取二升。温服一升。多吐下虫。
此产后血虚风入而成热之证。地黄生血。苦参、黄芩除热也。若头痛者。风未全变为热。故宜柴
胡解之。
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。或苦少腹急。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。
当归（四两） 桂枝 生姜（各三两） 芍药（六两） 甘草（二两） 大枣（十二枚）
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。
问：刚生产完的产妇会有三种病。一种是痉病，一种是郁冒，第三种是大便困难。这是什么原因呢？医生说：产后血液亏虚且多汗，容易感受风邪，所以导致痉病；失血后又出汗，寒气偏盛，所以导致郁冒；津液耗损导致胃中干燥，所以大便困难。
痉病，是筋脉的病变。血液亏虚、汗出过多，导致筋脉失去滋养，风邪侵入后加剧了筋脉的拘急。郁冒，是神志的病变。阴血亡失而血虚，阳气随之厥逆，加上寒邪郁闭，就会出现头晕眼花的症状。大便困难，是津液的病变。胃贮藏津液并渗灌到各阳经，津液亡失导致胃燥，大肠失去滋润，所以排便困难。这三种病虽然表现不同，但根本原因都是失血伤津，所以都是产后常见的疾病。
产妇出现郁冒时，脉象微弱，呕吐不能进食，大便反而干结，只有头部出汗。之所以这样，是因为血虚导致气机厥逆，厥逆必然引起昏冒。郁冒想要缓解，必须通过全身大汗来解除。因为血虚导致下部阳气厥逆，孤立的阳气向上冲出，所以只有头部出汗。因此产妇喜欢出汗，是因为阴血亡失而血虚，阳气独盛，应当通过出汗使阴阳恢复平衡。对于大便干结、呕吐不能进食的情况，用小柴胡汤主治。
郁冒虽然有外感邪气，但根本原因是体内虚弱，所以脉象微弱。呕吐不能进食，大便反而干结，只有头部出汗，这是津气和阳气上行而不能下达下部的征象。之所以这样，是因为阴血亡失，孤阳上逆，津气随之上行。厥逆必然导致昏冒，郁冒患者想要缓解，必须全身大汗，这是因为阴阳暂时分离，所以出现厥逆和昏冒；等到阴阳重新通畅，就会大汗出而病愈。产妇身体刚刚虚弱，不适宜多汗，但这里反而喜欢出汗，是因为失血导致阴虚，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调和，这就是所说的“损阳以就阴”。使用小柴胡汤的原因，是因为邪气不可不散，而正气虚弱也不能不顾，只有这种方法能解散外邪，调和阴阳。
如果病解后能进食，过了七八天又发热的，这是胃中有实热，宜用大承气汤主治。
“病解能食”，是指郁冒解除且能接受饮食。到了七八天又发热，说明病不在表而在里，不属于虚证而属于实证。这时应该用大承气汤来攻下里的实热。
产后腹中疼痛，用当归生姜羊肉汤主治。同时也主治腹中寒疝和虚劳不足。
产后腹中疼痛，与妊娠期间的腹中疼痛不同。妊娠腹痛是因为血虚且有湿邪干扰在内；产后腹痛是因为血虚且有寒邪扰动在中焦。当归、生姜能温通血脉、散除寒邪。孙思邈说：羊肉能止痛，利于产妇。
产后腹痛，发展到烦闷胀满、无法躺卧的程度，可知是血郁化热，且下部病变阻碍了上部气机。这与虚寒性腹痛不同。将枳实烧成黑色，能入血分行滞，与芍药配合成为和血止痛的药剂。
枳实（烧成黑色，不要过度） 芍药（等量）
以上两味药，捣碎过筛制成散剂。每次服用一方寸匕，每日三次。此方也主治痈脓。用大麦粥送服。
医生说：产妇腹痛，按法应当用枳实芍药散。假如服药后不愈，这是因为腹中有瘀血凝结在脐下，宜用下瘀血汤主治。此方也主治月经不通畅。
服用枳实芍药散治疗腹痛而不愈的，是因为有瘀血在脐下，凝结不去，这不是攻坚破积的药物不能除去。大黄、桃仁、䗪虫，破血逐瘀的力量很猛，制成蜜丸是为了缓和药性，防止药力骤发，以免损伤上、中二焦。用酒煎煮顿服，是因为“治下焦之病，制方宜急”，且祛除病邪唯恐不尽。
下瘀血汤方
以上三味药研成细末，用炼蜜和匀制成四丸。用一升酒煮一丸，取八合，一次服下。排出新下的瘀血像猪肝一样。
产后七八天，没有太阳病的表证，少腹部坚硬疼痛，这是恶露排出不尽。伴有大便不通、烦躁发热，切脉微实，发热加重，傍晚时分烦躁加剧，不能进食，进食后就说胡话，到了夜间症状减轻。宜用大承气汤主治。这是热邪在里，结聚在膀胱（此处指下焦少腹部位）。
“无太阳证”，是指没有头痛、恶寒等表证。产后七八天，少腹坚硬疼痛，恶露不尽，本应只需用活血化瘀的方法即可。但是，如果伴有大便不通、烦躁、发热、脉实，则是胃中有实热。日晡时（下午3-5点）是阳明经旺盛的时候，此时烦躁比其他时间更严重，又是胃热的验证。食物进入胃中，助长阳气，食物入胃助长胃热就会导致谵语，到了夜间阳明气衰，谵语也就停止，这又是胃热的验证。所以说热在里，结在膀胱。“里”即指阳明胃，“膀胱”在此处指代少腹部位。意思是不仅血结在下焦，而且热也聚在中焦。如果只治血而忽略胃，那么血虽去而热不除，即使血也不一定能够去除。在大承气汤中，大黄、枳实也都具有活血作用，张仲景选用它们，大概是想一举两得吧。
产后中风，持续几十天症状不解，轻微头痛，怕冷，时不时发热，心下痞闷，干呕，出汗。虽然病程较长，但只要阳旦证仍在，就可以给予阳旦汤。
产后中风，经过几十天之久，头疼、寒热等症状仍未解除，这说明不能简单推测为虚证而不给予解表发散的治疗。阳旦汤治疗伤寒太阳中风兼有内热的情况，这里风邪久留而热势持续存在，也适宜用此方治疗。审察证候用药，不拘泥于天数，表里既已分清，汗法下法自然判定。
上一条提到里热成实，虽然是产后七八天，用大承气汤也不至于过于峻猛；这一条提到表邪不解，虽然长达数十天，用阳旦汤也不必担心发散太过。不通晓权变之道的人，不足以谈论这些。
这是产后体表有邪气而体内恰好虚弱的证候。如果攻伐表邪，则气浮易脱；如果补益体内，则表邪多不服从。竹叶汤，用竹叶、葛根、桂枝、防风、桔梗，解除外面的风热；用人参、附子，固护体内的元气防脱；用甘草、生姜、大枣，调和阴阳之气使其平和，这是表里兼顾的治疗方法。
凡是风热外侵而里气不固者，适宜从这里取法。
竹叶汤方
竹叶（一把） 葛根（三两） 防风 桔梗 桂枝 人参 甘草（各一两） 附子（一枚，炮制） 生姜（五两） 大枣（十五枚）
以上十味药，用水一斗，煮取二升半，分三次温服。服药后覆盖衣被使出汗。如果头项强痛，用大附子一枚，破开如豆大小，先煎前药扬去沫。如果有呕吐，加半夏半升，洗净。
妇女哺乳期气血虚弱，心烦意乱，呕吐逆气，用竹皮大丸安中益气。
妇女哺乳期气血虚弱，心烦意乱，呕吐逆气的，是在哺乳期间，气虚火旺，内扰而上逆。竹茹、石膏，甘寒清胃；桂枝、甘草，辛甘化气；白薇性寒入阳明经，治疗狂惑邪气。所以说它能安中益气。
竹皮大丸方
以上五味药研成细末，用枣肉和丸，如弹子大小。饮水送服一丸，白天服三次，晚上服两次。如果有热，加倍使用白薇；如果心烦气喘，加柏实一分。
产后腹泻，身体极度虚弱，用白头翁加甘草阿胶汤主治。
伤寒热利伴有下重感的，用白头翁汤主治。用寒药胜热，用苦药燥湿。这也是热利下重，但发生在产后极度虚弱的情况下，所以加入阿胶以救阴，甘草以补中生阳，并且缓和黄连、黄柏的苦味。
以上六味药，用水七升，煮取二升半，放入阿胶令其溶化，分三次温服。
附方
千金三物黄芩汤 治疗妇人在产褥期，自发露身体感受风邪，四肢烦热，头痛的，给小柴胡汤；头不痛，只是烦热的，用此汤主治。
以上三味药，用水六升，煮取二升，温服一升。服药后可能会吐出或拉出虫子。
这是产后血虚，风邪侵入化热而成的证候。地黄生血，苦参、黄芩清热。如果头痛，说明风邪未完全变为热，所以适宜用柴胡解表。
千金内补当归建中汤 治疗妇人产后虚弱羸瘦，腹中刺痛不止，气息微弱，或者苦于少腹拘急，疼痛牵引腰背，不能饮食。产后一个月内，每天服用四五剂为好，能使人强壮适宜。
当归（四两） 桂枝 生姜（各三两） 芍药（六两） 甘草（二两） 大枣（十二枚）
以上六味药，用水一斗，煮取三升，分三次温服，一天内服完。如果非常虚弱，加饴糖六两，汤成后加入其中，在火上加热令饴糖融化。如果失血过多，崩漏或内出血不止，加地黄六两，阿胶二两，合成八味药，最后加入阿胶。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。
Question: A woman who has just given birth may suffer from three types of illness. One is Jing disease (spasm), the second is Yu Mao (depression and dizziness), and the third is difficulty in defecation. What does this mean? The Master said: After childbirth, blood deficiency and excessive sweating make one prone to contracting wind pathogens, thus causing Jing disease (spasm). Loss of blood followed by sweating leads to an excess of cold, thus causing Yu Mao (depression and dizziness). Depletion of body fluids leads to dryness in the stomach, thus causing difficulty in defecation.
Jing disease (spasm) is a disorder of the sinews. Blood deficiency and excessive sweating cause the sinews and vessels to lose nourishment; when wind pathogens invade, they exacerbate the stiffness of the sinews. Yu Mao (depression and dizziness) is a disorder of the spirit. Loss of yin blood leads to blood deficiency, causing yang qi to rebel upward; combined with the constraint of cold pathogens, it results in dizziness and blurred vision. Difficulty in defecation is a disorder of body fluids. The stomach stores body fluids and distributes them to the yang channels. Depletion of body fluids leads to stomach dryness, causing the large intestine to lose its moisture, resulting in difficult defecation. Although these three illnesses present differently, their root cause is the same: loss of blood and injury to body fluids. Therefore, they are all diseases common after childbirth.
When a postpartum woman suffers from Yu Mao (depression and dizziness), her pulse is faint, she vomits and cannot eat, her stool is hard, and only her head sweats. This occurs because blood deficiency causes qi rebellion, which inevitably leads to dizziness. For Yu Mao (depression and dizziness) to resolve, there must be profuse sweating throughout the body. Due to blood deficiency causing lower jiao qi rebellion, isolated yang qi rushes upward, resulting in sweating only on the head. Therefore, postpartum women tend to sweat because the loss of yin blood leads to blood deficiency, allowing yang qi to become hyperactive. Sweating allows yin and yang to restore balance. For cases involving hard stool, vomiting, and inability to eat, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Although Yu Mao (depression and dizziness) involves external pathogens, its root lies in internal deficiency, hence the faint pulse. Vomiting, inability to eat, hard stool, and sweating only on the head are signs that yin fluids and qi ascend but do not descend. This happens because yin blood is depleted, isolated yang qi rebels upward, and fluids and qi follow. Rebellion inevitably causes dizziness. For those suffering from dizziness to recover, profuse sweating is required because yin and yang have temporarily separated, causing rebellion and dizziness; once yin and yang reconnect, profuse sweating occurs, leading to recovery. Postpartum women are newly deficient and should not sweat excessively, yet here they prefer to sweat because blood loss leads to yin deficiency, and yang qi, affected by pathogens, becomes hyperactive. Sweating expels the pathogens; as yang qi weakens, it can harmonize with yin. This is what is meant by "diminishing yang to accommodate yin." Xiao Chai Hu Tang (Minor Bupleurum Decoction) is used because pathogens must be dispersed, and the deficiency of healthy qi must not be ignored. Only this method can disperse external pathogens and harmonize yin and yang.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) formula (see section on Vomiting).
If the patient recovers and can eat, but develops fever again after seven or eight days, this indicates excess heat in the stomach. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
"Recovery and ability to eat" refers to the resolution of Yu Mao (depression and dizziness) and the return of appetite. Fever developing after seven or eight days indicates that the pathology is no longer in the exterior but in the interior, shifting from deficiency to excess. In such cases, Da Cheng Qi Tang (Major Order the Qi Decoction) should be used to purge interior excess.
Da Cheng Qi Tang (Major Order the Qi Decoction) formula (see section on Spasm).
For abdominal pain after childbirth, Dang Gui Sheng Jiang Yang Rou Tang (Angelica, Ginger, and Mutton Decoction) is indicated. It also treats abdominal cold cramps and deficiency-wasting conditions.
Abdominal pain after childbirth differs from abdominal pain during pregnancy. Pregnancy-related pain is due to blood deficiency and internal dampness disturbance; postpartum pain is due to blood deficiency and internal cold movement. Dang Gui (Angelica Root) and Sheng Jiang (Fresh Ginger) warm the blood and dispel cold. Sun Simiao stated that mutton relieves pain and benefits postpartum women.
Dang Gui Sheng Jiang Yang Rou Tang (Angelica, Ginger, and Mutton Decoction) formula (see section on Cold Cramps).
For postpartum abdominal pain accompanied by irritability, fullness, and inability to lie down, Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) is indicated.
Postpartum abdominal pain progressing to irritability, fullness, and inability to lie down indicates blood stagnation transforming into heat, where lower jiao pathology obstructs the upper jiao. This differs from deficiency-cold abdominal pain. Zhi Shi (Immature Bitter Orange) is charred to enter the blood level and move stagnation; combined with Shao Yao (Peony Root), it harmonizes blood and relieves pain.
Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) formula
Zhi Shi (Immature Bitter Orange) (charred until black, but not overly so) Shao Yao (Peony Root) (equal parts)
Grind the two ingredients into a powder. Take one cun bi (measure) per dose, three times daily. This formula also treats abscesses and pus. Administer with Barley Porridge.
The Master said: For postpartum abdominal pain, Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder) is the standard treatment. If it fails to cure, it indicates blood stasis adhering below the navel. Xia Yu Xue Tang (Decoction to Drain Blood Stasis) is indicated. It also treats irregular menstruation.
If abdominal pain persists despite taking Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder), it is because blood stasis is fixed below the navel. Strong agents that break accumulation are required. Da Huang (Rhubarb Root), Tao Ren (Peach Seed), and E Chong (Ground Beetle) have potent blood-draining effects. Forming pills with honey slows their action to prevent sudden onset, protecting the upper and middle jiao. Decocting in wine and taking it at once follows the principle of "urgent preparation for treating the lower jiao," ensuring complete removal of the pathogen.
Xia Yu Xue Tang (Decoction to Drain Blood Stasis) formula
Da Huang (Rhubarb Root) (3 liang) Tao Ren (Peach Seed) (20 seeds) E Chong (Ground Beetle) (20 pieces, feet removed, roasted)
Grind the three ingredients into powder. Mix with refined honey to form four pills. Decoct one pill in one sheng of wine, reduce to eight he, and take at once. Freshly expelled blood will resemble pig liver.
Seven or eight days after childbirth, without Taiyang syndrome symptoms, if there is hardness and pain in the lower abdomen, this is due to incomplete expulsion of lochia. Accompanied by constipation, irritability, fever, and a slightly solid pulse, with worsening fever, evening irritability, anorexia, delirium after eating, and relief at night, Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. The heat is in the interior, and the knot is in the Bladder (referring to the lower abdomen).
"No Taiyang syndrome" means absence of exterior symptoms like headache and aversion to cold. Seven or eight days postpartum, with hardness and pain in the lower abdomen and incomplete lochia, blood-invigorating and stasis-resolving methods are appropriate. However, constipation, irritability, fever, and a solid pulse indicate stomach excess. Shen Wang (Shen hour, 3-5 PM) is the peak time for Yangming meridian activity; severe irritability at this time confirms stomach heat. Food entering the stomach boosts yang qi; food intake aggravating stomach heat causes delirium. Delirium subsiding at night when Yangming qi declines further confirms stomach heat. Thus, "heat in the interior, knot in the Bladder." "Interior" refers to Yangming Stomach; "Bladder" here refers to the lower abdomen. This means not only is blood knotted in the lower jiao, but heat also gathers in the middle jiao. Treating only blood while neglecting the stomach leaves heat unremoved, and blood may not be effectively cleared. In Da Cheng Qi Tang (Major Order the Qi Decoction), Da Huang (Rhubarb Root) and Zhi Shi (Immature Bitter Orange) also act on blood. Zhang Zhongjing likely used them to achieve two goals with one strike.
For postpartum wind-stroke persisting for dozens of days without resolution, with mild headache, aversion to cold, intermittent fever, chest oppression, dry retching, and sweating, even if prolonged, if the Yang Dan syndrome persists, Yang Dan Tang is indicated.
Postpartum wind-stroke lasting dozens of days with unresolved headache, chills, and fever should not be assumed as purely deficiency requiring no dispersal. Yang Dan Tang treats Taiyang wind-stroke complicated by heat. Here, wind lingers with persistent heat, making this formula suitable. Treatment depends on syndrome differentiation, not duration. Once exterior and interior are distinguished, sweating and purging methods are determined.
The previous case involved interior heat becoming excess; even seven or eight days postpartum, Da Cheng Qi Tang (Major Order the Qi Decoction) was not too harsh. This case involves unresolved exterior pathogens; even after dozens of days, Yang Dan Tang is safe from excessive dispersal. Those unfamiliar with flexible application cannot discuss these matters.
Yang Dan Tang formula (Guizhi Tang [Cinnamon Twig Decoction] plus Huang Qin [Scutellaria Root]).
For postpartum wind-stroke with fever, bright red face, wheezing, and headache, Zhu Ye Tang (Bamboo Leaf Decoction) is indicated.
This is a pattern of exterior pathogens with concurrent interior deficiency in postpartum women. Attacking the exterior risks floating qi and collapse; tonifying the interior may fail to address exterior pathogens. Zhu Ye Tang (Bamboo Leaf Decoction) uses Zhu Ye (Bamboo Leaves), Ge Gen (Kudzu Root), Gui Zhi (Cinnamon Twig), Fang Feng (Saposhnikovia Root), and Jie Geng (Platycodon Root) to release exterior wind-heat; Ren Shen (Ginseng Root) and Fu Zi (Aconite Root) secure interior qi against collapse; Gan Cao (Licorice Root), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube Fruit) harmonize yin and yang. This is a method of treating both exterior and interior simultaneously.
For exterior wind-heat invasion with insecure interior qi, this formula serves as a model.
Zhu Ye Tang (Bamboo Leaf Decoction) formula
Zhu Ye (Bamboo Leaves) (1 bundle) Ge Gen (Kudzu Root) (3 liang) Fang Feng (Saposhnikovia Root) Jie Geng (Platycodon Root) Gui Zhi (Cinnamon Twig) Ren Shen (Ginseng Root) Gan Cao (Licorice Root) (each 1 liang) Fu Zi (Aconite Root) (1 piece, processed) Sheng Jiang (Fresh Ginger) (5 liang) Da Zao (Jujube Fruit) (15 pieces)
Decoct the ten ingredients in one dou of water, reduce to two and a half sheng, divide into three warm doses. Cover to induce sweating. For stiff neck, use one large Fu Zi (Aconite Root), broken into bean-sized pieces. Boil prior medicines, skimming off foam. Add Ban Xia (Pinellia Tuber), half a sheng, washed, if vomiting occurs.
During lactation, if a woman suffers from deficiency, irritability, restlessness, vomiting, and regurgitation, Zhu Pi Da Wan (Bamboo Peel Large Pill) is used to calm the middle and boost qi.
Irritability, restlessness, vomiting, and regurgitation during lactation result from qi deficiency and fire hyperactivity disturbing internally and ascending. Zhu Ru (Bamboo Shavings) and Shi Gao (Gypsum) are sweet and cold, clearing the stomach; Gui Zhi (Cinnamon Twig) and Gan Cao (Licorice Root) are pungent and sweet, generating qi; Bai Wei (Anemarrhenae Rhizoma) is cold, enters the Yangming channel, and treats mania and evil qi. Hence, it calms the middle and boosts qi.
Zhu Pi Da Wan (Bamboo Peel Large Pill) formula
Sheng Zhu Ru (Fresh Bamboo Shavings) Shi Gao (Gypsum) (each 2 fen) Gui Zhi (Cinnamon Twig) Bai Wei (Anemarrhenae Rhizoma) (each 1 fen) Gan Cao (Licorice Root) (7 fen)
Grind the five ingredients into powder. Mix with date paste to form pills the size of a quail egg. Take one pill with water, three times during the day and twice at night. Increase Bai Wei (Anemarrhenae Rhizoma) if heat is present; add Bai Zi Ren (Biota Seed), 1 fen, if irritability and wheezing occur.
For postpartum diarrhea with extreme deficiency, Bai Tou Weng Jia Gan Cao E Jiao Tang (Baitouweng Decoction with Added Licorice and Donkey-Hide Gelatin) is indicated.
For heat-dysentery with heaviness in the lower rectum caused by cold damage, Bai Tou Weng Tang (Baitouweng Decoction) is used. Cold overcomes heat; bitterness dries dampness. This is also heat-dysentery with heaviness, but occurring in extreme postpartum deficiency. Therefore, E Jiao (Donkey-Hide Gelatin) is added to nourish yin, and Gan Cao (Licorice Root) to tonify the middle and generate yang, while moderating the bitterness of Lian Mu (Coptis Rhizome) and Huang Bo (Phellodendron Bark).
Bai Tou Weng Jia Gan Cao E Jiao Tang (Baitouweng Decoction with Added Licorice and Donkey-Hide Gelatin) formula
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) Huang Bo (Phellodendron Bark) (each 3 liang)
Decoct the six ingredients in seven sheng of water, reduce to two and a half sheng. Dissolve E Jiao (Donkey-Hide Gelatin) into the decoction. Divide into three warm doses.
Supplementary Formula
Qian Jin San Wu Huang Qin Tang (Three-Ingredient Scutellaria Decoction from Essential Prescriptions Worth a Thousand Gold) treats women in the puerperium who expose themselves to wind. Symptoms include vexed heat in the four limbs and headache. Give Xiao Chai Hu Tang (Minor Bupleurum Decoction); if there is no headache but only vexation, this formula is indicated.
Huang Qin (Scutellaria Root) (1 liang) Ku Shen (Sophora Root) (2 liang) Gan Di Huang (Rehmannia Root Preparata) (4 liang)
Decoct the three ingredients in six sheng of water, reduce to two sheng. Take one sheng warm. Worms may be vomited or excreted.
This is a pattern of heat generated by wind invasion following blood deficiency postpartum. Di Huang (Rehmannia Root) generates blood; Ku Shen (Sophora Root) and Huang Qin (Scutellaria Root) clear heat. If headache is present, wind has not fully transformed into heat, so Chai Hu (Bupleurum Root) is suitable to resolve the exterior.
Qian Jin Nei Bu Dang Gui Jian Zhong Tang (Internal Tonifying Angelica and Middle-Building Decoction from Essential Prescriptions Worth a Thousand Gold) treats postpartum weakness, emaciation, and insufficiency, with unceasing stabbing pain in the abdomen, shortness of breath, or distress from lower abdominal urgency, pain radiating to the back, and inability to eat or drink. During the first month postpartum, taking four or five doses daily is beneficial for strengthening the body.
Dang Gui (Angelica Root) (4 liang) Gui Zhi (Cinnamon Twig) Sheng Jiang (Fresh Ginger) (each 3 liang) Shao Yao (Peony Root) (6 liang) Gan Cao (Licorice Root) (2 liang) Da Zao (Jujube Fruit) (12 pieces)
Decoct the six ingredients in one dou of water, reduce to three sheng. Divide into three warm doses, consuming within one day. If very deficient, add Yi Tang (Maltose), 6 liang, to the finished decoction, warming on fire until dissolved. If blood loss is excessive, with metrorrhagia or internal hemorrhage uncontrolled, add Di Huang (Rehmannia Root), 6 liang, and E Jiao (Donkey-Hide Gelatin), 2 liang, forming an eight-ingredient decoction, adding E Jiao (Donkey-Hide Gelatin) last. If Dang Gui (Angelica Root) is unavailable, use Xiong Duan (Ligusticum Rhizome); if Sheng Jiang (Fresh Ginger) is unavailable, use Gan Jiang (Dried Ginger).