一 一妊妇咳嗽，其痰上涌，日五、六碗，诸药不应。
立斋以为此水泛为痰，用六味丸料及四君子汤，一剂稍安。数剂而愈。
二 一妇怀孕腹胀满，用鲤鱼汤，〔白术、茯苓、桑皮、木瓜、秦艽、紫苏、橘红、姜皮、大鲤
鱼一尾，破洗煎汁煎药。〕数剂而安。
丹溪云∶余族妹苦于难产，遇胎则驱之，余甚悯焉。盖其体肥而勤女工，体肥则气虚，久坐则气不
运，儿在胞胎，亦不能自运耳，后怀孕至五、六月，用紫苏饮加参，数十而产甚快。
三一孕妇累日不产，催生药不验，此坐草太早，心怀畏惧，气结不行焉。用紫苏饮一剂而产。
四一妇年三十余岁始生产，交骨不开。用归芎汤，加龟甲、〔一个。酥炙。〕妇人头发，〔一握，
存性。〕连进三、四剂，顿开分娩。此方能治交骨不开难产，陈自明云∶交骨不开，阴气虚也。
五一妇怀孕，勤苦负重，腹中阴冷重堕，口中甚秽立斋曰∶此必其胎已死，令视其舌青黑，与芒硝
五钱服之，化下秽水而安。
产后十人九虚，皆由怀胎十月，气血半荫其儿；加之产下，去其恶露，子宫空虚。故丹溪云∶
产后宜大补气血为要，虽有杂症，以末治之。又仲淳曰∶治产后大法，宜行败血，次宜补血清热，总宜
补养心脾肝肾为主，忌破气升提，燥热苦寒汗、吐、下诸药。稽方书论产后病症甚多，姑举大略言
之。如昏晕不省人事，或因去血过多，气血两虚而致者。〔清魂散、参苏汤之属。〕或因瘀血不行，反
逆冲上而致者，〔黑神散治之。〕乍寒乍热如疟，或由气血虚损，营卫不和而作者，〔加味归脾、逍遥
之属。〕或由瘀血停留，相连肝胆经脉而作者。〔黑神散。〕头痛或由血虚火炎者。〔四物加甘菊、银
花、二冬、牛膝之属。〕或由败血入肝，随经上冲巅顶者。〔黑神散。〕腰痛若悠悠隐隐，喜人按摩者，
血去多而肾虚也，〔六味加牛膝、杜仲、续断之属。〕若胀痛如刺时作时止，手不可按着，败血流入腰肾
间也。〔黑神散。〕少腹痛而按之即止者，为血虚。〔芍甘汤加归
地、牛膝、续断、沉砂之属。〕按之愈痛者为瘀凝。腹中有块，时上时下，痛不可忍，此名儿枕块
痛，乃宿血也。〔黑神散。〕胁痛亦以可按为肝经血虚气逆，〔生地、归、芍、甘菊、续断、羚羊、
郁金、降香之属。〕拒按者，为肝经血凝气滞。〔黑神散。〕呕恶有因胃气虚逆。〔宜分寒热。热
者、竹茹汤加参、苓、橘红、木瓜之属，寒者异功去术、甘，加豆寇、生姜之属。〕腹胀有因脾阴
衰弱，〔异功去术、甘，加白芍、枣仁、莲肉、扁豆之属。〕二症亦有因败血入脾胃而然者。〔调荣
散去莪术，加楂肉、黑豆之属。〕气急喘促，因血脱气无所根据，上逆胸中，名曰孤阳，〔人参固本
汤，加苏子、橘红、栝蒌仁、枇杷叶、童便之属。〕最为难治。亦有因败血入肺所致者。〔茅根、桑
皮、藕汁、童便之属。挟虚者、合参苏汤。〕若心神恍惚，睡卧不安，语言失度，如见鬼状者，此属
血舍空虚，神魂不宁之故。亦有因血少不能上荣于舌，而言语含糊謇涩者〔补心丹，接命丹之类。〕
若心下胀满，烦躁犯乱谵言妄语，如见鬼状者，此原败血停滞，上干心君所致。亦因败血上冲，而神昏
舌强不语，以心藏神而舌为心苗故也。〔犀角地黄汤加丹参，琥珀、羚羊之属。〕恶露不下，而痛不
甚者，阴血素虚，败
血亦少之故。〔柏仁丸、加丹参、黑豆之属。〕小腹胀满刺痛者，此责停滞之咎。〔黑神散。〕恶露
不止，肝虚不藏，有因脾虚不摄者，有因血热妄行之不同。〔宜参调经门诸方以治之。〕然诸条总不越
血气大虚为病，败血为殃二端。若别有所因者，又当随其所因，而各从本门参酌治之。按《金匮》论新
产妇人有三病∶一曰病痉。因新产血虚多汗出，易中风邪所致。然痉病多由亡血，筋无所荣，不必拘
定复中风邪而然。二曰病郁冒，东垣言∶妇人分娩，及半产漏下，昏冒目瞑，盖因血暴亡，而火上炽，但
补其血，则神自昌。三曰大便难。盖血与汗，则津液所生∶血虚汗出，津液亡而胃燥；燥则热而干，大
便难于出矣。又沈氏谓∶产后大虚，外邪易侵，或身表经络受邪，或从阴户入于胞宫，则病状千变。故
虚中常带实疗，而实中常有藏虚，攻补之法，不可不明。如《金匮》治产后腹中 痛， 痛者，绵绵而痛，
是属虚也。责之气血两虚，或有微寒阻滞气血所致，用羊肉汤。以羊肉补益气血，当归养血而行血滞，生
姜散寒而行气滞，温补之法也。治产后腹中痛，有瘀血着脐下，用下瘀血汤。以大黄、桃仁、 虫蜜
丸，酒化调服，峻药缓治，攻之法也。治产妇腹痛烦满，不得卧，责其脾虚气滞食停之“故，用枳芍散，
以枳实通气消食，芍药补脾养肝，一攻一
补，攻补兼施之法也。故或补或攻，或攻补兼施，应仿此法，随宜用药施治，毋拘丹溪之说，而固执不
通。然攻之。一法，又必妇人形盛气实，果有不得不下之症者，方可小剂微下之，否则未有不蹈虚虚
之祸，而杀人矣。
黑神散〔加减。〕
生地〔凉血。三钱。〕当归〔和血。二钱。〕赤芍、蒲黄〔行血生用，各一钱五
分，〕干姜〔炒黑，引血药入血分，祛恶养新。三、五、七分。〕黑豆〔炒，一大撮。以上六
味，即黑神散原方，有肉桂、甘草，天寒内无热者，可用桂、姜。〕牛膝〔生用。三钱。〕续断
〔酒炒。〕泽兰〔四味皆行瘀而带补。〕元胡〔酒炒。各二钱。〕楂肉〔均行结气滞血。拌
砂糖炒。〕桃仁〔善破瘀血。炒研，各二钱。〕红花〔少用和血，多用行血。八分。〕荆
芥〔能入血分散瘀。炒黑，一钱。〕益母草煎汤煎药。口干舌缩，加生鸡子〔一枚。〕调服。寒
热往来，加鳖甲〔五钱。〕头痛，加川芎。〔一钱。〕腰痛，加杜仲。〔三钱。〕儿枕痛极、加乳香、没
药。〔各六、七分，〕虚汗，加枣仁。〔炒研，三钱。〕悸惊亦加之。汗不止，加参、 。〔各二钱，〕
此以祛恶露为主，乃产后必用之剂。然当随所见症，而加以的药治之。如恶露过多，少腹已显无
块，按之不痛者，即宜禁用行血破血诸药。
清魂散
人参〔血脱补气，虚者议加。〕当归〔引诸药各归其所当归之经。〕泽兰〔独入血
海，攻击稽留。〕荆芥〔古方一味，炒黑为末。童便白汤各一杯，调服三钱，产下即服，不患血
晕。原方有川芎，嫌其辛散去之。〕童便〔产家圣药，一杯。〕
此方治产后血晕，不省人事，虚者宜之。房中宜预置炭火，俟产下以醋泼之，使尝闻醋气，可免血
晕。或烧旧漆器亦可。产妇房中，宜闭户牖，毋使冒风，设一犯之，其患最巨。宜本方去参，同海藏防风
当归汤，参酌治之。若盛暑之时，当置大盆井水于房中，勿近帐帏，隆冬必置炭火，勿令受寒，受则难治。
参苏汤
人参〔能固元气于垂亡。一两。〕真苏木〔少用和血，多用破血。二两。〕加童便〔一
杯。〕顿服。一方加鹿角胶，〔益气补血。五分。生鹿角屑，逐瘀血，随宜采用。〕随症加减，难以尽
述。
此攻补兼施之法也，施于恶露未行，元气将脱者甚当。若去血过多，气血两虚而昏晕者，是当以人参
为君，鹿胶为臣，而以苏木、童便为佐使矣。虚人须预煎汤，俟产下即服，可兔血晕。左方加独参汤、参
汤、参附汤之类，皆治虚脱之剂，宜参酌取用。
加味归脾汤 逍遥散 六味地黄丸 保阴煎 左归丸 人参固本丸 集灵散 天王补心丹〔俱
见虚劳。〕接命丹
〔俱见中风。〕竹茹汤 犀角地黄汤〔俱见伤寒。〕柏仁丸〔见调经。〕加味四物汤〔见
头痛。〕调荣散 加味异功散〔俱见肿胀；〕
此数方各随所宜，活法加减用之。产后应用诸方甚多，不能尽列，须临机应变，向各门中采取用
之可也。
胞衣不下方
益母草〔三两。一方单用益母草六两，酒煎入童便顿饮，治横生甚验。〕牛膝、当归〔各五
分。〕芒硝〔二、三钱，或用元明粉代之。虚人勿用。〕酒煎入童便〔一杯。〕或合失笑
散∶浦黄、五灵脂同用。
此方责之血入衣中，胀大难下腹中胀痛，手不可近，甚至胸满喘急，速进此药，血散胀消，其衣自
下，缓则不救，一方以产妇头发入口作呕，即出。亦有因气虚无力送出者，本方可合参苏汤，或因血少
干涩不下者，本方可加麻油，生鸡子白各一杯顿服。
子肠不收方
有用蓖麻子捣贴丹田，及涂头顶心者，如已收上，即宜洗去。有用半夏末吹鼻，取嚏而入者。有用
鳖头灰，白芨、五倍子末、枯矾、羊脂等药，可加冰片敷托而入之者。亦可煎汤频洗。有用麻油煎热熏
洗，即用鳖头灰汤调服者。若日久不能收上，宜大补气血为主，暂加升提，如补中益气汤之类。如恶露
未尽，及喘咳呕恶等症，仍宜戒投。
玉门不敛方
有用八珍汤加黄 、五味子等药者，责之气血大虚也。
有用加味逍遥散者，责之肝经虚热，其症必肿胀 痛，当兼用敷药汤洗，并随宜疗治。
加味涌泉散
王不留行〔一钱五分。〕穿山甲〔炙研，七分。〕木通〔一钱五分。〕麦冬〔五
钱。〕当归〔三钱。〕栝蒌仁〔一枚，捣。〕猪蹄煎浓汤煎药。
此治乳汁不下之方也。参、 随宜加用外，用木梳于乳房梳下。
免怀汤
归尾 赤芍 红花 牛膝
此摘乳之方，妇人之血，下则为月经。上则为乳，欲摘乳者，通其月事，则乳汁下行，免乳胀之苦
矣。方曰免怀，子生三年，然后免于父母之杯也。
新产脉宜小缓，若数大发热为凶。
如胞衣未下，恶露未来，腹胀如鼓，呕吐黄水，多带腥臭，加喘者，必产后口鼻有黑气者〔胃绝
肺败也。〕死。或血脱过多，或汗出不止而致痉〔乃为败症〕，不治。产后汗出，手拭不及者难治。产
后虚喘，产后痢疾，产后蓐劳，皆难治。〔生产名曰坐草，蓐草蓐也。产中虚乏劳倦，寒热如疟，百节
酸疼，肢体倦怠，咳嗽痰逆，名曰蓐劳。〕
一、一位孕妇咳嗽，痰液上涌，每天吐出五六碗，各种药物均无效。
薛立斋认为这是水湿泛滥化为痰饮，使用六味地黄丸的药材及四君子汤，服用一剂后症状稍安，服用数剂后痊愈。
二、一位妇女怀孕时腹部胀满，使用鲤鱼汤（白术、茯苓、桑白皮、木瓜、秦艽、紫苏、橘红、生姜皮、大鲤鱼一条，剖开洗净煎汁来煎药），服用数剂后病情安定。
朱丹溪说：我的族妹深受难产之苦，每次怀孕都设法堕胎，我很怜悯她。大概因为她身体肥胖且勤于女工，身体肥胖则气虚，久坐则气机不运，胎儿在胞胎中也无法自行运转。后来再次怀孕至五、六个月时，使用紫苏饮加入人参，几十天后分娩非常顺利。
三、一位孕妇连续几天未能分娩，催产药无效，这是因为坐草太早，心中畏惧，导致气结阻滞不通。使用紫苏饮一剂后便分娩。
四、一位三十多岁的妇女初次生产，交骨（耻骨联合）不开。使用归芎汤，加入龟甲（一个，用酥炙）、妇人头发（一握，存性），连续服用三四剂，交骨顿时打开而分娩。此方能治疗交骨不开导致的难产，陈自明说：交骨不开，是阴气虚弱所致。
五、一位妇女怀孕时，因勤劳辛苦负重，腹中感到阴冷沉重欲坠，口中气味极臭。薛立斋说：这一定是胎儿已经死亡，让她查看舌头呈青黑色，给予芒硝五钱服用，化下秽浊液体后病情安定。
产后十人中九人属虚证，皆因怀胎十月，气血一半荫庇滋养胎儿；加之分娩时排出恶露，子宫空虚。所以朱丹溪说：产后以大补气血为要务，即使有其他杂症，也应作为次要处理。又陈实功（仲淳）说：治疗产后大法，宜先行散败血，其次宜补血清热，总体应以补养心脾肝肾为主，忌用破气升提、燥热苦寒以及汗、吐、下等攻伐药物。查阅方书论述产后病症很多，姑且列举大致情况来说明。如昏晕不省人事，或因失血过多，气血两虚所致者。（可用清魂散、参苏汤之类。）或因瘀血不行，反而逆冲上行所致者，（用黑神散治疗。）忽冷忽热像疟疾一样，或由气血虚损，营卫不和所致者，（可用加味归脾汤、逍遥散之类。）或由瘀血停留，牵连肝胆经脉所致者。（用黑神散。）头痛或由血虚火炎所致者。（可用四物汤加甘菊、金银花、天冬麦冬、牛膝之类。）或由败血入肝，随经脉上冲头顶所致者。（用黑神散。）腰痛若悠悠隐隐，喜欢被人按摩者，是去血多而肾虚也，（可用六味地黄丸加牛膝、杜仲、续断之类。）若胀痛如针刺，时作时止，手不可触碰，是败血流入腰肾之间也。（用黑神散。）小腹痛且按压即缓解者，为血虚。（可用芍甘汤加当归、熟地、牛膝、续断、沉香砂仁之类。）按压后更痛者为瘀血凝结。腹中有块，时上时下，痛不可忍，这名叫儿枕块痛，是宿血所致。（用黑神散。）胁痛亦以可按者为肝经血虚气逆，（可用生地、当归、芍药、甘菊、续断、羚羊角、郁金、降香之类。）拒按者，为肝经血凝气滞。（用黑神散。）呕恶有因胃气虚逆者。（宜分辨寒热。热者，用竹茹汤加人参、茯苓、橘红、木瓜之类；寒者，用异功散去白术、甘草，加豆蔻、生姜之类。）腹胀有因脾阴衰弱者，（用异功散去白术、甘草，加白芍、酸枣仁、莲子肉、扁豆之类。）这两种症状也有因败血进入脾胃而造成的。（用调荣散去莪术，加山楂肉、黑豆之类。）气急喘促，因血脱气无所依附，上逆胸中，名叫孤阳，（用人参固本汤，加苏子、橘红、瓜蒌仁、枇杷叶、童便之类。）最为难治。也有因败血入肺所致者。（用茅根、桑白皮、藕汁、童便之类。挟带虚证者，合用参苏汤。）若心神恍惚，睡卧不安，言语失常，如见鬼状者，这属于血舍空虚，神魂不宁的缘故。也有因血少不能上荣于舌，而言语含糊謇涩者（用补心丹、接命丹之类。）若心下胀满，烦躁扰乱谵言妄语，如见鬼状者，这原是败血停滞，上扰心神所致。也因败血上冲，而神昏舌强不语，因为心藏神而舌为心之苗窍的缘故。（用犀角地黄汤加丹参、琥珀、羚羊角之类。）恶露不下，而疼痛不严重者，是阴血素来虚弱，败血也少的缘故。（用柏子仁丸、加丹参、黑豆之类。）小腹胀满刺痛者，这是责在于停滞的过错。（用黑神散。）恶露不止，肝虚不能藏摄，有因脾虚不能统摄者，有因血热妄行者不同。（宜参考调经门诸方来治疗。）然而诸条总不离血气大虚为病，败血为殃两端。若有其他原因，又应当根据其原因，各自从相关门类中斟酌治疗。按《金匮要略》论新产妇人有三种病：一曰病痉。因新产血虚多汗出，易受中风邪所致。然而痉病多由亡血，筋脉失去濡养，不必拘泥于是复感中风邪所致。二曰病郁冒，李东垣说：妇人分娩，及半产漏下，昏冒闭目，盖因血暴亡，而火上炽盛，只要补其血，则神气自然昌盛。三曰大便难。盖血与汗，都是津液所生；血虚汗出，津液亡失而胃燥；燥则热而干，大便难于排出。又沈氏说：产后大虚，外邪易侵，或身表经络受邪，或从阴户入于胞宫，则病状千变万化。所以在虚证中常带有实证治疗，而在实证中常有脏腑虚损，攻补之法，不可不明白。如《金匮要略》治产后腹中 𫐖𫐖 痛， 𫐖𫐖 痛者，绵绵而痛，是属虚证。责之于气血两虚，或有微寒阻滞气血所致，用羊肉汤。以羊肉补益气血，当归养血而行血滞，生姜散寒而行气滞，这是温补之法。治产后腹中痛，有瘀血着脐下，用下瘀血汤。以大黄、桃仁、䗪虫蜜丸，酒化调服，峻药缓治，这是攻法。治产妇腹痛烦满，不得卧，责其脾虚气滞食停的缘故，用枳实芍药散，以枳实通气消食，芍药补脾养肝，一攻一补，这是攻补兼施之法。所以或补或攻，或攻补兼施，应仿照此法，随宜用药施治，不要拘泥于朱丹溪的说法，而固执不通。然而攻之一法，又必须妇人形体壮实气盛，果有不得不下的症状者，方可用小剂量轻微攻下，否则没有不陷入虚虚之祸，而杀人的。
黑神散〔加减〕
生地〔凉血。三钱。〕当归〔和血。二钱。〕赤芍、蒲黄〔行血生用，各一钱五分，〕干姜〔炒黑，引血药入血分，祛恶养新。三、五、七分。〕黑豆〔炒，一大撮。以上六味，即黑神散原方，有肉桂、甘草，天寒内无热者，可用桂、姜。〕牛膝〔生用。三钱。〕续断〔酒炒。〕泽兰〔四味皆行瘀而带补。〕元胡〔酒炒。各二钱。〕楂肉〔均行结气滞血。拌砂糖炒。〕桃仁〔善破瘀血。炒研，各二钱。〕红花〔少用和血，多用行血。八分。〕荆芥〔能入血分散瘀。炒黑，一钱。〕益母草煎汤煎药。口干舌缩，加生鸡蛋〔一枚。〕调服。寒热往来，加鳖甲〔五钱。〕头痛，加川芎。〔一钱。〕腰痛，加杜仲。〔三钱。〕儿枕痛极、加乳香、没药。〔各六、七分，〕虚汗，加枣仁。〔炒研，三钱。〕悸惊亦加之。汗不止，加人参、黄芪。〔各二钱，〕此以祛除恶露为主，乃产后必用之剂。然当随所见症，而加以对症药物治之。如恶露过多，少腹已显无块，按之不痛者，即宜禁用行血破血诸药。
清魂散
人参〔血脱补气，虚者议加。〕当归〔引诸药各归其所当归之经。〕泽兰〔独入血海，攻击稽留。〕荆芥〔古方一味，炒黑为末。童便白汤各一杯，调服三钱，产下即服，不患血晕。原方有川芎，嫌其辛散去之。〕童便〔产家圣药，一杯。〕
此方治产后血晕，不省人事，虚者宜之。房中宜预置炭火，俟产下以醋泼之，使尝闻醋气，可免血晕。或烧旧漆器亦可。产妇房中，宜闭户牖，毋使冒风，设一犯之，其患最巨。宜本方去参，同海藏防风当归汤，参酌治之。若盛暑之时，当置大盆井水于房中，勿近帐帏，隆冬必置炭火，勿令受寒，受则难治。
参苏汤
人参〔能固元气于垂亡。一两。〕真苏木〔少用和血，多用破血。二两。〕加童便〔一杯。〕顿服。一方加鹿角胶，〔益气补血。五分。生鹿角屑，逐瘀血，随宜采用。〕随症加减，难以尽述。
此攻补兼施之法也，施于恶露未行，元气将脱者甚当。若去血过多，气血两虚而昏晕者，是当以人参为君，鹿胶为臣，而以苏木、童便为佐使矣。虚人须预煎汤，俟产下即服，可免血晕。左方加独参汤、参汤、参附汤之类，皆治虚脱之剂，宜参酌取用。
加味归脾汤 逍遥散 六味地黄丸 保阴煎 左归丸 人参固本丸 集灵散 天王补心丹〔俱见虚劳。〕接命丹
〔俱见中风。〕竹茹汤 犀角地黄汤〔俱见伤寒。〕柏仁丸〔见调经。〕加味四物汤〔见头痛。〕调荣散 加味异功散〔俱见肿胀；〕
此数方各随所宜，活法加减用之。产后应用诸方甚多，不能尽列，须临机应变，向各门中采取用之可也。
胞衣不下方
益母草〔三两。一方单用益母草六两，酒煎入童便顿饮，治横生甚验。〕牛膝、当归〔各五分。〕芒硝〔二、三钱，或用元明粉代之。虚人勿用。〕酒煎入童便〔一杯。〕或合失笑散∶蒲黄、五灵脂同用。
此方责之血入衣中，胀大难下腹中胀痛，手不可近，甚至胸满喘急，速进此药，血散胀消，其衣自下，缓则不救，一方以产妇头发入口作呕，即出。亦有因气虚无力送出者，本方可合参苏汤，或因血少干涩不下者，本方可加麻油，生鸡子白各一杯顿服。
子肠不收方
有用蓖麻子捣贴丹田，及涂头顶心者，如已收上，即宜洗去。有用半夏末吹鼻，取嚏而入者。有用鳖头灰，白芨、五倍子末、枯矾、羊脂等药，可加冰片敷托而入之者。亦可煎汤频洗。有用麻油煎热熏洗，即用鳖头灰汤调服者。若日久不能收上，宜大补气血为主，暂加升提，如补中益气汤之类。如恶露未尽，及喘咳呕恶等症，仍宜戒投。
玉门不敛方
有用八珍汤加黄芪、五味子等药者，责之气血大虚也。
有用加味逍遥散者，责之肝经虚热，其症必肿胀 𫐖𫐖 痛，当兼用敷药汤洗，并随宜疗治。
加味涌泉散
王不留行〔一钱五分。〕穿山甲〔炙研，七分。〕木通〔一钱五分。〕麦冬〔五钱。〕当归〔三钱。〕栝蒌仁〔一枚，捣。〕猪蹄煎浓汤煎药。
此治乳汁不下之方也。参、芪随宜加用外，用木梳于乳房梳下。
免怀汤
归尾 赤芍 红花 牛膝
此摘乳之方，妇人之血，下则为月经。上则为乳，欲摘乳者，通其月事，则乳汁下行，免乳胀之苦矣。方曰免怀，子生三年，然后免于父母之杯也。
新产脉宜小缓，若数大发热为凶。
如胞衣未下，恶露未来，腹胀如鼓，呕吐黄水，多带腥臭，加喘者，必产后口鼻有黑气者〔胃绝肺败也。〕死。或血脱过多，或汗出不止而致痉〔乃为败症〕，不治。产后汗出，手拭不及者难治。产后虚喘，产后痢疾，产后蓐劳，皆难治。〔生产名曰坐草，蓐草蓐也。产中虚乏劳倦，寒热如疟，百节酸疼，肢体倦怠，咳嗽痰逆，名曰蓐劳。〕
1. A pregnant woman suffered from coughing with phlegm surging upward, expelling five to six bowls daily, and various medicines were ineffective.
Xue Lizhai considered this to be water flooding transforming into phlegm (Tan Yin), and used the ingredients of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) combined with Sijunzi Tang (Four Gentlemen Decoction). After one dose, symptoms slightly stabilized; after several doses, she recovered.
2. A woman experienced abdominal distension and fullness during pregnancy. She was treated with Liyu Tang (Carp Decoction) [containing Baizhu, Fuling, Sangbaipi, Mugua, Qinjiao, Zisu, Juhong, Jiangpi, and one large carp, cleaned and decocted in its juice to cook the herbs]. After several doses, her condition stabilized.
Zhu Danxi said: My clan sister suffered greatly from difficult labor, inducing abortion whenever she became pregnant, which I deeply pitied. It is likely that due to her obesity and diligence in female work, obesity leads to Qi deficiency, and prolonged sitting causes Qi stagnation. The fetus in the womb could not move itself. Later, when she became pregnant again up to five or six months, she used Zisu Yin (Perilla Infusion) added with Renshen (Ginseng), and delivered very quickly after dozens of days.
3. A pregnant woman failed to deliver for several days, and parturition-inducing medicines were ineffective. This was because she went into labor too early, harboring fear, causing Qi knotting and obstruction. One dose of Zisu Yin resulted in delivery.
4. A woman over thirty years old experienced failure of the pubic symphysis (Jiaogu) to open during her first delivery. She was treated with Guixiong Tang (Angelica and Ligusticum Decoction), added with Tortoise Shell (one piece, fried with butter) and a handful of women's hair (kept charred but intact). After three to four consecutive doses, the pubic symphysis suddenly opened, allowing delivery. This formula treats difficult labor caused by the opening failure of the pubic symphysis. Chen Ziming stated: Failure of the pubic symphysis to open is due to deficiency of Yin Qi.
5. A woman, while pregnant, engaged in hard labor and carried heavy loads, feeling cold and heavy descending pain in the abdomen, with a foul odor in her mouth. Xue Lizhai said: This must indicate that the fetus has died. He had her check her tongue, which appeared dark blue-black, and administered Mangxiao (Mirabilite) five qian. After expelling foul fluid, she stabilized.
Postpartum, nine out of ten cases are deficiency syndromes, all resulting from ten months of pregnancy where half of the Qi and Blood nourish the fetus; plus the expulsion of lochia during birth, leaving the uterus empty. Therefore, Zhu Danxi said: Postpartum treatment should prioritize tonifying Qi and Blood in large amounts. Even if there are other miscellaneous diseases, they should be treated as secondary. Furthermore, Chen Shigong (Zhongchun) said: The general principle for treating postpartum conditions is to first promote the discharge of stagnant blood, then tonify Blood and clear Heat. Overall, it should focus on tonifying the Heart, Spleen, Liver, and Kidney. Medicines that break Qi and lift Yang, as well as drying-hot, bitter-cold, and diaphoretic, emetic, and purgative drugs, should be avoided. Examining medical texts, there are many discussions on postpartum diseases; here we briefly outline them. For example, fainting and unconsciousness may be caused by excessive blood loss leading to dual deficiency of Qi and Blood. [Use Qinghun San (Clear Soul Powder), Renshen Su Tang (Ginseng and Perilla Decoction), etc.] Or it may be caused by stagnant blood failing to move, reversing and rushing upward. [Treat with Heishen San (Black God Powder).] Alternating chills and fever resembling malaria may arise from Qi and Blood deficiency causing disharmony of Ying and Wei. [Use Jiawei Guipi Tang (Modified Spleen-Tonifying Decoction), Xiaoyao San (Free Wanderer Powder), etc.] Or it may be caused by stagnant blood lingering and affecting the Liver and Gallbladder meridians. [Use Heishen San.] Headache may be caused by Blood deficiency with Fire flaring. [Use Siwu Tang (Four Substances Decoction) added with Ganju, Yinhua, Dongtian, Niuxi, etc.] Or it may be caused by stagnant blood entering the Liver and rushing up along the meridian to the vertex. [Use Heishen San.] Lower back pain that is dull and隐隐 (hidden/lingering), relieved by massage, indicates excessive blood loss and Kidney deficiency. [Use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Niuxi, Duzhong, Xuduan, etc.] If it is distending and stabbing pain, intermittent, and intolerable to touch, it indicates stagnant blood flowing into the waist and Kidney area. [Use Heishen San.] Lower abdominal pain relieved by pressure indicates Blood deficiency. [Use Shaogan Tang (Peony and Licorice Decoction) added with Danggui, Shudi, Niuxi, Xuduan, Chenxia, Sharen, etc.] Pain worsened by pressure indicates Blood stasis coagulation. A mass in the abdomen moving up and down with unbearable pain is called Erzhen Kuai Tong (Child Pillow Mass Pain), caused by residual blood. [Use Heishen San.] Hypochondriac pain, if tender to touch, indicates Liver Meridian Blood deficiency and Qi rebellion. [Use Shengdi, Danggui, Shaoyao, Ganju, Xuduan, Lingyang, Yujin, Jiangxiang, etc.] Rejection of pressure indicates Liver Meridian Blood stasis and Qi stagnation. [Use Heishen San.] Nausea and vomiting may be due to deficiency and rebellion of Stomach Qi. [Differentiate Cold and Heat. For Heat, use Zhuru Tang (Bamboo Shavings Decoction) added with Renshen, Fuling, Juhong, Mugua, etc.; for Cold, use Yigong San (Five Friends Powder) without Baizhu and Gancao, added with Doukou, Shengjiang, etc.] Abdominal distension may be due to weakness of Spleen Yin. [Use Yigong San without Baizhu and Gancao, added with Baishao, Zaoren, Lianrou, BianDou, etc.] Both symptoms can also be caused by stagnant blood entering the Spleen and Stomach. [Use Tiaorong San (Regulate Blood Powder) without Ezhu, added with Zharon, Heidou, etc.] Rapid breathing and panting, caused by Qi having no basis due to Blood depletion, rushing upward into the chest, is named Guyang (Lone Yang). [Use Renshen Guben Tang (Ginseng Root-Solidifying Decoction) added with Suzi, Juhong, Gualouren, Pipaye, Tongbian, etc.] This is the most difficult to treat. It may also be caused by stagnant blood entering the Lung. [Use Maogen, Sangbaipi, Ouji, Tongbian, etc. For cases with deficiency, combine with Renshen Su Tang.] If the mind is confused, sleep is restless, speech is inappropriate, resembling seeing ghosts, this belongs to emptiness of the Blood residence causing instability of Hun and Shen. There are also cases where insufficient Blood fails to nourish the tongue, resulting in slurred and stiff speech. [Use Buxin Dan (Heart-Nourishing Pill), Jieming Dan (Life-Connecting Pill), etc.] If there is subcardiac fullness, irritability, confusion, delirious speech, resembling seeing ghosts, this originates from stagnant blood blocking and disturbing the Heart Emperor. It is also due to stagnant blood rushing upward, causing coma, stiff tongue, and inability to speak, because the Heart houses the Spirit and the tongue is the sprout of the Heart. [Use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Danshen, Hupo, Lingyang, etc.] Lochia not discharging with mild pain indicates inherent deficiency of Yin Blood and little stagnant blood. [Use Bairén Wan (Bai Ren Pill) added with Danshen, Heidou, etc.] Lower abdominal distension and stabbing pain is blamed on stagnation. [Use Heishen San.] Continuous lochia discharge may be due to Liver deficiency failing to store, or Spleen deficiency failing to control, or differentiating based on Blood Heat causing reckless bleeding. [Refer to formulas in the Menstrual Regulation section for treatment.] However, all these conditions generally do not exceed two ends: disease caused by severe deficiency of Qi and Blood, and disaster caused by stagnant blood. If there are other causes, one must treat according to the specific cause, referring to relevant sections. According to "Jinkui Yaolue", new postpartum women have three diseases: First, Jing Disease (Spasm). Caused by blood deficiency and excessive sweating after birth, making one susceptible to Wind pathogen. However, spasm is mostly due to blood loss, where sinews lose nourishment; one should not rigidly attribute it to contracting Wind. Second, Yumao Disease (Depression and Vertigo). Li Dongyuan said: Women after delivery or miscarriage with leakage experience vertigo and closed eyes because sudden blood loss causes Fire to blaze; tonifying Blood will naturally restore Spirit. Third, Difficulty in Defecation. Blood and Sweat are generated from Jin Ye (Body Fluids); blood deficiency leads to sweating, loss of Jin Ye, and Stomach dryness; dryness leads to Heat and dryness, making defecation difficult. Shen Shi said: Postpartum severe deficiency makes external pathogens easy to invade; whether affecting surface meridians or entering the Uterus from the vagina, symptoms vary infinitely. Thus, deficiency often carries excess treatment, and excess often contains organ deficiency; methods of attacking and tonifying must be understood. For example, "Jinkui" treats postpartum abdominal cramping pain (Kongtong), which is continuous and dull, indicating deficiency. Blamed on dual Qi and Blood deficiency or slight Cold obstructing Qi and Blood, use Yangrou Tang (Mutton Decoction). Mutton tonifies Qi and Blood, Danggui nourishes Blood and moves Blood stasis, Shengjiang disperses Cold and moves Qi stagnation; this is a warming and tonifying method. For postpartum abdominal pain with Blood stasis adhering below the umbilicus, use Xiayuxue Tang (Downward-Promoting Blood-Removing Decoction). Da Huang, Taoren, and E Chong made into honey pills, taken with wine; this is using strong medicine gently, an attacking method. For postpartum abdominal pain, irritability, fullness, and inability to lie down, blamed on Spleen deficiency, Qi stagnation, and food retention, use Zhishi Shaoyao San (Immature Orange and Peony Powder). Zhishi promotes Qi and digests food, Shaoyao tonifies Spleen and nourishes Liver; one attacks, one tonifies, combining attack and tonification. Therefore, whether tonifying, attacking, or combining both, follow this method, apply medicines appropriately, do not stick to Zhu Danxi's views rigidly. However, the attacking method requires the woman to be physically robust and Qi abundant, with definite indications for purgation; only then can small doses mildly purge. Otherwise, one will inevitably fall into the disaster of "deficiency causing deficiency," leading to death.
Heishen San [Modifications]
Shengdi [Cool Blood. 3 qian.] Danggui [Harmonize Blood. 2 qian.] Chishao, Puhuang [Promote Blood, raw, 1.5 qian each.] Ganjiang [Charred black, guides blood herbs into blood level, removes evil and nourishes new. 0.3-0.7 qian.] Heidou [Fried, a large pinch. The above six ingredients constitute the original Heishen San formula; if cold weather and internal heat are absent, Rougui and Ganjiang can be used.] Niuxi [Raw. 3 qian.] Xuduan [Fried with wine.] Zelán [These four promote stasis with tonifying properties.] Yuanhu [Fried with wine. 2 qian each.] Zharon [Resolve Qi knot and Blood stasis. Fried with brown sugar.] Taoren [Good at breaking Blood stasis. Fried and ground, 2 qian each.] Honghua [Small dose harmonizes Blood, large dose promotes Blood. 0.8 fen.] Jingjie [Enters blood level to scatter stasis. Charred black, 1 qian.] Yimucao [Decoct soup to cook herbs.] Dry mouth and shrunken tongue, add raw egg [one piece], mix and take. Alternating chills and fever, add Biejia [5 qian.] Headache, add Chuanxiong [1 qian.] Lower back pain, add Duzhong [3 qian.] Severe Erzhen pain, add Ruxiang, Moyao [0.6-0.7 qian each.] Deficient sweating, add Zaoren [Fried and ground, 3 qian.] Palpitations and fright also add this. Unstopping sweat, add Renshen, Huangqi [2 qian each.] This focuses on removing lochia and is a necessary postpartum formula. However, add symptomatic herbs based on observed signs. If lochia is excessive, lower abdomen shows no mass, and pressing is painless, immediately prohibit blood-promoting and blood-breaking herbs.
Qinghun San
Renshen [Tonify Qi for Blood depletion, consider adding for deficiency.] Danggui [Guide herbs to their respective meridians.] Zelán [Enters Blood Sea alone, attacks stagnation.] Jingjie [Ancient formula uses single herb, charred black and powdered. Mix with Tongbian and white soup, one cup each, take 3 qian mixed, administer immediately after birth to prevent blood syncope. Original formula has Chuanxiong, removed due to pungent dispersion.] Tongbian [Holy medicine for childbirth, one cup.]
This formula treats postpartum blood syncope with unconsciousness, suitable for deficiency. The room should have charcoal fire prepared; after birth, splash vinegar so the patient smells it, preventing blood syncope. Burning old lacquerware also works. In the delivery room, close doors and windows to avoid wind exposure; if exposed, consequences are severe. Use this formula without Renshen, combined with Haicang Fangguang Danggui Tang, for reference treatment. In midsummer, place a large basin of well water in the room, away from curtains; in deep winter, ensure charcoal fire to prevent cold, which is hard to treat.
Renshen Su Tang
Renshen [Secure Yuan Qi on the verge of collapse. 1 liang.] Zhen Sumu [Small dose harmonizes Blood, large dose breaks Blood. 2 liang.] Add Tongbian [one cup], take in one dose. Another formula adds Lujiaojiao [Tonify Qi and Blood. 0.5 fen. Raw deer horn powder removes Blood stasis, choose as appropriate.] Modify according to symptoms, difficult to list all.
This is a method of combining attack and tonification, very appropriate for cases where lochia has not moved and Yuan Qi is about to collapse. If excessive blood loss causes dual Qi and Blood deficiency with fainting, Renshen should be the Sovereign herb, Lujiaojiao the Minister, and Sumu, Tongbian the Assistants and Guides. Deficient patients should pre-decoct soup and take immediately after birth to avoid blood syncope. Adding Dushen Tang, Shen Tang, Shenfu Tang to the left formulas are all treatments for collapse; refer and select as appropriate.
Jiawei Guipi Tang, Xiaoyao San, Liuwei Dihuang Wan, Baoyin Jian, Zuogui Wan, Renshen Guben Wan, Jiling San, Tianwang Buxin Dan [All see Consumption.] Jieming Dan
[All see Stroke.] Zhuru Tang, Xijiao Dihuang Tang [All see Cold Damage.] Bairén Wan [See Menstrual Regulation.] Jiawei Siwu Tang [See Headache.] Tiaorong San, Jiawei Yigong San [All see Distension and Swelling;]
These formulas are used flexibly with modifications as appropriate. Many formulas are applied postpartum, cannot be listed entirely; adapt to changes and adopt from respective sections.
Formula for Retained Placenta
Yimucao [3 liang. Another formula uses single Yimucao 6 liang, decocted in wine with Tongbian, taken in one dose, very effective for transverse presentation.] Niuxi, Danggui [0.5 fen each.] Mangxiao [2-3 qian, or replace with Yuanmingfen. Do not use for deficient persons.] Decoct in wine with Tongbian [one cup.] Or combine with Shixiao San: Puhuang, Wulingzhi used together.
This formula addresses blood entering the placenta, causing swelling and difficulty in expulsion, abdominal distension and pain, intolerable to touch, even chest fullness and panting. Administer this medicine quickly; once blood scatters and swelling subsides, the placenta falls naturally. Delay means no rescue. Another method: put产妇 hair in mouth to induce vomiting, then it comes out. Also due to Qi deficiency lacking strength to expel; combine this formula with Renshen Su Tang. Or due to Blood deficiency causing dryness and non-expulsion; add Sesame Oil and raw Egg White, one cup each, taken in one dose.
Formula for Prolapsed Uterus
Some use castor beans pounded and applied to Dantian, or smeared on the crown of the head; wash off once retracted. Some use Banxia powder blown into nose to induce sneezing for retraction. Some use turtle head ash, Baiji, Wubeizi powder, Gufan, Yangzhi, etc., possibly adding Bingpian for application/support. Can also decoct soup for frequent washing. Some use hot sesame oil fumigation and washing, then take turtle head ash soup mixed. If long-standing and unable to retract, prioritize major tonification of Qi and Blood, temporarily add lifting herbs like Buzhong Yiqi Tang. If lochia is not finished, or with panting, cough, nausea, still prohibit administration.
Formula for Non-contracting Vulva
Some use Bazhen Tang added with Huangqi, Wuweizi, etc., blaming severe Qi and Blood deficiency.
Some use Jiawei Xiaoyao San, blaming Liver Meridian deficiency Heat; symptoms must include distension and pain. Combine with topical applications and washing, treat as appropriate.
Jiawei Yongquan San
Wubuliuxing [1.5 qian.] Chuanshanjia [Fried and ground, 0.7 fen.] Mutong [1.5 qian.] Maidong [5 qian.] Danggui [3 qian.] Gualouren [One piece, pounded.] Pig trotters decocted thick soup to cook herbs.
This is a formula for milk non-discharge. Add Renshen, Huangqi as appropriate. Outside of this, comb breasts with wooden comb downwards.
Mianhuai Tang
Dangguiwei, Chishao, Honghua, Niuxi
This is a weaning formula. Women's Blood flows down as menstruation, up as milk. To wean, regulate menstruation so milk flows downward, avoiding breast distension pain. The formula is named Mianhuai (Avoid Embracing); children are free from parents' embrace after three years of birth.
New birth pulse should be small and slow; if rapid and large with fever, it is ominous.
If placenta not down, lochia not come, abdomen distended like drum, vomiting yellow water, mostly with fishy smell, plus panting, must have black qi from mouth/nose postpartum [Stomach exhausted, Lung failed.] Death. Or excessive blood loss, or unstopping sweat causing spasm [this is a defeat syndrome], untreatable. Postpartum sweating, hand wiping cannot keep up, difficult to treat. Postpartum deficiency panting, postpartum dysentery, postpartum Ruhao, all difficult to treat. [Birth is called Zuocao (Sitting on Grass), Ru is grass. Exhaustion and fatigue during birth, alternating chills and fever like malaria, soreness and pain in hundred joints, limb fatigue, coughing with reverse phlegm, named Ruhao.]