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。
新产妇人有三病四句。当是古医经之文。仲景设为问答。以明其病因耳。何谓也者。即何因而病痉。病郁冒。
大便难乎。下文三段。正答问词。而曰新产妇人有三病。明非产前之宿病。因新产以虚其血。则阴不恋阳。而
阳且逼阴。故多汗出。肝藏血主筋脉。且属风木。血虚风动。喜引同类。则喜中风。风入而筋脉劲急。故令病痉。
寒滞为郁。风升则冒。郁冒之因于亡血复汗。与中风同。第亡血较血虚为重。寒多亦风中所带之寒。若中风
而寒多于风者。故令郁冒。津液统于胃。血虚汗出。津液大伤。因上源既涸。下流自干。则胃燥而肠亦枯。故大
便难。约此三病。总因血虚。惟新产妇人其血骤虚者。故有此三病。
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。孤阳上升。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。大便坚不能食者。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。
此申言郁冒之脉症。及冒之所以不解。与解后诸症。定其所主之方也。产妇郁冒。与平人不同。且郁冒之脉。
或大且强。今不大而微。不强而弱。适合产妇平脉。尚未至正败无权。邪入为主也。冒则胃逆。故不能食。郁则
脾陷。其便易溏。以血虚津伤而胃燥。故大便反坚。血虚于下。气盛于上。为阴不平阳不闭。故但头汗出。所以
然者。血本阴而涵阳。血虚而阳反内陷故厥。厥者。手足逆冷也。气本阳而育阴。汗出。而阴随外越故冒。冒者。
心神蒙昧也。幸脉见微弱。邪未夺正。当攻补两难之际。勿妄治之。俟其气过血还。阴阳复通。因气过不升动
其血。则血还而送泄其气。故得汗而冒解。此郁冒之始于厥。而终于汗之道也。症中但头汗出。大似可下之
候。而实非者。以新产血虚。则下寒而下厥。孤阳失附。则上热而上蒸。故头汗耳。若误认而早下之则危矣。至
郁冒之不解于头汗。而必解于通身之汗者。因产妇亡血。而血乍虚。则阳气自长而孤盛。故冒于外。阴虚。故
不能送之外泄。而尚自郁滞也。夫汗自出者。是阴生而阳泄。故阴阳复得其平矣。若郁冒既解。所有便坚、呕
不能食二症。当先主小柴。以解其 热上冲之气。令呕止能食。至七八日更发热者。是确于七八日之中。积
其所食者。而为胃实外蒸之所致。然后可直任大承下之。而无所顾虑矣。
产后腹中 痛。当归生姜羊肉汤主之。并治腹中寒疝。虚劳不足。（归姜羊肉汤别见）
此气空血虚之 痛也。气空则胞胎新下。而肠胃一时未得安妥。故作馁痛。血虚则络脉干缩。故作吊痛。当
归苦温以补血。生姜、羊肉。辛温甘温以补气。使阳气匀满。而阴血滋润。故可为止痛之主药也。又温上者。能
化下寒。补上者能固下脱。故并治寒疝之上犯腹中。虚劳之下滑精汁者也。
产后。腹痛烦满。不得卧。枳实芍药散主之。
枳实芍药散方 枳实（烧令黑勿太过） 芍药（各等分）
上二味。杵为散。服方寸匕。日三服。并主痈脓。以麦粥下之。
此腹中之血暴虚。而客气挽留血分之症治也。腹为阴。腹中之血分。为阴中之阴。乘其虚而客气留于空处。
故痛满也。痛则阳气不能内伏。满则息道艰于下引。故不得卧也。枳实善破留气。烧黑则入阴分而破血中
之滞。又得走血之芍药以领之。则直入阴血中而无可挪移。故主之。麦粥当是小麦。以小麦为心谷。既与血
虚者相宜。且并治其症中之烦故也。痈脓亦系客气留滞于血分之所成。故并主之。但在经络者。或可加麻
桂之类以外引之。归芎之类以散行之耶。盖主之之义。特以此为主。而原与人以增减之谓也。
师曰。产后腹痛。法当主枳实芍药散。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。
下瘀血汤方 大黄（三两） 桃仁（三十枚） 虫（二十枚熬去足）
上三味。末之。炼蜜和为四丸。以酒一升。煎一丸取八合。顿服之。瘀血下如豚肝。
产后腹痛。止留气瘀血两因。服枳芍散不愈。则非留气。而为瘀血之痛可知。故宜下瘀汤。以下其瘀矣。以气
重破血之桃仁。合性走缝络而行血之 虫。则直达瘀血之所。然后君以气味俱重。而善于攻血之大黄。逐
而下之。酒煎顿服。取其性行而并力也。经水不利者。非由十二经脉。其渗灌血室之细络。为 病所阻。即血
室之下通贴脊腰俞等之细络。为干血所瘀。故亦可主此。则瘀去而经自利矣。
产后七八日。无太阳症。少腹坚满。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。至夜则愈。宜大承气汤主之热在里。结在膀胱也。
前第二条。申言郁冒。后文七八两条。申言喜中风之治例。盖所以防其 也。本条是言大便难之变症耳。故
前后诸症。总以不大便句为主。盖产后血虚而肠胃干涩。故大便难。便难至七八日。则肠实而气滞。气滞。故
恶露不行。而种种危机。俱优于此矣。是恶露不行。由于便难之故。苟非下之以通其气而行其血。乌可施治
哉。然产后自虚。务须诊得千真万确。方可任下。否则蹈虚虚之戒。而速之死耳。比如产后已七八日。是七八
日之中。先曾饮食矣。却又无太阳之头疼恶寒等候。是不曾中风寒可知。又不该有烦躁发热之表症矣。今
诊得少腹坚满。则知其为七八日中。但食而不大便。以致气滞阻血。故恶露不尽。结于少腹而坚满者也。夫
不大便。则下干者上吸精华。故烦躁。又不大便。则内实者外托经脉。故发热也。但犹不敢径下。又须切脉微
实。是内结气聚之诊。再倍发热。是内结愈久愈热之候。日晡烦躁。是手足阳明火炎官旺之乡。不食是肠胃
实而莫容之应。食则谵语。津液既干。又因食而塞其神气转舒之位也。日为阳。主腑。夜为阴。主脏。病在手足
阳明。属胃与大肠之腑。故日甚。与阴脏无关。故至夜则愈也。据种种之脉症。而以大承下之。岂过举哉。热在
里。缴前无太阳症一句。结在膀胱。缴前少腹坚满两句。盖谓此为在里之热外蒸。故太阳无风寒而亦发表
热。此为因热实而恶露之瘀血结在膀胱之后。故少腹坚满。统属下症也。结在膀胱。勿泥作膀胱之内。盖
指膀胱之后隔壁也。夫两肠通于大便。其路在后。膀胱浮居少腹。其位在前。产后之血。系胞门子户间。荫子
之润余者。子落而血无所归。故从二肠及膀胱之中道。即产路而下为恶露耳。恶露结于少腹。因大肠在膀
胱之微下处。大肠热实。热则滞其行血之气。实则挤其行血之窍。而兜住其瘀血。却在膀胱之后。而与膀胱
平对。然又不可名状。故借膀胱为外层之尺寸耳。明者察之。钱塘李氏旧注。牵扯伤寒论文以为妄解。未
梦见在。
产后风。续续数十日不解。头微痛。恶寒。时时有热。心下闷。干呕。汗出虽久。阳旦汤症续在耳。可与阳旦汤。
产后多汗中风。致成 病者常也。然亦有平日津液不甚虚。故但病风而不成 者。数十日不解。即下文头
痛恶寒。及有热汗出等候。阳旦之本症也。心下闷干呕。胃气虚寒痞塞之应。阳旦之兼症也。言虽隔数十日
之久。风因尚在。仍可与阳旦汤。名义解见伤寒论。但有心下闷。及干呕之兼症。当于原汤加姜半为合。曰可
与阳旦。以文例推之。其减半之轻剂。以薄发之耶。观于数十日不解。犹与此汤。则初续风。及续风而病 者。
俱不外此汤可见矣。
产后。中风发热。面正赤。喘而头痛。竹叶汤主之。
竹叶汤方
竹叶（一把） 人参（一两） 附子（一枚炮） 桂枝（一两） 葛根（三两） 防风（一两） 桔梗
（一两） 甘草（一两） 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。温覆使汗出。颈项强。用大附子一枚。破之如豆大煎药。扬去
沫。呕者。加半夏半升洗。
此条之中风。与前条不同。前条为风邪单在太阳经表。其阳明胃腑。虽自虚寒。而风邪未经传入之候。故主
阳旦本汤。以解太阳之风。而愚谓加姜半以温降之。而闷呕并愈者是也。此条之中风。因其人之阳气。本自
虚寒。故风从太阳中入。即乘虚而传阳明之经腑。且聚有水气在胃。而太阳尚未罢之候也。太阳未罢。故头
痛不止。胃腑受阳邪而化虚热。面为阳明之应。故正赤。水气聚于胃而上熏。肺性恶湿而其窍不利。故喘。两
阳之邪。以阳虚而不推之出表。故发热也。诸症会心了了。则汤意之一丝不紊者自见矣。本汤中之葛根、桂
枝、甘草、姜枣。即阳明经之葛根汤。葛根汤意。原所以借胃中之水气。行为解肌之汗。而不伤胃液者。故以之
为主。胃中属虚热。非苦寒所宜。故但君清凉之竹叶。以轻散之。阳气虚寒。不能送邪出表。故两用参、附以温
补之。风邪水气。两相怫郁。故加桔梗、以开提之。产后既虚。又温覆以取汗。恐去风而复为风所袭。故加防风、
以固密之。颈项强者。为阳气之柔者不能养筋。故易大附子而助其兼力也。其曰用者。盖以大附换本方之
小者。而非另加之谓。扬去沫者。附性上行。而沫尤甚。扬之去沫。欲乱其上行之性。而并防其助面赤而致呕
也。半夏降逆。故于呕者加之。首条明列产妇三病。郁冒便难。已详二条六条。至七八两条。明言中风而全
不及 。以 病之症治。详本门故耶。
妇人乳中虚。烦乱咳逆。安中益气。竹皮大丸主之。
竹皮大丸方 生竹茹（二分） 白薇（一分） 桂枝（一分） 石膏（二分） 甘草（七分）
上五味。末之。枣肉和丸弹子大。以饮服一丸。日三夜二服。有热者。倍白薇。烦喘者。加柏实一分。
妇人乳。谓当儿乳食时也。中虚。指胃脘中之阴津阳气而言。乳从胃腑之阴津。上浮脘中之络脉。而注于乳
房者。吸乳则精汁奔赴之。而阳热独盛。故脘中一时枯涩而烦乱。又吸乳则膈气亦虚。而下气乘之。故咳逆
也。此非新产之症。亦非产后之重症。凡阳气素盛之妇人。产后二三月。及岁余中。常有之候。但于儿乳时。每
当奶阵经流。心中如焦渴而慌慌者。即其初候也。以甘寒辛凉之味。济阴以抑阳。则安中而烦乱可除。以辛
温甘平之品。补上以御下。则益气而咳逆可止。此竹皮大丸之所以独任也。尝观竹生干山。贯四时而青翠
不衰。薇根长细。历久远而柔软可屈。则其自多精汁。而善滋阳液者可见。又何止甘寒苦寒。而仅能降气伏
热耶。与辛凉之石膏为偶。则微雨轻风。滋干解热。而得清和之化矣。非安中而何。桂枝辛温。而具生阳之性。
得甘浮之甘草。重用至七倍。而上托之。则所益者。在上中之气。譬之旭日照临。而阴氛之气不得上犯。复何
咳逆之有哉。此益气之义也。枣肉为丸。即重用甘草之义。盖取浮诸药以补上治上。故知所谓中虚者。指胃
脘之上穿胸膈而言也。丸大如弹子。而以饮嚼服者。取其易发。而且使渣质少停也。一丸而日夜五服者。又
取其缓滋。而并令药力之无间也。白薇微苦而寒。苦能泄热。寒能解热。故有热者倍二分。柏枝凌冬指西。不
畏霜雪。得木气之正。其西指者。受金气之吸引也。花于三月。实于九月。柏实、更得金木之精。其味甘平。甘能
缓中。平可降逆。故中虚而烦肺逆而喘者、加一分。古份、作分。原方当作十三份。如倍白薇。加柏实。则十五份矣。
产后下利虚极。白头翁加甘草阿胶汤主之。
白头翁加甘草阿胶汤方
白头翁（二两） 秦皮（三两） 黄连（三两） 黄柏（三两） 甘草（二两） 阿胶（二两）
上六味。以水七升煮。取二升半。内胶令消尽。分温三服。
此肝血失藏。肝阳妄泄之症也。产后血虚。大盒饭坚因便坚而结热于大肠。以致热极而旁流。是犹其标也。
夫人身之血。藏于肝。肝泌胆汁。下灌二肠。所以大便通调。不坚亦不利也。今产后血虚。肝无藏血。而肝阳急
躁之气。仍从胆管走注二肠。成为腹痛。里急。后重。欲下不能。不下不得之下利。本属血虚之产妇。乘以下利
努撑。更伤其气。虚极者。血虚而气极也。仲景一眼觑定本症之由于血虚肝旺。直任白头翁加甘草阿胶汤。
白头翁方。注已见伤寒厥阴下利。加甘草阿胶者。缓中以补血也。主之者。可加减。而不能挪移。如下利赤多。
加当归。白多。加白芍。气滞溲少。加枳实、车前。在司诊者之临时斟酌耳。
问：新近分娩的妇女，会患三种病。第一种是痉病（以项背强直、角弓反张为特征的病证），第二种是郁冒（头昏目眩、意识模糊的病证），第三种是大便难。这是什么原因呢？
医生说：新产之后，阴血亏虚，汗出过多，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。津液耗伤，胃中干燥，所以导致大便难。
“新产妇人有三病”这四句，应当是古代医经中的原文。张仲景设为问答的形式，是为了阐明这三种病的病因。“何谓也”的意思是，即是什么原因导致了痉病、郁冒和大便难呢？下文三段文字，正是对这三个问题的回答。文中说“新产妇人有三病”，明确说明这不是产前就有的宿疾，而是因为新产导致血液骤然亏虚，阴血不足不能恋摄阳气，反而逼迫阴液外泄，所以汗出过多。肝藏血而主筋脉，且五行属风木，血虚则内风妄动，容易引动同类的外风，所以容易感受风邪。风邪侵入后，导致筋脉拘急僵硬，因此发生痉病。寒邪停滞导致气机郁结，风邪升发导致头目昏蒙，这就是郁冒产生的原因。郁冒由失血和复汗引起，与中风有关联。但这里的亡血比一般的血虚更严重，寒气多也是风中夹带的寒邪。如果是中风而寒邪重于风邪，就会导致郁冒。津液统属于胃，血虚汗出导致津液大量损伤，由于上源枯竭，下流自然干涸，导致胃燥而肠道枯涩，所以大便难。概括这三种病，总的原因都是血虚，只有新产后的妇女会出现这种血液骤然亏虚的情况，所以会有这三种病。
产妇出现郁冒症状时，脉象微弱，不能进食，大便反而坚硬，只有头部出汗。之所以这样，是因为血虚导致厥逆（气血逆乱），厥逆必然导致昏冒。郁冒想要解除，必须全身大汗出。因为血虚于下导致厥逆，孤阳独自上升，所以只有头部出汗。所以产妇喜欢出汗，是因为亡失阴血导致血虚，阳气独盛，应当通过出汗来调和，使阴阳恢复平衡。如果大便坚硬、不能进食，用小柴胡汤主治。如果病解后能进食，过了七八天又出现发热，这是胃家实热证，用大承气汤主治。
这一段进一步阐述郁冒的脉象和症状，以及郁冒为何不解，和解后出现的各种症状，并确定所主治的方剂。产妇的郁冒与普通人的不同。而且郁冒的脉象，有时大而强劲，现在却不大而微，不强而弱，这符合产妇平素的脉象，尚未达到正气败坏、邪气为主的地步。郁冒意味着胃气上逆，所以不能进食；气机郁滞导致脾气下陷，大便通常容易溏泄，但因为血虚津伤导致胃燥，所以大便反而坚硬。血虚于下，气盛于上，造成阴不制阳、阳不固密，所以只有头部出汗。之所以这样，是因为血属阴而涵纳阳气，血虚则阳气反而内陷导致厥逆。厥逆，就是手足逆冷。气属阳而养育阴液，出汗则阴液随之外越导致昏冒。昏冒，就是心神蒙昧。幸好脉象见微弱，说明邪气未夺走正气，正处于攻补两难的境地，不要胡乱治疗。等待其气机经过、血液归还，阴阳重新通畅，因为气机经过不再升动血液，则血液归还并疏导排出气机，所以能够出汗而使郁冒解除。这是郁冒始于厥逆而终于出汗的道理。症状中只有头部出汗，很像可以使用下法的情况，但实际上不是，因为新产后血虚，导致下焦寒而下厥，孤阳失去依附，导致上焦热而上蒸，所以只有头部出汗。如果误认而过早使用下法，就会危及生命。至于郁冒不在头部出汗时解除，而必须在全身出汗时解除，是因为产妇失血，血液刚刚亏虚，阳气自然生长而孤盛，所以在外部表现为郁冒。阴虚，所以不能送阳气向外发泄，而仍然自我郁滞。如果汗自出，这是阴生而阳泄，所以阴阳重新获得平衡。如果郁冒已经解除，剩下的便秘坚硬、呕吐不能进食两个症状，应当先主用小柴胡汤，以解除上冲的热气，令呕吐停止、能够进食。到了七八天又出现发热，这是在七八天之中，积存了所吃的食物，导致胃家实热外蒸所致，然后才可以直接使用大承气汤下之，而没有顾虑了。
产后腹中疼痛，用当归生姜羊肉汤主治。同时也治疗腹中寒疝和虚劳不足。（归姜羊肉汤另见其他篇章）
这是气空血虚引起的腹痛。气空则胞胎刚娩出，肠胃一时未能安妥，所以产生空虚的疼痛。血虚则络脉干枯收缩，所以产生牵引性的疼痛。当归味苦性温以补血，生姜、羊肉味辛性温、甘性温以补气，使阳气均匀充满，阴血得到滋润，所以可以作为止痛的主药。另外，温补上部，能化解下部的寒邪；补益上部，能固摄下部的滑脱。所以同时治疗寒疝上犯腹中，以及虚劳导致的下部滑精漏汁的症状。
枳实芍药散方：枳实（烧至黑色，但不要过度）、芍药（各等分）。
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。同时也主治痈脓。用麦粥送服。
这是腹中血液突然亏虚，客气（外邪或病理产物）滞留于血分的病症和治疗。腹部属阴，腹中的血分，是阴中之阴。趁着虚弱的时候，客气留滞在空虚之处，所以产生疼痛和胀满。疼痛则阳气不能内伏，胀满则呼吸通道难以向下引导，所以不能仰卧。枳实善于破除停留的气机，烧黑后进入阴分，破除血中的瘀滞，再加上能走窜血分的芍药来引领它，就能直接深入阴血之中，无处可移，所以用它来主治。麦粥应当是指小麦，因为小麦是心之谷，既适合血虚的人，并且也能治疗症状中的烦闷。痈脓也是客气留滞于血分所形成的，所以也主治此症。但在经络的，或许可以加入麻黄、桂枝之类以向外引导，或者加入当归、川芎之类以散行气血。所谓“主之”的意思，特以此方为主，而原本允许后人根据情况进行增减。
医生说：产后腹痛，按照法则应当主用枳实芍药散。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。
下瘀血汤方：大黄（三两）、桃仁（三十枚）、䗪虫（二十枚，熬去足）。
以上三味药，研成细末，炼蜜调和制成四丸。用一升酒，煎煮一丸，取八合药液，一次性服用。瘀血排出时像猪肝一样。
产后腹痛，只留有气滞和瘀血两个原因。服用枳实芍药散后不愈，那就不是气滞，而是瘀血疼痛，可知宜用下瘀血汤，以攻下瘀血。用重破血的桃仁，配合性善走窜缝络而行血的䗪虫，就能直达瘀血所在之处，然后用气味俱重、善于攻逐瘀血的大黄作为君药，驱逐而下之。用酒煎煮并一次性服用，是取其药性运行迅速并合力攻邪。月经不通利，并非由十二经脉引起，而是渗灌血室的细小络脉，被瘀血阻滞，或者是血室下方连通腰俞等穴位的细络，被干血瘀阻，所以也可以主治此方。那么瘀血去除后，月经自然通利。
产后七八天，没有太阳病的症状，少腹坚硬胀满，这是恶露不尽。大便不通，烦躁发热，切脉微实，发热加倍，日晡时（下午3-5点）烦躁，不能进食，进食后出现谵语，到了夜间则好转，宜用大承气汤主治。热在体内，结聚在膀胱部位。
前第二条，进一步阐述郁冒；后文第七、第八条，进一步阐述喜中风的治例，大概是为了防止变证。本条是讲述大便难的变症。所以前后的各种症状，都以“不大便”这一句为主。因为产后血虚导致肠胃干涩，所以大便难。大便难持续七八天，则肠实而气机阻滞。气机阻滞，所以恶露不行，种种危机都集中于此了。这是恶露不行，是由于大便难造成的。如果不是用下法来通其气而行其血，怎么能进行治疗呢？然而产后本身虚弱，务必诊断得千真万确，才可以任用下法。否则违背“虚虚”的戒律（使虚者更虚），会加速死亡。比如产后已经七八天，在这七八天之中，曾经有过饮食，却又没有太阳病的头痛恶寒等症状，这就知道没有感受风寒，也不该有烦躁发热的表症了。现在诊察发现少腹坚硬胀满，就知道是在这七八天中，只吃了东西而不大便，导致气滞阻碍血液运行，所以恶露不尽，结聚在少腹而坚硬胀满。因为不大便，下焦干燥者会上吸精华，所以烦躁；又不大便，内实则外托经脉，所以发热。但仍然不敢直接下之，还必须切脉微实，这是内结气聚的脉象；发热加倍，是内结时间越久热势越高的征候；日晡时烦躁，是因为手足阳明经火旺之时（申酉时）；不能进食，是肠胃实热无法容纳食物的反应；进食后出现谵语，是因为津液已经干枯，又因食物堵塞了神气转输的位置。日为阳，主腑；夜为阴，主脏。病在手足阳明，属于胃与大肠之腑，所以白天加重。与阴脏无关，所以到了夜间就好转。根据种种脉症，而用大承气汤下之，难道有过错吗？“热在里”，呼应前文“无太阳症”一句；“结在膀胱”，呼应前文“少腹坚满”两句。意思是说，这是体内的热邪外蒸，所以虽然没有太阳风寒表证也有发热；这是因热实导致恶露中的瘀血结聚在膀胱之后，所以少腹坚硬胀满。统属下法的范畴。“结在膀胱”，不要拘泥理解为膀胱内部，大概是指膀胱后面隔壁的地方。两条肠道通向大便，其路径在后；膀胱浮居少腹，其位在前。产后的血液，来源于胞门子户之间，滋养胎儿的润滑余血，胎儿娩落后血液无所归属，所以从两条肠道及膀胱的中道，即产路而下成为恶露。恶露结聚在少腹，因为大肠在膀胱的稍下方，大肠热实，热则阻滞其行血之气，实则挤压其行血的窍道，从而兜住瘀血，却在膀胱之后，与膀胱平对，但又无法具体形容，所以借用膀胱作为外层测量的标准。明眼人仔细考察就知道了。钱塘李氏的旧注，牵扯《伤寒论》的文字作为妄解，简直连梦都没做过。
产后中风，连续几十天不缓解，头部轻微疼痛，恶寒，时不时有发热，心下痞闷，干呕，出汗虽然时间长，但阳旦汤的症状依然存在，可以与阳旦汤。
产后多汗导致中风，进而形成疟疾样病症是常事。但也有平日津液不甚亏虚的，所以只患中风而不形成疟疾样病症。连续几十天不缓解，就是下文提到的头痛恶寒，以及有热出汗等症状，这是阳旦汤的本证。心下痞闷、干呕，是胃气虚寒痞塞的反应，是阳旦汤的兼证。意思是虽然隔了几十天之久，风邪依然在内，仍可以与阳旦汤。名义解释见《伤寒论》。但有心下痞闷及干呕的兼证，应当在原汤中加入生姜、半夏来调和，称为可与阳旦汤。从文例推断，这可能是减半的轻剂，以轻微发汗。观察连续几十天不缓解，还给予此汤，那么初起中风，以及中风后形成疟疾样病症的，都不外乎此汤可见一斑。
竹叶汤方：竹叶（一把）、人参（一两）、附子（一枚，炮制）、桂枝（一两）、葛根（三两）、防风（一两）、桔梗（一两）、甘草（一两）、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。服药后覆盖衣被使其出汗。如果颈项强直，用大附子一枚，打破如豆大小煎药，扬去沫。如果有呕吐，加半夏半升洗净。
这一条的中风，与前一条不同。前一条是风邪单独在太阳经表，其阳明胃腑虽然自虚寒，但风邪尚未传入的迹象，所以主用阳旦本汤，以解太阳之风，而我认为是加入生姜、半夏以温降，从而使痞闷和呕吐一并痊愈是正确的。这一条的中风，是因为病人的阳气本来虚寒，所以风从太阳中入，随即乘虚传入阳明经腑，且胃中聚有水气，而太阳表证尚未罢除的状态。太阳未罢，所以头痛不止。胃腑受阳邪而化生虚热，面为阳明之应，所以面色正红。水气聚于胃而上熏，肺性恶湿而其窍不利，所以气喘。两阳之邪，因为阳虚而不能推之出表，所以发热。诸症领会清楚后，则汤剂的用意一丝不乱地自然显现。本汤中的葛根、桂枝、甘草、姜枣，就是阳明经的葛根汤。葛根汤的用意，原本是借胃中的水气，化为解肌的汗，而不损伤胃液，所以以此为主。胃中属虚热，不适合苦寒药，所以只用清凉的竹叶，以轻散之。阳气虚寒，不能送邪出表，所以重用参、附以温补之。风邪与水气，相互怫郁，所以加桔梗以开提之。产后既已虚弱，又温覆取汗，担心祛风后再次被风邪侵袭，所以加防风以固密之。颈项强直，是因为阳气中的柔润部分不能养筋，所以换用大附子以助其兼力。所说的“用”，大概是用大附子替换本方中的小附子，而不是另外添加的意思。扬去沫，是因为附子药性上行，而沫尤其厉害，扬去沫是想扰乱其上行的药性，并防止其助长面赤而导致呕吐。半夏降逆，所以对于呕吐者加入。首条明确列出产妇三病，郁冒、便难已在第二、六条详述，直到第七、八条，明确言中风而全不及疟疾样病症，是因为疟疾样病症的症治在本门已有详述的缘故。
妇人哺乳期间，中气虚弱，心烦意乱，咳嗽气逆，安中益气，用竹皮大丸主治。
竹皮大丸方：生竹茹（二分）、白薇（一分）、桂枝（一分）、石膏（二分）、甘草（七分）。
以上五味药，研成细末，用枣肉调和制成弹子大小的丸剂。用饮服一丸，每日三次，夜间两次。有热者，倍用白薇。烦喘者，加柏实一分。
“妇人乳”，指婴儿吃奶的时候。“中虚”，指胃脘中的阴津和阳气而言。乳汁从胃腑的阴津，上浮至胃脘中的络脉，而注入乳房，吸吮乳汁时精汁奔赴于此，而阳热独盛，所以胃脘一时枯涩而烦乱。又吸吮乳汁时膈气也虚，而下气乘虚而上逆，所以咳嗽气逆。这不是新产的病症，也不是产后的重症。凡是阳气素来旺盛的妇人，产后两三个月，及一年多中，常有这种情况。只是在婴儿吃奶时，每当奶阵流经，心中像焦渴而慌张，就是其初期的征兆。用甘寒辛凉的味道，济助阴液以抑制阳气，则安中和除烦乱可用；用辛温甘平的品性，补益上部以抵御下部，则益气而止咳逆可止。这就是竹皮大丸之所以独任此方的原因。曾观察竹子生于深山，贯穿四季而青翠不衰，薇草根长细，历经久远而柔软可屈，则它们自身多含精汁，而善于滋养老阴液的道理可见。又何止是甘寒苦寒，而仅能降气伏热呢。与辛凉的石膏为偶，则如微雨轻风，滋润干燥解除热邪，而得到清和的化育作用。这不就是安中吗？桂枝辛温，而具有生发阳气的性质，得到甘浮的甘草，重用至七倍，而上托之，则所增益的是在上中之气，譬如旭日照射，而阴氛之气不得上犯，又有什么咳嗽气逆呢？这就是益气的含义。枣肉为丸，就是重用甘草的意义。大概取浮扬诸药以补上治上，所以知道所谓的“中虚”，是指胃脘之上穿过胸膈的部位而言。丸大如弹子，而以饮嚼服，是取其易发散，而且使药渣质少停留。一丸而日夜五服，又是取其缓慢滋养，并令药力不间断。白薇微苦而寒，苦能泄热，寒能解热，所以有热者倍用二分。柏树凌冬指西，不畏霜雪，得木气之正，其西指者，受金气之吸引。花于三月，实于九月，柏实更得金木之精，其味甘平，甘能缓中，平可降逆，所以中虚而烦、肺逆而喘者，加一分。古“份”字作“分”，原方应当作十三份。如果倍用白薇，加柏实，则十五份了。
白头翁加甘草阿胶汤方：白头翁（二两）、秦皮（三两）、黄连（三两）、黄柏（三两）、甘草（二两）、阿胶（二两）。
以上六味药，用水七升煮，取二升半，放入胶令其完全溶解，分三次温服。
这是肝血失于藏守，肝阳妄泄的病症。产后血虚，大便应当坚硬，因大便坚硬而结热于大肠，以致热极而旁流，这是其标象。人身之血，藏于肝，肝分泌胆汁，下灌于大小肠，所以大便通调，既不坚硬也不下利。现在产后血虚，肝无血可藏，而肝阳急躁之气，仍从胆管走注于大小肠，成为腹痛、里急后重、欲下不能、不下不得的下利。本属于血虚的产妇，乘以下利努责，更伤其气，虚极者，是血虚而气也极虚。张仲景一眼看定本症由于血虚肝旺，直接任用白头翁加甘草阿胶汤。白头翁方的注解已见于《伤寒论》厥阴下利篇。加甘草阿胶，是为了缓中而补血。所谓“主之”，是可以加减，而不能挪移他方。如下利赤多，加当归；白多，加白芍；气滞尿少，加枳实、车前。在于医生诊察时的临时斟酌罢了。
Question: A woman who has recently given birth may suffer from three diseases. The first is Jing disease (a condition characterized by stiffness of the neck and back, and opisthotonos), the second is Yumao disease (a condition characterized by dizziness and blurred consciousness), and the third is difficulty in defecation. What is the reason for this?
The Master said: After recent childbirth, there is a deficiency of Yin blood, excessive sweating, and susceptibility to wind pathogenic factors, which leads to Jing disease. Loss of blood followed by sweating, with an excess of cold, leads to Yumao disease. Consumption of body fluids and dryness in the stomach leads to difficulty in defecation.
The four sentences "A woman who has recently given birth may suffer from three diseases" should be text from ancient medical classics. Zhang Zhongjing used a question-and-answer format to clarify the etiology of these three diseases. "What is the reason?" means, what causes Jing disease, Yumao disease, and difficulty in defecation? The following three paragraphs are direct answers to these questions. The text states "A woman who has recently given birth may suffer from three diseases," clearly indicating that these are not chronic conditions present before childbirth, but result from the sudden deficiency of blood caused by recent childbirth. When Yin blood is insufficient, it cannot retain Yang Qi, instead forcing Yin fluids to escape outward, leading to excessive sweating. The Liver stores blood and governs the sinews and vessels, and its element corresponds to Wind-Wood. Blood deficiency leads to internal wind stirring, which easily attracts similar external wind, making one susceptible to wind pathogens. Once the wind pathogen enters, it causes stiffness and tension of the sinews, resulting in Jing disease. Cold stagnation causes Qi mechanism depression, and wind rising causes dizziness and clouding of the mind; this is the cause of Yumao disease. Yumao arises from blood loss and subsequent sweating, related to wind strike. However, the blood loss here is more severe than general blood deficiency, and the cold is mostly cold carried by the wind. If wind strike occurs with cold exceeding wind, it leads to Yumao. Body fluids are governed by the Stomach. Blood deficiency and sweating cause massive damage to body fluids. Since the upper source is dried up, the lower flow naturally becomes dry, leading to stomach dryness and intestinal withering, thus causing difficulty in defecation. Summarizing these three diseases, the total cause is blood deficiency. Only women after recent childbirth experience such sudden blood deficiency, hence these three diseases occur.
When a postpartum woman presents with Yumao symptoms, the pulse is faint and weak, she cannot eat, her stool is hard, and only her head sweats. This is because blood deficiency leads to Jue (reversal of Qi and blood flow), and Jue inevitably leads to Mao (dizziness/clouding). For Yumao to resolve, there must be profuse sweating over the whole body. Because blood is deficient at the lower jiao leading to Jue, solitary Yang rises alone, so only the head sweats. Therefore, postpartum women tend to sweat because losing Yin blood leads to blood deficiency and solitary excess of Yang. Sweating allows the harmonization of Yin and Yang, restoring balance. If the stool is hard and eating is impossible, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated. If the illness resolves and she can eat, but fever returns after seven or eight days, this indicates Excess Heat in the Stomach (Wei Shi), treated with Da Cheng Qi Tang (Major Order the Qi Decoction).
This section further elaborates on the pulse and symptoms of Yumao, why Yumao does not resolve, and various symptoms appearing after resolution, determining the governing formulas. Postpartum Yumao differs from that of ordinary people. The pulse of Yumao can sometimes be large and strong, but now it is neither large nor small, neither strong nor weak, fitting the normal pulse of a postpartum woman, indicating that Zheng Qi (Upright Qi) has not yet failed and pathogens do not dominate. Mao implies rebellious Stomach Qi, hence inability to eat. Depression causes Spleen Qi to sink, usually leading to loose stools, but due to blood deficiency and fluid injury causing stomach dryness, the stool is hard. Blood deficiency at the lower jiao and Qi excess at the upper jiao result in Yin failing to control Yang and Yang failing to secure, causing only head sweating. Specifically, blood belongs to Yin and nourishes Yang; blood deficiency causes Yang to sink inward leading to Jue. Jue refers to cold extremities. Qi belongs to Yang and nourishes Yin; sweating causes Yin to escape outward leading to Mao. Mao refers to mental clouding. Fortunately, the pulse is faint and weak, indicating pathogens have not overwhelmed Zheng Qi. In this difficult situation of attacking vs. tonifying, do not treat rashly. Wait for the Qi phase to pass and blood to return, allowing Yin and Yang to reconnect. As Qi no longer stirs blood upward, blood returns and guides Qi downward, allowing sweating to resolve Yumao. This is the process of Yumao starting with Jue and ending with sweating. Although head sweating resembles indications for purgation, it is not so. Postpartum blood deficiency causes lower jiao cold and Jue; solitary Yang lacks attachment, causing upper jiao heat steaming upward, hence head sweating. Misdiagnosing this and using purgation early would be dangerous. Yumao does not resolve with head sweating but requires whole-body sweating because postpartum blood loss leaves blood temporarily deficient, allowing Yang to grow solitary and excess, manifesting as external depression. Yin deficiency fails to send Yang out, causing self-depression. Spontaneous sweating indicates Yin generation and Yang release, restoring Yin-Yang balance. Once Yumao resolves, if constipation and vomiting/inability to eat persist, initially use Xiao Chai Hu Tang to clear rebellious Heat Qi, stopping vomiting and restoring appetite. If fever returns after seven or eight days, it is due to food accumulation causing Wei Shi (Stomach Excess) steaming outward. Then Da Cheng Qi Tang can be safely used for purgation.
Postpartum abdominal pain is treated with Dang Gui Sheng Jiang Yang Rou Tang (Angelica Ginger Mutton Decoction). It also treats abdominal Han Shan (Cold Hernia) and Xu Lao (Deficiency Consumption) insufficiency. (Dang Gui Ginger Mutton Decoction is mentioned elsewhere.)
This is abdominal pain due to empty Qi and deficient blood. Empty Qi means the uterus has just delivered, and the intestines and stomach are unsettled, causing hollow pain. Blood deficiency causes collaterals to dry and contract, causing pulling pain. Dang Gui is bitter and warm to tonify blood; Ginger and Mutton are pungent-warm and sweet-warm to tonify Qi, ensuring even distribution of Yang Qi and moistening of Yin blood, making them the main analgesic herbs. Warming the upper transforms lower cold; tonifying the upper secures lower slipping. Thus, it treats Cold Hernia invading the abdomen and seminal emission/slippage from Deficiency Consumption.
Postpartum abdominal pain with irritability, fullness, and inability to lie flat is treated with Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder).
Zhi Shi Shao Yao San Formula: Zhi Shi (burned until black but not too much), Shao Yao (equal parts).
Crush the two ingredients into a powder. Take one cun bi (measure) per dose, three times daily. It also treats carbuncles and pus. Administer with wheat porridge.
This addresses symptoms where abdominal blood is suddenly deficient and Ke Qi (pathogenic factor) lingers in the blood level. The abdomen is Yin; abdominal blood level is Yin within Yin. Taking advantage of deficiency, Ke Qi stays in empty spaces, causing pain and fullness. Pain prevents Yang Qi from settling internally; fullness makes breathing difficult to guide downward, causing inability to lie flat. Zhi Shi breaks stagnant Qi; burning it black enters the Yin level to break blood stasis. Combined with Shao Yao, which moves blood, it penetrates directly into Yin-blood without deviation, hence it is indicated. Wheat porridge likely refers to wheat, as wheat is the grain of the Heart, suitable for blood deficiency and treating irritability in symptoms. Carbuncles and pus also form from Ke Qi lingering in the blood level, hence treated here. For those in the meridians, Mahuang-Guizhi type herbs might be added to guide outward, or Dang Gui-Xiong type herbs to disperse and move. "Mainly treat" implies using this as the primary formula while allowing modifications.
The Master said: Postpartum abdominal pain should primarily be treated with Zhi Shi Shao Yao San. If it does not heal, it is because dry blood is adhering below the umbilicus. Xia Yu Xue Tang (Downward Expel Blood Decoction) is indicated. It also treats irregular menstruation.
Xia Yu Xue Tang Formula: Da Huang (3 liang), Tao Ren (30 seeds), E Chong (20 pieces, roasted and feet removed).
Grind the three ingredients into powder. Mix with refined honey to make four pills. Decoct one pill in one sheng of wine to obtain 8 he of liquid. Take all at once. Expelled blood will resemble pig liver.
Postpartum abdominal pain has only two causes: Qi stagnation and Blood stasis. If Zhi Shi-Shao Yao San fails, it is not Qi stagnation but Blood stasis pain, hence Xia Yu Xue Tang is needed to purge stasis. Using heavy blood-breaking Tao Ren combined with E Chong, which travels through collaterals to move blood, reaches the site of stasis directly. Then Da Huang, heavy in flavor and nature and skilled at attacking blood, acts as the sovereign herb to drive it down. Decocting in wine and taking once leverages rapid action and combined force. Irregular menstruation is not caused by the twelve main meridians but by fine collaterals irrigating the Blood Chamber being blocked by stasis, or fine collaterals connecting the Blood Chamber to Yaoshu being obstructed by dry blood. Hence this formula works; removing stasis restores regular menstruation.
Seven or eight days postpartum, without Taiyang symptoms, the lower abdomen is hard and full, indicating incomplete expulsion of lochia. Constipation, irritability, and fever are present. The pulse is slightly solid. Fever doubles. Irritability worsens at dusk (Shen-You hours). Inability to eat; eating triggers delirium. Symptoms improve at night. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. Heat is in the interior; binding is in the Bladder region.
The previous second paragraph elaborated on Yumao; the later seventh and eighth paragraphs elaborate on treatments for wind strike, likely to prevent complications. This paragraph discusses variations of difficulty in defecation. Thus, preceding symptoms center on "constipation." Postpartum blood deficiency causes dry intestines and constipation. After seven or eight days of constipation, intestinal exuberance and Qi stagnation occur. Qi stagnation prevents lochia discharge, creating crises. Lochia retention is caused by constipation. Without purgation to unblock Qi and move blood, treatment is impossible. However, postpartum patients are inherently deficient; diagnosis must be absolutely certain before using purgatives. Otherwise, violating the prohibition against "deficient-deficient" (weakening the weak) accelerates death. For example, seven or eight days postpartum, food was consumed, yet there are no Taiyang headache/chills symptoms, ruling out wind-cold. There should be no exterior irritability/fever. Now, lower abdomen hardness/fullness indicates that during these days, food intake without defecation caused Qi stagnation blocking blood, leaving lochia bound in the lower abdomen. Constipation causes lower dryness to absorb essence upward, causing irritability. Interior excess pushes outward to meridians, causing fever. One dare not purge immediately; the pulse must be slightly solid, indicating internal Qi aggregation. Doubled fever indicates prolonged internal binding increasing heat. Dusk irritability corresponds to the peak time of Hand-Foot Yangming Fire (Shen-You hours). Inability to eat reflects intestinal/stomach excess rejecting food. Eating triggers delirium because fluids are dry and food blocks the pathway for Shen Qi circulation. Day is Yang, governing Fu organs; Night is Yin, governing Zang organs. Disease in Hand-Foot Yangming involves Stomach and Large Intestine Fu organs, worsening during the day. Unrelated to Yin Zang organs, improving at night. Based on these pulses and symptoms, using Da Cheng Qi Tang is justified. "Heat in the interior" echoes "no Taiyang symptoms"; "Binding in the Bladder" echoes "lower abdomen hardness/fullness." This means interior heat steams outward, causing fever without Taiyang wind-cold. Interior heat-excess causes lochia blood to bind behind the Bladder, causing lower abdomen hardness/fullness. Both fall under purgation categories. "Binding in the Bladder" should not be taken literally as inside the Bladder, but rather the space adjacent behind it. The two intestines lead to defecation, located posteriorly; the Bladder floats anteriorly in the lower abdomen. Postpartum blood originates from the womb, providing lubrication for the fetus. After delivery, blood has nowhere to go, so it exits via the path between the intestines and Bladder, becoming lochia. Lochia binds in the lower abdomen because the Large Intestine is slightly below the Bladder. Large Intestine heat-excess stagnates Qi moving blood and compresses orifices, trapping blood behind the Bladder, opposite the Bladder, though indescribable, so the Bladder serves as an outer reference. Careful observation clarifies this. Li's old annotation from Qiantang erroneously borrows Shanghan Lun text, a misunderstanding beyond imagination.
Postpartum wind strike persists for dozens of days without relief, with mild headache, chills, intermittent fever, chest oppression, dry retching, and prolonged sweating. Yang Dan Tang symptoms remain. Yang Dan Tang (Yang Shield Decoction) can be administered.
Postpartum excessive sweating leading to wind strike forming malaria-like symptoms is common. However, some with sufficient daily fluids only get wind strike without malaria-like symptoms. Persistence for dozens of days matches the headache, chills, fever, and sweating of Yang Dan Tang's primary syndrome. Chest oppression and dry retching reflect Stomach Qi deficiency-cold and obstruction, secondary symptoms of Yang Dan Tang. Even after dozens of days, wind remains, so Yang Dan Tang is appropriate. Meaning explained in Shanghan Lun. With chest oppression and dry retching, add Ginger and Banxia to the original decoction. Calling it "can give Yang Dan Tang" implies a lighter, halved dose for mild sweating. Observing efficacy after dozens of days suggests initial wind strike and subsequent malaria-like symptoms are also managed by this decoction.
Postpartum wind strike with fever, bright red face, wheezing, and headache is treated with Zhu Ye Tang (Bamboo Leaf Decoction).
Zhu Ye Tang Formula: Zhu Ye (1 bundle), Ren Shen (1 liang), Fu Zi (1 piece, processed), Gui Zhi (1 liang), Ge Gen (3 liang), Fang Feng (1 liang), Jie Geng (1 liang), Gan Cao (1 liang), Sheng Jiang (5 liang), Da Zao (15 pieces).
Ten ingredients. Decoct in 1 dou of water to obtain 2.5 sheng. Divide into three warm doses. Cover warmly to induce sweating. For stiff neck, use 1 large Fu Zi, broken bean-sized, decocted. Skim foam. For vomiting, add 0.5 sheng washed Banxia.
This wind strike differs from the previous case. The previous case involved wind pathogen solely in Taiyang exterior, with Stomach deficiency-cold but no transmission, treated with Yang Dan Tang plus Ginger/Banxia to resolve Taiyang wind and warm/descend. This case involves inherent Yang deficiency-cold, allowing wind to enter Taiyang and transmit to Yangming channels/organs, accompanied by fluid retention in the Stomach, while Taiyang exterior signs persist. Persistent Taiyang signs cause ongoing headache. Yang pathogen transforming into deficiency-heat in the Stomach manifests as bright red face (Yangming correspondence). Fluid retention steaming upward affects Lung moisture, causing wheezing. Two Yang pathogens, unable to be expelled due to Yang deficiency, cause fever. Understanding these symptoms reveals the decoction's logic. Ge Gen, Gui Zhi, Gan Cao, Ginger, and Jujube in this formula constitute Ge Gen Tang (Kudzu Decoction) for Yangming channel. Ge Gen Tang uses Stomach fluids to generate muscle-releasing sweat without damaging Stomach fluids, serving as the base. Stomach deficiency-heat is unsuitable for bitter-cold herbs; thus, cool Zhu Ye is used to lightly dissipate heat. Yang deficiency-cold cannot expel pathogens; thus, Ren Shen and Fu Zi are doubled to warm and tonify. Wind and fluid retention are constrained; Jie Geng lifts and opens. Postpartum deficiency plus induced sweating risks re-exposure to wind; Fang Feng secures the exterior. Stiff neck indicates Yang softness failing to nourish sinews; replace small Fu Zi with large Fu Zi for added strength. "Use" implies replacing, not adding. Skimming foam reduces Fu Zi's ascending nature and prevents aggravating facial redness/vomiting. Banxia descends rebellious Qi, added for vomiting. The first paragraph listed three postpartum diseases: Yumao and constipation detailed in paragraphs 2 and 6. Paragraphs 7 and 8 discuss wind strike without mentioning malaria-like symptoms, likely because their treatments are detailed elsewhere in this chapter.
During lactation, a woman suffers from middle-jiao deficiency, irritability, restlessness, cough, and counterflow qi. An Zhong Yi Qi Wan (Peace the Middle and Tonify Qi Pill) is indicated.
Zhu Pi Da Wan Formula: Sheng Zhu Ru (2 fen), Bai Wei (1 fen), Gui Zhi (1 fen), Shi Gao (2 fen), Gan Cao (7 fen).
Five ingredients. Grind into powder. Mix with date paste to form pills the size of a bullet. Take one pill with water, three times daily, twice at night. For heat, double Bai Wei. For irritability/wheezing, add Bo Shi (Cupressus fruit) 1 fen.
"Lactation" refers to nursing. "Middle deficiency" refers to Yin fluids and Yang Qi in the epigastrium. Milk derives from Stomach Yin fluids, floating up through epigastric collaterals to breasts. Nursing draws essence, causing solitary Yang heat excess, leading to temporary epigastric dryness and irritability. Nursing also empties Diaphragm Qi, allowing lower Qi to rebel, causing cough and counterflow. This is not a new postpartum or severe postpartum condition. Women with inherent Yang excess often experience this 2-3 months to over a year postpartum, especially during milk let-down, feeling anxious thirst. Sweet-cold and pungent-cool herbs nourish Yin and suppress Yang, calming the middle and resolving irritability. Pungent-warm and sweet-flat herbs tonify the upper to resist the lower, boosting Qi and stopping cough. Zhu Pi Da Wan achieves this. Bamboo grows evergreen; Viola roots remain flexible long-term, showing their ability to nourish Yin fluids beyond mere bitter-cold heat-clearing. Paired with pungent-cool Shi Gao, they act like gentle rain/wind, moistening dryness and clearing heat, achieving "peace the middle." Gui Zhi is pungent-warm, generating Yang. Paired with heavy Gan Cao (7x), it lifts Qi to the upper/middle, like sunrise dispelling Yin mist, preventing counterflow cough. This is "tonifying Qi." Date paste pills reinforce Gan Cao's role, lifting herbs to treat the upper. "Middle deficiency" refers to the epigastrium piercing the diaphragm. Large pills chewed allow quick release and less residue retention. Five doses daily ensure slow nourishment and continuous effect. Bai Wei is bitter-cold, clearing heat; doubled for heat. Cypress fruits, enduring winter, receiving Metal energy, are sweet-flat, soothing the middle and descending rebellion; added for middle deficiency irritability and Lung rebellion wheezing. Original formula had 13 parts; doubling Bai Wei and adding Bo Shi makes 15 parts.
Postpartum diarrhea with extreme exhaustion is treated by Bai Tou Weng Jia Gan Cao E Jiao Tang (Pulsatilla Decoction with Licorice and Donkey-Hide Gelatin).
Bai Tou Weng Jia Gan Cao E Jiao Tang Formula: Bai Tou Weng (2 liang), Qin Pi (3 liang), Huang Lian (3 liang), Huang Bo (3 liang), Gan Cao (2 liang), E Jiao (2 liang).
Six ingredients. Decoct in 7 sheng of water to obtain 2.5 sheng. Dissolve E Jiao. Divide into three warm doses.
This is a syndrome of Liver Blood failing to store and Liver Yang leaking recklessly. Postpartum blood deficiency typically causes hard stool; heat binding in the Large Intestine due to hardness leads to extreme heat causing paralytic diarrhea (this is the branch). Blood is stored in the Liver; Liver secretes bile to irrigate intestines, ensuring normal bowel movements. Postpartum blood deficiency leaves the Liver without blood to store, and Liver Yang's irritable Qi flows through the gallbladder duct into the intestines, causing abdominal pain, tenesmus, and urgent desire to defecate with little output. This diarrhea stems from postpartum blood deficiency. Straining during diarrhea further injures Qi, leading to extreme exhaustion (blood deficiency compounded by Qi exhaustion). Zhang Zhongjing identifies the root as blood deficiency and Liver Yang hyperactivity, directly prescribing Bai Tou Weng Jia Gan Cao E Jiao Tang. Bai Tou Weng Tang notes are in Shanghan Lun Jueyin diarrhea. Adding Gan Cao and E Jiao soothes the middle and tonifies blood. "Mainly treat" allows modification but not substitution. For bloody diarrhea, add Dang Gui; for white mucus, add Bai Shao; for Qi stagnation/scanty urine, add Zhi Shi and Che Qian Zi. These adjustments depend on the physician's discretion.