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Postpartum blood syncope (Xue Yun) is caused by inherent deficiency before delivery and excessive blood loss during delivery, leading to the floating upward of deficient fire, loss of bodily control, and resulting in fainting. Zhang’s commentary: This condition occurs in severe illnesses and states of extreme deficiency. Although named "blood syncope," it is actually not caused by blood stasis leading to fainting. Medical texts state that when敗血 (decayed blood) flows into the Liver meridian, causing black spots to appear before the eyes, dizziness preventing one from rising or sitting, and unconsciousness, it is called blood syncope. This theory posits that heat in the blood surges upward against the Heart due to deficiency, causing coma and a sense of qi closure nearing extinction, suggesting that drinking urine from an uncircumcised boy (Tongzi Bian) is best. This argument only considers the decayed blood and completely ignores the state of extreme deficiency, merely stating qi closure and near extinction. Can urine from an uncircumcised boy really restore nearly extinct primordial qi? A prescription: Use Dang Gui (Angelicae Sinensis Radix) 2 qian, Yimucao (Leonuri Herba) 1 qian, Renshen (Ginseng Radix et Rhizoma) 2 qian, Honghua (Carthami Flos) 6 fen, and Heijiang (Zingiberis Rhizoma Carbonisatum) 8 fen, mixed with hot Tongzi Bian for ingestion. This formula addresses both aspects. Whenever Zhang encounters parturients with a history of blood syncope, he prescribes Shiquan Dabu Tang (Decoction for Ten Significant Tonifications), Guipi Tang (Spleen-Restoring Decoction), and Yangrong Tang (Nourishing the Vigor Decoction) several days before delivery to regulate and tonify qi and blood. At the time of delivery, 1 to 2 liang of Renshen (Ginseng Radix et Rhizoma) is decocted and ingested to tonify before birth and before depletion occur; thus, postpartum there is no deficiency for pathogenic factors to exploit and no syncope to develop.

When a woman faints and closes her eyes during childbirth, it is because sudden massive loss of yin blood causes the heart-mind (Shen) to lose nourishment. The Heart and Pericardium correspond to Ministerial Fire and Sovereign Fire; they are calm when nourished by blood and endangered when blood is lost. With fire blazing intensely, one becomes faint; with fire invading the Lung, one closes the eyes and loses consciousness, as the sudden loss of yin blood fails to suppress the fire. The Classics state: When disease qi is insufficient, tonification is indicated, not purgation. Closing the eyes indicates the pathology belongs to Yin. Sudden loss of有形之血 (concrete blood) causes fire to blaze; tonifying blood allows the spirit to settle naturally. When the Heart receives blood, it is nourished, and the spirit does not become confused. However, in severe cases, qi-tonifying herbs should be added concurrently, lest the urgent condition outpace the effect of yin-tonifying herbs, given that qi generates blood.

Profuse bleeding accompanied by syncope is named blood exhaustion (Xue Tuo); large doses of Renshen (Ginseng Radix et Rhizoma) can restore yang. If bleeding is scant yet syncope occurs, it is either due to blood stasis or blood exhaustion. For stasis, warm methods should be used to promote circulation; for exhaustion, thick, turbid tonics should be used. One must never recklessly administer blood-breaking or blood-moving agents.

For postpartum blood syncope, gently assist the patient into a sitting position. Burn charcoal and pour vinegar on it, or burn old lacquerware, allowing the smoke to enter the nose and mouth to induce recovery. Urgently press Renzhong (GV26, Philtrum) acupoint and wait quietly. As primordial qi gradually recovers, avoid unnecessary movement, which would further scatter the spirit and qi.