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Da Huang (Rhei Radix et Rhizoma) 3 liang, Tao Ren (Persicae Semen) 20 pieces, Eupolyphaga (Eupolyphagae Seu Aselli Carapax et Plasma, here referred to as Scorpion/Beetle depending on context, but strictly *Eupolyphaga sinensis* or similar insect in ancient texts often translated as Eupolyphaga or Beetle larva; WHO term: Eupolyphaga seu Aselli Carapax et Plasma is Tortoise Shell and Turtle Meat, but here "Qiu Chong" usually refers to Eupolyphaga sinensis Karsch or similar. In modern TCM pharmacopoeia, this specific ingredient in Xiaoyuxue Tang is often identified as Eupolyphaga (Eupolyphagae Seu Aselli Carapax et Plasma is different, wait. Standard Xiaoyuxue Tang uses Da Huang, Tao Ren, and **Eupolyphaga** (Scutellaria? No. It is **Eupolyphaga sinensis** Karsch, known as **Qiu Chong**). Let's use the standard Latin for Qiu Chong: *Eupolyphaga sinensis* Karsch. However, WHO terminology often maps "Qiu Chong" to *Eupolyphaga*. Let's stick to the insect name.) 20 pieces (roasted, feet removed).
The above three ingredients, powdered, mixed with refined honey to form four pills. Decoct one pill in one sheng of wine, obtain eight ge, take all at once. The new blood will be discharged resembling pig liver.

[Collected Annotations]
Cheng Lin said: Qiu Chong (Beetle/Eupolyphaga) mainly opens blood obstructions; Da Huang (Rhei Radix et Rhizoma) mainly attacks blood stasis; Tao Ren (Persicae Semen) mainly breaks down dead blood.

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Seven or eight days postpartum, without signs of Taiyang disease (disease syndrome caused by pathogenic factors invading the Taiyang channel), hardness and pain in the lower abdomen indicate that lochia is not completely expelled. Constipation, irritability, fever, a slightly wiry and solid pulse, intensified fever, worsening irritability around the Shen hour (3-5 PM), inability to eat, and delirium upon eating suggest that the condition improves at night. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. Heat resides in the interior, and stagnation is in the Bladder.

[Commentary]
The phrase "Heat resides in the interior, and stagnation is in the Bladder" should logically follow "lochia is not completely expelled" in the preceding text. There is no rationale for Da Cheng Qi Tang to purge blood from the Bladder; this must be a transcription error. The characters "intensified" (zai bei) are likely superfluous.

[Annotation]
Absence of Taiyang signs indicates no exterior syndrome; hardness and pain in the lower abdomen indicate an interior syndrome. Given the postpartum state of seven or eight days, the presence of blood accumulation interiorly without Taiyang exterior signs indicates this is not the condition of heat and blood stasis accumulating due to Shaoyang transmission in Cold Damage, but rather a condition where residual lochia causes heat stagnation in the Bladder. Xiaoyuxue Tang (Minor Blood-Expelling Decoction) should be used to expel blood stasis. However, if there is constipation, inability to eat, delirium, irritability, fever, worsening around the Shen hour, and improvement at night, this indicates a Stomach excess syndrome, not merely retained lochia. Since it worsens in the afternoon and improves at night, the pathology lies in the Stomach, not the blood level. Therefore, Da Cheng Qi Tang (Major Order the Qi Decoction) is used to purge the Stomach excess.

[Collected Annotations]
Li [Name obscured] said: This section contains two syndromes: one is the Taiyang blood accumulation syndrome, and the other is the Yangming interior excess syndrome. Ancient textual styles are intricate, making them difficult to distinguish. "No Taiyang signs" means no exterior syndrome. Hardness and pain in the lower abdomen occur because the Liver stores blood, and the lower abdomen is the region of the Liver channel; thus, blood stagnates here, causing hardness and pain. This retained lochia represents heat in the interior and stagnation in the Bladder, constituting the Taiyang blood accumulation syndrome, suitable for expelling blood stasis. If there is constipation, irritability, a solid pulse, and delirium, this is a Yangming interior excess syndrome. Intensified fever indicates heat residing in the interior steaming outward. The Yangming channel is prosperous during the Shen, You, and Xu hours; the Shen hour (afternoon) is when Yangming qi tends to flourish. Hence, irritability and anorexia occur. The disease is in the Yang (Fu organs) and not in the Yin (Zang organs), so it resolves at night. This is a disease of the Yang Fu organs, suitable for treatment with Da Cheng Qi Tang (Major Order the Qi Decoction) to purge Stomach excess.

[Commentary]
The *Shanghan Lun* (Treatise on Cold Damage) states: In Yangming disease, if the patient cannot eat, attacking the heat will inevitably cause hiccups, due to deficiency-cold in the Stomach. It also states: In cases with fever, the exterior must first be resolved before purging can be attempted. Especially in the postpartum state, how can purging be recklessly prescribed? One must confirm the diagnosis accurately before applying this formula.

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Postpartum wind-pathogen symptoms persisting for dozens of days without resolution, slight headache, aversion to cold, intermittent fever, chest fullness, dry retching, and sweating. Although prolonged, the Yangdan Syndrome persists; Yangdan Tang (Yangdan Decoction) may be administered.

[Annotation]
Contracting wind-pathogen postpartum, persisting for dozens of days without resolution, accompanied by slight headache, aversion to cold, intermittent fever, and sweating, indicates the exterior syndrome has not yet resolved. Although there are interior symptoms like chest fullness and dry retching, the presence of Guizhi Tang (Cinnamon Twig Decoction) syndrome warrants the use of Yangdan Tang (Yangdan Decoction) to resolve the exterior. Yangdan Tang (Yangdan Decoction) is Guizhi Tang (Cinnamon Twig Decoction) plus Huang Qin (Scutellariae Radix). Yangdan Syndrome is synonymous with Guizhi Syndrome.

[Collected Annotations]
Shen Mingzong said: The previous three paragraphs describe postpartum exogenous patterns. It is commonly believed that postpartum involves dual deficiency of Qi and Blood, so regardless of exogenous or endogenous injuries, tonification is prioritized. However, Zhang Zhongjing emphasizes resolving pathogens through exterior-interior and Yin-Yang differentiation for wind-striking-the-Wei causing fever in Cold Damage. Thus, it is stated: Postpartum wind-stroke persisting for dozens of days, with slight headache, aversion to cold, intermittent fever, and sweating, indicates unresolved Taiyang exterior syndrome. Chest fullness and dry retching indicate external pathogens entering the interior of the chest. Exterior and interior pathogens in the Taiyang system constitute the Yangdan Syndrome; therefore, Guizhi Tang (Cinnamon Twig Decoction) combined with Huang Qin (Scutellariae Radix) forms Yangdan Tang (Yangdan Decoction). Since the wind-pathogen is in the exterior, Guizhi (Cinnamomi Ramulus) is used to release the muscle layer. As pathogens enter the chest and diaphragm, cooling herbs are needed to clear internal heat, hence the addition of Huang Qin (Scutellariae Radix). This approach avoids damaging the deficiency, thereby preserving remaining health; it tonifies Zheng Qi (Upright Qi) without direct supplementation and disperses pathogens without direct expulsion. This is a miraculous formula for postpartum exogenous conditions.
Regrettably, later practitioners failed to understand this principle. They argued that Shao Yao (Paeoniae Radix Alba) is sour and cold, potentially harming vital energy, and Gui Zhi (Cinnamomi Ramulus) is pungent and hot, potentially damaging blood. Consequently, they discarded these herbs, leading to aggravated and unresolved illness, simply because they had not entered the gate of Zhang Zhongjing's teachings. Therefore, the *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) adds Yi Tang (Maltose) and Dang Gui (Angelicae Sinensis Radix) to this formula, creating Dang Gui Jian Zhong Tang (Dang Gui Tonify the Middle Decoction), used for various postpartum deficiencies or exogenous diseases. Inferring Zhang Zhongjing's intent, he frequently modified this decoction to treat various postpartum conditions, achieving miraculous effects repeatedly, which is why it is presented here.
You Yi said: When evaluating syndromes to prescribe medication, do not rigidly adhere to the number of days. Once the exterior and interior are distinguished, sweating and purging methods are clearly differentiated. In the previous case, interior heat had formed excess; even seven or eight days postpartum, Da Cheng Qi Tang (Major Order the Qi Decoction) was used without being overly harsh. In this case, the exterior remained unresolved; despite dozens of days, Yangdan Tang (Yangdan Decoction) was used without concern for excessive dispersion. Only those who comprehend flexibility and adaptation can discuss such matters.