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General Discussion
Women who have just given birth are prone to three types of diseases: one is Jing disease (spasm); the second is Yu Mao (depression and dizziness); the third is difficulty in defecation. What is the reason? The Master said: Postpartum blood deficiency, excessive sweating, and susceptibility to wind pathogen lead to Jing disease; loss of blood followed by sweating with excess cold leads to Yu Mao; consumption of body fluids leading to dryness of the Stomach results in difficulty in defecation. (From *Jin Gui Yao Lue*)

When diagnosing a new postpartum woman, first examine whether there is pain in the lower abdomen to determine if lochia (postpartum uterine discharge) remains; secondly examine whether defecation is unobstructed to assess the abundance or depletion of body fluids; thirdly examine whether lactation flows and the amount of food intake to assess the strength or weakness of Stomach Qi. One must first examine these three aspects, corroborate symptoms with pulse diagnosis, and ensure the pulse and symptoms match; treatment will surely succeed. ○ There are three main categories of postpartum diseases: one is irritability and fever caused by blood deficiency and hyperactive fire; the second is dizziness and abdominal pain caused by hyperactive fire ascending and chaotic blood flow; the third is diarrhea and epigastric fullness caused by Spleen and Stomach weakness and dietary injury. (From *Zhang Shi Yi Tong*)

Among critical postpartum conditions, none are more severe than "Three Rushes" and "Three Urgencies." The "Three Rushes" refer to chaotic blood rushing to the Lung, Heart, and Stomach; the "Three Urgencies" refer to vomiting, diarrhea, and excessive sweating. There are three major prohibitions in medication: forbid Fo Shou San because Chuan Xiong induces sweating; forbid Si Wu Tang because Di Huang causes diarrhea; forbid Xiao Chai Hu Tang because Huang Qin obstructs lochia expulsion. (Fei Zhangchou)

Treating pregnancy and childbirth diseases should be discussed based on Jue Yin syndrome patterns, without damaging Stomach Qi and the Upper Two Jiaos (Upper and Middle Jiao). This is referred to as the "Three Prohibitions": do not induce sweating, do not purge downward, and do not promote urination. Inducing sweating causes harm similar to premature purging in Cold Damage diseases; purging damages the Spleen; promoting urination leads to internal fluid depletion. While these principles are general guidelines for childbirth care, pathological changes vary. If specific symptoms exist, corresponding medications must be used, as stated: "When there is disease, the disease receives the treatment." While standard methods must be known, adaptive flexibility must not be rigidly adhered to. (From *Bao Chan Ji Yao*)

There are two types of postpartum diseases: one is distension and reversal due to retained blood; the other is collapse of Yuan Qi (Original Qi). If there is lower abdominal distending pain, nausea, and fever, this indicates incomplete expulsion of retained blood, risking blood distension affecting the Heart; appropriate treatment involves breaking and moving blood. If there is cold sweat, diarrhea, poor appetite, and reluctance to speak, this risks collapse of Yuan Qi; appropriate treatment involves greatly tonifying Yuan Qi, adding Fu Zi for severe cases to assist Ren Shen, facilitating Qi recovery. One belongs to excess of Blood, the other to deficiency of Qi. A slight error in attacking or tonifying can lead to danger. Contemporary physicians treat all postpartum diseases indiscriminately with blood-moving formulas regardless of excess or deficiency, applying a uniform approach. While effective for retained blood obstruction, it is dangerous for Yuan Qi collapse. (Yu Fushan)

A question was raised: Danxi stated that postpartum treatment should primarily focus on greatly tonifying Qi and Blood, treating miscellaneous symptoms as secondary. He also stated that postpartum wind-stroke should not be treated as typical wind-stroke using wind-dispelling herbs. Therefore, is it appropriate to greatly tonify Qi and Blood for all postpartum conditions regardless of symptoms? The answer is: Examining the words "primary" and "secondary," the meaning becomes clear. For pure deficiency without other symptoms, greatly tonifying Qi and Blood is suitable. For deficiency complicated by Wind-Cold invasion, tonification combined with wind-dispelling is needed. For Spleen deficiency with food stagnation, tonification combined with digestion-promoting herbs is required. For incomplete lochia expulsion, removing blood stasis must precede tonification. The *Classic* states: "In acute cases, treat the branch; in chronic cases, treat the root." "Primary" and "secondary" correspond to "root" and "branch." ○ Another question: Ancient formulas often use Si Wu Tang for postpartum diseases, but Danxi prohibited Shaoyao because its sour-cold nature damages growing Qi. Why? The answer is: New mothers have both Qi and Blood deficiency. Therefore, postpartum diseases generally do not tolerate cold-cool herbs; sweet-warm herbs are preferred to support the source of transformation and generation. The ancients formulated Si Wu Tang, using the warmth of Xiong Gui and Dang Gui to balance the coldness of Di Huang and Shaoyao, achieving a moderate balance of cold and warm, making it an excellent formula for women's diseases. However, when used postpartum, Shaoyao must be stir-fried with wine to remove its sour-cold property, retaining only its ability to generate and move blood. Danxi warned against this because careless doctors might use it unprocessed, so he highlighted the harm to caution them. (Yu Tianmin)

Commentary: Danxi claimed Shaoyao is sour-cold and severely damages living Qi, thus contraindicated postpartum. This statement is excessive. Shaoyao's coldness is merely slightly clearing among blood-nourishing herbs, unlike the intense bitter-cold nature of Huang Qin and Huang Lian. If Shaoyao were strictly forbidden, even colder herbs would be unusable. I often see overly cautious families, or young robust women, overusing warming foods and tonics, leading to frequent heat disorders. Assuming all postpartum states are purely deficient and require universal tonification is not always perfect. Moreover, Shaoyao is clear, slightly sour, and astringent, making it highly suitable for conditions of Yin dispersion, thus potentially a key herb for postpartum care. ○ There are postpartum cases without deficiency, such as young women or those accustomed to hard labor. These individuals are not inherently deficient. During pregnancy, the fetus causes Qi and Blood congestion, leading to distension and vomiting—this is an added excess. After delivery, the excess is removed, returning to normal. Many ordinary births follow this pattern; where is the deficiency? However, internal injuries or external invasions cannot be ruled out. If they occur, removing the pathogen cures the disease. Although delivery consumes some Qi and Blood, causing temporary depletion, the remaining congested state is merely supportive of the fetus. What leaves should leave; what generates should regenerate. It is not true that all births result in deficiency. Treatment should be symptom-based. Insisting on universal Qi and Blood tonification may worsen excess conditions. (Zhang Jingyue)

*Liang Fang* states: Postpartum treatment prioritizes eliminating chaotic blood. Blood stasis causes various diseases. Since postpartum Yuan Qi is depleted and circulation is disordered, blood stasis inevitably remains. Treatment must first eliminate stasis before tonifying. Modern practitioners often use tonics indiscriminately, leading to chaotic blood attacking the Heart and death. Be cautious! (Ye Yiji)

Sheng Hua Tang with added Ren Shen is suitable for postpartum patients with sudden fainting and physical collapse. Without these symptoms, do not add it. For severe pain from blood clots, add Hong Hua and Rou Gui; do not immediately use tonics. (Dan Yangxian)

Blood Syncope
During delivery, fainting and closed eyes occur due to sudden massive loss of Yin Blood, depriving the Heart Spirit of nourishment. The Heart and Pericardium govern Ministerial Fire and Sovereign Fire. They are calm with blood and endangered without it. Postpartum fainting is due to sudden Yin Blood loss, hyperactive false fire failing to be anchored. Supplementing blood allows the Heart to be nourished, calming the Spirit. (Li Dongyuan)

If chaotic blood enters the Liver and lochia attacks upward, it is due to blood stasis, representing an Excess type of blood syncope; treatment involves moving blood and resolving stasis. If sudden Yin Blood loss causes false fire to rise, it is due to abdominal emptiness, representing a Deficiency type; treatment involves nourishing Yin and descending fire. However, avoid Di Huang and Shaoyao for nourishing Yin, and avoid bitter-cold herbs for descending fire. (Xiao Shenzhai)

Postpartum blood syncope has Excess and Deficiency distinctions. Excess is false excess due to stasis; Deficiency is true deficiency of Qi and Blood. Blood moves with Qi; Qi stagnation causes blood blockage. After delivery, sudden Yin Blood loss causes sudden Qi deficiency, losing movement power. Remaining blood stagnates into stasis, rushing upward to the chest and abdomen, causing pain. Symptoms include dizziness, blurred vision, and in severe cases, unconsciousness and locked jaw. External treatment involves burning lacquerware or smoking vinegar charcoal. Internal treatment uses Sheng Hua Tang or Shi Xiao San. Add Tong Bian (child's urine) for constitutionally Yin-deficient patients; add Rou Gui for Yang-deficient patients; add Ren Shen for severe cases. Folk belief that "Ren Shen prevents stasis removal" misleads many, causing Qi collapse. This is false excess. If blood loss is excessive, leaving Qi isolated, observe external signs: eyes closed, mouth open, pale face, relaxed hands, more exhalation than inhalation, cold limbs, cold sweat, thread-like or floating rootless pulse. This indicates Kidney Qi failing to grasp and Lung Qi failing to dominate, with the foundation shaking—a sign of Qi collapse. Treatment requires benefiting Qi for blood loss, generating Yang to grow Yin. Urgently use large doses of Ren Shen assisted by Dang Gui, Di Huang, Gan Jiang, and Fu Zi to save the critically ill. This is true deficiency. (From *Hui Xin Lu*)

Chaotic Blood Rushing Upward
Chaotic blood rushing upward has three types: singing, dancing, talking, laughing, cursing, sitting, lying down, or climbing walls/roofs indicates chaotic blood rushing to the Heart; prognosis is mostly fatal. Treat with Hua Rui Shi San. If restless but not manic, treat with Shi Xiao San plus Yu Jin. If bloated, nauseous, with abdominal fullness and pain, indicates chaotic blood rushing to the Stomach. Treat with Ping Wei San plus Sheng Jiang and Rou Gui. If ineffective, administer Lai Fu Dan. If vomiting, abdominal distension, and blood transforms into water, treat with Xia Yu Xue Tang from *Jin Gui*. If red face, severe vomiting, or wheezing, indicates chaotic blood rushing to the Lungs. Treat with Ren Shen Su Mu Yin; add Mang Xiao for severe cases to purge. Generally, Heart rush saves 1 in 10; Stomach rush saves 5 in 10; Lung rush saves 1-2 in 10. (From *Zhang Shi Yi Tong*)

Incomplete Lochia Expulsion
When examining postpartum diseases, asking about the amount and presence of lochia is crucial. Fresh lochia is residual blood from pregnancy. If Qi and Blood are strong, lochia flows down easily; if weak, it obstructs the lower abdomen causing disease. Upward attack causes blood syncope; stagnation causes "Child Pillow" abdominal pain, masses, limb swelling, and blood鼓 (drum-like distension). (Peng Yongguang)

For the above symptoms: If Liver Heat fails to generate blood, use Liu Wei Wan; if Liver Xu fails to store blood, use Xiao Yao San; if Spleen Xu fails to control blood, use Liu Jun Zi Tang; if Qi sinking fails to command blood, use Bu Zhong Yi Qi Tang; if Spleen channel depression-heat causes blood to stray, use Jia Wei Gui Pi Tang; if Spleen channel anger-fire forces blood to run wild, use Jia Wei Si Wu Tang; if both Qi and Blood are deficient, use Shi Quan Da Bu Tang; if Liver channel wind-pathogen causes blood to boil, use Yi Wei Fang Feng Wan. (Xue Lizhai)

Postpartum lochia typically lasts about one month. Stopping before one month indicates Qi and Blood deficiency. Lingering beyond one month indicates either Qi deficiency failing to control blood or Liver/Spleen channel deficiency. *Da Quan* attributes this to menstrual blood deficiency, which is correct. However, it also attributes it to organ cold retention. Blood flows with heat and coagulates with cold; how can lingering lochia be caused by cold? Lizhai attributes it to Liver/Spleen depression-heat and anger-fire, accurately grasping the pathology. (Xiao Shenzhai)

Selected Case
A woman had incomplete lochia expulsion for six or seven days, with fresh blood gushing, fever, thirst, hypochondriac pain, screaming, and inability to eat. Si Wu Tang and blood-moving herbs like Shan Zha, Qing Pi, and Yan Hu Suo were ineffective. Pulse was surging and rapid. I said: Lochia is incomplete, stagnating in the Sea of Blood. Newly generated blood loses its proper path. Without removing accumulation and promoting stasis, abnormality becomes routine. How to resist it? Prescribed Vinegar-processed Da Huang 30g, Sheng Di Huang 30g, Tao Ren paste 15g, Gan Xi 9g. Someone asked: Postpartum is greatly deficient; shouldn't the medicine be mild? I said: The new generates itself, the old removes itself. Where is the deficiency? Drink urgently. She slept soundly all night. Next morning, several liters of black blood clots were passed; all symptoms vanished. Then used Bu Zhong Yi Qi Tang for regulation and recovery. (From *Ji Ren Bian*)

Vulva Not Closing
Vulva not closing is mostly due to Qi and Blood deficiency failing to retain. Use Shi Quan Da Bu Tang. For initial postpartum vulvar swelling and pain without closure, use Jia Wei Xiao Yao San; for swelling without pain, use Bu Zhong Tang plus Wu Wei Zi. Avoid cold-cool herbs. (Chen Liangfu)

Postpartum syndromes are generally treated by addressing great Qi and Blood deficiency, especially for vaginal prolapse and vulvar non-closure. Reading Danxi and Lizhai's cases, descriptions include tissue like handkerchiefs, bowls, bifurcated shapes, meat strips, or uterine prolapse. All belong to Qi deficiency and Blood collapse. Their prescriptions mainly use Ren Shen, Huang Qi, Dang Gui, Di Huang, plus lifting and astringent herbs, applied flexibly in practice. (Xiao Shenzhai)

For vulvar non-closure, use several jin of sesame oil, warm it, pour into a basin, let the patient sit in the oil for the time it takes to eat one meal. Blowing powder from Gao Jiao into the nose to induce sneezing helps close it. (*Dan Xi Xin Fa*)

Selected Case
A woman had vulvar non-closure with a strip of flesh hanging down, over a chi long, accompanied by back pain preventing movement. Doctors suspected small intestine prolapse and mistakenly applied castor seeds to the head, causing coma, wheezing, vomiting, and imminent death. I diagnosed it as Dai Mai sinking. Prescribed Hui Tian Yin plus Bai Guo, Sheng Ma, and Chu Pi. After two doses, wheezing and vomiting stopped, and the flesh retracted. Then gave Fo Shou San plus Ge Li Chi powder, finally closing the vulva. (Cheng Huazhong)

A woman had a meat strip three to four chi long protruding from the urethra, worsening with movement. Ordered Shi Xiao San first. Then used three jin of Sheng Jiang, pounded and mixed with two jin of sesame oil, fried until dry. Wrapped the meat strip in silk, placed it beside the urethra, and fumigated with hot ginger. Re-fried ginger when cool. Retracted in one day, fully retracted in two days. Regulated with Xiong Gui Tang. If the meat strip breaks, it is incurable. (*Dan Xi Xin Fa*)

Blood Stasis Flowing into Meridians
Excessive postpartum bleeding depletes Qi, preventing the expulsion of stasis. Stasis flows into meridians, blocking joints, causing chills, fever, swelling, or pain. Physicians misunderstanding this attribute it to Wind-Cold stagnation, using diaphoretic or digestive herbs. This further depletes Blood and weakens Qi, leading to critical changes. When encountering this, I urgently tonify Qi and Blood to allow Ying and Wei Qi to circulate freely. Accumulated stasis in meridians then exits spontaneously, sometimes suppurating or exiting through natural orifices. Blindly pursuing stasis without saving the root never succeeds. Even for robust constitutions, combining attack and tonification, or sequencing them, requires clinical judgment. The *Classic* states: "Ying Qi does not follow, reversing in muscle tissue." Current stasis reversing in interstices confirms Ying Qi dysfunction. (From *Hui Xin Lu*)

Wind Stroke
Postpartum, wind pathogen persists for dozens of days unresolved, with slight headache, aversion to cold, intermittent fever, chest oppression, dry retching, and sweating. Despite the duration, Yang Dan syndrome persists; prescribe Yang Dan Tang. ○ Postpartum wind stroke with fever, bright red face, wheezing, and headache is primarily treated with Zhu Ye Tang. (*Jin Gui Yao Lue*)

Yang Dan Tang is Gui Zhi Tang plus Fu Zi. People doubt it, claiming no basis. Observing the use of Yang Dan for wind here, and Fu Zi in Zhu Ye Tang for wind later, it is clear Yang Dan Tang is Gui Zhi Tang plus Fu Zi. For Yang deficiency with wind invasion without heat, Yang Dan Tang is the correct treatment; for Yang deficiency with wind invasion and floating heat, Zhu Ye Tang is used. Zhu Ye Tang uses Fu Zi for wind; certainly, Gui Zhi Tang's purpose is to assist Yang Qi and dispel evil wind. Who says Zhongjing's text implies adding Huang Qin instead of Fu Zi? (Wei Litong)

Food Injury
For postpartum fever, inquire about dietary injury/stagnation. If symptoms include fullness, food aversion, or diarrhea, treat as food injury. If diet is normal, proceed with blood-tonifying methods. (Wang Jiezhai)

Cold Damage-Like Syndromes
Postpartum Cold Damage-like Yang Ming syndromes: Aversion to cold, fever, headache—do not diagnose as Tai Yang syndrome; Headache, alternating chills/fever, hypochondriac pain—do not diagnose as Shao Yang syndrome; Tidal fever, spontaneous sweating, constipation—do not diagnose as Yang Ming syndrome. These arise from Qi and Blood dual deficiency and Yin-Yang disharmony, mimicking external contraction. Heavy sweating causes "deficiency of deficiency" disaster. Postpartum Cold Damage-like Yin syndromes: Abdominal fullness and dry throat—do not diagnose as Tai Yin syndrome; Dry mouth/tongue and thirst—do not diagnose as Shao Yin syndrome; Sweating, delirium, constipation—do not diagnose as Yang Ming excess requiring purging. These are mostly due to fatigue injuring the Spleen, difficult transportation, Qi/Blood exhaustion, and intestinal dryness. They are deficiency mimicking excess, requiring tonification. (From *Hui Xin Lu*)

Newborns may have fever from effort strain, excessive blood loss, incomplete lochia, milk engorgement on the third day, or early labor with food stagnation. Symptoms mimic Cold Damage; careful differentiation is essential. Do not induce sweating lightly. Postpartum Qi and Blood are empty; reckless sweating leads to muscle twitching, Yu Mao coma, convulsions, and constipation, causing serious harm. (Wu Mengzhai)

Fever
Postpartum fever from external contraction occurs because exposure and exertion during delivery allow Cold pathogen to invade easily. Symptoms include headache, body ache, aversion to cold, fever, back stiffness, and tight/rapid pulse. This is immediate reaction to pathogen; mild dispersal cures it. Do not say postpartum prohibits dispersal; simply adjust for deficiency/excess appropriately. (*Jing Yue Quan Shu*)

Postpartum blood deficiency leaves Yang unanchored, floating externally, causing frequent fever. Use Si Wu Tang plus Pao Jiang (bitter-warm) to gather floating Yang back to Yin. If Qi and Blood are both deficient with chills, fever, irritability, and thirst, use Shi Quan Da Bu Tang. If blood deficiency causes night fever with lower abdominal/flank pain, use Si Wu Tang plus Huang Qi and Rou Gui. If red face and thirst, use Dang Gui Bu Xue Tang. However, postpartum Spleen/Stomach are often weak; food injury fever is common. Do not mistake it for blood deficiency. (*Zhang Shi Yi Tong*)

Sudden massive loss of Yin Blood postpartum causes high fever. Treating with cold herbs causes death. Urgently use Du Shen Tang or Dang Gui Bu Xue Tang to generate form from formless, Yang generating Yin...