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Zhu Danxi treated a postpartum woman presenting with edema of the four limbs and alternating chills and fever. This was due to lochia (residual blood after childbirth) flowing into the meridians and infiltrating the limbs, resulting in panting, coughing, chest and diaphragm discomfort, vomiting of sour fluid, and pain in both hypochondria. He then prescribed Xuanfu Hua Tang (Inula Flower Decoction), which gradually resolved the symptoms through mild sweating. She frequently took Xiaotiaojing San (Minor Regulating Menses Powder), administered with decoction of Zelan Geng (Eclipta Stem) to help dissipate the swelling.

Yu Zhen’s commentary: This type of edema is caused by lochia flowing into the meridians and represents only one aspect of postpartum edema. Edema not caused by lochia requires different treatment methods. However, postpartum edema is also a critical condition, and these two formulas may not necessarily be effective.

Wang Shishan stated: One day, while residing in my country estate, a villager came to my door begging for help, saying his wife had recently given birth and was suffering from frequent panting and shortness of breath, unable to lie flat. Phlegm and blood surged upward together, requiring two people to support her sitting upright day and night; any slight change in position caused airway obstruction. I requested treatment. Based on my clinical judgment, immediately after childbirth, Qi, Blood, Spleen, and Stomach are severely deficient and damaged. Thus, deficiency-phlegm becomes abundant, and lochia takes advantage of this weakness to ascend. I prescribed Xijiao Liujunzi Tang (Rhinoceros Horn Six Gentlemen Decoction) combined with Shixiao San (Instant Success Powder). After one dose, phlegm and blood were expelled, and the pantting stopped immediately. The next day, he returned to thank me, stating that all other symptoms had resolved, except for an inability to eat. I prescribed Shenling Baizhu San (Ginseng and Poria Powder to Strengthen the Spleen) for regulation, leading to complete recovery.

Yu Zhen’s commentary: This condition is very critical, and this formula is quite ingenious. If one used only Liujunzi Tang without adding Xijiao (Rhinoceros Horn) and Shixiao San, it would not have worked. Conversely, using Xijiao and Shixiao San without combining them with Liujunzi Tang would also have failed. Relying solely on subjective judgment without pulse diagnosis demonstrates Dr. Wang’s skill derived from experience. The pathogenesis lies in the simultaneous surging of phlegm and blood upwards, causing obstruction upon slight movement, clearly indicating that lochia ascends following the phlegm. However, without severe deficiency of Qi, Blood, Spleen, and Stomach, how could lochia ascend with the phlegm? This formula is precisely targeted. "Building a cart behind closed doors that fits the ruts outside" perfectly describes your approach, Sir.

A parturient woman suffered from continuous urinary leakage because the midwife was negligent and ruptured the bladder (Niaopao). Zhu Danxi said: When muscles are injured externally, they can still be repaired. Although the bladder is located within the abdomen, it is likely treatable as well. Her pulse was extremely deficient, indicating that difficult labor resulted from Qi and Blood deficiency, making the postpartum state even more depleted. I attempted vigorous tonification, using Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala Rhizome) as sovereign herbs, Chuan Xiong (Szechwan Lovage Rhizome) and Dang Gui (Angelica Sinensis Root) as minister herbs, Tao Ren (Peach Kernel), Chen Pi (Tangerine Peel), Huang Qi (Astragalus Root), and Fu Ling (Poria) as assistant herbs. The medicine was decocted in a broth made from pig or sheep bladders and consumed when extremely hungry. Within one month, she stabilized. Rapid regeneration of Qi allows the bladder to heal completely; delay might hinder success.

Another postpartum woman presented with a mass protruding from the vagina resembling an inverted bowl with two branches, which was the uterus (Zigong). Due to weak Qi and Blood, the uterus descended along with the fetus. She received large doses of Sheng Ma (Cimicifuga Rhizome), Dang Gui, and Huang Qi twice. Subsequently, a tanner’s method was employed: washing the area with Wu Bei Zi (Galla Chinensis) decoction to induce skin contraction. Afterward, a snapping sound was heard, and the organ retracted. However, lying on the mat overnight caused a palm-sized piece of tissue to slough off, causing great fear. Zhu Danxi said: This is not connected to the intestines or stomach. Muscle injuries can still heal. She took dozens of doses of Siwu Tang (Four Substance Decoction) added with Ren Shen. Three years later, she gave birth to another child.

Yu Zhen’s commentary: Difficult labor due to Qi and Blood deficiency leads to an even more deficient postpartum state; this is a profound truth. However, regarding the discussion of ruptured bladder and uterine prolapse, the analysis is particularly accurate and unshakable. Other conditions should be viewed flexibly.