Library

Postpartum constipation arises from excessive blood loss, leading to dryness of the Large Intestine (大肠), or from blood deficiency with internal fire causing dryness. One should not merely count the days since onset. If dietary intake is heavy, using purgative or moistening medications requires waiting until the patient feels abdominal fullness and a tenesmus-like urge but cannot defecate; only then is it determined that feces are impacted in the rectum, at which point Pig Bile (猪胆汁) is suitable for moistening the intestines. If one takes bitter herbs like Sophora Flavescens Root (苦参) to promote lubrication, it will instead damage the Yuan Qi (Original Qi) of the Middle Jiao (中焦), potentially making defecation even more difficult, or causing unceasing diarrhea after initial passage, inevitably leading to a fatal condition. If the pattern is blood deficiency with fire dryness, use Modified Xiao Yao San (加味逍遥散). If both Qi and Blood are deficient, use Ba Zhen Tang (Eight Treasures Decoction). One must strictly avoid using seeds like Hemp Seed (麻子), Apricot Kernel (杏仁), or Aurantium Fruit (枳壳).

Clinical Case 1:
A postpartum woman had been unable to defecate for seven days. Her diet was normal, and her abdomen felt unchanged. I said, "Although food intake may exceed the usual amount, the absence of abdominal distension indicates deficiency. Use Ba Zhen Tang plus Peach Kernel (桃仁) and Apricot Kernel (杏仁)." By the twenty-first day, she experienced abdominal fullness and an urge to defecate. I used Pig Bile (猪胆汁) to moisten the intestines. She first passed five to seven pieces of hard stool, followed by normal stools, and recovered.

Clinical Case 2:
Another postpartum woman had not defecated for eight days. After taking purgative medicines, she experienced pain in the Zhongwan region (中脘) and had very little appetite. Some argued, "If there is free flow, there is no pain; if there is pain, there is obstruction." Consequently, Honey Suppositories (蜜导) were used, resulting in fecal incontinence, hiccups, and inability to eat. I stated, "This is further injury to the Spleen and Kidney. Use Liu Jun Zi Tang (Six Gentlemen Decoction) added with Evodia Fruit (吴茱), Nutmeg (肉果), Psoralea Fruit (骨脂), and Schisandra Berry (五味子). Fortunately, she was young and strong; otherwise, this would likely have proven fatal."

Postpartum alternating chills and fever results from Qi and Blood deficiency or Spleen and Stomach impairment, constituting a deficiency syndrome. The Classic states: "Yin deficiency leads to fever; Yang deficiency leads to aversion to cold." If accompanied by constipation, it particularly points to Qi and Blood deficiency. One must absolutely avoid using diaphoretic (sweat-inducing) or heat-clearing/descending methods. If the Cun (Inch) pulse is faint, it is named Yang Qi deficiency; when Yin Qi enters the Yang aspect, it causes aversion to cold, treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If the Chi (Cubit) pulse is weak, it is named Yin Qi deficiency; when Yang Qi sinks into the Yin aspect, it causes fever, treated with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). Generally, when Yin is insufficient, Yang follows it inward, causing Yang to sink internally and resulting in fever; when Yang is insufficient, Yin follows it upward, causing Yin to rise and resulting in aversion to cold. This failure of Yin and Yang to remain in their proper positions leads to a struggle between cold and heat, manifesting as chills and fever, which should be treated with Ba Zhen Tang (Eight Treasures Decoction). If limbs feel hot after illness, or if there is fatigue and lassitude of form and Qi, this is due to incomplete recovery of Yuan Qi (Original Qi) with damp-heat taking advantage of the weakness; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is appropriate. If there is skin heat, intense thirst with desire to drink, red eyes, and ruddy complexion, this is fever due to Blood deficiency, treated with Dang Gui Bu Xue Tang (Angelica Tonifying the Blood Decoction); mistaking this for a cold pattern would be an error.

Clinical Case 3:
A postpartum woman presented with chills and fever. I treated her with Shi Quan Da Bu Tang (Great Tonifying Decoction for Ten Powers) added with Prepared Ginger (炮姜), resulting in recovery. However, she had poor appetite and limb fatigue, which resolved after treatment with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).

Clinical Case 4:
Another postpartum woman became angry after eating, presenting with chills, fever, convulsions, and teeth grinding. It was difficult to palpate her pulse. Observing her facial color, which showed blue with hidden yellow, and noting that she protected her abdomen when I attempted to press it, I diagnosed Liver Wood overacting on Spleen Earth due to food stagnation. Treatment with Liu Jun Zi Tang (Six Gentlemen Decoction) added with Aucklandia Root (木香) resulted in relief after one dose.

Clinical Case 5:
A postpartum woman presented with chills and fever. I intended to treat her with Ba Zhen Tang (Eight Treasures Decoction) added with Prepared Ginger (炮姜). Her family, who were knowledgeable in medicine, believed it was Wind-Cold and administered Xiao Chai Hu Tang (Minor Bupleurum Decoction). I stated, "The irregular timing of chills and fever indicates Qi and Blood deficiency." They did not believe me and continued with one dose. This led to continuous sweating, delirious speech, irritability, heat sensation, thirst, and limb convulsions. I switched to Shi Quan Da Bu Tang (Great Tonifying Decoction for Ten Powers). After two doses, the condition worsened, and the pulse became flooding (Hong) but empty upon deep pressure. I retained the previous formula but added Aconite Root (附子). After four doses, symptoms slightly eased, and after several more doses, she recovered.