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Postpartum blood syncope is caused by inherent deficiency before delivery and excessive blood loss during delivery, leading to the floating up of deficient fire, loss of bodily control, and resulting in fainting. Zhang Jingyue's note: This condition occurs in severe illnesses and states of great deficiency. Although named "blood syncope," it is actually not caused by blood stasis leading to fainting. Medical texts state that when foul blood flows into the Liver meridian, causing black spots in vision, dizziness preventing sitting or rising, and unconsciousness, it is called blood syncope. This theory suggests that heat from blood surges upward against the Heart due to deficiency, causing coma and near-closure of Qi. It recommends drinking child's urine (Tongzi Bian) as the best remedy. This discussion only considers foul blood and completely ignores great deficiency, merely stating Qi closure and impending collapse. Can child's urine really restore collapsing Yuan Qi? One prescription uses Dang Gui (Angelicae Sinensis Radix) 2 qian, Yimucao (Leonuri Herba) 1 qian, Renshen (Ginseng Radix) 2 qian, Honghua (Carthami Flos) 6 fen, and Heijiang (Scorched Zingiberis Rhizoma) 8 fen, taken with hot child's urine. This formula addresses both aspects. Whenever Zhang Jingyue encountered parturients with a history of blood syncope, he prescribed Shiquan Dabu Tang (Decoction for Ten-Absence Tonification), Guipi Tang (Restore the Spleen Decoction), and Yangrong Tang (Nourish 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) was decocted and administered. By tonifying before delivery and before depletion, there would be no deficiency for pathogenic factors to exploit postpartum, and thus no syncope would occur.

Women experiencing fainting and closed eyes during delivery do so because sudden massive loss of Yin Blood deprives the Heart Spirit (Shen) of nourishment. The Heart and Pericardium correspond to Ministerial Fire and Sovereign Fire; they are peaceful when nourished by Blood but endangered when Blood is lost. The blazing fire causes fainting; when Fire attacks the Lung, it causes closed eyes and unconsciousness, indicating that sudden Yin Blood loss fails to anchor and calm Yang. The Classics state: When disease involves Qi insufficiency, tonification is indicated, not purgation. Closed eyes indicate Yin syndromes. Sudden loss of有形 (substantial) Blood causes fire to blaze; tonifying Blood will naturally calm the Spirit. When the Heart receives Blood, it can nourish itself, and the Spirit will not become confused. However, in severe cases, Qi-tonifying herbs should be added, as urgent situations may render Yin tonification too slow, and Qi generates Blood.

Profuse bleeding with syncope is named Blood Collapse (Xue Tuo); large doses of Renshen (Ginseng Radix) can rescue Yang. If bleeding is scant yet syncope occurs, it is either not Blood Stasis or belongs to Blood Exhaustion. For stasis, use warming methods to promote flow; for exhaustion, use rich, cloying tonics. Do not recklessly administer blood-breaking or blood-moving drugs.

For postpartum blood syncope, gently assist the patient to sit. Burn charcoal and sprinkle vinegar, or burn old lacquerware, allowing the smoke to enter the nose and mouth to induce recovery. Urgently pinch the Renzhong acupoint (GV26), wait quietly, and allow Yuan Qi to gradually recover. Do not move the patient erratically, as this will further scatter the Spirit and Qi.