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Chen Liangfu stated: When a woman's labor process is not smooth, it may cause injury to the bladder (bladder), resulting in involuntary urination at any time.

Zhu Danxi stated: There are cases where careless midwifery damages the urinary bladder of the parturient woman, causing symptoms of dribbling urine. Treatment can involve decocting pig or sheep bladders and using the broth to administer medicine. Ren Shen (Ginseng) and [Bai Zhu (Atractylodes Rhizome)] serve as the sovereign drugs; Dang Gui (Angelica Sinensis) and Shu Di Huang (Prepared Rehmannia Root) serve as minister drugs; Tao Ren (Peach Kernel), Chen Pi (Tangerine Peel), and Fu Ling (Poria) serve as envoy drugs. It should be taken when extremely hungry to rapidly generate Qi and Blood, allowing the bladder to repair itself naturally; if the treatment is delayed, success will be difficult to achieve.

Xue Lizhai stated: If a midwife is careless, causing damage to the bladder with dribbling urine, Ba Zhen Tang (Eight-Treasure Decoction) should be used to tonify Qi and Blood. If frequent urination is due to deficiency of Qi in the bladder, the Spleen and Lung should be tonified. If dribbling urine is due to Yin deficiency of the bladder, the Lung and Kidney must be tonified. The formula used is Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), with Shan Zhu Yu (Cornus Fruit) and Shan Yao (Dioscorea Rhizome) as the main drugs, assisted by Sang Piao Xiao San (Mantis Egg-case Powder).

Shenzhai commented: The above six sections describe postpartum urinary conditions characterized by frequency, incontinence, and dribbling. The Classic states that the Kidney governs the two lower orifices and opens into the anterior and posterior yin openings. Incontinence and dribbling of urine are diseases of the anterior yin. Postpartum, Qi and Blood are severely deficient, and internal organs may be injured. If it is not Lung Qi deficiency failing to exert control, leading to enuresis and incontinence, then it is Kidney Qi exhaustion, often accompanied by deficient heat transferring to the bladder, causing dribbling and strangury. The general treatment principle is to nourish Qi and Blood and add herbs that lift and secure/astringe. Using diuretic and draining methods would further deplete deficiency; this must be avoided.

The Da Quan (Great Compendium) stated: Postpartum hematuria occurs because Qi and Blood are deficient, allowing Heat pathogens to invade. Blood becomes agitated by Heat and flows erratically, seeping into the uterus/bladder, thus blood exits with urine. Some parturient women presenting with hematuria, sallow complexion, hypochondriac distension, and poor appetite suffer from Liver Wood overacting on Spleen Earth. Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be administered concurrently for recovery.

Xue Lizhai stated: Postpartum hematochezia (blood in stool) may result from improper diet and lifestyle or from Six Excesses and Seven Emotions, causing depletion of Yuan Qi and external injury to Yang collaterals. Treatment methods vary by etiology: if caused by accumulation of heat from rich foods, use Jia Wei Qing Wei San (Modified Stomach-Clearing Powder); if caused by damp-toxin from alcohol, use Ge Hua Jie Xing Tang (Ardisia Japonica Decoction to Resolve Intoxication); if caused by anger stirring Liver Fire, use Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Chuan Xiong (Sichuan Lovage Rhizome), Dang Gui, Bai Shao (White Peony Root), and Chai Hu (Bupleurum Root); if caused by constraint injuring the Spleen, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction); if caused by overthinking injuring the Heart, use Miao Xiang San (Miraculous Incense Powder); if caused by Wind-Heat in the Large Intestine, use Si Wu Tang (Four-Substance Decoction) plus Ce Bai Ye (Biota Tops), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia Root), Zhi Ke (Bitter Orange), and Huai Hua (Sophora Flower); if caused by Blood-Heat in the Large Intestine, use Si Wu Tang plus Huang Qin (Scutellaria Root) and Lian Zi (Lotus Plumule)/Lian Qiao (Forsythia) [Note: Text says Qin, Lian]; if caused by Spleen-Stomach weakness, use Liu Jun Zi Tang plus Sheng Ma (Cimicifuga Rhizome) and Chai Hu; if caused by Spleen-Stomach deficiency-cold, use Liu Jun Zi Tang plus Rou Dou Kou (Nutmeg) and Mu Xiang (Aucklandia Root); if caused by sinking of Yuan Qi, use Bu Zhong Yi Qi Tang plus Fu Ling and Ban Xia (Pinellia Tuber); if caused by weak Stomach Qi, use Liu Jun Zi Tang plus Sheng Ma; if caused by Blood deficiency, use Si Wu Tang plus Sheng Ma; if caused by Qi and Blood deficiency, use Ba Zhen Tang plus Sheng Ma and Chai Hu for warm tonification.

Shenzhai commented: The above two sections describe postpartum bleeding from both bowels. Since postpartum hemorrhage has already depleted blood, the occurrence of bleeding from both upper and lower orifices is not a case of ordinary Heat pathogens seeping into the bladder or returning to the Large Intestine that can be treated conventionally. It is either Blood deficiency or Qi collapse. The Heart governs Blood, and the Spleen controls Blood. If Heart Qi is deficient, the Small Intestine cannot restrain flow, leading to bleeding; if Spleen Qi is weak, the Large Intestine lacks support, leading to downward bleeding. Therefore, bleeding from both orifices should be attributed to pathology in the Heart and Spleen meridians. If the *Da Quan* attributes it solely to Heat, and Xue Lizhai’s section lists mixed etiologies with detailed syndrome differentiation and formulas, it may be too rigid and difficult to achieve efficacy. Xue Lizhai’s works focus on tonifying Original Yin and Original Yang, often establishing theories based on nourishing the source of transformation and generation, which has greatly benefited later scholars. However, his tendency to match specific formulas to specific diseases seems to encourage practitioners to follow maps blindly or mark boats to find swords. Those who read Xue Lizhai’s books well—do they consider my words to be nonsense?