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Xue Lizhai stated: If the aforementioned syndrome is caused by excessive blood loss leading to deficiency fire flaming upward, use Tongbian (Child's urine) added to Siwu Tang (Four Substances Decoction), along with Baizhu (Atractylodis Rhizoma), Maidong (Ophiopogonis Radix), and Danpi (Moutan Cortex). If there is heat due to deficient stomach qi, use Zhuye Huangtang (Bamboo Leaf and Yellow [Gypsum] Decoction) [Note: Likely refers to Zhuye Shigao Tang].

If there is fever due to blood deficiency, use Bawu Tang (Eight Treasures Decoction) added with Maidong (Ophiopogonis Radix) and Wuwei Zi (Schisandrae Fructus). If restlessness occurs due to blood collapse, use Danggui Buxue Tang (Dangui Tonifying Qi and Blood Decoction). If stomach qi is weak, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder).

Shenzhen commented: The above four points describe postpartum syndromes of deficiency irritability and thirst for blood. Blood constitutes the body's fluids; excessive blood loss postpartum leads to yin deficiency and hyperactive fire, resulting in symptoms such as restlessness and thirst. It is appropriate to use large doses of herbs that nourish yin, descend fire, and resolve stasis, with Tongbian (Child's urine) as the principal agent. *Jiyin Gangmu* states: Postpartum blood deficiency leaves qi without attachment, causing it to rebel and transform into fire. As the fire rebels upward, it carries stasis with it, leading to heart irritability and agitation. Tongbian is a turbid yin substance, bitter, cold, and salty in flavor, with a downward nature, capable of descending fire and resolving stasis, which aligns with the principle that "turbid yin exits through the lower orifices." Combining these two approaches is excellent. Regarding Zhang Zhongjing's Erwu Huangqin Tang (Two-Ingredient Scutellaria Decoction), which contains Huangqin (Scutellariae Radix), Kushen (Sophorae Flavescentis Radix), Zhuru (Bambusae Caulis in Taeniam), and Shigao (Gypsum Fibrosum), used to treat postpartum middle jiao deficiency causing mental confusion and extreme heat in the four limbs, I dare not readily accept it; one should primarily rely on the discussion in *Sanyin Fang*.

Guo Jizhong asked: What is the cause of black qi appearing at the mouth and nose, and epistaxis (nosebleed) postpartum? He answered: The Yangming meridian is the sea of the meridians, originating at the nose, intersecting at Jingming (BL1, Inner Canthus), returning to emerge at the cheek and mouth, intersecting at Renzhong (GV26), with the left side connecting to the right and vice versa. Postpartum, qi and blood are deficient and scattered, Ying and Wei (Nutritive and Defensive qi) are disharmonious, and they scatter into the various meridians but cannot return, causing black qi to appear at the mouth and nose, eventually transforming into epistaxis. This arises from postpartum deficiency heat generating this syndrome. It indicates Stomach exhaustion and Lung failure, which is incurable. *Bingji* states: Epistaxis occurring postpartum is incurable.

Xue Lizhai stated: The Stomach meridian encircles the lips and passes through Chengjiang (CV24); the tip of the nose belongs to Spleen Earth, and the nostrils belong to Lung Metal. This represents Stomach deficiency and Lung damage, a critical syndrome of qi collapse and blood death. Urgently use Erwei Rensu Yin (Two-Ingredient Ginseng and Nardus Decoction) added with Fuzi (Aconiti Lateralis Radix Praeparata); some patients have survived.

Shenzhen commented: The above two points describe postpartum epistaxis. Epistaxis itself is not necessarily a fatal syndrome, but when it occurs postpartum, it may be due to lochia not being discharged, with deficiency fire carrying blood upward, overflowing from the nasal cavity, failing to follow the normal meridian pathways. The Lung and Stomach have already been affected by fire-heat, hence black qi manifests at the nose and mouth. This is heat extreme manifesting as water transformation (dark color associated with Water/Kidney in Five Phase theory, indicating severe heat consuming yin/fluids). Thus, it is said that Lung and Stomach failure is incurable. Xue Lizhai's use of Rensu Yin added with Fuzi seems unstable. It would be better to use a large cup of Tongbian (Child's urine) added with Niuxi (Achyranthis Bidentatae Radix), Danpi (Moutan Cortex), Zelan (Leonuri Herba), Shengdihuang (Rehmanniae Radix), Shudihuang (Rehmanniae Radix Preparata), and doubled Ren Shen (Ginseng Radix et Rhizoma).