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Xue Lizhai stated: The Liver belongs to Wood and governs the sinews. If there is wind-heat and blood dryness in the Liver channel, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); if ineffective, use Liuwei Wan (Six-Ingredient Pill with Rehmannia) to tonify Kidney Water. The Classic says: "When wind lodges and disrupts Qi, essence is depleted, because pathogenic factors damage the Liver."

Shen Zhai commented: The above five items describe postpartum syndromes such as trismus (lockjaw), opisthotonos (arched back), convulsions, and spasms. These syndromes are manifestations of internal wind from stroke. Although they have different names (such as trismus and opisthotonos), they are all caused by severe deficiency of Qi and Blood after childbirth. Therefore, all wind-dispelling herbs should not be used. Only by following the theories of Danxi and Lizhai for treatment can one grasp the essential approach to treating stroke in postpartum women.

Guo Jizhong asked: What causes aphasia after childbirth? He answered: The human heart has seven apertures and three hairs. The Heart is the sovereign official, from which spirit and consciousness emerge, externally corresponding to the tongue; the tongue is the mechanism of speech. After childbirth, due to weakness,敗血 (retained blood/stasis) often stagnates and accumulates, disturbing the Heart upwards, closing the Heart orifices, and preventing clear consciousness. Furthermore, Heart Qi connects to the tongue; when Heart Qi is blocked, the tongue becomes stiff and speechless. One should simply administer Shizhen San (Seven Treasures Powder).

Wu Shuqing said: Postpartum aphasia may result from taking too many medicines and decoctions during labor, causing dampness in the Stomach. It may also result from phlegm-heat confusing the Heart, leading to aphasia, which can be treated with Daotan Tang (Phlegm-Conducting Decoction).

Fang Yuezhi stated: Postpartum aphasia can be caused by hot blood blocking the Heart orifices, or by phlegm-heat blocking the Heart orifices. The aforementioned Shizhen San treats hot blood, while Gufeng San (Lone Phoenix Powder) treats phlegm-heat. Obese individuals tend to have phlegm-heat, while thin individuals tend to have hot blood.

Xue Lizhai stated: The Classic says, the meridians of the Large Intestine spread under the tongue. It also says, when the meridians of the Spleen undergo change, the disease manifests as stiffness of the tongue root and inability to speak. It further states, the divergent meridian of the Kidney enters the Heart and connects to the tongue root; deficiency leads to inability to speak. For the aforementioned conditions, if there is deficiency of Heart and Kidney Qi, use Shizhen San. For Kidney deficiency with wind-heat, use Dihuang Yin (Rehmannia Decoction). For Large Intestine wind-heat, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with Fangfeng (Saposhnikovia Root) and Baizhi (Angelica Dahurica). For Spleen channel wind-heat, use Qinjiao Shengma Tang (Gentian and Cimicifuga Decoction). For Liver channel wind-heat, use Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) with Fangfeng and Baizhi. For Spleen Qi stagnation, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction) with Shengma (Cimicifuga Rhizome). For excessive Liver Wood, use Xiao Chaihu Tang (Minor Bupleurum Decoction) with Gouteng (Uncaria Ramulus). When Spleen is invaded by Liver Wood (Wood insulting Earth), add Baizhi, Shengma, and Gouteng. For Liver and Spleen blood deficiency, use Foshou San (Buddha's Hand Powder). For Spleen Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction). For combined Qi and Blood deficiency, use Bazhen Tang (Eight Treasures Decoction). If ineffective, use Dushen Tang (Single Ginseng Decoction) with Fuzi (Aconite Lateral Root) to tonify Qi to generate Blood. If one merely uses blood-tonifying herbs, it would be a mistake.

Shen Zhai commented: The above four items describe postpartum aphasia. Guo Jizhong attributes it to retained blood confusing the Heart, while *Jiyin Gangmu* attributes it to Stomach dampness, heat, and phlegm; both discuss pathological excess. Postpartum excessive blood loss leads to deficient fire ascending, depressing and confusing the Heart spirit, causing aphasia; this type of syndrome is mostly deficiency. Retained blood and phlegm-heat occur only occasionally. To attribute it to Stomach dampness is overly pedantic. As for Xue Lizhai addressing Liver and Spleen wind-heat, frequently using Fangfeng, Baizhi, Shengma, and Chaihu as dispersing agents, it seems he did not accurately target the pathogenesis.