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Chen Liangfu stated: Postpartum labor and exhaustion damage the blood and qi, leaving the cou li (skin texture and pores) deficient. Wind pathogens take advantage of this deficiency to invade. The pathogen clashes with the qi, preventing its free diffusion and dispersion, resulting in a flaccid, light edema. This is Qi Edema caused by the pathogen clashing with the qi. If the skin exhibits pitting edema resembling a ripe plum, it transforms into Water Edema. Qi Edema is cured by inducing sweating; Water Edema is cured by promoting urination.

Shenzhai commented: Postpartum flaccid edema mostly belongs to deficiencies of blood and qi, coupled with weak spleen and stomach, leading to impaired circulation of Ying and Wei (nutritive and defensive qi). To advocate sweating or promoting urination would further deplete body fluids, thereby exacerbating the existing deficiency. How can postpartum edema be treated merely as an excess syndrome of external pathogens?

Zhu Danxi stated: Postpartum edema accompanied by scanty urine, thirst, aversion to cold, weakness, and a deep pulse indicates that the constitution is deficient while damp-heat accumulates. This inevitably causes fullness and oppression in the upper jiao. It is appropriate to tonify the middle, guide water downward, and move qi. The prescription uses Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Mutong (Akebiae Caulis).

Zhu Danxi further stated: Postpartum edema must primarily be treated with substantial tonification of blood and qi, with minor additions of Cangzhu (Atractylodis Rhizoma) and Fuling (Poria), allowing water to drain naturally.

Xue Lizhai stated: In the aforementioned conditions, if Cold-Water insults Earth (Spleen), one should nourish the Spleen and Lungs. If edema is due to Qi deficiency, one should benefit the Spleen and Stomach. If edema is due to Water-Qi, one should tonify Middle Qi. He also stated: Postpartum edema, especially when accompanied by wheezing and coughing, with a deep, thin, and forceless pulse, indicates decline of Mingmen Fire (Gate of Life fire) and deficiency-cold of Spleen Earth. It should be treated with Bawei Wan (Eight-Ingredient Pill).

Shenzhai commented: The above six items describe the syndrome of edema occurring after childbirth. Although edema may arise from external pathogens such as wind, cold, damp, and heat, postpartum cases mostly belong to deficiencies of blood and qi, with failure of Spleen Earth to transport and Lung Qi to distribute. Therefore, the following four items from *Chanbao* (Precious Prescriptions for Women) advocate treating excess guest pathogens; whereas Danxi and Lizhai emphasize only tonifying blood and qi and supporting Spleen Earth as the key.

Li Shi stated: Postpartum external contraction, often due to getting out of bed too early or exposure to wind during clothing changes, allows cold to enter the lower part of the body, causing chills and fever resembling malaria and unceasing headache. For Blood deficiency, Xiongui Tang (Peony and Ligusticum Decoction) is used with added Renshen (Ginseng Radix et Rhizoma), Chaihu (Bupleuri Radix), and Gegen (Puerariae Lobatae Radix). For Qi deficiency, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Enrich the Qi) is used with added Fangfeng (Saposhnikoviae Radix) and Ganjiang (Zingiberis Rhizoma). One must absolutely not treat this according to the methods for Shanghan (Cold Damage).