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The *Daquan* (Compendium) states: The Kidney governs the waist and legs. Postpartum lower back pain occurs because the Kidney is connected to the uterus; childbirth labors and injures Kidney Qi, damaging the uterine collaterals. Before the deficiency has recovered, wind-cold pathogens invade. Cold qi attacks the waist, causing lower back pain. If cold pathogenic factors linger in the spine, and pain persists for a long time, followed by a subsequent pregnancy, it will inevitably cause damage, as the uterine collaterals belong to the Kidney, and the Kidney governs the waist.

Xue Lizhai stated: In the aforementioned condition, the True Qi is deficient, allowing pathogens to take advantage of this weakness. Use Danggui Huangqi Tang (Astragalus and Angelica Decoction) or Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) as the main formula, assisted by Jisheng Tang (Decoction for Preserving Life); if ineffective, add Fuzi (Prepared Aconite Root) to Shiquan Dabu Tang.

Shen Zhai commented: The above three passages describe the syndrome of postpartum lower back pain. The uterus is tied to the Kidney, and the waist is the external manifestation of the Kidney. Postpartum labor injures Kidney Qi and damages the uterine collaterals; most cases belong to deficiency. Even if there are wind-cold and stagnant blood, the key must be to tonify the True Qi. Xue Lizhai’s commentary reveals the essence of this matter.

The *Daquan* states: Postpartum distension and fullness in the two hypochondriac regions with qi-related pain is caused by retained water previously present in the Bladder. Because lochia is not completely discharged after childbirth, water accumulates, forming a palpable mass that struggles with qi, accumulating in the Bladder. This causes distension and fullness in the hypochondriac regions. The agitation between qi and water causes pain.

Xue Lizhai said: For this condition, if it is blood stasis in the Liver Channel, use Xuanhusuo San (Corydalis Powder). If it is qi deficiency in the Liver Channel, use Sijunzi Tang (Four Gentlemen Decoction) added with Chaihu (Bupleurum Root) and Qingpi (Aged Tangerine Peel). If it is blood deficiency in the Liver Channel, use Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome). If Kidney Water is insufficient and cannot nourish the Liver, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If Lung Metal is overly strong and suppresses Liver Wood, use Xiebai San (White Powder to Drain), treating according to the previous syndromes. Unless ginger and cinnamon (warm and acrid herbs) are used to assist the Spleen and Lung in moving the medicinal action, not only will the treatment fail, but it may also exacerbate the distension.

Shen Zhai commented: The above two passages describe the syndrome of postpartum hypochondriac pain. The hypochondrium is the area governed by the Liver; the Liver stores blood. Both incomplete discharge of lochia and excessive blood loss after childbirth can lead to hypochondriac pain; it does not necessarily belong to the agitation of water and qi. One must refer to Xue Lizhai’s commentary to be appropriate.

Guo Qizhong asked: What causes generalized body pain after childbirth? He answered: It is because childbirth disturbs the movement of qi and blood, causing their ascending and descending to lose their normal rhythm. They stagnate in the joints, drawing the sinews and vessels into spasm, resulting in generalized body pain. In severe cases, the waist and back become stiff, preventing flexion and extension; the hands and feet become cramped, preventing bending and straightening. There may also be fever and headache. These should not be treated as other diseases; one should simply administer Chen Tong San (Pain-Chasing Powder) to guide the flow of blood and qi, soothing the sinews and vessels, so that the pain stops naturally.

Chen Wuze stated: Chen Tong San not only treats postpartum qi deficiency and blood stagnation but also treats headache due to wind affecting the Taiyang Channel, along with lower back pain, spontaneous sweating, and fever. However, if the pain is caused by cold invasion, food stagnation, worry, fear, shock, or anger, leading to body ache, fever, and headache, especially when complicated by postpartum consumptive disease (Rulao), Chen Tong San cannot cure these conditions. It would be better to use Wuji San (Five Accumulations Powder) decocted with vinegar, which is acceptable.

Xue Lizhai commented: Wuji San treats postpartum body pain accompanied by cold invasion and food stagnation. It is not suitable for those with qi deficiency and weak blood. If pressing on the painful area increases the pain, it indicates blood stasis; use Siwu Tang (Four Substances Decoction) added with Paojiang (Fried Ginger), Taoren (Peach Kernel), Honghua (Safflower), and Zelan (Lycopus Herb) to tonify and dissipate. If pressing slightly relieves the pain, it indicates blood deficiency; use Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), and Paojiang (Fried Ginger) to nourish.

Shen Zhai commented: The above passage describes the syndrome of generalized body pain after childbirth. After childbirth, all joints open, and blood vessels disperse. "Generalized" means that from sinews, bones, skin, and flesh to the hands, feet, hypochondrium, abdomen, waist, and back, there is no place without pain. The *Daquan* attributes this to blood stagnation in the meridians, suggesting an excess condition. However, excessive blood loss leads to deficiency, and wind-cold attacking due to this deficiency also causes pain. Therefore, Chen Tong San is the specific remedy. Chen Wuze’s claim that it cannot cure, and his suggestion of Wuji San instead, is indeed inaccurate.