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Xue Lizhai stated: The treatment of *Rulao* (chronic deficiency syndrome postpartum due to improper care) should primarily focus on nourishing the upright Qi. This is often caused by Spleen and Stomach weakness, leading to reduced food intake, which results in fatigue of all meridians. Therefore, one must tonify the Spleen and Stomach. Once food intake resumes, Jing-Qi (Essence and Qi) will be generated and transformed, providing support for all Zang-Fu organs, and the disease will heal spontaneously.

Shen Zhai commented: The above four passages describe the syndrome of *Rulao* occurring postpartum. The formation of *Rulao* stems from the deficiency and damage of Qi and Blood after childbirth. If daily life is not managed carefully, or if Wind-Cold external pathogens are contracted, or if the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sadness, Fear, Fright) cause emotional distress, leading to irregular activity and improper recuperation, the condition of *Rulao* ensues. *Chanbao* advocates regulation and care as the guideline, while Lizhai prioritizes nourishing the upright Qi.

Guo Jizhong asked: What is postpartum *Benglong* (sudden heavy vaginal bleeding)? He answered: It occurs because excessive lochia discharge causes a sudden deficiency of Qi and Blood, which has not yet recovered. If further aggravated by overexertion or by fright and anger, it leads to sudden violent bleeding. Additionally, those whose Ying-Wei (Nutritive and Defensive Qi) were originally damaged, with weak Qi and Blood, may also develop *Bengzhong* (metrorrhagia). If the lower abdomen is full and painful, this indicates the Liver Meridian is compromised, making it difficult to treat; Gujing Wan (Solidify the Menses Pill) is suitable to stop the bleeding in all such cases. However, if the lower abdomen is distended but not painful, this indicates the presence of stagnant Blood inside. One must not stop the bleeding immediately, otherwise it will result in persistent dripping.

Chen Liangfu stated: Postpartum meridians are depleted. Before they have recovered, overexertion can trigger sudden violent bleeding. Alternatively, immoderate consumption of sour and salty flavors may damage Ying-Wei, also transforming into *Bengzhong*.

Chen Wuzhe stated: *Benglong* is not a mild disease; occurring postpartum, it constitutes severe injury. It is likely not solely caused by immoderate consumption of sour and salty flavors. It is often due to fright, worry, and anger causing disharmony of the Zang-Qi, or taking hemostatic drugs too early after childbirth, preventing the expulsion of lochia. This leads to stagnation, distension, and hardening, resulting in *Bengzhong*. In such cases, relying solely on Gujing Wan is unlikely to be effective. Instead, a large dose of Zhuxiong Gui Tang (Decoction of Chuanxiong and Angelica Sinensis) added with Shaoyao (Paeoniae Radix Alba) should be used, treating according to the specific syndrome.

Xue Lizhai stated: For the aforementioned syndromes, if there is blood stasis with lower abdominal distension, Shixiao San (Smile Powder) should be used. If Liver Fire causes reckless blood flow, Jiawei Xiaoyao San (Modified Free Wanderer Powder) is indicated. If Spleen depression fails to control the blood, Jiawei Guipi Tang (Modified Restore the Spleen Decoction) is appropriate. If Spleen deficiency fails to hold the blood, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used. If rich flavors accumulate heat damaging the blood, Qingwei San (Clear the Stomach Powder) added with Huaihua (Sophorae Flos) is suitable. If Wind-Heat combats each other damaging the blood, Sijunzi Tang (Four Gentlemen Decoction) added with Fangfeng (Saposhnikoviae Radix) and Zhike (Aurantii Fructus Immaturus) should be employed.

Shen Zhai commented: The above four passages describe the syndrome of *Benglong* occurring postpartum. Since the patient has already lost blood during childbirth, the occurrence of *Beng* suggests it is not a mild condition, often belonging to the category of Yin Qi collapse. Jizhong attributes it to exertion and emotional disturbance, viewing internal injury to the Seven Emotions as the root cause. Liangfu’s attribution to dietary imbalance and Wuzhe’s to premature use of hemostatics are not key to the pathogenesis. I believe that excessive postpartum bleeding leads to Yin depletion; thus, Zhang Zhongjing’s methods must be adopted. When blood is lost, Qi must be tonified; using only blood-nourishing herbs is of no help. In *Xue Shi Yi An* (Medical Cases of Xue), a woman with torrential postpartum bleeding was cured using Liujunzi Tang (Six Gentlemen Decoction) added with Paojiang (Prepared Ginger), which grasped the essence of this principle.