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A student asked, "Regarding postpartum syndromes, various schools of thought offer different discussions and treatment methods. However, in our Fujian region, it has been passed down for a long time to follow Zhu Danxi's saying: 'If there is disease after childbirth, first consolidate Qi and Blood.' Therefore, the main treatment for postpartum conditions is to greatly tonify Qi and Blood; even if there are other miscellaneous diseases, they are treated as secondary issues. Xue Lizhai and Wang Shishan highly praised the efficacy of this method, while the arguments of Chen Liangfu and Shan Yangxian all fell within this scope. Yu Tianmin and Ye Yiqian, on the other hand, advocated removing blood stasis as the primary approach. By referring to these two theories together, one can derive the two major methods of attacking (pathogens) and tonifying (deficiency). Which one should ultimately be followed?"

I said, "These are all vulgar and shallow views, and moreover, they are one-sided statements not worth listening to. Now, I will excerpt two passages from *Huangdi Neijing* (Yellow Emperor's Inner Canon) and the entire chapter on Postpartum Diseases from *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) to annotate them. All other schools' theories will be disregarded, which is what is meant by 'when many voices confuse, rely on the Sages.'"

*Huangdi Neijing* states: "When a woman is nursing (during lactation) and suffers from Shanghan (Cold Damage) with fever, the pulse should be fine and small (it should not be full and large, because the body is newly deficient after childbirth). If the hands and feet are warm, life is possible (prognosis is good); if the pulse is fine and small but the hands and feet are cold, this indicates the exhaustion of Spleen Qi and the sudden rise of Yin pathogenic factors, leading to death."

It also states: "When a nursing woman contracts Wind, and her body becomes extremely hot, leading to wheezing, noisy breathing, and coarse respiration, this is due to Wind-Heat counterflowing to the Yang positions. Therefore, her pulse must not be fine and small, but rather full and large. However, within the fullness and largeness, there must be a sense of coming and going that is harmonious and slow, indicating that the Qi of the Spleen and Stomach is still nourishing the pulse, so life is possible; if the pulse is rapid and urgent, it indicates the exhaustion of Spleen and Stomach Qi, leading to death." These two sections emphasize the Spleen and Stomach, showing that *Huangdi Neijing* places unique importance on them. The mutual refutations among various schools are ultimately insufficient to discuss. An ancient saying goes: 'Short phrases that resonate with the heart are not few,' which refers to grasping the essence while reading.

The student asked again, "*Jingui Yaolue* is more difficult to read than *Shanghan Lun* (Treatise on Cold Damage). Why do you exclusively advocate it for postpartum diseases, Master?"

I said, "Medicine is the undertaking of Confucian scholars. To tackle the difficult tasks first is a clear instruction from Donglu (Confucius in Lu). Merely following old routines and taking shortcuts makes one merely a market doctor. Furthermore, *Jingui Yaolue* categorizes symptoms and lists prescriptions systematically. Without understanding the thread, it is like trying to organize silk threads, resulting in confusion. Now, taking *Jingui Yaolue* as the main text, even gaining a partial understanding is sufficient to save lives, so I have recorded the whole chapter below."

I have often commented that since ancient times, there has been no examination system for doctors, allowing unemployed individuals to pass themselves off as physicians to make a living. Consequently, medical standards have declined daily, especially in gynecology. If a rational person meets a physician and asks, "After Qibo and Huangdi, can Zhang Zhongjing be called a Superior Physician?" Those who do not know will say, "I do not know who he is." Those who know will say, "He was the Medical Sage of the Han Dynasty; the times are too distant to follow." Although times change from ancient to modern, do the Five Movements and Six Qi of Heaven, or the Five Zang and Six Fu organs of humans, undergo inversion and change? Knowing or not knowing is merely fifty steps laughing at a hundred steps. Suppose a rational person copies the original text of the first and second sections of this book and asks current practicing physicians to explain it simply sentence by sentence. If they can explain it well, they are excellent physicians; if they cannot explain it immediately but are willing to take the copied original text back to check against old commentaries and can roughly explain it, we know they possess correct books and their interpretations are not overly fragmented, making them good physicians; or if they take the original text to consult their close physician friends, gathering bits and pieces to explain superficially, we know they have scholarly friends and their views are not absurdly荒唐, making them good physicians. I wish to find such people but cannot meet them soon, which is truly regrettable. Moreover, I hear them boasting: "That belongs to Zhang Zhongjian's school; I belong to the school of Liu Wansu, Zhang Congzheng, Zhu Zhenheng, and Li Dongyuan, the first four great masters; I belong to the school of Wang Kentang, Xue Lizhai, Zhang Jingyue, and Yu Jiayan, the latter four great masters." And the currently popular *Linzheng Zhinan* (Guidelines for Clinical Practice) habitually uses ginger dregs, processed mild Aconite, Rehmannia charred, processed mild Evodia, washed mild Atractylodes, and all kinds of charred medicines, as well as various dried shells from the sea, which are devoid of Qi and flavor. Their treatment methods start by talking about the harmony of Five Elements and Three Combinations, dual mountain inversions, and the subtleties of combination, all vague and baseless claims. For deficiency diseases, they claim to use 'humans supplementing humans,' relying heavily on Placenta humanus boiled into paste (this substance is highly impure, toxic, and inflammatory; I have seen cases where every hundred doses resulted in death. Patients should maintain kindness and perform good deeds, never listening to such cruel and unreasonable advice). For chronic diseases, they speak of 'entering the collaterals,' using old loofah, fresh bamboo shavings, Dang Gui tails, Honeysuckle vine, and Tribulus as secret remedies; they regard watermelon rind, fresh lotus stems, dried mussel meat, and sea cucumber as novel treatments. Instead of selecting the merits from *Zhinan*, they only collect its flaws. If Ye Tianshi were alive, he would surely reprimand and condemn them. Yet they exaggerate, saying, "I am of Ye Tianshi's school." They speak falsely, and we listen falsely; what does this mean for the Dao of Medicine?

I hope all practitioners of the Way will quickly discard these inherited ailments and devote themselves to the teachings of the Sages and Worthies, thereby remaining gentlemen capable of correcting their mistakes!

*Jingui Yaolue* states: "Question: New mothers suffer from three diseases: one is Spasm (Jing), two is Depression and Dizziness (Yumao), and three is Difficulty in Defecation (Dabian Nan). What does this mean? The Master said: New mothers fear lack of sweating. If there is no sweat, Ying and Wei Qi are not harmonious, leading to fever and anhidrosis, resembling exterior Shanghan syndromes. However, the tongue lacks white coating, and there is no headache or stiff neck to distinguish it. Although one might want to sweat, one fears Blood deficiency. Heat causes pores to open, leading to profuse sweating. Sweating opens pores further, making one prone to contracting Wind. Since Blood fails to nourish tendons, and Wind stirs Fire, Spasm results. New mothers fear stagnant blood. If blood does not flow, it stagnates internally, causing fever and abdominal pain, resembling interior Shanghan syndromes. However, the tongue lacks yellow coating, and there is no severe restlessness or extreme thirst to distinguish it. Although one might want blood to flow down, one fears excessive bleeding. Loss of Blood means Qi has no partner and escapes outward, leading to recurrent sweating. Both Blood and Qi are depleted, generating internal Cold, leading to excessive Cold. Blood is Yin; loss of Yin leads to loss of control. Qi is Yang; Yang deficiency leads to counterflow upward. Thus, Dizziness and fainting (Yumao) occur. New mothers, although hoping for sweat and blood flow, fear excessive loss of sweat and blood, leading to depletion of Body Fluids. Dryness of the Stomach and intestines results in difficulty in defecation. Although the three differ, the loss of Blood and injury to Fluids are the same. This presents three diseases as the outline for postpartum conditions, not implying these are the only postpartum diseases."

(Above, it was stated that the outline of new postpartum diseases has three aspects. However, Spasm has the treatment method of Zhuye Tang, detailed later. Let us first discuss the combined symptoms of Yumao and Difficulty in Defecation.) In postpartum Yumao, both Yumao and Difficulty in Defecation are caused by loss of Blood and injury to Fluids. Therefore, the pulse is weak and minute. There is vomiting and inability to eat, and stool is hard, which is a concurrent symptom of the Difficulty in Defecation outline. The body has no sweat, but only the head sweats, which is a specific symptom of the Yumao outline. The reason is that Blood deficiency leads to Yin exhaustion below, causing Cold reversal below (Jue). Cold reversal below causes solitary Yang to float upward, leading to dizziness. Generally speaking, anyone suffering from chronic dizziness is called a 'Majia' (person with dizziness). I observe that for Majia to resolve, heavy sweating must occur. Because Blood deficiency causes Cold reversal below, and Cold reversal below causes solitary Yang to lack foundation and float upward, head sweat occurs. This head sweat is the key point in the Yumao outline. Therefore, for postpartum women, after head sweat occurs, general sweating is welcomed. Because Yin Blood is depleted and Yang Qi is excessively dominant, Yang must be reduced through sweating. Reducing Yang to join Yin allows Yin and Yang to return to balance. The pivot of Yin and Yang is controlled by Shaoyang; only Xiaochaihu Tang can turn this pivot to bring balance. Regarding the outline of postpartum Difficulty in Defecation, the symptoms include dry and hard stools. Due to excessive blood flow, the Sea of Blood in Yangming is dried up, and Blood fails to moisten below. Failure to moisten below causes rebellion upward, leading to vomiting, and disharmony in the middle, leading to inability to eat. Yangming belongs to the Stomach, which is the Sea of Blood. Blood does not generate itself but comes from ingested food and water. People usually know that digestion clears the Stomach, descending rebellious Qi soothes the Stomach, and sweet-cold moistening tonifies the Stomach, but they do not know that Xiaochaihu Tang is a deeper method of harmonizing the Stomach. The phrase in the formula instructions of Xiaochaihu Tang in *Shanghan Lun*: 'When the Upper Jiao is unobstructed, fluids descend, and Stomach Qi harmonizes' serves as an ironclad footnote for this syndrome. Therefore, these two symptoms are collectively treated with Xiaochaihu Tang. This details the etiology and provides the prescription for combined Yumao and Difficulty in Defecation.

(When the) disease (is resolved and the patient can eat,) if fever recurs after seven or eight days, since the fever is without aversion to cold, we know it is not in the exterior but in the interior. Because the patient can eat and then develops fever, we know it is not a deficiency disease but a relapse due to food retention. This is excess in the Stomach, treated primarily with Dachengqi Tang. This states that after severe deficiency, if excess symptoms appear, they should be treated as excess. If one fears the harshness of Chengqi and dares not use it, one risks delaying treatment, leading to worsening deficiency and myriad changes. Alas! Mediocre physicians are unfit for serious matters. If one fears the harshness of Chengqi and uses Barley Sprout, Malt, Hawthorn, and Medicated Leaven instead, consuming Stomach Qi, it is also harmful.

Postpartum (belonging to deficiency, with external Cold obstructing Qi and Blood,) causes abdominal pain, treated primarily with Danggui Shengjiang Yangrou Tang (Dang Gui, Ginger, and Lamb Soup); it also treats abdominal Cold cramps and deficiency fatigue.

Referencing various schools: Pain here refers to lingering pain. It is generally attributed to obstruction by external Cold. Therefore, Dang Gui is used to unblock stagnation in the Blood aspect, and Sheng Jiang (Fresh Ginger) to move Cold in the Qi aspect. During pregnancy, emphasis is placed on excess, so Fuling and Ze Xie are added to Dang Gui Bai Zhu San to drain dampness. In postpartum, emphasis is generally placed on deficiency. Therefore, Dang Gui nourishes Blood and moves Blood stagnation; Sheng Jiang disperses Cold and moves Qi stagnation; and Lamb, being rich in flavor, warms and tonifies Qi and generates Blood. When Qi and Blood are warmed, pathogens disperse and pain stops. This formula combines attack and tonification, thus treating Cold cramps and deficiency. Some doubt that Lamb is too tonifying, not knowing that Sun Simiao said: 'Lamb stops pain and benefits postpartum women.' Ancient teachings are solid evidence, why doubt?

(However, pain may not always belong to deficiency, which must be known.) Postpartum abdominal pain, if accompanied by irritability and fullness without distension, is due to central deficiency and moving Cold. Now, if Fire rebels upward causing irritability, Qi stagnates causing fullness, and Stomach disharmony prevents lying down, this is Heat郁 (stagnating) below and obstructing above. It is treated primarily with Zhishi Shaoyao San (Immature Bitter Orange and Peony Powder). This provides the prescription for abdominal pain with irritability, fullness, and inability to lie down. The formula's intent is to harmonize Qi and Blood stagnation, a mild agent of the principle 'unblocked means no pain.' Following with Barley Porridge harmonizes Liver Qi and nourishes Heart and Spleen, thus also treating abscesses and pus.

The Master said: For postpartum abdominal pain, the method dictates Zhishi Shaoyao San. If it does not heal, this is due to Heat scorching Blood, with dry Blood in the abdomen. The pain is fixed below the umbilicus, beyond the reach of Zhishi and similar herbs. It should be treated primarily with Xiayu Xue Tang (Remove Stagnant Blood Decoction); it also treats irregular menstruation. This provides the prescription for pain fixed below the umbilicus. The idea is that once the pathogen is removed, deficiency naturally returns; there is no need to doubt its harshness.

(However, there are cases where one cannot solely purge Blood stasis, which must be known.) Seven or eight days postpartum, without Taiyang symptoms (headache, fever, aversion to cold), but with firm pain in the lower abdomen, this is incomplete expulsion of Lochia. The practitioner merely purges Blood stasis. However, if there is constipation, irritability, fever, and the pulse is slightly full, this indicates excess in the Stomach house. Yangming is prosperous during Shen, You, and Xu hours (3 PM - 9 PM); dusk is when Yangming tends to prosper. Double fever occurring at dusk with irritability is another verification of Stomach Heat. Food enters the Stomach and augments Yang Qi. If not eating, it stops; but if eating aids Stomach Heat to cause delirium, this is another verification of Stomach Heat. However, there is a most precise differentiation: Day is Yang and Night is Yin. If the disease were truly in Yin, it should be lighter by day and heavier by night. Now, at night, when Yangming Qi should be declining, the condition improves slightly. This leaves no doubt that it is excess Heat in the Stomach house. Dachengqi Tang is used primarily. This soup dispels both Heat and accumulation; the Heat is in the interior of Yangming, and the accumulation is in the Bladder area (lower abdomen). This states that although Blood is accumulated in the lower abdomen, if there is excess Heat in the Stomach, Dachengqi Tang should be used primarily. If one only treats the Blood and neglects the Stomach, although Blood may be removed, Heat will not be eliminated, and Blood removal may not succeed.

The four characters 'improves at night' in this clause are the major eye for syndrome differentiation. Day is Yang and governs Qi; dusk is Yin and governs Blood. Observing the previous section: 'In women with Shanghan fever, whose menses just arrived, clarity during the day and delirium at night, seeing ghosts, this is Heat entering the Blood Chamber.' From these words, reasoning oppositely, we know that 'improves at night' indicates the disease is not solely in the Blood.

Postpartum Wind Strike, persisting for dozens of days without resolution, seemingly not fitting the Guizhi Syndrome example. However, slight headache, aversion to cold, and intermittent fever are all original symptoms of Guizhi. Only the sensation of stuffiness in the epigastrium indicates pathogen entering the chest and diaphragm, an interior syndrome of Taiyang. The remaining symptoms of dry retching and sweating are originally present in the Guizhi syndrome example. Thus, Guizhi syndrome advancing one level becomes Yangdan Syndrome. Slightly increasing Guizhi Tang creates Yangdan Tang. If the disease has lasted long but Yangdan Syndrome persists, Yangdan Tang can be given.

Zhang Shiwan said: Citing this alongside the Dachengqi Tang above forms a pair of Exterior and Interior, not doubting the exterior syndrome due to the number of days.

(Nan Yuanxi) Commentary: This states that postpartum Yangdan Syndrome has not ceased; although the disease is long-standing, its formula is still used. *Shanghan Lun · Taiyang Chapter* has the phrase 'adding Fuzi between them, increasing Gui Zhi to induce sweating.' 'Adding' implies continuing from the preceding symptoms resembling Guizhi, hence taking the original Guizhi formula. 'Increasing Gui Zhi' means adding two liang of Cinnamon Twig to the original Guizhi Tang, totaling five liang. Sun Simiao failed to recognize these sentences, instead claiming Yangdan Tang is Guizhi Tang plus Scutellaria. Later generations followed this, and it remains unresolved to this day. How difficult reading is! However, *Shanghan Lun* specifically uses the three characters 'induce sweating' in this formula, which is a major eye. Its difference from Guizhi Jia Fuzi Tang treating leakage is a difference within similarity, and also a similarity within difference. Stopping leakage is a corrective function; inducing sweating is an expelling force. Adapting appropriately is how formulas enter the divine realm. The previous section had interior Heat forming excess; even seven or eight days postpartum, giving Dachengqi Tang did not harm due to harshness. This section has exterior pathogen unresolved; even after dozens of days, giving Yangdan Tang did not deplete due to duration. The mystery within is hard to explain to shallow people. Danxi said postpartum requires mainly great tonification of Qi and Blood, with others treated as secondary. He also said: 'Shaoyao destroys the energy of life.' This teaches mediocre physicians a way to hide their incompetence, misleading people; I must directly斥 (reprimand) it.

(Zhangsun Xindian Bing) Commentary: Headache, aversion to cold, intermittent fever, spontaneous sweating, and dry retching are all Guizhi symptoms. Not using Guizhi Tang is because of epigastric stuffiness, requiring the method of Guizhi Qu Shaoyao Tang. Now, due to postpartum Blood loss, one cannot directly remove Shaoyao. One must increase Gui Zhi to disseminate Yang. Sweating lasting dozens of days, although distinct from leakage after inducing sweating, should borrow the main method of Guizhi Jia Fuzi Tang to secure the root of Shaoyin to stop sweating. Moreover, stopping sweating is within inducing sweating. This is why Yangdan Tang fits perfectly.

(Prior to this, Spasm was one of the three outlines of postpartum. However, Spasm originates from Wind Strike. Now discussing Wind Strike potentially transforming into Spasm.) Postpartum Wind Strike, fever, red face, wheezing, and headache. This disease is in Taiyang, extending to Yangming. Postpartum Zheng Qi is too deficient to overcome the pathogen, genuinely fearing transformation into Spasm. Zhuye Tang is used primarily. This provides a formula to tonify Zheng and scatter pathogen for postpartum Wind Strike with deficient Zheng and abundant pathogen. Using Zhuye as the sovereign herb in the formula is because Wind is a Yang pathogen; if unresolved, it transforms into Heat. Excessive Heat scorches tendons causing Spasm. Therefore, among warm-dispersing herbs, Zhuye is used first to curb its momentum, which is the way to prevent gradual development. (Taiyang meridian ascends to the head; Yangming meridian passes over the diaphragm and follows the face; combined diseases of these two meridians often add Ge Gen.)

For women nursing who are deficient, experiencing irritability, chaos, retching, and counterflow, Anzhong Yiqi Wan (Peace the Middle and Tonify Qi Pill) is used primarily.

Xu Zhongke said: 'Ru' refers to a nursing woman. It means excessive milk loss leads to insufficient Yin Blood and deficiency in the Stomach. *Neijing* says: 'Yin is the guardian within.' Yin deficiency cannot overcome Yang, so Fire surges upward causing irritability, and Qi surges upward causing retching. Irritability with chaos is severe irritability; retching with counterflow is severe retching. The disease fundamentally arises from central deficiency. However, the medicine only uses Bamboo Shavings, Cinnamon, Licorice, Gypsum, and Anemarrhena. Because central deficiency leads to retching and irritability, the Gallbladder organ receives pathogen, with irritability and retching as main diseases. Therefore, Bamboo Shavings, which clears irritability and stops retching, is the sovereign; Yang Qi in the chest is unused, so Cinnamon and Licorice support Yang and transform counterflow Qi as ministers; Gypsum cools deficiency Heat in the Qi aspect of the Upper Jiao as assistants; Anemarrhena removes floating Heat on the exterior as guides. Know that irritability, chaos, retching, and counterflow without intestinal pain or dysentery indicate deficiency without Cold. The wonder lies in adding Cinnamon to cooling agents, and especially in using raw Licorice in large amounts. The intent is to scatter accumulated pathogen and restore clear Yang Qi; the middle becomes peaceful, Qi self-tonifies, hence no tonifying agents. And noting the original intent of establishing the decoction, it says 'Peace the Middle and Tonify Qi.' How miraculous is Zhupi Da Wan! For wheezing, add Bi Zi (Biota Seed). Biota faces west, receiving Western Qi deeply, thus benefiting Metal Qi, moistening Liver Wood, and nourishing the Heart, so the Lung is not scorched, and wheezing calms. With Heat, double Anemarrhena, as Anemarrhena removes floating Heat. Thus, *Duanju* Guizhi Jia Longgu Muli Tang says: 'For excessive sweating and floating Heat, remove Cinnamon, add Anemarrhena and Aconia each three fen, named Erjia Longgu Tang.' Thus, Anemarrhena's ability to remove floating Heat is known.

(Every dysentery disease is mostly due to Damp-Heat. Qinghao's bitterness defeats Dampness, and Cold eliminates Heat, certainly appropriate. But) postpartum dysentery with extreme deficiency, (seems one must consider tonifying agents; but Renshen and Baizhu may cause stagnation, Fuling and Zexie may injure Fluids. Only Beitouweng Jia Gancao Ejiao Tang is used primarily.) Truly symptomatic. In the formula, Licorice's sweet-coolness clears the middle, which is tonifying the middle; Ejiao's moistening removes Wind, which harmonizes Blood; using this to treat dysentery is using it as great tonification. Those who treat dysentery and favor Renshen and Baizhu should reflect. This provides the prescription for postpartum dysentery with extreme deficiency.

*Jingui Yaolue* Appendix Formula says: *Qianjin Fang* Sanwu Huangqin Tang treats women (who have not yet left the birthing place, still lying on straw mats, spontaneously (removing covers,) exposing (their bodies, and getting