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[Guo] What is the reason for constipation and dryness of stool after childbirth? The answer is: After delivery, while resting in bed, blood and body fluids are lost along with the birth process, leading to emptiness and exhaustion of the intestines and stomach, and a deficiency of body fluids. Therefore, the stool becomes constipated and difficult to pass. If five or six days pass and there is a feeling of stuffiness and distension in the abdomen, this indicates that dry feces are retained within the zang-fu organs. Because the feces are dry and sticky, they cannot be expelled. It is appropriate to take Mahuang Wan (Cannabis Seed Pill) to moisten the intestines. If mistakenly believed to be due to internal heat, and cold-natured medicines are administered, yang qi will decline and yin will grow, resulting in various complications and endangering life.

[Xue] Constipation after childbirth is caused by excessive blood loss, leading to dryness of the large intestine; or it may be due to blood deficiency generating fire, causing dryness through heat. In such cases, one should not rely solely on counting days. Even if food intake is substantial, using purgative or moistening medicines requires waiting until abdominal fullness and a sensation of urgency arise, where the patient desires to defecate but cannot. This indicates that hardened feces are stuck in the rectum. In this situation, it is appropriate to use pig bile to lubricate. If bitter herbs like Kushen (Sophora Root) are used to moisten and unblock, it will instead damage the yuan qi of the middle jiao. This may lead to even greater difficulty in defecation, or if defecation occurs, diarrhea may become uncontrollable, inevitably resulting in a fatal condition. If the cause is blood deficiency with fire dryness, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) should be used. If both qi and blood are deficient, Bazhen Tang (Eight Treasures Decoction) is indicated. One must strictly avoid using substances like Hemp Seeds (Huo Ren), Apricot Kernels (Xing Ren), and Aurantium Peel (Zhi Qiao).

Case 1: A puerpera had not passed stool for seven days, yet her diet was normal and her abdomen felt fine. I said: Although food intake is high, the abdomen is not distended. Use Bazhen Tang added with Taoren (Peach Kernel) and Xingren (Apricot Kernel). On the twenty-first day, when abdominal distension occurred and she desired to defecate, use pig bile to lubricate. She first passed five or seven pieces of hard feces, followed by normal stools, and recovered.

Case 2: A puerpera had not passed stool for eight days. After using purgative medicines, she experienced pain at Zhongwan (CV12) and had very little appetite. Some argued that "if there is free flow, there is no pain; if there is pain, there is no free flow." I then used honey suppositories (Mi Dao). However, this led to involuntary defecation, hiccups, and an inability to eat. I said: This indicates further injury to the spleen and kidney. Use Liujunzi Tang (Six Gentlemen Decoction) added with Wuzhuyu (Evodia Fruit), Roudoukou (Nutmeg), Gubao Gu (Bone Fat/likely referring to a specific preparation or typo for another herb, contextually warming), and Wuweizi (Schisandra Berry). After several doses, fortunately, because she was young and strong, she recovered. Otherwise, death would likely have ensued.

Case 3: A puerpera suffered from severe constipation and lower abdominal distending pain. After using Dahuang (Rhubarb) and other medicines, she developed vomiting, diarrhea, anorexia, abdominal pain, and chest oppression. I treated her with Liujunzi Tang added with Muxiang (Aucklandia Root) and Paojiang (Prepared Ginger), which cured her.

Case 4: A woman suffered from severe constipation, to which all medicines failed to respond, causing unbearable suffering. I instructed her to drink human milk, which cured her.

Mahuang Wan (Cannabis Seed Pill)
Hemp Seed (Ma Ren, Cannabis Fructus) (ground into paste) - 1 liang
Aurantium Peel (Zhi Qiao, Aurantii Fructus Perfricatus) - 1 liang
Ginseng Root (Ren Shen, Ginseng Radix et Rhizoma) - 1 liang
Rhubarb Root (Da Huang, Rheum Palmati Radix) - 0.5 liang

Grind the above ingredients into fine powder. Mix with refined honey to form pills the size of paulownia seeds. Take 20 pills with warm wine on an empty stomach. If stool does not pass, gradually increase the number of pills, but do not exceed the appropriate dose.

Commentary: Postpartum patients should not be given purgatives lightly; misuse can be fatal. Due to excessive blood loss, the zang-fu organs become dry, leading to constipation. Slipping/moistening methods are indeed appropriate. Dahuang (Rhubarb) should not be used lightly. Instead, mixing scallion juice with tea from the twelfth lunar month to form pills, and taking them down with the same tea, will effectively promote bowel movement. (I often use Siwu Tang (Four Substances Decoction) from the Bureau of Formulas, substituting Sheng Dihuang (Rehmannia Root) for Shu Dihuang, adding Qingpi (Aurantium Peel without white pith), and decocting for administration. This is very effective.)

[Benshi] There are three types of postpartum disorders in women. Yu Mao (depression and dizziness) leads to excessive sweating; excessive sweating leads to constipation. Therefore, medication is difficult to administer. Only Mazisu Zi Zhou (Hemp Seed and Perilla Seed Porridge) is the safest option. Use Zisuzi (Perilla Seed) and Damazi (Hemp Seed), half he each. Wash them and grind them extremely finely. Grind again with water to extract the juice, obtaining one cup. Divide into two portions and cook as porridge to consume. This porridge is suitable not only for postpartum women but also generally for elderly people suffering from various deficiency-induced wind-type constipation.

Case: The mother of one person, aged eighty-four, suddenly experienced abdominal distension, headache, nausea, and anorexia. Several doctors were summoned, who all prescribed medicines to tonify the spleen, promote digestion, treat wind, and clear the head and eyes. Although she recovered after several days, she could not eat at all, causing great worry to her family. I analyzed that the previous prescriptions were incorrect. This case was precisely wind-type constipation in the elderly, characterized by stagnation in the zang-fu organs. Accumulation in the chest causes abdominal distension, nausea, and anorexia; upward movement to the vertex causes headache and mental cloudiness. If the zang-fu organs become smooth and flowing, all diseases will disappear. I ordered the preparation of this porridge. After two servings, qi began to move, and she first passed more than ten pellets of hard feces resembling peppercorns. Subsequently, bowel movements became regular, and she healed without further medication.

[Dan] For postpartum constipation accompanied by abdominal distension, where breathing is rapid and sitting or lying down is difficult, use Da Mai (Barley) stir-fried until yellow, ground into powder. Take one he with wine. The effect is miraculous. (From Bingbu Shouji).