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[Guo] What is the cause of abdominal pain and diarrhea after childbirth? The answer is: After childbirth, the intestines and stomach are weak, making them susceptible to invasion by cold pathogens. If one drinks cold water or exposes oneself to wind before the completion of one month, the cold pathogen takes advantage of the deficiency to invade and remain in the huangmo (membranous tissue within the abdominal cavity), spreading to the abdomen and hypochondrium. Consequently, paroxysmal abdominal pain occurs, feeling as if pierced by awls or knives; if the cold flows into the large intestine, causing undigested food and water, it leads to profuse watery diarrhea (dongxie) and borborygmus, or passage of red and white mucus, distension in the hypochondrium, or wandering pain. In such cases, one should urgently take Tiaozhong Tang (Regulate the Middle Decoction) for immediate relief. If a physician mistakenly treats it as accumulation and uses purgatives, disaster will follow immediately; one must be cautious, most cautious.

Chen Wuyue commented: Postpartum dysentery presents various syndromes and should be regulated according to the specific etiology. Since drinking cold water and exposure to wind were mentioned, various external factors may be involved. Cold, heat, wind, and dampness belong to external causes, while joy, anger, worry, and thought stem from internal nature. Moreover, exertion, rest, hunger, and satiety can all induce disease. If it is profuse watery diarrhea, Tiaozhong Tang can be taken. However, for red and white dysentery, this formula cannot cure it; one should refer to other categories for specific correct formulas.

[Xue] Postpartum diarrhea and dysentery may result from dietary injury damaging the Spleen Earth, or from Spleen Earth deficiency failing to digest food. Treatment must be carefully assessed. If injured by rice, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Gu Ya (Valley Sprout). If injured by wheat products, use Liu Jun Zi Tang plus Mai Ya (Wheat Sprout). If injured by meat, use Liu Jun Zi Tang plus Shan Zha (Hawthorn) and Shen Qu (Medicated Leaven). For cases accompanied by vomiting, add Huo Xiang (Patchouli). If accompanied by sour regurgitation or vomiting, administer the aforementioned medicines with Yue Ju Wan (Pill to Resolve Depression). If Liver Wood overacts on Spleen Earth, use Liu Jun Zi Tang plus Chai Hu (Bupleurum) and Pao Jiang (Prepared Ginger). If Cold Water overacts on Spleen Earth, use Qian Shi Yi Huang San (Qian's Formula to Strengthen the Yellow/Spleen). For chronic diarrhea or sinking of Yuan Qi (Primal Qi), combine with Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi) to raise Yang Qi. If the stool/dysentery is yellow, indicating the true Qi of Spleen Earth leaking out, add Mu Xiang (Aucklandia) and Rou Dou Kou (Nutmeg). If Spleen Earth is deficient and cold, use Liu Jun Zi Tang plus Mu Xiang, Gan Jiang (Dried Ginger), and Gui Zhi (Cinnamon Twig). If both Spleen and Kidney are deficient and cold, use Bu Zhong Yi Qi Tang and Si Shen Wan (Four Spirits Pill). If Ming Men Fire (Fire of the Gate of Life) is deficient leading to Spleen Earth deficiency and cold, use Ba Wei Wan (Eight-Ingredient Pill) to tonify the mother of Spleen Earth (Kidney). If urination is obstructive, limbs gradually swell, or asthma/cough accompanies, use Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill) to tonify Spleen and Kidney and promote water metabolism. If Stomach Qi deficiency causes limb edema, treatment must focus on tonifying the Stomach. If prolonged without resolution, or not caused by diet, it belongs to Kidney Qi deficiency. Since the conception sac is governed by the Ren Mai (Conception Vessel) and connected to the Kidneys, and months nine and ten of pregnancy are nourished by Kidneys and Bladder, one must use Si Shen Wan, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), and Ba Wei Wan to tonify the Kidneys. Using diuretic and water-draining agents would further deplete deficiency.

Case 1: A postpartum woman suffered diarrhea and dysentery, fever, thirst, excessive phlegm expectoration, emaciation, poor appetite, occasional chest fullness, and lower abdominal bearing-down sensation for over a year. I diagnosed it as Spleen-Stomach diarrhea. She took Er Shen Wan (Two Spirit Pill) in the morning and Liu Jun Zi Tang in the evening, recovering after three months.

Case 2: A postpartum woman had diarrhea with vomiting and sour regurgitation, facial edema, indicating Spleen Qi deficiency and cold. Initially, Liu Jun Zi Tang plus Pao Jiang was used as the main formula, assisted by Yue Ju Wan, resolving the sour regurgitation. Then, Bu Zhong Yi Qi Tang plus Fu Ling (Poria) and Ban Xia (Pinellia) was used, restoring Spleen and Stomach health.

Case 3: A postpartum woman had diarrhea for over a year, appearing skeletal, with internal heat, afternoon fever, spontaneous and night sweats, oral ulcers, expectorating about three bowls of phlegm daily, and a洪大 (surging-large) pulse that vanished upon heavy pressure. This indicated Ming Men Fire deficiency, Spleen Earth deficiency and cold, manifesting as false heat. The phlegm resulted from Spleen deficiency failing to control and return essence to its source. Ba Wei Wan was used to tonify fire to generate earth, and Bu Zhong Yi Qi Tang was combined to tonify Lung Metal, thereby strengthening Spleen and Stomach.

Case 4: A postpartum woman experienced abdominal pain with tenesmus, uncontrolled dysentery, fatigue, and anorexia, nearing death due to dual deficiency of Spleen and Kidney. She recovered using Si Shen Wan and Shi Quan Da Bu Tang (Great Tonifying Decoction for Ten Insufficiencies). Subsequently, for difficulty digesting food and limb fatigue, she recovered using Bu Zhong Yi Qi Tang.

Case 5: A woman developed dysentery in the fifth month, day and night without cessation, lower abdominal bearing-down pain, fever, and aversion to cold. She took Xiang Lian Wan (Pill with Aucklandia and Coptis) delivered by Liu Jun Zi Tang, improving after two doses. Continuing Liu Jun Zi Tang delivering Si Shen Wan, she fully recovered after four doses. By the end of the seventh month, she exhibited lethargy, desire to sleep, inability to move limbs, heavy body and joint pain, dry mouth and tongue, tasteless food, loose stools, frequent urination, chills, and depression. This indicated dual deficiency of Lung and Spleen-Stomach, with Yang Qi constrained by cold. She recovered using Sheng Yang Yi Wei Tang (Decoction to Raise Yang and Benefit the Stomach).

Wang Shishan treated a postpartum woman with slippery diarrhea, unable to retain even a spoonful of water or grain, which was immediately expelled. This persisted for over half a month. Others considered it critical and used Wu Ling San (Five-Ingredient Powder with Poria) and Ping Wei San (Powder to Maintain Equilibrium), worsening the condition. Wang diagnosed a Ru Huan Ruo (soft, slow, weak) pulse. He stated: "This is stomach injury due to labor during childbirth. Decoctions would increase stomach dampness and are unsuitable." He prescribed Shen Ling Bai Zhu San (Powder of Ginseng, Poria, and Atractylodes Macrocephala) minus Sha Ren (Amomum), plus Chen Pi (Tangerine Peel) and Rou Dou Kou (Nutmeg), administered with Ginger and Jujube decoction. She stabilized after more than ten days.

[Dan] Treating postpartum diarrhea with lochia retention: This is residual blood seeping into the large intestine causing diarrhea, uncontrollable profuse discharge of green, white, or black stool. Use four or five large spikes of Jing Jie (Schizonepeta), burn them to ash in a cup without oil or fire contact, mix with Moschus (Shexiang), and take mixed in three cups of water. Though mild, this medicine cures major illness. (Formula name: Qi San / Miracle Powder.)

Postpartum Diarrhea Formula
Fu Ling (Poria), Chuan Xiong (Ligusticum), Huang Qin (Scutellaria), Bai Zhu (Atractylodes Macrocephala), Gan Jiang (Dried Ginger), Hua Shi (Talc), Chen Pi (Tangerine Peel), Shao Yao (Peony Root, stir-fried) [each equal parts].
Boil in water and take.

Tiaozhong Tang (Regulate the Middle Decoction)
Gao Liang Jiang (Galangal), Dang Gui (Angelica Sinensis), Gui Xin (Cinnamon Heart), Shao Yao (Peony Root), Fu Zi (Aconite Root, prepared), Chuan Xiong (Ligusticum) [each 1 liang], Gan Cao (Licorice Root) [0.5 liang].
Grind into coarse powder. Take 3 qian bi per dose, boil in 3 zhan of water until reduced to 1 zhan, remove dregs, and take hot.
The above formula is suitable only for dongxie caused by cold invading the middle. If there is heat in the intestines and stomach, one should take Huang Lian (Coptis) preparations to recover, such as Ru Jin Wan (Like Gold Pill) or Xiang Lian Wan. Formulas like Wu Ji Wan, Gu Chang Wan, Si Shen Wan, and Wu Wei Zi Wan are essential for postpartum loose stools, detailed in miscellaneous diseases and previous diarrhea sections, so they are not repeated here.