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[Guo Jizhong] What is the cause of abdominal distension, chest fullness, and irregular vomiting after childbirth? The answer is: This is caused by retained blood (postpartum stasis) scattering into the Spleen and Stomach. When the Spleen is affected, it cannot transport and transform essential nutrients, leading to abdominal distension. When the Stomach is affected, it cannot receive and digest food and fluids, leading to vomiting and regurgitation. If physicians do not understand this, and treat it with ordinary medications for distension and vomiting, the medicine will be irrelevant to the disease, further damaging the healthy Qi, making the illness harder to cure. Simply administering Disheng Tang (Cinnamon Twig and Angelica Decoction) will result in recovery.

[Xue Ji] For the aforementioned syndrome caused by retained blood damaging the Spleen and Stomach, the previous formula is appropriate. If food stagnation is in the Spleen, Liu Jun Zi Tang (Six Gentlemen Decoction) added with Hou Po (Magnolia Bark) is appropriate. If food injury is in the Stomach, Liu Jun Zi Tang is appropriate. Generally, when the Spleen is damaged, regulating diet is beneficial. A postpartum patient suffered from the aforementioned syndrome; someone used Didang Tang (Ephedra and Rhubarb Decoction). Although the retained blood was expelled, the symptoms worsened, with a heavy, bearing-down sensation in the lower abdomen and a feeling of needing to defecate. I considered this to be deficiency of Spleen Qi with sinking. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Pao Jiang (Roasted Ginger) to warm and tonify Spleen Qi, resolving the heavy sensation. Subsequently, Liu Jun Zi Tang was used to stabilize the condition.

Disheng Tang includes Ban Liang (approx. 15g) of fresh ginger, roasted dry and decocted in water. (See Abdominal Distension during Pregnancy section. Xue stated: This formula is most suitable.) Pingwei San (Stomach-Pacifying Powder) from *Ju Fang* added with Renshen (Ginseng) may also be used.

[Guo Jizhong] The cause of edema in the four limbs after childbirth is retained blood accumulating due to deficiency, flowing along the meridians into the limbs, lingering deeply, failing to return, rotting like water, thus causing yellow complexion and limb edema. Physicians unfamiliar with this condition often treat it as fluid retention disease. Treatments for fluid retention mostly use diuretic drugs, which are detrimental to extremely deficient individuals. Since the postpartum state is already deficient, using drugs to further deplete it constitutes "double deficiency," often leading to premature death. Simply administering Xiao Tiaojing San (Minor Regulating Menstruation Powder) allows blood circulation to restore and swelling to subside, resulting in recovery.

Chen Wuyue stated: Postpartum edema has various causes. Some swellings begin during pregnancy and persist postpartum. Others result from improper postpartum care, external invasion of cold, heat, wind, or dampness, or internal emotional disturbances (anger, joy, worry, fright), causing Qi and Blood to clash and stagnate in the meridians. One must distinguish between Qi-level and Blood-level pathologies and treat according to the specific etiology, pulse, and symptoms to ascertain the true nature. While Xiao Tiaojing San is effective for Blood-level edema, its action is mild and unreliable. Wu Zhu Yu Tang (Evodia Decoction), Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction), Duohun San (Soul-Rescuing Powder), and Da Tiaojing San (Major Regulating Menstruation Powder) are more critical remedies.

Furthermore, it is discussed that postpartum labor damages Qi and Blood. When the interstices (cou li) are deficient, Wind pathogens invade. Pathogens clashing with Qi prevent its free diffusion, causing deficient swelling and lightness; this is Qi-level swelling due to pathogen-Qi interaction. If the skin resembles a ripe plum, it transforms into Water-level edema. Qi-level swelling resolves with sweating; Water-level edema resolves with promoting urination.

[Zhang Yuansu] If postpartime Wind-Cold remains in the exterior, causing facial and limb edema, Qisheng Wan (Seven-Sage Pill) from *Ju Fang* should be used, taken with warm water, increasing the dose daily until bowel movement occurs. If edema extends to the knees with wheezing and coughing, double the dosage of Muxiang (Aucklandia Root) and Binglang (Areca Seed), indicating excessive Qi stagnation. If edema is accompanied by headache and dizziness, double the dosage of Qianghuo (Notopterygium Rhizome) and Chuanxiong (Ligusticum Rhizome), indicating excessive Wind. If only edema is present, take the original Qisheng Wan.

[Li Dongyuan] Zhongman Fenxiao Wan (Middle Fullness Dispersing Pill) (for miscellaneous diseases with distension). Swallow with Siwu Tang (Four Substances Decoction).

[Zhu Danxi] Postpartum edema must be primarily treated by greatly tonifying Qi and Blood, with minor additions of Cangzhu (Atractylodes Rhizome) and Fuling (Poria), allowing fluids to drain naturally.

[Xue Ji] For the aforementioned syndrome, if Cold-Water insults Earth (Kidney Water overacting on Spleen Earth), nourishing Spleen and Lung is appropriate. If Qi-deficiency edema, benefiting Spleen and Stomach is appropriate. If Water-Qi edema, tonifying Central Qi is appropriate. Refer to the treatment principles in the respective miscellaneous disease sections. A postpartum patient had poor appetite and took digestive aids, resulting in limb edema. I diagnosed insufficient Central Qi, prescribing Buzhong Yiqi Tang in the morning and Liu Jun Zi Tang in the evening, leading to recovery. Later, anger caused abdominal distension; mistakenly taking Chenxiang Huaqi Wan (Agarwood Promoting Qi Pill) led to continuous vomiting and diarrhea, anorexia, dysuria, and abdominal/limb edema, which resolved with Jin Gui Jiashen Shenqi Wan (Modified Kidney Qi Pill from the Golden Cabinet). Another postpartum patient with diarrhea, limb/facial edema, wheezing, and aversion to cold was diagnosed with Spleen-Lung Deficient-Cold. Liu Jun Zi Tang added with Sheng Jiang (Fresh Ginger) and Rougui (Cinnamon Bark) cured the diarrhea; Buzhong Yiqi Tang strengthened the Spleen and Stomach.

[Du Zizhai] Zhang Xuanhui’s concubine developed sudden edema half a month postpartum. Obstetricians treated her for half a month without improvement, and the condition worsened. Du was summoned. Du asked: What did other doctors diagnose? Zhang replied: All said it was Water-Qi Edema. Du said: Incorrect. Water-Qi typically presents with cough and dysuria. Your concubine has neither; she only has cold hands and feet. This is deficiency of the Blood Organs (Liver/Heart) with Qi obstruction, flowing to the face causing edema. He treated her with herbs to nourish Blood and harmonize Qi. After ten days, seven or eight parts of the illness were gone; fully recovered in half a month. The prescription was Mudan San (Moutan Powder) from *Ling Yuan Fang*. It states: Treats Wind-Cold Deficiency of Blood Organs. Currently widely used by obstetricians for postpartum ailments with miraculous effect, also known as Sunjin Tang (Damage-Gold Decoction). (Mudan San see Syncope section.) A postpartum patient with limb edema, alternating chills and fever, suffered because retained blood flowed into meridians and limbs, causing wheezing, cough, chest oppression, sour regurgitation, and hypochondriac pain. She was given Xuanfuhua Tang (Inula Flower Decoction), resolving slightly through mild sweating; frequent administration of Xiao Tiaojing San, taken with Zelan Geng (Agastache Stem) decoction, gradually reduced the swelling.

Da Tiaojing San (Major Regulating Menstruation Powder) treats postpartum distension/fullness, wheezing, irritability, thirst, and dysuria. (See Alternating Chills and Fever after Childbirth section.)

Xiao Tiaojing San (Minor Regulating Menstruation Powder)
Myrrh (Mo Yao), Amber (Hupo), Cinnamon Heart (Guixin), Peony (Shaoyao), Angelica Sinensis (Danggui) (each 1 qian); Asarum (Xixin), Musk (Shexiang) (each 0.5 qian).
Grind into fine powder. Take 0.5 qian per dose, mixed with a little Fresh Ginger Juice and Warm Wine.

Treats generalized cyanotic swelling and pain postpartum, and postpartum blood-water disorders. (From *Furen Jingyan Fang*).
Dry Lacquer (Ganqi), Barley (Damai) (equal parts).
Grind each into fine powder. Layer barley and dry lacquer in a new clay pot, filling it completely. Seal with salt mud, fire-roast until red hot, cool, and grind into powder. For any postpartum disorder, take 2 qian mixed with Hot Wine.

The Classics state: For postpartum superficial swelling, take Tangerine Peel (Ganpi) with wine. (Orange peel ground to powder, 2 qian per dose, taken with wine.)

Baizhu Tang (Atractylodes Macrocephala Decoction) treats heart and abdomen hard and large like a plate, with edges like a spinning top, caused by fluid retention, named Qi Fen (Qi Level).
Immature Bitter Orange (Zhishi, 1.5 liang), Atractylodes Macrocephala (Baizhu, 3 liang).
Cut into pieces. Take 4 qian per dose, decoct in 1.5 cups of water until 0.7 cup remains, strain, and take warm. If rumbling sounds occur in the abdomen, the accumulation will dissipate.

[Zhu Danxi] Women with postpartum edema, scant urine, thirst, aversion to cold, weakness, and deep pulses have constitutional deficiency with damp-heat accumulation, likely causing upper jiao fullness. Tonifying the middle, guiding out water, and moving Qi is appropriate.
Atractylodes Macrocephala (Baizhu, 2.5 liang), Tangerine Peel (Chenpi, 1 liang), Ligusticum (Chuanxiong, 0.5 liang), Akebia (Mutong, 6 qian), Poria (Fuling, 3 qian).
Decoct in water. Take with Yudian Wan (With-Dot Pill) 25 pills. (Scutellaria powder made into pills with rice paste, named Yudian Wan or Qingjin Wan.)

Duohun San (Soul-Rescuing Powder) treats postpartum deficient swelling and wheezing; recovery follows promotion of urination.
Fresh Ginger (Shengjiang, 3 liang, juice extracted), Wheat Flour (Baifan, 3 liang), Large Pinellia (Banxia, 7 pieces).
Mix flour with ginger juice, wrap Pinellia, form into 7 cakes. Roast until charred/cooked, grind to powder. Mix with water (1 cup); effectiveness indicated by urination.

Zhang Shi Formula treats postpartum Blood deficiency, Wind-swelling, and Water-edema.
Agastache (Zelan Ye), Stephania Tetrandra (Fangji) (equal parts).
Grind to powder. Take 2 qian per dose with Warm Wine. Non-drinkers may use Vinegar Water.

Hanfangji San (Stephania Tetrandra Powder) (Contraindicated for deficient persons.)
Stephania Tetrandra (Hanfangji), Polyporus (Zhuling), Bitter Orange (Zhiqiao), Mulberry Root Bark (Sangbaipi) (each 1 liang); Phytolacca (Shanglu), Licorice (Gancao) (each 0.75 liang).
Grind to coarse powder. Take 4 qian per dose, decoct with 1.5 cups water and 3 slices ginger until 0.7 cup remains, strain, and take warm on an empty stomach.

Qisheng Wan (Seven-Sage Pill) (For miscellaneous diseases with constipation.)

Jiawei Wuzhuyu Tang (Modified Evodia Decoction) treats women with inherent organ deficiency, chronic Wind-Cold, chest/diaphragm fullness/pain, abdominal/hypochondriac stabbing pain, vomiting/nausea, reduced appetite, facial/body deficient swelling, aversion to cold/shivering, or persistent diarrhea, shortness of breath, emaciation, and acute organ deficiency postpartum with internal Cold pathogens exacerbating old diseases.
Evodia (Wuzhuyu, 1.5 liang); Platycodon (Kugeng), Dried Ginger (Ganjiang), Licorice (Gancao), Ophiopogon (Maidong), Saposhnikovia (Fangfeng), Pinellia (Banxia), Asarum (Xixin), Angelica (Danggui), Red Poria (Chifuling), Moutan (Mudanpi), Cinnamon Heart (Guixin) (each 0.5 liang).
Grind to coarse powder. Take 4 qian per dose, decoct with 1.5 cups water until 0.7 cup remains, strain, and take hot before meals.

Jin Gui Jiashen Shenqi Wan (Modified Kidney Qi Pill from Golden Cabinet) (See Miscellaneous Diseases: Edema section.)

Jiawei Bawu Tang (Modified Eight-Ingredient Decoction) treats postpartum generalized edema, rapid breathing, and tidal fever.
Ginseng (Renshen), Poria (Baifuling), Prepared Rehmannia (Shudihuang), Small Fennel (Xiaohui) (each 3 qian); Atractylodes (Baizhu), Ligusticum (Chuanxiong) (each 4 qian); Angelica (Danggui), White Peony (Baishaoyao), Cyperus (Xiangfuzi) (each 5 qian); Licorice (Gancao), Scutellaria (Huangqin), Bupleurum (Chaihu) (each 1 qian).
Cut into fragments. Divide into 6-7 doses. Each dose decocted with 1.5 cups water and 3 slices ginger until 0.7 cup remains. Take hot on an empty stomach. After finishing this medicine, take Tiaojing Wan (Regulating Menstruation Pill). If abdominal pain, add Corydalis (Yanhusuo), Dry Lacquer (Ganqi), Bitter Orange (Zhiqiao) (each 3 qian). If vomiting/nausea, add Galangal (Liangjiang), Amomum (Sharen) (each 2 qian). If numbness of limbs, add Cinnamon Bark (Rougui) (1.5 qian). If cough, add Schisandra (Wuweizi), Coltsfoot (Kuandonghua), Apricot Kernel (Xingren).