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The treatment of postpartum diseases: I have seen Zhu Danxi state, "Postpartum conditions require substantial tonification of Qi and Blood. Even if other miscellaneous symptoms arise, they should be treated as secondary. Most illnesses are due to Blood deficiency, and diaphoretic (sweating) methods for releasing the exterior should not be used." His intent was that since Qi and Blood are lost along with the fetus, there must be a severe deficiency. Therefore, regardless of the presenting syndrome, substantial tonification should take precedence, while other treatments can be deferred. In my early years, I genuinely admired this view. However, when I strictly applied it, I often found myself in difficulty. After several iterations and reflections, I realized that while his words had merit, they were somewhat overly absolute. Currently, the obstetrics field reveres this method. I have witnessed numerous errors caused by this approach and personally intervened to rescue patients affected by it. Thus, I dare to analyze the following points based on my own insights. It is not out of a desire to self-aggrandize or disparage sages; doing so would only invite ridicule and censure. Although I am extremely dull, I would never do such a thing. Readers are urged to deeply contemplate this meaning.

In all cases where Qi and Blood are lost after childbirth, there are indeed many deficiency syndromes. However, there are also non-deficiency cases and even complete excess cases. For these three categories, one must assess the specific syndrome and the patient's constitution to distinguish between deficiency and excess, treating them according to standard methods. One must not hold rigid preconceptions and indiscriminately apply substantial tonification, which may exacerbate pathogenic factors. Such differentiation must be precise.

First, postpartum deficiency syndromes depend on the individual's original Qi. They are common in those who were constitutionally weak prior to pregnancy, or whose condition worsens due to the loss of Qi and Blood during childbirth. Treatment requires observing the pulse in relation to the person, and interpreting symptoms based on the pulse. If the pulse energy, physical constitution, and disease presentation all indicate insufficiency, it should be treated as a total deficiency. If the physical constitution is deficient but the disease manifestation indicates excess—such as accompanying Fire pathogen, external pathogen, or food stagnation—it represents a deficiency mixed with excess. This requires careful examination and treatment. The complexities involved cannot be fully expressed in words; only those with clarity can comprehend them.

Second, postpartum non-deficiency syndromes occur in individuals who were previously healthy, were young and vigorous at the time, or possessed constitutions accustomed to hard labor and poverty. These individuals originally lacked no vitality. Upon conception, the addition of the fetus causes Qi and Blood to become congested, leading to distension and vomiting—symptoms arising from an excess condition added to a previously balanced state. After delivery, relief is felt as stagnation clears, and the body returns to its normal state. This is very common among ordinary births; where is the deficiency? However, internal injury or external contraction can still cause illness postpartum. If such pathogens are present, removing them leads to recovery. Would indiscriminate substantial tonification be bearable? Although some Qi and Blood are inevitably consumed during delivery, what remains is largely protective material associated with the fetus. What needs to go goes, and new generation occurs rapidly. Within a few days, recovery is inevitable due to natural physiological processes. Why assume all postpartum cases are deficient? For such cases, treatment must follow the specific syndrome. Insisting that postpartum always requires substantial tonification will inevitably lead to "excess reinforcing excess," worsening mild conditions and endangering severe ones. Thus, formulating theories is difficult, but applying them correctly is even harder.

Third, postpartum complete excess syndromes include external contraction of Wind-Cold, presenting with headache, fever, constipation, abdominal fullness, and a tight, rapid, surging, large, and forceful pulse—this is an exterior excess syndrome. Severe Fire excess presents with thirst, irritability, constipation, abdominal distension, blackened dry tongue and lips, intense craving for cold drinks, excessive eye discharge, painful red urination, and a surging slippery pulse—this is an interior heat excess syndrome. Liver Qi stagnation due to anger causes chest and hypochondriac distension and pain, difficult bowel movements, and a wiry slippery pulse—this is a Qi reversal excess syndrome. Incomplete expulsion of lochia with blood stasis rushing upward causes cardiac and abdominal distension, pain upon pressure, difficult defecation but free urination—this is a Blood reversal excess syndrome. Over-protection in wealthy families, or excessive use of herbs like Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu), leads to Qi congestion. Excessive consumption of sugar, alcohol, or charcoal fire causes internal heat. Using substantial tonics unnecessarily in non-deficient cases aggravates illness—these are management-induced excess syndromes. Overeating postpartum to prevent fatigue, forcing intake despite lack of appetite, leads to food retention—this is an internal injury excess syndrome. The above are merely representative examples. If there is an exterior pathogen, it must be released; if there is Fire, it must be cleared; if there is internal injury and stagnation, it must be unblocked and digested. People vary in strength, childbirth varies in deficiency/excess, diseases vary in truth/falsehood, and treatments vary in counteracting/following approaches. They cannot be discussed uniformly. As stated in the *Suwen: Liuyuan Zhengji Da Lun* ("Great Treatise on the Six Ordinances and Correct Principles"): "If a pregnant woman takes toxic medicines, what happens?" The answer is: "If there is a disease (pathology), the medicine will harm the disease but not the mother or fetus." This is an immutable principle. Why elaborate so much? It is solely because people tend to be biased by Zhu Danxi's words, necessitating detailed explanation to resolve future confusion. Detailed treatments for various deficiency and excess syndromes are provided in subsequent sections.