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Zhu Danxi stated: It is essential to greatly tonify Qi and Blood before treating Phlegm. Treatment should be differentiated based on the relative abundance or deficiency of Qi and Blood as indicated by the pulses at the left and right wrists. One must absolutely not treat it as Wind-Stroke (Zhong Feng, a condition caused by external wind pathogen invading the meridians) and use Wind-dispelling medicines such as Xiao Xuming Tang (Minor Continuation Life Decoction).

Xue Lizhai stated: Postpartum opisthotonos (back arching) and limb convulsions are caused by excessive blood loss, leading to a lack of nourishment for the sinews. Greatly tonifying Qi and Blood will mostly ensure safety; however, if one uses methods to release the exterior and dispel Wind, fewer than one in a hundred will survive.

Wu Shuqing stated: Cold pathogen causes contraction and pulling. Stiffness and rigidity of the back and neck indicate Cold in the Taiyang Meridian (Taiyang Channel). Various schools advocate the use of Xuming Tang, which is an ancient method. However, Ms. Guo indiscriminately applies Xuming Tang without considering the postpartum constitution's deficiency or excess, or the presence or absence of pathogens, which seems biased. As for Mr. Xue, who specifically advocates that excessive blood loss requires Shiquan Dabu Tang (Ten Complete Tonifying Decoction), this might be a limited observation. *Yijian Zhi* records cures using Dadou Zi Tang (Soybean Purple Decoction) and Duhuo Tang (Angelica Pubescens Decoction), which also focus on treating Wind. Thus, Xuming Tang is not necessarily misused, but since the formula contains Mahuang (Ephedrae Herba) and Fuzi (Aconiti Lateralis Radix Praeparata), it should not be used lightly in patients with dual deficiency of Qi and Blood. Yet, in her discussion, Ms. Guo advises rapid administration to induce sweating for resolution, seemingly ignoring the contraindication of Mahuang. Why is this? Both perspectives have merit and require careful consideration during clinical practice.

Shen Yaofeng stated: Zhang Zhongjing discussed opisthotonos as Jing disease (Spasm). Those without sweating are called Gang Jing (Yang Spasm), treated primarily with Gegen Tang (Kudzu Root Decoction); those with sweating are called Rou Jing (Yin Spasm), treated primarily with Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction). Guizhi Tang (Cinnamon Twig Decoction) is the main formula for treating Wind-Strike (Zhong Feng, a condition characterized by susceptibility to wind due to Wei Qi deficiency), so spasms with sweating belong to Wind; Gegen Tang uses Mahuang, which is the primary herb for dispersing Cold, so spasms without sweating belong to Cold. When treating Shaoyin Shanghan (Cold Damage to the Shaoyin channel) without interior signs such as hematemesis or epistaxis, Zhang Zhongjing used Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction) or Mahuang Fuzi Gancao Tang (Ephedra, Prepared Aconite, and Licorice Decoction) to induce slight sweating. This is because the Cold pathogen takes advantage of Shaoyin deficiency to enter; urgently using Fuzi protects the Yang in Kan (the Kidney/Water element), while Mahuang disperses the external Cold. This is truly a divine prescription. Although Xiao Xuming Tang was not formulated by Zhang Zhongjing, its use of these two herbs perfectly illustrates the synergy between attacking and defending. Wu Shuqing, conversely, claimed that Mahuang and Fuzi should not be used lightly in cases of dual Qi and Blood deficiency. If Mahuang were removed, how would one disperse the invading Cold? If Fuzi were removed, how would one preserve True Yang? They are simply contraindicated in Rou Jing with sweating! There are two types of Rou Jing with sweating: one is due to deficiency allowing external Wind invasion; the other is sinew tension due to Blood deficiency without external Wind. In cases with Wind, despite sweating, there is aversion to wind, treated primarily with Hua Yuanhua’s Yufeng San (Wind-Peace Powder). In cases of pure Blood deficiency without Wind, there is no aversion to wind, and treatment should purely focus on nourishing Blood.

Shen Yaofeng further stated: Beyond Qi and Blood, the human body possesses True Yang and True Yin hidden in Kan, which form the foundation of life. The fetus is connected to the Kidneys, which govern the lower orifices. During childbirth, the lower Jiao opens widely; can the Yin and Yang in Kan remain undamaged? Moreover, the four rows of meridians along the spine are all Taiyang channels; the interior of Taiyang is Shaoyin; the single meridian within the spine is the Du Mai (Governing Vessel), which also belongs to Shaoyin. The urgency and contraction of this meridian are closely related to Shaoyin. This reveals the profound intention behind using Mahuang together with Fuzi. If this principle is ignored and one merely clings to treating Qi and Blood deficiency for all postpartum diseases, medical practice becomes too simplistic!

Xiao Xuming Tang: Treats postpartum Wind-Strike, with body stiffness or flaccidity, numbness and anesthesia, deviation of the mouth and eyes, trismus (lockjaw), and opisthotonos.
Fangfeng (1 qian), Mahuang (devoid of joints), Huangqin, Baishao, Renshen, Chuanxiong, Fangji, Rougui (each 0.7 qian), Fuzi (prepared), Xingren (each 0.5 qian), Gancao (0.4 qian, honey-fried).
Add fresh ginger, decoct in water, and take orally.

Hua Tuo’s Yufeng San: Treats postpartum Wind-Strike, trismus, lockjaw, convulsions of hands and feet resembling opisthotonos. Also treats postpartum Blood Syncope with loss of consciousness, limb rigidity; or sensation of organs reversing, severe vomiting and diarrhea threatening death. This medicine clears the Spirit, Qi, Blood, and vessels, with miraculous efficacy.
Jingjie (Schizonepetae Spica), slightly fried and powdered. Take 3 qian per dose, mixed with wine infused with black soybeans; child’s urine may also be used. For trismus, pry open the mouth and administer, or insufflate into the nose.

Li Shizhen stated: This formula is highly praised in various texts. Yao Sengyuan’s *Jiyan Fang* administers it with wine, naming it Rusheng San (Like-Sage Powder), taking effect immediately upon ingestion. Chen’s formula is named Juqing Gubai San. Xiao Cunjing’s formula uses ancient copper coins decocted in water, named Yinnian Jin. Xu Shumi’s *Benshi Fang* states: This medicine indeed has miraculous effects. A puerperal woman slept for a long time; upon waking, she was dizzy as if drunk and unconscious. The physician used this medicine and Jiaojiao San. He predicted she would sleep after taking it and must scratch her head with her left hand. It happened exactly as predicted. Zan Yin’s *Chanbao Fang* states: This illness is often caused by anger injuring the Liver, sorrow causing internal stagnation, or catching wind during labor; this medicine is suitable. Dai Shi’s *Zhengzhi Yaojue* names it Duxing San. Jia Sidao’s *Yueshengtang Suichao* calls it Zaisheng Dan. *Zhimi Fang* adds Danggui in equal parts.

Shen Yaofeng stated: In March of the Dingchou year, the fourth daughter-in-law of Jin Yuxun from Liantang suffered postpartum complications, and her husband invited me to consult. He first described the symptoms: In October last year, delivery was healthy. By early December, facial edema appeared. Wind-dispelling treatments failed; adding three doses of Mahuang resulted in generalized swelling and oliguria; treating with Wupi Yin (Five-Bark Decoction) worsened umbilical protrusion; using Rougui combined with Wuling San slightly improved urination and reduced swelling; continuing with Guifu Dihuang Wan gradually reduced edema, except in the right hand and foot. Suddenly, one day, deviation of the mouth and eyes occurred, the right hand and foot could not move, and speech was impaired. Treating as Blood deficiency led to inability to extend the back. Days later, a basinful of black blood was vomited; afterward, flexion and extension returned to normal. After ten days, inability to extend recurred, followed by vomiting black blood again; administering blood-resolving herbs caused the closed mouth to suddenly open as if relieved. Her mother decocted 3 qian of Renshen overnight and administered it, restoring consciousness; she then asked for food and drank a small cup. Recently, she experienced syncope; Renshen infusion did not revive her, and this had persisted for three days and nights. I went to examine her. The right pulse was absent, likely due to extreme edema, so I did not find it strange; the left pulse was imperceptible on superficial palpation but felt like touching a blade on deep pressure. I said: This is an Excess pattern; stopping Renshen allows for curable treatment. I prescribed Danshen (Arisaematis Cum Bile), Banxia (Pinelliae Rhizoma Preparatum), Shichangpu (Acori Tatarinowii Rhizoma), Chuanpi (Citri Reticulatae Pericarpium), Tianchong (Mylabris), Dilong (Pheretima), and Zicao (Arnebiae Radix seu Lithospermi Radix), decocted in water, with Zhuli (Bamboo Sap) and Jiangzhi (Fresh Ginger Juice) added. Improvement was seen after one dose; limbs could move after four doses. Without changing the formula, after twelve doses, she could leave the inner room for pulse diagnosis, with all ailments subsiding, except unclear speech, which resolved with the same formula. When Jin asked about the origin of this strange disease, I said: Human viscera are adjacent; after conception, a mass increases in the abdomen, disrupting visceral mechanisms. The five fluids gather into Phlegm-Fluids; thus, half of prenatal diseases involve Phlegm stagnation. Banxia Fuling Tang (Pinellia and Poria Decoction) from *Qianjin* is therefore miraculous. At parturition, Phlegm-saliva and lochia exit together, resulting in health; if bleeding is stopped but Phlegm-Fluids do not descend, various diseases arise. Therefore, if regulating Blood postpartum fails, Liushen Tang (Six-God Decoction) is the key medicine. This case began with Phlegm-Fluids obstructing the airway causing edema; Blood was originally unaffected. The reduction of swelling with Wuling San and Shenqi Wan was because Phlegm obstruction in the airway temporarily opened due to heat. Prolonged use overheated the Blood level, causing two episodes of hematemesis. Regarding hemiplegia, deviation of the mouth and eyes, and tongue dysfunction, these are all manifestations of Phlegm stagnating in the collaterals. Even syncope here was caused by Phlegm confusing the mind, not Deficiency collapse. Thus, resolving Phlegm and unblocking collaterals leads to gradual recovery. What is strange about this?

Wang Mengying commented: Such profound insights come from experience. Zhu Shengfu’s son Zhonghe’s wife suffered this after delivery; medical treatment could not eradicate the root; it recurred after subsequent deliveries, persisting for years; upon re-pregnancy, attacks became more frequent. I used large doses of Phlegm-draining medicines for over a month; postpartum she was safe, and the root cause was eradicated.

Shen Yaofeng stated: A woman from Zhenze, more than ten days postpartum, consulted my teacher Jin Dawen, with me accompanying. She reported that at delivery, symptoms resembled Deficiency collapse, and several doses of warming-tonifying medicines were taken. Recently, a strange syndrome developed: the left side is cold, the right side is hot, affecting the whole body and limbs, divided front-to-back. Cold feels like ice, heat feels like charcoal, even the nose reflects this; the tongue coating is white on the left and black on the right. My teacher asked: What disease is this? Which formula should be used? I said: It is not recorded in books, nor have I seen it with my own eyes; I do not know which formula to apply. My teacher said: Strange syndromes should be sought in books without formulas. Does the Classic not say: Left and right are the pathways of Yin and Yang; Yin and Yang are the omens of Water and Fire. Retained Blood blocks the pathways of Yin and Yang ascending and descending, preventing rotation. Where Yang is abundant, it naturally heats; where Yin is abundant, it naturally chills, hence the偏热偏寒 (bias toward heat and cold). Two doses of Zelán (Leonuri Fructus), Zharon (Crataegi Fructus), Liuji Nu (Josephinae Herba), Sumu (Pterocarpus Santalinus), Taoren (Persicae Semen), and Hupo (Amber) reduced the heat by half, but subsequent doses were ineffective. Physicians changed and treated杂乱ly, leading to death. Reflecting now, this syndrome involved not only Blood stasis but also Phlegm stagnation. My teacher identified the blockage of Yin-Yang pathways and recognized the source of the disease, but he remained trapped in the circle of postpartum blood-resolving. If blood-resolving failed, combining Phlegm-resolving might have revived her like the previous case of Mrs. Jin. At that time, Peng was just beginning his studies; my teacher’s insight was outstanding, but he had not fully comprehended Blood stasis syndromes. Regrettably!

Xue Lizhai Medical Case: Sister-in-law of Guo Maoxun, Lady Jinhua, did not eat for seven days postpartum, then complained of headache. After the headache ceased, heart pain arose, followed by eye pain like cutting or stabbing, recurring intermittently without pause. Whenever the headache occurred, she desired a heavy stone to press on her head; after a long while, it gradually settled. When heart pain arose, she scratched her chest with ten fingers, filling her palms with blood. When pain subsided, eye pain returned, and she dug at her eyes with both hands. This continued for ten days without relief; physicians had no plan. Administering half a pill of Heilong Dan (Black Dragon Pill) alleviated the disease slightly. Taken again at midnight, she slept soundly until morning. Upon rising, she passed stool, approximately three sheng, resembling locust larvae; the disease halved. At the Si hour, she passed stool again as before, and pain was completely eliminated.

Heilong Dan: Treats difficult labor and retained placenta, Blood confusion and syncope, loss of consciousness, and any critical emergency conditions nearing death. As long as the medicine is swallowed, survival is assured.
Danggui (Angelicae Sinensis Radix), Wulingzhi (Trogopterori Faeces), Chuanxiong (Ligustici Chuanxiong Rhizoma), Liangjiang (Galangal Rhizome), Shudi (Rehmanniae Radix Preparata) (each 2 liang, chopped, placed in a stir-fry pan, sealed with paper paste and salt mud, calcined over fire), Baicaoshuang (Herba Artemisiae Argyi Carbonis) (1 liang), Liuhuang (Sulfur), Ruxiang (Olibanum) (each 2 qian), Hupo (Amber), Huaruishi (Pyritum) (each 1 qian).
Grind into fine powder, make pills with vinegar paste, size of a bullet. Use 1-2 pills per dose, calcine until red-hot on charcoal fire, immerse in fresh ginger juice until dissolved, mix with child’s urine and wine, and administer orally.