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Guo Jizhong said: What is the cause of constipation and dryness of stool after childbirth? The answer is: After delivery, while lying in bed, both water (body fluids) and blood are discharged. This leads to deficiency and exhaustion of Stomach Qi, and insufficiency of Jin-Ye (Body Fluids), resulting in constipation and difficulty in defecation. If five or six days pass and the abdomen feels distended and stifling, this indicates that dry feces are retained within the Zang-Fu organs. Because the feces are dry and astringent, they cannot be expelled. It is appropriate to administer Mahuan Wan (Hemp Seed Pill) to moisten the intestines. If mistakenly treated as having internal Heat by administering cold-natured medicines, Yang will decline and Yin will grow, leading to various complicated syndromes and endangering life.

Xue said: The aforementioned symptoms are caused by excessive blood loss, leading to dryness of the Large Intestine. One should not rely solely on the number of days passed. Even if food intake is high, one should not arbitrarily use purgatives. One must wait until the abdomen feels full and distended, with the urge to defecate but inability to do so; only then can it be determined that the feces are impacted in the rectum. In such cases, pig bile is suitable for lubricating the intestines. If bitter-cold purgative agents are taken, they will damage the Qi of the Middle Jiao (Spleen and Stomach). This may result in increased difficulty in defecation, uncontrolled diarrhea, or the formation of Pi Syndrome (abdominal masses/distension). For cases of excessive blood loss, Shiquan Dabu Tang (Decoction for Complete Great Tonification) should be used. For cases of Blood Deficiency with Fire Dryness, Jiawei Siwu Tang (Modified Four Substances Decoction) should be used. For cases of both Qi and Blood Deficiency, Bazhen Tang (Eight Treasures Decoction) should be used. Even if there is no bowel movement for several days, provided that appetite remains normal and the abdomen feels unchanged, Bazhen Tang added with Tao Ren (Peach Kernel) and Xing Ren (Apricot Kernel) should still be used. If one rigidly adheres to the number of days and uses purgatives merely because food intake is high, it would be an error.

A postpartum woman had not had a bowel movement for seven days. Her diet was normal, and her abdomen felt unchanged (this requires keen observation and discernment). I stated: Although food intake exceeds the usual amount, the abdomen is not distended. I prescribed Bazhen Tang added with Tao Ren and Xing Ren. By the twentieth day, when abdominal distension occurred and she felt the urge to defecate, I used pig bile to lubricate the bowels. She first passed five to seven pieces of dry feces, followed by normal stools, and her condition stabilized.

Another postpartum woman had not had a bowel movement for eight days. Someone administered purgative medicines, causing distending pain in the Zhongwan (CV12) region and reduced food intake. Some argued, "If there is free flow, there is no pain; if there is pain, there is no free flow." Consequently, honey suppositories were used, leading to involuntary defecation, hiccups, and inability to eat. I stated: This is a secondary injury to the Spleen and Kidney. I prescribed Liujun Zi Tang (Six Gentlemen Decoction) added with Wuzhuyu (Evodia Fruit), Roudoukou (Nutmeg), Gusuibu (Drynaria Rhizome), and Wuweizi (Schisandra Berry) over several doses. Fortunately, she was young and vigorous, and she recovered; otherwise, it likely would have been fatal.

Another postpartum woman suffered from constipation and lower abdominal distending pain. After using Rhubarb (Dahuang) and other medicines, she developed vomiting, diarrhea, anorexia, abdominal pain, and chest oppression. I treated her with Liujun Zi Tang added with Muxiang (Aucklandia Root) and Paojiang (Prepared Ginger), which cured her.

Another woman suffered from severe constipation and dryness, to which various medicines failed to respond, causing unbearable suffering. I instructed her to drink human milk, which brought relief.

Li said: For postpartum fecal impaction, Xionggui Tang (Ligusticum and Angelica Decoction) added with Fangfeng (Saposhnikovia Root), Zhike (Bitter Orange), and Gancao (Licorice Root) should be used. For constipation and dryness, Maziren Wan (Hemp Seed Pill) or Susu Zhou (Perilla and Hemp Seed Porridge) should be used. Generally, excessive blood loss after childbirth leads to Yu Mao (Depression and Vertigo); Yu Mao causes profuse sweating; profuse sweating leads to constipation. All these stem from Blood Deficiency.

Tiaodao San (Regulating and Guiding Powder): Treats constipation in women before and after childbirth.
Danggui (Angelica Sinensis Radix), Chuanxiong (Ligusticum Chuanxiong Rhizoma), Fangfeng (Saposhnikovia Divaricata Radix [Note: Fangfeng is used because to descend, one must first ascend]), Zhike (Aurantii Fructus) (each 4 qian), Gancao (Glycyrrhizae Radix et Rhizoma, prepared with honey) (2 qian).
Crush the herbs. Take 1 liang per dose, with three slices of fresh ginger and one jujube. Decoct in water and take warm. Avoid foods that stir wind.

Mahuan Wan (Hemp Seed Pill): Treats constipation and dryness due to excessive blood loss after childbirth, depletion of Jin-Ye (Body Fluids), and failure of transportation and transformation.
Dama Ren (Cannabis Sativa Semen), Zhike (Aurantii Fructus, stir-fried with flour), Renshen (Panax Ginseng Radix et Rhizoma) (each 1 liang), Dahuang (Rhei Radix et Rhizoma) (0.5 liang).
Grind into powder, mix with refined honey to form pills the size of paulownia seeds. Take 20 pills per dose on an empty stomach with warm wine or rice gruel. If unrelieved, gradually increase the number of pills, but do not exceed the limit. Commentary: Purging is contraindicated after childbirth; those who purge rarely survive. Due to excessive blood loss and dryness of the Zang-Fu, constipation occurs, and lubrication is indeed indicated. However, Dahuang (Rhubarb) should not be used lightly. A better method is to mix scallion juice with La Cha (aged tea) to form pills, and take them down with aged tea, which ensures passage. (This is also a good method. While Dahuang should not be used lightly postpartum, if the Large Intestine is severely constipated or lochia does not exit, Dahuang is necessary to promote free flow. However, immediately after purging, large doses of tonics such as Renshen, [missing character, likely Huangqi], Baizhu, Gancao, Chuanxiong, and Danggui must be used to restore Yuan Qi (Primal Qi). Otherwise, collapse of Yuan Qi will occur, making recovery impossible.)

Zichang Wuren Wan (Intestine-Nourishing Five Seeds Pill): Treats constipation and difficult defecation due to Qi and Blood deficiency after childbirth.
Xing Ren (Armeniacae Semen Amarum, peeled and stir-fried with flour), Tao Ren (Persicae Semen, prepared as above) (each 1 liang), Baizi Ren (Platycladi Semen), Songzi Ren (Pinus Massoniana Semen), Yuliren (Pruni Semen) (stir-fried with flour) (1 qian), Juhong (Citri Reticulatae Pericarpium Rubrum) (4 liang, ground into powder) [Juhong is the sovereign herb to harmonize Qi and promote downward movement].
One variation adds Danggui Shao (Angelica Sinensis Radix tip) (5 qian).
Grind the five seeds separately into a paste, mix with Citrus powder, and grind again. Mix with refined honey to form pills the size of paulownia seeds. Take 30 pills per dose, increasing to 50-60 pills, before meals with clear rice gruel.

Ejiao Zhike Wan (Donkey-Hide Gelatin and Bitter Orange Pill): Treats postpartum constipation.
Ejiao (Colla Corii Asini), Zhike (Aurantii Fructus) (equal parts).
Grind into powder, mix with refined honey to form pills the size of paulownia seeds. Coat with Talcum Powder. Take 20 pills with warm water. Repeat if unrelieved.

Mazu Zhou (Hemp Seed and Perilla Porridge): Postpartum women may suffer from three conditions: Yu Mao (Depression/Vertigo) leads to sweating; sweating leads to constipation. Therefore, medication is difficult to use. Mazu Zhou is the safest option.
Suzi (Perillae Fructus), Dama Ren (Cannabis Sativa Semen) (each half he, washed clean).
Grind extremely finely, add water, grind again, and extract one cup of juice. Divide into two portions and cook into porridge to consume.

Ben Shi Fang states: This porridge is suitable not only for postpartum women but also generally for elderly patients with various deficiencies and Wind Constipation. Once, a patient's mother, aged 84, suddenly suffered from abdominal pain, headache, nausea, and anorexia. Dozens of doctors were summoned, all prescribing spleen-tonifying, appetite-stimulating, wind-dispelling, and head-clearing herbs. Although she improved after several days, she could not eat at all. Her family was anxious. I analyzed that previous prescriptions were incorrect. This case was precisely Wind Constipation in the elderly, with stagnation in the Zang-Fu accumulating in the chest, causing abdominal distension, nausea, and anorexia, and rising to the vertex, causing headache and mental cloudiness. If the Zang-Fu become smooth and flowing, all diseases will resolve. I ordered the preparation of this porridge. After two servings, Qi descended, and she first passed more than ten hard fecal pellets resembling walnuts, followed by gradual regularity. She healed without further medication.

Bingbu Shouji Fang (Ministry of War Manual Formula): Treats postpartum constipation with bloating, fullness, and shortness of breath, making sitting and lying difficult.
Use Da Mai (Hordei Fructus Germinatus), stir-fried until yellow and ground into powder. Take one he with wine. Effect is miraculous. (Using Da Mai reflects personal insight.)