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Guo Jizhong said: What is the reason for the appearance of black qi around the mouth and nose accompanied by epistaxis (nosebleed) after childbirth? The answer is: The Yangming Meridian is the sea of the twelve meridians, originating at the nose, crossing at the forehead, emerging to pass through the cheeks and lips, crossing at the Renzhong point, with the left side connecting to the right and the right to the left. After childbirth, Qi and Blood are deficient, blood scatters, and Ying (Nutritive) and Wei (Defensive) Qi fail to circulate properly. Blood scatters into the various meridians but cannot return to its proper place, thus causing black qi to appear around the mouth and nose, which then transforms into epistaxis. This arises from postpartum deficiency-heat generating this syndrome. If Stomach Qi is exhausted and the pulse is ruined, it is incurable. An empirical prescription states: Quickly take a red thread and two hairs from the vertex of the parturient's head, tie them tightly around the middle joint of the middle finger to stop bleeding. There is no medicine for this; it is also a form of apotropaic suppression. (This is truly an effective method; one should keep it in mind for emergencies.)

Xue said: According to the Stomach Meridian, it surrounds the lips and passes through the Chengjiang point. The tip of the nose belongs to Spleen Earth, and the nostrils belong to Lung Metal. This is considered a syndrome of Stomach deficiency, Lung damage, Qi collapse, and Blood death. Urgently use Erwei Rensu Yin (Two-Ingredient Ginseng and Perilla Decoction) added with five qian of Fuzi (Prepared Aconite Root), and there have been cases of survival.

Wang Shishan treated a woman who, after childbirth, experienced upward reversal of blood, resulting in epistaxis, dry mouth, mental restlessness, and a black tongue coating. This was due to rising blood stasis. He administered two pills of Yimu Wan (Motherwort Pill), dissolved in child's urine (Tongbian). The epistaxis gradually stopped, and blood circulation gradually normalized. (The combination of Motherwort and Child's Urine is excellent for treating deficiency-heat.)

Li said: This is caused by postpartum deficiency-heat; it should be rescued with Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction).

Jiawei Rensu Yin (Modified Ginseng and Perilla Decoction)
Renshen (Ginseng Root) (2 liang)
Sumu (Sappan Wood) (2 liang)
Fuzi (Prepared Aconite Root) (5 qian)
Crush these ingredients, decoct in water, and take orally. (This formula is also effective for deficiency-heat; adding Tongbian if heat is prominent is even better.)

Guo Jizhong said: What is the reason for abdominal pain and diarrhea after childbirth? The answer is: Postpartum intestines and stomach are weak and timid, making them susceptible to invasion by Cold Evil. If within one month, one drinks cold water or exposes oneself to wind, the pathogenic factor invades due to deficiency and remains in the Huangmo (Tri-Jiao membrane), spreading to the abdomen and hypochondrium. Thus, paroxysmal abdominal pain occurs, feeling like stabbing with awls or knives. If it flows into the Large Intestine, water and grain are not digested, leading to profuse watery diarrhea (Dongxie), borborygmus, or passage of red and white mucus. There may be hypochondriac distension or wandering pain. Urgently take Tiaozhong Tang (Regulate the Middle Decoction) for immediate cure. If a physician mistakenly treats it as food stagnation and uses purgatives, disaster will follow immediately. Be extremely cautious.

Chen Wuze commented: Postpartum dysentery/diarrhea is not a single syndrome; treatment should be adjusted according to the cause. Since it mentions drinking cold water and exposure to wind, various conditions can arise. Cold, Heat, Wind, and Dampness belong to external causes; Joy, Anger, Worry, and Thought stem from internal nature. Moreover, overwork and irregular diet can all cause disease. If it is profuse watery diarrhea, Tiaozhong Tang can be taken; if it is red and white leukorrhea, this formula cannot cure it. Refer to respective categories for three other formulas. (In this method, one must re-examine deficiency and excess to be appropriate.)

Xue said: Postpartum diarrhea and dysentery may be due to dietary injury damaging Spleen Earth, or Spleen Earth deficiency failing to digest food. Treatment should be determined after careful examination. If injured by rice, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Gu Ya (Grain Sprout); if injured by wheat products, use Liu Jun Zi Tang plus Mai Ya (Malt); if injured by meat, use Liu Jun Zi Tang plus Shan Zha Shen Qu Wan (Hawthorn and Medicated Leaven Pill). If accompanied by vomiting, add Huo Xiang (Patchouli). If accompanied by acid regurgitation or vomiting, send down Yueju Wan (Yueju Pill) with the previous medicine. If Liver Wood insults Spleen Earth, use Liu Jun Zi Tang plus Chai Hu (Bupleurum Root) and Pao Jiang (Prepared Ginger). If Cold Water insults Earth, use Qian Shi Yihuang San (Qian's Yellow Soothing Powder). If chronic diarrhea or sinking of Yuan Qi occurs, combine with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Yang Qi. If diarrhea/dysentery stool is yellow, indicating Spleen Earth true Qi leaking out, add Mu Xiang (Aucklandia Root) 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 Rou Gui (Cinnamon Bark). If Spleen and Kidney are deficient and cold, use Buzhong Yiqi Tang and Sishen Wan (Four Spirits Pill). (These eleven methods require thorough understanding; however, using only eight base formulas with modifications is concise. Among these eight, Liu Jun Zi Tang variants account for five, Buzhong Yiqi Tang for two, while Yihuang San, Sishen Wan, and Bawei Shengqi Wan are used singly or combined appropriately. Mastering this allows flexibility in other prescriptions.) If Mingmen Fire declines causing Spleen Earth deficiency-cold, use Bawei Wan (Eight-Ingredient Pill) to tonify the mother of Earth (Kidney). If urination is obstructed, limbs swell, or asthma/cough occurs, use Jin Gui Shenqi Wan (Golden Cabinet Kidney Qi Pill) to tonify Spleen and Kidney and promote water metabolism. If Kidney Qi is weak causing limb edema, treatment must focus on tonifying the Stomach. If prolonged and not due to dietary injury, it belongs to Kidney Qi depletion. The Bao Tai (Fetus) is governed by the Ren Mai and connected to the Kidney. In the ninth and tenth months of pregnancy, nourishment comes from the Kidney and Bladder. One must use Sishen Wan, Liuwei Wan (Six-Ingredient Pill), and Bawei Wan to tonify the Kidney. Using diuretic and draining agents would further deplete deficiency.

A parturient suffered diarrhea and dysentery with fever, thirst, excessive phlegm, emaciation, poor appetite, occasional chest fullness, and lower abdominal bearing-down sensation for over a year. I diagnosed it as Spleen-Kidney diarrhea, prescribingershen Wan (Two Spirits Pill) in the morning and Liu Jun Zi Tang in the evening. She recovered after more than three months.

A parturient had postpartum diarrhea with vomiting and acid regurgitation, facial swelling. This was Spleen Qi deficiency-cold. First, use Liu Jun Zi Tang plus Pao Jiang as the main treatment. (Note: The general text says for Spleen Earth deficiency-cold, use Liu Jun Zi Tang plus Mu Xiang, Ginger, and Cinnamon; here only Pao Jiang is used primarily, showing one need not rigidly adhere to fixed methods.) Assist with Yueju Wan to cure acid regurgitation, then use Buzhong Yiqi Tang plus Fu Ling (Poria) and Ban Xia (Pinellia) to restore Spleen and Stomach health.

A parturient had diarrhea for over a year, becoming emaciated, with afternoon internal heat, spontaneous and night sweats, oral ulcers, expectorating about three bowls of phlegm daily. The pulse was large and forceful on superficial pressure but empty on deep pressure. This indicated Mingmen Fire decline, Spleen Earth deficiency-cold, and false heat. The phlegm resulted from Spleen deficiency failing to control and return essence. Use Bawei Wan to tonify Fire to generate Earth, and Buzhong Yiqi Tang to tonify Lung Metal, thereby strengthening Spleen and Stomach. (Examining symptoms and pulse accurately, and prescribing accordingly, requires expert insight.)

A parturient had abdominal pain with tenesmus, profuse dysentery, fatigue, and inability to eat, nearing death. This was dual deficiency of Spleen and Kidney. She recovered using Sishen Wan and Shiquan Dabu Tang (Ten Great Tonification Decoction). However, due to difficulty digesting food and limb fatigue, she recovered fully with Buzhong Yiqi Tang. (This case shows that while previous guidelines suggested only Buzhong Yiqi Tang and Sishen Wan, adding Shiquan Dabu Tang here demonstrates the necessity of adapting to specific symptoms rather than rigid adherence.)

A woman contracted dysentery in May, with day and night frequency, lower abdominal bearing-down pain, fever, and aversion to cold. She took Liujunzi Tang sending Xianglian Wan (Costus and Coptis Pill), improving after two doses. Then, the same decoction sent Sishen Wan, curing her after four doses. By late July, she felt lethargic, desired sleep, had flaccid limbs, heavy body and joint pain, dry mouth and tongue, loss of taste, loose stools, frequent urination, chills, and depression. This indicated dual deficiency of Lung and Spleen-Stomach, with Yang Qi deficiency-cold unable to extend. She recovered using Shengyang Yiewei Tang (Raise Yang and Benefit Stomach Decoction). (There is profound meaning beyond words in stating principles.)

Wang Shishan treated a parturient with postpartum slippery diarrhea, unable to retain even a spoonful of water or grain, expelling it immediately. This persisted for over half a month, and others deemed it critical. (Danxi stated: Diarrhea is worst when all soups and drinks are prohibited. Shishan agreed, as the principle is the same.) Someone used Wuling San (Five-Ling Powder) and Pingwei San (Level the Middle Powder), worsening the condition. Wang diagnosed a soft, slow, and weak pulse, stating: This is stomach injury due to labor during childbirth. Using liquid medicines would increase Stomach Dampness, which is unsuitable. Now, use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), removing Sha Ren (Amomum Fruit), adding Chen Pi (Tangerine Peel) and Rou Dou Kou (Nutmeg), decocted with Ginger and Jujube, taken orally. She stabilized after ten days.

Tiaozhong Tang (Regulate the Middle Decoction) Treats postpartum weakness of intestines and stomach, invasion by Cold Qi, stabbing pain in abdomen and hypochondrium, and unceasing profuse diarrhea.
Liang Jiang (Galangal Rhizome)
Dang Gui (Angelica Sinensis Root) (soaked in wine)
Rou Gui (Cinnamon Bark) (avoid fire)
Bai Shao (White Peony Root) (stir-fried)
Chuan Xiong (Ligusticum Rhizome)
Fuzi (Prepared Aconite Root) (processed, skin and bud removed, each 1 liang)
Renshen (Ginseng Root)
Gan Cao (Licorice Root) (honey-fried, each 0.5 liang)
Crush these ingredients. Take 3 qian per dose, decoct in water, and take orally.

Doukou Lizhong Wan (Cardamom Regulate the Middle Pill) Treats postpartual Yuan Qi deficiency, umbilical and abdominal pain, unceasing diarrhea; also treats male Spleen-Stomach deficiency and chronic diarrhea.
Renshen (Ginseng Root) (1 liang)
Baizhu (Atractylodes Macrocephala Rhizome) (2 liang)
Gan Jiang (Dried Ginger) (processed)
Gan Cao (Licorice Root) (honey-fried, each 5 qian)
Rou Dou Kou (Nutmeg) (wrapped in flour and baked, 7 qian)
Grind into fine powder, make pills with refined honey the size of paulownia seeds. Take 40-50 pills per dose on an empty stomach with rice water. Pills made with wine-boiled wheat paste are also acceptable.

Shenxiao Shenxiang San (Miraculous Ginseng and Aucklandia Powder) Treats postpartum Spleen-Stomach deficiency-cold, profuse diarrhea, and long-term dysentery where foul accumulation is exhausted but slippery diarrhea persists. This astringent formula works miraculously.
Renshen (Ginseng Root)
Muxiang (Aucklandia Root) (each 2 qian)
Rou Dou Kou (Nutmeg) (baked)
Bai Ful Ling (Poria)
Bai Bian Dou (Hyacinth Bean) (each 4 qian)
Chen Pi (Tangerine Peel)
Yangsuke Ke (Poppy Shell) (remove stalk and pith, vinegar-fried, each 1 liang)
Grind into fine powder. Take 1 qian-bi per dose, mixed with clear rice water, taken well after meals. (In this astringent formula, the equal dosage of Tangerine Peel and Poppy Shell reflects the subtlety of prescription design.)

In the Ji Hai year of the Wanli era, I served in Jinling. My wife had difficult labor in December, delivering only after a night passed. Ten days later, she developed profuse diarrhea; any water entered, it was immediately expelled. She cried in fear, believing she would die. I happened to have this medicine, gave her 1 qian mixed with rice water. As soon as it swallowed, the diarrhea stopped. It was truly a life-saving drug.