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Painful Sha (Sha syndrome characterized by pain) during pregnancy involves toxic qi attacking the fetus, causing fear that the fetal movement will be disturbed, leading to injury or loss of the fetus. Moreover, since Sha syndrome involves toxic blood rushing forward, and the fetus is delicate, it is impossible for the fetus to remain calm. Regarding methods to stabilize the fetus, using herbs such as Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), and Poria (Fuling) is strictly contraindicated in Sha syndrome; if mistakenly used, it will immediately lead to critical and dangerous Sha distension. The treatments suitable for Sha distension are primarily decoctions that break blood and move qi, which are also contraindicated for pregnancy. I have carefully considered this dilemma. If scraping and bloodletting do not resolve the condition, and blood-activating and detoxifying measures are necessary, one may use Lonicerae Japonicae Flos (Jinyinhua), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Leonuri Herba (Yimucao), Carthami Flos (Honghua), and Eucommiae Cortex (Sangjisheng) to eliminate stasis without damaging the fetal foundation; for regulating qi, Cyperi Rhizoma (Xiangfu), Citri Reticulatae Pericarpium (Chenpi), Magnoliae Officinalis Cortex (Zhipu), Amomi Fructus Rotundus (Sharen), and Linderæ Fructus (Wuyao) can be used to promote qi movement without harming fetal qi; for dispersing Sha, Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Angelicae Pubescentis Radix (Duhuo), Asari Radix et Rhizoma (Xixin) can be used to open orifices without disturbing the fetus; for resolving food stagnation, Crataegi Fructus (Shanzha), Raphani Semen (Buzi), Medicated Leaven (Shenqu), and Malty (Maiya) can be used to broaden the middle jiao without impairing fetal nature. Selecting from these options is the most prudent approach. However, when Sha toxicity is severe, these herbs may not act quickly; alternatively, using one or two harsh purgative herbs might harm the fetus. This is why I deliberate repeatedly and dare not prescribe lightly.

Medication for postpartum conditions must be warming; medication for Sha distension emphasizes cooling; these two conditions are contrary in nature. In treating this syndrome, one should not rigidly adhere to warming solely for postpartum conditions, nor to cooling solely for Sha distension. I have encountered such cases and believed that although blood-breaking and stasis-resolving herbs are similar, other aspects cannot be universally applied. Therefore, I formulated a specific prescription for clinical practice. For dispersing Sha, use Duhuo and Xixin; for breaking blood, use Persicae Semen (Taoren) and Honghua; for regulating qi, use Xiangfu, Wuyao, and Chenpi; for detoxification, use Jinyinhua and Violae Herba (Zihuadiding); for resolving food stagnation, use Shanzha, Buzi, Shenqu, and Maiya. Using Carbonized Zingiberis Rhizoma (Jiantan) and Cinnamomi Cortex (Rougui) to warm blood is strictly contraindicated in Sha syndrome. Conversely, using Jingjie and Fangfeng to disperse Sha, and Forsythiae Fructum (Lianqiao) and Menthae Haplocalycis Herba (Bohe) to clear heat, are unsuitable for postpartum conditions. Furthermore, in cases of extreme Sha distension, Rheum Palmatum Radix et Rhizoma (Dahuang), Aurantii Fructus Immaturus (Zhishi), and Arecae Semen (Binglang) are heavily relied upon to unblock stagnation, whereas postpartum medications must be avoided to prevent damaging the qi aspect after childbirth. Additionally, postpartum patients should take warm medicines, while Sha patients should take cold medicines. If warm medicines are used for Sha, distension will worsen; if cold medicines are used postpartum, stasis will deepen. Therefore, in my clinical practice, I only utilize mildly warm properties, which neither harm the postpartum state nor exacerbate Sha disasters. If Sha is extremely severe and mild warmth is insufficient, adding Humanis Urine (Tongbian) to clear heat and resolve stasis provides appropriate treatment for both postpartum and Sha conditions.

Clinical Cases:
1. The wife of Gu Yuexi, three days postpartum, suffered from severe abdominal cramping and distension resembling drum-tightness, with no lochia discharge. Upon consultation, I reasoned that postpartum abdominal pain should occur in the lower abdomen, and distension in the large abdomen would only cause slight pain. The patient’s severe large abdominal cramping was not typical of postpartum conditions. Pulse diagnosis revealed a surging, rapid, and forceful pulse. I stated, "This is postpartum complicated by Sha distension; we must examine the Sha veins." The family did not believe me and administered postpartum remedies indiscriminately, resulting in increased coma. Seeking further treatment, the condition became critical with no visible Sha veins. I first had her drink a cup of Tongbian, after which she slightly revived. Examining the veins on the fingertips, I performed acupuncture to release twenty-one needles' worth of purple-black toxic blood. Then, supporting the patient, I performed bloodletting at the popliteal fossa (leg bend) with six needles, which slightly stabilized the cramping. She took Duhuo Honghua Decoction (Angelica Pubescentis and Carthamus Decoction) while lukewarm. Once the Sha toxicity was eliminated and distension/pain ceased, and lochia flowed freely, she recovered after tonic supplementation.

2. The wife of Jiang Nanxuan, eight days postpartum, experienced excessive lochia loss, followed suddenly by aversion to cold, fever, chest distension, and impending danger. Upon consultation, the pulse was overwhelmingly surging and large. I reasoned that incomplete lochia discharge is understandable, but complete discharge followed by such a pulse is abnormal. I told him, "The pulse is ominous; if complicated by Sha, there is hope for rescue." Nanxuan, skilled in bloodletting, examined the patient and found two purple-red Sha veins, from which toxic blood was released. On re-examination, the pulse was no longer surging and large. I then punctured the fingers and arms to release over thirty needles' worth of purple-black toxic blood. She took four doses of a decoction containing Duhuo, Xixin, Bupleuri Radix (Chaihu), Jinyinhua, Danshen, Yimcao, Achyranthis Bidentatae Radix (Niuxi), Dendrobii Caulis (Shihu), Wuyao, Shanzha, and Chenpi, taken lukewarm. The chills, fever, distension, and oppression were completely resolved, and she recovered after tonic supplementation.

3. The wife of Shan Gonglian, six days postpartum, suffered from generalized body pain, chills and fever resembling malaria, and extreme drowsiness and oppression. Upon consultation, the six pulses showed intermittent stopping. Examination of the left middle finger and right ring finger revealed a slight black discoloration, indicating a complication with Sha. I punctured seven needles on the fingers to release purple-black toxic blood, one needle on the arm, and one under the tongue, which slightly alleviated the drowsiness and pain. She took two doses of a decoction containing Duhuo, Taoren, Atractylodis Rhizoma (Cangzhu), Xiangfu, Tongbian, Curcumae Longae Rhizoma (Jianghuang), and Shanzha, taken lukewarm, which resolved the pain and drowsiness. However, chills and fever persisted. She then took four doses of a decoction containing Jinyinhua, Danshen, Yimcao, Artemisiae Argyi Folium (Ai), Chaihu, Duhuo, Ginger Ash (Jianghui), Niuxi, and Shanzha, taken warm. The chills and fever subsided, and she regained health after one month of tonic supplementation.