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A woman, after childbirth, expelled a strip of fleshy tissue from the urinary tract (Shuidao), three to four chi in length. Touching it caused excruciating pain. She first took Shixiao San (Pain-Stopping Powder) for several doses. Then, three jin of ginger with skin were pounded into a paste, mixed with two jin of refined sesame oil, and boiled until the oil was dry. The fleshy strip was gathered in silk gauze, bent, and placed beside the urethral opening, then fumigated with the residual ginger. When cool, it was applied as a warm compress. After six days and nights, it retracted by more than half; within another twelve days, it completely retracted inside. Subsequently, she took Shixiao San and Xionggui Tang (Safflower and Angelica Decoction) for regulation. If the fleshy strip had ruptured, it would have been incurable.

For excessive postpartum lochia that does not stop, use 2 liang of Fulonggan (Dragon's House Earth), decocted in water, clarified, and dissolved with 1 liang of Ejiao (Donkey-hide Gelatin). If ineffective, add Renshen (Ginseng). This formula is from Shen Yaofeng's *Nuke Jiyao* (Essentials of Gynecology).

Lu Xiaoyu treated the wife of Wu Jingzhi, who was in her twenties. Before delivery, she already had symptoms of a cold. Three days after giving birth, while scolding a maid for leaving the bed, during the winter season, she felt chills, followed by fever and headache. Someone administered Shen Su Yin (Ginseng and Perilla Decoction) to induce sweating. The headache ceased, but the fever persisted. It was then assumed that postpartum conditions require substantial tonification of Qi and Blood. After several doses, irritability and heat intensified. A decision was made to use Buzhong Yiqi Tang (Decoction for Boosting the Middle and Augmenting Qi). Upon pulse diagnosis, both wrists showed weak pulses, but the left still carried a floating quality, and the right showed rapidness. He stated: "A weak pulse is a normal postpartum pulse. However, the left floating indicates that exterior pathogenic factors have not dispersed. The right rapidness suggests the pathogen is about to transmit inward. We must urgently release the exterior and mildly unblock the interior. Delaying this risks developing Chengqi Syndrome (Yangming Fu-organ excess syndrome)." He used Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Jiegeng (Platycodonis Radix), Huangqin (Scutellariae Radix), Huafen (Trichosanthis Radix), Gancao (Glycyrrhizae Radix), and Shanzha (Crataegi Fructus). After one dose, irritability decreased; after two doses, body temperature normalized. She was then regulated with Qingqi Yangying Tang (Decoction for Clearing Heat and Nourishing Ying). (Xu Lingtai's note: Left floating indicates postpartum blood deficiency; right rapidness indicates unresolved external pathogens.)

Ma Yuanyi treated a Lady Lu, who suffered from aversion to cold after childbirth. Even with thick mattresses and heavy quilts, the sensation did not subside. Multiple attempts at tonification failed, and Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) were nearly prescribed. Pulse diagnosis revealed deep and hidden pulses in both wrists, flushed face, dry mouth, and chest fullness. This was not new postpartum deficiency, but latent pathogens from pregnancy. Repeated use of Renshen (Ginseng) and Baizhu (Atractylodis Macrocephalae Rhizoma) caused further pathogen consolidation and obstruction of healthy Qi. The surface aversion to cold resulted from internal pathogenic heat forcing Yin outward. Dry mouth, flushed face, and chest fullness indicated pathogens carrying fire and food stagnation attacking the clear orifices. Treatment should address both exterior and interior. He used Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Sugen (Perillae Caulis), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), Suzi (Perillae Fructus), and Bohe (Menthae Haplocalycis Herba). After one dose, exterior symptoms resolved, and the right Guan and Chi positions became slippery and solid. He then used Dahuang (Rhei Radix et Rhizoma) 5 qian, Yuanmingfen (Mirabilite) 3 qian, and Gancao (Glycyrrhizae Radix) 1 qian. One dose expelled significant fecal impaction. Subsequently, rashes appeared on the body and parotid swelling occurred, signs of harmonized interior/exterior and complete expulsion of residual pathogens. She recovered with acrid-cool releasing and penetrating agents. This case involved latent pathogens lingering internally. Using clearing yang to release the exterior and bitter-cold to drain downward, even with rash and parotid swelling, if one blindly uses warm tonification, mistaking deep pulse and aversion to cold for Yang deficiency, it shows a profound failure to examine the disease mechanism. (Xu Lingtai's note: Recognizing latent pathogens postpartum and using exterior-interior dual treatment is indeed expert skill. Avoiding Suye, Fangfeng, Gegen, and Jiegeng could have prevented the later parotid swelling.)

Lady Wang, one month postpartum, presented with mental fatigue, shortness of breath, chest fullness and pain, cough, and fever. All treatments failed. Pulse diagnosis showed deep, choppy, and knotted pulses in both wrists. Latent pathogens existed before delivery, compounded by postpartum Qi and Blood deficiency, leading to deeper pathogen consolidation. The method should harmonize interior and exterior, allowing pathogens to exit outward and Qi to vent inward. She used Guizhi (Cinnamon Twig), Chaihu (Bupleuri Radix), Sugen (Perillae Caulis), Zhike (Aurantii Fructus), Banxiaqu (Pinelliae Fermentatum), Luoboziren (Raphani Semen), Xingren (Armeniacae Semen Amarum), and Guangpi (Citri Reticulatae Pericarpium). As an agent to penetrate pathogens and resolve stagnation, she was instantly relieved. Pulses relaxed slightly. Someone administered Renshen (Ginseng), Dihuang (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), and Shaoyao (Paeoniae Radix Alba)—astringent and stagnating herbs—causing all-night restlessness and loss of spirit. This was because tonifying when pathogens are consolidated causes complications. Instead, Guizhi (Cinnamon Twig), Paojiang (Prepared Ginger Rhizome), Huanglian (Coptidis Rhizoma), Zhishi (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex), and Guangpi (Citri Reticulatae Pericarpium) were used. One dose relieved chest fullness and mid-abdominal pain. Then, Louren (Fructus Trichosanthis), Chaihu (Bupleuri Radix), Guizhi (Cinnamon Twig), Banxia (Pinelliae Rhizoma), Zhike (Aurantii Fructus), Xingren (Armeniacae Semen Amarum), Suzi (Perillae Fructus), and Jiegeng (Platycodonis Radix) were used. Two doses resolved exterior heat, wheezing, and cough. Only constipation remained due to fluid depletion from chronic illness. Adding 1 liang of Sheng Shouwu (Polygoni Multiflori Radix) induced bowel movement, removing residual pathogens. With severe Qi and Blood deficiency, she was finally stabilized with tonifying agents.

Li Jiu treated the principal wife of Wei Jichang. Postpartum dietary irregularity combined with wind-cold invasion led to fever, delirium, wheezing, cough, and cessation of lochia. The condition was urgent. He stated: Symptoms caused by external pathogens are salvageable; if they result from collapse of healthy Qi, there is no hope. Why? Because the pulse was floating, large, and forceful. Large doses of wind-dispersing and food-resolving agents cured her in two doses. Previously, tonics like Baizhu (Atractylodis Macrocephalae Rhizoma), Xiong (Ligustici Chuanxiong Rhizoma), and Danggui (Angelicae Sinensis Radix) nearly misled the treatment. (From *Guang Biji*)

Zhang Yitian treated a woman ill for half a year postpartum. Others treated it as consumptive disease, claiming extreme Yin deficiency and poor prognosis. Zhang diagnosed five times and determined Xiao Chaihu Tang (Minor Bupleurum Decoction) was indicated. Despite objections that Renshen (Ginseng) and Chaihu (Bupleuri Radix) are unsuitable for Yin deficiency and lung heat cough, he insisted. The family trusted him. One dose caused intense chills and fever; three doses resolved them and stopped cough; ten doses cured her. Case record: Six pulses were rapid. Right Cun was large and soft; Guan and Chi were wiry and urgent upon deep pressure. Left Cun was flooding and rapid; Guan was deficient and rapid across three positions; Chi was hollow and large. Right Cun soft/large indicates Lung Qi deficiency. Deep Guan/Chi wiry/urgent indicates Liver Wood invading the center (Spleen/Stomach) and Fire following Wood movement. Left Cun flooding/rapid indicates Heart deficient fire. Guan deficient/rapid indicates Liver blood deficiency. Chi hollow/large indicates Kidney Water deficiency. Although the pulse suggests Yin deficiency, cold pathogens invaded and lingered. Symptoms: Fever at dawn (Yin-Mao hours, Wood peak) indicates Liver fire carrying pathogens. Morning chills/fever resolving with sweat indicates slight pathogen release. Stagnant cough indicates Lung damage and inability to disperse pathogens. Abdominal distension/borborygmus indicates Liver Wood invading Spleen Earth. Combined, this is deficiency with excess, where pivot mechanism fails to expel pathogens. *Daquan* states: Postpartum Qi/Blood weakness, improper diet/care within 100 days allows wind-cold to invade, causing emaciation, indigestion, cough, dizziness, joint pain. Ying/Wei pathogens affect Liver, flow to organs, causing frequent cough, no sweat, malaria-like chills/fever—signs of *Rulao* (Childbed Consumption). Jingyue states: Weak persons with initial external pathogens, if not released but treated with cooling or tonics, trap cold pathogens, causing alternating chills/fever or cough, mimicking consumption. Differentiate by checking if pain resolves with slight sweat or recurs without sweat; or if loud cough has wiry-tight but not rapid pulse despite long duration. This is "apparent consumption, not actual." Do not misdiagnose. This case fits. Use Xiao Chaihu Tang to rotate the pivot, utilizing Shaoyang's generating Qi to move from inside-out, bottom-up, harmonizing Yin/Yang and dispersing latent pathogens. Remove Banxia (Pinelliae Rhizoma), add Niuxi (Achyranthis Bidentatae Radix). Banxia raises Yin Qi, contraindicated here due to postpartum Yin deficiency and dry mouth. Abdominal distension requires Niuxi to guide downward. Medicine matches pathology, ensuring efficacy. (Xu Lingtai's note: My wife had difficult labor. On day 3, sudden numbness/cold, then high fever/thirst, unremitting sweat, tinnitus, tearing, crimson tongue without fluids, yellow-dry coating, abdominal pain refusing pressure, epigastric fullness/anorexia, ongoing lochia, hot urine. Pulse wiry-slippery, stronger on right. Prenatal warm pathogen absorption with phlegm-heat stasis and Yin injury. I used Xuanshen (Scrophulariae Radix), Danshen (Salviae Miltiorrhizae Radix), Baiwei (Cynanchi Atrati Radix), Zhimu (Anemarrhenae Rhizoma), Huafen (Trichosanthis Radix), Zhuru (Bambusae Caulis in Taenia), Doujuan (Sojae Semen Praeparatum), Xuanfu (Inulae Flos), Sangye (Mori Folium). Heat subsided, pulse unchanged, anorexia persisted. Continued same prescription. Two days later, numbness/cold returned with fever, tongue moister, coating thinner. Treatment correct but weak. Added Shichangpu (Acori Tatarinowii Rhizoma), Zhishi (Aurantii Fructus Immaturus), Lianshi (Meliae Fructus), Louren (Fructus Trichosanthis). Heat subsided; expelled viscous phlegm; tolerated gruel. Next day, chills/fever recurred. Suspected malaria or labor injury. I ignored doubts, kept original formula. Heat shortened, thirst reduced. Days passed, chills/fever continued. Adhered strictly. On day 11, passed black dry stool, all symptoms resolved, appetite returned. Total 10 doses. Thereafter, only gruel, no medicine. Relatives amazed. Without determination, success would be hard. If I used Shenghua Tang (Life-Restoring Decoction) for blood stasis, or Chaihu Guizhi Tang for malaria, or Siwu Tang for Yin deficiency, pathogens would entangle, leading to *Rulao*. In late winter, Sun Zhou's daughter-in-law, having many children, refused nursing, used abortifacients prenatally. Failed. Day 3 postpartum, chills/fever, painful diarrhea, anuria, black stool. Doctor saw stasis, gave Huisheng Dan (Life-Returning Pill). Improved. Chills/fever persisted. Day 8, I examined. Right Cun/Guan large, lacking resonance, with a jumping sensation. Spirit calm, coating thin-yellow, desired gruel. Just finished, previous doctor arrived. I said pulse bad, risk of sudden change. He said: Much better than yesterday, harmless. I withdrew politely. Host seemed disappointed. I added: Vital Qi too damaged, harsh drugs forbidden. Heard night chills/fever and abdominal pain returned. Doctor again used Huisheng Dan. Died next day.)

Lai Tianpei treated Lady Pan. Late summer, 20+ days postpartum, chills/fever, bloody stool, incomplete lochia. Specialist gave Xiangru Yin (Elsholtzia Decoction) for four doses. Result: vomiting, vertigo, abdominal pain, spontaneous sweating, nausea, fever, shortness of breath, macules (light red), pale-red cheeks. Pulse: Left thread-thin, Right deep-fine. Deficiency with infection. Vomiting injured Stomach. Liver Wood overacting on Ministerial Fire insulting Metal (Lung). Upper/Lower rejection syndrome. Treatment: Invigorate blood, nourish Yin, move Qi, soothe Spleen, scatter Qi, direct rebellion, support interior, resolve macules. Used Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria), Qizi (Lycii Fructus), Danggui (Angelicae Sinensis Radix), Honghua (Carthami Flos), Huangqi (Astragali Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Muxiang (Aucklandiae Radix), Xiangfu (Cyperi Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Banxiaqu (Pinelliae Fermentatum), Shengjiang (Zingiberis Rhizoma Recens). One dose greatly reduced symptoms, pulses harmonious. Mild cough, vertigo, palpitations, chest discomfort remained due to pathogen departure and Zheng deficiency. Removed Chuanxiong, Muxiang, Niuxi; added Fushen (Poria cum Pinodia), Danshen (Salviae Miltiorrhizae Radix), Xingren (Armeniacae Semen Amarum), Beimu (Fritillariae Thunbergii Bulbus). Two doses cleared prior symptoms. Palpitations/dizziness remained. Switched to Guipi Tang (Restore the Spleen Decoction) minus Renshen, Muxiang; added Fangdangshen (Codonopsis Radix), Qizi (Lycii Fructus), Shaoyao (Paeoniae Radix Alba). Regulated and cured.