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Postpartum blood masses are accumulations of residual blood from pregnancy. This is because women have abundant blood but relatively deficient Qi; at age fourteen, Tian Gui (substances promoting reproductive development) arrives, occurring every thirty days, symbolizing the moon's fullness leading to waning. When its flow is regular, it is called menstruation. During pregnancy, menstruation ceases, and residual blood enters the uterus to protect the fetal origin. The first month is called "Tai Pei" (fetal embryo), the second month "Shi Gao" (beginning paste), and only in the third month does it begin to take shape and be called a fetus, receiving maternal blood protection. Since the fetal form is still small, although it consumes maternal blood, there remains surplus fluid, which, combined with blood from the previous two months, accumulates in the uterus. Over time, it forms blood masses, which should be expelled along with the infant at delivery. If due to the mother exerting force to deliver the baby or placenta, leading to fatigue and weakness; or due to improper care and insufficient abdominal warmth; causing blood masses to persist for a long time without dissipating, resulting in pain and tenderness upon pressure, it is appropriate to use Shenghua Decoction to promote blood circulation. Externally, warming the abdomen with hot clothes is also suitable. One must not lightly administer harsh purgatives, lest they cause uncontrollable hemorrhage.

Shenghua Decoction (See discussion on Shenghua Decoction later in this volume.)

Both postpartum fainting (Yun) and coma (Jue) syndromes arise from the simultaneous exhaustion of Qi and Blood. Without urgent tonification, how can one salvage the nearly extinct Yuan Shen (Primordial Spirit)? This is beyond doubt. However, fainting occurring during labor is more acute than Jue. If medication cannot be administered in time, emergency rescue methods must be used. For those with slight deficiency, symptoms include blurred vision and dizziness, chest fullness and oppression, unconsciousness with clenched jaws, unawareness of surroundings, followed by spontaneous recovery after a short while. Or, due to excessive blood loss, deficient fire flares up vacuously, leading to unclear consciousness and loss of bodily control. Sudden massive loss of Yin Blood deprives the Heart Spirit of nourishment. The Ministerial Fire and Sovereign Fire within the Heart and Uterine Collaterals are calm when nourished by blood but endangered when blood is lost. Intense upward flaming causes昏冒 (dizziness/fainting); fire invading the Lung causes closed eyes and unconsciousness. This indicates that sudden Yin Blood loss fails to anchor and soothe. The Classics state: "When disease Qi is insufficient, tonification is preferred over purgation." Closed eyes indicate Yin syndromes. Sudden loss of有形 (formative) blood intensifies upward fire. In all such cases, frequent administration of Shenghua Decoction is suitable. Alternatively, as an emergency measure, administer 2-3 doses of Shenghua Decoction to first replenish Blood aspect deficiency. Once blood masses resolve and blood abundance returns, consciousness clears and fainting stops. For extreme deficiency, symptoms include pale complexion, closed eyes, open mouth, cold extremities, profuse sweating, unconsciousness, and extremely weak and fine pulses in all six positions. This signifies Qi escaping with Blood, nearing extinction. Large doses of Ginseng are required to restore Yang. Fearing that tonifying Yin is too slow for the urgency, Qi-tonifying herbs must be added, following the principle of "Yang generates Yin." Emergency use of Renshen-added Shenghua Decoction, or simply Renshen-added Shenghua Decoction, is most effective. If decoction preparation is delayed, rapidly prepare Dushen Decoction (Single Herb Ginseng Decoction) using approximately 30g of Ginseng, decoct and administer urgently. As long as it is swallowed, survival is possible; any delay renders it futile. Some claim Ginseng should only be used seven days postpartum; this is a foolish rumor of unknown origin and must not be believed. However, since fainting strikes instantly, external emergency treatments cannot be delayed. Quickly help the patient sit upright gently, preventing her from lying down. Alternatively, heat charcoal until red, pour vinegar on it, or burn old lacquerware, allowing the smoke to enter the nose and mouth to induce revival. Urgently press the Renzhong (GV26) acupoint and wait quietly. As Yuan Qi gradually recovers, avoid agitation to prevent dispersion of Shen Qi. Another method: take a handful of Chinese chives, chop finely, place in a spouted porcelain bottle, boil vinegar, pour into the bottle, immediately cover the mouth, and direct the spout towards the woman's nostrils so the vapor enters the nose to induce revival. Generally, patients with severe illness or extreme deficiency may experience fainting. Postpartum fainting is named "Blood Fainting" due to blood loss, but actually, fainting is not caused solely by blood. Blindly trusting ancient formulas and diagnosing fainting as "Evil Blood Snatching the Heart," one might recklessly use drugs like Suxmu (Sappan Wood), Niuxi (Achyranthes Root), Honghua (Safflower), or formulas like Mudan Tang and Duoming Tang. Or misdiagnosing it as Phlegm-Fire and using non-tonifying phlegm-resolving formulas causes great error. Folk remedies for postpartum patients, sometimes due to retained dead fetus or placenta with evil blood reversing upward, causing convulsions, vomiting, and fainting, involve pouring warm urine (Tongbian) down the throat. If one sip is swallowed, it stops. For women with strong Stomach Qi who do not fear the fishy odor, efficacy may be seen. However, Tongbian does not inherently stop fainting or restore Yuan Qi; its action is likely due to directing downward flow, reducing fire, and resolving stasis. Medical texts state: "If敗血 (decayed blood) flows into the Liver Meridian, black spots appear in the eyes, head and eyes become dizzy, and consciousness is lost. This is Blood-Heat rising vacuously to the Heart, causing coma and Qi closure nearing extinction. Taking Tongbian is best." This view focuses only on decayed blood, completely ignoring postpartum deficiency. Moreover, given "Qi closure nearing extinction," can Tongbian really restore nearly extinct Yuan Qi? Even in cases of evil blood reversal and stagnation, Shenghua Decoction, acting warmly to move blood, is superior for resolving stasis and stopping fainting. I have observed obstetricians in Jiangnan using Danggui (Angelica Sinensis) 6g, Yimucao (Motherwort) 3g, Renshen (Ginseng) 6g, Honghua (Safflower) 1.8g, Paojiang (Prepared Ginger) 2.4g, decocted hot, mixed with Tongbian to treat fainting. This formula combines benefits and is closer to correctness. For women prone to blood fainting, it is better to pre-select tonifying formulas like Bazhen Tang, Guipi Tang, or Shiquan Dabu Tang several days before delivery to regulate and tonify Qi and Blood. Using Renshen to facilitate delivery just before birth tonifies before depletion occurs. Thus, postpartum, there is no deficiency for pathogens to exploit, and no fainting will occur.

Regarding Jue syndrome, occurring after delivery, it results from excessive effort during labor, fatiguing and damaging the Spleen. The isolated Zang organ cannot distribute to the four limbs, causing cold extremities and Jue. The Classics state: "Yang Qi deficiency below leads to Cold Jue. Jue Qi ascends, filling the vessels and separating from the form." Roughly, rebellious Qi fills the meridians, causing Shen Qi to float and scatter away from the body. Da Bu Hui Yang Shenghua Decoction is suitable. Administer two consecutive doses. Wait until Qi and Blood are abundant and Shen recovers; Jue will naturally cease. It cannot be cured by merely tonifying the Blood aspect. If thirst occurs after taking medicine, use Shenmai San instead of tea to assist Jin Ye (Body Fluids) and rescue dry Zang organs. There are also cases of cold extremities with diarrhea resembling Cold Syndrome of Taiyang Shaoyin Cold Disease. Si Ni Tang should not be used. Instead, Shenghua Decoction with doubled Renshen should be decocted and taken, or add one slice of Shu Fuzi (Prepared Aconite). This can reverse rebellion, restore Yang, and demonstrate the efficacy of Renshen and Danggui. If blood mass pain subsides but Jue persists, Zirong Yiqi Tang is most effective. Both fainting and Jue are critical postpartum syndromes. If fresh postpartum blood mass pain remains, one should not abruptly add Sanleng (Sparganium Rhizome) and Ezhu (Curcuma Rhizome). Therefore, urgently add Renshen as an emergency measure. Once fainting stops and Jue reverses, remove Renshen to address blood mass pain. This is a key principle.

Emergency Rescue Method for Fainting: If the mother becomes unconscious immediately after the baby is born, medicines cannot be administered orally at this stage; delay means death. The method: Urgently use very soft old clothing to tightly close the vaginal opening. Have a sensible woman use her knee to hold it down, preventing Qi leakage from below. Another person should hold the hair with one hand and cover the nose and mouth with the other, preventing Qi leakage from above. Wait until there is slight movement and breath sounds, then use hot water to catch the breath/vapor, and urgently administer Shenghua Decoction.

Zhi Quan Ji Jiu Shenghua Tang (Emergency Shenghua Decoction for Weight): Treats three grades of blood fainting, simultaneously resolving stasis and generating new blood. Chuanxiong (9g), Danggui (18g or 24g, wine-washed), Ganjiang (1.2g, roasted black), Taoren (10 kernels, skin and tip removed), Zhigancao (1.5g), Jingjiesui (1.2g, roasted black. Contraindicated if sweating is profuse), Jujube (2 pieces). Decoct in water and take. For severe fatigue, metrorrhagia, or fainting due to profuse sweating and collapse of form/Qi, add Renshen (9g) and Rougui (1.2g). Take urgently 1-2 doses; efficacy is miraculous. Do not hesitate to use Renshen thinking tonification is too slow. For fainting due to Phlegm-Fire flaring up vacuously, add Juhong (1.2g); for extreme deficiency, also add Renshen (2.4g). For obese individuals, add Zhuli (Bamboo Sap) several spoons and Jiangzhi (Ginger Juice) a little.

Zhi Quan Ji Jiu Jiashen Shenghua Tang (Emergency Renshen-Added Shenghua Decoction for Weight): Treats postpartum collapse of form and color. Renshen (12g, wine-washed), Chuanxiong (6g), Danggui (12g, wine-washed), Ganjiang (1.2g, roasted black), Taoren (10 kernels, skin and tip removed), Zhigancao (1.5g), Jingjiesui (1.2g, roasted black. Contraindicated if sweating is profuse), Jujube (2 pieces). Decoct in water and take. For severe blood mass pain, add Rougui (2.1g). For thirst, add Maidong (Ophiopogon Tuber) (3g, heart removed) and Wuweizi (Schisandra Berry) (10 kernels). For profuse sweating, add Mahuanggen (Ephedra Root) (3g). If no blood mass pain, add Zhi Huangqi (Honey-fried Astragalus Root) (3g) to stop sweating. For food stagnation from flour, add Chao Shenqu (Fried Medicated Leaven) (2.4g) and Chao Maiya (Fried Hordeum Sprout) (1.5g). For food stagnation from meat, add Shanzha (Hawthorn Fruit) and Sharen (Amomum Fruit) (1.8g each).

Jiashen Shenghua Tang (Attached: Da Bu Hui Yang Shenghua Tang): Renshen (6g), Chuanxiong (12g), Danggui (24g, wine-washed), Ganjiang (1.2g, roasted black), Zhigancao (1.5g), Taoren (10 kernels, skin and tip removed), Jujube (2 pieces). Decoct in water and take. This formula is generally applicable to all critical postpartum syndromes. Must take 3-4 doses per day to reconnect nearly extinct Qi. If within three days postpartum, blood mass pain remains, wait until Yuan Qi slightly recovers and life signs return, then remove Renshen and continue with original Shenghua Decoction. For collapse, Jue reversal, and profuse sweating, add Renshen (9-12g). If pulse and form both show collapse nearing extinction, this formula must be frequently administered. For Jue accompanied by sweating, add Maidong (3g, heart removed). For profuse sweating and severe thirst, add Maidong (9g, heart removed). For profuse sweating, phlegm, and wheezing, add Zhuli (Bamboo Sap), Jiangzhi (Ginger Juice), and Xingren (Apricot Seed) (10 kernels, skin and tip removed). For profuse sweating, wheezing, coughing with heavy voice, add Jiegeng (Platycodon Root) and Xingren (1.5g each, skin and tip removed). For no sweating, wheezing, coughing, and shortness of breath, add Zhi Banxia (Prepared Pinellia Tuber) (3g), Xingren (10 kernels, skin and tip removed), and Jiegeng (1.5g). For profuse sweating, feverish sensation, and shortness of breath, add Renshen. For weak Left Chi pulse, also add Renshen. If sweating does not stop, after 3-4 doses, add Zhi Huangqi (Honey-fried Astragalus Root) (3g). Another variation: halve Chuanxiong and Danggui, named Da Bu Hui Yang Shenghua Tang, treating new postpartum Jue syndrome. Use Jujube as a guide, decoct quickly, two doses yield immediate effect. If Jue syndrome presents with thirst, accompany with Shengmai Wuwei Yin as tea to rescue Jin Ye, then thirst decreases and Jue reverses.

Shenmai Wuwei Yin (Removing Wuweizi, named Shenmai Yin. Also known as Shengmai Tang or Shengmai San): Renshen (6g, another version 9g), Maidong (6g, heart removed), Wuweizi (7 kernels, crushed). Decoct in water to make tea, drink frequently. For decoction, silver or clay vessels are preferable.

Zirong Yiqi Tang: Treats Jue persisting after blood mass pain subsides. Renshen, Danggui (each 9g), Chuanxiong, Baizhu (Earth-fried), Huangqi (Honey-fried, each 4.5g or 3g), Shudi (Rehmannia Root) (6g), Maidong (2.4g or 3g, heart removed), Zhigancao (1.2g), Wuweizi (10 kernels), Chuan Fuzi (Aconite Lateralis Radix Praeparata) (1.5-3g, prepared). Decoct in water and take. For profuse sweating, add Mahuanggen (Ephedra Root) and Chao Zaoren (Fried Ziziphus Seed) (3g each). For difficult defecation, add Jiuxi Rongrong (Wine-washed Cistanche Stem) (4.5g).

Shenghua Decoction (See discussion on Shenghua Decoction later in this volume.) Bazhen Tang (See Pain Section in Upper Volume.) Guipi Tang (See Uterine Bleeding and Miscarriage Section in Upper Volume.) Shiquan Dabu Tang (See Fetal Malnutrition Section in Upper Volume.) Da Bu Hui Yang Shenghua Tang (Attached under Jiashen Shenghua Tang in this section.)