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During pregnancy, the uterus contains a "blood coat" (a membrane-like structure formed by blood) wrapping the fetus. Beneath this blood coat lies a "water coat" (amniotic fluid/membrane) acting as a cushion. At the time of delivery, the amniotic sac first ruptures, and the water coat is expelled first. Subsequently, the blood coat breaks, and the infant is born. After the infant is delivered, the blood coat is then expelled. The common belief holds that the water coat cushions the fetus; because the water coat is expelled first, it causes the fetal head to descend, thereby facilitating birth. This is a superficial argument that fails to grasp the underlying mechanism.

In fact, matters of gestation and childbirth are related to Qi transformation (Qi Hua), and cannot be compared to ordinary objects relying on physical cushioning or suspension. I elucidate the principle thus: In the vast universe, Yang always governs Yin. In human life, Qi always governs Blood. Qi is the Yang aspect transformed from Kidney Water. Therefore, when Qi attaches to matter, it reverts to water. Hence, my theory states that "Qi is Water." The "water coat" that cushions the fetus during pregnancy is essentially Qi. The fetus is carried and supported by Qi. Since Qi is Water, although we say water cushions the fetus, in reality, Qi carries the Blood. At the time of delivery, the water coat goes first because Qi moves downward; thus, water moves downward. The movement of water actually reflects the movement of Qi. Once Qi moves downward, the uterine blood naturally follows. Blood follows Qi; how could there be a case where Qi moves but Blood does not? Therefore, before birth, the fetus is carried by Qi; at the time of birth, the fetus is propelled by Qi. Understanding this, one knows that protecting the fetus requires regulating Qi, inducing labor requires promoting Qi movement, and treating all blood disorders should also involve treating Qi. These insights can be derived from this principle.

Severe pain in the lower back and abdomen during labor occurs because Qi desires to move downward while Blood has not yet moved. Blood obstructs Qi, and Qi forcefully attempts to compel Blood to move, causing severe pain. This is common in first-time mothers whose birth canal is newly opened, creating resistance to Qi flow, leading to intense pain. It may also occur in multiparous women due to internal blood stasis obstructing Qi. However, in robust women without blood stasis, labor involves only mild pain or slight distension. This is because Qi descends and Blood follows; since the birth canal is familiar and free of stasis, why would there be pain? If pain is extreme and the fetus does not deliver, the method for inducing labor should primarily focus on invigorating Blood to prevent obstruction of Qi. When Qi descends, the fetus will follow. The principal formula is Foshou San (Buddha's Hand Powder). If the pubic symphysis (Jiaogu) fails to open, add Gui Ban Jiao (Tortoise Shell Gelatin) and ash from burnt human hair. The rationale is to invigorate Blood; when Blood flows freely, Qi unblocks, and the fetus delivers smoothly.

Postpartum body pain and lower back pain result from incomplete expulsion of lochia (evil blood), which obstructs Qi mechanism, causing pain. Blood that has left its vessels must descend and not remain stagnant; otherwise, Qi will be obstructed, leading to pain. Furthermore, if stasis remains, new Blood cannot be generated, resulting in suffering. The appropriate treatments are Guixiong Shixiao San (Angelica and Ligusticum Shixiao Powder) and Shenghua Tang (Generation of New Blood Decoction). Although postpartum deficiency of all meridians necessitates tonifying Blood, I strongly emphasize removing stasis first. Without removing stasis, new Blood cannot possibly be generated. As detailed in my discussion on gender differences, despite severe postpartum deficiency, removing stasis is urgent because it is the prerequisite for generating new Blood. Patients with hematemesis or epistaxis also require removal of stasis, confirming this view.

Postpartum syncope (Blood Dizziness) is caused by Blood ascending with Qi, confusing the Spirit (Shen), leading to visual disturbances like seeing flowers. Severe cases present with coma, locked jaws, unconsciousness, and cold limbs. Syncope due to excessive bleeding belongs to Deficiency, characterized merely by drowsiness and restlessness. The treatment should tonify Blood, using Zhigancao Tang (Licorice Decoction) or Bazhen Tang (Eight Treasures Decoction) supplemented with Suanzaoren (Ziziphus Seed), Longgu (Dragon Bone), Zhusha (Cinnabar), and Mudanpi (Moutan Bark). Syncope with minimal bleeding indicates lochia rushing upward to the Heart, causing fullness and urgency below the heart, coma, locked jaws, and loss of consciousness. The treatment should break Blood stasis, using Danggui (Angelica Sinensis), Yanhusuo (Corydalis Rhizome), Xuejie (Dragon's Blood), Moyao (Myrrh), Jingjiesui (Schizonepeta Spike), and Jingmo (Beijing Ink), quenched in Hongcu (Red Vinegar), and guided by Tongbian (Child's Urine). Syncope can also occur in patients with hematemesis or epistaxis; physicians must be aware of this.

Postpartum metrorrhagia (profuse bleeding) results from emptiness of Ying Qi (Nutritive Qi), failing to control Blood within its vessels. A large dose of Guipi Tang (Restore the Spleen Decoction) is indicated. If accompanied by sweating and panting, it signifies a critical condition of Blood depletion and Qi scattering. Treat with Shenfu Tang (Ginseng and Aconite Decoction) plus Ejiao (Donkey-hide Gelatin), Shudi (Rehmannia Root), Fuling (Poria), and Gancao (Licorice). Alternatively, anger injuring the Liver may cause Liver Qi to surge recklessly, preventing Blood storage. In such cases, Guipi Tang plus Chao Zhizi (Fried Gardenia), Ejiao, Aiye (Mugwort Leaf), and Chaihu (Bupleurum Root) is suitable. Or Xiaoyao San (Free and Easy Wanderer Powder) plus Ejiao, Muli (Oyster Shell), Zongtan (Palmito Char), Chao Zhizi, Lianye (Lotus Leaf), and Xiangfu (Cyperus Rhizome) is also appropriate.

Stasis interfering with the Lung manifests as blackening of the mouth and nose, a face color resembling an eggplant, or epistaxis. This is a critical sign of rebellious Qi and ascending Blood. Symptoms may include急促 breathing or violent coughing. The root cause is Lung deficiency, failing to regulate the lower aspects, allowing descending Blood to ascend and interfere. Treat with Rensu Yin (Ginseng and Perilla Drink). Add Xingren (Apricot Seed) for epistaxis; add Wuweizi (Schisandra Berry) for coughing. Patients with hematemesis or epistaxis suffering from dryness affecting the Lung are treated similarly. Stasis interfering with the Heart causes Heart Qi blockage, stiff tongue, aphasia, coma, delirium, and hallucinations. Treat with Guixiong Shixiao San plus Nao Bing (Borneol), Zhusha, Xuejie, and Moyao. Niuxi San (Achyranthes Powder) plus Suanzaoren, Hupo (Amber), Shudi, and Renshen is also suitable.

Stasis interfering with the Spleen causes vomiting, abdominal distension, and anorexia. Treat with Shenghua Tang plus Banxia (Pinellia Tuber), Fuling, Zhike (Immature Bitter Orange), and Houpo (Magnolia Bark). If edema develops, it indicates Blood transforming into Water, similar to Blood turning into pus. Since it transforms via Water, treat it as a Water disorder using Wuling San (Five-Ingredient Powder with Poria) plus Huangpu (Polygonatum Rhizome - *Note: Text says Pu Huang, likely Lygodii Spora*) and Mudanpi to promote diuresis.

In summary, Blood moving downward is favorable (Shun); moving upward is unfavorable (Ni). Understanding that postpartum Blood rebellion causes disease clarifies that upward-rebellious Blood in hematemesis/epistaxis is also pathological. However, the etiology differs between postpartum conditions and hemorrhagic diseases, so treatments differ. Several other postpartum syndromes share principles with hematemesis and are listed below for reference.

Postpartum panting is a critical sign. It results from sudden exhaustion of Ying Blood, leaving Wei Qi (Defensive Qi) without support, indicating Blood depletion and Qi scattering. Treat with Shenfu Tang. Simo Tang (Four-Mortar Decoction) may also be used. If panting, black vision, and soot-like nasal discharge occur due to stasis attacking the Lung, it indicates impending Lung Qi exhaustion. Treat with Rensu Yin. These two conditions represent either Kidney Qi deficiency with Yang floating upward, or Lung Qi exhaustion with Blood ascending. Both formulas prioritize Renshen (Ginseng) to generate abundant fluids. Water is the mother of Qi; tonifying Qi via Ginseng generates Water. For floating Yang, add Fuzi (Aconite Root) to guide it back to its root. For ascending Blood, add Sumu (Sappan Wood) to accelerate its descent. These are excellent emergency formulas for postpartum crises, applicable to men suffering from Qi and Blood collapse as well.

Postpartum sweating: Mild perspiration is auspicious. Postpartum Blood deficiency allows Qi to join Blood, and Yang to harmonize Yin. Sweat is water within the Qi aspect. With insufficient Blood and excess Qi, mild sweating releases excess Qi to match Blood, which is a good sign. Internal Yin deficiency with external Yang floating causes spontaneous sweating (Zihan), distinct from mild sweating. Treat by tonifying Yin and guiding Yang using Shengyu Tang (Generate Survival Decoction) plus Fuzi, Wuweizi, Maidong (Ophiopogon Tuber), and Longgu. Profuse sweating resembling flowing water indicates Yang collapse and Yuan Qi scattering. Since Qi is Water, Qi collapse causes profuse sweating; only a large dose of Shenfu Tang can restore Yang. Sweating limited to the head, stopping at the neck, indicates Blood disharmony and Qi steaming upward due to depression. Zhang Zhongjing calls this Yu Mao (Depression and Fullness); treat with Xiao Chaihu Tang (Minor Bupleurum Decoction). Night sweats due to Yin deficiency are treated with Danggui Liuhuang Tang (Angelica Six-Huang Decoction). These relate to sweating patterns in hematemesis/epistaxis and should be cross-referenced.

Postpartum fever: Caused by sudden injury to Yin Blood, leaving Yang without attachment. Treat with Siwu Tang (Four Substance Decoction) plus Paojiang (Roasted Ginger) to draw Yang from Yin, which is the correct approach. Fever with headache and aversion to cold indicates external contraction; do not treat as typical Shaoyang syndrome. Use Siwu Tang plus Jingjie (Schizonepeta), Chaihu, and Congbai (Scallion White) to harmonize Blood and release the exterior. Fever due to food stagnation presents with distension, belching, and retching. Treat with Yigong San (Extra Merit Powder) plus Shanzha (Hawthorn Fruit), Shenqu (Medicated Leaven), Maiya (Barley Sprout), Houpo, and Shengjiang (Fresh Ginger). Fever due to Blood stasis obstruction presents with stabbing pain in the body or abdomen. Treat with Shenghua Tang. Excessive blood loss causing irritability, thirst, red face, and fever is treated with Danggui Buxue Tang (Angelica Tonify Blood Decoction). Fever due to Yin deficiency with unattached Yang (Lone Yang floating outward) requires immediate Shenfu Tang. The *Yizong Jinjian* covers both excess and deficiency types of postpartum fever, similar to treating fever after blood loss in men. The difference lies in direction: blood loss involves upward movement (rebellious), while postpartum involves downward movement (favorable).

There are many other postpartum miscellaneous syndromes. The few listed here illustrate connections with hematemesis. Others are omitted but available in obstetric texts.

Supplementary discussion: Postpartum Qi tends to descend, leading to many collapse syndromes. Hematemesis involves Qi rebelling upward, so collapse syndromes are rare. Collapse in hematemesis requires descending methods; collapse in postpartum conditions requires ascending methods. These are fundamentally different.