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[Guo] What is the cause of constipation and dryness of stool after childbirth? The answer is: After delivery, water and blood are discharged together, leading to deficiency and exhaustion of the stomach and intestines, and a lack of body fluids (Jin-Ye), thus causing constipation and dryness of stool. If five or six days pass and there is abdominal stuffiness and distension, this indicates dry feces retained in the zang-fu organs; because the feces are dry and astringent, they cannot be expelled. It is appropriate to take Mahuang Wan (Cannabis Seed Pill) to moisten the intestines. If mistakenly treated as having internal heat by administering cold-natured herbs, yang will decline and yin will grow, resulting in various complicated syndromes and endangering life.

[Xue] Postpartum inability to defecate is caused by excessive blood loss, leading to dryness of the large intestine, or by blood deficiency with fire-dryness causing intestinal dehydration. One should not judge solely by the number of days. Even if food intake is high, using purgative or moistening drugs requires waiting until the patient feels fullness and distension in the abdomen, desires to defecate but cannot. This indicates dry feces impacted in the rectum, suitable for treatment with pig bile to moisten and unblock. If bitter herbs like Sophora flavescens root (Kushen) are used to moisten and unblock, it may damage the primordial qi of the middle jiao, making defecation even more difficult, or causing persistent diarrhea after evacuation, inevitably leading to a critical syndrome (Bai Zheng). If the syndrome belongs to blood deficiency with fire-dryness, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If both qi and blood are deficient, use Bazhen Tang (Eight Treasures Decoction). One must strictly avoid using seeds like hemp seed (Mazi), apricot kernel (Xingren), or aurantium peel (Zhiqiao). One postpartum patient had not defecated for seven days, yet her diet was normal and abdomen felt fine. I said: Although food intake was double the usual amount, the abdomen was not distended. Use Bazhen Tang added with Peach Kernel (Taoren) and Apricot Kernel (Xingren). By the twentieth day, when abdominal distension occurred and she desired to defecate, use pig bile to moisten. First, five or seven pieces of hard feces were passed, followed by normal stools, and she recovered. Another postpartum patient had not defecated for eight days. After using purgatives, pain occurred at Zhongwan (CV12), and food intake was scant. Some said "unblocked means no pain, pain means unblocked." Thus, honey suppositories (Mi Dao) were used, resulting in involuntary defecation, hiccups, and inability to eat. I said: This is further injury to the spleen and kidney. Use Liujunzi Tang (Six Gentlemen Decoction) added with Evodia fruit (Wuzhuyu), Myristica seed (Roudoukou), Achyranthes root (Guzhi), and Schisandra berry (Wuweizi). After several doses, fortunately, due to her young age, she recovered. Otherwise, death would likely have ensued. A postpartum patient with constipation and lower abdominal distending pain used Rhubarb (Dahuang) and other drugs, resulting in vomiting, diarrhea, anorexia, abdominal pain, and chest oppression. I treated her with Liujunzi Tang added with Aucklandia root (Muxiang) and roasted ginger (Paojiang), and she recovered. A woman with severe constipation and dryness found all medicines ineffective and suffered greatly. She was instructed to drink human milk and recovered.

Mahuang Wan (Cannabis Seed Pill)
Hemp Seed (Maren, ground into paste), Aurantium Peel (Zhiqiao), Ginseng Root (Renshen) (each 1 liang), Rhubarb Root and Rhizome (Dahuang) (0.5 liang).
Grind the above into powder, mix with refined honey to form pills the size of paulownia seeds. Take 20 pills on an empty stomach with warm wine. If stool does not pass, gradually increase the number of pills, but do not exceed the appropriate dose.

Commentary states: Purging is contraindicated after childbirth; those who undergo purging rarely survive. Due to excessive blood loss and dryness of the viscera causing constipation, lubrication is indeed indicated. However, Rhubarb (Dahuang) should not be used lightly. Only by mixing scallion juice with tea from the twelfth lunar month (Lacha) to form pills, and taking them down with Lacha, can the bowels be unblocked. (I often use Siwu Tang (Four Substances Decoction) from the Bureau of Medical Relief Formulas, substituting Rehmannia Root (Sheng Dihuang) for processed Rehmannia Root (Shu Dihuang), adding peeled Citrus Aurantium Peel (Qingpi), and decocting for administration; this is very effective.)

[Benshi] There are three types of diseases in women after childbirth. Yu Mao (depression and dizziness) leads to profuse sweating; profuse sweating leads to constipation. Therefore, medication is difficult to administer. Only Mazisu Zi Zhou (Hemp Seed and Perilla Seed Porridge) is the safest option. Use Perilla Seed (Zisuzi) and Hemp Seed (Damaizi), half he each, wash clean, grind extremely finely, add water and grind again to extract juice, obtaining one cup. Divide into two portions and cook into porridge to consume. This porridge is not only suitable for postpartum use but also generally appropriate for the elderly suffering from various deficiency-induced wind-constipation. Once, an eighty-four-year-old mother suddenly experienced abdominal distension, headache, nausea, and anorexia. Several doctors were summoned, and all discussed using spleen-tonifying, appetite-stimulating, wind-dispelling, and head-clearing herbs. Although symptoms improved after several days, she could not eat at all, causing great worry to her family. I analyzed that the previous medications were incorrect. This case was precisely wind-constipation in the elderly, with obstruction of the zang-fu organs. Accumulation in the chest causes abdominal distension, nausea, and anorexia; ascending to the vertex causes headache and mental cloudiness. If the zang-fu organs become smooth and flowing, all diseases will disappear. I instructed them to make this porridge. After two sips, qi descended, and first, more than ten pellets of hard feces resembling peppercorns were passed. Subsequently, bowel movements became regular, and she healed without medication.

[Dan] For postpartum constipation with abdominal distension, where breathing is rapid and sitting or lying down is difficult, use barley stir-fried until yellow, ground into powder. Take one he with wine. The effect is miraculous. (From Bingbu Shouji.)