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[Guo] What is the cause of abdominal pain and diarrhea/dysentery after childbirth? The answer is: After childbirth, the intestines and stomach are weak and deficient, making them susceptible to invasion by cold pathogens. If one drinks cold water or exposes oneself to wind within a month postpartum, the pathogen will take advantage of the deficiency to invade and remain in the huangmo (the fatty membrane between the heart and diaphragm), spreading to the abdomen and hypochondrium. Consequently, paroxysmal abdominal pain occurs, feeling as if pierced by awls or knives. If the pathogen flows into the large intestine, causing food and fluids to fail to digest, it results in watery diarrhea with borborygmus, or the passage of red and white mucus, fullness and distension in the hypochondrium, or wandering pain. In such cases, one should immediately administer Tiaozhong Tang (Regulate the Middle Decoction) for immediate recovery. If a physician mistakenly treats this as food stagnation and uses purgatives, disaster will follow instantly; caution is paramount.

Chen Wuyue commented: Postpartum dysentery presents various syndromes and must be regulated according to the specific etiology. Since drinking cold water and exposure to wind were mentioned, various external pathogens may invade. Cold, heat, wind, and dampness belong to external causes, while joy, anger, worry, and thought stem from internal nature. Moreover, both overwork and lack of exertion, hunger and satiety can induce disease. For watery diarrhea, Tiaozhong Tang may be used. However, for bloody and purulent dysentery (Chi Bai Zhi Xia), this formula alone is insufficient; one should refer to respective categories for specific formulas.

[Xue] Postpartum diarrhea and dysentery may result from dietary injury damaging the Spleen Earth, or from Spleen Earth deficiency failing to digest food. Treatment must be determined through careful examination. If injured by rice, use Liu Junzi Tang (Six Gentlemen Decoction) plus Gu Ya (Valley Sprout). If injured by wheat products, use Liu Junzi Tang plus Mai Ya (Wheat Sprout). If injured by meat, use Liu Junzi Tang plus Shan Zha (Crataegus) and Shen Qu (Medicated Leaven). For cases accompanied by vomiting, add Huo Xiang (Pogostemon). For cases with acid regurgitation or vomiting, administer the aforementioned herbs with Yueju Wan (Yueju Pill). If Liver Wood insults Spleen Earth, use Liu Junzi Tang plus Chai Hu (Bupleurum) and Pao Jiang (Prepared Ginger). If Cold Water insults Earth, use Qian Shi's Yihuang San (Yellow Protecting Powder). For chronic diarrhea or sinking of Yuan Qi (Primal Qi), combine with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Yang Qi. If the stool is yellow, indicating the true Qi of Spleen Earth leaking out, add Mu Xiang (Aucklandia) and Rou Dou Kou (Myristica). For Spleen Earth deficiency-cold, use Liu Junzi Tang plus Mu Xiang, Sheng Jiang (Fresh Ginger), and Rou Gui (Cinnamon Bark). For Spleen-Kidney deficiency-cold, use Buzhong Yiqi Tang and Sishen Wan (Four Spirits Pill). If Mingmen Fire (Gate of Life Fire) is deficient leading to Spleen Earth deficiency-cold, use Ba Wei Wan (Eight-Ingredient Pill) to tonify the Mother of Spleen Earth (Kidney). If urination is obstructed, limbs gradually swell, or asthma/cough accompanies, use Jin Gui Shenqi Wan (Golden Cabinet Kidney Qi Pill) to tonify Spleen and Kidney and promote water metabolism. If Stomach Qi weakness causes limb edema, treatment must focus on tonifying the Stomach. If prolonged without resolution, or not caused by diet, it belongs to Kidney Qi deficiency. Since the uterus is governed by the Ren Mai (Conception Vessel) and connected to the Kidneys, and months nine and ten of pregnancy are nourished by Kidneys and Bladder, one must use Sishen Wan, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), and Ba Wei Wan to tonify the Kidneys. Using draining and diuretic agents would further deplete the deficiency.

Case 1: A postpartum woman suffered diarrhea/dysentery, fever, thirst, excessive phlegm, emaciation, poor appetite, occasional chest/epigastric fullness, and lower abdominal bearing-down sensation for over a year. I diagnosed this as Spleen-Stomach diarrhea. She tookershenshen Wan in the morning and Liu Junzi Tang in the evening, recovering after three months.

Case 2: A postpartum woman had diarrhea with vomiting, acid regurgitation, and facial edema, indicating Spleen Qi deficiency-cold. Initially treated with Liu Junzi Tang plus Pao Jiang as the main formula, assisted by Yueju Wan, resolving the acid regurgitation. Then treated with Buzhong Yiqi Tang plus Fu Ling (Poria) and Ban Xia (Pinellia), restoring Spleen-Stomach health.

Case 3: A postpartum woman suffered diarrhea/dysentery for a year, becoming emaciated ("bone-standing"), experiencing internal heat, afternoon fever, spontaneous and night sweats, oral ulcers, expectorating about three bowls of phlegm daily, with a洪大 (Surging) pulse that vanished upon heavy pressure. This indicated Mingmen Fire deficiency, Spleen Earth deficiency-cold, and false heat. The phlegm resulted from Spleen deficiency failing to control fluid retention. Treated with Ba Wei Wan to tonify Fire to generate Earth, and Buzhong Yiqi Tang to tonify Lung Metal, thereby strengthening Spleen-Stomach.

Case 4: A postpartum woman had abdominal pain with tenesmus, profuse dysentery, fatigue, and anorexia, nearing death due to Spleen-Kidney dual deficiency. Cured with Sishen Wan and Shiquan Dabu Tang (Ten Great Tonification Decoction). Subsequent indigestion and fatigue resolved with Buzhong Yiqi Tang.

Case 5: A woman developed dysentery in the fifth month, day and night without cessation, lower abdominal bearing-down pain, fever, and aversion to cold. Treated with Liujunzi Tang delivering Xianglian Wan (Aucklandia-Coptis Pill); improved after two doses. Continued with the same decoction delivering Sishen Wan; fully recovered after four doses. By the end of the seventh month, she exhibited lethargy, desire to sleep, inability to move limbs, heavy body and joint pain, dry mouth/tongue, tasteless food, loose stools, frequent urination, chills, and depression. This indicated Lung-Spleen-Stomach deficiency with Yang Qi cold and constrained. Cured with Shengyang Yiewei Tang (Raise Yang and Benefit Stomach Decoction).

Wang Shishan treated a postpartum woman with slippery diarrhea, unable to retain even a spoonful of water or grain, which was immediately expelled. This persisted for over half a month. Others considered it critical and used Wuling San (Five-Ingredient Powder with Poria) and Pingwei San (Level the Stomach Powder), worsening the condition. Wang diagnosed a Ru Huan Ruo (Soggy, Slow, Weak) pulse. He stated: "This is Stomach Qi injured by labor during childbirth. Decoctions would increase Stomach dampness and are unsuitable." He prescribed Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) minus Sha Ren (Amomum), plus Chen Pi (Tangerine Peel) and Rou Dou Kou (Myristica), taken with Ginger-Jujube decoction. She stabilized after ten days.

[Dan] Treating postpartum diarrhea with lochia stasis: This is residual blood seeping into the large intestine causing diarrhea, uncontrollable watery discharge, passing green-white-black stool. Use 4-5 large spikes of Jingjie (Schizonepeta), burn to ash in a cup without oil/fire contact, mix with Shexiang (Musk), and take with three mouthfuls of water. Though mild, this medicine cures major illness. (Formula name: Qisan / Miracle Powder.)

Postpartum Diarrhea Formula
Fuling (Poria), Chuanxiong (Ligusticum), Huangqin (Scutellaria), Baizhu (Atractylodes), Ganjiang (Dried Ginger), Huashi (Talc), Chenpi (Citrus Peel), Shaoyao (Peony Root) [Stir-fried, equal parts].
Decoct in water and take.

Tiaozhong Tang (Regulate the Middle Decoction)
Gaoliangjiang (Galangal), Danggui (Angelica Sinensis), Guixin (Cinnamon Twig/Cortex Cinnamomi), Shaoyao (Peony Root), Fuzi (Aconite Root [Prepared]), Chuanxiong (Ligusticum) [each 1 liang], Gancao (Licorice Root) [0.5 liang].
Grind into coarse powder. Take 3 qianbi per dose, with 3 zhan of water, decoct to 1 zhan, remove dregs, and take hot.
The above formula is suitable only for cold-mid obstruction causing watery diarrhea. For intestinal-stomach heat,黄连 (Coptis) preparations such as Rujin Wan (Like-Gold Pill) or Xianglian Wan should be used. Formulas like Wuji Wan, Guchang Wan, Sishen Wan, and Wuweizi Wan are essential for postpartum loose stools, detailed in miscellaneous diseases and previous diarrhea sections, thus not repeated here.