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[Guo Jizhong] What is the cause of abdominal distension, chest fullness, and irregular vomiting after childbirth? The answer is: This is caused by lochial stasis (residual blood after delivery) scattering into the Spleen and Stomach. When the Spleen is affected, it cannot transport and transform essence and turbidity, leading to abdominal distension. When the Stomach is affected, it cannot receive and digest food and fluids, leading to vomiting and regurgitation. If physicians do not understand this, and treat it with ordinary medicines for distension and vomiting, the medicine will be irrelevant to the disease, further damaging the healthy Qi, making the illness harder to cure. Simply administering Disheng Tang (Cinnamon Twig and Angelica Decoction) will result in recovery.

[Xue Ji] For the aforementioned syndrome caused by lochial stasis injuring the Spleen and Stomach, the previous formula (referring to Disheng Tang) should be used. If food stagnation is in the Spleen, Liujunzi Tang (Six Gentlemen Decoction) plus Houpo (Magnolia Bark) should be used. If food injury is in the Stomach, Liujunzi Tang should be used. Generally, when the Spleen is damaged, regulating diet is beneficial. A postpartum patient suffered from the aforementioned syndrome; someone administered Didang Tang (Ephedra and Rhubarb Decoction). Although the lochial stasis was discharged, the previous symptoms worsened, with a heavy bearing sensation in the lower abdomen, as if defecation were imminent. I considered this to be deficiency of Spleen Qi with sinking. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Paojiang (Prepared Ginger) to warm and tonify Spleen Qi, and the heavy bearing sensation disappeared. Subsequently, she took Liujunzi Tang and recovered.

Disheng Tang includes half taels of fresh ginger, baked dry and decocted in water. (The formula is found under "Abdominal Distension during Pregnancy." Xue stated: This formula is most suitable.) Pingwei San (Stomach-Pacifying Powder) from *Ju Fang* added with Renshen (Ginseng) can also be used.

[Guo Jizhong] The cause of edema in the four limbs after childbirth is that lochial stasis accumulates due to deficiency, flows along the meridians into the four limbs, stays and infiltrates deeply over time, yet fails to return and dissipate. It rots and transforms like water, causing yellow complexion and edema in the four limbs. Physicians who do not recognize this may mistakenly treat it as fluid retention disease. Treatments for fluid retention often use diuretic drugs, which are extremely harmful to those who are severely deficient. Since the body is already deficient postpartum, using drugs to further deplete it is called "double deficiency," often leading to premature death. Simply administering Xiaotiaojing San (Minor Regulating the Menses Powder) will allow blood circulation to resume and swelling to subside, resulting in recovery.

Chen Wuyue said: Postpartum edema has various causes. Some swell during pregnancy and do not resolve after delivery. Others result from improper postpartum care, where external pathogenic factors like cold, heat, dampness, and wind invade, or internal emotional disturbances like anger, joy, worry, and fright occur. Blood and Qi contend and stagnate in the meridians. One must distinguish between disorders of the Qi level and the Blood level. Treatment must follow the specific etiology, pulse, and symptoms to ascertain the true nature of the condition. Xiaotiaojing San is effective for blood-level edema, but its action is mild and insufficient alone. Wuzyuyu Tang (Evodia Decoction), Zhizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction), Duohun San (Soul-Rescuing Powder), and Datiaojing San (Major Regulating the Menses Powder) are all essential formulas.

Another discussion states: Postpartum labor injures Qi and Blood. When the Couli (pores and interstices) are deficient, Wind pathogens invade. Pathogens contend with Qi, preventing its dissemination and transcendence, leading to empty swelling and light floating, which is Qi swelling caused by pathogen-Qi contention. If the skin resembles a ripe plum, it transforms into Water Edema. Qi swelling resolves with sweating; Water Edema resolves with promoting urination.

[Zhang Congzheng] If Wind-Cold is on the exterior after childbirth, causing facial and limb edema, Qisheng Wan (Seven Sages Pill) from *Ju Fang* should be used, taken with plain water, increasing the dose daily until bowel movement occurs. If edema extends to the knees with wheezing and coughing, double the dosage of Muxiang (Aucklandia Root) and Binglang (Areca Seed), indicating excessive Qi stagnation. If edema is accompanied by headache and dizziness, double the dosage of Qianghuo (Notopterygium Rhizome) and Chuanxiong (Ligusticum Rhizome), indicating excessive Wind. If there is only simple edema, take the original Qisheng Wan formula alone.

[Li Dongyuan] Zhongman Fenxiao Wan (Middle Fullness Dispersing and Differentiating Pill) (for miscellaneous diseases with distension and fullness). Swallow with Siwu Tang (Four Substances Decoction).

[Zhu Danxi] For postpartum edema, the primary treatment must be greatly tonifying Qi and Blood, with minor additions of Cangzhu (Atractylodes Lancea Rhizome) and Fuling (Poria), allowing water to drain naturally.

[Xue Ji] For the aforementioned syndrome, if Cold-Water insults Earth (Kidney Water counter-acting Spleen Earth), nourish the Spleen and Lungs. If it is Qi-deficiency edema, benefit the Spleen and Stomach. If it is Water-Qi edema, tonify Middle Qi. Refer to the main treatments in the respective chapters of miscellaneous diseases. A postpartum patient had poor appetite and took digestive aids, resulting in limb edema. I diagnosed insufficient Middle Qi. She took Buzhong Yiqi Tang in the morning and Liujunzi Tang in the evening, recovering fully. Later, anger caused abdominal distension; she mistakenly took Chenxiang Huaqi Wan (Agarwood Promoting Qi Circulation Pill), leading to continuous vomiting and diarrhea, inability to eat, difficult urination, and abdominal and limb edema. She recovered after taking Jin Gui Jiashen Shenqi Wan (Modified Kidney Qi Pill from the Golden Cabinet). Another postpartum patient had diarrhea, facial and limb edema, wheezing, and aversion to cold. I diagnosed Spleen-Lung Deficiency-Cold. She took Liujunzi Tang plus Shengjiang (Fresh Ginger) and Rougui (Cinnamon Bark) to stop diarrhea, and Buzhong Yiqi Tang to strengthen the Spleen and Stomach.

[Du Zizhai] Zhang Xuanhui’s favored concubine developed sudden edema half a month after childbirth. Obstetricians were summoned but failed to cure her after half a month; the condition worsened. Du was summoned. Upon arrival, Du asked: What did other doctors diagnose? Zhang replied: They all said it was Water-Qi Edema. Du said: Incorrect. Water-Qi typically presents with cough and scanty, painful urination. Now your concubine has no urinary difficulty nor cough, only cold hands and feet. This is deficiency of the Blood Zang organs, with Qi blockage preventing flow, overflowing to the face causing edema. He treated her with herbs to nourish blood and harmonize Qi. After ten days, seven or eight parts of the illness had passed; after half a month, she was fully recovered. The medicine used was Mudan San (Peony Powder) from *Ling Yuan Fang*. The formula states: It treats Wind-Cold-Deficiency of the Blood Zang. Currently, obstetricians use this frequently for postpartum conditions with miraculous results, renamed Sunjin Tang (Damaging Metal Decoction). (Mudan San is seen under Syncope due to Lochial Stasis.) A postpartum patient had limb edema, alternating chills and fever, because lochial stasis flowed into the meridians, infiltrating the limbs. She had wheezing, cough, chest oppression, sour regurgitation, and hypochondriac pain. She was given Xuanfuhua Tang (Inula Flower Decoction); slight sweating led to gradual relief. Frequent administration of Xiaotiaojing San, taken with Ze Lan Geng (Leonurus Stem) decoction, gradually reduced the swelling.

Datiaojing San (Major Regulating the Menses Powder) treats postpartum swelling and fullness, wheezing, urgency, thirst, and difficult urination. (Formula seen under Postpartum Alternating Chills and Fever.)

Xiaotiaojing San (Minor Regulating the Menses Powder)
Moyao (Myrrh), Hupo (Amber), Guixin (Cinnamon Heart), Shaoyao (White Peony Root), Danggui (Angelica Sinensis) (each 1 qian), Xixin (Asarum), Shexiang (Musk) (each 0.5 qian).
Grind into fine powder. Take 0.5 qian per dose, mixed with a little Ginger Juice and Warm Wine.

Treats generalized cyanotic swelling and pain after childbirth, and postpartum blood-water disorders. (From *Furen Jingyan Fang*.)
Ganqi (Dry Resin of Toxicodendron), Damai (Barley) (equal parts).
Grind each into fine powder. Layer barley and Ganqi in a new clay pot, filling it completely. Seal with salt mud, fire-roast until red hot, cool, and grind into powder. For any postpartum disorder, take 2 qian mixed with Hot Wine.

The Classics state: For postpartum superficial swelling, take Tangerine Peel with wine. (Orange peel ground to powder, 2 qian per dose, taken with wine.)

Baizhu Tang (Atractylodes Macrocephala Decoction) treats firm and large epigastric distension like a plate, with edges like a rotating plate, caused by fluid retention, named Qi Fen (Qi Level).
Zhishi (Immature Bitter Orange) (1.5 liang), Baizhu (Atractylodes Macrocephala Rhizome) (3 liang).
Cut into pieces. Take 4 qian per dose, decoct in 1.5 cups of water until 0.7 cup remains, strain, and take warm. If rumbling sounds are heard in the abdomen, the accumulation will dissipate.

[Zhu Danxi] In women with postpartum edema, scanty urine, thirst, aversion to cold, weakness, and deep pulses, this indicates constitutional deficiency with accumulation of Damp-Heat. There is必然 (necessarily) upper Jiao fullness. Tonifying the middle while guiding out water and moving Qi is appropriate.
Baizhu (2.5 liang), Chenpi (Tangerine Peel) (1 liang), Chuanxiong (0.5 liang), Mutong (Akebia Caulis) (6 qian), Fuling (Poria) (3 qian).
Decoct in water. Take with 25 pills of Dian Dian Wan (Point-Dot Pill). (Huangqin (Scutellaria Root) ground to powder, pillified with rice porridge paste, named Dian Dian Wan, also called Qingjin Wan (Clear Metal Pill).)

Duohun San (Soul-Rescuing Powder) treats postpartum empty swelling and wheezing; recovery follows promotion of urination.
Shengjiang (Fresh Ginger, 3 liang, juice extracted), Baifan (Wheat Flour) (3 liang), Dabanxia (Large Pinellia Tuber) (7 pieces).
Knead flour with Ginger Juice, wrap Banxia, form into seven cakes. Roast until charred and cooked, grind to powder. Mix with water, one cup per dose. Effectiveness is indicated by free urination.

Zhang Shi Formula (Zhang's Formula) treats postpartum Blood Deficiency, Wind Swelling, and Water Edema.
Zelan Ye (Herba Leonuri Capillaris), Fangji (Stephania Tetrandra Root) (equal parts).
Grind to powder. Take 2 qian per dose, mixed with Warm Wine. If alcohol is not consumed, Vinegar Water may be used.

Hanfangji San (Stephania Tetrandra Powder) (Contraindicated for deficient patients.)
Hanfangji (Stephania Tetrandra), Zhuling (Polyporus), Zhiqiao (Bitter Orange), Sangbaipi (Mulberry Root Bark) (each 1 liang), Shanglu (Phytolacca Root), Gancao (Licorice Root) (each 0.75 liang).
Grind to coarse powder. Take 4 qian per dose, decoct in 1.5 cups of water with 3 slices of Ginger until 0.7 cup remains, strain, and take warm on an empty stomach.

Qisheng Wan (Seven Sages Pill) (For miscellaneous diseases with constipation.)

Jiajian Wuzhuyu Tang (Modified Evodia Decoction) treats women with inherent visceral deficiency, chronic Wind-Cold retention, chest and diaphragm fullness/pain, cramping/stabbing pain in abdomen and flanks, vomiting/nausea, decreased appetite, empty swelling of body and face, aversion to cold and shivering, or continuous diarrhea, shortness of breath and emaciation. Also treats acute visceral deficiency due to childbirth, with internal excess of Cold pathogens exacerbating old diseases.
Wuzhuyu (Evodia Fruit) (1.5 liang), Kugeng (Platycodon Root), Ganjiang (Dried Ginger), Gancao (Licorice Root), Maimendong (Ophiopogon Tuber), Fangfeng (Saposhnikovia Root), Banxia (Pinellia Tuber), Xixin (Asarum), Danggui (Angelica Sinensis), Chifuling (Red Poria), Mudanpi (Tree Peony Bark), Guixin (Cinnamon Heart) (each 0.5 liang).
Grind to coarse powder. Take 4 qian per dose, decoct in 1.5 cups of water until 0.7 cup remains, strain, and take hot before meals.

Jin Gui Jiashen Shenqi Wan (Modified Kidney Qi Pill from the Golden Cabinet) (Formula seen under Miscellaneous Diseases: Edema.)

Jiawei Bawu Tang (Augmented Eight-Ingredient Decoction) treats generalized postpartum edema, rapid breathing, and tidal fever.
Renshen (Ginseng), Baifuling (White Poria), Shudihuang (Prepared Rehmannia Root), Xiao Huixiang (Small Fennel) (each 3 qian), Baizhu (Atractylodes Macrocephala Rhizome), Chuanxiong (Ligusticum Rhizome) (each 4 qian), Danggui (Angelica Sinensis), Baishaoyao (White Peony Root), Xiangfuzi (Cyperus Rhizome) (each 5 qian), Gancao (Licorice Root), Huangqin (Scutellaria Root), Chaihu (Bupleurum Root) (each 1 qian).
Cut into fragments. Divide into six or seven doses. Each dose decocted in 1.5 cups of water with 3 slices of Ginger until 0.7 cup remains. Take hot on an empty stomach. After finishing this medicine, take Tiaojing Wan (Regulating Menses Pill). If abdominal pain, add Yanhusuo (Corydalis Rhizome), Ganqi (Dry Resin of Toxicodendron), Zhiqiao (Bitter Orange) (each 3 qian). If vomiting/nausea, add Liangjiang (Alpinia Katsumadai Rhizome), Sharen (Amomum Fruit) (each 2 qian). If numbness of hands and feet, add Rougui (Cinnamon Bark) (1.5 qian). If cough, add Wuweizi (Schisandra Berry), Kuandonghua (Farfola Flower), Xingren (Apricot Seed).