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[Guo] What is the cause of black qi appearing at the mouth and nose, as well as epistaxis (nosebleed), postpartum? The answer is: The Yangming meridian is the sea of the twelve meridians. It originates beside the nose, intersects at the root of the nose, returns to pass through the cheeks and mouth, and crosses at the Renzhong point. Postpartum, Qi and Blood are deficient and scattered; Ying and Wei (Nutritive and Defensive Qi) fail to circulate properly. Qi and Blood scatter into the various meridians but cannot return to their proper positions, thus causing black qi to appear at the mouth and nose and triggering epistaxis. This arises from postpartum deficiency-heat generating this syndrome. If it progresses to the exhaustion of Stomach Qi and failure of Lung Qi, it is incurable.
The *Experience Formulas* records: Urgently take one red thread and two hairs from the vertex of the parturient woman's head, tie them tightly around the middle finger joint, and the bleeding will stop immediately. Although there is no medicinal treatment, this is also a form of apotropaic ritual.

[Xue] According to my analysis: The Stomach meridian flanks the mouth and surrounds the Chengjiang point. The tip of the nose belongs to Spleen Earth, and the nostrils belong to Lung Metal. If it is indeed Stomach deficiency and Lung damage, it constitutes a critical syndrome of Qi collapse and Blood death. Urgently using Erwei Rensu Yin (Two-Ingredient Ginseng and Asarum Decoction) with five qian of Fuzi (Prepared Aconite Root) has resulted in survival.

[Wang] A postpartum patient experienced upward reversal of blood, presenting with epistaxis, dry mouth, mental restlessness, and a black tongue coating. This was due to the ascent of stagnant blood. Therefore, Yi Mu Wan (Motherwort Pills) were administered, two pills dissolved and taken with child's urine. The epistaxis gradually ceased, and lochia flow became smooth.

[Chen] What is the cause of metrorrhagia (uterine bleeding) postpartum? The answer is: Childbirth injures and depletes the meridians. If they have not yet recovered and are subjected to physical exertion, it causes sudden violent bleeding, dripping continuously. Alternatively, immoderate consumption of sour and salty foods damages Ying and Wei, leading to weakness, which also transforms into metrorrhagia. If there is fullness and pain in the lower abdomen, it indicates that the Liver meridian is damaged and difficult to treat; urgently administer Gujing Wan (Solidify the Menses Pill) to stop the bleeding.
Chen Wuze commented: Metrorrhagia is not a mild disease, especially when occurring postpartum, which is termed severe injury. It is likely caused not only by immoderate intake of salty and sour foods but often by fright, worry, or anger, leading to disharmony of Zang organ Qi. Or, if hemostatic drugs are taken too early postpartum, preventing the expulsion of lochia, the stagnant blood accumulates, becomes distended and hard, also resulting in metrorrhagia. Gujing Wan alone is unlikely to be effective. It is better to use a large dose of Xiong Gui Tang (Ligusticum and Angelica Decoction) added with Shaoyao (Peony Root). Once stabilized, subsequent treatment should follow the specific symptoms.

[Xue] Regarding the aforementioned syndromes: If blood stagnation causes lower abdominal fullness, use Shixiao San (Pain-Relieving Powder). If blood deficiency causes lower abdominal empty bloating, use Xiong Gui Tang. If Liver fire causes reckless blood movement, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If Spleen depression fails to control blood, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). If Spleen Qi deficiency fails to hold blood, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If rich flavors accumulate heat damaging blood, use Qingwei San (Clear the Stomach Powder) added with Huaihua (Sophora Flower). If wind-heat struggle damages blood, use Sixia Junzi Tang (Four Gentlemen Decoction) added with Fangfeng (Saposhnikovia Root) and Zhike (Aurantium Fructus).
One postpartum patient suffered metrorrhagia with lower abdominal distension and pain. After using formulas that break Qi and move blood, the bleeding surged like a fountain, limbs became flaccid, accompanied by aversion to cold, vomiting, and frequent diarrhea. I used Liujun Zi Tang (Six Gentlemen Decoction) added with Pao Ganjiang (Prepared Dried Ginger). After four doses, there was slight improvement, followed by thirty-plus doses of Shiquan Dabu Tang (Ten Complete Tonifying Decoction) for recovery.
Another postpartum patient suffered metrorrhagia; due to anger, blood surged like a fountain, she collapsed with locked jaw and deviated eyes, and convulsions of hands and feet. This was Wind generated from Liver Blood depletion. I administered one dose of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) ingredients, after which all symptoms receded. However, she had poor appetite and afternoon fever, so Si Jun Zi Tang (Four Gentlemen Decoction), Chaihu (Bupleurum Root), and Mudanpi (Moutan Bark) were added to achieve cure.

Gujing Wan (Solidify the Menses Pill)
Aiye (Mugwort Leaf), Chishizhi (Red Halloysite, calcined), Buguzhi (Psoralea Fruit, stir-fried), Muzei (Equisetum Herba) (each half liang), Fuzi (Prepared Aconite Root, one piece, processed).
Grind into powder, mix with aged rice paste to make pills the size of wutong seeds. Take twenty pills before meals with warm wine; rice water is also acceptable.

Xiong Gui Tang Jia Shaoyao Formula (Ligusticum and Angelica Decoction Added with Peony Root)
Xionggui (Ligusticum Chuanxiong Rhizome), Danggui (Angelica Sinensis Radix), Shaoyao (Paeonia Lactiflora Radix) (equal parts).
Cut into pieces. Take four qian per dose, add one and a half cups of water, decoct until seven-tenths remain, remove dregs, and drink hot. Take at any time.

Shugen Dihuang San (Cooked Rehmannia Powder)
Treats postpartum metrorrhagia, vertigo, coma, limb restlessness, and loss of consciousness.
Shu Dihuang (Prepared Rehmanniae Radix), Fulonggan (Dragon's House Soil), Huangqi (Astragali Radix), Chishizhi (Red Halloysite) (each one liang), Ejiao (Donkey-hide Gelatin), Gancao (Licorice Root), Baizhu (Atractylodis Macrocephalae Rhizoma), Aiye (Mugwort Leaf, stir-fried), Chuanxiong (Ligusticum Chuanxiong Rhizome), Renshen (Ginseng Radix) (each half liang), Danggui (Angelicae Sinensis Radix) (seven qian and half).
Cut into pieces. Take four qian per dose, add one and a half cups of water and three slices of ginger, decoct until seven-tenths remain, remove dregs, and drink warm.

Baishaoyao San (White Peony Powder)
Treats postpartum metrorrhagia with continuous dripping, sallow complexion, and deficiency wasting.
Baishaoyao (White Peony Root), Muli (Ostrea Shell), Ganjiang (Dried Ginger), Shu Dihuang (Prepared Rehmanniae Radix), Guixin (Cinnamon Twig), Huangqi (Astragali Radix), Wuzheiyugu (Sepiae Endoconcha), Lu Jiaojiao (Deer Antler Glue), Longgu (Fossilized Mammoth Teeth/Bones) (each one liang).
Grind into powder. Take two qian per dose before meals with warm wine.

Another Formula
Chishizhi (Red Halloysite), Shu Dihuang (Prepared Rehmanniae Radix) (each one liang), Lurong (Deer Antler), Muli (Ostrea Shell), Danggui (Angelicae Sinensis Radix) (each half liang).
Grind into fine powder. Take two qian before meals mixed with porridge water.

Ejiao Wan (Donkey-hide Gelatin Pills)
Treats persistent postpartum metrorrhagia with emaciation and weakness.
Ejiao (Donkey-hide Gelatin), Chishizhi (Red Halloysite) (each one and a half liang), Xuduan (Dipsaci Radix), Chuanxiong (Ligusticum Chuanxiong Rhizome), Danggui (Angelicae Sinensis Radix), Gancao (Licorice Root), Danshen (Salviae Miltiorrhizae Radix et Rhizoma) (each one liang), Longgu (Fossilized Mammoth Teeth/Bones), Lurong (Deer Antler, baked with rice wine), Wuzheiyugu (Sepiae Endoconcha), Biejia (Testudinis Carapax et Plastrum, roasted) (each two liang, ground together into fine powder).
Make pills with refined honey, size of wutong seeds. Take twenty to thirty pills on an empty stomach with warm wine.

Changpu Jiu (Acorus Wine)
Treats persistent postpartum metrorrhagia.
Changpu (Acori Tatarinowii Rhizoma, one and a half liang, finely cut). Boil in two cups of wine until one cup remains, remove dregs, divide into three warm doses, taken before meals.

Ruilian San (Auspicious Lotus Powder)
Treats postpartum lochia metrorrhagia resembling flowing spring water.
Ruilian (Nelumbinis Plumula, one hundred pieces, burned to retain properties), Zonglv (Palmae Folium, burned to retain properties), Danggui (Angelicae Sinensis Radix), Guixin (Cinnamon Twig) (each one liang), Liyu Lin (Cyprini Carpio Squama, burned), Chuanxiong (Ligusticum Chuanxiong Rhizoma) (each seven qian and half), Binglang (Arecae Semen) (two pieces).
Grind into fine powder. Take three qian before meals mixed with roasted ginger wine. If bleeding does not stop, take another dose. For irregular metrorrhagia where no medicine is available, taking three doses will stop it.

*Supplement* treats postpartum metrorrhagia.
Xiangfu (Cyperi Rhizoma, stir-fried until red, two liang), Lianpeng Ke (Nelumbinis Calyx Shell, five pieces, burned to retain properties).
Grind into powder. Take two qian mixed with rice water.

For postpartum metrorrhagia in patients with pre-existing heat, Qixiao Siwu Tang (Miraculous Efficacy Four Substances Decoction) is excellent. (Formula see section on Metrorrhagia.)