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One Treatise, Six Syndromes (Note: Actually five), Eight Formulas.

Question: There are three diseases in women who have recently given birth.

Note: The syndrome and treatment of postpartum convulsion (a condition characterized by stiffness of the neck and back, opisthotonos, caused by deficiency of fluids and blood failing to nourish the sinews or external wind pathogen) are no different from those described in the preceding classics, so it is not discussed separately here. Yu Mao (a condition of dizziness and clouded consciousness resembling being covered by a hat, caused by loss of blood and fluids combined with cold pathogen leading to qi and blood rebellion) is elaborated in the next clause. However, regarding constipation (difficulty in defecation due to fluid depletion postpartum), no formula is provided. Nevertheless, moistening and purgative methods such as Pi Yue Wan are not employed.

Furthermore, according to "General Discussion on Miscellaneous Diseases in Women" in Chao Yuanfang's *Zhu Bing Yuan Hou Lun*: "Zhang Zhongjing said: If a woman has excessive menstrual flow and loses body fluids, she will also suffer from constipation." This is likely an erroneous citation of this clause.

Postpartum Yu Mao presents with a faint pulse. ("Constipation, vomiting, and inability to eat," seven characters, appear in *Mai Jing* as "The reason for constipation is vomiting and inability to eat.")

My elder brother stated: *Ming Li Lun* says: "Yu" refers to stagnation where qi does not circulate freely; "Mao" refers to mental confusion and lack of clarity. What the world calls coma is exactly this. This clause does not mention fever, but subsequent clauses mention further fever, implying the presence of heat. Thus, it is clearly due to catching wind during the puerperal period.

Note: The syntax of this clause is slightly inverted. "Xiao Chai Hu Tang governs it" should originally follow "only sweating on the head." Because the principle of distinguishing Yu Mao is presented first, these three sentences are added at the end of the chapter. Profuse sweating in patients with Yu Mao is the effect appropriate for Xiao Chai Hu Tang, similar to the shaking sweat resolution in Shaoyang disease. Furthermore, the phrase "blood deficiency leading to lower reversal" explains the mechanism of head sweating; the four sentences "Therefore, postpartum women welcome sweating" explain the mechanism of losing blood followed by sweating in the previous clause. This is the manifestation of blood deficiency with pathogenic retention. The phrase "yin and yang then recover" corresponds to "when Yu Mao is about to resolve, there must be profuse sweating."

Generally, welcoming sweating, head sweating, and profuse sweating are three different syndromes and should be viewed separately.

Furthermore, the character "fan" (reversely/unexpectedly) in "constipation reversely becomes hard" contrasts with "vomiting and inability to eat." Since "vomiting and inability to eat" is a Shaoyang syndrome, the stool would not normally be hard. Now, due to dryness of fluids postpartum, the stool becomes unexpectedly hard. *Ben Shi Fang* states: When a person is healthy without illness, suddenly they seem like a corpse, motionless, silent and unaware, eyes closed unable to open, mouth clenched unable to speak. Or slightly aware, hating human voices, only feeling dizzy and confused, waking up after some time. This is because too much sweat has already been lost, blood is scant, qi merges with blood, yang floats alone upward without descending, qi becomes obstructed and fails to circulate, so the body seems dead. After qi passes and blood returns, yin and yang reconnect, so they wake up after some time. It is named Yu Mao, also called Blood Jue (syncope). It is common in women. Bai Wei Tang and Cang Gong San are suitable. Bai Wei Tang: Bai Wei (Anemarrhenae Rhizoma), Dang Gui (Angelicae Sinensis Radix) each 1 liang, Ren Shen (Ginseng Radix) 0.5 liang, Gan Cao (Licorice Radix et Rhizoma) 1 fen (roasted), decocted in water and taken orally. Cang Gong San: Gua Di (Thlapsidis Fructus), Li Lu (Veratri Radix), Xiong Huang (Realgar), Fan Shi (Alumen), equal parts. A small amount insufflated into the nose. (Note: These two formulas are not suitable for the syndrome in this clause, recorded here tentatively.)

It is also said: Women postpartum have three types of ailments. Yu Mao leads to profuse sweating, which leads to severe constipation, making medication difficult. Only Mazi Suzi Zhou (Hemp Seed and Perilla Seed Porridge) is best and safest. (Note: For patients whose Yu Mao resolves with sweating, leaving only intestinal dryness and constipation, this porridge is excellent. The constipation mentioned in the first clause may also be suitable for it.)

After the illness resolves and appetite returns, if fever recurs after seven or eight days,

Note: Regarding this syndrome, Xu Lingtai and Zhu Danxi consider it a recurrence due to diet (Shi Fu). Wei Litong and Zhou Xuehai share this view. Shen Jin'ao and these physicians base their theories on the ability to eat. However, You Zaijing states: "Illness resolves and ability to eat" means Yu Mao has resolved and food can be tolerated. The fever recurring after seven or eight days indicates the pathology is interior rather than exterior, and excess rather than deficiency. Da Cheng Qi Tang should be used to purge interior excess. This interpretation differs slightly and is preserved for study.

Postpartum abdominal pain,

*Qian Jin Fang*: Treats postpartum emaciation, panting and fatigue, spontaneous sweating, and colicky abdominal pain. Mutton Soup Formula.
To this formula, add Gui Xin (Cinnamomi Ramulus), Shao Yao (Paeoniae Radix Alba), Gan Cao (Licorice Radix et Rhizoma), Xiong Diao (Chuanxiong Rhizoma), and Di Huang (Rehmanniae Radix). (*Sheng Hui Fang*: Mutton and Rehmannia Decoction, plus Ren Shen.)

*Wai Tai Mi Yao*, Xu Renze formula: Postpartum, with no other symptoms, only feeling weak, desiring to tonify qi and strength, accompanied by abdominal pain. Mutton and Angelica Soup Formula is suitable.
To this formula (Dang Gui 5 liang, Sheng Jiang 6 liang), add Huang Qi (Astragali Radix) 4 liang. If lochia is not fully discharged, add Gui Xin 3 liang. If lochia discharge is excessive and wind sensation is felt, add Xiong Diao 3 liang. If qi stagnation is felt, add Xi Xin (Asari Radix et Rhizoma) 2 liang. If cold is felt, add Wu Zhu Yu (Evodiae Fructus) 1 liang. If heat is felt, add Sheng Di Huang (Rehmanniae Radix Recens Juice) 2 he.

*Sheng Ji Zong Lu*: Treats postpartum unfavorable flow of blood and qi, acute heart and abdominal pain, attacking sensations moving up and down, rebellious qi causing vexation and oppression. Huang Qi Tang Formula.
To this formula, add Huang Qi, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao, and Ren Shen.

Xia Yu Xue Tang Formula
[Zhao] considers it similar to Di Dang Tang, but milder in action.

Note: This formula follows the pattern of Di Dang Wan and Da Xian Xiong Wan. It should be called "Xia Yu Xue Wan." The current use of "Tang" is likely a transcription error. The word "jian" (decoct) after the formula should also be "zhu" (boil/cook) to conform to ancient meaning.

Seven or eight days postpartum, without Taiyang syndrome. (*Mai Jing*: omits "taking pulse," repeats "there is this person" twice later, changes "bu shi" to "bu neng shi".)

Note: Li Shizhen's annotation is very appropriate. Examining the phrase "without Taiyang syndrome," one can infer the presence of interior syndrome. It is likely that after childbirth, a pathogen entered and sank downward, clashing with blood. There are heat manifestations and hardness/pain in the lower abdomen. This resembles the syndrome of postpartum Wei Jia Shi (Yangming Interior Excess) and is easily confused, hence the need for differential diagnosis. Additionally, "Bladder" here refers to the Lower Jiao, requiring no deep analysis. Postpartum Wind Strike, fever, face bright red.

[Xu] Wind strike with fever and headache is an exterior pathogen. However, a bright red face is not a mild pinkness; it is described as "face painted with vermilion," indicating floating True Yang. Combined with wheezing and high-pitched breathing, it clearly indicates extreme postpartum deficiency where Yuan Qi cannot consolidate itself, compounded by an exterior pathogen. Tonification and purging should be applied simultaneously.

Postpartum dysentery/diarrhea with extreme debility.

[Xu] In treating dysentery, damp-heat cannot be cleared without bitter-cold herbs, so gathering four bitter-cold ingredients is not excessive. To harmonize blood and calm the middle, using just Gan Cao and E Jiao is sufficient. Physicians who prefer using Ren Shen and Bai Zhu for dysentery simply do not understand this principle.

Note: "Extreme debility" implies exhaustion. Xuancun Ningxi says: This syndrome originates from heat dysentery, so even with extreme debility, Bai Tou Weng Tang is still used. The addition of Gan Cao and E Jiao serves not only to tonify blood and qi but also to moderate the middle and regulate the intestines. Tao Shi says: Gan Cao unblocks meridians and detoxifies. Dongyuan says: Bitter-cold herbs become milder with it; hot herbs become less heating with it. Zhen Shi says: E Jiao stops dysentery. Yang Renqi says: Dysentery often results from summerheat and latent heat; E Jiao is a key herb for the Large Intestine. If heat qi is stagnant, it can guide it out; if not stagnant, it maintains peace. Based on these statements, the intent of adding these herbs is clear. Using E Jiao for both deficiency and obstruction aligns with this logic. This explanation is precise.