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Postpartum blood masses are accumulations of residual blood after pregnancy. In women, when Qi and Blood are abundant, Tian Gui (substances promoting reproductive development) arrives at age fourteen, and menstruation occurs monthly at age thirty, resembling the waxing and waning of the moon with regularity, termed Jing (menstruation). Once pregnant, menstruation ceases, and residual blood enters the Bao Gong (uterus) to protect the Tai Yuan (fetal origin). At one month of gestation, it is called Tai Pei (fetal embryo); at two months, Shi Gao (beginning paste); at three months, it begins to take form and is named Tai (fetus), only then receiving nourishment from maternal blood. The fetal form is still small; although it consumes maternal blood, surplus fluid remains. Combined with blood accumulated in the previous two months within the uterus, over time it forms blood masses. At delivery, these should be expelled along with the infant. If due to the mother's exhaustion during labor or expulsion of the placenta, or improper care leading to a lack of warmth in the abdomen, the blood masses may fail to dissipate for a long time, causing pain that rejects pressure. At this time, Sheng Hua Tang (Decoction for Generating New Blood) should be used to promote blood circulation, and external warming of the abdomen with hot garments is sufficient. One must not lightly administer harsh purgatives, lest they cause Bing Lou (flooding/bleeding) and Tuo Zheng (collapse) which cannot be saved.

Both Yun (fainting/dizziness) and Jue (syncope/cold extremities) postpartum arise from the simultaneous depletion of Qi and Blood. Without urgent tonification, how can the nearly extinct Yuan Shen (original spirit) be挽救ed? This is beyond doubt. However, Yun occurring during labor is more urgent than Jue. If medication is too slow, emergency rescue methods must be employed. For those with slight deficiency, symptoms include blurred vision and dizziness, fullness and oppression below the heart, coma with clenched jaws, loss of consciousness, followed by spontaneous recovery after a short while. Or, due to excessive blood loss, empty fire rises vacuously clouding the spirit, leaving the body without control. Sudden loss of Yin Blood deprives the Xin Shen (heart spirit) of nourishment. The Jun Huo (monarch fire) and Xiang Huo (minister fire) of the Heart and Bao Luo (pericardium/luteal vessels) are calm with blood but endangered without it. Intense fire causes coma; fire invading the Lung leads to closed eyes and unconsciousness. This is because sudden Yin Blood loss fails to anchor Yang. The *Jing* (Classic) states: When disease Qi is insufficient, tonification is suitable, not purgation. Closed eyes indicate Yin pathology. Sudden loss of有形 (formative) blood intensifies fire. Frequent administration of Sheng Hua Tang is appropriate, or ad hoc emergency measures. After 2-3 doses of Sheng Hua Tang, if the deficiency of the Blood aspect is not addressed, the mass will dissolve, blood will flourish, spirit will clear, and fainting will stop. For severe deficiency, symptoms include pale face, closed eyes, open mouth, cold hands, profuse sweating, coma, and extremely fine and minute pulses in all six positions. This indicates Qi following Blood loss towards extinction. Large doses of Renshen (Ginseng Root) are required to restore Yang. Fearful that rapid Yin tonification is insufficient, Qi-tonifying herbs must be combined, following the principle of Yang generating Yin. For emergency rescue, Sheng Hua Tang with Ginseng is most effective. If decoction is unavailable, use Dushen Tang (Single Ginseng Decoction) rapidly; once swallowed, survival is possible. Delay renders it futile. Some claim Ginseng should only be used seven days postpartum; this is an ignorant rumor and must not be believed. Since Yun strikes instantly, external emergency treatments cannot be delayed. Quickly assist the patient to sit gently, do not let her lie down. Alternatively, heat charcoal until red and pour vinegar on it; or burn old lacquerware so smoke enters the nose and mouth to induce revival. Press Renzhong (GV26) urgently and wait quietly for Yuan Qi to recover. Do not move randomly to avoid scattering Shen Qi (spiritual energy). Another method: chop a handful of Chinese chives, place them in a spouted porcelain bottle, boil vinegar, pour into the bottle, cover tightly, and direct the spout to the nostrils to allow gas entry for revival. Any person with major illness or severe deficiency can experience fainting. Postpartum fainting due to blood loss is named Xue Yun (Blood Fainting), but it is not actually caused by blood per se. Blindly trusting ancient formulas to diagnose Yun as E Xue Qiang Xin (Evil Blood Snatching the Heart) and lightly using drugs like Sumu (Calamus Rhizome), Niuxi (Achyranthes Root), Honghua (Safflower), or formulas like Mudan Duoming Tang, or diagnosing it as Phlegm-Water and using phlegm-resolving formulas, is a grave error. Folk remedies sometimes treat postpartum convulsions, vomiting, and fainting caused by retained dead fetus or placenta blood by pouring warm urine. If swallowed, it stops. In women with strong Stomach Qi who tolerate the odor, efficacy is seen. However, Tong Bian (child's urine) does not stop fainting or restore Yuan; it works by descending via old pathways, clearing heat, and resolving stasis. Formulas record:敗血 (failed blood) flowing into the Liver Meridian causes black spots in vision, dizziness, and unconsciousness. This is blood-heat rising vacuously to the Heart, causing coma and Qi closure approaching extinction. Taking Tong Bian is best. This view only considers failed blood, ignoring postpartum deficiency. With "Qi closure approaching extinction," can Tong Bian really restore near-extinct Yuan Qi? Even with evil blood reversal or blood stasis, Sheng Hua Tang warmed and circulated is superior for removing stasis and stopping fainting. I have seen Jiangnan obstetricians use Danggui (Angelica Sinensis Root) 2 qian, Yimucao (Motherwort Herb) 1 qian, Renshen 2 qian, Honghua 6 fen, Paojiang (Prepared Ginger) 8 fen, decocted hot and mixed with Tong Bian to treat fainting. This formula captures the essence well. For women prone to Xue Yun, it is better to pre-decoct and take Bazhen Tang (Eight-Treasure Decoction), Shiquan Dabu Tang (Ten-Tonifying Decoction), or Guipi Tang (Restore the Spleen Decoction) days before delivery to tonify Qi and Blood. Use Renshen to facilitate delivery at term. Tonifying before birth and before deficiency allows no deficiency to exploit postpartum, thus preventing fainting.

As for Jue syndrome, occurring after delivery, it results from excessive effort during labor damaging the Spleen Qi. The isolated Zang organ cannot irrigate the four limbs, causing cold extremities and Jue. The *Jing* states: Yang Qi declining below leads to Cold Jue; Jue Qi ascending fills the meridians and separates from the form. Rebellious Qi filling the meridians causes Shen Qi to float away and scatter. Profound tonification and Yang restoration are indicated. Two doses of Sheng Hua Tang consecutively. When Blood and Qi flourish and Spirit returns, Jue stops. This cannot be cured by merely tonifying the Blood aspect. If thirst occurs after medication, Shenmai San (Ginseng and Ophiopogon Powder) taken as tea assists Jin Ye (body fluids) to save Zang dryness. Cases with cold extremities and dysentery resemble Cold Syndrome of Shaoyin in Shanghan (Cold Damage); Sibii Tang (Decoction for Four Reversals) is contraindicated. Instead, use Sheng Hua Tang with doubled Renshen, or add one slice of Shufuzi (Prepared Aconite Root) to stop rebellion, restore Yang, and demonstrate the merit of Renshen and Danggui. If blood mass pain ceases but Jue persists, Zirong Yiqi Tang (Nourish Glory and Tonify Qi Decoction) is most effective.

Yun and Jue are critical postpartem emergencies. If postpartum blood mass pain remains, Baidu (Atractylodes Macrocephala) and Baizhu (Atractylodes Lancea) should not be added abruptly. Therefore, urgently add Renshen for ad hoc rescue. Once Yun stops and Jue reverses, remove Renshen to resolve blood mass pain. This is the key principle.