Postpartum Conditions and Pulse Diagnosis, Section 21 (Final)
1.
Question: A newly delivered woman has three conditions: one is convulsions, the second is qi stagnation, and the third is constipation. What do these mean? The teacher said: After childbirth, blood deficiency leads to excessive sweating, making one prone to wind, hence convulsions; loss of blood and excessive sweating leads to coldness, hence qi stagnation; loss of body fluids leads to dryness in the stomach, hence constipation.
A woman who has just given birth may experience three conditions: the first is convulsions, which are due to blood deficiency, excessive sweating, and a weakened body that is prone to wind invasion; the second is qi stagnation, where water qi rises to the head, causing dizziness, due to blood deficiency and damage to the spleen and stomach, leading to an inability to control water; the third is constipation, which is caused by blood deficiency, excessive sweating, and a lack of body fluids, resulting in dry stools.
2.
If the postpartum woman experiences qi stagnation, her pulse is weak, she cannot eat due to nausea, and her stools are hard, but she sweats from the head. This is due to blood deficiency leading to qi collapse, which must result in qi stagnation. To resolve qi stagnation, there must be significant sweating. Blood deficiency leads to qi collapse, and the solitary yang rises, hence the sweating from the head. Therefore, postpartum women who sweat excessively have lost yin and blood, and the yang is overly strong, thus they need to sweat to restore balance between yin and yang. Hard stools and inability to eat indicate the use of Xiao Chai Hu Tang (Minor Bupleurum Decoction) to treat this condition.
This section discusses the treatment of postpartum qi stagnation and constipation.
For postpartum women with qi stagnation, feeling a rising qi, dizziness, and a weak pulse, the weak pulse indicates yang deficiency, while the weak state indicates yin deficiency, both of which signify a deficiency in yin and yang. In cases of yang deficiency, the internal yang cannot connect smoothly, leading to liver fire invading the stomach, causing nausea, and liver fire invading the spleen, resulting in poor digestion and inability to eat; the patient has yin deficiency and insufficient body fluids; simultaneously, with liver fire present, the liver governs the smooth flow of qi, leading to hard stools. The internal yang cannot connect smoothly, and the yang qi rises to the head, causing sweating from the head. This occurs because of blood deficiency in the postpartum woman, where yin and yang are interdependent; blood deficiency leads to collapse, which indicates yang deficiency. When yang is deficient, the internal yang cannot connect smoothly, and the rising yang qi carries water upwards, leading to qi stagnation. For patients with qi stagnation, to recover, they must sweat, allowing the rising yang qi to expel the water qi, restoring the balance of yin and yang within the body, thus resolving the illness. If the patient has hard stools and cannot eat, then Xiao Chai Hu Tang should be administered, and the condition will improve. Why? Because Xiao Chai Hu Tang contains Ren Shen (Ginseng) and Da Zao (Jujube) to tonify yang qi; Ban Xia (Pinellia) and Sheng Jiang (Fresh Ginger) to eliminate water from the stomach; Huang Qin (Scutellaria) and Chai Hu (Bupleurum) to clear liver and gallbladder fire; Gan Cao (Licorice) to harmonize the spleen and stomach and balance the herbs. When the spleen and stomach are healthy and there is no fire, the stools will not be hard, and the patient will be able to eat.
3.
If the patient can eat but develops a fever after seven or eight days, this indicates a condition of excess in the stomach, and Da Cheng Qi Tang (Major Order the Qi Decoction) should be used. This is discussed in the context of convulsions.
This section continues from the previous one. The previous section stated that the patient has recovered, the stools are no longer hard, and she can eat; this section states that after seven or eight days, the patient develops a fever again after eating, indicating that the food has not been digested and has turned into heat in the intestines and stomach, which is a condition of excess in the stomach, and the patient should take Da Cheng Qi Tang.
4.
For postpartum abdominal pain, use Dang Gui Sheng Jiang Yang Rou Tang (Angelica, Ginger, and Lamb Soup), which also treats abdominal cold hernia and deficiency.
Dang Gui Sheng Jiang Yang Rou Tang formula: see in the context of cold hernia.
Why does a woman experience abdominal cramping after childbirth? It is mostly due to blood deficiency. What should be done? Let her drink Dang Gui Sheng Jiang Yang Rou Tang. In this formula, Dang Gui (Angelica) nourishes the blood, lamb meat replenishes essence and is warming, and Sheng Jiang (Ginger) harmonizes the stomach and alleviates pain while generating yang qi.
5.
For postpartum abdominal pain, if the patient is restless and cannot lie down, use Zhi Shi Shao Yao San (Bitter Orange and Peony Powder).
Zhi Shi Shao Yao San formula:
Zhi Shi (Bitter Orange) roasted until black, do not overdo it; Shao Yao (Peony) in equal parts.
These two ingredients should be ground into a powder, and taken with a spoonful three times a day, and it also treats abscesses with millet porridge.
This postpartum abdominal pain is due to qi stagnation and blood stasis. After childbirth, blood deficiency leads to deficiency fire and restlessness, which causes qi stagnation, leading to an inability to lie down comfortably. How to treat it? Use Zhi Shi Shao Yao San. Zhi Shi alleviates qi stagnation, while Shao Yao nourishes blood and treats abdominal pain.
6.
If the postpartum woman has abdominal pain and Zhi Shi Shao Yao San does not work, this indicates that there is stasis of blood in the lower abdomen, and Xie Yu Xue Tang (Blood Stasis Decoction) should be used; it also treats menstrual irregularities.
Xie Yu Xue Tang formula:
Da Huang (Rhubarb) 2 liang, Tao Ren (Peach Kernel) 20 pieces, Wu Ling Zhi (Flying Squirrel Feces) 20 pieces, decoct and remove the residue.
These three ingredients should be ground into a powder, mixed with honey to form four pills, and take one pill with one liter of wine, decocting it to eight portions for immediate consumption, with fresh blood expelled like pig liver.
If the postpartum woman has abdominal pain and taking Zhi Shi Shao Yao San does not work, it indicates that the condition is severe and the medicine is too light, and there is stasis of blood accumulation; Xie Yu Xue Tang should be used. In the formula, Da Huang promotes the discharge of old blood, Tao Ren invigorates blood and resolves stasis, and Wu Ling Zhi invigorates blood and resolves stasis.
7.
After seven or eight days postpartum, if there are no signs of Tai Yang (Greater Yang) syndrome, and there is hardness and pain in the lower abdomen, this indicates that lochia has not been expelled; if there is no bowel movement, restlessness, fever, and a pulse that is slightly firm, with increased fever in the afternoon, the patient should not eat; if she eats, she will have delirium, and by night, she will recover, indicating the use of Da Cheng Qi Tang. The heat is internal, and it is lodged in the bladder. This is discussed in the context of convulsions.
After seven or eight days postpartum, if the patient has no Tai Yang syndrome, and there is hardness and pain in the lower abdomen, this indicates that lochia has not been expelled; if there is also no bowel movement, this is due to postpartum blood deficiency and internal heat, which burns the body fluids in the large intestine. Additionally, the internal heat causes restlessness. When checking the pulse, it is slightly firm, indicating excess in the Yang Ming (Bright Yang) organ, and in the afternoon, the Yang Ming channel is active, causing restlessness and increased fever; if the patient can still eat, it indicates that there is strong stomach fire, and the food qi further generates heat, exacerbating the yang heat and causing delirium. How to determine if this delirium is due to food qi exacerbating the heat evil? Observe that the delirium improves at night, indicating that by night, the food qi in the stomach has been digested, the heat has lessened, and the external yang is not as strong, thus the heat subsides and the delirium stops. How to treat this condition of unexpelled lochia and hard stools? Use Da Cheng Qi Tang. Patients with Da Cheng Qi Tang syndrome generally have a good constitution; observe that this postpartum woman has given birth, has unexpelled lochia, has hard stools, and can still eat; this indicates that her constitution is not poor, and the yang heat is still strong, thus she can take Da Cheng Qi Tang. Da Cheng Qi Tang can expel lochia and relieve constipation, serving as a remedy for two conditions.
8.
If postpartum wind persists for several days without resolution, with slight headache, chills, occasional fever, chest tightness, dry heaving, and sweating, even after a long time, the Yang Dan syndrome persists, and Yang Dan Tang (Yang Dan Decoction) can be used, which is Gui Zhi Tang (Cinnamon Twig Decoction), as seen in the context of diarrhea.
If a woman postpartum is affected by wind evil, she develops Tai Yang wind syndrome, which has not resolved for several days, with slight headache, chills, fever, dry heaving, and sweating, these are typical symptoms of wind syndrome, and chest tightness indicates stomach disharmony. What should be done? The main symptoms are still wind syndrome, so let the patient take Gui Zhi Tang.
9.
For postpartum wind, fever, a red face, wheezing, and headache, use Zhu Ye Tang (Bamboo Leaf Decoction).
Zhu Ye Tang formula:
A handful of bamboo leaves, 3 liang of Ge Gen (Kudzu), 1 liang of Fang Feng (Siler), 1 liang of Jie Geng (Platycodon), 1 liang of Gui Zhi (Cinnamon Twig), 1 liang of Ren Shen (Ginseng), 1 liang of Gan Cao (Licorice), 1 piece of Fu Zi (Aconite), prepared, 15 pieces of Da Zao (Jujube), and 5 liang of Sheng Jiang (Fresh Ginger).
These ten ingredients should be boiled in 10 liters of water to yield 2.5 liters, divided into three warm doses to induce sweating, with stiffness in the neck, using one piece of Fu Zi, broken into bean-sized pieces, and skim off the foam. If there is nausea, add Ban Xia (Pinellia) half a sheng, washed.
Through studying the “Shang Han Lun” (Treatise on Cold Damage), we know that all six channels have exterior syndromes. This section discusses the exterior syndrome of the Yang Ming channel. After the Yang Ming channel is affected by wind, fever, and a red face (because the Yang Ming channel runs through the face, its exterior is affected by wind evil, leading to a red face), wheezing occurs because the Yang Ming is interiorly connected to the lungs, and if lung qi is obstructed, wheezing occurs. The Yang Ming channel runs upwards, hence the headache. How to treat it? Use Zhu Ye Tang. In this formula, bamboo leaves clear heat; Ge Gen raises body fluids; Gui Zhi harmonizes yang qi; Ren Shen, Da Zao, and Sheng Jiang tonify qi and harmonize the spleen and stomach; Fang Feng prevents wind evil; Jie Geng promotes lung qi; Fu Zi tonifies kidney yang to benefit lung qi; Gan Cao harmonizes the herbs.
10.
For women with insufficient milk, restlessness, and nausea, use Zhu Pi Da Wan (Bamboo Skin Big Pill).
Zhu Pi Da Wan formula:
2 fen of fresh bamboo skin, 2 fen of gypsum, 1 fen of Gui Zhi, 7 fen of Gan Cao, 1 fen of Bai Wei (Cynanchum)
These five ingredients should be ground into powder, mixed with jujube flesh to form pills the size of a marble, and take one pill with drink, three times a day and twice at night. If there is heat, double the Bai Wei; if there is restlessness, add Bai Shi (Artemisia).
This section discusses women during lactation, who may experience a loss of milk, leading to qi and blood deficiency. Qi deficiency results in the internal yang qi being unable to connect smoothly, causing yang heat to rise and leading to restlessness and nausea; blood deficiency leads to fire, which further exacerbates restlessness. What should be done? Use Zhu Pi Da Wan. In this formula, Zhu Ru (Bamboo Skin) and Shi Gao (Gypsum) clear heat from the stomach and lungs; Gan Cao and Da Zao tonify the spleen and stomach; Gui Zhi harmonizes the qi; Bai Wei cools the blood and clears yin fire.
11.
For postpartum diarrhea with extreme deficiency, use Bai Tou Weng Jia Gan Cao A Jiao Tang (Bai Tou Weng Decoction with Licorice and Ejiao).
Bai Tou Weng Jia Gan Cao A Jiao Tang formula:
Bai Tou Weng (Pulsatilla) 2 liang, Gan Cao (Licorice) 2 liang, Ejiao (Donkey-hide Gelatin) 2 liang, Qin Pi (Fleeceflower) 3 liang, Huang Lian (Coptis) 3 liang, Bai Pi (Cortex) 3 liang.
These six ingredients should be boiled in seven sheng of water to yield 2.5 sheng, and the gelatin should be completely dissolved, divided into three warm doses.
If a woman experiences postpartum diarrhea for a long time, she becomes very deficient. What should be done? Treat diarrhea with Bai Tou Weng Tang, and treat deficiency with Gan Cao and Ejiao.
[Additional Formula]
San Wu Huang Qin Tang from “Qian Jin” (Three Ingredients Huang Qin Decoction): Treats women who, while sitting on grass mats, develop wind exposure, with four limbs feeling hot, and headache, use Xiao Chai Hu Tang; if there is no headache but restlessness, this decoction should be used.
Huang Qin (Scutellaria) 1 liang, Ku Shen (Sophora) 2 liang, Gan Di Huang (Rehmannia) 4 liang.
These three ingredients should be boiled in eight sheng of water to yield 2 sheng, and take one sheng warm, which can induce vomiting and expel parasites.
This section discusses the treatment of postpartum fever. Women may experience liver blood deficiency and may be affected by damp heat from sitting on grass mats for too long. If due to liver blood deficiency, treat with Xiao Chai Hu Tang; if damp heat invades the lower burner, treat with San Wu Huang Qin Tang. Damp heat invading the lower burner, heat enters the kidneys, which govern yang qi, and heat follows the yang qi to the extremities, causing the four limbs to feel hot.
[Qian Jin] Nei Bu Dang Gui Jian Zhong Tang: Treats women postpartum who are weak and insufficient, with persistent stabbing abdominal pain, shortness of breath, or urgent pain in the lower abdomen radiating to the waist and back, unable to eat or drink; after one month postpartum, taking four to five doses is beneficial for strengthening.
Dang Gui (Angelica) 4 liang, Gui Zhi (Cinnamon Twig) 3 liang, Shao Yao (Peony) 6 liang, Sheng Jiang (Fresh Ginger) 3 liang, Gan Cao (Licorice) 1 liang, Da Zao (Jujube) 12 pieces.
These six ingredients should be boiled in ten sheng of water to yield three sheng, divided into three warm doses to be consumed in one day. If there is great deficiency, add 6 liang of rock candy to the decoction, warming it on the fire until the candy dissolves. If there is excessive blood loss, leading to continuous bleeding, add 6 liang of Di Huang (Rehmannia) and 2 liang of Ejiao (Donkey-hide Gelatin), making a total of eight ingredients; if there is no Dang Gui, use Chuan Xiong (Chuanxiong) as a substitute; if there is no Sheng Jiang, use Gan Jiang (Dried Ginger) instead.
This section discusses the treatment of postpartum abdominal pain. Women postpartum may experience qi deficiency and blood loss, leading to stagnation and pain in the abdomen. Due to qi deficiency, they may experience shortness of breath. Additionally, due to deficiency in qi and blood, the spleen and stomach may be weak, leading to an inability to eat or drink. How should this be treated? Use Gui Zhi Tang and Dang Gui. Gui Zhi Tang can regulate the spleen and stomach, tonify qi and blood; Dang Gui nourishes blood, invigorates blood circulation, and resolves stasis.
March 5, 2025, Wednesday