Loading...
Chapter 23 of 27
金匮要略
This chapter discusses the pattern differentiation and treatment of common postpartum diseases, organized into one general introduction, six specific patterns, and seven formulas.
Someone asked: Women who have just given birth often suffer from three kinds of diseases: the first is hypertonic convulsion (a condition characterized by stiffness of the neck and back, locked jaw, and twitching of the limbs), the second is oppressive faintness (postpartum dizziness, blurred vision, and a stuffy, faint sensation caused by blood deficiency with rebelling qi), and the third is difficulty in defecation. Why is this?
The teacher replied: Immediately after childbirth, there is blood deficiency (depletion of blood), copious sweating, and susceptibility to wind evil, so hypertonic convulsion occurs. After blood loss followed by sweating, cold evil predominates, so oppressive faintness occurs. With depletion of body fluids, the stomach and intestines become dry, so defecation becomes difficult.
When a postpartum woman develops oppressive faintness, the pulse is weak and faint, she cannot eat, yet the stool is paradoxically hard, and she sweats only from the head. The reason for this is that blood deficiency leads to reverse cold (here referring to qi and blood failing to properly warm the extremities, causing cold limbs or upward rebellion of qi), and with reversal, fainting inevitably occurs. For oppressive faintness to resolve, there must be sweating over the entire body. Because blood is deficient below with reversal, solitary yang floats upward, so there is sweating only from the head. The reason postpartum women sweat easily is that yin and blood are depleted, and yang qi is relatively dominant. Therefore, sweating should occur to allow yin and yang to regain balance. If the stool is hard, with vomiting and inability to eat, treat with Minor Bupleurum Decoction. (Formula found in the vomiting disease chapter.)
After oppressive faintness resolves and the woman can eat, if fever reappears seven to eight days later, this indicates accumulation of substantive evil in the stomach and intestines. Treat with Major Purgative Decoction. (Formula found in the hypertonic convulsion disease chapter.)
For persistent, dull postpartum abdominal pain, treat with Angelica, Ginger, and Mutton Decoction. This formula also treats cold hernia in the abdomen and vacuity exhaustion deficiency. (Formula found in the cold hernia disease chapter.)
For postpartum abdominal pain with vexation, distention, and fullness, preventing the patient from lying down quietly, treat with Trichosanthes and Peony Powder.
Trichosanthes and Peony Powder Formula: Trichosanthes fruit (roasted until black, but not burnt excessively), peony — equal amounts. Grind the above two ingredients into a powder. Take one square-inch spoonful each time, three times daily. This formula also treats abscesses and welling abscesses; take with barley congee.
The teacher said: For postpartum abdominal pain in a woman, according to standard protocol, Trichosanthes and Peony Powder should be used. If the condition does not resolve after taking the medicine, this indicates the presence of dried blood (accumulated blood stasis that has congealed over time, dry and hard) attached below the navel. Appropriate treatment is with Downward Expelling Stasis Decoction; this formula also treats irregular menstruation.
Downward Expelling Stasis Decoction Formula: Rhubarb 2 liang, peach kernel 20 pieces, ground beetle 20 pieces (dry-roasted, feet removed). Grind the above three ingredients into a fine powder, mix with refined honey to form four pills. Decoct one pill in one sheng of wine, reduced to eight ge, and take in a single dose. After taking, the newly discharged blood stasis will resemble pig liver.
Seven to eight days after childbirth, if there is no taiyang exterior pattern, but the lower abdomen is hard and painful, this indicates that lochia (the residual blood and turbid fluids discharged from the uterus after childbirth) has not been fully expelled. If there is also no bowel movement, vexation and fever, a somewhat excess pulse, worsening fever, pronounced vexation at the hour of ri-zhu (3–5 PM, corresponding to yangming), inability to eat, delirium after eating food, with relief at nighttime, then treat appropriately with Major Purgative Decoction. This indicates heat in the interior, bound in the bladder region. (Formula found in the hypertonic convulsion disease chapter.)
After childbirth, when wind evil has been contracted and persists for dozens of days without resolution — with slight headache, aversion to cold, intermittent fever, stuffiness below the heart, dry retching, and sweating — although the condition has lasted a long time, if the yangdan pattern (i.e., the cinnamon twig decoction pattern, manifesting as fever, sweating, and aversion to wind, indicating exterior vacuity) is still present, Yangdan Decoction (i.e., Cinnamon Twig Decoction; formula found in the diarrhea chapter) may be given.
For postpartum wind stroke with fever, bright red complexion, wheezing, and headache, treat with Lophatherum Decoction.
Lophatherum Decoction Formula: Lophatherum leaves 1 handful, pueraria root 3 liang, saposhnikovia, platycodon, cinnamon twig, ginseng, licorice — 1 liang each, prepared aconite 1 piece, Chinese dates 15 pieces, fresh ginger 5 liang. Decoct the above ten ingredients in one dou of water, reducing to two and a half sheng. Take warm in three divided doses, and cover with clothing and bedding to induce sweating. If the neck and back are stiff, use one large aconite piece, broken to bean size, and skim the foam while decocting. If vomiting, add half a sheng of pinellia (washed).
When a woman who is breastfeeding develops deficiency of center qi, vexation and restlessness, and nausea with rebellious counterflow, one should settle the center and boost qi, treating with Bamboo Bark Large Pills.
Bamboo Bark Large Pills Formula: Fresh bamboo shavings 2 fen, gypsum 2 fen, cinnamon twig 1 fen, licorice 7 fen, blackend swallowwort root 1 fen. Grind the above five ingredients into powder, mix with jujube flesh to form pills the size of dan bullets. Take one pill with water, three times during the day and two times at night. If there is heat, double the blackend swallowwort root; for vexation with wheezing, add 1 fen of arborvitae seed.
For postpartum diarrhea with extreme vacuity and debility, treat with Pulsatilla Plus Licorice and Donkey-Hide Gelatin Decoction.
Pulsatilla Plus Licorice and Donkey-Hide Gelatin Decoction Formula: Pulsatilla, licorice, donkey-hide gelatin — 2 liang each; ash bark, coptis, phellodendron bark — 3 liang each. Decoct the above six ingredients in seven sheng of water, reducing to two and a half sheng. Add the donkey-hide gelatin and melt it. Take warm in three divided doses.
Qianjin Three-Ingredient Scutellaria Decoction: Treats women who, during the puerperal period, expose their bodies and contract wind evil. If there is pronounced vexing heat in the four limbs with headache, give Minor Bupleurum Decoction. If there is no headache but only vexing heat, treat with this formula.
Scutellaria 1 liang, sophora flavescens root 2 liang, dried rehmannia 4 liang. Decoct the above three ingredients in eight sheng of water, reducing to two sheng. Take one sheng warm. After taking, the patient will often vomit or purge parasites.
Qianjin Internal Supplement Angelica Center-Building Decoction: Treats postpartum vacuity, emaciation, and insufficiency, with persistent stabbing pain in the abdomen, shortness of breath, or lower abdominal gripping and tension, pain drawing into the lower back, and inability to eat. During the first month after childbirth, taking four to five doses is beneficial and can strengthen the patient.
Angelica 4 liang, cinnamon twig 3 liang, peony 6 liang, fresh ginger 3 liang, licorice 2 liang, Chinese dates 12 pieces. Decoct the above six ingredients in one dou of water, reducing to three sheng. Take warm in three divided doses, completing within one day. If there is great vacuity, add 6 liang of malt sugar; after the decoction is completed, add it and warm over fire to dissolve. If there has been excessive blood loss, flooding and spotting, or internal hemorrhage that does not stop, add 6 liang of rehmannia and 2 liang of donkey-hide gelatin, making eight ingredients total; add the donkey-hide gelatin after the decoction is completed. If angelica is unavailable, substitute with cnidium; if fresh ginger is unavailable, substitute with dried ginger.
The formula compositions and preparation methods above are all from the original classical text and are provided solely for academic study of the principles and methods. They do not constitute any medication guidance.
The central focus of this chapter is grasping the special pathophysiological state of postpartum "multiple vacuity and multiple stasis."
The three postpartum diseases arise from blood loss and fluid injury
Hypertonic convulsion, oppressive faintness, and difficulty in defecation — though appearing different — all point to the same foundation: postpartum blood deficiency and depletion of body fluids. With blood deficiency, the sinews and vessels lose nourishment and become susceptible to wind evil, causing hypertonic convulsion. Blood deficiency with qi rebellion causes oppressive faintness. Fluid depletion with stomach dryness causes difficult defecation. This embodies Zhang Zhongjing's holistic view of "different diseases sharing the same origin."
The key pathogenesis of oppressive faintness lies in "blood deficiency with reversal, solitary yang ascending"
The postpartum woman sweats only from the head while the body remains dry — this is not an ordinary exterior pattern but rather blood deficiency below with yang qi floating alone above. The treatment of oppressive faintness with Minor Bupleurum Decoction appears to harmonize shaoyang but actually works by supporting the upright and expelling evil, regulating qi mechanism to allow the floating yang to descend and yin-yang to be restored.
Layered pattern differentiation of postpartum abdominal pain
For postpartum abdominal pain, this chapter provides three pathways:
The purgative approach of "do not be constrained by the postpartum state"
Although the postpartum woman is vacuous, if yangming stomach excess, retained lochia with heat binding, and interior excess appear, Major Purgative Decoction can still be used for attack. This shows that the postpartum state does not absolutely prohibit purgation; whenever the pattern exists, the corresponding formula may be used. The key lies in accurate pattern differentiation.
Special management of postpartum wind stroke
When postpartum wind stroke lingers without resolution and the pattern still conforms to the cinnamon twig decoction pattern, Yangdan Decoction may still be used. If red face, wheezing, and headache appear, this indicates upright vacuity with yang floating, complicated by exterior evil — use Lophatherum Decoction to warm yang and release the exterior, support the upright and dispel evil, reflecting that postpartum exterior resolution must also address yang qi.
Postpartum diarrhea and vacuity heat
Pulsatilla Plus Licorice and Donkey-Hide Gelatin Decoction treats postpartum diarrhea with extreme vacuity by combining clearing heat and drying dampness with nourishing blood and enriching yin. Bamboo Bark Large Pills treats vacuity during breastfeeding with vexation, turmoil, and retching by clearing vacuity heat and settling the center, boosting qi. Both reflect the complexity of postpartum diseases as "mixed vacuity and excess."
Verifiable postpartum physiological changes
Modern medicine observes that postpartum women experience changes in blood volume, increased sweating, dramatic hormonal fluctuations, slowed gastrointestinal motility, and constipation. The classical text's statements about "newly postpartum blood deficiency, excessive sweating," and "depleted fluids, dry stomach, therefore difficult defecation" correspond with postpartum physiological changes.
Postpartum sweating is partly the excretion of fluid retained during pregnancy, partly related to hormonal changes and autonomic nervous regulation. The head sweating, dizziness, and vexation of "oppressive faintness" may relate to postpartum blood pressure fluctuations, anemia, hypoglycemia, or autonomic dysfunction — conditions corresponding to recognizable phenomena.
Pattern differentiation thinking retains reference value
The chapter's differentiation of postpartum abdominal pain, retained lochia, and postpartum fever demonstrates early awareness of classifying obstetric conditions. For example, "lower abdominal hardness and pain, indicating retained lochia" roughly corresponds to poor uterine involution or intrauterine retained products; "no bowel movement, vexation and fever, pronounced vexation at sun-dusk, and delirium" resembles postpartum infection, fever, or intestinal obstruction. Of course, modern practice requires imaging and laboratory studies to establish diagnosis — symptoms alone cannot justify the use of purgative drugs.
Historical limitations require objective assessment
Some descriptions in the original text, such as "new blood descending like pig liver" or "will vomit or purge parasites," are expressions of ancient clinical observation and cannot be understood as safe, reproducible modern diagnostic or therapeutic evidence. The aconite, rhubarb, and mirabilite in attacking formulas carry significant risk in the postpartum period and must only be considered under modern medical evaluation. They cannot be self-prescribed by readers.
Demystification note
This chapter contains no incantations or spirit-related content. However, the mention of "vomiting or purging parasites" in the appended formulas should be understood in modern terms as the potential of certain drugs to expel parasites or stimulate the gastrointestinal tract — not as a diagnostic basis for parasitic infection. Such statements should be read rationally.
The following are general life-nurturing considerations and do not pertain to any specific disease:
This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication advice, or treatment recommendation. If unwell, please seek medical attention promptly.