[Guo] What is the reason for the appearance of black qi around the mouth and nose, as well as epistaxis (nosebleed), after childbirth? The answer is: The Yangming meridian is the sea of the twelve meridians. It originates from beside the nose, intersects at the root of the nose, emerges to the cheeks and mouth, crosses at the philtrum (Ren Zhong). The left side runs to the right, and the right side runs to the left. After childbirth, Qi and Blood are deficient, and Blood scatters. Ying and Wei (Nutritive and Defensive Qi) fail to circulate properly. The scattered Qi and Blood enter various meridians but cannot return to their original positions, thus causing black qi to appear around the mouth and nose and leading to epistaxis. This condition arises from postpartum deficiency-heat transforming into this syndrome. If it progresses to the point of Stomach Qi exhaustion and Lung Qi failure, it is incurable.
The *Experience Formulas* states: Quickly take a red thread and two hairs from the vertex of the mother's head, tie them tightly around the middle finger joint, and the bleeding will stop. If no medicine is available, this serves as a form of apotropaic ritual.

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

[Wang] A female patient experienced upward reversal of Blood after childbirth, 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 in child's urine and taken orally. The epistaxis gradually ceased, and lochia began to flow smoothly.

[Chen] What is the cause of metrorrhagia (profuse uterine bleeding) after childbirth? The answer is: Childbirth and lying-in consume the meridians, which have not yet recovered. Physical exertion damages and disturbs them, causing sudden profuse bleeding that drips continuously. Alternatively, immoderate consumption of sour and salty flavors damages Ying and Wei, weakening them, which can also transform into metrorrhagia. If there is fullness and pain in the lower abdomen, it indicates damage to the Liver meridian, making it difficult to treat. Urgently administer Gujing Wan (Solidify the Menses Pill) to stop the bleeding.
Chen Wuzhe commented: Metrorrhagia is not a mild disease; occurring postpartum, it is termed a severe injury. It is likely caused not only by immoderate sour and salty intake but often by fright, worry, or anger, leading to disharmony of Zang-Qi. Or, if hemostatic drugs are taken too early postpartum, lochia fails to dissipate, becoming stagnant, full, and hard, thus forming 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 lower abdominal distension and pain are due to Blood stagnation, use Shixiao San (Pain-Relieving Powder). If lower abdominal empty bloating is due to Blood deficiency, use Xiong Gui Tang. If reckless Blood movement is due to Liver Fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If inability to control Blood is due to Spleen depression, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). If inability to hold Blood is due to Spleen Qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If heat accumulation from rich flavors damages Blood, use Qingwei San (Clear the Stomach Powder) added with Huaihua (Sophora Flower). If Wind-Heat combats and damages Blood, use Sijunzi Tang (Four Gentlemen Decoction) added with Fangfeng (Saposhnikovia Root) and Zhike (Aurantium Fruit).
One parturient had metrorrhagia with lower abdominal distension and pain. After using Qi-breaking and Blood-moving agents, the bleeding surged like a fountain, limbs became flaccid and unresponsive, accompanied by aversion to cold, vomiting, and frequent diarrhea. I used Liujun Zi Tang (Six Gentlemen Decoction) added with Pao Heigan Jiang (Charred Dried Ginger). After four doses, she improved slightly. Subsequently, using Shiquan Dabu Tang (Ten Superb Tonifying Decoction) for over thirty doses led to recovery.
Another parturient had metrorrhagia triggered by anger, with blood surging, collapsing to the ground, locked jaw, deviated eyes, and convulsions of hands and feet. This was Liver meridian Blood depletion generating Wind. I used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pills) for one dose, after which all symptoms subsided. However, she still had poor appetite and afternoon fever. Supplementing with Sijunzi Tang, Chaihu (Bupleurum Root), and Mudanpi (Tree Peony Bark) led to recovery.

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

Xiong Gui Tang Added with Shaoyao Formula
Xiong (Ligusticum Rhizome), Danggui (Angelica Sinensis Root), Shaoyao (Peony Root) (equal parts).
Cut into pieces. Take four qian per dose, boil in one and a half cups of water until reduced to seven-tenths. Strain and drink hot. Take at any time.

Shu Gan Di Huang San (Prepared Rehmannia Powder)
Treats postpartum metrorrhagia, dizziness, coma, limb restlessness, and loss of consciousness.
Shu Gan Di Huang (Prepared Rehmannia Root), Fulonggan (Dragon's House Earth), Huangqi (Astragalus Root), Chishizhi (Red Stone Lip) (each one liang), Ejiao (Donkey-hide Gelatin), Gancao (Licorice Root), Baizhu (Atractylodes Macrocephala Rhizome), Ai Ye (Mugwort Leaf, stir-fried), Chuanxiong (Ligusticum Chuanxiong Rhizome), Renshen (Ginseng Root) (each half liang), Danggui (Angelica Sinensis Root) (seven qian and half).
Cut into pieces. Take four qian per dose, boil in one and a half cups of water with three slices of ginger until reduced to seven-tenths. Strain and drink warm.

Baishaoyao San (White Peony Powder)
Treats postpartum metrorrhagia with continuous dripping, sallow emaciation, and deficiency.
Baishaoyao (White Peony Root), Muli (Oyster Shell), Ganjiang (Dried Ginger), Shu Gan Di Huang (Prepared Rehmannia Root), Guixin (Cinnamon Twig), Huangqi (Astragalus Root), Wutouyu Gu (Cuttlefish Bone), Lu Jiao Jiao (Deer Antler Gelatin), Longgu (Fossilized Bones) (each one liang).
Grind into powder. Take two qian before meals with warm wine.

Another Formula
Chishizhi (Red Stone Lip), Shu Dihuang (Prepared Rehmannia Root) (each one liang), Lurong (Deer Antler), Muli (Oyster Shell), Danggui (Angelica Sinensis Root) (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, physical emaciation, and weakness.
Ejiao (Donkey-hide Gelatin), Chishizhi (Red Stone Lip) (each one and a half liang), Xuduan (Dipsacus Root), Chuanxiong (Ligusticum Chuanxiong Rhizome), Danggui (Angelica Sinensis Root), Gancao (Licorice Root), Danshen (Salvia Miltiorrhiza Root) (each one liang), Longgu (Fossilized Bones), Lurong (Deer Antler, baked with butter), Wutouyu Gu (Cuttlefish Bone), Biejia (Turtle Shell, roasted) (each two liang, ground together into fine powder).
Mix with refined honey to make pills the size of smartweed seeds. Take twenty to thirty pills on an empty stomach with warm wine.

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

Ruilian San (Auspicious Lotus Powder)
Treats postpartum lochia leakage resembling a gushing spring.
Ruilian (Lotus Seed Pod, one hundred pieces, burned until carbonized but retaining nature), Zonglv (Date Palm Stem Fiber, burned until carbonized), Danggui (Angelica Sinensis Root), Guixin (Cinnamon Twig) (each one liang), Liyulin (Carp Scales, burned), Chuanxiong (Ligusticum Chuanxiong Rhizome) (each seven qian and half), Binglang (Areca Seed) (two pieces).
Grind into fine powder. Take three qian before meals mixed with ginger-warmed wine. If bleeding does not stop, take another dose. For irregular metrorrhagia where no medicine is suitable, three doses will suffice to stop it.

*Supplementary Text* treats postpartum metrorrhagia.
Xiangfu Zi (Cyperi Rhizome, stir-fried until red, two liang), Lianpeng Ke (Lotus Pod Husk, five pieces, burned until carbonized but retaining nature).
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. (See the Metrorrhagia section for the formula.)