Going Crazy After Childbirth, Picking Up a Knife to Kill, or Panicking at Every Sound? Doctor Miao Xiyong Treated Two Cases of Postpartum Emotional Illness: Nourish the Blood, Settle the Spirit, Clear Deficiency Fire
Patient’s search words: postpartum madness / postpartum depression / losing emotional control after childbirth / picking up a knife and trying to kill / heart racing at every sound / postpartum fear Medical terms: postpartum mania (postpartum psychosis) · postpartum palpitations and fright · sudden collapse of yin blood · deficiency of the heart, spleen and liver channels together
Opening: on the sixth day after giving birth, she picked up a knife and tried to kill people
One day in the late Ming dynasty, Doctor Miao Xiyong was hurriedly called into a household where something terrible had happened: the wife of Zhang Xuanpu, only six days after giving birth, had gone mad. How mad? She had picked up a knife, glared with wild eyes, and was trying to kill people — “I’ll kill you! I’ll kill you!” — charging at everyone with the blade raised.
💬 Note from Doctor Luo: This is Doctor Miao Xiyong, courtesy name Zhongchun, a great physician of the late Ming from Changshu, Jiangsu. He wrote the Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening) and the Shen Nong Ben Cao Jing Shu (Commentary on the Divine Husbandman’s Classic of the Materia Medica), and he was one of the originators of the warm-pathogen (wen bing) school. Mental illness is the kind of disease that gives doctors the worst headaches — with other illnesses you can talk to the patient and communicate; with this one, when it erupts you say to her “put down the knife, isn’t our life fine?” and she simply cannot understand — her mind is completely out of control, and the whole family suffers along with her.
Dian and kuang are two different things: madness comes in “models”
Before discussing the treatment, Doctor Miao and Doctor Luo first sorted out the categories of “madness” — what the ancients called dian kuang is actually two different diseases:
💬 Note from Doctor Luo: Kuang is the manic, agitated type — the person cannot control himself, tears off roof tiles, hits and kills people, and his strength is enormous; dian is the dull, dazed type — talks nonsense, always feels “someone is following me” or “someone wants to harm me,” all hallucinations. One is agitated, the other is stupefied — completely different. Zhang Xuanpu’s wife belonged to the kuang type, manic to the point of trying to kill people with a knife.
Doctor Miao saw through it at a glance: sudden collapse of yin blood, liver deficiency with flaring fire — terrifying mania that was actually a deficiency pattern
The whole family was terrified and at a loss. Doctor Miao looked at her and said one sentence: “Yin xue bao beng, gan xu huo yan gu ye” — the yin blood has suddenly collapsed, the liver is deficient and its fire is flaring up.
💬 Note from Doctor Luo: What does that mean? She had just given birth, and her yin blood suddenly collapsed in great loss — blood is stored by the liver, and when the liver has no blood it becomes deficient, and once deficient, the liver fire flares right up. So you see, she appeared manic like an excess pattern, but the root was actually deficiency! Many women’s emotions suddenly collapse after childbirth — postpartum depression is extremely common. Why? The body has suddenly undergone a violent upheaval, and blood loss is one important factor. When the blood is deficient, the spirit becomes disordered.
First, drink a bowl of tong bian to open the road
Doctor Miao’s method was unusual: don’t rush into herbs — first drink a bowl of tong bian.
💬 Note from Doctor Luo: Tong bian is the urine of a young boy. It is cold in nature — it cools the blood, clears fire, and dissolves blood stasis — so if there is a little stagnant blood after childbirth, it dissolves it first. This one bowl counts as “opening the road.” And indeed, after drinking the tong bian, the lady’s manic energy seemed to ease a little.
Breaking down the prescription: nourish the blood, settle the spirit, and dissolve stasis at the same time
After the opening move, Doctor Miao wrote the prescription. The logic of this formula is crystal clear: nourish the blood as the main thrust, nourish yin and settle the spirit, with a little stasis-resolving.
Long chi (dragon tooth) settles fright and calms the spirit — when the bones of ancient animals become fossils in the earth they are called “dragon bone” (long gu), and the fossilized teeth are called “dragon teeth”; ze lan (bugleweed) dissolves stasis, reduces swelling, invigorates blood and promotes urination; sheng di (raw rehmannia) cools the blood and nourishes yin — when yin blood is damaged you must both nourish the blood and nourish the yin; dang gui (angelica root) tonifies the blood, and paired with sheng di it does not become dry and hot; niu xi (achyranthes) dissolves stasis, opens the channels, tonifies the liver and kidney, strengthens the sinews and bones, and also guides the blood downward, sending the qi and blood down; fu shen (poria with pine root) calms the spirit — when poria grows wrapped around a pine root and you cut it open to find the pine-wood core inside, that is fu shen, and its spirit-calming action is especially good; yuan zhi (polygala) nourishes the heart and calms the spirit; suan zao ren (sour jujube seed) tonifies the blood and calms the spirit — the herb Doctor Miao used constantly for postpartum illness. To the formula he also added tong bian — a very important ingredient — to cool the blood and dissolve stasis.
💬 Note from Doctor Luo: Look at this formula: dang gui and suan zao ren nourish the blood, sheng di nourishes yin, long chi, fu shen and yuan zhi calm the spirit, ze lan dissolves stasis and removes dampness — as a whole it is blood-nourishing and spirit-settling as the main strategy, nourishing yin and clearing deficiency heat. Let me insert a note here: suan zao ren has been driven by speculation to an absurd price today, and ordinary people can hardly afford it anymore — but in ancient times it was a common, everyday herb. I hope someday we can plant more sour jujube trees — this is genuinely a treasure.
“Dun fu er zhi”: one bowl down, the madness was gone
The medicine was decocted. How was it to be taken? Dun fu — gulp it down, the entire large bowl at once. And then? Dun fu er zhi — after this single administration, the mania stopped! This mentally deranged patient recovered at once.
💬 Note from Doctor Luo: This case looks simple, but it is actually extremely difficult. A mentally deranged patient cured in one dose — that is a very high level of skill — his diagnosis was precise! He saw at a glance that the root was blood loss: yin blood suddenly collapsed, liver deficient with flaring fire, so tonify the blood, dissolve stasis, cool the blood — the logic was perfectly clear, so it resolved at once. An accurate diagnosis matters more than anything.
Case two: at the slightest sound she cried “I’m dying!” — she had to be held tight
Among Doctor Miao’s relatives there was another very similar case — the wife of Wang Liuxin, also with a postpartum problem, this time falling into jing ji (palpitations and fright).
💬 Note from Doctor Luo: How bad was she? Wen sheng zhe si — the moment she heard a sound she would cry “Oh no, I can’t take it, I’m going to die!” The moment she heard someone speak, panic seized her — she had to be held tightly, comforted over and over with “it’s all right, it’s all right,” otherwise she was xu fan yu si — restless and tormented beyond endurance, convinced she was about to die. This description matches postpartum depression very closely. And so it went “ru shi lei yue” — a whole month of this torment. Everyone should understand: women really do develop many problems after childbirth, and many people have no idea — when the body changes so violently, illness does follow.
Deficiency of the heart, spleen and liver channels together: blood loss wounded all three organs that govern the spirit
Doctor Miao looked and saw: this too was a deficiency pattern. He said, ci xin pi gan san jing ju xu ye — after the great blood loss of childbirth, all three organs were wounded at once.
💬 Note from Doctor Luo: The heart governs the blood vessels — the blood vanished suddenly, the heart could not bear it, blood could no longer nourish the heart; the liver stores the blood — with no blood in the liver to store, the liver went wrong; the spleen generates the blood — in a woman whose spleen was already weak, this sudden blood loss now wounded the spleen as well, like a child dragging its mother down. And the heart, spleen and liver channels are all connected with the spirit — so all three channels had to be adjusted together.
Pills with longan decoction: one month, little by little, rebuilding the blood
This time Doctor Miao prescribed pills: ren shen (ginseng) to tonify the qi — when the qi is replenished, the po and hun (the soul-aspects) return; ginseng can anchor the po and hun and calm the spirit; suan zao ren (sour jujube seed) to tonify the blood and nourish the liver blood; fu shen (poria with pine root) to calm the heart spirit; yuan zhi (polygala) to nourish the heart and calm the spirit; shao yao (white peony) to astringe the liver; gan cao (licorice) to tonify the spleen; shi hu (dendrobium) and mai dong (ophiopogon) to nourish the yin — when yin blood is insufficient, the body fluids must be replenished too; wu wei zi (schisandra berry) to astringe the qi of the five organs and astringe the liver; and zhu sha (cinnabar) for its heavy, settling action on the spirit. Once the pills were made, what was used to take them? Longan decoction — longan flesh simmered into a soup, to swallow the pills; longan tonifies the blood.
💬 Note from Doctor Luo: Two details here. First, zhu sha must never go into a decoction — when heated, its toxicity is released; made into pills and swallowed directly, the toxicity does not come out and it simply does its spirit-settling work, which is why the ancients put it in pill form — that is safe. Second, using longan decoction to take the pills is Doctor Miao’s clever touch — longan tonifies the blood, so he was nourishing the blood while delivering the medicine at the same time. The Yu Ling Gao (Stewed Longan Extract) that people eat today follows the idea Doctor Miao handed down — simmer 24 pieces of longan flesh into a steamed paste. This formula tonifies the qi, nourishes the blood, calms the spirit, nourishes the yin — it is remarkably thorough and classically designed. And the result? Mi yue er yu — after one month, the illness was cured. Postpartum deficiency has to be rebuilt a little at a time; this takes a process.
A note from the narrator: emotional illness cannot be treated by phlegm-resolving alone — the regrets of Coco Lee and Leslie Cheung
After telling these two cases, Doctor Luo’s tone grew heavy: emotional illness is truly a big matter.
💬 Note from Doctor Luo: Hong Kong singer Coco Lee passed away from depression, and Leslie Cheung jumped to his death because of it too — such brilliant stars! This kind of disease begins with internal imbalance, which damages the emotions; the damaged emotions then continue to unbalance the body — a vicious cycle. In fact Chinese medicine has a genuine advantage in treating emotional illness, but unfortunately there was no good Chinese medicine physician beside these celebrities — what a loss. In the past, everyone treated dian kuang by resolving phlegm; but frankly, most of the time it did not work. An old physician who spent his whole career in a psychiatric hospital told me: using phlegm-resolving herbs to treat dian kuang — not one single case ever got better. The ancient records are sometimes flawed too; we cannot use whatever the ancients wrote just because they wrote it. What really works is adjusting by qi, blood, yin and yang: whatever is deficient, tonify it; deficiency fire, clear it; liver fire, soothe the liver and regulate the qi — and that actually takes effect.
Bonus: remember these three herbs — emotional illness is not a death sentence
At the end, Doctor Luo laid out the “family assets” of these two cases.
💬 Note from Doctor Luo: These two cases display a model: when yin blood suddenly collapses, the person develops mental-emotional problems — what to do? Nourish the blood, calm the spirit, nourish the yin and clear deficiency fire, walk the path through to the end, and the illness resolves. Of course this is not the only road — some need to soothe the liver and relieve constraint, some are yang-deficient and need warming — you must differentiate patterns. For ordinary people, mastering just suan zao ren, fu shen and yuan zhi is basically enough — these three appear constantly in spirit-regulating formulas; in severe cases add long chi, long gu, mu li and zhu sha. Illnesses where physical problems cause psychological illness are called somatic-psychological disorders (shen xin ji bing); illnesses where psychological problems cause physical illness are called psychosomatic disorders (xin shen ji bing) — the two feed each other. Open one lock, and the other lock becomes easier to open too. So I hope everyone will look after their bodies and keep their spirits optimistic.
Arranged from Doctor Luo Dalun’s explanation of Doctor Miao Xiyong’s case records. The original case comes from the Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening), by Doctor Miao Xiyong (late Ming dynasty).