Postpartum Bleeding for 28 Days? Doctor Zhang Xichun Cured Blood Collapse Due to Qi Deficiency with Fu Qingzhu’s Modified Danggui Buxue Decoction

Search keywords: postpartum bleeding / bleeding that won’t stop after childbirth / lochia that won’t clear / heavy bleeding after giving birth / heart racing and shortness of breath after delivery / endless trickling bleeding / postpartum weakness

Opening: a mother in Tianjin bled for twenty-eight days without stopping

Today’s story is the opening of the gynecology section of Doctor Zhang Xichun’s case records. In Hedong, Tianjin, a woman surnamed Li, nearly forty years old, gave birth — by the standards of that era, that already counted as an advanced maternal age. After the delivery, something frightening happened: postpartum bleeding that simply would not stop.

💬 Note from Doctor Luo: Why do we move from external-contraction diseases to gynecology? Because we have more or less finished the external-disease material — the ideas there are similar case after case, and by now you should know how to handle them. Gynecological disease is different. Doctor Zhang Xichun stressed it again and again: in gynecology you must look at the whole picture. Look at only one aspect, and sometimes you truly cannot cure the disease.

Who was this patient? Weak by constitution, and she pushed her body to the limit in childbirth

Why did this woman fall ill? Doctor Zhang Xichun states the cause plainly, in two phrases: constitutionally weak (xing shen su ruo), plus overexertion during labor (lin pen shi lao lu guo sheng).

She had always been frail. And when she gave birth, she worked far too hard — modern women mostly give birth in hospitals, well cared for, sometimes even over-nourished. But working women of the old days had to arrange and do almost everything themselves. When labor itself is exhausting on top of a weak constitution, the body collapses — and illness arrives.

💬 Note from Doctor Luo: Pay attention to those four characters — “constitutionally weak.” They are connected to every symptom that follows. When your foundation is weak, a single childbirth can drag the whole body down. That is the groundwork of this illness.

First, let’s understand: what is lochia (e lu)?

To understand this disease, you need one concept — lochia (e lu). After a normal birth, the uterus must expel the leftover tissue and residue that the body no longer needs. That discharge is the lochia.

Normal lochia changes over time: for the first three days it is bloody lochia (genuinely bloody — usually gone within about three days), then serous lochia (a watery, serum-like fluid), and finally white lochia. How long it lasts varies from woman to woman, but it must be expelled under normal circumstances — left inside the body, it causes harm.

💬 Note from Doctor Luo: The lochia must come out — it is a necessary part of the body’s self-cleansing after childbirth.

How sick was she? Fresh blood, palpitations, back pain, shortness of breath

In this woman’s case, after childbirth she never passed proper lochia — well, not exactly: what came out instead was fresh blood. That looks terrifying. She repeatedly called doctors and took medicine, but the bleeding never stopped. By the time Doctor Zhang Xichun saw her, it had been 28 days — nearly a month.

💬 Note from Doctor Luo: Normal bloody lochia is done within three days. Bleeding fresh blood for a whole month is definitely not normal — that is a serious illness.

Look at her condition then: every sign was one of deficiency. Mental exhaustion (she was constitutionally weak to begin with, and childbirth had worn her out further), emaciation, feverish all over — this was deficiency heat (xu re): when the blood and yin are insufficient, deficiency heat is generated; palpitations — her heart raced and fluttered, she could barely hold on, the classic picture of blood failing to nourish the heart; and because the blood loss was severe, she also felt lower back pain, very intense; on top of that, shortness of breath — she could not draw breath with strength.

💬 Note from Doctor Luo: Be alert to those four characters — “shortness of breath.” If you have listened to my lectures on Doctor Zhang Xichun, a suspicion should already be rising in your mind: is this sinking of the great qi (da qi xia xian)?

One hand on the pulse, Doctor Zhang understood at once: this is purely a deficiency pattern

The pulse: the left pulse was somewhat thready — that represents blood deficiency. And the qi was not full either. Her heartbeat was about 82 times per minute — by that era’s standards, slightly fast.

Combining pulse and symptoms, the conclusion was clear: qi and blood insufficiency, deficient upright qi. Doctor Zhang Xichun said: this is blood sinking, and qi sinking too — the upright qi is insufficient, the great qi drifts downward and drags, unable to hold and secure the blood — so the blood escapes.

💬 Note from Doctor Luo: Under normal circumstances, when qi is sufficient it holds the blood, and the blood travels within the channels along its proper route. When qi deficiency reaches a certain degree, the great qi sinks, loses its holding power, and the blood leaves the channels. So Doctor Zhang saw it in a glance: this is purely a deficiency pattern.

Where did the previous doctors go wrong? They saw only the blood

Doctor Zhang Xichun examined the prescriptions the earlier doctors had written and found the problem: they all saw bleeding and treated the blood — their eyes were on nothing but the blood. That is wrong.

Why? Traditional Chinese medicine says: qi is the commander of blood; blood is the mother of qi (qi wei xue zhi shuai, xue wei qi zhi mu) — the two coexist and cannot be separated. Sometimes what you see is a blood disease, but the root is actually a qi disease — the qi is deficient and has lost control of the blood. So you must look at qi and blood together; looking at one alone will not do.

💬 Note from Doctor Luo: Especially in gynecology — you must see the whole picture. Focus on one aspect, and sometimes the disease truly cannot be cured.

The treatment strategy was set: supplement and cultivate the qi and blood, assisted by astringent, securing herbs. Build up qi and blood as the foundation, then use astringent herbs to hold the blood in.

Whose formula? Fu Qingzhu’s prescription for flooding bleeding in elderly women

Here is the interesting part — this formula was not Doctor Zhang Xichun’s own creation. It belongs to Fu Qingzhu, and Doctor Zhang admired it enormously. He said this formula treats flooding bleeding in elderly women (lao fu xue beng — heavy uterine hemorrhage in older women). He used it for women’s bleeding conditions and for beng lou (flooding and leaking uterine bleeding) — especially the leaking type (lou zheng), where menstrual bleeding trickles on endlessly. It worked extremely well, and with slight modifications it worked even better.

Fu Qingzhu’s original formula has just four herbs:

• Raw astragalus (sheng huang qi), 1 liang (about 30 g) — supplements qi. Raw astragalus was Doctor Zhang’s specialty; his Sheng Xian Tang (Raise the Sinking Decoction) for sinking of the great qi is built around it. This formula fit his intentions perfectly;
• Danggui body (dang gui shen), 1 liang — supplements blood. Astragalus and danggui together: qi and blood supplemented together;
• Mulberry leaf (sang ye), 14 pieces — clears deficiency heat. When qi and blood are insufficient and yin blood runs low, deficiency heat often appears; mulberry leaf is specifically for that. The usual dose is 15–30 g; using 30 g is fine and works beautifully;
• Notoginseng powder (san qi fen), 3 qian (9 g) — divided into two portions. The decoction is split into two bowls: one portion with the morning bowl, one portion with the evening bowl.

💬 Note from Doctor Luo: Doctor Zhang Xichun had a habit in decocting: decoct once, pour it out and take half the notoginseng powder with it; then add water to the dregs and decoct again for the evening dose. It is basically the same method as Fu Qingzhu’s — we needn’t dwell on it.

Doctor Zhang’s modification: one liang of raw rehmannia, and the effect was immediate

The original formula alone was not enough. Doctor Zhang Xichun added raw rehmannia (sheng di huang), 1 liang — a fairly large amount. Why? There is a story behind it:

💬 Note from Doctor Luo: Doctor Zhang himself told it: he once treated a middle-aged woman with flooding bleeding — the hemorrhage was very severe. He used Fu Qingzhu’s original formula without effect; after drinking it, she instead felt heat in the chest. Doctor Zhang thought it over: there must be heat inside. So he added 1 liang of raw rehmannia — and the addition worked immediately. The disease was cured. From then on, whenever he used this formula, he always added 1 liang of raw rehmannia.

What is the reasoning? Astragalus is somewhat warm. Raw rehmannia nourishes yin and restrains astragalus’ warmth — supplement qi, yes, but don’t let it get too hot, because heat can make the bleeding worse. Add something that cools the blood: when blood is cooled, it becomes still (xue liang ze jing) — and the bleeding stops.

After the rehmannia, Doctor Zhang added cornel (shan yu rou), 8 qian — cornel is sour, and sour has astringing power, while it also nourishes the liver and kidneys. In a woman whose qi and blood are both depleted and who keeps losing blood — the liver stores the blood; replenish the liver’s stored blood and the blood can slowly recover. He then added raw dragon bone (sheng long gu), 8 qian, crushed — dragon bone is also astringent, securing the qi transformation of the lower burner.

💬 Note from Doctor Luo: A detail here: in ordinary practice, calcined dragon bone (duan long gu) is considered more strongly astringent, but Doctor Zhang Xichun rarely used the calcined form — he almost always used raw dragon bone, believing it worked better. We respect his choice. His explanation: in a patient like this, the qi transformation of the lower burner cannot hold; adding cornel and dragon bone secures the qi transformation of the lower burner so it can run normally again.

After two doses, more than half cured

After two doses of this formula, the bleeding and the shortness of breath were both more than half cured (yu jie yu qiang ban) — a big improvement; all the complaints improved and the pulse turned for the better. Only when she sat for a while did she feel sore and weak in the bones and sinews — the upright qi was still not sufficient.

So the treatment continued without changing the strategy, with a slight adjustment. This time he wrote a toning formula:

• Raw astragalus (sheng huang qi), 1 liang — astragalus again;
• Longan meat (long yan rou), 8 qian — nourishes heart blood, calms the spirit, supplements spleen qi; outstanding for nourishing the blood. This time it replaces danggui;
• Raw huai rehmannia (sheng huai di huang), 8 qian — nourishes yin and clears heat;
• Cornel (shan yu rou), 8 qian — unchanged;
• Walnut kernel (hu tao rou) — tonifies the kidneys and strengthens the qi transformation of the kidney channel;
• North glehnia (bei sha shen), 5 qian — nourishes yin;
• Cimicifuga (sheng ma), 1 qian — pairs with astragalus; here you can already see the shadow of the Sheng Xian Tang (Raise the Sinking Decoction): she kept feeling short of breath, as if the qi would not come up. I lift the qi upward so it does not sink — and that includes the bleeding, which is connected to qi mechanism moving downward;
• Deerhorn glue (lu jiao jiao), 3 qian — supplements qi and blood; melted into the warm decoction before drinking.

💬 Note from Doctor Luo: A word on deerhorn glue: antlers slowly turn into bone. An antler that was not harvested while growing and has turned into bone is called deer antler (lu jiao); the glue boiled out of it is deerhorn glue (lu jiao jiao), and what remains is deerhorn frost (lu jiao shuang), a separate medicinal material. Deerhorn glue warms and supplements the liver and kidneys, benefits essence and supplements blood — outstanding for nourishing blood, and especially effective for conditions of the yang-deficient governing vessel (du mai). Doctor Zhang used it here not only to greatly supplement qi and blood but also for another property he prized — activating blood and resolving stasis. The formula has eight herbs: the first seven are decocted into one large cup, then the deerhorn glue is melted into it and drunk.

Marvelous: the lochia began to come out — an auspicious sign

He continued three doses, and she no longer had shortness of breath. But the woman still saw a little bleeding — note, what came out now was no longer the fresh blood of before. What was this? Doctor Zhang Xichun explained: this is lochia that should have come down before and never did (cong qian wei xia zhi e lu). Now it was beginning to be expelled.

💬 Note from Doctor Luo: This is an auspicious sign! If this lochia never comes out, it will certainly cause disease later. It must be expelled completely. So expelling is far better than not expelling.

So Doctor Zhang wrote another formula, combining stasis-resolving herbs to hasten its exit — let me help you push it out. The formula: raw astragalus 1 liang, longan meat 8 qian, raw huai rehmannia 8 qian, raw huai yam (sheng huai shan yao) 6 qian (supports the upright qi — Doctor Zhang’s favorite), walnut kernel (tonifies kidney qi transformation), danggui (dang gui) 4 qian (nourishes blood), north glehnia (nourishes yin), deerhorn glue 3 qian, plus finely ground Guangdong notoginseng (guang san qi xi mo). After the medicine is decocted and the deerhorn glue melted in, the notoginseng powder is taken in two portions with the decoction.

The secret of notoginseng: first it stopped the bleeding, now it resolves stasis

Here is a truly subtle question: notoginseng powder was in the very first formula, and now it appears again — are the two uses the same?

Absolutely not. At first the bleeding was extreme, and the notoginseng in Fu Qingzhu’s original formula was there to stop bleeding. Now that the bleeding has gradually stopped, Doctor Zhang wants to expel the remaining stasis — so the notoginseng this time is for activating blood and resolving stasis.

💬 Note from Doctor Luo: You may wonder: is notoginseng for stopping bleeding or for moving blood? That is its two-way regulatory action (shuang xiang tiao jie). The logic runs like this: a great deal of bleeding happens because stasis is present — stasis blocks the way, normal blood cannot travel within the channels, so it leaves the channels and becomes bleeding. That is why the method is called activate blood and resolve stasis: dissolve the stasis, and the escaped blood returns to its normal track — then the bleeding stops. Notoginseng has exactly this ability: where there is stasis it resolves it, where there is bleeding it stops it, and the body gradually returns to normal. Modern research is still investigating precisely how — at what dose and in what way — to use this herb to its best effect.

Then why not use peach kernel (tao ren) or safflower (hong hua), the usual blood-moving herbs? Doctor Zhang Xichun had thought it through himself: the blood in front I just secured; if I suddenly hit it with strong blood-moving herbs, I may easily make it bleed again. So he used notoginseng — it both moves blood and stops bleeding. And with great caution he paired it with deerhorn glue: this is what he called resolving stasis without injuring heart blood (hua yu xue, bu shang xin xue) — it dissolves stasis while supplementing and securing at the same time, far better than the single-minded blood-moving of peach kernel and safflower.

💬 Note from Doctor Luo: Doctor Zhang Xichun used medicine with extraordinary measure and precision.

After five doses: the lochia was completely expelled, and the illness was cured

He had the medicine decocted and drunk — five doses in a row, the lochia came out completely, and the illness was cured. A woman who had bled for nearly a month after childbirth was healed by Doctor Zhang Xichun.

💬 Note from Doctor Luo: What do we learn from this case? Among women’s beng lou (flooding and leaking), true beng (sudden violent hemorrhage) is rare today, but the lou (leaking) type is very common: many women have endless trickling after their period — it simply will not stop. Why? Mostly qi and blood deficiency. Qi is too weak to hold the blood, so blood is lost; and once blood is lost, the body is weaker, the qi deficiency worse — mutually reinforcing, cause and effect spiraling. At a certain point, sinking of the great qi is added on top — the qi mechanism drifts downward, and it gets even worse.

What to do? Use Doctor Zhang’s formula — he learned it from Fu Qingzhu and considered it exceptionally good. Raw astragalus, danggui body, mulberry leaf, notoginseng powder, plus Doctor Zhang’s raw rehmannia — four herbs plus one, very easy to remember. Many patients have told me: my condition was quite severe, nothing I tried worked, and when I used this formula it got better — proof that the combination is exquisite: it supports the upright qi; if deficiency heat is suspected, mulberry leaf clears it; notoginseng powder stops the bleeding while resolving stasis — when your qi and blood are depleted to that degree, how could there be no stasis inside?

💬 Note from Doctor Luo: The original formula uses a fairly large dose of notoginseng powder — 9 g. These days I usually use about 6 g, but the original calls for 9 g. With a formula like this, what we study is the approach — qi and blood deficiency leads to sinking of the qi mechanism and to blood collapse, hence the endless trickling. But we should also study the formula itself, because there is real subtlety in how Chinese formulas are composed. Doctor Zhang Xichun was a master of the highest order — could he have just made up his own formula? No. He respected Fu Qingzhu’s original and only made slight additions. When you meet a formula this effective, remember it.

Bonus story: who was Fu Qingzhu?

To close, a story. Fu Qingzhu is one of the most mysterious figures in Chinese medicine. Many people think he is the Fu Qingzhu from Liang Yusheng’s wuxia novel Seven Swordsmen of Mount Heaven — he is not. Fu Qingzhu was a great master of Chinese classical learning, and his achievement in medicine ran deep.

💬 Note from Doctor Luo: Fu Qingzhu’s medical books are full of mysteries: his books and those of another master, Chen Shiduo, overlap in large stretches — very strange. To this day, historians of medicine have not reached a verdict — what their relationship was, how the books circulated; there are all kinds of guesses. But whatever the case, the formulas in his books are truly classic: the formulas in Fu Qing Zhu Nv Ke (Fu Qingzhu’s Gynecology) are still used today, especially effective — like this formula for beng lou, particularly the leaking type, which works extraordinarily well.

Women’s health matters enormously — it is the foundation of society. Everyone should take care of their own health — and I hope this approach and this formula can help the people around you.

Arranged from Doctor Luo Dalun’s lecture on Doctor Zhang Xichun’s case records; the original case is from Medical Records of Integrating Chinese and Western Medicine (《医学衷中参西录》).