Hard Lump in Lower Belly After Childbirth? Doctor Zhang Xichun Dissolved the Postpartum Mass by Tonifying Qi and Blood While Removing Stasis with Li Chong Tang

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Opening: Doctor Zhang Xichun’s case records are nearly finished — today, a farm woman’s belly lump

Doctor Luo Dalun says that Doctor Zhang Xichun’s great case-record book is almost finished — only a few more days of material remain. Up to now the cases were told in order; from here on he is picking and choosing — some external-contraction cases are being skipped, because what really matters is teaching you the way of thinking. Case-study lectures are always selections; there is no need to go through every single case.

The illness today is called postpartum zheng jia (产后癥瘕). What is zheng jia? It is a traditional Chinese medicine term: benign tumors and lumps in women, usually growing in the abdomen. Doctor Luo says that zheng jia are extremely common today — uterine fibroids and ovarian cysts should both be counted within the zheng jia category.

💬 Note from Doctor Luo: Why is this case worth telling? Because Doctor Zhang Xichun had his own method for zheng jia — he did not attack the lump blindly, but tonified on one side while resolving on the other. In an era when uterine fibroids and ovarian cysts are so common, that way of thinking is enormously valuable.

Who was this patient? The lochia never cleared, and she paid it no attention

The patient lived in Xihan Family Village, west of the county seat. She surnamed Han, 36 years old, had just given birth when she developed postpartum zheng jia.

It began on the day she delivered. During the birth, very little lochia came down (e lou suo xia shen shao) — the residue that should have been expelled never really came out. But she did not take it to heart (wei chang jie yi): women in the countryside sometimes do not pay much attention to these things, believing their bodies are strong. And so it dragged on — six months later, it had become a zheng jia.

💬 Note from Doctor Luo: Everyone, note this detail — the lochia should have come out but did not, and at first nobody took it seriously. So many illnesses start exactly this way. The body’s signals come earliest and most gently, and they are the easiest to ignore.

How sick was she? First bloating, then pain, a growing lump, and no period for half a year

After her month of confinement, she began to feel distension and fullness in the lower abdomen. At the time it was wheat-harvest season (mai qiu mang zhong) — the family was busy bringing in the wheat, farm people live by their labor, so she did not call a doctor; she simply went out to the fields and worked.

Another month passed, and then what? Distension plus pain. Only then did she try a few folk remedies — the simple little formulas passed around among the villagers — several times, with no effect at all. The pain grew worse and worse, and when she pressed the place, it felt hard.

Only now did she seriously call a physician, who treated her for more than a month: the pain seemed to ease a little, but the hard place only grew larger. And there was an even more alarming signal — half a year after childbirth, her period had still never returned.

💬 Note from Doctor Luo: Physiologically, a woman’s period should return two months after giving birth; for a mother who breastfeeds, four months at the latest. This woman had gone six months with nothing — that definitely means something is wrong.

One hand on the pulse: left sinking and wiry, right sinking and rough — Doctor Zhang understood at once

Doctor Zhang Xichun felt the pulse: left position sinking and wiry (chen xian), right position sinking and rough (chen se), about five beats per respiration — the breathing slightly fast.

Where was the problem? Doctor Zhang’s judgment: the lochia that should have been expelled after childbirth was never passed, it stagnated between the Chong and Ren vessels (chong ren zhi jian) and knotted into a zheng jia. That mass blocked the running pathways of the channels. The newly produced blood that should have come down as the period could not descend — it piled up on top of the zheng jia — and so the mass grew larger and larger.

💬 Note from Doctor Luo: What exactly is this lump? Actually we do not need to know. We only need two facts: first, the lochia did not clear, so there is stasis inside; second, the mass kept growing and the period never came. That is enough — blood stasis obstruction, and the treatment is activate blood and resolve stasis, dissolving the zheng jia. This is the diagnostic skill of grasping the mechanism without obsessing over the name of the disease.

Why the old treatments failed: Xia Yu Xue Tang too fierce, peach kernel and safflower too weak

In the past, doctors treated this kind of disease with Zhang Zhongjing’s stasis-resolving formulas, such as Xia Yu Xue Tang (Decoction for Expelling Stasis Below) and Di Dang Tang (Resistance Decoction). But Doctor Zhang Xichun said their results were actually not good. Of the women with zheng jia, those who were truly cured by medication were not many — not because the disease is hard to treat, but because the method was wrong.

Formulas like Xia Yu Xue Tang and Di Dang Tang are too fierce. Taking them for a short time is fine — a few doses at the time works — but you cannot take them long-term. When a zheng jia first forms, the tangible mass is not yet firm, and a few doses can dissolve it; but some zheng jia are hard as iron and stone, extremely fixed — can you dissolve that in a few doses? And if a few doses will not do it, what about long-term use? These formulas break blood very forcefully — Xia Yu Xue Tang contains rhubarb (da huang) — who can stomach that for months?

So there is a contradiction: short-term use does not work, and long-term use the body cannot endure. Modern physicians gradually switched to gentle herbs — they no longer dare use Di Dang Tang or Xia Yu Xue Tang, and turned to peach kernel, safflower, salvia, red peony. But these mild herbs also struggle to dissolve a real zheng jia.

💬 Note from Doctor Luo: So Doctor Zhang Xichun said that following either of these two approaches, the results really are poor. What was his approach? You must use herbs that activate blood, resolve stasis and break up masses — but always paired with tonic herbs. Tonify on one side, resolve on the other, and only then can the stasis be dissolved. This is where Doctor Zhang Xichun was truly brilliant.

The worst thing: treating only the disease you see — patients ruined by fierce drugs, riverbanks torn to pieces

When regulating women’s diseases, what do you fear most? Treating only the disease you see — you see blood stasis, so your eyes see nothing but blood stasis and you must resolve it. That will not do.

Some women have a little stasis after childbirth, and the doctor attacks at once: Di Dang Tang! Break up the stasis! I’ll dissolve it for you. The result? She has just given birth — her upright qi is already insufficient, qi and blood are greatly depleted — and now this. Devastating.

💬 Note from Doctor Luo: Here is an analogy — think of a river and its dikes: the dike is already thin and fragile. To dredge the channel you should first drain the water, then repair the embankment, and clear it out slowly. But you go straight in with a shovel — you tear the riverbank to pieces. That destroys people. I have seen patients who, after taking this kind of medicine, collapsed instantly: their spirit was disturbed, their eyes saw everything blurred, they wandered in a daze all day, their speech rambled — and from then on the body never recovered: skin and bone, no strength to speak, unable to work.

When I looked at the old medical records, I was stunned: patients like this easily become the vanguard of the anti-TCM movement — they were genuinely harmed! If they did not curse Chinese medicine, I would say that was already very generous. Because this doctor was too reckless — his eyes saw nothing but blood stasis!

💬 Note from Doctor Luo: So why is Doctor Zhang Xichun’s case valuable? Because his thinking is crystal clear: after childbirth you cannot lightly break blood and resolve stasis — you must support the upright qi at the same time. That way of thinking is truly extraordinary.

The first formula: tonify qi and nourish blood as the base, san leng and e zhu to break stasis — six doses and the pain stopped, the lump softened

Look at how Doctor Zhang Xichun composed the prescription:

• Raw astragalus (sheng huang qi), 5 qian (about 15 g) — first supplement qi and build it up fully;
• Trichosanthes root (tian hua fen), 5 qian — moistens dryness and generates fluids, because activating blood and resolving stasis can easily injure yin; trichosanthes protects against that;
• Raw huai yam (sheng huai shan yao), 5 qian — supports upright qi, greatly tonifies the spleen and lungs;
• Danggui (dang gui) — nourishes blood. Qi and blood tonified together — truly thoughtful;
• Atractylodes (bai zhu) — tonifies the spleen. Where does qi and blood come from? Always from the spleen and stomach, so huai yam and atractylodes are used to tonify the spleen and stomach;
• Anemarrhena (zhi mu) — moistens dryness and nourishes yin, guarding against the heat of raw astragalus;
• San leng (triangular spurge), 3 qian, and e zhu (zedoary), 3 qian — the blood-activating, stasis-resolving herbs Doctor Zhang Xichun especially loved. Conventionally san leng and e zhu are thought to break blood fiercely and are used sparingly; but Doctor Zhang believed that when stasis has knotted into a mass, only san leng and e zhu can break it open — and their force is not that fierce; they do not harm upright qi;
• Raw chicken gizzard lining (sheng ji nei jin), 2 qian — also activates blood, resolves stasis and breaks up masses. Doctor Zhang said: chickens eat all kinds of things, sometimes even iron nails, and nothing happens — because the dissolving power of the gizzard lining is extremely strong;
• Peach kernel (tao ren) — peach kernel with safflower is the usual pairing, but safflower is best at resolving formless stasis, while peach kernel is best at resolving tangible stasis.

This formula is led by tonifying qi and blood, combined with stasis-resolving herbs — very complete.

💬 Note from Doctor Luo: Notice the logic of the composition — tonify qi (astragalus), nourish blood (danggui), tonify the spleen and stomach (huai yam, atractylodes), nourish yin and moisten dryness (trichosanthes, anemarrhena), plus resolve stasis and break masses (san leng, e zhu, raw chicken gizzard lining, peach kernel). Tonify on one side while resolving on the other — that is Doctor Zhang Xichun’s general principle for zheng jia.

The result? Six doses in a row: the belly no longer hurt; the hard place had not disappeared, but pressed soft now — first of all, the pain was gone, which mattered enormously; her appetite, previously very small, gradually returned to normal — the spleen and stomach were opening up; and the pulse also became more comfortable than before.

The second formula: huai achyranthes guides the medicine downward, raw leech breaks the hardened mass

He continued with the same formula, adjusted. How?

• Raw astragalus 5 qian, trichosanthes root 3 qian, raw huai yam 4 qian — basically unchanged;
• San leng and e zhu — unchanged;
• Added huai achyranthes (huai niu xi) — why? To guide the medicinal force downward. Huai achyranthes strengthens the sinews and bones and tonifies the liver and kidneys, and at the same time pulls the medicine down — the disease is in the abdomen, so the medicine is led down to it;
• Added codonopsis (dang shen) — to support upright qi; it replaced the atractylodes;
• Raw chicken gizzard lining — unchanged;
• Anemarrhena — unchanged;
• Removed peach kernel, and in its place raw leech (sheng shui zhi), 2 qian, crushed.

What does leech do? Breaks blood. Doctor Zhang Xichun emphasized: the leech must be used raw; only then does it work well.

💬 Note from Doctor Luo: This is Doctor Zhang’s insight — these animal medicines from the water all carry the cool, clear qi of water; if you heat or process them, the nature of the medicine changes. That is why he also used raw oyster shell (sheng mu li). Raw leech is not as fierce as people imagine, but its power to break stasis and dissolve stagnant blood is outstanding.

The formula was decocted into one large cup and drunk warm. The result? Fifteen or sixteen doses in a row, with small adjustments along the way — and then, suddenly she passed several purple blood clots, and the illness was completely cured (hu xia zi xue kuai ruo gan, bing sui quan yu). After persisting with the medicine for a while, this postpartum zheng jia patient was completely well.

This is Li Chong Tang: from postpartum masses to consumptive diseases in men

Remember this formula — it is one of Doctor Zhang Xichun’s most famous prescriptions: Li Chong Tang (Regulate the Chong Decoction) (in the transcription the name appears as “Li Chong Tang” — same formula). Li Chong Tang is roughly these herbs, with Doctor Zhang adding and subtracting as he pleased — sometimes atractylodes and danggui appear together, and so on. After Li Chong Tang comes another formula, Li Chong Wan (Regulate the Chong Pill).

💬 Note from Doctor Luo: Doctor Zhang Xichun himself said: at first I used it only for postpartum lochia that would not clear and abdominal masses; later I found that masses anywhere in the body — as long as they formed from insufficient qi and blood plus blood stasis — could be treated effectively; and still later it worked for men’s consumptive disease (lao zhai) — tuberculosis, the kind of illness where the whole person is desperately weak. His own evaluation of the formula: if a person’s qi and blood are insufficient and they are very weak, then somewhere in the body stasis is certain to have formed; this formula tonifies qi, tonifies blood and resolves stasis, allowing the body to recover. So even extremely weak people can use it.

One practical note: for unmarried girls who have never given birth, the doses of san leng and e zhu should be cut in half.

The lesson is the thinking: tonify qi and blood, open the stasis, and the body repairs itself

Doctor Zhang Xichun said a great deal about this formula. He explained: a person’s qi and blood circulate through the body as one continuous stream; the organs are nourished by qi and blood. When something goes wrong in one place, the other organs actually come to its rescue — as long as qi and blood are sufficient, the rest of the body’s qi and blood will help repair it. But sometimes qi and blood are insufficient, and with stasis present, repair is impossible. At that point we tonify qi and blood and help resolve the stasis, and the body can repair itself.

💬 Note from Doctor Luo: Yet some physicians today do not understand this principle. They pile on qi-regulating, qi-moving, qi-breaking herbs — throwing the qi and blood into chaos. What was more or less normal becomes disordered: a dozen qi-regulating herbs, and the organs’ qi and blood are all in confusion, so the body no longer knows how to save itself. Doctor Zhang said it very simply: this formula tonifies qi and blood, adds a little blood-activating, stasis-resolving, blood-breaking medicine to open the obstruction in the Chong vessel — and the body should recover on its own.

The logic of this formula is very simple and clear: tonify qi, tonify blood, tonify the spleen and stomach, plus san leng, e zhu, and raw chicken gizzard lining (or peach kernel, raw leech) to resolve stasis and break masses, matched with anemarrhena and trichosanthes root to nourish yin and moisten dryness — preventing both the tonics from generating heat and the blood-activating herbs from injuring yin. Today, Li Chong Tang’s way of thinking is still frequently used when regulating gynecological disorders.

💬 Note from Doctor Luo: In his own time Doctor Zhang Xichun was called the number one physician of Chinese medicine in China. His formulas were not thrown together — one formula embodies one way of thinking and opens up a whole field. Li Chong Tang is followed by many attached case records: some of abdominal masses that had resisted treatment for years, some of patients on the verge of death who were rescued with this formula. If you have the chance, open Medical Records of Integrating Chinese and Western Medicine and study the range of this formula’s applications.

Friends, as always: spending a little time every day talking about Chinese medicine is Doctor Luo Dalun’s job. If the listeners gain insight, broaden their horizons, and learn one more way of thinking, that is a good thing. The more ways of thinking you learn and the more you see, the better — tomorrow we continue with Doctor Zhang Xichun’s clinical stories.

What to take away

• Zheng jia (abdominal masses in women — uterine fibroids and ovarian cysts in modern terms) often grow out of unexpelled lochia after childbirth: the stasis blocks the Chong and Ren vessels, the new blood piles on top of it, and the lump keeps growing.
• Doctor Zhang Xichun’s principle: tonify on one side, resolve on the other. Build up qi (astragalus), blood (danggui) and the spleen and stomach (huai yam, atractylodes), protect yin and moisture (trichosanthes, anemarrhena), and only then break the mass (san leng, e zhu, raw chicken gizzard lining, peach kernel, raw leech).
• Avoid the two extremes: fierce blood-breaking formulas like Xia Yu Xue Tang and Di Dang Tang cannot be taken long-term and wreck the constitution; gentle herbs like peach kernel and safflower alone cannot dissolve a firm mass.
• The worst mistake is treating only the disease you see — attacking stasis in a postpartum woman without supporting her depleted qi and blood can ruin her permanently.
• Li Chong Tang (and its pill form, Li Chong Wan) is the famous formula: for postpartum masses, for masses anywhere in the body formed from qi-blood deficiency with stasis, and even for men’s consumptive disease (tuberculosis). For unmarried, childless young women, cut san leng and e zhu in half.

Compiled from Doctor Luo Dalun’s lectures 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》).