Advice from the “Childbirth Treasure”
The following post is my literal translation of the first and last chapters in a text called Chǎnbǎo (“Childbirth Treasure”) 《產寶》 by Ní Zhīwéi 倪枝維, published in 1728. I prepared this for the course on “Postpartum Pampering” that Leo Lok and I are currently teaching but am happy to share it more widely. I hope it’s helpful…. The first half is the very first formula, after the introduction to the whole text, called Shenghuatang. This is THE most important formula used in East Asia for postpartum care, often taken as a standard practice even without a concrete medical indication or condition in need of treatment. We do, however, have centuries of discussion on whether childbirth is a physiological or pathological process by its nature, and thus whether it is inherently in need of any treatment at all. The Birth Treasure follows up on this basic formula with numerous modifications and additional advice to guide the experienced physician or care provider in fine-tuning it to any specific situation. That is where the skill of a trained Chinese medicine diagnostician and herbalist really is able to shine! The second half of this short article here is my translation of the concluding essay in the Birth Treasure, on “Postpartum Nursing.” It is a rare example of concrete clinical advice found in a medical text on the cultural practice of zuo yuezi 坐月子 (“sitting out the month”). The many practices prescribed or prohibited during the first month after delivery are so much part and parcel of East Asian childbirth culture that they are usually just mentioned in passing and taken as a given. In addition, this was information that was historically passed on orally by women for women, while the vast majority of medical texts were written by men and for men. So it is interesting for me for both historical and medical reasons.
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1. Shēnghuàtāng (Generating and Transforming Decoction) 生化湯
Chuanxiong (1 qian 2 fen, a.k.a. Xiongqiong)
Danggui (5 qian)
Zhiganjiang (blackened, 5 fen)
Zhigancao (3 fen)
Taoren (skin and tips removed and ground, 11 pieces)
Simmer the medicinals above in 1 cup of water and 0.5 cup of old liquor until reduced to 1 cup. Take it slightly hot.
Shenghuatang is named as such because of the effect of the nature of the medicinals.
After childbirth, the long-abiding blood should get dissolved, and new blood should be generated. If you focus only on dissolving, new blood will not get generated, and if you only focus on generating, then the long-abiding blood will become stagnant instead. Investigating the nature of the various medicinals in this formula, the three ingredients chuanxiong, danggui, and taoren excel at treating long-abiding blood and specifically generate new blood. They are assisted by blackened ganjiang and gancao to draw these three into the liver and spleen. There is no better method for generating blood and re-patterning the Qi. Referred to as “including supplementing in the midst of moving, and including generating in the midst of transforming,” it truly is a sacred medicinal for postpartum!
Whenever a pregnancy reaches the eighth or ninth month, prepare 2-3 batches in advance, and when you reach the point where the water breaks, quickly decoct one batch in anticipation of the moment when the baby leaves the body, so the patient can immediately take it. Regardless of whether it is a regular birth or miscarriage, even for young and strong individuals who are stable and healthy without any problems, it is appropriate to have them take 2-3 batches. As a result, anything malign will dissolve on its own accord and the new will be generated on its own accord. Within the first few hours after delivery, before they have ingested any food or drink, continuously decoct this medicine and give it to them, to make sure the “malign dew” (i.e., lochia) is in the Lower Jiāo. Thus make them take a lot and thereby persistently cause the malign to be easily transformed and the new to be easily generated, and hopefully you can avoid the evil of fainting from blood loss.
If the patient was frail by constitution prior to the pregnancy or is fatigued from overexertion after the delivery, make them take an additional two batches, in order to avoid fainting and exhaustion. If such a patient takes a single batch every day according to the norm, how could we possibly rescue their imperiled Qi and blood that are about to get cut off?
When we have a depleted patient who is showing perilous pathological signs or critical heat conditions and miscarriage, or is experiencing severe taxation, generalized heat, and headache, make them take 4-5 batches. Even though they might feel a bit more stable, as long as the clots and pain are not eliminated, they should be taking this.
川芎（一錢二分）當歸（五錢）乾姜（炙黑五分）甘草（炙三分）桃仁（去皮尖研十一粒）
上藥用水一盞，陳酒半盞，煎作一盞，稍熱服。
生化者，因藥性功用而立名也。
夫產後宿血當消，新血當生，若專消則新血不生，專生則宿血反滯。考諸藥性，川芎、當歸、桃仁，三品善治宿血，專生新血，佐以黑姜、甘草，引三品入於肝脾。生血理氣，莫善於此。所謂行中有補，化中有生，實產後聖藥也。
凡懷孕至八九月，預備二三劑，至胞衣破時，速煎一劑，俟兒分身即速服之。不問正產半產，雖少壯產婦，平安無恙者，亦宜服二三劑，則惡自消而新自生。第須初產一二時辰之內未進飲食之先，相繼煎服，以惡露在下焦，故服多而頻使惡易化而新易生，庶免血暈之惡。
若胎前素弱，及產後勞倦，又當多服二劑，以防昏倦。
若照常每日一服，豈能救將危絕之氣血乎。
至虛人見危症及熱疾墮胎，或勞甚身熱頭痛服藥四五劑，雖覺稍安，塊痛未除仍當服之。。。
2. Postpartum Nursing 產後調護法
After the delivery is completed, the new mother must close her eyes and sit down for a while. Only after that may she get into the bed (Sabine’s note: Delivery did not take place lying down in the mother’s bed traditionally but in a specially prepared, ritually demarcated space with something covering the ground to catch the placenta and birth fluids and the woman squatting or even standing and hanging from a rope suspended from a roof beam during labor and delivery). Use bedding to prop her up. In the summer months, prop her up with a rolled sitting mat or multiple pillows. If she is unable to keep herself upright, have an older experienced woman hold her up. She may not immediately fall over and go to sleep.
Regularly massage her by rubbing from the heart to the navel with your hand in whatever way feels good, to make the lochia move downward.
In her room, place a basin filled with vinegar, and use red glowing coals to heat it, in order to prevent fainting due to blood loss. Above the abdomen, use a small cloth that has been heated up, replacing it as needed to warm her. Even in the hot summer months, you must not cover here only with a single blanket. Don’t let her abdomen get cold, leading to blood clots and pain. In late winter and early spring, when the weather is severely cold, you must tightly seal the birthing chamber, carefully blocking all openings and cracks. Surround her on all four sides with sources of heat and constantly envelope her with warmth, thereby avoiding other problems. The only exception is that you should not burn incense since it can cause leakage of genuine Qi.
Right after birth, she may not eat ordinary food. Only make her take 2-3 batches of Shenghuatang and, if her hunger is extreme, first make her drink one cup of white rice decoction. Next have her eat white rice gruel. For the first ten days, her food should be bland, and she needs to avoid drinking cold fluids. It only after half a month has passed that she may eat eggs, and they must be cracked open and cooked in liquid, in order to prevent spleen vacuity and difficulties with transformation. When a full month has passed, she can eat pork and mutton but you must moderate the amount. Regarding alcohol, even though it enlivens the blood, the nature of its Qi is fierce and ferocious, so it is not good to consume a lot.
Within the first seven days, combing her hair or washing her is not appropriate, and it is especially prohibited to wash her feet, for fear that she may be exposed to wind or contract dampness, so that critical illness will attack her like a swarm of bees! Day and night, make somebody keep her company and do not let her get needlessly alarmed, which will transform her condition and cause a hundred pathologies. Make her be judicious with her speech and keep her from talking a lot, which exhausts and scatters her Source Qi. Also keep her from feeling strong positive or negative emotions, which will get her riled up or depressed and thereby starve and weaken her Center Qi. Both of these can equally make her sick.
產畢須閉目稍坐，然後上床，以被褥靠之。暑月以席卷，數枕靠之。若自己把持不住，令老練女人靠之。不可實時睡倒。
常以手從心至臍，隨意按摩，俾惡露下行。房中安放醋盆，以燒紅烈炭之，以防血暈。腹上用小衣烘熱，替換溫之，雖暑月不可僅蓋單被。毋令腹寒而血塊作痛。冬末春初，天氣嚴寒，宜閉密產室，緊塞隙孔，四圍置火，常令暖氣和融，以免他患。但不宜熏香，走泄真氣。
才產不宜食物，即服生化湯二三劑，饑甚先服白米湯一盞，次食白粥。十日內食物宜淡，切忌飲冷。半月後方可食雞子，亦須打開煮之，以防脾虛難化。盈月食豬羊肉，亦須撙節。酒雖活血，然氣性剽悍，亦不宜多。
七日內不宜梳洗，尤忌濯足，惟恐招風受濕，疾病蜂起。晝夜令人陪侍，毋致虛驚，變癥百出。言語宜慎，勿以多言，耗散元氣。勿以愛憎，輒生惱悶，以中氣餒弱。二者均能致病。
