Precautions

Generation and Transformation Decoction is a good prescription for postpartum conditions, with simple ingredients and significant effects, widely used in clinical practice. However, it has its specific indications and should not be considered a must-use postpartum formula without proper differentiation. In collecting medical cases, the author found 11 cases where Generation and Transformation Decoction was ineffective and caused adverse reactions. In the medical cases of Qing Dynasty's Wang Mengying, there were 6 cases of misuse of Generation and Transformation Decoction, all of which were successfully treated by him. Analyzing the 11 cases where Generation and Transformation Decoction was not suitable, it can be summarized as: simple qi deficiency unable to control blood, yin deficiency with effulgent fire, excessive blood loss, simple blood heat, or symptoms caused by warm heat, which are contraindicated. Especially for postpartum abdominal distension and fullness, Generation and Transformation Decoction should not be used indiscriminately. In the 204 cases the author analyzed, none showed symptoms of abdominal distension and fullness, confirming this point. Therefore, the clinical use of Generation and Transformation Decoction must adhere to the treatment principle of nourishing blood and generating new blood, invigorating blood, and resolving stasis, and should be used for "blood clot pain" to achieve good results. It should not be used as a tonifying formula indiscriminately.

Generation and Transformation Decoction was first established by the Qian family of Huiji and later recorded by the Ming Dynasty physician Zhang Jingyue in the Jingyue Quanshu's Women's Regulations Ancient Prescriptions. It is a family prescription of the Qian family for treating women's diseases. The claim that Fu Qingzhu established Generation and Transformation Decoction is not accurate. The composition of Qian's Generation and Transformation Decoction: Chinese Angelica 15g, Sichuan Lovage Rhizome 6g, Liquorice Root (roasted) 1.5g, scorched ginger 0.9g, Peach Kernel 10 pieces (peeled and pointed, double kernels), Prepared Rehmannia Root 9g (one version without Prepared Rehmannia Root). "For cases of placenta not descending, or cold blood qi blockage, blood dryness and qi weakness, taking Generation and Transformation Decoction for two or three doses will cause it to descend, or using this to send down one pill of Motherwort Pill is also possible."

Modification methods:

• Postpartum dizziness due to hemorrhage and deficiency dizziness, add fineleaf nepeta spike 1.8g～2.1g;
• Postpartum qi deficiency and qi collapse, fatigue and lack of strength, add Ginseng, Astragalus Root;
• Yang deficiency reversal cold of limbs, add Aconite Lateral Root, Cassia Bark;
• Pulse deficiency and thirst, add Ophiopogon Tuber, Schisandra Fruit;
• Qi stagnation with phlegm, add Dried Tangerine Peel, Bamboo Shavings;
• Blood deficiency and blood dryness with constipation, add Hemp Seed, Bitter Apricot Seed, Cistanche;
• Profuse sweating and insomnia, add Poria with Pine, Jujube Seed, Astragalus Root;
• Upper body profuse sweating, add Ephedra Root;
• Lower body profuse sweating, add Fourstamen Stephania Root;
• Feverishness, add Moutan Bark, Chinese Wolfberry Root-bark;
• Lockjaw like wind, convulsions, add Schizonepeta, Saposhnikovia Root each 0.9～1.2g;
• Lochia not completely expelled, body with cold and heat, headache and flank distension, lower abdomen must have distending pain, add Carthamus, Moutan Bark, Cassia Bark each 0.9～1.2g, Corydalis Tuber 3g

... It is also said: "The Huiji Qian family's tradition says, discussing postpartum conditions, they are originally blood deficiency, yin loss, yang isolation, qi also suffers, if greatly tonified then qi and blood suddenly generate, if not regulated then various evils easily invade, Four Substances avoid the cold of Peony Root, Four Substances get the benefits of ginger and peach; qi should not be dissipated, the method should also tonify deficiency." It can be seen that the Qian family had rich experience in using Generation and Transformation Decoction to treat postpartum conditions. Fu Qingzhu also clearly stated that "the original prescription of the Qian family had Prepared Rehmannia Root." Therefore, the Generation and Transformation Decoction undoubtedly originates from the Qian family of Huiji. However, the era of this Qian family physician remains unverifiable.

The Ming Dynasty physician Fu Qing-zhu inherited the academic views of the Qian family and systematically analyzed, summarized, and revised the efficacy and usage of the Generation and Transformation Decoction. The composition of Fuqingzhu Gynecology Generation and Transformation Decoction includes: Chinese Angelica 24g, Sichuan Lovage Rhizome 9g, Peach Kernel 14 pieces (peeled and ground), carbonized ginger 1.5g, and roasted licorice root 1.5g. It is decocted with equal parts of yellow wine and child's urine. Its functions are invigorating blood and resolving stasis, warming the meridians, and relieving pain. It is primarily used for postpartum lochia retention and lower abdominal pain, especially suitable for those with postpartum cold and blood stasis. In the formula, Chinese Angelica is used in a large dose to nourish blood, Liquorice Root tonifies the middle, Sichuan Lovage Rhizome regulates qi in the blood, Peach Kernel disperses blood stasis, Blast-Fried Ginger, being black, enters the nutrient level, assists Angelica and Licorice in generating new blood, and aids Sichuan Lovage Rhizome and Peach Kernel in resolving stasis. Child's urine benefits yin and clears heat, guiding stagnant blood downward. Modifications: For severe pain due to cold food causing lumps, add Cassia Bark 2.4g; if blood clots are not dissolved, do not add Ginseng or Astragalus, as their use will cause continuous pain. Fu stated: "Generation and Transformation Decoction is the primary remedy for new mothers and the holy medicine for blood clots. Whenever there is postpartum clot pain or other illnesses, always use Generation and Transformation Decoction as the main treatment, adjusting according to symptoms, not constrained by the number of doses. It must be taken continuously three to four times a day and night until the illness subsides." He criticized: "People often use Four Ingredients Decoction for childbirth, but Rehmannia is cold and stagnates blood, Peony Root is sour and cold without tonifying, damaging healthy qi, which is far from perfect. This decoction can replace Four Ingredients Decoction, and by removing Prepared Rehmannia Root from the original formula, the medicine becomes very balanced, and the effect can be seen immediately." In Fu's "Postpartum Compilation," among the 17 conditions in the first volume, 14 prescriptions use Generation and Transformation Decoction (or its modifications); among the 26 conditions in the second volume, 12 prescriptions use Generation and Transformation Decoction (or its modifications), expanding the use of Qian's Generation and Transformation Decoction and broadening its application scope.

The commonly used Generation and Transformation Decoction in the north is not this prescription, but another postpartum official prescription, named "Postpartum Generation and Transformation Decoction," which was included in the clinical experience collection of gynecology by the renowned Chinese medicine teacher Liu Fengwu. Its composition of medicinal ingredients includes: Chinese Angelica 9g, Sichuan Lovage Rhizome 3g, Carthamus 3g, Motherwort Herb 3g, Shiny Bugleweed 3g, Peach Kernel 1.5g, Prepared Liquorice Root 1.5g, Blast-Fried Ginger 1.5g, Southern Hawthorn Fruit 6g, and old wine 15g cooked together. Chinese Angelica is the main medicine, sweet and pungent in taste, warm in nature, entering the liver, heart, and spleen meridians, tonifying blood and promoting blood circulation; Sichuan Lovage Rhizome is pungent and warm, promoting blood circulation and moving the qi within the blood; Carthamus, Motherwort Herb, Shiny Bugleweed, and Peach Kernel are all for invigorating blood and resolving stasis, used in small amounts to invigorate blood and nourish blood, dispelling stasis to promote regeneration; Southern Hawthorn Fruit enters the blood aspect to transform static blood. This prescription gathers multiple light blood-activating medicines, working together to primarily promote blood circulation and generate new blood. Additionally, Blast-Fried Ginger 1.5g is added to enhance the warming and unblocking effect; Prepared Liquorice Root assists Chinese Angelica in tonifying the middle and generating qi and blood as an adjuvant. It embodies the principle of "if you want to unblock, you must first fill," where the blood vessels are full and abundant, and the qi circulates smoothly, allowing static blood to disperse and new blood to generate and then resolve stasis. When using this Postpartum Generation and Transformation Decoction, if there are no special accompanying symptoms, the original dosage of the whole prescription should be used. For obvious abdominal pain, combine with Sudden Smile Powder; for excessive vaginal bleeding, use Typha stir-fried to scorch, which can also stop bleeding. For low fever, remove Blast-Fried Ginger; for lumbago, add Sichuan Dipsacus, Eucommia Bark, and Chinese Taxillus Herb. This prescription nourishes blood, invigorates blood, and resolves stasis, mainly suitable for postpartum lochiorrhea and static blood stagnation inside. As well as symptoms caused by postpartum such as abdominal pain, low fever, and continuous vaginal bleeding. Additionally, it can also be used for natural late abortion and artificial late abortion for residual fetal membrane retention causing abdominal pain and vaginal bleeding. From clinical efficacy, it not only tonifies blood and supports the right, but often can completely remove residual fetal membranes, seemingly having the effect of a medicinal curettage.