32.寒热往来递更换, 乍寒乍热时热寒, 寒热似疟按时发, 壮热憎寒
热畏寒.
【注】产后寒热, 名既不同, 其证亦异, 当先明辨之. 如曰寒热往来
者,谓寒去热来, 热去寒来, 递相更换也. 曰乍寒乍热者, 谓有时寒
有时热, 寒热无定时也. 曰寒热似疟者, 谓或先寒后热, 或先热后寒
,一定不移, 至其时而始作也. 曰壮热憎寒者, 谓其身既壮热, 而复
时时畏寒也.
33.往来寒热阴阳格, 时热时寒荣卫乘, 寒热似疟瘀兼食, 壮热憎寒
带表推.
【注】产后血气虚损, 阴阳不合, 则寒热往来; 阴阳相乘, 荣卫不调
,则时寒时热; 败血不散, 饮食停滞, 则寒热似疟; 汗出遇风, 则壮
热憎寒. 有诸内, 自形诸外, 辨之既明, 然后治无不愈矣.
34.往来寒热阴阳格, 柴胡四物各半汤, 荣卫不和乍寒热, 归芍芎参
甘草姜. 寒热似疟瘀兼食, 生化柴胡查麴良, 憎寒壮热更生散, 归地
芎参荆穗姜.
【注】产后阴阳不和, 往来寒热者, 宜柴胡四物汤. 若荣卫不调, 乍
寒乍热者, 用增损四物汤, 其方即当归, 白芍, 川芎, 人参, 甘草,
干姜也. 若停瘀兼食寒热似疟者, 用生化汤加柴胡, 山查, 神麴. 若
感受风寒, 憎寒壮热者, 宜更生散, 即当归, 熟地, 川芎, 人参, 荆
芥穗, 干姜也.
柴胡四物汤 方见首卷
32. 寒热往来交替更换，忽冷忽热，时而发热时而发冷；寒热症状类似疟疾，按时发作；高热伴恶寒，发热时怕冷。
【注】产后的寒热证，名称不同，症状也各异，应当首先明确辨别。所谓“寒热往来”，是指寒气退去热气来，热气退去寒气来，交替更换。所谓“乍寒乍热”，是指有时发冷，有时发热，寒热没有固定时间。所谓“寒热似疟”，是指或者先冷后热，或者先热后冷，规律固定不变，到了特定时间才发作。所谓“壮热憎寒”，是指身体虽然高热，却又时时感到畏寒。
33. 往来寒热是阴阳格拒，时热时寒是营卫相乘（失调），寒热似疟兼有瘀血和食积，壮热憎寒需从表证推求。
【注】产后气血虚损，阴阳不和，则出现寒热往来；阴阳相乘，营卫不调，则出现时寒时热；败血不散，饮食停滞，则出现寒热似疟的症状；出汗后受风，则出现壮热憎寒。内在的病变必然反映在外部，辨别清楚之后，治疗就没有不痊愈的了。
34. 往来寒热属阴阳格拒，用柴胡四物各半汤；营卫不和导致乍寒乍热，用归芍芎参甘草姜（即增损四物汤）；寒热似疟因瘀血兼食积，用生化汤加柴胡、山楂、神曲效果良好；憎寒壮热用更生散，方含当归、熟地、川芎、人参、荆芥穗、干姜。
【注】产后阴阳不和，出现往来寒热的，适宜用柴胡四物汤。如果是营卫不调，出现乍寒乍热的，使用增损四物汤，其方剂组成即当归、白芍、川芎、人参、甘草、干姜。如果有停瘀兼有食积，寒热似疟的，使用生化汤加柴胡、山楂、神曲。如果感受风寒，出现憎寒壮热的，适宜用更生散，即当归、熟地、川芎、人参、荆芥穗、干姜。
柴胡四物汤 方剂见首卷
32. Alternating chills and fever change successively; sudden chills and fevers occur, with heat and cold appearing intermittently. The chills and fever resemble malaria, occurring at regular intervals; high fever is accompanied by aversion to cold, and during fever there is a fear of cold.
[Note] Postpartum chills and fevers have different names and distinct symptoms, which must be clearly distinguished first. "Alternating chills and fever" refers to the cycle where cold recedes and heat arrives, or heat recedes and cold arrives, alternating successively. "Sudden chills and fevers" means sometimes experiencing chills and sometimes fever, without a fixed timing. "Chills and fever resembling malaria" implies either cold preceding heat or heat preceding cold, following a fixed pattern that manifests only at specific times. "High fever with aversion to cold" describes a condition where the body has high fever yet constantly feels afraid of cold.
33. Alternating chills and fever result from Yin-Yang repulsion (Ge); intermittent heat and cold stem from Ying-Wei interaction (disharmony). Chills and fever resembling malaria involve blood stasis and food retention; high fever with aversion to cold should be analyzed as a exterior syndrome.
[Note] When postpartum Qi and Blood are deficient and Yin-Yang are disharmonious, alternating chills and fever occur; when Yin-Yang interact pathologically and Ying-Wei are unregulated, intermittent chills and heat arise; when foul blood does not disperse and food stagnates, chills and fever resembling malaria appear; when sweat occurs followed by wind exposure, high fever with aversion to cold results. Internal conditions naturally manifest externally; once clearly differentiated, treatment will invariably lead to recovery.
34. For alternating chills and fever due to Yin-Yang repulsion, use Chaihu Siwu Geban Tang (Bupleurum and Four Substances Half-Decoction). For Ying-Wei disharmony causing sudden chills and fevers, use Guishao Xiongshen Gancao Jiang (Angelica, White Peony, Ligusticum, Ginseng, Licorice, and Dried Ginger Decoction, i.e., Zengsun Siwu Tang). For chills and fever resembling malaria due to stasis and food retention, Shenghua Tang added with Chaihu, Shan Zha (Hawthorn), and Shen Qu (Medicated Leaven) is effective. For aversion to cold with high fever, use Gengsheng San, containing Dang Gui, Shu Di, Chuan Xiong, Ren Shen, Jing Jie Sui, and Gan Jiang.
[Note] For postpartum Yin-Yang disharmony presenting with alternating chills and fever, Chaihu Siwu Tang is appropriate. If Ying-Wei regulation is impaired causing sudden chills and fevers, Zengsun Siwu Tang should be used, composed of Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Gan Jiang (Zingiberis Rhizoma). In cases of retained stasis combined with food retention leading to chills and fever resembling malaria, Shenghua Tang added with Chai Hu (Bupleuri Radix), Shan Zha (Crataegi Fructus), and Shen Qu (Massa Medicata Fermentata) is suitable. For exterior wind-cold invasion presenting with aversion to cold and high fever, Gengsheng San is indicated, consisting of Dang Gui, Shu Di Huang (Rehmanniae Radix Praeparata), Chuan Xiong, Ren Shen, Jing Jie Sui (Schizonepetae Spica), and Gan Jiang.
Chaihu Siwu Tang: See formula in the first volume.