郭稽中曰∶产后乍寒乍热者何。答曰∶阴阳不和，败血不散，能令乍寒乍热。产后血气
虚损，阴胜则乍寒，阳胜则乍热，阴阳相乘，则或寒或热。若因产劳伤脏腑，血弱不得宣越，
故令败血不散，入于肺则热，入于脾则寒（何为败血入肺则热，人脾则寒也，岂以肺主气，
气不和而热，脾统血，血不荣而寒乎，抑脾阴肺阳，而自为寒热也。然总以逐瘀为主，而温
凉之法有不同焉），若误作疟疾治之则谬矣。阴阳不和，宜增损四物汤；败血不散，宜夺命
丹。又问∶二者何以别之。时有刺痛者，败血也，但寒热无他证者，阴阳不和也，增损四物
汤不一，皆随病加减。
陈无择评曰∶乍寒乍热，荣卫不和，难以轻议。若其败血不散，岂止入脾肺二脏耶。大
抵一阴闭一阳，即作寒热，阴胜故寒，阳胜故热，只可云败血循经流入，闭诸阴则寒，闭诸
阳则热，血气与卫气解则休，遇再会而复作，
大调经散五积散入醋煎佳。（闭阴闭阳之说，卒难理解。以败血闭阴则寒，闭阳则热，而有
解休会作之时，则似疟矣。若瘀血为有形之物，闭则壅矣，而安有解会之所也。愚谓血闭
于阳经，而荣卫行之不通则寒，闭于阴经，而荣卫行之不通则热；故必其瘀通而寒热自已
也。又就大调经散而言，行瘀于内也，五积散行瘀于外也。又意为外经或为寒客，则肺为之
病，肺病则肌表瘀而荣卫不通则热，内腑或为冷物所伤则脾病，脾病而荣卫不通则为寒。故
所用之方，一主里，一主表也，亦或内外俱瘀，则寒热并作，而其药又均不可废也。粗浅之
言，伏惟裁之）
薛氏曰∶产后寒热，因气血虚弱，或脾胃亏损，乃不足之证。经云∶阴虚则发热；阳虚则
恶寒。若兼大便不通，尤属气血虚弱，切不可用发表降火。若寸口脉微，名阳气不足，阴气
上入于阳中则恶寒，须用补中益气汤；尺部脉弱，名阴气不足，阳气下陷于阴中则发热，用
六味地黄丸。大抵阴不足，阳往从之，则阳内陷而发热；阳不足，阴往从之，则阴上入而恶
寒。此阴阳不归其分，以致寒热交争，故恶寒而发热也，当用八珍汤。若病后四肢发热，或
形气倦怠，此元气未复，湿热乘之故耳，宜补中益气汤。若肌热，大渴引饮，目赤面红，此血
虚发热，用当归补血汤，若认为实则误矣（误矣，指白虎汤而言）。
一产妇恶寒发热，用十全大补加炮姜治之而愈，但饮食不甘，肢体倦怠，用补中益气
而安，又饮食后犯怒，恶寒发热，抽搐切牙，难候其脉，视其面色青中隐黄，欲按其腹，以手
护之，此肝木侮脾土，饮食停滞而作，用六君加木香一剂而安。（以欲按腹手护，中虚也，以
犯怒抽搐面青，肝木也，六君补中，木香调肝，以治肝木侮土是矣，然亦有不受补者，又以疏
肝为急，所谓标而本之，亦有之焉）
一产妇恶露发热，余欲用八珍加炮姜治之，其家知医，以为风寒，用小柴胡汤。余曰∶
寒热不时，乃气血虚乏。不信，仍服一剂，汗出不止，谵语不绝，烦热作渴，肢体抽搐。余用十
全大补汤二剂，益甚，脉洪大，重按如无，仍以前汤加附子四剂稍缓，数剂而安。
吴茭山治一妇人，产后去血过多，食后着恼，头疼身痛，寒热如疟，左手弦大，微有寒
邪，右手弦滑不匀，食饮痰火也，二者因虚而得，宜养正祛邪，遂以茯苓补心汤去地黄，加
羌活、青皮、葱、枣三服，汗出身凉，其患渐瘥，然后以八物汤调理，半月后痊愈（此翁善补，
然亦认症的确，故可用，设不的，即败乃事矣，慎之）。一妇产后恶露未尽，瘀血入络，又感寒
邪，身热如疟，即以生料五积散五帖，恶露自下，而寒热除。（此正治常法，此法宜知）
又一妇产后恶露未尽，因起抹身，寒气客于经络，乍寒乍热，脉紧而弦，（弦紧为寒，审
症法尤宜如是察识）以葱白散二帖安。一少妇初产四日，冷物伤脾胃（冷物是病根，故诸症
皆从瘀血变怪），但觉身分不快，呕逆，饮食少，心腹满闷，时或腹胁刺痛，晨恶寒，晚潮
热，夜则恍惚谵语，昼则抽搐，颇类风状，变异多端，诸医莫测，或作虚风，或云血凝实热，用
甘温而行血，以寒凉退实热，如此半月不效。汪至，见医满座，亦局缩，诊其脉弦而紧，遂
令按之，小腹急痛，知瘀血未尽也，思患者大势，恶露已下，未必还有余血，偶因寒凉所伤，
瘀血停滞下焦，日久客于经络，所以变生诸证，须得大调经散，倍入琥珀（重在琥珀，岂大
豆有如是之神也），化诸恶血成水，其患方愈，遂合前药服之，五日后行恶水斗许，臭不可
近，患人觉倦，病势渐减，然后以人参养荣汤数十帖，月余如初。
柴胡四物汤 治产后往来寒热及日久虚劳，微有寒热，脉沉而数。
当归 川芎 白芍 熟地黄（各一钱半） 柴胡（一钱） 人参 黄芩 半夏 甘草（各三钱）
上锉，每服一两，水煎服。（以小柴胡合四物，一名三之一气汤，其参、 、甘、半各用三
钱，为重在补气也，而甘草、芩、半何为亦倍之，似可损益也，原方有姜、陈，亦不可少）
增损柴胡汤 治产后虚弱，寒热如疟，饮食少，腹胀。
柴胡 人参 甘草 半夏（炒） 陈皮 川芎 白芍（炒，各等分）
上 咀，每服八钱，加生姜五片，枣二枚，水煎服。（此亦小柴变法，而去黄芩加陈皮者，
所以益胃除胀也，加芍药、川芎者，所以和血也，本草以当归治洒洒寒热不已，则产后寒热
正宜加之，何为不用，宜思之）
增损四物汤 治产后阴阳不和，乍寒乍热，如有恶露未尽，停滞胞络，亦能令人寒热
（按往来寒热者，寒往热来，热往寒来也；寒热如疟者，寒热有时也；乍寒乍热者，时乎寒，时
乎热也；发热憎寒者，身发热而又恶寒也。治各有法，不能备录），但小腹急痛为异。
当归 芍药 川芎 人参 干姜（各一两） 甘草（炙，半两）
上 咀，每服四钱，加生姜三片，水煎服。
释曰∶此方治阴阳不和，乍寒乍热之寒热，不治恶露未尽，血滞胞络，小腹急痛之寒
热，宜详之。
更生散 治产后去血过多，或不止，或眩晕眼暗，口噤，发热憎寒。
人参 当归 熟地黄（姜汁炒，各一两） 川芎 荆芥穗（香油灯上烧过） 干姜（炒黑，各三钱）
上锉，水煎，空心服（此方前三味各一两，何其多，后三味各三钱，何其少，非有大智能
大力量大见解者，不能处此方，治此病，名之曰更生，能不于危急时用乎。下三味乃固涩急
药，非血大下不止者不用）。如血大下不止，加龙骨赤石脂，各火 等分，每二钱同前药调
服。外以五倍子末，津调纳脐中即止。
大调经散 治产后血虚，恶露未消，气为败浊凝滞，荣卫不调，阴阳相乘，憎寒发热，或
自汗，或肿满，皆气血未平之所为也。
大豆（一两半，炒，去皮） 茯神（一两） 真琥珀（一钱）
上为细末，每服二钱，浓煎乌豆紫苏汤下。（此方重在恶露未消，而茯神之用，所以和
阴阳也，有谓此方如神者，功在琥珀大豆汤饮间也）
黄龙汤 治产后伤风，热入胞室，寒热如疟及病后劳复，余热不解。
柴胡（四钱八分） 黄芩 人参 甘草（各一钱八分）
上作一服，水煎服。（此方重在伤风二字，故以柴胡为君，盖风邪陷入胞中则发热，故宜
柴胡为君，少阳气陷入厥阴，而寒热如疟者，气不得条达也，故亦以柴胡为君，劳复余热
者，亦为余邪热陷也。故亦用柴胡）
小柴胡加生地黄汤 治产后往来寒热，而脉弦者，少阳也。
柴胡（二两） 黄芩（五钱） 人参（三钱） 半夏（制，两半） 生地黄 栀子 枳壳（麸炒，各半两）
大枣（三枚）
上锉，加姜枣，水煎服。（此方以治少阳等症似矣。然以弦脉而加生地山栀者，伤寒家以
弦脉为阳也，故以柴胡为君）
加减乌金散 治产后寒热似疟，（此治错杂之邪）
浓朴 柴胡 黄芩 麻黄 羌活 草果 半夏（各二钱） 当归 川芎 白芍 熟地
陈皮 茯苓 桔梗（各一钱半） 桂枝 苍术 白芷 枳壳（各一钱） 甘草（九分）
上锉为散，分作两服，每服用水一钟半，姜三片，葱三茎，煎至一钟，不拘时服（此方治
表里风寒，食积气血痰饮，无不赅括，故曰治错杂之邪。盖此方也，与五积散相为伯仲，
苦借此以治三阴疟之有错杂之邪者，必臻至效，语云∶医者意也，请尝试之）。有汗。多当
归、川芎、白芍药、熟地黄；有胀，多浓朴、陈皮；有热，多柴胡、黄芩；有寒，多苍术、草果、
桂枝；有痰，多半夏、桔梗、茯苓；有头痛，多川芎、白芷、羌活；有泻，去枳壳、甘草不用；有余
血块在腹，作潮热疼痛，加三棱、莪术，多用玄胡索、八角、茴香；遍身痛，加羌活、独活；寒热
往来，加黄芩、柴胡。（加减法切中，不可不法）
产宝方 疗产后恶寒壮热，一夜三五度发，恶语，口中生疮，时时干呕，困乏闷绝。
人参 独活 白鲜皮 葛根 防风 青竹茹 远志（各一两半） 茯神（二两） 白蔹（二两半）
元参（三两） 竹沥（一升）
上取银一斤，水一斗五升煮取七升，纳诸药重煮取三升，分温三服，忌鱼、酒、湿面等。
（此方虽出《产宝》，然阅其 ，考其药，皆治产后外邪乘虚传入之热症也。如恶寒壮热，一夜
三五度发，恶语者，即热入血室类也，故用防、独、葛根以散之，口疮干呕者，热传胸中也，故
用玄参二竹以清之，白鲜皮苦寒，治产后百病，白蔹、白银、人参、远志、茯神为邪散热清，
故用之治困乏也）
知母汤 治产后乍寒乍热，通身温壮，胁心烦闷。
知母（三两） 芍药 黄芩（各二两） 桂心 甘草（各一两）
上 咀，用水五升煮取二升半，分三服。一方不用桂心，用生地黄。（按自黄龙汤以下，
皆集外感治法，至于错杂之邪，时热之症，罔不备载，而次第有节，真如网之有纲也，今人
但知产后寒热以补气血为主者，其不误尽世人乎）
郭稽中说：产后忽冷忽热是什么原因？回答说：阴阳失调，瘀血不散，会导致忽冷忽热。产后气血虚损，阴气偏胜则忽冷，阳气偏胜则忽热，阴阳相互搏结，所以时而发冷时而发热。如果因为分娩劳累损伤脏腑，血液虚弱不能宣通发散，导致瘀血不散，瘀血进入肺脏则发热，进入脾脏则发冷（为什么瘀血入肺则热，入脾则寒呢？是因为肺主气，气机不和而发热；脾统血，血不荣养而发冷吗？还是说脾阴肺阳，自然产生寒热呢？总之以祛除瘀血为主，但温法和凉法有所不同），如果误当作疟疾治疗就错了。阴阳失调，适宜用增损四物汤；瘀血不散，适宜用夺命丹。又问：这两者如何区分？如果有刺痛症状的，是瘀血；只有寒热没有其他症状的，是阴阳失调。增损四物汤的配方不一，都根据病情加减。
陈无择评论说：忽冷忽热，是营卫不和，难以轻易议论。如果是瘀血不散，难道只进入脾、肺两脏吗？大抵是一阴闭塞一阳，就出现寒热，阴气胜故寒冷，阳气胜故发热，只能说瘀血顺着经络流入，闭塞诸阴经则冷，闭塞诸阳经则热，血气与卫气和解则停止，遇到再次交会又发作。（闭阴闭阳的说法，很难理解。认为瘀血闭阴则冷，闭阳则热，且有和解停止和再次发作的时候，就像疟疾了。如果瘀血是有形的物质，闭塞就会壅滞，哪里有和解交会的地方呢？我认为瘀血闭塞于阳经，营卫运行不通则冷；闭塞于阴经，营卫运行不通则热；所以必须瘀血通畅，寒热自然停止。另外就大调经散而言，是在体内行瘀；五积散是在体外行瘀。又认为外经受寒邪侵袭，肺就会生病，肺病则肌表瘀滞而营卫不通则热；内腑被冷物所伤则脾生病，脾病而营卫不通则发冷。所以所用的方剂，一个主治里证，一个主治表证，或者内外都有瘀血，则寒热并见，而药物也都不可废弃。浅陋之言，请裁断。）
薛氏说：产后寒热，因为气血虚弱，或脾胃亏损，属于不足之证。经书说：阴虚则发热；阳虚则恶寒。如果兼有大便不通，尤其属于气血虚弱，切不可用发表降火药。如果寸口脉微，名叫阳气不足，阴气上入阳分则恶寒，须用补中益气汤；尺部脉弱，名叫阴气不足，阳气下陷阴分则发热，用六味地黄丸。大抵阴不足，阳气往从之，则阳气内陷而发热；阳不足，阴气往从之，则阴气上入而恶寒。这是阴阳不归其位，以致寒热交争，所以恶寒而发热，应当用八珍汤。如果病后四肢发热，或形体气息倦怠，这是元气未恢复，湿热乘虚而入的缘故，适宜用补中益气汤。如果肌表发热，大渴引饮，目赤面红，这是血虚发热，用当归补血汤，如果认为是实证就错了（指白虎汤而言）。
一位产妇恶寒发热，用十全大补汤加炮姜治愈，但饮食无味，肢体倦怠，用补中益气汤而安顿。又在饮食后发怒，恶寒发热，抽搐咬牙，难以候脉，看面色青中隐黄，想要按压腹部，用手护住，这是肝木侮脾土，因饮食停滞而发作，用六君子汤加木香一剂而安。（因为想按腹手护，是中虚；因为发怒抽搐面青，是肝木。六君子补中，木香调肝，治疗肝木侮土是对的，但也有不受补的，又以疏肝为急，所谓标而本之，也有这种情况。）
一位产妇恶露发热，我想用八珍汤加炮姜治疗，家属懂医，认为是风寒，用小柴胡汤。我说：寒热不时，是气血虚乏。不信，仍服一剂，汗出不止，胡言乱语，烦热作渴，肢体抽搐。我用十全大补汤二剂，病情加重，脉洪大，重按如无，仍用前汤加附子四剂稍缓，数剂而安。
吴茭山治疗一位妇人，产后失血过多，食后恼怒，头疼身痛，寒热如疟，左手脉弦大，微有寒邪，右手脉弦滑不匀，是食饮痰火所致，两者因虚而得，宜扶正祛邪，于是用茯苓补心汤去地黄，加羌活、青皮、葱、枣，三服后汗出身凉，患病逐渐好转，然后用八物汤调理，半月后痊愈（这位老先生善于补益，但也辨证确切，所以可用，如果不确切，就会失败，务必谨慎）。一位产妇产后恶露未尽，瘀血入络，又感寒邪，身热如疟，即用生料五积散五帖，恶露自下，而寒热除。（这是正治常法，此法应当知晓。）
又一产妇产后恶露未尽，因起身擦身，寒气客于经络，忽冷忽热，脉紧而弦（弦紧为寒，审症方法尤其应当这样察识），用葱白散二帖安顿。一位少妇初产四天，冷物伤脾胃（冷物是病根，所以诸症皆从瘀血变怪），只觉身体不舒服，呕逆，饮食少，心腹满闷，有时腹胁刺痛，早晨恶寒，晚上潮热，夜间则恍惚谵语，白天则抽搐，颇像风状，变异多端，众医无法猜测，有的说是虚风，有的说是血凝实热，用甘温而行血，以寒凉退实热，如此半月无效。汪医生至，见医满座，也局促收敛，诊其脉弦而紧，遂令按压，小腹急痛，知瘀血未尽也，思考患者大势，恶露已下，未必还有余血，偶然因寒凉所伤，瘀血停滞下焦，日久客于经络，所以变生诸证，须得大调经散，倍入琥珀（重在琥珀，难道大豆有如是之神效吗），化诸恶血成水，其患方愈，遂合前药服之，五日后行恶水斗许，臭不可近，患人觉倦，病势渐减，然后以人参养荣汤数十帖，月余如初。
柴胡四物汤 治疗产后往来寒热及日久虚劳，微有寒热，脉沉而数。
当归 川芎 白芍 熟地黄（各一钱半） 柴胡（一钱） 人参 黄芩 半夏 甘草（各三钱）
上锉，每服一两，水煎服。（以小柴胡合四物，一名三之一气汤，其参、草、甘、半各用三钱，为重在补气也，而甘草、芩、半何为亦倍之，似可损益也，原方有姜、陈，亦不可少）
增损柴胡汤 治疗产后虚弱，寒热如疟，饮食少，腹胀。
柴胡 人参 甘草 半夏（炒） 陈皮 川芎 白芍（炒，各等分）
上咀，每服八钱，加生姜五片，枣二枚，水煎服。（此亦小柴变法，而去黄芩加陈皮者，所以益胃除胀也，加芍药、川芎者，所以和血也，本草以当归治洒洒寒热不已，则产后寒热正宜加之，何为不用，宜思之）
增损四物汤 治疗产后阴阳不和，乍寒乍热，如有恶露未尽，停滞胞络，亦能令人寒热（按往来寒热者，寒往热来，热往寒来也；寒热如疟者，寒热有时也；乍寒乍热者，时乎寒，时乎热也；发热憎寒者，身发热而又恶寒也。治各有法，不能备录），但小腹急痛为异。
当归 芍药 川芎 人参 干姜（各一两） 甘草（炙，半两）
上咀，每服四钱，加生姜三片，水煎服。
释曰：此方治阴阳不和，乍寒乍热之寒热，不治恶露未尽，血滞胞络，小腹急痛之寒热，宜详之。
更生散 治疗产后去血过多，或不止，或眩晕眼暗，口噤，发热憎寒。
人参 当归 熟地黄（姜汁炒，各一两） 川芎 荆芥穗（香油灯上烧过） 干姜（炒黑，各三钱）
上锉，水煎，空心服（此方前三味各一两，何其多，后三味各三钱，何其少，非有大智能大力量大见解者，不能处此方，治此病，名之曰更生，能不于危急时用乎。下三味乃固涩急药，非血大下不止者不用）。如血大下不止，加龙骨赤石脂，各火煅等分，每二钱同前药调服。外以五倍子末，津调纳脐中即止。
大调经散 治疗产后血虚，恶露未消，气为败浊凝滞，荣卫不调，阴阳相乘，憎寒发热，或自汗，或肿满，皆气血未平之所为也。
大豆（一两半，炒，去皮） 茯神（一两） 真琥珀（一钱）
上为细末，每服二钱，浓煎乌豆紫苏汤下。（此方重在恶露未消，而茯神之用，所以和阴阳也，有谓此方如神者，功在琥珀大豆汤饮间也）
黄龙汤 治疗产后伤风，热入胞室，寒热如疟及病后劳复，余热不解。
柴胡（四钱八分） 黄芩 人参 甘草（各一钱八分）
上作一服，水煎服。（此方重在伤风二字，故以柴胡为君，盖风邪陷入胞中则发热，故宜柴胡为君，少阳气陷入厥阴，而寒热如疟者，气不得条达也，故亦以柴胡为君，劳复余热者，亦为余邪热陷也。故亦用柴胡）
小柴胡加生地黄汤 治疗产后往来寒热，而脉弦者，少阳也。
柴胡（二两） 黄芩（五钱） 人参（三钱） 半夏（制，两半） 生地黄 栀子 枳壳（麸炒，各半两）
大枣（三枚）
上锉，加姜枣，水煎服。（此方以治少阳等症似矣。然以弦脉而加生地山栀者，伤寒家以弦脉为阳也，故以柴胡为君）
加减乌金散 治疗产后寒热似疟，（此治错杂之邪）
浓朴 柴胡 黄芩 麻黄 羌活 草果 半夏（各二钱） 当归 川芎 白芍 熟地
陈皮 茯苓 桔梗（各一钱半） 桂枝 苍术 白芷 枳壳（各一钱） 甘草（九分）
上锉为散，分作两服，每服用水一钟半，姜三片，葱三茎，煎至一钟，不拘时服（此方治表里风寒，食积气血痰饮，无不赅括，故曰治错杂之邪。盖此方也，与五积散相为伯仲，苦借此以治三阴疟之有错杂之邪者，必臻至效，语云∶医者意也，请尝试之）。有汗。多当归、川芎、白芍药、熟地黄；有胀，多浓朴、陈皮；有热，多柴胡、黄芩；有寒，多苍术、草果、桂枝；有痰，多半夏、桔梗、茯苓；有头痛，多川芎、白芷、羌活；有泻，去枳壳、甘草不用；有余血块在腹，作潮热疼痛，加三棱、莪术，多用玄胡索、八角、茴香；遍身痛，加羌活、独活；寒热往来，加黄芩、柴胡。（加减法切中，不可不法）
产宝方 治疗产后恶寒壮热，一夜三五度发，恶语，口中生疮，时时干呕，困乏闷绝。
人参 独活 白鲜皮 葛根 防风 青竹茹 远志（各一两半） 茯神（二两） 白蔹（二两半）
元参（三两） 竹沥（一升）
上取银一斤，水一斗五升煮取七升，纳诸药重煮取三升，分温三服，忌鱼、酒、湿面等。（此方虽出《产宝》，然阅其 ，考其药，皆治产后外邪乘虚传入之热症也。如恶寒壮热，一夜三五度发，恶语者，即热入血室类也，故用防、独、葛根以散之，口疮干呕者，热传胸中也，故用玄参二竹以清之，白鲜皮苦寒，治产后百病，白蔹、白银、人参、远志、茯神为邪散热清，故用之治困乏也）
知母汤 治疗产后乍寒乍热，通身温壮，胁心烦闷。
知母（三两） 芍药 黄芩（各二两） 桂心 甘草（各一两）
上咀，用水五升煮取二升半，分三服。一方不用桂心，用生地黄。（按自黄龙汤以下，皆集外感治法，至于错杂之邪，时热之症，罔不备载，而次第有节，真如网之有纲也，今人但知产后寒热以补气血为主者，其不误尽世人乎）
Guo Jizhong said: What is the cause of alternating chills and fever after childbirth? The answer is: Disharmony of Yin and Yang, and failure of blood stasis to dissipate can cause alternating chills and fever. After childbirth, Qi and Blood are deficient and damaged. If Yin prevails, there are sudden chills; if Yang prevails, there are sudden fevers. When Yin and Yang contend with each other, one may experience either chills or fever. If the labor damages the Zang-Fu organs due to exertion, and the weakened Blood cannot circulate freely, leading to blood stasis that fails to dissipate, when it enters the Lung, fever occurs; when it enters the Spleen, chills occur (Why does blood stasis entering the Lung cause fever, and entering the Spleen cause chills? Is it because the Lung governs Qi, and disharmony of Qi leads to heat? Or because the Spleen controls Blood, and lack of nourishment leads to cold? Or is it due to Spleen Yin and Lung Yang naturally producing cold and heat? In any case, the primary treatment is to expel blood stasis, but the methods of warming and cooling differ). If mistakenly treated as malaria, it would be erroneous. For disharmony of Yin and Yang, Zengsun Siwu Tang (Modified Four Substances Decoction) is appropriate; for blood stasis failing to dissipate, Duoming Dan (Life-Restoring Pill) is appropriate. Another question: How to distinguish between the two? If there is stabbing pain, it is blood stasis; if there are only chills and fever without other symptoms, it is disharmony of Yin and Yang. The formula for Zengsun Siwu Tang varies and should be modified according to the condition.
Chen Wuyue commented: Alternating chills and fever indicate disharmony of Ying and Wei (Nutritive and Defensive Qi), which is difficult to discuss lightly. If it is blood stasis failing to dissipate, how could it only enter the Spleen and Lung? Generally, when one Yin closes off one Yang, chills and fever arise. Yin prevailing causes cold; Yang prevailing causes heat. It can only be said that blood stasis flows along the meridians, closing off the Yin meridians causes cold, and closing off the Yang meridians causes heat. When Blood Qi and Wei Qi harmonize, it stops; when they meet again, it recurs. (The theory of closing Yin and Yang is hard to understand. Believing that blood stasis closing Yin causes cold and closing Yang causes heat, and having times of resolution and recurrence, resembles malaria. If blood stasis is a tangible substance, closure would lead to obstruction, so where is the place for resolution and meeting? I believe that when blood stasis closes the Yang meridians, the unobstructed flow of Ying and Wei causes cold; when it closes the Yin meridians, the unobstructed flow of Ying and Wei causes heat. Therefore, only when the stasis is cleared will the chills and fever cease. Regarding Da Tiaojing San (Great Regulation of Menstruation Powder), it moves stasis internally, while Wuji San (Five Accumulations Powder) moves stasis externally. Furthermore, if the exterior meridians are invaded by cold pathogens, the Lung becomes diseased; Lung disease causes stagnation in the muscle surface and obstruction of Ying and Wei flow, leading to heat. If the interior fu-organs are injured by cold substances, the Spleen becomes diseased; Spleen disease causes obstruction of Ying and Wei flow, leading to cold. Thus, the formulas used target the interior and the exterior respectively. If both interior and exterior have stasis, chills and fever occur together, and neither medicine should be discarded. These are shallow words, please judge.)
Xue said: Postpartum chills and fever, caused by deficiency and weakness of Qi and Blood, or damage to the Spleen and Stomach, belong to deficiency syndromes. The Classics state: Yin deficiency causes fever; Yang deficiency causes aversion to cold. If accompanied by constipation, it particularly belongs to Qi and Blood deficiency. One must absolutely not use diaphoretic or fire-clearing drugs. If the Cun (Inch) position pulse is faint, it is named Yang Qi deficiency, where Yin Qi ascends into the Yang aspect causing aversion to cold; Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is required. If the Chi (Cubit) position pulse is weak, it is named Yin Qi deficiency, where Yang Qi sinks into the Yin aspect causing fever; Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is used. Generally, if Yin is insufficient, Yang follows it, causing Yang to sink internally and produce fever; if Yang is insufficient, Yin follows it, causing Yin to ascend and produce aversion to cold. This is Yin and Yang not returning to their proper places, leading to contention between cold and heat, thus causing aversion to cold and fever; Bazhen Tang (Eight-Treasures Decoction) should be used. If after illness the limbs feel hot, or there is fatigue and lassitude of form and Qi, this is due to Yuan Qi (Original Qi) not yet recovered, with damp-heat taking advantage; Buzhong Yiqi Tang is appropriate. If there is muscle heat, extreme thirst with desire to drink, red eyes and face, this is Blood deficiency causing fever; Danggui Buxue Tang (Dongquiang Tonifying Blood Decoction) is used. Mistaking this for an excess syndrome is an error (referring to Baihu Tang).
A parturient woman had aversion to cold and fever, treated with Shiquan Dabu Tang (Ten Complete Tonifying Decoction) plus Paojiang (Roasted Ginger), and was cured. However, she had poor appetite and limb fatigue, treated with Buzhong Yiqi Tang and settled. Later, after eating, she became angry, experienced aversion to cold and fever, convulsions, and teeth grinding, making pulse diagnosis difficult. Her complexion showed green hiding yellow. She wanted her abdomen pressed but protected it with her hand. This indicates Liver Wood insulting Spleen Earth, caused by food stagnation. Liujunzi Tang (Six Gentlemen Decoction) plus Muxiang (Aucklandiae Radix) for one dose settled it. (Protecting the abdomen upon pressure indicates middle deficiency; anger, convulsions, and green face indicate Liver Wood. Liujunzi tonifies the middle, Muxiang regulates the Liver, treating Liver Wood insulting Earth is correct. However, some cases do not tolerate tonification, and regulating the Liver becomes urgent. This is treating the branch first, then the root, which also exists.)
A parturient woman had fever due to lochia. I intended to treat her with Bazhen Tang plus Paojiang. Her family, knowing medicine, thought it was wind-cold and used Xiaochaihu Tang (Minor Bupleurum Decoction). I said: Irregular chills and fever indicate deficiency of Qi and Blood. They did not believe me and took one dose. This resulted in continuous sweating, delirious speech, irritability, thirst, and limb convulsions. I used Shiquan Dabu Tang for two doses, but the condition worsened. The pulse was flooding and large, but empty on deep pressure. I used the previous decoction plus Fuzi (Aconite Lateralis Radix Preparata) for four doses, which slightly alleviated it, and several doses brought stability.
Wu Jiaoshan treated a woman who lost excessive blood after childbirth. After eating, she became annoyed, suffering from headache and body pain, chills and fever like malaria. The Left Hand pulse was wiry and large, indicating slight cold pathogen; the Right Hand pulse was wiry, slippery, and irregular, indicating food retention, phlegm, and fire. Both conditions arose from deficiency. Treatment should support healthy Qi and expel pathogens. He used Fuling Buxin Tang (Poria Nourishing Heart Decoction) minus Dihuang (Rehmanniae Radix), plus Qianghuo (Notopterygii Rhizoma et Radix), Qingpi (Citri Reticulatae Pericarpium Viride), Scallion, and Jujube. After three doses, she sweated and her body cooled, and the illness gradually improved. Then she was regulated with Bawu Tang (Eight Substances Decoction), and recovered fully after half a month. (This physician excels at tonification, but also diagnosed accurately, so it was effective. If inaccurate, it would fail. Be cautious.) A parturient woman had incomplete lochia expulsion, blood stasis entering the collaterals, and caught a cold pathogen. She had body heat like malaria. She was given Shengliao Wuji San (Raw Material Five Accumulations Powder) for five doses. Lochia expelled spontaneously, and chills/fever ceased. (This is standard orthodox treatment; this method should be known.)
Another parturient woman had incomplete lochia expulsion. Due to getting up to wipe herself, cold pathogen invaded the meridians. She had alternating chills and fever, with tight and wiry pulse. (Wiry and tight indicate cold; diagnostic scrutiny should be like this.) Congbai San (Scallion White Powder) for two doses settled it. A young woman, four days postpartum, injured her Spleen and Stomach with cold substances (Cold substances are the root cause, so all symptoms transform strangely from blood stasis). She felt general discomfort, retching, poor appetite, fullness in heart and abdomen, occasional stabbing pain in abdomen and hypochondrium. Morning chills, evening tidal fever, night confusion and delirium, daytime convulsions. It resembled wind patterns, with many variations, baffling physicians. Some called it deficiency wind, others blood coagulation with excess heat. They used sweet-warm herbs to move blood and cold-bitter herbs to clear excess heat. After half a month, no effect. Dr. Wang arrived, saw crowded physicians, and hesitated. Pulse was wiry and tight. Upon pressing, acute lower abdominal pain indicated incomplete blood stasis. Considering the patient's major trend, lochia had been discharged, likely no residual blood remained. Accidental injury by cold caused blood stasis to stagnate in the Lower Jiao. Over time, it lodged in the meridians, generating various symptoms. Da Tiaojing San was needed, with doubled Hupo (Amber) to transform all evil blood into water. Only then would the illness heal. Combined with previous medicine, after five days, she passed a bucket of foul-smelling fluid. The patient felt tired, and the disease trend decreased. Then, Renshen Yangrong Tang (Ginseng Nourishing Young Decoction) for dozens of doses restored health after over a month.
Chaihu Siwu Tang treats postpartum alternating chills and fever, long-term deficiency consumption, slight chills and fever, sinking and rapid pulse.
Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba), Shudihuang (Rehmanniae Radix Praeparata) (each 1.5 qian); Chaihu (Bupleuri Radix) (1 qian); Renshen (Ginseng Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix) (each 3 qian).
Decocted, take 1 liang per dose with water. (Combining Xiaochaihu Tang with Siwu Tang, also known as Sanzhi Yiqi Tang. Ginseng, Licorice, Pinellia each use 3 qian, emphasizing tonifying Qi. Why are Licorice, Scutellaria, and Pinellia doubled? Modification might be considered. Original formula includes Ginger and Chenpi, which are indispensable.)
Zengsun Chaihu Tang treats postpartum weakness, chills and fever like malaria, poor appetite, abdominal distension.
Chaihu, Renshen, Gancao, Banxia (stir-fried), Chenpi, Chuanxiong, Baishao (stir-fried, equal parts).
Crushed, take 8 qian per dose, add 5 slices of fresh ginger and 2 jujubes, decoct with water. (This is also a variation of Xiaochaihu, removing Scutellaria and adding Chenpi to benefit the Stomach and remove distension. Adding Baishao and Chuanxiong harmonizes Blood. Materia Medica states Danggui treats persistent chills and fever; thus it is suitable for postpartum chills/fever. Why is it not used? Consider this.)
Zengsun Siwu Tang treats postpartum disharmony of Yin and Yang, sudden chills and fever. If lochia is incomplete and stagnates in the uterine collaterals, it can also cause chills and fever. (Note: Alternating chills and fever means cold goes and heat comes, heat goes and cold comes. Chills and fever like malaria means chills and fever occur at specific times. Sudden chills and fever means sometimes cold, sometimes heat. Fever with aversion to cold means body heat plus aversion to cold. Treatments differ; cannot record all.) The difference is acute lower abdominal pain.
Danggui, Shaoyao, Chuanxiong, Renshen, Ganjiang (Dried Ginger) (each 1 liang); Gancao (roasted, 0.5 liang).
Crushed, take 4 qian per dose, add 3 slices of fresh ginger, decoct with water.
Explanation: This formula treats chills and fever due to disharmony of Yin and Yang, sudden chills and fever. It does not treat chills and fever due to incomplete lochia, blood stasis in uterine collaterals, and acute lower abdominal pain. Please note carefully.
Gengsheng San treats postpartum excessive blood loss, or continuous bleeding, dizziness, dim vision, locked jaw, fever with aversion to cold.
Renshen, Danggui, Shudihuang (fried with ginger juice, each 1 liang); Chuanxiong, Jingjie Sui (Schizonepetae Spica, burned over sesame oil lamp), Ganjiang (fried black, each 3 qian).
Decocted, taken on an empty stomach. (The first three ingredients are 1 liang each, very much; the last three are 3 qian each, very little. Only those with great wisdom, strength, and insight can prescribe this for this disease. Named Gengsheng (Regeneration), it is surely used in critical situations. The last three are astringent emergency medicines, not used unless blood loss is massive and unceasing.) If blood loss is massive and unceasing, add Longgu (Fossilia Ossis Mastodi) and Chishizhi (Halloysit Rubra) calcined in equal parts. Take 2 qian mixed with previous medicine. Externally, apply Wubeizi (Galae Chinensis) powder mixed with saliva into the umbilicus to stop bleeding.
Da Tiaojing San treats postpartum Blood deficiency, uneliminated lochia, Qi stagnant due to turbid败血, disharmony of Ying and Wei, contention of Yin and Yang, aversion to cold and fever, spontaneous sweating, or swelling/fullness. All are results of unsettled Qi and Blood.
Daydou (Soybean, fried, peeled) (1.5 liang); Fushen (Poria with Hostwood) (1 liang); Zhen Hupo (True Amber) (1 qian).
Ground into fine powder. Take 2 qian per dose, washed down with strong decoction of Black Soybean and Perilla Leaf. (This formula focuses on uneliminated lochia. Fushen is used to harmonize Yin and Yang. Some say this formula is miraculous; its efficacy lies in the Amber and Soybean decoction.)
Huanglong Tang treats postpartum wind-cold, heat entering the uterus, chills and fever like malaria, and relapse after illness with lingering heat.
Chaihu (4.8 qian); Huangqin, Renshen, Gancao (each 1.8 qian).
One dose, decoct with water. (This formula emphasizes "wind-cold". Thus Chaihu is the sovereign herb. Wind pathogen sinking into the uterus causes fever, so Chaihu is sovereign. Shaoyang Qi sinking into Jueyin causing chills/fever like malaria indicates Qi stagnation, so Chaihu is sovereign. Relapse with lingering heat is also due to lingering pathogenic heat sinking, so Chaihu is used.)
Xiaochaihu Shengdihuang Tang treats postpartum alternating chills and fever with wiry pulse, indicating Shaoyang syndrome.
Chaihu (2 liang); Huangqin (5 qian); Renshen (3 qian); Banxia (processed, 1.5 liang); Shengdihuang (Rehmanniae Radix), Zhizi (Gardeniae Fructus), Zhike (Aurantii Fructus Immaturus, bran-fried) (each 0.5 liang); Dazao (Jujubae Fructus) (3 pieces).
Decocted with ginger and jujube. (This formula seems suitable for Shaoyang symptoms. However, adding Shengdihuang and Zhizi for wiry pulse: Shanghan scholars consider wiry pulse as Yang, thus Chaihu is sovereign.)
Jiajian Wujin San treats postpartum chills and fever resembling malaria. (Treats complex pathogens.)
Houpo (Magnoliae Officinalis Cortex), Chaihu, Huangqin, Mahuang (Ephedrae Herba), Qianghuo, Caoguo (Tsao-ko Fructus), Banxia (each 2 qian); Danggui, Chuanxiong, Baishao, Shudi, Chenpi, Fuling, Jiegeng (Platycodonis Radix) (each 1.5 qian); Guizhi (Cinnamomi Ramulus), Cangzhu (Atractylodis Rhizoma), Baizhi (Angelicae Dahuricae Radix), Zhike (each 1 qian); Gancao (0.9 qian).
Ground into powder, divided into two doses. Each dose decocted with 1.5 zhong water, 3 slices ginger, 3 stalks scallion, until 1 zhong remains. Take anytime. (This formula covers exterior-interior wind-cold, food retention, Qi/Blood/Phlegm/Water retention. Hence it treats complex pathogens. It is comparable to Wuji San. Borrowing it to treat Three-Yin malaria with complex pathogens will surely achieve excellent results. As the saying goes: Medicine is intention. Please try it.) Sweating: increase Danggui, Chuanxiong, Baishao, Shudi. Distension: increase Houpo, Chenpi. Heat: increase Chaihu, Huangqin. Cold: increase Cangzhu, Caoguo, Guizhi. Phlegm: increase Banxia, Jiegeng, Fuling. Headache: increase Chuanxiong, Baizhi, Qianghuo. Diarrhea: remove Zhike, Gancao. Residual blood masses in abdomen causing tidal fever/pain: add Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Xiyansu (Corydalis Rhizoma), Bajiao (Illicii Fructus), Huixiang (Foeniculi Fructus). General body pain: add Qianghuo, Duhuo (Angelicae Pubescentis Radix). Alternating chills/fever: add Huangqin, Chaihu. (Modification methods are precise; they must be learned.)
Chanbao Fang treats postpartum severe aversion to cold and high fever, occurring 3-5 times a night, delirious speech, mouth ulcers, frequent dry retching, exhaustion and suffocation.
Renshen, Duhuo, Baixianpi (Dictamni Cortex), Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Qingzhuru (Green Bamboo Sap), Yuanzhi (Polygalae Radix) (each 1.5 liang); Fushen (2 liang); Bailian (Tiliaceae Folium) (2.5 liang); Xuanshen (Scrophulariae Radix) (3 liang); Zhuli (Bamboo Sap) (1 sheng).
Take 1 jin silver, 1.5 dou water, boil to 7 sheng. Add herbs, boil again to 3 sheng. Divide into three warm doses. Avoid fish, alcohol, wet noodles. (Although from Chanbao, reviewing the herbs shows they treat heat syndromes where external pathogens enter via deficiency postpartum. Severe chills/fever, delirium resemble Heat Entering Blood Chamber. Fangfeng, Duhuo, Gegen disperse it. Mouth ulcers/dry retching indicate heat transmitting to Chest. Xuanshen and Bamboo sap clear it. Baixianpi is bitter/cold, treating postpartum diseases. Bailian, Silver, Renshen, Yuanzhi, Fushen clear heat and resolve toxicity, treating exhaustion.)
Zhimu Tang treats postpartum sudden chills and fever, whole body warmth, hypochondriac vexation.
Zhimu (Anemarrhenae Rhizoma) (3 liang); Shaoyao, Huangqin (each 2 liang); Guixin (Cinnamomi Cortex), Gancao (each 1 liang).
Decocted with 5 sheng water to 2.5 sheng. Divide into three doses. Another version uses Shengdihuang instead of Guixin. (From Huanglong Tang onwards, all collect external contraction treatments. Complex pathogens and intermittent fevers are comprehensively recorded in order, truly like a net with a cord. Those who only know tonifying Qi/Blood for postpartum chills/fever will mislead the world.)