产后七日，内外发热，其证多端，除伤食发热已论见伤食门矣。然又有发热恶
寒头痛似太阳证，或寒热头痛胁痛似少阳证，皆由气血两虚，阴阳不和，其状颇类伤寒。治者慎勿轻
产而执偏门，以麻黄汤治类太阳证，以柴胡汤治类少阳证。盖产后大血空虚，一经发汗，重则亡阳，轻
则筋惕肉 ，或郁冒昏迷，或搐搦便秘，变证百出矣。昔仲景云∶亡血家不可发汗。丹溪云∶产后切
不可发表。二先生非谓产后无伤寒之证也，非谓柴胡、麻黄汤之不为对证也，诚恐后学执偏门而轻产，泥成
方而发表耳。虽明知感有外邪，其生化汤内芎、姜亦能散之，否则辛散生化汤亦可，何用发表以犯不可汗
之禁乎！产时伤力发热，去血过多发热，恶露不快发热，三日蒸乳发热，早于起床劳动发热，多因血虚
阳无所根据，浮散于外而为热。只服生化汤二三剂，去恶生新，阳生阴长，其诸热悉能退之。《尊生》用丹
溪法，以四君子汤加芎、归、黄 、炮姜，治产后发热，亦甘温除大热意也。又云∶大热面赤大渴，脉
洪大而虚者，黄 当归等分煎服。此仿当归补血汤也。冯氏用四物为君，去川芎，生地换熟地，加软苗柴
胡、人参、炮姜，治热最效，此亦取炮姜收其浮散之热，而兼芍药敛阴之意。予谓当分块痛有无，如
七日内尚有块痛，及初产时发热，自宜生化汤为妙，其参、 、柴、术、地、芍尚须缓用。若无块痛，
产日已久，《尊生》、
冯氏之方，亦合经旨也。养葵云∶如胎前原有阴虚火证，产后去血过多，必大热烦躁汗出等证，若大补
气血，其证必甚。当用逍遥散以清肝火、养肝血。因其去血既多，肝虚血燥之故，不可泥于气血两虚而治。
予谓此以肝虚有火立论，当以脉候参详可耳。薛立斋又云∶新产妇人，阴血暴亡，阳无所附而外热，宜
四物加炮姜，补阴以配阳。若系误用寒凉克削之剂而外热者，此为寒气格阳于外，宜四君子加姜、
桂。不应，急加附子。若肌肤发热，面赤大渴引饮者，此血脱发燥也，当归补血汤。又曰∶产后虚烦发热，
乃阳随阴散，气血俱虚，故恶寒发热。若误作火证，投以寒凉；误作表证，轻用表散，祸在反掌。予谓
立斋之论及治法，深得产后之要，但四物加炮姜一方，不若易生化汤则全美矣。
辛散生化汤（附辛散汤。）治产后感冒风寒，恶寒发热头痛。
川芎（一钱五分） 当归（三钱） 炙草 干姜（炙黑） 羌活 防风（各四分） 桃仁（十粒，去皮尖）
水煎服。若头疼身热不除，加白芷八分，细辛三分。头疼如破，加连须葱头五根。虚加人参二三钱。
一方用生化汤，加白芷八分，羌活、细辛各四分，葱头五根，不用防风，通治之。虚亦加人参，名辛散汤。
予谓产后七日前当用生化汤，
七日后可用此方。
当归补血汤 治血虚至夜发热，烦渴引饮，其脉洪大而虚，重按全无者。
黄 （六钱，蜜酒炙） 归身（二钱）
水煎服。
生化汤（见本卷生化汤论后。） 四君子汤 逍遥散（俱见上卷胎逆上逼门。） 四
物汤（见上卷安胎门。）
产后第七天，出现全身及局部发热，症状表现多种多样。除了因饮食积滞引起的发热已在“伤食门”中论述过之外，还有表现为发热、怕冷、头痛，类似太阳病（外感风寒初期，邪在肌表）的证候；或者寒热往来、头痛、胁肋疼痛，类似少阳病（邪在半表半里）的证候。这些情况都是由气血两虚、阴阳失调所致，其症状颇像伤寒。治疗者千万不要轻视产妇体质，而固执地使用偏激的方法，用麻黄汤来治疗类似太阳病的证候，或用柴胡汤来治疗类似少阳病的证候。因为产后血液大量空虚，一旦使用发汗法，严重的会导致亡阳（阳气暴脱），轻微的会出现肌肉跳动、抽搐，或者郁冒昏迷，或者抽搐痉挛、便秘，变证百出。过去张仲景说：失血的人不可发汗。朱丹溪说：产后切不可使用发表（发散表邪）的药物。这两位先生并不是说产后没有伤寒的证候，也不是说柴胡汤、麻黄汤不对症，实在是担心后学者固执于偏激之法而轻视产妇，拘泥于成方而滥用发表药。虽然明知感受了外邪，但在生化汤中的川芎、干姜也能起到疏散作用，否则使用辛散生化汤也可以，何必用发表药去触犯不可发汗的禁忌呢！
产时用力过度导致的发热，失血过多导致的发热，恶露排出不畅导致的发热，产后三天乳汁分泌旺盛导致的发热，过早起床劳动导致的发热，多是因为血虚，阳气无所依附，浮散于体外而发热。只需服用二三剂生化汤，去除瘀血、生成新血，使阳气生发、阴血增长，各种发热都能消退。《尊生》一书采用朱丹溪的方法，用四君子汤加川芎、当归、黄芪、炮姜，治疗产后发热，这也是甘温除大热的意思。又说：如果高热、面红、大渴，脉象洪大但按之无力，用黄芪、当归等量煎服。这是仿照当归补血汤的用法。冯氏用四物汤为主药，去掉川芎，将生地换成熟地，加入软苗柴胡、人参、炮姜，治疗发热效果最好，这也是取炮姜收敛浮散之热，兼有芍药敛阴的意思。我认为应当根据是否有块痛（子宫收缩痛或瘀血阻滞痛）来区分，如果在七日内仍有块痛，以及刚生产完时的发热，自然适宜用生化汤为妙，其中的人参、黄芪、柴胡、白术、熟地、芍药等尚需缓用。如果没有块痛，且产后时间已久，《尊生》和冯氏的方子，也符合经旨。养葵说：如果胎前原有阴虚火旺的证候，产后失血过多，必然出现大热、烦躁、出汗等症状，如果大补气血，症状一定会加重。应当用逍遥散来清肝火、养肝血。因为失血既多，导致肝虚血燥，不可拘泥于气血两虚来治疗。我认为这是以肝虚有火立论，应当结合脉象详细诊察即可。薛立斋又说：新产妇人，阴血突然亡失，阳气无所依附而外热，适宜用四物汤加炮姜，补阴以配阳。如果是误用寒凉克削药物而导致外热的，这是因为寒气格拒阳气于外，适宜用四君子汤加生姜、肉桂。如果无效，急加附子。如果肌肤发热，面红、大渴引饮，这是血脱发燥，用当归补血汤。又说道：产后虚烦发热，是阳气随阴血散失，气血俱虚，所以恶寒发热。如果误作火证，投以寒凉药；误作表证，轻用表散药，祸患就在眨眼之间。我认为立斋的论述及治法，深得产后治疗的要领，但四物汤加炮姜一方，不如改用生化汤则更为完美。
辛散生化汤（附辛散汤）：治疗产后感冒风寒，恶寒、发热、头痛。
川芎（一钱五分）、当归（三钱）、炙甘草、干姜（炙黑）、羌活、防风（各四分）、桃仁（十粒，去皮尖）。水煎服。如果头疼身热不除，加白芷八分，细辛三分。头疼剧烈如破，加连须葱头五根。体虚加人参二三钱。
另一方用生化汤，加白芷八分，羌活、细辛各四分，葱头五根，不用防风，通治此证。体虚也加人参，名为辛散汤。
我认为产后七日前当用生化汤，七日后可用此方。
On the seventh day postpartum, fever occurs both internally and externally, with various manifestations. Apart from fever caused by food stagnation, which has been discussed in the section on Food Stagnation, there are cases presenting with fever, aversion to cold, and headache resembling Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian), or alternating chills and fever, headache, and hypochondriac pain resembling Shaoyang disease (a syndrome where pathogens reside between the exterior and interior). These conditions arise from deficiency of both Qi and Blood, and disharmony of Yin and Yang, closely mimicking Shanghan (Cold Damage) syndromes. Practitioners must not lightly dismiss the postpartum condition nor adhere to biased treatments, such as using Mahuang Tang (Ephedra Decoction) for symptoms resembling Taiyang syndrome, or Chaihu Tang (Bupleurum Decoction) for those resembling Shaoyang syndrome. Since postpartum blood volume is significantly depleted, inducing sweating may lead to severe Yang collapse (profound deficiency of Yang Qi) or mild muscle twitching and tremors, Yu Mao coma (dizziness and fainting due to fluid loss), convulsions, constipation, and numerous other complications. Zhang Zhongjing previously stated: "Those who have lost blood should not be induced to sweat." Zhu Danxi stated: "Postpartum patients must absolutely not be treated with diaphoretic (sweat-inducing) methods." These two masters did not deny that postpartum patients can suffer from Cold Damage, nor did they claim that Chaihu Tang or Mahuang Tang are inappropriate for specific indications; rather, they feared that later practitioners would rigidly apply biased methods, neglecting the delicate postpartum state and blindly using established formulas to induce sweating. Although it is known that external pathogens are involved, the Chuanxiong and Shengjiang (Dried Ginger) within Shenghua Tang (Mother-Reviving Decoction) can also disperse them. Alternatively, Xinsan Shenghua Tang (Dispersing Wind and Reviving Mother Decoction) can be used. Why use strong diaphoretics to violate the prohibition against sweating?
Fever resulting from excessive exertion during delivery, excessive blood loss, sluggish lochia discharge, breast engorgement around the third day, or early rising and labor, is mostly due to Blood deficiency causing Yang to lack a foundation, floating outward and manifesting as heat. Simply administering two or three doses of Shenghua Tang (Mother-Reviving Decoction) removes stasis and generates new blood, allowing Yang to grow with Yin, thereby resolving all fevers. *Zunsheng* adopts Zhu Danxi’s method, using Sijunzi Tang (Four Gentlemen Decoction) augmented with Chuanxiong, Danggui, Huangqi, and Paojiang (Prepared Ginger) to treat postpartum fever, embodying the principle of using sweet-warm herbs to eliminate high fever. It further states: For severe heat, flushed face, and intense thirst with a flooding yet empty pulse, equal parts of Huangqi and Danggui should be decocted and taken. This imitates Danggui Buxue Tang (Angelica Sinensis and Astragalus Decoction). Feng Shi uses Siwu Tang (Four Substances Decoction) as the base, removing Chuanxiong, replacing Shengdi (Rehmannia Root) with Shudi (Prepared Rehmannia Root), and adding Ruanmiao Chaihu (Soft-stemmed Bupleurum), Renshen (Ginseng), and Paojiang. This is highly effective for heat, taking advantage of Paojiang to consolidate scattered heat and the yin-astringent property of Baishao (White Peony Root). I suggest distinguishing based on the presence of uterine cramping pain (Kutong). If cramping pain persists within seven days or immediately after delivery, Shenghua Tang is optimal, while Renshen, Huangqi, Chaihu, Baizhu, Shudi, and Baishao should be used cautiously. If there is no cramping pain and considerable time has passed since delivery, the formulas from *Zunsheng* and Feng Shi align well with classical principles. Yangkui stated: If the patient had Yin deficiency with fire hyperactivity before pregnancy, excessive blood loss postpartum will inevitably cause severe heat, restlessness, and sweating. In such cases, massive tonification of Qi and Blood will exacerbate symptoms. Xiaoyao San (Free and Easy Wanderer Powder) should be used to clear Liver Fire and nourish Liver Blood. Due to significant blood loss leading to Liver deficiency and dryness, one must not rigidly treat only for Qi and Blood deficiency. I believe this argument is based on Liver deficiency with fire, and diagnosis should rely on detailed pulse examination. Xue Lizhai further stated: In newly delivered women, sudden loss of Yin Blood leaves Yang unanchored, causing external heat. Siwu Tang (Four Substances Decoction) with Paojiang is suitable to nourish Yin and harmonize Yang. If external heat results from the erroneous use of cold/clearing and draining agents, this indicates Cold rejecting Yang to the exterior; Sijunzi Tang (Four Gentlemen Decoction) with Shengjiang and Rougui (Cinnamon Bark) is indicated. If ineffective, Fuzi (Aconite Root) should be added urgently. If skin feels hot, face is flushed, and there is intense thirst with desire to drink, this is Blood depletion causing dryness; Danggui Buxue Tang (Angelica Sinensis and Astragalus Decoction) is appropriate. He also noted: Postpartum deficiency vexation and fever occur because Yang dissipates with Yin, leaving both Qi and Blood deficient, resulting in aversion to cold and fever. Mistaking this for a Fire syndrome and administering cold herbs, or mistaking it for an Exterior syndrome and using mild diaphoretics, leads to disaster instantly. I consider Xue Lizhai’s discussion and treatment methods to grasp the essentials of postpartum care. However, regarding Siwu Tang with Paojiang, replacing it with Shenghua Tang would be more comprehensive.
Xinsan Shenghua Tang (Dispersing Wind and Reviving Mother Decoction) [Appendix: Xinsan Tang]: Treats postpartum exposure to Wind-Cold, presenting with aversion to cold, fever, and headache.
Chuanxiong (1.5 qian), Danggui (3 qian), Zhi Gancao (Honey-fried Licorice Root), Ganjiang (Roasted Black Dried Ginger), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root) (each 0.4 qian), Taoren (Peach Kernel, 10 grains, peeled and slit). Decoct in water and take orally. If headache and body heat persist, add Baizhi (Angelica Dahurica Root) 0.8 qian and Xixin (Asarum Root) 0.3 qian. If headache is severe ("like breaking"), add five roots of Lianxu Congtou (Scallion bulb with roots). For deficiency, add Renshen (Ginseng Root) 2–3 qian.
Another formula uses Shenghua Tang, adding Baizhi 0.8 qian, Qianghuo and Xixin each 0.4 qian, and five scallion bulbs, omitting Fangfeng, for general treatment. Add Renshen for deficiency; this is named Xinsan Tang (Dispersing Wind Decoction).
I suggest using Shenghua Tang within the first seven days postpartum, and this formula thereafter.
Danggui Buxue Tang (Angelica Sinensis and Astragalus Decoction): Treats night-time fever due to Blood deficiency, accompanied by vexation, thirst with desire to drink, and a flooding yet empty pulse that vanishes upon heavy pressure.
Huangqi (6 qian, honey-wine fried), Danggui Shen (Body of Angelica Root) (2 qian). Decoct in water and take orally.
Shenghua Tang (See discussion at the end of this volume). Sijunzi Tang (Four Gentlemen Decoction). Xiaoyao San (Free and Easy Wanderer Powder) (Both seen in Volume 1, Section on Fetal Rebellious Qi Pressing Upward). Siwu Tang (Four Substances Decoction) (Seen in Volume 1, Section on Fetal Protection).