王好古曰。发热恶寒。不离桂枝、芍药。往来寒热。不离柴胡、前胡。大渴引饮。不离知母、
石膏、麦冬、五味。大便泄利。不离干姜、白术。大便燥结。不离大黄、黄芩。月经适来适断。不
离小柴胡。胎动不安。不离人参、阿胶、黄芩、白术。要汗。不离姜、豉、旋覆。头痛。不离山栀、
石膏、前胡。伤暑头痛。不离柴胡、甘草、石膏。满闷。不离枳实、陈皮。胎气不安。不离黄芩、
麦冬、人参。斑色发黑。不离黄芩、山栀、升麻。
朱震亨曰。产后发热恶寒。皆属血气虚。左手脉不足。补血。右手脉不足。补气。凡恶寒发热。
又腹痛。当去恶血。恶寒发热。乳汁不通及膨者。无子当消。用麦芽二两。炒研作四服。白汤下。
有子当下。用木通、通草、猪蹄汁。煎服。
产后才身热。不可发表。并一切苦寒药。
大凡产后。头痛身疼。不可便作感冒治之。此等多是血虚。或败血作梗。宜以平和之剂与服。
必效。如玉露散。或四物汤加北柴胡等分。若便以小柴胡及竹叶石膏汤之类。竟不救者多矣。
吴绶曰。新产后患伤寒。不可轻易发汗。盖有产时伤力发热。去血过多发热。恶露不去发热。
三日蒸乳发热。或有早起劳动。饮食停滞。一皆发热。状似伤寒。要在仔细详辨。不可便发汗。大
抵产后。大血空虚。若汗之。则变筋惕肉 。或冒郁昏迷而不省。或风搐搦而不定。或大便秘涩而
难去。其害非轻。切宜精审。凡有发热。且与四物汤。以芎、归为君。炒白芍、熟地佐之。如发热。
加软苗柴胡、人参、干姜。最效。盖干姜能引血药入血分。气药入气分。且能去恶养新。有阳生阴
长之道。予尝用之取效。如有恶露未尽者。益母丸。黑神散。必兼用之。若胃虚食少。必加白术、
茯苓。有痰呕逆。必
加半夏、陈皮。其余六经。各条治例皆同。但药中必加四物汤为主。乃养血务本之要。产后中风。
数十日不解。头微痛。恶寒。时时有热。心下闷。干呕。汗出。虽多阳旦症。或可治。与阳旦汤。
产后中风。发热面赤。喘而头痛。竹叶汤。
鳌按。产后气血大亏。若恶寒发热。固当以四物汤为主。即用表药。只可荆芥、苏叶、桔梗、甘菊
轻清之品。然犹当少用。即用凉药。亦不过丹皮、石斛之类。亦须少用。余以此意治产妇。无一失
者。尝见俗工。用大散大凉之剂。往往几日即毙。反此便大热大补。加参、桂、姜、附。亦多致
死。呜呼。可谓不知高下者矣。
Wang Haogu stated: For symptoms of fever and aversion to cold, the treatment must not depart from Guizhi (Cinnamon Twig) and Shaoyao (Peony Root); for alternating chills and fever (Wanglai Hanre), the treatment must not depart from Chaihu (Bupleurum Root) and Qianhu (Peucedani Radix); for extreme thirst with excessive drinking, the treatment must not depart from Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus); for loose stools or dysentery, the treatment must not depart from Ganjiang (Zingiberis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma); for dry and constipated stool, the treatment must not depart from Dahuang (Rhei Radix et Rhizoma) and Huangqin (Scutellariae Radix); when menstruation has just started or just stopped, the treatment must not depart from Xiaochaihu Tang (Minor Bupleurum Decoction); for restless fetus, the treatment must not depart from Renshen (Ginseng Radix), Ejiao (Donkey-hide Gelatin), Huangqin (Scutellariae Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma); when sweating is required, the treatment must not depart from Jiang (Zingiberis Rhizoma), Chi (Sojae Semen Praeparatum), and Xuanfu (Inulae Flos); for headache, the treatment must not depart from Shanzhi (Gardeniae Fructus), Shigao (Gypsum Fibrosum), and Qianhu (Peucedani Radix); for headache caused by summerheat, the treatment must not depart from Chaihu (Bupleurum Root), Gancao (Glycyrrhizae Radix et Rhizoma), and Shigao (Gypsum Fibrosum); for chest and epigastric fullness and oppression, the treatment must not depart from Zhishi (Aurantii Fructus Immaturus) and Chenpi (Citri Reticulatae Pericarpium); for unstable fetal qi, the treatment must not depart from Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix), and Renshen (Ginseng Radix); for macules turning black, the treatment must not depart from Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), and Shengma (Cimicifugae Rhizoma).
Zhu Zhenheng stated: Postpartum fever and aversion to cold all belong to deficiency of blood and qi. If the pulse at the left position is insufficient, tonify blood; if the pulse at the right position is insufficient, tonify qi. Whenever there are aversion to cold, fever, accompanied by abdominal pain, one should remove stasis blood. In cases of aversion to cold, fever, blocked lactation, and breast distension without a fetus (referring to milk stasis in non-lactating women or pathological conditions), one should dissipate the milk using Erliang Maiya (Two taels of Fried and Crushed Malt), divided into four doses, taken with warm water; if there is a fetus, one should promote downward movement using Mutong (Akebiae Caulis), Tongcao (Tetrapanacis Medulla), and Zhu Ti Ji (Pig's Trotter Juice), decocted and taken.
Immediately after childbirth, if body heat appears, do not use exterior-releasing (diaphoretic) medicines, nor any bitter-cold drugs.
Generally speaking, postpartum headache and body ache should not be immediately treated as common cold. These cases are mostly due to blood deficiency or obstruction by stale blood (failed blood). It is advisable to administer mild and balanced formulas, which will surely be effective, such as Yulu San (Jade Dew Powder) or Siwu Tang (Four Substances Decoction) added with equal parts of Bei Chaihu (Northern Bupleurum Root). If one directly uses Xiaochaihu Tang (Minor Bupleurum Decoction) or Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), many cases fail to be cured.
Wu Shou stated: For women suffering from Shanghan (Cold Damage) shortly after childbirth, one should not lightly employ diaphoresis (sweating therapy). This is because exertion during labor causes fever, excessive blood loss causes fever, retention of Eluo (lochia) causes fever, milk production around the third day causes fever, and early physical labor or food stagnation also cause fever. These conditions resemble Shanghan, but careful differentiation is essential; one must not simply induce sweating. Generally, postpartum blood volume is empty. If sweating is induced, it may lead to twitching of tendons and flesh (Jinti Rouyue), dizziness and coma with loss of consciousness, convulsions and spasms, or severe constipation and difficulty in defecation. The harm is significant, so precision and caution are imperative. Whenever fever occurs, initially administer Siwu Tang (Four Substances Decoction), with Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) as the sovereign herbs, and fried Baishao (White Peony Root) and Shudi (Rehmanniae Radix Preparata) as assistant herbs. If fever persists, add Ruanmiao Chaihu (Soft-stemmed Bupleurum Root), Renshen (Ginseng Radix), and Ganjiang (Zingiberis Rhizoma), which is most effective. Ganjiang can guide blood-invigorating herbs into the blood level and qi-regulating herbs into the qi level, while also eliminating lochia and nourishing new blood, following the principle of "yang generating yin." I have used this method with success. If lochia is not yet exhausted, Yimu Wan (Motherwort Pill) and Heishen San (Black Divine Powder) must be used concurrently. If there is stomach deficiency and poor appetite, add Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria). If there is phlegm, vomiting, and counterflow, add Banxia (Pinelliae Rhizoma) and Chenpi (Citri Reticulatae Pericarpium). The treatment principles for the other six meridians are identical, but Siwu Tang (Four Substances Decoction) must always be the main formula, as it is crucial for nourishing blood and addressing the root. For postpartum wind-stroke persisting for dozens of days, with slight headache, aversion to cold, intermittent fever, epigastric oppression, dry retching, and sweating, although this resembles Yangdan Syndrome (Guizhi Tang pattern), it may be treatable with Yangdan Tang. For postpartum wind-stroke with fever, red face, wheezing, and headache, use Zhuye Tang (Bamboo Leaf Decoction).
Shen Jin'ao commented: Postpartum qi and blood are severely depleted. If aversion to cold and fever occur, Siwu Tang (Four Substances Decoction) should indeed be the primary formula. Even if exterior-releasing herbs are used, only light and clear agents like Jingjie (Schizonepetae Spica), Suye (Perillae Folium), Jiegeng (Platycodonis Radix), and Ganju (Chrysanthemi Flos) should be chosen, and even then, in small doses. Even if cooling herbs are used, they should be limited to Mudanpi (Moutan Cortex) and Shihu (Dendrobii Caulis), also in small doses. I have treated postpartum patients with this approach without failure. I have seen quacks use strong dispersing and strongly cooling agents, often causing death within a few days; conversely, using strongly heating and strongly tonifying agents with Renshen (Ginseng Radix), Guizhi (Cinnamon Twig), Ganjiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Preparata) also frequently leads to death. Alas, these practitioners truly do not know how to weigh priorities and severity.