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A woman surnamed Li from Tianjin, aged twenty-seven, contracted a warm disease (Wenbing) after the Mid-Autumn Festival.

Etiology: On the sixth day postpartum, she caught wind while using the toilet.

Symptoms: Upon returning from the toilet, she felt cold all over her body. After several hours, as the cold sensation subsided, fever returned. She self-medicated by decocting fresh ginger and brown sugar, drinking it hot. Sweating provided slight relief, but the fever persisted after sweating. The condition dragged on for two days with increasing heat intensity, accompanied by irritability in the chest and thirst. I was urgently summoned to examine her. Her face appeared flushed like fire, and she had slight panting. Her pulse was surging and solid, particularly on the right side, beating ninety-three times per minute. The tongue coating was fully covered with white fur tinged slightly yellow. She had not had a bowel movement since the onset of illness.

Diagnosis: This is a warm disease formed due to internal heat generated by yin deficiency postpartum, exacerbated slightly by external constraint. The irritability and thirst are caused by damage to kidney yin postpartum, which fails to ascend to the root of the tongue and cannot harmonize with heart fire. The slight panting is due to kidney deficiency failing to grasp qi. The white tongue coating with slight yellow indicates that heat has entered the Yangming fu organs. The surging, solid, and rapid pulse indicates that yangming fu heat is excessive and solid, combined with signs of yin deficiency. Treatment should employ Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction), with minor modifications to ensure safety for the postpartum state.

Prescription: Raw Gypsum Fibrosum (Sheng Shigao, 3 liang, crushed fine); Wild Taishen Root (Yetaishen, 4 qian); Scrophulariae Radix (Xuanshen, 1 liang); Dioscoreae Rhizoma (Sheng Huai Shanyao, 8 qian); Licorice Root (Gancao, 3 qian).
Decoct together to yield three bowls of liquid, taken warm in three divided doses.

Formula Analysis: This formula is essentially Baihu Jia Renshen Tang, substituting Xuanshen (Scrophulariae Radix) for Zhimu (Anemarrhenae Rhizoma) and Sheng Shanyao (Raw Dioscoreae Rhizoma) for Jingmi (Rice Grain). In Shanghan Lun, the standard rule for using Baihu Tang is to add Renshen after sweating, vomiting, or purgation methods because of deficiency; if there is thirst, Renshen is added because fluids fail to ascend. Postpartum represents extreme deficiency, compounded by thirst, making the addition of Renshen obvious. Xuanshen replaces Zhimu because Shen Nong Ben Cao Jing records Xuanshen as treating residual diseases after childbirth. Sheng Shanyao replaces Jingmi because its sweet and warm nature harmonizes the stomach like rice, and its high protein content further tonifies kidney deficiency in postpartum women. With such modifications, although used postpartum, the formula causes no harm. Moreover, Shen Nong Ben Cao Jing records Shigao as mildly cold and explicitly states it treats postpartum conditions.

Follow-up Visit: After one dose, the fever receded by more than half, and thirst and panting resolved. The pulse approached normalcy, but the bowels remained unopened. It is appropriate to greatly nourish true yin to clear residual heat, assisted by a small amount of qi-tonifying herbs. Indeed, when qi is robust, blood is easily generated, and true yin is easily restored.

Prescription: Scrophulariae Radix (Xuanshen, 2 qian); Codonopsis Radix (Yedangshen, 5 qian).
Decoct together to yield two bowls of liquid, taken warm in two divided doses.

Outcome: After taking two doses, bowel movements were restored, and the illness was completely cured.