Library

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.