Library

Xue Lizhai stated: According to Liangfu, this condition arises from deficiency and damage of Qi and Blood, with disharmony between Yin and Yang. It is appropriate to use Siwu Tang (Four Substances Decoction) with modifications. If retained blood (lochia) fails to disperse, causing abdominal pain, Duoming Dan should be used. In cases where Yang Qi is insufficient and Yin Qi invades the Yang aspect, resulting in aversion to cold, Buzhong Tang is indicated. When Yin Qi is insufficient and Yang Qi sinks, causing heat sensation within the Yin aspect, Liuwei Wan (Six-Ingredient Pill with Rehmannia) is prescribed. For conditions involving insufficiency of both Qi and Blood manifesting as aversion to cold and fever, Bazhen Tang (Eight Treasures Decoction) is suitable.

Shen Zhai commented: The above five points describe the syndrome of alternating chills and fever occurring postpartum. Alternating chills and fever are characteristic of Shaoyang channel diseases. When observed postpartum, it clearly belongs to a pattern of dual deficiency of Yin and Yang, and disharmony of Ying (Nutritive) and Wei (Defensive) Qi. Treatment should follow Danyu’s principle of greatly tonifying Qi and Blood; it cannot be treated simply by analogy with Xiaochaihu Tang (Minor Bupleurum Decoction). Regarding the theory that retained blood causes chills and fever, Guo Jizhong proposed theories of invasion into the Lung and Spleen, while Chen Wuyue discussed closure of Yin and closure of Yang. Both arguments are questionable. How can stagnant retained blood logically enter either the Lung or the Spleen exclusively? Moreover, why would chills and fever be specific only to the Spleen and Lung, while excluding the Heart, Kidney, and Liver? If retained blood closes Yin causing chills, it cannot simultaneously close Yang causing fever; if it closes Yang causing fever, it cannot close Yin causing chills. Can one claim it is "retained blood failing to disperse" if it involves both closing Yin and closing Yang? Such erroneous statements may confuse future practitioners. In summary, the generation of chills and fever due to retained blood stems fundamentally from the obstruction of Ying and Wei circulation and the mutual rejection of Yin and Yang. Only Wu Shuqing truly grasped this essence.

The *Daquan* (Great Compendium) states: Persistent spontaneous sweating postpartum occurs because Yin Qi is deficient, allowing Yang Qi to invade. Internal deficiency allows Yang Qi to radiate outward alone, resulting in sweating. Blood belongs to Yin; childbirth injures Blood, constituting a deficiency of Yin Qi. Qi belongs to Yang; when Qi is substantial, Yang adds to Yin, causing sweating. If Yin Qi is weak and fails to recover, sweating persists indefinitely. Exposure to wind may then transform this into Jing disease (spasms/tetanus). Even if spasms do not develop, the patient will suffer from weakness, shortness of breath, emaciation, dry lips and mouth, and eventually amenorrhea due to the exhaustion of Jin-Ye (Body Fluids).

Dan Yangxian stated: Regarding postpartum spontaneous sweating, the *Huangdi Neijing* (Yellow Emperor's Inner Canon) says: "Yang Qi, when refined, nourishes the Spirit; when soft, nourishes the Sinews." Postpartum, having already lost Blood, excessive sweating constitutes Wang Yang (Loss of Yang). Sweat originates from Blood, belonging to Yin. When Yin is lost, Yang follows and dissipates; thus, it is termed Loss of Yang. Postpartum blood loss combined with profuse sweating leads to dual deficiency of Yin and Yang, representing an extremely critical condition. Therefore, medication differs from other syndromes; caution is essential. The formula uses Renshen (Ginseng), [missing character], Baizhu (Atractylodes Macrocephala Rhizome), Mahuanggen (Ephedrae Radix et Rhizoma), Fangfeng (Saposhnikoviae Radix), and Guizhi (Cinnamon Twig).