〔郭〕产后乍寒乍热者何？答曰∶阴阳不和，败血不散，能令乍寒乍热。产后血气
虚损，阴阳不和，阴胜则乍寒，阳胜则乍热，阴阳相乘则或寒或热。若因产劳伤脏腑，血
弱不得宣越，故令败血不散，入于肺则热，入于脾则寒，医人若误作疟疾治之则谬矣。阴
阳不和，宜增损四物汤。败血不散，宜夺命丹。又问∶二者何以别之？时有刺痛者，败
血也，但寒热无他证者，阴阳不和也。增损四物汤不一，皆随病加减。
〔薛〕产后寒热因气血虚弱或脾胃亏损，乃不足之证。经云∶阴虚则发热，阳虚
则恶寒。若兼大便不通，尤属气血虚弱，切不可用发表降火。若寸口脉微，名阳气不足，
阴气上入于阳中则恶寒，用补中益气汤。尺部脉弱，名阴气不足，阳气下陷于阴中则发
热，用六味地黄丸。大抵阴不足，阳往从之，则阳内陷而发热。阳不足，阴往从之，则阴
上入而恶寒。此阴阳不归其分，以致寒热交争，故恶寒而发热也，当用八珍汤。若病后
四肢发热，或形气倦怠，此元气未复，湿热乘之故耳，宜补中益气汤。若肌热大渴引饮，
目赤面红，此血虚发热，用当归补血汤。若认为实则误矣。一产妇恶寒发热，用十全
大补加炮姜治之而愈。但饮食不甘，肢体倦怠，用补中益气而安。又饮食后犯怒，恶寒
发热，抽搐切牙，难候其脉，视其面色青中隐黄，欲按其腹，以手护之，此肝木侮脾土，
饮食停滞而作，用六君加木香，一剂而安。一产妇恶寒发热，余欲用八珍加炮姜治之，其
家知医，以为风寒，用小柴胡汤。余曰∶寒热不时，乃气血虚也。不信，仍服一剂，汗
出不止，谵语不绝，烦热作渴，肢体抽搐。余用十全大补汤二剂益甚，脉洪大，重按如无，
仍以前汤加附子四剂稍缓，数剂而安。
吴茭山治一妇人产后去血过多，食后着恼头疼身痛，寒热如疟，左手弦大，微有寒
邪，右手弦滑不匀，食饮痰火也。二者因虚而得，宜养正祛邪。遂以茯苓补心汤去地黄
加羌活、青皮、葱、枣，三服汗出身凉，其患渐瘥，然后以八物汤调理半月后全愈。
一妇产后恶露未尽，瘀血入络，又感寒邪，身热如疟，即以生料五积散五帖，恶露自下而
寒热除。又一妇产后恶露未尽，因起抹身，寒气客于经络，乍寒乍热，脉紧而弦，以葱
白散二帖安。一少妇初产四日，冷物伤脾胃，但觉身分不快，呕逆，饮食少思，心腹
满闷，时或腹胁刺痛，晨恶寒，晚潮热，夜则恍惚谵语，昼则抽搐，颇类风状，变异多
端，诸医莫测，或作虚风，或云血凝实热，用甘温而行血，以寒凉退实热，如此半月不效。
汪至，见医满座，亦踞缩，诊其脉弦而紧，遂令按之小腹急痛，知瘀血未尽也。思患者大
势恶露已下，未必还有余血，偶因寒凉所伤，瘀血停滞下焦，日久客于经络，所以变生诸
证，须得大调经散倍入琥珀化诸恶血成水，其患方愈。遂合前药服之，五日后行恶水斗许，
臭不可近，患人觉倦，病势渐减，然后以人参养荣汤数十帖，月余如初。
〔云〕产后往来寒热，四物内加小柴胡汤。
〔保〕治日久虚劳，微有寒热，脉沉而数，宜柴胡四物汤。
川芎 当归 芍药 熟地黄（各一钱半） 柴胡（八钱） 人参 黄芩 甘草 半夏（各三钱）
上为末，水煎服。
〔云〕产后往来寒热，脉弦者少阳也，小柴胡加生地黄汤。
柴胡（二两） 黄芩（五钱） 人参（三钱） 半夏（一两半，汤洗） 大枣（三枚）
生地黄 栀子 枳壳（麸炒，各五钱）
上如前煎服。
增损柴胡汤 治产后虚，发寒热，饮食少，腹胀。
柴胡 人参 甘草 半夏 陈皮 川芎 白芍药（各等分为 咀）
上每服三钱，姜五片，枣二枚，水同煎，食后日二服。
增损四物汤（方见本卷腹痛。）
评曰∶乍寒乍热，荣卫不和，难以轻议。若其败血不散，岂止入脾肺二脏邪。大抵一
阴闭一阳即作寒热，阴胜故寒，阳胜故热，只可云败血循经流入，闭诸阴则寒，闭诸阳则
热，血气与卫气解则休，遇再会而复作。大调经散、五积散入醋煎佳。
云岐熟地黄散 治产后蓐劳，皆由体虚气力未壮，劳复所起，四肢烦疼，时发寒热，
不思饮食。
熟地黄 人参 白芍药 白茯苓 白术 续断（各一两） 黄 桂心 五味子 当归
川芎（各七钱半《大全》方有麦门冬七钱半）
上 咀，每服四钱，姜三片，枣一枚，水煎服。一方无桂心、五味、续断，有柴胡、
黄芩、半夏（各七钱半）作散。
黄 丸 治产后蓐劳，寒热进退，头目眩痛，骨节酸疼，气力羸乏。
黄 鳖甲 当归（炒，各一两） 桂心 白芍药 续断 川芎 牛膝 苁蓉 沉香 柏
子仁 枳壳（各七钱半） 五味子 熟地黄（各半两，共为细末）
上炼蜜和丸，梧子大。每服四、五十丸，食后粥饮下。
大调经散 治产后血虚，恶露未消，气为败浊凝滞，荣卫不调，阴阳相乘，憎寒发
热，或自汗，或肿满，皆气血未平之所为也。
大豆（一两半，炒去皮） 茯神（一两） 真琥珀（一钱）
上为细末，浓煎乌豆、紫苏汤调下。
加减乌金散 治产后寒热似疟。
浓朴 柴胡 黄芩 麻黄（各二钱） 陈皮 当归 川芎 桔梗 茯苓（各一钱五分）
桂枝 苍术 白芷 枳壳（各一钱） 羌活 草果 半夏（各二钱） 甘草（九分）
白芍药 熟地黄（各一钱五分）
上锉为散，分作两服，每服用水一盅半，姜三片，葱三茎，煎至一盅，不拘时服。有
汗，多当归、川芎、白芍药、熟地黄。有胀，多浓朴、陈皮。有热，多柴胡、黄芩。有寒，
多苍术、草果、桂枝。有痰，多半夏、桔梗、茯苓。有头痛，多川芎、白芷、羌活。有泻，
去枳壳、甘草不用。（如方用有余血块在腹，作潮热疼痛，加三棱、莪术，多用玄胡索、八角
香。遍身痛，加羌活、独活。寒热往来，加黄芩、柴胡。）
《产宝》疗产后恶寒壮热，一夜三五度，发恶语，口中生疮，时时干呕，困乏闷绝。
人参 独活 白鲜皮 葛根 防风 青竹茹 远志（各一两半） 茯神（二两） 白敛（二两半）
玄参（三两） 竹沥（二升半）
上取银一斤，水一斗五升，煮取七升，下诸药重煮，取三升分温三服。忌鱼、酒、湿
面等。
知母汤 治产后乍寒乍热，通身温壮，胸心烦闷。
知母（三两） 芍药 黄芩（各二两） 桂心 甘草（各一两，以上为 咀）
上水五升，煮取二升半，分三服。一方不用桂心，用生地黄。
[Guo] What is the cause of alternating chills and fever after childbirth? The answer is: Disharmony of Yin and Yang, and failure of blood stasis to dissipate can cause alternating chills and fever. After childbirth, Qi and Blood are deficient and damaged, leading to disharmony of Yin and Yang. When Yin prevails, there is sudden chills; when Yang prevails, there is sudden fever. When Yin and Yang interfere with each other, there is alternation of chills and fever. If it is due to labor injury to the Zang-Fu organs during delivery, causing weak Blood that cannot circulate freely, thus leading to undissipated blood stasis. If blood stasis enters the Lung, there is fever; if it enters the Spleen, there is chills. If physicians mistakenly treat this as malaria (Malaria), it would be erroneous. For disharmony of Yin and Yang, Zengsun Siwu Tang (Modified Four Substances Decoction) is appropriate. For undissipated blood stasis, Duoming Dan (Life-Restoring Pill) is appropriate. Another question: How to distinguish between the two? If there is stabbing pain, it is blood stasis; if there are only chills and fever without other symptoms, it is disharmony of Yin and Yang. There are various modifications of Zengsun Siwu Tang, all adjusted according to the condition.
[Xue] Postpartum chills and fever are caused by deficiency of Qi and Blood or damage to the Spleen and Stomach, belonging to deficiency syndromes. The Classics state: Yin deficiency leads to fever, Yang deficiency leads to aversion to cold. If accompanied by constipation, it especially belongs to deficiency of Qi and Blood. One must absolutely not use diaphoretic (sweating-releasing) or fire-descending (heat-clearing) methods. If the Cun (inch) pulse is faint, it is named insufficient Yang Qi; when Yin Qi enters the Yang aspect, there is aversion to cold, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If the Chi (cubit) pulse is weak, it is named insufficient Yin Qi; when Yang Qi sinks into the Yin aspect, there is fever, use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). Generally, when Yin is insufficient, Yang follows inward, causing Yang to sink internally and resulting in fever. When Yang is insufficient, Yin follows upward, causing Yin to enter upward and resulting in aversion to cold. This is because Yin and Yang do not remain in their proper positions, leading to a struggle between cold and heat, hence both aversion to cold and fever occur; Bazhen Tang (Eight-Treasures Decoction) should be used. If after illness there is heat in the four limbs, or fatigue in form and Qi, this is because Yuan Qi (Original Qi) has not yet recovered, and Damp-Heat takes advantage of the weakness; Buchong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is appropriate. If there is skin heat, excessive thirst with desire to drink, red eyes, and ruddy complexion, this is Blood deficiency fever; Danggui Buxue Tang (Danggui Tonifies the Blood Decoction) is used. Mistaking this for an Excess syndrome would be an error. A postpartum woman with aversion to cold and fever was cured using Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) plus Paojiang (Prepared Ginger). However, with poor appetite and limb fatigue, Buchong Yiqi Tang brought relief. Another case: A postpartum woman became angry after eating, developing aversion to cold, fever, convulsions, and teeth grinding, making pulse diagnosis difficult. Her complexion showed blue hiding yellow. She protected her abdomen when pressed, indicating Liver Wood insulting Spleen Earth, caused by food stagnation. Liujunzi Tang (Six Gentlemen Decoction) plus Muxiang (Aucklandiae Radix) relieved it in one dose. Another postpartum woman had aversion to cold and fever. I intended to use Bazhen Tang plus Paojiang. Her family, knowing medicine, thought it was Wind-Cold and used Xiaochaihu Tang (Minor Bupleurum Decoction). I said: Irregular chills and fever indicate Qi and Blood deficiency. They did not believe me and took one dose. The result was continuous sweating, delirious speech, irritability, thirst, and limb convulsions. I used two doses of Shiquan Dabu Tang, but the condition worsened. The pulse was洪大 (Huge and Large), empty on deep pressure. I still used the previous decoction plus Fuzi (Aconiti Lateralis Radix Praeparata) for four doses, which slightly alleviated it, and after several doses, she stabilized.
Wu Jiaoshan treated a woman who lost too much blood after childbirth. After eating and becoming angry, she had headache and body pain, with chills and fever resembling malaria. The Left hand pulse was Xian Da (Wiry and Large), indicating slight Cold pathogen. The Right hand pulse was Xian Hua Bu Jun (Wiry, Slippery, and irregular), indicating food retention, phlegm, and Fire. Both conditions arose from deficiency; thus, nourishing righteousness (Zheng Qi) and dispelling evil pathogens was indicated. He used Fuling Buxin Tang (Poria Nourishing the Heart Decoction), removing Dihuang and adding Qianghuo (Notopterygii Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Congbai (Scallion White), and Zao (Jujube). After three doses, she sweated and her body cooled, and the illness gradually improved. Then, Bayi Tang (Eight Substances Decoction) was used for regulation for half a month until full recovery.
A postpartum woman had incomplete lochia discharge, with blood stasis entering the collaterals, compounded by Cold pathogen invasion. She had fever resembling malaria. Immediately, Shengliao Wuji San (Raw Material Five Accumulations Powder) was given for five doses. The lochia discharged naturally, and the chills and fever resolved. Another postpartum woman had incomplete lochia. Because she got up to wipe herself, Cold pathogen lodged in the meridians, causing alternating chills and fever. The pulse was Jin Xian (Tight and Wiry). Congbai San (Scallion White Powder) for two doses brought relief.
A young woman, four days after first delivery, ingested cold substances damaging the Spleen and Stomach. She felt general discomfort, retching, poor appetite, chest and abdominal fullness, occasional stabbing pain in the abdomen and hypochondrium. Morning chills, evening tidal fever, night-time confusion and delirium, daytime convulsions. It resembled wind patterns with varied manifestations, baffling many physicians. Some called it Deficiency Wind, others Blood coagulation with Excess Heat. Warm-natured blood-moving herbs and cold-natured heat-clearing herbs were used for half a month without effect. When Wang arrived, seeing many doctors, he also squatted. The pulse was Xian Jin (Wiry and Tight). Pressing the lower abdomen revealed acute pain, indicating incomplete blood stasis. Considering the main flow of lochia had passed, residual blood might be minimal, but accidental Cold injury caused blood stasis to stagnate in the Lower Jiao. Over time, it lodged in the meridians, generating various symptoms. It required Datiaojing San (Great Regulation of Menstruation Powder) with doubled Hupo (Amber) to transform the bad blood into water for cure. The combined medicine was taken. After five days, about a dou of foul-smelling dark fluid was discharged. The patient felt tired, and the disease trend decreased. Then, Ren Shen Yang Rong Tang (Ginseng Nourishing the Spirit Decoction) was taken for dozens of doses. Within a month, she returned to normal.
[Yun] For postpartum alternating chills and fever, add Xiaochaihu Tang (Minor Bupleurum Decoction) to Siwu Tang (Four Substances Decoction).
[Bao] For chronic deficiency consumption with slight chills and fever, and a Chen Shuo (Deep and Rapid) pulse, Chaihu Siwu Tang (Bupleurum Four Substances Decoction) is appropriate.
Chuanxiong, Danggui, Shaoyao, Shudihuang (each 1.5 qian), Chaihu (8 qian), Renshen, Huangqin, Gancao, Banxia (each 3 qian).
Grind into powder, decoct in water and take orally.
[Yun] For postpartum alternating chills and fever, if the pulse is Xian (Wiry), it is Shaoyang (Lesser Yang) disease. Use Xiaochaihu Tang plus Shengdihuang (Minor Bupleurum Decoction plus Rehmannia).
Chaihu (2 liang), Huangqin (5 qian), Renshen (3 qian), Banxia (1.5 liang, washed with boiling water), Dazao (3 pieces), Shengdihuang, Zhizi, Zhike (bran-fried, each 5 qian).
Decoct as previously described and take orally.
Zengsun Chaihu Tang: Treats postpartum deficiency, chills and fever, poor diet, abdominal distension.
Chaihu, Renshen, Gancao, Banxia, Chenpi, Chuanxiong, Baishyaoyao (equal parts, cut into coarse pieces).
Take 3 qian per dose, with 5 slices of ginger and 2 jujubes, decoct in water. Take twice daily after meals.
Zengsun Siwu Tang (Formula see Abdominal Pain in this volume.)
Commentary: Sudden chills and fever indicate disharmony of Ying (Nutrient) and Wei (Defensive) Qi, making it difficult to discuss lightly. If it is undissipated blood stasis, how could it only affect the Spleen and Lung? Generally, when one Yin closes one Yang, chills and fever occur. Yin prevalence causes chills, Yang prevalence causes fever. It can only be said that blood stasis flows along the meridians, closing the Yin aspects causes chills, closing the Yang aspects causes fever. When Qi and Blood harmonize with Wei Qi, it stops; upon re-meeting, it recurs. Datiaojing San and Wuji San are best decocted with vinegar.
Yunqi Shudihuang San: Treats postpartum Rudao (Childbed Fever/Consumption), all arising from weak constitution and unstrong Qi, caused by relapse due to overexertion. Symptoms include vexing pain in four limbs, intermittent chills and fever, and loss of appetite.
Shudihuang, Renshen, Baishyaoyao, Baifuling, Baizhu, Xuduan (each 1 liang), Huangqi, Guixin, Wuweizi, Danggui, Chuanxiong (each 7.5 qian; *Daquan* formula has Maidong 7.5 qian).
Cut into coarse pieces. Take 4 qian per dose, with 3 slices of ginger and 1 jujube, decoct in water. One variation excludes Guixin, Wuweizi, Xuduan, and includes Chaihu, Huangqin, Banxia (each 7.5 qian) as powder.
Huangqi Wan: Treats postpartum Rudao, alternating chills and fever, dizziness and headache, soreness and pain in bone joints, and physical weakness.
Huangqi, Biejia, Danggui (fried, each 1 liang), Guixin, Baishyaoyao, Xuduan, Chuanxiong, Niuxi, Rongrong, Chenxiang, Baiziren, Zhike (each 7.5 qian), Wuweizi, Shudihuang (each 0.5 liang, ground into fine powder).
Mix with refined honey and make pills the size of wutong seeds. Take 40-50 pills per dose, swallowed with porridge drink after meals.
Datiaojing San: Treats postpartum Blood deficiency, uneliminated lochia, Qi stagnation due to turbid waste, disharmony of Ying and Wei, mutual interference of Yin and Yang, aversion to cold and fever, spontaneous sweating, or swelling and fullness. All are due to unbalanced Qi and Blood.
Dadou (1.5 liang, fried and peeled), Fushen (1 liang), Zhenhupo (1 qian).
Grind into fine powder. Mix with strong decoction of black soybean and Zisu (Perilla Leaf) tea and take orally.
Jiajian Wujin San: Treats postpartum chills and fever resembling malaria.
Houpo, Chaihu, Huangqin, Mahuang (each 2 qian), Chenpi, Danggui, Chuanxiong, Jiegeng, Fuling (each 1.5 qian), Guizhi, Cangzhu, Baizhi, Zhike (each 1 qian), Qianghuo, Caoguo, Banxia (each 2 qian), Gancao (0.9 fen), Baishyaoyao, Shudihuang (each 1.5 qian).
Cut into powder, divide into two doses. Each dose uses 1.5 zhong of water, 3 slices of ginger, 3 stalks of scallion, decoct to 1 zhong. Take at any time. If sweating, increase Danggui, Chuanxiong, Baishyaoyao, Shudihuang. If distension, increase Houpo, Chenpi. If heat, increase Chaihu, Huangqin. If cold, increase Cangzhu, Caoguo, Guizhi. If phlegm, increase Banxia, Jiegeng, Fuling. If headache, increase Chuanxiong, Baizhi, Qianghuo. If diarrhea, remove Zhike and Gancao. (If there are residual blood masses in the abdomen causing tidal fever and pain, add Sanleng, Ezhu, and more Xiyansuo, Bajiaoxiang. For whole-body pain, add Qianghuo, Duhuo. For alternating chills and fever, add Huangqin, Chaihu.)
*Chanbao* treats postpartum severe aversion to cold and high fever, occurring 3-5 times a night, with foul speech, mouth sores, frequent dry heaving, exhaustion and suffocation.
Renshen, Duhuo, Baixianpi, Gegen, Fangfeng, Qingzhuru, Yuanzhi (each 1.5 liang), Fushen (2 liang), Bailian (2.5 liang), Xuanshen (3 liang), Zhuli (2.5 sheng).
Take 1 jin of silver, 1.5 dou of water, boil to 7 sheng. Add all medicines and boil again to 3 sheng. Divide into three warm doses. Avoid fish, alcohol, and wet noodles.
Zhimu Tang: Treats postpartum sudden chills and fever, generalized warmth and heat, chest and heart vexation and stuffiness.
Zhimu (3 liang), Shaoyao, Huangqin (each 2 liang), Guixin, Gancao (each 1 liang, above cut into coarse pieces).
Use 5 sheng of water, boil to 2.5 sheng. Divide into three doses. One variation excludes Guixin and uses Shengdihuang.