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Postpartum fever may arise from external contraction of wind-cold, internal excess of pathogenic fire, deficiency of yin due to fluid depletion, fatigue and mental restlessness after childbirth, or excessive blood loss leading to dizziness, oppression, and irritability. These syndromes differ, and treatment must be based on differentiation and observation.

First, postpartum fever due to external contraction: During delivery, the body is often exposed and exertion is required, leaving little time for protection. At this time, if cold pathogens are encountered, they easily enter through the deficiency, making infection most likely. If headache, body ache, aversion to cold with fever, or stiffness and tension in the waist and back are observed, along with a tight or rapid pulse, it is a case of postpartum external contraction. However, such external contractions occur immediately upon exposure and differ from true Shanghan (Cold Damage) where pathogens lie dormant before manifesting. Therefore, slight dispersal of the exterior will lead to recovery. One should not assume that exterior-releasing methods are contraindicated after recent childbirth; rather, one must assess deficiency and excess to apply appropriate treatment. For postpartum patients contracting pathogens without significant Qi deficiency, San Chaihu Yin (Three Bupleurum Decoction) is suitable. For those with Qi deficiency and weak Spleen contracting pathogens, Si Chaihu Yin (Four Bupleurum Decoction) or Wu Chaihu Yin (Five Bupleurum Decoction) are suitable. For those with insufficiency of the Liver, Spleen, and Kidney Yin contracting pathogens, Buyin Yiqi Jian (Yin-Nourishing and Qi-Replenishing Decoction) is suitable. For severe deficiency-cold, Liyin Jian (Nourishing Yin Decoction) is suitable. For robust postpartum women with excess Qi contracting pathogens, Zheng Chaihu Yin (Standard Bupleurum Decoction) is suitable. For cases with internal fire excess and unresolved exterior pathogens, Yi Chaihu Yin (One Bupleurum Decoction) is suitable. For simultaneous contraction of wind and cold with stagnation in both interior and exterior, Wuji San (Five Accumulations Powder) is suitable.

Second, postpartum fever due to Fire syndrome: Exterior heat from external contraction usually resides at the surface, whereas heat from Fire syndrome resides internally. This is invariably caused by excessive care or environmental factors: extreme seasonal heat, forced alcohol consumption, erroneous use of strongly tonifying herbs like Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), or Rougui (Cinnamomi Cortex); excessive use of charcoal fires; overly sealed windows and doors causing stagnant air; or excessive physical activity in individuals with originally robust constitutions. Any excess can generate fire. Internal fire excess typically presents as tidal fever (fever that occurs at specific times or worsens periodically) and internal heat, irritability, thirst preferring cold drinks, headache with profuse sweating, dry stools, dark urine, and reckless bleeding due to blood-heat, provided there are no exterior signs and the pulse is slow, slippery, not tight, yet accompanied by fever. This indicates Fire syndrome, treated with Qinghua Yin (Clearing Transforming Decoction) or Baoyin Jian (Preserving Yin Decoction). If the root vitality is not deficient, or if the fire is intense and the condition acute, Xixin Yin (Removing Firewood Decoction) or Chouxin Yin (Drawing Out Firewood Decoction) are commonly used without hesitation.

Third, postpartum fever due to Yin deficiency: This necessarily stems from constitutional insufficiency of the Spleen and Kidneys, compounded by postpartum deficiency of both Qi and Blood. Symptoms include alternating sensations, intermittent onset, occurring day or night irregularly, mental fatigue, palpitations, and mental confusion. Provided there are no exterior signs, but the pulse is wiry and rapid, or floating, wiry, and large/hollow, or faint, thin, and forceless, and the onset is gradual rather than sudden, this is a sign of Yin deficiency. Treatment should focus exclusively on nourishing True Yin, using Xiaoying Jian (Minor Camp Decoction), Sanyin Jian (Three Yin Decoction), or Wuyin Jian (Five Yin Decoction) as appropriate. If Yin deficiency is accompanied by mild fire, Yiyin Jian (One Yin Decoction) is suitable. If Yin deficiency is accompanied by severe fire and high fever, Jiajian Yiyin Jian (Modified One Yin Decoction) is suitable. If Yin deficiency with fire excess causes fever and profuse sweating, Danggui Liu Huang Tang (Angelica Hexapartite Decoction) is suitable. If Yang within Yin is deficient, causing fire to fail to return to its source (floating fire) and resulting in fever, Daying Jian (Major Camp Decoction), Liyin Jian (Nourishing Yin Decoction), or Yougui Yin (Right Restoration Decoction) are suitable. If Blood deficiency leads to Yang failing to attach to Yin, causing irritability, heat, and thirst, Renshen Danggui Tang (Ginseng and Angelica Decoction) is suitable. If both Qi and Blood are deficient, causing fever, irritability, red face, and thirst, Bazhen Tang (Eight Treasures Decoction) or Shiquan Dabu Tang (Ten Complete Tonification Decoction) are suitable. If the heat is severe but the pulse is faint, Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Lateral Root) should be added urgently; misidentifying this as fire will lead to disaster in an instant.

Fourth, postpartum fever due to excessive blood loss: Symptoms must include irritability, thirst, shortness of breath, headache, dizziness, oppression, and internal heat. This also belongs to Yin deficiency, treated with Renshen Danggui Tang (Ginseng and Angelica Decoction).

Xue Lizhai stated: Generally, fever arising from weak Yuan Qi (Primal Qi) is characterized by true cold inside and false heat outside. Using Liujunzi Tang (Six Gentlemen Decoction) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Paojiang (Roasted Ginger) to warm and tonify Spleen Qi will cause symptoms to recede. If limbs are cold, add Fuzi (Prepared Aconite Lateral Root) urgently. In new mothers where Yin blood is suddenly injured and Yang has no attachment, causing external heat, Siwu Tang (Four Substances Decoction) and Paojiang (Roasted Ginger) should be used to nourish Yin and harmonize Yang. If external heat results from erroneously taking cold and purgative agents, this is cold rejecting Yang to the exterior; use Sijunzi Tang (Four Gentlemen Decoction) with Shengjiang (Fresh Ginger) and Rougui (Cinnamon Bark); if ineffective, add Fuzi (Prepared Aconite Lateral Root) urgently. If skin feels hot, face and eyes are red, and there is irritability, thirst, and desire to drink, this is agitation due to blood loss and hair follicle exhaustion; use Danggui Buxue Tang (Angelica Tonifying Blood Decoction).