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Xue said: Postpartum deficiency vexation and fever occur when Yang follows the dispersion of Yin, resulting in both Qi and Blood deficiency. If accompanied by aversion to cold and fever, restlessness, and thirst, Shiquan Dabu Tang (Ten Great Tonifying Decoction) should be used urgently. If the heat intensifies, Rougui (Cinnamon Twig) and Fuzi (Aconite Lateral Root Preparated) should be added urgently. If characterized by thirst and a red face, Danggui Buxue Tang (Dong Quai Decoction for Tonifying Blood) is appropriate. Mistaking this for a Fire syndrome and administering cooling agents will bring disaster instantly.

Wang Taipu stated: If the body feels extreme cold that cannot be warmed even with heating, it indicates a lack of Fire (Mingmen Fire Deficiency), and the Heart should be treated. If heat comes and goes, appearing during the day and latent at night, or occurring at irregular intervals, this also indicates a lack of Fire, and the Heart should be treated. If the body feels extreme heat that cannot be cooled even with cold applications, it indicates a lack of Water (Kidney Yin Deficiency), and the Kidneys should be assisted. If heat flares up and subsides intermittently, coming and going suddenly, this also indicates a lack of Water, and the Kidneys should be assisted. Therefore, excessive Heart Fire generates heat, while excessive Kidney Water generates cold; Kidney Qi deficiency causes cold to move internally, and Heart Qi deficiency causes heat to collect internally. Furthermore, if heat cannot overcome cold, it is a lack of Fire; if cold cannot overcome heat, it is a lack of Water. Treatment methods: For lack of Water, use Liuwei Wan (Six-Ingredient Pill with Rehmannia); for lack of Fire, use Bawei Wan (Eight-Ingredient Pill with Rehmannia); for simultaneous Qi and Blood deficiency, use Bazhen Tang (Eight-Treasure Decoction) or Shiquan Dabu Tang.

The wife of Yu, a Grand Administrator, suffered from postpartum fever with worsening heat in the late afternoon, hematemesis, hematochezia, night sweats, frequent urination, distending pain in the chest and hypochondrium, and abdominal fullness. I said: This is due to deficiency and damage of the Five Zang organs; treatment should prioritize consolidating the root. Relying on her medical knowledge, she used fire-descending agents, which worsened her condition, leading to dysentery, borborygmus, vomiting, anorexia, abdominal pain, and cold feet. Only then did she believe my words. Her pulse was sometimes floating and surging, sometimes deep and fine, and sometimes imperceptible. Her complexion was sometimes greenish-yellow, sometimes red and white, indicating signs of deficiency-cold with false-heat. It was midsummer, so we should disregard the season and treat according to the syndrome. We first administered Liujunzi Tang (Six-Gentlemen Decoction) with Paojiang (Prepared Ginger) and Rougui (Cinnamon Twig) for several doses. As Stomach Qi gradually recovered (the brilliance lies in prioritizing Stomach Qi), symptoms subsided. Subsequently, Shiquan Dabu Tang was added, and she recovered after half a year.

The wife of Yang Jingzhi, a scholar, suffered from the same condition but with salivation of phlegm-saliva. Previous treatments with warming and tonifying phlegm-resolving agents failed. Her complexion was dark, and the radial pulses at both cun positions were floating and large but fine upon deep pressure. This was due to Mingmen Fire deficiency failing to generate Spleen Earth, and Spleen Earth failing to nourish the other Zang organs. She recovered using Bawei Wan (Eight-Ingredient Pill with Rehmannia) to tonify the mother of Spleen Earth (Kidney).

A woman experienced body heat three days postpartum after rising early, when Qi and Blood were not yet stabilized. She felt heat and her vision was dim as if affected by wind. Two doses of Qinghun San (Clear Soul Powder), a wind-dispersing tonic, induced slight sweating, and she recovered. Hua Borin treated a parturient with retained lochia, umbilical and abdominal pain, headache, and alternating chills and fever. Others attributed this to cold invasion and treated with warming agents like Jiang (Ginger) and Fu (Aconite), which exacerbated the heat, causing convulsions, delirium, upward staring of the eyes, wiry and rapid pulse, red face, closed eyes, indistinct muttering, black dry tongue without moisture, and tenderness upon palpation of the chest and abdomen. This was caused by drying agents binding the blood, generating internal heat and wind, with blood stasis causing pain. He said: This is postpartum heat entering the Blood Chamber, generating wind. First, cooling and fire-descending, wind-treating, and blood-cooling agents were given twice with good effect. Then, Hupo (Amber) and Niuhuang (Calculus Bovis) were used to slightly resolve the mental confusion. Finally, Zhang Congzheng's Sanhe San (Three-Harmony Powder) was used to move blood and break stasis. After three or four doses, lochia flowed heavily as before. Ten days postpartum, all symptoms resolved. (This shows that although there was an external contraction, knowing that internal heat generated wind, one should only treat the heat, not the wind, seeking the root rather than the branch. Using Sanhe San or Tao Ren Cheng Qi Tang would both be excellent. Sanhe San contains Dahuang/Rhubarb.)

A woman delivered in midsummer and developed fever three days later. Her pulse was deficient, rapid, and large. Retained lochia led to "败血" (damaged blood) attacking the Heart, causing delirium, shouting, running, and inability to restrain her. A decoction of dried lotus leaf, Shengdihuang (Rehmannia Root), and Mudanpi (Tree Peony Bark) was concentrated and mixed with 2 qian of ShengPuhuang (Raw Polygoni Cuspidati Pollen). This is a damaged-blood resolving agent; Dahuang was omitted because the pulse was deficient and large. One dose settled the condition, lochia discharged, and she became calm.

A woman experienced recurrent fainting and dizziness postpartum, with body heat, profuse sweating, vertigo, thirst, occasional headache, and nausea. The physician used Siwu Tang (Four-Substance Decoction) for blood cooling without improvement, then Xiao Chaihu Tang (Minor Bupleurum Decoction), which worsened the condition. When Shishan arrived, the pulse was floating, surging, and beating against the finger. Wang Ji said: Obtaining such a pulse postpartum with profuse sweating, where the pulse does not weaken with sweating, indicates a hopeless prognosis, fortunately without panting or diarrhea. Such a pulse suggests stimulation by cooling medicines. Ren Shen (Ginseng Radix) 3 qian, Huangqi (Astragalus Root) 2 qian, Gancao (Licorice Root) and Danggui (Angelica Sinensis) 6 fen each, Baizhu (Atractylodes Macrocephala Rhizome) and Maidong (Ophiopogon Tuber) 1 qian each, Ganjiang (Zingiberis Rhizoma) and Chenpi (Citrus Reticulata Pericarpium) and Huangqin (Scutellariae Radix) 5 fen each were decocted and taken for five doses. The pulse converged, and the illness gradually stabilized. (Recognizing from the pulse that cooling medicines caused Yin excess repelling Yang, and using Ren Shen, Huangqi, Ganjiang, and Baizhu for a strong, beating pulse implies a lack of Yang to harmonize it. In some cases, Fuzi might be used, which must be known.)

The wife of Wang Qianxian developed fever, vomiting, nausea, thirst for cold water and fruits, delirium resembling mania, and anorexia postpartum after bathing. Her constitution was robust and resistant to tonification. Physicians used cooling agents, increasing the heat. The six pulses were floating, large, surging, and rapid. Wang Ji said: Postpartum sudden loss of Qi and Blood leads to floating solitary Yang, true cold inside and false heat outside. Great tonification of Qi and Blood is needed. (Mr. Shishan advocates substantial dietary habits and is experienced in medicine; his words are reliable. However, beginners find it difficult to apply, especially for robust individuals resistant to tonification. One must be bold yet cautious to succeed; otherwise, do not act rashly.) Eightzhen Tang (Eight-Treasure Decoction) with 8 fen of Paojiang (Prepared Ginger) reduced the heat by more than half. The patient believed she was unsuited for Ren Shen and Huangqi and refused further doses. The next day, high fever returned. The previous formula was repeated with increased Ren Shen, Huangqi, and Paojiang. After two or three doses, the heat receded, and she recovered. (How satisfying!)

Danxi said: For postpartum fever, use Ren Shen, Baizhu, Huangqi, Chenpi, Danggui, Chuanxiong, and Zhigancao (Honey-fried Licorice Root) to tonify deficiency. For mild cases, add Fuling (Poria) for mild diuresis, and the heat will clear. For severe cases, add Ganjiang (Dried Ginger). (Ancients often used Ganjiang in blood syndromes, while moderns mostly use Paojiang. Which is correct? Ganjiang enters the Lung, Shengjiang (Fresh Ginger) enters the Liver, and Paojiang warms the Spleen and middle Jiao, differing in their staying, moving, and following properties. If using Paojiang, it must be fried until very black for best effect.) Some ask: Why use Ganjiang for great heat? Answer: This heat is not excess pathogenic heat but internal heat generated by Yin deficiency. Ganjiang enters the Lung to benefit Lung Qi and the Liver to guide other herbs to generate blood. It cannot be used alone but must be combined with Yin-nourishing and blood-tonifying herbs. This is the wonder of natural creation; only the most divine can achieve this.

Wang Jiezhai said: Postpartum women have Yin Blood deficiency, leaving Yang unanchored and floating externally, causing frequent fever. Treatment uses Siwu Tang (Four-Substance Decoction) to tonify Yin Blood, combined with Zhi Ganjiang (Honey-fried Dried Ginger) to warm and guide, collecting the floating Yang and anchoring it in Yin. However, postpartum Spleen and Stomach are weak, and fever often results from food stagnation due to overeating. Mistaking this for Blood deficiency renders treatment ineffective (Key Point). When encountering postpartum fever, inquire about diet and potential stagnation. If there is chest/epigastric fullness, belching, aversion to food, or diarrhea, treat as food stagnation. Only if fever occurs with normal appetite should blood-tonifying methods be used.

Danxi Formula for Postpartum Fever:
Danggui, Chuanxiong, Huangqi, Ren Shen, Baizhu, Baifuling (each 1 qian), Zhigancao (0.5 qian).
Decoct and take orally. (This combines Foshou San and Sizijunzi Tang with Huangqi, omitting Shaoyao and Dihuang. Postpartum requires tonifying Qi for blood loss, not astringing or descending, to avoid damaging vital Qi. Suitable for Qi and Blood deficiency or Qi deficiency. Add Ganjiang for severe heat.)

Modified Siwu Tang for Postpartum Yin Deficiency and Blood Weakness Fever:
Danggui, Chuanxiong, Baishao, Shudihuang, Baifuling (each 1 qian).
Decoct and take orally. (This formula uses no Qi-moving herbs, suitable for Blood deficiency without Qi deficiency and good digestion. Adding Fuling allows Heaven Qi to descend, generating Yin, which clears heat. Add fried Ginger for severe heat to guide Yang into Yin and Yin into Yang. Profoundly subtle.) Add fried Ganjiang for severe heat; add Fushen (Poria with Hostwood) and Yuanzhi (Polygalae Radix) for deficiency vexation.

Chouxin San for Postpartum Blood Deficiency Fever:
Danggui, Shudihuang (each 4 qian), Ganjiang (fried black, 2 qian).
Decoct one dose and take orally. (A variation of the previous formula, omitting Chuanxiong and Baishao, suggesting focus on Liver and Kidney.)

Ren Shen San for Postpartum Various Deficiencies, Fever, and Night Sweats:
See previous formula for spontaneous sweating.

Ren Shen Danggui Tang for Postpartum Excessive Blood Loss:
Causes Blood deficiency leading to Yin deficiency and internal heat, resulting in vexation, shortness of breath, spontaneous sweating, and headache.
See previous formula for deficiency vexation. (Uses Ren Shen and Danggui as main Qi and Blood tonics, combined with Shudihuang, Maidong, Rougui, Baishao, Jingmi (Rice), and Zhuyez (Bamboo Leaf). Add Shengdihuang if blood heat is severe.)

Modified Xiaoyao San for Postpartum Fever, Dry Mouth, Thirst, Cracked Lips, and Sores:
Danggui, Baishao, Gegen (Kudzu Root) (each 2 qian), Shengdihuang, Chuanxiong, Huangqin (each 1.5 qian), Chaihu (1 qian), Ren Shen, Maidong (each 0.9 qian), Wumei (Chinese Plum) (2 pieces), Gancao (0.6 qian).
Powdered, divided into two doses. Decoct with one zhong of water to 0.7 zhong, take on an empty stomach. (Differs from original Xiaoyao San and Lizhai's Modified Xiaoyao San. This combines Xiao Chaihu Tang, Siwu Tang, and Shengmai San, removing Banxia and Wuweizi, adding Wumei and Gegen. While original uses Bohe (Mint) as guiding herb, this uses Gegen, each having merits. I often remove Chuanxiong, Gegen, and Bohe, adding Qinghao (Artemisia Annua) and Biejia (Carapax Trionycis) to treat bone-steaming, respecting ancient laws.)

Xijiao Yinzi for Postpartum Fluid Depletion, Deficiency, Spontaneous Sweating, Fever, Fatigue, Dry Lips and Mouth:
(Clears Heart, cools blood, benefits Qi, expands chest, opens stomach, strengthens spleen, a stable orthodox formula.)
Xijiao (Rhinoceros Horn - *Note: Substitute with Niuhuang or Shuiniu Jiaojiao in practice*), Maidong, Baizhu (each 0.5 liang), Chaihu (1 liang), Zhike (Bran-fried Aurantium Fructus), Gubipi (Lycii Cortex), Shengdihuang, Huangqi, Danggui, Ren Shen, Fuling, Huangqi, Huangqin, Zhigancao (each 7 qian).
Chopped, take 4 qian per dose with 3 slices of Shengjiang (Fresh Ginger) and 70 grains of Fumai (Floating Wheat). (Shengjiang induces sweating, Fumai stops sweating; together they nourish Heart internally and harmonize Exterior externally. Decoct with water.)

Sanhe San for Postpartum Long-standing Consumption Fever:
(Combines Siwu Tang, Sizijunzi Tang, and Xiao Chaihu Tang. A balanced formula worthy of emulation.)
Danggui, Chuanxiong, Baishao, Shudihuang, Baizhu, Baifuling, Huangqi (each 1 qian), Ren Shen, Chaihu (each 1.5 qian), Huangqin, Banxia, Gancao (each 0.5 qian).
One dose with 3 slices of Shengjiang and 1 Red Date. Decoct and take before meals.