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On the seventh day postpartum, fever occurs both internally and externally, with various manifestations. Apart from fever caused by food stagnation, which has been discussed in the section on Food Stagnation, there are cases presenting with fever, aversion to cold, and headache resembling Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian), or alternating chills and fever, headache, and hypochondriac pain resembling Shaoyang disease (a syndrome where pathogens reside between the exterior and interior). These conditions arise from deficiency of both Qi and Blood, and disharmony of Yin and Yang, closely mimicking Shanghan (Cold Damage) syndromes. Practitioners must not lightly dismiss the postpartum condition nor adhere to biased treatments, such as using Mahuang Tang (Ephedra Decoction) for symptoms resembling Taiyang syndrome, or Chaihu Tang (Bupleurum Decoction) for those resembling Shaoyang syndrome. Since postpartum blood volume is significantly depleted, inducing sweating may lead to severe Yang collapse (profound deficiency of Yang Qi) or mild muscle twitching and tremors, Yu Mao coma (dizziness and fainting due to fluid loss), convulsions, constipation, and numerous other complications. Zhang Zhongjing previously stated: "Those who have lost blood should not be induced to sweat." Zhu Danxi stated: "Postpartum patients must absolutely not be treated with diaphoretic (sweat-inducing) methods." These two masters did not deny that postpartum patients can suffer from Cold Damage, nor did they claim that Chaihu Tang or Mahuang Tang are inappropriate for specific indications; rather, they feared that later practitioners would rigidly apply biased methods, neglecting the delicate postpartum state and blindly using established formulas to induce sweating. Although it is known that external pathogens are involved, the Chuanxiong and Shengjiang (Dried Ginger) within Shenghua Tang (Mother-Reviving Decoction) can also disperse them. Alternatively, Xinsan Shenghua Tang (Dispersing Wind and Reviving Mother Decoction) can be used. Why use strong diaphoretics to violate the prohibition against sweating?

Fever resulting from excessive exertion during delivery, excessive blood loss, sluggish lochia discharge, breast engorgement around the third day, or early rising and labor, is mostly due to Blood deficiency causing Yang to lack a foundation, floating outward and manifesting as heat. Simply administering two or three doses of Shenghua Tang (Mother-Reviving Decoction) removes stasis and generates new blood, allowing Yang to grow with Yin, thereby resolving all fevers. *Zunsheng* adopts Zhu Danxi’s method, using Sijunzi Tang (Four Gentlemen Decoction) augmented with Chuanxiong, Danggui, Huangqi, and Paojiang (Prepared Ginger) to treat postpartum fever, embodying the principle of using sweet-warm herbs to eliminate high fever. It further states: For severe heat, flushed face, and intense thirst with a flooding yet empty pulse, equal parts of Huangqi and Danggui should be decocted and taken. This imitates Danggui Buxue Tang (Angelica Sinensis and Astragalus Decoction). Feng Shi uses Siwu Tang (Four Substances Decoction) as the base, removing Chuanxiong, replacing Shengdi (Rehmannia Root) with Shudi (Prepared Rehmannia Root), and adding Ruanmiao Chaihu (Soft-stemmed Bupleurum), Renshen (Ginseng), and Paojiang. This is highly effective for heat, taking advantage of Paojiang to consolidate scattered heat and the yin-astringent property of Baishao (White Peony Root). I suggest distinguishing based on the presence of uterine cramping pain (Kutong). If cramping pain persists within seven days or immediately after delivery, Shenghua Tang is optimal, while Renshen, Huangqi, Chaihu, Baizhu, Shudi, and Baishao should be used cautiously. If there is no cramping pain and considerable time has passed since delivery, the formulas from *Zunsheng* and Feng Shi align well with classical principles. Yangkui stated: If the patient had Yin deficiency with fire hyperactivity before pregnancy, excessive blood loss postpartum will inevitably cause severe heat, restlessness, and sweating. In such cases, massive tonification of Qi and Blood will exacerbate symptoms. Xiaoyao San (Free and Easy Wanderer Powder) should be used to clear Liver Fire and nourish Liver Blood. Due to significant blood loss leading to Liver deficiency and dryness, one must not rigidly treat only for Qi and Blood deficiency. I believe this argument is based on Liver deficiency with fire, and diagnosis should rely on detailed pulse examination. Xue Lizhai further stated: In newly delivered women, sudden loss of Yin Blood leaves Yang unanchored, causing external heat. Siwu Tang (Four Substances Decoction) with Paojiang is suitable to nourish Yin and harmonize Yang. If external heat results from the erroneous use of cold/clearing and draining agents, this indicates Cold rejecting Yang to the exterior; Sijunzi Tang (Four Gentlemen Decoction) with Shengjiang and Rougui (Cinnamon Bark) is indicated. If ineffective, Fuzi (Aconite Root) should be added urgently. If skin feels hot, face is flushed, and there is intense thirst with desire to drink, this is Blood depletion causing dryness; Danggui Buxue Tang (Angelica Sinensis and Astragalus Decoction) is appropriate. He also noted: Postpartum deficiency vexation and fever occur because Yang dissipates with Yin, leaving both Qi and Blood deficient, resulting in aversion to cold and fever. Mistaking this for a Fire syndrome and administering cold herbs, or mistaking it for an Exterior syndrome and using mild diaphoretics, leads to disaster instantly. I consider Xue Lizhai’s discussion and treatment methods to grasp the essentials of postpartum care. However, regarding Siwu Tang with Paojiang, replacing it with Shenghua Tang would be more comprehensive.

Xinsan Shenghua Tang (Dispersing Wind and Reviving Mother Decoction) [Appendix: Xinsan Tang]: Treats postpartum exposure to Wind-Cold, presenting with aversion to cold, fever, and headache.
Chuanxiong (1.5 qian), Danggui (3 qian), Zhi Gancao (Honey-fried Licorice Root), Ganjiang (Roasted Black Dried Ginger), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root) (each 0.4 qian), Taoren (Peach Kernel, 10 grains, peeled and slit). Decoct in water and take orally. If headache and body heat persist, add Baizhi (Angelica Dahurica Root) 0.8 qian and Xixin (Asarum Root) 0.3 qian. If headache is severe ("like breaking"), add five roots of Lianxu Congtou (Scallion bulb with roots). For deficiency, add Renshen (Ginseng Root) 2–3 qian.
Another formula uses Shenghua Tang, adding Baizhi 0.8 qian, Qianghuo and Xixin each 0.4 qian, and five scallion bulbs, omitting Fangfeng, for general treatment. Add Renshen for deficiency; this is named Xinsan Tang (Dispersing Wind Decoction).
I suggest using Shenghua Tang within the first seven days postpartum, and this formula thereafter.

Danggui Buxue Tang (Angelica Sinensis and Astragalus Decoction): Treats night-time fever due to Blood deficiency, accompanied by vexation, thirst with desire to drink, and a flooding yet empty pulse that vanishes upon heavy pressure.
Huangqi (6 qian, honey-wine fried), Danggui Shen (Body of Angelica Root) (2 qian). Decoct in water and take orally.

Shenghua Tang (See discussion at the end of this volume). Sijunzi Tang (Four Gentlemen Decoction). Xiaoyao San (Free and Easy Wanderer Powder) (Both seen in Volume 1, Section on Fetal Rebellious Qi Pressing Upward). Siwu Tang (Four Substances Decoction) (Seen in Volume 1, Section on Fetal Protection).