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[Guo] What is the cause of alternating chills and fever after childbirth? The answer is: Disharmony of Yin and Yang, and failure of stagnant blood (stasis) to dissipate can cause alternating chills and fever. After childbirth, Qi and Blood are deficient, leading to disharmony of Yin and Yang. When Yin prevails, there is sudden cold; when Yang prevails, there is sudden heat; when Yin and Yang contend, there is alternating cold and heat. If this is due to labor damaging the Zang-Fu organs, causing Qi and Blood to be weak and unable to circulate freely, resulting in stagnant blood failing to dissipate: if the stagnant blood enters the Lung, it causes heat; if it enters the Spleen, it causes cold. If physicians mistakenly treat this as malaria, they will be erroneous. For disharmony of Yin and Yang, Zengsun Siwu Tang (Modified Four Substances Decoction) is appropriate. For stagnant blood failing to dissipate, Duoming Dan (Life-Restoring Pill) is appropriate. Another question arises: How to distinguish between the two? Answer: Cases accompanied by stabbing pain are due to stagnant blood; cases with only chills and fever without other symptoms are due to disharmony of Yin and Yang. Zengsun Siwu Tang has various modifications, all adjusted according to the specific condition.

[Xue] Postpartum chills and fever result from deficiency of Qi and Blood or damage to the Spleen and Stomach, representing a deficiency syndrome. The Classics state: Yin deficiency leads to fever, while Yang deficiency leads to aversion to cold. If accompanied by constipation, it particularly belongs to Qi and Blood deficiency. One must absolutely avoid using diaphoretic (surface-releasing) or fire-descending (heat-clearing) methods. If the Cun (inch) pulse is faint, it indicates insufficiency of Yang Qi; when Yin Qi invades the Yang aspect, there is aversion to cold, treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If the Chi (cubit) pulse is weak, it indicates insufficiency of Yin Qi; when Yang Qi sinks into the Yin aspect, there is fever, treated with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). Generally, when Yin is insufficient, Yang follows it, causing Yang to sink internally and produce fever. When Yang is insufficient, Yin follows it, causing Yin to ascend and produce aversion to cold. This is because Yin and Yang fail to remain in their proper positions, leading to contention between cold and heat, resulting in both aversion to cold and fever; Bazhen Tang (Eight-Treasure Decoction) should be used. If there is heat in the four limbs after illness, or fatigue in form and Qi, this is due to Yuan Qi (Original Qi) not yet recovering, allowing damp-heat to invade; Buzhong Yiqi Tang is appropriate. If there is surface heat, excessive thirst with desire to drink, red eyes, and ruddy complexion, this is fever due to Blood deficiency; Danggui Buxue Tang (Angelica Tonifying Blood Decoction) should be used. Mistaking this for an excess syndrome would be an error. A postpartum patient 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, she was stabilized using Buzhong Yiqi Tang. Another postpartum patient, after eating and becoming angry, experienced aversion to cold, fever, convulsions, and teeth grinding, making pulse diagnosis difficult. Her complexion showed blue hiding yellow. She guarded her abdomen against palpation. This indicated Liver Wood insulting Spleen Earth, caused by food stagnation. Liujunzi Tang (Six Gentlemen Decoction) plus Muxiang (Aucklandia Root) relieved her in one dose. Another postpartum patient had aversion to cold and fever. I intended to use Bazhen Tang plus Paojiang, but her family, knowing medicine, believed it was Wind-Cold and administered Xiaochaihu Tang (Minor Bupleurum Decoction). I stated that irregular chills and fever indicate Qi and Blood deficiency. They did not believe me and took one dose. Consequently, she had incessant sweating, delirious speech, irritability, heat, thirst, and limb convulsions. I then used Shiquan Dabu Tang for two doses, but the condition worsened. The pulse was large and flooding, but empty upon heavy pressure. I continued with the previous decoction plus Fuzi (Aconite Root) for four doses, which slightly alleviated the condition, and after several doses, she stabilized.

Wu Jiaoshan treated a woman who had lost excessive blood after childbirth. After eating and becoming annoyed, she suffered headache and body pain, with chills and fever resembling malaria. The left hand pulse was wiry and large, indicating slight Cold pathogen; the right hand pulse was wiry, slippery, and uneven, indicating food retention, phlegm, and Fire. Both conditions arose from deficiency, so the treatment should nourish righteousness and expel pathogens. He prescribed FulingBXixin Tang (Poria Nourishing Heart Decoction) minus Shudihuang (Prepared Rehmannia), adding Qianghuo (Notopterygium Rhizome), Qingpi (Green Tangerina Peel), Congbai (Scallion White), and Zao (Jujube). After three doses, she sweated and her body cooled, and the illness gradually improved. Then, Bayi Tang (Eight Ingredients Decoction) was used for regulation for half a month until full recovery.

Another postpartum patient had incomplete lochia discharge, with stasis entering the collaterals, compounded by Cold pathogen invasion. She had fever resembling malaria. Shengliao Wuji San (Raw Material Five Accumulations Powder) was given for five doses. Lochia discharged naturally, and chills/fever ceased. Another postpartum patient had incomplete lochia. Because she rose to wipe herself, Cold pathogen invaded the meridians, causing alternating chills and fever. The pulse was tight and wiry. Congbai San (Scallion White Powder) for two doses brought relief.

A young woman, four days postpartum, injured her Spleen and Stomach with cold foods. She felt general discomfort, retching, reduced appetite, chest and abdominal fullness, occasional stabbing pain in the abdomen and hypochondrium. Morning chills, evening tidal fever, night-time delirium, daytime convulsions. It resembled wind patterns with varied manifestations, baffling many physicians. Some considered it Deficient Wind, others Blood stasis with Excess Heat. Warm-natured blood-invigorating herbs and cool-natured heat-clearing herbs were used for half a month without effect. Wang Zhi arrived, saw many doctors present, and also squatted aside. He diagnosed a wiry and tight pulse. Pressing the lower abdomen revealed acute pain, indicating incomplete stasis. Although most lochia had passed, he reasoned that accidental injury by cold foods caused stasis to stagnate in the Lower Jiao, lingering in the meridians over time, thus generating various symptoms. He required Datiaojing San (Great Menstruation Regulating Powder) with doubled Hupo (Amber) to transform the evil blood into water. The combined medicine was taken. After five days, about one dou of foul-smelling dark fluid was discharged. The patient felt tired, and the disease trend decreased. Then, Renshen Yangrong Tang (Ginseng Nourishing Young Decoction) was taken for dozens of doses, and she recovered fully after more than a month.

[Yun] For postpartum alternating chills and fever, add Xiaochaihu Tang to Siwu Tang.

[Bao] For chronic deficiency consumption with mild chills and fever, and a deep, rapid pulse, Chaihu Siwu Tang 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 with a wiry pulse, it is Shaoyang disease. Use Xiaochaihu Tang plus Shengdihuang.
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 and take as described above.

Zengsun Chaihu Tang: Treats postpartum deficiency, chills and fever, poor appetite, abdominal distension.
Chaihu, Renshen, Gancao, Banxia, Chenpi, Chuanxiong, Baishaoyao (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 (See formula for abdominal pain in this volume).

Commentary: Alternating chills and fever indicate disharmony of Ying (Nutrient) and Wei (Defensive) Qi, and cannot be lightly discussed. If stagnant blood fails to dissipate, it affects more than just the Spleen and Lungs. Generally, when one Yin obstructs one Yang, chills and fever occur. Yin prevalence causes cold; Yang prevalence causes heat. It can be said that stagnant blood flows along the meridians, obstructing various Yin channels causes cold, and obstructing various Yang channels causes heat. The condition ceases when Qi/Blood harmonizes with Wei Qi, but recurs upon re-contention. Datiaojing San and Wuji San are best decocted with vinegar.

Yunqi Shudihuang San: Treats postpartum rutao (childbed consumption), caused by physical weakness and lack of strength, relapse due to overexertion. Symptoms include painful limbs, intermittent chills and fever, and loss of appetite.
Shudihuang, Renshen, Baishaoyao, Baifuling, Baizhu, Xuduan (each 1 liang), Huangqi, Guixin, Wuweizi, Danggui, Chuanxiong (each 7.5 qian; *Daquan* formula includes Maidong 7.5 qian).
Cut into coarse pieces. Take 4 qian per dose, with 3 slices of ginger and 1 jujube. Decoct in water. Another version excludes Guixin, Wuweizi, Xuduan, and includes Chaihu, Huangqin, Banxia (each 7.5 qian) as powder.

Huangqi Wan: Treats postpartum rutao, alternating chills and fever, dizziness and headache, sore joints, and physical weakness.
Huangqi, Biejia, Danggui (fried, each 1 liang), Guixin, Baishaoyao, 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 to make pills the size of wutong seeds. Take 40-50 pills per dose after meals, washed down with porridge drink.

Datiaojing San: Treats postpartum Blood deficiency, uneliminated lochia, Qi stagnation due to turbid remnants, disharmony of Ying and Wei, mutual contention of Yin and Yang, aversion to cold with fever, spontaneous sweating, or swelling/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 Perilla Leaf soup, 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 qian), Baishaoyao, Shudihuang (each 1.5 qian).
Cut into coarse powder. Divide into two doses. Each dose uses 1.5 zhong of water, 3 slices of ginger, and 3 stalks of scallion. Decoct to 1 zhong. Take at any time. For sweating, increase Danggui, Chuanxiong, Baishaoyao, Shudihuang. For distension, increase Houpo, Chenpi. For heat, increase Chaihu, Huangqin. For cold, increase Cangzhu, Caoguo, Guizhi. For phlegm, increase Banxia, Jiegeng, Fuling. For headache, increase Chuanxiong, Baizhi, Qianghuo. For diarrhea, remove Zhike and Gancao. (If residual blood clots in the abdomen cause tidal fever and pain, add Sanleng, Ezhu, and more Xiyansu, Bajiaoxiang. For generalized 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, bad speech, mouth ulcers, 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 and 1.5 dou of water. Boil to obtain 7 sheng. Add the herbs and boil again to obtain 3 sheng. Divide into three warm doses. Avoid fish, alcohol, and wet noodles.

Zhimu Tang: Treats postpartum alternating chills and fever, generalized warmth and heat, chest and heart vexation.
Zhimu (3 liang), Shaoyao, Huangqin (each 2 liang), Guixin, Gancao (each 1 liang, cut into coarse pieces).
Use 5 sheng of water. Boil to obtain 2.5 sheng. Divide into three doses. Another version excludes Guixin and uses Shengdihuang instead.