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[Lou] Postpartum malaria is mostly caused by lochia stasis (blood stasis) mixed with cold and heat pathogens. The general treatment principle is to regulate with Chaihu Siwu Tang (Bupleurum and Four Substances Decoction). If heat predominates, Caoguo Yinzi (Tsaoko Drink) should be used; if cold predominates, Shengshu Yinzi (Raw and Cooked Drink) should be used.

[Xue] Postpartum malaria arises from spleen and stomach deficiency, food stagnation, external pathogenic invasion, emotional depression injuring the spleen, or latent summerheat pathogens. If confirmed as food injury, Liu Jun Zi Tang (Six Gentlemen Decoction) with Jiegeng (Platycodon Root), Cangzhu (Atractylodis Rhizoma), and Huoxiang (Patchouli Herb) is used. If external pathogens are heavy and food stagnation is light, Huoxiang Zhengqi San (Patchouli Powder for Rectifying the Qi) is used. If external pathogens are light and food stagnation is heavy, Renshen Yangwei Tang (Ginseng Stomach-Nourishing Decoction) is used. For cases due to diet and overexertion, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) is used. For qi and blood deficiency, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) with Paojiang (Prepared Ginger) is used. For deficiency-cold, Liu Jun Zi Tang (Six Gentlemen Decoction) with Jiang (Ginger) and Gui (Cinnamon Twig) is used. For collapse of yuan qi (original qi), Fuzi (Aconite Lateral Root) is urgently added. Generally, chronic malaria belongs to deficiency-cold of yuan qi (original qi); qi deficiency generates cold, blood deficiency generates heat, stomach deficiency causes aversion to cold, and downward flow of yin fire leads to alternating chills and fever, or vomiting, diarrhea, anorexia, abdominal pain, irritability, thirst, fever with delirium, or cold extremities and shivering like a millet panicle. Although various symptoms appear, vigorous warming and tonification should be employed, and the disease will recede spontaneously. If mistakenly treated with drugs for clearing spleen-heat or arresting malaria, it often leads to death.

One postpartum woman suffered from malaria with fever, thirst, chest and diaphragm fullness, generalized body pain, no food intake for three days, sour regurgitation, and belching/vomiting. This was food injury where the spleen and stomach failed to digest food. Liu Jun Zi Tang (Six Gentlemen Decoction) with Shenqu (Massa Medicata Fermentata) and Shanzha (Crataegi Fructus) was administered. After four doses, sourness ceased. Shenqu and Shanzha were then removed, and after several more doses, appetite returned. Her bowel movement remained unobstructed until the thirty-fifth day. Having consumed over seventy bowls of food, her abdomen finally felt stuffy. Pig bile enema was used to induce defecation, and the stool was not very dry.

Another postpartum woman suffered from prolonged malaria that did not heal, with myriad diseases arising. Her pulse was sometimes surging and large, sometimes minute and fine, sometimes wiry and tight, sometimes deep and hidden, difficult to describe. Liu Jun Zi Tang (Six Gentlemen Decoction) with Paojiang (Prepared Ginger) was used for over twenty doses, after which the pulse and symptoms slightly improved. Then, a paste made from Renshen (Ginseng Root) and Baizhu (Atractylodis Macrocephalae Rhizoma) was used, assisted by Guipi Tang (Restore the Spleen Decoction) for over one hundred doses, leading to recovery.

Yet another postpartum woman experienced morning chills and evening fevers, or intermittent chills and fevers, which persisted for a long time. Liu Jun Zi Tang (Six Gentlemen Decoction) and Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) were taken concurrently. After over one hundred doses, she recovered shortly thereafter.

Caoguo Yinzi (Tsaoko Drink): Treats postpartum malaria in women with equal amounts of chills and fever, or those with predominant heat.
Banxia (Pinelliae Rhizoma, soaked in water) Chifuling (Poria with Red Coir) Gancao (Licorice Root, honey-fried) Caoguo (Tsaoko Cardamom Fruit, processed and peeled) Chuanxiong (Ligusticum Rhizome) Chenpi (Citrus Reticulatae Pericarpium) Baizhi (Angelicae Dahuricae Radix) [each 2 qian] Qingpi (Citrus Reticulatae Viride Pericarpium, white pith removed) Liangjiang (Alpiniae Officinarum Rhizoma) Zisu (Perillae Folium) [each 2.5 qian] Gange (Puerariae Lobatae Radix) [4 qian]
The above herbs are chopped. Take 3 qian per dose, add one large cup of water, three slices of ginger, and two dates. Decoct together to 70% volume, remove dregs. On the day of malaria onset, early in the morning, take three consecutive doses without fail.

Shengshu Yinzi (Raw and Cooked Drink): Treats postpartum malaria with predominant cold.
Roudoukou (Myristica Seed) Caoguoren (Tsaoko Cardamom Seed) Houpo (Magnolia Bark, raw, coarse skin removed) Banxia (Pinelliae Rhizoma) Chenpi (Citrus Reticulatae Pericarpium) Gancao (Licorice Root) Dazao (Jujube Fruit, pitted) Shengjiang (Fresh Ginger)
The above eight ingredients are finely chopped and mixed equally. Half are used raw, half are wrapped in wet cotton paper and baked until fragrant and cooked. Remove the paper and mix with the raw half. Weigh 5 qian per dose, add two cups of water, decoct to 70% volume. Take one dose before meals and one dose after meals.

[Supplement] For postpartum malaria with more heat than chills, use Qingspi Tang (Clear the Spleen Decoction). For more chills than heat, use Yangwei Tang (Nourish the Stomach Decoction). For persistent cases, use Qibao Yin (Seven Treasures Drink) to arrest the malaria. (Formulas are found in the section on miscellaneous diseases: malaria.)