王好古曰。发热恶寒。不离桂枝、芍药。往来寒热。不离柴胡、前胡。大渴引饮。不离知母、
石膏、麦冬、五味。大便泄利。不离干姜、白术。大便燥结。不离大黄、黄芩。月经适来适断。不
离小柴胡。胎动不安。不离人参、阿胶、黄芩、白术。要汗。不离姜、豉、旋覆。头痛。不离山栀、
石膏、前胡。伤暑头痛。不离柴胡、甘草、石膏。满闷。不离枳实、陈皮。胎气不安。不离黄芩、
麦冬、人参。斑色发黑。不离黄芩、山栀、升麻。
朱震亨曰。产后发热恶寒。皆属血气虚。左手脉不足。补血。右手脉不足。补气。凡恶寒发热。
又腹痛。当去恶血。恶寒发热。乳汁不通及膨者。无子当消。用麦芽二两。炒研作四服。白汤下。
有子当下。用木通、通草、猪蹄汁。煎服。
产后才身热。不可发表。并一切苦寒药。
大凡产后。头痛身疼。不可便作感冒治之。此等多是血虚。或败血作梗。宜以平和之剂与服。
必效。如玉露散。或四物汤加北柴胡等分。若便以小柴胡及竹叶石膏汤之类。竟不救者多矣。
吴绶曰。新产后患伤寒。不可轻易发汗。盖有产时伤力发热。去血过多发热。恶露不去发热。
三日蒸乳发热。或有早起劳动。饮食停滞。一皆发热。状似伤寒。要在仔细详辨。不可便发汗。大
抵产后。大血空虚。若汗之。则变筋惕肉 。或冒郁昏迷而不省。或风搐搦而不定。或大便秘涩而
难去。其害非轻。切宜精审。凡有发热。且与四物汤。以芎、归为君。炒白芍、熟地佐之。如发热。
加软苗柴胡、人参、干姜。最效。盖干姜能引血药入血分。气药入气分。且能去恶养新。有阳生阴
长之道。予尝用之取效。如有恶露未尽者。益母丸。黑神散。必兼用之。若胃虚食少。必加白术、
茯苓。有痰呕逆。必
加半夏、陈皮。其余六经。各条治例皆同。但药中必加四物汤为主。乃养血务本之要。产后中风。
数十日不解。头微痛。恶寒。时时有热。心下闷。干呕。汗出。虽多阳旦症。或可治。与阳旦汤。
产后中风。发热面赤。喘而头痛。竹叶汤。
鳌按。产后气血大亏。若恶寒发热。固当以四物汤为主。即用表药。只可荆芥、苏叶、桔梗、甘菊
轻清之品。然犹当少用。即用凉药。亦不过丹皮、石斛之类。亦须少用。余以此意治产妇。无一失
者。尝见俗工。用大散大凉之剂。往往几日即毙。反此便大热大补。加参、桂、姜、附。亦多致
死。呜呼。可谓不知高下者矣。
王好古说：出现发热、恶寒症状，治疗离不开桂枝和芍药；出现往来寒热（忽冷忽热）症状，治疗离不开柴胡和前胡；出现极度口渴且大量饮水的症状，治疗离不开知母、石膏、麦冬和五味子；出现大便泄泻或痢疾症状，治疗离不开干姜和白术；出现大便干燥结滞症状，治疗离不开大黄和黄芩；月经刚来或刚停止，治疗离不开小柴胡汤；胎动不安，治疗离不开人参、阿胶、黄芩和白术；需要发汗时，治疗离不开生姜、豆豉和旋覆花；出现头痛症状，治疗离不开山栀、石膏和前胡；伤暑引起的头痛，治疗离不开柴胡、甘草和石膏；出现胸脘痞闷症状，治疗离不开枳实和陈皮；胎气不安，治疗离不开黄芩、麦冬和人参；斑疹颜色发黑，治疗离不开黄芩、山栀和升麻。
朱震亨说：产后出现发热、恶寒，都属于血气和气的虚弱。如果左手脉象不足，应当补血；右手脉象不足，应当补气。凡是出现恶寒、发热，又伴有腹痛的，应当祛除瘀血。如果是恶寒、发热、乳汁不通且乳房胀大膨隆的，若无胎儿（指非哺乳期积乳或无子之症），应当消散乳汁，用麦芽二两，炒后研碎，分四次服用，用白开水送下；若有胎儿，应当通利下行，用木通、通草和猪蹄汁煎服。
产后刚刚出现身体发热，不可使用发表（解表）药物，以及一切苦寒性质的药物。
大凡产后，出现头痛、身体疼痛，不可立即当作感冒来治疗。这种情况大多是由于血虚，或者是败血（瘀血）阻滞所致，适宜给予平和的药物服用，必定有效，如玉露散，或者四物汤加入北柴胡等量。如果直接使用小柴胡汤及竹叶石膏汤之类的方剂，不能治愈的情况很多。
吴绶说：新近产后的妇女患伤寒，不可轻易使用发汗法。因为产时用力过度会发热，失血过多会发热，恶露（产后余血浊液）不去会发热，产后三天蒸乳（泌乳期）会发热，或者有早起劳动、饮食停滞等情况，都会引起发热，这些症状看起来像伤寒，关键在于仔细详细辨别，不可轻易发汗。大体上产后，血液空虚，如果强行发汗，就会导致筋惕肉瞤（肌肉跳动）、冒郁昏迷不省人事、风搐搦（抽搐）不止、大便秘涩难下等后果，危害不小，务必精心审慎。凡是遇到发热，暂且给予四物汤，以川芎、当归为君药，炒白芍、熟地黄为佐药。如果发热，加入软苗柴胡、人参、干姜，效果最好。因为干姜能引导血药进入血分，气药进入气分，并且能去除恶露、滋养新血，符合“阳生阴长”的道理。我曾用此法取得疗效。如果有恶露未尽的情况，益母丸和黑神散必须兼用。如果胃虚食少，必须加入白术、茯苓。有痰呕逆，必须加入半夏、陈皮。其余六经病症，各条治例都相同，但用药中必须以四物汤为主，这是养血固本的关键。产后中风，几十日未愈，头部微痛，恶寒，时常有热，心下痞闷，干呕，汗出，虽然多为阳旦证（桂枝汤证），或许可以治疗，给予阳旦汤。产后中风，发热面赤，气喘且头痛，使用竹叶汤。
沈金鳌按语：产后气血大亏，如果出现恶寒发热，固然应当以四物汤为主。即使使用解表药物，也只可用荆芥、苏叶、桔梗、甘菊等轻清之品，而且用量要少。即使使用凉药，也不过是丹皮、石斛之类，也必须少量使用。我用这个意思治疗产妇，没有一次失误的。曾见庸医，使用大发散、大寒凉的药剂，往往几天就导致死亡；反过来又用大热大补的药物，加入人参、桂枝、干姜、附子，也常导致死亡。唉，这真可以说是不知道权衡轻重缓急的人了。
Wang Haogu stated: For symptoms of fever and aversion to cold, the treatment must not depart from Guizhi (Cinnamon Twig) and Shaoyao (Peony Root); for alternating chills and fever (Wanglai Hanre), the treatment must not depart from Chaihu (Bupleurum Root) and Qianhu (Peucedani Radix); for extreme thirst with excessive drinking, the treatment must not depart from Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus); for loose stools or dysentery, the treatment must not depart from Ganjiang (Zingiberis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma); for dry and constipated stool, the treatment must not depart from Dahuang (Rhei Radix et Rhizoma) and Huangqin (Scutellariae Radix); when menstruation has just started or just stopped, the treatment must not depart from Xiaochaihu Tang (Minor Bupleurum Decoction); for restless fetus, the treatment must not depart from Renshen (Ginseng Radix), Ejiao (Donkey-hide Gelatin), Huangqin (Scutellariae Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma); when sweating is required, the treatment must not depart from Jiang (Zingiberis Rhizoma), Chi (Sojae Semen Praeparatum), and Xuanfu (Inulae Flos); for headache, the treatment must not depart from Shanzhi (Gardeniae Fructus), Shigao (Gypsum Fibrosum), and Qianhu (Peucedani Radix); for headache caused by summerheat, the treatment must not depart from Chaihu (Bupleurum Root), Gancao (Glycyrrhizae Radix et Rhizoma), and Shigao (Gypsum Fibrosum); for chest and epigastric fullness and oppression, the treatment must not depart from Zhishi (Aurantii Fructus Immaturus) and Chenpi (Citri Reticulatae Pericarpium); for unstable fetal qi, the treatment must not depart from Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix), and Renshen (Ginseng Radix); for macules turning black, the treatment must not depart from Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), and Shengma (Cimicifugae Rhizoma).
Zhu Zhenheng stated: Postpartum fever and aversion to cold all belong to deficiency of blood and qi. If the pulse at the left position is insufficient, tonify blood; if the pulse at the right position is insufficient, tonify qi. Whenever there are aversion to cold, fever, accompanied by abdominal pain, one should remove stasis blood. In cases of aversion to cold, fever, blocked lactation, and breast distension without a fetus (referring to milk stasis in non-lactating women or pathological conditions), one should dissipate the milk using Erliang Maiya (Two taels of Fried and Crushed Malt), divided into four doses, taken with warm water; if there is a fetus, one should promote downward movement using Mutong (Akebiae Caulis), Tongcao (Tetrapanacis Medulla), and Zhu Ti Ji (Pig's Trotter Juice), decocted and taken.
Immediately after childbirth, if body heat appears, do not use exterior-releasing (diaphoretic) medicines, nor any bitter-cold drugs.
Generally speaking, postpartum headache and body ache should not be immediately treated as common cold. These cases are mostly due to blood deficiency or obstruction by stale blood (failed blood). It is advisable to administer mild and balanced formulas, which will surely be effective, such as Yulu San (Jade Dew Powder) or Siwu Tang (Four Substances Decoction) added with equal parts of Bei Chaihu (Northern Bupleurum Root). If one directly uses Xiaochaihu Tang (Minor Bupleurum Decoction) or Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), many cases fail to be cured.
Wu Shou stated: For women suffering from Shanghan (Cold Damage) shortly after childbirth, one should not lightly employ diaphoresis (sweating therapy). This is because exertion during labor causes fever, excessive blood loss causes fever, retention of Eluo (lochia) causes fever, milk production around the third day causes fever, and early physical labor or food stagnation also cause fever. These conditions resemble Shanghan, but careful differentiation is essential; one must not simply induce sweating. Generally, postpartum blood volume is empty. If sweating is induced, it may lead to twitching of tendons and flesh (Jinti Rouyue), dizziness and coma with loss of consciousness, convulsions and spasms, or severe constipation and difficulty in defecation. The harm is significant, so precision and caution are imperative. Whenever fever occurs, initially administer Siwu Tang (Four Substances Decoction), with Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) as the sovereign herbs, and fried Baishao (White Peony Root) and Shudi (Rehmanniae Radix Preparata) as assistant herbs. If fever persists, add Ruanmiao Chaihu (Soft-stemmed Bupleurum Root), Renshen (Ginseng Radix), and Ganjiang (Zingiberis Rhizoma), which is most effective. Ganjiang can guide blood-invigorating herbs into the blood level and qi-regulating herbs into the qi level, while also eliminating lochia and nourishing new blood, following the principle of "yang generating yin." I have used this method with success. If lochia is not yet exhausted, Yimu Wan (Motherwort Pill) and Heishen San (Black Divine Powder) must be used concurrently. If there is stomach deficiency and poor appetite, add Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria). If there is phlegm, vomiting, and counterflow, add Banxia (Pinelliae Rhizoma) and Chenpi (Citri Reticulatae Pericarpium). The treatment principles for the other six meridians are identical, but Siwu Tang (Four Substances Decoction) must always be the main formula, as it is crucial for nourishing blood and addressing the root. For postpartum wind-stroke persisting for dozens of days, with slight headache, aversion to cold, intermittent fever, epigastric oppression, dry retching, and sweating, although this resembles Yangdan Syndrome (Guizhi Tang pattern), it may be treatable with Yangdan Tang. For postpartum wind-stroke with fever, red face, wheezing, and headache, use Zhuye Tang (Bamboo Leaf Decoction).
Shen Jin'ao commented: Postpartum qi and blood are severely depleted. If aversion to cold and fever occur, Siwu Tang (Four Substances Decoction) should indeed be the primary formula. Even if exterior-releasing herbs are used, only light and clear agents like Jingjie (Schizonepetae Spica), Suye (Perillae Folium), Jiegeng (Platycodonis Radix), and Ganju (Chrysanthemi Flos) should be chosen, and even then, in small doses. Even if cooling herbs are used, they should be limited to Mudanpi (Moutan Cortex) and Shihu (Dendrobii Caulis), also in small doses. I have treated postpartum patients with this approach without failure. I have seen quacks use strong dispersing and strongly cooling agents, often causing death within a few days; conversely, using strongly heating and strongly tonifying agents with Renshen (Ginseng Radix), Guizhi (Cinnamon Twig), Ganjiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Preparata) also frequently leads to death. Alas, these practitioners truly do not know how to weigh priorities and severity.