bubble_chart Concept

Fever that occurs in women before or during menstruation and subsides after menstruation is called menstrual fever. A single episode of fever during menstruation is not within the scope of this condition.

bubble_chart Pattern Analysis

1. Liver Depression Transforming into Fire︰Low-grade fever before or during menstruation, which subsides after menstruation, advanced menstruation, heavy flow with dark purple and thick consistency, or prolonged menstrual period, chest tightness and hypochondriac distension, irritability, dizziness, or red face and eyes, or bitter taste in the mouth and dry throat, reddish tongue texture, thin or yellow greasy coating, wiry and rapid pulse. It is caused by internal damage from the seven emotions, liver failing to act freely, and prolonged stagnation transforming into fire. The clinical manifestations often include fever before or during menstruation, accompanied by distending pain in the chest and hypochondrium, irritability, dizziness, reddish tongue texture, wiry and rapid pulse, etc. Treatment should focus on soothing the liver and relieving depression, clearing heat and regulating menstruation, using Peony and Gardenia Peripatetic Powder with modifications.
2. Yin Deficiency︰Persistent low-grade fever worsens during menstruation, often with early periods that are scanty and dark red in color. Symptoms include irritability, dry mouth and throat, dizziness, blurred vision, emaciation, red tongue with thin coating, and thready rapid pulse. This condition arises from constitutional yin deficiency or excessive menstrual bleeding leading to insufficient yin-blood and internal heat. Manifestations include afternoon fever, emaciation, dry mouth and throat, irritability, red tongue with scant coating, and thready rapid pulse. Treatment should focus on enriching yin and clearing heat to regulate menstruation, using Modified Chinese Wolfberry Root-bark Decoction.
3. External Contractionwind-cold︰During each premenstrual or menstrual period, fever and chills, generalized body pain, headache nasal congestion, scanty and pale menstruation, dull pain in the lower abdomen, pale tongue with thin white coating, floating and slow or floating and slippery pulse. The treatment should focus on dispelling wind and regulating menstruation, using Cinnamon TwigFour Ingredients Decoction with added Schizonepeta.
4. Wind-heat External Contraction︰Before or during each menstrual period, fever without aversion to cold, clear nasal discharge, headache with distension, thirst and sore throat, advanced menstruation with slightly increased flow, red menstrual color, red tongue with thin yellow coating, floating and rapid pulse. Treatment should focus on clearing heat and regulating menstruation, using Modified Lonicera and Forsythia Powder.
5. Uterine Blood Stasis︰Low-grade fever before or during menstruation, scanty menstrual flow with dark brown and thick discharge, lower abdominal pain that refuses pressure or feels like needle pricks, stiffness in the waist making it difficult to turn, dark complexion, insomnia with dreamfulness, dry mouth without desire to drink, dark red tongue texture or with purpura, wiry and choppy pulse. This condition is often caused by static blood stagnation in the uterus and appendages, which over time transforms into heat and worsens during menstruation due to accumulated stasis and heat. Symptoms include low-grade fever during menstruation, scanty flow with dark brown and thick discharge, and lower abdominal pain that refuses pressure. Treatment should focus on invigorating blood and resolving stasis, clearing heat and regulating menstruation. The recommended formula is modified Zedoary Rhizome Decoction.
6. Qi Deficiency and Blood Deficiency︰During menstruation: mild fever, advanced menstruation, heavy flow with pale color, palpitation and insomnia, puffy and sallow complexion, dizziness and blurred vision, fatigue and mental fatigue, swollen and tender tongue with thin coating, thin and slightly rapid pulse. Often caused by prolonged deficiency of qi and blood due to pestilent qi, or spleen-stomach weakness leading to insufficient generation and transformation of qi and blood, exacerbated during menstruation when qi and blood are further depleted. Symptoms include low-grade fever during menstruation, puffy and sallow complexion, dizziness and blurred vision, palpitation or severe palpitation, pale menstrual flow, swollen tongue with thin coating, and thin, slightly rapid pulse. Treatment should focus on tonifying qi and nourishing blood, using Eight Precious Ingredients Decoction with modifications.

Menstrual fever is mostly attributed to internal damage. Even if there is an external contraction exterior pattern, it occurs on the basis of an internal damage deficiency pattern, where wind evil takes advantage and invades. Therefore, attention should also be paid to dietary and mental aspects of recuperation. With sufficient qi and blood, and abundant energy, there will naturally be no concern of fever.

bubble_chart Documentation

1. Yizong Jinjian-Gynecology Essentials: "Menstrual fever with tidal fever, premenstrual blood heat and postmenstrual deficiency, fever without timing indicates guest heat, tidal fever in the afternoon suggests yin deficiency."
2. Jiyin Gangmu．On Alternating Chills and Fever: "When menstrual flow comes and stops, or there is alternating chills and fever, first take Minor Bupleurum Decoction to remove the cold and heat, then harmonize with Four Ingredients Decoction." Jiyin Gangmu．On Menstrual Fever: "Premenstrual tidal fever with blood deficiency and stagnation, Peripatetic Powder add Peony Bark, Peach Kernel, and Corydalis Tuber. Postmenstrual tidal fever with blood deficiency and heat, Peripatetic Powder remove Bupleurum and replace with Chinese Wolfberry Root-bark, add Unprocessed Rehmannia Root."