bubble_chart Concept

Postpartum fever refers to the occurrence of systemic fever accompanied by other symptoms after childbirth.

As early as in the Suwen．Tongping Xushi Lun, there are records of "fever in nursing mothers" and "apoplexy fever in nursing mothers"; by the Han Dynasty, the Jingui Yaolue．婦人 postpartum disease 脈證治篇》contains treatments for postpartum fever. A mild fever occurring one or two days after childbirth due to sudden deficiency of yin blood is a physiological phenomenon and does not require treatment.

bubble_chart Pattern Analysis

1. External Contraction of Wind Evil︰Fever and chills, headache and body pain, soreness in the waist and back, dry mouth without thirst, absence of sweating or spontaneous sweating, thin white tongue coating, floating pulse. The pathogenic factor is predominantly superficial.
2. External Contraction of Pathogenic Toxin︰fever, slight aversion to cold, sweating, headache, flushed face, dry mouth with little desire to drink, lower abdominal pain or tenderness, foul-smelling lochia, slightly red tongue texture with thin yellow coating, slippery and rapid pulse. As the virulent toxin blazes internally, postpartum external-contraction fever should be treated by dispersing and resolving methods, with the formula selection being Bamboo Leaf Decoction with modifications; postpartum virulent toxin fever should be treated by clearing and draining methods, with the formula selection being Fire-Draining Drink plus Submature Bitter Orange.
3. Qi Deficiency︰The body heat is not severe but increases with activity, accompanied by dizziness, blurred vision, flusteredness, shortness of breath, low and timid speech, physical fatigue, or spontaneous sweating. The tongue texture is swollen and pale with thin white coating, and the pulse is floating, rapid, and weak. $Qi deficiency postpartum fever and blood deficiency postpartum fever both belong to postpartum deficiency heat, but there are significant differences in the patient's constitution, disease cause, and symptoms. Qi-deficiency fever occurs in individuals with qi deficiency and yang deficiency constitution, often exacerbated by early postpartum exertion, leading to middle qi injury and floating deficient yang, resulting in fever. Blood-deficiency fever occurs in individuals with blood deficiency and yin deficiency constitution, typically due to excessive bleeding during childbirth, causing yin to fail in restraining yang, thus manifesting as fever. The key points for differentiation are as follows: qi-deficiency fever presents with mild heat that worsens with fatigue, accompanied by shortness of breath, physical exhaustion, spontaneous sweating, and a swollen, pale tongue texture. Blood-deficiency fever shows increased heat at night, accompanied by flushed cheeks, night sweats, palpitations, and a thin, rapid pulse. For qi-deficiency fever, treatment should focus on relieving fever with sweet and warm herbs, and the recommended formula is Middle-Tonifying Qi-Replenishing Decoction with Schisandra Fruit added. For blood-deficiency fever, treatment should emphasize nourishing blood and clearing heat, and the recommended formula is Peony and Gardenia Peripatetic Powder with Blackend Swallowwort Root and Tangshen added.
4. Blood Deficiency︰The fever worsens at night, with occasional reddening of both cheeks, or night sweats, dizziness, blurred vision, palpitations, insomnia, poor appetite, a pale tongue with scant coating, and a thready rapid pulse. $Qi-deficiency postpartum fever and blood-deficiency postpartum fever! Both belong to postpartum deficiency-heat, but the patient's constitution, disease cause, and symptoms are distinctly different. Qi-deficiency fever occurs in individuals with qi deficiency and yang deficiency, exacerbated by early postpartum exertion, which injures middle qi, leading to floating deficient yang and thus fever. Blood-deficiency fever occurs in individuals with blood deficiency and yin deficiency, due to excessive bleeding during childbirth, causing yin to fail to anchor yang, resulting in fever. The key points for differentiation are: Qi-deficiency fever presents with mild heat that worsens with fatigue, accompanied by shortness of breath, bodily fatigue, spontaneous sweating, a swollen pale tongue, etc. Blood-deficiency fever presents with increased heat at night, accompanied by flushed cheeks, night sweats, palpitations, a thready rapid pulse, etc. Qi-deficiency fever should be treated by relieving fever with sweet and warm herbs, using the formula Middle-Tonifying Qi-Replenishing Decoction plus Schisandra Fruit. Blood-deficiency fever should be treated by nourishing blood and clearing heat, using the formula Peony and Gardenia Peripatetic Powder plus Blackend Swallowwort Root and Tangshen.
5. Food Stagnation︰The fever is not pronounced, accompanied by aversion to food, foul belching, nausea and vomiting, epigastric distension and fullness, foul-smelling stools, a thick and greasy tongue coating, and a slippery pulse. This condition is caused by improper postpartum diet leading to food stagnation in the stomach. Its characteristics include: a low-grade fever that comes and goes, accompanied by foul belching and occasional vomiting, epigastric distension and fullness, foul-smelling stools, and a thick, greasy, and yellowish tongue coating. The treatment should focus on {|###|}invigorating the spleen and harmonizing the stomach{|###|}, resolving stagnation, and promoting digestion. The recommended formula is Harmony-Preserving Pill with modifications.
6. Blood Stasis︰There is occasional low-grade fever, scant lochia that is dark purple or mixed with blood clots, intermittent lower abdominal pain that is tender to pressure, dry mouth without desire to drink, slightly purple tongue with thin coating, and choppy or thin weak pulse. This is caused by postpartum lochiostasis, static blood obstruction, and disharmony between nutrient and defensive qi.
7. Steaming Breast Milk︰Within two or three days after childbirth, there is a sudden fever, with distending pain in the breasts but no redness or swelling, accompanied by irritability and a tendency to anger. The tongue texture is normal, and the pulse is wiry-slippery or wiry-rapid. This is due to stagnation of Yangming qi, obstruction of the mammary vessels, and stagnation of breast milk. Therefore, although both conditions present with fever, their causes differ. In the case of blood-stasis fever, symptoms include postpartum lochiostasis, lower abdominal pain that is tender to pressure, a choppy pulse, and a purple tongue. For phlegmonous mastitis with steaming heat, symptoms include inhibited lactation, distending pain in the breasts, and a wiry-slippery pulse. For blood stasis, it is advisable to invigorate blood and resolve stasis, using Generation and Transformation Decoction with additions such as Salvia, Carthamus, and motherwort herb. For steaming milk, it is advisable to nourish blood and promote lactation, using Four Ingredients Decoction with additions like Cowherb Seed, Ricepaperplant Pith, and fistula disease reed.

Postpartum fever has complex causes. In clinical diagnosis, it is essential to consider the physiological characteristics of the postpartum period, which involve a combination of deficiency and blood stasis, as well as blood stasis with underlying deficiency. The nature of symptoms and signs should then be determined based on the strength or weakness of the pathogenic qi.

bubble_chart Documentation

1. Nyuke Jinglun. Postpartum symptoms, as quoted by Guo Jizhong: "Why do postpartum women experience alternating chills and fever? The answer is: due to the disharmony of yin-yang, the stagnant blood does not disperse, which can cause alternating chills and fever. Postpartum blood qi deficiency and disharmony of yin-yang, when yin prevails, there are sudden chills; when yang prevails, there is sudden fever. The interaction of yin and yang results in either chills or fever. Due to labor injury zang-fu organs, the weak blood cannot circulate properly, hence the stagnant blood does not disperse. If it affects the lungs, it causes fever; if it affects the spleen, it causes chills. If doctors mistakenly treat it as malaria, it is wrong. For disharmony of yin-yang, it is appropriate to modify the Four Ingredients Decoction; for stagnant blood not dispersing, it is suitable to use Duoming Dan. Another question is, how to distinguish between the two? The answer is: if there is occasional stabbing pain, it is due to stagnant blood; if there are only chills and fever without other symptoms, it is due to disharmony of yin-yang."