PUERPERAL FEVER (POSTPARTUM FEVER)

GENERAL

Clinical Manifestations	Puerperal fever is a fever that lasts for more than 24 hours within the first 10 days after a woman has had a baby. Puerperal fever is due to an infection, most often of the placental site within the uterus. If the infection involves the bloodstream, it constitutes puerperal sepsis. Puerperal fever has gone by a number of different names including childbirth fever, child bed fever and postpartum fever. In Latin a "puerpera" is a woman in childbirth since "puer" means child and "parere" means to give birth. The puerperium is the time immediately after the delivery of a baby.
Treatment Principle
Herb Formulas	Blood loss: Dang Gui Bu Xue Tang
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WIND

Clinical Manifestations	Continuous high fever after delivery Aversion to Cold Sallow, withered complexion Emaciation Listlessness Headache Vertigo Low back pain Shortness of breath Cough Muscle ache of the head and neck Nausea Vomiting T: Pink C: Thin and white P: Floating and thready
Treatment Principle	Expel wind Nourish the blood
Herb Formulas	Zhu Ye Shi Gao Tang
Points	GB-20, LI-4, LU-7, ST-36, UB-10, UB-20, UB-21

TAI YANG ZHONG FENG

Clinical Manifestations	Aversion to Wind Mild, or severe chills Postpartum fever which may be persistent Uneasiness from fever Spontaneous perspiration Headache Nausea Nasal irritation Nasal obstruction Tendency to snore Itchy throat T: Normal C: Thin and white P: Superficial and slow or Moderate and maybe weak
Treatment Principle	Create sweat to relieve the Exterior and expel Wind Harmonize Ying and Wei to protect digestion and nourish Wei Qi
Herb Formulas	Gui Zhi Tang Gui Zhi Jia Ge Gen Tang
Points	Bitong, DU-16, GB-20, KI-7, LI-4, LI-20, LU-7, SJ-5, UB-12, UB-13, Yintang With stiff neck and shoulders: + GB-21 With Dampness: + SP-6, SP-9 With dyspnea, asthma and sputum: Dingchuan, REN-22 With nocturnal emission, excess dreams, Cold lower extremities, dizziness and hair loss: + DU-4, KI-3, UB-23 With continuous perspiration, muscle spasms of the limbs with difficult flexion and extension and difficult urination: + REN-4 With sustained fever of long duration accompanied by severe chills: + DU-14

SHAO YANG JING

Clinical Manifestations	Alternating chills and fever Restlessness Irritability Anorexia Sometimes fatigue Nausea Occasional vomiting Headaches (side of head) Hypochondriac pain Rib pain Achiness Ear infection Hearing difficulty Red eyes Stiff shoulders Throat pain Hip pain T: Normal with bumps or dots on side C: Thin white P: Wiry
Treatment Principle	Harmonize the Liver and Gall Bladder
Herb Formulas	Xiao Chai Hu Tang
Points	GB-41, SJ-5 To harmonize the Liver and Gall Bladder: GB-34, LIV-3, LIV-14, SJ-5 To stop nausea and vomiting: PC-6, SP-4, ST-36 To treat headache: GB-1, GB-8, GB-14, Taiyang To treat constipation: SJ-6, ST-25 To treat fever: DU-13, DU-14 To support the San Jiao and Regulate Yin: PC-5, PC-6 To support Yin: KI-7 To support the Ying: SP-10 Head: GB-8, SJ-20, Yintang Eyes: GB-14, GB-20, ST-1, UB-1, UB-2 Ear: GB-2, SJ-5, SJ-17, SJ-21 Hypochondriac area: GB-34, GB-40 Ear: Shenmen, Gall Bladder, Point 0

SHAO YANG FU WITH CONGESTED FLUIDS

Clinical Manifestations	Alternating chills and fever (chills predominate) or Chills without fever Sensation of irritability in the chest Sweating from the head Fatigue Gastrointestinal weakness Heavy head Neuralgia Epigastric distension Lower abdominal pain Tension around pubic bone Periumbilical pain Urinary difficulty T: Moist C: White and slippery P: Superficial and wiry
Treatment Principle	Disperse Clumping Harmonize the Shao Yang Warm the Interior Dispel Cold
Herb Formulas	Chai Hu Gui Zhi Gan Jiang Tang
Points	GB-41, SJ-5, moxa or moxa needle REN-4, REN-6, REN-8, REN-12, SJ-6, ST-25, ST-36

WEI STAGE: WIND-HEAT

Clinical Manifestations	Inflammation of throat and/or tongue Fever and chills with more fever than chills Perspiration Cough with sticky yellow sputum Aversion to Wind and Heat Yellow nasal discharge Thirst with desire for cold drinks Red bumps around mouth and lips (herpes simplex) Headache Nasal obstruction Sore, swollen throat Dyspnea Chest pain Dry mouth Rapid breathing Maybe constipation Maybe scanty urine T: Red tip C: Thin and yellow P: Floating and rapid
Treatment Principle	Disperse Wind Clear Heat Clear the Lungs
Herb Formulas	Yin Qiao San
Points	Bleed UB-40, needle Dingchuan, DU-14, DU-16, DU-23, DU-24, GB-20, LI-4, LI-11, LU-5, LU-7, LU-10, REN-22, SJ-5, ST-8, ST-40, Taiyang, UB-12, UB-13

YING STAGE HEAT ATTACKS THE PERICARDIUM

Clinical Manifestations	Postpartum high fever worse at night Thirst Insomnia Major mental problems Dramatic change of personality Delirium Skin rashes Speech difficulty Aphasia Poor memory Dizziness Maybe fainting Maybe coma Feverish extremities T: Deep red P: Thready and rapid
Treatment Principle	Clear Heat in Pericardium
Herb Formulas	An Gong Niu Huang Wan Zi Xue Dan
Points	KI-6, LI-4, LI-11, LIV-5, PC-8, REN-3, SP-6 To Clear Heat from the Heart: HT-3, PC-8, Sifeng, bleed Shixuan For delirium: PC-7 To detoxify: LI-11 To Pacify Heart and calm the Shen: HT-5, HT-6, HT-7 To Nourish Yin: KI-3, SP-6

SPLEEN YANG DEFICIENCY

Clinical Manifestations	Sallow complexion Anorexia (maybe with vomiting) Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations (pain is relieved by warmth) Cold limbs Feeling chilled Frequent, clear urination Mental fatigue Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale C: Thin and white P: Deep and weak
Treatment Principle	Warm the Center Dispel Cold
Herb Formulas	Huang Qi Jian Zhong Tang
Points	Moxa LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

SPLEEN AND STOMACH DEFICIENCY COLD

Clinical Manifestations	Mild constant epigastric pain; relieved by warmth and pressure Anorexia Abdominal pain and fullness after meals Nausea Vomiting Loose, unformed stools Excessive salivation Cold limbs Lassitude Weakness Sallow or pale, dull complexion Maybe edema Maybe scanty urination Maybe clear, watery, copious vaginal discharge T: Pale C: White and greasy P: Deep, thready and forceless
Treatment Principle	Strengthen the Spleen Warm Yang Warm the Center Dispel Cold
Herb Formulas	Xiao Jian Zhong Tang
Points	Moxa or moxa needle LIV-13, REN-12, SP-3, SP-6, ST-36, UB-20, UB-21

FOOD STAGNATION

Clinical Manifestations	Continuous high fever after delivery Fullness of the chest and abdomen Acid regurgitation Emaciation Anorexia Abdominal distention and pain Vomiting Diarrhea T: Normal C: Dirty and sticky P: Slippery and rapid
Treatment Principle	Remove Food Stagnation
Herb Formulas	Si Jun Zi Tang modified
Points	LI-4, REN-12, ST-25, ST-36, ST-44

HEART QI DEFICIENCY

Clinical Manifestations	Palpitations Shortness of breath (especially on exertion) Excessive perspiration (in daytime) Symptoms worse after exertion or when tired Facial pallor Fatigue Weakness Suffocating sensation in chest T: Pale and swollen C: White P: Weak or Big and weak or Intermittent
Treatment Principle	Reinforce and Strengthen Heart Qi
Herb Formulas	Zhi Gan Cao Tang
Points	HT-7, PC-6, REN-6, REN-14, REN-17, ST-36, UB-15

LIVER AND KIDNEY YIN DEFICIENCY WITH LIVER YANG RISING GENERATING WIND

Clinical Manifestations	Dizziness Vertigo Temporal or vertex headache Tinnitus Pressure behind the eyes Blurred vision Sudden loss of vision in one eye Facial flushing Irritability Restlessness Insomnia Dream disturbed sleep Lower back ache Progressive unilateral motor dysfunction Weakness, paralysis or numbness of the extremities Facial paralysis Dysphasia which may develop over a few hours or days Hypertension T: Red C: Little or None P: Thready, wiry and rapid
Treatment Principle	Sedate Liver Yang Extinguish Wind Nourish Yin Anchor Yang
Herb Formulas	Ling Yang Jiao Tang Tian Ma Gou Teng Yin Zhen Gan Xi Feng Tang
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KIDNEY YIN DEFICIENCY WITH FIRE FLARING

Clinical Manifestations	Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of the low back Spermatorrhea or Premature ejaculation Aching in the bones Aching in the leg and heel Dry mouth Thirst Night sweats Five Sole Heat Malar flush Low grade fever in the afternoon Dry throat, maybe recurrent sore throat Dry stools and/or Constipation Urine short and red Heightened libido If Heart Fire also Flares: Insomnia Frequent dreams Palpitations If Liver Yang also Rises: Dizziness Blurred vision T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Subdue Fire
Herb Formulas	Zhi Bai Di Huang Wan
Points	KI-1, KI-2, KI-3, KI-6, KI-9, KI-10, REN-4, SP-6, UB-23 If Heart Fire also Flares: HT-7, PC-7, UB-15 If Liver Yang also Rises: LIV-3, UB-18

QI AND BLOOD DEFICIENCY

Clinical Manifestations	Prolonged lochia Excessive postpartum bleeding Profuse bleeding Puerperal fever Spontaneous sweating Dry mouth Heart irritability Light headedness Delirium Irritability Nausea Vomiting Nervousness Anorexia Abdominal pain Flank distention and fullness Dizziness Blurred vision Tinnitus Excessive loss of Blood Emotional instability Fullness and distention of the hypochondrium Epigastric pain Aversion to Cold T: Pale C: Slippery P: Weak and Deep
Treatment Principle	Tonify Qi and Blood Invigorate the Blood Regulate Qi Transform Stasis Harmonize the Liver and Spleen Regulate menstruation
Herb Formulas	Xiong Gui Tiao Xue Yin
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BLOOD STAGNATION

Clinical Manifestations	Continuous high fever after delivery Abdominal pain made worse with pressure Scanty lochia Hemorrhaging purple, darkly clotted Blood T: Dark purplish C: Thin and white P: Wiry and choppy
Treatment Principle	Invigorate the Blood Remove Stagnation
Herb Formulas	Sheng Hua Tang Shi Xiao San
Points	LI-11, LIV-3, REN-4, SP-6, UB-25

BLOOD STAGNATION WITH BLOOD HEAT

Clinical Manifestations	Acute lower abdominal pain, which is worse with pressure Fever which is worse art night Constipation or Black, tarry stools Manic behavior in severe cases Delirium in severe cases T: Deep red with purple spots C: Yellow P: Deep and full
Treatment Principle	Clear Heat Break up Blood Stagnation
Herb Formulas	Tao He Cheng Qi Tang
Points	LIV-2, PC-9, SP-4, SP-6, SP-8, SP-10, ST-40, Zigong

BLOOD DEFICIENCY

Clinical Manifestations	Continuous high fever after delivery Tinnitus Palpitations Heartburn Insomnia Constipation Aversion to Cold with early resumption of work Tidal fever Alternating chills and fever Pallor Dizziness Fatigue Weak low back and knees Blurred vision Pale, lusterless complexion Pale nails Pale lips Generalized muscle tension Irregular menstruation with little flow Amenorrhea Periumbilical pain Lower abdominal pain Vertigo Spotting of pale Blood Postpartum uterine bleeding Maybe Five Sole Heat Delayed menstruation Dry skin Maybe leukorrhea Firm, painful abdomen Menorrhagia Hard abdominal masses with recurrent pain T: Pale C: Normal P: Thready and weak or Thready and wiry or Thready and choppy
Treatment Principle	Nourish the Blood Regulate the Liver Improve Blood circulation Regulate menstruation
Herb Formulas	Si Wu Tang Ba Zhen Tang Shi Quan Da Bu Tang Ren Shen Dang Shao Tang Dang Gui Jian Zhong Tang With alternating chills and fever: Xiao Chai Hu Tang modified
Points	KI-6, PC-7, SP-6, ST-36, UB-20, UB-21, UB-43

BLOOD DEFICIENCY WITH BLOOD STAGNATION

Clinical Manifestations	Retention of the lochia with Cold, hardness and pain in the lower abdomen The pain is worse with pressure May be masses in the sore area The Blood is dark purplish T: Pale and purple or Pale with purple spots C: Normal P: Deep and choppy
Treatment Principle	Invigorate the Blood Transform and dispel Blood Stasis Warm the menses Warm the channels Alleviate pain
Herb Formulas	Sheng Hua Tang
Points

TOXIC HEAT

Clinical Manifestations	Unchecked fever Aversion to Cold Alternating chills and fever Sweating Lower abdominal pain which is worse with pressure Profuse lochia Dark purplish lochia with a repulsive odor Anxiety Red complexion Constipation Scanty urine Thirst Delirium Severe: Red skin rashes T: Red or Scarlet C: Yellow or Thick, yellow and dry P: Large and rapid or Wiry, thready and rapid
Treatment Principle	Clear Heat Remove toxicity Invigorate the Blood Eliminate Stagnation
Herb Formulas	Qing Re Jie Du Hua Yu Tang modified For an obstinate high fever with a red face, labored breathing, profuse sweating and a large pulse: Ren Shen Bai Du San modified With pain predominating, obstructed lochia an obstinate high fever and constipation: Da Huang Mu Dan Tang
Points	KI-6, LI-4, LI-11, LIV-5, PC-8, REN-3, SP-6

LOWER JIAO BLOOD STAGNATION WITH HEAT (INFECTION)

Clinical Manifestations	Irregular or intermittent fever followed by chills and perspiration May be mass in lower right quadrant of abdomen Aversion to Cold Hard lumps Lower abdominal distention and pain (usually on right) Pain increases on pressure with rebound tenderness Guarding of the abdominal musculature Groin pain resembling urinary dysfunction without urinary difficulty Groin pain relieved by flexing hip and knee Groin pain intensified by extending hip Perspiration T: Pink C: Thin, white or yellow and greasy P: Slippery and rapid or Tight or Wiry and tight or Tight and rapid
Treatment Principle	Drain Heat Break up Blood Stasis Invigorate the Blood Disperse nodules Reduce swelling
Herb Formulas	Da Huang Mu Dan Tang Tao Hong Cheng Qi Tang
Points

OBSTRUCTED LACTATION

Clinical Manifestations	Lochia and fever for 2-3 days after delivery Breast distention with palpable lumps Impeded lactation T: Pale C: Thin and white P: Wiry and rapid
Treatment Principle	Restore smooth lactation
Herb Formulas	Gua Lou San 60g Fr. Hordei Germinatus Mai Ya
Points	LIV-2, LIV-14, PC-7, REN-17, ST-18, ST-40

PUERPERAL FEVER (POSTPARTUM FEVER)

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