Postpartum Fever with Chills and Unquenchable Thirst? Doctor Zhang Xichun’s Case of Sinking Chest Qi After Childbirth Treated with Shengxian Tang
Patient search words: postpartum fever / alternating hot and cold after childbirth / chills after giving birth / fever after delivery / postpartum thirst that water cannot relieve / pain under both ribs
Corresponding medical terms: sinking of the chest qi (da qi xia xian) · postpartum fever (chan hou fa re) · deficiency of qi and blood (qi xue kui xu)
Opening: this illness began with a woman who had just become a mother
For many episodes now, Doctor Luo Dalun has been telling us about sinking of the chest qi (da qi xia xian): working on an empty stomach can make it sink; getting angry can make it sink; even talking too much can make it sink. But the cause in today’s case is more special still — it is giving birth.
💬 Note from Doctor Luo: Sinking of the chest qi means the "great qi" of the chest — what we usually call pectoral qi (zong qi), the yang qi of the chest — becomes deficient and sinks downward. This case shows us: when a woman strains too hard in labor and exhausts her qi and blood, she too can develop sinking of the chest qi. And this new mother had also been injured by hot medicines, so the illness turned and twisted — a story well worth telling.
Who was the patient? A woman who had just given birth
The patient was a woman who had just had a baby. Childbirth in those days was nothing like today, when cesarean sections exist — all births were natural deliveries, and when the baby came, she had to summon every ounce of strength in her body.
💬 Note from Doctor Luo: So in our daily lives we should be grateful to our mothers — to bring us into the world, every mother really does pass through the gates of death. It is extremely hard.
How did the illness start? Straining too hard in labor, then sudden pain below the ribs after childbirth
Because she had strained far too hard during labor, a few days after the delivery she suddenly developed pain below the ribs — pain in the sides of the body, at the place just under the ribs slanting outward. About ten days later, matters took another turn: chills and fever appeared — she felt cold on one side while her body burned with high fever; or she alternated between cold and hot. Either way, she was running a fever.
💬 Note from Doctor Luo: Pain below the ribs plus chills and fever — that combination looks like an external invasion, like a liver–gallbladder problem. But the root lay in the qi exhausted by the strain of labor. And there are even more confusing twists ahead — let us read on slowly.
Round one: an elder at home knew some Chinese medicine — two doses of Shenghua Tang brought improvement
The family had an elder who understood Chinese medicine. He examined her and prescribed Shenghua Tang (Birth-Transforming Decoction), two doses. What is Shenghua Tang for? Invigorating the blood, dissolving stasis, and warming the meridians. In the old days, in many regions there was a custom of giving a woman two doses of Shenghua Tang after childbirth to dissolve any lingering blood stasis.
And what happened? After taking it, the illness improved immediately — she felt considerably better.
💬 Note from Doctor Luo: Shenghua Tang is a famous postpartum formula; the old custom was to take two doses after delivery to resolve blood stasis. In this case it helped — but notice, that was only "relief." The root was not removed, and the trouble would rise again.
Round two: a new doctor, heavy doses of dried ginger — the worse it got, the harder it fought
A few days later, however, the chills and fever returned — she was feverish again, alternating cold and hot. The elder at home saw this was not working and called in another doctor. The new doctor’s diagnosis: retained blood stasis from the childbirth, plus an invasion of cold. So in the blood-invigorating formula he loaded it with dried ginger (ganjiang) — a great deal of it.
After a few doses, the chills and fever grew far worse, and she developed unquenchable thirst — she gulped down water endlessly, but it did nothing at all. Her body simply could not take it anymore.
💬 Note from Doctor Luo: Mark this twist — the doctor assumed it was cold, so he piled on dried ginger, and the more he gave, the worse she became. Why? Because this was never simple cold. This was sinking of the chest qi combined with injury from hot medicines. The direction was wrong, and the more he fed the fire, the higher it blazed.
Midsummer: a body hot as roast meat, yet a back so cold the wind drilled into it
This happened in midsummer. How hot was this woman’s body? Like a piece of meat roasting over a fire — burning. But here is the strange part: although her body blazed with fever, she had to cover her back because she felt cold; the slightest movement of her back and she felt chilly air drilling into her.
A high fever — and yet she was terrified of cold.
💬 Note from Doctor Luo: This picture is so typical — the outside burning like a coal, the inside cold as a draft. High fever with chills: many people would treat it as exterior cold. But when Doctor Zhang Xichun placed his fingers on her pulse, the truth came clear.
Doctor Zhang Xichun arrives: the left pulse sunken and faint, almost gone — this is sinking of the chest qi!
At this point Doctor Zhang Xichun was called in. He felt the pulse: the left pulse was sunken and faint, almost imperceptible (zuo mai chen xi, yu wu) — the left hand’s pulse could barely be felt; the right pulse was sunken and tight (you mai chen jin), and rapid. Doctor Zhang Xichun judged at once: this woman’s chest qi had sunk!
Why? After childbirth her qi and blood were depleted; labor had demanded too much strength; the great qi was exhausted. On top of that, she had been injured by hot medicines — all that dried ginger had fanned the fire even higher.
💬 Note from Doctor Luo: Doctor Zhang Xichun recorded several cases of postpartum sinking of the chest qi — after childbirth a woman’s qi and blood are insufficient, and if she strains herself, the chest qi can sink. This case adds one more factor: injury from hot medicines. One of the doctor’s key diagnostic signs was the left pulse sunken and faint, almost gone — when the great qi collapses, the left pulse empties first.
A small detail: why did Shenghua Tang work at first?
Someone will ask: then why did the first round of Shenghua Tang make her feel better? Doctor Zhang Xichun explained it in one sentence: because Shenghua Tang contains chuanxiong (Sichuan lovage root), and this herb lifts upward — that single ingredient raised the qi, and so the formula seemed to work.
💬 Note from Doctor Luo: This detail is so important — chuanxiong lifts and raises, which quietly matches the principle that "qi that sinks downward must be lifted upward." So the reason Shenghua Tang worked at first was not the blood-invigorating action at all; it was the chuanxiong lifting the qi.
The prescription: Shengxian Tang, with zhimu increased to 8 qian and xuanshen 6 qian added
So what to do? Doctor Zhang Xichun used Shengxian Tang (Raise the Sinking Qi Decoction) — a formula Doctor Luo has discussed many times, whose principal herb is huangqi (astragalus). Doctor Zhang Xichun adjusted it: he raised the zhimu (anemarrhena) in the formula to 8 qian, and added xuanshen (figwort root) 6 qian.
Here there is a subtlety: as a rule, cold medicines are forbidden after childbirth — but in this situation there was no choice. The woman’s body was burning too hot, and more than a month had already passed since the delivery, so this formula was used.
💬 Note from Doctor Luo: Shengxian Tang is Doctor Zhang Xichun’s famous formula for sinking chest qi: sheng huangqi (raw astragalus) greatly tonifies the great qi of the chest; zhimu is cool and moistening and checks the heat of astragalus; chaihu (bupleurum) and shengma (cimicifuga) — with jiegeng (platycodon) in the original — lift the qi upward. In this case the heat signs were overwhelming, so Doctor Zhang Xichun enlarged the zhimu to 8 qian and added xuanshen 6 qian specifically to clear that heat. "No cold medicines after childbirth" is the usual rule, but "when the pattern is present, use the medicine that fits it" — Doctor Zhang Xichun never clung rigidly to convention.
One dose: the chills and fever stopped, and she could eat again
What was the result? After a single dose, the chills and fever ceased, and her thirst was gone. Before this, she had been unable to eat for two days; from this dose onward, she could take food again. Only a slight pain below the ribs remained.
💬 Note from Doctor Luo: One dose — fever gone, thirst gone, appetite back. That is the power of an accurate diagnosis. When the direction is right, you do not need many medicines; a single dose shows the result.
Winding up: two doses of Liyu Shengxian Tang — complete recovery
For the lingering pain below the ribs, Doctor Zhang Xichun prescribed Liyu Shengxian Tang (Regulate Stagnation and Raise the Sinking Qi Decoction) — one of his own signature formulas. After two more doses, she was completely cured.
In all, from beginning to end, it took only three doses.
💬 Note from Doctor Luo: You see, friends — masters like this are truly hard to find nowadays. Why has Doctor Zhang Xichun influenced so many people? Because his treatments really did work. This woman was in a dreadful state — freezing cold, desperately ill — and Doctor Zhang Xichun cured her with just three doses. When I wrote my book This Is Chinese Medicine (《这才是中医》), I placed Doctor Zhang Xichun at the very front — why? Because I feel he represents one of the very highest levels of Chinese medicine: accurate diagnosis and uniquely masterful prescriptions.
What this case says to women: take good care of yourselves
What does this case teach us? Women sometimes exhaust their qi and blood to an extreme degree — especially during a miscarriage or childbirth. If at such a time they over-consume their upright qi (zheng qi) — in the old days natural labor demanded great effort, and nowadays many women, after a miscarriage, pay no attention and go straight back to work — then sinking of the chest qi can result. This was a special point Doctor Zhang Xichun emphasized.
So, ladies, learn to protect yourself: when your qi and blood have been seriously depleted, you must rest, do not overwork. Even during menstruation you should take care to rest — that is only right and proper. But the pace of modern life is frantic and work pressure is heavy, so many women keep working right through it — and if the upright qi is damaged at such a time, the body will develop problems.
💬 Note from Doctor Luo: This case reminds us to protect ourselves. After childbirth, after a miscarriage, during the menstrual period — these are all times of qi and blood deficiency, and you must set aside time to rest. Do not tough it out. Once the upright qi is hurt and the chest qi sinks, getting it back is hard. Let us learn about sinking chest qi step by step — I hope everyone gains a deeper understanding of their own body.
(Compiled from Doctor Luo Dalun’s explanations of Doctor Zhang Xichun’s case records; the case is from Yixue Zhongzhong Canxi Lu, Records of Chinese Medicine with Reference to Western Medicine.)