Fever for 8 Days After Childbirth, Until Convulsions? Doctor Wu Jutong’s Postpartum Wind-Warm Case — Not One Heat-Clearing Herb, Just Nourishing Yin to Break the Fever
Patient search terms: fever after childbirth / fever after giving birth / fever that won’t break for seven or eight days / fever rising until convulsions / postpartum convulsions / sweating a lot
Medical terms for this condition: postpartum exterior contraction · postpartum convulsions (chan hou jing feng) · warm disease (wen bing; puerperal fever)
Opening: on the 12th day of the fourth month, a woman who had been feverish for seven or eight days
Doctor Wu Jutong — the great master of the Warm Disease school and the founder of triple-burner pattern differentiation (san jiao bian zheng) — received a woman patient that day. She was 30 years old. The year was the ding-hai year — 1827, the 12th day of the fourth month — spring.
💬 Note from Doctor Luo: The moment you hear this case, you frown — postpartum wind-warm. She had just given birth, and then she caught a warm disease; heat evil had wounded her body. In those days this was one of the most difficult situations imaginable.
Who was the patient? Just after childbirth, she ran into “wind-warm”
This woman’s trouble began with one word: postpartum. Right after giving birth, the body is at its weakest — and into that weakness came wind-warm, a variety of warm disease common in spring, caused by heat evil attacking the body.
💬 Note from Doctor Luo: Catching an exterior illness during pregnancy is bad enough — every medicine has to be weighed against the fetus, just as in Western medicine you must deliberate before giving antibiotics. Chinese medicine is the same; one careless prescription and the baby may be lost. After childbirth it is equally troublesome: the body is desperately weak, and most postpartum women are yang deficient — cold, cooling herbs simply knock them flat. So the dosage balance is extremely hard to strike. And yet this patient had caught a warm disease — heat evil — so you could not avoid cooling herbs altogether. That was the difficulty.
How sick was she? Spontaneous sweating, high fever that wouldn’t break — and finally, convulsions
Her symptoms? Spontaneous sweating — sweat pouring out of her on its own. Body heat that would not break for seven or eight days. And when he felt her pulse, it was racing (mai shu — a rapid pulse).
What’s more frightening — she had convulsions! The fever rose until she went into spasms. In folk language this is called “postpartum convulsions” (chan hou jing feng).
💬 Note from Doctor Luo: Why would a postpartum woman convulse? Doctor Wu Jutong’s judgment: the yin fluids inside her were insufficient. The liver governs the sinews, and the sinews must be moistened by yin fluids and body fluids. When yin fluids are depleted, the sinews are not nourished, and a person goes into spasms. The evil he spoke of travels deeper and deeper into the body along the upper, middle and lower burners — the further the evil penetrates, and the more the yin fluids drain away, the worse the illness becomes.
Doctor Wu Jutong’s thinking: “insufficient yin fluid” — so he reached for the Pulse-Restoring formula
The strategy Doctor Wu Jutong used is called the Fu Mai (Pulse-Restoring) method — and he added one particular instruction: “you must begin light and only then go heavy” — don’t start with large doses.
💬 Note from Doctor Luo: The Fu Mai Tang is the Zhi Gan Cao Tang (Honey-Fried Licorice Decoction), the formula of Zhang Zhongjing. What is it for? After an exterior illness has damaged both qi and yin — especially when the external evil has wounded the heart, producing jie dai mai (a knotted, skipping pulse) and xin dong ji (palpitations) — a heart that skips beats and races wildly. The core pattern is qi-yin dual damage: yin deficient and qi deficient at the same time. The Fu Mai Tang rebuilds the material the body needs for qi and blood to circulate, so the pulse returns to normal — that is why it is called “Fu Mai,” restoring the pulse.
The Fu Mai Tang is a kind of seesaw — in it sit yang-tonifying herbs, yin-nourishing herbs, qi-tonifying herbs and fluid-supplementing herbs, adjusted according to the situation. This patient was convulsing, which told him that yin-fluid deficiency was the chief contradiction, so the yin-nourishing herbs had to be increased and the yang-warming ren shen (ginseng) and gui zhi (cinnamon twig) had to be removed.
Prescription breakdown: the Fu Mai formula without the warming herbs — not a single heat-clearing, toxin-resolving herb
The first prescription: xi sheng di (raw rehmannia), 4 qian (about 12 g) — it cools the blood and carries a light heat-clearing, heat-venting quality; after childbirth cooling herbs are usually avoided, but when wind-warm has truly been contracted they must be used — mai dong (ophiopogon), with the core left in (it supplements body fluids and nourishes yin), huo ma ren (hemp seed), 2 qian (about 6 g) — it moistens dryness and carries oil; people usually know it as a laxative, but it is also very kind to the heart, nourishing yin and moistening — sheng bai shao (white peony) — it astringes liver yin and nourishes yin — mu dan pi (moutan bark), 3 qian (about 9 g) — it drains liver fire — zhi gan cao (honey-fried licorice), 1 qian (about 3 g), sheng bie jia (fresh turtle shell, broken up), 5 qian (about 15 g) — it nourishes yin and clears heat, and can drill into the most hidden, subtle network vessels to push the evil outward — and e jiao (donkey-hide gelatin), 2 qian (about 6 g). In all, three cups, taken in three doses.
💬 Note from Doctor Luo: Notice — compared with the Zhi Gan Cao Tang, this formula has dropped the yang-warming ren shen and gui zhi, no sheng jiang (fresh ginger) either, and has added bie jia, mu dan pi and bai shao — the yin-nourishing power is greatly strengthened. Why? Because her convulsions were rooted precisely in yin-fluid deficiency.
Two days later: the fever broke, but the pulse was still fast — keep nourishing yin
On the 14th day of the fourth month, two days later, Doctor Wu Jutong saw her again: the body heat had already broken — after seven or eight days of fever, it was finally down! But the pulse was still racing — still yin deficiency.
So he wrote a second formula: dan shen (salvia), 3 qian (about 9 g) — it invigorates the blood — sheng di (raw rehmannia), 3 qian — nourishes yin — sheng mu li (raw oyster shell) — nourishes yin and anchors the yang — bai shao (white peony) — astringes yin — bie jia (turtle shell) — nourishes yin, anchors yang, and strips out the evil — ma ren (hemp seed), 3 qian, mai dong (ophiopogon), 3 qian, zhi gan cao (honey-fried licorice), mu dan pi (moutan bark), 3 qian — clears a little deficient heat — and e jiao (donkey-hide gelatin), 3 qian — nourishes yin. Decocted thick into three cups, taken in three doses, finished within two days — and the illness was cured.
💬 Note from Doctor Luo: A tiny case record, cured in two consultations — it looks plain. But the genius of a great physician is exactly what hides inside this plainness. Let’s take the reasoning apart piece by piece — the scholarship inside is vast.
Why did an exterior-warm disease get not a single heat-clearing, toxin-resolving herb?
Here is the big question: this was clearly a warm disease, heat evil. Most people would think — shouldn’t you use lian qiao (forsythia), jin yin hua (honeysuckle), di ding (violet), huang qin (skullcap) — the heat-clearing, toxin-resolving herbs — to “kill the virus”? Doctor Wu Jutong used none of them!
💬 Note from Doctor Luo: You must understand — “clearing heat and resolving toxin,” “killing viruses and bacteria,” is actually the Western way of thinking. Lian qiao, jin yin hua and pu gong ying (dandelion) do have bacteria- and virus-killing actions, but in Chinese medicine’s eyes they are simply heat-clearing, mass-dissolving medicines. Chinese medicine treats the person. Why do you catch an exterior illness? The Yellow Emperor’s Inner Canon said it long ago: “xie zhi suo cou, qi qi bi xu” — wherever evil gathers, the qi must have been deficient first. Your upright qi was the first to fail, and only then could the evil get in.
How does upright qi fail? Improper diet and overwork, and the internal injuries of the seven emotions — you wreck your own body from the inside. Where it fails differs: the qi-deficient person is listless all day, tongue edges scalloped with teeth marks, tired at the slightest motion and sweating at the slightest motion; the yang-deficient person is usually afraid of cold, wearing more clothes than everyone else; the yin-deficient and blood-deficient person has insufficient body fluids and deficient heat inside — like a riverbed gone dry: where a hundred soldiers of the immune force should be shipped in, only fifty can be carried. When the weather turns cold, the qi- and yang-deficient catch colds first; when the weather suddenly turns hot, the yin-deficient sweat and lose still more fluids, and when the wind blows, the exterior evil slips in.
💬 Note from Doctor Luo: This postpartum woman is the classic case: she may have been yin deficient all along; childbirth drained a great deal of blood, making her yin blood even scarcer; then came the warm fourth-month weather — a little heat and she sweated in torrents, and with the sweat went still more of her body fluids. The exterior evil entered through the gap, drilled deeper and deeper, and in the end the fluids could no longer moisten even the channels and sinews — so she convulsed. If you had looked at her tongue then: a red tongue, with very thin coating — the classic yin-deficient picture; and because the fluids were depleted, her urine output would also have fallen, since the water was all escaping through sweat. At such a moment, would it help just to clear the exterior evil? No! This was a lesson I learned in medical school, and it is a principle many Chinese medicine doctors still do not understand: when the enemy has invaded, and your own country’s people have no food and no ammunition, if you fight for them they cannot keep up — you win one battle, and the enemy comes right back. So when deficiency of upright qi is the main contradiction, strengthening upright qi is the key.
Strengthening upright qi IS releasing the exterior: the great wisdom of Chinese medicine with exterior diseases
That is why Doctor Wu Jutong used nothing but e jiao, sheng di, mai dong, bai shao, bie jia — yin-nourishing herbs. Once the yin is topped up, the fever naturally breaks.
💬 Note from Doctor Luo: Some people shake their heads when they hear of tonic herbs for an exterior disease: “You can’t use ren shen during an exterior illness! You can’t use e jiao!” — This is completely the talk of people who do not understand Chinese medicine! A person with genuinely insufficient upright qi who catches an exterior illness is exactly the one who must have upright qi strengthened. For yang deficiency, use ren shen and gui zhi to warm the yang; for qi deficiency, in my own clinic I often use the bu zhong yi qi (Tonify the Center and Boost Qi) line of thinking — dang shen, fu ling, bai zhu, dang gui — and the moment it goes in, patients who have burned with fever for days feel like “a cool, clear world has opened up” — they come back to life. The Si Jun Zi Tang (Four Gentlemen Decoction) and Liu Jun Zi Tang (Six Gentlemen Decoction) follow exactly this road. On the other hand, if you take fang feng tong sheng, du huo, qiang huo and drive outward, driving and driving — that is worse; the upright qi cannot keep up, the more you take the weaker you get, and the virus clings on and on. During the pandemic, some doctors used yin-nourishing and qi-tonifying formulas to “release the exterior” and were challenged by other Chinese medicine doctors. I said: that criticism comes from not yet understanding the relationship between upright qi and evil. When deficiency of upright qi is severe, strengthening upright qi IS releasing the exterior; strengthening upright qi IS saving the patient.
Of course, the proportions must be weighed: how much deficiency, how much evil, whether dampness is present inside — while nourishing yin you must be careful not to feed dampness. This is the craft of Chinese medicine.
Bonus: what should a person with insufficient upright qi do when they catch an exterior illness?
At the end, Doctor Luo Dalun offers one plain, honest piece of advice:
💬 Note from Doctor Luo: A person with strong upright qi catches a cold and any small remedy settles it — a patent medicine, Xiao Chai Hu, a cold-flu granule, even a bowl of hot-and-sour soup or a bit of moxibustion; tell cold from heat and almost anything works. But if you are the sort who is listless all day and knows your body is a wreck, and an exterior illness will not resolve after days — that means your upright qi can no longer organize a defense, and at that point you absolutely must strengthen upright qi. That is why I have always argued: during an exterior illness you can eat a little shan yao (Chinese yam) powder — yam greatly tonifies the lung, spleen and kidney, and builds upright qi; only when upright qi rises can it push the evil out. Someone may object: “How can yam release the exterior?” It is the same principle as bu zhong yi qi releasing the exterior. But — don’t take this backwards: it does not mean every cold should be treated with bu zhong yi qi or Zhi Gan Cao Tang. Those are for people whose upright qi is already depleted — people with strong upright qi do not need them. Knowing which kind you are is the key.
Arranged from Doctor Luo Dalun’s commentary on Doctor Wu Jutong’s case records; the case is from Wu Jutong’s Case Records (postpartum section).