Puerperal Fever

WESTERN MEDICINE: Puerperal fever in Chinese medicine includes the puerperal infection in western medicine. Puerperal infection may be presumed when the temperature is elevated to 100.4 F. or above for any two successive days after the first 12 to 24 hrs, a significant fever must be evaluated at least by examination of lungs and uterus, and cultures of the urinary tract and blood. The most common cause off ever in the early puerperium is dehydration. However, a febrile amnionitis during labor may be followed by secondary endometritis, myometritis, parametritis, and puerperal pyrexia. Febrile reactions appearing later are most frequently due to mastitis, though cystitis is not uncommon. Fever between the fourth and tenth days may be symptomatic of a developing femoral thrombophlebitis.

SYMPTOMS AND SIGNS: Successive fever after 12 hr. or 24 hr. of postpartum period, combined with other symptoms and signs, such as lower abdominal pain, refusal to press, or bleeding with strong odor, or alternate fever and chills, or aversion to cold. Red tongue or with petechiae, rapid and strong, or uneven, or weak pulse. 

ETIOLOGY AND PATHOLOGY: The pathogenic mechanism for puerperal fever is due to blood deficiency after giving birth, excessive Yang floating, and weak Yin nourishing Qi and Wei defending Qi. The following etiological factors are commonly seen in practice: 

  1. Puerperal fever is caused by the invasion of external pathogenic factors. 
  2. Puerperal fever is caused by the blood stasis due to giving birth. 
  3. Puerperal fever is caused by the infection of exogenous factors. 
  4. Puerperal fever is caused by blood deficiency. 

DIFFERENTIATIONS: 

1. Puerperal Fever due to Exogenous Factor:

Indications: Fever, aversion to cold, headache, sore or pain body, no perspiration, or cough, nasal discharge. White and thin tongue coating, floating pulse. 

Treatment & Formulas: Tonify the blood and dispel exogenous wind.

Products:

    •  Si Wu Tang (Tang - kuei Four Combination, Item No. 2060): Can be combined with Ren Shen Bai Du San (Ginseng and Mentha Formula, Item No. 2004). This combination of the two formulas is very good to treat puerperal fever due to exogenous cold factor. 
    • Yin Qiao San (Lonicera and Forsythia Formula, Item No. 2248): This treats puerperal fever due to the wind heat factor. 

2. Puerperal Fever due to Infection:

Indications: Fever, aversion to cold, lower abdominal pain, refusal to press, profuse or scanty bleeding, deep dark color, strong annoying odor, restlessness, thirsty, scanty yellowish urine, constipation, red tongue, yellow coating, rapid and strong pulse. 

Treatment & Formula: Clear heat, eliminate the blood stasis and cool the blood. 

Products:

    • Da Huang Mu Dan Pi Tang (Rhubarb and Moutan Combination, Item No. 2040): This is a strong formula to treat the infection and blood stasis at lower burner. 
    • Tao He Cheng Qi Tang (Persica and Rhubarb Combination, Item No. 2165): This is used for the patient with strong constipation and interior blood stasis. 

3. Puerperal Fever due to Blood Stasis: 

Indications: Alternate fever and chills, unsmooth or no uterine bleeding after giving birth, bleeding with dark purplish color, lower abdominal pain, refusal to press, dry mouth, thirsty without desire to drink. Dark purplish tongue or with peteachia, wiry and uneven pulse. 

Treatment & Formulas: Regulate blood and promote the circulation. 

Products:

    • Sheng Hua Tang (Tang - kuei and Ginger Combination, Item No. 2077): This is a very popular formula to use during postpartum period. It treats puerperal fever, uterine bleeding, lower abdominal pain due to blood stasis. 

4. Puerperal Fever due to the Blood deficiency:

Indications: Profuse postpartum bleeding, then showing lower fever, spontaneous sweating, dizziness, blurry vision, palpitation, insomnia, numb sensation of the Iimbs. Slight red tongue, thin coating, weak and slight rapid pulse. 

Treatment & Formulas: Tonify the blood and Qi together. 

Products:

    • Ba Zhen Tang (Tang - kuei and Ginseng Eight Combination, Item No. 2010): This is the typical formula for Qi and blood tonic.
    • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron, and Rehmannia Formula, Item No. 2123): This can be used for puerperal fever due to Yin deficiency.

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