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Fever Due to Impairment of Internal Organs

Fever other than that due to exogenous pathogenic factors is grouped under this category. Its basic mechanism is the dysfunction of the zang-fu organs and the deficiency of qi, blood, yin and yang. Fever of this kind usually has an insidious onset and a prolonged course and manifests itself as low fever (high fever on occasion), subjective fever or a feverish sensation over palms, soles and the chest but without a rise in body temperature.

Fever of functional and unknown origins and that occurring with tumors, blood diseases, tuberculosis, endocrine diseases, diseases of connective tissue and some chronic infectious diseases may be differentiated and treated with the principles mentioned in this section.

Etiology and Pathogenesis

A. Cases with asthenia-syndrome are usually due to: (1) a constitution with yin-deficiency, a prolonged seasonal febrile disease or heat-syndrome, chronic diarrhea or an erroneous or overuse of drugs with warm-dryness nature, leading to consumption of yin-essence, so that yin becomes deficient, yang hyperactive and water fails to control fire; (2) consumption of heart and liver blood after a long-term disease, inability to produce blood due to spleen deficiency or blood loss due to various cases, which leads to insufficiency of yin-blood and then floating up of yang; or (3) a constitution with yang-qi insufficiency, impairment of yang after a prolonged cold-syndrome or erroneous or overuse of drugs of a cold nature, leading to deficiency of yang-qi and internal domination of yin-cold, with the deficiency yang dispelled to the superficies.

B. Cases with sthenia-syndrome usually occur as a result of: (1) overstrain, improper food intake or derangement after a long-term disease which leads to deficiency of the spleen-qi and stomach-qi and endogenous production of yin-fire; (2) mental depression with dysfunction of liver, which leads to the stagnated liver-qi changing with fire; or (3) emotional upset, overstrain and trauma, leading to retention of blood stasis and stagnation of qi. However, the asthenia and sthenia syndromes may exchange with each other.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Identification of the cause of fever: fever caused by impairment of internal organs is characterized by insidious onset, prolonged course, intermittent occurrence over a definite period of time, fever without chilliness and usually accompanied by a feverish sensation over palms, soles and the chest, dizziness, mental fatigue, spontaneous perspiration, night sweating and no subsidence of fever after sweating. Fever due to exogenous pathogenic factors is marked by an acute onset and a short course and is usually accompanied by chilliness, nasal stuffiness and discharge, headache, sore throat and subsidence of fever after sweating.

(b) Differentiation between asthenia and sthenia syndromes: Fever due to impairment of internal organs mostly manifests itself as asthenia-syndrome, but whether qi or blood, yin or yang, is predominantly deficient and which zang-organ is involved should be determined. In cases with sthenia-syndrome, it should be differentiated whether qi stagnation or blood stasis is present.

(c) Identification of the severity of disease: A case is considered more serious when its course is longer, the fever higher and sustained the complications greater in number, the conditions intractable, the stomach-qi exhausted and the healthy qi more deficient, and vice versa.

B. Therapeutic principles

The therapies of nourishing yin and clearing away heat, benefiting qi and strengthening the spleen, tonifying qi and blood, warming yang and invigorating the kidneys, releasing the stagnated liver-qi, activating blood circulation and eliminating blood stasis are the principles commonly employed. In addition, tonifying therapy is recommended for cases with asthenic fever, and the therapy of releasing stagnated qi and removing blood stasis is recommended for sthenic fever. Indiscriminate use of drugs with dispersing action and those of bitter-cold nature for purging fire is inadvisable. Moreover, as fever of this kind is a chronic disease, protection of the stomach and spleen must be emphasized, and overuse of tonics or application of large dosages should be avoided.

Classification and Treatment

A. Fever due to yin deficiency

Manifestations: Afternoon or night fever, feverish sensation over palms, soles and the chest, flushed cheeks, hectic fever, dryness of mouth and throat, insomnia, dreamfulness, vexation, night sweating, red and dry tongue with fissures and little coating and thready and rapid pulse.

Therapeutic principles: Nourish yin, and clear away heat.

Prescription: The Modified Powder for Clearing Away Heat from Bone

Radix Stellariae 12 g
Herba Artemisiae Annuae 12 g
Cortex Lycii Radicis 10 g
Rhizoma Picrorrhizae 10 g
Rhizoma Anemarrhenae 10 g
Carapax Trionycis 10 g
Concha Ostreae Usta (decocted first) 30 g
Radix Scrophulariae 15-30 g

Remarks: Add Fructus Tritici Levis, Os Draconis Usta and omit Artemisiae Annuae for cases with marked night sweating. Add Radix Rehmanniae for cases with severe dryness of mouth and throat due to marked yin-deficiency. Add Radix Adenophorae Strictae, Radix Ophiopogonis and fructus Schisandrae for cases with dizziness, shortness of breath and fatigue.

B. Fever due to blood deficiency

Manifestations: Low fever, dizziness, fatigue, palpitations, pale complexion, lips and nails, pale tongue and thready and weak pulse.

Therapeutic principles: Benefit qi, and nourish blood.

Prescription: The Modified Decoction for Invigorating the Spleen and Nourishing the Heart

Radix Astragali 15 g
Radix Codonopsis Pilosulae 10 g
Poria 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Angelicae Sinensis 10 g
Radix Polygalae 10 g
Radix Glycyrrhizae Praeparata 6 g
Semen Ziziphi Spinosae 10 g
Pericarpium Citri Reticulatae 10 g

C. Fever due to qi-deficiency

Manifestations: Fever induced or aggravated by overstrain, dizziness, shortness of breath, fatigue, spontaneous sweating, susceptible to catching cold, poor appetite, loose stool, pale and corpulent tongue with thin white coating and thready and weak pulse.

Therapeutic principles: Benefit qi, strengthen the spleen, and clear away heat by sweet-warm drugs.

Prescription: The Modified Decoction for Strengthening Middle Jiao and Benefiting Qi

Radix Codonopsis Pilosulae 12 g
Radix Astragali 12 g
Rhizoma Atractylodis Macrocephalae 10 g
Poria 10 g
Radix Glycyrrhizae Praeparata 6 g
Pericarpium Citri Reticulatae 10 g
Rhizoma Dioscoreae 10 g

D. Fever due to yang deficiency

Manifestations: Low fever, cold extremities, pale complexion, fatigue, soreness over the loins and knees, morning diarrhea, dysuria or frequent urination, pale and corpulent tongue with teeth marks on its margin and white coating and deep and thready or floating and feeble pulse with weak chi pulse.

Therapeutic principles: Arm yang, and tonify the kidneys.

Prescription: The Modified Pill for Invigorating Kidney-Qi

Radix Rehmanniae Praeparata 12 g
Rhizoma Dioscoreae 12 g
Poria 15 g
Fructus Corni 10 g
Rhizoma Alismatis 10 g
Fructus Psoraleae 10 g
Cortex Cinnamomi 5 g
Radix Aconiti Lateralis Praeparata 6-10 g
Rhizoma Atractylodis Macrocephalae 10 g

Remarks: Add Radix Codonopsis Pilosulae and Radix Astragali for cases with shortness of breath and debility due to yang-deficiency and weakness of qi.

E. Fever due to stagnated liver-qi

Manifestations: Fever varying with emotional changes, irritability or mental depression, distention and oppression over the chest and hypochondrium, bitter taste in the mouth, dryness of throat, irregular menstruation, dysmenorrhea, distention of the breasts, thin, yellow tongue coating and wiry and rapid pulse.

Therapeutic principles: Release the stagnated liver-qi, and clear away liver-heat.

Prescription: The Modification of Xiaoyao Powder of Moutan Radicis and Gardeniae

Radix Bupleuri 10 g
Radix Paeoniae Rubra 10 g
Radix Paeoniae Alba 10 g
Radix Angelicae Sinensis 10 g
Herba Artemisiae Annuae 12 g
Poria 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Herba Menthae 3 g
Cortex Moutan Radicis 10 g
Fructus Gardeniae 10 g

Remarks: Add Cortex Lycii Radicis, Radix Cynanchi Atrati and omit Atractylodis Macrocephalae for cases of serious heat-syndrome with dryness of mouth and constipation. Add Radix Gentianae and radix Scutellariae for cases with redness of face and eyes and irritability due to stagnated qi changing into fire. Add Radix Curcumae, Rhizoma Cyperi, Fructus Toosendan and Pericaripium Citri Reticulatae Viride for cases with distention of chest and hypochondrium or breast distention before menstruation due to sever stagnation of qi. Add Massa Fermentata Medicinalis, Fructus Crataegi, Fructus Hordei Germinatus and Endothelium Corneum Gigeriae Galli for cases with poor appetite and fullness of the stomach due to inhibition of the spleen by stagnated liver-qi.

F. Fever due to blood stasis

Manifestations: Afternoon or night fever, feverish sensation over a certain part of the body, dryness of throat without desire for drink, localized pain or mass pain over the trunk or limbs, harshness of skin or squamous and dry skin, sallow or dark complexion, dark purplish tongue with petechiae and ecchymoses and thready and uneven pulse.

Therapeutic principles: Activate blood circulation, and eliminate blood stasis.

Prescription: The Modified Decoction for Removing Blood Stasis in the Chest

Flos Carthami 10 g
Semen Persicae 10 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Rubra 10 g
Radix Achyranthis Bidentatae 10 g
Radix et Rhizoma Rhei (prepared with wine) 6 g
Radix Rehmanniae 10 g
Rhizoma Cyperi 10 g

Remarks: Add Radix Scrophulariae, Cortex Lycii Radicis and Radix Cynanchi Atrati for cases with severe dryness of mouth and throat. Add Radix Astragali and Rhizoma Atractylodis Macrocephalae for cases with Significant shortness of breath and debility. Add Ramulus Cinnamomi for cases with aversion to cold and coldness of limbs.

Copyright 1995 Hopkins Technology

 


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