Tuesday, February 21, 2012

Symptomatic Diagnosis: Fever & Chills


Chinese medicine has a long history, back to the year 200 at least, of treating viral and bacterial infections. This article describes the differentiations, treatment principles and formulas for said infections and indications such as:
Aversion to wind and cold along with chills
Shivers or “severe chills”
Alternating fever and chills
Aversion to heat without chills
Tidal fever (low grade fever)
Five center heat
Night sweats

Aversion to wind and cold along with chills

  • Exterior syndrome

    Fever and chills caused by wind, though it can be combined with other factors.
    • Muscle aches, headache
    • Wind with cold
    • Chills and aches
    • Formula:
      • Ma Huang Tang (Ephedra Decoction)
      • Ma Huang is currently banned in USA. Replacement: consider Qiang Huo Sheng qi Tang (Notopterygium Decoction to Overcome dampness)
    • Wind with heat
    • Fever and sore throat
    • Formula:
      • Yin Qiao San (Honeysuckle and Forsythia Powder)
    • Wind with damp
    • stuffiness, aching in joints
    • Formula:
      • Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome dampness)
  • yang deficiency

    Clinical Manifestations:
    • Aversion to cold
    • Cold hands and feet
    • Fatigue, bloating, gas, loose stools (Spleen yang deficiency)
    • Palpitations, shortness of breath, fatigue, cyanosis (Heart yang deficiency)
    • Low back pain, frequent urination, infertility or impotence, low libido (Kidney yang deficiency)
    Formula:
    • Heart yang deficiency, use Gui Zhi Tang (Cinnamon Twig Decoction) with more Zhi Gan Cao (Honey-fried Licorice Root) and using Rou Gui (Cinnamon bark) instead of Gui Zhi (Cinnamon twig)
    • Spleen yang deficiency, add Li Zhong Tang
    • Kidney yang deficiency add Jin Gui Shen qi Tang AKA Ba Wei Di Huang Wan
  • Yang Collapse (more severe than yang deficiency)

    Clinical Manifestations:
    • Feeble or faint pulse
    • Very low energy
    • Confusion and disorientation
    • Cold sweat, cold body, cold extremities
    • Low blood pressure
    • Patient prefers fetal position
    • Diarrhea with undigested food
    • Clear copious urine
    Treatment principle:
    • Restore yang from Collapse
    Formula:
    • Shen Fu Tang (Ginseng and Prepared Aconite Decoction)
    • Note: this is a critical state and emergency biomedical treatment is indicated.
  • True Heat, False Cold

    An excess condition due to a variety of etiologies which pushes the yin from the interior to the superficial.
    Clinical Manifestations:
    • Cold symptoms externally
    • Aversion to cold
    • Cold skin (which warms upon prolonged touch)
    • Warm symptoms internally
    • Doesn’t desire warm clothes
    • Bad breath, constipation
    • T: Red with yellow coat (hint on the interpretation of “false” signs, the “tongue doesn’t lie”)
    • P: Forceful and Rapid
    Formula:
    • Bai Hu Tang (White Tiger Decoction)
  • phlegm Accumulation

    A condition in which a yin evil blocks the flow of yang energy, leading to aversion to cold.
    Clinical Manifestations:
    • Thirst, with no desire to drink
    • Aversion to cold
    • T: Thick greasy white coat
    • P: Slippery
    Formula: Er Chen Tang (Two Aged Decoction)

Shivers or “Severe Chills”

  • Exterior syndrome

    Severe stagnation caused by exterior factors, skin pores close, Wei qi pushes up against the closed pores in an attempt to push out the pathogenic factor. This creates shivering.
    • Formula:
      • Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction)
  • Febrile Disease

    Any attack of pathogenic heat. According to Wen Bing theory, the heat is generally located in the Wei and qi stages.

Alternating fever and chills

  • Shao Yang disease

    Clinical Manifestations:
    • Bitter taste in mouth
    • Dry mouth
    • Chest and hypochondriac discomfort
    • Irritability
    • Nausea and vomiting
    • T: Red tip with thin yellow coat
    • P: Wiry
    Treatment principle
    • “Harmonize interior and exterior” which means disperse exterior and clear interior.
    Formula:
    • Xiao Chai Hu Tang (Minor Bupleurum Decoction)
    Note: Chai Hu (Rx. Bupleurum) doesn’t get along well with interferon therapy. Avoid using both at the same time.

Aversion to heat without chills

An interior excess condition effecting the Lung and Stomach
  • Hot phlegm in Lung (Phenomena, Bronchitis)

    Clinical Manifestations:
    • Fever
    • Cough
    • Chest pain
    • Sputum is thick and yellow, brown, or green
    • Thirst
    • Constipation
    • Note: one can also remove heat from Lungs by purging the bowels when constipation is present.
    • T: Red with thick greasy yellow coat
    • P: Rapid and slippery
    Formula:
    • Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction)
  • Yang Ming Jing Disease (Stomach channel)

    No chills because the pathogen is too far interior
    Clinical Manifestations:
    • “Four Big Symptoms”
    • Big thirst
    • Big fever
    • Big sweating
    • Big pulse
    Formula:
    • Bai Hu Tang (White Tiger Decoction)
  • Yang Ming Fu (Large Intestine organ disease)

    Clinical Manifestations:
    • Heat leads to…
    • Fever
    • Constipation
    • Bloating
    • Palpable hardnesses in abdomen (dry stool)
    • P: Deep, strong, rapid (due to heat) or slow (due to stagnation)
    Formula:
    • Da Cheng Qi Tang (Major Order the Qi Decoction)
  • Ying (Nutritive) or Xue (blood) level syndromes (Pericardium heat)

    Clinical Manifestations:
    • High fever (104 degrees F. and above)
    • Mental manifestations (confusion, delirium, etc…)
    • T: Red tongue with scanty, or no coat (yin deficiency)
    Formula:
    • Important herbs include: Xi Jiao (rhino horn, no longer used), Ling yang Jiao (antelope horn) and Shui Niu Jiao (water buffalo horn)
    • Qing Ying Tang (Clear the Nutritive Decoction)

Tidal fever (Low grade fever which comes and goes on a regular basis like the tide)

  • yin deficiency

    Clinical Manifestations:
    • Low grade fever in the afternoon or evening
    • Five center heat
    Formula:
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia)
  • Qi deficiency (Spleen/Stomach qi deficiency

    Clinical Manifestations:
    • Low grade fever at no regular time
    • Fever + qi deficiency symptoms
    Formula:
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
  • Blood stagnation (Late stage stagnation leads to blood deficiency, as in late stage cancer)

    Clinical Manifestations:
    • Low grade fever in evening
    • Aches
    • Dry skin
    • Dark circles under eyes
    • Tumor formation
    • T: Purple
    • P: Choppy and thready
    Treatment principle:
    • Remove blood stagnation
  • Yang Ming Fu syndrome (Large Intestine)

    Clinical Manifestations:
    • Low fever possible, due to stagnation
    • Fever
    • Constipation
    Formulas:
    • Da Cheng Qi Tang (Major Order the Qi Decoction), or any of the related “Cheng Qi Tang” formulas.

Five Center Heat

  • yin deficiency with deficiency heat

    Clinical Manifestations:
    • Five center heat, which is heat manifesting on the yin surfaces of the body, such as
      the palms, bottom of the feet, and the chest.
    • Night sweats, hot flashes.
    • T: Red, narrow, scanty coat
    • P: Thin and rapid
    Treatment principle
    • Nourish yin, remove heat
    Formula:
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) (Tonifies yin)
    • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) (Clears deficiency heat)
    Important herbs:
    • Huang Bai (Cx. Phellodendri), Zhi Mu (Rz. Anemarrhenae). Bitter and cold, they cool both deficiency and excess heat.
  • blood deficiency leading to deficiency heat.

    Clinical manifestations:
    • Five center heat especially in the afternoon and evening.
    • Fatigue, poor appetite, palpitations, dizziness, vertigo, pale complexion.
    • T: Pale
    • P: Thready, soft, or choppy.
    Treatment principle:
    • Nourish blood
    Formula:
    • Si Wu Tang

Night Sweats (Think Heart, since sweat is the fluid of the heart)

  • Heart blood deficiency

    Clinical manifestations:
    • Night sweats
    • Palpitations, insomnia, pale complexion, fatigue
    • T: Pale
    • P: Weak
    Treatment principle:
    • Tonify Heart blood, astringe sweat.
    Formula
    • Si Wu Tang, plus an astringent such as Wu Wei Zi (Fr. Schisandrae), Long Gu (Os Draconis), Mu Li (Concha Ostreae), Fu Xiao Mai (Fr. Tritici).
    • Gui Pi Tang (Bolster the Spleen Decoction)
  • Yin deficiency with deficiency heat.

    Clinical manifestations:
    • Night sweats
    • Palpitations, insomnia, pale complexion fatigue
    • T: Red with scanty coating
    • P: Thin and rapid
    Treatment principle
    • Tonify yin
    Formula:
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) + astringent such as Fu Xiao Mai (Fr. Tritici).

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