Recent Experiences and Lessons in Treating Various Febrile Diseases with Chinese Medicine

Deep winter and the height of summer have always been high-incidence seasons for various febrile diseases. In midsummer, febrile diseases often come on fiercely; if treatment is not timely, the patient's high fever persists and the situation becomes extremely dangerous. There are many causes of febrile disease; some belong to externally contracted febrile diseases, while others do not—for example, cancer fever is different from externally contracted febrile disease. When the causes differ, the treatment methods differ as well. The key to treating disease in TCM is pattern differentiation and treatment, but accurate pattern differentiation and precise treatment that cures the disease at once can, in the end, only ever be an ideal. Recently I have treated various febrile diseases, with both successes and failures. I now record several successful and failed cases for readers' reference and correction. Case 1: Back pain after summer air-conditioning, patient not yet febrile. This patient lives in Inner Mongolia; several of her relatives have been treated by me. On July 1, 2018, the patient suddenly had severe back pain, could not sweat, and felt as though the cervical spine were blocked. She asked for my help. I surmised that this was caused by summer air conditioning—indulging in coolness and comfort, which had blocked all the pores of the body. It belonged to the Gegen Tang pattern of "stiff and tight neck and back." Judging from the presentation, although she was not yet febrile, a fever was not far off. It was appropriate to treat immediately at the onset with a sweating method. I prescribed: Mahuang (Ephedra) 9g, Guizhi (Cinnamon Twig) 9g, Baishao (White Paeony) 9g, Gegen (Pueraria) 12g, Zhi Gancao (honey-fried Licorice) 6g, Shengjiang (Fresh Ginger) 5 slices, Dazao (Jujube) 5 pieces. The patient consulted at around five in the afternoon; upon receiving the prescription she went to buy the herbs. After decocting, she drank one dose, slept, and woke at eight-thirty in the evening already cured. Amazed at how quickly it worked, she asked what had caused the illness. I told her: the air conditioning. Many TCM physicians in clinical practice are bound by the ancient maxim "do not use Mahuang in summer," and dare not use Ephedra in summer. In my experience, modern people's lifestyles are very different from those of the ancients; air conditioning has become commonplace. So in summer many people develop cervical spondylosis and various joint and muscle pains from air conditioners and fans. For such patients, as long as the pattern differentiation is correct, using Gegen Tang and boldly using Mahuang is entirely appropriate. Case 2: Persistent high fever in a lymphoma patient. The patient, Tan, from Yingtan, Jiangxi, had been receiving moxibustion from her family all year. This summer she ate some melons and fruits; after a bath, she suddenly developed a high fever. She was admitted to the internal medicine department of Peking University Third Hospital for antibiotic treatment, but after IV infusion the fever grew worse, eventually reaching around 40°C. On July 2, 2018, her family invited me to make a house call at the hospital. The patient was sweating and averse to wind; the tongue coating was fairly normal; the pulse was soft and soggy with a slight thin-wiry quality. No bitter or dry mouth; slight discomfort below the ribs. She had previously tried Xiaochaihu Tang granules without effect. Based on this presentation, I judged this to be a Guizhi plus Chaihu Tang pattern, and prescribed Guizhi Chaihu Tang. After one day it had no effect. I then switched to Guizhi Tang; after taking it, the fever dropped somewhat, from a high of 40°C to about 38.5°C, but it would not come down further. Later I adjusted the prescription several times, with the same result. After taking Guizhi Tang, she also had one episode of hemorrhoidal bleeding. Her family looked things up online and thought it resembled a Sanren Tang indication, so they tried Sanren Tang, also with poor effect. But while looking up Sanren Tang, the family found lecture videos by Professor Pei Yongqing of Beijing University of Chinese Medicine, found them quite convincing, and went to Professor Pei for a prescription. After pattern differentiation, Professor Pei judged it still to be a Sanren Tang indication, and added a few herbs: Xingren (Apricot kernel) 9g, Qing Banxia (prepared Pinellia) 12g, Fuling (Poria) 30g, Yinchen (Artemisia capillaris) 30g, Baikouren (Amomum fruit) 3g, Bai Tongcao (Tetrapanax pith) 6g, Zhuling (Polyporus) 15g, Mutong (Akebia) 6g, Sheng Yiyiren (raw Coix) 30g, Huashi (Talcum) 30g, Zexie (Alisma) 18g, Cangzhu (Atractylodes) 15g, Houpo (Magnolia bark) 3g, Zhuye (Lophatherum) 6g, Huoxiang (Agastache) 3g, Sheng Shigao (raw Gypsum, decocted first) 30g. After the second visit, he changed the formula once more: Xingren 9g, Qing Banxia 12g, Fuling 30g, Yinchen 30g, Baikouren 3g, Bai Tongcao 6g, Zhuling 15g, Sheng Yiyiren 30g, Huashi 30g, Zexie 18g, Cangzhu 15g, Houpo 3g, Zhuye 6g, Huoxiang 3g, Sheng Shigao (decocted first) 30g, Huangqin (Scutellaria) 10g, Lianqiao (Forsythia) 10g. Professor Pei had the patient take two doses a day, each dose divided into two intakes—four intakes daily. After the fever subsided, it was changed to one dose a day, morning and evening. Three days later, the fever was gone and the patient was at peace. It so happened that I had two other patients in Beijing with persistent cancer fever whom I had treated for many days without reducing the fever. Seeing how effectively Professor Pei had brought down the fever, I recommended him to these two patients and urged them to go see him. In one case, the patient could not leave home and the plan fell through; the other was still undergoing some Western debridement treatment, and I do not know whether she went. Case 3: A late-stage cancer patient tormented by cancer fever and intestinal obstruction. The aforementioned patient who could not leave home had, in recent days, again developed fever from a tumor in the lower abdomen, and the tumor at that site had caused intestinal obstruction. The patient's daughter insisted that I treat her, so I decided to use a method that simultaneously releases the exterior and the interior, prescribing modified Zengye Tang combined with Baihu Tang: Xuanshen (Scrophularia) 30g, Maidong (Ophiopogon) 24g, Shengdi (Raw Rehmannia) 24g, Danggui (Angelica) 12g, Baishao (White Paeony) 12g, Mangxiao (Mirabilite) 30g (taken in two divided doses, dissolved in the decoction), Sheng Dahuang (raw Rhubarb) 20g (added later), Sheng Shigao (raw Gypsum, decocted first) 30g, Zhimu (Anemarrhena) 10g, Zhi Gancao (honey-fried Licorice) 6g, a small handful of rice. After the patient's daughter decocted the herbs, she had the patient drink half a bowl. A few hours later, the bowels moved, the fever came down, and the temperature fell to 37.1°C. By the way, the first seven herbs in this formula are a tried-and-true prescription I often use for incomplete intestinal obstruction. The dose of Dahuang must be large; when I use it heavily, I go up to 30 g. This experience is offered for reference. In addition, Baihu Tang is also a prescription I commonly use in summer for persistent high fever, with excellent results. This summer I used it to cure high fever in no fewer than ten people. The patient Professor Pei successfully treated after my own failure was also treated on the basis of Sanren Tang combined with half a dose of Baihu Tang. The typical indications for Baihu Tang are the "three bigs": a big flooding pulse, big profuse sweating, and big great thirst. These are symptoms that many patients easily develop after catching cold in the height of summer. But not all patients show all "three bigs" together, so in pattern differentiation, as long as the main symptoms appear, it can be used. Case 4: Patient with urinary retention (longbi) and persistent high fever. This was a gastric cancer patient in stable phase, treated long-term by me. This summer she suddenly developed urinary retention—no urine passed, with distending pain and discomfort. Western examination showed no abnormality; a day later she developed a high fever. She turned to me. I thought this might be an indication for Liuyi San, and prescribed: Huashi (Talcum) 30g, Gancao Shao (Licorice tip) 5g (later, unable to find licorice tip, I used raw Licorice instead). Three to six doses a day. After one dose, urination became free; after another dose, the fever subsided. I told the patient to stop once the fever resolved and to eat light food for two days. There was no recurrence. Case 5: Patient with unexplained agitation-heat and edema. This was a family member of a patient I treat. One day in late June 2018, the family told me that the patient had lately been agitated and feverish, with chest tightness, shortness of breath, and generalized fatigue. They turned to me for help. I judged this to belong to "deficiency vexation," a typical indication for Zhizi Chi Tang (Gardenia and Prepared Soybean Decoction). I prescribed: Zhizi (Gardenia) 10g, Dan Douchi (Prepared Soybean) 10g. After two doses, the family reported that the patient felt much lighter. But the family added that this time the patient also had swelling of the limbs. I then switched to Huangqi Fangji Tang to drain dampness and reduce swelling. Because the patient had already bought several days' worth of Zhizi Douchi Tang, she did not go buy Huangqi Fangji Tang and just kept drinking Zhizi Douchi Tang for several more days; afterward the edema also resolved. Had the patient listened to me and promptly bought Huangqi Fangji Tang, would the edema have resolved this quickly? It is hard to say. Sometimes, after accurate pattern differentiation and an effective result, one should not casually change the formula. This shows that treating febrile diseases cannot be done with one single universal formula, nor can all cold-damage formulas treat everything. In recent years I have studied the Shanghan Lun extensively, so unconsciously I always hope to get results with the cold-damage formulas; as a result I neglected the use of famous warm-disease formulas, and clinical results were unsatisfactory. In the end, studying medicine requires not being bound by sectarian boundaries but drawing widely from many sources to achieve higher efficacy.