High Fever Won't Budge — A *Shanghan* Formula Brings Recovery as if by Marvel
Beijing Cui Yueli Center for Traditional Medicine — Xiang Hong
Early-spring Beijing — biting cold; spring chill yet sharp. Though grass has slipped through the ground, showing dots of green, winter's cold still keeps pedestrians in fur coats and padded jackets, scarves and hats.
At noon a phone call: an 82-year-old woman, suddenly externally invaded with a high fever of 39.5 °C, with nausea, vomiting, cough, sore throat, nasal congestion, aversion to cold. She asked the doctor to come. Professor Fan and I took the task — to see her.
At her bedside: face waxy yellow, eyes faintly closed, breath thick, spirit listless; cough now and then; vomiting up Chinese medicine and mucus.
The little aide said: from morning she had had 38 °C; she took two packs each of Zheng Chaihu Yin, Lingqiao Jiedu Chongji, and Zhi Sou San. By afternoon the fever had not gone but risen. In the afternoon she had vomited twice — herbal liquid and phlegm. Now the temperature reading was 39.5 °C. Professor Fan, taking the pulse, asked: "Sweating?" She: "No sweat." "Stomach uncomfortable?" She: "Yes."
Stepping out of the bedroom, Professor Fan said: "The surface pattern is unrelieved, inside there is heat, beneath the heart it is bound. We should use Da Qinglong Tang combined with Xiao Xianxiong Tang." He wrote the prescription:
raw mahuang 6 g (decoct first, skim foam) | guizhi 9 g | raw shigao 45 g (decoct first)
gualou 12 g | fa-banxia 6 g | huanglian 3 g (cracked) | zhishi 6 g | stir-fried xingren 6 g
zhi-gancao 6 g | fresh ginger 3 slices | dazao 4 pieces — one dose.
At 7 p.m. the patient took the decoction; due to stomach discomfort she again vomited it and mucus. By 9:30 p.m. the fever still had not dropped, mind unclear, occasional rambling speech; by dawn the fever rose to 40.4 °C. One pack of Zixue San (1.5 g) was given; twenty minutes later, fever fell to 38.5 °C.
The next morning Professor Fan wrote another formula: Xiao Chaihu Tang, Xiao Xianxiong Tang, with raw shigao 30 g, guizhi 9 g, dahuang 6 g — one dose. After the dose, the patient began to pass loose stool with phlegm-like matter; temperature fell to 37.8 °C. On the third day, 37.1 °C — she could take rice porridge. The previous formula with jiegeng 9 g, xingren 9 g added, two more doses; the temperature fell to 36.7 °C.
Shanghan Lun, line 38: In Greater-Yang wind-stroke, the pulse is floating-tight, fever, aversion to cold, body ache, no sweat, restless and agitated — Da Qinglong Tang governs.
The patient was generally fond of sweet and oily food, with the disposition to form phlegm-fluid; Da Qinglong Tang is in fact a formula for yi-yin (overflow fluid). Yi-yin means fluid running and going, gathering at the four limbs; should sweat but does not — the outer surface is unrelieved, the inside has heat. Da Qinglong Tang is in effect Mahuang Tang plus raw shigao, fresh ginger, dazao: Mahuang Tang to release the surface pattern; raw shigao to clear inner heat; ginger and dazao to harmonize the middle and strengthen the stomach.
This year's external-invasion high fevers come heavily with stomach-bowel signs; many patients on a week of IV drip still have unbroken high fever. Professor Fan, with this shanghan formula — relieving surface heat and clearing inner heat together — used only one or two doses to cure the 82-year-old's fever. A marvelous touch, a medicine that strikes home.
Professor Fan often says: humans receive nature's whole qi; things receive nature's leaning qi. TCM treatment is to use the herb's leaning to correct the body's leaning. Humans live in nature: follow the four seasons and live; defy them and die.
By five-movements-six-qi: last year was metal-ruling-movement; the winter climate was unusually cold; cold evil bound the surface. Add the Spring-Festival feasting on rich, sweet, greasy fare — gastrointestinal stagnation; so heat is held within. The Neijing: "Wounded by cold in winter, surely warm-disease in spring." This spring's host qi is jueyin wind-wood, guest qi yangming dry-metal; metal restrains wood; wood-qi cannot rise — heat is further pent up. So this spring's external invasion is best treated by simultaneous outer-and-inner release. At the first sign of cold, Fangfeng Tongsheng Wan — outwardly dispersing wind-cold, inwardly clearing inner heat — is best. The center is now studying Chai Qin Ganmao Granules, with still finer effect.
So one sees: TCM's marvel in treatment is inseparable from her Heaven and the human as one thought, her treating by place, by time, by person pattern-discernment.