Fever - Fa Re
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Definition
In TCM, fa re is not only referring to higher than normal body temperature, but also referring to the hot feelings in certain parts of the body, e.g. in the middle of the palms, soles and the chest, the so-called “hot feelings in the 5 Centers.”
Causes and Pathological Mechanisms
- Fa re is classified into 2 groups: excess re (shi re) and deficiency re (xu re).
- Excess re (Shi Re): fa re caused by exogenous attacks of the 6 exogenous evils and warm-heat evils are mostly excess re. This type of fa re is seen in hot-nature diseases and infectious diseases. Also called “wai gan fa re” (exogenous attack fever).
- Deficiency re (Xu Re): fa re caused by internal damages in the body, abnormal Zang Fu organ functions, consumption and Qi Deficiency, Blood Deficiency and fluid deficiency. All these lead to the imbalance between Yin and Yang and result in fa re. This type of fa re is seen in chronic diseases and consumptive diseases. Also called “nei shang fa re” (internal damage fever).
- In the cause of a disease, because of the struggle between the Genuine Qi and the Evil Qi, pathological transformation can happen and excess re can become deficiency re. This transformation is the result of damages to the Yin and Yang and the destruction to the Genuine Qi.
Patterns
Exterior Cold
- Symptoms: Fever without sweating, aversion to cold, headache with stiff and painful neck, body and joint pain.
- Tongue: Thin white tongue coating
- Pulse: Floating and Tight
- Treatment strategy: Pungency and warmth to relieve the exterior
- Formula: Ma Huang Tang
- Acupoints:
Exterior Heat
- Symptoms: Fa re with little or no aversion to cold, headache, thirst and a sore throat.
- Tongue: Yellowish-white tongue coating
- Pulse: Floating and Rapid
- Treatment strategy: Pungency and cool to relieve the exterior
- Formula: Yin Qiao San
- Acupoints:
Evils in Shaoyang
- Symptoms: Alternate chill and fever, chest and hypochondriac distension, bitter mouth, dry throat, dizziness, vexation, nausea and a poor appetite.
- Tongue:
- Pulse: Wiry
- Treatment strategy: Harmonise shaoyang
- Formula: Xiao Chai Hu Tang
- Acupoints:
- Symptoms: Alternate chill and fever but more fever than chill, or fa re in the afternoon, chest and hypochondriac pain, epigastrium distension, retch and vomit, vexation, bitter mouth, poor appetite, dizziness and yellow urine.
- Tongue: Yellow or yellow and greasy tongue coating
- Pulse: Rapid and Wiry or Slippery
- Treatment strategy: Resolving dampness and clearing heat
- Formula: Hua Qin Qing Ban Tang
- Acupoints:
Dampness blockage in Mo Yuan
- Symptoms: Alternate chill and fever, or fa re in the afternoon, headache with heavy feelings, fatigue, chest and epigastrium distension, frequent sighing, thirst but no desire to drink.
- Tongue: White and greasy or rotten tongue coating
- Pulse: Soggy and Rapid
- Treatment strategy: Disperse and clear Mo Yuan
- Formula: Da Yuan Yin
- Acupoints:
Qi Stage - Warm Heat - Yangming extreme Heat
- Symptoms: High fever, dysphoria, profuse sweating and thirst for fluids.
- Tongue: Red tongue with yellow coating
- Pulse: Surging, Large and Rapid
- Treatment strategy: Clear heat and generate fluid
- Formula: Bai Hu Tang
- Acupoints:
Qi Stage - Warm-heat - Stomach and intestines Heat masses
- Symptoms: High fever higher in the afternoon, constipation, distending abdomen refusing palpation, dysphoria and delirium.
- Tongue: Rough yellow or dry black tongue coating with prickles
- Pulse: Rapid and Forceful or Deep and Forceful
- Treatment strategy: Purging excessive heat
- Formula: Da Cheng Qi Tang
- Acupoints:
Qi Stage - Damp Heat - Damp-heat blockage in the chest
- Symptoms: Fever, red face, thirst for drinks, chest and epigastrium distension with pain when palpated, nausea and vomiting with constipation.
- Tongue: Yellow and greasy tongue coating
- Pulse: Slippery and Rapid
- Treatment strategy: Clear heat and resolve dampness, unlock the chest and resolve blockage
- Formula: Xiao Xian Xiong Tang
- Acupoints:
Qi Stage - Damp Heat - Damp-heat blockage in the Middle Jiao
- Symptoms: Fever in the afternoon, fever recedes after sweating but recurs soon after, chest distension, nausea, vomit, diarrhea, short and yellow urine.
- Tongue: Yellow and greasy tongue coating
- Pulse: Soggy and Rapid
- Treatment strategy: Separate and clear heat and dampness
- Formula: Wang Si Lian Po Yin
- Acupoints:
Qi Stage - Damp Heat - Damp-heat blockage in the Stomach and the intestines
- Symptoms: Chest and abdominal burning heat, vomit, loose and sticky bowels with yellow and jam-like feces.
- Tongue: Thick yellow and greasy tongue coating
- Pulse: Deep and Slippery
- Treatment strategy: Clear and purge damp-heat
- Formula: Zhi Shi Dao Zhi Tang
- Acupoints:
Ying Stage and Xue Stage - Heat invasion in ying and xue
- Symptoms: High fever worse at night, not too thirsty, dysphoria and disturbance, mapules and papules, bleeding, coma and delirium.
- Tongue: Red and crimson or dull purple tongue with little fluid
- Pulse: Small and Rapid
- Treatment strategy: Clear heat and cool the blood to resolve the mapules and stop bleeding
- Formula: Hua Ban Tang and/or Xi Jiao Di Huang Tang
- Acupoints:
Ying Stage and Xue Stage - Heat invasion in Pericardium
- Symptoms: High fever worse at night, dysphoria and disturbance and delirium.
- Tongue: Red crimson and dry tongue with yellow coating
- Pulse: Rapid
- Treatment strategy: Clear ying, cool the blood and opening up the orifice
- Formula: Qing Ying Tang
- Acupoints:
Ying Stage and Xue Stage - Heat stirring up Liver Wind
- Symptoms: High fever, coma, spasm and convulsion or even opisthotonos.
- Tongue: Red or crimson tongue with yellow coating
- Pulse: Wiry and Rapid
- Treatment strategy: Clear heat to stop the wind
- Formula: Ling Jiao Gou Teng Tang
- Acupoints:
Qi Stage and Xue Stage extreme Heat
- Symptoms: High fever, profuse sweating, thirst for drinks, dysphoria, hidden mapules and papules.
- Tongue: Red or crimson and dry tongue
- Pulse: Rapid
- Treatment strategy: Clear qi and cool the blood
- Formula: Qing Wen Bai Du Yin
- Acupoints:
Late stage of wai gan fa re - Evils linger in the Yin
- Symptoms: Low and persistent fever worse in the afternoon or evening, tiredness, vexation and insomnia and heat in the 5 centers.
- Tongue: Red tongue with no coating
- Pulse: Wiry, Thready and Rapid
- Treatment strategy: Nourish yin and clear heat
- Formula: Qing Hao Bie Jia Tang
- Acupoints:
Late stage of wai gan fa re - Blood Deficiency generates Wind
- Symptoms: Low fever, floating red face, dysphoria, palpitation and tics or even spasms in the limbs.
- Tongue: Red tongue with no coating
- Pulse: Thready and Rapid
- Treatment strategy: Nourish yin and blood, calm the liver and stop wind
- Formula: San Jia Fu Mai Tang
- Acupoints:
Zang Fu organ, Qi and Blood Deficiency - Yin Deficiency fever
- Symptoms: Tidal fever and bone steaming, vexation, hot feeling at 5 centres, reddened cheeks, night sweat, insomnia, seminal emission, cough with little phlegm and traces of blood and a dry throat with a rough voice.
- Tongue: Red tongue
- Pulse: Thready, Weak and Rapid
- Treatment strategy: Nourish yin and lower the fire
- Formula: Qin Jiao Bie Jia Tang
- Acupoints:
Zang Fu organ, Qi and Blood Deficiency - Qi Deficiency fever
- Symptoms: Low fever, tiredness, short of breath, weak feelings, spontaneous sweating and aversion to wind and a poor appetite.
- Tongue: Pale tongue with thin white coating
- Pulse: Large but Empty
- Treatment strategy: Reinforce the middle and tonify qi
- Formula: Bu Zhong Yi Qi Tang
- Acupoints:
Zang Fu organ, Qi and Blood Deficiency - Blood Deficiency fever
- Symptoms: Low fever, wilting complexion, tiredness, indolence of speech, reduced appetite, palpitation and dizziness.
- Tongue: Pale tongue
- Pulse: Thready and Weak
- Treatment strategy: Tonify qi and blood
- Formula: Gui Pi Tang
- Acupoints:
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