Pro.

Gao Huiyuan's Experience in Treating Fever

mebo posted on May 26, 2009 07:12
By Yu Youshan
(Norman Bethune International Peace Hospital, Shijiazhuang 050082,
Hebei Province, China)
Dr Gao Huiyuan, a chief physician of the PLA 305 Hospital, was appointed in
199l as one of the national TCM tutors. He learned medicine from the famous
TCM physician Dr Pu Fuzhou. Going in the research and practice of TCM for
more than 50 years, he is extraordinarily good at the treatment of fever.
Under the guidance of Dr Gao, We have learned quite a lot in clinical practice
from his deliberate differential methods for diagnosis and treatment of fever
The following is a brief account of his unique academic ideas and rich clinical
experience.
Fever due to Wind-Cold
Fever with aversion to cold, headache and general pain, anhidrosis, pale
tongue with
white coating, and superficial-tense pulse results from the stagnation of
pathogenic
wind-cold on the superficies of the body. Dr Gao treats Tangyang fever
based on the
differentiation of the six meridians, with the formula for relieving the
exterior syndromes using the drugs pungent and warm in nature. For the
mild cases, he often uses Xing Su San (Apricot kernel and Perilla Powder)?
plus Congchi (Bulbus Allii Fistulosi and Semen Sojae Praeparatum)?to
disperse the pathogenic wind-cold, relieve the exterior syndrome and dispel
the pathogenic heat, and activate yang and induce diaphoresis. As a result,
remarkable therapeutic effect is obtained without any impairment of the body
fluid. For severe cases, he uses Mahuang Tang (Ephedra Decoction )?to
induce diaphoresis and open the pores. He does not approve of those who
regard all fevers as "inflammation" and use indiscriminately those drugs
bitter and cold in nature to clear away the heat and toxic materials. He warns
his students not to put the one-sided stress on "cooling the heat for the cold
syndrome", but to put a thorough study on the real connotation of TCM
differentiation so as to grasp the principles of treatment and to avoid any
grave mistakes.
A typical case report of wind-cold attacking the lung (virus pneumonia):
A male patient aged 20 years had been admitted into the hospital for five
days because of fever The x-ray examination showed patchy shadows on his
right lower lung. Although there was a temporary drop of the body
temperature due to sweating induced
by intravenous drip of antibiotics, and oral administration of western
antipyrtics and
herbal medicine for clearing away heat and toxic materials, the fever rose
again afterwards. During the consultation by Dr Gao, the patient was still
suffering from a high fever of 39.2oC with aversion to cold. He also
presented with headache and general pain, anhidrosis, cough, dyspnea and
choking, pale tongue with white coating, and superficial-rapid pulse. It was

dignosed as attack of the lung by pathogenic wind-cold, and Yue Bi Tang

(Decoction for Relieving Edema )? and Banxia Tang
(Decoction of Pinellia )?were prescribed. The recipe consisted of
Mahuang (Herba Ephedra) l0g, Xingren (Semen Armeniacae Amature) l0g,
Ziwan (Radix Asteris) 10g, Fuling (Poria) l0g, (Fa) Banxia (Rhizoma Pinelliae
Preparata) l0g, (Chao) Suzi (Parched Fructus Perillae) l0g, (Sheng) Shigao
(Gypsum Fibrosum, decocted first) 20g, (Zhi) Gancao (Radix Glycyrrhizae
Preparata )5g, Chenpi (Pericarpium Citri Reticulatae) 8g, Sheng Jiang
(Rhizoma Zingiberis Recens) 3 pieces, and Dazao (Fructus Ziziphi Jujubae) 5.
Having taken 4 doses of the above prescription, the patient had his cold
dispelled and fever subsided. The x-ray examination showed
disappearance of the lung shadows.
Comment: The reason why the patient's body temperature rose again
even after the
sweating induced by anti-inflammatory and antipyretic western drugs
and Chinese herbs was that the superficial pathogenic factors had not been
eliminated and the body fluids were greatly impaired due to the sweating. By
stressing on the pathogenesis, Dr. Gao stuck to the principle of using
pungent drugs for dispersion while warm drugs for inducing perspiration. The
disease was therefore cured only with four doses when the pathogenic windcold was expelled and the dispersion of lung-qi was regained. Dr. Gao also
advised us that bitter and cold drugs can't be used for all the pneumonia
cases without any differentiation, otherwise the pathogenic cold might be
stagnated to bungle the treatment.
Fever due to Wind-Heat
Fever with or without aversion to cold, thirst, red tongue with yellow
coating and little
fluid, and superficial-rapid pulse are the major characteristics of
stagnation of pathogenic wind-heat on the superficies of the body Dr. Gao
holds that pungent, cool, aromatic, and tasteless drugs with mild actions can
be used first to open and disperse the inhibited lung-qi. Drugs pungent and
warm in nature should be cautiously used, for the wrong use of these drugs
may, like fanning the fire with fire, lead to consumption of yin-essence by the
excessive heat. If this condition is mixed with
stagnation of pathogenic cold, mild pungent or warm drugs can be used
for relieving the exterior syndrome. However, the transferred use of cool
drugs should be followed
immediately after the cold and heat are cleared away yet overuse of the
drugs should be avoided.
A typical case report of wind-heat syndrome (upper respiratory tract
infection): A
28-year-old male patient complained of fever of 38.7oC, accompanied
with aversion to cold, general aching, slight thirst, cough, red tongue with
thin-yellow coating, and superficial-rapid pulse. The symptoms refused to
subside even after a 3-day administration of drugs pungent and warm in
nature. On the contrary such symptoms as thirst, spontaneous perspiration,
cough, and body temperature became even worsened. In the consultation,
Dr. Gao diagnosed it as a wind-warm syndrome, and

prescribed the patient with the modified Yin Qiao San (Powder of
Lonicera and Forsythea)? a light diaphoretic prescription with drugs
pungent and cool in nature. The prescription includes Yinhua (Flos Lonicerae)
l0g, Lianqiao (Fructus Forsythiae) 10g, Zhuye (Folium Bambusae) 10g,
Huafen (Radix Trichosanthis) l0g, Jiegeng (Radix Platycodi) 6g, Xingren
(Semen Armeniacae Amarum) 6g, Niubangzi (Fructus Arctii) 6g, Lugen
(Rhizoma Phragmitis) l5g, Bohe (Herba Menthae) 3g, and Gancao (Radix
Glycyrrhizae) 5g. Only after two doses, the patient was completely cured
with the fever gone and thirst checked.
Comment: For this case, mild, pungent and cool diaphoretic prescription
should be
used first to disperse the lung qi. Dr. Gao gave his treatment based on an
overall analysis of symptoms and signs. Since the patient had already been
treated with warm diaphoretic drugs, it would not be necessary for him to be
treated again with pungent diaphoretic drugs. Therefore, in Dr. Gao's
prescription, drugs pungent in nature like Jingjie (Herba Schizonepetae) and
Douchi (Semen Sojae Preparatum) were left out, while those bitter, sweet,
cool in nature like Xingren (Semen Armeniacae Amarum), and Huafen (Radix
Trichosanthis) were added, thus resulting in an immediate and wonderful
effect after only two doses.
Alternate Attacks of Chills and Fever
Alternate occurrence of fever and aversion to cold, bitter taste in mouth,
dry throat, irritability, nausea, red tongue with yellow coating, and wiry pulse
are the manifestations of the heat stagnated in the Shaoyang Meridian due to
disorder of qi. There is still an argument on the concept of alternate attacks
of chills and fever. In Dr. Gao's opinion, "alternate attacks of chills and fever
means that there is no fever when there is chills, and vice versa, with several
alternate attacks a day This syndrome should be treated by expelling the
pathogenic factors from both the exterior and interior of the body,
administering bitter and pungent drugs at the same time; acquiring balance
by reducing the excess; and jointly applying the reinforcing
and reducing methods.
The following is a sample case of heat stagnation in the Shaoyang
Meridian? A 36year old male patient had got alternate attacks of chills and fever for
more than one week. His condition was characterized by reduction of the
sustained fever for several hours after sweating followed by aversion to cold,
with a body temperature between 37.8oC -- 38.5oC, distress and discomfort
feelings in the chest and hypochondrium, vexation, general weakness, poor
appetite, dull tongue with white-greasy coating, and wiry-rapid pulse. It was
diagnosed by Dr. Gao as stagnation of pathogenic factors in the Shaoyang
Meridian due to disorder of qi. The modified Xiao Chaihu Tang (Minor
Decoction of Bupleurum )was used in the treatment, which included Chaihu
(Radix Bupleuri) l0g, Huangqin (Radix Scutellariae) 10g, Taizishen (Radix
Pseudostellariae) 10g, Cangzhu (Rhizoma Atractylodis) l0g, Chishao (Radix
Paeoulae Rubra) l0g, Douchi (Semen Sojae Preparatum) l0g, Jianqu (Massa
Fermentata Medcinalis) 10g, (Fa) Banxia (Rhizoma Pinellie Preparata)6g,
(Sheng) Yiren (Semen Coicis) 15g, Zhizi (Fructus Gardeniae) 8g, and (Zhi)

Gan Cao (Radix Glycyrrhizae Preparata) 5g. Three doses of the above
Prescription induced mild general diaphoresis. The patient was then cured
with normal body temperature and disappearance of
all the symptoms.
Comment: this condition belongs to alternate attacks of chills and fever with
no
obvious signs of both the exterior syndrome and the interior syndrome.
Therefore, it was considered as being caused by the struggle between the
vital energy and the pathogenic factors half exteriorly and half interiorly. In
the treatment, Dr. Gao only
used three doses of Xiao Chaihu Tang? The pathogenic factors both in
the exterior and interior were cleared away and the alternate chil1s and fever
were cured. From this case, we can see Dr Gao's flexible use of classical
prescriptions.
High Fever Without Chills
High fever with aversion to heat is a sign of inward transmission of
pathogenic heat
into the qi system. It is characterized by high fever, excessive thirst,
hyperhidrosis, red
tongue with yellow coating, and full and rapid pulse. If the heat invades
the Ying and blood systems, high fever with coma and delirium, and clonic
convulsion, or with hemorrhage, ecchymosis and petechiae on the skin, darkred tongue with yellow coating, and thready-rapid pulse will appear. Dr Gao's
therapeutic principle for this syndrome is clearing away heat by using the
drugs cool in nature. However in clinical practice, he never sticks to the fixed
rules, but treats the disease through careful differentiation, and prescribes
the drugs in accordance with the nature of the pathogenic factors and status
of the body constitution. For patients with weak constitution and mild
invasion of pathogenic factors, he would rather insufficiently use the drug
cool in nature than over dosed.
Here is a sample case of "summer-heat (viral cold)": A postpartum
woman of 28
years old had had high fever for 5 days. The delivery happened in the
sultry summer. She was diagnosed as postpartum fever and given Sheng
Hua Tang (DecoctiOn for Postpartum Troubles)?plus Bu Xue Tang (BloodTonifying Decoction )?with Danshen (Radix Salviae Miltiorrhizae) and
Dihuang (Radix Rehmanniae). The response was poor and the condition of
the patient became even worse. Then, she was treated by Dr Gao. The
patient had a high fever of 39.2oC, with excessive thirst, diaphoresis,
headache, flushed face, vexation, red tongue with yellow coating,
yellow urine, dry stool, and full and rapid pulse. Dr Gao prescribed her
with Bai Hu
Tang (White Tiger Decoction)?plus Xiyangshen (Radix Panacis
Quinquefolii). The
ingredients include Xiyangshen (Radix Panacis Quinquefolii) l0g, (Sheng)
Shigao

(Gypsum Fibrosum) 20g, Zhimu (Rhizoma Anemarrhena) 6g, Gancao

(Radix Glycyrrhizae) 5g, and husked rice 15g. After taking three doses of the
above prescription, the pulse became normal, and the fever subsided.
Comment: In treating postpartum fever, Dr Gao is not restrained by the
concept that after delivery warm drugs are indicated while cool drugs are
contraindicated. Being pungent and cool, Bai Hu Tang?was once strictly
prohibited. However the cure of the case has proved that there is no
hesitation in the use of Bai Hu Tang?under such a condition. Otherwise,
the body fluid would be exhausted by high fever. In addition, administration
of Xiyangshen (Radix Panacis Quinquefolii) after the delivery may produce
the effect of strengthening the body resistance to eliminate pathogenic
factors.
Afternoon Fever
Tidal fever or fever worse in the afternoon, accompanied with red face
and eyes,
.excessive thirst, abdominal fullness, constipation, yellow or thorny
tongue coating,
and deep-rapid pulse are all the manifestations of accumulation of heat
pathogen in the intestines. It should be treated by purging the bowels and
clearing away heat. The ancient physicians held that purgation should be
timely adopted to preserve yin; hence,
purgative therapy is not exclusively prohibited in the treatment of febrile
diseases.
A typical case report of accumulation of heat in the Yangming Meridian
(viral
encephalitis): A l8-year-old female patient had had fever for one week,
which got worse in the afternoon. Administration of Chinese herbal medicine
for clearing away heat and toxic materials couldn't make the condition any
better. At the time when Dr. Gao gave the consultation, the patient presented
with a body temperature of 40.3oC, red eyes, irritability, coma and delirium,
slight cold limbs without sweat, fullness and slight hardness in the abdomen,
constipation, nausea and vomiting, grimy-sticky tongue coating, and deeprapid-forceful pulse. It was diagnosed as accumulation of heat in the
Yangming Meridian. The modified Xiao Cheng Qi Tang?was then used. The
recipe includes Dahuang (Radix et Rhizoma Rhei) l0g, Zhishi (Fructus Aurantii
Immaturus) l0g, Yinhua (Flos Lonicerae) l0g, Yujin (Radix Curcumae) l0g,
Chishao (Radix Paeoniae Rubra) 10g, Taoren (Semen Persicae) l0g, Yuanshen
(Radix Scrophulariae) l5g, Lianqiao (Fructus Forsythiae) 15g, Lugen
(Rhizoma Phrgmitis) l5g, Gouteng (Ramulus Uncariae cum Uncis) l5g, Houpo
(Cortex Magnoliae Officinalis) 8g, and (Zhi) Gancao (Radix Glycyrrhizae
Preparata) 5g. After administration of five doses of the above prescription, all
the symptoms disappeared. Then, drugs for nourishing yin and the stomach
were prescribed until the patient was complete1y cured.
Commnt: This is a case of accumulation of pathogenic heat in the
Yangming Meridian. However drugs for clearing away heat and toxic
materials and for nourishing Yin could not bring down the fever when
purgative drugs were used. The exterior syndrome was improved as soon as
the interior syndrome was relieved.

Recessive Fever
Fever, heaviness of the head, feeling of stuffiness in the chest and
stomach, poor appetite, and white-thick-greasy tongue coating are the
characteristics of accumulation of dampness-heat. In Dr Gao's opinion, the
mixture of dampness and heat makes the condition more complicated. The
principle of treatment should be eliminating both the
dampness and heat, neither of which should be neglected It is improper
to eliminate the heat without removing the dampness or only remove the
dampness without clearing away the heat. A good physician should flexibly
treat both the dampness and heat at the same time, using the slight bitter,
pungent, and tasteless drugs. Drugs tasteless and slightly warm and
aromatic in nature are selected when dampness prevails, while drugs
pungent, tasteless, and bitter in nature are used for those with prevailing
heat, so as to remove the dampness and expel the heat by promoting the Qi
circulation.
The following is a case of damp-heat (acute hepatitis B) treated by Dr
Gao: A male
patient of 40 years old had had a fever of 37.6oC-38.2oC for two weeks.
He also had
headache, abdominal distention, hypochondriac pain, poor appetite,
aversion to oily food, unformed stool and yellow urine. The lab examinations
showed HBsAg positive,
glutamic-pyruvic transaminase (GPT) 86U/L.His tongue was red with
white-greasy and yellowish coating, and the pulse was thready wiry and
rapid. It was diagnosed as
retention of dampness-heat in the middle-jiao, and the patient was
treated by eliminating dampness and heat, regulating the spleen and
stomach, and soothing the liver and gallbldder. The modified Gan Lu Xiao Du
Yin (Sweet Dew Detoxication Decoction)?was prescribed, consisting of
Yinchen (Herba Artemisiae Scopariae) 15g,
Huangqin (Radix Scutelleriae) 10g, Lianqiao (Fructus Forsythiae) 10g,
Fuling (Poria)
l0g, Huashi (Talcum) 10g, Zhizi (Fructus Gardeniae) l0g, Doukou (Ren)
(Fructus Amomi Rotundus) l0g, zhiqiao (Fructus Aurantii) l0g, Doujuan
(Semen Sojae Germinatum) 10g, and Tongcao (Medulla Tetrapanacis) 3g.
After administration of l4 doses of the above prescription, the patient's
temperature turned normal, with all the symptoms removed and appetite
improved. But the tongue coating was still white-sticky and the pulse wiryslow. The prescription was modified to regulate the liver
and spleen and to eliminate the dampness-heat. Houpo Xia Ling Tang
(Decoction of
Agastrachis, Magnolia, Pinellia and Poria)?was used, which included
Houpo (Cortex Magnoliae Officinalis) l0g, Baizhu (Rhizoma Atractylodis
Macrocephalae) l0g, Fuling (Poria) 10g, Yinchen (Herba Artemisiae
Scopariae) l0g, Zexie (Rhizoma Alismatis) 10g, Maiya (Fructus Hordei
Germinatus) l0g, Zhuling (Polyporus Umbel1atus) 10g, Banxia (Rhizoma
Pinelliae) 6g, Doukou (Ren) (Fructus Amomi Rotundus) 6g, and (Sheng)
Yiyiren (Semen Coicis) l5g. Eighteen doses of the above prescription were

given before the patient was found with normal GPT. Administration of
another 12 doses of drugs for regulating the spleen and stomach was
followed, which resulted in
complete recovery of the patient.
Comment: This case was caused by failure of the liver in promoting free
flow of qi
due to disturbance of the spleen and stomach and accumulation of
dampness-heat. At
the beginning, drugs slightly bitter, pungent and tasteless in nature were
used to eliminate the dampness and heat. After administration of the
modified Gan Lu Xiao Du Yin? the dampness prevailed. Therefore, the
modified Houpo Xia Ling Tang?with drugs pungent, tasteless, and slightly
warm and aromatic in nature was used.
However in the whole course of the treatment, the principle adopted was
regulating the spleen and stomach, and soothing the liver and gallbladder.
Thus, it can be seen that treating the fundamental aspect of a disease has
always been Dr Gao's experience in his differential treatment of diseases,
which is really worth learning.