🌿 Folk Prescriptions

High fever is a common complication after brain injury. While treating these cases, I observed that moderate to severe brain injuries predominantly affect young adults, and high fever reflects the struggle between pathogenic factors and vital energy. When we effectively suppress the pathogenic factors, excellent results are often achieved. Here are three illustrative cases.
Case 1: Ms. Yin, female, 40 years old. She sustained acute closed brain injury (severe type) due to a traffic accident and was admitted on May 20, 1998. Diagnosis: primary brainstem injury, hemorrhage in the right ambient cistern, scalp laceration, and fracture of the left upper limb. At admission, she was deeply comatose with respiratory distress and BP 24/14 kPa. Immediate treatments included hypothermia therapy, artificial respiration, anti-inflammatory measures, and dehydration therapy. After 48 hours, hypothermia therapy was discontinued, and her temperature gradually rose above 39°C, managed with ice blankets for physical cooling. Blood test showed WBC 10.7×10⁹/L, N: 91%, L: 9%. Western diagnosis: central fever post-primary brainstem injury with pulmonary infection. Despite treatment with ciprofloxacin, Xipixin, Stamicillin, and Tienam, improvement was minimal. On May 27, a consultation with TCM was requested. Examination revealed: high fever, coma, T 39°C, hot skin without sweating, scattered purple bruises across the body. Tracheostomy in place with audible phlegm sounds in the throat. Tongue red with yellow, rough coating; pulse stringy, slippery, rapid, and forceful. Diagnosis: phlegm-heat obscuring the clear orifices, blood stasis obstructing the brain meridians. Treatment: clear heat, resolve phlegm, remove blood stasis, and open the orifices. Prescription: Trichosanthes 18g, Pinellia and Bamboo Shreddings each 12g, Scutellaria, Calamus, and Curcuma each 9g, Ligusticum 3g, Houttuynia 15g, Angelica Root and Prepared Polygala each 6g, Antelope Horn Powder (to be taken separately) 0.6g. Four doses, one daily, decocted and administered twice daily via gastric tube. Follow-up on June 1: Still high fever, unconsciousness, T 40.5°C, no bowel movement for one week, tongue and pulse unchanged. Treatment: drain the root cause, purge heat, and expel pathogens. Modified Da Chengqi Decoction: Rhubarb (added last), Magnolia Bark, Mirabilite (dissolved) each 5g, Artificial Buffalo Horn (dissolved) 0.3g, Bamboo Shreddings and Gardenia each 12g, Fermented Soybean 6g, Antelope Horn Powder (dissolved) 12g, Trichosanthes 18g, Fried Citrus Aurantium and Calamus each 9g. Four doses, one daily, decocted and divided into two servings. After two doses, large amounts of foul-smelling stool were passed, temperature dropped to 38°C. After four doses, temperature was 36.8°C. Three additional doses were given to consolidate efficacy. Patient remained in light coma, breathing stable, reduced sputum, temperature did not rise again.
Case 2: Mr. Zou, male, 42 years old. Two days after brain injury, one day after right temporal intracranial hematoma surgery, admitted on June 22, 1998, with secondary brainstem injury post-surgery. At admission, unconsciousness. After receiving hypothermia therapy, artificial respiration, anti-inflammatory treatment, dehydration therapy, and lumbar puncture drainage to reduce intracranial pressure, consciousness improved. However, the wound on the right temporal region ruptured and split open, discharging purulent secretion and cerebrospinal fluid (CSF). High fever and confusion followed. Blood test: WBC 19.9×10⁹/L, N: 80%, L: 19%. CSF routine: yellowish slightly turbid appearance, positive Pandy test, total cell count 16×10⁹/L, white blood cells 11×10¹⁰/L, monocytes 42%, polymorphonuclear cells 58%. CSF biochemistry: glucose 19 mmol/L, chloride 80 mmol/L, protein 193 mg/L. CSF culture: Citrobacter freundii. Western diagnosis: infectious fever due to intracranial infection. Despite treatment with Cefepime, sulfonamides, Tienam, Rocephin, and An Gong Niu Huang Wan for clearing heat, detoxifying, resolving phlegm, and opening orifices, the condition failed to improve. On July 16, a TCM consultation was requested. Examination revealed: high fever, unconsciousness, T 39.3°C, hot skin, CSF leakage and purulent discharge from head wound, poor healing, aphasia, frequent urination with dark yellow urine, loose stools, red tongue with thin, greasy yellow coating, rapid and irregular pulse. Diagnosis: widespread damp-heat, toxic pathogen lingering in qi stage. Treatment: clear heat, promote diuresis, detoxify. Formula: Huo Pu Xia Ling Tang combined with Gan Lu Xiao Du Dan with modifications. Prescription: Agastache, Pinellia, Gardenia, Plantago Seed (wrapped) each 12g, Honeysuckle, Forsythia each 15g, Fermented Soybean, Balloon Flower Root each 6g, Coix Seed 25g, Curcuma, Scutellaria, Perilla Leaf each 9g, Magnolia Bark 5g, Antelope Horn Powder (to be dissolved) 0.6g. Four doses, one daily, decocted and divided into two servings. After taking the medicine, temperature gradually decreased, CSF leakage and purulent discharge reduced, wound began healing. Follow-up on July 24: T 37.8°C, confused consciousness, abundant phlegm in throat, no bowel movement for two days, red tongue with greasy yellow coating, slippery and rapid pulse. Treatment: clear heat and phlegm, assist with purgation. Prescription: Trichosanthes, Poria each 18g, Starfish Rhizome, Pinellia, Gardenia, Red Peony each 12g, Scutellaria 15g, Fried Citrus Aurantium, Bupleurum each 9g, Rhubarb (added last) 5g, Antelope Horn Powder (dissolved) 0.6g, Artificial Buffalo Horn (dissolved) 0.3g, four doses. After completing the course, temperature normalized, consciousness returned, speech resumed (though reluctant to speak), wound healed well, woke up with profuse sweating, thin tongue coating, weak cun pulse. Final treatment focused on strengthening spleen, tonifying qi, drying dampness, and resolving phlegm.
Case 3: Mr. Guo, male, 13 years old. Three hours after a car accident with brain injury and vomiting, admitted on May 15, 1998, diagnosed with moderate acute closed brain injury. At admission, conscious, able to speak, but lethargic, no scalp laceration, no bleeding from ears or nose. CT showed subarachnoid hemorrhage and hydrocephalus due to trauma. Soon after admission, headache, vomiting, fever, right-sided hemiplegia, aphasia. Underwent ventriculoperitoneal shunt surgery and other symptomatic treatments, but symptoms improved minimally. CSF routine: yellowish slightly turbid appearance, Pandy test (-), total cell count 7.25×10⁹/L, white blood cells 7.2×10⁹/L, polymorphonuclear cells 65%, monocytes 35%. CSF biochemistry: glucose 0.2 mmol/L, chloride 119 mmol/L, protein 57 mg/L. CSF culture: Staphylococcus epidermidis, Enterobacter aerogenes. Diagnosis: infectious fever due to intracranial infection. Despite treatment with penicillin, Cefuroxime, Cefotaxime, Indomethacin suppositories, and Chinese herbal decoctions based on Bupleurum, antibacterial, anti-inflammatory, and antipyretic effects were ineffective. On June 17, a TCM consultation was requested. Examination revealed: fever, T 39°C, hot skin without sweating, pale face, emaciated body, conscious, aphasia, right-sided hemiplegia, headache, restlessness, poor appetite, no bowel movement for several days, red tongue with thick white greasy coating, fine, rapid, weak pulse. Ventriculoperitoneal shunt revealed bloody CSF. Diagnosis: trauma-induced obstruction of brain meridians, blood stasis and water retention. Treatment: primarily resolve blood stasis and promote diuresis. Modified Diding Tang: Rhubarb (added last), Mosquito Beetle, Leech, Sanqi Powder (dissolved) each 3g, Peach Kernel, Safflower, Cola Nut each 9g, Motherwort 15g, Plantago Seed (wrapped), Agastache each 12g, Ginseng (dissolved separately) 6g, Poria 24g. Two doses, decocted and consumed over three days. Follow-up on June 21: Temperature returned to normal, other symptoms improved.
Comment: These three cases of post-brain injury fever were treated differently. Case 1 was mainly due to intestinal stagnation with concurrent phlegm-heat. Accumulated intestinal turbidity combined with phlegm-heat disturbing the clear orifices caused high fever and unconsciousness. Treatment with modified Da Chengqi Decoction drained the root cause, rapidly purged heat, cleared intestinal stagnation, allowing heat to exit via the bowels. Since the lung and large intestine are interior-exterior partners, eliminating bowel movements also clears phlegm-heat, relieving the clear orifices. Thus, once intestinal function recovered, fever subsided, body cooled, coma lessened, breathing stabilized, and sputum volume decreased.
Case 2 presented with widespread damp-heat and toxic pathogen lingering in the qi stage. Damp-heat steaming upward obscured the clear orifices, causing high fever and impaired consciousness. Treatment should use aromatic, light, and cool herbs rather than heavy, bitter, cold medicines. Light, cool formulas clear heat without damaging the spleen and stomach. Medicines like Scutellaria, Gardenia, Plantago Seed, Honeysuckle, and Forsythia are effective. Aromatic herbs like Agastache, Magnolia Bark, Perilla Leaf, and Fermented Soybean invigorate the spleen, awaken the stomach, and facilitate the spleen’s transformation and transportation of fluids. As damp-heat is dispersed, fever gradually declines. Then, formulas to clear heat and phlegm and strengthen the spleen and resolve phlegm are used to stabilize recovery.
Case 3 presented with blood stasis and water retention. Blood stasis obstructs the brain meridians, impeding blood flow, leading to cerebral edema. Internal blood stasis generates heat, disturbing the spirit, resulting in fever, restlessness, headache, and aphasia. Pale face, emaciation, and limb dysfunction indicate that stagnant blood prevents new blood formation, depriving the body of nourishment. The formula Diding Tang breaks up blood stasis and removes stagnation; Sanqi resolves blood stasis and stops bleeding; Motherwort promotes blood circulation and diuresis; combined with Cola Nut and Plantago Seed to promote diuresis and reduce intracranial pressure; Ginseng, Poria, and Agastache strengthen qi, support the body, and transform dampness.
Author Biography
Fan Yongping, male, studied under Professor Wang Mianzhi. Received Ph.D. in Formulas from Beijing University of Chinese Medicine in 1996. Currently works at the Department of Traditional Chinese Medicine, Beijing Tian Tan Hospital, Capital Medical University, serving as Chief Physician, Head of Department, and Master’s Supervisor in Integrative Medicine. He is a member of the Council of Chinese Medical Association, Committee Member of the Internal Medicine Branch, Standing Committee Member of the Doctoral Research Society, Committee Member of the Internal Medicine Professional Committee of Beijing Chinese Medical Association, Standing Committee Member of the Clinical Pharmacy Professional Committee, Committee Member of the Hospital Management Professional Committee, Committee Member of the Youth Work Committee of Beijing Integrated Medicine Association, Chairman of the Youth Work Committee of Beijing Chinese Medical Association, Member of the Expert Database of the State Administration of Traditional Chinese Medicine, and Member of the National Basic Drug Directory Expert Panel.