🌿 Folk Prescriptions

Regarding the etiology of acute internal medicine fever, I agree with the mechanism that “toxin resides within pathogenic factors, toxin enters with pathogenic factors, and pathogenic factors arise from toxin.” I support the “Unification of Cold and Warm Diseases Theory” and advocate integrating eight principles differentiation, six-jing differentiation, wei-qi-yin-ying differentiation, and sanjiao differentiation into a unified diagnostic approach. Drawing from external experiences and my own long-term clinical practice, I developed a comprehensive method called “Staged Differentiation,” dividing fever into three stages: initial fever phase, high fever phase, and residual heat phase, and formulating three basic prescriptions accordingly. Here is the specific method:
1. Initial Fever Phase
This refers to the early stage of fever when pathogenic factors reside on the surface. Symptoms include fever with chills, headache, generalized body pain, nasal congestion, cough, sore throat or itching, thin white or slightly yellow tongue coating, and floating or floating-rapid pulse. Treatment: release exterior pathogenic factors, relieve surface symptoms. Formula: Self-designed Ge Su Yin Qiao Tang: 30g Gegen, 15g Jinyinhua, 12g Lianqiao, 10g Suzi, 10g Jingjie, 10g Fangfeng, 6g Sheng Gancao. Gegen releases muscle layer and reduces fever; Jinyinhua and Lianqiao clear heat and detoxify while having a mild dispersing effect, suitable for releasing exterior heat; although Suzi and Jingjie are warm in nature, they are not overly drying and, when combined with Gegen, Jinyinhua, and Lianqiao, enhance the ability to release exterior heat; Fangfeng dispels wind and relieves exterior symptoms, known as the “moistening agent among wind-dispelling herbs,” with moderate antipyretic effects demonstrated in animal studies; Gancao harmonizes all herbs. Together, these herbs achieve the effect of releasing exterior pathogenic factors and clearing heat.
Additions and modifications: If headache is severe, add 10g Manjingzi and 10g Jiangcan to relieve wind and stop pain; if fever without sweating, add 5g Mahuang and 5g Qianghuo to induce sweating and release exterior; if cough is prominent, add 10g Chao Xingren and 10g Qianhu to promote lung function and stop cough; if nausea, vomiting, abdominal distension, and thick greasy tongue coating are present, add 10g Huoxiang, 10g Peilan, and 15g Bai Biandou to resolve dampness and harmonize the center.
2. High Fever Phase
This is the critical stage of the entire fever process and deserves special attention. Mainly characterized by persistent high fever exceeding 39°C, marked by intense body heat, flushed face, red eyes, irritability, thirst, and rapid pulse. It develops quickly, changes rapidly, progresses fiercely, and poses serious threats. Therefore, the “cutting off and reversing” method must be applied. Treatment: clear heat and detoxify, cool blood, and purge fire. Formula: Self-designed Chai Ge Ku Ling Tang: 30g Chaihu, 30g Gegen, 30g Tufuling, 30g Huangqin, 20g Kusen, 10g Sheng Dahuang, 60g Sheng Shigao. Usage: decocted in water, one dose daily, divided into two servings or administered via nasogastric tube. For severe cases, two doses daily, divided into seven servings. Once fever subsides, reduce to three servings daily; upon complete resolution of fever, revert to one dose daily, always served warm. Alternatively, each dose can be decocted into 1000 ml and administered rectally in four portions. Dosage adjustment: reduce by 10% for ages 13–16, by 20% for ages 6–12 or >60 years, and by 30% for <5 years and >70 years. Chai Ge Ku Ling Tang is derived from Tao’s Chai Ge Jieji Tang in "Six Books of Shanghan," originally intended for exterior pathogenic factors progressing into the three yang channels. Its original formulation emphasizes exterior release but lacks strength in clearing interior heat. The original indication remains exterior pathogenic invasion. Given that high fever arises from “toxin residing in pathogenic factors, toxin entering with pathogenic factors,” clearing heat and detoxifying must run throughout the treatment of high fever. Based on this rationale, certain warming herbs like Qianghuo, Bai zhi, Shengjiang, and Dazao were removed, and several heat-clearing and detoxifying herbs were added, including Kusen, Tufuling, and Sheng Dahuang. Kusen, according to "Bencao Zhengyi," is “extremely bitter and cold, capable of reducing fever, lowering heat, and clearing damp-heat toxins.” Tufuling, as described in "Bencao Zhengyi," “promotes diuresis, clears heat, penetrates meridians, and removes latent toxins from damp-heat.” Dahuang not only purges the bowels but also clears heat, eliminates fire, detoxifies, and resolves stasis, possessing strong antibacterial and anti-inflammatory properties. My clinical experience shows that Dahuang is one of the most commonly used drugs for treating acute internal medicine fever. Even if bowel movements are normal during high fever, it can be boldly used. However, since this formula contains many bitter and cold herbs, it risks harming the stomach and depleting vital energy. Therefore, dosage must be moderate; once the condition improves, dosage should be reduced or stopped promptly. For patients with weak constitution or depleted vital energy who remain febrile, a combined approach of reinforcing vital energy and removing pathogenic factors should be adopted—while administering detoxifying, purgative, and heat-clearing treatments, add herbs to tonify qi and generate body fluids.
Additions and modifications: For severe fever with intense thirst and profuse sweating, add 20g Zhimu; for high fever with restlessness and occasional convulsions, add Antelope Horn Powder; for heat injuring yin, add Ginseng, Sha Shen, Shi Hu, etc.; for excessive heat in the upper jiao with cough and shortness of breath, yellow thick phlegm, combine Ma Xing Shi Gan Tang with 30g Yuxingcao; for swollen and painful throat, add Shan Dougen 10g, Ma Bo 10g, Xuan Shen 15g; for red, swollen, hot joints, add Qin Jiao and Ren Dong Teng each 30g, Sheng Di 20g; for bloody pus in stool, add Bai Tou Weng 30g, Huang Lian 10g; for painful urination, add Huashi 30g, Zhu Ye 10g, Bian Xu and Qu Mai each 15g.
3. Residual Heat Phase
This phase occurs when the illness persists and pathogenic factors linger while vital energy is weakened. Symptoms include night fever with morning relief, or persistent low-grade fever, hot palms and soles, physical weakness, fatigue, dry mouth, thirst, drowsiness, red tongue with little moisture, scant or no coating, and fine, rapid, weak pulse. Treatment: tonify qi and nourish yin, clear residual heat. Formula: Self-designed Shengmai Zengye Tang: 15g Dangshen, 12g Taizi Shen, 12g Maidong, 12g Wuweizi, 12g Shashen, 12g Xuan Shen, 12g Shengdi, 10g Zhimu, 10g Zhu Ye, 6g Sheng Gancao. This formula is an enhanced version of Shengmai San from "Lunwen Wai Nei Shang Bian Hui Lun," where Dangshen tonifies qi, strengthens the spleen and lungs, and generates body fluids; Maidong, Shashen, and Taizi Shen are sweet and cold to nourish yin; Xuan Shen, Shengdi, and Zhimu nourish yin and reduce fever; Zhu Ye clears heart fire and relieves irritability; Wuweizi acid and astringent, gathers yin. Together, these herbs achieve the effect of tonifying qi and nourishing yin, generating fluids, quenching thirst, and clearing residual heat.
Additions and modifications: For bone-steaming fever, combine Qinggu San; for insomnia and frequent dreams, add 10g Suanzaoren and 10g Baihe; for excessive night sweats, add 30g Zhai Mu Li, 30g Fu Xiao Mai, 15g Ma Huang Gen, and 15g Huang Qi; if fever has subsided but persistent fatigue and lack of energy remain, take patent medicines like Bu Zhong Yi Qi Wan or Shengmai Koufu Ye for gradual recovery until full restoration of health.