🌿 Folk Prescriptions

High fever is a common complication after brain trauma. During my clinical differentiation and treatment, I found that moderate to severe brain injuries mostly affect young adults, and high fever reflects the struggle between pathogenic factors and vital energy. If we can effectively suppress the pathogen, good results are often achieved. Here are several examples.
Case 1: Ms. Yin, female, 40 years old. She suffered acute closed brain injury (severe type) due to a traffic accident and was admitted on May 20, 1998. Diagnosis: primary brainstem injury, right ambient hemorrhage, scalp laceration, left upper limb fracture. At admission, she was deeply comatose, experiencing respiratory distress, BP 24/14 kPa. Immediate treatments included mild hypothermia, mechanical ventilation, anti-inflammatory therapy, and dehydration. After 48 hours, mild hypothermia was discontinued, and body 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, Cefepime, Moxifloxacin, and Meropenem, no improvement was seen. On May 27, a TCM consultation was requested. Examination revealed: high fever, coma, T 39°C, hot skin without sweat, scattered purple abrasions over the body. Tracheostomy in place, audible phlegm in the throat, red tongue with yellow, rough coating, wiry, slippery, rapid, forceful pulse. Syndrome: phlegm-heat obscuring the orifices, blood stasis obstructing brain meridians. Treatment: clear heat, resolve phlegm, remove stasis, unblock orifices. Formula: Trichosanthes 18g, Pinellia and Bamboo Shreddings 12g each, Scutellaria 9g, Calamus 9g, Curcuma 9g, Ligusticum 3g, Houttuynia 15g, Angelica 6g, Prepared Polygala 6g, Balloon Flower Root 6g, Antelope Powder (dissolved) 0.6g. Four doses, one daily, decocted and administered via gastric tube twice daily. Follow-up on June 1: still high fever, unconsciousness, T 40.5°C, no bowel movement for a week, same tongue and pulse. Treatment: purge the root cause, clear heat, expel pathogens. Modified Da Chengqi Decoction: Rhubarb (added last), Magnolia Bark, Mirabilite (dissolved) 5g each, Artificial Bezoar (dissolved) 0.3g, Bamboo Shreddings, Gardenia 12g each, Fermented Soybean 6g, Antelope Powder (dissolved) 12g, Trichosanthes 18g, Fried Citrus Aurantium, Calamus, Curcuma 9g each. Four doses, one daily, decocted and taken twice daily. After two doses, large amounts of foul-smelling stool were passed, temperature dropped to 38°C. After four doses, temperature reached 36.8°C. Three additional doses were given to consolidate effect. Patient remained in shallow coma, breathing stable, minimal phlegm, no further fever rise.
Case 2: Mr. Zou, male, 42 years old. Two days after brain trauma, one day after right temporal intracerebral hematoma surgery, admitted on June 22, 1998, with secondary brainstem injury post-surgery. Upon admission, unconsciousness. After mild hypothermia, mechanical ventilation, anti-inflammation, dehydration, lumbar puncture drainage to reduce intracranial pressure, consciousness improved. However, the wound on the right temporal region ruptured and split open, with purulent discharge and cerebrospinal fluid leakage. High fever and confusion followed. Blood test: WBC 19.9×10⁹/L, N: 80%, L: 19%. CSF routine: yellowish slightly turbid, positive Pandy test, total cell count 16×10⁹/L, white 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 spp. Western diagnosis: intracranial infection-induced fever. Despite treatment with Ceftazidime, sulfonamides, Meropenem, Rocephin, and An Gong Niu Huang Wan for clearing heat, detoxifying, resolving phlegm, opening orifices, condition did not improve. On July 16, TCM consultation requested. Examination: high fever, unconsciousness, T 39.3°C, hot skin, cerebral spinal fluid leakage at head wound, purulent exudate, poor healing, aphasia, frequent urination with yellow urine, loose stools, red tongue with thin, greasy yellow coating, rapid and irregular pulse. Syndrome: widespread damp-heat, toxic pathogen lingering in qi stage. Treatment: clear heat, promote dampness elimination, detoxify. Formula: Modified Huo Pu Xia Ling Tang combined with Gan Lu Xiao Du Dan: Agastache 12g, Pinellia 12g, Gardenia 12g, Plantago Seed (wrapped) 12g, Honeysuckle 15g, Forsythia 15g, Fermented Soybean 6g, Balloon Flower Root 6g, Coix Seed 25g, Curcuma 9g, Scutellaria 9g, Perilla Leaf 9g, Magnolia Bark 5g, Antelope Powder (dissolved) 0.6g. Four doses, one daily, decocted and taken twice daily. After medication, temperature gradually decreased, CSF leakage and purulent discharge reduced, wound began to heal. 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, resolve phlegm, assist in purging bowels. Formula: Trichosanthes 18g, Poria 18g, South Star 12g, Pinellia 12g, Gardenia 12g, Red Peony 12g, Scutellaria 15g, Fried Citrus Aurantium 9g, Bupleurum 9g, Rhubarb (added last) 5g, Antelope Powder (dissolved) 0.6g, Artificial Bezoar (dissolved) 0.3g. Four doses. After finishing medication, temperature normalized, consciousness returned, able to speak (though reluctant), wound healed well, profuse sweating after waking, thin tongue coating, weak cun pulse. Final treatment focused on strengthening spleen, tonifying qi, drying dampness, resolving phlegm.
Case 3: Mr. Guo, male, 13 years old. After a car accident, brain trauma, vomiting for three hours, admitted on May 15, 1998, 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 due to trauma and hydrocephalus. Soon after admission, headache, vomiting, fever, right-sided hemiplegia, aphasia. Underwent ventriculoperitoneal shunt surgery and other symptomatic treatments, but symptom relief was limited. CSF routine: yellowish slightly turbid, Pandy test (-), total cell count 7.25×10⁹/L, white 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: intracranial infection-induced fever. Despite treatment with penicillin, Cefuroxime, Cefotaxime, Indomethacin suppositories, and traditional Chinese herbal preparations, no improvement. On June 17, TCM consultation requested. Examination: fever, T 39°C, hot skin without sweat, pale face, emaciated, conscious, aphasia, right-sided hemiplegia, headache, irritability, poor appetite, no bowel movement for many days, red tongue with white greasy coating, fine, rapid, weak pulse. Ventriculoperitoneal shunt revealed bloody CSF. Syndrome: trauma damaging brain meridians, blood stasis obstructing water retention. Treatment: primarily resolve stasis and promote water elimination. Formula: Modified Di Dang Tang: Rhubarb (added last), Tabanus, Leech, Sanqi powder (dissolved) 3g each, Peach Pit, Safflower, Ephedra 9g each, Motherwort 15g, Plantago Seed (wrapped), Agastache 12g each, Ginseng (separately decocted) 6g, Poria 24g. Two doses, decocted and taken over three days. Follow-up on June 21: normal body temperature, other symptoms improved.
Comment: The three cases of post-traumatic high fever were treated differently. Case 1 mainly featured intestinal stagnation with phlegm-heat. Accumulated turbidity and phlegm-heat disturbing the clear orifices caused high fever and unconsciousness. Treatment used modified Da Chengqi Decoction to purge the root cause, rapidly relieve heat, restore intestinal function, expel turbidity through the gastrointestinal tract. Since lungs and large intestine are interrelated, eliminating bowel obstruction clears phlegm-heat and relieves disturbance of the orifices. Once intestinal passage opens, fever subsides, body cools, coma improves, breathing stabilizes, phlegm decreases.
Case 2 presented with widespread damp-heat, toxic pathogen lingering in qi stage. Damp-heat rising, clouding the clear orifices, leading to high fever and impaired consciousness. Treatment should use light, fragrant, cool herbs—avoiding strong bitter-cold drugs. Light, cool formulas clear heat without harming the spleen and stomach. Herbs like Scutellaria, Gardenia, Plantago Seed, Honeysuckle, Forsythia; fragrant herbs like Agastache, Magnolia Bark, Perilla Leaf, Fermented Soybean stimulate the spleen, awaken the stomach, promote qi movement, aiding spleen’s transformation and transportation of fluids. Damp-heat is dispersed, heat gradually declines. Then, formulas to clear heat and resolve phlegm, plus those strengthening spleen and resolving phlegm, are used to stabilize recovery.
Case 3 presented with blood stasis and water retention. Blood stasis obstructing brain meridians impairs blood flow, causing hydrocephalus. Blood stagnation generates heat, disturbing the spirit, resulting in fever, irritability, headache, aphasia. Pale face, emaciation, limb dysfunction indicate that stagnant blood prevents new blood formation, depriving the body of nourishment. Formula used Di Dang Tang to break up blood stasis, Sanqi to resolve stasis and stop bleeding, Motherwort to resolve stasis and promote diuresis; combined with Ephedra and Plantago Seed to promote diuresis and reduce intracranial pressure; Ginseng, Poria, Agastache to tonify qi, strengthen spleen, dry 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 TianTan Hospital, Capital Medical University, serving as Chief Physician, Head of Department, and Master’s Supervisor in Integrated Traditional and Western Medicine Clinical Program. Member of the Council of Chinese Medicine Association, Committee member of Internal Medicine, Standing Committee of the Doctoral Research Society, Committee member of Beijing Branch of Chinese Medicine Association for Internal Medicine, Committee member of Clinical Pharmacy, Committee member of Hospital Management, Youth Committee of Beijing Integrated Traditional and Western Medicine Association, Chairperson of Beijing Young Members Committee, Member of Expert Database of National Administration of Traditional Chinese Medicine, and Member of the National Basic Drug List Expert Panel.