🌿 Folk Prescriptions

Regarding the etiology of acute internal medicine fever, I agree with the mechanism of “toxin hidden within pathogenic factors, toxin entering with pathogen, pathogen arising from toxin,” support the “unified theory of cold and warm diseases,” and advocate integrating eight principles, six-jing, defensive-qi-nutrient-blood, and triple energizer differentiation into a single diagnostic approach. Drawing on external experiences and personal insights over many years, I developed a comprehensive method—“staged differentiation”—dividing fever into three stages: initial fever phase, high fever phase, and residual heat phase—and formulated three basic prescriptions accordingly. Below is the detailed method:
1. Initial Fever Phase
This refers to the early stage of fever, where pathogenic factors reside on the exterior. Symptoms include fever with aversion to cold, headache, generalized body pain, nasal congestion, cough, sore throat or itchiness, thin white or slightly yellow tongue coating, floating or floating-rapid pulse. Treatment: release exterior pathogen, formula: self-developed Ge Su Yin Qiao Decoction: Kudzu Root 30g, Honeysuckle 15g, Forsythia 12g, Perilla Leaf, Schizonepeta Spike, and Saposhnikovia 10g each, Raw Licorice 6g. Kudzu Root resolves muscle tension and reduces fever; Honeysuckle and Forsythia clear heat and detoxify, with a dispersing action, suitable for releasing exterior heat; Perilla Leaf and Schizonepeta Spike, though warming, are not drying, enhancing the ability to disperse exterior heat when combined with Kudzu Root, Honeysuckle, and Forsythia; Saposhnikovia disperses wind and relieves exterior symptoms, known as the “moistening agent among wind-dispersing herbs,” proven in animal studies to have moderate antipyretic effects; Licorice harmonizes all herbs. Combined, these herbs achieve the effect of resolving muscle tension, releasing exterior heat, and dispelling wind-heat.
Additions: If headache is severe, add Vitex Berry and Silkworm Pupa 10g each to dispel wind and relieve pain; if fever without sweating, add Ephedra and羌活 5g each to induce sweating and release exterior; if cough is prominent, add stir-fried Apricot Kernel and Peucedanum 10g each to promote lung function and stop cough; if nausea, abdominal distension, thick greasy coating, add Agastache and Patchouli 10g each, White Lablab Bean 15g to transform dampness and harmonize the center.
2. High Fever Phase
This is the critical phase of the entire fever process and deserves special attention. Mainly characterized by persistent high fever above 39°C, marked by intense body heat, flushed face, red eyes, thirst, rapid pulse, featuring rapid progression, swift changes, sudden onset, severe course, and significant danger. Therefore, the “cutting off and reversing” strategy must be adopted. Treatment: clear heat and detoxify, cool blood and purge fire. Formula: self-developed Chai Ge Ku Ling Tang: Bupleurum, Kudzu Root, Smilax, Scutellaria 30g each, Sophora 20g, Raw Rhubarb 10g, Raw Gypsum 60g. Usage: decocted in water, one dose daily, divided into two servings or administered via nasogastric tube. In severe cases, two doses daily, divided into seven servings. When fever subsides, reduce to three times daily; when fever disappears, revert to one dose daily, all served warm. Alternatively, each dose can be decocted into 1000 ml, divided into four portions for retention enema. Dosage adjustment: 13–16 years old, reduce by 10%; 6–12 years or >60 years, reduce by 20%; <5 years or >70 years, reduce by 30%. Chai Ge Ku Ling Tang is derived from Tao’s Chai Ge Jie Ji Tang in *Six Books of Shanghan*, originally intended for exterior pathogen invading the three yang channels. Its original formulation leans toward exterior release but lacks strength in clearing interior heat. The condition remains exterior, but since high fever stems from “toxin hidden within pathogen, toxin entering with pathogen,” clearing heat and detoxifying must run throughout the treatment. Based on this rationale, certain warming herbs like Qianghuo, Bai Zhi, Ginger, and Jujube were removed, and heat-clearing, detoxifying herbs like Sophora, Smilax, and Raw Rhubarb added. Sophora, described in *Bencao Zhengyi* as “extremely bitter and cold, reducing fever and descending heat, cleansing damp-fire”; Smilax, according to *Bencao Zhengyi*, “promotes dampness elimination and clears heat, enters the network, removes latent toxins of damp-heat.” Rhubarb not only purges bowels but also clears heat, reduces fire, detoxifies, and resolves stasis, with strong antibacterial and anti-inflammatory properties. My experience shows rhubarb is one of the most commonly used main drugs in treating acute internal medicine fever. Even if bowel movements are normal during high fever, it can be boldly used. Since this formula contains many bitter-cold herbs, it risks damaging the stomach and weakening vital energy. Therefore, dosage must be moderate; once the condition improves, reduce or stop promptly. For patients with weak constitution or depleted vital energy with persistent high fever, adopt a dual approach of reinforcing vital energy and removing pathogen—add qi-tonifying and yin-nourishing herbs while clearing toxins, promoting bowel movement, and reducing heat.
Additions: If high fever with intense thirst, profuse sweating, and large, rapid pulse, add Anemarrhena 20g; if high fever with agitation, occasional convulsions, add Antelope Horn Powder; if heat injures yin, add Ginseng, Adenosma, and Dendrobium; if upper jiao heat is severe, coughing with shortness of breath, yellow thick phlegm, combine Mahuang Xing Ren Shi Gan Tang with Houttuynia 30g; if sore throat, add Sophora Root 10g, Fungus 10g, Scrophularia 15g; if joint redness, swelling, heat, pain, add Qinjiao and Honeysuckle Vine 30g each, Rehmannia 20g; if bloody stools, add Whitehead Elder 30g, Coptis 10g; if painful urination, add Talc 30g, Bamboo Leaves 10g, Polygonum and Dianthus 15g each.
3. Residual Heat Phase
This phase refers to prolonged illness with lingering pathogen and weakened vital energy. Symptoms include evening fever with morning coolness, or persistent low-grade fever, hot palms and soles, fatigue, dry mouth, drowsiness, red tongue with little moisture, scant or no coating, fine, rapid, weak pulse. Treatment: tonify qi and nourish yin, clear residual heat. Formula: self-developed Shengmai Zengye Tang: Codonopsis 15g, Prince Ginseng, Ophiopogon, Five-leaf Ginseng, Adenosma, Scrophularia, Rehmannia 12g each, Anemarrhena, Bamboo Leaves 10g each, Raw Licorice 6g. This formula is an enhanced version of Shengmai San from *Treatise on Internal and External Injuries*. Codonopsis strengthens spleen and lung qi to generate body fluids; Ophiopogon, Adenosma, Prince Ginseng nourish yin with sweet-cold nature; Scrophularia, Rehmannia, Anemarrhena nourish yin and reduce fever; Bamboo Leaves clear heart fire and relieve irritability; Five-leaf Ginseng astringes and consolidates yin. Together, they achieve the effect of tonifying qi and nourishing yin, generating fluids, quenching thirst, and clearing residual heat.
Additions: If bone-steaming fever, combine Qinggu San; if insomnia with frequent dreams, add Sour Jujube Seed and Lily 10g each; if excessive night sweats, add Calcined Oyster Shell, Floating Wheat 30g each, Ephedra Root, Astragalus 15g each; if fever has subsided but still feel fatigued, weak, and listless, take Bu Zhong Yi Qi Wan or Shengmai Oral Liquid as patent medicines for gradual recovery until full recovery.