Fever is the body’s normal and intrinsic response to a variety of conditions, the most common of which is an infection. For instance, although a chronic low-grade fever is a symptom for a variety of cancers, particularly blood and lymph cancers, the resolution of cancers has been reported when high fevers have been spiked after inducing hyperthermia (high body temperature) as means to treat cancer. It is as if the low-grade fevers is the body’s mechanistic attempt to treat itself, but without success. It is only when fever is induced at high enough levels that certain diseases can be treated. Unfortunately, not everyone can survive such a raise in body temperature, so it is not a panacea for everyone since one needs to actually be able to survive the hyperthermic event. Those who did survive, for example, often go into mini-comas/ unconsciousness lasting for a few days and if they do wake up then often the cancer is in remission. Therefore, fever is the body’s attempt to clean house, i.e. a self-corrective rectification of physiology, an immunological expression back to normalcy.
Clinically those with an immunological compromise such as those with Lyme disease, Chronic Fatigue, to HIV, and other viral conditions often report the sensation of low-grade fever. This is because the body is attempting to combat the virus without success, making the person feel chronically feverish, the temperature, if taken, may even be slightly elevated, usually not pass 100 degrees. But even if it isn’t elevated, they might still feel feverish, what’s important is the subjective sensation they are experiencing. In biomedicine, to categorize a fever as a fever then the body temperature must be elevated more than normal, whereas in CM the subjective sensation is just as clinically valid than just an objective flux; we call this 发热 heat effusion. The subjective and objective are both considered as important signs to what is happening, one can be having an external event without objective signs of heat, line 3 of the treatise of Cold/ external damage says in Taiyang disease, whether there is already heat effusion or whether there is not yet heat effusion 太陽病，或已發熱，或未發熱….. This line tells us that heat effusion isn’t a necessary sign for external damage, this is important because certain individuals who are immunologically compromised often do not have normal spikes in temperatures, like the elderly or those with autoimmune or endocrine imbalances.
We also see clinically that not everyone has the same normal bodily temperature, i.e. normothermia. Some people with cold and frail constitution and/ or endocrine imbalance (like those with hypothyroid disorder) often have lower body temperatures and so a raise in temperature for them might be in the range of normal to slightly elevated in someone with standard body temperature. So it can be misleading and one might be thinking they are not spiking a fever, since their temperature is in the normal range, but for their starting baseline it is not normal.
Line 7 of the Shang han lun says “In those where there is heat effusion and aversion to cold, this is emanating from yang, and those without heat [but with] aversion to cold, this is emanating from yin. 病有發熱惡寒者，發於陽也；無熱惡寒者，發於陰也
This passage has several meanings, first of all yang and yin here can pertain to the yang and yin stages (taiyang-yangming-shaoyang as yang and taiyin, shaoyin, and jueyin as yin). Commentators state that yang here can pertain more specifically to Taiyang and yin pertains to shaoyin.
What’s more we can say since this is speaking about Taiyang disease, that this yang and yin is pertaining to a yang or yin pattern of Taiyang, whether the surface is closed or open and causing a fever. That’s all valid ways of interpreting the line and clinically useful.
Now, let us begin breaking down the various causes and treatment of fever. This is a summation of the 16 methods of abating fever from the famous 20th century physician, Qin Bo Wei 秦伯未, in his anthology of medical essays collated in Qin Bo Wei Yi Wen Ji 秦伯未医文椺.
What is important to notate that Qin Bo Wei was a synthesist from the Meng he tradition, so his ideas spans many CM schools of thought and is not limited to one.
His 16 methods of abating fever 退热 are as followed:
2. Harmonization of ying and wei/ constructive and nutritive
3. Clearing the stomach
4. Freeing the stool
5. Ejection/ vomiting
7. Joint resolution of exterior and interior
8. Clearing and transforming damp-heat
9. Clearing the constructive and resolving fire toxins
10. Soothing depression
11. Dispelling stasis and abscess
12. Abduction and dispersal (for food stasis and gan accumulation)
13. Combatting Malaria
14. Averting epidemic
15. Warming the channels and supplementing qi/ yang
16. Enriching yin and/ or blood
Now, within these 16 categorical methods, each one can be broken down further. Just because one needs to diaphorese, doesn’t mean one uses Ma huang tang without the formula presentation. There has to be tha pathophysiology for one to use those medicinals. Within diaphoresis, one needs to differentiate the cause, from wind-heat to wind-cold, to summerheat, to autumn warmth dryness to autumn cool dryness, to external damage causing feverish illness (such as mumps, gingival swelling, peridontitis with chills and fever, throat moth/ tonsilitis, infection the ear/ middle and inner ear to mastoiditis, etc). All require different formula, even though they are technically under the banner of diaphoresis. So that’s number one. So representative formulas include, but are not limited to, Yin qiao san, Sang ju yin, Xiang su yin, Shen zhu san, sang xing tang, xing su yin, chai hu ge gen tang, xie huang san, xi gan san, gan jie she gan tang.
Number 2 is Gui zhi tang essentially, where the surface is open, and there is sweating/ moist skin, due to wind strike.
Number 3 is a yangming method of treating, i.e. Bai hu tang and its variants, that’s yangming channel involvement. But if there is yangming fire/ toxicity with possible qi level bleeding one can use Da huang huang lian xie xin tang or huang lian jie du tang.
Number 4 and 5 are purgation methods, where one either expelling from above or from below (Gua di san and Zhi zi chi tang to induce vomiting, to the Cheng qi tangs variants to precipitate from below).
Number 6 is the method of treating the half-exterior and half-interior so Xiao chai hu tang and its variants. Interestingly, Qin Bo Wei puts Huo xiang zheng qi san in this category.
Number 7 is the treatment of joint resolution exterior and interior. This is not to be confused with half-exterior and half-interior since that is an actual layer. Here there is damage at Taiyang/ yangming with some taiyin approach. But can be a triple yang approach with some interior approach. Representative approaches include San huang shi gao tang, chai hu sheng ma tang, chai ge jie ji tang, and fang feng tong shen san.
Number 8 is the treatment of damp-heat or damp-cold that basically obstructs the san jiao, yangming, or taiyin domain. This oppressive dampness causes the spleen and to not be able to raise the clear yang and leads to easy contraction of evils in the exterior with wei qi disharmony. Formulas include San ren tang, gan lu xiao du dan, shen xi dan, yin chen hao tang. One can include here the methods of freeing up the bladder, such as Wuling san, which might have fever since the Qi hua of tai yang is blocked since the inhibited urination is causing Tai yang to heat up. One can also include th other formulas with jaundice, which all have some combination of dampheat and blood stasis, particularly Mahuang lian qiao chi xiao dou tang.
Number 9 is the treatment of ying and xue level, ala Wen bing 4 levels. Formulas include the 3 treasures for loss of conscousness due to evils in the pericardium (Zi xue dan, an gong niu huang wan, zhi bao dan), to macule transforming formulas Hua ban tang, to ying level formulas- Qing ying tang, to xue level- Xi jiao di huang tang. Also can be both qi and blood level, i.e. Yu nu jian and zhu ye liu bang tang.
Number 10 is the coursing of liver qi and unbinding depression. This is emotionally caused pyrogenic events, methods includes Xiao yao san, si ni san, yue ju wan, and hua gan jian. It is important to notate the long-term depression causes desiccation of fluids and flesh; this can lead to chronic fevers as the body’s qi circulation is chronically impeded the ability of zheng qi to fight off xie qi is impeded as well as the ability to nourish the body’s spirit-mind is hampered, this is linked with Zhu Dan Xi 6 depression theory as well.
Number 11 is the recognition of blood stasis and pus/ abscess causing fever. This is interlinked with the idea of infection. Formulas include Tao he cheng qi tang and Da huang mu dan pi tang to Tao si xiao chai hu tang, wu wei xiao du yin, Zhen ren huo ming yin, to more deficient causes of flesh putrification and welling-abscess such as Huang qi jian zhong tang, Shi Liu wei liu qi yin, Qian jin nei tuo san, Tuo li xiao du yin, Nei bu huang qi tang, etc. Pretty much any formula that treats abscess can treat this fever. Albeit, it is more likely excess causes will lead to fever.
Number 12 is for treatment of food accumulation, gan disorder worm accumulation, gu disorder, and dysentery. All these can cause fever, albeit as Qin states “fever in early stages dysentery is not considered a serious condition” since its a normal and expected progression of the disease. Now fever in long-term dysentery and diarrhea is quite concerning since it can lead to blood exhaustion and yin-yang separation.
Number 13 is the various methods of combating malaria. Now there are various types of malaria within the nosolgical classification with CM, there is: Heat malaria, cold malaria, taxation malaria, glomus/lump malaria/ mother of malaria, male malaria, female malaria, and various types of different kind of malarias that happen in different times (intermittent malarias that occur every two days instead of daily events). I wrote an extensive breakdown of malaria from a Classical perspective here: https://www.facebook.com/ivan.zavala.732/posts/2555161534546817?comment_tracking=%7B%22tn%22%3A%22O%22%7D
Formula for malaria include: Chai hu gui zhi gan jiang tang, Bai hu jia gui tang, Chai hu qu ban xia jia gua lou tang, Gui zhi huang tang, Shu qi san, Qi bao yin, Chan shan yin, Chai po tang, Bie jia wan, Chai hu xiong gui tang.
Number 14 is abating fever by averting epidemic. This is now in the realm of treating infectious disease in different bodily layers: Da Yuan Yin, Pu ji xiao du yin, Sheng ma ge gen tang, Sheng ma bie jia tang are examples of this.
Number 15 is treating both shaoyin and taiyang at the same time, this is taiyang cold contraction when one is shaoyin yang deficient. One cannot induce sweating here with gui zhi-ma huang approaches, but instead one has to use Fu zi ma huang approaches. Ma huang is not a taiyang based herb, but Taiyin since it opens the lungs. It is gui zhi and sheng jiang that causes ma huang to have a strong diaphoretic effect. So representative formula is Ma huang fu zi xi xin tang and Ma huang fu zi gan cao tang. Also tong mai si ni tang for yang seperating from yin causing false heat. If the patient is weak due to a weak constitution one can use Yu ping feng san and Shu yu wan to help the patient ward off the hundred wind illnesses. These last two formulas are more for those with tendency to external contraction, but not with resent contracture.
Bu zhong qi yi tang is also her for qi deficiency fever and yin fire fever/ internal damage fever.
Lastly, number 16 is fever caused blood and/ or yin deficiency. The formulas are Qing gu san, qin jiao bie jia san, qin jiao fu lei tang, dang gui bu xue tang, gui zhi ren shen tang, xiao jian zhong tang, ren shen bai du san, Wei rui tang (for underlying yin deficiency with cold contracture). SHL tells us that those whose throat is dry and parched we cannot effuse sweat 咽喉乾燥者，不可發汗, it also tells us we cannot sweat those with death of blood 亡血家，不可發汗. Sweating these patients will lead to severe yang and blood collapse and further fluid dessication, and possible death since one is summoning yang to the surface from a yangless root, expediating yin-yang seperation.
That’s all folks.