Unexplained low fever generally indicates an internal injury. High fever usually comes on suddenly and can be alarming, potentially leading to coma or convulsions. However, high fever is easier to diagnose and often resolves quickly. In contrast, low fever, while appearing less severe, can be more harmful as it is typically caused by internal injuries. The pathogenesis of low fever is often difficult to grasp, especially in cases of irregular low fever, which can be challenging to diagnose without experience and theoretical knowledge.
On August 17, 2019, a patient, a 31-year-old woman and mother of a 4-year-old child, sought treatment. She reported that since April of this year, she had been experiencing low fever, initially occurring about once a week, but later increasing to two to three times a week. During fever episodes, she felt dizzy, sluggish, and had lost a significant amount of weight. Assuming she had an infection, she went to the hospital for tests, but nothing was found. The hospital administered intravenous fluids for a week, but her fever became more frequent, and her overall condition worsened. She sometimes felt inexplicably cold or hot, yet had no thirst. After switching to another hospital, the results were still inconclusive, with no signs of infection. The doctors speculated that her immune system might be weak and prescribed cephalosporin antibiotics, which she took for a few days without improvement, and she experienced stomach discomfort, leading her to stop taking them. Eventually, she sought Traditional Chinese Medicine (TCM) treatment and tried several herbal remedies without success. She mentioned that she had been following my work for a long time but had not thought to consult me until a friend recommended it, which gave her some confidence.
The four diagnostic examinations revealed the following: her complexion was poor, her spirit was low, her appetite was bad, and she sometimes experienced bloating. She had a bitter taste and dry throat upon waking, felt phlegm but had no thirst, and experienced low fever four to five times a week, each lasting a few hours, typically starting around 2 PM and improving by evening, with dizziness being the main symptom. Her stools were somewhat dry, and her urine was short and red. The tongue showed no coating but had spots, and the surface was moist. The pulse was thin, rapid, and weak. The heart pulse was thin and strong upon pressure, the liver pulse was wiry and weak upon pressure, the kidney pulse was thin, the lung pulse was weak, the spleen pulse was thin and firm upon pressure, and the life pulse was normal. After careful consideration, I diagnosed her condition as due to residual heat, stagnant heat, and liver blood deficiency. I prescribed a formula of five doses containing: Dang Shen (Codonopsis), Qing Hao (Artemisia annua), Bie Jia (Soft-shelled Turtle Shell), Dan Pi (Moutan Root), Sheng Di (Rehmannia), Chai Hu (Bupleurum), Huang Qin (Scutellaria), Zhi Shi (Bitter Orange), and Chi Shao (Red Peony).
I informed her that I could not guarantee absolute results and suggested she try the medicine first. If she improved, she could return for a follow-up; if not, she could decide how to proceed. On August 25, 2019, she returned for a follow-up. Upon seeing her, I noticed she appeared much better, having gained some weight. She happily reported that she had intentionally delayed her follow-up to observe whether she would continue to have fevers. Since starting the medication, she had only experienced two fevers: one occurred after taking the second dose, lasting about an hour, and the other after the fourth dose, just before taking the fifth dose, but it resolved within half an hour after taking the medicine. She had not felt feverish since then, and her other symptoms had improved significantly, with her spirit also much better. She hoped to adjust her formula again. I mentioned that her low fever might be resolved, but she needed to observe for a few more weeks. The current focus should be on tonifying the liver and spleen to enhance her immunity. I adjusted her formula to include: Ren Shen (Ginseng), Gan Jiang (Dried Ginger), Chai Hu (Bupleurum), Huang Qin (Scutellaria), Huang Lian (Coptis), Sheng Gan Cao (Raw Licorice), Ban Xia (Pinellia), Da Zao (Jujube), Sheng Di (Rehmannia), Shan Yao (Chinese Yam), Shan Zhu Yu (Cornus), Fu Ling (Poria), Dan Pi (Moutan Root), Ze Xie (Alisma), Bu Guo Zhi (Psoralea), Guo Sui Bu (Euphorbia), Dang Gui (Angelica), Niu Xi (Achyranthes), and Che Qian Zi (Plantago Seed). I advised her that if she felt well, she could take three more doses.
Recently, she mentioned wanting to schedule an appointment for her child. Regarding her own condition, she felt great, her complexion had improved, she had gained weight, and her spirit was excellent. She had previously suffered from chronic pharyngitis, which she forgot to mention, but it had also resolved. Previously, during the Spring Festival, she would often experience heat symptoms, oral ulcers, and sore throat, but this year, none of those issues occurred, which was unexpected. She plans to come back with her child for another check-up. The pandemic has made her acutely aware of the importance of health.
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