In Traditional Chinese Medicine (TCM), we often hear the phrase “扶正祛邪” (Upholding the Vital Qi and Expelling Pathogenic Factors), to the point where it feels like a cliché. However, these words are not just empty rhetoric; they are the result of centuries of clinical practice. Without upholding the Vital Qi, it is difficult to expel pathogenic factors. Let’s look at a case study. Patient: Male, adult.Location: TianjinWeather characteristics: Cold and dryOnline consultation time: February 4, 2020, 10 AMMain complaint: Fever for 4 daysMedical history (as reported by spouse):Returned from Guangxi on January 30, developed sore throat on the evening of the 30th,and fever started on the morning of the 31st, reaching 37 degrees Celsius.Initially diagnosed as “急火攻心” (acute fire attacking the heart) and acute pharyngitis. He tends to have throat issues when stressed or fatigued. Started taking Qingkailing (清开灵) at 1 PM, and I immediately began massaging him. He took a hot bath in the evening and consumed two doses of Qingkailing oral solution. On February 1, I started massaging and tapping from 6 AM until 11 AM, and his temperature dropped to 36.6 degrees. Continued massage in the afternoon and evening, with significant improvement in his throat condition.On February 2, his temperature returned to normal at 36.3 degrees.He continued taking Qingkailing twice. On February 1 and 2, he also drank a beverage made from Jin Yin Hua (金银花, Honeysuckle), Lian Qiao (连翘, Forsythia), and Huang Qin (黄芩, Scutellaria). The next morning, he took Qingkailing capsules and drank the Jin Yin Hua, Lian Qiao, and Huang Qin infusion, feeling completely normal.On February 3, before bed (10:30 PM), I checked his temperature, which was 36.8 degrees. I began massaging his abdomen and comforted him to sleep.On February 4,at 5 AM, I checked on him. He said he had a restless night, so I started massaging until 7 AM. He felt sleepy and was allowed to sleep until 9 AM. Upon waking, his temperature was 37.8 degrees, and he reported throat discomfort. I reassured him and encouraged him to have breakfast, which included a large bowl of plain congee, a big vegetarian bun, and steamed carrots. He felt his appetite and spirits were good.Not feeling cold, his current temperature was37.5 degrees.Tongue diagnosis 1
Note:There is a significant presence of dampness; do not take any more heat-clearing medications.Prescription:Huo Po Xia Ling Tang (藿朴夏苓汤) + Jie Geng (桔梗) 2 dosesHuo Xiang (藿香) 6g, Hou Po (厚朴) 3g, Jiang Ban Xia (姜半夏) 5g, Fu Ling (茯苓) 9g,Xing Ren (杏仁) 9g, Sheng Yi Ren (生苡仁) 12g, Bai Dou Kou (白蔻仁) 3g, Zhu Ling (猪苓) 9g,Jie Geng (桔梗) 9g, Dan Dou Chi (淡豆豉) 9g, Ze Xie (泽泻) 5g, Tong Cao (通草) 3g.Preparation method: Boil for 20 minutes on low heat after reaching a boil, and take in two doses.Try to finish one dose around noon and take a nap afterward. Take the second dose in the evening and then sleep again. If all goes well, he should feel better by tomorrow.Massage can also be done on the abdomen, at the points Zu San Li (足三里) and Yin Ling Quan (阴陵泉).Feedback on February 6 at 8:30 AM:Last night before taking the medicine at 9 PM, my husband said he felt hot again, measuring 37.4 degrees, so I let him quickly finish the medicine and sleep.He had a fair sleep, waking up several times, and at 6:00 AM, his temperature was 37.4 degrees. I massaged his abdomen for a while, gave him some water, and his temperature was 37.2 degrees.His bowel movements were normal the day before and yesterday.His spirits were acceptable.Currently, he feels slightly dizzy, his throat hurts when swallowing saliva, his lips are red, he has a canker sore on his tongue, and the inner corners of his eyes are slightly red.He has not been sweating (the night before, I felt some sticky sweat on his forehead), and his appetite is normal.During the day, his temperature was 36.6 degrees.Tongue diagnosis 2
Prescription:Huo Po Xia Ling Tang (藿朴夏苓汤) + Qing Hao Bie Jia Tang (青蒿鳖甲汤) 2 dosesHuo Xiang (藿香) 6g, Hou Po (厚朴) 3g, Jiang Ban Xia (姜半夏) 5g, Fu Ling (茯苓) 9g, Qing Hao (青蒿) 6g, Zhi Mu (知母) 6g, Dan Pi (丹皮) 6g, Sheng Di (生地) 9g, Bie Jia (鳖甲) 12g, Xing Ren (杏仁) 9g, Sheng Yi Ren (生苡仁) 12g, Bai Dou Kou (白蔻仁) 3g, Zhu Ling (猪苓) 9g, Dan Dou Chi (淡豆豉) 9g, Ze Xie (泽泻) 5g, Tong Cao (通草) 3g.Preparation method: Soak for one hour, boil for 20 minutes on low heat, and take in two doses.Finish one dose around noon and take a nap afterward. Take the second dose in the evening and then sleep again.Feedback on February 6 at 3 PM:My spouse finished the medicine at 12:45 and went to sleep, just woke up,and his temperature rose to 38.1 degrees, with no sweating and a headache.It felt cool in the house, and the temperature was only 17 degrees, so I just turned on the air conditioning.His tongue coating became very thick.Tongue diagnosis 3
Advice: If the headache is not too severe, you can use plum blossom needles for puncturing or guasha around the back of the neck, at Feng Chi (风池) and Feng Fu (风府). Continue taking the medicine in the evening.After finishing this prescription, if all goes well, his condition should improve by tomorrow morning.Feedback on February 7 at 9 AM:Much better, temperature at 37 degrees.Last night, he covered himself with two blankets and had sticky sweat on his chest and forearms during the night, but no sweat elsewhere.In the morning, his temperature dropped, and he had no other symptoms.He slept well. Today, his throat is still a bit swollen, but it is not serious.Feedback on February 8 at 7:30 AM:I just measured his temperature, which is 36.6 degrees.Aside from the canker sore on his tongue being a bit uncomfortable, everything else is fine. Do you think he needs to take more medicine or any auxiliary treatment today?Tongue diagnosis 4
Advice:He can take Huo Xiang Zheng Qi capsules three times a day, two to three capsules each time, for two more days to finish up. For the canker sore, he can use a topical canker sore powder.Note: This patient exhibited clear characteristics of evening fever. Both instances of fever started in the evening, indicating a pattern of Yin deficiency heat. There was an initial misdiagnosis.The ineffectiveness of the Huo Po Xia Ling Tang (藿朴夏苓汤) 2 doses was primarily due to insufficient Yin fluids, which were unable to produce sweat.On February 6, the fever occurred 2 hours after taking the medicine, indicating that the timing had shifted to the afternoon, which is a manifestation of the struggle between the righteous and the evil after the Yin fluids were supported. Excluding the possibility of being exposed to cold again, he can continue taking the medicine with peace of mind.Insight: This round of external pathogens often presents with dampness, or a combination of cold and heat. However, for individuals with a history of Yin deficiency, exposure to dampness can be treated with both nourishing Yin and expelling dampness simultaneously. If dampness is the primary concern, simply reduce the quantities of Di Huang (地黄) and Bie Jia (鳖甲) slightly. TCM’s principle of “扶正祛邪” (Upholding the Vital Qi and Expelling Pathogenic Factors) is not a cliché; it is an effective method honed through practice. TCM can effectively treat complex external febrile diseases.As the pandemic has progressed, the recognition and role of TCM have significantly improved compared to before. We hope for a collaboration between TCM and Western medicine to help more patients recover quickly from mild cases and alleviate severe cases. May there be no illness in the world.Further Reading1. Don’t Panic! What We Need Most is to Ensure Proper Isolation 2. Don’t Panic! What You Have is Likely Just a Common Flu3. Don’t Panic! Upholding the Vital Qi is the Key to Facing Viruses4. Two Case Studies of Dampness-Heat Fever“Wuji Academy Premium Course: 100 Lectures on TCM Basics”will guide you to observe the human body and understand diseases from a TCM perspective; teaching you how to protect the Vital Qi and expel pathogenic factors.Click the “Read the Original” button below to listen for free.
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