CHAPTER 24 Fever at Period Time

‘Fever’ here includes both an actual fever and a pronounced feeling of heat, which is more frequent before or during the period but may also occur after it. It should be stressed that if there is only a feeling of heat, this should be both subjective and objective, i.e. the patient has a feeling of heat and her skin (particularly of the dorsum of the hands) also feels hot to the touch.

Aetiology

Identification of patterns and treatment

Blood-Heat

Clinical manifestations

An intense feeling of heat or fever before or during the period, heavy period, mental restlessness, agitation, headache, blood-shot eyes, thirst, hot nose, red lips. Tongue: Red. Pulse: Rapid, Overflowing.

Treatment principle

Clear Heat, cool Blood, regulate the periods.

Acupuncture

L.I.-11 Quchi, SP-10 Xuehai, Du-14 Dazhui, LIV-2 Xingjian, KI-2 Rangu, SP-1 Yinbai, SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), L.I.-4 Hegu, HE-6 Yinxi, P-7 Daling. All with reducing or even method, no moxa.

Explanation

– L.I.-11 and SP-10 clear Heat and cool Blood.

– Du-14 clears Heat.

– LIV-2 and KI-2 cool Blood. LIV-2 also clears Liver-Fire which is often the root cause of this type of Blood-Heat.

– SP-1 cools Blood and reduces excessive uterine bleeding.

– SP-4 and P-6 open the Penetrating Vessel. This vessel is the Sea of Blood and one of its main pathologies is Qi rebelling upwards which, by itself, can also cause a feeling of heat. The rebellious Qi carries Blood with it, and when the latter is hot this would contribute to the feeling of heat. For this reason, SP-4 and P-6 are used to harmonize the Penetrating Vessel and subdue rebellious Qi.

– L.I.-4 is used to regulate the ascending and descending of Qi and thus reduce the feeling of heat which usually occurs on the face.

– HE-6 and P-7 calm the Mind and also clear Heat. These points are used also because the pattern of Blood-Heat is often caused by emotional stress and, in turn, it causes irritability (as Heat usually does).

Herbal treatment

c Prescription

– DAN ZHI XIAO YAO SAN Variation

– Moutan-Gardenia Free and Easy Wanderer Powder Variation

Modifications

• If there is also some stasis of Liver-Blood, the formula Shi Xiao San Breaking into a Smile Powder can be added.

Three Treasures remedy

– DRAIN FIRE

This remedy is a variation of the formula Long Dan Xie Gan Tang Gentiana Draining the Liver Decoction which drains Liver-Fire. The tongue presentation appropriate to this remedy is a Red body, with redder sides and with a yellow, dry coating.

Kidney- and Liver-Yin deficiency with Empty-Heat

Clinical manifestations

A fever or feeling of heat during or after the period, less intense than the previous case, worse in the evening, five-palm heat, mental restlessness, night sweating. Tongue: Red without coating. Pulse: Floating-Empty or Fine-Rapid.

Treatment principle

Strengthen Kidneys and Liver, nourish Yin, clear Empty-Heat.

Herbal treatment

Qi and Blood deficiency with disharmony of Nutritive and Defensive Qi

Clinical manifestations

A fever or feeling of heat during or after the period, scanty periods, pale complexion, dizziness, tiredness. Tongue: Pale and Thin. Pulse: Choppy or Fine.

Summary

Kidney- and Liver-Yin deficiency with Empty-Heat

Clinical manifestations

Treatment principle

Strengthen Kidneys and Liver, nourish Yin, clear Empty-Heat.

Acupuncture

LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), Ren-4 Guanyuan, SP-6 Sanyinjiao, KI-3 Taixi, HE-6 Yinxi, KI-2 Rangu. LU-7 and KI-6 with even method, Ren-4, SP-6 and KI-3 reinforced, and HE-6 and KI-2 with reducing or even method, no moxa.

Herbal treatment

Prescriptions

• DI GU PI YIN (from the Golden Mirror of Medicine) Cortex Lycii Decoction

• LIANG DI TANGTwo ‘Di’ Decoction

Women’s Treasure remedy

• EASE THE JOURNEY-YIN

Treatment principle

Tonify Qi, nourish Blood, clear Heat with sweet, warm herbs.

Herbal treatment

Prescription

– BU ZHONG YI QI TANG

– Tonifying the Centre and Benefiting Qi Decoction

Explanation

This formula (from Li Dong Yuan) is specific to clear Heat deriving from Qi and Blood deficiency and a decline of the Original Qi. As explained above, when this declines, a pathological Minister Fire takes its place giving rise to a feeling of heat. Thus, this type of Heat is treated by tonifying the Original Qi with sweet, warm herbs, which is what this formula does.

The Discussion on Stomach and Spleen (1249) in fact says:

Dietary irregularity and immoderate eating of cold and warm foods damage the Spleen and Stomach. Joy, anger, worry and fright consume and bring detriment to the Original Qi. If Spleen and Stomach Qi become decrepit and the Original Qi becomes insufficient, Heart-Fire becomes effulgent on its own. This Heart-Fire is a Yin Fire. It starts from the Lower Burner and its ligation links to the Heart. The Heart does not reign personally, Ministerial Fire is its deputy. Ministerial Fire is the Fire of the Pericardium developing from the Lower Burner. It is a foe to the Original Qi. This Yin Fire and the Original Qi are irreconcilable to each other. When one is victorious, the other must be the loser.¹

The book Treatment of Different Kinds of Diseases (Lei Zheng Zhi Cai) written in 1839 by Lin Pei Qin says:

If there is a feeling of heat after the period, with tiredness and a feeling as if the eyes were covered by a silk sheet, it means that the pure essences of the Spleen and Kidneys cannot brighten the eyes; in such a case, use Bu Zhong Yi Qi Tang in the morning and Liu Wei Di Huang Wan with the addition of Gou Qi Zi in the evening.²

– Huang Qi, Ren Shen and Bai Zhu tonify and raise Qi and strengthen the Original Qi.

– Dang Gui nourishes Blood.

– Chen Pi resolves Dampness.

– Sheng Ma and Chai Hu, in combination with Huang Qi, raise Qi. The original reason for the inclusion of these herbs, however, was to clear the pathological Minister Fire in the upper part of the body (as these herbs have an ascending movement).

This remedy is the same as the homonymous formula and it therefore has the same actions and indications. The tongue presentation appropriate to this remedy is a pale body.

Three Treasures remedy

– TONIFY QI AND EASE THE MUSCLES

This remedy is a variation of the formula Bu Zhong Yi Qi Tang with the same actions and indications. The main difference is that this remedy has some herbs to resolve Dampness. The tongue presentation appropriate to this remedy is a Pale body with thin, sticky, white coating.

Blood stasis with Heat

Clinical manifestations

A fever or feeling of heat before or during the periods, dark menstrual blood with clots, abdominal pain. Tongue: Purple. Pulse: Wiry or Choppy.

Treatment principle

– Invigorate Blood, eliminate stasis, clear Heat.

Herbal treatment

Three Treasures remedy

– RED STIRRING

This remedy is a variation of Xue Fu Zhu Yu Tang Blood Mansion Eliminating Stasis Decoction. It invigorates Blood and eliminates stasis but it does not clear Heat. Therefore, attention should be paid to clearing Heat with acupuncture. The tongue presentation appropriate to this remedy is a Purple body.

Ancient acupuncture prescriptions for fever during periods ³

1. ST-30 Qichong (ABC of Acupuncture, Zhen Jiu Jia Yi Jing, AD 259).

2. Bailao (extra point situated on the Governing Vessel 2 cun above Du-14 Dazhui), BL-23 Shenshu, BL-12 Fengmen, Ren-3 Zhongji, Ren-6 Qihai, SP-6 Sanyinjiao for feelings of heat and cold and loss of weight; or also L.I.-4 Hegu, Bailao, Zhongquan (an extra point situated on the dorsum of the hand half way between L.I.-5 Yangxi and T.B.-4 Yangchi), BL-15 Xinshu, P-8 Laogong and KI-1 Yongquan for mental restlessness and fever during the period (Great Compendium of Acupuncture, Zhen Jiu Da Cheng, 1601).

Prognosis and prevention

Both acupuncture and herbs can be effective in treating this condition, but herbs probably more so. The two most difficult patterns to treat are those from Blood-Heat and Stasis of Blood with Heat.

As for prevention, it is important that women suffering from this complaint do not consume excessive amounts of hot foods, i.e. meat (especially lamb, beef or game), spices and alcohol. They should also avoid overwork as this may lead to Liver- and Kidney-Yin deficiency.