Fever due to internal disorders is marked by fever, with the dysfunction of the zang-fu organs and deficiency of qi,

blood, yin and yang as its pathogenesis. It usually has a gradual onset and a long duration. Clinically it
is manifested as a low fever in most cases, but as a high fever in some cases.
This kind of fever is mainly caused by internal disorders like emotional stress, improper diet and overstrain. In occasional cases, it is first caused by exogenous factors but afterwards prolonged fever may lead to the
impairment of zang-fu organs and fever due to internal disorders occurs. The pathogenesis of fever due to internal disorders mainly includes stagnation of heat in liver meridians, stagnation of blood, retention of
dampness, insufficiency of middle energizer qi, deficiency of blood, depletion of yin essence and deficiency of yang qi. Fever that is not caused by exogenous factors is considered to be of the category of fever due to
internal disorders. It may be present in some cases of functional low fever, tumor, hemotopathy, desmosis, endocrinopathy, chronic infective diseases and fever of unknown causes in western medicine.

Essentials for Diagnosis

Fever due to internal disorders develops slowly and has a long duration, mostly characterized by low fever or subjective fever and high fever in rare cases, no chilliness, or aversion to cold which can be relieved by
wearing more clothes. Accompanying symptoms are dizziness,listlessness, spontaneous sweating, night sweating and weak pulse.

In general, the patient has a background of stagnation of qi, blood, and fluids, or deficiency of qi, blood,yin and yang, or a recurrent fever.

Examinations of blood, urine, blood biochemistry, immunology, serology and endocrine function should be done, which help make accurate diagnosis.

Fever due to internal disorders should be differentiated from fever caused by exogenous factors, which has an acute onset, a shorter course, and a higher temperature (>38C). The fevers vary with different diseases.
In most cases, fever comes with chilliness at the initial stage and can not be relieved by wearing more clothes. Accompanying symptoms include headache, bodily pain, nasal stuffiness with discharge, cough, and
superficial pulse. If the case is attacked by exogenous pathogenic factors resulting in the conflict between healthy qi and pathogenic factors, it is attributed to an excess syndrome.

Syndrome Differentiation and Treatment

The differentiation of fever due to internal disorders is to determine whether the case is of the deficiency or of the excess syndromes. It is a deficiency syndrome if it is caused by deficiency of qi, blood, yin and yang,
and an excess syndrome if it is caused by stagnation of qi and blood. Treatment for the excess syndrome centers on dispersing the stagnant liver qi, relieving blood stagnation and clearing away heat; while treatment
for deficiency syndrome should be replenishing yin, yang, qi and blood to clear deficient heat.

Fever Caused by Stagnation of Qi

Chief Manifestations: Low fever or hectic fever which fluctuates with emotions, emotional depression, a feeling of fullness and oppression over the chest and hypochondrium, restlessness, irritability, dry mouth with
bitter taste, impaired appetite, red tongue with yellow coating, wiry and rapid pulse.

Therapeutic Methods: To soothe the liver, regulate qi, alleviate depression and purge heat.

Prescription: Modified Dan Zhi Xiaoyao San (Xiaoyao Powder with Moutan and Gardeniae), composed of Chaihu (Radix Bupleuri ) 6 g, Bohe ( Herba Menthae )6 g, Mudanpi ( Cortex Moutan Radicis ) 10 g,
Zhizi( Fructus Gardeniae ) 10 g, Baizhu ( Rhizoma Atractylodis Macrocephalae) 10 g, Fuling (Poria) 10 g, Danggui( Radix Angelicae Sinensis) 10 g and Baishaoyao (Radix Paeoniae Alba ) 10 g.

Modifications: For pronounced stagnation of qi,add Yujin (Radix Curcumae) 10 g, Xiangfu (Rhizoma Cyperi) 10 g and Qingpi (Pericarpium Citri Reticulatae Viride) 6 g; for pronounced heat-syndrome manifested with
red tongue, dry mouth and constipation, remove Baizhu, add Longdancao (Radix Gentianae) 6 g and Huangqin (Radix Scutellariae) 10 g; for female cases with irregular menstruation, add Zelan (Herba Lycopi) 10 g
and Yimucao (Herba Leonuri) 10 g.

Fever Caused by Blood Stagnation

Chief Manifestations: Fever in the afternoon or at night, subjective fever in some parts of the body, dry mouth and throat, but with a desire to drink a little, localized pain or masses in the body or limbs, sallow or
lusterless complexion, bluish-purple tongue with occasional macules or ecchymosis, wiry or unsmooth pulse.

Therapeutic Methods: To activate blood circulation and remove blood stasis.

Prescription: Modified Xuefu Zhuyu Tang (Decoction for Removing Blood Stasis in Chest), composed of Taoren (Semen Persicae) 10 g, Honghua (F los Carthami) 10g, Chishaoyao (Radix Paeoniae Rubra )
10g,Mudanpi ( Cortex Moutan Radicis) 10 g, Niuxi (Radix Achyranthis Bidentatae ) 10 g, Zhidahuang ( Radix et Rhizoma Rhei Preparata ) 10 g, Danggui (Radix Angelicae Sinensis ) 10 g, Chuanxiong ( Rhizoma
Chuanxiong) 10 g, Shengdihuang (Radix Rehmanniae) 10 g, Chaihu ( Radix Bupleuri) 6 g, Zhike ( Fructus Aurantii) 6 g and Jiegeng (Radix Platyeodi) 6 g.

Modifications: For high fever, add Qinjiao (Radix Gentianae Macrophyllae) 10g, Baiwei (Radix Cynanchi Atrati) 10 g and Mudanpi (Cortex Moutan Radicis) 10 g; for edema of limbs, add Danshen (Radix Salviae
Miltiorrhizae) 10 g, Yujin (Radix Curcumae) 10 g and Yanhusuo (Rhizoma Corydalis) 10 g.

Fever Due to Retension of Dampness

Chief Manifestations: Low fever which is prominent in the afternoon, fullness and oppression in the chest, bodily heaviness, poor appetite, thirst but with no desire to drink, nausea, vomiting, loose or sticky stools,
yellow greasy or white greasy tongue coating, soft-superficial and rapid pulse.

Therapeutic Methods: To promote diuresis and clear away heat.

Prescription: Modified Sanren Tang (Three-Seed Decoction), composed of Xingren ( Semen Armeniacae) 10 g, Yiyiren ( Semen Coicis) 12 g, Baikouren ( Semen Amomi Rotundus ) 3 g, Chuanhoupo (Cortex Magnoliae
Offinalis) 6 g, Tongcao (Medulla Tetrapanacis) 6 g,Huashi (Talcum, wrapped) 10 g, Zhibanxia (Rhizoma pinelliae Preparata ) 10 g and Zhuye (Herba Lophatheri) 10 g.

Modifications: For pronounced vomiting, add Zhuru (Caulis Bambusae in Taeniam ) 10 g, Huoxiang (Herba Agastachis) 10 g and Chenpi (Pericarpium cirri Reticulatae) 6 g; for fullness in the chest and greasy tongue
coating, add Yujin ( Radix Curcumae ) 10 g and Peilan (Herba Eupatorii) 10 g; for retention of damp heat in shaoyang meridian manifested as pronounced fever like malaria, bitter taste in the mouth and vomiting, add
Qinghao (Herba Artemisiae Annuae) 10 g and Huangqin (Radix Scutellariae ) 10 g.

Fever Due to Deficiency of Qi

Chief Manifestations: Low fever or high fever which is induced or aggravated by overwork, lassitude, shortness of breath, hypologia, spontaneous sweating, susceptibility to the colds, poor appetite, loose stools, pale
tongue with thin white coating, thready and weak pulse.

Therapeutic Methods: To replenish qi, invigorate the spleen and clear away heat with sweet warm herbs.

Prescription: Modified Buzhong Yiqi Tang (Decoction for Strengthening Middle Energizer and Benefiting Qi), composed of Huangqi (RadixAstragali) 12 g, Dangshen (Radix Codonopsis ) 10 g, Baizhu ( Rhizoma
Atractylodis Macrocephalae ) 10 g, Zhigancao ( Rad ix Glycyrrhizae, roasted) 3 g, Danggui ( Radix Angelicae Sinensis ) 10 g, Chenpi ( Pericarpium Citri Reticulatae) 6 g, Shengma ( Rhizoma Cimicifugae ) 6 g and
Chaihu (Radix Bupleuri ) 6 g.

Modifications: For pronounced spontaneous sweating, add Muli (Concha Ostreae, to be decocted first) 20 g, Fuxiaomai (Fructus Tritici Levis) 12 g and Nuodaogen (Rhizoma et Radix Oryzae Glutinosae ) 20 g; for
alteration of chills and fever, accompanied with sweating and aversion to wind, add Guizhi (Ramulus Cinnamomi) 6 g and Baishaoyao (Radix Paeoniae Alba) 10 g; for spleen deficiency complicated by dampness
retention, manifested as fullness and oppression in the chest, white and greasy tongue coating, add Cangzhu (Rhizoma Atractylodis) 10 g, Fuling (Poria) 10 g and Houpo ( Cortex Magnoliae Officinalis ) 10 g.

Fever Due to Deficiency of Blood

Chief Manifestations: Fever and mostly low fever, dizziness, lassitude, palpitation, pale complexion, pale lips and nails, pale tongue, thready and weak pulse.

Therapeutic Methods: To replenish qi and nourish blood.

Prescription: Modified Guipi Tang (Decoction for Invigorating Spleen and Nourishing Heart), composed of Dangshen (Radix Codonopsis ) 10 g, Baizhu ( Rhizoma Atractylodis Macrocephalae) 10 g, Huangqi (Radix
Astragali ) 12 g, Danggui ( Radix Angelicae Sinensis ) 10 g, Baishaoyao ( Radix Paeoniae Alba ) 10 g, Guiyuanrou (Arillus Longan ) 10 g, Yuanzhi (Radix Polygalae) 6 g, Fushen (Sclerotium Poriae circum Radicem
Pini) 10 g, Yejiaoteng (Caulis et Folium Polygoni Multiflori ) 10 g, Chenpi ( Pericarpium Citri Reticulatae) 6 g, Dazao (Fructus Jujubae) 5 pcs and Zhigancao (Radix Glycyrrhizae, roasted) 3 g.

Modifications: For pronounced blood deficiency,add Shudihuang (Radix Rehmanniae Preparata) 12 g,Gouqizi (Fructus Lycii ) 12 g and Zhiheshouwu (Radix Polygoni Multiflori Preparata) 12 g; for high fever, add
Yinchaihu ( Radix Stellariae ) 10 g and Baiwei ( Radix Cynanchi Atrati) 10 g; for blood deficiency due to chronic hemorrhage with little bleeding, add Shensanqifen (Radix Notoginseng, powdered and to be taken
separately) 3 g, Xianhecao (Herba Agrimoniae) 10 g and Qiancao (Radix Rubiae) 10 g.

Fever Due to Deficiency of Yin

Chief Manifestations: Afternoon or night fever, no desire for clothes, hot feeling of the palms and soles, restlessness, dreamful sleep, night sweating, dry throat and mouth, red tongue with fissures, or with little coating,
even no coating, thready and rapid pulse.

Therapeutic Methods: To nourish yin and clear away heat.

Prescription: Modified Oinggu San (Powder for Clearing away Heat in Bones), composed of Yinchaihu (Radix Stellariae) 10 g, Digupi ( Cortex Lycii) 10 g, Huhuanglian (Rhizoma Picrorhizae) 10 g, Zhimu (Rhizoma
Anemarrhenae ) 10 g, Qinjiao (Radix Gentianae Macrophyllae) 10 g, Biejia ( Carapax Trionycis, to be decocted first) 15 g, Xuanshen (Radix Scrophulariae) 12 g and Shengdihuang (Radix Rehmanniae) 12g.

Modifications: For night sweating, add Duanmuli (Concha Ostreae Usta, to be decocted first) 20 g, Fuxiaomai ( Fructus Tritici Levis ) 12 g and Nuodaogen (Radix Oryzae Glutinosae ) 20 g; for predominant yin
deficiency, add Xuanshen ( Radix Scrophulariae ) 10 g, Shengdihuang (Radix Rhemanniae) 10 g and Zhiheshouwu (Radix Polygoni Multiflori Preparata ) 10 g; for pronounced insomnia, add Suanzaoren (Semen
Ziziphi Spinosae) 10 g, Baiziren ( Semen Platycladi ) 10 g and Yejiaoteng (Caulis et Folium Polygoni Multiflori )lOg.

Fever Due to Deficiency of Yang

Chief Manifestations: Fever with a desire for being covered up, aversion to cold, cold limbs, hypologia,dizziness, somnolence, soreness and weakness of loins and knees, poor appetite, loose stools, pale
complexion,swollen pale tongue with white and moist coating, or teeth marks on its margin, and deep, thready and forceless pulse.

Therapeutic Methods: To warm and replenish yang qi and direct the fire back to its origin.

Prescription: Modified Jingui Shenqi Wan (Pill for Invigorating Kidney Qi from Golden Cabinet), composed of Zhifuzi ( Radix Aconiti Lateralis Preparata ) 6 g, Rougui ( Cortex Cinnamomi ) 3 g, Shudihuang ( Radix
Rehmanniae Preparata ) 12 g, Shanzhuyu ( Fructus Corni) 12 g, Shanyao (Rhizoma Dioscoreae) 12 g, Zexie (Rhizoma Alismatis ) 10 g, Mudanpi ( Cortex Moutan Radicis) 10 g and Fuling (Poria) 10 g.

Modifications: For shortness of breath, add Hongshen (Radix Ginseng Rubra, to be decocted separately) 10 g; for loose stools and diarrhea, add Baizhu (Rhizoma Atractylodis Macrocephalae ) lOg and Paoganjiang
(Rhizoma Zingiberis, roasted in hot cinders) 3 g.

Other Treatments

Chinese Patent Drugs

Liuwei Dihuang Wan (Pill of Six Drugs Containing Rehmanniae) : 6 g each time,twice daily; indicated for fever due to yin dificiency.

Dan Zhi Xiaoyao Wan (Xiaoyao Pill with Moutan and Gardeniae) : 6 g each time,twice daily; indicated for fever due to stagnation of liver qi.

Buzhong Yiqi Wan (Pill for Strengthening Middle Energizer and Benefiting Qi): 6 g each time, twice daily; indicated for fever due to qi deficiency.

Single-drug or Experiential Prescriptions

Take one tortoise and one carapax trionycis, remove their heads and viscera, then stew them in water and take the soup, once per week. It is indicated for fever due to yin deficiency.

Soak 10 g of tremella in boiled water and cook it over a slow fire until it is soft enough, and then put some crystal sugar and take the soup, once or twice a week. It is indicated for fever due to yin deficiency.

Autumn is a transitional season from summer to winter in which it turns from cool to cold. The
yang qi in nature shifts from outward dispersion to inward constriction. This creates the conditions
to store the vital essence in winter. Sleeping rhythm should be also adjusted in conformity to the
seasonal, changes. The ancient Chinese health preservation experts believed people should get
up early and go to bed early in autumn. Getting up early promotes free circulation of the lung qi;

going to bed early prolongs the sleeping time slightly in conformity to the storage of yin and
essence and the gathering of qi by means of nourishment. The early risers may have physical
training according to their interests. In the early morning, the autumn wind blows gently and the
air is fresh. People may come to the lakeside and garden to jog, practice Taijiquan, etc. This can
remove the inhibitory state of the brain after sleeping, activate every organ of the body, make
people more energetic and more resourceful, consequently creating the good physical conditions
for physical labor, work and study.
"Muffling the body in spring and freezing the body in autumn" is a Chinese folk saying and the
summarization of Chinese people's experience in health preservation as well. The saying means
that people should not add clothing and quilts too early. At the beginning of autumn, summer heat
does not vanish completely. When cool wind blows, people should add garments and quilts
gradually, and never add too many at a time to muffle the body. In late autumn, though the wind
soughs and signs, people should control clothing as well and consciously to let the body be
slightly frozen deliberately. This can avoid perspiration due to wearing too many garments which
cause sweat to consume yin and body fluids, make yangqi release outwards, and conform to the
internal accumulation of yin and essence as well as the internal gathering of yangqi in autumn
and prepare the conditions to store essence in winter as well.
Generally speaking, the climatic variations are relatively stable in autumn. But in late fall,
particularly in September in the north, the cold wind and excessive rain, together with the
increasingly intensified cold air make the temperature lower and lower. In this case, people are
susceptible to common cold. Especially, the slow metabolism and poor circulation in old people
make them fear both cold and heat. They are very sensitive to weather changes. More autumnal
garments should be prepared to keep the body temperature constant by modifying the number of
clothes instantly. Old people should pay more attention to keeping the hands and feet warm
because of their poor peripheral circulation.