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Abstract: The patient is a 30-year-old male with recurrent low-grade fever for more than 2 months. After a series of examinations by Western medicine, no obvious cause was found, accompanied by vicious cold, obvious weakness, soft and loose stools, and weak pulse with heavy pressure.
Basic information】Male, 30 years old
Disease Type】Qi deficiency with fever
Hospital】The First Affiliated Hospital of Nanchang University
Date of Consultation】January 2022
Treatment plan】Treatment with Chinese herbal medicine (tonifying and benefiting Qi Tang plus reduction treatment)
Treatment Period】3 times of outpatient treatment and regular follow-up
Treatment effect] The patient’s fever was controlled.
I. Initial consultation
The patient had been suffering from hypothermia for more than 2 months, during which she had been transferred to many local hospitals, and no cause was identified after various tests. After anti-infective treatment with injectable piperacillin sodium tazobactam sodium, levofloxacin lactate tablets and metronidazole tablets, her body temperature still rose repeatedly up to 38.5℃, and she became dizzy and weak during episodes.
The patient’s current symptoms were: low fever of 37.6-38.2℃, weakness of the limbs, tasteless diet, soft loose stools 3 times a day, dry mouth, desire for hot drinks, some chills, restlessness at night, desire for sleep but sleep is not sweet, weak and slightly counted pulse, weakness on heavy pressure, light and fat tongue with teeth marks on the side. Routine blood examination showed a white blood cell count of 12.06×10^9/L, a neutrophil percentage of 84.8%, and a C-reactive protein of 126.77 mg/L.
II. Treatment history
After positive dialysis, the patient was found to have Qi deficiency fever evidence in the heat evidence, and the clinical treatment was based on helping Qi to rise and lift. The prescription included Huang Qi, Radix Codonopsis, Chai Hu, Sheng Ma, Jiao Shu, Radix Angelicae Sinensis, Chen Pi, Licorice, and Wu Wei Zi.
As the concomitant symptoms of fever help to identify the type of fever, and the patient presented with dizziness and weakness, shortness of breath and lazy speech, loose stools, a pale and fat tongue with teeth marks on the sides and thin white fur are all manifestations of Qi deficiency, the patient was treated with tonifying Zhong Yi Qi Tang with addition and subtraction, with the formula emphasizing the Qi tonic Huang Qi. On review, the patient’s tongue was found to be dark with blue patches on it, which was thought to have persistent stasis that would naturally subside when the fever subsided. However, we cannot rule out the possibility that this evidence is caused by low heat and Qi deficiency leading to blood stasis.
III. Treatment effect
Five days later, the patient visited the clinic again. At that time, the low-grade fever had been reduced to 37.4℃, the spirit was slightly better, the head felt fresh, the limbs felt strong, the mouth was dry, the night sleep was restless, the pulse was stronger, the pulse and tongue were as before, and the stool was more formed. The patient was then instructed to continue with the medication. After 5 days of medication again, the patient came to the third consultation. At this time, the low-grade fever had subsided, and the blood count and C-reactive protein were normalized, but the patient still had significant dizziness, slightly counted pulse, yellow tongue moss had receded, and the tongue was dark blue with plaques. The patient continued to take the medication and after 5 days, at the fourth consultation, the patient did not have fever again, his spirit gradually recovered, his head was slightly dizzy from time to time, the dark blue of the tongue receded during the period, the thin yellow moss, the pulse was not counted, and the heavy pressure was strong, so the medication was discontinued.
IV. Notes
I am glad that the patient’s symptoms have improved after treatment, but because the patient has symptoms of qi deficiency, such as little qi and lazy speech, poor appetite, tiredness, weakness, soft stools, weak pulse or weak pulse, etc. Therefore, bad habits in life that can affect the function of the spleen and stomach in transporting and transforming can lead to qi deficiency, and the patient should pay more attention to good dietary habits and pay attention to controlling emotions and not to be overly anxious. In addition, patients should ensure sufficient sleep and take tonic at the right time in order to keep the right qi inside and regulate the symptoms of qi deficiency.
V. Personal insight
At present, Western medicine adopts symptomatic treatment for acute fever, and there is no special treatment for fever caused by virus. For fever caused by bacterial infection, Western medicine usually chooses to apply antibiotics for anti-infection treatment, but there is no special solution for fever that is ineffective in anti-infection treatment and hormone shock. It is precisely in this field that TCM has accumulated a lot of clinical experience, and it is where TCM has its advantages.
In this article, the patient used the method of tonifying qi and raising it to treat the symptoms of fever that has been untreated for a long time, and obtained better results. In this type of fever, the patient’s body temperature is not very high, usually at 38℃, and it does not subside for a long time, and the white blood cells are mostly normal or mildly elevated. For the treatment of this patient, the correct confrontation, the correct use of medicine, and the identification and treatment are exactly what the doctor really experiences when he is in the clinic.