1. What is Fever?
Pyrogens and Fever
- Pyrogens can originate from inside or outside the body.
- Examples of external pyrogens: Microorganisms and their toxins.
- Examples of internal pyrogens: Substances produced by monocytes and macrophages (types of white blood cells).
- External pyrogens can cause fever by stimulating the body to release its own pyrogens or by directly affecting the brain's temperature control area.
Causes of Fever
| Cause Type | Examples |
|---|---|
| Infection | Most common cause of fever |
| Inflammation | Reaction to a drug, allergic reaction |
| Autoimmune disorders | Body produces abnormal antibodies that attack its own tissues |
| Neoplastic (cancer) | Undetected cancer (especially leukemia, lymphoma, or kidney cancer) |
| Other | Prolonged or recurring fever often indicates a noninfectious cause |
Most Common Infectious Causes of Fever
- Upper and lower respiratory tract infections
- Gastrointestinal infections
- Urinary tract infections (UTIs)
- Skin infections
- Most acute respiratory tract and gastrointestinal infections are viral.
Red Flags of Acute Fever
- Change in mental function, such as confusion
- Headache, stiff neck, or both
- Flat, small, purplish-red spots on the skin (petechiae), indicating bleeding under the skin
- Low blood pressure
- Rapid heart rate or rapid breathing
- Shortness of breath (dyspnea)
- Temperature higher than 104° F (40° C) or lower than 95° F (35° C)
- Recent travel to an area where a serious infectious disease such as malaria is common
- Recent use of drugs that suppress the immune system (immunosuppressants)
Treatment of Fever
- Debate exists on whether fever should be routinely treated as it helps the body defend against infection.
- People with high fever generally feel better when the fever is treated.
- People with heart or lung disorders and those with dementia are at particular risk of dangerous complications, so their fever should be treated.
- Other cooling measures are needed only if the temperature is about 106° F (41.1° C) or higher.
- Sponging with alcohol is avoided due to potential harmful effects.
(Summarized above from https://www.msdmanuals.com/)
2. Stages of Fever
- Chills Stage (Rising Phase)
- Fever Stage
- Defervescence Stage (Falling Phase)
Each stage has its own symptoms and interventions. For example, during the chills stage, the person may experience shivering, vasoconstriction, piloerection (goosebumps), and increased respiration leading to dehydration. The interventions at this stage include providing warmth, hydration, limiting activity, and supplying oxygen if heart/respiratory conditions are present.
1. Chilling stage (Rising stage)
The hypothalamus raises the set point temperature
Experiences chills and shivering (because the body temperature has not yet reached the set point, thus feeling cold)
근육긴장이 커져 눈에 띄고 율동적이 될 때 이를 오한 (shivering)이라 부르며 정상보다 5배 정도 열생산이 증가한다
Heat production mechanism occurs (in order to reach the set point)
Chilling stage symptoms: Chills (shivering), vasoconstriction → Cold and pale skin, piloerection (goosebumps), increased respiration → Dehydration
Chilling stage intervention: Insulation (covering with a blanket), hydration, limiting physical activity, providing oxygen in case of heart/respiratory disease
Even though body temperature is rising, it's not appropriate to cool down the body during chills
2. Fever stage
The body reaches the set point temperature
The elevated body temperature continues for a certain period
Heat production and heat loss balance → Neither feeling cold nor hot
Fever stage symptoms: Warm and hot skin, increased heart rate/respiration, dehydration symptoms (thirst, dry oral mucosa, reduced urination, increased urine concentration)
Increased protein denaturation → Fatigue, lethargy, muscle pain, brain nerve cell stimulation → Confusion, instability, convulsion (in children-febrile seizures)
Fever stage intervention: Removing extra blankets or clothes → Light and warm clothing, hydration, tepid bath during high fever, maintaining safety in case of instability/seizures
3. Defervescence stage (Ending/Recovery stage)
The hypothalamus lowers the set point temperature to normal levels
Feeling hot (because the body temperature is higher than the set point, hence feeling heat)
Heat loss mechanism occurs (in order to reach the set point)
Defervescence stage symptoms: Heat loss mechanism → Vasodilation → Warm and flushed skin, sweating → Possibility of dehydration
Defervescence stage intervention: Adequate hydration
| Stage | Description | Symptoms | Interventions |
|---|---|---|---|
| Chilling (Rising) | Hypothalamus raises set point, body experiences chills due to inability to reach set point, heat production mechanism begins | Chills, vasoconstriction leading to cold and pale skin, goosebumps, increased respiration, dehydration | Insulation (covering with a blanket), hydration, limiting physical activity, providing oxygen in case of heart/respiratory disease |
| Fever | Body reaches set point, elevated body temperature continues for a certain period, heat production and loss reach a balance | Warm and hot skin, increased heart rate and respiration, dehydration symptoms, fatigue, confusion, instability, possible seizures | Removing extra blankets or clothes, wearing light and warm clothing, hydration, tepid bath during high fever, maintaining safety in case of instability/seizures |
| Defervescence (Ending/Recovery) | Hypothalamus lowers set point to normal, body feels hot due to temperature being higher than set point, heat loss mechanism begins | Vasodilation leading to warm and flushed skin, sweating, possible dehydration | Adequate hydration |
3. Understanding Different Types of Fever in Traditional Chinese Medicine
☑ Tai Yang fever is a type of fever that occurs due to pathogenic factors invading the body's exterior. It is associated with cold symptoms, such as chills, headaches, and stiff neck. The fever may appear suddenly and release within 2-3 days. Tai Yang fever is treated with Ma Huang Tang, a herbal formula that contains ephedra, apricot kernel, and cinnamon twig. This formula induces sweating and helps to release the pathogenic factors that have invaded the body.
☑ Yang Ming fever is a type of fever that occurs due to excess heat in the body's Yang Ming region. It is characterized by a high fever, aversion to heat, and may worsen in the afternoon. Patients with Yang Ming fever may also experience constipation and thirst. The recommended treatment for Yang Ming fever is Bai Hu Tang, a herbal formula that contains gypsum, anemarrhena, and licorice. This formula clears excess heat and promotes the body's fluid production. Yang Ming organ fever can be presented as tidal fever.
Shang Han Lun (Song Dynasty 201) : Yang Ming, float and tight pulse, must have tidal fever same time a day. If only float pulse without tight, thief sweating must presented.
[201]陽明病, 脈浮而緊者, 必潮熱, 發作有時; 但浮者, 必盜汗出. (自汗是陽明證，盜汗是少陽證，「盜汗」當是「自汗」，文義始屬。)
☑ Shao Yang fever is a type of fever that occurs due to a pernicious energy in Shao Yang region between Tai Yang and Yang Ming. It is characterized by alternating chills and fever, along with other symptoms such as a bitter taste in the mouth, nausea, and irritability. The recommended treatment for Shao Yang fever is Xiao Chai Hu Tang, a herbal formula that contains bupleurum, ginger, and pinellia. This formula helps to expel heat between Yang Ming and Tai Yang, which is Shao Yang.
☑ Qi deficiency fever is a type of fever that occurs due to a deficiency in the body's Qi. It is characterized by a low-grade fever that worsens in the morning, after exertion, or with hot feelings only on the skin(it is also sign of fever due to exertion). Patients with Qi deficiency fever may also experience fatigue, shortness of breath, and lack of appetite. The recommended treatment for Qi deficiency fever is Bu Zhong Yi Qi Tang, a herbal formula that contains astragalus, ginseng, and licorice. This formula helps to tonify the body's Qi and promote overall health.
☑ Yin deficiency fever is a type of fever that occurs due to a deficiency in the body's Yin. It is characterized by a tidal fever at night or evening, night sweating, with hot feelings on the palms. Patients with Yin deficiency fever may also experience dry mouth, thirst, and night sweats. The recommended treatment for Yin deficiency fever is Zhi Bai Di Huang Wan, a herbal formula that contains rehmannia, cornus, and dioscorea. This formula helps to nourish the body's Yin and promote the production of body fluids.
☑ Latent fever is a type of fever that occurs due to damage to the body's Yin and fluids by febrile disease. It is characterized by a low heat feeling on the head, worse at night, and feeling coolness in the morning. The recommended treatment for latent fever is Qing Hao Bie Jia Tang, a herbal formula that contains artemisia, soft-shelled turtle, and gypsum. This formula helps to clear heat, nourish Yin and promote the production of body fluids.
