CHAPTER 24 Fever at Period Time
Aetiology
Emotional stress, irregular diet
Emotional stress such as actual or repressed anger, resentment or frustration may lead to Liver-Qi stagnation which frequently turns into Fire; Fire can invade the Blood portion (especially Liver-Fire because this organ stores Blood) and give rise to Blood-Heat. Since Blood accumulates before the periods, Blood-Heat causes a feeling of heat or fever before or during the periods.
The pathology of this condition is also influenced by a disharmony of the Penetrating Vessel. This vessel is the Sea of Blood and its chief pathology is Qi rebelling upwards. The Penetrating Vessel has a deep influence on the menstrual function and the vessel is full of Blood before the period. If Blood has Heat, and if Qi rebels upwards, this may carry Blood with it and cause an intense feeling of heat in the face. In fact, as we have seen in Chapter 7, even rebellious Qi of the Penetrating Vessel by itself (without Blood-Heat) may cause a feeling of heat in the face.
Overwork
Overwork (in the sense explained before) and having too many children too close together may lead to Yin deficiency and Empty-Heat: the latter heats the Blood and also causes Blood-Heat. Since Blood is in a state of relative depletion after each period, the Empty-Heat becomes more pronounced at this time and causes a feeling of heat or fever after the period. This type of Heat is different from Full- or Empty-Heat insofar as it derives from Qi and Blood deficiency: it is treated by using not bitter, cold herbs but sweet, warm ones that gently tonify Qi and the Original Qi.
The idea behind this method derives from Li Dong Yuan who said that when the Fire of the Original Qi declines, a pathological Minister Fire takes over, giving rise to a feeling of heat. Since this derives from a decline of the Original Qi, it is treated by tonifying this with sweet, warm herbs.
Chronic illness, excessive physical work
A long, chronic illness may cause Qi and Blood deficiency, while excessive physical work (including sports) may injure the Spleen and also lead to Qi and Blood deficiency. This causes a disharmony between Nutritive and Defensive Qi so that there is a feeling of heat or fever during or after the period.
Emotional stress, surgery
Emotional stress as mentioned above may also lead to Blood stasis; when Blood stagnates for a long time it may give rise to Heat. Blood-Heat causes a feeling of heat or fever before or during the period. The stasis of Blood may also derive from abdominal surgery following a hysterectomy, ovarectomy or an operation for endometriosis.
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.
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
Herbal treatment
a Prescription
Explanation
The last four herbs are the formula Si Wu Tang Four Substances Decoction (with Sheng Di Huang substituted for Shu Di Huang). These are used to enter the Blood portion. Sheng Di Huang is used to cool Blood.
b Prescription
c Prescription
Explanation
This formula is chosen if there is a pronounced stagnation of Liver-Qi and this has given rise to Liver-Fire.
The first eight herbs constitute a variation of the formula Dan Zhi Xiao Yao San (also called Jia Wei Xiao Yao San Augmented Free and Easy Wanderer Powder) which is specific for Liver-Fire deriving from stagnation of Liver-Qi.
Three Treasures remedy
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.
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