Fever can be broadly categorized into two types: external contraction and internal damage. As Ye Tianshi stated, "In the defensive level, sweating is permissible," which illustrates the treatment principle for fever due to external contraction. Internal damage fever is often caused by deficiency or imbalance of the visceral qi and blood, requiring careful clinical differentiation. High fever is commonly seen in heat-toxicity, infectious, and malignant conditions, with the disease progression typically moving from the exterior to the interior and from shallow to deep layers. In diagnosis and treatment, it is often differentiated and managed according to the warm disease theory of the defensive, qi, nutrient, and blood levels.

Treating Wind-Warm with Pungent-Cool Dispersing and Venting As Ye Tianshi stated: "Wind-warm refers to exposure to wind in spring when the qi is already warm." Wind is the yang qi of heaven, while warmth is an evil that transforms into heat. Wind-warm enters from above, with the upper burner close to the lungs, scorching the lung-defense system, leading to fever, aversion to cold, thirst, spontaneous sweating, headache, and cough. In severe cases, symptoms such as clouded spirit and delirium may appear, indicating "reverse transmission to the pericardium." "The various transformations and manifestations are all rooted in the diseases of the three hand-yin channels." Xu Jingshi analyzed that when wind-warm enters the lungs, the qi refuses to descend, resulting in external cold and internal heat, and the lung qi fails to circulate smoothly. The treatment should involve mild bitterness to clear and descend, and mild pungency to disperse and unblock, allowing the lung qi to disperse, descend, and regulate, thereby promoting recovery.

Typical Case: Mr. Xia, male, 62 years old at the time. Presented with aversion to cold, high fever, cough, chest pain, and rusty sputum. The illness had persisted for five days before emergency admission. Symptoms included rapid breathing, thirst with a desire to drink. Examination revealed a temperature of 39.2°C, heart rate of 82 beats per minute, blood pressure of 130/82 mmHg, faint heart sounds, diminished breath sounds in the right lung with a few moist rales audible, no abnormalities in the left lung, and mild dehydration. Chest X-ray showed a large, uniform, dense shadow in the right lung. White blood cell count was 21.3×10⁹/L, with neutrophils at 80%. The tongue coating was yellow, slippery, and greasy, and the pulse was weak, floating, and rapid. Based on the pulse and symptoms, this was identified as wind-warm, characterized by warm evil injuring the lungs, heat damaging the fluids and qi, with underlying deficiency and superficial excess, and signs of exhaustion of the source of transformation. The treatment principle was to use pungent-cool dispersing and venting, clearing the lungs and resolving phlegm, supplemented by boosting qi and nourishing yin to prevent collapse.

Prescription: American Ginseng (Xiyangshen) 5g, Southern Adenophora Root (Nanshashen) 12g, Sichuan Fritillaria Bulb (Chuanbeimu) 10g, Trichosanthes Peel (Gualoupi) 15g, Apricot Kernel (Xingren) 10g, Ephedra (Mahuang) 5g, Raw Gypsum (Shengshigao) 25g, Scutellaria Root (Huangqin) 10g, Winter Melon Seed (Dongguaren) 20g, Houttuynia Cordata (Yuxingcao) 10g, Fresh Reed Rhizome (Xianlugen) 20g, Raw Licorice Root (Shenggancao) 6g. Two doses were administered daily for five consecutive days, supplemented with fluid replacement. The body temperature gradually decreased to 37°C, and the cough lessened. However, sudden persistent spontaneous sweating occurred, with blood pressure dropping to 78/60 mmHg and fluctuating, indicating signs of collapse. Ginseng Decoction (Dushen Tang) was immediately added and taken frequently, leading to improvement in the condition. Spontaneous sweating gradually ceased, and blood pressure recovered. Treatment continued with boosting qi, nourishing yin, and clearing phlegm turbidity. After several days, the remaining evil was gradually eliminated, and the illness trended toward recovery.

Aromatic Opening and Unblocking to Resolve Heat Syncope Syncope refers to reversal; heat syncope is a condition where excessive pathogenic heat damages body fluids, causing yang qi stagnation and obstruction, preventing its circulation to the limbs and resulting in cold hands and feet. In severe cases, clouded spirit and delirium may occur. Xu Jingshi analyzed that heat syncope results from prolonged high fever transmitting to the nutrient level, leading to critical signs such as coma, mutism, and incontinence of urine and feces. To reverse the situation and avert danger, emergency treatment with cool-opening methods is necessary to achieve efficacy.

Typical Case: Ms. Gao, female, 29 years old at the time. She had persistent fever for dozens of days during several months of pregnancy, with no relief after treatment. It was midsummer, and she continued to have high fever after childbirth. She was admitted to a hospital and diagnosed with malignant histiocytosis. Despite using various treatments, her condition worsened day by day. Within a few days, she developed delirium, unconsciousness, and urinary incontinence. Treatment was ineffective, and she was advised to be discharged to prepare for the end. That evening, the patient's family sought treatment from Xu Jingshi. Xu Jingshi visited and examined her, finding a red tongue with little moisture and a thin, rapid, and forceful pulse. He believed that prolonged heat had entered the nutrient level, and the syndrome belonged to heat syncope. The treatment should focus on aromatic resuscitation to expel pathogens outward. He urgently prescribed Angong Niuhuang Pills. Two pills were taken overnight, and by the next morning, the fever had reduced, her mental state improved, and she regained control of urination. During the follow-up visit, he instructed her to continue taking two more Angong Niuhuang Pills and prescribed a formula to replenish qi and nourish yin, clear the heart, and protect the nutrient level.

Prescription: American ginseng 10g, tender sweet wormwood 15g, vinegar-processed turtle shell 15g, Hangzhou Ophiopogon japonicus 12g, stir-fried Scutellaria baicalensis 10g, fresh Rehmannia glutinosa 15g, raw gypsum 20g, fresh reed rhizome 30g, bamboo leaf heart 20 pieces, raw licorice root 6g. After decocting and taking several doses, the fever resolved, the illness was cured, appetite gradually increased, and she returned to normal.

In this case of high fever crisis, urgent cooling and resuscitation were required. Angong Niuhuang Pills were administered to reverse the situation, turning danger into safety. Angong Niuhuang Pills have the effects of resuscitating the brain and opening the orifices, clearing heat and detoxifying, aromatic resuscitation to relieve stagnation, and expelling pathogens outward. Tracing back, this formula originates from "Detailed Analysis of Warm Diseases," over two hundred years ago. Its composition is very refined, consisting of 12 herbs, with relatively precise dosages. Most of the ingredients in the formula clear liver heat and resuscitate the brain and open the orifices. Musk and borneol are skillfully used to provide a moving rather than stationary force, synergizing with the other herbs to reach the affected area and achieve the full therapeutic effect. Xu Jingshi believed that although the disease in this case differed between Chinese and Western medicine, based on the clinical signs, it was identified as heat syncope. As long as the syndrome differentiation is deepened and the formula and herbs are accurately selected, satisfactory results can be achieved. In practice, this formula is not only effective for high fever and unconsciousness but can also treat various types of "stagnation."

Harmonizing Shaoyang to Eliminate Latent Pathogens: The so-called latent pathogen syndrome is caused by "latent qi," where "latent" means the toxic pathogen is deeply hidden inside and manifests after a period of time. Latent qi belongs to warmth, and warmth is heat, so it often occurs at the turn of summer and autumn. Moreover, the pathogen tends to lurk in the lungs. The lungs govern dryness and correspond to autumn, combined with latent summerheat, making it prone to symptoms such as thirst with desire to drink and profuse sweating. These are characteristic features of summerheat injuring qi. However, alternating chills and fever belong to Shaoyang, as stated in "Suwen: Treatise on Vital Qi Connecting with Heaven": "Latent pathogen warm diseases... none fail to involve Shaoyang." This is also a natural progression pattern in the transmission of warm diseases. For diseases of "latent qi (pathogens)," the superficial symptoms are easy to resolve, but the underlying root is difficult to eliminate. To completely clear it, advanced treatment is necessary to hopefully prevent recurrence.

Typical Case: Wang, male, 53 years old at the time. He had long worked as a stonemason, leading to chronic lung injury from overexertion, presenting with chest tightness and back pain, occasional stifled cough with scant sputum. Over time, the symptoms gradually worsened. In the past two years, during the hot summer months, he developed persistent chills and fever, with body temperature reaching above 39.5°C. After the fever, sweating occurred but did not resolve the condition. He experienced bitter taste in the mouth, dark yellow urine, thirst with a preference for drinking, reduced appetite, physical weakness, and fatigue. Examination revealed a red tongue with a slippery coating and a wiry, rapid pulse. Based on the comprehensive pulse and symptom analysis, the condition was identified as internal retention of heat toxin, with pathogenic factors affecting the Shaoyang channel, leading to liver fire attacking the lung and impaired lung diffusion. The treatment principle focused on harmonizing Shaoyang, clearing heat, and purifying the lung.

Prescription: Southern and Northern Glehnia Root (Nán Běi Shā Shēn) 12g each, Bupleurum Root (Chái Hú) 12g, Scutellaria Root (Huáng Qín) 10g, Sweet Wormwood (Qīng Hāo) 15g, Forsythia Fruit (Lián Qiào) 10g, Gypsum (Shēng Shí Gāo) 15g, Ophiopogon Root (Mài Dōng) 15g, Lophatherum Herb (Dàn Zhú Yè) 10g, Honey-fried Platycodon Root (Zhì Jié Gěng) 10g, Reed Rhizome (Lú Gēn) 20g, Cicada Slough (Chán Tuì) 10g, Licorice Root (Gān Cǎo) 6g.

After taking 5 doses of the medication, the fever resolved, and all symptoms significantly improved. However, the tongue coating remained unchanged. Therefore, the original formula was maintained, but Gypsum, Ophiopogon Root, and Lophatherum Herb were removed. Benincasa Seed (Dōng Guā Rén) 15g, Eupatorium Herb (Pèi Lán Gěng) 10g, and Plantain Herb (Chē Qián Cǎo) 15g were added to resolve dampness and promote diuresis. The condition improved further after taking the modified prescription.