Klinikal na Paggamot ng Mataas na Bala sa Pagkakasakit ng Ulo (Treatments with Clinical Experience)
Ang mataas na temperatura ay isang karaniwang komplikasyon pagkatapos ng trauma sa utak. Habang ako ay nagpapasiya sa paggamot, natuklasan ko na ang matinding trauma sa utak ay karaniwan sa mga batang lalaki at babae, at ang mataas na temperatura ay isang reaksyon ng katawan laban sa dayuhan. Kung ang paggamot ay nakakapigil sa dayuhan, madalas ang magandang resulta. Narito ang ilang halimbawa.
Halimbawa 1: Si Yin, babae, 40 taong gulang. Dahil sa aksidente sa sasakyan, siya ay may acute closed head injury (matinding). Nalapag sa ospital noong Mayo 20, 1998. Ang diagnosis: primary brain stem injury, right cisterna magna hemorrhage, scalp laceration, left upper limb fracture. Sa oras na iyon, siya ay nasa malalim na coma, nahihirapan sa hingahan, bp 24/14 kPa. Agad na ginawa ang hypothermia therapy, artificial respiration, anti-inflammatory, at dehydration therapy. Pagkalipas ng 48 oras, binalewalay ang hypothermia therapy, at ang temperatura ay paulit-ulit na tumataas, umabot sa 39°C, at ginamit ang ice blanket para sa physical cooling. Ang blood test: wbcs 10.7×10⁹/L, n: 91%, l: 9%. Ang diagnosis ng Western medicine: central fever after primary brain stem injury with pulmonary infection. Ang iba't ibang gamot tulad ng ciprofloxacin, cephalosporins, stable, at tienamyl ay hindi epektibo. Noong Mayo 27, hiniling ang consultation ng TCM. Ang pagsusuri: mataas na temperatura, coma, t39°C, mainit na skin, walang pawis, maraming purple bruises sa buong katawan. Tracheostomy, may amoy sa lalamunan, red tongue, yellow and rough coating, wiry, slippery, rapid pulse. Ang diagnosis: phlegm heat blocking the mind, blood stasis in the brain vessels. Ang paggamot: clear heat, resolve phlegm, remove blood stasis, open the orifices. Prescription: Trichosanthes 18g, Pinellia, Tianzhu Huang each 12g, Scutellaria, Calamus, Curcuma each 9g, Ligusticum 3g, Houttuynia 15g, Angelica dahurica, Polygala, and Thunbergia each 6g, Antelope horn powder (mixed) 0.6g. 4 doses, one dose per day, decocted and given via stomach tube twice daily. Noong Hunyo 1, review: still high fever, unconscious, t40.5°C, no bowel movement for a week, same tongue and pulse. Treatment: relieve the root cause, purge heat and eliminate pathogenic factors. Use Da Chengqi Decoction with modifications: Rheum (added later), Magnolia bark, Mirabilis (mixed) each 5g, Artificial bezoar (mixed) 0.3g, Tianzhu Huang, Gardenia each 12g, Fermented soybean 6g, Antelope horn powder (mixed) 12g, Trichosanthes 18g, Fructus Aurantii Immaturus, Calamus, Curcuma each 9g. 4 doses, one dose per day, decocted and taken twice daily. After two doses, passed large amounts of foul-smelling stool, temperature dropped to 38°C, after four doses, temperature was 36.8°C. To consolidate results, took three more doses. Patient remained in light coma, breathing steady, less phlegm, temperature did not rise again.
Halimbawa 2: Si Zou, lalaki, 42 taong gulang. Two days post-traumatic brain injury, one day after right temporal intracranial hematoma surgery, admitted on June 22, 1998 due to secondary brainstem injury after surgery. Upon admission, patient was unconscious. Given hypothermia therapy, artificial respiration, anti-inflammatory, dehydration, and lumbar puncture drainage to reduce intracranial pressure. After treatment, consciousness improved, but wound on the right temporal region ruptured and opened, with purulent discharge and cerebrospinal fluid leakage. High fever and confusion followed. Blood test: wbcs 19.9×10⁹/L, n: 80%, l: 19%. CSF routine: yellowish turbid appearance, positive Pandy test, total cell count 16×10⁹/L, white blood cells 11×10¹⁰/L, monocytes 42%, polymorphonuclear 58%. CSF biochemistry: glucose 19 mmol/L, chloride 80 mmol/L, protein 193 mg/L. CSF culture: Citrobacter. Western medicine diagnosis: intracranial infection-induced fever. Used antibiotics such as Cefepime, sulfonamide, Tienam, Rocephin, and An Gong Niu Huang Wan for clearing heat, detoxifying, resolving phlegm, opening orifices, but condition did not improve. On July 16, consulted TCM. Examination: high fever, unconscious, t39.3°C, hot skin, CSF leakage from head wound, purulent discharge, poor healing, aphasia, frequent urination with yellow urine, loose stools, red tongue, thin yellow greasy coating, rapid and irregular pulse. Diagnosis: damp-heat spreading, toxic factor lingering in qi level. Treatment: clear heat, promote diuresis, detoxify. Formula: Huo Xiang, Pinellia, Gardenia, Plantago seed (wrapped) each 12g, honeysuckle, forsythia each 15g, fermented soybean, Thunbergia each 6g, Coix seed 25g, Curcuma, Scutellaria, Perilla leaf each 9g, Magnolia bark 5g, Antelope horn powder (mixed) 0.6g. 4 doses, one dose per day, decocted and taken twice daily. After medication, temperature gradually decreased, CSF leakage and purulent discharge reduced, wound began to heal. On July 24, follow-up: t37.8°C, confused consciousness, abundant phlegm in throat, no bowel movement for two days, red tongue, yellow greasy coating, slippery and rapid pulse. Treatment: clear heat, resolve phlegm, assist in bowel movement. Prescription: Trichosanthes, Poria each 18g, Starfish Rhizome, Pinellia, Gardenia, Red Peony each 12g, Scutellaria 15g, Fructus Aurantii Immaturus, Bupleurum each 9g, Rheum (added later) 5g, Antelope horn powder (mixed) 0.6g, Artificial bezoar (mixed) 0.3g, 4 doses. After finishing the medicine, temperature returned to normal, consciousness cleared, able to speak, though reluctant to talk, wound healed well, woke up with excessive sweating, thin coating on tongue, weak pulse at cun position. Used tonifying spleen, invigorating qi, drying dampness, resolving phlegm to complete treatment.
Halimbawa 3: Si Guo, lalaki, 13 taong gulang. After car accident, traumatic brain injury, vomiting for 3 hours, admitted on May 15, 1998 with moderate closed head injury. Upon admission, conscious, able to speak, but feeling unwell, no scalp laceration, no bleeding from ears or nose. CT showed: subarachnoid hemorrhage due to trauma, hydrocephalus. Soon after admission, headache, vomiting, fever, right hemiplegia, aphasia. Underwent ventriculoperitoneal shunt surgery and other symptomatic treatments, but symptoms did not improve significantly. CSF routine: yellowish slightly turbid appearance, negative Pandy test, total cell count 7.25×10⁹/L, white blood cells 7.2×10⁹/L, polymorphonuclear 65%, monocytes 35%. CSF biochemistry: glucose 0.2 mmol/L, chloride 119 mmol/L, protein 57 mg/L. CSF culture: Staphylococcus epidermidis, Enterobacter aerogenes. Diagnosis: intracranial infection-induced fever. Used penicillin, cefdinir, ceftriaxone, indomethacin suppository, and traditional Chinese herbal preparations for antibacterial, anti-inflammatory, and antipyretic effects, but ineffective. On June 17, consulted TCM. Examination: fever, t39°C, hot skin without sweat, pale face, thin body, conscious, aphasia, right-sided hemiplegia, headache, restlessness, poor appetite, no bowel movement for several days, red tongue, white greasy coating, fine, rapid, weak pulse. Ventriculoperitoneal CSF shunt showed bloody CSF. Diagnosis: trauma to brain meridians, blood stasis and water retention. Treatment: focus on resolving blood stasis and promoting diuresis. Formula: Rheum (added later), Tabanus, Hirudo, Sanqi powder (mixed) each 3g, Persica, Carthamus, Ephedra each 9g, Leonurus 15g, Plantago seed (wrapped), Huoxiang each 12g, Ginseng (separately mixed) 6g, Poria 24g. 2 doses, decocted and taken over 3 days. On May 21, follow-up: temperature normalized, other symptoms improved.
Comment: The three cases of post-traumatic high fever were treated differently. Case 1 focused on intestinal stagnation with phlegm-heat. Intestinal turbidity combined with phlegm-heat disturbing the clear orifices caused high fever and unconsciousness. Treatment used Da Chengqi Decoction to clear the root cause, quickly eliminate stagnation, preserve yin, allowing the intestines to open and toxins to be expelled through the digestive tract. Since lungs and large intestine are related, defecation clears phlegm-heat and prevents disturbance of the clear orifices. Thus, once the intestines are open, fever subsides, body cools down, coma improves, breathing stabilizes, and phlegm decreases.
Case 2: Damp-heat spreading, toxic factor lingering in qi level. Damp-heat rising, obscuring the clear orifices, causing high fever and mental confusion. Treatment should use aromatic and light-clearing agents, avoiding heavy-duty bitter-cold medicines. Light-clearing agents clear heat without harming the spleen and stomach. Medicines like Scutellaria, Gardenia, Plantago seed, honeysuckle, forsythia; aromatic herbs like Huoxiang, Magnolia bark, Perilla leaf, fermented soybean stimulate the spleen, awaken the stomach, promote qi movement, aiding in the spleen's function of transforming dampness. As damp-heat dissipates, fever gradually decreases. Then, use formulas to clear heat and resolve phlegm, and tonify the spleen to resolve phlegm for stabilization.
Case 3: Blood stasis and water retention. Blood stasis obstructing brain meridians leads to poor blood circulation, resulting in hydrocephalus. Internal blood stasis generates heat, disturbing the spirit, causing fever, restlessness, headache, and aphasia. Pale face, thin body, and impaired limb movement indicate that blood stasis prevents new blood formation, leading to malnutrition. Used Di Dang Tang to break up blood stasis, Sanqi to resolve blood stasis and stop bleeding, Leonurus to resolve blood stasis and promote diuresis; combined with Ephedra and Plantago seed to promote diuresis and lower intracranial pressure; Ginseng and Poria to tonify qi and strengthen the spleen; Huoxiang to dry dampness and harmonize the stomach.
Author Biography
Fan Yongping, male, studied under Professor Wang Mianzhi, earned his Ph.D. in Formulas from Beijing University of Chinese Medicine in 1996. Currently works at the Department of Traditional Chinese Medicine, Beijing TianTan Hospital, Capital Medical University, serving as Chief Physician, Head of Department, and Master’s Supervisor in Integrative Medicine at Capital Medical University. He is currently a member of the Executive Committee of the Chinese Association of Traditional Chinese Medicine, a committee member of the Internal Medicine Section, a standing committee member of the Doctoral Research Committee, a committee member of the Beijing Branch of Internal Medicine, a standing committee member of the Clinical Pharmacy Section, a committee member of the Hospital Management Section, a committee member of the Youth Work Committee of the Beijing Integrated Medicine Society, Chairman of the Youth Work Committee of the Beijing TCM Society, a member of the Expert Database of the State Administration of Traditional Chinese Medicine, and an expert on the National Basic Drug List for Medical Insurance.