DIFFERENTIATION OF FEVER
A fever can be a most feared thing. Fever ranks as one of the major symptoms, or complaints, that lead people to consult their doctor, or seek medical help.
In Greek Medicine, fever, or pyrexia, is seen as a manifestation of the Fire element in the human body. A localized manifestation of heat, or Fire, is inflammation; fever is basically inflammation that has spread through the lymphatic or circulatory systems and gone systemic to affect the whole organism.
Many fevers can be broken through sweating. Sweat is the waste product of the Fire element, which drains excess heat and fever from the body.
Although Western medicine tends to look upon fever as something that should always be brought down or suppressed, in Greek Medicine, fever isn't always a bad thing. Fever is seen as a protective cleansing response, or catharsis, of the organism; by manifesting a fever, the elevated metabolic heat can burn off toxins, pathogens and superfluous morbid humors at a faster rate once they have accumulated to critical levels.
And so, as a natural protective cleansing response of the organism, many fevers tend to be self-limiting, and of limited duration. After the offending toxins and superfluous morbid humors have been consumed, the fever has served its purpose and run its course, homeostasis is reestablished, and the body returns to normal.
Hippocrates once boasted that, if he were only allowed to create or provoke a fever, he could heal any disease. Although it could be argued that, in making this statement, Hippocrates indulged in hyperbole and overstated his case, it indicates the level of respect that Greek Medicine has for fevers, which are an effective cleansing and healing response that the organism uses to burn off excess toxins and superfluous morbid humors.
Nevertheless, any realistic assessment of fevers must admit that many of them can be fatal if allowed to run their course without any intervention. The Fire of fever, if moderate and kept within tolerable limits, can purify the organism and burn off the dross of accumulated toxins and metabolic wastes. But if the Fire of fever is allowed to run wild and exceed these tolerable limits, it can easily turn destructive, and consume the vital substance and fluids of the organism, causing its demise.
And so, Greek Medicine takes a natural holistic approach to treating fevers that calls for intelligent management and timely and appropriate intervention when and where necessary. The physician is the Servant of Nature, who assists the organism in the cleansing and catharsis it is trying to accomplish. With appropriate assistance from the physician in this manner, the fever can usually be kept within tolerable limits; once the catharsis is accomplished, the fever will run its course, and the body will return to normal.
Fevers and Infection
The organism will often develop and manifest a fever as a response to infection, especially if the infection is acute, severe or systemic. Like fever itself, infections are classified as an exogenous heat factor in Greek Medicine, because the invading microbe represents a foreign metabolic heat invading the body.
Greek Medicine calls infections putrefactions, which is basically a spoiling. And what is spoiling or putrefying is one, or more, of the Four Humors; the vital fluids that nourish the organism, which have now, through corruption and imbalance, become food for pathogenic microbes.
Modern medicine sees the invading microbe as the primary cause of the infection, and the fever it generates. Greek Medicine accepts that microbes do play a role in infections, but sees the primary cause as being the accumulation of morbid, superfluous humors and toxins and a morbid, unbalanced biological and metabolic terrain that allows pathogenic microbes to thrive. For more information on the biological ground, or terrain, which is a very important immunological concept in Greek Medicine, please refer to the Immune System page in the Physiology section.
In Greek Medicine, fevers caused by infections, or putrefactions, are called putrid fevers, and are classified according to the type of humor that is undergoing putrefaction. And so, you have Sanguine fevers (blood), Phlegmatic fevers (phlegm), Bilious fevers (yellow bile), and Atrabilious fevers (black bile). Each of these types of putrid fevers has its own characteristic signs and symptoms, as well as its own characteristic cycles and patterns of onset, duration and remission.
By responding to an infection, or putrefaction, with the elevated metabolic heat of a fever, the organism accomplishes two things: First, it burns off toxins and morbid, superfluous humors at a faster rate; and secondly, through an increased rate of phagocytosis, pathogenic microbes are consumed and eliminated.
In treating infections, modern medicine relies primarily on antibiotics to kill off the offending microbes. But this is only half the job; Greek Medicine sees the primary objective as eliminating the offending morbid or superfluous humors and restoring metabolic balance to the organism. If this is not done, true immunological health and soundness are not restored, and the biological terrain, or ground, remains vulnerable to future infections.
Fever Assessment and Prognosis
Every fever is like a pitched battle. On the one hand you have the host, and all the inherent resources and liabilities for fighting the fever that he/she brings to the table. On the other hand, you have the fever, and the strength and virulence of the pathogenic factors that are causing it.
Fevers are of several different types, some quite virulent and life threatening, and others much less so. Each type of fever will present typical patterns of signs and symptoms, as well as a characteristic life cycle of onset, duration and remission. The basic factors, or variables, that decide how a fever will manifest and play out are:
1) The fever's point of origin, or cause, and which parts, organs or faculties of the organism are affected;
2) The nature of the offending morbid humors and pathogens and their level of accumulation in the organism;
3) The host's immune resistance and his/her constitutional vigor and vitality;
4) The host's constitutional nature and temperament, as well as his/her biological and metabolic ground, or terrain;
5) The nature and temperament of the ambient environment - the weather, season and climate.
If the balance of all these factors favors the patient, the assessment and prognosis of a fever will be good. If the disease and its fever are favored, then the prognosis and probable outcome will be poor.
Basic Typology and Terminology of Fevers
Greek Medicine first classifies fevers into three broad categories:
Ephemeral fevers are those that affect the mind, spirits, Vital Force, and Vital Faculty. They are primarily pneumatic, or energetic in nature.
Putrid fevers are caused by putrefactions of the Four Humors, and affect the Natural Faculty. Depending on which humor is affected, the characteristic signs and symptoms and cyclic patterns of manifestation will vary.
Hectic fevers can be the most deep-seated and chronic, and usually originate in the principal or noble organs. Hectic fevers are basically of two types: a tertian fever, which appears on every third day; and a quatrain fever, which appears on every fourth day.
An ague refers to an acute fever; its derivation is from the French word for acute. The term is also used more broadly to denote certain intermittent fevers, such as a tertian ague or a quatrain ague, with the focus being on the acute phases of active febrile manifestation.
A grippe is an acute fever caused by a superficial cold or hot draft or dystemper. It is often accompanied or followed by a catarrh or upper respiratory tract infection.
A continuous fever is one whose temperature is steady, and doesn't waver. Either the fever stays at the same level, declines slowly, or rises steadily, showing no signs of abating; of these three types, the last is the most dangerous. Continuous fevers are the most dangerous because they progressively exhaust the organism and allow it no rest; they are also not self-limiting.
An intermittent or periodic fever is one whose temperature is not constant, but rises and falls in peaks and valleys, or on/off cycles. Intermittent fevers are of many kinds, and each will have its own characteristic cycles and patterns.
The period during which the intermittent fever is actively manifesting is called the paroxysm, whereas the passive, latent stage in between active phases is called the rigor. The final crisis or climax of a fever is called its acme.
If the fever is treated or managed successfully, the acme will be followed by a restoration of health. If the fever overwhelms its host, the acme may be followed by demise and death.
The nature and duration of an intermittent fever's paroxysm is determined, or can be altered, by certain factors, which are as follows:
The constitutional vigor and vitality of the host - The stronger the host, the shorter, more acute and vehement the paroxysm, as the strong host tends to wage a more vigorous and decisive battle against the disease. Conversely, the weaker the host, the longer and more drawn out, and less vehement, the paroxysm.
The constitutional nature and temperament of the host - The hotter the host's temperament and metabolism, the shorter the paroxysm, as morbid superfluous humors are burned off more quickly. Conversely, the colder the host's temperament, the longer the paroxysm.
The nature and temperament of the morbid humors and pathogens being eliminated - Generally, the colder and thicker they are, the slower the elimination and the accompanying paroxysm; the hotter and thinner they are, the faster the elimination and the shorter the accompanying paroxysm.
Weather and climactic factors - Morbid humors mature and ripen more quickly in hot weather, which favors quicker elimination and shorter paroxysms; with cold weather, the contrary. Excessive moisture and humidity tend to encourage and prolong putrefactions.
If the regularity of the classic textbook patterns of rigor and paroxysm is disturbed or unclear, it may be due to two things: dramatic changes or fluctuations in any of the above four factors; or the interweaving or interplay of multiple febrile processes simultaneously.
Ephemeral fevers are those that affect the mind, spirit, emotions and Vital Force; they involve the Vital Faculty and its vital principles. Ephemeral means that the fevers are primarily energetic in nature, and not substantial in origin.
Ephemeral fevers are quotidian, typically lasting for only a day, or 24 hours. Their temperature is constant, not rising.
Because ephemeral fevers affect the Vital Force and Vital Faculty, they also involve our Innate Heat, Thymos and immunity. These vital principles operate on two levels: an outer immune level, or shield; and an inner core level, involving the Vital Faculty as a whole.
Grippes, or acute ephemeral fevers, primarily affect the body's outer immune shield. Their cause is primarily hot or cold drafts or dystempers, usually exogenous in origin, by environmental exposure or ingestion. They also frequently involve wind, which provides the motive force that enables the exogenous heat or cold to penetrate the body's immune shield.
A cold grippe is caused by catching a chill, or by exposure to a chilly draft. Depending on the strength of the host's constitution, and the consequent vigor of his/her immune response, the signs and symptoms can vary considerably:
If the immune response is strong, there will be fever and chills, with fever predominating. The skin pores will close tightly, stopping all perspiration, both subtle and sensible; this blocked moisture release will back up into the respiratory tract, causing coughing, wheezing and lung congestion. There may also be shooting muscular aches and pains, nasal congestion, a stiff neck and headache. The tongue will have a thin white coat, and the pulse will be superficial, tense and rapid.
If host vitality and immunity are weak, there will be fever and chills, with chills predominating. The pores will be lax and open, and there will be a furtive perspiration. The complexion will be pale and the body cold, with poor circulation, rheumatic aches and pains, and an aversion to cold. There will also be fatigue, malaise and lethargy. The tongue will be pale with a thin white coat and the pulse will be superficial, soft and slow.
Hot grippes will vary little according to the host's vitality and immunity levels. There will be fever, profuse sweating and irritability. There may also be sore throat, headache, thirst, earaches, swollen glands, red sore eyes, and heat rashes. There may also be an aversion to wind and/or heat, since these are the main dystempers. The tongue body may be red, and there will usually be a thin yellow coat; the pulse will be superficial and rapid.
The best time to stop a cold is in the initial stages, before it becomes too entrenched. This is usually done with stimulants and diaphoretics, to break the fever by inducing sweating. The choice of medicines and treatments depends both on the nature of the dystemper as well as the constitutional nature and temperament of the host and the strength and vigor of his/her immune response.
When an exogenous hot or cold dystemper penetrates below the surface immune level to engage the host's Vital Force in its totality, agues, or acute fevers, can get very forceful and vehement, becoming an ardent fever. The cardinal signs and symptoms of an ardent fever are a high fever, extreme thirst; a full, rapid, bounding pulse; and profuse sweating. Because sustaining such a high, ardent fever is very exhausting to the organism, it should be brought down quickly and decisively with strong febrifuges.
A high, ardent fever may be complicated or aggravated by toxicity and waste retention in the colon and bowels. In these cases, there may be constipation, an irritable bowel, nausea and vomiting, GI reflux symptoms, or a severe sore throat. Purging the bowels with an enema often brings relief.
Many ephemeral fevers have a strong mental/emotional component. Strong emotions like anger, hate, rage, sexual passion, or grief can disturb and agitate the Vital Force and vital spirits, generating an ephemeral fever. Excessive physical agitation, shock or overwork can also disturb the Vital Force and generate an ephemeral fever. Because emotions are always one's own reactions, or responses, to external events and circumstances, these emotionally generated ephemeral fevers are endogenous in origin.
Putrid fevers are caused by a putrefaction of the humors. They're named and classified according to the humor affected: Sanguine, Phlegmatic, Bilious or Atrabilious.
Putrid fevers generally have five causes, any one of which can lead to humoral putrefaction, and then to fever:
The humor can be overabundant;
The humor can be too thick and viscous;
The humor can be too tenacious and sticky;
The humor can be blocked or obstructed;
The humor can stagnate for too long and lack ventillation.
Putrid fevers are generally intermittent, with the exception of blood. Each humor, according to its inherent nature and temperament, will be collected, ripened and expelled at different rates, with varying degrees of difficulty. And so, all the intermittent putrid fevers will have their own characteristic cycles and patterns of rigor and paroxysm.
The paroxysm always corresponds to the period of active catharsis of a morbid humor. During the rigor, the organism is resting and gathering its forces for the next catharsis. The basic patterns, cycles and characteristics of putrid fevers are:
Sanguine fevers, or putrid fevers of the blood, are continuous, and have no on/off cycle or limit to their duration; therefore, they are the most dangerous. They begin at a certain temperature, which either remains constant, declines steadily, or rises steadily; of these three types, the last is the most dangerous.
Blood fevers usually involve some infectious microbe. Depending on its virulence, the seriousness and temperature level of the Sanguine fever will vary. In addition to being acute or severe, blood fevers can also be chronic and low grade, lingering on for a long time to become a consumptive or strumous fever of the blood.
A Sanguine fever that's incompletely or unsuccessfully resolved in the acute stage can also linger on to become chronic or consumptive, slowly eating away at the organism; they can also flare up again at any time if conditions are right. The Sanguine fever is thus analogous to a campfire, which leaves some smouldering embers behind unless it is put out completely.
Since the blood carries the Vital Force, blood fevers often disturb the mind and vital spirits. Mental cloudiness and confusion, restlessness, agitation, malaise, insomnia or manic behavior are common signs and symptoms.
Phlegmatic fevers, caused by putrefactions of phlegm, generally follow a 12 hours on / 12 hours off pattern, or quotidian cycle, with no set time limit to the fever as a whole, although they soon exhaust themselves once the superfluous morbid phlegm is consumed. The paroxysm phase usually happens during the warmer daytime hours, and the rigors at night.
Most Phlegmatic fevers generally manifest as some form of the common cold. When phlegm builds up to critical levels, manifesting a cold with a fever gives the organism the opportunity to burn it off. If the phlegm accumulates in the respiratory tract, you will have a cold or upper respiratory infection; if the phlegm accumulates in the digestive tract, you will have a stomach flu. Due to the cold, wet temperament of phlegm, most Phlegmatic fevers aren't very high.
Bilious fevers, caused by putrefactions of yellow bile, typically follow a day on / day off pattern, with both the initial paroxysm and the subsequent rigor lasting about 24 hours each. The liver and gall bladder are usually involved, and there may be headaches, irritability, red sore eyes, a bitter taste in the mouth, a sallow complexion, generalized malaise, nausea and vomiting, poor appetite, fullness and distension beneath the ribs, diarrhea and irritable bowel.
Atrabilious fevers are putrid fevers of black bile. Because black bile is thicker and colder in temperament than yellow bile, it is ripened and eliminated more slowly. Therefore, Atrabilious fevers have an on/off cycle that's longer and more drawn out. Typically, Atrabilious fevers follow a one day on / two days off pattern, with the paroxysm lasting 24 hours, and the rigor 48 hours.
The spleen, bowels and nerves will usually be involved in Atrabilious fevers, and there may be dizziness, vertigo, insomnia, neuraesthenia, poor appetite, indigestion, an acrid or bittersweet taste in the mouth, and sluggish or obstructed bowels. The complexion will be dark or dull yellow, and there may be dark circles under the eyes.
Complexion, in addition to fever pattern and cycle, is also a reliable indicator of the offending humor. The complexion in Sanguine fevers is red and flushed; in Phlegmatic fevers pallid; in Bilious fevers sallow; and in Atrabilious fevers dark, ashen or swarthy.
The above cyclic patterns in putrid fevers are for the pure types. If a putrid fever doesn't fit neatly into any one of the four patterns presented here, it's usually because multiple putrefying humors are involved. If this is the case, other signs and symptoms must be relied upon.
The general line of treatment in putrid fevers is to assist the body with medicines and treatments that ripen and purge the offending humor(s). Food should be kept to a bare minimum, preferably a liquid diet, during paroxysms, so the organism can concentrate on elimination and detoxification. Throughout the course of a fever, heating and drying foods such as mustard, garlic, chilies and onions should be strictly avoided, as these tend to aggravate fever in general.
Hectic fevers are the most chronic and deep-seated of all fevers. They generally originate in the noble and principal organs, and are usually intermittent.
Tertian fevers repeat their cycle every third day. They have a 12 hour paroxysm followed by a 36 hour rigor, for a total of 48 hours before the cycle repeats. The entire span of the fever, from the first paroxysm to the last, is typically seven days.
Tertian fevers are usually caused by yellow bile that's gotten too cold and moist. Being a fever of yellow bile, the liver and gall bladder are involved. The overall signs and symptoms will be similar to those for bilious fevers, but the paroxysms won't be as ardent or vehement, since the tertian fever is colder in temperament; in addition, there may also be alternating fever and chills.
If constipation is present, the offending cold, moist bilious humor is in the veins, and not in any of the noble or principal organs. If there is abundant phlegm in the mouth, the fever has a colder temperament, and cooling foods and herbs should be avoided. If there's a salty or bitter taste in the mouth, the tertian fever is hotter in temperament, and cooling foods and medicines may be given.
Tertian fevers are best treated with mild purgatives that concoct and ripen bile and stimulate and cleanse a torpid liver and gall bladder. These herbs are generally pungent and bitter, and mildly warming in temperament.
Quatrain fevers repeat their cycle every fourth day, and usually involve black bile. They typically have an 18 hour paroxysm followed by a 54 hour rigor for a total cycle of 72 hours. Quatrain fevers are caused by a corruption in one of the noble or principal organs. The signs and symptoms will vary, depending on which organ is affected.
With both the tertian and quatrain fevers, food intake should be light and limited, preferably a liquid diet, during the paroxysms, which allows the organism to concentrate on concocting and purging itself of the pathogenic matter. A slightly fuller diet can be given during the rigors, but still, it must be kept light, pure and easy to digest.
Consumptive fevers are chronic, lingering fevers that have consumed the blood and/or serous fluids, and finally the Radical Moisture of the organism. They are like a raging bonfire that has dwindled down into smouldering embers.
Consumptive fevers are continuous and low grade, but tend to get worse in the evenings, and at night. Marasmus, or a state of severe fatigue and prostration, often with a thin, furtive sweat, is also commonly seen. The tongue will usually be thin, emaciated and dark red, and the pulse will be thin, thready and rapid.
Consumptive fevers can either involve the serous fluids or the blood; they can also be centered in one of the noble or principal organs. In addition to the common signs and symptoms listed above, each type of consumptive fever will present with additional signs and symptoms peculiar to itself:
If the consumptive fever is in the serous fluids, there will be signs of wasting and dehydration; extreme thirst, often with no desire to drink; mental restlessness, malaise and insomnia; and spots and maculae on the skin. Consumptive fevers affecting the serous fluids are often the result of Phlegmatic fevers that have gone chronic; they may also go on to affect the blood as well.
Consumptive fevers affecting the blood are more ardent, vehement and serious, since blood is hotter in temperament than the serous fluids. There will be fever, rashes and skin eruptions; agitated or manic behavior; and various types of abnormal bleeding: epistaxis (nosebleed), hematemesis (vomiting blood) or hemoptysis (coughing up blood).
Consumptive fevers affecting the liver will present with: headache, irritability, red sore eyes, dizziness, vertigo, tinnitus, indigestion, poor appetite, and fullness and distension underneath the ribs.
Consumptive fevers affecting the heart will present with restlessness, delirium, insomnia and night sweats. Such a fever will disturb and agitate the vital spirits.
Consumptive fevers affecting the lungs will present with: dyspnea, or shallow breathing; a weak, chronic cough; wasting and consumption; chronic thirst and sore throat; a fine, furtive perspiration; and in severe cases, coughing up blood, or hemoptysis. These are the classic signs and symptoms of pulmonary tuberculosis.
Convulsive fevers are generated by high, ardent fevers that enter the liver, stirring up internal wind. The distinguishing signs and symptoms will be: giddiness, nausea, dry heaves, projectile vomiting, mania, insomnia and disturbed sleep, apoplexy, convulsions, rolling eyes, tremors, spasms and deviation of the tongue.
Fevers: Greek Medicine versus Modern Medicine
There is a world of difference between Greek Medicine and modern medicine in how they treat fevers and the infections that are often associated with them.
Modern medicine sees fever as something negative and undesirable, that must be quelled and suppressed unconditionally, at all costs. Strong antibiotics are used to kill off the invading infectious microbes.
Greek Medicine sees fever as a natural immune response of the organism, as a process of cleansing and catharsis that must be managed and worked with by the physician as the Servant of Nature. Infectious microbes are seen as secondary to morbidities and imbalances in the biological and metabolic terrain that allowed the proliferation of pathogenic microbes in the first place.
Although resorting to modern medical methods to treat fevers and infections is quick and convenient, in the long run, overindulgence in such methods can do the organism a disservice. Like any organ, muscle or physiological function of the body, the natural cathartic response of fever can weaken with continued disuse and suppression, and not be around when it's needed.
Antibiotics may kill off pathogenic microbes, but their mortal remains still linger around to clog the circulatory and lymphatic systems. These microbial corpses still have to be digested, concocted and eliminated by the spleen and lymphatic systems, then eliminated via the excretory organs; this is all part of the clean up work done by the natural healing methods of Greek Medicine.
An ecological disaster in the microbial world looms on the horizon, which has been created by our own indiscriminate use, misuse and abuse of antibiotics. Originally designed to be used only in life-threatening infections, their overuse and consequent microbial overexposure has led to the rise of new "superbugs" resistant to multiple antibiotics. Truly, the waning twilight of the antibiotic age may be at hand.
There was nothing inherently wrong with the weapon of antibiotics; the only error was in how they were overused, misused and abused, like selling them en masse to factory farms to prevent infections and accelerate growth in livestock. Developing new technologies like antibiotics is relatively easy. New technologies are a dime a dozen; much rarer and more precious is the moral and ethical maturity and enlightened sense of values necessary to use them properly.
And so, perhaps in a spirit of dire necessity, modern medicine may once again have to revert back to the natural, holistic methods of Greek Medicine in fighting fevers and infections.