BLUE POPPY PRESS RECENT RESEARCH REPORT # 284

Dengue Fever & Chinese Medicine

tant mosquito-borne viral disease affecting
humans, with an estimated 2.5 billion people
living in areas at risk for epidemic transmission.
Each year, tens of millions of cases of dengue
fever occur worldwide. From 1977-1994, there
were 2,248 suspected cases of imported dengue
reported in the United States. Effective prophylactic vaccines are not expected to be available
for another 5-10 years.

by

Bob Flaws, Dipl. Ac. & C.H., FNAAOM,

FRCHM

Keywords: Chinese medicine, Chinese herbal

medicine, dengue fever
Dengue fever, also called breakbone and dandy
fever, is an acute febrile disease of sudden onset
accompanied by headache, fever, prostration,
severe joint and muscle pain, lymphadenopathy,
and a rash which typically appears with a second rise in temperature after a period of no
fever. According to Western medicine, dengue
fever is caused by any of four closely related
Flaviviruses, DEN-1, DEN-2, DEN-3, and
DEN-4. These viruses are transmitted to
humans by the Aedes aegypti mosquito, a
domestic, day-biting mosquito that prefers to
feed on humans. Dengue is endemic throughout
the tropics and subtropics. The first reported
epidemics of dengue fever occurred in the late
1770s in Asia, Africa, and North America. A
global pandemic of dengue began in Southeast
Asia after World War II and has intensified during the last 15 years. Outbreaks have occurred
in the Caribbean since 1969, including Puerto
Rico and the U.S. Virgin Islands and cases have
been imported to the U.S. mainland by tourists.
In 1970, the government of the United States
discontinued its Aedes aegypti eradication program (this mosquito is also a carrier of yellow
fever), and, since then, this species has begun to
reinfest areas from which it had been previously
eliminated. In 1997, the geographic distribution
of Aedes aegypti was wider than its distribution
before the Pan American Health Organization
eradication program. According to the Center
for Disease Control, dengue is the most impor-

Sign & symptoms:

After an incubation period of 3-15 days (usually
5-8 days), there is an abrupt onset of chills,
headache, retro-orbital pain on moving the eyes,
low back pain, and severe prostration. Extreme
aching in the legs and joints occurs within the
first hours of the illness. There is a rapid rise in
temperature up to 408C (1048F) with relative
bradycardia and hypotension. The bulbar and
palpebral conjunctivae are injected, and there is
transient flushing or a pale pink macular rash
which is most pronounced on the face. The
spleen may be soft and slightly enlarged, and
cervical, epitrochlear, and inguinal lymph nodes
are typically enlarged. Fever and other symptoms persist for 48-96 hours. Then the fever
rapidly breaks with a profuse sweat. This is followed by 24 hours free from fever during which
the patient feels quite good. However, this is but
a brief respite, since a second rapid rise in temperature follows accompanied by a characteristic maculopapular rash spreading from the
extremities to cover the whole body except the
face. The patients palms and soles may be
bright red and swollen. This fever, rash, and
headache cum other pains constitute the
dengue triad. Although rarely fatal in typical
cases, convalescence often lasts several weeks

and is accompanied by marked fatigue and

weakness.

a floating, rapid pulse

Treatment principles: Clear heat and course the
exterior, resolve toxins and out-thrust evils

Diagnosis:

Rx: Yin Qiao San Jia Jian (Lonicera &

Forsythia Powder with Additions &
Subtractions)

Dengue fever may be confused with Colorado

tick fever, typhus, yellow fever, or other hemorrhagic fevers. In dengue fever, leukopenia is
usually present by the second day of fever. By
the fourth or fifth day, white blood cells have
dropped to 2000-4000/F L, with only 20-40%
granulocytes. Moderate albuminuria and a few
casts may be found.
Western medical treatment:

Ingredients: Flos Lonicerae Japonicae (Jin Yin

Hua), 15g, Fructus Forsythiae Suspensae (Lian
Qiao), 15g, Folium Lophatheri Gracilis (Dan
Zhu Ye), 6g, Fructus Arctii Lappae (Niu Bang
Zi), 10g, Flos Seu Herba Schizonepetae
Tenuifoliae (Jing Jie Sui), 6g, Herba Menthae
Haplocalycis (Bo He), 3g, uncooked Radix
Rehmanniae (Sheng Di), 15g, Cortex Radicis
Moutan (Dan Pi), 10g, Radix Rubrus Paeoniae
Lactiflorae (Chi Shao), 10g, and Folium
Daqingye (Da Qing Ye), 10g

The Western medical treatment of dengue fever

is solely symptomatic. For instance, although
aspirin should be avoided, acetominophen and
codeine may be given for severe headache and
muscle-joint pain. Complete bed rest is considered important.

Additions & subtractions: For simultaneous

vomiting, ductal glomus, fatigue, diarrhea, and
slimy tongue fur, add Herba Eupatorii Fortunei
(Pei Lan), Herba Agastachis Seu Pogostemi
(Huo Xiang), and Herba Elsholtziae (Xiang Ru),
10g each, and Fructus Amomi (Sha Ren) and
Pericarpium Citri Reticulatae (Chen Pi), 6g
each. If there is constipation, add Radix Et
Rhizoma Rhei (Da Huang), 10g. If oral thirst is
marked, add Radix Trichosanthis Kirlowii (Tian
Hua Fen) and Radix Scrophulariae Ningpoensis
(Xuan Shen), 10g each. If aversion to cold and
body pain is severe, add Ramulus Mori Albi
(Sang Zhi), Radix Gentianae Macrochyllae (Qin
Jiao), Radix Et Rhizoma Notopterygii (Qiang
Huo), and Radix Angelicae Pubescentis (Du
Huo), 10g each. If there is high fever and no
aversion to cold, omit Jing Jie Sui and add
uncooked Gypsum Fibrosum (Shi Gao), 30-60g.

Chinese medical treatment based on

pattern discrimination:
The following pattern breakdown and treatment
options are based on Zhang Tian-ming et al.s
Bing Du Xing Ji Bing De Liang Fang Miao Fa
(Fine Formulas & Wonderous Methods for Viral
Diseases), China National Medicine &
Medicinal Publishing Co., Beijing, 1997, and
Ma Chao-ying and Li Yuan-shis Bing Du Xing
Ji Bing De Zhong Yi Zhi Liao (The Chinese
Medical Treatment of Viral Diseases), Shanghai
University of Chinese Medicine Publishing Co.,
Shanghai, 1996.
1. Warm evils depressed in the exterior

Symptoms: Abrupt onset of fever accompanied

by aversion to cold, headache, aching and pain
of the joints and muscles of the four limbs, low
back pain, oral thirst, the appearance of a macular rash which is pale red and worse on the
lower limbs, enlarged lymph nodes, a red
tongue with thin, white or thin, yellow fur, and

2. Evils obstructing the membrane origin

Symptoms: Increasing cold, strong fever or

fever and no cold, increased headache, a red
face and eyes, soreness and heaviness of the

limbs, torpid intake, chest and ductal glomus

and oppression, hiccup or vomiting, abdominal
fullness, distention, and pain, diarrhea or constipation, short, reddish urination, a red tongue
with white, slimy fur, and a soggy, rapid pulse

Decoction with Additions & Subtractions)

Ingredients: uncooked Gypsum Fibrosum (Shi
Gao), 30-60g, Rhizoma Anemarrhenae
Aspheloidis (Zhi Mu), 10g, Folium Lopthatheri
Gacilis (Dan Zhu Ye), 10g, Radix Isatidis Seu
Baphicacanthi (Ban Lan Gen), 15g, Radix
Glycyrrhizae (Gan Cao), 6g, uncooked Radix
Rehmanniae (Sheng Di), 15g, Folium Daqingye
(Da Qing Ye), 15g, and Rhizoma Imperatae
Cylindricae (Bai Mao Gen), 30g

Treatment principles: Course, disinhibit, outthrust, and extend, cleanse filth and transform
turbidity
Rx: Da Yuan Yin Jia Jian (Extend the Origin
Drink with Additions & Subtractions)
Ingredients: Cortex Magnoliae Officinalis (Hou
Po), 10g, Semen Arecae Catechu (Bin Lan),
10g, Herba Artemisiae Apiaceae (Qing Hao),
15g, Rhizoma Pinelliae Ternatae (Ban Xia),
10g, Radix Albus Paeoniae Lactiflorae (Bai
Shao), 10g, Rhizoma Anemarrhenae
Aspheloidis (Zhi Mu), 10g, Radix Bupleuri
(Chai Hu), 15g, Fructus Amomi Taso-ko (Cao
Guo), 6g, Fructus Forsythiae Suspensae (Lian
Qiao), 15g, Fructus Cardamomi (Bai Dou Kou),
6g, and Radix Glycyrrhizae (Gan Cao), 6g

Additions & subtractions: If the stools are constipated, add uncooked Radix Et Rhizoma Rhei
(Da Huang), 10g. For severe thirst, add
Rhizoma Polygoni Odorati (Yu Zhu) and Herba
Dendrobii (Shi Hu), 15g each, and Radix
Trichosanthis Kirlowii (Tian Hua Fen), 10g. If
macular rash is marked, add Radix Lithospermi
Seu Arnebiae (Zi Cao), Cortex Radicis Moutan
(Dan Pi), and Radix Rubrus Paeoniae
Lactiflorae (Chi Shao), 15g each. If there is
epistaxis, add Cacumen Biotae Orientalis (Ce
Bai Ye) and Nodus Rhizomatis Nelumbinis
Nuciferae (Ou Jie), 10g each. If there is spitting
blood, add uncooked Radix Et Rhizoma Rhei
(Da Huang), 5g, and Radix Pseudoginseng (San
Qi), 3g, powdered and swallowed with the
decocted medicinals. For hemafecia, add carbonized Radix Sanguisorbae (Di Yu) and Flos
Immaturus Sophorae Japonicae (Huai Hua Mi),
10g each. These last three additions are for
dengue hemorrhagic fever (DHF), not just
dengue fever.

Additions & subtractions: If aversion to cold is

severe, add Herba Agastachis Seu Pogostemi
(Huo Xiang), 10g, and Herba Elsholtziae (Xiang
Ru), 6g. If fever is relatively severe, add Flos
Lonicerae Japonicae (Jin Yin Hua), 15g, and
Gypsum Fibrosum (Shi Gao), 30g. If the tongue
fur is thick, white, and slimy, add Rhizoma
Atractylodis (Cang Zhu), 10g.
3. Qi heat blazing & exuberant

Symptoms: High fever with no aversion to cold,

headache, low back pain, oral thirst, sweating, a
red facial complexion, red eyes, rapid, hasty
breathing, heart vexation, dry, bound stools, a
red tongue with dry, yellow fur, and a slippery
rapid or surging, large, forceful pulse

4. Qi & constructive both ablaze

Symptoms: High fever, oral thirst, clouded

vision, vexation and agitation, an obvious macular rash, spirit clouding and deranged speech if
severe, epistaxis, spitting blood, and/or hemafecia, a crimson red tongue with dry, yellow or
burnt black fur, and a slippery, rapid pulse

Treatment principles: Greatly clear heat from

the qi aspect or division

Note: If there is bleeding, there is dengue hemorrhagic fever, not just dengue fever.

Rx: Bai Hu Tang Jia Jian (White Tiger

Treatment principles: Clear the qi, cool the constructive, and resolve toxins

macular rash, a red, dry tongue, and a a fine,

rapid pulse

Rx: Qing Yi Bai Du Yin Jia Jian (Clear the

Epidemic & Vanquish Toxins Drink with
Additions & Subtractions)

Treatment principles: Clear heat and resolve

toxins, boost the qi and nourish yin
Rx: Sheng Mai San (Engender the Pulse
Powder) plus Qing Ying Tang (Clear the
Constructive Decoction) with additions and subtractions

Ingredients: uncooked Gypsum Fibrosum (Shi

Gao), 50g, uncooked Radix Rehmanniae (Sheng
Di), 15g, Rhizoma Anemarrhenae Aspheloidis
(Zhi Mu), 10g, Rhizoma Coptidis Chinensis
(Huang Lian), 5g, Fructus Gardeniae
Jasminoidis (Zhi Zi), 10g, Rhizoma Imperatae
Cylindricae (Bai Mao Gen), 30g, Flos
Lonicerae Japonicae (Jin Yin Hua), 10g, Fructus
Forsythiae Suspensae (Lian Qiao), 10g, Cortex
Radicis Moutan (Dan Pi), 10g, Radix Rubrus
Paeoniae Lactiflorae (Chi Shao), 15g, Radix
Scrophulariae Ningpoensis (Xuan Shen), 10g,
Cornu Bubali (Shui Niu Jiao), 30g, and Radix
Et Rhizoma Rhei (Da Huang), 10g

Ingredients: Radix Pseustellariae Heterophyllae

(Tai Zi Shen), 30g, Tuber Ophiopogonis
Japonici (Mai Men Dong), 30g, Fructus
Schisandrae Chinensis (Wu Wei Zi), 10g,
Fructus Corni Officinalis (Shan Zhu Yu), 15g,
Radix Scrophulariae Ningpoensis (Xuan Shen),
15g, Radix Salviae Miltiorrhizae (Dan Shen),
30g, uncooked Radix Rehmanniae (Sheng Di),
15g, Cortex Radicis Moutan (Dan Pi), 15g,
Radix Rubrus Paeoniae Lactiflorae (Chi Shao),
15g, and Fructus Forsythiae Suspensae (Lian
Qiao), 10g

Additions & subtractions: For epistaxis, add

carbonized Flos Seu Herba Schizonepetae
Tenuifoliae (Jing Jie Sui) and carbonized Radix
Scutellariae Baicalensis (Huang Qin), 10g each.
For spitting blood or hemafecia, add Radix
Pseudoginseng (San Qi), 3g, powdered and
swallowed with the decocted medicinals, and
Herba Et Radix Cirsii Japonici (Da Ji) and
Herba Cephalanoploris Segeti (Xiao Ji), 10g
each. For spirit clouding and deranged speech,
add An Gong Niu Huang Wan (Quiet the Palace
Bezoar Pills), 1-2 pills swallowed with the
decocted medicinals. For tugging and slackening, add Ramulus Uncariae Cum Uncis (Gou
Teng), 15g, and powdered Cornu Antelopis
Saiga-tatarici (Ling Yang Jiao), one count.

Additions & subtractions: If there is simultaneous yang qi deblility and exhaustion with an
ashen white facial complexion, chilled limbs
extending up to the elbows and knees, and dribbling and dripping of chilly sweat, add Radix
Lateralis Praeparatus Aconiti Carmichaeli (Fu
Zi), 15g, Cortex Cinnamomi Cassiae (Rou Gui),
6g, and Os Draconis (Long Gu) and Concha
Ostreae (Mu Li), 30g each. If fever is not
marked and th face is not flushed red, omit
Sheng Di, Lian Qiao, and Dan Pi.
6. Lung-stomach yin damage

Symptoms: A dry mouth and parched tongue,

possible low-grade fever, cough with scanty
phlegm, a red tongue with scanty fur, and a fine
pulse

5. Heat sinking, righteous deserting

Symptoms: A hot body but chilled limbs, a red

facial complexion, heart vexation, rapid, distressed breathing, if severe, agitation, anxiety,
and restlessness or spirit clouding and deranged
speech, hypotension, cyanotic lips, possible

Note: This pattern describes the resolution stage

and lingering sequelae.

Treatment principles: Clear and resolve remaining heat, nourish yin and engender fluids

(Bai Bian Dou), 10g, and Rhizoma Atractylodis

Macrocephalae (Bai Zhu), 10g.

Rx: Sha Shen Mai Dong Tang Jia Jian (Glehnia

& Ophiopogon Decoction with Additions &
Subtractions)

Conclusion:

Ingredients: Radix Glehniae Littoralis (Sha

Shen), 10g, Tuber Ophiopogonis Japonici (Mai
Men Dong), 10g, Folium Mori Albi (Sang Ye),
10g, Radix Trichosanthis Kirlowii (Tian Hua
Fen), 10g, Radix Polygoni Odorati (Yu Zhu),
15g, Herba Dendrobii (Shi Hu), 15g, Folium
Lophatheri Gracilis (Dan Zhu Ye), 6g, Fructus
Forsythiae Suspensae (Lian Qiao), 10g, and
Radix Glycyrrhizae (Gan Cao), 5g
Additions & subtractions: For simultaneous lassitude of the spirit and lack of strength, shortness or breath and disinclination to speak due to
qi vacuity, add Radix Codonopsitis Pilosulae
(Dang Shen), 10g, Semen Dolichoris Lablab

While dengue fever is not currently of great

concern in the continental U.S., cases do appear
in Texas and among tourists returning to the
mainland from the Caribbean and other tropical
and subtropical locales where dengue fever is
endemic. Therefore, Western practitioners may
be asked to treat patients with this condition. In
addition, the Chinese medical pattern discrimination of dengue fever (including dengue hemorrhagic fever) may be used as a template for
the Chinese medical treatment of Colorado tick
fever and hanta virus.
Copyright Blue Poppy Press, 2002. All
rights reserved.

Copyright Blue Poppy Press, 2002

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