bubble_chart Concept

Tidal fever refers to a fever that rises and falls at regular intervals, much like the tides.

This condition is referred to as "late afternoon tidal fever" in the "Cold-Damage Disease Treatise," and later generations also have the term "afternoon tidal fever." Its clinical manifestations differ from those of a general fever. If it occurs several times a day, it is considered a fever and does not fall within the scope of tidal fever.

Although the fever in malaria occurs at regular intervals, it is characterized by alternating chills and fever, whereas tidal fever is fever without chills, making the two easily distinguishable.

bubble_chart Pattern Analysis

1. Yangming Fu-organ Excess︰late afternoon tidal fever, sweating on the hands and feet, abdominal hardness and fullness with pain, severe constipation or heat retention with watery discharge, or unconsciousness and delirious speech, dysphoria and restlessness, scorched yellow tongue coating, and a deep, replete pulse. This condition is mostly caused by unresolved exterior pathogens transforming into heat internally and binding with substantial pathogens in the intestines, resulting in "excess of the stomach and intestine." Yangming qi flourishes during the Shen-You hours (between 4-8 PM), hence the manifestation of late afternoon tidal fever. *Treatise on Cold Damage Diseases: Differentiation of Yangming Disease Patterns and Treatment* states: "In Yangming disease, if the pulse is slow, and there is sweating without aversion to cold, the body will feel heavy, with shortness of breath, abdominal distension and fullness, and panting. If there is tidal fever, this indicates the exterior is resolving, and purgation may be applied internally... If there is profuse sweating with slight fever and chills, the exterior has not yet resolved, and the heat is not tidal. In such cases, the Chengqi Decoction should not be administered." This suggests that tidal fever indicates the formation of the Yangming fu-organ pattern, and purgation may be applied. The key points of differentiation include fever that worsens in the evening, intense heat with sweating, and symptoms of dry stool accumulation (abdominal distension and fullness with tenderness, constipation, and scorched yellow tongue coating). Treatment should focus on purgation to drain heat, with the selection of Major Purgative Decoction, Minor Purgative Decoction, or Stomach-Regulating Purgative Decoction depending on the severity of heat accumulation.
2. Yin Deficiency with Blood Depletion︰Afternoon or evening tidal fever, feverish feeling in palms and soles, vexation and insomnia, palpitation and night sweat, emaciation and mental fatigue, {|###|}red tongue with scant coating{|###|}, thready and rapid pulse. Mostly caused by constitutional {|###|}yin deficiency{|###|} or after sweating, vomiting, diarrhea, loss of blood, or {|###|}fluid exhaustion{|###|}, leading to yin depletion and qi dryness, with {|###|}deficiency fire flaming upward{|###|}. Suwen·Tiaojing Lun states: "{|###|}Yin deficiency{|###|} leads to internal heat." It can occur in various chronic sexually transmitted diseases or the late stage [third stage] of acute Rebing, also known as "{|###|}steaming bone fever{|###|} or consumptive heat." Its characteristics include: afternoon tidal fever, accompanied by symptoms of {|###|}deficiency fire flaming upward{|###|} (flushed cheeks, vexing heat in the chest, palms and soles, night sweat, red tongue, and thready rapid pulse). Treatment should focus on {|###|}nourishing yin and blood{|###|} to clear heat, with prescriptions such as Bone-Clearing Powder plus Chinese Angelica, Peony Root, etc.
3. Spleen-Stomach Qi Deficiency︰Morning tidal fever, afternoon fever subsides or afternoon fever, shortage of qi and reluctance to speak, mental fatigue and limb weakness, spontaneous sweating, pale complexion, pale and tender tongue, weak and thin pulse. It mostly occurs in adults, often caused by overstrain and internal damage, improper diet, middle qi deficiency leading to sinking, and ascending of yin fire to the earth position. Suwen．Tiaojing Lun states: "Due to overstrain, the form and qi decline, grain qi is insufficient, the upper energizer does not function, the lower stomach is obstructed, stomach qi becomes hot, and the heat steams the chest, hence internal heat." This is also what Li Dongyuan mentioned in Piwei Lun．"Fire and original qi cannot coexist; when one prevails, the other declines." Typically, fever occurs in the morning and subsides in the afternoon, though some may experience fever in the afternoon. Accompanied by other qi deficiency symptoms (shortness of breath, reluctance to speak, fatigue, and spontaneous sweating). Treatment should focus on relieving fever with sweet and warm herbs, and the recommended formula is Middle-Tonifying Qi-Replenishing Decoction.
4. Summerheat Impairing Qi︰It is mostly infantile summer consumptive disease fever, with symptoms such as fever in the morning and coolness in the evening, or fever in the evening and coolness in the morning, thirst and desire to drink, dysphoria and restlessness, anorexia and mental fatigue, greasy tongue coating, and thin rapid pulse. This is a common condition in children during summer, which may resolve on its own as the weather cools in autumn. It is often a clinical manifestation of infantile summer consumptive disease, as children's yin qi is not yet sufficient and yang qi is not yet robust, making them unable to endure the steaming summer heat, leading to damage of qi and yin, hence presenting as tidal fever, also known as "summer fever." Adults may occasionally experience it as well. Danxi Xinfa · summerheat stroke states: "Summerheat stroke belongs to yin deficiency, with insufficient original qi. At the beginning of summer and the end of spring, symptoms such as headache, weak legs, reduced appetite, and bodily heat are present." The key points for differentiating the two conditions are: fever in the morning and coolness in the evening, or fever in the evening and coolness in the morning, accompanied by symptoms of summerheat damaging qi (thirst and desire to drink, bodily fatigue and mental fatigue). The treatment should focus on clearing summerheat and replenishing qi, with the recommended formula being Wang's Summerheat-Clearing Qi-Replenishing Decoction.
5. Static Blood︰Afternoon or nighttime fever, dry throat and mouth, desire to rinse the mouth but reluctance to swallow, abdominal masses, or localized pain, even scaly skin, dark circles under the eyes, ecchymosis or cyanosis on the tongue, and a thin, rough pulse. Afternoon or nighttime tidal fever, manifested as low-grade fever, is often caused by traumatic injury, congealing cold and qi stagnation, reckless movement of blood due to heat, and other factors affecting blood circulation, leading to stagnation and the formation of stasis, with static blood internally stagnating and transforming into heat. Its characteristics include: afternoon or nighttime tidal fever, accompanied by symptoms of static blood internal binding (fixed pain or masses in the body, scaly skin, ecchymosis or cyanosis on the tongue). Treatment should focus on invigorating blood and resolving stasis to clear heat. The recommended formula is Blood House Stasis-Expelling Decoction with the addition of prepared Rhubarb Rhizoma, Cortex Moutan, and other herbs.

The syndrome of tidal fever mostly belongs to the interior pattern, but it can be either deficiency or excess. Excess pattern tidal fever is often caused by external contraction, with a higher fever that does not completely subside and rises again at a certain time; deficiency pattern tidal fever is often caused by overstrain and internal damage leading to qi and blood deficiency, with a lower fever or only a subjective sensation of fever, and the condition tends to linger. However, prolonged excess pattern can also lead to deficiency, so many cases of tidal fever are often sequelae of acute Rebing. In clinical differentiation, it is essential to grasp the characteristics of tidal fever and analyze it in combination with the disease history and accompanying symptoms.

bubble_chart Documentation

1. "On Cold Damage Diseases: Differentiation of Yangming Disease Pulse Signs and Treatment": "Yangming disease, delirious speech, tidal fever, slippery and rapid pulse, treat with Minor Purgative Decoction." "Yangming disease, delirious speech... with tidal fever, inability to eat, there must be five or six dry stools in the stomach. If able to eat, it is only hardness, treat with Major Purgative Decoction for purgation."
2. Miscellaneous Diseases Zhengzhi Zhunsheng · Cold and Heat Section: "Tidal fever comes and goes like the tide, occurring at regular intervals, once a day, or three to five times a day, which is fever; not tidal fever."
3. Miscellaneous Diseases Extensive Essentials · Internal Causes: "For those with tidal fever, assess deficiency and excess. If stools are hard and dry, prefer cold and fear heat, feel fullness in the chest, and cannot sleep, these are signs of excess, so-called excess tidal fever, treat with Diaphragm-Cooling Powder and Bupleurum for purgation; if stomach qi is weak, spirit is weary, appetite is reduced, and there is gradual emaciation, though the disease temporarily subsides, and there is a tendency to hyperactivity of the five heart qi, this belongs to deficiency pattern, treat with Peripatetic Powder and minor Bupleurum with modifications; for those who experience mild fever at night without the patient noticing, are active in the morning without issues, and have normal appetite, with no other symptoms to suspect, it is just blood deficiency, yin failing to nourish yang, use Supplemented Peripatetic Powder in the morning and Six-Ingredient Pill in the evening, if ineffective, use Angelica Blood-Tonifying Decoction and modified Eight-Ingredient Pill."