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Wednesday, 30 March 2011

Glandular fever and its TCM treatment

Tiejun Tang

Glandular fever is an infectious disease caused by the Epstein-Barr virus. Some TCM practitioners who were trained in China might not be familiar with this, but its formal name -- infectious mononucleosis, will be more familiar.

The diagnosis of this disease is not difficult. The main points of diagnosis are included in the names of the disease. The clinical manifestations are fever with swollen glands, sore throat, headache, fatigue and muscle ache. These symptoms are similar to flu, except that the patient will have a unique blood test result with monocytes count significantly increased. There may be swollen lymph nodes, enlarged liver and spleen, widespread red skin rash without itchiness.

This disease can occur in any age groups but young people between 10 and 25 years are most vulnerable to this infection. The incubation period from infection to when the symptoms first appear is between 30 and 50 days.

Western medicine does not have any efficient treatment for infections caused by virus. Usually patients will be prescribed medicine such as paracetamol or ibuprofen to ease the symptoms. Antibiotics may be used if the patient developed a secondary bacterial infection of the throat. Steroids may also be prescribed in severe swelling of tonsils.

Chinese medicine diagnosed this disease as Wenbing (温病, epidemic febrile). It is due to wind-heat or wind-cold invading the superficies. The exogenous evils produce heat and toxin. These heat-toxin spread to the blood, it consumes qi and body fluid, then causing qi and yin deficiency at a later stage.

Chinese medicine treats glandular fever with different treatment principles at different stages. In the early stage the diagnosis is due to wind-heat invading the lung, we can use modified Yinqiao San to clear and detoxify wind-heat.  In the middle stage where the heat develops from Wei stage to Qi stage, we need to use modified Baihu Tang to purge the internal fire. In the later stage the heat develops to Ying stage, we select Qingying Tang to clear heat and cool the blood. At the recovery stage, patients usually have qi and yin deficiency symptoms, we should then select modified Zhuye Shigao Tang to clear the remaining fever and tonify qi and yin.

Some Chinese herbs have a good function of inhibiting virus which can be applied to treat glandular fever.  These are Banlangen (Radix Isatidis), Daqingye (Folium Isatidis), Lianqiao (Fructus Forsythiae), Jinyinhua (Lonicera japonica Thunb), Guanzhong (Cyrtomium Rhizome), Huangqin (Radix Scutellariae). If the patient has red skin rash appearing, I would like to add Chishao (Red Peony Root), Mudanpi (Tree Peony Bark), Zhicao (Radix Lithospermi), Qiancao (Radix Rubiae), Xuanshen (Radix Scrophulariae) to cool blood. If the patient has qi and yin deficiency, Maimendong (Dwarf Lilyturf Tuber), Zhuye (Folium Phyllostach Lophatheri), Zhimu (Rhizoma Anemarrhenae), Taizishen (Radix Pseudostellariae) can be added.

In addition to Chinese herbal medicine, acupuncture can also be used to treat glandular fever. The commonly used points are Hegu (LI4), Quchi (LI11), Waiguan (SJ5), Dazhui (Du14), Fengmeng (BL12), Feishu (BL13), Xuehai (SP10).  A reducing manipulation can be applied. In some severe cases with high temperature, bloodletting cupping at Dazhui (DU14) is necessary.

Glandular fever usually takes 2-4 weeks to resolve without complications. In about 3 per cent of the cases, it might develop into complications such as pneumonia, anaemia, thrombocytopenia, meningitis or encephalitis. Three per cent is a very low chance, but if it happened to an individual person that mean a hundred per cent to him/her. Glandular fever should not be ignored.  If a patient has got this disease, he should have plenty of rest, drink plenty of water, and access to a Chinese medicine practitioner. I am sure Chinese herbal medicine and acupuncture can give more help than chemical drugs.