Dr. Sunil Kumar Singh1
Dr. Rakesh Kumar Meena2
Dr. Kumari Rakesh3
1M.D. (PGR), Repertory, Swasthya Kalyan Homoeopathic Medical College and Research Centre, Sitapura, Jaipur, Rajasthan, India.
2M.D. (PGR), Repertory , Swasthya Kalyan Homoeopathic Medical College and Research Centre, Sitapura, Jaipur, Rajasthan, India.
3M.D. (PGR), Materia Medica, Swasthya Kalyan Homoeopathic Medical College and Research Centre, Sitapura, Jaipur, Rajasthan, India.
In a neutral temperature environment, the human metabolic rate produces more heat than is necessary to maintain the core body temperature in the range of 36.5-37.5 degree oC and 97.7-99.5 degree oF. A normal body temperature is ordinarily maintained despite environmental variations because the hypothalamic thermoregulatory center balances the excess heat production derived from metabolic activity in muscle and the liver with heat dissipation from the skin and lungs. According to studies of healthy individuals 18-40 years of age the mean oral temperature is 36.8o ± O.4oC and 98.2o ± 0.7o With low levels at 6 A.M. and higher levels at 4-6 P.M. The maximal normal oral temperature is 37.2oC (98.9oF) at 6 A.M. and 37.7oC (99.9oF) at 4 P.M.; these values define the 99th percentile for healthy individuals. In light of these studies, an A.M. temperature of >37.2oC (>98.9oF) or a P.M. temperature of >37.2oC (>99.9oF) would define a fever. Fever is body temperature exceeding what is considered normal for the site at which the measurement is taken. Fever is thus occurs when temperature in the rectum is above 38.0ºC, temperature in the mouth is over 37.8ºC, and temperature in the axilla exceeds 37.2ºC. Fever is used by many in determining if an individual is in a healthy state or not, underlying the importance attached to it. In children, fever is a most common presenting symptom of childhood diseases. Fever is a cause of great concern and anxiety among caregivers due to the various misconceptions attributed to it. This article emphasis on types, clinical features Diagnosis and management of fever with homoeopathic medicines.
Keywords: Fever, Homoeopathy.
Body temperature is controlled by the hypothalamus. Neurons in both the preoptic anterior hypothalamus and the posterior hypothalamus receive two kinds of signals: one from peripheral nerves that transmit information from warmth/cold receptors in the skin and the other from the temperature of the blood bathing the region. These two types of signals are integrated by the thermoregulatory center of the hypothalamus to maintain normal temperature. In a neutral temperature environment, the human metabolic rate produces more heat than is necessary to maintain the core body temperature in the range of 36.5-37.5 degree oC (97.7 – 99.5 degree oF).1
Classiﬁcation, types and patterns of fever
- Fevers can be arbitrary classiﬁed into acute, subacute and chronic fevers based on duration. Acute fevers (<7 days in duration) are characteristics of infectious diseases such as malaria and viral-related upper respiratory tract infection while sub-acute fevers (usually not more than 2 weeks in duration) may be seen in cases of typhoid fever and intra- abdominal abscess, among others.2
- Chronic or persistent fevers (>2 weeks duration) are typical of chronic bacterial infections such as tuberculosis, viral infections like HIV, cancers and connective tissue diseases.2 However, any cause of acute fever can become persistent or chronic if untreated.
- Based on the height of body temperature, fever can also be classiﬁed into low grade, moderate grade, high grade and hyperpyrexia.3,4
- Three major fever types have been described including sustained/continuous fever, intermittent fever and remittent fever.3,5
- Major fever patterns. Continuous or sustained fever is deﬁned as fever that does not ﬂuctuate more than about 1oC (1.5 oF) during 24 h, but at no time touches normal.70 Continuous fevers are characteristics of lobar and gram-negative pneumonia, typhoid, acute bacterial meningitis, urinary tract infection, among others.3
- Fever characterised by slow stepwise temperature rise and a high plateau are classical of typhoid fever.6 However, this fever pattern is reported in only about 12% of cases in clinical practice,6 possibly because most patients with fever self-medicate with antibiotics and anti-pyretics before consulting a health personnel.
Symptoms of fever
- The reset of the thermal balance point to a higher level by humoral and neural fever signals described above initiates a feedback loop that lead to sequence of clinical and behavioural manifestations that characterise the febrile response.
- To meet the new balance point, heat loss is inhibited by skin vasoconstriction (leading to chills and goose pimples), as well as by behavioural mechanisms such as assuming a fetal position to reduce body surface area or wearing thick clothing and seeking warmer environments.7,8
- Various heat gain mechanisms are then activated including increase muscle contraction (leading to rigors). When the fever signal is no longer present in the CNS, the balance point drops to normal with activation of heat loss mechanisms such as sweating. Hence, fever is often characterised by chills, rigors, rise in body temperature and subsequently sweating and fall in body temperature.
- Systemic symptoms such as headache, malaise, anorexia and other sickness behaviours may also accompany fever.
These symptoms are due to the systemic effects of microbial products and pyrogenic cytokines that lead to various acute phase responses mediated through the neuroendocrine system.8,9
Diagnosis of Fever1:
Table: Diagnostic Imaging in Patients with Fever.1
|Chest radiograph||Tuberculosis, malignancy, Pneumocystis carinii pneumonia|
|CT of abdomen or pelvis with contrast agent||Abscess, malignancy|
|Gallium 67 scan||Infection, malignancy|
|Indium-labeled leukocytes||Occult septicemia|
|Technetium Tc 99m||Acute infection and inflammation of bones and soft tissue|
|MRI of brain||Malignancy, autoimmune conditions|
|PET scan||Malignancy, inflammation|
|Transthoracic or transesophageal echocardiography||Bacterial endocarditis|
|Venous Doppler study||Venous thrombosis|
FUO = fever of unknown origin; CT = computed tomography; MRI = magnetic resonance imaging; PET = positron emission tomography
Figure: Algorithm for the diagnosis of fever of
unknown origin. (CBC = complete blood count; LFT = liver function test; ESR =
erythrocyte sedimentation rate; PPD = purified protein derivative; CT =
computed tomography; AFB = acid-fast bacilli; HIV = human immunodeficiency
virus; CMV = cytomegalovirus; EBV = Epstein-Barr virus; ASO =
antistreptolysin-O antibodies; ANA = antinuclear antibody; TTE = transthoracic
echocardiography; TEE = transesophageal echocardiography; MRI = magnetic
Homoeopathy is a method of curing the suffering of a person by the administration of the drug which has been experimentally proved to possess power of producing similar suffering in a healthy human being. It is specialized system of drug therapy and nothing more or nothing less.10
There are a large number of medicines available in Homoeopathic Literature. Various medicines indicated for fever are:11-13
- The Aconite Restlessness comes in the earlier stages of inflammatory diseases, with fever of a high grade. Heat, with thirst; hard, full and frequent pulse, anxious impatience, inappeasable, beside himself, tossing about with agony.”
- Sudden violent attack of fever with high-rise of temperature. Severe chill in the
- beginning, violent and more chill in the evening and at night, very chill if uncovered, but with internal heat. the acute fever is generally of short and sharp attack
- Intermittent fever Chill begins at 3 p.m. with thirst. Pulse is full and rapid, small and trembling intermittently. Chilliness from least motion. Swelling and burning of lips during entire paroxysm. After fever paroxysms there is deep sleep. After perspiration, there may be nettle rash, also with shuddering. No thirst in sweat stage. Worse from warm and heated room and external heat.
- Given in Quotidian, tertian, quartan, double tertian. Anticipates every 14 days, every year. Remittent and relapsing typhoid and malarial fevers dur to abuse quinine derivatives.
- Afternoon paroxysms (1-2 a.m. and 12-2 p.m.)
- Dry heat with thirst, inclination to uncover.
- Baptisia is the king of all remedies for typhoid.it is claimed that baptisia will, cut the diseases short if given soon as typhoid is suspected. Given in typhoid in any stage.
- Temperature ranging from 103oF to 106oF. There is great nervousness, chilliness and aching pain especially in head, back and limbs. Sore and burnished feeling of the parts rested upon; in whatever position he lies is well marked.
- Sudden and violent is the onset of belladonna fever.
- There is severe chill in the evening mostly on arms with heat of head. Along with natural chill, there is external burning heat. Chill and great often alternate. Extremities are usually cold.
- High fever with sudden rise of temperature with red face and throbbing of carotids; pulse strong and quick. Intense burning heat both internally and externally. Sweat is only on the covered parts and on head or there may be complete lack of any sweat. Sweat, if it occurs appears and disappears suddenly.
- Pulse is frequent and full or slow. Fever comes at 3 pm.
- Indicated in fever of all kinds and even typhoid fever.
- Slow and insidious onset of fever
- Pulse is full, hard tense and quick, Profuse perspiration during fever.
- Chillat 2 pm begins internally in stomach region. Fever with sweat.
- Pulse full and frequent.
- In eruptive fever, especially in measles,the face is pale, blue and Hippocratic face.
- The body is cold to touch,still the patient likes to be uncovered.
- Fever continue with weakness. System depleted.
- Weak limbs. Cold hands and feet, knees and limbs. Tearing pain.
- Fever: Chills daily at 3 p.m. painful swelling of various veins during a chill. Shivering even in a warmroom. Anguish. Subnormal temperature.
- Various kind of intermittent fevers are manifested in china.
- Tertian or double tertian, quotidian type, or the paroxysms may return every seventh or fourteenth day.
- Periodicity is well-marked in the fever but it is never at night.
- Adapted to diseases of old people; worn-out constitutions, especially from inebriety; cachexia, from prolonged or frequent attacks of bilious or intermittent fevers.
- The more general and severe, the better adapted.
- < at night; following measles or suppressed intermittents.
- Fever: chill to 9 a. m. one day, at noon the next day; bitter vomiting at close of chill; drinking hastens chill and causes vomiting; bone pains, before and during chill.
- All catarrhal and inflammatory fevers, chilled every day at 1 p.m.
- High fever, quick, pulse and increased temperature; copious night sweat dry heat of palm, face, throat and chest.
- Indicated in Intermittent and remittent fever
- Pulse slow, full, soft, compressible.
- Cerebral congestion, or alternate congestion of the head and heart.
- Throbbing, pulsating headache; holds head with both hands; could not lie down, “the pillow would beat.”.
- In intermittent fever, During fever patient must be covered from head to foot in every stage; chill, heat and sweat.
- Cold stage predominates.
- Chilly every evening.
- Adynamic with lack of thirst, but unnatural hunger.
- Hectic, with small, quick pulse; viscid night-sweats. Stupid delirium.
- Chilliness, even in warm room, without thirst.
- Chilly with pains, in spots, worse evening.
- Chill about 4 pm.
- Indicated in intermittent, continuous, remittent fever.
- Typhoid; tongue dry and brown; sordes; bowels loose; great restlessness.
- Intermittent; chill, with dry cough and restlessness.
- During heat, urticaria. Hydroa.
- Chilly, as if cold water were poured over him, followed by heat and inclination to stretch the limbs.
- Frequent flashes of heat.
- Violent ebullitions of heat throughout entire body.
- Dry skin and great thirst, Night sweat, on nape and occiput.
- Kasper, Fauci, Hauser, Longo, Jameson, Loscalzo. Harison’s Principle of Internal Medicine. New York: Mc Graw Hill Publisher; 2018
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- Wikipedia. Fever; updated September 2009. Retrieved December 2010, from: www.wikipedia.org.
- Springhouse. Fever in handbook of signs & symptoms. 3rd edition Lippincott Williams & Wilkins; 2006. Available at: http://www. wrongdiagnosis.com/m/mononucleosis/book- diseases-5a.htm.
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- Leggett J. Approach to fever or suspected infection in the normal host. In: Lee G, Ausiello D, editors. Cecil medicine. 23rd edition Saunders Elsevier; 2008. p. 2112-24 [chapter 302].
- El-Radhi AS, Carroll J (1994) Fever in paediatric practice. Blackwell Scientific Publications.
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- Kent JT.Lectures on Homoeopathic Materia Medica. NewDelhi: B.Jain Publishers;2012
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