Heat Stroke
Definition
Western
Heatstroke is a serious acute medical condition characterised by elevated body temperature higher than 40° C, due to the dysfunction of the sweating mechanism in the body [1]. An important cause of heat stroke is dehydration. A dehydrated body cannot sweat efficiently to cool down hence the body temperature increases to a dangerously high temperature [2]. Heatstroke is a life-threatening emergency if proper treatment is delayed [2]. If persistent for a prolonged period of time, disability of the central nervous system can occur [3-4]. In some cases, heat stroke can also cause breakdown of muscles (rhabdomyolysis) [5].
Traditional Chinese Medicine (TCM)
It refers to a medical condition when the body is invaded by both internal and external pathogenic factors during the hot climate in summer or warm humid climate in the tropical countries. This may cause the body to move to a “hyperactive” state which results in excessive heat production and excessive loss of body fluids and energythrough sweating in attempt to cool the heated body. Overheating may also cause mental state disorders like unconsciousness as well as gastrointestinal symptoms such as diarrhoea and vomiting.
Symptoms Displayed and Classifications in TCM Context
Severe Heat Stroke
Symptoms include high fever, profuse sweating, extreme fatigue, dry and flushed skin, thirsty with strong desire for cold drinks, dark yellowish urine. Signs of central nervous dysfunction displayed include irritability, lack of muscle coordination, confusion or even seizures [6].
Mild Heat Stroke
Symptoms include mild fever, irritability, dizziness, headaches, tightness in chest, diarrhoea, nausea and vomiting [6]. Some people may show flu-like symptoms such as chills, sneezing and runny nose.
Causes
Environment/Climate Factors
In general, heat stroke is resulted from prolonged exposure to warm and humid climate [7-8] or during heat waves in temperate countries [3, 7]. Moving to air-conditioned room during profuse sweating or a sudden drop in external temperatures in the environment may also trigger heat stroke.
Lifestyle Factors
Dehydration and lost of salts through sweating affect the body’s ability to regulate core body temperature [3]. Changes in diets such as consuming cold drinks and frozen foods like ice cream under hot temperature or humid climate, and even overdressing or wearing thick clothing that limits heat dissipation mainly cause heat stroke.
Risk Factors
Age and Health
Young children and infants are more vulnerable because of immature sweating capability and inadequate consumption of fluids [3]. Heat stroke is also dangerous for elderly because of their poor thermoregulation ability [9], or individuals with chronic diseases or side effects from medications [3]. In addition, individuals with pre-existing illnesses, alcoholism and poor fitness levels are also prone to get heat strokes [7].
Occupation
Individuals undergoing intense physical stress such as athletes (e.g. marathon runners, race car drivers), occupational workers (e.g., fire fighters, farmers), and military personnel are at higher risk of getting heat strokes [10].
Treatments
Herbs commonly used in prescriptions:
1. Guang Huo Xiang – 广藿香
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English/ Common name
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Patchouli, Wrinkled Gianthyssop
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Latin species
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Pogostemon cablin (Blanco) Benth
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Park of plant used
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Whole organism, except roots
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Action/s
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Helps to alleviate nausea and prevents vomiting [11]. Helps to relieve symptoms of mild heat stroke [16].
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Precaution/s
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Unsuitable for individuals with deficiency of fluids in blood.
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2. Pei Lan – 佩兰
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English/ Common name
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Eupatorium
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Latin species
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Eupatorium fortunei Turcz.
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Park of plant used
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Whole organism, except roots
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Action/s
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Helps to relieve symptoms of mild heat stroke [16]and ease tightness in chest [12].
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Precaution/s
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No significant side effects.
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3. Sha Ren – 砂仁
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English/ Common name
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Cardamon Seed, Seed of Grains-of-Paradise
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Latin species
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Amomum villosum Lour., A.villosum Lour. Var. xanthioides T. L. Wu et Senjen, A.longiligulare T. L. Wu.
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Park of plant used
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Dried fruit
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Action/s
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Helps to alleviate nausea, vomiting and diarrhoea [16]. Also helps to improve appetite and promote digestion [12-13].
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Precaution/s
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Unsuitable for individuals with deficiency of fluids in blood.
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4. Mai Men Dong – 麦门冬
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English/ Common name
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Mondo grass, fountain plant, monkey grass
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Latin species
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Ophiopogon japonicus (Thunb.)Ker-Gawl.
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Park of plant used
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Roots
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Action/s
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Helps to clear internal body heat, promotes production of body fluids and quenches thirst [16].This herb also helps to prevent circulatory shock and neuronal damage [14].
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Precaution/s
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No significant side effects.
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5. Bo He – 薄荷
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English/ Common name
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Peppermint
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Latin species
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Herba menthe
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Park of plant used
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Whole organism, except roots
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Action/s
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Helps to promote secretion of sweat to dissipate heat [16].
Has analgesic effects [15] thus helps to relieve mild headaches.
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Precaution/s
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Excessive peppermint consumption can induce stomatitis [15] (mouth sores and ulcers).
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Test & Diagnosis
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Temperature Measurement
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Measurement of persistent core body temperature higher than 40°C [4].
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Blood Tests
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Blood tests (including the measurement of creatine kinase) can be used to check for rhabdomyolysis [5] and to evaluate the status of the various organ functions [4].
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Home Remedies
Green Bean + White Fungus +Dried Orange peel
a) Put all ingredients in a cooking pot and pour enough water to fill half the pot.
b) Bring to boil for 10 minutes. Simmer for a further 30 minutes.
c) Remove from heat. Add rock sugar to taste. Serve warm.
Test & Diagnosis
· Rest in a cool and shady place.
· Drink lots of water or isotonic drinks to replenish lost salts.
· Take cool showers regularly.
References
1. Heatstroke, R.S. Porter and J.L. Kaplan, Editors, The Merck Manuals:The Merck Manual For Healthcare Professionals.
3. Bailes, B.K. and K. Reeve, Prevention of Heat-Related Illness. The Journal for Nurse Practitioners, 2007. 3(3): p. 161-168.
4. Yaqub, B. and S. Al Deeb, Heat strokes: aetiopathogenesis, neurological characteristics, treatment and outcome. Journal of the Neurological Sciences, 1998. 156(2): p. 144-151.
5. Cervellin, G., I. Comelli, and G. Lippi, Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features. Clinical Chemistry and Laboratory Medicine, 2010. 48(6): p. 749-756.
6. Yeo, T.P., Heat Stroke: A Comprehensive Review. AACN Advanced Critical Care, 2004. 15(2): p. 280-293.
7. Leon, L.R. and B.G. Helwig, Heat Stroke: Role of the Systemic Inflammatory Response. J Appl Physiol, 2010: p. japplphysiol.00301.2010.
8. Leon, L.R., Heat stroke and cytokines, in Progress in Brain Research, S. Hari Shanker, Editor. 2007, Elsevier. p. 481-524.
9. Jean, B.W., Heat Waves: Their Impact on the Health of Elders. Geriatric nursing (New York, N.Y.), 2000. 21(2): p. 70-77.
10. Kumar, V., et al., Robbins Basic Pathology. 8th ed. 2007, Philadelphia: Saunders Elesevier.
11. Lu, T.-C., et al., Analgesic and Anti-Inflammatory Activities of the Methanol Extract from Pogostemon cablin. eCAM, 2009: p. nep183.
12. Aromatic Herbs That Transform Damp, in Chinese Herbal Medicine. 2004, CRC Press.
13. Xu, L. and W. Wang, Chinese materia medica: combinations and applications. 2002, Donica Publishing.
14. Wang, N.-L., et al., Chinese Herbal Medicine, Shengmai San, Is Effective for Improving Circulatory Shock and Oxidative Damage in the Brain During Heatstroke. Journal of Pharmacological Sciences, 2005. 97(No.2): p. 253-265.
15. Tucker, A., Mentha, in Mint. 2006, CRC Press.
16. Gao, X.M., Zhong Yao Xue. First ed, ed. Y.Y. Wang and Z.H. Yan. 2002, Beijing: Zhong Yao Zhong Yi Yao Chu Ban She. 635.