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Qing (Clearing) refers to clearing heat. When the Zang-Fu organs have heat, one should clear it. The Classic states: "For heat, use cold," which is correct. However, there are errors where treatment should be clearing but is not, causing harm; where treatment should not be clearing but is used, causing harm; where clearing is indicated but fails to distinguish between internal injury and external contraction, causing harm; and where clearing is indicated but fails to consider the patient's constitution and the severity of the syndrome, causing harm. These situations must be carefully examined.

Among the Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), except for Cold and Cold-Dampness, all tend to cause heat syndromes. Heat qi steaming and steaming may manifest in the mouth, tongue, lips, and teeth, or during thirst and urination/defecation. If heat is clearly identified but not cleared, symptoms such as macules, jaundice, mania, cold extremities, vomiting, and epistaxis will arise in endless variety. This is the error of "failing to clear when one should."

However, why is there sometimes clearing when one should not? For example, individuals engaged in hard physical labor often suffer from severe deficiency of Middle Qi (Spleen/Stomach Qi), presenting with fever, fatigue, mental restlessness, and dark urine. This is called "Deficient Fire." It arises because the Spring-generating function fails, lacking Yang to protect Ying and Wei (Nutritive and Defensive Qi). This is worlds apart from external heat syndromes. There are also cases of Yin-deficiency consumption diseases (such as tuberculosis) presenting with tidal fever in the late afternoon, or postpartum blood deficiency causing fever and irritability. These symptoms resemble a Baihu Tang (White Tiger Decoction) syndrome; if mistakenly treated with Baihu Tang, rescue is difficult. Furthermore, there is decline of Mingmen Fire (Gate of Life Fire) with floating Yang rising, appearing like fire. There is also Yin-excess repelling Yang (Yin-Cold forcing Yang to float outward), presenting as false heat: the patient has a red face, mania, and agitation, desiring to sit in mud or water; or has constipation for several days; or has a black but moist tongue coating; or has a pulse that appears surging and large, beating vigorously under the fingers but empty upon deep pressure; or has thirst desiring cold drinks but unable to swallow them; or due to deficiency-cold in the Lower Yuan (Kidneys and Bladder), frequently drinks hot soup to save themselves. Laypeople do not understand this and mistakenly administer cooling medicines, which can be fatal upon ingestion. This is the error of "clearing when one should not."

However, why is there sometimes clearing without distinguishing between internal injury and external contraction? If Fire is closed by Wind-Cold, one should disperse and clear it, as stated in the Classic: "For constrained Fire, vent it." If Summer-heat damages Qi, one should tonify and clear it, as in Li Dongyuan's Qingshu Yiqi Tang (Clear Summer-heat and Boost Qi Decoction). If it is Fire from Damp-Heat, one should clear it through dispersing, leaching out, or purging methods, i.e., opening the ghost gates (sweating), cleansing the pure mansion (urination), and removing old filth (bowel movement). If it is Fire from Dryness-Heat, one should moisten and clear it by unblocking the bowels. If it is accumulated food generating heat, one should digest and clear it; once the food is removed, the fire calms naturally. Only when Shaoyang disease transmits to the Stomach Fu organ, with heat intense like steaming, spontaneous sweating, thirst, and the ability to drink cold water and digest it, is a formula like Baihu Tang (White Tiger Decoction) rarely ineffective. In cases of Yang-excess repelling Yin, where cooling medicines are rejected and vomited immediately upon ingestion, a small amount of Ginger Juice can be used as a guide, or Ginger-processed Huanglian (Coptis Rhizome) can be used for counter-assistance, known as "using cold for heat." This is the method of clearing external excess Fire. Regarding Fire arising internally from emotional constraint (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) interacting with each other, Zhu Danxi treated it with Yueju Wan (Regulate All Pill) to open the Six Constraints. Xue Lizhai advocated Xiaoyao San (Free and Easy Wanderer Powder) to regulate Liver Qi, intending that treating Wood constraint would resolve all constraints. However, the Classic states: "Anger causes Qi to rise, Joy causes Qi to slacken, Sorrow causes Qi to dissipate, Fear causes Qi to descend, Fright causes Qi to become chaotic, Thought causes Qi to knot." Xiaoyao San is suitable for rising and knotted Qi, but likely inappropriate for slackening, dissipating, chaotic, or descending Qi. Generally, for Qi deficiency, one must tonify Qi; for Blood deficiency, one must nourish Blood. When Qi is vigorous and Blood is abundant, Fire from the Seven Emotions naturally calms. For insufficiency of True Yin causing Fire to flare upward, one must strengthen the Master of Water (nourish Kidney Yin) to suppress Solar Fire. For insufficiency of True Yang causing Fire to flare upward, one must guide Fire back to its source, leading the Dragon and Thunder into the sea. This is the treatment method for internal deficient Fire. Some ask: If the disease is caused by Fire, why treat with hot medicines? One must know that external Fire is pathogenic, human, tangible, and postnatal Fire; it is extinguished by water, so it can be subdued by water. Internal Fire is deficient, Dragon-Thunder, intangible, and prenatal Fire; it flares up with water, so it cannot be subdued by water. It is like a dragon flying higher when it gets water, or thunder shaking more intensely with rain, stirring up yin obscurity, illuminating the sky; only when clouds gather and sun emerges do the dragon and thunder return to their homes. Therefore, deficient Fire can be tonified but not purged. Those who use only Renshen (Ginseng Root) and Huangqi (Astragalus Root) without Bajun Wan (Eight-Ingredient Pill) do so because their dwelling place lacks cold. Those who use only Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) without Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) do so because their dwelling place lacks water. The principle of tonification is the same, but the guiding method differs slightly. Essentially, external Fire is cleared with coolness; internal Fire is cleared with tonification.

However, why is there sometimes clearing without considering the patient's condition? For robust individuals suffering from excess heat, using slightly heavier clearing agents is harmless. But for those constitutionally weak, with inherently cold Zang-Fu, poor diet, and loose bowels, or those postpartum, post-illness, or post-coitus, even if heat syndromes exist, clearing agents should be used sparingly. It is better to under-dose than over-dose. If residual heat remains, light agents should substitute. Thus, the disease leaves and the person remains safe. If clearing agents are excessive, cold will arise before the heat is fully resolved. This emphasizes weighing the patient when clearing.

However, why is there sometimes clearing without considering the syndrome's severity? For severe heat syndromes, if the clearing agent is too weak, the disease persists; for mild heat syndromes, if the clearing agent is too strong, cold syndromes will appear. If the dose is insufficient, one can clear again; if excessive, harm results. Moreover, for diseases not resolved by clearing, there is another method: strengthening Water (nourishing Yin). Wang Bing said: "Severe heat that does not respond to cold treatment indicates lack of Water; one should nourish the Kidney." Kidney Water is pristine Water. Using this pristine Water to control external pathogens, what pathogen would not submit? What heat would not be eliminated? Why cling to cold and cool herbs, thereby incurring fault? From this, we see that even external Fire should be controlled by nourishing Water, let alone internal Fire. Generally, fire-clearing drugs should not be relied upon long-term; one must ultimately return to nourishing Yin. Nourishing Yin methods must also open the stomach and support the Spleen to restore Yuan Qi. Therefore, Renshen (Ginseng Root), Fuling (Poria), Shanyao (Dioscorea Rhizome), and Baizhu (Atractylodes Macrocephala Rhizome) should be used judiciously. It is not that one must always tonify after clearing; if Yuan Qi is intact, tonification is unnecessary; if Yuan Qi is depleted, it must be tonified. Wait until appetite gradually returns and spirit becomes bright and alert before stopping medication. This emphasizes weighing the syndrome when clearing. In summary, there is external Fire and internal Fire. External is excess; internal is deficiency. Their origins differ, and their treatments are distinct. Can one say that "for heat, use cold" suffices to complete the physician's duties?