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Medical texts state that the fire in the lower jiao (Lower Burner) originates from the Mingmen (Gate of Life), is called the fire of the yin aspect, and is also referred to as "Dragon-Lei Fire" (Fire of the Dragon and Thunder). This is actually a superficial argument. The fire in the lower jiao is the congenital Yuan Yang (Primal Yang Qi), which arises from the Yuan Qi (Primal Qi) of the Qihai (Sea of Qi). Generally speaking, regarding its ability to support the whole body, it is called Yuan Qi; regarding its ability to warm the whole body, it is called Yuan Yang. This Yuan Yang within the Qihai is the root source of human life; whether it is the fire of the yin aspect or the yang aspect, all establish their foundation here. The Qihai is formed entirely by fat membranes wrapping around and condensing. One branch extends from these membranes laterally, connecting to the seventh vertebra counting from below. On both sides of this seventh vertebra, there is an acupoint each; the *Neijing* (Classic of Internal Canon) states, "Beside the seven vertebrae lies the 'Xiaoxin' (Lesser Mind)." The Yuan Yang of the Qihai penetrates into the spine from here. Because Yuan Yang is the root of life, the place where Yuan Yang penetrates the spine is called the Mingmen (Gate of Life). From this perspective, the actual function of the Mingmen is merely to serve as the lock and key for the management of the Qihai. Therefore, the fire of the lower jiao should still be attributed to the Yuan Yang of the Qihai. Discussing the upward窜 (rushing) of lower jiao fire that fails to return to its origin is essentially the floating and drifting of the Qihai's Yuan Yang. However, although this disease is broadly named "Fire Failing to Return to Its Origin," there are several distinct etiological factors, each requiring specific treatment methods. These are detailed below.

There is a case where the Yuan Qi of the Qihai is deficient and damaged, failing to secure and control the qi transformation of the lower jiao, causing the Yuan Yang to float and drift due to this deficiency. The pulse is weak at the chi (cun-knee) position and strong at the cun (wrist) position, floating, large, and rootless. Symptoms may include dizziness and vertigo of the head and eyes, redness of the face and heat in the ears, heat in the heart with palpitations (Zhen Tong), or coarse breathing with rebellious qi. Treatment should employ Jing Yurou (Cleaned Cornus Fruit) and Sheng Shanyao (Raw Dioscorea Rhizome), each 1 liang; Renshen (Ginseng Root), Xuanshen (Scrophularia Root), Daizheshi (Haematite), Sheng Longgu (Fossilized Bones), and Sheng Muli (Oyster Shell), each 5 qian. If there is heat in the heart, add Sheng Dihuang (Raw Rehmannia Root) and Tiandong (Asparagus Tuber) in varying amounts of several qian. This method tonifies and astringes, anchors and calms, allowing the Yuan Yang to naturally return to its residence. The reason for using Daizheshi (Haematite) in the formula is that although Renshen (Ginseng Root) has abundant warming and tonifying properties, its force tends to move upward. When used together with Daizheshi (Haematite), the force focuses downward. Moreover, the heavy and sinking nature of Daizheshi (Haematite) assists Longgu (Fossilized Bones) and Muli (Oyster Shell) in subduing yang.

There is a case where the True Yin of the lower jiao is deficient and damaged, leaving the Yuan Yang without attachment, causing it to float and drift. The pulse is often wiry and rapid, or powerless upon deep pressure. Symptoms include intermittent burning heat sensations, bitter taste in the mouth and dry tongue, or continuous wheezing and coughing. Treatment should use Sheng Shanyao (Raw Dioscorea Rhizome) and Shu Dihuang (Prepared Rehmannia Root), each 1 liang; Xuanshen (Scrophularia Root), Sheng Longgu (Fossilized Bones), Sheng Muli (Oyster Shell), Sheng Guiban (Turtle Carapace), Gouqizi (Goji Berry), each 5 qian; Sheng Hangshaoyao (Raw Paeonia Lactiflora Root) 3 qian; Sheng Jineijin (Chicken Gizzard Membrane) and Gancao (Licorice Root), each 1.5 qian. This is what is referred to as "Strengthening the Master of Water to Control the Sunlight."

If the yin aspect of the lower jiao is deficient, and the yang aspect is also slightly insufficient, the person often feels heat in the upper jiao (Upper Burner), while the lower jiao occasionally feels cool. Treatment should employ Cui Shi Ba Wei Wan (Cui's Eight-Ingredient Pill) from the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), substituting Sheng Dihuang (Raw Rehmannia Root) for Shu Dihuang (Prepared Rehmannia Root) (the original Fanggan Di Huang was Sheng Dihuang in pharmacy stores). Furthermore, reduce the dosage of Fuling (Poria) and Zexie (Alisma Rhizome) by two-thirds. Prepare one dose of pills and divide it into eight doses of decoction for administration.

There is a case where the Yuan Yang of the Qihai is severely deficient, and the lower jiao is accumulated with deep cold and stubborn chill, forcing the Yuan Yang upward like a flame about to extinguish but flaring up. The pulse is wiry, slow, fine, and weak, or the two cun positions seem powerful upon superficial palpation. Symptoms include: restlessness and irritability in the heart, intermittent burning heat in the upper jiao, while the lower jiao feels extremely cold, or frequent diarrhea. Treatment should use Wufuzi (Prepared Aconite Root), Renshen (Ginseng Root), and Sheng Shanyao (Raw Dioscorea Rhizome), each 5 qian; Jing Yurou (Cleaned Cornus Fruit) and Hutao Ren (Walnut Kernel), each 4 qian; Daizheshi (Haematite), Sheng Hangshaoyao (Raw Paeonia Lactiflora Root), and Huainiuxi (Achyranthes Root), each 3 qian; Yunlingpian (Sliced Poria) and Gancao (Licorice Root), each 1.5 qian. If diarrhea is present, remove Daizheshi (Haematite). This is the method known in medical texts as "Guiding Fire Back to Its Source." The reason for using Shaoyao (Paeonia Root) in the formula is not to dissipate heat in the upper jiao, but because when combined with Renshen (Ginseng Root) and Fuzi (Aconite Root), it greatly converges the Yuan Yang, guiding it back to its residence. However, the method of "Guiding Fire Back to Its Source" cannot be universally applied to all cases of "Fire Failing to Return to Its Origin." It must only be used when encountering such specific symptoms and pulses. Furthermore, the medicine must be cooled to slightly warm before ingestion, so as not to interfere with the dryness and heat in the upper jiao.

There is a case where Chong Qi (Penetrating Vessel Qi) rushes upward accompanied by Stomach Qi rebellion, causing the Yuan Yang of the Qihai to float and drift along with it. The pulse is often wiry, long, and forceful, especially on the right side, described in Li Shicai's Pulse Rhyme as "straight up and straight down." Symptoms include a sensation of fullness, oppression, and irritability in the chest, frequent hiccups, excessive expectoration of phlegm-saliva, and in severe cases, a sensation of phlegm-fire and rushing qi blocking the throat, making breathing nearly impossible. Treatment should employ my formulated Jiangwei Zhenchong Tang (Stomach-Descending and Penetrating-Vessel-Anchoring Decoction) (see section "On the Etiology, Symptoms, Pulse, and Treatment of Penetrating Vessel Qi Rushing Upward"), allowing the Chong Qi and Stomach Qi to descend, thereby curing all diseases spontaneously.

There is a case where excessive mental exertion generates heat in the heart, stirring up the Shaoyang Xiang Huo (Ministerial Fire) (which resides in the Gallbladder and Liver), causing it to rush upward and outward. The pulse at the cun and guan positions is forceful, often slippery, or slightly rapid. Symptoms include: restlessness and irritability in the heart, excessive doubtfulness, frequent anger, or a sensation of heat rising from the hypochondrium and dispersing throughout the body. Treatment uses Xi Huaishanyao (Fine Powder of Wild Yam Rhizome) 6–7 qian, boiled into porridge. In the morning, administer Mangxiao (Mirabilite) 3 qian with the porridge; in the evening, administer Western Medicine "Choubao" (Bromine) 2 wa (approx. 12g) with the porridge. Mangxiao (Mirabilite) is salty and cold, effectively resolving heat in the Heart Meridian and opening heat-phlegm under the heart (this condition often involves heat-phlegm under the heart); Choubao (Bromine) is also salty and cold, resolving heat in the Heart Meridian and restraining the reckless movement of Ministerial Fire. The reason for using Shan Yao (Yam) porridge for administration is that salty-cold medicines are incompatible with the Spleen and Stomach and can consume body fluids, whereas Shan Yao (Yam) nourishes the Spleen and Stomach and generates fluids. Using it to deliver Mangxiao (Mirabilite) and Choubao (Bromine) seeks mutual assistance for success, similar to how Xiaoshi Fanshi San (Niter and Alum Powder) in the *Jingui Yaolue* is administered with Barley Porridge.

There is a case where the Yang of the Heart, Lung, Spleen, and Stomach is severely deficient, leading to the retention of Cold-Fluid in the middle jiao (Middle Burner), overflowing above the diaphragm, and forcing the Yang of the Heart, Lung, Spleen, and Stomach to rush upward and outward. The pulse is often wiry, slow, fine, and weak across all six positions, or occasionally floating, large, and soft, feeling empty upon pressure. Present symptoms include: dizziness and deafness, generalized fever, shortness of breath, coughing and wheezing, heat in the heart, and a desire for fresh fruits, yet after eating, abdominal fullness worsens the condition. Treatment should employ my formulated Liyin Tang (Regulating Fluids Decoction). After taking several doses, if the heart no longer feels hot and instead feels cool, remove Shaoyao (Paeonia Root). If there is a sensation of qi deficiency, add Sheng Jianqi (Raw Astragalus Root) 3 qian. Treating this condition in this manner corresponds to the medical text assertion that warming, drying, and strengthening Spleen-Stomach medicines can suppress Ministerial Fire. However, what is suppressed is not Ministerial Fire itself; rather, the warming-drying medicines eliminate Cold-Fluid, allowing the Yang of the Heart, Lung, Spleen, and Stomach to naturally remain in its residence.

The aforementioned cases of "Fire Failing to Return to Its Origin," although differing in etiology, are all internal injuries. Regarding external contraction diseases, there are also cases of "Fire Failing to Return to Its Origin," such as the Daiyang Syndrome (Floating Yang Syndrome) in Shanghan (Cold Damage) and Wenbing (Warm Diseases). The current presentation includes: red face, coarse breathing, restlessness and irritability. Although the pulse is large, it is powerless upon pressure, and often shows excess at the cun position and deficiency at the chi position. This is a critical sign of deficiency-cold in the lower jiao with solitary yang rushing upward, resembling the syndrome of extreme yin mimicking yang in cold-warm diseases. However, "extreme yin mimicking yang" results from internal-external contradictions, whereas "Daiyang Syndrome" results from upper-lower contradictions. Treatment should employ Tongmai Sini Tang (Pulse-Reviving Four-Reversal Decoction) from the *Shanghan Lun* (Treatise on Cold Damage), adding Congbai (Green Onion White) and Renshen (Ginseng Root) (the original text states to add Congbai for red face, and red face indicates Daiyang Syndrome).

However, Daiyang Syndrome presents with varied pulses. Only if the pulse is truly deep and fine like the Shaoyin pulse, or if it is not deep and fine but feels empty and rootless upon pressure, with a non-rapid rate, can Tongmai Sini Tang (Pulse-Reviving Four-Reversal Decoction) be used. If the pulse is deep, fine, and rapid, or floating, large, and rapid, this formula must absolutely not be used. I once treated Patient Wang XX, aged over forty, who was constitutionally weak. During the fourth or fifth day of Shanghan (Cold Damage), he sought my consultation. His pulse was surging and slippery anterior to the guan position, while the two chi positions were powerless. I prescribed my formulated Xinlu Tang (Immortal Dew Decoction). Due to the weak chi pulse, I instructed him to drink the medicine slowly, taking only one large warm sip at a time, to prevent cold-cold medicines from invading the lower jiao. The patient's family suddenly disregarded my instructions and administered the entire dose at once. Consequently, he experienced watery diarrhea several times, with stool containing much cold froth. The upper jiao became increasingly irritable, his nose felt as if smoked, and his face felt as if roasted by fire. His pulse anterior to the guan position doubled in size, reaching seven beats per respiration. Recognizing this had become Daiyang Syndrome (Floating Yang Syndrome), I urgently prepared Ye Taishen (Wild Taihang Ginseng Root) 1 liang, decocted to 0.8 cup, mixed with half a cup of Tongbian (Child Urine) (must be from a boy under five years old). I placed the medicine bowl in a basin of cold water, waited for it to cool completely, and then administered it in one gulp. I also urgently decocted Zhimu (Anemarrhena Rhizome), Xuanshen (Scrophularia Root), and Sheng Dihuang (Raw Rehmannia Root), each 1 liang, into a large bowl for backup. After administering the ginseng decoction, I frequently checked his pulse. Half an hour later, the pulse gradually converged, but the rate seemed to increase further. I urgently heated the backup medicine to boiling point and administered it slowly, one sip at a time. Over two hours, the entire dose was consumed, resulting in a slight general sweating and recovery.

Note: This condition originally had dryness-heat in the upper jiao. Because the initial cold medicine was taken in one gulp, passing through the diseased area directly to the lower jiao, the dryness-heat in the upper jiao remained. When the lower jiao suffered watery diarrhea, the Yuan Yang floated upward, further assisting the heat in the upper jiao, presenting various heat signs and a pulse rate of seven beats. At this time, not only dare I not use Ginger (Shengjiang/Ganjiang) and Aconite (Fuzi) in the slightest amount, but even single-use of Renshen (Ginseng Root) would be rejected by the dryness-heat in the upper jiao. Therefore, I used the downward-pouring nature of Tongbian (Child Urine) to assist it, and administered the medicine when extremely cold in one gulp. After a short while, the pulse converged, and the rate increased. This indicated that the lower jiao received the warming-tonifying power of Renshen (Ginseng Root), causing the Yuan Yang to return, while the upper jiao experienced increased dryness-heat due to the reverse-stimulating effect of Renshen (Ginseng Root). Thus, I urgently employed large-cooling and large-moistening medicines, administered hot and slowly, to clear the dryness-heat in the upper jiao without allowing the cold-natured properties to invade the lower jiao again. In this extremely difficult situation for medication, striving for every prescription to align perfectly with the pathology required immense deliberation.