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1. Heat Stagnation due to Wind-Cold

Yang Qi moves from the interior to the exterior; it prefers free flow and dislikes obstruction and closure. If wind-cold pathogens invade from the exterior, the yin cold coagulating qi is sufficient to close the cou-li (skin pores and interstices), causing the exterior Yang to fail in its dissemination, thereby stagnating and transforming into heat. Manifestations include stiffness and pain in the head and neck, aversion to wind with sweating, and a floating, moderate pulse, which indicates Wind Injury. Accompanied by body pain, aversion to cold, no sweating, and a floating, tight pulse, it indicates Cold Injury. Treatment should employ muscle-relaxing and exterior-releasing methods; upon sweating, the heat dissipates and recovery occurs. (This is exterior Yang being stagnant.)

2. Heat Stagnation due to Dietary Retention

When food and drink stagnate in the Zhongwan (epigastrium), the Yang Qi of the Spleen and Stomach is suppressed and inhibited, unable to circulate freely, thus also stagnating and generating heat. Manifestations include headache and fever, resembling Cold Injury but without body pain; aversion to food with nausea; belching with a putrid odor; acid regurgitation; chest fullness and oppression, or distending pain; the Qi Kou pulse is slippery and large, or even deep and hidden. Treatment should employ digestion-promoting and stagnation-resolving methods. (This is interior Qi being stagnant.)

3. Heat Stagnation due to Phlegm-Fluids

Wherever Phlegm-Fluids reside, Qi is obstructed, stagnating and generating heat; the principle is the same as food retention. Manifestations include aversion to wind with spontaneous sweating, resembling Cold Injury, but without headache or neck stiffness; or headache that comes and goes irregularly; discomfort in the chest and diaphragm; nausea; rising Qi; grayish or smoky-black discoloration under the eyes; and a string-taut, slippery pulse. Treatment should employ phlegm-resolving methods.

4. Heat Stagnation due to Blood Stasis (Same Principle for Carbuncles and Sores)

The principle is the same as Phlegm-Fluids. Manifestations include clear urination, black stools, urgency and binding in the lower abdomen, umbilical region, or hypochondrium, painful upon pressure; or cold extremities; or hematemesis and epistaxis; absence of thirst, or if thirsty, only rinsing the mouth without swallowing; and a choppy pulse. Treatment should employ blood-invigorating methods. Use Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Tao Ren (Persicae Semen), Wu Ling Zhi (Trogopterori Faeces), and Gan Cao (Glycyrrhizae Radix et Rhizoma). If stool is constipated, add Da Huang (Rhei Radix et Rhizoma) and thick honey; recovery follows the passage of black matter. For toxic sores, the pulse is string-taut and rapid with aversion to cold, diet remains normal, but there is a painful area.

5. Heat Stagnation due to Water-Dampness

Water-dampness caused by external contraction follows the principle of wind-cold; that caused by internal injury follows the principle of phlegm-fluids. Manifestations include heavy body, or heavy pain preventing turning over; pulling pain in joints; difficulty in flexion and extension; sweating with aversion to wind; reluctance to remove clothing; sensation of the head being wrapped; voice sounding as if coming from an urn; and a slow pulse. Treatment should employ dampness-draining methods.

6. Heat Stagnation due to Liver Qi

Unexpressed anger, merely suppressed internally, causes Liver Qi to fail in dissemination, stagnating and generating heat. This condition is most common in women. Manifestations include distending pain in the chest and hypochondrium; or diarrhea with undigested food; greenish complexion; cold hands and feet; sighing and unhappiness; and a deep, string-taut pulse. When Wood is stagnant, it should be dispersed; Xiao Yao San (Free Wanderer Powder) is appropriate. (See "Stagnation" chapter.)

7. Heat Stagnation due to Spleen Qi

Whether due to fatigue causing Qi dispersion, worry causing Qi knotting, or hunger causing Qi deficiency, the Middle Qi becomes weak and unable to transport and transform normally. It may stagnate in the middle or sink to the lower jiao, leading to stagnation and heat generation. Manifestations include lethargy and desire to sleep; panting and fatigue upon movement; and tired limbs. (This is damage from fatigue and hunger.) Or speaking to oneself at times, unaware of context. (This is damage from worry.) Fever at midnight, (as Qi travels inward toward the lower part, stagnation and sinking become more severe.) Relief at dawn, (as Qi moves outward and upward, stagnation and sinking are slightly relieved. This is early-stage stagnation heat.) Or fever persisting day and night, (prolonged stagnation leads to intense heat, regardless of time.) Or fever worsening when the sun rises and warmth increases, easing when the sky is cloudy and night is cool, (prolonged stagnation heat consumes Qi; the more heat, the more consumption; the more consumption, the more heat. Daytime activity floats Yang, aggravating vexatious heat; stillness preserves Qi, hence easing on cloudy nights. Initially, stagnation heat generates fire; subsequently, fire erupts intensifying heat; finally, strong fire consumes Qi. These stages represent the transformation of disease, a principle not to be ignored.) Five-palm heat; severely, muscles and bones feel like burning. This is what Li Dongyuan calls Yang Deficiency Fever. (In *Nei Jing*, this symptom is named Yin Deficiency Fever. "Yin" here should be read as "Interior". Li Dongyuan names it Yang Deficiency Fever, where "Yang" refers to "Qi". Synthesizing both views, it is Interior Qi Deficiency Fever.) This differs from the aforementioned Yang Deficiency Fever and Dai Yang/Ge Yang syndromes. Here, it involves Middle Jiao Yang; there, Lower Jiao Yang. Ge Yang is interior cold with exterior heat; here, interior and exterior are both hot without cold. Dai Yang is upper heat with lower cold; here, heat sinks downward without cold. Thus, they differ. Treatment should tonify Middle Qi. When Qi is vigorous, stagnation is transported; when Qi ascends, sinking is lifted. (For Five Zang stagnation syndromes, only Liver and Spleen are listed here; seek others in the Stagnation chapter.) For fatigue, add sour-flavored herbs to astringe floating Yang. The above discusses the principles of fever generation. Regarding heat differentiated by Zang-Fu, meridians, San Jiao, day/night, Qi/Blood, and deficiency/excess, see below.

8. Heat Differentiated by Zang-Fu and Meridians

Li Dongyuan said: When pathogens affect the Five Zang, each presents with fever, varying in appearance. (Pulses are all surging and rapid, but differ in depth.) Light palpation reveals heat; heavy pressure does not. (Wang Haizang stated: Skin feels like burning, but heavy pressure reveals less heat. Thus, Li Dongyuan's "no heat" means not completely absent, but less intense. The following follows this logic.) This indicates heat in the skin, hair, and vessels. Heat in the skin/hair belongs to Lung Heat, worsening during Shen and You hours (when Metal Qi is prosperous). Symptoms include wheezing and coughing, shivering with aversion to cold. Mild cases use Xie Bai San (Drain White Powder); severe cases use Liang Ge San (Cool the Diaphragm Powder), Bai Hu Tang (White Tiger Decoction), or Di Gu Pi San (Lycium Root Bark Powder). Red sclera, vexation, and thirst are treated with decocted Huang Qin (Scutellariae Radix) alone, or Danxi Qing Jin Wan (Danxi Clear Metal Pill), made of Huang Qin powder mixed with congee pills. Both formulas drain Fire from Lung Blood level; Xie Bai San drains Fire from Lung Qi level. Heat in vessels belongs to Heart Heat, worsening at noon. Symptoms include vexation and heat in palms. Use Huang Lian Xie Xin Tang (Coptis Decoction to Drain the Heart) to drain Ding (Heart/Fire); Dao Chi San (Direct the Red Powder) to drain Bing (Small Intestine/Fire); Huo Fu Dan (Fire Organ Pill - see Strangury) drains both Bing and Ding; Zhu Sha An Shen Wan (Cinnabar Calming Spirit Pill - see Vexation) or Qing Liang Yin Zi (Cooling Drink - see Dryness Injury) are used. Heavy pressure to sinews and bones causes intense heat radiating to the hand; light touch reveals no heat. This indicates heat between sinews and bones. Heat in sinews (below muscle, above bone) belongs to Liver Heat, worsening during Yin and Mao hours (or Yin-Shen hours). Symptoms include chest/hypochondriac fullness, difficult defecation, tendon spasms, irritability and fright, hot/tired limbs, tendon flaccidity preventing getting out of bed. Use Xie Qing Wan (Drain Green Pill) or Chai Hu Yin (Bupleuri Drink - see Deficiency Damage); or Dang Gui Long Hui Wan (Angelica Dragon Bile Pill - see Hypochondriac Pain) or Zuo Jin Wan (Left Metal Pill). Heat in bones belongs to Kidney Heat, worsening during Hai and Zi hours. Symptoms include bone-steaming fever, a tingling sensation like insect erosion, unbearable heat/tiredness, inability to rise from bed. Use Zi Sheng Wan (Nourish Kidney Pill - see Urinary Obstruction) or Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia - see Deficiency Damage). Light and heavy pressure reveal no heat; moderate pressure reveals heat. This indicates heat in muscle, belonging to Spleen Heat, worsening at night. (Spleen is Yin Earth; night is Yin.) Symptoms include lethargy, desire to sleep, limp limbs, lack of energy to move. Excess heat is treated with Xie Huang San (Drain Yellow Powder) or Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct the Qi Decoction - see Constipation). Deficiency heat is treated with Ren Shen Huang Qi San (Ginseng and Astragalus Powder) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction - see Qi). Heat in the Stomach promotes digestion, causing hunger and a feeling of emptiness/vexation in the heart (Heart Spirit scorched by Fire, hence unsettled). Hunger with heat above the umbilicus (Stomach is above the umbilicus). Heat in the Intestines causes yellow, porridge-like stools (porridge-like consistency); heat below the umbilicus (Intestines are below the umbilicus). From this, we deduce: Liver/Gallbladder heat implies hypochondriac heat; Heart/Lung heat implies chest/back heat; Kidney heat implies lumbar heat. Excessive heat in both hands, feeling like fire, is called Bone Jue; mooring Yongquan (KI 1) three moxa cones brings immediate cure. Heat in palms and soles is treated with Zhi Zi (Gardeniae Fructus), Xiang Fu (Cyperi Rhizoma), Cang Zhu (Atractylodis Rhizoma), Bai Zhi, Ban Xia (Pinelliae Rhizoma), Chuan Xiong, powdered and pillified with Shen Qu (Massa Medicata Fermentata) paste. Five-palm heat, Fire stagnant in Spleen, uses Huo Yu Tang (Stagnant Fire Decoction). San Wu Huang Qin Tang (Three Ingredient Scutellaria Decoction - see Vexation) treats four-limb vexatious heat in women. Fever that comes and goes indicates it is not in the Exterior (Exterior heat is constant). Normal urination/defecation indicates it is not in the Interior. Neither Exterior nor Interior, it is in the Meridians.

9. Heat Differentiated by San Jiao

Heat in Upper Jiao: dry throat, ulcerated mouth. Use Zhi Zi (Gardeniae Fructus), Huang Qin. Heat in Middle Jiao: vexation, thirst. Use Huang Lian (Coptidis Rhizoma), Shao Yao (Paeoniae Radix). Heat in Lower Jiao: constipation, dark urine. Use Huang Bo (Phellodendri Cortex), Da Huang.

10. Heat Differentiated by Day/Night and Qi/Blood (See End of Aversion to Cold Chapter)

Day fever, night quiet: Yang Pathogen (i.e., Heat Pathogen) prospers in Yang divisions. (Yang divisions refer to Exterior, Fu Organs, Qi. Yang Pathogen in Yang division, encountering Yang time, causes fever.) Day quiet, night fever: Yang Pathogen has sunk into Yin divisions. (Observe Heat Entering Blood Chamber syndrome: lighter by day, heavier by night. See *Shang Han Lun · Shao Yang Chapter*.) Fever day and night with vexation: Double Yang without Yin. Urgently drain Yang and vigorously tonify Yin. Day fever in Qi level: Chai Hu Yin, Bai Hu Tang, to drain Fire in Qi. (Not suitable for Yin Deficiency.) Night fever in Blood level: Di Gu Pi San, Qing Liang Yin Zi, to drain Fire in Blood.

11. Heat Differentiated by Excess and Deficiency

Abundant flesh and blood, lustrous skin and hair, excess Yin with heat, ability to eat with heat, bitter taste, dry mouth, difficult defecation, surging/full pulse indicate Excess Heat. Withered bones, dry flesh, relaxed sinews, depleted blood, contracted skin, fallen hair, insufficient Yin with heat, inability to eat with heat, shortness of breath, deficient pulse indicate Deficiency Heat.