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Fire syndromes belong to heat diseases, which is indeed the case. However, when fire maintains its proper state, it constitutes Yang Qi (Yang Energy), a type of fire that is indispensable and must not be deficient. Deficiency indicates a depletion of Yang Qi. Conversely, when fire deviates from its proper state, it becomes pathogenic heat (Evil Heat); such fire should not exist and certainly must not be excessive. Excessiveness leads to the damage and failure of True Yin (True Essence). Here, "Yang" refers to Yuan Qi (Original Qi), whereas "fire" refers to pathogenic qi. Therefore, diseases involving Yuan Qi cannot simply be discussed in terms of "fire." Why? Because human Yuan Qi needs only to be sufficient; how could there ever be an excess? Since it is not an excess, why speak of "fire"? The concept that "formless transformations become deficiency" refers precisely to this situation. Only when disease manifests in the physical form can one observe fire syndromes, as the pathology resides either in Qi or Blood. The concept that "formed transformations become excess" refers to this scenario. Thus, for any disease caused by fire, if located externally, it must manifest in the skin, flesh, sinews, and bones; if located internally, it must manifest in the Zang-Fu organs and the nine orifices. If there are no heat symptoms evident in the physical structure, yet one claims it is "fire" or "heat," this is entirely baseless speculation. Moreover, even when all signs of fire syndrome are present, distinctions between deficiency and excess, and between true and false, must be carefully differentiated. If one truly suffers from a fire disease, the nature of fire is urgent and fierce, which is indeed formidable. However, excess fire follows the physical form; I therefore call it ordinary fire (Fan Huo) or evil fire (Xie Huo). Fire-induced diseases represent merely the branch manifestations of illness; cleansing and purging them is hardly difficult. It is only deficiency fire (Xu Huo) that originates from Yuan Qi. Since Yuan Qi is already deficient, attacking the fire further would be akin to striking with a club or blade. Therefore, among various fatal diseases, fire diseases are particularly lethal precisely because ordinary fire may not kill, but treating deficiency as excess invariably leads to death—a sight too heartbreaking to witness.

1. Regarding fire in the five Zang organs: Lung heat causes dryness of the nose, and severely, nasal discharge; Liver heat results in thick eye discharge; Heart heat leads to excessive talking and laughing; Spleen heat causes frequent hunger and thirst; Kidney heat results in hot and painful urination. For such cases, clearing heat (Qing Re) is appropriate. Details on other instances can be found in Volume 1, Chapter on Cold and Heat.

2. When examining fire syndromes, one must distinguish between deficiency and excess. Although Yuan Qi is inherently deficient, cases where deficiency is complicated by excess (Xu Zhong Jia Shi) are easier to treat. How can this be identified? For instance, if there is dry and constipated stool, or frequent hunger with increased food intake, or mental clarity, or strong voice, accompanied by a forceful pulse, these indicate excess within deficiency. Such cases can be treated by clearing heat and resolving pathogens according to symptoms. Conversely, if there is internal and external heat but accompanied by loose stools, reduced appetite, weak voice, and shortness of breath—manifesting various deficiency signs—if warm tonification is contraindicated, this indicates that Stomach Qi has failed and vitality is exhausted, which is an ominous sign.