风寒暑湿燥皆外因，惟火多属内因，经言壮火食气，少火生气。注谓火在丹田之下为少火，少火则生气，
是为真火；火离丹田而上为壮火，壮火则食气，是为邪火。然有实火、虚火、湿火、郁火、阴火、五脏六腑火、
游行不归经之火。治实火上焦热，清心汤、加减凉膈散。中焦积热，渴燥便秘，凉膈散。三焦火盛，狂躁吐衄，
黄连解毒汤。阳明潮热，白虎汤。下焦火，溺血淋闭，立效散。一切血分火热丹毒，四顺清凉饮。治虚火，
饮食劳倦，内生虚热，此伤脾阳也，补中益气汤。思虑房劳，血虚火亢，此伤肾阴也，六味地黄汤。肾阴虚极，
火升躁渴，舌刺脉洪，此虚阳无附也。急用八味丸料煎服。产后阴伤发热，口渴面红，为无
根之火，独参汤。治湿火，湿甚生热，肿胀溺闭，胃苓汤。治郁火，肌表热，五心烦，如火燎，及胃虚食冷，
遏抑脾阳，升阳散火汤。手心热如烙，脉沉数，火郁汤。下部骨蒸，属血虚，五蒸丸、四物汤。血中伏火，
加味四物汤。风劳骨蒸，秦艽鳖甲散。治阴火，气从脐下起，大补阴丸、坎离既济丸。气从足下起入腹，为
虚极难治，七味地黄丸，外以附子末津调敷涌泉穴。治五脏火，气郁火起于肺，泻白散、清金丸。大怒火起于
肝，加味逍遥饮加青皮、胆草。醉饱火起于脾，泻黄散加白芍、枳壳。怵惕思虑火起于心，导赤散、清心莲子
饮。房欲火起于肾，八味丸。治六腑火，胃火牙疼颐肿，清胃散。胆火眩晕口苦，羚羊角、丹皮、山栀、桑叶、
连翘、龙胆草。大肠火便秘不通，通幽汤加槐米。小肠火癃闭淋沥，八正散加减。膀胱火腹痛溺涩，大补丸。
三焦火肢热体倦，上焦山栀，中焦连翘，下焦地骨皮。心包火怔忡不安，麦冬、丹皮、犀角、连翘、菖蒲、
灯心。其游行之火，或宜散宜清宜降，各随微甚而调之。诸病属火者多，《内经》病机属火五条，其曰诸热
瞀螈，皆属于火。谓邪热伤神，则昏乱，亢阳伤血，则抽掣。治以清心养肝。地、冬、连、芍之属。曰诸禁
鼓栗，如丧神守，皆属于火。谓热极反寒，治以透热安神。栀、连、朱砂之属。曰诸逆冲上，皆属于火。
谓龙相上升，治以镇逆潜阳。青铅、牡蛎之属。丹溪云∶病患言冷气自下而上，非真冷也，上升之气，自肝而
出，中挟龙相火，自下而上，其热为甚。自觉冷者，火极似水，积热之甚也，阳亢阴微，故见此症。曰诸躁狂
越，皆属于火，谓重阳便秘，治以清镇通降。牛黄、石膏、硝、黄之属。曰诸病 肿，酸痛惊骇，皆属于火。
谓热郁神扰，一治以升阳，升麻、薏仁、当归、香附之属。一治以敛镇。枣仁、茯神、龙骨之属。此其概也。
丹溪云∶治火症不可骤用寒凉，须兼温散，火甚，用甘凉以缓之，生甘草兼泻兼缓。火盛癫狂，人壮气实者，
可用正治，冰水之类饮之。虚者，用生姜汤。若投冰水，立死。或补阴，令火自降，地黄、白芍之属。其劳
倦内伤为气虚，火起于脾。宜甘平温养以退之，参、 、甘、苓之属。经言劳者温之，损者温之是也。如阴
虚躁烦，唾痰如涌，面目俱赤，口渴便秘，
外极似火，脉亦洪大，然按之不鼓指，此肾阴虚而阳浮越，非火也，乃假热症，用承气白虎汤立毙。当峻补真
阴。七味丸料，重加肉桂。水煎冷服，诸症必退。翌日畏寒足冷，真候自现，乃峻补其阳，八味丸料煎服。
此脉症变常，不可以常法治也。又产后及大失血后，阴伤发热，切忌凉剂，即以四物汤滋阴，亦属不宜，须独
参汤补气，方见阳生阴长之妙。此宜辨阳虚阴虚，阳虚者，面必赤，无根之火戴于上也。果属阳盛，火郁于内，
面必不赤，其口渴者，肾液干，引水自救耳。且口虽渴，舌必滑润，脉虽数，尺必无力，惟过服凉药，脉反有
力而鼓指。戴复庵曰∶服凉药而脉反数，此火郁也，宜升宜补，切忌寒凉，犯之必死。
经曰∶一水不能胜二火，二火，君火、相火也。心为君火，心主藏神属阳。在天为太阳之火；相火附于
肝肾，代君行令属阴。在天为龙雷之火。心火过亢，可以寒凉正治。如黄连、生地黄之属。如天上太阳火，
人感之而伤热中 ，亦可以凉水苦寒解。若龙蟠于海，雷伏于地，木水中之焰也。秋后则蛰，随阳而升，得
雨益炽，此不可以水灭矣。人身命门相火，龙火也，少阳相火，雷火也。龙雷相附，命火衰，右尺脉弱，治须
益火之源，桂附八味丸。与火同气，据其窟宅而招之。肾水虚，左尺脉弱，须壮水之主，六味丸。与火相配，
滋其真阴以潜之，或肾阴弱，相火强，须从其性而伏之，滋肾丸。肾水亏，龙火升，须从其类而引之，七味丸。
火起脐下，冲脉上冲而喘，都气丸、黑锡丹。补而镇之，不可以水折也。经曰∶一水不能胜五火。五火者五志
之火，临于五位，即相火之煽而妄动者也。相火易动，五志激之，变幻莫测，煎灼真阴，阴虚则病，阴绝则死，
故东垣谓火为元气之贼。古云∶神静则心火自降，欲断则肾水自升，有以夫。凡治五志之火起于五位者∶
肺火，以黄芩清肺饮加豆豉、杏仁、枇杷叶降之，以人参平肺散调之；心火，以泻心汤泄之，以补心丹养之；
脾火，以泻黄散发之，以补中益气汤升之；肝火，以左金丸平之，以龙荟丸折之；肾火，治法见上。虚火以
人参竹叶汤清之，以保元汤补之；虚火盛而狂乱，以生姜汤从治之；实火，以三黄汤泻之；痰
火，以淡竹茹汤涤之；郁火，以发郁汤散之。一切壮火狂阳，痰壅心包，内外热炽，以紫雪平之。积热烦躁，
咽肿口疮，以碧雪主之。好饵丹石，药毒发渴壮热，千金朴硝煎主之。
东垣曰∶黄连泻心火，黄芩泻肺火，柴胡泻肝火，黄连佐之。知母泻肾火，木通泻小肠火，黄芩泻大肠火，
羚羊角泻胆火，龙胆草佐之。滑石泻膀胱火，麦冬、丹皮泻心包火，连翘、山栀泻三焦火，地骨皮佐之。
石膏、大黄泻胃火。
Wind, cold, summer-heat, dampness, and dryness are all external pathogens; only fire is mostly due to internal causes. The Classics state: "Exuberant fire consumes Qi, while mild fire generates Qi." Commentaries explain that fire located below the Dantian (Lower Elixir Chamber) is called mild fire (Shao Huo); mild fire generates Qi, which is True Fire. Fire that leaves the Dantian and flares upward is called exuberant fire (Zhuang Huo); exuberant fire consumes Qi, which is Evil Fire. However, there are also excess fire, deficiency fire, damp-fire, constrained fire, Yin fire, fire of the five Zang and six Fu organs, and wandering fire that does not follow the meridians.
To treat excess fire: For heat in the Upper Jiao (Upper Burner), use Qingxin Tang (Clear Heart Decoction) or Jiajian Liange San (Modified Cool the Diaphragm Powder). For accumulated heat in the Middle Jiao with thirst, dryness, and constipation, use Liange San. For exuberance of fire in the Three Jiaos with mania, restlessness, vomiting, and epistaxis, use Huanglian Jiedu Tang (Coptis Decoction for Detoxification). For tidal fever of the Yangming channel, use Baihu Tang (White Tiger Decoction). For fire in the Lower Jiao with hematuria, strangury, and urinary retention, use Lixiao San. For all blood-level heat causing erysipelas, use Sishun Qingliang Yin (Four-Obedience Cooling Beverage).
To treat deficiency fire: Due to improper diet and overexertion generating internal deficiency heat, this injures Spleen Yang; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Due to excessive thinking or sexual exhaustion causing blood deficiency with hyperactive fire, this injures Kidney Yin; use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill). When Kidney Yin deficiency is extreme, with rising fire, irritability, thirst, prickles on the tongue, and a surging pulse, this indicates floating Yang without attachment; urgently use Bawei Wan (Eight-Ingredient Pill) decocted and taken orally. For postpartum fever due to Yin injury, with thirst and red face, this is rootless fire; use Dushen Tang (Single Ginseng Decoction).
To treat damp-fire: Excessive dampness generating heat, with swelling and urinary obstruction, use Weiling Tang (Stomach and Atractylodes Macrocephala Decoction).
To treat constrained fire: Heat on the muscle surface, five-palm heat, feeling like burning, and stomach deficiency with consumption of cold food suppressing Spleen Yang, use Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction). Heat in palms like branding iron with a deep, rapid pulse, use Huoyu Tang (Fire-Constrained Decoction). Bone-steaming in the lower body due to blood deficiency, use Wuzheng Wan (Five Steaming Pills) or Siwu Tang (Four-Substance Decoction). Hidden fire in the blood, use Jiawei Siwu Tang (Modified Four-Substance Decoction). Wind-consumption bone-steaming, use Qinjiao Biejia San (Gentian and Turtle Shell Powder).
To treat Yin fire: Qi rising from below the navel, use Dubu Yin Wan (Great Supplement Yin Pill) or Kanli Jiji Wan (Kan and Li Mutual Completion Pill). Qi rising from the soles into the abdomen, indicating extreme deficiency difficult to treat, use Qiwei Dihuang Wan (Seven-Ingredient Rehmannia Pill); externally apply Fuzi powder (Aconite Root powder) mixed with saliva to Yongquan (KI 1).
To treat fire of the five Zang organs: Qi stagnation transforming into fire originating in the Lung, use Xiebai San (Drain White Powder) or Qingjin Wan (Clear Metal Pill). Anger transforming into fire originating in the Liver, use Jiawei Xiaoyao Yin (Modified Free and Easy Wanderer Beverage) with Qingpi (Green Tangerina Peel) and Longdancao (Gentiana Root). Fire from overeating/drinking originating in the Spleen, use Xiehuang San (Drain Yellow Powder) with Baishao (White Peony Root) and Zhike (Bitter Orange). Fear/worry transforming into fire originating in the Heart, use Daochi San (Guide Out Redness Powder) or Qingxin Lianzi Yin (Clear Heart Lotus Seed Beverage). Fire from sexual excess originating in the Kidney, use Bawei Wan.
To treat fire of the six Fu organs: Stomach fire causing toothache and jaw swelling, use Qingwei San (Clear Stomach Powder). Gallbladder fire causing dizziness and bitter taste, use Lingyangjiao (Antelope Horn), Danpi (Moutan Cortex), Zhizi (Gardenia Fruit), Sangye (Mulberry Leaf), Lianqiao (Forsythia Fruit), and Longdancao. Large Intestine fire causing constipation, use Tongyou Tang (Unblock the Abyss Decoction) with Huaimi (Sophora Flower). Small Intestine fire causing urinary retention and dribbling, use Bazheng San (Eight-Utensils Powder) modified. Bladder fire causing abdominal pain and dysuria, use Dabu Wan (Great Tonify Pill). Sanjiao fire causing limb heat and fatigue: use Zhizi (Gardenia Fruit) for the Upper Jiao, Lianqiao for the Middle Jiao, and Digupi (Lycium Bark) for the Lower Jiao. Pericardium fire causing palpitations and unrest, use Maidong (Ophiopogon Tuber), Danpi, Xijiao (Rhinoceros Horn - *note: substitute with water buffalo horn clinically*), Lianqiao, Shichangpu (Acorus Rhizome), and Dengxincao (Juncus Pith).
For wandering fire, some require dispersing, some clearing, some descending; regulate each according to its severity.
Many diseases belong to fire. The *Neijing* lists five pathogenesis clauses related to fire:
1. "All heat disorders with confusion and convulsions belong to fire." This means evil heat damages the spirit, causing confusion; hyperactive Yang damages blood, causing spasms. Treat by clearing the Heart and nourishing the Liver using Dihuang (Rehmannia), Dongchongxiacao (Ophiopogon/Dendrobium contextually often implies cooling yin herbs here, specifically Maidong/Ludong), Lian (Huanglian), and Shaoyao (Peony).
2. "All cases of clenched jaws, shivering, and loss of mental control belong to fire." This means extreme heat mimics cold. Treat by venting heat and calming the spirit using Zhizi (Gardenia), Lian (Huanglian), and Zhusha (Cinnabar).
3. " All rebellious upward rushing belongs to fire." This means Dragon/Ministerial fire rises. Treat by subduing rebellion and anchoring Yang using Qingqian (Lead) and Muli (Oyster Shell).
Zhu Danxi said: Patients feel cold air rising from below, but it is not true cold. The rising Qi comes from the Liver, carrying Dragon/Ministerial fire upward, making the heat severe. Feeling cold is fire extremity resembling water, indicating severe accumulated heat, Yang hyperactivity, and Yin deficiency.
4. "All restlessness, mania, and overaction belong to fire." This means excessive Yang and constipation. Treat by clearing, subduing, and descending using Niuhuang (Calculus Bovis), Shigao (Gypsum), Xiaoshuo (Mirabilite), and Dahuang (Rhubarb).
5. "All swellings, painful soreness, fright, and terror belong to fire." This means heat constraint disturbing the spirit. One treatment raises Yang using Shengma (Cimicifuga), Yiren (Coix Seed), Danggui (Angelica Sinensis), and Xiangfu (Cyperus Rhizome). Another treatment anchors and calms using Zaoren (Ziziphus Seed), Fushen (Poria with Hostwood), and Longgu (Fossilized Bone). These are general principles.
Zhu Danxi said: Treating fire syndromes should not abruptly use cold/cooling herbs; one must combine warming dispersal. For severe fire, use sweet-cool herbs to moderate it; Gancao (Licorice Root) clears and moderates. For fire-induced mania in robust individuals with strong Qi, direct treatment with ice water may be used. For deficiency patterns, use Shengjiang (Fresh Ginger) decoction. If ice water is given to deficient patients, death ensues immediately. Alternatively, tonify Yin to let fire descend naturally using Dihuang and Baishao. For fatigue/internal injury causing Qi deficiency with fire arising from the Spleen, use sweet-neutral-warming herbs to retreat it, such as Renshen (Ginseng), Huangqi (Astragalus), Gancao, and Fuling (Poria). As the Classics say: "Treat fatigue with warmth, treat deficiency with warmth."
If Yin deficiency causes irritability, profuse phlegm, red face/eyes, thirst, and constipation, appearing externally like fire with a surging pulse, but pressing reveals no force (non-pounding), this is Kidney Yin deficiency with floating Yang, not true fire, but false heat. Using Chengqi Tang or Baihu Tang will cause immediate death. One must severely tonify True Yin using Qiwei Wan formula with heavy Rougui (Cinnamon Bark), decocted in water and taken cold; symptoms will recede. The next day, chills and cold feet appear, revealing the true pattern; then severely tonify Yang using Bawei Wan formula. This is a variation of pulse/symptoms requiring non-routine treatment.
Furthermore, after childbirth or massive hemorrhage, Yin injury causes fever; cold formulas are strictly contraindicated. Even Siwu Tang for nourishing Yin is unsuitable; one must use Dushen Tang to tonify Qi to witness the miracle of Yang generating Yin. Differentiate Yang vs. Yin deficiency. Yang deficiency presents with red face due to rootless fire floating above. If truly Yang excess with internal constrained fire, the face will not be red. Thirst in such cases is due to dried Kidney fluids seeking water. Although thirsty, the tongue will be slippery; although the pulse is rapid, the Chi (cun-chi) position will be weak. Only after overdosing cold herbs does the pulse become forceful and pounding. Dai Fu'an said: If the pulse becomes rapid after taking cold herbs, this is constrained fire; raise and tonify, strictly avoid cold/cooling, violation leads to death.
The Classics state: "One Water cannot overcome Two Fires." The two fires are Ministerial Fire and Sovereign Fire. The Heart is Sovereign Fire, governing the Spirit, belonging to Yang (Heavenly Sun Fire). Ministerial Fire attaches to Liver/Kidney, acting for the Sovereign, belonging to Yin (Dragon/Thunder Fire). Hyperactive Heart fire can be treated directly with cold/cooling herbs like Huanglian and Shengdihuang, like extinguishing solar heat with cold water. But if Dragon hides in the sea and Thunder lies in the earth (fire within wood/water), it hibernates in autumn, rises with Yang, and blazes with rain; it cannot be extinguished by water. The Life Gate Ministerial Fire in the body is Dragon Fire; Shaoyang Ministerial Fire is Thunder Fire. When Dragon/Thunder attach, if Mingmen Fire declines and Right Chi pulse is weak, treat by benefiting the source of fire using Guifu Bawei Wan (Cinnamon/Aconite Eight-Ingredient Pill), attracting it to its lair with similar nature. If Kidney Water is deficient and Left Chi pulse is weak, strengthen the master of water using Liuwei Wan, pairing with fire to nourish True Yin and anchor it. If Kidney Yin is weak and Ministerial Fire strong, follow its nature to subdue it using Zishen Wan. If Kidney Water is depleted and Dragon Fire rises, guide it by similarity using Qiwei Wan. Fire rising from below the navel with Chong Mai rebellion causing asthma, use Duqi Wan and Heixi Dan. Tonify and anchor; do not break with water.
The Classics state: "One Water cannot overcome Five Fires." The five fires are fires of the Five Emotions, manifesting at their respective positions, fanned by Ministerial Fire. Ministerial Fire moves easily; stimulated by emotions, it changes unpredictably, scorching True Yin. Yin deficiency leads to disease, Yin exhaustion leads to death. Hence Li Dongyuan said fire is the thief of Yuan Qi. Ancients said: Calm spirit lowers Heart fire; cut desires raises Kidney water.
Treatment for fires of the five emotions at their positions:
Lung fire: Clear with Huangqin Qingfei Yin (Scutellaria Lung-Clearing Beverage) plus Douchi, Xingren, Pipaye; regulate with Ren Shen Ping Fei San.
Heart fire: Drain with Xiexin Tang; nourish with Buxin Dan.
Spleen fire: Disperse with Xiehuang San; raise with Buzhong Yiqi Tang.
Liver fire: Pacify with Zuojin Wan; suppress with Longhui Wan.
Kidney fire: See above.
Deficiency fire: Clear with Renshen Zhuye Tang; tonify with Baoyuan Tang.
Severe deficiency fire with mania: Treat inversely with Shengjiang Tang.
Excess fire: Drain with Sanhuang Tang.
Phlegm-fire: Purge with Danzhuru Tang.
Constrained fire: Disperse with Fayu Tang.
All exuberant fire/yang, phlegm obstructing Pericardium, intense internal/external heat: Pacify with Zixue (Purple Snow).
Accumulated heat with irritability, swollen throat/mouth ulcers: Use Bixue (Green Snow).
Preference for cinnabar/realgar, drug toxicity causing thirst/fever: Use Qianjin Pu Xiao Jian (Thousand Gold Mirabilite Decoction).
Li Dongyuan said: Huanglian drains Heart fire; Huangqin drains Lung fire; Chaihu drains Liver fire, assisted by Huanglian. Zhimu drains Kidney fire; Mutong drains Small Intestine fire; Huangqin drains Large Intestine fire; Lingyangjiao drains Gallbladder fire, assisted by Longdancao. Huashi drains Bladder fire; Maidong and Danpi drain Pericardium fire; Lianqiao and Zhizi drain Sanjiao fire, assisted by Digupi. Shigao and Dahuang drain Stomach fire.