Library

[Fire Heat, Mania and Delirium (Appendix), Tidal Fever with Yin Deficiency and Fire Movement (Appendix), Upper Part, Lower Part, Sores and Ulcers]

Pulse: A pulse that is surging (Hong) and rapid (Shu), or dry and urgent, coming and going tight, large, and solid indicates Fire. A surging and slippery pulse at the left Cun position indicates Heart Fire; a surging and rapid pulse indicates Small Intestine Fire. A wiry (Xian), large, and long pulse at the left Guan position indicates Liver Fire; a wiry, small, and rapid pulse indicates Gallbladder Fire. A deep (Chen) and rapid pulse at the left Chi position indicates Kidney and Bladder Fire. A floating (Fu) and rapid pulse at the right Cun position indicates Lung Fire; a surging, large, and rapid pulse indicates Large Intestine Fire. A surging and rapid pulse at the right Guan position indicates Stomach Fire; a surging and solid pulse indicates Spleen Fire. A deep and rapid pulse at the right Chi position indicates Mingmen Fire; a deep and minute (Wei) pulse indicates Mingmen Fire Decline. A floating and rapid pulse indicates Sanjiao Fire; a deep, fine, and floating-rapid pulse indicates Yin Deficiency with Fire Movement. If the pulses in all six positions are surging and forceful, it is easy to treat; if they are contrary, deep, difficult, and fine, it is difficult to treat. The *Mai Jue* states: A floating, wiry, and rapid pulse indicates fever; a surging and rapid pulse indicates vexatious heat; a slippery and rapid pulse indicates stagnation-heat in the epigastrium; a wiry, tight, and rapid pulse indicates alternating chills and fever; a deep, fine, rapid, and hurried pulse indicates heat combined with cold. A tight and rapid pulse at the Cun position with a deep and minute pulse at the Chi position indicates upper heat and lower cold. A floating, tight, and slippery pulse indicates exterior heat and interior cold. A slightly slow pulse on light palpation with a tight and slippery pulse on heavy palpation indicates exterior cold and interior heat. A floating, large, and rapid pulse at both Cun positions indicates heat in the Heart and Lungs; a wiry, slippery, and rapid pulse at both Guan positions indicates heat in the Liver and Spleen; a surging and solid pulse, or deep and rapid pulse at both Chi positions, indicates heat in the Lower Jiao. A surging and solid pulse at the right Cun and Guan positions indicates heat in the Spleen and Lungs; a slippery and rapid pulse at the right Guan position overflowing past the Cun Kou indicates heat in the stomach opening, manifesting as vomiting. A short, choppy, and rapid pulse, or a deep, fine, and rapid pulse in all six positions, indicates heat in the Yin aspect; a surging, large, and long pulse, or a floating, surging, slippery, and rapid pulse, indicates heat in the Yang aspect. The *Classic* states: When the pulse arrives following the disease, but does not throb upon pressure, this applies to all Yang channels. Wang Bing's commentary notes: In cases of febrile disease with a rapid pulse, if it does not throb upon pressure, it is caused by severe Cold repelling Yang, and is not true heat. If symptoms indicate cold, but the pulse qi strikes the fingers vigorously upon pressure, this is due to excessive Heat rejecting Yin, causing illness, and is not cold. It also states: Pushing inward, if the exterior does not yield inward, there is heat in the body. The *Treatise on Cold Damage* states: A faint pulse at the Cun Kou indicates insufficient Yang Qi; when Yin Qi enters the Yang center, it causes shivering and aversion to cold. A weak pulse at the Chi position indicates insufficient Yin Qi; when Yang Qi sinks into the Yin center, it causes fever. This is consistent with the meaning of "Fu and Yi interacting" and the principles of floating-damaged-small and deep-solid-large pulses in the *Classic of Difficult Issues*, which are essential diagnostic methods, particularly suitable for heat syndromes.

Symptoms: According to Zhu Danxi, among the Nineteen Pathomechanisms in the *Su Wen*, five belong to Fire, and Liu Hejian expanded upon this theory, noting that Fire causes many diseases, deeply aligning with the *Nei Jing*. He stated: Various diseases such as panting, vomiting, acid regurgitation, sudden diarrhea with tenesmus, muscle spasms, turbid urination, abdominal distension with drum-like sound, carbuncles, sores, ulcers, tumors, phlegm nodules, vomiting and diarrhea cholera, dizziness and depression, swelling, nasal congestion, rhinorrhea, epistaxis, hematemesis, hematochezia, strangury with fever, aversion to cold and trembling, or weeping/laughing delirium, and bloody discharges, all belong to the Ministerial Fire of Shaoyin, which is associated with the Qi of the Heart and Small Intestine. If there is dizziness, sudden aphonia, confusion, dryness and agitation, mania, cursing, fright, swelling, pain, soreness, rebellious Qi rushing upward, trembling as if losing spiritual control, sneezing, vomiting, sores, ulcers, throat obstruction, tinnitus, and deafness, vomiting and gurgling, overflow of food without swallowing, blurred vision, sudden diarrhea, sudden illness, and sudden death, these all belong to the Heat of Shaoyang (Ministerial Fire), which is associated with the Qi of the Pericardium and Sanjiao. The *Yuan Bing Shi* states: Various wind diseases with tremors and vertigo belong to the movement of Liver Fire; various pains, itching, sores, and ulcers belong to the function of Heart Fire; various dampness, swelling, and fullness belong to the excess of Spleen Fire; various Qi rebellion, depression, and flaccidity diseases belong to the rising of Lung Fire. These are all diseases caused by Fire originating from the Zang-Fu organs. As for the mutual attack of the Five Emotions and the reckless movement of the Seven Emotions, Fire arises accordingly. For example, great anger causes Fire to arise in the Liver; drunkenness and overeating cause Fire to arise in the Spleen; sexual exhaustion causes Fire to arise in the Kidneys; sorrow moving the center causes Fire to arise in the Lungs. The Heart is the Sovereign Fire; if it burns itself, death ensues. The *Bian Yi Lu* states: Humans inherit one of each of the Five Elements, but Fire has two types, distinguished as Sovereign and Ministerial. The Sovereign Fire does not govern commands; the Ministerial Fire takes its place. It resides within the Liver and Kidneys and attaches to the Spleen and Lungs. Movements in all meridians belong to Fire. Arising from the Liver, it is called Wind-Fire; born from the Spleen, it is called Phlegm-Fire; entering Qi, it is Rootless Fire; moving in the Kidneys, it is Yin-consuming Hidden Fire; residing in the Heart and Lungs and entering the Blood aspect, it is Excess Fire; scattering through the meridians, it is Wandering Fire. Thus it is said, "Fire is transformation." It moves quickly and changes unpredictably. The *Classic* again states: For those who are treated with cold remedies yet remain hot, treat the Yin. The commentary explains: Treating the Yin means tonifying the insufficiency of Kidney Water to restrain the excess of Heart Fire. Li Dongyuan stated: Febrile diseases include heat due to Yuan Qi deficiency, heat of the Five Zang, and internal, middle, and external heat. Therefore, heat felt on light palpation is in the skin and vessels, governed by the Heart and Lungs; heat felt steaming upon heavy palpation to the bone is in the sinews and bones, governed by the Kidneys and Liver; heat felt neither lightly nor heavily is in the muscles, governed by the Spleen. He also stated: Fever during the day and quietness at night indicates Yang Qi flourishing in the Yang aspect; quietness during the day and fever/agitation at night indicates Yang Qi sinking into the Yin, named Heat Entering the Blood Chamber; fever and quietness indistinguishable between day and night indicates Double Yang with no Yin, requiring urgent draining of Yang and vigorous tonification of Yin. The *Classic of Difficult Issues* states: Double Yang leads to mania; with surging and solid pulses in all six positions, bitter-cold herbs should be used to drain it. Double Yin leads to epilepsy; with deep and minute pulses, sweet-warm herbs should be used to tonify it. Zhang Zhongjing stated: If a patient has high body heat but desires to wrap themselves in clothes, the heat is in the skin and the cold is in the marrow; if the body is very cold but does not desire clothes, the cold is in the skin and the heat is in the marrow. Treatment requires careful differentiation.

Therapeutic Methods: Dai Shi stated: The harm of Fire diseases is great, the changes are rapid, the manifestation is obvious, and death can be sudden. Why? Because it can scorch and fly, leap and burn, nothing can resist it, wandering through the two paths of deficiency and excess in the Sanjiao. The Sovereign Fire, i.e., Heart Fire, can be subdued by dampness, extinguished by water, and directly折 (broken/restrained); only herbs like Huanglian can control it. The Ministerial Fire, i.e., Dragon Fire, cannot be subdued by dampness or water, nor directly broken; it must be subdued according to its nature; only herbs like Huangbai can descend it. Alas, the method of draining fire is not limited to this. There are many aspects of deficiency and excess that must be examined. Considering Zang Qi: Huanglian drains Heart Fire, Huangqin drains Lung Fire, Shaoyao drains Spleen Fire, Chaihu drains Liver Fire, Zhimu drains Kidney Fire, Chaihu and Huangqin drain Sanjiao Fire, Mutong drains Small Intestine Fire, Shigao drains Stomach Fire, Huangbai drains Bladder Fire. These are all bitter-cold flavors capable of draining excess Fire. However, if diet and labor injure the Yuan Qi, and Fire and Yang cannot coexist, it is a disease of Yang Deficiency, treated with sweet-warm agents to descend it, such as Renshen, Baizhu, Danggui. If Heart Fire is extremely hyperactive with stagnant heat and interior excess, it is a disease of Yang Mania, treated with cold-salty agents to break it, such as Xiaoshi and Dahuang. If Kidney Water is injured and True Yin is lost, with Rootless Fire flaming recklessly, it is a disease of Yin Deficiency, treated with agents to strengthen Water to control it, such as Huangbai, Dihuang, Xuanshen. If Mingmen Fire at the right Chi is declining, it is a disease of Yang Collapse, treated with warm-hot agents to control it, such as Jiang and Fuzi. If Stomach deficiency leads to excessive consumption of cold foods, suppressing Yang Qi within the Spleen Earth, it is a disease of Fire Stagnation, treated with ascending-dispersing agents to emit it, such as Shengma and Gegen. Another treatment method states: For slight heat Qi, use coolness to harmonize it; for major heat Qi, use cold to resolve it; for severe heat Qi, use sweating to emit it. If emission is incomplete, then use counter-treatment. It also states: Sudden heat diseases are in the Heart and Lungs; accumulated heat diseases are in the Kidneys and Liver. Deficient heat with inability to eat, spontaneous sweating, and shortness of breath belongs to Spleen Deficiency, treated with sweet-cold and warm agents. Excess heat with ability to eat, dry mouth and tongue, and difficult defecation belongs to Stomach Excess, treated with bitter-acrid major-cold purgatives. Fire stagnation with heat occurs when Heart Fire sinks into Spleen Earth, suppressed and unable to extend, causing five-palm heat; it should be emitted via sweating. Vexed mind with hidden fire in the blood, feeling steamingly uneasy, requires calming Heart Fire, treated with Zhusha Anshen Wan. Bone-steaming consumptive fever is a disease where all Five Zang are damaged, manifesting as emaciation, fever, night sweats, and blood loss; it requires nourishing Yin and tonifying Blood. If one does not understand these various Fire Heat diseases, how can treatment have a basis? Thus, I have collected the essentials for reference, to avoid the disaster of treating excess as excess and deficiency as deficiency.

Formulas: Sanbu Tang treats general excess heat and excess fire; it is not suitable for deficiency.
Huangqin (wine-fried 2.5 qian), Huanglian (ginger juice-fried 1.5 qian), Huangbai (salt-wine fried 2.5 qian).
Take as one dose, decoct in water, take hot far from meals. For accompanying symptoms, modify according to the following.
Heart Fire Excess Heat: Add Shengdihuang, Maidong (each 1.5 qian), Sheng Gancao (0.5 qian), add Huanglian (1 qian).
Liver Fire Excess Heat: Add Chuanxiong (1 qian), Chishao Yao (1 qian), Longdan Cao (1.5 qian), Dahuang (3 qian).
Spleen Fire Excess Heat: Add Baishao Yao (1 qian), Shanzhi (1.5 qian).
Lung Fire Excess Heat: Add Shigao, Tiandong (each 1.5 qian), Sangbaipi (1 qian), Shanzhi (1.5 qian).
Kidney Fire: Add Shudihuang, Zhimu (each 1.5 qian), Xuanshen (1 qian), Zexie (0.8 qian), reduce Huangqin and Huanglian.
Small Intestine Fire: Add Mutong (2 qian), Huoshi (1.5 qian), Gancao Shao (0.5 qian), Chifuling (1 qian).
Gallbladder Fire: Add Chaihu (1.5 qian), Zhuru (0.8 qian), Qingpi (0.7 qian).
Stomach Excess Fire (Mild): Add Shigao, Zhimu (each 2 qian), Gancao (0.7 qian), Jingmi (1.5 qian). Severe: Add Dahuang (3 or 5 qian), Mangxiao (1 qian).
Large Intestine Fire: Add Danggui (1.5 qian), Lianqiao, Huaishi (each 1.5 qian).
Bladder Fire: Add Zexie (1 qian), Baifuling (1.5 qian), Xixin (0.5 qian).
Sanjiao Fire: Add Lianqiao, Fangfeng, Jingjie, Shanzhi (each 1.5 qian).
Mingmen Fire Excess: Descend with Sizhi Huangbai Wan. Fire Decline: Warm with Rongfu Wan.
Stagnant Fire: Remove Huangqin and Huangbai, add Xiangfu, Shanzhi (each 1.5 qian), Qingdai, Chuanxiong (each 1 qian).
Excessive Heat in Heart, Liver, and Lungs with red, swollen, painful eyes: Add Chishao Yao, Chuanxiong (each 1 qian), Danggui, Shengdihuang (each 1.5 qian), Longdan Cao, Ganhua Ju (each 1.2 qian), Fangfeng, Jingjie, Bohe (each 0.7 qian).
Heart Fire Extremely Hyperactive, Stomach and Liver Fire Excess with mania and delirium: Add Shigao (2 qian), Shanzhi (1.5 qian), Dahuang (3 or 5 qian), Mangxiao (1 qian), which is Sanhuang Shigao Tang.
Heat-Fire in Middle and Upper Jiao: Main formula is Liangge San. Remove Huanglian and Huangbai from this formula, add Shanzhi, Lianqiao, Dahuang (each 2 qian), Puxiao, Bohe, Gancao (each 0.7 qian).
Upper Jiao Heat-Fire with sore throat, throat obstruction, swollen tongue, and mouth ulcers: Add Shandougen (1.5 qian), Xuanshen (1 qian), Jiegeng, Gancao (each 0.8 qian).
Yangming Fire Excess attacking upwards with head/face swelling, or cheek/jaw swelling, gum swelling, toothache: Add Shengma (0.5 qian), Baizhi (0.8 qian), Fangfeng (1 qian), Xixin (0.5 qian), Shigao (2 qian), remove half of Huangbai.
Shaoyang Fire Excess with ear swelling/pain, neck/swelling: Add Chuanxiong (1 qian), Chaihu (1.5 qian), Xiakucao, Niubangzi, Lianqiao (each 1.5 qian), Fangfeng (0.8 qian), Gancao, Qingpi (each 0.5 qian).
Taiyang Fire Excess with headache and profuse phlegm: Add Shigao (2 qian), Shengma (0.5 qian), Qianghuo (1 qian), Banxia, Nanting (each gall-treated 1.5 qian), Chuanxiong (1 qian), halve all ingredients of this formula.
Heat Knot in Lower Jiao with constipation of urine and stool: Add Shanzhi, Mutong (each 1.5 qian), Dahuang (3 or 5 qian), Gancao Shao (0.5 qian).
Intestinal wind and visceral toxin bleeding, hemorrhoids and fistulas: All caused by accumulated fire in Stomach and Large Intestine and wind-heat. Add Huaishi (gall-treated), Jingjie, Fangfeng (each 1.2 qian), Shengdihuang, Danggui (each 1.5 qian), Diyü, Lianqiao, Renshen, Baizhu (each 1 qian), tonify and clear.
Five Stranguries with red/white turbidity and difficult urination: Caused by stagnant fire in Heart/Lungs and Small Intestine/Bladder agitated by external pathogens. Add Mutong, Chifuling (each 1.5 qian), Cheqianzi, Zexie, Yuliren, Gancao Shao (each 1 qian), Dahuang (3 qian). For blood strangury and hematuria: Add Danggui, Shengdihuang, Diyü (each 1.5 qian), Fenhui (0.5 qian), Niuxi (1 qian).
Qi Strangury and Qi Constipation: Add Muxiang (0.5 qian), Qingpi (1 qian), Mutong (1.5 qian), Wuyao (0.8 qian).
Epilepsy, mania, and delirium belonging to Phlegm and Fire. Excess type: Combine this formula with Erchen Tang, add Nanting, Zhuli, Jiangzhi, take first dozen doses to clear phlegm. Then main formula is Niuhuang Hupo Wan. Deficiency type: First use Shiquan Yibu Tang, remove Chuanxiong and Guigui, add Maidong, Suanzaoren, Huanglian (each 1 qian), Yuanzhi (0.5 qian) to nourish Qi and Blood. Then also use Niuhuang Hupo Wan. (Pill formula see appendix later).
Postpartum convulsions and twitching in women with vague speech: Treat similarly, but do not remove Chuanxiong and Guigui, add Fangfeng, Tianma, Baizhi (each 1 qian).
The above modifications are general guidelines; clinical judgment is required to master flexibility. According to ancient sages: For severe Fire, sudden use of cold-coolants must be accompanied by warm dispersal. For extremely urgent Fire, it must be slowed. Raw Gancao clears and slows; for deficiency, Renshen and Gancao can also be used. For robust individuals with strong Qi and severe Fire mania, it can be used. The aforementioned orthodox treatment involves giving nitre water or ice water. For deficient Fire mania, ginger juice and bamboo sap are used to control it. If orthodox treatment based on the previous methods is applied immediately, death will follow. There is also the theory that tonifying Yin causes Fire to descend naturally, such as fried Huangbai and Dihuang. The *Classic* says: "The master of vigorous Fire controls the sunlight." Alas, treatment for deficiency and excess are worlds apart; the mechanism of auspiciousness and danger responds like an echo. Can one not think deeply and distinguish clearly?

Another Formula: Tiaozhong Sanhuo Tang treats symptomatic fever and heat, generally for deficient fire.
Renshen, Huangqi (honey-fried each 0.8 qian), Danggui, Baishao Yao, Baizhu (each 1 qian), Gancao (0.4 qian), Chaihu (0.6 qian), Shengma (0.5 qian), Gegen, Fangfeng, Qianghuo, Huangqin (0.7 qian).
Take as one dose, decoct with Ginger and Jujube, take far from meals. For accompanying symptoms, modify according to the following.
Yin Deficiency Fever: Add Maidong, Huangbai, Zhimu, Digupi (each 1 qian), double Chaihu.
Palmar Heat: Add Shanzhi, Xiangfu (each 1 qian), Chuanxiong, Baizhi (each 0.7 qian).
Deficient Heat with inability to eat, spontaneous sweating, shortness of breath: Add Fuling, Chenpi (each 0.8 qian).
Fever at dawn: Add Maidong, Digupi (each 0.8 qian), double Chaihu.
Lung Meridian Fever: Heat felt in skin upon pressure, worse in evening: Add Shigao, Zhimu, Digupi (each 1 qian).
Heart Meridian Mild Fever: Heat felt in vessels upon heavy pressure, worse at noon: Add Maidong, Huanglian (each 1 qian).
Liver Meridian Fever: Heat felt below muscle to bone upon heavy pressure, worse at Yin/Mao hours: Double Chaihu, add Qingpi (0.7 qian).
Upper Jiao Fever: Add Zhimu, Tiandong, Maidong (each 1 qian) to stabilize Lung Qi.
Middle Jiao Fever: Belongs to Spleen Deficiency, double Renshen and Baizhu, add Chenpi, Baifuling (each 1 qian).
Lower Jiao Damp-Heat or Bladder Fire Evil: Add Hanfangji, Longdan Cao, Huangbai (each 1 qian).
Steaming Fever unceasing day and night: Add Zhimu, Qinjiao, Mudanpi, Digupi (each 1 qian), double Chaihu.
Fever during day, quiet at night: Sijunzi Tang, add Maidong, Huhuanglian, Qinjiao, Digupi (equal parts).
Fever and agitation at night, quiet during day: Siwu Tang combined with Xiaochaihu Tang, cured in 1-2 doses.
Cool Blood to relieve five-palm heat: Siwu Tang, add Maidong, Lianqiao, Shanzhi, Bohe.