Yang deficiency with floating fire refers to the condition where “those with Yang deficiency can also experience fever, as the original Yang is depleted, and the fire does not return to its source.” Clinically, it presents two sets of opposing symptoms: the first is Kidney Yang deficiency, which is the essence of the disease: pale complexion, cold limbs, especially in the lower extremities, fatigue, weakness, male impotence, premature ejaculation, and cold semen; in females, it manifests as cold in the uterus leading to infertility, decreased libido, or symptoms such as loose stools, early morning diarrhea, frequent clear urination, and pale tongue with white coating, weak and thin pulse, especially in the wrist. If only these symptoms appear, the differentiation of Yang deficiency is not difficult; the second is deficient fire, which is a false appearance of the disease. As stated in the Complete Book of Jingyue: “When cold arises from within, Yang Qi has no place to attach and disperses outward, which is called deficient fire, or false heat.”
Zhang Zhongjing proposed that when Yang Qi is weak and floating, it may lead to restlessness and insomnia, or to Yang counterflow, or excessive sweating. The symptoms of Ginger and Aconite Decoction include “restlessness day and night, quiet at night” and the symptoms of Four Reverse Decoction include “the person’s complexion is red,” all belong to this category.
Wang Haogu summarized: “If the body feels slightly warm, with a red face and a weak pulse, it is all Yin syndrome. A slightly warm body indicates internal cold. If the practitioner does not observe the pulse and misinterprets the floating Yang as real heat, it can lead to serious illness. The Secret Essentials of External Medicine states: ‘When Yin is excessive, it causes restlessness, desiring to sit in a well, and should be treated with warming herbs.’ In the case of Zhang Zhongjing’s Shaoyin syndrome, a red face indicates that Four Reverse Decoction with Scallion White is the main treatment.
Zhang Jingyue pointed out: “There are two sources of deficient fire: one is that Yin deficiency can cause heat, as true Yin is depleted, and water cannot control fire. The second is that Yang deficiency can also cause heat, as the original Yang is depleted, and fire does not return to its source; these are the two origins of the disease.” He also classified the symptoms of Yang deficiency with floating fire: “One is when Yang is on top and manifests between the head, face, and throat; although it is hot above, it is cold below, which is called rootless fire; the second is when Yang floats outward and manifests as heat in the skin and muscles; although it is hot outside, it is truly cold inside, which is called the fire of counterflow Yang; the third is when it is trapped below and manifests between the two Yin of urination and defecation; although it is hot below, it is cold in the middle, which is called misplaced fire.” Zhang also proposed treatment principles and experiences for Yang deficiency with floating fire: “If treating Yang deficiency with fire, the treatment should be to nourish fire; the method of nourishing fire should only be warm and hot, strictly avoiding coolness. The effect of warming is quick; often after one or two doses, it can be effective… The treatment should warm and tonify blood and Qi, allowing the heat to subside naturally, and should use Yin Nourishing Decoction, Right Return Decoction, Regulating Middle Pill, Great Tonifying Yuan Decoction, Six Flavor Rehmannia Decoction, etc. This is called nourishing the source of fire, and it is also said that warmth can eliminate great heat.”
1. Classification of Yang Deficiency with Floating Fire
Clinically, it is generally divided into three types: Yang counterflow, Yang floating, and misplaced fire.
(1) Yang Counterflow
Yang counterflow refers to the floating Yang rising, with symptoms mainly in the head, face, and five sensory organs, such as sores in the mouth and tongue, toothache, throat obstruction and pain, headache and dizziness, thirst and dryness in the throat. As Zhang Jingyue said, “When Yang is on top and manifests between the head, face, and throat; although it is hot above, it is cold below, which is called rootless fire.”
(2) Yang Floating
Yang floating refers to the floating Yang outside, with symptoms mainly throughout the body, such as fever, rashes, red face, swelling, and sweating. This is “Yang floating outside and manifesting in the skin and muscles; although it is hot outside, it is truly cold inside, which is called the fire of counterflow Yang.” Clinically, it often presents as mixed cold and heat, but careful differentiation is still easy. For example, fever or subjective feeling of heat, desiring to cover with clothing, no burning sensation when touching the chest and abdomen; the complexion is floating red like makeup, not uniformly red; mental agitation and restlessness, fatigue and weakness; thirst but not wanting to drink or preferring warm drinks; throat pain but not red or swollen; pulse is floating and large or rapid, weak when pressed; constipation with soft stools, or diarrhea with clear liquid; clear and long urination or reduced urination with edema; pale tongue with white coating, etc.
(3) Misplaced Fire
Yang deficiency with floating fire can also be trapped below, manifesting as hot and painful urination or urgency, and constipation, which is called misplaced fire. As Zhang Jingyue said, “When trapped below and manifesting between the two Yin of urination and defecation; although it is hot below, it is cold in the middle, which is called misplaced fire.”
2. Key Differentiation Points
(1) Both knees are cold, while the upper body temperature is normal; the knees feel as cold as ice.
(2) The condition is violent and urgent, changing like lightning.
(3) Following the seasonal rhythm of Yin and Yang, the phenomenon of heaven and man responding is most evident, such as when Yang is born in winter, the disease occurs; in spring, Yang rises and turns heavy, in summer, Yin is born and gradually slows down, the disease worsens at noon and eases at sunset, and self-heals at night.
(4) The heat is roaring or there is heat in the soles of the feet or below the navel, attacking the head and face; if bitter cold is used directly, it can be dangerous.
(5) No thirst but frequent urination, thirst preferring warm drinks.
In addition to the above five points, some scholars believe that the pulse must be weak or empty or floating at the cun and chi positions, which is called rootless pulse; it is a manifestation of Yang not being stored or floating Yang; the pulse may be large or hollow, which is a sign of dispersion, and hollow means rootless; there may also be a thin pulse, which is also weak when pressed, indicating the common appearance of both Yin and Yang deficiency, often seen in superficial Yin deficiency, Yin deficiency and Yang.
3. Fire Not Returning to the Source Accompanied by “Qi Not Returning to the Source” and “Water Not Returning to the Source”
(1) “Qi Not Returning to the Source”
The clinical symptoms are: breath rising from below the navel, asthma with excessive sweating, and the internal response is moving clothing. The reverse sound rises from the Dan Tian. Symptoms include coughing due to reversed Qi, or the Qi rushing upward, making it difficult to lie down, etc. The pulse at both cun positions is floating and large, while the double chi positions feel as if there is none. Qi not returning to the source is often due to excess above and deficiency below, or complex critical conditions such as excess above and cold below. The differentiation is that the kidney belongs to water and the lung governs Qi; Qi is the mother of water. Kidney deficiency leads to the upward leakage of Zong Qi, resulting in cough and asthma. The treatment should not only focus on the lung but should also guide Qi back to the source, either by tonifying the water master or nourishing the fire source, promoting the balance of Yin and Yang.
(2) “Water Not Returning to the Source”
The clinical symptoms are: dizziness, collapse, phlegm rising and coughing without stopping, or swelling in the head, face, and limbs, fullness in the middle, and the six pulses are rapid and weak, or large and heavy with no response when pressed. The pathogenesis is due to the decline of the fire at the Mingmen, the spleen being cold and deficient, and Yang deficiency unable to control water, leading to the rampant water evil. The treatment should warm and tonify the spleen and kidney, and promote the transformation of water and dampness.
4. Symptoms of Yang Deficiency with Floating Fire
Yang deficiency with floating fire presents two sets of opposing symptoms:
(1) Kidney Yang deficiency, which is the essence of the disease: pale complexion, cold limbs, especially in the lower extremities, fatigue, weakness, male impotence, premature ejaculation, and cold semen; in females, it manifests as cold in the uterus leading to infertility, decreased libido, or symptoms such as loose stools, early morning diarrhea, frequent clear urination, and pale tongue with white coating, weak and thin pulse, especially in the wrist. If only these symptoms appear, the differentiation of Yang deficiency is not difficult.
(2) Deficient fire, which is a false appearance of the disease, as stated in the Complete Book of Jingyue: “When cold arises from within, Yang Qi has no place to attach and disperses outward, which is called deficient fire, or false heat.”
Clinically, there is a distinction between severity. In mild cases, floating Yang rises, and deficient fire surges, with symptoms mainly in the head, face, and five sensory organs, such as sores in the mouth and tongue, toothache, throat obstruction and pain, headache and dizziness, thirst and dryness in the throat; in severe cases, floating Yang surges outward, with symptoms mainly throughout the body, such as fever, rashes, red face, swelling, and sweating. Clinically, it often presents as mixed cold and heat, but careful differentiation is still easy. For example, fever or subjective feeling of heat, desiring to cover with clothing, no burning sensation when touching the chest and abdomen; the complexion is floating red like makeup, not uniformly red; mental agitation and restlessness, fatigue and weakness; thirst but not wanting to drink or preferring warm drinks; throat pain but not red or swollen; pulse is floating and large or rapid, weak when pressed; constipation with soft stools, or diarrhea with clear liquid; clear and long urination or reduced urination with edema; pale tongue with white coating, etc.
5. Mechanism of Yang Deficiency with Floating Fire
Kidney Yang plays a warming, stimulating, and promoting role in the body, being the root of all Yang Qi. When Kidney Yang is deficient, its storage function declines, and true Yang cannot be concealed in the kidney palace, floating outward. Additionally, Yang deficiency fails to warm, leading to excessive internal cold, forcing Yang to float outward, both of which can cause changes in the rejection of Yin and Yang. The rejected Yang Qi can float upward and outward, leading to symptoms of counterflow Yang and Yang counterflow, where the accumulation of Yang Qi can cause various heat manifestations, becoming a typical representation of floating fire. Zhang Jiebin pointed out, “Yang deficiency can also cause heat, as the original Yang is depleted, and fire does not return to its source.”
Its manifestations can take the following forms:
(1) Excessive cold in the lower jiao, where the deficient Yang Qi is rejected outward, presenting as internal cold and external heat. The symptoms include cold hands and feet, weak pulse, or clear diarrhea, but “the body does not feel cold” is a typical manifestation. This body heat is Yang floating outward and manifesting in the skin and muscles, which Zhang Jiebin calls “the fire of counterflow Yang.”
(2) Deficient Yang is rejected upward, floating in the head, face, and throat, presenting as cold below and heat above, with symptoms such as red cheeks, red face, throat pain, restlessness, and thirst. This is Yang on top and manifesting between the head, face, and throat, which Zhang Jiebin calls “rootless fire.”
(3) The kidney governs urination and defecation, and the Yang of the kidney has the function of vaporization and transformation. When Kidney Yang is deficient, the transformation fails, and the fluids do not circulate, leading to symptoms such as clear and long urination and loose stools. This is due to the Yang being displaced from its original position, which Zhang Jiebin calls “misplaced fire.”
Regardless of where the heat manifestations occur, they are fundamentally due to the deficiency of original Yang. However, Yang deficiency does not necessarily lead to the manifestation of floating Yang; this only occurs in cases of extreme internal cold and extreme deficiency of true Yang. This is a serious and critical condition, and if it further develops, it will lead to the separation of Yin and Yang. The degree of Yang deficiency ranges from mild to severe, divided into three stages: Yang deficiency with excessive cold, excessive Yin rejecting Yang, and Yang deficiency on the verge of collapse. The stage of Yang deficiency with excessive Yin presents a clear picture of deficiency and cold, which is easy to differentiate clinically; the stage of Yang deficiency on the verge of collapse is on the edge of the separation of essence and Qi, and the manifestations of weakness are also not difficult to distinguish; while the Yang deficiency with floating fire discussed in this article is the stage of excessive Yin rejecting Yang, including both floating Yang rising and floating Yang surging outward. Due to the confusing symptoms of mixed cold and heat, it is easy to be misdiagnosed.
Yang deficiency leads to excessive Yin, and Yang deficiency leads to cold. After Kidney Yang deficiency, the body’s internal cold evil naturally becomes excessive. As Yang deficiency worsens, the internal cold also becomes increasingly rampant, forcing Yang outward, leading to a mixed cold and heat situation where floating Yang is above and excessive Yin is below. When Kidney Yang is deficient and weak, warming and vaporization fail, leading to excessive internal cold, dampness, phlegm, and blood stasis forming. These pathological products manifest symptoms wherever they reside.
6. Treatment Principles for Yang Deficiency with Floating Fire
Deficient fire is different in nature from ordinary fire; “when it encounters moisture, it blazes, and when it meets water, it burns.” Therefore, in treatment, it should be “driven away by fire, and the flames will extinguish themselves, and the blaze will be put out.” The application of methods to nourish fire and guide fire is necessary, namely warming the kidney and strengthening Yang, so that the Yang Qi can absorb fire and return to the source, allowing true Yang to be concealed in the kidney palace; guiding fire back to the source allows the floating true fire to return to the kidney. As the Qing Dynasty scholar He Mengyao said: Yang deficiency with floating fire “is due to the heat above, directly probing its root below. Since the disease is rooted below, it cannot be treated by treating above… Treating fire deficiency with cold and coolness only assists the cold of the lower jiao, causing the fire to be further forced upward and float.” Cheng Guopeng pointed out: “When Yang is insufficient and fire is inflamed above, guiding fire back to the source is like leading the dragon back to the sea; this is the treatment for internal injury from deficient fire. Internal injury fire is deficient fire… When it encounters water, it blazes, so it is not advisable to directly suppress it… This deficient fire can be supplemented but not drained… Internal injury fire should be treated with supplementation rather than purging.” He also said: “When Kidney Qi is deficient and cold, forcing the rootless and lost fire to float above, it should be guided downward with warm herbs mixed with warming water herbs, leading it downward. This is called leading the dragon to the sea, guiding fire back to the source, as in Eight Flavor Decoction and similar formulas.”
The Medical Records of Traditional Chinese Medicine states: “In discussing throat conditions, if the true Yang is forced upward due to deficiency and cold in the lower jiao, leading to throat conditions, it should be treated with the method of guiding fire back to the source, which is indeed a wise saying.” It can be seen that warming and tonifying Kidney Yang and guiding fire back to the source is the correct method for treating this type of fire disease. Although guiding fire back to the source is the main approach, according to the principles of compatibility and the pathological products generated in the disease, it is also necessary to use Yin-nourishing herbs and diuretic herbs.
7. Prescriptions and Medications for Yang Deficiency with Floating Fire
For Kidney Yang deficiency with floating fire, the treatment is to warm the kidney and assist Yang, guiding fire back to the source, using Kidney Qi Pill with modifications. The Medical Formulas states: “Aconite and cinnamon are the main medicines for treating Kidney deficiency and cold, and also the wonderful method of guiding the dragon back to the sea.” Zhang Jingyue also said: “There are cold medicines that treat heat diseases but do not cure the heat; instead, they use ginseng, ginger, cinnamon, aconite, and Eight Flavor Pill and similar formulas to cure, which is the method of treating false heat with heat, also known as sweet warmth to eliminate great heat. Nowadays, there are many people with deficiency and few with excess, so true cold and false heat diseases are extremely common, while true heat and false cold diseases are rarely seen.” In the formula, the dosages of aconite and cinnamon are increased to warm the kidney and strengthen Yang, guiding fire back to the source. Aconite revives Yang and dispels Yin cold, circulating through the twelve meridians, its effect is rapid and intense, capable of restoring the lost and nearly extinguished original Yang, which ancient scholars called “rescuing the Yang within Yin.”
The Compendium of Materia Medica states: “Aconite revives Yang Qi, disperses Yin cold, expels cold phlegm, and is a powerful medicine for opening joints. For all diseases of true Yang deficiency and rising deficient fire, throat discomfort, and inability to eat, if treated with cold medicines, it will worsen; aconite is the main medicine for the Mingmen, capable of entering its cave and summoning it, guiding fire back to the source, thus extinguishing the floating fire.” Using cinnamon instead of cinnamon twig, because cinnamon has a gentle and rich effect, can supplement the insufficient true fire in the lower jiao of the kidney, effectively guiding the floating fire downward to the kidney to extinguish the rootless fire. Therefore, ancient scholars called it “rescuing the Yang within Yang,” as the Compendium of Materia Medica states: “Cinnamon disperses cold evils and benefits Qi, descends and supplements the kidney, and can guide fire back to the source to unblock its Qi.”
In summary, cinnamon and aconite are spicy, sweet, and hot, thick in Qi and descending to the kidney, strongly supplementing the true fire of the lower source, guiding the floating deficient fire downward to the kidney, allowing it to return to its residence, which is the essence of the disease; this is the principle of treating diseases by seeking the root. Dryland, mountain cornel, and yam nourish Yin and benefit essence, and the combination of Yang tonifying herbs with Yin nourishing products has two layers of meaning: Kidney Yang is constrained by Kidney Yin, which is called fire in water. Only with sufficient Kidney Yin can it restrain Kidney Yang, allowing this Yang to play a warming role in the lower jiao without floating outward. Simply using hot herbs like cinnamon and aconite to tonify Yang will harm Yin.
After tonifying Yang and harming Yin, without the restraint of Yin, it cannot settle in the lower jiao and will act recklessly. This not only fails to achieve the goal of tonifying Yang but also leads to further deficiency of Yin and Yang. One reason is that tonifying Yang consumes Yin fluids; overusing tonifying Yang herbs while lightly using Yin nourishing products is the key to restraining the hot and dry nature of tonifying Yang herbs; the second reason is that tonifying Yang must be accompanied by tonifying Yin to maintain the balance of the two. The compatibility of Fu Ling, Zea mays, and Dan Pi has two aspects of meaning:
One is to drain and eliminate water evils; when Kidney Yang is deficient and weak, it cannot transform Qi and eliminate water, so water and dampness accumulate internally, producing various water evils;
The second is to descend and unblock Yang, guiding various Yang herbs to break through the cold and directly enter the kidney palace, just as stated in the Medical Records of Traditional Chinese Medicine: “When Yang is floating upward, to guide it back to its residence, it cannot be collected and calmed without the force of descending and draining.” Therefore, using the light draining effect of Fu Ling to descend the Yang within Yin, the salty draining effect of Zea mays to descend the Yin within Yin, and the bitter cold effect of Dan Pi to guide dampness and drain heat, utilizing the descending force of the “three drains” allows the floating fire to reach below, returning to the kidney palace, and exerting its warming and generating physiological effects, achieving the physiological state of Yin balance and Yang secrecy.
In the nineteen pathogenesis points, due to heat and fire, patients account for a large proportion. However, fire has different types: real fire, deficient fire, Yang fire, and Yin fire. Real fire and Yang fire should be drained, and the method of draining fire is to use bitter cold to drain heat, which is the most common direct treatment and easy for many doctors to master. However, deficient fire and Yin fire cannot be effectively treated through direct draining methods; instead, they will exacerbate the fire evil. As Li Shizhen said: “All Yang fire, when encountering herbs, blazes; when encountering wood, it burns; it can be dampened or extinguished by water; all Yin fire does not burn herbs or wood but flows through metals and stones; when it encounters moisture, it blazes; when it encounters water, it blazes even more; if extinguished by water, the flames reach the sky, and the matter is exhausted; if driven away by fire or extinguished by ash, the burning nature extinguishes itself, and the flames self-extinguish.” It can be seen that the treatment methods for the two are completely different. Among them, the treatment methods for Yin fire and deficient fire are more difficult to grasp, requiring our attention. “Guiding fire downward” is one of the main methods for treating Yin fire and deficient fire. However, it is not only a major method for treating Yin fire and deficient fire but also an important method for treating Yang fire and real fire, so it requires us to master it proficiently.
Although the nature of fire is to rise, all parts of the body need the warmth of fire. Therefore, under physiological conditions, fire can circulate throughout the body along the meridians, reaching all parts under the control of the organs. However, under pathological conditions, when the fire element is excessive, it will not be restrained by the meridians and organs, and will act recklessly. The nature of fire is to rise, and when the fire evil moves recklessly, it is easy to cause diseases in the upper and outer parts, requiring fire expulsion treatment. In addition to directly using bitter cold to drain fire, Qi-moving methods can also be used, as “when Qi is abundant, it is fire”; Qi stagnation, Qi depression, Qi obstruction, and prolonged Qi stasis can all present heat manifestations. Moving Qi can disperse Qi, and dispersing Qi can expel fire, so moving Qi can also expel fire.
Summarizing methods can also be used, as the fire evil is dispersed, and the fire nature rises; collecting the fire back to its proper position, that is, returning it to its original place, prevents it from overflowing, so summarizing methods can also expel fire. Additionally, Qi-nourishing methods can also be used, as Qi is divided into Yin and Yang. Generally speaking, Qi deficiency may be due to Yang Qi deficiency; when Yang Qi is insufficient, Yin fire may rise. This type of Yin fire only needs to nourish Yang to coordinate with it. At this time, nourishing Yang is equivalent to nourishing Qi, especially using sweet warming methods can achieve satisfactory results. Sometimes, when both Yin and Yang are deficient in Qi, although Yang Qi deficiency is the main issue, there may also be Yin Qi deficiency. In addition to using sweet warming methods, it can also be assisted with sweet cooling methods for better results.
Guiding fire downward should include several methods beyond direct bitter cold fire-draining methods. Specifically, it has the following four aspects of meaning:
(1) Guiding fire downward method. That is, when there are fire manifestations in the head or upper body, the treatment should guide the fire downward to achieve the purpose of expelling fire. For example, if there is swelling and pain in the gums due to excessive stomach fire, the Neiting point on the foot Yangming meridian can be drained for treatment. Since the gums are located in the mouth area and Neiting is located on the toes, the swelling and pain in the gums belong to excessive stomach fire, and the Yangming stomach meridian circulates downward from above, so Neiting guides the Yangming meridian Qi to flow downward, hence it is called guiding fire downward. Once the Qi mechanism flows smoothly, the issues of Qi stagnation, Qi depression, Qi obstruction, and Qi stasis will be resolved, thus expelling the fire evil. This method is often used in acupuncture treatment. Another example is when “heart fire descends to the small intestine”; the treatment does not use direct fire-draining methods but uses Guide Red Powder to guide heart fire into urination and expel it from the body. Since the heart is above and the small intestine is below, urination is downward, it is also a method of guiding fire downward. At this time, the main targets of treatment are real fire and Yang fire.
(2) Connecting the heart and kidney method. Since the heart is the sovereign organ, heart fire is the source of dynamic activation, while the kidney stores essence, which is the foundation of dynamic activation. The heart is above, and the kidney is below; heart fire must be able to rise and fall to activate the source of life. Therefore, it is said that all fires rise, but only heart fire descends. If heart fire cannot descend, it will lead to manifestations of excessive heart fire—if below, kidney Qi cannot be developed, leading to fatigue and cold in the lower jiao; if above, due to heart fire disturbance, the spirit will be unsettled. This will lead to manifestations of mental fatigue, insomnia, and restlessness. At this time, the main treatment method is to connect the heart and kidney. The key to connecting the heart and kidney is to guide the heart fire that cannot descend smoothly downward. Therefore, it is also a method of guiding fire downward. Jiaotai Pill uses Huang Lian to clear the accumulated heart fire above and Cinnamon to warm the kidney essence below to guide heart fire downward. The dosage of Huang Lian can be adjusted according to the amount of heart fire, increasing if heart fire is too strong, and decreasing if it is weak.
Meanwhile, the dosage of cinnamon should match the patient’s response ability. For those sensitive to the medicine, the dosage should be relatively small; for those less sensitive, the dosage can be larger. As stated in the Gynecology of Fu Qingzhu: “For slightly warming products, measure by money; for strongly warming products, measure by fen; this is to guide fire, not to strengthen fire.” I remember a patient with a sore tongue who had been treated locally with heat-clearing and fire-draining medicines for a long time without effect. Later, he came to Beijing, and a doctor prescribed Jiaotai Pill with modifications. After the prescription, the patient felt the medicine was small and cheap and was hesitant to take it. After occasionally seeing me, he showed me the prescription, and I strongly advised him to take it. After five doses, he was cured. This disease is often thought by Western medicine to be caused by Candida albicans, and general anti-inflammatory drugs have no therapeutic effect. Traditional Chinese medicine believes it is due to rising deficient fire, so the method of guiding fire downward can cure it.
(3) Guiding fire back to the source method. Since the kidney stores essence and governs water, heart fire stimulates kidney Yang and activates kidney Yin to energize the whole body. If cold dampness (cold damp) is excessive, it will obstruct kidney Yang, preventing it from merging with kidney Yin and settling in the lower jiao, leading to floating Yang without a master, spreading everywhere, theoretically called Yin fire. This fire, when encountering water (due to increased cold damp obstruction), becomes vigorous; when encountering fire (which can reduce or eliminate cold damp obstruction), it extinguishes. Therefore, it is also called the fire of dragon thunder. For example, in clinical cases of hypertension, due to cold damp in the lower jiao, often the use of heavy stabilizing medicines is ineffective, and Western medicine’s antihypertensive drugs also show limited effects. However, using warming methods for the lower jiao, such as Aconite Decoction and Zhenwu Decoction, can significantly lower blood pressure. Some patients with insomnia treated with Kidney Qi Pill also use this method.
(4) Nourishing Qi and lowering fire method. This is often used by Li Dongyuan in treating Yin fire. It belongs to the method of promoting descent through elevation. Li Dongyuan believed that “original Qi and fire cannot coexist; one wins, the other loses.” When original Qi is insufficient or damaged, Yin fire will rise.
Similarly, when evil Yin is excessive, true Yin will be restrained. As stated in the Warm Disease Theory: “When evil water is strong by one part, true water is depleted by one part.” Therefore, there is a saying of tonifying true Yang to eliminate evil Yang (heat) and tonifying true Yin to eliminate evil Yin (cold damp). Li Dongyuan created the method of “sweet warmth to eliminate great heat,” which has been greatly beneficial. My teacher, Professor Wan Yousheng, has done considerable research on this. He treated a case of an elderly woman who was very representative: “The elderly woman said: ‘I have fire in my body; when I move, it becomes upward fire, my eyes, nose, and mouth emit fire, my throat hurts as if it is splitting, my teeth hurt, my hands and feet are hot, and I have had frequent bowel movements for many years, and I am extremely fatigued, with severe lower back pain, pale tongue, and weak pulse.’ The signs of Qi deficiency were very evident, and previous doctors had used many cold and cool medicines, which were ineffective. Therefore, I diagnosed it as a case of spleen deficiency with Yin fire. I prescribed Middle Tonifying Qi Decoction (with Dang Shen and American Ginseng, along with Sweet Licorice and Roasted Licorice), removing Angelica, adding Silver Chai Hu, Yam, Lotus Seed, Dendrobium, and Platycodon to protect spleen Yin and preserve lung Qi. After three doses, the throat pain was relieved, all fire symptoms disappeared, and energy increased. Continuing for a week, the long-standing chronic disease was cured.” In our clinical practice, we often use Middle Tonifying Qi Decoction to treat Qi deficiency colds or summer heat in children, with very good results. We can also replace Dang Shen with American Ginseng to achieve the effect of nourishing Qi and lowering fire.
In traditional Chinese medicine prescriptions, there is a saying of guiding herbs. In the method of “guiding fire downward,” guiding herbs are often used, which mainly refer to herbs that can guide fire from the upper body or external fire downward or inward. Commonly used herbs include Chuan Niu Xi, Cinnamon, and Du Zhong. Regarding Chuan Niu Xi, the Compendium of Materia Medica states: “It can run and supplement, and its nature is good for descending.” It can guide blood downward to reduce the fire of inflammation above. We often use it in treating hypertensive patients, whether Yin fire or Yang fire, but when treating Yin fire, the dosage is relatively light, and when treating Yang fire, the dosage is relatively large. Cinnamon has the effect of guiding fire with fire, as it ignites the fire of the lower jiao to expel cold dampness, replacing heaven (heart) to guide the kidney fire, thus guiding the external scattered fire downward to return to the kidney. In practice, the key is to control the dosage, which is generally small. Du Zhong mainly enters the liver meridian but does not elevate liver Qi; instead, it can lower liver Qi. Since the liver often has excess conditions, with excessive liver Qi being common, it is often used to guide fire downward in treating symptoms of excessive fire.
The Compendium of Materia Medica states: “Because its Qi does not rise, it instead guides downward… However, Du Zhong is a supplement for the liver and kidney, which can directly reach the lower parts of the muscles and bones, unlike Niu Xi, which reaches the lower parts through the meridians and blood. When using Du Zhong for hypertensive patients, it is essential to have manifestations of liver and kidney Yin deficiency and excessive liver fire for satisfactory results. The dosage is relatively large, generally 10-15g as a common dosage. Acupuncture points used in guiding fire downward are also numerous. Generally speaking, points selected at the distal ends of the limbs, such as Shixuan, Baixie, Shaoshang, Shangyang, Zhongchong, Yujie, Hegu, Baifeng, Neiting, Taichong, Xingjian, Qihai, Guanyuan, Shen Shu, etc., all have the effect of “guiding fire downward.” In clinical practice, any of these points can be added to the application points or prescriptions. The technique used for real fire and Yang fire is generally draining, while for deficient fire and Yin fire, it is generally tonifying.
“Guiding Water Downward”
Because the nature of water is to flow downward, it is common to say that there is no “guiding water downward” method. However, when water cannot flow downward and requires treatment, it is also common, so there is indeed a practical aspect of “guiding water downward.” Therefore, I refer to some clinical treatment methods as “guiding water downward” to express the ancient wisdom and confirm the modern understanding.
Because “water moistens and descends,” it indicates that water in the body can be divided into two types: one is true water, and the other is guest water. True water is born from the heavens; guest water is overflow from food and drink. Therefore, true water desires to rise, while guest water desires to descend. “Moistening and descending” also indicates that the flow of water in the body has two directions.
One is moistening, which means nourishing the body. Due to the need to nourish the body, water flows to all parts of the body, including the upper and outer parts, which is its characteristic. For example, the foot Shaoyin kidney meridian starts at the sole of the foot and flows upward while nourishing the entire body; this flow can be considered a form of upward movement.
The second is downward, which means flowing downward. Water flows to lower places as a natural phenomenon. The metabolism of water liquid in the body mainly involves the lungs, spleen, and kidneys. The lungs govern regulation, the spleen governs transportation, and the kidneys govern opening and closing, while the main passage for flow is the Sanjiao. In certain pathological conditions, water may accumulate in the body and fail to flow downward normally, leading to diseases such as edema, swelling, and abdominal distension. As Zhao Yuhuang said: “If lung Qi does not function, the high source is blocked, and the middle jiao does not transport, then the body will overflow; if the kidney does not have Yang, then ice will form inside, and water will ultimately not be able to flow on its own.” The so-called inability to flow on its own means it cannot flow according to its nature, leading to water rising to higher places or stagnating without moving, resulting in pathological water liquid stagnation and a series of diseases caused by water.
The “moistening” and “descending” of water are also interrelated and influence each other. For example, in the Warm Disease Theory, it states: “When it is in the middle jiao, water stops under the heart, obstructing heart Qi from descending, which causes it to rise and scorch the throat, and also obstructs the true liquid of the kidney from rising to the throat, leading to dryness and thirst… When it is in the lower jiao, water accumulates in the bladder, obstructing true water from nourishing upward… Now, when water accumulates in the lower jiao, the kidney meridian cannot be regulated, leading to thirst as well.” Water accumulation in the lower jiao and water obstruction in the bladder not only prevent turbid water from being expelled but also prevent clear water from nourishing upward, leading to dryness and thirst. This indicates that stagnation of guest water can lead to a series of diseases due to disordered water metabolism, and it will also affect the nourishing function of true water, leading to a series of diseases where the body is not nourished. Of course, conversely, if true water cannot nourish the meridians, organs, and limbs, it will also affect the ability to metabolize water liquid.
Guiding water downward includes the following four commonly used methods:
(1) Soothe and descend lung Qi. The lungs are the upper source of water; their dispersing and descending functions are closely related to Qi and water metabolism. The lungs are delicate organs that dislike dryness; the atmosphere must be in a misty state to nourish the organs. In the surface, it disperses, and in the lower part, it descends, regulating the water pathways to produce urination. If external evils invade, the lung Qi’s dispersing and descending functions will be obstructed, leading to water dampness accumulation. For example, in the early stages of wind water disease, Yuebi Decoction is used to target wind evil invasion, especially for initial facial swelling (especially facial swelling), which can not only disperse lung Qi but also regulate water pathways.
Yu Jiayan once said: “Yuebi Decoction is a subtle formula for unexpressed conditions; it generally aims to regulate Ying and Wei. When Ying and Wei are deficient, either cold or hot Qi can block their pathways, preventing them from communicating with the inside and outside; therefore, it is used for wind water on the surface, and for internal water with thirst and spontaneous urination, it must also be used.” Another example is in the analysis of Wupizhi in the Convenient Reading, Zhang Bingcheng explained that it treats water diseases with swelling and fullness, upper Qi obstruction, and urgent breathing, or swelling below the waist. This is also due to the lung’s failure to regulate, leading to water overflowing the skin, resulting in the above symptoms. Therefore, using Sang Pi to drain lung Qi, clearing lung Qi will allow water to descend naturally.
(2) Unblock the spleen and stomach. The spleen governs the transportation and transformation of water and dampness, with two pathways of operation:
○1 It transports water liquid upward to the lungs, that is, the ability to “return to the lungs”;
○2 When lung Qi descends and regulates water liquid, it passes through the spleen and stomach, and the spleen and stomach smoothly transport water liquid to the kidneys and bladder, which is the ability to “regulate water pathways.” As stated in the Plain Questions: Discussion on Meridians: “When drinking enters the stomach, it flows through the essence and Qi, returns to the spleen, and the spleen Qi disperses the essence, returning to the lungs, regulating the water pathways, and descending to the bladder, distributing water essence in four directions, with the five meridians operating together.” If the spleen and stomach’s transportation ability is limited, water dampness will accumulate. If the spleen and stomach are cold and deficient, the earth cannot control water, and water will recklessly flow to the skin surface, leading to symptoms such as heaviness and swelling. If the spleen and stomach are cold, the middle jiao will be cold and unable to transform water, leading to symptoms such as poor appetite, no thirst, and unformed bowel movements. In treatment, in addition to transforming dampness and phlegm, promoting water and guiding dampness is also an important method. For example, in the analysis of Shizhi Decoction in the Revised Medical Formulas, it states: “Using ginger, aconite, and grass fruit to warm the cold of the spleen and stomach, further assisting with Da Fu, Fu Ling, Hou Po, Mu Xiang, and Mu Guo to guide water and benefit Qi, as Qi is the mother of water, and earth is the defense of water. When Qi moves, water moves; when the earth is solid, water is treated, hence the name ‘solid spleen.'” The spleen is closely related to water dampness; strengthening the spleen and transporting dampness mainly has two aspects:
○1 Drying dampness and transforming dampness, which means dealing with damp evils on-site.
○2 Promoting dampness, which means guiding damp evils downward to the kidneys and bladder; this method falls within the scope of “guiding water downward.” As for using Da Fu for water accumulation, using Boat Pill is even more direct for promoting water.
Guiding fire back to the source is one of the unique treatment methods in traditional Chinese medicine, and when applied appropriately, it can significantly improve efficacy.
Guiding fire back to the source treats stubborn diseases.
Guiding fire back to the source is a method for treating rising kidney fire, also known as “floating kidney fire,” “floating Yang,” “Yang not contained,” “floating fire,” etc. It manifests as heat above and cold below, floating red complexion, dizziness, tinnitus, mouth and tongue ulcers, tooth pain, lower back pain, cold feet, tender red tongue, and weak pulse.
The treatment can involve adding cinnamon and aconite to kidney-nourishing herbs (such as cooked rehmannia, yam, cornel, and ligustrum) to guide the medicine downward, or using cinnamon, aconite, and schisandra with cooked rehmannia for treatment. Cinnamon and aconite guide the floating fire downward to return to the kidney; cooked rehmannia and schisandra nourish the kidney and contain the fire, preventing kidney fire from rising, thus alleviating symptoms of heat above and cold below.
Kidney fire is the fire of the Mingmen. The kidney stores original Yin and original Yang. Kidney Yin requires the warmth of the Mingmen fire, while the Mingmen requires the nourishment of kidney Yin. Some people liken the Mingmen fire to dragon fire, as the dragon lies in the water and should not float upward. This illustrates the relationship between Mingmen fire and kidney Yin. If kidney Yin is insufficient, it often leads to the floating of dragon fire (i.e., rising kidney fire), resulting in the aforementioned symptoms.
“Floating kidney fire” has both a Yin deficiency aspect and a Yang deficiency aspect. In treatment, if only nourishing is done without considering warming Yang or using large doses of warming Yang, or if only nourishing Yin is done without considering Yang, the floating kidney fire will become more intense. The ancients created the method of guiding fire back to the source, adding cinnamon and aconite to Yin-nourishing herbal formulas to guide fire downward, achieving a balance of Yin and Yang, preventing deficient fire from rising, and achieving better therapeutic effects. As Chen Zhongling said: “When Kidney Qi is deficient and cold, forcing the rootless and lost fire to float above, it should be guided downward with warm herbs mixed with water herbs, leading it downward, which is called guiding the dragon to the sea, guiding fire back to the source, as in Eight Flavor Decoction and similar formulas.”
Guiding fire back to the source method is widely applied in clinical practice and can treat the following diseases:
1. Neurogenic headache: (stubborn headache), recurrent paroxysmal headache, dizziness and pressure pain, especially in the temples, irritability, flushed face, dry mouth with no desire to drink, tongue and lip ulcers, cold limbs, cold feet, pale tongue, thin white coating, thin and wiry pulse, indicating deficiency of the lower source, Yin not containing Yang, Yang floating above, and deficient fire disturbing, treated with tonifying essence, warming the kidney, and guiding fire back to the source.
Prescription: He Shou Wu, Goji Berries, Tortoise Shell, Dragon Bone each 30g, Cinnamon 5g (added later), Xixin 4-5g, Wuyuan 6g, Chuanxiong, Artemisia each 10g, Licorice 6g, decoct in water for oral administration.
2. Diabetes insipidus: extreme thirst, excessive drinking, frequent urination with large volumes, flushed face and red lips, cold intolerance, red tongue without coating, weak and rapid pulse, indicating deficiency and cold in the lower source, floating Yang, treated with warming the kidney and tonifying deficiency, guiding fire back to the source.
Prescription: Prepared Aconite 10g (first decocted), Cinnamon Flower 3-6g, Yam 30g, Cooked Rehmannia 2g.