寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

Fire

Hwa

한글  ·  Pinyin Huo

火門

Fire is twofold — sovereign and minister 火有君相之二

五行, 各一其性, 惟火有二. 曰君火, 人火也. 曰相火, 天火也. 火內陰而外陽, 主乎動者也. 以名而言, 形質相生, 配於五行, 故謂之君. 以位而言, 生於虛無, 守位稟命, 因其動而可見, 故謂之相. 天主生物, 故恒於動, 人有此生, 亦恒於動, 其所以恒於動者, 皆相火之所爲也. 《東垣》 ○君火者, 乃眞心小腸之氣所爲也. 相火者, 乃心包絡三焦之氣所爲也. 《丹心》

Of the five phases, each has a single nature — fire alone has two. The one called sovereign fire is the fire of humankind; the one called minister fire is the fire of Heaven. Fire is Yin within and Yang without, and it governs movement. Spoken of by name — form and substance engendering one another, matched among the five phases — it is called the sovereign. Spoken of by position — born from empty nothingness, keeping its post and receiving its mandate, visible only through its movement — it is called the minister. Heaven governs the engendering of things and is therefore constant in movement; a human being, having this life, is likewise constant in movement — and that which keeps all in constant movement is, in every case, the work of the minister fire (Dongwon 東垣). — The sovereign fire is the doing of the Qi of the true heart and small intestine; the minister fire is the doing of the Qi of the pericardium and triple burner. (Dansim 丹心)
Clinical note The chapter opens with its founding asymmetry — four phases get one nature each, fire gets two: a named, visible sovereign and an unnamed, positional minister known only by what it moves. The second clause is the doctrine's boldest claim, that all of life's ceaseless motion is minister fire at work — physiology's engine and, as the next section warns, its arsonist, in one.

Dongwon 東垣 · Dansim 丹心

Fire is the thief of the origin Qi 火爲元氣之賊

火能消物. 凡爍金, 虧土, 旺木, 涸水者, 皆火也. 《丹心》 ○火之爲病, 其害甚大, 其變甚速, 其勢甚彰, 其死甚暴. 人身有二火. 曰君火, 猶人火也. 曰相火, 猶龍火也. 在氣交之中, 多動少靜, 凡動皆屬火化, 動之極也, 病則死矣. 《河間》 ○相火易起, 五性厥陽之火相扇, 則妄動矣. 火起於妄, 變化莫測, 無時不有, 煎熬眞陰, 陰虛則病, 陰絶則死. 《東垣》

Fire can consume things: whatever melts Metal, erodes Earth, makes Wood flourish, and dries Water — all of it is fire (Dansim 丹心). — As illness, fire's harm is very great, its changes very swift, its momentum very manifest, its deaths very sudden. The human body holds two fires: the sovereign, like the fire of humankind; the minister, like the fire of dragons. Amid the intercourse of Qi there is much movement and little stillness, and all movement belongs to fire's transformation — movement at its extreme is illness, and then death (Hagan 河間). — The minister fire rises easily: when the reverting-Yang fires of the five natures fan one another, it stirs recklessly. Fire risen from recklessness — its changes unfathomable, no hour without it — decocts and scorches the true Yin: Yin vacuous, one sickens; Yin severed, one dies. (Dongwon 東垣)
Clinical note Three masters, one escalating indictment — Danxi names fire's appetite (it eats the other four phases), Hejian names its criminal profile (great harm, swift change, sudden death — the dragon fire), and Dongyuan names the mechanism of ruin: reckless fire slowly boiling away the body's true Yin. That last image — 煎熬, to decoct and scorch, the same verb used for simmering herbs — is the chapter's thesis: pathological fire cooks you.

Dansim 丹心 · Hagan 河間 · Dongwon 東垣

又有藏府厥陽之火, 根於五志之內, 六慾七情激之, 其火隨起. 大怒則火起於肝, 醉飽則火起於胃, 房勞則火起於腎, 悲哀則火起於肺, 心爲君主, 自焚則死矣. 《河間》 ○火者, 元氣ㆍ穀氣ㆍ眞氣之賊也. 《東垣》

There are further the reverting-Yang fires of the viscera and bowels, rooted within the five minds: when the six desires and seven affects provoke them, fire rises accordingly. Great anger, and fire rises in the Liver; drunkenness and surfeit, and fire rises in the Stomach; bedroom taxation, and fire rises in the Kidney; grief and sorrow, and fire rises in the Lung. The Heart is lord and sovereign — should it burn of itself, one dies (Hagan 河間). — Fire is the thief of the origin Qi, the grain Qi, and the true Qi. (Dongwon 東垣)
Clinical note The chapter's most quoted paragraph — an emotional cartography of fire, each passion assigned its organ of ignition: rage to the liver, the feast to the stomach, the bedchamber to the kidney, grief to the lung. And at the center, the one fire with no treatment listed: the sovereign heart, which does not catch fire from elsewhere but self-immolates. Dongyuan's closing epigram gives the chapter its title and its politics — fire as the thief inside the treasury.

Hagan 河間 · Dongwon 東垣

Pulse signs 脉法

火脉, 洪數, 虛則浮. 《脉訣》 ○脉實數者, 有實熱. 《丹心》 ○脉浮而洪數爲虛火, 脉沈而實大爲實火. ○洪數見於左寸爲心火, 見於右寸爲肺火, 見於左關爲肝火, 見於右關爲脾火, 見於兩尺爲腎經命門之火. 男子兩尺洪大者, 必遺精, 陰火盛也. 《正傳》 ○骨蒸勞熱, 脉數而虛. 熱而澁小, 必損其軀, 加汗加咳, 非藥可治. 《脉訣》 ○虛火浮數, 實火沈大. 隨其所見, 細數爲害. 《回春》

The fire pulse is surging and rapid; in vacuity, it floats (Maekgyeol 脉訣). — A pulse replete and rapid: there is replete heat (Dansim 丹心). — Floating with surging rapidity is vacuous fire; sunken with replete largeness is replete fire. — Surging rapidity at the left inch is Heart fire; at the right inch, Lung fire; at the left bar, Liver fire; at the right bar, Spleen fire; at both cubits, the fire of the Kidney channel and the life gate. A man whose both cubits are surging and large will surely have seminal loss — Yin fire in exuberance (Jeongjeon 正傳). — In bone-steaming taxation heat the pulse is rapid and vacuous; heat with a rough small pulse must ruin the frame, and with sweating and cough added, no medicine can treat it (Maekgyeol 脉訣). — Vacuous fire floats and races; replete fire sinks and swells. Whatever the presentation, a fine rapid pulse bodes harm. (Hoechun 回春)
Clinical note The wrist as a fire map — six positions, six flames, with the chapter's central dichotomy already legible in a fingertip: vacuous fire floats to meet you, replete fire sinks and pushes back. The grim closing entries matter clinically: the fine rapid pulse of advanced consumption is the one presentation the pulse literature refuses to promise anything for.

Maekgyeol 脉訣 · Dansim 丹心 · Jeongjeon 正傳 · Hoechun 回春

Distinguishing the heat signs of the five viscera 辨五臟熱證

身熱有五, 而其狀各異. 《東垣》 ○肝熱者, 按之肌肉之下, 至骨之上, 乃肝之熱也, 寅卯間尤甚. 其證四肢滿悶, 便難, 轉筋, 多怒多驚, 筋痿不能起於床. 宜瀉靑丸 方見五藏ㆍ柴胡飮子. ○心熱者, 微按至皮膚之下, 肌肉之上, 輕手乃得, 是熱在血脉也, 日中太甚. 其證煩心心痛, 掌中熱而啘. 宜導赤散 方見五藏ㆍ黃連瀉心湯 方見神部. 《東垣》

Bodily heat is fivefold, and its forms each differ (Dongwon 東垣). — Liver heat: press to beneath the flesh, above the bone — that is the liver's heat, severest between the tiger and hare hours before dawn. Its signs: the four limbs full and oppressed, stool and urine difficult, cramping sinews, much anger and much fright, sinew wilting that cannot rise from bed. Sacheong-hwan — formula in the Five Viscera chapter — and Sihoeum-ja are appropriate. — Heart heat: press lightly to just beneath the skin, above the flesh — a light hand finds it, for this heat dwells in the blood vessels — severest at midday. Its signs: a vexed heart with heart pain, hot palms, and dry retching. Dojeok-san — formula in the Five Viscera chapter — and Hwangryeonsasim-tang — formula in the Spirit chapter — are appropriate.
Clinical note Dongyuan's touch-and-clock diagnostics begin — each organ's heat located by how deep the fingers must go and what hour the fever keeps. Liver heat lives at the bone's doorstep and rages before dawn; heart heat floats just under the skin and peaks with the sun at its height. A differential requiring no instrument but a hand and a watch.

Dongwon 東垣

脾熱者, 輕手捫之不熱, 重按至筋骨亦不熱, 不輕不重, 在輕手重手之間, 此熱在肌肉, 遇夜尤甚. 其證必怠惰嗜臥, 四肢無氣以動. 實熱則用瀉黃散 方見五藏ㆍ調胃承氣湯 方見寒門, 虛熱則用人參黃芪散ㆍ補中益氣湯 方見內傷. ○肺熱者, 輕手乃得, 微按全無, 瞥瞥然見於皮毛上, 日西尤甚, 乃皮毛之熱也. 其證必見喘咳, 洒淅寒熱. 輕者宜瀉白散 方見五藏ㆍ人參地骨皮散, 重者白虎湯 方見寒門ㆍ涼膈散. ○腎熱者, 輕按之不熱, 重按至骨, 其熱蒸手, 如火如灸. 其證骨蘇蘇然, 如蟲蝕其骨, 困熱不任, 亦不能起於床. 滋腎丸 方見小便ㆍYukmijihwang-hwan 六味地黃丸 主之. 《東垣》

Spleen heat: touched with a light hand it is not hot, pressed heavily to sinew and bone it is not hot either — neither light nor heavy, it lives between the light hand and the heavy: this heat dwells in the flesh, and worsens with night. Its signs: certain indolence and craving to lie down, the four limbs without Qi to move. For replete heat, Sahwang-san — formula in the Five Viscera chapter — and Jowiseunggi-tang — formula in the Cold chapter —; for vacuous heat, Insamhwanggi-san 人參黃芪散 and Bojungikgi-tang 補中益氣湯 — formula in the Internal Damage chapter —. — Lung heat: a light hand finds it, the slightest pressure loses it — glimpsed flickering upon the skin and hair, severest as the sun goes west: the heat of skin and hair. Its signs: certain panting and cough, with shivering chills and heat. For the light case, Sabaek-san — formula in the Five Viscera chapter — and Insamjigolpi-san; for the grave, Baekho-tang 白虎湯 — formula in the Cold chapter — and Yanggyeok-san. — Kidney heat: pressed lightly it is not hot; pressed heavily, to the bone, its heat steams the hand like fire, like moxa. Its signs: the bones faintly crawling, as if insects gnawed within them; weary heat past bearing, likewise unable to rise from bed. Jasin-hwan — formula in the Urine chapter — and Yukmijihwang-hwan 六味地黃丸 govern it. — Dongwon 東垣
Clinical note The table completes its five layers — spleen heat hiding in the middle depth where neither light nor heavy touch finds it, lung heat flickering on the very surface and vanishing under pressure, and kidney heat waiting at the bone, steaming the hand 'like fire, like moxa,' the bones crawling 'as if insects gnawed them.' Depth of touch maps to depth of organ, hour to its phase — the whole differential is a clock laid over an anatomy. Note the spleen entry's fork: even here, vacuous heat routes back to Bojungikgi-tang, the internal-damage doctrine reaching into the fire chapter.

Dongwon 東垣

Distinguishing the depth of heat by pressing with the hand 手按辨熱深淺

以手捫摸有三法. 輕手捫之則熱, 重按之則不熱, 是熱在皮毛血脉也. ○重按至筋骨之分, 則熱蒸手極甚, 輕摸之則不熱, 是熱在筋骨間也. ○輕手捫之不熱, 重手按之亦不熱, 不輕不重按之則熱, 是熱在筋骨之上, 皮毛血脉之下, 乃熱在肌肉也, 以三黃丸通治之. 《東垣》 ○輕手按之熱甚, 重手按之不甚熱, 此熱在肌表, 宜淸之. 重手按之熱甚而烙手, 輕手按之不覺熱, 此熱在肌肉之內, 宜發之. 《正傳》

Palpating with the hand has three methods. Touched lightly it is hot, pressed heavily it is not: this heat dwells in skin, hair, and blood vessels. — Pressed heavily to the division of sinew and bone, the heat steams the hand to an extreme, while a light touch finds nothing: this heat dwells between sinew and bone. — Not hot to the light hand, not hot to the heavy hand, but hot when pressed neither lightly nor heavily: this heat lies above sinew and bone, below skin and vessels — heat in the flesh, treated across the board with Samhwang-hwan (Dongwon 東垣). — Hot under the light hand and less so under the heavy, the heat is at the fleshy exterior: clear it. Hot under the heavy hand — searing the hand — and unfelt by the light, the heat is within the flesh: effuse it. (Jeongjeon 正傳)
Clinical note The five-organ clock-table distilled into a three-depth field method, and then into a treatment rule — the Jeongjeon's closing couplet is the payoff: surface heat is cleared downward, buried heat is effused outward. Which way the fire leaves the body is decided entirely by where the fingers find it.

Dongwon 東垣 · Jeongjeon 正傳

Locating the heat of the viscera and bowels by region 審臟腑熱之部分

內經曰, 心熱病者, 顔先赤 顔卽額也. 脾熱病者, 鼻先赤. 肝熱病者, 左頰先赤. 肺熱病者, 右頰先赤. 腎熱病者, 頤先赤. ○心肺居胸背, 心熱則胸熱, 肺熱則背熱. ○肝膽居脇, 肝膽熱則當脇亦熱. ○腎居腰, 腎熱則當腰亦熱. ○胃居臍上, 故胃熱則臍以上熱. 腸居臍下, 故腸熱則臍以下熱. 《綱目》

The Inner Classic says: in heart heat illness, the brow reddens first — 顔 here means the forehead —; in spleen heat illness, the nose reddens first; in liver heat illness, the left cheek first; in lung heat illness, the right cheek first; in kidney heat illness, the chin first. — Heart and lung dwell at chest and back: heart heat, and the chest is hot; lung heat, and the back. — Liver and gallbladder dwell at the flanks: their heat, and the flanks are hot. — The kidney dwells at the lumbus: its heat, and the lumbus. — The stomach dwells above the navel, hence stomach heat heats above the navel; the intestines dwell below it, hence intestinal heat heats below. (Gangmok 綱目)
Clinical note Two body maps in one section — the Inner Classic's face, where each organ files its heat report on an assigned fifth of the countenance before symptoms speak, and the Gangmok's torso, where heat simply shows up over the organ's home address. The face map in particular is working clinical furniture to this day: the flushed left cheek of the angry, the red nose of the overfed, the burning chin of the depleted.

Naegyeong 內經 · Gangmok 綱目

Fire and heat may be replete or vacuous 火熱有實有虛

能食而熱, 口舌乾燥, 大便難者, 實熱也. 以辛苦大寒之劑下之, 瀉熱補陰. 脉洪盛而有力者, 是已. ○不能食而熱, 自汗氣短者, 虛熱也. 以甘寒之劑, 瀉熱補氣. 脉虛弱無力者, 是已. 《東垣》 ○五藏, 陰也, 所主皆有形, 骨肉筋血皮毛, 是也. 此五藏皆陰足, 陰足而熱反勝之, 是爲實熱. 若骨痿肉爍, 筋緩血枯, 皮聚毛落, 是陰不足而熱病, 是爲虛熱. 《海藏》

Able to eat, yet hot — mouth and tongue parched, stool difficult: replete heat. Purge it with acrid, bitter, greatly cold preparations, draining the heat and supplementing the Yin; a pulse surging, exuberant, and forceful confirms it. — Unable to eat, yet hot — spontaneous sweat, short breath: vacuous heat. With sweet cold preparations, drain the heat and supplement the Qi; a pulse vacuous, weak, and forceless confirms it (Dongwon 東垣). — The five viscera are Yin, and what they govern all has form: bone, flesh, sinew, blood, skin, and hair. When the five viscera's Yin is ample and heat prevails against it nonetheless, that is replete heat. But when bones wilt and flesh melts, sinews slacken and blood dries, skin puckers and hair falls — Yin insufficient and heat sickening it — that is vacuous heat. (Haejang 海藏)
Clinical note The chapter's great fork, and the appetite question decides it — the same test that anchored the internal-damage table returns as fire's dividing line: the fever that eats is an invader to be purged; the fever that cannot eat is a deficit wearing heat's costume. Haizang restates it in tissue: replete heat attacks intact Yin, vacuous heat is what burning looks like when the fuel itself is running out.

Dongwon 東垣 · Haejang 海藏

實火, 內外皆熱, 口渴, 日夜潮熱, 大小便閉. 熱在表, 宜羌活冲和湯 方見寒門, 熱入裏, 宜調胃承氣湯 方見寒門, 燥渴者, 宜白虎湯 方見寒門. ○虛火, 潮熱有間, 口燥不渴, 宜人參地骨皮散, 或補中益氣湯, 加芍藥ㆍ黃柏. 《入門》 ○實火可瀉, 黃連解毒湯之類. 虛火可補, 參ㆍ朮ㆍ甘草(生)之類. 《丹心》

Replete fire: hot within and without, thirst, tidal heat day and night, stool and urine blocked. Heat at the exterior — Ganghwalchunghwa-tang — formula in the Cold chapter —; heat entered the interior — Jowiseunggi-tang — formula in the Cold chapter —; parched with thirst — Baekho-tang 白虎湯. — Vacuous fire: tidal heat with intervals, mouth dry without thirst — Insamjigolpi-san 人參地骨皮散, or Bojungikgi-tang 補中益氣湯 with peony and phellodendron added (Immun 入門). — Replete fire may be drained: the kind of Hwangryeonhaedok-tang 黃連解毒湯. Vacuous fire may be supplemented: the kind of ginseng, white atractylodes, and raw licorice. (Dansim 丹心)
Clinical note Danxi's closing couplet is the constitution of the entire fire chapter — every formula that follows is one clause or the other elaborated: drain the fire that is an enemy, feed the fire that is a famine. Even the details discriminate: replete thirst drinks; the vacuous mouth is dry but does not ask.

Immun 入門 · Dansim 丹心

Heat divides between day and night 熱有晝夜之分

晝熱則行陽二十五度, 宜柴胡飮子. 夜熱則行陰二十五度, 宜四順淸涼飮. ○平旦發熱, 熱在行陽之分, 肺氣主之, 故用白虎湯, 以瀉氣中之火. 日晡潮熱, 熱在行陰之分, 腎氣主之, 故用地骨皮散, 以瀉血中之火. 《海藏》 ○夜則靜, 晝發熱者, 熱在氣分, 小柴胡湯, 加梔子ㆍ黃連ㆍ知母ㆍ地骨皮. 晝則靜, 夜發熱者, 熱在血分, 四物湯, 加知母ㆍ黃柏ㆍ黃連ㆍ梔子ㆍ柴胡ㆍ牡丹皮. ○晝夜俱發熱者, 熱在氣血之分, 四物湯合小柴胡湯, 加黃連ㆍ梔子. 《回春》

Daytime heat travels the Yang's twenty-five circuits: Sihoeum-ja 柴胡飮子 is appropriate. Night heat travels the Yin's twenty-five: Sasuncheongryang-eum 四順淸涼飮. — Heat effusing at daybreak lies in the Yang's circuit, governed by Lung Qi — hence Baekho-tang 白虎湯, to drain the fire within the Qi. Tidal heat at late afternoon lies in the Yin's circuit, governed by Kidney Qi — hence Jigolpi-san, to drain the fire within the Blood (Haejang 海藏). — Quiet by night, heated by day: heat in the Qi aspect — Sosiho-tang 小柴胡湯 with gardenia, coptis, anemarrhena, and lycium bark added. Quiet by day, heated by night: heat in the Blood aspect — Samul-tang 四物湯 with anemarrhena, phellodendron, coptis, gardenia, bupleurum, and moutan added. — Heated day and night both: heat in Qi and Blood together — Samul-tang joined with Sosiho-tang, coptis and gardenia added. (Hoechun 回春)
Clinical note Fever read as a timetable — the defensive Qi's fifty daily circuits split the clock in half, and the hour of the flare names its address: day fevers live in the Qi and take bupleurum's family, night fevers live in the Blood and take the Four Substances, and the fever that never rests takes both houses joined. The tradition's most portable prescription rule: before asking what the fever is, ask when.

Haejang 海藏 · Hoechun 回春

Heat of the upper burner 上焦熱

上焦熱, 宜用凉膈散ㆍ龍腦飮子ㆍ抑靑丸ㆍ淸心蓮子飮ㆍ上淸元ㆍ淸金降火丹ㆍ子芩散ㆍ加減凉膈散. 《諸方》

For heat of the upper burner, appropriate are Yanggyeok-san 凉膈散, Yongnoeeum-ja 龍腦飮子, Eokcheong-hwan 抑靑丸, Cheongsimyeonja-eum 淸心蓮子飮, Sangcheong-won 上淸元, Cheonggeumganghwa-dan 淸金降火丹, Jageum-san 子芩散, and Gagamyanggyeok-san 加減凉膈散.
Clinical note The top floor's shelf — lozenges that dissolve on the tongue, a syrup nearly candy, and the boat-formula that floats to the diaphragm: every entry engineered for altitude. Four of eight now open; the rest will link as their pages arrive.

Various formularies 諸方

膈與六經, 乃至高之分. 此藥浮載, 亦至高之劑, 故能於無形之中, 隨高而走. 《易老》

The diaphragm and the six channels are the highest of stations; this drug, buoyantly laden, is likewise a preparation of the heights — able, within the formless, to race wherever is high.
Clinical note The Yeokro's navigation principle, excerpted from the boat-formula's commentary because it governs the whole floor — medicine matched to altitude, the highest heat requiring the most buoyant drug. The pharmacological imagination at its most spatial.

Yeokro 易老

Heat of the middle burner 中焦熱

中焦熱, 宜用調胃承氣湯 方見寒門ㆍ洗心散ㆍ四順淸涼飮ㆍ當歸龍薈丸 方見五藏ㆍ桃仁承氣湯 方見寒門ㆍ白朮除濕湯ㆍ旣濟淸神散. 《諸方》 ○旣濟淸神散, 治中焦熱, 淸上實下. 桔梗ㆍ黃芩ㆍ赤茯苓ㆍ川芎ㆍ梔子ㆍ當歸ㆍ羌活ㆍ白朮 各一錢, 知母ㆍ薄荷ㆍ甘草 各五分. 右剉, 作一貼, 煎水, 調蜜一匙服. 《奇效》

For heat of the middle burner, appropriate are Jowiseunggi-tang — formula in the Cold chapter —, Sesim-san 洗心散, Sasuncheongryang-eum 四順淸涼飮, Danggwiyonghoe-hwan — formula in the Five Viscera chapter —, Doinseunggi-tang — formula in the Cold chapter —, Baekchuljeseup-tang 白朮除濕湯, and Gijecheongsin-san 旣濟淸神散. — Gijecheongsin-san treats middle-burner heat, clearing above and securing below: platycodon, scutellaria, red poria, cnidium, gardenia, Korean angelica, notopterygium, and white atractylodes, 1 don each; anemarrhena, mint, and licorice, 0.5 don each — cut, made into one packet, decocted, and taken with a spoonful of honey stirred in (Gihyo 奇效).
Clinical note The middle floor's shelf runs from the Cold chapter's purgatives to Dongyuan's dehumidifier, closing with the aptly-named After-Completion Powder — 旣濟, the I Ching's hexagram of water over fire, order achieved: clear above, secure below. The Classic of Changes keeps turning up in this pharmacy's names, always as a therapeutic endpoint.

Various formularies 諸方 · Gihyo 奇效

Heat of the lower burner 下焦熱

下焦熱, 宜用大承氣湯 方見寒門ㆍ立效散ㆍ八正散 方見小便ㆍ五苓散 方見寒門ㆍ防風當歸飮子ㆍ黃柏丸ㆍ回金丸ㆍ佐金丸. 《諸方》 ○腎氣內虛, 邪熱流入於腎經, 尺脉洪大, 小便頻澁, 赤濁而痛, 宜以瞿麥ㆍ燈心煎湯, 調五苓散, 滲泄其熱, 則勿藥有喜. 《直指》

For heat of the lower burner, appropriate are Daeseunggi-tang — formula in the Cold chapter —, Iphyo-san 立效散, Paljeong-san — formula in the Urine chapter —, Oryeong-san 五苓散, Bangpungdanggwieum-ja 防風當歸飮子, Hwangbaek-hwan 黃柏丸, Hoegeum-hwan 回金丸, and Jwageum-hwan 佐金丸. — Where the Kidney Qi is inwardly vacuous and evil heat flows into the Kidney channel — the cubit pulse surging and large, the urine frequent, rough, red-turbid, and painful — decoct fringed pink and rush pith, stir Oryeong-san 五苓散 into the liquid, and percolate the heat away: then, without further medicine, there is cause for joy (Jikji 直指).
Clinical note The ground floor's shelf — purgatives and water-freers below, the five-phase pills standing duty, and the Jikji's lovely closing idiom for a treatment that suffices: 勿藥有喜, 'no more medicine, and there is joy' — the I Ching's own phrase for recovery, here meaning the heat has found the drain.

Various formularies 諸方 · Jikji 直指

Treating the fire of the triple burner across the board 通治三焦火

通治三焦火, 宜用三黃湯ㆍ三黃元ㆍ三補丸ㆍ加味金花丸ㆍ淸心丸ㆍ大金花丸ㆍ黃連解毒湯 方見寒門ㆍ防風通聖散 方見風門ㆍ淸火湯. 《諸方》 ○藏府積熱, 頰赤煩渴, 口舌生瘡, 五心煩躁, 便尿秘澁, 或溫壯連滯, 致生瘡癤癰疽. 五藏俱熱, 乃三焦熱也, 卽生癰癤瘡痍, 及五般痔疾. 《得效》 《宣明》

For treating the fire of the triple burner across the board, appropriate are Samhwang-tang 三黃湯, Samhwang-won 三黃元, Sambo-hwan 三補丸, Gamigeumhwa-hwan 加味金花丸, Cheongsim-hwan 淸心丸, Daegeumhwa-hwan 大金花丸, Hwangryeonhaedok-tang 黃連解毒湯 — formula in the Cold chapter —, Bangpungtongseong-san 防風通聖散 — formula in the Wind chapter —, and Cheonghwa-tang 淸火湯. — Where accumulated heat fills the viscera and bowels: cheeks red with vexing thirst, sores arising on mouth and tongue, the five hearts vexed and agitated, stool and urine blocked and rough — or warmth persisting and lingering until sores, boils, welling- and flat-abscesses arise. When all five viscera are hot, that is triple-burner heat — whence come abscesses, boils, sores, and the five kinds of hemorrhoids. (Deukhyo 得效 · Seonmyeong 宣明)
Clinical note The whole-building shelf — from the three-sibling standard to the nineteen-herb orchestra, seven of nine now open, anchored by the two great cross-chapter workhorses. The accumulated-heat paragraph is the shelf's rationale: when every floor is burning at once, heat stops being a symptom and becomes a manufacturer — of sores, abscesses, and the five hemorrhoids — and the treatment must be as systemic as the fire.

Various formularies 諸方 · Deukhyo 得效 · Seonmyeong 宣明

Rising Qi belongs to fire 上升之氣屬火

病人自言, 冷氣從下而上者, 非眞冷氣也. 此上升之氣, 自肝而出, 中挾相火, 自下而上, 其熱爲甚. 自覺其冷者, 此火極似水, 積熱之甚也. 陽亢陰微, 故見此證. 冷生氣者, 出於高陽生之謬言也. 《丹心》 ○凡氣有餘便是火, 不足者是氣虛. 《丹心》

When a patient says of themselves that cold Qi rises from below — it is not true cold Qi. This rising Qi issues from the Liver, carrying the minister fire within it as it climbs from below, and its heat is severe. That the person feels it as cold: this is fire at its extreme resembling water — accumulated heat at its worst. Yang hyperactive and Yin faint, hence this sign. 'Cold engenders Qi' comes of Gao Yangsheng's mistaken teaching (Dansim 丹心). — In all cases, Qi in surplus is simply fire; Qi insufficient is Qi vacuity. (Dansim 丹心)
Clinical note Danxi's most counterintuitive diagnostic — the cold draft patients feel climbing their body is fire wearing water's costume, 火極似水, an extreme so hot the sensorium reads it inverted. His closing epigram ('surplus Qi is simply fire') became one of the most-quoted sentences in the tradition: the bridge over which every stress symptom crosses into the fire chapter.

Dansim 丹心

氣從左邊起者, 肝火也. 氣從臍下起者, 陰火也. 氣從脚下起, 入腹如火者, 乃虛之極也. 盖火起于九泉之下, 十不救一. ○氣從左邊起, 宜回金丸ㆍ當歸龍薈丸 方見五藏. 氣從臍下起, 宜黃柏丸ㆍ坎离丸 方見下. 氣從脚下起, 宜用四物湯, 加黃柏ㆍ知母(幷鹽炒), 或滋陰降火湯, 外用附子末, 津調罯涌泉穴, 引下其熱. 《丹心》

Qi rising from the left side is Liver fire. Qi rising from below the navel is Yin fire. Qi rising from beneath the feet and entering the abdomen like fire is vacuity at its extreme — for when fire rises from beneath the Nine Springs, not one in ten is saved. — For Qi rising from the left: Hoegeum-hwan 回金丸 and Danggwiyonghoe-hwan — formula in the Five Viscera chapter —. From below the navel: Hwangbaek-hwan 黃柏丸 and Gamri-hwan — formula below —. From beneath the feet: Samul-tang 四物湯 with salt-fried phellodendron and anemarrhena added, or Jaeumganghwa-tang — and externally, aconite powder mixed with saliva and plastered on the Yongcheon point of the sole, to conduct the heat back down.
Clinical note The rising heat sorted by its port of departure — left flank, lower abdomen, or the soles themselves, each address naming a deeper fire, the deepest rising 'from beneath the Nine Springs,' the land of the dead. The sole-departure treatment is the entry's marvel: hot aconite pasted on the foot's bubbling spring, a decoy hearth lit downstairs to call the flame home — the classical ancestor of every warming-foot-bath a hot-flash patient has ever been prescribed.

Dansim 丹心

Aversion to heat and aversion to cold 惡熱惡寒

惡熱非熱, 明是虛證. 惡寒非寒, 明是熱證. 《丹心》 ○經曰, 陰虛則發熱. 夫陽在外, 爲陰之衛, 陰在內, 爲陽之守. 精神外馳, 嗜慾無節, 陰氣耗散, 陽無所附, 遂致浮散於肌表之間而惡熱, 當作陰虛治之. 《內經》 ○經曰, 惡寒戰慄, 皆屬於熱. 原病式曰, 病熱而反覺自冷, 實非寒也. 古人遇戰慄之證, 有以大承氣下燥糞而愈者, 明是熱證耳. 《內經》 ○陽虛惡寒, 四君子湯 方見氣門, 減茯苓, 倍加黃芪ㆍ桂枝, 或加附子少許. 陰虛惡寒發熱, 二陳湯合四物湯, 加知母ㆍ黃柏ㆍ地骨皮. 《入門》

Aversion to heat is not heat — plainly a vacuity sign. Aversion to cold is not cold — plainly a heat sign (Dansim 丹心). — The Classic says: Yin vacuous, heat effuses. Yang dwells without as Yin's guard; Yin dwells within as Yang's keeper. When essence-spirit gallops outward and craving knows no measure, the Yin Qi wears and scatters, the Yang has nothing to adhere to — and so it drifts loose between flesh and surface, and one hates the heat: treat it as Yin vacuity (Naegyeong 內經). — The Classic says: aversion to cold with shivering — all of it belongs to heat. The Origins of Illness explains: to be ill with heat yet feel oneself cold is in truth no cold at all; the ancients, meeting a shivering sign, sometimes purged dry stool with Great Order-the-Qi and cured it — plainly a heat sign (Naegyeong 內經). — Yang vacuity with aversion to cold: Sagunja-tang 四君子湯 minus the poria, astragalus and cinnamon twig doubled in, or a little aconite added. Yin vacuity with aversion to cold and heat effusion: Ijin-tang 二陳湯 joined with Samul-tang 四物湯, anemarrhena, phellodendron, and lycium bark added. (Immun 入門)
Clinical note The chapter's mirror-image doctrine, opened by Danxi's perfect chiasmus — what the body complains of is the opposite of what it has. The Inner Classic's mechanism for the heat-hater is one of its finest paragraphs of physiology: a life spent galloping outward wears the Yin thin, until the unmoored Yang drifts to the surface like heat with no address. Every flushed, sweating, heat-intolerant patient of a certain age is described in these four lines — and the treatment fork at the end is the clinic's daily bread.

Dansim 丹心 · Naegyeong 內經 · Immun 入門

一人脚自踝以下常覺熱, 冬不可加綿於上, 常誇稟質壯, 不怕冷. 予曰, 此足三陰之虛, 宜早斷慾事, 以補養陰血, 庶乎可免. 彼笑而不答, 年近五十, 患痿而死. 《丹心》 ○一婦人身冷惡寒, 六月重裘猶覺寒, 泄注不止, 脉如橫繩有力. 予以凉布熨心, 以新汲水淋之, 其人呼呌殺人, 猶不止, 連灌三四十桶, 大戰汗出, 昏困一二日, 而所苦皆除. 漢華佗, 北齊徐文伯, 亦治痼寒人, 候冬寒月, 以冷水發之, 此其法也. 《丹心》

A man felt constant heat from the ankles down — in winter he could not bear cotton over his feet, and always boasted his constitution robust, that he feared no cold. I said: this is vacuity of the foot's three Yin — cut off the affairs of desire early and supplement the Yin Blood, and you may perhaps be spared. He laughed and did not answer; near fifty, he sickened with wilting and died (Dansim 丹心). — A woman was cold of body with aversion to cold — in the sixth month, doubled furs and still she felt chilled — with pouring diarrhea unceasing, her pulse like a taut rope, forceful. I pressed cool cloths to her heart region and doused her with freshly drawn water; she screamed murder. I did not stop — thirty, forty buckets poured on — until a great shiver broke sweat, she lay dazed a day or two, and every suffering was gone. Hua Tuo of Han and Xu Wenbo of Northern Qi likewise treated the entrenched-cold by waiting for winter's coldest month and effusing them with cold water: this is that method. (Dansim 丹心)
Clinical note Two case histories, one for each face of the paradox — the man whose warm feet flattered him while his Yin drained (Danxi's coldest line in the literature: 'he laughed and did not answer'), and the fur-wrapped woman in midsummer whose 'cold' was heat locked in, broken loose by forty buckets of well water and a sweat. The second case names its lineage back to Hua Tuo: shock hydrotherapy as the ancient art of calling fire's bluff.

Dansim 丹心

Yin vacuity with fire stirring 陰虛火動

潮熱, 盜汗, 咳嗽痰盛, 咯唾血, 氣力困怠, 形容消瘦, 腰痛脚痿, 遺精夢泄, 皆陰虛火動之證也. 《入門》 ○陰虛火動, 宜滋陰降火湯ㆍ淸离滋坎湯, 後服滋陰淸化膏 方見咳嗽ㆍ六味地黃丸 方見虛勞. 愈後, 用坎离旣濟丸, 乃收功保後之藥也. 《回春》 ○四物湯, 加知母ㆍ黃柏(幷鹽水炒), 是降火補陰之妙劑, 甚者加龜板. 《丹心》

Tidal heat, night sweats, cough with copious phlegm, expectorated and spat blood, strength weary and slack, form and features wasting, lumbar pain with wilting legs, seminal loss and dream emission — all are signs of Yin vacuity with fire stirring (Immun 入門). — For Yin vacuity with fire stirring: Jaeumganghwa-tang 滋陰降火湯 and Cheongrijagam-tang 淸离滋坎湯; afterward take Jaeumcheonghwa-go — formula in the Cough chapter — and Yukmijihwang-hwan 六味地黃丸 — formula in the Vacuity Taxation chapter —. And once cured, use Gamrigije-hwan — the medicine that gathers in the achievement and guards what follows (Hoechun 回春). — Samul-tang 四物湯 with anemarrhena and phellodendron, both salt-water-fried, added, is the wondrous preparation for downing fire and supplementing Yin; in the severe, add turtle plastron. (Dansim 丹心)
Clinical note The section every menopause clinic still runs on — the symptom register (the flush that keeps hours, the soaked sheets, the wasting strength) followed by a genuinely staged protocol: decoctions for the acute campaign, paste and pills for consolidation, and a named formula whose entire job is 'gathering the achievement and guarding what follows.' Acute, recovery, maintenance — three phases of care, prescribed in 1613. Danxi's closing line adds the portable version: Four Substances plus the salt-fried cold pair, turtle shell when it's grave.

Immun 入門 · Hoechun 回春 · Dansim 丹心

陰虛火動, 宜滋陰降火湯ㆍ淸离滋坎湯ㆍ淸肺滋陰散ㆍ陰虛生內熱湯ㆍ補陰瀉火湯ㆍ補陰丸ㆍ六味地黃丸ㆍ坎离膏ㆍ先坎离丸ㆍ後坎离丸ㆍ坎离旣濟丸. 《諸方》

For Yin vacuity with fire stirring, appropriate are Jaeumganghwa-tang 滋陰降火湯, Cheongrijagam-tang 淸离滋坎湯, Cheongpyejaeum-san 淸肺滋陰散, Eumheosaengnaeyeol-tang 陰虛生內熱湯, Boeumsahwa-tang 補陰瀉火湯, Boeum-hwan 補陰丸, Yukmijihwang-hwan 六味地黃丸, Gamri-go 坎离膏, Seongamri-hwan 先坎离丸, Hugamri-hwan 後坎离丸, and Gamrigije-hwan 坎离旣濟丸. 《諸方》
Clinical note The vacuous-fire cabinet in full — seven doors now open, with the four Kan-Li preparations (Before, After, and Complete — the water-fire hexagrams conjugated like a verb) still to come. No shelf in the book is more directly continuous with a modern practice's daily work.

Various formularies 諸方

陰虛證, 本難治. 用四物湯, 加炒黃柏, 降火補陰. 兼氣虛, 加人參ㆍ黃芪ㆍ白朮, 此爲氣血兩虛也. 《丹心》

The Yin vacuity pattern is, at root, hard to treat. Use Samul-tang with dry-fried phellodendron added, to down the fire and supplement the Yin. Where Qi vacuity joins it, add ginseng, astragalus, and white atractylodes — for this is Qi and Blood both vacuous.
Clinical note Danxi's honest coda — 本難治, hard to treat at the root — the tradition admitting that its most elegant doctrine faces its most stubborn illness. The compound instruction that follows is the working reality: when the depletion runs on both ledgers, the Yin formula must carry the Qi tonics too.

Dansim 丹心

Yin vacuity with fire stirring is hard to treat 陰虛火動者難治

近世陰虛火動之疾, 十無一活, 何也. 盖其始也, 飮食如舊, 起居如常, 惟痰嗽一二聲, 自謂無恙, 諱疾忌醫, 滅身無悟. 及蔓延日久, 倒臥於床, 而堅氷已至, 不可復救. 余意揆之, 方疾之始, 必致謹於三事而後可. 三者維何. 一要遇明醫, 二要肯服藥, 三要守禁戒. 三者缺一, 不可治也. 《醫鑑》

In recent times, of those ill with Yin vacuity and stirring fire, not one in ten survives. Why? Because at its beginning, eating and drinking are as before, rising and resting as usual, and there is only a phlegmy cough — one or two sounds of it. The person calls themselves unharmed, hides the illness and shuns the physician, and destroys themselves without ever waking to it. By the time it has spread over long days and they lie fallen on the bed, the solid ice has already arrived, and there is no more saving them. Weighing it in my own mind: at the very beginning of the illness, one must be careful in three matters, and only then is there hope. Which three? First, to meet an enlightened physician. Second, to be willing to take the medicine. Third, to keep the prohibitions. Lacking any one of the three, it cannot be treated.
Clinical note The chapter's most quietly devastating page — a whole prognosis pinned on the first cough being dismissed. 'The solid ice has already arrived' borrows the Book of Changes' image of frost underfoot warning of the winter to come. And the three conditions are as true in a Koreatown clinic as in 1613: the right clinician, actual compliance, and the discipline to keep the restrictions — miss one, and the other two cannot carry it.

Uigam 醫鑑

There is a method for controlling fire 制火有方

儒者立敎, 曰正心, 收心, 養心, 皆所以防此火之動於妄也. 醫者立敎, 曰恬澹虛無, 精神內守, 亦所以遏此火之動於妄也. 《丹溪》 ○火不妄動, 動由於心. 靜之一字, 其心中之水乎. 《入門》 ○神靜則心火自降, 慾斷則腎水自升. 《入門》

When the Confucians set forth their teaching — rectify the mind, gather the mind, nourish the mind — all of it was to prevent this fire from stirring recklessly. When the physicians set forth theirs — be tranquil, plain, empty of striving, keep the essence-spirit within — that too was to check this fire's reckless stirring (Danxi 丹溪). — Fire does not stir of itself; its stirring comes from the mind. That single word, stillness — is it not the water within the heart? (Immun 入門) — When the spirit is still, the Heart fire descends of itself; when craving is cut off, the Kidney water ascends of itself. (Immun 入門)
Clinical note The chapter's philosophical summit, where the Confucian and the medical traditions are shown teaching one thing in two vocabularies. The Immun's line is among the loveliest in the book — stillness itself proposed as the water in the heart, the missing coolant that no pharmacy stocks. And the closing couplet states the whole Kan-Li project without a single herb: still the spirit and the fire falls, cut the craving and the water rises.

Danxi 丹溪 · Immun 入門

There is a method for retreating heat 退熱有法

退熱之法, 全在淸心, 必用麥門冬ㆍ燈心草ㆍ白朮ㆍ茯苓. 盖心者, 一身之主宰, 而萬事之本根, 萬令從心. 心不淸則妄動而熱不退. 然熱能傷血, 血滯則氣鬱, 而熱愈不退. 退熱之法, 又在調血, 法用川芎ㆍ當歸. 若夫陽浮於外, 則當斂以降之, 法用參苓白朮散 方見內傷, 薑ㆍ棗煎服. 《丹心》 ○凡熱皆出於心, 心血不可不淸, 麥門冬不可缺也, 以燈心草爲引子. 《丹心》

The method of retreating heat lies wholly in clearing the Heart: ophiopogon, rush pith, white atractylodes, and poria must be used. For the Heart is the ruler of the whole body and the root of the ten thousand affairs — every command follows the Heart. If the Heart is not clear, it stirs recklessly and the heat does not retreat. Yet heat can damage the Blood, and Blood stagnant makes the Qi depress, so that the heat retreats still less. The method of retreating heat therefore lies also in regulating the Blood: use cnidium and Korean angelica. And where the Yang floats to the outside, one should gather it in to bring it down: use Samryeongbaekchul-san 參苓白朮散 — formula in the Internal Damage chapter —, decocted with ginger and jujube (Dansim 丹心). — All heat issues from the Heart; the Heart Blood cannot go unclear, and ophiopogon cannot be lacking — with rush pith as the conductor. (Dansim 丹心)
Clinical note Danxi's practical close to the doctrine — four herbs named as the standing base for any fever, the Heart identified as the seat from which every heat issues, and a second front opened on the Blood, since heat that thickens the blood locks itself in. The floating-Yang clause sends the reader back to the Internal Damage chapter: even here, at the end of the fire chapter, the answer to heat that has drifted loose is to feed the center and let it settle.

Dansim 丹心

Steaming-bone heat 骨蒸熱

蒸病有五. 一曰骨蒸, 其根在腎. 二曰脉蒸, 其根在心. 三曰皮蒸, 其根在肺. 四曰外蒸, 其根在脾. 五曰內蒸, 其根在五藏六府. 蒸病皆因陰氣不足, 血氣不榮, 骨髓枯竭而得之. 腎主骨, 以其先從骨熱, 故曰骨蒸. 《類聚》 ○凡人嗜慾無節, 勞傷過度, 眞水枯竭, 陰火上炎, 而發蒸蒸之燥熱, 古方名曰蒸病. 其證咳嗽發熱, 咯血吐痰, 白濁白淫, 遺精盜汗, 精神恍惚, 日漸尫羸, 漸成勞劇. 《正傳》

Steaming illness is of five kinds. First, bone steaming, whose root is in the Kidney. Second, vessel steaming, whose root is in the Heart. Third, skin steaming, whose root is in the Lung. Fourth, outer steaming, whose root is in the Spleen. Fifth, inner steaming, whose root is in the five viscera and six bowels. All steaming illnesses arise because the Yin Qi is insufficient, the Blood and Qi do not flourish, and the bone marrow has dried and been exhausted. The Kidney governs the bones, and because the heat comes first from the bones, it is called bone steaming (Yuchwi 類聚). — Where craving knows no measure and taxation damage passes all bounds, the true water dries and is exhausted, the Yin fire flames upward, and there breaks out a steaming, steaming dryness heat: the old formularies named it steaming illness. Its signs are cough with heat effusion, blood expectorated and phlegm spat, white turbidity and white seepage, seminal loss and night sweats, spirit abstracted and clouded, the body daily more wasted and frail — gradually becoming grave consumption. (Jeongjeon 正傳)
Clinical note The tradition's name for the fever of chronic wasting — heat that seems to rise from inside the bones, as from a steamer. The five-fold classification assigns each depth its organ, and the etiology is unflinching: marrow dried out, the true water spent, a fire with nothing left to check it. This is where the Fire chapter and the Vacuity Taxation chapter meet and share a patient.

Yuchwi 類聚 · Jeongjeon 正傳

肺蒸, 鼻乾. 大腸蒸, 右鼻孔痛. 皮蒸, 舌白唾血. 《綱目》

In lung steaming, the nose is dry. In large-intestine steaming, the right nostril is painful. In skin steaming, the tongue is white and the spittle bloody.
Clinical note A fragment of the great steaming table, where every viscus and bowel is given its own tell — the right nostril alone reporting for the large intestine. Whatever one makes of the correspondences, the ambition is remarkable: a fever mapped to twenty-odd distinct sites, each with a sign a patient could actually notice.

Gangmok 綱目

Heat of the five hearts 五心熱

五心煩熱者, 是火鬱於地中也. 四肢者, 脾土也. 心火下陷於脾土之中, 鬱而不得伸故也. 火鬱則發之, 是也. 《東垣》 ○凡男女四肢熱, 肌熱, 筋熱, 骨髓中熱如燎, 捫之烙手, 此熱伏土中, 由血虛而得, 或過食冷物, 抑遏陽氣於脾土之中. 火鬱則發之, 宜升陽散火湯ㆍ火鬱湯. 《東垣》 ○虛損, 手心脚心發熱不可當, 宜加減小柴胡湯. 《醫鑑》 ○五心之熱, 小兒傷食證也, 大人亦然. 《資生》

Vexing heat of the five hearts is fire constrained within the Earth. The four limbs are Spleen Earth: the Heart fire has fallen down into the midst of Spleen Earth, where it is constrained and cannot stretch out. 'When fire is constrained, effuse it' — this is that case (Dongwon 東垣). — Where a man or woman has heat in the four limbs, heat of the flesh, heat of the sinews, heat in the bone marrow as if scorched — searing the hand that touches it — this is heat lying hidden within the Earth, arising from Blood vacuity, or from eating too much cold food, which presses the Yang Qi down into Spleen Earth. When fire is constrained, effuse it: Seungyangsanhwa-tang 升陽散火湯 and Hwaul-tang 火鬱湯 are appropriate (Dongwon 東垣). — In vacuity detriment, with heat effusing in palms and soles past all bearing: Gagamsosiho-tang 加減小柴胡湯 (Uigam 醫鑑). — The heat of the five hearts is, in children, a sign of food damage; and so it is in adults too. (Jasaeng 資生)
Clinical note Burning palms and soles, explained by geology — heat fallen into the Earth of the spleen and trapped there, which is why cold medicine can make it worse and lifting herbs make it better. The last line is the section's quiet ambush: in a child, burning hands means they ate too much. The Jasaeng adds, and in adults too — sending the reader straight back to the Internal Damage chapter.

Dongwon 東垣 · Uigam 醫鑑 · Jasaeng 資生

Tidal heat 潮熱

潮熱者, 有時而熱, 不失其時. 寒熱者, 寒已而熱相繼而發. 至於發熱, 則無時而熱也. 《醫鑑》 ○潮熱有時, 爲內傷, 爲虛. 潮熱無時, 爲外感, 爲實. 《入門》 ○平朝潮熱者, 熱在行陽之分, 肺氣主之, 故用白虎湯 方見寒門, 以瀉氣中之火. 日晡潮熱者, 熱在行陰之分, 腎氣主之, 故用地骨皮飮 卽上人參地骨皮散也, 以瀉血中之火. 《正傳》

Tidal heat is heat that comes at its hour and does not miss its hour. Alternating cold and heat is when the cold ends and the heat follows upon it in succession. As for plain heat effusion, that is heat without any hour at all (Uigam 醫鑑). — Tidal heat that keeps an hour is internal damage, and is vacuity; tidal heat that keeps no hour is external contraction, and is repletion (Immun 入門). — Tidal heat at daybreak: the heat lies in the Yang's circuit, governed by Lung Qi — hence Baekho-tang 白虎湯 — formula in the Cold chapter —, to drain the fire within the Qi. Tidal heat at late afternoon: the heat lies in the Yin's circuit, governed by Kidney Qi — hence the Lycium Bark Drink — that is, Insamjigolpi-san above —, to drain the fire within the Blood. (Jeongjeon 正傳)
Clinical note Fever sorted by punctuality — the tide that keeps its hour is depletion's fever and belongs to this chapter; the one that keeps no hour is an invasion and belongs to the Cold chapter. One question at intake ('does it come at the same time?') routes the entire case.

Uigam 醫鑑 · Immun 入門 · Jeongjeon 正傳

潮熱, 宜人參淸肌散 方見上. 血虛有汗潮熱, 宜人參養榮湯 方見虛勞. 血虛無汗潮熱, 宜茯苓補心湯 方見血門. 氣血兩虛無汗潮熱, 宜茯苓補心湯. 氣血兩虛有汗潮熱, 宜加減逍遙散. 血虛夜分潮熱, 宜四物二連湯. ○參蘇飮 方見寒門, 大解潮熱, 將欲成勞, 痰咳喘熱最效. 《醫鑑》

For tidal heat, Insamcheonggi-san — formula above —. Blood vacuity with sweating and tidal heat: Insamyangyeong-tang — formula in the Vacuity Taxation chapter —. Blood vacuity without sweating: Bokryeongbosim-tang — formula in the Blood chapter —. Qi and Blood both vacuous without sweating: Bokryeongbosim-tang. Qi and Blood both vacuous with sweating: Gagamsoyo-san 加減逍遙散. Blood vacuity with tidal heat at the night watches: Samulyiryeon-tang 四物二連湯. — Samso-eum — formula in the Cold chapter — greatly resolves tidal heat, and where consumption is about to form, is most effective for phlegm cough with panting heat. (Uigam 醫鑑)
Clinical note A decision table of unusual precision — the same tidal fever sorted by two variables, sweating and which ledger is empty, yielding a different formula for each cell. Sweat present or absent turns out to matter more than the fever's height: the body that can still sweat is treated as one that can still spend.

Uigam 醫鑑

Accumulated heat 積熱

積熱, 宜三黃元ㆍ三黃湯ㆍ凉膈散ㆍ紫雪ㆍ紅雪通中散ㆍ防風通聖散 方見風門. ○紫雪, 治一切積熱, 口舌生瘡, 狂易呌走, 內外煩熱不解, 及野道熱毒. 黃金 十兩, 寒水石ㆍ石膏 各四兩八錢, 玄參 一兩六錢, 犀角ㆍ羚羊角 各一兩, 甘草 八錢, 升麻 六錢, 沈香ㆍ木香ㆍ丁香 各五錢. 以水五升, 先煮黃金及二石至三升, 入諸藥再煎至一升, 去滓, 入芒硝三兩二錢, 慢火煎, 以柳枝不住手攪, 候欲凝, 入磁盆中, 更下朱砂ㆍ麝香末 各三錢, 急攪不住, 候冷, 凝成紫雪. 每取一錢, 細細嚥之, 或以井水調下一錢. 《入門》

For accumulated heat: Samhwang-won 三黃元, Samhwang-tang 三黃湯, Yanggyeok-san 凉膈散, Jaseol 紫雪, Hongseoltongjung-san 紅雪通中散, and Bangpungtongseong-san 防風通聖散 — formula in the Wind chapter —. — Jaseol treats every kind of accumulated heat: sores on mouth and tongue, mania with shouting and running, vexing heat within and without that will not resolve, and the heat toxins of the wild roads. Gold 10 nyang; glauberite and gypsum, 4 nyang 8 don each; scrophularia 1 nyang 6 don; rhinoceros horn and antelope horn, 1 nyang each; licorice 8 don; cimicifuga 6 don; aquilaria, aucklandia, and clove, 5 don each. In five doe of water, first boil the gold and the two stones down to three doe; add the remaining medicinals and decoct again to one doe; strain, add 3 nyang 2 don of mirabilite, and simmer over a slow fire, stirring without pause with a willow branch. When it is about to set, pour it into a porcelain basin, add 3 don each of powdered cinnabar and musk, stir hard without stopping, and let it cool until it congeals into purple snow. Take 1 don at a time, swallowed little by little, or 1 don stirred into well water (Immun 入門). Note on modern practice: rhinoceros and antelope horn are prohibited under CITES and are not used; cinnabar and musk are likewise restricted — the formula is recorded here for textual and historical fidelity only.
Clinical note Accumulated heat is heat that has moved in — built over seasons rather than caught in a day — and the shelf answers accordingly, from a three-herb pill to Purple Snow itself: gold and two stones boiled down, stirred with a willow branch until it congeals in a porcelain basin. The recipe is a court pharmacy's showpiece, and belongs to a world whose materia medica we no longer share; it is preserved here as text, not as prescription.

Various formularies 諸方 · Immun 入門

Heat effusion from drinking wine 飮酒發熱

飮酒發熱, 黃連解毒湯, 加葛根主之 方見寒門. 《仲景》 ○因酒發熱, 用靑黛ㆍ瓜蔞仁爲末, 入薑汁, 每日服數匙, 三日而安. 《丹心》 ○酒熱內鬱而惡寒者, 黃芪 一兩, 葛根 五錢, 水煎服, 大汗而愈. 《入門》 ○凡發熱人, 極忌飮酒. 《入門》 ○飮酒人發熱者難治, 不飮酒人因酒發熱者, 亦難治. 《丹心》

For heat effusion from drinking wine, Hwangryeonhaedok-tang 黃連解毒湯 with kudzu root added governs it — formula in the Cold chapter — (Junggyeong 仲景). — For heat effusing on account of wine: natural indigo and trichosanthes seed powdered and stirred into ginger juice, several spoonfuls daily — settled by the third day (Dansim 丹心). — Where wine heat is depressed within and one has aversion to cold: astragalus 1 nyang and kudzu root 5 don, decocted in water — a great sweat, and it is cured (Immun 入門). — Anyone with heat effusion must strictly avoid wine (Immun 入門). — A drinker who effuses heat is hard to treat; and one who does not drink, effusing heat on account of wine, is likewise hard to treat. (Dansim 丹心)
Clinical note A short section with a long shadow — the fire chapter's overlap with the wine chapter next door, and Danxi's closing line the sort of clinical aphorism that only comes from having tried: hard to treat if they drink, hard to treat if they don't. The 'depressed within with aversion to cold' entry is the practical gem: astragalus and kudzu, one great sweat, and the trapped heat leaves the way it came in.

Junggyeong 仲景 · Dansim 丹心 · Immun 入門

Heat effusion from stagnant Blood 滯血發熱

其人脉澁, 必有漱水之證, 必有嘔惡痰涎之證, 必有兩脚厥冷之證, 亦有小腹結急之證, 或唾紅, 或鼻衄. 宜以柴胡ㆍ黃芩, 佐以川芎ㆍ白芷ㆍ桃仁ㆍ五靈脂, 更加大黃ㆍ濃蜜, 使滯血一通, 黑物流利, 則熱不復作矣. 《直指》

Such a person's pulse is rough. There will certainly be the sign of rinsing the mouth with water without swallowing; certainly the sign of retching and phlegmy drool; certainly the sign of both legs turning reversal-cold; and there may be the sign of the lower abdomen bound and urgent — with red-streaked spittle, perhaps, or nosebleed. One should use bupleurum and scutellaria, assisted by cnidium, angelica dahurica, peach kernel, and flying-squirrel droppings, further adding rhubarb and thick honey: let the stagnant Blood once move through, and the black matter flow freely — then the heat will not arise again.
Clinical note The chapter's most distinctive fever — heat from blood that has stopped moving, and its tell is unforgettable: the patient rinses the mouth but will not swallow, thirsty in the mouth and not in the body. Cold legs beneath a fever, a bound lower abdomen, blood appearing where it shouldn't — and the treatment logic is plumbing, not cooling: open the stagnation, let the dark matter pass, and the fever has nothing left to burn.

Jikji 直指

The method of medicines that treat fire and heat across the board 通治火熱藥法

除熱瀉火, 非甘寒不可也. 有大熱脉洪大, 服苦寒劑而熱不退者, 加石膏. 《東垣》 ○火妄動夏月, 用益元散 方見暑門 鎭墜之妙. 《丹心》 ○虛熱, 用荊芥ㆍ薄荷ㆍ梔子ㆍ黃芩. 實熱, 用大黃ㆍ芒硝. 《得效》 ○實火可瀉, 黃連解毒湯之類. 虛火可補, 參ㆍ朮ㆍ甘草(生)之類. 《丹心》 ○火盛者, 不可驟用寒涼, 必兼溫散. 《丹心》 ○火急甚者, 必緩之, 甘草(生)兼瀉兼緩, 參ㆍ朮亦可. 《丹心》 ○火盛癲狂, 人壯氣實者, 可用正治, 氷水之類飮之. 人虛者, 飮以生薑湯, 若投氷水, 正致立死. 《丹心》 ○補陰則火自降, 炒黃柏ㆍ生地黃之類. 《丹心》

To remove heat and drain fire, nothing will do but the sweet and cold. Where the heat is great and the pulse surging and large, and the heat does not retreat on bitter cold preparations, add gypsum (Dongwon 東垣). — When fire stirs recklessly in the summer months, Igwon-san — formula in the Summerheat chapter — settles and weighs it down, wonderfully (Dansim 丹心). — For vacuous heat, use schizonepeta, mint, gardenia, and scutellaria; for replete heat, rhubarb and mirabilite (Deukhyo 得效). — Replete fire may be drained: the kind of Hwangryeonhaedok-tang 黃連解毒湯. Vacuous fire may be supplemented: the kind of ginseng, atractylodes, and raw licorice (Dansim 丹心). — Where fire is exuberant, one must not abruptly use the cold and cool: warm scattering must accompany it (Dansim 丹心). — Where fire is urgent and severe, it must be slowed: raw licorice both drains and slows, and ginseng and atractylodes will serve (Dansim 丹心). — In mania from exuberant fire, if the person is robust and their Qi replete, the direct treatment may be used and ice water and the like given to drink. If the person is vacuous, give a ginger decoction — for to throw ice water at them brings death on the spot (Dansim 丹心). — Supplement the Yin and the fire descends of itself: dry-fried phellodendron, raw rehmannia, and the like. (Dansim 丹心)
Clinical note The chapter's working rules, gathered at the end where they belong — and every one of them is a check on the reflex to simply cool. Do not use cold abruptly on a great fire; slow an urgent one before draining it; give ice water only to the strong, and ginger tea to the weak, because the same treatment that saves one kills the other on the spot. The closing line is the whole chapter in seven characters: supplement the Yin, and the fire descends of itself.

Dongwon 東垣 · Dansim 丹心 · Deukhyo 得效

黃連ㆍ黃芩ㆍ白芍藥ㆍ柴胡ㆍ知母, 此皆苦寒之味, 能瀉五藏有餘之火耳. 若內傷勞倦, 爲陽虛之病, 以甘溫之劑除之, 如參ㆍ芪ㆍ甘草之屬. 若相火熾盛, 日漸煎熬, 爲血虛之病, 以甘寒之劑降之, 如當歸ㆍ地黃之屬. 若心火亢極, 爲陽强之病, 以醎冷之劑折之, 如大黃ㆍ朴硝之屬. 若腎水受傷, 眞陰失守, 爲陰虛之病, 以壯水之主制之, 如生地黃ㆍ玄參之屬. 若命門火衰, 爲陽脫之病, 以溫熱之劑濟之, 如附子ㆍ乾薑之屬. 若胃虛食冷, 鬱遏陽氣, 爲火鬱之病, 以升散之劑發之, 如升麻ㆍ葛根之屬. 《丹心》 ○火熱通治, 宜防風通聖散 方見風門ㆍ黃連解毒湯 方見寒門. ○防風通聖散, 此方治熱ㆍ風ㆍ燥三者之總劑也. 防風ㆍ麻黃ㆍ薄荷ㆍ荊芥, 使熱邪從玄府出也. 梔子ㆍ滑石, 使熱邪從小便出也. 大黃ㆍ朴硝, 使熱邪從大便出也. 其餘, 黃芩散肺火, 連翹散心火, 石膏散胃火, 芍藥散脾火, 川芎ㆍ當歸和血潤燥, 白朮ㆍ甘草補脾和中, 桔梗開膈, 可謂善於處方也. 《丹心》

Coptis, scutellaria, white peony, bupleurum, and anemarrhena — these are all bitter cold in flavor, and can drain a surplus fire of the five viscera, no more. If it is internal damage from taxing toil, that is an illness of Yang vacuity: remove it with sweet warm preparations, such as ginseng, astragalus, and licorice. If the minister fire blazes and day by day decocts and scorches, that is an illness of Blood vacuity: bring it down with sweet cold preparations, such as angelica and rehmannia. If the Heart fire is hyperactive to its extreme, that is an illness of Yang hyperstrength: break it with salty cold preparations, such as rhubarb and mirabilite. If the Kidney water has been damaged and the true Yin has lost its guard, that is an illness of Yin vacuity: control it by strengthening the ruler of water, such as raw rehmannia and scrophularia. If the life gate's fire has waned, that is an illness of Yang desertion: aid it with warm hot preparations, such as aconite and dried ginger. If the stomach is vacuous and has taken cold food, and the Yang Qi is depressed and blocked, that is an illness of fire constraint: effuse it with upraising scattering preparations, such as cimicifuga and kudzu root (Dansim 丹心). — For treating fire heat across the board: Bangpungtongseong-san 防風通聖散 — formula in the Wind chapter — and Hwangryeonhaedok-tang 黃連解毒湯 — formula in the Cold chapter —. — Of Bangpungtongseong-san: this formula is the comprehensive preparation treating all three of heat, wind, and dryness. Saposhnikovia, ephedra, mint, and schizonepeta send the heat evil out by the mysterious mansions of the pores; gardenia and talcum send it out by the urine; rhubarb and mirabilite send it out by the stool. As for the rest — scutellaria scatters Lung fire, forsythia scatters Heart fire, gypsum scatters Stomach fire, peony scatters Spleen fire; cnidium and angelica harmonize the Blood and moisten dryness; white atractylodes and licorice supplement the Spleen and harmonize the center; platycodon opens the diaphragm. It may be called a formula excellently composed. (Dansim 丹心)
Clinical note The chapter's final doctrine, and its most useful single page — six kinds of fire, six flavors of answer, laid out as a decision table: bitter cold only for a genuine surplus; sweet warm for the burned-out; sweet cold for the scorched blood; salty cold for the raging heart; water-strengthening for the spent Yin; warm-hot for the failing gate; and upraising for the fire that is merely trapped. Six illnesses that all present as heat, and only one of them wants cooling. The Bangpungtongseong-san commentary that follows is a masterclass in reading a formula: three exits opened, five organ-fires assigned their herb, and the blood and center guarded while it all leaves.

Dansim 丹心

Simple medicinals 單方

凡四十五種. 有單石膏丸ㆍ玉液丸ㆍ淸金丸ㆍ荊黃湯ㆍ柔金丸ㆍ山梔丸ㆍ甘豆湯. ○石膏, 除三焦火熱, 及胃熱ㆍ身熱ㆍ煩渴. 石膏 四兩, 甘草 二錢半, 硏如粉, 水服二錢, 日再. 亦治骨蒸熱. ○鷄子, 心胸煩熱, 生呑鷄子淸一枚. 熱毒發, 鷄子白三顆, 和蜜一合, 頓服卽差. ○牛乳, 解熱毒, 除胸中熱, 生飮之良, 烏牛乳尤佳. ○猪肚, 主骨蒸熱勞, 蒸熟食之, 猪膽亦好, 和水服之. 《本草》

In all, forty-five kinds, including Dansseokgo-hwan 單石膏丸, Okaek-hwan 玉液丸, Cheonggeum-hwan 淸金丸, Hyeonghwang-tang 荊黃湯, Yugeum-hwan 柔金丸, Sanchi-hwan 山梔丸, and Gamdu-tang 甘豆湯. — Gypsum removes the fire heat of the triple burner, and stomach heat, body heat, and vexing thirst: gypsum 4 nyang with licorice 2.5 don, ground to a powder, 2 don taken in water twice daily; it also treats steaming-bone heat. — Hen's egg: for vexing heat of heart and chest, swallow the white of one egg raw. Where heat toxin has broken out, the whites of three eggs mixed with one hop of honey, taken at a draught, cures at once. — Cow's milk resolves heat toxin and removes heat in the chest; drunk raw it is good, and the milk of a black cow is finer still. — Pig's stomach governs steaming-bone taxation heat: steam it thoroughly and eat. Pig's gallbladder also serves, taken mixed with water. (Bonchō 本草)
Clinical note Forty-five simples, sampled here at the kitchen end of the pharmacy — a raw egg white swallowed for a burning chest, honey and egg for heat toxin, black cow's milk, steamed pig's stomach for the bone-steaming fever. After twenty-six sections of doctrine, the chapter's last pharmacological word is that some fires are answered from the larder.

Bonchō 本草

Acupuncture and moxibustion 鍼灸法

骨蒸勞熱, 取膏肓ㆍ三里. 《綱目》 ○骨蒸勞熱, 形氣未脫者, 灸崔氏四花穴, 無有不安. 《正傳》

For steaming-bone taxation heat: BL43 Gohwang and ST36 Samni (Gangmok 綱目). — For steaming-bone taxation heat, where form and Qi have not yet deserted, moxa Cui's Four Flowers points: there is none who is not settled by it. (Jeongjeon 正傳)
Clinical note The Fire chapter closes at the needle, and with a condition attached — moxa the Four Flowers 'where form and Qi have not yet deserted,' which is the classical way of saying: while there is still something to build on. After the hexagram pastes and the purple snow, the last instruction is four moxa cones and an honest prognosis.

Gangmok 綱目 · Jeongjeon 正傳