Heat-clearing agents

Medicinals that clear interior heat and that are mainly used in heat-clearing formulas. Interior heat patterns are any heat patterns other than exterior heat patterns, which are generally treated not by clearing heat, but by resolving the exterior.

Interior heat patterns can be caused by external evils entering the interior and transforming into heat. They can also be caused by disorders of the bowels and viscera, as well as qì and blood, giving rise to exuberance of yáng qì. Quite often, they arise when internal damage by excesses of the seven affects (joy, anger, anxiety, thought, sorrow, fear, and fright) leads to transformation into heat or fire. The general signs of interior heat are generalized heat effusion, red face, thirst with taking of cold drinks, vexation and agitation, reddish urine, a red tongue and yellow tongue fur, and a rapid pulse. Note that fire denotes an intense, upward flaming form of heat that manifests in upper body signs such as red face and eyes, headache, and dizziness.

Because interior heat patterns are varied in nature, the medicinals that address them are divided into categories that treat specific types.

Subcategories

Heat-clearing agents are divided into five categories.

• Heat-clearing fire-draining agents
• Heat-clearing dampness-drying agents
• Heat-clearing blood-cooling agents
• Heat-clearing toxin-resolving agents
• Vacuity-heat–clearing agents

Nevertheless, quite a few heat-clearing agents have the actions of more than one category and therefore have broad applications.

Heat-clearing fire-draining medicinals are general-purpose medicinals for any repletion heat or repletion fire patterns. Clearing heat denotes a cooling action that eliminates evil heat. Draining fire denotes the action of eliminating the intense, upward flaming form of heat that is referred to as fire; it implies a downward release of upper-body heat.

The other subcategories of heat-clearing medicinals are more specific in their action. Heat-clearing dampness-drying medicinals address damp-heat. Heat-clearing blood-cooling medicinals are heat-clearing medicinals that are particularly effective for frenetic movement of hot blood, which manifests in bleeding or pronounced macular eruptions. Both of these subcategories, like the heat-clearing and fire-draining medicinals, treat repletion heat. Heat-clearing toxin-resolving medicinals are often important for treating sores and febrile disease. Vacuity-heat–clearing medicinals differ from these in that they are particularly effective for heat patterns arising from yīn vacuity.

Properties

Nature: Heat-clearing medicinals are mostly cold. Some are slightly cold, cool, or balanced.

Flavor: They are mostly bitter. Bitterness is associated with a clearing and draining action. Some are sweet (they mostly nourish yīn and engender liquid). Some are acrid (they have an effusing-dispersing action or move qì and blood). A few are salty (they cool the blood).

Channel entry: Varying.

Bearing: Generally downsinking.

Toxicity: Yā dǎn zǐ (Bruceae Fructus) and shān dòu gēn (Sophorae Tonkinensis Radix) are toxic.

Actions And Indications

Heat-clearing medicinals treat interior heat patterns. Thus, they are often described as having the ability to clear and discharge interior heat or clear and resolve interior heat.

Heat patterns are generally characterized by heat effusion (i.e., fever), red face, thirst with taking of cold drinks, vexation and agitation, reddish urine, a red tongue and yellow tongue fur, and a rapid pulse. However, there are many different interior heat patterns resulting from different causes, affecting different parts of the body, and arising at different stages of an illness. According to eight-principle pattern identification, we can differentiate repletion heat and vacuity heat. According to four-aspect pattern identification, we can distinguish qì-aspect patterns and provisioning-blood patterns. According to bowel and visceral pattern identification, we can distinguish interior heat affecting any of the five viscera and six bowels.

Heat-clearing fire-draining agents address repletion heat patterns due either to qì-aspect heat in warm-heat disease or to internal damage in miscellaneous disease.

Those whose action is described as clearing qì-aspect heat mainly treat qì-aspect heat patterns in warm-heat disease, with signs such as vigorous heat effusion, sweating, vexing thirst, and a pulse that is surging, large, and forceful. In severe cases, there may be clouded spirit and delirious speech. Qì-aspect heat in warm-heat disease corresponds to yáng brightness (yáng míng ) channel disease in the cold damage system of pattern identification.

Heat-clearing medicinals that act upon the viscera primarily clear lung heat, stomach heat, heart heat, or liver heat.

• Lung-heat–clearing agents treat cough or cough and panting due to heat evil congesting the lung.
• Stomach-heat–clearing agents treat stomach heat with mouth sores, vomiting, or painful swollen gums.
• Heart-heat–clearing agents treat heart fire flaming upward with heart vexation, insomnia, mouth and tongue sores, and inhibited voidings of reddish urine due to heart fire spreading heat to the small intestine.
• Liver-heat–clearing agents treat liver fire flaming upward, giving rise to red painful swollen eyes, irascibility, headache, dizziness, and eye problems. They also treat other liver heat patterns, such as liver heat invading the stomach or lung, and liver heat combined with wind.
• Some heat-clearing fire-draining medicinals have specific actions, such as clearing lung heat and suppressing cough, clearing stomach heat and checking vomiting, clearing heart heat and eliminating vexation, and clearing the liver and brightening the eyes. In addition, some can be employed in the treatment of sores, and others can disinhibit dampness.

Heat-clearing dampness-drying agents are bitter and drying. They treat damp-heat disease. Damp-heat disease is characterized by heat signs accompanied by signs of dampness, such as cumbersome heavy head, cumbersome fatigued limbs, thirst with no desire to drink, and a red tongue with slimy yellow fur. They are used for the following specific conditions:

• Damp warmth or summerheat with damp-heat brewing and binding: The qì dynamic is inhibited, giving rise to unsurfaced heat effusion, and glomus and oppression in the chest and stomach duct.
• Damp-heat encumbering the center burner, affecting spleen upbearing and stomach downbearing: This gives rise to distension and fullness in the stomach duct and abdomen, nausea, vomiting, and reduced eating.
• Damp-heat pouring down into the large intestine, with impaired conveyance causing diarrhea with ungratifying defecation or dysentery with abdominal pain, tenesmus, and pus and blood in the stool.
• Damp-heat obstructing the liver and gallbladder causing loss of free coursing and gives rise to distending pain in the rib-side. Bile fails to keep to its normal pathways and spills outward, giving rise to jaundice.
• Damp-heat pouring downward, affecting qì transformation in the lower burner, giving rise to strangury (lín) patterns with painful rough urination. When it affects the girdling (dài) vessel, vaginal discharge may arise. Damp-heat pouring downward also can cause genital itch.
• Damp-heat pouring into the joints, causing redness, swelling, heat, and pain in the joints in impediment (bì) patterns.
• Damp-heat spreading through the skin, giving rise to eczema and damp sores.
• Some heat-clearing dampness-drying medicinals also have the power to treat repletion heat in the bowels and viscera or in the qì and defense aspects.

Heat-clearing blood-cooling agents treat provisioning-blood heat patterns in warm disease and frenetic movement of hot blood in miscellaneous disease.

• Heat entering provisioning-blood in warm-heat disease: Heat evil entering the provisioning aspect is characterized by generalized heat that is more pronounced at night, thirst, heart vexation and sleeplessness, faint maculopapular eruption, a red or crimson tongue, and a pulse that is rapid and fine. Severe cases may present as clouded spirit with delirious speech. Heat evil entering the blood aspect is characterized by frenetic movement of hot blood (vomiting of blood, nosebleed, bloody stool, or pronounced macules), and a deep crimson tongue. In severe cases, there is clouding mania and delirious speech.
• Frenetic movement of hot blood in miscellaneous disease: This arises when excesses of the seven affects (joy, anger, anxiety, thought, sorrow, fear, and fright) cause qì to become depressed and transform into fire. It can also arise as a result of yīn vacuity. It is characterized by vomiting of blood, expectoration of blood, bloody stool, bloody urine, nosebleed, advanced menstruation, or flooding and spotting (heavy and mild bleeding via the vagina). Bleeding is often profuse and the blood is either bright red or purple-black in color. General signs include heart vexation, thirst, a red or deep red tongue, and a rapid pulse.

Heat-clearing blood-cooling medicinals have other functions such as stanching bleeding, nourishing yīn, resolving toxin, and quickening the blood, which make them suitable for treating bleeding patterns, yīn vacuity patterns, heat toxin patterns, and static blood patterns.

Heat-clearing toxin-resolving agents are cold-cool medicinals that eliminate heat toxin, that is, any virulent form of heat evil that causes redness, swelling, pain, and suppuration. Warm-heat disease and many kinds of sores are attributed to heat toxin. Hence, heat-clearing toxin-resolving medicinals treat clove sores, boils, welling-abscesses, warm-heat disease, dysentery, painful swollen throat, cinnabar toxin (erysipelas), and mumps.

Some heat-clearing toxin-resolving medicinals can also treat burns and scalds, as well as snake and insect bites and stings. Some have been found to help in the treatment of cancer. Note that the Chinese concept of toxin is significantly different than the toxins of biomedicine or popular notions of toxins that are prominent in some alternative medicine circles in the West.

Most heat-clearing toxin-resolving medicinals have additional actions. Such actions include: clearing heat and draining fire, clearing heat and cooling the blood, clearing heat and disinhibiting dampness, disinhibiting the throat, and disinhibiting urine.

The indications for heat-clearing toxin-resolving medicinals can be broadly discussed under two headings.

• Yáng-pattern sores: These include acute sores on the fleshy exterior of the body that are red, swollen, painful, and hot to the touch, such as welling-abscesses, clove sores, and boils. They also include pulmonary welling-abscesses and intestinal welling-abscesses. These are broadly attributed to heat toxin.
• Warm-heat disease patterns: These are externally contracted disease patterns caused by warm evil.

Vacuity-heat–clearing agents are also called vacuity-heat–abating medicinals. They are mostly bitter-cold or sweet-cold medicinals that mainly enter the liver and kidney channels. They are chiefly used to treat liver-kidney yīn vacuity with internal heat, manifesting in steaming bone tidal heat, vexing heat in the five hearts (i.e., palpable heat in the palms and soles, and subjective feeling of heat in the chest), night sweating, seminal emission, a red tongue with little liquid, and a pulse that is fine and rapid.

Steaming bone tidal heat is a major sign of yīn vacuity, hence abating vacuity heat is often called eliminating steaming bone or eliminating steaming. In children, vacuity heat is most commonly seen in gān accumulation (often translated as malnutrition). Abating heat in the treatment of child gān accumulation is commonly referred to as eliminating gān heat.

Most medicinals that clear vacuity heat usually also clear heat and drain fire, cool the blood, or resolve toxin. Furthermore, many medicinals in other subcategories of heat-clearing medicinals also have the ability to clear vacuity heat. Zhī mǔ (Anemarrhenae Rhizoma), huáng bǎi (Phellodendri Cortex), shēng dì huáng (Rehmanniae Radix), xuán shēn (Scrophulariae Radix), and mǔ dān pí (Moutan Cortex) are prominent examples.

Generalities

• Avoid damage to yīn: Heat is a yáng evil; it easily damages yīn liquid. Heat-clearing medicinals are bitter, cold, and dry, so they also tend to damage yīn. For this reason, they are often combined with agents that nourish yīn and engender liquid.
• Avoid damage to the spleen and stomach: Heat-clearing medicinals are bitter and cold; they easily damage the spleen and stomach. Hence, they are often combined with agents that fortify the spleen and stomach.
• Exterior evils: When treating conditions of interior heat that are accompanied by exterior evils, heat-clearing medicinals are combined with exterior-resolving medicinals. Treatment methods of this kind are called dual resolution of exterior and interior. They prevent the external evils from invading the inner body.
• Constipation: Particularly when there is food accumulation, interior heat can bind in the intestines, giving rise to constipation. In some cases, the heat will flame upward, giving rise to clouded head, headache, red face and eyes, and sores of the mouth and tongue. In such situations, heat-clearing medicinals have to be combined with draining-precipitants. This treatment is called raking the firewood from beneath the cauldron. It conducts the heat downward and eliminates toxin from the body.
• Warm-heat disease: Warm-heat disease not only damages yīn liquid, but also wears qì, giving rise to thirst with desire to drink, as well as shortness of breath and lack of strength. In such cases, heat-clearing medicinals are often combined with agents that boost qì and engender liquid.
• Blood stasis and phlegm-damp: When interior heat is complicated by blood stasis or phlegm-damp, there may be bleeding, cough and panting, spasm, or insomnia. In such cases, heat-clearing agents can be combined according to need with medicinals that quicken the blood, transform phlegm, eliminate dampness, suppress cough and calm panting, cool the blood and stanch bleeding, extinguish wind and check tetany, or quiet the spirit.

Heat-Clearing Fire-Draining Agents

• Warm-heat disease: Warm-heat may be caused by warm-heat epidemic toxin. To treat such cases, heat-clearing fire-draining medicinals need to be combined with heat-clearing toxin-resolving agents.
• Patterns of simultaneous disease of defense and qì in warm-heat disease: Combine with agents that course wind-heat.
• Patterns of blazing of both qì and provisioning or blazing of both qì and blood in warm-heat disease: Combine with heat-clearing blood-cooling medicinals.
• Lung-heat cough and panting: Combine with agents that suppress cough and calm panting.
• Liver heat stirring wind: Combine with agents that extinguish wind and check tetany.
• Hyperactive heart fire with vexation, agitation, and insomnia: Combine with spirit-quieting medicinals.
• Exuberant heat damaging qì and liquid: Add qì-boosting yīn-nourishing medicinals.

Heat-Clearing Dampness-Drying Agents

• Spleen-stomach vacuity or insufficiency of yīn liquid: Heat-clearing dampness-drying medicinals are very cold; they easily damage the spleen and stomach. Being bitter and dry, they can also damage yīn. If they have to be used, they should be combined with agents that fortify the spleen and boost qì or with agents that nourish yīn and engender liquid.
• Pronounced damp turbidity: Combine with agents that disinhibit dampness and/or ones that dry dampness or transform dampness. The choice between these three groups of medicinals will reflect whether the damp-turbidity is primarily located in the lower, middle, or upper burner, respectively.
• Qì stagnation: When dampness and heat brew and bind together, they often cause the qì dynamic to become depressed and stagnant. Hence, they are often combined with qì-moving agents.
• Damp warmth and summerheat-damp: Combine with heat-clearing fire-draining medicinals.
• Sores and welling-abscesses: Combine with heat-clearing toxin-resolving medicinals.
• Damp impediment (shī bì): Combine with wind-damp–dispelling medicinals and water-disinhibiting dampness-percolating medicinals.

Heat-Clearing Blood-Cooling Agents

• Heat entering provisioning and/or blood in warm-heat disease: Select heat-clearing blood-cooling medicinals that resolve toxin, nourish yīn, and quicken the blood. Combine these with heat-clearing toxin-resolving medicinals to address the heat evil. If there is frenetic movement of blood and bleeding, add blood-stanching medicinals. When blood stasis arises from damage to yīn by exuberant heat or from bleeding, blood-quickening agents can be included as assistants in the formula.
• Blazing of both qì and provisioning in warm disease: Combine heat-clearing blood-cooling medicinals with heat-clearing fire-draining medicinals.
• Frenetic movement of hot blood in miscellaneous disease: Select heat-clearing blood-cooling medicinals that address the focus of the disease in the bowels and viscera, and use ones that have a blood-stanching effect.

Heat-Clearing Toxin-Resolving Agents

• Yáng sores: For these conditions, heat-clearing toxin-resolving medicinals are often combined with agents that quicken the blood and disperse binds. This disperses the swelling and redness and prevents suppuration.
• If pus has formed and the sore has ruptured, but the heat toxin has not been eliminated, heat-clearing toxin-resolving medicinals can be combined with agents that boost qì and nourish the blood in order to help express the toxin.
• Warm-heat disease: Heat-clearing toxin-resolving medicinals address the cause of the disease, but depending on the stage of the disease, they need to be combined with wind-heat–dispersing medicinals, heat-clearing fire-draining medicinals, or heat-clearing blood-cooling medicinals for a good effect.
• Dysentery: When used to treat initial-stage dysentery in which damp-heat and heat toxin are both exuberant, these medicinals need to be combined with heat-clearing dampness-drying medicinals, assisted by agents that quicken the blood and move qì. This treatment addresses the pus and blood in the stool; it also relieves the tenesmus.
• Painful swollen throat: Heat-clearing toxin-resolving medicinals are often used to treat painful swollen throat due to heat toxin. They can also be used to treat painful swollen throat due to wind-heat invading the inner body or to vacuity fire flaming upward, but in these cases they must be combined with medicinals that disperse wind-heat and ones that enrich yīn and downbear fire.

Vacuity-Heat–Clearing Agents

Vacuity heat is hyperactivity of yáng heat due to insufficiency of yīn humor. The hyperactivity of yáng heat is the tip of the condition, whereas the insufficiency of yīn humor is the root. Vacuity-heat–clearing medicinals treat the tip. To be fully effective, they must be combined with agents that enrich liver and kidney yīn, so as to treat both root and tip.

Method Of Use And Warnings

True cold and false heat: Heat-clearing medicinals are contraindicated for cold conditions. When a patient presents with both cold and heat signs, it is important to rule out true cold and false heat. In critical cases, administering heat-clearing medicinals may endanger the patient’s life if the pattern is wrongly identified. True cold and false heat is observed when a patient has generalized heat effusion, thirst, red face, and a large pulse, but on further scrutiny is found not to be suffering from a true heat pattern. Despite the heat effusion, the patient needs clothing and bedding to keep warm. Despite the thirst, there is a preference for warm drinks in small quantities. Although the complexion is red, it is only a pinkish red; it is like a dab of rouge on the upper cheek that drifts around. Although the pulse is large, it is forceless under pressure. Furthermore, there are distinct signs of severe cold such as reversal cold of the extremities, long voidings of clear urine, thin sloppy stool, listlessness of essence-spirit, and a pale tongue with white fur. This condition is explained as exuberant internal yīn repelling yáng to the outer body. It is often called exuberant yīn repelling yáng.

Avoid damaging yīn liquid, yáng qì, and the stomach and spleen: Heat-clearing medicinals are often bitter and cold; some also tend to be drying. Excessive use can damage yīn-liquid, yáng qì, and the spleen and stomach.