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Heat-clearing formulas

清熱劑 〔清热剂〕qīng rè jì

Medicinal formulas that treat heat patterns using cool and cold heat-clearing agents, which have heat-clearing, fire-draining, blood-cooling, and toxin-resolving actions that are effective in the treatment of interior heat patterns. Heat-clearing formulas correspond to clearing heat among the five methods. The Sù Wèn (Chapter 74) states, heat is treated by cold and warmth is treated by clearing.

Warmth, heat, and fire are the same in nature. Exuberant warmth is heat; extreme heat is fire, but they share the same characteristics, so they are generically referred to as heat or, especially when severe, fire-heat. The three terms can refer to different kinds of heat in certain contexts, but they all denote the same fundamental phenomenon.

Heat arises in different ways. It can enter the body from outside or origine in the body itself. Externally contracted evils, including heat or other evils, can pass into the interior and transform into heat. Excesses among the five minds can also give rise to five, creating interior heat patterns.

Interior heat patterns vary in their manifestations and is treated in different ways according to whether it is located in the qì aspect, the blood aspect, whether it is repletion or vacuity heat, and where among the bowels and viscera it is prominent. Hence there are formulas that clear qì-aspect heat, ones that clear provisioning and cool the blood, ones that clear heat and resolve toxin, ones the clear both qì and blood heat, ones that clear bowels and visceral heat, and others that clear vacuity heat. Note that summerheat-dispelling formulas in some sources are included within the category of heat-clearing formulas, but in this database they form a distinct category.

The guiding principle for the use of heat-clearing formulas is that any existing exterior pattern must be resolved and interior heat must already have developed, but at the same time the pattern is principally of heat rather than repletion. If there is evil heat in the exterior, exterior-resolving formulas should be used. If interior heat has already become fully replete, offensive precipitant formulas should be used. When the exterior evils have not been resolved and heat has already entered the interior, dual exterior-interior resolution formulas are called for. If heat is in the qì and blood-cooling treatment is given, this can cause the evil to move into the interior. If heat is in the blood and qì-clearing treatment is given, the heat will be difficult to quash. So careful attention must be paid to correct pattern identification.

Cautions

It is important to pay attention to the following points.

Subcategories

Note that according to some classifications, summerheat-heat dispelling formulas are included as a subcategory of heat clearing agents. In this database, they discussed as a separate category.

Qì-Aspect Heat-Clearing Formulas

Formulas that clear qì-aspect heat treat warm disease patterns in which the external evil is in the qì aspect, corresponding to the yáng brightness channel disease in cold damage. When evils enter the qì aspect, this usually means that the exterior has already been resolved, and the heat is gradually growing in exuberance, so that there is heat effusion without aversion to cold or with aversion to heat, profuse sweating, thirst, and a pulse that is surging and large.

Main agents: The aim is to clear heat and protecting liquid, so that acrid, sweet, and cold gypsum (Gypsum Fibrosum, 石膏 shí gāo) and cold, bitter anemarrhena (Anemarrhenae Rhizoma, 知母 zhī mǔ) are used as the main agents.

For residual heat in the qì aspect after illness with damage to both qì and yīn, formulas include not only gypsum (Gypsum Fibrosum, 石膏 shí gāo) but also 淡竹叶 dàn zhú yè) to clear heat and alleviate vexation, combined with ginseng (Ginseng Radix, 人参 rén shēn) and ophiopogon (Ophiopogonis Radix, 麦门冬 mài mén dōng) to boost qì and nourish yīn.

Representative formulas

Provisioning-Clearing Blood-Cooling Formulas

Formulas that clear provisioning and cool the blood treat heat entering the provisioning and blood aspects in warm disease. Evil heat passing into provisioning manifests in generalized heat effusion worsening at night with heart vexation and reduced sleep, in some cases with delirious speech or faint maculopapular eruption. Heat entering the blood aspect manifests in bleeding, macules, delirious speech and mania, together with a crimson tongue with prickles.

Main agents

Such conditions are treated with rhinoceros horn (Rhinocerotis Cornu, 犀角 xī jiǎo), which is now replaced with water buffalo horn (Bubali Cornu, 水牛角 xī jiǎo) and dried/fresh rehmannia (Rehmanniae Radix, 生地黄 shēng dì huáng) to clear provisioning and cool the blood.

Because heat in provisioning mostly comes from the qì aspect, medicinals that clear provisioning heat are combined with agents such as lonicera (Lonicerae Flos, 金银花 jīn yín huā), forsythia (Forsythiae Fructus, 连翘 lián qiào), and 淡竹叶 dàn zhú yè) to outthrust the heat to the qì aspect.

Because heat entering the blood aspect causes frenetic movement of hot blood with bleeding and macules and static blood due to extravasation, moutan (Moutan Cortex, 牡丹皮 mǔ dān pí) and 赤芍药 chì sháo yào) are often used.

Representative formulas

Heat-Clearing Toxin-Resolving Formulas

Formulas that clear heat and resolve toxin treat warm epidemics, warm toxin, and the toxin of sores and welling-abscesses. When fire- toxin is exuberant within the triple burner, signs include with heat vexation, incoherent speech, vomiting of blood, and macular eruptions and external medicine conditions such as sores, clove sores, and welling-abscesses. When heat gathers in the chest and diaphragm, signs include generalized heat effusion, red face, heat vexation, mouth and tongue sores, constipation, and red urine.

Main agents

Other agents are combined with the above for specific conditions.

Representative formulas

Qì-Blood Heat-Clearing Formulas

These formulas clear qì, cool the blood, discharge fire, and resolve toxin and treat epidemic toxin fire-heat in the inner and outer body with dual vacuity of qì and blood. They are used for qì-aspsect exuberant heat with great heat effusion, vexation, and thirst, for frenetic movement of hot blood with vomiting of blood, for heat toxin falling inward to cause clouded spirit and delirious speech.

Main agents

Representative formula: Scourge-Clearing Toxin-Vanquishing Beverage (清瘟败毒饮 qīng wēn bài dú yǐn).

Bowel and Visceral Heat-Clearing Formulas

Formulas that clear bowel and viscera heat treat conditions in which fire-heat is especially exuberant in particular bowels and viscera.

Representative formulas

Vacuity-Heat-Clearing Formulas

Formulas that clear vacuity heat treat (a) residual heat after febrile disease with damage to liquid with evening heat effusion that cools in the morning with red tongue and little fur; (b) liver-kidney yīn vacuity steaming bone tidal heat. They use agents such as turtle shell (Trionycis Carapax, 鳖甲 biē jiǎ), anemarrhena (Anemarrhenae Rhizoma, 知母 zhī mǔ), dried/fresh rehmannia (Rehmanniae Radix, 生地黄 shēng dì huáng), which enrich yīn and clear heat, as well as sweet wormwood (Artemisiae Annuae Herba, 青蒿 qīng hāo), large gentian (Gentianae Macrophyllae Radix, 秦艽 qín jiāo), bupleurum (Bupleuri Radix, 柴胡 chái hú), and lycium root bark (Lycii Cortex, 地骨皮 dì gǔ pí), which clear and outthrust latent heat. Qì-boosting agents are added if qì vacuity is present. For severe vacuity heat, cold bitter fire-draining agents can also be used.

Representative formulas

See clearing heat and heat-clearing medicinals.

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