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A pathological change that results in a fire pattern. Excessive exuberance of the yáng qì of the body, externally contracted evils (or stagnant qì, blood, phlegm, or food), seven-affect internal damage, and depletion of yīn humor may all cause transformation into fire.

1. Extreme heat transforming into fire, as a result of excessive exuberance of the yáng qì of the body. Under normal circumstances, yáng qì nourishes the spirit and emolliates the sinews, warms the bowels and viscera and the whole body, and drives all physiological activity. Under such normal circumstances, yáng qì is what is called the lesser fire. But when yáng qì becomes overexuberant, qì, blood, fluids, and essence are damaged. When this happens, yáng qì becomes a damaging force that is known as vigorous fire. Dan Xi described this as Exuberant qì is fire. Plain Questions (素问 sù wèn, yīn yáng yìng xiàng dà lùn) explains the physiological and pathological significance of the lesser fire and the vigorous fire as follows: The vigorous fire consumes qì, qì consumes the lesser fire; the vigorous fire disperses qì, the lesser fire engenders qì.
2. Depressed evils transforming into fire. Externally contracted evils (wind, cold, dryness, dampness, etc.) may all enter the interior and become stagnant. Withthe yáng qì of the body they then transform into heat or fire. Depressed cold transforms into heat, and depressed dampness transforms into fire. Pathological products of the body (such as phlegm-damp or static blood), food accumulations, and worm accumulations may also become depressed and transform into fire. The reason why depressed evils transform into fire is that they cause depression of yáng qì. Depressed yáng qì engenders heat and transforms into fire, causing an internal repletion heat bind.
3. Excesses among the five minds transforming into fire. Mental and emotional stimulus can cause imbalances of the yīn and yáng and the qì and blood of the body, which given rise to binding depression of qì dynamic, which in time transforms into heat. The most common clinical example of this is affect-mind depression preventing the normal free coursing of the liver and causing liver qì to become depressed and stagnant and transform into fire. This is called liver fire.
4. Effulgent yīn vacuity fire. When essence and blood are depleted or yīn humor suffers major damage, the resulting yīn vacuity give rise to yáng hyperactivity, creating vacuity heat that engenders vacuity fire. Generally speaking, yīn vacuity with internal heat manifests in generalized signs, while yīn vacuity with effulgent fire is concentrated in a particular place, giving rise to local signs such as toothache, sore throat, steaming bone, or reddening of the cheeks.

Repletion Fire and Vacuity Fire

Repletion fire mostly arises when depressed evils transform into fire; it is of rapid onset and tends follow a short courseand is characterized by vigorous heat [effusion], red face, thirst with a liking for cold things, short voidings of yellow urine, constipation, erosion and sores of the mouth, red tongue and red eyes, dry yellow tongue fur, and surging rapid pulse. In severe cases, there is clouded spirit and manic agitation.

Vacuity fire arises from depletion of essence and blood; it tends to develop slowly and last for long timeand is characterized by vexing heat in the five hearts, in some cases steaming bone, postmeridian reddening of the cheeks, insomnia, night sweating, dry mouth and throat, dizziness and tinnitus, red tongue with scant fur, and a rapid fine pulse. Excess among the five minds transforming into fire can manifest in the form of repletion fire, as in liver fire flaming upward; it can also manifest in the form of vacuity fire, as in effulgent heart fire. See repletion fire; vacuity fire.

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