YIN FIRE

The concept of Yin Fire was introduced by Li Dong Yuan in his book "Discussion on Stomach and Spleen" (Pi Wei Lun), 1249.  The following is a translation of the chapter from this book dealing with Yin Fire.

"Dietary irregularity and excessive consumption of cold or warm foods damage the Spleen and Stomach. Joy, anger, worry and fright weaken the Yuan Qi. If the Spleen and Stomach are depleted and the Yuan Qi weakened, Fire of the Heart becomes excessive on its own. This Fire of the Heart is a Yin Fire. It starts from the Lower Burner and links with the Heart above. The Heart does not rule personally, rather the Minister Fire is its deputy.
     The Minister Fire is the Fire of the Pericardium (Bao Luo) developing from the Lower Burner. It is a “thief” of the Yuan Qi. This Yin Fire and the Yuan Qi are mutually opposed [cannot occupy the same place]: when one is victorious, the other is the loser. When the Spleen and Stomach Qi becomes empty, their Qi flows down to the Kidneys and Yin Fire has a chance to overwhelm the Earth.
     Because of this, with a Spleen pathology, there is raised Qi with breathlessness, fever, an Overflowing [Hong, Da] pulse, headache, thirst. There is a feeling of cold and of heat. As Yin Fire surges upwards [Shang Chong], there is raised Qi with breathlessness, fever, headache, thirst and an Overflowing pulse.
     As Qi of the Stomach and Spleen sinks, Gu Qi cannot rise and float. Therefore, there is no Yang to sustain Ying and Wei Qi. As these are unable to withstand Wind and Cold, there is a feeling of heat and of cold. All this is due to a deficiency of the Stomach and Spleen.
     The treatment of this condition is to use pungent, sweet and warm herbs to strengthen the Centre and lift Yang, together with sweet and cold herbs to drain Fire.  The use of bitter and cold herbs is absolutely counterproductive.  
BU ZHONG YI QI TANG
Huang Qi Radix Astragali 5 fen
     Increase to 1 qian for Lao diseases or Heat
Zhi Gan Cao Radix Glycyrrhizae 5 fen
Ren Shen Panax Ginseng 3 fen
     Remove in case of cough. The above three ingredients are “divine” for eliminating Damp-
    Heat and mental restlessness with heat [fan re].
Dang Gui Radix Angelicae sinensis 2 fen
     Baked dry with wine or sun-dried to harmonize Blood.
Chen Pi Pericarpium Citri 2-3 fen.
    With the inner white skin preserved to conduct Qi and strengthen Yuan Qi.  It is all right in 
    combination with sweet herbs; if used alone, it could drain the Stomach and Spleen.
Sheng Ma Rhizoma Cimicifugae 2-3 fen.
    To lift Stomach-Qi to its proper place and move the rising [Qi] of Spring.
Chai Hu Radix Bupleuri 2-3 fen.
    To attract clear Qi and move Qi of Shao Yang upwards.
Bai Zhu Rhizoma Atractylodis 3 fen.
    To clear Stomach-Heat and “benefit” [harmonize] Blood between back and umbilicus."

NOTE: 1 qian equals 3.125g and 1 fen is a 1/10 of a qian, i.e. 0.3g.

Comments
The above is the actual text from Li Dong Yuan’s book Pi Wei Lun.  I personally diagnose Yin Fire and use variations of Bu Zhong Yi Qi Tang whenever there are symptoms and signs of Heat in the upper part of the body which are not reconcilable with Full Heat nor with Empty Heat because they are combined with some Cold symptoms such as cold feet and a Pale tongue.

Manifestations of Heat above may include feeling of heat of the face, red cheeks, thirst, mouth ulcers. In my experience, mouth ulcers are frequently caused by Yin Fire. 

Another important clinical manifestation is general tiredness (from deficiency of the Yuan Qi) and some clinical manifestations of deficiency of Stomach and Spleen.

Yin Fire is neither Full Heat nor Empty Heat but simply a different kind of Heat that derives from a deficiency of the Yuan Qi.  It follows that Yin Fire is not treated by clearing Heat with pungent-cold formulae or draining Fire with bitter-cold formulae, but by tonifying the Yuan Qi with sweet formulae and gently clearing Heat upwards. That is what Sheng Ma and Chai Hu do in the formula: besides lifting Qi, they also clear Heat.

Remember, the essential characteristics of Yin Fire are that there is some Heat above (which is neither Full nor Empty Heat) from the rising of Minister Fire and a deficiency of the Yuan Qi deriving from dietary irregularity and overwork. The rising of the Minister Fire is particularly caused by emotional stress. 

Therefore, suspect Yin Fire whenever there is:
a) a deficiency of the Yuan Qi manifesting with great tiredness
b) some Heat above (red face, thirst, mouth ulcers)
c) some Cold symptoms (feeling cold in general, Pale tongue). 

In particular, I would always check for Yin Fire when there are symptoms of Heat and a Pale tongue. Yin Fire may be a factor in some auto-immune diseases.

Dampness in Yin Fire
The pathology of Yin Fire is also related to Dampness and to the Middle Burner. When there is Spleen deficiency, Dampness if formed and this infuses down to the Lower Burner.  Here it “swamps” the Yuan Qi and the Minister Fire, displacing the latter from the place (the Lower Burner) where it should be “concealed”.   The Middle Burner has Dampness too, Spleen-Qi (and even Spleen-Yang) is deficient and fails to rise.

For this reason, Bu Zhong Yi Qi Tang is used to raise Spleen-Qi and warm Spleen-Yang so that Dampness no longer infuses downwards to the Lower Burner.  It may seem contradictory to lift Qi when there are symptoms of Heat above.  When the Lower Burner is opened and unblocked from Dampness, the Minister Fire will return to its place of concealment in the Lower Burner, thus eliminating the symptoms of Yin Fire.

Emotions
Emotional stress is an important aetiological factor of Yin Fire and specifically of a deficiency of the Yuan Qi, as Li Dong Yuan himself says.  Any emotion can lead to Yin Fire as all emotions may stir the Minister Fire out of its residing place in the Lower Dan Tian.  Zhu Dan Xi said “Not a day goes by in people’s lives that the Minister Fire is not stirred”.  All emotions lead to Qi stagnation which, in turn, eventually leads to some Heat. The situation can be aggravated by the presence of Dampness in the Lower Burner (as it happens in shame). 

Yin Fire accounts for symptoms of Heat in mental-emotional problems that may defy a classification into Full- or Empty-Heat when there are contradicting symptoms of Heat and Cold (especially Pale tongue).  Emotional stress is more likely to lead to Yin Fire when it is combined with overwork and dietary irregularity.

Acupuncture treatment of Yin Fire
- Tonify Yuan Qi: Ren-4 Guanyuan.
- Tonify Stomach and Spleen: Ren-12 Zhongwan, BL-20 Pishu, ST-36 Zusanli.
- Lift Qi: Du-20 Baihui and Ren-6 Qihai.
- Resolve Dampness: Ren-9 Shuifen, Ren-5 Shimen, BL-22 Sanjiaoshu, SP-9 Yinlingquan.

     Please note that it may seem a contradiction to raise Qi when the pathology of Yin Fire consists in the rising of the Minister Fire.  However, we raise Qi to lift Spleen-Qi so that the Dampness is resolved from the Middle and Lower Burner.  Resolving Dampness from the Lower Burner unblocks it and allows the Yuan Qi to take its proper place there, and the Minister Fire to return to its place of "concealment".

Acupuncture treatment of Yin Fire emotional disturbance
- Tonify the Yuan Qi: Ren-4 Guanyuan.
- Tonify and raise Spleen-Qi: Ren-12 Zhongwan, Ren-6 Qihai, ST-36 Zusanli.
- Calm the Shen and make Heat descend: Du-24 Shenting, Du-19 Houding, Ren-15 Jiuwei, HE-5
     Tongli.
- Clear Heat upwards: P-8 Laogong, P-7 Dalig.
- Regulate the Triple Burner: TB-5 Waiguan.