Formulas that Clear Heat
Chapter 4 (19 Formulas)
Heat without internal clumping or mixing with body substances like fluid, phlegm or stagnant food. = Heat without form, many parts of the body but if it's in the LI its open intestines
Clearing removes heat from the Qi or Blood Levels without impeding their movement or transformation
Uses Acrid and Cold substances like Sang Ye, Shi Gao, Shui Niu Jiao, Mu Dan Pi
Unblock the pathways of qi in the TW: Zhi Zi, Dan Zhu YeDraining fire directs fire downwards and removes it from the body via the urine and bowels like Huang Qin, Huang Lian, Huang Bai, Long Dan Cao
Contraindications for Heat Clearing
Before using the Clearing method, be sure there is no heat on the exterior (Tai Yang not involved) and there is no clumping of heat on the interior (closed/blocked LI that needs purging)
Identify whether heat is excess or deficient.
Identify the location – level, organ
Lots of these formulas have herbs to protect the ST bc the ingredients are so cold.
Most are for acute conditions and should be discontinued after the heat has been successfully treated.
Take the constitution into account – for example, take great caution in those with long standing yang deficiency
Be sure you are treating true heat rather than false heat which would instead require warming to lead the floating fire back to its source.
When the Clearing heat method using formulas with cold medicinals does not work, it is likely bc the heat is deficient heat– enriching the yin will be necessary.
If conditions of vigorous heat do not allow for the oral ingestion of the decoction – cool the decoction or add a small amount of ginger juice
Formulas that clear heat in the qi level/yang ming block heat
4 bigs + Irritability
Or recovery stage of the 4 Bigs when heat hasn’t been fully cleared and there is injury to the yin and blood (constraint in chest included, pulse no longer so big)
Thirst (especially for cold beverages) is a helpful symptom to identify Qi level heat, YM block in the ST and LU(not more superficial or deeper)
Key ingredients: Shi Gao, Dan Zhu Ye, Zhi Zi, plus Gan Cao and Jing Mi to protect the middle, and Ren Shen, Mai Men Dong and Zhi Mu to replenish what has been lost
Bai Hu Tang (White Tiger Decoction) - QI LEVEL HEAT
Formula
Chief: Shi Gao
Deputy: Zhi Mu
Zhi Gan Cao, Jing Mi
Confirmation
Zhang Fu: Blazing ST and LU channel fire
6 confirmation: Yang Ming Block with heat building
4 levels: Qi Level Heat
Symptoms
high fever with profuse sweating and an aversion to heat, a red face, severe thirst and irritability. May also include a headache, toothache, or bleeding of the gums and nose.
Pulse: flooding, forceful or slippery, and rapid
Contraindications
Pulse that is floating, wiry, and thin
A submerged pulse
The absence of thirst
the absence of sweating
Modifications
Bai Hu jia Ren Shen Tang: BHT + Ren Shen/Xi Yang Shen + double the Jing mi –
BHT pattern where the qi has been exhausted with unquenchable thirst, forceless pulse, generalized weakness, or sl. Aversion to cold on
their back. Yang Ming, Tai Yin pattern
Bai Hu jia Gui Zhi Tang: BHT + Gui Zhi -
BHT pattern with pain and swelling of the joints or mild external cold, white tongue coating and a wiry and rapid pulse – Tai yang, Yang
Ming pattern. “..pain and irritability of the bones and joints indicates lurking cold in the sinews and joints. One employs Gui Zhi to drive it
out.”
Bai Hu Cheng Qi Tang: BHT + Da Huang and Mang Xiao –
BHT pattern with LI excess – constipation with clumping of dry stools in the intestines, dark, scanty and painful urination and, in severe
cases, delirious speech or manic behavior
Yang Ming ST/LI pattern
Case Study
Sick with irritability and high fever
Yang X, male, 32 year old commune member. FOC September 3, 1964. The patient was well-nourished and had been sick for 2-3 days with fever
(39.8/103.7), profuse sweating, thirst that led to drinking fluids, skin that was moist and hot to the touch, and a dry mouth and tongue. The chief complaint was irritability, fever and a slight sensitivity to drafts. There was also epigastric focal distention.
Pulse: slippery and hollow
I prescribed Bai hu jia Ren Shen Tang and the next day his temperature was normal, but because he had a headache and thirst, he continued on the previous formula for 2 more days. On follow-up several days later, he said everything had returned to normal after the second day on the medicine.
Zhu Ye Shi Gao Tang (Lophatherum and Gypsum Decoction) - QI LEVEL HEAT
Formula
Chief: Shi Gao
Deputy(ies): Dan Zhu Ye, Ren Shen, Mai Men Dong
Ban Xia, Zhi Gan Cao, Jing Mi
Confirmation
Qi level heat lingering in the LU and ST where the excess heat has damaged the fluids
YM Block - Qi level heat lingering in the LU and ST where it injures the fluids, usually in the recovery stage or aftermath of a febrile disease
Zhang Fu: ST Fire w/ST, LU yin Deficiency
6 Confirmation: Yang Ming Block with Tai Yin Deficiency
Symptoms
Lingering fever (from a febrile disease) accompanied by vomiting, irritability, thirst, parched mouth, lips and throat, choking cough, stifling sensation in the chest. Some Patients experiences restlessness and insomnia
Tongue: Red with little coating, Pulse: Rapid and Deficient
Contraindications
Not appropriate for febrile disease without interior deficiency, when the fever remains high, or when the qi and yin have not yet been injured
Modifications
for more intense blazng ST fire with persistent hunger add Tien Hua Fen and Zhi Mu
With coughing, add Xing Ren
For severe Yin Deficiency with mild ST fire, add Nu Zhen Zi and Mo Han Lian
For profuse sputum add Bei Mu, Chen Pi
For Yin Deficiency leading to yang deficiency wth symptoms of abandonment, such as sever dyspenea or sweating, add Fu Zi
Case Study
Post Surgery Fever
Yang XX, 23 yo female. After being treated by surgery for mastitis, she developed a fever of 39° (102.2°F) that continued without abating. It did not recede even after she was injected with different types of antibiotics. She developed mouth ulcers with thrush everywhere. Her western doctors were afraid that she had developed septicemia. She had also been unable to ingest food for several days, as she had also developed vomiting. She was irritable and distressed.
Pulse: rapid and forceless
Discussion: This pattern was originally heat clumping in the YM that manifested as breast abscess. After undergoing surgery, the qi and blood were damaged and because of this the body fluids could not be enriched and the deficiency heat was not eliminated. This led to upward rebellion of ST qi, manifesting as vomiting. Treatment was to enrich and tonify the qi and yin, while simultaneously clearing deficiency heat and stopping the
vomiting. After taking 2 packets, the fever went down to 37.8°(100.04°), the vomiting calmed down, and she was able to eat and drink. After 3 more packets of the same formula, the fever had receded and she was discharged.
Comparing Bai Hu Tang and Zhu Ye Shi Gao Tang
BHT: Shi Gao, Zhi Mu, Zhi Gan Cao, Jing Mi
ZYSGT: Dan Zhu Ye, Shi Gao, Zhi Gan Cao, Jing Mi, Ren Shen, Mai Men Dong, Ban Xie
Qing Ying Tang (Clear the Nutritive-Level Decoction) - NUTRITIVE LEVEL HEAT AND COOL THE BLOOD
Formula
Chief: Shui Niu Jiao
Deputies: Xuan Shen, Sheng Di, Mai Men Dong
Jin Yin Hua, Lian Qiao, Huang Lan, Dan Zhu Ye, Dan Shen
Confirmation
clears heat from the Ying Level, relieves fire toxin, nourishes the yin
Unblocks the Yang Ming and nourishes the Tai Yin Jue Yin
Zhang Fu: This is heat entering the Ying/Nutritive Level
6 Confirmation: Yang Ming heat damaging the Tai Yin, Jue Yin Fluids
Symptoms
High Fever that worsens at night, sever irritability and restlessness. Some patients are thirst, some delirious, some have faint erythema and purpura
Tongue: scarlet, dry ; Pulse: Thin, rapid
Contraindications
In cases with a white, slippery tongue coating which is an indication of dampness
Modifications:
For severe Qi-Level fire, add shi Gao
For severe depletion of yin, add Sha Shen, Gou Qi Zi
For tremors and spasms, add Gou Teng, Ling Yang Jiao, Di Long
Huang Lian Je Du Tang (Coptis Decoction to Resolve Toxicity) - CLEAR HEAT AND RESOLVE TOXCITY