Yin Fire Case Histories from China

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

The theory of yin fire was developed by Li Gao (a.k.a. Dong-yuan) in the Jin-Yuan dynasties. It is my experience that this theory is one of the most important for understanding how to pattern discriminate and treat knotty, difficult to treat diseases with Chinese medicine. Unfortunately, this theory is not well known either in China, its birthplace, or in the West, the adopted home of Chinese medicine. Recently, in talking to a graduate of a six year program at the Guangdong College of Chinese Medicine, it became apparent to me that this theory is not routinely taught even to postgraduate students in the People’s Republic of China. Therefore, I am always on the look-out for any information on this theory and its clinical use. To me, it is one of the irreplaceable keys to success in clinical practice. Recently, Zhang Qi and Long Jia-jun presented a series of case histories in the Zhe Jiang Zhong Yi Za Zhi (Zhejiang College of Chinese Medicine) which were all treated based on yin fire theory.[1] A summary of these is presented below.

Zhang and Long begin their article by stating that the lower burner ministerial fire between the kidneys should be downborne and should be stored if it is to perform its healthy function in the body and that it and the original or source qi mutually control each other.[2]^,[3] If the original qi is exuberant, this leads to ministerial fire being downborne and stored. However, if the spleen and stomach are vacuous and declining, i.e., the source of engenderment and transformation of the original qi, it will not be able to control ministerial fire. In that case, ministerial fire may seize this opportunity to leave its place in the lower burner and rather surge and attack the upper and middle two burners. This is essentially Li Dong-yuan’s definition and description of the engenderment of yin fire, a pathological manifestation or transformation of ministerial fire. However, I think it is a particularly clear and succinct description. Following Li’s lead, when the Zhang and Long come across yin fire in their clinical practice, they use the methods of upbearing yang and scattering fire as the basis of their treatment methods. In this way, they have been able to treat a number of so-called difficult to treat diseases with good results.

Chronic cholecystitis

The patient was a 40 year old female. For four years, this woman had been dieting to reduce her weight. However, her weight did not decrease. Her appetite was poor, and her stools tended to be soft and formless. If she became fatigued, this would easily lead to loose stools. She had already been administered Bu Zhong Yi Qi Tang and Wan (Supplement the Center & Boost the Qi Decoction and Pills) and Xiang Sha Liu Jun Zi Wan (Auklandia & Amomum Six Gentlemen Pills), following which her condition had improved somewhat. Beginning in 1996, the woman had felt an insidious, nagging pain in her upper right abdomen which was worse after eating greasy, oily food. She lost all though for eating and drinking, and ultrasonography confirmed a diagnosis of chronic cholecystitis. For this, she was administered many different types of Chinese and Western medicines, all without marked effect. Therefore, she came to Zhang and Long for examination.

This examination revealed a pale red tongue with teeth-marks on its edges and white fur and a fine, bowstring pulse. Her pattern was categorized as spleen-stomach qi vacuity with yin fire upbearing and jumping and gallbladder depression qi stagnation. The formula used was Sheng Yang Yi Wei Tang (Upbear Yang & Boost the Stomach Decoction): Radix Codonopsitis Pilosulae (Dang Shen), Radix Astragali Membranacei (Huang Qi), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis (Ze Xie), and Radix Albus Paeoniae Lactiflorae (Bai Shao), 10g each, Rhizoma Coptidis Chinensis (Huang Lian), 2g, Rhizoma Pinelliae Ternatae (Ban Xia), Radix Et Rhizoma Notopterygii (Qiang Huo), and Radix Angelicae Pubescentis (Du Huo), 6g each, Pericarpium Citri Reticulatae (Chen Pi), Radix Ledebouriellae Divaricatae (Fang Feng), and Radix Bupleuri (Chai Hu), 5g each, and mix-fried Radix Glycyrrhizae (Gan Cao), 3g.

After a half month of administering the above medicinals, the upper right-sided abdominal pain was decreased, her appetite gradually had improved, and her stools had form. Therefore, the formula was continued for another two months in order to consolidate the treatment effects. At that time, repeat ultrasonography was normal. On follow-up after one year, there had been no recurrence.

From my point of view, we may have also described this woman’s condition as a liver-spleen disharmony with depressive heat. However, in this case, spleen vacuity was more severe than liver depression, and I think that is why the authors of this case chose to use the theory of yin fire. According to yin fire theory, there are five basic mechanisms to yin fire: 1) spleen vacuity, 2) liver depression/depressive heat, 3) damp heat, 4) yin-blood vacuity/vacuity heat, and 5) stirring of ministerial fire. In order to have a yin fire scenario, one must have at least two of these five: marked spleen and stirring of ministerial fire. However, in real-life practice, it is rare to find spleen vacuity without liver depression and vice versa. Therefore, most patients with yin fire scenarios have at least three patterns concomitantly: spleen vacuity, liver depression, and stirring of ministerial fire, with this stirring of ministerial fire being due to either depressive, damp, or vacuity heat. Further, it should be noted that there is scant difference between exterior-resolving, qi-rectifying, and wind-treating medicinals. All are acrid and windy natured medicinals which scatter and move. In this case, the use of these types of yang-upbearing and out-thrusting medicinals coursed the liver and rectified the qi, cleared depressive heat by out-thrusting, and helped the spleen qi recuperate by upbearing the clear and, therefore, downbearing the turbid.

Neurasthenia

The patient was a 39 year old female who had had chronic gastritis for 20 years. In 1993, the woman began to sleep poorly at night with difficulty falling asleep. When this was severe, she would not be able to sleep the whole night. For a long time, she had been administered various types of Western sedatives, such as Valium. Her insomnia was accompanied by6 heart vexation and restlessness, dizziness, impaired memory, low-grade fever in the afternoon, burning skin on the palms of her hands, devitalized eating and drinking, and lassitude of the spirit. Her tongue was pale with teeth-marks on its edges and white fur, while her pulse was fine.

Based on the above, the patient’s pattern was categorized as middle burner vacuity and dispiritedness with yin fire internally harassing the heart spirit. For this, the formula used was Sheng Yang San Huo Tang (Upbear Yang & Scatter Fire Decoction): Radix Puerariae (Ge Gen), Radix Codonopsitis Pilosulae (Dang Shen), and Cortex Albizziae Julibrissinis (He Huan Pi), 10g each, mix-fried Rhizoma Cimicifugae (Sheng Ma) and Radix Ledebouriellae Divaricatae (Fang Feng), 6g each, Radix Bupleuri (Chai Hu), Radix Et Rhizoma Notopterygii (Qiang Huo), and Radix Angelicae Pubescentis (Du Huo), 5g each, Radix Albus Paeoniae Lactiflorae (Bai Shao), 12g, Caulis Polygoni Multiflori (Ye Jiao Teng), 15g, and mix-fried Radix Glycyrrhizae (Gan Cao), 3g.

After a half month of administration of these medicinals, the patient’s sleep was markedly improved and she did not have to use sedatives to go to sleep. The above formula was continued for another month to consolidate the treatment effects, the insomnia was cured, and the woman was considered cured.

The authors quote Li Dong-yuan in their discussion by saying, "[If] the original qi is full and sufficient, then there is no place from which the spleen and stomach can be damaged. They also quote Zhu Dan-xi by saying, "Stomach vacuity leads to non-obtaining of sleep." According to Zhang and Long, because of chronic stomach disease, the central qi had become vacuous and depleted and movement and transformation had lost their duty, the very source of the engenderment and production of the original qi. Hence the lower burner ministerial fire between the kidneys had taken advantage of this vacuity to frenetically stir, harassing and causing chaos to the heart spirit above. This then resulted in difficulty sleeping at night and insomnia. What is interesting about this case is the correct result was achieved without using any heavy, yang-subduing, spirit-quieting medicinals. In fact, yang-upbearing medicinals where used instead. These rectified the qi mechanism so that the spleen could engender and transform blood to nourish the heart spirit. These acrid, windy, upbearing medicinals also scattered and out-thrust depressive heat harassing the heart. Hence no bitter, cold medicinals were employed. This is an excellent example of controlling upwardly counterflowing and harassing yin fire by paradoxically upbearing clear yang. Once again, the key was that spleen vacuity was the single most prominent among all the woman’s several disease mechanisms.

Oral cavity sore & ulcers

The patient was a 33 year old female. During the previous year, this woman had had vomiting and diarrhea for which she had been treated and her condition had improved. However, her stools still tended to be somewhat loose and her epigastrium was sometimes distended. Further, she frequently had sores and ulcerations with her oral cavity. These typically occurred approximately once a month. The woman had been treated by both Western and Chinese medicines for these oral sores but without marked effect. For instance, she had been given Huang Lian Shang Qing Pian (Coptis Clear the Upper Tablets).

When Zhang and Long examined this woman, they found an ulcerated sore the size of a yellow soybean on the woman’s lower lip which was white in color with slightly red edges. According to the patient, both diet and lifestyle made such sores worse. The sore was accompanied by epigastric distention, oppression, and discomfort, poor appetite, loose, formless stools, lassitude of the spirit, and lack of strength. The woman’s tongue was pale and fat with teeth-marks on its edges and white fur. Her pulse was fine and slippery. Therefore, her pattern was categorized as spleen-stomach qi vacuity with yin fire flaming upward. The formula used was Bu Zhong Yi Qi Tang Jia Jian (Supplement the Center & Boost the Qi Decoction with Additions & Subtractions): uncooked Radix Astragali Membranacei (Huang Qi), 20g, Radix Codonopsitis Pilosulae (Dang Shen), 12g, stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Angelicae Sinensis (Dang Gui), and Fructus Forsythiae Suspensae (Lian Qiao), 10g each, Rhizoma Cimicifugae (Sheng Ma), 6g, Radix Bupleuri (Chai Hu), Pericarpium Citri Reticulatae (Chen Pi), and Radix Glycyrrhizae (Gan Cao), 5g each.

After administering five ji of the above formula, the oral cavity aching and pain improved, the oral ulcers marked shrunk in size, and the woman’s appetite increased. She was administered another five ji and the ulcers had healed and all her symptoms had disappeared. When she stopped taking these medicinals, there was no recurrence.

According to the Kou Chi Lei Yao (Mouth & Teeth Categorized Essentials): "Mouth sores... middle burner vacuity cold, lower burner yin fire." The spleen opens into the orifice of the mouth and the spleen channel connects with the underside of the tongue. This patient had a history of acute vomiting and diarrhea for which she had been treated with bitter, cold ingredients. Although these had removed the damp heat, they had caused the spleen and stomach to become vacuous. Thus ministerial fire had lost its restraint and had floated upward to the spleen orifice where, as yin fire, it had brewed and putrefied the skin and flesh, thus forming sores and ulcers. Once again, the treatment for re-exerting control over this upwardly counterflowing ministerial fire was to upbear yang, with only a single ingredient to clear heat and resolves toxins from the local area, i.e., Lian Qiao. By promoting the spleen and stomach’s fortification and movement, the original qi was filled and made replete. Thus ministerial fire was controlled and made to hide or lie deeply once again, and the oral sores healed themselves.

Chronic sinusitis

The patient was a 27 year old male who had been having recurrent sinusitis for one year. There was profuse nasal mucous which was yellow in color and thick in consistency. This was accompanied by headache which came and went. The man had already been diagnosed as suffering from chronic sinusitis at an ENT clinic and had been administered a number of different types of Chinese and Western medicines without much result.

When the man came to see Zhang and Long, his nose was congested and there was yellow, turbid mucous running from his nose. In addition, there was headache, dizziness, and decreased memory. His tongue was pale red with slimy, white fur. His pulse was fine and slippery. Therefore, his pattern was categorized as central vacuity with dampness and stagnation and yin fire flaming upward, steaming and burning the orifice of the nose. The formula used was Bu Pi Wei Xie Yin Huo Sheng Yang Tang (Supplement the Spleen & Stomach, Drain Yin Fire & Upbear Yang Decoction): Radix Bupleuri (Chai Hu), 8g, Radix Et Rhizoma Notopterygii (Qiang Huo), Rhizoma Cimicifugae (Sheng Ma), Radix Codonopsitis Pilosulae (Dang Shen), Radix Astragali Membranacei (Huang Qi), Rhizoma Atractylodis (Cang Zhu), and Fructus Xanthii Sibirici (Cang Er Zi), 10g each, Radix Scutellariae Baicalensis (Huang Qin), 6g, Rhizoma Coptidis Chinensis (Huang Lian) and mix-fried Radix Glycyrrhizae (Gan Cao), 3g each.

After administering seven ji of this formula, the patient’s condition was greatly reduced. In order to promote complete resolution, he was prescribed another 14 ji. after which he was deemed cured. On follow-up one year later, there had been no recurrence.

In their discussion of this man’s case, Zhang and Long mention that, due to his occupation, he suffered from excessive thinking and worry and eat at irregular times. Therefore, hunger and satiation were inconstant, and this had resulted in his spleen and stomach becoming vacuous and weak and movement and transformation losing their duty. Therefore, dampness and turbidity had collected internally, and the clear yang was not upborne. Instead, with nothing to control it, yin fire had mixed with dampness and followed the channels upward to steam the nasal orifices. This had caused putrefaction of the membranes within the nose and thus the symptoms of sinusitis, such as the nasal congestion and yellow discharge. While other practitioners may simply have classified this case as damp heat in the gallbladder channel, Zhang and Long recognized the importance of the spleen vacuity component in this patient, and, therefore, were able to apply Li Dong-yuan’s yin fire theory quite successfully.