“Internal Heat” refers to a state of “excessive internal heat” or “internal heat” in the human body, indicating an excess of heat within the body. Common symptoms include mouth and tongue sores, a swollen and sore throat, dry mouth and tongue, dark yellow urine, and hard, dry stools.
The Story of Releasing Kongming Lanterns
Every year on the fifteenth day of the first lunar month, people release Kongming lanterns, sending their wishes and thoughts soaring into the dark night sky.
On the Lantern Festival two years ago, my family and I went out to see the lantern festival after dinner. On the bridge, several families were releasing sky lanterns—each consisting of a large lantern shade with a short, lit candle beneath it. Once the candle heated the air inside the shade, they could let go and watch it soar.
Seeing a neighbor’s family releasing a sky lantern, I stopped in my tracks.
A little girl asked her father, “Daddy, why do sky lanterns fly?”
“It’s because the candle’s flame rises upward, heating the air inside the lantern. Hot air is lighter than cold air, so that’s why it can fly!”
“Why does the candle flame go up? Once the lantern flies up into the sky, won’t the flame turn downward? Then the air inside the lantern will get cold, and it’ll fall back down, right?”
“You’re so silly! Fire always burns upward—fire never burns downward!” said the little girl’s older brother.
The little girl was naturally very dissatisfied with her brother’s answer, but since her father didn’t respond, she could only stare wide-eyed at the rising sky lantern, hoping the candle inside wouldn’t start burning downward.
I had intended to explain to her why fire burns upward and not downward, but I couldn’t immediately think of the most appropriate words that she would understand. Just then, my wife called out to me, so I had to temporarily leave the family as they released their lantern.
As we walked, my wife asked me, “I’ve eaten too many meat dishes over the New Year holidays and have developed a ‘heat’ condition—my teeth are aching. Do we have any medicine at home to clear the heat?”
“Our pharmacy only carries traditional Chinese medicine—we don’t have any over-the-counter formulas. When we get home later, I’ll prepare some herbal tea for you.”
“That’s too bitter.”
“Then let’s go buy a box of Huanglian Shangqing Tablets.”
“Why are they called Huanglian Shangqing Tablets? Is there a ‘Xiaqing Tablet’?” my wife asked jokingly.
“Xiaqing Tablets”? Why aren’t there any “Xiaqing Tablets”? My wife studied Western medicine, and her playful remark actually stumped me.
As I walked, I pondered this and couldn’t help but recall the little girl who had released the sky lantern and the question she’d asked: “Why does fire burn upward? Why doesn’t it burn downward?”
Isn’t this exactly what Traditional Chinese Medicine refers to as “fire rises upward”?
I. Fire Rises to Higher Places; “Upper Fire” Necessarily Starts in the Head
Because heat rises and cold descends, fire in nature always moves upward. By the same principle, fire within the human body also rises. Therefore, when a person experiences “upper fire,” it manifests in the upper jiao—specifically in the head and face. This is a natural law and one of the most fundamental principles.
It is precisely because of this characteristic—that fire rises—that the head and face have such vigorous fire energy and are therefore unafraid of the cold. The *Huangdi Neijing* states: “The head is the convergence point of all yang.” In other words, the body’s yang energy should gather in the head; once there is a deficiency or excess of yang energy in the head, pathological changes will occur.
When yang energy is in excess—“excess qi becomes fire”—the head and face will exhibit various symptoms of “excess heat,” such as a swollen and sore throat, sores in the mouth and on the tongue, red and swollen gums, red, swollen, and painful eyes, and facial bumps… These are all manifestations of “excess heat,” resulting from the nature of fire rising upward!
Conversely, when yang qi is deficient, the head becomes sensitive to cold and wind, leading to chronic deficiency-cold conditions—all manifestations of insufficient yang qi in the head.
Thinking of the Xiaqing Tablets reminded me of sky lanterns; the sky lanterns led me to the nature of fire rising upward; the rising nature of fire led me to the concept that “the head is the convergence of all yang qi”; and this, in turn, led me to consider the excess and deficiency of yang qi in the head… Suddenly, many things clicked into place, and the pathogenesis of numerous chronic head and facial conditions became crystal clear to me.
After my wife took Huanglian Shangqing Tablets, her throat discomfort improved rapidly. A few days later, the treatment of a patient with chronic rhinitis left a deep impression on me as well.
This patient had been suffering from nasal congestion for three years, and the condition had worsened significantly over the past month.
In the patient’s own words, for the past three years, he had suffered from daily nasal congestion; his nose was often clear but not fully unblocked. Even the slightest exposure to cold would trigger a continuous sneezing fit. His symptoms were typically worse upon waking in the morning but would ease after physical activity. A month ago, after being exposed to air conditioning, his condition worsened; he could only breathe through his mouth while sleeping, and prolonged mouth breathing led to a dry mouth and throat discomfort. After using ephedrine nasal drops, she experienced immediate relief, but within two hours, her symptoms returned to their original state. The hospital diagnosed her with chronic allergic rhinitis. After a week of treatment with no significant improvement, she sought treatment from a TCM practitioner. At the time of her consultation, she had a clear nasal discharge, severe nasal congestion, accompanied by a headache in the forehead and stiffness in the neck. Her tongue coating was thin and white, her six pulses were floating and tight, and the left cun pulse was absent.
After taking her pulse, I explained to her that the nasal congestion was caused by cold invading the head. This cold invasion resulted from an insufficiency of yang qi in the head, which in turn stemmed from an insufficiency of internal “fire” in the body. It’s like on a cloudy day when the sun isn’t shining on our heads, and we feel a chilly, damp cold. Similarly, when the heart lacks this “fire,” the head suffers from a deficiency of yang qi, leading to sensitivity to the cold. Even a slight exposure to cold air can easily result in a cold and nasal congestion.
The patient listened to my analysis with a look of partial understanding, then asked, “Does that mean I should eat fewer raw and cold foods and more ‘heaty’ foods from now on?”
I nodded and wrote her a prescription: Guizhi, Baishao, Gegen, Sheng Ma Huang, Tongcao, Shengjiang, and Dazao. I instructed her to take five doses initially, one dose per day, divided into three doses—morning, noon, and evening—to be taken orally after meals.
After taking just three doses, the patient’s condition improved significantly; by the time she finished the fifth dose, her headache and nasal congestion had completely resolved.
This is a classic case of insufficient yang qi in the head. The formula is based on Ge Gen Tang, with the addition of Tongcao.
Many people know that Tongcao is a herb used to promote lactation; it clears heat, promotes urination, and stimulates milk production. In fact, Tongcao has other benefits as well. This white-colored herb enters the Qi level and can regulate the flow of Qi within the body. Whenever there is stagnation of Qi leading to blood stasis or dampness obstruction, combining Tongcao yields remarkable results. Additionally, Tongcao ascends to the head, so it can be used to treat any issues involving blocked orifices in the head and face. In the case described above, Tongcao was added specifically for its ability to clear nasal passages.
When yang energy is deficient in the head and face, cold arises; when yang energy is in excess, it transforms into fire.
Clinically, we often see large boils and abscesses on the head and face—these are all signs of “fire” in the body. Why do large boils appear more frequently on the head and face than on the lower limbs? This is the result of “fire rising upward.” Fire belongs to yang, and yang energy tends to rise; therefore, when fire pathogens harm the body, they are more likely to manifest in the head and face.
II. Clearing “Fire” Requires Care; Do Not Abuse Medications
How should one treat “fire” in the body?
Anyone with a basic understanding of health care knows to take medications that clear “fire”!
What kind of medications should one take?
There are many Chinese patent medicines and herbal remedies that clear heat and eliminate toxins—but can they be chosen at random?
In fact, treating “fire” in the upper jiao requires great care, because improper use of medication can actually exacerbate internal cold—resulting in the “fire” not being cleared while the cold pathogen is instead intensified.
The pathogenesis of “excessive internal heat” can be attributed to the category of warm diseases. The principle proposed by Qing Dynasty warm disease scholar Ye Tianshi in *Treatise on Exogenous Warm-Heat Diseases*—“Treating the upper jiao is like a feather; it cannot be lifted without lightness”—serves as a key guiding principle for treating heat-related conditions in the head and face.
According to the theory of “ascending, descending, floating, and sinking,” a herb’s tendency to move in these directions is related not only to its nature, flavor, medicinal part, and density but also to the dosage administered.
For the same herb, a small dose can ascend to the exterior, while a large dose can descend to the interior.
For example, the Mulberry and Chrysanthemum Decoction (Sangju Decoction) treats wind-heat exogenous pathogens and is most effective for patients who only have a cough and no fever. The selection of herbs in this formula is highly meticulous: not only are their nature and flavor both mild, but the quantities listed in the formula—”1 qian of chrysanthemum, 2 qian and 5 fen of mulberry leaf, 2 qian of apricot kernel, 1 qian and 5 fen of forsythia, 8 fen of mint, Platycodon root 2 qian, Licorice root 0.8 fen, and Reed root 2 qian”—all in very small quantities.
Another example is the Mulberry and Apricot Decoction, which is also an effective remedy for external pathogenic factors. Its composition is “Apricot kernels 1.5 qian, Mulberry leaves 1 qian, Scrophularia root 2 qian, Oyster shell 1 qian, Fermented soybeans 1 qian, Gardenia peel 1 qian, and Pear peel 1 qian.” The largest dosage in this formula does not exceed two qian, clearly demonstrating how light the doses are!
“Light” means as light as a feather, drifting upward to reach the Upper Jiao, where it harnesses the natural flow to expel pathogens outward. Conversely, if the dosage is heavy, it sinks downward, causing pathogens to become trapped internally or giving rise to other conditions.
The saying, “Treating the Upper Jiao is like a feather—only lightness can lift it,” carries two meanings: First, the dosage must be light; second, one must select herbs that are both mild in nature and aroma, such as mulberry leaves, chrysanthemum, dandelion, and mint.
Wu Jutong also noted in his commentary on the Mulberry and Apricot Decoction in *Treatise on Warm Diseases*: “Light herbs must not be used in heavy doses; if used heavily, they will inevitably exceed the affected area.”
It is difficult for patients to determine the appropriate dosage on their own. In such cases, I recommend that patients take proprietary Chinese medicines, such as Huanglian Shangqing Tablets, Niuhuang Shangqing Tablets, or Sanhuang Tablets. Taken after meals, these will take effect promptly.
Proprietary Chinese medicines are taken in very small doses—just a few tablets at a time—and are taken after meals. As the medicine travels to the upper jiao, this approach aligns with the principle that “treating the upper jiao is like a feather; it cannot be lifted without lightness.”
For those who frequently experience “internal heat,” in addition to taking medication, I also recommend regularly brewing teas with chrysanthemum flowers and mulberry leaves. These mild ingredients can provide excellent therapeutic and preventive benefits.
III. When “Fire” from the Five Zang Organs Rises to the Head, It Can Be Distinguished Based on the Site of Manifestation
“Fire rises upward by its nature.” The “fire” referred to here encompasses both external pathogens that invade the head and face and transform into fire, as well as fire originating from the zang-fu organs. When the qi and blood of the five zang organs become stagnant and fail to flow smoothly, excess qi transforms into fire. Once transformed, this fire travels upward to the head via its corresponding meridians. Therefore, when we observe “excessive heat” in the head and face, in addition to clearing the upper jiao, we must also consider the source of the fire—namely, the fire of the five zang organs.
Fire manifesting on the scalp (itching, bumps) is related to excessive lung fire, because “the lung governs the skin and hair” .
Fire rising to the eyes (redness, swelling, heat, and pain) is related to excessive liver fire, because “the liver opens its orifice to the eyes.”
Fire rising to the face (lumps) is related to the heart, because “the radiance of the heart is reflected on the face.”
Fire rising to the ears (pain, lumps) is related to the kidneys, because “the kidneys open their orifice to the ears.”
Fire manifesting in the nose (heat in the nasal cavity and boils) is related to the lungs, because “the lungs open to the nose.”
Fire manifesting in the mouth and tongue (sores) is related to the heart, because “the tongue is the sprout of the heart.”
Fire manifesting in the gums (swelling and pain) is related to the stomach, because “the gums belong to the stomach.”
By understanding these characteristics, one can identify the specific condition and, when selecting light and cooling herbs to treat “excess fire,” choose medications purposefully to target the root of the problem.
Some might ask: Since fire naturally rises—meaning that fire within the body tends to ascend to the head and face—why do some people experience redness and swelling in their lower limbs? Why does Traditional Chinese Medicine attribute many gynecological inflammations to heat and fire?
Let’s look at another story: the story of the wet clothes.
