In my recent outpatient clinic, I've noticed a quite common phenomenon: many people, upon feeling symptoms of "excessive internal heat," such as mouth ulcers, sore throat, or breakouts on the face, immediately think of taking Sanhuang Pian, Niuhuang Jiedu Pian (Cow Gallstone Detoxification Tablets), or Qingre Jiedu Pian (Clearing Heat and Detoxification Tablets) to suppress it. At first glance, the heat seems to be temporarily subdued, but gradually, many individuals notice that their hands and feet become increasingly cold, their energy levels drop, and they may even begin experiencing palpitations, shortness of breath, and poor sleep at night. What's going on?

This is actually a case of medication being misdirected in its "approach," ultimately harming the body's "fundamental fire source" – the heart yang.

Traditional Chinese medicine holds an important theory that regards "the heart as the monarch among organs," acting as the "supreme commander" of the zang-fu organs. The heart's yang energy (heart yang) is like the sun within the body, warmly illuminating the entire body. If, to clear "internal heat," one indiscriminately uses extremely cold and cooling herbs to "extinguish" heart fire, this overly suppresses the body's "primary fire," inevitably leading to insufficient heat supply throughout the body. With insufficient heat, other organs responsible for bodily functions, particularly the spleen and stomach, will develop problems.

The spleen and stomach are the "source of qi and blood production." What we eat relies on them to transform into nutrients and energy. However, this transformation process especially requires the warmth of heart yang to drive it. Just as cooking requires a stove fire, excessive use of cold, heat-clearing herbs weakens the heart fire (stove fire), and the spleen and stomach (cooking stove) lose their heat source, impairing their function—this is what Chinese medicine calls "insufficient spleen yang." The result? Poor appetite, abdominal bloating after eating, persistent fatigue, and possible dizziness, tinnitus, with various manifestations of "deficiency-cold" emerging. Thus, the spleen and stomach, as the "root of postnatal essence," must never be allowed to become cold. Only warm soil (spleen earth) can nourish all things.

So, when encountering "excess heart fire" conditions, such as irritability, insomnia, reddened tongue tip, and mouth or tongue sores, what should be done? Chinese medicine emphasizes the approach of "guiding fire back to its source" or "leading fire downward," rather than simply and bluntly "extinguishing" it.

For a concrete example: Take the commonly used formula Daochi Powder (a basic formula; specific herbs require a physician's diagnosis and pattern differentiation). Its approach is not to directly "extinguish" heart fire. In the formula, raw Rehmannia root (Sheng Di Huang) nourishes yin and clears heat, equivalent to replenishing moisture for the body's "dry-heat" that lacks water; Akebia stem (Mu Tong) promotes diuresis and relieves strangury, guiding heart fire to be expelled through urine; Lophatherum leaf (Dan Zhu Ye) clears the heart and relieves irritability—its medicinal nature is cool but relatively mild, avoiding excessive damage to heart yang. This is akin to diverting the excessive "fire-water" from the upper reaches of the river (the heart) by dredging channels (diuresis) safely to the lower reaches (the bladder) for expulsion.

Take, for example, the classic *Jiaotai Wan* (composed of *Coptis chinensis* and *Cinnamomum cassia*). Its brilliance lies in its elegant approach to fostering communication between the heart and kidneys. In TCM theory, there is the principle of "Heart-Kidney Interaction": the heart fire needs to descend to warm the kidney water, while the kidney water needs to ascend to nourish the heart fire; balance between the two is ideal. *Jiaotai Wan* employs a small amount of *Coptis chinensis* to clear heart fire, paired with a small amount of *Cinnamomum cassia* to warm kidney yang, guide fire downward, and simultaneously stimulate the kidney water to rise. This prevents the heart fire from burning too intensely, achieving the harmonious state of "water and fire in balance."

【Real Case Study】

Just last week, I saw a 42-year-old woman, Ms. Li. She had been taking *Niuhuang Jiedu Pian* (Bovine Gallstone Antidote Tablets) whenever she got a canker sore and had been doing so for over six months. The result? The sores would come and go, but she became increasingly sensitive to cold, with icy hands and feet. Eating anything slightly cold or greasy would cause abdominal bloating and diarrhea. She felt constantly fatigued and experienced frequent heart palpitations. Upon examining her tongue, I saw it was pale, swollen with tooth marks, and had a white, greasy coating—a classic sign of impaired heart-spleen yang and internal accumulation of cold-dampness. I advised her to immediately stop taking those cold, heat-clearing herbs. Based on her condition, I prescribed a formula to warm and activate spleen yang while guiding fire downward (containing *Zingiberis Rhizoma* / dried ginger, *Atractylodis Macrocephalae Rhizoma*, *Poria*, *Cinnamomum cassia*, etc.) and combined it with moxibustion on Zhongwan (CV12) and Zusanli (ST36) acupoints. After less than a month of this regimen, she reported that her hands and feet were warmer, abdominal bloating and diarrhea were largely gone, her energy had improved significantly, and even her stubborn canker sores were occurring less frequently and with less severity. This case perfectly illustrates how the misuse of cold, heat-clearing herbs can fail to "put out the fire" and instead damage the body!

Doctor Wang concludes: There are many causes of "excessive internal heat," and the adjustment methods vary. Do not mistake heat-clearing and fire-purging medications for cooling herbal tea. Protecting the heart yang and spleen yang is fundamental. If you frequently experience "excessive internal heat" or feel discomfort after using heat-clearing medicines, it is best to consult a professional TCM practitioner for differentiation of symptoms. Find the root cause and choose gentler, more fundamental adjustment methods, such as "guiding fire downward," to restore the body's own balance and warmth.