See heat sign? Clearing Heat may not be the correct treatment plan

Diagnosed heat signs was one of the easier patterns to recognize while I was studying as an acupuncture and oriental medicine student. Every time when I see redness and hot symptoms I automatically strategize a clearing heat treatment plan, without a doubt. One incident that peaked my interest in diagnosed heat symptom was when one of my classmate had an allergy reaction that resulted in hot and red skin rashes during flare-ups. The classmate was given a herbal formula Xiao Feng San, but had only saw slight improvement. Not giving up hope, the classmate sought after another acupuncturist that was well known and was prescribed Fu Zi Li Zhong Wan, which surprisingly eased the hot and red skin rashes. To my amazement and lack of experience, I began to seek more knowledge on why the acupuncturist used a hot property herb, Fu Zi, to treat heat symptoms. My first patient, after I became a licensed acupuncturist, the chief complaint was persistent acne and acne scars. The patient’s acne, like most people, was red and located around the Yang Ming Channels. Patient had previously sought treatment for the same issue with another acupuncturist for one and a half years. The acupuncturist prescribed her herbal formulas which had cold properties and clearing heat function. In the beginning there was slight improvements and the acne seemed to lessen. However, this only lasted a shorten amount of time and the acne would flare up causing more acne. This made me wonder why such visible heat symptoms was given the proper diagnoses and treatment, but did not have any improvements. I checked my patient’s tongue and pulse and to my surprise there wasn’t much heat signs. The patient’s tongue did present slight red dots on the front of the tongue but overall the tongue had presented spleen deficiency and slight cold in the middle jiao, while the pulse had no heat sign. I, then began to strategist the questions and treatment plan. I asked the patient if there was feelings of bloating after taking those herbal formulas? Patient said yes, which then I asked the patient to take a hiatus on those herbal formulas and begin a new set of acupuncture treatments to balance the yin and yang. It’s always easy to differentiate visible heat signs, but the root of the heat sign is more important. Before jumping into conclusion on a treatment plan for diagnosed heat, we can take a step back to the essential elements of our body, Yin and Yang.

Huang Di Nei Jing, Su Wen, Chapter 5: "As for yin and yang, they are the Way of heaven and earth, the fundamental principles [governing] the myriad beings, father and mother to all changes and transformations, the basis and beginning of generating life and killing, the palace of spirit brilliance. To treat diseases, one must search for the basis."(Unschuld, Tessenow, & Zheng, 2011, P. 95)

Where was the heat coming from?

Acne in TCM is a mixture of damp and heat. Dampness accumulation, in most cases, can create heat. When a practitioner automatically diagnose an acne patient as heat and focuses the treatment on clearing heat, the patient may feel slight improvement for a short duration of time. The herbs prescribed by the practitioner was suppressing the heat which causes temporary relief. Every organ has it's own balance of Yin and Yang (Cold/Heat). When a person consumes excessive amount of cold food or herbs, coldness will dominate in the stomach and cause an imbalance of Yin and Yang. This will then cause the normal heat(yang) in Stomach Organ to rise upward which will cause acne to flare up. The patient may also feel bloated due to the stagnant cold energy in the Middle Jiao. Like Huang Di Nei Jing said:

When turbid qi* is in the upper [regions], then this generates bloating (Unschuld, Tessenow, & Zheng, 2011, P. 96-97).

*Turbid qi is yin and in normal state it should go down not stay up.

In this case the treatment focus should not be clearing heat but bring the heat (Stomach yang qi) back into the right place. We may use acupuncture to balance the Yin and Yang. We may also prescribe large dose of warm/hot herbs (ginger is a great choice) and make sure patient is not consuming cold food/drink/herbs during this period of time. If not, the coldness will push all the warming herb/food up which will become more problematic. It is best to follow up with the patient regularly to check their progress, as you need to alter hot herbs. Long term use of hot herbs may generate heat and cause dryness which will result in illness. Always remember about balancing Yin and Yang is the key when treating patients! For acne cases, I like to focus on draining damp rather than just clearing heat. But of course, every case is different and it is best to check the patients' condition to find an optimal treatment plan. In my treatment plan I would also recommend acne patients to cook red beans and job’s tear soup to help drain dampness. Remember, food is also one of the essential elements for healing.

Now, back to the original allergy case, it is now easier to understand why the acupuncturist prescribed Fu Zi Li Zhong Wan to my classmate. The coldness in the middle jiao pushed heat(yang) out causing red rashes. Fu Zi Li Zhong Wan formula will warm and strengthen the middle jiao. Therefore, when Yin and Yang are balanced, illnesses are gone.

Make sure you explain to patients

Recently one patient came in for consultation. He was holding a huge ice cold drink when he walked in and within 15 minutes he already finished 2/3 of his icy cold drink. He complained of a diarrhea problem during the morning and on occasion the diarrhea would persist the whole day. He also complained of muscle ache. The patient had sought an acupuncturist prior to coming to me. The previous acupuncturist checked his tongue and said "you have heat" but did not explain more. The patient went home started drinking chrysanthemum tea everyday hoping to clear "the heat." As we can see, the cold has dominated the digestive system. Yang energy has become too weak to make clear qi rise. In Huang Di Nei Jing we know:

When clear qi* is in the lower [regions of the body], then this generates outflow of [undigested] food** (Unschuld, Tessenow, & Zheng, 2011, P. 96).

*normal clear qi should go up

**outflow of food means diarrhea

Therefore, diarrhea occurred. We also know extreme cold generates heat. Upon checking the patient’s tongue there was notable red dots but was lacking heat signs in his pulse. There is some inflammation (heat) in the body, but that is not the main cause of the disease. Patient went home with a understanding of "I need to drink more ice cold stuff to clear my heat" when in actuality there is cold in Yang Ming. Drinking chrysanthemum tea and ice cold drink made the condition worse and aggravated the problems. It is our responsibility as practitioners to explain to the patient about how to balance yin and yang (heat/cold) and provide better treatment plan. I believe in holistic approach medicine. Healing only starts when patients and practitioners work together.

**Disclaimer: this blog is meant to be sharing my experience when treating patients. The treatment suggestion in the article may not be suitable for everyone. Every individual's case is different, if you are a patient, please make sure always talk to a professional before trying any remedies. If you are a student or practitioner, please always thoroughly check patients condition before deciding the treatment plan.**

Citation

1. Unschuld, P. U., Tessenow, H., & Zheng, J. (2011). Huang Di nei jing su wen: An annotated translation of Huang Dis inner classic-basic questions. Berkeley, CA: University of California Press.