What is Heat and Fire in Chinese Medicine

By Dr. Chun-Kai Jason Wang, Dr.TCM, BA, practices in Surrey BC


Following the previous article regarding what is dampness in Chinese Medicine, this article will seek to address the next common factor in Chinese Medicine’s view of the disease process—heat/fire. This will be a difficult topic to explain because its nature is less physical than dampness. Heat and fire are actually two separate categories of disease grouping in TCM. The former is a milder, chronic form while the latter is a more acute form. For the sake of brevity, we will refer to both as “heat.” I will say that over 80% of people I have treated have this as part of their problem.

The question many people would like to ask is if “heat” in Chinese Medicine is the same as “inflammation” in Western Medicine. In my experience and understanding, so far one can say they are the same, or at least talking about the same thing; but this “thing” has levels of understanding. Western Medicine, as far as I know, does not differentiate inflammation the same way as Chinese Medicine does. For most of the cases I’ve seen, inflammation in Western Medicine is dealt with using steroids, which are almost always one of a few drugs, never out of the range. Other classes of drugs used are NSAIDS and biologics. I have found little differentiation between the uses of such medications by Western Medicine in relation to the nuances of diseases—they appear to be differentiated by strength mainly. Perhaps it is because of this reason that unfortunately it does not work for everybody.

In TCM, heat is further differentiated into “excess” and “deficiency” heat. In the Huang Di Nei Jing, translated as the Yellow Emperor’s Internal Medicine (the foundational text of TCM), deficiency is defined as the “absence of righteous qi” while excess is termed “firm presence of evil qi.” Here the English translations may vary depending on the author, but their meaning is roughly that “righteous qi,” or “zheng qi,” is the life force of the body which repels outside influences and regulates and maintains the stability of the internal body environment. The “evil qi,” or “xie qi,” is all manners of non-native substances and influences which cause turmoil for the body. Therefore, “deficiency heat” points to the presence of heat from the absence of a foreign influencer, while “excess heat” points to the “firm” presence of such.

These ideas, among others in TCM, may sound almost philosophical, which is a common argument for the lack of scientific rigour in TCM. This is borne from the linearity of Western scientific thinking and the lack of general awareness of the dynamic state of life exhibited in a living human body and the changes it manifests as a result of the disease process, in my opinion. For any person who is practicing Chinese Medicine using these core theories as clinical guidance, they are realities presented in front of the practitioner in real-time and dynamically respond as treatment progresses from point A to point B.

So, readers must be questioning why there is heat when there is an absence of external influencers? For those of you who are Western Medicine minded, the question has actually answered itself. Inflammation for most patients in the clinic is not caused by anything foreign actually. It is mainly autoimmune; the heat is actually the body’s own heat, situated and redirected, or distributed the wrong way. These people can never get any clear positives on blood tests for any causative factors; they will only frequently get readings of various altitudes of inflammation markers such as CRP. This is in contrast to “excess heat” conditions where sometimes patients will test positive for bacterial infection, which is the “external influencer.” For astute audiences, I may be asked if I am contradicting myself because earlier I just mentioned that Western Medicine does not differentiate between types of inflammation. They most certainly do but the above example is a simplified version of the equivalence of TCM heat to Western Medicine inflammation for the sake of brevity. Within even autoimmune, which seemingly is “deficiency heat,” there is also “excess heat.” And within “bacterial infection” that seems to be obviously “excess heat,” there can also be “deficiency heat.” The distinction is important here because depending on how it is determined in TCM, the treatment is different; so, it is not mere philosophical rhetoric—there are marked differences in the way treatment is carried out. But for Western Medicine, once something is determined to be autoimmune or bacterial infection, the drugs used are deterministically linear and do not really change after that.

The final concluding remark is that deficiency heat and excess heat are not clear-cut didactic ideas. They are actually two opposing ends of a spectrum. An absence of righteous qi is never literally complete absence of righteous qi, because that would mean total death as the life force is completely gone. The presence of foreign influence also does not mean there is complete control of the body by such factors because that would the patient is completely overrun and would quickly march towards death as well. There are always scales of severity which tip to either side and shifts cyclically due to the changing state of health of the person. This understanding is important because many patients may already know they are in an “inflammatory” state but do not necessarily get clear diagnoses from their doctor and hence there is no treatment. Yet, their symptoms are clearly manifest. Using TCM lens, these cases are still “diseases” in progress. They simply haven’t gone to the point of being recognized as such in Western Medicine such that immediate hospitalization under intense drug therapy regime is warranted to control the situation. Such cases frequently show up in early-stage conditions of various diseases such as rheumatoid arthritis, IBS, sinus problems, among others. They may also show up in the aftermath of a previous bout of disease such as post-Covid syndrome and upper respiratory tract infections.

Heat is a central pillar in TCM diagnosis because it is present in many patients that seek TCM. However, it is largely metaphysical in nature since there is no physical entity one can assign it to. Even in Western Medicine, vestiges of “less scientific” ancient Greek Medicine lingers in the official nomenclature. When I was studying human anatomy and physiology, one of the 4 types of immunity is still termed “humoral immunity”---humoral alludes to “humor” in Greek Medicine—one of the vital fluids of the body.