A dichotomy encountered endlessly in Chinese medicine exists between those treating symptoms, and those who treat conditions. It is my practice, described elsewhere, to acquire exhaustively all symptoms through an organized interview process that includes a comprehensive review of systems (ROS), once the initial complaints have been detailed. I then translate all symptoms into Chinese medical conditions, organize these conditions, and collate them with signs such as the pulse, tongue, eyes, and sometimes the abdomen.

There are many ways of organizing the acquired information in Chinese medicine. There are the eight principles, the five phases, substances, solid or hollow organs, and pathogenic factors (external and internal). Let us assume that, after having gone through the diagnostic process described above, we have established a diagnosis, and arrive at ‘Heat in the Blood’ as the Chinese medical condition most in need of attention. We have many well-known treatment options, such as Weng Qin Yin, and moxa on Xuehai SP 10.

However, assuming that our treatment reduces the ‘Heat in the Blood’ and symptoms such as hypertension are ameliorated, what will keep the ‘Heat in the Blood’ from returning if we do not also eliminate the source of the ‘Heat in the Blood’? To determine this, we need to ascertain what caused the condition initially, and what aspects of the patient’s lifestyle may perpetuate it.

There are many possibilities. These can be external causes, such as working in a very hot unventilated environment (restaurant kitchens), summer heat and meningitis, are easily identified. Internal causes, such as excess heat in the Stomach-Intestines, are diagnostically more difficult to recognize. However, in such a case, the question would then be raised: why is there excess heat in the Stomach-Intestines? Is it because the food is indigestible and therefore, like a car that overworks and overheats, the Stomach is overworking and overheating? Is this because the person cannot afford easily digestible food, or does not know enough about nutrition? Perhaps he is emotionally driven to eat anything to assuage his hunger for other, more intangible things like love? Or, is the food good, but the amount inappropriate for the patient, and beyond the Stomach’s ability to digest it adequately? It may be that the person eats too rapidly. If so, does he do this because of Heart Qi Agitation, or because he works in an industry where little time is afforded for lunch, or perhaps he is driven by his own ambition, and sets aside pleasure for gain? The food could be too spicy, thereby generating heat, or it could be very cold food that has created stagnation in the Stomach-Intestines, and the body has brought metabolic heat to the area to overcome the stagnation.

An inefficient digestive process due to Spleen-Stomach Qi deficiency can lead to the same overwork scenario described above, due to the accumulation of incompletely-digested food, and the metabolic heat brought to move it. Since Liver Qi is responsible for moving the Qi throughout the body, and is especially responsible for peristalsis, either Liver Qi stagnation (often from repressed emotion) or, more frequently in our time, Liver Qi deficiency will inhibit the downward movement of Qi. It is also possible that a hyper-vigilant ‘Nervous System Tense’ patient could overwork the Liver, and lead to the same result. Problems may also be caused by anorexia and bulimia, the first of which creates Spleen Qi deficiency due to inadequate nutrition, and the latter that drains Spleen-Stomach Qi by repeatedly going against the normal flow of that Qi.

While most symptoms have multiple aetiologies, probably the most common contribution to heat in the blood is repressed emotion (Liver Qi stagnation). This sets off a process which involves the Liver mobilizing metabolic heat to move the stagnation. If this process does not succeed, the heat will become toxic, and the Liver must remove it. Since the Liver stores the Blood, it will usually move the toxic heat there. Being retained in the Blood, the heat will then become a pathogenic entity in itself, usually raising blood pressure over time. Some of the other causes of ‘Heat in the Blood’ could be medications, or heat-creating drugs of abuse (cocaine, amphetamines).

To where does all of this lead? It brings us to the personal questions we must somehow ask patients: what emotions are being repressed, why does someone eat to assuage his emotional pain, why is he eating so rapidly in order to realize his ambitions. Now, we are getting closer to the Root.

The Root usually lays in the deepest part of a person’s psyche, or in the earliest experiences at conception, in utero, at birth or shortly thereafter. Equally, the Root can be emotional shock, such as the loss of a parent or sexual abuse in childhood, or another emotional insult. Each of these complex issues is the subject of further in-depth exploration too extensive for this discussion, but each is at the heart of our search for the Root of our patient’s ‘Heat in the Blood’.

The point of this exercise is to demonstrate that our conventional approaches to diagnosis and treatment – eight principles, etc., described above – are insufficient to heal the core human pain at the Root of our afflictions. It is this that is given so little thought by patients or by many practitioners, but which demands constant attention by all.