Foundations of Chinese Medicine: Heat
In Chinese medicine, heat is not simply a symptom or a sign of illness—it is a fundamental part of life. Heat, as a physiological force, makes things move, ripen, transform, and come alive. Without it, we would not be able to digest food, circulate blood, generate thoughts, or maintain consciousness. The natural warmth of the body is what fuels all the processes we associate with vitality.
This healthy, life-giving heat is considered an expression of yáng 陽—the active, dynamic, outward-moving force that balances the body’s cooling, moistening yīn 陰. A warm stomach helps transform food into nutrients. A warm uterus facilitates conception. A warm liver courses the blood and marshalls the qì 氣. In daily life, we see the presence of proper heat when someone feels energized but not frantic, focused but not agitated, and warm without being overheated. It is an essential ingredient in core human function.
Yet just as heat is necessary, it can also become harmful. When it accumulates beyond what the body can manage, or shows up in places it doesn’t belong, it becomes pathogenic heat. In this state, heat begins to dry, inflame, irritate, and disturb. Symptoms can vary widely depending on where the heat expresses itself. A person might experience headaches, red eyes, skin eruptions, or bitter taste in the mouth. Others might notice restlessness, irritability, dry stools, or insomnia. In some cases, heat manifests emotionally: a short fuse, a racing mind, or an inability to settle. In others, it shows up in the tongue and pulse—a red tongue body, a rapid pulse, or thick yellow coating.
Understanding heat as both vital and potentially disruptive is central to Chinese medicine, and this duality is not a new idea. The earliest medical texts, including the Huáng Dì Nèi Jīng 黃帝內經 (Yellow Emperor’s Inner Classic), describe the importance of internal warmth as a foundation for life, while also warning of what happens when heat becomes excessive or enters from the outside. The Shāng Hán Lùn 傷寒論, a classical text on externally-contracted disease, outlines six stages of cold-induced illness, several of which involve the transformation of cold into heat as the body’s yáng rises to fight back. In this framework, heat often emerges as a secondary pattern—something that develops when the body’s defenses are engaged but not yet successful.
The Wēn Bìng Lùn 溫病論, or Treatise on Warm Diseases, later refined this view by focusing on illnesses characterized by heat from the beginning—febrile conditions, seasonal epidemics, and lingering internal inflammation. These texts laid the foundation for how we understand the progression, location, and treatment of heat in the body. They also taught us to distinguish between heat that arises from external factors (such as weather or infection) and heat that is generated internally due to lifestyle, diet, emotion, or constitutional tendencies.
How Heat Shows Up
In the clinic, we see both types regularly. Pathogenic heat from external sources often shows up acutely—fevers, sore throats, inflamed tonsils, or skin outbreaks that come on quickly and with intensity. Internally generated heat is more common in chronic conditions. This might take the form of persistent irritability, digestive inflammation, hormonal heat signs such as hot flashes or night sweats, or heat in the Heart system causing insomnia and vivid dreaming. Heat may also be subtle at first: dryness in the mouth without thirst, slight flushing in the cheeks, or restlessness in the evening. These early signs are often the body’s way of asking for support before something becomes more entrenched.
Seasonally, heat tends to be more of a challenge in the warmer months. Summer is ruled by Fire in the Five Phase system, and it corresponds to the Heart and Small Intestine. During this time, external heat is more present in the environment, and our own yáng rises to meet the season. For many people, this results in a sense of lightness, expansiveness, and energy. But for those who already run warm, or whose yīn resources are insufficient, summer can easily tip into agitation, sleeplessness, or inflammation. This is particularly true if the heat is compounded by stress, overwork, or drying foods and beverages like alcohol, caffeine, or spicy meals.
That said, heat patterns are not limited to summer. People can experience heat in the dead of winter—especially if their internal systems are out of balance. Deficient yīn can no longer anchor the body's natural yáng, resulting in what we call false or empty heat. In these cases, symptoms may include night sweats, five-center heat (warmth in the palms, soles, and chest), or a sensation of heat in the body despite cold weather outside. This is one reason why we always ask about heat signs, regardless of the season.
What To Do About Heat
Managing heat begins with recognition. If the body feels too warm, if the mind is racing, if sleep becomes difficult, or if digestion feels inflamed or overactive, it may be time to assess how much heat is circulating and why. In some cases, the cause is dietary: rich, spicy, fried, or greasy foods tend to generate internal heat, especially if eaten frequently. Alcohol, coffee, and excess red meat can do the same. In other cases, the root is emotional or lifestyle-based. High stress, constant stimulation, late nights, and a lack of cooling rhythms in the day—such as rest, stillness, and adequate hydration—can slowly build heat over time.
There are many ways to support the body when heat becomes a concern. From a lifestyle perspective, establishing routines that allow for adequate rest and regular meals helps anchor yáng activity and prevents it from rising excessively. Favoring foods that are lightly cooked, hydrating, and gentle—such as cooked greens, mung beans, or lightly sweet fruits—can help cool and nourish without taxing digestion. Herbs are often used as a primary intervention, chosen depending on the nature and depth of the heat. Some formulas clear acute, surface-level heat, while others are designed to nourish yīn and drain deficiency fire.
Acupuncture can also play a role in guiding heat where it needs to go, restoring the body’s internal balance of yīn and yáng, and calming the shén when the Heart is overactive. The approach depends on careful assessment: not all heat needs to be cleared, and in some cases, clearing too aggressively can damage the body's healthy warmth.
It’s important to remember that heat, in itself, is not the problem. Heat is life. It is the force that drives us, that moves digestion and thought, that allows us to act and respond. The goal is not to eliminate it, but to keep it appropriate—to support the body in regulating when to rise, when to rest, when to burn, and when to simmer. When that regulation is working, we feel grounded but awake, clear but calm, energized but not overextended. And in that place, heat is not a burden. It is a companion.