this is severe obstruction of the three jiaos by fire toxin (heat toxin), which pervades both the interior and exterior.

toxin can develop when an external pathogenic influence is transformed by constraint, or from the accumulation of internally-generated heat. the fire toxin that ensues in turn pervades the three jiaos and disturbs the spirit. this manifests as high fever, irritability, and in severe cases, incoherent speech and insomnia.

the searing heat injures the fluids and dries the mouth and throat. severe heat may also induce reckless movement of blood (especially in the upper part of the body) which causes nosebleed or vomiting of blood. injury to the blood vessels can result in leakage to the skin and the muscle layer produces carbuncles, boils, and other types of suppurative swellings.

a red tongue with a yellow coating and a fast, forceful pulse reflect the presence of fire toxin. in some cases, fire toxin from constraint may cause damp-heat dysenteric disorders or jaundice.

(bensky & barolet)