Disturbance of the heart by phlegmatic fire refers to the syndrome of mental derangement due to fire, heat and phlegmatic turbid substance disturbing the heart spirit. This syndrome is usually caused by emotional stimulation, transformation of fire from qi stagnation scorching fluid into phlegm; or by exogenous damp heat that accumulates into fire; or by exogenous pathogenic heat that scorches fluid into phlegm and leads to internal disturbance of phlegmatic fire.
 
Clinical manifestations:
Fever, restlessness, or coma with delirium, flushed complexion, thirst, hoarse breath, constipation, yellow urine, or sputum rale in the throat, chest oppression, dysphoria, insomnia, or even mania, fighting against people, breaking objects, ravings, emotional disorder, reddish tongue, yellow and greasy fur as well as slippery and fast pulse, usually seen in craniocerebral infection and manic schizophrenia, etc.

Analysis of symptoms:
Disturbance of the heart by phlegmatic fire is due to either exogenous pathogenic factors or internal impairment. Fever, restlessness, or even coma with delirium and mania are due to phlegmatic fire disturbing heart spirit in exogenous febrile disease; flushed complexion, red eyes and hoarse breath are due to fumigation of internal heat; yellow urine and constipation are due to heat scorching fluid; yellowish thick sputum, or sputum rale in the throat and chest oppression are due to internal exuberance of phlegmatic fire and stagnation of qi; in miscellaneous diseases due to internal impairment, internal exuberance of phlegmatic fire and disturbance of heart spirit lead to dysphoria and insomnia in mild case and mania, ravings, emotional disorder, fighting against people and breaking objects in severe case. Reddish tongue, yellowish greasy fur and slippery and fast pulse are signs of internal exuberance of phlegmatic fire.

Key points for syndrome differentiation: High fever, restlessness or coma with delirium and sputum rale in the throat in exogenous febrile diseases; mania and internal exuberance of phlegmatic fire in miscellaneous diseases with internal impairment.