Teacher Wu Xiongzhi integrates cold and warm theories to interpret damp-heat disease from the Six Meridian system, which is very interesting. Here are some notes from the lecture.
Overview of Damp-Heat
1. Hidden Pathogens and New Infections
Hidden pathogens primarily manifest as damp-heat disease. Hidden pathogens move directly from the Ying (nutritive) and Xue (blood) levels to the Wei (defensive) Qi level, while new infections arise from the Wei Qi and Ying Xue. Hidden pathogens in warm diseases are often seen in many severe illnesses.
Warm and Damp-Heat
Warm diseases are often new infections, while hidden pathogens are mostly damp-heat, although damp-heat can also present as new infections. Damp-heat diseases can be treated with warming herbs, while warm diseases should avoid warming herbs like ginger. It is essential to differentiate between the Spleen-Stomach and Liver-Gallbladder in damp-heat diseases; if the tongue coating is thick and greasy but the San Ren Tang (Three Nut Decoction) is ineffective, then Gan Lu Xiao Du Dan (Sweet Dew Detoxifying Pill) is needed for the Liver-Gallbladder.
2. Key Symptoms and Signs of Damp-Heat Disease
Four Major Symptoms of Damp-Heat: Sweating, chest fullness, greasy tongue coating, thirst (without desire to drink).
“1. Damp-heat syndrome begins with aversion to cold, followed by heat without cold, sweating, chest fullness, white tongue, and thirst without desire to drink.” (from the chapter on Damp-Heat Disease)
Greasy White Coating
Greasy coating indicates damp-heat obstruction; although the coating may be white and greasy, the tongue body is red.
Chest Fullness Location: Epigastrium and Heart Region
Chest fullness arises from damp-heat, where Qi deficiency leads to dampness, which then obstructs the Spleen; most cases are Qi stagnation, but there can also be water retention or food stagnation.
Sweating
① Only sweating on the head, returning to the neck ② Sweating all over the body.
Fever
Damp-heat closure leads to body heat without elevation; upon touch, the body feels hot, and sweating does not relieve the heat, distinguishing it from the fever of typhoid.
Jaundice
① Damp-heat pulse is deep, with heat stagnating internally, preventing heat from rising; use Yin Chen Hao Tang (Artemisia Scoparia Decoction). Individuals with damp-heat often have yellowish skin.
② In cases of severe damp-heat, symptoms like vomiting and fullness are prominent; if heat is severe, fever is also pronounced.
③ For jaundice due to damp-heat, treatment should last at least eighteen days; if treated for more than ten days and symptoms worsen, it becomes difficult to manage.
④ In Yangming disease, where heat cannot rise, there is a feeling of frustration; use Zhi Zi Chi Tang (Gardenia and Prepared Soybean Decoction).
Possible Symptoms of Damp-Heat Disease: Thirst without desire to drink, difficulty urinating, and rapid bowel movements.
3. Pulse Characteristics of Damp-Heat Disease: Fine, Slippery, Wiry, and Slow
Fine Pulse:
① Yin deficiency with Shaoyin disease; antagonistic effects of natriuretic peptide and the renin-angiotensin-aldosterone system.
② Middle cold: use Dang Gui Si Ni Tang (Angelica Decoction for Cold Extremities).
③ Middle dampness: the limbic system regulates emotions, and increased smooth muscle tension leads to a fine wiry pulse, indicating Shaoyang disease.
Slippery Pulse:Indicates phlegm or food; if a slippery pulse is felt at the wrist, damp-heat is descending, possibly indicating inflammation or tumors in the lower jiao reproductive system.
Wiry Pulse:Corresponds to the Liver-Gallbladder meridian; phlegm, cold, and heat can cause headaches and excessive phlegm.
Slow Pulse:Similar to the slow pulse seen in Western medicine for typhoid; heat is obstructed by dampness. However, a slow pulse may indicate deficiency of Qi and excess of Wei, or wind, dampness, or Spleen deficiency.
Hidden Pathogen Pulse:Fine and weak pulse.
4. Overview of Tongue Signs in Damp-Heat Disease
1) A red tongue indicates hidden heat, while a yellow coating often accompanies bacterial infections.
2) White Coating (often with a crimson tongue base):
If the white coating is thick and dry, it indicates stomach dryness and Qi injury; if thin and dry, it indicates lung fluid injury; a white coating with a crimson base indicates dampness obstructing heat; a swollen tongue indicates the need for Da Huang (Rhubarb) to clear the bowels; a white, sticky coating with thick, turbid saliva and a sweet taste indicates Spleen dampness, treated with Peilan (distinguishing it from Ban Xia syndrome with fine saliva and double line tongue coating); a white coating thick as powder with purple edges indicates epidemic disease (typhoid tongue); if this tongue is seen, the prognosis is poor;
3) Yellow Coating:
If the yellow coating is not too thick and slippery, it indicates heat has not yet injured fluids, and it can still be treated with cooling herbs; if it is thin but dry, it indicates that although the pathogen has left, the fluids are injured, and bitter heavy herbs should be avoided, using sweet, cold, and light herbs instead;
Heat transmitted to the Ying level will cause the tongue to be crimson: inflammation activates the coagulation system, leading to a hypercoagulable state (if external heat invades, internal channels will close, which cannot be opened by herbs like Acorus or Curcuma); a crimson tongue with yellow and white indicates that the Qi-level pathogen has not yet been resolved, and the Wei and Ying levels can be harmonized; if the tongue is crimson and feels moist, it indicates the presence of fluids; this fluid deficiency with damp-heat will lead to turbid phlegm, obstructing the heart; a crimson tongue with a sticky coating that resembles coating but is not coating indicates the presence of foul gas, requiring urgent aromatic herbs to expel it; a crimson tongue that is difficult to retract indicates phlegm obstructing the root of the tongue, indicating internal wind (which may lead to convulsions); a crimson and shiny tongue indicates stomach Yin deficiency, requiring urgent use of sweet, cool, and moistening herbs; a crimson tongue with yellow and white spots indicates the potential for sores (fungal), while large red spots indicate heat toxin affecting the heart, treated with Huang Lian (Coptis) and Jin Zhi (Golden Juice); if the tongue is crimson but not fresh, dry, and withered, it indicates kidney Yin deficiency, requiring urgent treatment with Ejiao (Donkey-hide Gelatin), egg yolk, Rehmannia, and Asparagus; if treatment is delayed, it may lead to severe deficiency with no recovery (Huang Lian Ejiao Tang, modified Bai He Di Huang Tang).
4) Purple Tongue:
In cases of heat transmitted to the Ying and blood levels, individuals may have pre-existing blood stasis in the chest, leading to a purple and dark tongue; upon palpation, it feels damp, requiring blood-moving herbs like amber, Salvia, peach kernel, and Moutan root; otherwise, blood stasis and heat will obstruct the righteous Qi, leading to manic symptoms; if the tongue is purple and swollen, it indicates alcohol toxicity affecting the heart; if purple and dull, it indicates kidney and liver color deviation, which is difficult to treat.
2. Characteristics of Dampness.
Dampness is sticky, causing oily skin, sticky stools, and thick discharge;
Dampness is heavy and turbid, causing a feeling of heaviness throughout the body;
Dampness is persistent, leading to long-term illness and easy recurrence;
Dampness tends to descend, easily affecting the Yin position, descending and steaming upward, diffusing through the three jiao.
3. Key Points for Differentiating Damp-Heat Disease:
Yang pathways are full, while Yin pathways are deficient: Taiyin Qi deficiency with heavy dampness, Yangming heat is severe.
All wind-related dizziness belongs to the liver: use Xiao Chai Hu Tang (Minor Bupleurum Decoction) for Shaoyang;
All cold-related retractions belong to the kidney: Tai Shao two sensations;
All Qi stagnation belongs to the lung: disperse lung and treat dampness, Taiyin;
All dampness-related swelling belongs to the spleen: internal and external pathogens combine, Taiyin;
All spasms and stiffness belong to dampness: damp-heat enters the meridian tunnels;
All reversal of fluids, muddy water, belongs to heat: reversal leads to twisting, stomach angle bending backward, twisting indicates bending;
All diseases with clear, cold fluids belong to cold;
All vomiting and sourness, violent downward pressure, belong to heat;
All diseases with swelling, pain, and fright belong to fire: foot swelling accompanied by low back pain, fright and restlessness, such as erysipelas, pain, acute rheumatic arthritis.
The two major differentiation methods for warm diseases focus on Wei, Qi, Ying, and blood, primarily used for warm diseases, while the three jiao differentiation is mainly used for damp-heat diseases. Damp-heat diseases are easily influenced by internal and external factors.
4. Treatment of Damp-Heat Disease.
Clear and transform: Taiyin and Yangming; treat liver and spleen separately: Shaoyang and Jueyin; external release and internal invasion: Taiyang and Shaoyin. Separate and transform (Lu Gen and Hua Shi); open orifices (Acorus and Curcuma). Three prohibitions in treating damp-warm diseases: sweating leads to confusion and deafness, severe cases may lead to closed eyes and unwillingness to speak. Purging leads to diarrhea. Moistening leads to deep illness without resolution.
ICopyright Statement
- This article is excerpted from Wu Xiongzhi’s lecture on damp-heat disease, and the copyright belongs to the relevant rights holders. Sharing this article is for the purpose of dissemination and learning exchange. If there are any improper uses, please feel free to contact me.