‘Differentiation of Damp-Heat Syndrome’
Damp-heat syndrome begins with aversion to cold, followed by heat without cold, sweating, chest oppression, a white tongue, and thirst without desire to drink. (1) This is the outline of damp-heat syndrome. Damp-heat diseases mostly belong to the Yangming and Taiyin meridians. If the central qi is strong, the disease is in Yangming; if the central qi is weak, the disease is in Taiyin. When the disease is on the surface of these two meridians, it often also involves the Shaoyang and Sanjiao; when the disease is within these two meridians, it often involves the Jueyin and Wind-Wood. The Shaoyang and Jueyin govern the fire, while the Yangming and Taiyin damp-heat are internally constrained. If the constraint is severe, the lesser fire becomes a strong fire, leading to a chaotic state both internally and externally, hence this syndrome is most likely to cause ear deafness, dry retching, spasms, and convulsions. The symptoms not mentioned in the outline are due to the changes seen in damp-heat diseases, rather than being essential symptoms of damp-heat diseases.
Aversion to cold at the beginning indicates that Yang is obstructed by dampness, leading to aversion to cold, which is different from the aversion to cold caused by exterior cold. The subsequent heat without cold indicates that the constraint has turned into heat, leading to aversion to heat. When heat is excessive in Yangming, sweating occurs; when dampness obstructs clear Yang, chest oppression occurs; when dampness is internally excessive, the tongue is white; when damp-heat steams together, the tongue is yellow; when heat is present, fluids do not rise, leading to thirst, while dampness retains fluids internally, leading to no desire to drink. The so-called surface refers to the surface of Taiyin and Yangming, not the surface of Taiyang. The surface of Taiyin is the limbs, and Yangming; the surface of Yangming is the muscles and the chest. Therefore, chest oppression is a symptom that must be present in damp-heat syndrome, along with heaviness in the limbs and muscle soreness. The reason it does not involve Taiyang is that Taiyang is the organ of cold water, governing the body’s surface, and wind-cold must enter from the surface, hence it belongs to Taiyang.
The damp-heat pathogen injures from the surface in only 10-20% of cases, while 80-90% enter through the mouth and nose.
Yangming is the sea of water and grain, while Taiyin is the organ of damp earth, hence diseases often affect Yangming and Taiyin. The membrane source connects externally to the muscles and internally to the stomach and intestines, being half surface and half interior of the body. When the pathogen enters from above, it directly targets the middle path, hence diseases often return to the membrane source. In summary, damp-heat diseases are not only different from cold damage but also significantly different from warm diseases. Warm diseases involve both Shaoyin and Taiyin, while damp-heat involves both Yangming and Taiyin. The outline does not mention the pulse because the pulse in damp-heat syndrome does not have a fixed pattern; it can be surging or slow, hidden or thin, varying according to the symptoms, hence it is difficult to define a fixed pulse for future practitioners.
Damp-heat syndrome must involve both Yangming and Taiyin. It is only known that the organs are interconnected and that damp earth shares the same qi, but it is not known that it must proportionally involve Shaoyin in warm diseases. When Shaoyin does not store, wood and fire burn internally, and wind pathogens attack externally, hence it is a warm disease. When Taiyin is internally injured, dampness and fluids accumulate, and external pathogens come again, leading to mutual attraction between internal and external, hence the disease is damp-heat. This all indicates prior internal injury followed by external pathogen invasion, not a direct attack from the organs to the viscera. If damp-heat syndrome does not involve internal injury, and the central qi is strong, the disease must be mild, or there may be a prior cause of dampness followed by hunger and fatigue, which also belongs to internal injury with dampness, indicating a simultaneous disease of both the root and branch. However, fatigue injures the spleen leading to deficiency, while dampness accumulation indicates excess, hence the balance of internal injury and external invasion, whether more or less, whether strong or weak, must be weighed during clinical practice. Damp-heat syndrome presents with aversion to cold without sweating, heaviness in the body, and headache, indicating dampness on the surface. It is advisable to use herbs such as **Huo Xiang (Agastache)**, **Xiang Ru (Elsholtzia)**, **Qiang Huo (Notopterygium)**, **Cang Zhu (Atractylodes)**, **Bo He (Mint)**, and **Niu Bang Zi (Burdock Seed)**. If there is no headache, remove **Qiang Huo**. (2) Heaviness and aversion to cold indicate that dampness obstructs the Wei Yang on the surface. Headache must involve wind pathogens, hence add **Qiang Huo**, which not only overcomes dampness but also dispels wind. This clause indicates the condition of yin-dampness injuring the surface. Damp-heat syndrome with aversion to cold and fever, heaviness, and joint pain indicates dampness in the muscles, not relieved by sweating. It is advisable to use herbs such as **Hua Shi (Talcum)**, **Da Dou Huang (Soybean)**, **Fu Ling Pi (Poria Skin)**, **Cang Zhu (Atractylodes)**, **Huo Xiang Ye (Agastache Leaf)**, **Xian He Ye (Fresh Lotus Leaf)**, **Bai Tong Cao (Plantago)**, and **Jie Geng (Platycodon)**. If there is no aversion to cold, remove **Cang Zhu**. (3) This clause has the same external symptoms as the previous one, but sweating is uniquely different. Increased joint pain indicates that the damp pathogen has initially invaded the Yangming surface. It is necessary to clear the heat from the stomach and intestines, desiring the damp pathogen’s stagnant heat to descend rather than rise. This indicates the condition of Yang dampness injuring the surface. Damp-heat syndrome, after three to four days, leads to mouth closure, limbs being pulled and stiff, and severe cases may present with opisthotonos, indicating damp-heat invading the meridians and collaterals. It is advisable to use herbs such as **Xian Di Long (Earthworm)**, **Qin Jiao (Gentiana)**, **Wei Ling Xian (Clematis)**, **Hua Shi (Talcum)**, **Cang Er Zi (Xanthium)**, **Si Gua Luo (Luffa)**, **Hai Feng Teng (Uncaria)**, and **Jiu Chao Huang Lian (Wine-fried Coptis)**. (4) This clause indicates dampness combined with wind. Wind is the qi of wood; when wind moves, wood expands. When it enters the Yangming collaterals, it leads to mouth closure, and when it invades the Taiyin meridian, it causes stiffness. Hence, the herbs not only overcome dampness but also heavily use wind-dispelling herbs, as wind herbs can overcome dampness and also soothe the liver. The selection of **Di Long (Earthworm)** and various vines aims to promote the circulation of the collaterals. Damp-heat syndrome presents with strong heat, thirst, a yellow or scorched red tongue, spasms, confusion, delirium, or laughter, indicating that the pathogen burns the pericardium, and the nutritive and blood have been consumed. It is advisable to use herbs such as **Xi Jiao (Rhinoceros Horn)**, **Ling Yang Jiao (Antelope Horn)**, **Lian Qiao (Forsythia)**, **Sheng Di (Rehmannia)**, **Xuan Shen (Scrophularia)**, **Gou Teng (Uncaria)**, **Yin Hua Lu (Honeysuckle Dew)**, **Xian Chang Pu (Acorus)**, and **Zhi Bao Dan (Treasure Pill)**. (5) The previous clause mentions spasms, while this clause mentions convulsions. The heat from summer and heat injuries the Yang qi, and when the heat reaches extreme levels, it invades the nutritive yin, leading to the consumption of fluids and the illness of yin; the pericardium is burned, and the spirit becomes confused. The medication should focus on clearing heat, rescuing yin, draining pathogens, and calming the liver.
Damp-heat syndrome presents with spasms, confusion, and laughter, with a surging and rapid pulse that is strong, and if purging does not work, it indicates that damp-heat is accumulating in the chest cavity. It is advisable to use a formula similar to **Liang Ge San (Cool the Diaphragm Powder)**; if there is constipation for several days, it indicates that the heat pathogen is blocking the intestines and stomach, and it is advisable to use a formula similar to **Cheng Qi Wei Xia (Mild Purging)**. (6) This clause indicates Yangming excess heat, either blocking above or below. Clearing heat and draining pathogens can only disperse the heat flowing through the collaterals but cannot eliminate the pathogens accumulated in the intestines, hence the Yangming pathogen still relies on Yangming as the exit. Damp-heat syndrome presents with strong heat, thirst, a scorched red or shriveled tongue, rashes, chest oppression, diarrhea, confusion, and convulsions, indicating that the heat pathogen fills the three jiaos. It is advisable to use large doses of **Xi Jiao (Rhinoceros Horn)**, **Ling Yang Jiao (Antelope Horn)**, **Sheng Di (Rehmannia)**, **Xuan Shen (Scrophularia)**, **Yin Hua Lu (Honeysuckle Dew)**, **Zi Cao (Lithospermum)**, **Fang Zhu (Fangji)**, **Jin Zhi (Gold Juice)**, and **Xian Chang Pu (Acorus)**. (7) This clause indicates the most severe convulsions, with chest oppression above and heat and diarrhea below, rashes and convulsions, indicating that yin and yang are both exhausted. The urgent matter is to clear the heat from Yangming and rescue the fluids of Yangming, fearing that the gastric fluids may not survive, leading to self-immolation. Damp-heat syndrome presents with alternating chills and fever, indicating that damp-heat obstructs the membrane source, and it is advisable to use herbs such as **Chai Hu (Bupleurum)**, **Huang Qin (Scutellaria)**, **Bing Lang (Areca)**, **Cao Guo (Tsaoko)**, **Huo Xiang (Agastache)**, **Cang Zhu (Atractylodes)**, **Ban Xia (Pinellia)**, **Gan Chang Pu (Acorus)**, and **Liu Yi San (Six One Powder)**. (8)
Damp-heat syndrome is caused by summer heat and dampness invading internally, leading to autumn coolness binding externally. If the pores are widely open in summer, how can it lead to damp-heat? However, chills and fever have a fixed period; for those with symptoms of damp-heat, the membrane source is half surface and half interior of Yangming, and damp-heat obstructs, hence the nutritive and defensive qi contend. Although the symptoms resemble damp-heat, they cannot be treated the same as damp-heat, hence it can be treated similarly to **Da Yuan Yin (Great Source Drink)**. This is due to one being bound by external coolness and the other being obstructed by internal dampness. Damp-heat syndrome, after several days, leads to slight oppression in the stomach, knowing hunger but not eating, indicating that dampness is enveloping the three jiaos. It is advisable to use herbs such as **Huo Xiang (Agastache)**, **Bo He (Mint)**, **Pi Pa Ye (Loquat Leaf)**, **Pei Lan Ye (Eupatorium)**, **Lu Jian (Winter Melon Seed)**, and **Dong Gua Ren (Winter Melon Seed)**. (9) This indicates that damp-heat has been resolved, but residual pathogens obscure the clear Yang, leading to discomfort in the stomach. It is advisable to use very light clearing herbs to promote the qi mechanism of the upper jiao. If heavy herbs are used, they will not relate to the condition. Damp-heat syndrome, initially presenting with fever, sweating, chest oppression, thirst, and a white tongue, indicates dampness lurking in the middle jiao. It is advisable to use herbs such as **Huo Geng (Houttuynia)**, **Jiao Ren (Cardamom)**, **Xing Ren (Apricot Kernel)**, **Zhi Ke (Bitter Orange)**, **Jie Geng (Platycodon)**, **Yu Jin (Curcuma)**, **Cang Zhu (Atractylodes)**, **Huang Qin (Scutellaria)**, **Ban Xia (Pinellia)**, **Gan Chang Pu (Acorus)**, **Pei Lan Ye (Eupatorium)**, and **Liu Yi San (Six One Powder)**. (10) When the turbid pathogen rises, it leads to chest oppression, and when the gastric fluids do not rise, it leads to thirst. The disease is in the middle jiao qi division, hence it is advisable to open the middle jiao qi division. This clause often has food retention, with a yellow tongue root, hence it is advisable to add **Gua Lou (Trichosanthes)**, **Zha Rou (Flesh of Ziziphus)**, and **Lai Fu Zi (Radish Seed)**. Damp-heat syndrome, after several days, leads to diarrhea, red urine, and thirst, indicating that dampness flows to the lower jiao. It is advisable to use herbs such as **Hua Shi (Talcum)**, **Zhu Ling (Polyporus)**, **Ze Xie (Alisma)**, **Bi Xie (Dioscorea)**, and **Tong Cao (Tetrapanax)**. (11) The lower jiao belongs to yin, governed by Taiyin. The deficiency of the yin leads to diarrhea, and stagnation of the source leads to red urine, while the spleen does not transform fluids, leading to thirst. This is all due to the excess of Taiyin dampness. The stagnation of dampness in the lower jiao hence requires treatment focused on diarrhea, but if there are accompanying symptoms of thirst and chest oppression, it is necessary to add **Jie Geng (Platycodon)**, **Xing Ren (Apricot Kernel)**, and **Da Dou Huang (Soybean)** to open the middle and upper jiao, allowing the source to clear and the flow to purify, which must not be overlooked. Damp-heat syndrome presents with a white tongue coating, thirst, and dampness stagnating in Yangming, hence it is advisable to use pungent herbs such as **Huang Qin (Scutellaria)**, **Cao Guo (Tsaoko)**, **Ban Xia (Pinellia)**, and **Gan Chang Pu (Acorus)**. (12) This indicates a condition of extreme dampness. Thirst indicates that fluids do not rise, not due to heat. Excessive pungent herbs can turn into heat, but at this time, dampness has not yet transformed into heat, hence it is necessary to heavily use pungent herbs to allow the upper jiao to open and the fluids to descend. Damp-heat syndrome presents with a white tongue root and a red tongue tip, indicating that dampness gradually transforms into heat, with residual dampness still stagnating. It is advisable to use pungent herbs to assist in clearing heat, such as **Jiao Ren (Cardamom)**, **Ban Xia (Pinellia)**, **Gan Chang Pu (Acorus)**, **Xing Ren (Apricot Kernel)**, **Lian Qiao (Forsythia)**, **Lu Dou Pi (Mung Bean Skin)**, and **Liu Yi San (Six One Powder)**. (13) This indicates a condition of both dampness and heat. Among the drying dampness, those that assist in clearing heat are also to preserve the fluids of Yangming. The previous two clauses rely on examining the tongue to determine the medication, which is a key point in clinical practice. The tongue is the external manifestation of the heart; when turbid pathogens rise and disturb the heart and lungs, the tongue coating shifts accordingly. Damp-heat syndrome, initially presenting with chest oppression and confusion, leads to shouting in pain, indicating that damp-heat obstructs the middle and upper jiao. It is advisable to use herbs such as **Cao Guo (Tsaoko)**, **Bing Lang (Areca)**, **Xian Chang Pu (Acorus)**, **Yuan Su (Coriander)**, and **Liu Yi San (Six One Powder)**, each used heavily, or add **Zao Jiao (Soapberry)** and **Di Jiang (Water)** for decoction. (14) This clause indicates a condition of both dampness and heat. However, the dampness herbs are mostly heat-clearing herbs, as the disease initially arises and closes, hence it is urgent to use pungent warming herbs to open the closure, avoiding the use of cold herbs that may stagnate the qi mechanism. Damp-heat syndrome, after four to five days, presents with great thirst, chest oppression, dry retching, a thin pulse, and a tongue that is as bright as a mirror, indicating that gastric fluids are being robbed, and gallbladder fire is surging. It is advisable to use **Watermelon Juice**, **Gold Juice**, **Fresh Rehmannia Juice**, **Sugar Cane Juice**, and grind herbs such as **Yu Jin (Curcuma)**, **Mu Xiang (Aucklandia)**, **Xiang Fu (Cyperus)**, and **Wu Yao (Lindera)**. (15) This indicates that the nutritive yin is fundamentally deficient, and wood and fire are fundamentally excessive. Wood occupies Yangming, consuming its fluids, and fortunately, there is no dampness pathogen, hence it is necessary to clear the heat from Yangming and disperse the Shaoyang pathogen. Those who do not use decoction take the full essence. Damp-heat syndrome presents with vomiting clear water or excessive phlegm, indicating that dampness and heat are retained internally, with wood and fire rising. It is advisable to use **Wen Dan Tang (Warm the Gallbladder Decoction)**, adding **Gua Lou (Trichosanthes)** and **Bi Yu San (Jade Powder)**. (16) This indicates that there is a pre-existing phlegm and dampness, and both Yangming and Shaoyang are affected, hence one must clear the phlegm and descend the reverse. The treatment is appropriate to combine with the previous clause, as the vomiting is the same but the treatment differs. Damp-heat syndrome presents with persistent vomiting, day and night without relief, leading to a desire to die, indicating that the lung and stomach are not in harmony, and stomach heat has moved to the lung, preventing the lung from receiving the pathogen. It is advisable to use **Chuan Lian (Coptis)**, **Su Ye (Perilla Leaf)**, two to three fen of each, decocting them together and drinking immediately to stop. (17) The disharmony between the lung and stomach easily leads to vomiting, as stomach heat moves to the lung, preventing the lung from receiving the pathogen, hence it is necessary to use **Chuan Lian** to clear damp-heat and **Su Ye** to open the lung and stomach. The immediate effect of the medication indicates that the qi of the lung and stomach is involved, and only **Su Ye** can open it. The lighter the medication, the more appropriate it is for treating upper jiao diseases. Damp-heat syndrome presents with cough that is restless day and night, even leading to difficulty breathing and inability to sleep, indicating that summer heat has entered the lung collaterals. It is advisable to use herbs such as **Ting Li (Desmodium)**, **Pi Pa Ye (Loquat Leaf)**, and **Liu Yi San (Six One Powder)**. (18) People only know that summer heat injures lung qi, leading to lung deficiency, but do not know that summer heat stagnates in the lung collaterals, leading to lung excess. **Ting Li** guides **Hua Shi (Talcum)**, directly draining lung pathogens, hence the disease resolves. Damp-heat syndrome, after more than ten days, shows that the general condition has improved, but only thirst remains, sweating occurs, and joint pain indicates that residual pathogens are lingering in the meridians. It is advisable to soak **Yuan Mi (Rice)** in **Cang Zhu (Atractylodes)**, leaving it overnight, then remove the Atractylodes and drink the decoction. (19) After the illness, damp-heat has not yet dissipated, leading to the initial injury of yin fluids, hence thirst and body pain. At this time, rescuing fluids will assist dampness, while treating dampness will rob yin. Following the method of **Zong Zhongjing’s Ma Fei Decoction**, one takes the qi without taking the flavor, moving Yang without moving yin, and assists with **Yuan Mi (Rice) Soup** to nourish yin and expel dampness, achieving both benefits. Damp-heat syndrome, after several days, presents with sweating that does not resolve, or convulsions, suddenly leading to persistent headaches. This indicates that the nutritive fluids are greatly depleted, and the Jueyin wind-fire is rising. It is advisable to use herbs such as **Ling Yang Jiao (Antelope Horn)**, **Man Jing Zi (Vitex)**, **Gou Teng (Uncaria)**, **Yuan Shen (Scrophularia)**, **Sheng Di (Rehmannia)**, and **Nu Zhen Zi (Ligustrum)**. (20) Damp-heat injures the nutritive fluids, leading to liver wind rising, blood not nourishing the muscles, hence convulsions occur. The rising of the head indicates headache, and the heat has retreated, while wood energy is still rising, hence convulsions occur without fainting. The medication should focus on calming wind as the primary goal, while nourishing yin is the foundation. Damp-heat syndrome presents with chest oppression and fever, with slight muscle soreness, and no sweating throughout, indicating that summer heat is internally closed. It is advisable to use **Liu Yi San (Six One Powder)**, **Bo He (Mint)**, and **Hua Shi (Talcum)**, decocting and adjusting to induce sweating. (21) Damp-heat induces sweating, and ancient sages had prohibitions against it. If there is no slight sweating, the disease must not be resolved. There are both prohibitions against sweating and methods to induce sweating, hence practitioners must know how to adapt in clinical practice.
Damp-heat syndrome, treated according to the method, after several days, or vomiting and diarrhea occurring simultaneously indicates that the central qi is depleted, leading to reversed rising and falling. It is advisable to use herbs such as **Sheng Guo Ya (Sprouted Grain)**, **Lian Xin (Lotus Heart)**, **Bian Dou (Hyacinth Bean)**, **Mi Ren (Rice Kernel)**, **Ban Xia (Pinellia)**, **Gan Cao (Licorice)**, and **Fu Ling (Poria)**. If severe, use the method of **Li Zhong (Regulate the Middle)**. (22) Reversed rising and falling should be harmonized, similar to the use of **Liu He Tang (Six Harmony Decoction)** for cholera. If Taiyin is severely fatigued and the central qi cannot support, the method of **Li Zhong** is necessary. Damp-heat syndrome, after more than ten days, presents with a left guan pulse that is rapid, abdominal pain at times, and blood in the stool, with a burning sensation in the anus, indicating that the blood is internally dry, and the heat pathogen has entered the Jueyin. It is advisable to use a method similar to **Bai Tou Weng Tang (Pulsatilla Decoction)**. (23) Heat entering the Jueyin and causing diarrhea, even if there is no blood in the stool, it is necessary to follow **Zhongjing’s method for treating heat diarrhea**. If it forces its way into the nutritive yin, how can one not use **Bai Tou Weng Tang** to cool the blood and disperse the pathogen? If heat enters Yangming and causes diarrhea, even if there is no blood in the stool, it is also advisable to follow **Zhongjing’s method for treating diarrhea with delirium** using **Xiao Cheng Qi Tang (Minor Order the Qi Decoction)**. Damp-heat syndrome, after more than ten days, presents with a rapid pulse, diarrhea, or sore throat, thirst, and irritability, indicating that the heat pathogen directly invades the Shaoyin. It is advisable to use a method similar to **Zhu Fu Tang (Pig Skin Decoction)** to cool and moisten. (24) The same diarrhea has different manifestations of Jueyin and Shaoyin, hence the herbs used differ in temperature. However, Shaoyin has symptoms of pus in the stool, which must be examined carefully. Damp-heat syndrome presents with cold body, thin pulse, sweating, chest oppression, thirst, and a white tongue, indicating that dampness is injuring the Yang of Shaoyin. It is advisable to use herbs such as **Ren Shen (Ginseng)**, **Bai Zhu (Atractylodes)**, **Fu Zi (Aconite)**, **Fu Ling (Poria)**, and **Yi Zhi Ren (Alpinia)**. (25) This clause indicates that dampness injures Yang, hence it is necessary to support Yang and expel dampness. Thirst indicates a Shaoyin condition; how can one recklessly use cold herbs? During the summer months, if the disease initially presents with aversion to cold, a yellow face, no thirst, fatigue, and weakness in the limbs, with a deep weak pulse and abdominal pain with diarrhea, it indicates that dampness is obstructing the Yang of Taiyin. It is advisable to use a method similar to **Suo Pi Yin (Spleen Contracting Drink)**, and if severe, use **Da Shun San (Great Smooth Powder)** or **Lai Fu Dan (Return to Life Pill)**. (26) The summer months are when Yang qi leaks externally, and Yin qi consumes internally, hence heat pathogens injure Yin, leading to Yangming exhaustion. Taiyin becomes fatigued, and dampness spreads, hence it is necessary to warm and disperse. The ancient methods are most detailed, and practitioners should observe them. Damp-heat syndrome, treated according to the method, leads to the resolution of all symptoms, but if the eyes are closed, it indicates fright, nightmares, and residual pathogens internally, with gallbladder qi not yet relaxed. It is advisable to use wine-soaked **Yu Li Ren (Cyananthus)**, **Ginger Juice Fried Jujube Seed**, and **Pig Gallbladder Skin**. (27) “Slippery can remove the attachment”; **Yu Li Ren** is the most slippery, and ancient practitioners used it to treat fright when the liver is stagnant and does not descend, hence it is used to descend the liver and remove stagnation. This clause borrows from the damp-heat pathogen lingering in the gallbladder, which is the residence of clear and empty, hence it is stored and not excreted. Therefore, when the disease resolves, the internal lingering pathogen does not leave, and when asleep, Yang qi moves in Yin, leading to internal gallbladder heat disturbing the liver spirit. **Yu Li Ren** is used to expel the pathogen, and wine is used to guide it, as the wine qi uniquely returns to the gallbladder. The sourness of the jujube seed enters the liver to calm the spirit, and ginger juice is used to calm the spirit while also dispersing the pathogen. Damp-heat syndrome, having opened and drained, with all symptoms resolved, but the spirit is unclear, fatigue, lack of appetite, frequent urination, and dry lips and teeth, indicates that the gastric qi is not transmitted, and the lung qi is not distributed, leading to a great loss of the original spirit. It is advisable to use herbs such as **Ren Shen (Ginseng)**, **Mai Dong (Ophiopogon)**, **Shi Hu (Dendrobium)**, **Mu Guo (Wood Apple)**, **Sheng Gan Cao (Raw Licorice)**, **Sheng Guo Ya (Sprouted Grain)**, and **Xian Lian Zi (Fresh Lotus Seed)**. (28) Opening and draining leads to the resolution of all symptoms, but the original spirit is also greatly injured. Hence, it is necessary to clear and tonify the original qi. If greasy and stagnant yin herbs are used, it will lead to further distance from the original. Damp-heat syndrome, after four to five days, suddenly presents with excessive sweating, cold hands and feet, a thin pulse like a thread or absent, thirst, and pain in the stem, yet the person can sit up and speak clearly. This indicates that excessive sweating has temporarily lost the Yang of the exterior, while the damp-heat pathogen still accumulates, leading to a temporary blockage of both the interior and exterior, hence the pulse is hidden, not a true loss of Yang. It is advisable to use **Wu Ling San (Five Ingredient Powder)**, removing Atractylodes and adding **Hua Shi (Talcum)**, **Jiu Chao Chuan Lian (Wine-fried Coptis)**, **Sheng Di (Rehmannia)**, and **Qi Pi (Qing Pi)**. (29) This clause indicates that the pulse symptoms resemble a loss of Yang, but the movement and spirit reveal the true condition. Ah! This is why practitioners must value observation. Damp-heat syndrome presents with spasms and confusion, with cold feet and a contracted Yin. The lower body is externally affected by cold, hence it is necessary to treat damp-heat, using only pungent warming herbs for decoction and fumigation. (30) The contraction of the Yin indicates the exterior of Jueyin, combined with cold feet, resembling deficiency cold. However, upon careful observation of this condition, there is nothing deficient, and it is known that cold has invaded the lower body, leading to a temporary failure of the nutritive qi. This indicates that the condition is not deficiency cold, nor is it a case of upper heat and lower cold, hence it is still necessary to treat damp-heat, with no doubts. Damp-heat syndrome, initially presenting with strong heat and thirst, chest oppression, and a feeling of heaviness, with the eyes wanting to close, and occasional delirium, indicates that turbid pathogens obscure the upper jiao. It is advisable to use herbs such as **Zhi Ke (Bitter Orange)**, **Jie Geng (Platycodon)**, **Dan Dou Chi (Fermented Soybean)**, and **Sheng Zhi Zi (Fresh Gardenia)**, and if there is no sweating, add **Ge Gen (Pueraria)**. (31) This clause should be compared with the ninth clause; the latter belongs to residual pathogens, and the method should be light and dispersing; this clause indicates that turbid pathogens obscure the upper jiao, hence causing heaviness and discomfort. If the eyes want to close, it indicates that lung qi is not comfortable. If there is occasional delirium, it indicates that the pathogen is obstructing the pericardium. If light herbs are used, the disease will not be resolved. The classic text states: “The high ones surpass it.” Using **Zhi Zhi Tang (Gardenia Decoction)** to induce drainage will guide the Yang of the stomach and open the chest surface, allowing the pathogen to be expelled through vomiting. Damp-heat syndrome, with menstruation arriving appropriately, presents with strong heat, thirst, delirium, confusion, chest and abdominal pain, or a tongue without coating, and a slippery rapid pulse, indicating that the pathogen has invaded the nutritive level. It is advisable to use large doses of **Xi Jiao (Rhinoceros Horn)**, **Zi Cao (Lithospermum)**, **Qian Gen (Rubia)**, **Guan Zhong (Corydalis)**, **Lian Qiao (Forsythia)**, and **Xian Chang Pu (Acorus)**. (32) Heat entering the blood chamber does not only affect women; men can also experience this. It is necessary to cool the blood and detoxify, but heavy doses are required for efficacy. Damp-heat syndrome presents with blood loss from above and below, or sweating blood, indicating that the toxic pathogen has deeply penetrated the nutritive level, leading to a desire to expel. It is advisable to use large doses of **Xi Jiao (Rhinoceros Horn)**, **Sheng Di (Rehmannia)**, **Chi Shao (Red Peony)**, **Dan Pi (Moutan)**, **Lian Qiao (Forsythia)**, and **Zi Cao (Lithospermum)**. (33) Heat pressing leads to blood loss from above and below, and the situation is extremely dangerous but not immediately fatal, as the toxin is expelled from the blood. The vitality lies here. It is necessary to use large doses of cooling blood and detoxifying herbs to rescue the yin and expel the pathogen, allowing the pathogen to resolve and the blood to stop. After the blood stops, it is necessary to use **Ren Shen (Ginseng)** and **Huang Qi (Astragalus)** to recover. Sweating blood is what Zhang’s term refers to as **Ji Ru (Muscle Rupture)**. The **Nei Jing** states: “Heat is excessive internally, treated with salty and cold herbs,” hence the formula should include salty and cold flavors. Damp-heat syndrome, after seven to eight days, presents with no thirst, inability to speak, and no rejection of food and drink, remaining silent and confused, indicating that the spirit is unclear. It is advisable to use a formula similar to **Wu You Ke San (Three-Medicine Powder)**, including **Di Bie Chuan (Earthworm)**, **Vinegar-fried Turtle Shell**, **Stir-fried Pangolin**, **Fresh Silkworm**, **Chai Hu (Bupleurum)**, and **Tao Ren (Peach Kernel)**. (34)
Summer heat first injures the Yang aspect, but if the illness does not resolve for a long time, it must affect the Yin. Both Yin and Yang are exhausted, leading to qi stagnation and blood stasis, preventing summer heat and dampness from being expelled, hence deeply penetrating the Jueyin, causing the collaterals to coagulate and stagnate, leading to the inability of Yang to sprout, with vitality descending and not rising, the heart is obstructed, and the spirit is not clear, hence confusion and silence. Breaking stagnation and resolving stasis will allow the collaterals to open and the pathogen to be resolved. Damp-heat syndrome presents with thirst, a yellow tongue coating, a stringy and slow pulse, a contracted tongue, confusion, and inability to recognize people, with both hands twitching, indicating that fluids are dry and pathogens are stagnant. It is advisable to use fresh **Sheng Di (Rehmannia)**, **Lu Gen (Reed Root)**, **Sheng Shou Wu (Fresh Fallopia)**, and **Fresh Rice Root**. If the pulse is strong and there is constipation, **Da Huang (Rhubarb)** can also be added. (35) The gastric fluids are robbed, and the heat pathogen is internally established. If moistening and descending are not used to expel the pathogen, it cannot be reached, hence it is advisable to follow the example of **Cheng Qi (Order the Qi)**, using sweet and cool herbs instead of bitter and cold herbs, fearing that the gastric qi may be injured and the gastric fluids may not recover. Damp-heat syndrome presents with spasms, confusion, and laughter, with a dry yellow tongue coating or turning black, and constipation, indicating that the heat pathogen is blocking the stomach and intestines. It is advisable to use **Cheng Qi Tang (Order the Qi Decoction)** to purge. (36) The condition of spasms indicates either great excess or great deficiency; if deficient, the spirit is scattered, leading to the risk of collapse; if excessive, the spirit is forced, hence there are many chaotic symptoms. Now the tongue coating is dry and yellow, and constipation is present, indicating that the heat pathogen is internally blocking Yangming, with abdominal heat being evident. Merely clearing heat and draining the pathogen can only disperse the heat flowing through the collaterals but cannot eliminate the pathogens accumulated in the stomach, hence it is necessary to use **Cheng Qi** to open the pathway. However, if the tongue is not dry and yellow, it should not be used. **Cheng Qi** uses **Niao (Sodium Bicarbonate)** and **Huang (Rhubarb)** to expel the dryness and heat of Yangming, which is not suitable for those with dampness internally stagnating. However, if the gastric fluids are consumed by heat, leading to spasms and chaos, the tongue coating is dry and yellow, indicating that the heat in the stomach is extreme, and the gastric fluids are exhausted, leading to dampness transforming into heat. Hence, it is necessary to use **Cheng Qi** to attack, as **Cheng Qi** is meant to connect the remaining yin qi at a single point. Damp-warm diseases reaching this point are also dangerous. Damp-heat syndrome presents with strong heat, thirst, spontaneous sweating, heaviness, and chest oppression, with a surging and long pulse, indicating that the dampness of Taiyin is combined with the heat of Yangming. It is advisable to use **Bai Hu (White Tiger)** with **Cang Zhu (Atractylodes)**. (37) Thirst and spontaneous sweating indicate Yangming heat; chest oppression and heaviness indicate Taiyin dampness. The surging and long pulse indicates that damp-heat is stagnating in the Yangming meridian, hence it is necessary to use **Cang Zhu Bai Hu Tang (White Tiger with Atractylodes)** to clear heat and disperse dampness, indicating that there is more heat than dampness. **Bai Hu Tang** is used by Zhongjing to clear the invisible dryness and heat of Yangming; if the gastric juices are exhausted, add **Ren Shen (Ginseng)** to generate fluids, called **Bai Hu Jia Ren Shen Tang (White Tiger with Ginseng)**; if there is a history of biqi in the body, add **Gui Zhi (Cinnamon)** to open the collaterals, called **Gui Zhi Bai Hu Tang (Cinnamon White Tiger)**, but the essence is to clear the heat from the stomach. Therefore, in later treatments for summer heat injuring qi, leading to body heat and thirst, **Bai Hu Jia Ren Shen Tang** is also used; for heat thirst, spontaneous sweating, and joint pain, **Bai Hu Jia Gui Zhi Tang** is also used; for chest oppression and heaviness, **Bai Hu Tang** is added with **Cang Zhu** to regulate the dampness of Taiyin; for alternating chills and fever, **Bai Hu Tang** is added with **Chai Hu** to disperse the half surface and half interior pathogen. All of these indicate that heat is excessive in Yangming, and other symptoms are present, hence **Bai Hu** is used to clear heat, while each is adjusted according to symptoms. If it is not heat thirst and spontaneous sweating, **Bai Hu** should not be used. Differentiating symptoms and observing the pulse is most advisable. Damp-heat syndrome presents with damp-heat injuring qi, leading to heaviness in the limbs, reduced spirit, high body heat, irritability, yellow urine, thirst, and spontaneous sweating, hence it is advisable to use **Dong Yuan Qing Shu Yi Qi Tang (Eastern Garden Clear Summer Heat and Benefit Qi Decoction)**. (38) This indicates the same thirst and spontaneous sweating, but the pulse is weak and the spirit is fatigued, indicating that the central qi is injured and not Yangming stagnation. **Qing Shu Yi Qi Tang** is made by Dong Yuan, containing many herbs, and practitioners should consider the selection during clinical practice. Summer heat injures the original qi, leading to shortness of breath and fatigue, thirst, and excessive sweating, indicating lung deficiency and cough. It is advisable to use herbs such as **Ren Shen (Ginseng)**, **Mai Dong (Ophiopogon)**, and **Wu Wei Zi (Schisandra)**. (39) This is the same as **Qian Jin Sheng Mai San (Thousand Golds Revive Pulse Powder)**, and while the eighteenth clause indicates lung disease, there is a distinction between coarse and short breath, hence lung excess and lung deficiency are different. Excess should be drained, while deficiency should be supplemented, which is a fixed principle. However, the name of the formula indicates that the heat injures qi, hence the pulse is weak and nearly exhausted. Summer heat, when avoiding cold drinks, leads to Yang qi being restrained by Yin cold, causing the skin to steam with heat, leading to chills, headache, and heaviness, spontaneous sweating, thirst, or abdominal pain and diarrhea. It is advisable to use herbs such as **Huo Xiang (Agastache)**, **Cang Zhu (Atractylodes)**, and **Bian Dou (Hyacinth Bean)**. (40) This is due to avoiding summer heat and being affected by cold dampness, hence although the illness occurs in summer, it is not a summer disease. Ancient practitioners did not say that summer heat injures cold dampness but referred to it as Yin summer heat, leading to confusion among later practitioners, which is a significant error, hence it is particularly noted. The use of **Huo Xiang** is pungent and warm, dispersing the Yin pathogen and promoting Yang qi; **Cang Zhu** is bitter and warm, eliminating dampness and promoting qi; **Bian Dou** is sweet and bland, promoting water and harmonizing the middle. If there are no symptoms of aversion to cold and headache, then there is no need to use **Huo Xiang** to disperse. If there are no symptoms of abdominal pain and diarrhea, then there is no need to use **Cang Zhu** and **Bian Dou** to promote qi and harmonize. Therefore, if there is severe thirst, add **Huang Lian (Coptis)** to clear summer heat, called **Si Wei Huo Xiang Yin (Four Flavor Agastache Drink)**; if **Bian Dou** is removed, it is called **Huang Lian Huo Xiang Yin (Huang Lian Agastache Drink)**; if dampness is excessive internally, leading to abdominal distension and diarrhea, remove **Huang Lian** and add **Fu Ling (Poria)** and **Gan Cao (Licorice)**, called **Wu Wu Huo Xiang Yin (Five Ingredient Agastache Drink)**; if the middle is deficient and qi is weak, leading to excessive sweating, add **Ren Shen (Ginseng)**, **Huang Qi (Astragalus)**, **Bai Zhu (Atractylodes)**, **Chen Pi (Tangerine Peel)**, and **Mu Guo (Wood Apple)**, called **Shi Wei Huo Xiang Yin (Ten Ingredient Agastache Drink)**. However, the use of **Huo Xiang** is primarily for external cold dampness invasion, and it should not be used to treat summer heat without cold dampness. Damp-heat stagnating in Taiyin, if it persists for a long time, leads to stagnation below, with symptoms of chest oppression, abdominal pain, heaviness, purulent blood, urgency, and a heavy pulse. It is advisable to use herbs such as **Huang Qin (Scutellaria)**, **Zhi Ke (Bitter Orange)**, **Shen Qu (Fermented Wheat)**, **Guang Pi (Citrus Peel)**, **Mu Xiang (Aucklandia)**, **Bing Lang (Areca)**, **Chai Hu (Bupleurum)**, **Wei Ge Gen (Pueraria)**, **Yin Hua Tan (Honeysuckle Charcoal)**, and **Jing Jie Tan (Schizonepeta Charcoal)**. (41) The ancient term for stagnation below refers to what is now called dysentery. This is due to the damp-heat pathogen internally invading Taiyin, obstructing the qi mechanism, leading to Taiyin losing its healthy function. Shaoyang loses its ability to disperse. Heat stagnates and dampness steams, leading to the loss of normal conduction, steaming into foul turbid blood, leading to urgency at the anus, hence the heaviness. Qi stagnation leads to white stools, while blood stagnation leads to red stools; both qi and blood are injured, leading to red and white stools, indicating that damp-heat is excessive, leading to dysentery with five colors. Hence, it is necessary to use **Huang Qin** to eliminate dampness and promote qi, **Bing Lang** to descend and break the stagnant qi, **Zhi Ke** to clear the heat of the metal, **Mu Xiang** and **Shen Qu** to promote the stagnation of the middle qi, **Ge Gen** to raise the descending stomach qi, and **Chai Hu** to raise the wood qi in the middle. If heat is excessive internally, it is necessary to use **Huang Lian** to clear heat; if there is great excess and pain, it is advisable to increase **Da Huang** to expel the pathogen. In ancient times, Zhang Jiegu used **Shao Yao Tang (Peony Decoction)** to treat blood dysentery, using **Gui (Cinnamon)**, **Shao (Peony)**, **Qin (Scutellaria)**, **Lian (Coptis)**, **Da Huang (Rhubarb)**, **Mu Xiang (Aucklandia)**, **Bing Lang (Areca)**, **Gan Cao (Licorice)**, and **Gui Xin (Cinnamon Heart)**, and named it after **Shao Yao** because it is necessary to adjust the blood-storing organs when treating blood dysentery, hence it is used as the monarch, not only to promote the earth to drain wood but also to rely on it to harmonize the liver and yin. However, **Shao Yao** is sour and astringent, and it is not suitable for those with damp-heat internally stagnating. If dysentery persists for a long time, leading to deficiency, it is advisable to use **Shao Yao** and **Gan Cao** to transform the earth, as it is difficult to tolerate the bitter and cold of **Qin (Scutellaria)** and **Lian (Coptis)**, and the qi-breaking properties of **Mu Xiang** and **Bing Lang**. If the dysentery is just beginning, with damp-heat being excessive, **Bai Shao (White Peony)** should not be used to stop the pathogen. Although ancient practitioners have tried this formula, it should not be used as a model for later practitioners. If dysentery persists and injures Yang, with a weak and slippery pulse, it is advisable to use **Ren Shen (Ginseng)**, **Bai Zhu (Atractylodes)**, **Fu Zi (Aconite)**, **Fu Ling (Poria)**, and **Yi Zhi Ren (Alpinia)**. (42)