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In clinical practice of Traditional Chinese Medicine (TCM), aside from precise differentiation and treatment, how to maximize the use of prescriptions and medications is both an art and a skill, and is the highest pursuit of TCM practitioners. Therefore, “half a day in clinical practice, half a day in study” is particularly important. Learning from the discussions and prescriptions of TCM masters, and repeatedly pondering them, will surely yield personal insights. TCM is vast, and one must progress step by step, learning with a method. This article will explore the treatment of Damp-Heat in the Middle Jiao based on the methods of Master Chen (Chen Chaozu).
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Overview
Damp-Heat in the Middle Jiao refers to the obstruction of the spleen’s function, imbalance of fluids and qi, qi stagnation transforming into heat, and the condensation of fluids into dampness, leading to the mutual accumulation of dampness and heat. Clearing heat and eliminating dampness is the treatment method based on the pathogenesis of Damp-Heat in the Middle Jiao.
Indications
Main symptoms include fever without significant heat, profuse sweating, poor appetite, chest fullness and abdominal distension, nausea and loose stools, or loose stools that are unsatisfactory, or alternating vomiting and diarrhea, or fatigue in the limbs, and muscle soreness; with signs such as a greasy complexion, foul odor, a red tip and edges of the tongue, yellow and greasy coating, and a slippery and rapid pulse, which serve as the basis for the diagnosis of Damp-Heat.
Pathological Analysis
Damp-Heat often centers on the spleen and stomach, and can affect the other four organs through the Shaoyang Sanjiao, leading to simultaneous disease in two or three organs.
The “Wen Re Jing Wei: Damp-Heat Disease” states: “Damp-Heat diseases mostly belong to the Yangming and Taiyin channels; if the central qi is full, the disease is in Yangming; if the central qi is deficient, the disease is in Taiyin. Diseases on the surface of these two channels often also involve the Shaoyang Sanjiao; diseases within these two channels often also involve the Jueyin Wind-Wood.”
The Damp-Heat pathogen often enters the body through the mouth and nose. If the pathogen enters through the mouth, it invades the gastrointestinal tract, affecting the function of the spleen and stomach, thus presenting as Damp-Heat in the Middle Jiao. Additionally, external invasion of wind-cold or warm pathogens can affect the lungs, returning to the intestines and stomach through the Sanjiao; and internal injury from cold can disrupt the transformation and transportation, leading to qi stagnation and heat transformation, resulting in the condensation of fluids into dampness. Therefore, Damp-Heat in the Middle Jiao is very common.
Although Damp-Heat primarily affects the spleen and stomach, the symptoms can manifest in all five organs.
Obstruction of spleen function leads to internal retention of dampness, obstruction of fluids and qi, and disruption of ascending and descending functions, resulting in symptoms such as a pale yellow complexion, or a greasy appearance, foul odor, thirst without desire to drink, reduced appetite, chest fullness, abdominal distension, nausea, loose stools, or alternating vomiting and diarrhea, with a red tongue and yellow greasy coating as the main symptoms.
If the disease is on the surface of the two channels, it often also involves the Shaoyang Sanjiao, leading to poor water metabolism, dampness stagnation, and heat steaming, presenting as alternating chills and fever, fever without significant heat, profuse sweating, fatigue in the limbs, and muscle soreness;
If it flows down to the kidneys, it presents as painful urination, dampness in the scrotum, and foul-smelling discharge;
If it obstructs the liver and gallbladder, it presents as chest and hypochondriac pain, or jaundice, or convulsions;
If it invades the lungs, it presents as nasal congestion, throat swelling, and cough;
If it obstructs the clear orifices, it presents as swollen gums, deafness, dizziness, and blurred vision. The fundamental pathology is the mutual accumulation of dampness and heat. Dampness is due to dysfunction, leading to condensation; heat is due to external invasion and qi stagnation.
Formulation and Prescription
Dampness is a Yin pathogen, characterized by its stickiness, while heat is a Yang pathogen, characterized by its extreme ferocity. When heat and dampness combine, they become like oil on the skin, difficult to separate, unlike surface conditions that can be resolved with sweating, or internal conditions that can be resolved quickly. To treat this condition, simply clearing heat will leave dampness behind, and simply eliminating dampness will exacerbate heat; thus, it is necessary to clear heat and eliminate dampness, separating and dissipating their influence.
Since dampness is a Yin pathogen, treatment should focus on warming and transforming it, while heat is a Yang pathogen, treatment should focus on clearing and resolving it. Therefore, this condition often uses bitter and cold herbs such as Zhi Zi (Gardenia), Huang Qin (Scutellaria), Huang Lian (Coptis), and Huang Bai (Phellodendron) to clear heat and detoxify, eliminating the cause of the disease or resolving the stagnant heat;
Additionally, warm and drying herbs such as Cang Zhu (Atractylodes), Hou Po (Magnolia Bark), Ban Xia (Pinellia), and Cao Guo (Tsaoko); aromatic herbs that transform dampness such as Chang Pu (Acorus), Huo Xiang (Agastache), Sha Ren (Amomum), Bai Dou Kou (White Cardamom), Chen Pi (Tangerine Peel), and Pei Lan (Eclipta); and herbs that awaken the spleen and transform dampness to restore spleen function. To eliminate dampness, do not forget to add herbs that open the lung qi such as Jie Geng (Platycodon), Xing Ren (Apricot Kernel), Bo He (Mint), and Pi Pa Ye (Loquat Leaf) to open the water pathways and expand the qi mechanism; and herbs that promote urination and drain dampness such as Fu Ling (Poria), Hua Shi (Talc), Tong Cao (Tetrapanax), Zhu Ling (Polyporus), Ze Xie (Alisma), Fang Ji (Stephania), Yi Yi Ren (Job’s Tears), Yin Chen (Virgate Wormwood), and Lu Gen (Reed Rhizome) to clear the water pathways and relieve stagnation. Combining these five categories of herbs—spicy to open, bitter to drain, drying to eliminate dampness, aromatic to transform, and light to drain—into a formula can eliminate the pathogenic causes and regulate organ functions, removing the stagnant dampness. Such a combination is a complete structure.
Commonly used formulas include Gan Lu Xiao Du Dan (Sweet Dew Detoxification Pill), San Ren Tang (Three Nut Decoction), Yi Yi Zhu Ye San (Job’s Tears and Bamboo Leaf Powder), Xuan Bi Tang (Dispersing Bi Decoction), Jia Jian Mu Fang Ji Tang (Modified Stephania Decoction), Lian Po Yin (Lian Po Drink), Can Shi Tang (Silkworm Excrement Decoction), Ban Xia Xie Xin Tang (Pinellia Heart-Resolving Decoction), Sheng Jiang Xie Xin Tang (Fresh Ginger Heart-Resolving Decoction), and Gan Cao Xie Xin Tang (Licorice Heart-Resolving Decoction).
When formulating with these types of prescriptions, attention should be paid to several points: the relative severity of dampness and heat; whether the disease is more superficial or deeper; whether there are accompanying symptoms that are more upper or lower; and if damp-heat is mismanaged leading to adverse conditions, corrective measures should be taken.
Damp-Heat stagnation is difficult to resolve quickly, akin to peeling layers of a banana, and should be treated patiently without haste.
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References: TCM Treatment Methods and Formulas