Heat diseases are a collective term for summer dampness, damp-heat, and warm diseases, which arise from the invasion of damp-heat pathogens or from the internal accumulation of damp-heat due to spleen and stomach deficiency. This condition is characterized by “damp obstructing heat” and “damp-heat steaming”. It often results from external pathogenic factors or from dietary indiscretion that injures the spleen and stomach, leading to obstruction of qi and metabolic disorders due to damp-heat. The concept of damp-heat diseases was first noted in the Qing Dynasty by Wang Mengying in “Wen Re Jing Wei” and by Xue Shengbai in “Damp-Heat Disease Chapter”. It can occur when both dampness and heat are present. This is known as damp-warmth, and it can also arise from prolonged dampness transforming into heat. Yu believes that the three qi refer to the summer terrestrial heat combined with the celestial heat. Initially, there may be aversion to cold, followed by heat without cold, sweating, chest oppression, a white tongue (with a note that it may also be yellow), and thirst without a desire to drink (as noted by Xiong). This condition can occur in all four seasons, but is most common in summer and autumn. Clinically, the key symptoms include initial aversion to cold, followed by heat, sweating, chest oppression, a white tongue, and thirst without a desire to drink. The etiology is due to the invasion of damp-heat pathogens, hence the name. The term heat refers to a type of heat manifestation. The heat in damp-heat is often present simultaneously with dampness, which can occur due to the hot and humid weather in summer and autumn, or due to prolonged dampness transforming into heat, or due to a “yang-heat constitution” causing dampness to transform into heat. Therefore, the simultaneous presence of dampness and heat is quite common.
As a major category, damp-heat diseases have the following characteristics:
1. Strong seasonality, primarily occurring in the late summer and early autumn when temperatures remain high and humidity is prevalent, making it easy to contract the disease.
2. Centered around the spleen and stomach, it diffuses throughout the body. It obstructs the flow of qi, leading to metabolic disorders of fluids.
3. Contradictory symptoms may appear, such as body heat without a flushed face, a pale yellow complexion instead of red, a slow pulse instead of rapid, no thirst or a preference for warm drinks, no irritability but rather lethargy, and infrequent but not dry stools with a white greasy tongue coating.
4. Long course of illness, often lingering and difficult to resolve.
In the general evolution of damp-heat diseases, the initial stage often shows more dampness than heat; as damp-heat gradually transforms into dryness, a phenomenon of equal dampness and heat may occur, and in severe cases, heat may dominate over dampness. In the early stages of damp-heat syndrome, damp-heat obstructs the qi level, primarily affecting the Taiyin spleen and Yangming stomach, but the pathogenic factors can diffuse through the three jiao, affecting other organs and presenting various symptoms, such as: liver channel damp-heat syndrome, liver-gallbladder damp-heat syndrome, spleen-stomach damp-heat syndrome, bladder damp-heat syndrome, large intestine damp-heat syndrome, damp-heat obstructing the meridians syndrome, damp-heat diffusing through the three jiao syndrome, damp-heat transforming into dryness syndrome, damp-heat diarrhea syndrome, damp-heat dysentery syndrome, damp-heat toxicity syndrome, Yangming damp-heat syndrome, Yangming damp-heat interior excess syndrome, Yangming damp-heat with exterior syndrome, damp-heat descending syndrome, damp-heat descending through the Chong and Ren channels syndrome, skin damp-heat syndrome, liver-gallbladder damp-heat invading the ear syndrome, flesh wheel damp-heat syndrome, qi wheel damp-heat syndrome, wind wheel damp-heat syndrome, and water wheel damp-heat syndrome, among others. Additionally, corresponding syndromes include: damp obstructing the qi level syndrome, summer dampness obstructing the middle jiao syndrome, gallbladder heat syndrome, gallbladder depression phlegm disturbing syndrome, damp obstructing heat syndrome, extreme heat generating wind syndrome, summer dampness steaming syndrome, summer dampness with stagnation syndrome, Taiyang heat disturbing the chest diaphragm syndrome, Taiyin cold-damp obstructing syndrome, heat binding and flowing syndrome, and other similar or suspected syndromes.
【Etiology and Pathogenesis】:
Wu Jutong in “Wen Bing Tiao Bian” states that “summer heat, warm dampness, and damp warmth all share the same etiology”; they are all caused by damp-heat pathogens. Damp-heat diseases often arise from being caught in the rain or from exposure to damp-heat qi. They are more likely to occur in the late summer and early autumn when there is more rainfall and the climate is hot and humid, leading to dampness and heat accumulation, making individuals with weak constitutions more susceptible to damp-heat pathogens. This condition is closely related to the individual’s constitution; those with poor spleen and stomach function and weak transformation ability are more prone to external dampness. Clinically, when damp-heat is present, it is often necessary to avoid greasy and rich foods, as they may exacerbate internal dampness, and a light diet is recommended.
【Differentiation and Treatment】:
Due to the sticky and difficult nature of dampness, even if the damp-warmth pathogen is on the surface, it cannot be easily resolved by superficial treatments. Therefore, there is a saying that “damp-warmth should avoid sweating”; excessive sweating can lead to fluid depletion without resolving dampness. Thus, it is necessary to use aromatic and dispersing methods to open the pores, promote the flow of qi, and allow for slight sweating to resolve the condition, preventing damp-heat from lingering. When damp-heat is initially resolved, residual pathogens may still linger, requiring both medicinal treatment and careful dietary management. The “Suwen” states: “When heat is slightly resolved, eating meat can cause a relapse; excessive eating can lead to residual symptoms; this is the prohibition.” In clinical practice, when damp-heat is initially resolved, if the appetite improves, excessive eating or consuming rich foods too soon can often lead to a relapse of the condition. Therefore, after suffering from severe damp-heat, one should only consume light, thin porridge for a period of recovery before gradually increasing food intake.
According to “Yilin Shengmo”: “If dampness is predominant, it should be cleared; if heat is predominant, it should be cleared; one cannot treat heat with heat, as it will exacerbate dampness; if heat is stronger than dampness, one cannot treat dampness, as it will exacerbate heat.” Therefore, if dampness is predominant, the focus should be on promoting urination and clearing dampness to prevent dampness from becoming heat. Over time, if dampness transforms into heat, one should not further promote dampness, as it will only assist heat in becoming stronger. This is an ancient saying, which, while providing reference for treating damp-heat syndromes with predominant dampness and lesser heat, or vice versa, I believe is not entirely correct; the proper approach should be to clear both dampness and heat. Although damp-heat syndromes may present with initial dampness predominating over heat, or heat predominating over dampness, the treatment must always involve addressing both dampness and heat, treating dampness without neglecting heat, and treating heat without ignoring dampness. Furthermore, it is essential to analyze the emphasis on dampness or heat based on the severity of the condition and various transformations. Additionally, when prescribing formulas and medications for different types of damp-heat syndromes, one must not uniformly use damp-resolving and heat-clearing herbs mechanically; otherwise, satisfactory results may be difficult to achieve. Instead, a more nuanced approach, such as using a combination of 30% damp-resolving and 70% heat-clearing herbs, should be employed, along with additional herbs for accompanying symptoms. Based on the above understanding, the general treatment approach for damp-heat syndromes is: In the initial stage, when both internal and external pathogens are present, and dampness obstructs the defensive qi, aromatic and dispersing methods should be used to transform the dampness in both the exterior and interior. Once the exterior symptoms are resolved, one should then focus on clearing the dampness and turbidity in the qi level, and consider accompanying symptoms to clear heat as needed. When damp-heat transforms into heat, with heat predominating over dampness, the focus should be on clearing heat while also addressing dampness. When damp-heat completely transforms into heat and dryness, the treatment should focus on transforming dryness and clearing heat.
The differentiation of damp-heat syndromes allows practitioners to initially discern the relative severity of dampness and heat, facilitating the appropriate selection of heat-clearing and damp-resolving herbs. The simplest and most effective method for distinguishing between damp-heat is: First, observe the tongue coating; second, inquire about thirst. If dampness predominates over heat, the tongue coating will be white and greasy, and there will be little or no thirst; if dampness and heat are equal, the tongue coating will be yellow, thick, and greasy, with thirst but a preference for warm drinks; if heat predominates over dampness, the tongue coating will be yellow, slightly greasy or dry, with significant thirst and a desire to drink. Most heat-clearing and damp-resolving herbs are cold and cooling, belonging to the “yin” category of herbs, which are heavy and sticky, making them difficult to mobilize and affecting their efficacy, as well as impacting spleen and stomach function. Therefore, when using such herbs, it is advisable to combine them with warming and drying herbs, such as Chuan Houpo, Chenpi, Muxiang, Cangzhu, Fa Banxia, and Guizhi, which belong to the “yang” category of herbs (even in cases of heat predominating over dampness). This promotes the rise and fall of qi and aids in the mobilization of the herbs while also protecting spleen and stomach function, thereby enhancing efficacy. This principle can be observed in Wang Mengying’s famous formulas such as Wang’s Lianpu Decoction and Ganlu Disinfectant Pill. This is a remarkable aspect of traditional Chinese medicine in the formulation and use of herbs! The use of heat-clearing and damp-resolving herbs to promote urination inevitably depletes body fluids. Therefore, when employing heat-clearing and damp-resolving methods, moderation is key. Those with a constitution of yin deficiency and fluid depletion should use this method cautiously or combine it with nourishing yin and generating fluids herbs. This method should be avoided if dampness is not present or if dampness has already transformed into dryness or fire.
Damp-heat syndrome is one of the common clinical syndromes, appearing across various medical specialties and in multiple diseases. Its clinical manifestations also have distinct characteristics, leading to different treatment methods. Therefore, when treating damp-heat diseases, it is essential to grasp the commonalities and individualities of the same pathogenic nature (damp-heat) in terms of etiology, location (different locations lead to different formulas), course (different courses require different treatment approaches), pathology (different pathological characteristics lead to different treatments), severity (light or heavy, acute or chronic), and pathogenesis, while also analyzing the similarities and differences in formulas; emphasizing the differentiation between similar and suspected syndromes to ensure that the treatment of damp-heat diseases in clinical practice is objective and scientific, and that the patient’s treatment is simple yet effective. Damp-heat diseases are caused by both damp and heat pathogens, thus exhibiting a diffuse nature. Before transforming into dryness, the condition is characterized by the same disease in the defensive level, with unclear boundaries between the defensive qi and the nutritive blood, making differentiation based on the defensive qi and nutritive blood not very meaningful. The process of damp-heat disease transformation is “beginning in the upper jiao and ending in the lower jiao”; therefore, differentiation based on the three jiao is more clinically significant.
【Differentiation and Treatment】:
The characteristic of damp-heat diseases is their diffusion through the three jiao, obstructing the flow of qi, often centered around a specific area. There may be transmission from one area to another, or the pathogenic qi may invade directly. Therefore, clinical medication should consider all three jiao; for example, if the disease is in the middle jiao, it can also diffuse upwards or downwards, so a small amount of aromatic dispersing herbs and light damp-resolving herbs should be added appropriately. Damp-heat diseases are always centered around the spleen and stomach, as the spleen governs the transformation and transportation of water and dampness; if the spleen is not functioning well, dampness cannot be eliminated. Thus, in the treatment process, regardless of the jiao affected, the issue of strengthening the spleen must be considered. Once the spleen’s function is restored, the ability to transform and transport water and dampness improves, allowing for the elimination of damp pathogens. Therefore, herbs that strengthen the spleen and awaken the stomach should be added, such as: Fu Ling, Bai Zhu, and Yi Yi Ren (note: any herbs that are heavy and dampening should not be used in the middle jiao!). Awakening the stomach can be achieved with herbs like: Shan Zha, Shen Qu, Mai Ya, Ji Nei Jin, Sha Ren, and Cao Ren. Treatment of dampness cannot be separated from regulating qi; within the scope of damp-heat, qi-regulating herbs such as Hou Po, Zhi Shi, Chen Pi, Da Fu Pi, and Huo Geng should be added. Additionally, to eliminate dampness, lung qi should be opened, using Xing Ren and Jie Geng, but damp-heat should avoid rising; therefore, Jie Geng should be used sparingly. Further differentiation can be made by adding the following herbs.
[Upper Jiao Damp-Heat]: Primarily manifests as body heat without elevation, significant aversion to cold, heavy pain in the head and body, greasy tongue coating, and a pulse that is slippery yet rapid.
[Principle]: Aromatic warming and dispersing, aromatic transformation of dampness.
[Formula]: Huo Xiang 9g, Hou Po 3g, Jiang Ban Xia 4.5g, Chi Fu Ling 9g, Xing Ren 9g, Sheng Yi Ren 12g, Bai Cao Ren (added later) 1.8g, Zhu Ling 4.5g, Dan Dou Chi 9g, Ze Xie 4.5g. Method: Decoction in water, one dose per day, mixed and divided into two to three doses.
Middle Jiao Damp-Heat: If upper jiao damp-heat is unresolved, it can transmit to the middle jiao. Additionally, individuals with a constitution prone to dampness may directly experience damp-heat invasion in the middle jiao. The middle jiao consists of the spleen and stomach; heat enters the stomach and dampness enters the spleen, leading to symptoms of heaviness from dampness or heat. Whether heat or dampness predominates depends on the nature of the pathogenic qi and the individual’s constitution.
[Damp Predominant over Heat]: In the early stages of damp-heat disease, it is often damp predominant over heat, or the invading pathogenic qi itself is damp predominant and heat light. Symptoms include body heat without elevation, abdominal fullness without muscle tension, loose stools without urgency, little or no thirst, a white greasy tongue coating, and a slippery pulse.
[Principle]: Aromatic warming to open, bitter warming to dry dampness (aromatic opening and bitter descending method).
[Commonly Used Herbs]: Ban Xia, Cang Zhu, Bai Cao Ren, Cao Guo (aromatic warming), Hou Po, Da Fu Pi, Chen Pi (bitter warming).
[Damp-Heat Equal]: Dampness and heat are mutually entangled, heat stews dampness, and dampness wraps around heat, clinically presenting as body heat, irritability, abdominal fullness, nausea, vomiting, loose stools that are yellow and foul, sweating reduces heat, followed by a return of heat, yellow greasy tongue coating, and a slippery rapid pulse.
[Principle]: Bitter cold to clear and dry.
[Commonly Used Herbs]: Huang Lian, Huang Qin, Zhi Zi.
[Heat Predominant over Damp]: High fever, significant thirst, profuse sweating, a rapid and strong pulse, abdominal fullness, body heaviness, a yellow dry tongue coating, and a rapid or slippery pulse.
[Principle]: Cold cooling to clear heat, combined with drying dampness.
[Formula]: Shi Gao 60g, Qing Hao 30g, Bai Wei 30g, Sang Ye 10g, Chi Shao 10g, Chai Hu 10g, Jing Jie 9g, Huang Lian 6g, Shan Zha 15g, Shen Qu 15g, Bing Lang 9g, Hua Fen 15g, Da Qing Ye 30g, Zhi Mu 10g, Ban Xia 10g.
Method: Decoction in water, one dose per day, mixed and divided into two to three doses.
[Lower Jiao Damp-Heat]: The lower jiao primarily consists of the large intestine and bladder, governing urination and defecation; obstruction of qi leads to difficulty or inability to pass urine or stool.
[Principle]: Lightly draining and resolving dampness.
[Formula]: Shi Chang Pu 9g, Chao Zhi Zi 9g, Fresh Bamboo Leaves 9g, Mu Dan Pi 9g, Yu Jin 6g, Lian Qiao 6g, Deng Xin 6g, Mu Tong 4.5g, Zhu Li (dissolved) 15g, Yu Shu Dan (dissolved) 1.5g.
Method: Decoction in water, one dose per day, mixed and divided into two to three doses.
[Three Jiao Damp-Heat]: Damp-heat combined with pathogens invades the Yangming and Taiyin, obstructing the middle, reversing in the upper, and invading the lower, diffusing through the three jiao, leading to dysfunction in the upper jiao’s clarity, middle jiao’s elevation, and lower jiao’s excretion, presenting with symptoms of chest oppression, abdominal fullness, nausea, body heaviness, red urine, loose stools, gray-white or yellow greasy tongue coating as the main symptoms. Symptoms include chest tightness, abdominal fullness, body heaviness and pain, fever and thirst, nausea and vomiting, loose or unformed stools, short and red urine, sweating, gray-white or yellow greasy tongue coating, and a slippery pulse. The damp-heat pathogen often invades through the mouth and nose, although it can also enter through rain and dew, but this is less common. Once it enters the body, it primarily affects the spleen and stomach, often involving the Shaoyang and three jiao. This damp-heat internally transmits, obstructing the qi transformation in the three jiao, and due to the different focal points of the pathogenic heat, the manifestations can vary. The damp-heat syndrome of warm diseases often presents with gray-white tongue coating, chest and abdominal fullness, tidal fever, nausea, thirst, diarrhea, sweating, and short urination, resulting from heat within dampness, dampness generating heat, and the mixing of damp-heat obstructing the qi transformation in the middle jiao, reversing in the lungs and obstructing the intestines.
[Principle]: Bitter and aromatic to open and drain.
[Commonly Used Formula]: Use Xing Ren and Hua Shi Decoction: Formula: Xing Ren 9g, Hua Shi 9g, Huang Qin 6g, Ju Hong 3g, Huang Lian 3g, Yu Jin 6g, Tong Cao 3g, Hou Po 6g, Ban Xia 9g.
(“Wen Bing Tiao Bian”). If the three jiao is obstructed by damp-heat, with abdominal fullness and loose stools as the main symptoms, the obstruction is primarily in the middle jiao, causing the Taiyin to fail to rise and the Yangming to fail to descend, leading to stagnation of water and food, and qi stagnation in the middle. The treatment should focus on bitter and aromatic cold methods to elevate and descend the qi of the middle jiao, allowing for the removal of the pathogenic qi.
Use a modified Zhengqi Powder: Formula: Huo Xiang 15g, Hou Po 9g, Fu Ling Pi 9g, Xing Ren 9g, Chen Pi 9g, Shen Qu 6g, Mai Ya 6g, Yin Chen 9g, Da Fu Pi 9g.
(“Wen Bing Tiao Bian”). If dampness obstructs the three jiao, with symptoms of abdominal fullness, loose stools, body heaviness, white tongue coating, and a slippery or fuzzy pulse, this indicates damp-heat internally obstructing the middle jiao and externally affecting the meridians, leading to body heaviness and pain, and a fuzzy pulse indicating qi stagnation. The treatment should focus on bitter, aromatic, and light methods to transform dampness, regulate qi, and open the meridians, using a modified Zhengqi Powder: Huo Xiang 9g, Chen Pi 6g, Hou Po 6g, Yi Yi Ren 9g, Fu Ling Pi 9g, Mu Fang Ji 9g.
(“Wen Bing Tiao Bian”). If dampness obstructs the three jiao and presents with yellow tongue and abdominal fullness symptoms, this indicates that the qi mechanism in the upper and middle jiao is not functioning properly, and the foul dampness is gradually transforming into heat. At this time, a bitter and aromatic cold method should be used to open the lungs, regulate qi, drain heat, and resolve dampness, using a modified Zhengqi Powder: Huo Xiang 9g, Fu Ling Pi 9g, Hou Po 6g, Chen Pi 6g, Xing Ren 9g, Hua Shi 15g.(“Wen Bing Tiao Bian”).
【Medication Contraindications】:
1. Avoid excessive sweating (e.g., Ma Gui type); prefer mild sweating methods. “If one sweats excessively, it can lead to confusion and deafness, and in severe cases, to unconsciousness and inability to speak.”
2. Avoid excessive purging; it can be combined with purging methods. “If purged excessively, it can lead to severe diarrhea.”
3. Avoid tonics (e.g., ginseng, astragalus); “if nourished, the disease will deepen and not resolve.”
4. Avoid warming tonics (e.g., ginseng, astragalus); “even if the stove is extinguished, there is still fire in the ashes.”
【Other Therapies】:
1. Acupuncture: Needle the Shaoshang, Quchi, and Weizhong points, or bleed at the sublingual veins or black veins. This treats cholera and intestinal cramps.
2. Body acupuncture: Select Zhongwan, Neiguan, and Zusanli points; for severe vomiting, add Hegu; for severe diarrhea, add Tianshu; for abdominal pain, add Gongsun point, using purging methods to treat cholera.
【Prevention and Health Care】:
When damp-heat is initially resolved, residual pathogens often linger, requiring both medicinal treatment and careful dietary management. The “Suwen” states: “When heat is slightly resolved, eating meat can cause a relapse; excessive eating can lead to residual symptoms; this is the prohibition.” In clinical practice, when damp-heat is initially resolved, if the appetite improves, excessive eating or consuming rich foods too soon can often lead to a relapse of the condition. Therefore, after suffering from severe damp-heat, one should only consume light, thin porridge for a period of recovery before gradually increasing food intake.
Thus, attention should be paid to the following points:
1. Maintain hygiene in diet and drinking water; during summer, do not indulge excessively in cold foods, keep indoor air circulation, and eliminate dampness. In summer, it is advisable to use fresh Huo Xiang, fresh Peilan, fresh lotus leaves, and roasted barley as beverages to aromatically transform turbidity, awaken the spleen, and prevent damp obstruction diseases.
2. If there is vomiting and diarrhea, do not eat until the pathogenic qi is cleared; once vomiting and diarrhea have stopped, gradually resume eating, starting with light, liquid, or semi-liquid foods.
3. For patients with abdominal distension, characterized by a large, hard, and painful abdomen, it is advisable to take a semi-reclining position, consume a low-salt or salt-free diet, and avoid fried, hard, coarse, and spicy foods, opting for semi-liquid, residue-free foods, eating small amounts frequently, and having a light dinner. If diuretic medications are needed, they should be taken on an empty stomach in the morning. After taking medication, pay attention to the frequency, volume, and color of urination and defecation. Patients with abdominal distension should also regularly measure their weight and abdominal circumference to monitor changes in their condition.
Note: Be cautious of counterfeit medications, such as expired or moldy drugs; traditional Chinese medicine is particularly prone to mold. Moldy drugs not only fail to treat diseases but can also lead to liver cancer. Many people buy medications based solely on price, unaware that the quality of medicinal materials directly affects efficacy. Nowadays, many people prefer to buy things on Taobao; if purchasing medicine there, ensure it is from an official flagship store. Otherwise, you may end up with counterfeit drugs that can be fatal. Many inferior drugs are treated with sulfur, leading to heavy metal poisoning, and counterfeit drugs made from flour, brown sugar, and talcum powder are everywhere, making them hard to avoid. Counterfeit drugs are often cheap, ineffective, and can worsen the condition, potentially leading to death. For example, honey, regardless of where you buy it, is often fake, made from water, white sugar, brown sugar, and alum. The best fake honey is mixed with grape powder, so what you buy is likely this type of honey, which can harm your health if consumed excessively. When buying other items, only official flagship stores on Taobao are authentic. When seeking a doctor, be cautious of quacks; many scammers exist. Consider this: good doctors do not need advertising; as long as they treat patients well, patients will spread the word. If a doctor successfully treats six or seven out of ten patients, their clinic will have a long line. Think about what I said.
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