Summary: Ye Tianshi distinguished warm diseases from cold damage, and Xue Shengbai further separated damp-heat diseases from warm diseases. Xue Shengbai, also known as Xue Xue, is the foremost expert in treating damp-heat diseases throughout history! His work, Shire Bing Pian (Treatise on Damp-Heat Diseases), has become the standard for treating damp-heat diseases in later generations! The renowned TCM scholar Ren Yingqiu commented on Shire Bing Pian, saying: “Damp-heat diseases are highly variable; those who grasp the key to their treatment are rare, and this work should be studied diligently and not neglected.” Xue Shengbai categorized damp-heat diseases into exterior syndrome, half-exterior half-interior syndrome (i.e., evil hidden in the membrane source), and interior syndrome, with a focus on learning the diagnosis and treatment of the exterior syndrome of damp-heat disease, explained as follows:
1. Damp-Heat Exterior Syndrome
1. Xue Shengbai stated: “Damp-heat diseases entering from the exterior account for 10-12%, while those entering through the mouth and nose account for 70-80%.” This means that the probability of damp-heat evil entering the body through the skin is only 10-12%, while the probability of it entering through the mouth and nose is 70-80%.
2. The transmission pattern of damp-heat evil entering through the skin is: exterior → membrane source → spleen and stomach. The transmission pattern of damp-heat evil entering through the mouth and nose is: mouth and nose → membrane source → spleen and stomach.
3. When damp-heat evil enters the skin, it causes damp-heat exterior syndrome. Although the probability of developing damp-heat exterior syndrome is low, it is still necessary to diagnose and treat it.
4. Damp-heat exterior syndrome is divided into yin-damp injury to the exterior and yang-damp injury to the exterior. The term “yin-damp” refers to a condition where damp evil predominates in symptoms and disease mechanism, with damp not yet transforming into heat, and is not a cold-damp syndrome. It represents the initial stage of damp-heat disease, with evil in the defensive exterior and damp evil predominating. The term “yang-damp” refers to a condition where heat evil predominates in symptoms and disease mechanism, with damp having transformed into heat, and is not purely a heat-without-damp syndrome. It represents the initial stage of damp-heat disease, with evil in the defensive exterior and heat evil predominating. How to differentiate between yin-damp injury to the exterior and yang-damp injury to the exterior? No sweat and no heat indicate yin-damp injury to the exterior, while sweating and heat indicate yang-damp injury to the exterior.
5. Regardless of whether it is yin-damp injury to the exterior or yang-damp injury to the exterior, the disease location is in the exterior, and the disease nature is damp-heat, thus both are classified as damp-heat exterior syndrome.
6. In damp-heat exterior syndrome, initially there is more dampness, which obstructs the defensive yang, leading to chills. As damp gradually transforms into heat, heat predominates, resulting in fever without chills. Therefore, the key symptoms state: “initially chills, then only fever without chills.”
7. Key symptoms of damp-heat disease: initially chills, then only fever without chills, sweating, chest oppression, white tongue coating, thirst without desire to drink. Among these, the symptoms of initially chills and then only fever without chills are the key indicators for diagnosing damp-heat exterior syndrome. The symptoms of chest oppression (i.e., chest tightness, abdominal distension), sweating, white tongue coating, and thirst without desire to drink are key indicators for diagnosing damp-heat interior syndrome. If a patient exhibits three of these symptoms, they can be diagnosed with damp-heat disease.
2. Yin-Damp Injury to the Exterior Syndrome
1. Original text: Damp-heat syndrome, chills without sweating, heavy body and headache, damp in the exterior, suitable for use of Huo Xiang (Agastache), Xiang Ru (Elsholtzia), Qiang Huo (Notopterygium), Cang Zhu (Atractylodes), Bo He (Mint), Niu Bang Zi (Burdock Seed), etc. If there is no headache, remove Qiang Huo.
2. Verse: Yin-damp injury to the exterior must have no sweating, chills, heavy body, and headache, Huo, Cang, Ru, Bo, etc., if no headache, remove Qiang Huo.
3. Explanation: Yin-damp injury to the exterior syndrome is characterized by damp-heat in the exterior with a predominance of damp evil, where the defensive yang is significantly obstructed by damp. The treatment should primarily focus on dispersing exterior dampness, hence the use of Huo Xiang, Xiang Ru, and Qiang Huo for their aromatic and dispersing properties to eliminate exterior dampness. Cang Zhu is used to drain and benefit dampness. Bo He and Niu Bang Zi assist in dispelling evil and resolving the exterior. The combination of these herbs helps to eliminate damp evil and resolve the exterior syndrome. Yin-damp injury to the exterior syndrome presents with no sweating and chills, headache, and heavy body, resembling wind-cold exterior syndrome. How to differentiate it as yin-damp injury to the exterior syndrome? Yin-damp injury to the exterior syndrome must have a white tongue coating and chest oppression.
3. Yang-Damp Injury to the Exterior Syndrome
1. Original text: Damp-heat syndrome, chills with fever, heavy body and joint pain, damp in the muscles, not relieved by sweating, suitable for use of Hua Shi (Talc), Da Dou Huang Juan (Soybean), Fu Ling Pi (Poria Skin), Cang Zhu (Atractylodes), Huo Xiang Ye (Agastache Leaf), fresh He Ye (Lotus Leaf), Bai Tong Cao (Plantago), Jie Geng (Platycodon), etc. If there is no aversion to cold, remove Cang Zhu.
2. Verse: Yang-damp injury to the exterior has spontaneous sweating, sweating does not relieve heat, joint pain with slight aversion to cold, damp in the skin, heavy body, Da Juan, Fu Ling, Cang Zhu, Hua Shi, Huo Ye, fresh He Ye, Tong Cao, Jie Geng, etc. If no aversion to cold, remove Cang Zhu.
3. Explanation: Yang-damp injury to the exterior syndrome is characterized by damp-heat in the exterior with a predominance of heat evil. Although there is sweating, the body heat does not decrease or resolve, indicating that the invading evil in the skin is not wind-cold but damp-heat. It is not appropriate to use warming and dispersing methods to induce sweating or to use pungent and drying methods to eliminate dampness. However, the heat is not overly intense, so it is only necessary to lightly clear the heat while also using aromatic herbs to transform dampness and promote urination. Therefore, Hua Shi, Da Dou Huang Juan, and Bai Tong Cao are used to clear heat and promote urination. Huo Xiang Ye and He Ye are used for their aromatic properties to transform dampness and resolve the exterior. Fu Ling Pi and Cang Zhu are used to drain and benefit dampness. Jie Geng is used to promote lung qi, as the transformation of lung qi will also help to transform dampness. The combination of these herbs works to clear heat and eliminate dampness, achieving the goal of resolving damp-heat.