Damp-heat is a common issue faced by many individuals, leading to conditions such as gastric diseases, eczema, hair loss, prostatitis, vaginitis, cholecystitis, and more. The underlying cause of these diseases is often excessive damp-heat in the body, with individuals of damp-heat constitution making up about one-quarter of the general population.
Among the damp-heat syndromes, the most common are Liver-Gallbladder Damp-Heat and Spleen-Stomach Damp-Heat. Due to the similarity in symptoms caused by both, many people often confuse whether they are experiencing Spleen-Stomach Damp-Heat or Liver-Gallbladder Damp-Heat. Traditional Chinese Medicine (TCM) teaches how to differentiate between the two.
Spleen-Stomach Damp-Heat
Spleen-Stomach Damp-Heat, also known as Middle Jiao Damp-Heat, is often caused by the invasion of damp pathogens or by improper diet, such as excessive consumption of rich and fatty foods, leading to the accumulation of damp-heat within the Spleen and Stomach. Symptoms include abdominal fullness, fatigue, loose stools, bitter mouth, little thirst, yellow and scanty urine, and even a yellowish complexion. The tongue is typically yellow and greasy, and the pulse is slippery and rapid. The treatment principle focuses on clearing heat and draining dampness.
Spleen-Stomach Damp-Heat syndrome is commonly seen in outpatient clinics, involving various diseases across digestive, tumor, and urinary systems, with digestive system diseases being the most prevalent, such as chronic gastritis, gastroesophageal reflux disease, gastric or duodenal ulcers, chronic hepatitis B, liver cirrhosis, fatty liver, and gallstones. In the context of liver cancer surgery or surgeries involving the esophagus, stomach, or intestines, different stages of development may occur, with chronic gastritis being the most common. The primary causes of Spleen-Stomach Damp-Heat syndrome are ineffective treatment of the aforementioned diseases, leading to recurrent and progressive pathological changes. Additionally, poor lifestyle choices, such as overeating rich and greasy foods, consuming spicy foods, smoking, and drinking alcohol, can damage the Spleen and Stomach, resulting in damp accumulation and heat generation. Therefore, to prevent the occurrence of Spleen-Stomach Damp-Heat, it is essential to actively treat the underlying diseases and change unhealthy lifestyle habits, such as maintaining a balanced diet, avoiding smoking, and refraining from alcohol.
1
The Physiological Characteristics of the Spleen and Stomach are Ascending and Descending
The Spleen and Stomach are the foundation of postnatal life and the source of Qi and blood production. Their functional characteristics primarily focus on ascending and descending. The Spleen governs transportation and transformation, ascending the clear Qi; the Stomach receives and rots food and drink, descending the turbid. When the Spleen ascends properly, it is healthy; when the Stomach descends properly, it is harmonious. If the Spleen fails to transport effectively, the clear Qi does not ascend; if the Stomach fails to descend harmoniously, the turbid Qi does not descend and may even rise in reverse. The Spleen is a Yin organ, while the Stomach is a Yang organ, mutually interdependent, with one ascending and the other descending. This interplay not only governs the rotting and ripening of food and the distribution of essence but also relates to the overall balance of Yin and Yang, Qi and blood, and the movement of water and fire in the body, making it a crucial pivot for bodily functions. The ascending and descending of the Spleen and Stomach are also causally related; if the Stomach fails to descend, the Spleen Qi cannot ascend; if the Spleen fails to ascend, the Stomach will not descend. As Yu Jiayan stated, “When the Qi of the Zhongwan (Middle Jiao) is strong, the clear Qi of food and drink rises and nourishes the meridians, while the turbid Qi of food and drink descends to the large and small intestines for excretion.” The Spleen’s clear Yang ascends, and the Stomach’s turbid Yin descends, thus providing a source for the production of Qi and blood, with orderly entry and exit. If there is no transportation or ascension, there will be no production; if there is no descent, there will be no transformation, leading to stagnation and disease.
2
Prominent Manifestations of Spleen and Stomach Diseases are Dampness and Stagnation
Although there are many Spleen and Stomach diseases, dampness and Qi stagnation are common pathological mechanisms. The Spleen and Stomach are the officials of storage and the sea of food and drink, receiving all substances. Pathogenic factors can easily invade and reside within, causing abnormal ascending and descending, leading to water becoming damp and food becoming stagnant. Dampness obstruction, food accumulation, phlegm obstruction, Qi stagnation, blood stasis, and heat depression can all arise from this. The interaction of pathogenic and righteous Qi leads to obstruction of the Qi pathways, resulting in stagnation in the Middle Jiao, which is classified as excess stagnation. If the Spleen and Stomach are deficient, their transportation and transformation functions are impaired, leading to disordered ascending and descending, and the mixing of clear and turbid, resulting in dampness and stagnation, known as deficiency leading to excess, with excess occurring amidst deficiency. As stated in the “Su Wen: Treatise on Regulation of Menstruation”, “If there is labor and fatigue, the body and Qi will weaken, and the Qi of food will not be abundant, the upper Jiao will not function, and the lower Jiao will not be unblocked…” Since dampness and stagnation are key pathological mechanisms, treatment of Spleen and Stomach diseases should focus on moving stagnation, draining dampness, and restoring normal ascending and descending.
3
Regulating Spleen and Stomach Diseases with Attention to Lung Qi Dissemination
Spleen and Stomach diseases often involve dampness and stagnation, with Spleen diseases being more damp-prone and easily obstructed by dampness, while Stomach diseases are often heat-prone and easily obstructed by heat. Therefore, Spleen and Stomach diseases should not be treated with excessive tonification or purging; rather, they should be regulated, exploring the root causes of Qi dysfunction, and treating based on the cause to restore the normal ascending and descending of the Spleen and Stomach, allowing dampness and stagnation to dissipate and harmonizing the ascending and descending, thus alleviating various symptoms.
When regulating the Spleen and Stomach, attention should also be given to the dissemination of Lung Qi. The Spleen governs the transportation of food and drink, transforming food like fermentation, while the Lung governs the distribution of essence like mist. The Spleen requires the assistance of the Lung to complete the distribution of the essence of food and drink, as stated in the “Su Wen: Treatise on Meridians” which states, “The Spleen governs the distribution of essence, ascending to the Lung, and regulating the water pathways, descending to the bladder.” The Lung governs the dissemination and descending of Qi, while the Spleen and Stomach govern the ascending of clear and descending of turbid, both managing the movement of Qi. Therefore, when treating the Spleen, one must not forget to manage the Lung; when treating the Lung, one must consider the Spleen. In clinical practice, medications should include those that strengthen the Spleen and harmonize the Stomach, with the addition of herbs that disseminate Lung Qi and relieve stagnation, such as Xing Ren (Apricot Kernel), Gua Lou (Trichosanthes Fruit), and Ma Huang (Ephedra). Ye Tian Shi in the “Clinical Guidelines for Medical Cases” used Xing Ren to disseminate Lung Qi and relieve stagnation, allowing dampness to be transported and facilitating the dissemination of Lung Qi to benefit the Spleen.Spleen-Stomach Damp-Heat: Symptoms of Spleen-Stomach Damp-Heat are diverse, including gastric pain, a burning sensation, dry mouth with little desire to drink, hunger without desire to eat, yellow urine, and constipation, which are key points for differentiating Spleen-Stomach Damp-Heat. The treatment for this syndrome should adhere to the principle of clearing heat without hindering dampness, and draining dampness without promoting heat, using San Ren Tang (Three Nut Decoction) with modifications, often adding Dong Gua Pi (Winter Melon Peel) and Yin Chen (Virgate Wormwood) to clear dampness and heat, and harmonize the Spleen and Stomach. For damp-heat diarrhea, Ge Gen Qin Lian Tang (Pueraria, Scutellaria, and Coptis Decoction) is often used with modifications; if jaundice symptoms appear, Yin Chen Wu Ling San (Virgate Wormwood and Five-Ingredient Powder) can be used with modifications.
Liver-Gallbladder Damp-Heat
Main Symptoms: fullness and oppression in the hypochondrium, bitter mouth, poor appetite, nausea, abdominal distension, irregular bowel movements, short and red urine, red tongue with yellow greasy coating, and a wiry, slippery, rapid pulse. Symptoms may include yellowing of the skin and eyes, alternating chills and fever, scrotal eczema, swollen and painful testicles, or yellow and foul vaginal discharge with vulvar itching. Diagnosis: Often due to the invasion of damp-heat pathogens; or excessive consumption of rich and fatty foods leading to damp-heat generation; or dysfunction of Spleen and Stomach leading to internal dampness, which transforms into heat, resulting in damp-heat accumulation in the Liver and Gallbladder. Damp-heat steams and accumulates in the Liver and Gallbladder, leading to dysfunction of the Liver and Gallbladder, hence the fullness and oppression in the hypochondrium, red tongue with yellow greasy coating, and wiry, slippery, rapid pulse; when bile Qi overflows, it causes a bitter mouth; damp-heat obstruction leads to dysfunction of Spleen and Stomach, resulting in poor appetite, nausea, abdominal distension, and irregular bowel movements; damp-heat steaming the Liver and Gallbladder leads to bile overflow and jaundice, with the pathogen residing in the Shaoyang, hence the alternating chills and fever; damp-heat descending leads to short and red urine, scrotal eczema, swollen and painful testicles, and in women, yellow and foul vaginal discharge with vulvar itching. Treatment principle: drain dampness and clear heat, clear the Liver and benefit the Gallbladder.
Comparing Spleen-Stomach Damp-Heat and Liver-Gallbladder Damp-Heat
Similarities Between the Two
1. Common Etiology: Both Spleen-Stomach Damp-Heat and Liver-Gallbladder Damp-Heat are often caused by the invasion of damp-heat pathogens or by a preference for rich and fatty foods, leading to dampness and heat generation.2. Both exhibit symptoms of poor appetite, nausea, and abdominal distension.3. Both may present with jaundice, which is caused by damp-heat steaming, leading to bile overflow onto the skin.4. Tongue examination reveals a red tongue with yellow greasy coating, indicating damp-heat.The differences between the two can be identified as follows:
Differences Between the Two
1. Focus of Damp-Heat: Spleen-Stomach Damp-Heat emphasizes dampness, with manifestations such as heaviness in the limbs, poor appetite, abdominal distension, and pronounced loose stools, while heat manifestations are relatively mild; Liver-Gallbladder Damp-Heat emphasizes heat, with manifestations such as fever, dry mouth, bitter taste, constipation, and short red urine being more pronounced, while damp manifestations are relatively mild.2. Symptoms of Damp-Heat Descending: Liver-Gallbladder Damp-Heat presents with symptoms of damp-heat descending, such as scrotal eczema, dampness, swollen and painful testicles, or yellow and foul vaginal discharge with vulvar itching, which are not present in Spleen-Stomach Damp-Heat.3. Symptoms of Hypochondrial Distension: Liver-Gallbladder Damp-Heat is associated with distension and pain in the hypochondrium due to damp-heat stagnation in the Liver and Gallbladder, while Spleen-Stomach Damp-Heat presents with fullness and pain in the epigastric region without hypochondrial distension.4. More Pronounced Spleen-Stomach Symptoms: Both Spleen-Stomach Damp-Heat and Liver-Gallbladder Damp-Heat exhibit symptoms of Spleen-Stomach dysfunction, but in Liver-Gallbladder Damp-Heat, the Spleen-Stomach symptoms are relatively mild due to the Liver Qi invading the Stomach, while in Spleen-Stomach Damp-Heat, the symptoms are more pronounced due to damp-heat accumulation in the Spleen and Stomach, leading to significant dysfunction.5. Different Treatment Focus: Treatment for Liver-Gallbladder Damp-Heat focuses on clearing and draining damp-heat from the Liver and Gallbladder, promoting diuresis and reducing jaundice; treatment for Spleen-Stomach Damp-Heat focuses on clearing heat, transforming dampness, regulating Qi, harmonizing the Middle Jiao, and strengthening the Spleen to eliminate dampness.