Chinese Medicine Book Club Issue 2807
Daily updates to accompany the growth of TCM practitioners
Introduction: For Yang deficiency, warming Yang herbs are used to support Yang, while for damp-heat conditions, clearing heat and eliminating dampness is the common method. The late TCM practitioner Ma Yunxiang from Jiangsu proposed the method of supporting Yang and expelling dampness. The insights of our predecessors are worth inheriting and learning from. (Editor/Qian Cheng)
Experience in Treating Damp-Heat Conditions with the Method of Supporting Yang and Expelling Dampness
Author/Ma Yunxiang
1. Initial Experience of Using Fu Zi for Damp-Warmth Syndrome
During my studies in Shanghai, I had the opportunity to intern under Teacher Zhu Weiju, which alleviated some of my fears regarding Fu Zi (Aconite). This laid a psychological foundation for my later clinical use of Fu Zi. However, at that time, I only encountered non-heat cases, and I lacked rational and experiential knowledge on how and whether to apply it in warm diseases. Therefore, at the beginning of my practice after graduating from medical school, I did not dare to use it in acute heat diseases.
In the early 1940s, I myself suffered from a damp-warmth syndrome. Initially, I sought treatment from others, but after using various mild diaphoretic and aromatic agents without effect, I decided to use herbs like Cang Zhu (Atractylodes) and Hou Po (Magnolia Bark) to dry and warm. However, the results were still the same, and there was no significant drying thirst response. Finally, I added Fu Zi to the aromatic agents such as Huo Po, Pei Lan, and Qing Hao, and after one dose, I observed significant effects. After taking the medicine at noon, I fell into a deep sleep and upon waking, my temperature had dropped by one degree Fahrenheit.
Subsequently, I further tested this on other patients, and all received similar results. This accidental attempt brought unexpected rewards, and I kept it as my secret formula, which I was reluctant to share. Now, of course, there is no longer a need for that.
2. Two Development Directions of Damp-Heat Conditions and Characteristics of Damp-Warmth Syndrome
After the surface symptoms of damp-heat conditions resolve, they often develop in two directions: one is when heat predominates over dampness, developing into Yangming channel syndrome or organ syndrome (entering Qi); the other is when dampness predominates over heat, leading to persistent fever, lethargy, chest fullness, poor appetite, limb pain, and little or no thirst, as described in the first chapter of Xue Xue’s “Damp-Heat Disease” which states, “Initially there is aversion to cold, then only heat without cold, sweating with chest fullness, a white tongue coating, and thirst without desire to drink”—this is the damp-warmth syndrome. The 43rd entry in Wu’s differentiation also belongs to this category.
Damp-warmth syndrome is currently very prevalent. Its characteristics include, aside from the aforementioned little or no thirst, that objectively measured body temperature is high (39 degrees Celsius or above), yet the patient feels lethargic and heavy, unaware of such high fever, and there is no restlessness.
3. Treatment Methods for Damp-Warmth Syndrome
The treatment principles established by predecessors for this syndrome have generally been to clear heat and transform dampness, or to transform dampness and clear heat, using damp-heat separation to resolve its binding, which is also what Ye refers to as “draining dampness from heat.” Based on the specific manifestations of the patient, the proportion of dampness and heat is clarified, and in clinical application, there are methods such as mild diuresis, aromatic transformation of dampness, and bitter-spicy drying of dampness. However, in practice, all these methods for draining, transforming, and drying dampness do not yield quick results, and the disease often remains recurrent and unresolved, hence the analogy of peeling silk from cocoons.
In my early clinical practice, I also used these methods for treatment, and the results were indeed not ideal. It was only after using Fu Zi as the monarch herb that the situation underwent a significant, even considerable change. After taking it, there were no adverse reactions, and the fever subsided quickly and stably.
4. Indications for the Application of the Method of Supporting Yang and Expelling Dampness
For any patient with fever who is not restless, and has little or no thirst, Fu Zi can be used as the monarch herb. The degree of greasy tongue coating only serves as a standard for the dosage of Fu Zi. For those who exhibit the above clinical characteristics, even if the tongue coating is not greasy, it can still be applied. As for the pulse, it is generally only a reference and not a basis for whether Fu Zi can be used. After using Fu Zi for these symptoms, the previous analogy of peeling silk from cocoons can be said to have lost its practical significance.
This method for treating damp-heat conditions, which I have coined as the Method of Supporting Yang and Expelling Dampness, is because when Yang is trapped by dampness, it cannot be released, leading to persistent illness. When Yang is supported and invigorated, the dampness will naturally be expelled. This is also a specific application of Wang Taipu’s “nourishing the source of fire to dispel the shadow of Yin.”
In Wu Tang’s “Differentiation of Warm Diseases,” the section on the upper jiao states, “Cold dampness injures Yang,” and he used Gui Zhi Jiang Fu Decoction. My view is that it is not only cold dampness that can injure Yang; dampness, being a Yin pathogen, can also injure Yang in damp-warmth and damp-heat conditions as long as dampness predominates over heat. This has been proven through practice. In the future, when encountering this syndrome in clinical practice, it may be worth trying.
Regarding the dosage of Fu Zi, based on the analysis of the proportion of dampness (mainly observing the degree of greasy tongue coating, thirst, and mental lethargy), I prescribe a dosage ranging from 5 to 10 grams per dose, additionally pairing it with Qing Hao (Artemisia Annua), Huo Xiang (Agastache), Pei Lan (Eupatorium), Chen Pi (Tangerine Peel), Cao Ren (Cardamom), and Cang Zhu (Atractylodes), with the total number of herbs generally not exceeding nine. This is because too many herbs not only make it difficult to observe the effects but also create confusion in the mind, fearing mutual interference, which can lead to complications.
In summary, for damp-heat conditions, as previously mentioned: fever without restlessness, little or no thirst, mental lethargy, a not overly dry tongue, and a not overly rapid pulse (especially the first two symptoms) can all indicate the use of Fu Zi for treatment. Not only is the efficacy reliable, but there are also no adverse reactions, and it can be used with confidence.
Recommended Reading
This formula effectively treats “damp-heat” conditions.
Xiong Jibai: Case studies of damp-heat fever, discussing the differences between Chengqi Decoction and Zhi Shi Dao Zhi Decoction【Recommended Reading】
Yellow greasy tongue coating indicates not only damp-heat but also Qi deficiency and Yang deficiency…
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