Learning to Treat Damp-Heat Diseases from Master Pei Yongqing
Author: Dai Xiaohong
Liaoning Province Phoenix Hospital
Pei Yongqing is a professor at Beijing University of Chinese Medicine, an expert at Beijing Hongyitang TCM Hospital, and a renowned master of traditional Chinese medicine in the capital. Although he is a master of typhoid fever, his treatment approach for damp-heat diseases, which emphasizes “first determining its nature, then clarifying its location, and differentiating the methods of dispersing and draining,” has greatly benefited me. I summarize it as follows.
Determining the Nature of Damp-Heat
The “Treatise on Damp-Heat” states: “Damp-heat diseases begin with aversion to cold, followed by heat without cold, sweating with chest oppression, a white or yellow tongue, and thirst without desire to drink,” which outlines the characteristics of damp-heat syndrome. The initial aversion to cold indicates that yang is obstructed by dampness, not that cold has harmed the exterior. The subsequent heat without cold indicates that stagnation has transformed into heat. When heat is abundant in the Yangming, sweating occurs; when dampness obstructs the clear yang, chest oppression arises; when dampness is internally abundant, the tongue appears white; when damp-heat combines, the tongue appears yellow; heat causes fluids not to rise, leading to thirst, while dampness retains fluids internally, resulting in no desire to drink. Dampness is a yin pathogen, heavy and sticky; if it lingers on the skin, muscles, bones, or joints, it causes a heavy head, body fatigue, joint swelling and pain, and a feeling of heaviness. Dampness obstructs the flow of qi, leading to chest tightness and abdominal fullness, unsatisfactory bowel movements, and difficulty urinating. Dampness, being a yin pathogen, easily injures yang qi, can obstruct spleen yang, and hinder transformation and transportation, resulting in poor appetite, nausea, and loose stools. Dampness tends to descend and easily invades yin locations, clinically manifesting as turbid urine, itching, eczema, excessive and thick vaginal discharge, etc. The sticky nature of dampness, when combined with heat, resembles oil in flour, leading to a lingering and difficult-to-treat condition. Professor Pei often says: In clinical practice, one must determine the nature of damp-heat from the tongue, pulse, and symptoms; without understanding its nature, how can one establish a treatment plan? Nowadays, many people indulge in rich, spicy foods, leading to the internal generation of phlegm-dampness, which over time accumulates and generates stagnant heat. The external manifestations often resemble cold-dampness or yang deficiency, but in reality, it is yang being obstructed by dampness, causing qi stagnation, and internal stagnant heat. One must not recklessly administer warming and heat-clearing agents, violating the principles of deficiency and excess, heat and cold. In clinical practice, one must often observe the tongue and pulse, often prioritizing the tongue and pulse over symptoms, as the tongue’s appearance is more important for identifying the root of the syndrome and recognizing damp-heat syndrome and its nature.
Clarifying the Location of Damp-Heat
The damp-heat pathogen also has distinctions between exterior and interior locations. Externally, it can be located in the head and face, limbs, or chest and abdomen. Internally, it can be emphasized in the upper, middle, or lower jiao, and is often closely related to the organs. Therefore, Professor Pei often says: First determine its nature, then clarify its location; different locations require different treatments. For example, in clinical practice, damp-heat diseases in the head and face are often treated with modified Pujixiaoduan Decoction, while skin and limb damp-heat syndromes are treated with modified Yi Yi Ren and Zhu Ye Powder. For internal damp-heat, depending on the location and in conjunction with organ differentiation, in the upper jiao, phlegm (damp) heat obstructing the lungs is often treated with self-formulated lung heat cough and asthma formulas; in the middle jiao, spleen and stomach damp-heat syndromes are primarily treated with Qing Wei Li Pi Decoction; for gallbladder stagnation with phlegm (damp) heat disturbing, often use Wendan Decoction as a base; for phlegm (damp) fire disturbing the spirit, use Long Shi Gun Tan Wan with modifications; for liver and gallbladder damp-heat, often use Long Dan Cao Decoction with modifications; for lower jiao damp-heat, commonly use Si Miao San, Bai Tou Weng Decoction, Ba Zheng San, or modified Cang Bai San. For diffuse damp-heat in the three jiao, depending on the severity of damp-heat, one can use San Ren Tang, Huo Po Xia Ling Tang, or Gan Lu Xiao Du Dan according to the syndrome. Professor Pei emphasizes that whether the injury is internal or external, the quantity of damp-heat, and whether it is real or false, must be grasped in clinical practice, treating different diseases with the same method, which requires the physician’s judgment in clinical practice.
Dispersing, Draining, and Protecting the Spleen and Stomach, Along with Invigorating Blood
Dispersing and draining is a major method for treating damp-heat diseases. Ye Tianshi states in the “External Warm Diseases” that: “Further discussing qi diseases that do not transmit to the blood aspect, but the pathogen lingers in the three jiao… this is the principle of dispersing and draining up and down, changing methods according to the syndrome, such as recent use of apricot, po, and ling, or like the dispersing method of Wendan Decoction.” Professor Pei often uses modified San Ren Tang to treat fever caused by damp-heat with remarkable results. Patients with this type of fever have four characteristics: first, although the fever lasts for several days, there is no thirst; second, the patient experiences tidal fever and sweating without resolution of heat; third, body temperature tends to rise in the afternoon; fourth, the tongue coating is greasy, and the pulse is slippery and thin. Moreover, Professor Pei often states: “For damp-heat diseases, the treatment should primarily focus on resolving dampness; when dampness is removed, heat will also be eliminated,” which aligns with Ye Tianshi’s saying, “When dampness is removed, heat will be isolated.” He emphasizes that dampness in the upper jiao should be aromatically transformed, dampness in the middle jiao should be bitter and warm to dry dampness, and dampness in the lower jiao should be light and draining to eliminate dampness, which is the specific application of dispersing and draining.
Professor Pei also emphasizes several points to note in clinical treatment of damp-heat diseases: 1. Protect the spleen and stomach, focusing on the spleen and stomach to ensure smooth qi flow; therefore, in clinical practice, he often adds Jiao San Xian, Zhi Ke, etc. 2. Depending on whether dampness or heat is more severe, in conjunction with clinical practice, one may focus on eliminating dampness, or simultaneously eliminate dampness and clear heat, or clear heat while promoting dampness, but be cautious of overusing cold and cooling heat-clearing products, which may cause dampness to sink deeper and become difficult to resolve. 3. Damp-heat diseases are prone to include blood stasis; therefore, in clinical practice, depending on the severity of stasis, one may combine blood-invigorating and stasis-resolving products, such as E Zhu, Dan Shen, Chi Shao, Dan Pi, or add Di Dang Tang.
Case Study
Du, female, 67 years old. Initial diagnosis date: August 4, 2017. Chief complaint: “Whole body feels cold, with a sensation of cold air from the stomach to the throat for 9 months.” She has visited multiple hospitals, where doctors often treated her with warming yang and dispersing cold formulas such as Fu Zi Li Zhong Tang and Si Ni San, but to no avail. In July 2017, she underwent a comprehensive examination in Japan with no abnormalities and returned to seek treatment. During the visit, she reported feeling cold all over, wearing thick cotton clothes in the summer, and described a sensation of cold air from the stomach to the throat, along with excessive phlegm, anxiety, and difficulty sleeping, often crying uncontrollably. She also experienced pain in the right knee, poor appetite, slightly loose stools, and yellowish urine. The tongue was dark red with a thick greasy yellow coating, the sublingual veins were congested and twisted, and the pulse was wiry, slippery, and rapid. She was prescribed a modified Wendan Decoction combined with Di Dang Tang.
Prescription: Ban Xia 12g, Fu Shen 30g, Chen Pi 10g, Zhu Ru 6g, Zhi Shi 10g, Yu Jin 15g, Xiang Fu 10g, Dan Shen 15g, Shi Chang Pu 15g, Yuan Zhi 6g, Cang Zhu 12g, Chuan Xiong 6g, Sheng Zhi Zi 12g, Dou Chi 10g, Chao Shen Qu 15g, Sheng Shui Zhi 10g, Tu Bie Chong 10g, Tao Ren 10g, Jiu Da Huang 6g, Chao Shan Zha 10g. Four doses, one dose per day, taken in two doses in the morning and evening, avoiding spicy and rich foods.
Second Diagnosis: The patient reported that after taking the above prescription, the cold sensation in her back had disappeared, appetite improved, and right knee pain decreased. The tongue was dark red, with a white greasy coating, sublingual veins congested, and the pulse was wiry, slippery, and rapid.
Prescription: Chai Hu 10g, Huang Qin 10g, Ban Xia 12g, Fu Shen 30g, Chen Pi 10g, Cang Zhu 12g, Hou Po 12g, Jiao San Xian 10g each, Sheng Zhi Zi 10g, Dou Chi 10g, Sheng Shui Zhi 10g, Tu Bie Chong 10g, Tao Ren 10g, Jiu Da Huang 6g, Xia Ku Cao 20g, Zhen Zhu Mu 30g (added later). Four doses, decocted in water, one dose per day.
Third Diagnosis: The patient felt the cold sensation alleviated but still felt cold in the stomach, with soft stools, going twice a day, and improved sleep. The tongue was dark with a white greasy coating, and the pulse was wiry, slippery, and slightly rapid.
Prescription: Ban Xia 12g, Fu Shen 30g, Chen Pi 10g, Zhu Ru 6g, Zhi Ke 10g, Yu Jin 15g, Xiang Fu 10g, Dan Shen 15g, Dang Gui 12g, Chuan Xiong 6g, Sheng Shui Zhi 10g, Tu Bie Chong 10g, Tao Ren 10g, Jiu Da Huang 6g. Three doses, decocted in water, one dose per day.
Fourth Diagnosis: After taking the medicine, appetite increased, and the patient no longer felt cold, able to wear short sleeves for the visit. The tongue was dark, with a slightly greasy white coating, and the pulse was deep, wiry, and slippery.
Prescription: Ban Xia 12g, Fu Shen 30g, Chen Pi 10g, Zhu Ru 6g, Zhi Ke 10g, Yu Jin 15g, Xiang Fu 10g, Dan Shen 15g, Dang Gui 12g, Chuan Xiong 6g, Sheng Shui Zhi 10g, Tu Bie Chong 10g, Tao Ren 10g, Jiu Da Huang 6g, Yuan Zhi 6g. Seven doses, decocted in water, one dose per day.
Analysis: This case has three characteristics: the patient feels cold all over, has a sensation of cold air from the stomach to the throat; wears thick cotton clothes in summer and cannot reduce them; has excessive phlegm and poor appetite. The patient presents a typical cold pattern, so previous doctors often treated her with warming yang and dispersing cold, using very spicy and hot products. However, upon detailed examination of her tongue and pulse, the tongue was dark red with a thick greasy yellow coating, the sublingual veins were heavily congested and twisted, and the pulse was wiry, slippery, and rapid, along with signs of anxiety and insomnia, indicating a complex condition. Upon inquiry, the patient often indulged in rich foods, which easily injure the spleen and generate phlegm-dampness, leading to dampness obstructing and accumulating heat over time. The combination of damp (phlegm) and heat obstructs qi flow, causing qi stagnation and blood stasis, ultimately resulting in the intermingling of dampness, heat, and stasis. The obstruction of qi flow leads to internal damp-heat and external false cold, defining the condition as damp-heat with blood stasis, with the disease location in the liver and gallbladder, spleen and stomach, and the three jiao. Therefore, the treatment plan was to clear heat, transform dampness (phlegm), regulate qi and harmonize the stomach, invigorate blood and resolve stasis, to unblock yang qi, using a combination of Wendan Decoction and Di Dang Tang, resulting in recovery after eighteen doses. The Wendan Decoction originates from Chen Wuzhe’s “San Yin Ji Yi Bing Zheng Fang Lun: Treatment of Palpitations” stating: “Wendan Decoction treats heart and gallbladder deficiency, easily startled by external stimuli, or experiencing ominous dreams or strange phenomena, leading to palpitations and fright, qi stagnation producing phlegm, phlegm and qi clashing, resulting in various symptoms, such as shortness of breath, palpitations, or spontaneous sweating, with floating edema, tastelessness in food, heart deficiency, irritability, and restlessness.” The formula includes Er Chen Tang with Zhu Ru and Zhi Shi to clear and transform phlegm-heat, harmonizing the stomach and unblocking the Yangming, combined with Zhi Zi and Dou Chi Tang to clear the stagnant heat in the three jiao, assisted by Shi Chang Pu and Yuan Zhi to transform dampness, harmonize the stomach, and calm the spirit, with Jiao San Xian to protect the spleen and stomach, and combined with Di Dang Tang to resolve stasis, ensuring the expulsion of pathogens and stabilization of the righteous qi. The use of this formula for this case effectively expanded the indications of Wendan Decoction while also demonstrating the excellent blood-invigorating and stasis-resolving properties of Di Dang Tang, without harming the righteous qi, which can be said to be “without loss, yet no loss.”
Source: China Traditional Chinese Medicine News