▲ Master Li Zhenhua （1924.11-2017.5）
Li Zhenhua, the first Master of Traditional Chinese Medicine, served as the chief physician at the Henan Provincial Hospital of Traditional Chinese Medicine, and was one of the national renowned experts in traditional Chinese medicine. He made significant contributions in clinical practice. Below, we present Master Li’s experience in treating Damp-Heat Syndrome for the benefit of colleagues.
Master Li stated that Damp-Heat Syndrome can manifest in various diseases such as jaundice, dysentery, diarrhea, abdominal distension, summer heat, and damp heat, with onset being either acute or chronic, and the condition often being difficult to treat.Due to the complex pathogenesis of Damp-Heat Syndrome, there are many clinical misdiagnoses that can worsen the condition.Although external pathogens can cause Damp-Heat Syndrome, its root cause lies in insufficient Earth element, leading to Spleen deficiency which generates dampness, obstructing the Qi mechanism and transforming into heat, ultimately resulting in the syndrome of Damp-Heat intermingling.The pathogenesis involves the Spleen’s role in transporting and transforming water and dampness; when Spleen Qi is deficient, it fails to perform its function, leading to dampness accumulation;dampness is a tangible evil, belonging to Yin and cold;dampness obstructs the Qi mechanism, and when Qi is excessive, it transforms into heat;heat is also a tangible evil, belonging to Yang and heat.The Spleen is fundamentally deficient, while Damp-Heat is a manifestation of excess; thus, the interplay of deficiency, excess, Yin, Yang, cold, and heat, with fundamentally different pathogenesis, intertwines and can present different diseases at various locations, making it a challenging and difficult syndrome to treat. A slight misstep can easily lead to misdiagnosis or mistreatment.Therefore, Ye Tianshi stated:“Damp-Heat is difficult to deal with, and the disease does not resolve quickly.”Based on his years of clinical experience, Master Li emphasized the following points in the diagnosis and treatment of Damp-Heat:1. The pathogenesis of Damp-Heat Syndrome involves the interplay of deficiency, excess, cold, heat, and dampness, which are not equal in clinical practice. Attention should first be paid to the predominance of dampness and heat, as well as the different evolutions that occur based on the patient’s age, constitution, and medication. Clinical observation of pulse and symptoms should guide treatment, which is the guiding principle for treating Damp-Heat Syndrome.2. The basic principle for treating Damp-Heat Syndrome is to clear heat and eliminate dampness, distinguishing whether heat is predominant over dampness or vice versa based on the different stages of the disease. Dampness is a Yin pathogen, and the pathogenesis of dampness and heat is fundamentally different, so medication must be appropriate. Clearing heat requires the use of bitter and cold substances; excessive use can lead to the generation of cold from heat, harming Spleen Qi, which can transform into cold dampness and worsen the condition. Clinically, there are many cases of errors due to excessive use of heat-clearing medications. To eliminate dampness, one should warm Yang and promote dampness elimination, assisted by aromatic and light diuretics, but excessive use of warming medications should be avoided to prevent exacerbating heat and worsening the disease.3. The treatment of Damp-Heat Syndrome requires rigorous medication selection for heat-predominant or damp-predominant conditions, as seen in Zhang Zhongjing’s practices. For treating jaundice with predominant heat over dampness, Yin Chen Hao Decoction is used. The formula includes Yin Chen (Artemisia capillaris), Zhi Zi (Gardenia), and Da Huang (Rhubarb), all of which are bitter and cold substances, as bitterness can dry dampness and cold can clear heat; when dampness is predominant over heat, Yin Chen Wu Ling San is used, although Yin Chen is still used to clear heat and reduce jaundice, Zhi Zi and Da Huang are removed, and Bai Zhu (Atractylodes) and Gui Zhi (Cinnamon Twig) are added, along with Zhu Ling (Polyporus) and Ze Xie (Alisma) to eliminate dampness and reduce jaundice, preventing excessive heat-clearing from harming the Spleen and assisting dampness, which can lead to Yin Jaundice. Renowned physician Cheng Guopeng in the Qing Dynasty used Yin Chen Shu Fu Decoction to treat Yin Jaundice, although he also used Yin Chen to treat jaundice, he found that the warmth of Bai Zhu and Gui Zhi was insufficient to eliminate cold dampness, so he added Fu Zi (Aconite) and Gan Jiang (Dried Ginger) to warm Yang and transform dampness, demonstrating his profound insight and achieving excellent results.Additionally, Zhang Zhongjing emphasized the importance of selecting medications based on different accompanying symptoms when using bitter and cold heat-clearing medications for treating jaundice with predominant heat over dampness. For heat with difficulty in urination, Yin Chen Hao Decoction is used to promote urination and clear heat; for irritability, Zhi Zi Da Huang Decoction is used, adding Zhi Shi (Bitter Orange) and Dou Chi (Fermented Soybean) to regulate Qi and relieve irritability; if there is heat with difficulty in urination, Da Huang Nao Shi Decoction is used, adding Mang Xiao (Glauber’s Salt) to Da Huang to purge heat accumulation; if there are initial symptoms of exterior syndrome with chills and fever, Ma Huang Lian Qiao Chi Xiao Dou Decoction is used. This illustrates the skillful selection of medications by Zhang Zhongjing based on symptoms. In clinical practice, in addition to the conditions of urination, attention should also be paid to the amount of sweating, presence of fever, complexion, and appetite, as well as careful observation of tongue coating, tongue quality, and pulse condition.When treating general Damp-Heat Syndrome, Master Li particularly emphasized the location of the disease and the meridian affinities of bitter and cold heat-clearing medications. For Damp-Heat in the upper jiao (lung), Huang Qin (Scutellaria) is often used; for the middle jiao (stomach), Huang Lian (Coptis) and Huang Qin are commonly used; for the lower jiao (kidney and bladder), Huang Bai (Phellodendron) is often used; and for the liver and gallbladder, Zhi Zi, Yin Chen, and Long Dan Cao (Gentiana) are commonly used.4. When treating Damp-Heat Syndrome with predominant heat over dampness, Master Li prefers to add Qi-regulating and non-drying substances to the dampness-eliminating medications, such as Yu Jin (Curcuma), Zhi Ke (Bitter Orange), and Wu Yao (Lindera), as Qi movement promotes dampness elimination, enhancing the efficacy of dampness elimination, while also ensuring that dampness is eliminated and heat has no place to reside. Furthermore, clearing heat and eliminating dampness should also emphasize the use of Spleen and Stomach tonics, as a healthy Spleen and Stomach fundamentally eliminate dampness and heat, preventing recurrence, and also preventing dampness from injuring Yang Qi and transforming into Spleen and Stomach sinking syndrome. In the later stages of treating Damp-Heat, as heat gradually clears but dampness cannot be resolved quickly, and Spleen Qi has not yet recovered, it often presents as lingering evil, Spleen deficiency, and poor transportation, making old diseases prone to recurrence. At this time, it is still necessary to continue taking Spleen tonics to strengthen Qi and adjust treatment to consolidate the efficacy. Diet should also be light and easily digestible, avoiding excessive eating or consuming raw, cold, or rich foods that can burden the Spleen and Stomach or damage them, leading to recurrence.Typical CaseMr. Li, male, aged 62. He has long suffered from diabetes, hypertension, and chronic hepatitis. He developed ascites and was diagnosed with liver cirrhosis with ascites. After using various Western medications without improvement and worsening condition, he presented with full-body jaundice, transitioning from drowsiness to coma, having not defecated for 12 days and not urinated for nearly 2 days, and was given a critical illness notice. At this moment, he was in deep coma, with significant jaundice, a greenish-yellow complexion, relying on intravenous fluids to sustain life, with a red tongue, swollen tongue body, yellow greasy coating, and slippery rapid pulse.Diagnosis: abdominal distension, jaundice, coma. The treatment should urgently use methods to purge heat accumulation and regulate Qi to invigorate blood. Modified Tao Ren Cheng Qi Decoction: Tao Ren (Peach Kernel) 10g, Sheng Da Huang (Raw Rhubarb) 10g, Zhi Shi (Bitter Orange) 10g, Hou Po (Magnolia Bark) 10g, Yin Chen (Artemisia capillaris) 15g, Mang Xiao (Glauber’s Salt) 10g (to be decocted in the evening). One dose, administered via nasal feeding. It was instructed that if urination and defecation occur about 3 hours after taking the medication, the consciousness would gradually clear, and then re-evaluate and adjust the medication.Second Diagnosis:After taking the above medication for 3 hours, urination and defecation occurred. That evening, two decoctions were administered via nasal feeding, and the next day consciousness was clear, but he still could not eat. The tongue was red, the tongue body was swollen, the tongue coating was greasy and slightly yellow, and the pulse was wiry and slippery. The treatment was to tonify the Spleen, promote urination, and soothe the liver and gallbladder.Medication: Modified Yin Chen Si Ling San: Tu Chao Bai Zhu (Atractylodes) 10g, Fu Ling (Poria) 20g, Zhu Ling (Polyporus) 10g, Ze Xie (Alisma) 15g, Yin Chen (Artemisia capillaris) 12g, Chao Xiang Fu (Cyperus) 10g, vinegar-fried Yu Jin (Curcuma) 10g, Chai Hu (Bupleurum) 6g, Corn Silk 20g, Bai Dou Kou (Cardamom) 10g, Tao Ren (Peach Kernel) 10g, Gan Cao (Licorice) 3g, 7 doses, decocted for oral administration.Third Diagnosis:After taking the above medication, abdominal distension and jaundice significantly reduced, urination and defecation returned to normal, he was able to eat, and his appetite gradually increased, with improved spirit. The tongue was light red, the tongue body slightly swollen, the tongue coating was white and greasy, and the pulse was wiry and slippery. The heat symptoms significantly reduced, and the previous formula remained unchanged, adding Gui Zhi (Cinnamon Twig) 6g to promote Yang and facilitate urination, assisting the bladder’s Qi transformation, for 14 doses, decocted for oral administration.Fourth Diagnosis:Abdominal distension and jaundice disappeared, diet was acceptable, spirit improved, and he was able to get out of bed for light activities. The tongue was light red, the tongue coating was thin white, and the pulse was wiry and thin. The treatment was to soothe the liver, tonify the Spleen, regulate Qi, and invigorate blood to address both the root and branch.Medication: Dang Gui (Angelica) 10g, Chao Bai Shao (White Peony) 12g, Tu Chao Bai Zhu (Atractylodes) 10g, Fu Ling (Poria) 15g, Chai Hu (Bupleurum) 6g, Chao Xiang Fu (Cyperus) 10g, Sha Ren (Amomum) 8g, vinegar-fried Yu Jin (Curcuma) 10g, Bie Jia (Tortoise Shell) 15g, Qing Pi (Green Tangerine Peel) 10g, Chao Yi Yi Ren (Job’s Tears) 20g, Tai Zi Shen (Pseudostellaria) 15g, Hou Po (Magnolia Bark) 10g, Gan Cao (Licorice) 3g. The above formula was taken continuously for over a month, with good diet and spirit, and abdominal distension was basically cured, allowing for discharge and recuperation. Five years later, follow-up showed that the abdominal distension had not recurred.Abdominal distension due to Damp-Heat accumulation is a difficult and serious condition. Damp-Heat intermingling leading to coma can only be treated urgently with bitter and cold Da Huang (Rhubarb) and Mang Xiao (Glauber’s Salt) to purge heat accumulation, while generally, caution should be exercised. After resolving heat accumulation, medications should be selected based on the changes in pathogenesis. After critical symptoms are resolved, the focus should be on soothing the liver and tonifying the Spleen, especially emphasizing Spleen tonification. To tonify the Spleen and eliminate dampness, warming medications should be used, avoiding bitter and cold substances that harm the Spleen, while also not limiting to a single formula and losing the principle of differential medication selection. The formulas used are all commonly used clinical formulas, but adjustments based on symptoms often yield satisfactory results.
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