▲ Master Yang Chunbo (1934.1—)
Professor Yang Chunbo is a third-generation Master of Traditional Chinese Medicine (TCM), a renowned TCM physician in Fujian Province, and the honorary president of the Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine. He is also a leading academic figure in the field of spleen and stomach diseases in Fujian Province and a guiding teacher for the second and fourth batches of national TCM experts’ academic experience inheritance. In 1992, he was the first in the country to initiate research on Spleen-Stomach Damp-Heat Syndrome and its related diseases. Currently, Professor Yang’s treatment strategies and medication experience for Spleen-Stomach Damp-Heat Syndrome are summarized as follows for the benefit of colleagues.
Spleen-Stomach Damp-Heat Syndrome is a common clinical syndrome characterized by excess in the spleen and stomach. With the warming of the Earth’s climate, improvements in living standards, changes in dietary structure, and the abuse of medications, this syndrome has shown an upward trend. It can manifest in many diseases across various systems, closely related to digestive system diseases. Due to the particularity of its pathogenic factors, it poses certain difficulties for clinical diagnosis and treatment.
➤ Understanding of Pathogenesis
● EtiologyExternal Factors: Damp-heat pathogenic qi, climate, environment, and various insects.Internal Factors: Dietary irregularities, excessive thinking, overwork, or inherent weakness of the spleen and stomach.● PathogenesisThe disease is located in the spleen and stomach, as the spleen governs dampness (yin organ), while the stomach governs dryness (yang organ). “Damp-heat evil, although initially received externally, ultimately returns to the spleen and stomach,” due to the principle of “similarities attract” (Qing Dynasty, Zhang Xugu). Internal injuries from diet or inherent weakness of the spleen and stomach can lead to dysfunction of the spleen and stomach, resulting in the accumulation of damp-heat. The pathology contains both yin and yang characteristics, which can present as equal damp-heat, or with a predominance of dampness or heat. Dampness often stagnates the qi mechanism, which can lead to collateral damage over time. Since dampness is a yin evil, it easily stagnates qi; qi is the commander of blood, and prolonged stagnation can lead to blood stasis. Dampness can transform. Due to the body’s yang qi being strong and leaning towards heat, and the yin qi being abundant and leaning towards dampness, it can also transform into heat, cold, or even consume qi, damage yang, harm yin, and deplete blood. Damp-heat can ascend, spread laterally, or descend. When damp-heat occupies the middle jiao, it can ascend to disturb the orifices, cloud the spirit, and affect the lungs; spread laterally to the liver, gallbladder, tendons, and skin; or descend to the bladder, anterior and posterior yin, and women’s uterus.➤ Clinical CharacteristicsSlow Onset The course of the disease or latency period is relatively long, presenting progressively.Complex Symptoms Such as hunger without desire to eat, thirst without preference for drinking, fever with a slow pulse, loose stools that are not smooth, or first dry then loose, with a greasy yellow tongue coating, etc., showing symptoms of both yin and yang. Recurrent and lingering symptoms are common.
➤ Diagnostic Criteria Based on a clinical survey of 400 cases, Yang Chunbo revised the diagnostic criteria for this syndrome.Main Symptoms: ① Yellow greasy tongue coating; ② Distension and fullness in the epigastrium; ③ Poor appetite; ④ Loose stools or mucus-like stools.Secondary Symptoms: ① Light yellow or yellow urine; ② Bitter and sticky mouth, thirst with a preference for warm drinks; ③ Burning sensation in the epigastrium or acid reflux; ④ Urgency or heaviness after defecation or difficulty; ⑤ Fever; ⑥ Pale red or red tongue; ⑦ Slippery or wiry pulse.Predominance: ① Predominantly Heat: Red tongue, yellow greasy dry coating, rapid pulse, thirst with a preference for cool drinks, yellow urine, dry or mucus-blood-like stools. ② Predominantly Damp: Pale red or pale tongue, white greasy coating with yellow, slow pulse, bitter and bland mouth, clear urine, loose or watery stools.Determination: Main symptom ① is essential, plus one main symptom and one secondary symptom. For predominant judgment: the tongue condition is essential, plus two symptoms.➤ Treatment Strategies and Medication● Treatment StrategiesImplement the Five Combinations, comprehensively observing the treatment The Five Combinations refer to the combination of disease and syndrome, overall and local, macro and micro, function and structure, and the body and environment. The disease includes the main disease and coexisting diseases. A comprehensive understanding, clarifying priorities, forming an overall view, and determining treatment direction.
The Spleen and Stomach are the Focus, Do Not Forget Their Organs The Spleen-Stomach Damp-Heat Syndrome is located in the spleen and stomach, which is naturally the focus of treatment. It is essential to regulate the spleen and stomach’s ability to transform and transport, and to ascend the clear and descend the turbid, while not forgetting the relationship between the spleen and stomach and other organs, primarily the liver, gallbladder, and intestines, followed by the heart, lungs, and also the kidneys, bladder, and women’s uterus.Distinguish Between Excess and Deficiency to Establish Supplementation and Drainage Damp-heat syndrome is certainly an excess syndrome, and should be treated with draining methods, but there may also be concurrent qi deficiency, blood weakness, yang decline, yin deficiency, etc. Additionally, due to spleen deficiency leading to dysfunction, causing dampness to obstruct heat, it is necessary to clarify priorities and urgency, and establish whether to drain first, supplement first, or use a combination of both.Clearing and Transforming as the General Principle, Yet Distinguish the Predominance Clearing heat and dispelling dampness is the general principle for treating Spleen-Stomach Damp-Heat Syndrome, but clinically there are different presentations of equal damp-heat, predominant dampness, or predominant heat, which should be carefully distinguished and treated accordingly.Micro and Local Changes, Understanding TCM Theory For micro and local pathological changes, use TCM theory for understanding, then combine with macro and overall differentiation to determine treatment methods and medication.Promote Comprehensive Methods, Dietary Guidance is Essential In TCM treatment of Spleen-Stomach Damp-Heat Syndrome, in addition to oral decoctions and enemas, there are also acupuncture, external applications, tuina, and massage among other methods. These should be combined according to the syndrome and symptoms. Furthermore, dietary and labor guidelines must be clearly stated to achieve significant results.
● Medication ExperiencePrescription SelectionEqual Damp-Heat: Use self-formulated Qinghua Decoction (Yin Chen (Artemisia capillaris), Bai Bian Dou (White Hyacinth Bean), Huang Lian (Coptis chinensis), Hou Po (Magnolia Bark), Pei Lan (Eupatorium), Bai Dou Kou (White Cardamom), Yi Yi Ren (Job’s Tears), etc.), or Gan Lu Xiao Du Dan, Er Miao Wan, Huang Qin Shi Wei Decoction with modifications.Heat Predominant: Lian Po Decoction, Bai Hu Decoction with Cang Zhu (Atractylodes).Damp Predominant: San Ren Decoction, Huo Po Xia Ling Decoction, Huang Lian Ping Wei San, Da Yuan Decoction, etc.Damp-Heat Jaundice: Yin Chen Hao Decoction, Yin Chen Wu Ling San.Damp-Heat Disturbing the Spirit: Chang Pu Yu Jin Decoction.Damp-Heat Skin Issues: Yi Yi Zhu Ye San.Damp-Heat Fever: Xin Jia Xiang Ru Decoction, Huang Lian Wen Dan Decoction, Da Yuan Decoction.Damp-Heat Diarrhea: Bai Tou Weng Decoction.Damp-Heat Vaginal Discharge: Zhi Dai Fang.Medication To dispel dampness, use aromatic, warming, and draining methods; to clear heat, use bitter, sweet, and salty methods. Dispersing dampness can be aromatic, warming, or draining. When dampness evil steams the upper jiao, aromatic methods are preferred, such as Huo Xiang (Agastache) and Pei Lan; when dampness obstructs the middle jiao, warming and drying methods are preferred, such as Bai Dou Kou and Cao Guo; when dampness descends to the lower jiao, light draining methods are preferred, such as Yi Yi Ren and Tong Cao (Tetrapanax). Clearing heat can be bitter-cold, sweet-cold, or salty-cold. Bitter-cold clears heat and dries dampness, such as Huang Qin (Scutellaria baicalensis) and Huang Lian, which are the first choice; if heat transforms and causes dryness, sweet-cold herbs like Jin Yin Hua (Honeysuckle), Pu Gong Ying (Dandelion), Zhi Mu (Anemarrhena) or salty-cold herbs like Shi Gao (Gypsum) and Han Shui Shi (Cold Water Stone) should be used; for damp-heat dysentery or diarrhea, astringent herbs like Xian He Cao (Agrimonia) and Di Yu (Sanguisorba) can also be used.
▲ Huang Qin (Scutellaria baicalensis) To dispel dampness, it is essential to regulate qi, distinguishing between cold and warm. To dispel dampness, it is necessary to regulate qi; when qi flows, dampness is easily transformed. However, qi-regulating herbs have cold and warm properties. If dampness is predominant, select Hou Po (Magnolia Bark) and Chen Pi (Dried Tangerine Peel) for drying and regulating qi; if heat is predominant, use Zhi Qiao (Bitter Orange) and Zhi Shi (Unripe Bitter Orange) for clearing heat and regulating qi. Qi stagnation often leads to blood stasis; it is important to know whether to “activate” or “transform.” Qi is the commander of blood, and qi stagnation can lead to blood stasis, so when regulating qi, it is also important to consider using blood-moving herbs. However, blood-moving can be divided into activating blood (such as Chi Shao (Red Peony), Dang Gui (Angelica), Dan Shen (Salvia)) and transforming stasis (such as San Leng (Sparganium) and E Zhu (Curcuma)), and there are also distinctions between cooling blood (such as Dan Pi (Moutan) and Chi Shao) and warming blood (such as Dang Gui and E Zhu), which should be selected according to the syndrome. Regulate the middle and differentiate ascending and descending, understanding food injury. The stomach should descend, while the spleen should ascend; when the ascending and descending functions of the spleen and stomach are disordered, if the stomach qi is rebellious, it should be harmonized and descended, using Ban Xia (Pinellia), Pi Pa Ye (Loquat Leaf), Xuan Fu Hua (Inula), and Zhu Ru (Bamboo Shavings); if the spleen qi is sinking or the clear qi fails to ascend, it should be lifted and raised, using Sheng Ma (Cimicifuga), Ge Gen (Pueraria), Jie Geng (Platycodon), and He Ye (Lotus Leaf). For food injury, use Mai Ya (Barley Sprout) for grain injury; Shan Zha (Hawthorn) for meat injury; and other options include Shen Qu (Fermented Grain) and Ji Nei Jin (Chicken Gizzard Lining). Constipation can be due to deficiency or excess, and should be treated with attack, supplementation, or regulation. For heat accumulation due to damp-heat, cooling methods can be used, such as Da Huang (Rhubarb), Fan Xie Ye (Senna), and Hu Zhang (Japanese Knotweed); for damp turbidity accumulation, warming and unblocking methods should be used, such as Cao Guo and Hou Po combined with Da Huang; for deficiency constipation, use Sheng Bai Zhu (Fresh Atractylodes) and Cang Zhu; for qi constipation, regulate with Mu Xiang (Costus) and Xing Ren (Apricot Kernel). The throat is the orifice of the stomach, and careful observation of heat, stasis, and phlegm is necessary. Damp-heat ascending often causes throat pain or itchiness or a sensation of obstruction; careful examination of the throat is required: redness indicates heat, dark red indicates stasis, and follicles indicate phlegm or phlegm-stasis obstruction, which can be treated with Ma Bo (Morus), Mu Die (Butterfly Pea), Cheng Zhu (Chrysanthemum), and Chi Shao. Strengthening the spleen requires warmth and balance, and supplementation should be carefully considered. Strengthening spleen herbs are mostly warming, thus they can dry dampness, so Bai Bian Dou, Cang Zhu, and Bai Zhu are commonly used; however, if drying transforms and injures yin, select Shan Yao (Chinese Yam) for its sweet and neutral properties to nourish the spleen. If deficiency is also present, supplementary herbs can be added, but care must be taken to supplement without causing stagnation, to avoid obstructing dampness or creating heat. For qi deficiency, add Sheng Huang Qi (Astragalus) and Jiao Gu Lan (Gynostemma); for blood deficiency, add Ji Xue Teng (Spatholobus); for yin deficiency, add Yu Zhu (Polygonatum) and Xuan Shen (Scrophularia) or Bai Shao (White Peony) combined with Gan Cao (Licorice) for sweet and sour to nourish yin; for yang deficiency, add Pao Fu Zi (Processed Aconite). When other organs are involved, appropriate methods must be used. For liver qi stagnation, add herbs to soothe the liver and regulate qi, such as Chai Hu (Bupleurum), Xiang Fu (Cyperus), and Chuan Lian Zi (Melia); for disturbed heart and insomnia, combine aromatic herbs to calm the spirit, such as He Huan Pi (Albizia) with Fu Ling (Poria); if there is also kidney deficiency with floating yang, damp-heat internally obstructing and yang not warming the defensive qi, it is necessary to carefully assess and add herbs.
▲ Chai Hu (Bupleurum) Accompanied by alternating chills and fever, clarify the location and nature of the disease. If there are chills and fever, it is necessary to clarify whether it is exterior, interior, or half-exterior half-interior, as well as the predominance of damp-heat. For exterior defense syndrome, use Huo Xiang Zheng Qi San; for half-exterior half-interior, select Ao Qing Qing Dan Decoction or Da Yuan Decoction; for interior damp-heat syndrome, choose Gan Lu Xiao Du Dan according to the severity of damp-heat.➤ Treatment Insights Yang Chunbo believes that in treating Spleen-Stomach Damp-Heat, regardless of the method used, it is crucial to pay close attention to the spleen and stomach’s transport functions, ensuring that treatment is appropriate to the condition, avoiding heavy medication for mild conditions and light medication for severe conditions, and avoiding reckless benefits, excessive purging, or excessive attacking. Sometimes it is better to use smaller doses or divided doses rather than heavy doses or single doses that harm the “transport”. Regarding the formation of Spleen-Stomach Damp-Heat, it is due to “dampness causing heat,” “heat causing dampness,” or “damp-heat jointly causing”; historical physicians have had different views. From clinical treatment analysis, Yang Chunbo tends to favor “dampness causing heat”. Yang Chunbo believes that the difficulty in treating this syndrome lies in “dampness” or “turbidity,” which is manifested by a thick and turbid tongue coating. Wu You can achieve effective results with Da Yuan Decoction, but there are also cases of ineffectiveness; the path forward remains to be explored. Additionally, “damp-heat” often coexists with deficiency, frequently with qi deficiency, and may also include yin deficiency, yang deficiency, and blood deficiency. Supplementing deficiency often affects the transformation of damp-heat, and there are also cases where supplementation resolves damp-heat, which must be carefully considered in terms of prescription selection, compatibility, dosage, administration, and dosage forms. Yang Chunbo believes that this syndrome is difficult to cure quickly and prone to recurrence during treatment, which is determined by its pathological state of “yin and yang duality”; therefore, the selection of formulas and medications must be carefully evaluated and adjusted. Yang Chunbo believes that in treating Spleen-Stomach Damp-Heat Syndrome, medications can directly reach the disease site, which is beneficial, but daily dietary intake must be maintained to prevent the gastrointestinal tract from being idle; thus, dietary regulation and guidelines are extremely important. Of course, lifestyle, rest, and emotional management should not be overlooked.
Important Statement:
Due to individual differences in constitution and condition, the prescriptions and dosages in this case are only applicable to the patient at that time. Without TCM differentiation and diagnosis, do not copy the prescriptions and dosages in this case. Readers in need should seek treatment at a regular hospital to avoid delaying the condition.
【Content compiled from: “China Traditional Chinese Medicine News”, January 2, 2017, Fourth Edition, Author: Wang Wenrong, Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine】
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