Damp-Heat Diseases Xue Shengbai of the Qing Dynasty (1) The damp-heat syndrome begins with aversion to cold, followed by heat without cold, sweating, chest fullness, a white tongue, and thirst without desire to drink. My note: This line outlines the damp-heat syndrome. Damp-heat diseases mostly belong to the Yangming and Taiyin categories. If the central qi is strong, the disease is in Yangming; if the central qi is weak, the disease is in Taiyin. If the disease is on the surface of these two meridians, it often also involves the Shaoyang and Sanjiao. If the disease is within these two meridians, it often also involves the Jueyin and Wind-Wood, as the Shaoyang and Jueyin share the same fire. Damp-heat accumulates internally, and if it becomes severe, the lesser fire turns into a strong fire, thus filling the upper and lower parts, causing rebellious qi. Therefore, this syndrome easily leads to ear deafness, dry retching, spasms, and convulsions, which are not mentioned in the outline because these symptoms are variations seen in damp-heat diseases, not necessarily present in the standard syndrome. The initial aversion to cold indicates that dampness obstructs Yang, causing aversion to cold, which is different from aversion to cold caused by exterior cold. The later heat without cold indicates that stagnation leads to heat, thus causing aversion to heat. Dampness obstructs clear Yang, leading to chest fullness; severe dampness causes a white tongue; damp-heat steaming leads to a yellow tongue; heat prevents fluids from rising, causing thirst, while dampness retains fluids internally, leading to no desire to drink. The term “exterior” refers to the surface of Taiyin and Yangming, not the exterior of Taiyang. The surface of Taiyin is the limbs, while the surface of Yangming is the muscles and chest. Therefore, chest fullness is a symptom that must be present in damp-heat. Fatigue in the limbs and muscle pain must also be present. The reason it does not involve Taiyang is that Taiyang is the exterior of the cold-water organ, which governs the body’s exterior. Wind-cold must enter from the exterior, thus belonging to Taiyang. The damp-heat pathogen entering from the exterior is rare, only about 10-20%. Most enter through the mouth and nose, about 80-90%. Yangming is the sea of food and drink, while Taiyin is the organ of damp earth, thus most diseases affect Yangming and Taiyin. The membrane source is externally connected to the muscles and internally close to the stomach and intestines, being half exterior and half interior of the body. The pathogen enters from above and directly approaches the middle path, thus most diseases return to the membrane source. In summary, damp-heat diseases are not only different from cold damage but also significantly different from warm diseases. Warm diseases involve the Shaoyin and Taiyang, while damp-heat involves the Yangming and Taiyin. The outline does not mention the pulse because the pulse in damp-heat syndrome lacks a fixed pattern; it can be surging, slow, hidden, or thin, depending on the symptoms, and does not adhere to a single pattern. Therefore, a single pulse cannot be used to restrict future practitioners’ perspectives. The damp-heat syndrome must involve both Yangming and Taiyin. It is only known that the organs are interconnected, and damp earth shares the same qi, but it is not known that it must also involve the Shaoyin in warm diseases. The Shaoyin does not store, and Wood and Fire burn internally. Wind pathogens attack from the outside, corresponding to the exterior, thus causing warm diseases. Taiyin is internally injured by dampness and fluid retention, and external pathogens come again, leading to damp-heat diseases. This all indicates that there is first internal injury, then external pathogen invasion, not from the organs. If the damp-heat syndrome does not involve internal injury and the central qi is strong, the disease must be mild, or there may be a prior cause of dampness followed by hunger and fatigue, which also belongs to internal injury with dampness, where the superficial and root conditions are the same. However, fatigue injures the spleen, leading to insufficiency, while fluid retention is excess. Therefore, the balance of internal injury and external invasion, whether more or less, whether strong or weak, is determined during clinical practice.(2) Damp-heat syndrome with aversion to cold and no sweating, heavy body, and headache indicates dampness in the exterior, suitable for herbs like **Huo Xiang** (Agastache), **Xiang Ru** (Elsholtzia), **Qiang Huo** (Notopterygium), **Cang Zhu** (Atractylodes), **Bo He** (Mint), and **Niu Bang Zi** (Burdock Seed). If there is no headache, remove **Qiang Huo**.My note: Heavy body and aversion to cold indicate that dampness obstructs the Wei Yang in the exterior. Headache must involve wind pathogens, thus **Qiang Huo** is added, as it not only overcomes dampness but also dispels wind. This line indicates the symptoms of Yin-dampness injuring the exterior.(3) Damp-heat syndrome with aversion to cold, fever, heavy body, and joint pain indicates dampness in the muscles, not relieved by sweating. Suitable for herbs like **Hua Shi** (Talc), **Da Dou Huang** (Soybean), **Yao Juan** (Poria), **Cang Zhu** (Atractylodes), **Huo Xiang** (Agastache), **Xian He Ye** (Lotus Leaf), **Bai Tong Cao** (Lobelia), and **Jie Geng** (Platycodon). If there is no aversion to cold, remove **Cang Zhu**.This line indicates that the external symptoms are the same as the previous line, but sweating is different, with added joint pain, indicating that dampness initially invades the Yangming exterior and immediately clears the heat of the stomach. It does not want the dampness to stagnate and steam upwards but rather to disperse downwards. This is a symptom of Yang dampness injuring the exterior.(4) Damp-heat syndrome with mouth locked after three to four days, limbs pulling and stiffness, severe cases may lead to opisthotonos. This indicates damp-heat invading the meridians and collaterals, suitable for herbs like **Xian Di Long** (Earthworm), **Qin Jiao** (Gentiana), **Wei Ling Xian** (Clematis), **Hua Shi** (Talc), **Cang Er Zi** (Xanthium), **Si Gua Teng** (Luffa), and **Hai Feng Teng** (Cayratia). This line indicates that dampness is accompanied by wind. Wind is the qi of Wood; when wind moves, Wood expands. If it enters the Yangming collaterals, it leads to mouth locking. If it moves into the Taiyin meridian, it leads to stiffness. Therefore, the herbs not only overcome dampness but also heavily use wind-dispelling herbs. One may ask why Zhang Zhongjing treated spasms with **Gui Zhi** (Cinnamon Twig) plus **Gua Lou Gen** (Trichosanthes Root) and **Ge Gen Tang** (Kudzu Decoction) in ancient times but not in modern times. Today’s spasms are connected to convulsions, and Zhang Zhongjing did not believe in convulsions. Could it be that the **Jin Kui** has missing texts? I say no; the herbs are used according to the disease. The source of the disease is different, and the treatment methods are also different. The spasms from cold damage come from the outside, treated primarily by dispersing the external pathogen, while the spasms from damp-heat arise from within, affecting the Taiyang, treated primarily by calming internal wind. The Sanjiao and liver-gallbladder share the same fire. If the middle Jiao’s damp-heat does not resolve, the heat becomes excessive, and the lesser fire turns into a strong fire. When fire moves, wind arises, leading to muscle spasms and rapid pulse. When wind stirs, fire blazes, leading to confusion and disorientation. The qi within the body rises with wind and fire, leading to ascension without descent, causing a complete loss of normalcy, resulting in a state resembling corpse-like convulsions. The internal classic states that blood and qi both ascend, leading to violent convulsions. If the pathogen invades the collaterals, it leads to spasms; if it invades internally, it leads to convulsions. Spasms and convulsions often appear together. If the righteous qi still exists, the qi can recover and regenerate. If the stomach fluids cannot support, the convulsions will not return. Therefore, spasms and convulsions are often connected. The spasms from cold damage come from the outside; how can this be? The spasms in hot months and cholera arise from the same source. Wind arises from fire, and when fire emerges, it follows the wind. If it enters the Yangming, it leads to vomiting; if it invades the Taiyin, it leads to diarrhea, known as cholera. If it enters the muscles, it leads to spasms; if it flows into the collaterals, it leads to opisthotonos. However, spasms often accompany convulsions, while cholera has fewer convulsions. This is because spasms are caused by wind-fire obstruction, and the more obstructed, the more severe the evil force becomes, leading to confusion. Cholera, with wind-fire leaking out, leads to the evil force resolving externally, thus having fewer convulsions. This is the distinction between spasms and cholera. However, spasms obstruct the Sanjiao, and the Sanjiao is responsible for transformation. If wind obtains fire, it stirs, leading to internal convulsions and violent convulsions. Cholera’s evil runs into the spleen and stomach, which are responsible for damp transformation. The evil lingers due to dampness, thus affecting the collaterals and leading to stiffness. When fire is obstructed, it leads to convulsions; when fire leaks, it leads to stiffness. Thus, both spasms and convulsions are the aftermath of damp-heat and wind, mixing the clear and turbid, leading to abnormal ascension and descent. If there is more dampness and less heat, then wind enters the earth, leading to cholera. If there is more heat and less dampness, then wind rides the Sanjiao, leading to spasms and convulsions. If convulsions do not return, it leads to death, as the stomach fluids dry up, and the fire evil lingers. If the spasms enter the abdomen, it leads to death, as the stomach fluids dry up, and the wind evil is strong. Therefore, the fluids in the stomach are crucial. For convulsions, use pungent herbs to open and leak the invisible evil in the chest. For cholera, use emetics to leak the tangible stagnation in the stomach. However, if the evil leaks and the stomach fluids do not rise, the heat evil becomes more intense. If emetics are used and the stomach fluids do not distribute, the wind evil increases, ultimately leading to death. This must be understood.(5) Damp-heat syndrome with strong heat and thirst, yellow or scorched red tongue, spasms, confusion, delirium, or laughter indicates that the evil burns the heart and pericardium, and the nutrients are depleted. Suitable for herbs like **Xiang Ru** (Elsholtzia), **Ling Yang Jiao** (Antelope Horn), **Lian Qiao** (Forsythia), **Sheng Di** (Rehmannia), **Yuan Shen** (Polygala), **Gou Teng** (Uncaria), and **Yin Hua** (Honeysuckle). This line mentions spasms, while this line mentions convulsions. The heat and summer heat evil primarily injure Yang qi, and when the heat is extreme, it enters the nutrient yin, leading to depletion of fluids and illness. The pericardium is burned, leading to confusion. The herbs are used to clear heat, rescue yin, and drain evil while calming the liver.(6) Damp-heat syndrome with vomiting of clear water or excessive phlegm indicates damp-heat retained internally, with wood-fire rising. Suitable for **Wen Dan Tang** (Warm Gallbladder Decoction) plus **Gua Lou** (Trichosanthes) and **Bi Yu San** (Jade Dew Powder). This line indicates that there is phlegm retention, and Yangming and Shaoyang share the same disease. Thus, one uses herbs to clear phlegm and one to descend the rebellious qi, which is the same as the previous line.(7) Damp-heat syndrome with continuous vomiting and nausea, day and night without relief, indicating disharmony between the lung and stomach, with stomach heat moving to the lung, preventing the lung from receiving evil. Suitable for **Chuan Lian** (Coptis), **Su Ye** (Perilla Leaf), decocted together and taken immediately to stop. Disharmony between the lung and stomach easily leads to vomiting, as stomach heat moves to the lung, and the lung cannot receive evil, thus returning to the stomach. One must use **Chuan Lian** to clear damp-heat and **Su Ye** to open the lung and stomach. If taken, it will immediately cure, as the qi of the lung and stomach cannot be opened without **Su Ye**. For lighter cases, use lighter herbs to treat the disease of the upper Jiao.(8) Damp-heat syndrome with intermittent chills and fever, damp-heat obstructing the membrane source, suitable for herbs like **Chai Hu** (Bupleurum), **Huang Po** (Magnolia Bark), **Bing Lang** (Areca), **Cao Guo** (Tsaoko), **Huo Xiang** (Agastache), **Cang Zhu** (Atractylodes), **Ban Xia** (Pinellia), **Gan Cao** (Licorice), and **Qing Chang Pu** (Acorus). Intermittent chills and fever arise from summer heat hidden within, with autumn coolness binding it. If the pores are widely open, the hair follicles are unobstructed, how can it lead to intermittent chills and fever? The chills and fever have a fixed period, as the symptoms resemble intermittent chills and fever, but the membrane source is half exterior and half interior of Yangming. Damp-heat obstructs, thus the nutrient and defensive qi contend. Although the symptoms resemble intermittent chills and fever, they cannot be treated the same way, thus one can refer to the original drink. This is because one arises from external coolness binding, while the other arises from internal damp obstruction.(9) Damp-heat syndrome after several days, with internal dampness and heaviness, knowing hunger but not eating, indicates dampness obstructing the Sanjiao. Suitable for herbs like **Huo Xiang Ye** (Agastache Leaf), **Bo He Ye** (Mint Leaf), **Xian He Ye** (Lotus Leaf), **Pi Pa Ye** (Loquat Leaf), **Pei Lan Ye** (Eclipta), and **Dong Gua Ren** (Winter Melon Seed). This indicates that damp-heat has resolved, but residual evil obscures the clear Yang, leading to discomfort in the stomach. One should use very light and clear herbs to promote Yang qi in the upper Jiao. If heavy herbs are used, they will not relate to the condition.This line must be compared with the thirty-first line, as the former indicates the initial real evil, thus it is suitable to induce and drain. This light prescription does not match, and it must also be compared with the following lines, as the treatment methods differ between the upper and middle Jiao.(10) Damp-heat syndrome initially presents with fever, sweating, chest fullness, thirst, and a white tongue, indicating dampness hidden in the middle Jiao. Suitable for herbs like **Huo Xiang** (Agastache), **Bing Lang** (Areca), **Xing Ren** (Apricot Kernel), **Zhi Ke** (Bitter Orange), **Jie Geng** (Platycodon), **Yu Jin** (Curcuma), **Cang Zhu** (Atractylodes), **Huang Po** (Magnolia Bark), **Ban Xia** (Pinellia), **Gan Cao** (Licorice), and **Pei Lan Ye** (Eclipta). When the turbid evil rises, it leads to chest fullness, and when the stomach fluids do not rise, it leads to thirst. The disease is in the middle Jiao’s qi division, thus many herbs are used to open the middle Jiao’s qi division. This line often has food retention, as indicated by the yellow at the root of the tongue, thus **Gua Lou** (Trichosanthes) and **Zha Ren** (Hawthorn) should be added.(11) Damp-heat syndrome after several days with diarrhea and red urine, thirst, indicates dampness flowing to the lower Jiao. Suitable for herbs like **Hua Shi** (Talc), **Zhu Ling** (Polyporus), **Ze Xie** (Alisma), and **Tong Cao** (Tetrapanax). The lower Jiao belongs to Yin, and Taiyin governs it. The Yin pathway is weak, leading to diarrhea, and stagnation leads to red urine. The spleen does not transform fluids, leading to thirst. This is all due to Taiyin dampness being excessive, thus dampness stagnates in the lower Jiao, thus the treatment focuses on draining.However, if there are accompanying symptoms of thirst and chest fullness, one should add **Jie Geng** (Platycodon), **Xing Ren** (Apricot Kernel), and **Da Dou Huang** (Soybean) to open and drain the middle Jiao, ensuring that the source is clear, thus the flow is clean. This must be understood. The above three lines all indicate that dampness is heavier than heat.The damp-heat evil does not enter from the exterior, thus there is no exterior to differentiate, but there has never been a differentiation of the three Jiao. Just as in the case of treating diabetes by differentiating the three Jiao, heat is the qi of heaven, while dampness is the qi of earth. When heat encounters dampness, it becomes more intense; when dampness encounters heat, it becomes more rampant. When dampness and heat are separated, the disease is mild and slow; when dampness and heat combine, the disease is severe and rapid. If there is more dampness and less heat, it leads to obstruction in the upper and lower parts, while if there is both dampness and heat, both the upper and lower parts are obstructed, thus the three Jiao are all troubled. This is similar to the cold damage of the two Yangs and the disease of the three Yangs. The Taiyin dampness transforms, while the Sanjiao fire transforms. If there is dampness without heat, it can only obscure the clear Yang, either obstructing the upper, middle, or lower parts. If dampness and heat combine, then the internal lesser fire transforms into a strong fire, and the Sanjiao’s fire rises, leading to chaos. Thus, the upper and lower parts are filled, and the internal and external are tortured, leading to the most severe condition. Coupled with the Wood and Fire sharing the same qi, the exterior and interior are the same, thus leading to liver wind, and convulsions arise immediately. How much fluid can the stomach provide? The Yangming is the sea of food and drink, and the nose receives qi, while the mouth receives flavor, all returning to Yangming. If the evil enters through the mouth and nose, it must enter Yangming. Initially, the evil enters Yangming, early on injuring the stomach fluids. Subsequently, the evil overwhelms the Sanjiao, wanting to draw resources from the stomach fluids. Can the one in charge not be concerned about Yangming? One may ask how the Wood and Fire share the same qi, and how excessive heat leads to wind, causing convulsions. This reasoning is indeed correct. However, in the case of damp-heat syndrome, if the exterior is extremely hot, why are there no convulsions or seizures? I reply that the Wood and Fire are the heat that stirs, as the Wood qi is originally strong, and the liver yin is first deficient. The internal and external draw together, and the two Yangs stir, thus leading to movement. If the liver and kidney are originally strong and there is no heat, how can heat attract liver wind? Consider postpartum women and children; once they experience strong heat, they easily develop convulsions due to blood loss and a pure Yang body, with insufficient yin. One may ask, are there also those with deficient yin who suffer from damp-heat, even developing rashes externally, becoming delirious and confused at night, yet not having convulsions or seizures? I reply that the disease evil is more severe than the Yangming nutrient, thus it rises from above and affects the chest, leading to delirium at night. If the evil does not reside in the three Jiao’s qi division, then metal does not suffer imprisonment, and wood has something to fear, thus it does not dare to act. As for rashes belonging to Yangming and spots belonging to Taiyin, they are both the heat extremes of the two nutrient divisions, not involving the three Jiao, thus not drawing in the Wood and Fire. Therefore, convulsions and seizures must occur when the stomach fluids are completely depleted, leading to exhaustion of the heart’s nutrients, thus liver wind arises, and the person has already lost their physiological state.(12) Damp-heat syndrome with a white tongue coating, thirst, indicates dampness stagnating in Yangming. Suitable for pungent herbs like **Huang Po** (Magnolia Bark), **Cao Guo** (Tsaoko), and **Ban Xia** (Pinellia). This indicates that the damp evil is extremely strong, and thirst arises because the fluids do not rise, not due to heat. If pungent herbs are used excessively, it can turn into heat. At this time, the damp evil has not yet accumulated heat, thus pungent herbs are heavily used to open the upper Jiao, allowing the fluids to descend.(13) Damp-heat syndrome with a white tongue root and red tongue tip indicates that dampness gradually transforms into heat, with residual dampness still stagnating. Suitable for pungent herbs to drain and assist in clearing heat, such as **Hua Jiao** (Zanthoxylum), **Ban Xia** (Pinellia), **Da Dou Huang** (Soybean), **Lian Qiao** (Forsythia), **Lu Dou Pi** (Mung Bean Skin), and **Liang Yi San** (Six-One Powder). This indicates that damp-heat is in the middle stage, and the drying of dampness is accompanied by clearing heat, thus preserving the Yangming fluids. The above two lines rely on examining the tongue to determine the prescription, which is a key point in clinical practice, as the tongue is the exterior manifestation of the heart. The turbid evil rises and affects the heart and lungs, thus the tongue coating shifts accordingly.(14) Damp-heat syndrome initially presents with chest fullness, confusion, shouting in pain, indicating damp-heat obstructing the middle and upper Jiao. Suitable for herbs like **Cao Guo** (Tsaoko), **Bing Lang** (Areca), **Xian Chang Pu** (Acorus), **Coriander**, and **Liang Yi San** (Six-One Powder). This line indicates that both dampness and heat are strong, and since the disease evil initially obstructs, it is necessary to use pungent herbs to open the obstruction urgently, without wanting to use cold and cool herbs that would stagnate the qi mechanism.(15) Damp-heat syndrome after four to five days, with great thirst, chest fullness, dry retching, thin pulse, and a tongue like a mirror, indicates that the stomach fluids are robbed, and gallbladder fire rises. Suitable for **Watermelon Juice**, **Golden Juice**, **Sheng Di** (Rehmannia), **Sugar Cane Juice**, **Yin Hua** (Honeysuckle), **Mu Xiang** (Aucklandia), and **Xiang Fu** (Cyperus). This indicates that the nutrient yin is fundamentally deficient, and the Wood and Fire are fundamentally strong. The Wood qi invades Yangming, consuming its fluids. Fortunately, there is no fluid evil, thus one clears the Yangming heat and disperses the Shaoyang evil. No decoction is needed, as the essence is fully retained.(16) Damp-heat syndrome with vomiting of clear water or excessive phlegm indicates damp-heat retained internally, with wood-fire rising. Suitable for **Wen Dan Tang** (Warm Gallbladder Decoction) plus **Gua Lou** (Trichosanthes) and **Bi Yu San** (Jade Dew Powder). This line indicates that there is phlegm retention, and Yangming and Shaoyang share the same disease. Thus, one uses herbs to clear phlegm and one to descend the rebellious qi, which is the same as the previous line.(17) Damp-heat syndrome with continuous vomiting and nausea, day and night without relief, indicating disharmony between the lung and stomach, with stomach heat moving to the lung, preventing the lung from receiving evil. Suitable for **Chuan Lian** (Coptis), **Su Ye** (Perilla Leaf), decocted together and taken immediately to stop. Disharmony between the lung and stomach easily leads to vomiting, as stomach heat moves to the lung, and the lung cannot receive evil, thus returning to the stomach. One must use **Chuan Lian** to clear damp-heat and **Su Ye** to open the lung and stomach. If taken, it will immediately cure, as the qi of the lung and stomach cannot be opened without **Su Ye**. For lighter cases, use lighter herbs to treat the disease of the upper Jiao.(18) Damp-heat syndrome with cough, day and night without peace, even leading to difficulty breathing and inability to sleep, indicates summer heat entering the lung collaterals. Suitable for herbs like **Ting Li** (Desmodium), **Pi Pa Ye** (Loquat Leaf), and **Liang Yi San** (Six-One Powder). When summer heat injures lung qi, it leads to lung deficiency, while summer heat stagnates in the lung collaterals. **Ting Li** leads and **Hua Shi** (Talc) directly drains the lung evil, thus the disease resolves.(19) Damp-heat syndrome after ten days, with the general condition improving, but still experiencing thirst, sweating, and joint pain, indicates residual evil lingering in the collaterals. Suitable for **Yuan Mi Tang** (Original Rice Decoction) soaked in **Cang Zhu** (Atractylodes), removed after one night, and then decocted for drinking.This indicates that the damp evil has not yet completely resolved, and the yin fluids have been injured first, thus leading to thirst and body pain. At this time, rescuing the fluids will assist dampness, while treating dampness will harm the yin. Following Zhang Zhongjing’s method of **Ma Fei Tang**, one focuses on qi rather than flavor, moving Yang without moving Yin, and adding **Yuan Mi Tang** to nourish yin and expel dampness, thus achieving both benefits.(20) Damp-heat syndrome after several days, with sweating and heat not resolving, or sudden convulsions and persistent headaches, indicates that the nutrient fluids are greatly depleted, and the rebellious Yang rises with wind-fire. Suitable for herbs like **Ling Yang Jiao** (Antelope Horn), **Man Jing Zi** (Vitex), **Gou Teng** (Uncaria), **Yuan Shen** (Polygala), **Sheng Di** (Rehmannia), and **Nu Zhen Zi** (Ligustrum). Damp-heat injures the nutrients, leading to liver wind rising, thus blood does not nourish the muscles, leading to spasms. When the Yang rises to the top, it leads to headaches. The heat and qi have already retreated, while the Wood qi rises alone, thus leading to spasms without convulsions. The herbs are used to calm wind as the primary focus, while nourishing yin is the foundation.(21) Damp-heat syndrome with chest fullness and fever, with slight muscle pain, and no sweating throughout, indicates that the summer heat evil is internally closed. Suitable for **Liang Yi San** (Six-One Powder) and **Bo He Ye** (Mint Leaf), steeped in water and taken to induce sweating.In damp diseases, sweating is traditionally prohibited. This is not a slight sweat; if the disease is not resolved, it must be treated. There are both major prohibitions against sweating and methods to induce sweating. Practitioners must know how to adapt in clinical practice.(22) Damp-heat syndrome treated according to the method, after several days, suddenly leads to vomiting and diarrhea simultaneously, indicating that the central qi is depleted, and the ascending and descending mechanisms are reversed. Suitable for herbs like **Sheng Guo Ya** (Sprouted Grain), **Lian Xin** (Lotus Heart), **Bian Dou** (Hyacinth Bean), **Ban Xia** (Pinellia), **Gan Cao** (Licorice), and **Fu Ling** (Poria). In severe cases, use the **Li Zhong** method.When the ascending and descending mechanisms are reversed, the method should harmonize the middle. This is similar to the use of **Liu He Tang** (Six Harmonies Decoction) in cholera. If the Taiyin is severely fatigued and the central qi cannot support, the **Li Zhong** method is necessary.(23) Damp-heat syndrome after ten days, with a left pulse that is thin and rapid, abdominal pain at times, and blood in the stool, indicates that the blood is internally dry, and the heat evil has entered the Jueyin. Suitable for herbs following the method of **Bai Tou Weng** (Pulsatilla). If heat enters the Jueyin and leads to diarrhea, it does not lead to blood in the stool. One should also follow Zhang Zhongjing’s method for treating heat diarrhea, and if it enters the nutrient yin, how can one not use **Bai Tou Weng Tang** to cool the blood and disperse the evil?(24) Damp-heat syndrome after ten days, with a rapid pulse, diarrhea, or sore throat, thirst, and irritability, indicates that the heat evil directly invades the Shaoyin. Suitable for herbs following the method of **Zhu Fu Tang** (Pig Skin Decoction) to cool and moisten. In the case of diarrhea, there is a distinction between convulsions and less convulsions, thus the herbs differ in coldness and cooling. However, the Shaoyin has symptoms of pus in the stool, which must be examined closely.(25) Damp-heat syndrome with cold limbs, thin pulse, sweating, chest fullness, thirst, and a white tongue indicates that dampness injures the Yang of the Shaoyin. Suitable for herbs like **Ren Shen** (Ginseng), **Bai Zhu** (Atractylodes), **Fu Zi** (Aconite), and **Fu Ling** (Poria). This line indicates that dampness injures Yang, thus it is appropriate to support Yang and expel dampness. Thirst indicates a Shaoyin syndrome, thus one cannot recklessly use cold and cooling herbs.(26) In the hot month, the disease initially presents with aversion to cold, yellow face, no thirst, fatigue, and weakness in the limbs, with a deep weak pulse and abdominal pain and diarrhea, indicating that dampness obstructs the Yang of the Taiyin. Suitable for herbs following the method of **Suo Pi Yin** (Spleen-Reducing Decoction), and in severe cases, use **Da Shun San** (Great Smooth Powder) or **Lai Fu Dan** (Return to Life Pill). In the hot month, Yang qi leaks externally, while Yin qi consumes internally, thus heat evil injures Yin, leading to Yangming’s depletion. It is necessary to clear and nourish, while Taiyin is fatigued, and dampness spreads, thus it is necessary to warm and disperse. The ancient methods are most detailed, and practitioners should observe them.(27) Damp-heat syndrome treated according to the method, with all symptoms retreating, but still experiencing eye closure, leading to fright, nightmares, and residual evil lingering internally, indicating that the gallbladder qi has not yet relaxed. Suitable for herbs like **Jiu Zhi** (Fermented Plum), **Yin Li Ren** (Coriander Seed), **Ginger Juice**, **Jujube Skin**, and **Pig Gallbladder Skin**. **Yin Li Ren** is most slippery and can easily remove stagnation. The ancients treated fright after liver stagnation and did not descend, thus they used it to treat liver stagnation and remove stagnation. This syndrome borrows from the damp-heat evil lingering in the gallbladder, which is the residence of clarity. If it is stored and not released, the disease will leave residual evil internally. When sleeping, Yang qi moves into Yin, and gallbladder heat internally disturbs, leading to unrest in the liver spirit. Use **Yin Li Ren** to leak the evil and use wine to guide it, as wine qi returns to the gallbladder. The sourness of jujube skin enters the liver to calm the spirit, while ginger juice regulates and disperses the evil.(28) Damp-heat syndrome after opening and draining, with all symptoms improving, but still experiencing unclear thoughts, fatigue, lack of appetite, frequent urination, and dry lips, indicating that the stomach qi is not flowing, and the lung qi is not distributing. Suitable for herbs like **Ren Shen** (Ginseng), **Mai Dong** (Ophiopogon), **Shi Hu** (Dendrobium), **Mu Guo** (Papaya), and **Gan Cao** (Licorice). Opening and draining have improved the symptoms, but the righteous qi is greatly injured, thus many symptoms of qi deficiency appear. It is necessary to clear and supplement the original qi. If greasy and stagnant herbs are used, they will lead to constipation.(29) Damp-heat syndrome after four to five days, suddenly leading to excessive sweating, cold hands and feet, thin pulse like silk or absent, thirst, and pain in the stem, while rising and sitting is easy, indicating excessive sweating leading to temporary loss of exterior Yang, while the damp-heat evil still lingers. Suitable for **Wu Ling San** (Five Ingredient Powder) minus **Cang Zhu** and adding **Hua Shi** (Talc), **Jiu Zhi** (Fermented Plum), and **Sheng Di** (Rehmannia). This line indicates that the pulse and symptoms are all signs of Yang loss, but the true feelings are revealed in movement and spirit. This is the reason why medical practitioners value observation.(30) Damp-heat syndrome with spasms and confusion, cold feet, and contraction of the lower body, indicating that the lower body is externally affected by cold. It is still necessary to treat damp-heat, using only pungent and warm herbs, decocted and washed.Contraction of the lower body is caused by convulsions from the outside, combined with cold feet, resembling false cold. This indicates that there is no significant deficiency, and it is necessary to observe the true condition of the syndrome. This is not a case of false cold, nor is it a case of heat above and cold below, thus it is still necessary to treat damp-heat.(31) Damp-heat syndrome initially presents with heat and thirst, with fullness in the chest, irritability, and desire to close the eyes, with occasional confusion and delirium, indicating that the turbid evil obscures the upper Jiao. Suitable for herbs like **Zhi Ke** (Bitter Orange), **Jie Geng** (Platycodon), **Dan Dou Chi** (Fermented Soybean), and **Sheng Zhi** (Fresh Gardenia). If there is no sweating, add **Ge Gen** (Kudzu). This is similar to the ninth line and should be compared. The former indicates residual evil, thus the method should be light and dispersive. This indicates that the turbid evil obscures the upper Jiao, thus leading to irritability and desire to close the eyes, indicating that lung qi is not smooth. Occasional confusion indicates that the evil is obstructing the heart. If light herbs are used, the disease will not be resolved. The classic states that the high ones should be surpassed, using **Zhi Shi Tang** to induce and disperse the evil, guiding the Yang of the stomach to open the chest and disperse the evil through vomiting.(32) Damp-heat syndrome with menstruation arriving, strong heat and thirst, confusion, and abdominal pain, or a tongue without coating, rapid pulse, indicates that the evil has entered the nutrient division. Suitable for large doses of **Ling Yang Jiao** (Antelope Horn), **Zi Cao** (Lithospermum), **Qian Cong** (Corydalis), **Lian Qiao** (Forsythia), **Sheng Di** (Rehmannia), and **Yin Hua** (Honeysuckle). (33) Heat syndrome with blood loss or sweating, indicating that the toxic evil has deeply entered the nutrient division, leading to a desire to leak. Suitable for large doses of **Ling Yang Jiao** (Antelope Horn), **Sheng Di** (Rehmannia), **Chi Shao** (Red Peony), **Dan Pi** (Moutan), and **Lian Qiao** (Forsythia). Heat and blood loss lead to danger, but it is not immediately fatal. The toxic evil exits with the blood, and life is in this. One should greatly increase the cooling blood detoxifying herbs to rescue the yin and leak the evil, thus the evil resolves and the blood stops. After the blood stops, one must take **Sheng Gan** (Three Good After) to recover.Blood loss refers to what Zhang refers to as muscle bleeding. The internal classic states that heat lingers internally, treated with salty and cold herbs, thus the formula should increase salty and cold flavors.(34) Damp-heat syndrome after seven to eight days, with no thirst, no voice, and no rejection of food, remaining silent and not speaking, indicating confusion and delirium, with hands twitching, indicating that the fluids are depleted and the evil is stagnant. Suitable for herbs like **Xian Lu Gen** (Rehmannia), **Sheng Shou Wu** (Polygonum), and **Sheng Dao Gen** (Fresh Rice Root). If the pulse is strong and there is no bowel movement, **Da Huang** (Rhubarb) can also be added.The stomach fluids are robbed, and the heat evil internally occupies, thus it cannot be moistened and drained. Therefore, one should follow the example of **Cheng Qi** (Purge Qi) to use sweet and cool herbs instead of bitter and cold herbs, as the stomach qi is injured and cannot recover.(35) Damp-heat syndrome with spasms and confusion, yellow tongue coating, or turning black, with constipation, indicates that the heat evil obstructs the stomach and intestines. Suitable for **Cheng Qi Tang** (Purge Qi Decoction). Spasms indicate that it is either very real or very deficient. If it is deficient, the spirit is scattered, leading to the risk of collapse. If it is real, the spirit is obstructed, thus leading to chaotic symptoms. Today, the yellow tongue coating indicates dryness and obstruction, with constipation. The heat evil is clearly obstructing the Yangming intestines, thus one must use **Cheng Qi** to open the path. However, if the tongue is not dry and yellow, it cannot be used.(36) Heat syndrome with strong heat, thirst, and spontaneous sweating, heavy body, and chest fullness, with a large and long pulse, indicates that the Taiyin dampness combines with Yangming heat. Suitable for **Bai Hu Tang** (White Tiger Decoction) plus **Cang Zhu** (Atractylodes). Thirst and sweating indicate Yangming heat, while chest fullness and heavy body indicate Taiyin dampness. The large and long pulse indicates that damp-heat stagnates in the Yangming meridian, thus using **Cang Zhu Bai Hu Tang** to clear heat and disperse dampness. This indicates that there is more heat than dampness.**Bai Hu Tang** is used by Zhang Zhongjing to clear the Yangming’s formless dryness and heat. If the stomach fluids are depleted, add **Ren Shen** (Ginseng) to generate fluids, thus it is called **Bai Hu Jia Ren Shen Tang**. If there is qi in the body, add **Gui Zhi** (Cinnamon Twig) to open the collaterals, thus it is called **Gui Zhi Bai Hu Tang**. If there is chest fullness and heavy body, add **Cang Zhu** to regulate the Taiyin dampness. If there are alternating cold and heat, add **Chai Hu** (Bupleurum) to disperse the half-exterior and half-interior evil. All of these indicate that heat is excessive in Yangming, and other symptoms are present, thus using **Bai Hu Tang** to clear heat while adjusting according to symptoms.(37) Damp-heat syndrome indicates that damp-heat injures qi, leading to fatigue in the limbs, reduced spirit, body heat, high qi, irritability, yellow urine, thirst, and spontaneous sweating, with a weak pulse. Suitable for **Qing Shu Yi Qi Tang** (Clear Summer Heat and Nourish Qi Decoction). This indicates that there is both thirst and spontaneous sweating, while the pulse is weak and the spirit is fatigued, indicating that the central qi is injured, not Yangming’s stagnant heat. **Qing Shu Yi Qi Tang** is designed for yellow thirst and spontaneous sweating, thus it is a formula created by Dong Yuan.(38) In the hot month, heat injures the original qi, leading to shortness of breath, fatigue, thirst, and excessive sweating, with lung deficiency and fear. Suitable for herbs like **Ren Shen** (Ginseng), **Mai Dong** (Ophiopogon), and **Wu Wei Zi** (Schisandra). This is the **Qian Jin Sheng Mai San** (Thousand Gold Life Pulse Powder), which is the same as the eighteenth line regarding lung diseases. There is a distinction between coarse and short breaths, thus lung deficiency and lung fullness are different. If it is real, it is treated with purging; if it is deficient, it is treated with tonifying, which is a definite principle. However, the name indicates that it is for restoring the pulse after heat injures qi.(39) In the hot month, if one drinks cold excessively, the Yang qi is harmed by Yin cold, leading to skin steaming and chills, headache, spontaneous sweating, irritability, or abdominal pain and vomiting, indicating that one should use herbs like **Huo Xiang** (Agastache), **Huang Po** (Magnolia Bark), and **Bian Dou** (Hyacinth Bean). This arises from avoiding summer heat and feeling cold and damp. Although the disease occurs in the hot month, it is not a summer disease. The ancients did not say that summer heat causes cold dampness, but rather that it is Yin summer heat, leading to confusion and significant errors. Today, it is particularly corrected. The use of **Huo Xiang** is pungent and warm, dispersing the Yin evil and promoting Yang qi. **Huang Po** is bitter and warm, removing dampness and promoting the flow of stagnation. **Bian Dou** is sweet and bland, promoting water and harmonizing the middle. If there are no symptoms of aversion to cold and headache, then there is no need to use **Huo Xiang** to disperse. If there are no symptoms of abdominal pain and vomiting, then there is no need to use **Huang Po** and **Bian Dou** to promote flow and harmonize. Therefore, if there is significant thirst, add **Huang Lian** (Coptis) to clear summer heat, thus it is called **Si Wei Huo Xiang**. If there is excessive dampness and abdominal distension, remove **Huang Lian** and add **Fu Ling** (Poria) and **Gan Cao** (Licorice), thus it is called **Wu Wu Huo Xiang**. If the middle is deficient and the qi is weak, add **Ren Shen** (Ginseng), **Bai Zhu** (Atractylodes), and **Chen Pi** (Tangerine Peel), thus it is called **Shi Shi Huo Xiang**. However, the use of **Huo Xiang** is primarily for external cold dampness and should not be used to treat summer heat without cold dampness.(40) Damp-heat stagnation in the Taiyin, lingering for a long time, leads to stagnation below, with symptoms of chest fullness, abdominal pain, and a feeling of heaviness, with thick and sticky blood and pus, leading to a feeling of heaviness. Suitable for herbs like **Huang Po** (Magnolia Bark), **Huang Qin** (Scutellaria), **Shen Qu** (Malt), **Guang Pi** (Citrus Peel), **Mu Xiang** (Aucklandia), **Bing Lang** (Areca), **Chai Hu** (Bupleurum), **Wei Ge Gen** (Kudzu), **Yin Hua** (Honeysuckle), **Charcoal** (Charcoal), and **Jing Jie** (Schizonepeta). This indicates that damp-heat evil has internally hidden in the Taiyin, obstructing the qi mechanism, leading to Taiyin’s inability to transport, while Shaoyang loses its dispersing function, leading to heat stagnation and damp steaming, resulting in turbid blood and pus flowing down to the anus, thus leading to a feeling of heaviness and qi stagnation. If the qi is injured, it leads to white stools; if the blood is injured, it leads to red stools. If both qi and blood are injured, it leads to both red and white stools. If damp-heat is excessive, it leads to five colors of diarrhea. Thus, one uses **Huang Po** to remove dampness and promote the flow of qi, **Bing Lang** to reverse and break the stagnation, **Huang Qin** to clear the heat, **Mu Xiang** and **Shen Qu** to relieve the stagnation of the middle qi, **Ge Gen** to lift the stomach qi, and **Chai Hu** to raise the wood qi in the middle. If the heat invades the blood division, leading to blood in the stool, use **Yin Hua** and **Jing Jie** to clear heat in the nutrient division. If the heat is excessive, use **Huang Lian** to clear heat. If there is significant fullness and pain, increase **Da Huang** to expel the evil. In ancient times, Zhang Jiegu used **Shao Yao Tang** to treat blood dysentery, using **Gui Shao**, **Qin Lian**, **Da Huang**, **Mu Xiang**, **Bing Lang**, **Gan Cao**, and **Gui Xin**. The reason it is called **Shao Yao Tang** is that it is said that blood must be adjusted and stored in the organs, thus it is used as the monarch. It is not only to want to drain the wood from the earth but also to rely on it to nourish the liver and harmonize the yin. However, **Shao Yao** is sour and astringent, which is not suitable for those with damp-heat internally hidden. If one encounters dysentery that has lasted a long time, it is necessary to use **Shao Yao** and **Gan Cao** to transform the earth, as it is difficult to endure the bitter cold of **Qin Lian** and **Da Huang**. The initial stage of dysentery with excessive damp-heat is indicated by the sourness of **Shao Yao**, which must not be used. Although the ancients have tried this formula, it cannot be used as a model for future practitioners.
My note: For vomiting and nausea, avoid **Mu Xiang**; for those without exterior symptoms, avoid **Chai Hu** and **Ge Gen**. The stomach’s actions below are smooth, while stagnation leads to turbid evil wanting to descend, and if mixed with ascending herbs, the turbid qi will rebound and lead to vomiting and nausea. As for **Jie Gu Tang**, it is most suitable for the symptoms of abdominal fullness and pain. If the internal heat evil is excessive, even with the presence of **Qin Lian** and **Da Huang**, it may still lead to excessive symptoms. If **Shao Yao** is used, it is only slightly sour, but it has a bitter taste. The classic states that it is used to clear blood, break down hard accumulations, and treat cold and heat syndromes. It is used to clear liver qi and break down blood stagnation. Zhang Zhongjing often uses it for abdominal fullness and pain. If the pulse is weak, the person continues to have diarrhea, indicating that the Yang is weak. If one uses **Da Huang** and **Shao Yao**, it is necessary to reduce the dosage, as the stomach qi is weak and easily moves. Thus, **Da Huang** opens the Yang, while **Shao Yao** opens the Yin. If the person has diarrhea, it is necessary to use **Shao Yao** to treat the stagnation, while **Da Huang** is used to treat the obstruction. This is the appropriate treatment for dysentery.