Treatment of Damp-Heat Syndrome in the Middle Jiao (Part 1)

Treatment of Damp-Heat Syndrome in the Middle Jiao (Part 1)

Continuing from the previous issue:Treatment of Damp-Heat Syndrome in the Upper Jiao (Part 2)

1. Characteristics of the Syndrome

The syndrome of Damp-Heat in the Middle Jiao can arise from two pathways: either due to unresolved Damp-Heat in the Upper Jiao gradually transmitting to the Middle Jiao, or due to dysfunction of the Spleen and Stomach in transforming and transporting, leading to internal accumulation of Damp-Heat, which is then further invaded by external Damp-Heat pathogens, resulting in a combined internal and external pathogenic attack.

Damp-Heat diseases tend to linger the longest in the Middle Jiao, with the primary pathological changes occurring in the Spleen and Stomach. Due to individual differences in constitution, the degree of predominance of Damp and Heat pathogens varies, leading to different pathogenesis and manifestations of Damp-Heat syndrome in the Middle Jiao. If the individual has a Yang deficiency constitution, or if Dampness predominates with mild Heat, the symptoms often present with more Dampness than Heat, with the pathological focus in the Spleen (Taiyin); conversely, if the individual has a Yang excess constitution, or if Heat predominates with mild Dampness, the symptoms will typically show more Heat than Dampness, with the pathological focus in the Stomach (Yangming). As Ye Tianshi stated: “In a body with abundant Yang, the Stomach is often damp; in a body with abundant Yin, the Spleen is not without dampness” (from “External Contracted Warm Diseases”). If both Spleen Dampness and Stomach Heat are present equally, the symptoms will reflect a balance of Damp and Heat.

When Dampness predominates over Heat, it is characterized by Dampness as the main feature, with Heat symptoms not prominent. The Dampness obstructs and hinders, leading to the Spleen’s failure to function properly. The main characteristics include a heavy body sensation, fullness in the epigastrium without hunger, a bland mouth without thirst, loose stools that are unsatisfactory, a greasy tongue coating, and a slippery pulse.

When Heat predominates over Dampness, it is often seen in summer Damp-Heat diseases, where the symptoms are primarily characterized by internal Heat, accompanied by Dampness. The main features include high fever, irritability, thirst, and other signs of internal Heat, along with abdominal distension and fullness as Dampness symptoms, and may also present with a red tongue with a yellow greasy coating and a rapid slippery pulse. Additionally, from a developmental perspective, symptoms of Heat predominating over Dampness often easily transform into dryness, leading to Warm-Heat diseases.

When Dampness and Heat are both present, it is characterized by Dampness stagnating and Heat steaming, making it difficult to differentiate between the two. The main features include chest tightness and abdominal distension, little thirst or even no thirst, sweating with Heat resolution, followed by renewed Heat, and a pale yellow, slippery tongue coating.

2. Treatment Principles

For Damp-Heat syndrome in the Middle Jiao, the treatment should focus on drying Dampness to eliminate the Damp pathogen and adjust the functions of the Spleen and Stomach, restoring their balance of ascending and descending. As Wu Jutong stated: “Treating the Middle Jiao is like balancing a scale; it cannot be stable without equilibrium” (from “Differentiation of Warm Diseases”). However, due to the different presentations, the choice of herbs will also vary.

When Dampness predominates over Heat, it is a syndrome primarily characterized by Dampness. The treatment should focus on warming and dispersing, and using bitter and warming herbs to dry Dampness. The selection of warming and bitter herbs should be combined, with warming herbs opening and bitter herbs descending, drying and transforming Dampness; when Dampness is eliminated, Heat will also recede. Since Damp-Heat in the Middle Jiao can easily spread to the Upper and Lower Jiao, it is advisable to include aromatic herbs that transform Dampness and mildly promote urination in the treatment to transform and drain the turbid Dampness.

When Heat predominates over Dampness, it is a syndrome primarily characterized by Heat with accompanying Dampness. The treatment should focus on bitter, cold herbs to clear Heat and dry Dampness. Bitter and cold herbs can clear Heat and also dry Dampness, thus eliminating Heat and expelling Dampness to resolve the disease.

When Dampness and Heat are both present, it is a syndrome characterized by Dampness stagnating and Heat steaming, making it difficult to differentiate between the two. The treatment should simultaneously dry Dampness and clear Heat, using a combination of warming, bitter warming, and bitter cold herbs to achieve the goal of drying Dampness and clearing Heat. If Damp-Heat in the Middle Jiao is stagnant and diffuses to the Upper and Lower Jiao, it is advisable to include aromatic herbs that transform Dampness and mildly promote urination to provide an opportunity for the Damp-Heat to be expelled externally.

Damp-Heat syndrome in the Middle Jiao is characterized by Damp-Heat obstructing the Middle Jiao, leading to impaired Qi dynamics, sluggish Spleen and Stomach functions, and loss of control over ascending and descending. Therefore, while eliminating Damp-Heat pathogens, it is also essential to regulate Qi stagnation, strengthen the Spleen, tonify Qi, and use herbs that awaken the Stomach and promote digestion.

3. Differentiation and Treatment

1. Dampness predominates over Heat

1) Dampness with Food Stagnation

Clinical Manifestations: Abdominal distension and fullness, poor appetite, nausea and vomiting, loose stools that are unsatisfactory, a white greasy tongue coating, and a slippery pulse.

Pathogenesis Analysis: This syndrome is due to Dampness obstructing the Middle Jiao, leading to the Spleen and Stomach’s failure to control ascending and descending. Dampness obstructs the flow of Qi, causing abdominal distension and fullness, poor appetite, and nausea. When Dampness with food stagnation descends into the Large Intestine, it leads to loose stools, or the presence of undigested food. Due to the sticky nature of Dampness, it obstructs the flow of Qi, hence the stools are loose but unsatisfactory. The white greasy tongue coating and slippery pulse are signs of internal Dampness.

Treatment Method: Dry Dampness and resolve stagnation.

Formula: Modified Zhengqi Decoction (from “Differentiation of Warm Diseases”)

Huo Xiang (Agastache) 2 qian,Hou Po (Magnolia Bark) 2 qian,Xing Ren (Apricot Kernel) 2 qian,Fu Ling Pi (Poria Peel) 2 qian,Chen Pi (Aged Tangerine Peel) 1 qian,Shen Qu (Malt) 1.5 fen,Mai Ya (Barley Sprout) 1.5 fen,Mian Yin Chen (Eclipta) 2 qian,Da Fu Pi (Areca Peel) 1 qian.

Use 5 cups of water, boil down to 2 cups, and take.

Formula Discussion: In this formula, Huo Xiang transforms Dampness aromatically and also has the function of moving Qi. Hou Po, Da Fu Pi, and Chen Pi are combined to use both bitter warming and spicy warming, with the spicy opening and bitter descending, drying Dampness and moving Qi, thus unblocking the Qi dynamics. Shen Qu and Mai Ya awaken the Stomach and promote digestion to resolve stagnation. Fu Ling Pi and Yin Chen work together to drain and benefit the turbid Dampness, with Yin Chen also having the function of transforming Dampness aromatically. Additionally, Xing Ren descends Lung Qi to benefit the Large Intestine and also regulates the water pathways. The combination of these herbs expels turbid Dampness, resolves food stagnation, and unblocks the Qi dynamics to regulate the ascending and descending functions of the Spleen and Stomach.

Literature Excerpt: “Dampness obstructing the San Jiao, leading to loss of control over ascending and descending, with abdominal distension and unsatisfactory stools, Modified Zhengqi Decoction is the main treatment.” (from “Differentiation of Warm Diseases, Middle Jiao Section, Article 58”)

Notes: The phrase “Dampness obstructing the San Jiao, leading to loss of control over ascending and descending” refers to the obstruction of the Middle Jiao by Dampness, resulting in the Spleen and Stomach’s failure to control ascending and descending. Due to the diffusion of turbid Dampness, it can affect the Upper and Lower Jiao, hence the term “San Jiao Dampness obstruction,” with the Middle Jiao Spleen and Stomach as the center. “Abdominal distension and unsatisfactory stools” are signs of Dampness obstructing the Spleen and Stomach.

2) Dampness Obstructing Both Interior and Exterior

Clinical Manifestations: Abdominal distension and fullness, loose stools, generalized heaviness and pain, a white greasy tongue coating, and a slippery pulse.

Pathogenesis Analysis: This syndrome is due to Dampness obstructing the interior, causing dysfunction of the Spleen and Stomach, while also obstructing the exterior channels and collaterals, leading to simultaneous interior and exterior disease. Internal Dampness obstructs the flow of Qi, causing abdominal distension and fullness, and loose stools. Dampness obstructing the exterior channels leads to poor circulation of Qi and blood at the surface, resulting in generalized heaviness and pain. The white greasy tongue coating and slippery pulse are both signs of excessive Dampness.

Treatment Method: Dry Dampness, benefit the Dampness, and promote circulation of both interior and exterior.

Formula: Modified Zhengqi Decoction (2) (from “Differentiation of Warm Diseases”)

Huo Xiang (Agastache) 3 qian,Chen Pi (Aged Tangerine Peel) 2 qian,Hou Po (Magnolia Bark) 2 qian,Fu Ling Pi (Poria Peel) 3 qian,Mu Fang Ji (Dewberry) 3 qian,Da Dou Huang (Soybean) 2 qian,Chuan Tong Cao (Lonicera) 1.5 fen,Yi Yi Ren (Job’s Tears) 3 qian.

Use 8 cups of water, boil down to 3 cups, and take three times.

Formula Discussion: In this formula, Huo Xiang transforms Dampness aromatically and also has the function of moving Qi. Chen Pi and Hou Po are combined to use both bitter warming and spicy warming, opening and descending, drying Dampness and moving Qi, thus unblocking the Qi dynamics. Fu Ling Pi benefits the turbid Dampness, while Mu Fang Ji and Da Dou Huang help to clear and resolve the exterior Dampness. The combination of these herbs dries Dampness, benefits the turbid Dampness, and promotes circulation of both interior and exterior.

Literature Excerpt: “Dampness obstructing the San Jiao, with abdominal fullness, loose stools, generalized heaviness and pain, a white greasy tongue coating, and a slippery pulse, Modified Zhengqi Decoction (2) is the main treatment.” (from “Differentiation of Warm Diseases, Middle Jiao Section, Article 59”)

Notes: “Abdominal fullness and loose stools” indicate the obstruction of the Middle Jiao by Dampness. “Generalized heaviness and pain” indicate the obstruction of the exterior channels. The simultaneous presence of both symptoms indicates the interior and exterior disease.

3) Dampness Accumulating and Transforming into Heat

Clinical Manifestations: Abdominal distension and fullness, loose stools, yellow urine, a yellow greasy tongue coating, and a slippery pulse.

Pathogenesis Analysis: This syndrome is due to Dampness obstructing the Middle Jiao, leading to accumulation and transformation into Heat. Abdominal distension and fullness, loose stools are signs of Dampness obstructing the Middle Jiao, resulting in the Spleen and Stomach’s failure to control ascending and descending. Internal Dampness obstructs the flow of Qi, leading to stagnation of Yang Qi, which eventually transforms into Heat, hence the yellow urine. The yellow greasy tongue coating is a sign of Damp-Heat rising. The slippery pulse indicates excessive Dampness.

Treatment Method: Expel Dampness and drain Heat.

Formula: Three-Modified Zhengqi Decoction (from “Differentiation of Warm Diseases”)

Huo Xiang (Agastache) 3 qian,Fu Ling Pi (Poria Peel) 3 qian,Hou Po (Magnolia Bark) 2 qian,Chen Pi (Aged Tangerine Peel) 1.5 fen,Xing Ren (Apricot Kernel) 3 qian,Hua Shi (Talc) 5 qian.

Use 5 cups of water, boil down to 2 cups, and take.

Formula Discussion: In this formula, Huo Xiang transforms Dampness aromatically, while Fu Ling Pi benefits the turbid Dampness. Hou Po and Chen Pi are combined to use both bitter warming and spicy warming, opening and descending, drying Dampness and moving Qi. Xing Ren descends Lung Qi to benefit the Large Intestine, while Hua Shi helps to drain Heat. The combination of these herbs expels Dampness, drains Heat, and promotes circulation of Qi.

Literature Excerpt: “Dampness obstructing the Middle Jiao, with abdominal distension, loose stools, yellow urine, a yellow greasy tongue coating, and a slippery pulse, Three-Modified Zhengqi Decoction is the main treatment.” (from “Differentiation of Warm Diseases, Middle Jiao Section, Article 60”)

Notes: “Dampness obstructing the Middle Jiao” indicates the obstruction of the Middle Jiao by Dampness. “Yellow urine” indicates the transformation of Dampness into Heat.

4) Damp-Heat Steaming, External Manifestation of White Sores

Clinical Manifestations: Fever, body aches, sweating that does not resolve, dull expression, chest and abdominal fullness, nausea, loose stools, and the appearance of white sores on the chest and abdomen, a yellow greasy tongue coating, and a slippery pulse.

Pathogenesis Analysis: This syndrome is due to Damp-Heat obstructing the Middle Jiao, leading to steaming and external manifestation of white sores. Damp-Heat obstructs the Middle Jiao, causing Dampness to steam and manifest externally, resulting in fever. Damp-Heat obstructing the exterior channels leads to poor circulation of Qi and blood at the surface, resulting in body aches. The steaming of Damp-Heat can lead to sweating. However, due to the sticky nature of Dampness, the Damp-Heat pathogen cannot be resolved by sweating alone, hence the fever and body aches persist despite sweating. Dampness obscures the clear orifices, leading to a dull expression. Damp-Heat obstructing the Middle Jiao causes Qi stagnation, leading to chest and abdominal fullness. The Stomach loses its harmony, resulting in nausea and loose stools.White sores typically appear around a week into the Damp-Heat disease, resembling corn, raised above the skin, filled with light yellow fluid, resembling crystal, often seen on the chest and abdomen, sometimes extending to the back, rarely on the limbs, usually not numerous, with a few or dozens appearing, and occasionally large patches. After the white sores rupture, fluid seeps out, and the skin returns to normal without leaving scars or pigmentation. It is common for one episode of sweating to coincide with the appearance of one episode of white sores. The appearance of white sores indicates that Damp-Heat has an opportunity to manifest externally, often accompanied by a reduction in fever and chest tightness.However, if the white sores are deflated and contain no fluid, it indicates depletion of both Qi and Yin, termed “dry sores.” The yellow greasy tongue coating indicates the steaming of Damp-Heat. The slippery pulse is a sign of excessive Dampness.

Treatment Method: Clear and drain Damp-Heat, and allow the pathogen to manifest externally.

Formula: Yi Yi Zhu Ye San (from “Differentiation of Warm Diseases”)

Yi Yi Ren (Job’s Tears) 5 qian,Zhu Ye (Bamboo Leaf) 3 qian,Hua Shi (Talc) 5 qian,Bai Dou Kou (Cardamom) 1.5 fen,Lian Qiao (Forsythia) 3 qian,Fu Ling (Poria) 5 qian,Bai Tong Cao (White Herb) 1.5 fen.

Grind into a fine powder, take 5 qian each time, three times a day (now often made into a decoction).

Formula Discussion: In this formula, Yi Yi Ren, Fu Ling, Hua Shi, and Tong Cao work together to drain and benefit Dampness, while Yi Yi Ren and Fu Ling also have the function of tonifying the Spleen. Bai Dou Kou is aromatic and helps to awaken the Stomach and transform Dampness. Zhu Ye and Lian Qiao are light and clear, helping to clear and allow the Damp-Heat to manifest externally. The combination of these herbs clears and drains while also allowing the pathogen to manifest externally, treating both the interior and exterior simultaneously, as Wu Jutong stated: “This is a syndrome of Damp-Heat stagnation, hence the use of spicy-cool herbs to resolve the Heat at the muscle surface, and the use of light herbs to drain the Dampness internally, allowing the exterior pathogen to disperse through Qi transformation and the internal pathogen to be expelled through urination, achieving the dual effect of treating both the exterior and interior” (from “Differentiation of Warm Diseases, Middle Jiao Section, Article 66”).

This formula is derived from San Ren Tang by removing Xing Ren, Ban Xia, and Hou Po, and adding Fu Ling and Lian Qiao. Since the syndrome belongs to Damp-Heat stagnation in the Middle Jiao, the warming and drying properties of Xing Ren, Ban Xia, and Hou Po are removed to prevent exacerbating Heat. Fu Ling is added to tonify the Spleen and drain Dampness, and Lian Qiao is added to clear and drain Damp-Heat, allowing the pathogen to manifest externally. Compared to the original formula, Yi Yi Zhu Ye San is cooler in nature and has a stronger ability to clear and drain. If the syndrome of Damp-Heat stagnation manifests externally with a predominance of Dampness, San Ren Tang can also be used for treatment.

If dry sores are observed, indicating depletion of both Qi and Yin, Sheng Mai San should be used (see the previous section on “Qi and Yin Depletion”).

Literature Excerpt: “Damp-Heat invading the channels, with fever, body aches, excessive sweating, and white sores on the chest and abdomen, indicating internal and external combined pathogens, the use of Yi Yi Zhu Ye San is the main treatment.” (from “Differentiation of Warm Diseases, Middle Jiao Section, Article 66”)

Notes: “Damp-Heat invading the channels” indicates the invasion of Damp-Heat into the skin and channels. “Fever, body aches, excessive sweating, and white sores” are all signs of Damp-Heat manifesting externally. The treatment should focus on both the interior and exterior.

5) Damp-Heat Causing Wind Movement

Clinical Manifestations: Tight jaw, limb spasms, stiff neck, severe cases may present with opisthotonos, confusion, a white greasy or yellow greasy tongue coating, and a slippery pulse.

Pathogenesis Analysis: This syndrome is due to Damp-Heat accumulating in the Middle Jiao, obstructing the channels and collaterals, leading to Wind movement. As stated in the “Suwen: Theory of Vital Energy and Heaven”: “Caused by Dampness, it wraps around like a cover; if Damp-Heat is not dispelled, the large tendons become soft and short, while the small tendons become slack and long; soft and short leads to contraction, slack and long leads to atrophy.” Internal Damp-Heat stagnates in the channels and collaterals, leading to insufficient nourishment of Qi and blood, resulting in spasms and contractions. If Damp-Heat obstructs the flow of Qi, it can lead to excessive Wind movement. If Damp-Heat obscures the Heart, it can cause confusion. This syndrome differs from the Wind movement caused by extreme Heat in Warm diseases, which typically presents with high fever and agitation, a red tongue, and a rapid pulse; whereas this syndrome is characterized by internal Damp-Heat, hence confusion, a white greasy or yellow greasy tongue coating, and a slippery pulse.

Treatment Method: Expel Dampness, clear Heat, open the channels, and extinguish Wind.

Formula: Xue’s Formula for Expelling Dampness and Extinguishing Wind (from “Warm and Heat Classics”)

Fresh Di Long (Earthworm) 5 qian,Qin Jiao (Gentiana) 2 qian,Wei Ling Xian (Clematis) 2 qian,Hua Shi (Talc) 6 qian,Cang Er Zi (Xanthium) 1 qian,Si Gua Teng (Luffa) 5 qian,Hai Feng Teng (Sea Wind Vine) 3 qian,Jiu Chao Huang Lian (Wine-fried Coptis) 2 qian.

Note: The original formula only lists the above herbs, without specifying the formula name or dosage. We have named this formula “Xue’s Formula for Expelling Dampness and Extinguishing Wind” based on the intent of the herbal selection by Xue Shengbai, and have supplemented it with clinical dosages.

Formula Discussion: This syndrome is due to Damp-Heat accumulating in the Middle Jiao, obstructing the channels and collaterals, leading to Wind movement. To extinguish the Wind, it is essential to first expel Dampness and Heat. Internal Damp-Heat stagnates, and Heat is within Dampness; if Dampness is not expelled, Heat cannot be cleared, hence the treatment should focus on expelling Dampness. If Dampness is expelled, Heat will not remain. The herbs Qin Jiao, Wei Ling Xian, Cang Er Zi, and Hai Feng Teng are all Wind-dispelling herbs that also have the function of expelling Dampness and soothing the Liver. Additionally, Huang Lian clears Heat and dries Dampness, while Hua Shi drains Dampness and clears Heat, thus enhancing the ability to expel Dampness and Heat. The combination of these herbs expels Dampness, clears Heat, opens the channels, and extinguishes Wind.

If Liver Heat is more pronounced, Ling Yang Jiao (Antelope Horn Powder) 5 fen (taken in water) can be added to the formula.

Literature Excerpt: “Damp-Heat syndrome, within three to four days, can lead to lockjaw, limb spasms, and severe cases may present with opisthotonos; this is due to Damp-Heat invading the channels, hence the use of Fresh Di Long, Qin Jiao, Wei Ling Xian, Hua Shi, Cang Er Zi, Si Gua Teng, Hai Feng Teng, and Jiu Chao Huang Lian.” (from “Warm and Heat Classics, Xue Shengbai’s Damp-Heat Disease Section, Article 4”)

Notes: This section discusses the causes, pathogenesis, clinical manifestations, and treatment methods for Wind movement caused by Damp-Heat. In Damp-Heat diseases, Wind movement can occur; if treated as Wind caused by extreme Heat, or as internal Wind movement, using nourishing Yin to extinguish Wind, it will not only be ineffective but may also lead to other complications. Xue Shengbai points out that the pathogenesis is “Damp-Heat invading the channels,” which is indeed a key point worth pondering, and treating with herbs that expel Dampness and open the channels to extinguish Wind is also a valuable experience worth emulating.

6) Damp-Heat Hidden in the Mu Yuan (Damp-Heat Epidemic)

Clinical Manifestations: Initially, there is aversion to cold followed by fever, then only fever without aversion to cold, worsening in the afternoon, with headache and body aches, chest tightness and abdominal fullness, occasional nausea, a white greasy tongue coating, and a wiry rapid pulse.

Pathogenesis Analysis: This syndrome is due to the invasion of Damp-Heat epidemic pathogens into the body. Regarding the etiology, pathogenesis, and location of this syndrome, Wu Youke discusses it in detail in “Warm Epidemics”, stating: “Epidemics are caused by the pathogenic Qi of heaven and earth… This Qi does not discriminate between old and young, strong and weak; those who come into contact with it will become ill. The pathogen enters through the mouth and nose, and does not reside in the organs, nor in the channels, but rather hides within the Mu Yuan, not far from the surface, near the Stomach, thus it is a half-exterior, half-interior condition, as described in the “Suwen: Discussion on Malaria” as ‘horizontally connecting to the Mu Yuan’.”

The Damp-Heat epidemic pathogen invades the body rapidly, hence it does not go through the exterior phase but directly hides within the Mu Yuan. The Mu Yuan, also known as the membrane origin, is located between the half-exterior and half-interior, hence the pathogen hiding in the Mu Yuan initially presents with aversion to cold followed by fever, indicating a half-exterior, half-interior condition. Aversion to cold indicates a strong aversion to cold, which is due to the obstruction of Yang Qi by the Damp-Heat epidemic pathogen, preventing it from reaching the surface, leading to abnormal exterior defense. The pathogen lingers, and the righteous Qi rises to expel it, hence the aversion to cold is followed by fever. As the disease progresses, the struggle between the righteous and the evil intensifies, leading to the development of interior Heat symptoms, hence only fever without aversion to cold. The afternoon is the time when the Yangming channel is most active, and during this time, the Yangming channel is abundant in Qi and blood, making it more effective in resisting the pathogen, hence the fever worsens. Headache and body aches are signs of the Damp-Heat epidemic pathogen spreading to the surface, obstructing the channels and muscles, leading to poor circulation of Qi and blood. Chest tightness and abdominal fullness, along with occasional nausea, indicate that the Damp-Heat epidemic pathogen is spreading internally, obstructing the Middle Jiao, leading to the Spleen and Stomach’s failure to control ascending and descending. The white greasy tongue coating indicates the retention of Dampness and the hidden nature of Heat. The wiry rapid pulse indicates the obstruction of Qi and the internal accumulation of Heat.

Treatment Method: Open the Mu Yuan.

Formula: Da Yuan San (Drink) (from “Warm Epidemics”)

Areca 2 qian,Hou Po 1 qian,Grass Fruit 5 fen,Zhi Mu 1 qian,Bai Shao 1 qian,Huang Qin 1 qian,Gan Cao 5 fen.

Use 2 cups of water, boil down to 1 cup, and take warm in the afternoon.

Formula Discussion: In this formula, Areca, Hou Po, and Grass Fruit are combined to use both bitter warming and spicy warming, opening and descending, drying Dampness and moving Qi, thus unblocking the Mu Yuan and expelling the hidden epidemic pathogen. Huang Qin clears Heat and dries Dampness. Zhi Mu clears Heat and nourishes Yin, while Bai Shao harmonizes and nourishes the blood, preventing the drying and harsh effects of Areca, Hou Po, and Grass Fruit. Gan Cao harmonizes the herbs. The combination of these herbs opens the Mu Yuan, expels the pathogen, and does not harm the righteous Qi, belonging to the category of harmonizing methods. In clinical application, the formula can be adjusted according to the symptoms, as Wu Youke states: “If there is pain in the hypochondrium and deafness, with cold and heat, nausea and bitter mouth, this indicates that the evil Heat is overflowing into the Shaoyang channel, and this formula can be supplemented with Bai Hu 1 qian; if there is pain in the waist and back, this indicates that the evil Heat is overflowing into the Taiyang channel, and this formula can be supplemented with Qiang Huo 1 qian; if there is pain in the eyes, brow bone pain, eye socket pain, and dry nose with insomnia, this indicates that the evil Heat is overflowing into the Yangming channel, and this formula can be supplemented with Ge Gen 1 qian.”

Literature Excerpt: “At the onset of a warm epidemic, there is initially aversion to cold followed by fever, and later only fever without aversion to cold. In the first two to three days, the pulse is neither floating nor sinking but rapid, with fever day and night, worsening in the afternoon, headache and body aches. At this time, the pathogen is hidden in the Mu Yuan, behind the intestines; although there is headache and body aches, this evil Heat is floating in the channels, and should not be treated as a surface syndrome, nor should strong sweating be used. If the pathogen is not in the channels, sweating will only harm the defensive Qi, and the Heat will not decrease; it should not be purged either, as the pathogen is not in the interior, and purging will only harm the Stomach Qi, leading to increased thirst; hence Da Yuan San is the main treatment.” (from “Warm Epidemics”)

Notes: This section outlines the clinical manifestations and pathogenesis of the initial stage of Damp-Heat epidemics, distinguishing it from surface syndrome of cold damage. Wu Youke’s analysis is quite thorough, as it cannot be treated with sweating or purging, but rather with harmonizing methods to open the Mu Yuan, establishing Da Yuan San as a new treatment approach for future generations.

7) Post-Recovery Regulation

Clinical Manifestations: Slight chest tightness, hunger without appetite, food that does not taste good, mental fatigue, a thin greasy tongue coating, and a slow pulse.

Pathogenesis Analysis: This syndrome occurs after recovery from Damp-Heat syndrome, where residual pathogens remain, and the Qi of the Spleen and Stomach has not yet recovered, leading to reduced transformation and transportation functions. Slight chest tightness indicates that residual pathogens remain, and Dampness is obstructing the Middle Jiao, leading to Qi stagnation. Hunger without appetite, food that does not taste good, and mental fatigue are due to the insufficient recovery of the Spleen and Stomach Qi, leading to reduced transformation and transportation functions. The thin greasy tongue coating indicates residual Dampness. The slow pulse indicates insufficient Middle Qi.

Treatment Method: Transform Dampness and harmonize the Middle Jiao.

Formula: Bai Zhu Harmonizing Decoction (from “Revised Common Cold Theory”)

Sheng Bai Zhu (Atractylodes) 0.5 qian,Xinhui Pi (Aged Tangerine Peel) 0.5 qian (fried),Jiao Liu Qu (Fermented Barley) 3 qian,Fo Shou Hua (Buddha’s Hand Flower) 0.5 fen,Zhe Fu Ling (Poria) 4 qian,Chun Sha Ren (Cardamom) 1 fen (crushed),Wu Gu Chong (Fly Larva) 3 qian (cleaned),Chen Cang Mi (Rice) 3 qian (wrapped in lotus leaf).

Formula Discussion: In this formula, Bai Zhu strengthens the Spleen and dries Dampness, while Fu Ling strengthens the Spleen and benefits Dampness. The two herbs work together to transform Dampness and harmonize the Middle Jiao. Chen Pi and Fo Shou Hua promote Qi movement and harmonize the Stomach. Jiao Liu Qu and Sha Ren awaken the Stomach and promote digestion. Chen Cang Mi nourishes the Stomach Qi, and wrapping it in lotus leaf enhances its aromatic and Damp-transforming properties. The combination of these herbs works together to transform Dampness, promote digestion, and strengthen the Spleen and harmonize the Stomach, making it an excellent formula for post-recovery regulation of Damp-Heat diseases. As He Xiushan stated in the notes for this formula: “Nourishing without stagnation, dispersing without depleting, this is a good formula for gently warming the Spleen and Stomach, and smoothing the Qi dynamics.” The use of Wu Gu Chong (fly larva) is no longer common in modern practice.

Based on our experience, when clinically applying this formula, it can be adjusted by adding Huo Xiang 3 qian and Pei Lan 3 qian to enhance the aromatic and Damp-transforming effects.

8) Damp-Heat Disease Manifestations

(1) Continuous Blood in Stools, Yang Qi Collapse

Clinical Manifestations: Continuous blood in stools, pale complexion, continuous sweating, cold limbs, and a weak pulse.

Pathogenesis Analysis: This syndrome is often seen in the later stages of Damp-Heat disease in the Middle Jiao, due to excessive blood loss leading to Yang Qi collapse. In Damp-Heat syndrome, the Spleen and Stomach are the centers of the disease. If the Dampness transforms into dryness, it can turn into Warm-Heat disease and penetrate into the blood level. In addition to fever, irritability, and a red tongue, it can also damage the blood vessels of the Large Intestine, forcing blood downward and leading to blood in stools. If blood loss is excessive, it can lead to the collapse of Qi along with the blood, resulting in Yang Qi collapse. The exterior is not nourished, leading to a pale complexion. The collapse of Yang Qi leads to unstable surface Qi, resulting in continuous sweating. Yang Qi does not reach the extremities, leading to cold limbs. The weak pulse indicates the collapse of Yang Qi and the weak movement of Qi and blood. This condition is critical and requires urgent rescue.

Treatment Method: First, use Du Shen Decoction to tonify Qi and stabilize the collapse, and once Yang Qi is restored, follow with Huang Tu Decoction to warm Yang, tonify Yin, and nourish blood to stop bleeding.

Formula:

Du Shen Decoction(from “Ten Medicinal Divine Books”)

Ren Shen (Ginseng)

Huang Tu Decoction(from “Golden Chamber Essentials”)

Gan Cao, Gan Di Huang, Bai Zhu, Fu Zi (processed), and E Jiao, Huang Qin each 2 liang (3 qian each), and half a jin of yellow earth from the stove.

Use 8 sheng of water, boil down to 3 sheng, and take in two warm doses.

Formula Discussion: Due to continuous blood in stools and the collapse of Qi along with blood, it is urgent to tonify Qi and stabilize the collapse; only by preserving Yang Qi can life be sustained. Du Shen Decoction uses only Ginseng, which is powerful in tonifying Qi and stabilizing the collapse. In clinical application, the dosage can be adjusted to 3 to 5 qian for a concentrated decoction. Once Yang Qi is restored, if blood in stools continues, and the complexion is pale, with cold limbs, a pale tongue with little coating, and a weak pulse, indicating Yang deficiency and blood deficiency, Huang Tu Decoction should be used to warm Yang, tonify Yin, and nourish blood to stop bleeding.

In Huang Tu Decoction, “yellow earth” refers to Fu Long Gan, which has the function of warming the Spleen and stopping bleeding. Bai Zhu and Fu Zi warm Yang and strengthen the Spleen. The combination of these three herbs warms and invigorates Spleen Yang. Additionally, Gan Cao helps to tonify Spleen Qi, allowing the Spleen’s Yang Qi to recover, thus regulating blood flow and stopping bleeding. Di Huang and E Jiao nourish Yin and blood. The combination of these herbs works together to warm Yang without being harsh, nourish Yin without harming Yang, achieving the goal of warming Yang, tonifying Yin, and nourishing blood to stop bleeding, making it a good formula that is warm but not harsh, nourishing but not soft.

(2) Excessive Dampness, Yang Deficiency

Clinical Manifestations: Palpitations, dizziness, cold limbs, mental fatigue, limb swelling, difficulty urinating, pale tongue with slippery coating, and a weak pulse.

Pathogenesis Analysis: This syndrome occurs in the later stages of Damp-Heat disease, where Dampness obstructs and injures Yang Qi, transforming into cold, leading to deficiency of Yang Qi in the Heart, Spleen, and Kidney. Yang Qi is weak, unable to transform and transport, leading to excessive water accumulation. Weak Heart Yang leads to water not being controlled, resulting in palpitations. Water rises and obstructs the clear orifices, leading to dizziness. Yang Qi is weak, and the surface Yang is not stable, leading to cold limbs. Yang Qi does not reach the extremities, resulting in cold limbs. Yang deficiency and Qi deficiency lead to mental fatigue. Spleen and Kidney Yang deficiency leads to water accumulation in the skin, resulting in limb swelling. Kidney Yang deficiency leads to impaired Qi transformation, resulting in difficulty urinating. The pale tongue indicates Yang Qi deficiency, and the slippery coating indicates the accumulation of water and Dampness. The weak pulse indicates Yang Qi deficiency and weak movement of Qi and blood.

Treatment Method: Warm Yang and promote water movement.

Formula: Zhen Wu Decoction (from “Treatise on Cold Damage”)

Fu Ling, Bai Shao, Sheng Jiang each 3 liang (3 qian each), Bai Zhu 2 liang (2 qian), and Fu Zi 1 piece (processed, cut into 8 pieces).

Use 8 sheng of water, boil down to 3 sheng, and take 7.5 liang warm.

Formula Discussion: This syndrome is due to the obstruction of Yang Qi by Dampness, leading to Yang deficiency. Hence, the treatment should focus on warming and invigorating Yang Qi to promote water movement. In this formula, Fu Zi is spicy and warm, warming Yang and dispelling cold. Fu Ling strengthens the Spleen and promotes water movement. Bai Zhu strengthens the Spleen and dries Dampness. Sheng Jiang warms and disperses water Dampness. The combination of these herbs warms and invigorates Yang Qi in the Heart, Spleen, and Kidney, promoting water movement. Additionally, Bai Shao nourishes blood and Yin, moderating the harshness of Fu Zi, Bai Zhu, and Sheng Jiang, allowing for warming without being harsh, expelling pathogens without harming the righteous Qi.

Copyright Statement

• This article is excerpted from the Complete Works of Zhao Shaoqin

• Author/Zhao Shaoqin. Compiled by Zhao Shaoqin Research Studio

• Copyright belongs to the relevant rights holders. If there are any improper uses, please feel free to contact us.

• If you like the works of Zhao Shaoqin, please support by purchasing genuine books.

I Submission Email: 150085803@qq.com

Series on “Warm Diseases”【Click the text to read directly】:

Introduction to Warm Disease	Etiology, Pathogenesis, and Treatment of Warm Diseases
Overview of Warm-Heat Diseases	Classification and Differentiation of Warm Diseases
Warm-Heat Disease – Wei Level Treatment	Formation and Development of Warm Disease Theory
Warm-Heat Disease – Qi Level Treatment (1)	Warm-Heat Disease – Ying Level Treatment (1)
Warm-Heat Disease – Qi Level Treatment (2)	Warm-Heat Disease – Ying Level Treatment (2)
Warm-Heat Disease – Qi Level Treatment (3)	Warm-Heat Disease – Ying Level Treatment (3)
Warm-Heat Disease – Qi Level Treatment (4)	Warm-Heat Disease – Blood Level Treatment (1)
Warm-Heat Disease – Qi Level Treatment (5)	Warm-Heat Disease – Blood Level Treatment (2)
Warm-Heat Disease – Qi Level Treatment (6)	Warm-Heat Disease – Blood Level Treatment (3)
Overview of Damp-Heat Diseases	Warm-Heat Disease – Blood Level Treatment (4)
Treatment of Damp-Heat in the Upper Jiao (1)
Treatment of Damp-Heat in the Upper Jiao (2)