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

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

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

2. Equal Presence of Damp and Heat

1) Damp-Heat Obstruction

【Clinical Manifestations】 Fever, irritability, chest and epigastric fullness, nausea and vomiting, loose stools that are yellow and foul-smelling, yellow greasy tongue coating, and a slippery rapid pulse.

【Pathophysiological Analysis】 This syndrome is characterized by an equal presence of dampness and heat, obstructing the middle jiao, leading to dysfunction of the spleen and stomach. Damp-heat steaming internally causes fever. Heat disturbs the mind, resulting in irritability. The accumulation of damp-heat obstructs the qi mechanism, leading to chest and epigastric fullness. The symptoms of fever, irritability, and fullness in the chest and epigastrium are indicative of the equal presence of damp and heat. If dampness is heavier than heat, the fever may not be pronounced, and the mind may be dull rather than irritable; if heat is excessive without dampness, there will be no fullness in the chest and epigastrium. The equal presence of damp and heat obstructs the middle jiao, resulting in both fever and irritability, as well as fullness in the chest and epigastrium. Damp-heat obstructing the middle jiao leads to dysfunction of the spleen and stomach, causing the stomach to fail to descend turbid substances, resulting in nausea and vomiting; if the spleen fails to transport dampness, damp-heat descends to the large intestine, leading to yellow foul-smelling diarrhea. The greasy tongue coating and slippery pulse indicate dampness retained internally; the yellow tongue coating and rapid pulse indicate heat excess internally.

【Treatment Method】 Dry dampness and clear heat.

【Formula】 Lian Pi Yin (from “Revised Treatise on Cholera”)

Prepared Hou Po (Magnolia Bark) 6g, Chuan Lian (Coptis) (stir-fried with ginger juice) 3g, Shi Chang Pu (Acorus) 3g, Ban Xia (Pinellia) 3g, Xiang Dou Chi (Fermented Soybean) 9g, Jiao Zhi Zi (Gardenia) 9g, Lu Gen (Reed Root) 60g

Decoct in water and take warm.

【Formula Discussion】 This syndrome is characterized by an equal presence of damp and heat, and treatment should focus on clearing heat and drying dampness simultaneously. In the formula, Huang Lian and Zhi Zi are bitter and cold, clearing heat, draining fire, and drying dampness. The combination of Hou Po, Ban Xia, and Shi Chang Pu employs both bitter-warm and spicy-warm herbs, which open and drain, dry dampness, and transform turbidity. Ban Xia also has the function of harmonizing the stomach, descending rebellious qi, and stopping vomiting. Dou Chi disperses stagnation and clears heat. Lu Gen clears heat and generates fluids. The combination of these herbs creates an excellent formula for drying dampness and clearing heat.

【Case Study】

Example 1: Damp-Heat (Equal Presence of Damp and Heat)

Patient Zhang, female, 43 years old, initial diagnosis on September 4, 1939

Headache with chills, fever, cough with itchy throat, yellow greasy tongue coating, thirst with desire to drink, fullness in the chest and epigastrium, slippery rapid pulse, cold legs, constipation with difficulty in defecation. The damp-heat has persisted for over four weeks, with excessive accumulation of summer dampness, proposing to use aromatic herbs to disperse it. The evil is strong while the righteous qi is weak, and there is concern about reverse transmission causing changes; dietary temperature should be carefully managed.

Xiang Dou Chi 12g, Jiao Shan Zhi 4.5g, Qian Hu 3g, Bai Ji Li 10g, Fresh Loquat Leaf 10g, Jin Fei Cao 4.5g, Ban Xia 10g, Powdered Licorice 4.5g, Prepared Hou Po 4.5g, Chuan Lian 2g, Jiao Yi Mi 10g, Bai Dou Kou 4.5g, Chen Pi 6g, Chi Ling 10g

Two doses.

Second Diagnosis on September 6, 1939

Chills and fever gradually reduced, headache and dizziness, cough with phlegm like foam, legs have warmed, thirst has also decreased, the middle jiao is active, pressing it causes pain, tongue coating white and slippery, pulse soft and slippery, pressing it reveals a rapid pulse. Damp-heat accumulation in the Yangming channel, further dispersing and transforming is needed; although there is slight improvement, it is still insufficient.

Xiang Dou Chi 12g, Jiao Shan Zhi 4.5g, Qian Hu 3g, Bai Ji Li 10g, Fresh Loquat Leaf 10g, Bitter Apricot 10g, Ban Xia 10g, Prepared Hou Po 4.5g, Chuan Lian 2g, Su Zi 4.5g, Bai Dou Kou 4.5g, Chen Pi 3g, Da Fu Pi 10g, Si Gua Luo 10g, Jiao Yi Mi 10g

One dose.

Third Diagnosis on September 7, 1939

Chills and fever reduced, headache also eased, cough with phlegm like foam, the middle jiao is active, tongue coating white and greasy, thirst without taste, appetite is still good, the two pulses are rapid and slippery. The severe damp-heat syndrome has persisted for over four weeks, the body is thin and weak, but the spirit is still strong, proposing to further disperse and transform the upper and middle jiao, differentiating damp and heat; the condition is real but the righteous qi is weak, dietary temperature should be carefully managed.

Bai Ji Li 10g, Xiang Dou Chi 12g, Jiao Shan Zhi 4.5g, Qian Hu 3g, Xiang Qing Hao 4.5g, Prepared Hou Po 4.5g, Chuan Lian 2g, Jiao Yi Mi 10g, Hua Bing Lang 10g, Lai Fu Zi 10g, Ban Xia 10g, Chi Ling Pi 12g, Bai Dou Kou 3g, Bai Mi 30g (stir-fried)

Decoct in water for two doses.

Fourth Diagnosis on September 9, 1939

Fever has subsided but the head still feels slightly painful, bowel movements are frequent and smooth, cough with much phlegm, the middle jiao is no longer active, tongue coating white and greasy, thirst without taste, both pulses are harmonious and energetic. The damp-heat has just begun to resolve, but the damp-heat in the stomach has not yet cleared; further dispersing the remaining evil and harmonizing the Yangming is necessary. Although the condition is improving, the righteous qi is greatly depleted, leading to weakness; dietary temperature should be carefully managed.

Bai Ji Li 10g, Xiang Qing Hao 4.5g, Powdered Dan Pi 4.5g, Prepared Hou Po 4.5g, Chuan Lian 2g, Fresh Loquat Leaf 10g, Su Zi 4.5g, Chuan Bei Mu 10g, Bitter Apricot 10g, Stir-fried Yi Mi 10g, Fu Zhi Pi 3g, Xiang Sha Zhi Shu Wan 15g (wrapped in cloth), Fan Zhi Qu 12g, Xin Hui Pi 6g, Bai Mi 30g (stir-fried)

Decoct in water for two doses.

Fifth Diagnosis on October 6, 1936

Frequent bowel movements, smooth and abundant, with a strong foul smell, fever gradually subsiding, tears during crying, tongue coating yellow and thick, thus adding Chuan Jun Tan 4.5g to the original formula for two doses.

Sixth Diagnosis on December 10, 1936

Fever has subsided, cough with much phlegm, severe nausea, tongue coating white, irritability, feeling fatigued and weak, both pulses are thin and slippery, pressing reveals a slightly rapid pulse. Although the condition is improving, residual heat has not cleared; further clearing and descending the lung and stomach is necessary, dietary temperature should be carefully managed.

Fresh Purple Aster 3g, Family Su Zi 4.5g, Lai Fu Zi 6g, Chuan Bei Mu 6g, Fresh Loquat Leaf 10g, Bao He Wan 15g (wrapped in cloth), Prepared Ban Xia 10g, Fo Shou 6g, Prepared Hou Po 4.5g, Chuan Lian 2g, Ginger Bamboo 6g, Xin Hui Pi 4.5g, Bitter Platycodon 3g, Small Zhi Ke 4.5g, Fresh Hai Shi 15g

Two doses.

【Note】 The late onset of summer heat, whether in late summer or autumn, indicates that the summer heat and dampness have accumulated internally, leading to illness after the autumn cold. This indicates that the body was still healthy at the time, and the pathogenic factors could not manifest until conditions were right. Treatment methods should also be based on the current damp-heat and any accompanying stagnation or food retention. However, the primary focus should still be on aromatic dispersal and the elimination of dampness. If there is cold dampness or food stagnation that cannot be transformed, treatment should be adjusted according to the pulse, tongue, and symptoms.

2) Damp-Heat with Phlegm, Obstructing the Heart Below

【Clinical Manifestations】 Fever, dry mouth, thirst without desire to drink, fullness below the heart, soft and non-painful upon pressing, poor appetite, food intake is unsatisfactory, occasional nausea and vomiting, constipation for several days, red tongue with white greasy coating, slippery rapid pulse.

【Pathophysiological Analysis】 This syndrome often occurs in summer, characterized by the accumulation of damp-heat and phlegm below the heart. In summer, heat is intense and rain is abundant, leading to the invasion of damp-heat, which harms the spleen and stomach. The spleen loses its ability to transport and transform, and the stomach loses its ability to harmonize and descend, resulting in the internal retention of dampness, which generates heat. The interaction of damp and heat leads to the generation of phlegm. The internal retention of damp-heat and phlegm results in fever. Dampness obstructs the qi mechanism, leading to poor transformation, and fluids do not ascend, resulting in dry mouth and thirst; however, due to the internal retention of damp phlegm, the patient does not desire to drink despite thirst. Damp-heat obstructing the stomach leads to fullness below the heart and poor appetite. Rebellious stomach qi leads to occasional nausea and vomiting. Dampness obstructs the qi mechanism, leading to constipation. The white greasy coating indicates phlegm-dampness, while the red tongue indicates heat accumulation. The slippery pulse indicates phlegm, while the rapid pulse indicates heat.

The fullness below the heart and constipation for several days are caused by the obstruction of qi by damp-heat and phlegm, and are not due to the dryness and heat of the Yangming bowel syndrome. The fullness is located below the heart and not in the abdomen, and pressing it is soft and non-painful. Although the patient has not had a bowel movement for several days, it is not dry and hard, which distinguishes it from the dryness and constipation of the Yangming bowel syndrome, and the two should not be confused.

【Treatment Method】 Dry dampness, clear heat, transform phlegm, and move qi.

【Formula】 Ban Xia Xie Xin Tang (remove dried ginger and licorice, add Zhi Shi and Xing Ren) (from “Differentiation of Warm Diseases”)

Ban Xia 30g, Huang Lian 6g, Huang Qin 9g, Zhi Shi 6g, Xing Ren 9g

Use 8 cups of water, boil down to 3 cups, divide into three doses; for those with deficiency, add Ren Shen 6g and Da Zao 3 pieces.

【Formula Discussion】 This formula is derived from the Ban Xia Xie Xin Tang in “Shang Han Lun”. The original Ban Xia Xie Xin Tang treats external cold pathogens, where the Taiyang disease has not resolved, and improper purging damages the spleen and stomach, leading to the external pathogen penetrating internally, causing dysfunction of the spleen and stomach and qi stagnation in the middle jiao, resulting in fullness below the heart. This syndrome is caused by the external damp-heat pathogen, with damp-heat and phlegm obstructing below the heart. Since it is not a deficiency syndrome caused by improper purging, and there is internal accumulation of damp-heat and phlegm, the warming and tonifying herbs Ren Shen, Licorice, Da Zao, and the warming Ginger are removed. The formula emphasizes the use of the spicy and bitter Ban Xia to dry dampness, transform phlegm, harmonize the stomach, and descend rebellious qi, eliminating the turbidity from the middle jiao and stopping nausea and vomiting. Huang Qin and Huang Lian are bitter and cold, clearing heat and drying dampness, and when used together with Ban Xia, they open and descend, eliminating damp-heat and phlegm. Zhi Shi is bitter and cold, moving qi and breaking stagnation, allowing qi to flow and dampness to move, enhancing the ability to expel phlegm. Xing Ren is used to descend lung qi and clear the upper source. The combination of these herbs works together to dry dampness, clear heat, transform phlegm, and move qi. Wu Ju Tong provides a detailed analysis of this formula, stating: “Using Ban Xia and Zhi Shi to open the dampness in the qi aspect, Huang Lian and Huang Qin to open the heat in the qi aspect, and Xing Ren to open the lung and large intestine qi obstruction. In the summer heat, the heat is intense, so dried ginger is removed. It is not a deficiency syndrome caused by improper purging, so Ren Shen, Licorice, Da Zao are removed, as they may assist dampness and cause fullness.” (from “Differentiation of Warm Diseases”)

【Literature Selection】

“In Yangming summer heat, with a slippery rapid pulse, no appetite, no hunger, and no bowel movements, phlegm and turbidity accumulate, leading to fullness below the heart, Ban Xia Xie Xin Tang (remove Ren Shen, Ginger, Da Zao, and Licorice, add Zhi Shi and Xing Ren) is the main treatment.” (from “Differentiation of Warm Diseases”)

【Note】 The combination of “Yangming summer heat” and “phlegm and turbidity accumulation” indicates that the summer heat pathogen, combined with dampness and phlegm, invades the middle jiao. The “slippery rapid pulse” indicates internal phlegm-heat accumulation. The accumulation of damp-heat and phlegm in the stomach leads to the loss of the stomach’s ability to receive and transform, and the spleen’s ability to transport and transform, affecting digestion and transformation, hence the symptoms of “no appetite, no hunger, and no bowel movements.” When damp-heat and phlegm accumulate in the stomach, it leads to “fullness below the heart.” The treatment uses the method of opening with spicy and descending with bitter herbs to relieve the accumulation of dampness and phlegm; using bitter and cold herbs to clear heat and dry dampness, allowing the evil to be expelled, thus resolving the fullness below the heart.

3) Diffuse Damp-Heat

【Clinical Manifestations】 Tidal fever with sweating, irritability, thirst, chest and epigastric fullness, nausea and vomiting, loose stools, and scanty yellow urine, gray tongue coating, and slippery rapid pulse.

【Pathophysiological Analysis】 This syndrome is characterized by an equal presence of damp and heat, centered on the spleen and stomach, diffusing through the upper, middle, and lower jiao. Damp-heat steaming leads to fever. In the afternoon, the Yangming channel’s qi is active, and the righteous qi rises to expel the evil, causing the heat to increase in the afternoon, resulting in tidal fever. Heat steams dampness, leading to sweating. Heat disturbs the mind, causing irritability. Heat damages fluids, leading to thirst and scanty yellow urine. Chest and epigastric fullness is caused by dampness obstructing the qi mechanism. Nausea and vomiting, as well as loose stools, are due to dampness obstructing the middle jiao, leading to dysfunction of the spleen and stomach. The gray tongue coating and slippery rapid pulse indicate internal damp-heat excess. Tidal fever with sweating, irritability, and thirst are caused by heat evil; chest and epigastric fullness, nausea, and loose stools are caused by damp evil, hence this syndrome is characterized by an equal presence of damp and heat. Chest tightness and irritability indicate a problem in the upper jiao; epigastric fullness, nausea, and loose stools indicate a problem in the middle jiao; scanty yellow urine indicates a problem in the lower jiao, hence this syndrome is characterized by diffuse damp-heat in the three jiao.

【Treatment Method】 Clear and transform damp-heat in the three jiao.

【Formula】 Xing Ren Hua Shi Tang (from “Differentiation of Warm Diseases”)

Xing Ren 9g, Hua Shi 9g, Huang Qin 6g, Ju Hong 4.5g, Huang Lian 3g, Yu Jin 6g, Tong Cao 3g, Hou Po 6g, Ban Xia 9g

Use 8 cups of water, boil down to 3 cups, divide into three doses.

【Formula Discussion】 This syndrome is characterized by an equal presence of damp and heat, diffusing through the three jiao, and treatment should focus on clearing and transforming damp-heat in the three jiao. In the formula, Xing Ren enters the upper jiao, descending lung qi to regulate the water pathways. Yu Jin is paired with Xing Ren to promote the qi mechanism. Huang Qin and Huang Lian enter the upper and middle jiao, clearing heat and drying dampness. Ju Hong, Ban Xia, and Hou Po work together to open and drain, dry dampness, and move qi to eliminate dampness from the middle jiao. Xing Ren and Tong Cao clear and benefit damp-heat, facilitating the smooth flow of the three jiao. The combination of these herbs allows the damp-heat evil in the three jiao to be dispersed and eliminated.

【Literature Selection】

“In summer heat, with damp-heat invading the three jiao, gray tongue coating, chest fullness, tidal fever, nausea, thirst with frequent urination, sweating, and scanty urine, Xing Ren Hua Shi Tang is the main treatment.” (from “Differentiation of Warm Diseases”)

【Note】 This section discusses the treatment of diffuse damp-heat in the three jiao. The phrase “summer heat” indicates that this syndrome is caused by the invasion of summer damp-heat. Summer is characterized by extreme heat and abundant dampness, which can lead to the development of damp-heat syndrome. The clinical manifestations of damp-heat being equal indicate that the treatment should focus on clearing and transforming damp-heat in the three jiao.

4) Damp-Heat Adhesion

【Clinical Manifestations】 Fever, body aches, sweating with reduced heat, followed by a resurgence of heat, thirst without much desire to drink, or even no thirst, chest and epigastric fullness, loose stools that are not satisfactory, pale yellow greasy tongue coating, and a slippery slow pulse.

【Pathophysiological Analysis】 This syndrome is characterized by damp-heat binding in the middle jiao, leading to difficult resolution. Fever is caused by the steaming of damp-heat. Body aches are due to dampness obstructing the muscles and meridians, leading to poor circulation of qi and blood. Heat steaming dampness can cause sweating, and the heat evil can be expelled through sweating, leading to reduced heat. However, dampness is sticky and cannot be expelled with a single sweat, and heat trapped in dampness cannot be cleared unless dampness is expelled. Therefore, the heat can resurge. When heat is excessive, it leads to thirst, but due to the internal retention of dampness, the patient may not desire to drink much or may not feel thirsty at all. Dampness obstructs the qi mechanism, leading to chest and epigastric fullness. Damp-heat descending to the large intestine can cause loose stools, but damp-heat adhesion makes it difficult to pass, leading to unsatisfactory bowel movements.

【Treatment Method】 Clear and transform damp-heat.

【Formula】 Huang Qin Hua Shi Tang (from “Differentiation of Warm Diseases”)

Huang Qin 9g, Hua Shi 9g, Fu Ling Pi 9g, Da Fu Pi 6g, Bai Dou Kou 3g, Tong Cao 3g, Zhu Ling 9g

Use 6 cups of water, boil down to 2 cups, and divide into three warm doses.

【Formula Discussion】 In this formula, Huang Qin clears heat and dries dampness. Hua Shi clears heat and benefits dampness. Fu Ling Pi, Tong Cao, and Zhu Ling promote dampness and benefit the body. Da Fu Pi dries dampness and moves qi, allowing qi to flow and dampness to be expelled. Bai Dou Kou is spicy and warm, awakening the spleen and stomach, and relieving dampness. The combination of these herbs works together to clear damp-heat, promote qi flow, and relieve damp-heat adhesion.

【Literature Selection】

“With a slow pulse, body aches, pale yellow and greasy tongue coating, thirst without much desire to drink, or even no thirst, sweating with reduced heat, followed by a resurgence of heat, and internal inability to transport dampness, while externally feeling the seasonal dampness, both methods cannot be applied; misdiagnosing as cold damage will worsen the condition. Simply clearing heat will not resolve dampness, and simply expelling dampness will exacerbate heat; Huang Qin Hua Shi Tang is the main treatment.” (from “Differentiation of Warm Diseases”)

【Note】 This section discusses the treatment of damp-heat adhesion syndrome. The phrase “slow pulse, body aches, pale yellow and greasy tongue coating, thirst without much desire to drink, or even no thirst, sweating with reduced heat, followed by a resurgence of heat” indicates damp-heat binding, which is difficult to resolve. The cause of the disease is the inability to transport dampness internally, while externally feeling the seasonal dampness. When both internal and external dampness obstruct the body, the qi mechanism is not smooth, leading to the generation of heat. The heat is trapped in dampness, leading to damp-heat adhesion. The treatment should focus on Huang Qin Hua Shi Tang to clear damp-heat and promote qi flow.

5) Damp-Heat Filth and Stagnation

【Clinical Manifestations】 Fever, fatigue, heavy head and dizziness, limbs feeling heavy, and even body aches, chest fullness and abdominal distension, frequent vomiting and diarrhea, scanty red urine, yellow greasy tongue coating, and slippery rapid pulse.

【Pathophysiological Analysis】 This syndrome is caused by the invasion of damp-heat evil or damp-heat epidemic evil, which accumulates in the middle jiao, obstructing the qi mechanism, leading to an equal presence of damp and heat, resulting in stagnation and steaming. The accumulation of damp-heat leads to fever. Damp-heat damages qi, leading to fatigue and weakness. A heavy head and dizziness indicate that damp-heat is clouding the clear orifices. Heavy limbs and even body aches indicate that damp-heat is obstructing the skin, leading to stagnation of qi and blood. Dampness obstructs the qi mechanism, leading to chest fullness and abdominal distension. Dampness obstructs the spleen and stomach, leading to vomiting and diarrhea, with heat forcing frequent vomiting and diarrhea. Heat damages fluids, leading to scanty red urine. The yellow greasy tongue coating and slippery rapid pulse indicate damp-heat excess.

【Treatment Method】 Transform dampness, dispel filth, clear heat, and detoxify.

【Formula】 Gan Lu Xiao Du Dan (from “Warm and Heat Classics”)

Fei Hua Shi 450g, Mian Yin Chen 330g, Dan Huang Qin 300g, Shi Chang Pu 180g, Chuan Bei Mu 150g, Mu Tong 150g, Huo Xiang 120g, She Gan 120g, Lian Qiao 120g, Bo He 120g, Bai Dou Kou 120g

All herbs should be dried and finely ground. When exposed to fire, the medicinal properties change to heat. Each dose is 9g, mixed with hot water for administration, twice daily. Alternatively, they can be made into pills the size of a marble, dissolved in hot water for administration (modern practice often uses decoction).

【Formula Discussion】 In this formula, Huang Qin clears heat and dries dampness. Lian Qiao and She Gan clear heat and detoxify. Yin Chen, Hua Shi, and Mu Tong clear and benefit damp-heat. Huo Xiang, Shi Chang Pu, and Bai Dou Kou are all aromatic herbs that transform dampness and dispel filth. The accumulation of damp-heat can easily lead to phlegm and turbidity, so Chuan Bei Mu is used to clear and transform heat-phlegm. Bo He paired with Lian Qiao lightly clears and disperses, promoting the qi mechanism and allowing the heat evil to be expelled. The combination of these herbs works together to transform dampness, dispel filth, clear heat, and detoxify, effectively treating the damp-heat filth and stagnation syndrome.

【Literature Selection】

“Fever, fatigue, chest fullness and abdominal distension, heavy limbs, and dizziness, with yellow greasy tongue coating, scanty red urine, frequent vomiting and diarrhea, and other symptoms. If the patient’s tongue coating is pale white, thick greasy, or dry yellow, this indicates that the damp-heat epidemic evil is still in the qi aspect; all of these can be treated effectively with this pill, and it is also indicated for diseases caused by poor water and soil.” (from “Warm and Heat Classics”)

【Note】 This section discusses the clinical manifestations and treatment methods for damp-heat evil or damp-heat epidemic evil. Overall, the syndrome is characterized by damp-heat filth and stagnation, leading to obstruction and steaming, hence the use of Gan Lu Xiao Du Dan to transform dampness, dispel filth, clear heat, and detoxify.

6) Damp-Heat Stagnation, Qi Stagnation in the Three Jiao

【Clinical Manifestations】 Alternating chills and fever, dizziness, fullness in the epigastrium and abdominal distension, occasional nausea and vomiting, difficulty urinating, yellow greasy tongue coating, and slippery pulse.

【Pathophysiological Analysis】 This syndrome is characterized by damp-heat evil centered on the spleen and stomach, obstructing the three jiao, leading to qi stagnation. Damp-heat stagnation prevents lung qi from dispersing, and the defensive qi cannot be expressed externally, leading to chills; when the yang qi is obstructed, it rises to fight against the evil, resulting in fever, hence the alternating chills and fever. Damp-heat steams upward, clouding the clear orifices, leading to dizziness. Damp-heat obstructs the qi mechanism, causing fullness in the epigastrium and abdominal distension. Damp-heat invades the stomach, leading to dysfunction and rebellious qi, resulting in nausea and vomiting. Dampness obstructs the three jiao, leading to poor urination. The yellow greasy tongue coating indicates damp-heat accumulation, while the slippery pulse indicates dampness retention.

【Treatment Method】 Disperse damp-heat and promote qi flow.

【Formula】 Qin Lian Er Chen Tang (from “Revised Common Cold Treatise”)

Qing Zi Qin 6g, Xian Ban Xia 4.5g, Dan Zhu Ru 6g, Chi Fu Ling 9g, Xiao Chuan Lian 1.5g, Xin Hui Pi 4.5g, Bi Yu San 9g (wrapped in cloth), fresh ginger juice 2 drops, Dan Zhu Li 2 cups (mix well and take)

【Formula Discussion】 This formula is derived from the modified Wen Dan Tang. The formula includes Huang Qin and Huang Lian to clear heat and dry dampness, addressing the damp-heat in the upper and middle jiao. The addition of Zhu Li enhances the ability of Qin and Lian to clear damp-heat. Ban Xia paired with Chen Pi promotes qi flow and dries dampness, harmonizing the stomach and stopping nausea, eliminating dampness from the middle jiao. Ginger juice assists Ban Xia in harmonizing the stomach and stopping nausea. Bi Yu San consists of Hua Shi, Gan Cao, and Qing Dai, which clear and benefit the lower jiao, guiding damp-heat out through urination, enhancing the ability to strengthen the spleen and promote dampness. The combination of these herbs works together to clear heat, transform dampness, and promote qi flow, allowing the damp-heat stagnation in the three jiao to be dispersed and eliminated.

【Literature Selection】

“In cases of alternating chills and fever, with dizziness, fullness in the epigastrium and abdominal distension, occasional nausea and vomiting, and difficulty urinating, the yellow greasy tongue coating and slippery pulse indicate damp-heat stagnation in the three jiao; Qin Lian Er Chen Tang is the main treatment.” (from “Revised Common Cold Treatise”)

【Note】 This section discusses the treatment of damp-heat stagnation in the three jiao, with the phrase “alternating chills and fever” indicating that the treatment should focus on dispersing damp-heat and promoting qi flow. The combination of Qin Lian Er Chen Tang is suitable for treating this syndrome.

7) Damp-Heat Bi Pain

【Clinical Manifestations】 High fever with chills, pale yellow and dull complexion, joint swelling and pain, gray or yellow greasy tongue coating, and slippery rapid pulse.

【Pathophysiological Analysis】 This syndrome is characterized by damp-heat evil obstructing the joints and meridians, leading to damp-heat bi pain. High fever with chills is caused by damp-heat obstruction, with the righteous qi rising to expel the evil, leading to a battle between the righteous and the evil. High fever with a pale yellow complexion indicates that heat is trapped in dampness, leading to damp-heat rising and clouding the complexion. Damp-heat obstructs the joints and meridians, leading to stagnation of qi and blood, resulting in joint swelling and pain. The gray or yellow greasy tongue coating and slippery rapid pulse indicate internal damp-heat retention.

【Treatment Method】 Clear and transform damp-heat, relieve bi pain.

【Formula】 Xuan Bi Tang (from “Differentiation of Warm Diseases”)

Fang Ji 15g, Xing Ren 15g, Hua Shi 15g, Lian Qiao 9g, Shan Zhi 9g, Yi Yi Ren 15g, Ban Xia (stir-fried with vinegar) 9g, Wan Can Sha 9g, Chi Xiao Dou Pi 9g

Use 8 cups of water, boil down to 3 cups, divide into three doses. If pain is severe, add Jiang Huang 6g and Hai Tong Pi 9g.

【Formula Discussion】 In this formula, Fang Ji is bitter and cold, dispelling dampness and clearing heat, promoting joint mobility and relieving bi pain. Xing Ren enters the upper jiao, descending lung qi and regulating the water pathways. Hua Shi clears heat and benefits dampness, while the two herbs work together to promote qi flow and allow damp-heat to be expelled. Shan Zhi clears heat and promotes the three jiao, guiding damp-heat out through urination. Yi Yi Ren strengthens the spleen and clears dampness in the meridians. Chi Xiao Dou Pi promotes the flow of dampness in the meridians, allowing for the resolution of bi pain. Ban Xia and Wan Can Sha work together to open and transform dampness. The combination of these herbs works together to clear damp-heat, promote joint mobility, and relieve bi pain.

【Literature Selection】

“Dampness accumulates and steams, obstructing the meridians, leading to chills and fever, joint pain, gray tongue coating, and pale yellow complexion; this is called damp bi, and Xuan Bi Tang is the main treatment.” (from “Differentiation of Warm Diseases”)

【Note】 The phrase “dampness accumulates and steams, obstructing the meridians” indicates that the cause of joint pain is due to damp-heat accumulation. Wu Ju Tong named this syndrome “damp bi,” which may not be entirely accurate, as the bi pain is caused by “dampness accumulation and steaming,” hence it should be referred to as “damp-heat bi pain.”

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“Warm Disease Overview” Series【Click the text to read directly】:

Introduction to Warm Disease	Causes, Mechanisms, and Treatment of Warm Disease
Overview of Warm Diseases	Classification and Differentiation of Warm Diseases
Warm Disease – Wei Aspect Treatment	Formation and Development of Warm Disease Theory
Warm Disease – Qi Aspect Treatment (I)	Warm Disease – Ying Aspect Treatment (I)
Warm Disease – Qi Aspect Treatment (II)	Warm Disease – Ying Aspect Treatment (II)
Warm Disease – Qi Aspect Treatment (III)	Warm Disease – Ying Aspect Treatment (III)
Warm Disease – Qi Aspect Treatment (IV)	Warm Disease – Blood Aspect Treatment (I)
Warm Disease – Qi Aspect Treatment (V)	Warm Disease – Blood Aspect Treatment (II)
Warm Disease – Qi Aspect Treatment (VI)	Warm Disease – Blood Aspect Treatment (III)
Overview of Damp-Heat Diseases	Warm Disease – Blood Aspect Treatment (IV)
Upper Jiao Damp-Heat Treatment (I)
Upper Jiao Damp-Heat Treatment (II)
Middle Jiao Damp-Heat Treatment (I)