Spleen-Stomach Damp-Heat Syndrome: Treatment Insights and Medication Experience▲Yang Chunbo, Master of Traditional Chinese MedicineSpleen-Stomach Damp-Heat Syndrome is a common clinical condition characterized by excess in the spleen and stomach. With the warming of the Earth’s climate, improvements in living standards, changes in dietary structure, and the abuse of medications, this syndrome has been on the rise. It can manifest in many diseases across various systems, closely related to digestive system disorders. Due to the particularity of its pathogenic factors, clinical diagnosis and treatment can be challenging.Professor Yang Chunbo is a guiding teacher for the second and fourth batches of national academic experience inheritance of old Chinese medicine experts, honorary president of the Second People’s Hospital of Fujian University of Traditional Chinese Medicine, and a leading academic figure in the field of spleen and stomach diseases in Fujian Province.In 1992, he was the first in the country to research Spleen-Stomach Damp-Heat Syndrome and its related diseases, accumulating rich clinical experience that holds significant guiding value. Below is a summary of his insights on the diagnosis and treatment of Spleen-Stomach Damp-Heat Syndrome.Understanding of Etiology and PathogenesisEtiologyExternal Factors:Damp-heat pathogenic qi, climate, environment, and various insects.Internal Factors:Irregular diet, excessive thinking, overwork, or inherent weakness of the spleen and stomach.PathogenesisThe disease is located in the spleen and stomach, as the spleen governs dampness (yin organ) and the stomach governs dryness (yang organ). “Damp-heat evil, although initially received externally, ultimately returns to the spleen and stomach,” due to the principle of “similarities attract” (Qing Dynasty, Zhang Xugu). Internal injuries from diet or inherent weakness of the spleen and stomach can lead to dysfunction and the generation of damp-heat.The pathology contains both yin and yang aspects, which can present as equal damp-heat, or with a predominance of dampness or heat.Dampness often stagnates qi, which can lead to collateral damage over time. Since dampness is a yin evil, it easily stagnates qi; qi is the commander of blood, and prolonged stagnation can lead to blood stasis.Dampness can transform. Due to the body’s abundant yang qi, it can become overly hot, while excessive yin can lead to increased dampness, which can also transform into heat, cold, or even consume qi, damage yang, harm yin, and deplete blood.Damp-heat can ascend, spread laterally, or descend. When damp-heat occupies the middle jiao, it can ascend to disturb the orifices, cloud the spirit, and affect the lungs; spread to the liver, gallbladder, tendons, and skin; or descend to the bladder, genitalia, and uterus.Clinical CharacteristicsGradual OnsetThe course of the disease or latent period is relatively long, presenting progressively.Complex SymptomsSymptoms may include hunger without desire to eat, thirst without preference for drinking, fever with a slow pulse, loose stools that are not smooth, or initially dry then loose, with a greasy yellow tongue coating, reflecting the dual nature of yin and yang.Chronic and recurrent, it often recurs and relapses.Diagnostic CriteriaBased on a clinical survey of 400 cases, Yang Chunbo revised the diagnostic criteria for this syndrome.Main Symptoms:① Yellow greasy tongue coating; ② Distension and fullness in the epigastrium; ③ Poor appetite; ④ Loose stools or mucus-like stools.Secondary Symptoms:① Light yellow or yellow urine; ② Bitter and sticky mouth, preference for warm drinks; ③ Burning sensation in the epigastrium or acid reflux; ④ Urgency or heaviness after defecation; ⑤ Fever; ⑥ Pale red or red tongue; ⑦ Slippery or wiry slow pulse.Predominance:① Predominantly heat: red tongue, yellow greasy dry coating, rapid pulse, thirst with a preference for cool drinks, yellow urine, dry or mucus-blood-like stools. ② Predominantly damp: pale red or pale tongue, white greasy coating with yellow, slow pulse, bitter and bland mouth, clear urine, loose or watery stools.Confirmation:Main symptom ① is essential, plus one main symptom and one secondary symptom. For predominant judgment: the tongue manifestation is essential, plus two symptoms.Treatment Approach and MedicationTreatment ApproachImplement Five Integrations, Comprehensive Treatment The Five Integrations refer to the integration of disease and syndrome, overall and local, macro and micro, function and structure, and the body and environment. The disease includes the main disease and coexisting diseases. A comprehensive understanding, clarifying priorities, forming a holistic view, and determining treatment direction are essential.Spleen and Stomach as the Focus, Do Not Forget Other Organs The Spleen-Stomach Damp-Heat Syndrome is located in the spleen and stomach, which is naturally the focus of treatment. It is crucial to regulate the spleen and stomach’s ability to transform and transport, and to ascend clear and descend turbid, while not neglecting the relationship between the spleen and stomach and other organs, primarily the liver, gallbladder, and intestines, followed by the heart, lungs, and also the kidneys, bladder, and uterus.Distinguish Between Excess and Deficiency to Determine Treatment Damp-heat syndrome is certainly an excess syndrome, and should be treated with purging methods, but there may also be concurrent qi deficiency, blood weakness, yang decline, yin deficiency, etc. Additionally, due to spleen deficiency leading to dysfunction, causing dampness to obstruct heat, it is necessary to distinguish priorities and urgency, and to determine whether to first purge, first tonify, or use a combination of both.Clearing and Transforming as the General Principle, Yet Distinguish Predominance Clearing heat and dispelling dampness is the general principle for treating Spleen-Stomach Damp-Heat Syndrome, but clinically there are different presentations of equal damp-heat, predominant dampness, or predominant heat, which should be carefully distinguished for treatment.Micro and Local Changes, Understanding Through TCM Theory For micro and local pathological changes, understanding through TCM theory is necessary, then combining with macro and overall differentiation to determine treatment methods and medications.Promote Comprehensive Methods, Dietary Guidance is Essential In TCM treatment of Spleen-Stomach Damp-Heat Syndrome, in addition to oral decoctions and enemas, other methods such as acupuncture, external applications, tuina, and massage should also be combined as needed based on symptoms and signs. Furthermore, dietary and labor guidelines must be clearly stated to achieve significant results.Medication ExperiencePrescription SelectionEqual Damp-Heat:Use self-formulated Qinghua Decoction (Yinchen (Artemisia capillaris), Bai Bian Dou (White Hyacinth Bean), Huang Lian (Coptis), Hou Po (Magnolia Bark), Peilan (Eupatorium), Bai Dou Kou (White Cardamom), Yi Yi Ren (Job’s Tears), etc.), or Ganlu Disinfectant Pill, Er Miao Wan, Huangqin Shizhi Decoction with modifications.Heat Predominant:Lianpu Decoction, Bai Hu Decoction with Cang Zhu (Atractylodes) added.Damp Predominant:San Ren Decoction, Huo Po Xia Ling Decoction, Huang Lian Ping Wei San, Da Yuan Decoction, etc.Damp-Heat Jaundice:Yinchenhao Decoction, Yinchen Wuling Powder.Damp-Heat Disturbing the Spirit:Changpu Yujin Decoction.Damp-Heat Skin Issues:Yi Yi Zhu Ye San.Damp-Heat Fever:Newly Added Xiangru Decoction, Huanglian Wenzhi Decoction, Da Yuan Decoction.Damp-Heat Diarrhea:Bai Tou Weng Decoction.Damp-Heat Vaginal Discharge:Zhi Dai Fang.MedicationDispelling dampness with aromatic, warming, and draining properties, and clearing heat with bitter, sweet, and salty properties. Dispelling dampness can be aromatic, warming, or draining; when dampness evil steams upward, aromatic dampness dispelling herbs like Huo Xiang (Agastache) and Peilan (Eupatorium) are appropriate; when dampness obstructs the middle jiao, warming and drying herbs like Bai Dou Kou (White Cardamom) and Cao Guo (Tsaoko) should be used; when dampness descends to the lower jiao, light draining herbs like Yi Yi Ren (Job’s Tears) and Tong Cao (Rice Paper Plant) are suitable. Clearing heat can be bitter-cold, sweet-cold, or salty-cold; bitter-cold herbs like Huangqin (Scutellaria) and Huanglian (Coptis) are the first choice for clearing heat and drying dampness; if heat transforms into dryness harming yin, sweet-cold herbs like Jin Yin Hua (Honeysuckle), Pu Gong Ying (Dandelion), Zhi Mu (Anemarrhena), or salty-cold herbs like Shi Gao (Gypsum) and Han Shui Shi (Cold Water Stone) should be used; for damp-heat diarrhea or dysentery, astringent herbs like Xianhe Cao (Agrimonia) and Di Yu (Sanguisorba) can also be used.Transforming dampness must regulate qi, distinguishing between cold and warm. Dispelling dampness should be combined with regulating qi, as qi movement facilitates dampness transformation. However, qi-regulating herbs have cold and warm properties. For predominant dampness, choose Hou Po (Magnolia Bark) and Chen Pi (Aged Tangerine Peel) for drying dampness and regulating qi; for predominant heat, use Zhi Qiao (Bitter Orange) and Zhi Shi (Unripe Bitter Orange) for clearing heat and regulating qi.Qi stagnation often leads to blood stasis, so it is important to know whether to “activate” or “transform.” Qi is the commander of blood, and qi stagnation can lead to blood stasis, thus qi-regulating herbs should also be combined with blood-activating herbs. However, blood-activating herbs can be divided into those that invigorate blood (like Chi Shao (Red Peony), Dang Gui (Angelica), Dan Shen (Salvia)) and those that transform stasis (like San Leng (Sparganium), E Zhu (Curcuma), Tao Ren (Peach Kernel)), and there are also cooling blood (like Dan Pi (Moutan) and Chi Shao) and warming blood (like Dang Gui and E Zhu) distinctions, which should be selected according to the syndrome.Regulating the middle and differentiating ascending and descending, understanding food injury. The stomach should descend, while the spleen should ascend; when the ascending and descending functions of the spleen and stomach are disordered, the stomach qi may rebel and should be harmonized or descended using Ban Xia (Pinellia), Pi Pa Ye (Loquat Leaf), Xuan Fu Hua (Inula), and Zhu Ru (Bamboo Shavings); if the spleen qi is sinking or the clear qi fails to ascend, it should be lifted and raised using Sheng Ma (Cimicifuga), Ge Gen (Pueraria), Jie Geng (Platycodon), and He Ye (Lotus Leaf). For food injury, add Mai Ya (Barley Sprout) for grain injury; add Shan Zha (Hawthorn) for meat injury; other options include Shen Qu (Malt) and Ji Nei Jin (Chicken Gizzard Lining).Constipation has both deficiency and excess, requiring careful attack, tonification, and regulation. Damp-heat transforming into heat can be treated with cooling herbs like Da Huang (Rhubarb), Fan Xie Ye (Senna), and Hu Zhang (Japanese Knotweed); damp turbidity obstructing the bowels should be warmed and unblocked with Cao Guo and Hou Po combined with Da Huang; for deficiency constipation, use Sheng Bai Zhu (Fresh Atractylodes) and Cang Zhu (Atractylodes); for qi constipation, regulate with Mu Xiang (Costus) and Xing Ren (Apricot Kernel).The throat is the orifice of the stomach, requiring careful observation of heat, stasis, and phlegm. Damp-heat ascending often causes throat pain or itchiness; careful examination of the throat is necessary: redness indicates heat, dark red indicates stasis, and follicular indicates phlegm or phlegm-stasis obstruction, which can be treated with Ma Bo (Mushroom), Mu Die (Butterfly Pea), Cheng Qian (Corydalis), and Chi Shao (Red Peony), etc.Strengthening the spleen requires warmth and balance, and tonification must be carefully assessed for deficiency. Spleen-strengthening herbs are mostly warming, thus they can dry dampness, so Bai Bian Dou (White Hyacinth Bean), Cang Zhu (Atractylodes), and Bai Zhu (Atractylodes) are commonly used; however, if drying transforms into heat harming yin, choose Shan Yao (Chinese Yam) for its sweet, neutral, and moistening properties to nourish the spleen. If deficiency is also present, tonifying herbs can be added, but care must be taken to tonify without stagnation to avoid obstructing dampness and drying heat. For qi deficiency, add Sheng Huang Qi (Fresh Astragalus) and Jiao Gu Lan (Gynostemma); for blood deficiency, add Ji Xue Teng (Spatholobus); for yin deficiency, add Yu Zhu (Polygonatum) and Xuan Shen (Scrophularia) or Bai Shao (White Peony) combined with Gan Cao (Licorice) for sweet and sour to nourish yin; for yang deficiency, add Pao Fu Zi (Processed Aconite) etc.When other organs are involved, corresponding methods must be applied. For liver qi stagnation, add liver-soothing and qi-regulating herbs like Chai Hu (Bupleurum), Xiang Fu (Cyperus), and Chuan Lian Zi (Toosendan); for disturbed heart and insomnia, combine with calming and aromatic herbs like He Huan Pi (Mimosa) and Fu Ling (Poria); if there is also kidney deficiency with floating yang, and damp-heat internally obstructing and preventing yang from warming the defensive qi, careful assessment and medication adjustment is necessary.Accompanied by cold and heat, clarify the location and nature of the disease. If there is aversion to cold and fever, it is necessary to clarify whether it is exterior, interior, or half-exterior half-interior, as well as the predominance of damp-heat. For exterior defense syndrome, use Huo Xiang Zheng Qi San, etc.; for half-exterior half-interior, choose Ao Qing Qing Dan Decoction or Da Yuan Decoction; for interior damp-heat syndrome, select Ganlu Disinfectant Pill, etc. based on the severity of damp-heat.Treatment InsightsYang Chunbo believes that regardless of the method used for treating Spleen-Stomach Damp-Heat, it is crucial to pay close attention to the spleen and stomach’s transport function, ensuring that treatment is appropriate to the condition, avoiding heavy medication for mild conditions and light medication for severe conditions, and avoiding reckless benefits, excessive purging, or aggressive attacks. Sometimes it is better to use smaller doses or divided doses rather than heavy doses or sudden doses that harm “transportation.”Regarding the formation of Spleen-Stomach Damp-Heat, it is due to “dampness causing heat,” “heat causing dampness,” or “damp-heat jointly causing,” with various interpretations by historical physicians. From clinical treatment analysis, Yang Chunbo tends to favor the view of “dampness causing heat.”Yang Chunbo believes that the difficulty in treating this syndrome lies in “dampness” or “turbidity,” which manifests as a thick and turbid tongue coating. Wu You can achieve effective results with Da Yuan Decoction, but there are also cases of ineffectiveness, leading to further exploration. Additionally, “damp-heat” often coexists with deficiency, frequently accompanied by qi deficiency, and may also include yin deficiency, yang deficiency, and blood deficiency. Tonifying deficiency often affects the transformation of damp-heat, and there are also cases where tonification resolves damp-heat, which must be carefully considered in terms of medication selection, compatibility, dosage, administration, and dosage forms.Yang Chunbo believes that this syndrome is difficult to cure quickly and prone to relapse during treatment, which is determined by its pathological state of “yin and yang duality,” thus the selection of prescriptions and medications must be carefully reviewed and adjusted.Yang Chunbo believes that for treating Spleen-Stomach Damp-Heat Syndrome, medications should directly reach the disease site, which is beneficial, but daily dietary intake must be maintained to prevent the stomach and intestines from being idle, making dietary regulation and guidelines extremely important. Of course, daily routines, work, and emotional adjustments should not be overlooked.■
Content compiled from:“China Traditional Chinese Medicine News” January 2, 2017, Fourth Edition, Author:Wang Wenrong, Second People’s Hospital of Fujian University of Traditional Chinese Medicine