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Source: Yijian Jingfang
In my clinical practice, I categorize damp-heat diseases into four stages based on the amount of dampness and the degree of obstruction: Damp Obstruction, Cool Stagnation, Cold Congestion, and Ice Seepage. The treatment often achieves good results. Here is a brief introduction:
1.
Damp Obstruction
When damp-heat evil invades a person, it often obstructs the flow of Qi, primarily affecting the upper jiao. If a person has a deficiency of the Taiyin Spleen (Taiyin Pi Xu) with internal dampness, the evil returns to the Taiyin, mainly obstructing the middle jiao with dampness.Dampness accumulates in the upper jiao, initially, the damp-heat evil constrains the exterior, disrupting the harmony of Ying and Wei, leading to a feeling of heaviness and soreness throughout the body; the damp-heat evil obstructs the clear Yang, preventing it from rising, resulting in dizziness and a heavy head, as described in the Suwen: Theory of Vital Qi “caused by dampness, the head feels wrapped”. If the damp-heat evil obstructs the lung Qi, the lung’s ability to disperse and descend is impaired, leading to chest tightness, cough, and wheezing. A slippery and moist tongue coating, along with a soft and moist pulse, are clear signs of damp evil invasion.The treatment should focus on lightly lifting, dispersing, and transforming dampness. The lung, being the highest organ, governs the dispersal and descent of Qi, and connects with the skin and hair. When damp-heat evil invades, the lung is the first to be harmed. If the lung is affected, it becomes obstructed, and its Qi transformation is hindered, causing dampness to stagnate. Therefore, the treatment should first aim to disperse lung Qi. As Wu Jutong said: “The lung governs the Qi of the whole body; when Qi transforms, dampness also transforms.” Suitable herbs include Da Dou Juan (大豆卷), Chao Shan Zhi (炒山栀), Qian Hu (前胡), Xing Ren (杏仁), Zhe Bei Mu (浙贝母), Lu Gen (芦根), or formulas like San Ren Tang (三仁汤), Huo Po Xia Ling Tang (藿朴夏苓汤), Huo Xiang Zheng Qi (藿香正气) with modifications. This will help the lung to disperse dampness and the heat will follow the dampness out.If dampness obstructs the middle jiao, the spleen and stomach are affected, leading to a loss of the normal rise and fall of Qi. Zhang Xugu said: “The Qi of the three jiao rises and falls, driven by the spleen; when the middle jiao is harmonious, the upper and lower jiao are in order.” The harmony of the middle jiao refers to the harmony of the spleen and stomach. The Yangming is the sea of food and fluids, while the Taiyin is the organ of damp earth; the stomach governs receiving, and the spleen governs transformation. When the spleen rises, it is strong, and when the stomach descends, it is harmonious. Therefore, when the middle jiao is harmonious, the spleen and stomach rise and fall appropriately, the heart and lungs are above, circulating Ying and Wei to nourish the exterior, while the liver and kidneys are below, nourishing the tendons and bones to strengthen the interior. The spleen and stomach are in the middle, transmitting and transforming the essence to nourish the surroundings, maintaining the normal movement of Qi rise and fall in the body, which is the state of being free from disease.The spleen governs dampness, primarily by rising. If the spleen is obstructed by dampness, its Qi cannot rise, and the stomach Qi cannot descend, leading to symptoms such as chest and epigastric fullness, loose stools, fatigue, heaviness in the limbs, a pale and bright complexion, and dizziness with a feeling of fullness. The tongue coating is white and greasy, and the pulse is soft and moist.Damp-heat obstructing the middle jiao, the treatment should focus on harmonizing the middle and transforming dampness. Herbs such as Ban Xia (半夏), Chen Pi (陈皮), Hou Po (厚朴), Xing Ren (杏仁), Da Fu Pi (大腹皮), Huang Lian (黄连) should be used to help the spleen Qi rise and the stomach Qi descend, thus resolving dampness and dispelling heat. Even if there is heat evil, one should not excessively use cold and cool herbs. As Zhang Xugu said: “If the spleen Qi is weak, dampness will arise from within; if dampness is excessive, the spleen cannot function properly, leading to stagnation. One may feel extreme fullness, and even if there is heat evil, if there is excessive internal dampness, the tongue coating will not be dry. One should first resolve the dampness, and then clear the heat; one should not use cold and cool herbs to close the dampness.”
2.
Cool Stagnation
When one is exposed to damp-heat evil, excessively consuming cold foods, or taking cold and cool medications, or being affected by damp-heat evil, and if dampness is heavy and heat is mild, the cold and cool substances can obstruct the middle Yang, leading to stagnation of the spleen and stomach’s rise and fall, resulting in a blockage of the entire body’s Qi flow.Symptoms include: chest and epigastric fullness, a feeling of suffocation and bloating, sighing, body aches, loose stools, difficulty urinating, a pale yellow complexion, a slippery and greasy tongue coating, and a soft pulse, or a slow and soft pulse that is also moist.The treatment should use slightly warm bitter herbs to open dampness and promote the middle Yang to benefit the three jiao. Once the damp evil is resolved, the Qi flow will be smooth, and the heat evil will follow the dampness out. Suitable herbs include Ban Xia (半夏), Chen Pi (陈皮), Xing Ren (杏仁), Bai Dou Kou (白蔻仁), Cang Zhu (苍术), Mu Xiang (木香), Cao Dou Kou (草蔻), etc.If the cool stagnation is more pronounced in the upper jiao, where the Wei Qi is not dispersing and Yang Qi is not circulating, with red lips and no thirst, often sighing and feeling suffocated, one can select Bai Zhi (白芷), Su Ye (苏叶), Huo Geng (藿梗), Fang Feng (防风), etc., to disperse the stagnation. Once the dampness is resolved, one can then consider clearing heat, such as using Huo Po Xia Ling (藿朴夏苓) with Cao Dou Kou (草蔻) and similar herbs.
3.
Cold Congestion
Individuals with insufficient middle Yang, when affected by dampness that transforms into damp-heat evil, return to the Taiyin. Additionally, excessive consumption of cold foods or cold and greasy substances can lead to excessive dampness and weak Yang, with dampness belonging to cold water. When exposed to cold, it condenses and causes Qi stagnation. Symptoms include: chest and epigastric fullness, unusual bloating and suffocation, wheezing, abdominal pain, loose stools, clear urine, a pale tongue with a white and greasy coating, and a soft or slippery pulse.Cold congestion leads to stagnation; warmth is needed to dispel cold and open the blockage. Suitable herbs include: Gui Zhi (桂枝), Su Ye (苏叶), Cao Dou Kou (草蔻), Sheng Jiang (生姜). Using spicy and warm herbs to treat heat is a temporary measure for cold congestion; it should not be used for long. Once the pulse becomes soft and the tongue coating transforms from cold congestion (middle disease), it should be stopped to prevent excessive heat.
4.
Ice Seepage
Ice seepage is more severe than cold congestion; it does not occur simply from damp-heat disease being treated with cold. It is often seen in patients with a constitution of Yang deficiency who consume excessive cold drinks or heavy cold medications. Cold enters the stomach, severely injuring the middle Yang, leading to excessive dampness and weak Yang, with damp-heat evil being condensed by cold, resulting in a frozen state deeply embedded within, causing Qi stagnation due to cold. Symptoms include: pale complexion, increased chest and epigastric fullness, cold limbs, abdominal cramping, a pale and moist tongue with abundant liquid, loose and watery stools, clear and frequent urination, and a deep and slow or hidden pulse. This condition cannot be alleviated by spicy, warm, or drying herbs; they cannot relieve ice seepage, disperse cold, or open the blockage. Urgent use of Si Ni San (四逆) and Li Zhong Wan (理中) methods is required. Commonly used herbs include: Gui Zhi (桂枝), Rou Gui (肉桂), Sheng Jiang (生姜), Gan Jiang (干姜), Chuan Jiao (川椒), Cao Dou Kou (草蔻), etc. Once the ice is resolved, cold is dispersed, the tongue coating transforms, and the complexion becomes moist, the medication should be stopped to prevent excessive heat.
Case Examples
Damp Obstruction
Zhang, Male, 65 years old, August 11, 1936After the rain, the weather cleared, and due to improper living habits, he was affected by the evil. He now feels body heat, dizziness, fullness in the chest, body aches, fatigue, slight nausea, lack of appetite, and difficulty urinating. The tongue coating is white and greasy, and the pulse is slightly slippery and rapid.The condition is due to external heat invasion, damp obstruction in the middle and upper jiao, leading to Qi stagnation. The treatment should focus on aromatic dispersal and slightly bitter drainage.Fresh Pei Lan (佩兰) (10g), fresh Huo Xiang (藿香) (10g), Da Dou Juan (大豆卷) (10g), Ban Xia (半夏) (10g), Zhi Hou Po (制厚朴) (6g), Chen Pi (陈皮) (6g), Chuan Lian (川连) (3g), Liuyi San (六一散) (10g), one dose.Second diagnosis, August 12, 1936. After taking the medicine, he sweated slightly all over, body heat gradually decreased, dizziness reduced, and body aches also lightened. However, the fullness in the middle jiao remains, with slight nausea, the tongue is white and greasy, and the pulse is slippery. The original prescription was adjusted with an addition of Cao Dou Kou (草蔻) (1g) and Xing Ren (杏仁) (10g), and after three doses, he recovered.
Cool Stagnation
Zhou, Female, 57 years old, September 3, 1941Usually has a weak spleen and stomach, with internal dampness accumulation, and then affected by summer heat evil, she feels body heat, dizziness, fullness in the chest, thirst, and the doctor did not notice the internal dampness accumulation, leading to the administration of Bai Hu Tang (白虎). After taking it, she felt an unusual fullness in the chest, and the lower abdomen was uncomfortable. The tongue coating is white and greasy, and the pulse is soft and weak. With a constitution of insufficient Yang Qi, the heavy spicy and cool medication harmed the middle Yang, leading to dysfunction in the middle jiao, with slight abdominal pain. Slightly warm and spicy herbs should be used to transform the damp evil, along with aromatic herbs to relieve pain. All cold foods are to be avoided.Su Ye (苏叶) (6g), Huo Xiang Geng (藿香梗) (10g), Da Dou Juan (大豆卷) (10g), Ban Xia (半夏) (10g), Zhi Hou Po (厚朴) (6g), Bai Dou Kou (白蔻仁) (3g), Wei Jiang (煨姜) (2g), Mu Xiang (木香) (5g), Fu Ling Pi (茯苓皮) (10g), two doses.Second diagnosis: After advancing the aromatic dispersal and slightly warm herbs to transform dampness, the fullness in the middle jiao gradually resolved, and the abdominal pain did not recur. The pulse remains soft and weak, with slightly increased strength. Further aromatic dispersal treatment was applied to the middle jiao.Su Huo Geng (苏藿梗) (6g), Ban Xia Qu (半夏曲) (10g), Chen Pi (陈皮) (6g), Zhi Hou Po Hua (厚朴花) (6g), Bai Dou Kou (白蔻仁) (3g), fresh Wei Jiang (煨姜) (3g), Jiao Mai Ya (焦麦芽) (10g), two doses, and she recovered.
Cold Congestion
Bao, Male, 21 years old, August 25, 1947After several days of heat, he suddenly fell ill, feeling body heat, dizziness, irritability, and thirst, having consumed six or seven ice pops and excessive cold fruits. After a while, he felt fullness in the chest, suffocation, rapid breathing, abdominal bloating, short urination, and abdominal pain, and came for consultation. His complexion is dark blue, the tongue is pale with a slippery coating, and the pulse is deep and rough.This is due to external heat invasion, excessive consumption of cold, leading to stagnation of Yang Qi, with dampness being cold and condensed. The treatment should first use slightly warm and spicy herbs to disperse stagnation and relieve pain, warming and resolving cold congestion. This will transform cold, open the blockage, and remove dampness, followed by methods to clear and transform.Chen Xiang Ruo (陈香薷) (5g), Huo Su Geng (藿苏梗) (10g), Bai Zhi (白芷) (6g), Wei Jiang (煨姜) (6g), Gui Zhi (桂枝尖) (2g), Cao Dou Kou (草豆蔻) (3g), Mu Xiang (木香) (6g), Bai Dou Kou (白蔻仁) (2g), Ban Xia (半夏) (10g), two doses.Second diagnosis: August 27, 1947, after taking the medicine, he sweated slightly all over, body heat and dizziness decreased, chest fullness and suffocation symptoms lightened, and rapid breathing resolved. His complexion is slightly dark, and urination is very smooth. The tongue is pale with a greasy coating, and both pulses have gradually become smooth and free. The original prescription was adjusted by removing Chen Xiang Ruo (陈香薷), Gui Zhi (桂枝尖), and Cao Dou Kou, and after two doses, he felt well.
Ice Seepage
Zhang, Female, 40 years old, August 23, 1948Recently fell ill, feeling dizzy, body heat, nausea, chest tightness, and overall weakness. Yesterday, she self-administered two pills of An Gong Niu Huang Wan (安宫牛黄丸), and the next day felt unusual chest tightness, coarse breathing, lower limb edema, overall weakness, cold limbs, pale and swollen complexion, with both pulses deep and hidden, feeling rough and not smooth. The tongue is pale with a white coating, moist and liquid, with unsatisfactory urination, and a lack of energy. This is due to summer dampness accumulating heat, excessive consumption of cold, leading to the evil being frozen within. Urgent use of slightly warm methods to open Yang, aromatic herbs to dispel dampness, resolve ice seepage, and disperse cold evil to open the blockage is required.Gui Zhi (桂枝) (10g), Gan Jiang (干姜) (6g), Xiang Ruo (香薷) (6g), Ban Xia (半夏) (10g), Zhi Hou Po (厚朴) (6g), Cao Dou Kou (草蔻) (3g), Chao Chuan Jiao (炒川椒) (6g), Sheng Jiang (生姜) (6g), one dose, decocted in water for oral administration.Second diagnosis: August 24, 1948After taking the medicine, she sweated slightly all over, body heat has retreated, chest tightness has greatly reduced, breathing is normal, and the swelling of the face and limbs has subsided. Both pulses have gradually become smooth, and the limbs are warming up. The cold has dissipated, and the ice has resolved, so the treatment was changed to aromatic dispersal methods.Huo Xiang (藿香) (10g), Ban Xia (半夏) (10g), Zhi Hou Po (厚朴) (6g), Cao Dou Kou (草蔻) (3g), Chen Pi (陈皮) (10g), Cang Zhu (苍术) (6g), Sheng Jiang (生姜) (6g), Fu Ling (茯苓) (10g), Dong Gua Pi (冬瓜皮) (20g), and after three doses, she recovered.
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