Zhao Shaoqin is skilled in the treatment of warm diseases and is a renowned contemporary scholar in this field. He has unique insights and understanding of Ye Tianshi’s methods for differentiating and treating Wei (Defensive Qi), Qi, Ying (Nutritive Qi), and Xue (Blood), proposing his own views. He believes that “in the case of Wei sweating, it is not appropriate to use sweating methods, and cold herbs should not be administered too early in cases of Qi deficiency. The method of clearing heat and transforming Qi can be widely applied at various stages of warm diseases involving Wei, Qi, Ying, and Xue.” His unique experience in treating damp-heat syndromes is of significant clinical guidance, which is discussed as follows.
1. Use of Light and Harmonious Medicinals
Zhao’s approach to treating dampness involves using few but precise herbs, favoring light, clear, agile, and mildly aromatic substances. He often employs aromatic herbs to transform dampness and regulate Qi, avoiding sweet, cold, and greasy substances.
For dampness obstructing the upper jiao (upper burner), he frequently uses Huo Xiang (Agastache), Pei Lan (Eupatorium), Duan Dou Chi (Fermented Soybean), Dou Juan (Bean Sprouts), Qian Hu (Peucedanum), Xing Ren (Apricot Kernel), and Pi Pa Ye (Loquat Leaf) to aromatically transform dampness and open the lung Qi. Since the lungs govern Qi, when Qi is transformed, dampness can also be transformed, and when dampness is transformed, heat can be easily cleared.
For dampness obstructing the middle jiao (middle burner), while using aromatic herbs to transform dampness and descend lung Qi, he also employs Chen Pi (Aged Tangerine Peel), Ban Xia (Pinellia), Hou Po (Magnolia Bark), Mu Xiang (Saussurea), Da Fu Pi (Trichosanthes), Bai Dou Kou (White Cardamom), Cao Dou Kou (Grass Cardamom), and Wei Jiang (Ginger) to open the middle.
For dampness accumulating in the lower jiao (lower burner), he uses Liu Yi San (Six-to-One Powder), Zhu Ye (Bamboo Leaf), Xian Bai Mao Gen (Fresh Imperata), Xian Lu Gen (Fresh Reed Root), and Tong Cao (Rice Paper Plant) to guide dampness downward.
When heat evil is obstructed internally, it should also be cleared. However, excessive use of bitter and cold herbs can lead to the stagnation of damp evil, preventing its transformation, causing Qi stagnation, and even obstructing the clear orifices, leading to confusion of consciousness. Therefore, cold herbs should be used sparingly and in light doses. Huang Qin (Scutellaria), Zhi Zi (Gardenia), and Huang Lian (Coptis) can be used judiciously, with a small dose of 2-3 grams and a maximum of 10 grams.
Zhi Zi clears the San Jiao (Three Burners) and, when combined with Duan Dou Chi, clears and disperses stagnant heat. Prolonged damp-heat can lead to putrid Qi, and the combination of Zhi Zi and Dou Chi is particularly effective in dispelling putrid Qi, thus having the function of dispersing Yang and relieving stagnation. Ban Xia, Sheng Jiang (Fresh Ginger), Huang Qin, and Huang Lian open and descend, clearing heat and drying dampness, and relieving the accumulation of damp-heat in the middle jiao. He Ye (Lotus Leaf), Zhu Ru (Bamboo Shavings), Qing Song (Green Pine), Mu Dan Pi (Moutan Root), and Bai Ji Li (Tribulus) are also commonly used.
To treat damp-heat, formulas such as San Ren Tang (Three Nut Decoction) and Huo Xiang Zheng Qi San (Agastache Correct Qi Powder) are often modified. Heavy, cold, greasy substances are generally avoided. If there is confirmed excess heat, Bai Hu Tang (White Tiger Decoction) can also be used; if there is severe heat with confusion of consciousness and obstructed bowel Qi, San Bao (Three Treasures), Ling Yang Jiao Fen (Antelope Horn Powder), and Da Huang (Rhubarb) should be used sparingly. However, treatment should stop once the condition improves, and prolonged use should be avoided to prevent transformation of the syndrome.
2. Emphasizing the Smooth Flow of the San Jiao and Regulating Qi Mechanism
The San Jiao is the pathway for water and grain, the origin and end of Qi, and the governing organ for excretion. When the San Jiao is unobstructed, the evil can be expelled. When the San Jiao is clear, the heat in the Ying and blood can be released externally, and the damp-heat in the upper, middle, and lower jiao can be expelled.
In cases of damp-heat stagnation, with Qi not flowing smoothly, symptoms such as headache, eye swelling, and fullness in the chest and abdomen may occur. Treatment should focus on aromatic herbs to transform and regulate lung Qi to promote the flow of Qi.
If the tongue coating is thick and greasy, especially at the root, additional herbs to eliminate accumulation and guide stagnation should be added, such as Bao He Wan (Preserve Harmony Pill), Lai Fu Zi (Radish Seed), Jiao San Xian (Fried Three Immortals), Sui Hong Hua Zi (Water Red Flower Seed), and Ji Nei Jin (Chicken Inner Gold). Additionally, Bai Fu Ling (White Poria), Chi Fu Ling (Red Poria), Yi Yi Ren (Job’s Tears), and Fu Ling Pi (Poria Skin) can be used to eliminate damp-heat. After taking the herbs, the San Jiao becomes unobstructed, and the Qi mechanism is regulated, leading to a slight sweat from the head to the chest and eventually to the toes, indicating that the heat has completely retreated. “To treat damp-warmth, one must achieve a slight sweat throughout the body, even in the spaces between the toes, which is a sign that the evil has been completely expelled.”
If cold and greasy substances are mistakenly used, the damp evil will become more severe, and the evil will not be expelled. Although sweating is generally prohibited in damp-warmth, it is essential to induce sweating to resolve the evil. The smooth flow of the San Jiao and the regulation of the Qi mechanism are prerequisites for sweating and expelling the evil.
3. Skillful Use of the Method of Clearing Heat and Transforming Qi
Zhao is adept at using Ye Tianshi’s method of clearing heat and transforming Qi to treat critical conditions such as persistent high fever and coma. He extends the principle of clearing heat and transforming Qi to be widely applicable in the treatment of warm diseases at all stages involving Wei, Qi, Ying, and Xue, with the principle of expelling the evil externally. For cases of damp-heat obstruction, Qi stagnation, and deepening heat, leading to phlegm-heat and obstructing Qi, internal closure of the heart sac, and constipation, where the heat in the Ying cannot be released externally, it is crucial to aromatically transform dampness, open the obstruction, and regulate Qi, using Zi Xue Dan (Purple Snow Pill) to clear the heart and open the orifices, allowing the internal orifices to open and the bowel Qi to flow, transforming dampness and promoting the smooth flow of Qi. The heat in the heart sac can then be expelled through bowel movements.
In cases of mistakenly using cold and cooling herbs, which suppress Yang Qi, not only will dampness not be expelled, but it will also lead to internal cooling in the middle jiao, obstructing the Qi mechanism, and the evil will have no way out, resulting in symptoms such as confusion of consciousness, persistent high fever, pale complexion, and a pulse that is deep, weak, and slightly rapid, with a white, greasy, and slippery tongue coating, especially with a red tip.
In such cases, treatment must involve warming and dispersing the cold obstruction, using herbs such as Gan Jiang (Dried Ginger), Hua Jiao (Sichuan Pepper), and Cao Dou Kou (Grass Cardamom); aromatic herbs are necessary to promote the Qi mechanism and awaken consciousness, such as Huo Xiang, while avoiding the cooling Pei Lan. Additionally, Ban Xia, Hou Po should be used to open and descend, drying dampness and promoting the flow of Qi in the middle jiao; Qian Hu and Xing Ren should be used to descend lung Qi to open the upper jiao; Shi Chang Pu (Acorus) and Yu Jin (Curcuma) should be used to transform phlegm and open the orifices. Furthermore, Zhi Zi and Dou Chi should be used to clear stagnant heat and promote the flow of Qi. The combination of these herbs will help to resolve the cold and transform dampness, allowing the evil to be expelled, thus enabling the heat in the Ying to be released externally. After taking the herbs, a slight sweat over the body and a return of color to the face indicate that the cold has been resolved. However, if the Ying Yin has been damaged and the heat has been expelled, attention must also be given to nourishing the Ying with sweet and cold herbs.
In cases of damp-heat obstructing the lungs, excessive use of cold and cooling herbs will obstruct the Qi mechanism, preventing the lungs from dispersing and descending, thus preventing the heat in the Ying from being released externally. In such cases, lung Qi should be regulated and phlegm transformed to apply the method of clearing heat and transforming Qi, using Qian Hu, Xing Ren, Chuan Bei Mu (Fritillaria), and Dai Ge San (Dai Ge Powder) to regulate lung Qi and transform phlegm. Huang Qin should be used to clear residual heat in the Qi level, and Ling Yang Jiao Fen should be used to clear the heart and Ying, promoting the flow of Ying heat externally and achieving the goal of clearing heat and transforming Qi. A return to clarity of consciousness after taking the herbs is a sign of successful heat clearing and Qi transformation. If the patient is already clear-headed but has overeaten, leading to food stagnation and confusion, this indicates that food stagnation is obstructing the middle, preventing the flow of Qi and the expulsion of the evil. In this case, digestive herbs should be added to the prescription to aid in clearing heat and transforming Qi, and a small amount of An Gong Niu Huang Wan (Calm the Palace Pill) can be taken orally to assist in opening the internal orifices.
In summary, there is no fixed method for using the method of clearing heat and transforming Qi. To achieve this, one must identify the reasons for the inability to clear and transform, and then use targeted herbs. The goal is to provide a pathway for the evil to exit, regulate the Qi mechanism, and ensure the smooth flow of the San Jiao, allowing the evil to be expelled externally.
4. Misdiagnosis and Transformation Syndromes Classified into Four Types
When damp-heat syndrome first arises, aromatic herbs should be used to disperse the evil externally. If the physician, due to persistent high fever, solely relies on cold herbs for treatment, the damp evil will congeal and obstruct the Qi mechanism, leading to stagnation in the San Jiao and resulting in transformation syndromes. Zhao classifies transformation syndromes into four types: damp obstruction, cooling obstruction, cold congealment, and ice entrapment. Damp Yang is the lightest transformation syndrome, which can also represent the initial stage of damp-heat, where damp evil predominates, obstructing the middle and upper jiao, not yet transforming into heat, or if heat is not severe, symptoms may include dizziness, heaviness, and fatigue, with fullness and oppression in the chest. Treatment should focus on aromatic herbs to disperse and regulate Qi, as Qi transformation leads to dampness transformation, using herbs such as Qian Hu, Xing Qi (Apricot), Lu Gen (Reed Root), and Zhe Bei Mu (Zhejiang Fritillaria).
If dampness obstructs the middle jiao, with symptoms of nausea, poor appetite, and loose stools, the focus should be on moving the spleen Qi, using light, dispersing, and agile herbs, avoiding heavy substances. The method of opening with acrid and descending with bitter should be employed to eliminate damp-heat, using herbs such as Chen Pi, Ban Xia, Xing Ren, Da Fu Pi, Huang Qin, and Huang Lian, while being cautious with the doses of Huang Qin and Huang Lian to prevent damage to Yang. In cases of damp obstruction, regardless of whether it is in the upper or middle jiao, there will be a thick, greasy, and slippery tongue coating, and a soft, slippery pulse, indicating the presence of dampness. All should be treated for dampness first, avoiding excessive use of cold herbs, and once dampness is transformed, then consider clearing heat.
Cooling obstruction is a more severe transformation syndrome. Due to cold and cooling obstructing the middle Yang, the ascending and descending functions of the spleen and stomach are hindered, with symptoms of chest fullness, heaviness, and fatigue throughout the body, loose stools, and difficulty urinating. Treatment should focus on slightly warming and bitter methods to first open the damp obstruction and promote the middle Yang, resolving the cooling obstruction, allowing the damp evil to transform, and the Qi mechanism to flow freely, thus allowing heat and dampness to have a pathway out. Herbs such as Ban Xia, Chen Pi, Xing Ren, Bai Dou Kou, Cao Dou Kou, Cang Zhu (Atractylodes), and Mu Xiang should be used. If cooling obstruction is more pronounced in the upper jiao, with significant chest oppression, treatment should focus on acrid herbs to open the obstruction, using Zi Su Ye (Perilla Leaf), Zi Su Gen (Perilla Stem), Huo Xiang, Bai Zhi (Angelica), and Fang Feng (Siler). The damp obstruction must be opened first, and then the cooling obstruction resolved before considering clearing heat; this is the established method.
Cold congealment is a more severe transformation syndrome, where in addition to the above symptoms, there may be significant chest oppression, wheezing, abdominal pain, and a deep pulse. Treatment should involve herbs such as Gui Zhi (Cinnamon Twig), Wei Jiang, Cao Dou Kou, Xiang Su (Aromatic), Bai Dou Kou, and Zi Su Ye. The focus is on using warming and dispersing herbs to resolve cold congealment; this is the method of rescue, and treatment should stop once the condition improves. If sweating occurs and symptoms reduce, then reduce the warming herbs and add aromatic herbs to disperse.
Ice entrapment is the most severe form of misdiagnosed damp-heat syndrome, often occurring in individuals with a constitution of Yang deficiency. Overuse of cold and heavy doses, or excessive consumption of cold drinks, can lead to severe dampness and weakened Yang Qi, with damp-heat evil being forced deep within. Symptoms include a pale complexion, extreme chest fullness, difficulty breathing, cold extremities, and a deep, weak pulse. Treatment should focus on methods such as Si Ni San (Frigid Extremities Powder) and Li Zhong Wan (Regulate the Middle Pill), using herbs such as Gui Zhi, Rou Gui (Cinnamon), Hua Jiao, Cao Dou Kou, Wu Zhu Yu (Evodia), Sheng Jiang, and Fu Zi (Aconite) to warm and promote Yang, and aromatically transform dampness. After taking the herbs, a return of color to the face, warmth in the extremities, reduced fullness, and slight sweating indicate that the ice entrapment has been resolved and Yang Qi is being promoted. Treatment should be stopped promptly to avoid excessive warming and increasing heat.
5. Emphasizing Dietary Regulation
Zhao places particular emphasis on dietary considerations in his treatment. Damp-heat diseases can arise from improper diet, and excessive consumption of cold foods can lead to transformation syndromes. Additionally, irregular eating can lead to food stagnation. Therefore, he stresses that patients should be cautious with their diet and moderate their tastes, avoiding fatty and sweet foods that promote dampness, spicy foods that increase heat, and cold foods that inhibit Yang. Otherwise, even with excellent herbs, the treatment will not be effective. To raise awareness among patients, he often provides a dietary list along with prescriptions, specifying which foods are permissible and which should be avoided. His meticulousness and seriousness are evident.