Chapter Six. Herbs that transform Dampness
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1. What are the indications for herbs that transform and drain Dampness? What are the characteristics of the syndrome of Dampness accumulation?
Herbs that transform and drain Dampness are used for treating syndromes of accumulation of Dampness in the body. These syndromes are usually due to disturbance of the water metabolism, which is a result of dysfunction of the Lung, Spleen, Kidney, Bladder or San Jiao meridians.
The symptoms of Dampness accumulation are edema, scanty and difficult urination, retention of urine, fullness of the chest, a large amount of phlegm, asthma, distension of the abdomen, diarrhea, pain in the joints and heaviness of the body. If Dampness is complicated with Heat in the Middle or Lower Jiao, then disorders such as jaundice, skin diseases and infections from various pathogenic microorganisms may be present.
Dampness is a Yin pathogenic factor and it has a stagnating tendency. This characteristic is shown not only by the symptoms, such as heaviness, fullness and numbness of the body, but also by a lingering, recurrent or chronic course to the disease.
If Dampness is complicated by other pathogenic factors, especially Heat, it will be very difficult to separate these out because to clear Heat may injure the Spleen-Yang and increase Dampness, and to remove Dampness may injure the Yin and increase Heat, so the course of treatment will be longer than if treating disorders caused by only one exogenous pathogenic factor.
2. What are the characteristics of the herbs that transform and drain out Dampness? What precautions should be observed in the use of these herbs?
Herbs that transform and drain Dampness are able to eliminate it by promoting urination and reducing the accumulation of water; therefore they can treat those syndromes and symptoms caused by the accumulation of Dampness or water. These herbs have the following characteristics.
Bland taste
Since a bland taste has the ability to leach out Dampness by promoting urination, most of the herbs that increase urination and drain out Dampness are bland, including Fu Ling ( Poria), Zhu Ling ( Polyporus), Ze Xie ( Alismatis rhizoma), Hua Shi ( Talcum), Yi Yi Ren ( Coicis semen), Tong Cao ( Tetrapanacis medulla), Che Qian Zi ( Plantaginis semen) and Deng Xin Cao ( Junci medulla).
Sweet, bland and cold
Blandness has the ability to leach out water or Dampness and it has a descending tendency in action. Cold can clear Heat, and sweetness and Cold can generate the Yin and Body Fluids, which may have been injured by pathogenic Heat or by the draining action of some herbs. These herbs are suitable for treating water accumulation that is complicated with Heat, especially when the accumulation is in the Lower Jiao. Sweet-bland-cold herbs are also suitable for situations where draining actions are required in this area. The commonly used herbs in this category are Hua Shi, Yi Yi Ren, Tong Cao, Deng Xin Cao, Zhu Ling, Ze Xie and Che Qian Zi.
Sweet, bitter and cold
Some of the herbs are sweet, bitter and cold in nature. They are excellent herbs for treating Damp-Heat accumulation. Because bitterness can dry Dampness and direct Fire downwards, sweetness can tonify the body, and Cold can clear Heat, the bitter-cold nature of these herbs can strongly reduce Heat, and their sweet-cold nature can generate the Yin and Body Fluids, which may have been injured by pathogenic Heat or by the draining action of some herbs. These herbs can be used for a longer period of time than the bitter-cold herbs that dry Dampness and clear Heat. The commonly used herbs are Di Fu Zi ( Kochiae fructus), Shi Wei ( Pyrrosiae folium) and Jin Qian Cao ( Lysimachiae herba).
Entering the Bladder, Kidney and Small Intestine meridians
Because, according to TCM, urination is carried out by the Kidney, the Bladder and the Small Intestine, most of the herbs enter these meridians. They also enter other meridians such as the Lung, Spleen and Large Intestine. They can also regulate the function of these organs and meridians and improve water metabolism.
Moreover, some herbs that drain Dampness can open up meridians and collaterals. They also have the function of increasing the secretion of milk and therefore treat lactation problems.
Herbs that transform and drain out Dampness should be used with caution. Generally speaking, they are suitable only for treating Excess syndromes. In treatment, herbs that regulate the Liver-Qi or the Qi of the San Jiao meridian should also be used because Qi stagnation may directly obstruct the water passage and cause water accumulation. Furthermore, in treating accumulation of Dampness caused by weakness of the Qi and Yang of the Heart, Lung, Spleen and Kidney, herbs that drain out Dampness can be prescribed only if they are combined with herbs that tonify the Yang and Qi.
Herbs that treat Cold-Dampness have a pungent-warm, bitter-warm or bland nature, and they should be used with caution because they can consume the Yin if they are used in large dosage and for a long period of time. The herbs that treat Damp-Heat have a bitter and cold nature, which can injure the Yang of Spleen and that may increase the dampness accumulation. Therefore, the dosage and treatment period should be carefully considered. Moreover, pregnant women should use these herbs with caution as these aromatic, pungent, bitter and bland herbs can activate Qi and Blood, and the bitter and bland herbs usually move downwards. These actions may bring danger to the pregnancy.
3. What are the commonly used methods for eliminating Dampness?
Dampness is one of the six exogenous pathogenic factors. It is also a pathological product caused by disorder of water metabolism in the body. The associated organs are the Kidney, Bladder, Small Intestine, Spleen, Lung and San Jiao. To eliminate the accumulation of Dampness or water, there are several possibilities. The commonly used strategies are as follows.
Promoting urination and leaching out Dampness
Bland or bland-sweet-cold herbs, which enter the Bladder, Small Intestine and Kidney meridians, can promote urination and reduce accumulation of water or Dampness directly. They are particularly suitable for use where there is water accumulation in the Lower Jiao. The commonly used herbs are Fu Ling ( Poria) and Ze Xie ( Alismatis rhizoma).
Drying Dampness
Pungent-bitter-warm herbs can dry Dampness directly. They are particularly suitable when water or Dampness accumulates in the Middle Jiao. The commonly used herbs are Cang Zhu ( Atractylodis rhizoma), Hou Po ( Magnoliae cortex), Ban Xia ( Pinelliae rhizoma) and Du Huo ( Angelicae pubescentis radix).
Bitter-cold herbs are able to clear Heat and dry Dampness and they are often used for transforming Damp-Heat. Examples are Huang Qin ( Scutellariae radix), Huang Lian ( Coptidis rhizoma), Huang Bai ( Phellodendri cortex) and Zhi Zi ( Gardeniae fructus).
Expelling Dampness
Pungent herbs have the function of expelling Wind and can also disperse and transform Dampness. These herbs can be used alone if the Dampness accumulates in the Upper Jiao. They can also be used in combination with other methods for treating Dampness in the Middle Jiao and Lower Jiao. The commonly used herbs are Fang Feng ( Saposhnikoviae radix), Qin Jiao ( Gentianae macrophyllae radix) and Qiang Huo ( Notopterygii rhizoma).
Aromatically transforming Dampness
Because aromatic herbs can penetrate turbidity, revive the Spleen and transform Dampness, they are particularly suitable for situations where Dampness obstructs the sense orifices. These herbs are Huo Xiang ( Agastachis herba), Pei Lan ( Eupatorii herba), Cao Guo ( Tsaoko fructus), Sha Ren ( Amomi xanthioidis fructus) and Qing Hao ( Artemisiae annuae herba).
Strengthening the function of the Spleen and transforming Dampness
Herbs that tonify the Qi of the Spleen so as to strengthen the function of water transportation and transformation are often used in a Dampness syndrome; examples are Bai Zhu ( Atractylodis macrocephalae rhizoma) and Huang Qi ( Astragali radix).
Warming the Kidney-Yang and ‘steaming’ the Dampness
Pungent-hot herbs that enter the Kidney meridian are able to strengthen the Kidney-Yang, to ‘steam’ the water, to separate the clean water from the turbid part and accelerate the water metabolism. They are often used for chronic or severe cases of accumulation of water or Dampness in the body. The commonly used herbs are Fu Zi ( Aconiti radix lateralis preparata)*, Rou Gui ( Cinnamomi cassiae cortex) and Wu Yao ( Linderae radix).
Warming the Spleen-Yang and transforming Dampness
Pungent-hot herbs that enter the Spleen meridian are able to strengthen the Spleen-Yang, accelerate the transportation and transformation of the Spleen, and therefore transform Dampness. The commonly used herbs are Sheng Jiang ( Zingiberis rhizoma recens) and Gan Jiang ( Zingiberis rhizoma).
Dispersing the Lung-Qi and regulating the water passage
Since water is moved by the Qi in the body, herbs that can disperse the Lung-Qi can also disperse Dampness; examples are Ma Huang ( Ephedrae herba)* and Jie Geng ( Platycodi radix).
For the same reason, herbs that direct the Lung-Qi to descend can also be used to regulate the passage of water and eliminate Dampness; examples include Sang Bai Pi ( Mori cortex), Xing Ren (Xing Ren) and Ting Li Zi ( Lepidii/Descurainiae semen).
Promoting the Qi movement and eliminating Dampness
Since the movement of Qi can accelerate water metabolism, herbs that promote Qi movement can treat accumulation of Dampness. This strategy is often combined with other methods. The commonly used herbs are Xiang Fu ( Cyperi rhizoma), Chen Pi ( Citri reticulatae pericarpium), Da Fu Pi ( Arecae pericarpium) and Hou Po ( Magnoliae cortex).
4. Fu Ling ( Poria) can promote urination, tonify the Spleen and calm the Mind. What are its characteristics compared with other herbs which have the same function?
Fu Ling is sweet, bland and neutral, and enters the Heart, Spleen, Stomach, Lung and Kidney meridians. It is able to drain out Dampness by promoting urination. It can also tonify the Spleen and calm the Mind.
Compared with the other herbs that transform Dampness, Fu Ling is characterized by being used for both Damp-Heat and Damp-Cold syndromes to promote urination and drain out Dampness; this is because it is bland and neutral in nature. Because it is sweet and bland, it drains out Dampness without the side-effect of injuring the Yin and Yang of the body. In clinical practice, it is often used for treating accumulation of water and Dampness in the Middle or Upper Jiao, manifesting as edema, heaviness of the body and difficult urination, such as in the diseases of the Kidney, Lung, Liver and Heart.
Comparing Fu Ling with other herbs that tonify the Spleen, its neutral and gentle nature brings this herb its characteristic actions: Fu Ling is white in color and has no taste; it has a gentle action of tonifying the Spleen-Qi but is without a cloying nature. It can therefore be used for treating chronic disorders and for people who have a weak constitution and are very sensitive to the tastes of most herbs. For the same reason, this herb is also recommended in prescriptions for children. It is also an ideal herb for putting in biscuits, cakes, soup or porridge and using in the diet over a longer period of time. Another characteristic of Fu Ling is that it not only tonifies the Spleen, but also transforms Dampness and moves it downwards. Unlike most of the tonifying herbs, which place extra burden on the Stomach and must be used with herbs that regulate the Qi, Fu Ling can be used alone without any side-effects. It is especially useful in patients suffering from edema, difficult urination and diarrhea caused by Spleen deficiency.
Comparing Fu Ling with other herbs that calm the Mind, it is most suitable for treating restlessness, palpitations and insomnia due to deficiency of the Heart-Qi and Spleen-Qi. These patients may also suffer from poor appetite, tiredness, excessive thinking, depression and restless sleep. In most cases, there is a history of chronic disease or long-term mental stress. Fu Ling has no special taste, so it is a good herb for children suffering from restless sleep, crying at night and indigestion.
5. What are the differences between Fu Ling ( Poria), Fu Ling Pi ( Poriae cocos cortex), Fu Shen ( Poriae cocos pararadicis) and Chi Fu Ling ( Poriae cocos rubrae)?
Fu Ling is sweet, bland and neutral, and enters the Heart, Spleen, Stomach, Lung and Kidney meridians. It is able to drain out Dampness by promoting urination, and tonifies the Spleen. It can also calm the Mind gently.
Fu Ling Pi is the peel of Fu Ling. Unlike Fu Ling, it does not have the function of tonifying the Spleen and calming the Mind, but it is especially effective for transforming Dampness in the skin and subcutaneous regions by promoting urination; therefore it can treat edema and puffiness.
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