Chapter Seven. Syndrome of dampness and formula composition

CHAPTER CONTENTS

1 Damp-cold syndrome202

Treatment principle 203

Herb selection principles and formula composition strategies 203

Cautions 203

Structure of the formula and selection of herbs 204

Common accompanying symptoms and treatment 207

Examples of classical formulas 207

2 Damp-heat syndrome211

Treatment principle 213

Herb selection principles and formula composition strategies 213

Cautions 213

Structure of the formula and selection of herbs 214

Common accompanying symptoms and treatment 216

Examples of classical formulas 217

CHAPTER OUTLINE

This chapter introduces the principles, methods and strategies for the composition of formulas that can disperse, dry, dissolve and leach out dampness. They are used to treat the syndromes of dampness.

The syndrome of dampness is directly caused by dampness accumulation in the body. The causes of the syndrome can be exterior and interior. Dampness, as one of the exogenous pathogenic factors, can invade the body and accumulate in the subcutaneous region, the muscles and the joints; it obstructs the meridians and collaterals. This disorder occurs particularly in areas where the climate is humid. External dampness can also directly invade the Middle-Jiao as a result of consuming inappropriate drinks and food that cause accumulation of dampness. Interior dampness is a result of dysfunction of the water metabolism, involving the Lung, Spleen, Kidney, Bladder and San Jiao. No matter how the dampness is formed (either by exterior or interior factors), as soon as it accumulates, it becomes a pathogenic factor, blocking the Qi circulation and causing further pathological changes.

In the diagnosis, the syndrome of dampness can be divided into damp-cold syndrome and damp-heat syndrome, which are decided by constitution and dietary habit of the individual, as well as the nature of the pathogenic factors. The treatment principles and the strategies of composing formulas are quite different in these two types. For clarity, these two syndromes are discussed separately.

1. Damp-cold syndrome

Manifestations

Main symptoms

Edema, cough with thin, watery phlegm, hydrothorax, ascites, diarrhea, difficult urination or retention of urine, painful, swollen, heavy and cold limbs, fear of cold.

Secondary symptoms

Heaviness of the body, distension in the abdomen and fullness in the chest, palpitations, shortness of breath, dizziness, vertigo, vomiting and tiredness. The syndrome has a lingering and recurrent process.

Tongue

Slightly pale with a watery or moist coating.

Pulse

Soft.

Associated disorders in western medicine

Acute and chronic bronchitis, pneumonia, upper respiratory infection, pulmonary emphysema, pulmonary heart disease, heart failure, acute nephritis and renal failure, chronic nephritis, gastritis, hypothyroidism, hypoadrenalism, fibromyalgia, rheumatic arthritis and rheumatoid arthritis.

Analysis of the syndrome

Water metabolism depends on the proper functioning of the Lung, Spleen, Kidney and San Jiao, especially the Yang and Qi aspects of these organs.

• When the functions of the Lung, Spleen, Kidney and San Jiao are disturbed, the water may accumulate inside the body. Edema and accumulation of fluid are the most commonly seen symptoms.

• If the Lung-Qi is blocked, edema often shows on the face and fingers, there is cough with thin, watery phlegm and hydrothorax.

• If the Spleen is disturbed, or the Yang and Qi are weak, edema shows in the legs and joints, and in ascites. Diarrhea may also occur.

• If the Kidney is disturbed or the Yang and Qi of the Kidney are weak, edema appears mainly in the legs and joints. Patients may suffer from difficult urination, retention of urine and incontinence.

• Dampness is a Yin pathogenic factor and has a stagnating tendency. This characteristic is shown not only by the symptoms, but also by a lingering, recurrent or chronic pathological process.

Exterior dampness is a Yin pathogenic factor. It often invades the body with wind and cold.

• The exterior dampness stays at the skin, the subcutaneous region, the muscles and the joints. It blocks the Qi movement and blood circulation, and causes Bi syndrome.

• When dampness predominates, patients have heaviness of the body and swelling of the joints of a lingering and recurrent nature. Complaints can get worse in humid weather.

A constitution of internal cold and a diet of cold and raw food or low-calorie food may generate cold, further injure the Yang of the Spleen and form damp-cold in the body. Milk products may also increase the possibility of dampness accumulation.

(See Figure 7.1 on page 221.)

• When Qi is blocked, fullness of the chest, stomach and abdomen occur.

• When Qi is unable to move freely, patients may easily feel tired.

• When there is Yang deficiency in the body, the accumulated cold fluid in the Lower-Jiao may move upward and attack the Heart, Lung and head, causing palpitations, shortness of breath, dizziness, vertigo and vomiting.

• Damp-cold obstructs and weakens the Yang, thus patients often have a feeling of cold in the limbs and are also afraid of cold.

• A watery tongue coating and a soft pulse indicate the accumulation of dampness in the body.

(See Figure 7.2 on page 222.)

Treatment principle: Disperse, dry, dissolve and leach out dampness, regulate and strengthen the function of the Lung, Spleen, Kidney and San Jiao

Herb selection principles and formula composition strategies

Herbs should first be selected according to the regions or organs involved:

• If exterior dampness accumulates in the Upper-Jiao and superficial region of the body, warm, aromatic or pungent herbs that enter the Lung, Bladder and Spleen meridians, and can disperse and induce mild sweating are often selected.

• If dampness accumulates in the Middle-Jiao, the first priority is to select herbs that are aromatic and warm, pungent and warm, bitter and warm or bland and neutral, and can respectively disperse, dry, dissolve or leach out dampness.

• If dampness accumulates in the Lower-Jiao and disturbs the function of the Bladder, bland, bitter and warm herbs are selected to leach out dampness or warm the Kidney and accelerate water metabolism.

• Second, pungent and warm herbs that can warm the interior are selected.

• Herbs that strengthen and tonify the Spleen in order to activate its function are used in all types of dampness syndrome.

• A small amount of sour herbs can be added to the formula to protect the Yin, along with sweet herbs to protect the Stomach.

• To treat Bi syndrome, herbs that expel damp-cold from the meridians are used.

• Herbs that promote digestion and regulate the Qi are often selected.

CAUTIONS

1. Caution in Yin deficiency:

Herbs and formulas that drain dampness are pungent, warm, bitter or bland and they may injure the Yin. Patients with Yin deficiency should not use them, especially for a long period of time.

2. Avoid large dosage:

Since dampness is a Yin pathogenic factor and has a heavy, turbid and sticky nature, herbs and formulas should have a steady and constant action. Large dosage should be avoided in a long treatment course.

3. Caution in pregnancy:

Pregnant women should use the formulas with caution as these formulas contain aromatic, pungent and bitter herbs, which can easily move Qi and blood, and drain dampness. They may bring danger to the pregnancy.

4. Avoid heavy sweating in the treatment:

When wind, dampness and cold attack the superficial region of the body, the treatment method of inducing mild sweating may help to open the pores and expel dampness there. However, sweating heavily does not help to remove dampness, as dampness has a lingering nature and heavy sweating can also injure the Yin of the body.