Before starting our discussion I would like to clarify something regarding the nature of Damp-Heat. In Damp-Heat, Dampness is the predominant pathogenic factor: it is the Dampness that is hot, not the Heat that is damp. In fact, it would be better to call it “Hot Dampness” rather than “Damp-Heat”; however, I will continue calling it “Damp-Heat” because this term is in such common use. This means that, in the treatment of Damp-Heat, we must concentrate on draining or resolving Dampness rather than on clearing Heat. However, we do of course use cold herbs too to clear Heat.
I would like also to point out that generally Chinese books and doctors overstate the frequency of Damp-Heat and always talk about Damp-Heat, seldom of “Dampness”. For example, in China, every urinary problem is due to Damp-Heat, whereas we also see a lot of urinary problems with Dampness but without Heat, and a lot of urinary problems caused by Qi stagnation or Qi sinking. Similarly, any Gall-Bladder problem will always be attributed to Gall-Bladder Damp-Heat, whereas in the West we see a lot of patients with Gall-Bladder problems and Dampness but not much Heat. I discuss here Dampness in the context of Heat because it is such a common pathogenic factor in many different symptoms and diseases.
AETIOLOGY OF DAMPNESS
Dampness can derive from environmental or climatic dampness: thus, it may be due to humid weather (whether hot or cold), but also to damp living conditions, such as living in damp houses. Exterior Dampness can also be caught by wearing wet clothes, wading in water, working in damp places or sitting on damp ground.
External Damp-Heat is more predominant in summer and late summer, and specifically from the “Great Heat” period (of the 24 periods of a year) to the “White Dew” period, i.e. roughly two months before the Autumn equinox.
Prevailing Qi of the place
The seasonal is a heavenly exterior factor, the prevailing Qi of a place is an earthly exterior factor. This is due to prevailing conditions of a place, i.e. a low-lying, damp place, a place prone to fog, damp living conditions in the house, etc.
Dampness may result from the excessive consumption of greasy foods, dairy foods, sweets, sugar, cold-raw foods. Damp-Heat may also arise from excessive alcohol drinking together with that of greasy-fried foods. Dampness may also be due to overeating (in the same way as Retention of Food) or from irregular eating habits.
Excessive physical work (including sports, exercises, lifting, gym, etc.) can weaken the Spleen and lead to Dampness. Internal injury of Spleen Weakness of the Spleen deriving from a chronic illness.
A constitutional weakness of the Earth element predisposes the patient to Spleen deficiency and Dampness. On the other hand, a constitutional tendency to a Fullness of the Earth (for example, people with a constitutional tendency to Stomach-Heat) may lead to Heat in the Stomach and Spleen which combines with Dampness.
CHARACTERISTICS OF DAMPNESS
The following are the characteristics of Dampness:
– it is sticky
– it is difficult to get rid of
– it is heavy
– it slows things down
– it infuses downwards
– it causes repeated attacks
– it is lingering
When exterior Dampness invades the body, it tends to invade the lower part first, typically the legs. From the legs, it can flow upwards in the leg channels to settle in any of the pelvic cavity organs. If it settles in the female genital system it causes vaginal discharges, if it settles in the Intestines it will cause loose stools and if it settles in the Bladder it will cause difficulty, frequency and burning of urination. However, Dampness is also common in the head and always the cause of sinusitis for example.
The clinical manifestations of Dampness are extremely varied according to its location and nature (hot or cold), but the general ones are:
– a feeling of heaviness of body or head
– no appetite
– a feeling of fullness of chest or epigastrium
– a sticky taste
– a vaginal discharge
– a sticky tongue coating
– Slippery or Soggy pulse.
According to its location, the more specific clinical manifestations of internal Dampness are:
– Head: feeling of heaviness of the head
– Eyes: red-swollen eyelids, eyes oozing a fluid, sties
– Mouth: mouth ulcers on gums, swollen-red lips
– Stomach and Spleen: feeling of fullness of epigastrium, feeling of fullness after eating, sticky taste, loose stools, poor appetite, Soggy pulse.
– Lower Burner: excessive vaginal discharge, painful periods, infertility, turbid urine, difficult and painful urination, scrotal sweating or eczema, genital eczema, genital itching.
– Skin: papules (Damp-Heat with more Heat), vesicles (Dampness without Heat), pustules, (Damp-Heat with Toxic Heat), greasy sweat, boils, any oozing skin lesion, oozing eczema, puffy skin.
– Joints: swollen-painful joints (Fixed Bi syndrome).
– Luo Channels: numbness and loss of sensation.
Figure 1 illustrates the classification of Dampness.
TREATMENT PRINCIPLES FOR DAMPNESS
There are many treatment principles when treating Dampness depending on its nature (hot or cold) and its location. I will discuss only the three major ones: drain Dampness through urination with bland-neutral herbs, resolve Dampness from the digestive system and muscles through sweating with fragrant-pungent herbs and dry Dampness with bitter-cold herbs.
Table 1, 2 and 3 illustrate the main herbs and formulae according to the above treatment principles.
Table 1. Bland-neutral herbs and formulae for Dampness which drain Dampness through urination.
Table 2. Fragrant-pungent herbs and formulae for Dampness in the digestive system and muscles which resolve Dampness through sweating.
Table 3. Bitter-cold herbs and formulae for Damp-Heat which dry Dampness.
SUMMARY OF TASTES/TEMPERATURE AND ACTIONS
To summarize the three main treatment principles for Dampness with examples of herbs, these are:
Drain Dampness through urination, diuretics (FU LING)
Resolve Dampness through sweating (CANG ZHU)
Dry Dampness (HUANG QIN)
These are also summarized in Figure 2.
Figure. 2. The three main treatment principles for Dampness with sub-types.
Damp-Heat should be discussed separately from Heat because it is such a common pathogenic factor that can be the cause of a very wide variety of problems.
Damp-Heat is particularly important as a pathogenic factor because it itself can become a cause of disease. In fact, not only Dampness obstructs the Qi mechanism leading to more Dampness, but Heat also dries up the fluids and condenses them into more Dampness. Furthermore, the Heat part of Damp-Heat (especially if predominant) may also injure Yin. These pathological processes are illustrated in Figure 3.
Figure 3. Consequences of Damp-Heat.
CHARACTERISTICS OF DAMP-HEAT
I discussed above the characteristics of Dampness; here I describe the characteristics of Damp-Heat.
1) Seasonal character
Prevalent in summer and late summer, even in countries that are not that hot but are damp in the summer. The seasonal Damp-Heat also exacerbates a pre-existing internal condition of Damp-Heat (e.g. urinary problems, Gall-Bladder problems, Wei syndrome, MS, intestinal problems, etc.).
2) Lingering, long course of disease
Damp-Heat is lingering. The Heat part of Damp-Heat also perpetuates the problem as Heat condenses the body fluids into Dampness.
3) Gives rise to Phlegm
Damp-Heat easily gives rise to Phlegm and Phlegm-Heat because the Heat in Damp-Heat can condense the body fluids into Phlegm.
4) Manifests with complex symptoms
Due to the combination of Dampness and Heat which may give rise to contradicting symptoms and signs. For example, the patient may feel hot (from Heat) but the skin may be cold to the touch, or he may have cold feet. Or the patient may feel cold in general, but he may also get hot easily. There may be a feeling of heat but the pulse is not rapid or vice versa. There may be a thirst (because of the Heat) but with no desire to drink (because of the Dampness). The bowels may be sometimes loose (from Dampness) and sometimes dry (from Heat).
5) Damp-Heat may injure Yin
The Heat part of Damp-Heat, if predominant, may injure Yin: this leads to even more complex clinical manifestations, e.g. the patient has obvious symptoms of Damp-Heat but the tongue has no coating.
6) Damp-Heat is frequently toxic (Toxic Heat)
Damp-Heat frequently gives rise to Toxic Heat. Toxic Heat is characterized by heat, swelling, pain and often pus. A skin bacterial infection causing pustules is an example of Toxic Heat.
7) Damp-Heat easily damages Stomach and Spleen
Of course, Dampness by itself also damages Stomach and Spleen but Damp-Heat even more because Dampness tends to injure the Spleen while Heat tends to injure the Qi and Yin of the Stomach.
SYMPTOMS OF DAMP-HEAT
The following is a summary of the symptoms of Damp-Heat. Please note that symptoms such as low-grade fever or afternoon fever are not common and they appear only when the Heat is pronounced.
ache in muscles
feeling of heat
body hot to touch
afternoon fever (rare)
a feeling of oppression of the epigastrium
a feeling of heaviness of body and head
thirst with no desire to drink
SKIN SYMPTOMS OF DAMP-HEAT
There are many skin diseases that manifest with Damp-Heat; for example, eczema and acne. There are three main skin eruptions to consider: papules, vesicles and pustules.
Papules are red and stick out. They may indicate Damp-Heat but they may also indicate Heat. Examples of papules from Damp-Heat are eczema, acne and herpes.
Vesicles also stick out but are not red and are filled with a clear fluid. An example of vesicles is the rash that appears in chicken pox.
Pustules are like vesicles but they are red and filled with pus. Acne presents with pustules if the skin spots are large, red and painful.
Many signs indicate Damp-Heat such as oozing skin eruptions, swollen-painful eyes, sty on eyelids, oozing eyes, mouth ulcers. The following three pictures are examples of Damp-Heat.
The picture below is an example of Damp-Heat with Toxic-Heat.
When diagnosing Damp-Heat we must differentiate between prevalence of Dampness and prevalence of Heat because it makes a difference to the treatment. In prevalence of Dampness we will use bland-neutral or pungent-fragrant herbs and formulae. In prevalence of Heat, we will use bitter-cold herbs and formulae.
The following illustrates the differentiation between prevalence of Dampness and prevalence of Heat in Damp-Heat.
Prevalence of Dampness
Fever, feeling of heat, greasy sweat, greasy skin
Feeling of heaviness of eyes and head
Sweet-sticky taste, no thirst, likes warm drinks
Weariness, likes to lie down, feeling of oppression of the chest, likes to be quiet, no irritability
Stools with mucus or watery, turbid urine
Sticky-white or sticky-yellow tongue coating
Pulse Slow, Weak-Floating
Prevalence of Heat
More fever or feeling of heat, skin not greasy
Slightly red eyes, dizziness, headache
Bitter taste, no desire to drink
Hungry but no desire to eat
Constipation, scanty-dark urine
Red tongue-body, or red sides, sticky-dry-yellow coating
Pulse Rapid and weak-Floating or Rapid and Wiry
TREATMENT OF DAMPNESS WITH ACUPUNCTURE
With acupuncture, when treating Damp-Heat, we must concentrate the attention on draining or resolving Dampness. In order to do that, I stimulate the movement, transformation and excretion of fluids in each of the three Burners with the points listed below.
– Upper Burner: Du-26 Shuigou, LU-7 Lieque, LI-4 Hegu, LI-6 Pianli, TB-4 Yangchi, TB-6 Zhigou, Ren-17 Shanzhong.
– Middle Burner: Ren-9 Shuifen, Ren-12 Zhongwan, ST-22 Guanmen, Ren-11 Jianli.
– Lower Burner: ST-28 Shuidao, BL-22 Sanjiaoshu, Ren-5 Shimen, BL-39 Weiyang, SP-9 Yinlingquan, SP-6 Sanyinjiao, KI-7 Fuliu.
For example, for Dampness in the Lower Burner, I would use several points from the Lower Burner list but also some of the Upper and Middle Burner, e.g. Ren-5 Shimen, BL-39 Weiyang, SP-9 Yinlingquan, BL-22 Sanjiaoshu (Lower Burner) plus LU-7 Lieque (Upper Burner) and Ren-9 Shuifen (Middle Burner).
I will now list the most common Zangfu Damp-Heat patterns with their treatment.
DAMP-HEAT IN THE SPLEEN
A feeling of fullness of the epigastrium and/or lower abdomen, epigastric and/or abdominal pain, poor appetite, a feeling of heaviness, thirst without desire to drink, nausea, loose stools with offensive odour, burning sensation in the anus, a feeling of heat, scanty-dark urine, low-grade fever, dull headache with feeling of heaviness of the head, dull-yellow complexion like tangerine peel, yellow sclera of the eyes, oily sweat, bitter taste, itchy skin or skin eruptions (papules or vesicles), if there is a fever and sweating, this does not relieve the fever and does not lead to the clearing of Heat.
Tongue: Red with sticky-yellow coating.
SP-9 Yinlingquan, SP-6 Sanyinjiao, Du-9 Zhiyang, L.I.-11 Quchi, BL-20 Pishu, G.B.-34 Yanglingquan, Ren-9 Shuifen, Ren-11 Jianli, ST-22 Guanmen, ST-28 Shuidao, BL-22 Sanjiaoshu.
Lian Po Yin Coptis-Magnolia Decoction.
DAMP-HEAT IN THE LIVER
Fullness of the hypochondrium, abdomen or hypogastrium, bitter taste, poor appetite, nausea, feeling of heaviness of the body, yellow vaginal discharge, vaginal itching, vulvar eczema or sores, mid-cycle bleeding and/or pain, pain, redness and swelling of the scrotum, genital, papular or vesicular skin rashes and itching, urinary difficulty, burning on urination, dark urine.
Tongue: Red body with redder sides, sticky-yellow coating.
Long Dan Xie Gan Tang Gentiana Draining the Liver Decoction.
DAMP-HEAT IN THE GALL-BLADDER
Hypochondrial pain, fullness and distension, nausea, vomiting, inability to digest fats, yellow complexion, scanty and dark yellow urine, fever, thirst without desire to drink, bitter taste, dizziness, tinnitus, irritability, feeling of heaviness of the body, numbness of the limbs, swelling of the feet, loose stools or constipation, alternation of hot and cold feeling, yellow sclera, feeling of heat.
Tongue: thick-sticky-yellow coating, either bilateral in two strips or unilateral.
G.B.-24 Riyue, LIV-14 Qimen, Ren-12 Zhongwan, G.B.-34 Yanglingquan, extra point Dannangxue, Du-9 Zhiyang, BL-19 Danshu, BL-20 Pishu, L.I.-11 Quchi, T.B.-6 Zhigou, ST-19 Burong.
Yin Chen Hao Tang Artemisia Capillaris Decoction.
DAMP-HEAT IN LIVER AND GALL-BLADDER
Fullness of the hypochondrium, abdomen or hypogastrium, bitter taste, poor appetite, nausea, feeling of heaviness of the body, yellow vaginal discharge, vaginal itching, vulvar eczema or sores, mid-cycle bleeding and/or pain, pain, redness and swelling of the scrotum, genital, papular or vesicular skin rashes and itching, urinary difficulty, burning on urination, dark urine, hypochondrial pain, fever, yellow complexion and eyes, vomiting.
Tongue: Red body with redder sides, unilateral or bilateral sticky-yellow coating.
LIV-14 Qimen, G.B.-24 Riyue, G.B.-34 Yanglingquan, BL-18 Ganshu, BL-19 Danshu, Du-9 Zhiyang, Ren-12 Zhongwan, SP-9 Yinlingquan, SP-6 Sanyinjiao, SP-3 Taibai, L.I.-11 Quchi, LIV-2 Xingjian, LIV-3 Taichong.
Long Dan Xie Gan Tang Gentiana Draining the Liver Decoction.
A feeling of fullness and pain of the epigastrium, a feeling of heaviness, facial pain, stuffed nose or thick-sticky nasal discharge, thirst without desire to drink, nausea, a feeling of heat, dull-yellow complexion, a sticky taste, mouth ulcers.
Tongue: Red tongue with sticky-yellow coating.
ST-44 Neiting, ST-34 Liangqiu, ST-21 Liangmen, Ren-12 Zhongwan, Ren-13 Shangwan, L.I.-11 Quchi, L.I.-4 Hegu, Ren-11 Jianli, ST-25 Tianshu, ST-40 Fenglong, SP-9 Yinlingquan, Ren-9 Shuifen.
Lian Po Yin Coptis-Magnolia Decoction.
DAMP-HEAT IN THE SMALL INTESTINE
Loose stools or diarrhoea with mucus in the stools, abdominal fullness and pain, mental restlessness, scanty and dark urine, burning pain on urination, blood in urine.
Tongue: Red with redder and swollen tip, yellow coating.
Pulse: Overflowing-Rapid, especially in the Front position. If there are urinary symptoms the pulse would be Wiry on the Left-Rear position.
ST-25 Tianshu, ST-37 Shangjuxu, ST-39 Xiajuxu, ST-28 Shuidao, SP-9 Yinlingquan, BL-27 Xioaochangshu.
Bai Tou Wen Tang Pulsatilla Decoction.
DAMP-HEAT IN THE LARGE INTESTINE
Abdominal pain that is not relieved by a bowel movement, diarrhoea, mucus and blood in stools, offensive odour of stools, burning in the anus, scanty-dark urine, fever, sweating which does not decrease the fever, a feeling of heat, thirst without desire to drink, feeling of heaviness of the body and limbs.
Tongue: Red with sticky-yellow coating.
SP-9 Yinlingquan, SP-6 Sanyinjiao, BL-22 Sanjiaoshu, ST-25 Tianshu, ST-27 Daju, Ren-6 Qihai, BL-25 Dachangshu, L.I.-11 Quchi, Ren-12 Zhongwan, ST-37 Shangjuxu, BL-20 Pishu.
Ge Gen Qin Lian Tang Pueraria-Scutellaria-Coptis Decoction.
Bai Tou Weng Tang Pulsatilla Decoction.
Shao Yao Tang Paeonia Decoction.
DAMP-HEAT IN THE BLADDER
Frequent and urgent urination, burning on urination, difficult urination (stopping in the middle of flow), dark-yellow and /or turbid urine, blood in the urine, fever, thirst with no desire to drink, hypogastric fullness and pain, feeling of heat.
Tongue: thick-sticky-yellow coating on the root with red spots.
Pulse: Slippery-Rapid and slightly Wiry on the Left-Rear position.
SP-9 Yinlingquan, SP-6 Sanyinjiao, BL-22 Sanjiaoshu, BL-28 Pangguangshu, Ren-3 Zhongji, BL-63 Jinmen, BL-66 Tonggu, ST-28 Shuidao.
Ba Zheng Tang Eight Upright Powder.
THE TONGUE IN DAMP-HEAT
Dampness manifests on the tongue primarily on the coating and Heat on the tongue-body colour. Therefore Damp-Heat manifests with a sticky-yellow coating and a red tongue-colour. The more Heat there is, the more the tongue body is red: the more Dampness there is, the thicker the coating.
The following are examples of tongue with a sticky-yellow coating from Damp-Heat.