bubble_chart Concept

The pattern of dampness and heat is a general term for pathological changes caused by the invasion of dampness-heat filthy turbidity or the internal accumulation of dampness-heat due to spleen and stomach dysfunction, leading to "heat retention due to block of dampness" and "dampness-heat steaming together." It is often caused by external contraction of pathogenic qi, or excessive consumption of alcohol and dairy products, which damage the spleen and stomach, resulting in dysfunction of the spleen in transportation and the obstruction of dampness-heat.

The main clinical manifestations include: hiding fever, heaviness in the head and body, dry mouth without desire to drink, chest tightness, abdominal distension and fullness, loss of appetite, or yellowing of the face and body, itchy skin, dark and scanty urine, yellow and thick leukorrhea with a foul odor in women, greasy tongue coating, and a soggy and slow or soggy and rapid pulse.

The pattern of dampness and heat is commonly seen in diseases such as "diarrhea," "dysentery," "jaundice," "tympanites," "edema," "stranguria," "ischuria," "atrophy-flaccidity disease," "Bi disease," "dampness warm disease," "latent summerheat," "summerheat warmth," and "leukorrhea."

This syndrome should typically be differentiated from the "pattern of cold dampness" and the "pattern of dampness obstruction in the qi phase."

bubble_chart Differentiation and Treatment

The pattern of dampness and heat can manifest in various diseases, each with distinct clinical features and differing treatment approaches, necessitating careful differentiation.

1. For instance, in diarrhea disease, the pattern of dampness and heat often presents with symptoms such as diarrhea, abdominal pain, urgent bowel movements, or incomplete evacuation, yellow-brown and foul-smelling stools, burning sensation in the anus, thirst, and scanty dark urine, characteristic of "dampness-heat pouring down." This is caused by exposure to dampness-heat pathogens, or excessive consumption of alcohol and rich foods, which injure the stomach and intestines, leading to abnormal transmission and transformation, and resulting in dampness-heat pouring down. Treatment should focus on clearing heat and resolving dampness, using modified Pueraria, Skullcap and Coptis Decoction (from the "Treatise on Cold Damage Diseases").
2. In dysentery, the pattern of dampness and heat typically presents with abdominal pain, tenesmus, bloody and mucous stools, burning sensation in the anus, scanty dark urine, red tongue with yellow greasy coating, and slippery rapid pulse, characteristic of "dampness-heat dysentery." This is often due to external exposure to dampness-heat and epidemic toxins, internal damage from unclean food, affecting the spleen, stomach, and intestines, leading to dampness-heat stagnation, obstruction of qi and blood, and transformation into pus and blood. Treatment should focus on clearing heat and draining dampness to stop dysentery, using Aucklandia and Coptis Pill (from "Taiping Huimin Heji Jufang").
3. In jaundice disease, the pattern of dampness and heat manifests as yellowing of the eyes and body, bright orange-yellow coloration, fever, thirst, or hidden fever, yellow greasy tongue coating, and wiry or soggy rapid pulse. This is often caused by seasonal pathogens invading and stagnating, or improper diet and excessive alcohol consumption, injuring the spleen and stomach, leading to dampness-heat obstruction, steaming the liver and gallbladder, and causing bile to overflow into the skin. Treatment should focus on clearing heat and draining dampness to resolve jaundice, using Virgate Wormwood Decoction (from the "Treatise on Cold Damage Diseases") or modified Powder of Capillaris and Five Ingredients with Poria (from "Jingui Yaolue").
4. In tympanites, the pattern of dampness and heat may present with a distended and firm abdomen, epigastric and abdominal pain, feverish sensation, bitter taste in the mouth, thirst without desire to drink, dark urine, constipation, or yellowing of the body and eyes. This is often due to excessive consumption of spicy foods and alcohol, leading to dampness-heat, or prolonged jaundice and abdominal masses, causing dampness-heat to accumulate and stagnate. Treatment should focus on clearing heat and draining dampness, expelling water by purgation, using modified Middle Fullness Separatively Eliminating Pill (from "Lanshi Micang"); for strong constitutions, Boats and Carts Pill (from "Danxi Xinfa") can be used temporarily to expel water by purgation, stopping once diarrhea occurs.
5. In disease with edema, the pattern of dampness and heat often presents with generalized edema, glossy skin, chest and abdominal stuffiness, feverish sensation, thirst, scanty dark urine, yellow greasy tongue coating, and deep rapid pulse, characteristic of "dampness-heat exuberance." This is caused by exposure to external pathogens, or wading in water, leading to internal invasion of water-dampness, or improper diet, causing dampness to accumulate and transform into heat, leading to dampness-heat stagnation internally and impaired bladder transformation. Treatment should focus on dispersing wind and expelling pathogens through the exterior, separating and draining dampness-heat, using modified Dredging and Channelling Decoction (from "Shiyi Dexiao Fang").
6. In strangury and ischuria, the pattern of dampness and heat often presents with hot, painful, and difficult urination, or even complete urinary blockage, dark yellow or turbid urine resembling rice water, lower abdominal distension and fullness, bitter taste and stickiness in the mouth, or thirst without desire to drink, characteristic of "dampness-heat in the lower energizer." This is often due to dampness-heat stagnation in the bladder, or heat from the kidneys transferring to the bladder, leading to dampness-heat obstruction and impaired bladder qi transformation. Treatment should focus on clearing heat and draining dampness to relieve strangury, using Eight-Ingredient Rectification Powder (from "Taiping Huimin Heji Jufang") or modified Cheng's Rhizoma Dioscoreae Decoction for Clearing Turbid Urine (from "Yixue Xinwu").
7. In atrophy-flaccidity disease, the pattern of dampness and heat often presents with limp and weak limbs, possibly with mild swelling and numbness, especially in the lower limbs, or fever, chest and gastric stuffiness, and difficult and painful urination. This is caused by prolonged residence in damp environments, or working in water, leading to external dampness invasion and stagnation, or improper diet and excessive consumption of rich foods, injuring the spleen and stomach, leading to internal dampness and heat accumulation, and dampness-heat soaking the sinews and vessels. Treatment should focus on clearing heat and draining dampness, using modified Two Wonderful Herbs Powder (from "Zabing Yuanliu Xizhu").
8. If in Bi disease, the pattern of dampness and heat is observed, the clinical manifestations often include redness, swelling, and burning heat in the joints, pain that worsens with pressure and is relieved by cold, often accompanied by fever, sweating, aversion to wind, thirst, restlessness, dark urine, and a yellow, greasy tongue coating. This is due to an inherent excess of yang qi or yin deficiency with yang hyperactivity in the body. When wind-cold dampness invades, it transforms into heat upon encountering yang, leading to multiple abscesses in the meridians and joints. Treatment should focus on clearing heat and unblocking the collaterals, dispelling wind, and draining dampness. The formula used is Impediment-Diffusing Decoction (Wenbing Tiaobian) with modifications.
9. In skin diseases such as eczema, if the pattern of dampness and heat is observed, the clinical manifestations are characterized by skin redness, swelling, erosion, constipation or diarrhea, scanty and dark urine, a red tongue with yellow and greasy coating, and a slippery and rapid pulse. This is caused by internal accumulation of dampness-heat, external contraction of wind pathogens, and the convergence of wind-dampness pathogenic heat in the skin. The treatment should focus on clearing heat and draining dampness, and the formula used is Gentian Liver-Draining Decoction(Lanshi Micang) with modifications.

In external contraction dampness-heat diseases such as "dampness warm disease," "summerheat warmth" (summerheat dampness disease), "latent summerheat," and "pestilence" (warm-heat epidemic), the triple energizer differentiation of dampness-heat can be observed:

1. Upper energizer dampness-heat manifests as severe aversion to cold, mild fever, or no fever, or afternoon fever, a heavy head as if wrapped, heaviness of the limbs, chest tightness without sweating, mental dullness, sticky mouth without thirst, gastric stuffiness and anorexia, or borborygmus and loose stools, a white and greasy tongue coating, and a soft and slow pulse. This is mostly caused by exposure to damp pathogens, stagnation of pathogens in the muscle surface, and internal obstruction of spleen qi. The treatment should focus on warming and dispersing superficial dampness, and the formula used is Patchouli Qi-Righting Powder(Taiping Huimin Heji Jufang); if heat signs are already evident, the treatment should focus on resolving dampness and heat, and the formula used is Huo Po Xia Ling Tang (from "Yiyuan").
2. Middle energizer dampness-heath manifests as hidden fever, or fever that decreases with sweating but then returns, or fever that worsens in the afternoon, heaviness of the limbs, chest and gastric stuffiness, nausea and vomiting, no hunger or appetite, thirst without desire to drink, a shallow yellow or pale yellow complexion, mental dullness and few words, or even unconsciousness, scanty and dark urine, loose stools with difficulty, or white miliaria, a gray and yellow tongue coating, and a soft and rapid pulse. This is caused by transmission from upper energizer dampness-heat or by exposure to summerheat dampness pathogens, leading to internal damage to the spleen and stomach. The treatment should focus on clearing and resolving dampness and heat, and the formula used is Sweet Dew Detoxicating Pill(Wenre Jingwei); if phlegm obstructs the seven orifices and causes mental confusion, the treatment should focus on resolving phlegm for resuscitation, and the formula used is Acorus Curcuma Root Decoction (from "Complete Book of Warm Diseases").
3. Dampness-heat in the lower energizer manifests as urinary retention, thirst without much desire to drink, or constipation, hard and full lower abdomen, a heavy and dull head, unconsciousness, a grayish-white and yellow greasy tongue coating, and a soft and rapid pulse. This is caused by the transmission of dampness-heat pathogens to the lower energizer, obstructing the bladder and large intestine, leading to dysfunction of bladder qi transformation and obstruction of large intestine qi. The treatment should focus on promoting urination and separating the clear from the turbid, and the formula used is Tuckahoe Peel Decoction (Wenbing Tiaobian), or promoting the discharge of turbidity and stagnation, and the formula used is Xuan Qing Dao Zhuo Tang (Wenbing Tiaobian).

The above shows that the triple energizer differentiation is based on the location and sequence of damage to the zang-fu organs by dampness-heat, divided into upper, middle, and lower parts, and also represents the initial, middle, and final stages of dampness-heat diseases. Clearly, this forms a self-contained system in theory, and its significance is not entirely the same as the Zabing pattern of dampness and heat. In summary, although the symptoms and signs belong to dampness-heat, their manifestations vary in different diseases, and clinical differentiation should be based on the characteristics of the above syndromes.

Moreover, the pattern of dampness and heat often occurs in summer and autumn, when rainfall is abundant and dampness is prevalent. People with spleen-stomach weakness are more susceptible. In women, the pattern of dampness and heat mainly manifests as excessive and sticky leucorrhea, with a foul odor, yellow color, or blood streaks. Treatment should be "in accordance with individuality."

Dampness is a yin pathogen, and heat is a yang pathogen. The two are intertwined and difficult to separate. Especially in dampness-heat diseases, the pathogens often linger in the middle energizer for the longest time and undergo more changes, which is related to dampness obstructing the spleen and impairing its transportation and transformation. Generally, the progression can be divided into two scenarios: transforming into heat from yang or transforming into cold from yin. Transforming into heat from yang occurs when the patient's constitution is yang-qi abundant, or the symptom and sign type is heat predominating over dampness, or during treatment, excessive use of warm and drying substances leads to gradual retreat of dampness and gradual increase of heat, eventually transforming into dryness-heat. Transforming into cold from yin occurs when the patient's constitution is yang-deficient, or the symptom and sign type is dampness predominating over heat, or during treatment, excessive use of bitter and cold substances damages yang qi, leading to dampness not being expelled and heat gradually retreating, eventually developing into cold-dampness syndrome.

bubble_chart Differentiation of Similar Patterns

1. Pattern of dampness obstruction in qi phase and pattern of dampness and heat: Both syndromes belong to the category of dampness disease. In terms of disease cause, the pattern of dampness and heat is mostly caused by direct exposure to dampness-heat pathogens, or by unclean diet, excessive consumption of spicy and greasy foods, which injure the spleen and stomach, leading to the spleen's inability to transform and transport, resulting in internal retention of water-dampness, which then stagnates and transforms into heat, causing the steaming of dampness-heat. Heat within dampness, dampness-heat steaming, hence hidden fever, with fever worsening in the afternoon; dampness-heat obstruction, qi movement is not smooth, ascending and descending are abnormal, hence chest and gastric stuffiness, nausea, no hunger, and no desire to eat; heat damages fluids, dampness overcomes heat, hence thirst but no desire to drink much or no thirst; dampness stagnation and heat steaming the liver and gallbladder, gall bladder overflow, leading to yellowing of the face and eyes; dampness-heat obstruction in the lower energizer, qi loses its smooth flow, hence scanty and reddish urine, loose stools with incomplete evacuation, women may see sticky leukorrhea, filthy and turbid with odor. The pattern of dampness obstruction in qi phase is also caused by irregular diet, excessive consumption of raw, cold, greasy, and sweet foods, injuring the spleen and stomach, leading to the spleen's inability to transform and transport, resulting in internal retention of water-dampness, dampness obstruction is caused by dampness pathogens obstructing the middle energizer, its clinical manifestations mainly include general heaviness and lack of strength, chest tightness, abdominal distension and fullness, bland taste in the mouth, sticky mouth, no desire to eat, scanty urine, mainly characterized by thick and greasy tongue coating. It can be seen that the pattern of dampness and heat has heat signs, while dampness obstruction has no heat signs, which can be used for differentiation.
2. Pattern of cold dampness and pattern of dampness and heat: Both also belong to the category of dampness pathogen diseases. Cold-dampness mostly belongs to spleen yang deficiency, unable to transform and transport water-dampness, leading to dampness transforming into cold, internally generating cold-dampness, seen as abdominal distension and fullness, diarrhea, etc., or as phlegm-fluid retention, edema, etc. Dampness-heat is mostly caused by direct exposure to dampness-heathexternal pathogens, or by overeating greasy and sweet foods, intense stomach fire, leading to dampness transforming into heat. The difference between the pattern of cold dampness and the pattern of dampness and heat lies in that the pattern of cold dampness has cold signs, while the pattern of dampness and heat has heat signs.

bubble_chart Documentation

1. "Shen Zhai's Posthumous Writings ‧ Dysentery": "Dysentery is mostly caused by dietary injury, the struggle between dampness and heat. If there is tenesmus, no fever, and normal diet, this is true dysentery. It is due to excess in the spleen and stomach, and should first be treated by dredging, followed by Skullcap Root Peony Root Decoction for regulation."
2. "Yixue Xinwu ‧ Jaundice": "Jaundice is characterized by yellowing of the eyeballs, gradually spreading to the skin, all showing yellow color. This is caused by the obstruction of dampness-heat, similar to fermenting yeast, where dampness steams and heat stagnates to form yellow color. However, the yellow of dampness-heat is like that of oranges and cypress bark, shining due to fire qi, known as yang jaundice. ... For yang jaundice, use Gardenia and Phelloendron Decoction. If there is constipation, use Virgate Wormwood Rhubarb Rhizoma Decoction. ... Among them, those caused by food injury (dyspepsia) are called dietary jaundice. Those caused by alcohol injury are called alcoholic jaundice, and those whose sweat stains clothes yellow are called yellow sweat, all of which are types of yang jaundice."
3. "Zhengzhi Huibu ‧ Atrophy-Flaccidity": "Dampness-heat wilting is caused by rain and dampness soaking, pathogenic qi steaming the spleen, flowing to the limbs, with a self-sensation of qi rising against the foot meridians, or soreness, weakness, swelling, and pain in the limbs, or numbness and stubborn itching in the toes, red and astringent urine, and a deep, soggy, and rapid pulse. This is all due to dampness-heat in purgation."
4. "Zhengzhi Yuanbu ‧ Dampness Pattern": "All cases of jaundice, yellowing, swelling, distension, stuffiness, diarrhea, strangury, turbidity, leukorrhea, body heaviness, swelling and pain, pus sores, and dysentery with tenesmus are caused by dampness-heat. They should be treated differently. If dampness is predominant, clear the dampness; if heat is predominant, clear the heat. If dampness overcomes heat, do not treat with heat and use cold medicine, as this will make the dampness heavier; if heat overcomes dampness, do not treat with dampness and use drying medicine, as this will make the heat more severe."
5. "Zhang's Medical Treatise ‧ Wilting Impediment Section": "For those caused by dampness-heat, there is pain in the limbs and joints, heaviness in the shoulders and back, discomfort in the chest and diaphragm, and pain and swelling in the lower legs, use Angelica Pain-Relieving Decoction."