Chapter 9: Dampness Disease: Pulse, Signs, and Treatment
Dampness Disease: Pulse, Pattern, and Treatment, Part Nine
Dampness, as a pathogenic factor, flows everywhere—inside and outside the body, above and below. It changes according to the pathogenic influences it combines with, each manifesting in different disease patterns. One should follow the rules to diagnose and treat, not losing the guiding principles.
When dampness is in the upper body, attacked by the pathogenic influence of mist and dew, there is headache, stiff neck, pain in both temples, and a floating and rough pulse. Treat it with Huang Qi Gui Zhi Fu Ling Xi Xin Tang (Astragalus, Cinnamon Twig, Poria, and Asarum Decoction).
Huang Qi Gui Zhi Fu Ling Xi Xin Tang Formula:
Astragalus (Huang Qi) 3 liang
Cinnamon Twig (Gui Zhi) 2 liang
Poria (Fu Ling) 3 liang
Asarum (Xi Xin) 1 liang
These four ingredients, use 5 sheng of water to decoct until 3 sheng remain. Remove the dregs, and take 1 sheng warm, three times daily.
When dampness is in the lower body, attacked by the pathogenic influence of water and cold, there is heaviness from the waist down, swelling of both feet, and a deep and rough pulse. Treat it with Gui Zhi Fu Ling Bai Zhu Xi Xin Tang (Cinnamon Twig, Poria, Atractylodes, and Asarum Decoction).
Gui Zhi Fu Ling Bai Zhu Xi Xin Tang Formula:
Cinnamon Twig (Gui Zhi) 3 liang
Poria (Fu Ling) 4 liang
Atractylodes (Bai Zhu) 3 liang
Asarum (Xi Xin) 2 liang
These four ingredients, use 6 sheng of water to decoct until 2 sheng remain. Remove the dregs, and take 1 sheng warm, twice daily.
When dampness is on the body surface, because it struggles and binds with wind pathogen, it flows and pours into the channels and collaterals, causing painful joints, lying down unwilling to eat, a floating and moderate pulse, and a rough sensation when pressed. Treat it with Gui Zhi Tang (Cinnamon Twig Decoction) to induce slight sweating, so that both wind and dampness are eliminated together. If there is aversion to cold, body pain, numbness of the four limbs, and a floating, thin, and tight pulse, this is due to cold pathogen. Treat it with Gui Zhi Ma Huang Ge Ban Tang (Equal Combination of Cinnamon Twig and Ephedra Decoction).
Gui Zhi Tang Formula:
Cinnamon Twig (Gui Zhi) 3 liang (remove bark)
Peony (Shao Yao) 3 liang
Licorice (Gan Cao) 2 liang (honey-fried)
Fresh Ginger (Sheng Jiang) 3 liang (cut)
Chinese Dates (Da Zao) 12 pieces (split)
These five ingredients, crush with the mouth. Use 7 sheng of water, decoct over a low fire until 3 sheng remain. Remove the dregs, adjust to a comfortable temperature, and take 1 sheng.
Shortly after taking the medicine, drink a little over 1 sheng of hot congee to assist the medicinal power. Cover with a blanket to keep warm, so that after about one shichen (two hours) the whole body sweats slightly. It is best to have a sensation of sweat barely appearing; do not let the sweat flow like running water, for then the disease will certainly not be eliminated.
If after the first dose sweating occurs and the disease is cured, stop taking the remaining doses; you need not finish all the medicine. If no sweating occurs, take the medicine again according to the previous method. If still no sweating, the interval between subsequent doses may be slightly shortened, finishing three doses within about half a day.
If the disease is severe, take the medicine day and night, observing the patient throughout the day. After finishing one entire package of doses, if the disease pattern still exists, continue taking the medicine again.
If sweating does not occur, take up to two or three packages. Avoid raw, cold, sticky, slippery, meat, flour, the five acrid vegetables, wine, cheese, and foul-smelling foods.
Ma Huang Tang (Ephedra Decoction) Formula:
Ephedra (Ma Huang) 3 liang (remove nodes)
Cinnamon Twig (Gui Zhi) 3 liang (remove bark)
Licorice (Gan Cao) 1 liang (honey-fried)
Apricot Kernel (Xing Ren) 70 pieces (remove skin and tip)
These four ingredients, use 9 sheng of water. First decoct the Ephedra until the water is reduced by 2 sheng, skim off the foam, then add the other ingredients. Decoct until 2½ sheng remain. Remove the dregs, take 8 ge warm, cover with a blanket to induce slight sweating as if sweat is barely appearing. There is no need to drink congee. For the rest, follow the method of Gui Zhi Tang for convalescence.
Gui Zhi Ma Huang Ge Ban Tang Formula:
Take 3 ge of Gui Zhi Tang and 3 ge of Ma Huang Tang, combine to make 6 ge, take in one dose. The method of convalescence is the same as for Gui Zhi Tang.
When dampness is internally and struggles with the spleen, it causes middle jiao distention and fullness. If cold in the stomach accompanies it, it transforms into diarrhea. For middle jiao distention and fullness, Bai Zhu Fu Ling Hou Po Tang (Atractylodes, Poria, and Magnolia Bark Decoction) is appropriate. For diarrhea, Li Zhong Tang (Regulate the Center Decoction) is appropriate.
Bai Zhu Fu Ling Hou Po Tang Formula:
Atractylodes (Bai Zhu) 3 liang
Poria (Fu Ling) 4 liang
Magnolia Bark (Hou Po) 2 liang (honey-fried, remove bark)
These three ingredients, use 5 sheng of water to decoct until 1 sheng 5 ge remain. Remove the dregs, divide into two doses, and take warm.
Li Zhong Tang Formula:
Ginseng (Ren Shen) 3 liang
Dried Ginger (Gan Jiang) 3 liang
Atractylodes (Bai Zhu) 3 liang
Licorice (Gan Cao) 3 liang (honey-fried)
These four ingredients, use 8 sheng of water to decoct until 3 sheng remain. Remove the dregs, take 1 sheng warm, three times daily.
If dampness invades upward and attacks the lung, causing lung cold, treat it with Xiao Qing Long Tang (Minor Green Dragon Decoction). If it moves downward to the kidney, causing dribbling and painful urination, treat it with Wu Ling San (Five-Ingredient Powder with Poria). If it flows into the muscles, causing yellow swelling, treat it with Ma Huang Fu Ling Tang (Ephedra and Poria Decoction).
Xiao Qing Long Tang Formula:
Ephedra (Ma Huang) 3 liang (remove nodes)
Peony (Shao Yao) 3 liang
Asarum (Xi Xin) 3 liang
Cinnamon Twig (Gui Zhi) 3 liang (remove bark)
Dried Ginger (Gan Jiang) 3 liang
Pinellia (Ban Xia) half a sheng (wash)
Licorice (Gan Cao) 3 liang (honey-fried)
Schisandra (Wu Wei Zi) half a sheng
These eight ingredients, use 1 dou of water. First decoct the Ephedra until the water is reduced by 2 sheng, skim off the foam, then add the other ingredients. Decoct until 3 sheng remain. Remove the dregs, take 1 sheng warm, three times daily.
Wu Ling San Formula:
Polyporus (Zhu Ling) 18 zhu (remove bark)
Alisma (Ze Xie) 1 liang 6 zhu
Poria (Fu Ling) 18 zhu
Cinnamon Twig (Gui Zhi) half a liang (remove bark)
Atractylodes (Bai Zhu) 18 zhu
These five ingredients, grind into a powder. Take one fangcunbi (about 1 gram) mixed with white rice water, three times daily. Drink plenty of warm water; sweating will bring about cure.
Ma Huang Fu Ling Tang Formula:
Ephedra (Ma Huang) 2 liang (remove nodes)
Poria (Fu Ling) 3 liang
Atractylodes (Bai Zhu) 3 liang (remove nodes)
Stephania (Fang Ji) 1 liang
Red Beans (Chi Xiao Dou) 1 sheng
These five ingredients, use 7 sheng of water. First decoct the Ephedra until it boils again, skim off the foam, then add the other ingredients. Decoct until 3 sheng remain. Remove the dregs, take 1 sheng warm, three times daily.
If dampness flows into the channels and collaterals and intermingles with heat pathogen, it will generate abscesses and pus. If the spleen and stomach are originally cold and dampness lingers for a long time, it generates fluid retention. If it struggles with dryness pathogen, it generates phlegm-rheum. Treatment falls under the category of phlegm-rheum disease.
Taiyang disease, with joint pain and vexation, and a deep and thin pulse, is called dampness bi (impediment). The symptoms of dampness bi include the patient having difficult urination but relatively smooth defecation. Only draining the urine is appropriate.
A person suffering from dampness disease has pain throughout the whole body, fever, and a body color like that of smoke-smudged yellow.
A person suffering from dampness disease has sweating only on the head, a stiff back, and desires to cover with blankets and approach fire. If purgation is used prematurely, there will be hiccough, chest fullness, difficult urination, and a slimy, smooth tongue coating. This is because there is heat in the lower dantian and cold in the chest. The patient is thirsty and wants to drink, but cannot drink; the mouth is dry and vexatious.
If a person suffering from dampness disease is treated with purgation and then has sweating on the forehead, slight panting, and smooth urination, death will occur. If there is incessant diarrhea, death will also occur.
Question: When wind and dampness struggle and bind together, causing pain throughout the whole body, it stands to reason that inducing sweating should resolve the disease. But if it happens to be a time of continuous overcast rain, and the doctor says sweating can be induced, yet after inducing sweating the disease is not cured—why is this? The teacher answers: When inducing sweating, if the sweating is too profuse, only the wind pathogen is eliminated; the dampness pathogen remains. Therefore the disease is not cured. In treating wind-dampness disease, when inducing sweating, one should only cause a slight, almost imperceptible sweating. Then both wind and dampness will be eliminated together.
A person suffering from dampness disease has pain throughout the whole body, fever, a yellow facial complexion, panting, headache, nasal congestion and vexation, and a large pulse. The person can eat and drink normally, and the abdomen is harmonious without disease. The disease is due to cold-dampness in the head, hence the nasal congestion. Insert medicine into the nose, and it will be cured.
Nasal Plug Formula:
Incinerated Cattail Pollen (Pu Hui)
Asarum (Xi Xin)
Gleditsia Fruit (Zao Jia)
Ephedra (Ma Huang)
These four ingredients, grind into a fine powder in equal parts and mix evenly. Insert a small amount into the nose; sneezing will bring about cure.
A person suffering from dampness disease has generalized painful vexation. It is appropriate to induce sweating with Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction). Be cautious not to use fire-based methods.
Ma Huang Jia Zhu Tang Formula:
Ephedra (Ma Huang) 3 liang (remove nodes)
Cinnamon Twig (Gui Zhi) 2 liang (remove bark)
Licorice (Gan Cao) 1 liang (honey-fried)
Atractylodes (Bai Zhu) 4 liang
Apricot Kernel (Xing Ren) 70 pieces (remove skin and tip)
These five ingredients, use 9 sheng of water. First decoct the Ephedra until the water is reduced by 2 sheng, skim off the foam, then add the other ingredients. Decoct until 2½ sheng remain. Remove the dregs, take 8 ge warm, cover with a blanket to induce slight sweating. If no sweating occurs, take again. After sweating, stop taking the remaining doses.
A patient with pain throughout the whole body, fever, and aggravation in the afternoon (at the Shen and You hours, i.e., 3–7 PM) is called wind-dampness. This disease is caused by exposure to wind while sweating, or prolonged exposure to cold and coolness. Treat it with Ma Huang Xing Yi Gan Cao Tang (Ephedra, Apricot Kernel, Coix, and Licorice Decoction).
Ma Huang Xing Yi Gan Cao Tang Formula:
Ephedra (Ma Huang) 1 liang
Apricot Kernel (Xing Ren) 20 pieces (remove skin and tip)
Coix Seed (Yi Yi) 1 liang
Licorice (Gan Cao) 1 liang (honey-fried)
These four ingredients, use 6 sheng of water. First decoct the Ephedra until the water is reduced by 2 sheng, skim off the foam, then add the other ingredients. Decoct until 3 sheng remain. Remove the dregs, take 1 sheng warm, three times daily.
For wind-dampness disease, with a floating pulse, heavy body, sweating, and aversion to wind, treat it with Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction).
Fang Ji Huang Qi Tang Formula:
Fangji two liang, Gancao one liang (honey-fried), Baizhu one liang, Huangqi two liang, Shengjiang one liang, Dazao twelve pieces (split).
The above six herbs, use one dou of water, decoct to obtain five sheng, remove the dregs, then decoct further to obtain three sheng. Take one sheng warm, three times daily.
For asthma, add Mahuang five fen; for disharmony and discomfort in the stomach, add Shaoyao three fen; for qi rushing upward, add Guizhi three fen; for chronic cold in the lower body, add Xixin three fen.
After taking the medicine, one should feel as if worms are crawling within the skin, and from the waist downward it will be like ice. Then sit on a quilt, wrap another quilt around the body, warm it so that slight sweating occurs, and recovery will follow.
In the ninth or eighth day of a cold damage disorder, when wind pathogen and dampness pathogen bind together, the patient cannot turn over on their own, does not vomit, is not thirsty, and the pulse is floating, vacuous, and rough. Guizhi Fuzi Tang governs. If the stool is hard and urination is naturally smooth, Baizhu Fuzi Tang governs.
Guizhi Fuzi Tang formula:
Guizhi four liang (peeled), Fuzi two pieces (roasted, peeled, broken into eight pieces), Gancao two liang (honey-fried), Shengjiang three liang (cut), Dazao twelve pieces (split).
The above five herbs, use six sheng of water, decoct to obtain three sheng, remove the dregs, and take warm in three divided doses.
Baizhu Fuzi Tang formula:
Baizhu one liang, Fuzi one piece (roasted, peeled, broken into eight pieces), Gancao two liang (honey-fried), Shengjiang one and a half liang, Dazao six pieces (split).
The above five herbs, use three sheng of water, decoct to obtain one sheng, remove the dregs, and take warm in three divided doses. After the first dose, the body will feel numb. After about half a day, take the next dose. After finishing all three doses, the patient may appear dizzy or dazed; do not be surprised. This is because the combined strength of Baizhu and Fuzi is moving within the skin, expelling water qi, and has not yet been completely eliminated.
When wind pathogen and dampness pathogen bind together, causing bone and joint pain and vexation, pulling pain, inability to flex or extend, pain worsening upon approach, sweating, shortness of breath, difficult urination, aversion to wind, unwillingness to remove clothing, or slight swelling of the body, Gancao Fuzi Tang governs.
Gancao Fuzi Tang formula:
Gancao two liang (honey-fried), Fuzi two pieces (roasted, peeled, broken into eight pieces), Baizhu two liang, Guizhi four liang.
The above four herbs, use six sheng of water, decoct until three sheng remain, strain out the dregs. Take one sheng warm, three times daily. If slight sweating occurs after the first dose, the disease will be resolved. If the patient can eat and still feels oppressed after sweating, take five ge. If one sheng is feared to be too much, taking six or seven ge is best.