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Damp-heat accumulates in the Yangming channel, steaming and steaming the Liver Wood, consuming Kidney Yin. The Liver governs the sinews of the whole body, the Kidneys control the water of all meridians, and the Yangming is the leader of the twelve meridians. It is like summer dampness stagnating and steaming, causing trees and forests to wither and weaken; therefore, there is fatigue, excessive sleepiness, rising heat disturbing the clear orifices, ulcers on the lips with exudation, dry and light-averse eyes, swollen cheeks, sore throat, yellow tongue coating, and crimson tongue body. After taking yin-nourishing and damp-draining medicines for more than sixty doses, the disease receded but then returned because the condition had lasted for six years, and the medicinal strength was shallow while the pathogen was deep. Still using yin-nourishing and damp-draining methods to make pills for slow treatment.

Shu Di Huang (Rehmanniae Radix Praeparata) (8 liang), Mai Dong (Ophiopogonis Tuber) (3 liang), Tian Men Dong (Asparagi Radix) (2 liang), Da Sha Shen (Glehniae Radix) (3 liang), Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma) (1 liang), Suan Zao Ren (Ziziphi Spinosae Semen) (3 liang), Dong Bai Zhu (Atractylodis Macrocephalae Rhizoma) (3 liang), Chuan Huang Bo (Phellodendri Chinensis Cortex) (3 liang), Chuan Huang Lian (Coptidis Rhizoma) (1 liang), Ren Shen (Ginseng Radix et Rhizoma) (3 liang), Yun Fu Ling (Poria) (3 liang), Fu Ze Xie (Alismatis Rhizoma) (3 liang). The above twelve ingredients are made into pills with water. Take 3 qian every morning and 3 qian every evening.

Excessive fire consumes Qi, Yin fails to anchor Yang, Qi fails to move Water, leading to the accumulation of Damp-heat, damaging Yangming Yin, and stirring up Shaoyin Fire. When Yangming Yin is damaged, the Zongjin (major sinews) become flaccid, unable to bind bones and tendons and facilitate joint movement; Water flows to dampness and drains downward, causing weak and flabby calves, trembling when walking, diarrhea with borborygmus. When Shaoyin Fire is hyperactive, fluids are consumed and Metal (Lung) is injured, unable to store Essence, transform Qi, and execute regulatory functions, resulting in phlegm-cough, reduced appetite, and frequent nocturnal emissions. The prescribed formulas follow orthodox and gentle principles, acting slowly and difficult to expect rapid results. When nourishing Yin, one must consider the accumulation of Damp-heat; when draining Dampness, one fears further depletion of Yin fluids. Therefore, Si Jin Wan (Four Sinew Pill) combined with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) is used to tonify both Spleen and Kidney. Whether this is correct is submitted to wise physicians for judgment.

Shu Di Huang (Prepared Rehmanniae Radix) (8 liang), Dan Cong Rong (Cynomorii Herba) (2 liang), Huai Shan Yao (Dioscoreae Rhizoma) (4 liang), Shan Yu Rou (Corni Fructus) (4 liang), Yun Fu Ling (Poria) (3 liang), Wu Wei Zi (Schisandrae Fructus) (2 liang), Xuan Mu Gua (Chaenomelis Fructus) (2 liang), Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma) (3 liang), Fei Du Zhong (Eucommiae Cortex) (3 liang), Xuan Wu Jiao (Colla Corii Asini) (2 liang), Sang Piao Xiao (Mantis Oötheca) (1 liang), Ren Shen (Ginseng Radix et Rhizoma) (3 liang). Grind into powder, mash Shu Di Huang into a paste, melt the gelatin, add refined honey, and make pills the size of tung seeds. Take 3 qian morning and evening with warm water.

Jiang Baosu said: Dampness syndrome is one of the Six Excesses, generated by the Central Earth of the Spleen, rising from Earth Qi and descending from Heaven Qi. (Lanting said: The classics state that Earth Qi rises to form clouds, and Heaven Qi descends to form rain. All things belonging to clouds, mist, rain, and dew are Dampness. Dampness steams and rises; the hotter it is, the higher it rises; the colder it is, the lower it descends. Observe a cup of heated water: in mid-winter, the steam rises a foot high, but in mid-summer it is invisible, because heat enters heat. Thus, the steaming Qi of summer Damp-heat is higher than tall buildings and invisible. People living in this Qi are immersed without realizing it, so among hundred diseases, many involve Dampness.) Dampness is abundant in Summer, hidden in Winter, gathers in the Southeast, and condenses in the Northwest. However, Earth has no fixed position, and Dampness has no specific master; thus, Dampness among the Six Excesses returns to its own category. Wet-Warmth returns to the Category of Hidden Pathogens, or appears as symptoms in various categories. *Jingui Yaolue* states: In Taiyang disease, if there is joint pain and vexation, with a deep and fine pulse, this is called Bi-Dampness. The manifestation of Bi-Dampness involves ineffective urination and loose stools; only promoting urination should be employed. For patients with Dampness, the whole body aches, there is fever, and the complexion is like smoked yellow. Patients with Dampness may have sweating only on the head, stiffness in the back, and desire to cover themselves and face fire. If purgatives are used too early, hiccups or chest fullness may occur, along with ineffective urination and a moss-like coating on the tongue, due to Heat in the Dantian and Cold in the Chest. Thirst with desire to drink but inability to do so leads to dry mouth and vexation. If Dampness is treated with purgatives, sweating on the forehead, slight panting, and effective urination (or ineffective urination) indicate death. If diarrhea persists, death also ensues. When Wind-Dampness combats, the whole body aches; the method is to induce sweating for resolution. If it rains continuously and the doctor says sweating is appropriate, but the disease does not resolve after sweating, why? Because profuse sweating expels Wind but leaves Dampness behind, hence no resolution. To treat Wind-Dampness, inducing slight sweating allows both Wind and Dampness to leave. For Dampness patients with body ache, fever, yellow face, panting, headache, nasal congestion, and vexation, with a large pulse, normal appetite, and harmonious abdomen, the pathology is Cold-Dampness in the head causing nasal congestion; inserting medicine into the nose cures it. For Dampness patients with body vexation and pain, Mahuang Jia Zhu Tang (Ephedra Decoction plus Atractylodes) is suitable to induce sweating; severe purgation must be avoided. For patients with whole-body ache and fever worsening at dusk, named Wind-Dampness, caused by sweating exposed to wind or long-term exposure to cold, Mahuang Xingyi Yiyi Gancao Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) can be used. For Wind-Dampness with floating pulse, heavy body, sweating, and aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is indicated. After eight or nine days of Cold Damage, if Wind-Dampness combats causing body pain and vexation, inability to turn over, no vomiting or thirst, and a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is indicated. If stool is hard and urination is free, remove Cinnamon Twig and add Atractylodes. For Wind-Dampness combatting causing joint pain and vexation, pulling pain preventing flexion and extension, severe pain upon touch, sweating, shortness of breath, ineffective urination, aversion to wind with desire to keep clothes on, or slight swelling, Gancao Fuzi Tang (Licorice and Aconite Decoction) is indicated. These eleven items (seven identical in *Shanghan Lun*) belong to Dampness among the Six Excesses. *Nanjing* states: Cold Damage includes five types: Wind Strike, Cold Damage, Wet-Warmth, Warm Disease, and Heat Disease. *Heren Shu* states: Wet-Warmth presents with inverted coldness in both shins, chest and abdominal fullness, profuse sweating, headache, delirium. The patient was previously injured by Dampness, then caught Heatstroke; the combat of Summer-Heat and Dampness causes Wet-Warmth. It also states: Wet-Warmth is similar to Heatstroke, but with cool body and no thirst. *Benshi Fang* records a case in late summer: chest and neck sweating, inverted coldness in feet, and delirium, diagnosed as Wet-Warmth. This implies Summer-Heat injury followed by Dampness invasion. First, Renshen Baitu Tang (Ginseng and White Tiger Decoction) was used, followed by Cangzhu Baitu Tang (Atractylodes and White Tiger Decoction). Feet gradually warmed, sweating stopped, cured in three days. These three items discuss Wet-Warmth syndrome. Hidden pathogens erupt due to Warmth, sharing unity with Warm-Heat diseases, hence named Wet-Warmth. Dampness syndromes erupt due to Spring Warmth (named Warm), Summer Heat (named Heatstroke), or Long Summer Dampness (named Wet-Warmth). Thus, *Nanjing* classifies Wet-Warmth with Wind-Cold, Dampness, and Heat; *Heren* associates Dampness with Long Summer, combining it with Heatstroke to define Wet-Warmth as the combat of Summer-Heat and Dampness. This ignorance fails to understand that *Nanjing* names Wet-Warmth to show its unity with Warm-Heat, i.e., hidden Cold erupting due to Dampness, not Heatstroke. The combat of Summer-Heat and Dampness naturally produces malaria, dysentery, and miasma syndromes, and cannot be named Wet-Warmth. Later generations mostly followed *Heren*, defining Wet-Warmth by cool body and no thirst, neglecting differentiation, thinking without grasping the essence of *Nanjing*, the entirety of *Jingui*’s Dampness, and the origin of hidden pathogens erupting due to Dampness. I discuss this for scholars to consider. However, Dampness nature is sinking, profound, and stagnant; treatment should be warming and unblocking. Hidden pathogens transforming into Heat damage Yin; the method should be clearing and resolving. To treat Wet-Warmth, focus on hidden pathogens, incorporating Dampness-treatment concepts, such as adding warming and unblocking agents to clearing-resolving methods, returning to the Hidden Pathogen category. *Ling Shu: Xieqi Zangfu Bingxing Pian* states: "The lower half of the body is struck by Dampness." This means Dampness rises from Earth, injuring the lower first. Return to Foot Qi category. *Su Wen: Shengqi Tongtian Lun* states: "Due to Dampness, the head feels wrapped." This means Dampness descends from Heaven, injuring the upper first. Return to Six Excesses Dampness category. It also states: "If Damp-Heat is not removed, large sinews become soft and short, small sinews become lax and long; soft and short causes constraint, lax and long causes flaccidity." This means Dampness transforms via Heat. Return to Flaccidity category. *Chang Ci Jie Lun* states: "Whole skin and muscles ache, named Ji-Bi, injured by Cold-Dampness." This means Dampness transforms via Cold. Return to Bi category. *Yin Yang Ying Xiang Da Lun* states: "Excessive Dampness leads to loose stools." This means Dampness invades internally into the Spleen. Return to Loose Stool category. It also states: "Autumn injury by Dampness leads to winter cough." This means Dampness hides in the Spleen, ferments into Phlegm, and transmits upward to the Lung. Return to Cough category. *Zhi Zhen Yao Da Lun* states: "All Dampness swelling and fullness belong to the Spleen." This means Dampness returns to Earth, and Spleen fails to transport. Return to Swelling category. It also states: "All spasms and neck stiffness belong to Dampness." This means extreme Dampness, controlled by Wind transformation as described by He Jian. Return to Spasm category. *I Ching* states: "Water flows to dampness." This means water flows to what is already damp; Dampness belongs to Earth, but Water can also cause dampness, because Earth has no fixed position and Dampness has no specific master. *Zuo Zhuan* states: "Rain excess causes abdominal disease." *Nanjing* Chapter 49 states: "Kidneys govern Dampness," all implying water flows to dampness. *Jingui* follows *Nanjing*’s Kidneys governing Dampness, establishing the name Shen Zhu (Kidney Fixation). Dong Yuan extended external Dampness invading the Spleen, regarding alcohol-dampness injuring the center as internal Dampness, similar to stroke concepts. Dan Xi based on autumn injury by Dampness, Spleen Dampness generating Phlegm, often treating with Phlegm methods. Fang Yueben followed Dong Yuan’s internal Dampness concept, regarding fire from seven emotions and labor steaming Spleen-Stomach food and fluid to create Damp-Heat. Ignoring that internal Dampness is like stroke concepts. Dai Yanli distinguished regional differences and internal/external variations, adjusting treatment according to symptoms, which aligns with Earth having no fixed position and Dampness having no specific syndrome or method. However, ignoring that newly acquired Dampness can also be treated with specific formulas. Zhang Jingyue stated Dampness near Southeast combines with Fire and Earth to form Damp-Heat; Dampness near Northwest combines with Water and Earth to form Cold-Dampness. (Lanting notes: Dividing Dampness quantity by North/South is acceptable, but dividing Cold/Heat by North/South is not; does Southeast lack Cold-Dampness? Does Northwest lack Damp-Heat?) Dividing Cold/Heat by North/South is somewhat rigid. Medical cases show long-standing Dampness often transforms into Heat damaging Yin; treatment focuses on supporting Yin and transforming Dampness, similar to stroke treatment, supplementing predecessors' incompleteness. Medical conversations formulated Huashi Tang (Transforming Dampness Decoction) as a specific formula for newly acquired Six Excesses Dampness,堪称 a pillar of support. Briefly: Internal and External Dampness are like True Stroke and Similar Stroke concepts. Northwest is high and cold, with much internal and little external Dampness. Southeast is low and damp, with much external and little internal Dampness. Just as Northwest has more True Stroke and less Similar Stroke, Southeast has more Similar Stroke and less True Stroke. However, in the damp Southeast, hundred diseases should consider Dampness treatment.

Formulas Listed for Dampness Syndrome

Mahuang Jia Zhu Tang (18), Mahuang Xingyi Yiyi Gancao Tang (19), Fangji Huangqi Tang (20), Guizhi Fuzi Tang (21), Guizhi Qu Gui Jia Baizhu Tang (22), Renshen Baitu Tang (9), Cangzhu Baitu Tang (23), Gancao Fuzi Tang (24).

Dryness Syndrome Chapter 6