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(Rheumatic Wind, Damp-Heat, Cold-Damp, Summerheat-Damp, with Appendix: Central Dampness)

Dampness is a Yin pathogen; it is heavy, turbid, and has substantial form, unlike Summerheat-Heat which is pervasive and formless. When contracted from the exterior, it comes from mist, dew, mud, and water, steaming upward from the earth's qi. As stated in the *Classic of Difficult Issues* (*Jing*), "The dampness of the earth, when felt by humans, harms the skin, flesh, sinews, and vessels." When generated internally, it arises from consuming raw and cold food and drink due to the failure of Spleen Yang to transform and transport. As stated in the *Classic*, "All dampness-induced swelling and fullness belong to the Spleen." When dampness steams upward, the head feels distended as if wrapped or hooded, as stated in the *Classic*: "Affected by dampness, the head feels like it is bound." When dampness invades downward, edema attacks and flows downward on the dorsum of the feet, as stated in the *Classic*: "Those injured by dampness are first affected below." In the meridians and collaterals, it causes Bi syndrome (painful obstruction), Wei syndrome (flaccidity), heaviness, and stagnation, as stated in the *Classic*: "If Damp-Heat is not dispelled, the large sinews shorten and the small sinews relax and lengthen; shortening leads to spasm, and relaxation/lengthening leads to flaccidity." In the Zang-Fu organs, it causes vomiting, nausea, swelling, and dark, scanty, painful urination, as stated in the *Classic*: "When Dampness prevails, loose stools occur." Furthermore, if at the muscle surface, there is aversion to cold and spontaneous sweating; if in the muscle layers, there is numbness and edema; the body feels heavy as if carrying a mountain, making turning difficult; waist and knees swell and bones/joints ache; urine is obstructed, and stools are loose. There may be Dampness combined with Wind, Dampness combined with Heat, Dampness combined with Cold, or Dampness combined with Summerheat. There is also Central Dampness causing stiffness of the mouth and tongue, coma, and unconsciousness, resembling Stroke (Zhong Feng); this must not be mistakenly treated as Stroke. If the pathology is in the exterior and upper, mild diaphoresis (sweating) is indicated; if in the interior and lower, seepage and drainage (diuresis) are indicated; if Middle Qi is deficient, strengthening the Spleen is indicated; if accompanied by Wind and exterior contraction, releasing the muscle layer is indicated; if accompanied by Cold and located in the half-exterior/half-interior, warming and dispersing is indicated; if accompanied by Summerheat-Heat and stagnant in the San Jiao (Triple Burner), clearing, draining, and separating/dispersing is indicated; if Damp-Heat steams into Phlegm, causing internal closure and syncope, opening the orifices and expelling filth is indicated. These are the essentials of treating Dampness.

[Dampness Obstructing the Upper Jiao] Symptoms include head distension, epigastric stuffiness, lack of appetite, and scanty/stagnant urination. The treatment should open Lung Qi and unblock the Bladder. Herbs such as Platycodon Root (Jiegeng), Akebia Stem (Tongcao), Talcum (Huashi), Pinellia Rhizome (Banxia), Trichosanthes Fruit (Gualou), Magnolia Bark (Houpo), Apricot Seed (Xingren), Cardamom Seed (Kouren), Coix Seed (Yimi), Poria (Fuling), Fermented Soybean (Xiangchi), and Bamboo Leaf (Dan Zhuye) are suitable.

[Dampness Stagnating in the Middle Jiao] The Intestines and Stomach are Fu organs; prolonged Dampness generates Heat, leading to sluggish transportation and unsatisfactory bowel movements. The treatment should prioritize warming and unblocking, assisted by bland leaching herbs, such as Aurantium Peel (Zhiqiao), Amomum Shell (Sharen Qiao), Tangerine Peel (Ju Bai), Black Cardamom (Caoguo), Patchouli (Huoxiang), Fermented Pinellia (Banxia Qu), Areca Peel (Dafupi), Polyporus (Zhuling), and Alisma (Zexie). If Spleen Yang fails to transform and Dampness stagnates causing abdominal distension, use Atractylodes Macrocephala Rhizome (Baizhu), Magnolia Bark (Houpo), Ginger (Jiang), and Pinellia (Banxia) to warm and transform. Use Poria (Ling), Alisma (Ze), Areca Peel (Fupi), and Talcum (Huashi) to drain and leak. If accompanied by Cold, use Shipi Yin (Spleen-Strengthening Decoction). If accompanied by Wind, use Shengshi Tang (Wind-Dispelling Decoction).

[Damp-Phlegm Blocking the Orifices] Stagnant Dampness steams into Phlegm, causing mental dullness and slurred speech. The treatment should prioritize resolving stagnation, assisted by acrid-aromatic herbs. Herbs such as Curcuma Tuber (Yujin), Salvia Miltiorrhiza Root (Shichangpu - *Note: Standard is Rhizoma Polygoni Tenellii*), Magnolia Bark (Houpo), Pinellia (Banxia), Eupatorium Herb (Peilan), Honeysuckle Flower (Jinyinhua), Poria with Hostwood (Fushen), Trichosanthes Fruit (Gualou), and Aurantium Peel (Zhiqiao) are suitable. If there is coma and internal closure with pathogens entering the Pericardium, use aromatic herbs to open the orifices. Herbs such as Eupatorium Herb (Peilan), Honeysuckle Dew, Rhinoceros Horn (Xijiao - *Note: Substitute with Buffalo Horn in modern practice*), and Forsythia Heart (Lianqiao Xin) are used to deliver Zhibao Dan (Treasure Guard Pill).

[Dampness Flowing into Joints] Body soreness and bone pain with limited flexion and extension are treated with Du Huo Ji Sheng Tang (Decoction for Expelling Rheumatism and Nourishing the Liver and Kidneys) or Qiang Huo Sheng Shi Tang (Notopterygium Decoction for Dispelling Dampness). If accompanied by Wind, there will necessarily be vexatious heat, wandering pain, and spasms; treat with Fang Feng Tang (Saposhnikovia Decoction). If accompanied by Cold, there will necessarily be cramping pain and edema; treat with Wu Ji San (Five Accumulations Powder) with modifications. The combination of Wind, Cold, and Dampness forms Bi Syndrome; see the section on Bi Syndrome.

[Rheumatic Wind] Whole-body pain indicates Wind-Dampness struggling against each other. Treat with Chushi Qiang Huo Tang (Dampness-Expelling Notopterygium Decoction). Vexatious pain in limbs, heavy head, nasal congestion, diarrhea/dysentery, or passage of clear blood indicates Wind-Wood pathogen injuring Damp-Earth internally. Treat with Shen Zhu Tang (Divine Atractylodes Decoction). Floating pulse, heavy body, sweating, and aversion to wind indicate treatment with Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction). Zhang Zhongjing discusses the pulse of Wind-Dampness as floating, deficient, and choppy.

[Damp-Heat] Slippery and rapid pulse, dark/scanty urination, thirst with desire to drink, and spontaneous sweating indicate Damp-Heat. The treatment should prioritize clearing Fire, assisted by separating and draining methods. Use Qingre Shenshi Tang (Heat-Clearing and Damp-Draining Decoction) or Xiao Li Qing Yin (Minor Clearing Decoction). If Dampness predominates causing body pain, scanty uritation, heavy body, and thirst, use Wuling San (Five-Ling Powder) plus Qiang Huo. Yellow complexion like an orange, scanty urination, and slight abdominal fullness indicate Yinchen Hao Tang (Artemisiae Scopariae Decoction). Yellow complexion, scanty urination, and thirst indicate Wuling San plus Yinchen. Vexatious heat, scanty urination, and thirst indicate Guiling Ganlu Yin (Cassia and Licorice Sweet Dew Drink). Struggle between Dampness and Heat is treated with Qingre Shenshi Tang. Heaviness in shoulders/back, vexatious pain in joints, or whole-body pain with swollen/painful feet/knees indicates external Damp-Heat; treat with Danggui Niang Tong Yin (Angelica Pain-Relieving Drink). Internal Damp-Heat causes edema and difficult urination; treat with Wuling San or Shenxiong Wan (Divine Ligusticum Pill). Drain according to severity, then regulate with Spleen-strengthening agents such as Liu Jun Zi Tang (Six-Gentlemen Decoction) or Yigong San (Extraordinary Assistance Powder). If Yin deficiency with excessive Fire and seminal emission occurs, it is Dampness invading the essence orifice; treat with Hujian Wan (Tiger-Knee Pill) or add Baizhu and Muli. If Qi rises like fire from the feet into the abdomen, it is Dampness stagnating into Heat; treat with Ermiao Wan (Two-Marvels Pill) plus Niuxi and Fangji. Shuhe's *Mai Jing* states: "The pulse of Damp-Heat is slippery and swift."

[Cold-Damp] Pulse is not slippery/rapid; urine is clear and frequent; body pain without sweat; joint stiffness and pulling pain indicate Cold-Damp. The treatment should be warming and draining, using Qiwei Shenshi Tang (Seven-Ingredient Damp-Draining Decoction) or Wuling San. If the pulse is deficient, warming and tonifying is indicated: Lizhong Tang (Regulate the Middle Decoction) plus Fuling and Yimi. Edema of four limbs, limited flexion/extension, and frequent loose stools are treated with Chushi Tang (Dampness-Expelling Decoction) or Shengyang Chushi Tang (Raising-Yang Dampness-Expelling Decoction). Lower back pain, heavy body, and difficult urination are treated with Shen Zhuo Tang (Kidney-Dwelling Decoction). If Cold-Heat Qi invades from outside, differing from internally generated Dampness, use warming and dispersing methods: Wu Ji San or Jiawei Wuling San (Modified Five-Ling Powder). Shuhe's *Mai Jing* states: "Pulse large and floating, deficient and choppy, all indicate Cold-Damp."

[Summerheat-Damp] Humid summer heat brews Dampness, causing vomiting and diarrhea; treat with Liuhe Tang (Harmonizing Six Decoction). If initially injured by Dampness and subsequently struck by Summerheat, with reverse coldness in calves, chest/head heaviness, delirium, and profuse sweating, and a pulse that is weak in Yang and urgent in Yin, the disease name is Wet Warmth (Shi Wen). Diaphoresis must strictly be avoided. Use Cangzhu Baitu Tang (Atractylodes White Tiger Decoction). Zhang Zhongjing discusses the pulse of Summerheat stroke as wiry, fine, hollow, and slow; if accompanied by Dampness, it becomes deficient and soggy, or deficient and choppy.

[Central Dampness] Heavy/painful joints, edema, wheezing/fullness, abdominal distension, coma/unconsciousness, with a sinking-slow or sinking-micro pulse, indicate Central Dampness. Treat with Chushi Tang. If there is a wound where bathwater/Dampness entered the sore, causing coma, heaviness, body rigidity, and lockjaw, resembling Central Dampness, it is named Traumatic Dampness (Po Shang Shi). Use Baizhu Wine, or 2 qian of Oyster Shell Powder (Muli Fen) mixed with Licorice Decoction for oral administration. Apply powder topically to the wound. Shuhe's *Mai Jing* states: "Pulse sinking and slow, sinking and fine, all indicate Central Dampness."

Mr. Shen says: For Dampness in the upper part, use Fangfeng, as Wind can dry Dampness; for Dampness in the middle, use Cangzhu, as Earth can dry Dampness; for Dampness in the lower part, promote urination to open ditches and drain Dampness. For Dampness throughout the body, use Wayao and Qianghuo. For Dampness in both arms, use Sangtiao (Mulberry Twig) and Weilingxian. For Dampness in both thighs, use Niuxi, Fangfeng, and Bibi. Treat according to location. If Dampness injury is due to Kidney deficiency, with cold waist as if sitting in water, use Shen Zhuo Tang. If due to Spleen deficiency, with abdominal fullness and sour regurgitation, use Lingjiang Shugui Tang. If constitution is weak, with heavy body and loose stools, use Qingzao Tang. For Dampness from alcohol, with vomiting, diarrhea, and fever, use Gegua Jie Cheng Tang (Honeysuckle Flower Relieving Intoxication Decoction). For sitting/lying in damp places, exposure to cool wind, causing foot/knee spasms, use Du Huo Ji Sheng Tang. For elderly debility or women with Kidney deficiency and blood exhaustion causing waist/foot pain, use Du Huo Ji Sheng Tang. For Spleen-Stomach disharmony with latent Dampness and watery diarrhea, use Jiawei Pingwei San. For Spleen-Damp diarrhea, use Weiling Tang or Cangzhu Wan.

Generally, the treatment for Dampness patients involves mild diaphoresis and promoting urination to separate and drain Dampness from above and below. Zhang Zhongjing states that Dampness patients should avoid strong sweating because they already have sweat, risking Yang collapse. Therefore, mistakenly inducing sweat in Wet Warmth is called "Chong Yue" (Heavy Miasma) and must be deeply guarded against. However, if one has been exposed to Wind/Cool for a long time and washed with water causing sweat, suppressing Yang generation, mild sweating is necessary. Do not induce strong sweating; strong sweating removes Dampness but leaves Heat, preventing complications. Dong Yuan states that treating Dampness without promoting urination is incorrect. However, in those with inherent True Yang deficiency, sweating followed by dribbling urine indicates exhaustion of True Yin and impending Yang collapse. If mistaken for Damp-Heat and heavily drained, death will occur instantly due to lack of water for Yang. Do not over-drain; remove 60-70% of Dampness, then switch to Spleen-regulating agents, otherwise Kidney Water will be depleted. Mr. Luo says: In spring-summer transition, symptoms resembling Taiyang disease with spontaneous sweating, heavy/painful limbs, difficulty turning, and difficult urination are named Rheumatic Wind. Due to seasonal rain, lying in damp low places, or excessive drinking, promote urination with Wuling San. Once Dampness is gone, the disease resolves. Strictly avoid sweating and purging; errors are fatal. Physicians who fail to recognize the syndrome and treat it as Wind-Cold injury cause death by sweating or purging. Danxi states: Dampness originates from Earth Qi; Fire/Heat generates Damp-Earth, hence summer heat makes things moist, while autumn coolness makes things dry. Heat stagnation generates Dampness; Dampness generates Phlegm. Use Erchen Tang plus Jiu Huangqin (Wine-fried Scutellaria), Qianghuo, and Fangfeng to move Wind and expel Dampness, as Wind overcomes Dampness. Also states: When Dampness is severe with Heat, treat with Acrid-Warm methods, assisted by Sweet-Acrid. Pingwei San is primary. For Dampness in the upper part, resolve with mild sweating, avoiding excessive sweat. Avoid Mahuang and Gegen; use Fangji Huangqi Tang. For Dampness in the middle/lower parts, promote urination with Wuling San. This is the method of bland-leaching to treat Dampness.