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(Also known as Cold-Dampness)

[Etiology] First, the body is injured by Dampness, then by Cold. Or sudden exposure to fog, dew, rain, and water; or wind blowing when sweating, causing water retention in between. This occurs mostly in summer and early autumn. Dampness is formed by the combination and transformation of Cold and Heat. Therefore, Shaoyang disease (Taiyang disease) complicated with Dampness originally has two types: Cold syndrome and Heat syndrome. Some have Cold blocking the exterior and Dampness stagnating internally; others have Dampness suppressing the upper part and Heat stagnating in the lower part. One cannot generally categorize Shaoyang disease complicated with Dampness solely as Yin pathogen (Yin Evil).

[Symptoms] Those complicated with Cold-Dampness experience pain all over the body, especially in the joints, severe aversion to cold, even cold feet, heavy and distending headache as if wrapped or covered, heavy body and flaccid limbs, stuffiness and fullness in the chest and diaphragm, bland taste in mouth without thirst, difficult urination, loose stools instead of constipation, sometimes fever, sallow complexion like smoked yellow, lethargy and desire to sleep, white slippery and thick tongue coating, or white coating with grey and slippery texture, or white coating covering the whole tongue, thick like accumulated powder and floating slippery, or accompanied by black spots and lines and sticky texture. Those complicated with Damp-Heat experience fatigue in the four limbs, vexing pain in muscles, distending and dizzy headache, yellow-red complexion like oily smoke, foul breath, chest fullness and vexation, dry mouth and thirst but inability to swallow, no sweat on the body except for head sweating, nasal congestion and stiffness in the back, desire to cover with quilt and face fire, alternating chills and fever in the afternoon resembling malaria, abdominal fullness and loose stools, short yellow hot urine, sometimes vomiting and inability to eat, body yellow like orange peel color, or faint rashes appearing on skin, white base with yellow overlay on tongue coating, or yellow greasy tongue coating, white edges and red tip, or white coating gradually turning yellow with grey greasiness, or yellow with black, floating slippery and sticky.

[Pulse] Deep and slow, or even deep fine resembling hidden pulse, vague and unclear. This indicates Cold blocking the exterior and Dampness bi-syndrome internally, involving both Foot-Taiyang Bladder Meridian and Foot-Taiyin Spleen Meridian. If deep and wiry, or even deep rapid, rapid and stagnant irregular, this indicates Cold in the chest and Heat in the Dantian, involving both Foot-Taiyang Bladder Meridian and Foot-Shaoyin Kidney Meridian.

[Treatment] For those complicated with Cold-Dampness, first administer Suqiang Dabiao Decoction (Perilla and Notopterygium Releasing Exterior Decoction) added with Cangzhu (Atractylodis Rhizoma, 1 qian), Chuanpu (Magnoliae Officinalis Cortex, 2 qian), to induce slight sweating to release the exterior. Then administer Lingzhu Erchen Decoction (Poria and Atractylodes Two-Aged Phlegm Decoction) to warm the middle and transform Dampness to promote urination. Finally, use Xiangsha Erchen Tang (Amomum and Aucklandia Two-Aged Phlegm Decoction) added with Jiaoguyaya (Scorized Coix Seed, 3 qian), Chaomaiya (Fried Hordeum Sprout, 2 qian) to warm and transport Middle Yang to open the stomach appetite. For those complicated with Damp-Heat, first administer Huoxiang Zhengqi Tang (Patchouli Regulating Qi Decoction) added with Dongguapi Zi (Winter Melon Peel and Seed, 4 liang), Sitongcao (Tetrapanacis Medulla, 5 qian, decocted as water substitute), aromatic and light to resolve Dampness and double-resolve exterior and interior. Then use Zengjian Huanglian Xiexin Tang (Modified Coptis Heart-Purging Decoction) to use bitter and acrid to unblock and descend, rectifying Damp-Heat. Finally, use Baizhu Hezhong Tang (Atractylodes Harmonizing Middle Decoction) added with Huangcao Chuanhu (Dendrobii Caulis, 3 qian), Changxuguyaya (Long-stemmed Coix Seed fried with fresh lotus leaf corner, 1 piece) to mildly warm Middle Qi to open appetite. Both syndromes treated thus will surely recover.

[Xu Rongzhai's Note] The syndrome of Shaoyang disease complicated with Dampness is most prevalent in Jiangsu and Zhejiang provinces. The common standard prescription is Wuling San (Five-Ingredient Poria Pill) added with Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix).
If Dampness exhausts and transforms into Dryness, and extreme Heat causes spasms, mis-treatment is frequent. Select Qingzao Yangying Tang (Clear Dryness Nourishing Ying Decoction) or Lingjiao Gouteng Tang (Antelope Horn and Uncaria Decoction), modify according to syndrome to remedy errors. If rashes do not emerge quickly, use Xinjia Baihu Tang (Newly Added White Tiger Decoction) added with Chaoniubangzi (Fried Arctii Fructus, 3 qian), Daqingye (Isatidis Folium, 4 qian), Xianxiheliuye (Fresh Tamarisci Ramulus, 3 qian), acrid-cool to open and reach to vent them. If complicated with food stagnation and constipation, use Zhishi Daozhi Tang (Immature Bitter Orange Guiding Out Stagnation Decoction) to purge stagnation and unblock bowels to digest. Weighing severity and urgency depends on the clinician's flexible response.

[Xiu's Note] Shaoyang disease complicated with Damp-Heat is common, and Damp-Heat brewing Phlegm is also very common. Thus, Master Danxi (Zhu Zhenheng) greatly expounded the method of Phlegm-Dampness, stating that nine out of ten people have Dampness; Dampness generates Phlegm, Phlegm generates Heat. However, his discussion focused mostly on externally generated Dampness, rarely touching upon internally generated Damp-Heat. Zhang Zhongjing's books discuss Cold-Damp and Wind-Damp more, discussing Damp-Heat only in Jaundice and Pi Syndrome (Glomus). Formulas like Yinchin Zhizi Tang (Coir and Gardenia Decoction) and methods like Xiaoxiantong Tang (Small Trap Chest Decoction) and Xiexin Tang (Heart-Purging Decoctions) are all set for Damp-Heat causing jaundice and Damp-Heat forming Pi. Generally, Shaoyang disease mis-treated and suppressed causes internal Dampness to rise and become Heat; Heat stagnates causing jaundice. Mild cases use Yinchen Hao Tang (Coir and Artemisia Decoction) or Yinchen Wuling San (Coir Five-Ingredient Poria Pill); severe cases use Zhizi Dahuang Tang (Gardenia and Rhubarb Decoction) or Dahuang Xiaoshi Tang (Rhubarb and Nitrostone Decoction). Whether promoting urination or purging, all aim to remove internally stagnated Damp-Heat. Mis-purging Shaoyang disease leads to Pi fullness; some have chest Pi without purging, because the person usually has much Phlegm-Damp-Heat; once touched by external pathogen, it reverses upward causing Pi fullness. Thus Zhang Zhongjing specifically established Xiaoxiantong Tang and various Xiexin methods to remove upward-reversing Phlegm-Damp-Heat. Luo Qianfu said Xiexin Tang formulas are most appropriate for treating Damp-Heat due to their acrid-opening and bitter-descending nature. I believe Ginseng, Licorice, and Jujube should be used cautiously; Ginger should be replaced by Immature Bitter Orange and Tangerine Peel to avoid assisting Damp-Heat. Alternatively, add diuretics like Shihuo (Talcum), Tongcao (Tetrapanacis Medulla), Fuling (Poria), Zhuling (Polyporus); or add laxatives like Qingning Wan (Clear Peace Pill) or Zhishi Daozhi Wan (Immature Bitter Orange Guiding Out Stagnation Pill). This depends on the clinician's discretion.

[Liankan's Note] My hometown Shaoxing is low and damp, weather warm; people like tea and wine, indulge in fruits and melons. Those with inherent strong Yang have much Stomach Dampness; those with inherent strong Yin have much Spleen Dampness. During summer and autumn, catching heat by day and chilling by night, many suffer from Shaoyang disease complicated with Dampness. Yu distinguishes Cold-Damp and Damp-Heat clearly; his treatment methods and formulas are orthodox. I follow his method: initially using acrid-light-aromatic penetrating to release exterior, modifying Huoxiang Zhengqi Tang, which is most commonly used. Then observing obese pale individuals, considering Yang Qi, treating with acrid-bitter-light-warm method, adding Guizhi (Cinnamomi Ramulus) and Fuling (Poria), or Ganjiang (Zingiberis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). Observing thin dark-complexioned individuals, considering Jin Ye (Body Fluids), treating with acrid-bitter-light-cool method, adding Lugen (Phragmitis Rhizoma) and Maogen (Imperatae Rhizoma), or Pear juice and Sugarcane juice. Only alcoholics with inherent internal Dampness, neglecting health preservation, with Yin deficiency complicated with Damp-Heat, are most lingering and hard to cure. Predecessors good at treating Dampness recommend Ye Tianshi (Ye Tiao). To clear Qi-level Dampness, he uses Cardamomi Fructus, Talcum, Armeniacae Semen Amarum, Magnoliae Officinalis Cortex, Zingiberis Rhizoma Recens, Trichosanthis Pericarpium as main herbs; adding Zhu Ye (Bambusae Folium), Lianqiao (Forsythiae Fructus), Lugen if Heat exists. All taking light-clear substances, moving through Qi pathways to remove Dampness. When Dampness injures Spleen Yang, causing abdominal distension and difficult urination, he uses Wuling San (Five-Ingredient Poria Pill) plus Jiaomu (Schoenoplecti Granmeniscus), treating from Lung using acrid-light-clear-transforming method, and treating from Spleen using acrid-light-warm-unblocking method. These two are correct methods for transforming Qi and promoting urination. Treating Damp-Heat via Lung, Cold-Damp via Spleen, is Mr. Ye's unique new transmission. Other methods: Pi fullness and loose stools use Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Glycyrrhiza Decoction); acid regurgitation and aversion to cold use Lingjiang Shugui Tang (Poria, Dried Ginger, Atractylodes, and Cinnamon Twig Decoction); mis-purging Cold-Damp causing Pi and single abdominal distension use Zhenwu Tang (True Warrior Decoction) modified; Cold-Damp stagnation injuring Yang gathering for pain use Bitong Tang (White Pass Decoction) added; alcoholics with Triple Burner closure, chest fullness, anorexia, urinary/fecal obstruction use Banshen Wan (Half-Sulfur Pill); alcoholics with Spleen-Stomach injury, abdominal distension, limb edema, imperfect urination/defecation use Xiaowenzhong Wan (Minor Warm Middle Pill). Though ancient methods, applied flexibly with slight modifications, they hit the pathology accurately, proving deep study of classics. Another case: eating rich foods during illness, intestinal grease remains despite purging, Dampness unresolved, stomach dislikes food, anal dragging pain, white rot on tongue, use Pingwei San (Peaceful Stomach Powder) minus Licorice, add Renshen (Ginseng Radix), Paogjiang (Prepared Ginger), Chaoheishengfuzi (Fried Black Raw Aconite). Yang injury causing flaccidity, Yin-Damp causing numbness, even with hemorrhoids, use Ginger-Aconite, Poria, Atractylodes. These two cases, not mistaking alcohol toxicity/hemorrhoids for Damp-Blood/Heat-Blood, use acrid-bitter-warm drugs to unblock Yang and seize Dampness, showing superior skill. Another case: white tongue, body pain, foot dorsum edema, Taixi (KI3) water flowing like a spring, indicating Dampness lurking in Foot-Shaoyin Kidney Meridian, use Deer Antler, Danfuzi (Mild Aconite), Caoguoren (Tsaoko Fruit), Zhe Ling (Zhejiang Poria), Tusizi (Cuscutae Semen) to warm Yang. Long-term Dampness depletes Spleen Yang, Kidney Essence fails; mid-aged infertility uses Poria, Cuscuta, Atractylodes, Leek Seed, Star Anise, Deer Antler, Mild Aconite, Dodder Seed, Psoralea, Red Kaolin, imitating Anshen Wan (Calming Kidney Pill), beyond shallow understanding to imitate. These are methods of Cold-Damp transmission. Damp-Heat rising to clear orifices, head distension, deafness, hiccups, epistaxis, white-tinged tongue, throat closing sensation, indicating pathogen blocking empty upper orifices, not treatable by bitter-cold directly entering Stomach, use Forsythia, Arctii, Honeysuckle, Polystichum, Belamcanda, Gold Juice, lightly lifting Lung Qi, clearing fragrance reaching depression. Damp-Heat sinking into Pericardium, fever, coma, cold limbs, use Rhinoceros Horn (substitute), Scrophulariae Radix, Forsythia Heart, Acori Tatarinowii Rhizoma, Honeysuckle, Vigna Integri Cuticle, decocted with Zhibao Dan (Treasure Preservation Pill), clearing Heat opening orifices, aromatic repelling filth. Damp-Heat carrying filth, distributing in Ying and Wei, filling Triple Burner, head/body pain, mental confusion, little thirst, urinary obstruction, white greasy tongue coating, use Coix Seed, Poria Skin, Areca Peel, Tetrapanax Medulla, Polyporus, Bamboo Leaf, Curcuma Juice, Acori Juice, decocted sending Niuhuang Wan (Calculus Bovis Pill), light渗 opening orifices, aromatic communicating spirit. Damp-Heat obstructing middle, Qi stagnation epigastric pain, imperfect defecation, use Fermented Soybean, Immature Bitter Orange, Coptis, Ginger Juice, Poria, Pinellia; if Heat mild, remove Coptis, add Curcuma, Tangerine Peel, Coix, Apricot Seed. This is treating Damp injuring Qi Bi. If Heat severe, use Coptis, Raw Atractylodes, Magnolia, Tangerine Peel, Mild Ginger Residue, Wine-fried Rhubarb, water-pill服用. This treats Qi obstruction, bowels should be unblocked. If Damp-Heat severe, white tongue yellow eyes, thirst red urine, use Cinnamon Twig Wood, Zhejiang Poria Skin, Polyporus, Alisma, Hypocoelostone, Raw Atractylodes, Mian Yinchen, modified from Guiling Ganlu Yin (Cinnamon and Poria Sweet Dew Drink) to unblock Triple Burner. These are Damp-Heat transmission methods. Regarding medication, generally Acrid-Bitter-Warm for Cold-Damp, Acrid-Bitter-Cool for Damp-Heat, assisted by Light-Penetrating; Sweet-Sour-Greasy-Turbid are avoided. With these methods for Dampness, the general outline is clear.

[Xu Rongzhai's Note] Mr. Lu Yuanlei, author of "Modern Interpretation of Shanghan Lun," analyzed the pathology of "Dampness" very clearly. He said: "Dampness disease can be divided into two categories: External Dampness and Internal Dampness. External Dampness refers to air saturated with water vapor, where sweat cannot evaporate, leading to improper excretion. Healthy people excrete about two pounds of sweat per day; laborers and summer days may not reach this. However, sweat drops are rarely seen on skin because once exiting sweat glands, it evaporates into steam and scatters in air. During plum rain season or in humid places, air vapor is often saturated; sweat already in glands cannot evaporate, sweat not yet in glands is blocked at gland openings, un-evaporated sweat cannot re-enter, causing External Dampness disease. Internal Dampness refers to inflammatory exudate caused by inflammation. In early inflammation, capillaries in affected areas dilate, showing congestion; liquid and solid components of blood often seep out of vessels. The liquid component seeping out is called inflammatory exudate. Accumulated in body cavities is Yin (Fluid Retention); infiltrating tissues is Shi (Dampness); severe cases are Edema. Inflammation often occurs in organs with mucous membranes; at this time, plasma exudes from capillaries on mucosal surfaces, and mucus secretion increases simultaneously. Such lesions occurring in Stomach cause Phlegm-Fluid; in Uterus cause Leukorrhea; in Throat/Trachea/Bronchi cause Itchy Throat/Cough; in Large Intestine cause Diarrhea; in Duodenum cause Jaundice; these are all called Internal Dampness." This text uses scientific methods to explain diseases caused by sweat blockage in evaporation as External Dampness; diseases caused by inflammatory exudate as Internal Dampness. Clearly exposing the etiology and pathology of Dampness, it provides great help to us."