Chapter Seven. Syndrome of dampness and formula composition
CHAPTER CONTENTS
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that can disperse, dry, dissolve and leach out dampness. They are used to treat the syndromes of dampness.
In the diagnosis, the syndrome of dampness can be divided into damp-cold syndrome and damp-heat syndrome, which are decided by constitution and dietary habit of the individual, as well as the nature of the pathogenic factors. The treatment principles and the strategies of composing formulas are quite different in these two types. For clarity, these two syndromes are discussed separately.
1. Damp-cold syndrome
Manifestations
Main symptoms
Edema, cough with thin, watery phlegm, hydrothorax, ascites, diarrhea, difficult urination or retention of urine, painful, swollen, heavy and cold limbs, fear of cold.
Secondary symptoms
Heaviness of the body, distension in the abdomen and fullness in the chest, palpitations, shortness of breath, dizziness, vertigo, vomiting and tiredness. The syndrome has a lingering and recurrent process.
Tongue
Slightly pale with a watery or moist coating.
Pulse
Soft.
Associated disorders in western medicine
Acute and chronic bronchitis, pneumonia, upper respiratory infection, pulmonary emphysema, pulmonary heart disease, heart failure, acute nephritis and renal failure, chronic nephritis, gastritis, hypothyroidism, hypoadrenalism, fibromyalgia, rheumatic arthritis and rheumatoid arthritis.
Analysis of the syndrome
Water metabolism depends on the proper functioning of the Lung, Spleen, Kidney and San Jiao, especially the Yang and Qi aspects of these organs.
• When the functions of the Lung, Spleen, Kidney and San Jiao are disturbed, the water may accumulate inside the body. Edema and accumulation of fluid are the most commonly seen symptoms.
• If the Lung-Qi is blocked, edema often shows on the face and fingers, there is cough with thin, watery phlegm and hydrothorax.
• If the Spleen is disturbed, or the Yang and Qi are weak, edema shows in the legs and joints, and in ascites. Diarrhea may also occur.
• If the Kidney is disturbed or the Yang and Qi of the Kidney are weak, edema appears mainly in the legs and joints. Patients may suffer from difficult urination, retention of urine and incontinence.
• Dampness is a Yin pathogenic factor and has a stagnating tendency. This characteristic is shown not only by the symptoms, but also by a lingering, recurrent or chronic pathological process.
Exterior dampness is a Yin pathogenic factor. It often invades the body with wind and cold.
• The exterior dampness stays at the skin, the subcutaneous region, the muscles and the joints. It blocks the Qi movement and blood circulation, and causes Bi syndrome.
• When dampness predominates, patients have heaviness of the body and swelling of the joints of a lingering and recurrent nature. Complaints can get worse in humid weather.
A constitution of internal cold and a diet of cold and raw food or low-calorie food may generate cold, further injure the Yang of the Spleen and form damp-cold in the body. Milk products may also increase the possibility of dampness accumulation.
(See Figure 7.1 on page 221.)
• When Qi is blocked, fullness of the chest, stomach and abdomen occur.
• When Qi is unable to move freely, patients may easily feel tired.
• When there is Yang deficiency in the body, the accumulated cold fluid in the Lower-Jiao may move upward and attack the Heart, Lung and head, causing palpitations, shortness of breath, dizziness, vertigo and vomiting.
• Damp-cold obstructs and weakens the Yang, thus patients often have a feeling of cold in the limbs and are also afraid of cold.
• A watery tongue coating and a soft pulse indicate the accumulation of dampness in the body.
(See Figure 7.2 on page 222.)
Treatment principle: Disperse, dry, dissolve and leach out dampness, regulate and strengthen the function of the Lung, Spleen, Kidney and San Jiao
Herb selection principles and formula composition strategies
Herbs should first be selected according to the regions or organs involved:
• If exterior dampness accumulates in the Upper-Jiao and superficial region of the body, warm, aromatic or pungent herbs that enter the Lung, Bladder and Spleen meridians, and can disperse and induce mild sweating are often selected.
• If dampness accumulates in the Middle-Jiao, the first priority is to select herbs that are aromatic and warm, pungent and warm, bitter and warm or bland and neutral, and can respectively disperse, dry, dissolve or leach out dampness.
• If dampness accumulates in the Lower-Jiao and disturbs the function of the Bladder, bland, bitter and warm herbs are selected to leach out dampness or warm the Kidney and accelerate water metabolism.
• Second, pungent and warm herbs that can warm the interior are selected.
• Herbs that strengthen and tonify the Spleen in order to activate its function are used in all types of dampness syndrome.
• A small amount of sour herbs can be added to the formula to protect the Yin, along with sweet herbs to protect the Stomach.
• To treat Bi syndrome, herbs that expel damp-cold from the meridians are used.
• Herbs that promote digestion and regulate the Qi are often selected.
CAUTIONS
1. Caution in Yin deficiency:
Herbs and formulas that drain dampness are pungent, warm, bitter or bland and they may injure the Yin. Patients with Yin deficiency should not use them, especially for a long period of time.
2. Avoid large dosage:
Since dampness is a Yin pathogenic factor and has a heavy, turbid and sticky nature, herbs and formulas should have a steady and constant action. Large dosage should be avoided in a long treatment course.
3. Caution in pregnancy:
Pregnant women should use the formulas with caution as these formulas contain aromatic, pungent and bitter herbs, which can easily move Qi and blood, and drain dampness. They may bring danger to the pregnancy.
4. Avoid heavy sweating in the treatment:
When wind, dampness and cold attack the superficial region of the body, the treatment method of inducing mild sweating may help to open the pores and expel dampness there. However, sweating heavily does not help to remove dampness, as dampness has a lingering nature and heavy sweating can also injure the Yin of the body.
5. Avoid sweet food and herbs:
Sweet food and herbs may cause dampness retention in the Middle-Jiao and should be avoided.
Structure of the formula and selection of herbs
Chief: Treat dampness directly – (A). Dampness in the Upper-Jiao: Induce mild sweating and expel dampness; descend the Lung-Qi, warm the Lung and regulate the water passage
Qiang Huo ( Notopterygii rhizoma), Qin Jiao ( Gentianae macrophyllae radix), Fang Feng ( Saposhnikoviae radix), Xiang Ru ( Moslae herba), Xing Ren ( Armeniacae semen) and Dan Dou Chi ( Sojae semen praeparatum)
Qiang Huo is pungent, bitter and warm. It enters the Bladder Meridian primarily and the Liver and Kidney meridians secondly. The pungent and warm nature gives Qiang Huo a strong dispersing and ascending ability; it can very effectively and quickly expel wind, dampness and cold in the superficial region of the body, such as the skin, subcutaneous region and the muscles, especially of the upper half of the body. It can be selected as chief in a formula to treat general pain, headache and stiffness of the back due to obstruction of the meridians by damp-cold. Since it has a strong drying property, it has a tendency to consume the fluid, blood and Yin, and therefore should be used with caution.
Qin Jiao is pungent, bitter and neutral, and primarily enters the Stomach and Large Intestine meridians. Pungent can disperse the dampness, and bitterness can drain and dry the dampness. In particular, this herb expels the dampness from the subcutaneous region and the muscles and can therefore relax the tendons and muscles. It can be used as chief in a formula to expel dampness in the Upper-Jiao. Since it is a neutral herb, it can be used in either damp-cold or damp-heat syndrome.
Fang Feng is sweet, pungent and warm, and enters the Bladder, Liver and Spleen meridians. It can expel the wind, eliminate the dampness and relieve the exterior. It treats heaviness and pain of the body. This herb can be selected as chief in a formula where there is dampness in the superficial region. Compared with Qiang Huo and Qin Jiao, this herb is gentle in action and does not have a drying nature; thus it can be used in a mild condition or for a reasonably long period of time.
Xiang Ru is a warm and aromatic herb. It is able to induce sweating, disperse wind and dampness, and release the exterior. It is especially useful when there is fever, general pain and heaviness of the body but no sweating in the symptoms. This herb is referred to as Summer Ma Huang because its gentle action is similar to that of Ma Huang ( Ephedrae herba)* in inducing sweating. It is better to use Xiang Ru in the summer when the pores are not closed as tightly as in the winter. It also has the function of transforming dampness in the Middle-Jiao and can treat abdominal pain, vomiting, diarrhea and edema, but this function is not as strong as that of the other three herbs.
Xing Ren is bitter and warm, and enters the Lung meridian. Dan Dou Chi is warm and pungent if it is processed by Zi Su Ye ( Perillae folium); it enters the Lung and Stomach meridians. These two herbs can disperse the constrained Qi in the chest and accelerate the dispersing and spreading of the Qi and fluid in the Upper-Jiao, preventing the accumulation of dampness there. Moreover, as Dan Dou Chi can induce mild sweating, it can therefore eliminate dampness.
Ting Li Zi ( Lepidii/Descurainiae semen), Sang Bai Pi ( Mori cortex), Gui Zhi ( Cinnamomi cassiae ramulus), Sheng Jiang ( Zingiberis rhizoma recens) and Gan Jiang ( Zingiberis rhizoma)
Ting Li Zi and Sang Bai Pi are cold, and enter the Lung meridian. They are able to direct the Lung-Qi downwards, and eliminate phlegm and water accumulation. They can therefore reduce obstruction of the Lung-Qi and arrest wheezing. They are used together in formulas to treat cough, asthma, fullness in the chest, edema and difficult urination.
Ting Li Zi is very pungent, bitter and cold. In a damp-cold syndrome, this herb must be used together with warm herbs and is selected for its strong function. It is much stronger than Sang Bai Pi in directing the Lung-Qi downwards and draining water. It is thus considered as an agent that drives out water and phlegm. It also enters the Large Intestine meridian, and can drain water and phlegm via bowel movement. It is only suitable for treating the excess syndromes of phlegm and water accumulation in the Lung. However, since Ting Li Zi is a harsh and cold herb, and easily injures the Qi, Yang and Yin of the Lung, it is only used in excess syndromes for a short period of time.
Gui Zhi, Sheng Jiang and Gan Jiang are all warm and pungent. They can warm the interior, disperse the cold, accelerate the water metabolism and transform dampness in the Upper-Jiao. They can be used as chief in formulas that treat water obstruction in the Upper-Jiao. Among these herbs, Gui Zhi accelerates the water metabolism through stimulating the Yang, accelerating the process of water changing into Qi; Sheng Jiang enters the Lung and Stomach meridians, disperses the congested water and soothes the Stomach-Qi; Gan Jiang is warmer than Sheng Jiang and primarily enters the Spleen meridian. As it dries dampness and warms the Yang of the Middle-Jiao, it can control the water that has the tendency of rising and attacking the Lung and Heart.
Chief: Treat dampness directly – (B). Dampness in the Middle-Jiao: Dry and transform dampness
Cang Zhu ( Atractylodis rhizoma), Hou Po ( Magnoliae cortex), Sha Ren ( Amomi xanthioidis fructus) and Bai Dou Kou ( Amomi fructus rotundus)
Cang Zhu is pungent, bitter and warm, and enters the Spleen and Stomach meridians. It has a strong drying nature. It can either disperse the exterior dampness from the meridians or transform the interior dampness in the Middle-Jiao. Thus it can be chosen as chief in formulas that treat dampness.
Hou Po is bitter, pungent and warm. Bitterness can descend the Qi; pungent and warm can disperse and dry the dampness. It is a very effective herb to transform dampness and phlegm, and to descend the Qi, thereby reducing the fullness in the chest and distension in the abdomen. Since it enters the Spleen, Stomach, Lung and Large Intestine meridians, it can be used to treat Qi obstruction due to dampness and phlegm in the Upper-, Middle- and Lower-Jiao.
Sha Ren and Bai Dou Kou are pungent, warm and aromatic, and enter the Spleen and Stomach meridians. They are able to transform dampness, regulate the Qi and revive the function of the Spleen. However, Sha Ren is stronger in regulating the Qi in the Middle-Jiao and reducing distension, nausea and pain in the abdomen; Bai Dou Kou is stronger in transforming dampness and warming the Middle-Jiao. It treats abdominal pain with a cold sensation, vomiting of clear fluid and watery diarrhea.
Huo Xiang ( Agastachis herba) and Pei Lan ( Eupatorii herba)
Huo Xiang and Pei Lan are pungent and aromatic, and enter the Spleen and Stomach meridians. Both are able to transform dampness in the Middle-Jiao, revive the Spleen, improve appetite and reduce the fullness in the Stomach. Huo Xiang and Pei Lan are often used together to enhance the ability of transforming dampness.
These two herbs have strong aromatic smells, which have a very special function in transforming dampness and opening up the blockage of the Qi. They can penetrate into turbid dampness because their light but sharp smells are able to separate the clean from the turbid. In addition, their light but exceptional smell can wake up the Spleen that has been covered and confused by dampness. The aromatic and pungent smells of these herbs can, on the one hand, stimulate the Spleen to transform dampness and treat the causes of dampness accumulation; on the other hand, these smells can activate the Qi movement so as to accelerate the functions of the involved organs.
Huo Xiang is slightly warm, aromatic and pungent. It can penetrate into the turbidity and scatter the accumulation of dampness. Its action is strong but not harsh and is particularly effective in regulating the Qi in the Middle-Jiao, soothing the Stomach-Qi and treating nausea, vomiting and poor appetite.
Pei Lan is neutral and gentle. Its light fragrant smell can particularly separate the clean from the turbid in the Middle-Jiao and revive the Spleen. It is effective in treating the sweet and sticky sensation in the mouth, a foul smell in the mouth, fullness in the chest, heavy limbs and a heavy sensation in the head.
Chief: Treat dampness directly – (C). Dampness in the Lower-Jiao: Warm the Lower-Jiao, leach out dampness
Fu Ling ( Poria)
Fu Ling is sweet, bland and neutral, and enters the Heart, Spleen, Stomach, Lung and Kidney meridians. It is able to drain out dampness by promoting urination. It can also tonify the Spleen and calm the mind. Compared with the other herbs that transform dampness, it is bland and neutral in nature; thus Fu Ling is characterized by being applied for either damp-heat or damp-cold syndrome. Because it is sweet and bland, it drains out dampness without the side effect of injuring the Yin and Yang of the body.
Fu Zi ( Aconiti radix lateralis preparata)*, Rou Gui ( Cinnamomi cassiae cortex) and Wu Yao ( Linderae radix)
These pungent and hot herbs enter the Kidney meridian. They are able to strengthen the Kidney-Yang and accelerate the water metabolism by steaming the water so as to separate the clean water from the turbid part. They can be used as chief in formulas to treat chronic or severe cases of accumulation of water or dampness in the body.
Among these herbs, Fu Zi is the strongest at expelling cold and dampness; however, its harsh and poisonous nature can bring side effects and therefore it is used for only a short period of time in severe cases. Rou Gui is pungent, warm and sweet. As its sweet taste brings a moderate but consistent dispersing and drying action, it can be used for a longer period of time. Wu Yao is able to warm the Lower-Jiao, Kidney, Bladder and Liver, and spread the Qi, thus accelerating the water metabolism and treating dampness in the Lower-Jiao.
Deputy: Regulate the Qi; enhance the ability of the chief herbs
Chen Pi ( Citri reticulatae pericarpium), Mu Xiang ( Aucklandiae radix)**, Sha Ren ( Amomi xanthioidis fructus) and Da Fu Pi ( Arecae pericarpium)
These herbs are all pungent and warm. They can effectively promote the Qi movement to enhance the ability of the chief herbs in eliminating dampness. Chen Pi principally regulates the Qi in the Middle-Jiao; Mu Xiang regulates the Qi of the Liver and Large Intestine; Sha Ren regulates the Spleen and intestines; Da Fu Pi moves both Qi and water in the entire abdomen.
Assistant: Strengthen the Spleen; promote Qi movement; nourish the Yin
Bai Zhu ( Atractylodis macrocephalae rhizoma) and Huang Qi ( Astragali radix)
These herbs tonify the Spleen-Qi so as to accelerate water transportation and transformation.
Huang Qi is sweet and warm, and enters the Spleen and Lung meridians. It can strengthen and ascend the Qi. It is used principally to treat tiredness, weakness and heaviness of the muscles.
Bai Zhu is bitter and warm, and enters the Spleen meridian. As it not only tonifies the Spleen-Qi, but also dries dampness, it is a perfect herb for a syndrome of dampness accumulation due to Spleen-Qi deficiency.
Ma Huang ( Ephedrae herba)* and Jie Geng ( Platycodi radix)
Ma Huang is able to enhance the chief herbs that expel dampness in the Lung by dispersing and descending the Lung-Qi, regulating the water passage and promoting urination.
Jie Geng enters the Lung meridian. It has obvious ascending ability. As it can disperse the Lung-Qi, it can accelerate the descending action of the other herbs.
Peels
According to Chinese herbal conception, peels and bark of plants enter the skin of humans. Some peels can be used as assistants to treat dampness accumulation in the subcutaneous region that causes mild edema. The commonly used peels are Chen Pi ( Citri reticulatae pericarpium), Fu Ling Pi ( Poriae cocos cortex), Sheng Jiang Pi ( Zingiberis rhizoma recens cortex), Sang Bai Pi ( Mori cortex) and Da Fu Pi ( Arecae pericarpium).
Mu Gua ( Chaenomelis fructus) and Wu Wei Zi ( Schisandrae fructus)
Mu Gua is sour and warm, and enters the Liver and Spleen meridians. It is used as a helping assistant in the formula because its sour taste can stabilize the body fluids and Yin, and its warm nature can dissolve dampness. It is also selected to treat cramping, stiffness, swelling and heaviness of the joints and muscles.
Wu Wei Zi is also sour and warm. It can stabilize the Yin and Qi, and is used as an assistant to correct the side effects of pungent, bitter and warm herbs.
Common accompanying symptoms and treatment
• Food accumulation: add Jiao Mai Ya (deep-fried Hordei fructus germinatus), Jiao Shen Qu (deep-fried Massa medicata fermentata) and Jiao Shan Zha (deep-fried Crataegi fructus) to treat food accumulation.
• Phlegm accumulation: add Ban Xia ( Pinelliae rhizoma) and Chen Pi ( Citri reticulatae pericarpium) to remove the phlegm.
• Blood stagnation: add Chuan Xiong ( Chuanxiong rhizoma), Hong Hua ( Carthami flos) and Gui Zhi ( Cinnamomi cassiae ramulus) to promote blood circulation.
Examples of classical formulas
Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome Dampness) 
Source: Nei Wai Shang Bian Huo Lun 
Composition
Qiang Huo ( Notopterygii rhizoma) 6 g
Du Huo ( Angelicae pubescentis radix) 6 g
Fang Feng ( Saposhnikoviae radix) 3 g
Gao Ben ( Ligustici sinensis radix) 3 g
Chuan Xiong ( Chuanxiong rhizoma) 3 g
Man Jing Zi ( Viticis fructus) 2 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 3 g
Analysis of the formula
This formula expels wind and eliminates dampness from the superficial part of the body and the subcutaneous region. It treats wind-dampness at the superficial level of the body and the Qi movement and blood circulation are blocked. This disorder is manifested as stiffness and pain of the neck, back and shoulders, headache, heaviness of the body, aversion to cold with mild fever, a white, slightly sticky tongue coating and a superficial pulse.
In this formula:
• The pungent and warm Qiang Huo and Du Huo are used as chief. They can expel wind, cold and dampness from the upper part of the body and the lower part of the body respectively. Qiang Huo can reduce headache on the back of the head and can also treat stiffness of the neck.
• The deputies are Fang Feng and Gao Ben. Fang Feng enters the Bladder and Spleen meridians, expels wind-dampness from superficial and subcutaneous regions and reduces the heavy sensation of the head. Gao Ben enters the Bladder meridian, expels wind and cold, and effectively relieves headache as its aromatic smell can quickly reach the top of the head.
• Man Jing Zi, as helping assistant, can expel wind-dampness, regulate the Qi in the head and relieve headache with blurred vision. Chuan Xiong also serves as assistant. It can activate the Qi and blood, expel wind and relieve headache, especially on the lateral sides of the head.
• Zhi Gan Cao is used as envoy in the formula to harmonize the herbs in the formula.
Commentary on strategies
In this formula, a group of herbs that treat headache are introduced. According to the meridian entered, they treat headache in different parts of the head.
• Qiang Huo enters the Bladder meridian and treats headache particularly on the back of the head.
• Gao Ben also enters the Bladder meridian, but treats pain on the top of the head.
• Chuan Xiong enters the Liver and Gall Bladder meridians, and relieves headache, especially on the lateral sides of the head.
In this formula, pungent, warm and aromatic herbs are used to expel wind, dampness and cold. However, the dosages are quite small, which suggests that a gentle dispersing action in the superficial region is expected at this moment because the heavy and lingering dampness in the superficial region cannot be expelled by a quick moving action of herbs.
Ling Gan Wu Wei Jiang Xin Tang (Poria, Licorice, Schisandra, Ginger and Asarum Decoction) 
Source: Jin Kui Yao Lue 
Composition
Gan Jiang ( Zingiberis rhizoma) 9 g
Xi Xin ( Asari herba)* 6 g
Fu Ling ( Poria) 12 g
Wu Wei Zi ( Schisandrae fructus) 6 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Analysis of the formula
This formula can warm the Lung and transform cold-phlegm. It is used for treating accumulation of cold-phlegm in the Lung. The manifestations are cough with a large amount of thin, watery or white phlegm, an uncomfortable sensation in the chest, a white and moist tongue coating and a wiry and slippery pulse.
In this formula:
• Gan Jiang and Xi Xin are chosen as chief to warm the interior, especially the Spleen and Kidney respectively, accelerate the water metabolism and dissolve the accumulation of water and cold-phlegm in the Lung.
• Fu Ling, as deputy, is used in a reasonably large dosage to leach out dampness directly by increasing urination.
• Wu Wei Zi is a corrective assistant. It stabilizes the Lung-Qi, thus protecting the Yin and fluid, which can be consumed by the hot herbs.
• Zhi Gan Cao serves as both assistant and envoy. As assistant, it is used to protect and strengthen the Middle-Jiao; as envoy, it harmonizes the herbs in the formula that work on different aspects and in different directions.
Commentary on strategies
• This formula demonstrates two approaches to remove cold-phlegm from the Lung – one is to warm the interior, the other is to dissolve phlegm.
• Although there are only five herbs in this formula, each has a specific function and demonstrates one procedure of treating cold-phlegm in the Lung. The dispersing herbs are used with stabilizing herbs. Since they are strong, effective and active, it is not necessary to use extra herbs to regulate the Qi. This formula clearly shows the composition style of Dr Zhang Zhong Jing.
Ping Wei San (Calm the Stomach Powder) 
Source: Tai Ping Hui Min He Ji Ju Fang 
Composition
Cang Zhu ( Atractylodis rhizoma) 15 g
Hou Po ( Magnoliae cortex) 9 g
Chen Pi ( Citri reticulatae pericarpium) 9 g
Gan Cao ( Glycyrrhizae radix) 4 g
Sheng Jiang ( Zingiberis rhizoma recens) 2 slices
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