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
Da Zao ( Jujubae fructus) 2 pieces
Analysis of the formula
This formula can dry dampness and stimulate the Spleen, regulate the Qi and soothe the Stomach. It treats accumulation of dampness in the Middle-Jiao that obstructs the Qi movement of the Spleen and Stomach. The symptoms are distension and fullness in the epigastria and abdomen, reduced appetite, nausea, vomiting, belching and acid regurgitation, heaviness of the limbs and reluctance to move. A white, sticky or thick tongue coating and a slow and soft pulse indicate the accumulation in this syndrome.
In this formula:
• Cang Zhu is used as chief. It is bitter, warm and pungent, can directly dry the dampness in the Middle-Jiao and restore the function of the Spleen and Stomach.
• Hou Po is the deputy. It is pungent, bitter and warm, can effectively promote the Qi movement, dry dampness and particularly reduce the distension.
• Chen Pi is used as an assistant. It is also pungent, warm and bitter, but is gentler than the first two herbs. It is used particularly to regulate the Qi of the Middle-Jiao, promote digestion and remove food accumulation, a common accompanying condition with dampness accumulation in the Middle-Jiao.
Commentary on strategies
As the formula shows the basic principles of eliminating dampness from the Middle-Jiao, it is considered a principal formula for treating dampness.
• It is characterized by using bitter, warm and pungent herbs to dry the dampness directly.
• Herbs that regulate the Qi and strengthen the Spleen and Stomach are used to enhance the function of herbs that dry the dampness.
Huo Xiang Zheng Qi San (Agastache Powder to Rectify the Qi) 
Source: Tai Ping Hui Min He Ji Ju Fang 
Composition
Huo Xiang ( Agastachis herba) 90 g
Bai Zhi ( Angelicae dahuricae radix) 30 g
Zi Su Ye ( Perillae folium) 30 g
Ban Xia ( Pinelliae rhizoma) 60 g
Chen Pi ( Citri reticulatae pericarpium) 60 g
Bai Zhu ( Atractylodis macrocephalae rhizoma) 60 g
Fu Ling ( Poria) 30 g
Hou Po ( Magnoliae cortex) 60 g
Da Fu Pi ( Arecae pericarpium) 30 g
Jie Geng ( Platycodi radix) 60 g
Sheng Jiang ( Zingiberis rhizoma recens) 3 slices
Da Zao ( Jujubae fructus) 1 piece
Zhi Gan Cao ( Glycyrrhizae radix preparata) 75 g
Analysis of the formula
This formula can release exterior, transform dampness, regulate the Qi and harmonize the Middle-Jiao. It is used for treating invasion of exterior pathogenic wind-cold-dampness in the superficial region, as well as obstruction of damp-cold in the Middle-Jiao by inappropriate eating and drinking. The symptoms are developed from these two pathological changes. On the one hand, the exterior wind-damp-cold shows itself in chills, fever, headache and general pain of the body; on the other hand, damp-cold in the Stomach causes nausea, vomiting and fullness in the chest and epigastria. As dampness blocks the Middle-Jiao, the Spleen-Qi is unable to ascend, and diarrhea and abdominal pain thus appear. A white and sticky tongue coating and a soft pulse suggest the presence of dampness.
In this formula:
• Huo Xiang is used as chief. It has the function of either expelling wind, damp and cold from the exterior, or eliminating damp-cold from the Middle-Jiao. These functions are derived from its warm, pungent and aromatic properties and the ability to enter the Lung, Stomach and Spleen meridians.
• The deputies are divided into two groups:
– Zi Su Ye, Bai Zhi and Jie Geng enhance the ability of Huo Xiang to expel wind, dampness and cold in the exterior.
– Hou Po, Chen Pi and Zi Su Ye enhance the function of Huo Xiang to eliminate damp-cold in the Middle-Jiao and harmonize the Qi.
• The assistants are:
– Fu Ling, Ban Xia and Da Fu Pi. They focus on regulating the Qi. Moreover, Fu Ling can leach out dampness by promoting urination; Ban Xia can eliminate phlegm and soothe the Stomach-Qi; Da Fu Pi eliminates the dampness and promotes Qi movement in the entire abdomen.
– Bai Zhu, Sheng Jiang, Da Zao and Zhi Gan Cao. As helping assistants they focus on recovering the function of the Spleen and Stomach. Bai Zhu can strengthen the function of the Spleen and thus reduce dampness; Sheng Jiang, Da Zao and Zhi Gan Cao are able to strengthen the Middle-Jiao and promote digestion.
• Zhi Gan Cao is also used as envoy to harmonize the herbs in this formula.
Commentary on strategies
Although this formula is quite large, its structure is clear.
• One chief treats two pathogenic changes in the body. The remaining herbs are clearly divided into two groups of deputies and two groups of assistants. Each group has its special function. When they are used together they can enhance the ability of the chief and widely cover the secondary symptoms.
• This formula has gathered the functions and strategies of Ping Wei San (Calm the Stomach Powder), which removes dampness, and Er Chen Tang (Two-Cured Decoction), which removes phlegm. The variations bring a deeper understanding of the relationship between the syndromes and the variations of composition.
• The dosages of the herbs in the formula are only for making a large stock in pharmacies. A total dose of 6 g of fine powder can be prescribed, and mild sweating is expected to occur after taking it.
Shi Pi Yin (Bolster the Spleen Decoction) 
Source: Chong Ding Yan Shi Ji Sheng Fang 
Composition
Fu Zi ( Aconiti radix lateralis preparata)* 6 g
Gan Jiang ( Zingiberis rhizoma) 6 g
Fu Ling ( Poria) 6 g
Bai Zhu ( Atractylodis macrocephalae rhizoma) 6 g
Mu Gua ( Chaenomelis fructus) 6 g
Hou Po ( Magnoliae cortex) 6 g
Mu Xiang ( Aucklandiae radix)** 6 g
Da Fu Pi ( Arecae pericarpium) 6 g
Cao Guo ( Tsaoko fructus) 6 g
Gan Cao ( Glycyrrhizae radix) 3 g
Sheng Jiang ( Zingiberis rhizoma recens) 5 slices
Da Zao ( Jujubae fructus) 1 piece
Analysis of the formula
This formula can warm the Yang, strengthen the Spleen, move the Qi and drain the water. It treats severe accumulation of water in the body due to Spleen-Yang and Kidney-Yang deficiency. The manifestations are severe edema, particularly of the abdomen and legs, cold hands and feet, no thirst, fullness and distension of the chest and abdomen, soft stool, a thick and sticky tongue coating and a deep and slow pulse.
In this formula:
• Gan Jiang, Fu Zi and Cao Guo are used as chief. They can warm the Spleen and Kidney directly, expel cold and accelerate water metabolism.
• Bai Zhu, Fu Ling and Gan Cao are used as deputies to strengthen the function of the Spleen and accelerate the transformation and transportation of water. In addition, Bai Zhu can directly dry dampness and Fu Ling can leach out dampness by promoting urination.
• Hou Po, Mu Xiang, Da Fu Pi and Cao Guo, as assistants, can promote Qi movement and eliminate the dampness.
• Mu Gua is used as both helping assistant and corrective assistant because it can transform dampness directly as well as stabilize the Yin, which can be injured by the pungent and hot herbs or the herbs that move the Qi and drain the water.
• Sheng Jiang is able to warm the Middle-Jiao and to promote digestion. Da Zao can tonify the Qi and blood. They are used as a pair of assistant herbs to strengthen the Middle-Jiao so as to help the chief and deputy herbs to eliminate dampness.
Commentary on strategies
This formula is large in composition and strong in function. It shows the four essential approaches to draining water so as to reduce severe edema: warming the Yang, strengthening the Spleen, regulating the Qi and draining water. These functions are balanced by using the sour and warm Mu Gua.
Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction) 
Source: Jin Kui Yao Lue 
Composition
Fu Ling ( Poria) 12 g
Gui Zhi ( Cinnamomi cassiae ramulus) 9 g
Bai Zhu ( Atractylodis macrocephalae rhizoma) 6 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Analysis of the formula
This formula can warm and transform congested fluid, strengthen the Spleen and resolve dampness. It is used to treat congested fluid in the epigastria and weakness of the Spleen-Yang. The manifestations are fullness in the chest and hypochondria, palpitations, shortness of breath, coughing up clear and watery sputum, dizziness or vertigo, a pale, flabby tongue with a white and watery coating and a slippery, wiry or deep pulse.
In this formula:
• Fu Ling is used as chief in a comparatively large dosage. It can directly leach out the dampness and promote urination.
• Gui Zhi is used as deputy. As it can stimulate the Yang and accelerate the water turning into Qi, it can reduce the retention of water.
• Bai Zhu and Zhi Gan Cao are used as assistants to strengthen the function of the Spleen so as to stimulate the transforming process of water. Bai Zhu can also dry dampness.
• Zhi Gan Cao is used as envoy to harmonize the functions of the herbs in the formula.
Commentary on strategies
• In this formula, the basic strategies that have been shown in other formulas for eliminating water, such as leaching out dampness and strengthening the Spleen, are used.
• Moreover, a unique new strategy is carried out by using Gui Zhi. As it is light and subtle, it can steam water into Qi and therefore dissolve the water.
2. Damp-heat syndrome
Manifestations
In the Upper-Jiao
Main symptoms
Mild chills, fever, a warm sensation that remains in the flesh and cannot escape, headache with a heavy sensation, sleepy, generalized pain and heaviness of the body.
Secondary symptoms
Cough, dizziness, fullness in the chest.
In the Middle-Jiao
Main symptoms
Heaviness and aching of the body, fever, irritability, thirst, fullness in the Stomach and no appetite.
Secondary symptoms
Sticky sensation in the mouth, reduced appetite, nausea, vomiting; eczema or other itchy and weeping skin disorders; Bi syndrome of wind-damp-heat type, poor concentration, inability to study, impaired memory, slow reactions; convulsions and mental confusion; heavy, painful and stiff limbs, swollen joints; tiredness, lassitude, jaundice.
In the Lower-Jiao
Main symptoms
Difficult urination, difficult bowel movement and soft and sticky stool.
Secondary symptoms
Blood, pus and mucus in the stool, abdominal pain, distension, diarrhea and tenesmus; painful, urgent and frequent urination, blood in the urine.
Tongue
Red with a sticky white or yellow coating.
Pulse
Rapid, soft or slippery.
Associated western disorders
Acute and chronic viral, bacterial, microbial and parasitic infections, skin disease, metabolic disorders, chronic liver disease and kidney disease.
Analysis of the syndrome
Damp-heat syndrome is a very complicated condition. It is often caused by external damp-heat and is seen frequently in damp-febrile disease, referred to as Shi Re Bing in Chinese.
Damp-febrile disease is one type of febrile disease; the other is warm-febrile disease, which is discussed in Chapter 3, Internal heat syndrome and formula composition. Damp-febrile disease is an infectious disease caused by exterior pathogenic damp-heat and is related to area and climate.
• Pathogenic damp-heat invades the body through the nose and mouth. Sometimes the body reacts directly to the pathogenic factor, starting with exterior syndrome characterized by fever and chills with a superficial pulse.
• Sometimes the pathogenic factor has an incubation period. It stays in the body without any symptoms and starts after a certain period of time when the body’s resistance is weak.
• The disease is characterized by the symptoms of tidal fever, afternoon fever or low-grade fever, but the heat cannot get out of the body. It mainly disturbs the function of the Spleen and Stomach and causes disorders of digestion and water metabolism. It has a lingering course and patients need time to recover. (See Figure 7.3 on page 222.)
• Damp-heat usually invades the Upper-Jiao first. It mainly disturbs the function of the Lung, causing disorders in the superficial region and water passage, and leads to fever, chills, cough and fullness of the chest.
• When damp-heat in the Upper-Jiao is not eliminated in time, it can invade the Middle-Jiao, obstruct the Qi and disturb the functions of the Spleen, Stomach, Large Intestine, Liver and Gall Bladder. It causes digestive disorders, skin diseases, tiredness, and swelling, pain and heaviness of the muscles and joints. The lingering dampness holds the heat, which can remain in the body for a very long period of time. When the function of the Spleen is injured by damp-heat, the excess condition of damp-heat can be complicated by Spleen deficiency.
• Damp-heat can descend to the Lower-Jiao when it has accumulated for too long in the Middle-Jiao. It disturbs the Qi and blood, which shows in abnormal bowel movement and urination.
• As well as the common development of damp-heat in the body, sometimes damp-heat can invade the Middle- and Lower-Jiao directly.
(See Figure 7.4 on page 223.)
In addition to the above causes of damp-heat syndrome, as well as the influence of climate, an individual’s constitution and eating habits can directly generate damp-heat in the body. A Yang constitution and indulgence in sweet, greasy and heavy food may generate damp-heat in the Middle-Jiao. After a long period of time, the Spleen is injured and the syndrome becomes excess with deficiency. When the function of the Spleen and Stomach have been impaired for a long period of time, a damp-heat syndrome can also arise. Once this complicated condition exists, it is very difficult to eliminate. (See Figure 7.5 on page 223.)
• Dampness is a Yin pathogenic factor; heat is a Yang pathogenic factor. When they are mixed together, dampness may restrain the heat. Fever appears but is normally not high. If the body’s resistance is strong, patients can have high fever.
• Whether the fever is high or low, patients experience a very unpleasant sensation when the damp-heat remains in the flesh, cannot escape and cannot be reduced by heavy sweating.
• Since Qi is obstructed by dampness, fullness, distension, tiredness and heaviness of the body may occur.
• As the Spleen relates to flesh, damp-heat can cause skin and muscular disorders.
• When damp-heat obstructs bile secretion, jaundice may present.
• When there is damp-heat in the Large Intestine and when dampness obstructs the Qi movement, irregular bowel movement, diarrhea, abdominal pain, distension, tenesmus and a bearing-down sensation may appear.
• If damp-heat injures the blood and the flesh, mucus and blood appear in the stool.
• If damp-heat obstructs the Bladder and injures blood vessels, urine is painful, frequent and bloody.
• The Spleen is responsible for thinking and study. If the Spleen is covered by dampness, patients may feel sleepy, be unable to study and suffer from poor concentration and impaired memory.
• When the clean-Qi of the Spleen is unable to ascend to support the Heart, patients may have difficulty in observation and responding quickly to the environment.
• Damp-heat disturbs the function of the Spleen and Stomach and often causes digestive disorders leading to accumulation of food and phlegm. The tongue coating can therefore be yellow, sticky and thick, which is increased by the degree of damp-heat in the body. A red color indicates the degree of heat in the body at the same time. A soft pulse indicates the presence of dampness. In a strong person, or in a case of severe food, phlegm or water accumulation, a slippery, forceful or wiry pulse can be felt; a rapid pulse is the result of heat.
(See Figure 7.6 on page 224.)
Treatment principle: Separate dampness and heat by dispersing, transforming, drying and draining damp-heat; regulate the Qi; protect and strengthen the function of the Spleen
Herb selection principles and formula composition strategies
First priority
• When damp-heat accumulates in the Upper-Jiao, herbs that are pungent and warm, and can induce mild sweating to disperse and expel dampness should be selected along with aromatic herbs that can transform the dampness. It is also important to select aromatic and cold herbs that enter the Heart and Lung meridians, and can disperse and clear the heat.
• When damp-heat accumulates in the Middle-Jiao, pungent and warm herbs that can open up the obstruction should be selected along with bitter and warm herbs that can dry the dampness. Bland and cold herbs that can clear the heat and leach out the dampness should be used at the same time.
• When damp-heat accumulates in the Lower-Jiao, bland and cold or bitter and cold herbs that enter the Bladder and Small Intestine meridians and can leach out or dry damp-heat should be selected if there is a urinary disorder. Pungent and warm herbs that can stimulate the intestines and eliminate dampness should be used together with bitter and cold herbs that clear heat in the intestines when there is a disorder of bowel movement.
Second priority
• When Damp-heat accumulates in the Upper-Jiao, aromatic herbs that clear and disperse heat should be used.
• When damp-heat accumulates in the Middle-Jiao, herbs that aromatically disperse and transform dampness should be used together with herbs that are bland and neutral and can leach out dampness by promoting urination. Herbs that are bitter and cold, can dry dampness and clear heat are also used.
Third priority
• Herbs that regulate the Qi of the Lung and the water passage should be used.
• Herbs that promote digestion and regulate the Qi in the Middle-Jiao should be used.
• Herbs that regulate the function of the Spleen and Stomach, and herbs that promote bile secretion and open the Heart orifice should be used when damp-heat disturbs the functions of the Gall Bladder and Heart.
• Herbs that open up the collaterals and benefit the muscles and joints should be used as required.
CAUTIONS
1. Pay attention to the condition of the Yin:
Herbs that treat dampness should be used with caution in conditions of Yin consumption. This is because, in the process of separating dampness from heat, pungent and warm herbs are used to disperse dampness, bitter and warm herbs are used to dry dampness and bland herbs are used to leach out dampness.
2. Pay attention to the condition of the Yang:
Cold herbs that clear heat should be used with caution as they can weaken the Yang and may increase the possibility of dampness generation.
3. Use steady and constant action in the treatment course:
Since dampness is a Yin pathogenic factor and heat is a Yang pathogenic factor, when heat is held by dampness, it cannot leave easily from the body. Herbs in formulas to eliminate damp-heat should have a steady and constant action. Large dosage should be avoided.
4. Caution in pregnancy:
Pregnant women should use the formulas with caution as these formulas contain aromatic, pungent and bitter herbs, which can activate Qi and blood, and drain dampness. They may bring danger to the pregnancy.
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: Separate dampness and heat, and eliminate them
Ma Huang ( Ephedrae herba)* or Xiang Ru ( Moslae herba), Xing Ren ( Armeniacae semen), Jin Yin Hua ( Lonicerae flos) and Bo He ( Menthae herba)
These herbs treat damp-heat that starts in the superficial region and in the Upper-Jiao.
Ma Huang and Xiang Ru are both pungent and warm. As they can disperse the Lung-Qi, open the pores and induce mild sweating, they can eliminate dampness. They are often used for an exterior wind-dampness syndrome. Xiang Ru is gentler than Ma Huang. When damp-heat blocks the Qi in the Upper-Jiao, either one can be used. In addition, since both herbs can also descend the Qi and fluid from the Lung, they can increase urination and eliminate dampness.
Xing Ren is pungent, bitter and warm, and enters the Lung meridian. It can regulate the Qi of the Lung as its pungent and warm property has a dispersing function and its bitter taste brings a descending action. Xing Ren is often used when damp-heat obstructs the Qi in the Lung. In addition, it can also dry dampness and eliminate phlegm.
Jin Yin Hua and Bo He are aromatic but cold herbs. They can disperse, penetrate the dampness, clear and reduce the heat. They are frequently selected when damp-heat invades the Upper-Jiao.
When these pungent, aromatic herbs with warm and cold natures are used together, the damp and heat can be separated and eliminated.
Huo Xiang ( Agastachis herba), Yi Yi Ren ( Coicis semen) and Hua Shi ( Talcum)
These herbs particularly treat damp-heat accumulation in the Middle-Jiao.
Huo Xiang is pungent and slightly warm, and enters the Lung, Spleen and Stomach meridians. It can aromatically disperse dampness, revive the function of the Spleen and Stomach, and transform the dampness from the Middle-Jiao. Yi Yi Ren is sweet, bland and slightly cold, and enters the Spleen, Stomach and Lung meridians. It can directly dissolve damp-heat in the Middle-Jiao. Hua Shi is sweet and cold, and can leach out dampness by promoting urination.
When these herbs are used together, they can disperse, transform and leach out dampness.
Bai Dou Kou ( Amomi fructus rotundus) with Zhu Ling ( Polyporus) and Ze Xie ( Alismatis rhizoma)
These herbs particularly treat dampness accumulation in the Lower-Jiao and the damp-heat disturbs the function of the Bladder.
Bai Dou Kou is pungent and warm, and enters the Spleen, Stomach and Lung meridians. It is able to dry and disperse dampness, and promote the Qi movement in the Middle-Jiao. Zhu Ling is sweet and neutral and Ze Xie is sweet, bland and cold. They can eliminate the damp-heat by promoting urination. The combination of warm and cold, pungent and bland can activate the water metabolism in the Lower-Jiao.
Deputy: Eliminate damp-heat by promoting urination; dry dampness and drain damp-heat; regulate the Qi; stimulate and revive the function of the Spleen, open the orifice and meridians
Dan Zhu Ye ( Lophatheri herba), Zhi Zi ( Gardeniae fructus), Mu Tong ( Mutong caulis)* and Deng Xin Cao ( Junci medulla)
These herbs can be used alone or in a group as deputy in the formulas. They are bitter and cold, and enter the Heart and Small Intestine meridians. They can clear the heat from the Heart and Small Intestine, promote urination and thus leach out damp-heat. They are particularly used when stress and emotional disturbance create heat in the Heart that influences urination. Since they move downwards, they can regulate the San Jiao water passage and accelerate the Qi movement in the San Jiao. Among these herbs, Dan Zhu Ye and Deng Xin Cao are the gentle ones and can be used for a relatively long period of time; Zhi Zi and Mu Tong are the strong ones and are only used for acute cases and for a short time.
Huang Qin ( Scutellariae radix), Yin Chen Hao ( Artemisiae scopariae herba), Yu Jin ( Curcumae radix) and Lian Qiao ( Forsythiae fructus)
This group of herbs can be used as deputies to transform the damp-heat from the Middle-Jiao, promote bile secretion and reduce jaundice.
Ban Xia ( Pinelliae rhizoma), Hou Po ( Magnoliae cortex) and Su Geng ( Perillae caulis)
The herbs in this group are pungent and warm, or pungent, bitter and warm. They can be used as deputies when the dampness accumulates in the Middle-Jiao, especially in the Stomach, which causes fullness and nausea. These herbs should be used with herbs that clear heat. They can promote Qi movement, disperse and transform dampness, and soothe the Stomach-Qi in the Middle-Jiao.
Ban Xia can break up the accumulation of dampness as well as phlegm. It can efficiently soothe the Stomach-Qi. Hou Po has a strong and steady function of eliminating, drying the dampness and promoting the Qi movement. The strong point of this herb is that it can activate the Qi so as to eliminate dampness in the Upper-, Middle- and Lower-Jiao. Su Geng is the gentlest of the three and particularly promotes the Qi movement in the Upper- and Middle-Jiao.
Huo Xiang ( Agastachis herba) and Pei Lan ( Eupatorii herba)
Huo Xiang and Pei Lan can be used as deputies to treat damp-heat in the Middle-Jiao. They are aromatic herbs and can penetrate the dampness and revive the Spleen. They can therefore disperse the heat and dampness, and transform the dampness. They should be used with herbs that clear the heat.
Shi Chang Pu ( Acori graminei rhizoma) and Yu Jin ( Curcumae radix)
These two herbs are commonly used as deputies to open the orifices. Shi Chang Pu and Yu Jin are cold and aromatic. They can remove dampness from the Middle-Jiao and allow the clear Qi to ascend to the head. They are particularly used in conditions of headache, heaviness in the head, poor concentration and mental confusion.
Han Fang Ji ( Stephaniae tetrandrae radix), Yi Yi Ren ( Coicis semen), Fang Feng ( Saposhnikoviae radix), Qin Jiao ( Gentianae macrophyllae radix) and Cang Zhu ( Atractylodis rhizoma)
Han Fang Ji and Yi Yi Ren are cold and are able to eliminate damp-heat, increase urination, and relax the tendons and muscles. They can be used in the condition of Bi syndrome due to damp-heat in the Middle-Jiao.
Fang Feng is pungent and slightly warm, and enters the Spleen meridian. It can disperse wind-dampness, ascend the clear Qi of the Spleen, eliminate dampness from the muscles and subcutaneous region, and treat heaviness and uneasy sensations in the muscles. Fang Feng can also promote digestion in the sense of reducing abdominal distension.
Qin Jiao is pungent, bitter and neutral, and is able to induce mild sweating and reduce dampness in the superficial region of the body, as well as treat stiffness, heaviness and pain of the muscles.
Cang Zhu is very pungent and warm. It can directly dry dampness in the Middle-Jiao. As it can also slightly induce sweating, it can disperse wind and dampness from the superficial region of the body.
Assistant: Strengthen the Spleen; reduce the heat, remove phlegm and food accumulation; stabilize the Yin and body fluids
Bai Bian Dou ( Dolichoris lablab semen), Fu Ling ( Poria) and Bai Zhu ( Atractylodis macrocephalae rhizoma)
These herbs are able to tonify the Spleen-Qi as well as eliminate dampness from the Middle-Jiao.
Bai Bian Dou has a very gentle function of tonifying the Spleen-Qi and is also able to transform the dampness. It is astringent and can stabilize the fluid from the intestines. This herb is particularly selected for treating chronic diarrhea due to Spleen-Qi deficiency and dampness accumulation in the Middle-Jiao.
Fu Ling is bland and neutral, and enters the Spleen and Bladder meridians. It is able to tonify the Spleen, promote urination and therefore leach out dampness from the Middle- and Lower-Jiao.
Bai Zhu can directly dry dampness as it is pungent and warm. It has a relatively strong function to tonify the Spleen-Qi compared with the other two herbs.
Fresh Jin Yin Hua ( Lonicerae flos), He Ye ( Nelumbinis folium), Bai Mao Hua ( Imperatae cylindricae flos) and Si Gua Luo ( Luffae fructus)
These aromatic fresh herbs can reduce the summer-heat and transform and disperse the dampness. They can be used as assistants in the formula if the damp-heat occurs in a humid and warm area. The main indications are fullness in the chest, reduced appetite, a sticky feeling in the mouth and sleepiness. The aromatic fresh herbs can penetrate the dampness in the Middle-Jiao, revive the function of the Spleen and accelerate the transformation of dampness.
Fo Shou ( Citri sarcodactylis fructus), He Ye ( Nelumbinis folium), Sha Ren ( Amomi xanthioidis fructus), Mai Ya ( Hordei fructus germinatus) and Shen Qu ( Massa medicata fermentata)
These herbs are able to promote digestion, regulate the Qi in the Middle-Jiao and revive the function of the Spleen and Stomach. They are often used in the recovery period of syndromes of damp-heat in the Spleen and Large Intestine.
Fo Shou is also able to spread the Liver-Qi and is more suitable to treat distension in the epigastria and hypochondriac region with slight depression.
He Ye has a light fragrant smell; it can wake up the Spleen and improve appetite.
Sha Ren is particularly useful for distension in the abdomen and for treating Qi stagnation with dampness in the Large Intestine.
Mai Ya and Shen Qu are useful for treating poor appetite because they particularly aid the digestion of wheat, rice and cereals respectively.
Sang Bai Pi ( Mori cortex) and Gua Lou ( Trichosanthis fructus)
These two herbs can remove phlegm, clear heat and descend the Qi. They are often used when phlegm has accumulated together with dampness.
Mu Gua ( Chaenomelis fructus) and Bai Shao Yao ( Paeoniae radix lactiflora)
These are sour herbs. Mu Gua is warm and Bai Shao Yao is cold. They may be used in formulas as corrective assistants in order to stabilize the Yin and body fluids which can be weakened by the large group of herbs that eliminate dampness. Mu Gua enters the Liver and Spleen meridians, and can dissolve dampness. It treats cramping, stiffness, swelling and heaviness of the joints and muscles.
Envoy
An envoy is not usually necessary since the chief, deputy and assistant are not harsh in action or temperature. In addition, Zhi Gan Cao ( Glycyrrhizae radix preparata), the most commonly used envoy, is not suitable in this case as sweetness may retain and generate dampness.
Common accompanying symptoms and treatment
• Blood and mucus in stool: use Bai Tou Weng ( Pulsatilla radix), Huang Qin ( Scutellariae radix), Huang Lian ( Coptidis rhizoma) and Huang Bai ( Phellodendri cortex) to clear the heat and dry the dampness.
• Painful, bloody urine due to urinary tract stone: use Hai Jin Sha ( Lygodii spora) and Jin Qian Cao ( Lysimachiae herba) to clear heat and remove the tiny stones, which are often referred to as sand.
• Red, itchy and weeping skin disorder: use Bai Xian Pi ( Dictamni cortex), Di Fu Zi ( Kochiae fructus) and Ku Shen ( Sophorae flavescentis radix) to clear heat and dry dampness.
• Abscess: use Dong Gua Zi ( Benincasae semen), Yi Yi Ren ( Coicis semen) and Lu Gen ( Phragmitis rhizoma) to clear heat and transform pus.
• Leukorrhea: use Jing Jie ( Schizonepetae herba), Huang Qin ( Scutellariae radix) and Shan Yao ( Dioscoreae rhizoma) to disperse and transform dampness.
• Mental confusion: use Shi Chang Pu ( Acori graminei rhizoma), Yu Jin ( Curcumae radix), Bing Pian ( Borneol) and Niu Huang ( Bovis calculus)** to open the Heart orifice.
Examples of classical formulas
Xin Jia Xiang Ru Yin (Newly-Augmented Elsholtzia Decoction) 
Source: Wen Bing Tiao Bian 
Composition
Xiang Ru ( Moslae herba) 6 g
Jin Yin Hua ( Lonicerae flos) 9 g
Xian Bai Bian Dou Hua (fresh Dolichoris lablab flos) 9 g
Hou Po ( Magnoliae cortex) 6 g
Lian Qiao ( Forsythiae fructus) 6 g
Analysis of the formula
This formula is able to induce sweating and expel dampness in the superficial region. It treats damp-cold invasion of the superficial region and summer-heat that is constrained in the body. The manifestations are chills, fever, no sweat, general pain and heaviness, fullness in the stomach, irritation, thirst, scanty urine, a white, sticky tongue coating and a soft and rapid pulse.
In this formula:
• Xiang Ru is used as chief to induce a mild sweating so as to expel dampness and cold in the superficial region.
• Jin Yin Hua, Lian Qiao and Bian Dou Hua are also used as chief. As they have a light, aromatic smell, they can gently disperse the obstructed Qi, penetrate dampness and eliminate it. At the same time, they clear the summer-heat. They make a good combination with the pungent and warm Xiang Ru.
• Hou Po is the deputy. It can directly dry dampness and regulate the Qi.
Commentary on strategies
• The combination of herbs in the formula demonstrates the strategy of inducing sweating together with clearing heat.
• Following the principle of treating dampness in the Upper-Jiao, in the superficial region of the body, all herbs are aromatic, light in weight and light in function. They possess a dispersing nature.
San Ren Tang (Three-Nut Decoction) 
Source: Wen Bing Tiao Bian 
Composition
Xing Ren ( Armeniacae semen) 15 g
Bai Dou Kou ( Amomi fructus rotundus) 6 g
Yi Yi Ren ( Coicis semen) 18 g
Hua Shi ( Talcum) 18 g
Tong Cao ( Tetrapanacis medulla) 6 g
Dan Zhu Ye ( Lophatheri herba) 6 g
Hou Po ( Magnoliae cortex) 6 g
Ban Xia ( Pinelliae rhizoma) 10 g
Analysis of the formula
This formula can promote free flow of Qi and eliminate damp-heat. It is used to treat dampness which is mingled with mild heat that obstructs the Qi in the Middle-Jiao. This occurs at the initial stage of damp-febrile disease or in humid summer conditions. The manifestations are headache with a heavy sensation, heaviness of the body, a wan complexion, fullness in the chest and epigastria, no appetite, afternoon fever, an absence of thirst, a white, sticky, thick tongue coating and a wiry, thready pulse, which is soft in the deep position.
In this formula, three seeds are used as chief herbs:
• Xing Ren, Bai Dou Kou and Yi Yi Ren are used together to disperse, transform and leach out dampness respectively. They treat damp-heat in the Upper- and Middle-Jiao.
• Xing Ren is pungent, bitter and warm, and enters the Lung and Large Intestine meridians. The pungent and warm nature can disperse the Lung-Qi and the dampness and open up the Upper-Jiao. The bitterness can descend the Qi, and bitter with warm can dry dampness directly.
• Bai Dou Kuo is also pungent and warm, but it enters the Spleen meridian. It can dry the dampness in the Middle-Jiao and regulate the Qi there.
• Yi Yi Ren is bland and slightly cold, and enters the Spleen, Stomach and Lung meridians. It can eliminate the dampness from the Middle-Jiao and clear the heat by increasing urination.
When these three herbs are used together, they can separate the dampness and eliminate it. Qi movement in the San Jiao passage is therefore freed and all the symptoms disappear.
• Hou Po is used as deputy. It is pungent, bitter and warm, and enters the Lung, Spleen and Large Intestine meridians. It is an excellent herb to regulate the Qi in the San Jiao passage, as well as removing phlegm and dampness, thereby enhancing the ability of the chief herbs.
• Ban Xia is an assistant. It can directly dry the dampness in the Middle-Jiao and help Bai Dou Kuo .
• Hua Shi, Tong Cao and Dan Zhu Ye form a group of assistants. They promote urination and assist Yi Yi Ren to clear heat and leach out dampness.
Commentary on strategies
This formula demonstrates how to separate and eliminate damp-heat when dampness and heat are mixed together, accumulate in the Middle-Jiao, spread over the entire body and block the Qi movement.
Gan Lu Xiao Du Dan (Sweet Dew Special Pill to Eliminate Toxin) 
Source: Wen Re Jing Wei 
Composition
Hua Shi ( Talcum) 450 g
Yin Chen Hao ( Artemisiae scopariae herba) 330 g
Huang Qin ( Scutellariae radix) 300 g
Shi Chang Pu ( Acori graminei rhizoma) 180 g
Chuan Bei Mu ( Fritillariae cirrhosae bulbus) 150 g
Mu Tong ( Mutong caulis)* 150 g
Huo Xiang ( Agastachis herba) 120 g
She Gan ( Belamcandae rhizoma) 120 g
Lian Qiao ( Forsythiae fructus) 120 g
Bo He ( Menthae herba) 120 g
Bai Dou Kou ( Amomi fructus rotundus) 120 g
Analysis of the formula
This formula is able to leach out and transform turbid dampness and clear heat-toxin. It is used for treating damp-febrile disease when the damp-heat accumulates in the Qi level and the dampness and heat are equal in intensity. They block the Qi movement and injure the Yin. The manifestations are fever, sleepiness, fullness in the chest, abdominal distension, stiff and sour limbs, painful and swollen throat, thirst, vomiting, diarrhea, difficult urination, wan complexion or jaundice, a white or thick, sticky or dry, yellow tongue coating and a soft and rapid pulse.
In this formula, the chief herbs are administered in large dosages and are used to separate and eliminate damp-heat:
• Hua Shi is sweet and cold, can clear heat, leach out dampness and generate the body fluids.
• Yin Chen Hao is an aromatic herb. It can disperse and transform dampness, and clear heat in the Upper- and Middle-Jiao.
• Huang Qin is bitter and cold, can clear heat and dry dampness in the Upper- and Middle-Jiao.
• Mu Tong is bitter and cold. It can strongly clear heat and promote urination so as to leach out damp-heat from the body.
Several assistants enhance the ability of the chief herbs:
• Shi Chang Pu, Bo He and Huo Xiang enhance the ability of Yin Chen Hao. They are all aromatic herbs and especially reduce the sleepy and heavy sensation of the head.
• Chuan Bei Mu, She Gan, Lian Qiao and Bai Dou Kou enhance the ability of the chief herbs from different approaches. They all have a pungent taste. Chuan Bei Mu and She Gan can regulate the Qi and open up the Upper-Jiao; Lian Qiao can disperse and clear heat from the Heart; Bo He can disperse the heat in the Upper-Jiao and spread the Qi of the Liver and Gall Bladder; Bai Dou Kou can dry dampness and regulate the Qi in the Middle-Jiao.
Commentary on strategies
As the damp-heat pathogenic factor has two conflicting natures in one, and it blocks many places in the body, several combinations are used in this formula to suit this complicated situation.
• The aromatic and pungent herbs, which can disperse dampness and heat and open up the Upper-Jiao, are used with the bitter and cold herbs, which directly dry dampness, clear heat and descend the Qi.
• Herbs that leach out damp-heat are used with herbs that dry dampness and herbs that disperse dampness.
• Herbs that enter the San Jiao, Spleen, Large Intestine, Heart and Lung as well as Liver meridians are used together.
• All these combinations come from profound thought about the syndrome and the treatment.
Xuan Bi Tang (Disband Painful Obstruction Decoction) 
Source : Wen Bing Tiao Bian 
Composition
Han Fang Ji ( Stephaniae tetrandrae radix) 15 g
Xing Ren ( Armeniacae semen) 15 g
Hua Shi ( Talcum) 15 g
Lian Qiao ( Forsythiae fructus) 9 g
Zhi Zi ( Gardeniae fructus) 9 g
Yi Yi Ren ( Coicis semen) 15 g
Ban Xia ( Pinelliae rhizoma) 9 g
Can Sha ( Bombycis mori excrementum) 9 g
Chi Xiao Dou ( Phaseoli semen) 9 g
Analysis of the formula
This formula is able to clear heat and transform dampness, reduce pain and treat damp-heat Bi syndrome. The manifestations are high fever, chills, dark complexion, painful and swollen joints, a gray or yellow sticky tongue coating, and a soft and rapid pulse.
In this formula:
• Han Fang Ji, which is bitter, pungent and cold, is used as chief. It is able to clear heat, transform dampness, benefit the joints and stop pain.
• Xing Ren and Hua Shi are deputies. Xing Ren enters the Upper-Jiao, disperses the Lung-Qi and regulates the water passage. Hua Shi enters the Lower-Jiao, clears heat and leaches out dampness.
• The remaining herbs are assistants. Zhi Zi drains damp-heat from San Jiao; Yi Yi Ren transforms damp-heat from the Middle-Jiao. Together with Chi Xiao Dou, Yi Yi Ren eliminates the damp-heat in the meridians, muscles and joints. Ban Xia and Can Sha can open the obstruction of the Qi and eliminate dampness.
Commentary on strategies
• In this formula, herbs are selected with pungent, bitter and cold properties to treat Bi syndrome.
• Herbs are selected with the function of regulating the San Jiao, particularly eliminating damp-heat from the meridians, muscles and joints.
Yin Chen Hao Tang (Artemisia Yinchenhao Decoction) 
Source: Shang Han Lun 
Composition
Yin Chen Hao ( Artemisiae scopariae herba) 30 g
Zhi Zi ( Gardeniae fructus) 15 g
Da Huang ( Rhei rhizoma) 9 g
Analysis of the formula
This formula can clear heat, transform dampness and reduce jaundice. It is used to treat damp-heat in the Spleen, Stomach, Liver and Gall Bladder which obstructs bile secretion. The manifestations are jaundice with a fresh tangerine color, slight abdominal distension, thirst and difficult urination, a yellow, sticky tongue coating and a deep, rapid pulse.
In this formula:
• Yin Chen Hao is used as chief. It is bitter and cold, and enters the Liver, Gall Bladder, Spleen and Stomach meridians. It can clear heat and eliminate dampness. It has an aromatic smell, can revive the function of the Spleen and transform the dampness. It can benefit the Gall Bladder and reduce the jaundice.
• Zhi Zi is used as deputy. It is bitter and cold, and enters the San Jiao meridian. It can clear heat, reduce the fire, regulate the San Jiao, promote urination and eliminate dampness.
• Da Huang is used as assistant. It is bitter and cold, and enters the Spleen and Stomach meridians. It is used in a relatively small dosage compared with the formulas of Dr Zhang Zhong Jing to purge the bowel. Here it is used to reduce damp-heat, increase urination, promote blood circulation and reduce heat-toxin and dampness accumulation.
Commentary on strategies
• In this formula, ascending and descending actions of herbs are used together to separate the dampness and heat.
• The cold and bitter properties of the herbs are used to eliminate heat and dampness.
• Herbs that clear heat are greater in number and stronger in function than those for treating dampness.
• Da Huang is used in small dosage to reduce damp-heat, increase urination, promote blood circulation and reduce heat-toxin and dampness accumulation.
Ba Zheng San (Eight-Herb Powder for Rectification) 
Source: Tai Ping Hui Min He Ji Ju Fang 
Composition
Mu Tong ( Mutong caulis)* 500 g
Hua Shi ( Talcum) 500 g
Che Qian Zi ( Plantaginis semen) 500 g
Qu Mai ( Dianthi herba) 500 g
Bian Xu ( Polygoni avicularis herba) 500 g
Zhi Zi ( Gardeniae fructus) 500 g
Da Huang ( Rhei rhizoma) 500 g
Gan Cao ( Glycyrrhizae radix) 500 g
Analysis of the formula
This formula can clear heat, drain excess fire, promote urination and relieve pain. It is used to treat Lin syndrome (painful urinary dysfunction) due to damp-heat in the Bladder, which injures the blood and blocks the Qi. The manifestations are turbid and dark urine, painful and difficult urination, lower abdominal pain and distension, dry mouth and thirst, a yellow and sticky tongue coating, and a slippery and wiry pulse.
Commentary on strategies
When the dampness invades the Lower-Jiao, it can be eliminated via urination.
• In this formula, many bitter and cold herbs are used to clear heat and promote urination so as to eliminate damp-heat.
• At the same time, Da Huang is used to promote bowel movement, which is a strategy to reduce dampness via the intestines.
• Gan Cao is used as assistant to protect the Stomach from the cold and draining herbs. It also serves as envoy to harmonize the herbs in the formula.
Bai Tou Weng Tang (Pulsatilla Decoction) 
Source: Shang Han Lun 
Composition
Bai Tou Weng ( Pulsatilla radix) 15 g
Huang Bai ( Phellodendri cortex) 12 g
Huang Lian ( Coptidis rhizoma) 4–6 g
Qin Pi ( Fraxini cortex) 12 g
Analysis of the formula
This formula is able to clear heat, eliminate heat-toxin, cool the blood and stop diarrhea.
It is used to treat heat-toxin and dampness accumulation in the intestines, which obstruct the Qi and injure the blood. The manifestations are abdominal pain, tenesmus, a burning sensation around the anus, diarrhea containing more blood than pus, and thirst. Patients often have a red tongue with a yellow coating, and a wiry and rapid pulse.
Commentary on strategies
In clinical practice, this formula should be used with variation.
• This formula is used for treating the syndrome where heat predominates and manifests in the amount of blood and the burning sensation of the anus.
• Most of the herbs in the formula are cold and bitter, and can strongly reduce the damp-heat in the intestines.
• In acute and excess conditions, some herbs should be added, such as Di Yu ( Sanguisorbae radix) and Huai Hua ( Sophorae flos), which can enhance the ability of Bai Tou Weng ( Pulsatilla radix) to cool the blood; Zhi Ke ( Aurantii fructus) and Fang Feng ( Saposhnikoviae radix), which can moderate the Liver-Qi and reduce the urgent, frequent bowel movement and tenesmus; and Jing Jie ( Schizonepetae herba) and Lian Qiao ( Forsythiae fructus), which can clear the obstruction of Qi and blood.
• Qin Pi is essential in the treatment of chronic conditions where the diarrhea lasts for a long time and the Spleen-Qi has been injured. However, it should not be used in excess conditions when the heat in the intestines is strong.
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| Figure 7.1 ·. |
| Etiology and pathology of internal damp-cold syndrome. |
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| Figure 7.2 ·. |
| Pathology of Qi obstruction due to damp-cold. |
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| Figure 7.3 ·. |
| Characteristics of damp-febrile diseases. |
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| Figure 7.4 ·. |
| Damp-heat in the San Jiao regions. |
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| Figure 7.5 ·. |
| Etiology of damp-heat syndrome. |
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| Figure 7.6 ·. |
| Symptoms in damp-febrile diseases. |
