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Dampness and the Circle of Wellness

The circle of wellness is a continual transformation and movement of various energetic and material components. Without this interwoven process, the circle is broken causing illness and death. The essential components are Qi, Blood and Jin/Ye (all of them being manifestations of QI in various stages). The intrinsic flow of the circle is powered by the polar relationships of Kidney and Heart (Fire and Water) and Liver and Lung (regulating and descending of QI). Physiologically the key mechanisms within the circle are the Triple Burner (San Jiao) and Spleen/Stomach. Figure 1 demonstrates the essential roles these organs play in the circle. The triple burner connects the poles and acts as the waterways for transporting the essential components to and from the various organs to power their function and maintain wellness, in the process allowing the pure to rise and the turbid to drain. The Spleen (with its raising function) and the Stomach (with its descending function) comprise the central junction within the poles driving the flow. The critical role of Spleen and Stomach is further increased by the fact that the rotting and ripening of the stomach and transforming and transporting of the spleen are the sole source for replenishing Jing -- the ancestral essence. It is this critical placement of the Spleen and Stomach that finds these two organs involved in some of the most complex and most commonly seen illnesses.

Dampness is one such complex and commonly* seen illness with varied etiology and subtle differentiation and treatment challenges. Dampness is Yin; it is sticky, heavy, turbid and tends to slow things down; thus, when dampness occurs, the central junction gets clogged and the flow of the circle is greatly impaired. The pure cannot rise and the turbid accumulates and festers. Furthermore, this starts a chain reaction by impairing further transformation and transportation of vital substances from food, which reduces the availability of energy for the organs and replenishment of the Jing. Dampness is a combined replete condition (accumulation) with an underlying vacuity (SP Qi most directly, or Yuan Qi).

There are external, internal and lifestyle pathogenic factors involved in creating dampness. Figure 2 illustrates these. External damp conditions (primarily climate related) attack the Spleen Yang and by impairing the transformation and transportation function of the spleen, lead to internal dampness. Internal damp condition always involves some vacuity condition and is insidious, long lasting and difficult to clear. Internal dampness can make the patient susceptible to external acute damp attacks. Internal dampness is created when the Spleen’s transformation and transportation of vital fluids is impaired. Causes for internal dampness include spleen Qi vacuity or lack of Ki Yang (Yuan Qi) for warm transformation in the stomach, or a depressively bound liver assailing the Stomach or Spleen. Lifestyle can also cause dampness. Excessive eating, stress eating, heavy Yin foods (oily, fatty, starchy, dairy or raw) over a long period have profound effects causing stagnation of the vital substances due to digestive dysfunction.

As stated previously dampness tends to fester and can generate and/or combine with other pathogenic factors to compound the condition. Dampness easily combines with cold or heat (whether self-generated or exogenous in nature). Heat can be introduced by an exogenous toxin or by a pre-existing Yin vacuity pattern leading to unchecked exuberance of Yang. In damp-heat patterns the differentiation becomes even more complex because damp-heat by nature is a Yang pathogen but dampness itself is a yin pathogen and the combination of the two makes it even more difficult to resolve. Damp-heat can brew and transform into substantial phlegm.

In all cases dampness can settle in any or all of the three burners and in addition to the effects on the spleen/stomach, can cause specific ailments particular to the burner and organs involved, including the heart, lungs, liver, gall bladder, large intestine and urinary bladder. The specific etiology, symptomatology, and treatment principles relative to the three burners are reviewed in the subsequent paragraphs.

General Symptoms of Dampness:

Epigastric and abdominal fullness, lack of thirst, loss of appetite, obstruction of digestion, heavy limbs, heavy (cloudy, muffled) feeling in the head (due to damp preventing the pure Yang from ascending to the head), acid reflux, nausea and vomiting, loose stools, excess salivation, sweet taste in mouth. Damp is turbid and dirty causing dirty and turbid discharges. Symptoms are generally worse in the morning since the accumulation festers overnight. Tongue presentation will vary according to the external or internal, replete or vacuity and hot or damp predominance.

Tongue Body:

The body will be swollen (with teeth marks) and may be moist or dry (dry indicates inability of spleen to raise fluids to the tongue).

Tongue Coat:

Externally contracted - thick sticky coating or white frothy coating
Internal conditions - sticky but thinner, If heat is present, Yellow color in coat is present

Pulse:

In external contracted damp it will be full and slippery, In internal conditions it will be rolling, big but forceless. If heat is present it may be rapid and rolling, if depressive binding of the liver QI is involved the pulse may also be string taut.

General Treatment principles:

1. Transform or dry dampness, through pungent aromatic substances
2. Strengthen the spleen and stomach
3. Regulate QI
4. Liu Jun Zi tang is the governing formula

The three burners are:

• Upper Burner: - “the mist” -- disperses and vaporizes the vital fluids
• Middle Burner: - “the muddy pool”– the central junction in the circle, source of post heaven Jing
• Lower Burner: - “ The drainage ditch” – extracting the pure from impure and excreting

Damp Heat in the Upper Burner

The classics state that the Spleen creates dampness and the Lungs store dampness. When dampness settles in the upper burner, the Lungs are easily affected. Lungs, being the most exterior of the Yin organs, tend to have exogenous pathologic attacks readily. A wind heat attack here will intermingle with the dampness creating damp heat. Physiologically the mechanism can be explained by the sticky, turbid and heavy dampness (or transformed phlegm) clogging the terminal bronchioles and alveolar ducts preventing proper respiratory function. This in turn impacts the Lungs’ dispersing and descending function; it cannot disperse the pure “mist” of the body fluids and the defensive Wei Qi through the body, and fails to properly initiate the proper descending motion of the circle of wellness. Furthermore, this condition can attack laterally the heart and the Shen.

The Syndromes Include:

Phlegm heat obstructing the lungs:
The lungs are the most external Yin organ and hence are readily attacked by exogenous pathogens; The presence of dampness in the Lungs can easily combine with heat from such exogenous pathogens and turn into substantial phlegm heat.

Symptoms will include:
Fullness in the chest, Shortness of breath, cough with yellow difficult to expectorate sputum, possibly green or blood tinged, and sore throat.

Tongue – Red body; Thick, sticky, yellow coating
Pulse – Slippery, rapid, full
Treatment – Clear heat, resolve phlegm, stimulate Lungs’ descending function
Prescription – Sang Bai Pi Tong, also Huang Qin

Phlegm fire harassing the heart, or Misting the Mind:
The heart houses the shen and when the shen becomes disturbed and cannot rest, thinking, sleeping and behavioral anomalies surface.

Symptoms will include:
Mental restlessness, or mental confusion, palpitations, and dream disturbed sleep

Tongue – Red Body; Yellow sticky coating; tip may be redder and swollen
Pulse – Slippery, rapid, full; also rapid, full, wiry
Treatment – Clear heat, transform phlegm and calm the shen
Prescription – Gan Tan Wan - Lapis, Rhubarb, Scute, Aquilaria

Damp Heat in the Middle Burner

The middle burner is the source of the post heaven Jing and functions as the central junction in the circle of wellness. Obstruction or dysfunction in this region will have dramatic effects up and down the circle of wellness. There is an intricate dynamic with the Liver, gall bladder and the spleen stomach in the middle burner.

Damp heat in the Spleen:
The spleen hates dampness, but often finds itself engulfed in it. Inability to transform and transport vital substances, which accumulate, and either generate heat or contract heat from exogenous pathogens are some of the causes. Lifestyle also plays a key role, as discussed earlier.

The symptoms include:
Fullness of the abdomen and epigastria, no appetite, thirst without desire or little desire to drink, nausea-vomiting, loose sloppy stools or explosive diarrhea with offensive odor, Low grade fever (caused by the steaming of the damp heat and constant throughout the day, not to be confused with Yin Xu fever which appears in the afternoon or evening), burning sensation during defecation, scanty and dark urination.

Tongue – may be red body (if heat predominating), may be swollen, Thick sticky yellow coating, Moisture will depend on the heat components and its level of damage to the fluids.
Pulse – Slippery, rapid
Treatment – Clear heat, transform damp, (regulate QI)
Herbs – Huang Lian, Fu Ling

Liver/Gall bladder and Spleen/Stomach dynamic causes complex damp heat patterns where the relationship and effects are mutually initiating. The spleen dampness and the depressive binding of the liver Qi are the causes. Figure 3 illustrates this complex dynamic. One can lead to the other, (Spleen Qi vacuity causing dampness, interfering with proper flow of QI through the circle, causing Liver Qi to stagnate etc.) or the fact that the same root causes (like lifestyle and diet) can take different vectors and reconnect through the two different organ systems acting in unison to create a complex pattern.

Damp heat in the Liver/Gall Bladder:
Heat in the liver and dampness in the spleen obstructs the smooth flow of Liver Qi and stagnates it. Dampness will also block the Fu organ the Gall Bladder and cause Bile metabolism and transportation problems resulting in jaundice. Furthermore in western physiology Damp heat in the gall bladder is often seen as cholelithiasis. The stagnation will also cause the Liver to attack Spleen or the Stomach.

The symptoms include:
Fever, scanty dark urine, fullness and pain in chest, hypochondria, jaundice, bitter taste, nausea, vomiting, pain, redness or swelling in the scrotum, vaginal discharges or itching.

Tongue - Red body and sticky yellow coating
Pulse - Slippery, wiry and rapid
Treatment – Resolve Dampness; disperse the Liver and Gall Bladder, Clear Heat.
Herbs – Long Dan Cao, Yin Chen Hao (for jaundice)

1. Liver attacking the Stomach (causing stomach Qi rebellion) with such symptoms as irritability, epigastria pain, GERD, belching, Nausea, vomiting, with tongue body red on sides or pale depending on the predominance of the replete vs. vacuity) and a pulse that is weak on the right guan and strung taut on the left guan position.
   Treatment – Harmonize the liver and tonify the stomach.
2. Liver Attacking the Spleen with such differentiating symptoms as alternate constipation and diarrhea, with dry bitty and sometime loose stools, flatulence, tiredness, abdominal fullness, pain.
   Treatment: - Harmonize the liver and tonify the spleen.

Stomach Phlegm Fire:
Full heat in the stomach can combine with phlegm and turn into phlegm fire. Simultaneous fire and phlegm symptoms will appear.

The symptoms include:
Fullness and burning sensation in epigastria, Mucous in stools, thirst (less) or thirst with desire to drink in small amounts. Shen disturbances like insomnia, severe mental symptoms, and manic depression.

Tongue – Red body and sticky yellow coating (may include yellow prickles inside a midline crack)
Pulse - Slippery, full and rapid.
Treatment –Clear heat, stimulate stomachs descending function.

Damp Heat in the Lower Burner

The lower burner is the drain of the body and the lower pole of the circle of wellness. Damp heat in the lower burner affects the draining and excretory functions producing urinary and defecation dysfunction. The affected organs include the urinary bladder, kidneys and intestines.

Damp Heat in the Large Intestine:
Even through the large intestine is physically in the lower burner, it is more readily affected by middle burner pathology because of the physiological connection to the gastrointestinal tract.

The symptoms include:
Abdominal pain, diarrhea with mucous and/or blood in stools. Offensive odor in stools, burning anus, scanty dark urine, fever, sweating which does not alleviate fever, thirst without desire to drink, feeling of heaviness in the body and limbs, fullness in the chest and epigastria.

Tongue - Red body and sticky yellow coating
Pulse - Slippery, rapid
Treatment – Clear heat, resolve dampness, stop diarrhea, General for lower burner, Huang Bai

Damp Heat in the Urinary Bladder:
Here the etiology may differ in that the urinary bladder, being a Fu organ and connected to the exterior via the urinary ducts may contract external damp or heat pathogens (including venereal diseases and fungal infections), most often this dampness turns into damp heat. The reasons for this may be due to its proximity to the gate of vitality, the source of the internal heat in the body. Intense jealousy and bottled- up oppressive emotions over a long period can also cause this condition.

The symptoms include:
Fullness in lower abdomen, plolyuria, but may be scanty in volume due to the damp obstruction, Burning, difficult urination (stopping in the middle of the flow), dark yellow, turbid or bloody urine, fever and thirst. Dark indicates damp with heat predominating, cloudy indicates damp predominating.

Tongue – Red, thick sticky yellow coating towards the root with red spots
Pulse – Slippery, rapid, and slightly wiry on the left chi position
Treatment – Resolve dampness, clear heat, open water passages of the lower burner.
Prescription – San Miao wan – and Achyranthes (Niu Xi)

Conclusion

Dampness has many etiologies but almost always includes an underlying problem with the Spleen and Stomach, the middle burner junction of the circle of wellness. Dampness has diverse manifestations: It can settle up and down the circle of wellness and cause complex patterns and difficult-to-resolve illnesses. Practitioners need to focus on differentiating the damp component to the heat component; this will determine the relative Yin or Yang of the pathology, the intricacies of the involved organs and treatment principles. The properties of the treatment substances may have adverse effects worsening the situation rather then curing. For example most heat clearing herbs are cold and may adversely effect the spleen. Treating the Liver/Stomach or Liver/Spleen dynamic needs careful attention to the condition of the organs and predominance of the excess patterns (liver) versus the vacuity patterns (spleen). A carefully planned and methodical diagnosis and inquiry will supply the appropriate information (often in form of incongruencies), which will drive the treatment principles.

“… In healing, one must always grasp the root of the disharmony.
Which is always subject to the law of Yin and Yang …”

Huang Di. The Yellow Emperor’s Classic of Medicine

Aram Akopyan is a student at Yo San University of Traditional Chinese Medicine. (310) 577-3000.

December 2003
Volume 1, Number 10

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Dampness and the Circle of Wellness

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