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Treating Damp-Warmth Disease with San ren tang/Three Kernels Decoction:
From Wen bing tiao bian/Systematized Identification of Warm Disease by Wu Jutong, translated and edited by Fred Wong and Z'ev Rosenberg, L. Ac.
Introduction (by Z'ev Rosenberg)
This piece is taken from the classical warm disease text, Wen bing tiao bian/Systematized Identification of Warm Disease, written by Wu Jutong, a Qing dynasty physician, in 1798 C.E. It has become one of the most significant warm disease "classics," and is the source of such famous prescriptions as yin qiao san/Lonicera and Forsythia Powder, sang ju yin/Mulberry and Chrysanthemum Cool Decoction, and san ren tang/Three Kernel Decoction. Fred Wong and I have developed a combination study group and translation team, where we take writings from several significant texts and translate them into English. Few, if any, writings from the Wen bing tiao bian have appeared in English so far, and we thought it would be interesting to share this section about the disease pattern of damp warmth and its treatment. For more information about damp-warmth disease patterns, see Warm Disease Theory, translated by Jian Minwen and Garry Seifert (Paradigm Publications), and Warm Diseases: A Clinical Guide by Guohui Liu (Eastland Press). All technical terms can be referenced in the Practical Dictionary of Chinese Medicine, by Wiseman/Feng (Paradigm Publications). The source material is from Wen bing tiao bian bai hua jie/Plain Language Explanation of the Systematized Identification of Warm Disease, edited by Zhejiang College of Traditional Chinese Medicine, published by People's Health Publishers, Zhejiang, 1979 (second edition). All mistakes in the rendering are our own.
Section 43 Original text:
The patient has a headache and aversion to cold. The body is heavy, sore and painful. The tongue is white, and the patient is not thirsty. The pulse is wiry, thin and soggy. Face color is light yellow. There is chest oppression without hunger, and afternoon tidal heat effusion. The condition is similar to yin vacuity tidal heat effusion. Therefore, this is a difficult disease from which one cannot recover quickly. This disease is called damp-warmth. If you use a treatment method utilizing medicinals that cause sweating, then you will get clouded consciousness (hun). If the condition becomes more serious, the eyes will close tightly, and the patient will not have desire to speak. Thorough flux diarrhea will occur if you use cathartic purgatives. You cannot use lubricating and/or moistening medicinals as they will make the illness worse, so that it cannot be relieved. However, even if you treat damp-warmth disease in long summer, deep autumn or winter, you can still use san ren tang/Three Kernel Decoction.
Commentary: This section discusses the main pattern and pulse differentiation of damp-warmth. At the same time, the pulse finding is the differentiation point of damp-warmth with cold damage, summer heat-warmth, and yin vacuity patterns. In this section, the initial description of headache, aversion to cold, heaviness and body ache, white tongue, and no thirst that describe this pattern are very similar to a shang han/ tai yang exterior pattern. But in shang han/cold damage, you have a tight pulse, or in zhong feng/wind strike, you have a leisurely pulse, whereas in this pattern, the
pulse is wiry, thin and soggy. This is the main pulse picture for damp-heat.
Damp is a sticky type of evil. Tai yin is the viscera of damp earth. The spleen governs muscles of the four extremities. The lung occupies upper burner, and controls the qi of the whole body. The exterior corresponds with the skin and hair. The middle chest (zhong xiong) is the location of the clear yang (qing yang). Because of damp evil obstructing the clear yang, qi transformation cannot disperse (the turbid qi). Therefore, the accumulation of damp causes headache and aversion to cold. At the same time, you have body heaviness and aching. This is different from cold evil damaging tai yang channel, causing headache, aversion to cold and body aches (because of different patho-mechanisms). Because the clear yang has been obstructed, the spleen dampness cannot be transformed; you have a white tongue, no
thirst, a light yellow facial complexion, and qi depression in the middle chest. The patient has no appetite. This is also
distinguished in its patho-mechanism from summer heat warmth, which causes the fire to blaze upward, causing thirst and red face. Damp is a yin evil, therefore the pulse appears as thin and wiry or soggy and weak. This is again different from summer heat warmth, where the yang evil manifests a surging and large pulse. Afternoon is the period when yang qi is weakened. Damp as a yin evil must be strong during yin division. Therefore, you have more serious heat
effusion, resembling tidal fever of a yin vacuity patient. Actually, yin vacuity tidal heat effusion must be accompanied by bilateral red cheeks. The pulse is thin and rapid, the palms and soles have heat, so this is a yin vacuity, yang repletion patho-mechanism. This is clearly a different pattern from damp warmth.
If one contracts a wind-cold evil, and uses the sweating method thereby getting relief, then contracts warm-heat evil qi, then adds cool medicinals, one can actually cure it. But because the damp evil has a characteristic stickiness, it lingers in the body; therefore, it is not easy to get rid of. You have a slow, long course of illness, and
it is very difficult to cure it quickly.
In the area of treatment, you likely need to open the lung qi of the upper burner, because the lung controls the qi of the upper body. If you transform the qi, then you can transform the damp as well. You must grasp this treatment principle, then you can obtain the goal of a cure. You must avoid using sweating medicinals, precipitating or moistening medicinals. If you ever use them by mistake, then you will cause a serious consequence.
If, using the symptoms of headache, aversion to cold, body aches, etc., you mistake it for a shang han exterior pattern and use sweating, this will cause excessive sweating and exhaust the yang. At the same time, the damp evil following the acrid-warm sweating medicinals will actually steam upwards and block the heart orifices causing the clouding of consciousness, obstructing the clear orifices, and causing the ears to lose sensitivity to sound. If the condition is serious, then you will see the two eyes tightly shut, and the patient will have no desire to speak.
If the physician observes these symptoms - qi depression in the middle chest, poor appetite and no hunger - concludes that it is gastrointestinal stagnation, and uses the precipitation method, it will damage the fluids, and the spleen yang will be prevented from dispersing upwards. Hence, the spleen qi will sink downwards, causing continuous diarrhea. If you take afternoon heat effusion, and mistake it for yin vacuity tidal heat effusion, then you will use nourishing yin and moistening method; the yin evil and yin medicinals together will correspond to the same qi, thus causing clumping together without being able to be separated. Therefore, when treating the damp warmth disease, generally speaking, you need to avoid sweating, precipitation, or moistening.
If you are certain of a mixed cold pattern, you can sparingly use the sweating method. If you are certain that there is accumulation and stagnation of the stomach and intestine, you can sparingly use precipitation. The damp evil usually will transform into dryness, damage the yin and fluid, and become dry. At that point, you can sparingly use the moistening method. This is called the bian fa/flexible method of modification within the standard treatment method. Overall, it is important to (properly) differentiate so you can be flexible in your treatment.
Damp-warm disease: if patients have the above signs and symptoms, aside from the symptoms due to misdiagnosis or mistreatment, it doesn't matter if it is in the long summer, deep autumn or winter. Even though the seasons are different, you can still use sanren tang/Three Kernel Decoction to treat. Using hou po and ke ren, their acrid, aromatic nature transforms damp to awaken the spleen. Xing ren, and ban xia , because of their bitter acrid nature, can disperse
the lung and harmonize the stomach. Then you have hua shi, yi yi ren, tong cao, bland penetrating medicinals that percolate dampness. Combining these, you can likely get rid of the repletion disease. You can use this prescription with damp-warmth disease every time with success.
Prescription:
xing ren 5 qian
hua shi 6 qian,
bai tong cao 2 qian
bai (dou) kou ren 2 qian
dan zhu ye 2 qian
huo po 2 qian
(sheng) yi yi ren 6 qian
ban xia 5 qian
Use eight cups of water, cook down to three bowls, take one bowl per dose, three times per day.
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