Damp obstruction

　　How is damp obstruction caused? Let's talk about the causes of damp obstruction in detail:

　　1. Because of long-term dampness due to continuous rain, humid air, or long-term residence in a damp and cold place, or water-related work, or working in a humid place, or exposure to rain, dew, and mist, dampness is prone to attack people and cause disease. In the Yangtze River basin, coastal areas, and other places, during the plum rain season in summer, there is a concentrated rainfall, humid air, and a long duration. During this period, if one is not careful, one may be affected by dampness and fall ill.

　　2. Spleen deficiency leads to dampness, and irregular lifestyle. For example, excessive consumption of cold and raw foods, alcohol, sweet and greasy foods, or irregular meals and snacks, which may damage the spleen and stomach, leading to malfunctions in the transformation of the spleen and stomach, and the transformation of body fluids cannot take place, causing dampness to accumulate.

　　Therefore, there are external dampness and internal dampness in etiology. The way dampness invades the human body is from the body surface and skin in terms of external sensation. 'Its injury to people is either from above, or from below, or throughout the body, this is about the dampness of external sensation that affects the body'. As for endogenous dampness, it is caused by the dysfunction of the spleen and stomach, resulting in malfunctions in transformation. External dampness and internal dampness often influence each other in the process of disease onset. External dampness often affects the spleen and stomach, leading to malfunctions in the healthy movement of the spleen, and dampness generates internally; while malfunctions in the healthy movement of the spleen also easily attract the invasion of external dampness.

　　The pathological location of damp obstruction is in the spleen, because the spleen is the damp earth. Whether it is external dampness or internal dampness, it must seek the same qi, so dampness must go to the spleen and harm the spleen. The basic pathogenesis of damp obstruction is that the dampness obstructs the middle-jiao, causing abnormal rise and fall and malfunctions in transformation. The spleen is the damp earth, and its nature is to like dryness and hate dampness. Dampness is a yin pathogen, with sticky, heavy, and turbid nature. When dampness obstructs the spleen and stomach in the middle-jiao, the spleen is trapped by dampness, and it cannot uplift the clear qi, while the stomach cannot descend the turbid. The transformation of the spleen and stomach is impaired. Since the transformation of food and drink cannot take place, there will be epigastric distension, poor appetite, abdominal distension, and loose stools; and the transformation of water essence cannot take place either. The spleen is responsible for the muscles, and when the muscles are trapped by dampness, there will be heaviness and fatigue in the head and body. Due to the sticky nature of dampness, the disease tends to be lingering and have a long course.

　　No matter external dampness or internal dampness, in the process of disease, there are pathogenic changes from cold to dampness and from heat to dampness. The main conditions for forming different pathological changes of dampness transformation from cold to heat are: (1) nature of the pathogen or environment. For example, in a high temperature and high humidity environment, or under the heat of the sky and the steam of the earth, or due to excessive consumption of alcohol and milk, dampness tends to transform from heat; or living in a cold and damp place, or due to excessive consumption of cold and raw foods, dampness tends to transform from cold. (2) Physical constitution differences. For those with fair complexion and yang deficiency, once affected by dampness, dampness is prone to transform from cold, becoming a syndrome of cold dampness; for those with red complexion and yin deficiency, once affected by dampness, it is prone to transform from heat, becoming a damp-heat syndrome. (3) Spleen and stomach condition. Those with inherent weakness of the spleen and stomach are prone to dampness transforming from cold; those with accumulated heat and fire in the stomach are prone to dampness transforming from heat. (4) Treatment and medication. If excessive use of cold and cool remedies, dampness is prone to transform from cold; if using drying and hot remedies recklessly, dampness is prone to transform from heat. Dampness transforming from cold is prone to damage the spleen yang; dampness transforming from heat is prone to damage the stomach yin, which is the pathological development trend after dampness transforms from cold to heat. But dampness is a yin pathogen, with sticky, heavy, and turbid nature. When dampness prevails, yang is weak. Dampness transforming from cold is the main trend of dampness causing disease, so in clinical manifestations, cold transformation is more than heat transformation.

　　Although the prognosis of damp obstruction is good, the condition is often lingering, and some people may have recurrent attacks. This diseaseInitially, there may be a feeling of head weight like wrapping, discomfort all over the body, listlessness of the limbs, and soft and slow pulse. Subsequently, there may be body weight, or discomfort all over the body, slight fever, little sweat, stuffiness in the chest and abdomen, poor appetite, loose stools, thirst without a desire to drink water, white or yellow and greasy tongue coating, and soft and slow pulse..

　　What are the manifestations of damp obstruction? Let's briefly talk about the symptoms of damp obstruction:

　　1. People of all ages, genders, and ages can be affected, but those with weak spleen and stomach are more prone to it. It often occurs during the plum rain season or after a long rainy day. The onset is slow and the condition is lingering.

　　2. Initially, there may be dizziness like wrapping, discomfort all over the body, listlessness of the limbs, and soft and slow pulse. Subsequently, there may be body weight, or discomfort all over the body, slight fever, little sweat, stuffiness in the chest and abdomen, poor appetite, loose stools, thirst without a desire to drink water, white or yellow and greasy tongue coating, and soft and slow pulse.

　　3. There may be no obvious signs, and laboratory tests may also show no abnormalities.

　　The prevention of damp obstruction lies in paying attention to improving the damp environment of work and life, changing dry clothes in time after wading through water or in the rain; during the plum rain season, use fresh huoxiang, fresh peilan, and roasted wheat sprout, etc., to decoct and drink as tea, to awaken the spleen and transform dampness; in summer, pay attention not to overwork to avoid reducing the ability to resist dampness. Whether for prevention or adjustment, be cautious about eating greasy foods in the diet.

　　The laboratory tests required for damp obstruction include: blood pressure, pulse, electrocardiogram, urine routine, blood routine, and stool routine.

　　The four diagnostic methods of TCM, namely observation, olfaction, inquiry, and palpation, are four different diagnostic methods for investigating and understanding diseases, each with its unique role and should not be replaced by each other, but should be combined with each other to complement each other's strengths and weaknesses. The four diagnoses are interrelated and inseparable, so they must be organically combined in clinical application, that is, to 'integrate the four diagnoses'. Only in this way can a comprehensive and systematic understanding of the condition be achieved, and correct judgments can be made.

　　What should be paid attention to in the dietetic health care for damp obstruction? A brief introduction is as follows:

　　1. Consume light and plain foods mainly, and pay attention to dietary regularity.

　　2. Avoid eating greasy, salty, and spicy foods.

　　3. Avoid smoking and drinking.

　　The key points of dialectical treatment for damp obstruction lie in distinguishing cold and heat, that is, cold damp syndrome and damp-heat syndrome. Both have common manifestations such as stuffiness in the chest, body weight, poor appetite, greasy tongue coating, and soft pulse. The differentiation can be compared from aspects such as body temperature, taste, tongue coating, and pulse. Cold damp syndrome is characterized by body weight and aversion to cold, stuffiness in the chest and abdomen, a desire for rubbing, a tasteless mouth, or sweet taste, loose stools, white and greasy tongue coating, and soft and slow pulse; damp-heat syndrome is characterized by body weight and heat, stuffiness in the chest resembling pain, a dislike for rubbing, a bitter and sticky taste in the mouth, red urine, yellow and greasy tongue coating, and soft and rapid pulse.

　　一、治疗原则

　　1, Treatment principle.

　　The treatment of this disease involves two aspects: dampness elimination and spleen movement. Dampness elimination is to eliminate the evil, removing the cause of dampness obstruction in the spleen and stomach. Spleen movement is to restore the function of the spleen and stomach that has been trapped. Dampness elimination helps with spleen movement, and spleen movement also helps with dampness elimination.

　　1, Dampness elimination. 'Compendium of Materia Medica - Ten Agents' states that 'wind herbs can overcome dampness, drying herbs can eliminate dampness, light herbs can permeate dampness, ... For dampness with heat, use bitter-cold agents to dry it; for dampness with cold, use acrid-warm agents to dry it.' It is evident that it advocates the use of wind herbs, drying herbs, and diuretic herbs to eliminate dampness. Clinically, according to whether the dampness is transformed from cold or heat, the most commonly used methods are fragrant dampness transformation, bitter-warm drying dampness, and bitter-cold drying dampness. Regardless of whether it is transformed from cold or heat, it must be supplemented with light-permeating substances, and sometimes wind herbs are also used to overcome dampness.

　　In summary, for the treatment of dampness obstruction, the prescription should be light, dispersing, and lively. Light refers to a light dose, which can remove the excess; dispersing refers to promoting the flow of Qi, following the rising and descending of the spleen and stomach; lively refers to the efficacy of the formula, which is flexible in structure; active refers to the formula should not be stagnant, and avoid using sticky and greasy substances. Light, dispersing, and lively can not only allow the dampness evil to permeate, but also make the spleen's function of transporting and transforming dampness vigorous. As mentioned in 'Medical Cases of the Guiding Principles for Clinical Practice - Dampness': 'Treating dampness without understanding the spleen is not the right treatment.' For those with dampness caused mainly by spleen deficiency, treat with spleen-invigorating, supplemented by dampness-transforming; for those with dampness obstruction and spleen Qi stagnation, treat with spleen-waking and spleen-moving, supplemented by dampness-transforming. For those with dampness transforming from cold and affecting the spleen Yang, in addition to bitter-warm drying dampness, it should be combined with methods of warming and transporting the spleen Yang. For those with dampness transforming from heat and affecting the spleen Yin, it should be treated with dampness-transforming, Yin-nourishing, and清热 transforming dampness without harming Yin, producing Jing and nourishing Yin without aiding dampness.

　　2, Differential diagnosis and treatment.

　　1, Dampness affecting the spleen and stomach.

　　Symptoms: Limb fatigue and heaviness, or head feeling heavy as if wrapped, chest and abdominal distension, lack of appetite, sticky and tasteless mouth, loose stools; or with chilliness, white greasy tongue coating, and soft and slippery pulse.

　　Treatment Method: Fragrant dampness transformation.

　　Prescription: Huoxiang Zhengqi San.

　　This proof mainly refers to the cold-damp syndrome caused by dampness transforming from cold, represented by Huoxiang Zhengqi San, which has excellent dampness-transforming effects. The formula uses Huoxiang, Zisou, Chenpi, and Baizhi for their fragrant dampness-transforming properties; Houpu, Fanzha, and Baizhu for their bitter-warm and drying dampness properties; Dafupi and Fuling for their light and permeating dampness-relieving effects. The formula combines fragrant, bitter-warm, and light-permeating properties in one, and is complemented by Jiegeng to promote lung Qi, Gancao to sweeten and harmonize, collectively achieving the effect of warming and transforming cold dampness. If there is a sweet taste in the mouth, add Peelan to enhance the fragrant turbidity-transforming power. If there are symptoms of food retention, belching, and acid regurgitation, add Shanzha, Shengfu, and Jinejin to digest food and relieve retention. If there is abdominal distension and loose stools, combine with Pingwei San to enhance the健脾 drying dampness effect. If there are concurrent exterior symptoms of cold and heat, add Jingjie and Fangfeng for acrid dispersing of the exterior evil.

　　2. Damp-heat Obstruction in the Middle Burner

　　Symptoms: Chest stuffiness resembling pain, poor appetite, loose stools, bitter and sticky taste in the mouth, no desire to drink, heavy and tired limbs; or with fever that is not easily reduced, sweating but heat not receding, yellow greasy tongue coating, and soft and rapid pulse.

　　Treatment method: Clear heat and transform dampness.

　　Herbal medicine: Wang's Lianpo Decoction.

　　This formula uses Coptis and Gardenia to clear heat and dry dampness; Bupleurum and Magnolia to transform the spleen and transform dampness to relieve fullness; Acorus, Lophatherum, and Flos Fructus Platycladi to harmonize the middle burner, clear heat, and transform dampness, and invigorate the spleen. It can also add Talcum, fresh lotus leaves, and Coix seed to clear and permeate dampness. For those with epigastric and abdominal distension, add Chenpi and Dahuapí to regulate Qi and relieve fullness. For those with heavy and painful body, add Moutan and Scutellaria to transform dampness, permeate collaterals, and relieve pain. This syndrome can also take Ganlu Xiaodan, 5-10g per dose, twice a day, to clear heat and transform dampness, and to fragrance transform turbidity.

　　3. Spleen Qi Deficiency and Dampness Retention

　　Symptoms: Lethargy of the limbs, chest and abdominal stuffiness, preference for massaging, loose stools, fatigue, lack of appetite for greasy food, thin greasy tongue coating or thick and pale tongue body.

　　Treatment method: Invigorate the spleen and transform dampness.

　　Herbal medicine: Xiangsha Liujun Decoction.

　　This formula uses Codonopsis, Poria, Atractylodes, and Licorice to invigorate the spleen and Qi; Bupleurum and Chenpi to regulate Qi and transform dampness; Mosla and Amomum to harmonize the stomach and invigorate the spleen. It can also add Pueraria, agastache, and Coix seed to invigorate Qi, transform dampness, and reduce swelling. For those with facial edema and limb swelling, Astragalus, Dolichos, and Coix seed can be added to invigorate Qi, transform dampness, and reduce swelling.

　　In dampness obstructing diseases, some patients may experience symptoms such as restlessness, thirst, no sweating or less sweating, persistent fever, chest tightness, poor appetite, fatigue, greasy tongue coating, and rapid pulse during the hot summer season. This is due to the external attack of summer dampness, also known as 'damp-heat summer'. Fresh agastache, fresh lotus leaves,羌活, mint, isatis root, and Sanli powder can be used to clear heat and transform dampness, and they often achieve good results.

　　3. Prognosis

　　The condition of this disease changes little, and the prognosis of patients is good, most of whom can recover completely. At the beginning, there is dampness attacking the spleen and stomach, and the vital energy is not injured. Timely treatment makes it easy to remove dampness and restore the function of the spleen and stomach. If the treatment is not effective, the outcome may be due to dampness injuring Yang and causing damage to the spleen Yang, resulting in malfunctions of transportation and transformation, and the retention of dampness and fluid inside, leading to swelling; or due to dampness transforming into heat, resulting in the syndrome of damp-heat obstruction. If damp-heat is blocked and misused bitter-warm drying method to assist heat, or overused to transform dampness and promote diuresis while injuring Yin, it will transform into the syndrome of damp-heat with Yin deficiency. Transforming dampness will injure Yin, and nourishing Yin will obstruct dampness. Although the treatment is difficult, it can be cured with careful treatment. If the disease is delayed and not treated, the spleen Qi is weakened, dampness remains, the spleen does not transform and transport dampness and fluid, and it is more difficult to remove dampness, which is prone to persistent disease, and slight external dampness or improper diet can cause or worsen the symptoms.