By Aram Akopyan
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).
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
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.
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).
Externally contracted - thick sticky coating or white frothy
Internal conditions - sticky but thinner, If heat is present, Yellow color in
coat is present
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:
The three burners are the
pathway openings of the circle of wellness into the various organs. These are
important in distributing nutrients and energy and transporting waste from these
organs. Pathology in the three burners has very distinct manifestations and
affects different organs, but since these burners are interconnected and
function as a unit, pathology in one burner often affects the others. For
example upper burner damp heat affecting the lungs’ dispersing and descending
function also may affect the Kidneys’ grasping ability, or through the LU/LI
relationship affect the Large intestines’ excretory functions.
- Transform or dry dampness, through pungent aromatic
- Strengthen the spleen and stomach
- Regulate QI
- Liu Jun Zi tang is the governing formula
The three burners are:
- Upper Burner:
- “the mist” -- disperses and vaporizes the vital
- 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
Symptoms will include:
Fullness in the chest, Shortness of breath, cough with yellow
difficult to expectorate sputum, possibly green or blood tinged, and sore
Tongue – Red body; Thick, sticky, yellow coating
Pulse – Slippery, rapid, full
Treatment – Clear heat, resolve phlegm, stimulate Lungs’ descending
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
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
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
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,
Herbs – Long Dan Cao, Yin Chen Hao (for jaundice)
- 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.
- 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
Prescription – San Miao wan – and Achyranthes (Niu Xi)
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
Which is always subject to the law of Yin and Yang …”
The Yellow Emperor’s Classic of Medicine
Aram Akopyan is a student at Yo San University of Traditional
Chinese Medicine. (310) 577-3000.