ON DAMP HEAT & HARDENING THE KIDNEYS

translated with an introduction by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

INTRODUCTION

Damp heat plays a very important role in Li Dong-yuan's theory of yin fire. Dampness due to spleen vacuity may pour downward to the lower burner, transforming into damp heat. This damp heat may stir the ministerial fire to counterflow upward, damaging the spleen even more. It may also damage the liver and kidneys below. In my opinion, this aspect of damp heat is not well understood in the West, in part because discussions of this issue have yet to appear in the English language literature. The following is a functional translation of a Chinese journal article that deals with damp heat's effect on the kidneys. Although this article does not use the words "yin fire" nor does it discuss treatment aimed at the spleen, in Western patients, damp heat is usually internally engendered. This internal engenderment is usually due to either faulty diet directly giving rise to damp heat or to faulty diet damaging the spleen. In the latter case, the spleen becomes vacuous and weak and can no longer perform its duty of moving and transforming water liquids. These yin fluids gather and accumulate and obstruct the free flow of yang qi, which transforms into depressive heat. When this depressive heat combines with accumulated dampness, they give rise to damp heat. Therefore, when damp heat is due to spleen vacuity as it is with so many Westerners, spleen-fortifying, qi-boosting medicinals can be added to the protocols discussed below.

(From "Resolutely Upholding the Concept of Hardening the Kidneys Method"1 by Kong Ling-qi, Si Chuan Zhong Yi [Sichuan Chinese Medicine], #6, 1998, p. 8-9)

The method of hardening the kidneys mainly uses bitter, cold medicinal substances

Cortex Phellodendri (Huang Bai) and Rhizoma Coptidis Chinensis (Huang Lian) join in or comply with the transformation of cold water. Their qi and flavor are both thick, [yet] their nature is swift and disinhibiting. Thus they are doubly essential bitter-flavored medicinals which harden yin. They are commonly combined with [such] yin-enriching medicinals [as] uncooked Radix Rehmanniae (Sheng Di), cooked Radix Rehmanniae (Shu Di), and Fructus Corni Officinalis (Shan Zhu Rou); with yang subduing medicinals [like] Plastrum Testudinis (Gui Ban), Carapax Amydae Sinensis (Bie Jia), and Concha Haliotidis (Shi Jue Ming); with dampness-transforming medicinals [like] Sclerotium Poriae Cocos (Fu Ling), Rhizoma Atractylodis (Cang Zhu), Radix Achyranthis Bidentatae (Niu Xi), and Fructus Chaenomelis Lagenariae (Mu Gua); and with constraining and astringing medicinals [like] Semen Gingkonis Bilobae (Bai Guo), Cortex Ailanthi Altissimi (Chun Pi), and Concha Ostreae (Mu Li).

A. The scope of application & the effects of the method of hardening the kidneys

1. Hardening the kidney viscus & fortifying its strengthening
If dampness and heat mutually bind in the yin division of the lower burner, then the ancestral sinews [or gathering of the sinews]2 will become slack and relaxed. [This will then cause] the onset of stalk wilting [i.e., impotence]. This is mainly treated with Zhi Bai Di Huang Tang (Anemarrhena & Phellodendron Rehmannia Decoction), [in which] Rhizoma Anemarrhenae Aspheloidis (Zhi Mu) and Cortex Phellodendri (Huang Bai) are bitter and draining and harden the kidneys, ordering and controlling ministerial fire and clearing the source of the root of righteousness. This redoubles the vitalization of yang indomitability, produces the fortification of strengthening, and promotes the power of skill and ability. If the essence chamber suffer harassment and the essence loses its securing and containment and there is seminal emission or premature discharge, one can use San Cai Feng Sui Tang (The Three Powers Seal the Marrow Decoction): Tuber Asparagi Cochinensis (Tian Dong), cooked Radix Rehmanniae (Shu Di), Radix Panacis Ginseng (Ren Shen), Cortex Phellodendri (Huang Bai), Fructus Amomi (Sha Ren), and Radix Glycyrrhizae (Gan Cao).

2. Hardening the ancestral sinews & quieting walking
The Su Wen [chapter titled] "Treatise on Wilting" says, "The ancestral sinews rule the binding of the bones and the disinhibition of the joints." If damp heat invades and assails the muscles and flesh and sinews and bones, the qi and blood will not move. The sinew vessels will become slack and not pulled together and, hence, will be useless [or non-functional]. If severe, the liver and kidneys will become debilitated and consumed and the ancestral sinews will cease their duty. [In this case,] Master Ye [Tian-shi], in his Lin Zheng Zhi Nan Yi An (Guide to Clinical Conditions & Case Histories) [chapter titled] "Vacuity Taxation" highly praised [Zhu] Dan-xi's Hu Qian Wan (Crouching Tiger Pills) for their effect of subduing yang and hardening yin.

[These pills] use Phellodendron and Anemarrhena's bitterness to harden yin. This causes the source to be cleared and flow to be cleaned. Rhizoma Atractylodis (Cang Zhu) and Semen Coicis Lachryma-jobi (Yi Ren) dispel dampness. Herba Cistanchis Deserticolae (Cong Rong), Herba Cynomorii (Suo Yang), Radix Achyranthis Bidentatae (Niu Xi), and Os Tigridis (Hu Jing Gu) strengthen the sinews and bones. Radix Albus Paeoniae Lactiflorae (Bai Shao) and Fructus Chaenomelis Lagenariae (Mu Gua) emolliate the sinews and relax tension. Cooked Radix Rehmanniae (Shu Di) and Plastrum Testudinis (Gui Ban) enrich yin and boost the marrow. Thus damp heat is discharged and transformed, yin essence is subdued and astringed, the ancestral sinews are hardened and strengthened, and the feet are able to walk.

3. Hardening the chong & ren and regulating the tian gui
If yin becomes debilitated and fire become exuberant, damp heat may harass and seize. The chong and ren may thus lose their regularity [or regulation], the menstrual blood may move frenetically, and, therefore, there may be flooding and leaking downward of blood. [In that case,] one should use Gu Jing Wan (Secure the Essence Pills) to clear heat and harden the kidneys, secure the chong and contain the blood.

4. Hardening the dai mai & boosting [its] tying and restraining
Foulfishy-smelling abnormal vaginal discharge may dribble and drip. Its color is yellow consistency thick. The formula to choose > Yi Huang Tang (Change Yellow Decoction) plus Cortex Ailanthi Altissimi (Chun Pi), Rhizoma Smilacis Glabrae (Tu Fu Ling), Radix Angelicae Sinensis (Dang Gui), and Semen Phaseoli Calcarati (Chi Xiao Dou) in order to harden the kidneys and tie-up the dai [mai]. If there is yin debility, add Concha Ostreae (Mu Li) and Herba Cistanchis Deserticolae (Rou Cong Rong). This is what the Lin Zheng Zhi Nan Yi An [chapter titled] "Strangury & Abnormal Vaginal Discharge" refers to as the "salty, bitter, hardening yin" method.

5. Hardening the intestine bowels & disinhibiting conduction and transformation
Damp heat may accumulate and stagnate causing congestion gathering. Thus the intestine bowels lose normalcy of their transformation substance conduction leading. If there is downward dysenteryuse Shao Yao Tang (Peony Decoction) [and] Ge Gen Huang Qi Huang Lian Tang (Pueraria, Scutellaria & Coptis Decoction). If there are heat toxins falling and entering into the blood division, steaming and burning the intestinal network vessels with downward dysentery of pure blood, use Bai Tou Weng Tang (Pulsatilla Decoction). If downward dysentery damages yin, use Zhu Che Wan (Halt the Vehicle Pills)3 [and] Bai Tou Weng Jia E Jiao Gan Cao Tang (Pulsatilla Plus Donkey Skin Glue & Licorice Decoction). If hemorrhoids are binding in the grain passageway with sagging, distention, and lack of crispness [in defecation], use Radix Angelicae Sinensis (Dang Gui), Radix Et Rhizoma Rhei (Da Huang), Radix Scutellariae Baicalensis (Huang Qin), Rhizoma Coptidis Chinensis (Huang Lian), Rhizoma Cimicifugae (Sheng Ma), Radix Bupleuri (Chai Hu), Radix Glycyrrhizae (Gan Cao), Flos Immaturus Sophorae Japonicae (Huai Hua), and Rhizoma Smilacis Glabrae (Tu Fu Ling). Within the above formulas, Scutellaria, Coptis, Phellodendron, Ailanthus, and Pulsatilla all harden yin and thicken the intestines and their bitterness has the effect of securing discharge.

6. Hardening the bladder & invigorating qi transformation
If damp heat brews and binds, the kidney viscus's qi transformation may not move. The water prefecture loses its command over treasuring and restraining. This leads to urinary pain and lack of crispness. For this, Master Ye said to use the hardening yin and clearing heat method. For dribbling urinary block, use Zi Shen Tong Guan San (Enrich the Kidneys & Free the Flow of the Barrier Powder). When the qi transformation flows smoothly again, then the flow of urination will be freed and disinhibited.

7. Hardening the constructive and yin & treating discharge of sweat
If there is yin vacuity with heat blazing, this may burn and disperse true yin. The constructive and yin lose their abode and heart fluids are discharged. [Zhu] Dan-xi's Da Bu Yin Wan (Greatly Supplementing Yin Pills) conform to this situation. They harden yin and restrain fire, thus securing the abode of the constructive and yin. If there is qi vacuity and fire flaming, heat may force [out] the constructive and yin. Then one should use Dang Gui Liu Huang Tang (Dang Gui Six Yellows Decoction) in order to [use] bitter and cold to clear heat, drain fire and harden yin.

B. Representative case histories

1. Wilting condition
The patient was a 13 year old boy whose first examination occurred on Aug. 22, 1964. He had had a fever for two days. This was accompanied by generalized discomfort. There was venter glomus and nausea. His four limbs were numb and painful. His throat lacked strength to swallow and drinking water made him choke. Both lower legs were wilted, limp, and without strength. He was not able to stand. He was taken to a hospital were he received the diagnosis of Guillain-Barré syndrome. He was then sent to the author's hospital for treatment.

[The boy's] tongue fur was yellow, dirty, turbid, and slimy. His pulse was bowstring, large, slippery, and rapid. His pattern was categorized as dampness and warmth combining to cause the occurrence of wilting condition. First, he was given Lian Po Yin (Coptis & Magnolia Drink) plus Succus Bambusae (Zhu Li), Succus Rhizomatis Zingiberis (Jiang Zhi), Excrementum Bombycis Mori (Can Sha), and Lumbricus (Di Long). Then he was given Si Miao Tang (Four Wonders Decoction) with Fructus Chaenomelis Lagenariae (Mu Gua) and Caulis Trachelospermi Jasminoidis (Lou Shi Teng).

By Oct. 16, all his symptoms had decreased. His numbness and pain had disappeared and he was able to stand. Afterwards, he was administered Hu Qian Wan (Crouching Tiger Pills). In Jan. 1965, he was able to go to school.

2. Flooding & leaking
The patient was a 43 year old female whose first examination on Mar. 271997.s menstrual period had been long for half year. When menses came normally they continued 10 days without stop.Their amount profuse color darkand were mixed with blood cots. [The womans] mouth dry her tongue fur thin yellow pulse rapid. Ultrasonography showed no abnormalities of uterus or adnexa.

Her formula [consisted of]: Plastrum Testudinis (Gui Ban), Gelatinum Corii Asini (E Jiao), Radix Scutellariae Baicalensis (Huang Qin), and Cortex Phellodendri (Huang Bai), 10g @, mix-fried Cortex Ailanthi Altissimi (Chun Pi), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Radix Albus Paeoniae Lactiflorae (Bai Shao), and uncooked and stir-fried Pollen Typhae (Pu Huang), 12g @, Os Sepiae Seu Sepiellae (Wu Zei Gu), 30g, Radix Rubiae Cordifoliae (Qian Cao) and carbonized Rhizoma Guanchong (Guan Zhong), 15g @.

After two ji, the amount of bleeding was reduced. After another two ji, her menses had stopped. During her next menstrual periods, she was given the same formula. Between the menses, she was administered Zhi Bai Di Huang Wan (Anemarrhena & Phellodendron Rehmannia Pills). After three months of regulation and rectification, she was cured.

3. Sweating
The patient was a 44 year old man whose first examination was on Dec. 26, 1995. [The patient] habitually had a liking for tobacco, alcohol, and thick-flavored [foods]. In winter, he liked to sleep under double layers of thick cotton quilts. For the past two months, he had been sweating very profusely. At night, this was even worse. His mouth was dry, his skin was hot, and his body was fat. His tongue was red with thick, turbid fur, while his pulse was bowstring.

He was told to use less quilts [at night] and was given Dang Gui Liu Huang Tang (Dang Six Yellows Decoction) with additions and subtractions: Radix Angelicae Sinensis (Dang Gui), Cortex Phellodendri (Huang Bai), Radix Scutellariae Baicalensis (Huang Qin), Cortex Radicis Moutan (Dan Pi), and Radix Ephedrae (Ma Huang Gen), 10g @, Rhizoma Coptidis Chinensis (Huang Lian), 6g, uncooked Rehmanniae (Sheng Di), Rhizoma Alismatis (Ze Xie), and Sclerotium Poriae Cocos (Fu Ling), 15g @, Radix Cynanchi Atrati (Bai Wei) and Cortex Radicis Lycii Chinensis (Di Gu Pi), 12g, Fructus Levis Tritici Aestivi (Fu Xiao Mai), 20g. After 12 ji the sweating condition had disappeared.

4. Hematuria
The patient was a 51 year old male whose first examination was on June 12, 1990. [The patient reported that he had had] "unusually recurring hematuria" for 20 years. Recently, due to over-taxation working in the fields, the hematuria had recurred. There was no urinary urgency or pain. Urine examination [showed that] RBCs were ++++ and proteinuria was +. Abdominal x-ray and ultrasonography [showed] no abnormalities in either kidney, ureters, or bladder. His tongue was red with thin, yellow fur, while his pulse was bowstring and fine.

[The patient's] formula [consisted of]: saltwater stir-fried Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), Cortex Radicis Moutan (Dan Pi), stir-fried Fructus Gardeniae Jasminoidis (Shan Zhi), pearled Gelatinum Corii Asini (E Jiao), and Succinum (Hu Bo), 10g @, uncooked Radix Rehmanniae (Sheng Di), Radix Scrophulariae Ningpoensis (Yuan Shen), and Radix Rubiae Cordifoliae (Qian Cao), 15g @, fresh Herba Cirsii Japonici (Xiao Ji), 30g, fresh Rhizoma Imperatae Cylindricae (Mao Gen), 60g, Radix Pseudoginseng (San Qi), 3g (washed down with the decoction), Os Sepiae Seu Sepiellae (Wu Zei Gu), 20g.

After five ji, the hematuria had stopped and urine examination was normal. [The patient] was advised to constantly take Zhi Bai Di Huang Wan. Alcohol was prohibited and he was told to shun over-taxation. After several years, there had been no recurrence.