The subject of etiology is study of the origins of disease, the causative factors, in the body. Pathogenesis is the study of the actual processes within the body whereby disease occurs, develops and changes. One of the most central concepts of Traditional Chinese Medicine (TCM) is that of the intimate connection between the body of man and the environment within which man lives, works and plays. The physiology of the cells, tissues, zang-fu organs and meridian system of the body is in dynamic internal equilibrium and constantly adjusts to the vagaries of the external environment. If the body is not able to cope with changes in the environment, if the body is not able to adjust to changing external conditions, internal equilibrium will be lost and disease will be the result. Thus, according to the constitution of any particular individual, the presence of disease is due to a lack of adaptability by the physiology of the individual to the conditions of the environment.(1)
The above paragraph assumes that one is healthy, eating nourishing foodstuffs, drinking clean water and getting the proper amount of exercise. In addition to being able to alter the physiology of the body to changing environmental conditions, a healthy body needs nutritious foodstuffs and clean water in order to maintain the integrity of the body. Our ancestors did not have or use herbicides and pesticides that are of manmade origin. All of their food was what we call today as "organic". Also, while they may have needed to drink fermented beverages in order to ingest liquids that were not contaminated with pathogenic microorganisms, these beverages were not contaminated with injurious manmade organic compounds that seem to be ubiquitous in today's drinking water. The reason that the condition of Dampness seems to be rampant in industrialized societies is due in part to the burden of un-natural substances in our food and water that needs to be eliminated from our bodies after ingestion/consumption.
TCM etiology lists many factors that are the cause of disease. These include the six exogenous factors, the seven emotions, the lack of physical exercise, an improper diet, traumatic injury, bites of insects and animals, stagnant blood and phlegm fluid. The causative factors will affect the body in a specific manner or ways. These aberrations are the signs and symptoms that are used in order to analyze clinical manifestations. The clinical manifestations provide the basis for the etiology of disease produced by each causative factor.
There is a saying in TCM - "The earth element creates dampness and the metal element stores it." In CM, The organs associated with the earth element are the Stomach and Spleen. The organs associated with the metal element are the Lungs and Large Intestine. When dampness is created by impaired digestion, caused by chronic improper nutrition, it likes to end up in the Lungs and Large Intestine. When dampness moves into the Lungs, the usual symptom is phlegm coming up while coughing (especially after eating something that is inherently difficult to digest such as a milk shake, other cold dairy products, or greasy foods). When the dampness is stored in the Large Intestine, we find mucus-lined stools, loose stools, sticky stools that are difficult to clean up after, or diarrhea with undigested bits of food in it. Even intestinal rumblings are due to dampness in the intestines. These are all forms of internal dampness. Internal dampness is directly due to the impaired transformative and transportive function of the Spleen system that then results in some form of pathogenesis within the body, zang-fu organs and meridians.
In Chinese Medicine, dampness is considered to be the cause of many illnesses such as high cholesterol, cancer, metabolic disorders, chronic fatigue syndrome, fibromyalgia, allergies and environmental illness.
For the sake of this discussion, only the symptoms of the aberrations of water metabolism will be considered. There are two general categories of Dampness: external and internal. Internal dampness is most common and will easily combine with Heat or Cold to cause Damp-Heat or Damp-Cold. Dampness can be thought of as the condition of "high humidity" inside the body. Symptoms can include a feeling of heaviness, swelling (edema) or water retention, distended abdomen, any type of phlegm discharge, nodular masses (lymph nodes), loose bowels and turbidity of fluids. Individuals with a Dampness condition often have sluggish energy and easily gain weight. The pulse is commonly described as slippery; the tongue is often puffy with teeth mark indentations on the sides, very moist looking and with a greasy looking tongue coating.
Exposure to damp weather, wearing wet clothes and a humid environment can cause External Dampness to invade. External dampness is a condition of prolonged high humidity that usually occurs in late summer. When exterior Dampness invades the body it tends to do so from the lower extremities first. Damp then works its way up the legs and settles into the lower jiao (lower abdomen) and then from there it spreads throughout the body. Patients often complain of dizziness, a heavy sensation in the head (as if wrapped in a towel), heaviness of the body and soreness, pain and heaviness of the joints. In both cases, external and internal, there may be turbid discharges from the body (such as suppurating sores, weeping eczema, profuse purulent leukorrhea with a foul odor, dark & turbid urine and stools containing mucus and perhaps even blood).(2) Summer heat with dampness causes dizziness, heaviness in the head, a stifling sensation in the chest, nausea, poor appetite, loose stools, general lassitude, fever, restlessness and thirst.
A collection of dampness and heat may lead to such problems as inflammation, allergies (especially food allergies), high blood sugar, weight gain, and urinary tract infections. Symptoms can include heaviness, a sensation of fullness in the chest, a smelly and sluggish bowel, abdominal pain, leukorrhea, eczema, and deep yellow colored urine. The pulse is often slippery and fast; the tongue is commonly red with a yellow, thick greasy coating; the nails are often red; the hands are often puffy and red with a mottled appearance with swollen, red cuticles. Especially in women, the ankles and feet may also be swollen.
Classicaly, Dampness describes a condition of viscosity and stagnation. Patients usually have a thick, greasy looking, sticky tongue coating and perhaps a viscous stool that is difficult to void and/or in some manner an obstructed urination. Diseases due to Dampness tend to be prolonged and intractable. Damp is a yin pathogen that impairs yang and easily causes qi stagnation. Signs and symptoms include a sensation of fullness in the chest, epigastric distention, difficult & scanty urination and hesitant & viscous stools. Pathogenic Damp impairs Spleen yang that leads to distention and fullness in the epigastrium and abdomen, poor appetite, loose stools and generalized edema. All conditions of Dampness will yield to treatment only after an appropriate long term concerted and persevering regimen.
What is the difference between Damp, Phlegm Fluids and Water? All three of these concepts refer to the products of the disturbance of water metabolism in the human body, which after being produced will cause further pathologic changes, and thus also are regarded as pathogenic factors in TCM. They are often used interchangeably, but they really have some differences and should, therefore, be used differently. Dampness is both a physiological and a pathologic concept in TCM. As a TCM physiological concept it refers to the water received by the Stomach and digested and absorbed by the Spleen, so it is also sometimes called Water Damp. The Stomach likes dampness but the Spleen abhors dampness. As a TCM pathologic concept, it refers to the retained water caused by disturbances of the Spleen, so it is mainly used in the case of water retention due to diseases of the Spleen system. Phlegm fluid retention is a general term for all congealed water metabolism in the human body. This is mainly an indication of retained water that is not directly related to altered Spleen function. For example, we may ascribe the cause of diarrhea to the downward flow of excess dampness from the Stomach/Spleen (Middle Jiao or upper abdomen), or the cause of edema to the outward flow of dampness as a result of a disturbance in the Spleen system. But we usually say the causative factor of scrofula (nodules as thickened, rubbery feeling lymph nodes) is the accumulation of Phlegm Fluids, because this is a disease mainly secondary to stagnation of Liver Qi (which further disturbs water metabolism) instead of being secondary to Spleen disorders. As for Water, it is mainly used to describe the fluid that accumulates in a cavity of the body, such as pleural effusion, ascites or edema that is easily rectified with the return of normal Spleen functionality.
Phlegm also affects the brain. One of the major causes of brain phlegm is the consumption of all kinds of dairy products. The condition of brain phlegm is commonly known as brain fog. It is the opinion of the author that brain phlegm leads to the conditions known as Alzheimer's disease and Prion disease. It is also the opinion of the author that no-one after the age of 4 years should eat any dairy products except for very well aged cheeses and naturally fermented kefir & yogurt.
Worry, pensiveness and mental overwork often negatively affect the transporting and transforming function of the Spleen and contribute to deranged water metabolism as internal dampness. Organs of the body other than the Spleen also contribute to the action of water metabolism. The lungs (Upper Jiao or chest cavity) produce arginine-vasopressin that acts on the kidney nephron to alter water balance in the body. Grief and melancholy stifle Lung qi that disrupts the production of arginine-vasopressin. The mineral corticoids of the adrenal glands (part of the TCM Kidneys in the Lower Jiao) also regulate water balance in the body via the kidney nephron. The liver (Lower Jiao) produces angiotensinogen that assists in water balance via the angiotensin-renin-aldosterone system. The kidney (Lower Jiao) produces rennin that assists in the regulation of water balance in the above-mentioned system. Disharmonies between the organ systems of the Lungs, Kidneys and Liver with the Spleen system all cause some form of disrupted water metabolism. The degree of aberration, the length of time of disruption and the systems involved determine the symptoms and progression of pathogenesis within the body. According to TCM, the San Jiao meridian is the pathway for the movement of all fluids within the body.(3) Thus any obstruction in the channels and meridians will ultimately affect water metabolism adversely in some manner. The role of diet in contracting internal Dampness and that of food therapy in combating internal Dampness is well known. Foods that impair digestion, yield food stagnation and in general interfere with the Spleen in some manner contributing to the development of internal Dampness due to the impairment of water metabolism within the body. When one overeats, a condition of food stagnation ensues and the digestive system will not function properly. This gives rise to such clinical manifestations as foul belching, sour regurgitation, distention, bloating, pain in the epigastrium & abdomen, loss of appetite, vomiting and diarrhea. Overindulgence in cold or raw foods can easily impair Spleen yang and leads to the development of interior damp-cold.(4) The resulting symptoms are diarrhea and abdominal pain. Likewise, the overindulgence of alcoholic beverages or greasy, sweet and spicy foods may lead to damp-heat, phlegm and stagnation of qi & blood. Symptoms resulting are the sensation of fullness or stifling fullness in the chest with profuse sputum, dizziness and vertigo, bleeding hemorrhoids and yang type sores (red, weepy, itchy).
An excellent, clear and concise description of the diagnosis of Damp conditions may be found in the text by G. Maciocia.(12)
External Dampness Condition Categories are:
Internal Dampness Condition Categories are:
The Formulas and Strategies text(13) lists formulae the treat conditions of Dampness that are categorized into 5 sections.
Many of the foods that one finds in the typical grocery store have been manufactured such that they are inimical to your health, one estimate being at least 85%. Any food that causes any kind of adverse affect on the Spleen system (in TCM) will eventually result in Dampness in the organs and meridians, depending upon the particular genetic constitution of the patient.
One may find the result of decades of dampness in the body by searching the skin and finding the following lesions: white or dark colored patchy and rough raised splotches around the eyes due to cholesterol deposits, skin tags due to toxic damp-heat in the skin and seborrheic keratoses due to chronic damp-heat in the skin.
The author has found that the daily drinking of a decoction (tea) made from dried flowers (seed pods) of the Roselle (Hibiscus sabdariffa) and Ju Hua (Chrysanthemum flower) is very effective in drying up these type of lesions. One must make the tea very concentrated for it to be effective. Results may not become visible for as long as a year and longer due to the number of years the condition has been building. If the tea is too weak, there is no affect. If the tea is too strong it may cause constipation. Each person will need to determine their effective dose for themselves through trial and error.
If your intention is also to loose weight, brew your favorite Oolong tea (or other tea type) with the Roselle. Sweeten your tea sparingly with Maple syrup, raw sugar, honey or Agave syrup. Make the tea as bitter as you can stand in order to get the polyphenols that are beneficial (http://en.wikipedia.org/wiki/Polyphenol_antioxidant).
Studies have shown that drinking Hibiscus tea can effectively lower high blood pressure and reduce high cholesterol levels in many individuals! Read an article about it in the February 1, 2009 issue of Internal Medicine News. Hibiscus and Hibiscus Mint tea are caffeine free. Hibiscus tea is also rich in Vitamin C; has a unique, delicious taste; has a smooth, pleasant fragrance; has a distinctive, vibrant, natural color (fushia to purple); is great served hot or cold; has long been known in the deep South of the USA to act as a natural body refrigerant. This is particularly useful during the time of summer heat.
In dealing with the many problems of Dampness, the organs involved in the metabolism of water need particular attention. The Lungs, the Spleen and the Kidneys are all intimately involved in various ways with the issue of water metabolism in the body. Dampness and its combinations with Wind, Cold and Heat cause some form of obstruction of Qi and Blood or blockage of the channels in some manner, if not directly impairing the function of the Lungs, the Spleen and the Kidneys. Treatment of Damp and its combinations involves removing the obstructions and dissipating the pathological products as well as returning the normal functionality of the Zang-Fu organs. Both the use of acupuncture and Chinese herbal medicine is very effective for resolving the pathological conditions of Dampness. Treatment is as always dependent upon the skill of the practitioner in determining the diagnosis from the signs and symptoms of the patient. Choice in use of points and herbal formulae and their modifications comes with observation, experience and practice. The patient needs to be aware that there is no quick fix for the treatment of Dampness conditions. Depending upon how many years the condition has been developing and been evident, it may take a few years to correct. All will be to no avail if the patient does not make serious lifestyle changes to the better. Perseverance furthers!
Oriental Medicine Section