Water-disinhibiting dampness-percolating agents

Water-disinhibiting dampness-percolating medicinals free the waterways and discharge water-damp in the treatment of water and dampness (water-damp) collecting internally, giving rise to water swelling, phlegm-rheum, strangury, and jaundice patterns.

Subcategories

• Water-disinhibiting swelling-dispersing agents
• Urine-disinhibiting strangury-freeing agents
• Dampness-disinhibiting jaundice-abating agents

Pathomechanisms

Production and distribution of fluids: According to traditional doctrine, the spleen extracts the fluids from grain and water in the stomach. It carries them up to the heart and lung, from where they are distributed around the body. As food passes down the digestive tract, more fluid is drawn off in the small and large intestines.

The lung has an important role in the distribution of fluids. Lung qì has two actions: an upward and outward movement called diffusion and a downward action called depurative downbearing. By diffusion, fluids are carried outward and around the whole body to moisten the skin, flesh, orifices, and bowels and viscera. By depurative downbearing, fluids are carried down to the kidney and bladder. The aspect of the lung’s depurative downbearing that involves the fluids is called governing the regulation of the waterways.

The kidney plays a major role in fluid metabolism. It produces urine and passes it down to the bladder, where it is stored temporarily and from which it is periodically voided. However, the role of the kidney is conceived in a very dynamic fashion. The kidney is the basis of the yīn and yáng balance in the whole body.

The yáng qì of the kidney powers the spleen’s function of distributing essence, the lung’s diffusion and depurative downbearing action, and the small intestine’s function of separating the clear and turbid. Kidney yáng also has the specific action of steaming the fluids: This means that fluids descending to the kidney are heated by kidney yáng, so that the clear part steams upward to be used again by the body, while the turbid part becomes urine and is passed down to the bladder. This action of the kidney is often referred to by the term qì transformation (气化 qì huà).

The liver and the triple burner also play a minor role in fluid metabolism. The free coursing action of the liver, for example, helps to keep fluids moving.

Accumulations of water-damp: Water-damp is unwanted water and dampness in the body. It gathers when either the distribution or excretion of fluids is impaired. Water-damp can occur in external contraction or by miscellaneous internal damage diseases. It takes the form of water, dampness (including cold-damp and damp-heat), or phlegm-rheum.

Water is a form of water-damp that runs to the surface of the body, giving rise to water swelling. This is most commonly due to disturbances of the kidney, but the spleen and lung also play important roles. It is less commonly due to external evils.

Water swelling is often referred to in English as edema. However, in Chinese medicine, water swelling is a distinct concept. In ancient texts, it was simply referred to as water. It is distinguished from toxin swelling, which is localized swelling associated with pain and heat. water swelling is disease name. As a symptom, the condition it denotes is usually referred to as puffy swelling.

Dampness is a diffuse form of water-damp. Clammy and stagnant in nature, it is a yīn evil. The spleen is averse to dampness. It is vulnerable to dampness entering the body from outside. When in spleen qì or spleen yáng vacuity the spleen fails to move and transform fluids adequately, dampness can arise internally. The lung and kidney often play a role, but the spleen plays the most important role. Because water-damp is closely associated with the spleen, it primarily affects the center burner. This is called dampness obstructing the center burner, which is characterized by oppression in the chest, nausea and vomiting, distension and fullness in the stomach duct, heavy-headedness and generalized heaviness, sliminess in the mouth with no thirst, sloppy stool and diarrhea, and yellow facial complexion. Dampness obstructing the center burner is treated by aromatic dampness-transforming agents.

Dampness in the center burner can develop into damp-heat or cold-damp. A diet of sweet, fat, and rich foods clogs the action of the spleen and also produces intense stomach fire. Under such circumstances, the dampness will form with heat, which means that dampness develops under the influence of preexisting heat to produce damp-heat. When there is only yáng vacuity and no heat, the dampness forms with cold to produce cold-damp.

Damp-heat and cold-damp can give rise to other conditions. For example, both can obstruct the liver and gallbladder giving rise to yellowing of the skin and whites of the eyes, which is called jaundice. Damp-heat can pour down into the lower burner and cause conditions of dribbling and usually painful urination which are called strangury.

Dampness and cold-damp are treated mainly with aromatic dampness-transforming agents, while damp-heat is treated with Water-disinhibiting dampness-percolating medicinals and with heat-clearing dampness-drying medicinals (heat-clearing agents.

Water-damp can also concentrate to form phlegm-rheum. Phlegm-rheum is a generic term for local accumulations of pathological fluid. Phlegm is a thick form of pathological fluid that accumulates in the lung and other parts of the body. Rheum is a thinner form that collects in specific locations.

Since phlegm is mainly treated with phlegm-transforming agents, the emphasis of water-disinhibiting dampness-percolating medicinals on rheum. However, it is important to understand that not all water-rheum patterns are treated by disinhibiting water and percolating dampness. For example, aromatic dampness-transforming agents may be used to warm the lung and transform rheum, and draining-precipititant agents can be used to expel water to treat severe fluid accumulation in the abdomen.

Water-disinhibiting dampness-percolating medicinals all share the action of promoting the downward flow of fluids. They are divided into three categories: dispersing swelling, freeing strangury, and abating jaundice.

• Medicinals that disinhibit water and disperse swelling mainly treat water swelling.
• Medicinals that disinhibit urine and free strangury treat strangury (lín).
• Medicinals that disinhibit dampness and abate jaundice treat jaundice.

It is important to understand the distinctions between disinhibiting water (利水lì shuǐ), disinhibiting urine (利尿 lì niào), and disinhibiting dampness (利湿lì shī). Disinhibiting water means removing excess accumulation of water anywhere in the body—upper body or lower body (in the treatment of water swelling). Disinhibiting urine means disinhibiting water in the lower burner (in the treatment of strangury). Disinhibiting dampness means removing dampness from the lower burner (in the treatment of jaundice).

These three actions are often rendered in English as promote urination or induce diuresis. This not only blurs the previously mentioned distinctions; it is pharmacologically inaccurate. Diuretic substances increase urine output in all patients. Not all the medicinals ascribed this action are true diuretics in terms of modern pharmacology, e.g., chē qián zǐ (Plantaginis Semen). Furthermore, agents with a diuretic action are found in other categories, e.g., niú bàng zǐ (Arctii Fructus).

In contrast, the Chinese concept is that of freeing inhibited flow to allow dampness or water to be expelled from the body, without forcing the body to increase urine output. Because of this conceptual difference, we choose to render these phrases with the concept of disinhibiting water, dampness, or urine, instead of the more familiar, but potentially misleading notion of inducing diuresis.

Most agents that disinhibit water and percolate dampness are cool or cold in nature. They are bland, sweet, or bitter in flavor. Most enter the kidney channel. In general, they are downsinking.

Properties

Nature: Cold, balanced or warm.

Flavor: Sweet, bitter or bland.

Channel entry: A large number enter the bladder and kidney channel. Some enter the spleen or stomach. Some enter the liver and gallbladder.

Actions

Water-disinhibiting dampness-percolating medicinals free urine and eliminate water-damp. They fall into three different categories: dispersing swelling, freeing strangury, and abating jaundice.

Some water-disinhibiting dampness-percolating medicinals are cold or cool in nature and have a heat-clearing action, causing damp-heat to be eliminated through urine. This is called clearing and disinhibiting damp-heat.

Indications

Medicinals of all three different action categories have the following indications:

• Water-disinhibiting swelling-dispersing medicinals: Water swelling, phlegm-rheum, diarrhea, inhibited urination, and vaginal discharge.
• Urine-disinhibiting strangury-freeing medicinals: strangury patterns.
• Dampness-disinhibiting jaundice-abating medicinals: jaundice patterns.

Other indications for medicinals of this category include damp sores, damp-warmth, and damp impediment patterns. The main disease patterns treated by water-disinhibiting dampness-percolating medicinals are as follows:

Yang Water Swelling (repletion)

Pathomechanism: Repletion patterns are attributed to externally contracted wind-cold that passes into the interior and transforms into heat, impairing the diffusion of lung qì, the triple burner’s governing of the sluices, and/or the qì transformation function of the bladder. Note that yáng water swelling includes wind water (water swelling due to contraction of wind evil) and skin water (water swelling with drumlike enlargement of the abdomen).

Signs: Swelling of the face first, together with aversion to cold and heat effusion, as well as cough and sore throat. As the wind-cold passes into the interior and transforms into heat, there will be rough voidings of reddish urine, constipation, abdominal fullness, slimy tongue fur, and a rapid pulse.

Treatment method: Course wind, diffuse the lung, clear heat, and disinhibit water.

Yīn water swelling (vacuity)

Pathomechanism: Vacuity patterns mostly due to spleen-kidney yang vacuity resulting from constitutional insufficiency, dietary irregularities, enduring illness, and/or the general decline of health in later life. Spleen-kidney yáng vacuity prevents the normal movement and transformation of water-damp.

Signs: Yīn water swelling is characterized by swelling of the face and instep of the foot, or swelling of the lower limbs first. The swelling often pits under pressure. Accompanying signs include oppression in the chest, reduced eating, cold limbs, lassitude of spirit, sloppy stool, scant urine, heavy body and aching lumbus, an enlarged tongue with white fur, and a pulse that is sunken, slow, and weak.

Treatment method: Fortify the spleen, warm the kidney, free yáng, and transform dampness.

Phlegm-rheum

Pathomechanism: Water-damp collecting in various locations, primarily arising as a result of lung, spleen, or kidney disturbances preventing the normal transportation and transformation of fluid.

Signs: The signs of phlegm-rheum vary depending on location. In practice, phlegm-rheum generally refers to (a) any rheum pattern or (b) specifically to rheum lodged in the stomach and intestines. There are four major rheum patterns, which are called the four rheums (四饮 sì yǐn).

Treatment method: Water-disinhibiting dampness-percolating medicinals combined with phlegm-transforming medicinals.

Heat Strangury (Damp-heat strangury)

Pathomechanism:There are different forms of strangury (lín) . Here, we are only concerned with heat strangury, which is due to damp-heat pouring down from the center burner into the lower burner.

Signs: Strangury is dribbling urination (frequent, short, rough voidings) with scorching or stinging pain in the urethra and tension in the smaller abdomen. In some cases, there is pain stretching into the lumbus or abdomen. There may be alternating heat effusion and aversion to cold.

Treatment method: Disinhibit urine and free strangury.

Jaundice

Pathomechanism: Jaundice is a disease characterized by generalized yellowing of the skin and whites of the eyes. It arises when contraction of external evils or dietary irregularities cause damage to the spleen and stomach and give rise to damp evil. The damp evil obstructs the center burner and affects the liver and gallbladder. This causes the bile to fail to keep to its normal path and instead spill into the blood, and from the blood into the skin. Jaundice can take the form of yīn yellowing or yáng yellowing, depending on whether the dampness forms with cold or with heat.

Signs: Generalized yellowing of the skin and yellowing of the whites of the eyes (sclera). Yáng yellowing (yáng jaundice) is characterized by eyes and body the color of tangerines and urine the color of tea, with heat effusion and thirst. Yīn yellowing (yīn jaundice) is characterized by a dull withered-yellow complexion, bland taste in the mouth, absence of thirst, lassitude of spirit and lack of strength, torpid intake and abdominal distension, and unsolid stool.

Treatment method: Disinhibit dampness and abate jaundice.

Note: Jaundice was traditionally explained in terms of spleen-stomach disease. The re-explanation in terms of gallbladder disease is the result of Western medical influence.

Combinations

Water-damp with qì stagnation: Dampness is a yīn evil. It is clammy and stagnant, and easily obstructs the qì dynamic to give rise to distension and fullness. Under these circumstances, water-disinhibiting dampness-percolating medicinals should be combined with qì-moving agents such as chén pí (Citri Reticulatae Pericarpium).

Water-damp with nondiffusion of lung qì: Combine water-disinhibiting dampness-percolating medicinals with agents that diffuse lung qì.

Water-damp with spleen vacuity: Combine with qì-supplementing spleen-fortifying medicinals.

Water-damp with kidney vacuity: Combine with agents that supplement kidney vacuity.

Phlegm-rheum: When dampness gathers to form phlegm-rheum, water-disinhibiting dampness-percolating percolating medicinals can be combined with phlegm-transforming medicinals.

Cold-damp patterns: Combine water-disinhibiting dampness-percolating medicinals with interior-warming or warm bitter dampness-drying medicinals.

Wind-damp impediment: When wind contends with cold and settles in the joints, giving rise to wind-damp impediment pain, water-disinhibiting dampness-percolating medicinals can be combined with wind-damp–dispelling medicinals.

Damp-heat strangury: Urine-disinhibiting strangury-freeing medicinals are combined with heat-clearing toxin-resolving agents.

Yáng yellowing (damp-heat jaundice): Combine dampness-disinhibiting jaundice-abating agents with heat-clearing liver-coursing medicinals or aromatic dampness-transforming medicinals.

Damp warmth, damp-heat sores: Combine cold-natured medicinals that disinhibit water and percolate dampness with heat-clearing dampness-drying medicinals, aromatic dampness-transforming medicinals, and heat-clearing toxin-resolving medicinals.

Warnings

Many medicinals in this category should be used with care or may be contraindicated in patients suffering from yīn depletion and scant liquid or from seminal emission or enuresis due to kidney vacuity. Water-disinhibiting strangury-freeing agents are generally not appropriate in pregnancy.

Medicinals with a diuretic effect should be used with care in patients who are concurrently using diuretic biomedical medication.