With the coming of the late summer, Summer Heat, consisting of Heat and Damp, now starts to injure the Yin. This can manifest in many ways.

This Heat and Damp may accumulate in the Exterior creating an obstruction to the flow of Qi, fluid (Jin-ye) and Blood in the channels and collaterals of the Exterior. This can manifest as Damp-Heat in the skin. Damp-Heat is considered a severe dermatology pattern compared to a mild External Wind or moderate Wind-Heat we see in the springtime.

As the Xie Qi or Pathogenic Qi (Damp) moves Interiorly it impairs the Spleen Qi and Yang. The Spleen prefers dry and the Damp hinders the  Spleen transforming and transporting function by impeding the ascending aspect of the Spleen Qi and Yang.  This leads to a poor appetite, diarrhea, and/or a painful or bloated abdomen as well as a slippery pulse.

With the Stagnation in the Exterior and as the Damp and Heat move Interiorly, the muscles and organs can become affected. Damp can be difficult to resolve.  Patients’ may present with complaints such as stiff or weak movement, bloody or mucoid feces, as well as skin lesions.

Hypothetical Case 1 (Bovine)

Species: Bovine
Breed: Holstein
Age: 3 years
Gender: F

Clinical Diagnosis (conventional): Bovine Viral Diarrhea Virus (BVD)

Conventional Indications:

Diagnosed two days ago with Bovine Viral Diarrhea (BVD).  The diagnosis was based on clinical signs. A rapid test with a commercially available test is available and may be the next step. The primary concern with this diagnosis is to prevent wide spread infection within the herd. Infection with this disease can lead to “Transitory” or “Persistent” infections depending on a variety of factors. This patient presents with acute diarrhea. There is tenesmus with a malodorous stool. Her appetite is decreased. She has been isolated from the herd and is presently being treated. She is presently open and may soon be culled unless she responds to this treatment.

Traditional  Indications:

Acute onset of disease with malodorous diarrhea and tenesmus. Decreased appetite and decreased to stopped milk production.

Viral infections may start as Wind-Cold Invasions, while bacterial infections are considered more Heat or Heat Toxin. With viruses, this quickly progresses to Heat or Damp-Heat as the Wei Qi engages and the Exterior stagnates. As the virus enters the Qi level (Shao-yang level) clinical signs become more organ specific.

Tongue: Red

Pulse: Rapid and Full

TCVM Diagnosis:  Large Intestine Damp-Heat/Heat Toxin

TCVM Assessment:

• Acute onset-Excess condition
• Diarrhea-Spleen Qi Deficiency and decreased Large Intestine function due to the presence of External Pathogenic Factors (Damp and Heat).
• Malodorous stool-Indicates Heat
• Tenesmus-Heat
• Decreased appetite-Spleen Qi Deficiency
• Red tongue- Heat
• Rapid and Full pulse- Heat and Damp

Treatment Principles:

• Clear Heat
• Resolve Damp
• Release the Exterior
• Tonify the Spleen
• Stop diarrhea
• Improve Appetite

Acupoint Prescription:

LI-4, LI-11, ST-25, ST-36, SP-6, SP-9, BL-20+BL-20, BL-21+BL-21, BL-25+BL-25, GB-34, GV-1, GV-14, Wei-jian, Shan-gen

Note: Moxibustion is contraindicated in this pattern. Electroacupuncture is recommended.

• Clear Heat-LI-4, LI-11, GV-14, ST-25, GB-34, Wei-jian, Shan-gen
• Resolve Damp- LI-11, ST-25, ST-36, SP-6, SP-9, BL-20+BL-20, GB-34
• Release the Exterior-LI-4, LI-11, GV-14
• Tonify the Spleen- ST-36, SP-6, SP-9, BL-20+BL-20
• Stop diarrhea-GV-1,
• Improve Appetite-ST-36, Shan-gen

Chinese Herbal Prescription:

• Great Saussurea Coptis
• Dose: 90 grams twice daily until diarrhea stops
• This formula was created by Dr. Huisheng Xie. It’s classical antecedent is Da Xiang Lian Wan.

Hypothetical Case 2 

Species: feline
Breed: DSH
Age: 7 years
Gender: male neutered

Clinical Diagnosis (conventional): severe food allergies and atopic dermatitis

Conventional Indications:

Chronic ear infections (cytology predominantly yeast) and facial dermatitis since early adulthood. Limited protein prescription diets and varying protocols with steroids and/or cyclosporines to allow for good quality of life. In addition he has also receives hyposensitization injections to address his atopic allergies.  Antibiotics (Baytril most effective) have been needed on and off to keep him comfortable. 

Seasonally though, usually in late July or August (hot and humid Western Pa), his facial lesions  get so severe that  he stops eating and becomes very lethargic and miserable. His lip commissures  split and bleed, his lips swell, most of his skin around his eyes and cheeks develop miliary dermatitis and his yeast ear infections become overwhelming. Intense pruritus prevails despite steroids.

Traditional Indications:

Simon is a rather metal constitution. He is a finicky eater, which has made it difficult finding an appropriate diet for him. He is very set in his routines and reserved towards strangers. His coat is a tad greasy and not very shiny. His tongue is red with a yellow coating. He feels damp and hot on palpation of his face and ears. He prefers cool environments and is quite thirsty. Pulses are deep and slippery, weaker on the left.

TCVM Assessment:

Greasy coat – damp

Red tongue with yellow coating  - damp heat

Hot and damp to touch – damp heat

Pruritus – external wind

Slippery pulses – damp

TCVM Diagnosis:

Damp Heat Skin

Treatment Principles:

• Clear Heat
• Resolve Damp
• Clear Wind
• Release the Exterior

Acupuncture – was not performed in this patient, as owner was not willing to commit to regular treatment sessions at the hospital. Cat does not travel well.

Chinese Herbal Prescription:

Damp Heat Skin 0.2 g capsules, 1 po sid, starting beginning of July in anticipation of seasonal worsening of symptoms, staying on formula until first frost (mid to end October usually)

Edited by Greg Todd, DVM, CVA. Hypotherical Cases by Greg Todd, DVM, CVA

Cat Photo Credit: Adult png from pngtree.com/