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Updated June 2015


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 man-made 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 man-made 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 unnatural substances in our food and water that needs to be eliminated from our bodies after ingestion/consumption. Dampness is a condition that is partly hormonal based. The body reaction to chronic stress is to produce more cortisol which can then result in the accumulation of fat tissue. Another source of weight gain is the eating of much of the manufactured foodstuffs in a developed country. The use of white flour, refined sugar, hydrogenated oils and soybean products in the manufacture of foodstuffs is a quite serious problematical health issue in itself. Also, the ingestion of xenoestrogens ( that are found in our food severely complicates the problem. Xenoestrogens are a sub-category of endocrine disruptor compounds that specifically have estrogen-like effects in the body. These compounds are found in multiple aspects of contemporary life. Please read the above link to discover these sources and how to avoid them. See the link on osteoarthritis for more information.

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. Dampness then works its way up the legs and settles into the lower jiao (lower abdomen). 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 & soreness, and pain & 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.

Classically, 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 pathological 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 pathological 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:

  1. Simple invasion of Dampness in the Zang-Fu
    • a. Urinary Bladder – difficulty and pain on urination, scanty but frequent urination, cloudy urine, a feeling of heaviness in the lower abdomen, tongue with a thick & sticky coating on the root, pulse slippery. If associated with Heat – a burning on urination, dark urine, thirst with no desire to drink, yellow tongue coating, slightly rapid pulse
    • b. Stomach – acute onset of vomiting, watery diarrhea without smell, epigastric pain, a feeling of stuffiness in the epigastrium, cold limbs, no appetite, a thick sticky & white tongue coating, a slippery or soggy pulse
    • c. Intestines – acute onset of watery diarrhea without smell, abdominal pain, a feeling of heaviness, thick sticky & white tongue coating, slippery pulse
    • d. Uterus – acute onset of painful periods, excessive vaginal discharge, thick sticky & white tongue coating, slippery pulse
    • e. Gall Bladder – acute onset of hypochondrial pain, a feeling of heaviness, a bitter taste in the mouth, a sticky yellow coating on one the side of the tongue, slippery pulse
  2. Invasion of acute, external dampness in the channels/meridians manifesting as pain, swelling and heaviness of the joints
  3. Invasion of external Damp-Heat at the defensive (wei) qi level manifesting with fever: external Damp-Heat, external Summer-Heat with Dampness

Internal Dampness Condition Categories are:

  1. Chronic
    • a. Internal dampness in the Zang-Fu
      • (1. Stomach & Spleen – epigastric pain and fullness, poor digestion, a feeling of fullness, a sticky taste in the mouth and a poor appetite
      • (2. Urinary Bladder – difficult and painful urination and cloudy urination
      • (3. Intestines – loose stools with mucus, abdominal pain and fullness
      • (4. Uterus – infertility or excessive vaginal discharge
      • (5. Gall Bladder – hypochondrial pain & fullness
      • (6. Liver – hypochondrial fullness, distension and pain, jaundice
      • (7. Kidneys – cloudy urine, difficult urination
    • b. Dampness in the channels/meridians manifesting as pain, swelling and heaviness of the joints
    • c. Dampness in the skin manifesting mainly as eczema, puffiness and oozing lesions
  2. Acute – Damp-Heat at the qi level with fever that is worse in the afternoon, body that is hot to the touch, aversion to cold, swollen glands, headache, a feeling of heaviness, a feeling of oppression in the epigastrium, a sticky taste in the mouth and thirst with no desire to drink, sticky white tongue coating and soggy pulse

Treatments – Acupuncture


  1. St36 – strengthens the Spleen and disperses Damp-Heat and Wind-Damp in the whole body
  2. St40 – resolves Damp and Phlegm in the whole body
  3. St44 – cools Heat in the Stomach and removes obstruction from the Intestines – for conditions of Damp-Heat diarrhea and dysentery
  4. LI4 – dispels Damp-Heat from the Stomach and Intestines
  5. LI11 – cools Heat and alleviates Dampness; for Damp-Heat dysentery or skin conditions (e.g. eczema)
  6. Sp3 – best with Dampness in the channels
  7. Sp9 – disperses Dampness but is used more for Damp-Heat than Damp-Cold, more for Damp-Heat diarrhea, dysentery, vaginal discharge or urinary disorders
  8. Ren9- resolves Dampness in the middle jiao
  9. Ren12 – regulates Stomach Qi and disperses Dampness in the middle jiao
  10. UB20 – used more for Damp-Cold to reinforce Spleen yang
  11. Pc6 – pacifies the Stomach and resolves Dampness in the middle jiao

Treatments – Herbal Formulae

The Formulas and Strategies text (13) lists formulae the treat conditions of Dampness that are categorized into 5 sections.

  1. Formulae that Promote Urination and Leach out Dampness
    • a. wu ling san (5 Ingredient Powder with Poria) – exterior pathogenic influences that disrupt the functions of the Urinary Bladder
    • b. zhu ling tang (Polyporus decoction) – injury from Cold entering the Yangming or Shaoyin where it transforms into Heat
    • c. wu pi san (5 Peel Powder) – skin edema due to invasion of wind disrupting the function of the Lungs to move qi downwards
    • d. fang ji huang qi tang (Stephania & Astragalus Decoction) – Wind-Dampness or Wind edema due to invasion of Wind & Damp
  2. Formulae that Transform Damp Turbidity
    • a. ping wei san (Calm the Stomach Powder) – Damp-Cold stagnating in the Spleen and Stomach
    • b. huo xiang zheng qi san (Agastache Powder to Rectify Qi) – externally contracted Wind-Cold causing qi stagnation
  3. Formulae that Clear Damp-Heat
    • a. san ren tang (3 Nut Decoction) – early-stage damp warm-febrile disease or summerheat warm-febrile disease where Dampness predominates and the pathogenic influences are lodged in the wei and qi levels
    • b. gan lu xiao du dan (Sweet Dew Special Pill to Eliminate Toxin) – early-stage of a damp warm-febrile disease or seasonal epidemic disorder
    • c. lian po yin (Coptis and Magnolia Bark) – sudden turmoil disorder due to an aggregation of Damp-Heat in the body
    • d. yin chen hao tang (Artemisia Yinchenhao Decoction) – yang-type or “fresh tangerine” color jaundice due to Dampness and Heat interior accumulation
    • e. zhong man fen xiao wan (Separate and Reduce Fullness in the Middle Pill) – drum-like abdominal distention due to Heat
    • f. ba zheng san (8 Herb Powder for Rectification) – hot or bloody painful urinary dysfunction due to clumping of Damp-Heat in the lower jiao
    • g. shao yao tang (Peony Decoction) – Damp-Heat lodged in the Intestines causing Qi and Blood stagnation
    • h. er miao san (2 Marvel Powder) – Damp-Heat in the lower jiao
  4. Formulae that Warm and Transform Water and Dampness
    • a. zhen wu tang (True Warrior Decoction) – Kidney yang deficiency or Kidney and Spleen yang deficiency with retention of pathogenic water
    • b. shi pi yin (Bolster the Spleen decoction) – yin type edema due to Spleen and Kidney yang deficiency
    • c. bei xie fen qing yin (Dioscorea Hypoglauca Decoction to Separate the Clear) – cloudy painful urinary dysfunction due to Cold from deficiency in the lower jiao
    • d. ji ming san (Powder to take at Cock’s Crow) – “damp” leg qi caused by Damp-Cold obstructing the smooth flow of Qi and Blood in the legs
  5. Formulae that Dispel Wind-Dampness
    • a. qiang huo sheng shi tang (Notopterygium Decoction to Overcome Dampness) – Wind-Dampness in the superficial aspects of the body
    • b. juan bi tang (Remove Painful Obstruction Decoction) – joint pain due to local obstruction by Wind-Cold-Damp
    • c. gui zhi shao yao zhi mu tang (Cinnamon Twig, Peony and Anemarrhena Decoction) – recurrent Wind-Cold-Damp localized painful obstruction causing Heat
    • d. xaun bi tang (Disband Painful Obstruction Decoction) – painful obstruction due to containment of Damp-Heat in the channels
    • e. du huo ji sheng tang (Angelica Pubescens and Sangjisheng Decoction) – painful obstruction with Liver and Kidney deficiency
    • Treatments – Food Therapy
    • 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 (
    • 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!
    1. Cheng, X. N., Chief Editor, 1987, “Chinese Acupuncture and Moxibustion”, Foreign Languages Press, Beijing, pg 254
    2. Ibid, pgs 256-257
    3. Akopyan, A., 2003, “Dampness and the Circle of Wellness”,
    4. Ibid, pg 260
    5. Bensky, D., Gamble, A., 1993, “Chinese Herbal Medicine Materia Medica, Revised Edition”, Eastland Press, Seattle, pg 134
    6. Ibid, pg 386
    7. Ibid, pg 145
    8. Ibid, pg 390
    9. Treharne, A., “Food Therapy for Diarrhoea”,
    10. Chia. M., 2006, “Guidelines for Eating”,
    11. Dharmananda, S., 1997, “The Use of Aromatic Agents for Regulating Qi, Vitalizing Blood and Relieving Pain”,
    12. Maciocia, G., 2004, “Diagnosis in Chinese Medicine: A Comprehensive Guide”, Churchill Livingstone, pgs 948-950
    13. Bensky, D., Barolet, R., 1990, “Chinese Herbal Medicine: Formulas and Strategies”, Eastland Press, Seattle, pgs 173-212


Why Honey Is the Only Sweet Food that Does Not Cause Dampness


Honey is magic. Besides its delicious taste, it’s pretty much the only food that does not spoil while in an edible state. But why, exactly, doesn’t honey go bad?

Honey has a lot of pretty incredible properties. It’s been used and investigated for medicinal properties for a long time, especially as a treatment for open wounds. Herodotus reported that the Babylonians buried their dead in honey, and Alexander the Great may have been embalmed in a coffin full of honey.

The oldest honey ever found was unearthed in Georgia, and dates back over 5,000 years. So, if you found yourself in possession of some 5,000 year-old honey, could you eat it? Well. . .

Chemical Properties of Honey

Honey is a sugar. You may have heard all sorts of things about the health benefits of substituting honey for sugar, which may or may not be true. While honey isn’t the same as regular, granulated, white sugar, it’s still a sugar. And sugars are hygroscopic – they don’t contain much water in their natural state. And very few bacteria and microorganisms can live in the resulting low-moisture environment.

Amina Harris, executive director of the Honey and Pollination Center at the Robert Mondavi Institute at Univeristy of California, Davis says, “Honey in its natural form is very low moisture. Very few bacteria or microorganisms can survive in an environment like that, they just die. They’re smothered by it, essentially.” The fact that organisms can’t survive long in honey means they don’t get the chance to spoil it.

Another thing that sets honey apart from other sugars is its acidity. Honey’s pH is between 3 and 4.5 (or, more precisely, 3.26-4.48), which also kills off anything trying to make a home in honey.

And there are a few factors behind honey’s low moisture content, including:


First, bees contribute to the low water content of honey by flapping their wings to dry out nectar. Second, the way bees get nectar into honey combs is by vomiting it there. This sounds really gross, but the chemical makeup of bees’ stomachs also contributes to honey’s long shelf-life. Bees’ stomachs have the enzyme glucose oxidase, which is added to the honey when the nectar is regurgitated. The enzyme and nectar break mix to create gluconic acid and hydrogen peroxide. The hydrogen peroxide is also a hostile force for anything trying to grow in honey. (Although, maybe not that effective in your cuts.)

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