Transcription
Hey everyone, Dr. Richard Lai here with Study Acupuncture With Me. Now, today's episode is on dampness, so we're going to go into all that and more after we hear a quick word from our sponsor.
All right, and we're back. So today's episode is on dampness, and this comes from a request on Spotify where a listener named Ashanti responded to my Q&A. And Shanti said, "Please talk about dampness and all of its facets. Also, discuss how to diagnose. I'm a student, and I struggle with diagnosis during clinic."
So, Shanti, you've come to the right place because my whole mission with Study Acupuncture With Me is to help people exactly like you. And that's because I was there too. I was once you, and I know exactly what it's like to feel really overwhelmed in clinic. Where you're driving to clinic, where you're driving to class, and you're feeling really nervous because you don't even fully understand the material, and the teacher's already going on to another topic. You're still confused about last week's topic, and now you're in clinic, and there's a real live patient in front of you, and you're supposed to figure out what the pattern is, and what the treatment approach is, and what the treatment principle, and what the point prescription is. And then you look at your clinical instructors and your other students, and some of them, they're just spewing out like beautiful, poetic diagnoses, and you're just like, if you're like me, I'm just like, "Where did you pull that from? Like, how did you even get to that diagnosis?"
So believe me when I say, I've been there too. And so that's why I make this content so that listeners like you can get a quick win because you need education that's easy to digest and easy to understand because between juggling work, juggling family, juggling school, maybe you're just too busy to really dive into some of the textbooks. So if I can help you in any way, I'm happy to do so.
All right, so let's dive into dampness and dive into diagnosis in general. So the first thing you need to understand about diagnosing patients in the clinic is that your patients can present very differently almost every time they come into the clinic. And that's because they're people, and people can change, and things that they go through can change from a day-to-day basis. Now, as people, we fall into our daily routines, we fall into our daily habits, we fall into our work habits, we fall into also our daily living activity habits. And those daily activity living habits can actually default us into being exposed to similar pathologies from day to day. For example, if we work a very high-stress job, or we work a very laborious job where we have to lift heavy things, where we have to crawl under things, and we have to fix things while lying on our back, and our hands are above our head, these things can expose us to similar types of injuries over time.
Now, as an acupuncturist, we have to figure out what's going on with our patient. Like, what's the actual root cause? Is it an internal pathology? Is it an external pathology? Is it because they're constantly stressed about work that they're not sleeping well? Or is it because of pain because of their day-to-day labor that they have to get on their hands and knees and they need to lift heavy things, that's causing them pain and that's why they can't sleep?
So as an acupuncturist, when we look at our patients, we can look at them through four pillars. Now, these are called the four pillars of examination, which number one is looking, number two is asking, number three is palpating, and then number four is listening and smelling. Now, to be honest, a lot of time for me is spent on one, two, and three, which is looking, asking, and palpating. And number four is sort of more passive data that comes in as I'm evaluating the patient.
Now, with these four pillars too, it's not like you're just going from one pillar to the next and to the next. You're looking at your patient, you're evaluating them, and you're taking information from all the four pillars at the same time. So let me give you an example. So if you look at all the subtopics under each of these pillars, you're going to see how we could bounce around from pillar to pillar. And honestly, even we may not even get to all of them during our evaluation because we already get the data that we need to complete our diagnosis.
All right, so let's give a clinical example. So let's say you have a patient that comes into your treatment room, and you're saying, "Hi there, how are you?" And they say they're good because they're a nice person, and we all know they're in your clinic because they're feeling terrible. So they're lying to you, and they're saying, "Yes, I'm wonderful." So at this point, as your patient's entering into your treatment room, you should already be taking in data because you're, your patient's coming into your treatment room for treatment. So you should be looking to see how are they coming in? Are they hobbling in? Are they limping? Are they slow? Are they guarding a certain part of their body? Right from the get-go, you can get information about the patient's presentation.
Now, at the same time, you can be asking the patient, "Oh wow, I see you're having some trouble moving your legs. Okay, how long has that been happening? When did it start?" And now the patient's starting to talk about their legs and how their legs feel heavy, and they say that they've had a harder time getting their socks on, and even they're having a harder time getting their feet onto their bed at night because their feet just feel so heavy.
So at this point, you help your patient onto the treatment table, and you can start to inspect other parts of their body. So when you look at their feet, you're looking for one, you're looking for changes in skin color, maybe you're looking for changes in musculature. Is there atrophy involved? What's the color of their skin? What's the temperature of their skin? Is it hot to the touch? Is it cold? You can even assess the skin for moisture, like, is the skin dry, or is the skin wet? And when you look at the muscles, when you palpate them, you can see if there's atrophy or maybe there's swelling.
Now, all these different presentations, they correspond to different things. So let's say, for example, when you inspect the legs, you notice that the legs are swollen. When you press your finger into it, the skin, it makes an indent, and it takes some time for that skin to return to normal. You also notice that when you touch the skin, it's slightly weeping, like it's slightly wet. So then you bring that data and you start to ask questions. "How long have you had this swelling? How long have you had that weeping? Does your primary doctor know about the swelling? Are you taking any medications for this swelling?"
And when you're evaluating your patient and you're finding some of these symptoms, and they just make you feel like a flag is raised, then you should always recommend that other disciplines see them. So you can refer them back to their primary care, or you can refer them to a specialist, however you see clinically fit.
All right, so back to the evaluation. Patients on your table, you're asking them questions, you're inspecting their skin, you're inspecting the different parts of their body. So you're palpating their skin, you're palpating their pulse, you're palpating their channels, you're assessing the swelling. You're also at the same time, you're listening to their voice. How strong is their voice, or how weak is their voice? And you're even taking in any smells that could correspond to a potential diagnosis. So that's what I mean by your jumping from pillar to pillar, and that's the four pillars in a nutshell.
Now, like I said before, it's not like you're doing it one at a time, but you're weaving into and out of the different pillars, just like how a detective looks for clues. So you're like a detective looking for clues to what the diagnosis could be.
So now, with the four pillars, the first pillar is looking. Now, looking is also called inspection. So in this pillar, you're inspecting the patient, you're looking at their presentation. And some texts will say that you're inspecting their form and their bearing. Now, form and bearing is basically their posture and their ability to move. Now, it goes further than that, though, because you're assessing their spirit, you're assessing their presentation in so many different parts of their body. You're assessing their complexion in their face, assessing their head, you're assessing their eyes, their nose, their mouth, their ears, you're assessing their arms and their legs, you're assessing their skin. You're looking at their tongue. You're looking at the tongue for tongue body color, tongue body shape, tongue coat, moisture. You're also looking at the channels, especially the ones that go over the area that the patient's complaining about.
And so you're pulling in data from all of these areas, and you're trying to see if there's any recurring themes, anything that keeps poking its head up and saying, "Hey, it's me, I'm the problem. It's me." So in our patient before, in the clinical example, we inspected their legs, we saw swelling, we even saw moisture, and we saw pitting edema. So now we take this data, the swelling, the moisture, the pitting edema, we combine this with the fact that they told us that they feel heavy, their legs have felt heavy. So already we have swelling, we have edema, we have heaviness. So then what's the pathology that we're thinking? We're thinking dampness, right? Dampness could be the pathology here.
So then we can use the other pillars to help us rule in the diagnosis. So we can look at the tongue and we can look at the pulse. So if it's a dampness type tongue or a dampness type pulse, what kind of tongue might we expect to find, and what kind of pulse might we expect to find? So in terms of the tongue, we look at the tongue in four different ways. Now, number one, we look at the tongue body color. Number two, we look at the tongue body shape. And number three and four, we look at the tongue coat and the moisture of the tongue overall.
So in terms of the tongue body color, we look to see if the tongue is normal, meaning is it a pale red, or is there some sort of color that's pathological? Like, for example, is it red, then that pale red, or maybe is the tongue purple, or is it blue, or is it crimson? Now, all these can mean something different. Like, for example, a purple tongue will always mean blood stasis, and a red tongue will generally mean heat or fire.
Next, we can look at the tongue body shape. So the tongue body shape is the overall shape of the tongue. Is it long? Is it thin? Is it short? Or is it swollen? And all these can mean different pathologies too.
Next, we can look at the tongue coating. Like, what color is the coating? How thick is the coating? Is it white? Is it yellow? Is it thick? Is it thin? Or maybe there's no tongue coating at all. Again, all these can mean different pathologies. And then lastly, we can look at the moisture of the tongue. Is it dry? Is it wet? Is it sticky? Is it slippery? All these different presentations also mean different pathologies.
So now the question is, what does a dampness type tongue look like? And with a dampness type tongue, it's generally found in the moisture of the tongue. And the biggest indicator is if the tongue is sticky or slippery. If the tongue is sticky or slippery, it could mean that the patient is presented with dampness or phlegm.
And then with the pulse, we have 28 different kinds of pulses. And when we assess the pulse, we're using our fingers to inspect the pulse, and we're assessing the pulse in three dimensions. So when we put our finger on the pulse, we can do a lot of different things. We can lift, which means we're lifting the fingers to see what the level the pulse is in. Is it superficial? Is it deep? Or is it somewhere in between? This is the Z-axis that you see in the picture. And then we can also press down. So when we press down, we see how strong the pulse is against our fingers, and we can see how deep the pulse goes.
Another thing we can do with the pulse is we can search. So when we search, there's no movement involved at all. We just rest our fingers and we see what the rate of the pulse is. Is the pulse fast, or is the pulse slow? And then we can also push. Now, pushing is just moving our fingers side to side. Now, this lets you see the overall shape of the pulse. Is the pulse slippery? Is it thin? Is it tight like a rope? And the last thing we can do with the pulse is we can roll. So rolling is just moving your fingers up and down or proximal and distal. Now, this is so you can see the length of the pulse. So is the pulse long? Is it short? Or is the pulse moving?
In terms of a dampness type pulse, a dampness type pulse generally presents as two different pulses. It could either be soggy or it could be slippery.
Now, we assessed our patient, we inspected, we palpated, we asked questions, and we also listened and smelled. And we take all that data together and we interpret our findings to get a diagnosis.
Okay, so I hope that was helpful as an eagle eye view of what an evaluation looks like because easily, an actual lecture on evaluation and the four pillars and all the different details and different presentations in your evaluation, like color changes in the face, the eyes, the ears, all that can actually take a couple classes worth of time. But this was just an eagle eye view of an evaluation.
All right, so for the remainder of this episode, we're going to talk about these things. First, we're going to talk about the general clinical manifestations that your patient will feel if there's dampness. Then we're going to talk about the characteristics of dampness, and there you're going to understand why dampness causes the clinical manifestations that it does. And then we're going to talk about where dampness can go in the body. And then we're going to end the episode by pulling back and looking at dampness in an eagle eye view in the two ways that it can happen in the body, and that's in terms of an external dampness and an internal dampness.
All right, so first of all, what is dampness? Dampness is a pathogenic factor. Now, we have different pathogenic factors that can invade our body. So we have things like wind, we have cold, we have dampness, we have dryness, we have summer heat, we have fire, right? These all can invade the body. Now, with these, they can be either exterior or interior, and I'm referring to the eight principles there. For example, with wind, wind can come from an exterior origin where it's invading the body, but wind can also be generated internally, which, remember, I have a video on if you haven't seen it before. I will link it in the description below. It's a good episode on internal wind and how liver wind works.
All right, so now let's talk about the clinical manifestations that your patient can present with if there's dampness present. So here I have a list of all the different presentations of dampness. Now, these are just in general. So if there's dampness present, your patient could complain of a feeling of heaviness, a poor appetite, a feeling of fullness, sticky taste, urinary difficulty, vaginal discharge, sticky tongue coating, and slippery or soggy pulse. And the reason they can feel this is because of the characteristics of dampness, which there are three basic characteristics of dampness.
Number one, dampness is heavy in the body. Imagine like when you get stuck in the rain, and all your clothes are wet, and you feel heavy because all your clothes are weighing you down. Now, that's the same effect that dampness has on your body. Now, depending on where the dampness has invaded, that dampness will also present as different manifestations. Like, for example, if it invades the abdomen, your patient might say, "My stomach feels really full." Or if the dampness has invaded like their legs, they might say, "Their legs feel full." Or if the dampness invaded their head, they might say that their head feels like it weighs a thousand pounds, or they might say they feel really tired and sleepy, or they just feel fuzzy in the head. And that's because of the dampness invading and causing that feeling of tiredness, or feeling weighed down, or just feeling fuzzy overall.
Now, the next characteristic of dampness is that it's dirty. So dampness is dirty in the body. So, for example, when you're asking your 10 questions, you're asking things like, "How is your urine? What's the color of your urine? Is it pale yellow? Is your urine cloudy? Is your urine dark amber?" And if they say, "Yes, my urine has been cloudy," then that's a sign of dampness because dampness is dirty.
Now, dampness is also characteristic number three is sticky. And that's why we have things like a sticky tongue coating, that's why our patient may complain of a sticky taste in their mouth, and that's also why the pulse is slippery. Now, another thing about dampness is that because it's sticky, it tends to stick around longer. So that means it can become chronic more easily because of that stickiness.
All right, so now let's talk about the different areas that dampness can invade our body. So in general, regardless of external or internal dampness, dampness can invade the internal organs, it can invade the channels, and it can be the skin. Now, depending on the organ, the patient may present differently. Now, I do have a study guide that details exactly how the patient may present depending on the organ. So if you want a copy of that study guide, please go to www.studyacupuncturewithme.com/dampness. You can download it there for free.
All right, so now this slide is a general eagle eye view of dampness. So as you can see, we have dampness at the top, and that dampness can be split off into external dampness and internal dampness. Now, external dampness is easier to grasp, so let's start talking about that one first. Now, external dampness just invades the body, and it happens because of the climate. Like, for example, someone was out in the rain for a long time, or maybe they live in an area that's really damp, or maybe they were in the pool for too long, or maybe they were out and for some reason they had to sit on wet things, like maybe they had to sit in the wet grass, or they had to sit on wet towels, or something wet on the floor. These are all opportunities for external dampness to invade the body.
So then the question becomes, where does it invade? Now, external dampness can invade three areas. So it can invade the internal organs, it can invade our channels, and it can invade the Wei Qi level. Now, the Wei Qi level, if you look back on your notes on the four levels theory, you're gonna see these two things here on the slide. The Damp Heat and the Dampness with Summer Heat are two patterns in the Wei Qi level of the four levels theory.
All right, so now let's pull back again. So dampness can be external, or it can be internal. External dampness can invade the internal organs, it can invade the channels, or it can invade the Wei Qi level. The Wei Qi level has those two patterns there, but the two patterns that have to do with dampness are Damp Heat and Summer Heat. Now, both of these patterns are in the four levels theory.
All right, so now dampness can also invade the internal organs. Now, depending on the organ, the patient may present with different manifestations. And again, you can get that study guide. You go to www.studyacupuncturewithme.com/dampness.
All right, now in terms of channels, external dampness can also invade our channels, and when it invades the channels, this is known as Bi syndrome or painful obstruction syndrome. Now, what kind of painful obstruction syndrome? It depends on the manifestations. That's how you know what kind of painful obstruction syndrome. Now, in terms of damp painful obstruction syndrome, your patient is going to complain of heaviness in the joint, maybe swelling in the joints, or even achiness. Sometimes the dampness can combine with other pathogenic factors, so they might complain of a mixture of things. Like, for example, if the joints are swollen, it's heavy feeling, it's aching, and it's also hot and red, that could mean that dampness has also combined with heat. So it's a Damp Heat painful obstruction syndrome.
All right, so now let's talk about internal dampness. So now, why might internal dampness happen in the body? Now, to understand this, we have to bring it back to the general theory of body fluids. Now, we have three general organs that have a major effect on the body fluids in our body. Number one, the first organ is the Spleen. Spleen, we know, controls or governs Qi. It governs transformation and transportation. What is it transforming and transporting? It transforms and transports food essence, Qi, and body fluids. Now, if there's a weakness in the spleen organ, so that means the ability for the spleen to transform and transport body fluids is going to be impaired. So what's going to happen is that the body fluids are going to accumulate because it's not being transformed and it's not being transported. And what's going to happen if the body fluids accumulate? It's going to form into dampness in the body.
Now, this can affect also the Lung. Then, because the Lung is supposed to regulate the water passages, and because the Lung receives fluids from the Spleen, and what it does with the fluids is that it diffuses those fluids into the space between the skin and the muscles. What's going to happen? Since it's not diffusing, it's going to accumulate, and that can also cause dampness. And then with the Kidneys, the Kidneys govern water, and the Kidneys are actually a source of energy for the Spleen to transform body fluids because they provide heat that the Spleen needs to transform body fluids. Now, also the Kidneys assist the other organs in terms of the separation of the body fluids. So basically, what I'm saying is that a kink in any part of the system here can cause fluid to accumulate and turn into dampness.
So you, as an acupuncturist or an acupuncture student, you are basically a mechanic. And when you're evaluating your patient, you're evaluating their body, you're checking under the hood. So you're looking at all the different parts of the car and you're figuring out, is it an external cause or is it an internal cause? Maybe the Spleen is deficient? Maybe the Lung is deficient? Or maybe the Kidney? Or maybe all three are deficient?
And with internal dampness, it can either be chronic or it can be acute. If it's acute, it presents as either an acute flare-up of chronic internal dampness that they have already, meaning they have dampness, they've had it for a long time, and it just flares up every once in a while. Or it can present as the Damp Heat pattern in the Qi level of the four levels theory. Now, if it's chronic, then that chronic dampness can affect either the organs, the channels, or it can be retained in the skin. Now, depending on the organ, the manifestations in the patient may present differently. Again, I have all those manifestations in a study guide, which you can get for free at www.studyacupuncturewithme.com/dampness.
If there's chronic dampness in the channels, then this presents as painful obstruction syndrome, which with dampness, the patient's going to complain of those three things. They're going to complain of swelling, heaviness, and aching of the joints. And then if there's dampness in the skin, then this can present as edema, it can present as oozing or weeping of the skin, or it can present as fluid-filled blisters.
All right, and that brings us to the end of this episode. If you found value out of this episode, I hope that you interact with this episode. You can interact by commenting below, by answering the Q&A. Maybe when you comment, say hello and suggest another topic that you'd like to see on this channel. And of course, if you found value out of this episode, someone else might also find value. So please share this episode with a friend. Text it to them, email to them, share it on your Instagram stories. Just help me spread the message out there. And until next time, God bless and happy studying.