小便不利，大便快，湿在里者居多，故即从里治，利其小便。又曰∶湿家但头汗出，背强，
欲覆被向火，若下之早则哕；或胸满，小便不利，舌上白苔者，以丹田有热，胸中有寒，热
为寒搏，故渴欲饮水而不能饮，口燥而烦。按∶湿家本多汗，头汗出者，寒气凝敛于上也；
背
便不利者，误下津液内竭也。下后里虚，上焦阳气陷入下焦，为丹田有热；舌苔白滑，误下
表寒陷入胸中，为胸中有寒；惟丹田有热，则渴欲饮水；惟胸中有寒湿，虽得水而不能饮，
但口燥而烦也。又曰∶湿家下之，额上汗出，微喘，小便利者死，若下利不止者，亦死。盖
湿在表，下之则虚其里，额为诸阳之会，额上汗出，孤阳无根而上脱也；微喘，里热不守而
上逆也；小便自遗，或下利者，阴气不藏而下泄也；阴阳脱离，故死。观此可知在里之寒湿
，宜利而不宜下也明矣。其湿合风寒伤人，致表虚里虚者，表虚则固表，里虚则温阳。盖固
表则阳气外卫，阴气自消；温阳则离照当空，阴霾自退。君子道长，小人道消，理固有一定
者也。故仲景治风湿，脉浮、身重，见其汗出、恶风，知为表虚，主防己黄 汤，疏而固之
；治风湿相抟，身体烦疼，不能转侧，不呕，不渴（里无邪也），见其脉浮虚而涩，知为阳虚
，主桂枝附子汤，和而温之；若大便坚，小便自利者，知在内之津液不足，主桂枝去桂加白
术汤，温而润之（甜术生用，气虽燥而质润，既能胜湿，又不伤津）；治风湿相搏，骨节疼痛
烦掣，不得屈伸，近之痛剧，小便不利，或身微肿，见其汗出、气短、恶风不欲去衣，知为
表里两虚，主甘草附子汤，温以化之。此汉儒医学也。继此而知之者，则惟有喻氏嘉言。其
曰∶人身阳盛则轻矫，湿盛则重着，乃有身重如山，百脉痛楚，不能转侧，此犹不用附子回
阳胜湿，更欲何待？在表之湿，其有可汗者，附子合桂枝汤，驱之外出；在里之湿，其有可
下者，附子合细辛、大黄，驱之下出；在中之湿，附子合白术温中燥脾。然则喻氏之学，其
直登张氏之堂也乎！更有湿化为热者，如经所谓风、寒、湿三气杂至，沓合而成痹。本论又
合风、寒、湿、热四气名湿痹，是始则湿与风、寒合，继则湿与热合。湿与热合，又当用辛
凉淡法，如苍术白虎汤、治痹防己汤，或细辛、石膏并用，俾天气清肃下降，则经络湿热自
随之以降，而痹者通矣。又有湿热化燥者，如经所谓诸痉项强，皆属于湿。又曰∶湿热不攘
，大筋软短，小筋弛长；软短为拘，弛长为痿。又曰∶经热则痹，络热则痿。又曰∶肺叶焦
萎，则病痿 之类。湿化为燥，燥中犹有余湿，须治湿不碍燥，如防己汤中加龟板、决
明、牡蛎、金钗石斛之类；化燥而无余湿，须治燥不动湿，如熟地炭、苁蓉、枸杞、玉竹、
沙参、制首乌、胡麻之类。乃世俗治拘挛等证，惯用木瓜，且盛称其养筋、舒筋之功。抑知
木瓜味酸涩而质燥，断无养筋、舒筋之理。此说创自明人，《神农本草》原无是解，宜陈氏
修园非之。更有藤属，如络石藤、海风藤、薜荔藤等味，惯用以治痹，抑知此类藤属，辛燥
走窜，穿经破络，化热化燥，愈服愈痛。夫湿为寒搏，寒搏则燥生，初起即当辛润、湿润以
解外燥，参以淡渗治湿；湿热化燥，即当治以清润，重者清润不效，又当治以湿润。即以痹
论，痹为湿痹，治湿为本，风寒兼之，方合圣经治病求本之旨。若谓借以引经，彼桂枝、桑
枝、当归、牛膝诸品，不独引经，且能流利关节，不较胜于藤属多多乎？
再以内伤湿热言之。其病天气也，肺伤湿热，清肃不行，或多自汗，或成肤肿，或淋闭
，或火泻，或痢如西瓜水等证，如溽暑蒸腾，必得凉风至、白露降，溽暑乃收，且上窍一开
，下窍自注。治法不外辛淡、清淡，如白虎汤、甘露饮加杏仁、芥子、苡仁、通草之类。其
病地气也，湿热伤脾胃之阴，上而熏蒸肺肝，下而壅塞二肠、膀胱，或生痰、生饮，或吞酸
、吐酸，或呕逆、吐泻，或土壅木遏，山有风而成蛊，或下塞上闭，天地隔而成否，或湿热
滞于中，而为噤口痢疾，或水湿溢于外，而为皮肤水肿。土属杂气，为病最多。治法总不外
辛通苦降，如五泻心汤、二妙散、清热渗湿汤、资生丸、六君加黄连、鳖甲、泽泻、姜汁、
竹沥之类。其有痞满呕逆，上下不通者，乘其初起，元气未衰，投控涎丹十余粒通之，或用
小温中丸数服化之，及早图治，切勿养痈，致贻后患。其由中土而病及下焦也，或湿热伤肾
，水不济火而为梦遗、为黄浊；传入大肠，而为痢；或湿热伤肝，流入筋脉而为疝；或湿热
伤脾，而为泄泻。治法亦不外苦辛淡渗，如猪肚丸、知柏生地黄汤、宣清导浊汤、黄芩芍药
汤、渗湿断下汤、桂苓甘露饮、五苓散、牡蛎泽泻散之类。其有化燥者，始为湿热，继又阴
虚，上实下虚，火升痰涌，或胸痞、胁满，或喘嗽、眩晕，或四肢乏力，或周身疼痛，或血
溢、便闭，或面赤、足冷，或痿痹、瘫废。治法又与寻常湿热不同，若淡渗燥湿，必致真阴
下竭，若柔腻滋阴，又助痰湿上壅，务使燥润得宜，刚柔并济，如知柏地黄丸、虎潜丸之类
。复有阴阳两虚，真元下衰，湿热上乘，乘于内则痰热喘满、眩晕，溢于外则肢体疼重、麻
木，如此则将有类中之虞，如痰厥昏仆、舌强语涩、口角流涎、口眼 斜、半身不遂等证。
宜用刘守真地黄饮子，多加姜汁、竹沥送下，或服黑锡丹一分，服后半日许，乘其气息稍平
，急进大剂参汤，和竹沥、姜汁、童便分服之。若过此时，则痰火复升，补气之药难于突入
重围矣。其喘满多热汗者，急进生脉散以摄阴气；喘满多冷汗者，急进参附汤以回阳气，或
用理阴煎以收摄阴阳二气。治湿热化燥，有如此者。
再以内伤寒湿言之。或因于天，或因于人，或外无所因，而湿从内起。因于天者，久雨
湿胜，外湿引动内湿；因于人者，夏月纳凉饮冷，或嗜食茶酒瓜果，急者当时为患，缓者秋
后乃发；外无所因者，乃水谷之湿，停蓄于中。三者之原，总由阳虚不能输水所致。其病天
气也，肺阳伤则水冷，金寒气不化水，有霾雾蔽空之象；肺阳遏，心阳亦为其所掩，有阴云
蔽日之象。或水泛高原，为喘满，为痰嗽；或饮邪凌心，为心悸；或上干于头，为眩晕、呕
吐。治法以辛淡为主，表轻者六安煎，表重者小青龙汤，有汗小青龙去麻黄，或如苓桂术甘
、苓桂术姜、《外台》茯苓饮之类。其阳虚湿重，及喘满多冷汗者，又非参附汤、真武汤回
阳胜
见脘痞、腹胀、腹痛、肿胀、便溏、洞泄、三阴 疟等证，法宜温中燥湿，如附子理中、真
武等汤之类；胃阳伤则见脘胀、呕逆、不饥、不食、不便等证，法宜辛温淡渗，如平胃散、
胃苓汤、除湿汤之类。亦有湿郁化热，舌苔先白滑灰滑，而后转黄燥，口渴不饥，小便涩痛
，大便坚实，即古称湿火是也。治法又宜苦辛凉淡，如半夏泻心等汤。要之，湿为阴邪，伤
人之阳也，得理之常；伤人之阴也，乃势之变。其病地气，而及地中之水、火、木也。肾阳
虚，则三焦不能化水渗入膀胱，而见湿痢、滑泄、五更泄泻、腰腿酸痛等证。邪水旺一分，
则真水亏一分。治法以温肾阳、泄膀胱为主。温肾阳，即所以生脾土；泄膀胱，即所以安肾
阳。温肾阳，如真武汤、《金匮》肾气汤、参茸汤之类。泄膀胱，如五苓散之类。其病肝木
者何
》所谓风湿交争，风不胜湿之意。治法宜逍遥散、小柴胡汤、补中益气、调中益气等汤，以
复其风木之性，则水随气转，由决渎入州都，而汜滥者治矣。此治内伤寒湿之大较也。学人
博览群书，自知所论不诬矣。
小便排出不畅，大便稀溏，多因湿邪在体内，因此应当从里证论治，通过利小便来祛湿。又说：患有湿病的人，仅头部出汗，背部僵硬，想要盖被子靠近火源取暖；如果过早使用泻下法，会导致呃逆；或者出现胸中满闷、小便不利、舌苔白滑等症状，这是因为丹田（下焦）有热，胸中有寒，热邪被寒邪搏结，所以口渴想喝水却无法喝下，口燥且烦躁。按语：湿病患者本应多汗，若仅头部出汗，是因为寒气凝敛于上部；背部僵硬和大便不利，是误用泻下法导致津液内竭所致。泻下后里气虚弱，上焦阳气陷入下焦，形成丹田有热；舌苔白滑，是表寒误下后陷入胸中，形成胸中有寒；正因为丹田有热，所以口渴想喝水；正因为胸中有寒湿，虽然得到水却无法饮用，只是感到口燥和烦躁。又说：湿病患者误用泻下法，若额头出汗，微喘，小便通利的，预后不良属死证；如果腹泻不止的，也属死证。因为湿邪在表，误用泻下则使里气虚损，额头是诸阳经汇聚之处，额头出汗意味着孤阳无根而上脱；微喘，是里热不守而上逆；小便失禁或腹泻，是阴气不藏而下泄；阴阳离决，所以死亡。由此可知，在里的寒湿，适宜利小便而不适宜用泻下法，这是很明显的。其湿邪结合风寒伤人，导致表虚里虚的，表虚则固护表气，里虚则温补阳气。因为固护表气则阳气在外卫护，阴气自然消散；温补阳气则如烈日当空，阴霾自然退散。君子之道增长，小人之道消减，道理本来就是这样确定的。所以张仲景治疗风湿，脉象浮、身体沉重，见到汗出、恶风，知道是表虚，主方用防己黄芪汤，疏风并固表；治疗风湿相搏，身体烦痛，不能翻身转动，不呕吐，不渴（说明里没有邪气），见到脉象浮虚而涩，知道是阳虚，主方用桂枝附子汤，调和并温阳；如果大便干硬，小便自利的，知道是体内津液不足，主方用桂枝去桂加白术汤，温阳并润燥（白术生用，气味虽燥但质地滋润，既能胜湿，又不伤津液）；治疗风湿相搏，骨节疼痛剧烈牵掣，不能屈伸，触碰时疼痛加剧，小便不利，或者身体轻微浮肿，见到汗出、气短、恶风不想脱衣，知道是表里两虚，主方用甘草附子汤，温阳以化湿。这是汉代儒者的医学。继承此道并有所发挥的，只有喻嘉言。他说：人身阳气盛则轻健矫捷，湿气盛则沉重着滞，如果有身体重如大山，百脉疼痛，不能翻身转动，这还不使用附子回阳胜湿，还要等待什么？在表的湿邪，有可以发汗的，用附子合桂枝汤，将湿邪驱除外出；在里的湿邪，有可以泻下的，用附子合细辛、大黄，将湿邪驱除向下排出；在中的湿邪，用附子合白术温中燥脾。那么喻氏的学问，岂不是直接登堂入室进入张仲景的殿堂了吗！更有湿邪转化为热邪的，如经典所说风、寒、湿三气杂至，混合而成痹证。本篇又结合风、寒、湿、热四气称为湿痹，这是起初湿与风、寒结合，后来湿与热结合。湿与热结合，又应当用辛凉淡渗的方法，如苍术白虎汤、治痹防己汤，或者细辛、石膏并用，使天气清肃下降，则经络中的湿热自然随之而降，痹证也就通了。又有湿热化为燥邪的，如经典所说各种痉病项强，都归属于湿。又说：湿热不去除，大筋软缩变短，小筋弛缓变长；软缩为拘挛，弛长为痿废。又说：经热则成痹，络热则成痿。又说：肺叶焦枯萎弱，则发生痿证之类。湿化为燥，燥中仍有余湿，必须治湿而不碍燥，如在防己汤中加入龟板、决明子、牡蛎、金钗石斛之类；化燥而无余湿，必须治燥而不扰动湿，如熟地黄炭、肉苁蓉、枸杞、玉竹、沙参、制何首乌、胡麻之类。然而世俗治疗拘挛等证，习惯用木瓜，并且极力称赞它养筋、舒筋的功效。岂不知木瓜味酸涩而质地燥，绝无养筋、舒筋的道理。这种说法创自明代人，《神农本草经》原本没有这种解释，陈修园对此表示反对。更有藤类药材，如络石藤、海风藤、薜荔藤等味道，习惯用来治疗痹证，岂不知这类藤属药材，辛燥走窜，穿透经络，化热化燥，越服用越痛。湿被寒邪搏结，寒搏则燥生，初起就应当用辛润、湿润的方法来解外燥，参以淡渗法治湿；湿热化燥，就应当用清润法治之，重症清润无效，又当用湿润法治之。就以痹证而论，痹为湿痹，治湿为本，兼治风寒，才符合经典治病求本的宗旨。如果说借藤类药引经，那些桂枝、桑枝、当归、牛膝等药物，不仅引经，而且能流利关节，不是比藤类药好得多吗？
再从内伤湿热来说。这是病在天之气，肺受湿热所伤，清肃功能不行，或者多自汗，或者形成肤肿，或者淋证闭阻，或者火性腹泻，或者痢疾如西瓜水样等证候，如同闷热潮湿蒸腾，必须等到凉风吹来、白露降下，闷热潮湿才能收敛，且上窍一开，下窍自然通畅。治法不外乎辛淡、清淡，如白虎汤、甘露饮加杏仁、芥子、薏苡仁、通草之类。这是病在地之气，湿热损伤脾胃之阴，向上熏蒸肺肝，向下壅塞大肠、膀胱，或者生痰、生饮，或者吞酸、吐酸，或者呕逆、吐泻，或者土壅木郁，如山有风而成蛊毒，或者下塞上闭，天地隔绝而成否塞之证，或者湿热滞于中焦，而为噤口痢疾，或者水湿溢于体表，而为皮肤水肿。土属杂气，致病最多。治法总不外乎辛通苦降，如五泻心汤、二妙散、清热渗湿汤、资生丸、六君子汤加黄连、鳖甲、泽泻、姜汁、竹沥之类。其中有痞满呕逆，上下不通的，趁着初起元气未衰，投予控涎丹十余粒以通之，或者用小温中丸数服以化之，及早图治，切勿养痈遗患。由中土波及下焦的，或者湿热伤肾，水不济火而为梦遗、黄浊；传入大肠，而为痢疾；或者湿热伤肝，流入筋脉而为疝气；或者湿热伤脾，而为泄泻。治法也不外乎苦辛淡渗，如猪肚丸、知柏生地黄汤、宣清导浊汤、黄芩芍药汤、渗湿断下汤、桂苓甘露饮、五苓散、牡蛎泽泻散之类。其中有化燥的，起初为湿热，继而又阴虚，上实下虚，火升痰涌，或者胸痞、胁满，或者喘嗽、眩晕，或者四肢乏力，或者周身疼痛，或者血溢、便秘，或者面赤、足冷，或者痿痹、瘫废。治法又与寻常湿热不同，若用淡渗燥湿，必致真阴下竭；若用柔腻滋阴，又助痰湿上壅，务必使燥润得宜，刚柔并济，如知柏地黄丸、虎潜丸之类。又有阴阳两虚，真元下衰，湿热上乘，乘于内则痰热喘满、眩晕，溢于外则肢体疼重、麻木，如此则有类似中风的忧虑，如痰厥昏仆、舌强语涩、口角流涎、口眼歪斜、半身不遂等证候。宜用刘完素的地黄饮子，多加姜汁、竹沥送服，或者服用黑锡丹一分，服药后半日左右，趁着气息稍平，急进大剂人参汤，配合竹沥、姜汁、童便分次服用。如果过了这个时机，则痰火复升，补气之药难于突入重围了。其喘满多热汗的，急进生脉散以摄纳阴气；喘满多冷汗的，急进参附汤以回阳救逆，或者用理阴煎以收摄阴阳二气。治疗湿热化燥，有如此方法。
再从内伤寒湿来说。或者由于天时，或者由于人事，或者外无所因，而湿从内起。由于天时的，久雨湿胜，外湿引动内湿；由于人事的，夏季纳凉饮冷，或者嗜好饮茶酒瓜果，急者当时为患，缓者秋季后才发作；外无所因的，乃水谷之湿，停蓄于中。这三者的根源，总由阳虚不能输布水液所致。这是病在天之气，肺阳受伤则水冷，金寒气不化水，有雾霾蔽空之象；肺阳被遏，心阳也被其掩盖，有阴云蔽日之象。或者水泛高原，为喘满，为痰嗽；或者饮邪凌心，为心悸；或者上干于头，为眩晕、呕吐。治法以辛淡为主，表轻者用六安煎，表重者用小青龙汤，有汗者小青龙汤去麻黄，或者用苓桂术甘汤、苓桂术姜汤、《外台秘要》茯苓饮之类。其阳虚湿重，及喘满多冷汗的，又非参附汤、真武汤回阳胜湿不能治愈。若见脘痞、腹胀、腹痛、肿胀、便溏、洞泄、三阴疟等证候，法宜温中燥湿，如附子理中汤、真武汤之类；胃阳受伤则见脘胀、呕逆、不饥、不食、不便等证候，法宜辛温淡渗，如平胃散、胃苓汤、除湿汤之类。也有湿郁化热的，舌苔先白滑灰滑，而后转黄燥，口渴不饥，小便涩痛，大便坚实，即古称湿火是也。治法又宜苦辛凉淡，如半夏泻心汤等。总之，湿为阴邪，损伤人之阳气，是常理；损伤人之阴气，是变局。这是病在地之气，而波及地中之水、火、木。肾阳虚，则三焦不能化水渗入膀胱，而见湿痢、滑泄、五更泄泻、腰腿酸痛等证候。邪水旺一分，则真水亏一分。治法以温肾阳、泄膀胱为主。温肾阳，就是生脾土；泄膀胱，就是安肾阳。温肾阳，如真武汤、《金匮要略》肾气汤、参茸汤之类。泄膀胱，如五苓散之类。这是病在肝木的情况，正如《内经》所谓风湿交争，风不胜湿之意。治法宜逍遥散、小柴胡汤、补中益气汤、调中益气汤等，以恢复其风木之性，则水随气转，由决渎入州都，而泛滥者得以治理。这是治疗内伤寒湿的大概原则。学者博览群书，自然知道我的论述没有虚假了。
Urination is difficult, and stools are loose; this is mostly due to dampness in the interior. Therefore, treatment should focus on the interior, promoting urination to drain dampness. It is also said: Patients with dampness may only sweat from the head, have a stiff back, and desire to cover themselves with blankets and sit near fire. If purgatives are used too early, hiccups may occur; or there may be chest fullness, difficulty urinating, and a white coating on the tongue. This is because there is heat in the Dantian (lower jiao) and cold in the chest. The heat is constrained by the cold, causing thirst and a desire to drink water but an inability to do so, resulting in dry mouth and irritability. Commentary: Patients with dampness usually sweat profusely. Head sweating indicates that cold qi has condensed in the upper part. Back stiffness and bowel dysfunction result from the depletion of body fluids due to erroneous purgation. After purgation, the interior becomes deficient, and the yang qi of the upper jiao sinks into the lower jiao, creating heat in the Dantian. A white and slippery tongue coating indicates that exterior cold has sunk into the chest after erroneous purgation, creating cold in the chest. Because of the heat in the Dantian, there is thirst and a desire to drink; because of the cold-dampness in the chest, although water is obtained, it cannot be drunk, leading only to dry mouth and irritability. It is also said: If a patient with dampness is treated with purgatives and develops sweating on the forehead, slight asthma, and free urination, the prognosis is fatal. Similarly, if diarrhea persists uncontrollably, it is also fatal. When dampness is in the exterior, purgation causes interior deficiency. The forehead is the meeting point of all yang meridians; sweating on the forehead indicates isolated yang floating upwards without root. Slight asthma indicates interior heat rising rebelliously due to lack of containment. Incontinence or diarrhea indicates yin qi leaking downwards due to failure to store. The separation of yin and yang leads to death. From this, it is clear that for cold-dampness in the interior, promoting urination is appropriate, while purgation is not. When dampness combines with wind-cold to injure the body, causing both exterior and interior deficiency, exterior deficiency requires securing the exterior, and interior deficiency requires warming yang. Securing the exterior allows yang qi to guard the outside, causing yin qi to dissipate naturally; warming yang is like the sun shining brightly, causing yin pathogens to retreat naturally. Just as the way of the gentleman grows and the way of the petty man declines, this principle is fixed. Thus, Zhang Zhongjing treated wind-dampness with floating pulse and heavy body, noting sweating and aversion to wind as signs of exterior deficiency, prescribing Fangji Huangqi Tang (Astragalus and Stephania Decoction) to disperse wind and secure the exterior. For wind-dampness binding together, causing severe body pain and inability to turn over, without vomiting or thirst (indicating no pathogen in the interior), and with a floating, deficient, and choppy pulse indicating yang deficiency, he prescribed Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) to harmonize and warm. If stools were hard and urination normal, indicating insufficient internal fluids, he prescribed Guizhi Qu Gui Jia Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Atractylodes Macrocephala Decoction) to warm and moisten (Raw Atractylodes Macrocephala Rhizome is drying in aroma but moist in substance; it overcomes dampness without damaging fluids). For wind-dampness binding together, causing painful joints that cannot flex or extend, worsened by touch, with difficulty urinating or slight swelling, noting sweating, shortness of breath, and aversion to wind with a desire to keep clothes on, indicating both exterior and interior deficiency, he prescribed Gancao Fuzi Tang (Licorice and Aconite Decoction) to warm and transform dampness. This represents Han dynasty Confucian medicine. Later scholars who understood this include Yu Jia Yan. He stated: When yang qi is abundant in the body, one is light and agile; when dampness is abundant, one feels heavy and sluggish. If the body feels as heavy as a mountain, with pain in all meridians and inability to turn over, one must use Fuzi (Aconiti Lateralis Radix Praeparata) to restore yang and overcome dampness; what else can one wait for? For dampness in the exterior that can be released via sweating, combine Fuzi with Guizhi Tang (Cinnamon Twig Decoction) to drive it out; for dampness in the interior that can be purged, combine Fuzi with Xixin (Asari Radix et Rhizoma) and Dahuang (Rhei Radix et Rhizoma) to drive it downward; for dampness in the middle, combine Fuzi with Baizhu (Atractylodis Macrocephalae Rhizoma) to warm the middle and dry spleen dampness. Thus, Yu’s learning directly ascends to the hall of Zhang’s teachings! Furthermore, when dampness transforms into heat, as the classics state, wind, cold, and dampness mix to form Bi syndrome (obstruction syndrome). This treatise combines wind, cold, dampness, and heat to name "Damp-Bi". Initially, damp combines with wind and cold; subsequently, damp combines with heat. When damp combines with heat, one should use acrid-cool and bland methods, such as Cangzhu Baihu Tang (Atractylodes and White Tiger Decoction) or Zhibi Fangji Tang (Stephania for Bi Decoction), or combine Xixin with Shigao (Gypsum Fibrosum), allowing heavenly qi to descend clearly, so that heat-dampness in the meridians descends with it, and Bi is unblocked. There is also heat-dampness transforming into dryness, as the classics state: various spasms and neck stiffness belong to damp. Also: If heat-dampness is not removed, large tendons become soft and short, small tendons become flaccid and long; shortness causes contracture, flaccidity causes atrophy. Also: Heat in the channels causes Bi, heat in the collaterals causes Wei syndrome (atrophy). Also: Withered and shriveled lung lobes lead to Wei syndrome. When damp transforms into dryness, but residual dampness remains, treat dampness without hindering dryness, such as adding Guiban (Testudinis Carapax et Plastrum), Juemingzi (Cassiae Semen), Muli (Ostreae Concha), and Shihu (Dendrobii Caulis) to Fangji Tang. If dryness exists without residual dampness, treat dryness without disturbing dampness, such as using Shudihuang Tan (Charred Rehmanniae Radix), Rongrong (Cynomorii Herba), Gouqi (Lycii Fructus), Yuzhu (Polygonati Odorati Rhizoma), Shashen (Glehniae Radix), and Zhi Heshouwu (Prepared Polygoni Multiflori Radix), and Huma (Sesami Fructus). However, laypeople often use Mugua (Chaenomelis Fructus) for contractures, praising its tendon-nourishing and relaxing properties. Yet, Mugua is sour, astringent, and drying; it cannot nourish or relax tendons. This view originated in the Ming Dynasty and is absent from the *Shennong Bencao Jing*; Chen Xiuyuan rightly refuted it. Vine herbs like Luoshiteng (Trachelospermi Caulis), Haifengteng (Sargentodoxae Caulis), and Biliteng (Fici Trichocaulis) are commonly used for Bi. These vines are acrid, drying, and penetrating, breaking through meridians and collaterals, generating heat and dryness, worsening pain with continued use. When damp is bound by cold, cold binding generates dryness. At onset, use acrid-moist and moist methods to resolve exterior dryness, combined with bland-draining methods for damp. When heat-damp transforms into dryness, use clearing-moistening methods; if severe and ineffective, use moistening methods. Regarding Bi syndrome, since it is Damp-Bi, treating damp is fundamental, addressing wind and cold concurrently, aligning with the classic principle of seeking the root. If vine herbs are used merely as guiding drugs, consider that Guizhi (Cinnamomi Ramulus), Sangzhi (Mori Ramulus), Danggui (Angelicae Sinensis Radix), and Niuxi (Achyranthis Bidentatae Radix) not only guide but also lubricate joints, far superior to vines.
Regarding internal injury from heat-dampness: This relates to pathological changes in heavenly qi. Lung injury from heat-damp impairs descending and clearing functions, causing spontaneous sweating, skin edema, stranguria, fire-type diarrhea, or dysentery resembling watermelon juice. Like muggy heat steaming, relief comes only with cool winds and white dew, opening upper orifices to allow lower orifices to flow freely. Treatment involves acrid-bland and clear-bland methods, such as Baihu Tang (White Tiger Decoction) or Ganlu Yin (Sweet Dew Drink) added with Xingren (Armeniacae Semen Amarum), Jiezi (Brassicae Semiparvum), Yiyiren (Coicis Semen), and Tongcao (Tetrapanacis Medulla). This relates to earthly qi, where heat-damp damages spleen-stomach yin, steaming upward to lungs and liver, and obstructing downward intestines and bladder. Symptoms include phlegm, fluid retention, acid regurgitation, vomiting, belching, earth stagnation blocking wood (leading to蛊 disease), lower obstruction and upper closure (Pi syndrome), mid-jiao stagnation causing anorexic dysentery, or external water-damp causing skin edema. Earth-related mixed pathogens cause many diseases. Treatment generally uses acrid-unblocking and bitter-descending methods, such as Wuxiexin Tangs (Five Heart-Purging Decoctions), Ermiao San (Two Marvels Powder), Qingre Shen Shi Tang (Clear Heat and Drain Dampness Decoction), Zisheng Wan (Nourishing Life Pill), or Liujun Zi Tang (Six Gentlemen Decoction) added with Huanglian (Coptidis Rhizoma), Biejia (Trionychis Carapax), Zexie (Alismatis Rhizoma), Jiangzhi (Zingiberis Recens Juice), and Zhuli (Bambusae Caulis in Taenia). For epigastric fullness, vomiting, and blockage of upper and lower orifices, if caught early while yuan qi is intact, administer Kongxian Dan (Control Phlegm Pill) ten grains to unblock, or Xiaowenzhong Wan (Minor Warm Middle Pill) several doses to resolve. Treat early to avoid nurturing the tumor and causing future trouble. When pathology spreads from central earth to lower jiao: heat-damp injuring kidney leads to dream emission and turbid urine due to water failing to control fire; entering large intestine causes dysentery; injuring liver and flowing into sinews causes hernia; injuring spleen causes diarrhea. Treatment uses bitter-acrid bland-draining methods, such as Zhudu Wan (Pork Stomach Pill), Zhibai Shengdi Huang Tang (Anemarrhenae, Phellodendri, and Rehmanniae Decoction), Xuanqing Dao Zhuo Tang (Dispel Clear and Guide Turbid Decoction), Huangqin Shaoyao Tang (Scutellaria and Paeonia Decoction), Shen Shi Duan Xia Tang (Drain Dampness and Stop Diarrhea Decoction), Guiling Ganlu Yin (Guiling Sweet Dew Drink), Wuling San (Five Ling Powder), or Muli Zexie San (Oyster Shell and Alisma Powder). If transforming into dryness, initially heat-damp, later yin deficiency, with upper excess and lower deficiency, rising fire and surging phlegm, causing chest oppression, hypochondriac fullness, asthma/cough, dizziness, limb weakness, body pain, bleeding, constipation, red face, cold feet, or Wei-Bi paralysis. Treatment differs from ordinary heat-damp. Bland-draining drying agents deplete true yin; greasy tonics aggravate phlegm-damp. Balance dryness and moisture, hardness and softness, using Zhibai Dihuang Wan (Anemarrhenae, Phellodendri, and Rehmannia Pill) or Huqian Wan (Tiger Knee Pill). If yin-yang dual deficiency with declining true yuan, heat-damp rises internally causing phlegm-heat asthma/fullness/dizziness, or externally causing limb heaviness/pain/numbness, risking stroke-like symptoms: phlegm-jue fainting, stiff tongue/slurred speech, drooling, facial deviation, hemiplegia. Use Liu Shouzhen’s Dihuang Yinzi (Rehmannia Drink) with extra Jiangzhi and Zhuli, or Heixi Dan (Black Tin Pill) one fen. Half a day later, when breathing stabilizes, urgently administer large dose Renshen Tang (Ginseng Decoction) mixed with Zhuli, Jiangzhi, and Tongbian (Infans Urine). If missed, phlegm-fire rises again, making tonifying qi drugs unable to penetrate. For asthma/fullness with hot sweat, urgently use Shengmai San (Generate Pulse Powder) to grasp yin qi; for cold sweat, use Shenfu Tang (Ginseng and Aconite Decoction) to restore yang, or Liyin Jian (Yin-Gathering Decoction) to gather yin-yang qi. This treats heat-damp transforming into dryness.
Regarding internal injury from cold-damp: Due to heaven, human factors, or internal generation. Heavenly cause: prolonged rain increases dampness, exterior damp moves interior damp. Human cause: summer cooling/cold drinks, tea/alcohol/fruits; acute cases manifest immediately, chronic cases appear in autumn. No external cause: food-water dampness stagnates in the middle. All stem from yang deficiency failing to transport water. Pathology in heavenly qi: Lung yang injury causes cold water; metal-cold fails to transform water, resembling foggy skies. Lung yang suppression suppresses heart yang, resembling cloudy skies. Water flooding highlands causes asthma/fullness/phlegm cough; fluid pathogen harassing heart causes palpitations; ascending to head causes dizziness/vomiting. Treatment focuses on acrid-bland. Mild exterior: Liu’an Jian (Six An Decoction); severe exterior: Xiao Qinglong Tang (Minor Blue Dragon Decoction). With sweating, remove Mahuang (Ephedrae Herba) from Xiao Qinglong Tang, or use Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction), Linggui Zhujing Tang, or Waitai Fuling Yin (External Standard Poria Drink). For severe yang deficiency with damp, or asthma/fullness with cold sweat, use Shenfu Tang or Zhenwu Tang (True Warrior Decoction) to restore yang and overcome damp. Symptoms include epigastric stuffiness, abdominal distension/pain/swelling, loose stools, watery diarrhea, or three-yin malaria. Method: warm middle and dry damp, using Fuzi Lizhong Tang (Aconite and Center-Supplementing Decoction) or Zhenwu Tang. Stomach yang injury causes epigastric distension, vomiting, lack of appetite/anorexia, constipation. Method: acrid-warm bland-draining, using Pingwei San (Calm Stomach Powder), Weiling Tang (Stomach and Five Ling Decoction), or Chushi Tang (Remove Dampness Decoction). If damp stagnates and transforms into heat, tongue coating turns from white-slippery-gray-slippery to yellow-dry, with thirst, lack of appetite, painful scanty urination, and hard stools, known as "Damp-Fire". Treatment: bitter-acrid cool-bland, such as Banxia Xiexin Tang (Pinellia and Heart-Purging Decoction). Generally, damp is yin pathogen injuring yang (normal); injuring yin is variation. Pathology in earthly qi affecting water/fire/wood: Kidney yang deficiency prevents sanjiao transforming water into bladder, causing damp dysentery, sliding diarrhea, dawn diarrhea, sore waist/legs. Excess evil water decreases true water. Treatment: warm kidney yang, drain bladder. Warming kidney yang generates spleen earth; draining bladder calms kidney yang. Warm kidney yang: Zhenwu Tang, Jin Gui Shenqi Tang (Golden Cabinet Kidney Qi Pill), Shenrong Tang (Ginseng and Deer Antler Decoction). Drain bladder: Wuling San. Pathology in liver wood: As classics say, wind-damp contend, wind fails to overcome damp. Treatment: Xiaoyao San (Free and Easy Wanderer Powder), Xiao Chaihu Tang (Minor Bupleurum Decoction), Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction), Tiaozhong Yiqi Tang, to restore wood nature, allowing water to follow qi transformation, entering Duodu and Zhou Du, resolving flooding. This summarizes internal cold-damp treatment. Scholars reading widely will know my arguments are sound.