有在天之湿。雨露雾是也。在天者本乎气。故先中表之荣卫。有在地之湿。泥水是也。在地者本乎形。
故先伤肌肉筋骨血脉。有饮食之湿。酒水乳酪是也。胃为水谷之海。故伤于脾胃。有汗液之湿。谓汗出沾衣。
未经解换者是也。有太阴脾土所化之湿。不从外入者也。阳盛则火胜。化为湿热。阴盛则水胜。化为寒湿。其
证发热恶寒。身重自汗。筋骨疼痛。小便秘涩。大便溏泄。腰痛不能转侧。跗肿肉如泥。按之不起。
经曰。因于湿首如裹。湿气蒸于上。故头重。又曰。湿伤筋。故大筋 短。小筋弛长。 短为拘。弛长
为痿。又曰。湿胜则濡泄。故大便溏泄。大便泄故小便涩。又曰。湿从下受之。故跗肿。
又曰。诸湿肿满。皆属脾土。故腹胀肉如泥。湿气入肾。肾主水。水流湿。各从其类。故腰肾痛。
治法在上者当微汗。羌活胜湿汤。在下者当利小便。五苓
散。夫脾者。五脏之至阴。其性恶湿。今湿气内客于脾。故不能腐熟水谷。致清浊不分。水入肠间。虚莫能
制。故濡泄。法当除湿利小便也。
东垣曰。治湿不利小便。非其治也。又曰。在下者引而竭之。圣人之言。虽布在方策。其不尽者。可以
意求耳。夫湿淫从外而入里。若用淡渗之剂以除之。是降之又降。是复益其阴。而重竭其阳。则阳气愈削。
而精神愈短矣。是阴重强阳重衰。反助其邪之谓也。故用升阳风药即瘥。以羌活独活柴胡升麻各一钱。防风根
半钱。炙甘草半钱。水煎热服。大法云。湿淫所胜。助风以平之。又曰。下者举之。得阳气升腾而愈矣。又
曰。客者除之。是因曲而为之直也。夫圣人之法。可以类推。举一而知百也。
有香港脚。类伤寒。发热恶寒。必脚胫间肿痛。俱从湿治。千金方有阴阳之分。阴香港脚。胫处肿而不红。
阳香港脚。肿而红者是也。
有湿热发黄者。当从郁治。凡湿热之物。不郁则不黄。禁用茵陈五苓散。凡见用五苓茵陈者。十不一生。
当用逍遥散。方见郁论。
凡伤寒必恶寒。伤风必恶风。伤湿必恶雨。如伤湿而兼恶寒无汗。骨节疼痛者。仲景有甘草附子汤。
甘草附子汤
甘草（炙一钱） 附子（钱半） 白术（二钱） 桂枝（四钱） 水煎。作一服。
金匮防己汤 治湿胜身重阳微。中风则汗出恶风。故用黄 炙。甘草以实表。防己白术以胜湿。
防己（三钱） 甘草（钱半炙） 白术（二钱） 黄 （三钱半） 加生姜大枣。水煎作一服。
羌活胜湿汤 通治湿证。
羌活 独活 本 防风 甘草 川芎（各一钱） 蔓荆子（三分）
如身重腰痛沉沉然。经中有寒也。加酒防己五分。附子五分。
有一友宦游京师。病腿痛发热。不能履地。众以为腿痈。延予视之。扶掖而出见。予曰。非痈也。以补
中益气汤。加羌活防风各一钱。一服如失。次日乘马来谢。
余一日患阴丸一个肿如鸭卵。发热。以湿热证治之。不效。细思之。数日前从定海小船回。有湿布风帆
在坐下。比上岸始觉。以意逆之。此感寒湿在肾丸也。乃用六味地黄。加柴胡吴茱萸肉桂各一钱。独活五分。
一服而热退。再服而肿消。后有患偏坠者。此方多妙。
有来自天部的湿邪，如雨露雾气。在天部的湿邪源于气，所以首先侵犯体表的营卫。有来自地部的湿邪，如泥水。在地部的湿邪源于形体，所以首先损伤肌肉、筋骨和血脉。有因饮食产生的湿邪，如酒水、乳酪。胃是水谷之海，所以伤及脾胃。有因汗液产生的湿邪，指出汗后衣服沾湿，未及时更换的情况。有由太阴脾土运化功能失调而产生的内湿，并非从外侵入。阳气盛则火胜，化为湿热；阴气盛则水胜，化为寒湿。其症状表现为发热恶寒、身体沉重、自汗、筋骨疼痛、小便短涩不利、大便溏泄、腰痛不能转身侧卧、足背浮肿且按之凹陷不起。
《内经》说：“因于湿，首如裹。”湿气蒸腾于上，所以头部沉重。又说：“湿伤筋”，所以大筋收缩变短，小筋松弛变长。筋短导致拘挛，筋弛长导致痿软无力。又说：“湿胜则濡泄”，所以大便溏泄。大便泄泻导致小便涩滞。又说：“湿从下受之”，所以出现足背浮肿。又说：“诸湿肿满，皆属脾土”，所以腹部胀满，肌肉松软如泥。湿气侵入肾脏，肾主水，水流向湿处，各从其类，所以腰部和肾脏疼痛。
治疗原则：病位在上者应当用微发汗的方法，方用羌活胜湿汤；病位在下者应当利小便，方用五苓散。脾是五脏中至阴的脏器，其性质厌恶湿邪。现在湿气内客居于脾，所以脾不能腐熟水谷，导致清浊不分，水液进入肠间，正气虚弱无法制约，所以发生濡泄。治法应当除湿并利小便。
李东垣说：“治疗湿邪如果不通利小便，就不是正确的治疗方法。”又说：“病位在下者，应当引导而竭除它。”圣人的言论，虽然记载在医书中，但未尽之意，可以通过意会来推求。湿邪淫溢，从外侵入体内，如果使用淡渗利尿的药物来祛除它，这是降之又降，反而增益其阴，从而再次耗竭其阳，导致阳气更加削弱，精神更加短少。这是阴气过强而阳气过衰，反而助长了邪气。所以使用升阳的风药即可痊愈。处方：羌活、独活、柴胡、升麻各一钱，防风根半钱，炙甘草半钱，水煎热服。大法云：“湿淫所胜，助风以平之。”又说：“下者举之”，使阳气升腾而痊愈。又说：“客者除之”，这是通过弯曲（湿邪困阻）而使其正直（恢复气机升降）。圣人的法则，可以类推，举一反三。
有一种病叫香港脚（脚气），类似伤寒，发热恶寒，必定伴有小腿肿痛，都从湿邪治疗。《千金方》中有阴阳之分。阴证香港脚，小腿肿胀但不发红；阳证香港脚，肿胀且发红。
有湿热发黄者，应当从“郁”论治。凡是湿热的病邪，不郁结就不会发黄。禁用茵陈五苓散。凡是用茵陈五苓散的，十人之中难救活一人。应当用逍遥散，方剂见《郁论》章节。
凡是伤寒必定恶寒，伤风必定恶风，伤湿必定恶雨。如果伤湿兼有恶寒无汗、骨节疼痛的情况，张仲景有甘草附子汤。
甘草附子汤：
甘草（炙一钱）、附子（一钱半）、白术（二钱）、桂枝（四钱），水煎，一次服完。
金匮防己汤：治疗湿邪偏胜、身体沉重而阳气微弱。中风则汗出恶风，所以用黄芪、炙甘草来固表，防己、白术来胜湿。
防己（三钱）、甘草（一钱半，炙）、白术（二钱）、黄芪（三钱半），加生姜、大枣，水煎，一次服完。
羌活胜湿汤：通治各种湿证。
羌活、独活、藁本、防风、甘草、川芎（各一钱）、蔓荆子（三分）。
如果身体沉重、腰痛且感觉沉重，说明经中有寒，加酒制防己五分、附子五分。
有一位朋友在京师做官时患病，腿部疼痛发热，不能行走。众人认为是腿痈，请我诊治。他被人搀扶着出来见我。我说：“这不是痈。”用补中益气汤，加羌活、防风各一钱，服用一次后病愈。第二天他骑马前来致谢。
我有一天患左侧睾丸肿大如鸭卵，发热，按湿热证治疗无效。仔细思考，数日前我从定海乘船回来，坐下的地方有湿布和风帆受潮，直到上岸才察觉。推测此感寒湿于肾丸（睾丸）也。于是用六味地黄丸，加柴胡、吴茱萸、肉桂各一钱，独活五分，服用一次热退，再服用肿块消退。后来有患偏坠（疝气）的人，用此方多有效。
There is dampness from the Heaven (upper body/environment), such as rain, dew, fog, and mist. Dampness originating from Heaven is based on Qi; therefore, it first affects the Ying and Wei (Nutritive and Defensive Qi) at the exterior. There is dampness from the Earth (lower body/environment), such as mud and water. Dampness originating from Earth is based on Form; therefore, it first damages the muscles, sinews, bones, and blood vessels. There is dampness from diet, such as alcohol, milk, and cheese. The Stomach is the Sea of Water and Grain; thus, it injures the Spleen and Stomach. There is dampness from sweat, referring to sweat-soaked clothes that are not changed promptly. There is dampness transformed by the Taiyin Spleen Earth, which does not enter from the exterior. When Yang is excessive, Fire prevails, transforming into Damp-Heat; when Yin is excessive, Water prevails, transforming into Cold-Damp. The manifestations include fever with aversion to cold, heaviness of the body, spontaneous sweating, pain in the sinews and bones, scanty and difficult urination, loose stools, lower back pain preventing turning or side-bending, edema of the dorsum of the foot where depression remains after pressure.
The Classic states: "Due to dampness, the head feels wrapped." Dampness steams upward, causing heaviness of the head. It also states: "Dampness injures the sinews," causing the large sinews to shorten and the small sinews to relax and lengthen. Shortening leads to spasms/contracture; relaxation and lengthening lead to flaccidity. It also states: "Excess dampness causes loose diarrhea," hence loose stools. Loose stools cause urinary obstruction. It also states: "Dampness enters from below," hence edema of the feet. It also states: "All dampness-related swelling and fullness belong to Spleen Earth," hence abdominal distension and flesh soft like mud. When dampness enters the Kidney, and since the Kidney governs Water, water flows toward dampness, following its kind, hence pain in the lower back and Kidneys.
Treatment principles: For conditions located above, slight diaphoresis (sweating) should be induced using Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness). For conditions located below, promoting urination should be used using Wuling San (Five-Ingredient Poria Pill). The Spleen is the most Yin organ among the Five Zang organs; its nature dislikes dampness. Now, dampness resides internally within the Spleen, so it cannot rot and cook food and drink, leading to a failure to separate the clear from the turbid. Water enters the intestines, and deficiency fails to control it, resulting in loose diarrhea. The method should be to eliminate dampness and promote urination.
Li Dongyuan said: "In treating dampness, if one does not promote urination, it is not the correct treatment." He also said: "For those located below, guide and exhaust them." The words of the Sages, though recorded in texts, have未尽 meanings that can be sought through intuitive understanding. When dampness overflows and moves from the exterior to the interior, if one uses bland and leaching agents to remove it, this is lowering again and lowering, further benefiting Yin and doubly exhausting Yang, causing Yang to be further depleted and Spirit to become short. This means Yin is excessively strong while Yang is excessively weak, which inadvertently assists the pathogen. Therefore, using ascending wind herbs will cure the disease. Prescription: Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma) each 1 qian, Fangfeng Gen (Saposhnikoviae Radix) half qian, Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) half qian. Decoct in water and take hot. The general principle states: "When dampness overflows, assist with wind to calm it." It also says: "Lift those that sink," allowing Yang Qi to ascend and recover. It also says: "Remove the guest," which is straightening what is curved due to pathology. The methods of the Sages can be analogized; knowing one allows knowing hundreds.
There is a condition called Hong Kong Foot (Jiaoxi / Beriberi), resembling Shanghan (Cold Damage), with fever and aversion to cold, necessarily accompanied by swelling and pain in the calves. All are treated from the perspective of dampness. The *Qianjin Fang* distinguishes between Yin and Yang types. Yin-type Hong Kong Foot presents with swelling in the calves but no redness; Yang-type Hong Kong Foot presents with swelling and redness.
For yellowing caused by Damp-Heat, treatment should focus on "Stagnation" (Yu). Any Damp-Heat pathogen, if not stagnant, will not cause yellowing. Yinchen Wuling San (Artemisiae Scopariae and Five-Ingredient Poria Decoction) is strictly prohibited. Those who use Yinchen and Wuling San rarely survive (one in ten lives). Instead, Xiaoyao San (Free and Easy Wanderer Powder) should be used. See the chapter on "Yu" for the formula.
Generally, Shanghan involves aversion to cold; Shangfeng (Wind Injury) involves aversion to wind; Shangshi (Dampness Injury) involves aversion to rain. If dampness injury is combined with aversion to cold, absence of sweat, and joint pain, Zhang Zhongjing provides Gancao Fuzi Tang (Licorice and Aconite Decoction).
Gancao Fuzi Tang:
Zhi Gancao (Prepared Licorice Root) 1 qian, Fuzi (Processed Aconite Lateral Root) 1.5 qian, Baizhu (Atractylodis Macrocephalae Rhizoma) 2 qian, Guizhi (Cinnamon Twig) 4 qian. Decoct in water, take in one dose.
Jinkui Fangji Tang: Treats excess dampness with heavy body and mild Yang. Wind-stroke causes sweating and aversion to wind, so Huangqi (Astragali Radix) and Zhi Gancao are used to solidify the exterior, while Fangji (Stephaniae Tetrandrae Radix) and Baizhu overcome dampness.
Fangji 3 qian, Zhi Gancao (Prepared Licorice Root) 1.5 qian, Baizhu 2 qian, Huangqi 3.5 qian. Add Shengjiang (Fresh Ginger) and Dazao (Jujube). Decoct in water, take in one dose.
Qianghuo Shengshi Tang: Universally treats dampness conditions.
Qianghuo, Duhuo, Gaoben (Ligustici Rhizoma et Radix), Fangfeng, Gancao, Chuanxiong (each 1 qian), Manjingzi (Viticis Semen) 0.3 qian.
If there is body heaviness, lower back pain feeling heavy, indicating cold in the meridians, add Jiu Fangji (Wine-processed Stephaniae Tetrandrae Radix) 0.5 qian and Fuzi 0.5 qian.
A friend serving as an official in the capital fell ill with leg pain and fever, unable to walk. Others believed it was a leg abscess (Tong) and invited me to examine him. He was supported out to see me. I said, "It is not an abscess." I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Qianghuo and Fangfeng, 1 qian each. After one dose, the illness disappeared. The next day, he came to thank me riding a horse.
One day, I suffered from swelling of one testicle (Yinwan) the size of a duck egg, with fever. Treating it as a Damp-Heat pattern was ineffective. Upon careful reflection, a few days prior I returned from Dinghai by boat; there was a wet cloth and sail under my seat. I only realized this upon disembarking. Inferring from this, I concluded that Cold-Damp had invaded the Kidney Testicles. I then used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with added Chaihu, Wuzhuyu (Evodiae Fructus), Rougui (Cinnamon Bark) each 1 qian, and Duhuo 0.5 qian. After one dose, the fever subsided; after two doses, the swelling disappeared. Later, patients with unilateral hernia/scrotal swelling found this formula highly effective.