脉
经云∶脉浮而缓,湿在表也。脉沉而缓,湿在里也。或弦而
缓,或缓而浮,皆风湿相搏也。又曰∶或涩或细,或缓或濡,皆可得而断。
证
夫湿之为病,所感不同。有从外感而得之者,有从内伤而得之者。若居处卑湿之地,与夫道途冲斥风雨,
或动作辛苦之人,汗出沾衣,皆湿从外感者也。或恣饮酒浆醺酩,多食柑橘瓜果之类,皆
湿从内伤也。湿之中人,入皮肤为顽麻,入气血为倦怠,入肺为喘满,入脾为湿痰肿胀,入肝为胁满而肢
节不利,入肾则腰疼胯痛,身如板夹,脚如砂坠,入腑则麻木不仁,入脏则舒伸不得,而肢体强硬。又云∶湿
本土气,火热能生湿土,故夏月则万物湿润,秋凉则万物干燥。湿病本不自生,因热而怫郁,不
能宣行水道,故脾滞而生湿也。
治
因湿生痰,故用二陈汤加羌活、防风、酒炒黄芩,去风行湿,
盖风能胜湿故也。大抵宜发汗及利小便,使上下分消其湿,是其治也。
方
独活寄生汤〔批〕(按此方补虚除湿之剂)
治肾气虚弱,坐卧湿地,腰背拘急,筋挛骨痛。或当风取凉过
度,风邪流入脚膝,为偏枯冷痹,缓弱疼痛。或腰痛牵引,行步艰辛,及白虎历节风。
独活(一两五钱) 桑寄生(三两,如无,以续断代之) 当归(一两五钱) 川芎
(一两五钱) 白芍(一两五钱) 熟地黄(一两) 人参(一两,去芦) 茯苓(一两) 牛膝
(酒浸,一两) 杜仲(酒炒,一两) 秦艽(去芦,一两) 细辛(一两) 防风(去芦,一两)
桂心(一两) 甘草(炙,三钱)
上锉,每服一两五钱,加生姜三片,水煎服。妇人带下,作腰腿痛,合平胃散,加附子、小茴香。
羌活胜湿汤 治风湿相搏,一身尽痛。
羌活(七分) 独活(七分) 防风(五分) 升麻(五分) 柴胡(五分) 本(一钱)
苍术(一钱) 川芎(八分) 蔓荆子(八分) 甘草(五分)
上锉一剂,水煎温服。
升阳除湿汤 治湿郁在下,此汤升以散之。
升麻(一钱) 柴胡(一钱) 防风(一钱) 茯苓(八分) 猪苓(一钱) 泽泻(一钱)
苍术(一钱) 陈皮(八分)
上锉一剂,加生姜一大片,水煎服。
经验白术酒(秘方) 治中湿遍身疼痛,难以转侧。
白术(去芦,一两)
上锉一剂,无灰老酒一钟半,煎一钟,去渣温服。
《脉经》中说:脉象浮而缓,说明湿邪在体表;脉象沉而缓,说明湿邪在体内。或者脉象弦而缓,或者脉象缓而浮,都是风湿邪气相互搏结的表现。又说:脉象涩或细,或缓或濡,都可以据此进行判断。
关于证候
湿邪致病,感受的途径各不相同。有从外部感受而得的,有从内部损伤而得的。如果居住在低洼潮湿的地方,或者在道路上奔波遭受风雨侵袭,或者是从事体力劳动辛苦出汗、汗水浸湿衣服的人,这些都属于湿邪从外感受的情况。如果恣意饮酒,或者多吃柑橘、瓜果等生冷之物,这些都属于湿邪从内损伤所致。湿邪侵入人体,进入皮肤则表现为顽固性麻木,进入气血则导致倦怠乏力,进入肺脏则引起气喘胸闷,进入脾脏则形成湿痰和肿胀,进入肝脏则胁肋胀满且肢体关节活动不利,进入肾脏则腰痛胯痛,身体像被木板夹住一样僵硬,双脚像挂着沙袋一样沉重,进入六腑则出现麻木不仁,进入五脏则伸展受限,肢体强硬。又云:湿是土的本气,火热能生湿土,所以夏季万物湿润,秋季凉爽则万物干燥。湿病本身不会凭空产生,是因为热邪郁结,不能宣通水道,导致脾脏停滞而生湿。
关于治疗
因为湿邪生痰,所以使用二陈汤(燥湿化痰的基础方)加入羌活、防风、酒炒黄芩,以祛风除湿,因为风能胜湿的缘故。大抵适宜采用发汗及利小便的方法,使湿邪从上、下分消,这是治疗的原则。
关于方剂
独活寄生汤【批注】(按:此方为补虚除湿的药剂)
治疗肾气虚弱,坐卧湿地,腰背拘急,筋脉挛缩骨痛。或者当风取凉过度,风邪流入脚膝,导致偏枯冷痹,肢体缓弱疼痛。或者腰痛牵引,行走艰难,以及白虎历节风(一种关节剧烈疼痛的疾病)。
独活(一两五钱) 桑寄生(三两,如果没有,可以用续断代替) 当归(一两五钱) 川芎(一两五钱) 白芍(一两五钱) 熟地黄(一两) 人参(一两,去芦头) 茯苓(一两) 牛膝(酒浸泡,一两) 杜仲(酒炒,一两) 秦艽(去芦头,一两) 细辛(一两) 防风(去芦头,一两) 桂心(一两) 甘草(炙,三钱)
以上药材切碎,每次服用一两五钱,加生姜三片,水煎服。妇女带下病,伴有腰腿痛,配合平胃散(燥湿运脾的基础方),加入附子、小茴香。
羌活胜湿汤 治疗风湿相搏,全身疼痛。
羌活(七分) 独活(七分) 防风(五分) 升麻(五分) 柴胡(五分) 藁本(一钱) 苍术(一钱) 川芎(八分) 蔓荆子(八分) 甘草(五分)
以上药材切碎为一剂,水煎温服。
升阳除湿汤 治疗湿邪郁结在下焦,此汤通过升提发散来消除湿邪。
升麻(一钱) 柴胡(一钱) 防风(一钱) 茯苓(八分) 猪苓(一钱) 泽泻(一钱) 苍术(一钱) 陈皮(八分)
以上药材切碎为一剂,加生姜一大片,水煎服。
经验白术酒(秘方) 治疗中湿导致遍身疼痛,难以转动侧身。
白术(去芦头,一两)
以上药材切碎为一剂,用无灰老酒一钟半,煎至一钟,去渣滓温服。
The *Mai Jing* (Pulse Classic) states: A pulse that is floating and slow indicates dampness in the exterior. A pulse that is deep and slow indicates dampness in the interior. Whether it is wiry and slow, or slow and floating, these all indicate the interplay of wind-dampness. It further states: Whether the pulse is choppy or fine, slow or soggy, these can all be diagnosed accordingly.
Regarding Syndromes
The pathogenesis of dampness varies depending on the mode of contraction. Some are contracted externally, while others result from internal injury. Those who dwell in low-lying, damp places; those exposed to wind and rain during travel; or those engaged in strenuous labor whose sweat soaks their clothes—all these constitute external contraction of dampness. Conversely, excessive consumption of alcohol or eating too much citrus fruit and melons constitutes internal injury leading to dampness. When dampness invades the human body, entering the skin causes stubborn numbness; entering the qi and blood leads to fatigue and lassitude; entering the Lung causes wheezing and chest fullness; entering the Spleen generates damp-phlegm and swelling; entering the Liver results in hypochondriac fullness and stiffness of the limbs and joints; entering the Kidney causes lower back and hip pain, a sensation as if the body were clamped between boards, and legs feeling heavy as if weighed down with sand; entering the Fu organs causes numbness and loss of sensation; entering the Zang organs restricts extension and flexion, causing limb rigidity. Furthermore, it is said that dampness is the native qi of Earth; fire and heat generate damp Earth, hence the ten thousand things are moist in summer and dry in autumn. Dampness does not arise spontaneously; rather, due to heat stagnation, the water passages cannot circulate freely, causing Spleen stagnation which generates dampness.
Regarding Treatment
Since dampness generates phlegm, Er Chen Tang (Two-Aged Decoction) is used with added Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix), and Huang Qin (Scutellariae Radix) stir-fried with wine, to dispel wind and eliminate dampness, for wind can overcome dampness. Generally, treatment should involve inducing sweating and promoting urination to dissipate dampness from both the upper and lower aspects, which is the therapeutic principle.
Regarding Formulas
Du Huo Ji Sheng Tang (Radix Angelicae Pubescentis Decoction to Support the Living) [Commentary] (Note: This formula tonifies deficiency and eliminates dampness.)
Treats weakness of Kidney Qi, sitting or lying on damp ground, tension and spasm of the lower back and back, tendon contraction and bone pain. Or, when cooling oneself excessively in the wind, allowing wind pathogens to flow into the feet and knees, resulting in hemiplegia, cold bi-syndrome, flaccidity, weakness, and pain. Or lower back pain radiating, difficulty walking, and Bai Hu Li Jie Feng (White Tiger Joint Pain Syndrome).
Du Huo (Qiang Huo, 1 liang 5 qian) Sang Ji Sheng (Taxilli Cacuminis, 3 liang; if unavailable, Xu Duan replaces it) Dang Gui (Angelicae Sinensis Radix, 1 liang 5 qian) Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 1 liang 5 qian) Bai Shao (Paeoniae Radix Alba, 1 liang 5 qian) Shu Di Huang (Rehmanniae Radix Praeparata, 1 liang) Ren Shen (Ginseng Radix, 1 liang, remove rhizome) Fu Ling (Poria, 1 liang) Niu Xi (Achyranthis Bidentatae Radix, soaked in wine, 1 liang) Du Zhong (Eucommiae Cortex, stir-fried with wine, 1 liang) Qin Jiao (Gentianae Macrophyllae Radix, remove rhizome, 1 liang) Xi Xin (Asari Radix et Rhizoma, 1 liang) Fang Feng (Saposhnikoviae Radix, remove rhizome, 1 liang) Gui Xin (Cinnamomi Cortex, 1 liang) Gan Cao (Licorice Root, honey-fried, 3 qian)
Chop the above ingredients. For each dose, take 1 liang 5 qian, add 3 slices of fresh ginger, decoct in water, and take warm. For women with leukorrhea accompanied by lower back and leg pain, combine with Ping Wei San (Powder to Maintain Equilibrium) plus Fu Zi (Aconiti Lateralis Radix Praeparata) and Xiao Hui Xiang (Foeniculi Fructus).
Qiang Huo Sheng Shi Tang (Notopterygii Decoction to Overcome Dampness)
Treats wind-dampness interplay causing pain throughout the entire body.
Qiang Huo (Notopterygii Rhizoma et Radix, 7 fen) Du Huo (Angelicae Pubescentis Radix, 7 fen) Fang Feng (Saposhnikoviae Radix, 5 fen) Sheng Ma (Cimicifugae Rhizoma, 5 fen) Chai Hu (Bupleuri Radix, 5 fen) Ben Cao (Ligustici Wallichii Rhizoma et Radix, 1 qian) Cang Zhu (Atractylodis Rhizoma, 1 qian) Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 8 fen) Man Jing Zi (Vittariae Fructus, 8 fen) Gan Cao (Licorice Root, 5 fen)
Chop one dose, decoct in water, and take warm.
Sheng Yang Chu Shi Tang (Decoction to Raise Yang and Eliminate Dampness)
Treats dampness stagnant in the lower jiao; this formula raises and disperses it.
Sheng Ma (Cimicifugae Rhizoma, 1 qian) Chai Hu (Bupleuri Radix, 1 qian) Fang Feng (Saposhnikoviae Radix, 1 qian) Fu Ling (Poria, 8 fen) Zhu Ling (Polyporus, 1 qian) Ze Xie (Alismatis Rhizoma, 1 qian) Cang Zhu (Atractylodis Rhizoma, 1 qian) Chen Pi (Citri Reticulatae Pericarpium, 8 fen)
Chop one dose, add one large slice of fresh ginger, decoct in water, and take.
Jing Yan Bai Zhu Jiu (Experienced White Atractylodes Wine) [Secret Formula]
Treats middle-jiao dampness causing pain throughout the body and difficulty turning or changing position.
Bai Zhu (Atractylodis Macrocephalae Rhizoma, remove rhizome, 1 liang)
Chop one dose, use unadulterated aged wine (one zhong and half), decoct until reduced to one zhong, strain dregs, and take warm.