经云。诸湿肿满。皆属于脾。地之湿气。感则害人皮肉筋脉。阳受风气。阴受湿气。身半以
下者。湿中之也。伤于湿者。下先受之。声如从室中言。是中气之湿也。湿胜则濡泻。因于湿。
首如裹。湿热不攘。大筋 短。小筋弛长。 短为拘。弛长为痿。因于气为肿。四维相代。阳气乃竭。
首为诸阳之会。其位高。其气清。其体虚。故聪明系焉。却被湿土之独气熏蒸。清道不通。
故沉重不利。似乎有物蒙之。失而不治。湿郁为热。热留不去。热伤血不能养筋。故为拘挛。湿
伤筋不能束骨。故为弱痿。素尝气疾。湿热加之。气湿热争。故为肿。诸阳受气于四肢也。今人
见膝间关节肿痛。全以风治者误矣。
风寒暑皆能中人。惟湿气积久。留滞关节。故能中。非如中风寒暑之暴也。外中湿者。或山
岚瘴气。或天雨湿蒸。或远
行涉水。或久卧湿地。则湿从外中矣。其证关节疼重。头重体疼。腹胀烦闷。昏不知人。或四肢
倦怠。腿膝肿痛。身重浮肿。大便泄泻。小便黄赤。羌活胜湿汤。若一身尽痛。为风湿相搏。除
风湿羌活汤。肢体烦疼。头重鼻塞。或见泄利。或下清血。为风木之邪内干湿土。神术汤。湿毒
下血。大便泄泻。四肢沉重。升阳除湿防风汤。若腰以下重着。为湿滞经络。渗湿汤。然病有伤
中之不同。伤湿者。足太阳膀胱经也。中湿者。足太阴脾经。或足少阴肾经。伤膀胱则烦渴引饮。
小便不利而肿胀。五苓散。着脾则四肢浮肿。不能屈伸。大便多溏。此醇酒浓味水湿等物所伤。
湿从内中也。除湿汤。着肾则腰疼身重。小便不利。此醉卧湿地。或下体湿衣所伤。湿从外中也。
肾着汤。湿盛身疼。小便不利。体重发渴者。五苓散加羌活。治湿在上在外者当微汗。羌活胜湿
汤。在下在内者。当利小便。五苓散。东垣云。治湿不利小便。非其治也。然亦不可过治。病去
六七。即当改用理脾之剂。如水去其地犹湿。若过用之。肾水受亏矣。
罗谦甫云。春夏之交。病如伤寒。其人汗自出。肢体重痛。转侧难。小便不利。此名风湿。
非伤寒也。阴雨之后卑湿。或引饮过多。多有此证。但多服五苓散。小便通利。湿去则愈。切忌
转泻发汗。小误必不可救。初虞世云。医者不识。妄作伤风治之。发汗死。下之死。己未京师大
疫。正为此。罗得其说。救人甚多。大抵五苓散能分水去湿。胸中有停饮及小儿吐 欲作痫。五
苓散最妙。以中有桂。辛温能散肝脾之结耳。戴复庵云。五苓散。仲景本治太阳汗湿之邪自经犯
本。故取治风湿自汗。肢体重痛。渴而小便不利者最宜。若无烦渴小便不利者。此邪犹在经。宜
用羌活胜湿汤。或除风湿羌活汤选用。不必拘于前说也。
戴人曰。夏月人之腠理疏豁。元气不闭。故易于伤风伤湿。如汗出未拭而风闭之。则为风湿。
素有热而湿临之。则为
湿热。湿久菀亦然也。元气素虚而受湿。则为寒湿。或受于地。或受于天。或受于酒酪 乳。治
者宜分别之。如风湿。小建中加黄 、白术、羌活、防风。湿热。苓桂术甘汤。寒湿。小青龙加
减。阳虚者。去麻黄加熟附、白术。或麻黄加术汤。湿家无汗身烦疼者。麻黄加术汤。伤湿而兼
感风。则眩晕呕逆烦热。恶风不欲去衣被。或额上微汗。或身体微肿。汗渍衣湿。当风坐卧。多
有此证。麻黄杏仁薏苡甘草汤。或羌活胜湿汤。令微发汗。若大发汗。则风去湿在。已得汗而发
热不去者。败毒散加苍术、防己。伤湿又兼感寒。则拳挛掣痛。无汗惨惨烦痛。五积散。风湿脉
浮。身重汗出恶风者。防己黄 汤缓脉。风湿相搏。身重烦疼。不能自转侧。不呕不渴。脉浮虚
而涩者。桂枝附子汤。若其人大便硬。小便自利者。白术附子汤。骨节烦疼掣痛。不得屈伸。近
之则痛剧。汗出短气。小便不利。恶风不欲去衣。或身微肿者。甘草附子汤。
喻嘉言曰。人身阳盛则轻矫。湿盛则重着。乃至身重如山。百脉痛楚。不能转侧。而此不用
附子回阳胜湿。更欲何待。在表之湿。其有可汗者。用附子合桂枝汤以驱之外出。在里之湿。其
有可下者。用附子合细辛、大黄以驱之下出。在中之湿。则用附子合白术以温中而燥脾。今之用白
术。杂入羌、防、枳、朴、栀、橘等药。且无济于事。况用槟榔、滑石、舟车、导水等法乎。湿
家不可发汗。以身本多汗。易至亡阳。故湿温之证。误发其汗。名曰重 。故为深戒。若久冒风
凉。以水灌汗。抑郁其阳者。又不得不微汗之。湿家当利小便。此大法也。而真阳素虚之人。汗
出小便滴沥。正泉竭而阳欲出亡之象。若以为湿热。恣胆利之。真阳无水维附。顷刻脱离而死矣。
湿热 贾真孙曰。湿为土气。热能生湿。故夏热则万物湿润。秋凉则万物干燥。湿病本不自
生。因热而怫郁。不能
宣行水道。故停滞而生湿也。况形盛气弱之人。易为感受。岂必水流而后为湿哉。人只知风寒之
威严。不知暑湿之炎喧。感于冥冥之中也。原病式曰。诸痉项强。皆属于湿。或 肿体寒而有水
气。必小便赤少或渴。是蓄热入里极深。非病寒也。治法。宜理脾清热利小便为上。治湿不利小便。
非其治也。湿证有二。湿热证多。湿寒证少。当以脉证明辨之。如脉滑数。小便赤涩。引饮自汗。
为湿热证。若小便自利清白。大便泻利。身疼无汗。为寒湿也。湿热身黄如橘子色。而小便不利。
腹微满者。茵陈蒿汤。身黄小便不利而渴者。五苓散加茵陈。烦热小便不利而渴者。桂苓甘露饮。
湿热相搏者。清热渗湿汤。肩背沉重疼痛。上热胸膈不利。及遍身疼痛者。属外因之湿热。当归
拈痛汤。其人平素阴虚多火。加之走精者。湿袭精窍也。虎潜丸。或拈痛加龟板、白术、牡蛎。
湿热之属于里者。则水肿小便不利。当与五苓、神芎辈。分轻重以泄之。后用实脾之剂调理。若
夫阴水肿胀。另详水肿本门。
石顽曰。昔人有云。湿热一证。古所未详。至丹溪始大发其奥。故后世得以宗之。殊不知其
悉从东垣痹证诸方悟出。然其所论。皆治标之法。绝无治本之方。及读仲景书至痞论中。则湿热
治本之方具在。盖伤寒误下。则有痞满之变。然亦有不经攻下而痞者。皆由痰气逆满之故。故仲
景特立泻心汤诸法。正以祛逆上之湿热也。湿热证类最多。如鼓胀水肿。呕逆吞酸。黄瘅滞下。
腰腿重痛。香港脚痹着等候。悉属湿热为患。然皆别有所致而然。咸非湿热之本病也。尝见苍黑肥
盛之人。及酒客辈。皆素多湿热。其在无病之时。即宜常服调气利湿之剂。如六君子加黄连、沉香、
泽泻之类。夏秋则清燥汤。春夏则春泽汤加姜汁、竹沥。使之日渐消弭。此谓不治已病治未病也。
及乎五旬内外。气血向衰。渐至食少体倦。或胸腹痞满。或肢体烦疼。或不时举发。或偶有所触
而发。忽然胸高喘胀。烦闷呕遂。甚至上下不
通者。须乘初起元气未衰。急投控涎丹十余粒。不下。少顷再服。当此危急之时。不下必死。下之
庶或可生。此系专攻湿热痰涎之药。不可与硝、黄辈同视也。世医舍此而用香燥之剂。未有不相
引丧亡而已。以与身偕老之固疾。因元气衰惫而骤然僭发。已为九死之候。更兼误治。必无生理。
慎勿复药。自贻其咎也。又有素禀湿热而挟阴虚者。在膏粱辈。每多患此。以其平时娇养。未惯
驰驱。稍有忧劳。或纵恣酒色。或暑湿气交。即虚火挟痰饮上升。轻则胸胁痞满。四肢乏力。重
则周身疼重。痰嗽喘逆。亦有血溢便秘。面赤足寒者。甚则痿厥瘫废不起矣。大抵体肥痰盛之人。
则外盛中空。加以阴虚。则上实下虚。所以少壮犯此最多。较之中年以后触发者更剧。而治又与
寻常湿热迥殊。若用风药胜湿。虚火易于僭上。淡渗利水。阴津易于脱亡。专于燥湿。必致真阴
耗竭。纯用滋阴。反助痰湿上壅。务使润燥合宜。刚柔协济。始克有赖。如清燥汤、虎潜丸等方。
皆为合剂。复有阴阳两虚。真元下衰。湿热上盛者。若乘于内。则不时喘满眩晕。溢于外。则肢
体疼重麻瞀。见此即当从下真寒上假热例治之。否则防有类中之虞。即如痰厥昏仆。舌强语涩。
或口角流涎。或口眼 斜。或半肢倾废。非内热招风之患乎。历观昔人治法。惟守真地黄饮子多加
竹沥、姜汁。送下黑锡丹。差堪对证。服后半日许。乘其气息稍平。急进大剂人参入竹沥、姜汁、
童便。 时中。分三次服之。喘满多汗者。生脉散以收摄之。若过此时。药力不逮。火气复升。
补气之药。又难突入重围矣。服后元气稍充。喘息稍定。更以济生肾气丸。杂以黑锡丹一分。缓
图收功可也。至于但属阳虚。而阴不亏者。断无是理。虽有邪湿干之。亦随寒化。不能为热也。
即使更感客邪。自有仲景风湿寒湿治法可推。不似阴虚湿热之动辄扼腕也。其湿热挟外感诸例。
另详绪论本条。
〔诊〕石顽曰。湿脉自缓。得风以播之。则兼浮缓。寒以束之。则兼沉细。此皆外伤于湿之诊
也。若湿中三阴。则脉有沉缓沉细微缓之分。治有术附、姜附、桂附之异。盖沉缓沉细。为太少
二阴寒湿之本脉。人所易明。独厥阴脉见微缓。世所共昧。今特申之。夫厥阴为风木之藏。内藏
生阳。虽有湿着。风气内胜。鼓激其邪。流薄于经络之中。所以脉不能沉。而见阳浮阴缓之象。
是知微缓。亦厥阴受邪之本脉。观仲景厥阴例中。可以类推。至于湿袭经中。得人身浊气。蕴酿
而为湿热。则脉多软大。若浮取软大。而按之滑者。湿并在胃之痰也。浮取软大。而按之涩者。
湿伤营经之血也。湿寒湿热之辨。大略不出乎此。
罗谦甫治中山王知府子。年十三。六月中豪雨水泛。戏水湿衣。至精神昏愦。怠惰嗜卧。次
日头痛身热。腿脚重。一医用和解发散。重衾覆之。致苦热不禁。遂发狂言。欲去其衾而不得。
汗至四更。湿透其衾。明日循衣撮空。又以承气下之。语言不出。四肢不能收持。有时项强。手
足螈 搐急而挛。目左视而白睛多。口唇肌肉蠕动。罗视之。具说前由。盖伤湿盛暑之时。过发
其汗。更复误下。虚热生风发痉也。与保元汤加升、柴、芍药、五味、甘草。二日语声渐出。四
肢柔和。饮食渐进而愈。
丹溪治一人。患湿气。背如负二百斤重。以肾着汤加桂心、猪苓、泽泻、酒芩、木通、苍术。
服之而愈。
又治一人。腰似折。胯如冰。用除湿汤加附子、半夏、浓朴、苍术而愈。
石顽治沈汝 子。夏月两膝胫至脚痛极。僵挺不能屈者十余日。或用敷治之法。不效。其脉
软大而数。令拭去敷药。与当归拈痛汤二剂。汗出而愈。
《黄帝内经》说：“各种湿邪导致的肿胀和腹满，都归属于脾。”大地的湿气，侵袭人体就会伤害皮肉筋脉。阳经受风邪，阴经受湿邪。身体半以下部位，是湿邪中伤的地方。被湿邪所伤的人，病邪先从下部受累。说话声音沉闷，像是从封闭的房间里传出来，这是中焦之气有湿的表现。湿邪偏胜就会导致大便稀溏。因于湿邪，头部感觉像被包裹一样沉重。如果湿热之邪不能及时消除，会导致大筋收缩变短，小筋松弛变长。大筋缩短会引起拘挛，小筋松弛会导致痿弱无力。因气机阻滞导致肿胀，四肢交替出现症状，阳气就会衰竭。
头为诸阳经汇聚之处，位置高，气清，体虚，所以人的听觉视觉（聪明）依赖于它。但如果被湿土独盛之气熏蒸，清窍不通畅，就会感到沉重不利，好像有什么东西蒙蔽着头部。如果不及时治疗，湿郁结化为热，热邪停留不去，热邪损伤血液导致无法滋养筋脉，从而引起拘挛。湿邪损伤筋脉导致无法约束骨骼，从而引起虚弱痿软。如果素来有气疾，加上湿热侵袭，气、湿、热相互争斗，从而引起肿胀。诸阳经的气血都源于四肢。现在人们见到膝关节肿痛，完全按照风邪治疗是错误的。
风、寒、暑都能侵袭人体，只有湿气积久，留滞关节，才能深入其中。不像中风、寒、暑那样暴烈。外感湿邪，可能是因为山岚瘴气，或者是雨天湿气蒸腾，或者是长途跋涉涉水，或者是长期卧睡在潮湿之地，这样湿邪就从外部侵入。其症状表现为关节疼痛沉重，头部沉重身体疼痛，腹胀烦闷，昏迷不省人事，或者四肢倦怠，腿膝肿痛，身体沉重浮肿，大便泄泻，小便黄赤。可用羌活胜湿汤。如果全身都疼痛，属于风湿相搏，用除风湿羌活汤。肢体烦疼，头部沉重鼻塞，或者见泄利，或者下脓血，属于风木之邪内侵干扰湿土，用神术汤。湿毒导致下血，大便泄泻，四肢沉重，用升阳除湿防风汤。如果腰部以下沉重着着，属于湿邪阻滞经络，用渗湿汤。
然而疾病有“伤”和“中”的不同。伤湿者，涉及足太阳膀胱经；中湿者，涉及足太阴脾经或足少阴肾经。伤及膀胱则出现烦躁口渴想喝水，小便不利且肿胀，用五苓散。湿邪留着于脾则四肢浮肿，不能屈伸，大便多溏薄，这是由于醇酒厚味、水湿等物所伤，湿邪从内部产生，用除湿汤。湿邪留着于肾则腰痛身体沉重，小便不利，这是由于醉酒后卧睡湿地，或下身穿着湿衣所伤，湿邪从外部侵入，用肾着汤。湿盛导致身体疼痛，小便不利，体重且口渴的，用五苓散加羌活。治疗在上在外的湿邪应当微发汗，用羌活胜湿汤；在下在内的湿邪应当利小便，用五苓散。李东垣说：“治湿如果不通利小便，就不是正确的治疗方法。”但是也不可过度治疗，病去六七成时，就应当改用调理脾胃的药物。就像水排干了土地仍然潮湿一样，如果过度使用利水药，会亏损肾水。
罗谦甫说：春夏之交，病症像伤寒，病人自汗出，肢体沉重疼痛，转侧困难，小便不利，这名叫风湿，不是伤寒。阴雨之后地势卑湿，或者饮水过多，多有此证。只要多服五苓散，小便通利，湿去则痊愈。切忌误用泻下或发汗法，稍有错误就不可救药。初虞世说：医生不认识此病，妄作伤风治疗，发汗致死，泻下致死。己未年京城大瘟疫，正是为此病。罗谦甫得到这个说法，救活了很多人。大体上五苓散能分利水湿，胸中有停饮以及小儿呕吐欲作癫痫，五苓散最妙，因为其中有桂枝，辛温能疏散肝脾之结滞。戴复庵说：五苓散，张仲景原本用于治疗太阳经汗后湿邪由经入腑（犯本），所以用来治疗风湿自汗，肢体沉重疼痛，口渴而小便不利者最合适。如果没有烦渴和小便不利，说明邪气还在经脉，宜选用羌活胜湿汤，或除风湿羌活汤，不必拘泥于前面的说法。
张子和说：夏天人的腠理疏豁，元气不闭藏，所以容易伤风伤湿。如出汗后未擦拭就被风吹闭，就成为风湿。素来有热又遇到湿邪，就成为湿热。湿邪久郁也会化热。元气素虚又受湿邪，就成为寒湿。或受于地气，或受于天气，或受于酒酪乳汁，治疗者应当分别对待。如风湿，用小建中汤加黄芪、白术、羌活、防风。湿热，用苓桂术甘汤。寒湿，用小青龙汤加减。阳虚者，去麻黄加熟附子、白术，或用麻黄加术汤。湿病患者无汗身体烦疼的，用麻黄加术汤。伤湿又兼感风邪，则眩晕呕逆烦热，恶风不想脱去衣被，或者额头微汗，或者身体微肿，汗水浸湿衣服，当风坐卧，多有此证，用麻黄杏仁薏苡甘草汤，或羌活胜湿汤，令其微发汗。如果大发汗，则风去湿仍在。已经出汗但发热不退的，用败毒散加苍术、防己。伤湿又兼感寒邪，则手足蜷缩掣痛，无汗惨痛，用五积散。风湿脉浮，身体沉重汗出恶风的，用防己黄芪汤缓脉。风湿相搏，身体沉重烦疼，不能自行转侧，不呕不渴，脉浮虚而涩的，用桂枝附子汤。如果其人大便硬，小便自利的，用白术附子汤。骨节烦疼掣痛，不能屈伸，靠近则痛剧，汗出短气，小便不利，恶风不想穿衣，或者身体微肿的，用甘草附子汤。
喻嘉言说：人身阳气盛则轻捷，湿邪盛则沉重，甚至身重如山，百脉痛楚，不能转侧，此时不用附子回阳胜湿，还要等待什么？在表的湿邪，有可汗出的，用附子合桂枝汤以驱之外出。在里的湿邪，有可下的，用附子合细辛、大黄以驱之下出。在中的湿邪，则用附子合白术以温中燥脾。现在使用白术，混杂加入羌活、防风、枳实、厚朴、栀子、橘皮等药，且无济于事，何况使用槟榔、滑石、舟车丸、导水丸等方法呢？湿病患者不可发汗，因为身体本来多汗，容易至亡阳。所以湿温证，误发其汗，名叫重暍，故深以为戒。如果久冒风凉，用水冲洗汗水，抑郁其阳气，又不得不微发其汗。湿病患者应当利小便，这是大法。但是真阳素虚之人，汗出小便滴沥，是真阴枯竭而阳气欲脱的征象，如果认为是湿热，肆意利水，真阳没有阴液维系依附，顷刻间脱离而死。
贾真孙说：湿为土气，热能生湿，所以夏天热则万物湿润，秋天凉则万物干燥。湿病本身不自行产生，因热而怫郁，不能宣行水道，所以停滞而生湿。况且形体壮盛但气弱的人，容易感受湿邪，难道一定要水流才叫湿吗？人们只知道风寒的威严，不知道暑湿在冥冥之中炎喧伤人。《原病式》说：“各种痉病项强，都归属于湿。”如果有水肿体寒而有水气，必须小便赤少或口渴，这是蓄热入里极深，不是寒病。治疗方法，以调理脾胃、清热利小便为上策。治湿不利小便，不是正确的治疗方法。湿证有两种，湿热证多，湿寒证少，应当通过脉证明辨。如脉滑数，小便赤涩，引饮自汗，为湿热证。若小便自利清白，大便泻利，身疼无汗，为寒湿。湿热身黄如橘子色，而小便不利，腹部微满的，用茵陈蒿汤。身黄小便不利而口渴的，用五苓散加茵陈。烦热小便不利而口渴的，用桂苓甘露饮。湿热相搏的，用清热渗湿汤。肩背沉重疼痛，上热胸膈不利，以及遍身疼痛的，属于外因之湿热，用当归拈痛汤。其人平素阴虚多火，加之遗精的，是湿邪侵袭精窍，用虎潜丸，或拈痛汤加龟板、白术、牡蛎。湿热属于里的，则水肿小便不利，应当与五苓散、神芎丸之类，分轻重以泄之，后用实脾药物调理。至于阴水肿胀，另详水肿门。
石顽说：过去有人说，湿热一证，古代论述不详，直到朱丹溪才开始大发其奥妙，所以后世得以宗奉。殊不知这些理论全都从李东垣的痹证诸方悟出。然而他所论述的，都是治标的方法，绝无治本之方。等到读张仲景的书到《痞论》中，则湿热治本之方具在。大概伤寒误用下法，则有痞满的变化，但也有不经攻下而痞的，都是由痰气逆满的缘故。所以张仲景特别设立泻心汤诸法，正是为了祛除逆上的湿热。湿热证类很多，如鼓胀水肿，呕逆吞酸，黄疸痢疾，腰腿重痛，脚气痹着等症，都属于湿热为患。然而都有其他原因导致，都不是湿热之本病。曾见面色苍黑肥盛之人，以及嗜酒之辈，都素多湿热，在他们无病之时，就应当常服调气利湿的药物，如六君子汤加黄连、沉香、泽泻之类。夏秋则用清燥汤，春夏则用春泽汤加姜汁、竹沥，使之日渐消弭，这叫不治已病治未病。到了五十岁左右，气血向衰，渐渐出现食少体倦，或者胸腹痞满，或者肢体烦疼，或者不时发作，或者偶有所触而发，忽然胸高喘胀，烦闷呕吐，甚至上下不通的，必须乘初起元气未衰，急投控涎丹十余粒，不下，过一会儿再服。当此危急之时，不下必死，下之或许可以生还。这是专门攻逐湿热痰涎的药物，不可与硝石、大黄等同视。世医舍弃此法而用香燥之剂，没有不相继丧亡的。以与身偕老的固疾，因元气衰惫而骤然僭发，已是九死之候，更兼误治，必无生理，千万不要再用药，自取其咎。又有素禀湿热而挟阴虚的，在富贵膏粱之辈，每多患此，因为他们平时娇养，不惯劳作，稍有忧劳，或纵恣酒色，或暑湿气交，即虚火挟痰饮上升，轻则胸胁痞满，四肢乏力，重则周身疼重，痰嗽喘逆，也有血溢便秘，面赤足寒的，甚则痿厥瘫废不起。大体上体肥痰盛之人，则外盛中空，加以阴虚，则上实下虚，所以少壮犯此最多，较之中年以后触发者更剧烈，而治疗又与寻常湿热迥然不同。如果用风药胜湿，虚火易于僭上；淡渗利水，阴津易于脱亡；专于燥湿，必致真阴耗竭；纯用滋阴，反助痰湿上壅。务使润燥合宜，刚柔协济，始克有赖。如清燥汤、虎潜丸等方，皆为合剂。又有阴阳两虚，真元下衰，湿热上盛的，若湿热乘于内，则不时喘满眩晕；溢于外，则肢体疼重麻木昏沉。见此即应当从下真寒上假热的例子治疗，否则防备有类中风的危险。就如痰厥昏仆，舌强语涩，或者口角流涎，或者口眼歪斜，或者半身不遂，不是内热招风之患吗？纵观昔人治法，只有刘守真地黄饮子多加竹沥、姜汁，送下黑锡丹，差堪对证。服药后半日许，乘其气息稍平，急进大剂人参入竹沥、姜汁、童便，时时中服，分三次服之。喘满多汗者，用生脉散以收摄之。如果过了这个时候，药力不逮，火气复升，补气之药，又难突入重围了。服药后元气稍充，喘息稍定，再以济生肾气丸，杂以黑锡丹一分，缓图收功可也。至于但属阳虚，而阴不亏的，断无是理，虽有邪湿干之，亦随寒化，不能为热也。即使更感客邪，自有张仲景风湿寒湿治法可推，不像阴虚湿热动辄令人扼腕叹息。其湿热挟外感诸例，另详绪论本条。
〔诊法〕石顽说：湿脉自缓，得风邪以播之，则兼浮缓；寒邪以束之，则兼沉细，这都是外伤于湿的诊法。若湿邪中于三阴，则脉有沉缓、沉细、微缓之分，治疗有术附、姜附、桂附之异。盖沉缓、沉细，为太阴、少阴二阴寒湿的本脉，人所易明，唯独厥阴脉见微缓，世人共同迷惑。今天特申述之。夫厥阴为风木之脏，内藏生阳，虽有湿着，风气内胜，鼓激其邪，流薄于经络之中，所以脉不能沉，而见阳浮阴缓之象。是知微缓，也是厥阴受邪的本脉，观察张仲景厥阴例中，可以类推。至于湿邪侵袭经脉中，得人身浊气，蕴酿而为湿热，则脉多软大。若浮取软大，而按之滑者，是湿并在胃之痰也。浮取软大，而按之涩者，是湿伤营经之血也。湿寒湿热之辨，大略不出乎此。
罗谦甫治疗中山王知府的儿子，十三岁，六月豪雨水泛，戏水湿衣，导致精神昏愦，怠惰嗜卧。次日头痛身热，腿脚重。一医用和解发散法，用厚被子覆盖，导致苦热不禁，遂发狂言，想要去掉被子却做不到。汗至四更，湿透其衾。第二天循衣撮空，又用承气汤下之，语言不出，四肢不能收持，有时项强，手足抽搐急而挛，目左视而白睛多，口唇肌肉蠕动。罗谦甫查看后，详细说出前因。大概是伤湿盛暑之时，过发其汗，更复误下，导致虚热生风发痉。给予保元汤加升麻、柴胡、芍药、五味子、甘草。两天后语声渐出，四肢柔和，饮食渐进而愈。
朱丹溪治疗一人，患湿气，背如负二百斤重，用肾着汤加桂心、猪苓、泽泻、酒芩、木通、苍术，服之而愈。
又治疗一人，腰似折，胯如冰，用除湿汤加附子、半夏、浓朴、苍术而愈。
石顽治疗沈汝之子，夏月两膝胫至脚痛极，僵挺不能屈者十余日，或用敷治之法，不效。其脉软大而数，令拭去敷药，给予当归拈痛汤二剂，汗出而愈。
The *Yellow Emperor's Inner Classic* states: "Various swellings and abdominal fullness caused by dampness all belong to the Spleen." The dampness of the earth, when it invades the human body, harms the skin, flesh, sinews, and vessels. The Yang meridians are affected by wind, while the Yin meridians are affected by dampness. The lower half of the body is where dampness strikes. Those injured by dampness first suffer from below. A voice that sounds muffled, as if coming from a room, indicates dampness in the Middle Jiao (middle burner). When dampness prevails, it leads to loose stools (diarrhea with watery consistency). Due to dampness, the head feels wrapped or heavy. If damp-heat is not eliminated promptly, the large tendons shorten, and the small tendons relax and lengthen. Shortening of the large tendons causes spasms (contracture), while relaxation of the small tendons leads to flaccidity (weakness and atrophy). Swelling due to Qi stagnation, with symptoms alternating among the four limbs, results in the exhaustion of Yang Qi.
The head is the meeting place of all Yang meridians; its position is high, its Qi is clear, and its structure is hollow, so hearing and vision ("brightness") depend on it. However, if steamed by the exclusive damp-earth Qi, the clear orifices become blocked, leading to heaviness and dysfunction, as if something were covering the head. If left untreated, dampness stagnates and transforms into heat. Persistent heat damages blood, preventing it from nourishing the tendons, thus causing spasms. Dampness damages the tendons, preventing them from binding the bones, thus causing weakness and flaccidity. If one has a pre-existing Qi disorder, compounded by damp-heat, the struggle between Qi, dampness, and heat causes swelling. The Qi of all Yang meridians originates in the four limbs. Today, people often mistakenly treat knee joint pain and swelling solely as Wind pathogens.
Wind, Cold, and Summer-heat can all invade humans, but only Dampness, after accumulating for a long time and lingering in the joints, can deeply penetrate. It is not as sudden as Wind, Cold, or Summer-heat. External invasion of dampness may occur due to mountain miasma, rainy weather humidity, wading through water during travel, or lying on damp ground for a long time. Symptoms include painful and heavy joints, heavy head and body pain, abdominal distension and stifling sensation, coma, limb fatigue, swollen and painful legs and knees, heavy body and edema, diarrhea, and yellow-red urine. Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness) is indicated. If the whole body aches, indicating Wind-Dampness struggling, Chufengshi Qianghuo Tang (Decoction for Removing Wind-Dampness with Notopterygium) is used. For limb pain, heavy head, nasal congestion, diarrhea, or bloody stools, indicating Wood-Wind pathogen interfering with Earth-Dampness, Shenzhu Tang (Atractylodes Macrocephala Decoction) is prescribed. For damp-toxin causing bloody stools, diarrhea, and heavy limbs, Shengyang Chushi Fangfeng Tang (Decoction for Raising Yang and Draining Dampness with Saposhnikovia) is used. If heaviness is concentrated below the waist, indicating dampness blocking the meridians, Shen Shi Tang (Decoction for Percolating Dampness) is applied.
However, there are differences between "injury" (Shang) and "strike" (Zhong) by dampness. Injury by dampness involves the Foot-Taiyang Bladder Meridian; strike by dampness involves the Foot-Taiyin Spleen Meridian or Foot-Shaoyin Kidney Meridian. Injury to the Bladder causes irritability, thirst with desire to drink, difficult urination, and swelling; Wuling San (Five-Ingredient Powder with Poria) is used. Dampness lodging in the Spleen causes edema of the four limbs, inability to flex and extend, and frequent loose stools, caused by damage from rich foods, alcohol, and internal dampness; Chushi Tang (Dampness-Removing Decoction) is used. Dampness lodging in the Kidney causes lower back pain, heavy body, and difficult urination, caused by sleeping on damp ground after drunkenness or wearing wet clothes externally; Shen Zhuo Tang (Kidney-Lodging Decoction) is used. For dampness causing body pain, difficult urination, heavy body, and thirst, Wuling San plus Qianghuo (Notopterygium) is used. For dampness located above and outside, slight sweating should be induced using Qianghuo Shengshi Tang; for dampness located below and inside, diuresis should be promoted using Wuling San. Li Dongyuan stated: "To treat dampness without promoting urination is incorrect treatment." However, over-treatment must be avoided. Once 60-70% of the disease is resolved, transition to Spleen-regulating formulas. Just as land remains wet even after water drains, excessive use of diuretics depletes Kidney Water.
Luo Qianfu said: In the transition between Spring and Summer, symptoms resembling Taiyang syndrome (cold damage) occur, with spontaneous sweating, heavy and painful limbs, difficulty turning, and difficult urination. This is named Wind-Dampness, not cold damage. After rainy days or excessive drinking, this pattern is common. Frequent use of Wuling San promotes urination; once dampness is removed, recovery occurs. Diarrhea-inducing or sweating methods are strictly contraindicated; minor errors here can be fatal. Chu Yushi noted that doctors misdiagnosing this as Wind-Cold and inducing sweating or purgation caused deaths during the epidemic in the capital in the Jiwei year. Luo Qianfu's method saved many. Generally, Wuling San separates fluids and removes dampness; it is excellent for fluid retention in the chest and pediatric vomiting threatening epilepsy, because Guizhi (Cinnamon Twig) disperses Liver-Spleen stagnation. Dai Fu'an stated: Zhang Zhongjing originally used Wuling San for dampness invading the interior after sweating in Taiyang syndrome. It is most suitable for Wind-Dampness with spontaneous sweating, heavy painful limbs, thirst, and difficult urination. If there is no thirst or difficult urination, the pathogen remains in the meridians; Qianghuo Shengshi Tang or Chufengshi Qianghuo Tang should be selected, without rigid adherence to previous statements.
Zhang Yuansu (Zihehe) said: In summer, pores are open, and Yuan Qi is not closed, making one susceptible to Wind and Dampness. Sweating followed by wind exposure causes Wind-Dampness. Pre-existing heat combined with dampness causes Damp-Heat. Long-standing dampness also transforms into heat. Pre-existing deficiency of Yuan Qi combined with dampness causes Cold-Dampness. Whether acquired from earth, heaven, or dairy/alcohol, treatment must differentiate. For Wind-Dampness, Xiao Jianzhong Tang plus Huangqi (Astragalus), Baizhu (Atractylodes), Qianghuo, and Fangfeng is used. For Damp-Heat, Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, Licorice Decoction) is used. For Cold-Dampness, Xiao Qinglong Tang modified is used. For Yang deficiency, remove Mahuang (Ephedra) and add Shu Fuzi (Prepared Aconite) and Baizhu, or use Mahuang Jia Zhu Tang (Ephedra Plus Atractylodes Decoction). For damp patients with no sweat and body pain, Mahuang Jia Zhu Tang is used. For dampness complicated by Wind, causing dizziness, vomiting, fever, aversion to wind, slight forehead sweating, or mild edema, Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coix Seed, Licorice Decoction) or Qianghuo Shengshi Tang is used to induce slight sweating. Profuse sweating leaves dampness behind. If fever persists after sweating, Baidu San (Rescue the Hundred Decoction) plus Cangzhu (Atractylodes Lancea) and Fangji (Stephania) is used. For dampness complicated by Cold, causing curling pain, no sweat, and severe pain, Wuji San (Five Accumulations Powder) is used. For Wind-Dampness with floating pulse, heavy body, sweating, and aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is used. For Wind-Dampness struggling, causing heavy painful body, inability to turn, no vomiting/thirst, and floating-deficient-choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is used. If stool is hard and urination is normal, Baizhu Fuzi Tang (Atractylodes and Aconite Decoction) is used. For painful joints, inability to flex/extend, pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind, or mild edema, Gancao Fuzi Tang (Licorice and Aconite Decoction) is used.
Yu Jiayan stated: Excess Yang makes the body light; excess dampness makes it heavy, even as heavy as mountains, with pain preventing movement. At this stage, Fuzi (Aconite) must be used to restore Yang and overcome dampness. For exterior dampness amenable to sweating, combine Fuzi with Guizhi Tang to expel outward. For interior dampness amenable to purgation, combine Fuzi with Xixin (Asarum) and Dahuang (Rhubarb) to expel downward. For middle dampness, combine Fuzi with Baizhu to warm the center and dry Spleen dampness. Using Baizhu mixed with Qianghuo, Fangfeng, Zhishi, Houpo, Zhizi, or Chenpi is ineffective. Using Binglang (Betel Nut), Huashi (Talc), Zhouche Wan, or Daoshui Wan is even worse. Damp patients must not be sweated profusely, as they already sweat easily, risking Yang collapse. Mis-sweating in Wet-Warmth is called "Chong Yue" (Double Muggy Heat) and is strictly forbidden. However, if Yang is depressed by prolonged wind/cold and water washing, slight sweating is necessary. Promoting urination is the general rule for dampness. But in patients with deficient True Yang, scanty dripping urine after sweating indicates exhaustion of True Yin and impending Yang collapse. Mistaking this for Damp-Heat and aggressively diuresing will cause immediate death due to lack of Yin anchoring Yang.
Jia Zhen Sun stated: Dampness is Earth Qi; Heat generates Dampness. Thus, summer heat brings moisture, while autumn coolness brings dryness. Dampness does not arise spontaneously but stagnates due to Heat obstructing water pathways. People with robust bodies but weak Qi are susceptible. People know the severity of Wind-Cold but ignore the insidious nature of Summer-Heat and Dampness. The *Yuan Bing Shi* states: "All spasms and stiff necks belong to Dampness." Edema with cold and water qi, accompanied by scanty red urine or thirst, indicates deep internal Heat accumulation, not Cold. Treatment prioritizes regulating Spleen, clearing Heat, and promoting urination. "Treating dampness without promoting urination is incorrect." There are two types of dampness: Damp-Heat (common) and Cold-Damp (rare). Slippery-rapid pulse with red/scanty urine, thirst, and sweating indicates Damp-Heat. Normal clear urine, diarrhea, body ache, and no sweat indicate Cold-Damp. Yellow skin like orange peel with difficult urination and mild abdominal fullness requires Yinchen Hao Tang (Artemisia Capillaris and Gardenia Decoction). Yellow skin with difficult urination and thirst requires Wuling San plus Yinchen. Stifling heat, difficult urination, and thirst require Guiling Ganyin Tang (Cinnamon, Poria, and Hydrangea Drink). Struggling Damp-Heat requires Qingre Shen Shi Tang (Clear Heat and Percolate Dampness Decoction). Heavy shoulder/back pain, upper heat/chest oppression, and generalized pain indicate external Damp-Heat; Dangni Tongtong Tang (Angelica and Ligusticum Pain-Relieving Decoction) is used. For chronic Yin deficiency with fire and seminal emission, dampness attacks the essence orifice; Hujian Wan (Tiger Knee Pill) or Dangni Tongtong Tang plus Guiban (Turtle Shell), Baizhu, and Muli (Oyster Shell) is used. Internal Damp-Heat causing edema and difficult urination requires Wuling San or Shenxiong Wan, graded by severity, followed by Spleen-fortifying agents. Yin-type edema is detailed elsewhere.
Shi Wan stated: Ancient texts did not detail Damp-Heat extensively until Zhu Danxi. However, his theories derived from Li Dongyuan's Bi syndrome formulas, focusing on symptoms rather than root causes. Reading Zhang Zhongjing's *Pi Lun* reveals root treatments for Damp-Heat. Post-cold damage improper purgation causes Pi (glomus/fullness), sometimes without purgation, due to Phlegm-Qi rebellion. Zhang Zhongjing established Xiexin Tang (Drain the Epigastrium Decoctions) to clear rebellious Damp-Heat. Many conditions stem from Damp-Heat:鼓胀 (drum-like distension), edema, vomiting, acid regurgitation, jaundice, dysentery, lower back/leg heaviness, and Hong Kong foot (podagra/bi syndrome). These have specific causes but are manifestations of Damp-Heat. Robust, dark-complexioned individuals and drinkers often harbor latent Damp-Heat. Preventive treatment involves Tiaoqi Lishi agents like Liujunzi Tang plus Huanglian (Coptis), Chenxiang (Agarwood), and Zexie (Alisma). Use Qingzao Tang in Autumn/Winter and Chunze Tang plus Ginger Juice and Bamboo Juice in Spring/Summer to gradually dissipate dampness—this is treating disease before it arises. Around age fifty, Qi and Blood decline, leading to poor appetite, fatigue, epigastric fullness, limb pain, or sudden severe distension, vomiting, and blockage. Early intervention with Kongxian Dan (Controlling Phlegm Pill) 10+ pills is critical; failure to purge leads to death. This targets Damp-Heat Phlegm, distinct from Mangxiao (Mirabilite) or Dahuang. Physicians using aromatic-drying herbs cause death. Chronic diseases exacerbated by Qi deficiency are critical; mis-treatment is fatal. Avoid further medication.
For those with innate Damp-Heat and Yin deficiency (common in pampered elites), emotional stress, alcohol/sex excess, or seasonal damp-heat causes Deficient Fire carrying Phlegm upward. Mild cases: chest/flank fullness, limb weakness. Severe cases: generalized heaviness, phlegm-cough, wheezing, hematemesis, constipation, red face, cold feet, or paralysis. Fat-phlegm constitutions with Yin deficiency present as Upper Excess/Lower Deficiency. Young adults are most affected. Treatment differs from standard Damp-Heat. Wind herbs aggravate Deficient Fire; diuretics deplete Yin; drying herbs exhaust True Yin; pure yin-nourishing herbs increase Phlegm. Balance moistening and drying, rigid and soft. Qingzao Tang and Hujian Wan are appropriate combinations. For Yin-Yang dual deficiency with Lower True Cold and Upper False Heat (manifesting as wheezing, vertigo, limb numbness/heaviness), treat as Lower Cold/Upper Heat to prevent stroke-like symptoms (Phlegm-Fainting, tongue stiffness, drooling, facial deviation, hemiplegia). Liu Wansu's Dihuang Yinzi plus Bamboo Juice and Ginger Juice, followed by Heixi Dan (Black Tin Pill), is effective. After half a day, administer Ren Shen (Ginseng) with Bamboo Juice, Ginger Juice, and Tongbian (Child's Urine) in three doses. For wheezing/sweating, use Shengmai San (Generate Pulse Powder). If delayed, Qi-tonics cannot penetrate. Once Qi stabilizes, use Jisheng Shenqi Wan mixed with Heixi Dan for gradual recovery. Pure Yang deficiency without Yin deficit is rare; dampness converts to Cold. Zhang Zhongjing's Wind/Cold-Damp methods apply. Unlike Yin-deficient Damp-Heat, these are manageable. External-complicated Damp-Heat examples are detailed in the Introduction.
[Diagnosis] Shi Wan stated: Damp pulses are naturally slow. With Wind, they become Floating-Slow; with Cold, Deep-Fine. These are external dampness diagnoses. Dampness striking the Three Yin meridians presents as Deep-Slow, Deep-Fine, or Micro-Slow pulses, treated with Shu-Fu, Jiang-Fu, or Gui-Fu variations. Deep-Slow/Fine are Taiyin/Shaoyin Cold-Damp roots. Weiyuan (Jueyin) Micro-Slow pulse is often misunderstood. Jueyin is Wind-Wood, containing Life-Giving Yang. Even with dampness, internal Wind agitates the pathogen, preventing deep pulses, resulting in Floating-Yang/Slow-Yin imagery. Micro-Slow is the Jueyin root pulse, verifiable in Zhang Zhongjing's Jueyin examples. Dampness in meridions combining with turbid Qi creates Damp-Heat, presenting as Soft-Large pulses. Floating Soft-Large with Slipping pressure indicates Phlegm-Damp in the Stomach. Floating Soft-Large with Choppy pressure indicates Damp injuring Ying-Blood. Differentiation of Cold/Damp-Heat follows these principles.
Luo Qianfu treated a 13-year-old boy who played in floodwaters in June, getting wet. He became lethargic and sleepy. Next day: headache, fever, heavy legs. A physician used harmonizing/dispersing herbs and covered him heavily, causing intense heat and mania. Sweat soaked bedding by 3 AM. Next day: finger tracing, empty grasping. Another physician used Chengqi (Purgative) decoction, leading to mutism, limb paralysis, neck stiffness, convulsions, eyes deviated left with white sclera visible, and lip twitching. Luo diagnosed post-dampness/summer-heat injury, excessive sweating, and erroneous purgation causing Deficient Heat generating Wind and Spasms. He prescribed Baoyuan Tang plus Shengma, Chaihu, Shaoyao, Wuweizi, and Gancao. Within two days, speech returned, limbs relaxed, and appetite improved.
Danxi treated a patient with heavy back sensation (like 200 jin weight) using Shen Zhuo Tang plus Guixin, Zhuling, Zexie, Huangqin, Mutong, and Cangzhu, resulting in cure.
He treated another with waist breaking sensation and cold hips using Chushi Tang plus Fuzi, Banxia, Houpo, and Cangzhu, resulting in cure.
Shi Wan treated Shen Ru's son with extreme pain from knees to feet in summer, unable to flex for 10 days. Topical treatments failed. Pulse was Soft-Large-Rapid. After removing topicals, Dangni Tongtong Tang for two doses induced sweating and cure.