经云∶诸湿肿满,皆属于脾。又曰∶风雨则伤上,清湿则伤下。陈飞霞曰∶是湿之为病,有出于天气者,雨
露是也。有出于地气者,泥水是也。有出于饮食者,酒浆生冷是也。有出于人事者,汗衣卧湿,如小儿澡浴、粪
秽、衣襁不干皆是也。然所因虽异,悉由乎脾气之虚。而辨治之法,其要惟二。一曰湿热,一曰寒湿,尽之矣。
病而发热者,谓之湿热。病而多寒者,谓之寒湿。湿热之治,宜清利,热去湿亦去也。寒湿之治,宜燥宜温,非温
不能燥也。湿热症,其症发热身痛,多燥渴,小便赤涩,大便秘结,脉见洪滑,方是热症。宜清宜利,柴苓汤、
茵陈饮。如果湿热之甚,或元气壮而兼秘结不通者,方可推荡之,《集成》沆瀣丹。寒湿证,为胀满泄泻呕吐,
皆寒湿之病也。凡小儿喜弄冷水,坐卧湿地,其证头痛身重,寒热往来,宜胃苓汤。如兼呕吐,加藿香、砂仁。如
因中湿浮肿者,胃苓汤合五皮饮。如不效,必用温补,俟阳气渐复,如理中汤、八味丸、宜择用之。凡脾虚多病湿。
内因酒曲停滞、嗜瓜果,喜生冷、炙肥甘,以致湿热壅溢,而为病者,此内因也。复有坐卧湿地,雾露阴雨所客,
澡浴为风所闭、泥水为湿所郁于腠理,则发黄也,此湿由外生。
可见内外所感,皆由脾气虚弱,而湿邪乘而袭之。中湿发黄者,茵陈五苓散;不效,六君子汤。燥脾而黄自退。
《集成》紫苓汤 治中湿恶热如疟。
党参 柴胡 黄芩 半夏 白术 茯苓 猪苓 泽泻(湿一钱) 桂枝(五分) 炙甘草(一钱) 生姜(一钱)
大枣(一枚)
《集成》柴瀣丹 治小儿一切热症,如胎毒、鹅口、重舌、乳蛾、便结、癣疥、风热等症。
川芎(九钱,酒洗) 大黄(九钱) 黄芩(九钱,酒洗) 黄柏(九钱,酒洗) 黑牵牛(六钱,炒去头末)
薄荷(四钱五分) 滑石(六钱,水飞) 槟榔(七钱半,童便洗晒) 枳壳(四分半,面炒) 连翘(六分,去心)
赤芍(六分,炒)
上为末,蜜丸如芡实大。月内之儿,每服一丸,稍大者二丸。茶汤化服,乳母忌油腻。以微泻病愈为度。
胃苓汤 (见前泄泻方内。)治中湿头重身体往来寒热,
《集成》茵陈饮 治中湿发黄,大小便涩。
茵陈(二钱) 栀子 赤茯苓 甜葶苈 甘草 灯心(各一钱) 小枳实(七分)
五皮饮 合胃苓汤专治浮肿
生姜 大腹皮 茯苓 桑白皮 五加皮 灯心 大枣(各一钱)
茵陈五苓散 治中湿发黄。
茵陈(二钱) 白术 茯苓 猪苓 炙甘草 生姜(各一钱) 桂枝(五分) 大枣(一枚)
涂蔚生曰∶湿与燥反。湿为水火相交之气,燥乃水火不交之气。然脾土非湿不足以濡化水谷之坚,非燥又不
足以消烁水谷之阴。是燥湿虽属相反,而实相生相济者也。如欲脾土无病,则惟有调剂其燥湿之得其平耳。盖湿
甚壅寒,足以发生肿满咳嗽,呕吐泄泻等症。而积湿成热,又足以发生面目赤黄,胸满气逆等症。故治湿之方,湿
寒淮在温燥,湿热惟在清利。虽燥与湿远,清与湿近,而其使之刚柔得中,亦即同为湿之良将。经云∶脾土
喜燥而恶湿。又曰∶太阴之上,湿气治之,中见阳明。解者既以其恶湿,而无湿之必要。又于中见阳明之义,仅拘为
太阴经之支络,见走于阳明经络之上。是未免将治湿之全副底蕴,得半失半者也。吾以为中见阳明之义,不是仅拘
于支络者。是谓太阴之上,虽是湿气治之,不使发生湿病。然其治法,究以何者为中和。曰∶欲其中和,必须见阳明
之气为若何,而后湿气之治为何若。阳明之气,以燥为本,其中和亦即以燥为本也。盖必如是而后能中和,必如是
而后无不中和也。后贤虽未将此中微义揭出,而知治湿以燥,是其将先圣之妙得心法,亦无不体会毕具者矣。
《黄帝内经》说:各种湿邪导致的肿胀和腹满,都归属于脾。又说:风雨之邪容易伤害人体上部,清冷潮湿之邪容易伤害人体下部。陈飞霞说:湿邪致病,有的源于天气,如雨露;有的源于地气,如泥水;有的源于饮食,如酒浆、生冷食物;有的源于人事,如穿着汗湿的衣服睡觉、躺在潮湿处,像小儿洗澡、接触粪便污秽、衣被包裹不干爽等。虽然病因各异,但根本原因都是脾气虚弱。而辨证治疗的方法,要点只有两个:一是湿热,二是寒湿,这就概括尽了。患病且发热的,称为湿热。患病且怕冷的,称为寒湿。湿热证的治疗,适宜清热利湿,热去则湿亦去。寒湿证的治疗,适宜燥湿温中,不用温法就不能燥湿。
湿热症的症状是发热、身体疼痛、多口渴、小便赤红涩痛、大便秘结、脉象洪滑,这才是热症。适宜用清利之法,方剂可用柴苓汤、茵陈饮。如果湿热极重,或者元气壮实兼有大便秘结不通的,才可以采用推荡攻下的方法,《医宗集成》中的沆瀣丹。寒湿证表现为腹胀满、泄泻、呕吐,这些都是寒湿的病证。凡是小儿喜欢玩弄冷水,坐卧湿地,出现头痛、身体沉重、寒热往来的症状,适宜用胃苓汤。如果兼有呕吐,加藿香、砂仁。如果是因中湿导致浮肿的,用胃苓汤合五皮饮。如果无效,必须使用温补法,等待阳气逐渐恢复,如理中汤、八味丸,宜酌情选用。凡是脾虚的人多患湿病。内因方面,如酒曲停滞、嗜食瓜果、喜吃生冷、炙烤肥甘厚味,导致湿热壅滞溢散而发病,这属于内因。又有坐卧湿地,受雾露阴雨侵袭,洗澡时被风闭塞毛孔,泥水湿气郁阻在腠理之间,从而导致发黄,这是湿邪由外而生。
可见内外所感的湿邪,都是因为脾气虚弱,湿邪乘虚侵袭。中湿发黄的,用茵陈五苓散;如果无效,用六君子汤。燥脾土则黄色自然消退。《医宗集成》中的紫苓汤治疗中湿恶热如疟疾状。
党参、柴胡、黄芩、半夏、白术、茯苓、猪苓、泽泻(一钱)、桂枝(五分)、炙甘草(一钱)、生姜(一钱)、大枣(一枚)。
《医宗集成》中的柴瀣丹治疗小儿一切热症,如胎毒、鹅口疮、重舌、乳蛾、便秘、癣疥、风热等症状。
川芎(九钱,酒洗)、大黄(九钱)、黄芩(九钱,酒洗)、黄柏(九钱,酒洗)、黑牵牛(六钱,炒去头末)、薄荷(四钱五分)、滑石(六钱,水飞)、槟榔(七钱半,童便洗晒)、枳壳(四分半,面炒)、连翘(六分,去心)、赤芍(六分,炒)。
以上研为细末,蜜炼为丸,大小如芡实。一个月内的婴儿,每次服一丸,稍大的服两丸。用茶汤送化服用,乳母忌食油腻。以轻微腹泻、病愈为度。
胃苓汤(见前文泄泻方内)。治疗中湿引起的头重、身体寒热往来。
《医宗集成》中的茵陈饮治疗中湿发黄,大小便涩滞。
茵陈(二钱)、栀子、赤茯苓、甜葶苈、甘草、灯心草(各一钱)、小枳实(七分)。
五皮饮合胃苓汤专门治疗浮肿。
生姜、大腹皮、茯苓、桑白皮、五加皮、灯心草、大枣(各一钱)。
茵陈五苓散治疗中湿发黄。
茵陈(二钱)、白术、茯苓、猪苓、炙甘草、生姜(各一钱)、桂枝(五分)、大枣(一枚)。
涂蔚生说:湿与燥相反。湿是水火相交之气,燥是水火不交之气。然而脾土如果没有湿,就不足以濡润消化水谷的坚硬部分;如果没有燥,又不足以消烁水谷的阴液。所以燥湿虽然属性相反,但实际上是相生相济的。如果想要脾土无病,就只有调剂其燥湿使之平和罢了。大概湿盛则壅滞寒冷,足以发生肿胀、咳嗽、呕吐、泄泻等症状。而积湿成热,又足以发生面目赤黄、胸满气逆等症状。所以治疗湿病的方剂,湿寒证主要在温燥,湿热证主要在清利。虽然燥与湿相距甚远,清与湿相近,但使它们刚柔得中,也都是治疗湿病的良将。《内经》说:脾土喜燥而恶湿。又说:太阴之上,湿气治之,中见阳明。解释的人因为脾恶湿,认为没有湿的必要;又对于“中见阳明”的含义,仅仅拘泥于它是太阴经的支络,行走于阳明经络之上。这未免对治疗湿病的全面底蕴,得一半失一半了。我认为“中见阳明”的含义,不仅仅是拘泥于支络。是说太阴之上,虽然是湿气主令,但不使其发生湿病。然而它的治法,究竟以什么为中和之道呢?回答说:想要达到中和,必须看阳明之气是如何表现的,然后才能知道湿气该如何治理。阳明之气以燥为本,其中和之道也以燥为本。因为只有这样才能中和,只有这样才能无不中和。后辈贤人虽然没有将此中的微妙义理揭示出来,但知道治疗湿病要用燥法,这也是完全体会并具备了先圣的妙得心法啊。
The *Yellow Emperor's Inner Canon* states: All swellings and fullness caused by dampness belong to the Spleen. It also says: Wind and rain injure the upper part of the body, while cold and dampness injure the lower part. Chen Feixia stated: The disease of dampness arises from four sources. One is from the heavenly qi, such as rain and dew. Another is from the earthly qi, such as mud and water. A third is from diet, such as wine, beverages, and raw or cold foods. The fourth is from human activities, such as sleeping in sweat-soaked clothes, lying on wet surfaces, like infants bathing, contact with fecal matter, or dryness not being achieved in swaddling clothes. Although the causes differ, they all stem from the deficiency of Spleen Qi. The key to differentiation and treatment lies in only two aspects: one is Damp-Heat (Shi Re), and the other is Cold-Damp (Han Shi). This covers it all. When the illness presents with fever, it is called Damp-Heat. When the illness presents with excessive cold, it is called Cold-Damp. The treatment for Damp-Heat should be clearing and draining; when heat is removed, dampness is also removed. The treatment for Cold-Damp should be drying and warming; without warmth, dampness cannot be dried.
For Damp-Heat syndrome, symptoms include fever, body pain, frequent thirst, red and scanty urine, constipation, and a surging and slippery pulse; this constitutes a Heat syndrome. The appropriate method is clearing and draining, using formulas such as Chai Ling Tang (Bupleurum and Poria Decoction) or Yin Chen Yin (Artemisia Capillaris Drink). If Damp-Heat is severe, or if the Yuan Qi is robust with accompanying constipation, pushing and purging methods may be used, such as Hangxie Dan from *Yizong Jicheng*. Cold-Damp syndrome manifests as abdominal distension, diarrhea, and vomiting; these are diseases of Cold-Damp. Whenever children play with cold water or sit/lie on wet ground, presenting with headache, heavy body, and alternating chills and fever, Wei Ling Tang (Stomach-Ling Formula) is appropriate. If accompanied by vomiting, add Huoxiang (Patchouli Herb) and Sharen (Amomum Fruit). If edema results from dampness invasion, combine Wei Ling Tang with Wu Pi Yin (Five Peel Decoction). If ineffective, warm tonification must be used, waiting for Yang Qi to gradually recover, selecting from Lizhong Tang (Regulate the Middle Decoction) or Bawei Wan (Eight-Ingredient Pill) as appropriate. Generally, Spleen deficiency leads to many damp diseases. Internal causes include stagnation of yeast/wine residue, craving fruits and melons, preference for raw/cold foods, and roasted/fatty/sweet foods, leading to accumulation and overflow of Damp-Heat; this is an internal cause. External causes include sitting/lying on wet ground, invasion by fog/dew/rain, pores closed by wind during bathing, or mud/water dampness郁stagnating in the cou-li (interstitial spaces), leading to jaundice; this is dampness generated externally.
Thus, both internal and external dampness invasions occur due to Spleen Qi deficiency, allowing damp pathogens to attack. For jaundice caused by dampness invasion, use Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Powder); if ineffective, use Liujunzi Tang (Six-Gentlemen Decoction). Drying the Spleen Earth will naturally make the yellow color recede. *Yizong Jicheng*'s Ziling Tang treats dampness invasion with aversion to heat resembling malaria.
Dangshen (Codonopsis Root), Chaihu (Bupleurum Root), Huangqin (Scutellaria Root), Banxia (Pinellia Tuber), Baizhu (Atractylodes Rhizome), Fuling (Poria), Zhuling (Polyporus), Zexie (Alisma Rhizome - 1 qian), Guizhi (Cinnamon Twig - 5 fen), Zhigancao (Honey-fried Licorice Root - 1 qian), Shengjiang (Fresh Ginger - 1 qian), Dazao (Jujube - 1 piece).
*Yizong Jicheng*'s Chaixie Dan treats all heat syndromes in infants and children, such as fetal toxin, thrush, double tongue, tonsillar swelling, constipation, tinea, scabies, and wind-heat.
Chuanxiong (Ligusticum Rhizome - 9 qian, wine-washed), Dahuang (Rhubarb Root - 9 qian), Huangqin (Scutellaria Root - 9 qian, wine-washed), Huangbai (Phellodendron Bark - 9 qian, wine-washed), Heiqianniu (Black Morning Glory Seed - 6 qian, stir-fried, head and tail removed), Bohe (Mint Leaf - 4.5 qian), Huashi (Talcum - 6 qian, water-ground), Binglang (Areca Seed - 7.5 qian, washed and dried in child's urine), Zhiqiao (Bitter Orange Fruit - 0.45 qian, flour-fried), Lianqiao (Forsythia Fruit - 0.6 fen, heart removed), Chishao (Red Peony Root - 0.6 fen, stir-fried).
Grind into powder, form pills with honey the size of Euryale Seed. Infants within one month take one pill; older infants take two pills. Dissolve in tea or broth. Nursing mothers must avoid greasy food. Stop when mild diarrhea occurs and the illness resolves.
Wei Ling Tang (see Diarrhea formula above). Treats dampness invasion causing heavy head and alternating chills and fever.
*Yizong Jicheng*'s Yincheng Yin treats dampness-induced jaundice with obstructed urination and defecation.
Yinchen (Artemisia Capillaris Herba - 2 qian), Zhizi (Gardenia Fruit), Chi Fuling (Red Poria), Tiantingli (Descurainia Seed), Gancao (Licorice Root), Dengxincao (Juncus Medulla) (each 1 qian), Xiao Zhishi (Immature Bitter Orange - 0.7 fen).
Wu Pi Yin combined with Wei Ling Tang specifically treats edema.
Shengjiang (Fresh Ginger), Dafupi (Areca Peel), Fuling (Poria), Sangbaipi (Mulberry Root Bark), Wujiaopi (Acanthopanax Bark), Dengxincao (Juncus Medulla), Dazao (Jujube) (each 1 qian).
Yinchen Wuling San treats dampness-induced jaundice.
Yinchen (Artemisia Capillaris Herba - 2 qian), Baizhu (Atractylodes Rhizome), Fuling (Poria), Zhuling (Polyporus), Zhigancao (Honey-fried Licorice Root), Shengjiang (Fresh Ginger) (each 1 qian), Guizhi (Cinnamon Twig - 5 fen), Dazao (Jujube - 1 piece).
Tu Weisheng said: Dampness is contrary to Dryness. Dampness is the qi of Water and Fire interacting; Dryness is the qi of Water and Fire not interacting. However, Spleen Earth requires Dampness to moisten and transform the hardness of food and drink; it requires Dryness to consume and dissolve the yin of food and drink. Thus, although Dryness and Dampness are opposite, they actually generate and assist each other. To keep Spleen Earth healthy, one must balance its Dryness and Dampness. Excessive Dampness leads to stagnation and cold, causing swellings, coughs, vomiting, and diarrhea. Accumulated Dampness turning into Heat causes red/yellow face and eyes, chest fullness, and rebellious Qi. Therefore, treatments for Damp-Cold focus on warming and drying, while treatments for Damp-Heat focus on clearing and draining. Although Dryness and Dampness are far apart, and Clearing and Dampness are close, making them balanced in rigidity and softness makes them excellent generals for treating dampness. The *Canon* states: Spleen Earth likes Dryness and dislikes Dampness. It also says: Above Taiyin, Dampness governs; internally connected to Yangming. Interpreters, because Spleen dislikes Dampness, argue that Dampness is unnecessary; regarding "internally connected to Yangming," they restrict it to being a collateral branch of Taiyin running along Yangming meridians. This misses half the comprehensive understanding of treating dampness. I believe "internally connected to Yangming" is not just about collaterals. It means that although Dampness governs above Taiyin, it does not necessarily cause Dampness disease. The question is: what is the middle way in its treatment? Answer: To achieve harmony, one must observe how Yangming Qi behaves, then determine how to treat Dampness. Yangming Qi takes Dryness as its root; its harmony also takes Dryness as its root. Only thus can there be harmony, and only thus can there be no disharmony. Later scholars have not revealed this subtle meaning, but those who know to treat dampness with Dryness have fully comprehended the profound method of the sages.