湿有从外入者。有自内得者。阴雨湿地。皆从外入。其症头重腰冷。一身尽重。冷浆瓜
果。皆自内得。其症泄泻腹胀。肠有水气。淋浊痰饮。然外湿亦可渐入于内。内湿亦有浸渍
于外。失此不治。则郁而为热。变症多端。不可不察。湿脉多缓。（是怠缓。非和缓。） 浮
大者易治。沉细小者难医。
一内外湿总方。宜
二陈汤加苍术白术羌活王之。○外湿加紫苏防风猪苓泽泻干葛木瓜主之。○内湿。加木
通泽泻砂仁木香。食积。加山楂麦芽枳实。寒湿。加干姜。湿热。加黄连黄芩。热轻者。只
用连翘。○槟榔时嚼。亦妙。（八十二）
受湿腰痛。其痛冷重沉着。如带五千钱。宜肾着汤。（八十四）
白浊不止。为湿热下注。妇人白带亦然。宜萆 厘清饮。○如妇人白带。加半夏芡实苡
仁黄柏生白术主之。（八十三）
一伤湿一身尽痛。不可转动。宜
一味白术酒。（八十五）
一苍术多脂易霉而治湿。与僵蚕死于风而治风。驴皮动火制成阿胶而降火。俱是造物妙
处。即大易所谓同气相求。内经所谓衰之以其属是也。盖湿邪在人肠胃。原自不安。一得苍
术。气味便与之合一。气从汗出。味随水谷下行。先诱之。而后攻之也。
大抵暂痛为邪。久痛为虚。邪则分寒热而除之。虚则审阴阳而补之。然亦有久痛为邪所
缠。新痛因虚而发者。当因脉证而辨之。
脉浮滑者生。短涩者死。
一伤寒六经俱有头痛。太阳痛在脑后。必连项强。宜九味羌活汤。加葱白三根。○阳明
痛在额前。必连目眶。宜升麻葛根汤。○少阳痛在侧。必兼两胁痛多呕。宜逍遥散。去白术。
加半夏黄芩川芎。○太阴无头痛。然湿土动而生痰。亦为头痛。宜二陈汤。加制南星苍术川
芎。○少阴头痛。脉细俱欲寐。宜五积散。加细辛附子。○厥阴头痛如破。干呕吐涎沫。宜
吴茱萸二钱。人参一钱五分。生姜四钱。大枣四枚。水煎服。名吴茱萸汤。
一火邪头痛。火盛者宜竹叶石膏汤加减。方见伤寒。如火势轻者。只用辛凉之品。火郁
发之之义也。宜
加味逍遥散。加葛根二钱酒炒。黄柏一钱。薄荷五分。（四十八）
一气实有痰。或头重眩晕。用大黄酒炒三遍为末。茶调三钱服。此釜下抽薪之法也。
一偏头痛。宜
二陈汤。偏在右者。宜沙参一两酒炒。黄芩黄连川芎防风制南星之类。偏在左者。
加当归一
气虚头痛。宜
补中益气汤。少加川芎蔓荆子之类。（五）
一血虚头痛。宜
四物汤。倍川芎。加黄柏知母。少加蔓荆子细辛之类。（九）
当归补血汤。加鹿茸五钱。水酒各半煎。（六）
一眉棱角痛。宜半夏六钱。生姜三片。水煎。调沉香末五分服。
一真头痛。痛甚。脑尽痛。手足寒至节不治。然不忍坐视其死。急灸百会。吞黑锡丹。
（三十）
一肾虚头痛。诸药不效。宜
六味汤。去丹泽。加枸杞三钱炙甘草细辛各一钱。川芎二钱。肉苁蓉三钱五分。
○如命门火
一蒸法最效方。用川芎半两。晚蚕砂二两。僵蚕如患者年岁之数。以水五碗。煎至三碗。
就砂锅中。以浓纸糊满。中间开钱大一孔。取药气。熏蒸痛处。每日一次。虽年久者。三五
次永不再发。
湿邪有从外部侵入的，也有从内部产生的。阴雨天气和潮湿环境导致的湿气，都是从外部侵入的。其症状表现为头部沉重、腰部发冷、全身困重。生冷瓜果等饮食不当导致的湿气，都是从内部产生的。其症状表现为泄泻、腹胀、肠道内有水气停滞、小便淋沥浑浊或痰饮内停。然而，外感湿邪也可以逐渐内传入里，内生湿邪也可以浸渍于体表。如果不及时诊治，湿邪郁结就会化热，变证繁多，不可不仔细辨别。湿病的脉象多呈缓脉。（这里的“缓”是指怠慢迟缓，而非平和舒缓。）脉象浮大的容易治疗，脉象沉细小难的难以医治。
一方：治疗内外湿邪的总方，适宜使用二陈汤（燥湿化痰、理气和中的基础方）加苍术、白术、羌活来主治。○如果是外湿，加紫苏、防风、猪苓、泽泻、干葛、木瓜来主治。○如果是内湿，加木通、泽泻、砂仁、木香。如果有食积，加山楂、麦芽、枳实。如果是寒湿，加干姜。如果是湿热，加黄连、黄芩；热势较轻的，只用连翘。○槟榔细细咀嚼，效果也很好。（第八十二条）
受湿邪引起的腰痛，疼痛感觉寒冷、沉重且固定不移，如同腰上系着五千枚铜钱一样沉重。适宜使用肾着汤。（第八十四条）
白浊（尿道口流出白色分泌物）不止，是因为湿热下注所致。妇女白带过多也是同样的道理。适宜使用萆薢分清饮。○如果是妇女白带，加半夏、芡实、薏苡仁、黄柏、生白术来主治。（第八十三条）
一方：伤湿导致全身疼痛，身体僵硬不能转动。适宜使用一味白术酒。（第八十五条）
一方：苍术多油脂，容易发霉，但能治疗湿邪；僵蚕死于风病，却能治疗风病；驴皮本易动火，制成阿胶后反而能降火。这些都是造化的奇妙之处，也就是《易经》所说的“同气相求”，《内经》所说的“衰之以其属”（用同类性质的药物来削弱病邪）。大概湿邪在人的肠胃中，原本就不安分，一旦遇到苍术，气味便与它相合，气随汗液排出，味随水谷下行，先诱导它，然后再攻逐它。
大抵，突然发作的疼痛属于邪气实证，久治不愈的疼痛属于正气虚证。邪气实证则分辨寒热而祛除它，正气虚证则审察阴阳而补益它。然而，也有久痛是因为邪气纠缠，新痛是因为正气虚弱而引发的情况，应当根据脉象和症状来辨别。
脉象浮滑的预后良好，脉象短涩的预后不良（主死）。
一方：伤寒六经都有可能出现头痛。太阳经头痛在后脑勺，必定牵连项部僵硬。适宜使用九味羌活汤，加葱白三根。○阳明经头痛在前额，必定牵连眼眶。适宜使用升麻葛根汤。○少阳经头痛在头部两侧，必定兼有两胁疼痛、多呕吐。适宜使用逍遥散，去掉白术，加半夏、黄芩、川芎。○太阴经一般没有头痛，但如果湿土之气发动而生痰，也会引起头痛。适宜使用二陈汤，加制南星、苍术、川芎。○少阴经头痛，脉象细弱，精神萎靡想睡觉。适宜使用五积散，加细辛、附子。○厥阴经头痛剧烈如破，干呕、吐涎沫。适宜使用吴茱萸二钱，人参一钱五分，生姜四钱，大枣四枚，水煎服，名为吴茱萸汤。
一方：火邪引起的头痛，火势旺盛的适宜使用竹叶石膏汤加减（方剂见伤寒篇）。如果火势轻微的，只用辛凉性质的药物，这是遵循“火郁发之”的原理。适宜使用加味逍遥散，加葛根二钱（酒炒）、黄柏一钱、薄荷五分。（第四十八条）
一方：气实且有痰，或者头部沉重眩晕，使用大黄（酒炒三次研为末），用茶调服三钱。这是釜底抽薪的方法。
一方：偏头痛，适宜使用二陈汤。偏在右侧的，适宜使用沙参一两（酒炒）、黄芩、黄连、川芎、防风、制南星等药。偏在左侧的，加当归一钱。
一方：气虚引起的头痛，适宜使用补中益气汤，少量加入川芎、蔓荆子等药。（第五条）
一方：血虚引起的头痛，适宜使用四物汤，加倍川芎，加黄柏、知母，少量加入蔓荆子、细辛等药。（第九条）
一方：眉棱骨角痛，适宜使用半夏六钱，生姜三片，水煎，调入沉香末五分服用。
一方：真头痛，疼痛非常剧烈，全脑皆痛，手足冰冷至关节，属于不治之症。然而不忍心坐视其死亡，急灸百会穴，吞服黑锡丹。（第三十条）
一方：肾虚引起的头痛，诸药无效时，适宜使用六味地黄汤，去掉牡丹皮、泽泻，加枸杞三钱、炙甘草一钱、细辛一钱、川芎二钱、肉苁蓉三钱五分。○如果命门火衰……
一方：蒸法是最有效的方子。使用川芎半两，晚蚕砂二两，僵蚕的数量等同于患者的年龄数。用水五碗，煎至三碗。放在砂锅中，用浓纸糊满锅口，中间开一个铜钱大小的孔，利用药气熏蒸疼痛部位。每天一次，即使是多年的老病，三五次后也永不再发。
Dampness pathogen may enter from the exterior or arise from the interior. Dampness caused by rainy weather and damp environments enters from the exterior, presenting with symptoms of heavy head, cold lower back, and generalized heaviness of the body. Dampness arising from improper diet, such as raw and cold melons and fruits, originates from the interior, manifesting as diarrhea, abdominal distension, water qi in the intestines, stranguria, turbid urine, or phlegm-fluid retention. However, external dampness can gradually penetrate inward, and internal dampness can also permeate outward. If left untreated, dampness stagnates and transforms into heat, leading to numerous variable syndromes; this must be carefully distinguished. The pulse in dampness diseases is mostly slow (here "slow" refers to lethargic and sluggish, not harmonious). A floating and large pulse indicates an easier treatment, while a deep, thin, and small pulse indicates a difficult prognosis.
General formula for both internal and external dampness: Er Chen Tang (Two-Aged Decoction) combined with Cang Zhu (Atractylodis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Qiang Huo (Notopterygii Rhizoma et Radix). ○ For external dampness, add Zi Su Ye (Perillae Folium), Fang Feng (Saposhnikoviae Radix), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Ge Gen (Puerariae Lobatae Radix), and Mu Gua (Chaenomelis Fructus). ○ For internal dampness, add Mu Tong (Akebiae Caulis), Ze Xie (Alismatis Rhizoma), Sha Ren (Amomi Fructus Rotundus), and Mu Xiang (Aucklandiae Radix). For food stagnation, add Shan Zha (Crataegi Fructus), Mai Ya (Hordei Fructus Germinatus), and Zhi Shi (Aurantii Fructus Immaturus). For cold-dampness, add Gan Jiang (Zingiberis Rhizoma). For damp-heat, add Huang Lian (Coptidis Rhizoma) and Huang Qin (Scutellariae Radix); if heat is mild, only use Lian Qiao (Forsythiae Fructus). ○ Chewing Bing Lang (Arecae Semen) slowly is also effective. (Article 82)
Low back pain due to dampness is characterized by cold, heavy, and fixed pain, feeling as if five thousand coins are tied around the waist. Shen Zhuo Tang (Kidney-Dampening Decoction) is indicated. (Article 84)
Persistent leukorrhea (white vaginal discharge) or urethral discharge is caused by damp-heat pouring downward; women's leukorrhea follows the same pattern. Bi Xie Fen Qing Yin (Grassleaf Snakegourd Root Decoction for Separating the Turbid) is indicated. ○ For women's leukorrhea, add Ban Xia (Pinelliae Rhizoma), Qian Shi (Euryales Semen), Yi Yi Ren (Coicis Semen), Huang Bo (Phellodendri Cortex), and Sheng Bai Zhu (Raw Atractylodis Macrocephalae Rhizoma). (Article 83)
Formula for injury by dampness causing generalized pain and immobility: Yi Wei Bai Zhu Jiu (One-Ingredient Atractylodis Macrocephalae Rhizoma Wine). (Article 85)
Cang Zhu (Atractylodis Rhizoma) is rich in oil and prone to mold, yet it treats dampness; Jiang Can (Bombyx Batryticatus) dies from wind but treats wind; Donkey-hide gelatin (Ejiao) is derived from skin that generates fire internally, yet processed Ejiao descends fire. These are wonders of creation, illustrating the principle of "similar qi attracts similar qi" from the *I Ching* and "diminish it by its category" from the *Nei Jing*. Dampness pathogen in the stomach and intestines is inherently unsettled; upon encountering Cang Zhu, its aroma merges with the pathogen. The qi exits via sweat, and the flavor travels down with food and water, first attracting and then attacking the pathogen.
Generally, acute pain belongs to excess pathogens, while chronic pain belongs to deficiency. Excess pathogens are dispelled by distinguishing cold and heat; deficiency is treated by examining yin and yang for tonification. However, some chronic pains persist due to pathogen entanglement, and new pains arise due to deficiency; these must be differentiated based on pulse and symptoms.
A floating and slippery pulse indicates survival; a short and choppy pulse indicates death.
Headache occurs in all six meridians in Shang Han (Cold Damage). Tai Yang headache is at the back of the head, extending to neck stiffness; Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction) with three stalks of Cong Bai (Allii Fistulosi Bulbus) is indicated. ○ Yang Ming headache is in the forehead, extending to the eye sockets; Sheng Ma Ge Gen Tang (Cimicifugae and Puerariae Decoction) is indicated. ○ Shao Yang headache is on the sides, accompanied by hypochondriac pain and vomiting; Xiao Yao San (Free and Easy Wanderer Powder) with Ban Xia (Pinelliae Rhizoma), Huang Qin (Scutellariae Radix), and Chuan Xiong (Ligustici Chuanxiong Rhizoma), omitting Bai Zhu (Atractylodis Macrocephalae Rhizoma), is indicated. ○ Tai Yin usually does not present with headache, but if damp-earth stirs and generates phlegm, headache may occur; Er Chen Tang (Two-Aged Decoction) with Zhi Nan Xing (Prepared Arisaematis Rhizoma), Cang Zhu (Atractylodis Rhizoma), and Chuan Xiong (Ligustici Chuanxiong Rhizoma) is indicated. ○ Shao Yin headache presents with a thin pulse and drowsiness; Wu Ji San (Five Accumulations Powder) with Xi Xin (Asari Radix et Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) is indicated. ○ Jue Yin headache feels like bursting, with dry heaving and spitting of saliva; Wu Zhu Yu Tang (Evodia Decoction) consisting of Wu Zhu Yu (Evodiae Fructus) 2 qian, Ren Shen (Ginseng Radix) 1.5 qian, Sheng Jiang (Zingiberis Rhizoma Recens) 4 qian, and Da Zao (Jujubae Fructus) 4 pieces, decocted in water, is indicated. (Article 82 continued/related context)
Headache due to Fire Pathogen: If fire is excessive, Zhu Ye Shi Gao Tang (Leafy Bamboo and Gypsum Decoction) modified is indicated (see Shang Han section). If fire is mild, use acrid-cool herbs to vent the constrained fire, following the principle of "venting fire constraint." Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) with Ge Gen (Puerariae Lobatae Radix) 2 qian (wine-fried), Huang Bo (Phellodendri Cortex) 1 qian, and Bo He (Menthae Haplocalycis Herba) 0.5 fen is indicated. (Article 48)
For excess qi with phlegm, or heavy head and vertigo, Da Huang (Rhei Radix et Rhizoma) fried three times in wine and powdered, taken 3 qian with tea, acts as "removing firewood from under the cauldron." (Article 48 continued)
Hemicrania: Er Chen Tang (Two-Aged Decoction) is indicated. For right-sided pain, use Sha Shen (Glehniae Radix) 1 liang (wine-fried), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Fang Feng (Saposhnikoviae Radix), and Zhi Nan Xing (Prepared Arisaematis Rhizoma). For left-sided pain, add Dang Gui (Angelicae Sinensis Radix) 1 qian. (Article 48 continued)
Qi Deficiency Headache: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with minor additions of Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Man Jing Zi (Viticipis Fructus) is indicated. (Article 5)
Blood Deficiency Headache: Si Wu Tang (Four Substances Decoction) with doubled Chuan Xiong (Ligustici Chuanxiong Rhizoma), plus Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma), and minor additions of Man Jing Zi (Viticipis Fructus) and Xi Xin (Asari Radix et Rhizoma) is indicated. (Article 9)
Dang Gui Bu Xue Tang (Angelica Tonifies Blood Decoction) with Lu Rong (Cervi Cornu Pantotrichum) 5 qian, decocted in half water and half wine, is indicated. (Article 6)
Pain at the brow bone angle: Ban Xia (Pinelliae Rhizoma) 6 qian and Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, decocted in water, taken with Chen Xiang (Aquilariae Resina) powder 0.5 fen. (Article 6 continued)
True Headache: Severe pain involving the entire brain, with cold limbs reaching the joints, is untreatable. However, unwilling to watch the patient die, urgently moxa Bai Hui (GV20) and swallow Hei Xi Dan (Black Tin Pill). (Article 30)
Kidney Deficiency Headache refractory to other treatments: Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) modified by removing Mu Dan Pi (Moutan Cortex) and Ze Xie (Alismatis Rhizoma), adding Gou Qi Zi (Lycii Fructus) 3 qian, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 1 qian, Xi Xin (Asari Radix et Rhizoma) 1 qian, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 2 qian, and Rou Cong Rong (Cynomorphii Herba) 3.5 qian. ○ If Ming Men Fire (Gate of Life Fire) is deficient... (Article 30 continued)
Steaming Method Formula: Use Chuan Xiong (Ligustici Chuanxiong Rhizoma) 0.5 liang, Wan Can Sha (Bombyx Batryticatus Sand) 2 liang, and Jiang Can (Bombyx Batryticatus) equal to the patient's age count. Decoct in five bowls of water until reduced to three bowls. Place in a clay pot, seal tightly with thick paper leaving a coin-sized hole in the center, and steam the painful area with the medicinal vapor once daily. Even for chronic cases lasting years, three to five treatments will prevent recurrence permanently.