此门所收，系湿邪外犯证，如饮食郁为湿与内湿溢为肿者，自有其类，兹不录入。（伤寒广要所收论方，
不敢重出，当并考。）
证候 病者身重脚弱，关节重疼，发热恶寒，小便秘涩，大便飧泄，自汗，腰脚冷痹，腿膝浮肿，小
便或自利，不渴，皆久坐卑湿，或为雨露所袭，或汗出衣里，受湿渐渍得之，名曰湿痹。（《三因方》）
天气下降，地气上腾，二气熏蒸，此即湿也，岂必水流湿而后为湿哉。且风之撼动，人知其为风；寒之严
凝，人知其为寒，暑之炎热，人知其为暑；惟湿之入人，行住坐卧，实熏染于冥冥之中，人居戴履，受湿最多。
况夫湿能伤脾，脾土一亏，百病根源，发轫于此矣。滞而为喘嗽，渍而为呕
吐，渗而为泄泻，溢而为浮肿，湿瘀热则发黄，湿遍体则重着，湿入关节则一身尽痛，湿聚痰涎则昏不知人，
至于为身热，为鼻塞，为直视，为郑声，为虚汗，为香港脚，为腹中胀、脐下坚，为小便难、大便自利，皆其证
也。（《直指》）
湿者，天之阴雨宿雾，地之山泽蒸气，人或中之，必溢于血脉而流于关节也。其或久处卑湿，常住水湿，
或冒雨露而行，劳伤汗出，衣里冷湿，皆能为病。经云湿为停着，《左传》曰雨淫腹疾，是以受湿之人，一身
痛重，百节酸疼，四肢肿满，筋脉弛长，发热恶寒，小便秘涩，大便飧泄也。若气不和平，湿中稍重，亦令人
半身不遂，口眼 斜，涎潮昏塞，有类风证。（《简易》）
大抵中湿，变证万端，挟风者为烦热、为流走、为拘急，兼寒者为痛、为浮肿，与风寒二气合则为痹，皆
由中湿而后，挟以异气而然也。（《济生》）
湿气伤人，在上则头重目黄、鼻塞声重，在中则痞闷不舒，在下则足胫跗肿，在经络则日晡发热，在肌肉
则肿满如泥，在肢节则屈伸强硬，在隧道则重着不移，在皮肤则顽麻。（《汇补》）
湿伤经络，人倦怠惰，世所不知。久痹历节，类痿偏欹，为恶疮湿痰寒热怪症，医所不识，此由湿之害也。
后学审明其症，从湿治之可也。（《活人心统》）
凡诸病中多兼乎惰，而世人不知治者有矣。后之医者，宜慎辨之。（《诸证辨疑》）
湿热湿寒之别 贾真孙曰∶湿为土气，火热能生湿土，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。况脾土脆弱之人，易为感冒，岂必水不流而后为湿哉。
人只知风寒之威严，不
知暑湿之炎暄，感人于冥冥之中也。《病式》云∶诸痉强直积饮等证，皆属于湿。或 肿体寒而有水气，里必
小便赤少不通或渴，是蓄热入里极深，非病寒也。大抵治法，宜理脾清热利小便为上，故治湿不利小便，非其
治也，宜桂苓甘露、木香葶苈木通治之云云。其湿证有二，湿热证多，湿寒证少，当以脉证明辨之。如脉滑数
，小便带赤，引饮，为湿热证。若小便自利清白，大便泻痢，身疼自汗，为寒湿证，治之宜五苓散加生附、苍术
、木瓜主之。（《玉机》）（按∶湿热证，《宣明论》既论之，而《医林绳墨》并立其门，论说颇繁，今不具
载。）湿者，天地郁蒸之气也，方其升腾于上，气犹笼结而未开，虽寒天值之，亦觉其温暖，此湿气之热者也。
及其布护于下，气将流演而舒散，虽暑月值之，亦觉其清凉，此湿气之寒者也。湿气之热者，多中于气虚之
人，则发而为湿热之症，头面如裹而四肢浮肿，身体沉重而转侧不便者是也。湿气之寒者，多中于血虚之人。
则发而为寒湿之症，四肢酸疼而关节不利，筋脉拘挛而行履重滞者是也。其有不因郁蒸之气而得者，必其冒雨
而行，涉水而走，或露卧以取凉，或汗衣而不解，渐渍于肌肉之中，渗入于骨髓之内，流溢于脾胃之间，牢缠
于腰肾之处，则肌肉冷而骨髓痛，脾胃薄而腰肾疼。挟于风痰则麻而不仁，兼乎死血则木而不觉，动乎火邪则
肿痛而难忍，随其所感而病斯痼焉。其有不因冒雨涉水等而得者，必其内伤生冷酒面之类，多肚腹肿胀，医者
审其湿之或寒或热，或虚或壮，病之在上在下，感之在外在内，因其病而药之，庶乎其得之矣。（《玉案》）
治例 夫寒热风湿，皆能并合为病，所谓风湿、寒湿、湿温者，其证各不同，为治亦别，不可不辨。
若治单单中
湿，只宜利小便，忌不得以火攻并转利。论曰∶治湿不利小便，非其治也。（《三因》）（按∶治湿之病，不
下小便，非其法也。本出王冰《至真要大论》注。《证治汇补》曰∶湿乃津液之属，随气化而出者也。清浊不
分，则湿气内聚，故治湿以利小便为主。）
经云∶风雨袭虚，山泽蒸气，民多受湿。湿流关节，则一身尽痛，发热身黄，小便不利，大便反快，六脉
濡弱，此感湿证也。轻者与渗湿汤、不换金正气散、和解散，甚者异功五积散、术附汤。不任热药或小便不利
者，五苓散主之。（《管见良方》）
如寒湿所伤，身重腰脚酸痛，或气弱浮肿，宜藿香正气散。如兼风寒，脚痹肿，宜五积散加防风、木瓜。
如少年有热，坐卧湿地，足肿痛，宜败毒散加苍术。（《如宜方》）
夫去湿以术为主，古方及《本经》止言术，未尝有苍白之分，自陶隐居言术有两种，后人以白者难得，故
贵而用之。殊不知白术肉浓而味甘，甘入脾能缓而养气，凡养气调中则相宜耳。苍术肉薄而味辛烈，辛烈走气
而发外，凡于治风去湿则相宜耳。以此观之，则白术治湿，不如苍术明矣。（《续易简方》）
驱湿诸方 茯苓白术汤，治受湿身体痛重。
茯苓 干姜（炮） 甘草（炙） 白术 辣桂 苍术（炒等分）
上锉。每三钱，水煎服。（《直指》）（按∶此甘姜苓术汤变方。又《三因》茯苓白术散治暑湿，与此同，
无苍术。）
苓术汤，治冒暑遭雨，暑湿郁发，四肢不仁，半身不遂，骨节离解，缓弱不收，或入浴晕倒，口眼 斜，
手足 曳，皆湿温类也。
附子（炮去皮脐） 茯苓 白术 干姜（炮） 泽泻 桂心（等分）
上为锉散，每服四钱，水盏半，煎至七分，去滓空心服。（《三因》）《杨氏》渗湿汤，治肤腠不密，易
冒风湿，身体烦疼，不能屈伸，多汗恶风，头目昏重，项背强急，手足时厥，周身麻痹，肢体微肿。于本方去
泽泻，加白芍药、人参、甘草。（按∶《三因》又有渗湿汤，与《杨氏》稍同，彼有苍术、陈皮、丁香，无附
子、芍药、人参、肉桂为异。又按∶《杨氏》此方本出《千金·历节》中，今录在彼门，宜参。）
七味除湿汤，治寒湿所伤，身重体痛，腠开汗出，大便溏泄，小便或涩或利，腰脚酸疼，腿膝浮肿，及冒
寒呕逆，悉主之。
半夏曲 川朴（姜制） 苍术（各二两） 藿香叶 陈橘皮 茯苓（各一两） 甘草（炙七钱）
上锉散，每服四钱，水一盏半，生姜七片，枣一枚，同煎至七分，去滓食前温服。（《续易简方》）
（按∶此方本出《指迷方》，无茯苓，《十便》引。）《百一》除湿汤，治一切中湿自汗，渐渐恶风，翕翕发
热，阳虚自汗，呼吸少气。于本方加白术、附子。《直指》加剂除湿汤，治气虚伤湿，身重腰疼，四肢微冷，
或呕逆，或溏泄。于本方去半夏、藿香，加白术、干姜、辣桂。
加味防己黄 汤，治风湿相搏，客于皮肤，四肢少力，关节烦疼。
防己（三钱） 黄 （四钱） 白术（三钱） 甘草（一钱） 苍术（一钱） 薏苡仁（一钱五分）
川独活（一钱） 姜（三片） 红枣（一枚）
上作一服。水二钟。煎一钟。不拘时服。（《医经会元》）
清湿方 动于火为湿热，腰背跨疼，身重倦怠，身如板夹，脚似沙坠，表里温热，尺脉强而寸弱，宜
用清湿汤。
羌活 独活 防风 泽泻 薏苡仁 防己 赤芍 黄柏 黄芩 甘草
小便赤涩或秘，加炒栀子仁、茵陈、商陆、海金沙、滑石、木通。（《医经会解》）
过汗亡阳治验 中山王知府次子薛里，年十三岁，六月十三日，豪雨方过，池水泛溢，因而戏水，衣
服尽湿，其母责之，至晚觉精神昏愦，怠惰嗜卧，次日病头痛身热，腿脚沉重。一女医用和解散发之，闭户塞
牖，覆以重衾，以致苦热不胜禁，遂发狂言，欲去其衾而不能得去，是夜汗至四更，湿透其衾，明日寻衣撮空。
又以承气汤下之，下后语言渐不出，四肢不能收持，有时项强，手足 搐急而挛，目左视而白睛多，口唇肌
肉蠕动，饮食减少，形体羸瘦。命予治之，具说前由。予详之，盖伤湿而失于过汗也。且人之元气，起于脐下
肾间动气，周于身，通行百脉。今盛暑之时，大发其汗，汗多则亡阳，百脉行涩，故三焦之气不能上荣心肺，
心火旺而肺气 。况因惊恐内蓄，《内经》曰恐则气下，阳主声，阳既亡而声不出也。阳气者精则养神，柔则养
筋。又曰夺血无汗，夺汗无血。今发汗过多，气血俱衰，筋无所养，其病为痉，则项强，手足 搐急而挛。
目通于肝，肝者筋之合也，筋既燥而无润，故目左视而白睛多。肌肉者脾也，脾热则肌肉蠕动，故口唇蠕动，
有时而作。经云肉痿者，得之湿地也。脾热者，肌肉不仁，发为肉痿。痿者痿弱无力运动，久为不仁。阳主于
动，今气欲竭，热留于脾，故四肢不用。此伤湿过汗而成坏证明矣。当治时之热，益水之原救其逆，补上升生
发之气《黄帝针经》曰∶上气不
足，推而扬之。此之谓也。以人参益气汤治之。《内经》曰∶热淫所胜，治以甘寒，以酸收之。人参、黄 之
甘温，补其不足之气而缓其急搐，故以为君。肾恶燥，急食辛以润之。生甘草甘微寒，黄柏苦辛寒，以救肾水
而生津液，故以为臣。当归辛温和血脉，橘皮苦辛，白术苦甘，炙甘草甘温，益脾胃，进饮食。肺欲收，急食
酸以收之。白芍药之酸微寒，以收耗散之气而补肺金，故以为佐。升麻、柴胡苦平上升，生发不足之气，故以
为使。乃从阴引阳之谓也。
人参益气汤。
黄 （五分） 人参 黄柏（去皮） 升麻 柴胡 白芍药（各三分） 当归 白术 炙甘草（各二分）
陈皮（三分） 生甘草（二分）
上十一味 咀，都为一服，水二盏半，先浸两时辰，煎至一盏，去渣热服，早食后、午食前各一服投之。
三日后语声渐出，少能行步，四肢柔和，食饮渐进，至秋而愈。（《宝鉴》）
足跟肿痛治验 江篁南自治一少年，夏月因以冷水浸两足跟，又坐湿地，患足跟肿痛，不能移步，困
卧数月。教以干土圾一块，挖一凹如足跟大，炭火烧红去火，用醋一碗沃之，任其渗干，乃以足跟临土圾，初
略悬高熏之，渐渐近之，其下体骨节皆酸快不可言，且有微汗，连换土砖，熏三四日而愈。（《类案》）
本门收录的，是湿邪从外部侵袭的证候。至于因饮食停滞郁结化为湿，以及内湿泛滥导致浮肿的情况，自有专门的门类记载，这里不再录入。（《伤寒广要》中收录的论述和方剂，不敢重复列出，应当一并考证。）
证候 患者身体沉重、脚部软弱无力，关节沉重疼痛，发热恶寒，小便短少涩滞，大便完谷不化（飧泄），自汗，腰部和脚部寒冷麻木，腿部和膝盖浮肿，小便有时通畅，口不渴。这些都是因为久坐低洼潮湿之地，或被雨露侵袭，或出汗后衣服里层受湿逐渐浸渍而得病，称为湿痹。（《三因方》）
天气下降，地气上升，二气熏蒸，这就是湿，难道一定要水流向湿处才叫湿吗？况且风的摇动，人们知道它是风；寒的严酷凝结，人们知道它是寒；暑的炎热，人们知道它是暑；只有湿侵入人体，在行走、站立、坐着、躺卧时，实际上是在不知不觉中熏染着人，人头顶天脚踏地，受湿最多。何况湿能损伤脾脏，脾土一旦亏损，百病的根源便由此发端了。湿气滞留则变成喘咳，浸渍则变成呕吐，渗漏则变成泄泻，溢出则变成浮肿，湿与瘀热结合则发黄，湿遍全身则身体重着，湿进入关节则全身疼痛，湿聚集成痰涎则神志昏迷不知人事，至于表现为身热、鼻塞、直视、郑声（语声低微重复）、虚汗、香港脚（脚气病）、腹中胀满、脐下坚硬、小便困难、大便通畅等，都是它的证候。（《直指》）
湿，是天上的阴雨宿雾，地上的山泽蒸气，人如果中了它，必定会溢于血脉并流注于关节。或者久处低洼潮湿之地，常住水湿环境，或者冒雨淋露而行，劳累出汗后衣服冷湿，都能致病。经书说湿具有停着不移的特性，《左传》说雨水淫滥会导致腹部疾病，所以受湿的人，全身疼痛沉重，各个关节酸痛，四肢肿满，筋脉松弛伸长，发热恶寒，小便短少涩滞，大便完谷不化。如果气机不和平，湿邪稍重，也会让人半身不遂，口眼歪斜，痰涎上涌神志昏塞，症状类似中风。（《简易》）
大抵中湿，变证万千，挟带风邪的表现为烦热、游走性疼痛、拘急，兼夹寒邪的表现为疼痛、浮肿，与风寒二气结合则为痹证，都是由中湿之后，挟带其他邪气而导致的。（《济生》）
湿气伤人，在上部则头重、目黄、鼻塞声音重浊，在中部则痞闷不舒，在下部则小腿和足背肿胀，在经络则傍晚发热，在肌肉则肿满如泥，在肢节则屈伸强硬，在隧道（指深层脉络）则重着不移，在皮肤则顽麻。（《汇补》）
湿伤经络，人会倦怠懒惰，世人并不知晓。久痹历节，类似痿证偏侧倾斜，成为恶疮、湿痰、寒热怪症，医生不认识，这都是湿害造成的。后学者审明其症状，从湿治疗就可以了。（《活人心统》）
各种病症中多兼有倦怠，但世人不知道治疗的也有。后来的医生，应该谨慎辨别。（《诸证辨疑》）
湿热与湿寒的区别 贾真孙说：湿是土之气，火热能生湿土，所以夏天热万物湿润，秋天凉万物干燥。湿病本来不是自己产生的，是因为热而郁结，不能宣通水道，所以停滞而生湿。何况脾土脆弱的人，容易感冒，难道一定要水不流动才叫湿吗？人们只知道风寒的威严，不知道暑湿的炎暄，是在不知不觉中感染人的。《病式》说：各种痉强直、积饮等证候，都属于湿。或者身体浮肿怕冷而有水气，体内必定小便赤少不通或口渴，这是蓄热入里极深，不是寒病。大抵治法，以调理脾胃、清热、利小便为上策，所以治疗湿如果不利小便，就不是正确的治法，适宜用桂苓甘露散、木香葶苈木通汤等治疗。湿证有两种，湿热证多，湿寒证少，应当通过脉象和症状来辨别。如脉滑数，小便带红色，想喝水，是湿热证。若小便自利清白，大便泻痢，身体疼痛自汗，是寒湿证，治疗适宜用五苓散加生附子、苍术、木瓜为主。（《玉机》）（按：湿热证，《宣明论》已经论述过，而《医林绳墨》并立其门，论述颇繁，现在不详细记载。）湿，是天地郁蒸之气，当它升腾于上时，气还笼结而未开，即使是寒冷的天气遇到它，也觉得温暖，这是湿气的热者。当它布护于下时，气将流演而舒散，即使是暑月遇到它，也觉得清凉，这是湿气的寒者。湿气的热者，多中于气虚之人，则发为湿热之症，头面像被包裹一样，四肢浮肿，身体沉重而转侧不便。湿气的寒者，多中于血虚之人，则发为寒湿之症，四肢酸痛而关节不利，筋脉拘挛而行走迟缓。那些不是因为郁蒸之气而得的，一定是冒雨而行，涉水而走，或者露天睡觉取凉，或者出汗的衣服不解开，逐渐浸渍于肌肉之中，渗入骨髓之内，流溢于脾胃之间，牢缠于腰肾之处，则肌肉冷而骨髓痛，脾胃薄弱而腰肾疼。挟带风痰则麻木不仁，兼夹死血则木然不觉，触动火邪则肿痛难忍，随着所感的邪气不同，病就顽固了。那些不是因为冒雨涉水等而得的，一定是内伤生冷酒面之类，大多肚腹肿胀，医生审察湿的或寒或热，或虚或实，病在上在下，感邪在外在内，根据病情用药，差不多就能治好了。（《玉案》）
治例 寒、热、风、湿，都能合并致病，所谓风湿、寒湿、湿温，它们的证候各不相同，治疗方法也不同，不可不辨别。如果治疗单纯的中湿，只宜利小便，忌讳用火攻和过度利尿。论曰：治疗湿如果不利小便，就不是正确的治法。（《三因》）（按：治疗湿病，不下小便，不是正法。本出自王冰对《至真要大论》的注释。《证治汇补》说：湿属于津液，随气化而出。清浊不分，则湿气内聚，所以治湿以利小便为主。）
经书说：风雨袭击虚弱之处，山泽蒸气，百姓多受湿。湿流注关节，则全身疼痛，发热身黄，小便不利，大便反而快，六脉濡弱，这是感湿证。轻的用渗湿汤、不换金正气散、和解散，重的用异功五积散、术附汤。不耐热药或小便不利的，用五苓散主治。（《管见良方》）
如果是寒湿所伤，身体沉重腰脚酸痛，或者气弱浮肿，适宜用藿香正气散。如果兼夹风寒，脚部麻木肿胀，适宜用五积散加防风、木瓜。如果是少年有热，坐卧湿地，足部肿痛，适宜用败毒散加苍术。（《如宜方》）
去除湿邪以白术为主，古方及《本经》只说术，未曾有苍白之分，自从陶隐居说术有两种，后人因为白术难得，所以珍贵并使用它。殊不知白术肉质浓密而味甘，甘入脾能缓而养气，凡是养气调中都适宜。苍术肉质薄而味辛烈，辛烈走气而发散向外，凡是治疗风去湿都适宜。由此看来，白术治湿，不如苍术明显。（《续易简方》）
驱湿诸方 茯苓白术汤，治疗受湿身体痛重。
茯苓、干姜（炮制）、甘草（炙）、白术、辣桂（肉桂）、苍术（炒，各等分）。
以上切碎。每服三钱，水煎服。（《直指》）（按：这是甘姜苓术汤的变方。另外《三因》茯苓白术散治暑湿，与此相同，没有苍术。）
苓术汤，治疗冒暑遭雨，暑湿郁结发作，四肢麻木不仁，半身不遂，骨节分离感，弛缓软弱不收，或者洗澡晕倒，口眼歪斜，手足牵引，都是湿温类病。
附子（炮制去皮脐）、茯苓、白术、干姜（炮制）、泽泻、桂心（各等分）。
以上锉成散剂，每服四钱，水一盏半，煎至七分，去渣空腹服。（《三因》）《杨氏》渗湿汤，治疗肤腠不紧密，容易冒受风湿，身体烦疼，不能屈伸，多汗恶风，头目昏重，项背强急，手足时常厥冷，周身麻痹，肢体微肿。在本方中去掉泽泻，加白芍药、人参、甘草。（按：《三因》又有渗湿汤，与《杨氏》稍同，彼方有苍术、陈皮、丁香，无附子、芍药、人参、肉桂为异。又按：《杨氏》此方本出《千金·历节》篇，现在录在那一门，宜参考。）
七味除湿汤，治疗寒湿所伤，身体沉重体痛，腠理开泄汗出，大便溏泄，小便或涩或利，腰脚酸痛，腿膝浮肿，以及冒寒呕逆，都主治。
半夏曲、川朴（姜制）、苍术（各二两）、藿香叶、陈橘皮、茯苓（各一两）、甘草（炙七钱）。
以上锉散，每服四钱，水一盏半，生姜七片，枣一枚，同煎至七分，去渣食前温服。（《续易简方》）（按：此方本出《指迷方》，无茯苓，《十便》引用。）《百一》除湿汤，治疗一切中湿自汗，渐渐恶风，翕翕发热，阳虚自汗，呼吸少气。在本方加白术、附子。《直指》加剂除湿汤，治疗气虚伤湿，身体沉重腰疼，四肢微冷，或呕逆，或溏泄。在本方去掉半夏、藿香，加白术、干姜、辣桂。
加味防己黄芪汤，治疗风湿相搏，客于皮肤，四肢少力，关节烦疼。
防己（三钱）、黄芪（四钱）、白术（三钱）、甘草（一钱）、苍术（一钱）、薏苡仁（一钱五分）、川独活（一钱）、姜（三片）、红枣（一枚）。
以上作一服。水二钟。煎一钟。不拘时候服。（《医经会元》）
清湿方 动于火为湿热，腰背胯部疼痛，身体沉重倦怠，身如板夹，脚似沙坠，表里温热，尺脉强而寸弱，适宜用清湿汤。
羌活、独活、防风、泽泻、薏苡仁、防己、赤芍、黄柏、黄芩、甘草。
小便赤涩或秘，加炒栀子仁、茵陈、商陆、海金沙、滑石、木通。（《医经会解》）
过汗亡阳治验 中山王知府次子薛里，十三岁，六月十三日，豪雨刚过，池水泛溢，因而戏水，衣服尽湿，他母亲责骂他，到晚上觉得精神昏愦，怠惰嗜睡，第二天病头痛身热，腿脚沉重。一女医用和解散发汗，关闭门窗，盖上厚被子，以致苦热不胜忍受，于是发狂言，想要去掉被子却做不到，这天夜里汗出直到四更，湿透了他的被子，第二天寻衣撮空（胡摸乱抓）。又用承气汤攻下，下后语言渐渐不出，四肢不能收持，有时项强，手足抽搐拘挛，眼睛向左看而白睛多，口唇肌肉蠕动，饮食减少，形体消瘦。请我治疗，详细说明前因。我详查，原来是伤湿而失于过汗。而且人的元气，起于脐下肾间动气，周流全身，通行百脉。现在盛暑之时，大发其汗，汗多则亡阳，百脉行涩，所以三焦之气不能上荣心肺，心火旺而肺气...（原文此处可能有缺字，推测为“肺气虚”或类似含义，结合下文“夺汗无血”，意指气阴两伤）。况且因惊恐内蓄，《内经》说恐则气下，阳主声，阳气既亡而声不出。阳气者精则养神，柔则养筋。又说夺血无汗，夺汗无血。现在发汗过多，气血俱衰，筋无所养，其病为痉，则项强，手足抽搐拘挛。目通于肝，肝者筋之合也，筋既燥而无润，故目左视而白睛多。肌肉者脾也，脾热则肌肉蠕动，故口唇蠕动，有时而作。经云肉痿者，得之湿地也。脾热者，肌肉不仁，发为肉痿。痿者痿弱无力运动，久为不仁。阳主于动，现在气欲竭，热留于脾，故四肢不用。这是伤湿过汗而成坏证明显了。应当治疗当时的热，益水之源救其逆，补上升生发之气。《黄帝针经》说：上气不足，推而扬之。说的就是这个。用人参益气汤治疗。《内经》说：热淫所胜，治以甘寒，以酸收之。人参、黄芪的甘温，补其不足之气而缓其急搐，所以作为君药。肾恶燥，急食辛以润之。生甘草甘微寒，黄柏苦辛寒，以救肾水而生津液，所以作为臣药。当归辛温和血脉，橘皮苦辛，白术苦甘，炙甘草甘温，益脾胃，进饮食。肺欲收，急食酸以收之。白芍药的酸微寒，以收耗散之气而补肺金，所以作为佐药。升麻、柴胡苦平上升，生发不足之气，所以作为使药。这就是从阴引阳的意思。
人参益气汤。
黄芪（五分）、人参、黄柏（去皮）、升麻、柴胡、白芍药（各三分）、当归、白术、炙甘草（各二分）、陈皮（三分）、生甘草（二分）。
以上十一味捣碎，都为一服，水二盏半，先浸泡两个时辰，煎至一盏，去渣热服，早食后、午食前各服一次。三天后语声渐出，稍微能行走，四肢柔和，饮食渐进，到秋天痊愈。（《宝鉴》）
足跟肿痛治验 江篁南自我治疗一个少年，夏天因为用冷水浸泡双脚脚跟，又坐湿地，患足跟肿痛，不能移步，困卧数月。教他用干土块一块，挖一凹如脚跟大小，炭火烧红去火，用一碗醋浇在上面，任其渗透干透，然后把脚跟靠近土块，起初略悬高熏之，渐渐靠近它，其下体骨节都酸快不可言，且有微汗，连换土砖，熏三四日而愈。（《类案》）
This section collects syndromes where dampness pathogen invades from the exterior. As for dampness formed by dietary stagnation and internal dampness overflowing to cause edema, these have their own categories and are not included here. (The discussions and formulas collected in *Shanghan Guangyao* will not be repeated; they should be cross-referenced.)
**Syndromes** The patient experiences heavy body and weak legs, heavy and painful joints, fever with aversion to cold, scanty and difficult urination, undigested stool in diarrhea (Sun Xie), spontaneous sweating, cold and numbness in the lower back and legs, and edema in the thighs and knees. Urination may be normal or unthirsty. These conditions arise from sitting long in low and damp places, being exposed to rain and dew, or having sweat-soaked clothes that gradually soak the body with dampness. This is called Damp Bi Syndrome (Dampness Obstruction). (*Sanyin Fang*)
When heavenly Qi descends and earthly Qi ascends, steaming each other, this is Dampness. Must there be flowing water to constitute Dampness? People know wind by its shaking, cold by its freezing, and heat by its scorching; but when Dampness enters the human body, it infiltrates silently during walking, standing, sitting, and lying down. Humans live under heaven and walk on earth, receiving the most Dampness. Moreover, Dampness damages the Spleen. Once Spleen Earth is deficient, the root of all diseases begins here. Stagnant Dampness becomes asthma and cough; soaking Dampness becomes vomiting; seeping Dampness becomes diarrhea; overflowing Dampness becomes edema. Dampness combined with stagnant heat causes jaundice; Dampness pervading the body causes heaviness; Dampness entering joints causes whole-body pain; Dampness gathering into phlegm-saliva causes unconsciousness. Other manifestations include fever, nasal congestion, staring eyes, Zheng Sheng (repetitive low voice), deficiency sweating, Hongxiangjiao (Charley Horse/Foot Qi), abdominal distension, hardness below the umbilicus, difficult urination, and free stool. All are symptoms of Dampness. (*Zhizhi*)
Dampness refers to lingering fog and rain from the sky, and vapor from mountains and marshes on earth. If humans are affected by it, it must overflow into the blood vessels and flow into the joints. Whether staying long in damp places, living in wet environments, walking in rain and dew, or sweating after labor with cold, damp clothes, all can cause disease. The Classics state that Dampness tends to stagnate and adhere. The *Zuo Zhuan* says excessive rain causes abdominal diseases. Thus, those affected by Dampness suffer from whole-body pain and heaviness, soreness in all joints, swelling of the four limbs, flaccid and elongated sinews, fever with aversion to cold, scanty and difficult urination, and undigested stool. If Qi is not harmonious and Dampness is slightly severe, it can also cause hemiplegia, deviation of the mouth and eye, flooding of saliva, and unconsciousness, resembling Wind Stroke. (*Jianyi*)
Generally, Zhong Shi (Middle Dampness) has myriad variations. Accompanied by Wind, it presents as irritability, heat, wandering pain, and spasms. Accompanied by Cold, it presents as pain and edema. Combined with Wind-Cold, it becomes Bi Syndrome. All result from Dampness followed by the invasion of other pathogens. (*Jisheng*)
When Dampness injures humans: in the Upper Jiao, it causes heavy head, yellow eyes, and nasal congestion with heavy voice; in the Middle Jiao, it causes chest fullness and discomfort; in the Lower Jiao, it causes swelling of the calves and dorsum of feet; in the meridians, it causes afternoon fever; in the muscles, it causes swelling like mud; in the joints, it causes stiffness and difficulty in flexion/extension; in the deep channels, it causes immovable heaviness; in the skin, it causes woody numbness. (*Huib*)
Dampness injuring the meridians causes fatigue and laziness, unknown to the world. Chronic Bi affecting the joints resembles Wei Syndrome (flaccidity syndrome) with lateral tilt, becoming malignant sores, damp-phlegm, and strange fevers, unrecognized by doctors. This is the harm of Dampness. Later learners should clarify the symptoms and treat based on Dampness. (*Huoxin Tong*)
Many diseases involve lethargy, yet people do not know how to treat it. Future physicians should distinguish carefully. (*Zhuzheng Banyi*)
**Distinction between Damp-Heat and Damp-Cold** Jia Zhen Sun said: Dampness is the Qi of Earth. Fire and Heat generate Earth-Dampness, hence summer heat makes things moist, while autumn coolness makes things dry. Dampness does not arise spontaneously; it arises because Heat causes obstruction, preventing the smooth flow of water passages, leading to stagnation and Dampness formation. Especially in people with fragile Spleen Earth, who are easily attacked, one need not wait for stagnant water to define Dampness. People only know the majesty of Wind-Cold, not the insidious nature of Summer-Heat and Dampness which infects silently. The *Bingshi* states: Various spasms, rigidity, and fluid retention syndromes belong to Dampness. Or, if the body is swollen, cold, and has water qi, with internal scanty, red, or blocked urination or thirst, this indicates deep accumulation of Heat in the interior, not Cold. Generally, treatment should prioritize regulating the Spleen, clearing Heat, and promoting urination. Therefore, treating Dampness without promoting urination is incorrect. Suitable formulas include Guiling Ganlu San, Muxiang Tingli Mutong Tang, etc. There are two types of Dampness syndromes: Damp-Heat is common, Damp-Cold is rare. They must be distinguished by pulse and symptoms. Slippery and rapid pulse, reddish urine, and desire to drink indicate Damp-Heat. Free and clear urine, diarrhea/dysentery, body ache, and spontaneous sweating indicate Damp-Cold. Treatment should use Wuling San plus Raw Fuzi, Cangzhu, and Mugua. (*Yuji*) (Note: Damp-Heat was discussed in *Xuanming Lun*, and *Yilin Shengmo* established a category for it with extensive discussion, which is not fully recorded here.) Dampness is the steaming Qi of Heaven and Earth. When ascending, the Qi is condensed and closed; even in cold weather, it feels warm—this is the "Hot" aspect of Dampness. When spreading downward, the Qi flows and disperses; even in summer, it feels cool—this is the "Cold" aspect of Dampness. The "Hot" Dampness often affects those with Qi deficiency, causing Damp-Heat syndrome: head wrapped feeling, limb edema, heavy body, and difficulty turning over. The "Cold" Dampness often affects those with Blood deficiency, causing Damp-Cold syndrome: sore limbs, stiff joints, contracted sinews, and heavy gait. Those not caused by steaming Qi, but by walking in rain, wading through water, sleeping outdoors to cool off, or keeping sweaty clothes on, gradually soak into muscles, penetrate marrow, overflow into Spleen/Stomach, and entangle waist/kidneys. This causes cold muscles, painful marrow, thin Spleen/Stomach, and painful waist/kidneys. Accompanied by Wind-Phlegm, it causes numbness; accompanied by dead Blood, it causes insensibility; triggered by Fire Evil, it causes unbearable swelling and pain. The illness becomes chronic depending on the pathogen. Those not caused by external exposure but by internal injury from raw/cold food, wine, or wheat, usually present with abdominal distension. Physicians should examine whether the Dampness is Cold or Heat, Deficiency or Excess, located Upper or Lower, External or Internal, and medicate accordingly. (*Yu'an*)
**Treatment Principles** Cold, Heat, Wind, and Dampness can combine to cause disease. Wind-Damp, Cold-Damp, and Damp-Warmth have different syndromes and treatments, which must be distinguished. For simple Zhong Shi, only promoting urination is suitable; fire therapy and excessive purgation are contraindicated. It is said: Treating Dampness without promoting urination is not the correct method. (*Sanyin*) (Note: Treating Dampness without promoting urination is not the proper method. This originates from Wang Bing's commentary on *Zhi Zhen Yao Da Lun*. *Zhengzhi Huibu* states: Dampness belongs to body fluids, exiting with Qi transformation. If Clear and Turbid are not separated, Dampness accumulates internally; thus, treating Dampness focuses on promoting urination.)
The Classics say: Wind and Rain attack deficiency; mountain and marsh vapors cause many to suffer Dampness. Dampness flowing into joints causes whole-body pain, fever, jaundice, difficult urination, and loose stool. Six pulses are soggy and weak; this is a Dampness contraction. For mild cases, use Shen Shi Tang, Buhuanjin Zhengqi San, or Hejie San. For severe cases, Yigong Wuji San or Shu Fu Tang. For those intolerant to hot herbs or with difficult urination, Wuling San is primary. (*Guanjian Liangfang*)
If injured by Cold-Damp, with heavy body, sore waist/legs, or Qi-deficient edema, use Huoxiang Zhengqi San. If complicated by Wind-Cold with leg numbness/swelling, use Wuji San plus Fangfeng and Mugua. If a youth has Heat from sitting on wet ground with swollen/painful feet, use Baidu San plus Cangzhu. (*Ruyi Fang*)
To remove Dampness, Atractylodes (Zhu) is primary. Ancient formulas and *Ben Jing* only mention Zhu, without distinguishing White or Green. Since Tao Hongjing stated there are two types, later generations valued White Zhu due to scarcity. However, White Zhu has thick flesh and sweet taste; Sweet enters Spleen to soothe and nourish Qi, suitable for nourishing Qi and regulating middle. Green Zhu has thin flesh and pungent-hot taste; Pungent-Hot moves Qi and disperses outward, suitable for treating Wind and removing Dampness. Thus, Green Zhu is clearly better for removing Dampness than White Zhu. (*Xu Yijian Fang*)
**Formulas for Expelling Dampness**
**Fuling Baizhu Tang**: Treats body pain and heaviness from Dampness.
Fuling, Ganjiang (Pao), Gancao (Zhi), Baizhu, Lagui (Rougui), Cangzhu (Chao), equal parts.
Crush. Take 3 qian, decoct in water. (*Zhizhi*) (Note: This is a variation of Ganjiang Lingzhu Tang. Also, *Sanyin*'s Fuling Baizhu San treats Summer-Dampness, same as this but without Cangzhu.)
**Lingzhu Tang**: Treats Summer-Dampness郁结 from rain/heat, causing limb numbness, hemiplegia, joint separation sensation, flaccidity, fainting in bath, deviation of mouth/eye, and limb dragging—all Wet-Warmth types.
Fuzi (Pao, peel navel), Fuling, Baizhu, Ganjiang (Pao), Zexie, Guixin, equal parts.
Crush into powder. Take 4 qian, decoct in 1.5 cups water to 0.7 cup, strain, take empty stomach. (*Sanyin*)
**Yangshi's Shen Shi Tang**: Treats loose pores susceptible to Wind-Damp, body pain, inability to bend/stretch, sweating, aversion to wind, heavy head/eyes, stiff neck/back, cold extremities, whole-body numbness, slight limb swelling. Remove Zexie from base formula, add Baishaoyao, Renshen, Gancao. (Note: *Sanyin* has another Shen Shi Tang similar to Yangshi's, containing Cangzhu, Chenpi, Dingxiang, lacking Fuzi, Shaoyao, Renshen, Rougui. Note: Yangshi's formula originates from *Qianjin* Lijie chapter, recorded there for reference.)
**Qiwei Chushi Tang**: Treats Cold-Damp injury, heavy body/pain, open pores/sweating, loose stool, variable urination, sore waist/legs, knee edema, cold-induced vomiting/reversal.
Banxia Qu, Chuanpu (Jiang zhi), Cangzhu (2 liang each), Huoxiang Ye, Chenjupi, Fuling (1 liang each), Gancao (Zhi, 7 qian).
Crush. Take 4 qian, decoct with 1.5 cups water, 7 slices ginger, 1 date, to 0.7 cup, strain, take warm before meals. (*Xu Yijian Fang*) (Note: Originates from *Zhimi Fang*, without Fuling, cited in *Shibian*.)
**Baiyi Chushi Tang**: Treats all Zhong Shi with spontaneous sweating, gradual aversion to wind, slight fever, Yang-deficiency sweating, short breath. Add Baizhu, Fuzi to base.
**Zhizhi Added-Chushi Tang**: Treats Qi-deficiency Dampness injury, heavy body/lower back pain, slightly cold limbs, vomiting, or loose stool. Remove Banxia, Huoxiang from base, add Baizhu, Ganjiang, Lagui.
**Jiawei Fangji Huangqi Tang**: Treats Wind-Damp intermingling in skin, weak limbs, annoying joint pain.
Fangji (3 qian), Huangqi (4 qian), Baizhu (3 qian), Gancao (1 qian), Cangzhu (1 qian), Yiyiren (1.5 qian), Chuanduhuo (1 qian), Jiang (3 slices), Hongzao (1 date).
One dose. Decoct 2 zhong water to 1 zhong. Take anytime. (*Yijing Huiyuan*)
**Qingshi Fang**: Movement of Fire creates Damp-Heat, causing lower back/hip pain, heavy/lazy body, board-like sensation, sand-heavy feet, internal/external warmth, strong Chi pulse and weak Cun pulse. Use Qingshi Tang.
Qianghuo, Duhuo, Fangfeng, Zexie, Yiyiren, Fangji, Chishao, Huangbai, Huangqin, Gancao.
For red/scanty/blocked urination, add Fried Zhizi Ren, Yinchen, Shanglu, Jinshasahua, Huashi, Mutong. (*Yijing Huijie*)
**Case of Yang Loss from Excessive Sweating** Xue Li, second son of Prefect Zhongshan Wang, age 13. On June 13, after heavy rain and overflowing ponds, he played in water, getting clothes wet. His mother scolded him. That night, he felt mentally confused, lazy, and sleepy. Next day, headache, fever, heavy legs. A female doctor used Hejie San to induce sweating, closed doors/windows, covered with heavy quilts. He suffered unbearable heat, spoke madly, wanted to remove quilts but couldn't. Sweated until 4th watch, soaking quilts. Next day, picked at air/clothes. Given Chengqi Tang to purge. After purging, speech became difficult, limbs unable to hold, occasional neck stiffness, hand/foot spasms, leftward gaze with white sclera showing, lip/muscle twitching, reduced diet, emaciation. I treated him. Cause: Dampness injury compounded by excessive sweating. Yuan Qi originates from Kidney movement Qi below navel, circulating body and vessels. In midsummer, excessive sweating causes Yang loss, vessel sluggishness, preventing Sanjiao Qi from nourishing Heart/Lungs. Heart Fire flares, Lung Qi fails. Fear causes Qi to sink; Yang governs voice; Yang lost, voice absent. Yang nourishes Spirit and Sinews. Losing Blood prevents sweating; losing sweat prevents Blood. Excessive sweating depletes Qi/Blood, sinews lack nourishment, causing Spasm (neck stiffness, spasms). Eyes connect to Liver (Sinew master); dry sinews cause gaze deviation. Muscles belong to Spleen; Spleen Heat causes muscle twitching. Classics: Meat Wei comes from damp ground. Spleen Heat causes Meat Wei (flaccidity). Yang governs movement; Qi exhausted, Heat stays in Spleen, limbs unusable. This is a bad manifestation from Dampness/Excessive Sweat. Treat current Heat, benefit Water source, rescue rebellion, tonify ascending Qi. *Huangdi Zhenjing*: "Insufficient upper Qi, push and raise." Use Renshen Yiqi Tang. *Neijing*: "Excessive Heat, treat with Sweet-Cold, astringe with Sour." Renshen/Huangqi (Sweet-Warm) tonify Qi and relax spasms (Monarch). Kidney dislikes Dryness, eat Pungent to moisten. Sheng Gancao (Sweet-Slight Cold), Huangbai (Bitter-Pungent-Cold) save Kidney Water/generate fluids (Minister). Danggui (Sweet-Warm) harmonizes vessels; Chenpi (Bitter-Pungent), Baizhu (Bitter-Sweet), Zhi Gancao (Sweet-Warm) benefit Spleen/Stomach/appetite. Lung desires astringency, eat Sour to astringe. Baishaoyao (Sour-Slight Cold) astringes dissipating Qi/nourishes Lung Metal (Assistant). Shengma/Chaihu (Bitter-Ping Ascending) generate insufficient Qi (Envoy). This is drawing Yang from Yin.
**Renshen Yiqi Tang**:
Huangqi (5 fen), Renshen, Huangbai (peel), Shengma, Chaihu, Baishaoyao (3 fen each), Danggui, Baizhu, Zhi Gancao (2 fen each), Chenpi (3 fen), Sheng Gancao (2 fen).
Eleven ingredients, crush. One dose, 2.5 cups water, soak 2 hours, decoct to 1 cup, strain, take hot. After morning meal, before noon meal. After 3 days, voice returns, walks slightly, limbs soft, diet improves, cured by Autumn. (*Baojian*)
**Case of Heel Swelling/Pain** Jiang Huangnan self-treated a youth. Summer, soaked heels in cold water, sat on damp ground. Heel swollen/painful, unable to walk, bedridden for months. Taught to take a block of dry soil, hollow it heel-sized, heat red with charcoal, remove fire, pour 1 bowl vinegar, let soak dry. Place heel near soil. Initially hover high to smoke, then gradually approach. Lower body joints felt extremely pleasant, slight sweat. Changed soil bricks repeatedly, smoked 3-4 days, cured. (*Lei'an*)