陈无择曰脾虚多中湿故曰湿流关节中之多使人 胀四肢关节疼痛而烦久则浮肿喘满昏不
知人挟风则眩晕呕哕兼寒则挛拳掣痛治之不得猛发汗及灼艾泄泻惟利小便为佳也
谨按脾虚中湿内因多中满痞膈泻痢外感多为痿痹 肿疼痛等证盖脾主肌肉尔况有挟风寒
暑热
不一详前人以挟风与湿在表者宜解肌兼寒与在半表里者宜温散宜渗泄唯湿热在里宜下里虚者
宜分消实脾土为上外感非脾虚宜汗之灸之要在适中病情也
详见痰饮门
详见中风门
详见香港脚门
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守真师曰葶苈木香散下神芎丸此药下水湿消肿胀
利
小便理脾胃无出乎此也腹胀脚肿甚者舟车丸下之湿热内深发黄茵陈汤下之或佐以防己黄 一
身
尽肿痛或无汗是湿流关节邪气在表宜五苓散加官桂苍术微汗之不可大汗若自汗出多热燥津液
内水不利切勿利之重损津液也宜防风白术甘草汤主之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赤涩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
陈无择说:脾虚容易感受湿邪,所以说湿气流注关节,常常使人四肢肿胀、关节疼痛且烦躁。时间久了会出现浮肿、气喘、胸满、神志昏蒙甚至不知人事。如果兼夹风邪,则出现眩晕、呕吐呃逆;兼夹寒邪,则出现肢体拘挛、抽搐疼痛。治疗时不可用猛烈的发汗法,也不可用艾灸或泻下法,只有通利小便才是最好的方法。
谨按:脾虚中湿,内因多表现为脘腹痞满、膈间不适、腹泻痢疾;外感多表现为痿证、痹证、浮肿疼痛等证候。这是因为脾主肌肉的缘故。况且还有夹带风寒暑热等不同情况,不一而足。详细论述如下:前人认为,风与湿在表者,宜用解肌法;寒与湿在半表半里者,宜用温散法或渗泄法;唯有湿热在里者,宜用攻下法;若里虚者,宜分消走泄,健脾实土为上策。若是外感而非脾虚所致,宜用发汗或艾灸,关键在于适中病情。
详见痰饮门。
详见中风门。
详见香港脚门。
贾真孙说:湿是土的气化表现,火热能生湿土之气,所以夏天炎热万物湿润,秋天凉爽万物干燥。湿病本身并非凭空产生,是因为热邪郁结,导致水道宣行不畅,从而停滞而生湿。况且脾土脆弱的人容易感冒外邪,难道一定要水流不通才算是湿吗?人们只知道风寒的威严猛烈,却不知道暑湿的炎热带人于不知不觉之中。《病式》说:各种痉病、强直、积饮等证候都属于湿。或者身体浮肿、怕冷而有水气,体内必然小便短赤、量少甚至不通,或者口渴,这是蓄热入里极深,并不是寒病。大抵治疗方法,以调理脾胃、清热、利小便为上策。所以治疗湿病如果不通利小便,就不是正确的治法。适宜用桂苓甘露散、木香葶苈汤、木通等药治疗。守真老师说:葶苈木香散、下神芎丸这些药,能下水湿、消肿胀、利小便、理脾胃,没有比这更好的了。如果腹胀脚肿严重,用舟车丸攻下之;湿热内蕴深重导致发黄,用茵陈汤攻下之;或者佐以防己黄芪汤。如果一身尽痛肿胀,或者无汗,这是湿气流注关节,邪气在表,适宜用五苓散加官桂、苍术,微微发汗即可,不可大汗淋漓。如果自汗出多,热燥伤津液,体内水液不利,切勿使用利水药,以免再次损伤津液。适宜用防风白术甘草汤主治。其湿证分为两种:湿热证多,寒湿证少,应当通过脉象和症状来明辨。如脉滑数、小便赤涩、引饮(想喝水)为湿热证;若小便自利清白、大便泻痢、身体疼痛、自汗,则为寒湿证。治疗寒湿证,适宜用五苓散加生附子、苍术、木瓜主治。
Chen Wuzhe stated: Spleen deficiency often leads to the invasion of dampness; thus, it is said that when dampness flows into the joints, it frequently causes distension in the limbs and joint pain accompanied by irritability. Over time, this may progress to edema, asthma (wheezing), chest fullness, mental confusion, or even unconsciousness. If complicated by wind pathogen, symptoms such as vertigo, vomiting, and hiccups occur; if complicated by cold pathogen, symptoms such as limb spasms, convulsions, and pulling pain appear. Treatment should not employ vigorous sweating methods, nor moxibustion or purgation; promoting urination is the best approach.
According to commentary: Spleen deficiency with internal dampness often manifests internally as abdominal fullness, diaphragmatic obstruction, diarrhea, and dysentery; externally, it often presents as flaccidity syndromes (Wei syndrome), bi-syndromes (painful obstruction), edema, and pain. This is because the Spleen governs the muscles. Furthermore, there are various combinations involving wind, cold, summer-heat, and heat pathogens. Detailed discussions follow: Predecessors held that for wind and dampness at the exterior, muscle-releasing methods are suitable; for cold and dampness at the half-exterior/half-interior level, warming and dispersing or渗泄 (percolating and draining) methods are suitable; only for damp-heat in the interior, purgative methods are suitable; for interior deficiency, separating and eliminating dampness while strengthening the Spleen Earth is the superior strategy. For external contraction not caused by Spleen deficiency, sweating or moxibustion may be used, provided the condition is treated appropriately.
See the section on Phlegm-Retention.
See the sections on Diarrhea and Dysentery.
See the section on Wind-Stroke.
See the section on Hong Kong Foot (Gouty Arthritis).
Jia Zhen Sun stated: Dampness is the qi of Earth; fire and heat can generate damp Earth. Thus, in summer heat, all things are moist; in autumn coolness, all things are dry. Damp diseases do not arise spontaneously but are generated because heat pathogen causes stagnation and depression, preventing the smooth flow of water passages, leading to dampness accumulation. Moreover, individuals with fragile Spleen Earth are easily affected by external pathogens; one need not wait for stagnant water to constitute dampness. People only recognize the severity of wind and cold but fail to realize how insidiously summer-heat and dampness affect them. The *Bingshi* states: Various spasmodic conditions, rigidity, and accumulated fluid retention syndromes all belong to dampness. Or, body swelling, aversion to cold with water qi, where internally there must be scanty, dark red, or obstructed urination, or thirst—this indicates deep accumulation of heat in the interior, not a cold disease. Generally, treatment should prioritize regulating the Spleen, clearing heat, and promoting urination. Therefore, treating dampness without promoting urination is incorrect. Suitable treatments include Guiling Ganlu San (Cassia Seed and Poria Decoction), Muxiang Tingli Tang (Aucklandia and Lepidium Decoction), and Mutong (Akebia Caulis). Master Shouzhen stated: Tingli Muxiang San (Lepidium and Aucklandia Powder) and Xia Shenxiong Wan (Divine Xion Pill for Descending) are medicines that drain damp-water, reduce swelling, promote urination, and regulate the Spleen and Stomach; nothing surpasses these. For severe abdominal distension and leg swelling, Zhouche Wan (Boat and Cart Pill) should be used to purge; for deep-seated damp-heat causing jaundice, Yinchin Tang (Artemisiae Scopariae Decoction) should be used to purge; or supplemented with Fangji Huangqi Tang (Stephania and Astragalus Decoction). If the whole body is swollen and painful, or if there is no sweating, this indicates dampness flowing into the joints with pathogenic factors at the exterior; Wuling San (Five-Ingredient Poria Decoction) plus Guigui (Cinnamon Twig) and Cangzhu (Atractylodis Rhizoma) should be used to induce slight sweating, not profuse sweating. If spontaneous sweating is excessive, leading to heat-dryness damaging fluids and internal water imbalance, diuretics must not be used, as they would further damage fluids. Fangfeng Baizhu Gancao Tang (Saposhnikovia, Atractylodes Macrocephala, and Licorice Decoction) is indicated. There are two types of dampness syndromes: damp-heat is common, while damp-cold is rare; they must be distinguished clearly by pulse and symptoms. For example, a slippery and rapid pulse, dark and astringent urination, and polydipsia indicate a damp-heat syndrome. If urination is clear and abundant, stool is loose or dysenteric, body aches, and there is spontaneous sweating, it is a damp-cold syndrome. Treatment for damp-cold should use Wuling San (Five-Ingredient Poria Decoction) plus Sheng Fuzi (Prepared Aconite Root), Cangzhu (Atractylodis Rhizoma), and Mugua (Chaenomelis Fructus).