薛立斋治一妇，肥胖，头目眩晕，肢体麻木，腿足痿软，自汗身重，其脉滑数，按之沉缓。此湿热乘虚也，
用清燥、羌活二汤，渐愈。更佐以加味逍遥散全安。
赵养葵治一人，宦游京师，病腿肿发热，不能履地。众以为腿痈，延赵视之，扶掖而出。赵曰∶非痈也。
以补中益气汤，加羌活、防风各一钱，（此开鬼门例。）一服如失。次日乘马来谢。
赵养葵自患睾丸一枚肿如鸭卵，遂以湿症治之，不效。细思之，数日前从定海小船回，有湿布风帆在坐下，
比上岸，始觉。以意逆之，此感寒湿在肾丸也。乃用六味地黄（此洁净府例。）加柴胡、肉桂、吴萸各一钱，独活五
分，一服热退，再服肿消。后有患偏坠者，此方多效，亦惟寒湿者宜之。若厥阴燥火郁结者，不宜服。此去吴
茱萸、肉桂，加黄柏，则得之矣。何不可服之有？司命者其审诸。
孙文垣治沈大官，左膝肿痛，不能起止者半年，大便泻三次，脉之弦紧。曰∶此脾虚湿热凝于经络，流于
下部也。肿属湿，痛属火，用苍术、黄柏、苡仁为君，泽泻、猪苓、五加皮为臣，炙甘草、防风、桂枝为佐，
木通为使。四帖痛减肿消，泄泻亦止。改用苍耳子、五加皮、苡仁、当归、枸杞、杜仲、丹参、黄柏、乌药叶，
酒糊为丸，调理月余，步履如故。
吴孚先治一人，风湿，骨节掣痛，不能屈伸，遍身俱肿。医用麻黄汤发汗，汗大出而肿不退。吴曰∶前方
未尝谬也，但宜微汗之。今过汗，风去而湿未除，故不愈也。（说本仲景桂枝汤症。）与胃苓汤二帖而瘳。
张子和治李文卿，两膝膑屈伸，有声剥剥然。或以为骨鸣，张曰∶非也。骨不戛，焉能鸣，此筋湿也。湿
则筋急，有独缓者，缓者不鸣，急者鸣也。若用药一涌一泻，上下去其水，水去则自无声矣。从其言，既而果
愈。
朱丹溪治朱秀衣，久坐受湿，能饮酒，下血以苦涩药兜之，遂成肿疾而肚足皆肿，口渴，中满无力，脉涩
而短，乃血为湿气所伤。法当行湿顺气，清热化积，用滑石一钱五分，白术五分，木通七分，浓朴五分，干葛
五分，苍术三分，苏叶七片，水煎，次第下保和丸与温中丸各五十丸。
冯官人因内有湿积，兼时令湿热，右腿少阳分，发烂疮如掌大，痒甚。两手脉洪缓略数，面目手足俱虚肿，
膈中午前痞闷，午后肿到两足则膈宽。茯苓、木通、苍术、犀角、枳壳炒各五分，陈皮、连翘、白术各一钱，
甘草二分，加姜汁煎服。
朱恕八哥肚肿，因湿气起，能饮酒，自五月左胁有块，两足时肿。白术、三棱醋炒，木通、陈皮、赤茯苓、
海金沙、浓朴各五分，甘草二分，肉桂三分，煎汤下保和丸三十，温中丸三十，抑青丸十丸。
张三锡治一人，体浓，自觉遍身沉重，难于转侧，两膝时痛肿，不红不硬，六脉濡弱，天阴更甚。作湿郁
治，加减羌活胜湿汤，不十剂愈。
许叔微治王彦龙，季夏时，病胸胁多汗，两足逆冷，谵语。医者不晓，杂进药已旬日。诊之，脉关前濡，
关后数，曰∶当湿温治之。先以白虎加人参汤，次白虎加苍术汤，头痛渐退，足渐温，汗渐止，三日愈。此名
贼邪，误用药有死之理。有人难曰∶何名贼邪？曰《难经》五邪，假令心病中暑为正邪，中湿得之为贼邪。心
先受暑，而湿邪乘之。水克火，从所不胜，斯谓之贼邪，五邪中之最逆也。又曰∶湿温之脉，阳濡而弱，阴小
而急。濡弱见于阳部，湿气搏暑也；小急见于阴部，暑气蒸湿也。故曰暑湿相搏，名曰湿温，是谓贼邪也。（不
特此，予素有停饮之疾，每至暑月，汗两足 未尝干，每服此药，二三盏即愈。）
薛立斋治张县丞，年逾五十，两腿肿胀，或生 ，小便频而少，声如瓮出，服五皮等散，不应。掌医院
银台李先生，疑为疮毒，令请薛治。诊其脉，右关沉缓，此脾气虚，湿气流注而然，非疮毒也。河间云∶诸湿
肿满，皆属于土。按之不起，皆属于湿。遂投以五苓散加木香、苍术，亦不应。意至阴之地，关节之间，湿气
凝滞，且水性下流，脾气既虚，安能运散。若非辛温之药，开通腠理，使行经活血，则邪气不能发散。遂以五
积散二剂，势退大半。更以六君子汤加木香、升麻、柴胡、苡仁，两月余而愈。设使前药不应，更投峻剂，虚
虚之祸不免矣。
高兵部连日饮酒，阴茎并囊湿痒，服滋阴药不应。谓前阴者，肝经络脉也。阴器纵挺而出，素有湿，继以
酒，为湿热合于下部，引而竭之，遂以龙胆泻肝汤，及清震汤治之而愈。若服此药不应，宜补肝汤，或四生散治之。
赵大用两臂肿痛，服托里药日甚。谓肿属湿，痛属火，此湿热流注经络也。以人参败毒散，加威灵仙、酒
芩、南星，数剂渐愈。更以四物汤加苍术、黄柏，二十余剂而消。又一妇，下体肿痛，亦与人参败毒散，加威
灵仙、黄柏、苍术，数服痛减。更以四物汤加黄柏、红花、防己、苍术、泽泻，三十余剂亦消。
叶巡检两腿作痛，每痛时即以湿布 之少愈，月余痛甚，夜痛尤剧。丹溪云∶血热极已自沸腾，或涉冷，
或就湿取凉，热血得寒浊凝涩，所以作痛。夜痛甚，气行于阴也。苟痛，以冷折之，即前所谓取凉之症也。以
五积散二剂，顿愈。更以四物汤，加黄柏、苍术、牛膝、木瓜，三十余剂而消。夫湿痰浊血，注于僻道，若非
流湿推陈致新不能瘳也。如用药蒸罨，或用凉药敷贴，或用寒药降火，反成败症矣。
一男子腿痛筋挛，遍身酸软。一道人与痰药及托里药，期三日可痊，皆不应。此非疮毒，乃湿热为患也。
以人参败毒散，加苍术、黄柏、槟榔、木瓜治之少愈，更以清燥汤二十帖而痊。夫内有湿热，外有风寒，当泄
不当补，反用甘温之剂，必不效矣。
张意田治一人，时症已二十余日，凉解不愈，大便自利，不欲饮食，舌赤燥硬，神清肌削，晡际寒热似疟，
无汗。诊之，六脉不浮不沉，惟大而缓，胁肋边有痛处，按之在肝位。此湿温病不解，结于肝部，故寒热如疟。
胃中津液耗涸，则舌燥而赤，是邪热留于心胃也。用玉女煎加犀角、苍术、木通，一服舌生津液，胁痛亦减。
即于原方加柴胡，数服渐瘳，更以补阴全愈。
王宇泰曰∶昔人治湿温，通身皆润，足冷至膝下，腹满，不省人事，六脉皆弱而急。问所服，皆阴病类。
此非受病重，药能重病耳。以五苓合白虎，十余剂少苏。更与清燥汤调理而安。（未选入。）
端州太守吴淞岩，病几四十日矣。延诊，告以初时恶心倦怠，食减便溏。既而夜不寐，躁而数起，起而复
卧，凌晨必呕痰数升。或以为暑，而用香薷六一，或以为湿，而用萆 五苓；或以为瘴，而用平胃；或以为痰，
而用二陈，遍尝无效。渐加烦渴，与肾气丸及生脉饮，服之转剧。脉之濡而缓，右关为甚。据脉与症，湿热无
疑，何诸治罔效？因思病患素喜肥甘，又饮酒食面，其脾胃如土在雨中，沾渍既久，值夏令乃蒸郁而发。故非
渗利厘清可愈，亦非风行燥发可瘳。唯圣术煎，一味白术重两许，酒煎，从而治之，必应。令如法服之，再以
菟丝子五钱，煎饮代茶，服至一旬，渐瘥，半月全愈。
张路玉治沈汝楫子，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。
薛立斋治疗一位妇女，体型肥胖，头部和眼睛眩晕，肢体麻木，腿脚痿软无力，自汗且身体沉重，脉象滑数，重按则沉缓。这是湿热之邪乘虚侵袭所致，使用清燥汤、羌活汤，逐渐痊愈。随后辅以加味逍遥散，完全康复。
赵养葵治疗一个人，他在京城做官时，腿部肿胀发热，无法站立行走。众人认为是腿痈，请赵养葵诊治，他扶着病人出来。赵养葵说：“这不是痈。”用补中益气汤，加入羌活、防风各一钱（这是“开鬼门”即发汗法的例子），服一次后症状消失。第二天骑马前来致谢。
赵养葵自己患有一侧睾丸肿大如鸭蛋大小，起初按湿症治疗，无效。仔细回想，几天前从定海坐小船回来，有湿布风帆放在座位下，直到上岸后才感觉到不适。推测病因，这是感受寒湿在肾囊部位。于是用六味地黄丸（这是“洁净府”即利小便法的例子），加入柴胡、肉桂、吴茱萸各一钱，独活五分，服一次热退，再服肿消。后来有患偏坠（一侧睾丸肿大）的人，此方多有效，但仅适用于寒湿证。若是厥阴经燥火郁结者，不宜服用。去掉吴茱萸、肉桂，加入黄柏，就对了。有什么不能服用的呢？治病者应当审慎考察。
孙文垣治疗沈大官，左膝肿痛，无法站立行走半年，大便每天泻三次，脉象弦紧。他说：“这是脾虚导致湿热凝结于经络，流注于下部。”肿属于湿，痛属于火，用苍术、黄柏、薏苡仁为君药，泽泻、猪苓、五加皮为臣药，炙甘草、防风、桂枝为佐药，木通为使药。四帖后疼痛减轻、肿胀消退，泄泻也停止。改用苍耳子、五加皮、薏苡仁、当归、枸杞、杜仲、丹参、黄柏、乌药叶，酒糊为丸，调理月余，行走恢复如初。
吴孚先治疗一个人，患风湿，骨节牵掣疼痛，不能屈伸，全身都肿。医生用麻黄汤发汗，大汗出而肿胀不退。吴孚先说：“前面的方子并没有错，只是应该微发其汗。现在发汗太过，风邪已去而湿邪未除，所以不愈。”（理论依据来自张仲景关于桂枝汤证的论述。）给予胃苓汤两帖而痊愈。
张子和治疗李文卿，双膝髌骨屈伸时有剥剥的响声。有人以为是骨鸣，张子和说：“不是。骨头不摩擦，怎么能发出声音？这是筋受湿邪所致。湿邪使筋急，有的筋松弛，松弛的不发声，急迫的发声。如果用涌吐和泻下的方法，上下排除水湿，水湿去除自然就没有声音了。”听从他的建议，不久果然痊愈。
朱丹溪治疗朱秀衣，久坐受湿，能饮酒，因便血用苦涩药收敛止血，遂成肿胀病，腹部和足部都肿，口渴，脘腹胀满无力，脉象涩而短，这是血液被湿气所伤。治法应当行气化湿，顺气清热，化解积滞，用滑石一钱五分，白术五分，木通七分，厚朴五分，干葛五分，苍术三分，苏叶七片，水煎，依次服用保和丸与温中丸各五十丸。
冯官人因为体内有湿积，兼之时令湿热，右腿少阳经部位，发生溃烂疮疡如手掌大，瘙痒严重。两手脉象洪缓略数，面目手足都虚肿，胸膈中午前痞闷，午后肿胀蔓延至双脚则胸膈宽舒。茯苓、木通、苍术、犀角、炒枳壳各五分，陈皮、连翘、白术各一钱，甘草二分，加姜汁煎服。
朱恕的八哥肚子肿，因湿气引起，能饮酒，自五月起左胁下有肿块，两足时常肿胀。白术、醋炒三棱、木通、陈皮、赤茯苓、海金沙、厚朴各五分，甘草二分，肉桂三分，煎汤送服保和丸三十丸，温中丸三十丸，抑青丸十丸。
张三锡治疗一个人，体态丰腴，自觉全身沉重，难以转身，两膝时常肿痛，不红不硬，六脉濡弱，阴天更严重。诊断为湿郁，用加减羌活胜湿汤，不到十剂痊愈。
许叔微治疗王彦龙，季夏时节，患病胸胁多汗，两足逆冷，谵语。医生不懂，杂乱用药已十天。诊脉，关前脉濡，关后脉数，说：“应当按湿温病治疗。”先用白虎加人参汤，后用白虎加苍术汤，头痛渐退，足渐温，汗渐止，三日痊愈。这称为贼邪，误用药有致死之理。有人问：“什么叫贼邪？”说：《难经》中的五邪，假如心病中暑为正邪，中湿得之为贼邪。心先受暑，而湿邪乘之。水克火，从所不胜而来，这就叫贼邪，是五邪中最凶逆的。又说：湿温的脉象，阳部脉濡而弱，阴部脉小而急。濡弱见于阳部，是湿气搏结暑气；小急见于阴部，是暑气蒸腾湿气。所以说暑湿相搏，名叫湿温，这就是贼邪。（不仅如此，我素有停饮之疾，每到暑月，两足出汗从未干过，每次服用此药，二三盏即愈。）
薛立斋治疗张县丞，年过五十，双腿肿胀，有时生疮，小便频而量少，声音像从瓮中传出，服用五皮散等方，无效。掌医院银台李先生，怀疑是疮毒，请薛立斋诊治。诊脉，右关沉缓，这是脾气虚，湿气流注所致，不是疮毒。河间说：诸湿肿满，皆属于土。按之不起，皆属于湿。于是投以五苓散加木香、苍术，也无效。想到阴寒之地，关节之间，湿气凝滞，且水性下流，脾气既虚，怎能运化消散。如果不是辛温药物，开通腠理，使气血运行，则邪气不能发散。于是用五积散两剂，病势退去大半。再用六君子汤加木香、升麻、柴胡、薏苡仁，两个多月痊愈。如果前面的药无效，再投峻猛之剂，犯虚虚实实之祸不可避免。
高兵部连续饮酒，阴茎及阴囊湿痒，服用滋阴药无效。他说前阴是肝经络脉所在。阴器纵挺而出，素体有湿，继之以酒，湿热合于下部，引而竭之，于是用龙胆泻肝汤，及清震汤治疗而愈。如果服用此药无效，宜用补肝汤，或四生散治疗。
赵大用两臂肿痛，服用托里药日益加重。他说肿属湿，痛属火，这是湿热流注经络。用人参败毒散，加威灵仙、酒芩、南星，数剂后逐渐痊愈。再用四物汤加苍术、黄柏，二十余剂后消肿。又一妇人，下体肿痛，也给人参败毒散，加威灵仙、黄柏、苍术，数服后疼痛减轻。再用四物汤加黄柏、红花、防己、苍术、泽泻，三十余剂后也消肿。
叶巡检两腿作痛，每次疼痛时用湿布敷贴稍好，月余后疼痛加剧，夜间尤其剧烈。丹溪说：血热极已自沸腾，或接触寒冷，或就湿取凉，热血得寒浊凝涩，所以作痛。夜间痛甚，是因为气行于阴分。如果疼痛，用冷物折之，就是前面所说的取凉之症。用五积散两剂，顿时痊愈。再用四物汤，加黄柏、苍术、牛膝、木瓜，三十余剂后消肿。夫湿痰浊血，注于僻道，如果不是流湿推陈致新，不能痊愈。如用药蒸罨，或用凉药敷贴，或用寒药降火，反而变成坏症。
一男子腿痛筋挛，遍身酸软。一道人与化痰药及托里药，期望三日可痊愈，都不见效。这不是疮毒，而是湿热为患。用人参败毒散，加苍术、黄柏、槟榔、木瓜治疗稍好，再用清燥汤二十帖而痊愈。体内有湿热，外有风寒，应当泄邪不当补益，反用甘温之剂，必然无效。
张意田治疗一个人，时令病已二十余日，凉解法不愈，大便自利，不欲饮食，舌赤燥硬，神志清醒但肌肉消瘦，傍晚寒热似疟，无汗。诊脉，六脉不浮不沉，惟大而缓，胁肋边有痛处，按之在肝位。这是湿温病不解，结于肝部，故寒热如疟。胃中津液耗涸，则舌燥而赤，是邪热留于心胃。用玉女煎加犀角、苍术、木通，一服后舌生津液，胁痛亦减。即在原方加柴胡，数服后渐好，再用补阴法全愈。
王宇泰说：前人治疗湿温，通身皆润，足冷至膝下，腹满，不省人事，六脉皆弱而急。问所服药，都是治阴病的药。这不是病重，是药能重病。用五苓散合白虎汤，十余剂后稍苏醒。再用清燥汤调理而安。（未选入。）
端州太守吴淞岩，生病近四十日。延医诊治，告知初时恶心倦怠，食减便溏。继而夜不寐，躁动而多次起床，起而复卧，凌晨必呕吐痰数升。有人以为是暑，用香薷六一散；有人以为是湿，用萆薢分清饮合五苓散；有人以为是瘴，用平胃散；有人以为是痰，用二陈汤，遍尝无效。渐加烦渴，给肾气丸及生脉饮，服用后病情转剧。诊脉濡而缓，右关尤为明显。据脉与症，湿热无疑，为何诸治罔效？因思病患素喜肥甘，又饮酒食面，其脾胃如土在雨中，沾渍既久，值夏令乃蒸郁而发。故非渗利厘清可愈，亦非风行燥发可瘳。唯有圣术煎，一味白术重一两许，酒煎，从而治之，必应。令如法服之，再以菟丝子五钱，煎饮代茶，服至一旬，渐瘥，半月全愈。
张路玉治疗沈汝楫之子，夏月两膝胫至脚，痛极僵挺，不能屈者十余日。或用敷治之法，无效。其脉软大而数，令拭去敷药，与当归拈痛汤两剂，汗出而愈。
Xue Lizhai treated a woman who was obese, suffering from dizziness of the head and eyes, numbness of the limbs, flaccidity and weakness of the legs and feet, spontaneous sweating, heaviness of the body, with a slippery and rapid pulse that became deep and slow upon heavy pressure. This was due to damp-heat invading due to deficiency. He used Qingzao Tang (Clearing Dryness Decoction) and Qianghuo Tang (Notopterygium Decoction), leading to gradual recovery. Subsequently, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) was added, resulting in complete healing.
Zhao Yangkui treated a man who was serving as an official in the capital, suffering from swelling and fever in the legs, unable to stand or walk. The crowd believed it was a leg abscess (Leg Carbuncle) and invited Zhao for consultation. Zhao supported the patient out and said, "This is not an abscess." He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix), each one qian. (This is an example of "opening the ghost gate," i.e., inducing sweating.) After one dose, the symptoms disappeared. The next day, the patient returned on horseback to express his gratitude.
Zhao Yangkui himself suffered from swelling of one testicle the size of a duck egg. Initially treating it as a damp syndrome yielded no effect. Upon careful reflection, he recalled returning from Dinghai by boat a few days prior, where a wet cloth sail had been placed beneath him, and discomfort was only felt after disembarking. Inferring the cause, he determined this was cold-dampness affecting the scrotum. He then used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (this is an example of "purifying the water reservoir," i.e., promoting urination), adding Chaihu (Bupleuri Radix), Rougui (Cinnamomi Cortex), and Wuyu (Evodiae Fructus), each one qian, and Duhuo (Angelicae Pubescentis Radix), five fen. After one dose, the fever subsided; after another dose, the swelling resolved. Later, patients with unilateral testicular swelling (Hemiscrotum) found this formula effective, but it is suitable only for cold-dampness patterns. It should not be taken by those with Jueyin dry-fire stagnation. Removing Wuyu and Rougui and adding Huangbai (Phellodendri Cortex) would be appropriate. Why would it not be acceptable? Practitioners must examine this carefully.
Sun Wen Yuan treated Shen Daguan, who had had painful swelling of the left knee for half a year, unable to stand or walk, with three bowel movements daily and a string-tight pulse. He stated, "This is spleen deficiency causing damp-heat to coagulate in the collaterals and flow to the lower part." Swelling belongs to dampness, pain belongs to fire. He used Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), and Yiren (Coicis Semen) as sovereign herbs, Zexie (Alismatis Rhizoma), Zhuling (Polyporus), and Wujia Pi (Acanthopanacis Cortex) as minister herbs, Zhi Gancao (Prepared Licorice Root), Fangfeng (Saposhnikoviae Radix), and Guizhi (Cinnamomi Ramulus) as assistant herbs, and Mutong (Akebiae Caulis) as envoy herb. After four doses, pain decreased and swelling subsided, and diarrhea stopped. He then changed to a pill formula made of Can'er Zi (Xanthii Fructus), Wujia Pi (Acanthopanacis Cortex), Yiren (Coicis Semen), Danggui (Angelicae Sinensis Radix), Gouqi (Lycii Fructus), Duzhong (Eucommiae Cortex), Danshen (Salviae Miltiorrhizae Radix), Huangbai (Phellodendri Cortex), and Wuyaoye (Tetradii Folium), bound with rice paste. After more than a month of regulation, walking returned to normal.
Wu Fuxian treated a person with wind-dampness, experiencing pulling pain in bone joints, inability to flex or extend, and generalized edema. A physician used Mahuang Tang (Ephedra Decoction) to induce sweating. Profuse sweating occurred, but the edema did not recede. Wu said, "The previous prescription was not incorrect, but mild sweating should have been induced. Now, excessive sweating has removed the wind but not the dampness, hence the lack of cure." (The theory originates from Zhang Zhongjing's discussion on Guizhi Tang syndromes.) He administered Weiling Tang (Stomach-Calm Decoction) for two doses, resulting in recovery.
Zhang Zihe treated Li Wenqing, whose knees made a crackling sound when flexing and extending. Some thought it was bone noise. Zhang said, "No. Bones do not rub against each other to make sound; this is tendons affected by dampness. Dampness causes tendon tension. Where tendons are relaxed, there is no sound; where they are tense, there is sound. If we use emesis and purgation to remove water from above and below, once the water is gone, the sound will cease naturally." Following his advice, the patient recovered shortly thereafter.
Zhu Danxi treated Zhu Xiuyi, who sat for long periods in damp conditions and drank alcohol. Due to hematochezia, bitter-astringent herbs were used to stop bleeding, leading to a swelling disease with abdominal and foot edema, thirst, epigastric fullness, weakness, and a choppy and short pulse. This indicated blood injured by dampness. The method should be to move dampness, smooth qi, clear heat, and resolve accumulation. He used Huashi (Talcum), Baizhu (Atractylodis Macrocephalae Rhizoma), Mutong (Akebiae Caulis), Houpo (Magnoliae Officinalis Cortex), Ge Gen (Puerariae Lobatae Radix), Cangzhu (Atractylodis Rhizoma), and Suye (Perillae Folium). Water decoction was prepared. Bahe Wan (Harmonize the Stomach Pill) and Wenzhong Wan (Warm the Middle Pill) were administered sequentially, fifty pills each.
Guanren Feng had internal damp accumulation compounded by seasonal damp-heat. On the lateral aspect of the right leg (Shaoyang distribution), a ulcerating sore the size of a palm developed, with severe itching. The pulses in both hands were surging, moderate, and slightly rapid. The face, eyes, hands, and feet were puffy. There was epigastric stuffiness before noon, which widened when swelling reached the feet in the afternoon. Fuling (Poria), Mutong (Akebiae Caulis), Cangzhu (Atractylodis Rhizoma), Xijiao (Rhinocerotis Cornu - *Note: Modern substitute often used*), and fried Zhike (Aurantii Fructus) were used, each five fen; Chenpi (Citri Reticulatae Pericarpium), Lianqiao (Forsythiae Fructum), and Baizhu (Atractylodis Macrocephalae Rhizoma) were used, each one qian; Gancao (Glycyrrhizae Radix et Rhizoma) was two fen. Ginger juice was added to the decoction.
Zhu Shu's eighth brother had abdominal swelling caused by dampness. He drank alcohol. Since May, a mass appeared in the left hypochondrium, and the feet swelled intermittently. Baizhu (Atractylodis Macrocephalae Rhizoma), Cu Chao Sanleng (Vinegar-fried Curcumae Rhizoma), Mutong (Akebiae Caulis), Chenpi (Citri Reticulatae Pericarpium), Chi Fuling (Red Poria), Haijinsha (Lygodii Spora), and Houpo (Magnoliae Officinalis Cortex) were used, each five fen; Gancao (Glycyrrhizae Radix et Rhizoma) was two fen; Rougui (Cinnamomi Cortex) was three fen. This decoction was used to administer Bahe Wan (Harmonize the Stomach Pill) thirty pills, Wenzhong Wan (Warm the Middle Pill) thirty pills, and Yiqing Wan (Suppress Green Pill) ten pills.
Zhang Sanxi treated a person who was corpulent, feeling heavy all over, difficult to turn, with intermittent painful swelling of both knees, not red or hard. The six pulses were soggy and weak, worsening on cloudy days. Diagnosed as damp stagnation, he used Modified Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness). In less than ten doses, the patient recovered.
Xu Shumi treated Wang Yanlong. In late summer, the patient had excessive sweating on the chest and hypochondrium, cold feet, and delirious speech. Physicians did not understand and administered miscellaneous drugs for ten days. Pulse diagnosis showed a soggy pulse at the cun position and a rapid pulse at the chi position. Xu said, "This should be treated as Damp-Warmth." First, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) was given, followed by Baihu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodis Rhizoma). Headache gradually receded, feet warmed, sweating stopped, and the patient recovered in three days. This is called "Thief Pathogen" (Ze Xie). Misusing medication can lead to death. Someone asked, "What is Thief Pathogen?" Xu replied, "In the 'Five Pathogens' of the Nan Jing, if heart disease is caused by summerheat, it is the Correct Pathogen; if caused by dampness, it is the Thief Pathogen. The heart first suffers summerheat, and dampness invades subsequently. Water overcomes Fire, coming from the element that does not overcome it, thus it is called Thief Pathogen, the most adverse of the Five Pathogens." He further stated, "The pulse of Damp-Warmth is soggy and weak in the yang position, and small and urgent in the yin position. Soggy and weak in the yang position indicates dampness clashing with summerheat; small and urgent in the yin position indicates summerheat steaming dampness. Thus, summerheat and dampness clashing is named Damp-Warmth, which is the Thief Pathogen." (Furthermore, I have had retained fluid pathology since youth. Every summer, my feet sweat and never dry. Taking this medicine, two or three cups suffice for recovery.)
Xue Lizhai treated County Magistrate Zhang, over fifty years old, with swollen legs, occasional sores, frequent and scanty urination, and a muffled voice. He had taken Wupi San (Five-Bark Powder) without effect. Li Taiyi, an official from the Imperial Hospital, suspected carbuncle toxin and invited Xue. Pulse diagnosis revealed a deep and slow pulse at the right guan position. Xue diagnosed spleen qi deficiency with dampness flowing into collaterals, not carbuncle toxin. He cited He Jian: "All dampness, swelling, and fullness belong to Earth. Pressing and leaving an indentation belongs to dampness." He prescribed Wuling San (Five-Ingredient Powder with Poria) plus Muxiang (Aucklandiae Radix) and Cangzhu (Atractylodis Rhizoma), but it was ineffective. Considering the location as yin and cold, between joints where dampness stagnates, and knowing water flows downward, spleen qi being deficient cannot transport and disperse. Without acrid-warm herbs to open the pores and promote circulation, pathogenic factors cannot be dispersed. He then used Wuji San (Five-Accumulations Powder) for two doses, reducing the condition by more than half. Subsequently, Liujunzi Tang (Six-Gentleman Decoction) plus Muxiang (Aucklandiae Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), and Yiren (Coicis Semen) were used. Recovery took over two months. Had stronger medicines been used if the first failed, the disaster of damaging deficiency would have been unavoidable.
Bingbu Gao drank continuously, resulting in dampness and itching of the penis and scrotum. Yin-nourishing medicines were ineffective. He explained that the anterior yin is the pathway of the Liver meridian. Flaccidity and protrusion of the genitalia, combined with pre-existing dampness and subsequent alcohol consumption, led to damp-heat combining in the lower jiao. He treated it with Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) and Qingzhen Tang (Clear and Shake Decoction), resulting in recovery. If these were ineffective, Bogan Tang (Tonify Liver Decoction) or Sisheng San (Four Living Powder) should be used.
Zhao Dayong had painful swelling of both arms, worsening with tonifying interior medicines. He stated that swelling belongs to dampness and pain belongs to fire, indicating damp-heat flowing into collaterals. Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxins) was used, adding Weilingxian (Clematidis Radix et Rhizoma), Jiu Qin (Wine-fried Scutellariae Radix), and Nanting (Pinelliae Rhizoma Praeparatum). Gradual recovery occurred after several doses. Then, Siwu Tang (Four-Substance Decoction) plus Cangzhu (Atractylodis Rhizoma) and Huangbai (Phellodendri Cortex) was used for over twenty doses, resolving the swelling. Another woman with lower body painful swelling was also given Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxins) plus Weilingxian (Clematidis Radix et Rhizoma), Huangbai (Phellodendri Cortex), and Cangzhu (Atractylodis Rhizoma). Pain decreased after several doses. Then, Siwu Tang (Four-Substance Decoction) plus Huangbai (Phellodendri Cortex), Honghua (Carthami Flos), Fangji (Stephaniae Tetrandrae Radix), Cangzhu (Atractylodis Rhizoma), and Zexie (Alismatis Rhizoma) was used for over thirty doses, resolving the swelling.
Xunjian Ye had painful legs. Each time pain occurred, applying a wet cloth provided slight relief. After a month, pain intensified, especially at night. Danxi said: "When blood heat reaches extreme, it boils. Contact with cold or seeking coolness in dampness causes hot blood to congeal and become turbid and stagnant, resulting in pain. Night pain is severe because qi travels through the yin channels during the night. If pain is treated with cold, it is the aforementioned 'seeking coolness' syndrome." Wuji San (Five-Accumulations Powder) was given for two doses, resulting in immediate recovery. Then, Siwu Tang (Four-Substance Decoction) plus Huangbai (Phellodendri Cortex), Cangzhu (Atractylodis Rhizoma), Niuxi (Achyranthis Bidentatae Radix), and Mugua (Chaenomelis Fructus) was used for over thirty doses, resolving the swelling. Damp-phlegm and turbid blood flowing into obscure pathways require draining dampness and eliminating stale matter to restore health. Using steam compresses, cooling applications, or cold herbs to subdue fire would instead create complicated diseases.
A man suffered from leg pain, tendon spasms, and generalized soreness. A Daoist priest gave phlegm-resolving and interior-tonifying medicines, expecting recovery in three days, but to no avail. This was not carbuncle toxin but damp-heat pathology. Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxins) plus Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Binglang (Arecae Semen), and Mugua (Chaenomelis Fructus) provided slight improvement. Qingzao Tang (Clearing Dryness Decoction) for twenty doses led to complete recovery. Internal damp-heat with external wind-cold requires purging, not tonifying. Using sweet-warm agents would inevitably fail.
Zhang Yitian treated a person with a seasonal illness lasting over twenty days, unresponsive to cooling and resolving methods. There was spontaneous diarrhea, loss of appetite, a red, dry, and stiff tongue, clear spirit but emaciated muscles, evening chills and fevers resembling malaria, and no sweating. Pulse diagnosis showed pulses neither floating nor deep, but large and slow. There was pain at the hypochondrium, corresponding to the liver position upon palpation. This was unresolved Damp-Warmth binding in the liver region, causing malaria-like chills and fevers. Exhaustion of stomach fluids caused the dry, red tongue, indicating lingering pathogenic heat in the heart and stomach. Yv Nu Jian (Jade Woman Decoction) plus Xijiao (Rhinocerotis Cornu - *Note: Modern substitute often used*), Cangzhu (Atractylodis Rhizoma), and Mutong (Akebiae Caulis) was used. After one dose, saliva generated in the tongue, and hypochondriac pain decreased. Chaihu (Bupleuri Radix) was added to the original formula, leading to gradual improvement after several doses. Finally, Yin-tonifying methods ensured complete recovery.
Wang Yutai said: Previously, someone treated Damp-Warmth with whole-body moisture, cold feet down to the knees, abdominal fullness, and unconsciousness. All six pulses were weak and urgent. The medicines taken were for yin diseases. This was not severe disease, but medication aggravating the condition. Wuling San (Five-Ingredient Powder with Poria) combined with Baihu Tang (White Tiger Decoction) for over ten doses brought slight revival. Qingzao Tang (Clearing Dryness Decoction) was then used for regulation and peace. (Not selected for inclusion.)
Wu Songyan, Prefect of Duanzhou, had been ill for nearly forty days. Upon consultation, he reported initial nausea, fatigue, reduced appetite, and loose stools. Later, insomnia, restlessness, frequent rising and lying down, and vomiting several sheng of phlegm every early morning occurred. Some attributed it to summerheat, using Xiangru Liuyi San (Elsholtzia Six-Ingredient Powder); some to dampness, using Bibi Fenqing San (Dioscorea Hypoglauca Separating Turbidity Powder) combined with Wuling San (Five-Ingredient Powder with Poria); some to miasma, using Pingwei San (Calm the Stomach Powder); some to phlegm, using Erchen Tang (Two-Aged Decoction). None were effective. Irritability and thirst increased. Shengji Wan (Kidney Qi Pill) and Shengmai San (Generate the Pulse Powder) were given, worsening the condition. Pulse was soggy and slow, particularly at the right guan position. Based on pulse and symptoms, damp-heat was undeniable. Why did various treatments fail? Reflecting on the patient's preference for rich and sweet foods, alcohol, and wheat noodles, his spleen and stomach were like soil in rain, soaked for a long time. In summer, it steamed and stagnated, erupting. Therefore, it could not be cured by diuresis alone, nor by drying with wind. Only Shengzhu Jian (Holy Atractylodes Decoction), consisting solely of Baizhu (Atractylodis Macrocephalae Rhizoma) weighing about one liang, decocted in wine, would work. Administered as directed, followed by Tusizi (Cuscutae Semen) five qian decocted as tea, the patient improved after ten days and fully recovered after half a month.
Zhang Luyu treated the son of Shen Ruji. In summer, pain extended from both knees and calves to the feet, extreme stiffness preventing flexion for over ten days. External applications were ineffective. Pulses were soft, large, and rapid.敷药 (external application) was wiped off. Danggui Nian Tong Tang (Angelica Decoction to Alleviate Pain) was given for two doses. Sweating occurred, and the patient recovered.