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Guo Yong said. The *Huoren Shu* (Book of Vitality) records three types of dampness diseases: one is Zhongshi (Central Dampness), one is Fengshi (Wind-Dampness), and one is Shiwen (Damp-Warmth).

Question: What is Zhongshi (Central Dampness)? Zhang Zhongjing said: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), if there is joint pain accompanied by restlessness, and the pulse is deep and slow, (Zhu's commentary notes: "Some versions read 'fine' instead of 'slow', which is incorrect."), this is named Shib Bi (Dampness Bi Syndrome). (Also known as Zhongshi.) The manifestations of Shib Bi include difficulty in urination and loose stools. The treatment should promote diuresis. Zhu's commentary states: For cases with generalized body pain, fever, and jaundice with normal urination, Shu Fu Tang (Atractylodes Macrocephala and Aconite Decoction) is used. For cases with difficulty in urination and loose stools, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) or Wuling San (Five-Ingredient Powder with Poria) are indicated. Furthermore, the *Zhizhen Yao Lun* (Treatise on the Most Essential Principles) states: The method for treating dampness must involve promoting diuresis; otherwise, it is not the correct treatment.

Question: What is the nature of Bi syndrome caused by Zhongshi? Guo Yong said: Zhongshi combined with wind-cold qi forms Bi syndrome. Thus, the *Suwen* (Basic Questions) states: When wind, cold, and dampness mix and invade together, they form Bi syndrome. As described in the *Lingshu* (Spiritual Pivot), wind-cold-dampness pathogens lodge between the muscle intervals of the exterior. Zhu's commentary adds: When Zhongshi combines with wind-cold to form Bi, excessive cold manifests as pain and edema, requiring Baizhu (Atractylodis Macrocephalae Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), and Guizhi (Cinnamomi Ramulus) to dispel. Excessive wind manifests as severe irritability, wandering pain, and spasms, requiring Mahuang (Ephedrae Herba), Yiyiren (Coicis Semen), and Wutou (Aconiti Radix) to scatter. Excessive dampness manifests as hardness and fullness, and qi obstruction, requiring Gansui (Kansui Radix), Tinglizi (Descurainiae Semen Lepidii Semen), Zhishi (Aurantii Fructus Immaturus), and Baizhu (Atractylodis Macrocephalae Rhizoma) to drain.

Question: What is Fengshi (Wind-Dampness)? Zhang Zhongjing said: Generalized body pain, fever, and worsening in the late afternoon characterize this condition, named Fengshi. This disease results from sweating while exposed to wind, or prolonged exposure to cold. The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: Mahuang Xingzi Yiyi Gancao Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) may be administered. Zhu's commentary notes: A floating pulse indicates Wind-Dampness. Options include Mahuang Xingren Tang (Ephedra and Apricot Kernel Decoction), Fangji Huangqi Tang (Stephania and Astragalus Decoction), Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction), Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction), Zhufu Xingren Tang (Atractylodes and Apricot Kernel Decoction), or Baidu San (Detoxification Powder); these may be selected according to the case.

Zhang Zhongjing asked: When wind and dampness contend, causing generalized body pain, perspiration should theoretically resolve the condition. However, during continuous rainy weather, a physician suggests inducing sweat, yet the patient does not recover. Why? The answer is: If sweat is induced profusely, only the wind is expelled while the dampness remains, hence no recovery. To treat wind-dampness, inducing slight, continuous perspiration allows both wind and dampness to be eliminated.

The *Jingui Yaolue* states: For patients with dampness suffering from vexatious body pain, Mahuang Tang (Ephedra Decoction) with four liang of Baizhu (Atractylodis Macrocephalae Rhizoma) can be used to induce mild sweating. Fire therapy must strictly be avoided. Zhu's commentary adds: Patients with dampness, despite body pain, should not undergo heavy sweating, as this will alter the disease course.

Furthermore, for wind-dampness presenting with a floating pulse, heaviness of the body, sweating, and aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is the primary formula.

Zhang Zhongjing stated: When wind and dampness contend, causing painful, distending joint pain that prevents flexion and extension, exacerbating upon touch, accompanied by sweating, shortness of breath, difficulty urinating, aversion to wind, reluctance to remove clothing, or slight swelling, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) is indicated. The *Qianjin Fang* names this Siewu Fuzi Tang (Four-Ingredient Aconite Decoction).

Additionally, after eight or nine days of Shanghan (Cold Damage), if wind and dampness contend, causing painful body vexation, inability to turn oneself over, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction) is indicated. If the patient has hard stools and free urination, Guizhi (Cinnamomi Ramulus) should be removed and Baizhu (Atractylodis Macrocephalae Rhizoma) added, using the modified formula. Pang's commentary states: Guizhi Fuzi Tang treats cases with free stools but difficult urination. Guo Yong clarifies: Guizhi Fuzi Tang is not merely Guizhi plus Fuzi; it is originally the seventeenth formula named Guifu Tang (Cinnamon-Aconite Decoction). See details under Taiyang Syndrome Treatment.

Zhang Zhongjing stated: In patients with chronic dampness, if there is sweating only on the head, stiffness of the back, and a desire to cover up and face fire, premature use of purgatives will lead to hiccups, chest fullness, difficulty urinating, and a tongue coating resembling moss. This occurs because heat resides in the lower abdomen (Dantian) while cold exists in the stomach, causing thirst for water that cannot be swallowed due to oral dryness and vexation.

Furthermore, in dampness diseases, generalized body pain, fever, and a sallow yellow complexion like smoked tobacco occur. Pang's commentary suggests Fangji Huangqi Tang (Stephania and Astragalus Decoction).

Also, in dampness diseases, body pain, fever, yellowish face, and wheezing occur. (*Maijing* notes: "Patient wheezes," omitting the twelve characters above including "and"). Headache, nasal congestion, and vexation follow. The pulse is large, appetite is normal, and the abdomen is harmonious without internal pathology. The pain originates from cold-dampness in the head, causing nasal congestion; inserting medicine into the nose leads to recovery. Pang's commentary recommends using fine powder of Gengti (Melonis Fructus) mixed with water, insufflated slightly into the nose.

Furthermore, if purgatives are incorrectly used on dampness patients, resulting in sweating on the forehead, slight wheezing, and free urination (or conversely, difficulty urinating), death ensues. Similarly, unceasing diarrhea leads to death. Guo Yong remarks: Generally, purgatives are contraindicated in dampness. Chu Yushi states: Death from sweating and purging results from misdiagnosing dampness as Shanghan and applying inappropriate treatments.

Question: How to differentiate the pulses of Zhongshi and Fengshi? Guo Yong answered: A deep and slow pulse indicates Zhongshi. A floating pulse with aversion to wind indicates Fengshi. This is because Zhongshi lacks the wind pulse characteristics.

Question: What is Shiwen (Damp-Warmth)? Wang Shuhe stated: In Shanghan Shiwen, the patient has previously suffered from dampness, then contracted summerheat. The combination of dampness and heat triggers Shiwen. Symptoms include coldness reversing up the calves, abdominal fullness extending to the chest, headache and eye pain, delirium. Treatment focuses on the Foot-Taiyin (Spleen) channel. Sweating is contraindicated; inducing sweat leads to aphonia, deafness, loss of pain sensation, jaundice, and color changes, termed Chongyue (Severe Heatstroke). Such deaths are caused by the physician's error. Zhu's commentary adds: Shiwen often presents with sweating, headache, eye pain, and delirium. The pulse is soggy and weak at the cun (superficial) position, and small and rapid at the chi (deep) position. Treatment targets the Foot-Taiyin channel. (Context remains consistent throughout.) Guo Yong states: Baihu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodis Lanceae Rhizoma) is the primary formula. The *Huoren Shu* records Zhongshi, Fengshi, and Shiwen, but omits Han Bi (Cold-Damp Bi). It is now appended here. Shi Bi refers to slow wind-damp Bi, also called Shi Feng (Damp-Wind), distinct from Feng Wen (Wind-Warmth).

Zhang Zhongjing stated: After inducing sweat in Shanghan, if the body and eyes turn yellow, it is because cold-dampness lingers internally. Purging is contraindicated; treatment should seek resolution within the context of cold-dampness. Chang's commentary suggests Wuling San (Five-Ingredient Powder with Poria). Guo Yong adds: In dampness diseases where sweat does not occur, cold-dampness lingers internally. For dampness patients developing jaundice, Wuling San is appropriate.

Furthermore, when dampness affects the head with cold-dampness, causing headache, nasal congestion, and vexation, intranasal medication leads to recovery. Details are provided above.

The *Qianjin Fang* states: For Shi Bi and slow wind, causing body pain as if breaking, or feeling like needle pricks and knife wounds, Qi Wu Fuzi Tang (Seven-Ingredient Aconite Decoction) is indicated.

Also, for Shi Feng causing body pain as if breaking, and flesh pain like needle pricks and knife wounds, Ba Wu Fuzi Tang (Eight-Ingredient Aconite Decoction) is used.