【纲】仲景曰。太阳病。关节疼痛而烦。脉沉而细者。此名湿痹。湿痹之候。其人小便不利。
则大便反快。但当利其小便。
【目】李 曰。痹者。痛也。太阳病。脉沉而细。关节烦疼。皮肤麻木。自汗者。防己黄 汤。
无汗者。五积交加散。然湿气四时有之。兼风兼热兼寒者。随症加减。兼风者。先伤湿而后伤风。
风在上受。湿先下受。风湿相搏。风在外而湿在内。大汗则其气暴。而内邪不能出。故风去而湿
存。湿流入里则病重。微汗则其气缓。而内外之邪俱去。或湿症去而风症未去者。不久自解。寒热
身痛。麻杏薏甘汤。身痛发热。小便不利。麻黄汤加苍术。肩脊腰背强痛者。羌活胜湿汤。肿痛微
喘。杏仁汤。汗多。汉防己汤。虚者。身重难转侧。桂枝汤加白术。身重昏迷。自汗失音。下利不
禁者。白通汤加术、草。身痛小便不利者。甘草附子汤。身重走痛者。小续命汤去麻黄、附子。热
而重痛烦渴者。败毒散去柴胡、人参。加栝蒌。小便自利。及下利不止者死。兼寒者。伤寒无汗。
寒湿相搏而有汗。不能周身。惟在头耳。身背强者。表不利也。症与风湿相似。渗湿汤主之。带表。
五积交加散。里寒。理中汤加附子。寒多浮肿。术附汤妙。
徐彬曰。此论湿之挟风。而湿胜以致痹着者。谓发热恶寒。太阳病也。乃湿胜而疼痛。太阳病
来。邪自表入。湿挟风。风走空窍。故流关节。关节者。机关腠会之处也。风气滞于中。故逼心而
烦。然风为湿所搏。而失其风之体。故脉沉而细。则知湿胜即名中湿。亦曰湿痹。痹着不去也。气
既为湿所痹。则气化不敏。或小便不利。大肠主津。湿则反快而不艰涩也。病风者多燥闭。故以湿
胜而快者为反耳。但当利小便者。便利而气化。气化而湿行。见不必狃于太阳而治风。亦非痛在关
节而当温散之比矣。
鳌按。仲景论湿病。而湿痹其最重者。故列首条。其余若风湿。风湿相搏。寒湿相搏。头中寒
湿。湿温。湿热。风寒湿杂
为痹为痉。此数种。皆湿病也。俱列于后。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (disease of the Taiyang channel), if there is pain in the joints accompanied by restlessness, and the pulse is deep and fine, this is named Shi Bi (Bi syndrome caused by dampness). The manifestations of Shi Bi include difficulty in urination, while the stool becomes loose and unobstructed. The treatment should focus solely on promoting diuresis to eliminate dampness.
[Specifics] Li stated: "Bi" refers to pain. In cases of Taiyang disease with a deep and fine pulse, painful and vexatious joints, numbness of the skin, and spontaneous sweating, Fangji Huangqi Tang (Stephania and Astragalus Decoction) should be used. In cases without sweating, Wuji Jiaojiao San (Five Accumulations Combined Powder) is indicated. However, dampness exists throughout the four seasons. If complicated by wind, heat, or cold pathogens, modifications should be made according to symptoms. When complicated by wind, dampness is usually contracted first, followed by wind. Wind enters from above, while dampness enters from below. Wind and dampness interact; wind remains in the exterior while dampness resides in the interior. Profuse sweating causes a sudden depletion of Qi, preventing the internal pathogen from being expelled, resulting in the departure of wind but the retention of dampness. If dampness flows inward, the condition worsens. Mild sweating allows Qi to recover gradually, expelling both external and internal pathogens. Alternatively, if dampness resolves but wind persists, it will resolve spontaneously soon. For chills, fever, and body pain, Mahuang Xingyi Gancao Decoction (Ephedra, Apricot Seed, Licorice, and Honeysuckle Decoction) is used. For body pain with fever and difficulty in urination, Mahuang Decoction (Ephedra Decoction) with added Atractylodis Rhizoma (Cangzhu) is prescribed. For stiffness and pain in the shoulders, back, and waist, Qianghuo Shengshi Decoction (Notopterygium and Dampness-Expelling Decoction) is used. For swelling, pain, and slight wheezing, Xingren Decoction (Apricot Seed Decoction) is applied. For excessive sweating, Hanfangji Decoction (Hanfangji Decoction) is used. For deficiency patterns characterized by heavy body and difficulty turning over, Guizhi Decoction (Cinnamon Twig Decoction) with added Atractylodis Macrocephalae Rhizoma (Baizhu) is indicated. For heavy body, coma, spontaneous sweating, loss of voice, and uncontrollable diarrhea, Baitong Decoction (White Connecting Decoction) with added Baizhu and Glycyrrhizae Radix et Rhizoma (Gancao) is prescribed. For body pain and difficulty in urination, Gancao Fuzi Decoction (Licorice and Prepared Aconite Decoction) is used. For heavy body and wandering pain, Xiao Xuming Decoction (Minor Continuation of Life Decoction) without Ephedrae Herba (Mahuang) and Aconiti Lateralis Radix Praeparata (Fuzi) is indicated. For heat with heavy painful sensations, restlessness, and thirst, Baidu San (Detoxifying Powder) without Bupleuri Radix (Chaihu) and Ginseng Radix (Renshen), but with added Trichosanthis Fructus (Gualou), is used. If urination is normal and diarrhea is unceasing, the prognosis is fatal. When complicated by cold, in Shanghan (Cold Damage) with no sweating, cold-dampness interacts causing sweating only on the head and ears, not covering the whole body, accompanied by stiffness in the back, indicating obstruction of the exterior. The symptoms resemble wind-dampness; Shenshi Decoction (Dampness-Oozing Decoction) is the primary treatment. With exterior involvement, Wuji Jiaojiao San is used. For interior cold, Lizhong Decoction (Regulate the Middle Decoction) with added Fuzi is prescribed. For excessive cold leading to edema, Zhufu Decoction (Atractylodes and Aconite Decoction) is excellent.
Xu Bin commented: This section discusses dampness complicating wind, where dampness predominance leads to bi-syndrome stagnation. Fever and chills belong to Taiyang disease. Here, pain is caused by dampness predominance. When Taiyang disease occurs, pathogens enter from the exterior. Dampness carries wind; wind moves through orifices and joints. Joints are places where sinews, bones, and pores intersect. Wind qi stagnates internally, pressing on the heart and causing vexation. However, wind is constrained by dampness, losing its characteristic lightness, hence the pulse is deep and fine. Thus, dampness predominance is called "Zhong Shi" (Middle Dampness) or "Shi Bi," meaning bi-stagnation that does not depart. Since Qi mechanism is blocked by dampness, Qi transformation becomes sluggish, potentially causing difficulty in urination. The Large Intestine governs fluids; when dampness prevails, stool becomes loose rather than dry. Wind diseases often present with dry constipation, so loose stool due to dampness is considered an anomaly. Treatment should focus on promoting diuresis; clearing the bladder restores Qi transformation, which in turn moves dampness. This shows one should not rigidly adhere to treating Taiyang as merely wind, nor simply apply warming dispersal for joint pain.
Shen Jin'ao noted: Zhang Zhongjing's discussion on damp diseases lists Shi Bi as the most severe, placing it as the first item. Others such as wind-dampness, wind-damp interaction, cold-damp interaction, cold-damp in the head, damp-warmth, damp-heat, and mixed wind-cold-dampness causing bi or spasm syndromes all fall under damp diseases and are listed subsequently.