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Cheng Wuji's Commentary: There are several types of dampness pathogen. There is Damp Bi (Dampness obstruction syndrome causing pain), where Bi means pain; dampness causes joint pain, and the treatment should be to promote urination. There is Cold-Dampness binding together, with symptoms of sweating only on the head, stiffness in the back, and a desire to cover oneself and face fire for warmth. There is Wind-Dampness binding together, causing pain throughout the body, which should be resolved through sweating. There is Cold-Dampness in the head, which is a superficial condition, hence nasal congestion, treatable by administering medicine into the nose. There is a case where dampness is contracted first and wind secondarily, characterized by body pain, fever, and exacerbation at Shen hour (15:00-17:00), named Wind-Dampness. The disease of Taiyang Dampness sufferers resembles Taiyang Shanghan (Cold Damage), differing in that the pulse is deep and fine. The pulse of Jing (Spasm) sufferers is also deep and fine, appearing similar; however, it is answered that although the pulses are similar, the symptoms differ: dampness causes body pain, whereas Jing does not.

Pulse Diagnosis
The *Mai Jing* (Classic of Pulses) states: A pulse that is deep and slow, or deep and fine, indicates contracting dampness. A large pulse, or a floating, deficient, and choppy pulse, indicates Cold-Dampness. A slippery and rapid pulse indicates Damp-Heat. A surging and slow pulse with deficiency of both Yin and Yang indicates severe Damp-Heat. A floating pulse indicates Wind-Dampness.
Zhao Sizhen states: Zhang Zhongjing discusses the pulse of Wind-Dampness as floating, deficient, and choppy. Floating indicates Wind, and choppy indicates Dampness. The *Mai Jing* also states: An extremely vigorous pulse indicates Cold-Dampness disease. The *Huo Ren Shu* (Book that Saves People) takes the floating pulse as indicative of Wind-Dampness; while floating can denote Wind, it cannot denote Dampness. One should follow Zhang Zhongjing’s description of "floating, deficient, and choppy."

Wind-Dampness
When a patient suffers from pain throughout the body, fever, and exacerbation at Shen hour, this is named Wind-Dampness. This disease arises from sweating while exposed to wind, or from long-term exposure to cold. (Cheng Wuji notes: Pain throughout the body is due to dampness; fever exacerbating at Shen hour is due to wind. If contracted via sweating and exposure to wind, dampness resides first and wind secondarily; if contracted via long-term cold exposure, wind injures first and dampness follows. Ma Huang Xing Yi Yi Ren Gan Cao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction) may be used.)

Ma Huang Xing Yi Yi Ren Gan Cao Tang Formula
Ma Huang (Ephedrae Herba, nodes removed) [0.5 liang], Yi Yi Ren (Coicis Semen) [0.5 liang], Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) [2.5 qian], Xing Ren (Armeniacae Semen Amarum, skin and tips removed, stir-fried) [10 seeds]. Boil in 3 cups of water until reduced to 1.5 cups. Strain and divide into two doses. Avoid wind after taking, aiming for slight perspiration.

Wind-Dampness Binding Together
After eight or nine days of Shanghan, Wind-Dampness binds together, causing painful body discomfort preventing self-turning, without vomiting or thirst, and with a floating, deficient, and choppy pulse. Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Root Decoction) is the primary treatment. (To disperse Wind-Dampness in the exterior. If the stool is hard and urination is spontaneous, remove Gui Zhi and add Bai Zhu.) The subtlety of this clause lies in the floating, deficient, and choppy pulse; if the pulse were deep, solid, slippery, large, or rapid, it would be incorrect. When Wind-Dampness binds together causing whole-body pain, the method should be to resolve via sweating. If it coincides with continuous rainy weather, and the physician prescribes sweating, but the illness does not improve, why? It is answered: If sweating produces profuse sweat, only the Wind pathogen leaves, while Dampness remains, hence no improvement. To treat Wind-Dampness, sweating should only be slight, as if about to sweat, so that both Wind and Dampness are expelled. (Cheng Wuji notes: Continuous rain indicates excess Dampness. The *Nei Jing* says: Yang receives Wind, Yin receives Dampness; also, those injured by Wind suffer upper parts first, those injured by Dampness suffer lower parts first. In Wind-Dampness binding, Wind is external and Dampness internal. Profuse sweating implies violent Qi expulsion, driving out external pathogens but failing to expel internal ones, so Wind leaves but Dampness remains. Slight sweating implies gentle Qi movement, allowing both internal and external pathogens to exit, so both Wind and Dampness leave. ○ Ma Huang Bai Zhu Tang, Gui Zhi Fu Zi Tang are suitable for sweating in Wind-Dampness; Gui Zhi Jia Bai Zhu Huang Qi Fang Ji Tang.) When Wind-Dampness binds together, causing vexing bone-joint pain, pulling pain preventing flexion and extension, severe pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind, reluctance to remove clothes, or slight body swelling, Gan Cao Fu Zi Tang (Licorice and Aconite Root Decoction) is the primary treatment. (*Huo Ren Shu* uses Xing Ren Tang).

Cold-Dampness Binding Together
A Dampness sufferer sweats only on the head, has back stiffness, and desires to cover themselves and face fire. If purgatives are used prematurely, hiccups, chest fullness, difficult urination, and a tongue coating resembling moss will occur. This is because there is heat in the Dan Tian (lower abdomen) and cold in the chest, leading to a desire to drink water but inability to do so, resulting in dry mouth and vexation. (Cheng Wuji notes: Excess Dampness causes profuse sweating, whereas Shanghan causes no sweating. In Cold-Dampness binding, although there is sweating, it does not cover the whole body, hence only head sweating. The back is Yang, the abdomen is Yin. The Taiyang meridian runs along the spine to the waist; when invaded by Cold-Dampness, exterior Qi is obstructed, causing back stiffness. Internal pathogens do not cause aversion to cold externally; external pathogens cause aversion to cold. Desiring to cover and face fire indicates Cold-Dampness in the exterior causing aversion to cold. Premature purgation damages Stomach Qi and consumes fluids, causing hiccups, chest fullness, and difficult urination. Post-purgation interior deficiency causes Upper Jiao Yang Qi to sink into the Lower Jiao, creating heat in the Dan Tian; Cold-Dampness from the exterior/interior enters the chest, creating cold in the upper chest, leading to a white, slippery tongue coating. Interior dryness creates a desire to drink, but due to Cold-Dampness in the chest, drinking is impossible, causing only dry mouth and vexation. ○ Some suggest Xiao Xian Xiong Tang, Gan Cao and Fu Zi Tang; for difficult urination, Wu Ling San; Li Zhong Tang plus Gan Jiang and Bai Zhu; select based on urination. For clear urination, Gui Zhi Jia Fu Zi Tang; Li Zhong Tang plus Fu Ling; Fu Ling Bai Zhu Tang.)

Cold-Dampness in the Head
A Dampness sufferer has body pain, fever, yellowish complexion with wheezing, headache, nasal congestion, and vexation. The pulse is large, they can eat normally, and the abdomen is harmonious without disease. The pathology is Cold-Dampness in the head, causing nasal congestion; administering medicine into the nose leads to recovery. (Cheng Wuji notes: Diseases have depth, symptoms have interior/exterior locations; this is a shallow dampness condition. Why? Dampness does not mention vexing joint pain but mentions body pain, indicating dampness does not flow into joints but resides on the muscle surface. It does not mention fever with body like smoked yellow, but fever with yellowish face and wheezing, indicating dampness does not affect the Spleen but affects the Upper Jiao. Yin receiving dampness makes the pathogen deep; now headache, nasal congestion, and vexation indicate dampness resides in Yang meridians, not Yin. Dampness pulse should be deep and fine for internal flow; a large pulse is Yang, indicating dampness is not internal but external. Furthermore, normal eating and lack of abdominal fullness/stagnation confirm interior harmony, knowing dampness is mild and shallow. Administering medicine into the nose vents Cold-Dampness in the head. ○ Gua Di San)

Wen Re (Warm Heat)
A Wen sufferer has pain throughout the body, fever, and body color resembling smoked yellow. (Cheng Wuji notes: Body yellow like an orange peel is Yangming Blood stasis heat; this smoked yellow is not Yangming blood stasis heat. For body yellow with fever, Zhi Zi Bai Pi Tang (Gardenia, Phellodendron Bark, and Licorice Decoction) is used. If there is heat in both interior and exterior, the body does not hurt; this whole-body pain is not Shanghan exogenous heat. Knowing dampness pathogen is in the meridians, affecting the Spleen which dislikes dampness, injury to dampness injures the Spleen and manifests color, hence body yellow. Because it is yellow like smoke, not true yellow. ○ Xu Shi says: This is originally a Damp-Heat syndrome, but no treatment method is discussed. Or treating with Bai Zhu Fu Zi Tang, Gan Cao Fu Zi Tang, Gui Zhi Jia Gui Tang, etc., I fear this is unsuitable for Damp-Heat disease.)

Shi Bi (Damp Bi)
Taiyang disease with vexing joint pain and a deep, fine pulse is named Shi Bi. The manifestation of Shi Bi includes difficult urination and loose stools; the treatment should solely be to promote urination. (Some say use Gan Cao Fu Zi Tang, Ma Huang Lian Qiao Chi Xiao Dou Tang; *Qian Jin Yi* reads Huan. ○ *Jin Gui Yao Lue* says: Mist injures skin and pores, dampness flows into joints, causing vexing pain, indicating dampness flowing internally. Dampness is like water; deep and fine pulse indicates water tendency downward. Bi pain, named Shi Bi due to vexing joint pain, is not Hong Kong Foot Bi. *Nei Jing* says: Excess dampness causes loose stools. Difficult urination and loose stools indicate internal dampness excess. Solely promote urination to vent abdominal dampness. Ancient saying: Treating dampness without promoting urination is not the correct method. ○ Zhao Shi says: *Huo Ren Shu* says whole-body pain, fever, body yellow, difficult urination, loose stools is named Zhong Shi, and annotates that fine pulse is incorrect. I carefully examine Zhang Zhongjing’s earlier text stating deep and fine pulse is Shi Bi; now *Huo Ren Shu* says fine pulse is incorrect. Are Shi Bi and Zhong Shi different? Since it mentions body yellow, yet does not specify if it is smoked yellow or orange-peel yellow, are Zhong Shi and Yangming blood stasis heat the same? Regarding treatment, since it says no moxibustion or sweating, yet Zhang Zhongjing mentions premature purgation in Dampness sufferers causes hiccups, or forehead sweating with slight panting, or free urination/death if diarrhea persists, there are also cases where purgation is forbidden.)

Wind-Cold-Dampness Combined Causes Bi and Jing
*Huo Ren Shu* says: Wind, Cold, and Dampness combine to form Bi, with heavy body, sweating, aversion to wind, and pain like Li Jie (joint destruction) pattern; Fang Ji Huang Qi Tang is used. ○ *Jing* (Nei Jing) says: Disease with body heat, cold feet, stiff neck and nape, aversion to cold, periodic head heat, red face, red eye vessels, only head shaking, sudden jaw lock, opisthotonos, is Taiyang Wind Strike re-infected with Cold-Dampness causing Jing. Or some say Bai Zhu Huang Qi Fu Zi Tang. (Xu Shi says: Mixed pathogens combining should be treated according to their sequence and quantity, separately.)

Dampness Disease Similar to Shanghan
Huang Shi says: Taiyang Dampness sufferers resemble Taiyang Shanghan, differing in that the dampness pulse is deep and fine. I note: *Mai Jing* says large or floating-deficient pulses are Cold-Dampness; dampness pulse is not exclusively deep and fine. How can one rely on this to distinguish Shanghan? One must also refer to symptoms to avoid error. Dampness pulse and Jing pulse are similar, but symptoms differ: dampness causes body pain, Jing does not. Zhao Shi says: Headache, fever, back stiffness, body pain seem similar to Shanghan, differing in deep-fine pulse, forehead sweating, yellow face, ability to eat. Taiyang Shanghan pulse must be floating and vigorous; now the pulse is deep and fine. If not dampness, it is a Yang disease receiving a Yin pulse. Clearly, yellow face and forehead sweating indicate dampness. Dampness sufferers who can eat have disease in the meridians not affecting the interior. However, loose stools and stagnant urination are caused by meridian stagnation failing to transform and distribute.

Shi Wen (Damp-Warmth)
*Huo Ren Shu* says: If one is injured by dampness and then struck by summerheat, it is named Shi Wen. Symptoms include cold reverse in both calves, chest fullness, headache and eye pain, delirium, and profuse sweating. The pulse is Yang floating and weak, Yin small and urgent. Use Fu Ling Bai Zhu Tang or Bai Hu Jia Cang Zhu Tang. Do not induce sweating; inducing sweating is grave and fatal. Zhao Shi says: *Huo Ren Shu* states: Having been injured by dampness and subsequently struck by summerheat, Damp-Heat binding causes Shi Wen. Xu Xueshi says: First receiving summerheat then dampness; although the sequence differs, the syndrome and treatment are the same. Discussing pulse: Yang soft and weak, Yin small and urgent. Xu Xueshi considers Guan front as Yang, Guan rear as Yin; Ji Shi considers Floating as Yang, Deep as Yin. Although locations differ, pulse shapes are the same. Both theories are valid and should not be biased. However, regarding medication, Bai Hu Jia Cang Zhu is indeed appropriate. But *Huo Ren Shu* previously mentioned Shu Fu Tang in the non-surface chapter, yet here in Shi Wen chapter only mentions Bai Hu and not Shu Fu, why? Pang Shi Fang says: Ignorant doctors confused by hot/cold pulses, seeing cold calves often use Si Ni category drugs; such doctors kill patients. Shi Wen pulse is small and tight, resembling Shanghan pulse, but symptoms differ; frequently administering Bai Hu warms calves and cures. Zhu Shi’s intention might be that Shu Fu is similar to Si Ni drugs, fearing violation of Pang Shi’s warning, hence omitted. If dampness is excessive, Zang-Fu deficient, and stools loose, can Shu Fu be discarded? Tu Shi’s drug methods are seen earlier. Ben Yi says: Whole-body pain preventing turning is called Shi Wen. Wu Shi says: *Nei Jing* states: Shi Wen pulse is Yang soft and weak, Yin small and urgent. *Huo Ren Shu* says first injured by dampness then summerheat, Damp-Heat binding, symptoms of profuse sweating, delirium, cold reverse in both calves, should use Shu Fu Tang plus Ren Shen, Xiang Ru, Bian Dou. If pulse is large and forceful, spontaneous sweating, vexation and thirst, use Ren Shen Bai Hu Tang plus Bai Zhu. Mild cases may use Shi Wei Xiang Ru Yin or Qing Shu Yi Qi Tang modified. The key is removing dampness, benefiting Yuan Qi, and clearing summerheat. Formulas see Summerheat chapter.

Death Syndromes
If a Dampness sufferer is purged, leading to forehead sweating, slight panting, and free urination, death ensues. If diarrhea persists, death also ensues. (Cheng Wuji notes: Dampness sufferers recover via sweating. *Jin Gui Yao Lue* says: Dampness sufferer with vexing body pain, Ma Huang Jia Zhu Tang four liang, inducing slight sweating is appropriate. If wrongly purged, it is a great deviation. Forehead sweating with slight panting indicates upward reversal of Yang Qi; free urination or diarrhea indicates downward flow of Yin Qi. Yin and Yang separation leads to death. *Nei Jing* says: Yin and Yang separation, essence and Qi perish.)

Ma Huang Jia Zhu Tang Formula
Ma Huang (Ephedrae Herba, 3 liang, nodes removed), Gui Zhi (Cinnamomi Ramulus, bark removed), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 2 liang), Xing Ren (Armeniacae Semen Amarum, 70 seeds, skin and tips removed), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 4 liang).
These five ingredients, boil in 9 sheng of water. First boil Ma Huang, reduce by 2 sheng, remove foam. Add other herbs, boil to obtain 2.5 sheng. Strain and take 8 ge warm. Cover to induce slight sweating.

Discussions on other external treatments for dampness are detailed in the first volume of miscellaneous diseases and are not repeated here.