太阳病。关节疼痛而烦。脉沉而细者。此名湿痹。其候小便不利。大便反快。但当利其小便
。
湿为六淫之一。故其感人。亦如风寒之先在太阳。但风寒伤于肌腠。而湿则流入关节。风脉浮
。寒脉紧。而湿脉则沉而细。湿性濡滞而气重着。故名湿痹。痹者。闭也。然中风者。必先有内风
。而后召外风。中湿者。亦必先有内湿。而后感外湿。由其人平日土德不及。而湿动于中。由是气
化不速。而湿侵于外。外内合邪。为关节疼痛。为小便不利。大便反快。治之者。必先逐内湿。而
后可以除外湿。故当利其小便。东垣亦云。治湿不利小便。非其治也。
湿家之为病。一身尽疼。发热。身色如熏黄。
湿外盛者。其阳必内郁。湿外盛为身疼。阳内郁则发热。热与湿合。交蒸互郁。则身色如熏黄
。熏黄者。如烟之熏。色黄而晦。湿气沉滞故也。若热黄则黄而明。所谓身黄如橘子色也。
湿家。其人但头汗出。背强。欲得被覆向火。若下之早则哕。或胸满。小便不利。舌上如苔者
。以丹田有热。胸
上有寒。渴欲得水。而不能饮。则口燥烦也。
寒湿居表。阳气不得外通。而但上越。为头汗出。为背强。欲得被覆向火。是宜用温药以通阳
。不可与攻法以逐湿。乃反下之。则阳更被抑而哕乃作矣。或上焦之阳不布。而胸中满。或下焦之
阳不化。而小便不利。随其所伤之处而为病也。舌上如苔者。本非胃热。而舌上津液。燥聚如苔之
状。实非苔也。盖下后阳气反陷于下。而寒湿仍聚于上。于是丹田有热。而渴欲得水。胸上有寒。
而复不能饮。则口舌燥烦。而津液乃聚耳。
湿家下之。额上汗出。微喘。小便利者。死。若下利不止者。亦死。
湿病在表者宜汗。在里者宜利小便。苟非湿热蕴积成实未可遽用下法。额汗出微喘。阳已离而上行。
小便利。下利不止。阴复决而下走。阴阳离决。故死。一作小便不利者死。谓阳上浮而阴不下济也
。亦通。湿家病。身疼痛。发热。面黄而喘。头痛。鼻塞而烦。其脉大。自能饮食。腹中和无病
。病在头中寒湿。故鼻塞。内药鼻中则愈。
寒湿在上。则清阳不布。身疼头痛鼻塞者。湿上盛也。发热面黄烦喘者。阳被郁也。而脉大则
非沉细之比。腹和无病则非小便不利大便反快之比。是其病不在腹中而在头。疗之者。宜但治其头
而无犯其腹。内药鼻中。如瓜蒂散之属。使黄水出。则寒湿去而愈。不必服药。以伤其中也。
Taiyang disease (disease pattern caused by pathogenic factors invading the Taiyang channel), characterized by joint pain accompanied by restlessness, and a pulse that is deep and fine, is named Shi Bi (Bi syndrome caused by dampness obstructing the meridians). Its manifestations include difficulty in urination and loose stools. The treatment should focus on promoting diuresis to resolve dampness.
Dampness is one of the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire). Therefore, when it invades the human body, it initially affects the Taiyang channel, similar to Wind and Cold pathogens. However, while Wind and Cold damage the muscle interstices, Dampness flows into the joints. The pulse for Wind is floating; the pulse for Cold is tight; whereas the pulse for Dampness is deep and fine. Dampness has a sticky and stagnant nature, causing heaviness and fixed sensations in the body, hence it is called Shi Bi. "Bi" means obstruction. In cases of Wind-stroke, there must first be internal Wind before external Wind can be attracted; similarly, in cases of Dampness invasion, there must first be internal Dampness before external Dampness can be contracted. This occurs because the person's Spleen Earth function is deficient, leading to the generation of internal Dampness. Consequently, Qi transformation becomes sluggish, allowing external Dampness to invade. The combination of internal and external pathogenic factors results in joint pain, difficulty in urination, and loose stools. The treatment must first eliminate internal Dampness before addressing external Dampness. Therefore, promoting diuresis is indicated. Li Dongyuan also stated that treating Dampness without promoting diuresis is not the correct method.
Patients with chronic Dampness often present with generalized body pain, fever, and a sallow complexion resembling smoked yellow (dark, dull yellow).
When external Dampness is excessive, internal Yang Qi is necessarily constrained within. External Dampness excess causes body pain; internal constraint of Yang causes fever. When Heat combines with Dampness, they steam and constrain each other, resulting in a complexion like smoked yellow. Smoked yellow refers to a yellow color that is dull and dark due to the heavy and stagnant nature of Dampness. In contrast, jaundice caused by Heat presents as bright yellow, described as "yellow like an orange peel."
In patients with Dampness, sweating may occur only on the head, accompanied by stiffness in the back and a desire to cover up and face fire for warmth. If purgative therapy is applied prematurely, hiccups may occur, or there may be chest fullness, difficulty in urination, and a tongue coating that resembles moss. This condition arises from Heat in the Lower Jiao (Dantian) and Cold-Damp in the Upper Jiao (Chest). The patient feels thirsty and desires water but cannot drink it, leading to dry mouth and irritability.
Cold-Damp residing in the exterior prevents Yang Qi from circulating outward, causing it to float upward instead. This leads to head sweating, back stiffness, and a desire to cover up and face fire. Warm herbs should be used to unblock Yang Qi; aggressive purgative methods to expel Dampness are contraindicated. If purgatives are mistakenly used, Yang Qi is further suppressed, triggering hiccups. Alternatively, if Yang Qi of the Upper Jiao fails to distribute, chest fullness occurs; if Yang Qi of the Lower Jiao fails to transform, difficulty in urination occurs. These symptoms arise according to the site of injury. A tongue surface resembling moss is not due to Stomach Heat but rather the accumulation and drying of fluids on the tongue after purgation, mimicking a coating. After purgation, Yang Qi sinks downward while Cold-Damp remains gathered upward. Thus, Heat exists in the Lower Jiao (causing thirst), and Cold exists in the Upper Jiao (preventing drinking), leading to oral dryness, irritability, and fluid aggregation.
If a patient with Dampness is treated with purgatives and subsequently develops sweating on the forehead, slight panting, and free urination, the prognosis is fatal. Similarly, if diarrhea persists uncontrollably, death ensues.
For Dampness in the exterior, diaphoresis (sweating) is appropriate; for Dampness in the interior, promoting diuresis is appropriate. Purgatives should not be used hastily unless Damp-Heat has accumulated into a solid excess. Sweating on the forehead and slight panting indicate that Yang Qi has dispersed and floated upward. Free urination and persistent diarrhea indicate that Yin Qi has ruptured and descended. The separation of Yin and Yang leads to death. Another interpretation suggests that death occurs if urination is difficult, meaning Yang floats upward while Yin fails to descend, which is also logically consistent.
In another presentation of Dampness disease, the patient experiences body pain, fever, sallow complexion with panting, headache, nasal congestion, and irritability. The pulse is large. The patient can eat normally, and the abdomen is harmonious without pathology. This indicates that the pathogen is Cold-Damp located in the head, causing nasal congestion. Administering medication intranasally will lead to recovery.
When Cold-Damp is located in the upper part, Clear Yang fails to distribute. Generalized pain, headache, and nasal congestion indicate Dampness excess in the upper region. Fever, sallow complexion, irritability, and panting indicate constrained Yang. A large pulse differs from the deep-fine pulse mentioned earlier. A harmonious abdomen differs from the urinary difficulty and loose stools mentioned earlier. This confirms that the disease is located in the head, not the abdomen. Treatment should focus solely on the head without affecting the abdomen. Intranasal administration of medicines, such as Gengdi San (Melon Trichosanthes Powder), induces the discharge of yellow fluid, eliminating Cold-Damp and restoring health. Oral medication is unnecessary to avoid damaging the Middle Jiao.