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Urination is difficult, and stools are loose; this is mostly due to dampness in the interior. Therefore, treatment should focus on the interior, promoting urination to drain dampness. It is also said: Patients with dampness may only sweat from the head, have a stiff back, and desire to cover themselves with blankets and sit near fire. If purgatives are used too early, hiccups may occur; or there may be chest fullness, difficulty urinating, and a white coating on the tongue. This is because there is heat in the Dantian (lower jiao) and cold in the chest. The heat is constrained by the cold, causing thirst and a desire to drink water but an inability to do so, resulting in dry mouth and irritability. Commentary: Patients with dampness usually sweat profusely. Head sweating indicates that cold qi has condensed in the upper part. Back stiffness and bowel dysfunction result from the depletion of body fluids due to erroneous purgation. After purgation, the interior becomes deficient, and the yang qi of the upper jiao sinks into the lower jiao, creating heat in the Dantian. A white and slippery tongue coating indicates that exterior cold has sunk into the chest after erroneous purgation, creating cold in the chest. Because of the heat in the Dantian, there is thirst and a desire to drink; because of the cold-dampness in the chest, although water is obtained, it cannot be drunk, leading only to dry mouth and irritability. It is also said: If a patient with dampness is treated with purgatives and develops sweating on the forehead, slight asthma, and free urination, the prognosis is fatal. Similarly, if diarrhea persists uncontrollably, it is also fatal. When dampness is in the exterior, purgation causes interior deficiency. The forehead is the meeting point of all yang meridians; sweating on the forehead indicates isolated yang floating upwards without root. Slight asthma indicates interior heat rising rebelliously due to lack of containment. Incontinence or diarrhea indicates yin qi leaking downwards due to failure to store. The separation of yin and yang leads to death. From this, it is clear that for cold-dampness in the interior, promoting urination is appropriate, while purgation is not. When dampness combines with wind-cold to injure the body, causing both exterior and interior deficiency, exterior deficiency requires securing the exterior, and interior deficiency requires warming yang. Securing the exterior allows yang qi to guard the outside, causing yin qi to dissipate naturally; warming yang is like the sun shining brightly, causing yin pathogens to retreat naturally. Just as the way of the gentleman grows and the way of the petty man declines, this principle is fixed. Thus, Zhang Zhongjing treated wind-dampness with floating pulse and heavy body, noting sweating and aversion to wind as signs of exterior deficiency, prescribing Fangji Huangqi Tang (Astragalus and Stephania Decoction) to disperse wind and secure the exterior. For wind-dampness binding together, causing severe body pain and inability to turn over, without vomiting or thirst (indicating no pathogen in the interior), and with a floating, deficient, and choppy pulse indicating yang deficiency, he prescribed Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) to harmonize and warm. If stools were hard and urination normal, indicating insufficient internal fluids, he prescribed Guizhi Qu Gui Jia Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Atractylodes Macrocephala Decoction) to warm and moisten (Raw Atractylodes Macrocephala Rhizome is drying in aroma but moist in substance; it overcomes dampness without damaging fluids). For wind-dampness binding together, causing painful joints that cannot flex or extend, worsened by touch, with difficulty urinating or slight swelling, noting sweating, shortness of breath, and aversion to wind with a desire to keep clothes on, indicating both exterior and interior deficiency, he prescribed Gancao Fuzi Tang (Licorice and Aconite Decoction) to warm and transform dampness. This represents Han dynasty Confucian medicine. Later scholars who understood this include Yu Jia Yan. He stated: When yang qi is abundant in the body, one is light and agile; when dampness is abundant, one feels heavy and sluggish. If the body feels as heavy as a mountain, with pain in all meridians and inability to turn over, one must use Fuzi (Aconiti Lateralis Radix Praeparata) to restore yang and overcome dampness; what else can one wait for? For dampness in the exterior that can be released via sweating, combine Fuzi with Guizhi Tang (Cinnamon Twig Decoction) to drive it out; for dampness in the interior that can be purged, combine Fuzi with Xixin (Asari Radix et Rhizoma) and Dahuang (Rhei Radix et Rhizoma) to drive it downward; for dampness in the middle, combine Fuzi with Baizhu (Atractylodis Macrocephalae Rhizoma) to warm the middle and dry spleen dampness. Thus, Yu’s learning directly ascends to the hall of Zhang’s teachings! Furthermore, when dampness transforms into heat, as the classics state, wind, cold, and dampness mix to form Bi syndrome (obstruction syndrome). This treatise combines wind, cold, dampness, and heat to name "Damp-Bi". Initially, damp combines with wind and cold; subsequently, damp combines with heat. When damp combines with heat, one should use acrid-cool and bland methods, such as Cangzhu Baihu Tang (Atractylodes and White Tiger Decoction) or Zhibi Fangji Tang (Stephania for Bi Decoction), or combine Xixin with Shigao (Gypsum Fibrosum), allowing heavenly qi to descend clearly, so that heat-dampness in the meridians descends with it, and Bi is unblocked. There is also heat-dampness transforming into dryness, as the classics state: various spasms and neck stiffness belong to damp. Also: If heat-dampness is not removed, large tendons become soft and short, small tendons become flaccid and long; shortness causes contracture, flaccidity causes atrophy. Also: Heat in the channels causes Bi, heat in the collaterals causes Wei syndrome (atrophy). Also: Withered and shriveled lung lobes lead to Wei syndrome. When damp transforms into dryness, but residual dampness remains, treat dampness without hindering dryness, such as adding Guiban (Testudinis Carapax et Plastrum), Juemingzi (Cassiae Semen), Muli (Ostreae Concha), and Shihu (Dendrobii Caulis) to Fangji Tang. If dryness exists without residual dampness, treat dryness without disturbing dampness, such as using Shudihuang Tan (Charred Rehmanniae Radix), Rongrong (Cynomorii Herba), Gouqi (Lycii Fructus), Yuzhu (Polygonati Odorati Rhizoma), Shashen (Glehniae Radix), and Zhi Heshouwu (Prepared Polygoni Multiflori Radix), and Huma (Sesami Fructus). However, laypeople often use Mugua (Chaenomelis Fructus) for contractures, praising its tendon-nourishing and relaxing properties. Yet, Mugua is sour, astringent, and drying; it cannot nourish or relax tendons. This view originated in the Ming Dynasty and is absent from the *Shennong Bencao Jing*; Chen Xiuyuan rightly refuted it. Vine herbs like Luoshiteng (Trachelospermi Caulis), Haifengteng (Sargentodoxae Caulis), and Biliteng (Fici Trichocaulis) are commonly used for Bi. These vines are acrid, drying, and penetrating, breaking through meridians and collaterals, generating heat and dryness, worsening pain with continued use. When damp is bound by cold, cold binding generates dryness. At onset, use acrid-moist and moist methods to resolve exterior dryness, combined with bland-draining methods for damp. When heat-damp transforms into dryness, use clearing-moistening methods; if severe and ineffective, use moistening methods. Regarding Bi syndrome, since it is Damp-Bi, treating damp is fundamental, addressing wind and cold concurrently, aligning with the classic principle of seeking the root. If vine herbs are used merely as guiding drugs, consider that Guizhi (Cinnamomi Ramulus), Sangzhi (Mori Ramulus), Danggui (Angelicae Sinensis Radix), and Niuxi (Achyranthis Bidentatae Radix) not only guide but also lubricate joints, far superior to vines.

Regarding internal injury from heat-dampness: This relates to pathological changes in heavenly qi. Lung injury from heat-damp impairs descending and clearing functions, causing spontaneous sweating, skin edema, stranguria, fire-type diarrhea, or dysentery resembling watermelon juice. Like muggy heat steaming, relief comes only with cool winds and white dew, opening upper orifices to allow lower orifices to flow freely. Treatment involves acrid-bland and clear-bland methods, such as Baihu Tang (White Tiger Decoction) or Ganlu Yin (Sweet Dew Drink) added with Xingren (Armeniacae Semen Amarum), Jiezi (Brassicae Semiparvum), Yiyiren (Coicis Semen), and Tongcao (Tetrapanacis Medulla). This relates to earthly qi, where heat-damp damages spleen-stomach yin, steaming upward to lungs and liver, and obstructing downward intestines and bladder. Symptoms include phlegm, fluid retention, acid regurgitation, vomiting, belching, earth stagnation blocking wood (leading to蛊 disease), lower obstruction and upper closure (Pi syndrome), mid-jiao stagnation causing anorexic dysentery, or external water-damp causing skin edema. Earth-related mixed pathogens cause many diseases. Treatment generally uses acrid-unblocking and bitter-descending methods, such as Wuxiexin Tangs (Five Heart-Purging Decoctions), Ermiao San (Two Marvels Powder), Qingre Shen Shi Tang (Clear Heat and Drain Dampness Decoction), Zisheng Wan (Nourishing Life Pill), or Liujun Zi Tang (Six Gentlemen Decoction) added with Huanglian (Coptidis Rhizoma), Biejia (Trionychis Carapax), Zexie (Alismatis Rhizoma), Jiangzhi (Zingiberis Recens Juice), and Zhuli (Bambusae Caulis in Taenia). For epigastric fullness, vomiting, and blockage of upper and lower orifices, if caught early while yuan qi is intact, administer Kongxian Dan (Control Phlegm Pill) ten grains to unblock, or Xiaowenzhong Wan (Minor Warm Middle Pill) several doses to resolve. Treat early to avoid nurturing the tumor and causing future trouble. When pathology spreads from central earth to lower jiao: heat-damp injuring kidney leads to dream emission and turbid urine due to water failing to control fire; entering large intestine causes dysentery; injuring liver and flowing into sinews causes hernia; injuring spleen causes diarrhea. Treatment uses bitter-acrid bland-draining methods, such as Zhudu Wan (Pork Stomach Pill), Zhibai Shengdi Huang Tang (Anemarrhenae, Phellodendri, and Rehmanniae Decoction), Xuanqing Dao Zhuo Tang (Dispel Clear and Guide Turbid Decoction), Huangqin Shaoyao Tang (Scutellaria and Paeonia Decoction), Shen Shi Duan Xia Tang (Drain Dampness and Stop Diarrhea Decoction), Guiling Ganlu Yin (Guiling Sweet Dew Drink), Wuling San (Five Ling Powder), or Muli Zexie San (Oyster Shell and Alisma Powder). If transforming into dryness, initially heat-damp, later yin deficiency, with upper excess and lower deficiency, rising fire and surging phlegm, causing chest oppression, hypochondriac fullness, asthma/cough, dizziness, limb weakness, body pain, bleeding, constipation, red face, cold feet, or Wei-Bi paralysis. Treatment differs from ordinary heat-damp. Bland-draining drying agents deplete true yin; greasy tonics aggravate phlegm-damp. Balance dryness and moisture, hardness and softness, using Zhibai Dihuang Wan (Anemarrhenae, Phellodendri, and Rehmannia Pill) or Huqian Wan (Tiger Knee Pill). If yin-yang dual deficiency with declining true yuan, heat-damp rises internally causing phlegm-heat asthma/fullness/dizziness, or externally causing limb heaviness/pain/numbness, risking stroke-like symptoms: phlegm-jue fainting, stiff tongue/slurred speech, drooling, facial deviation, hemiplegia. Use Liu Shouzhen’s Dihuang Yinzi (Rehmannia Drink) with extra Jiangzhi and Zhuli, or Heixi Dan (Black Tin Pill) one fen. Half a day later, when breathing stabilizes, urgently administer large dose Renshen Tang (Ginseng Decoction) mixed with Zhuli, Jiangzhi, and Tongbian (Infans Urine). If missed, phlegm-fire rises again, making tonifying qi drugs unable to penetrate. For asthma/fullness with hot sweat, urgently use Shengmai San (Generate Pulse Powder) to grasp yin qi; for cold sweat, use Shenfu Tang (Ginseng and Aconite Decoction) to restore yang, or Liyin Jian (Yin-Gathering Decoction) to gather yin-yang qi. This treats heat-damp transforming into dryness.

Regarding internal injury from cold-damp: Due to heaven, human factors, or internal generation. Heavenly cause: prolonged rain increases dampness, exterior damp moves interior damp. Human cause: summer cooling/cold drinks, tea/alcohol/fruits; acute cases manifest immediately, chronic cases appear in autumn. No external cause: food-water dampness stagnates in the middle. All stem from yang deficiency failing to transport water. Pathology in heavenly qi: Lung yang injury causes cold water; metal-cold fails to transform water, resembling foggy skies. Lung yang suppression suppresses heart yang, resembling cloudy skies. Water flooding highlands causes asthma/fullness/phlegm cough; fluid pathogen harassing heart causes palpitations; ascending to head causes dizziness/vomiting. Treatment focuses on acrid-bland. Mild exterior: Liu’an Jian (Six An Decoction); severe exterior: Xiao Qinglong Tang (Minor Blue Dragon Decoction). With sweating, remove Mahuang (Ephedrae Herba) from Xiao Qinglong Tang, or use Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction), Linggui Zhujing Tang, or Waitai Fuling Yin (External Standard Poria Drink). For severe yang deficiency with damp, or asthma/fullness with cold sweat, use Shenfu Tang or Zhenwu Tang (True Warrior Decoction) to restore yang and overcome damp. Symptoms include epigastric stuffiness, abdominal distension/pain/swelling, loose stools, watery diarrhea, or three-yin malaria. Method: warm middle and dry damp, using Fuzi Lizhong Tang (Aconite and Center-Supplementing Decoction) or Zhenwu Tang. Stomach yang injury causes epigastric distension, vomiting, lack of appetite/anorexia, constipation. Method: acrid-warm bland-draining, using Pingwei San (Calm Stomach Powder), Weiling Tang (Stomach and Five Ling Decoction), or Chushi Tang (Remove Dampness Decoction). If damp stagnates and transforms into heat, tongue coating turns from white-slippery-gray-slippery to yellow-dry, with thirst, lack of appetite, painful scanty urination, and hard stools, known as "Damp-Fire". Treatment: bitter-acrid cool-bland, such as Banxia Xiexin Tang (Pinellia and Heart-Purging Decoction). Generally, damp is yin pathogen injuring yang (normal); injuring yin is variation. Pathology in earthly qi affecting water/fire/wood: Kidney yang deficiency prevents sanjiao transforming water into bladder, causing damp dysentery, sliding diarrhea, dawn diarrhea, sore waist/legs. Excess evil water decreases true water. Treatment: warm kidney yang, drain bladder. Warming kidney yang generates spleen earth; draining bladder calms kidney yang. Warm kidney yang: Zhenwu Tang, Jin Gui Shenqi Tang (Golden Cabinet Kidney Qi Pill), Shenrong Tang (Ginseng and Deer Antler Decoction). Drain bladder: Wuling San. Pathology in liver wood: As classics say, wind-damp contend, wind fails to overcome damp. Treatment: Xiaoyao San (Free and Easy Wanderer Powder), Xiao Chaihu Tang (Minor Bupleurum Decoction), Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction), Tiaozhong Yiqi Tang, to restore wood nature, allowing water to follow qi transformation, entering Duodu and Zhou Du, resolving flooding. This summarizes internal cold-damp treatment. Scholars reading widely will know my arguments are sound.