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Rain and dew originate from Heaven, belonging to Clear Yang Qi (Qingyang Qi), so when injured by them, the pathogen only affects the skin and hair; (if sweating is excessive and wet clothes are not changed, causing dampness to re-enter the interior, the condition is the same.)
Mud and water originate from Earth, belonging to Turbid Yin Qi (Zhuoyin Qi), so when injured by them, it starts from the lower part and invades the bones and flesh; both of these enter from the exterior. Dampness from diet and dampness generated by the Spleen Earth originate from within the human body, all arising from the interior. For dampness in the exterior and upper parts, treat with diaphoresis (sweating method), using agents that are bitter, warm, sweet, and pungent; (Pungent flavors disperse dampness, bitter flavors dry dampness, and sweet-warm flavors tonify Qi to dispel pathogens.) For dampness in the interior and lower parts, treat with diuresis (urination-promoting method), using substances that are bitter, hot, sour, and bland. (To prevent the medicinal properties from ascending, sour flavors are used to astringe and direct downward, while bland flavors are used to leach out dampness.) To treat dampness caused by diet, if located in the upper part, use emesis; if in the lower part, use purgation; (dampness from food stagnation is expelled via stool.) or diuresis. (dampness from fluid retention is expelled via urine.) To treat dampness generated by the Spleen Earth itself, observe its accompanying transformations, as the virtue of Earth encompasses all; accompanied by Wind, it becomes Wind-Dampness (manifesting as wandering pain); accompanied by Fire, it becomes Damp-Heat (manifesting as vexatious heat); accompanied by Cold, it becomes Cold-Dampness (manifesting as Bi syndrome pain). Furthermore, dampness reaches everywhere above, below, inside, and outside; (in the upper part: heavy head, chest fullness, vomiting; in the middle part: abdominal distension and obstruction; in the lower part: swelling of shins and feet; on the exterior: heavy body, joint pain.) Treatment should be differentiated by location, and herbs selected according to the accompanying Cold, Heat, Warmth, or Coolness. One must also observe which Zang-Fu organ is affected: if Spleen Earth deficiency generates dampness, tonify Earth; if Heart Fire excess generates dampness, clear the Heart; if Liver Qi stagnation forms dampness, soothe and raise the Liver; if Lung Metal cold and Kidney Water overflow cause disaster, warm the Kidney. The medicaments used follow their respective entry pathways, not limited merely to Atractylodis Rhizoma (Cangzhu) and Atractylodis Macrocephalae Rhizoma (Baizhu). Symptoms include fever and aversion to cold, aversion to dampness with heaviness of the body, spontaneous sweating, joint pain, scanty and difficult urination, frequent loose stools, cold Bi sensation in waist and legs, edema of dorsum pedis with flesh resembling mud; use Shiqu Tang (Dampness-Dispersing Decoction) (see Zhongshi chapter). If accompanied by severe lower back pain, inability to turn or lie sideways, feeling as heavy as five or six strings of coins, this indicates Dampness entering the Kidney; use Shen Zhuo Tang (Kidney-Attaching Decoction) or Shen Shi Tang (Dampness-Leaching Decoction). If urine is scanty and stool is loose, use Wuling San (Five-Ingredient Powder with Poria) taken with Wuji Wan (Wuji Pill) (see Xie chapter). If accompanied by Wind invasion, symptoms include aversion to wind or slight sweating on the forehead; use half a dose each of Shiqu Tang and Guizhi Tang (Cinnamon Twig Decoction) to induce mild sweating. (Do not induce profuse sweating.) If fever persists after sweating, use Baidu San (Decoction for Resolving Toxicity) plus 1 qian of Cangzhu and 0.5 qian of Fangji. If accompanied by Cold invasion, there is no sweating, with chilling and vexatious pain; mix half a dose each of Wuji San (Five-Accumulations Powder) (see Zhonghan chapter), Shiqu Tang, and Wuling San. If invaded by both Cold and Wind, symptoms include sweating followed by body heaviness, aversion to wind, wheezing and chest fullness, vexatious joint pain, resembling Lijie Feng (Gout-like Bi), cold Bi from umbilicus to feet, inability to flex and extend; this is Wind-Cold-Dampness combining to form Bi syndrome; use Fangji Huangqi Tang (Fangji and Astragalus Decoction) or Wu Bi Tang (Five-Bi Decoction) (see Bi chapter). If bathing without removing wet skirts/pants leads to sudden deep sleep, allowing Dampness to invade the Kidney Meridian, causing swelling and pain of the external genitals, curvature of waist and back; add a small amount of Zhenzhu Mu (Pearl Shell) to Wuling San, and administer Qingmuxiang Wan (Blue Musk Pill) (see Qi chapter). After three doses, the Zang-Fu become unobstructed, swelling subsides, waist straightens, and pain stops. Sitting in damp places causing swelling and pain of the "Kidney Pills" (testicles); use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (see Xu Xu chapter) plus Chaihu, Wuzhuyu, Rougui each 1 qian, and Duhuo 0.5 qian. If Dampness and Heat struggle against each other, use Qingre Shenshi Tang (Clear Heat and Leach Out Dampness Decoction). Symptoms include heavy and painful shoulders and back (Heat ascends to shoulders and back), upper body heat with chest/diaphragm discomfort, and whole-body pain; use Niantong Tang (Relieve Pain Decoction) (see Shenti Tong chapter). For Jaundice due to Damp-Heat, treat from the perspective of Stagnation (all Damp-Heat substances must stagnate before turning yellow); use Xiaoyao San (Free and Easy Wanderer Powder). (Do not use Yinchen Wuling San.) For stagnation of alcohol, noodles, milk, and cheese that fail to transform, use Shiqu Tang and Cangbai Erchen Tang (Bitter-Warm Two-Chen Decoction) for careful management. (This is Erchen Tang added with Cangzhu and Baizhu. Erchen Tang see Tanyin chapter.) Between emesis and purgation/leaching methods, leaching is used more often because water-dampness tends to flow downward. Between promoting bowel movements and promoting urination, promoting urination is used more often because Dampness, unless mixed with Phlegm-Food turbid matter, should exit via urine. Thus it is said: Treating dampness without promoting urination is not the correct method. Three methods of drying dampness: Use Wind herbs to overcome dampness (wind moves, earth dries), such as Qianghuo, Fangfeng; Use Earth herbs to desiccate dampness (water dries with mud), such as Fuling, Baizhu; Use Sour herbs to astringe dampness (preventing overflow, muscle tightness prevents looseness), such as Huangdan, Baifan. (When muscle is tight, water cannot be retained and must exit via two excretions.) Pulse of dampness is invariably Hu (Slow/Slack); combined with Fu (Floating) indicates Exterior; combined with Chen (Deep) indicates Interior; combined with Xian (Wiry) indicates Wind-Damp; combined with Shuo (Rapid) indicates Damp-Heat; combined with Chi (Delayed) indicates Cold-Damp. Commonly used herbs include Cangzhu, Fuling, Zhuling, Mutong, Mugua, Shihu. Add Fangfeng for upper part; double Cangzhu for middle part; add Wuyao, Qianghuo for whole body; add Sangzhi, Weilingxian for arms; add Niuxi, Bibi, Fangji for legs. For Cold-Damp, even in summer months if feeling cold, add Hugujia (Tiger Bone - *note: substitute legally*), Guigui. If Blood deficiency, add Danggui.