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[Classical Discourse]
Those injured by dampness, the lower part is affected first. ○ The dampness of the earth, when it affects the body, harms the skin, flesh, sinews, and vessels. ○ Therefore, the Yang meridians receive wind pathogenic factors, and the Yin meridians receive dampness pathogenic factors. ○ Dampness injures the flesh; wind overcomes dampness. ○ When there is excessive fullness in the center and distension in the viscera, with qi rebellion causing fear, and the voice sounds as if coming from a room, this indicates dampness in the Middle Jiao (Middle Burner). ○ If dampness is injured in autumn, it rebels upward causing cough, developing into Wei syndrome (flaccidity syndrome) and Jue syndrome (cold extremities). ○ Due to dampness, the head feels like it is wrapped; if damp-heat is not resolved, the large sinews become soft and short, and the small sinews become flaccid and long; softness and shortness lead to spasms, while flaccidity and length lead to atrophy. ○ Sweating and then encountering dampness generates acne and prickly heat. ○ When dampness prevails, loose stools occur. ○ All swellings and distensions caused by dampness belong to the Spleen. ○ All spasms and neck stiffness belong to dampness. ○ The Spleen suffers from dampness; urgently eat bitter foods to dry it. ○ When dampness floods internally, treat with bitter-hot herbs, assist with sour and bland herbs, use bitter to dry, and use bland to drain. (Su Wen)

[Philosophical Sayings]
Patients with dampness diseases suffer from whole-body pain, fever, and a body color resembling smoked yellow. ○ Patients with dampness only sweat on the head, have a stiff back, and desire to be covered with blankets and face fire for warmth. If purgation is used too early, it causes hiccups, chest fullness, or difficulty urinating. A tongue coating resembling moss indicates heat in the Dan Tian (Lower Jiao) and cold in the Chest; thirst wanting water but inability to drink leads to dry mouth and irritability. ○ If patients with dampness are purged, sweating on the forehead, slight panting, and free urination indicate death; if diarrhea persists, it also indicates death. ○ When wind and dampness struggle together, causing whole-body severe pain, perspiration should theoretically resolve it. However, if it rains continuously and the physician says perspiration is possible, but the disease does not improve after perspiring, why? Because heavy sweating removes only the wind pathogen, leaving the dampness behind, hence no improvement. To treat wind-dampness, induce mild perspiration ("slightly desirous of sweating"), so both wind and dampness are expelled. (Jin Gui Yao Lue)

There is heavenly dampness, such as rain, dew, and fog; Heaven belongs to Qi, so it first affects the Ying and Wei (Nutritive and Defensive) levels of the exterior. There is earthly dampness, such as water and mud; Earth belongs to Form, so it first injures the skin, flesh, sinews, bones, and blood vessels. There is dietary dampness, such as wine, drinks, and dairy; the Stomach is the sea of water and grain, so it injures the Spleen and Stomach. There is sweat dampness; sweat is also a product of Qi transformation, affecting only the exterior. There is human-generated dampness, transformed by Taiyin Damp-Earth, moving within. (Zheng Zhi Zhun Sheng)

The Classics state: "Those injured by dampness, the lower part is affected first." This means earthly dampness enters the person, first affecting the feet that touch the ground, then gradually spreading upward. It states: "Dampness flows into the joints." This means earthly dampness enters the person, flowing into the four limbs and hundred joints, without yet entering the Zang-Fu organs. It states: "Yin receives dampness." This means earthly dampness has entered the Taiyin Spleen Earth, but not yet the Yangming Stomach Earth. It states: "When dampness is excessive at the upper part, it becomes heat." This refers to dampness received from below, invading the Three Yang meridians, between the chest, back, head, and face, transforming into heat via the Yang of the Upper Jiao. Dampness becoming heat at the upper part is common in summer. Because in summer, earthly dampness combines with heavenly heat and solar heat, forming stifling steaming. The human body responds with red and swollen head and face, numerous boils and carbuncles, and epidemic pathogens occupying orifices. This accumulation does not happen overnight. ○ For thin individuals, dampness in the body is precious; with dampness, it is moist; without dampness, it is dry. (Yu Jiayan)

Dampness is a pathogenic factor without fixed abode; it must attach to something to move. Externally contracted dampness, if not attached to wind-cold, cannot invade the exterior; internally accumulated dampness, if not attached to cold-heat, cannot rampage in the interior. (Wei Litong)

Dampness is the Qi of Earth. Fire and heat generate Earth dampness, so in summer heat, all things are moist; in autumn coolness, all things are dry. Dampness diseases do not arise spontaneously; due to heat stagnation, water pathways cannot circulate freely, leading to stagnation and generation. Moreover, those with fragile Spleen Earth easily contract it. People only know the majesty of wind-cold, not the fierce intensity of summer-dampness, which injures people in the unseen.
There are two types of dampness syndromes: damp-heat is common, damp-cold is rare. Differentiate by pulse and symptoms: slippery and rapid pulse, red and scanty urine, craving drinks, spontaneous sweating indicate damp-heat syndrome; clear and abundant urine, loose stools, body pain without sweating indicate damp-cold syndrome. (Jia Zhen Sun)

When dampness injures the person: at the top, heavy head, yellow eyes, nasal congestion, heavy voice; in the middle, stuffiness and discomfort; at the bottom, swelling of shins and dorsum of feet; in the collaterals, afternoon fever; in the muscles, swelling and fullness like mud; in the joints, stiffness and difficulty bending/extending; in the tunnels, heaviness and immobility; in the skin, numbness; in Qi and Blood, fatigue; in the Lung, wheezing, fullness, cough; in the Spleen, phlegm-saliva and swelling; in the Liver, hypochondriac fullness and hernia; in the Kidney, lower back pain and damp scrotum; entering the Fu organs, diarrhea and borborygmus, vomiting and turbid urination; entering the Zang organs, coma and loss of consciousness, staring and muttering. (Zheng Hui Bu)

[Supplement]
Patients with dampness diseases have body pain, fever, yellow face, wheezing, headache, nasal congestion, and irritability. Their pulse is large, they can eat normally, and the abdomen is harmonious without disease. The pathology is in the head, where cold-dampness obstructs, causing nasal congestion; inserting medicine into the nose cures it. ○ For patients with dampness having vexing body pain, Mahuang Jia Zhu Tang (Ephedra Decoction with Atractylodes) is suitable to induce mild perspiration; strictly avoid fire therapy. ○ For patients with dampness having whole-body pain, fever, worsening in the afternoon, named Wind-Dampness. This disease results from sweating and exposure to wind, or prolonged cooling. Ma Huang Xing Yi Gan Cao Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) is indicated. ○ For Wind-Dampness with floating pulse, heavy body, sweating, and aversion to wind, Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction) governs. ○ After eight or nine days of Cold Damage, wind and dampness struggle, causing severe body pain, inability to turn oneself, no vomiting or thirst, floating, deficient, and choppy pulse; Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) governs. If stool is hard and urination is free, remove Cinnamon Twig and add Atractylodes. ○ When wind and dampness struggle, joint pain and vexation, pulling pain preventing flexion/extension, severe pain upon touch, sweating, shortness of breath, difficulty urinating, aversion to wind preferring to keep clothes on, and slight swelling; Gan Cao Fu Zi Tang (Licorice and Aconite Decoction) governs. (Jin Gui Yao Lue)

Dampness can be acquired externally by sitting/lying in damp places or being exposed to rain; or internally by excessive raw/cold food, tea, and wine, combined with Spleen/Stomach deficiency failing to control it. There are injuries from wind-damp, heat-damp, cold-damp, and summerheat-damp. There is injury from dampness pathogens causing paralysis, stiff tongue, slurred speech, and unconsciousness, resembling stroke. Dampness in the exterior and upper part should be treated by inducing perspiration; in the interior and lower part by promoting diuresis; for interior deficiency by strengthening the Spleen; with wind by releasing the muscle layer; with cold by warming and dispersing. (Yi Fang Ji Jie)

Dampness diseases differ in external/internal causes and damp-heat/damp-cold nature. External dampness comes from heaven/earth Qi (rain, dew, soil, water) or yin-dampness (lying on wet ground/clothes), injuring skin, flesh, sinews, and vessels. Internal dampness comes from diet (wine, dairy, fried foods) or accumulation (raw/cold fruits), injuring Zang-Fu organs and Spleen/Stomach. Manifestations: on the surface, fever, aversion to cold, spontaneous sweating; in collaterals, bi-syndrome heaviness, bone/joint pain, lower back pain preventing turning, limb flaccidity/pain; in muscles, numbness/swelling, jaundice, flesh feeling like mud; in viscera, nausea/vomiting/fullness, dark/scanty urine, diarrhea, tenesmus/hernia. Exterior dampness is light; interior dampness is heavy. In severe cases, exterior dampness connects to viscera, and interior dampness connects to collaterals. Moreover, internally generated dampness often stems from Qi/Blood deficiency, water failing to transform into Qi, and Yin failing to follow Yang. Even externally entered dampness occurs because where evil gathers, Qi must be deficient. Clinging to the idea that "treating dampness without promoting urination is incorrect" risks violating the prohibition against further weakening deficiency. Dampness transforms from Earth, flourishing in all four seasons. In Southeast Earth, Fire and Earth combine, transforming dampness into heat; symptoms include slippery/rapid pulse, red urine, constipation, craving drinks, sweating—treat with clearing/draining, e.g., Si Ling San, Xiao/Li Qing Yin, Yin Chen Yin. In Northwest Earth, Water and Earth combine, transforming dampness into cold; symptoms include fine/slow pulse, clear urine, diarrhea, body pain without sweating—treat with warming/drying, e.g., Wu Ling San, Li Zhong Tang, Jin Gui Shen Qi Wan. Generally, dampness with Fire steams and stagnates into heat; dampness without Fire fails to transform and accumulates as cold. For internal dampness: if Yin-deficient, damp generates heat, consuming essence/blood, trapping damp-heat; treat by nourishing Water/Yin. If Yang-deficient, damp transforms into cold, damaging True Fire, accumulating cold-damp; treat by tonifying Fire/Yang. Thus, internal injury and external contraction both stem from Yuan Qi weakness allowing dampness to attack internally or externally. The Classics say: "Strong people's Qi moves and resolves; weak people's Qi adheres and causes disease." If Spleen Yuan transports well, distributing essence to Lung, exterior pores are firm, preventing external dampness; if Kidney Qi is substantial, Yin/Yang harmonize, preventing internal dampness. Otherwise, merely knowing exterior-perspiring, drying, and diuretic methods without sparing Yuan Qi leads to swelling and diarrhea. (Hui Xin Lu)

To treat heavenly dampness, follow Si Tian method: for dampness excessive at top with heat, level with bitter-warm, assist with sweet-acrid, stop when sweating occurs. To treat earthly dampness, follow Zai Quan method: for dampness flooding internally, treat with bitter-hot, assist with sour-bland, dry with bitter, drain with bland. To treat dietary dampness: seize it in the middle, vomit it from above, draw it out from below. Sweat dampness is treated similarly to heavenly dampness. Only human-generated dampness (transformed by Taiyin Spleen Earth) exists in the Qi intersection, differing slightly from the previous four. Why? Earth encompasses Four Qi (Cold, Heat, Warm, Cool) and Six Directions (Rise, Fall, Float, Sink). Spleen/Stomach are different locations of Yin/Yang, alternating excess/deficiency and reversal/compliance. Thus, Yang excess leads to Wood excess (Wind-Damp); extreme Yang excess leads to Fire excess (Damp-Heat); Yin excess leads to Metal excess (Dry-Damp); extreme Yin excess leads to Water excess (Cold-Damp). Combining Four Qi, it invades everywhere. Generally: above causes vomiting, heavy head, chest fullness; outside causes heavy/swollen body; below causes shin swelling; inside causes abdominal distension/fullness. Treat according to location and accompanying Qi. If Spleen deficiency due to overcoming pathogens causes dampness, treat the overcoming pathogen first; if Spleen/Stomach deficiency generates dampness, tonify deficiency primarily; if depression-heat generates dampness, clear heat primarily. Medicines enter specific areas; what enters here cannot enter there. Danxi focused only on Cang Zhu (Atractylodes Rhizome); is this reasonable? (Zheng Zhi Zhun Sheng)

Various discussions on dampness only mention dampness flowing into joints, never addressing "dampness excessive at top becomes heat." Now fully discussed: "Dampness excessive at top becomes heat," Su Wen states "stop when sweating occurs," which is subtle. "Dampness excessive at top becomes heat" is like "Earth Qi rising to form clouds"; "sweating occurs" is like "Heaven Qi descending to form rain." When Heaven Qi descends as rain, the rising Earth Qi dissipates. ○ "Dampness excessive at top becomes heat," the patient's urination will likely be difficult. Bladder Qi transformation is blocked by damp-heat, making downward flow of upper dampness difficult. The Classics say: "Treating dampness without promoting urination is incorrect." Thus, promoting urination is primary for upper damp-heat. However, distinguish Yang-excess and Yang-deficiency: Yang-excess presents with red/painful urine; promoting urination opens Upper Jiao stagnation, allowing damp-heat to exit via Bladder. Yang-deficiency presents with white urine, dribbling, and profuse sweating; diuretics are contraindicated, otherwise violating the deficiency rule. ○ Jin Gui treats Upper Jiao dampness based on Su Wen's principle, distinguishing mild/severe cases. Su Wen has the method "treat upper by lowering"; since evil rises from below, drive it out from below. Mild cases: extract yellow fluid via nasal orifice; severe cases: extract via anterior/posterior orifices. The difficulty of purgation lies in understanding why perspiration is contraindicated. Zhang Zhongjing notes head shaking, jaw clenching, back arching indicate impending Yang collapse; further perspiration severely damages defensive Yang, worsening aversion to cold; if perspired, pulse like a snake indicates True Yang detachment and imminent death. Therefore, severe upper damp-heat requires purgation, but must use warm purgatives to preserve Yang while removing dampness. ○ Dampness patients should not be heavily perspired, as they already sweat easily, risking Yang collapse. Mistakenly perspiring damp-warmth is called "heavy heatstroke," a deep warning. If prolonged exposure to wind/coolness with water-induced sweating depresses Yang, mild perspiration is needed to resolve disease. ○ Those with chronic Yang deficiency become more deficient in summer; Yang fails to fill the body, allowing Yin-dampness to occupy. Using standard dampness drugs here drives deficient Yang away with dampness, leading to death. Thus, for Yang-deficiency with dampness excess, assisting Yang is the only way to expel dampness. ○ Exterior dampness can be perspired using Fuzi combined with Guizhi Tang; Interior dampness can be purged using Fuzi combined with Xixin and Dahuang; Middle dampness is treated with Fuzi combined with Baizhu to warm/dry Spleen. (Yu Jiayan)

Dampness is a heavy, turbid, substantive pathogen. Externally acquired, it rises from Earth Qi; internally generated, it stems from Spleen Yang failure. Although mist/dew/rain affect the top first, and earth moisture affects the bottom first, mist/dew/rain must rise from Earth Qi. If Earth Qi does not rise, Heaven Qi does not descend, resulting in dryness, not dampness. Injury occurs from top, bottom, or whole body, referring to external dampness attaching to the躯体. Not yet in Zang-Fu, treatment should be exterior-dispersing, but not heavy sweating. With wind, disperse mildly; with cold, assist with warm herbs; with heat, assist with cooling herbs. This refers to externally acquired dampness. However, water flows to dampness, fire goes to dryness; similar Qi resonates. If diet is irregular and Spleen has dampness, external dampness gradually enters viscera. Internally generated dampness results from excessive rich food/wine, tea, raw/cold fruits, or sweet/greasy foods. Differentiate constitution Yin/Yang to know cold/heat/excess/deficiency treatments. If pale/thin with firm muscles, constitution is Yang; external dampness easily transforms to heat; internal dampness from rich food causes damp-heat. If white/fat with soft muscles, constitution is Yin; external dampness rarely transforms to heat; internal dampness from tea/raw food causes damp-cold. For dampness blocking Upper Jiao, open Lung Qi, assist with bland-draining to unblock Bladder, guiding water downward. For Spleen Yang failure and dampness stagnating in Middle Jiao, use Baizhu, Houpo, Shengjiang, Banxia to warm/transport, and Fuling, Ze Xie, Pi Guo, Huashi to drain, like sun-drying lowlands, adding dry soil, or digging ditches. Treat damp-heat with bitter-acrid-cold, damp-cold with bitter-acrid-warm, generally assist with bland-draining or wind-medicines; avoid sweet, sour, greasy, turbid herbs. Ultimately, robust Kidney Yang and healthy Spleen transport prevent cold-damp; descending Lung Qi and smooth Bladder transformation prevent damp-heat. Untreated changes lead to swelling, jaundice, diarrhea, strangury, phlegm-fluid retention. (Lin Zheng Zhi Nan)

Treating interior dampness, promoting urination is primary; treating exterior dampness, inducing mild perspiration is primary. (Wei Litong)

Treatment of dampness focuses on regulating Spleen, clearing heat, and promoting urination; wind-damp struggles should be treated from the exterior. Thus, treating dampness should not use hot or cold extremes. Wind overcomes dampness, dryness overcomes dampness, bland-draining overcomes dampness. ○ Spleen deficiency often leads to dampness invasion; Spleen prefers dryness and dislikes dampness. Only when Spleen Earth weakens and loses transport capacity does dampness stagnate, causing limb distension, soaking flesh, wheezing/fullness, and coma. Thus, treating dampness without regulating Spleen is incorrect. ○ When dampness transforms to heat, do not use hot treatments or cold medicines that worsen dampness; when heat steams dampness, do not use damp treatments or drying medicines that worsen heat. Initially, promote urination to prevent heat formation; later, clear heat to prevent steaming dampness. (Zheng Hui Bu)

Damp-heat accompanied by Yin deficiency is common among those eating rich foods. Obese people with phlegm are hollow inside; with Yin deficiency, Upper is excess and Lower is deficient, requiring distinct treatment. Wind medicines exacerbate deficient fire; bland-diuretics deplete Yin fluids; drying medicines exhaust True Yin; pure Yin-nourishment assists phlegm-damp. Moisturizing and drying must be balanced, rigid and soft coordinated, using formulas like Qing Zao Tang and Hu Qian Wan. (Zhang Luyu)

Ancients said: regulating Spleen, clearing heat, and promoting urination are best for dampness. "Treating dampness without promoting urination is incorrect" is true. However, damp-heat suits clearing/draining, but damp-cold does not. Why? Dampness with cold stems from Yang deficiency; frequent urination injures Qi, worsening Yang deficiency. Mild cold/deficiency allows warming/draining; severe cold/deficiency prohibits draining. Damp-heat also has contraindications for draining if it injures Yin. Once Yin is injured, draining consumes essence/blood before clearing heat. For example, profuse sweating and thirst...