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Xue Lizhai treated a woman who was obese, suffering from dizziness of the head and eyes, numbness of the limbs, flaccidity and weakness of the legs and feet, spontaneous sweating, heaviness of the body, with a slippery and rapid pulse that became deep and slow upon heavy pressure. This was due to damp-heat invading due to deficiency. He used Qingzao Tang (Clearing Dryness Decoction) and Qianghuo Tang (Notopterygium Decoction), leading to gradual recovery. Subsequently, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) was added, resulting in complete healing.

Zhao Yangkui treated a man who was serving as an official in the capital, suffering from swelling and fever in the legs, unable to stand or walk. The crowd believed it was a leg abscess (Leg Carbuncle) and invited Zhao for consultation. Zhao supported the patient out and said, "This is not an abscess." He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix), each one qian. (This is an example of "opening the ghost gate," i.e., inducing sweating.) After one dose, the symptoms disappeared. The next day, the patient returned on horseback to express his gratitude.

Zhao Yangkui himself suffered from swelling of one testicle the size of a duck egg. Initially treating it as a damp syndrome yielded no effect. Upon careful reflection, he recalled returning from Dinghai by boat a few days prior, where a wet cloth sail had been placed beneath him, and discomfort was only felt after disembarking. Inferring the cause, he determined this was cold-dampness affecting the scrotum. He then used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (this is an example of "purifying the water reservoir," i.e., promoting urination), adding Chaihu (Bupleuri Radix), Rougui (Cinnamomi Cortex), and Wuyu (Evodiae Fructus), each one qian, and Duhuo (Angelicae Pubescentis Radix), five fen. After one dose, the fever subsided; after another dose, the swelling resolved. Later, patients with unilateral testicular swelling (Hemiscrotum) found this formula effective, but it is suitable only for cold-dampness patterns. It should not be taken by those with Jueyin dry-fire stagnation. Removing Wuyu and Rougui and adding Huangbai (Phellodendri Cortex) would be appropriate. Why would it not be acceptable? Practitioners must examine this carefully.

Sun Wen Yuan treated Shen Daguan, who had had painful swelling of the left knee for half a year, unable to stand or walk, with three bowel movements daily and a string-tight pulse. He stated, "This is spleen deficiency causing damp-heat to coagulate in the collaterals and flow to the lower part." Swelling belongs to dampness, pain belongs to fire. He used Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), and Yiren (Coicis Semen) as sovereign herbs, Zexie (Alismatis Rhizoma), Zhuling (Polyporus), and Wujia Pi (Acanthopanacis Cortex) as minister herbs, Zhi Gancao (Prepared Licorice Root), Fangfeng (Saposhnikoviae Radix), and Guizhi (Cinnamomi Ramulus) as assistant herbs, and Mutong (Akebiae Caulis) as envoy herb. After four doses, pain decreased and swelling subsided, and diarrhea stopped. He then changed to a pill formula made of Can'er Zi (Xanthii Fructus), Wujia Pi (Acanthopanacis Cortex), Yiren (Coicis Semen), Danggui (Angelicae Sinensis Radix), Gouqi (Lycii Fructus), Duzhong (Eucommiae Cortex), Danshen (Salviae Miltiorrhizae Radix), Huangbai (Phellodendri Cortex), and Wuyaoye (Tetradii Folium), bound with rice paste. After more than a month of regulation, walking returned to normal.

Wu Fuxian treated a person with wind-dampness, experiencing pulling pain in bone joints, inability to flex or extend, and generalized edema. A physician used Mahuang Tang (Ephedra Decoction) to induce sweating. Profuse sweating occurred, but the edema did not recede. Wu said, "The previous prescription was not incorrect, but mild sweating should have been induced. Now, excessive sweating has removed the wind but not the dampness, hence the lack of cure." (The theory originates from Zhang Zhongjing's discussion on Guizhi Tang syndromes.) He administered Weiling Tang (Stomach-Calm Decoction) for two doses, resulting in recovery.

Zhang Zihe treated Li Wenqing, whose knees made a crackling sound when flexing and extending. Some thought it was bone noise. Zhang said, "No. Bones do not rub against each other to make sound; this is tendons affected by dampness. Dampness causes tendon tension. Where tendons are relaxed, there is no sound; where they are tense, there is sound. If we use emesis and purgation to remove water from above and below, once the water is gone, the sound will cease naturally." Following his advice, the patient recovered shortly thereafter.

Zhu Danxi treated Zhu Xiuyi, who sat for long periods in damp conditions and drank alcohol. Due to hematochezia, bitter-astringent herbs were used to stop bleeding, leading to a swelling disease with abdominal and foot edema, thirst, epigastric fullness, weakness, and a choppy and short pulse. This indicated blood injured by dampness. The method should be to move dampness, smooth qi, clear heat, and resolve accumulation. He used Huashi (Talcum), Baizhu (Atractylodis Macrocephalae Rhizoma), Mutong (Akebiae Caulis), Houpo (Magnoliae Officinalis Cortex), Ge Gen (Puerariae Lobatae Radix), Cangzhu (Atractylodis Rhizoma), and Suye (Perillae Folium). Water decoction was prepared. Bahe Wan (Harmonize the Stomach Pill) and Wenzhong Wan (Warm the Middle Pill) were administered sequentially, fifty pills each.

Guanren Feng had internal damp accumulation compounded by seasonal damp-heat. On the lateral aspect of the right leg (Shaoyang distribution), a ulcerating sore the size of a palm developed, with severe itching. The pulses in both hands were surging, moderate, and slightly rapid. The face, eyes, hands, and feet were puffy. There was epigastric stuffiness before noon, which widened when swelling reached the feet in the afternoon. Fuling (Poria), Mutong (Akebiae Caulis), Cangzhu (Atractylodis Rhizoma), Xijiao (Rhinocerotis Cornu - *Note: Modern substitute often used*), and fried Zhike (Aurantii Fructus) were used, each five fen; Chenpi (Citri Reticulatae Pericarpium), Lianqiao (Forsythiae Fructum), and Baizhu (Atractylodis Macrocephalae Rhizoma) were used, each one qian; Gancao (Glycyrrhizae Radix et Rhizoma) was two fen. Ginger juice was added to the decoction.

Zhu Shu's eighth brother had abdominal swelling caused by dampness. He drank alcohol. Since May, a mass appeared in the left hypochondrium, and the feet swelled intermittently. Baizhu (Atractylodis Macrocephalae Rhizoma), Cu Chao Sanleng (Vinegar-fried Curcumae Rhizoma), Mutong (Akebiae Caulis), Chenpi (Citri Reticulatae Pericarpium), Chi Fuling (Red Poria), Haijinsha (Lygodii Spora), and Houpo (Magnoliae Officinalis Cortex) were used, each five fen; Gancao (Glycyrrhizae Radix et Rhizoma) was two fen; Rougui (Cinnamomi Cortex) was three fen. This decoction was used to administer Bahe Wan (Harmonize the Stomach Pill) thirty pills, Wenzhong Wan (Warm the Middle Pill) thirty pills, and Yiqing Wan (Suppress Green Pill) ten pills.

Zhang Sanxi treated a person who was corpulent, feeling heavy all over, difficult to turn, with intermittent painful swelling of both knees, not red or hard. The six pulses were soggy and weak, worsening on cloudy days. Diagnosed as damp stagnation, he used Modified Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness). In less than ten doses, the patient recovered.

Xu Shumi treated Wang Yanlong. In late summer, the patient had excessive sweating on the chest and hypochondrium, cold feet, and delirious speech. Physicians did not understand and administered miscellaneous drugs for ten days. Pulse diagnosis showed a soggy pulse at the cun position and a rapid pulse at the chi position. Xu said, "This should be treated as Damp-Warmth." First, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) was given, followed by Baihu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodis Rhizoma). Headache gradually receded, feet warmed, sweating stopped, and the patient recovered in three days. This is called "Thief Pathogen" (Ze Xie). Misusing medication can lead to death. Someone asked, "What is Thief Pathogen?" Xu replied, "In the 'Five Pathogens' of the Nan Jing, if heart disease is caused by summerheat, it is the Correct Pathogen; if caused by dampness, it is the Thief Pathogen. The heart first suffers summerheat, and dampness invades subsequently. Water overcomes Fire, coming from the element that does not overcome it, thus it is called Thief Pathogen, the most adverse of the Five Pathogens." He further stated, "The pulse of Damp-Warmth is soggy and weak in the yang position, and small and urgent in the yin position. Soggy and weak in the yang position indicates dampness clashing with summerheat; small and urgent in the yin position indicates summerheat steaming dampness. Thus, summerheat and dampness clashing is named Damp-Warmth, which is the Thief Pathogen." (Furthermore, I have had retained fluid pathology since youth. Every summer, my feet sweat and never dry. Taking this medicine, two or three cups suffice for recovery.)

Xue Lizhai treated County Magistrate Zhang, over fifty years old, with swollen legs, occasional sores, frequent and scanty urination, and a muffled voice. He had taken Wupi San (Five-Bark Powder) without effect. Li Taiyi, an official from the Imperial Hospital, suspected carbuncle toxin and invited Xue. Pulse diagnosis revealed a deep and slow pulse at the right guan position. Xue diagnosed spleen qi deficiency with dampness flowing into collaterals, not carbuncle toxin. He cited He Jian: "All dampness, swelling, and fullness belong to Earth. Pressing and leaving an indentation belongs to dampness." He prescribed Wuling San (Five-Ingredient Powder with Poria) plus Muxiang (Aucklandiae Radix) and Cangzhu (Atractylodis Rhizoma), but it was ineffective. Considering the location as yin and cold, between joints where dampness stagnates, and knowing water flows downward, spleen qi being deficient cannot transport and disperse. Without acrid-warm herbs to open the pores and promote circulation, pathogenic factors cannot be dispersed. He then used Wuji San (Five-Accumulations Powder) for two doses, reducing the condition by more than half. Subsequently, Liujunzi Tang (Six-Gentleman Decoction) plus Muxiang (Aucklandiae Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), and Yiren (Coicis Semen) were used. Recovery took over two months. Had stronger medicines been used if the first failed, the disaster of damaging deficiency would have been unavoidable.

Bingbu Gao drank continuously, resulting in dampness and itching of the penis and scrotum. Yin-nourishing medicines were ineffective. He explained that the anterior yin is the pathway of the Liver meridian. Flaccidity and protrusion of the genitalia, combined with pre-existing dampness and subsequent alcohol consumption, led to damp-heat combining in the lower jiao. He treated it with Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) and Qingzhen Tang (Clear and Shake Decoction), resulting in recovery. If these were ineffective, Bogan Tang (Tonify Liver Decoction) or Sisheng San (Four Living Powder) should be used.

Zhao Dayong had painful swelling of both arms, worsening with tonifying interior medicines. He stated that swelling belongs to dampness and pain belongs to fire, indicating damp-heat flowing into collaterals. Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxins) was used, adding Weilingxian (Clematidis Radix et Rhizoma), Jiu Qin (Wine-fried Scutellariae Radix), and Nanting (Pinelliae Rhizoma Praeparatum). Gradual recovery occurred after several doses. Then, Siwu Tang (Four-Substance Decoction) plus Cangzhu (Atractylodis Rhizoma) and Huangbai (Phellodendri Cortex) was used for over twenty doses, resolving the swelling. Another woman with lower body painful swelling was also given Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxins) plus Weilingxian (Clematidis Radix et Rhizoma), Huangbai (Phellodendri Cortex), and Cangzhu (Atractylodis Rhizoma). Pain decreased after several doses. Then, Siwu Tang (Four-Substance Decoction) plus Huangbai (Phellodendri Cortex), Honghua (Carthami Flos), Fangji (Stephaniae Tetrandrae Radix), Cangzhu (Atractylodis Rhizoma), and Zexie (Alismatis Rhizoma) was used for over thirty doses, resolving the swelling.

Xunjian Ye had painful legs. Each time pain occurred, applying a wet cloth provided slight relief. After a month, pain intensified, especially at night. Danxi said: "When blood heat reaches extreme, it boils. Contact with cold or seeking coolness in dampness causes hot blood to congeal and become turbid and stagnant, resulting in pain. Night pain is severe because qi travels through the yin channels during the night. If pain is treated with cold, it is the aforementioned 'seeking coolness' syndrome." Wuji San (Five-Accumulations Powder) was given for two doses, resulting in immediate recovery. Then, Siwu Tang (Four-Substance Decoction) plus Huangbai (Phellodendri Cortex), Cangzhu (Atractylodis Rhizoma), Niuxi (Achyranthis Bidentatae Radix), and Mugua (Chaenomelis Fructus) was used for over thirty doses, resolving the swelling. Damp-phlegm and turbid blood flowing into obscure pathways require draining dampness and eliminating stale matter to restore health. Using steam compresses, cooling applications, or cold herbs to subdue fire would instead create complicated diseases.

A man suffered from leg pain, tendon spasms, and generalized soreness. A Daoist priest gave phlegm-resolving and interior-tonifying medicines, expecting recovery in three days, but to no avail. This was not carbuncle toxin but damp-heat pathology. Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxins) plus Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Binglang (Arecae Semen), and Mugua (Chaenomelis Fructus) provided slight improvement. Qingzao Tang (Clearing Dryness Decoction) for twenty doses led to complete recovery. Internal damp-heat with external wind-cold requires purging, not tonifying. Using sweet-warm agents would inevitably fail.

Zhang Yitian treated a person with a seasonal illness lasting over twenty days, unresponsive to cooling and resolving methods. There was spontaneous diarrhea, loss of appetite, a red, dry, and stiff tongue, clear spirit but emaciated muscles, evening chills and fevers resembling malaria, and no sweating. Pulse diagnosis showed pulses neither floating nor deep, but large and slow. There was pain at the hypochondrium, corresponding to the liver position upon palpation. This was unresolved Damp-Warmth binding in the liver region, causing malaria-like chills and fevers. Exhaustion of stomach fluids caused the dry, red tongue, indicating lingering pathogenic heat in the heart and stomach. Yv Nu Jian (Jade Woman Decoction) plus Xijiao (Rhinocerotis Cornu - *Note: Modern substitute often used*), Cangzhu (Atractylodis Rhizoma), and Mutong (Akebiae Caulis) was used. After one dose, saliva generated in the tongue, and hypochondriac pain decreased. Chaihu (Bupleuri Radix) was added to the original formula, leading to gradual improvement after several doses. Finally, Yin-tonifying methods ensured complete recovery.

Wang Yutai said: Previously, someone treated Damp-Warmth with whole-body moisture, cold feet down to the knees, abdominal fullness, and unconsciousness. All six pulses were weak and urgent. The medicines taken were for yin diseases. This was not severe disease, but medication aggravating the condition. Wuling San (Five-Ingredient Powder with Poria) combined with Baihu Tang (White Tiger Decoction) for over ten doses brought slight revival. Qingzao Tang (Clearing Dryness Decoction) was then used for regulation and peace. (Not selected for inclusion.)

Wu Songyan, Prefect of Duanzhou, had been ill for nearly forty days. Upon consultation, he reported initial nausea, fatigue, reduced appetite, and loose stools. Later, insomnia, restlessness, frequent rising and lying down, and vomiting several sheng of phlegm every early morning occurred. Some attributed it to summerheat, using Xiangru Liuyi San (Elsholtzia Six-Ingredient Powder); some to dampness, using Bibi Fenqing San (Dioscorea Hypoglauca Separating Turbidity Powder) combined with Wuling San (Five-Ingredient Powder with Poria); some to miasma, using Pingwei San (Calm the Stomach Powder); some to phlegm, using Erchen Tang (Two-Aged Decoction). None were effective. Irritability and thirst increased. Shengji Wan (Kidney Qi Pill) and Shengmai San (Generate the Pulse Powder) were given, worsening the condition. Pulse was soggy and slow, particularly at the right guan position. Based on pulse and symptoms, damp-heat was undeniable. Why did various treatments fail? Reflecting on the patient's preference for rich and sweet foods, alcohol, and wheat noodles, his spleen and stomach were like soil in rain, soaked for a long time. In summer, it steamed and stagnated, erupting. Therefore, it could not be cured by diuresis alone, nor by drying with wind. Only Shengzhu Jian (Holy Atractylodes Decoction), consisting solely of Baizhu (Atractylodis Macrocephalae Rhizoma) weighing about one liang, decocted in wine, would work. Administered as directed, followed by Tusizi (Cuscutae Semen) five qian decocted as tea, the patient improved after ten days and fully recovered after half a month.

Zhang Luyu treated the son of Shen Ruji. In summer, pain extended from both knees and calves to the feet, extreme stiffness preventing flexion for over ten days. External applications were ineffective. Pulses were soft, large, and rapid.敷药 (external application) was wiped off. Danggui Nian Tong Tang (Angelica Decoction to Alleviate Pain) was given for two doses. Sweating occurred, and the patient recovered.