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Cheng Wuji's Commentary: There are several types of dampness. One type is Bi-dampness (Dampness Bi), where "Bi" refers to pain; dampness causes joint pain, and the treatment should involve promoting urination. Another type is the binding of cold and dampness, characterized by sweating only on the head, stiffness in the back, and a desire to cover oneself with blankets or approach fire for warmth.

Another type is the binding of wind and dampness, causing pain throughout the entire body. The treatment method should be to resolve it through sweating.

Another type is cold-dampness in the head, which is a superficial condition, thus presenting with nasal congestion; treatment involves administering medication into the nasal cavity.

Another type occurs when dampness is contracted first, followed by wind. This presents with body pain, fever, and exacerbation in the late afternoon, known as Wind-Dampness.

The disease pattern of a Taiyang patient with chronic dampness (Taiyang Shi Jia) resembles Taiyang Cold Damage (Shanghan). The difference lies in the pulse, which is deep and fine.

Patients with Jing disease (Spasm disorder) also have a deep and fine pulse, which seems similar. The answer is: although the pulses are similar, the symptoms differ. Dampness causes body pain, whereas Jing disease does not cause body pain.

Pulse Methods

The *Mai Jing* (Classic of Pulses) states: A pulse that is deep and slow, or deep and fine, indicates contracting dampness. A large pulse, or a floating, deficient, and choppy pulse, indicates cold-dampness. A slippery and rapid pulse indicates damp-heat. A surging and slow pulse indicates deficiency of both Yin and Yang with severe damp-heat. A floating pulse indicates wind-dampness.

Zhao Sizhen stated: Zhang Zhongjing discussed the pulse of wind-dampness as floating, deficient, and choppy. Floating indicates wind, and choppy indicates dampness. The *Mai Jing* also states that a very pronounced pulse indicates cold-dampness. The *Huo Ren Shu* (Book of Saving Lives) considers a floating pulse as indicative of wind-dampness; while floating can denote wind, it cannot denote dampness alone. Therefore, one should follow Zhongjing's description of "floating, deficient, and choppy."

Wind-Dampness

When a patient experiences pain throughout the entire body, fever, and exacerbation in the late afternoon, this is called Wind-Dampness. This disease results from sweating while exposed to wind, or from long-term exposure to cold and chilling conditions. (Cheng Wuji notes: Pain throughout the body is due to dampness; fever exacerbated in the late afternoon is due to wind. If contracted via sweating and exposure to wind, dampness enters first and wind follows. If contracted via long-term chilling, wind injures first and dampness follows. Ma Huang Xing Ren Yi Yi Ren Gan Cao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction) may be used.)

Ma Huang Xing Ren Yi Yi Ren Gan Cao Tang Formula

Ma Huang (Ephedrae Herba, nodes removed), Yi Yi Ren (Coicis Semen, each half tael), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, two and a half qian), Xing Ren (Armeniacae Semen Amarum, ten seeds, skin and tips removed, stir-fried). Use three cups of water, decoct until one and a half cups remain, remove dregs, divide into two doses. Avoid wind after taking the medicine, aiming for a slight sweat.

Binding of Wind and Dampness

After eight or nine days of Shanghan, if wind and dampness bind together, causing painful restlessness in the body, inability to turn over independently, no vomiting, no thirst, and a floating, deficient, and choppy pulse, Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) is the primary treatment. (This disperses wind and dampness in the exterior. If the stool is hard and urination is normal, remove Gui Zhi and add Bai Zhu Tang [Atractylodis Macrocephalae Decoction]. ○ The subtlety of this clause lies in the floating, deficient, and choppy pulse; if the pulse were deep, solid, slippery, large, or rapid, it would be incorrect.)

If wind and dampness bind, causing pain throughout the body, resolution through sweating is indicated. If it coincides with continuous rainy weather, and the physician prescribes sweating, but the illness does not resolve after sweating, why? The answer is: if sweating produces excessive perspiration, only the wind pathogen leaves, while dampness remains, hence the lack of cure. When treating wind-dampness, sweating should be mild, as if slightly perspiring, so that both wind and dampness are expelled. (Cheng Wuji notes: Continuous rain indicates excess dampness. The *Nei Jing* states: "Yang receives wind, Yin receives dampness," and "Injury by wind affects the upper part first; injury by dampness affects the lower part first." In wind-damp binding, wind is external and dampness is internal. Excessive sweating creates a violent Qi flow, expelling external pathogens but failing to expel internal ones, so wind leaves but dampness remains. Mild sweating creates a gentle Qi flow, allowing both internal and external pathogens to exit, so both wind and dampness leave. ○ Ma Huang Bai Zhu Tang, Gui Zhi Fu Zi Tang indicate that sweating is suitable for wind-dampness. Gui Zhi Jia Bai Zhu Huang Qi Fang Ji Tang [Cinnamon Twig plus Atractylodes, Astragalus, and Stephania Decoction] is also relevant.)

If wind and dampness bind, causing vexing pain in the bone joints, pulling pain, inability to flex or extend, severe pain upon touch, sweating, shortness of breath, difficulty in urination, aversion to wind, reluctance to remove clothing, or slight swelling of the body, Gan Cao Fu Zi Tang (Licorice and Aconite Decoction) is the primary treatment. (*Huo Ren Shu* uses Xing Ren Tang [Apricot Seed Decoction]).

Binding of Cold and Dampness

A patient with chronic dampness who sweats only on the head, has back stiffness, and desires to cover themselves and approach fire for warmth. If purgatives are used too early, hiccups, chest fullness, difficulty in urination, and a coating resembling moss on the tongue will occur. This is because there is heat in the Dantian (lower abdomen) and cold in the chest, leading to a desire to drink water but an inability to do so, resulting in dry mouth and vexation. (Cheng Wuji notes: Excess dampness causes profuse sweating, whereas Shanghan causes no sweating. In cold-damp binding, although there is sweating, it is not generalized, hence only head sweating. The back is Yang, the abdomen is Yin. The Taiyang meridian runs along the spine to the waist. When Taiyang is invaded by cold-dampness, exterior Qi is obstructed, causing back stiffness. Those with interior pathogens do not feel aversion to cold externally; those with exterior pathogens feel aversion to cold. Desiring blankets and fire indicates cold-dampness in the exterior causing aversion to cold. Early purgation damages Stomach Qi and depletes fluids, causing hiccups, chest fullness, and urinary difficulty. Post-purgation interior deficiency allows Upper Jiao Yang Qi to sink into the Lower Jiao, creating heat in the Dantian; meanwhile, exterior-cold penetrates the chest, creating cold in the upper chest, leading to a white, slippery coating on the tongue. Interior dryness creates a desire to drink, but cold-dampness in the chest prevents drinking, causing only dry mouth and vexation. ○ Some suggest Xiao Xian Xiong Tang [Minor Chest Trap Decoction], Gan Cao and Fu Zi Tang; for urinary difficulty, Wu Ling San [Five-Ingredient Powder with Poria]; modify Li Zhong Tang [Regulate the Middle Decoction] with Gan Jiang and Bai Zhu; select based on urination status: Gui Zhi Jia Fu Zi Tang for clear urine, Li Zhong Tang plus Fu Ling, or Fu Ling Bai Zhu Tang.)

Cold-Dampness in the Head

A patient with dampness suffering from body pain, fever, yellowish complexion with panting, headache, nasal congestion, and vexation. The pulse is large, digestion is normal, and the abdomen is peaceful without pathology. The disease is cold-dampness in the head, causing nasal congestion; administering medication into the nose leads to recovery. (Cheng Wuji notes: Diseases vary in depth, and symptoms in location. Here, dampness is superficial. Why? Chronic dampness patients do not complain of vexing joint pain but of body pain, indicating dampness does not flow into joints but resides in the muscle layer. They do not describe fever with a smoky-yellow body color, but rather fever with a yellow face and panting, indicating dampness does not affect the Spleen but settles in the Upper Jiao. Yin receives dampness deeply; here, headache and nasal congestion indicate dampness affecting Yang meridians, not Yin. The pulse for chronic dampness should be deep and fine, indicating internal dampness flow; a large pulse indicates Yang, meaning dampness is not internal but external. Furthermore, normal appetite and absence of abdominal fullness confirm the interior is healthy, proving dampness is slight and superficial. Nasal medication vents cold-dampness from the head. ○ Gua Di San [Melon Seed Powder].)

Warm-Dampness

Patients with warm-dampness suffer from pain throughout the body, fever, and a body color resembling smoked yellow. (Cheng Wuji notes: Yellow like an orange peel indicates Yangming stagnant heat. Smoked yellow is not Yangming stagnant heat. For yellow skin and fever, Zhi Zi Bai Pi Tang [Gardenia, Phellodendron, and Licorice Decoction] is used. This indicates heat in both interior and exterior, which typically does not cause body pain; thus, this generalized pain is not exogenous heat from Shanghan. Knowing dampness is in the meridions, affecting the Spleen which dislikes dampness, injury to dampness injures the Spleen, manifesting as color changes, hence yellow skin. The color is smoky, not bright yellow. ○ Xu Shi states: This discusses damp-heat but lacks heat-specific treatment methods. Using Bai Zhu Fu Zi Tang, Gan Cao Fu Zi Tang, or Gui Zhi Jia Gui Tang [Cinnamon Twig plus Cinnamon Decoction] is likely inappropriate for damp-heat.)

Damp-Bi

Taiyang disease with vexing joint pain and a deep, fine pulse is called Damp-Bi. The presentation of Damp-Bi includes difficulty in urination and loose stools, but the treatment should focus on promoting urination. (Some suggest Gan Cao Fu Zi Tang or Ma Huang Lian Qiao Chi Xiao Dou Tang [Ephedra, Forsythia, and Adzuki Bean Decoction]; *Qian Jin Yi* suggests slow preparation. ○ *Jin Gui Yao Lue* states: Mist injures skin and pores, dampness flows into joints. Vexing pain indicates internal dampness flow. Dampness is like water; a deep and fine pulse reflects water's tendency to flow downward. Due to vexing joint pain, it is named Damp-Bi, distinct from podagra. The *Nei Jing* states: "Excess dampness causes loose stools." Difficulty in urination and loose stools indicate internal dampness excess. Promoting urination drains dampness from the abdomen. Ancient saying: Treating dampness without promoting urination is not the correct method. ○ Zhao Shi states: *Huo Ren Shu* says generalized pain, fever, yellow skin, urinary difficulty, and loose stools constitute Zhong Shi (Midst Dampness), noting that a fine pulse is incorrect. However, Zhongjing previously stated deep and fine pulses indicate Damp-Bi. Are Damp-Bi and Zhong Shi different? Both mention yellow skin, yet neither specifies smoky yellow nor orange-peel yellow, suggesting Zhong Shi might equate to Yangming stagnant heat? Regarding treatment, it states fire therapy and sweating are contraindicated. Yet Zhongjing mentions that early purgation in dampness patients causes hiccups, forehead sweating with slight panting, and death if urination is clear or diarrhea persists. Thus, purgation is also contraindicated.)

Wind, Cold, and Dampness Combined to Form Bi and Jing

*Huo Ren Shu* states: Wind, cold, and dampness combine to form Bi, causing heaviness, sweating, aversion to wind, and pain resembling joint-by-joint involvement; Fang Ji Huang Qi Tang [Stephania and Astragalus Decoction] is used. ○ The Classics state: Body heat, cold feet, neck stiffness and urgency, aversion to cold, periodic head heat, red face, red eye vessels, isolated head shaking, sudden jaw lock, and opisthotonos indicate Taiyang Wind Strike compounded by cold-dampness, forming Jing (Spasm). Some suggest Bai Zhu Huang Qi Fu Zi Tang [Atractylodes, Astragalus, and Aconite Decoction]. (Xu Shi states: Mixed pathogens should be treated according to their sequence and quantity.)

Similarity Between Dampness Disease and Shanghan

Huang Shi states: Taiyang dampness patients resemble Taiyang Shanghan patients. The difference is the dampness pulse is deep and fine. I observe: The *Mai Jing* states large or floating-deficient pulses indicate cold-dampness, implying dampness pulses are not exclusively deep and fine. Relying solely on this to distinguish Shanghan is risky; symptoms must be considered to avoid error. Dampness pulses and Jing pulses are similar, but symptoms differ: dampness causes body pain, Jing does not.

Zhao Shi states: Headache, fever, back stiffness, and body pain resemble Shanghan. Differences include deep-fine pulse, forehead sweating, yellow face, and ability to eat. Taiyang Shanghan pulses must be floating and vigorous; a deep-fine pulse in this context, unless dampness, implies a Yang disease receiving a Yin pulse. Yellow face and forehead sweating clearly indicate dampness. Dampness patients who can eat have disease in the meridians, not affecting the interior. However, loose stools and sluggish urination result from meridian obstruction impairing transformation.

Damp-Warmth

*Huo Ren Shu* states: Injury by dampness combined with summerheat is called Damp-Warmth. Symptoms include coldness reversing up the calves, chest fullness, headache, eye and head pain, delirious speech, and profuse sweating. The pulse is floating and weak in the Yang position, and small and urgent in the Yin position. Use Fu Ling Bai Zhu Tang [Poria and Atractylodes Decoction] or Bai Hu Jia Cang Zhu Tang [White Tiger plus Atractylodes Decoction]. Do NOT induce sweating; sweating leads to Chong Re (Heavy Heat) and death.

Zhao Shi states: *Huo Ren Shu* mentions contracting dampness then summerheat, causing Damp-Warmth via damp-heat binding. Xu Xueshi said summerheat first, then dampness. Although the sequence differs, the syndrome and treatment are the same. Regarding pulses: Yang is soggy and weak, Yin is small and urgent. Xu Xueshi defined Yang as anterior Guan and Yin as posterior Guan; Ji Shi defined Yang as floating and Yin as sinking. Though locations differ, pulse qualities are consistent. Both views are valid and should not be discarded. For medication, Bai Hu Jia Cang Zhu Tang is indeed appropriate. However, *Huo Ren Shu* mentions Shu Fu Tang [Atractylodes and Aconite Decoction] in the non-surface chapter but omits it in the Damp-Warmth chapter, mentioning only Bai Hu Tang. Why? Pang Shi's formulas warn: Ignorant physicians seeing cold calves often use Si Ni Tang [Frigid Extremities Decoction], killing patients. Damp-warmth pulses are small and tight, resembling Shanghan pulses, but symptoms differ. Frequent administration of Bai Hu Tang warms the calves and cures the disease. Perhaps Zhu Shi omitted Shu Fu Tang fearing similarity to Si Ni Tang and violating Pang Shi's warning? If dampness is excessive, organs are deficient, and stools are loose, can Shu Fu Tang be abandoned?

Tu Shi's pharmacology is cited earlier. Ben Yi states: Generalized pain with inability to turn is called Damp-Warmth.

Wu Shi states: The Classics state: Damp-warmth pulse is Yang soggy-weak, Yin small-urgent. *Huo Ren Shu* says contracting dampness then summerheat causes damp-heat binding, presenting with sweating, delirium, and cold calves. Shu Fu Tang plus Ren Shen, Xiang Ru, and Bian Dou is suitable. If the pulse is large and forceful with spontaneous sweating, vexation, and thirst, Ren Shen Bai Hu Tang plus Bai Zhu is used. Mild cases may use Shi Wei Xiang Ru Yin or Qing Shu Yi Qi Tang modifications. The principle is draining dampness, benefiting Yuan Qi, and clearing summerheat. See Summerheat chapter.

Death Syndromes

If a dampness patient is purged, resulting in forehead sweating, slight panting, and clear urination, death ensues. If diarrhea persists, death also ensues. (Cheng Wuji notes: Sweating cures dampness patients. *Jin Gui Yao Lue* states: For body pain in dampness patients, Ma Huang Jia Zhu Tang [Ephedra plus Atractylodes Decoction] four liang is appropriate for sweating. Improper purgation is a major error. Forehead sweating and slight panting indicate rebellious Yang Qi; clear urination or diarrhea indicates flowing Yin Qi. Separation of Yin and Yang leads to death. The *Nei Jing* states: "Separation of Yin and Yang means extinction of Essence and Qi.")

Ma Huang Jia Zhu Tang Formula

Ma Huang (Ephedrae Herba, three liang, nodes removed), Gui Zhi (Cinnamomi Ramulus, bark removed), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, two liang each), Xing Ren (Armeniacae Semen Amarum, seventy seeds, skin and tips removed), Bai Zhu (Atractylodis Macrocephalae Rhizoma, four liang).

These five ingredients are boiled in nine sheng of water. First boil Ma Huang, reduce by two sheng, remove foam, add other herbs, boil to obtain two and a half sheng, remove dregs, take eight ge warm, cover to induce slight sweating.

Other external treatments for dampness are detailed in the first volume of miscellaneous diseases and are not repeated here.