湿症大意
诸痉强直。积饮痞满。霍乱吐下。体重跗肿。肉如泥。按之不起。皆属湿土之气。地之湿气。感则害人皮肉筋
脉。因于湿。首如裹。湿热不攘。大筋 短。小筋弛长。 短为拘。弛长为痿。（经文）
湿病内因
天之湿。雨雾是也。天本乎气。故先中肌表荣卫。地之湿。水泥是也。地本乎形。故先伤皮肉筋骨血脉。饮食
之湿。酒饮乳酪是也。胃为水谷之海。故伤乎脾胃。有汗液之湿。汗液亦气化也。止感乎外。人气之湿。太阴
湿土所化也。乃动于中。（准绳）大抵居湿涉水。汗雨沾衣。皆湿从外受者也。若嗜饮酒面。多食瓜果。皆湿从
内伤者也。（医鉴）
中湿外候
有脾胃素弱。内蓄痰饮。外触水湿。相搏而上冲。重者令人涎潮壅塞。颈强 斜。半身不遂。与中风相似。但
脉沉缓沉细沉涩之不同。（准绳）且湿气伤人。在上则头重目黄。鼻塞声重。在中则痞闷不舒。在下则足胫
跗肿。在经络则日晡发热。在肌肉则肿满如泥。在肢节则屈伸强硬。在隧道则重着不移。在皮肤则顽麻。
在气血则倦怠。在肺为喘满咳嗽。在脾为痰涎肿胀。在肝为胁满 疝。在肾为腰疼阴汗。入腑则泄泻肠
鸣。呕吐淋浊。入脏则昏迷不省。直视郑声。又湿家为病。一身尽痛。身如熏黄。身重如板夹为异耳。（汇补）
湿挟寒热
湿症之发。必挟寒挟热。大概溺赤口渴。为湿热。多患于黑瘦膏粱之人。溺清不渴。为寒湿。多患于肥白淡
薄之躯。（汇补）
湿分内外
东南卑下。山泽蒸气。湿从外入。自下而上。初宜汗散。久宜渗泄。西北地高。外燥内湿。不得宣越。从内发外。
初宜利便。久宜健脾。然南北方土虽异。其内外所感相似者有之。不可执一施治。（汇补）
湿症脉法
脉浮而缓。濡而小者。皆外湿。沉而缓。细而微者。皆内湿。又迟缓为寒湿。洪缓为湿热。弦缓为风湿。（汇补）
湿症总治
势轻者。宜燥湿。势重者。宜利便。在外宜微汗。在内宜渗泄。所贵乎上下分消其湿。（入门）凡风药可以胜湿。
泄小便可以引湿。通大便可以逐湿。吐痰涎可以祛湿。湿而有热。苦寒之剂燥之。湿而有寒。辛热之剂除
之。（时珍）
湿宜健脾
脾虚多中湿。（陈无择）脾本喜燥恶湿者也。惟脾土衰弱。失健运之堤防。湿气停聚不化。使 胀四肢。渍透皮
肉。喘满上逆。昏不知人。故治湿不知理脾。非其治也。（汇补）
湿宜利水
湿乃津液之属。随气化而出者也。清浊不分。则湿气内聚。故治湿以利小便为上。（汇补）
湿宜风药
湿淫所胜。助风以平之。（经文）有阳气不升。湿邪内陷者。当用升阳风药以辅佐之。不可过服淡渗。重竭其
气。（东垣）
治湿禁戒
凡湿家。不可大下。下之。额汗出。微喘或哕。小便利者。死。不利不止者。亦死。（伤寒论）
用药总法
主以四苓散。在上。加紫苏、防风微汗之。在中。加苍术、半夏、浓朴燥之。在下。加防己、木通利之。挟风。加
羌活、独活、 本、防己散之。挟寒。加干姜、肉桂、椒目、附子温之。挟热。加黄连、黄芩、山栀、黄柏清之。（景明）
病气实。元气虚者。苍白术同用之。病气元气俱实者。宜通利之。五子五皮饮、导水丸、舟车丸是也。病气元气俱虚者。
培补之。六君子汤、金匮肾气丸是也。
【附风湿】
伤湿又兼风。名曰风湿。因汗出当风。久坐湿地所致。其症头汗面黄。遍身重着。骨节烦疼发热。至日晡转
剧。不呕不渴。恶风不欲近衣。身有微汗。小便不利。大便亦难。脉浮虚而涩。症与伤寒相似。但脉不同耳。宜
微解之。不可大汗。当用羌活胜湿汤。若解表后。自汗多而身仍疼重者。防己黄 汤。（伤寒书）
【附寒湿】
伤湿又兼寒。名曰寒湿。因先受湿气。又伤生冷。其症头汗身痛。遍身拘急。不能转侧。近之则痛剧。遍身无
汗。小便不利。症与风湿相似。但大便转泄耳。宜渗湿汤主之。带表。五积交加散。里寒。附子理中汤。寒多浮
肿者。术附汤。（伤寒书）
【附湿痹】
伤湿而兼风寒。名曰湿痹。其症头痛脊强。恶寒发热。关节疼痛而烦。皮肤麻木。重着不移。脉沉而细。（仲景）
宜新制蠲痹汤主之。
【附湿热】
湿者土之气。土者火之子。湿病多自热生。盖火热能生湿土也。（良方）故六气之中。湿热为病。十居八九。（丹溪）
凡为疸为黄。为肿为胀。为痞为泻。为淋为浊。为带下。体重肿痛。为脓疮。痢疾后重。皆湿热所致也。当分治
之。如湿胜者。宜清其湿。热胜者。宜清其热。夫湿胜其热。不可以热治而用寒药。使湿愈重。热胜湿者。不可
以湿治而用燥药。使热愈甚也。然则初受湿者。当以利水为要。使湿不致成热也。久而湿化为热者。当以
清热为要。使热不致蒸湿也。（汇补）
湿症选方
四苓散 治湿气在中。清浊混乱。小便短少。大便溏泻。
白术（一钱） 茯苓 泽泻（各一钱半） 猪苓（一钱）
水煎服。
平胃散 治不服水土。脾胃胀泻。（方见暑症）
除湿汤 治脾虚停湿。腰脚重肿。大便泻。小便涩。
半夏 浓朴 苍术（炒各二两） 藿香 陈皮 茯苓（各一两） 甘草（七钱） 白术（生用一两）
为末。每服四钱。姜汤下。
清热渗湿汤 治湿病兼热。口渴。小便少而黄浊。
黄连 赤茯苓 泽泻 黄柏（各一钱） 苍术 白术（各一钱半） 甘草（五分）
水煎服。
和剂渗湿汤 治湿病兼寒。口不渴。小便短少而不黄。胸腹满。食不化。
苍术 白术 甘草（炙各一两） 茯苓 干姜（炮各二两） 橘红 丁香（各二钱半）
每服四钱。生姜一片。煎服。
六君子汤 治湿症脾虚。病气元气俱虚者。（方见中风）
金匮肾气丸 治脾肾虚而湿不化者。
地黄 山药 山茱萸 茯苓 丹皮 泽泻 附子 桂枝
导水丸（河间） 治湿热。通二便。必高燥之地。湿热之病。强实之人。若柔弱之躯。淡素之家。寒湿之病。必不
可服。
大黄（二两） 黄芩（一两） 滑石 牵牛（各四两）
水丸。绿豆大。温汤下二十丸。
舟车丸（河间） 治湿胜气实。内胀外肿。大便后重。小便赤涩。
牵牛（头末四两） 大戟 甘遂 芫花 大黄（各二两） 青皮 陈皮 木香 槟榔（各半两） 轻粉（一钱）
取蛊。加芜荑半两为末。水丸麻子大。空心服三丸。如不行。加二丸。至快利为度。
羌活胜湿汤（东垣） 治外感湿气。头身重痛。
羌活 独活 本 防风（各一钱） 甘草（五分） 川芎（二分） 蔓荆子（三分）
水煎。
防己黄 汤（仲景） 治风湿自汗。身疼而重。脉浮。
防已（一钱） 白术（七分半） 黄 （一钱二分） 甘草（五分）
姜四片。枣一枚。水煎服。
General Principles of Dampness Syndromes
Various spasms and limb rigidity, internal accumulation of fluid retention leading to epigastric fullness and distension, vomiting and diarrhea caused by cholera-like disorders, heavy body, edema of the dorsum of the foot, muscles soft like mud with pitting upon pressure, all belong to the pathogenic influence of Damp-Earth Qi. The dampness of the earth, when invading the human body, damages the skin, flesh, sinews, and vessels. Upon contracting dampness, the head feels as if wrapped; if Damp-Heat is not cleared, the large sinews shorten and the small sinews become lax. Shortening of large sinews manifests as spasm (Ju Luan), while laxity of small sinews manifests as flaccidity (Wei). (From the Classic texts)
Internal Causes of Damp Disease
The dampness from heaven refers to rain and mist. Heaven belongs to Qi, so dampness first invades the muscle surface, Ying, and Wei. The dampness from earth refers to water and mud. Earth belongs to Form, so dampness first injures the skin, flesh, bones, tendons, blood, and vessels. The dampness from diet refers to wine, drinks, milk, and cheese. The Stomach is the sea of water and grain, so dampness injures the Spleen and Stomach. The dampness from sweat: sweat is also produced by Qi transformation, affecting only the exterior. The dampness from human Qi is transformed by Taiyin Damp-Earth, moving internally. (From *Zhun Sheng*) Generally, living in damp places or wading in water, sweating while clothes are wetted by rain, these are cases where dampness is received from the exterior. If one indulges in alcohol and wheat products, or eats much fruit and melons, these are cases where dampness injures from the interior. (From *Yi Jian*)
External Manifestations of Contracting Dampness
Those whose Spleen and Stomach are inherently weak, harboring phlegm-fluid internally, and who come into contact with external water-dampness, may experience an upward surge due to the struggle between internal and external pathogens. Severe cases cause saliva to surge and obstruct, neck stiffness, deviation of the mouth and eye, hemiplegia, resembling Wind-Stroke but distinguished by a deep-slow, deep-thin, or deep-choppy pulse. (From *Zhun Sheng*) Furthermore, when dampness injures the body: in the upper part, it causes heavy head, yellow eyes, nasal congestion, and muffled voice; in the middle, it causes epigastric stuffiness and discomfort; in the lower part, it causes swelling of the shins and feet; in the collaterals, it causes afternoon fever; in the muscles, it causes swelling and fullness like mud; in the limbs and joints, it causes stiff and rigid flexion and extension; in the meridians (tunnels), it causes heaviness and immobility; in the skin, it causes numbness; in Qi and Blood, it causes fatigue; in the Lung, it causes wheezing, fullness, cough, and expectoration; in the Spleen, it causes phlegm-saliva and swelling; in the Liver, it causes hypochondriac fullness and hernia; in the Kidney, it causes lower back pain and sweaty yin. Entering the Fu organs, it causes diarrhea, borborygmus, vomiting, strangury, and turbid urine. Entering the Zang organs, it causes coma, unresponsiveness, staring gaze, and incoherent speech (Zheng Sheng). Additionally, patients with dampness suffer from whole-body pain, a sallow complexion like smoked yellow, and a body weight as if clamped by boards, which are their distinctive features. (From *Hui Bu*)
Dampness Accompanied by Cold or Heat
The onset of damp syndromes must involve either Cold or Heat. Generally, red urine and thirst indicate Damp-Heat, common in dark, thin individuals who consume rich foods. Clear urine and no thirst indicate Cold-Dampness, common in fat, fair-skinned individuals with bland diets. (From *Hui Bu*)
Differentiation of Internal and External Dampness
In the southeast, low-lying terrain generates vapor from mountains and marshes; dampness enters from the exterior, rising from below. Initially, diaphoresis should be used to disperse it; for chronic cases, diuresis should be used to drain it. In the northwest, high terrain creates external dryness and internal dampness; dampness cannot be ventilated and emerges from the interior outward. Initially, promoting urination is appropriate; for chronic cases, strengthening the Spleen is appropriate. However, although the soil of north and south differs, there are similarities in externally and internally contracted dampness; treatment should not be rigidly fixed. (From *Hui Bu*)
Pulse Diagnosis for Dampness Syndromes
A floating and slow pulse, or a soggy and small pulse, indicates external dampness. A deep and slow pulse, or a thin and minute pulse, indicates internal dampness. A slow and relaxed pulse indicates Cold-Dampness; a surging and relaxed pulse indicates Damp-Heat; a wiry and relaxed pulse indicates Wind-Dampness. (From *Hui Bu*)
General Treatment of Dampness Syndromes
For mild conditions, drying dampness is indicated; for severe conditions, promoting urination is indicated. For exterior dampness, mild diaphoresis is used; for interior dampness, diuresis is used. The key lies in draining dampness from both upper and lower aspects. (From *Ru Men*) Generally, wind herbs can overcome dampness; promoting urination guides dampness out; promoting defecation expels dampness; inducing vomiting of phlegm removes dampness. If dampness is accompanied by heat, bitter-cold herbs are used to dry it; if dampness is accompanied by cold, acrid-hot herbs are used to dispel it. (From Li Shizhen)
Dampness Requires Strengthening the Spleen
Spleen deficiency easily leads to contracting dampness. (Chen Wuze) The Spleen naturally prefers dryness and dislikes dampness. Only when Spleen Earth is weak and loses its defensive control over transportation and transformation does dampness stagnate and fail to transform, causing abdominal distension, swelling of the four limbs, infiltration into skin and flesh, wheezing and fullness ascending, and coma. Therefore, treating dampness without regulating the Spleen is incorrect treatment. (From *Hui Bu*)
Dampness Requires Promoting Water Metabolism
Dampness belongs to body fluids and exits through Qi transformation. If clear and turbid are not separated, dampness accumulates internally. Thus, treating dampness by promoting urination is the superior method. (From *Hui Bu*)
Dampness Requires Wind Herbs
When dampness prevails excessively, wind herbs assist in pacifying it. (From the Classics) If Yang Qi fails to ascend and damp pathogens sink inward, ascending Yang wind herbs should be used to assist; overly using bland-draining herbs will further deplete Qi. (From Li Dongyuan)
Contraindications in Treating Dampness
Patients with dampness must not undergo drastic purgation. If purged, sweating on the forehead, slight wheezing, or hiccups may occur. If urination is free, death ensues; if urination is blocked and persists, death also ensues. (From *Shang Han Lun*)
General Principles of Medication
The main formula is Si Ling San. For pathology in the upper jiao, add Zi Su and Fang Feng for mild diaphoresis; for the middle jiao, add Cang Zhu, Ban Xia, and Hou Po to dry dampness; for the lower jiao, add Fang Ji and Mu Tong to promote urination. If complicated by Wind, add Qiang Huo, Du Huo, Gao Ben, and Fang Ji to disperse; if complicated by Cold, add Gan Jiang, Rou Gui, Jiao Mu, and Fu Zi to warm; if complicated by Heat, add Huang Lian, Huang Qin, Shan Zhi, and Huang Bo to clear. (From Jing Ming)
If pathogenic qi is excess and healthy qi is deficient, Bai Zhu and Cang Zhu are used together. If both pathogenic and healthy qi are excess, promoting unblocking and draining is suitable, such as Wu Zi Wu Pi Yin, Dao Shui Wan, or Zhou Che Wan. If both pathogenic and healthy qi are deficient, tonification is suitable, such as Liu Jun Zi Tang or Jin Gui Shen Qi Wan.
[Appendix: Wind-Dampness]
Contracting dampness combined with wind is named Wind-Dampness, caused by sweating while exposed to wind or sitting long on damp ground. Symptoms include sweating on the head, sallow face, heaviness throughout the body, painful and hot joints worsening in the afternoon, no vomiting or thirst, aversion to wind and reluctance to wear clothes, slight sweating on the body, difficult urination, and difficult defecation. The pulse is floating, deficient, and choppy. The syndrome resembles Cold Damage but differs in pulse. It should be mildly resolved; profuse sweating is contraindicated. Qiang Huo Sheng Shi Tang is indicated. If after resolving the exterior, spontaneous sweating is excessive and body pain/heaviness persists, Fang Ji Huang Qi Tang is indicated. (From *Shang Han Shu*)
[Appendix: Cold-Dampness]
Contracting dampness combined with cold is named Cold-Dampness, caused by first contracting dampness and then injuring with raw/cold foods. Symptoms include sweating on the head, body pain, rigidity throughout the body, inability to turn over, pain exacerbated by touch, absence of sweating, and difficult urination. The syndrome resembles Wind-Dampness but involves loose stools. Shen Shi Tang is the main prescription. For exterior involvement, Wu Ji Jiao Jia San; for interior cold, Fu Zi Li Zhong Tang; for cold with significant edema, Zhu Fu Tang. (From *Shang Han Shu*)
[Appendix: Damp Bi]
Contracting dampness combined with wind and cold is named Damp Bi. Symptoms include headache, spinal rigidity, aversion to cold and fever, painful and irritable joints, skin numbness, heaviness with immobility, and a deep, thin pulse. (From Zhang Zhongjing) Xin Zhi Juan Bi Tang is indicated.
[Appendix: Damp-Heat]
Dampness is the Qi of Earth; Earth is the child of Fire. Damp diseases often arise from heat, as fire-heat generates damp-earth. (From *Liang Fang*) Among the six qi, damp-heat accounts for eight or nine out of ten cases. (From Zhu Danxi) Jaundice, edema, distension, epigastric fullness, diarrhea, strangury, turbid urine, leukorrhea, heavy body with swelling/pain, abscesses, and tenesmus after dysentery are all caused by damp-heat. They must be treated differently. If dampness exceeds heat, clear the dampness; if heat exceeds dampness, clear the heat. If dampness dominates heat, do not use cold herbs thinking it treats heat, as this worsens dampness. If heat dominates dampness, do not use drying herbs thinking it treats dampness, as this worsens heat. Therefore, in early dampness, promoting urination is key to prevent heat generation. In chronic cases where dampness transforms into heat, clearing heat is key to prevent steaming dampness. (From *Hui Bu*)
Selected Formulas for Dampness Syndromes
Si Ling San: Treats dampness in the middle jiao, confusion of clear and turbid, scanty urine, and loose stools.
Bai Zhu (1 qian), Fu Ling, Ze Xie (each 1.5 qian), Zhu Ling (1 qian).
Decoct in water and take orally.
Ping Wei San: Treats intolerance to local climate, Spleen/Stomach distension and diarrhea. (Formula see Summer-Heat Syndrome chapter)
Chu Shi Tang: Treats Spleen deficiency with stagnant dampness, heavy/swollen waist and legs, loose stools, and scanty/difficult urination.
Ban Xia, Hou Po, Cang Zhu (stir-fried, each 2 liang), Huo Xiang, Chen Pi, Fu Ling (each 1 liang), Gan Cao (7 qian), Bai Zhu (raw, 1 liang).
Grind into powder, take 4 qian per dose, washed down with ginger soup.
Qing Re Shen Shi Tang: Treats dampness with heat, thirst, scanty yellow-turbid urine.
Huang Lian, Chi Fu Ling, Ze Xie, Huang Bo (each 1 qian), Cang Zhu, Bai Zhu (each 1.5 qian), Gan Cao (0.5 qian).
Decoct in water and take orally.
He Ji Shen Shi Tang: Treats dampness with cold, no thirst, scanty non-yellow urine, chest/abdominal fullness, poor digestion.
Cang Zhu, Bai Zhu, Gan Cao (roasted, each 1 liang), Fu Ling, Gan Jiang (roasted, each 2 liang), Ju Hong, Ding Xiang (each 2.5 qian).
Take 4 qian per dose with one slice of fresh ginger, decocted in water.
Liu Jun Zi Tang: Treats Spleen deficiency in dampness syndromes, where both pathogenic and healthy qi are deficient. (Formula see Stroke chapter)
Jin Gui Shen Qi Wan: Treats Spleen/Kidney deficiency with failure to transform dampness.
Di Huang, Shan Yao, Shan Zhu Yu, Fu Ling, Mu Dan Pi, Ze Xie, Fu Zi, Gui Zhi.
Dao Shui Wan (He Jian): Treats damp-heat, unblocking both bowels. Suitable only for high/dry regions, damp-heat diseases, and robust constitutions. Contraindicated for frail bodies, bland diets, or cold-damp diseases.
Da Huang (2 liang), Huang Qin (1 liang), Hua Shi, Qian Niu (each 4 liang).
Make water pills, size of mung beans. Take 20 pills with warm water.
Zhou Che Wan (He Jian): Treats dampness excess with qi excess, internal distension and external edema, tenesmus, and red/scanty urine.
Qian Niu (head powder, 4 liang), Da Ji, Gan Sui, Yuan Hua, Da Huang (each 2 liang), Qing Pi, Chen Pi, Mu Xiang, Bing Lang (each 0.5 liang), Qing Fen (1 qian).
Add Qu Yi (half liang) to the powder made from the above. Make water pills, size of sesame seeds. Take 3 pills on an empty stomach. If ineffective, increase by 2 pills until rapid purgation is achieved.
Qiang Huo Sheng Shi Tang (Dong Yuan): Treats external contraction of dampness, heavy/painful head and body.
Qiang Huo, Du Huo, Gao Ben, Fang Feng (each 1 qian), Gan Cao (0.5 qian), Chuan Xiong (0.2 qian), Man Jing Zi (0.3 qian).
Decoct in water.
Fang Ji Huang Qi Tang (Zhong Jing): Treats Wind-Dampness with spontaneous sweating, painful/heavy body, and floating pulse.
Fang Ji (1 qian), Bai Zhu (0.75 qian), Huang Qi (1.2 qian), Gan Cao (0.5 qian).
Add 4 slices of ginger and 1 date. Decoct in water and take orally.