雍曰。活人书载湿病三种。一曰中湿。二曰风湿。三曰湿温。
问曰。何谓中湿。仲景曰。太阳病。关节疼痛而烦。脉沉而缓者。
（朱氏云。一作细者非也。）此名湿痹。（一云中湿）湿痹之候。其人小
便不利。大便反快。当利其小便。朱氏曰。一身尽疼。发热身黄。小便
自利者。术附汤。小便不利。大便反快者。甘草附子汤、五苓散主之。
又曰。至真要论曰。治湿之法。不利小便。非其治也。
问曰。中湿之痹何如。雍曰。中湿与风寒气合者为痹。故素问
曰。风寒湿三气杂至。合而为痹。灵枢所谓风寒湿气。客于外分肉之
间。朱氏曰。中湿与风寒气合者为痹。其寒多者为痛。为浮肿。非术
附桂不能去也。其风多者为烦剧。为流走。为拘急。非麻黄薏苡乌头
不能散也。其中湿气者为坚满。为气闭。非甘遂葶苈枳术不能泄也。
问曰。何谓风湿。仲景曰。一身尽疼。发热。日晡所剧者。此名风
湿。此病伤于汗出当风。或久伤取冷所致也。金匮要略曰。可与麻黄
杏子薏苡甘草汤。朱氏曰。脉浮为风湿。麻黄杏仁汤、防已黄 汤、
桂枝附子汤、甘草附子汤、术附杏仁汤、败毒散。可选而用之。
仲景问曰。风湿相搏。一身尽疼痛。法当汗出而解。值天阴雨不
止。医云。此可发汗。汗之病不愈者。何也。答曰。发其汗。汗大出者。
但风气去。湿气在。是故不愈也。若治风湿者。发其汗。但微微似欲
汗出者。风湿俱去也。
金匮要略曰。湿家身烦疼。可与麻黄汤。加术四两。发其汗为
宜。切不可以火攻之。朱氏曰。湿家。虽身体疼。不可大发汗。汗出则
作。
又曰。风湿。脉浮身重。汗出恶风者。防己黄 汤主之。
仲景曰。风湿相搏。骨节疼烦掣痛。不得屈伸。近之则痛剧。汗
出短气。小便不利。恶风。不欲去衣。或身微肿者。甘草附子汤主之。
千金方名四物附子汤。
又曰。伤寒八九日。风湿相搏。身体疼烦。不能自转侧。不呕不
渴。脉浮虚而涩者。桂枝附子汤主之。若其人大便硬。小便自利者。
去桂枝加白术汤主之。庞氏云。桂枝附子汤。治大便自利。小便不利
者。雍曰。桂枝附子汤。非桂枝加附子也。自是第十七方名桂附汤
者。详见太阳症治上。
仲景曰。湿家。其人但头汗出。背强。欲得被覆向火。若下之早
则哕。胸满。小便不利。舌上如苔者。以丹田有热。胃中有寒。渴欲得
水而不能饮。口燥烦也。
又曰。湿家之为病。一身尽疼。发热。身色如熏黄。庞氏曰。宜防
已黄 汤。
又曰。湿家病。身上疼痛。发热面黄而喘。（脉经曰。病患喘。无
而字以上十二字。）头痛鼻塞而烦。其脉大。自能饮食。腹中和。无
病。痛在头中寒湿。故鼻塞。纳药鼻中则愈。庞氏曰。用瓜蒂细末。含
水。搐少许于鼻中。
又曰。湿家下之。额上汗出。微喘。小便利者（一云不利者）死。
若下利不止者。亦死。雍曰。大抵湿家不可下也。初虞氏曰。发汗下
之死。谓误作伤寒治而汗下之也。
问曰。中湿风湿。脉何以辨。雍曰。脉沉而缓者。曰中湿。脉浮恶
风者。曰风湿。中湿无风脉故也。
问曰。何谓湿温。王叔和曰。伤寒湿温。其人常伤于湿。因而中
。湿热相搏。则发湿温。病苦两胫逆冷。腹满支胸。头目痛苦。妄
言。治在足太阴。不可发汗。汗出不能言。耳聋。不知痛所在。身黄而
色变。名曰重 。如此死者。医杀之也。朱氏曰。湿温多汗。头目痛
苦。妄言。其脉阳濡而弱。阴小而急。治在足太阴经。（余上下文同）
雍曰。白虎加苍术汤主之。活人书。载中湿风湿湿温三种之外。尚缺
寒湿痹。今续附于后。湿痹谓缓风湿痹。亦云湿风。非风温也。
仲景曰。伤寒发汗已。身目为黄。所以然者。以寒湿在里不解故
也。以为不可下也。于寒湿中求之。常氏云。可五苓散。雍曰。湿病汗
不出者。寒湿在里不解也。凡湿家发黄者。宜五苓散。
又曰。湿家病在头中寒湿。则头痛鼻塞而烦。内药鼻中则愈。其
详见上。
千金方曰。湿痹缓风。身体疼痛。如欲折。如锥刺刀剜。七物附
子汤主之。
又曰。湿风体痛如折。肉如锥刺刀所刺。八物附子汤。
郭雍说。《活人书》记载湿病有三种。一种是中湿。一种是风湿。一种是湿温。
问：什么是中湿？张仲景说：太阳病（太阳经受邪所致的病证），关节疼痛且烦扰不安，脉象沉而缓的，（朱氏云：一作细者非也。）这名叫湿痹。（一云中湿）湿痹的症状，病人小便不通利，大便反而通畅，应当通利小便。朱氏说：全身都疼痛，发热，身黄，小便自利的，用术附汤。小便不利，大便反快的，甘草附子汤、五苓散主治。又说：《至真要大论》说：治疗湿病的方法，如果不通利小便，就不是正确的治法。
问：中湿引起的痹症是怎样的？郭雍说：中湿与风寒之气结合成为痹症。所以《素问》说：风、寒、湿三种邪气混杂而至，合起来形成痹症。《灵枢》所说的风寒湿气，客居在体表的分肉之间。朱氏说：中湿与风寒之气结合成为痹症。其中寒气多的表现为疼痛、浮肿，不用白术、附子、桂枝不能去除。风气多的表现为烦躁剧烈、游走不定、拘挛紧急，不用麻黄、薏苡仁、乌头不能消散。湿气重的表现为坚硬胀满、气机闭塞，不用甘遂、葶苈子、枳实、白术不能泄除。
问：什么是风湿？张仲景说：全身都疼痛，发热，傍晚时分加重的，这名叫风湿。这种病是因为出汗时受风，或久处寒冷环境所致。《金匮要略》说：可以用麻黄杏仁薏苡甘草汤。朱氏说：脉浮是风湿。麻黄杏仁汤、防己黄芪汤、桂枝附子汤、甘草附子汤、术附杏仁汤、败毒散，可以选择使用。
张仲景问：风湿相搏结，全身都疼痛，按理应发汗而解。正值阴雨连绵不止，医生说：这可以发汗。发汗后病不愈的，为什么呢？回答说：发其汗，大汗出的，只有风气去了，湿气还在，所以不愈。如果治疗风湿，发其汗，只要微微似欲出汗的样子，风湿就能一起去除。
《金匮要略》说：患湿病的人身体烦疼，可以用麻黄汤，加白术四两，发其汗为宜。千万不要用火攻法。朱氏说：湿家，虽然身体疼，不可大发汗，汗出则会导致病情变化。
又说：风湿，脉浮，身重，汗出恶风的，防己黄芪汤主治。
张仲景说：风湿相搏结，骨节疼痛烦扰牵引作痛，不能屈伸，靠近就痛剧，汗出短气，小便不利，恶风，不想脱衣，或者身体微肿的，甘草附子汤主治。《千金方》名叫四物附子汤。
又说：伤寒八九日，风湿相搏结，身体疼痛烦扰，不能自行转侧，不呕不渴，脉浮虚而涩的，桂枝附子汤主治。如果其人大便硬，小便自利的，去桂枝加白术汤主治。庞氏说：桂枝附子汤，治大便自利，小便不利的。郭雍说：桂枝附子汤，不是桂枝加附子。它本身就是第十七方名为桂附汤的。详见太阳症治上。
张仲景说：湿家，其人只是头部出汗，背部强直，想要盖被子面向火取暖。如果过早用下法，就会呃逆，胸满，小便不利，舌上有苔，这是因为丹田有热，胃中有寒，口渴想喝水但不能喝，口燥烦闷。
又说：湿家的病，全身都疼痛，发热，身色像熏黄一样。庞氏说：宜用防己黄芪汤。
又说：湿家病，身上疼痛，发热面黄而喘。（《脉经》说：病患喘，无“而”字以上十二个字。）头痛鼻塞而烦，脉大，能饮食，腹部平和，无病。痛在头中寒湿，所以鼻塞，纳药入鼻中则愈。庞氏说：用瓜蒂细末，含水，搐少许于鼻中。
又说：湿家用下法，额头出汗，微喘，小便利的（一说小便不利的）死。如果下利不止的，也死。郭雍说：大抵湿家不可用下法。初虞氏说：发汗下之死，是说误作伤寒治而汗下之。
问：中湿和风湿，脉象如何辨别？郭雍说：脉沉而缓的，叫中湿。脉浮恶风的，叫风湿。中湿没有风脉的缘故。
问：什么是湿温？王叔和说：伤寒湿温，其人常伤于湿，因而中暑，湿热相搏结，则发湿温。病人苦于两小腿逆冷，腹满支撑胸部，头目痛苦，胡言乱语。治疗在足太阴脾经，不可发汗。汗出不能言，耳聋，不知痛所在，身黄而颜色变，名叫重暍。如此死去的，是医生杀死的。朱氏说：湿温多汗，头目痛苦，胡言乱语，其脉阳部濡弱，阴部小而急，治疗在足太阴经。（余上下文同）郭雍说：白虎加苍术汤主治。《活人书》记载中湿、风湿、湿温三种之外，还缺少寒湿痹，现在续附在后面。湿痹谓缓风湿痹，也称湿风，不是风温。
张仲景说：伤寒发汗后，身目发黄，之所以这样，是因为寒湿在里不解的缘故。认为不可用下法，应在寒湿中求治。常氏说：可用五苓散。郭雍说：湿病汗不出者，是寒湿在里不解。凡是湿家发黄的，宜用五苓散。
又说：湿家病在头中寒湿，则头痛鼻塞而烦，内药入鼻中则愈。其详见上文。
《千金方》说：湿痹缓风，身体疼痛，如欲折断，如锥刺刀剜，七物附子汤主治。
又说：湿风体痛如折，肉如锥刺刀所刺，八物附子汤。
Guo Yong said. The *Huoren Shu* (Book of Vitality) records three types of dampness diseases: one is Zhongshi (Central Dampness), one is Fengshi (Wind-Dampness), and one is Shiwen (Damp-Warmth).
Question: What is Zhongshi (Central Dampness)? Zhang Zhongjing said: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), if there is joint pain accompanied by restlessness, and the pulse is deep and slow, (Zhu's commentary notes: "Some versions read 'fine' instead of 'slow', which is incorrect."), this is named Shib Bi (Dampness Bi Syndrome). (Also known as Zhongshi.) The manifestations of Shib Bi include difficulty in urination and loose stools. The treatment should promote diuresis. Zhu's commentary states: For cases with generalized body pain, fever, and jaundice with normal urination, Shu Fu Tang (Atractylodes Macrocephala and Aconite Decoction) is used. For cases with difficulty in urination and loose stools, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) or Wuling San (Five-Ingredient Powder with Poria) are indicated. Furthermore, the *Zhizhen Yao Lun* (Treatise on the Most Essential Principles) states: The method for treating dampness must involve promoting diuresis; otherwise, it is not the correct treatment.
Question: What is the nature of Bi syndrome caused by Zhongshi? Guo Yong said: Zhongshi combined with wind-cold qi forms Bi syndrome. Thus, the *Suwen* (Basic Questions) states: When wind, cold, and dampness mix and invade together, they form Bi syndrome. As described in the *Lingshu* (Spiritual Pivot), wind-cold-dampness pathogens lodge between the muscle intervals of the exterior. Zhu's commentary adds: When Zhongshi combines with wind-cold to form Bi, excessive cold manifests as pain and edema, requiring Baizhu (Atractylodis Macrocephalae Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), and Guizhi (Cinnamomi Ramulus) to dispel. Excessive wind manifests as severe irritability, wandering pain, and spasms, requiring Mahuang (Ephedrae Herba), Yiyiren (Coicis Semen), and Wutou (Aconiti Radix) to scatter. Excessive dampness manifests as hardness and fullness, and qi obstruction, requiring Gansui (Kansui Radix), Tinglizi (Descurainiae Semen Lepidii Semen), Zhishi (Aurantii Fructus Immaturus), and Baizhu (Atractylodis Macrocephalae Rhizoma) to drain.
Question: What is Fengshi (Wind-Dampness)? Zhang Zhongjing said: Generalized body pain, fever, and worsening in the late afternoon characterize this condition, named Fengshi. This disease results from sweating while exposed to wind, or prolonged exposure to cold. The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: Mahuang Xingzi Yiyi Gancao Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) may be administered. Zhu's commentary notes: A floating pulse indicates Wind-Dampness. Options include Mahuang Xingren Tang (Ephedra and Apricot Kernel Decoction), Fangji Huangqi Tang (Stephania and Astragalus Decoction), Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction), Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction), Zhufu Xingren Tang (Atractylodes and Apricot Kernel Decoction), or Baidu San (Detoxification Powder); these may be selected according to the case.
Zhang Zhongjing asked: When wind and dampness contend, causing generalized body pain, perspiration should theoretically resolve the condition. However, during continuous rainy weather, a physician suggests inducing sweat, yet the patient does not recover. Why? The answer is: If sweat is induced profusely, only the wind is expelled while the dampness remains, hence no recovery. To treat wind-dampness, inducing slight, continuous perspiration allows both wind and dampness to be eliminated.
The *Jingui Yaolue* states: For patients with dampness suffering from vexatious body pain, Mahuang Tang (Ephedra Decoction) with four liang of Baizhu (Atractylodis Macrocephalae Rhizoma) can be used to induce mild sweating. Fire therapy must strictly be avoided. Zhu's commentary adds: Patients with dampness, despite body pain, should not undergo heavy sweating, as this will alter the disease course.
Furthermore, for wind-dampness presenting with a floating pulse, heaviness of the body, sweating, and aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is the primary formula.
Zhang Zhongjing stated: When wind and dampness contend, causing painful, distending joint pain that prevents flexion and extension, exacerbating upon touch, accompanied by sweating, shortness of breath, difficulty urinating, aversion to wind, reluctance to remove clothing, or slight swelling, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) is indicated. The *Qianjin Fang* names this Siewu Fuzi Tang (Four-Ingredient Aconite Decoction).
Additionally, after eight or nine days of Shanghan (Cold Damage), if wind and dampness contend, causing painful body vexation, inability to turn oneself over, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction) is indicated. If the patient has hard stools and free urination, Guizhi (Cinnamomi Ramulus) should be removed and Baizhu (Atractylodis Macrocephalae Rhizoma) added, using the modified formula. Pang's commentary states: Guizhi Fuzi Tang treats cases with free stools but difficult urination. Guo Yong clarifies: Guizhi Fuzi Tang is not merely Guizhi plus Fuzi; it is originally the seventeenth formula named Guifu Tang (Cinnamon-Aconite Decoction). See details under Taiyang Syndrome Treatment.
Zhang Zhongjing stated: In patients with chronic dampness, if there is sweating only on the head, stiffness of the back, and a desire to cover up and face fire, premature use of purgatives will lead to hiccups, chest fullness, difficulty urinating, and a tongue coating resembling moss. This occurs because heat resides in the lower abdomen (Dantian) while cold exists in the stomach, causing thirst for water that cannot be swallowed due to oral dryness and vexation.
Furthermore, in dampness diseases, generalized body pain, fever, and a sallow yellow complexion like smoked tobacco occur. Pang's commentary suggests Fangji Huangqi Tang (Stephania and Astragalus Decoction).
Also, in dampness diseases, body pain, fever, yellowish face, and wheezing occur. (*Maijing* notes: "Patient wheezes," omitting the twelve characters above including "and"). Headache, nasal congestion, and vexation follow. The pulse is large, appetite is normal, and the abdomen is harmonious without internal pathology. The pain originates from cold-dampness in the head, causing nasal congestion; inserting medicine into the nose leads to recovery. Pang's commentary recommends using fine powder of Gengti (Melonis Fructus) mixed with water, insufflated slightly into the nose.
Furthermore, if purgatives are incorrectly used on dampness patients, resulting in sweating on the forehead, slight wheezing, and free urination (or conversely, difficulty urinating), death ensues. Similarly, unceasing diarrhea leads to death. Guo Yong remarks: Generally, purgatives are contraindicated in dampness. Chu Yushi states: Death from sweating and purging results from misdiagnosing dampness as Shanghan and applying inappropriate treatments.
Question: How to differentiate the pulses of Zhongshi and Fengshi? Guo Yong answered: A deep and slow pulse indicates Zhongshi. A floating pulse with aversion to wind indicates Fengshi. This is because Zhongshi lacks the wind pulse characteristics.
Question: What is Shiwen (Damp-Warmth)? Wang Shuhe stated: In Shanghan Shiwen, the patient has previously suffered from dampness, then contracted summerheat. The combination of dampness and heat triggers Shiwen. Symptoms include coldness reversing up the calves, abdominal fullness extending to the chest, headache and eye pain, delirium. Treatment focuses on the Foot-Taiyin (Spleen) channel. Sweating is contraindicated; inducing sweat leads to aphonia, deafness, loss of pain sensation, jaundice, and color changes, termed Chongyue (Severe Heatstroke). Such deaths are caused by the physician's error. Zhu's commentary adds: Shiwen often presents with sweating, headache, eye pain, and delirium. The pulse is soggy and weak at the cun (superficial) position, and small and rapid at the chi (deep) position. Treatment targets the Foot-Taiyin channel. (Context remains consistent throughout.) Guo Yong states: Baihu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodis Lanceae Rhizoma) is the primary formula. The *Huoren Shu* records Zhongshi, Fengshi, and Shiwen, but omits Han Bi (Cold-Damp Bi). It is now appended here. Shi Bi refers to slow wind-damp Bi, also called Shi Feng (Damp-Wind), distinct from Feng Wen (Wind-Warmth).
Zhang Zhongjing stated: After inducing sweat in Shanghan, if the body and eyes turn yellow, it is because cold-dampness lingers internally. Purging is contraindicated; treatment should seek resolution within the context of cold-dampness. Chang's commentary suggests Wuling San (Five-Ingredient Powder with Poria). Guo Yong adds: In dampness diseases where sweat does not occur, cold-dampness lingers internally. For dampness patients developing jaundice, Wuling San is appropriate.
Furthermore, when dampness affects the head with cold-dampness, causing headache, nasal congestion, and vexation, intranasal medication leads to recovery. Details are provided above.
The *Qianjin Fang* states: For Shi Bi and slow wind, causing body pain as if breaking, or feeling like needle pricks and knife wounds, Qi Wu Fuzi Tang (Seven-Ingredient Aconite Decoction) is indicated.
Also, for Shi Feng causing body pain as if breaking, and flesh pain like needle pricks and knife wounds, Ba Wu Fuzi Tang (Eight-Ingredient Aconite Decoction) is used.