中山王知府次子薛里。年十三岁。六月豪雨。池水泛溢。因而戏水。衣服尽湿。其母责
之。至晚觉精神昏愦。怠惰嗜卧。次日病头痛身热。腿脚沉重。一医用发散药。闭户覆衾。
以致苦热不禁。遂发狂言。欲去其衾而不得去。是夜汗至四更。湿透其衾。明日寻衣撮空。
又以承气汤下之。后语言渐不出。四肢不能收持。有时项强。手足螈 搐急而挛。目左视而
白睛多。口唇肌肉蠕动。饮食减少。形体顿瘦。延罗谦甫视之。具说前由。盖伤湿而失于过
汗也。夫人之元气。起于脐下肾间动气。周流一身。通行百脉。今盛暑之时。大发其汗。汗
多则亡阳。百脉行涩。故三焦之气不能上荣心肺。心火旺而肺气焦。况因惊恐内蓄。内经曰
恐则气下。阳主声。阳既亡而声不出也。阳气者。精则养神。柔则养筋。今发汗过多。气
血俱衰。筋无所养。其病为 。则项强手足螈 搐急而挛。目通于肝。肝者筋之合也。筋既
燥而无润。故目左视而白睛多。肌肉者脾也。脾热则肌肉蠕动。故唇蠕动有时而作。经云。
肉痿者。得之湿地也。脾热者。肌肉不仁。发为肉痿。痿者。痿弱无力。今气欲竭。热留于
脾。故四肢不用。此伤湿过汗而成坏证明矣。当治时之热。益水之源。救其逆。补其上升生
发之气。内经曰。热淫所胜。治以甘寒。以酸收之。人参、黄 之甘温。补其不足之气而缓
其急搐。故以为君。肾恶燥。急食辛以润之。生甘草甘微寒。黄柏苦辛寒。以救肾水而生津
液。故以为臣。当归辛温和血脉。橘皮苦辛。白术苦甘。炙甘草甘温。以益脾胃。进饮食。
肺欲收。急食酸以收之。白芍药之酸微寒。以收耗散之气而补肺金。故以为佐。升麻、柴
胡苦平。上升生发不足之气。故以为使。乃从阴引阳之谓也。早晚各投一服。三日后。语声
渐出。少能行步。四肢柔和。食饮渐进。因志其方曰人参益气汤。
震按古人治湿病案。殊无高论奇方。故仅选此条以为辨证处方之模范。今临证指南佳案
甚多。良足私淑。其除气分之湿。用滑石、白蔻、杏仁、半夏、浓朴、栝蒌皮为主。有热则
加竹叶、连翘、芦根等。全取轻清之品。走气道以除湿。若湿热甚而舌白目黄。口渴溺赤。
用桂枝木、猪苓、泽泻、滑石、茯苓皮、寒水石、生白术、茵陈。此从桂苓甘露饮加减。湿
热作痞。神识如蒙。用人参、芩、连、枳实、生干姜、生白芍。此从泻心汤加减。若脘中阻
痛。大便不爽。用豆豉、枳实、川连、姜汁、苓、半。热轻则去川连。加郁金、橘红、苡仁
杏仁。此湿伤气痹治法。热甚则用川连、生术、浓朴、橘白、淡生姜渣、酒煨大黄。水法
丸服。此治气阻不爽。治腑宜通法。湿伤脾阳腹膨。用五苓散、二术膏。湿热横渍。脉腠腹
满。用小温中丸。以及脘痞便溏之用苓桂术甘汤。吞酸形寒之用苓姜术桂汤。虽皆古人成法
而信手拈来。无不吻合。湿温身热神昏。用犀角、元参、连翘心、石菖蒲、银花、野赤豆
皮。煎送至宝丹。乃清热通窍芳香逐秽法。更奇者湿温之头胀耳聋。呃忒鼻衄。舌色带白。
咽喉欲闭。谓邪阻上窍空虚之所。非苦寒直入胃中可治。而用连翘、牛蒡、银花、马勃、射
干、金汁。此俗人梦想不到者也。不食不寐。腹痛便窒。脉迟小涩。谓由平素嗜酒少谷。湿
结伤阳。寒湿浊阴。鸠聚为痛。而用炒黑生附子、炒黑川椒、生淡干姜、葱白。调入猪胆汁
此加味白通汤。亦神奇不可思议者也。更有嗜酒人。胸满不饥。三焦皆闭。二便不通。用
半硫丸。又有病中啖浓味者。肠胃滞。虽下。而留湿未解。肛门坠痛。胃不喜食。舌上白腐
用平胃散去甘草加人参、炮姜、炒黑生附。此二条不因酒肉认作湿热。竟以苦辛温药通阳
劫湿。尤觉高超。至如阳伤痿弱。有湿麻痹。虽痔血而用姜、附、茯苓、生术。舌白身痛。
足跗浮肿。太溪穴水流如注。谓湿邪伏于足少阴。而用鹿茸、淡附子、草果、茯苓、菟丝。
以温蒸阳气。均非浅识所能步武。湿久脾阳消乏。肾真亦惫。中年未育子。用茯、菟、苍术
韭子、大茴、鹿茸、附子、胡卢、补骨、赤石脂。仿安肾丸法。治病调元化为合璧。益有
观止之叹。湿门附此诸案。方法斯为全备。
中山王知府的次子薛里，十三岁。六月大雨，池水泛滥，他因此在水中嬉戏，衣服全部湿透。他的母亲责备了他。到了晚上，他感到精神昏沉困倦，懈怠懒惰想睡觉。第二天出现头痛、身体发热、腿脚沉重的症状。一位医生使用发散药治疗，让他关紧门窗并盖上被子发汗，导致他极度怕热无法忍受，于是胡言乱语，想要去掉被子却做不到。当天夜里出汗直到四更天，汗水湿透了被褥。第二天出现神志不清、伸手乱摸的症状（寻衣撮空）。另一位医生又用承气汤攻下。之后语言逐渐不能发出，四肢不能持握物品，有时颈部僵硬，手足抽搐拘挛，眼睛向左看且白睛显露较多，口唇肌肉蠕动，饮食减少，形体突然消瘦。后来请罗谦甫诊治，详细说明了之前的病情经过。这是因为感受湿邪而错误地过度发汗所致。
人的元气，起源于脐下肾间的动气，周流全身，通行百脉。如今在盛夏酷暑之时，大发其汗，汗出过多则亡阳，导致百脉运行涩滞，所以三焦之气不能上荣于心肺。心火旺盛而肺气焦枯。况且因为惊恐内郁，《内经》说“恐则气下”，阳主声音，阳气既已亡失，所以声音不能发出。阳气，精微部分滋养神志，柔和部分滋养筋脉。如今发汗过多，气血俱衰，筋脉得不到滋养，病症表现为项强、手足抽搐拘挛。目通于肝，肝是筋的合聚之处。筋既干燥而无滋润，所以眼睛向左看且白睛多。肌肉属于脾，脾热则肌肉蠕动，所以口唇蠕动有时发作。《经》云：“肉痿，得之湿地也。”脾热则肌肉麻木不仁，发为肉痿。痿，指痿弱无力。如今气欲枯竭，热留于脾，所以四肢不能使用。这是伤湿后过汗而成坏证，明摆着的事实。应当清治当时的热邪，益补水之源，挽救逆乱，补益上升生发之气。《内经》说：“热淫所胜，治以甘寒，以酸收之。”人参、黄芪的甘温，补益不足之气并缓解紧急抽搐，所以作为君药。肾恶燥，急食辛以润之。生甘草甘微寒，黄柏苦辛寒，用来救肾水而生津液，所以作为臣药。当归辛温和血脉，橘皮苦辛，白术苦甘，炙甘草甘温，用来补益脾胃，增进饮食。肺欲收，急食酸以收之。白芍药的酸微寒，用来收敛耗散之气并补益肺金，所以作为佐药。升麻、柴胡苦平，提升上升生发不足之气，所以作为使药。这就是所谓从阴引阳的方法。早晚各服一剂，三天后，语声逐渐发出，能稍微行走，四肢柔和，饮食逐渐增加。因此记录这个方子叫作人参益气汤。
俞震按：古人治疗湿病的医案，特别没有高论奇方，所以仅选取这一条作为辨证处方的模范。现在《临证指南》中的佳案很多，确实足以私下效法。其中清除气分之湿，用滑石、白蔻仁、杏仁、半夏、厚朴、瓜蒌皮为主药。有热则加竹叶、连翘、芦根等，全取轻清之品，走气道以除湿。如果湿热甚而舌苔白、目黄、口渴、尿赤，用桂枝木、猪苓、泽泻、滑石、茯苓皮、寒水石、生白术、茵陈。这是从桂苓甘露饮加减。湿热造成痞满，神识如蒙蔽，用人参、黄芩、黄连、枳实、生干姜、生白芍。这是从泻心汤加减。如果脘中阻塞疼痛，大便不爽，用豆豉、枳实、川连、姜汁、茯苓、半夏。热轻则去川连，加郁金、橘红、薏苡仁、杏仁。这是湿伤气痹的治疗方法。热甚则用川连、生白术、厚朴、橘白、淡生姜渣、酒煨大黄，用水泛丸服用。这是治疗气阻不畅，治腑宜通的方法。湿伤脾阳导致腹部膨隆，用五苓散、二术膏。湿热横溢，脉腠腹满，用小温中丸。以及脘痞便溏的用苓桂术甘汤。吞酸形寒的用苓姜术桂汤。虽然都是古人的成法，但信手拈来，无不吻合。湿温身热神昏，用犀角、玄参、连翘心、石菖蒲、金银花、野赤豆皮，煎送服至宝丹，这是清热通窍芳香逐秽的方法。更奇特的是湿温的头胀耳聋、呃逆鼻衄、舌色带白、咽喉欲闭，说是邪气阻滞上窍空虚之处，不是苦寒直入胃中可以治疗的，而用连翘、牛蒡子、金银花、马勃、射干、金汁。这是俗人梦想不到的方法。不食不寐，腹痛便窒，脉迟小涩，说是由于平时嗜酒少谷，湿结伤阳，寒湿浊阴，聚集为痛，而用炒黑生附子、炒黑川椒、生淡干姜、葱白，调入猪胆汁，这是加味白通汤，也是神奇不可思议的。更有嗜酒之人，胸满不饥，三焦皆闭，二便不通，用半硫丸。又有病中吃浓味者，肠胃滞，虽下，而留湿未解，肛门坠痛，胃不喜食，舌上白腐，用平胃散去甘草加人参、炮姜、炒黑生附。这两条不因酒肉认作湿热，竟以苦辛温药通阳劫湿，尤其觉得高超。至于如阳伤痿弱，有湿麻痹，虽有痔血而用姜、附、茯苓、生白术。舌白身痛，足跗浮肿，太溪穴水流如注，说是湿邪伏于足少阴，而用鹿茸、淡附子、草果、茯苓、菟丝子，以温蒸阳气，都不是浅识所能步武的。湿久脾阳消乏，肾真亦惫，中年未育子，用茯神、菟丝子、苍术、韭子、大茴香、鹿茸、附子、葫芦巴、补骨脂、赤石脂，仿安肾丸法。治病调元化为合璧，更有观止之叹。湿门附此诸案，方法斯为全备。
Zhongshan Wang Zhifu's second son, Xue Li, was thirteen years old. In June, heavy rain caused pond water to overflow, and he played in the water, getting his clothes completely wet. His mother reprimanded him. By evening, he felt mentally confused and lethargic, sluggish and sleepy. The next day, he developed headache, feverish body sensation, and heaviness in the legs and feet. A physician administered diaphoretic (sweating-inducing) medicine, instructing him to close doors and windows and cover himself with quilts to induce sweating. This resulted in unbearable heat, leading to delirious speech; he wanted to remove the quilts but could not. That night, he sweated profusely until the fourth watch (around 1-3 AM), soaking his bedding. The following day, he exhibited symptoms of searching for clothes and picking at empty air (a sign of severe mental confusion). Another physician then administered Chengqi Tang (Cathartic Decoction) to purge the bowels. Subsequently, his speech gradually ceased, his limbs became unable to grasp objects, and occasionally his neck became stiff. His hands and feet experienced spasms and convulsions, his eyes deviated to the left with excessive sclera visible, his lip muscles twitched, food intake decreased, and his physique emaciated suddenly. Later, Luo Qianfu was consulted, who reviewed the previous history. It was determined that this was due to injury from dampness compounded by improper excessive sweating.
Human Yuan Qi (Original Qi) originates from the moving qi between the kidneys below the navel, circulating throughout the body and penetrating all vessels. At this time of midsummer heat, inducing excessive sweating leads to loss of Yang Qi, causing stagnation in the vessel flow. Consequently, the Qi of the Sanjiao (Triple Burner) cannot ascend to nourish the Heart and Lungs. Heart Fire becomes hyperactive while Lung Qi scorches. Furthermore, due to internal accumulation of fear and fright, as stated in the *Neijing* (Inner Canon): "Fear causes Qi to sink." Yang governs voice; since Yang has been lost, voice production fails. Yang Qi, in its refined aspect, nourishes the Shen (Spirit); in its soft aspect, it nourishes the sinews. Excessive sweating now depletes both Qi and Blood, leaving the sinews without nourishment. The pathology manifests as neck stiffness and limb spasms/constrictions. The eyes connect to the Liver, which is the convergence of sinews. With sinews dried and lacking moisture, the eyes deviate left with exposed sclera. Muscles belong to the Spleen; Spleen Heat causes muscle twitching, hence the occasional lip movement. The Classics state: "Flesh Wei (Flaccidity) arises from damp ground." Spleen Heat causes muscle insensibility, manifesting as Flesh Wei. Wei denotes weakness and lack of strength. Now, Qi is nearly exhausted, and Heat remains in the Spleen, rendering the four limbs unusable. This is clearly a complicated disease (Huai Zheng) resulting from dampness injury followed by excessive sweating. Treatment should clear the current Heat, replenish the source of Water (Kidney Yin), rescue the rebellious Qi, and tonify the ascending and generating Qi. The *Neijing* states: "For excessive Heat, treat with Sweet-Cold herbs, and use Sour herbs to astringe." Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root), being Sweet-Warm, tonify deficient Qi and relieve urgent spasms, thus serving as the Sovereign (Jun) herbs. The Kidney dislikes dryness; urgently consume Pungent herbs to moisten it. Sheng Gan Cao (Raw Licorice Root), Sweet-Slightly Cold, and Huang Bo (Phellodendron Bark), Bitter-Pungent-Cold, rescue Kidney Water and generate fluids, serving as the Minister (Chen) herbs. Dang Gui (Angelica Sinensis Root), Pungent-Warm, harmonizes blood vessels; Ju Pi (Tangerine Peel), Bitter-Pungent; Bai Zhu (Atractylodes Rhizome), Bitter-Sweet; Zhi Gan Cao (Honey-fried Licorice Root), Sweet-Warm, tonify the Spleen and Stomach and promote appetite. The Lung desires astringency; urgently consume Sour herbs to gather it. Bai Shao Yao (White Peony Root), Sour-Slightly Cold, gathers dissipating Qi and tonifies Lung Metal, serving as the Assistant (Zuo) herb. Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root), Bitter-Neutral, lift the insufficient ascending and generating Qi, serving as the Envoy (Shi) herb. This is called "drawing Yang from Yin." Administer one dose morning and evening. After three days, speech gradually returned, walking ability improved slightly, limbs became supple, and diet increased. Thus, this formula was recorded as Renshen Yiqi Tang (Ginseng Qi-Boosting Decoction).
Yu Zhen notes: Ancient cases treating dampness diseases rarely contain profound theories or miraculous formulas; thus, I selected only this case as a model for syndrome differentiation and prescription. Currently, there are many excellent cases in *Lin Zheng Zhi Nan* (Guide to Clinical Practice), worthy of private emulation. To eliminate Dampness from the Qi level, use Shi Gao (though text says Hua Shi/Talcum here, context implies clearing damp-heat via light aromatic/diuretic methods, specifically Hua Shi/Talcum, Bai Kou Ren/Amomum Fruit, Xing Ren/Almond, Ban Xia/Pinellia Tuber, Hou Po/Magnolia Bark, Gua Lou Pi/Bitter Melon Rind) as main ingredients. If Heat is present, add Zhu Ye (Bamboo Leaf), Lian Qiao (Forsythia Fruit), Lu Gen (Reed Rhizome), etc., utilizing exclusively light and clear substances to move the Qi mechanism and dispel Dampness. If Damp-Heat is severe with white tongue coating, yellow eyes, thirst, and dark urine, use Gui Zhi Mu (Cinnamon Twig Wood), Zhu Ling (Polyporus), Ze Xie (Alisma Rhizome), Hua Shi (Talcum), Fu Ling Pi (Poria Peel), Han Shui Shi (Halloysitum), Sheng Bai Zhu (Raw Atractylodes Rhizome), Yin Chen (Artemisia Capillaris). This is a modification of Guiling Ganlu Yin (Cassia-Agaricus Sweet Dew Decoction). For Damp-Heat causing fullness and clouded consciousness, use Ren Shen (Ginseng), Qin (Scutellaria Root), Lian (Coptis Rhizome), Zhi Shi (Immature Bitter Orange), Sheng Gan Jiang (Raw Ginger), Sheng Bai Shao (Raw White Peony Root). This is a modification of Xiexin Tang (Drain the Epigastrium Decoction). For epigastric obstruction and pain with unsatisfactory stool, use Dou Chi (Fermented Soybean), Zhi Shi (Immature Bitter Orange), Chuan Lian (Coptis Rhizome), Jiang Zhi (Ginger Juice), Fu Ling (Poria), Ban Xia (Pinellia Tuber). If Heat is mild, remove Chuan Lian, add Yu Jin (Curcuma Tuber), Ju Hong (Red Tangerine Peel), Yi Yi Ren (Coix Seed), Xing Ren (Apricot Seed). This is the treatment method for Dampness injuring Qi obstruction. If Heat is severe, use Chuan Lian (Coptis Rhizome), Sheng Zhu (Raw Atractylodes Rhizome), Hou Po (Magnolia Bark), Ju Bai (White Tangerine Peel), Dan Sheng Jiang Zha (Light Ginger Residue), Jiu Wei Da Huang (Wine-processed Rhubarb), made into pills with water. This treats Qi blockage and unsmoothness, applying the principle that treating the Fu organs requires unblocking. For Dampness injuring Spleen Yang causing abdominal distension, use Wu Ling San (Five-Ingredient Powder with Poria) and Er Zhu Gao (Two-Atractylodes Paste). For Damp-Heat overflowing affecting pulses, pores, and abdomen, use Xiao Wen Zhong Wan (Minor Warming Middle Pill). For epigastric fullness and loose stools, use Ling Gui Zhu Gan Tang (Poria-Cinnamon-Atractylodes-Glycyrrhiza Decoction). For acid regurgitation and aversion to cold, use Ling Jiang Zhu Gui Tang (Poria-Ginger-Atractylodes-Cinnamon Decoction). Although these are established ancient methods, applied effortlessly, they fit perfectly. For Wet Warmth with fever and coma, use Xi Jiao (Rhinoceros Horn - note: modern substitute often used), Xuan Shen (Scrophularia Root), Lian Qiao Xin (Forsythia Heart), Shi Chang Pu (Acorus Rhizome), Yin Hua (Honeysuckle Flower), Ye Chi Dou Pi (Wild Red Bean Skin), decocted and administered with Zhi Bao Dan (Treasure Preserving Pill). This is the method of clearing Heat, opening orifices, using aromatic substances to expel turbidity. More remarkably, for Wet Warmth with head distension, deafness, hiccup, epistaxis, white tongue coating, and closing throat, it is said that pathogenic factors obstruct the empty spaces of the upper orifices, not treatable by bitter-cold herbs entering directly into the Stomach. Instead, use Lian Qiao (Forsythia), Niu Bang Zi (Arctium Fruit), Yin Hua (Honeysuckle), Ma Bo (Malabar Nut Seed), She Gan (Belamcanda Rhizome), Jin Zhi (Gold Juice). This is beyond the imagination of ordinary people. For anorexia, insomnia, abdominal pain, and constipation with slow, small, choppy pulse, it is attributed to habitual alcohol consumption and grain deficiency, where Dampness congeals and injures Yang, causing Cold-Damp turbid Yin to gather and cause pain. Treat with Chao Hei Sheng Fu Zi (Charred Raw Aconite), Chao Hei Chuan Jiao (Charred Sichuan Pepper), Sheng Dan Gan Jiang (Raw Light Ginger), Cong Bai (Green Onion White), mixed with Pig Gallbladder Juice. This is Jiawei Baitong Tang (Modified Baitong Decoction), also miraculous and inconceivable. Furthermore, for alcoholics with chest fullness, lack of hunger, closure of all three burners, and inability to urinate or defecate, use Banshen Wan (Half-Sulfur Pill). For those eating rich flavors during illness, causing intestinal stagnation where purging leaves residual Dampness, resulting in anal dragging pain, gastric aversion to food, and white rot on the tongue, use Pingwei San (Calm the Stomach Powder) removing Gan Cao, adding Ren Shen (Ginseng), Pao Jiang (Roasted Ginger), Chao Hei Sheng Fu (Charred Raw Aconite). These two cases do not mistake alcohol/meat-induced conditions for Damp-Heat, but instead use Bitter-Pungent-Warm herbs to unblock Yang and seize Dampness, showing superior insight. Regarding Yang injury causing flaccidity, Dampness causing numbness, even with hemorrhoids using Ginger, Aconite, Poria, Sheng Bai Zhu. For white tongue, body pain, dorsal foot edema, and fluid flowing like a spring from Taixi point, indicating Dampness lurking in Foot Shaoyin, use Lu Rong (Deer Antler Velvet), Dan Fu Zi (Mild Aconite), Cao Guo (Black Cardamom), Fu Ling (Poria), Tu Si Zi (Dodder Seed), to warm and vaporize Yang Qi. These are beyond the reach of shallow knowledge. When Dampness persists, Spleen Yang declines, and Kidney Essence exhausts, leading to infertility in middle age, use Fu Shen (Poria with Hostwood), Tu Si Zi (Dodder Seed), Cang Zhu (Atractylodes Lancea), Jiu Zi (Leek Seed), Da Hui (Fennel), Lu Rong (Deer Antler Velvet), Fu Zi (Aconite), Hu Lu Ba (Fenugreek), Bu Gu Zhi (Psoralea Fruit), Chi Shi Zhi (Red Halloysite), imitating Anshen Wan (Calming Kidney Pill). Treating disease and regulating Yuan Qi become complementary, evoking admiration. Attaching these cases to the Dampness chapter makes the methods comprehensive.