中湿者,即类中门中之湿中也。盖湿为阴邪,病发徐而不骤。今忽中者,必因脾胃素亏之体,宿有痰
饮内留,偶被湿气所侵,与痰相搏而上冲,令人涎潮壅塞,忽然昏倒,神识昏迷。与中风之证,亦颇相似,
但其脉沉缓、沉细、沉涩之不同,且无口眼 斜不仁不用之各异,此即丹溪所谓湿热生痰,昏冒之证
也。宜以增损胃苓法去猪苓、泽泻、滑石,加苏子、制夏、远志、
菖蒲治之。倘有痰筑喉间,声如鼎沸,诚有须臾变证之虞,可加苏合香丸,分为两次冲服。倘得
痰平人省,始有转机,否则不可救也。
冒湿之病,得之于早晨雾露,云瘴山岚,或天阴淫雨,晴后湿蒸。初受其气者,似乎有物蒙之,以致
首如裹,遍体不舒,四肢懈怠,脉来濡缓之象。宜用宣疏表湿法取其微汗,仿嘉言贵徐不贵骤之意,俾其湿
邪还表而解,毋使其由表而入于里。倘或脘中痞闷,微热汗少,小便短赤,是湿邪已入于里也。宣疏
之剂,又不相宜,宜改通利之方,自然中的。伤湿条内,须参阅之。
贾氏曰∶夏热则万物湿润,秋凉则万物干燥。若此论之,湿热之证,在长夏而不在秋,岂非与《内经》
之“秋伤于湿”不合耶?细思之,斯二句书,不重夏秋二字,当重在热凉二字也。盖热蒸则湿,凉胜则燥,理
固然矣。即如立秋处暑之令,炎蒸如夏,患者非秋湿,即秋暑。其实秋令之湿热,亦必夹之秋暑也。
考湿热之见证,身热有汗,苔黄而泽,烦渴溺赤,脉来洪数是也,当用通利州都法治之。如大便秘结,加栝
蒌、薤白,开其上以润其下。如大便未下,脉形实大有力者,是湿热夹有积滞也,宜本法
内加元明粉、制大黄治之。
或问曰∶先贤尝谓暑必夹湿,今先生谓湿热夹暑,有是说乎?答曰∶小暑之节,在于相火之后,大暑之
气,在于湿土之先,故先贤有暑必夹湿之训也。丰谓湿热夹暑,专在大暑至白露而言。盖
斯时湿土主气,暑气渐退,湿令方来,而湿甚于暑
者,故谓之湿热夹暑也。又问曰∶章虚谷录薛生白湿温之条,加之注解,统以湿温称为湿热。今先生分门而
论者何也?曰∶湿体本寒,寒湿可以温散;酝酿成热,热湿可以清通。惟湿温不热不寒,最为难治,断不可
混湿温为湿热,理当分列湿热湿温为二门。又问曰∶湿热致病者多,何略而弗详乎?曰∶因湿致病者,固属不
少,如肿满、黄胆、淋浊等证,诸先贤皆早详于杂证之书,是编专论时病,毋庸迭赘可耳。
中湿,就是类中风门中的湿邪中伤。因为湿属于阴邪,发病缓慢而不突然。现在忽然中湿,一定是因为脾胃素来虚弱的人,体内宿有痰饮停留,偶然被湿气侵袭,与痰相互搏结而上冲,导致涎沫如潮、壅塞气道,使人忽然昏倒,神识昏迷。这与中风的证候颇为相似,但其脉象呈沉缓、沉细或沉涩的不同,且没有口眼歪斜、肢体麻木不用的差异,这就是朱丹溪所说的湿热生痰、神志昏蒙的证候。适宜用增损胃苓汤法,去掉猪苓、泽泻、滑石,加入苏子、制半夏、远志、石菖蒲来治疗。如果有痰液阻塞喉间,声音像鼎沸一样,确实有短时间内发生变证的危险,可以加服苏合香丸,分两次冲服。如果得到痰平人醒,才有转机,否则就无法救治了。
冒湿的病,得之于早晨的雾露、云瘴山岚,或是天阴连绵大雨,雨后湿气蒸腾。初受这些邪气时,似乎有东西蒙蔽头部,以致头部沉重如包裹,全身不适,四肢懈怠无力,脉象呈现濡缓之象。适宜用宣疏表湿法,取其微微出汗,仿照喻嘉言“贵在徐缓而不在骤急”的意思,使湿邪从体表解除,不要让它由表入里。如果出现胃脘部痞闷、微热汗少、小便短赤,这是湿邪已经入里的表现。宣疏表湿的药剂就不适宜了,应当改用通利里湿的方剂,自然能对症。在伤湿条内,需要参考阅读。
贾氏说:夏天炎热则万物湿润,秋天凉爽则万物干燥。按照这种说法,湿热之证,发生在长夏而不是秋天,这难道不与《内经》所说的“秋伤于湿”相违背吗?仔细思考这两句话,重点不在夏秋二字,而应重在热凉二字。因为热气蒸腾则生湿,凉气胜则生燥,道理本来就是这样。就像立秋、处暑时节,炎热蒸腾如同夏季,患病者非秋湿即秋暑。其实秋季的湿热,也必然夹杂秋暑。考察湿热的见证,是身体发热有汗,舌苔黄而润泽,心烦口渴,小便短赤,脉象洪数,应当用通利州都(膀胱)法治之。如果大便秘结,加入瓜蒌、薤白,开通上部以滋润下部。如果大便未下,脉象实大有力,这是湿热夹有积滞,应当在本法中加入元明粉、制大黄治疗。
有人问:先贤曾说暑必夹湿,现在先生说湿热夹暑,有这样的说法吗?回答说:小暑节气,位于相火之后,大暑节气,位于湿土之前,所以先贤有“暑必夹湿”的教诲。我认为“湿热夹暑”,专指从大暑到白露这段时间。因为此时湿土主气,暑气渐退,湿令刚来,而且湿重于暑,所以称为湿热夹暑。又问:章虚谷收录薛生白关于湿温的条文,并加以注解,统称为湿热。现在先生分门别类论述的原因是什么?回答说:湿的本体属寒,寒湿可以用温散法;酝酿成热,热湿可以用清通法。只有湿温病不热不寒,最为难治,绝对不能将湿温混同为湿热,理应将湿热和湿温分为两门。又问:因湿热致病的情况很多,为什么略写而不详细呢?回答说:因湿致病的病症固然不少,如肿满、黄疸、淋浊等证,各位先贤在杂证书籍中早已详述,本书专门论述时病,无需重复赘述罢了。
Zhongshi (Stroke-like syndrome caused by Dampness) refers to the invasion of Dampness within the category of Lei Zhong (Apoplexy-like syndromes). Since Dampness is a Yin pathogenic factor, its onset is gradual rather than sudden. The current sudden occurrence of Zhongshi must be due to a constitution with inherent Spleen and Stomach deficiency, where phlegm-fluid retention has been lingering internally. Upon accidental invasion by external Dampness, it combats with the internal phlegm and rushes upward, causing saliva to surge like a tide and obstructing the airways, leading to sudden fainting and loss of consciousness. This presentation is quite similar to Fengzhong (Wind Stroke), but differs in that the pulse is deep-slow (Chen-Huan), deep-thin (Chen-Xi), or deep-choppy (Chen-Se), and lacks the asymmetry of the face and limbs numbness/paralysis seen in Wind Stroke. This is precisely what Zhu Danxi described as a syndrome of Damp-Heat generating Phlegm, leading to mental cloudiness. It should be treated with Zengsun Weiling Tang (Modified Cinnamon Twig and Atractylodes Macrocephala Decoction), removing Zhu Ling (Polyporus), Ze Xie (Alisma), and Hua Shi (Talcum), and adding Su Zi (Perilla Fruit), Zhi Ban Xia (Prepared Pinellia), Yuan Zhi (Polygala Root), and Chang Pu (Acorus Rhizome). If there is phlegm obstructing the throat with a sound resembling boiling water, there is indeed a risk of sudden transformation of the condition; Suhexiang Wan (Styrax Pill) can be added, taken in two divided doses dissolved in liquid. If the patient regains consciousness after the phlegm subsides, there is hope for recovery; otherwise, it may be incurable.
Maoshi (Superficial invasion by Dampness) is contracted from morning fog and dew, mountain miasma, or continuous rainy days followed by damp evaporation after clearing skies. Initially affected by these pathogens, one feels as if something is covering the head, resulting in a sensation of heaviness in the head as if wrapped, general body discomfort, flaccidity and lassitude of the four limbs, and a soggy-slow (Ru-Huan) pulse. It is appropriate to use Xuan Shu Biao Shi Fa (Method to Disperse and Ventilate Superficial Dampness) to induce slight sweating, following Yu Jiayan’s principle of "valuing slowness over haste," so that the Dampness pathogen is resolved through the exterior and does not penetrate inward. If epigastric fullness/stuffiness, slight fever, scanty sweating, and short red urine occur, this indicates that the Dampness pathogen has entered the interior. Agents for dispersing superficial Dampness are no longer suitable; instead, formulas for promoting urination and draining Dampness should be used, which will naturally hit the mark. Refer to the section on Shang Shi (Injury by Dampness) for further reading.
Jia stated: In summer heat, all things are moist; in autumn coolness, all things are dry. Based on this argument, Damp-Heat syndromes occur in Late Summer, not Autumn, which seems inconsistent with the *Neijing*’s statement "Autumn injury by Dampness." Upon careful consideration, the emphasis of these two sentences lies not in the characters "Summer" and "Autumn," but in "Heat" and "Coolness." Heat steaming generates Dampness, while Coolness overcoming leads to Dryness; this is the natural principle. For instance, during the Liqiu (Start of Autumn) and Chushu (Limit of Heat) solar terms, the heat and steam resemble summer; patients suffer either from Autumn Dampness or Autumn Heat. In fact, Autumn Damp-Heat must also be accompanied by Autumn Heat. Examining the manifestations of Damp-Heat: body heat with sweating, yellow and glossy tongue coating, irritability, thirst, dark urine, and a surging-numerous (Hong-Shu) pulse. These should be treated using Tong Li Zhou Du Fa (Method to Unblock and Drain the Zhou Du [Bladder]). If constipation is present, add Gua Lou (Trichosanthes Fruit) and Xie Bai (Macrostemon Bulb) to open the upper jiao to moisten the lower. If stool remains unpassed and the pulse is solid, large, and forceful, this indicates Damp-Heat combined with accumulation/stagnation; Yuan Ming Fen (Mirabilite) and Zhi Da Huang (Prepared Rhubarb) should be added to the base method for treatment.
A question was raised: Ancients once said that Summer Heat must be accompanied by Dampness; now you say Damp-Heat is accompanied by Summer Heat. Is such a theory valid? The answer is: The Xiao Shu (Minor Heat) solar term occurs after the phase of Ministerial Fire, and the Qi of Da Shu (Major Heat) occurs before the phase of Damp Earth; thus, the ancients taught that "Summer Heat must be accompanied by Dampness." I assert that "Damp-Heat accompanied by Summer Heat" specifically applies to the period from Da Shu to Bai Lu (White Dew). During this time, Damp Earth governs the Qi, Summer Heat gradually recedes, and the Damp command arrives, with Dampness being heavier than Summer Heat; hence it is called Damp-Heat accompanied by Summer Heat. Another question: Zhang Xugu recorded Xue Shengbai’s sections on Wen Shi (Damp-Warmth) and annotated them, collectively referring to it as Shi Re (Damp-Heat). Why do you classify them into separate categories? The answer is: The nature of Dampness is originally Cold; Cold-Dampness can be dispersed with warmth; when fermented into Heat, Damp-Heat can be cleared and unblocked. Only Wen Shi (Damp-Warmth) is neither hot nor cold, making it the most difficult to treat. One must absolutely not confuse Wen Shi with Shi Re; logically, Shi Re and Wen Shi should be listed as two separate categories. Another question: There are many diseases caused by Damp-Heat, why is it briefly mentioned without detail? The answer is: Diseases caused by Dampness are indeed numerous, such as edema/fullness, jaundice, strangury, and turbid urine; these have already been detailed by various ancients in books on miscellaneous diseases. This work specifically discusses seasonal diseases, so repetition is unnecessary.