【歌】东南土薄湿多生，风雨山蒸属外因。西北地高湿疾少，乳醪湿面内因成。腰如石坠头如裹，声壅
如同瓮里鸣。肢节痛兮兼痿痹，四肢缓纵不能行。脉来沉缓无疑惑，疸肿虚浮泄利频。上下分消施汗泄，若然
湿郁取风升。
【论】夫湿有自外入者，有自内出者，必须审其方土。东南地土卑下多阴雨，湿气必从外入，多自下起，
故重腿香港脚者多，治当汗散，久则渗泄。西北地高无湿，人多食湿面、潼乳、酒醪，以饮多快食为尚，或酒后
寒气怫郁，湿不得越，病从内生。故多腹皮胀满，水臌浮肿，按之如泥之病，治须通利二便，甚则逐水驱之，
责其根在内也。然南北方土，其内外所因感，亦互有之，但有多少之殊耳，不宜执一见也。
【脉】湿则濡缓，或兼涩小。入里缓沉，浮缓在表。若缓而弦，风湿相搅。
外因
湿从外受，在上，羌活胜湿汤、升阳除湿汤；在下，四苓散、平胃散；风湿胜，脉浮汗出身重，防己黄
汤调之；在下，气实、大小便不通者，导水丸。
羌活胜湿汤
治脊痛项强，腰似折，项似拔，上冲头痛，及足太阳经不行。
羌活 独活（各钱） 本 防风 甘草 川芎（各五分） 蔓荆子（三分）
水煎温服。
如身重，腰沉沉然，乃经中有湿也，加苍术二钱，黄柏一钱，附子五分。
按∶经曰∶风能胜湿。故用羌、防等诸风药，如卑湿之地，风行其上，不终日而湿去矣。又曰∶无窍不
入，惟风为能。故凡关节之病，非风药不可。用甘草为佐者，以风药悍燥，用以调之，此之谓有制之兵也。
升阳除湿汤
治脾虚不能运化，湿胜濡泻主之。
升麻（中） 柴胡（中） 防风（中） 苍术（上） 泽泻（中） 猪苓（中） 陈皮（下） 神曲（中）
麦芽（中） 甘草（下）
水煎，食前服。
按∶经曰∶清气在下，则生飧泄，故先用升麻、柴胡以提清气。又曰∶湿胜则濡泄，故用苍术、防风以发
汗，猪苓、泽泻以利水，此上下分消之法也。夫泻虽生于湿，必从饮食而得者，故用曲、麦、陈、甘以消食健
脾，脾能健运，则湿自除而泻自止矣。
防己黄 汤
治风湿相搏，客在皮肤，四肢少力，关节烦疼，脉浮身重，汗出恶风。
防己（一两） 甘草（炙，五钱） 白术（七钱半） 黄 （一两二钱）
上 咀，每服一两，枣一枚，姜三片，煎服。
内因
饮食入，湿从内生，二陈汤加苍术、白术，平胃散。饮食内伤停湿，胸满肿胀，发黄，茵陈五苓散，实
者舟车丸。
若饮酒动湿，升而汗之，解酲汤。
二陈汤（方见痰饮。）
四苓散
治内伤饮食有湿，小便赤少，大便溏泄。
白术 茯苓 猪苓 泽泻
按∶经曰∶湿胜则濡泄，故湿生于内者，令人水泄。湿并于膀胱，故小便不利。白术性燥，燥则健脾。茯
苓本淡，淡能渗湿。猪苓有渗而无补。泽泻润下而兼渗。丹溪云∶治湿不利小便，非其治也，故以此方主之。
加桂名五苓散，加茵陈名茵陈五苓散。
平胃散
治脾胃不和，土湿太过，腹胀不食者主之。
苍术（君，米泔浸） 浓朴（臣，姜汁炒） 陈皮（臣） 甘草（佐，炒）
按∶经曰∶谷气通于脾。今山岚瘴气，谷气也，令人不服水土而腹胀，是土湿太过也，故用苍术燥湿为君。
浓朴、陈皮宽中泄气为臣。甘草和诸药为佐。湿气去，则胃气平矣。
上为末，每服五钱，姜、枣煎服。
葛花解酲汤（方见内伤条。）
导水丸
主泻湿热，通利二便。必高燥之地，黑瘦之人，膏粱之家，热燥之病，服之切当。若下湿之地，肥白之人，
淡食之家，寒湿之病，犹未当也。
大黄 黄芩（各一两） 牵牛 滑石（各四两）
上为细末，水丸，如绿豆大，温水下二十丸，日三服。
舟车丸
治湿胜气实。
大黄（二两） 甘遂 大戟 芫花 青皮 陈皮（各一两） 牵
牛（头末四两） 木香（五钱）
上为细末，水丸，白汤送下，随病加减。
【歌诀】
东南地区土壤浅薄，湿气容易滋生，风雨山间蒸腾属于外感病因。
西北地区地势高亢，湿病较少，乳酪、酒醪、湿面等饮食不当导致内伤湿邪。
腰部沉重如坠石，头部昏沉如被包裹，声音沉闷如同在瓮中鸣响。
肢体关节疼痛并伴有痿软麻痹，四肢松弛无力无法行走。
脉象沉缓无疑，黄疸、浮肿、虚浮、泄利频繁。
采用上下分消的方法，通过发汗和利小便来治疗；如果湿邪郁结，则取用风药以升散湿邪。
【论述】
湿邪有从外部侵入的，也有从内部产生的，必须审察患者所处的地域环境。
东南地区地势低洼多阴雨，湿气必然从外部侵入，多从下部开始，
所以患下肢沉重、香港脚（足部肿胀溃烂）的人较多，治疗应当先发散汗液，日久则通过渗泄利尿治疗。
西北地区地势高燥无湿，人们多食用湿面、牛乳、酒醪，以饮酒畅快进食为风尚，或者酒后寒气郁闭，湿邪不得宣越，疾病从内生发。
所以多见腹皮胀满、水臌（腹部积水）、浮肿，按压后凹陷如泥的病证，治疗需要通利大小便，严重时逐水驱除，因为病根在于内部。
然而南北方地域，其内外因感受，也互有存在，只是程度有所不同罢了，不应当固执于一种见解。
【脉诊】
湿邪脉象濡缓，或兼见涩小。
入里则脉缓沉，在表则脉浮缓。
若脉缓而弦，则是风湿相搏。
外因
湿邪从外部受邪，病位在上焦，用羌活胜湿汤、升阳除湿汤；病位在下焦，用四苓散、平胃散；风湿偏盛，脉浮、出汗、身体沉重，用防己黄芪汤调理；病位在下焦，气实、大小便不通者，用导水丸。
羌活胜湿汤
治疗脊背疼痛、项强，腰部像折断一样，颈部像被拔起一样，头痛上冲，以及足太阳经气血不行。
羌活、独活（各一钱），藁本、防风、甘草、川芎（各五分），蔓荆子（三分）。
用水煎煮，温服。
如果身体沉重，腰部沉沉然，这是经络中有湿邪，加苍术二钱，黄柏一钱，附子五分。
按语：经文说：风能胜湿。所以使用羌活、防风等风药，就像在卑湿之地，风吹在上面，不到一天湿邪就去除了。又说：没有孔窍是不进入的，只有风药能通达。所以凡是关节的疾病，非风药不可用。使用甘草作为佐药，是因为风药悍烈燥热，用它来调和，这叫做有节制的军队。
升阳除湿汤
治疗脾虚不能运化，湿邪偏盛导致的濡泻（稀溏大便）为主症。
升麻（中等分量），柴胡（中等分量），防风（中等分量），苍术（上等分量），泽泻（中等分量），猪苓（中等分量），陈皮（下等分量），神曲（中等分量），麦芽（中等分量），甘草（下等分量）。
用水煎煮，饭前服用。
按语：经文说：清气在下，则产生飧泄（完谷不化的腹泻），所以先用升麻、柴胡来提升清气。又说：湿邪偏盛则导致濡泄，所以用苍术、防风来发汗，猪苓、泽泻来利水，这是上下分消的方法。腹泻虽然生于湿邪，但必定从饮食而来，所以用神曲、麦芽、陈皮、甘草来消食健脾，脾能健运，则湿邪自然去除而腹泻自然停止。
防己黄芪汤
治疗风湿相搏，客居在皮肤，四肢少力，关节烦疼，脉浮身重，出汗恶风。
防己（一两），甘草（炙，五钱），白术（七钱半），黄芪（一两二钱）。
切碎，每次服用一两，加枣一枚，姜三片，煎服。
内因
饮食入胃，湿邪从内生发，用二陈汤加苍术、白术，或平胃散。饮食内伤停积湿邪，胸满肿胀，发黄，用茵陈五苓散，实证用舟车丸。
如果饮酒动湿，宜升散发汗，用葛花解酲汤。
二陈汤（方剂见痰饮条）。
四苓散
治疗内伤饮食有湿，小便赤少，大便溏泄。
白术、茯苓、猪苓、泽泻。
按语：经文说：湿邪偏盛则导致濡泄，所以湿邪生于内部，令人水样泄泻。湿邪并入膀胱，所以小便不利。白术性燥，燥则健脾。茯苓本性淡，淡能渗湿。猪苓有渗利而无补益。泽泻润下而兼渗利。丹溪说：治湿如果不通利小便，不是正确的治疗方法，所以以此方为主。加桂枝名五苓散，加茵陈名茵陈五苓散。
平胃散
治疗脾胃不和，土湿太过，腹胀不食者为主症。
苍术（君药，米泔水浸），厚朴（臣药，姜汁炒），陈皮（臣药），甘草（佐药，炒）。
按语：经文说：谷气通于脾。现在山岚瘴气，也是谷气的一种，令人不服水土而腹胀，这是土湿太过，所以用苍术燥湿作为君药。厚朴、陈皮宽中泄气作为臣药。甘草调和诸药作为佐药。湿气去除，则胃气平和了。
研为上末，每次服用五钱，加姜、枣煎服。
葛花解酲汤（方剂见内伤条）。
导水丸
主治泻湿热，通利大小便。必须是高燥之地，黑瘦之人，膏粱之家（富贵人家），热燥之病，服用才恰当。如果是下湿之地，肥白之人，淡食之家，寒湿之病，就不恰当了。
大黄、黄芩（各一两），牵牛子、滑石（各四两）。
研为细末，水泛为丸，如绿豆大，温水送下二十丸，每日三次服用。
舟车丸
治疗湿胜气实。
大黄（二两），甘遂、大戟、芫花、青皮、陈皮（各一两），牵牛子（头末四两），木香（五钱）。
研为细末，水泛为丸，白开水送下，根据病情加减。
[Song]
In the southeast, where soil is shallow, dampness easily generates; wind, rain, and mountain steaming belong to external causes.
In the northwest, where land is high, damp diseases are few; milk, wine, and wet noodles constitute internal causes.
The waist feels heavy as if weighed down by stones, the head feels wrapped or bound,
Voice is obstructed, sounding like ringing in a jar.
Limbs and joints ache, accompanied by flaccidity and numbness;
Four limbs are relaxed and powerless, unable to walk.
Pulse comes deep and slow, leaving no doubt; jaundice, edema, deficiency, floating sensation, and frequent diarrhea occur.
Apply upper and lower dispersion through sweating and purgation; if dampness is stagnant, employ wind herbs to ascend and disperse.
[Dissertation]
Dampness may enter from the exterior or arise from the interior; one must examine the local geography.
In the southeast, the terrain is low and damp with frequent rain; dampness inevitably enters from the exterior, often starting from below.
Thus, those suffering from heavy legs and Hong Kong foot (podagra/foot swelling) are common; treatment should begin with diaphoresis, and if prolonged, with leeching and draining.
In the northwest, the terrain is high and dry; people consume wet noodles, cow's milk, and wine, valuing drinking to stimulate appetite. Or, after drinking, cold qi becomes constrained, preventing dampness from venting, causing disease to arise internally.
Thus, symptoms such as abdominal distension, ascites (water drum), and edema that pits upon pressure are common. Treatment requires unblocking urination and defecation; in severe cases, water-draining methods are used, addressing the root cause within.
However, regarding northern and southern regions, both external and internal causes exist, differing only in degree; one should not adhere rigidly to a single view.
[Pulse Diagnosis]
Dampness presents with a soggy and slow pulse, or possibly choppy and small.
Entering the interior, it is slow and deep; at the exterior, it is floating and slow.
If slow and wiry, wind-dampness is intertwining.
External Causes
Dampness acquired externally: if located above, use Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness) or Shengyang Chushi Tang (Decoction to Raise Yang and Dispel Dampness); if located below, use Siling San (Four-Ling Powder) or Pingwei San (Stomach-Pacifying Powder). If wind-dampness prevails, with floating pulse, sweating, and heavy body, Fangji Huangqi Tang (Stephania and Astragalus Decoction) regulates it. If located below, with excess qi and obstruction of urination and defecation, Daoshui Wan (Water-Guiding Pill) is used.
Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness)
Treats back pain and neck stiffness, waist feeling as if broken, neck feeling as if pulled, headache rushing upward, and dysfunction of the Foot-Taiyang Meridian.
Qianghuo (Rhizoma et Radix Notopterygii), Duhuo (Radix Angelicae Pubescentis) (each 1 qian); GaoBen (Rhizoma Ligustici Wallichii), Fangfeng (Radix Saposhnikoviae), Gancao (Radix Glycyrrhizae), Chuanxiong (Rhizoma Chuanxiong) (each 5 fen); Manjingzi (Fructus Viticis Expensae) (3 fen).
Decoct in water and take warm.
If the body feels heavy and the waist feels sinking, indicating dampness in the meridians, add Cangzhu (Rhizoma Atractylodis Lanceae) 2 qian, Huangbai (Cortex Phellodendri) 1 qian, Fuzi (Radix Aconiti Lateralis Preparata) 5 fen.
Note: The classics state: "Wind can overcome dampness." Therefore, wind herbs like Qianghuo and Fangfeng are used, similar to wind blowing over marshy land, removing dampness in less than a day. It is also said: "No orifice is immune to invasion; only wind herbs can penetrate." Thus, for joint diseases, wind herbs are indispensable. Gancao is used as an assistant because wind herbs are harsh and drying; this moderates them, representing a disciplined army.
Shengyang Chushi Tang (Decoction to Raise Yang and Dispel Dampness)
Treats spleen deficiency failing to transform and transport, primarily for loose stools due to dampness excess.
Shengma (Rhizoma Cimicifugae), Chaihu (Radix Bupleuri), Fangfeng (Radix Saposhnikoviae) (medium dosage); Cangzhu (Rhizoma Atractylodis Lanceae) (high dosage); Zexie (Rhizoma Alismatis), Zhuling (Polyporus) (medium dosage); Chenpi (Pericarpium Citri Reticulatae), Shenqu (Massa Medicata Fermentata), Maiya (Fructus Hordei Germinatus) (medium dosage); Gancao (Radix Glycyrrhizae) (low dosage).
Decoct in water and take before meals.
Note: The classics state: "When clear qi sinks below, sunken stool results." Therefore, Shengma and Chaihu are first used to lift clear qi. It is also stated: "Dampness excess leads to loose stools." Therefore, Cangzhu and Fangfeng are used to induce sweating, while Zhuling and Zexie promote urination. This is the method of upper and lower dispersion. Although diarrhea arises from dampness, it must originate from diet. Therefore, Shenqu, Maiya, Chenpi, and Gancao are used to digest food and strengthen the spleen. When the spleen functions well, dampness is removed and diarrhea stops.
Fangji Huangqi Tang (Stephania and Astragalus Decoction)
Treats wind-dampness combing, lodged in the skin, with weakness in four limbs, painful joints, floating pulse, heavy body, sweating, and aversion to wind.
Fangji (Radix Stephaniae Tetrandrae) (1 liang); Gancao (Radix Glycyrrhizae, honey-fried) (5 qian); Baizhu (Rhizoma Atractylodis Macrocephalae) (7.5 qian); Huangqi (Radix Astragali) (1.2 liang).
Coarsely crush. Take 1 liang per dose, with one jujube and three slices of ginger, decocted in water.
Internal Causes
Dietary intake generates internal dampness: use Erchen Tang (Two-Aged Decoction) added with Cangzhu (Rhizoma Atractylodis Lanceae) and Baizhu (Rhizoma Atractylodis Macrocephalae), or Pingwei San (Stomach-Pacifying Powder). Dietary injury with retained dampness, chest fullness, swelling, and yellowing: use Yinchen Wuling San (Artemisia Capillaris Four-Ling Powder); excess patterns use Zhouche Wan (Boat-Vehicle Pill).
If alcohol induces dampness, use Ge Hua Jiecheng Tang (Flos Fabaegranae Decoction for Relieving Hangover) to ascend and sweat.
Erchen Tang (Two-Aged Decoction) (See Phlegm-Fluids section).
Siling San (Four-Ling Powder)
Treats internal dietary injury with dampness, red and scanty urine, and loose stools.
Baizhu (Rhizoma Atractylodis Macrocephalae), Fuling (Poria), Zhuling (Polyporus), Zexie (Rhizoma Alismatis).
Note: The classics state: "Dampness excess leads to loose stools," so internal dampness causes watery diarrhea. Dampness merging into the Bladder causes difficult urination. Baizhu is drying and strengthens the spleen. Fuling is bland and leaches out dampness. Zhuling leaches but does not tonify. Zexie moistens downward and leaches. Danxi said: "Treating dampness without promoting urination is incorrect." Hence, this formula is primary. Adding Guizhi (Ramulus Cinnamomi) makes Wuling San (Five-Ling Powder); adding Yinchen (Herba Artemisiae Scopariae) makes Yinchen Wuling San.
Pingwei San (Stomach-Pacifying Powder)
Treats spleen-stomach disharmony and excessive earth dampness, primarily for abdominal distension and loss of appetite.
Cangzhu (Rhizoma Atractylodis Lanceae, sovereign herb, soaked in rice wash water); Houpo (Cortex Magnoliae Officinalis, minister herb, stir-fried with ginger juice); Chenpi (Pericarpium Citri Reticulatae, minister herb); Gancao (Radix Glycyrrhizae, assistant herb, stir-fried).
Note: The classics state: "Grain qi connects to the spleen." Mountain miasma is a form of grain qi, causing intolerance to local conditions and abdominal distension, indicating excessive earth dampness. Therefore, Cangzhu is used as the sovereign herb to dry dampness. Houpo and Chenpi broaden the middle and drain qi as minister herbs. Gancao harmonizes the herbs as an assistant. Once dampness is removed, stomach qi becomes peaceful.
Powderize. Take 5 qian per dose, decocted with ginger and jujube.
Ge Hua Jiecheng Tang (Flos Fabaegranae Decoction for Relieving Hangover) (See Internal Injury section).
Daoshui Wan (Water-Guiding Pill)
Mainly treats draining damp-heat and unblocking urination and defecation. It is suitable for people from high, dry lands, who are dark and thin, from wealthy families consuming rich foods, suffering from heat-dryness. It is inappropriate for people from low, wet lands, who are fat and fair, eating bland foods, suffering from cold-dampness.
Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae) (each 1 liang); Qianniu (Semen Pharbitidis), Huashi (Talcum) (each 4 liang).
Powder finely, make pills with water, size of mung beans. Take 20 pills with warm water, three times daily.
Zhouche Wan (Boat-Vehicle Pill)
Treats dampness excess with qi excess.
Dahuang (Radix et Rhizoma Rhei) (2 liang); Gansui (Radix Kansui), Daji (Radix Euphorbiae Pekinensis), Yuanhua (Flos Genkwa), Qingpi (Pericarpium Citri Reticulatae Viride), Chenpi (Pericarpium Citri Reticulatae) (each 1 liang); Qianniu (Semen Pharbitidis, head powder) (4 liang); Muxiang (Radix Aucklandoniae) (5 qian).
Powder finely, make pills with water. Take with plain boiled water, adjusting dosage according to the condition.