天之气一也。六之则为风火燥湿寒暑。故湿之气。六之一也。相乘而为之五变。其化在
天为
湿。
其泄也大瘕。若胃泄不已。变而为飧泄。飧泄不已。变而为洞泄。洞泄不
中。此风乘湿之变也。若脾泄不已。变而为霍乱。霍乱不已。变而为注下。注
为肿蛊。此暑乘湿之变也。若大肠泄不已。变而为 胀。 胀不已。变而为肠
变而为支满 溏。此燥乘湿之变也。若小肠泄不已。变而为肠 。肠 不已
脏毒不已。变而为前后便血。此火乘湿之变也。若大瘕泄不已。变而为脱肛。脱肛不已。
前为乳痔。内为肠风。此寒乘湿之变也。凡此二十五变。若无湿
则终不成疾。况脾胃二土。共管中州。脾好饮。脾亦恶湿。此泄之所由生也。凡下痢之脉。
微且小者生。浮大者死。水肿脉反变浮大者生。沉细者死。夫病在里者脉沉。在表者脉浮。
里当下之。表当汗之。下利之脉浮滑。水肿者沉细。表里俱受病。故反变也。凡脏便血。两
手脉俱弦细者死。俱滑大者生。血温身热者死。王太仆曰。若下血而身热血温。是血去
外逆也。属火。故曰七日而死。七者。火之成数也。夫飧泄得之于风。亦汗可愈。或伏惊怖
。则胆受之。暴下绿水。盖谓戊己见伐甲木也。婴儿泄绿水。素问有婴儿中风。理亦如之。
洞泄者。飧泄之甚。但飧泄近而洞泄久。久则寒中。温之可也。治法曰。和之则可。汗之则
不可。若在腑则易治。入脏则难攻。洞泄寒中。自腑而入脏。宜和解而无争。水肿之作未出
。遽然由湿变于大肠。小溲自涩。水湿既潴。充满日倍。面黄色。肢体如泥。湿气周身。难
专一法。越其高而夺其下。发其表而渗其中。酸收而辛散。淡渗而苦坚。则用攻剂以救其甚
。缓剂以平其余。如是则孤精得气。独魄近阳。亦可保行。陈 去而净府洁。彼以豆蔻乌梅
罂粟物聚用也。设病形易变。必至大误。或通而塞。或塞而通。塞塞通通。岂应一法。世俗
止知涩剂之能塞。而不知通剂之能塞者。乃拘于方也。凡治湿皆以利小便为主。诸泄不已。
灸水分之穴。谓水谷之所别也。脐之上一寸半。灸五壮。腹鸣似雷。水火行之候也。凡湿勿
针。内经虽云缪刺其处。莫若以张长沙治伤寒法治之。盖泄者亦四时伤寒之一也。仲景曰。
上涌下泄。表汗而里攻。半在表半在里。则亦和解之。表里俱见。随证参治。此虽以治伤寒
。其于治湿也同。仍察脉以知深浅。问年壮以知虚实。所投必如其意矣。
天的气是统一的。六气表现为风、火、燥、湿、寒、暑。所以湿只是六气之一。湿气相互乘袭而产生五种变化。其气化在天为湿。其病变表现为大瘕泄（一种严重的泄泻病）。如果胃泄不止，会转变为飧泄（完谷不化的泄泻）；飧泄不止，会转变为洞泄（水样直下的泄泻）；洞泄不止，则变为肿胀蛊胀。这是风邪乘袭湿邪产生的变化。如果脾泄不止，会转变为霍乱；霍乱不止，会转变为注下（急迫的腹泻）；注下不止，则变为肿蛊。这是暑邪乘袭湿邪产生的变化。如果大肠泄不止，会转变为腹胀；腹胀不止，会转变为肠澼（痢疾）；肠澼不止，则变为支满溏薄。这是燥邪乘袭湿邪产生的变化。如果小肠泄不止，会转变为肠痈；肠痈不止，则变为脏毒（肠道湿热蕴结所致的疮疡或出血）；脏毒不止，则变为前后便血。这是火邪乘袭湿邪产生的变化。如果大瘕泄不止，会转变为脱肛；脱肛不止，则前身为乳痔，内身为肠风。这是寒邪乘袭湿邪产生的变化。以上共二十五种变化，如果没有湿邪，最终也不会形成疾病。况且脾胃两脏属土，共同主管中焦。脾喜燥而恶湿，脾也厌恶湿气，这就是泄泻产生的原因。凡是患痢疾的人，脉象微细者生，浮大者死。水肿病患者，脉象反而变浮大者生，沉细者死。病在里的脉象沉，病在表的脉象浮。里证应当用攻下法，表证应当用发汗法。下利的脉象浮滑，水肿的脉象沉细。因为表里都受病，所以脉象反而出现变异。凡是脏腑便血，两手脉象都弦细者死，都滑大者生。血色温而身体发热者死。王太仆说：如果下血且身体热、血液温，这是血去而外逆的表现，属于火证，所以说七天后死亡。七是火的成数。飧泄得之于风邪，也可以通过发汗治愈。或者因潜伏的惊恐恐惧，导致胆受邪，突然排出绿水，这说的是戊己（脾胃）受到甲木（肝胆）的克制。婴儿拉绿水，在《素问》中有婴儿中风的记载，道理也是一样的。洞泄是飧泄的严重形式，但飧泄病程短而洞泄病程长，病程长则寒气在中焦，温补即可。治法说：调和则可，发汗则不可。如果在腑则容易治疗，入脏则难以攻治。洞泄寒中，自腑传入脏，宜和解而不宜争斗。水肿发作尚未外出，突然由湿邪变化于大肠，小便自然涩滞，水湿既已积聚，每天加倍充满，面色黄，肢体像泥一样，湿气遍布周身，不能专守一法。要越其上而夺其下，发其表而渗其中，酸收与辛散并用，淡渗与苦坚并用，然后用攻剂来救治严重的症状，用缓剂来平复其余的邪气。这样孤精得以生气，独魄接近阳气，也可以保全生命。陈旧的湿气去除而净府洁净。那些只用豆蔻、乌梅、罂粟等收敛药物聚积使用的人，如果病情形态发生变化，必然造成大的误治。或者通而致塞，或者塞而致通，塞塞通通，怎么能只对应一种方法？世俗只知道涩剂能止泻，却不知道通剂也能止泻，这是因为拘泥于方书。凡是治疗湿邪都以利小便为主。各种泄泻不止，可以灸水分穴，这是水谷分别的地方。脐上一寸半，灸五壮。腹鸣如雷，是水火运行的征候。凡是湿邪不要针刺，《内经》虽然说要缪刺其处，不如用张仲景治疗伤寒的方法。因为泄泻也是四时伤寒的一种。仲景说：上涌下泄，表汗而里攻。半在表半在里，则也用和解法。表里症状都出现，随证参合治疗。这虽然是用来治疗伤寒，但对于治疗湿邪也是相同的。仍然要察脉以知道深浅，询问年龄体质以知道虚实，所投的药物必定符合心意了。
The Qi of Heaven is unified. When manifested in six aspects, they are Wind, Fire, Dryness, Dampness, Cold, and Heat. Thus, Dampness is merely one of the six. Through mutual overacting (Xiang Cheng), it generates five transformations. Its transformation in Heaven is Dampness. Its pathological manifestation is Da Jia Xie (severe diarrhea with incomplete digestion). If Wei Xie (Stomach diarrhea) persists, it transforms into Sun Xie (diarrhea with undigested food); if Sun Xie persists, it transforms into Dong Xie (profuse watery diarrhea); if Dong Xie persists, it transforms into Zhang Zhong Gu Zhang (abdominal distension and ascites). This is the transformation caused by Wind attacking Dampness. If Pi Xie (Spleen diarrhea) persists, it transforms into Huo Luan (cholera-like syndrome with vomiting and diarrhea); if Huo Luan persists, it transforms into Zhu Xia (urgent profuse diarrhea); if Zhu Xia persists, it transforms into Zhong Gu (edema and ascites). This is the transformation caused by Summer-Heat attacking Dampness. If Da Chang Xie (Large Intestine diarrhea) persists, it transforms into Fu Zhang (abdominal distension); if Fu Zhang persists, it transforms into Chang Pi (dysentery); if Chang Pi persists, it transforms into Zhi Man Tang Bo (fullness and loose stools). This is the transformation caused by Dryness attacking Dampness. If Xiao Chang Xie (Small Intestine diarrhea) persists, it transforms into Chang Yong (intestinal abscess); if Chang Yong persists, it transforms into Zang Du (internal hemorrhoids or intestinal toxicity); if Zang Du persists, it transforms into Qian Hou Bian Xue (bleeding from both anterior and posterior orifices). This is the transformation caused by Fire attacking Dampness. If Da Jia Xie persists, it transforms into Tuo Gang (prolapse of the rectum); if Tuo Gang persists, it manifests externally as Ru Zhi (breast-like hemorrhoids) and internally as Chang Feng (wind in the intestines causing bleeding). This is the transformation caused by Cold attacking Dampness. All these twenty-five transformations will not ultimately result in disease without Dampness. Moreover, the Spleen and Stomach, both belonging to Earth, jointly govern the Middle Jiao. The Spleen prefers dryness and dislikes Dampness; thus, Dampness is the cause of diarrhea. In cases of dysentery, a pulse that is fine and small indicates survival, while a floating and large pulse indicates death. In edema, a pulse that becomes floating and large indicates survival, while a deep and fine pulse indicates death. Disease in the interior presents with a deep pulse; disease in the exterior presents with a floating pulse. Interior syndromes should be treated with purgation; exterior syndromes should be treated with sweating. Diarrhea typically presents with a floating and slippery pulse, while edema presents with a deep and fine pulse. Since both exterior and interior are affected, the pulse changes accordingly. In cases of blood from the organs, if both hands present a string-tight and fine pulse, death ensues; if both hands present a slippery and large pulse, survival is indicated. If the blood is warm and the body is hot, death ensues. Wang Taipu stated: "If there is bloody discharge accompanied by body heat and warm blood, this indicates blood loss with external rebellion, belonging to Fire. Therefore, death occurs on the seventh day. Seven is the completed number of Fire." Sun Xie results from Wind and can also be cured by sweating. Alternatively, due to latent fear or terror, the Gallbladder is affected, leading to sudden discharge of green water. This refers to the Wood (Jia) attacking Earth (Wu and Ji). Infants discharging green water corresponds to infants contracting Wind in the *Su Wen*, following the same principle. Dong Xie is a severe form of Sun Xie; however, Sun Xie is recent while Dong Xie is chronic. Chronicity leads to Cold in the Middle Jiao, which can be treated with warming. The treatment principle states: Harmonization is acceptable, but sweating is not. If the disease is in the Fu organs, it is easy to treat; if it enters the Zang organs, it is difficult to attack. Dong Xie with Cold in the Middle originates from the Fu and enters the Zang; it should be harmonized rather than aggressively attacked. Edema arises suddenly from Dampness transforming in the Large Intestine, causing urinary retention. As water and Dampness accumulate, they double daily, causing yellowish complexion and limbs like mud, with Dampness pervading the body. A single method cannot suffice. One must vent the upper and drain the lower, release the exterior and渗 (percolate) the interior, combine Sour astringency with Pungent dispersion, and combine Bland percolation with Bitter firming. Then use attacking agents to save the severe condition, and mild agents to calm the remainder. Thus, isolated Jing (essence) gains Qi, and solitary Po (corporeal soul) approaches Yang, preserving life. Old Dampness is removed, and the Clean Fu organs are purified. Those who only use cardamom, Chinese plum, and poppy shell for astringency will commit major errors if the disease pattern changes. Or obstruction leads to patency, or patency leads to obstruction. Obstruction and patency alternate; how can one single method apply? The vulgar only know that astringents stop diarrhea, not that patenting agents can also stop it, due to adherence to fixed formulas. Generally, treating Dampness focuses on promoting urination. For persistent diarrhea of various types, moxa is applied to the Shui Fen acupoint, where water and grain separate. Located 1.5 cun above the umbilicus, apply five moxa cones. Abdominal borborygmus resembling thunder is a sign of Water and Fire circulation. Dampness should generally not be treated with acupuncture. Although the *Nei Jing* mentions Miao Ci (oblique needling), it is better to follow Zhang Zhongjing's methods for treating Cold Damage. Diarrhea is also one of the four-season Cold Damage syndromes. Zhongjing said: "Upper emesis and lower purgation, exterior sweating and interior attacking. Half in the exterior, half in the interior, then use harmonization. If exterior and interior signs appear together, treat according to the syndrome." Although this applies to Cold Damage, it is the same for treating Dampness. Still, observe the pulse to know depth, and ask about age and constitution to know deficiency and excess. The prescribed medicine will then match the intent.