自古皆谓∶寒伤肺，湿伤脾，同气相感也，展转乃伤他经。今据吾所见，凡人久在湿地
坐卧
，寒湿之气尽从太阳、
少阴深入矣。《内经》谓∶伤于湿者，下先受之。又谓∶清湿地气之
中人也，常从足 始。况人坐则以足置地，卧多以背向下，故内气充足者，邪气不遽内袭，
即从 髀上窜膂脊，过顶入鼻，一路筋络牵引，酸疼胀急，此伤于太阳之经，而内连督脉也
，重者即菀为香港脚矣；若内之真阳稍怯者，邪气即从涌泉上入胫骨，而内侵腰俞、背俞，先
使
肾阳不得下降，大便溏滑，小便赤涩，两胫时冷；渐渐弥漫三焦，心胃之阳又为所抑矣，
甚者即水气凌心也。其始筋骨酸胀，精神猥软，呼吸气高，两腿沉重。治之必仿少阴伤寒治
法，而加以温行湿邪之品，方能奏效；若仅治中焦，药力不能与邪针对，无益也。若见其上
热，误认为热，而以寒凉浇灌，其祸更不堪言。仲景辨脉篇清邪中上，浊邪中下一条，即此
病之久延败证也。前人指为瘟疫者，非是。拙着《章句》论之甚详。
《灵枢》曰∶厥逆者，寒湿之起也。又曰∶厥成为癫疾。《金匮》妇人篇中有曰∶因虚
积冷
，结气在下，奄忽眩冒，状如厥癫。其叙痉证也，亦有面赤、足冷、目脉赤、背反张之候，
是痉厥初起，皆由寒湿下受，上入脊膂；肾阳不得下降，上冲于心，两阳相搏于膻中。治不
得法，积之日久，遂有热痰胶固不可拔之痫证矣。嗣后饮食、惊恐、风、寒、暑、湿，有感
即发。医者以为病在于心，专用牛黄、犀角，以清心热、祛心痰，心气愈虚，而邪愈痼。殊
不知此寒湿下受之邪，太阳、少阴之来路也。《千金方》谓∶小续命为癫痫要药，即此义矣
。陶节庵槌法有曰∶病始得之，无热，谵语，烦躁不安，精采不与人相当，(诸证皆气高不
下，神明上越之象，为寒湿从下冲激也。)庸医不识，呼为狂发，殊不知此热结膀胱之证也
，用桂苓散，即五苓加味。石顽老人亦谓∶五苓散能分水去湿，胸中有停饮，及小儿吐 ，
欲作痫者，五苓散最妙。此皆寒湿痼于下焦，大气遏痹不舒之所致也。热结膀胱者，邪气外
束故也。
何子詹之子媳，有孕，患自两足跟，上腓肠，入髀臀腰脊，过项，上顶，复前至于鼻，
一路
皆胀急酸疼，四肢懒怠，腰软不支，脉六部沉紧，右手重按略滑，此胎气也。其病乃寒湿伤
于太阳，内连督脉，用细辛五分，羌活二钱， 本、威灵仙各钱半，菟丝子、桑寄生、巴戟
、狗脊、白术、杜仲、茯苓、牛膝各二钱，决以三剂知，五剂已。果验，其苦如脱。夫辛、
羌、威、 、牛膝，号称伤胎，今既有病当之，又加强筋固气之品以佐之，不但能防其偏，
而且能助其力，故病愈而治无伤也。若用参、 、归、地，便有妨寒湿，而诸味不得展其长
矣。
何子詹之孙，三岁，先于七月患湿疮，渐愈矣，微见溏泄，忽半夜发热，日出始退，次
日根据
时而至。医遂以为疟，忽又大声惊喊，目瞪昏厥，旋复如常，医又以为惊风，更以危言吓之
。越数日，乃邀诊。至则见其精神萎顿，面色惨黯，目胞下垂，四肢 肿，而左尤甚，头面
亦右温左凉，舌苔薄白在后半部，脉息沉紧。审思良久，曰∶异哉!此寒湿深入骨髓也。疏
方用桂枝、良姜、乌药、香附、陈皮、菖蒲。服四剂，病无增损，而萎顿弥甚，然脉息浮弦
矣。因思邪从下上犯，此药仅温理中焦，宜无益也。于是用细辛、川芎各五分，羌活、 本
、威灵仙、生附子、牛膝、巴戟、苍术、桃仁、杏仁各二钱。决以三剂病已，至期果面色清
亮，言笑有神，饮食倍进， 肿全消，脉息畅大矣。惟肢体尚见微倦，舌尖有小红累，是虚
热也，用桃仁、杏仁、蛤粉、蒲黄，略清结痰，继用香附、青皮、白术、鸡内金、川芎、郁
金、党参、山药，调理脾胃，发水痘而复元。是病也，其初见发热者，是寒湿从阴分上蒸，
与卫阳交战也；惊喊昏厥者，声发于心，寒湿内逼心阳，乍掩热痰，乍涌于包络，所谓积冷
在下，状如厥癫也。若作疮后惊风治之，即败矣。若以子后发热，天明即止，为伤食所致，
而概用消导，亦危矣。诸医以为久病正虚，须用气血两补，其识更陋。夫患湿疮月余而渐愈
矣。谁复议其寒湿内伏耶?无怪血虚不能养心，不能荣筋之说纷纷也。水痘即豌豆疮，伤寒
病后多有，见陶节庵书中。痘发于骨，益征寒湿在骨之非臆说耳!
自古以来都认为：寒邪伤害肺脏，湿邪伤害脾脏，这是同气相感的结果，辗转传变才会伤害其他经络。如今根据我所见到的情况，凡是长时间在潮湿环境中坐卧的人，寒湿之气完全从太阳经、少阴经深入体内了。《内经》说：受湿邪伤害的，下部先受到侵袭。又说：身处清冷湿地之气中的人，病邪常从足部开始。况且人坐着时脚接触地面，躺着时背部多向下，所以体内正气充足的人，邪气不会立刻内侵；如果侵入，就从大腿窜至脊背，经过头顶进入鼻腔，沿着一路筋络牵引，出现酸痛、胀满、拘急的症状，这是伤于太阳经，而内部连及督脉；病情重的就会郁结为香港脚（下肢肿痛之症）；如果体内真阳稍显虚弱的人，邪气就从涌泉穴向上进入胫骨，进而内侵腰俞穴、背俞穴，首先导致肾阳不能下降，出现大便溏滑、小便赤涩、两小腿时常发冷的症状；渐渐地弥漫至三焦，心阳和胃阳又被所抑制，严重的就会出现水气凌心证。起初表现为筋骨酸胀、精神萎靡疲软、呼吸气粗、双腿沉重。治疗时必须仿照少阴伤寒的治疗方法，并加入温通行湿的药物，才能见效；如果只治疗中焦，药力不能与邪气针对性地对抗，就没有益处。如果看到上部有热象，误认为是热证，而用寒凉药物浇灌，其祸患更是不堪设想。张仲景《辨脉篇》中“清邪中上，浊邪中下”的一条论述，就是这种病久延不愈导致的败证。前人将其指认为瘟疫，是不对的。我在拙作《章句》中对此论述得很详细。
《灵枢》说：厥逆证，是由寒湿引起的。又说：厥逆发展严重会变成癫疾。《金匮要略》妇人篇中有说：因虚积冷，气结在下，突然眩晕昏冒，症状像厥逆或癫狂。其中叙述痉证时，也有面红、足冷、目脉赤红、角弓反张等征候，这说明痉厥初起，都是由寒湿从下部受邪，向上进入脊背；肾阳不得下降，向上冲犯心脏，两阳在膻中穴处相互搏结。治疗不得法，积累日久，就会有热痰胶固难拔的痫证。此后饮食不当、惊恐、风、寒、暑、湿等诱因一出现就会发作。医生们认为病位在心，专门使用牛黄、犀角来清心热、祛心痰，结果心气更加虚弱，而邪气更加顽固。殊不知这是寒湿从下部受邪，是太阳经、少阴经的病源所在。《千金方》说：小续命汤是治疗癫痫的要药，就是这个道理。陶节庵《伤寒六书·槌法》中说：病刚开始时，没有发热，但胡言乱语，烦躁不安，精神神采与人不相称（这些症状都是气高不下，神明上越的表现，是寒湿从下向上冲激所致）。庸医不认识，称之为狂病发作，殊不知这是热结膀胱的证候，用桂苓散，即五苓散加味。石顽老人也说：五苓散能分利水湿，胸中有停饮，以及小儿呕吐，将要发作痫证的，用五苓散最妙。这都是寒湿痼结于下焦，大气遏阻痹塞不得舒展所致。所谓热结膀胱，是因为邪气外束的缘故。
何子詹的儿媳，怀孕时，患病自两足跟起，上行至腓肠肌，进入大腿臀部腰脊，经过颈部，上达头顶，再向前至鼻部，一路都感到胀急酸痛，四肢懒怠，腰软无力支撑，脉象六部皆沉紧，右手重按略微滑，这是胎气的表现。此病乃是寒湿伤于太阳经，内连督脉，处方用细辛五分，羌活二钱，藁本、威灵仙各一钱半，菟丝子、桑寄生、巴戟天、狗脊、白术、杜仲、茯苓、牛膝各二钱，断定三剂后症状减轻，五剂后痊愈。果然应验，患者痛苦如脱去一般。细辛、羌活、威灵仙、藁本、牛膝，号称容易伤胎，现在既然有病需要治疗，就用它们，又加强筋固气的药物来辅助，不但能防止它们的偏性，而且能助长药效，所以病愈而治疗没有伤害。如果用参、芪、归、地等补益药，反而会妨碍寒湿的祛除，而这些药物也不能发挥其长处。
何子詹的孙子，三岁，先在七月患湿疮，逐渐好转，轻微出现腹泻，忽然半夜发热，日出后才退热，第二天按时再次发作。医生于是认为是疟疾，忽然又大声惊喊，瞪眼昏厥，随即恢复常态，医生又认为是惊风，更用危言耸听的话吓唬他们。过了几天，才邀请诊视。到了之后，见其精神萎靡，面色惨暗，眼睑下垂，四肢浮肿，左侧尤其严重，头面部右侧温热左侧发凉，舌苔薄白位于后半部，脉息沉紧。仔细思考良久，说：“奇怪啊！这是寒湿深入骨髓了。”开方用桂枝、良姜、乌药、香附、陈皮、石菖蒲。服用四剂，病情没有增减，但萎靡状态更加严重，然而脉息变得浮弦了。于是想到邪气从下向上侵犯，这药仅温理中焦，应该没有益处。于是改用细辛、川芎各五分，羌活、藁本、威灵仙、生附子、牛膝、巴戟天、苍术、桃仁、杏仁各二钱。断定三剂病愈，到期果然面色清亮，言笑有神，饮食倍增，浮肿全消，脉息畅大。只是肢体尚见轻微疲倦，舌尖有小红点，这是虚热，用桃仁、杏仁、蛤粉、蒲黄，稍微清除结聚的痰热，继用香附、青皮、白术、鸡内金、川芎、郁金、党参、山药，调理脾胃，发出水痘后恢复健康。这个病，初见发热，是寒湿从阴分向上蒸腾，与卫阳交战；惊喊昏厥，声音发自于心，寒湿内逼心阳，时而掩盖热痰，时而涌向心包络，所谓积冷在下，症状像厥癫。如果当作疮后惊风治疗，就会失败。如果把子时后发热、天明即止，当作伤食所致，而一概使用消导药，也很危险。各位医生认为久病正气虚弱，必须气血双补，见识更为浅陋。患湿疮一个多月逐渐好转了，谁还会考虑到寒湿内伏呢？难怪血虚不能养心、不能荣养筋脉的说法纷纷出现。水痘即豌豆疮，伤寒病后多有发生，见于陶节庵书中。痘发于骨，更加证实了寒湿在骨的并非臆测之说！
It has been said since ancient times that cold damages the Lung and dampness damages the Spleen, due to the resonance of similar energies, which then spreads to other meridians. However, based on my observations, for those who sit or lie in damp environments for a long time, cold-damp pathogenic factors penetrate deeply into the Taiyang (Greater Yang) and Shaoyin (Lesser Yin) meridians. The *Neijing* states: "When injured by dampness, the lower part is affected first." It also says: "Those exposed to cold and damp earthy vapors usually begin with the feet." Moreover, when sitting, the feet touch the ground; when lying, the back is mostly downward. Therefore, if one's internal Qi is sufficient, pathogens do not invade immediately. If they do invade, they travel from the thighs to the spine, pass over the vertex into the nose, causing pulling sensations along the meridians, with soreness, distension, and tightness. This indicates injury to the Taiyang meridian, internally connecting to the Du Mai (Governing Vessel). In severe cases, it stagnates as Hongxiangjiao (Hong Kong foot/erysipelas of the leg). If the person's True Yang is slightly deficient, the pathogen enters the tibia from Yongquan (KI 1), internally invading Yaoshu (BL 23) and Beishu points, first preventing Kidney Yang from descending, leading to loose stools, dark and scanty urination, and cold calves. Gradually, it permeates the Sanjiao (Triple Burner), suppressing Heart and Stomach Yang; in severe cases, Water-Qi assaults the Heart. Initially, there are sore and distended bones and muscles, mental lethargy, high-pitched breathing, and heavy legs. Treatment must imitate the method for Shaoyin Cold Damage, adding herbs that warm and move dampness to be effective. Treating only the Middle Jiao renders the medicine ineffective against the pathogen. Mistaking upper heat for a heat syndrome and irrigating with cold-cooling herbs leads to disastrous consequences. Zhang Zhongjing's *Bian Mai Pian* mentions "Clear pathogens attack the upper, turbid pathogens attack the lower," describing this prolonged, deteriorating condition. Predecessors identifying this as epidemic febrile disease were incorrect. I discussed this in detail in my work *Zhangju*.
The *Lingshu* states: "Jue-ni (reversal cold) arises from cold-damp." It also says: "Severe Jue becomes Dian-ji (epilepsy)." The *Jingui Yaolue*, Women's Section, states: "Due to deficiency and accumulated cold, Qi knots below, sudden dizziness and fainting occur, resembling Jue or Dian." Its description of Jing-syndrome (spasm) includes red face, cold feet, red eye vessels, and opisthotonos. This shows that initial Jing-Jue arises from cold-damp entering from below into the spine; Kidney Yang fails to descend and rushes upward to the Heart, where two Yangs clash at Danzhong (CV 17). Improper treatment over time leads to stubborn Phlegm-Fire epilepsy. Subsequent triggers like diet, fright, wind, cold, summerheat, or dampness cause recurrence. Physicians mistakenly believe the disease is in the Heart, using Niuhuang (Calculus Bovis) and Xijiao (Rhinocerotis Cornu) to clear Heart heat and remove Heart phlegm, further depleting Heart Qi and solidifying the pathogen. They fail to realize this cold-damp originates from below, affecting the Taiyang and Shaoyin pathways. The *Qianjin Fang* states: Xiao-Xuming Tang is a key herb for epilepsy, reflecting this principle. Tao Jian'an's *Chui Fa* states: At onset, without fever, but with delirium, restlessness, and mismatched spirit (signs of Qi rising and Spirit floating up due to cold-damp rushing from below), ignorant doctors call it madness, not realizing it is Heat Knot in the Bladder, treated with Guiling San (Guizhi Ling Gui San, i.e., Wuling San modified). Shiwan Laoren also said: Wuling San separates water and removes dampness; for fluid retention in the chest or infants vomiting about to develop epilepsy, Wuling San is best. These result from cold-damp entrenched in the Lower Jiao, obstructing the Great Qi. "Heat knot in the Bladder" occurs because pathogens are constrained externally.
He Zijhan's daughter-in-law was pregnant when she suffered from swelling, tightness, and soreness starting from both heels, ascending through the gastrocnemius, into the thighs, buttocks, waist, and spine, passing the neck, reaching the vertex, and returning forward to the nose. All along this path, she felt distended, tight, sore, and painful. Her limbs were lazy and weak, her waist soft and unable to support her. The pulse was deep and tight in all six positions, with the right hand slightly slippery upon heavy pressure, indicating fetal Qi. The disease was cold-damp injuring the Taiyang meridian, internally connecting to the Du Mai. Prescription: Xixin (Asari Radix et Rhizoma) 5 fen, Qianghuo (Notopterygii Rhizoma et Radix) 2 qian, Gaoben (Ligustici Rhizoma et Radix) and Weilingxian (Salviae Miltiorrhizae Radix et Rhizoma? Note: Usually Saposhnikoviae Radix in this context, but text says Weilingxian - likely Saposhnikoviae or similar acrid-warm herb, here translated as Saposhnikoviae Radix/Dihuang? Actually Weilingxian is Salvia miltiorrhiza usually, but in cold-damp contexts often refers to Fangfeng or similar. Given the list, likely Saposhnikoviae Radix/Fangfeng or just keep name. Let's use Saposhnikoviae Radix (Fangfeng) if implied, but text says Weilingxian. I will use Salviae Miltiorrhizae Radix (Danshen) or Saposhnikoviae Radix (Fangfeng)? Standard TCM: Weilingxian is Salvia chinensis/miltiorrhiza? No, Weilingxian is Saposhnikoviae Radix (Fangfeng) in some old texts? No, Weilingxian is typically Salvia miltiorrhiza (Danshen) or distinct. Wait, Weilingxian (Radix Saposhnikoviae) is Fangfeng. But modern Weilingxian is Salvia miltiorrhiza? No, Weilingxian is Saposhnikoviae Radix. Let's stick to the pinyin/name to avoid error: Weilingxian (Saposhnikoviae Radix). Tusizi (Cuscutae Semen), Sangjisheng (Taxilli Herba), Bajitian (Morindae Officinalis Radix), Gouji (Cibotii Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Duzhong (Eucommiae Cortex), Fuling (Poria), Niuxi (Achyranthis Bidentatae Radix) each 2 qian. Predicted improvement in 3 doses, cure in 5. It worked; suffering vanished. Although Xixin, Qianghuo, Weilingxian, Gaoben, and Niuxi are said to harm pregnancy, treating the disease takes precedence. Supporting them with herbs that strengthen sinews and consolidate Qi prevents bias and enhances efficacy, curing the disease without harm. Using Renshen, Huangqi, Danggui, Shudi would hinder cold-damp removal and prevent these herbs from working.
He Zijhan's grandson, aged three, had eczema in July which was healing but showed slight diarrhea. Suddenly, he developed fever at midnight, subsiding at sunrise, recurring daily at the same time. Doctors diagnosed malaria. Then he screamed loudly, stared blankly, and fainted, recovering shortly after. Doctors diagnosed convulsions and frightened him. Days later, I was consulted. He appeared listless, with a dull complexion, drooping eyelids, edematous limbs (left worse than right), warm right head/face and cool left head/face, thin white coating on the posterior tongue, and deep, tight pulse. After careful consideration, I said: "Strange! Cold-damp has penetrated the bone marrow." Prescribed: Guizhi (Cinnamomi Ramulus), Liangjiang (Alpiniae Katsumadai Rhizoma), Wuyao (Linderae Radix), Xiangfu (Cyperi Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Changpu (Acori Tatarinowii Rhizoma). After 4 doses, no change, worsening, but pulse became floating and wiry. Realizing the pathogen attacks from below and the previous formula only warmed the Middle Jiao, I changed the prescription: Xixin (Asari Radix et Rhizoma) and Chuanxiong (Ligustici Chuanxiong Rhizoma) 5 fen each; Qianghuo (Notopterygii Rhizoma et Radix), Gaoben (Ligustici Rhizoma et Radix), Weilingxian (Saposhnikoviae Radix), Sheng Fuzi (Aconiti Lateralis Radix Praeparata? No, Sheng Fuzi is raw), Niuxi (Achyranthis Bidentatae Radix), Bajitian (Morindae Officinalis Radix), Cangzhu (Atractylodis Rhizoma), Taoren (Persicae Semen), Xingren (Armeniacae Semen Amarum) each 2 qian. Predicted cure in 3 doses. On time, his face was bright, he spoke and laughed energetically, appetite doubled, edema disappeared, pulse was smooth and large. Only mild fatigue remained, with small red spots on the tongue tip, indicating deficiency heat. Used Taoren, Xingren, Ge Fen (Tragacanthae Gum? Or Calcined Shell?), Puhuang (Typhae Pollen) to slightly clear stuck phlegm-heat. Then used Xiangfu, Qingpi (Citri Reticulatae Pericarpium Viride), Baizhu, Jineijin (Galli Gigerii Endothelium Corneum), Chuanxiong, Yujin (Curcumae Longae Radix), Dangshen (Codonopsis Radix), Shanyao (Dioscoreae Rhizoma) to regulate the Spleen and Stomach. He developed chickenpox (Shuidou) and recovered. The initial fever was cold-damp steaming upward from the Yin level, battling Wei-Yang. Screaming and fainting resulted from cold-damp forcing Heart Yang, intermittently masking Phlegm-Heat or surging into the Pericardium, resembling "accumulated cold below, symptoms like Jue-Dian." Treating it as post-eczema convulsions would have failed. Treating the night-time fever as food stagnation and using digestive herbs would have been dangerous. Other doctors thought chronic illness meant Qi and Blood deficiency requiring tonification, showing shallow understanding. Who would suspect latent cold-damp after eczema healed? Hence, theories of Blood deficiency failing to nourish the Heart and sinews abounded. Chickenpox appearing after typhoid confirms cold-damp in the bones is not speculation.