经云∶燥胜则干。干为涩滞不通之疾。其病有外感、内伤之因，寒燥、燥热之异，伤人
气分、血分之次第浅深，皆辨之不可不早辨也。邵新甫曰∶外感之燥，首伤上焦气分，气分
失治，则延及血分；内伤之燥，乃人之本病，由于精血下夺而成，或因偏饵燥药所致，病从
下焦阴分先起，下焦失治，则槁及乎上，喘咳、痿厥、三消、噎膈之萌，总由于此。治法∶
外感之燥，津液结于上而为患者，结者必使之开解，非辛润流利气机不可；内伤之燥，精血
竭于下而为患者，竭者必使之复盈，非柔润静药，及血肉有情者以滋填之不可。大抵是病用
药，最忌者苦涩，最善者甘柔。此其大较也。独是外感、内伤宜分，寒燥、燥热尤不可混。
夫因寒而燥，为燥之化气；由燥而热，乃燥之本气。人但知燥热为燥之常，而不知寒燥为燥
之变，无怪乎其辛燥升散，动辄得咎也。不观诸《内经》乎？经曰∶阳明司天，燥淫所胜，
民病善呕，心胁痛不能转侧，治以苦温（苦当是微苦，如杏仁之类，取其通降。温当是温润
，非温燥升散之类）。此《内经》治寒燥之正法也。又曰∶阳明之胜，清发于中，左
胁痛、溏泄，内为嗌塞，外发 疝，大凉肃杀，华英改容，毛虫乃殃，胸中不便，嗌塞而咳
。据此经文，亦指凉燥搏束而言。《性理大全》谓燥属次寒。沈目南曰∶盛夏暑热熏蒸，人
身汗出 ，肌肤潮润而不燥，冬月严凝肃杀，人身干槁燥冽，故深秋燥气行，人
体肺金应之，肌肤亦燥。此亦指寒燥而言。寒燥如此，温燥可知。
夫干金主燥，于时为秋，然秋不遽燥也，秋分以后，渐至大凉，露寒霜肃，清气搏激，
燥乃行令。燥从天降，首伤肺金，肺主一身气化，气为燥郁，清肃不行，机关不利，势必干
咳连声、胸胁牵痛、不能转侧、胸懑气逆喘急、干呕。又或气为燥郁，不能行水，水停膈上
，则必口渴思饮、饮水则吐、烦闷不宁、气为燥郁，不能布津，则必寒热无汗、口鼻唇舌起
燥、嗌喉干疼。又或气为燥郁，内外皆壅，则必一身尽痛；肺主皮毛，甚至皮肤干疼、手不
可按、凛凛恶寒、甚而肢厥，虽覆以重裘不温，颇似阴寒之象。又或气为燥郁，治节无权，
中宫水饮不能屈曲输于膀胱，而直注于大肠，则必腹痛、泄泻，甚者挥霍搅乱、上吐下泻、
脉伏肢凉，又似阴寒寒湿之象。夏受暑燥，亦多病此。但燥气干滞，所泻必艰涩难行，与湿
泻、热泻之倾肠滑利者不同。吐泻甚则津液内夺，柔化为刚，肠燥拘急，有似硬梗，按之痛
甚，蜷曲难伸，任（脉）失荣养，当脐上下按之坚硬，动跃震手；冲（脉）失荣养，脐之两
旁按之坚硬，动跃震手。此皆燥极见证，切勿认为积滞，误行攻下。又或经络失于荣养，拘
挛掣痛，俗名转筋，立时阴亡液涸，目陷肉销，面青肤黑，舌中肉剥，神明昏乱，阴夺于内
，阳无根据附，遂至肢厥身冷，汗出如珠，内闭外脱不救。又或肺燥直逼大肠（肺与大肠同属
燥金），而成肠 （俗名痢疾）；燥郁气机，则肠垢下而色白，燥伤血络，则血渗大肠而色红
，
涩不通、行后稍止、气机终觉不利、糟粕又或结为燥粪。与湿痢之痛缓酸坠，而不里急艰涩
，大便溏而多者有别。
凡此燥病，多生于阴亏之辈，劳苦之人，夏月炎蒸，液为汗耗，水竭金枯，里气已燥，
以燥感燥，同气相求，最为易易。唐·孙思邈真人制生脉散（人参、麦冬、五味子，合为生
脉
人立法，周密如此）。使人夏月服之，以保肺金，治未病也。奈何汉唐以后，医道失传，不
知人生天地间，外感内伤，千变万化，总不外天地阴阳之气，即不外天地燥湿之气。乃世于
湿气，犹多发明，而于燥气，未能详究，所以每遇外感，浑曰风寒，不辨其为风燥、为风湿
、为寒燥、为寒湿，至暑燥初起，与寒燥相似，更不之辨。但见寒热、无汗、头身疼痛、咳
嗽、呕吐、胸懑气逆等证，辄用辛燥升散，见有胸懑，便曰感寒停滞，并用苦燥破滞，轻则
用苏、薄、荆、防，重则用羌、独、芎、芷，在夏月则用香薷、藿香，至青皮、枳壳、山楂
等味，亦惯行佐用。试思以上诸药，其为辛润乎？抑为辛燥乎？其在夹湿者，用之犹可，若是
风燥、寒燥之邪，则以燥治燥，变证必然蜂起，将见燥邪窜入肌肉则发斑，窜入皮肤则发疹
，窜入营分则舌赤无苔，神乱谵烦。斯时也，见其邪入营分，又用一派苦寒清火、柔腻滋阴
，逼令燥邪深入心包，深入骨髓。入心包则神烦意乱（烦属心肺），轻则多言，重则谵语，闭
极则神明昏乱，呓语不休，目睛频转；入肾则燥，循衣摸席，扬手掷足；阴液耗极则口噤齿
，身强发痉，内闭外脱，不可救援。又或上焦气分之邪未开，法宜辛润开达，或津液
聚于胸膈为痰，阻结气分，正在心下硬痛，法宜苦辛通降，如小陷胸汤、半夏泻心汤、温胆
汤、三子汤之类，对病发药，方能获效。乃不用开化，妄用大剂攻下，气为邪搏，不能传送
，正粪不行，但行稀水，徒伤气血；又或邪已传里，迁延不下，致成脏结，虽下不行。若是
者，始而以燥治燥，致邪走窜；继而苦寒冰伏、阴柔滋腻，致邪闭结；终而误下失下，致邪
实正虚，轻者重，重者死。盖不知凡几，其为可慨，不亦甚乎！
又见习俗，遇有霍乱，不辨燥湿，但见腹痛吐泻，辄用藿香正气散，甚有用香、砂、桂
、附、吴萸诸燥药，其在湿邪，自可冀以温中止泻，若是燥邪，不独泻不能止，必致耗液亡
阴，内闭外脱，或上焦之邪，走入中下，气分之邪，走入营分，每见大便下红，形如血
，遂不可救。
又见习俗，遇有肠 ，不辨燥湿，辄用败毒散升阳、芍药汤通里。其在风湿致痢，用败
毒散升阳转气，逆流挽舟，自可获效；湿热致痢，用芍药汤酸苦泄热、苦辛通降，亦可获效
。若是燥邪，治以辛燥、苦燥，必致伤及血液，剥尽肠膏。如此类推，不可枚举。
或曰；治法何如？曰∶病有燥湿，药有燥润；病有风燥、寒燥、暑燥、燥火、燥郁夹湿
之分，药有辛润、温润、清润、咸润、燥润兼施之别。且六气之邪，初无形质，以气伤气，
首先犯肺，必用轻药，乃可开通，汗出而解。经曰∶轻可去实，信不诬也。况人之汗，为津
液所化，而汗之出，乃气机所传。一经感邪，阻遏肺气，气为邪阻，不能布津外通毛窍，故
身无汗、寒热、疼痛；气为邪阻，不能布津上濡清窍，下通胃肠，故口干、舌燥、胸懑、气
逆、二便不调。治者当辨燥湿二气何气致病？所兼何邪（兼风、兼寒、兼暑）。所化何邪？（化火
、未化火）。所夹何邪？（夹水、夹痰、夹食、夹本病）。对病发药，使之开通，（开字横看，是由肺
外达皮毛，与升散之向上行者不同。通字竖看，是由肺下达胃肠，通润、通和，皆谓之通，
非专指攻下言也），邪一开通，津液流行，而汗自解，何必泥定风药发汗耶？且风药不独不能
发汗，反耗伤津液，绝其化汗之源，尚冀其化汗耶？
以燥气论，燥邪初起，在未化热时，宜用辛润开达气机，如杏仁、牛蒡、桔梗之属。兼
寒加以温润，如豆豉、前胡、姜、葱之类；邪机闭遏，加以通润，如白芥子、细辛之类；咳
嗽不止，胸前懑闷，加苏子、紫菀、百部之类，辛中带润，自不伤津。而且辛润又能行水，
燥夹湿者宜之；辛润又能开闭，内外闭遏者宜之。其里气不和者，佐以栝蒌皮、鲜薤白之类
，辛滑流利气机，气机一通，大便自解，浊邪解而清邪失所根据附，亦必化汗而解。其化热者
，于辛润剂中，酌加清润轻虚之品二三味，如梨皮、蔗皮、梨汁、蔗汁、荸荠、芦根、石膏
、知母、川贝母、南沙参、桑叶、菊花、银花、花粉之类，以泄其热，热泄则清肃令行，气
机流利，亦必化汗而解。其阴虚者，于辛润剂中，酌加生地、元参、沙参、麻仁、黑脂麻、
蜂蜜之类，养阴润肠，但不宜多用，恐腻着邪气。其夹湿者，于辛润剂中，酌加蔻仁、通草
、茯苓、半夏之类，辛淡渗湿，亦不宜多用，恐燥伤津液。其夹湿而化热者，于辛润剂中，
酌加滑石、淡竹叶之清渗，连翘、山栀之微苦微燥，重者酌加姜汁炒木通，炒芩、连之类，
苦降辛通，开化湿热。其邪已传里，根据附胃肠渣滓者，则攻下一法，又未可缓施，但下宜适
中，不可太过。观仲景用大承气汤，一剂分为三服，视其进退用之，以药力不及，犹可再服
，药力太过，不可挽回。其用心之细，有如此者。且上焦邪气开通，天气下降，地气自随之
以营运，又何必缓下为能乎？此治外燥之大法也。
或又曰∶误药不可以救乎？曰∶难也，药病相反也。燥邪用燥药，一相反也；肺喜清肃
，而药用浊烈，二相反也；肺主下降，而药用升散，三相反也；燥邪属气，以气伤气，原无
形质，而且肺为轻虚之脏，膻中为空灵之所，苦寒沉降，阴柔滞腻，气浊味浓，病未闭而药
闭之，病已闭而药复闭之，四相反也；气分之邪未开，而津液又被下夺，五相反也。一病而
五相反，不死何待？燥邪本易化热，今误被辛燥升散、寒凉冰伏、阴柔滋腻，不得再用热药
挽之，惟有用余氏普济丹、宁上丸，养液开闭，以回万一。曰∶辛燥、寒凉、阴柔三者之弊
，如此其甚，其不可以一用乎？而又非也。降佐以升（降非攻破，乃辛润流通，使之自降。升
非升散，不过用微燥之品数分，以和格拒而已），开佐以阖（凡寒凉阴柔，皆是阖机），君臣
佐使，配合得宜，亦何不可？夫天地阴阳之道，即升降开阖之道，人苟知此，立方自错综变
化，神妙不测矣。
又有内寒燥一证，考《医垒元戎》尝用温热药治之，如桂、附、硫黄、良姜、巴豆之属
，然彼系治北方之人，感受大寒，寒结于内，卒然腹痛，不曾化热，乃用热药为丸，以通寒
结。此偶用之方，非常法也。刘河间曰∶燥本属秋阴，异于寒湿，而同于风热，热甚则液耗
风生，肝主风木、主筋，肺不清肃下降，则津液聚于胸膈而为痰饮，不归正化以润其筋。其
为病，有经脉劲强而口噤者，燥甚干涩收敛故也；有经脉拘急，或时恶寒，或善伸数欠，脉
浮数而弦者，燥气怫郁，里气不舒故也；有脾胃干涸成消渴者，燥劫胃津故也；有风痫发作
，螈 、昏冒、僵仆者，燥甚化风涎，溢胸膈，因燥生湿故也（外燥昏闭，亦多由此）。至于
中风筋缓不收，与诸 郁病痿，似与劲切紧涩相反，而其为燥则同，特其燥之甚焉耳！
观秋深燥甚，草木有枯缩而不伸者，亦有萎落而不收者，其理可悟矣。夫手得血而能持，足
得血而能行，燥则血液衰少，而气不流畅，缓纵不收，必然之理。孙一奎曰∶燥旺于秋，然
必秋分以后，清气行而万物乃燥，燥属金，金属西方之气，在人为肺。乃运气以卯酉为阳明
燥金司天，而不言肺者何也？盖以肺脉起于中焦，津液出于中焦故也。彼医经统旨谓燥是阳
明所化，亦是故耳！沈生明曰∶《内经》病机一十九条，独遗燥气，盖为燥兼风热而化，言
风热而燥在其中矣。燥兼风化者，经曰∶风能胜湿，湿去则燥生，在人则风能烁液，液去则
燥生，燥伤肺金，金不胜水，而病及肝木，故中风筋脉动弦、风痫口噤、收敛急切诸病生；
燥兼热化者，《易》曰∶燥万物者，莫 乎火。始也火烁金而燥乃成，既也金不生水而
燥益甚，故消谷善饥、胃槁噎膈、二便闭塞、枯涸燥裂诸病又生。由热生风，由风生燥，燥
又生热，循环胜复，至于髓液俱枯，燥非浅患明矣！
推致燥之由，有因于天者，有因于人者。阳明燥金司天，或久旱无雨，燥化大行，伤及
肺金，此因于天者也；七情不节，气结、神伤、精损，及病时汗、吐、下太过，或久劳风日
之中，频近炉火之旁，或食味辛热太过，或虚劳误投温燥，与夫服食家久服金石之品，皆能
燥伤津液，此因于人者也。然究其本源，皆缘血液不足所致。盖阴血虚则不能营运乎百体，
津液耗则不能滋养乎三焦（指上、中、下三焦言）。由是邪热怫郁，燥变多端，或燥于外而皮
肤皴裂，或燥于内而精血枯涸，燥于上则咽鼻干疼，燥于下则便溺闭结，兼热则手足痿，化
风则痫痉作，实而燥热必发颠狂，虚而燥热必致劳咳，燥伤肺金不能敷布水精，则又停痰停
饮，燥中夹湿而为噎膈。因燥致病，何可胜言！
治燥之法，当观釜沸之理。血譬诸汤，气譬诸火。若火猛汤沸，而为实邪，则当沃薪灭
焰，使不涸竭，张太守所谓急下阳明以存津液者此也；若沸久将干，则又当益水胜火，使不
上僭，王太仆所谓壮水之主，以制阳光者此也。又按经云∶心移寒于肺，为肺消，饮一溲二
，死不治，谓之死阴。死阴者，谓心肺真阴枯涸，真阳亦衰，寒从中起，气不化液，肺之阴
气已死也。景岳曾以八味丸、归脾汤治一 绅而愈。又如大便闭结，食少，脉微，谓之阴结
，以半硫丸治之而愈。是皆血枯气涩，阴伤及阳，不能运化蒸变，如地气不上腾，则天气不
The Classic states: When dryness prevails, it leads to dryness. Dryness is a disease characterized by astringency, stagnation, and obstruction. Its etiology includes external contraction and internal injury; its nature differs between cold-dryness and dry-heat; and the depth of invasion from the Qi level to the Blood level varies. All these must be distinguished early. Shao Xinpu said: External dryness first injures the Qi level of the Upper Jiao; if the Qi level is not treated properly, it extends to the Blood level. Internal dryness is an inherent disease of the person, resulting from the depletion of Essence and Blood in the lower part, or caused by the biased use of drying herbs. The disease originates in the Yin level of the Lower Jiao; if the Lower Jiao is not treated properly, withering spreads upward, giving rise to the beginnings of wheezing and cough, flaccidity and cold limbs, San Xiao (Three Wasting-Thirst), and dysphagia. Treatment methods: For external dryness, where fluids are knotted in the upper part causing illness, the knots must be resolved; only acrid-moistening herbs that facilitate Qi mechanism can be used. For internal dryness, where Essence and Blood are exhausted in the lower part causing illness, the exhaustion must be replenished; only soft-moistening quiet herbs, and even blood-and-flesh有情 (sentient) substances to nourish and fill, can be used. Generally, for this disease, the most contraindicated herbs are bitter-astringent, while the most suitable are sweet-soft. This is the general principle. However, external and internal injuries should be distinguished, and cold-dryness and dry-heat especially must not be confused. Dryness caused by cold is the transformed Qi of dryness; dryness leading to heat is the original Qi of dryness. People only know that dry-heat is the normal state of dryness, but do not know that cold-dryness is the transformed state of dryness. No wonder the use of acrid-drying and ascending-dispersing herbs often leads to adverse reactions. Do we not look at the *Nei Jing*? The Classic states: When Yangming governs the year, and dryness overflows and prevails, the people suffer from frequent vomiting, pain in the heart and hypochondrium with inability to turn the side. Treatment uses bitter-warm (Bitter should be slightly bitter, such as Xingren [Apricot Seed], to obtain descending action; Warm should be moist-warm, not warming-drying and ascending-dispersing). This is the correct method for treating cold-dryness in the *Nei Jing*. It also states: When Yangming Qi wins, coolness erupts in the middle, causing left hypochondriac pain, loose stools, internal throat obstruction, and external hernia. Great coolness and austerity cause flowers and fruits to change appearance, and insects with hair suffer. There is chest discomfort, throat obstruction, and cough. According to this text, it also refers to cool-dryness binding and constraining. *Xingli Daquan* states that dryness belongs to secondary cold. Shen Munan said: In midsummer, summer-heat steams and蒸 (evaporates), people sweat, and skin and muscles are moist and not dry. In winter, when it is severe and austere, the body becomes withered and dry. Thus, in late autumn, when dryness Qi prevails, the human Lung Metal responds, and the skin and muscles become dry. This also refers to cold-dryness. If cold-dryness is like this, warm-dryness can be understood.
Lung Metal governs dryness, corresponding to the season of Autumn. However, Autumn does not become dry immediately. After the Autumn Equinox, it gradually becomes very cool; dew is cold, frost is austere, clear Qi beats and stimulates, and then dryness begins to exercise its command. Dryness descends from Heaven and first injures Lung Metal. Lung governs the Qi transformation of the whole body. When Qi is constrained by dryness, the clearing and descending function fails, and the joints and mechanisms become unsmooth. Consequently, there will inevitably be continuous dry cough, pulling pain in the chest and hypochondrium, inability to turn the side, chest fullness, rebellious Qi, wheezing, and urgency, and dry vomiting. Or, if Qi is constrained by dryness and cannot move water, water stops above the diaphragm, leading inevitably to thirst desire to drink, vomiting after drinking, restlessness, and vexation. If Qi is constrained by dryness and cannot distribute fluids, there will inevitably be aversion to cold and fever without sweat, dryness on the mouth, nose, lips, and tongue, and dry, painful throat. Or, if Qi is constrained by dryness and both interior and exterior are congested, there will inevitably be pain all over the body. Since Lung governs skin and hair, the skin and muscles may become painfully dry, unable to be touched, with severe aversion to cold, and even cold limbs. Even covered with heavy fur garments, warmth is not achieved, resembling Yin-cold syndrome. Or, if Qi is constrained by dryness and the regulation power is lost, the water-fluid in the Middle Jiao cannot be曲折ly transported to the Bladder but flows directly into the Large Intestine, leading inevitably to abdominal pain and diarrhea. Severe cases involve violent turmoil, vomiting and diarrhea, hidden pulse, and cold limbs, resembling Yin-cold dampness syndrome. Summer-heat and dryness contracted in summer also often cause this disease. But because dryness causes stagnation, the stool passed will be difficult and hard to pass, different from the profuse and slippery stools of damp-diarrhea or heat-diarrhea. Severe vomiting and diarrhea lead to internal depletion of fluids, transforming softness into rigidity. Intestinal dryness causes spasms, resembling a hard blockage; pressing causes severe pain, curling up makes extension difficult. If the Ren Mai loses nourishment, pressing above and below the navel feels hard and pulsating; if the Chong Mai loses nourishment, pressing on both sides of the navel feels hard and pulsating. These are all signs of extreme dryness. Do not mistake them for accumulation and stagnation and mistakenly use purgatives. Or, if meridians lose nourishment, spasms and pulling pain occur, commonly known as charley-horse. Suddenly, Yin perishes and fluids dry up; eyes sink, flesh wastes, face turns blue-black, tongue flesh peels, spirit becomes confused. Yin depletion internally leaves Yang without attachment, leading to cold limbs and body, sweating like pearls, internal closure and external collapse, which is incurable. Or, Lung dryness directly forces the Large Intestine (Lung and Large Intestine both belong to Dry Metal), forming Chang Pi (commonly known as dysentery). If dryness constrains Qi mechanism, intestinal mucus passes with white color; if dryness injures blood collaterals, blood seeps into the Large Intestine with red color. Stagnation prevents passage, slight relief after defecation, Qi mechanism remains obstructed, and residue may form dry feces. This differs from damp-dysentery, which has mild pain and acid bearing-down sensation, without tenesmus and difficulty, and loose, abundant stools.
All these dryness diseases mostly arise in those with Yin deficiency and laborers. In summer heat, fluids are consumed by sweat; Water is exhausted, Metal is withered, and interior Qi is already dry. Contracting dryness with dryness, same Qi seeks same, is easiest. Sun Simiao of the Tang Dynasty formulated Shengmai San (Renshen [Ginseng Root], Maidong [Ophiopogon Tuber], Wuweizi [Schisandra Fruit]) to form Shengmai San. His legislation for humans was so meticulous. He advised taking it in summer to protect Lung Metal and treat disease before it arises. Alas, since Han and Tang dynasties, medical Dao has been lost. People do not know that life between Heaven and Earth, whether external contraction or internal injury, changes infinitely, but ultimately does not exceed the Yin-Yang Qi of Heaven and Earth, nor the dryness-dampness Qi of Heaven and Earth. While people have elaborated much on dampness, they have not studied dryness in detail. Therefore, whenever encountering external contraction, they indiscriminately call it Wind-Cold, failing to distinguish Wind-Dryness, Wind-Dampness, Cold-Dryness, or Cold-Dampness. Especially when Summer-Dryness begins, resembling Cold-Dryness, they fail to distinguish it. Seeing symptoms like aversion to cold and fever, no sweat, headache and body pain, cough, vomiting, chest fullness, and rebellious Qi, they immediately use acrid-drying and ascending-dispersing drugs. Seeing chest fullness, they say it is Cold stagnation, and use bitter-drying drugs to break stagnation. Mild cases use Suzye [Perilla Leaf], Bohe [Mint], Jingjie [Schizonepeta], Fangfeng [Saposhnikovia]; severe cases use Qianghuo [Notopterygium], Duhuo [Angelica Pubescens], Xiong [Ligusticum], Baizhi [Angelica Dahurica]. In summer, they use Xiangru [Elsholtzia], Huoxiang [Patchouli]; even Qingpi [Green Tangerina Peel], Zhike [Aurantii Fructus], Shanzha [Crataegus] are habitually used as assistants. Consider these herbs: are they Acrid-Moist or Acrid-Drying? If used in cases with dampness, it might be acceptable. But if used for Wind-Dryness or Cold-Dryness pathogens, using drying to treat dryness will inevitably cause many complications. Dryness pathogen invading muscles causes macules; invading skin causes papules; invading Ying level causes red tongue without coating, mental confusion, delirium, and vexation. At this time, seeing pathogen enter Ying level, one uses a batch of Bitter-Cold fire-clearing and soft-nourishing Yin herbs, forcing dryness pathogen deep into Pericardium and Bone Marrow. Entering Pericardium causes mental vexation (Vexation belongs to Heart and Lung); mild cases talk excessively, severe cases delirious speech; extreme closure causes spirit confusion, muttering, frequent eye movement. Entering Kidney causes dryness, grasping clothes and bed, throwing hands and feet. Extreme consumption of Yin fluid causes locked jaw and clenched teeth, stiff body and convulsions, internal closure and external collapse, incurable. Or, if Upper Jiao Qi level pathogen is not opened, the method should be Acrid-Moist to open and reach. Or if fluids gather in chest and diaphragm as Phlegm, blocking Qi level, causing hardness and pain in epigastrium, the method should be Bitter-Acid to descend and penetrate, such as Xiaoxianxiong Tang, Banxia Xiexin Tang, Wandan Tang, Sanszi Tang, etc. Prescribing against the disease yields effect. Instead, opening transformation is ignored, and large doses of purgatives are used rashly. Qi is fought by pathogen, cannot transport; normal stool does not pass, only watery stool passes, injuring Qi and Blood vainly. Or, pathogen has transmitted to interior, lingering and not downbearing, forming Zang Jie (organ knotting); even purging does not work. Such cases: initially, using drying to treat dryness causes pathogen to scatter; subsequently, Bitter-Cold ice-freezes and Yin-soft greasy causes pathogen to close; finally, mistaken purging or failure to purge causes pathogen excess and Zheng deficiency, light cases become heavy, heavy cases die. How many such cases are there? It is truly lamentable, is it not serious!
Also, observing customs, when encountering Huoluan (cholera-like disease), without distinguishing dryness and dampness, seeing only abdominal pain, vomiting, and diarrhea, one uses Huoxiang Zhengqi San. Some even use Xiang [Patchouli], Sha [Amomum], Gui [Cinnamon Twig], Fu [Aconite], Wuyu [Evodia], and other drying herbs. In damp pathogen cases, one may hope for warming middle and stopping diarrhea. But in dry pathogen cases, not only will diarrhea not stop, it will inevitably consume fluids and destroy Yin, causing internal closure and external collapse. Or Upper Jiao pathogen moves to Middle and Lower, Qi level pathogen moves to Ying level. Often seeing red blood in stool, shaped like blood clots, making it incurable.
Also, observing customs, when encountering Chang Pi (dysentery), without distinguishing dryness and dampness, one uses Baidu San to raise Yang, or Shaoyao Tang to purge interior. In dysentery caused by Wind-Damp, using Baidu San to raise Yang and turn Qi, "rowing upstream against the current," naturally yields effect. In dysentery caused by Damp-Heat, using Shaoyao Tang to drain heat with Sour-Bitter and penetrate with Bitter-Acid, also yields effect. But in dry pathogen cases, treating with Acrid-Drying or Bitter-Drying will inevitably injure Blood and strip intestinal fat. By analogy, these cannot be enumerated.
Someone asks: What is the treatment method? I reply: Diseases have dryness and dampness; medicines have drying and moistening properties. Diseases have Wind-Dryness, Cold-Dryness, Summer-Dryness, Dry-Fire, and Dryness-Stagnation with Dampness distinctions; medicines have Acrid-Moist, Warm-Moist, Clear-Moist, Salty-Moist, and combined Drying-Moistening differences. Moreover, the six Qi pathogens initially have no form/substance; they injure Qi with Qi, first attacking Lung. Only light medicines can open and release, resolving through sweating. The Classic states: Light can remove excess. This is indeed true. Furthermore, human sweat is transformed from fluids, and its exit is transmitted by Qi mechanism. Once infected by pathogen, Lung Qi is blocked. Qi blocked by pathogen cannot distribute fluids to open pores externally, hence no sweat, aversion to cold/fever, pain. Qi blocked cannot distribute fluids to moisten clear orifices above and connect intestines/stomach below, hence dry mouth, dry tongue, chest fullness, rebellious Qi, irregular urination/defecation. The practitioner must distinguish which of Dryness/Dampness Qi causes the disease? What pathogen is combined (Wind, Cold, Summer-Heat)? What pathogen is transformed (Fire, No Fire)? What pathogen is夹杂 (Water, Phlegm, Food, Original Disease)? Prescribe against the disease to open it. ("Open" viewed horizontally means extending from Lung to skin/hair, different from ascending-dispersing upward movement. "Penetrate" viewed vertically means descending from Lung to intestines/stomach; moist-penetration and harmonizing-penetration are all called Penetration, not specifically referring to purgation). Once pathogen opens, fluids flow, and sweat resolves naturally. Why stick rigidly to Wind herbs for sweating? Moreover, Wind herbs not only fail to induce sweat but consume fluids, cutting off the source of sweat formation. How can one expect sweat?
Regarding Dryness Qi: When dryness pathogen first appears, before transforming into heat, use Acrid-Moist to open and reach Qi mechanism, such as Xingren [Apricot Seed], Niubang [Arctium Fruit], Jiegeng [Platycodon Root]. Combined with Cold, add Warm-Moist, such as Douchi [Fermented Soybean], Qianhu [Peucedanum], Jiang [Ginger], Cong [Scallion]. If pathogen mechanism is closed, add Penetrating-Moist, such as Baijiez [White Mustard Seed], Xixin [Asarum]. If cough persists and chest is full, add Suzi [Perilla Seed], Ziwan [Aster Root], Dubu [Stemona Root]; Acrid with Moist naturally does not injure fluids. Moreover, Acrid-Moist can move water, suitable for Dryness with Dampness; Acrid-Moist can open closure, suitable for internal/external closure. If interior Qi is disharmonious, assist with Gualoupi [Trichosanthes Peel], Xianxiebai [Fresh Allium Macrostemon Bulb]; Acrid-Slippery facilitates Qi mechanism. Once Qi mechanism opens, stool resolves naturally. Turbid pathogen resolves, Clear pathogen loses support, and also resolves via sweat. If transforming into Heat, in Acrid-Moist formula,酌情 add 2-3 Clear-Moist light items, such as Lipi [Pear Skin], Zhepi [Sugarcane Bark], Lizhi [Pear Juice], Zhezhi [Sugarcane Juice], Qishi [Water Chestnut], Lugeng [Reed Rhizome], Shigao [Gypsum], Zhimu [Anemarrhena], Chuanbeimu [Fritillaria Cirrhosa], Nanshashen [Adenophora], Sangye [Mulberry Leaf], Juhua [Chrysanthemum], Yinhua [Honeysuckle], Huafen [Trichosanthes Root], to drain heat. Once heat drains, clearing/descending command functions, Qi mechanism flows smoothly, and resolves via sweat. If Yin deficient, in Acrid-Moist formula,酌情 add Shengdi [Rehmannia], Yuanshen [Scrophularia], Shashen [Glehnia], Maren [Hemp Seed], Heizhima [Black Sesame], Fengmi [Honey], to nourish Yin and moisten intestine. But do not use too much, lest it cloy and trap pathogen. If with Dampness, in Acrid-Moist formula,酌情 add Keren [Cardamom], Tongcao [Tetrapanax], Fuling [Poria], Banxia [Pinellia]; Acrid-Light leaches dampness. Also do not use too much, lest drying injure fluids. If with Dampness transforming into Heat, in Acrid-Moist formula,酌情 add Huashi [Talc], Danzhuye [Lophatherum] for clear-leaching; Lianqiao [Forsythia], Shanzhi [Gardenia] for slightly bitter/slightly drying. Severe cases,酌情 add Jiangzhi chao Mutong [Akebia stem fried with ginger juice], Chao Qin [Scutellaria fried], Lian [Coptis] for Bitter-descending/Acid-penetrating to open-transform damp-heat. If pathogen has transmitted to interior, adhering to gastrointestinal dregs, then purgation method cannot be delayed, but purging should be moderate, not excessive. Observe Zhang Zhongjing using Dachengqi Tang: one dose divided into three servings, used according to progression/regression. If drug force insufficient, can take again; if drug force too strong, cannot be reversed. His meticulous care is such. Moreover, once Upper Jiao pathogen opens, Heaven Qi descends, Earth Qi follows to circulate. Why rely on slow purging? This is the great method for treating External Dryness.
Someone else asks: Can mistaken medication be saved? I reply: It is difficult. Medicine opposes disease. Dryness pathogen using drying medicine is one opposition; Lung likes clearing/descending, but medicine uses turbid/fierce is two opposites; Lung governs descending, but medicine uses ascending/dispersing is three opposites; Dryness pathogen belongs to Qi, injuring Qi with Qi, originally formless. Lung is a light/vacuous organ, Danzhong is an empty/spiritual place. Bitter-Cold sinks, Yin-soft greasy, Qi turbid flavor strong. Disease not closed but medicine closes it; disease already closed but medicine closes it again is four opposites. Qi level pathogen not opened, yet fluids are further depleted by purging is five opposites. One disease with five opposites, why wait for death? Dryness pathogen easily transforms into heat. Now mistakenly treated with Acrid-Drying ascending-dispersing, Cold-Freezing ice, Yin-Soft greasy, cannot use Hot medicine to rescue. Only use Yu Shi Pujidan, Ning Shang Wan, to nourish fluids and open closure, hoping for one in ten thousand recovery. Question: The evils of Acrid-Drying, Cold-Freezing, Yin-Soft are so severe, can they never be used? Reply: Not exactly. Descending assisted by Ascending (Descending is not breaking/purging, but Acrid-Moist circulation making it self-descend. Ascending is not ascending-dispersing, just using a few points of slightly drying herbs to harmonize rejection). Opening assisted by Closing (All Cold-Freezing Yin-Soft are Closing mechanisms). Sovereign, Minister, Assistant, Courier, if matched appropriately, why not? The Dao of Heaven and Earth Yin-Yang is the Dao of Ascending/Descending, Opening/Closing. If humans know this, prescribing formulas will naturally vary intricately, divine and unpredictable.
There is also Internal Cold-Dryness syndrome. Examining *Yilei Yuanrong*, hot/warm medicines were used to treat it, such as Guizhi [Cinnamon Twig], Fuzi [Aconite], Liuhuang [Sulfur], Liangjiang [Galangal], Badou [Croton Seed]. However, that was for treating Northern people contracting severe Cold, Cold knotting internally, sudden abdominal pain, not yet transformed into heat. They used hot medicine pills to unblock Cold knots. This is an occasional prescription, not standard method. Liu Hejian said: Dryness originally belongs to Autumn Yin, different from Cold-Dampness, similar to Wind-Heat. Extreme heat consumes fluids generating Wind. Liver governs Wind-Wood and Tendons. If Lung does not clear/descend, fluids gather in chest/diaphragm as Phlegm-Drink, not returning to proper transformation to moisten tendons. Diseases include: tendons/muscles stiff and strong with locked jaw, due to extreme dryness/astringency/convergence; tendons/muscles cramped, sometimes aversion to cold, often stretching/yawning, floating-numerous-stringy pulse, due to dryness Qi depression, interior Qi uncomfortable; Spleen/Stomach dried up forming Xiao Ke (Wasting-Thirst), due to dryness robbing Stomach Jin; Wind-Epilepsy attacks, convulsions, fainting, falling stiff, due to extreme dryness transforming into Wind-Phlegm overflowing chest/diaphragm, generating Dampness from Dryness (External Dryness coma/closure also often stems from this). As for Stroke tendon laxity/unretracting, and various Yu diseases/Wei syndromes, seemingly opposite to stiff/tight/astringent, but their Dryness is the same, merely extreme Dryness! Observing late Autumn extreme dryness, grass/trees have withered/shrunk without extending, or withered/fallen without retracting. Their logic can be understood. Hands hold blood to grasp, feet get blood to walk. Dryness means Blood/Qi decline, Qi not flowing smoothly, laxity unretracting, inevitable logic. Sun Yikui said: Dryness prospers in Autumn, but must be after Autumn Equinox, Clear Qi moves, then all things dry. Dryness belongs to Metal, Metal is West Qi, in humans it is Lung. Why does Yunqi (Five Movements and Six Qi) say Mao-You years are Yangming Dry Metal governing Heaven, but does not mention Lung? Because Lung meridian starts in Middle Jiao, fluids emerge from Middle Jiao. That *Yijing Tongzhi* says Dryness is transformed by Yangming, is also due to this reason! Shen Shengming said: *Nei Jing* Pathogenesis 19 clauses alone omit Dryness Qi, likely because Dryness combines with Wind-Heat to transform. Speaking of Wind-Heat, Dryness is included therein. Dryness combining Wind transformation: Classic says: Wind overcomes Dampness, Dampness gone then Dryness born. In humans, Wind scorches fluids, fluids gone then Dryness born. Dryness injures Lung Metal, Metal cannot control Water, disease reaches Liver Wood. Hence Stroke tendon vibration-stringy, Wind-Epilepsy locked jaw, convergence-urgent diseases arise. Dryness combining Heat transformation: *I Ching* says: Nothing dries things more than Fire. Initially Fire scorches Metal then Dryness forms; subsequently Metal does not generate Water then Dryness increases. Hence eating well/hunger, Stomach withering/dysphagia, urination/defecation closure, withered/dry/cracked diseases arise. From Heat generates Wind, from Wind generates Dryness, from Dryness generates Heat, cyclic victory/reversal, until Marrow/Fluids all wither. Dryness is clearly not a shallow affliction!
Deducing causes of Dryness: some due to Heaven, some due to Humans. Yangming Dry Metal governing Heaven, or long drought no rain, Dryness transformation greatly performs, injuring Lung Metal, this is due to Heaven. Seven emotions unregulated, Qi knotting, Spirit injury, Essence damage, and during illness excessive sweating/vomiting/purging, or long labor in wind/sun, frequently near stove fire, or eating pungent-hot flavors excessively, or Consumption mistakenly given warm-drying, or alchemists long taking mineral metals, all can dryness-injure fluids, this is due to Humans. However, investigating the root source, all originate from Blood insufficiency. Because Yin-Blood deficient cannot circulate hundred bodies, Fluids consumed cannot nourish Three Jiao (referring to Upper, Middle, Lower Jiao). Thus Evil-Heat depressed, Dryness changes manifold. Dryness externally causes skin cracking; Dryness internally causes Essence/Blood withering; Dryness above causes throat/nose dry/pain; Dryness below causes urination/defecation closure. Combined Heat causes limb flaccidity; Transforming Wind causes epilepsy/convulsions. Excess Dry-Heat causes mania; Deficient Dry-Heat causes Labor Cough. Dryness injuring Lung Metal cannot spread Water Essence, thus Phlegm/Drink stops. Dryness with Dampness causes dysphagia. Diseases caused by Dryness, how can they be counted!
Treating Dryness method, should observe boiling pot principle. Blood compared to Soup, Qi compared to Fire. If Fire fierce Soup boils, becoming Excess Evil, then should add wood extinguish flame, preventing depletion. Zhang Taishou said: Urgently purge Yangming to preserve fluids, this is it. If boiled long about to dry, then should add water overcome fire, preventing upward rebellion. Wang Taipu said: Strengthen Master of Water to control Sunshine, this is it. Also according to Classic: Heart transfers Cold to Lung, forming Fei Xiao (Lung Wasting-Thirst), drink one urine two, death untreatable, called Si Yin (Dead Yin). Dead Yin means Heart/Lung True Yin withered, True Yang also declines, Cold rises from inside, Qi does not transform fluid, Lung Yin Qi is dead. Jingyue once used Bawei Wan, Guipi Tang to treat a gentleman and cured. Also, constipation, little food, weak pulse, called Yin Jie, treated with Banshu Wan and cured. These are all Blood withered Qi stagnant, Yin injured affecting Yang, unable to circulate/transform/steam, like Earth Qi not ascending, then Heaven Qi...