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(Dryness Qi) descends, becomes blocked, and forms the climate of winter. This is because deficiency leads to cold, and cold leads to dryness; therefore, treatment should change from clearing and moistening (Qing Run) to warming and moistening (Wen Run). To understand both the norm and the expedient, to know the constant and the variable, one can truly be called a physician in charge of life!

Yu Jiayan said: Among the Nineteen Pathogenesis Patterns in *Suwen*, only Dryness Qi is omitted. The Six Qi correspond to the Four Seasons: Wind corresponds to Spring, Summer Heat corresponds to Summer, Dryness corresponds to Autumn, and Cold corresponds to Winter. Dampness arises from Earth, and Earth thrives during all four seasons, being especially vigorous during the eighteen days of Late Summer. I believe the original text of *Neijing* should read: "Spring injury by Wind, Summer injury by Summer Heat, Late Summer injury by Dampness, Autumn injury by Dryness, Winter injury by Cold." It was merely that copyists omitted some characters below the character for "Summer Heat" and above the character for "Dampness"! For "Autumn injury by Dryness" is a definitive principle, beyond doubt. The classic also states: "If cough persists and white blood is expectorated, death ensues." White blood refers to a pale red color, resembling flesh or lung tissue, which is a sign of lung consumption. Thus, the pathogenesis patterns state: "All qi stagnation belongs to the Lung. All flaccidity syndromes, wheezing, and vomiting belong to the Upper Jiao." These two clauses clearly refer to dryness diseases. As for left hypochondriac pain, inability to turn the body, dry throat, dusty complexion, lack of luster on the body, heat on the outer sole of the foot, lower back pain, fright, tendon contraction, hernia in men, lower abdominal pain in women, squinting eyes with sores, these are manifestations of dryness disease originating from the Liver but appearing scattered and varied; yet they are all signs of "Autumn injury by Dryness." Why do commentators, unaware of occasional omissions or errors in the Pathogenesis chapter, insist on identifying dryness disease as dampness disease, which blatantly contradicts the intent of the classics? The classic says: "Heart transfers heat to the Lung, transmitting into Ge Xiao (Diaphragmatic Consumption)." The origin of lung dryness is ancient! If a person's Kidney Water can ascend to communicate with the Heart, then Heart Fire can naturally descend to communicate with the Kidney; when Water and Fire are balanced, how could there be injury to the Lung? Even if Kidney Water is insufficient, as long as the fluids in the Stomach are sufficient to assist and supply upwards, the Lung will not become overly dry. If the pools of the Middle and Lower Jiao are exhausted, it is impossible for water from the high source to remain without tilting. The classic also says: "Jie (knotting) of the Two Yangs is called Xiao." This refers to the Hand-Yangming Large Intestine Meridian and Foot-Yangming Stomach Meridian; heat knotting causes essence and blood to fail to nourish, resulting in Xiao Ke (Wasting and Thirsting), cracked red tongue muscles, extreme thirst with desire to drink, which has the same meaning as Ge Xiao. Treating Ge Xiao uses Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) to clear dryness and save the lung. From this, we can see that for various qi stagnations, flaccidity syndromes, wheezing, and vomiting belonging to lung dryness, using this method is also appropriate. *Yin Yang Bie Lun* states: "Diseases of the Two Yangs originate in the Heart and Spleen; there are hidden difficulties [sexual dysfunction], women have no menstruation; if transmitted into Feng Xiao (Wind Consumption) or Xi Ben (Breath Bulging), it is incurable death." The Two Yangs refer to the Yangming Stomach. Originating in the Heart and Spleen means the disease of the Two Yangs originates in the Heart and Spleen. The Heart houses the Spirit (Shen), and the Spleen houses the Intent (Yi). What the Heart initiates and governs is called Intent; although the Spleen houses Intent, it fundamentally stems from the Heart. Overthinking causes Spleen Qi to knot and Heart Qi to knot; Heart Qi knotting causes Heart Blood to knot. Dryness arises from within, injuring the Yangming, which governs the muscles. Feng Xiao means muscles waste away as if blown by wind. Xi Ben means breathing is noisy and rebels upward without descending, caused by Lung Qi deficiency failing to descend to the Kidney, and Kidney Qi deficiency failing to ascend to the Lung. The yin fluids of the zang-fu organs are completely consumed, hence it is directly judged as incurable death.

Ke Yunbo discussed the similarities and differences between Jing (Spasm) and Shi (Dampness): Among the Nineteen Pathogenesis Patterns, only dryness disease is missing. If it is said that "all Jing syndromes with neck stiffness belong to Dampness," I privately doubt this. Even in this treatise, there is a distinction between Jing and Dampness, and it states that Taiyang disease (Cold injuring the Taiyang Meridian), if sweating is induced excessively, leads to Jing syndrome; thus, Jing syndrome undoubtedly belongs to dryness. Is the theory that "all Jing belongs to Dampness" a copying error? Or does Dampness transform into Dryness? Jing is a condition of tendon urgency due to blood deficiency. Examining the Six Qi, all can cause Jing syndrome. Jing caused by Wind-Cold results from the struggle of clear Qi. Jing caused by Summer Heat-Dampness may result from Wind-Cold struggling with Summer Heat-Dampness, or from Summer Heat-Dampness obstruction, or from Summer Heat-Dampness transforming into Dryness, or from excessive sweating. For those caused by struggle and obstruction, non-acrid-moistening and warm-moistening methods are required to resolve them; for those caused by transformation into dryness and excessive sweating, clearing-moistening, sweet-moistening, and warm-moistening methods are required to nourish them. Furthermore, Jing syndromes of the Six Channels have different locations: Those at the posterior of the body belong to Taiyang, with symptoms including neck stiffness, backward arching of the waist and spine, inability to flex the thighs, and tendons like knots; those at the anterior belong to Yangming, with symptoms including head and face tremors, locked jaw, pain in the supraclavicular fossa, and leg cramps; those at the sides belong to Shaoyang, with symptoms including facial deviation, pulling of hands and feet, hypochondriac tension, and hemiplegia; abdominal tension, or limb tension due to vomiting and diarrhea, belongs to Taiyin; aversion to cold, curling up, sitting on the buttocks instead of heels, hunching back instead of standing straight, unable to bend forward and stand up, belongs to Shaoyin; rising testicles, descent of the Zong Jin (General Tendon), lower abdominal urgency, genital cramping, and knee tendon cramping belong to Jueyin. Although the locations of the Six Channels differ, they all ultimately归结 to dryness. One must distinguish the cause of dryness (due to Cold, Wind, Wind-Cold binding, Summer Heat-Dampness obstruction) and its transformation (Wind-Cold transforming into dryness, Summer Heat-Dampness transforming into dryness), treat the root cause, add guiding herbs, and act as guides, without rigidly adhering to fixed meridians and losing the root while pursuing the branches. For Jing caused by Wind-Cold struggle, symptoms include fever, aversion to cold, anhidrosis, Qi rushing to the chest, difficult urination, firm and tight pulse, stiff posture, and locked jaw. This is acquired from heavenly Qi, i.e., the classic statement "all sudden stiffness belongs to Wind"; it is fierce and anhidrotic, hence called Gang Jing (Rigid Spasm). For Jing caused by Summer Heat-Dampness obstruction, symptoms include fever, sweating, but no aversion to cold, deep and slow pulse, indistinct and irregular pulse, and stiff neck. This is acquired from earthly Qi, i.e., the classic statement "all Jing with neck stiffness belongs to Dampness"; it is weak and diaphoretic, hence called Rou Jing (Soft Spasm). Zhang Zhongjing treats Jing due to Wind using Gegen (Puerariae Radix) as the sovereign herb, acrid-cool to treat wind movement, and clearing-moist to treat dryness (applicable only if Wind-Yang transforms into heat; not suitable for Wind-Cold binding); he treats Jing due to Damp-Heat using Gualou Gen (Trichosanthis Radix) as the sovereign herb, bitter-descending to resolve damp obstruction, and cool-moist to treat dryness. One herb serves two purposes, not only not conflicting but mutually assisting; scholars should infer other cases from this example. Moreover, good physicians must use observation methods to discern subtle signs early and treat disease before it arises. For instance, neck stiffness and pain are aspects of Jing; observing this reveals blood deficiency in the Taiyang meridian, allowing for prevention. As stated in *Shanghan Lun*: "Floating pulse, spontaneous sweating, vexation, aversion to cold, and leg cramps indicate impending Jing. Giving Guizhi Tang (Cinnamon Twig Decoction) would cause厥 (cold limbs), but giving Shaoyao Gancao Tang (Peony and Licorice Decoction) would allow the legs to extend naturally." Gancao (Glycyrrhizae Radix et Rhizoma) is sweet and緩 (relaxing) to relieve urgency; Shaoyao (Paeoniae Radix Alba) is slightly moist and bitter, treating dryness without cloying pathogens. Saint Zhang’s medication usage was not like later physicians who attended to one thing while neglecting another. However, custom sees this condition, not only failing to prevent it but mistakenly treating it as Wind, using acrid-diaphoretic sweating methods, aiding Yang and consuming Yin, leading to symptoms such as neck and back stiffness, locked jaw, leg cramps, and inability to lie flat on the bed. This is simply due to failure to examine deficiency and excess. The method for treating Jing should differentiate deficiency and excess and investigate the cause. For Jing caused by blood deficiency or mis-treatment, urgently use clearing-harmonizing and moistening methods, softening rigidity with gentleness. For severe deficiency, where Metal is cold and Water is cold, Qi is knotted and fluids are dried, clearing-moistening is unsuitable; one must use warm-moistening and sweet-moistening herbs such as Congrong (Cynomorii Herba), Gouqi (Lycii Fructus), Shudi (Rehmanniae Radix Preparata), Ejiao (Asini Corii Colla), Yuzhu (Polygonati Odorati Rhizoma), Lujiao (Cervi Cornu Colla), Tusizi (Cuscutae Semen), etc., which constitute the orthodox method. Clear-moistening herbs still carry the cool-cold Qi of late autumn, whereas sweet-moistening and warm-moistening herbs obtain the gentle nurturing energy of spring. The treatment of deficiency-dryness is generally similar. Alas! The paths of deficiency and excess are different, and life and death are separated by a palm's flip; scholars must discern subtly and early!