热燥而烦、小水干赤、中气不足、溲便如膏之类，切勿利之，以致重损津液，害必甚矣。故凡治阳虚者，只宜
补阳，阳胜则燥，而阴湿自退；阴虚者，只宜壮水，真水既行，则邪湿自无所容矣。此阴阳二证，俱有不宜
利者，不可不察。（张景岳）
凡风药可以胜湿，泄小便可以引湿，通大便可以逐湿，吐痰涎可以祛湿。湿而有热，苦寒之剂燥之；湿而
有寒，辛热之剂除之。（李时珍）
湿在上，宜防风，风能胜湿，犹湿衣悬透风处则易干也；湿在中，宜苍术，犹地上有湿，灰多则渗干也；
湿在下，宜利小便，犹欲地干，必开水沟也；湿在周身，宜乌药、羌活等；湿在两臂，宜桑条、威灵仙等；
湿在两股，宜牛膝、防己、萆 等。分其部位而治之，何患不效？（沈金鳌）
脾弱湿伤者，二陈、平胃之类主之；湿盛濡泄者，五苓、六一之类主之；水肿发黄者，五皮、茵陈之类主
之。若湿流关节，则非前药所宜，无窍不入，惟风为能。故凡关节之病，非风药不能到也。（吴鹤皋）
脉候
脉浮而缓、濡而小者，皆外湿；沉而缓、细而微者，皆内湿。又迟缓为寒湿，洪缓为湿热，弦缓为风湿。（《证治汇补》）
经义
西方生燥，燥生金。○清气太来，燥之胜也。○诸涩枯涸，干劲皴揭，皆属于燥○。燥胜则干。（《素问》）
哲言
涩，物湿则滑泽，干则涩滞，燥湿相反故也。枯，不荣生也。涸，无水液也。干，不滋润也。劲，不柔和
也。春秋相反，燥湿不同故也。皴揭，皮肤启裂也。干为天而为燥金；坤为地而为湿土。天地相反，燥湿异同
故也。（《原病式》）
燥者金之气，有冷燥，有热燥。冷燥者，晴空凛冽而枯槁；热燥者，晴空焦 而干枯。（《黄帝逸典》）
肥人气虚生寒，寒生湿，湿生痰；瘦人血虚生热，热生火，火生燥。故肥人多寒湿，瘦人多热燥。○燥是
阳明之化，虽因于风热所成，然究其原，皆本于血虚、津液不足所致者为多。何也？盖阴血虚则不能荣运百体，
津液衰则无以滋养三焦，由是邪热怫郁，而燥变多端。燥于外，则皮肤皴揭；燥于内，则精血枯涸；燥于上，
则咽鼻干焦；燥于下，则便溺闭结。治之者，外以滋益之，内以培养之，在上清解之，在下通润之，务使水液
自生，而燥热不容不退矣。（朱丹溪）
风燥，由肝血不能荣筋，故筋急爪裂；火燥，由脾多伏火，故唇揭便秘；血燥，由心血失散，故头多白屑、
发脱须落；虚燥，由肾阴虚涸，故小便数、咽干喉肿。此皆燥之因也。（《证治汇补》）
凡物近火则润，离火则燥，犹金之投入烈火而化为液。故燥证多有反似痿弱之证者，热伤阴血也。（张路玉）
燥之与湿，有霄壤之殊。燥者天之气也，湿者地之气也。水流湿，火就燥，各从其类。春月地气动而湿胜，
秋月天气肃而燥胜，故春分以后之湿，秋分以后之燥，各司其政。今指秋月之燥为湿，是必指夏月之热为寒然
后可，奈何《内经》病机一十九条，独遗燥气，他凡秋伤于燥，皆谓秋伤于湿，历代诸贤，随文作解，弗察其
讹，昌特正之。大意谓春伤于风，夏伤于暑，长夏伤于湿，秋伤于燥，冬伤于寒。觉六气配四时之旨，与五运
不相背戾，而千古之大疑，始一决也。○《病机》云∶诸涩枯涸，干劲皴揭，皆属于燥。燥金虽为秋令，虽属
阴经，然异于寒湿，同于火热。火热胜则金衰，火热胜则风炽，风能胜湿，热能耗液，转令阳实阴虚，故风、
火、热之气，胜于水土而为燥也。○诸气 郁之属于肺者，属于肺之燥，非属于肺之湿也。苟肺气不燥，则诸
气禀清肃之令而周身四达，亦胡致 郁耶？诸痿喘呕之属于上者，上亦指肺不指心也。若统上焦心肺并言，
则心病不主痿喘及呕也。惟肺燥甚，则肺叶痿而不用，肺气逆而喘鸣，食难过膈而呕出。三者皆燥证之极者
也。○肺为娇脏，寒冷所伤者十之二、三，火热所伤者十之七、八。寒冷所伤，不过裹束其外；火热所伤，则
更销烁其中，所以为害倍烈也。然火热伤肺，以致诸气 郁、诸痿喘呕而成燥证，只因《内经》脱遗燥证，
后之无识者竞以燥治燥，恬于操刃，曾罔顾阴气之消亡耳。○《经》云∶心移热于肺，传为膈消。肺燥之由来
者远矣，苟其人肾水足以上升而交于心，则心火下降而交于肾不传于肺矣，心火不传于肺，曾何伤燥之虞哉？
即肾水或见不足，其肠胃津血足以协济上供，肺亦不致过伤也。若夫中、下之泽尽竭，而高源之水犹得措于不
倾，则必无之事矣。○《阴阳别论》云∶二阳之病发心脾，有不得隐曲，男子少精，女子不月；其传为风消，
其传为息贲者，死不治。此亦肺
燥所由来而未经揭出者。然其始但不利于隐曲之事耳，其继则胃之燥传入于脾，而为风消；大肠之燥传入于肺，
而为息贲。是则胃肠合心脾以共成肺金之燥，三脏二腑阴气消亡殆尽，尚可救疗乎？○风热燥甚，怫郁在表，而
里气平者，善伸数欠，经脉拘急，或时恶寒，或筋惕而搐，脉浮数而弦；若风热燥并郁甚于里，则必为烦满闷
结。故燥有表、里、气、血之分也。○肝主筋，风气自甚，燥热加之，则液聚于胸膈，不荣于筋脉而筋燥，故
劲强紧急而口噤，或螈 、昏冒、僵仆也。○燥病必渴，而渴之所属各不同，有心肺气厥而渴，有肝痹而渴，有
脾热而渴，有肾热而渴，有胃与大肠热结而渴，有小肠瘅热而渴，有因病疟而渴，有原素食肥甘而渴，有因醉
饮入房而渴，有因远行劳倦遇大热而渴，有因伤害胃干而渴，有因风而渴。五脏部分不同，病之所遇各异，
其为燥热亡液则一也。（喻嘉言）
补编
休治风兮休治燥，治得火时风燥了。燥之为病，皆属燥金之化。然能令金燥者，火也。《系辞》云∶燥万
物者莫 乎火。夫金为阴之主，为水之源，而受燥气，寒水生化之源竭绝于上，而不能灌溉周身，荣养百骸，
色干而无润泽皮肤者，有自来矣。或大病克犯太过，或吐利津液内亡，或误饵金石补阳燥剂，皆能偏助阳火而
损真阴。阴中伏火，日渐煎熬，血液衰耗，燥热转甚。法宜甘寒滋润，甘能生血，寒能胜热。阴得滋而火杀，
液得润而燥除，源泉下降，精血上荣，阴液宣通，内神藏而外色泽矣。（张子和）
肺金被火，固已乏气，而营竭肝伤，血分更增其燥，以致虚阳失养，郁成枯火，火莫能降，只随腥涎浊瘀
紊而上攻。凡心肺所贮气血之膈，无复润泽而枯焦也。此际之火，既莫能攻，而虚又莫能补，故养营保肺，
首在生津，甘凉濡润，无非以补法为溉法。此《普济》门中之甘露也。○燥万物者莫如金，金令降；滋万物者
莫如木，木令升。凡金令之不从其燥者，全赖木气之升，
能致五脏之蒸溽到肺而成津液也。故木气升，则五脏之气奉春令而俱升；木气降，则五脏之气奉秋令而俱降，
降则五脏之气不得上承，自然下蚀。凡土邪陷下而克水，火淫寡畏而 金，皆职于此。金以蒸溽不到，而加火
淫，遂成燥金。津液之源已竭于上，周身百骸，谁为之灌溉者？是则一燥无不燥矣。降令多，升令少，而湿热
之邪，遂盛于下部而成痿软。盖湿热为物，升则化，不升则不化，欲救全体之燥，须从木令之升，但使五脏各
有升令之奉，则土能生金，金能生水，水能制火。虽其间有补有泻，皆可以此一字为循环法，所谓少阳为枢者
此也。曰清燥者，谓能致津液故也。（程郊倩）
燥证有外因者，六淫之一也；有内因者，血液之枯也。外因之燥，非雨露愆期，即秋日暴烈；非南方不毛，
即北方风劲，气偏阳亢而燥生。从皮毛而入者，则肺受之，肺受燥气，咳嗽咽痛之证见矣；从口而入者，则
胃受之，胃受燥气，结胸便秘之证见矣。喻嘉言谓∶秋伤于燥，冬生咳嗽。议论发前人之未发，而清燥一方，
可为治燥之灵丹。至于结胸、便秘，世俗多以伤寒混治，不知燥则生火，津液耗而肠胃干矣。若内伤之燥，本
于肾水之亏，精血之弱，真阴之涸。在肺则清肃之令不行，咳逆口渴，皮聚毛落矣；在肝则将军之性不敛，胁痛
暴怒，筋急拘挛；在脾则生血之原不运，蓄瘀便结，皮肤不泽矣。欲治其燥，先贵乎润；欲救其脾，先滋乎肾。
诚以肾主水而藏脏腑之精，养百骸而为性命之本。若肾阴充足，则四脏可以灌溉，燥无自而生也。第水日亏而
火日炽，决非清凉之味可疗，须用六味归芍汤合生脉散为主治，肺燥则加沙参、天冬、梨汁之属；肝燥则加丹
参、枣仁、乳汁之属；脾燥则加柏子仁、甘蔗汁之属。此燥病之正治也。倘久病而气因精虚，参、 、河车
及八味等汤，亦宜急投。盖阳生则阴长，气化则血润，此燥病之反治也。虽然草木之枯，得雨滋荣，人身之燥，
非血不泽，参乳汤救燥病之根，活命饮治燥病之
原，又何必纷纷而他求耶？经云∶诸涩枯涸，干劲皴揭，皆属于燥。又曰∶燥胜则干。其为血液之涸，已明效
大验。即如隔病之枯，胃之燥也；消病之渴，肺之燥也；爪甲之焦，筋之燥也；产后之痉，血之燥也；而敢谓
治燥为易哉？（《会心录》）
燥为干涩不通之疾，内伤外感宜分。外感者，由于天时风热过胜，或因深秋偏亢之邪，始必伤人上焦气
分，治以辛凉甘润肺胃为先，喻氏清燥救肺汤及玉竹、门冬、桑叶、薄荷、梨皮、甘草之类。内伤者，乃人之
本病精血下夺而成，或因偏饵燥剂所致，病从下焦阴分先起，治以纯阴静药柔养肝肾为宜，大补地黄丸、六味
丸之类。要知是证大忌者苦涩，最喜者甘柔。若气分失治，则延及于血；下病失治，则槁及乎上。喘咳、痿厥、
三消、噎隔，根萌总由此致。津液结者，必佐辛通之气味；精血竭者，必藉血肉之滋填。在表佐风药而成功；
在腑以缓通为要务。古之滋燥养营汤、润肠丸、五仁汤、琼玉膏、一 丹、牛羊乳汁等法，各有专司也。（《临证指南》）
夫燥有脏腑之燥，有血脉之燥。燥在上，必乘肺经，故上逆而咳，宜《千金》五味子汤；若外内合邪，
宜《千金》麦门冬汤。燥在下，必乘大肠，故大便燥结，然须分邪实、津耗、血枯三者为治∶邪实者，则烦
渴躁闷腹胀，用通幽汤、麻仁丸；津耗者，屡欲便而不可得圊，欲了而不了，外用蜜煎导；血枯者，呕逆食
不下，大便燥结如栗，用生料六味丸去山萸加生首乌、当归、苁蓉、桃仁。燥在血分，多见风证，木无所畏
也。燥本火之余，故以滋燥养营汤治外，大补地黄汤治内，润燥养阴为第一义。火热亢盛，津液耗竭，不能荣
养百骸，手足痿弱，不能收持，反似湿痹之证，养阴药中必加黄柏以苦坚之，如虎潜丸之类。若误作风治则殆
矣。（张路玉）
风燥一证，辨治尤难。盖燥为秋气，令不独行，必假风寒之威，而令乃振，病乃发也。然考之于《经》，
则不曰秋伤于燥，而言秋伤于湿，何也？夫秋令本燥，以长夏湿土郁蒸之余气渐渍身中，随秋令收敛而伏于肺
胃之间，直待秋深燥令大行，与湿不能兼容，至冬而为咳嗽也。此证有肺燥、胃湿两难分解之势。古方中惟
《千金》麦门冬汤、《千金》五味子汤独得其秘。不知者，以为敛散不分、燥润杂出，则又置而不用，总未达
分解风燥之义耳。喻氏不明湿气内伏燥令外伤之意，直云《内经》独遗长夏伤于湿句，致令秋伤于燥误为伤湿，
殊失《内经》精微之奥矣。（《伤寒析义》）
治风燥莫如养血，治燥热莫如壮水。更有冷燥一证，虽见便秘燥结，实由阴寒过极，如阳和之水，遇隆冬
而成层冰燥裂也。古方有半硫丸之设，意深远矣。（冯楚瞻）
壮水以制火，清金以润燥，人所共知；补脾以生肺，资母以益子，人所不晓。每见余师治燥用二冬、二
地为君，加山药等，无不应手而效。（方星岩）
润燥，以玉竹、麦冬、沙参为最，地、归不能及也。（《三秋病机》）
治燥病者，补肾水阴寒之虚，泻心火阳热之实，除肠中燥热之甚，济胃中津液之衰，使道路散而不结，津
液生而不枯，气血利而不涩，则病日已矣。○凡秋月燥病，误以为湿治者，操刃之事也。从前未明，咎犹可诿，
今明知故犯，伤人必多。孽镜当前，悔之无及。○凡治燥病，燥在气而治血，燥在血而治气，燥在表而治里，燥
在里而治表。药不适病，医之过也。○凡治杂病，有兼带燥证者，误用燥药，转成其燥，因致危困者，医之罪
也。○凡治燥病，须分肝肺二脏见证，肝脏见证，治其肺犹可也；若肺脏见证，反治其肝，则坐误矣，医之罪
也。○凡治燥病，不深达治燥之旨，但用润剂润燥，虽不重伤，亦误时日，只名粗工，所
当戒也。（《医门法律》）
脉候
燥有内外诸证，不能尽述，而脉之微、细、涩、小则一，间有虚、大、数、疾、浮、芤等状。以意察
之，重按无有不涩、不细、不微者，则知诸燥之证，皆肺金之一气，亦不出肺金之一脉也。（张路玉）
选案
Heat-dryness with irritability, scanty dark-red urine, deficiency of middle Qi, and excretion resembling paste should never be treated with diuretics, as this would severely damage body fluids, leading to grave harm. Therefore, in treating Yang deficiency, one should only tonify Yang; when Yang prevails, dryness manifests, and Yin-dampness naturally recedes. In treating Yin deficiency, one should only strengthen Water (Kidney Yin); once True Water flows, pathogenic dampness has no place to reside. Both these Yin and Yang patterns have indications against using diuretics, which must not be overlooked. (Zhang Jingyue)
Wind-dispelling herbs can overcome dampness; promoting urination can guide dampness out; unblocking the bowels can expel dampness; inducing vomiting of phlegm-saliva can remove dampness. If dampness is accompanied by heat, bitter-cold herbs are used to dry it; if dampness is accompanied by cold, acrid-hot herbs are used to dispel it. (Li Shizhen)
For dampness in the upper part of the body, Fangfeng (Saposhnikovia Root) is suitable, for wind overcomes dampness, just as wet clothes dry easily when hung in a ventilated place. For dampness in the middle part of the body, Cangzhu (Atractylodis Rhizoma) is suitable, just as damp earth dries when covered with ash. For dampness in the lower part of the body, promoting urination is suitable, just as digging drainage ditches dries the ground. For dampness throughout the body, Wuyao (Linderae Radix) and Qianghuo (Notopterygii Rhizoma et Radix) etc. are suitable. For dampness in both arms, Sangtiao (Mori Ramulus) and Weilingxian (Clematidis Radix et Rhizoma) etc. are suitable. For dampness in both thighs, Niuxi (Achyranthis Bidentatae Radix), Fangji (Stephaniae Tetrandrae Radix), and Bi Xie (Dioscoreae Hypoglaucae Rhizoma) etc. are suitable. By treating according to the location of the dampness, how could there be any lack of efficacy? (Shen Jin'ao)
For spleen weakness with dampness injury, Erchen Tang (Two-Cured Decoction) and Pingwei San (Peaceful Stomach Powder) are indicated. For excessive dampness causing loose stools, Wuling San (Five-Ingredient Powder with Poria) and Liuyi San (Six-to-One Powder) are indicated. For edema with yellowing, Wupi Yin (Five-Peel Decoction) and Yinchenshao Tang (Artemisiae Scopariae Decoction) are indicated. If dampness flows into the joints, the aforementioned medicines are not suitable; dampness penetrates every orifice, and only wind-dispelling herbs can reach it. Thus, for joint diseases, non-wind-dispelling herbs cannot be effective. (Wu Hegao)
Pulse Diagnosis
A pulse that is floating and slow, or soggy and small, indicates external dampness. A pulse that is deep and slow, or fine and minute, indicates internal dampness. Furthermore, a slow and soft pulse indicates cold-dampness; a surging and soft pulse indicates damp-heat; a wiry and soft pulse indicates wind-dampness. (*Zhengzhi Huibu*)
Classics
The West generates Dryness, and Dryness generates Metal. ○ An excess of clear Qi indicates an overabundance of Dryness. ○ All cases of astringency, withering, drying up, stiffness, and skin cracking belong to Dryness. ○ When Dryness prevails, there is dryness. (*Suwen*)
Philosophical Discourse
"Astringent" refers to the fact that objects are slippery when wet but sticky/stagnant when dry, due to the opposition between Dryness and Dampness. "Withered" means lacking nourishment for life. "Dried up" means having no fluid. "Dry" means lacking moisture. "Stiff" means lacking flexibility. Spring and Autumn are opposite, hence Dryness and Dampness differ. "Cracking" refers to skin fissures. Heaven (Qian) is Dryness-Metal; Earth (Kun) is Dampness-Earth. Heaven and Earth are opposite, hence Dryness and Dampness differ yet share connections. (Liu Wansu, *Yuanbing Shi*)
Dryness is the Qi of Metal. There is Cold-Dryness and Heat-Dryness. Cold-Dryness is when the clear sky is biting cold, causing withering; Heat-Dryness is when the clear sky is scorching hot, causing dryness. (*Huangdi Yidian*)
Obese people have Qi deficiency generating Cold, Cold generates Dampness, and Dampness generates Phlegm. Thin people have Blood deficiency generating Heat, Heat generates Fire, and Fire generates Dryness. Thus, obese people often suffer from Cold-Dampness, while thin people often suffer from Heat-Dryness. ○ Dryness is the transformation of the Yangming channel. Although it may result from Wind-Heat, its root is mostly due to Blood deficiency and insufficient body fluids. Why? Because when Yin-Blood is deficient, it cannot nourish the whole body; when body fluids decline, they cannot nourish the Triple Burner. Consequently, pathogenic heat becomes stagnant, leading to various forms of dryness. Dryness externally causes skin cracking; internally causes exhaustion of essence and blood; superiorly causes dry/burning throat and nose; inferiorly causes constipation and urinary retention. Treatment involves nourishing externally, tonifying internally, clearing/resolving superiorly, and unblocking/moistening inferiorly, ensuring body fluids regenerate so that dryness-heat cannot help but retreat. (Zhu Danxi)
Wind-Dryness arises because Liver Blood fails to nourish tendons, causing tendon tension and nail cracking. Fire-Dryness arises because Spleen has latent fire, causing lip peeling and constipation. Blood-Dryness arises because Heart Blood scatters, causing dandruff, hair loss, and beard falling. Deficiency-Dryness arises because Kidney Yin is exhausted, causing frequent urination, dry throat, and swollen larynx. These are all causes of Dryness. (*Zhengzhi Huibu*)
Generally, objects near fire become moist, while those away from fire become dry, like metal melting into liquid in fierce fire. Thus, dryness patterns often resemble flaccidity syndromes, because heat injures Yin-Blood. (Zhang Luyu)
Dryness and Dampness are worlds apart. Dryness is the Qi of Heaven; Dampness is the Qi of Earth. Water flows to dampness; Fire adheres to dryness, each following its kind. In spring, Earth Qi moves and Dampness prevails; in autumn, Heaven Qi becomes solemn and Dryness prevails. Thus, Dampness after the Spring Equinox and Dryness after the Autumn Equinox govern their respective seasons. To call Autumn Dryness Dampness now would be like calling Summer Heat Cold. Why did the *Neijing* omit Dryness from the Nineteen Pathomechanisms? Others stated "Autumn injury by Dryness" as "Autumn injury by Dampness." Past sages interpreted textually without noticing the error. I specifically correct this. The gist is: Spring injury by Wind, Summer injury by Summer-Heat, Late Summer injury by Dampness, Autumn injury by Dryness, Winter injury by Cold. This aligns the Six Qi with Four Seasons and Five Movements, resolving a millennium-old doubt. ○ *Pathomechanism* says: All astringency, withering, drying up, stiffness, and skin cracking belong to Dryness. Although Dryness-Metal is the Autumn command and belongs to Yin channels, it differs from Cold-Dampness and resembles Fire-Heat. Excess Fire-Heat weakens Metal; excess Fire-Heat intensifies Wind. Wind overcomes Dampness; Heat consumes Fluids, turning Yang-excess and Yin-deficiency. Thus, Wind, Fire, and Heat Qi surpass Earth/Water to create Dryness. ○ Qi stagnation belonging to the Lung belongs to Lung-Dryness, not Lung-Dampness. If Lung Qi is not dry, it follows the solemn command and circulates freely; why would it stagnate? Flaccidity, wheezing, and vomiting belonging to the Upper Jiao refer to the Lung, not the Heart. If speaking of Upper Jiao Heart/Lung together, Heart disease does not primarily cause flaccidity/wheezing/vomiting. Only severe Lung-Dryness causes Lung lobes to become flaccid/unfunctional, Lung Qi rebellious causing wheezing, and food difficulty passing the diaphragm causing vomiting. These three are extreme Dryness patterns. ○ The Lung is a delicate organ; 20-30% injured by Cold, 70-80% by Fire-Heat. Cold binds externally; Fire-Heat melts internally, causing double harm. However, Fire-Heat injuring the Lung leads to Qi stagnation, flaccidity, wheezing, vomiting forming Dryness patterns, simply because the *Neijing* omitted Dryness. Ignorant successors treated Dryness with Dryness methods, carelessly wielding knives, ignoring Yin consumption. ○ *Classic* says: Heart transfers heat to Lung, transmitting to Ge Xiao (Diaphragmic Thirst). Lung-Dryness origins are ancient. If Kidney Water ascends to interact with Heart, Heart Fire descends to Kidney and does not transfer to Lung; then what danger of Dryness injury? Even if Kidney Water is slightly insufficient, Intestine/Stomach fluids/blood assist upward supply, sparing the Lung. If Middle/Lower pools are exhausted, High Source water remaining stable is impossible. ○ *Yin Yang Bie Lun* says: Diseases of Two Yang originate in Heart/Spleen, involving hidden difficulties, male infertility, female amenorrhea; transmitting to Feng Xiao (Wind-Wasting) or Xi Ben (Breath-Retching) is fatal untreatable. This is also an unexposed origin of Lung-Dryness. Initially, it hinders private matters; subsequently, Stomach-Dryness transmits to Spleen becoming Feng Xiao; Large Intestine-Dryness transmits to Lung becoming Xi Ben. Thus, Stomach/Intestines combine with Heart/Spleen to complete Lung-Metal Dryness. With Yin Qi of three Zang and two Fu nearly exhausted, can it be saved? ○ Severe Wind-Heat-Dryness stagnating in the Exterior with calm Interior causes frequent stretching/yawning, tendon contraction, occasional aversion to cold, muscle twitching/spasms, floating-rapid-wiry pulse. If Wind-Heat-Dryness stagnates deeply in the Interior, it causes vexation/fullness/oppression. Thus, Dryness has Exterior/Interior, Qi/Blood distinctions. ○ Liver governs tendons. If Wind is strong and Dryness-Heat adds, fluids gather in chest/diaphragm, failing to nourish tendons causing tendon-dryness, stiffness, trismus, spasms, coma, or collapse. ○ Dryness disease always involves thirst, but causes vary: Heart/Lung Qi reversal, Liver Bi, Spleen Heat, Kidney Heat, Stomach/Large Intestine heat-binding, Small Intestine toxic heat, malaria, rich diet, drunkenness/coitus, travel/fatigue/heat, stomach injury, Wind. Different organs, different encounters, but all result in Dryness-Heat consuming fluids. (Yu Jia Yan)
Supplement
Do not treat Wind, do not treat Dryness directly; treat Fire, and Wind-Dryness resolves. Dryness disease belongs to Dryness-Metal transformation. Yet, what makes Metal dry is Fire. *Xici* says: Nothing dries things like Fire. Metal is master of Yin, source of Water, receiving Dryness Qi. If Cold-Water generation source exhausts above, unable to irrigate body/nourish bones, causing dry complexion/lack of skin luster, it has origins. Or major illness over-suppresses, or vomiting/diarrhea loses fluids, or mistakenly taking mineral/Yang-tonifying dry herbs, all bias Yang-Fire damaging True Yin. Latent Fire in Yin slowly boils, depleting Blood, worsening Dryness-Heat. Method: Sweet-Cold moisturizing. Sweet generates Blood; Cold overcomes Heat. Yin nourished, Fire suppressed; Fluids moistened, Dryness removed. Source descends, Essence/Blood ascends, Yin fluids circulate, Spirit hides internally, luster appears externally. (Zhang Zihe)
Lung-Metal injured by Fire lacks Qi; Ying depletion and Liver injury increase Blood-phase Dryness, causing Deficient Yang to lose nourishment, stagnating into Withered Fire. Fire cannot descend, rising with turbid phlegm/blood stasis. The diaphragm storing Heart/Lung Qi/Blood loses moisture, becoming scorched. At this time, Fire cannot be attacked, Deficiency cannot be tonified. Thus, nourishing Ying and protecting Lung starts with generating fluids. Sweet-cool moistening uses tonification as irrigation. This is the "Sweet Dew" of the *Puji* school. ○ Nothing dries like Metal; Metal command descends. Nothing nourishes like Wood; Wood command ascends. If Metal command does not follow Dryness, it relies entirely on Wood Qi ascending to vaporize/moisten Five Zang into Lung fluids. Thus, Wood Qi ascending means Five Zang Qi follows Spring command ascending; Wood Qi descending means Five Zang Qi follows Autumn command descending. Descending means Qi cannot ascend, naturally eroding downward. Earth evil sinking suppressing Water, Fire excess lacking fear suppressing Metal, all depend on this. Metal lacking vaporization plus Fire excess becomes Dryness-Metal. Fluid source exhausted above, who irrigates the body? Thus, one dryness means all dryness. More descending commands, fewer ascending commands, Damp-Heat evil prospers in lower part causing flaccidity. Damp-Heat transforms if ascending, stagnates if not. To save whole-body Dryness, must start from Wood command ascending. If Five Zang each have ascending command, Earth generates Metal, Metal generates Water, Water controls Fire. Whether tonifying or draining, use this "Ascending" character as a cycle method, the Shaoyang pivot. "Clearing Dryness" means enabling fluid generation. (Cheng Jiaoqian)
Dryness patterns have External Causes (one of Six Evils) and Internal Causes (Blood withering). External Dryness: either rain/dew delayed, or autumn sun fierce; either southern barren land, or northern strong wind. Qi biases Yang-excess generating Dryness. Entering via skin/hair, Lung receives it: cough/sore throat appear. Entering via mouth, Stomach receives it: chest knot/constipation appear. Yu Jiayan said: "Autumn injury by Dryness, Winter produces cough." This insight was unprecedented. Qingzao formula is a spiritual elixir for Dryness. Chest knot/constipation are often misdiagnosed as Cold Damage by laypeople, not knowing Dryness generates Fire, consuming fluids drying intestines. Internal Dryness roots in Kidney Water deficiency, Essence/Blood weakness, True Yin exhaustion. In Lung: solemn command fails, cough/reversal/thirst, skin/hair fall. In Liver: General nature uncontained, hypochondriac pain/rage, tendon tension. In Spleen: Blood source fails, stasis/constipation, dull skin. To treat Dryness, prioritize Moistening. To save Spleen, first nourish Kidney. Indeed, Kidney governs Water, stores Essence, nourishes bones, root of life. If Kidney Yin sufficient, Four Zang irrigated, Dryness不生. But Water daily declines, Fire daily blazes, cool/cold flavors cannot cure. Must use Liuwei Dihuang Wan combined with Guishao Tang and Shengmai San as main treatment. Lung-Dryness add Shashen, Tiandong, Pear juice. Liver-Dryness add Danshen, Zaoren, Milk. Spleen-Dryness add Baiziren, Sugarcane juice. This is standard treatment. If chronic illness with Qi/Essence deficiency, Renshen, Huangqi, Heche, and Bawei Wan should be urgently given. Yang generates Yin; Qi transformation moistens Blood. This is reverse treatment. Although plants wither needing rain, human Dryness needs Blood for luster. Shenru Tang saves Dryness root; Huoming Yin treats Dryness origin. Why seek elsewhere? Classic says: All astringency/withering/drying/cracking belongs to Dryness. Also: Dryness prevails causing dryness. Evidence of Blood exhaustion is clear. Like Ge disease withering (Stomach-Dryness); Xiao disease thirst (Lung-Dryness); Nail burning (Tendon-Dryness); Postpartum spasms (Blood-Dryness). Dare one say treating Dryness is easy? (*Huixin Lu*)
Dryness is a disease of dryness/astringency/blockage. Internal/External causes must be distinguished. External: due to Wind-Heat excess or late-autumn hyperactive evil, initially injuring Upper Jiao Qi. Treat with Acrid-Cool Sweet-Moistening Lung/Stomach first, e.g., Yu's Qingzao Jiufei Tang, Yuzhu, Maidong, Sangye, Bohe, Lipi, Gancao. Internal: original disease Essence/Blood depletion from below, or caused by dry herbs, starting in Lower Jiao Yin. Treat with Pure-Yin Quiet Herbs nourishing Liver/Kidney, e.g., Dabu Dihuang Wan, Liuwei Wan. Know this pattern forbids Bitter-Astringent, prefers Sweet-Soft. Qi-level mistreatment spreads to Blood; Lower-level mistreatment withers Upper. Wheezing/cough, flaccidity/cold limbs, Three Xiao, dysphagia all stem here. Fluid binding requires Acrid-Unblocking aromatics; Essence/Blood exhaustion requires Flesh-Blood tonics. Exterior benefits from Wind herbs; Interior focuses on gentle unblocking. Ancient Zizao Yangying Tang, Runchang Wan, Wuren Tang, Qiongyu Gao, Yidan, Cow/Sheep milk methods each have specific roles. (*Linzheng Zhinan*)
Dryness has Zang-Fu Dryness and Vessel-Blood Dryness. Dryness in Upper attacks Lung, causing upward rebellion/cough; Qianjin Wuweizi Tang is suitable. If External/Internal combined evils, Qianjin Maimendong Tang is suitable. Dryness in Lower attacks Large Intestine, causing hard stool. Must distinguish Pathogen-Excess, Fluid-Consumption, Blood-Withering. Pathogen-Excess: vexation/thirst/restlessness/bloating, use Tongyou Tang, Maren Wan. Fluid-Consumption: urge to defecate but cannot, use Honey Suppository externally. Blood-Withering: vomiting/inability to eat, stool hard as nut, use Shengliao Liuwei Wan minus Cornus, add He Shou Wu, Dang Gui, Cong Rong, Tao Ren. Dryness in Blood phase shows Wind signs, Wood fears nothing. Dryness is residue of Fire. Use Zizao Yangying Tang for Exterior, Dabu Dihuang Tang for Interior. Moistening-Dryness/Nourishing-Yin is primary. Hyperactive Fire-Heat, exhausted fluids, failing to nourish body, causing flaccid limbs unable to hold, resembling Damp-Bi. Add Huangbo (Bitter-Hardening) to Yin-nourishing meds, e.g., Hujian Wan. Mistaking for Wind treatment is dangerous. (Zhang Luyu)
Wind-Dryness is particularly hard to differentiate/treat. Dryness is Autumn Qi, not acting alone, borrowing Wind/Cold power to manifest. Yet *Jing* says "Autumn injury by Dampness," not Dryness. Why? Autumn is inherently Dry, but Late Summer Damp-Earth lingering steam infiltrates body, hiding in Lung/Stomach during Autumn convergence. Only when Deep Autumn Dryness dominates, incompatible with Dampness, does it cause Winter cough. This pattern has Lung-Dryness/Stomach-Dampness complexity. Only Qianjin Maimendong Tang and Qianjin Wuweizi Tang grasp the secret. Ignorants think mixing astringent/dispersing, dry/moist is wrong, discarding them, missing the meaning of separating Wind-Dryness. Yu failed to understand internal Damp-lagging/external Dry-injuring, claiming *Neijing* omitted "Late Summer injury by Dampness," confusing Autumn-Dryness with Dampness, missing *Neijing* subtlety. (*Shanghan Xiyi*)
Treating Wind-Dryness best by nourishing Blood; treating Dryness-Heat best by strengthening Water. There is also Cold-Dryness: although presenting with constipation/hard stool, actually due to extreme Yin-Cold, like warm water freezing into cracked ice in mid-winter. Banliu Wan in ancient formulas has profound intent. (Feng Chuzhan)
Strengthening Water to control Fire, Clearing Metal to moisten Dryness, is common knowledge; Tonifying Spleen to generate Lung, Nourishing Mother to benefit Child, is unknown. My teacher treats Dryness using Erdong (Tiandong/Maidong) and Erdi (Shengdi/Huadi) as sovereign, adding Yam, etc., always effective. (Fang Xingyan)
Moistening Dryness: Yuzhu, Maidong, Shashen are best; Di, Gui cannot match. (*Sanqiu Bingji*)
Treating Dryness disease: Tonify Kidney Water Yin-Cold deficiency, Drain Heart Fire Yang-Heat excess, Remove severe intestinal Dryness-Heat, Aid Stomach fluid decline, ensure pathways open not knotted, fluids generated not withered, Qi/Blood smooth not astringent, then disease heals. ○ Autumn Dryness misdiagnosed as Dampness is reckless. Past ignorance excusable; present knowing violation harms many. Mirror of Sin reflects, regret too late. ○ Treating Dryness: Dry in Qi treating Blood, Dry in Blood treating Qi, Dry in Exterior treating Interior, Dry in Interior treating Exterior. Mismatched medicine is doctor's fault. ○ Treating miscellaneous diseases with Dryness signs: Misusing Dry herbs worsens Dryness, causing danger, is doctor's sin. ○ Treating Dryness: Distinguish Liver/Lung signs. Liver signs, treating Lung is okay; Lung signs, treating Liver is mistake, doctor's sin. ○ Treating Dryness: Not understanding Dryness principles, merely using moistening agents, though not severely harmful, wastes time, qualifies as crude artisan, must beware. (*Yimen Falv*)
Pulse Diagnosis
Dryness has many internal/external signs, incompletely listed, but pulses are consistently Micro, Fine, Astringent, Small, occasionally Deficient, Large, Rapid, Hurried, Floating, Knotted. Observe carefully: heavy pressing reveals no pulse that is not Astringent, Fine, or Micro. Thus, all Dryness patterns belong to One Qi of Lung-Metal, not exceeding Lung-Metal Pulse. (Zhang Luyu)
Selected Cases