脉
燥脉涩而紧，或浮而弦，或芤而虚。
证
经云∶诸涩枯涸，干劲皴揭，皆属于燥。故燥气在里，耗其津液，则大便秘结，消渴生焉，血脉
枯而气亦滞也。或过食辛辣浓味之物而助火邪，伏于血中，耗散真阴，津液亏少，燥结有时。或风
燥于表，钟于皮肤，皮毛燥涩，干疥爪枯，劲强紧急，口噤善伸数
欠。或时恶寒，筋惕而搐，涎溢胸膈，燥烁螈 ，昏冒僵仆，皆由
阴血衰少，不能制火，火炽克金，金受邪则不能平木，以致肝气独盛，风邪内生，而成此疾矣。
治
治之之法，以辛润之，以苦泄之。因虚者，滋阴养血，因火
者，泻火软坚；因风者，消风散结。此三者，乃治燥证之大法也。
方
四物汤 治燥气在里，津液枯涸，便闭消渴等症。
当归（一钱五分） 白芍药（一钱） 川芎（八分） 生地黄（二钱） 加桃仁（二钱） 大黄（煨，二钱）
上锉一剂，水煎温服。
通幽汤 治燥热内甚，血液俱耗，以致大便闭结。
当归（一钱五分） 熟地黄（二钱） 升麻（八分） 红花（一钱） 甘草（一钱） 桃仁泥（二钱）
上锉一剂，水煎，调槟榔末一钱下。
脉
浮而洪数为虚火，沉而实大为实火。洪数见于左寸为心火；见于右寸为肺火；见于左关为肝火；见于
右关为脾火。两尺为肾与命门之火，男子两尺洪大者，必主遗精，阴火盛也。病热有火者可
治，洪大是也。无火者难治，沉细是也。
证
君火者，心火也。可以湿伏，可以水灭，可以直折。惟黄连之属，可以制之。相火者，龙火也，不可以水
湿折之，当从其性而伏之。惟黄柏之属，可以降之。泻火之法，岂止此哉。虚实多端，
不可不察。以脏气目之，如黄连泻心火，黄芩泻肺火，芍药泻脾火，石膏泻胃火，柴胡泻肝火，知母泻肾火，
此皆苦寒之味，能泻有
余之火。若饮食劳倦，内伤元气，火不两立，为阳虚之病，以甘温之剂除之，如黄 、人参、甘草之属。若
阴微阳强，相火炽盛，以乘阴位，为血虚之病，以甘寒之剂降之，如当归、地黄之属。
若心火亢极，郁热内实，为阳强之病，以咸冷之剂折之，如大黄、朴硝之属。若肾水受伤，真阴失守，为
无根之火，为阴虚之病，以壮水之剂制之，如生地黄、玄参之属。若右肾命门火衰，为阳
脱之病，以温热之剂济之，如附子、干姜之属。若胃虚过食冷物，抑遇阳气于脾土，为火郁之病，以升散之
剂发之，如升麻、干葛、柴胡、防风之属。不明诸此类，而求火之为病，施治何所据根据。
故于诸经集略其说，以备方之用，庶免实实虚虚之祸也。
治
火热之病，黄连为主。五脏皆有火，平则治，病则乱。方书有君火、相火、龙火、邪火之论，其实一气
而已。故丹溪云∶凡气有余便是火。分为一类。凡治本病略炒以从邪，实火以朴硝汤，假火
酒，虚火醋，痰火姜汁，俱浸透炒。气滞火以茱萸，食积泄以黄土，血疾 瘕痛以干漆，俱以水拌同炒。去
茱萸黄土干漆，下焦伏火，以盐水浸透焙。目疾以人乳浸蒸。
方
凉膈散 治诸般郁热，退六经实火。
连翘（一钱） 黄芩（一钱） 山栀子（一钱） 薄荷（八分） 大黄（一钱五分） 甘草
（八分） 芒硝（一钱） 加桔梗（八分）
上锉，水煎，入蜜一盏同服。咽喉痛，倍桔梗、加荆芥。酒毒，加黄连、干葛，名清心汤。用白蜜、竹
叶同煎。咳而呕，加半夏、生姜。衄血、呕血，加当归、赤芍药、生地黄。小便淋沥，加木通、滑石。茯
苓。风眩，加防风、川芎、石膏。斑疹，加干葛、荆芥、川芎、赤芍药、防风、桔梗。咳嗽，加桑白
皮、杏仁、桔梗、苏子。阳毒发斑，加青黛、当归。结胸心下满，加桔梗、枳壳。谵语发狂，逾墙赴井，皆
阳热极盛，加黄连、黄柏、赤芍药。眼生翳，赤涩流泪，加菊花、木贼、生地黄。
黄连解毒汤 治心火暴盛，以此汤直折之。
黄连 黄芩 黄柏 山栀仁（俱不炒）
上锉一剂，水煎服。以此四味为丸，名栀子金花丸。实者，可用硝黄、冰水正治。或君火转甚者，须用
姜汁，或酒制炒用，则火自伏。此寒因热用之法也。
清火汤（云林制） 治五脏六腑及上、中、下三焦火热。
连翘（一钱） 栀子（一钱，炒） 玄明粉（一钱，如无，以硝代之） 黄芩（一钱，酒
炒） 黄连（一钱。酒炒） 桔梗（一钱二分） 玄参（一钱二分） 薄荷（八分） 羌活（酒洗，
八分） 防风（六分） 贝母（一钱） 独活（酒洗，八分） 前胡（八分） 柴胡（八分） 天
花粉（一钱） 茯苓（一钱） 川芎（八分） 枳壳（一钱） 甘草（三分） 大黄（酒蒸，二钱）
酒毒加白粉葛（一钱）
既济解毒丸 治诸经客热及心肾二火炽焰。
黄连（去毛） 黄芩（去梗） 黄柏（去皮） 山栀（去壳） 知母（去毛） 连翘（去壳）
玄参（去老根） 柴胡（去毛，各等分）
上为末，炼蜜丸如桐子大，每服灯心汤下百丸。
黑金丹（云菜弟传）〔批〕（按上方皆治实热之剂，其余火证，各求之本门） 治上
焦邪热，咽喉肿痛，及牙齿疼痛，伤寒误补，大潮大热，声哑不
出，胸膈作痛。鼻衄吐红，痰壅火盛，癫狂谵语，一切实热之症。
黄连 黄芩 黄柏 山栀子 连翘 石膏 泽泻 赤芍药 大
黄枳壳 薄荷 牡丹皮 玄参 桔梗 防风 赤茯苓 荆芥（各等分）
上大合一剂，水八碗，煎七碗去渣，入芒硝一斤于内，化开，澄去泥水，将药入锅内，煎至干，须慢火
铲起，入新罐内，上用新灯盏一个盖住，入水于盏内，火 ，候干水三盏为度。取出放地上
去火毒，研为细末，入甘草末五分，搅匀，每服二钱，茶清送下。
Pulse
The pulse in dryness pathogenesis is choppy and tight, or floating and wiry, or hollow and deficient.
Symptoms
The *Huangdi Neijing* states: "All cases of choppy pulses, withering and drying, stiffness and scaling, belong to dryness." Therefore, when dryness qi resides internally, it consumes body fluids, leading to constipation and xiaoke (wasting-thirst syndrome characterized by polydipsia, polyphagia, polyuria, and emaciation). The blood vessels become withered and qi stagnation occurs. If one overconsumes pungent, spicy, and rich foods, aiding fire evil, the fire may lurk within the blood, dissipating true yin and causing a deficiency of body fluids, resulting in occasional dryness and accumulation. Alternatively, wind-dryness attacks the exterior, accumulating in the skin, causing dryness and roughness of the skin and hair, dry tinea, withered nails, stiff and tense sinews, lockjaw with frequent stretching and yawning. Sometimes accompanied by aversion to cold, muscle twitching and convulsions, salivary overflow in the chest and diaphragm, dryness scorching leading to spasms, coma, and sudden collapse. All these arise from a deficiency of yin-blood failing to control fire; the blazing fire conquers Metal (Lung), and as Metal is pathogenic, it fails to subdue Wood (Liver), leading to excessive Liver qi and endogenous wind, thus forming this disease.
Treatment
The method of treatment involves moistening with acrid substances and purging with bitter substances. For cases due to deficiency, nourish yin and tonify blood; for cases due to fire, purge fire and soften hardness; for cases due to wind, dispel wind and resolve nodules. These three are the general principles for treating dryness syndromes.
Formulas
Siwu Tang (Four Substances Decoction) treats dryness qi residing internally, withering of body fluids, constipation, and xiaoke symptoms.
Danggui (Radix Angelicae Sinensis) 1.5 qian, Baishaoyao (Radix Paeoniae Alba) 1 qian, Chuanxiong (Rhizoma Chuanxiong) 0.8 qian, Shengdihuang (Radix Rehmanniae Recens) 2 qian, add Taoren (Semen Persicae) 2 qian, Dahuang (Radix et Rhizoma Rhei) (roasted) 2 qian.
Chop the above into one dose, decoct with water, and take warm.
Tongyou Tang (Unblocking the Secretion Decoction) treats severe internal dryness-heat, consumption of blood, leading to constipation.
Danggui (Radix Angelicae Sinensis) 1.5 qian, Shudihuang (Radix Rehmanniae Preparata) 2 qian, Shengma (Rhizoma Cimicifugae) 0.8 qian, Honghua (Flos Carthami) 1 qian, Gancao (Radix Glycyrrhizae) 1 qian, Taoren paste (Semen Persicae) 2 qian.
Chop the above into one dose, decoct with water, and administer with 1 qian of Binglang powder (Arecae Semen).
Pulse
Floating, surging, and rapid pulses indicate deficient fire; deep, full, and large pulses indicate excess fire. A surging and rapid pulse at the left Cun position indicates Heart fire; at the right Cun position, Lung fire; at the left Guan position, Liver fire; at the right Guan position, Spleen fire. The two Chi positions indicate Kidney and Mingmen (Gate of Life) fire. In men, a surging and large pulse at both Chi positions necessarily indicates spermatorrhea due to vigorous yin-fire. Febrile diseases with fire are treatable, such as those presenting with surging and large pulses. Diseases without fire are difficult to treat, such as those presenting with deep and thin pulses.
Symptoms
Jun Fire (Monarch Fire) is Heart fire. It can be subdued by dampness, extinguished by water, or directly broken down. Only herbs like Huanglian (Coptidis Rhizoma) can control it. Xiang Fire (Minister Fire) is Dragon Fire. It cannot be broken down by water and dampness; rather, its nature should be followed to subdue it. Only herbs like Huangbai (Phellodendri Cortex) can descend it. Are there not other methods to purge fire? Deficiency and excess present in many forms and must be carefully examined. Considering organ qi: Huanglian purges Heart fire, Huangqin (Scutellariae Radix) purges Lung fire, Shaoyao purges Spleen fire, Shigao (Gypsum Fibrosum) purges Stomach fire, Chaihu (Bupleuri Radix) purges Liver fire, Zhimu (Anemarrhenae Rhizoma) purges Kidney fire. These are all bitter-cold substances capable of purging surplus fire. If diet and fatigue injure primordial qi, and fire opposes righteousness, constituting a yang-deficiency disease, use sweet-warm agents to eliminate it, such as Huangqi (Astragali Radix), Renshen (Ginseng Radix), and Gancao. If yin is weak and yang is strong, with minister fire blazing and invading yin positions, constituting a blood-deficiency disease, use sweet-cold agents to descend it, such as Danggui and Dihuang. If Heart fire is extremely hyperactive with stagnant heat internally solid, constituting a yang-excess disease, use salty-cold agents to break it down, such as Dahuang and Puxiao (Natrii Sulfas). If Kidney water is injured and true yin is lost, constituting rootless fire and a yin-deficiency disease, use agents to strengthen water (nourish yin) to control it, such as Shengdihuang and Xuanshen (Scrophulariae Radix). If Right Kidney Mingmen fire declines, constituting a yang-collapse disease, use warm-hot agents to assist it, such as Fuzi (Aconiti Lateralis Radix Preparata) and Ganjiang (Zingiberis Rhizoma). If Stomach deficiency leads to overconsumption of cold foods, suppressing yang qi in Spleen earth, constituting a fire-stagnation disease, use ascending-dispersing agents to vent it, such as Shengma, Gange (Puerariae Radix), Chaihu, and Fangfeng (Saposhnikoviae Radix). Without understanding these categories, how can one investigate fire pathogenesis and base treatment on what grounds?
Therefore, I have collected brief theories from various meridians to prepare for formula application, thereby avoiding the disaster of "reinforcing excess and depleting deficiency."
Treatment
For fire-heat diseases, Huanglian is the principal herb. The five zang organs all possess fire; when balanced, they govern properly; when diseased, they cause chaos. Medical texts discuss Jun Fire, Xiang Fire, Dragon Fire, and Evil Fire, but essentially, it is only one qi. Thus, Danxi stated: "Any excess of qi is fire." They are categorized together. When treating the root disease, slight stir-frying is used to accommodate the evil nature: excess fire is stir-fried after soaking in Puxiao solution; false fire in wine; deficient fire in vinegar; phlegm-fire in ginger juice. Qi-stagnation fire is stir-fried with Zhuyu (Evodiae Fructus); food-stagnation diarrhea with yellow earth; blood disorders and mass pain with Ganqi (Dryobalanops aromatica resin). All are stir-fried with water mixing. After removing Zhuyu, yellow earth, and Ganqi, lower-jiao lurking fire is soaked in salt water and baked. Eye disorders are steamed after soaking in human milk.
Formulas
Liangge San (Cooling the Diaphragm Powder) treats various types of stagnant heat and clears excess fire of the six meridians.
Lianqiao (Forsythiae Fructus) 1 qian, Huangqin 1 qian, Shanzhizi (Gardeniae Fructus) 1 qian, Bohe (Menthae Haplocalycis Herba) 0.8 qian, Dahuang 1.5 qian, Gancao 0.8 qian, Mangxiao (Natrii Sulfas) 1 qian, add Jiegeng (Platycodonis Radix) 0.8 qian.
Chop the above, decoct with water, and take with one liang of honey. For sore throat, double Jiegeng and add Jingjie (Schizonepetae Spica). For alcohol toxicity, add Huanglian and Gange, named Qingxin Tang (Clear Heart Decoction). Decoct with white honey and Zhuye (Phyllostachys Viridis Folium). For cough with vomiting, add Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens). For epistaxis and hematemesis, add Danggui, Chishaoyao (Paeoniae Radix Rubra), and Shengdihuang. For dysuria, add Mutong (Akebiae Caulis), Huashi (Talcum), and Fuling (Poria). For wind-induced vertigo, add Fangfeng, Chuanxiong, and Shigao. For macules and papules, add Gange, Jingjie, Chuanxiong, Chishaoyao, Fangfeng, and Jiegeng. For cough, add Sangbaipi (Mori Cortex), Xingren (Armeniacae Semen Amarum), Jiegeng, and Suzi (Perillae Fructus). For yang-toxin macules, add Qingdai (Indigo Naturalis) and Danggui. For chest binding and fullness below the heart, add Jiegeng and Zhike (Aurantii Fructus). For delirium and mania, climbing walls and jumping into wells (indicating extreme yang-heat), add Huanglian, Huangbai, and Chishaoyao. For eye nebula, redness, dryness, and tearing, add Juhua (Chrysanthemi Flos), Muze (Equiseti Herba), and Shengdihuang.
Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) treats violent Heart fire, using this decoction to directly break it down.
Huanglian, Huangqin, Huangbai, Shanzhiren (Gardeniae Semen) (none stir-fried).
Chop the above into one dose, decoct with water, and take. Making pills from these four ingredients is named Zhizi Jinhua Wan (Gardenia Golden Flower Pill). For excess patterns, Xiao (Natrii Sulfas) and Huang (Rhei Radix et Rhizoma) with ice water can be used for direct treatment. If Monarch Fire becomes more severe, ginger juice or wine-processed stir-frying must be used, so that fire naturally subdues. This is the method of using cold for heat.
Qinghuo Tang (Fire-Clearing Decoction, Yunlin Formula) treats fire-heat in the five zang and six fu organs, and the upper, middle, and lower jiao.
Lianqiao 1 qian, Zhizi (Gardeniae Fructus) 1 qian (stir-fried), Xuanmingfen (Mirabilite) 1 qian (if unavailable, substitute Mangxiao), Huangqin 1 qian (wine-stir-fried), Huanglian 1 qian (wine-stir-fried), Jiegeng 1.2 qian, Xuanshen 1.2 qian, Bohe 0.8 qian, Qianghuo (Notopterygii Rhizoma et Radix) (wine-washed) 0.8 qian, Fangfeng 0.6 qian, Beimu (Fritillariae Bulbus) 1 qian, Duohuo (Angelicae Pubescentis Radix) (wine-washed) 0.8 qian, Qianhu (Peucedani Radix) 0.8 qian, Chaihu 0.8 qian, Tianhuafen (Trichosanthis Radix) 1 qian, Fuling 1 qian, Chuanxiong 0.8 qian, Zhike 1 qian, Gancao 0.3 qian, Dahuang (wine-steamed) 2 qian.
For alcohol toxicity, add Baifen Ge (Puerariae Radix) 1 qian.
Jiji Jiedu Wan (Jiji Detoxifying Pill) treats guest heat in various meridians and blazing Heart and Kidney fires.
Huanglian (remove hairs), Huangqin (remove stems), Huangbai (remove bark), Shanzhi (remove shells), Zhimu (remove hairs), Lianqiao (remove shells), Xuanshen (remove old roots), Chaihu (remove hairs), equal parts.
Grind into powder, refine honey into pills the size of paulownia seeds. Take 100 pills per dose with Dengxin Cao (Junci Medullae) decoction.
Heijin Dan (Black Gold Pill, transmitted by Yun Caidi) [Commentary: The above formulas all treat excess heat; for other fire syndromes, refer to their respective sections.] Treats upper-jiao evil heat, sore throat and swelling, toothache, mistaken tonification in Shanghan (Cold Damage) leading to massive heat and fever, hoarseness or loss of voice, chest and diaphragm pain. Epistaxis and hematemesis, phlegm obstruction and vigorous fire, epilepsy, delirium, and all excess heat syndromes.
Huanglian, Huangqin, Huangbai, Shanzhizi, Lianqiao, Shigao, Zexie (Alismatis Rhizoma), Chishaoyao, Dahuang, Zhike, Bohe, Mudanpi (Moutan Cortex), Xuanshen, Jiegeng, Fangfeng, Chifuling (Poria with Red Host), Jingjie (equal parts).
Combine into one dose, add eight bowls of water, decoct to seven bowls, strain, add one jin of Mangxiao inside, dissolve, clarify to remove muddy water, pour the medicinal liquid back into the pot, decoct until dry over slow fire, scraping up slowly. Place in a new jar, cover with a new lamp cup, add water to the cup, apply fire until the water in the cup dries up (amounting to three cups of water evaporated). Remove and place on the ground to eliminate fire toxicity. Grind into fine powder, add 0.5 qian of Gancao powder, mix evenly. Take 2 qian per dose, delivered with clear tea.