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Note: The formulas and theories of autumn dryness discussed previously refer to the "rebound qi" (compensatory reaction) and "superficial qi" (manifestation) of dryness. Since dryness belongs to Metal in the Five Elements, and Metal overcomes Wood, while Wood's son is Shaoyang Ministerial Fire, when Fire qi rebounds, symptoms of dry-heat and dryness appear. Furthermore, the *Ling Shu* states that Bing-Ding days correspond to the Two Yangs Combining for Brightness in the hand (Yangming Meridian), and Chen-Si hours correspond to the Two Yangs Combining for Brightness in the foot (Yangming Meridian). Yangming's root qi is Dryness, and its superficial qi is Yang. Predecessors stated that Dryness transforms into Fire; the classics say "beneath Dryness Metal, Fire qi supports it," which refers to this phenomenon. Examining ancient medical texts, there are no specific discussions on diseases of autumn dryness. Since modern times, only Yu Jiayan began to supplement the theory of Dryness Qi, using sweet, moistening, and slightly cold herbs in his formulas; Ye Tianshi also had the theory that Dryness transforms into Fire, using pungent-cool and sweet-moistening herbs in his formulas. This aligns with the method in the *Su Wen*: "When Dryness transformation occurs due to Heaven, Heat may counter-vanquish it; treat with Pungent-Cool, assist with Bitter-Sweet." I, Wu Tang, have followed the precedents of predecessors, thus only narrating the rebound qi of Dryness syndromes as before. Although this book is completed, I privately reflect that it does not fully accord with the *Su Wen*'s discussion on "Excess of Dryness," so in the miscellaneous essays section, I specifically added a treatise on Dryness, detailing proper transformation, opposite transformation, vanquishing qi, and rebound qi to supplement this. Regarding the manifestation of Dryness disease's vanquishing qi in the Triple Burner, specific formulas were not provided, making this an incomplete work, leaving my mind uneasy. Later, I obtained Shen Munan's *Yi Zheng* Treatise on Warm Diseases, which contains an essay on Autumn Dryness with thorough and upright arguments. I adopted and recorded it hereafter, clarifying and distinguishing any partial or imperfect points, and specifically supplemented the treatment methods for the vanquishing qi of Dryness syndromes as follows. Furthermore, regarding the principles of vanquishing and rebound, proper and opposite transformations, and following the root or superficial aspect, few have sought deep understanding since modern times, and commentators have not investigated much. For instance, in Zhang Zhongjing's *Shang Han Lun*, Mahuang Tang and Guizhi Tang, along with Ganjiang and Fuzi formulas, treat the vanquishing qi of Cold, the proper transformation of Cold, and the root disease of Cold. Baihu Tang and Chengqi Tang treat the rebound qi of Cold, the opposite transformation of Cold, and the superficial disease of Cold. The other five Qi can be inferred from this. (Taiyang's root qi is Cold, superficial qi is Heat, opposite transformation is Fire; generally, Water excess must overcome Fire. Thus, the classics state that when Taiyang governs the year, Heart diseases are frequent. It concludes: The disease originates in the Heart; when Heart Fire is diseased, it must overcome Metal. Baihu Tang saves Metal. When Metal is diseased, it becomes hard and rigid, obstructed and unflowing; the rebound qi is Earth, whose nature is obstruction, counter-overcoming the true Water of itself. Chengqi Tang drains Metal and Earth to save Water. Additionally, the classics say: "For excess Cold, use Salty to drain." Commentators throughout history merely explained the text literally, failing to thoroughly explain the rationale behind the formula usage. This treatise cannot annotate all of *Shang Han Lun*; I briefly cite one end as an example for the rest. Those with clarity, obtaining this key and studying the *Nei Jing* thoroughly, will naturally solve problems easily; understanding *Shang Han Lun* makes understanding this treatise easy. By extension, this applies to all Six Qi.)

Shen Munan in *Zao Bing Lun* says: The *Tian Yuan Ji Da Lun* states: "Heaven uses Six as the rhythm, Earth uses Five as the system." Generally, Six refers to Wind, Cold, Summer-Heat, Dampness, Dryness, and Fire as rhythms; Five refers to Wood, Fire, Earth, Metal, and Water as systems. However, Heaven's Qi governs externally, with one Qi governing for over sixty days; Earth's movement governs internally, with one Yun governing for over seventy-two days. Thus, the combination of Five Yun and Six Qi completes a year, which is the unchangeable way of nature. The *Nei Jing* lost the phrases "Summer-Heat season injured by Dampness, Autumn injured by Dryness," causing Dryness syndromes to be obscured and unclear to this day. Although ancient sages mentioned it, they referred to internal injuries causing dryness of fluids and blood, not external contraction of cool-dry seasonal Qi. However, Dryness Qi arises after the Autumn Equinox and before Minor Snow, when Yangming Dryness Metal Cool Qi commands. The classics say: "Victory of Yangming, Clearness erupts within, left hypochondriac pain, loose stools, internal throat obstruction, external hernia. Great Cool desiccation, flowers and leaves change appearance, hair-bearing creatures suffer. Chest discomfort, throat obstruction and cough." Based on this scripture, the Dryness command must involve Cool Qi affecting humans, causing Liver Wood to be invaded and transform into Dryness. Only in modern times did Yu Jiayan openly propose this, bringing fortune to future generations; unfortunately, he called "all Qi stagnation, all flaccidity, wheezing, vomiting, persistent cough with white blood death" as Dryness disease, which speaks of internal injury, indeed unrelated to external Dryness syndromes. He further created Qingzao Jiufei Tang, using yin-nourishing and cool-clearing herbs, suitable for Fire scorching Metal and Lung Qi受热. If treating Dryness disease, using Cool to treat Cool will surely worsen the condition. Little do they know that Dryness disease belongs to Cool, termed Secondary Cold, similar to contracting Cold. The classics say for excess Cold, treat with Sweet-Hot; here for excess Dryness, level with Bitter-Warm. This involves external use of Bitter-Warm and Pungent-Warm to release the exterior, differing from winter cold treated with Mahuang, Guizhi, Ganjiang, Fuzi, though the principle of harmonizing middle and attacking interior remains the same, hence no formula was listed. Generally, the *Nei Jing* divides Six Qi into Yin-Yang for main treatment: Wind, Heat, Fire three Qi belong to Yang and are treated similarly, differing only in herbs being Pungent-Cool, Bitter-Cold, or Salty-Cold; Dampness, Dryness, Cold three Qi belong to Yin and are treated similarly, differing only in herbs being Bitter-Hot, Bitter-Warm, or Sweet-Hot. Zhang Zhongjing established Shanghan and Wenbing two treatises as the outline. The *Xingli Daquan* states Dryness belongs to Secondary Cold, but later scholars all say it belongs to Heat, a vast discrepancy. In midsummer heat steaming, the body sweats, muscles are moist, not dry; in winter cold condensation and desiccation, the body is dry and brittle. Thus, in late autumn when Dryness Qi acts, human Lung Metal responds, skin becomes dry, because Fire command lacks power, so Dryness belongs to Cool; predecessors saying it is Heat is incorrect.

Regarding Mr. Shen's argument, it shows unique insight, not submerged by vulgar trends. His criticism of Yu's Dryness supplementation using Sweet-Cold yin-nourishing herbs, missing the method "for excess Dryness, level with Bitter-Warm," is very reasonable. But stating that "all Qi stagnation, flaccidity, wheezing, vomiting, persistent cough with white blood" are entirely internal injuries is theoretically incomplete. While many such syndromes result from internal injury, many others arise from residual pathogenic factors in collaterals from external contraction, transforming into heat. Previously, under Wind-Warm cough sections, I refuted Xingsu San and supplemented Sangju Yin, extensively discussing how prolonged cough retains pathogens leading to damage, which shares the same logic as this syndrome. Saying Qingzao Jiufei Tang treats the rebound qi of Dryness, definitely not the vanquishing qi of Dryness, Yu has no grounds to argue; saying it is completely unrelated to Dryness is discussing from one side only. Essentially, Yu's Qingzao Jiufei Tang is the latter half of Fumai Tang in *Shang Han Lun*. Shanghan necessarily involves the dryness of the mother organ, so initially using Pungent-Warm Sweet-Hot, then Pungent-Cool Bitter-Cold, finally Sweet-Moist, following the progression of Qi transformation. As for Zhang Zhongjing establishing Shanghan and Wenbing as two outlines, like the *Su Wen* says "Cold and Summer-Heat enter six times, Summer-Heat unifies Wind and Fire, Cold unifies Dryness and Dampness," encompassing all external contractions, this view is particularly incomplete, likely due to excessive reverence for Zhang Zhongjing. If so, Zhongjing's book should be named Treatise on Six Qi or External Contractions, why solely name it Treatise on Cold Damage! Zhongjing wrote originally for Cold Damage, not comprehensively covering external contractions; his discussions on Warm, Summer-Heat, and Dampness were occasional mentions. Even Mr. Shen supplemented *Yi Zheng* Warm Disease Treatise; if it were a complete work, why supplement again! I am not arguing for the sake of arguing, fearing students will be confused, reverting to elders too much, mixing all external contractions into *Shang Han Lun*, a major flaw since modern times. How dare I stand such a theory amidst such dangers!

1. Autumn Dryness Qi, light is Dryness, heavy is Cold, transformed qi is Dampness, rebound qi is Fire.
This reveals the outline of Dryness Qi, including its mother-son qi and vanquishing-rebound qi, making Dryness Qi clear. Heavy becoming Cold is because Cold Water is the son of Dryness Metal; transformed qi becoming Dampness is because Earth generates Metal, Wet Earth is its mother qi. *Zhi Zhen Yao Da Lun* says: Yangming and Jueyin do not follow root/superficial, but follow the middle. Also: Following root means transformation born from root; following root/superficial means transformation of root/superficial; following middle means transformation by middle qi. According to above Yangming, Dryness Qi governs, middle sees Taiyin. Thus, this treatise initially did not elaborate on Dryness Metal root qi formulas, but attached malaria and hernia syndromes under Cold-Damp sections. Ye Tianshi's medical cases mention latent Summer-Heat erupting internally, new Cool externally, often seen in latent Summer-Heat stroke-like syndromes; Zhang Zhongjing's *Jin Gui*, often seen in abdominal pain and malaria-hernia sections.

2. Dryness injuring the root organ, slight head pain, aversion to cold, cough with thin phlegm, nasal congestion, throat obstruction, wiry pulse, no sweat, Xingsu San governs.
Root organ refers to Lung and Stomach. The classics explicitly mention throat obstruction and cough, so Upper Jiao diseases start here. Dryness injures skin and hair, hence slight head pain and aversion to cold; slight pain differs from severe pain in Shanghan. Yangming meridian ascends to head corners, hence head pain. Cough with thin phlegm occurs because Lung dislikes Cold, ancients called Dryness Small Cold; Lung constrained by Dryness Qi cannot regulate water passages, so Cold-fluid stagnates causing cough. Nasal congestion because nose is Lung orifice. Throat cold because throat is Lung connection. Wiry pulse indicates Cold combined with fluid retention. No sweat indicates Cool confronting skin and hair. Xingsu San is one grade lighter than Xiao Qinglong Tang. This section should be read together with several phlegm-fluid sections supplemented in Lower Jiao chapter. Also, Xingsu San is a general formula used by contemporaries for wind-cold coughs in four seasons, already refuted in this treatise's Wind-Warm section; for coughs injured by Dryness-Cool, treating with Bitter-Warm assisted by Sweet-Pungent is appropriate. For coughs with severe Cold and fluid retention, Qinglong Tang is used; for spring wind injury or Dryness transformed into Fire without phlegm, follow Sangju Yin or Sangxing Tang examples.

Xingsu San Formula
Suyu, Banxia, Fuling, Qianhu, Ku Jiegeng, Zhike, Gancao, Shengjiang, Dazao (pitted), Jupi, Xingren
[Modifications] No sweat, wiry or tight pulse, add Qianghuo to induce slight sweating. Cough persists after sweating, remove Suyu, Qianghuo, add Sugeng. With diarrhea and abdominal fullness, add Cangzhu, Houpo. Headache with supraorbital pain, add Baizhi. Severe heat add Huangqin, not used with diarrhea/abdominal fullness.
[Formula Analysis] This is Bitter-Warm Sweet-Pungent method. External contraction of Dryness-Cool, so use light Pungent-Warm Suyu, Qianhu to reach exterior; no sweat tight pulse, so add heavy Pungent-Warm Qianghuo to induce slight sweating. Gan, Jiegeng open from above, Zhike, Xingren, Qian, Qin descend from below, thus throat/nasal obstruction clears and cough stops. Jiegeng, Banxia, Fuling drain fluid and tonify Lung-Stomach Yang. Replacing Baizhu with Baizhi because Baizhu is Middle Jiao Spleen herb, Baizhi is Lung-Stomach meridian herb, and warms muscle/reaches skin. Jiang, Zao harmonize Ying and Wei. If exterior Cool recedes but interior pathogen remains, cough persists, remove exterior-reaching Suyu, add interior-descending Sugeng. Diarrhea/abdominal fullness is excessive Metal interior syndrome, so remove bitter-cold Huangqin, add bitter-pungent-warm Baizhu, Houpo.

3. Injury by Dryness, resembling Shanghan Taiyang syndrome, with sweat, no cough, no vomiting, no pain, Guizhi Tang harmonizes slightly.
Resembling Shanghan Taiyang syndrome refers to headache, body ache, aversion to wind-cold. With sweat, do not induce sweating again, similar to Shanghan rules, but Dryness is lighter than Cold, so give Guizhi Tang slightly to harmonize.

Guizhi Tang Formula (see previous)

4. Dryness Metal commanding, headache, alternating chills and fever, chest/hypochondriac pain, even hernia/mass pain, Guizhi Chaihu Ge Ban Tang plus Wuzhuyu, Lianzi, Huixiang, Muxiang Tang governs.
This is Metal overcoming Wood. Root disease and Metal disease appear together, exterior-interior simultaneously diseased, so use Chaihu to reach Shaoyang Qi, i.e., Liver Wood Qi, combined with Guizhi to exit Taiyang, adding aromatic pain-calming, bitter-warm descending agents. Dampness, Dryness, Cold are all Yin pathogens, so still follow Foot meridian examples.

Guizhi Chaihu Ge Ban Tang plus Wuzhuyu, Lianzi, Huixiang, Muxiang Tang Formula (Treat with Bitter-Warm, assist with Sweet-Pungent)
Guizhi, Wuzhuyu, Huangqin, Chaihu, Renshen, Guangmuxiang, Shengjiang, Baishao, Dazao (pitted), Chuanlianzi, Xiaohuixiang, Banxia, Zhigancao

5. Dryness invading Middle Jiao, short and choppy pulse, no exterior syndrome, no interior excess syndrome, chest pain, abdominal/hypochondriac distending pain, or vomiting, or diarrhea, Bitter-Warm Sweet-Pungent to harmonize.
Although Dryness invades Middle Jiao, lacking exterior-interior syndromes, do not mistakenly sweat or purge, but harmonizing with Bitter-Warm Sweet-Pungent suffices. Short-choppy pulse: Long is Wood, Short is Metal, Slippery is Moist, Choppy is Dry. Chest pain is Liver meridian passing through chest. Abdominal pain is Metal overcoming Wood, Wood disease overcoming Earth. Hypochondriac pain is Liver Wood's original position. Vomiting is also Metal overcoming Wood disease. Diarrhea is above Yangming, Dryness Qi governs, middle sees Taiyin. "Or" is indefinite; some have pain with vomiting/diarrhea, some vomiting only, some diarrhea only, some pain only. Disease nature is fixed, disease trend is variable, so only provide method not formula, students adjust according to syndrome. Herbs Bitter-Warm Sweet-Pungent: Classics say for excess Dryness, treat with Bitter-Warm, assist with Sweet-Pungent, drain with Bitter. Bitter-Warm transforms via Fire to overcome Metal, Sweet-Pungent transforms via Yang to overcome Yin. Draining with Bitter is because Metal nature is hard/rigid, forming clumps, deep-seated firmness requires purging. Next section discusses purging syndromes.

6. Yangming Dryness syndrome, interior excess and firm, not yet transformed into Heat, purge with Bitter-Warm; already transformed into Heat, purge with Bitter-Cold.
Yangming Dryness interior excess firm/full, classics generally say purge with Bitter, drain with Bitter. Modern practitioners mostly use Bitter-Cold purging. Not knowing this syndrome distinguishes transformed/untransformed, using Warm-Purge and Cold-Purge methods according to syndrome is accurate. Untransformed pulse remains short/choppy, choppy implies tight, face green-yellow. Bitter-Warm purge method: e.g., *Jin Gui* Dahuang Fuzi Xixin Tang, new Fang Tian Tai Wuyao San (see Lower Jiao Cold-Damp section) plus Radix Crotonis seed powder. Transformed pulse rapid/firm, face red, tongue yellow, cross-reference other syndromes. Bitter-Cold purge method: e.g., Three Chengqi formulas, Xiao Chengqi without Mangxiao, light Dahuang or wine-fried, heavy Zhike/Houpo, slightly warm.

[Attached Treatment Cases] In Bingchen year, I treated a幕友 (secretary) named Che from Shanyin, age 55, hair/beard mostly white. Firm mass like plate left of umbilicus, dull slight pain, no bowel movement for dozens of days. Initially treated by surgeons, who purged with Dachengqi Tang three-four times, still blocked. Consulted me, palpated firm/cold like stone, face green-yellow, pulse short/choppy/slow. Initially could eat, after repeated purging, refused porridge, no bowel movement for 49 days. I said: This syndrome is knotting of Metal Qi. Liver originally depressed, contracted Autumn Metal Dryness, minor pathogen entered interior, long-term knotting, harder over time, requires purging, but Cold-Purge is not the treatment. Use Tian Tai Wuyao San 2 qian, add Radix Crotonis seed powder 1 fen, mix with Ginger Decoction. Wait for Sanfu period, if not passed, second dose add 1.5 fen; if still not, third dose add 2 fen. After three doses, passed 49 black shiny balls, extremely hard. Then regulated with Bitter-Warm Sweet-Pungent method, gradually ate. Another 15 days no bowel movement, purged again as before, passed on second dose, 15 black shiny balls, also firm but breakable, just extreme dryness. Externally fried Sichuan Pepper in Sesame Oil, applied to firm area; internally took Bitter-Warm aromatic collateral-penetrating herbs, resolved in over a month. From this case, we see how Dryness Metal Qi harms people, and Warm-Purge/Cold-Purge methods must not be confused.

In Yichou year, treated Tong Tingwei, chronic hernia unresolved. Age 68. Previously when Tong served outside, every hernia attack, doctors used Renshen, thus retaining pathogen in collaterals, never healing. In late summer of Yichou, caught cold, relapsed, firm knot at anus, unable to sit/lie, unbearable distending pain, sweating like rain, no bowel movement for 7 days. I said: Hernia is originally Cold pathogen, all firm knots belong to Metal image, especially now critical situation, requires Warm-Purge. Used Tian Tai Wuyao San 1 qian, Radix Crotonis seed powder approx 1 fen. Passed after three doses, pain settled. Regulated with Wo Liuhuang Wan, combined with *Jin Gui* Zhizhu San, gradually resolved. Above two cases are Lower Jiao syndromes, illustrating Yangming firm knot purging method, included by association.

7. Dryness Qi extending to Lower Jiao, contending in Blood division, forming masses, regardless of gender, Huazheng Huisheng Dan governs.
Major pathogen affecting exterior Dryness syndrome, triggered by infection, truly as Mr. Munan said, same method as Shanghan, students judge severity. Previous supplemented sections, except two reducing Shanghan differentiation steps, one chest/hypochondriac/abdominal pain section slightly different from Shanghan, others all accompanied by hernia/masses, because classics have explicit text "excess Dryness, men hernia, women lower abdominal pain." Hernia/masses seen in Cold-Damp section, malaria/diarrhea/vomiting in Cold-Damp/Warm-Damp sections, this specifically supplements minor pathogen entering interior, deeply invading Lower Jiao Blood division, firm knotting unresolving chronic disease. If not knowing collaterals disease requires slow unblocking method, or recklessly using urgent attack, must violate warning of mass dispersing into gu. This gu is Blood Gu, more common in women, extremely serious difficult-to-treat syndrome, students must prevent. Huazheng Huisheng Dan method: Dryness inside, treat with Bitter-Warm, assist with Sweet-Pungent, drain with Bitter. Formula derived from *Jin Gui* Biejia Jian Wan and Huisheng Dan. This formula uses Renshen, Guizhi, Jiaojiao, Shengjiang to pass-tonify Yang Qi, Baishao, Shudi to guard-tonify Yin Fluid, Yimuao Paste to pass-tonify Yin Qi and drain water Qi, Biejia Jiao to pass-tonify Liver Qi and resolve masses, remaining herbs aromatic entering collaterals to transform turbidity. Moreover, blood-eating insects, flying ones traverse Qi division in collaterals, walking ones traverse Blood division in collaterals, penetrating every micro, breaking every firmness. Vinegar-boiled Dahuang three times, concentrates on disease site, sparing other organs, long-standing firm knots require this. Some complain too many herbs, not knowing medication way: single/few herbs strong/fast; many/herbs weak/slow. Ancient slow-resolution formulas are all like this, "disciplined army fears not numbers, undisciplined army chaotic even with few." This formula combines vinegar and honey totaling 36 ingredients, achieving number 49, Metal generation number.

Huazheng Huisheng Dan Formula
Renshen (6 liang), Annan Guizhi (2 liang), Liangtoujian (2 liang), Shexiang (2 liang), Pianzi Jianghuang (2 liang), Gong Dingxiang (3 liang), Chuanjiao Tan (2 liang), Mengchong (2 liang), Jingsanleng (2 liang), Puhuang Tan (1 liang), Zanghonghua (2 liang), Sumu (3 liang)