《经》曰∶诸燥枯涸，干劲（凡物之干燥者，必硬劲。）皴揭，（皴，裂也。揭，掀起也。凡物
干者，其皮必皴裂而掀起。）皆属于燥。燥为肺金之化，秋令也。所以致燥有二∶一因于
寒，秋风清肃，夏令之湿，至是而干，所谓风胜湿也；一因于热，夏时热盛，有湿
以润之，至秋则湿退而热犹未除故燥，所谓燥万物者莫 乎火也。其因于热者
固热矣，即因于寒者亦未始非热。何则？秋令降敛，阳气内入，寒气外束，故每当
秋凉，多觉口鼻气热，是其理也。此言天时之致燥也。若或亡血亡津，肾虚火盛，
致此多端，则又属于人事矣。在外则皮肤皴揭枯涩，在上则鼻咽焦干，在下则二便
涸涩，在手足则痿弱无力，（血不荣筋所致。）在脉则涩滞虚衰。治以甘寒润剂，清肺以滋
水源，庶几血充液满，泽及百骸，滋燥养荣汤、大补地黄丸、清凉饮子、导滞通幽
汤、润肠丸、（二方见大便不通。）八正散，（见淋。）皆可随证选用也。《内经》每云秋伤于湿，
盖运气之说，以立秋、处暑、白露三气属湿土也，毕竟伤燥者多。
（温疟 风温 温毒 湿温）
温，春阳之气也，时至春而阳气发动。人应之，身中之阳气亦发动，一遇风寒
外袭，闭其腠理，此气不得升发，即郁而为热，与冬月伤风寒发热无异。而有恶寒
不恶寒之分者，以冬时阳气潜藏，表阳虚，故怯寒；春月阳气升发，表阳盛，故不
怯寒也。无汗者当发散，然冬月阳微，可用辛温，春月阳盛，宜用辛凉。仲景麻黄
汤止为冬月伤寒立法，不可混施于此证也。《经》谓∶冬伤于寒，春必病温。又谓∶
冬不藏精，春必病温。又谓∶凡病伤寒而成热者，先夏至为病温，后夏至为病暑。
程郊倩谓∶冬伤于寒，寒字当肾字看。盖肾水属冬，其气寒，故古人往往言肾为寒，
如言肝为风，言脾为湿之类，细阅前代医书自见。冬伤寒云云，谓耗伤肾水，阴精
泄而不藏，阴虚则火炎，至春阳气发动，炎炎之势不可遏止，一为风寒所郁，故温
热病生耳。然岂特不藏精者乃然哉？即在平人，当春阳气升发，感受风寒郁而成病
者固多。《金鉴》谓能藏精者其病轻，不藏精者其病重，韪矣。或曰∶《经》言
温疟，谓得之冬中风寒，气藏骨髓中，至春则气大发，（寒郁火成热，因春阳而发
为温疟也，即先夏至为病温之意。）邪不能自出，（句上当有若字。）因遇暑气，脑髓
灼，肌肉消，（言热至骨。）腠理开发，（此五句，言若春时邪犹不能发，至夏乃
发也，即后夏至为病暑意。）或有所用力，邪气与
汗皆出，此病藏于肾，先后内出于外也。如是者，阴虚而阳盛，盛则热矣，衰
（热气衰也）则气复返入，入则阳虚，虚则寒矣。（阳气发泄太过，则表虚而怯寒，表怯寒则气敛而内返，
气内返则表愈虚，故寒也。）明是言冬时触寒，子何敢程说耶？曰∶《礼记》谓∶言
非一端，而各有当。各求其当可也。风温即春温之重者。仲景曰∶太阳病，发热而
渴，不恶寒者，（在冬月伤寒，则为阳明经证。）为热病。（春月感冒，邪在太阳，即得此证，不俟传至
阳明乃见，故知为春温病也。）发汗已，（发汗则热泄，应愈矣。）身灼热者，名风温。（热盛得发表之剂，其
势益扬，如风之煽火，愈加炽盛也。）风温为病，脉阴阳俱浮，自汗出，（风温原本有汗，由内热炽盛蒸
发之故，较春温内热不甚而无汗者为重矣。）身重，（壮热伤气，无气以动，故重。）多眠睡，鼻息必鼾，
（热壅神昏也）语言难出。（气伤懒言。）若被下者，小便不利，（亡阴泉竭。）直视，（精不荣于目也。）失
溲。（阴不守于内也。）若被火者，微发黄色，（火上加火，热湿欲发黄，而热多湿少，故微黄也。）剧则如
惊痫，（热极生风。）时螈 。（筋为热灼，干缩而抽搐也。）若火熏之，一逆尚引日，再逆促命
期。大抵风温忌汗，亦不宜下，（里热未实者不宜。）尤不宜火，当用双解散去麻黄，加桂
枝、石膏。（余谓桂枝不必加。）春温无汗虽宜解表，然必兼清里，双解散，审其表里之重
轻为加减可也。（双解散乃防风通圣散合六一散也，《金鉴》称其神效，加减用之可也。）此方虽内犯
芒硝、大黄，然泄热莫速于此，且分两有限，不至太下，无伤也。前人云∶温
热证误下不妨，误汗则殆。硝黄，可用则用之，可不用则去之，是在临证斟酌耳。
风温汗太多脉虚者，桂枝汤（见伤湿）合人参白虎汤。（见发热。）温病兼暑证，名温毒，治法
不出上条。湿温即温病挟湿者，其证∶身重、胸满、多汗、两胫冷，白虎汤加苍术、
茯苓。
《黄帝内经》说：各种干燥、枯槁、干硬、皮肤皴裂掀起的症状，都属于燥邪。燥是肺金的化生之气，对应秋季的时令。导致燥邪的原因有两个：一是因于寒，秋风清肃，夏季的湿气到了这时变得干燥，这就是所谓“风胜湿”；二是因于热，夏季时热气旺盛，有湿气滋润它，到了秋天湿气消退而热气仍未去除，所以产生燥，这就是所谓“没有比火更能使万物干燥的了”。那些因于热的，固然是热了，即使是因于寒的，也未尝不是热。为什么呢？因为秋季时令主降敛，阳气内入体内，寒气外束体表，所以当每当秋凉时，人们多觉得口鼻呼出的气热，就是这个道理。这是讲天时导致的燥。如果是因为失血、亡津液，或者肾虚火旺，导致出现多种情况，那就属于人事因素了。表现在外部则是皮肤皴裂、枯涩，在上部则是鼻咽焦干，在下部则是大小便干枯涩滞，在四肢则是痿弱无力（这是由于血液不能濡养筋脉所致），在脉象上则是涩滞、虚衰。治疗用甘寒滋润的药剂，清肺以滋生源水，这样才可能使血液充盈、津液满溢，润泽全身百骸，可选用滋燥养荣汤、大补地黄丸、清凉饮子、导滞通幽汤、润肠丸（这两个方剂见大便不通章节）、八正散（见淋证章节），都可以随证选用。《内经》常常说“秋伤于湿”，这是运气学说的观点，认为立秋、处暑、白露这三个节气属湿土，但终究伤于燥的情况更多。
（温疟 风温 温毒 湿温）
温，是春季阳气的表现，时间到了春天，阳气发动。人顺应这种变化，体内的阳气也随之发动，一旦遇到风寒外袭，闭塞腠理，这股阳气就不能升发，于是郁结而为热，这与冬季感受风寒发热没有不同。但有恶寒和不恶寒的区别，是因为冬季阳气潜藏，表阳虚，所以怕冷；春季阳气升发，表阳盛，所以不怕冷。无汗的应当发散，然而冬季阳气微弱，可用辛温药，春季阳气旺盛，宜用辛凉药。张仲景的麻黄汤只为冬季伤寒立法，不可混淆施用于此证。《内经》说：“冬伤于寒，春必病温。”又说：“冬不藏精，春必病温。”还说：“凡是患伤寒而变成热的，先夏至的为病温，后夏至的为病暑。”程郊倩说：“冬伤于寒”中的“寒”字应当看作“肾”字。因为肾水属冬，其气寒，所以古人往往说肾为寒，就像说肝为风，说脾为湿一样，细读前代医书自然可见。“冬伤寒云云”，是指耗伤肾水，阴精泄出而不藏，阴虚则火炎，到了春季阳气发动，炎炎之势不可遏制，一旦为风寒所郁遏，所以温热病就产生了。然而难道只有不藏精的人才会这样吗？即使在普通人中，当春季阳气升发，感受风寒郁结而成病的也很多。《医宗金鉴》说能藏精的人病轻，不藏精的人病重，这是正确的。有人说：《内经》言及温疟，说是冬天中风寒，气藏在骨髓中，到了春天则气大发（寒郁火成热，因春阳而发为温疟，即先夏至为病温的意思），邪气不能自行排出（句首应有“若”字），如果遇到暑气，脑髓被灼烧，肌肉消瘦（指热至骨），腠理开发（这五句是说如果在春季邪气尚不能发作，到了夏季才发作，即后夏至为病暑的意思），或者有所用力，邪气与汗一起出来，这病藏在肾，先后从内出于外。像这样的情况，阴虚而阳盛，盛则热；衰（热气衰退）则气复返入体内，入则阳虚，虚则寒。（阳气发泄太过，则表虚而怯寒，表怯寒则气收敛而内返，气内返则表更虚，所以寒。）明明白白说的是冬季触寒，你怎么敢指责程郊倩的说法呢？回答说：《礼记》说：话不是只有一种解释，而各有其恰当之处。各自寻求其恰当的解释就可以了。风温就是春温的重症。张仲景说：太阳病，发热而渴，不恶寒的（在冬季伤寒，则为阳明经证），称为热病（春季感冒，邪在太阳，即刻得到此证，不必等到传至阳明才出现，所以知道是春温病）。发汗之后（发汗则热泄，应该痊愈了），身体灼热的，名为风温（热盛得到发表之剂，其势更加扬起，如风煽火，愈加炽盛）。风温为病，脉阴阳俱浮，自汗出（风温原本有汗，由内热炽盛蒸发之故，较春温内热不甚而无汗者为重矣），身重（壮热伤气，无气以动，所以身重），多眠睡，鼻息必鼾（热壅神昏），语言难出（气伤懒言）。如果被误用下法，小便不利（亡阴泉竭），直视（精不荣于目），失溲（阴不守于内）。如果被误用火疗，轻微的发黄（火上加火，热湿欲发黄，而热多湿少，所以微黄），严重的则像惊痫（热极生风），时时抽搐（筋为热灼，干缩而抽搐）。如果用火熏蒸，一次误治还能拖延时日，再次误治则加速死亡。大体上风温忌用汗法，也不宜用下法（里热未实者不宜），尤其不宜用火，应当用双解散去掉麻黄，加桂枝、石膏（我认为桂枝不必加）。春温无汗虽然适宜解表，但必须兼清里热，双解散，审察其表里轻重进行加减即可（双解散乃防风通圣散合六一散，《医宗金鉴》称其神效，加减使用即可）。此方虽然内含芒硝、大黄，但泄热没有比这更快的，而且分量有限，不至于太下，没有伤害。前人说：温热证误下不妨碍，误汗则危险。硝黄，可用则用，可不用则去掉，这在于临证斟酌罢了。风温汗太多脉虚的，用桂枝汤（见伤湿章节）合人参白虎汤（见发热章节）。温病兼暑证，名为温毒，治法不出上述条文范围。湿温即温病挟湿者，其证候：身重、胸满、多汗、两胫冷，用白虎汤加苍术、茯苓。
The *Classic* states: All conditions of dryness, withering, drying up, stiffness, and skin cracking or peeling belong to Dryness. Dryness is the transformation of Lung Metal, corresponding to the Autumn season. There are two causes for Dryness: one is due to Cold; the clear and austere winds of autumn cause the dampness of summer to become dry at this time, which is what is meant by "Wind overcomes Dampness"; the other is due to Heat; during summer, heat is abundant and moisture moistens it, but in autumn, when the moisture recedes while the heat remains, Dryness results, which is what is meant by "Nothing dries things more than Fire." Those caused by Heat are indeed Heat, but even those caused by Cold are not necessarily not Heat. Why? Because the Autumn season governs descending and gathering, Yang Qi enters inwardly, and Cold Qi binds externally. Therefore, whenever it becomes cool in autumn, people often feel that the breath from their mouth and nose is hot; this is the principle. This refers to Dryness caused by celestial timing. If, however, it is due to loss of blood or body fluids, or Kidney deficiency with flourishing Fire, leading to various manifestations, then these belong to human factors. Externally, there is skin cracking, withering, and roughness; superiorly, there is scorching dryness of the nose and throat; inferiorly, there is dryness and obstruction of urination and defecation; in the limbs, there is flaccidity and weakness (caused by Blood failing to nourish the sinews); in the pulse, there is choppy, deficient, and declining quality. Treatment employs sweet and cold moistening agents to clear the Lungs and nourish the source of water, so that Blood may be sufficient and fluids full, moistening the entire body. Zaozao Yangrong Tang (Moisturizing Dryness and Nourishing Blood Decoction), Da Bu Dihuang Wan (Great Tonification of Rehmannia Pill), Qingliang Yinzi (Cooling and Refreshing Infusion), Daozhi Tongyou Tang (Guiding Stasis and Opening the Secluded Decoction), Run Chang Wan (Moistening Intestines Pill) [see Constipation], and Bazheng San (Eight Corrective Powder) [see Strangury] can all be selected according to the syndrome. The *Inner Classic* often says "Autumn injury by Dampness," which is a theory of Six Qi transformations, attributing Damp Earth to the three periods of Start of Autumn, End of Heat, and White Dew; nevertheless, injuries by Dryness are more common.
(Warm Malaria, Wind-Warmth, Warm-Toxicity, Damp-Warmth)
Warmth is the Qi of Spring Yang. When spring arrives, Yang Qi activates. Humans respond to this, and the Yang Qi within the body also activates. Once exposed to external invasion by Wind-Cold, which closes the Cou Li (pores and interstices), this Qi cannot ascend and diffuse, thus stagnating and transforming into Heat. This is no different from fever caused by Wind-Cold injury in winter. However, there is a distinction between aversion to cold and lack thereof. In winter, Yang Qi hides, causing exterior Yang deficiency, hence fear of cold; in spring, Yang Qi ascends and diffuses, causing exterior Yang abundance, hence no fear of cold. For cases without sweating, dispersal is indicated. However, in winter, when Yang is weak, acrid-warm herbs may be used; in spring, when Yang is abundant, acrid-cool herbs are appropriate. Zhang Zhongjing's Mahuang Tang (Ephedra Decoction) was established only for Winter Cold Damage and should not be indiscriminately applied to this syndrome. The *Classic* states: "Injury by Cold in winter leads to Warmth diseases in spring." It also states: "Failure to store essence in winter leads to Warmth diseases in spring." Furthermore: "For all Cold Damage illnesses that transform into Heat, those occurring before the Summer Solstice are Warmth diseases, and those after are Summer-Heat diseases." Cheng Jiaoqian stated that in "Winter injury by Cold," the character "Cold" should be interpreted as "Kidney." Since Kidney Water belongs to Winter and its nature is Cold, ancient physicians often referred to the Kidney as Cold, just as they referred to the Liver as Wind and the Spleen as Dampness; careful reading of past medical texts will reveal this. "Winter injury by Cold..." refers to the consumption of Kidney Water, where Yin Essence leaks out and fails to store. Yin deficiency leads to Fire flaming upward. When Spring Yang activates, its blazing momentum is unstoppable. Once constrained by Wind-Cold, Warm-Heat diseases arise. But does this happen only to those who fail to store essence? Even in healthy individuals, when Spring Yang ascends, many contract diseases due to Wind-Cold constraint. The *Jin Jian* (Golden Mirror of Medicine) states that those who can store essence have mild disease, while those who cannot have severe disease; this is correct. Some say: The *Classic* mentions Warm Malaria, stating it arises from Wind-Cold in winter, with Qi hiding in the bone marrow. By spring, Qi erupts greatly (Cold constrained transforms into Fire/Heat, which emerges as Warm Malaria due to Spring Yang, meaning Warmth disease before the Summer Solstice). The pathogen cannot exit on its own (the sentence likely implies "if"), and upon encountering Summer-Heat, the brain marrow is scorched, muscles waste away (indicating heat reaching the bones), and Cou Li open (these five sentences indicate that if the pathogen cannot erupt in spring, it erupts in summer, meaning Summer-Heat disease after the Summer Solstice). Or, through exertion, the pathogen exits with sweat. This disease hides in the Kidney, emerging from inside to outside sequentially. In such cases, Yin is deficient and Yang is abundant; abundance brings Heat; decline (of Heat) causes Qi to return inward; inward return makes Yang deficient; deficiency brings Cold. (Excessive emission of Yang Qi leads to exterior deficiency and fear of cold; exterior fear of cold causes Qi to contract and return inward; inward return makes the exterior even more deficient, hence Cold.) Clearly, this speaks of touching Cold in winter. How dare you criticize Cheng's interpretation? I reply: The *Book of Rites* states that words do not have only one meaning, but each has its appropriate context. Seek the appropriate meaning for each. Wind-Warmth is the severe form of Spring-Warmth. Zhang Zhongjing said: Taiyang disease with fever, thirst, and no aversion to cold (in winter Cold Damage, this is a Yangming Channel syndrome) is called Heat Disease (in spring cold damage, the pathogen is in the Taiyang channel, presenting this syndrome immediately, without needing to transmit to Yangming, thus identifying it as Spring-Warmth). After sweating (sweating dissipates heat, recovery should follow), if the body feels burning hot, it is named Wind-Warmth (severe heat, treated with releasing exterior agents, intensifies like wind fanning fire). Wind-Warmth presents with floating pulses at both cun and chi positions, spontaneous sweating (Wind-Warmth originally has sweating due to intense interior heat evaporating fluids, which is heavier than Spring-Warmth with less interior heat and no sweating), heaviness of the body (high fever damages Qi, lacking Qi to move causes heaviness), excessive sleepiness, snoring nasal breathing (heat congestion confuses the spirit), and difficulty speaking (Qi damage causes reluctance to speak). If purgatives are misapplied, there is difficult urination (loss of Yin, depletion of the source), fixed staring (essence fails to nourish the eyes), and urinary incontinence (Yin fails to guard internally). If fire therapy is misapplied, slight jaundice appears (fire upon fire, heat-dampness desires to cause jaundice, but heat exceeds dampness, hence slight yellowing); severely, it resembles convulsive epilepsy (extreme heat generates wind), with occasional clonic spasms (sinews scorched by heat, drying and contracting). If fumigated with fire, one error prolongs the illness, a second error hastens death. Generally, Wind-Warmth contraindicates sweating, is unsuitable for purging (if interior heat is not solid), and especially contraindicates fire therapy. Shuangjie San (Double Resolution Powder) minus Mahuang (Ephedra), plus Guizhi (Cinnamon Twig) and Shigao (Gypsum) should be used (I believe Guizhi need not be added). For Spring-Warmth without sweating, although resolving the exterior is suitable, clearing the interior must also be combined. Shuangjie San allows for modifications based on the severity of exterior vs. interior patterns (Shuangjie San is a combination of Fangfeng Tongsheng San and Liuyi San; the *Jin Jian* calls it miraculous, and it can be used with modifications). Although this formula contains Xiaoshi (Mirabilite) and Dahuang (Rhubarb), nothing clears heat faster, and the dosages are limited, preventing excessive purgation without harm. Ancients said: Misapplying purgatives in Warm-Heat syndromes is tolerable, but misapplying sweating is dangerous. Use Xiaoshi and Dahuang if indicated, remove them if not; this depends on clinical judgment. For Wind-Warmth with excessive sweating and a deficient pulse, use Guizhi Tang (Cinnamon Twig Decoction) combined with Renshen Baihu Tang (Ginseng White Tiger Decoction). Warmth disease complicated by Summer-Heat is named Warm-Toxicity; treatment follows the above principles. Damp-Warmth is Warmth disease complicated by Dampness. Its symptoms include: heaviness of the body, chest fullness, excessive sweating, and coldness in both calves. Baizhu Tang (White Tiger Decoction) plus Cangzhu (Atractylodes Rhizome) and Fuling (Poria) is used.