2，从“六经为百病立法”的角度来看，阳明病有虚证，更不足为怪了。因六经联系着五脏六腑，阳明内络届胃肠，外维系肢节，故胃肠肢节的病变，即为阳明病之实质，并非是除掉胃肠肢节之实体，还另有独立存在的阳明病。同时，六经分证本是《伤寒杂病论》的辨证论治方法，并不仅仅是《伤寒论》的辨证论治方法，虽“六经辨证用于外感，脏腑辨证用于杂病”的论点曾为许多中医所接受，但是否仲景本意，实很难说明。柯琴说：“仲景伤寒已兼六气，六经主病已赅杂证，非专指伤寒立言。”历来共此观点者，亦素不乏人，笔者曾将《金匮》中的一些杂病，如呕吐等，按六经归纳了其方证，亦均发现阳明病有虚实二证，此可参阅“伤寒论六经与呕吐方证的探讨”(见《辽宁中医杂志》1981年第1期)等文。
3·单就外感所致的阳明病来说，也有虚实二证，《温病条辨》中焦篇，对此论述颇详。如腑证，吴鞠通说：“温病之不大便，不出热结液干二者之外。”因此，他对邪盛之证，宗法仲景，主用承气，所以攻下其实；对正虚之证，仿效叶氏，“则用增液，所以迥护其虚。”因此，治外感所致的阳明病，辨证也要以虚实为纲，方不致误。后人认为外感之阳明病全是实证，没有虚证，这实在是一种误解。从《伤寒论》来看，对阳明病诸虚证之论述并不少，但有些人把“实则阳明，虚则太阴”这本是相对而说的二句话，理解为阳明病没有虚证，虚证都属于太阴，这是不正确的。
结语
1，根据以上分析，笔者认为：谓“胃的功能减弱或胃的阴液被邪热耗伤为主要临床表现”的虚证，如胃阴虚、胃阳虚诸证，只见于脏腑辨证中，而不存在于六经辨证内，从而提出：“就六经辨证来说，是实则阳明，就脏腑辨证来说，是实则未必阳明”的说法，实际上是不妥当的。
2·论阳明病诸虚证之文，《伤寒论》中很多，但治法后世有很大发展，因此，研究阳明病诸虚证之证治，尚须结合温热学派之著作，方才完善。但本文着重就《伤寒论》一书而言，故其他书中的内容论述从简。
清后，鞠通之学，影响日大，信奉者很多。其著《温病条辨》，近亦有人推其为中医四大经典之一，《吴鞠通医案》也颇受人重视。但此两书的论燥治燥，很值得商榷，现略作述评，以供参考。
鞠通认为：“秋燥之气，轻则为燥，重则为寒”，“燥气寒化，乃燥气之正。”所以他称“燥为小寒”，谓是“阴邪”。关于燥气之伤人，鞠通认为有大邪伤表与小邪中里两种形式，他说：“大邪中表之燥证，感而即发者，诚如沈目南先生所云，与伤寒同法。”《温病条辨》中，“伤燥，如伤寒太阳证，有汗、不咳、不呕、不痛者，桂枝汤小和之。”等条，即是这种治疗主张之体现。至于小邪中里，虽有深入下焦与血相搏、久伏下焦不与血搏以及直中伤阳等之不同，但概主以温法(治复气则否)，故治与血相搏之化症回生丹与治不与血搏之复亨丹等方，都是如此，《吴鞠通医案》中燥门诸案，亦莫不如此。如李四十六案，感受燥金之气为病，初诊即予刚燥温热，就是基于“燥为小寒”、“阴邪”之认识。五月初二，三诊时，虽云治燥此类药不宜久任，但转方取桂枝汤加减，药用桂枝、白芍各四钱，炙草、干姜各二钱，大枣二枚，生姜、广皮各三钱，半夏、生米仁，云苓块各五钱，仍不离乎温法。又如张女十五岁案；“燥金之气，直入中里，六脉全无，僵卧如死，四肢逆冷，已过肘膝，腿痛转筋，与通脉四逆汤加川椒、吴萸、公丁香一大剂，厥回脉出一昼夜，次日以食粥太早，复中宛如前证，脉复厥，体厥又死去矣，仍予前方，重加温热，一剂厥回其半，又两荆而复活，后以补阳收功。”对以上理论和治法，现述不同意见如次；
1·寒、燥各为六气之一气。六气中，寒与热对，指温度言；湿与燥对，指湿度言。湿度高并不等于热，燥气重亦不等于寒，故寒自为寒，燥自为燥，两气不能互混。鞠通不知别此，谓燥重为寒、(寒)轻为燥，这在理论上是错误的(鞠通论六气，常犯混二气为一气的错误，如谓暑系湿热二气所合成，亦一例，此已见驳于孟英，不复赘)。就上二案来说，李氏案如果说是寒之轻者，尚可称燥，则张氏案明是燥之重者，当称中寒，不当再称为中燥，既称中燥，又用大热药来治疗，这与寒轻为燥之说，便有矛盾之嫌。实际上，对寒燥两气，鞠通确实是混为一谈，概念模糊，分划不清的。所以他治足太阴寒湿，主以椒附白通汤，今治燥邪直中，主以通脉四逆汤加川椒、吴萸、公丁香，这二者在药法上实无甚区别。余谓就一般情况论，治寒须温热，治燥须柔润，如只温不润，实无涉于治燥。张氏一案以及中燥门其他但温不润的一些医案，与其说是治燥，到不如说是治寒，否则，已立中燥一门，似亦不必再另立寒门了。
2·燥的属阴属阳，医界争论不少，但以主阴说居多，鞠通也持这种观点，故若非治其复气，例用温热。余则谓阴阳学说是相对的，若论燥气之属性，应先问其前提如何。如所周知：六气分主四时，风为春季主气，春季气候温暖；燥为秋季主气，秋季气候凉爽，若基于这一前提上，以春秋之主气相对言，燥确是应该属阴的。但如果换一个前提，以燥与湿相对言，燥就应该属阳，所以燥字从火，湿字从水，水火相对，为阴阳之征兆，也是十分明显的。前人争燥气之属性，往往前提不统一，故都是各执一面谈理，鞠通之谓燥为阴邪，实际上也是如此。正因为阴阳属性的相对性原理，鞠通在论燥时未能顾到，所以他只是从胜气复气角度来谈燥气之凉温。然而，即如其所说，燥属阴邪、乃小寒，当以温热为治燥之正法，则秋燥就不应占九种温病之一格。既以秋燥为温病之一种、既云温邪伤人从上而下，寒邪伤人从下而上，出方就不应再用杏苏散治肺，凡此等等，略一思之，就可见其理论上之矛盾，可谓是不胜其多。
对燥与寒二气，鞠通在理性认识上是有错误的，所以在实践中混同一治。对燥与湿二气，鞠通在理性认识上知道二者是对立的，但在实践中仍然分划不清楚。他感到寒、湿、燥三气同属阴邪，很容易混淆，因此说：“盖以燥为寒之始，与寒相似，故(易)混入寒门。又阳明之上，燥气治之，中见太阴，而阳明从中，以中气为化，故又易混入湿门。但学医之士，必须眉目清楚，复《内经》之旧，而后中有定见，方不越乎规矩也。”这番话，他是在斥责前人“非将寒燥混入一门，即混入湿门”时说的，实际上他自己又何尝不是如此！鞠通既以此责前人，而我今仍以此责鞠通。
最明显的事实是：从《吴鞠通医案》中燥门诸案来分析，鞠通用的最多的是二种药：一是温热刚燥药，如吴萸、丁香、桂枝、附子、川椒、干姜、良姜、益智仁之类；二是淡渗芳化药，如茯苓、猪苓、半夏、陈皮、米仁、厚朴、苍术、泽泻之类。而禀柔润之性，具生津之功的治燥品，中燥门几无不用，这种药法，怎么能说是治燥呢？我们将这种药法和寒湿门的药法及《温病条辨》中治寒湿的药法略加比较，就可发觉：二者几乎是完全一致的。如中燥门传五十七案，感受燥金之气为病，药用云苓块、姜半夏、生苡仁各五钱，川椒炭，广皮各三钱，吴萸、良姜、益智仁各二钱，公丁香一钱，后连续数诊，或加佳枝、倍吴萸、良姜，或减川椒、吴萸、良姜，方药基本不变。其他如谢氏案、李氏案、余氏案等，药法大都类同。而寒湿门郭三十二案，病系太阴中湿，药用生姜一两，姜半夏六钱，桂枝、茯苓皮、生苡仁、茅术各五钱，厚朴四钱，川椒目、枳实、广皮、草果各三钱。其二诊用药，也大体如此。二二比观，治法可以说是如出一辙。正因为鞠通对湿燥分划不清，所以他将应属于寒湿门的治案都归入到了中燥门，以致寒湿门形同虚设(实际上寒湿门只有上述一案)，因此只好将痹证医案(本可另立一门)来顶充寒湿案。而从中燥门医案来看，治湿方药几乎替代了治燥方药，从这一事实来说，鞠通燥湿混淆不清，这一点是十分明显的。
又鞠通为治中燥吐泻而制之霹雳散，《温病条辨》及《吴鞠通医案》中两见之，此方“立方会萃温三阴经刚燥苦热之品”为之主，这种药法，也反映出鞠通对治燥湿药法异同认识之模糊。这一问题，诚如《医门法律》所云；“凡秋月燥病，误以为湿治之者，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。”显然，湿病误认作燥、燥病误作湿治，都是操刃之事，故吾人当注意分辨之。
又仲景治柔痉用枯萎桂枝汤，君以栝萎之生津润燥，后人治凉燥用桂枝杏仁汤，君以杏仁之微苦温润。就运用桂枝汤治燥证来说，这样子的化裁，很可宗法。但唯独鞠通用桂枝汤治燥，不加柔润之品，反加淡渗之药(如上案)，这样子加减，就治燥来说，是很不得法的，这也是燥湿混淆不清的一种表现。所以，中燥门的治案，就治燥来说，是不足以为训的。相反，如作为寒湿治案看，到可参考。
何廉臣说：“燥与火不同，火为实证，热盛阳亢，身热多汗，法宜苦寒夺其实而泻其热；燥为虚证，阴亏失润，肌肤叹燥，法宜甘寒养其阴而润其燥。”但鞠通治燥，独重攻实，他说：“阳明燥证，里实而坚，未以热化，下之以苦温。已从热化，下之以苦寒。”其自注云：“苦温下法，如《金匮》大黄附子汤，新方天台乌药散加巴豆霜之类。”“苦寒下法，如三承气汤之类。”《温病条辨》中附有其治燥之医案，如车姓案，前医用大承气下之不通，鞠通断为秋金燥气，小邪中里，认为证属寒燥，主以温下，药用天台乌药散加巴豆霜，先加一分，第二次加半分，第三次加二分，三服后始得便。后十五日又不大便，仍用上法治之。现对这种理法，略述不同意见如下：
1·阳明燥证不独要分寒热，而且应分虚实，不可因病在阳明，便谓均属实证。须知阳明燥证，津亏液涸，最多虚实相兼，虽实多虚少者亦有之，但在秋燥一证，究以虚多实少者为多，故凡热化而津液亏乏者，当重养阴生津，增水亦能行舟，若寒化而肠燥液枯者，当重润燥滑肠，润导亦能通便。若忽视甘寒增液、甘温润肠诸法，偏执峻攻，恣投苦燥刚剂，则决非治燥之正法。
2·老人便秘，以精血虚亏，肠燥液涸者居多，若非在外感热病过程中发生，当以杂病视之。鞠通根据“凡坚结牢固，皆属金象”的认识，认为是感受燥气而致，实系误会之言。因一，此证四季均可遇见，若不在秋季，与燥气何涉？二，寒湿门郭案是“寒湿为病，误用硝黄，致浊阴蟠踞，坚凝如石。”既如此，“凡坚结牢固，皆属金象”之说亦不攻而白破。所以治老人燥闭，总以五仁丸、半硫丸之类为正法。车姓案之听以暂效，是因不大便已四十九日，不能不“急则治标”，峻下后未至于脱，亦幸赖其体质之尚可。此案得便后若能以柔润滋养：继之，后当不致复结，结而再用峻攻，恐于正气不能无损。擅用巴豆、大黄，反复峻攻，决非治燥之良法。此诚如何廉臣云：“凡津液素亏者，胃肠本燥，大便每多秘结，适逢秋燥伤肺，气机不宣，则大便不通矣。若用承气猛攻，往往水泻洞泄，中气愈伤，津液益于，而燥屎不下，每致液涸动风，险证丛生。”吾人当注意之。巴豆攻下之力，较承气更为峻猛，老人燥闭，尤宜慎用。车姓案乃治实，非治燥，吾人治老人燥闭，不可以此为口实而轻投峻攻。
3·河间云，“热胜燥，燥自金生，热为火化，金余则制之以火，肺胜则制之以苦。"故治燥非不可用苦，但须知“苦能化燥"，故以苦治燥，唯属实者宜之。观喻昌之制清燥救肺汤，明知“知母能滋肾水，清肺金，亦以苦而不用。”燥病多虚，前人治燥，连性润之品尚谨慎如此，吾人于苦燥刚烈药岂可轻用。然观《温病条辨·补秋燥胜气论》后诸条及中燥门治案，柔润之品，几乎不用，苦燥刚烈，在所不忌，竟是治燥而忘燥！
4·就燥屎内结一证论，属实属虚均有之。而在秋燥一证。则每虚实相兼、有虚有实，实多虚少者固有之，虚多实少者亦不少，故临证必须细辨。就治疗方药论，诸如大黄附了细辛汤、巴豆霜以及承气汤之类，俱系治实而非治燥。大凡燥病，阴津必虚，即见侄闭，峻攻亦当慎用，且只可暂用，不可屡用，更不可独重攻下，竞只分寒热，不办虚实而恣用。须知因燥致结、虚多实少之便闭，所在皆有，若不以猪膏发煎，蜜煎导、济川煎等已效之成法为意，以峻攻治实偶效案视作为治燥之大法，即违背重津保阴之要旨。经云“以苦下之”，是治其实，实非治其燥。仲景云：小便利，大便粳，不可攻下，以脾约麻仁丸润之，，此正戒轻下而恐重伤津液之意也。
2. 从“六经为百病立法”的角度来看，阳明病有虚证，更不足为怪了。因为六经联系着五脏六腑，阳明内络属胃肠，外维系肢节，所以胃肠和肢节的病变，就是阳明病的实质，并不是说除去了胃肠肢节这些实体之外，还另外存在一个独立的阳明病。同时，六经分证本来是《伤寒杂病论》的辨证论治方法，并不仅仅是《伤寒论》的辨证论治方法。虽然“六经辨证用于外感，脏腑辨证用于杂病”的观点曾被许多中医所接受，但这是否是张仲景的本意，实在很难说明。柯琴说：“张仲景治疗伤寒已经兼及六气，六经主病已经包罗杂病，并非专门针对伤寒立论。”历来持有这种观点的人也不乏其人。笔者曾将《金匮要略》中的一些杂病，如呕吐等，按照六经归纳其方证，也都发现阳明病有虚实两种证型，这可以参考《辽宁中医杂志》1981年第1期发表的《伤寒论六经与呕吐方证的探讨》等文章。
3. 单就外感所致的阳明病来说，也有虚实两种证型，《温病条辨》中焦篇对此论述得很详细。例如腑证，吴鞠通说：“温病的大便不通，不出热结和液干这两种情况之外。”因此，对于邪气盛实的证候，他效法张仲景，主要使用承气汤类，以攻下其实邪；对于正气虚弱的证候，他仿效叶天士，“则使用增液汤，以回护其正气之虚。”因此，治疗外感所致的阳明病，辨证也要以虚实为纲领，才不会出错。后人认为外感引起的阳明病全是实证，没有虚证，这实在是一种误解。从《伤寒论》来看，对阳明病各种虚证的论述并不少，但有些人把“实则阳明，虚则太阴”这本是相对而说的两句话，理解为阳明病没有虚证，虚证都属于太阴，这是不正确的。
结语
1. 根据以上分析，笔者认为：所谓“胃的功能减弱或胃的阴液被邪热耗伤为主要临床表现”的虚证，如胃阴虚、胃阳虚等证型，只见于脏腑辨证中，而不存在于六经辨证内，从而提出：“就六经辨证来说，是实则阳明；就脏腑辨证来说，是实则未必阳明”的说法，实际上是不妥当的。
2. 论述阳明病各种虚证的文章，《伤寒论》中很多，但治疗方法在后世有了很大发展，因此，研究阳明病各种虚证的证治，还必须结合温热学派的著作，才能完善。但本文着重就《伤寒论》一书而言，所以其他书中的内容论述从简。
清代以后，吴鞠通的学说影响日益扩大，信奉者很多。他的著作《温病条辨》，近来也有人推崇其为中医四大经典之一，《吴鞠通医案》也颇受人重视。但是这两本书关于论燥治燥的内容，很值得商榷，现略作述评，以供参考。
吴鞠通认为：“秋燥之气，轻则为燥，重则为寒”，“燥气寒化，乃燥气之正。”所以他称“燥为小寒”，说是“阴邪”。关于燥气伤人，吴鞠通认为有大邪伤表与小邪中里两种形式，他说：“大邪中表之燥证，感而即发者，诚如沈目南先生所说，与伤寒同法。”《温病条辨》中，“伤燥，如伤寒太阳证，有汗、不咳、不呕、不痛者，桂枝汤小和之。”等条文，即是这种治疗主张的体现。至于小邪中里，虽有深入下焦与血相搏、久伏下焦不与血搏以及直中伤阳等不同情况，但概以温法为主（治疗复气则除外），所以治疗与血相搏的化症回生丹和治疗不与血搏的复亨丹等方剂，都是如此。《吴鞠通医案》中燥门诸案，也没有不是这样的。如李四十六案，感受燥金之气致病，初诊即用刚燥温热药，就是基于“燥为小寒”、“阴邪”的认识。五月初二，三诊时，虽说治燥此类药不宜久用，但转方取桂枝汤加减，药用桂枝、白芍各四钱，炙甘草、干姜各二钱，大枣二枚，生姜、广皮各三钱，半夏、生米仁、云苓块各五钱，仍不离乎温法。又如张女十五岁案：“燥金之气，直入中里，六脉全无，僵卧如死，四肢逆冷，已过肘膝，腿痛转筋，与通脉四逆汤加川椒、吴萸、公丁香一大剂，厥回脉出一昼夜，次日因吃粥太早，复发宛如前证，脉复厥，体厥又死去矣，仍予前方，重加温热，一剂厥回其半，又两剂而复活，后以补阳收功。”对以上理论和治法，现陈述不同意见如下：
1. 寒、燥各为六气之一气。六气中，寒与热相对，指温度而言；湿与燥相对，指湿度而言。湿度高并不等于热，燥气重亦不等于寒，所以寒自为寒，燥自为燥，两气不能互相混淆。吴鞠通不知道辨别这一点，说燥重为寒、（寒）轻为燥，这在理论上是错误的（吴鞠通论六气，常犯将二气混为一气的错误，如谓暑系湿热二气所合成，也是一例，这已被孟英驳斥，不再赘述）。就上二案来说，李氏案如果说是寒之轻者，尚可称为燥，则张氏案明是燥之重者，应当称为中寒，不应当再称为中燥，既然称为中燥，又用大热药来治疗，这与寒轻为燥之说，便有矛盾之嫌。实际上，对于寒燥两气，吴鞠通确实是混为一谈，概念模糊，划分不清的。所以他治疗足太阴寒湿，主以椒附白通汤，如今治疗燥邪直中，主以通脉四逆汤加川椒、吴萸、公丁香，这二者在药法上实在没有什么区别。我认为就一般情况而论，治寒须温热，治燥须柔润，如果只温不润，实在谈不上治燥。张氏一案以及中燥门其他但温不润的一些医案，与其说是治燥，倒不如说是治寒，否则，既然已立中燥一门，似乎也不必再另立寒门了。
2. 燥的属阴属阳，医界争论不少，但以主阴说居多，吴鞠通也持这种观点，所以若非治其复气，例用温热。我则认为阴阳学说是相对的，若论燥气的属性，应先问其前提如何。如所周知：六气分主四时，风为春季主气，春季气候温暖；燥为秋季主气，秋季气候凉爽，若基于这一前提上，以春秋之主气相对言，燥确实是应该属阴的。但是如果换一个前提，以燥与湿相对言，燥就应该属阳，所以燥字从火，湿字从水，水火相对，为阴阳之征兆，也是十分明显的。前人争燥气的属性，往往前提不统一，故都是各执一面谈理，吴鞠通之谓燥为阴邪，实际上也是如此。正因为阴阳属性的相对性原理，吴鞠通在论燥时未能顾及，所以他只是从胜气复气角度来谈燥气的凉温。然而，即使像他所说，燥属阴邪、乃小寒，当以温热为治燥之正法，则秋燥就不应占九种温病之一格。既以秋燥为温病的一种，既云温邪伤人从上而下，寒邪伤人从下而上，出方就不应再用杏苏散治肺，凡此等等，略一思之，就可见其理论上之矛盾，可谓是不胜其多。
对燥与寒二气，吴鞠通在理性认识上是有错误的，所以在实践中混同一治。对燥与湿二气，吴鞠通在理性认识上知道二者是对立的，但在实践中仍然划分不清楚。他感到寒、湿、燥三气同属阴邪，很容易混淆，因此说：“盖以燥为寒之始，与寒相似，故（易）混入寒门。又阳明之上，燥气治之，中见太阴，而阳明从中，以中气为化，故又易混入湿门。但学医之士，必须眉目清楚，复《内经》之旧，而后中有定见，方不越乎规矩也。”这番话，他是在斥责前人“非将寒燥混入一门，即混入湿门”时说的，实际上他自己又何尝不是如此！吴鞠通既以此责前人，而我今仍以此责吴鞠通。
最明显的事实是：从《吴鞠通医案》中燥门诸案来分析，吴鞠通用得最多的是二种药：一是温热刚燥药，如吴茱萸、丁香、桂枝、附子、川椒、干姜、良姜、益智仁之类；二是淡渗芳化药，如茯苓、猪苓、半夏、陈皮、米仁、厚朴、苍术、泽泻之类。而禀柔润之性，具生津之功的治燥品，中燥门几无不用，这种药法，怎么能说是治燥呢？我们将这种药法和寒湿门的药法及《温病条辨》中治寒湿的药法略加比较，就可发觉：二者几乎是完全一致的。如中燥门传五十七案，感受燥金之气致病，药用云苓块、姜半夏、生苡仁各五钱，川椒炭，广皮各三钱，吴茱萸、良姜、益智仁各二钱，公丁香一钱，后连续数诊，或加桂枝、倍吴茱萸、良姜，或减川椒、吴茱萸、良姜，方药基本不变。其他如谢氏案、李氏案、余氏案等，药法大都类同。而寒湿门郭三十二案，病系太阴中湿，药用生姜一两，姜半夏六钱，桂枝、茯苓皮、生苡仁、茅术各五钱，厚朴四钱，川椒目、枳实、广皮、草果各三钱。其二诊用药，也大体如此。二者相比，治法可以说是如出一辙。正因为吴鞠通对湿燥划分不清，所以他将应属于寒湿门的治案都归入到了中燥门，以致寒湿门形同虚设（实际上寒湿门只有上述一案），因此只好将痹证医案（本可另立一门）来顶充寒湿案。而从中燥门医案来看，治湿方药几乎替代了治燥方药，从这一事实来说，吴鞠通燥湿混淆不清，这一点是十分明显的。
又吴鞠通为治中燥吐泻而制的霹雳散，《温病条辨》及《吴鞠通医案》中两见之，此方“立方会萃温三阴经刚燥苦热之品”为之主，这种药法，也反映出吴鞠通对治燥湿药法异同认识之模糊。这一问题，诚如《医门法律》所云：“凡秋月燥病，误以为湿治之者，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。”显然，湿病误认作燥、燥病误作湿治，都是操刃之事，故吾人当注意分辨之。
又张仲景治柔痉用瓜蒌桂枝汤，君以栝楼之生津润燥，后人治凉燥用桂枝杏仁汤，君以杏仁之微苦温润。就运用桂枝汤治燥证来说，这样子的化裁，很可宗法。但唯独吴鞠通用桂枝汤治燥，不加柔润之品，反加淡渗之药（如上案），这样子加减，就治燥来说，是很不得法的，这也是燥湿混淆不清的一种表现。所以，中燥门的治案，就治燥来说，是不足以为训的。相反，如作为寒湿治案看，倒可参考。
何廉臣说：“燥与火不同，火为实证，热盛阳亢，身热多汗，法宜苦寒夺其实而泻其热；燥为虚证，阴亏失润，肌肤叹燥，法宜甘寒养其阴而润其燥。”但吴鞠通治燥，独重攻实，他说：“阳明燥证，里实而坚，未以热化，下之以苦温。已从热化，下之以苦寒。”其自注云：“苦温下法，如《金匮》大黄附子汤，新方天台乌药散加巴豆霜之类。”“苦寒下法，如三承气汤之类。”《温病条辨》中附有其治燥之医案，如车姓案，前医用大承气汤下之不通，吴鞠通断为秋金燥气，小邪中里，认为证属寒燥，主以温下，药用天台乌药散加巴豆霜，先加一分，第二次加半分，第三次加二分，三服后始得便。后十五日又不大便，仍用上法治之。现对这种理法，略述不同意见如下：
1. 阳明燥证不独要分寒热，而且应分虚实，不可因病在阳明，便谓均属实证。须知阳明燥证，津亏液涸，最多虚实相兼，虽实多虚少者亦有之，但在秋燥一证，究以虚多实少者为多，故凡热化而津液亏乏者，当重养阴生津，增水亦能行舟，若寒化而肠燥液枯者，当重润燥滑肠，润导亦能通便。若忽视甘寒增液、甘温润肠诸法，偏执峻攻，恣投苦燥刚剂，则决非治燥之正法。
2. 老人便秘，以精血虚亏，肠燥液涸者居多，若非在外感热病过程中发生，当以杂病视之。吴鞠通根据“凡坚结牢固，皆属金象”的认识，认为是感受燥气而致，实系误会之言。因为一，此证四季均可遇见，若不在秋季，与燥气何涉？二，寒湿门郭案是“寒湿为病，误用硝黄，致浊阴蟠踞，坚凝如石。”既如此，“凡坚结牢固，皆属金象”之说亦不攻而自破。所以治老人燥闭，总以五仁丸、半硫丸之类为正法。车姓案之所以暂效，是因不大便已四十九日，不能不“急则治标”，峻下后未至于脱，亦幸赖其体质之尚可。此案得便后若能以柔润滋养继之，后当不致复结，结而再用峻攻，恐于正气不能无损。擅用巴豆、大黄，反复峻攻，决非治燥之良法。此诚如何廉臣云：“凡津液素亏者，胃肠本燥，大便每多秘结，适逢秋燥伤肺，气机不宣，则大便不通矣。若用承气猛攻，往往水泻洞泄，中气愈伤，津液益损，而燥屎不下，每致液涸动风，险证丛生。”吾人当注意之。巴豆攻下之力，较承气更为峻猛，老人燥闭，尤宜慎用。车姓案乃治实，非治燥，吾人治老人燥闭，不可以此为口实而轻投峻攻。
3. 河间云，“热胜燥，燥自金生，热为火化，金余则制之以火，肺胜则制之以苦。”故治燥非不可用苦，但须知“苦能化燥”，故以苦治燥，唯属实者宜之。观喻昌之制清燥救肺汤，明知“知母能滋肾水，清肺金，亦以苦而不用。”燥病多虚，前人治燥，连性润之品尚谨慎如此，吾人于苦燥刚烈药岂可轻用。然观《温病条辨·补秋燥胜气论》后诸条及中燥门治案，柔润之品，几乎不用，苦燥刚烈，在所不忌，竟是治燥而忘燥！
4. 就燥屎内结一证论，属实属虚均有之。而在秋燥一证，则每虚实相兼、有虚有实，实多虚少者固有之，虚多实少者亦不少，故临证必须细辨。就治疗方药论，诸如大黄附子细辛汤、巴豆霜以及承气汤之类，俱系治实而非治燥。大凡燥病，阴津必虚，即见便闭，峻攻亦当慎用，且只可暂用，不可屡用，更不可独重攻下，竟只分寒热，不分虚实而恣用。须知因燥致结、虚多实少之便闭，所在皆有，若不以猪膏发煎、蜜煎导、济川煎等已效之成法为意，以峻攻治实偶效案视作为治燥之大法，即违背重津保阴之要旨。经云“以苦下之”，是治其实，实非治其燥。仲景云：小便利，大便硬，不可攻下，以脾约麻仁丸润之，此正戒轻下而恐重伤津液之意也。
2. From the perspective that "the Six Channels establish the principles for all diseases," it is even less surprising that Yangming disease has deficiency syndromes. This is because the Six Channels are connected to the Zang-Fu organs; internally, the Yangming channel connects to the stomach and intestines, and externally, it maintains the limbs and joints. Therefore, pathological changes in the stomach, intestines, limbs, and joints constitute the essence of Yangming disease; it does not mean that apart from the physical entities of the stomach, intestines, limbs, and joints, there exists an independent Yangming disease. Furthermore, the differentiation of the Six Channels was originally a method of syndrome differentiation and treatment in *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases), not merely in *Shanghan Lun* (Treatise on Cold Damage). Although the viewpoint that "Six Channel differentiation is used for exogenous diseases, while Zang-Fu differentiation is used for miscellaneous diseases" was accepted by many TCM practitioners, whether this was Zhang Zhongjing's original intent is difficult to ascertain. Ke Qin stated: "Zhang Zhongjing's treatment of cold damage already incorporates the Six Qi; the diseases governed by the Six Channels encompass miscellaneous diseases; it is not specifically formulated for cold damage." Those who have held this view throughout history are numerous. I once categorized some miscellaneous diseases in *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), such as vomiting, according to the Six Channels and their corresponding formulas and syndromes, and also found both excess and deficiency syndromes in Yangming disease. For details, refer to articles such as "Exploration of the Relationship between the Six Channels of Shanghan Lun and Formulas/Syndromes for Vomiting" published in the first issue of *Liaoning Journal of Traditional Chinese Medicine* in 1981.
3. Even considering only Yangming disease caused by exogenous pathogens, there are both excess and deficiency syndromes. The Middle Jiao chapter of *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) discusses this in detail. For example, regarding Fu-organ syndromes, Wu Jutong said: "Constipation in warm diseases falls into one of two categories: heat accumulation or fluid dryness." Therefore, for syndromes with pathogenic excess, he followed Zhang Zhongjing's methods, primarily using Chengqi Decoctions (Cinnamon Twig and Rhubarb Decoctions) to purge the excess; for syndromes with righteous qi deficiency, he emulated Ye Tianshi, "using Zengye Tang (Fluid-Increasing Decoction) to protect the deficient righteous qi." Thus, when treating Yangming disease caused by exogenous pathogens, differentiation must be based on the principle of excess versus deficiency to avoid errors. The later belief that Yangming disease caused by exogenous pathogens is exclusively an excess syndrome without any deficiency component is indeed a misunderstanding. According to *Shanghan Lun*, there are numerous discussions on various deficiency syndromes of Yangming disease. However, some people misinterpret the relative statement "Excess involves Yangming, Deficiency involves Taiyin" to mean that Yangming disease has no deficiency syndromes and that all deficiency syndromes belong to Taiyin, which is incorrect.
Conclusion
1. Based on the above analysis, I believe that the assertion claiming that deficiency syndromes characterized mainly by "weakened stomach function or consumption of stomach Yin fluids by pathogenic heat," such as Stomach Yin Deficiency and Stomach Yang Deficiency, exist only in Zang-Fu differentiation and not in Six Channel differentiation—and consequently proposing the saying "In terms of Six Channel differentiation, Excess is Yangming; in terms of Zang-Fu differentiation, Excess is not necessarily Yangming"—is actually inappropriate.
2. There are many texts in *Shanghan Lun* discussing various deficiency syndromes of Yangming disease, but treatment methods have developed significantly in later generations. Therefore, studying the syndrome differentiation and treatment of these deficiency syndromes requires integration with works from the Warm Disease School to be comprehensive. However, since this article focuses primarily on *Shanghan Lun*, discussions on content from other books will be simplified.
Brief Critique of Wu Jutong's Theory and Treatment of Dryness
After the Qing Dynasty, Wu Jutong's theories gained increasing influence, with many adherents. His work *Wenbing Tiaobian* is now regarded by some as one of the Four Great Classics of TCM, and *Wu Jutong's Medical Cases* is also highly valued. However, his theories and treatments regarding dryness are worthy of discussion. A brief critique is provided here for reference.
I. Confusion of Cold and Dryness: Named Treatment of Dryness, Actually Treatment of Cold.
Wu Jutong believed: "The Qi of Autumn Dryness, when light, is Dryness; when heavy, it becomes Cold." "Dryness transforming into Cold is the proper nature of Dryness." Therefore, he called "Dryness Minor Cold," describing it as a "Yin Pathogen." Regarding how Dryness affects the human body, Wu Jutong identified two forms: Major Pathogens injuring the exterior and Minor Pathogens entering the interior. He stated: "For Dryness syndromes where Major Pathogens injure the exterior and manifest immediately upon infection, as Mr. Shen Munan said, the method is the same as for Cold Damage." In *Wenbing Tiaobian*, clauses such as "Injuring Dryness, similar to Taiyang syndromes of Cold Damage, presenting with sweating, no cough, no vomiting, no pain, should be harmonized slightly with Guizhi Tang (Cinnamon Twig Decoction)" reflect this therapeutic approach. As for Minor Pathogens entering the interior, although there are differences such as deep penetration into the Lower Jiao clashing with blood, long-standing stagnation in the Lower Jiao without clashing with blood, or direct injury to Yang, the general principle is to use Warm Methods (except when treating Rebound Qi). Thus, formulas like Huazheng Huisheng Dan (Transforming Stasis Reviving Life Pill) for clashing with blood and Fuheng Dan (Restoring Prosperity Pill) for non-clashing cases are all applied this way. All cases in the Dryness Section of *Wu Jutong's Medical Cases* follow this pattern. For instance, in Case Li 46, illness caused by Dryness Metal Qi was treated initially with pungent-dry and warm-hot herbs, based on the understanding that "Dryness is Minor Cold" and a "Yin Pathogen." On May 2nd, during the third consultation, although it was noted that such herbs should not be used long-term for treating dryness, the formula shifted to modified Guizhi Tang, containing Cinnamon Twig (Guizhi) and White Peony Root (Baishao) each at 4 qian, Roasted Licorice (Zhigancao) and Dried Ginger (Ganjiang) each at 2 qian, 2 Jujubes (Dazao), Fresh Ginger (Shengjiang) and Tangerine Peel (Guapi) each at 3 qian, Pinellia (Banxia), Coix Seed (Sheng Yiren), and Poria (Fuling) each at 5 qian, still adhering to the Warm Method. Similarly, in Case Zhang, a 15-year-old female: "Dryness Metal Qi entered directly into the interior. Pulse was undetectable in all six positions; she lay rigid as if dead, with cold limbs extending past elbows and knees, leg pain, and muscle cramps. One large dose of Tongmai Sini Decoction (Pulse-Returning Sini Decoction) plus Sichuan Pepper (Chuanjiao), Evodia (Wuyu), and Clove (Gongdingxiang) restored her pulse and reversed cold within a day and night. The next day, due to eating porridge too early, symptoms recurred exactly as before; pulse became undetectable again, and she died of cold extremities. The previous formula was given again with increased warmth. After one dose, half the cold reversal occurred; after two more doses, she revived. Recovery was completed using Yang-tonifying methods." Regarding the above theories and treatments, differing opinions are presented below:
1. Cold and Dryness are distinct among the Six Qi. Among the Six Qi, Cold and Heat are opposites referring to temperature; Dampness and Dryness are opposites referring to humidity. High humidity does not equal heat, nor does heavy dryness equal cold. Thus, Cold is Cold, and Dryness is Dryness; they cannot be confused. Wu Jutong failed to distinguish this, stating that heavy Dryness is Cold and light Cold is Dryness, which is theoretically erroneous (Wu Jutong often committed the error of merging two Qi into one when discussing the Six Qi, such as claiming Summerheat is composed of Dampness and Heat, which was refuted by Meng Ying; this will not be repeated). Regarding the two cases mentioned: If Case Li could be considered light Cold, it might be called Dryness; however, Case Zhang clearly represents heavy Dryness and should be termed Direct Invasion of Cold, not Direct Invasion of Dryness. Since it is termed Direct Invasion of Dryness yet treated with major hot herbs, this contradicts the notion that light Cold equals Dryness. In reality, Wu Jutong indeed conflated Cold and Dryness, showing vague concepts and unclear distinctions. Therefore, when treating Cold-Dampness of Foot-Taiyin, he primarily used Jiaofu Baitong Decoction (Pepper, Aconite, and Bai Tong Decoction); whereas for Direct Invasion of Dryness, he used Tongmai Sini Decoction plus Sichuan Pepper, Evodia, and Clove. Therapeutically, there is little difference between these two approaches. Generally speaking, treating Cold requires Warm-Hot methods, while treating Dryness requires Moistening-Nourishing methods. If one only warms without moistening, it is truly not treating Dryness. Case Zhang and other cases in the Dryness Section that use warming without moistening are better described as treating Cold rather than Dryness. Otherwise, if a Dryness Section exists, there would be no need to separately establish a Cold Section.
2. Whether Dryness belongs to Yin or Yang has been debated extensively in the medical community, with the Yin theory being predominant. Wu Jutong also held this view, thus using Warm-Hot methods unless treating Rebound Qi. I argue that Yin-Yang theory is relative. To discuss the attribute of Dryness Qi, one must first consider the premise. As is well known: The Six Qi govern the four seasons; Wind is the primary Qi of Spring, when the climate is warm; Dryness is the primary Qi of Autumn, when the climate is cool. Based on this premise, comparing the primary Qi of Spring and Autumn, Dryness should indeed belong to Yin. However, if changing the premise to compare Dryness with Dampness, Dryness should belong to Yang. Hence, the character for Dryness (Zao) contains the Fire radical, and Dampness (Shi) contains the Water radical; Fire and Water are opposites, obvious signs of Yin and Yang. Predecessors debating the attribute of Dryness Qi often lacked unified premises, leading to biased arguments. Wu Jutong's classification of Dryness as a Yin Pathogen follows this pattern. Because he overlooked the relativity of Yin-Yang attributes when discussing Dryness, he only discussed the coolness or warmth of Dryness Qi from the perspective of Dominant Qi and Rebound Qi. However, even if we accept his statement that Dryness is a Yin Pathogen and Minor Cold, requiring Warm-Hot methods as the standard treatment, then Autumn Dryness should not be classified as one of the nine types of Warm Diseases. Since Autumn Dryness is considered a type of Warm Disease, and it is stated that Warm Pathogens attack from above while Cold Pathogens attack from below, prescribing Xingsu San (Almond and Perilla Powder) to treat the lungs is contradictory. Such theoretical inconsistencies are numerous.
II. Confusion of Dampness and Dryness: Named Treatment of Dryness, Actually Treatment of Dampness.
Regarding Cold and Dryness, Wu Jutong had erroneous rational understanding, leading to identical treatment in practice. Regarding Dryness and Dampness, although he rationally understood them as opposites, he still failed to distinguish them clearly in practice. Feeling that Cold, Dampness, and Dryness are all Yin Pathogens and easily confused, he stated: "Since Dryness is the beginning of Cold and resembles Cold, it is easily mixed into the Cold Section. Furthermore, Dryness governs the upper aspect of Yangming, revealing Taiyin in the middle, and Yangming transforms via the middle Qi; thus, it is easily mixed into the Dampness Section. But students of medicine must have clear distinctions, restore the ancient ways of *Neijing*, thereby establishing firm views, so as not to deviate from the rules." He said this while criticizing predecessors for either mixing Cold and Dryness into one section or mixing them into the Dampness Section. In reality, was he not doing the same? Since he criticized predecessors for this, I now criticize Wu Jutong for the same reason.
The most obvious fact is: Analyzing the cases in the Dryness Section of *Wu Jutong's Medical Cases*, the herbs he used most frequently were of two types: First, Pungent-Dry and Warm-Hot herbs, such as Evodia (Wuyu), Clove (Dingxiang), Cinnamon Twig (Guizhi), Aconite (Fuzi), Sichuan Pepper (Chuanjiao), Dried Ginger (Ganjiang), Galangal (Liangjiang), and Alpinia Oxyphylla (Yizhiren); second, Light-Purging and Aromatic-Transforming herbs, such as Poria (Fuling), Polyporus (Zhuling), Pinellia (Banxia), Tangerine Peel (Chenpi), Coix Seed (Yiren), Magnolia Bark (Houpo), Atractylodes Macrocephala (Baizhu), and Alisma (Zexie). Herbs possessing moistening-nourishing properties and generating fluids, which are essential for treating Dryness, were rarely used in the Dryness Section. How can such a method be called treating Dryness? Comparing this method with those in the Cold-Dampness Section and the Cold-Dampness treatment methods in *Wenbing Tiaobian*, one finds they are almost identical. For example, in Case Chuan 57 of the Dryness Section, illness caused by Dryness Metal Qi was treated with Poria (Fuling), Ginger-Processed Pinellia (Jiang Banxia), and Raw Coix Seed (Sheng Yiren) each at 5 qian, Charred Sichuan Pepper (Chuanjiao Tan) and Tangerine Peel (Guapi) each at 3 qian, Evodia (Wuyu), Galangal (Liangjiang), and Alpinia Oxyphylla (Yizhiren) each at 2 qian, and Clove (Gongdingxiang) at 1 qian. In subsequent consultations, the prescription remained basically unchanged, sometimes adding Cinnamon Twig or doubling Evodia and Galangal, or reducing Sichuan Pepper, Evodia, and Galangal. Other cases, such as Xie, Li, and Yu, showed similar medication patterns. In contrast, Case Guo 32 in the Cold-Dampness Section, involving Taiyin Dampness invasion, used 1 liang of Fresh Ginger, 6 qian of Ginger-Processed Pinellia, 5 qian each of Cinnamon Twig, Poria Skin (Fuling Pi), Raw Coix Seed, and Atractylodes (Maoshu), 4 qian of Magnolia Bark (Houpo), and 3 qian each of Sichuan Pepper Eye (Chuanjiaomu), Immature Bitter Orange (Zhishi), Tangerine Peel (Guapi), and Black Cardamom (Caoguo). The second consultation medication was largely the same. Comparing the two, the treatment methods are identical. Because Wu Jutong failed to distinguish between Dampness and Dryness, he categorized cases belonging to the Cold-Dampness Section into the Dryness Section, rendering the Cold-Dampness Section virtually empty (in fact, it contained only the aforementioned case). Consequently, Bi Syndrome cases (which could form a separate section) were used to fill the Cold-Dampness Section. Looking at the Dryness Section cases, Dampness-treating formulas almost replaced Dryness-treating formulas. This clearly demonstrates Wu Jutong's confusion between Dampness and Dryness.
Furthermore, Wu Jutong created Pili San (Thunderbolt Powder) to treat vomiting and diarrhea caused by Central Dryness, appearing in both *Wenbing Tiaobian* and *Wu Jutong's Medical Cases*. This formula is dominated by "a collection of pungent-dry, bitter, and hot herbs warming the Three Yin Channels," reflecting his blurred understanding of the differences between Dryness and Dampness treatment methods. As *Yimen Falv* (Medical Laws) states: "Treating Autumn Dryness diseases as Dampness is akin to wielding a blade [causing harm]. Previously, ignorance could be excused; now, knowingly committing this error causes much harm. Facing the mirror of retribution, regret will be useless." Clearly, mistaking Dampness for Dryness or treating Dryness as Dampness are dangerous errors requiring careful distinction.
Zhang Zhongjing used Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) to treat Flexible Spasm, using Trichosanthes Root (Gualou) as the sovereign herb to generate fluids and moisten dryness. Later physicians used Guizhi Xingren Tang (Cinnamon Twig and Apricot Kernel Decoction) to treat Cool Dryness, using Apricot Kernel (Xingren) as the sovereign herb for its slightly bitter and warm-moistening properties. Modifying Guizhi Tang to treat Dryness in this manner is commendable. However, Wu Jutong used Guizhi Tang to treat Dryness without adding moistening herbs, instead adding light-purging herbs (as in the above case). Such modifications are inappropriate for treating Dryness, further demonstrating his confusion between Dryness and Dampness. Therefore, the cases in the Dryness Section are not suitable as models for treating Dryness. Conversely, if viewed as Cold-Dampness cases, they are worth referencing.
III. Bitter-Dry and Violent Purging: Attacking Accumulation While Forgetting Deficiency: Named Treatment of Dryness, Actually Treatment of Excess.
He Lianchen stated: "Dryness differs from Fire. Fire is an Excess Syndrome, characterized by excessive heat and hyperactive Yang, with high fever and profuse sweating; the method should use Bitter-Cold to drain excess and clear heat. Dryness is a Deficiency Syndrome, characterized by Yin deficiency and loss of moisture, with dry skin; the method should use Sweet-Cold to nourish Yin and moisten dryness." However, Wu Jutong focused solely on attacking excess when treating Dryness, stating: "Yangming Dryness Syndromes involve interior excess and hardness. If not transformed by heat, purge with Bitter-Warm. If already transformed by heat, purge with Bitter-Cold." His self-note explains: "Bitter-Warm purging method, such as Dahuang Fuzi Tang (Rhubarb and Aconite Decoction) in *Jingui Yaolue*, or new prescriptions like Tiantai Wuyao San plus Croton Seed Frost (Badou Shuang). Bitter-Cold purging method, such as the three Chengqi Decoctions." *Wenbing Tiaobian* includes medical cases of his Dryness treatment, such as Case Che. Previous physicians failed to relieve constipation with Dachengqi Tang (Major Order the Qi Decoction). Wu Jutong diagnosed it as Autumn Metal Dryness Qi, Minor Pathogen entering the interior, determining the syndrome as Cold-Dryness, and primarily used Warm Purging. He prescribed Tiantai Wuyao San plus Croton Seed Frost, starting with 1 fen, increasing to 0.5 fen for the second dose, and 2 fen for the third dose. Bowel movement occurred only after three doses. Fifteen days later, constipation returned, and the same method was used again. Differing opinions on this theory and method are presented below:
1. Yangming Dryness Syndromes must be differentiated not only by Cold/Heat but also by Excess/Deficiency. One cannot assume all Yangming diseases are Excess Syndromes. It must be understood that Yangming Dryness Syndromes involve fluid depletion and dryness, mostly presenting as combined Excess and Deficiency. Although Excess may outweigh Deficiency in some cases, in Autumn Dryness, Deficiency usually outweighs Excess. Therefore, for Heat-Transformation with fluid deficiency, emphasis should be placed on nourishing Yin and generating fluids; "increasing water allows the boat to float." For Cold-Transformation with intestinal dryness and fluid exhaustion, emphasis should be on moistening dryness and lubricating the intestines; "moistening and guiding can promote bowel movement." Ignoring methods like Sweet-Cold fluid-increasing and Sweet-Warm intestinal-lubricating, and relying exclusively on violent purging with bitter-dry and harsh agents, is definitely not the correct method for treating Dryness.
2. Elderly constipation is mostly due to Essence-Blood deficiency, intestinal dryness, and fluid exhaustion. Unless occurring during an exogenous febrile disease, it should be viewed as a miscellaneous disease. Wu Jutong, based on the understanding that "all hard, firm, and solid accumulations belong to the Metal image," attributed it to Dryness Qi invasion, which is a misunderstanding. Firstly, this condition can occur in all four seasons; if not in Autumn, what relation does it have to Dryness Qi? Secondly, Case Guo in the Cold-Dampness Section describes "Cold-Dampness disease, mistakenly treated with Mirabilite and Rhubarb, causing turbid Yin to accumulate, becoming hard and solid like stone." Given this, the statement "all hard, firm, and solid accumulations belong to the Metal image" is disproven. Therefore, the correct method for treating elderly Dryness Constipation is generally formulas like Wuren Wan (Five Seeds Pill) or Banshu Wan (Half-Sulfur Pill). Case Che achieved temporary effect only because constipation had lasted 49 days, necessitating "treating the acute symptom first"; after violent purging, collapse did not occur, fortunately aided by his decent constitution. If moistening and nourishing had followed after bowel movement, recurrence might have been prevented. Using violent purging again upon recurrence risks damaging righteous Qi. Indiscriminate use of Croton and Rhubarb for repeated violent purging is certainly not a good method for treating Dryness. As He Lianchen said: "Those whose fluids are chronically deficient have naturally dry gastrointestinal tracts and frequent constipation. When encountering Autumn Dryness injuring the Lung, causing Qi mechanism obstruction, bowel movement ceases. If猛烈 (fierce) purging with Chengqi is used, it often causes watery diarrhea, further damaging Middle Qi, depleting fluids, failing to pass dry feces, and often leading to fluid exhaustion triggering Wind, resulting in critical conditions." We must pay attention to this. Croton's purging power is more violent than Chengqi; it should be used with extreme caution for elderly Dryness Constipation. Case Che treated Excess, not Dryness. We should not use this case as an excuse to lightly administer violent purging for elderly Dryness Constipation.
3. Hebao stated, "Heat overcomes Dryness; Dryness originates from Metal; Heat transforms into Fire. Excess Metal is controlled by Fire; Lung Excess is controlled by Bitter." Thus, using Bitter herbs to treat Dryness is not impossible, but one must know that "Bitter can induce Dryness." Therefore, using Bitter herbs to treat Dryness is suitable only for Excess Syndromes. Observing Yu Chang's formulation of Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction), he knew "Anemarrhena (Zhimu) can nourish Kidney Water and clear Lung Metal, yet he did not use it because it is Bitter." Dryness diseases are mostly Deficient; predecessors were so cautious about using moistening herbs when treating Dryness, how much more so should we avoid using bitter-dry and harsh herbs? However, observing the subsequent clauses in *Wenbing Tiaobian · Supplement to Autumn Dryness Overcoming Dominant Qi* and the cases in the Dryness Section, moistening herbs are hardly used, while bitter-dry and harsh herbs are used without taboo. This is treating Dryness while forgetting Dryness!
4. Regarding the syndrome of Dry Stool Accumulation, it can be either Excess or Deficiency. In Autumn Dryness, it is often a combination of Excess and Deficiency, having both; while cases with more Excess than Deficiency exist, those with more Deficiency than Excess are also common. Therefore, clinical differentiation must be meticulous. Regarding treatment formulas, such as Dahuang Fuzi Xixin Tang (Rhubarb, Aconite, and Asarum Decoction), Croton Frost, and Chengqi Decoctions, they all treat Excess, not Dryness. Generally, Dryness diseases involve Yin-Jing deficiency; even if constipation occurs, violent purging should be used cautiously, temporarily, and not repeatedly. More importantly, one should not focus solely on purging, distinguishing only Cold/Heat while ignoring Excess/Deficiency. It must be known that constipation caused by Dryness with Deficiency outweighing Excess is common everywhere. If one ignores effective established methods like Pig Fat and Hair Decoction (Zhigao Faxian Jian), Honey Suppository (Mijian Dao), and Jichuan Jian (Jichuan Decoction), and instead treats occasional successful cases of violent purging for Excess as the major method for treating Dryness, it violates the essential principle of valuing fluids and preserving Yin. The Classic states "Purge with Bitter," which treats Excess, not Dryness. Zhang Zhongjing said: "If urination is normal and stool is hard, do not purge; moisten with Miyue Mahuang Wan (Spleen-Restriction Hemp Seed Pill)." This warns against light purging to avoid severe fluid damage.