次论燥火之症治。易曰∶火就燥，燥万物者莫 乎火。沈尧峰曰∶温热二症，火气兼燥。薛瘦吟曰∶温热
之邪，皆从燥化，其为病也，多燥而少湿。有热而无寒，故只须以中焦津液为主，而清解络热为要。由是观之，
非特风温、暑温、伏暑、温毒之伏火症，火易就燥，即冷温、湿温之兼寒兼湿，
而寒郁之久，必从火化。湿郁之极，必兼燥化也。其病四时皆有，而深秋初冬为尤甚。其邪必伏于血络，内
经所谓内舍于营是也。大凡肝络郁而相火劫液，液结化燥者，火盛则发于少阳胆经，风动则发于厥阴肝经；
心络郁而君火烁阴，阴虚化燥者，上蒸则发于太阴肺经，下烁则发于少阴肾经。而无不累及阳明胃腑者，以
胃主一身之津液也（拯华注∶西医云肠胃消化器为一身之津液路）。初起邪在血分，当分别实火、虚燥。
实火从伏邪入血，血郁化火，火就燥而来，病势较湿火症尤急而重，用药必不可轻。如发自少阳胆经者，
必相火炽而营分大热，首犯胃经血分，其舌色必鲜红起刺；或鲜红而舌根强硬；或纯红而有小黑点；或纯红而
有深红星，间有红点如虫碎之状者；或纯红而苔粘有裂纹，如人字、川字、爻字不等，或裂纹如直槽者。脉息
弦滑而盛躁，或右大而左弦数。神多烦躁，甚或如醉如狂，搅乱惊窜。色必面赤如朱，目白均现红丝。症必壮
热而渴，不恶寒反恶热，目眩耳聋，口苦干呕，胸腹热甚，按之灼手，热汗时出；甚或发疹发斑，小便短数赤
热，大便燥结。治法宜清解胆火之郁，救胃液之燥，以预防肝经风动。先用犀地桑丹汤清营透络，俾伏邪从
斑疹而解，或从战汗而解；若斑疹及战汗出后，伏火犹炽，则用犀连承气汤合更衣丸急下之，使伏火从大便而
解。亦有火毒内结，清透之而斑疹不显，反从下后而斑疹始发透者。或有透发不应，只用清火解毒，如犀羚白
虎汤加金汁、白颈蚯蚓、甘萝根汁，斑疹反大透，而伏火始解。解后，用千金生地黄煎。清余火而复胃液。若
虚羸少气、气逆欲吐，用竹叶石膏汤加鲜竹茹、鲜茅根、青蔗浆，配姜汁数点，和胃气而复清津。
如发自厥阴肝经者，必肝火炽而内风扇动，最伤胃家津液，其舌色焦紫起刺如杨梅，或舌苔两旁有红紫点，或舌紫
而无苔有点，或舌红无苔而胶干，或泛涨而似胶非胶，或无液而干粘带涩。脉多弦紧搏数，神多昏沉蒙闭，或
如痴如醉，尸厥不语。症必热深厥深，咽干舌燥，头面动摇，口噤齿 ，腿脚挛急，时发螈 ；甚或睾丸上升，
宗筋下注，少腹里急，阴中拘挛；或肠燥拘急，有似硬梗，按之痛甚，蜷曲难伸；冲任脉失营养，当脐上下左
右，按之坚硬，动跃震手；虚里穴及心房亦必动跃异常。治法宜急救血液之燥，熄风火之亢，以预防阴竭阳越。
急用犀羚二鲜汤或滋液救焚汤，重加瓜霜紫雪丹，先清其神而熄风；继用龙胆泻肝汤或平阳清里汤，咸苦寒降，
以泻火；终用阿胶鸡子黄汤或三甲复脉汤，滋阴液以镇肝阳。
虚燥从伏邪伤阴，阴虚生火，火就燥而成。病势较实火症似缓实重，用药必贵乎补。如发于太阴肺经者，
必君火被内风相煽，蒸肺津而消胃液。其舌必嫩红而干，或绛底浮白，舌形胖嫩，甚或舌苔红中有白糜点。脉
多右浮大无力，左弦数无力，甚则细劲。神多困倦，或反烦躁。症多头昏心悸，咽干喉燥，气喘咳逆；或干咳
无痰，即有稀痰，亦粘着喉间，咯吐不爽；或痰中间有红丝红点，睡时不能仰卧，仰卧即气逆而咳，咳则心
下煽动，或只能侧卧一边，翻身则咳不休；朝凉暮热，少气薄力。治法宜清金制木，保肺和胃为首要，如清燥
救肺汤加岩制川贝，葛氏保和汤加润肺悉尼膏之类，以润燥而止咳。若燥回咳减，而发热不休者，则以青蒿鳖
甲煎合顾氏清金散，以退阴分伏热，而平其气咳。大势轻减后，当以顾氏保阴煎善其后。
如发自少阴肾经者，必君火与真水不交，水愈亏则火愈旺。其舌多嫩红而燥，或舌心虽黑无甚苔垢，或舌
本枯而不甚赤。脉多右大无力，左弦细数，甚或沉细涩数，或浮大革数。神多虚烦，甚或惊悸，或极疲倦。症多
梦遗精滑，或梦与鬼交，潮湿盗汗，平旦病减，午后病增，口干舌燥，颧红
唇赤，五心烦热，腰 足冷，甚或骨痿于床，气浮而咳，或气喘而促，或头晕咽病；大便多秘，或反溏滑；小
便短数，溺有余沥，或精随溺而带出。治法宜滋阴润燥，交济心肾为首要，周氏新加六味汤主之，间有可用六
味加犀角汤者。若济君火，则加枸杞、元参；若输肺金，则加生麦散；火甚者，加黄柏、龟板，或专用丹溪大
补阴丸滋阴潜阳，以苦寒培生气而坚阴，较六味地黄汤更优；如小便清和，无痰气者，只须专意滋肾，张氏左
归饮多服为佳。以上皆燥火症实与虚传变之大要也，余症亦详本书温热各论中。
总之，湿火、燥火症治最要厘清，惟湿去燥来、燥又夹湿之际，最难调治，稍一偏胜，则非液涸，即气滞
矣，临症者不可不细参也。
其次论述燥火病症的治疗。《易经》说：火趋向干燥，没有比火更能使万物干燥的了。沈尧峰说：温热两种病症，是火气兼夹燥邪。薛瘦吟说：温热的病邪，都从燥邪转化，它们致病时，多表现为燥而少湿。只有热而没有寒，所以只需要以中焦的津液为主，而清除经络中的热邪为关键。由此看来，不仅是风温、暑温、伏暑、温毒等伏火症，火容易趋向于燥；即使是冷温、湿温这些兼有寒和湿的病症，寒邪郁积久了，必然转化为火；湿邪郁积到了极点，也必然兼夹燥邪转化。这类疾病四季都有，但在深秋初冬时节尤为严重。病邪必定潜伏在血络之中，正如《内经》所说的“内舍于营”。大凡肝络郁结导致相火劫夺津液，津液凝结化为燥邪的，火盛则发作于少阳胆经，风动则发作于厥阴肝经；心络郁结导致君火灼伤阴液，阴虚化为燥邪的，向上蒸腾则发作于太阴肺经，向下灼烧则发作于少阴肾经。而且无不累及阳明胃腑，因为胃主管一身之津液（拯华注：西医认为肠胃消化器是一身津液的通道）。初起时病邪在血分，应当分别实火和虚燥。实火是从伏邪进入血分，血郁结化火，火趋向于燥而来，病情势头比湿火症更加急重，用药绝对不能轻率。如果病发于少阳胆经，必定是相火炽盛而营分大热，首先侵犯胃经血分，其舌色必定鲜红且起刺；或者鲜红而舌根强硬；或者纯红而有小黑点；或者纯红而有深红星，间或有红点像虫碎一样的形状；或者纯红而苔粘伴有裂纹，像人字、川字、爻字不等，或者裂纹像直槽一样。脉象弦滑而盛大躁动，或者右脉大而左脉弦数。神志多烦躁，甚至像醉酒或发狂，搅乱惊窜。面色必定面赤如朱砂，眼白均现红丝。症状必定壮热而口渴，不恶寒反而恶热，目眩耳聋，口苦干呕，胸腹热甚，按压时灼手，热汗不时流出；甚至出现发疹发斑，小便短少频数赤热，大便燥结。治疗方法宜清解胆火的郁结，拯救胃液的干燥，以预防肝经风动。先用犀地桑丹汤清营透络，使伏邪通过斑疹而解除，或者通过战汗而解除；如果斑疹及战汗出后，伏火仍然炽盛，则用犀连承气汤合更衣丸急下之，使伏火从大便而解除。也有火毒内结，清透之后斑疹不明显，反而在下法之后斑疹才开始透发的。或者有透发不应，只用清火解毒，如犀羚白虎汤加金汁、白颈蚯蚓、甘萝根汁，斑疹反而大透，而伏火始解。解后，用千金生地黄煎。清除余火并恢复胃液。如果身体虚弱消瘦、气短、气逆想吐，用竹叶石膏汤加鲜竹茹、鲜茅根、青蔗浆，配姜汁几滴，调和胃气并恢复清津。
如果病发于厥阴肝经，必定是肝火炽盛而内风扇动，最损伤胃家津液，其舌色焦紫起刺像杨梅，或者舌苔两旁有红紫点，或者舌紫而无苔有点，或者舌红无苔而胶干，或者泛涨而似胶非胶，或者无液而干粘带涩。脉象多弦紧搏数，神志多昏沉蒙闭，或者像痴呆或醉酒，尸厥不语。症状必定热深厥深，咽干舌燥，头面动摇，口噤齿（咬紧牙关），腿脚挛急，时而发生抽搐；甚至睾丸上升，宗筋下注，少腹里急，阴中拘挛；或者肠燥拘急，好像硬梗，按压疼痛剧烈，蜷曲难伸；冲任脉失去营养，肚脐上下左右，按压坚硬，跳动震手；虚里穴及心房也必定跳动异常。治疗方法宜急救血液之燥，熄灭火亢之风，以预防阴竭阳越。急用犀羚二鲜汤或滋液救焚汤，重加瓜霜紫雪丹，先清神而熄风；继用龙胆泻肝汤或平阳清里汤，咸苦寒降，以泻火；终用阿胶鸡子黄汤或三甲复脉汤，滋阴液以镇肝阳。
虚燥是从伏邪伤阴，阴虚生火，火趋向于燥而成。病情势头比实火症似乎缓和实则严重，用药必须贵在补益。如果病发于太阴肺经，必定是君火被内风煽动，蒸腾肺津而消耗胃液。其舌必定嫩红而干，或者绛底浮白，舌形胖嫩，甚至舌苔红中有白糜点。脉象多右浮大无力，左弦数无力，甚至细劲。神志多困倦，或者反烦躁。症状多头昏心悸，咽干喉燥，气喘咳逆；或者干咳无痰，即使有稀痰，也粘着喉间，咯吐不爽；或者痰中间有红丝红点，睡时不能仰卧，仰卧即气逆而咳，咳则心下煽动，或者只能侧卧一边，翻身则咳不休；朝凉暮热，少气薄力。治疗方法宜清金制木，保肺和胃为首要，如清燥救肺汤加岩制川贝，葛氏保和汤加润肺悉尼膏之类，以润燥而止咳。如果燥回咳减，而发热不休者，则以青蒿鳖甲煎合顾氏清金散，以退阴分伏热，而平其气咳。大势轻减后，当以顾氏保阴煎善其后。
如果病发于少阴肾经，必定是君火与真水不交，水愈亏则火愈旺。其舌多嫩红而燥，或者舌心虽黑无甚苔垢，或者舌本枯而不甚赤。脉象多右大无力，左弦细数，甚至沉细涩数，或浮大革数。神志多虚烦，甚至惊悸，或极疲倦。症状多梦遗精滑，或者梦与鬼交，潮湿盗汗，平旦病减，午后病增，口干舌燥，颧红唇赤，五心烦热，腰（酸）足冷，甚至骨痿于床，气浮而咳，或者气喘而促，或者头晕咽病；大便多秘，或者反溏滑；小便短数，溺有余沥，或者精随溺而带出。治疗方法宜滋阴润燥，交济心肾为首要，周氏新加六味汤主之，间有可用六味加犀角汤者。若济君火，则加枸杞、元参；若输肺金，则加生麦散；火甚者，加黄柏、龟板，或专用丹溪大补阴丸滋阴潜阳，以苦寒培生气而坚阴，较六味地黄汤更优；如小便清和，无痰气者，只须专意滋肾，张氏左归饮多服为佳。以上都是燥火症实与虚传变的大要，其余病症也详见本书温热各论中。
总之，湿火、燥火症治最要厘清，只有在湿去燥来、燥又夹湿之际，最难调治，稍一偏胜，则不是津液枯竭，就是气机阻滞了，临症者不可不仔细参考。
Next, we discuss the treatment of dryness-fire syndromes. The *I Ching* (Book of Changes) states: "Fire follows dryness; nothing dries up things more than fire." Shen Yaofeng said: "Warm-heat syndromes involve both fire and dryness." Xue Shouyin said: "The pathogenic factors of warm-heat diseases all transform from dryness; in their pathology, they manifest mostly as dryness with little dampness." There is heat but no cold, so one only needs to focus on the fluids of the Middle Jiao (Middle Burner), making the clearing and resolving of collateral heat essential. From this perspective, not only do the latent fire syndromes of Wind-Warmth, Summer-Warmth, Latent Summer-Warmth, and Warm-Toxicity easily follow dryness, but even Cold-Warmth and Damp-Warmth, which combine cold and dampness, will eventually transform into fire after prolonged cold stagnation, and into dryness after extreme damp stagnation. These diseases occur in all four seasons, but are particularly severe in late autumn and early winter. The pathogen must lie hidden in the blood collaterals, as stated in the *Neijing* (Inner Canon): "Internally residing in the Ying (Nutritive) level." Generally, when Liver collaterals are stagnant and Ministerial Fire (Xiang Huo) consumes fluids, leading to fluid condensation and dryness transformation, excessive fire manifests in the Shaoyang Gallbladder Meridian, while wind movement manifests in the Jueyin Liver Meridian; when Heart collaterals are stagnant and Sovereign Fire (Jun Huo) scorches Yin, leading to Yin deficiency and dryness transformation, upward steaming manifests in the Taiyin Lung Meridian, and downward scorching manifests in the Shaoyin Kidney Meridian. None fail to affect the Yangming Stomach Fu organ, because the Stomach governs the fluids of the whole body (Zhenhua's note: Western medicine considers the gastrointestinal digestive system as the pathway for the body's fluids). Initially, the pathogen is in the Blood level, and one must distinguish between Excess Fire and Deficiency Dryness. Excess Fire arises from latent pathogens entering the Blood, where Blood stagnation transforms into fire, and fire follows dryness; the disease progression is more urgent and severe than Damp-Fire syndromes, so medication must not be light or casual. If it originates from the Shaoyang Gallbladder Meridian, there must be blazing Ministerial Fire and intense heat in the Ying level, first invading the Stomach Meridian Blood level. The tongue color must be bright red with prickles; or bright red with a stiff root; or purely red with small black spots; or purely red with deep red stars, occasionally with red dots resembling crushed insects; or purely red with sticky coating and cracks, resembling characters like 'Ren', 'Chuan', 'Yao', etc., or cracks like straight grooves. The pulse is wiry, slippery, vigorous, and restless, or large on the right and wiry-rapid on the left. Spirit is often irritable, even drunk-like or manic, chaotic and startled. The complexion must be red like cinnabar, with red filaments visible in the whites of the eyes. Symptoms include high fever and thirst, aversion to heat rather than cold, vertigo and deafness, dry mouth, bitter taste, retching, intense heat in the chest and abdomen that feels burning to the touch, intermittent hot sweats; even rashes and macules may appear, short and frequent dark-red hot urine, and dry constipation. The treatment method should clear and resolve Gallbladder Fire stagnation, save Stomach Fluid dryness, and prevent Liver Meridian wind movement. First use Xi Di Sang Dan Tang (Rhinoceros Horn, Rehmannia, Mulberry Bark, and Moutan Decoction) to clear the Ying level and penetrate collaterals, allowing latent pathogens to resolve via rashes/macules or through battle-sweat; if latent fire remains blazing after rashes/macules and battle-sweat, use Xi Lian Cheng Qi Tang (Rhinoceros Horn, Coptis, Rhubarb, and Mirabilite Decoction) combined with Geng Yi Wan (Changing Clothes Pill) for urgent purgation, allowing latent fire to resolve via stool. There are cases where internal fire-toxin accumulation prevents rashes from appearing clearly after clearing/penetrating methods, but rashes emerge only after purgation. Or if eruption fails to respond, using only fire-clearing and toxin-resolving formulas, such as Xi Ling Bai Hu Tang (Rhinoceros Horn, Antelope Horn, White Tiger Decoction) plus Jin Zhi (Gold Juice), Bai Jing Qiu Yin (White Earthworm), and Gan Luo Gen Jiang (Radish Root Juice), may cause rashes to erupt massively, finally resolving latent fire. After resolution, use Qian Jin Sheng Di Huang Jian (Thousand Gold Raw Rehmannia Decoction) to clear residual fire and restore Stomach fluids. If there is emaciation, shortness of breath, rebellious Qi with desire to vomit, use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) plus fresh Zhu Ru (Bamboo Shavings), fresh Mao Gen (Imperata Rhizome), and Qing Zhe Jiang (Green Sugarcane Juice), mixed with a few drops of Ginger Juice, to harmonize Stomach Qi and restore clear fluids.
If it originates from the Jueyin Liver Meridian, there must be blazing Liver Fire and internal wind movement, most damaging Stomach fluids. The tongue color is scorched purple with prickles like a bayberry, or red-purple spots on the sides of the tongue coating, or purple tongue without coating but with spots, or red tongue without coating that is gelatinous and dry, or swollen and semi-gelatinous, or fluidless, dry, sticky, and rough. The pulse is often wiry, tight, forceful, and rapid. Spirit is often dull, confused, or closed, resembling dementia or drunkenness, or coma with silence. Symptoms include deep heat with deep cold extremities, dry throat and tongue, head and face tremors, locked jaw and clenched teeth, leg and foot spasms, occasional convulsions; even testicular ascent, tendon collapse downward, lower abdominal urgency, genital cramping; or intestinal dryness and cramping, feeling like a hard block, painful upon pressure, curled and difficult to extend; Chong and Ren meridians lack nourishment, hardness felt above and below, left and right of the navel, pulsating and shaking the hand; the Xulri acupoint and heart chamber also exhibit abnormal pulsation. Treatment urgently requires saving Blood dryness, extinguishing hyperactive wind-fire, and preventing Yin exhaustion and Yang floating. Urgently use Xi Ling Er Xian Tang (Rhinoceros Horn and Antelope Horn Two Fresh Decoction) or Zi Ye Jiu Fen Tang (Fluid-Nourishing Fire-Saving Decoction), heavily adding Gua Shuang Zi Xue Dan (Melon Frost Purple Snow Pellet), first clearing spirit and extinguishing wind; subsequently use Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) or Ping Yang Qing Li Tang (Pingyang Interior-Clearing Decoction), salty-bitter-cold descending, to drain fire; finally use E Jiao Ji Zi Huang Tang (Donkey-Hide Gelatin and Egg Yolk Decoction) or San Jia Fu Mai Tang (Three Shells Pulse-Recovering Decoction), nourishing Yin fluids to calm Liver Yang.
Deficiency Dryness arises from latent pathogens injuring Yin, Yin deficiency generating fire, and fire following dryness. The disease progression seems slower but is actually more severe than Excess Fire syndromes; medication must prioritize tonification. If it manifests in the Taiyin Lung Meridian, Sovereign Fire is fanned by internal wind, steaming Lung fluids and consuming Stomach fluids. The tongue must be tender-red and dry, or crimson base with floating white, tongue shape plump and tender, even red coating with white fungal spots. Pulses are often floating-large and powerless on the right, wiry-rapid and powerless on the left, even fine and rigid. Spirit is often fatigued, or conversely irritable. Symptoms include head dizziness, palpitations, dry throat and hoarse voice, wheezing and coughing; or dry cough without phlegm, even if thin phlegm exists, it sticks to the throat and is difficult to expectorate; or phlegm contains red filaments and spots, inability to lie supine during sleep, as supine position causes rebellious Qi and coughing, coughing causes palpitations in the epigastrium, or only able to lie on one side, turning over causes incessant coughing; cool in morning, hot in evening, shortness of breath and weak strength. Treatment should clear Metal to control Wood, protecting Lung and harmonizing Stomach as primary goals, such as Qing Zao Jiu Fei Tang (Clearing Dryness Saving Lung Decoction) plus Yan Zhi Chuan Bei (Rock-processed Fritillaria), Ge Shi Bao He Tang (Ge's Harmonizing Decoction) plus Run Fei Xi Ni Gao (Lung-Moistening Sydney Paste), to moisten dryness and stop cough. If dryness recedes and cough decreases but fever persists, use Qing Hao Bie Jia Jian (Artemisia Annua and Turtle Shell Decoction) combined with Gu Shi Qing Jin San (Gu's Clearing Metal Powder) to retreat latent heat in the Yin level and calm Qi and cough. After major symptoms subside, Gu Shi Bao Yin Jian (Gu's Nourishing Yin Decoction) should be used to conclude treatment.
If it originates from the Shaoyin Kidney Meridian, Sovereign Fire and True Water do not interact; as water diminishes, fire flares. Tongues are often tender-red and dry, or the center of the tongue is black with little coating/dirt, or the tongue root is withered but not very red. Pulses are often large-powerless on the right, wiry-fine-rapid on the left, even sunken-fine-choppy-rapid, or floating-large-leather-rapid. Spirit is often empty irritability, even palpitations, or extreme fatigue. Symptoms include nocturnal emission and seminal leakage, dreams of sexual intercourse with spirits, damp night sweats, symptoms alleviated at dawn and worsened in afternoon, dry mouth and tongue, malar flush and red lips, five-palm heat, sore/cold lower back and feet, even bedridden due to bone weakness, floating Qi with cough, or wheezing and急促 breathing, or dizziness and sore throat; stools are mostly constipated, or conversely loose/slippery; urine is short and frequent, dribbling after urination, or essence leaking with urine. Treatment should nourish Yin and moisten dryness, interacting Heart and Kidney as primary goals, primarily using Zhou Shi Xin Jia Liu Wei Tang (Zhou's New Modified Six-Ingredient Decoction), occasionally using Liu Wei plus Rhinoceros Horn Decoction. To assist Sovereign Fire, add Gou Qi (Goji Berry) and Yuan Shen (Scrophularia); to transmit to Lung Metal, add Sheng Mai San (Generate Pulse Powder); if fire is severe, add Huang Bo (Phellodendron) and Gui Ban (Turtle Plastron), or exclusively use Danxi Da Bu Yin Wan (Danxi Great Tonifying Yin Pill) to nourish Yin and submerge Yang, using bitter-cold to cultivate vital Qi and solidify Yin, superior to Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill); if urine is clear and harmonious without phlegm-Qi, only focus on nourishing Kidney, taking Zhang Shi Zuo Gui Yin (Zhang's Left Restoring Decoction) frequently is excellent. Above are the main principles of transmission between Excess and Deficiency in dryness-fire syndromes; other symptoms are detailed in the Warm-Heat sections of this book.
In summary, distinguishing wet-fire and dry-fire treatments is crucial. It is most difficult to regulate when dampness leaves and dryness arrives, or when dryness combines with dampness. Slight imbalance leads either to fluid exhaustion or Qi stagnation. Clinicians must carefully consider this.