至真要大论帝曰治之奈何岐伯曰诸气在泉风淫于内治以辛凉佐以苦甘以甘缓之以辛散之
王冰曰风性喜温而恶清故治之以凉是以胜气治之也佐以苦随其所利也木苦急则以甘缓之苦抑之以辛散之藏气
法时论肝
苦急急食甘以缓之肝欲散急食辛以散之此之谓也食亦音饲己曰食他曰饲大法正味如此诸为方者不必尽用之但一佐二佐病
已则止余气皆然吴昆曰不务德谓之淫风淫于内自外而入淫于内也风为木气金能胜之故治以辛凉辛过甚则恐伤其真气故佐
之以苦甘苦胜辛甘益气也木性急故以甘缓之木喜条达故以辛散之骥案素问至真要大论风气大来木之胜也六元纪风病行于
上风论风为百病之长善行而数变又有五藏之风左传秦和曰淫生六疾注淫过也气味声色所以养人然过则生害盖风为六气之
一刘守真六气病谓风为厥阴风木乃肝之气也辛凉仲景有麻黄连翘汤白虎汤吴鞠通有银翘散桑菊饮皆辛凉解肌之例然李东
垣有卒然昏愦不省人事之中风乃本气自病非外来之邪此由于酒色劳役七情口腹致伤藏气王安道谓之类风此风之变局非大
剂参附不能挽回不以辛凉治也
热淫于内治以咸寒佐以甘苦以酸收之以苦发之
王冰曰热性恶寒故治以寒也热之大盛甚于表者以苦发之不尽复寒制之寒制不尽复苦发之以酸收之甚者再方微者一方
可使必已时发时止亦以酸收之吴昆曰热为火气水能胜之故治之以咸寒佐之以甘甘胜咸所以防其过也必甘而苦者防咸之过
而又以泻热气作实也热散于诸经以酸收之热结而不散以苦发之张志聪曰热乃火气水能胜之故宜治以咸寒佐以苦甘甘胜咸
所以防咸之过苦能泄所以去热之实也酸乃木味火生于木以酸收之者收火归原也热郁于内而不解者以苦发之骥案素问热论
评热论两篇论热尤详刘守真六气病谓手少阴君火之热乃真心小肠之气也仲景苦寒有黄连黄芩汤咸寒有黄连阿胶汤重则阳
邪内陷少阴有急下三法用大承气汤皆寒咸苦甘之例是谓正治东垣有夏月中暑身形拘急疼痛心烦肌肤大热无汗谓为房室阴
寒所遏阳气不得升越有大顺散之例此又热淫之变局也
湿淫于内治以苦热佐以酸淡以苦燥之以淡泄之
王冰曰湿与燥反故治以苦热佐以酸淡也燥除湿故以苦燥湿也淡利窍故以淡渗泄也藏气法时论脾苦湿急食苦以燥之灵
枢经淡利窍也生气通天论味过于苦脾气不濡胃气乃浓明苦燥也新校正云按天元正纪大论下太阴其化下甘温吴昆曰湿为土
气苦热从火化能燥湿者也故治以苦热酸从木化能制土者也故佐以酸然必酸淡者淡能利窍故也使酸而非淡则味浓滋湿非所
宜矣湿热之湿以苦燥也湿濡而肿以淡泄之泄渗与汗也骥案杜桐峰湿论谓湿者天地间阴阳蒸润之气也伤则下先受之更喜侵
于脾胃者以其同气相求也刘守真六气病足太阴湿土乃脾胃之气也证见虚寒理中可以温补而淡渗又有五苓散猪苓汤之例若
手足自温未成厥逆亦有取乎四逆之治苦热淡泄此正治也
火淫于内治以咸冷佐以苦辛以酸收之以苦发之
王冰曰火气大行心腹心怒之所生也咸性柔软故以治之以酸收之大法候其须汗者以辛佐之不必要资苦味令其汗也欲柔
软者以咸治之藏气法时论心欲软急食咸以软之心苦缓急食酸以收之此之谓也吴昆曰相火畏火也故治以咸冷苦能泻热辛能
滋养既苦且辛则泻热而滋阴水矣以酸收之以苦发之其义详见上文热淫条下骥案少阳相火在经主半表半里仲景立小柴汤为
和解之局若火结甚而为痞则有泻心诸汤旋覆代赭汤黄芩汤干姜黄芩黄连汤诸治所以散结除满皆苦寒清冷之例刘守真六气
病少阳相火之热乃心包三焦之气故治有正法有变例刘宗浓火论凡动皆属火火不妄动随触而发人在气交之中多动少静火一
妄动元气更伤故火证独多内经病机十九条而属火者五然火有君火相火君火可以轻伏可以水灭可以直折芩连之属可以制之
相火则不可以水折当从其性而伏之若饮食劳倦内伤元气之火宜甘温之剂以除之阳亢阴微煎熬血液之火宜甘寒以降之若左
肾真阴失守而火炽则地黄元参之类可以壮水制阳若右肾命门虚弱火衰则桂附之类可以消阴益火若胃虚过食冷物抑遏阳气
于脾土之中则升麻葛根可以升散郁火然则治火之法多端未可一概也
燥淫于内治以苦温佐以甘辛以苦下之
王冰曰温利凉性故以苦治之下谓利之使不得也新校正云按藏气法时论肺苦气上逆急食苦以泄之用辛泻之酸补之又按
下文司天燥淫所胜佐以酸辛此云甘辛者甘字疑当作酸天元正纪大论下酸热与苦温之治又异又云以酸收之而安其下甚则以
苦泄之也吴昆曰燥为金气火能胜之故治以苦温苦温从火化故也甘辛亦温也燥而中寒者宜佐之燥热之燥以苦下之可也骥案
素问病机十九条遗漏燥证为其兼风热之化但言风热而燥在其中刘守真于六气病补出诸涩枯涸干劲皮揭皆属于燥谓阳明燥
金在肺与大肠之表也夫风能胜湿湿去则燥生燥兼热化热即火也易曰燥万物者莫叹乎火故喻
昌补燥气论其方用甘润微寒而有
清燥救肺之设叶桂亦有燥气化火之论主于辛凉甘润即经燥化于火热反胜之治以辛凉佐以苦甘也乃燥之胜气非燥之本气也
沈目南燥病论燥令必以凉气感人肝木受邪而为燥故燥病属凉谓之次寒病与伤寒同类故此但云燥淫于内治以苦温沈明生燥
论治燥之法以沸釜为喻血喻汤气喻火火猛汤沸当沃薪灭火犹芩连栀膏朴硝大黄大苦至寒等剂清降火邪若沸久将干又当添
益新水胜火犹冬地参 归芍甘寒甘温之剂气血双补则燥得所润而火有所制也医垒元戎治燥方北方其脉迟寒燥也宜温热药
治之如硫附桂姜之属吴溏温病条辨于燥门立桑菊饮沙参麦冬汤翘荷汤治胜气之燥立杏苏饮加味桂柴各半汤治本气之燥所
谓秋燥之气轻则为燥重则为寒化气为湿复气为火故经有辛凉苦温之二法也
寒淫于内治以甘热佐以苦辛以咸泻之以辛润之以苦坚之
王冰曰以热治寒是为摧胜折其气用令不滋繁也苦辛之佐通事行之新校正云按藏气法时论肾苦燥急食辛以润之肾欲坚
急食苦以坚之用苦补之咸泻之旧注引此在湿淫于内之下无义今移于此吴昆曰寒为水气甘从土化热从火化土能制水热能制
寒故治以甘热苦而辛亦热品也故佐以苦辛伤寒内热者以咸泻之伤寒内燥者以辛润之伤寒内热见血者以苦坚之骥案太阳寒
水之气在人主表为心肺之阳统一身之荣卫实寒水之所司刘守真六气病足太阳寒水乃肾与膀胱之气也仲景在太阳有麻桂
之例甘热也入少阴有麻辛附子汤附子汤真武汤四逆白通等汤诸法亦甘热也有黄连阿胶汤有急下承气三证又苦寒也张会卿
伤寒约法治分六端曰汗吐下温清补汗主温辛吐主发散下主咸寒清主苦寒温补主甘热于经旨适合盖太阳一经本寒标热对化
为火水胜必克火论中之麻桂姜附治寒之本气正化之本病也白虎承气治寒之复气对化之标病也故曰不明胜复之理不可与言
气化
司天之气风淫所胜平以辛凉佐以苦甘以甘缓之以酸泻之
王冰曰厥阴之气未为盛热故曰凉药平之夫气之用也积凉为寒积温为热以热少之则其温也以寒少之则其凉也以温多之
则其热也以凉多之则其寒也各当其分则寒寒也温温也热热也凉凉也方书之用可不务乎故寒热温凉升降多少善为方者意必
精通余气皆然从其制也新校正云按本论上文云上淫于下所胜平之外淫于内所胜治之故在泉曰治司天曰平也吴昆曰在泉言
治司天言平平与治少异治有攻去之义平则调和之也风胜而平以辛凉金能平木也佐以苦甘则苦不至于燥急木性急故以甘缓
之木气升而不降故以酸泻之张志聪曰按在泉之气曰淫于内而曰治司天之气曰所胜而曰平盖天气在外而地气在内也治者治
其内而使之外平者平其上而使之下是以在泉曰以辛散之在司天曰以酸泻之马莳曰风淫所胜则平以辛凉佐以苦甘以甘缓之
以酸泻之彼厥阴在泉者其法与此同而复有以辛散之之语耳无以酸泻之也骥案己亥岁半以上风化于天风为木气惟金能胜故
治以辛凉辛从金化凉为金气也辛凉太过反伤金气故佐以苦甘苦能温金甘能益气也经曰
肝苦急急食甘以缓之以酸泻之此生克
胜复之理五营运大论天地之气胜复之作不形于诊六微旨大论气有胜复太过者气胜胜而复制则伤害甚不及者气衰衰而复克
则败乱极胜复循环之理出乎天地之自然如木胜肝强必伤脾土肝胜不已燥必复之而肝亦病燥胜不已火必复之而肺亦病五藏
互有盛衰人身自有虚实惟其有虚而复强者胜之有胜而复承者复之无衰无胜无胜无复其气和平焉得有病有胜则复无胜则否
胜微复微胜甚复胜胜复之微甚实由变化之盛衰马元素辈假仲景之名而为伤寒铃法用运气之更迁拟主病之方治拘滞不通是
不明天道生克胜复之理不足与言医道
热淫所胜平以咸寒佐以苦甘以酸收之
王冰曰热气已退时发动者是为心虚气散不敛以酸收之既以酸收亦兼寒助乃能殄除其源本矣热见太甚则以苦发之汗已
便凉是邪气尽勿寒水之汗已犹热是邪气未尽则以酸收之已又热则复汗之已汗复热是藏虚也则补其心可矣法则合尔诸治热
者亦未必得再三发三治况四变而反复者乎吴昆曰热胜而平以咸寒水能平火也佐以苦甘者苦泻而甘缓也以酸收之者收其浮
热也张志聪曰此与在泉之治法相同但少以苦发之盖自下而上淫于内者宜从之而发散于外也骥案此子午岁半以上热化于天
热为火气惟水能胜故治以咸寒咸寒太过反伤君火故以苦燥以甘补以酸收恐热越不敛阳气散乱也
湿淫所胜平以苦热佐以酸辛以苦燥之以淡泄之
王冰曰湿气所淫皆为肿满但除其湿肿满自衰因湿生病不肿不满者亦尔治之湿气在上以苦吐之湿气在下以苦泄之以淡
渗之则皆燥也泄谓渗泄以利水道下小便为法然酸虽热亦用利小便去伏水也治湿之病不下小便非其法也新校正云按湿淫于
内佐以酸淡此云酸辛者辛疑当作淡吴昆曰湿胜而平以苦热苦能燥湿湿得热而消也木能制土故佐以酸酸而辛则非敛聚之酸
矣故宜佐之湿而热者以苦燥之湿而不热以淡渗之马莳曰湿淫所胜则平以苦热佐以酸辛以苦燥之以淡泄之彼太阴在泉者其
法与此大同而止有佐以酸淡与此佐以酸辛者少异骥案丑未岁半以上湿化于天湿为土气惟燥能胜故治以苦热苦从木化用以
制之辛酸并同者辛胜酸防酸之过也苦从火化火能助燥
湿上甚而热治以苦温佐以甘辛以汗为故而止
王冰曰身半以上湿气有余火气复郁郁湿相薄则以苦温甘辛药解表流汗而祛之故云以汗除病之故而已也吴昆曰金匮要
略腰以下肿当利小便腰以上肿当发汗乃愈此皆治水湿之要法骥案湿郁于上而化热苦温欲其燥甘辛取其汗
火淫所胜平以酸冷佐以苦甘以酸收之以苦发之以酸复之热淫同
王冰曰同热淫义热亦如此法以酸复其木气也不复其气则淫气空虚招其损马莳曰火淫所胜则平以咸冷佐以苦甘以酸收
之以苦发之以酸复之与上热淫所胜者同法盖上为君火而此为相火也又与彼少阳在泉者同法但无以酸复之之一语耳张介宾
曰此与在泉热淫治同盖水能胜火故平以咸冷苦能泻火之实甘能缓火之急故佐以苦甘火盛而散越者以酸收之火郁而伏留者
以苦发之然以发去火未免伤气故又当以酸复之而火热二气同治也骥案寅申岁半以上火化于天火即热气与热淫同此曰酸冷
者酸能收逆气寒能胜热气也火郁则伏以苦发之而复以酸复之者恐发之过而伤气也
燥淫所胜平以苦湿佐以酸辛以苦下之
王冰曰制燥之胜必以苦湿是以火之气味也宜下必以苦宜补必以酸宜泻必以辛清甚生寒留而不去则以苦湿下之气有余
则以辛泻之诸气同新校正云按上文燥淫于内治以苦温此云苦湿者湿当为温又注中湿字三并当作温又按六元正纪大论亦作
苦小温吴昆曰燥淫而平以苦湿苦从火化胜燥故也苦而湿则燥得其润矣佐以酸辛者酸生液辛润燥也燥甚非攻下不除是宜以
苦下之张志聪曰苦温能胜清金辛能润燥燥必内结故以酸苦泄之马莳曰燥淫所胜则平以苦温佐以酸辛以苦下之彼阳明在泉
者其法与此大同但彼则佐以甘辛而此则佐以酸辛耳骥案卯酉岁半以上燥化于天燥为金气惟火能胜苦从火化故平以苦温酸
泻木而补金辛泻金而补木故佐以酸辛燥兼热化燥万物者莫叹乎火苦能降火故以苦下之
寒淫所胜平以辛热佐以甘苦以咸泻之
王冰曰淫散止之不可过也新校正云按上文寒淫于内治以甘热佐以苦辛此云平以辛热佐以甘苦者此文为误又按六元正
纪大论云太阳之政岁宜苦以燥之也吴昆曰寒淫而平以辛热者辛能散寒热能回阳也佐以苦甘者苦以济辛热甘以和辛热也伤
寒入胃则为里热若是者以咸泻之张志聪曰夫淫于内则干涉于藏气故上文曰以辛润之以苦坚之此胜于外止宜平之泻之马莳
曰寒淫所胜则平以辛热佐以苦甘以咸泻之彼太阳在泉者则复有以辛润之以苦坚之之二语耳张介宾曰辛热足以散寒苦甘可
以胜水以咸泻之水之正味其泻以咸也骥案辰戌岁半以上寒化于天寒为水气惟热能胜热从火化也然阴病恶燥故以辛润辛从
金化水之母也
帝曰邪气反胜治之奈何岐伯曰风司于地清反胜之治以酸温佐以苦甘以辛平之
王冰曰厥阴在泉则风司于地谓五寅岁五申岁邪气胜盛故先以酸泻佐以苦甘邪气退则正气虚故以辛温养而平之吴昆曰
黄帝问道：对于这种情况该如何治疗？岐伯回答说：凡是邪气在泉（即位于地下，影响人体下部或内部）的情况，如果风气过盛侵入体内，应当用辛凉的药物来治疗，辅以苦味和甘味的药物。用甘味药来缓解肝气的急迫，用辛味药来疏散风邪。
王冰注释说：风的性质喜欢温暖而厌恶清凉，所以用凉性药来治疗，这是为了克制胜气。辅助使用苦味药是顺应病情的需要。木（肝）的特性是苦于急迫，所以要吃甘味药来缓和它；肝气欲散，所以要吃辛味药来疏散它。这就是《素问·藏气法时论》中说的：“肝苦急，急食甘以缓之；肝欲散，急食辛以散之。”的意思。这里的“食”字，读音同“饲”，意为吃。大致的用药原则就是这样，但制定方剂时不必完全照搬，只要有一味或两味佐使药，病好了就停止。其他邪气的治疗也都遵循这个原则。
吴昆注释说：不务德行称为“淫”。风邪从外侵入体内称为“风淫于内”。风属于木气，金能克木，所以用辛凉药治疗。如果辛凉太过，恐怕会损伤真气，所以辅助以苦甘药。苦味能胜辛，甘味能益气。木性急，所以用甘味药来缓和它；木喜条达舒畅，所以用辛味药来疏散它。
张骥按语：《素问·至真要大论》中提到“风气大来，木之胜也”，以及《六元正纪大论》中说“风病行于上”，《风论》中说风是百病之长，善于行走且变化多端。又有五脏之风，《左传》中秦国的医和说：“淫生六疾”，注解说“淫”是过度的意思。气味声色本来是用来养人的，但如果过度就会产生危害。风只是六气之一。刘完素（守真）在论述六气病时，认为风是厥阴风木，也就是肝的气化。辛凉解表的方剂，张仲景有麻黄连翘赤小豆汤、白虎汤；吴鞠通有银翘散、桑菊饮，这些都是辛凉解肌的例子。然而，李东垣提到的突然昏倒、不省人事的中风，属于本气自病，并非外来邪气，这是由于酒色、劳役、七情、饮食不当导致脏腑之气受伤。王安道称之为“类风”。这是风的一种变局，不是大剂量的人参、附子不能挽回，不能用辛凉药治疗。
热气过盛侵入体内，应当用咸寒的药物来治疗，辅以甘苦药。用酸味药来收敛，用苦味药来发散。
王冰注释说：热的性质厌恶寒冷，所以用寒性药治疗。热势盛大，甚至表现在体表时，用苦味药发散。如果发散不尽，再用寒性药制约它；如果寒性制约不尽，再用苦味药发散。用酸味药来收敛。病情严重的，可以多次处方；病情轻微的，只需一方即可痊愈。如果是时发时止的症状，也用酸味药来收敛。
吴昆注释说：热属于火气，水能克火，所以用咸寒药治疗。辅助以甘味药，是因为甘味能胜咸，防止咸味药过于峻猛。必须配合苦味药，是为了防止咸味药过量，同时又能泻除热气，使其充实。热邪散布在诸经，用酸味药收敛；热邪结聚不散，用苦味药发散。
张志聪注释说：热乃火气，水能胜之，所以宜用咸寒药治疗。辅助以苦甘，甘味胜咸，以防咸味过甚；苦味能泄，以去除热实的病邪。酸是木味，火生于木，用酸味药收敛，是为了收摄浮火，使其归原。热邪郁结在内而不能解除的，用苦味药发散。
张骥按语：《素问》中的《热论》和《评热论》两篇对热病的论述尤为详细。刘完素在六气病中认为，手少阴君火的热，是真心和小肠的气化。张仲景的苦寒方剂有黄连黄芩汤，咸寒方剂有黄连阿胶汤。如果病情严重，阳邪内陷少阴，有三法急下，使用大承气汤，这些都是咸、苦、甘、寒的治疗例子，称为正治。李东垣提到夏季中暑，身体拘急疼痛，心烦，肌肤大热无汗，认为是房室劳伤导致的阴寒遏制了阳气，使其不能升越，有大顺散的例子。这又是热淫的一种变局。
湿气过盛侵入体内，应当用苦热的药物来治疗，辅以酸淡药。用苦味药来燥湿，用淡味药来渗泄。
王冰注释说：湿与燥相反，所以用苦热药治疗，辅助以酸淡药。燥能除湿，所以用苦味药燥湿。淡味能通利窍道，所以用淡味药渗泄。《素问·藏气法时论》中说：“脾苦湿，急食苦以燥之。”《灵枢经》提到淡味能利窍。《生气通天论》说：“味过于苦，脾气不濡，胃气乃浓”，说明苦味过于燥烈。新校正按语指出：《天元正纪大论》中说，太阴在泉，其气化表现为甘温。
吴昆注释说：湿属于土气，苦热药从火化，能燥湿，所以用苦热药治疗。酸味从木化，能克制土，所以辅助以酸味。但必须配合淡味，因为淡味能利窍。如果使用酸味而不配淡味，则味道浓厚反而滋腻助湿，是不适宜的。湿热之湿，用苦味药燥之；湿邪濡滞肿胀，用淡味药泄之。泄就是渗利和发汗。
张骥按语：杜桐峰在《湿论》中说，湿是天地间阴阳蒸腾滋润之气。伤人时，首先受邪的是下部，更倾向于侵犯脾胃，这是因为同气相求。刘完素在六气病中认为，足太阴湿土是脾胃的气化。证见虚寒的，理中汤可以温补并淡渗；还有五苓散、猪苓汤等例子。如果手足自温，未形成厥逆，也可以取法四逆汤的治疗。苦热燥湿，淡渗利湿，这是正治。
火气过盛侵入体内，应当用咸冷的药物来治疗，辅以苦辛药。用酸味药来收敛，用苦味药来发散。
王冰注释说：火气大行，是由心腹之心怒所产生。咸性柔软，所以用它来治疗。根据大法，如果需要发汗，就辅助以辛味药，不一定非要借助苦味药来令其出汗。想要达到柔软的效果，就用咸味药治疗。《素问·藏气法时论》中说：“心欲软，急食咸以软之；心苦缓，急食酸以收之。”就是这个意思。
吴昆注释说：相火畏惧火，所以用咸冷药治疗。苦味能泻热，辛味能滋养。既苦又辛，就能泻热滋阴。用酸味药收敛，用苦味药发散，其含义详见上文“热淫”条下。
张骥按语：少阳相火在经脉中主管半表半里。张仲景设立小柴胡汤作为和解的方法。如果火邪结聚严重而形成痞证，则有泻心诸汤，如旋覆代赭汤、黄芩汤、干姜黄芩黄连汤等治疗方法，都是为了散结除满，都是苦寒清冷的例子。刘完素在六气病中认为，少阳相火的热，是心包和三焦的气化，所以治疗有正法和变例。刘宗浓在《火论》中说，凡是动的现象都属火，火不会妄动，随触而发。人在气交之中，多动少静，火一旦妄动，元气更加受损，所以火证特别多。《内经》病机十九条中，属于火的有五条。然而火有君火和相火之分。君火可以用轻剂伏制，用水灭掉，或者直接用黄芩、黄连等直折其火；相火则不能用水折服，应当顺从其性质而伏制它。如果是饮食劳倦内伤元气之火，适宜用甘温剂来消除；如果是阳亢阴微、煎熬血液之火，适宜用甘寒剂来降火；如果是左肾真阴失守而火炽，可以用地黄、玄参之类壮水制阳；如果是右肾命门虚弱、火衰，可以用肉桂、附子之类消阴益火；如果是胃虚过食冷物，抑遏阳气于脾土之中，可以用升麻、葛根升散郁火。那么治疗火的方法多种多样，不可一概而论。
燥气过盛侵入体内，应当用苦温的药物来治疗，辅以甘辛药。用苦味药来攻下。
王冰注释说：温性能利，凉性则否，所以用苦味药治疗。“下”是指通利，使其不得停滞。新校正按语指出：《藏气法时论》中说：“肺苦气上逆，急食苦以泄之；用辛泻之，酸补之。”又看下文“司天燥淫所胜，佐以酸辛”，这里说是“甘辛”，“甘”字疑当作“酸”。《天元正纪大论》中也有酸热与苦温的治疗，又说“以酸收之而安其下，甚则以苦泄之”。
吴昆注释说：燥属于金气，火能胜金，所以用苦温药治疗，因为苦温从火化。甘辛也是温性的。如果燥而兼中寒，应该辅助以甘辛。燥热之燥，用苦味药攻下是可以的。
张骥按语：《素问》病机十九条遗漏了燥证，因为它是兼夹风热变化的，只说了风热，而燥在其中。刘完素在六气病中补充了“诸涩枯涸，干劲皴揭，皆属于燥”，认为阳明燥金在肺与大肠之表。风能胜湿，湿去则燥生。燥兼热化，热即为火。《易经》说：“燥万物者，莫熯乎火。”所以喻昌补充了《燥气论》，他的方剂用甘润微寒，设有清燥救肺汤。叶桂也有燥气化火的论述，主张用辛凉甘润，即经过燥化后火热反胜，治以辛凉，辅助以苦甘。这是燥的胜气，而非燥的本气。沈目南在《燥病论》中说，燥令必然以凉气感人，肝木受邪而为燥，所以燥病属凉，称为次寒，病与伤寒同类。因此这里只说“燥淫于内，治以苦温”。沈明生在《燥论》中，将治燥之法比喻为烧沸的釜：血像汤，气像火。火猛汤沸，当添加薪柴灭火，犹如黄芩、黄连、栀子、石膏、朴硝、大黄等大苦大寒之剂清降火邪；如果烧久了水将干，又当添益新水，胜火犹如用地骨皮、熟地、人参、当归、芍药等甘寒、甘温之剂气血双补，则燥得到滋润，火得到制约。《医垒元戎》治燥方认为，北方脉迟，是寒燥，适宜用温热药治疗，如硫磺、附子、肉桂、干姜之类。吴溏在《温病条辨》燥门中，立桑菊饮、沙参麦冬汤、翘荷汤治疗胜气之燥；立杏苏饮、加味桂枝柴胡各半汤治疗本气之燥。所谓秋燥之气，轻则为燥，重则为寒，化为湿，复气为火。所以经文有辛凉、苦温两种方法。
寒气过盛侵入体内，应当用甘热的药物来治疗，辅以苦辛药。用咸味药来泻，用辛味药来润，用苦味药来坚。
王冰注释说：用热治寒，是为了摧毁胜气，折损其气势，使其不再滋长繁盛。苦辛作为辅助，是通用的做法。新校正按语指出：《藏气法时论》中说：“肾苦燥，急食辛以润之；肾欲坚，急食苦以坚之；用苦补之，咸泻之。”旧注将此引用于“湿淫于内”之下，没有意义，现在移于此。
吴昆注释说：寒属于水气，甘从土化，热从火化。土能制水，热能制寒，所以用甘热药治疗。苦和辛也是热性品，所以辅助以苦辛。伤寒内有热者，用咸味药泻之；伤寒内有燥者，用辛味药润之；伤寒内热见血者，用苦味药坚之。
张骥按语：太阳寒水之气在人主表，是心肺之阳统一身的荣卫，实为寒水之所司。刘完素在六气病中认为，足太阳寒水是肾与膀胱的气化。张仲景在太阳病中有麻黄汤、桂枝汤的例子，属于甘热；入少阴病有麻黄细辛附子汤、附子汤、真武汤、四逆汤、白通汤等诸法，亦属甘热。也有黄连阿胶汤和急下承气三证，又属苦寒。张会卿在《伤寒约法》中将治法分为六端：汗、吐、下、温、清、补。汗主温辛，吐主发散，下主咸寒，清主苦寒，温补主甘热，这与经文旨意相符。盖太阳一经，本寒标热，对化为火。水胜必克火。论中的麻黄、桂枝、干姜、附子治疗寒的本气、正化的本病；白虎汤、承气汤治疗寒的复气、对化的标病。所以说：不明白胜复的道理，不可以谈论气化。
司天之气，风气过盛，应当用辛凉药平调，辅以苦甘药。用甘味药来缓和，用酸味药来泻。
王冰注释说：厥阴之气尚未盛热，所以叫凉药平调。气的运用，积凉为寒，积温为热。稍微用热，则其温；稍微用寒，则其凉；用温多，则其热；用凉多，则其寒。各当其分，则寒寒、温温、热热、凉凉。方书的使用，能不讲究吗？所以寒热温凉、升降多少，善于开方的人必须精通。其他余气也都如此，顺从其制约。新校正按语指出：按本篇上文说“上淫于下，所胜平之；外淫于内，所胜治之”。所以在泉曰“治”，司天曰“平”。
吴昆注释说：在泉言“治”，司天言“平”。“平”与“治”稍有不同的意思。“治”有攻去的意思，“平”则是调和的意思。风胜而平以辛凉，金能平木。辅助以苦甘，则苦不至于燥急，木性急，所以用甘味药缓和它。木气升而不降，所以用酸味药泻之。
张志聪注释说：按在泉之气曰“淫于内”而曰“治”，司天之气曰“所胜”而曰“平”。大概天气在外而地气在内。治者是治其内而使之外，平者是平其上而使之下。所以在泉曰“以辛散之”，在司天曰“以酸泻之”。
马莳注释说：风淫所胜，则平以辛凉，佐以苦甘，以甘缓之，以酸泻之。彼厥阴在泉者，其法与此相同，但多了一个“以辛散之”的话，而没有“以酸泻之”的话。
张骥按语：己亥岁，上半年风化于天。风为木气，惟金能胜，故治以辛凉。辛从金化，凉为金气。辛凉太过，反伤金气，故佐以苦甘。苦能温金，甘能益气。经曰：“肝苦急，急食甘以缓之；以酸泻之。”这是生克胜复的道理。《五运行大论》说天地之气胜复之作，不形于诊；《六微旨大论》说气有胜复，太过者气胜胜而复制，则伤害甚；不及者气衰，衰而复克，则败乱极。胜复循环之理，出乎天地之自然。如木胜，肝强必伤脾土；肝胜不已，燥必复之而肝亦病燥；燥胜不已，火必复之而肺亦病。五脏互有盛衰，人身自有虚实。惟其有虚而复强者，胜之；有胜而复承者，复之。无衰无胜，无胜无复，其气和平焉，哪里有病？有胜则复，无胜则否。胜微复微，胜甚复胜。胜复之微甚，实由变化之盛衰。马元素等人假托张仲景之名而为《伤寒铃法》，用运气的更迁拟主病之方治，拘滞不通，是不明天道生克胜复之理，不足与言医道。
热气过盛，应当用咸寒药平调，辅以苦甘药。用酸味药来收敛。
王冰注释说：热气已退，时发动者，是为心虚气散不敛，以酸收之。既然以酸收，亦兼寒助，乃能殄除其源本矣。热见太甚，则以苦发之。汗已便凉，是邪气尽，勿寒水之；汗已犹热，是邪气未尽，则以酸收之。已又热，则复汗之。已汗复热，是脏虚也，则补其心可矣。法则合尔。诸治热者，亦未必得再三发、三治，况四变而反复者乎？
吴昆注释说：热胜而平以咸寒，水能平火也。佐以苦甘者，苦泻而甘缓也。以酸收之者，收其浮热也。
张志聪注释说：此与在泉之治法相同，但少以苦发之。盖自下而上淫于内者，宜从之而发散于外也。
张骥按语：此子午岁，上半年热化于天。热为火气，惟水能胜，故治以咸寒。咸寒太过，反伤君火，故以苦燥，以甘补，以酸收，恐热越不敛，阳气散乱也。
湿气过盛，应当用苦热药平调，辅以酸辛药。用苦味药来燥湿，用淡味药来渗泄。
王冰注释说：湿气所淫，皆为肿满。但除其湿，肿满自衰。因湿生病，不肿不满者，亦尔治之。湿气在上，以苦吐之；湿气在下，以苦泄之；以淡渗之，则皆燥也。泄谓渗泄，以利水道，下小便为法。然酸虽热，亦用利小便，去伏水也。治湿之病，不下小便，非其法也。新校正按语指出：按“湿淫于内，佐以酸淡”，这里说“酸辛”，“辛”疑当作“淡”。
吴昆注释说：湿胜而平以苦热，苦能燥湿，湿得热而消也。木能制土，故佐以酸。酸而辛，则非敛聚之酸矣，故宜佐之。湿而热者，以苦燥之；湿而不热，以淡渗之。
马莳注释说：湿淫所胜，则平以苦热，佐以酸辛，以苦燥之，以淡泄之。彼太阴在泉者，其法与此大同，而止有佐以酸淡，与此佐以酸辛者少异。
张骥按语：丑未岁，上半年湿化于天。湿为土气，惟燥能胜，故治以苦热。苦从木化，用以制之。辛酸并同者，辛胜酸，防酸之过也。苦从火化，火能助燥。
湿气在上而化热，应当用苦温药治疗，辅以甘辛药。以出汗为度而止。
王冰注释说：身半以上湿气有余，火气复郁郁，湿相薄，则以苦温甘辛药解表流汗而祛之。故云以汗除病之故而已也。
吴昆注释说：《金匮要略》说：“腰以下肿，当利小便；腰以上肿，当发汗乃愈。”此皆治水湿之要法。
张骥按语：湿郁于上而化热，苦温欲其燥，甘辛取其汗。
火气过盛，应当用酸冷药平调，辅以苦甘药。用酸味药来收敛，用苦味药来发散，用酸味药来恢复（正气）。热淫的治疗方法相同。
王冰注释说：同热淫义。热亦如此法。以酸复其木气也。不复其气，则淫气空虚，招其损。
马莳注释说：火淫所胜，则平以咸冷，佐以苦甘，以酸收之，以苦发之，以酸复之。与上热淫所胜者同法。盖上为君火而此为相火也。又与彼少阳在泉者同法，但无以酸复之之一语耳。
张介宾注释说：此与在泉热淫治同。盖水能胜火，故平以咸冷。苦能泻火之实，甘能缓火之急，故佐以苦甘。火盛而散越者，以酸收之；火郁而伏留者，以苦发之。然以发去火，未免伤气，故又当以酸复之。而火热二气同治也。
张骥按语：寅申岁，上半年火化于天。火即热气，与热淫同。此曰酸冷者，酸能收逆气，寒能胜热气也。火郁则伏，以苦发之，而复以酸复之者，恐发之过而伤气也。
燥气过盛，应当用苦温药平调，辅以酸辛药。用苦味药来攻下。
王冰注释说：制燥之胜，必以苦温，是以火之气味也。宜下必以苦，宜补必以酸，宜泻必以辛。清甚生寒，留而不去，则以苦温下之。气有余，则以辛泻之。诸气同。新校正按语指出：按上文“燥淫于内，治以苦温”，这里说“苦湿”，“湿”当为“温”。又注中“湿”字三，并当作“温”。又按《六元正纪大论》亦作“苦小温”。
吴昆注释说：燥淫而平以苦温，苦从火化，胜燥故也。苦而温，则燥得其润矣。佐以酸辛者，酸生津液，辛润燥也。燥甚，非攻下不除，是宜以苦下之。
张志聪注释说：苦温能胜清金，辛能润燥。燥必内结，故以酸苦泄之。
马莳注释说：燥淫所胜，则平以苦温，佐以酸辛，以苦下之。彼阳明在泉者，其法与此大同，但彼则佐以甘辛，而此则佐以酸辛耳。
张骥按语：卯酉岁，上半年燥化于天。燥为金气，惟火能胜。苦从火化，故平以苦温。酸泻木而补金，辛泻金而补木，故佐以酸辛。燥兼热化，“燥万物者，莫熯乎火”，苦能降火，故以苦下之。
寒气过盛，应当用辛热药平调，辅以甘苦药。用咸味药来泻。
王冰注释说：淫散止之，不可过也。新校正按语指出：按上文“寒淫于内，治以甘热，佐以苦辛”，这里说“平以辛热，佐以甘苦”，此文为误。又按《六元正纪大论》云：“太阳之政，岁宜苦以燥之也。”
吴昆注释说：寒淫而平以辛热者，辛能散寒，热能回阳也。佐以苦甘者，苦以济辛热，甘以和辛热也。伤寒入胃，则为里热，若是者，以咸泻之。
张志聪注释说：夫淫于内，则干涉于脏气，故上文曰“以辛润之，以苦坚之”。此胜于外，止宜平之、泻之。
马莳注释说：寒淫所胜，则平以辛热，佐以甘苦，以咸泻之。彼太阳在泉者，则复有“以辛润之，以苦坚之”之二语耳。
张介宾注释说：辛热足以散寒，苦甘可以胜水，以咸泻之。水之正味，其泻以咸也。
张骥按语：辰戌岁，上半年寒化于天。寒为水气，惟热能胜。热从火化也。然阴病恶燥，故以辛润。辛从金化，水之母也。
黄帝问道：如果邪气反胜，该如何治疗？岐伯回答说：风气在地下（在泉），如果清气（金气）反胜，应当用酸温药治疗，辅以苦甘药。用辛味药来平调。
王冰注释说：厥阴在泉，则风司于地。谓五寅岁、五申岁，邪气胜盛，故先以酸泻，佐以苦甘。邪气退则正气虚，故以辛温养而平之。
吴昆注释说：
Yellow Emperor asked, "How should this be treated?" Qibo replied, "In cases where pathogenic factors are in the Earth (influencing the lower body or interior), if Wind excess invades the interior, treatment should employ Pungent-Cool herbs. Bitter and Sweet herbs should be used as assistants. Sweet herbs are used to relieve hepatic urgency, and Pungent herbs are used to disperse Wind."
Wang Bing commented: "Wind's nature prefers warmth and dislikes coolness; therefore, Cool herbs are used to treat it, which is to counteract the excess pathogen. Bitter herbs are added as assistants to follow the beneficial direction. Wood (Liver) suffers from urgency, so Sweet herbs should be eaten to relax it; Liver desires dispersion, so Pungent herbs should be eaten to disperse it. This refers to the statement in *Suwen: Zangqi Fashi Lun*: 'When the Liver suffers from urgency, eat Sweet herbs quickly to relax it; when the Liver desires dispersion, eat Pungent herbs quickly to disperse it.' The character 'Shi' (eat) is pronounced like 'Si' (to feed). This is the general principle of medication. However, when formulating prescriptions, one need not use all of them strictly; once one or two assistant herbs have cured the disease, stop using them. The same applies to other pathogenic factors."
Wu Kun commented: "Lack of virtue is called 'Yin' (excess/abnormality). Wind pathogen entering the interior from the exterior is called 'Wind Yin Yu Nei'. Wind belongs to Wood Qi, and Metal can overcome Wood; thus, Pungent-Cool herbs are used for treatment. If Pungent-Cool is excessive, it may damage True Qi, so Bitter and Sweet herbs are used as assistants. Bitter overcomes Pungent, and Sweet tonifies Qi. Wood's nature is urgent, so Sweet herbs are used to relax it; Wood likes free flow, so Pungent herbs are used to disperse it."
Zhang Ji noted: "*Suwen: Zhizhen Yao Dalun* states 'When Wind Qi is great, Wood prevails,' and *Liuyuan Zhengji Dalun* states 'Wind diseases occur above.' *Feng Lun* states that Wind is the chief of a hundred diseases, moving swiftly and changing frequently. There are also Five Zang Winds. In *Zuo Zhuan*, Qin physician He said, 'Excess generates six illnesses,' with annotations explaining 'Yin' as excess. Flavors, smells, sounds, and colors nourish humans, but excess causes harm. Wind is only one of the Six Qi. Liu Wusou (Shouzhen) in his discussion of Six Qi diseases considered Wind as Jueyin Wind-Wood, which is the Qi transformation of the Liver. For Pungent-Cool exterior-resolving formulas, Zhang Zhongjing had Mahlian Lianqiao Xiaodou Tang (Mahuang, Forsythia, and Soybean Decoction) and Baihu Tang (White Tiger Decoction); Wujutong had Yinqiao San (Honeysuckle and Forsythia Powder) and Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction), all examples of Pungent-Cool muscle-relieving methods. However, Li Dongyuan's description of sudden fainting and loss of consciousness due to Stroke (Zhongfeng) belongs to primary Qi self-disease, not external pathogens. This results from injury to Zang Qi due to alcohol, sexual indulgence, labor, emotional stress, and improper diet. Wang Andao called this 'Lei Feng' (Similar Wind). This is a variant pattern of Wind, which cannot be reversed without large doses of Renshen (Ginseng) and Fuzi (Aconite Root), and should not be treated with Pungent-Cool herbs.
If Heat excess invades the interior, treatment should employ Salty-Cold herbs, assisted by Bitter and Sweet herbs. Sour herbs are used to astringe, and Bitter herbs are used to vent/discharge."
Wang Bing commented: "Heat's nature dislikes cold; thus, Cold herbs are used for treatment. When Heat is extremely abundant, even manifesting on the exterior, Bitter herbs are used to vent it. If venting does not resolve it completely, Cold herbs are used to control it; if Cold control is insufficient, Bitter herbs are used again to vent. Sour herbs are used to astringe. For severe cases, multiple prescriptions may be needed; for mild cases, one prescription suffices. For symptoms that come and go, Sour herbs are also used to astringe."
Wu Kun commented: "Heat belongs to Fire Qi, and Water can overcome Fire; thus, Salty-Cold herbs are used. Sweet herbs are added because Sweet overcomes Salty, preventing Salty herbs from being too harsh. Bitter herbs must be included to prevent excess Salty and to drain Heat, making it solid. When Heat scatters through the meridians, Sour herbs are used to astringe it; when Heat knots and does not scatter, Bitter herbs are used to vent it."
Zhang Zhicon commented: "Heat is Fire Qi, and Water can overcome it; thus, Salty-Cold herbs are appropriate. Assisted by Bitter and Sweet, Sweet overcomes Salty to prevent excess, while Bitter drains to remove Heat excess. Sour is the flavor of Wood; Fire is born from Wood. Using Sour herbs to astringe is to gather floating Fire back to its origin. When Heat is constrained internally and unresolved, Bitter herbs are used to vent it."
Zhang Ji noted: *Suwen*'s *Relun* and *Ping Relun* discuss Heat diseases in detail. Liu Wusou, in Six Qi diseases, stated that Hand Shaoyin Junfire Heat is the Qi transformation of the Heart and Small Intestine. Zhang Zhongjing's Bitter-Cold formula includes Huanglian Huangqin Tang (Coptis and Scutellaria Decoction), and Salty-Cold formula includes Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction). If severe, Yang pathogen sinks into Shaoyin, requiring three urgent purging methods using Dachengqi Tang (Major Order the Qi Decoction), all examples of Salty, Bitter, Sweet, and Cold treatments, known as Correct Treatment. Li Dongyuan mentioned summerheat stroke with stiffness, pain, restlessness, high skin temperature, and anhidrosis, attributing it to Yin cold from sexual activity suppressing Yang Qi, preventing its ascent, treating it with Dashun San (Great Harmony Powder). This is another variant of Heat Yin.
If Dampness excess invades the interior, treatment should employ Bitter-Hot herbs, assisted by Sour and Acrid/Light herbs. Bitter herbs are used to dry Dampness, and Light/Dan herbs are used to leach/draining."
Wang Bing commented: "Dampness is opposite to Dryness; thus, Bitter-Hot herbs are used, assisted by Sour and Dan (Light/Pale) herbs. Dryness removes Dampness, so Bitter herbs dry Dampness. Dan herbs benefit orifices, so Dan herbs leach Dampness. *Suwen: Zangqi Fashi Lun* states: 'The Spleen suffers from Dampness; eat Bitter herbs quickly to dry it.' *Lingshu Jing* mentions Dan herbs benefit orifices. *Shengqi Tongtian Lun* states: 'Overindulgence in Bitter flavors makes Spleen Qi unmoistened and Stomach Qi thick,' indicating Bitter is overly drying. New Correction notes: *Tianyuan Zhengji Dalun* states Taiyin in Earth has a transformation of Sweet-Warm."
Wu Kun commented: "Dampness belongs to Earth Qi. Bitter-Hot herbs transform via Fire and can dry Dampness, hence Bitter-Hot treatment. Sour transforms via Wood and can control Earth, hence assisted by Sour. But Dan must be included because Dan benefits orifices. If Sour is used without Dan, the thick flavor will moisten and aid Dampness, which is inappropriate. For Damp-Heat, Bitter dries; for Dampness causing edema, Dan leaches. Leaching involves percolation and sweating."
Zhang Ji noted: Du Tongfeng in *Shilun* (Discussion on Dampness) stated that Dampness is the steaming and moistening Qi of Yin and Yang in heaven and earth. When injuring humans, it first affects the lower part and tends to invade the Spleen and Stomach due to similar Qi seeking each other. Liu Wusou considered Foot Taiyin Damp-Earth as the Qi transformation of the Spleen and Stomach. For deficiency-cold patterns, Lizhong Tang (Regulate the Middle Decoction) warms and leaches; there are also examples like Wuling San (Five-Ling Powder) and Zhu Ling Tang (Polyporus Decoction). If hands and feet are warm without jue-ni (cold extremities), Sini Tang (Reverse Reversal Decoction) methods can be applied. Bitter-Hot drying and Dan-leaching constitute correct treatment.
If Fire excess invades the interior, treatment should employ Salty-Cold herbs, assisted by Bitter and Pungent herbs. Sour herbs are used to astringe, and Bitter herbs are used to vent/discharge."
Wang Bing commented: "Fire Qi acts greatly, arising from anger in the heart and abdomen. Salty nature is soft, so it is used for treatment. According to major principles, if sweating is required, Pungent herbs are assisted; Bitter herbs are not necessarily needed to induce sweat. To achieve softness, Salty herbs are used. *Suwen: Zangqi Fashi Lun* states: 'The Heart desires softness; eat Salty herbs quickly to soften it; the Heart suffers from laxity; eat Sour herbs quickly to astringe it.' This is what is meant."
Wu Kun commented: "Xianghuo (Ministerial Fire) fears Fire, so Salty-Cold herbs are used. Bitter drains Heat, and Pungent nourishes. Both Bitter and Pungent drain Heat and nourish Yin. Sour herbs astringe, and Bitter herbs vent. The meaning is detailed under the 'Heat Yin' section above."
Zhang Ji noted: Shaoyang Xianghuo in the meridians governs half-exterior and half-interior. Zhang Zhongjing established Xiaochaihu Tang (Minor Bupleurum Decoction) as a harmonizing method. If Fire knots severely forming Pi (glomus), there are Xiexin Decoctions (Drain the Epigastrium Formulas) such as Xuanfudaihzhe Tang (Inula and Oyster Shell Decoction), Huangqin Tang (Scutellaria Decoction), and Ganjiang Huangqin Huanglian Tang (Dry Ginger, Scutellaria, and Coptis Decoction). These treatments dissipate knots and remove fullness, all examples of Bitter-Cold clearing and cooling. Liu Wusou considered Shaoyang Xianghuo Heat as the Qi transformation of the Pericardium and Sanjiao. Thus, treatment has correct methods and variants. Liu Zongnong in *Huolun* (Discussion on Fire) stated that all movement belongs to Fire; Fire does not move randomly but arises upon contact. Humans exist in the intersection of Qi, moving more than resting; if Fire moves wildly, Yuan Qi is further damaged, so Fire diseases are numerous. Among the Nineteen Pathogenesis Statements in *Neijing*, five belong to Fire. However, Fire is divided into Junhuo (Ruler Fire) and Xianghuo (Ministerial Fire). Junhuo can be lightly suppressed, extinguished by water, or directly折 (broken) by herbs like Huangqin (Scutellaria) and Huanglian (Coptis). Xianghuo cannot be broken by water; its nature must be followed to suppress it. For Fire due to dietary/labor injury damaging Yuan Qi, Sweet-Warm agents are suitable. For Fire due to Yang hyperactivity and Yin deficiency burning blood, Sweet-Cold agents are suitable. For Fire blazing due to Left Kidney True Yin failure, Dihuang (Rehmannia) and Xuanshen (Scrophularia) strengthen Water to control Yang. For Fire decline due to Right Kidney Mingmen weakness, Guizhi (Cinnamon Twig) and Fuzi (Aconite) eliminate Yin and benefit Fire. For Stomach deficiency and cold food suppressing Yang Qi in Spleen Earth, Shengma (Cimicifuga) and Gegen (Pueraria) raise and disperse constrained Fire. Thus, treating Fire has many methods and cannot be generalized.
If Dryness excess invades the interior, treatment should employ Bitter-Warm herbs, assisted by Sweet and Pungent herbs. Bitter herbs are used to purge/downward-drain."
Wang Bing commented: "Warmth promotes flow, unlike Coolness; thus, Bitter herbs are used. 'Xia' (down/purge) means promoting flow to prevent stagnation. New Correction notes: *Zangqi Fashi Lun* states: 'The Lung suffers from rebellious Qi; eat Bitter herbs quickly to drain it; use Pungent to purge, Sour to tonify.' Also, below under 'Siantian Dryness Excess Prevails, Assist with Sour-Pungent', here it says 'Sweet-Pungent'; 'Sweet' is suspected to be a typo for 'Sour'. *Tianyuan Zhengji Dalun* also mentions Acid-Heat and Bitter-Warm treatments differently, stating 'Astringe with Sour to calm the lower, and if severe, drain with Bitter.'"
Wu Kun commented: "Dryness belongs to Metal Qi, and Fire can overcome Metal; thus, Bitter-Warm herbs are used because Bitter-Warm transforms via Fire. Sweet and Pungent are also Warm. If Dryness involves middle cold, assist with Sweet-Pungent. For Dry-Heat, purging with Bitter is appropriate."
Zhang Ji noted: *Suwen* Pathogenesis Nineteen Statements omitted Dryness because it combines with Wind-Heat transformation; only Wind-Heat was mentioned, with Dryness implied. Liu Wusou supplemented Six Qi diseases with 'All astringency, withering, drying, hardness, and scaling belong to Dryness,' considering Yangming Dry-Metal at the exterior of the Lung and Large Intestine. Wind overcomes Dampness; when Dampness leaves, Dryness arises. Dryness combined with Heat transformation becomes Fire. *I Ching* says: 'Nothing dries things like Fire.' Therefore, Yu Chang supplemented *Zaoqilun* (Discussion on Dryness Qi), using Sweet-Moist Mild-Cold herbs, establishing Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction). Ye Gui also discussed Dryness Qi transforming into Fire, advocating Pungent-Cool and Sweet-Moist, i.e., after Dryness transformation, Fire Heat prevails, treated with Pungent-Cool assisted by Bitter-Sweet. This is the prevailing Qi of Dryness, not its fundamental Qi. Shen Munan in *Zaobinglun* (Discussion on Dryness Diseases) stated that Dryness command infects humans with Cool Qi; Liver Wood is injured becoming Dryness, so Dryness diseases belong to Cool, called Secondary Cold, similar to Shanghan (Cold Damage). Thus, it only says 'Dryness Yin Yu Nei, Treat with Bitter-Warm.' Shen Mingsheng in *Zaolun* compared treating Dryness to boiling a pot: Blood is the soup, Qi is the fire. If fire is fierce and soup boils, add wood to extinguish fire, like using Great Bitter-Great Cold agents such as Huangqin, Huanglian, Zhizi, Shigao, Pumixiao, and Dahuang to clear and descend Fire. If boiled long until dry, add new water to overcome fire, like using Dongdi (Winter Date), Shudi (Prepared Rehmannia), Renshen, Danggui, and Baishao Sweet-Cold/Sweet-Warm agents to tonify Qi and Blood, so Dryness gets moisture and Fire is controlled. *Yilei Yuanrong* Dryness treatment formula suggests Northern pulse is slow/cold-Dryness, suitable for Warm-Hot herbs like Liuhuang, Fuzi, Rougui, and Ganjiang. Wu Tang in *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) Dryness chapter established Sangju Yin, Shashen Maidong Tang, and Qiaohe Tang for Prevailing Qi Dryness; established Xingsu Yin and Modified Guizhai Chaihu Ge Ban Tang for Fundamental Qi Dryness. Autumn Dryness Qi is light Dryness, heavy Cold, transforms to Dampness, and returns as Fire. Hence, scriptures mention Pungent-Cool and Bitter-Warm methods.
If Cold excess invades the interior, treatment should employ Sweet-Hot herbs, assisted by Bitter and Pungent herbs. Salty herbs are used to purge, Pungent herbs to moisten, and Bitter herbs to firm/solidify."
Wang Bing commented: "Using Heat to treat Cold destroys excess and breaks its momentum so it does not proliferate. Bitter and Pungent assistants are generally applicable. New Correction notes: *Zangqi Fashi Lun* states: 'The Kidney suffers from Dryness; eat Pungent herbs quickly to moisten it; the Kidney desires firmness; eat Bitter herbs quickly to firm it; use Bitter to tonify, Salty to purge.' Old annotations placed this under 'Dampness Yin Yu Nei' without meaning; now moved here."
Wu Kun commented: "Cold belongs to Water Qi. Sweet transforms via Earth, Hot via Fire. Earth controls Water, Fire controls Cold; thus, Sweet-Hot herbs are used. Bitter and Pungent are also Hot items, so assisted by Bitter-Pungent. For Cold Damage with internal Heat, Salty purges; for internal Dryness, Pungent moistens; for internal Heat with bleeding, Bitter firms."
Zhang Ji noted: Taiyang Cold-Water Qi governs the exterior in humans, unified by Xinfei (Heart-Lung) Yang as Yingwei (Nutritive-Defensive) of the whole body, actually governing Cold-Water. Liu Wusou considered Foot Taiyang Cold-Water as the Qi transformation of the Kidney and Bladder. Zhang Zhongjing in Taiyang disease has Mahuang Tang and Guizhi Tang examples, belonging to Sweet-Hot; entering Shaoyin disease has Mahuang Xixin Fuzi Tang, Fuzi Tang, Zhenwu Tang, Sini Tang, and Baitong Tang methods, also Sweet-Hot. There are also Huanglian Ejiao Tang and Ji Xia Chengqi Three Syndromes, which are Bitter-Cold. Zhang Huiqing in *Shanghan Yuefa* classified treatment into six ends: Sweating, Vomiting, Purging, Warming, Clearing, Tonifying. Sweating leads with Warm-Pungent, Vomiting with Dispersing, Purging with Salty-Cold, Clearing with Bitter-Cold, Warming-Tonifying with Sweet-Hot, fitting the scripture. Taiyang channel has Original Cold and Marked Heat, opposing transformation to Fire. Water overcoming Fire. The text's Mahuang, Guizhi, Ganjiang, Fuzi treat the Original Qi and Positive Transformation Primary Disease of Cold; Baihu and Chengqi treat the Reciprocal Qi and Opposing Transformation Marked Disease of Cold. Thus, it is said: Without understanding Winning and Repaying principles, one cannot speak of Qi transformation.
For Si Tian (Heavenly Command) Qi, if Wind excess prevails, level it with Pungent-Cool, assist with Bitter-Sweet. Use Sweet to relax, and Sour to purge."
Wang Bing commented: "Jueyin Qi is not yet excessively hot, so called Cool herbs to level it. The function of Qi: accumulating Cool creates Cold, accumulating Warm creates Heat. Using slightly Heat makes it Warm; slightly Cold makes it Cool; much Warm makes it Hot; much Cool makes it Cold. Each at its proper portion makes Cold Cold, Warm Warm, Hot Hot, Cool Cool. Can prescription usage not be studied? Thus, Cold/Hot/Warm/Cool, Ascending/Descending, Much/Little must be mastered by good prescribers. Other residual Qi are the same, following their control. New Correction notes: Above in this text, 'Upper Yin Yu Xia, Suo Sheng Ping Zhi; External Yin Yu Nei, Suo Sheng Zhi Zhi.' Thus, Zai Quan says 'Zhi' (Treat), Si Tian says 'Ping' (Level)."
Wu Kun commented: "Zai Quan speaks of 'Zhi', Si Tian speaks of 'Ping'. 'Ping' and 'Zhi' differ slightly. 'Zhi' has the meaning of attacking/removing; 'Ping' means harmonizing. Wind wins and is leveled with Pungent-Cool; Metal levels Wood. Assisting with Bitter-Sweet prevents Bitter from being too drying; Wood is urgent, so Sweet relaxes it. Wood Qi ascends but does not descend, so Sour purges it."
Zhang Zhicon commented: "Zai Quan Qi says 'Yin Yu Nei' and 'Zhi'; Si Tian Qi says 'Suo Sheng' and 'Ping'. Heaven Qi is outside, Earth Qi is inside. 'Zhi' treats the interior to make it exterior; 'Ping' levels the upper to make it lower. Thus, Zai Quan says 'Disperse with Pungent', Si Tian says 'Purge with Sour'."
Ma Shi commented: "Wind Yin Suo Sheng, then Ping with Pungent-Cool, assist with Bitter-Sweet, relax with Sweet, purge with Sour. That Jueyin Zai Quan method is the same as this, but adds 'Disperse with Pungent' and lacks 'Purge with Sour'."
Zhang Ji noted: Ji Hai year, first half Wind transforms in Heaven. Wind is Wood Qi, only Metal can overcome it, so treat with Pungent-Cool. Pungent transforms via Metal, Cool is Metal Qi. Excessive Pungent-Cool damages Metal Qi, so assist with Bitter-Sweet. Bitter warms Metal, Sweet tonifies Qi. Scripture says: 'Liver suffers urgency, eat Sweet quickly to relax it; purge with Sour.' This is the principle of Generation, Control, Winning, and Repaying. *Wuyunxing Dalun* states Heaven and Earth Qi winning/repaying do not show in pulse; *Liuzhi Dalun* states Qi has winning/repaying. Excessive Qi wins then repays, causing great harm; deficient Qi declines then is overcome, causing chaos. The cycle of winning/repaying comes naturally from Heaven and Earth. E.g., Wood wins, Liver strong must injure Spleen Earth; if Liver wins endlessly, Dryness repays and Liver becomes Dry; if Dry wins endlessly, Fire repays and Lung becomes ill. Five Zangs have fluctuating prosperity/decline, human body has deficiency/excess. Only when there is deficiency then recovering strength is it won; when there is winning then receiving support is it repaid. No decline, no winning; no winning, no repaying; Qi is peaceful, how can there be disease? Having winning implies repaying; no winning, no repaying. Minor winning, minor repaying; severe winning, severe repaying. The minor/severe nature of winning/repaying actually stems from the prosperity/decline of changes. Ma Yuansu et al. falsely attributed name to Zhang Zhongjing to create *Shanghan Lingfa*, using Qi Yun migration to mimic main disease prescriptions, rigid and inflexible, not understanding Heavenly Dao generation/control/winning/repaying principles, unworthy of discussing medical Dao.
If Heat excess prevails, level it with Salty-Cold, assist with Bitter-Sweet. Use Sour to astringe."
Wang Bing commented: "When Heat Qi has retreated but flares up intermittently, it is Heart Qi deficiency and scattering, not gathering; use Sour to astringe. Since astringing with Sour, also combine Cold assistance to eradicate the source. If Heat is too severe, vent with Bitter. After sweating, if cool, pathogen is exhausted; do not use Cold water. If still hot after sweating, pathogen is not exhausted; use Sour to astringe. If hot again after astringing, sweat again. If hot again after sweating, it is Zang deficiency; tonify the Heart. The method fits. Treating Heat does not necessarily require repeated sweating/treatment, let alone four changes and reversals."
Wu Kun commented: "Heat wins and is leveled with Salty-Cold; Water levels Fire. Assisting with Bitter-Sweet: Bitter drains, Sweet relaxes. Using Sour to astringe gathers floating Heat."
Zhang Zhicon commented: "This is the same as Zai Quan treatment, but lacks 'vent with Bitter'. Generally, invading interior from bottom up should be dispersed outward."
Zhang Ji noted: Zi Wu year, first half Heat transforms in Heaven. Heat is Fire Qi, only Water can overcome it, so treat with Salty-Cold. Excessive Salty-Cold damages Jun Fire, so dry with Bitter, tonify with Sweet, astringe with Sour, fearing Heat escape and Yang Qi scattering.
If Dampness excess prevails, level it with Bitter-Hot, assist with Sour-Pungent. Use Bitter to dry Dampness, and Dan (Light) to leach."
Wang Bing commented: "Dampness invasion causes swelling and fullness. Remove Dampness, and swelling/fullness naturally subside. Diseases caused by Dampness, whether swollen or not, are treated similarly. Dampness above, vomit with Bitter; Dampness below, drain with Bitter; leach with Dan, and all become dry. Leaching means percolating to benefit water passages, urinating is the method. Although Sour is Hot, it is also used to benefit urination and remove hidden water. Treating Dampness without benefiting urination is not the method. New Correction notes: 'Dampness Yin Yu Nei, assist with Sour-Dan'; here 'Sour-Pungent', 'Pungent' suspected to be 'Dan'."
Wu Kun commented: "Damp wins and is leveled with Bitter-Hot; Bitter dries Dampness, Damp消 (disappears) with Heat. Wood controls Earth, so assist with Sour. Sour and Pungent are not gathering Sour, so suitable to assist. Damp-Heat dried with Bitter; Damp non-Heat leached with Dan."
Ma Shi commented: "Damp Yin Suo Sheng, then Ping with Bitter-Hot, assist with Sour-Pungent, dry with Bitter, leach with Dan. That Taiyin Zai Quan method is mostly same as this, but only assists with Sour-Dan, differing slightly from assisting with Sour-Pungent here."
Zhang Ji noted: Chou Wei year, first half Dampness transforms in Heaven. Dampness is Earth Qi, only Dryness can overcome it, so treat with Bitter-Hot. Bitter transforms via Wood to control it. Sour and Pungent together: Pungent overcomes Sour to prevent Sour excess. Bitter transforms via Fire, Fire aids Dryness.
If Dampness is above and transforms to Heat, treat with Bitter-Warm, assist with Sweet-Pungent. Stop when sweating occurs."
Wang Bing commented: "Above half-body Dampness excess, Fire Qi郁郁 (oppressive), Damp interacts, so use Bitter-Warm Sweet-Pungent herbs to resolve exterior, flow sweat, and dispel. Hence, 'remove disease cause with sweat'."
Wu Kun commented: *Jingui Yaolue* states: 'Swelling below waist, benefit urination; swelling above waist, induce sweat to cure.' These are key methods for treating Water-Dampness."
Zhang Ji noted: Dampness constrained above transforms to Heat; Bitter-Warm desires drying, Sweet-Pungent seeks sweat.
If Fire excess prevails, level it with Acid-Cold, assist with Bitter-Sweet. Use Sour to astringe, Bitter to vent, and Sour to restore. Same as Heat Yin."
Wang Bing commented: "Same meaning as Heat Yin. Heat follows this method. Restore Wood Qi with Sour. Not restoring Qi makes excess Qi empty, inviting damage."
Ma Shi commented: "Fire Yin Suo Sheng, then Ping with Salty-Cold, assist with Bitter-Sweet, astringe with Sour, vent with Bitter, restore with Sour. Same method as previous Heat Yin Suo Sheng. Upper is Jun Fire, this is Xianghuo. Also same as Shaoyang Zai Quan, but lacks 'restore with Sour' phrase."
Zhang Jiebin commented: "Same as Zai Quan Heat Yin treatment. Water overcomes Fire, so level with Salty-Cold. Bitter drains Fire excess, Sweet relieves Fire urgency, so assist with Bitter-Sweet. Fire盛 (abundant) and scattered, astringe with Sour; Fire constrained and latent, vent with Bitter. However, venting to remove Fire inevitably damages Qi, so must restore with Sour. Fire and Heat Qi treated together."
Zhang Ji noted: Yin Shen year, first half Fire transforms in Heaven. Fire is Heat Qi, same as Heat Yin. Here 'Acid-Cold': Acid collects rebellious Qi, Cold overcomes Heat Qi. Fire constrained is latent, vented with Bitter, then restored with Sour, fearing excessive venting damages Qi.
If Dryness excess prevails, level it with Bitter-Warm, assist with Sour-Pungent. Use Bitter to purge/downward-drain."
Wang Bing commented: "Controlling Dryness excess must use Bitter-Warm, which is Fire flavor. Purge requires Bitter, tonify requires Sour, purge requires Pungent. Clear excess generates Cold; lingering and not going, purge with Bitter-Warm. Qi excess, purge with Pungent. All Qi are similar. New Correction notes: 'Dryness Yin Yu Nei, treat with Bitter-Warm'; here 'Bitter-Wet', 'Wet' should be 'Warm'. Also three 'Wet' characters in annotation should be 'Warm'. *Liuyuan Zhengji Dalun* also writes 'Bitter-Slight-Warm'."
Wu Kun commented: "Dryness Yin leveled with Bitter-Warm; Bitter transforms via Fire to overcome Dryness. Bitter and Warm, Dryness gets moistening. Assist with Sour-Pungent: Sour generates fluid, Pungent moistens Dryness. Severe Dryness cannot be removed without purging, so use Bitter to purge."
Zhang Zhicon commented: "Bitter-Warm overcomes Clear Metal, Pungent moistens Dryness. Dryness must knot internally, so drain with Sour-Bitter."
Ma Shi commented: "Dryness Yin Suo Sheng, then Ping with Bitter-Warm, assist with Sour-Pungent, purge with Bitter. That Yangming Zai Quan method is mostly same as this, but assists with Sweet-Pungent, whereas this assists with Sour-Pungent."
Zhang Ji noted: Mao You year, first half Dryness transforms in Heaven. Dryness is Metal Qi, only Fire can overcome it. Bitter transforms via Fire, so level with Bitter-Warm. Sour purges Wood and tonifies Metal, Pungent purges Metal and tonifies Wood, so assist with Sour-Pungent. Dryness combines Heat transformation; 'Nothing dries things like Fire', Bitter descends Fire, so purge with Bitter.
If Cold excess prevails, level it with Pungent-Hot, assist with Sweet-Bitter. Use Salty to purge."
Wang Bing commented: "Excess dispersal stopping, do not exceed. New Correction notes: 'Cold Yin Yu Nei, treat with Sweet-Hot, assist with Bitter-Pungent'; here 'Ping with Pungent-Hot, assist with Sweet-Bitter', this text is erroneous. Also *Liuyuan Zhengji Dalun* says: 'Taiyang governance, year suitable Bitter to dry it.'"
Wu Kun commented: "Cold Yin leveled with Pungent-Hot: Pungent disperses Cold, Hot restores Yang. Assist with Sweet-Bitter: Bitter aids Pungent-Hot, Sweet harmonizes Pungent-Hot. Cold Damage entering Stomach becomes interior Heat; such cases, purge with Salty."
Zhang Zhicon commented: "Yin Yu Nei interferes with Zang Qi, hence above 'Moisten with Pungent, Firm with Bitter'. This wins externally, only suitable to Level and Purge."
Ma Shi commented: "Cold Yin Suo Sheng, then Ping with Pungent-Hot, assist with Sweet-Bitter, purge with Salty. That Taiyang Zai Quan has additional 'Moisten with Pungent, Firm with Bitter' phrases."
Zhang Jiebin commented: "Pungent-Hot sufficient to disperse Cold, Sweet-Bitter sufficient to overcome Water, purge with Salty. Salty is the true flavor of Water, its purge is with Salty."
Zhang Ji noted: Chen Xu year, first half Cold transforms in Heaven. Cold is Water Qi, only Heat can overcome it. Heat transforms via Fire. However, Yin diseases dislike Dryness, so moisten with Pungent. Pungent transforms via Metal, Mother of Water.
Yellow Emperor asked, "If pathogen counter-wins, how to treat?" Qibo replied, "Wind governs in Earth; if Clear Qi (Metal) counter-wins, treat with Acid-Warm, assist with Bitter-Sweet. Level with Pungent."
Wang Bing commented: "Jueyin Zai Quan, Wind governs in Earth. Refers to Wu Yin and Wu Shen years. Pathogen wins strongly, so first purge with Acid, assist with Bitter-Sweet. When pathogen retreats, Zheng Qi is deficient, so nourish and level with Pungent-Warm."
Wu Kun commented: