下降，闭塞而成冬者然。此因虚而寒，因寒而燥，则又当改清润为温润矣。知经知权，知常
知变，乃不愧为司命焉！
喻嘉言曰∶病机一十九条，独遗燥气。夫六气配四时，风于时为春，暑于时为夏，燥于
时为秋，寒于时为冬。湿生于土，土寄旺四时，而季夏十八日为尤旺。窃谓《内经》原文，
当是春伤于风，夏伤于暑，长夏伤于湿，秋伤于燥，冬伤于寒。特传写者，误于暑字下、湿
字上，脱略数字耳！盖秋伤于燥，理之决然而无可疑者也。经又谓咳不止而出白血者死。白
血谓色浅红，似肉似肺，乃肺脏消削之验。然则病机云∶诸气 郁，皆属于肺。诸痿喘
呕，皆属于上。二条指燥病言明甚。至左 胁痛，不能转侧，嗌干面尘，身无膏泽，足
外反热，腰痛惊骇，筋挛，丈夫 疝，妇人少腹痛，目眯 疮，则又燥病之本于肝而散见不
一者也，而要皆秋伤于燥之征也。奈何解者不知病机篇之偶有脱误，竟指燥病为湿病，显与
经旨背而驰哉！经曰∶心移热于肺，传为膈消。肺燥之由来者远矣！苟其人肾水得上交于心，
则心火自得下交于肾，水火既济，何伤肺之有？即或肾水不足，而胃中津液犹足以协济上供
，肺亦不至过燥也。若中下之泽既竭，而高源之水，犹得措于不倾，此必无之事矣。经又云
∶二阳结，谓之消。是手阳明大肠、足阳明胃，热结而精血不荣，致成消渴，舌肉赤裂，大
渴引饮，与膈消义同，治膈消用白虎加人参汤，清燥救肺。观此可知诸气 郁、诸痿喘
呕之属肺燥者，用之亦无不合矣。阴阳别论曰∶二阳之病发心脾，有不得隐曲，女子不
月，其传为风消，传为息贲者，死不治。二阳，阳明胃也。发于心脾者，谓二阳之病发于心
、脾者也。心藏神，脾藏意，心之所发而有所主者谓之意，脾虽藏意，实本于心。思则脾气
结而心气亦结，心气结而心血亦结，燥从中起，伤及阳明，阳明主肌肉。风消者，肌肉如风
消削也。息贲者，息有音而上贲不下，乃因肺气虚不能下归于肾，肾气虚不能上纳乎肺也。
脏腑阴液，销亡殆尽，故直断之曰死不治。
柯韵伯论痉湿异同曰∶病机一十九条，独缺燥病，若诸痉项强，皆属于湿，愚窃疑之，
即本论亦自有痉湿之分，且曰太阳病（寒伤太阳经），发汗太过，因致痉，则痉之属燥无疑矣
。彼诸痉属湿之说，其传写之误乎？抑湿化为燥乎？夫痉乃血虚筋急之状。按六气皆足以致痉
。风寒之痉，乃清气搏激所致。暑湿之痉，或风寒搏激暑湿所致，或暑湿壅遏所致，或暑湿
化燥所致，或发汗太过所致。其搏激壅遏者，非辛润、温润以解之不可；其化燥者，及发汗
太过者，非清润、甘润、温润以濡之不可。又按六经痉病，各有部位∶身以后者属太阳，头
项强急，腰脊反折，髀不可屈， 筋如结，皆其证也；身以前者属阳明，头面动摇，口噤齿
，缺盆纽痛，腿脚挛急，皆其证也；身之侧者属少阳，口眼歪邪，手足牵引，两胁拘
急，半身不遂，皆其证也；腹内拘急，或因吐泻而四肢拘急，属太阴；恶寒蜷卧，尻以
代踵，脊以代头，俯不能仰，属少阴；睾丸上升，宗筋下注，少腹里急，阴中拘挛，膝筋拘
急，属厥阴。然六经部位虽不同，而要皆归于燥。但当辨燥之所因（因寒、因风、因风寒束
搏、暑湿壅遏）所化（风寒化燥、暑湿化燥），以治其原，加引经药，以为之使，不必泥定经
络，逐末而忘其本也。其因风寒搏激致痉者，其证发热、恶寒、无汗、气上冲胸、小便不利
，其脉坚紧，其状强直而口噤，此得之天气，即经所谓诸暴强直，皆属于风是也，勇猛无汗
，故曰刚痉；其因暑湿壅遏致痉者，其证发热、有汗、而不恶寒，其脉沉迟、模糊不清、往
来不利，其状项强KT KT ，此得之地气，即经所谓诸痉项强，皆属于湿是也，软弱有汗，
故名柔痉。仲景治因于风者君葛根，甘凉以治风之动，而又清润治燥也（风阳化热乃可用，
若风寒搏束，又非所宜）；治因于湿热者君栝蒌根，苦降以决湿之壅，而又凉润治燥也。一
药而两用之，不惟不相碍，且可相济，学人所当隅反也。且夫善医者，必用视观察之法，而
辨于其微，辨于其早，以治未病。如项强而痛，即痉之一端，观此便知是太阳经脉血虚，而
预防之。如《伤寒论》云∶脉浮、自汗、心烦、恶寒、而脚挛急，知痉之将作，与以桂枝汤
则厥，与以芍药甘草汤则其脚自伸。甘草甘以缓急，芍药微润微苦，治燥而不腻邪。仲圣用
药，非若后人之顾此失彼也。乃习俗见此，不独不能预防，而且误作风治，辛散发汗，助阳
耗阴，将见项背强直、口噤齿 、腿脚挛急、卧不着席，诸证生矣。此无他，不审虚实
故也。夫治痉之法，当分虚实，而究其所因。其因血虚发痉、妄治发痉者，亟用清和濡润，
以柔化刚之法。其虚甚者，金寒水冷，气结津枯，清润又非所宜，必得温润、甘润，如苁蓉
、枸杞、熟地、阿胶、玉竹、鹿胶、菟丝子之类，方为中HT 。以清润犹禀清秋凉寒之气
，甘润、温润，乃得春和煦育之机。虚燥治法，大率类此。嗟乎！虚实殊途，生死反掌，学
者所当辨于其微，辨于其早也已！
（燥气）下降，闭塞而成为冬季的气候特征。这是因为因虚导致寒，因寒导致燥，那么治疗时就应当将清润之法改为温润之法了。懂得常规与权变，知常达变，才不愧为掌管人命的医生！
喻嘉言说：《素问·至真要大论》中的病机十九条，唯独遗漏了燥气。六气对应四季，风对应春季，暑对应夏季，燥对应秋季，寒对应冬季。湿生于土，土寄旺于四季之中，而在季夏的十八天最为旺盛。我认为《内经》原文应当是：春伤于风，夏伤于暑，长夏伤于湿，秋伤于燥，冬伤于寒。只是传抄者，在“暑”字下、“湿”字上脱漏了一些文字罢了！因为“秋伤于燥”，这是确定的道理，无可怀疑。经文又说：“咳嗽不止且吐出白血的会死亡。”白血是指颜色浅红，像肉又像肺，这是肺脏消削的征象。既然这样，那么病机篇中说：“各种气机郁滞，都归属于肺。各种痿证、喘证、呕吐，都归属于上焦。”这两条明确指的是燥病。至于左侧胁肋疼痛，不能转侧，咽喉干燥，面色如蒙尘，身体没有光泽，足外侧反热，腰痛，惊骇，筋脉拘挛，男子疝气，女子少腹疼痛，眼睛眯细生疮，这些又是燥病源于肝而分散表现不一的情况，但总之都是“秋伤于燥”的征象。为什么解释的人不知道病机篇中偶尔有脱漏错误，竟然把燥病指认为湿病，这明显与经旨背道而驰呢！经文说：“心将热移交给肺，传变为膈消。”肺燥的由来已经很久了！如果一个人的肾水能够上交于心，那么心火自然能够下交于肾，水火既济，怎么会损伤肺呢？即使肾水不足，而胃中的津液还足以协助供给上承，肺也不会过于干燥。如果中焦和下焦的水泽已经枯竭，而高源之水还能保持不倾覆，这一定是没有的事。经文又说：“二阳结，称为消。”这是指手阳明大肠经和足阳明胃经，热结导致精血不能荣养，从而形成消渴，舌体肌肉赤裂，大渴引饮，这与膈消的意义相同，治疗膈消用白虎加人参汤，以清燥救肺。由此可知，对于属于肺燥的各种气机郁滞、各种痿证喘呕等，使用此法也没有不合宜的。《素问·阴阳别论》说：“二阳的病发于心脾，有难以启齿的隐曲之事，女子月经不来，其传变为风消，传变为息贲的，是死症，无法治愈。”二阳，就是阳明胃。发于心脾，是说二阳的病发于心、脾。心藏神，脾藏意，心所发动而有主宰的叫做意，脾虽然藏意，实际上根本在于心。思虑则脾气结滞而心气也结滞，心气结滞而心血也结滞，燥从内部产生，伤及阳明，阳明主肌肉。风消，是指肌肉像被风吹削一样消瘦。息贲，是指呼吸有声而上逆不下，是因为肺气虚不能下归于肾，肾气虚不能上纳于肺。脏腑阴液，销亡殆尽，所以直接断定为死症，无法治愈。
柯韵伯论述痉病与湿病的异同说：病机十九条，唯独缺少燥病，如果说“各种痉病项强，都归属于湿”，我私下对此表示怀疑。即本论中也有痉与湿的区别，并且说太阳病（寒邪伤害太阳经），发汗太过，因而导致痉病，那么痉病属于燥是毫无疑问的。那种“诸痉属湿”的说法，难道是传抄的错误吗？还是湿转化为燥了呢？痉是血虚筋脉紧急的状态。考察六气都足以导致痉病。风寒导致的痉病，是清气搏激所致。暑湿导致的痉病，或是风寒搏激暑湿所致，或是暑湿壅遏所致，或是暑湿化燥所致，或是发汗太过所致。那些因搏激壅遏的，非辛润、温润之法不能解除；那些因化燥及发汗太过的，非清润、甘润、温润之法不能濡养。又考察六经痉病，各有部位：身体后部的属于太阳，头项强急，腰脊反折，大腿不可弯曲，筋脉像打结一样，都是其症状；身体前部的属于阳明，头面动摇，口噤齿紧，缺盆纽痛，腿脚挛急，都是其症状；身体侧部的属于少阳，口眼歪斜，手足牵引，两胁拘急，半身不遂，都是其症状；腹部拘急，或因吐泻而导致四肢拘急，属于太阴；恶寒蜷卧，臀部着地代替脚跟，脊背弯曲代替头部，俯身不能仰起，属于少阴；睾丸上升，宗筋下注，少腹里急，阴中拘挛，膝部筋脉拘急，属于厥阴。然而六经部位虽然不同，但总之都归于燥。只应当辨别燥的原因（因寒、因风、因风寒束搏、暑湿壅遏）以及所化生的性质（风寒化燥、暑湿化燥），以治疗其本源，加入引经药作为向导，不必拘泥于定死的经络，舍本逐末。那些因风寒搏激导致痉病的，症状是发热、恶寒、无汗、气上冲胸、小便不利，脉象坚紧，状态强直而口噤，这是得之于天气，即经文所说的“各种突然发生的强直，都归属于风”，刚猛无汗，所以叫刚痉；那些因暑湿壅遏导致痉病的，症状是发热、有汗、而不恶寒，脉象沉迟、模糊不清、往来不利，状态项强僵硬，这是得之于地气，即经文所说的“各种痉病项强，都归属于湿”，软弱有汗，所以名叫柔痉。张仲景治疗因风邪引起的，以葛根为君药，甘凉以治疗风的动势，而又清润以治燥（如果是风阳化热才可用，若风寒束搏，又不适宜）；治疗因湿热引起的，以栝蒌根为君药，苦降以决断湿的壅遏，而又凉润以治燥。一味药有两种用途，不仅不相妨碍，而且可以相互辅助，学者应当举一反三。况且善于行医的人，一定运用视观察的方法，在细微处辨别，在早期辨别，以治疗未病。比如项强而痛，就是痉病的一个方面，看到这一点就知道是太阳经脉血虚，从而预防它。如《伤寒论》所说：脉浮、自汗、心烦、恶寒、而脚挛急，知道痉病将要发作，给予桂枝汤则会导致四肢厥冷，给予芍药甘草汤则脚自然伸直。甘草甘缓以缓解紧急，芍药微润微苦，治燥而不腻滞邪气。张仲圣用药，不像后人那样顾此失彼。然而习俗见到这种情况，不仅不能预防，反而误作风邪治疗，用辛温发散发汗，助阳耗阴，将会看到项背强直、口噤齿紧、腿脚挛急、卧床时背部不着席等诸证产生。这没有别的缘故，是不审察虚实造成的。治疗痉病的方法，应当分虚实，并探究其原因。那些因血虚发痉、误治发痉的，急切使用清和濡润，以柔化刚的方法。那些虚损严重的，金寒水冷，气结津枯，清润又不适宜，必须得到温润、甘润的药物，如肉苁蓉、枸杞、熟地黄、阿胶、玉竹、鹿角胶、菟丝子之类，才是中正之法。因为清润之品仍禀受清秋凉寒之气，而甘润、温润，则是获得春日和煦孕育之机。虚燥的治疗方法，大体类似于此。唉！虚实途径不同，生死只在掌间翻转之间，学者应当在细微处辨别，在早期辨别啊！
(Dryness Qi) descends, becomes blocked, and forms the climate of winter. This is because deficiency leads to cold, and cold leads to dryness; therefore, treatment should change from clearing and moistening (Qing Run) to warming and moistening (Wen Run). To understand both the norm and the expedient, to know the constant and the variable, one can truly be called a physician in charge of life!
Yu Jiayan said: Among the Nineteen Pathogenesis Patterns in *Suwen*, only Dryness Qi is omitted. The Six Qi correspond to the Four Seasons: Wind corresponds to Spring, Summer Heat corresponds to Summer, Dryness corresponds to Autumn, and Cold corresponds to Winter. Dampness arises from Earth, and Earth thrives during all four seasons, being especially vigorous during the eighteen days of Late Summer. I believe the original text of *Neijing* should read: "Spring injury by Wind, Summer injury by Summer Heat, Late Summer injury by Dampness, Autumn injury by Dryness, Winter injury by Cold." It was merely that copyists omitted some characters below the character for "Summer Heat" and above the character for "Dampness"! For "Autumn injury by Dryness" is a definitive principle, beyond doubt. The classic also states: "If cough persists and white blood is expectorated, death ensues." White blood refers to a pale red color, resembling flesh or lung tissue, which is a sign of lung consumption. Thus, the pathogenesis patterns state: "All qi stagnation belongs to the Lung. All flaccidity syndromes, wheezing, and vomiting belong to the Upper Jiao." These two clauses clearly refer to dryness diseases. As for left hypochondriac pain, inability to turn the body, dry throat, dusty complexion, lack of luster on the body, heat on the outer sole of the foot, lower back pain, fright, tendon contraction, hernia in men, lower abdominal pain in women, squinting eyes with sores, these are manifestations of dryness disease originating from the Liver but appearing scattered and varied; yet they are all signs of "Autumn injury by Dryness." Why do commentators, unaware of occasional omissions or errors in the Pathogenesis chapter, insist on identifying dryness disease as dampness disease, which blatantly contradicts the intent of the classics? The classic says: "Heart transfers heat to the Lung, transmitting into Ge Xiao (Diaphragmatic Consumption)." The origin of lung dryness is ancient! If a person's Kidney Water can ascend to communicate with the Heart, then Heart Fire can naturally descend to communicate with the Kidney; when Water and Fire are balanced, how could there be injury to the Lung? Even if Kidney Water is insufficient, as long as the fluids in the Stomach are sufficient to assist and supply upwards, the Lung will not become overly dry. If the pools of the Middle and Lower Jiao are exhausted, it is impossible for water from the high source to remain without tilting. The classic also says: "Jie (knotting) of the Two Yangs is called Xiao." This refers to the Hand-Yangming Large Intestine Meridian and Foot-Yangming Stomach Meridian; heat knotting causes essence and blood to fail to nourish, resulting in Xiao Ke (Wasting and Thirsting), cracked red tongue muscles, extreme thirst with desire to drink, which has the same meaning as Ge Xiao. Treating Ge Xiao uses Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) to clear dryness and save the lung. From this, we can see that for various qi stagnations, flaccidity syndromes, wheezing, and vomiting belonging to lung dryness, using this method is also appropriate. *Yin Yang Bie Lun* states: "Diseases of the Two Yangs originate in the Heart and Spleen; there are hidden difficulties [sexual dysfunction], women have no menstruation; if transmitted into Feng Xiao (Wind Consumption) or Xi Ben (Breath Bulging), it is incurable death." The Two Yangs refer to the Yangming Stomach. Originating in the Heart and Spleen means the disease of the Two Yangs originates in the Heart and Spleen. The Heart houses the Spirit (Shen), and the Spleen houses the Intent (Yi). What the Heart initiates and governs is called Intent; although the Spleen houses Intent, it fundamentally stems from the Heart. Overthinking causes Spleen Qi to knot and Heart Qi to knot; Heart Qi knotting causes Heart Blood to knot. Dryness arises from within, injuring the Yangming, which governs the muscles. Feng Xiao means muscles waste away as if blown by wind. Xi Ben means breathing is noisy and rebels upward without descending, caused by Lung Qi deficiency failing to descend to the Kidney, and Kidney Qi deficiency failing to ascend to the Lung. The yin fluids of the zang-fu organs are completely consumed, hence it is directly judged as incurable death.
Ke Yunbo discussed the similarities and differences between Jing (Spasm) and Shi (Dampness): Among the Nineteen Pathogenesis Patterns, only dryness disease is missing. If it is said that "all Jing syndromes with neck stiffness belong to Dampness," I privately doubt this. Even in this treatise, there is a distinction between Jing and Dampness, and it states that Taiyang disease (Cold injuring the Taiyang Meridian), if sweating is induced excessively, leads to Jing syndrome; thus, Jing syndrome undoubtedly belongs to dryness. Is the theory that "all Jing belongs to Dampness" a copying error? Or does Dampness transform into Dryness? Jing is a condition of tendon urgency due to blood deficiency. Examining the Six Qi, all can cause Jing syndrome. Jing caused by Wind-Cold results from the struggle of clear Qi. Jing caused by Summer Heat-Dampness may result from Wind-Cold struggling with Summer Heat-Dampness, or from Summer Heat-Dampness obstruction, or from Summer Heat-Dampness transforming into Dryness, or from excessive sweating. For those caused by struggle and obstruction, non-acrid-moistening and warm-moistening methods are required to resolve them; for those caused by transformation into dryness and excessive sweating, clearing-moistening, sweet-moistening, and warm-moistening methods are required to nourish them. Furthermore, Jing syndromes of the Six Channels have different locations: Those at the posterior of the body belong to Taiyang, with symptoms including neck stiffness, backward arching of the waist and spine, inability to flex the thighs, and tendons like knots; those at the anterior belong to Yangming, with symptoms including head and face tremors, locked jaw, pain in the supraclavicular fossa, and leg cramps; those at the sides belong to Shaoyang, with symptoms including facial deviation, pulling of hands and feet, hypochondriac tension, and hemiplegia; abdominal tension, or limb tension due to vomiting and diarrhea, belongs to Taiyin; aversion to cold, curling up, sitting on the buttocks instead of heels, hunching back instead of standing straight, unable to bend forward and stand up, belongs to Shaoyin; rising testicles, descent of the Zong Jin (General Tendon), lower abdominal urgency, genital cramping, and knee tendon cramping belong to Jueyin. Although the locations of the Six Channels differ, they all ultimately归结 to dryness. One must distinguish the cause of dryness (due to Cold, Wind, Wind-Cold binding, Summer Heat-Dampness obstruction) and its transformation (Wind-Cold transforming into dryness, Summer Heat-Dampness transforming into dryness), treat the root cause, add guiding herbs, and act as guides, without rigidly adhering to fixed meridians and losing the root while pursuing the branches. For Jing caused by Wind-Cold struggle, symptoms include fever, aversion to cold, anhidrosis, Qi rushing to the chest, difficult urination, firm and tight pulse, stiff posture, and locked jaw. This is acquired from heavenly Qi, i.e., the classic statement "all sudden stiffness belongs to Wind"; it is fierce and anhidrotic, hence called Gang Jing (Rigid Spasm). For Jing caused by Summer Heat-Dampness obstruction, symptoms include fever, sweating, but no aversion to cold, deep and slow pulse, indistinct and irregular pulse, and stiff neck. This is acquired from earthly Qi, i.e., the classic statement "all Jing with neck stiffness belongs to Dampness"; it is weak and diaphoretic, hence called Rou Jing (Soft Spasm). Zhang Zhongjing treats Jing due to Wind using Gegen (Puerariae Radix) as the sovereign herb, acrid-cool to treat wind movement, and clearing-moist to treat dryness (applicable only if Wind-Yang transforms into heat; not suitable for Wind-Cold binding); he treats Jing due to Damp-Heat using Gualou Gen (Trichosanthis Radix) as the sovereign herb, bitter-descending to resolve damp obstruction, and cool-moist to treat dryness. One herb serves two purposes, not only not conflicting but mutually assisting; scholars should infer other cases from this example. Moreover, good physicians must use observation methods to discern subtle signs early and treat disease before it arises. For instance, neck stiffness and pain are aspects of Jing; observing this reveals blood deficiency in the Taiyang meridian, allowing for prevention. As stated in *Shanghan Lun*: "Floating pulse, spontaneous sweating, vexation, aversion to cold, and leg cramps indicate impending Jing. Giving Guizhi Tang (Cinnamon Twig Decoction) would cause厥 (cold limbs), but giving Shaoyao Gancao Tang (Peony and Licorice Decoction) would allow the legs to extend naturally." Gancao (Glycyrrhizae Radix et Rhizoma) is sweet and緩 (relaxing) to relieve urgency; Shaoyao (Paeoniae Radix Alba) is slightly moist and bitter, treating dryness without cloying pathogens. Saint Zhang’s medication usage was not like later physicians who attended to one thing while neglecting another. However, custom sees this condition, not only failing to prevent it but mistakenly treating it as Wind, using acrid-diaphoretic sweating methods, aiding Yang and consuming Yin, leading to symptoms such as neck and back stiffness, locked jaw, leg cramps, and inability to lie flat on the bed. This is simply due to failure to examine deficiency and excess. The method for treating Jing should differentiate deficiency and excess and investigate the cause. For Jing caused by blood deficiency or mis-treatment, urgently use clearing-harmonizing and moistening methods, softening rigidity with gentleness. For severe deficiency, where Metal is cold and Water is cold, Qi is knotted and fluids are dried, clearing-moistening is unsuitable; one must use warm-moistening and sweet-moistening herbs such as Congrong (Cynomorii Herba), Gouqi (Lycii Fructus), Shudi (Rehmanniae Radix Preparata), Ejiao (Asini Corii Colla), Yuzhu (Polygonati Odorati Rhizoma), Lujiao (Cervi Cornu Colla), Tusizi (Cuscutae Semen), etc., which constitute the orthodox method. Clear-moistening herbs still carry the cool-cold Qi of late autumn, whereas sweet-moistening and warm-moistening herbs obtain the gentle nurturing energy of spring. The treatment of deficiency-dryness is generally similar. Alas! The paths of deficiency and excess are different, and life and death are separated by a palm's flip; scholars must discern subtly and early!