热燥而烦、小水干赤、中气不足、溲便如膏之类，切勿利之，以致重损津液，害必甚矣。故凡治阳虚者，只宜
补阳，阳胜则燥，而阴湿自退；阴虚者，只宜壮水，真水既行，则邪湿自无所容矣。此阴阳二证，俱有不宜
利者，不可不察。（张景岳）
凡风药可以胜湿，泄小便可以引湿，通大便可以逐湿，吐痰涎可以祛湿。湿而有热，苦寒之剂燥之；湿而
有寒，辛热之剂除之。（李时珍）
湿在上，宜防风，风能胜湿，犹湿衣悬透风处则易干也；湿在中，宜苍术，犹地上有湿，灰多则渗干也；
湿在下，宜利小便，犹欲地干，必开水沟也；湿在周身，宜乌药、羌活等；湿在两臂，宜桑条、威灵仙等；
湿在两股，宜牛膝、防己、萆 等。分其部位而治之，何患不效？（沈金鳌）
脾弱湿伤者，二陈、平胃之类主之；湿盛濡泄者，五苓、六一之类主之；水肿发黄者，五皮、茵陈之类主
之。若湿流关节，则非前药所宜，无窍不入，惟风为能。故凡关节之病，非风药不能到也。（吴鹤皋）
脉候
脉浮而缓、濡而小者，皆外湿；沉而缓、细而微者，皆内湿。又迟缓为寒湿，洪缓为湿热，弦缓为风湿。（《证治汇补》）
经义
西方生燥，燥生金。○清气太来，燥之胜也。○诸涩枯涸，干劲皴揭，皆属于燥○。燥胜则干。（《素问》）
哲言
涩，物湿则滑泽，干则涩滞，燥湿相反故也。枯，不荣生也。涸，无水液也。干，不滋润也。劲，不柔和
也。春秋相反，燥湿不同故也。皴揭，皮肤启裂也。干为天而为燥金；坤为地而为湿土。天地相反，燥湿异同
故也。（《原病式》）
燥者金之气，有冷燥，有热燥。冷燥者，晴空凛冽而枯槁；热燥者，晴空焦 而干枯。（《黄帝逸典》）
肥人气虚生寒，寒生湿，湿生痰；瘦人血虚生热，热生火，火生燥。故肥人多寒湿，瘦人多热燥。○燥是
阳明之化，虽因于风热所成，然究其原，皆本于血虚、津液不足所致者为多。何也？盖阴血虚则不能荣运百体，
津液衰则无以滋养三焦，由是邪热怫郁，而燥变多端。燥于外，则皮肤皴揭；燥于内，则精血枯涸；燥于上，
则咽鼻干焦；燥于下，则便溺闭结。治之者，外以滋益之，内以培养之，在上清解之，在下通润之，务使水液
自生，而燥热不容不退矣。（朱丹溪）
风燥，由肝血不能荣筋，故筋急爪裂；火燥，由脾多伏火，故唇揭便秘；血燥，由心血失散，故头多白屑、
发脱须落；虚燥，由肾阴虚涸，故小便数、咽干喉肿。此皆燥之因也。（《证治汇补》）
凡物近火则润，离火则燥，犹金之投入烈火而化为液。故燥证多有反似痿弱之证者，热伤阴血也。（张路玉）
燥之与湿，有霄壤之殊。燥者天之气也，湿者地之气也。水流湿，火就燥，各从其类。春月地气动而湿胜，
秋月天气肃而燥胜，故春分以后之湿，秋分以后之燥，各司其政。今指秋月之燥为湿，是必指夏月之热为寒然
后可，奈何《内经》病机一十九条，独遗燥气，他凡秋伤于燥，皆谓秋伤于湿，历代诸贤，随文作解，弗察其
讹，昌特正之。大意谓春伤于风，夏伤于暑，长夏伤于湿，秋伤于燥，冬伤于寒。觉六气配四时之旨，与五运
不相背戾，而千古之大疑，始一决也。○《病机》云∶诸涩枯涸，干劲皴揭，皆属于燥。燥金虽为秋令，虽属
阴经，然异于寒湿，同于火热。火热胜则金衰，火热胜则风炽，风能胜湿，热能耗液，转令阳实阴虚，故风、
火、热之气，胜于水土而为燥也。○诸气 郁之属于肺者，属于肺之燥，非属于肺之湿也。苟肺气不燥，则诸
气禀清肃之令而周身四达，亦胡致 郁耶？诸痿喘呕之属于上者，上亦指肺不指心也。若统上焦心肺并言，
则心病不主痿喘及呕也。惟肺燥甚，则肺叶痿而不用，肺气逆而喘鸣，食难过膈而呕出。三者皆燥证之极者
也。○肺为娇脏，寒冷所伤者十之二、三，火热所伤者十之七、八。寒冷所伤，不过裹束其外；火热所伤，则
更销烁其中，所以为害倍烈也。然火热伤肺，以致诸气 郁、诸痿喘呕而成燥证，只因《内经》脱遗燥证，
后之无识者竞以燥治燥，恬于操刃，曾罔顾阴气之消亡耳。○《经》云∶心移热于肺，传为膈消。肺燥之由来
者远矣，苟其人肾水足以上升而交于心，则心火下降而交于肾不传于肺矣，心火不传于肺，曾何伤燥之虞哉？
即肾水或见不足，其肠胃津血足以协济上供，肺亦不致过伤也。若夫中、下之泽尽竭，而高源之水犹得措于不
倾，则必无之事矣。○《阴阳别论》云∶二阳之病发心脾，有不得隐曲，男子少精，女子不月；其传为风消，
其传为息贲者，死不治。此亦肺
燥所由来而未经揭出者。然其始但不利于隐曲之事耳，其继则胃之燥传入于脾，而为风消；大肠之燥传入于肺，
而为息贲。是则胃肠合心脾以共成肺金之燥，三脏二腑阴气消亡殆尽，尚可救疗乎？○风热燥甚，怫郁在表，而
里气平者，善伸数欠，经脉拘急，或时恶寒，或筋惕而搐，脉浮数而弦；若风热燥并郁甚于里，则必为烦满闷
结。故燥有表、里、气、血之分也。○肝主筋，风气自甚，燥热加之，则液聚于胸膈，不荣于筋脉而筋燥，故
劲强紧急而口噤，或螈 、昏冒、僵仆也。○燥病必渴，而渴之所属各不同，有心肺气厥而渴，有肝痹而渴，有
脾热而渴，有肾热而渴，有胃与大肠热结而渴，有小肠瘅热而渴，有因病疟而渴，有原素食肥甘而渴，有因醉
饮入房而渴，有因远行劳倦遇大热而渴，有因伤害胃干而渴，有因风而渴。五脏部分不同，病之所遇各异，
其为燥热亡液则一也。（喻嘉言）
补编
休治风兮休治燥，治得火时风燥了。燥之为病，皆属燥金之化。然能令金燥者，火也。《系辞》云∶燥万
物者莫 乎火。夫金为阴之主，为水之源，而受燥气，寒水生化之源竭绝于上，而不能灌溉周身，荣养百骸，
色干而无润泽皮肤者，有自来矣。或大病克犯太过，或吐利津液内亡，或误饵金石补阳燥剂，皆能偏助阳火而
损真阴。阴中伏火，日渐煎熬，血液衰耗，燥热转甚。法宜甘寒滋润，甘能生血，寒能胜热。阴得滋而火杀，
液得润而燥除，源泉下降，精血上荣，阴液宣通，内神藏而外色泽矣。（张子和）
肺金被火，固已乏气，而营竭肝伤，血分更增其燥，以致虚阳失养，郁成枯火，火莫能降，只随腥涎浊瘀
紊而上攻。凡心肺所贮气血之膈，无复润泽而枯焦也。此际之火，既莫能攻，而虚又莫能补，故养营保肺，
首在生津，甘凉濡润，无非以补法为溉法。此《普济》门中之甘露也。○燥万物者莫如金，金令降；滋万物者
莫如木，木令升。凡金令之不从其燥者，全赖木气之升，
能致五脏之蒸溽到肺而成津液也。故木气升，则五脏之气奉春令而俱升；木气降，则五脏之气奉秋令而俱降，
降则五脏之气不得上承，自然下蚀。凡土邪陷下而克水，火淫寡畏而 金，皆职于此。金以蒸溽不到，而加火
淫，遂成燥金。津液之源已竭于上，周身百骸，谁为之灌溉者？是则一燥无不燥矣。降令多，升令少，而湿热
之邪，遂盛于下部而成痿软。盖湿热为物，升则化，不升则不化，欲救全体之燥，须从木令之升，但使五脏各
有升令之奉，则土能生金，金能生水，水能制火。虽其间有补有泻，皆可以此一字为循环法，所谓少阳为枢者
此也。曰清燥者，谓能致津液故也。（程郊倩）
燥证有外因者，六淫之一也；有内因者，血液之枯也。外因之燥，非雨露愆期，即秋日暴烈；非南方不毛，
即北方风劲，气偏阳亢而燥生。从皮毛而入者，则肺受之，肺受燥气，咳嗽咽痛之证见矣；从口而入者，则
胃受之，胃受燥气，结胸便秘之证见矣。喻嘉言谓∶秋伤于燥，冬生咳嗽。议论发前人之未发，而清燥一方，
可为治燥之灵丹。至于结胸、便秘，世俗多以伤寒混治，不知燥则生火，津液耗而肠胃干矣。若内伤之燥，本
于肾水之亏，精血之弱，真阴之涸。在肺则清肃之令不行，咳逆口渴，皮聚毛落矣；在肝则将军之性不敛，胁痛
暴怒，筋急拘挛；在脾则生血之原不运，蓄瘀便结，皮肤不泽矣。欲治其燥，先贵乎润；欲救其脾，先滋乎肾。
诚以肾主水而藏脏腑之精，养百骸而为性命之本。若肾阴充足，则四脏可以灌溉，燥无自而生也。第水日亏而
火日炽，决非清凉之味可疗，须用六味归芍汤合生脉散为主治，肺燥则加沙参、天冬、梨汁之属；肝燥则加丹
参、枣仁、乳汁之属；脾燥则加柏子仁、甘蔗汁之属。此燥病之正治也。倘久病而气因精虚，参、 、河车
及八味等汤，亦宜急投。盖阳生则阴长，气化则血润，此燥病之反治也。虽然草木之枯，得雨滋荣，人身之燥，
非血不泽，参乳汤救燥病之根，活命饮治燥病之
原，又何必纷纷而他求耶？经云∶诸涩枯涸，干劲皴揭，皆属于燥。又曰∶燥胜则干。其为血液之涸，已明效
大验。即如隔病之枯，胃之燥也；消病之渴，肺之燥也；爪甲之焦，筋之燥也；产后之痉，血之燥也；而敢谓
治燥为易哉？（《会心录》）
燥为干涩不通之疾，内伤外感宜分。外感者，由于天时风热过胜，或因深秋偏亢之邪，始必伤人上焦气
分，治以辛凉甘润肺胃为先，喻氏清燥救肺汤及玉竹、门冬、桑叶、薄荷、梨皮、甘草之类。内伤者，乃人之
本病精血下夺而成，或因偏饵燥剂所致，病从下焦阴分先起，治以纯阴静药柔养肝肾为宜，大补地黄丸、六味
丸之类。要知是证大忌者苦涩，最喜者甘柔。若气分失治，则延及于血；下病失治，则槁及乎上。喘咳、痿厥、
三消、噎隔，根萌总由此致。津液结者，必佐辛通之气味；精血竭者，必藉血肉之滋填。在表佐风药而成功；
在腑以缓通为要务。古之滋燥养营汤、润肠丸、五仁汤、琼玉膏、一 丹、牛羊乳汁等法，各有专司也。（《临证指南》）
夫燥有脏腑之燥，有血脉之燥。燥在上，必乘肺经，故上逆而咳，宜《千金》五味子汤；若外内合邪，
宜《千金》麦门冬汤。燥在下，必乘大肠，故大便燥结，然须分邪实、津耗、血枯三者为治∶邪实者，则烦
渴躁闷腹胀，用通幽汤、麻仁丸；津耗者，屡欲便而不可得圊，欲了而不了，外用蜜煎导；血枯者，呕逆食
不下，大便燥结如栗，用生料六味丸去山萸加生首乌、当归、苁蓉、桃仁。燥在血分，多见风证，木无所畏
也。燥本火之余，故以滋燥养营汤治外，大补地黄汤治内，润燥养阴为第一义。火热亢盛，津液耗竭，不能荣
养百骸，手足痿弱，不能收持，反似湿痹之证，养阴药中必加黄柏以苦坚之，如虎潜丸之类。若误作风治则殆
矣。（张路玉）
风燥一证，辨治尤难。盖燥为秋气，令不独行，必假风寒之威，而令乃振，病乃发也。然考之于《经》，
则不曰秋伤于燥，而言秋伤于湿，何也？夫秋令本燥，以长夏湿土郁蒸之余气渐渍身中，随秋令收敛而伏于肺
胃之间，直待秋深燥令大行，与湿不能兼容，至冬而为咳嗽也。此证有肺燥、胃湿两难分解之势。古方中惟
《千金》麦门冬汤、《千金》五味子汤独得其秘。不知者，以为敛散不分、燥润杂出，则又置而不用，总未达
分解风燥之义耳。喻氏不明湿气内伏燥令外伤之意，直云《内经》独遗长夏伤于湿句，致令秋伤于燥误为伤湿，
殊失《内经》精微之奥矣。（《伤寒析义》）
治风燥莫如养血，治燥热莫如壮水。更有冷燥一证，虽见便秘燥结，实由阴寒过极，如阳和之水，遇隆冬
而成层冰燥裂也。古方有半硫丸之设，意深远矣。（冯楚瞻）
壮水以制火，清金以润燥，人所共知；补脾以生肺，资母以益子，人所不晓。每见余师治燥用二冬、二
地为君，加山药等，无不应手而效。（方星岩）
润燥，以玉竹、麦冬、沙参为最，地、归不能及也。（《三秋病机》）
治燥病者，补肾水阴寒之虚，泻心火阳热之实，除肠中燥热之甚，济胃中津液之衰，使道路散而不结，津
液生而不枯，气血利而不涩，则病日已矣。○凡秋月燥病，误以为湿治者，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。○凡治燥病，燥在气而治血，燥在血而治气，燥在表而治里，燥
在里而治表。药不适病，医之过也。○凡治杂病，有兼带燥证者，误用燥药，转成其燥，因致危困者，医之罪
也。○凡治燥病，须分肝肺二脏见证，肝脏见证，治其肺犹可也；若肺脏见证，反治其肝，则坐误矣，医之罪
也。○凡治燥病，不深达治燥之旨，但用润剂润燥，虽不重伤，亦误时日，只名粗工，所
当戒也。（《医门法律》）
脉候
燥有内外诸证，不能尽述，而脉之微、细、涩、小则一，间有虚、大、数、疾、浮、芤等状。以意察
之，重按无有不涩、不细、不微者，则知诸燥之证，皆肺金之一气，亦不出肺金之一脉也。（张路玉）
选案
热燥而烦、小水干赤、中气不足、溲便如膏之类，切勿利之，以致重损津液，害必甚矣。故凡治阳虚者，只宜
补阳，阳胜则燥，而阴湿自退；阴虚者，只宜壮水，真水既行，则邪湿自无所容矣。此阴阳二证，俱有不宜
利者，不可不察。（张景岳）
对于热燥伴有烦躁、小便短少色红、中气虚弱、尿液和大便像脂膏一样浑浊等症状的患者，千万不要使用利尿的方法，以免进一步损伤津液，危害必然非常严重。因此，凡是治疗阳虚证的，只适宜补益阳气，阳气旺盛则燥象显现（注：此处原文逻辑似有笔误或特定语境，通常阳虚生寒湿，但依文意译为阳胜则燥，阴湿自退），阴湿自然消退；对于阴虚证的，只适宜滋补肾阴（壮水），真阴之水一旦运行通畅，邪湿自然无处存留。这两种阴阳证候，都有不适宜使用利尿法的情况，不可不仔细辨别。（张景岳）
凡风药可以胜湿，泄小便可以引湿，通大便可以逐湿，吐痰涎可以祛湿。湿而有热，苦寒之剂燥之；湿而
有寒，辛热之剂除之。（李时珍）
凡是风药能够胜湿，通利小便可以引导湿气排出，通导大便可以驱逐湿气，催吐痰涎可以祛除湿气。如果湿邪兼有热象，用苦寒的药物来燥湿；如果湿邪兼有寒象，用辛热的药物来散寒除湿。（李时珍）
湿在上，宜防风，风能胜湿，犹湿衣悬透风处则易干也；湿在中，宜苍术，犹地上有湿，灰多则渗干也；
湿在下，宜利小便，犹欲地干，必开水沟也；湿在周身，宜乌药、羌活等；湿在两臂，宜桑条、威灵仙等；
湿在两股，宜牛膝、防己、萆 等。分其部位而治之，何患不效？（沈金鳌）
湿邪在身体上部，适宜用防风，因为风能胜湿，就像湿衣服挂在通风处容易变干一样；湿邪在身体中部，适宜用苍术，就像地上有湿气，撒上很多草木灰就能渗透干燥一样；湿邪在身体下部，适宜通利小便，就像想要让地面干燥，必须开挖排水沟一样；湿邪遍布全身，适宜用乌药、羌活等药；湿邪在双臂，适宜用桑枝、威灵仙等药；湿邪在大腿，适宜用牛膝、防己、萆薢等药。根据湿邪所在的部位分别进行治疗，还担心什么没有疗效呢？（沈金鳌）
脾弱湿伤者，二陈、平胃之类主之；湿盛濡泄者，五苓、六一之类主之；水肿发黄者，五皮、茵陈之类主
之。若湿流关节，则非前药所宜，无窍不入，惟风为能。故凡关节之病，非风药不能到也。（吴鹤皋）
脾脏虚弱被湿邪所伤的，以二陈汤、平胃散这类方剂为主治；湿邪盛导致大便稀溏泄泻的，以五苓散、六一散这类方剂为主治；出现水肿且肤色发黄的，以五皮饮、茵陈蒿汤这类方剂为主治。如果湿邪流注于关节，那么前面提到的那些药物就不适宜了，因为湿邪无处不到，只有风药才能到达病所。所以凡是关节的疾病，不用风药是不能奏效的。（吴鹤皋）
脉候
脉浮而缓、濡而小者，皆外湿；沉而缓、细而微者，皆内湿。又迟缓为寒湿，洪缓为湿热，弦缓为风湿。（《证治汇补》）
脉象浮而缓、濡软而小的，都是外感湿邪；脉象沉而缓、细弱而微的，都是内伤湿邪。另外，脉迟而缓属于寒湿，脉洪大而缓属于湿热，脉弦而缓属于风湿。（《证治汇补》）
经义
西方生燥，燥生金。○清气太来，燥之胜也。○诸涩枯涸，干劲皴揭，皆属于燥○。燥胜则干。（《素问》）
西方产生燥气，燥气生成金行。○清气太过，是燥气偏胜的表现。○各种干涩、枯萎、干涸、皮肤干枯起皱开裂的症状，都归属于燥证。○燥气偏胜就会导致干燥。（《黄帝内经·素问》）
哲言
涩，物湿则滑泽，干则涩滞，燥湿相反故也。枯，不荣生也。涸，无水液也。干，不滋润也。劲，不柔和
也。春秋相反，燥湿不同故也。皴揭，皮肤启裂也。干为天而为燥金；坤为地而为湿土。天地相反，燥湿异同
故也。（《原病式》）
涩，物体湿润时就滑润，干燥时就涩滞，这是因为燥和湿性质相反的缘故。枯，是指不能滋养生机。涸，是指没有水液。干，是指不滋润。劲，是指不柔和。春和秋季节相反，燥和湿性质不同的缘故。皴揭，是指皮肤开裂。乾（天）代表燥金；坤（地）代表湿土。天和地性质相反，所以燥和湿既有差异又有联系。（刘完素《原病式》）
燥者金之气，有冷燥，有热燥。冷燥者，晴空凛冽而枯槁；热燥者，晴空焦 而干枯。（《黄帝逸典》）
燥是金行的气候特征，分为冷燥和热燥两种。冷燥，是指天空晴朗寒冷而导致万物枯槁；热燥，是指天空晴朗酷热而导致万物干枯。（《黄帝逸典》）
肥人气虚生寒，寒生湿，湿生痰；瘦人血虚生热，热生火，火生燥。故肥人多寒湿，瘦人多热燥。○燥是
阳明之化，虽因于风热所成，然究其原，皆本于血虚、津液不足所致者为多。何也？盖阴血虚则不能荣运百体，
津液衰则无以滋养三焦，由是邪热怫郁，而燥变多端。燥于外，则皮肤皴揭；燥于内，则精血枯涸；燥于上，
则咽鼻干焦；燥于下，则便溺闭结。治之者，外以滋益之，内以培养之，在上清解之，在下通润之，务使水液
自生，而燥热不容不退矣。（朱丹溪）
肥胖的人气虚而生寒，寒生湿，湿生痰；消瘦的人血虚而生热，热生火，火生燥。所以肥胖的人多患寒湿证，消瘦的人多患热燥证。○燥是阳明经的气化表现，虽然常由风热引起，但追根溯源，大多是由于血虚、津液不足导致的。为什么呢？因为阴血虚就不能滋养运行全身，津液衰少就不能滋养三焦，由此导致邪热郁结，从而产生多种燥变。燥在外部，就会皮肤开裂；燥在内部，就会精血枯竭；燥在上部，就会咽喉鼻腔干燥焦灼；燥在下部，就会大小便闭塞不通。治疗时，对外用滋补的方法，对内用培补的方法，在上部用清热解表的方法，在下部用通利滋润的方法，务必使水液自行生成，那么燥热自然无法存在而消退。（朱丹溪）
风燥，由肝血不能荣筋，故筋急爪裂；火燥，由脾多伏火，故唇揭便秘；血燥，由心血失散，故头多白屑、
发脱须落；虚燥，由肾阴虚涸，故小便数、咽干喉肿。此皆燥之因也。（《证治汇补》）
风燥，是由于肝血不能滋养筋脉，所以筋脉拘急、指甲开裂；火燥，是由于脾脏多有伏火，所以嘴唇干裂、大便秘结；血燥，是由于心血耗散，所以头部多头皮屑、头发脱落胡须掉落；虚燥，是由于肾阴枯竭，所以小便频数、咽喉干燥喉咙肿痛。这些都是导致燥证的原因。（《证治汇补》）
凡物近火则润，离火则燥，犹金之投入烈火而化为液。故燥证多有反似痿弱之证者，热伤阴血也。（张路玉）
凡是物体靠近火就湿润，离开火就干燥，就像金属投入烈火中熔化变成液体一样。所以燥证很多时候反而类似痿弱证，这是因为热邪损伤了阴血。（张路玉）
燥之与湿，有霄壤之殊。燥者天之气也，湿者地之气也。水流湿，火就燥，各从其类。春月地气动而湿胜，
秋月天气肃而燥胜，故春分以后之湿，秋分以后之燥，各司其政。今指秋月之燥为湿，是必指夏月之热为寒然
后可，奈何《内经》病机一十九条，独遗燥气，他凡秋伤于燥，皆谓秋伤于湿，历代诸贤，随文作解，弗察其
讹，昌特正之。大意谓春伤于风，夏伤于暑，长夏伤于湿，秋伤于燥，冬伤于寒。觉六气配四时之旨，与五运
不相背戾，而千古之大疑，始一决也。○《病机》云∶诸涩枯涸，干劲皴揭，皆属于燥。燥金虽为秋令，虽属
阴经，然异于寒湿，同于火热。火热胜则金衰，火热胜则风炽，风能胜湿，热能耗液，转令阳实阴虚，故风、
火、热之气，胜于水土而为燥也。○诸气 郁之属于肺者，属于肺之燥，非属于肺之湿也。苟肺气不燥，则诸
气禀清肃之令而周身四达，亦胡致 郁耶？诸痿喘呕之属于上者，上亦指肺不指心也。若统上焦心肺并言，
则心病不主痿喘及呕也。惟肺燥甚，则肺叶痿而不用，肺气逆而喘鸣，食难过膈而呕出。三者皆燥证之极者
者也。○肺为娇脏，寒冷所伤者十之二、三，火热所伤者十之七、八。寒冷所伤，不过裹束其外；火热所伤，则
更销烁其中，所以为害倍烈也。然火热伤肺，以致诸气 郁、诸痿喘呕而成燥证，只因《内经》脱遗燥证，
后之无识者竞以燥治燥，恬于操刃，曾罔顾阴气之消亡耳。○《经》云∶心移热于肺，传为膈消。肺燥之由来
者远矣，苟其人肾水足以上升而交于心，则心火下降而交于肾不传于肺矣，心火不传于肺，曾何伤燥之虞哉？
即肾水或见不足，其肠胃津血足以协济上供，肺亦不致过伤也。若夫中、下之泽尽竭，而高源之水犹得措于不
倾，则必无之事矣。○《阴阳别论》云∶二阳之病发心脾，有不得隐曲，男子少精，女子不月；其传为风消，
其传为息贲者，死不治。此亦肺
燥所由来而未经揭出者。然其始但不利于隐曲之事耳，其继则胃之燥传入于脾，而为风消；大肠之燥传入于肺，
而为息贲。是则胃肠合心脾以共成肺金之燥，三脏二腑阴气消亡殆尽，尚可救疗乎？○风热燥甚，怫郁在表，而
里气平者，善伸数欠，经脉拘急，或时恶寒，或筋惕而搐，脉浮数而弦；若风热燥并郁甚于里，则必为烦满闷
结。故燥有表、里、气、血之分也。○肝主筋，风气自甚，燥热加之，则液聚于胸膈，不荣于筋脉而筋燥，故
劲强紧急而口噤，或螈 、昏冒、僵仆也。○燥病必渴，而渴之所属各不同，有心肺气厥而渴，有肝痹而渴，有
脾热而渴，有肾热而渴，有胃与大肠热结而渴，有小肠瘅热而渴，有因病疟而渴，有原素食肥甘而渴，有因醉
饮入房而渴，有因远行劳倦遇大热而渴，有因伤害胃干而渴，有因风而渴。五脏部分不同，病之所遇各异，
其为燥热亡液则一也。（喻嘉言）
燥和湿，有着天壤之别。燥是天之气，湿是地之气。水往湿处流，火向燥处燃，各自遵循同类相从的规律。春季地气发动而湿气偏胜，秋季天气肃杀而燥气偏胜，所以春分以后的湿气，秋分以后的燥气，各自掌管其时令。现在把秋季的燥气说成是湿气，那一定要把夏季的热气说成寒气才可以，为什么《内经》的病机十九条中，唯独遗漏了燥气，其他凡是提到秋天受伤，都说秋天伤于湿，历代名医顺着文字解释，没有察觉其中的错误，我特意纠正它。大意是说春天伤于风，夏天伤于暑，长夏伤于湿，秋天伤于燥，冬天伤于寒。这样觉得六气配合四季的宗旨，与五运学说并不违背，而千古的大疑惑，这才得以解决。○《病机》说：各种干涩、枯萎、干涸、皮肤干枯起皱开裂，都归属于燥。燥金虽然是秋天的时令，虽然属于阴经，然而不同于寒湿，而与火热相同。火热偏胜则金气衰弱，火热偏胜则风势炽盛，风能胜湿，热能消耗津液，转而导致阳实阴虚，所以风、火、热之气，胜过水土而成为燥。○各种气机郁滞属于肺的，是属于肺的燥，不是属于肺的湿。如果肺气不燥，那么各种气机秉承清肃的命令而通达全身，怎么会导致郁滞呢？各种痿证、喘证、呕吐证属于上部的，上部也是指肺而不指心。如果笼统地说上焦心肺一起讲，那么心病并不主导痿证、喘证和呕吐证。只有肺燥非常严重时，才会肺叶痿废不用，肺气上逆而喘息有声，食物难以下咽通过横膈而呕吐出来。这三种情况都是燥证的极端表现。○肺是娇嫩的脏器，受寒冷伤害的占十分之二三，受火热伤害的占十分之七八。寒冷伤害，不过是束缚在外表；火热伤害，则会销蚀内部，所以危害加倍猛烈。然而火热伤肺，导致各种气机郁滞、各种痿证喘证呕吐证而形成燥证，只是因为《内经》遗漏了燥证，后来的无知之人竞相用燥法治燥证，安然地挥舞刀斧，竟然不顾阴气的消亡。○《内经》说：心将热邪转移给肺，传变为膈消。肺燥的来源已经很久了，假如这个人肾水充足能够上升并与心相交，那么心火就会下降并与肾相交而不传给肺，心火不传给肺，又有什么伤害燥证的担忧呢？即使肾水稍微不足，肠胃的津血足以协助供给上方，肺也不会受到过度伤害。如果中焦、下焦的水泽全部枯竭，而上游的高源之水还能保持不倾倒，那是绝对不可能的事情。○《阴阳别论》说：阳明经的病发于心脾，有难以启齿的隐疾，男子精少，女子月经不来；如果传变为风消，传变为息贲的，是死症无法治疗。这也是肺燥的来源而没有被揭示出来的。然而起初只是不利于隐秘之事，随后胃的燥传入脾，而成为风消；大肠的燥传入肺，而成为息贲。这就是胃肠结合心脾共同造成肺金的燥，三脏二腑的阴气消亡殆尽，还可以救治吗？○风热燥邪很盛，郁结在体表，而里气平和的，喜欢伸展频繁打哈欠，经脉拘急，有时怕冷，或者肌肉跳动抽搐，脉浮数而弦；如果风热燥邪并郁结在体内很深，那么就一定会出现烦闷胀满憋结。所以燥证有表、里、气、血的区分。○肝主管筋，风气本身就很盛，加上燥热，那么津液聚集在胸膈，不能滋养筋脉而导致筋燥，所以僵硬强直紧急而牙关紧闭，或者抽搐、昏迷、僵倒。○燥病一定口渴，而口渴的原因归属各不相同，有心肺气厥而渴，有肝痹而渴，有脾热而渴，有肾热而渴，有胃与大肠热结而渴，有小肠热毒而渴，有病疟疾而渴，有原本饮食肥甘厚味而渴，有因醉酒行房事而渴，有因远行劳累疲倦遇到大热而渴，有因损伤胃干而渴，有因风邪而渴。五脏部位不同，病情遭遇各异，但它们导致燥热亡失津液是一样的。（喻嘉言）
补编
休治风兮休治燥，治得火时风燥了。燥之为病，皆属燥金之化。然能令金燥者，火也。《系辞》云∶燥万
物者莫 乎火。夫金为阴之主，为水之源，而受燥气，寒水生化之源竭绝于上，而不能灌溉周身，荣养百骸，
色干而无润泽皮肤者，有自来矣。或大病克犯太过，或吐利津液内亡，或误饵金石补阳燥剂，皆能偏助阳火而
损真阴。阴中伏火，日渐煎熬，血液衰耗，燥热转甚。法宜甘寒滋润，甘能生血，寒能胜热。阴得滋而火杀，
液得润而燥除，源泉下降，精血上荣，阴液宣通，内神藏而外色泽矣。（张子和）
不要单纯治风也不要单纯治燥，治好火的时候风燥也就解决了。燥这种病，都属于燥金的气化。然而能让金变得燥的，是火。《易经·系辞》说：使万物干燥没有比火更大的了。金是阴的主宰，是水的源头，而承受燥气，如果寒水生化的源头在上焦枯竭断绝，就不能灌溉全身，滋养骨骼，面色干枯而没有润泽皮肤的，是有其原因的。或者是大病克制侵犯太过，或者是呕吐腹泻导致津液内亡，或者是误服金石类的补阳燥热药物，都能偏助阳火而损害真阴。阴中的伏火，一天天煎熬，血液衰少消耗，燥热变得更加严重。治疗方法适宜用甘寒滋润的药物，甘味能生血，寒性能胜热。阴得到滋养而火被抑制，津液得到滋润而燥除，水源下降，精血上荣，阴液宣通，内在精神潜藏而外在面色光泽。（张子和）
肺金被火，固已乏气，而营竭肝伤，血分更增其燥，以致虚阳失养，郁成枯火，火莫能降，只随腥涎浊瘀
紊而上攻。凡心肺所贮气血之膈，无复润泽而枯焦也。此际之火，既莫能攻，而虚又莫能补，故养营保肺，
首在生津，甘凉濡润，无非以补法为溉法。此《普济》门中之甘露也。○燥万物者莫如金，金令降；滋万物者
莫如木，木令升。凡金令之不从其燥者，全赖木气之升，
能致五脏之蒸溽到肺而成津液也。故木气升，则五脏之气奉春令而俱升；木气降，则五脏之气奉秋令而俱降，
降则五脏之气不得上承，自然下蚀。凡土邪陷下而克水，火淫寡畏而 金，皆职于此。金以蒸溽不到，而加火
淫，遂成燥金。津液之源已竭于上，周身百骸，谁为之灌溉者？是则一燥无不燥矣。降令多，升令少，而湿热
之邪，遂盛于下部而成痿软。盖湿热为物，升则化，不升则不化，欲救全体之燥，须从木令之升，但使五脏各
有升令之奉，则土能生金，金能生水，水能制火。虽其间有补有泻，皆可以此一字为循环法，所谓少阳为枢者
此也。曰清燥者，谓能致津液故也。（程郊倩）
肺金被火邪伤害，本来就已经缺乏气，而且营血枯竭肝脏受损，血分更加增加其燥，导致虚阳失去滋养，郁结成枯火，火不能下降，只随着腥臭的痰涎浊瘀混乱而上攻。凡是心肺储存气血的膈膜，不再润泽而枯焦。这个时候的火，既不能用攻法，虚又不能单纯用补法，所以养营保肺，首要在于生津，甘凉濡润，无非是用补法作为灌溉法。这是《普济方》门派中的甘露。○使万物干燥没有比金更厉害的，金的命令是下降；滋养万物没有比木更厉害的，木的命令是上升。凡是金的命令不顺从其燥性的，全靠木气的上升，能够使五脏的蒸腾湿润到达肺部而成为津液。所以木气上升，那么五脏之气秉承春令而一起上升；木气下降，那么五脏之气秉承秋令而一起下降，下降那么五脏之气不能上承，自然向下侵蚀。凡是土邪陷下而克制水，火气淫溢很少畏惧而克制金，都职责在此。金因为蒸腾湿润达不到，再加上火气淫溢，于是成为燥金。津液的源头已经在上面枯竭，全身的骨骼脏腑，谁来为它们灌溉呢？这就是一旦干燥就没有不干燥的了。下降的命令多，上升的命令少，而湿热邪气，于是在下部盛行而成为痿软。大概湿热这种东西，上升就能化解，不上升就不能化解，想要拯救全身的燥，必须从木令的上升入手，只要使五脏各有上升命令的奉持，那么土能生金，金能生水，水能制火。虽然其中有补有泻，都可以用这个“升”字作为循环法则，所说的少阳为枢纽就是这个意思。说清除燥，是因为能使津液生成的缘故。（程郊倩）
燥证有外因者，六淫之一也；有内因者，血液之枯也。外因之燥，非雨露愆期，即秋日暴烈；非南方不毛，
即北方风劲，气偏阳亢而燥生。从皮毛而入者，则肺受之，肺受燥气，咳嗽咽痛之证见矣；从口而入者，则
胃受之，胃受燥气，结胸便秘之证见矣。喻嘉言谓∶秋伤于燥，冬生咳嗽。议论发前人之未发，而清燥一方，
可为治燥之灵丹。至于结胸、便秘，世俗多以伤寒混治，不知燥则生火，津液耗而肠胃干矣。若内伤之燥，本
于肾水之亏，精血之弱，真阴之涸。在肺则清肃之令不行，咳逆口渴，皮聚毛落矣；在肝则将军之性不敛，胁痛
暴怒，筋急拘挛；在脾则生血之原不运，蓄瘀便结，皮肤不泽矣。欲治其燥，先贵乎润；欲救其脾，先滋乎肾。
诚以肾主水而藏脏腑之精，养百骸而为性命之本。若肾阴充足，则四脏可以灌溉，燥无自而生也。第水日亏而
火日炽，决非清凉之味可疗，须用六味归芍汤合生脉散为主治，肺燥则加沙参、天冬、梨汁之属；肝燥则加丹
参、枣仁、乳汁之属；脾燥则加柏子仁、甘蔗汁之属。此燥病之正治也。倘久病而气因精虚，参、 、河车
及八味等汤，亦宜急投。盖阳生则阴长，气化则血润，此燥病之反治也。虽然草木之枯，得雨滋荣，人身之燥，
非血不泽，参乳汤救燥病之根，活命饮治燥病之
原，又何必纷纷而他求耶？经云∶诸涩枯涸，干劲皴揭，皆属于燥。又曰∶燥胜则干。其为血液之涸，已明效
大验。即如隔病之枯，胃之燥也；消病之渴，肺之燥也；爪甲之焦，筋之燥也；产后之痉，血之燥也；而敢谓
治燥为易哉？（《会心录》）
燥证有外因的，是六淫邪气之一；有内因的，是血液枯竭。外因的燥，如果不是雨露延期，就是秋日暴烈；如果不是南方土地贫瘠不长草木，就是北方风势强劲，气偏阳亢而产生燥。从皮毛进入的，肺受邪，肺受燥气，咳嗽咽痛的病症就出现了；从口进入的，胃受邪，胃受燥气，结胸便秘的病症就出现了。喻嘉言说：秋天伤于燥，冬天产生咳嗽。这种议论阐发了前人未曾阐发的观点，而清燥一方，可以作为治疗燥证的灵丹妙药。至于结胸、便秘，世俗人多用伤寒混合治疗，不知道燥会产生火，津液消耗而肠胃干燥。如果是内伤引起的燥，根本在于肾水的亏损，精血的虚弱，真阴的枯竭。在肺则清肃的命令不能执行，咳嗽气逆口渴，皮肤聚拢毛发脱落；在肝则将军般的本性不能收敛，胁痛暴怒，筋脉拘急痉挛；在脾则生血的源头不能运转，蓄积瘀血大便秘结，皮肤没有光泽。想要治疗燥，首先贵在滋润；想要挽救脾，首先滋补肾。确实因为肾主水而储藏脏腑的精气，滋养全身骨骼而成为生命的根本。如果肾阴充足，那么其他四脏可以得到灌溉，燥自然不会产生。只是水日益亏损而火日益炽盛，绝对不是清凉的味道可以治疗的，必须用六味地黄丸合当归芍药汤配合生脉散作为主治，肺燥则加沙参、天冬、梨汁之类的药；肝燥则加丹参、酸枣仁、乳汁之类的药；脾燥则加柏子仁、甘蔗汁之类的药。这是治疗燥病的正治法。如果久病而气因为精虚，人参、黄芪、紫河车以及八味丸等汤剂，也应当急忙服用。因为阳生则阴长，气化则血润，这是治疗燥病的反治法。虽然草木枯萎，得到雨水滋润就能繁荣，人身体的燥，没有血就不能润泽，参乳汤拯救燥病的根本，活命饮治疗燥病的源头，又何必纷纷寻求其他方法呢？经文说：各种干涩、枯萎、干涸、皮肤干枯起皱开裂，都归属于燥。又说：燥气偏胜就会干燥。这作为血液枯竭的证据，已经是明显有效的验证。就像噎膈病的枯槁，是胃的燥；消渴病的口渴，是肺的燥；爪甲焦枯，是筋的燥；产后抽搐，是血的燥；而敢说治疗燥病很容易吗？（《会心录》）
燥为干涩不通之疾，内伤外感宜分。外感者，由于天时风热过胜，或因深秋偏亢之邪，始必伤人上焦气
分，治以辛凉甘润肺胃为先，喻氏清燥救肺汤及玉竹、门冬、桑叶、薄荷、梨皮、甘草之类。内伤者，乃人之
本病精血下夺而成，或因偏饵燥剂所致，病从下焦阴分先起，治以纯阴静药柔养肝肾为宜，大补地黄丸、六味
丸之类。要知是证大忌者苦涩，最喜者甘柔。若气分失治，则延及于血；下病失治，则槁及乎上。喘咳、痿厥、
三消、噎隔，根萌总由此致。津液结者，必佐辛通之气味；精血竭者，必藉血肉之滋填。在表佐风药而成功；
在腑以缓通为要务。古之滋燥养营汤、润肠丸、五仁汤、琼玉膏、一 丹、牛羊乳汁等法，各有专司也。（《临证指南》）
燥是干涩不通的疾病，内伤和外感应加以区分。外感的，是由于天时风热过胜，或者因为深秋偏亢的邪气，开始必定伤害人的上焦气分，治疗以辛凉甘润滋养肺胃为先，比如喻氏的清燥救肺汤以及玉竹、麦冬、桑叶、薄荷、梨皮、甘草之类的药。内伤的，是人本身的疾病精血下夺而成，或者因为偏服燥热药物所致，病从下焦阴分先发起，治疗以纯阴静药柔养肝肾为宜，比如大补地黄丸、六味地黄丸之类的药。要知道这个证候最忌讳的是苦涩，最喜欢的是甘柔。如果在气分失治，就会蔓延波及到血分；在下部失治，就会枯槁波及到上部。喘咳、痿厥、三消、噎隔，根源萌芽总是由此导致。津液凝结的，必须辅助辛通的气味；精血枯竭的，必须借助血肉有情之品来滋填。在表的辅助风药而成功；在腑以缓通为主要任务。古代的滋燥养营汤、润肠丸、五仁汤、琼玉膏、一捻金、牛羊乳汁等方法，各有专门的用途。（《临证指南医案》）
夫燥有脏腑之燥，有血脉之燥。燥在上，必乘肺经，故上逆而咳，宜《千金》五味子汤；若外内合邪，
宜《千金》麦门冬汤。燥在下，必乘大肠，故大便燥结，然须分邪实、津耗、血枯三者为治∶邪实者，则烦
渴躁闷腹胀，用通幽汤、麻仁丸；津耗者，屡欲便而不可得圊，欲了而不了，外用蜜煎导；血枯者，呕逆食
不下，大便燥结如栗，用生料六味丸去山萸加生首乌、当归、苁蓉、桃仁。燥在血分，多见风证，木无所畏
也。燥本火之余，故以滋燥养营汤治外，大补地黄汤治内，润燥养阴为第一义。火热亢盛，津液耗竭，不能荣
养百骸，手足痿弱，不能收持，反似湿痹之证，养阴药中必加黄柏以苦坚之，如虎潜丸之类。若误作风治则殆
矣。（张路玉）
燥有脏腑的燥，有血脉的燥。燥在上部，必定侵犯肺经，所以上逆而咳嗽，适宜用《千金方》的五味子汤；如果内外邪气结合，适宜用《千金方》的麦门冬汤。燥在下部，必定侵犯大肠，所以大便秘结，然而必须区分邪实、津耗、血枯三种情况来治疗：邪实的，就会出现烦渴躁闷腹胀，用通幽汤、麻子仁丸；津耗的，屡次想排便却排不出来，想结束却结束不了，外用蜜煎导法；血枯的，呕吐气逆吃不下东西，大便秘结像栗子一样硬，用生料六味丸去掉山茱萸加入生何首乌、当归、肉苁蓉、桃仁。燥在血分，多见风证，因为木（肝）无所畏惧。燥本是火的余气，所以用滋燥养营汤治疗外部，大补地黄汤治疗内部，润燥养阴是第一要义。火热亢盛，津液耗竭，不能滋养全身骨骼，手足痿弱，不能收持，反而类似湿痹的证候，在养阴药中必须加黄柏以苦味坚阴，比如虎潜丸之类的药。如果误当作风病治疗那就危险了。（张路玉）
风燥一证，辨治尤难。盖燥为秋气，令不独行，必假风寒之威，而令乃振，病乃发也。然考之于《经》，
则不曰秋伤于燥，而言秋伤于湿，何也？夫秋令本燥，以长夏湿土郁蒸之余气渐渍身中，随秋令收敛而伏于肺
胃之间，直待秋深燥令大行，与湿不能兼容，至冬而为咳嗽也。此证有肺燥、胃湿两难分解之势。古方中惟
《千金》麦门冬汤、《千金》五味子汤独得其秘。不知者，以为敛散不分、燥润杂出，则又置而不用，总未达
分解风燥之义耳。喻氏不明湿气内伏燥令外伤之意，直云《内经》独遗长夏伤于湿句，致令秋伤于燥误为伤湿，
殊失《内经》精微之奥矣。（《伤寒析义》）
风燥这一证候，辨别和治疗尤其困难。大概燥是秋天的气候，命令不单独施行，必须借助风寒的威力，命令才能振奋，病才能发作。然而考证《内经》，却不说是秋天伤于燥，而说秋天伤于湿，为什么呢？秋天的命令本来就是燥，因为长夏湿土郁蒸的余气逐渐浸渍身体中，随着秋天的收敛而潜伏在肺胃之间，一直等到深秋燥令大行，与湿不能兼容，到了冬天就发生咳嗽。这个证候有肺燥、胃湿两难分解的趋势。古方中只有《千金方》的麦门冬汤、《千金方》的五味子汤独自掌握了其中的奥秘。不懂的人，认为收敛和发散不分、燥和润混杂出现，就又放置不用，始终没有理解分解风燥的含义。喻氏不明白湿气内伏、燥令外伤的意思，直接说《内经》唯独遗漏了长夏伤于湿的句子，导致把秋天伤于燥误认为是伤湿，特别失去了《内经》精微的奥妙。（《伤寒析义》）
治风燥莫如养血，治燥热莫如壮水。更有冷燥一证，虽见便秘燥结，实由阴寒过极，如阳和之水，遇隆冬
而成层冰燥裂也。古方有半硫丸之设，意深远矣。（冯楚瞻）
治疗风燥没有比养血更好的，治疗燥热没有比滋补肾阴（壮水）更好的。还有冷燥这一证候，虽然见到便秘燥结，实际上是由阴寒过极造成的，就像温和的水，遇到隆冬就结成层层冰块干燥开裂一样。古方中有半硫丸的设置，用意深远啊。（冯楚瞻）
壮水以制火，清金以润燥，人所共知；补脾以生肺，资母以益子，人所不晓。每见余师治燥用二冬、二
地为君，加山药等，无不应手而效。（方星岩）
滋补肾阴以制约火邪，清肺金以润燥，是人们所共知的；补脾以生肺，资助母脏以益子脏，人们却不知道。每次看见我的老师治疗燥证用麦冬、天冬（二冬）、熟地黄、生地黄（二地）作为主药，加上山药等，没有不随手见效的。（方星岩）
润燥，以玉竹、麦冬、沙参为最，地、归不能及也。（《三秋病机》）
润燥，以玉竹、麦冬、沙参最为有效，地黄、当归比不上它们。（《三秋病机》）
治燥病者，补肾水阴寒之虚，泻心火阳热之实，除肠中燥热之甚，济胃中津液之衰，使道路散而不结，津
液生而不枯，气血利而不涩，则病日已矣。○凡秋月燥病，误以为湿治者，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。○凡治燥病，燥在气而治血，燥在血而治气，燥在表而治里，燥
在里而治表。药不适病，医之过也。○凡治杂病，有兼带燥证者，误用燥药，转成其燥，因致危困者，医之罪
也。○凡治燥病，须分肝肺二脏见证，肝脏见证，治其肺犹可也；若肺脏见证，反治其肝，则坐误矣，医之罪
也。○凡治燥病，不深达治燥之旨，但用润剂润燥，虽不重伤，亦误时日，只名粗工，所
当戒也。（《医门法律》）
治疗燥病的人，要补肾水阴寒的虚损，泻心火阳热的实证，清除肠道中严重的燥热，救济胃中津液的衰少，使经络道路疏散而不结滞，津液生成而不枯槁，气血流通而不涩滞，那么病就会一天天好了。○凡是秋天和秋天的燥病，误以为是湿病来治疗的，是拿着刀乱砍一样的愚蠢行为。以前不明白，过错还可以推卸，现在明明知道却故意违反，伤害的人一定很多。孽镜当前，后悔也来不及了。○凡是治疗燥病，燥在气分却治疗血分，燥在血分却治疗气分，燥在表却治疗里，燥在里却治疗表。药不对病，是医生的过错。○凡是治疗杂病，有兼带燥证的，误用燥药，反而加重其燥，因此导致危险困顿的，是医生的罪过。○凡是治疗燥病，必须分辨肝肺两脏的见证，如果是肝脏的见证，治疗肺还可以；如果是肺脏的见证，反而治疗肝，那就是白白耽误了，是医生的罪过。○凡是治疗燥病，如果不深刻理解治疗燥的宗旨，仅仅用润剂来润燥，虽然不会造成严重伤害，也会耽误时间，只配称为粗工，应当引以为戒。（《医门法律》）
脉候
燥有内外诸证，不能尽述，而脉之微、细、涩、小则一，间有虚、大、数、疾、浮、芤等状。以意察
之，重按无有不涩、不细、不微者，则知诸燥之证，皆肺金之一气，亦不出肺金之一脉也。（张路玉）
燥有内外的各种证候，不能完全叙述，但是脉象微、细、涩、小是一致的，间或有虚、大、数、疾、浮、芤等形状。用心观察，重按时没有不涩、不细、不微的，就知道各种燥证，都是肺金的一气所主，也不超出肺金一脉的范围。（张路玉）
选案
Heat-dryness with irritability, scanty dark-red urine, deficiency of middle Qi, and excretion resembling paste should never be treated with diuretics, as this would severely damage body fluids, leading to grave harm. Therefore, in treating Yang deficiency, one should only tonify Yang; when Yang prevails, dryness manifests, and Yin-dampness naturally recedes. In treating Yin deficiency, one should only strengthen Water (Kidney Yin); once True Water flows, pathogenic dampness has no place to reside. Both these Yin and Yang patterns have indications against using diuretics, which must not be overlooked. (Zhang Jingyue)
Wind-dispelling herbs can overcome dampness; promoting urination can guide dampness out; unblocking the bowels can expel dampness; inducing vomiting of phlegm-saliva can remove dampness. If dampness is accompanied by heat, bitter-cold herbs are used to dry it; if dampness is accompanied by cold, acrid-hot herbs are used to dispel it. (Li Shizhen)
For dampness in the upper part of the body, Fangfeng (Saposhnikovia Root) is suitable, for wind overcomes dampness, just as wet clothes dry easily when hung in a ventilated place. For dampness in the middle part of the body, Cangzhu (Atractylodis Rhizoma) is suitable, just as damp earth dries when covered with ash. For dampness in the lower part of the body, promoting urination is suitable, just as digging drainage ditches dries the ground. For dampness throughout the body, Wuyao (Linderae Radix) and Qianghuo (Notopterygii Rhizoma et Radix) etc. are suitable. For dampness in both arms, Sangtiao (Mori Ramulus) and Weilingxian (Clematidis Radix et Rhizoma) etc. are suitable. For dampness in both thighs, Niuxi (Achyranthis Bidentatae Radix), Fangji (Stephaniae Tetrandrae Radix), and Bi Xie (Dioscoreae Hypoglaucae Rhizoma) etc. are suitable. By treating according to the location of the dampness, how could there be any lack of efficacy? (Shen Jin'ao)
For spleen weakness with dampness injury, Erchen Tang (Two-Cured Decoction) and Pingwei San (Peaceful Stomach Powder) are indicated. For excessive dampness causing loose stools, Wuling San (Five-Ingredient Powder with Poria) and Liuyi San (Six-to-One Powder) are indicated. For edema with yellowing, Wupi Yin (Five-Peel Decoction) and Yinchenshao Tang (Artemisiae Scopariae Decoction) are indicated. If dampness flows into the joints, the aforementioned medicines are not suitable; dampness penetrates every orifice, and only wind-dispelling herbs can reach it. Thus, for joint diseases, non-wind-dispelling herbs cannot be effective. (Wu Hegao)
Pulse Diagnosis
A pulse that is floating and slow, or soggy and small, indicates external dampness. A pulse that is deep and slow, or fine and minute, indicates internal dampness. Furthermore, a slow and soft pulse indicates cold-dampness; a surging and soft pulse indicates damp-heat; a wiry and soft pulse indicates wind-dampness. (*Zhengzhi Huibu*)
Classics
The West generates Dryness, and Dryness generates Metal. ○ An excess of clear Qi indicates an overabundance of Dryness. ○ All cases of astringency, withering, drying up, stiffness, and skin cracking belong to Dryness. ○ When Dryness prevails, there is dryness. (*Suwen*)
Philosophical Discourse
"Astringent" refers to the fact that objects are slippery when wet but sticky/stagnant when dry, due to the opposition between Dryness and Dampness. "Withered" means lacking nourishment for life. "Dried up" means having no fluid. "Dry" means lacking moisture. "Stiff" means lacking flexibility. Spring and Autumn are opposite, hence Dryness and Dampness differ. "Cracking" refers to skin fissures. Heaven (Qian) is Dryness-Metal; Earth (Kun) is Dampness-Earth. Heaven and Earth are opposite, hence Dryness and Dampness differ yet share connections. (Liu Wansu, *Yuanbing Shi*)
Dryness is the Qi of Metal. There is Cold-Dryness and Heat-Dryness. Cold-Dryness is when the clear sky is biting cold, causing withering; Heat-Dryness is when the clear sky is scorching hot, causing dryness. (*Huangdi Yidian*)
Obese people have Qi deficiency generating Cold, Cold generates Dampness, and Dampness generates Phlegm. Thin people have Blood deficiency generating Heat, Heat generates Fire, and Fire generates Dryness. Thus, obese people often suffer from Cold-Dampness, while thin people often suffer from Heat-Dryness. ○ Dryness is the transformation of the Yangming channel. Although it may result from Wind-Heat, its root is mostly due to Blood deficiency and insufficient body fluids. Why? Because when Yin-Blood is deficient, it cannot nourish the whole body; when body fluids decline, they cannot nourish the Triple Burner. Consequently, pathogenic heat becomes stagnant, leading to various forms of dryness. Dryness externally causes skin cracking; internally causes exhaustion of essence and blood; superiorly causes dry/burning throat and nose; inferiorly causes constipation and urinary retention. Treatment involves nourishing externally, tonifying internally, clearing/resolving superiorly, and unblocking/moistening inferiorly, ensuring body fluids regenerate so that dryness-heat cannot help but retreat. (Zhu Danxi)
Wind-Dryness arises because Liver Blood fails to nourish tendons, causing tendon tension and nail cracking. Fire-Dryness arises because Spleen has latent fire, causing lip peeling and constipation. Blood-Dryness arises because Heart Blood scatters, causing dandruff, hair loss, and beard falling. Deficiency-Dryness arises because Kidney Yin is exhausted, causing frequent urination, dry throat, and swollen larynx. These are all causes of Dryness. (*Zhengzhi Huibu*)
Generally, objects near fire become moist, while those away from fire become dry, like metal melting into liquid in fierce fire. Thus, dryness patterns often resemble flaccidity syndromes, because heat injures Yin-Blood. (Zhang Luyu)
Dryness and Dampness are worlds apart. Dryness is the Qi of Heaven; Dampness is the Qi of Earth. Water flows to dampness; Fire adheres to dryness, each following its kind. In spring, Earth Qi moves and Dampness prevails; in autumn, Heaven Qi becomes solemn and Dryness prevails. Thus, Dampness after the Spring Equinox and Dryness after the Autumn Equinox govern their respective seasons. To call Autumn Dryness Dampness now would be like calling Summer Heat Cold. Why did the *Neijing* omit Dryness from the Nineteen Pathomechanisms? Others stated "Autumn injury by Dryness" as "Autumn injury by Dampness." Past sages interpreted textually without noticing the error. I specifically correct this. The gist is: Spring injury by Wind, Summer injury by Summer-Heat, Late Summer injury by Dampness, Autumn injury by Dryness, Winter injury by Cold. This aligns the Six Qi with Four Seasons and Five Movements, resolving a millennium-old doubt. ○ *Pathomechanism* says: All astringency, withering, drying up, stiffness, and skin cracking belong to Dryness. Although Dryness-Metal is the Autumn command and belongs to Yin channels, it differs from Cold-Dampness and resembles Fire-Heat. Excess Fire-Heat weakens Metal; excess Fire-Heat intensifies Wind. Wind overcomes Dampness; Heat consumes Fluids, turning Yang-excess and Yin-deficiency. Thus, Wind, Fire, and Heat Qi surpass Earth/Water to create Dryness. ○ Qi stagnation belonging to the Lung belongs to Lung-Dryness, not Lung-Dampness. If Lung Qi is not dry, it follows the solemn command and circulates freely; why would it stagnate? Flaccidity, wheezing, and vomiting belonging to the Upper Jiao refer to the Lung, not the Heart. If speaking of Upper Jiao Heart/Lung together, Heart disease does not primarily cause flaccidity/wheezing/vomiting. Only severe Lung-Dryness causes Lung lobes to become flaccid/unfunctional, Lung Qi rebellious causing wheezing, and food difficulty passing the diaphragm causing vomiting. These three are extreme Dryness patterns. ○ The Lung is a delicate organ; 20-30% injured by Cold, 70-80% by Fire-Heat. Cold binds externally; Fire-Heat melts internally, causing double harm. However, Fire-Heat injuring the Lung leads to Qi stagnation, flaccidity, wheezing, vomiting forming Dryness patterns, simply because the *Neijing* omitted Dryness. Ignorant successors treated Dryness with Dryness methods, carelessly wielding knives, ignoring Yin consumption. ○ *Classic* says: Heart transfers heat to Lung, transmitting to Ge Xiao (Diaphragmic Thirst). Lung-Dryness origins are ancient. If Kidney Water ascends to interact with Heart, Heart Fire descends to Kidney and does not transfer to Lung; then what danger of Dryness injury? Even if Kidney Water is slightly insufficient, Intestine/Stomach fluids/blood assist upward supply, sparing the Lung. If Middle/Lower pools are exhausted, High Source water remaining stable is impossible. ○ *Yin Yang Bie Lun* says: Diseases of Two Yang originate in Heart/Spleen, involving hidden difficulties, male infertility, female amenorrhea; transmitting to Feng Xiao (Wind-Wasting) or Xi Ben (Breath-Retching) is fatal untreatable. This is also an unexposed origin of Lung-Dryness. Initially, it hinders private matters; subsequently, Stomach-Dryness transmits to Spleen becoming Feng Xiao; Large Intestine-Dryness transmits to Lung becoming Xi Ben. Thus, Stomach/Intestines combine with Heart/Spleen to complete Lung-Metal Dryness. With Yin Qi of three Zang and two Fu nearly exhausted, can it be saved? ○ Severe Wind-Heat-Dryness stagnating in the Exterior with calm Interior causes frequent stretching/yawning, tendon contraction, occasional aversion to cold, muscle twitching/spasms, floating-rapid-wiry pulse. If Wind-Heat-Dryness stagnates deeply in the Interior, it causes vexation/fullness/oppression. Thus, Dryness has Exterior/Interior, Qi/Blood distinctions. ○ Liver governs tendons. If Wind is strong and Dryness-Heat adds, fluids gather in chest/diaphragm, failing to nourish tendons causing tendon-dryness, stiffness, trismus, spasms, coma, or collapse. ○ Dryness disease always involves thirst, but causes vary: Heart/Lung Qi reversal, Liver Bi, Spleen Heat, Kidney Heat, Stomach/Large Intestine heat-binding, Small Intestine toxic heat, malaria, rich diet, drunkenness/coitus, travel/fatigue/heat, stomach injury, Wind. Different organs, different encounters, but all result in Dryness-Heat consuming fluids. (Yu Jia Yan)
Supplement
Do not treat Wind, do not treat Dryness directly; treat Fire, and Wind-Dryness resolves. Dryness disease belongs to Dryness-Metal transformation. Yet, what makes Metal dry is Fire. *Xici* says: Nothing dries things like Fire. Metal is master of Yin, source of Water, receiving Dryness Qi. If Cold-Water generation source exhausts above, unable to irrigate body/nourish bones, causing dry complexion/lack of skin luster, it has origins. Or major illness over-suppresses, or vomiting/diarrhea loses fluids, or mistakenly taking mineral/Yang-tonifying dry herbs, all bias Yang-Fire damaging True Yin. Latent Fire in Yin slowly boils, depleting Blood, worsening Dryness-Heat. Method: Sweet-Cold moisturizing. Sweet generates Blood; Cold overcomes Heat. Yin nourished, Fire suppressed; Fluids moistened, Dryness removed. Source descends, Essence/Blood ascends, Yin fluids circulate, Spirit hides internally, luster appears externally. (Zhang Zihe)
Lung-Metal injured by Fire lacks Qi; Ying depletion and Liver injury increase Blood-phase Dryness, causing Deficient Yang to lose nourishment, stagnating into Withered Fire. Fire cannot descend, rising with turbid phlegm/blood stasis. The diaphragm storing Heart/Lung Qi/Blood loses moisture, becoming scorched. At this time, Fire cannot be attacked, Deficiency cannot be tonified. Thus, nourishing Ying and protecting Lung starts with generating fluids. Sweet-cool moistening uses tonification as irrigation. This is the "Sweet Dew" of the *Puji* school. ○ Nothing dries like Metal; Metal command descends. Nothing nourishes like Wood; Wood command ascends. If Metal command does not follow Dryness, it relies entirely on Wood Qi ascending to vaporize/moisten Five Zang into Lung fluids. Thus, Wood Qi ascending means Five Zang Qi follows Spring command ascending; Wood Qi descending means Five Zang Qi follows Autumn command descending. Descending means Qi cannot ascend, naturally eroding downward. Earth evil sinking suppressing Water, Fire excess lacking fear suppressing Metal, all depend on this. Metal lacking vaporization plus Fire excess becomes Dryness-Metal. Fluid source exhausted above, who irrigates the body? Thus, one dryness means all dryness. More descending commands, fewer ascending commands, Damp-Heat evil prospers in lower part causing flaccidity. Damp-Heat transforms if ascending, stagnates if not. To save whole-body Dryness, must start from Wood command ascending. If Five Zang each have ascending command, Earth generates Metal, Metal generates Water, Water controls Fire. Whether tonifying or draining, use this "Ascending" character as a cycle method, the Shaoyang pivot. "Clearing Dryness" means enabling fluid generation. (Cheng Jiaoqian)
Dryness patterns have External Causes (one of Six Evils) and Internal Causes (Blood withering). External Dryness: either rain/dew delayed, or autumn sun fierce; either southern barren land, or northern strong wind. Qi biases Yang-excess generating Dryness. Entering via skin/hair, Lung receives it: cough/sore throat appear. Entering via mouth, Stomach receives it: chest knot/constipation appear. Yu Jiayan said: "Autumn injury by Dryness, Winter produces cough." This insight was unprecedented. Qingzao formula is a spiritual elixir for Dryness. Chest knot/constipation are often misdiagnosed as Cold Damage by laypeople, not knowing Dryness generates Fire, consuming fluids drying intestines. Internal Dryness roots in Kidney Water deficiency, Essence/Blood weakness, True Yin exhaustion. In Lung: solemn command fails, cough/reversal/thirst, skin/hair fall. In Liver: General nature uncontained, hypochondriac pain/rage, tendon tension. In Spleen: Blood source fails, stasis/constipation, dull skin. To treat Dryness, prioritize Moistening. To save Spleen, first nourish Kidney. Indeed, Kidney governs Water, stores Essence, nourishes bones, root of life. If Kidney Yin sufficient, Four Zang irrigated, Dryness不生. But Water daily declines, Fire daily blazes, cool/cold flavors cannot cure. Must use Liuwei Dihuang Wan combined with Guishao Tang and Shengmai San as main treatment. Lung-Dryness add Shashen, Tiandong, Pear juice. Liver-Dryness add Danshen, Zaoren, Milk. Spleen-Dryness add Baiziren, Sugarcane juice. This is standard treatment. If chronic illness with Qi/Essence deficiency, Renshen, Huangqi, Heche, and Bawei Wan should be urgently given. Yang generates Yin; Qi transformation moistens Blood. This is reverse treatment. Although plants wither needing rain, human Dryness needs Blood for luster. Shenru Tang saves Dryness root; Huoming Yin treats Dryness origin. Why seek elsewhere? Classic says: All astringency/withering/drying/cracking belongs to Dryness. Also: Dryness prevails causing dryness. Evidence of Blood exhaustion is clear. Like Ge disease withering (Stomach-Dryness); Xiao disease thirst (Lung-Dryness); Nail burning (Tendon-Dryness); Postpartum spasms (Blood-Dryness). Dare one say treating Dryness is easy? (*Huixin Lu*)
Dryness is a disease of dryness/astringency/blockage. Internal/External causes must be distinguished. External: due to Wind-Heat excess or late-autumn hyperactive evil, initially injuring Upper Jiao Qi. Treat with Acrid-Cool Sweet-Moistening Lung/Stomach first, e.g., Yu's Qingzao Jiufei Tang, Yuzhu, Maidong, Sangye, Bohe, Lipi, Gancao. Internal: original disease Essence/Blood depletion from below, or caused by dry herbs, starting in Lower Jiao Yin. Treat with Pure-Yin Quiet Herbs nourishing Liver/Kidney, e.g., Dabu Dihuang Wan, Liuwei Wan. Know this pattern forbids Bitter-Astringent, prefers Sweet-Soft. Qi-level mistreatment spreads to Blood; Lower-level mistreatment withers Upper. Wheezing/cough, flaccidity/cold limbs, Three Xiao, dysphagia all stem here. Fluid binding requires Acrid-Unblocking aromatics; Essence/Blood exhaustion requires Flesh-Blood tonics. Exterior benefits from Wind herbs; Interior focuses on gentle unblocking. Ancient Zizao Yangying Tang, Runchang Wan, Wuren Tang, Qiongyu Gao, Yidan, Cow/Sheep milk methods each have specific roles. (*Linzheng Zhinan*)
Dryness has Zang-Fu Dryness and Vessel-Blood Dryness. Dryness in Upper attacks Lung, causing upward rebellion/cough; Qianjin Wuweizi Tang is suitable. If External/Internal combined evils, Qianjin Maimendong Tang is suitable. Dryness in Lower attacks Large Intestine, causing hard stool. Must distinguish Pathogen-Excess, Fluid-Consumption, Blood-Withering. Pathogen-Excess: vexation/thirst/restlessness/bloating, use Tongyou Tang, Maren Wan. Fluid-Consumption: urge to defecate but cannot, use Honey Suppository externally. Blood-Withering: vomiting/inability to eat, stool hard as nut, use Shengliao Liuwei Wan minus Cornus, add He Shou Wu, Dang Gui, Cong Rong, Tao Ren. Dryness in Blood phase shows Wind signs, Wood fears nothing. Dryness is residue of Fire. Use Zizao Yangying Tang for Exterior, Dabu Dihuang Tang for Interior. Moistening-Dryness/Nourishing-Yin is primary. Hyperactive Fire-Heat, exhausted fluids, failing to nourish body, causing flaccid limbs unable to hold, resembling Damp-Bi. Add Huangbo (Bitter-Hardening) to Yin-nourishing meds, e.g., Hujian Wan. Mistaking for Wind treatment is dangerous. (Zhang Luyu)
Wind-Dryness is particularly hard to differentiate/treat. Dryness is Autumn Qi, not acting alone, borrowing Wind/Cold power to manifest. Yet *Jing* says "Autumn injury by Dampness," not Dryness. Why? Autumn is inherently Dry, but Late Summer Damp-Earth lingering steam infiltrates body, hiding in Lung/Stomach during Autumn convergence. Only when Deep Autumn Dryness dominates, incompatible with Dampness, does it cause Winter cough. This pattern has Lung-Dryness/Stomach-Dampness complexity. Only Qianjin Maimendong Tang and Qianjin Wuweizi Tang grasp the secret. Ignorants think mixing astringent/dispersing, dry/moist is wrong, discarding them, missing the meaning of separating Wind-Dryness. Yu failed to understand internal Damp-lagging/external Dry-injuring, claiming *Neijing* omitted "Late Summer injury by Dampness," confusing Autumn-Dryness with Dampness, missing *Neijing* subtlety. (*Shanghan Xiyi*)
Treating Wind-Dryness best by nourishing Blood; treating Dryness-Heat best by strengthening Water. There is also Cold-Dryness: although presenting with constipation/hard stool, actually due to extreme Yin-Cold, like warm water freezing into cracked ice in mid-winter. Banliu Wan in ancient formulas has profound intent. (Feng Chuzhan)
Strengthening Water to control Fire, Clearing Metal to moisten Dryness, is common knowledge; Tonifying Spleen to generate Lung, Nourishing Mother to benefit Child, is unknown. My teacher treats Dryness using Erdong (Tiandong/Maidong) and Erdi (Shengdi/Huadi) as sovereign, adding Yam, etc., always effective. (Fang Xingyan)
Moistening Dryness: Yuzhu, Maidong, Shashen are best; Di, Gui cannot match. (*Sanqiu Bingji*)
Treating Dryness disease: Tonify Kidney Water Yin-Cold deficiency, Drain Heart Fire Yang-Heat excess, Remove severe intestinal Dryness-Heat, Aid Stomach fluid decline, ensure pathways open not knotted, fluids generated not withered, Qi/Blood smooth not astringent, then disease heals. ○ Autumn Dryness misdiagnosed as Dampness is reckless. Past ignorance excusable; present knowing violation harms many. Mirror of Sin reflects, regret too late. ○ Treating Dryness: Dry in Qi treating Blood, Dry in Blood treating Qi, Dry in Exterior treating Interior, Dry in Interior treating Exterior. Mismatched medicine is doctor's fault. ○ Treating miscellaneous diseases with Dryness signs: Misusing Dry herbs worsens Dryness, causing danger, is doctor's sin. ○ Treating Dryness: Distinguish Liver/Lung signs. Liver signs, treating Lung is okay; Lung signs, treating Liver is mistake, doctor's sin. ○ Treating Dryness: Not understanding Dryness principles, merely using moistening agents, though not severely harmful, wastes time, qualifies as crude artisan, must beware. (*Yimen Falv*)
Pulse Diagnosis
Dryness has many internal/external signs, incompletely listed, but pulses are consistently Micro, Fine, Astringent, Small, occasionally Deficient, Large, Rapid, Hurried, Floating, Knotted. Observe carefully: heavy pressing reveals no pulse that is not Astringent, Fine, or Micro. Thus, all Dryness patterns belong to One Qi of Lung-Metal, not exceeding Lung-Metal Pulse. (Zhang Luyu)
Selected Cases