原病式云。诸涩枯涸。干劲皴揭。皆属于燥。乃阳明燥金。肺与大肠之气也。盖风热火。同
阳也。寒燥湿。同阴也。然燥金虽属秋阴。而异乎寒湿。反同其风热也。故火热胜。则金衰而风
生。风热胜。则水竭而为燥也。燥之为病。皆属燥金之化。然能令金燥者。火也。故系辞曰。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。或大病克伐太过。或吐利津液内亡。或养
生误饵金石。或房劳致虚。补阳燥剂。辛热太多。皆能偏助狂火而损真阴。阴中伏火。日渐煎熬。
血液衰耗。使燥热转甚。而为诸病。在外则皮肤皴揭。在上则咽鼻生干。在中则水液衰少而烦渴。
在下则肠胃枯涸。津不润而便难。在手足则痿弱无力。在脉则细涩而微。此皆阴血为火热所伤。
法当治以甘寒滋润之剂。甘能生血。寒能胜热。阴阳滋而火杀。液得润而燥除。源泉下降。精血
上荣。如是则阴液宣通。内神茂而外色泽矣。
盛启东云。浚治之法。其理不出乎滋荣润燥。流通血气而已。且人身之中。水一火五。阳实
阴虚。皆缘嗜欲无节。以致肾水受伤。虚火为患。燥渴之病生焉。或前后秘结。或痰在咽喉干咯
不出。此皆津液不足之故。而火动元伤。肾虚恶燥也。理宜补养水中金。使金水相生。出入升降。
浚泽流通。何燥之有。
喻嘉言曰。燥之与湿。有霄壤之殊。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。各司其正。奈何内经独遗燥气。详病机诸气 郁。皆属于肺。诸痿喘呕。皆
属于上。二条明指燥病而言。生气通天论谓秋
伤于燥。上逆而咳。发为痿厥。燥病之要。可一言而终。只缘内经失却长夏伤于湿句。致误传秋
伤于燥为伤湿。而解者竞指燥病为湿病。宜乎经旨之不明也。戴人有云。休治风兮休治燥。治得
火时风燥了。斯治燥之要。亦一言而终也。老人多有大便后寒热。发作有时。颇似外感。实非外
感也。大便努挣伤气。故便出则乘于阳而寒。顷之稍定。则阳胜阴而热。若果外感之寒热。何必
大便后始然耶。世医遇此证。每谓湿热内蕴。而用滑利之剂以驱之。不知瘦人身中。以湿为宝。
有湿则润。无湿则燥。今指燥为湿。是欲出而反闭其户也。
石顽曰。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。
若外内合邪者。千金麦门冬汤。风热心烦。脾胃热壅。食不下者。千金地黄煎。积热烦渴。日晡
转剧。喘咳面青。能食便秘者。生地黄煎主之。燥于下必乘大肠。故大便燥结。然须分邪实津耗
血枯三者为治。邪实则大烦渴。躁闷腹胀。通幽汤、润燥汤、清凉饮、四顺清凉饮、麻仁丸。大
肠风秘血燥。润肠丸加郁李仁、防风。名润燥丸。润而下之。能食热盛。可用猪胆导法。津耗者。
屡欲便而不可得。圊欲了而不了。便出仍是大块。异功散加二冬、沉香。用麻仁擂水煎服。兼嚼
苏子、胡麻之类。外用蜜煎导。或削陈酱瓜导之亦佳。血枯者。呕逆食不下。大便日渐燥结如栗。
生料六味丸去山萸。加生何首乌、当归煎服。或生料六味丸加肉苁蓉、桃仁擂水煎服。兼食人乳
酥蜜之类。但苁蓉咸腐。服之每令呕吐。不可不知。老人气血俱耗竭者。固本丸作膏服。若至呕
逆不食。便如羊矢。不可治矣。燥在血脉。多见风证。木无所畏也。燥本火气之余。故以滋燥养
营汤治外。大补地黄汤治内。润燥养阴为第一义。火热亢甚。津液耗竭。不能荣养百骸。手足痿
弱。不能收持。反似痹湿之证。养阴药中。必加黄柏以坚之。如虎潜丸之类。若误作风治则殆矣。
〔诊〕凡物近火则润。离火则燥。犹金之投入烈火而化为液也。故燥证多有反似痹弱之证者。
热伤阴血也。燥有内外诸证。不能尽述。其在皮肤。则毛焦皴揭。在大肠。则脾约便难。在肺经。
则干咳痰结。在肺脏。则悲愁欲哭。证虽各异。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。
《原病式》中说：各种涩滞、干枯、涸竭，皮肤干裂起皱，都属于燥证。这是阳明燥金（肺与大肠的气化功能）的表现。风、火、热同属阳，寒、燥、湿同属阴。然而燥金虽然属于秋季的阴气，却不同于寒湿，反而与风热相似。所以火热亢盛，则金气衰弱而风气内生；风热亢盛，则肾水枯竭而产生燥证。燥邪致病，都归属于燥金的生化作用。但能使金气变燥的，是火邪。所以《周易·系辞》说：“使万物干燥的，没有比火更厉害的了。”金是阴气的主宰，是水液的源头，若受到燥气侵袭，作为寒水生化之源的上焦就会枯竭，无法灌溉周身，荣养骨骼肢体，导致面色干枯、皮肤失去润泽，这都是有其原因的。或者大病中攻伐太过，或者吐泻导致津液内亡，或者养生时误服金石类药物，或者房劳过度导致虚损，以及服用补阳燥剂、辛热药物过多，都能偏助狂火而损伤真阴。阴中潜伏的火邪，日渐煎熬，导致血液衰耗，使燥热更加严重，从而产生各种疾病。在体表则皮肤干裂起皱，在上部则咽喉鼻腔干燥，在中部则水液减少而烦渴，在下部则肠胃干枯涸竭，津液不能滋润而导致大便困难，在四肢则痿弱无力，在脉象上则细涩而微弱。这些都是阴血被火热所伤，治疗应当使用甘寒滋润的方剂。甘味能生血，寒性能胜热，阴阳得到滋养而火邪消退，津液得到滋润而燥邪去除，水源下降，精血上荣，这样阴液宣通，内在精神茂盛而外在色泽光亮了。
盛启东说：疏通治疗的方法，其原理不出于滋荣润燥、流通气血罢了。况且人身之中，水一火五，阳气实而阴气虚，都是因为嗜欲无节制，导致肾水受伤，虚火为患，从而产生燥渴之病。或者前后二便闭塞不通，或者痰阻咽喉干咳不出，这都是津液不足的缘故，而火动元气受损，肾虚厌恶燥邪。理应补养水中的金（即补肾润肺），使金水相生，出入升降，浚泽流通，哪里还会有燥证呢？
喻嘉言说：燥与湿，有着天壤之别。春季地气发动而湿气胜，秋季天气肃杀而燥气胜。所以春分以后的湿，秋分以后的燥，各自掌管其正令。为什么《内经》唯独遗漏了燥气？详细看《病机十九条》中“诸气膹郁，皆属于肺”、“诸痿喘呕，皆属于上”两条，明确指向燥病而言。《生气通天论》说“秋伤于燥，上逆而咳，发为痿厥”，燥病的要点，可以一言以蔽之。只因为《内经》缺失了“长夏伤于湿”的句子，导致误传“秋伤于燥”为“伤湿”，而解释经文的人竞相把燥病当作湿病来解，难怪经旨不明。戴人（张从正）说：“休治风兮休治燥，治得火时风燥了”，这也是治疗燥病的要点，同样是一言以蔽之。老人多有大便后出现寒热，发作有时，颇似外感，其实并非外感。大便用力努挣损伤正气，所以大便排出后乘于阳分而恶寒，片刻之后稍定，则阳胜阴而发热。如果果真是外感的寒热，何必在大便后才这样呢？世医遇到此证，每每说是湿热内蕴，而用滑利之剂来驱除它，不知道瘦人身体中，以湿为宝，有湿则润，无湿则燥。现在把燥证当作湿证，是想让门户打开反而关闭了它。
石顽（罗美）说：燥有脏腑之燥，有血脉之燥。燥在上部必然侵犯肺经，所以上逆而咳嗽，适宜用千金五味子汤。如果是外内合邪，用千金麦门冬汤。风热心烦，脾胃热壅，饮食不下者，用千金地黄煎。积热烦渴，日晡时分加重，喘咳面青，能食但便秘者，用生地黄煎主治。燥在下部必然侵犯大肠，所以大便燥结。然而必须区分邪实、津耗、血枯三者分别治疗。邪实则大烦渴，躁闷腹胀，用通幽汤、润燥汤、清凉饮、四顺清凉饮、麻仁丸。大肠风秘血燥，用润肠丸加郁李仁、防风，名为润燥丸，润而下之。能食且热盛者，可用猪胆导法。津耗者，屡次想排便却排不出，上厕所想结束却结束不了，排出的仍然是大块粪便，用异功散加天冬、麦冬、沉香，用麻仁擂水煎服，兼嚼苏子、胡麻之类。外用蜜煎导，或削陈酱瓜导之也很好。血枯者，呕逆饮食不下，大便日渐燥结如栗子状，用生料六味丸去掉山茱萸，加生何首乌、当归煎服。或者生料六味丸加肉苁蓉、桃仁擂水煎服，兼食人乳、酥蜜之类。但是肉苁蓉咸腐，服用时常引起呕吐，不可不知。老人气血俱耗竭者，用固本丸做成膏剂服用。如果到了呕逆不食，大便像羊屎一样，就无法治疗了。燥在血脉，多见风证，因为木无所畏也。燥本是火气的余绪，所以用滋燥养营汤治在外，大补地黄汤治在内，润燥养阴是第一要义。火热亢盛，津液耗竭，不能荣养百骸，手足痿弱，不能收持，反而类似痹湿之证。在养阴药中，必须加黄柏以坚阴，如虎潜丸之类。如果误作风证治疗那就危险了。
〔诊法〕凡是物体靠近火就湿润，离开火就干燥，就像金属投入烈火化为液体一样。所以燥证多有反类似痹弱的症状，这是因为热伤了阴血。燥有内外各种症状，不能全部叙述。在皮肤，则毛发焦枯、皮肤干裂；在大肠，则脾约便难；在肺经，则干咳痰结；在肺脏，则悲愁欲哭。症状虽然各异，但脉象微细涩小是一致的。间或有虚大数疾浮芤等状态，凭心意察验，重按无不表现为涩、细、微的，就知道诸燥之证，都是肺金一气所致，也不超出肺金一脉的范围。
The *Yuan Bing Shi* (Treatise on the Original Causes of Disease) states: Various conditions characterized by astringency, dryness, and withering, where the skin becomes dry, cracked, and peeling, all belong to Dryness. This is the manifestation of Yangming Dry Metal (the qi transformation function of the Lung and Large Intestine). Wind, Fire, and Heat are all Yang; Cold, Dryness, and Dampness are all Yin. However, although Dry Metal belongs to the Yin of Autumn, it differs from Cold and Dampness and is actually similar to Wind and Heat. Therefore, when Fire and Heat prevail, Metal Qi declines and Wind arises; when Wind and Heat prevail, Kidney Water dries up, resulting in Dryness. Diseases caused by Dryness all belong to the transformation of Dry Metal. However, what causes Metal to become dry is Fire. Thus, the *Xi Ci* (Commentary on the Words of the Trigrams) says: "Among all things that dry up the myriad entities, none is greater than Fire." Metal is the master of Yin and the source of Water. If it is affected by Dryness Qi, the source of Cold Water's generation and transformation at the Upper Jiao will be exhausted, unable to irrigate the whole body and nourish the bones and limbs. Consequently, the complexion becomes dry without luster, and the skin loses moisture and radiance; this has its origins. Whether due to excessive purgation during severe illness, internal loss of Body Fluids through vomiting and diarrhea, accidental ingestion of mineral drugs for health preservation, deficiency caused by sexual exhaustion, or taking too many warming and drying tonics and pungent-hot medicines, all can excessively assist raging Fire and damage True Yin. The latent fire within Yin slowly cauterizes day by day, depleting Blood and causing Dryness-Heat to intensify, thereby producing various diseases. Externally, the skin cracks and peels; superiorly, the throat and nose become dry; centrally, Body Fluids decrease leading to vexation and thirst; inferiorly, the intestines and stomach become withered and dry, lacking fluid lubrication and causing difficult defecation; in the limbs, there is flaccidity and weakness; in the pulse, it is fine, choppy, and faint. These are all cases where Yin Blood is damaged by Fire-Heat. The treatment method should employ sweet and cold moistening agents. Sweetness generates Blood, and Coldness overcomes Heat. When Yin and Yang are nourished, Fire subsides; when fluids are moistened, Dryness is removed. The source descends, Essence and Blood ascend to nourish; thus, Yin fluids circulate freely, internal spirit flourishes, and external luster appears.
Sheng Qidong stated: The principle of dredging and treating lies not beyond nourishing Ying (Nutritive Qi) and moistening Dryness, and circulating Blood and Qi. In the human body, Water is one and Fire is five; Yang is substantial while Yin is deficient. This is often due to unregulated desires, which injure Kidney Water, allowing Deficient Fire to cause pathology, giving rise to Dryness-Thirst diseases. Symptoms may include constipation of both bowels and anus, or phlegm stuck in the throat causing dry hacking coughs. All these are due to insufficient Body Fluids, where Fire moves and Yuan Qi (Original Qi) is damaged, and the Kidney dislikes Dryness. It is appropriate to tonify Metal in Water (nourish Kidney and moisten Lung), enabling Metal and Water to generate each other, ensuring smooth entry and exit, ascent and descent, and free flow of dampness. How could Dryness exist?
Yu Jiayan said: Dryness and Dampness differ as much as heaven and earth. In spring, Earth Qi rises and Dampness prevails; in autumn, Heaven Qi becomes solemn and Dryness prevails. Thus, after the Spring Equinox, Dampness governs its proper season; after the Autumn Equinox, Dryness governs its proper season. Why does the *Nei Jing* (Inner Canon) omit Dryness Qi? Examining the *Bing Ji* (Pathogenesis) section, "All Qi stagnations and fullness belong to the Lung" and "All flaccidity, wheezing, and vomiting belong to the Upper Jiao," clearly refer to Dryness diseases. The *Sheng Qi Tong Tian Lun* chapter states, "Injury by Dryness in Autumn leads to upward reversal and cough, developing into flaccidity and cold extremities." The essence of Dryness disease can be summarized in one sentence. The error arose because the *Nei Jing* missed the phrase "Injury by Dampness in Late Summer," leading to the mistaken transmission that "Autumn injury by Dryness" was actually "injury by Dampness." Commentators then conflated Dryness diseases with Dampness diseases, hence the obscurity of the canonical meaning. Dai Ren (Zhang Congzheng) said, "Do not treat Wind, do not treat Dryness; once Fire is treated, Wind and Dryness are resolved." This is also the essence of treating Dryness, summarized in one sentence. Many elderly people experience chills and fever after defecation, occurring at specific times, resembling exterior patterns but not being so. Straining during defecation damages Qi; thus, upon expulsion, Qi rides on Yang causing chills; shortly after stabilizing, Yang overcomes Yin causing fever. If it were truly an exterior pattern of chills and fever, why would it only occur after defecation? Physicians of the world often attribute this syndrome to internal accumulation of Damp-Heat and use slippery/lubricating agents to drive it out. They do not know that for thin individuals, Dampness is precious; with Dampness, there is moisture; without Dampness, there is Dryness. To treat Dryness as Dampness now is like wanting to open the door but instead closing it.
Shi Wan (Luo Mei) said: Dryness exists in Zang-Fu organs and in the Blood vessels. Dryness superiorly must invade the Lung Meridian, causing upward reversal and cough; Qianjin Wuweizi Decoction is suitable. If there is combined interior and exterior pathogenic factors, Qianjin Maimendong Decoction is used. For wind-heat causing vexation, Spleen-Stomach heat obstruction, and inability to eat, Qianjin Dihuang Jian is indicated. For accumulated heat causing vexation and thirst, worsening at dusk, wheezing, coughing, greenish face, ability to eat but constipation, Sheng Dihuang Jian is the primary treatment. Dryness inferiorly must invade the Large Intestine, causing dry and hard stools. However, treatment must distinguish between Pathogenic Excess, Body Fluid Depletion, and Blood Withering. In Pathogenic Excess, there is great vexation and thirst, restlessness, abdominal distension; treat with Tongyou Tang, Runzao Tang, Qingliang Yin, Sishun Qingliang Yin, or Mahuang Wan. For Large Intestine Wind Constipation and Blood Dryness, use Run Chang Wan plus Xingren (Apricot Seed) and Fuling (Poria), named Runzao Wan, to moisten and purge downward. For those who can eat and have intense heat, Pig Gallbladder Suppository method can be used. In Body Fluid Depletion, there is frequent urge to defecate but inability to pass stool, incomplete evacuation, and passage of large hard pieces; treat with Yigong San plus Donggu (Asparagus Root) and Chenxiang (Agarwood), decocted with Sesame paste water, accompanied by chewing Perilla seeds and Sesame. Externally, Honey Suppository can be used, or suppositories made from aged pickled mustard tuber are also good. In Blood Withering, there is vomiting, inability to eat, and daily increasing dryness and hardness of stool like chestnuts; treat with Shengli Liuwei Wan removing Cornus Fruit, adding raw Polygonum multiflorum and Angelica Sinensis, decocted and taken. Alternatively, Shengli Liuwei Wan added with Cistanche and Peach Kernel, decocted with sesame paste water, accompanied by consuming human milk, butter, and honey. Note that Cistanche is salty and putrid, often causing vomiting if taken, so this must be known. For elderly people with exhaustion of both Qi and Blood, Guben Wan taken as a paste is suitable. If vomiting prevents eating and stool resembles sheep dung, it is incurable. Dryness in the blood vessels often manifests as Wind patterns, because Wood has nothing to fear. Dryness is essentially the remnant of Fire Qi; therefore, Zizao Yangying Tang treats exterior manifestations, and Dabu Dihuang Tang treats interior manifestations. Moistening Dryness and nourishing Yin is the first principle. When Fire-Heat is hyperactive and Body Fluids are exhausted, failing to nourish the hundred bones, leading to flaccidity and weakness of limbs that cannot hold or grasp, resembling Bi-Dampness patterns. In Yin-nourishing formulas, Phellodendron Bark must be added to firm the Yin, such as in Hujian Wan. Mistaking this for Wind treatment would be dangerous.
[Diagnosis] Any substance near fire becomes moist; away from fire, it becomes dry, just as metal melts into liquid when thrown into fierce fire. Therefore, Dryness syndromes often resemble Bi-flaccidity symptoms, because Heat injures Yin Blood. Dryness presents with various interior and exterior signs, which cannot be fully enumerated. On the skin, hair becomes brittle and skin cracks; in the Large Intestine, Splee Restriction causes difficult defecation; in the Lung Meridian, dry cough with knotted phlegm occurs; in the Lung organ, sorrow and weeping arise. Although symptoms vary, the pulse is consistently fine, choppy, small, and subtle. Occasionally, there may be empty, large, rapid, floating, or hollow pulses. Upon careful palpation, deep pressure always reveals choppy, fine, or faint qualities. Thus, one knows that all Dryness syndromes stem from the single Qi of Lung Metal and do not exceed the single pulse of Lung Metal.