属白虎之经证和属承气之腑证，只是阳明病的二个常见证型。“‘阳明之为病，胃家实是也。’这一条是阳明病之提纲。"——这一说法，针对以上二个常见证型言，是可以的，但如果因之而认为阳明病全属实证，没有虚证，这就大失仲景之心法。因为阳明病不独内伤杂病有虚证，即外感热病亦是同样。《伤寒论》中论阳明病虚证的条文很多，一一可以复核，笔者鉴于《伤寒论》中阳明病渚虚证罕见专文论述，故不揣浅陋，对此作一探讨。
一、阳明病诸虚证之成因
1·阳虚中寒197条说：“阳明病，不能食，攻其热必哕，所以然者，胃小虚冷故也。以其人本虚，攻其热必哕。”这是胃阳虚亏：寒邪直中所引起，一般称之为阳明中寒证。对此证，仲景在195、196、228、229等条中作了反复讨论。因为这是属虚寒的阳明病，故谆谆告诫：既不可误攻其热，亦不能重发其汗，否则，“亡其阳，詀语，脉短者死”(216条)。
2·胃热伤津248条说：“脉浮而芤，浮为阳，芤为阴，浮芤相搏，胃气生热，其阳则绝。”《伤寒论讲义》说，这一条是“阳明胃热津亏的脉证。”此时已见芤脉，阳明气津之伤已成为矛盾之主要方面，故虽与白虎汤证几乎相似，但彼系阳热亢盛为主，属实；此则津亏阳绝，属虚，二者不同。若与下述误治转属一证相比较，则彼有燥结之标实，此有胃热而无腑实，亦宜区别，但属虚则一。此为阳明虚热证。
3·误治转属186条说：“太阳病，若发汗，若下，若利小便，此亡津液，胃中干燥，因转属阳明。”184条说：“少阳阳明者，发汗利小便已，胃中燥实烦，大便难是也。”这二条是太阳病与少阳病误治转属之阳明病。之所以转属阳明，是因为误治耗损津液，阳明里虚，邪得以内传，所以，是属于胃朋虚亏，津液内竭，病从燥化的一种虚证。但这种虚证往往因虚致实，因燥致结，成为一种本虚标实之证，但此时阴亏津竭，即有便难，亦不可攻下，否则愈耗其津，病必不去，且虚虚之祸，势所难免。这是阳明虚中央实证。
4·阳虚不摄247条说：“脉阳浮而汗出少者，为自和也。汗出多者，为太过。阳脉实，因发其汗，出多者，亦为太过。太过者，为阳绝于里，亡津液，大便因鞭也。”这一条因虚致实的病理与上同。但阳脉微，汗出多，是阳虚不摄致津伤，其成因与上述异。若阳脉实，发之太过，是阳以汗而外泄，亦属误治之转属，这也是虚中有实的阳明病。
5·病后正虚235条说，“阳明病，自汗出，若发汗，小便自利者，此为津液内竭，虽鞭不可攻之。”阳明病最易损耗津液，在病后有正虚津损现象是很自然的，从仲景立通导之法而禁用汗、攻，亦不用清热诸法为治来看，这一条作病后热退正虚、液干便闭之阳明虚证看甚合。从临床来说，热病后期，邪退正虚、肠枯液燥之“胃家实"证，殊不少见，此种病机，与误治转属者相比较，则前者仍多兼外邪未解，此则纯属津枯燥结。
二、阳明病诸虚证之证治
阳明经病之属虚者有三：
1·气津两虚证201条说：“阳明病，法多汗，反无汗，其身如虫行皮中状者，此以久虚故也。”这是胃气久虚而无燥结之阳明病，因胃为营卫生化之源，胃虚则营卫亦虚，营卫俱虚则汗乏化源，故这时无汗身痒既有津液不足一面，亦与胃阳虚失其温化之力有关。此时可用桂枝加黄芪汤治疗。如反误用麻黄剂，发汗多，或重发汗，就会亡其阳，甚至可能如216条所论，出现诂语，脉短等证而死亡。
2·阴虚而热证如248条所述为胃阴虚而兼热之经证，如阴津已虚而阳邪尚盛，见有脉芤而大，大烦渴不解，汗出恶寒，身热等证，则宜用白虎加人参汤，如虚象明显，脉象散大，宜倍参用之。如病在后期，元气虽伤，津液不足。但余热也不太盛，则宜竹叶石膏汤，如胃阴虚亏而余热已退，则《温病条辨》之益胃汤，可以取用。
3·阳虚而寒证196条说：“阳明病，若中寒者，不能食，小便不利，手足濈然汗出，此欲作固瘕，必大便初鞕后溏。所以然者，以胃中冷，水谷不别故也。”这是胃阳虚而兼寒之证，此时如以食谷欲呕为主证，则按245条所示：“吴茱萸汤主之”。如寒邪盛，有下利、格阳之证，则按228所云：“四逆汤主之”。
阳明腑病之属虚者亦有三：
1·液干兼热之燥结证上述太阳、少阳误冶转属之燥结证，不但因虚致实，因实致虚，虚实互为因果，且仍多兼有邪热未解，此时虚实症状错见，治法最难。仲景在217、219等条中，对此作了讨论，认为：“脉弦者生，涩者死”，如用小承气汤之后，“明日又不大便，脉反微涩者，里虚也，为难治，不可更与承气汤也。"这是正确的，但脉涩里虚者，虚不可不补，实不可不去，《伤寒论》中诸承气汤均不合适，似以参考后世温热学派著作，酌用护胃承气，增液承气，新加黄龙诸方为宜，而不应局限地只在《伤寒论》中寻治方。
2·液干夹淤之燥结征因液干可致燥结，亦有因燥结而致淤热者。或在胃中干屎不下，食难用饱的情况下，饮食不慎，强食饱食，食复生热，则除了脉迟，腹满诸证之外，还可引起发烦头眩，发黄等证，即属燥淤黄疸，此时宜猪膏发煎润导行淤，此法与《金匮要略》互参，不难窥知。因本证极易误作实证攻下，故200条说：“阳明病，脉迟，食难用饱，饱则发烦头眩，必小便难，此欲作谷疸。虽下之，腹满如故，所以然者，脉迟故也。"然注家多将此条作太阴病看，众说纷纭，致仲景之奥旨未得昌明，故余有“伤寒论第200条解疑”一文之所作，《冉注伤寒论》之见解与余大体同。
3·液干邪退之燥结证病后正虚的便闭，亦系肠枯液燥而致，但已刁二兼邪热，此时虽有便难腹满，食难用饱等阳明腑病的部分症状，但只能润导，不可攻下广。208条说：“阳明病，本自汗出，医更重发汗，病己差，尚微烦不了了者，此必大便鞕故也。以亡津液，胃中干燥，故令大便鞭，当问其小便日几行，若本小便日三四行，今日再行，故其大便不久出，今为小便数少，以津液当还入胃中，故知不久必大便也。”这就是说，仲景认为阳明病恢复期的小便渐少，是津液来复，胃中津液不偏渗于膀胱的表现，凭此可以判断“大便不久出"，这是仲师经验，所以，可以不予治疗。当然，也可予服一些凉润之品。但如“小便自利者，此为津液内竭，”因胃中津液偏渗于膀胱，自行恢复排便还有困难，此时则当用蜜煎导，土瓜根及猪胆汁之类导之，可促其除旧布新，加速康复。
三、阳明病诸虚证之讨论
总的来说，阳明病多实证，不可否定，阳明病有虚证，不可不讲。这在伤寒杂病，都是同样的，现对此作进一步的说明：
1·从“阳道实，阴道虚”的阴阳学说原理来说，六经病以三阳为实，以三阴为虚，但六经中的八纲概念，含有相对性原理。所以，若就三阳来说，太阳为虚，阳明为实，因太阳为虚，故仲景在太阳篇先出桂枝汤，且列述许多条忌汗之文，反复审不可汗之戒，说明太阳为三阳之虚，故治法重视和营卫而不主强发其汗。因阳明为实，故仲景治阳明病先出承气汤，且论下之文独多，攻下之法最详，说明阳明病为三阳之实，故治法重攻腑结而不主姑息养奸。如再进一步讲，太阳病亦可以经证为虚，以腑证为实，而经证可以麻黄汤证为实，以桂枝汤证为虚；腑证可以五苓散证为虚，以抵当汤证为实。阳明病亦可作如是观。故笔者认为：以阳明经腑证言虚实，则经证为虚，腑证为实。以经证言，则白虎汤证为实，竹叶石膏汤证为虚。以腑证言，则诸承气汤证为实，猪膏发煎、蜜煎导类为虚。
2，从“六经为百病立法”的角度来看，阳明病有虚证，更不足为怪了。因六经联系着五脏六腑，阳明内络届胃肠，外维系肢节，故胃肠肢节的病变，即为阳明病之实质，并非是除掉胃肠肢节之实体，还另有独立存在的阳明病。同时，六经分证本是《伤寒杂病论》的辨证论治方法，并不仅仅是《伤寒论》的辨证论治方法，虽“六经辨证用于外感，脏腑辨证用于杂病”的论点曾为许多中医所接受，但是否仲景本意，实很难说明。柯琴说：“仲景伤寒已兼六气，六经主病已赅杂证，非专指伤寒立言。”历来共此观点者，亦素不乏人，笔者曾将《金匮》中的一些杂病，如呕吐等，按六经归纳了其方证，亦均发现阳明病有虚实二证，此可参阅“伤寒论六经与呕吐方证的探讨”(见《辽宁中医杂志》1981年第1期)等文。
3·单就外感所致的阳明病来说，也有虚实二证，《温病条辨》中焦篇，对此论述颇详。如腑证，吴鞠通说：“温病之不大便，不出热结液干二者之外。”因此，他对邪盛之证，宗法仲景，主用承气，所以攻下其实；对正虚之证，仿效叶氏，“则用增液，所以迥护其虚。”因此，治外感所致的阳明病，辨证也要以虚实为纲，方不致误。后人认为外感之阳明病全是实证，没有虚证，这实在是一种误解。从《伤寒论》来看，对阳明病诸虚证之论述并不少，但有些人把“实则阳明，虚则太阴”这本是相对而说的二句话，理解为阳明病没有虚证，虚证都属于太阴，这是不正确的。
结语
1，根据以上分析，笔者认为：谓“胃的功能减弱或胃的阴液被邪热耗伤为主要临床表现”的虚证，如胃阴虚、胃阳虚诸证，只见于脏腑辨证中，而不存在于六经辨证内，从而提出：“就六经辨证来说，是实则阳明，就脏腑辨证来说，是实则未必阳明”的说法，实际上是不妥当的。
2·论阳明病诸虚证之文，《伤寒论》中很多，但治法后世有很大发展，因此，研究阳明病诸虚证之证治，尚须结合温热学派之著作，方才完善。但本文着重就《伤寒论》一书而言，故其他书中的内容论述从简。
清后，鞠通之学，影响日大，信奉者很多。其著《温病条辨》，近亦有人推其为中医四大经典之一，《吴鞠通医案》也颇受人重视。但此两书的论燥治燥，很值得商榷，现略作述评，以供参考。
鞠通认为：“秋燥之气，轻则为燥，重则为寒”，“燥气寒化，乃燥气之正。”所以他称“燥为小寒”，谓是“阴邪”。关于燥气之伤人，鞠通认为有大邪伤表与小邪中里两种形式，他说：“大邪中表之燥证，感而即发者，诚如沈目南先生所云，与伤寒同法。”《温病条辨》中，“伤燥，如伤寒太阳证，有汗、不咳、不呕、不痛者，桂枝汤小和之。”等条，即是这种治疗主张之体现。至于小邪中里，虽有深入下焦与血相搏、久伏下焦不与血搏以及直中伤阳等之不同，但概主以温法(治复气则否)，故治与血相搏之化症回生丹与治不与血搏之复亨丹等方，都是如此，《吴鞠通医案》中燥门诸案，亦莫不如此。如李四十六案，感受燥金之气为病，初诊即予刚燥温热，就是基于“燥为小寒”、“阴邪”之认识。五月初二，三诊时，虽云治燥此类药不宜久任，但转方取桂枝汤加减，药用桂枝、白芍各四钱，炙草、干姜各二钱，大枣二枚，生姜、广皮各三钱，半夏、生米仁，云苓块各五钱，仍不离乎温法。又如张女十五岁案；“燥金之气，直入中里，六脉全无，僵卧如死，四肢逆冷，已过肘膝，腿痛转筋，与通脉四逆汤加川椒、吴萸、公丁香一大剂，厥回脉出一昼夜，次日以食粥太早，复中宛如前证，脉复厥，体厥又死去矣，仍予前方，重加温热，一剂厥回其半，又两荆而复活，后以补阳收功。”对以上理论和治法，现述不同意见如次；
1·寒、燥各为六气之一气。六气中，寒与热对，指温度言；湿与燥对，指湿度言。湿度高并不等于热，燥气重亦不等于寒，故寒自为寒，燥自为燥，两气不能互混。鞠通不知别此，谓燥重为寒、(寒)轻为燥，这在理论上是错误的(鞠通论六气，常犯混二气为一气的错误，如谓暑系湿热二气所合成，亦一例，此已见驳于孟英，不复赘)。就上二案来说，李氏案如果说是寒之轻者，尚可称燥，则张氏案明是燥之重者，当称中寒，不当再称为中燥，既称中燥，又用大热药来治疗，这与寒轻为燥之说，便有矛盾之嫌。实际上，对寒燥两气，鞠通确实是混为一谈，概念模糊，分划不清的。所以他治足太阴寒湿，主以椒附白通汤，今治燥邪直中，主以通脉四逆汤加川椒、吴萸、公丁香，这二者在药法上实无甚区别。余谓就一般情况论，治寒须温热，治燥须柔润，如只温不润，实无涉于治燥。张氏一案以及中燥门其他但温不润的一些医案，与其说是治燥，到不如说是治寒，否则，已立中燥一门，似亦不必再另立寒门了。
阳明病中属于白虎汤证的经证和属于承气汤证的腑证，只是阳明病的两个常见证型。“‘阳明病的纲领是：胃家实。’”这一条是阳明病的提纲。——这种说法，针对上述两个常见证型而言是可以的，但如果因此认为阳明病全都是实证，没有虚证，这就大大违背了张仲景的心法。因为阳明病不仅在内科杂病中有虚证，在外感热病中也是如此。《伤寒论》中论述阳明病虚证的条文很多，一一可以复核，笔者鉴于《伤寒论》中阳明病诸虚证罕见专文论述，故不揣浅陋，对此作一探讨。
一、阳明病诸虚证的成因
1. 阳虚中寒 第197条说：“阳明病，不能进食，攻其热必呃逆，之所以这样，是因为胃中虚冷所致。因为病人本身体虚，攻其热必呃逆。”这是胃阳虚亏，由寒邪直中所引起，一般称之为阳明中寒证。对此证，仲景在第195、196、228、229等条中作了反复讨论。因为这是属虚寒的阳明病，故谆谆告诫：既不可误攻其热，亦不能重发其汗，否则，“亡其阳，谵语，脉短者死”（第216条）。
2. 胃热伤津 第248条说：“脉浮而芤，浮为阳，芤为阴，浮芤相搏，胃气生热，其阳则绝。”《伤寒论讲义》说，这一条是“阳明胃热津亏的脉证。”此时已见芤脉，阳明气津之伤已成为矛盾的主要方面，故虽与白虎汤证几乎相似，但彼系阳热亢盛为主，属实；此则津亏阳绝，属虚，二者不同。若与下述误治转属一证相比较，则彼有燥结之标实，此有胃热而无腑实，亦宜区别，但属虚则一。此为阳明虚热证。
3. 误治转属 第186条说：“太阳病，若发汗，若下，若利小便，此亡津液，胃中干燥，因转属阳明。”第184条说：“少阳阳明者，发汗利小便已，胃中燥实烦，大便难是也。”这两条是太阳病与少阳病误治转属之阳明病。之所以转属阳明，是因为误治耗损津液，阳明里虚，邪得以内传，所以，是属于胃腑虚亏，津液内竭，病从燥化的一种虚证。但这种虚证往往因虚致实，因燥致结，成为一种本虚标实之证，但此时阴亏津竭，即有便难，亦不可攻下，否则愈耗其津，病必不去，且虚虚之祸，势所难免。这是阳明虚中央实证。
4. 阳虚不摄 第247条说：“脉阳浮而汗出少者，为自和也。汗出多者，为太过。阳脉实，因发其汗，出多者，亦为太过。太过者，为阳绝于里，亡津液，大便因鞭也。”这一条因虚致实的病理与上同。但阳脉微，汗出多，是阳虚不摄致津伤，其成因与上述异。若阳脉实，发之太过，是阳以汗而外泄，亦属误治之转属，这也是虚中有实的阳明病。
5. 病后正虚 第235条说：“阳明病，自汗出，若发汗，小便自利者，此为津液内竭，虽鞭不可攻之。”阳明病最易损耗津液，在病后有正虚津损现象是很自然的，从仲景立通导之法而禁用汗、攻，亦不用清热诸法为治来看，这一条作病后热退正虚、液干便闭之阳明虚证看甚合。从临床来说，热病后期，邪退正虚、肠枯液燥之“胃家实”证，殊不少见，此种病机，与误治转属者相比较，则前者仍多兼外邪未解，此则纯属津枯燥结。
二、阳明病诸虚证的证治
阳明经病之属虚者有三：
1. 气津两虚证 第201条说：“阳明病，法多汗，反无汗，其身如虫行皮中状者，此以久虚故也。”这是胃气久虚而无燥结之阳明病，因胃为营卫生化之源，胃虚则营卫亦虚，营卫俱虚则汗乏化源，故这时无汗身痒既有津液不足一面，亦与胃阳虚失其温化之力有关。此时可用桂枝加黄芪汤治疗。如反误用麻黄剂，发汗多，或重发汗，就会亡其阳，甚至可能如第216条所论，出现谵语，脉短等证而死亡。
2. 阴虚而热证 如第248条所述为胃阴虚而兼热之经证，如阴津已虚而阳邪尚盛，见有脉芤而大，大烦渴不解，汗出恶寒，身热等证，则宜用白虎加人参汤，如虚象明显，脉象散大，宜倍参用之。如病在后期，元气虽伤，津液不足。但余热也不太盛，则宜竹叶石膏汤，如胃阴虚亏而余热已退，则《温病条辨》之益胃汤，可以取用。
3. 阳虚而寒证 第196条说：“阳明病，若中寒者，不能食，小便不利，手足濈然汗出，此欲作固瘕，必大便初鞕后溏。所以然者，以胃中冷，水谷不别故也。”这是胃阳虚而兼寒之证，此时如以食谷欲呕为主证，则按第245条所示：“吴茱萸汤主之”。如寒邪盛，有下利、格阳之证，则按第228所云：“四逆汤主之”。
阳明腑病之属虚者亦有三：
1. 液干兼热之燥结证 上述太阳、少阳误治转属之燥结证，不但因虚致实，因实致虚，虚实互为因果，且仍多兼有邪热未解，此时虚实症状错见，治法最难。仲景在第217、219等条中，对此作了讨论，认为：“脉弦者生，涩者死”，如用小承气汤之后，“明日又不大便，脉反微涩者，里虚也，为难治，不可更与承气汤也。”这是正确的，但脉涩里虚者，虚不可不补，实不可不去，《伤寒论》中诸承气汤均不合适，似以参考后世温热学派著作，酌用护胃承气，增液承气，新加黄龙诸方为宜，而不应局限地只在《伤寒论》中寻治方。
2. 液干夹瘀之燥结征 因液干可致燥结，亦有因燥结而致瘀热者。或在胃中干屎不下，食难用饱的情况下，饮食不慎，强食饱食，食复生热，则除了脉迟，腹满诸证之外，还可引起发烦头眩，发黄等证，即属燥瘀黄疸，此时宜猪膏发煎润导行淤，此法与《金匮要略》互参，不难窥知。因本证极易误作实证攻下，故第200条说：“阳明病，脉迟，食难用饱，饱则发烦头眩，必小便难，此欲作谷疸。虽下之，腹满如故，所以然者，脉迟故也。”然注家多将此条作太阴病看，众说纷纭，致仲景之奥旨未得昌明，故余有“伤寒论第200条解疑”一文之所作，《冉注伤寒论》之见解与余大体同。
3. 液干邪退之燥结证 病后正虚的便闭，亦系肠枯液燥而致，但已不兼邪热，此时虽有便难腹满，食难用饱等阳明腑病的部分症状，但只能润导，不可攻下。第208条说：“阳明病，本自汗出，医更重发汗，病己差，尚微烦不了了者，此必大便鞕故也。以亡津液，胃中干燥，故令大便鞭，当问其小便日几行，若本小便日三四行，今日再行，故其大便不久出，今为小便数少，以津液当还入胃中，故知不久必大便也。”这就是说，仲景认为阳明病恢复期的小便渐少，是津液来复，胃中津液不偏渗于膀胱的表现，凭此可以判断“大便不久出”，这是仲师经验，所以，可以不予治疗。当然，也可予服一些凉润之品。但如“小便自利者，此为津液内竭，”因胃中津液偏渗于膀胱，自行恢复排便还有困难，此时则当用蜜煎导，土瓜根及猪胆汁之类导之，可促其除旧布新，加速康复。
三、阳明病诸虚证的讨论
总的来说，阳明病多实证，不可否定，阳明病有虚证，不可不讲。这在伤寒杂病，都是同样的，现对此作进一步的说明：
1. 从“阳道实，阴道虚”的阴阳学说原理来说，六经病以三阳为实，以三阴为虚，但六经中的八纲概念，含有相对性原理。所以，若就三阳来说，太阳为虚，阳明为实，因太阳为虚，故仲景在太阳篇先出桂枝汤，且列述许多条忌汗之文，反复审不可汗之戒，说明太阳为三阳之虚，故治法重视和营卫而不主强发其汗。因阳明为实，故仲景治阳明病先出承气汤，且论下之文独多，攻下之法最详，说明阳明病为三阳之实，故治法重攻腑结而不主姑息养奸。如再进一步讲，太阳病亦可以经证为虚，以腑证为实，而经证可以麻黄汤证为实，以桂枝汤证为虚；腑证可以五苓散证为虚，以抵当汤证为实。阳明病亦可作如是观。故笔者认为：以阳明经腑证言虚实，则经证为虚，腑证为实。以经证言，则白虎汤证为实，竹叶石膏汤证为虚。以腑证言，则诸承气汤证为实，猪膏发煎、蜜煎导类为虚。
2. 从“六经为百病立法”的角度来看，阳明病有虚证，更不足为怪了。因六经联系着五脏六腑，阳明内络属胃肠，外维系肢节，故胃肠肢节的病变，即为阳明病之实质，并非是除掉胃肠肢节之实体，还另有独立存在的阳明病。同时，六经分证本是《伤寒杂病论》的辨证论治方法，并不仅仅是《伤寒论》的辨证论治方法，虽“六经辨证用于外感，脏腑辨证用于杂病”的论点曾为许多中医所接受，但是否仲景本意，实很难说明。柯琴说：“仲景伤寒已兼六气，六经主病已赅杂证，非专指伤寒立言。”历来有此观点者，亦素不乏人，笔者曾将《金匮》中的一些杂病，如呕吐等，按六经归纳了其方证，亦均发现阳明病有虚实二证，此可参阅“伤寒论六经与呕吐方证的探讨”（见《辽宁中医杂志》1981年第1期）等文。
3. 单就外感所致的阳明病来说，也有虚实二证，《温病条辨》中焦篇，对此论述颇详。如腑证，吴鞠通说：“温病之不大便，不出热结液干二者之外。”因此，他对邪盛之证，宗法仲景，主用承气，所以攻下其实；对正虚之证，仿效叶氏，“则用增液，所以迥护其虚。”因此，治外感所致的阳明病，辨证也要以虚实为纲，方不致误。后人认为外感之阳明病全是实证，没有虚证，这实在是一种误解。从《伤寒论》来看，对阳明病诸虚证之论述并不少，但有些人把“实则阳明，虚则太阴”这本是相对而说的二句话，理解为阳明病没有虚证，虚证都属于太阴，这是不正确的。
结语
1. 根据以上分析，笔者认为：谓“胃的功能减弱或胃的阴液被邪热耗伤为主要临床表现”的虚证，如胃阴虚、胃阳虚诸证，只见于脏腑辨证中，而不存在于六经辨证内，从而提出：“就六经辨证来说，是实则阳明，就脏腑辨证来说，是实则未必阳明”的说法，实际上是不妥当的。
2. 论阳明病诸虚证之文，《伤寒论》中很多，但治法后世有很大发展，因此，研究阳明病诸虚证之证治，尚须结合温热学派之著作，方才完善。但本文着重就《伤寒论》一书而言，故其他书中的内容论述从简。
清代以后，鞠通之学，影响日益扩大，信奉者很多。其著《温病条辨》，近亦有人推其为中医四大经典之一，《吴鞠通医案》也颇受人重视。但此两书的论燥治燥，很值得商榷，现略作述评，以供参考。
鞠通认为：“秋燥之气，轻则为燥，重则为寒”，“燥气寒化，乃燥气之正。”所以他称“燥为小寒”，谓是“阴邪”。关于燥气之伤人，鞠通认为有大邪伤表与小邪中里两种形式，他说：“大邪中表之燥证，感而即发者，诚如沈目南先生所云，与伤寒同法。”《温病条辨》中，“伤燥，如伤寒太阳证，有汗、不咳、不呕、不痛者，桂枝汤小和之。”等条，即是这种治疗主张之体现。至于小邪中里，虽有深入下焦与血相搏、久伏下焦不与血搏以及直中伤阳等之不同，但概主以温法（治复气则否），故治与血相搏之化瘀回生丹与治不与血搏之复亨丹等方，都是如此，《吴鞠通医案》中燥门诸案，亦莫不如此。如李四十六案，感受燥金之气为病，初诊即予刚燥温热，就是基于“燥为小寒”、“阴邪”之认识。五月初二，三诊时，虽云治燥此类药不宜久任，但转方取桂枝汤加减，药用桂枝、白芍各四钱，炙草、干姜各二钱，大枣二枚，生姜、广皮各三钱，半夏、生米仁，云苓块各五钱，仍不离乎温法。又如张女十五岁案：“燥金之气，直入中里，六脉全无，僵卧如死，四肢逆冷，已过肘膝，腿痛转筋，与通脉四逆汤加川椒、吴萸、公丁香一大剂，厥回脉出一昼夜，次日以食粥太早，复中宛如前证，脉复厥，体厥又死去矣，仍予前方，重加温热，一剂厥回其半，又两荆而复活，后以补阳收功。”对以上理论和治法，现述不同意见如次：
1. 寒、燥各为六气之一气。六气中，寒与热对，指温度言；湿与燥对，指湿度言。湿度高并不等于热，燥气重亦不等于寒，故寒自为寒，燥自为燥，两气不能互混。鞠通不知别此，谓燥重为寒、（寒）轻为燥，这在理论上是错误的（鞠通论六气，常犯混二气为一气的错误，如谓暑系湿热二气所合成，亦一例，此已见驳于孟英，不复赘）。就上二案来说，李氏案如果说是寒之轻者，尚可称燥，则张氏案明是燥之重者，当称中寒，不当再称为中燥，既称中燥，又用大热药来治疗，这与寒轻为燥之说，便有矛盾之嫌。实际上，对寒燥两气，鞠通确实是混为一谈，概念模糊，分划不清的。所以他治足太阴寒湿，主以椒附白通汤，今治燥邪直中，主以通脉四逆汤加川椒、吴萸、公丁香，这二者在药法上实无甚区别。余谓就一般情况论，治寒须温热，治燥须柔润，如只温不润，实无涉于治燥。张氏一案以及中燥门其他但温不润的一些医案，与其说是治燥，到不如说是治寒，否则，已立中燥一门，似亦不必再另立寒门了。
The syndrome of the meridian belonging to Baihu Tang (White Tiger Decoction) and the syndrome of the fu-organ belonging to Chengqi Tang (Purgative Decoction) are merely two common syndromes of Yangming disease (Yangming disorder). "The guideline for Yangming disease is: 'Stomach-fu organ excess'." — This statement, when applied to the above two common syndromes, is acceptable; however, if one concludes from this that Yangming disease consists entirely of excess syndromes with no deficiency syndromes, this greatly deviates from Zhang Zhongjing's (Zhang Zhongjing) core methodology. This is because Yangming disease presents deficiency syndromes not only in internal miscellaneous diseases but also in external febrile diseases. There are many clauses in *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) discussing deficiency syndromes of Yangming disease, which can be verified one by one. Given that there is rarely a dedicated discussion on various deficiency syndromes of Yangming disease in *Shanghan Lun*, I venture to explore this topic.
I. Etiology of Various Deficiency Syndromes in Yangming Disease
1. Yang Deficiency with Direct Invasion of Cold Clause 197 states: "In Yangming disease, if the patient cannot eat, attacking the heat will inevitably cause hiccups. The reason is that the stomach is deficient and cold. Because the person is originally deficient, attacking the heat will cause hiccups." This refers to a deficiency of Stomach-Yang caused by direct invasion of pathogenic cold, generally termed the "Yangming Central Cold Syndrome" (Yangming Zhonghan Zheng). Regarding this syndrome, Zhongjing discussed it repeatedly in clauses 195, 196, 228, and 229. Since this is a deficiency-cold type of Yangming disease, he earnestly warned: one must not mistakenly attack the heat, nor should one induce heavy sweating; otherwise, "loss of Yang, delirium, and a short pulse indicate death" (Clause 216).
2. Stomach Heat Injuring Body Fluids Clause 248 states: "A floating and hollow pulse; floating indicates Yang, hollow indicates Yin. When floating and hollow interact, Stomach-Qi generates heat, and its Yang is severed." *Shanghan Lun Lecture Notes* states that this clause describes "the pulse and symptoms of Yangming Stomach heat and fluid depletion." At this stage, the hollow pulse is already present, and the injury to Yangming Qi and fluids has become the primary aspect of the contradiction. Thus, although it is almost similar to the Baihu Tang syndrome, the latter is primarily characterized by hyperactive Yang-heat and belongs to excess; whereas this case involves fluid depletion and Yang severance, belonging to deficiency. They are different. Compared to the subsequent syndrome transformed by mis-treatment, the former has superficial excess due to dryness accumulation, while this one has Stomach heat without fu-organ excess; they should be distinguished, yet both belong to deficiency. This is the Yangming deficiency-heat syndrome.
3. Transformation due to Mis-treatment Clause 186 states: "In Taiyang disease, if sweating, purgation, or promoting urination is used, this leads to loss of body fluids, dryness in the Stomach, and thus transformation into Yangming disease." Clause 184 states: "Shaoyang-Yangming refers to cases where, after inducing sweating and promoting urination, the Stomach becomes dry and excessive, causing vexation and difficulty in defecation." These two clauses describe Yangming disease transformed from Taiyang and Shaoyang diseases due to mis-treatment. The reason for transformation into Yangming is that mis-treatment depletes fluids, leading to interior deficiency of Yangming, allowing pathogens to penetrate inward. Therefore, it is a deficiency syndrome characterized by deficiency of the Stomach-fu organ and exhaustion of internal fluids, with the pathology transforming towards dryness. However, such deficiency syndromes often lead to excess due to deficiency, and結 (accumulation) due to dryness, becoming a syndrome of root deficiency and branch excess. At this time, with yin deficiency and fluid exhaustion, even if there is difficulty in defecation, purgation must not be used; otherwise, fluids will be further depleted, the disease will not resolve, and the disaster of treating deficiency as deficiency (exacerbating weakness) is inevitable. This is the Yangming deficiency-syndrome with central excess.
4. Yang Deficiency Failing to Control Clause 247 states: "If the pulse is floating at the Yang position and sweating is scant, it indicates self-harmony. If sweating is profuse, it is excessive. If the Yang pulse is solid, and sweating is induced, resulting in profuse sweating, this is also excessive. Excessiveness leads to Yang severance within, loss of body fluids, and consequently hard stools." The pathology of leading to excess due to deficiency in this clause is the same as above. However, a faint Yang pulse with profuse sweating indicates that Yang deficiency fails to control, leading to fluid injury; its etiology differs from the above. If the Yang pulse is solid and sweating is induced excessively, Yang escapes through sweat; this also belongs to transformation due to mis-treatment. This is also a Yangming disease with deficiency containing excess.
5. Post-illness Righteous Qi Deficiency Clause 235 states: "In Yangming disease, spontaneous sweating occurs; if sweating is induced, and urination is free, this indicates exhaustion of internal body fluids. Even if stools are hard, they must not be attacked with purgatives." Yangming disease easily depletes body fluids; thus, post-illness deficiency of righteous Qi and injury to fluids is natural. From the perspective that Zhongjing established methods for unblocking and導 (guiding) while forbidding sweating and purgation, and did not use clearing heat methods, this clause fits well as a Yangming deficiency syndrome characterized by post-illness heat retreat, righteous Qi deficiency, dry fluids, and constipation. Clinically, in the late stage of febrile diseases, "Stomach-fu organ excess" syndromes characterized by pathogen retreat, righteous Qi deficiency, intestinal dryness, and fluid scarcity are quite common. Comparing this pathogenesis with that of transformation due to mis-treatment, the former often still involves unresolved exterior pathogens, whereas this one is purely dryness and fluid exhaustion leading to accumulation.
II. Syndrome Differentiation and Treatment of Various Deficiency Syndromes in Yangming Disease
There are three types of deficiency syndromes in Yangming Meridian disease:
1. Qi and Fluid Dual Deficiency Syndrome Clause 201 states: "In Yangming disease, sweating is customary; if there is no sweating, and the body feels like insects crawling under the skin, this is due to long-standing deficiency." This is Yangming disease with long-standing Stomach-Qi deficiency and no dryness accumulation. Since the Stomach is the source of production for Ying (Nutritive) and Wei (Defensive) Qi, Stomach deficiency leads to Ying and Wei deficiency. When both are deficient, there is a lack of source for sweat production. Therefore, the absence of sweating and body itching at this time relates not only to insufficient body fluids but also to Stomach-Yang deficiency losing its warming and transforming power. Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus Root) can be used at this time. If mistakenly treated with Mahuang preparations (Ephedra Decoction), inducing heavy sweating or repeated sweating, it will lead to loss of Yang, and possibly, as discussed in Clause 216, result in death with symptoms such as delirium and a short pulse.
2. Yin Deficiency with Heat Syndrome As described in Clause 248, this is a meridian syndrome of Stomach-Yin deficiency accompanied by heat. If Yin fluids are already deficient but Yang pathogens are still vigorous, presenting with a hollow and large pulse, severe vexation and unquenchable thirst, sweating with aversion to cold, and body heat, then Baitu Jia Renshen Tang (White Tiger Decoction plus Ginseng Root) should be used. If deficiency signs are obvious and the pulse is scattered and large, the dosage of Renshen should be doubled. If the disease is in the late stage, Yuan Qi (Original Qi) is injured and fluids are insufficient, but residual heat is not too strong, then Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is suitable. If Stomach-Yin deficiency exists but residual heat has retreated, then Yiwei Tang (Benefit the Stomach Decoction) from *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) can be used.
3. Yang Deficiency with Cold Syndrome Clause 196 states: "In Yangming disease, if affected by cold, the patient cannot eat, urination is difficult, hands and feet sweat continuously, this is about to become a Guji (solid mass), and stools will definitely be hard initially and loose later. The reason is that the Stomach is cold, failing to separate water and grain." This is a syndrome of Stomach-Yang deficiency accompanied by cold. If the main symptom is vomiting after eating, according to Clause 245, "Wuzhuyu Tang (Evodia Decoction) governs it." If cold pathogens are vigorous, presenting with diarrhea and floating Yang (Ge Yang), then according to Clause 228, "Sini Tang (Frigid Extremities Decoction) governs it."
There are also three types of deficiency syndromes in Yangming Fu-organ disease:
1. Dryness Accumulation Syndrome with Fluid Depletion and Heat The dryness accumulation syndromes transformed from Taiyang and Shaoyang mis-treatment mentioned above not only involve excess arising from deficiency and deficiency arising from excess, creating a causal relationship between the two, but also often accompany unresolved pathogenic heat. At this time, excess and deficiency symptoms appear mixed, making treatment most difficult. Zhongjing discussed this in clauses 217 and 219, stating: "A wiry pulse indicates survival, a choppy pulse indicates death." After using Xiao Chengqi Tang (Minor Purgative Decoction), "if the next day there is still no bowel movement and the pulse becomes faint and choppy, the interior is deficient, making it difficult to treat; Chengqi Decoctions should not be given again." This is correct. However, for those with a choppy pulse and interior deficiency, deficiency must be tonified, and excess must be removed. None of the Chengqi Decoctions in *Shanghan Lun* are suitable. It seems appropriate to refer to works of the Later Warmth School and酌情 (discretionarily) use Hugwei Chengqi Tang (Protect Stomach Purgative Decoction), Zengye Chengqi Tang (Increase Fluids Purgative Decoction), Xinjia Huanglong Tang (New Added Yellow Dragon Decoction), etc., rather than limiting the search for treatments solely to *Shanghan Lun*.
2. Dryness Accumulation Syndrome with Fluid Depletion and Blood Stasis Fluid depletion can lead to dryness accumulation, and dryness accumulation can also lead to stasis-heat. Or, when dry feces remain in the Stomach and the patient finds it difficult to eat until full, careless diet or overeating may generate heat again. Besides symptoms such as a slow pulse and abdominal fullness, this can cause vexation, dizziness, and jaundice, i.e., Dryness-Stasis Jaundice. At this time, Zhigao Faxian Jian (Pig Fat and Hair Decoction) should be used to moisten and guide out stasis. Referencing *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), this method is easy to understand. Because this syndrome is easily mistaken for an excess syndrome requiring purgation, Clause 200 states: "In Yangming disease, a slow pulse, difficulty eating until full, vexation and dizziness after eating, and necessarily difficult urination indicate impending Grain Jaundice. Even if purged, abdominal fullness remains as before. The reason is the slow pulse." However, commentators mostly view this clause as a Taiyin disease, leading to various opinions, preventing the profound meaning of Zhongjing from being clarified. Hence, my article "Clarification of Clause 200 of Shanghan Lun" was written, and the views in *Ran Zhu Shanghan Lun* (Annotated Shanghan Lun by Ran) are largely consistent with mine.
3. Dryness Accumulation Syndrome with Fluid Depletion and Retreat of Pathogens Constipation due to post-illness righteous Qi deficiency is also caused by intestinal dryness and fluid scarcity, but it no longer accompanies pathogenic heat. Although there are partial symptoms of Yangming Fu-organ disease such as difficulty in defecation, abdominal fullness, and difficulty eating until full, only moistening and guiding should be used, not purgation. Clause 208 states: "In Yangming disease, originally there was spontaneous sweating; if the physician induces heavy sweating again, and the illness has improved but slight vexation persists, this is certainly due to hard stools. Due to loss of body fluids and dryness in the Stomach, stools become hard. One should ask how many times the patient urinates daily. If originally urinating three or four times a day, and now only twice, the stool will likely pass soon. Now, since urination frequency has decreased, body fluids should return to the Stomach, so we know the stool will pass soon." This means Zhongjing believed that gradually decreasing urination in the recovery phase of Yangming disease indicates the return of fluids, showing that Stomach fluids are no longer shunting abnormally to the Bladder. Based on this, one can judge that "stools will pass soon." This is Zhongjing's experience, so treatment may not be necessary. Of course, some cooling and moistening substances can be administered. But if "urination is free, this indicates exhaustion of internal body fluids," because Stomach fluids shunt to the Bladder, restoring bowel movements spontaneously is difficult. At this time, Miyuan Dao (Honey Suppository), Tugua Gen (Trichosanthes Root), and Pig Bile should be used to guide, promoting renewal and accelerating recovery.
III. Discussion on Various Deficiency Syndromes in Yangming Disease
Generally speaking, Yangming disease is predominantly excess, which cannot be denied; Yangming disease does have deficiency syndromes, which must not be ignored. This applies equally to Shanghan (Cold Damage) and miscellaneous diseases. Further explanation is provided below:
1. From the principle of Yin-Yang theory "The pathway of Yang is excess, the pathway of Yin is deficiency," Six Meridian diseases consider the Three Yang meridians as excess and the Three Yin meridians as deficiency. However, the Eight Principles concept within the Six Meridians contains relative principles. Therefore, regarding the Three Yang meridians, Taiyang is deficiency, and Yangming is excess. Because Taiyang is deficiency, Zhongjing first presented Guizhi Tang (Cinnamon Twig Decoction) in the Taiyang chapter and listed many clauses warning against sweating, repeatedly emphasizing the prohibition of sweating, indicating that Taiyang is the deficiency of the Three Yang meridians; thus, treatment focuses on harmonizing Ying and Wei rather than forcibly inducing sweating. Because Yangming is excess, Zhongjing first presented Chengqi Tang in treating Yangming disease, and there are more clauses discussing purgation, with the most detailed description of purgative methods, indicating that Yangming disease is the excess of the Three Yang meridians; thus, treatment focuses on attacking fu-organ accumulation rather than indulging evil. Going further, Taiyang disease can also be viewed as meridian syndrome being deficiency and fu-organ syndrome being excess; the meridian syndrome can be seen as excess with Mahuang Tang (Ephedra Decoction) syndrome and deficiency with Guizhi Tang syndrome; the fu-organ syndrome can be seen as deficiency with Wuling San (Five-Ling Powder) syndrome and excess with Didang Tang (Should-Strike Decoction) syndrome. Yangming disease can also be viewed in this manner. Therefore, I believe: regarding Yangming meridian and fu-organ syndromes, the meridian syndrome is deficiency and the fu-organ syndrome is excess. Regarding meridian syndromes alone, Baitu Tang syndrome is excess, and Zhuye Shigao Tang syndrome is deficiency. Regarding fu-organ syndromes alone, all Chengqi Tang syndromes are excess, while Zhigao Faxian Jian and Miyuan Dao categories are deficiency.
2. From the perspective that "Six Meridians establish laws for hundred diseases," it is even less surprising that Yangming disease has deficiency syndromes. Because the Six Meridians connect the Zang and Fu organs, Yangming internally connects to the Stomach and Intestines, and externally links to limbs and joints. Therefore, lesions of the Stomach, Intestines, limbs, and joints constitute the essence of Yangming disease; it is not that apart from the physical entities of the Stomach, Intestines, limbs, and joints, there exists an independently existing Yangming disease. Simultaneously, Six Meridian differentiation is originally the method of syndrome differentiation and treatment in *Shanghan Zabing Lun* (Treatise on Cold Pathogenic and Miscellaneous Diseases), not merely in *Shanghan Lun*. Although the viewpoint that "Six Meridian differentiation is used for external diseases, and Zang-Fu differentiation is used for miscellaneous diseases" has been accepted by many TCM practitioners, whether this was Zhongjing's original intent is hard to determine. Ke Qin stated: "Zhongjing's Shanghan already incorporates the Six Qi, and the principal diseases of the Six Meridians encompass miscellaneous diseases; it is not specifically stated for Shanghan." Those holding this view throughout history are numerous. I once categorized some miscellaneous diseases in *Jingui Yaolue*, such as vomiting, according to the Six Meridians and their formula syndromes, and also found both excess and deficiency syndromes in Yangming disease. This can be referred to in articles such as "Exploration of Six Meridians and Formula Syndromes for Vomiting in Shanghan Lun" (*Liaoning Journal of Traditional Chinese Medicine*, 1981, Issue 1).
3. Considering only Yangming disease caused by external infections, there are also excess and deficiency syndromes. The Middle Jiao Chapter of *Wenbing Tiaobian* discusses this in detail. Regarding fu-organ syndromes, Wu Jutong said: "Constipation in warm diseases falls outside these two categories: heat accumulation and fluid dryness." Therefore, for syndromes with vigorous pathogens, he followed Zhongjing's method, primarily using Chengqi Decoctions to purge the excess; for syndromes with deficient righteous Qi, imitating Ye Tianshi, "he uses Zengye [Decoction] to protect the deficiency." Therefore, when treating Yangming disease caused by external infections, syndrome differentiation must also take excess and deficiency as the guideline to avoid errors. Later generations believed that Yangming disease caused by external infections is entirely excess, with no deficiency syndromes; this is truly a misunderstanding. From *Shanghan Lun*, there are not few discussions on various deficiency syndromes of Yangming disease. However, some people interpreted the two relatively spoken sentences "Excess belongs to Yangming, Deficiency belongs to Taiyin" to mean that Yangming disease has no deficiency syndromes and all deficiency syndromes belong to Taiyin, which is incorrect.
Conclusion
1. Based on the above analysis, I believe that deficiency syndromes defined by "main clinical manifestations of weakened Stomach function or consumption of Stomach Yin fluids by pathogenic heat," such as Stomach-Yin deficiency and Stomach-Yang deficiency syndromes, are only seen in Zang-Fu differentiation and do not exist within Six Meridian differentiation. Thus, proposing the statement "Regarding Six Meridian differentiation, it is excess in Yangming; regarding Zang-Fu differentiation, excess is not necessarily Yangming" is actually inappropriate.
2. There are many clauses in *Shanghan Lun* discussing deficiency syndromes of Yangming disease, but treatment methods have developed significantly in later generations. Therefore, studying the syndrome differentiation and treatment of various deficiency syndromes of Yangming disease must combine works of the Warmth School to be perfect. However, this paper focuses on *Shanghan Lun*, so content from other books is briefly discussed.
Brief Commentary on Wu Jutong's Theory and Treatment of Dryness
After the Qing Dynasty, Jutong's learning had an increasingly great influence, with many followers. His work *Wenbing Tiaobian* is recently promoted by some as one of the Four Great Classics of TCM, and *Wu Jutong Yian* (Medical Cases of Wu Jutong) is also highly valued. However, the theories and treatments of dryness in these two books are worthy of discussion. A brief commentary is provided here for reference.
I. Confusing Cold and Dryness Qi into One, Named Treating Dryness but Actually Treating Cold.
Jutong believed: "Autumn Dryness Qi, light is Dryness, heavy is Cold"; "Dryness Qi transforming into Cold is the proper state of Dryness Qi." Therefore, he called "Dryness minor Cold," referring to it as a "Yin Pathogen." Regarding how Dryness Qi harms humans, Jutong believed there are two forms: major pathogens injuring the exterior and minor pathogens entering the interior. He said: "For Dryness syndromes of major pathogens invading the exterior, those that manifest immediately upon infection, indeed as Mr. Shen Munan stated, follow the same methods as Shanghan." Clauses in *Wenbing Tiaobian* such as "Contracting Dryness, like Taiyang syndrome of Shanghan, with sweating, no cough, no vomiting, no pain, Guizhi Tang gently harmonizes it," reflect this treatment proposition. As for minor pathogens entering the interior, although there are differences such as deeply penetrating the Lower Jiao and battling blood, lingering in the Lower Jiao without battling blood, and directly injuring Yang, the general approach is to use Warm Methods (except for treating reversion Qi). Thus, formulas such as Huayu Huisheng Dan (Blood Stasis Resurrection Pill) for battling blood and Fuheng Dan for not battling blood are all like this. All cases in the Dryness section of *Wu Jutong Yian* are also like this. For example, Case 46 of Li, suffering from Dryness Metal Qi, was given rigid, drying, and warm-hot herbs at the first consultation, based on the understanding of "Dryness is minor Cold" and "Yin Pathogen." On May 2nd, during the third consultation, although it was said that such drugs for treating dryness should not be used for long, the prescription changed to modified Guizhi Tang, using Guizhi (Cinnamon Twig) and Baishao (White Peony Root) each 4 qian, Zhi Cao (Prepared Licorice) and Ganjiang (Dried Ginger) each 2 qian, Dazao (Jujube) 2 pieces, Shengjiang (Fresh Ginger) and Guangpi (Citrus Peel) each 3 qian, Banxia (Pinellia Rhizome), Sheng Yiren (Coix Seed), and Yunling Kuai (Poria Block) each 5 qian, still adhering to the Warm Method. Another example is Case 15 of Ms. Zhang: "Dryness Metal Qi entered directly into the interior, six pulses were absent, stiffly lying as if dead, limbs reversed cold past elbows and knees, leg pain and tendon contraction. Given a large dose of Tongmai Sini Tang (Unblock Extremities Frigid Extremities Decoction) plus Chuanjiao (Sichuan Pepper), Wuyu (Evodia Fruit), and Gong Dingxiang (Clove), the reversal returned and pulses emerged within a day and night. The next day, due to eating porridge too early, relapsed similarly to previous symptoms, pulses reversed again, body reversed cold, and died again. Still given the previous formula, heavily adding warm-hot herbs. One dose reversed half the condition, two doses brought her back to life, later concluded with tonifying Yang." Regarding the above theories and treatments, differing opinions are stated as follows:
1. Cold and Dryness are each one of the Six Qi. Among the Six Qi, Cold corresponds to Heat, referring to temperature; Dampness corresponds to Dryness, referring to humidity. High humidity does not equal heat, and heavy dryness does not equal cold. Therefore, Cold is itself Cold, Dryness is itself Dryness; the two Qi cannot be mixed. Jutong failed to distinguish this, claiming heavy Dryness is Cold and (light) Cold is Dryness, which is theoretically erroneous (Jutong often committed the error of mixing two Qi into one when discussing the Six Qi, such as claiming Summer Heat is composed of Dampness and Heat Qi, another example refuted by Mengying, no need to repeat). Regarding the above two cases, if Li's case is considered mild Cold, it can still be called Dryness; then Zhang's case is clearly heavy Dryness, should be called Central Cold, and should not be called Central Dryness anymore. Calling it Central Dryness yet using large hot drugs to treat it contradicts the saying that light Cold is Dryness. In fact, Jutong indeed confused Cold and Dryness Qi, with vague concepts and unclear distinctions. Therefore, when treating Foot-Taiyin Cold-Dampness, he primarily used Jiaofu Baitong Tang (Pepper, Aconite, and White Tongue Decoction); now treating Dryness Pathogen directly invading the interior, he primarily used Tongmai Sini Tang plus Chuanjiao, Wuyu, and Gong Dingxiang. These two have little difference in medicinal methods. I say that generally speaking, treating Cold requires Warm-Hot methods, treating Dryness requires Soft-Moist methods. If only warming without moistening, it truly has nothing to do with treating Dryness. Ms. Zhang's case and other medical cases in the Central Dryness section that are only warming without moistening are better described as treating Cold rather than treating Dryness. Otherwise, having established a Central Dryness section, it seems unnecessary to separately establish a Cold section.