诸涩枯涸，干痉皴揭，皆属于燥。阳明燥金，乃肺与大肠之气也。涩者、涩也。如物湿
则滑泽，今遍身内外涩滞，皆属燥金之化，由水液衰少而燥涩，气为壅滞，不得滑泽通利，
而为麻也。然中寒吐泻，亡液而成燥者，亦由于此。
枯涸干痉者，枯、不荣身也。涸、无水液也。干、不滋润也。痉、不柔和也。
皴揭者、皮肤启裂也。干为天而为燥金，坤为地而为湿土，天地相反，燥湿异用，湿土
旺于长夏，则万物滑泽荣茂，燥金旺于秋冬，则万物肃敛，燥涩皴揭之理，皆燥气之化也。
燥金主收敛，不可不知。
诸病上下所出，水液澄澈清冷，症瘕 疝，坚痞腹满急痛，下痢清白，食已不饥，吐利
腥秽，屈伸不便，厥逆禁固，皆属于寒。足太阳寒水，乃肾与膀胱之气也。
上下所出，澄澈清冷者，水谷不化，而吐利清冷，为病寒也。
症者、腹中坚硬，按之应手也。然水体柔顺，今反坚硬如地者，亢则害承乃制也。如病
湿过极则反燥，而筋脉劲急者，反兼金化制之也。病燥过极则烦渴，反兼火化制之也。热病
过极而反出五液，或为战栗恶寒者，反兼水化制之也。
瘕者、腹中虽硬，而忽聚忽散，无有常准。经曰，小肠移热于大肠，两热相搏，则血溢
而为伏瘕也。然则经言瘕病，亦有热者也。或阳气郁结，拂热壅滞，而为坚硬不消者，又非
寒病症瘕也，当以脉症辩之。
疝者、小腹控卵肿急绞痛也。寒主拘缩故也，寒极而土化制之，故肿痛也。经曰，疝
脉急。注云，脉急者、寒之象也。然寒脉当短小而迟，今言急者，何也？岂不曰紧脉主痛，
急为痛甚。然疝之湿热者，何以别之，若脉紧急兼洪数，则又为热痛之类也，不可不知。
坚痞腹满急痛者，寒主拘缩，故急痛也。又有热郁于内，而腹满坚结痛者，又不可例言
为寒
下痢清白者，水寒则清净明白也。
食已不饥者、胃热则消谷善饥，病寒则虽食已、而难腐化也。亦有邪热不杀谷，而腹热
胀满，虽数日不食，亦不饥者，又不可以寒目之。
吐利腥秽者、肠胃寒而传化失常也。故寒胜则火衰金旺，而吐利腥秽也。腥、金之臭也。
屈伸不便，厥逆禁固者，寒则四肢逆冷，而禁止坚固，舒卷失常，不便利也。
凡是出现涩滞、干枯、枯竭、痉挛、皮肤皲裂揭起等症状，都归属于燥证。阳明燥金之气，对应的是肺与大肠的功能。所谓“涩”，就是涩滞不通。就像物体湿润时就会滑利，如今全身内外都感到涩滞，这都是燥金之气的变化所致；由于体内水液减少而导致干燥涩滞，气机因此壅塞阻滞，不能滑利通畅，从而产生麻木感。然而，如果是中寒导致呕吐腹泻，津液耗损而形成的燥证，也是源于这个道理。
所谓“枯涸干痉”，“枯”是指身体得不到濡养，“涸”是指没有水液滋润，“干”是指缺乏润泽，“痉”是指筋脉不柔和拘急。
所谓“皴揭”，是指皮肤开裂脱皮。“天”属阳而为燥金，“地”属阴而为湿土，天地性质相反，燥与湿的作用不同。湿土之气旺盛于长夏季节，万物就滑润茂盛；燥金之气旺盛于秋冬季节，万物就肃杀收敛。关于干燥、涩滞、皮肤皲裂的道理，都是燥气变化的结果。燥金主收敛，这一点不可不知道。
凡是病邪从上或从下排出，排泄物清澈透明且寒冷，以及症瘕、疝气、腹部坚硬痞块、腹胀满且急痛，大便泻下清白之物，进食后不觉饥饿，呕吐和腹泻物带有腥臭味，肢体屈伸不便，四肢厥冷且僵硬不动，都归属于寒证。足太阳寒水之气，对应的是肾与膀胱的功能。
所谓“上下所出，澄澈清冷”，是指水谷不能消化，导致呕吐和腹泻物清冷，这是寒病的表现。
所谓“症”，是指腹中有坚硬的包块，按压时有应手的感觉。水的本性是柔顺的，现在反而坚硬如大地，这是因为亢盛则有害，需要制约才能平衡。例如，湿病过于严重反而会变燥，导致筋脉劲急，这是反兼金气（燥）来制约它；燥病过于严重反而会出现烦渴，这是反兼火气来制约它；热病过于严重反而排出五种体液，或者出现战栗恶寒，这是反兼水气来制约它。
所谓“瘕”，是指腹中虽然坚硬，但聚散无常，没有固定的位置。医经说：“小肠的热移入大肠，两热相搏结，就会导致血液溢出而形成伏瘕。”既然这样，医经所说的瘕病，也有属于热证的。或者是阳气郁结，拂逆发热壅滞，形成坚硬不消的包块，这又不是寒性的症瘕了，应当通过脉象和症状来辨别。
所谓“疝”，是指小腹牵引睾丸肿胀、紧急绞痛。这是因为寒性主收缩拘挛的缘故。寒极之时，土气来制约它，所以出现肿痛。医经说：“疝病的脉象急。”注释说：“脉急，是寒的表现。”然而，寒脉应当短小且迟缓，现在为什么说“急”呢？难道不是说紧脉主痛，急脉表示疼痛剧烈吗？但是，湿热型的疝气如何区别呢？如果脉象紧急且兼见洪数，那就属于热痛的范畴了，这点不可不知道。
所谓“坚痞腹满急痛”，是因为寒性主收缩，所以引起急痛。又有热邪郁结在体内，导致腹部胀满、坚硬结聚且疼痛的，又不能一概说是寒证。
所谓“下痢清白”，是因为水寒则清净明白。
所谓“食已不饥”，胃热则消化食物快且容易饥饿，患寒病则即使吃完食物，也难以腐熟消化。也有邪热不能消化谷物，导致腹部热胀满，即使几天不吃饭，也不觉得饿的情况，这又不能看作是寒证。
所谓“吐利腥秽”，是因为肠胃受寒，传导功能失常。所以寒气胜则心火衰、肺金旺，导致呕吐和腹泻物带有腥味。腥味，是金（肺/大肠）的气味。
所谓“屈伸不便，厥逆禁固”，是因为寒邪导致四肢逆冷，且僵硬固定，舒展卷曲失常，活动不便利。
All cases of astringency, withering, drying up, spasms, and skin cracking or peeling belong to Dryness (Zao). Yangming Dry Metal corresponds to the Qi of the Lung and Large Intestine. "Astringency" refers to obstruction and lack of flow. Just as objects are slippery when wet, now that the entire body feels obstructed and dry inside and out, this belongs to the transformation of Dry Metal; it arises from the depletion of body fluids leading to dryness and astringency, causing Qi to become congested and stagnant, unable to flow smoothly and freely, resulting in numbness. However, even if Dryness results from fluid loss due to Cold-induced vomiting and diarrhea, it stems from this same principle.
"Withering, drying up, and spasms": "Withering" means the body is not nourished; "drying up" means there is no fluid; "dry" means lacking moisture; "spasms" means lack of flexibility and softness.
"Cracking and peeling" refers to the splitting and peeling of the skin. Heaven is Yang and constitutes Dry Metal; Earth is Yin and constitutes Wet Earth. Heaven and Earth are opposite, and Dryness and Wetness have different functions. When Wet Earth is prosperous in late summer, all things are slippery, lush, and flourishing; when Dry Metal is prosperous in autumn and winter, all things are solemn and contracting. The principles of dryness, astringency, and skin cracking are all transformations of Dry Qi. Dry Metal governs convergence and storage; this must be known.
All diseases where discharges from above or below are clear, transparent, and cold, along with masses (Zheng), hernias (Shan), hard epigastric masses, abdominal fullness with urgent pain, dysentery with clear and white stools, feeling no hunger after eating, vomit and diarrhea with fishy or foul odors, difficulty in flexion and extension, cold limbs (Jue Ni), and rigidity/stiffness, all belong to Cold (Han). Foot-Taiyang Cold Water corresponds to the Qi of the Kidney and Bladder.
"Discharges from above and below, clear and cold": This refers to the failure to digest food and fluids, resulting in clear and cold vomiting and diarrhea, which indicates a Cold disease.
"Zheng" refers to hard masses in the abdomen that are palpable upon pressure. Water is naturally soft and compliant; for it to become hard like earth implies that excess leads to harm, requiring counteraction to maintain balance. For example, if Dampness becomes extreme, it may transform into Dryness, causing stiff sinews and tendons; this is a counter-transformation governed by Metal (Dryness). If Dryness becomes extreme, it may lead to irritability and thirst; this is a counter-transformation governed by Fire. If Heat becomes extreme, it may cause the discharge of the five fluids or manifest as shivering and aversion to cold; this is a counter-transformation governed by Water.
"Jia" refers to abdominal masses that are hard but gather and scatter intermittently without a fixed location. The Classics state: "Heat transferred from the Small Intestine to the Large Intestine, clashing together, causes blood extravasation forming hidden Jia." Thus, Jia diseases described in the classics can also involve Heat. Alternatively, if Yang Qi is constrained and stagnates with heat, forming hard, unresolving masses, this is not a Cold-type Zheng/Jia, and differentiation must be made based on pulse and symptoms.
"Shan" (Hernia) refers to swelling, urgency, and severe colicky pain in the lower abdomen radiating to the testicles. This is because Cold governs contraction and curling. When Cold reaches its extreme, Earth Qi counters it, resulting in swelling and pain. The Classics state: "The pulse in Shan is urgent." The commentary notes: "An urgent pulse is a sign of Cold." However, a Cold pulse should typically be short, small, and slow. Why is it described as "urgent"? Does this not imply that a Taut (Jin) pulse governs pain, and an Urgent pulse indicates severe pain? But how to distinguish Heat-Dampness type Shan? If the pulse is urgent and accompanied by Surging (Hong) and Rapid (Shu) qualities, it falls under the category of Heat-pain; this must be known.
"Hard masses, abdominal fullness, and urgent pain": Cold governs contraction, thus causing urgent pain. However, if Heat is constrained internally, causing abdominal fullness, hardness, clustering, and pain, one cannot simply categorize it as Cold.
"Dysentery with clear and white stools": This occurs because Cold water remains clear and pure.
"Feeling no hunger after eating": Stomach Heat causes rapid digestion and easy hunger; Cold disease makes it difficult to rot and transform food even after eating. There are also cases where pathogenic Heat fails to digest grains, leading to abdominal heat, fullness, and bloating, where one feels no hunger even after several days without food; this cannot be viewed as a Cold syndrome.
"Vomit and diarrhea with fishy/foul odors": This results from Cold in the intestines and stomach disrupting transmission and transformation. When Cold prevails, Heart Fire declines and Lung Metal prospers, leading to vomit and diarrhea with a fishy odor. Fishiness is the smell associated with Metal.
"Difficulty in flexion and extension, cold limbs, and rigidity": Cold causes cold limbs in the four extremities, making them rigid and fixed, disrupting normal movement and flexibility, leading to inconvenience.