燥湿同形者，燥极似湿，湿极似燥也。《内经》以痿 为肺热叶焦，以诸痉强直皆属于
湿，
其义最可思。故治法有发汗利水以通津液者，有养阴滋水以祛痰涎者。张石顽曰∶常有一种
燥证，反似湿痹，遍身疼烦，手足痿弱无力，脉来细涩而微。(重按则芤，以阴虚也。)此阴
血为火热所伤，不能荣养百骸，慎勿误认湿痹而用风药，则火益炽而燥热转甚矣。宜甘寒滋
润之剂，补养阴血，兼连、柏以坚之。又曰∶凡脉浮取软大，而按之滑者，湿并在胃之痰也
；按之涩者，湿伤营经之血也。夫《内经》云∶湿流关节。又云∶地之湿气，感则害人皮肉
筋脉。如此，则血液不得流通，而燥结之证见矣。故湿之证，有筋急，(《内经》因于湿，
大筋软短也。)口渴，(有欲饮、有不欲饮者。)大便秘结，(肺中浊气不降。)小便赤涩；(太
阳经、腑气皆郁滞。)燥之证，有肢痿，胸满溏泻，(微溏而泻不多。)痰坚，(粘结胸中，力
咯不出。)咳嗽。(湿咳夜甚、卧甚；燥咳昼甚、劳甚；)更有病湿脉涩，以气滞也，必兼弦
紧；病燥脉滑，以阴虚也，必兼芤弱，按之即无。此皆同形而异实也，宜求其本而委曲以治
之。
按∶风、寒、暑、湿、燥、火六淫之邪，亢甚皆见火化，郁甚皆见湿化，郁极则由湿而
转见
燥化。何者?亢甚则浊气干犯清道，有升无降，故见火化也；郁则津液不得流通，而有所聚
，聚则见湿矣；积久不能生新，则燥化见矣。故吾尝说六气之中，皆有正化，惟燥是从转化
而生。前人谓燥不为病，非无燥病也，谓无正感于燥之病也。凡转筋、疔疮、阴疽、心腹绞
痛，皆燥化之极致也，皆从湿、寒、风、热转来。
燥湿同病者，燥中有湿，湿中有燥，二气同为实病，不似同形者之互见虚象也。张石顽
曰∶
每有脾湿肺燥之人，阴中之火易于上升，上升则咽喉作痛而干咳，须用贝母之润，以代半夏
之燥，煨姜之柔，以易干姜之刚，更加姜汁竹沥，以行其滞。又有素禀湿热而挟阴虚者，在
膏粱辈少壮时每多患此，较之中年以后触发者更剧，又与寻常湿热治法迥异，当推东垣、河
间类中风例，庶或近之。原文云∶素禀湿热而挟阴虚者，以其平时娇养，未惯驰驱，稍有忧
劳，或纵恣酒色，或暑湿气交，即虚火挟痰饮上升，轻则胸胁痞满，四肢乏力，重则周身疼
痛，痰嗽喘逆。亦有血溢、便秘、面赤、足寒者，甚则痿厥瘫废不起矣。大抵体肥痰盛之人
，则外盛中空，加以阴虚则上实下虚，所以少壮犯此最多。若用风药胜湿，虚火易于僭上；
淡
渗利水，阴津易于脱亡；专于燥湿，必致真阴耗竭；纯用滋阴，反助痰湿上壅。务使润燥合
宜，刚柔协济，始克有赖。如清燥汤、虎潜丸等方，皆为合剂。复有阴阳两虚，真元下衰，
湿热上盛者，若乘于内，则不时喘满、眩晕；溢于外，则肢体疼重麻瞀。见此，即当从下真
寒上假热例治之，否则防有类中之虞。即此痰厥昏仆，舌强语涩，或口角流涎，或口眼 斜
，
或半肢偏废，非内热招风之患乎?历观昔人治法，惟守真地黄饮子，多加竹沥、姜汁，送下
黑
锡丹，差堪对证。服后半日许，乘其气息稍平，急进大剂人参，入竹沥、姜汁、童便，啐时
中分三次服之。喘满多汗者，生脉散以收摄之。若过此时，药力不逮，火气复升，补气之药
又难突入重围矣。服后元气稍充，喘息稍定，更以济生肾气丸，杂以黑锡丹一分，缓图收功
可也。至于但属阳虚而阴不亏者，断无是理。虽邪湿干之，亦随寒化，不能为热也。即使更
感客邪，自有仲景风湿、寒湿治法可推，不似阴虚湿热之动辄扼腕也。按此论义理精微，治
法确凿，真不厌百回读云。
按上所论，乃脾湿热而肾虚燥之事也。尝考《金匮》黑疸，亦即脾胃湿热流积于肾之所
致也
。《折肱漫录》云∶脾胃湿热盛，则克伤肾水。《内经》云∶肾者，胃之关也。水之入胃，
其精微洒陈于脏腑经脉，而为津液，其渣滓下出于膀胱，而为小便，皆赖肾中真阳有以运化
之。肾阳不足，则水之清浊不分，积而为饮，泛而为肿，此脾肾湿寒之证也。若脾胃湿热，
肾阴又虚，则湿热下陷于肾，而为黑疸。何者?肾恶燥者也。肾燥而适脾湿有余，遂吸引之
不暇矣，遂不觉并其热而亦吸之矣。湿热胶固，菀结浊气，不得宣泄，熏蒸渐渍，久郁下焦
，致血液之中久不得引受清气，而色为浊暗矣，故为黑疸也。若早治得法，肾阴早复，则阳
气有所助，而力足以运浊不出矣。若其始肾阴不亏，则本无借于脾之湿，而不致吸受其毒矣
，故黑疸发原于肾燥也。故治法往往有滋阴与利水并用者，此之谓也。(按∶肾气丸，即滋
阴利水之剂。内泽泻、茯苓、桂枝，即五苓之法也；地黄、薯蓣、山萸，滋阴之药也；丹皮
、附子，所以行经通络也。)
燥湿同形，是指燥证发展到极致时看似湿证，湿证发展到极致时看似燥证。《黄帝内经》认为痿证是由于肺热导致肺叶焦枯，而各种痉病、强直症状都归属于湿，其中的深意最值得深思。因此，治疗方法中有通过发汗、利水来通调津液的，也有通过滋养阴液、补充水源来祛除痰涎的。张石顽说：常有一种燥证，反而类似湿痹，表现为全身疼痛烦扰，手足痿弱无力，脉象细涩且微弱。（重按时脉象呈芤象，这是因为阴虚所致。）这是由于阴血被火热邪气所伤，不能濡养全身骨骼关节，千万不要误认为是湿痹而使用祛风药，否则火势会更旺，燥热症状会更加严重。适宜使用甘寒滋润的药物，补养阴血，并兼用黄连、黄柏以坚阴。他又说：凡是脉象轻取时柔软宽大，重按时滑利的，是湿气并在胃中形成的痰饮；重按时涩滞的，是湿气损伤了营经之血。《黄帝内经》说：湿气流注于关节。又说：大地的湿气，侵袭人体则伤害皮肉筋脉。像这样，血液就不能流通，从而出现燥结的症状。所以，湿证的表现有筋脉拘急（《黄帝内经》说因于湿，大筋会软短），口渴（有的想喝水，有的不想喝），大便秘结（肺中浊气不下降），小便赤涩（太阳经和腑的气机都郁滞）；燥证的表现有肢体痿废，胸满溏泻（微溏且腹泻不多），痰核坚硬（粘结在胸中，用力咳也咳不出），咳嗽（湿咳夜间加重、躺下加重；燥咳白天加重、劳累加重）。更有患湿病却见涩脉的，是因为气滞，脉象必然兼带弦紧；患燥病却见滑脉的，是因为阴虚，脉象必然兼带芤弱，重按即无。这些都是表象相同而实质不同，应当探究其根本原因，委婉细致地进行治疗。
按语：风、寒、暑、湿、燥、火这六种外感邪气，亢盛到极致都会显现出火化的特征，郁结到极致都会显现出湿化的特征，郁结到极点则由湿转而显现出燥化的特征。为什么呢？亢盛则浊气侵犯清道，只有升没有降，所以显现出火化；郁结则津液不能流通，从而有所积聚，积聚就显现出湿；积久不能生新，燥化就显现出来了。所以我常说六气之中，都有正化的表现，唯独燥是从转化中产生的。前人认为燥不致病，并非没有燥病，而是指没有直接感受燥邪而致的病。凡是转筋、疔疮、阴疽、心腹绞痛，都是燥化达到极致的表现，都是从湿、寒、风、热转化而来的。
燥湿同病，是指燥中有湿，湿中有燥，这两种气同时作为实证存在，不像“同形”那样互相见到虚象。张石顽说：常有脾湿肺燥的人，阴中之火容易上升，上升则咽喉疼痛且干咳，必须用贝母的润性，来代替半夏的燥性，用煨姜的柔和，来替代干姜的刚烈，再加姜汁、竹沥，来行散其滞气。又有素体湿热且夹杂阴虚的人，在富贵人家年轻力壮时多患此病，比中年以后发作的更剧烈，又与寻常湿热治法截然不同，应当参考李东垣、刘河间治疗类中风的方法，或许比较接近。原文说：素体湿热且夹杂阴虚的人，因为平时娇生惯养，不习惯奔波劳碌，稍有忧思劳累，或纵欲酗酒，或暑湿之气交加，就会使虚火挟带痰饮上升，轻则胸胁痞满，四肢乏力，重则周身疼痛，痰嗽喘逆。也有出现吐血、便秘、面赤、足冷的，甚至出现痿厥、瘫痪无法起身。大体上身体肥胖痰多的人，则是外实内空，加上阴虚则上实下虚，所以年轻人犯此病最多。如果使用祛风药胜湿，虚火容易僭越上行；使用淡渗利水药，阴津容易脱失亡竭；专门用于燥湿，必定导致真阴耗竭；纯用滋阴药，反而助长痰湿上壅。务必使润燥配合适宜，刚柔相互辅助，才能见效。如清燥汤、虎潜丸等方剂，都是合适的合剂。又有阴阳两虚，真元下衰，湿热上盛的，如果邪气乘袭于内，则不时气喘胸闷、眩晕；溢于体表，则肢体疼痛沉重麻木昏蒙。见此症状，就应当从下真寒上假热的例子来治疗，否则防备有中风的危险。即使是这种痰厥昏仆，舌强语涩，或口角流涎，或口眼歪斜，或半身偏废，难道不是内热招致风邪的祸患吗？纵观古人的治法，只有朱丹溪的地黄饮子，多加竹沥、姜汁，送服黑锡丹，勉强能对证。服药后约半天，趁其气息稍平，急忙进服大剂量人参，加入竹沥、姜汁、童便，啜饮时分三次服用。气喘胸闷多汗的，用生脉散来收敛固摄。如果过了这个时机，药力达不到，火气再次上升，补气药又难以突入重围了。服药后元气稍充，喘息稍定，再用济生肾气丸，杂入一分黑锡丹，缓慢图谋收功即可。至于只属于阳虚而阴不亏损的，断无此理。虽然邪湿侵犯，也会随寒气转化，不能成为热证。即使再感受客邪，自有张仲景治疗风湿、寒湿的方法可推演，不像阴虚湿热那样动辄令人扼腕叹息。按此论述义理精微，治法确凿，真是不厌百回阅读。
根据上述论述，这是脾湿热而肾虚燥的情况。曾考证《金匮要略》中的黑疸，也是脾胃湿热流积于肾所致。《折肱漫录》说：脾胃湿热盛，则克伤肾水。《黄帝内经》说：肾是胃的关口。水进入胃，其精微洒陈于脏腑经脉，成为津液，其渣滓下出于膀胱，成为小便，都依赖肾中真阳来运化。肾阳不足，则水的清浊不分，积聚成为饮，泛滥成为肿，这是脾肾湿寒的证候。如果脾胃湿热，肾阴又虚，则湿热下陷于肾，形成黑疸。为什么呢？肾厌恶燥。肾燥而恰逢脾湿有余，于是无暇顾及地吸引它，不知不觉连它的热也一起吸入了。湿热胶结，郁结浊气，不得宣泄，熏蒸渐渍，久郁于下焦，导致血液中长久不能接受清气，颜色变得浊暗，所以称为黑疸。如果早期治疗得法，肾阴早日恢复，则阳气有所帮助，力量足以运化浊气而不外现。如果起初肾阴不亏，则本来不需要借重于脾的湿，也不会导致吸收其毒害，所以黑疸的发源在于肾燥。因此治疗方法往往有滋阴与利水并用的，说的就是这个道理。（按：肾气丸，就是滋阴利水的方剂。其中泽泻、茯苓、桂枝，就是五苓散的方法；地黄、薯蓣、山萸，是滋阴的药物；丹皮、附子，是用来行经通络的。）
Tongxing of Dryness and Dampness refers to the phenomenon where extreme dryness resembles dampness, and extreme dampness resembles dryness. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) attributes Wei syndrome (Wasting-Thirst Syndrome / Flaccidity Syndrome) to Lung Heat causing the lung leaves to wither, and states that various Jing diseases (Spasm diseases) and rigidity belong to Dampness; the profound meaning here is worth deep contemplation. Therefore, treatment methods include those that induce sweating and promote urination to unblock Jin-Ye (Body Fluids), as well as those that nourish Yin and moisten Water to dispel Phlegm-Saliva. Zhang Shiwang stated: There is often a type of Dryness syndrome that falsely resembles Bi syndrome (Painful Obstruction Syndrome) caused by Dampness, presenting with whole-body pain and vexation, flaccid weakness and powerlessness in the limbs, and a fine, choppy, and faint pulse. (Upon heavy pressure, the pulse feels Kou [hollow], indicating Yin deficiency.) This occurs because Yin-Blood is damaged by Fire-Heat, failing to nourish the hundred bones. One must not mistakenly diagnose it as Damp-Bi and use Wind-dispelling herbs, for this would intensify the Fire and exacerbate the Dryness-Heat. It is appropriate to use sweet-cold moistening agents to tonify and nourish Yin-Blood, combined with Huanglian (Coptis Rhizome) and Huangbai (Phellodendron Bark) to firm the Yin. He further stated: Whenever the pulse is soft and large upon light palpation but slippery upon heavy pressure, it indicates Dampness combined with Phlegm in the Stomach; if it is choppy upon heavy pressure, it indicates Dampness damaging the Blood of the Ying (Nutritive) channels. The *Neijing* says: Dampness flows into the joints. It also says: The dampness of the earth, when invading, harms the skin, flesh, sinews, and vessels. In such cases, Blood cannot circulate freely, leading to the appearance of Dryness-accumulation syndromes. Thus, Dampness syndromes may present with tendon cramping (*Neijing*: "Due to Dampness, the large sinews become soft and short"), thirst (some desire water, others do not), constipation (turbid Qi in the Lung fails to descend), and dark, scanty, or painful urination (Stagnation of Qi in the Taiyang Channel and its associated Fu organ). Conversely, Dryness syndromes may present with limb flaccidity, chest fullness, and loose stools (slightly loose with little diarrhea), hard Phlegm nodules (adhering in the chest, difficult to expectorate even with force), and cough (Damp-cough worsens at night and when lying down; Dry-cough worsens during the day and with exertion). Furthermore, a Wet disease presenting with a Choppy pulse indicates Qi stagnation, and the pulse must be accompanied by Wiry and Tight qualities; a Dry disease presenting with a Slippery pulse indicates Yin deficiency, and the pulse must be accompanied by Kou and Weak qualities, disappearing upon heavy pressure. These are all cases where the manifestations are similar but the underlying realities differ; one must seek the root cause and treat with nuanced care.
Note: The six pathogenic factors—Wind, Cold, Summer-Heat, Dampness, Dryness, and Fire—when extremely excessive, all transform into Fire characteristics; when extremely stagnant, they all transform into Dampness characteristics; and when stagnation reaches its peak, Dampness transforms into Dryness characteristics. Why? When excessive, turbid Qi invades the clear pathways, rising without descending, thus manifesting as Fire transformation; when stagnant, Jin-Ye cannot circulate freely and accumulates, manifesting as Dampness; when accumulated over time and unable to generate new substances, Dryness transformation appears. Hence, I often say that among the Six Qi, each has its normal transformation, but Dryness arises solely from transformation. Predecessors claimed that Dryness does not cause disease; this is not to say Dryness diseases do not exist, but rather that there are no diseases caused by direct contraction of Dryness pathogens. Conditions such as muscle twitching/cramps, Ding sores (carbuncles), Yin abscesses, and severe colic in the heart and abdomen are all extremes of Dryness transformation, originating from transformations of Dampness, Cold, Wind, and Heat.
Tongbing of Dryness and Dampness refers to Dryness containing Dampness, and Dampness containing Dryness, where both Qi act as Excess syndromes simultaneously, unlike Tongxing which presents with mutual signs of Deficiency. Zhang Shiwang said: There are often individuals with Spleen Dampness and Lung Dryness, where the Fire within Yin easily ascends. Upon ascending, it causes sore throat and dry cough. One must use the moistening property of Beimu (Fritillaria Bulb) to replace the drying nature of Banxia (Pinellia Tuber), the softening property of Wei Jiang (Roasted Ginger) to replace the rigid nature of Ganjiang (Dried Ginger), and add Jiangzhi (Ginger Juice) and Zhuli (Bamboo Sap) to move stagnation. There are also those constitutionally predisposed to Damp-Heat who concurrently suffer from Yin deficiency. This is common among young, robust individuals from affluent backgrounds, appearing more severely than in middle-aged patients, and differs significantly from standard Damp-Heat treatments. One should refer to the examples of Lei Zhongfeng (Stroke-like Syndromes) treated by Li Dongyuan and Liu Hejian. The original text states: Individuals with constitutional Damp-Heat and concurrent Yin deficiency, due to being pampered and unused to physical exertion, may trigger this condition with slight worry or labor, indulgence in alcohol and sex, or the intersection of Summer-Heat and Dampness. This causes deficient Fire to carry Phlegm-Fluids upward, resulting in mild cases of chest/hypochondriac stuffiness and limb fatigue, and severe cases of whole-body pain, phlegmy cough, and wheezing/counterflow qi. Some may experience hematemesis, constipation, facial redness, and cold feet, progressing to flaccidity, syncope, paralysis, and inability to rise. Generally, obese individuals with abundant Phlegm have exterior excess and interior emptiness; combined with Yin deficiency, this leads to upper excess and lower deficiency, making young adults most susceptible. If Wind-dispelling herbs are used to overcome Dampness, deficient Fire easily rebels upward; if diuretic/drainage herbs are used, Yin-Jin (Fluids) easily perish; if strictly using drying-dampness methods, True Yin will be exhausted; if purely using yin-nourishing methods, Phlegm-Dampness will be aided to obstruct upwards. It is essential to balance moistening and drying appropriately, coordinating rigid and soft properties, to achieve success. Formulas such as Qingzao Tang (Clear Dryness Decoction) and Huqian Wan (Tiger-Knee Pill) are suitable compound formulas. For cases of dual Yin-Yang deficiency with declining True Yuan and flourishing Damp-Heat above, if pathogens invade internally, frequent wheezing, chest fullness, and dizziness occur; if overflowing externally, limb pain, heaviness, numbness, and confusion arise. Upon seeing these, one must treat according to the pattern of True Cold below and False Heat above; otherwise, one must guard against stroke-like events. Even in cases of Phlegm-Syncope with collapse, stiff tongue, slurred speech, drooling, facial deviation, or hemiplegia, are these not disasters of internal Heat attracting Wind? Reviewing past treatments, only Zhu Danxi's Dihuang Yinzi (Rehmannia Drink), augmented with Zhuli and Jiangzhi, administered with Heixi Dan (Black Tin Pill), is barely adequate for the syndrome. After half a day, once breathing stabilizes, urgently administer a large dose of Renshen (Ginseng Root) mixed with Zhuli, Jiangzhi, and Tongbian (Child Urine), taken in three divided sips. For wheezing, fullness, and profuse sweating, use Maishan San (Pulse-Recovering Powder) to consolidate and secure. If this window is missed, medicinal efficacy will fail, Fire will rise again, and Qi-tonifying drugs will struggle to penetrate the siege. Once Yuan-Qi is slightly replenished and breathing stabilizes, one may use Jisheng Shenqi Wan (Kidney-Qi Enhancing Pill) mixed with a small portion of Heixi Dan to slowly achieve recovery. As for cases belonging solely to Yang deficiency without Yin depletion, such a scenario is theoretically impossible. Even if invaded by pathogenic Dampness, it will transform with Cold and cannot become Heat. Even if additional external pathogens are contracted, one can deduce treatment from Zhang Zhongjing’s methods for Wind-Damp and Cold-Damp, which do not lead to the same despair as Yin-deficient Damp-Heat. Note: This discussion is profound in principle and precise in treatment, truly worthy of repeated reading.
Based on the above discussion, this concerns Spleen Damp-Heat and Kidney Dryness. Examining the *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet), Hei Dan (Black Jaundice) is also caused by Spleen-Stomach Damp-Heat accumulating in the Kidney. *Zegong Manlu* states: When Spleen-Stomach Damp-Heat is excessive, it damages Kidney Water. The *Neijing* says: The Kidney is the gate of the Stomach. Water entering the stomach, its essence is distributed to the Zang-Fu organs and channels to become Jin-Ye, while its dregs exit via the Bladder to become urine; all rely on the True Yang of the Kidney for transformation. If Kidney Yang is insufficient, clear and turbid waters are not distinguished, accumulating as Yin (Fluid retention) and flooding as edema; this is a Spleen-Kidney Cold-Damp syndrome. However, if Spleen-Stomach Damp-Heat exists alongside Kidney Yin deficiency, Damp-Heat sinks into the Kidney, forming Hei Dan. Why? The Kidney dislikes Dryness. When the Kidney is Dry and meets excess Spleen Dampness, it involuntarily attracts it, and unknowingly absorbs its Heat as well. Damp-Heat becomes firmly bound, stagnating turbid Qi, preventing discharge, steaming and soaking, and lingering in the Lower Jiao. Consequently, Blood long fails to receive Clear Qi, becoming turbid and dark, hence termed Hei Dan. If treated correctly early, restoring Kidney Yin allows Yang to assist, providing sufficient strength to transform turbidity without outward manifestation. If initially, Kidney Yin was not depleted, there would be no need to borrow Spleen Dampness, avoiding absorption of its toxicity; thus, the origin of Hei Dan lies in Kidney Dryness. Therefore, treatment methods often combine Yin-nourishing and Diuretic approaches, which is what this refers to. (Note: Shenqi Wan is a formula for nourishing Yin and promoting urination. Ze Xie, Fu Ling, and Gui Zhi therein follow the method of Wuling San; Di Huang, Shu Yu, and Shan Zhu Yu are Yin-nourishing herbs; Mu Dan Pi and Fu Zi are used to move meridians and unblock collaterals.)