这两味药在《本经》中的气味,功用分别如下:“柴胡,味苦平。主治心腹肠胃中结气,饮食积聚,寒热邪气,推陈致新。久服轻身、明目、益精。大黄,味苦寒。主下瘀血、血闭,寒热,破癥瘕积聚,留饮宿食,荡涤肠胃,推陈致新,通利水谷,调中化食,安和五藏。”柴胡和大黄在气味和功用上有差异,但是,透过《本经》的记载,我们发现这两味药在大的方面有很多共通之处。一方面就是破除积聚和通达肠胃,当然在这个破除和通达的力度上、层次上二者有区别,这一点我们以后会专门谈到。另一方面,也是最大的一个共通方面,就是“推陈致新”。据我查证,《本经》里面具有“推陈致新”功效的药仅有三味,还有另一味就是消石。消石不是常用的药,在这里不作讨论。下面就柴胡和大黄的共通问题,作进一步的引申讨论。(1)临界相变先来讨论“推陈致新”这个问题。陈与新是一个相对的概念,“陈”代表一种旧有的东西,旧有的状态,“新”当然就是一种相反的状态。将旧有的状态推翻了,建立新的状态,这是推陈致新,促使一个事物进行变化转换,以形成另一个事物,这也是推陈致新。在现代物理学前沿,有一门非常重要的学问,叫做“临界相变”。今天我们来谈这门学问,不是从专业的角度去谈(从专业的角度我们也没这个资格谈),而是把它泛化开来,作为一个一般的思想。这样我们就有处可入了。相变,说白了就是事物状态的变化,这个变化在中医看来就要归之于阴阳。故云:阴阳者,变化之父母。阴阳的变化是以象言,所以《内经》又将上述这个变化称为“象变”。事物由此一状态进入到彼一状态,必须经历一个变化过程,而这个过程的某一区间或状态,对于变化是否发生,变化的进程,以及变化的方向,都是至关重要的、决定性的因素。这样一个假设的区间或状态,就称之为临界或临界状态。在临界状态所发生的变化,即为临界相变。因此,临界状态以及临界相变的情况也就决定了事物的变化情况。临界状态的变化影响整个事物的变化,事物能否由“陈”的状态进入到“新”的状态,就要看临界相变的发生情况。从这一点上来看,柴胡与大黄这个“推陈致新”的作用,是否就是直接作用在临界状态及临界相变上呢?这是非常值得思考的一个问题。假如柴胡和大黄的这个功效确实能够很直接地作用于临界状态,确实能够很直接地促使临界相变的发生。那这个意义就太大了。疾病是一种状态,健康也是一种状态。有些时候我们从健康走向疾病,有些时候我们由疾病回到健康。为什么会有这个变化呢?相变不同,相变的方向不同,所以就有这个健康和疾病状态的不同。由疾病态进入健康态,这个相变是好的,是我们希望的;而由健康变为疾病呢?这就不是我们所希望的相变了。我们能否利用上述药物的特殊作用,通过适当的方法,适当的配伍来直接参与相变,影响相变,使相变的方向朝着有利于健康的方向发展。尤其是对那些突变性疾病,如恶性肿瘤类疾病,这应该是一个值得思考的路子。(2)东西法门我们由柴胡、大黄的“推陈致新”作用引入了“临界相变”这个概念,当然这还是一个很粗的思路,但是,把它作为与现代接轨的一个切入点还是值得提出来的。这是其一。其二,我们谈到柴胡、大黄在功用方面的另一个特点,是它对结气、积聚、瘀血、血闭的破决、通达作用。如果用现代一些的语言来描述柴胡、大黄的上述特点,就是它具有扫清障碍的作用。结气、积聚、瘀血、血闭,这些都是什么呢?这些就是人体五藏六府、四肢百骸、经络隧道中的阻滞和障碍。古人云:但使五藏元真通畅,则百病不生。人为什么会生百病,就因为五藏元真不通畅。而五藏元真为什么不通畅呢?因为阻滞了,障碍了。因此,你能拿掉阻滞,疏通障碍,也就解决了导致疾病的一个关键问题。柴胡、大黄有这样一个共性特点,那么,在这个共性上有没有区别呢?有一个很重要的区别。这就要连带扯出东西的问题。中国人讲东西很特别,英文的“thing”是完全翻译不出“东西”的。为什么呢?因为东西太大了,什么都可以包括进去,什么都可以叫东西。什么都可以叫东西,那东西又是什么呢?记得前面谈人中的时候,我们说人中这个称谓透着中医的三昧。其实这个“东西”也具有这样的内涵,而且更宽更广。中国人认识事物离不开阴阳,故《素问·阴阳应象大论》开首即云:“阴阳者,天地之道也,万物之纲纪,变化之父母,生杀之本始,神明之府也。”而阴阳的问题有如前述,都可以归结到“阳生阴长,阳杀阴藏”上来。什么是阳生?东就是阳生。什么是阳杀?西就是阳杀。而惟有生才有长,惟有杀才有藏。是以一个东西已然包赅“生长杀藏”。所以,东西的内涵很深刻,没法用“thing”来翻译。就像周汝昌先生说“红楼梦”没法用“A Dream ofRed Chamber”来翻译一样。用“A Dream ofRed Chamber”来翻译“红楼梦”,不但这个内涵表达不了,而且所有的义趣、境界也荡然无存。一个“东西”,生杀在里面了,变化在里面了,无常在里面了,传统的基本理念也在里面了。为什么孔子老是强调“君子食无求饱,居无求安”,为什么老子慎言,却要不停地唠叨“知足不辱,知足常乐”?因为事事生灭,事事无常。你要想在这个生灭里求一个永恒的东西,在这个无常里求常,那你永远没有出头的日子。与其这样,那还不如及早回头,不在物器里打转,而在道里面用功。因此,“东西”这个称谓确实透着理性的三昧。另一方面,在器这个层面,《素问》讲:“升降出入,无器不有。”升者出者,亦东也;降者入者,亦西也。一个东西,升降出入在其中,器亦在其中。升降出入对于维系生命,维系健康,都太重要了。所以,《素问·六微旨大论》又言:“出入废则神机化灭,升降息则气立孤危。非出入,则无以生长壮老已;非升降,则无以生长化收藏。”而出入升降为什么会废息呢?很重要的一个原因,就是出入升降的这个“道”阻滞了,障碍了。道路不通,你怎么出入?怎么升降?那就只好作罢。上述这个“道”粗分起来不外两条,一条是东边的道,它管升出,一条是西边的道,它管入降。这两条道都要通畅,通畅了,升降出入有保证,神机气立有保证,那当然健康就有保证。阻滞了,障碍了,神机化灭,气立孤危,怎么还会有健康。这就要设法疏通它。前面我们谈到柴胡和大黄在扫除阻滞,清理障碍方面有共同的地方,但也有区别。这个区别在哪呢?就在上述两条道上。柴胡善于清扫东道上,也就是升出这条道上的障碍,而大黄则善于清扫西道上,也就是入降这条道上的障碍。有些时候引起疾病是因为东道上的阻滞,有些时候引起疾病是因为西道上的障碍,而有的时候东西两道都障碍了。这就需要根据脉证来分别对待。东道上的问题当然用柴胡,西道上的问题当然用大黄,东西两道都有问题,那就柴胡、大黄一起上。太阳篇的大柴胡汤不就是一起上的吗?所以,小柴胡汤和大柴胡汤的功用我们应该很清楚。小柴胡汤是解决东道的问题,而大柴胡汤则是解决东西两道的问题。从上面这个切入点,是不是又引申出一个法门?这就叫东西法门,升降法门,出入法门。任何疾病,也都不出这个法门。要么是东道的问题,要么是西道的问题,要么是东西两道都有问题。而从这个法门,我们看到柴胡、大黄这两味药的重要性。先师在世时,对柴胡、大黄二味药特别重视,曾言:用好柴胡、大黄,横行天下无双。对此中奥秘,既可以从“推陈出新”言,从“临界相变”言,亦可以从东西法门言。前面讨论阳明篇的时候,我们曾经谈到了高血压的一个思路,高血压病很根本的一个起因就是阻滞。而谈阻滞,这又回到了东西的问题上来。在阳明篇的时候,我们谈阻滞还比较笼统,现在我们讨论少阳,讨论东西法门,这个问题就比较具体了。阻滞无非就是东西两道的阻滞,前面谈阳明重的是西道,这里讲少阳似乎重东道。东道也好,西道也好,只要阻滞了,都有可能导致血压升高。这就要求我们在治疗的时候区别对待。现在许多中医被西医这个“高血压”框死了,跳不出来。一想到高血压,就离不开平肝熄风。这就叫“辨病施治”吗?这个不叫“辨病施治”!这叫认奴为主。中医的主张没有了,你凭什么施治?西医治疗高血压,它用降压的方法,这是应该的。因为它有一个理在。如果中医你也如此这般,那就糟了!高血压是个什么“东西”?你降它的什么?临床上有的高血压服用西药不理想,中医也看了一大堆,都是平肝潜阳,镇肝熄风一类,血压还是降不下来。一看脉证,一派阳虚、水饮之证。你一温阳,一化饮,血压反而慢慢降下来。为什么呢?因为阳气一温,水饮一化,东道上的问题就解决了。所以,搞中医的一定要分清本末,主次,不要被西医的一个病名牵着你到处跑。这一牵着跑,那中医的本性就迷失了。6.少阳之脉下面我们简单地讲一讲少阳病的两个常见脉象。少阳病的两脉,我们一看书就知道了。一个是 265条:“伤寒,脉弦细,头痛发热者,属少阳。”一个是 266条:“本太阳病不解,转入少阳者,胁下硬满,干呕不能食,往来寒热,尚未吐下,脉沉紧者,与小柴胡汤。”一个是弦细,一个是沉紧。弦细也好,沉紧也好,都是少阳病脉。为什么呢?我们回看前面的内容,知道少阳病是在升达的过程中受到了压抑,产生郁结。一压抑,一郁结,脉气就无法升浮起来,条畅起来。或弦、或细、或沉、或紧便由兹产生。此如清代医家周岩所云:“然当阴尽生阳之后,未离乎阴,易为寒气所郁,寒气郁,则阳不得伸而与阴争。”故脉现弦细、沉紧也。少阳的问题就讨论到这里。
第八章 太阴病纲要
The flavors and efficacies of these two herbs in the *Shennong Bencao Jing* (Divine Farmer's Materia Medica) are as follows: "Chaihu (Bupleuri Radix), bitter, neutral. It treats knotting of qi in the heart, abdomen, stomach, and intestines; accumulation of food and drink; pathogenic factors of cold and heat; it pushes out the old and brings forth the new. Long-term use lightens the body, brightens the eyes, and benefits the essence. Dahuang (Rhei Radix et Rhizoma), bitter, cold. It primarily expels stasis blood, blood obstruction, cold-heat conditions; breaks up masses and accumulations; eliminates retained fluids and old food residues; cleanses the stomach and intestines; pushes out the old and brings forth the new; promotes the free flow of water and grain; regulates the middle jiao, transforms food, and harmonizes the five zang organs." Although Chaihu and Dahuang differ in flavor and efficacy, through the records of the *Shennong Bencao Jing*, we find that these two herbs share many commonalities on a macro level. On one hand, both break up accumulations and unblock the stomach and intestines. However, there are differences in the intensity and depth of this breaking and unblocking action, which we will discuss specifically later. On the other hand, and most significantly, is their shared efficacy of "pushing out the old and bringing forth the new" (Tui Chen Zhi Xin). According to my research, only three herbs in the *Shennong Bencao Jing* possess the efficacy of "pushing out the old and bringing forth the new"; the third is Xiaoshi (Natrii Sulfas). Since Xiaoshi is not a commonly used herb, it will not be discussed here. Below, further extended discussions will be made regarding the commonalities between Chaihu and Dahuang.
(1) Critical Phase Transition
Let us first discuss the issue of "pushing out the old and bringing forth the new." Old and new are relative concepts. "Old" represents something existing previously or an old state; "new," naturally, represents the opposite state. Overthrowing the old state to establish a new one is "pushing out the old and bringing forth the new." It promotes the transformation and conversion of a thing to form another thing, which is also "pushing out the old and bringing forth the new." In the frontier of modern physics, there is a very important field of study called "critical phase transition" (Linjie Xiangbian). Today, when we discuss this field, we do not do so from a professional perspective (we are not qualified to do so professionally), but rather generalize it as a general philosophical thought. This provides us with an entry point. Phase transition, in plain terms, refers to the change in the state of things. From the perspective of Traditional Chinese Medicine (TCM), this change is attributed to Yin and Yang (Yin-Yang). Thus it is said: "Yin and Yang are the parents of change." The changes of Yin and Yang are described through phenomena (Xiang); therefore, the *Neijing* (Inner Canon) refers to the aforementioned change as "phenomenal change" (Xiang Bian). For a thing to enter from one state to another, it must undergo a process of change. A certain interval or state within this process is crucial and decisive for whether the change occurs, the progress of the change, and the direction of the change. Such a hypothetical interval or state is called a critical state (Linjie Zhuangtai). The changes occurring in the critical state are termed critical phase transitions. Therefore, the situation of the critical state and critical phase transitions determines the changes of the thing. Changes in the critical state affect the entire change of the thing. Whether a thing can move from an "old" state to a "new" state depends on the occurrence of critical phase transitions. From this perspective, is the "pushing out the old and bringing forth the new" effect of Chaihu and Dahuang directly acting upon the critical state and critical phase transitions? This is a question worth pondering. If the efficacy of Chaihu and Dahuang can indeed act directly on the critical state and directly promote the occurrence of critical phase transitions, then the significance would be immense. Disease is a state, and health is also a state. Sometimes we move from health to disease, and sometimes from disease back to health. Why does this change occur? Because the phase transitions differ, and the directions of the phase transitions differ, leading to different states of health and disease. Moving from a diseased state to a healthy state is a favorable phase transition, which we desire; whereas moving from health to disease is a phase transition we do not desire. Can we utilize the special effects of the aforementioned herbs, through appropriate methods and compatible combinations, to directly participate in and influence phase transitions, directing them towards a direction beneficial to health? Especially for sudden diseases, such as malignant tumors, this should be a path worth exploring.
(2) The Method of East and West
We introduced the concept of "critical phase transition" through the "pushing out the old and bringing forth the new" effect of Chaihu and Dahuang. Although this is still a rough idea, it is worth proposing as an entry point for connecting with modern science. This is the first point. Secondly, we mentioned another characteristic of Chaihu and Dahuang in terms of efficacy: their ability to break through and unblock knotting of qi (Jie Qi), accumulations (Ji Zhu), stasis blood (Yu Xue), and blood obstruction (Xue Bi). If we were to describe the above characteristics of Chaihu and Dahuang using modern language, it would be that they have the function of clearing obstacles. What are knotting of qi, accumulations, stasis blood, and blood obstruction? These are blockages and obstacles within the five zang and six fu organs, limbs, bones, and meridians of the human body. The ancients said: "If the primordial true qi of the five zang organs is smooth and unobstructed, then hundred diseases will not arise." Why do people develop hundred diseases? Because the primordial true qi of the five zang organs is obstructed. And why is the primordial true qi obstructed? Because it is blocked and hindered. Therefore, if you can remove the blockages and clear the obstacles, you solve a key problem leading to disease. Chaihu and Dahuang share this common characteristic, but is there a difference within this commonality? There is a very important difference. This leads us to the issue of "East and West" (Dong Xi). The Chinese concept of "Dong Xi" is unique; the English word "thing" cannot fully translate "Dong Xi." Why? Because "Dong Xi" is too broad; it can include everything and anything can be called "Dong Xi." If everything can be called "Dong Xi," then what is "Dong Xi"? Remember when we discussed Renzhong (the philtrum) earlier, we said that the term Renzhong reveals the profound wisdom of TCM. Actually, "Dong Xi" has similar connotations, and even broader and wider ones. Chinese understanding of things cannot separate them from Yin and Yang. Thus, the *Suwen: Yin-Yang Yingxiang Dalun* opens with: "Yin and Yang are the way of heaven and earth, the net of all things, the parents of change, the origin of life and death, and the mansion of spiritual brilliance." As mentioned earlier, the issue of Yin and Yang can be归结 to "Yang generates, Yin grows; Yang kills, Yin stores." What is Yang generation? East is Yang generation. What is Yang killing? West is Yang killing. Only with generation can there be growth; only with killing can there be storage. Thus, "Dong Xi" already encompasses "generation, growth, killing, and storage." Therefore, the connotation of "Dong Xi" is profound and cannot be translated as "thing." Just as Mr. Zhou Ruchang said that *Dream of the Red Chamber* cannot be translated as "A Dream of Red Chamber." Translating *Dream of the Red Chamber* as "A Dream of Red Chamber" not only fails to express this connotation but also leaves all its meanings, interests, and realms completely empty. In "Dong Xi," generation and killing are contained; change is contained; impermanence is contained; and basic traditional concepts are contained. Why did Confucius always emphasize that "a gentleman does not seek satiety in food nor comfort in dwelling"? Why did Laozi speak cautiously yet constantly preach "He who knows contentment suffers no disgrace; he who knows contentment is always happy"? Because all things arise and perish; all things are impermanent. If you want to seek an eternal thing within this arising and perishing, or constancy within this impermanence, you will never have a day of success. Rather than this, it is better to turn back early, not to revolve within material objects, but to exert effort within the Dao. Therefore, the term "Dong Xi" indeed reveals rational wisdom. On the other hand, at the level of vessels/forms (Qi), the *Suwen* states: "Ascending, descending, exiting, and entering exist in every vessel." Those that ascend and exit are also East; those that descend and enter are also West. In "Dong Xi," ascending, descending, exiting, and entering are contained, and the vessel is also contained. Ascending, descending, exiting, and entering are too important for maintaining life and health. Thus, the *Suwen: Liuweizhi Dalun* further states: "If exiting and entering cease, the spirit mechanism perishes; if ascending and descending stop, the qi establishment becomes precarious. Without exiting and entering, there is no growth, flourishing, maturity, decline, and end; without ascending and descending, there is no growth, transformation, harvesting, and storing." Why do exiting, entering, ascending, and descending cease and stop? A very important reason is that the "Dao" (pathway) of exiting, entering, ascending, and descending is blocked and hindered. If the road is not open, how can there be exiting and entering? How can there be ascending and descending? Then one must give up. This aforementioned "Dao," roughly divided, consists of no more than two paths: one is the Eastern path, which manages ascending and exiting; the other is the Western path, which manages entering and descending. Both paths must be smooth. If smooth, ascending, descending, exiting, and entering are guaranteed, the spirit mechanism and qi establishment are guaranteed, and thus health is guaranteed. If blocked and hindered, the spirit mechanism perishes, and the qi establishment becomes precarious; how can there be health? One must try to dredge it. We previously mentioned that Chaihu and Dahuang have common ground in clearing blockages and obstacles, but also differences. Where is this difference? It lies in the aforementioned two paths. Chaihu is good at clearing obstacles on the Eastern path, i.e., the path of ascending and exiting; Dahuang is good at clearing obstacles on the Western path, i.e., the path of entering and descending. Sometimes disease is caused by blockage on the Eastern path; sometimes by obstruction on the Western path; and sometimes both Eastern and Western paths are obstructed. This requires differentiation based on pulse and symptoms. Problems on the Eastern path naturally call for Chaihu; problems on the Western path naturally call for Dahuang; if both paths have problems, then Chaihu and Dahuang are used together. Is Da Chaihu Tang (Major Bupleurum Decoction) in the Taiyang chapter not an example of using them together? Therefore, we should clearly understand the functions of Xiao Chaihu Tang (Minor Bupleurum Decoction) and Da Chaihu Tang. Xiao Chaihu Tang solves problems on the Eastern path, while Da Chaihu Tang solves problems on both Eastern and Western paths. From this entry point, does it not extend into another method? This is called the Method of East and West, the Method of Ascending and Descending, the Method of Exiting and Entering. Any disease does not go beyond this method. It is either a problem on the Eastern path, a problem on the Western path, or problems on both paths. From this method, we see the importance of these two herbs, Chaihu and Dahuang. When my late master was alive, he placed special emphasis on Chaihu and Dahuang, once saying: "If you can use Chaihu and Dahuang well, you can roam the world unmatched." Regarding the mysteries within this, one can speak from the perspective of "pushing out the old and bringing forth the new," from the perspective of "critical phase transition," or from the perspective of the Method of East and West. Previously, when discussing the Yangming chapter, we mentioned a line of thought for hypertension. A fundamental cause of hypertension is blockage. Discussing blockage brings us back to the issue of East and West. In the Yangming chapter, our discussion of blockage was relatively general; now, discussing Shaoyang and the Method of East and West, this issue becomes more specific. Blockage is nothing more than blockage on the Eastern and Western paths. Previously, discussing Yangming emphasized the Western path; here, discussing Shaoyang seems to emphasize the Eastern path. Whether Eastern or Western, as long as there is blockage, it may lead to elevated blood pressure. This requires differentiated treatment during therapy. Many TCM practitioners today are trapped by the Western medical diagnosis of "hypertension" and cannot break free. Whenever they think of hypertension, they rely on soothing the liver and extinguishing wind. Is this called "treating disease according to syndrome differentiation"? No! This is calling a slave the master. The propositions of TCM are lost; on what basis do you treat? Western medicine treats hypertension using hypotensive methods, which is appropriate because there is a rationale behind it. If TCM also does so, it would be disastrous! What kind of "thing" is hypertension? What exactly are you lowering? Clinically, some hypertensive patients do not respond well to Western medicine, and after seeing many TCM doctors, all prescribed formulas for soothing the liver and subduing yang, or calming the liver and extinguishing wind, their blood pressure still does not come down. Upon examining the pulse and symptoms, it presents as a pattern of Yang deficiency and fluid retention. Once you warm Yang and transform fluids, the blood pressure slowly comes down. Why? Because warming Yang and transforming fluids resolves the problem on the Eastern path. Therefore, those practicing TCM must distinguish between root and branch, primary and secondary, and must not be led around by a Western disease name. Once led around, the essential nature of TCM is lost.
6. Pulse of Shaoyang
Below, we briefly discuss two common pulses in Shaoyang disease. Looking at the books, we know the two pulses of Shaoyang disease. One is Clause 265: "In cold damage, if the pulse is wiry and fine, accompanied by headache and fever, it belongs to Shaoyang." The other is Clause 266: "When a previous Taiyang disease does not resolve and transfers to Shaoyang, presenting with hardness and fullness under the ribs, dry vomiting, inability to eat, alternating chills and fever, and having not yet undergone emesis or purgation, if the pulse is deep and tight, administer Xiao Chaihu Tang." One is wiry and fine; the other is deep and tight. Whether wiry and fine or deep and tight, both are Shaoyang disease pulses. Why? Reviewing previous content, we know that Shaoyang disease involves suppression during the process of rising and ascending, leading to stagnation. Once suppressed and stagnant, the qi of the pulse cannot rise and float, nor become smooth. Thus, wiry, fine, deep, or tight pulses arise. As the Qing dynasty physician Zhou Yan stated: "However, after yin ends and yang begins, before leaving yin, it is easily constrained by cold qi. Cold qi constrains, so yang cannot extend and contends with yin." Hence, the pulse appears wiry, fine, deep, or tight. The discussion on Shaoyang issues ends here.
Chapter 8: Outline of Taoyin Disease