一日之中,为晚上 11 点,至次日凌晨 5点。一月之中,为初一到上弦的这 7 天半。一年之中,则为农历十一月至次年一月。以下从两方面来讨论少阴病时相。1.子者复也(1)七日来复三阴的欲解时与三阳的欲解时有一个很大的差别,在三阴中,每经欲解时的三个时辰有两个互为相重。如太阴的亥子丑中,子丑与少阴相重;少阴的子丑寅中,丑寅与厥阴相重。故而在三阴欲解时的讨论中,开首的这一时就显得特别的重要。如太阴之于亥,少阴之于子,厥阴之于丑,皆具特别的意义。子于十二消息卦正与复卦相应,复卦卦辞云:“复,亨。出入无疾,朋来无咎。反复其道,七日来复,利有攸往。”复者指的是阳气来复,阳气恢复之意。而这个阳气的恢复需要七日的时间,故云:“反复其道,七日来复”。为什么需要七日呢?我们只要将十二消息卦综合起来看就能明白。按照奇门遁甲的说法,十二消息卦共分阴阳二局。其中复临泰大壮聎乾这六卦为阳局,因为这六卦所处的过程是一个阳在增长的过程;而姤遯否观剥坤这六卦为阴局,因为这六卦所处的过程为阴不断增长的过程。一个阳局走完之后就到了阴局,阴局由姤始,若按每卦一天算,走完整个阴局正好是六天。阴局完结之后,继续往前走,就又重新回复到下一个阳局。阳局由复卦始,由阴局到下一个新的阳局正好需要七天,这便是复卦卦辞所言:“反复其道,七日来复。”其实,不仅是阳复,亦即由姤至复需七日;阴复,亦即由复至姤,亦为七日。故七者,周而复始之数也。可见一周七日并非传自西方,《周易》里已经有这个周七之数。我们再回看六经传变,按《素问·热论》所云,伤寒一日,太阳受之,二日阳明受之,三日少阳受之,四日太阴受之,五日少阴受之,六日厥阴受之。六日竟后,至七日又复太阳。故伤寒六经的传变,亦是七日来复。(2)冬至一阳生复卦所在的月份中有一个很重要的节气,这个节气就是冬至。复卦虽配十一月,但严格地说,必须要等到冬至节来临的时候,复气才正式启动。所以,冬至的一阳,实际就是指的复卦的一阳。复卦的卦象是上坤下震,故曰地雷复。象曰:“雷在地中,复。先王以至日闭关,商旅不行。”至日就是指冬至日。冬至为什么要闭关呢?因为这个时候正是一阳初生的时候,正是阳气来复的时候,正是阳气归根的时候,正是阴阳转换的时候。这个来复、这个转换如果成功了,下一个周期的循环就能很顺利的进行。如何保证上述过程能够成功呢?闭关就是一个很好的方法。闭关也就是处静。通过闭关,杜绝一切烦劳之事,让机体在一个很安静的环境里进行上述的转换、来复。其实,不但是冬至需要闭关,夏至也一样地需要闭关。故《后汉书、鲁恭传》云:“易五月姤用事,先王施命令止四方行止者。”以五月乃夏至所居,姤卦启动之时也。先王施命令止四方行止者,即是“先王以至日闭关,商旅不行。”之意。反复其道,七日来复。故不但于冬至阴交阳时需闭关,于夏至阳交阴时,亦需闭关。于此阴阳交替之际,于此阴阳初生之时,皆需细心呵护。子午于一年为十一月和五月,于一日则子午时也。故子时亦有一阳生,午时亦有一阴生。故子午之时亦需小闭关。午时怎么闭关呢?小事休息,或静坐,或小睡,皆为闭关之举。由是亦知,中国人的午休习惯可以上溯至周代。目下有人遑论午休习惯无益于健康,是不知易者也。(3)欲解要义子居正北,为水之所在,为体之所在。阳用为什么要归根呢?就是要归到这个体里面。阳归于体,方得休养生息。故子交复以后,阳即得来复,阳气即进入慢慢增长的阶段。少阴病为什么要欲解于子丑寅呢?因少阴病系阳气虚衰,阳不归根,以此病遇子丑寅,则正值阳气归根来复,阳渐增息的过程,何得不愈?此为天道地道以助人道也。尤证“人禀天地之气而生”非虚语。少阴病很重要的一个方剂也是四逆汤,如太阴篇所述,其方以炙甘草为君,炙甘草气味甘平,得土气最全,故其象坤也。干姜、附子辛温辛热,颇得雷气,为臣使,其象震也。上君而下臣,上坤而下震,正好是地雷复。故知四逆汤一类,颇具复卦之象,这便与少阴病的欲解时很好地对应起来了。此亦方时相应也。2.欲解何以占三时以上我们重点地讨论了少阴病欲解时中的子,尽管子这一时对于少阴有非常特殊的意义,但,我们还是应该注意到欲解时是由三时构成的这个问题。欲解时为什么一定要由三时构成呢?这便引出了一个很重要的术数问题。三是一个什么数?它有什么特性呢?《素问·生气通天论》云:“其生五,其气三。”《素问·六节藏象论》云:“五日谓之候,三候谓之气。”故知三而成气也。一年由四时组成,一时有几个月呢?三个月。故知三而成时。易之经卦,由三爻组成,故知三而成卦。道有天道,地道,人道,三道俱乃为全,故知三而成道。《老子》云:“道生一,一生二,二生三,三生万物。”故知三而成物。前云时方合一,时方统一。时遇三乃成,方亦然也。故亥子丑乃得北方,寅卯辰乃得东方巳午未乃得南方,申酉戌乃得西方。是知三而成方。为什么中医的走向最终是由单方发展到复方呢?就是因为单味药很难构成一个完整的方,需多味药组合乃得构成全方为什么欲解时不是一个时,而一定要三个时呢?同样是这个道理。以一时不成方,三时乃得成方。方成则气全,气全才有欲解之用。另外,有关三这个数,还有很重要的一个内容,就是三而成合。五行配地支,除了正行相配,即寅卯木,巳午火,申酉金,亥子水,辰戌丑未土之外,还有三合相配。怎么三合呢?即亥卯未合木,寅午戌合火,巳酉丑合金,申子辰合水这便又成就了一个三而成合,三而成行。三合的概念非常重要,我们看五行的木火金水里都分别含一个辰、戌、丑未,———辰、戌、丑、未是什么呢?就是土!前面我们讨论五行的时候,曾谈到金木水火不因土不能成;我们讨论脾不主时而旺于四季的时候,曾谈到四时的交替没有土就不能成功,为什么呢?从这个三合里应该看得很清楚。三合的意义很多,比如我们临床辨证辨出了水虚或火虚,可是这个水火却补不进去。或者一补水,就有碍脾胃,一补火就口舌生疮。为什么呢?很可能的一个原因就是没有把握好时机。如果我们在三合的时候补,比如在申子辰的时候补水,在寅午戌的时候补火,以此类推,在亥卯未的时候补木,在巳酉丑的时候补金,我想没有补不进的。少阴的时相问题就讨论到这里。
四、对 AD 病的思考
AD 病也叫阿尔茨海默病,亦即我们现在习称的老年性痴呆,或早老性痴呆。它的英文简称就是 AD。AD 病为现代社会最常见的老年性中枢神经系统疾病之一,在北美及澳大利亚,65 岁以上的患病率为 6.6% ~15.8% 。过去认为,中国 AD 病的患病率远不如西方高,但九五期间的一项攻关课题显示,中国 AD 病的发率与西方已经没有什么差别。该项调查显示,北京市 65岁以上老人的患病率为 7.3% ,且每隔 5 年的年龄段,AD 病患病率增长约 1 倍。如 70 岁为 5.3% ,75 岁为 11.9% ,80 岁则为22% 。据 2000年 11月 6日的《健康报》报道,截至 2000年,中国 65岁以上人口按 8000万计,则 AD 病患者已达 500余万。现代医学认为,AD 病是一种不可逆性的脑功能逐渐衰退性疾病。迄今为止,尚无任何有效的能够治疗和阻断这一疾病的方法。所以,一旦患上这个疾病,那就无疑只有等待其逐渐衰竭,直至死亡。21 世纪,是中国真正走向现代化的世纪,同时也是老龄化的世纪。由于城镇家庭都是独生子女,所以,今后家庭必定会面临两个青年四个老人的格局。如果其中一个老人患上 AD 病,那这个家庭的境况就够呛。所以,这是一个日益严重的社会问题,也是迫切需要我们医界同仁解决的问题。作为中医,我们怎么看这个 AD 病?AD 病有没有治好的可能?对这个问题我是比较乐观的。其实 AD 病,我们如从六经的层面去思考它,它就是一个少阴病。AD 病的早期是由记忆障碍开始的,并逐渐发展到神志障碍。记忆的问题我们前面曾经谈到过,它实际就是心肾的问题。记为贮藏过程,这个过程与肾的主蛰、封藏相应,故记的过程系由肾所主。忆则为提取过程,这个过程与夏日之释放相应,故忆的过程实由心所主。因此,记忆的障碍实际就是心肾的障碍,就是少阴的障碍。而神志的障碍则更与少阴心肾相关,以心藏神,肾藏志也。少阴病的病机是:脉微细,但欲寐。寐的问题我们前面从寤寐的角度谈,这只是一个方面。还有另一个方面即如《康熙》所言:“寐之言迷也,不明之意。”老年性痴呆是一个什么状况呢?实际上就是一个迷而不明的状况。否则,怎么会连亲生儿女的名字也不知道,连居住了几十年的家也记不住呢?既然老年性痴呆是一个地地道道的“寐”的状态,那它当然就应该从少阴病去考虑。少阴病固然危重,但也还是有回转之机,救逆之法。因此,从少阴的层面去论治AD 病,应该大有文章可做。
In a day, it refers to the period from 11:00 PM to 5:00 AM the next morning. In a month, it refers to the 7.5 days from the first day to the first quarter moon. In a year, it refers to the period from the eleventh lunar month to the first month of the following year. The following discusses the temporal characteristics (Shixiang) of Shaoyin disease (a syndrome caused by pathogenic factors affecting the Shaoyin meridians) from two aspects.
1. Zi hour corresponds to the Fu Hexagram (Fu is one of the sixty-four hexagrams in the *I Ching*, symbolizing the return of Yang Qi). "Seven days for recovery." There is a significant difference between the Jie Shi (times when symptoms may alleviate) of the Three Yin meridians (Taiyin, Shaoyin, Jueyin) and the Three Yang meridians (Taiyang, Yangming, Shaoyang). Among the Three Yin meridians, two of the three hours constituting each meridian's Jie Shi overlap with each other. For example, among the Hai, Zi, and Chou hours for Taiyin disease, the Zi and Chou hours overlap with those of Shaoyin disease; among the Zi, Chou, and Yin hours for Shaoyin disease, the Chou and Yin hours overlap with those of Jueyin disease. Therefore, in the discussion of the Jie Shi for the Three Yin meridians, the initial hour mentioned appears particularly important. For instance, Taiyin disease corresponds to the Hai hour, Shaoyin disease to the Zi hour, and Jueyin disease to the Chou hour, all holding special significance. The Zi hour in the Twelve Message Hexagrams (twelve hexagrams representing the waxing and waning of Yin and Yang) corresponds exactly to the Fu Hexagram. The hexagram text of Fu states: "Fu, success. Going out and coming in without illness, friends come without blame. Repeating the way, seven days for recovery, favorable to have somewhere to go." "Fu" refers to the return of Yang Qi, meaning the restoration of Yang Qi. This restoration requires seven days, hence the statement: "Repeating the way, seven days for recovery." Why does it take seven days? We can understand this by viewing the Twelve Message Hexagrams comprehensively. According to Qimen Dunjia, the Twelve Message Hexagrams are divided into Yin and Yang bureaus. The six hexagrams Fu, Lin, Tai, Dazhuang, Guai, and Qian belong to the Yang bureau because they represent a process of increasing Yang Qi; while the six hexagrams Gou, Dun, Pi, Guan, Bo, and Kun belong to the Yin bureau because they represent a process of increasing Yin Qi. After completing one Yang bureau, one enters the Yin bureau, which starts with the Gou hexagram. If each hexagram represents one day, completing the entire Yin bureau takes exactly six days. After the Yin bureau ends, continuing forward leads back to the next Yang bureau. The Yang bureau starts with the Fu hexagram. It takes exactly seven days to go from the Yin bureau to the next new Yang bureau. This is what the Fu hexagram text means by: "Repeating the way, seven days for recovery." In fact, not only is Yang recovery (from Gou to Fu) seven days; Yin recovery (from Fu to Gou) is also seven days. Thus, "seven" is the number of cyclic repetition. It can be seen that the seven-day cycle did not originate from the West; the *I Ching* already contains this concept of a seven-day cycle. Let us revisit the transmission of the Six Meridians (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin). As stated in *Suwen: Relating Heat Disorders*: "On the first day of Shanghan, the Taiyang meridian receives it; on the second day, the Yangming meridian; on the third day, the Shaoyang meridian; on the fourth day, the Taiyin meridian; on the fifth day, the Shaoyin meridian; on the sixth day, the Jueyin meridian." After six days, on the seventh day, it returns to the Taiyang meridian. Thus, the transmission of Shanghan through the Six Meridians also follows the pattern of "seven days for recovery."
(2) Winter Solstice generates one Yang. Within the month associated with the Fu Hexagram, there is an important solar term: the Winter Solstice. Although the Fu Hexagram is paired with the eleventh lunar month, strictly speaking, the Fu Qi (energy of return) only formally activates upon the arrival of the Winter Solstice. Therefore, the "one Yang" of the Winter Solstice actually refers to the "one Yang" of the Fu Hexagram. The image of the Fu Hexagram is Kun (Earth) above and Zhen (Thunder) below, hence called "Earth Thunder Fu." The *Xiang Zhuan* says: "Thunder within the Earth, Fu. The former kings closed the passes on the solstice day, and travelers did not move." The solstice day refers to the Winter Solstice. Why close the passes at the Winter Solstice? Because this is precisely when one Yang is initially born, when Yang Qi is returning, when Yang Qi is returning to its root, and when Yin and Yang are transforming. If this return and transformation succeed, the cycle of the next period can proceed smoothly. How to ensure the success of the above process? Closing the passes is a good method. Closing the passes means maintaining stillness. By closing the passes, eliminating all distracting labors, allowing the body to undergo the aforementioned transformation and return in a quiet environment. In fact, not only the Winter Solstice requires closing the passes; the Summer Solstice also requires it. Thus, *Book of Later Han: Biography of Lu Gong* states: "In the fifth month, Gou acts; the former kings issued orders to stop travel in all directions." Since the fifth month resides at the Summer Solstice, it is when the Gou Hexagram activates. The order by the former kings to stop travel in all directions is equivalent to the meaning of "The former kings closed the passes on the solstice day, and travelers did not move." Repeating the way, seven days for recovery. Therefore, not only during the Winter Solstice when Yin intersects with Yang do we need to close the passes, but also during the Summer Solstice when Yang intersects with Yin. At these moments of Yin-Yang alternation and initial birth, careful nurturing is required. Zi and Wu correspond to the eleventh and fifth months in a year, and to the Zi and Wu hours in a day. Thus, the Zi hour also sees the birth of one Yang, and the Wu hour sees the birth of one Yin. Therefore, the Zi and Wu hours also require minor "closing of the passes." How to close the passes at the Wu hour? Resting from minor matters, sitting quietly, or taking a short nap are all acts of closing the passes. From this, we know that the Chinese habit of afternoon naps can be traced back to the Zhou Dynasty. Currently, some argue that the afternoon nap habit is detrimental to health; this shows ignorance of the *I Ching*.
(3) Key points of Jie Shi. Zi is located due North, where Water resides, which is the location of "Ti" (Substance/Body). Why must Yang Yong (Function) return to the root? It must return to this Ti. When Yang returns to Ti, it can rest and recuperate. Therefore, after the Zi hour transitions into the Fu Hexagram, Yang Qi achieves return and enters a stage of gradual growth. Why does Shaoyin disease tend to alleviate during the Zi, Chou, and Yin hours? Because Shaoyin disease is characterized by deficiency and decline of Yang Qi, with Yang failing to return to the root. When encountering the Zi, Chou, and Yin hours, it coincides with the process of Yang Qi returning to the root and recovering, gradually increasing. How could it not heal? This is the Way of Heaven and Earth assisting the Way of Humanity. It further proves that "Humans are born endowing the Qi of Heaven and Earth" is not empty talk. A very important formula for Shaoyin disease is Sini Tang (Counterflow Decoction). As described in the Taiyin chapter, this formula uses Zhi Gancao (Honey-fried Licorice Root) as the Sovereign herb. Zhi Gancao has a sweet and neutral flavor, possessing the most complete Earth Qi, thus its image is Kun (Earth). Ganjiang (Dried Ginger) and Fuzi (Prepared Aconite Root) are acrid, warm, and hot, possessing much of the Thunder Qi, serving as Ministers and Envoys, thus their image is Zhen (Thunder). With Sovereign above and Minister below, Kun above and Zhen below, this perfectly matches the Earth Thunder Fu Hexagram. Therefore, we know that formulas like Sini Tang possess the image of the Fu Hexagram, which corresponds well with the Jie Shi of Shaoyin disease. This is also the correspondence between Formula and Time.
2. Why does Jie Shi occupy three hours? Above, we focused on discussing the Zi hour in the Jie Shi of Shaoyin disease. Although the Zi hour has a very special significance for Shaoyin, we should still note that the Jie Shi is constituted by three hours. Why must the Jie Shi consist of three hours? This introduces an important numerological issue. What kind of number is three? What are its characteristics? *Suwen: Discussion on Living Qi Connecting with Heaven and Earth* states: "Its generation is five, its Qi is three." *Suwen: Six Sections and Zang-Fu Images* states: "Five days are called a Hou (pentad); three Hous constitute a Qi (solar term)." Thus, we know three constitutes Qi. A year consists of four seasons; how many months are in a season? Three months. Thus, we know three constitutes a Season. The trigrams of the *I Ching* are composed of three lines (Yao), thus we know three constitutes a Hexagram. The Dao has the Heavenly Dao, Earthly Dao, and Human Dao; all three together make completeness, thus we know three constitutes the Dao. *Laozi* states: "The Dao produced One; One produced Two; Two produced Three; Three produced All Things." Thus, we know three constitutes Things. Previously mentioned: Time and Formula are one; Time and Formula are unified. Time becomes complete with three, and so does the Formula. Thus, Hai-Zi-Chou obtains the North; Yin-Mao-Chen obtains the East; Si-Wu-Wei obtains the South; Shen-You-Xu obtains the West. Thus, we know three constitutes Fang (Direction/Square). Why did Traditional Chinese Medicine ultimately develop from single-herb prescriptions to compound prescriptions? Because a single herb is difficult to form a complete prescription; multiple herbs must be combined to form a whole prescription. Why is the Jie Shi not one hour, but necessarily three hours? It is the same principle. One hour does not form a prescription; three hours constitute a prescription. When the prescription is formed, the Qi is complete; only with complete Qi is there the function of alleviation. Additionally, regarding the number three, there is another important content: three constitutes He (Harmony/Combination). Matching the Five Phases with Earthly Branches, besides direct matching (Yin-Mao Wood, Si-Wu Fire, Shen-You Metal, Hai-Zi Water, Chen-Xu-Chou-Wei Earth), there is also San He (Three Harmony) matching. How does San He work? Hai-Mao-Wei combine to form Wood; Yin-Wu-Xu combine to form Fire; Si-You-Chou combine to form Metal; Shen-Zi-Chen combine to form Water. This creates another "three constitutes Harmony" and "three constitutes Phase." The concept of San He is very important. Looking at Wood, Fire, Metal, and Water in the Five Phases, each contains one of Chen, Xu, Chou, Wei. What are Chen, Xu, Chou, Wei? They are Earth! When we discussed the Five Phases earlier, we mentioned that Metal, Wood, Water, and Fire cannot form without Earth; when we discussed the Spleen not ruling a specific time but flourishing in the four seasons, we mentioned that the alternation of the four seasons cannot succeed without Earth. Why? This should be clearly seen from the San He. The significance of San He is manifold. For example, in clinical differentiation, if we identify Water Deficiency or Fire Deficiency, yet cannot tonify this Water or Fire. Or, upon tonifying Water, it hinders the Spleen and Stomach; upon tonifying Fire, mouth and tongue ulcers arise. Why? A likely reason is failing to grasp the timing. If we tonify during the San He periods, such as tonifying Water during Shen-Zi-Chen, tonifying Fire during Yin-Wu-Xu, and so on, tonifying Wood during Hai-Mao-Wei, and tonifying Metal during Si-You-Chou, I believe there would be no cases of failure to tonify. The discussion on the temporal characteristics of Shaoyin concludes here.
IV. Reflections on AD Disease. AD disease, also known as Alzheimer's disease, commonly referred to now as senile dementia or presenile dementia. Its English abbreviation is AD. AD disease is one of the most common geriatric central nervous system diseases in modern society. In North America and Australia, the prevalence rate among those over 65 is 6.6% to 15.8%. It was previously believed that the prevalence of AD disease in China was far lower than in the West, but a key research project during the Ninth Five-Year Plan period showed that the incidence rate of AD disease in China is now similar to that in the West. This survey showed that the prevalence rate among people over 65 in Beijing is 7.3%, and every 5-year age group sees the prevalence rate of AD disease double. For example, it is 5.3% at age 70, 11.9% at age 75, and 22% at age 80. According to a report in the *Health News* on November 6, 2000, as of 2000, with China's population over 65 estimated at 80 million, the number of AD patients has reached over 5 million. Modern medicine considers AD disease to be an irreversible disease of gradual decline in brain function. To date, there is no effective method to treat or block this disease. Therefore, once contracted, there is undoubtedly only waiting for gradual deterioration until death. The 21st century is the century in which China truly moves toward modernization, and simultaneously, the century of aging. Since urban families consist of only one child, future families will inevitably face a structure of two young adults supporting four elderly parents. If one elderly parent contracts AD disease, the family's situation will be dire. Thus, this is an increasingly serious social problem and an urgent issue requiring resolution by colleagues in the medical field. As practitioners of Traditional Chinese Medicine, how do we view AD disease? Is there a possibility of curing AD disease? I am relatively optimistic about this question. Actually, if we think about AD disease from the level of the Six Meridians, it is a Shaoyin disease. The early stage of AD disease begins with memory impairment and gradually develops into mental disorder. We have discussed memory issues before; it is essentially a matter of the Heart and Kidney. "Ji" (recording/storage) is a storage process, corresponding to the Kidney's governing of hibernation and sealing/storing; thus, the process of recording is governed by the Kidney. "Yi" (retrieval/recalling) is a retrieval process, corresponding to the release of summer; thus, the process of recalling is actually governed by the Heart. Therefore, memory impairment is essentially Heart-Kidney impairment, which is Shaoyin impairment. Mental disorder is even more closely related to the Shaoyin Heart and Kidney, as the Heart stores the Spirit (Shen) and the Kidney stores Will (Zhi). The pathogenesis of Shaoyin disease is: faint and fine pulse, only desiring sleep. Regarding the issue of sleep, we previously discussed it from the perspective of waking and sleeping, which is only one aspect. Another aspect is as stated in the *Kangxi Dictionary*: "Mei (sleep) sounds like Mi (confusion), meaning lack of clarity." What is the condition of senile dementia? It is essentially a state of confusion and lack of clarity. Otherwise, how could one not even know the names of their own children or forget a home lived in for decades? Since senile dementia is a quintessential state of "Mei" (sleep/drowsiness), it naturally should be considered from the perspective of Shaoyin disease. Although Shaoyin disease is indeed critical, there is still room for reversal and methods for rescue. Therefore, treating AD disease from the level of Shaoyin should offer great potential.