四明张世贤医学百问云弦之一脉在仲景则以为阴在叔和则以为阳吾苏卢丹谷谓世贤议论
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其说不归于一定决无为阳之说丹谷据脉经弦为阴三字辟之余窃疑焉按六经病篇曰尺寸俱弦者
少阳受病按此以弦为阳也切详仲景以弦为阴而又为阳者何谓也许叔微曰夫仲景之意以弦脉为
阴
者兼合乎众脉而言且浮大者阳也兼之以动滑数之类安得不为阳沉细者阴也兼之以涩弱弦微之
类安得不为阴也又少阴病篇曰手足寒脉弦迟者阴也盖此亦兼迟而言之乃为阴症宜矣若夫沉微
而弦沉伏而弦沉涩而弦沉细而弦皆为阴症之脉也盖少阳之脉弦者按仲景之意以一脉而言之也
然少阳之气通于春春脉弦者以应春阳时令之脉也岂得不为阳也如浮大而弦洪长而弦浮滑而弦
浮数而弦者皆为阳也夫仲景以弦脉分阴阳二用之理其义微也王叔和以弦脉为阳而不言弦为阴
者是以独指一脉而为杂病也故仲景之脉不可与杂病同日而语也丹谷驳之太过例以脉诀为高阳
生之赝本不足取信亦难矣哉
王叔和言三焦无状空有名千载之下议论不一至宋陈无择之通达尚惑徐遁之荒唐且曰三焦
有脂
膜如掌大正与膀胱相对有二白脉自中出夹春而上贯于脑何其谬也按内经六节藏象论曰胆胃大
肠小肠膀胱三焦者仓廪之本营之居也能化糟粕转味而出者也五脏别论曰夫胃大肠小肠膀胱三
焦此五者天气之所生也其气象天故泻而不藏此受五脏浊气名曰转化之腑由是观之圣人且以三
焦为有形状矣又按蔡西山脉经其间有论三焦一篇后引礼运记曰上焦若窍中焦若编下焦若渎然
未曾发明其义新安孙景思氏因推其义而解之曰上焦若窍窍者窍漏之义可以通达之物必是胃之
上脘经曰上焦在胃之上口主纳而不出是也中焦若编编者编络之义如有物编包之象胃之外有脂
如网包罗在胃之上以其能磨化饮食故脉诀云膏凝散半斤者此也必是脾之大络此为中焦经曰
主
腐熟水谷是也下焦若渎渎者沟渎之义可以决渎可以传道乃是小肠之下曰阑门泌别水谷自此而
厘清浊之所此为下焦经曰在膀胱上口主泻而不藏又曰主出而不内又曰下焦为传化之府又曰三
焦曰水谷之道路气之所终始也盖水谷之所入水自上而中自中而下至于糟粕转输传道
而下一无底滞如此尤可表其为有形明矣所谓形者非谓脏腑外别生一物不过指其所而为形耳或
曰经之本文乃中焦若沤今改作编字于理未安愚谓蔡西山据理运记而言又按白虎通性情篇沤亦
作编二说安得俱误恐沤与编殆相似而讹之耳
Zhang Shixian of Siming, in his *One Hundred Questions on Medicine*, stated: Regarding the "wiry" (Xian) pulse, Zhang Zhongjing considered it Yin, whereas Wang Shuhe considered it Yang. Lu Danggu of my native Suzhou argued that Zhang Shixian's discussion was contradictory and lacked a definitive conclusion, asserting there is absolutely no basis for calling it Yang. Lu Danggu refuted Zhang Shixian based on the three characters in the *Mai Jing* (Pulse Classic): "Wiry is Yin." However, I harbored private doubts.
Upon consulting the *Six Meridian Disease Chapters* (Liujing Bingpian), it states: "When both the Cun and Chi positions exhibit a wiry pulse, it indicates Shaoyang disease." This suggests treating the wiry pulse as Yang. Upon careful examination, why did Zhang Zhongjing consider the wiry pulse both Yin and Yang? Xu Shuwei explained: Zhang Zhongjing's intent to classify the wiry pulse as Yin was in conjunction with other pulses. For instance, Floating (Fu) and Large (Da) are Yang; if combined with Moving (Dong), Slippery (Hua), or Rapid (Shu) characteristics, how could they not be Yang? Sinking (Chen) and Fine (Xi) are Yin; if combined with Choppy (Se), Weak (Ruo), Wiry (Xian), or Minute (Wei) characteristics, how could they not be Yin? Furthermore, the *Shaoyin Disease Chapter* states: "Cold hands and feet with a wiry and slow (Chi) pulse indicate a Yin syndrome." This is also Yin because it combines the "slow" characteristic. Conversely, pulses that are Sinking-Micro-Wiry, Sinking-Deep-Wiry, Sinking-Choppy-Wiry, or Sinking-Fine-Wiry are all pulses of Yin syndromes. Generally, when discussing the Shaoyang pulse as wiry, Zhang Zhongjing refers to it from the perspective of a single pulse type. However, Shaoyang Qi corresponds to Spring; the Spring pulse is wiry to resonate with the Yang season of spring. How can this not be Yang? Pulses such as Floating-Large-Wiry, Surging-Long-Wiry, Floating-Slippery-Wiry, or Floating-Rapid-Wiry are all Yang. The principle behind Zhang Zhongjing dividing the wiry pulse into Yin and Yang applications is subtle. Wang Shuhe mentioned only that the wiry pulse is Yang and did not mention it being Yin because he referred to a single pulse type for miscellaneous diseases. Therefore, Zhang Zhongjing's pulse methodology cannot be compared to that of miscellaneous diseases. Lu Danggu's refutation was excessive; dismissing the *Mai Jue* (Pulse Rhymes) as a forgery by Gao Yangsheng is insufficiently convincing, yet difficult to refute entirely.
Wang Shuhe stated that the Sanjiao (Triple Burner) has no form and exists only in name, leading to endless debates over millennia. Even in the Song Dynasty, Chen Wuze, despite his medical erudition, was confused by the absurd claims of Xu Dun, who asserted that the Sanjiao possesses a fatty membrane the size of a palm, positioned opposite the Bladder, with two white vessels emerging from the center, running alongside the spine up to the brain. How erroneous is this!
Consulting the *Suwen: Chapter 6 - Six Sections of Zang-Fang Manifestations* (*Neijing*), it states: "The Gallbladder, Stomach, Large Intestine, Small Intestine, Bladder, and Sanjiao are the roots of granaries and dwellings of Ying (Nutritive) Qi. They transform dregs and flavors and expel them." The *Bie Lun: Chapter 9 - Differentiation of Five Zang Organs* states: "The Stomach, Large Intestine, Small Intestine, Bladder, and Sanjiao are generated by Heavenly Qi. Their forms resemble Heaven; thus, they 'drain but do not store,' receiving turbid Qi from the Five Zang organs, named 'Transforming and Transmitting Fu Organs.'" From this, we see that the Sages regarded the Sanjiao as having a physical form.
Furthermore, Cai Xishan (Cai Shen)'s commentary on the *Mai Jing* includes a treatise on the Sanjiao, quoting the *Liji: Liyun*: "The Upper Jiao is like an aperture, the Middle Jiao like weaving, and the Lower Jiao like a ditch." However, he did not elucidate its meaning. Sun Jingsi of Xin'an deduced and explained this: "Upper Jiao like an aperture"—an aperture implies leakage and passage; what must pass through is likely the upper part of the Stomach (Shangwan). The Classic states: "The Upper Jiao is at the mouth of the Stomach, governing intake without excretion," which aligns with this. "Middle Jiao like weaving"—weaving implies a network-like enclosure. Outside the Stomach lies a fatty tissue resembling a net, located above the stomach, capable of grinding and digesting food. Thus, the *Mai Jue* mentions "half a jin of congealed fat" referring to this. This is likely the great collateral of the Spleen, constituting the Middle Jiao. The Classic states: "It governs the rotting and ripening of water and grain," fitting this description. "Lower Jiao like a ditch"—a ditch implies drainage and transmission. Located below the Small Intestine at the Lamen gate, it separates clear from turbid, marking the Lower Jiao. The Classic states: "Located at the upper opening of the Bladder, governing excretion without storage," and "governing exit without entry." It is also called the "transmitting and transforming Fu organ" and the "pathway of water and grain, where Qi begins and ends." Water and grain enter; fluids move from Upper to Middle, and solids from Middle to Lower until dregs are transported and expelled downward without obstruction. This clearly demonstrates its tangible nature. The term "form" does not imply a separate entity outside the Zang-Fu organs but refers to the shape defined by its location and function.
Some argue: The original text reads "Middle Jiao like foaming" (Ruo Ou), and changing it to "weaving" (Bian) seems theoretically unsound. I contend that Cai Xishan relied on the *Liyun*. Additionally, the *Baihutong: Xingqing* records that "Ou" is also written as "Bian." How could both interpretations be wrong? It is likely that "Ou" and "Bian" were corrupted due to their visual similarity.