六经六气。各有所从所主之不同。必明。此而后知气化之理。若西洋医。既不知此。则亦不必与办也。
少阳太阴从本。少阴太阳从本从标。阳明厥阴不从标本。从乎中也。
此言六经气化。或以脏腑本气之阴阳。为主或以经脉标气之。阴阳为主或以中见之气化为主。各有性情之。不同也
陈修园伤寒论注。引张景岳之论曰。少阳太阴从本者。以少阳本火而标阳。太阴本湿而标阴。标本同气。故当从本。然
少阳太阴。亦有中气。而不从中者。以少阳之中。厥阴木也。木火同气。木从火化矣。太阴之中阳明金也。土金相生。
燥从湿化矣。故不从中也。少阴太阳从本从标者。以少阴本热而标阴。太阳本寒而标阳。标本异气故或从本或从标而主
治须审也。然少阴太阳。亦有中气。而不从者。以少阴之中。太阳水也。太阳之中。少阴火也。同于本则异于标同于标
则异于本故皆不从中气也。至若阳明厥阴。不从标本从乎中者。以阳明之中。太阴湿土也。亦以燥从湿化矣。厥阴之中。
少阳相火也。亦以木从火化矣。故阳明厥阴不从标本而从中气也。要之五行之气。以木遇火。则从火化。以金遇土。则
从湿化。总不离乎水。流湿火就燥同气相求之义耳。此注甚明。知此。而后知邪正之盛负。表里之传变也。
太阳为开。阳明为阖。少阳为枢。太阴为开。厥阴为阖。少阴为枢。
开之过。阳明胃经。主纳水谷化精汁洒行五脏六俯。化糟粕。传入大肠小肠。其气化主于内行。下达故阳明主阖。
凡是呕逆自汗等。皆阳明不能主阖之过。少阳三焦。内主膈膜。外主腠理。内外出。入之气均从腠理。往来故有邪在腠
理。则寒热往来。太阳之气不得外达诸证。上下往来之气。均从膈膜行走故有结胸陷胸。邪欲入胃则呕。甚则呕吐不止
诸证。凡此皆少阳不能司其。转枢之过也。太阴为开者。手太阴肺。主布散。足太阴脾主营运。凡血脉之周流。津液。
之四达皆太阴司之。故曰太阴为开也。厥阴为阖者。足厥阴肝经。主藏下焦之阴气。使血脉。潜而精不泄手厥阴心包络。
主藏上焦之阴气。使阴血敛。而火不作故曰厥阴为阖也。少阴为枢者手少阴心经。内合包络下。生脾土。故能为二经之
转枢足。少阴肾经。上济肺金。下生肝木。亦能为二经之转枢也。此数者。为审证施治之大关键。不可不详究也。
内经此数条。言人身气化最精。中国注伤寒者。尚有人知。西洋医法。从无论者。故论形虽精。而论治转粗耳。张
隐陈修园注伤寒。全本于此。读者详之。
六经与六气,各自有不同的来源和主治侧重。必须明确这一点,之后才能理解气化运行的原理。如果像西医那样完全不了解这些,那也就没有必要与他们讨论了。
少阳经和太阴经的病机变化主要遵循“本”(脏腑内在的阴阳属性);少阴经和太阳经的病机变化既遵循“本”,也遵循“标”(经脉外在的阴阳表现);阳明经和厥阴经不单纯遵循“本”或“标”,而是顺从中见之气(相表里的经络之气)。
这段话讲的是六经的气化规律:有的以脏腑本气的阴阳为主,有的以经脉标气的阴阳为主,有的以中见之气的化生为主,这是因为它们各自的性情不同。
陈修园在《伤寒论注》中引用张景岳的观点说:少阳经和太阴经之所以从本,是因为少阳的本气是火,标气是阳,标本同属阳;太阴的本气是湿,标气是阴,标本同属阴。因为标本之气相同,所以应当从本。然而,少阳和太阴也有中气,却不从中气而治,是因为少阳的中气是厥阴木,木与火同气,木随火而化;太阴的中气是阳明金,土与金相生,燥随湿而化。所以不从其中气。
少阴经和太阳经之所以从本也从标,是因为少阴的本气是热,标气是阴;太阳的本气是寒,标气是阳。因为标本之气不同,所以有时从本,有时从标,治疗时必须仔细审察。然而,少阴和太阳也有中气,却不从中气而治,是因为少阴的中气是太阳水,太阳的中气是少阴火。如果顺应本气则与标气不同,如果顺应标气则与本气不同,所以都不从中气。
至于阳明经和厥阴经,不遵循本和标而遵循中气,是因为阳明经的中气是太阴湿土,也是燥随湿而化;厥阴经的中气是少阳相火,也是木随火而化。所以阳明和厥阴不遵循本和标,而是遵循中气。总之,五行之气,遇到火则从火化,遇到土则从湿化,总不离乎“水流湿、火就燥、同气相求”的道理。这个注解非常明白,懂得这一点,就能知道邪正盛衰以及表里传变的规律了。
太阳经主“开”,阳明经主“阖”,少阳经主“枢”。太阴经主“开”,厥阴经主“阖”,少阴经主“枢”。
“开”的功能过度或失常方面:阳明胃经,主管受纳水谷,化生精微汁液,洒布运行于五脏六腑,转化糟粕,传入大肠和小肠。其气化作用主要向内下行,所以阳明主“阖”。凡是呕吐、呃逆、自汗等症状,都是阳明不能正常主“阖”造成的过失。
少阳三焦,内部主管膈膜,外部主管腠理。内外出入的气都经过腠理往来,所以有邪气停留在腠理时,会出现寒热往来的症状。太阳之气不得向外通达,上下往来之气都经过膈膜行走,所以会出现结胸、陷胸等证候,邪气想要进入胃里就会呕吐,严重时呕吐不止。所有这些症状,都是少阳不能主持其“转枢”功能造成的过失。
太阴主“开”:手太阴肺经,主管布散;足太阴脾经,主管营运。凡是血脉的周流、津液的四处通达,都由太阴所掌管,所以说太阴主“开”。
厥阴主“阖”:足厥阴肝经,主管封藏下焦的阴气,使血脉潜藏而精气不泄漏;手厥阴心包络,主管封藏上焦的阴气,使阴血收敛而虚火不妄动,所以说厥阴主“阖”。
少阴主“枢”:手少阴心经,内合心包络,下生脾土,所以能成为这两条经络的转枢;足少阴肾经,上济肺金,下生肝木,也能成为这两条经络的转枢。这几点,是审察病症施治的关键所在,不可不详细探究。
《内经》中的这几条论述,讲人身气化最为精妙,中国注释《伤寒论》的人,尚且有人知晓;而西洋医法,从来没有人提及。所以他们在论述形体结构方面虽然精细,但在论述治疗方法方面反而粗疏。张隐庵和陈修园注释《伤寒论》,完全是依据这些内容,读者请详细参考。
The Six Channels (Taiyang, Shaoyang, Yangming, Taiyin, Shaoyin, Jueyin) and the Six Qi (Wind, Heat, Fire, Dampness, Dryness, Cold) each have different origins and areas of governance. It is essential to clarify this in order to understand the principles of Qi transformation. If Western medicine does not know this, then there is no need to discuss it with them.
Shaoyang and Taiyin follow the "Ben" (Root/Intrinsic nature). Shaoyin and Taiyang follow both the "Ben" and the "Biao" (Branch/Superficial manifestation). Yangming and Jueyin do not follow the Ben or Biao, but rather follow the Zhongjian Qi (Intermediary Qi).
This statement refers to the Qi transformation of the Six Channels: some are governed primarily by the Yin-Yang of the Zang-Fu intrinsic Qi, some by the Yin-Yang of the Meridian superficial Qi, and some by the transformation of the Intermediary Qi. This is because their natures differ.
Chen Xiuyuan, in his commentary on the *Shanghan Lun*, cites Zhang Jingyue's argument: Shaoyang and Taiyin follow the Ben because Shaoyang's Ben is Fire and its Biao is Yang; Taiyin's Ben is Dampness and its Biao is Yin. Since the Ben and Biao share the same Qi, they should follow the Ben. However, Shaoyang and Taiyin also have Zhongqi (Intermediary Qi), yet they do not follow it. This is because the Zhongqi of Shaoyang is Jueyin Wood. Wood and Fire share the same nature, so Wood transforms according to Fire. The Zhongqi of Taiyin is Yangming Metal. Earth and Metal generate each other, so Dryness transforms according to Dampness. Therefore, they do not follow the Zhongqi.
Shaoyin and Taiyang follow both the Ben and the Biao because Shaoyin's Ben is Heat and its Biao is Yin; Taiyang's Ben is Cold and its Biao is Yang. Since the Ben and Biao have different Qi, treatment must carefully examine whether to follow the Ben or the Biao. However, Shaoyin and Taiyang also have Zhongqi, yet they do not follow it. This is because the Zhongqi of Shaoyin is Taiyang Water, and the Zhongqi of Taiyang is Shaoyin Fire. Following the Ben differs from the Biao, and following the Biao differs from the Ben; thus, neither follows the Zhongqi.
As for Yangming and Jueyin, they do not follow the Ben or Biao but follow the Zhongqi. This is because the Zhongqi of Yangming is Taiyin Damp-Earth, where Dryness transforms according to Dampness. The Zhongqi of Jueyin is Shaoyang Ministerial Fire, where Wood transforms according to Fire. Therefore, Yangming and Jueyin do not follow the Ben or Biao but follow the Zhongqi. In summary, among the Five Elements' Qi, when Wood meets Fire, it transforms according to Fire; when Metal meets Earth, it transforms according to Dampness. This always adheres to the principle that "water flows to dampness, fire moves toward dryness, and similar Qi seeks each other." This annotation is very clear. Understanding this allows one to comprehend the waxing and waning of pathogenic and righteous Qi, as well as the transmission changes between the Exterior and Interior.
Taiyang governs "Opening" (Kai). Yangming governs "Closing" (He). Shaoyang governs the "Pivot" (Shu). Taiyin governs "Opening". Jueyin governs "Closing". Shaoyin governs the "Pivot".
Regarding the function of "Opening": The Stomach Meridian of Yangming is responsible for receiving food and fluids, transforming them into essence, distributing them to the Five Zang and Six Fu organs, and converting waste into feces, which are transmitted to the Large Intestine and Small Intestine. Its Qi transformation mainly moves inward and downward, so Yangming governs "Closing". Symptoms such as vomiting, belching, and spontaneous sweating are all due to Yangming's failure to properly govern "Closing".
The Sanjiao (Triple Burner) of Shaoyang internally governs the diaphragm/membranes and externally governs the interstices (Couli). The Qi entering and exiting both internally and externally passes through the interstices. Therefore, when pathogens reside in the interstices, alternating chills and fever occur. The Qi of Taiyang cannot reach the exterior. The Qi moving up and down travels through the diaphragm, leading to conditions like Chest Binding (Jie Xiong) and Chest Sink (Xian Xiong). When pathogens attempt to enter the Stomach, vomiting occurs; severely, continuous vomiting ensues. All these symptoms are due to Shaoyang's failure to manage its "Pivoting" function.
Taiyin governs "Opening": The Lung Meridian of Hand-Taiyin governs distribution; the Spleen Meridian of Foot-Taiyin governs transportation and transformation. The circulation of blood vessels and the dissemination of body fluids are all controlled by Taiyin. Hence, it is said that Taiyin governs "Opening".
Jueyin governs "Closing": The Liver Meridian of Foot-Jueyin stores the Yin Qi of the Lower Jiao, ensuring blood vessels remain latent and essence is not leaked. The Pericardium Meridian of Hand-Jueyin stores the Yin Qi of the Upper Jiao, ensuring Yin blood is敛 (conserved) and Fire does not flare up. Hence, it is said that Jueyin governs "Closing".
Shaoyin governs the "Pivot": The Heart Meridian of Hand-Shaoyin internally connects with the Pericardium and generates Spleen Earth below, thus acting as the pivot for these two meridians. The Kidney Meridian of Foot-Shaoyin nourishes Lung Metal above and generates Liver Wood below, also acting as a pivot for these two meridians. These points are the key to diagnosing conditions and prescribing treatments, and must be investigated in detail.
These passages from the *Neijing* describe the Qi transformation of the human body with great precision. Among Chinese commentators on the *Shanghan Lun*, some still understand this. However, Western medical methods never mention it. Thus, while their discussion of anatomical form is precise, their discussion of therapeutic methods is rather coarse. Zhang Yinan and Chen Xiuyuan's commentaries on the *Shanghan Lun* are entirely based on these texts. Readers should study them in detail.