这一节我们讨论阴阳的离合机制，讨论开合枢，从《素问·阴阳离合论》里我们可以看到，它讲的是足三阴三阳，没有提手三阴三阳。而《灵枢·根结篇》里也谈到开合枢的问题，它讲开合枢也是在足经里讲，讲手经它不提这个问题。再加上《素问·热论》这样一篇论述“伤寒”的祖文，也是论足不论手，这就给后世的许多人产生一个误解，认为伤寒传足不传手，温病传手不传足。大家都知道，中医很重要的一个观念是整体观念，人与天地都是一个整体，天地的变化都会不时地影响人体，怎么可能手足之间不会产生影响、不会相传呢？但是，《内经》、《伤寒》在谈到上述问题时，又的确是偏重在足的一面，这是什么原因呢？要弄清这个问题，必须从以下几个方面来考虑。第一，我们从文化的含义上谈，人是什么东西呢？人是万物之灵。所以，大家得到这个人生着实不容易，应该真正做一些对自己、对人民有利益的事情。有些事做了对自己有利，但，对国家对人民不一定有利，而医这个行当，只要你发心不邪，对人对己都会有利。《素问》里常说“人禀天地之气生”，所以，考察人我们应该把他放到天地这个框架里。有关天地，古人常把它与经纬联系起来谈，我们看《三国》就经常会碰到“经天纬地”这个词。天以经言，地以纬言。经贯穿南北，连接上下，纬贯穿东西，连接左右。经纬这个概念看上去很简单，可是我们是否可以透过这个简单的概念去思考一些与中医相关的问题？大家想一想，人为什么叫万物之灵？在所有的动物中，除了人之外，其他的都是爬行动物，它是横行的，只有人是直立动物。所以，从天地这个角度，从经纬这个角度，人是沿经线走的，而其他动物是沿纬线走的。从禀气的多寡而言，当然人禀天气最多，而余者禀天气较少。这是造就人成为万物之灵的重要因素。第二，我们对干支的这个概念很熟悉，几乎每个人都知道天干地支。但是，大家想过没有，为什么我们不可以叫地干天支呢？因为干是直立的，而长在干上的支是横行的，所以，干象天而支象地。万物虽然都是长在地上，但是，这个地上的万物要很好的生长却离不开天，离不开太阳。文化大革命时期我们经常唱一首红歌，“大海航行靠舵手，万物生长靠太阳”，就说明了这个意思。花叶果实虽然都长在树枝（支）上，但，它必须靠树干提供营养。所以，一个干支的概念也体现了天地的含义，也体现了一个纵横的问题，也体现出人与其他动物的差别。第三，凡属于动物这一类，不管你是直立还是爬行，从象的角度而言，头都与天相应，足都与地相应。所以，《内经》说：“圣人象天以养头，象地以养足。”怎么养头呢？圣人说得很清楚，你就去思考天是什么一个样子，你按这个去做就是很好的养头，这样头脑就会发达。但是，这些都是后天的因素，而先天的东西已经固定在那里，没有办法改变。我们前面说了，人是走经线的，所以，从先天而言，他禀受的天气最多，而天象头。为什么人的头脑发达？为什么只有人类能够思维？为什么只有人类有智慧？为什么人类与其他动物有如此巨大的差别？根本的一个因素就在这个禀受天气的多寡。而其他的动物呢？它沿纬线走，所以，从先天而言，它禀受的地气最丰，而地象足。大家想一想，动物的脚力是不是比人好？你们有谁能跑过马？跑过老虎？跑过猴子？甚至你连猫、连狗、连鸡都跑不过。就是马家军也没办法！为什么呢？因为动物禀地气全，而人禀受地气相对要少得多。就这一点而言，人与动物是各有千秋的。当然，动物禀受地气全，脚力就好，这个问题还需相对来看。比如蚂蚁、乌龟，从行走的绝对速度上，那是没法跟人相比的，但是，从相对速度上、从耐力上，是不是也要比人强，这些问题恐怕需要大家从专门的角度来研究。第四，也许有人会提问：人睡眠的时候不也是横卧的吗？对！这个问题提得好。所有的动物中，只有人，他的睡眠姿势与觉醒姿势不同，觉醒的时候直立，而睡觉时就放平了。直禀经天之气，横禀纬地之气，为什么说人禀天地之气生，天气和地气都很全，道理就在这里。所以，人不是光禀天气，他也禀地气，他是“头脑不简单，四肢也发达”。当然，从量上而言，他禀受的地气还是不如其他动物全。其他动物觉醒和睡眠的姿势有不有改变？除了这个位的高低有改变，横直并没有改变。马家军的脚力很不错，跑一万米用不了多少时间，因为马俊仁教练知道怎么超强训练队员的体能。但是，我想如果马教练多来研究一下中医，从禀受地气的这个角度想想办法，开发队员的脚力，那么，多拿几块奥运金牌应该不成问题。第五，以上几个方面都思考过了，我们就知道人之所以能为万物之灵，就因为他是禀天地之气而生，而且在这个天地，在这个经纬上，他又偏重于天经的一面，这是人之所以为人的一个最显著的特点。也就是说人类是重经的，偏重于经，以经统纬是人的一个特点。这也使我们想到，中医的十二经为什么不叫十二纬？这也使我们想到了圣人的东西为什么一定要叫经典！明确了上面的这些原则，我们就可以来解答小节开首提出的问题。在人的十二经脉当中，我们看一看哪些经能够真正地贯穿南北，连接上下？是足经还是手经？很显然是足经。手经它只走到一半，它没有贯穿整个南北，它没有贯穿人的整个“经”，所以，手经它并不能完全的代表人的特性，惟有足经能够做到这一点。它从头到足，从天到地，走完人的整个“经”线，所以，足经才能真正地代表这个“经”。《内经》也好，《伤寒》也好，在谈到很重要的问题时都是举出足经为代表，道理就在这里。实际上，这是以足赅手，以足统手，言足经手在其中矣。并不是言足不言手，更不是传足不传手，这个问题大家应该这样来理解。第六，上面这个问题解决了，我们可以来思考另一个相关的问题，就是六经辨证与其他辨证有什么区别？当然，搞温病的肯定会强调卫气营血辨证、三焦辨证，搞脏腑的会说只有脏腑辨证、八纲辨证才行，而我们搞伤寒的是不是就要王婆卖瓜呢？我想这个不完全是王婆卖瓜，你要有依据，有道理，不要光是感情用事。为什么六经辨证有这个优越性呢？这就是刚刚谈到的，它是一个纵向的辨证，是一个贯穿天地的辨证，是一个真正的“经”的辨证。因此，这样的辨证才最符合人的本性，最能够体现人的这个特征，所以，这个辨证方法最能揭示疾病的根本。《素问》说“治病必求于本”，可以说这个辨证模式是一个最方便的求本模式。难怪后世要把六经这个辨证模式称为能“钤百病”的模式。而其他的辨证模式，像卫气营血辨证、三焦辨证，以及脏腑辨证，这些都是横向的辨证，都是注重纬线的辨证。所以，这些辨证在某方面都有局限性，而六经辨证或者说阴阳辨证没有这个局限性。
第四章 治病法要
在正式地进入太阳篇前，我们要讨论“治病法要”这样一个问题。只有这个问题清楚了、把握了，做医生才有一个依靠处。
一、医者的两个层次
陈存仁编辑有一套日本人写的很著名的丛书，叫做《皇汉医学》。《皇汉医学》里讲到一个“医诫十则”，就是做医生很需要注意的十个问题。十诫中有一诫我的印象最深，记得这是师父十多年前给我讲的。先师给我讲的许多问题都已经忘记，可是这一诫我记忆犹新，因为它太重要了。十多年来，我一直是以这一诫来告诫自己、鞭策自己、要求自己。现在就凭记忆把这一诫的内容转述给大家：“医有上工，有下工。对病欲愈，执方欲加者，谓之下工。临证察机，使药要和者，谓之上工。夫察机要和者，似迂而反捷。此贤者之所得，愚者之所失也。”我们看到这一诫里把医生分为上工、下工。上工这一类也就是我们今天所说的高明医生，而下工这一类，就是很差劲的医生，就是庸医。作为我们学医的人，在谈到这一诫时，就应该有所选择。我想大家应该是希望能在上工的行列，如果没有这个信心，大家就不要学医。否则，一辈子下来，只做一个下工，一个庸医，这有多凄凉。另外一点，做医生几乎没有中间路可走，你不是救人就是害人。你开药，如果没有治疗作用，那就是毒副作用，中间的路很少，这是肯定的。所以，选择做医生的路，大家应该很慎重。按照清代名医徐灵胎的话，做医生只有两条路，要么做苍生大医，要么做含灵巨贼。
1.下工层次
什么是上工？什么是下工？它的评判标准是什么？这一诫从根本上，从源头上给我们作了说明。“对病欲愈，执方欲加者，谓之下工。”这是什么意思？前些天我给医本的同学上课，下课休息的时候，就有同学问我：我们家乡有一个朋友得甲状腺肿，老师您看开个什么方？另外一个同学接着问我：老师，我最近经常失眠，您看开个什么方？现在我们暂时放下上面的提问，先来考虑另一个问题。中医与西医在很多原则问题上应该说是接近的，西医治疗一个甲状腺肿，不会马上想到割掉它，或者马上用什么消肿的药物。它要通过一些手段或方法，得到一个诊断。甲状腺肿只是一个体征或症状，它还不是诊断。它必须通过一系列手段和方法得出一个诊断，这个诊断是病因诊断。它是什么原因导致甲状腺肿？是缺碘呢？还是甲状腺机能亢进？还是单纯性甲状腺肿瘤？或者会是癌肿？这些都必须做相关的检查才能确定，或者做碘 131，或者做活检什么的。等到这个病因的判断明确之后，才能提出相关的治疗方案。有人说西医光治标，这个说法我不同意，病因治疗就是治本，只是这个“本”的层次不同而已。上面的同学告诉我一个甲状腺肿就要我开方，这就等于省略了这许多的过程。中医与西医在这个总体原则上也是一样。我们说甲状腺肿或者失眠，它只是一个“证”，而中医的特色是辨证论治，通过这个“证”来辨别疾病的“因”，然后根据这个“因”来进行治疗。这也叫做辨证求因，审因论治。你现在只说一个甲状腺肿、一个失眠，这个辨证论治的过程没有，这个诊断的过程没有，那怎么开方？没法开方。根据上面这个认识，我们对后世提出的内科就会有一些不同的看法，它有很多不合理的地方。比如，西医说肺结核，这是一个病，这是一个诊断，而这个诊断已经包含了病因的判断。又比如类风湿性关节炎，红斑狼疮等，这些疾病的最终原因虽然没有搞清楚，但是，这个病名已然包括有病因因素。而内科里面说“咳嗽”，说“胃痛”，说“泻泄”，这些都是病。“咳嗽”、“胃痛”这些是什么东西呢？它只是一个症状，它完全没有病因的成分，所以，西医要笑话中医，我觉得应该笑话。什么事情要模仿西医，都应该经过严密的思考，没有经过严密的思考，盲目地去模仿，就容易搞成半吊子，两头不到岸。当然，中医与西医在诊断上所采用的方法是大不相同的。西医有大量现代化的手段可以借助，而且这些手段越来越先进。中医呢？什么也没有，都得靠自己。因此，学中医要比学西医困难。学西医，整个世界的科技都在帮助你，现代物理学帮助你，现代化学帮助你，现代生物学更加帮助你。而学中医没有人帮助你，相反都在为难你，给你挑刺。所以要学好中医，特别是要在现代学好中医，那真是不容易。大家应该把这个困难考虑进去，树立牢固的信心。上面提到，说一个失眠，说一个甲状腺肿就要处方，这就是“对病欲愈，执方欲加”。很多人搞一辈子中医都是这样。听到甲亢，就开一个甲亢的方，病人又说胃痛，加两味胃痛的，又说腰痛，再加两味对付腰痛的，现在的很多中医就是这样看病。有些同学给我说，现在在医院里已经看不到中医了，心肌梗死就用益气养阴，活血化瘀，已经形成套路了。当然有的病人可能会适合于益气养阴，但，这个思路不对呀。心梗是西医的病名，由冠脉阻塞所致。中医怎么认识它呢？中医不一定说它是心梗，你要“察色按脉，先别阴阳”，怎么就只有益气养阴，活血化瘀呢？这个与“对病欲愈，执方欲加”有什么区别？这可是下工之所为啊。所以，我们一定要设法避免这样的方法，走另外一条路。
2.上工层次
本节我们探讨阴阳的离合机制，即开、合、枢的作用。从《素问·阴阳离合论》中我们可以看到，它论述的是足三阴经和足三阳经，并未提及手三阴经和手三阳经。而《灵枢·根结篇》也谈到了开、合、枢的问题，其论述同样局限于足经，对于手经则未涉及此问题。再加上《素问·热论》这篇论述“伤寒”（外感热病）的经典文献，也是只论足经不论手经，这就给后世许多人造成了一种误解，认为伤寒病只传变于足经而不传变于手经，温病（温热性质的外感病）则只传变于手经而不传变于足经。众所周知，整体观念是中医非常重要的一个核心理念，人与天地是一个整体，天地的变化会不时地影响人体，怎么可能手足之间互不影响、互不传变呢？但是，《内经》（包括《素问》和《灵枢》）和《伤寒杂病论》在谈到上述问题时，确实侧重于足经方面，这是什么原因呢？要弄清这个问题，必须从以下几个方面来考虑。
第一，从文化的含义上来谈，人是什么？人是万物之灵长。因此，大家意识到生命的来之不易，应该真正做一些对自己、对人民有益的事情。有些事对自己有利，但对国家和人民未必有利；而医学这个行业，只要你发心纯正无邪，对人对自己都会有利。《素问》中常说“人禀天地之气生”，所以在考察人时，我们应该把他置于天地的框架中去思考。关于天地，古人常将其与经纬联系起来谈论，我们在看《三国演义》时经常会碰到“经天纬地”这个词。天以经言，地以纬言。经线贯穿南北，连接上下；纬线贯穿东西，连接左右。经纬这个概念看似简单，但我们是否可以透过这个简单的概念去思考一些与中医相关的问题？大家想一想，人为什么被称为万物之灵？在所有动物中，除了人之外，其他都是爬行动物，它们是横行的，只有人是直立动物。所以，从天地角度、从经纬角度来看，人是沿经线行走的，而其他动物是沿纬线行走的。从禀受气的多少而言，当然人禀受天气最多，而其他动物禀受天气较少。这是造就人成为万物之灵的重要因素。
第二，我们对干支的概念很熟悉，几乎每个人都知道天干地支。但是，大家想过没有，为什么我们不能叫“地干天支”呢？因为“干”是直立的，而长在干上的“支”是横行的，所以，“干”象征天，“支”象征地。万物虽然都长在地上，但地上的万物要良好生长却离不开天，离不开太阳。“文化大革命”时期我们经常唱一首红歌：“大海航行靠舵手，万物生长靠太阳”，就说明了这个道理。花、叶、果实虽然都长在树枝（支）上，但它们必须依靠树干提供营养。所以，干支的概念也体现了天地的含义，体现了一个纵横的问题，也体现出人与其他动物的差别。
第三，凡属于动物这一类，不管你是直立还是爬行，从象的角度而言，头都与天相应，足都与地相应。所以，《内经》说：“圣人象天以养头，象地以养足。”怎么养头呢？圣人说得很清楚，你就去思考天是什么样子的，你按照这个去做就是很好的养头，这样头脑就会发达。但是，这些都是后天的因素，而先天的东西已经固定在那里，没有办法改变。我们前面说了，人是走经线的，所以，从先天而言，他禀受的天气最多，而天象头。为什么人的头脑发达？为什么只有人类能够思维？为什么只有人类有智慧？为什么人类与其他动物有如此巨大的差别？根本的一个因素就在于禀受天气的多寡。而其他的动物呢？它们沿纬线走，所以，从先天而言，它们禀受的地气最丰，而地象足。大家想一想，动物的脚力是不是比人好？你们有谁能跑过马？跑过老虎？跑过猴子？甚至你连猫、狗、鸡都跑不过。即使是当年的“马家军”也没办法！为什么呢？因为动物禀受地气全，而人禀受地气相对要少得多。就这一点而言，人与动物是各有千秋的。当然，动物禀受地气全，脚力就好，这个问题还需相对来看。比如蚂蚁、乌龟，从行走的绝对速度上，那是没法跟人相比的，但是从相对速度上、从耐力上，是不是也要比人强？这些问题恐怕需要大家从专门的角度来研究。
第四，也许有人会提问：人睡眠的时候不也是横卧的吗？对！这个问题提得好。所有的动物中，只有人，他的睡眠姿势与觉醒姿势不同，觉醒的时候直立，而睡觉时就放平了。直禀经天之气，横禀纬地之气，为什么说人禀天地之气生，天气和地气都很全，道理就在这里。所以，人不是光禀受天气，他也禀受地气，他是“头脑不简单，四肢也发达”。当然，从量上而言，他禀受的地气还是不如其他动物全。其他动物觉醒和睡眠的姿势有没有改变？除了位的高低有改变，横直并没有改变。马家军的脚力很不错，跑一万米用不了多少时间，因为马俊仁教练知道怎么超强训练队员的体能。但是，我想如果马教练多来研究一下中医，从禀受地气的这个角度想想办法，开发队员的脚力，那么，多拿几块奥运金牌应该不成问题。
第五，以上几个方面都思考过了，我们就知道人之所以能为万物之灵，就因为他是禀受天地之气而生，而且在这个天地、在这个经纬上，他又偏重于天经的一面，这是人之所以为人的一个最显著的特点。也就是说人类是重经的，偏重于经，以经统纬是人的一个特点。这也使我们想到，中医的十二经脉为什么不叫十二纬？这也使我们想到了圣人的著作为什么一定要叫经典！明确了上面的这些原则，我们就可以来解答小节开头提出的问题。在人的十二经脉当中，我们看一看哪些经能够真正地贯穿南北，连接上下？是足经还是手经？很显然是足经。手经它只走到一半，它没有贯穿整个南北，它没有贯穿人的整个“经”，所以，手经它并不能完全地代表人的特性，惟有足经能够做到这一点。它从头到足，从天到地，走完人的整个“经”线，所以，足经才能真正地代表这个“经”。《内经》也好，《伤寒杂病论》也好，在谈到很重要的问题时都是举出足经为代表，道理就在这里。实际上，这是以足赅手，以足统手，言足经手在其中矣。并不是言足不言手，更不是传足不传手，这个问题大家应该这样来理解。
第六，上面这个问题解决了，我们可以来思考另一个相关的问题，就是六经辨证与其他辨证有什么区别？当然，搞温病的肯定会强调卫气营血辨证、三焦辨证，搞脏腑的会说只有脏腑辨证、八纲辨证才行，而我们搞伤寒的是不是就要王婆卖瓜自卖自夸呢？我想这个不完全是王婆卖瓜，你要有依据，有道理，不要光是感情用事。为什么六经辨证有这个优越性呢？这就是刚刚谈到的，它是一个纵向的辨证，是一个贯穿天地的辨证，是一个真正的“经”的辨证。因此，这样的辨证才最符合人的本性，最能够体现人的这个特征，所以，这个辨证方法最能揭示疾病的根本。《素问》说“治病必求于本”，可以说这个辨证模式是一个最方便的求本模式。难怪后世要把六经这个辨证模式称为能“钤百病”的模式。而其他的辨证模式，像卫气营血辨证、三焦辨证，以及脏腑辨证，这些都是横向的辨证，都是注重纬线的辨证。所以，这些辨证在某方面都有局限性，而六经辨证或者说阴阳辨证没有这个局限性。
第四章 治病法要
在正式进入太阳篇之前，我们要讨论“治病法要”这样一个问题。只有这个问题清楚了、把握住了，做医生才有一个依靠处。
一、医者的两个层次
陈存仁编辑有一套日本人写的很著名的丛书，叫做《皇汉医学》。《皇汉医学》里讲到一个“医诫十则”，就是做医生很需要注意的十个问题。十诫中有一诫我的印象最深，记得这是师父十多年前给我讲的。先师给我讲的许多问题都已经忘记，可是这一诫我记忆犹新，因为它太重要了。十多年来，我一直是以这一诫来告诫自己、鞭策自己、要求自己。现在就凭记忆把这一诫的内容转述给大家：“医有上工，有下工。对病欲愈，执方欲加者，谓之下工。临证察机，使药要和者，谓之上工。夫察机要和者，似迂而反捷。此贤者之所得，愚者之所失也。”我们看到这一诫里把医生分为上工、下工。上工这一类也就是我们今天所说的高明医生，而下工这一类，就是很差劲的医生，就是庸医。作为我们学医的人，在谈到这一诫时，就应该有所选择。我想大家应该是希望能在上工的行列，如果没有这个信心，大家就不要学医。否则，一辈子下来，只做一个下工，一个庸医，这有多凄凉。另外一点，做医生几乎没有中间路可走，你不是救人就是害人。你开药，如果没有治疗作用，那就是毒副作用，中间的路很少，这是肯定的。所以，选择做医生的路，大家应该很慎重。按照清代名医徐灵胎的话，做医生只有两条路，要么做苍生大医，要么做含灵巨贼。
1. 下工层次
什么是上工？什么是下工？它的评判标准是什么？这一诫从根本上、从源头上给我们作了说明。“对病欲愈，执方欲加者，谓之下工。”这是什么意思？前些天我给医本的同学上课，下课休息的时候，就有同学问我：我们家乡有一个朋友得甲状腺肿，老师您看开个什么方？另外一个同学接着问我：老师，我最近经常失眠，您看开个什么方？现在我们暂时放下上面的提问，先来考虑另一个问题。中医与西医在很多原则问题上应该说是接近的，西医治疗一个甲状腺肿，不会马上想到割掉它，或者马上用什么消肿的药物。它要通过一些手段或方法，得到一个诊断。甲状腺肿只是一个体征或症状，它还不是诊断。它必须通过一系列手段和方法得出一个诊断，这个诊断是病因诊断。它是什么原因导致甲状腺肿？是缺碘呢？还是甲状腺功能亢进？还是单纯性甲状腺肿瘤？或者会是癌肿？这些都必须做相关的检查才能确定，或者做碘-131扫描，或者做活检什么的。等到这个病因的判断明确之后，才能提出相关的治疗方案。有人说西医光治标，这个说法我不同意，病因治疗就是治本，只是这个“本”的层次不同而已。上面的同学告诉我一个甲状腺肿就要我开方，这就等于省略了这许多的过程。中医与西医在这个总体原则上也是一样。我们说甲状腺肿或者失眠，它只是一个“证”，而中医的特色是辨证论治，通过这个“证”来辨别疾病的“因”，然后根据这个“因”来进行治疗。这也叫做辨证求因，审因论治。你现在只说一个甲状腺肿、一个失眠，这个辨证论治的过程没有，这个诊断的过程没有，那怎么开方？没法开方。根据上面这个认识，我们对后世提出的内科就会有一些不同的看法，它有很多不合理的地方。比如，西医说肺结核，这是一个病，这是一个诊断，而这个诊断已经包含了病因的判断。又比如类风湿性关节炎、红斑狼疮等，这些疾病的最终原因虽然没有搞清楚，但是，这个病名已然包括有病因因素。而内科里面说“咳嗽”，说“胃痛”，说“泄泻”，这些都是病。“咳嗽”、“胃痛”这些是什么东西呢？它只是一个症状，它完全没有病因的成分，所以，西医要笑话中医，我觉得应该笑话。什么事情要模仿西医，都应该经过严密的思考，没有经过严密的思考，盲目地去模仿，就容易搞成半吊子，两头不到岸。当然，中医与西医在诊断上所采用的方法是大不相同的。西医有大量现代化的手段可以借助，而且这些手段越来越先进。中医呢？什么也没有，都得靠自己。因此，学中医要比学西医困难。学西医，整个世界的科技都在帮助你，现代物理学帮助你，现代化学帮助你，现代生物学更加帮助你。而学中医没有人帮助你，相反都在为难你，给你挑刺。所以要学好中医，特别是要在现代学好中医，那真是不容易。大家应该把这个困难考虑进去，树立牢固的信心。上面提到，说一个失眠，说一个甲状腺肿就要处方，这就是“对病欲愈，执方欲加”。很多人搞一辈子中医都是这样。听到甲亢，就开一个甲亢的方，病人又说胃痛，加两味胃痛的，又说腰痛，再加两味对付腰痛的，现在的很多中医就是这样看病。有些同学给我说，现在在医院里已经看不到中医了，心肌梗死就用益气养阴，活血化瘀，已经形成套路了。当然有的病人可能会适合于益气养阴，但，这个思路不对呀。心梗是西医的病名，由冠脉阻塞所致。中医怎么认识它呢？中医不一定说它是心梗，你要“察色按脉，先别阴阳”，怎么就只有益气养阴，活血化瘀呢？这个与“对病欲愈，执方欲加”有什么区别？这可是下工之所为啊。所以，我们一定要设法避免这样的方法，走另外一条路。
2. 上工层次
In this section, we discuss the mechanism of separation and combination of Yin and Yang, specifically the concepts of Kai (Opening), He (Closing), and Shu (Pivot). From *Suwen: Treatise on the Separation and Combination of Yin and Yang* (*Suwen*, Chapter 25), we can see that it discusses the six Foot meridians (Foot Three Yin and Foot Three Yang meridians) but does not mention the Hand meridians (Hand Three Yin and Hand Three Yang meridians). Similarly, *Lingshu: Root and Terminal Chapter* (*Lingshu*, Chapter 60) also addresses the issues of Kai, He, and Shu, discussing them within the context of the Foot meridians and omitting this issue regarding the Hand meridians. Furthermore, *Suwen: Treatise on Heat Disorders* (*Suwen*, Chapter 31), a foundational text discussing "Shanghan" (Cold Damage/Exogenous Febrile Diseases), also focuses solely on the Foot meridians. This has led to a misunderstanding among many later generations, who believed that Shanghan transmits only through the Foot meridians and not the Hand meridians, while Wenbing (Warm Diseases/Warmth pathogens) transmits only through the Hand meridians and not the Foot meridians. As everyone knows, the holistic concept is a crucial tenet of Traditional Chinese Medicine (TCM); humans and Heaven and Earth constitute a single whole, and changes in Heaven and Earth constantly influence the human body. How could there be no mutual influence or transmission between the hands and feet? However, when *Neijing* (The Inner Canon, comprising *Suwen* and *Lingshu*) and *Shanghan Lun* (Treatise on Cold Damage) discuss these issues, they indeed emphasize the Foot meridians. What is the reason for this? To clarify this question, we must consider the following aspects.
First, from a cultural perspective, what is man? Man is the spirit of all things. Therefore, one should realize that life is hard-won and truly engage in activities beneficial to oneself and to the people. Some actions may benefit oneself but not necessarily the state or the people; however, the medical profession, provided one’s intention is upright and free from evil, benefits both others and oneself. *Suwen* often states, "Man is born by inheriting the Qi of Heaven and Earth." Thus, when examining humanity, we should place him within the framework of Heaven and Earth. Regarding Heaven and Earth, ancients often discussed them in terms of longitude and latitude (Jing and Wei). In reading *Romance of the Three Kingdoms*, one frequently encounters the term "Jing Tian Wei Di" (ordering Heaven and Earth). Heaven is described by Jing (longitude/meridians), and Earth by Wei (latitude/parallels). Jing runs north-south, connecting up and down; Wei runs east-west, connecting left and right. Although the concept of Jing and Wei appears simple, can we use it to ponder issues related to TCM? Consider why man is called the spirit of all things. Among all animals, except for man, others are reptiles/crawlers that move horizontally; only man is an upright animal. Therefore, from the perspective of Heaven and Earth, and of Jing and Wei, man walks along the Jing lines, while other animals walk along the Wei lines. In terms of the quantity of inherited Qi, man inherits the most Heavenly Qi, whereas others inherit less. This is a key factor in making man the spirit of all things.
Second, we are familiar with the concept of Heavenly Stems and Earthly Branches (Gan Zhi); almost everyone knows them. But have you ever wondered why we do not call them "Earthly Stems and Heavenly Branches"? Because "Gan" (Stem) is upright, while "Zhi" (Branch) growing on the stem is horizontal. Thus, Gan symbolizes Heaven, and Zhi symbolizes Earth. Although all things grow on the ground, their good growth depends on Heaven and the Sun. During the Cultural Revolution, we often sang a red song: "The ship at sea relies on the helmsman; all things grow relying on the sun," which illustrates this point. Flowers, leaves, and fruits grow on branches (Zhi), but they must rely on the trunk (Gan) for nutrition. Thus, the concept of Gan Zhi reflects the meaning of Heaven and Earth, the issue of vertical and horizontal orientation, and the difference between humans and other animals.
Third, belonging to the animal kingdom, whether upright or crawling, from the perspective of Xiang (image/symbolism), the head corresponds to Heaven, and the feet correspond to Earth. Therefore, *Neijing* says: "The sage models himself on Heaven to nourish the head, and on Earth to nourish the feet." How does one nourish the head? The sage explains clearly: contemplate what Heaven is like, and act accordingly; this is excellent nourishment for the head, leading to mental development. However, these are postnatal factors, while prenatal factors are fixed and unchangeable. We stated earlier that man walks along the Jing lines; thus, prenatally, he inherits the most Heavenly Qi, and Heaven corresponds to the head. Why is the human brain developed? Why can only humans think? Why do only humans possess wisdom? Why is there such a vast difference between humans and other animals? The fundamental factor lies in the amount of Heavenly Qi inherited. Other animals walk along the Wei lines; thus, prenatally, they inherit the richest Earthly Qi, and Earth corresponds to the feet. Consider whether animals have better physical stamina than humans. Can anyone outrun a horse, a tiger, or a monkey? Even cats, dogs, or chickens can outrun humans. Even the famous "Ma Family Army" runners could not match horses! Why? Because animals fully inherit Earthly Qi, while humans inherit relatively little Earthly Qi. In this regard, humans and animals each have their strengths. Of course, since animals inherit full Earthly Qi, their physical strength is superior, but this must be viewed relatively. For instance, ants and turtles cannot compare to humans in absolute walking speed, but in relative speed or endurance, are they not stronger than humans? These questions require specialized research.
Fourth, someone might ask: Is man not lying horizontally when sleeping? Yes! This is a good question. Among all animals, only man has different postures for sleep and wakefulness: upright when awake, and flat when sleeping. Upright posture inherits Jing (Heavenly) Qi; horizontal posture inherits Wei (Earthly) Qi. This is why man is said to be born inheriting both Heavenly and Earthly Qi fully; the logic lies here. Thus, man does not just inherit Heavenly Qi but also Earthly Qi; he is "mentally sophisticated and physically developed." However, quantitatively, his inheritance of Earthly Qi is still inferior to that of other animals. Do other animals change their posture between wakefulness and sleep? Aside from changes in height, their orientation (horizontal/vertical) does not change. The Ma Family Army had excellent running ability, completing 10,000 meters quickly because Coach Ma Junren knew how to super-train athletes' physical fitness. But if Coach Ma had studied TCM more and considered developing foot strength from the perspective of inheriting Earthly Qi, winning more Olympic gold medals would likely not be a problem.
Fifth, having considered the above aspects, we understand that man is the spirit of all things because he is born inheriting Heaven and Earth Qi, and within this Heaven-Earth framework, he leans towards the Heavenly Jing aspect. This is the most significant characteristic of being human. That is, humanity emphasizes Jing, leaning towards Jing, using Jing to govern Wei. This reminds us: why are the twelve meridians in TCM not called twelve Wei? It also reminds us: why are the works of sages called "Classics" (Jing Dian)! With these principles clarified, we can answer the question posed at the beginning of this subsection. Among the twelve meridians of the human body, which meridians truly run north-south and connect up-down? Are they the Foot meridians or the Hand meridians? Obviously, the Foot meridians. The Hand meridians only reach halfway; they do not span the entire north-south axis nor traverse the entire "Jing" of the human body. Therefore, the Hand meridians cannot fully represent human characteristics; only the Foot meridians can achieve this. They run from head to foot, from Heaven to Earth, completing the entire "Jing" line of man; thus, the Foot meridians truly represent "Jing." Whether in *Neijing* or *Shanghan Lun*, when discussing critical issues, the Foot meridians are cited as representatives. This is the reason. In essence, this is using the Foot to encompass the Hand, using the Foot to govern the Hand; speaking of Foot meridians implies the inclusion of Hand meridians. It does not mean speaking of Foot and ignoring Hand, nor does it mean transmitting through Foot and not Hand. Everyone should understand it this way.
Sixth, having resolved the above issue, we can consider another related question: what is the difference between Six-Meridian Syndrome Differentiation (Liu Jing Bian Zheng) and other differentiation methods? Certainly, those specializing in Warm Diseases will emphasize Wei-Qi-Ying-Blood differentiation and San Jiao differentiation; those focusing on Zang-Fu organs will insist on Zang-Fu differentiation and Eight Principles differentiation. Should those specializing in Shanghan merely boast? I believe this is not mere boasting; one must have basis and reasoning, not just emotional bias. Why does Six-Meridian differentiation have superiority? As discussed, it is a longitudinal differentiation, a differentiation spanning Heaven and Earth, a true "Jing" differentiation. Therefore, this differentiation best conforms to human nature and embodies human characteristics, making it the method most capable of revealing the root of disease. *Suwen* states, "In treating disease, one must seek the root." This differentiation model can be said to be the most convenient mode for seeking the root. No wonder later generations called the Six-Meridian differentiation model a pattern capable of "controlling hundred diseases." Other differentiation models, such as Wei-Qi-Ying-Blood, San Jiao, and Zang-Fu differentiation, are all lateral/horizontal differentiations, focusing on Wei lines. Thus, these methods have limitations in certain aspects, whereas Six-Meridian differentiation, or Yin-Yang differentiation, lacks these limitations.
Chapter 4: Essentials of Treating Disease
Before formally entering the Taiyang Chapter, we must discuss the issue of "Essentials of Treating Disease." Only when this issue is clear and grasped does a physician have a foundation to rely upon.
I. Two Levels of Physicians
Chen Curen edited a famous series written by Japanese scholars titled *Huang Han Yi Xue* (Imperial Han Medicine). *Huang Han Yi Xue* mentions "Ten Precepts for Physicians," ten issues requiring careful attention for doctors. Among these ten precepts, one left the deepest impression on me; I recall my master telling me about it over ten years ago. Many issues my late master taught me have been forgotten, but this precept remains vivid in my memory because it is too important. For over ten years, I have used this precept to admonish, spur, and demand of myself. Now, relying on memory, I recount its content to everyone: "There are superior physicians (Shang Gong) and inferior physicians (Xia Gong). Those who, aiming to cure a disease, rigidly apply formulas without adjustment are called inferior physicians. Those who observe the pathogenic mechanism during clinical practice and ensure the medicinal prescription is harmonious are called superior physicians. Observing the mechanism and ensuring harmony seems circuitous but is actually expedient. This is what the wise attain and the foolish lose." This precept divides physicians into Shang Gong and Xia Gong. Shang Gong refers to the highly skilled physicians we speak of today, while Xia Gong refers to poor physicians, i.e., quacks. As students of medicine, when discussing this precept, we must make a choice. I believe everyone hopes to belong to the ranks of Shang Gong; if lacking this confidence, one should not study medicine. Otherwise, spending a lifetime as a Xia Gong, a quack, would be desolate. Furthermore, there is hardly a middle path in practicing medicine; you either save lives or harm them. If your prescriptions lack therapeutic effect, they become toxic side effects; the middle ground is minimal, which is certain. Therefore, choosing the path of medicine requires great caution. According to the words of the famous Qing Dynasty physician Xu Lingtai, there are only two paths for physicians: either become a Great Physician for the Common People (Cang Sheng Da Yi) or become a Great Thief against Living Beings (Han Ling Ju Zei).
1. The Level of Inferior Physicians
What are Shang Gong and Xia Gong? What are their criteria for judgment? This precept provides a fundamental explanation from the source. "Those who, aiming to cure a disease, rigidly apply formulas without adjustment are called inferior physicians." What does this mean? A few days ago, while teaching my TCM basic science students, during the break, a student asked me: "Teacher, a friend from my hometown has goiter (thyroid swelling); what formula would you prescribe?" Another student followed up: "Teacher, I have been suffering from insomnia recently; what formula would you prescribe?" Let us temporarily set aside these questions and consider another issue. TCM and Western medicine are quite close on many principled issues. When Western medicine treats goiter, it does not immediately think of surgery or prescribing anti-swelling drugs. It uses various means to obtain a diagnosis. Goiter is merely a sign or symptom, not a diagnosis. It requires a series of methods to arrive at a diagnosis, specifically an etiological diagnosis. What causes the goiter? Is it iodine deficiency? Hyperthyroidism? Simple thyroid tumor? Or cancer? Relevant examinations, such as Iodine-131 scans or biopsies, must be performed to determine this. Only after clarifying the etiology can a relevant treatment plan be proposed. Some say Western medicine only treats symptoms; I disagree. Etiological treatment is treating the root; it is just that the level of "root" differs. The students asking for a prescription based solely on "goiter" are skipping many necessary steps. TCM shares this general principle with Western medicine. We say goiter or insomnia is merely a "Zheng" (Syndrome/Pattern). The hallmark of TCM is syndrome differentiation and treatment (Bian Zheng Lun Zhi): using the "Zheng" to identify the disease's "Yin" (Etiology/Cause), and then treating based on this cause. This is also called seeking the cause through syndrome differentiation and determining treatment based on the cause. If you only mention goiter or insomnia, there is no process of syndrome differentiation, no diagnostic process; how can one prescribe? One cannot. Based on this understanding, we have different views on the internal medicine systems proposed in later generations, which contain many irrationalities. For example, Western medicine identifies pulmonary tuberculosis as a disease and a diagnosis, which already includes an etiological judgment. Similarly, rheumatoid arthritis, lupus erythematosus, etc., although the ultimate causes may not be fully understood, the disease names inherently include etiological factors. However, in TCM internal medicine texts, terms like "cough," "stomach pain," and "diarrhea" are treated as diseases. What are "cough" and "stomach pain"? They are merely symptoms, containing no etiological component. Thus, if Western medicine laughs at TCM, it is justified. Any imitation of Western medicine should undergo rigorous thinking; blind imitation without rigorous thought leads to mediocrity, achieving neither goal. Of course, the diagnostic methods of TCM and Western medicine differ greatly. Western medicine utilizes numerous modern technological aids, which are becoming increasingly advanced. TCM has nothing external to rely on; it must depend entirely on itself. Therefore, learning TCM is more difficult than learning Western medicine. In learning Western medicine, the world's technology helps you: modern physics, modern chemistry, and modern biology all assist you. In learning TCM, no one helps you; instead, difficulties are created, and criticisms are raised. Thus, mastering TCM, especially in the modern era, is truly not easy. Everyone should consider this difficulty and establish firm confidence. As mentioned above, asking for a prescription based solely on "insomnia" or "goiter" exemplifies "aiming to cure a disease, rigidly applying formulas." Many practitioners spend their entire careers doing this. Hearing "hyperthyroidism," they prescribe a hyperthyroidism formula; the patient mentions stomach pain, so they add two herbs for stomach pain; the patient mentions back pain, so they add two herbs for back pain. This is how many modern TCM physicians treat patients. Some students tell me that TCM is no longer seen in hospitals; for myocardial infarction, the routine is always "tonifying Qi and nourishing Yin, invigorating blood and resolving stasis." While some patients may suit this approach, the mindset is incorrect. Myocardial infarction is a Western medical disease name caused by coronary artery occlusion. How does TCM perceive it? TCM does not necessarily label it as myocardial infarction; one must "observe complexion and palpate pulse, first distinguishing Yin and Yang." Why restrict oneself to tonifying Qi and nourishing Yin, invigorating blood and resolving stasis? What is the difference between this and "aiming to cure a disease, rigidly applying formulas"? This is the conduct of an inferior physician. Therefore, we must strive to avoid such methods and take another path.
2. The Level of Superior Physicians