总而言之，证为机体对病的反映。由于个体的因素不同，所以，反映的形式及轻重也会有很大的差别。有的反映程度轻微，有的反映形式隐匿，在临床上都不容易察觉。这些都构成了所谓的“无证”可察。虽然“无证”，但疾病却确实存在。比如部分癌症病人，在发现前往往都没有明显的不适，应该说这个病已经很重了，可是“证”却很轻微。为什么会导致这个病重证轻的情况呢？这个问题我们在今后的篇章里会详细的讨论到。这就告诉我们，中医的认证水平，实在就是辨识疾病的关键所在。像张仲景能够提前这么多年知道王仲宣的病变，这就是认证的高手。实际上，那个时候王仲宣不是没有病，也不是没有证。只是病尚未成形，证也非常轻微。如果一点影子也没有，那不成了无中生有。所以，张仲景既不是搞神通，也不是算命，只是见微知著罢了。见微知著，我们可以从形气上去看。见微者，言气也；知著者，言形也。在气的阶段，往往它很隐微。我们常说捕风捉影，可是在气的这个阶段，它往往连风影的程度都达不到。而一旦成形了，它就会显著起来。这个时候你很容易察觉，这个证是很明显的。任何事物的发展都是这个过程，由气到形。在气的阶段不容易显现，不容易发觉，而到形的阶段就不难识别了。如果在气这个阶段你就发觉了，这个就叫见微，那你肯定会知道沿着这个气的发展，将来必定会有一个成形的变化，知道这个变化，这就叫知著了。见微知著就是这个意思。见微知著，是中医一个很关键的问题。《内经》里反复强调“上工治未病”，未病是什么？未病是没病吗？没病你去治它，这不成了没事找事。未病不是没病，也不是预防医学。未病就是尚未成形的病，是处在酝酿阶段的病，是处在气这个阶段的病。这个时候你去治它，那真是不费吹灰之力，那真是小菜一碟。可是一旦等到它成形了，成为肿块，成为器质性的病，这个就是已病，已经成形的病。这个时候就病来如山倒，病去如抽丝了。所以，上工他从来不治这个已经成形的病，治这个病的就不叫上工。治这个病你再厉害，上工也会看你的笑话，说你这是：“渴而穿井，斗而铸锥，不亦晚乎！”前些年闲来无事翻看史书，有一个非常精彩的片断，当时以为记住了，所以，没有作笔记，也没有记标签。今天想把这一段告诉大家，可怎么也想不起细节来，是否出自《旧唐书》也不能记清。但，大体的情节还能勾画出来：有弟兄三个，都行医，三弟兄中，以老三的名气最大，病人最多，门庭若市，许多病人抬着来，走着回去；老二的名气略次，门庭也没有老三这样热闹；老大的门庭则是最冷落的，到他这里看病的也不是什么重病人。一次，一位高人带了弟子参访这弟兄三人，回去后，高人问弟子，你看这弟兄三个哪一个医术最高？哪一个医术最差？弟子不假思考地回答：当然是老三的医术高，你看老三的病号这么多，这么重，疗效这么好，所以，老三的医术是最高的。相比之下，老大的医术最差，你看他的门庭冷落，治的又都是些鸡毛蒜皮的小病，这算什么本事呢？师父听了连连摇头，非也！非也！三者之中，以老三之医术最差，老三之医道不能及老大的十分之一，老三充其量是下工，老二是中工，老大才是当之无愧的上工。老大治病不露痕迹，你在未病的阶段就给你消除了，这个病在老大那里根本就没有机会发展到成形的阶段，在微的阶段就消于无形了。所以，在老大这里怎么会见到像老三治的那些危重病人呢？老三治那么多的危重病人，而且也都救治过来了，看起来是救了人的命。可是在疾病根本没有发展到这个阶段的时候你不去发现它、治疗它，等到折腾成这个样了你才来救治，这不是“劳命伤财”吗？上述这个故事也许是史实，也许是虚构。但，不管怎么样，个中的理趣却是值得我们深思。你要治未病，首先是要知未病，在未病的阶段你要能够发现它，这就牵涉到认证的水平，见微知著的水平。你要能于“无证”中认证，这个才算是上工。现代医学目前的各种检查手段，也都只限在已病这个阶段、成形这个阶段发现问题，等到将来真正能够作基因诊断了，恐怕也就进入到知未病这个行列。
乙、有证必有病
有证必有病，这是一定的道理，这个问题我们不用广说。但在西医里面会有例外的情况，比如神经官能症，它会有很多的证，但它们却无病可言。而在中医里，不会出现这个情况。
丙、证之轻重
证是许多复杂因素综合作用的显现，所以，证的轻重程度还不一定能决定病的轻重。有些病人证很重，但，病却很小、很轻，像一个牙痛，俗话说：牙痛不是病，痛起来却要命。因此，对证的这个复杂性大家应该充分的考虑到。这也不是一时半时就能弄清的问题。证的有无轻重取决于机体对疾病的反映程度；取决于机体对疾病的敏感性，当然，它还取决于机体与疾病的对抗程度，这些因素在我们研究证的问题时，都应该考虑进去。
丁、证之特性
证的特性，略述之，有如下几点：其一，证反映疾病所在的部位，这是证的一般特性。比如胃脘这个部位疼痛，反映了病有可能在胃。头痛在前额，则说明病在阳明。也就是说证的部位与疾病的部位有一个相关性，这一点我们在辨证的时候应该考虑进去。其二，证反映了疾病的性质，这一点对证来说是一个非常重要的特性。辨出疾病之所在，那当然是重要的。比如你通过证确定了这是太阳病或阳明病，但是，六经里面它还有一个寒热虚实之分，不区分这个性质，笼统地说这是太阳病或者阳明病，那还不行。比如确定了太阳表病，那你还得分一个伤寒、中风。伤寒、中风怎么分呢？这就要靠证。以上两个特性合起来，就是病机。其三，证反映个体之差异，证的这个特性对于我们区别体质，区分个性非常重要。受同一个致病因素的作用，而在证的表现上却截然不同，比如都是伤食，而张三每每见泻，李四则每每见吐。这样一个证的差异，就把个体区分开来了。说明张三素体太阴这一块比较薄弱，而李四有可能是少阳这一块比较薄弱。其四，证的两面性。对于中医这个证的研究，我们应该把眼界放开来。证，其实就是疾病的表现，所以，从这个角度而言，我们不希望它有。但是，从另一个角度看，证又可以帮助我们及时发现疾病，使疾病不至于隐藏下来，继续危害生命。许多疾病，尤其是西医的许多疾病，一表现出来、一检查出来就已经是晚期，像一些癌肿和慢性肾炎。这个时候我们也许会说，这个证干吗不早些出来。证，它一方面带给我们痛苦，身体的痛苦，心灵的痛苦，但是，证往往又会提示我们疾病消除的途径。如出汗，呕吐，下利，这些都是常见的证，但是，中医又常常利用这些“证”（汗吐下）来治病。因此，证的这个两面性，证与病以及证与治的这个关系就值得我们好好的研究。做西医的你可以不在乎这些细节，凭一叠化验单你就可以定出乾坤，但是，做中医的必须注意这些细节，每一个证你都不能放过。每一个证都有可能是“主证”，每一个证都有可能是你治疗疾病的突破口。举一个前不久的病例，病人女性，60 来岁，主诉是失眠，剧时彻夜难眠，甚者会有幻觉、幻听、喃喃自语，中西医都治过不少，但都没有解决。观看前医，除西医的镇静治疗外，中医养心安神，滋阴潜阳的也用过不少。切诊两脉皆有滑象，于是开始我按痰浊来治疗，用过温胆及高枕无忧一类化裁，但，都没有明显效果。后来仔细听患者诉说，患者这个失眠尤其在劳累以后厉害。锻炼稍过，往往就难以入眠。正常人劳累之后，睡眠会更香，而这个病人却恰恰相反。听到这个“证”后，似乎什么都明白了。整个病的关键点就在这里，这个证就是突破口，古人讲：劳倦伤脾。所以，这个病就在脾家上，就在太阴上。依法治之，投归脾汤原方，数剂后即能安然入寐，到现在已经月余，每晚皆能安寐，再未服用安定一类。其五，见证最多的疾病。前面我们说过，病与证之间的关系很复杂，并不是说证多病就多，也不一定证重病就重，这要看你从哪个角度去看这个问题。我们研究《伤寒论》会发现病与证的这个关系，方与证的这个关系，有些病（方）的证非常简单，而有些病（方）的证却非常复杂，非常多变。从整部《伤寒论》看，证最复杂多变的要数枢机病，水气病。而方呢？就是对应的柴胡剂，以及治水气的方，如小青龙汤，真武汤等。何以看出这复杂性，多变性呢？就从这个或然证去看。我们看《伤寒论》的 397 条，112 方中，哪些条的或然证最多？就要数 96 条的小柴胡；318 条的四逆散；40 条的小青龙汤；316条的真武汤。小柴胡所治为少阳病，或然证最多，达七个，四逆散所治为少阴病，或然证有 5 个。少阳、少阴都主枢机，在前面第三章的时候我们已经讨论过这个枢机的灵活性，而从这个或然证的多寡，我们亦看到了这一点。说明枢机的影响面很广，临床见证很复杂。这样的关系弄清楚后，那么反过来，临床如果我们见到一些见证十分复杂，不知从何处下手的疾病，当然就要考虑这个枢机的可能性了。水气病的情况亦如此，大家可以自己去考虑。
戊、证之要素
证的问题我们谈了那么多，它的最重要的要素在哪里呢？也就是说通过这个证我们最想了解些什么呢？除了上面这些内容，我们再作一个关键性的概括，就是阴阳。证，我们可以通过望闻问切这些途径得到，得到这些证后，经过我们对这些证的思考、分析、判断，我们要得出一个什么呢？就是要得出一个阴阳来。就是要在阴阳上面讨一个说法，这个上面有了说法，治病才能抓住根本。这是大家任何时候都不能忘记的。所以，阴阳既是起手的功夫，也是落脚的功夫。证的问题就谈到这里。
6.治释
治在这里不准备作广说。治的本义是水名，《说文》云：“水出东莱曲城，阳丘山南入海。”水从东莱曲城发源，然后在阳丘山南这个地方入海，这样一条水的名字就叫治。所以，治的形符是水傍。治后又引申为理，所以，治理常同用。治这个字为什么要与水有这样密切的关系呢？因为水这个东西，治之则滋养万物，不治则危害众生。水之治，有疏之、导之、引之、决之、掩之、蓄之等等，总以因势利导为要，治病亦宜仿此，故用治也。所以，治病就必须从治水中悟这个道理。其实，不惟治病，治一切都要从此处去悟。
二、太阳病提纲
1.太阳病机条文
太阳病提纲这个内容我们主要讲太阳篇的第1条，即：“太阳之为病，脉浮，头项强痛而恶寒。”这一条历代都把它作为太阳篇的提纲条文，而清代的伤寒大家柯韵伯则将它作为病机条文来看待。在他的《伤寒来苏集》中这样说道：“仲景作论大法，六经各立病机一条，提揭一经纲领，必择本经至当之脉证而表章之。”病机就是疾病发生的关键因素，我们从何处去发现这个因素呢？就从这个脉证中去发现。所以，柯氏谈病机就用这个至当的脉证来表章。查阅上海科学技术出版社 1959年 3月版的《伤寒来苏集》，脉证它用的是“症”，证与症现在的许多人也分不清，有必要在这里稍作说明。症读第四声，意为疾病之症状或症候。症为今用字而非古字，第四声的症亦非繁体之简写，故《说文》、《康熙》皆未载此症字。且声符正字亦无简繁之别。秦伯未认为证症二字无别，可以通用。而从证症二字的造字涵义去分析，则二字的差别甚大，证义广而症义狭，故两者实不可以通用。西医用症而不用证，中医则以用证而不用症为宜。既然提纲条文即是病机条文，那么，将上述条文作一个病机格式化会有益于我们对条文的理解。即格式为十九病机式的行文：诸脉浮，头项强痛而恶寒，皆属于太阳。病机条文一共讲了三个脉证，一为脉浮，一为头项强痛，一为恶寒，这三个脉证便成为鉴别太阳病的关键所在。那么，是不是三者一定具备才能判为太阳病呢？当然三者俱备那一定是太阳病，但若是仅具其一，或仅具其二，这个算不算太阳病呢？这个问题在历代都有很大的争议。我的意见比较偏向后者，诊断太阳病，并不一定三者皆备，有其一、二就可以定为太阳病。比如第六条：“太阳病，发热而渴，不恶寒者为温病。”这里明确地指出了不恶寒，三者之中已然少了一者，按理不应再定为太阳病，可是条首仍赫然地冠以“太阳病”。这就很清楚的告诉我们，病机条文的三个脉证，并不一定都需要具备，三者有其一或有其二，就应该考虑到太阳的可能性。同样的道理，我们看《伤寒论》的条文，凡冠有太阳病者，都应该与这个病机条文的内涵相关，即便不完全具备这三个脉证，三者之一也是应该具备的。
2.释义
（1）脉浮
浮脉，就是触肤即应的脉，李时珍《濒湖脉学》说：“泛泛在上，如水漂木。”只要大家养成切脉时的举按寻三个步骤，而不是像跳水队员一头就扎进水底，这个浮脉还是容易体验的。有关脉浮，我们可以从以下几个方面来理解。
甲、脉之所在，病之所在
总而言之，证（Zheng, Syndrome）是机体对疾病（Bing, Disease）的反映。由于个体因素不同，所以，反映的形式及轻重也会有很大的差别。有的反映程度轻微，有的反映形式隐匿，在临床上都不容易察觉。这些都构成了所谓的“无证”可察。虽然“无证”，但疾病却确实存在。比如部分癌症病人，在发现前往往都没有明显的不适，应该说这个病已经很重了，可是“证”却很轻微。为什么会导致这个病重证轻的情况呢？这个问题我们在今后的篇章里会详细的讨论到。这就告诉我们，中医的认证水平，实在就是辨识疾病的关键所在。像张仲景能够提前这么多年知道王仲宣的病变，这就是认证的高手。实际上，那个时候王仲宣不是没有病，也不是没有证。只是病尚未成形，证也非常轻微。如果一点影子也没有，那不成了无中生有。所以，张仲景既不是搞神通，也不是算命，只是见微知著罢了。见微知著，我们可以从形气上去看。见微者，言气也；知著者，言形也。在气的阶段，往往它很隐微。我们常说捕风捉影，可是在气的这个阶段，它往往连风影的程度都达不到。而一旦成形了，它就会显著起来。这个时候你很容易察觉，这个证是很明显的。任何事物的发展都是这个过程，由气到形。在气的阶段不容易显现，不容易发觉，而到形的阶段就不难识别了。如果在气这个阶段你就发觉了，这个就叫见微，那你肯定会知道沿着这个气的发展，将来必定会有一个成形的变化，知道这个变化，这就叫知著了。见微知著就是这个意思。见微知著，是中医一个很关键的问题。《内经》里反复强调“上工治未病”，未病是什么？未病是没病吗？没病你去治它，这不成了没事找事。未病不是没病，也不是预防医学。未病就是尚未成形的病，是处在酝酿阶段的病，是处在气这个阶段的病。这个时候你去治它，那真是不费吹灰之力，那真是小菜一碟。可是一旦等到它成形了，成为肿块，成为器质性的病，这个就是已病，已经成形的病。这个时候就病来如山倒，病去如抽丝了。所以，上工他从来不治这个已经成形的病，治这个病的就不叫上工。治这个病你再厉害，上工也会看你的笑话，说你这是：“渴而穿井，斗而铸锥，不亦晚乎！”前些年闲来无事翻看史书，有一个非常精彩的片断，当时以为记住了，所以，没有作笔记，也没有记标签。今天想把这一段告诉大家，可怎么也想不起细节来，是否出自《旧唐书》也不能记清。但，大体的情节还能勾画出来：有弟兄三个，都行医，三弟兄中，以老三的名气最大，病人最多，门庭若市，许多病人抬着来，走着回去；老二的名气略次，门庭也没有老三这样热闹；老大的门庭则是最冷落的，到他这里看病的也不是什么重病人。一次，一位高人带了弟子参访这弟兄三人，回去后，高人问弟子，你看这弟兄三个哪一个医术最高？哪一个医术最差？弟子不假思考地回答：当然是老三的医术高，你看老三的病号这么多，这么重，疗效这么好，所以，老三的医术是最高的。相比之下，老大的医术最差，你看他的门庭冷落，治的又都是些鸡毛蒜皮的小病，这算什么本事呢？师父听了连连摇头，非也！非也！三者之中，以老三之医术最差，老三之医道不能及老大的十分之一，老三充其量是下工，老二是中工，老大才是当之无愧的上工。老大治病不露痕迹，你在未病的阶段就给你消除了，这个病在老大那里根本就没有机会发展到成形的阶段，在微的阶段就消于无形了。所以，在老大这里怎么会见到像老三治的那些危重病人呢？老三治那么多的危重病人，而且也都救治过来了，看起来是救了人的命。可是在疾病根本没有发展到这个阶段的时候你不去发现它、治疗它，等到折腾成这个样了你才来救治，这不是“劳命伤财”吗？上述这个故事也许是史实，也许是虚构。但，不管怎么样，个中的理趣却是值得我们深思。你要治未病，首先是要知未病，在未病的阶段你要能够发现它，这就牵涉到认证的水平，见微知著的水平。你要能于“无证”中认证，这个才算是上工。现代医学目前的各种检查手段，也都只限在已病这个阶段、成形这个阶段发现问题，等到将来真正能够作基因诊断了，恐怕也就进入到知未病这个行列。
乙、有证必有病
有证必有病，这是一定的道理，这个问题我们不用广说。但在西医里面会有例外的情况，比如神经官能症，它会有很多的证，但它们却无病可言。而在中医里，不会出现这个情况。
丙、证之轻重
证是许多复杂因素综合作用的显现，所以，证的轻重程度还不一定能决定病的轻重。有些病人证很重，但，病却很小、很轻，像一个牙痛，俗话说：牙痛不是病，痛起来却要命。因此，对证的这个复杂性大家应该充分的考虑到。这也不是一时半时就能弄清的问题。证的有无轻重取决于机体对疾病的反映程度；取决于机体对疾病的敏感性，当然，它还取决于机体与疾病的对抗程度，这些因素在我们研究证的问题时，都应该考虑进去。
丁、证之特性
证的特性，略述之，有如下几点：其一，证反映疾病所在的部位，这是证的一般特性。比如胃脘这个部位疼痛，反映了病有可能在胃。头痛在前额，则说明病在阳明。也就是说证的部位与疾病的部位有一个相关性，这一点我们在辨证的时候应该考虑进去。其二，证反映了疾病的性质，这一点对证来说是一个非常重要的特性。辨出疾病之所在，那当然是重要的。比如你通过证确定了这是太阳病或阳明病，但是，六经里面它还有一个寒热虚实之分，不区分这个性质，笼统地说这是太阳病或者阳明病，那还不行。比如确定了太阳表病，那你还得分一个伤寒、中风。伤寒、中风怎么分呢？这就要靠证。以上两个特性合起来，就是病机。其三，证反映个体之差异，证的这个特性对于我们区别体质，区分个性非常重要。受同一个致病因素的作用，而在证的表现上却截然不同，比如都是伤食，而张三每每见泻，李四则每每见吐。这样一个证的差异，就把个体区分开来了。说明张三素体太阴这一块比较薄弱，而李四有可能是少阳这一块比较薄弱。其四，证的两面性。对于中医这个证的研究，我们应该把眼界放开来。证，其实就是疾病的表现，所以，从这个角度而言，我们不希望它有。但是，从另一个角度看，证又可以帮助我们及时发现疾病，使疾病不至于隐藏下来，继续危害生命。许多疾病，尤其是西医的许多疾病，一表现出来、一检查出来就已经是晚期，像一些癌肿和慢性肾炎。这个时候我们也许会说，这个证干吗不早些出来。证，它一方面带给我们痛苦，身体的痛苦，心灵的痛苦，但是，证往往又会提示我们疾病消除的途径。如出汗，呕吐，下利，这些都是常见的证，但是，中医又常常利用这些“证”（汗吐下）来治病。因此，证的这个两面性，证与病以及证与治的这个关系就值得我们好好的研究。做西医的你可以不在乎这些细节，凭一叠化验单你就可以定出乾坤，但是，做中医的必须注意这些细节，每一个证你都不能放过。每一个证都有可能是“主证”，每一个证都有可能是你治疗疾病的突破口。举一个前不久的病例，病人女性，60 来岁，主诉是失眠，剧时彻夜难眠，甚者会有幻觉、幻听、喃喃自语，中西医都治过不少，但都没有解决。观看前医，除西医的镇静治疗外，中医养心安神，滋阴潜阳的也用过不少。切诊两脉皆有滑象，于是开始我按痰浊来治疗，用过温胆及高枕无忧一类化裁，但，都没有明显效果。后来仔细听患者诉说，患者这个失眠尤其在劳累以后厉害。锻炼稍过，往往就难以入眠。正常人劳累之后，睡眠会更香，而这个病人却恰恰相反。听到这个“证”后，似乎什么都明白了。整个病的关键点就在这里，这个证就是突破口，古人讲：劳倦伤脾。所以，这个病就在脾家上，就在太阴上。依法治之，投归脾汤原方，数剂后即能安然入寐，到现在已经月余，每晚皆能安寐，再未服用安定一类。其五，见证最多的疾病。前面我们说过，病与证之间的关系很复杂，并不是说证多病就多，也不一定证重病就重，这要看你从哪个角度去看这个问题。我们研究《伤寒论》会发现病与证的这个关系，方与证的这个关系，有些病（方）的证非常简单，而有些病（方）的证却非常复杂，非常多变。从整部《伤寒论》看，证最复杂多变的要数枢机病，水气病。而方呢？就是对应的柴胡剂，以及治水气的方，如小青龙汤，真武汤等。何以看出这复杂性，多变性呢？就从这个或然证去看。我们看《伤寒论》的 397 条，112 方中，哪些条的或然证最多？就要数 96 条的小柴胡；318 条的四逆散；40 条的小青龙汤；316条的真武汤。小柴胡所治为少阳病，或然证最多，达七个，四逆散所治为少阴病，或然证有 5 个。少阳、少阴都主枢机，在前面第三章的时候我们已经讨论过这个枢机的灵活性，而从这个或然证的多寡，我们亦看到了这一点。说明枢机的影响面很广，临床见证很复杂。这样的关系弄清楚后，那么反过来，临床如果我们见到一些见证十分复杂，不知从何处下手的疾病，当然就要考虑这个枢机的可能性了。水气病的情况亦如此，大家可以自己去考虑。
戊、证之要素
证的问题我们谈了那么多，它的最重要的要素在哪里呢？也就是说通过这个证我们最想了解些什么呢？除了上面这些内容，我们再作一个关键性的概括，就是阴阳。证，我们可以通过望闻问切这些途径得到，得到这些证后，经过我们对这些证的思考、分析、判断，我们要得出一个什么呢？就是要得出一个阴阳来。就是要在阴阳上面讨一个说法，这个上面有了说法，治病才能抓住根本。这是大家任何时候都不能忘记的。所以，阴阳既是起手的功夫，也是落脚的功夫。证的问题就谈到这里。
6.治释
治在这里不准备作广说。治的本义是水名，《说文》云：“水出东莱曲城，阳丘山南入海。”水从东莱曲城发源，然后在阳丘山南这个地方入海，这样一条水的名字就叫治。所以，治的形符是水傍。治后又引申为理，所以，治理常同用。治这个字为什么要与水有这样密切的关系呢？因为水这个东西，治之则滋养万物，不治则危害众生。水之治，有疏之、导之、引之、决之、掩之、蓄之等等，总以因势利导为要，治病亦宜仿此，故用治也。所以，治病就必须从治水中悟这个道理。其实，不惟治病，治一切都要从此处去悟。
二、太阳病提纲
1.太阳病机条文
太阳病提纲这个内容我们主要讲太阳篇的第1条，即：“太阳之为病，脉浮，头项强痛而恶寒。”这一条历代都把它作为太阳篇的提纲条文，而清代的伤寒大家柯韵伯则将它作为病机条文来看待。在他的《伤寒来苏集》中这样说道：“仲景作论大法，六经各立病机一条，提揭一经纲领，必择本经至当之脉证而表章之。”病机就是疾病发生的关键因素，我们从何处去发现这个因素呢？就从这个脉证中去发现。所以，柯氏谈病机就用这个至当的脉证来表章。查阅上海科学技术出版社 1959年 3月版的《伤寒来苏集》，脉证它用的是“症”，证与症现在的许多人也分不清，有必要在这里稍作说明。症读第四声，意为疾病之症状或症候。症为今用字而非古字，第四声的症亦非繁体之简写，故《说文》、《康熙》皆未载此症字。且声符正字亦无简繁之别。秦伯未认为证症二字无别，可以通用。而从证症二字的造字涵义去分析，则二字的差别甚大，证义广而症义狭，故两者实不可以通用。西医用症而不用证，中医则以用证而不用症为宜。既然提纲条文即是病机条文，那么，将上述条文作一个病机格式化会有益于我们对条文的理解。即格式为十九病机式的行文：诸脉浮，头项强痛而恶寒，皆属于太阳。病机条文一共讲了三个脉证，一为脉浮，一为头项强痛，一为恶寒，这三个脉证便成为鉴别太阳病的关键所在。那么，是不是三者一定具备才能判为太阳病呢？当然三者俱备那一定是太阳病，但若是仅具其一，或仅具其二，这个算不算太阳病呢？这个问题在历代都有很大的争议。我的意见比较偏向后者，诊断太阳病，并不一定三者皆备，有其一、二就可以定为太阳病。比如第六条：“太阳病，发热而渴，不恶寒者为温病。”这里明确地指出了不恶寒，三者之中已然少了一者，按理不应再定为太阳病，可是条首仍赫然地冠以“太阳病”。这就很清楚的告诉我们，病机条文的三个脉证，并不一定都需要具备，三者有其一或有其二，就应该考虑到太阳的可能性。同样的道理，我们看《伤寒论》的条文，凡冠有太阳病者，都应该与这个病机条文的内涵相关，即便不完全具备这三个脉证，三者之一也是应该具备的。
2.释义
（1）脉浮
浮脉，就是触肤即应的脉，李时珍《濒湖脉学》说：“泛泛在上，如水漂木。”只要大家养成切脉时的举按寻三个步骤，而不是像跳水队员一头就扎进水底，这个浮脉还是容易体验的。有关脉浮，我们可以从以下几个方面来理解。
甲、脉之所在，病之所在
In summary, Zheng (Syndrome) is the manifestation of the body's response to Bing (Disease). Due to individual differences, the form and severity of this response can vary significantly. Some responses are mild in degree, while others are subtle in form, making them difficult to detect clinically. These factors constitute the so-called "absence of Zheng" for observation. Although there is no obvious Zheng, the disease undoubtedly exists. For instance, some cancer patients often have no obvious discomfort before diagnosis; by then, the disease is likely severe, yet the Zheng is very mild. Why does this situation of severe disease but mild Zheng occur? This issue will be discussed in detail in future chapters. This tells us that the level of syndrome differentiation in Traditional Chinese Medicine (TCM) is indeed the key to identifying diseases. Zhang Zhongjing’s ability to predict Wang Zhongxuan’s pathological changes years in advance demonstrates his expertise in syndrome differentiation. In fact, at that time, Wang Zhongxuan did have a disease and did have a Zheng. It was just that the disease had not yet taken physical form, and the Zheng was extremely subtle. If there were absolutely no trace, it would be creating something out of nothing. Therefore, Zhang Zhongjing was neither practicing magic nor fortune-telling; he merely perceived the significant from the minute. Perceiving the significant from the minute can be viewed from the perspective of Xing (Form) and Qi (Energy). "Perceiving the minute" refers to Qi; "perceiving the significant" refers to Form. At the stage of Qi, it is often very subtle. We often speak of "catching wind and shadows," but at the stage of Qi, it often doesn't even reach the level of wind or shadow. Once it takes form, it becomes prominent. At this point, you can easily perceive it, and the Zheng is very obvious. The development of any thing follows this process: from Qi to Form. At the stage of Qi, it is not easy to manifest or detect, whereas at the stage of Form, it is not difficult to identify. If you detect it at the stage of Qi, this is called "perceiving the minute"; then you will certainly know that along the development of this Qi, there will inevitably be a change into Form in the future. Knowing this change is called "perceiving the significant." This is the meaning of perceiving the significant from the minute. Perceiving the significant from the minute is a crucial issue in TCM. The *Neijing* repeatedly emphasizes "Superior physicians treat disease before it arises." What is "disease before it arises"? Is it the absence of disease? Treating non-existent disease would be looking for trouble. "Disease before it arises" does not mean the absence of disease, nor does it refer to preventive medicine. It refers to disease that has not yet taken physical form, disease in the brewing stage, disease at the stage of Qi. Treating it at this time is truly effortless, like a piece of cake. However, once it takes form, becoming a mass or an organic disease, this is "existing disease," disease that has already taken shape. At this time, the illness strikes like a landslide, and recovery is as slow as drawing silk. Therefore, superior physicians never treat existing disease; those who treat existing disease are not called superior physicians. No matter how skilled you are in treating existing disease, a superior physician would laugh at you, saying: "Digging a well when thirsty, forging weapons when battle has begun—isn't this too late!" A few years ago, while browsing historical books in my spare time, I came across a very精彩 (wonderful) excerpt. I thought I had memorized it at the time, so I didn't take notes or tag it. Today, I want to share this passage with everyone, but I cannot recall the details, nor am I sure if it comes from the *Old Book of Tang*. However, the general plot can still be sketched out: There were three brothers, all practicing medicine. Among them, the third brother had the greatest reputation, the most patients, and his clinic was bustling like a market; many patients were carried in and walked out. The second brother's reputation was slightly lower, and his clinic was not as lively as the third's. The first brother's clinic was the coldest, and those who visited him were not seriously ill patients. Once, a master brought his disciples to visit these three brothers. Upon returning, the master asked the disciples, "Which of these three brothers has the highest medical skill? Which has the lowest?" Without hesitation, the disciple answered, "Obviously, the third brother has the highest skill. Look at how many patients he has, how severe their conditions, and how good the efficacy is; therefore, his skill is the highest. In contrast, the first brother has the lowest skill. Look at his empty clinic; he only treats trivial ailments. What kind of skill is that?" Hearing this, the master shook his head repeatedly, saying, "No! No! Among the three, the third brother has the lowest skill. His medical Dao cannot reach one-tenth of the first brother's. The third brother is at best a 'inferior physician' (Xia Gong), the second brother is a 'middle physician' (Zhong Gong), and the first brother is the true 'superior physician' (Shang Gong)." The first brother treats disease without leaving traces; he eliminates it for you at the stage of "disease before it arises." This disease never has the chance to develop to the stage of taking form in the first brother's hands; it dissipates into invisibility at the subtle stage. So, how could you see critically ill patients treated by the first brother, like those treated by the third brother? The third brother treats so many critically ill patients and saves them, seemingly saving lives. But if you do not discover and treat the disease when it hasn't developed to this stage, waiting until it reaches this state to rescue it, isn't this "exhausting lives and wasting wealth"? This story may be historical fact or fiction. Regardless, the philosophical interest within it is worth deep reflection. To treat disease before it arises, you must first know disease before it arises. You must be able to detect it at the stage of "disease before it arises." This involves the level of syndrome differentiation and the ability to perceive the significant from the minute. Only by being able to differentiate Zheng amidst "no Zheng" can one be considered a superior physician. Modern medicine's various diagnostic methods are currently limited to detecting problems at the stage of existing disease and taking form. Even when gene diagnostics become possible in the future, they might enter the realm of knowing disease before it arises.
Yi. Where there is Zheng, there must be Bing
Where there is Zheng, there must be Bing. This is a certain principle, which we need not elaborate extensively. However, in Western medicine, there are exceptions. For example, neurosis presents many Zheng, yet there is no specific Bing to speak of. In TCM, this situation does not occur.
Zheng is the manifestation of the combined action of many complex factors. Therefore, the severity of Zheng does not necessarily determine the severity of Bing. Some patients have severe Zheng, but the Bing is minor and light, such as toothache. As the saying goes: "Toothache is not a disease, but when it hurts, it kills." Therefore, everyone should fully consider the complexity of Zheng. This is not a problem that can be clarified in a short time. The presence or absence and severity of Zheng depend on the degree of the body's response to the disease; they depend on the body's sensitivity to the disease. Of course, they also depend on the degree of confrontation between the body and the disease. These factors should all be considered when researching the issue of Zheng.
Ding. Characteristics of Zheng
The characteristics of Zheng, briefly stated, are as follows: First, Zheng reflects the location of the disease, which is a general characteristic of Zheng. For example, pain in the epigastrium suggests the disease may be in the Stomach. Headache in the forehead indicates the disease is in the Yangming channel. That is, there is a correlation between the location of Zheng and the location of the disease, which should be considered during syndrome differentiation. Second, Zheng reflects the nature of the disease, which is a very important characteristic for Zheng. Identifying the location of the disease is certainly important. For example, if you determine through Zheng that this is Taiyang Bing or Yangming Bing, within the Six Channels, there is still a distinction between Cold/Heat and Deficiency/Excess. Without distinguishing this nature, simply saying this is Taiyang Bing or Yangming Bing is insufficient. For example, if Taiyang Exterior Bing is determined, you must further distinguish between Shanghan (Cold Damage) and Zhongfeng (Wind Strike). How to distinguish Shanghan and Zhongfeng? This relies on Zheng. Combining the above two characteristics constitutes the Pathogenesis (Bingji). Third, Zheng reflects individual differences. This characteristic of Zheng is very important for distinguishing constitutions and personalities. Affected by the same pathogenic factor, the manifestation of Zheng can be completely different. For example, both suffer from food stagnation, but Zhang San often experiences diarrhea, while Li Si often experiences vomiting. Such differences in Zheng distinguish individuals. This indicates that Zhang San's body is relatively weak in the Taiyin aspect, while Li Si might be weak in the Shaoyin aspect. Fourth, the duality of Zheng. In our research on Zheng in TCM, we should broaden our horizons. Zheng is essentially the manifestation of disease, so from this perspective, we do not wish for its existence. However, from another perspective, Zheng helps us detect disease in time, preventing it from hiding and continuing to harm life. Many diseases, especially many Western medical diseases, are already in the late stage when manifested or detected, such as some cancers and chronic nephritis. At this time, we might say, why didn't this Zheng appear earlier? Zheng brings us pain, physical and mental pain, but it often points us to the way to eliminate the disease. For example, sweating, vomiting, and diarrhea are common Zheng, but TCM often uses these "Zheng" (sweating, vomiting, purging) to treat disease. Therefore, the duality of Zheng, and the relationship between Zheng and Bing, and Zheng and treatment, are worth careful study. Western doctors may ignore these details and determine the outcome based on a stack of lab reports, but TCM practitioners must pay attention to these details. You cannot let go of any Zheng. Every Zheng could be the "Chief Zheng," and every Zheng could be the breakthrough point for treating the disease. Take a recent case: a female patient, around 60 years old, chief complaint was insomnia, sometimes unable to sleep all night, sometimes experiencing hallucinations, auditory hallucinations, and muttering. She had been treated by both Western and Chinese medicine, but none resolved it. Reviewing previous treatments, besides Western sedatives, TCM treatments for nourishing the heart and calming the spirit, and yin-nourishing with yang-subduing were used extensively. Palpation revealed slippery pulses in both wrists. Initially, I treated it according to Phlegm-Turbidity, using modifications of Wendan Tang and Gaozhi Wuyou Tang, but there was no obvious effect. Later, listening carefully to the patient's description, her insomnia was particularly severe after fatigue. Slight over-exertion often made it difficult to fall asleep. After normal fatigue, sleep is usually deeper, but this patient was exactly the opposite. Hearing this "Zheng," everything seemed clear. The key to the entire disease lies here; this Zheng is the breakthrough point. The ancients said: "Fatigue injures the Spleen." Therefore, the disease lies in the Spleen, in the Taiyin. Following this law, I administered the original formula of Guipi Tang (Restore the Spleen Decoction). After a few doses, she could sleep peacefully. It has been over a month now, she sleeps peacefully every night, and has not taken benzodiazepines again. Fifth, diseases with the most manifestations. As mentioned earlier, the relationship between Bing and Zheng is complex. It is not that more Zheng means more Bing, nor that severe Zheng means severe Bing; it depends on the angle from which you view the issue. Studying the *Shanghan Lun*, we find the relationship between Bing and Zheng, and between Formulae and Zheng. Some diseases (formulae) have very simple Zheng, while others have very complex and variable Zheng. Looking at the entire *Shanghan Lun*, the most complex and variable Zheng belong to Shuji (Pivot) diseases and Shuiqi (Water-Qi) diseases. And the formulae? They correspondingly are Chaihu agents, and formulae for treating Water-Qi, such as Xiao Qinglong Tang (Minor Blue Dragon Decoction) and Zhenwu Tang (True Warrior Decoction). How do we see this complexity and variability? By looking at these optional Zheng (Huoran Zheng). Looking at the 397 clauses and 112 formulae in the *Shanghan Lun*, which clauses have the most optional Zheng? They are Clause 96 Xiao Chaihu Tang; Clause 318 Sini San (Frigid Extremities Powder); Clause 40 Xiao Qinglong Tang; and Clause 316 Zhenwu Tang. Xiao Chaihu Tang treats Shaoyang Bing, with the most optional Zheng, reaching seven. Sini San treats Shaoyin Bing, with 5 optional Zheng. Both Shaoyang and Shaoyin govern the Pivot. We discussed the flexibility of the Pivot in Chapter 3 earlier, and from the number of optional Zheng, we see this point. It shows that the influence of the Pivot is broad, and clinical manifestations are complex. Once this relationship is clarified, conversely, if we encounter diseases with very complex manifestations and don't know where to start, we should naturally consider the possibility of the Pivot. The situation with Water-Qi diseases is similar, and everyone can consider it themselves.
Wu. Elements of Zheng
We have talked so much about Zheng. Where lies its most important element? That is, what do we most want to know through this Zheng? Besides the above content, let us make a key summary: Yin and Yang. Zheng can be obtained through Observation, Listening/Smelling, Inquiry, and Palpation. After obtaining these Zheng, through our thinking, analysis, and judgment of these Zheng, what must we derive? We must derive Yin and Yang. We must come to a conclusion regarding Yin and Yang. Only with a conclusion on Yin and Yang can we grasp the root when treating disease. This is something everyone must never forget. Therefore, Yin and Yang are both the starting skill and the final goal. This concludes the discussion on Zheng.
6. Explanation of Treatment (Zhi)
Here, I do not intend to elaborate extensively on Zhi (Treatment). The original meaning of Zhi is a river name. *Shuowen Jiezi* states: "Water emerges from Qucheng in Donglai, enters the sea south of Yangqiu Mountain." Water originates from Qucheng in Donglai and enters the sea at a place south of Yangqiu Mountain. The name of such a watercourse is called Zhi. Therefore, the radical of Zhi is Water (Shui). Zhi later extended to mean "manage" or "govern," so Zhi and Zhi (Govern) are often used interchangeably. Why does this character have such a close relationship with water? Because water, when managed, nourishes all things; when unmanaged, it harms sentient beings. Management of water includes dredging, guiding, leading, diverting, damming, storing, etc., always emphasizing guiding according to circumstances. Treating disease should follow this principle, hence the use of Zhi. Therefore, treating disease requires understanding this principle from managing water. In fact, not only treating disease, but managing everything requires insight from this point.
II. Outline of Taiyang Bing
1. Taiyang Pathogenesis Clause
The content of the Taiyang Bing outline mainly focuses on Clause 1 of the Taiyang Chapter: "Taiyang Bing is characterized by floating pulse, stiffness and pain in the head and neck, and aversion to cold." This clause has been regarded by past generations as the outline clause of the Taiyang Chapter, while Ke Yunbo, a Qing dynasty master of Shanghan studies, regarded it as a pathogenesis clause. In his *Shanghan Laisu Ji*, he stated: "Master Zhongjing's method of writing treatises establishes one pathogenesis clause for each of the Six Channels, highlighting the outline of one channel, selecting the most appropriate pulse and Zheng of the respective channel to highlight." Pathogenesis refers to the key factors in the occurrence of disease. From where do we discover these factors? We discover them from these pulse and Zheng. Therefore, Master Ke discusses pathogenesis by highlighting these most appropriate pulse and Zheng. Consulting the 1959 March edition published by Shanghai Science and Technology Press of *Shanghan Laisu Ji*, the term used for pulse and Zheng is "Zheng" (Symptom). Many people today cannot distinguish between Zheng (Syndrome) and Zheng (Symptom), so a brief explanation is necessary here. Zheng (Symptom) is pronounced with the fourth tone, meaning symptoms or signs of disease. Zheng (Symptom) is a modern character, not an ancient one. The fourth-tone Zheng is not a simplified form of the traditional character, thus neither *Shuowen* nor *Kangxi Dictionary* records this character. Furthermore, the phonetic component has no simplified/traditional difference. Qin Bowei believed there was no difference between Zheng (Syndrome) and Zheng (Symptom), and they could be used interchangeably. However, analyzing the etymology of the two characters, the difference is great: Zheng (Syndrome) has a broad meaning, while Zheng (Symptom) has a narrow meaning, so they cannot actually be used interchangeably. Western medicine uses Zheng (Symptom) and does not use Zheng (Syndrome); TCM is better suited to use Zheng (Syndrome) and not Zheng (Symptom). Since the outline clause is also a pathogenesis clause, formatting the above clause into a pathogenesis format would benefit our understanding. The format follows the style of the Nineteen Pathogeneses: "All floating pulses, stiffness and pain in the head and neck, and aversion to cold, all belong to Taiyang." The pathogenesis clause discusses three pulse-Zheng combinations: one is floating pulse, one is stiffness and pain in the head and neck, and one is aversion to cold. These three pulse-Zheng combinations become the key to differentiating Taiyang Bing. So, must all three be present to diagnose Taiyang Bing? Certainly, if all three are present, it is definitely Taiyang Bing. But if only one or two are present, does this count as Taiyang Bing? This question has caused great controversy throughout history. My opinion leans towards the latter: diagnosing Taiyang Bing does not require all three to be present; having one or two is sufficient to diagnose Taiyang Bing. For example, Clause 6: "Taiyang Bing, fever and thirst, without aversion to cold, is Warm Disease." Here, it explicitly points out the absence of aversion to cold. Among the three, one is missing. Logically, it should no longer be diagnosed as Taiyang Bing, yet the clause title still prominently bears the label "Taiyang Bing." This clearly tells us that the three pulse-Zheng combinations in the pathogenesis clause do not all need to be present. Having one or two of the three should lead us to consider the possibility of Taiyang. Similarly, looking at the clauses in the *Shanghan Lun*, any clause labeled with Taiyang Bing should relate to the connotation of this pathogenesis clause. Even if not all three pulse-Zheng combinations are fully present, at least one of the three should be present.
2. Explanation
(1) Floating Pulse
Floating pulse is a pulse that responds immediately upon touching the skin. Li Shizhen's *Binhu Maixue* (Riverside Pulse Studies) says: "Floating lightly on top, like wood floating on water." As long as everyone develops the habit of the three steps of lifting, pressing, and searching when palpating the pulse, rather than diving straight to the bottom like a diver, this floating pulse is still easy to experience. Regarding floating pulse, we can understand it from the following aspects.
Jia. Where the Pulse Is, the Disease Is