阳明病很重要的一个问题就是讨论燥。但是，这个燥是本燥还是标燥却应该搞清楚。阳明的本燥我们前面已经论述过，它是凉燥。所以，《内经》又称为清气。当然，太过了就成为清邪。这与阳阴主合，主收，主降的特性相符合。而阳明病呢？就是阳明这样一个主合，主收，主降的本性被破坏了，这就成了阳明病。而最容易导致这个阳明的习性受损，最容易破坏阳明这个本性的，就是火热。因为火性炎上，火的这个性用就正好与阳明的性用相反，使阳明不能正常的收敛、沉降。所以，阳明病的这个燥显然与本燥相违，它是标燥，也就是热燥（燥热）。我们治疗这样一个燥要用白虎汤，要用三承气。白虎和承气是干什么的呢？它们都是清剂、降剂，都是泻火之剂。火热泻掉了，阳明的本性自然恢复。所以，阳明病主要讨论的是这样一个问题，是本性相违与本性恢复的问题。另外，大家还应考虑到物性不灭的道理，这个地方有火热，这个地方蒸干了，另外一个地方就必然潮湿。反之亦然。自然气候也是这样，大涝之后必大旱，大旱之后必大涝。为什么大涝之后必大旱，大旱之后必大涝呢？这就是自然的平衡，自然的调节，这就是物性不灭。老是下雨哪有那么多下的？那就必然要干旱。干旱久了，老在蒸腾，这个水总不会蒸到银河去，总不会蒸到外星球去。所以，蒸到一定的程度，升到一定的高度，它就要受一个降的因素制约，它就要降下来。升的时间久，降的时间就必然久；升的量大，降的量必然也大。所以，大旱之后必大涝，大涝之后必大旱。老子讲有无、难易、长短、高下、音声、前后，都是相生、相成、相形、相盈、相合、相随，而寒热、燥湿、旱涝、昼夜、东西亦是如此。阳明病是气分热盛，是肠胃热盛。阳明热盛，蒸耗胃家津液，致胃肠干燥而成胃家实之病。那么，接着上面这个思路，胃家的这个津液被蒸耗到哪里去了呢？一部分从腠理排泄掉了，所以，阳明病有大汗，有手足濈然汗出。而另一部分呢？另一部分必往上走而形成湿。这个“湿”的产生过多，把清窍给蒙蔽住了，就会产生神昏和谵语。过去我们都说热盛神昏，热扰神明神昏，热盛怎么会神昏，热扰怎么会神昏？这个道理总不容易思考清楚。如果我们从上面这个角度去思考，是不是会清晰一些呢。孟浩然的《春晓》云：“春眠不觉晓，处处闻啼鸟；夜来风雨声，花落知多少。”春眠为什么不觉晓？为什么我们整个上午都昏昏欲睡？夏天上大课，到了上午 3、4节，总有一大片要“倒”下去。我看这并不是同学们不用心思，而是这个昏沉来了确实让人无法抗拒。除非你真的头悬梁，锥刺股。那为什么产生这个现象呢？这就是因为春夏的阳气升腾，水被蒸发成为湿，这个湿往上走，当然就会影响清窍的神明。不过这个影响是生理度上的影响，这个湿所造成的“蒙蔽”比较轻微，能为我们正常的生理所承受。所以它只是产生昏沉，只是产生嗜睡。但它毕竟是产生影响了，它毕竟使我们“不觉晓”。而一旦这个影响的度超过了生理的范围，这就是阳明病讨论的范围。上面这些内容实际上亦牵涉到一个标本的问题。运气里阳明为什么要与太阴互为标本呢？这个问题值得我们深入地去思考。在六气的治法里，太阳太阴从本，少阳少阴从本从标，阳明厥阴不从标本从乎中气。阳明为什么不从标本而从乎中气呢？其实也可以从燥湿的关系去思考。阳明病有我们刚刚讲过的火气太过，火气太过，阳明就失去了它的本性，这个时候要用白虎、承气来治疗。大家思考过没有，用大黄、芒硝、枳实、厚朴这些药，为什么要叫承气汤呢？承什么气？就是承的这个阳明之气，就是承的这个降气。现在火热来了，阳明不降了，所以要承气，要使它重新恢复降。我的先师把承气汤读作顺气汤，就是这个意思。顺气者，顺阳明之气也，顺降气也。如果反过来，阳明降得太厉害了，那也会引起燥。这个燥就是阳明本性的燥，只是太过而已。《素问》把这个燥称为燥淫，淫就是太过的意思。燥淫于内，治以苦温，佐以甘辛。这个时候再不能用承气汤，再承气不就燥上加燥，雪上加霜了。这个时候要改用辛温苦温的方法来润燥。阳明篇不有一个吴茱萸汤吗？吴茱萸汤就是针对这种情况而设。大家不要光看吴茱萸这味药很辛燥，反过来吴茱萸汤还可以治燥，还可以润燥。所以，关键的还是一个理，理搞清了，事情就好办。吴茱萸汤为什么不可以治凉燥？为什么不可以治燥咳？当然可以！这就叫信手拈来，头头是道。再一点就是今年是庚辰年，今年南方的雨水特别多。为什么呢？这与今岁的年之所加有没有关系？我想应该有关系。大家可以自己去思考、去分析，而方法我们前面已经讲过了，无非是一升一降，一出一入，一寒一热，一水一火的问题。而归结起来，就是阴阳的问题。阳明的运气义就讨论到这里，阳明的篇题也就讲到这里。
二、阳明病提纲
我们先看阳明篇的第一条，即 179条：“问曰：病有太阳阳明，有正阳阳明，有少阳阳明，何谓也？答曰：太阳阳明者，脾约是也；正阳阳明者，胃家实是也：少阳阳明者，发汗、利小便已，胃中燥、烦、实，大便难是也。”这一条我们可以从四个方面来进行讨论。
1.总义
（1）阳明病的不同路径
这一条讲到三个阳明，即太阳阳明，正阳阳明，少阳阳明，也就是说至少有三个途径能导致阳明病，而这里提到的三个途径都只局限在三阳里。在三阳篇里，太阳为表，阳明为里，少阳为半表半里，三阳的病发展到阳明，从病势上、从病位上、从病情上，好像都有加重的趋势。所以，张仲景在这里提出这样三个途径，在一定意义上是希望我们能及早阻断这些路径。三个路径阻断了，便不会有脾约、胃家实、大便难的发生。阳明病除了上面三个途径，还会不会有其他的途径？比如说除了太阳阳明，正阳阳明，少阳阳明，还会不会有太阴阳明，少阴阳明，厥阴阳明？这个问题需要我们共同来思考。从张仲景所给出的线索，好像应该有这三个阳明。比如太阴篇 278 条的“至七八日，虽暴烦下利日十余行，必自止，以脾家实，腐秽当去故也”。前人云：实则阳明，虚则太阴。因此，这一条实际是太阴转出阳明，亦即太阴阳明的典型例子。另外，少阴篇的三急下证，即 320 条，321 条，322条，是否可以看作是少阴阳明？厥阴篇 374条用小承气汤，是否可以看作是厥阴阳明？三阳导致阳明，好像病情加重了，三阴转出阳明呢？这就形成了完全不同的问题。
（2）对下法的现代思考
前面我们谈过阳明这一经很重要，为什么重要呢？它既是载宝的地方，水谷在这里；也是藏污纳垢的地方，大便也在这里。阳明是精华与污秽同在的地方。有正有邪，正邪同居。从现代的角度看，这个宝秽同处，正邪同居，也可以有许多的方面。比如人体有很多的细菌，这个细菌用重量来衡量有 1千多克，用体积来衡量相当于肝脏的大小。那么这些细菌主要居住在哪里呢？就在阳明这个系统里。这些细菌有部分是致病菌，一俟条件成熟，它就会为非作歹。而有些却是身体的有益菌群，机体的部分必须物质，如维生素族，就是由这些菌群来合成生产。此外，有益菌群对致病菌群还具有拮抗作用。现在很多人对细菌的常识不了解，以为凡是细菌对于身体都有害无益，都应该统统地消灭。因此，把细菌当作了所有导致机体不健康因素的罪魁祸首从而也就把抗生素当作了维系机体健康的头号法宝。老百姓无论遇到什么病，都以为要用抗生素才能治好，而作医生的无论遇到什么病，不用上一些抗生素也总觉得不放心。这是目前中国医界的一个大现状，也是现代医学的一个最大的误区。美国人对过去的这个20世纪进行了方方面面的深刻反省，总结了几个重大的失误。其中一个最大的失误就是“滥用抗生素”。对这个失误，美国已经采取了一系列的重要措施来防止。现在在美国，对于抗生素的管制要远远地严格于枪支，这说明了美国人已经意识到抗生素对生命的危害作用要远远大过枪支。水能载舟，亦能覆舟，美国人在这一点上是十分清醒的。相比之下，在这个问题的认识上、措施上，我们却十分糊涂！那么，如何让上述这个宝，上述这个正对机体发挥最大的作用？如何使上述这个秽、上述这个邪的有害影响降低到最低的程度？关键就要看阳明这个系统的功能。而阳明的功能主要体现在一个通降上。我们从很直观的角度看这个通降，通降就体现在对肠道内容物、对粪便的排泄上。因此，保持大便通畅，对于维系机体健康是一个非常重要的方面。阳明这个通降的特性，使我们很容易的想到，毛病要是在阳明这个系统里，就可以通过清扫的方法，很容易地把它祛除掉。所谓清扫就是下法，就是三承气所包含的治法。疾病只要在阳明这个系统里，都有可能用上面的方法来“一泻了之”。因此，下法的前提是它必须在阳明这个系统里，必须形成阳明的局面，必须有阳明病的格局。如果没有这样的局面，没有形成这样的格局，你也使用这个治法，那就叫做“妄下”。“妄下”就会出问题。我想胡万林就是一个最典型不过的例子。但是，对胡万林也应该一分为二来看，不能一刀切，不能一棍子打死。他使用下法的这样一种精神和勇气，以及他众多的成功病例，是值得我们很好地思索与借鉴的。只是这个度他没有很好的把握，这个前提他没能很好的把握。上面这个前提非常重要，如果疾病不在阳明这个系统里，在其他的地方，我们可不可以通过一定的方法把它引导到阳明这个系统里来？我们可不可以通过一定的方法来帮助形成阳明这个格局？然后再一泻了之。我想从理论上应该完全可能。而且不少的古代医家，像张子和这样的医家已经在这方面做了大量的探索和实践。借助这些探索，借助这些经验，上述这个引导过程的技术是可以形成和完善的。
在我们提出这样一个问题的时候，在我们作出这样一个思考的时候，我们突然发现，我们虽然还是在谈论一个很传统的问题，很经典的问题，但是，我们已经不是在原来的那个点上来讨论它，我们已经跨越了两个千年。我们利用现代的思维对传统的问题进行新视点、新角度的思考，这样一个过程算不算中医现代化呢？我想这个问题很值得大家思考，尤其是中医的主管部门、行政部门更不应该轻视这个问题。现在一提到现代化，大家很自然地都把目光聚焦在现代化的手段和现代化的仪器设备上，以为非要实验研究，非要进入现代化的实验室，非要把中医放在分子生物学甚至基因片断上来研究，这才是现代化。一句话，非要小白鼠、小白兔点头这才算现代化。现在你要申报课题，如果没有这些内容，你是很难获得通过的。当然，上面这些工作必须要人去做，但这仅仅是一个方面。如果我们把全部的精力，把所有的目光，都集中在这个方面，那就难免会犯错误。我们现在来谈现代化，就像我们上面谈下法，它有一个重要的前提。如我们跟台湾谈判，一个中国就是一个前提，有这个前提什么都能说，什么都能谈。如果没有这个前提，什么都不能谈。中医的现代化也是这样，中医就是一个根本的前提。
我所在的广西中医学院院长王乃平教授曾多次强调：“离开中医这个前提去搞现代化，其结果将会是现代化的程度越高，中医死得越快。”王院长的这个论断不但具有很深的战略意义，同时也有很深的哲学意义。这使我再次想到《庄子·应帝王》中的一则寓言：“南海之帝为儵，北海之帝为忽，中央之帝为浑沌。儵与忽时相与遇于浑沌之地，浑沌待之甚善。儵与忽谋报浑沌之德，曰：‘人皆有七窍以视听食息。此独无有，尝试凿之。’日凿一窍，七日而浑沌死。”中医要搞现代化，中医不能老是这副土里土气的样子。搞现代化的目的是为了让中医更好地适应现代，更好地服务现代。但是，如果这个现代化搞不好，中医会像浑沌一样死在我们手中，这是完全有可能的。
阳明病中一个非常重要的问题，就是讨论“燥”。但是，必须搞清楚这个燥是源于本性的“本燥”，还是源于外邪的“标燥”。阳明的本燥我们在前面已经论述过，它属于凉燥。因此，《黄帝内经》将其称为“清气”。当然，如果太过分，就会变成清邪。这与阳明主合、主收、主降的特性是相符的。那么，什么是阳明病呢？就是阳明这种主合、主收、主降的本性被破坏了，这就构成了阳明病。而最容易导致阳明习性受损、最容易破坏阳明本性的因素，就是火热。因为火的特性是炎上，火的作用正好与阳明的作用相反，使得阳明无法正常地收敛和沉降。所以，阳明病中的燥显然与本燥相违背，它是标燥，也就是热燥（燥热）。治疗这种燥，需要使用白虎汤和三承气汤。白虎汤和承气汤起什么作用呢？它们都是清热剂、降气剂，都是泻火之剂。火热被清除后，阳明的本性自然恢复。因此，阳明病主要讨论的是这样一个问题：本性相违与本性恢复的问题。另外，大家还应考虑到物性不灭的道理，这个地方有火热，这里被蒸干了，另一个地方就必然潮湿。反之亦然。自然气候也是如此，大涝之后必有大旱，大旱之后必有大涝。为什么大涝之后必有大旱，大旱之后必有大涝呢？这就是自然的平衡，自然的调节，这就是物性不灭。老是下雨哪有那么多雨可下？那就必然要干旱。干旱久了，一直在蒸腾，水总不会蒸到银河去，总不会蒸到外星球去。所以，蒸到一定的程度，升到一定的高度，它就会受到一个下降因素的制约，它就要降下来。上升的时间久，下降的时间就必然久；上升的量多，下降的量必然也大。所以，大旱之后必有大涝，大涝之后必有大旱。老子讲有无、难易、长短、高下、音声、前后，都是相生、相成、相形、相盈、相合、相随，而寒热、燥湿、旱涝、昼夜、东西亦是如此。阳明病是气分热盛，是肠胃热盛。阳明热盛，蒸耗胃家津液，导致胃肠干燥而成胃家实之病。那么，接着上面这个思路，胃家的津液被蒸耗到哪里去了呢？一部分从腠理排泄掉了，所以，阳明病有大汗，有手足濈然汗出。而另一部分呢？另一部分必往上走而形成湿。这个“湿”产生过多，把清窍给蒙蔽住了，就会产生神昏和谵语。过去我们都说热盛神昏，热扰神明神昏，热盛怎么会神昏，热扰怎么会神昏？这个道理总不容易思考清楚。如果我们从上面这个角度去思考，是不是会清晰一些呢。孟浩然的《春晓》云：“春眠不觉晓，处处闻啼鸟；夜来风雨声，花落知多少。”春眠为什么不觉晓？为什么我们整个上午都昏昏欲睡？夏天上大课，到了上午 3、4节，总有一大片要“倒”下去。我看这并不是同学们不用心思，而是这个昏沉来了确实让人无法抗拒。除非你真的头悬梁，锥刺股。那为什么产生这个现象呢？这就是因为春夏的阳气升腾，水被蒸发成为湿，这个湿往上走，当然就会影响清窍的神明。不过这个影响是生理度上的影响，这个湿所造成的“蒙蔽”比较轻微，能为我们正常的生理所承受。所以它只是产生昏沉，只是产生嗜睡。但它毕竟是产生影响了，它毕竟使我们“不觉晓”。而一旦这个影响的度超过了生理的范围，这就是阳明病讨论的范围。上面这些内容实际上亦牵涉到一个标本的问题。运气里阳明为什么要与太阴互为标本呢？这个问题值得我们深入地去思考。在六气的治法里，太阳太阴从本，少阳少阴从本从标，阳明厥阴不从标本从乎中气。阳明为什么不从标本而从乎中气呢？其实也可以从燥湿的关系去思考。阳明病有我们刚刚讲过的火气太过，火气太过，阳明就失去了它的本性，这个时候要用白虎、承气来治疗。大家思考过没有，用大黄、芒硝、枳实、厚朴这些药，为什么要叫承气汤呢？承什么气？就是承的这个阳明之气，就是承的这个降气。现在火热来了，阳明不降了，所以要承气，要使它重新恢复降。我的先师把承气汤读作顺气汤，就是这个意思。顺气者，顺阳明之气也，顺降气也。如果反过来，阳明降得太厉害了，那也会引起燥。这个燥就是阳明本性的燥，只是太过而已。《素问》把这个燥称为燥淫，淫就是太过的意思。燥淫于内，治以苦温，佐以甘辛。这个时候再不能用承气汤，再承气不就燥上加燥，雪上加霜了。这个时候要改用辛温苦温的方法来润燥。阳明篇不有一个吴茱萸汤吗？吴茱萸汤就是针对这种情况而设。大家不要光看吴茱萸这味药很辛燥，反过来吴茱萸汤还可以治燥，还可以润燥。所以，关键的还是一个理，理搞清了，事情就好办。吴茱萸汤为什么不可以治凉燥？为什么不可以治燥咳？当然可以！这就叫信手拈来，头头是道。再一点就是今年是庚辰年，今年南方的雨水特别多。为什么呢？这与今岁的年之所加有没有关系？我想应该有关系。大家可以自己去思考、去分析，而方法我们前面已经讲过了，无非是一升一降，一出一入，一寒一热，一水一火的问题。而归结起来，就是阴阳的问题。阳明的运气义就讨论到这里，阳明的篇题也就讲到这里。
二、阳明病提纲
我们先看阳明篇的第一条，即第179条：“问曰：病有太阳阳明，有正阳阳明，有少阳阳明，何谓也？答曰：太阳阳明者，脾约是也；正阳阳明者，胃家实是也：少阳阳明者，发汗、利小便已，胃中燥、烦、实，大便难是也。”这一条我们可以从四个方面来进行讨论。
1.总义
（1）阳明病的不同路径
这一条讲到三个阳明，即太阳阳明，正阳阳明，少阳阳明，也就是说至少有三个途径能导致阳明病，而这里提到的三个途径都只局限在三阳里。在三阳篇里，太阳为表，阳明为里，少阳为半表半里，三阳的病发展到阳明，从病势上、从病位上、从病情上，好像都有加重的趋势。所以，张仲景在这里提出这样三个途径，在一定意义上是希望我们能及早阻断这些路径。三个路径阻断了，便不会有脾约、胃家实、大便难的发生。阳明病除了上面三个途径，还会不会有其他的途径？比如说除了太阳阳明，正阳阳明，少阳阳明，还会不会有太阴阳明，少阴阳明，厥阴阳明？这个问题需要我们共同来思考。从张仲景所给出的线索，好像应该有这三个阳明。比如太阴篇 278 条的“至七八日，虽暴烦下利日十余行，必自止，以脾家实，腐秽当去故也”。前人云：实则阳明，虚则太阴。因此，这一条实际是太阴转出阳明，亦即太阴阳明的典型例子。另外，少阴篇的三急下证，即 320 条，321 条，322条，是否可以看作是少阴阳明？厥阴篇 374条用小承气汤，是否可以看作是厥阴阳明？三阳导致阳明，好像病情加重了，三阴转出阳明呢？这就形成了完全不同的问题。
（2）对下法的现代思考
前面我们谈过阳明这一经很重要，为什么重要呢？它既是载宝的地方，水谷在这里；也是藏污纳垢的地方，大便也在这里。阳明是精华与污秽同在的地方。有正有邪，正邪同居。从现代的角度看，这个宝秽同处，正邪同居，也可以有许多的方面。比如人体有很多的细菌，这个细菌用重量来衡量有 1千多克，用体积来衡量相当于肝脏的大小。那么这些细菌主要居住在哪里呢？就在阳明这个系统里。这些细菌有部分是致病菌，一俟条件成熟，它就会为非作歹。而有些却是身体的有益菌群，机体的部分必须物质，如维生素族，就是由这些菌群来合成生产。此外，有益菌群对致病菌群还具有拮抗作用。现在很多人对细菌的常识不了解，以为凡是细菌对于身体都有害无益，都应该统统地消灭。因此，把细菌当作了所有导致机体不健康因素的罪魁祸首从而也就把抗生素当作了维系机体健康的头号法宝。老百姓无论遇到什么病，都以为要用抗生素才能治好，而作医生的无论遇到什么病，不用上一些抗生素也总觉得不放心。这是目前中国医界的一个大现状，也是现代医学的一个最大的误区。美国人对过去的这个20世纪进行了方方面面的深刻反省，总结了几个重大的失误。其中一个最大的失误就是“滥用抗生素”。对这个失误，美国已经采取了一系列的重要措施来防止。现在在美国，对于抗生素的管制要远远地严格于枪支，这说明了美国人已经意识到抗生素对生命的危害作用要远远大过枪支。水能载舟，亦能覆舟，美国人在这一点上是十分清醒的。相比之下，在这个问题的认识上、措施上，我们却十分糊涂！那么，如何让上述这个宝，上述这个正对机体发挥最大的作用？如何使上述这个秽、上述这个邪的有害影响降低到最低的程度？关键就要看阳明这个系统的功能。而阳明的功能主要体现在一个通降上。我们从很直观的角度看这个通降，通降就体现在对肠道内容物、对粪便的排泄上。因此，保持大便通畅，对于维系机体健康是一个非常重要的方面。阳明这个通降的特性，使我们很容易的想到，毛病要是在阳明这个系统里，就可以通过清扫的方法，很容易地把它祛除掉。所谓清扫就是下法，就是三承气所包含的治法。疾病只要在阳明这个系统里，都有可能用上面的方法来“一泻了之”。因此，下法的前提是它必须在阳明这个系统里，必须形成阳明的局面，必须有阳明病的格局。如果没有这样的局面，没有形成这样的格局，你也使用这个治法，那就叫做“妄下”。“妄下”就会出问题。我想胡万林就是一个最典型不过的例子。但是，对胡万林也应该一分为二来看，不能一刀切，不能一棍子打死。他使用下法的这样一种精神和勇气，以及他众多的成功病例，是值得我们很好地思索与借鉴的。只是这个度他没有很好的把握，这个前提他没能很好的把握。上面这个前提非常重要，如果疾病不在阳明这个系统里，在其他的地方，我们可不可以通过一定的方法把它引导到阳明这个系统里来？我们可不可以通过一定的方法来帮助形成阳明这个格局？然后再一泻了之。我想从理论上应该完全可能。而且不少的古代医家，像张子和这样的医家已经在这方面做了大量的探索和实践。借助这些探索，借助这些经验，上述这个引导过程的技术是可以形成和完善的。
在我们提出这样一个问题的时候，在我们作出这样一个思考的时候，我们突然发现，我们虽然还是在谈论一个很传统的问题，很经典的问题，但是，我们已经不是在原来的那个点上来讨论它，我们已经跨越了两个千年。我们利用现代的思维对传统的问题进行新视点、新角度的思考，这样一个过程算不算中医现代化呢？我想这个问题很值得大家思考，尤其是中医的主管部门、行政部门更不应该轻视这个问题。现在一提到现代化，大家很自然地都把目光聚焦在现代化的手段和现代化的仪器设备上，以为非要实验研究，非要进入现代化的实验室，非要把中医放在分子生物学甚至基因片断上来研究，这才是现代化。一句话，非要小白鼠、小白兔点头这才算现代化。现在你要申报课题，如果没有这些内容，你是很难获得通过的。当然，上面这些工作必须要人去做，但这仅仅是一个方面。如果我们把全部的精力，把所有的目光，都集中在这个方面，那就难免会犯错误。我们现在来谈现代化，就像我们上面谈下法，它有一个重要的前提。如我们跟台湾谈判，一个中国就是一个前提，有这个前提什么都能说，什么都能谈。如果没有这个前提，什么都不能谈。中医的现代化也是这样，中医就是一个根本的前提。
我所在的广西中医学院院长王乃平教授曾多次强调：“离开中医这个前提去搞现代化，其结果将会是现代化的程度越高，中医死得越快。”王院长的这个论断不但具有很深的战略意义，同时也有很深的哲学意义。这使我再次想到《庄子·应帝王》中的一则寓言：“南海之帝为儵，北海之帝为忽，中央之帝为浑沌。儵与忽时相与遇于浑沌之地，浑沌待之甚善。儵与忽谋报浑沌之德，曰：‘人皆有七窍以视听食息。此独无有，尝试凿之。’日凿一窍，七日而浑沌死。”中医要搞现代化，中医不能老是这副土里土气的样子。搞现代化的目的是为了让中医更好地适应现代，更好地服务现代。但是，如果这个现代化搞不好，中医会像浑沌一样死在我们手中，这是完全有可能的。
One very important issue in Yangming disease (Yangming Syndrome) is the discussion of dryness (Zao). However, it must be clarified whether this dryness is "original dryness" (Ben Zao) originating from the nature of the channel, or "manifest dryness" (Biao Zao) caused by external pathogens. As discussed earlier, the original dryness of Yangming is cool dryness. Therefore, the *Huangdi Neijing* (Yellow Emperor's Inner Canon) refers to it as "clear qi" (Qing Qi). Of course, if it becomes excessive, it turns into clear pathogenic factors (Qing Xie). This conforms to the characteristics of Yangming, which governs conjunction (He), gathering (Shou), and descending (Jiang). So, what is Yangming disease? It occurs when the nature of Yangming—conjunction, gathering, and descending—is disrupted. The factor that most easily damages this Yangming habit and disrupts its nature is fire-heat. Because the nature of fire is flaming upward, its functional action is exactly opposite to that of Yangming, preventing Yangming from normally converging and sinking. Therefore, the dryness in Yangming disease obviously contradicts the original dryness; it is manifest dryness, namely heat-dryness (Re Zao). To treat such dryness, one should use Baihu Tang (White Tiger Decoction) and the three Chengqi formulas (Chengqi Formulas). What do Baihu Tang and Chengqi formulas do? They are all clearing agents, descending agents, and purgative agents for draining fire. Once the fire-heat is drained, the original nature of Yangming naturally recovers. Thus, Yangming disease mainly discusses the issue of deviation from original nature and the restoration of original nature. Additionally, everyone should consider the principle that material properties do not vanish: if there is fire-heat in one place, causing evaporation and dryness, another place will inevitably become damp. Conversely, the same applies. Natural climate is also like this: after a great flood, there must be a great drought; after a great drought, there must be a great flood. Why does a great flood lead to a great drought, and a great drought lead to a great flood? This is natural balance and natural regulation, which is the non-destruction of material properties. If it rains constantly, where would so much rain come from? It must inevitably become dry. After a long period of drought, continuous evaporation occurs; water cannot evaporate into the Milky Way or outer planets. Therefore, when evaporation reaches a certain degree and rises to a certain height, it is constrained by a descending factor and must fall back. The longer the rising time, the longer the descending time; the larger the rising volume, the larger the descending volume. Hence, after a great drought comes a great flood, and after a great flood comes a great drought. Laozi spoke of existence and non-existence, difficulty and ease, length and shortness, height and depth, sound and voice, front and back, all being mutually generated, completed, shaped, filled, combined, and following each other. Similarly, cold and heat, dryness and dampness, drought and flood, day and night, east and west follow this pattern. Yangming disease involves excess heat in the Qi level and excess heat in the stomach and intestines. Excess heat in Yangming steams and consumes the body fluids of the stomach family, leading to dryness in the stomach and intestines and resulting in the syndrome of "Stomach Family Excess" (Wei Jia Shi). Following this line of thought, where do the consumed body fluids go? Part of them is excreted through the interstices (Cou Li), hence Yangming disease presents with profuse sweating and continuous sweating on the hands and feet. The other part moves upward to form dampness. When this "dampness" becomes excessive, it obscures the clear orifices, producing unconsciousness (Shen Hun) and delirious speech (Zhan Yu). Previously, we said that excess heat causes unconsciousness and heat disturbing the mind spirit causes unconsciousness. How can heat cause unconsciousness? How can heat disturbance cause unconsciousness? This logic is often hard to clarify. If we think from the perspective mentioned above, wouldn't it be clearer? Meng Haoran's poem *Spring Dawn* says: "Sleeping in spring, I am unaware of dawn; everywhere I hear birds singing; last night came the sound of wind and rain, who knows how many flowers have fallen?" Why is spring sleep unaware of dawn? Why do we feel drowsy throughout the morning? In summer large lectures, by the third or fourth period, a large group tends to "collapse" (fall asleep). I believe this is not because students lack focus, but because this lethargy is indeed irresistible unless one literally ties their hair to the beam and pierces their thigh with an awl. Why does this phenomenon occur? It is because during spring and summer, Yang Qi ascends, water evaporates into dampness, and this dampness moves upward, affecting the clarity of the orifices and the mind spirit. However, this influence is within physiological limits; the "obscuration" caused by this dampness is relatively mild and can be borne by normal physiology. Thus, it only produces lethargy and somnolence. But since it has an effect, it makes us "unaware of dawn." Once this influence exceeds physiological limits, it falls within the scope of Yangming disease. The above content actually involves the issue of root (Ben) and branch (Biao). In the theory of Six Qi, why do Yangming and Taiyin serve as root and branch for each other? This question deserves deep reflection. In the treatment methods of the Six Qi, Taiyang and Taiyin follow the root; Shaoyang and Shaoyin follow both root and branch; Yangming and Jueyin do not follow root or branch but follow the intermediate Qi (Zhong Qi). Why does Yangming not follow root or branch but follow intermediate Qi? This can also be considered from the relationship between dryness and dampness. Yangming disease involves the excessive fire qi mentioned earlier. When fire qi is excessive, Yangming loses its original nature, requiring treatment with Baihu and Chengqi formulas. Have you ever thought about why the formula containing Da Huang (Rhubarb Root), Mang Xiao (Mirabilite), Zhi Shi (Immature Bitter Orange), and Hou Po (Magnolia Bark) is called Chengqi Tang? What "Qi" does it "inherit" or "support"? It supports the Qi of Yangming, specifically the descending Qi. Now that fire-heat has arrived and Yangming fails to descend, we need to "inherit/support" the Qi to restore its descending function. My late teacher read Chengqi Tang as Shunqi Tang (Smooth Qi Decoction), which means exactly this. Shunqi means smoothing the Qi of Yangming, i.e., the descending Qi. Conversely, if Yangming descends too excessively, it will also cause dryness. This dryness is the original dryness of Yangming, merely excessive. The *Suwen* calls this dryness "Dryness Overacting" (Zao Yin), where "Yin" means excessive. For dryness overacting internally, treat with bitter-warm herbs, assisted by sweet-acrid ones. At this time, Chengqi Tang should no longer be used; using it again would add dryness to dryness, making matters worse. Instead, acrid-warm and bitter-warm methods should be used to moisten dryness. Is there not a Wuzhuyu Tang (Evodia Decoction) in the Yangming chapter? Wuzhuyu Tang is designed for this situation. Do not just look at Wu Zhu Yu (Evodia Fruit) as being very acrid and drying; conversely, Wuzhuyu Tang can also treat dryness and moisten it. So, the key lies in understanding the principle. Once the principle is clear, matters become easy. Why can't Wuzhuyu Tang treat cool dryness? Why can't it treat dry cough? Of course it can! This is called handling things effortlessly and logically. Another point is that this year is the Gengchen year, and southern China has experienced particularly abundant rainfall. Why? Does this relate to the annual influence? I think it does. Everyone can think and analyze it themselves, using the methods discussed earlier: simply the issues of one ascending and one descending, one exiting and one entering, one cold and one hot, one water and one fire. Ultimately, it boils down to Yin and Yang. This concludes the discussion on the fortune meaning of Yangming and the title of the Yangming chapter.
II. Outline of Yangming Disease
Let us first look at the first article of the Yangming chapter, Article 179: "Question: There are diseases of Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming. What are they? Answer: Taiyang-Yangming is Pi Yue (Spleen Constriction); Zhengyang-Yangming is Wei Jia Shi (Stomach Family Excess); Shaoyang-Yangming is, after sweating and promoting urination, dryness, irritability, excess in the stomach, and difficulty in defecation." We can discuss this article from four aspects.
1. General Meaning
(1) Different Pathways of Yangming Disease
This article mentions three types of Yangming: Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming. This means there are at least three pathways leading to Yangming disease, and these three pathways are limited to the Three Yang channels. In the chapters on the Three Yang, Taiyang is exterior, Yangming is interior, and Shaoyang is half-exterior half-interior. The development of diseases in the Three Yang to Yangming seems to show a trend of aggravation in terms of disease momentum, location, and condition. Therefore, Zhang Zhongjing proposed these three pathways here, intending in a certain sense to hope that we can block these paths early. If the three paths are blocked, Pi Yue, Wei Jia Shi, and difficulty in defecation will not occur. Besides the above three pathways, are there other pathways for Yangming disease? For example, besides Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming, could there be Taiyin-Yangming, Shaoyin-Yangming, and Jueyin-Yangming? This is a question we need to ponder together. Based on the clues provided by Zhang Zhongjing, it seems there should be these three Yangmings. For instance, in Article 278 of the Taiyin chapter: "By the seventh or eighth day, although there is sudden irritability and diarrhea more than ten times a day, it must stop spontaneously, because the Spleen Family is full, and putrefied filth is being expelled." Ancients said: "Excess manifests in Yangming, deficiency manifests in Taiyin." Therefore, this article is actually an example of Taiyin transforming into Yangming, i.e., a typical case of Taiyin-Yangming. Additionally, can the three urgent purgation syndromes in the Shaoyin chapter (Articles 320, 321, 322) be regarded as Shaoyin-Yangming? Can the use of Xiao Chengqi Tang (Minor Chengqi Decoction) in Article 374 of the Jueyin chapter be regarded as Jueyin-Yangming? When Three Yang leads to Yangming, the condition seems to worsen; what about Three Yin transforming into Yangming? This forms a completely different problem.
(2) Modern Reflections on Purgation Method
We previously discussed that the Yangming channel is very important. Why is it important? It is both a place carrying treasures, where food and water reside; and a place hiding filth, where feces reside. Yangming is a place where essence and filth coexist. There is righteousness and evil, cohabiting. From a modern perspective, this coexistence of treasure and filth, righteousness and evil, can be viewed in many ways. For example, the human body has many bacteria, weighing over 1 kilogram and occupying a volume equivalent to the liver. Where do these bacteria mainly reside? In the Yangming system. Some of these bacteria are pathogenic; once conditions mature, they wreak havoc. Others are beneficial flora, essential substances for the body, such as vitamin groups, synthesized and produced by these flora. Furthermore, beneficial flora have antagonistic effects on pathogenic flora. Many people today lack common knowledge about bacteria, believing that all bacteria are harmful and should be eradicated. Thus, bacteria are seen as the chief culprits of all unhealthy factors in the body, and antibiotics are regarded as the primary magic weapon for maintaining health. Regardless of the illness, laypeople believe antibiotics are necessary for cure, and doctors feel uneasy without prescribing some antibiotics. This is a major current situation in Chinese medicine and a significant misconception in modern medicine. Americans have conducted profound reflections on various aspects of the past 20th century and summarized several major mistakes. One of the biggest mistakes was the "abuse of antibiotics." The US has taken a series of important measures to prevent this mistake. Currently, antibiotic control in the US is far stricter than gun control, indicating that Americans realize the harm of antibiotics to life is far greater than that of guns. Water can carry a boat but also capsize it; Americans are very clear-headed on this point. In contrast, our understanding and measures regarding this issue are very confused! So, how can we maximize the role of the aforementioned treasure and righteousness in the body? How can we minimize the harmful effects of the aforementioned filth and evil? The key lies in the function of the Yangming system. The function of Yangming is mainly reflected in "free flow and descent." Intuitively, free flow and descent are manifested in the excretion of intestinal contents and feces. Therefore, keeping bowel movements unobstructed is a very important aspect of maintaining health. The characteristic of free flow and descent in Yangming makes it easy to think that if the pathology is in the Yangming system, it can be easily removed by cleaning methods. Such cleaning refers to the purgation method (Xia Fa), which includes the treatments contained in the three Chengqi formulas. As long as the disease is in the Yangming system, it is possible to "purge it away" using the above methods. Therefore, the prerequisite for purgation is that it must be within the Yangming system, forming a Yangming situation and pattern. Without such a situation or pattern, using this treatment is called "reckless purgation" (Wang Xia). "Reckless purgation" will cause problems. Hu Wanlin is perhaps the most typical example. However, Hu Wanlin should be viewed dialectically, not judged entirely negatively. His spirit and courage in using purgation, along with his numerous successful cases, are worth thoughtful consideration and reference. He simply failed to grasp the degree and the prerequisites well. The above prerequisite is very important. If the disease is not in the Yangming system but elsewhere, can we guide it into the Yangming system through certain methods? Can we help form a Yangming pattern through certain methods, and then purge it away? Theoretically, this should be entirely possible. Moreover, many ancient physicians, such as Zhang Zihe, have done extensive exploration and practice in this regard. With the help of these explorations and experiences, the technology of this guiding process can be formed and perfected.
When we raise such a question and make such a reflection, we suddenly discover that although we are still discussing a very traditional and classic issue, we are no longer discussing it from the original point; we have transcended two millennia. Using modern thinking to reflect on traditional issues from new viewpoints and angles—does this process count as the modernization of Traditional Chinese Medicine (TCM)? I think this question is worth everyone's reflection, especially those in charge of TCM administration should not underestimate it. Nowadays, when mentioning modernization, people naturally focus on modern means and equipment, believing that only experimental research, entering modern laboratories, and studying TCM at the molecular biology or even gene fragment level constitutes modernization. In short, only when mice and rabbits nod does it count as modernization. Today, if you apply for a project without these contents, it is difficult to get approval. Of course, the above work must be done by people, but this is only one aspect. If we concentrate all energy and attention on this aspect, we are bound to make mistakes. Discussing modernization now is like discussing purgation; it has an important prerequisite. Just as in negotiations with Taiwan, "One China" is the prerequisite; with this prerequisite, anything can be discussed. Without this prerequisite, nothing can be discussed. The modernization of TCM is the same; TCM itself is the fundamental prerequisite.
Professor Wang Naiping, Dean of the Guangxi University of Chinese Medicine, where I work, has repeatedly emphasized: "Going for modernization while leaving aside the premise of TCM will result in higher degrees of modernization leading to faster death of TCM." This assertion by Dean Wang has profound strategic and philosophical significance. It reminds me again of a fable from *Zhuangzi: Ying Di Wang*: "The emperor of the South Sea was Shu, the emperor of the North Sea was Hu, and the emperor of the Central Region was Hundun. Shu and Hu frequently met in Hundun's territory, and Hundun treated them very well. Shu and Hu planned to repay Hundun's kindness, saying, 'All men have seven apertures for seeing, hearing, eating, and breathing. This one alone has none. Let us try to bore them.' They bored one aperture a day, and on the seventh day, Hundun died." TCM needs modernization and cannot always look rustic. The purpose of modernization is to allow TCM to better adapt to and serve the modern world. However, if modernization is mishandled, TCM may die in our hands like Hundun, which is entirely possible.