保持和发扬传统特色，走现代化道路。这是两全其美的事，这是非常值得赞叹的事。但，弄不好这又是一厢情愿的事。传统和现代化有些时候就像一个悖论，你抓住了这头就会失去那头，你抓了那头就会失去这头。不信大家往现实中看一看，有几个人能一头钻进实验室里，而另一头又埋在《内经》里？有几个人一手抓分子生物学，一手又抓《黄帝内经》？像现在的两个文明一样，两手都要抓，两手都要硬。很少有人能做到这一点。极大多数的人是抓了分子生物学就丢了《黄帝内经》。我在第一章里曾经提到过，在博士这个群体里，为什么有那么多的人不再光顾《内经》？不再光顾《伤寒论》？可见“此事两难全”。就像我一样，一头埋在《内经》、《伤寒》了，就再腾不出另一头放到实验室里。不过，我对现代是非常关注的，也在不时地运用现代思维来思考传统的问题。经过长期的关注与思考，使我得出了两个基本的看法：第一个看法，中医的现代化首先是思想上的现代化，思维上的现代化，表述上的现代化，应该急于进行思维上的现代化实验，而不宜急于小白鼠的实验；第二个看法，传统与现代的结合，应该是传统精英与现代精英的结合，只有这样的结合才能有成效，才会出硕果。过去这些年里我们把这个路子合起来了，想在一个人身上同时打造出两个精英，然后实现两个精英的自然结合。现在看来，这是欲速而不达。这个路子必须分开来走。对于现代精英的造就并不困难，因为现在整个世界，整个时代都在致力于这个精英的培养。而要培养一个传统精英，却是困难重重。因此，要实现传统与现代的结合，要实现中医的现代化，我们应该把很大的一部分精力放在传统上，放在传统精英的打造上。我想这是一个十分重要的前提。中医能不能用现代的这些手段，能不能用CT、核磁共振，当然能用。现代的一切手段我想中医都能用，但是，大家不要误以为这就是中医的现代化。如果你把这些当作中医现代化，那从内涵上和逻辑上都是讲不通的。从目前的情况看，运用现代化的这些手段，不能叫中医现代化，充其量只能算中医用现代化。中医不必老是长袍马褂，中医也可以穿西装革履，但并不意味穿上西装这个中医就改变了，中医没有改变，中医还是那个中医。这是两个不同的概念，希望大家能够分清楚。
第一章中我们谈到，先师用大量的陈皮、白芷、玉竹、大枣治疗血气胸，服药以后出现大量泻下，泻后胸腔的血气很快吸收。泻一泻肚，胸腔的血气就没有了。是胸腔的血气通过一个突然开放的通道直接转移到大肠里去了呢？还是被血液直接吸收了？为什么肠炎的拉肚子起不到这个作用？在这里先师为什么不用大小承气汤来泻下？而要用这些平常都不会引起泻下作用的药物来泻下？肺的问题，胸腔的问题，可以通过肺与大肠的这个表里关系直接转送到大肠，然后排泄出去。那么，其他地方的病是不是也可通过经络之间的互相联系，通过一个中转，也转送到大肠里，也转移到阳明里，然后排泄出去呢？如果这样的路子可行，那么很多疑难病症就有了解决的办法。我们学习这一条条文时，如果能够这样来思维，这就为我们今后的研究，为我们传统的研究，为我们现代的研究，留出了一大片空间，提出了一大堆研究课题。这样的一个思维过程难道就不是现代化吗？对于现代化的理解我们不应该太机械、太死板，应该把眼光放远一点。有些问题是很确凿的，二千年的历史都点头了，干吗一定还要小白鼠点头才行。
2.脾约
脾约就是太阳阳明，怎么叫做脾约呢？我们看六版《伤寒论》教材的词解：“脾约：胃热肠燥津伤而致的便秘。”有的则释为胃热津伤，脾之功能为胃热所约，致不能为胃行其津液，故致肠燥便秘者，是为脾约。对于上面这些解释，以及其他类似的许多解释，我一直感到难以信服。如果是这样的一个便秘，古人完全可以叫一个其他的名字，或者叫“津伤”，或者叫“燥肠”，或者叫“胃热”都行。干吗一定要叫这个不相干的脾约呢？脾约与太阳阳明有什么关联？如果这样来解释，至少在逻辑上我们看不出它与太阳阳明的关联。脾约的表现是肠中燥，便硬结，这一点是可以肯定的。问题是这个肠燥便秘为什么要叫脾约？而且为什么要太阳阳明才叫脾约？其实这个问题既复杂又简单，说它复杂是一千多年没能得出一个令人信服的说法，说它简单确实简单，你只要把它放进燥湿里去考虑，就很容易地解决了。有关燥湿的关系我们刚刚讨论过，就脾胃而言，脾属湿，胃属燥。约是什么意思呢？约就是约束的意思。脾约就等于把湿约束起来了，脾湿一约，胃燥自然就显现，自然就有肠燥便秘的现象。这好像是在做文字游戏，但是这个游戏很有意思。湿一约，当然就燥了，脾约就是这么一回事情。但为什么一定要太阳阳明才叫脾约呢？我们看 247条：“趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则硬，其脾为约，麻子仁丸主之。”这一条讲脾约点出了小便数、大便硬，是小便数导致这个肠中燥、大便硬，是小便数导致这个阳明，所以它叫太阳阳明。为什么叫太阳阳明？因为小便由膀胱所主，由太阳所主。由小便数所导致的这个阳明，那当然就可以叫做太阳阳明。可是为什么小便数一定要牵扯到脾约上来呢？这就是一个水土之间的关系问题。正常情况下土克水，土约水，现在土的自身功能受约制了，那当然就不能制水，那当然就会小便数。所以，太阳阳明就与脾约很有关联。另外，除了小便数大便因硬的情况外，临床上还可以见到汗出过多大便亦硬的情况。汗为腠理所司，亦为太阳所主。汗出过多所致的胃中干燥大便硬，是不是也可以叫做太阳阳明？是不是也可以按照脾约的方法去治疗？这个问题也希望大家共同来思考。
3.正阳阳明
（1）历代医家之释对于正阳阳明的释义，历代不尽相同。如六版教材云：“外邪入里，直犯阳明而形成，叫做正阳阳明”；尤在泾则以“邪热入胃，糟粕内结，阳明自病”为正阳阳明；有以阳明本燥，故阳明病燥结者，是其本气之病，故谓正阳阳明，如张锡驹即本此；有以不兼太阳、少阳的阳明病为正阳阳明，如汪琥即持此观点。对于以上各家的观点，大家可以参考。
（2）正阳本义
正阳这个词在《伤寒论》中没有单独使用，它只是与阳明搭配而成“正阳阳明”。正阳是否就是指太阳、少阳之外的阳明？或者正阳这个词还有其他的含义？这个问题上述的这些释义似乎都没有提出来。我们认为正阳不见得就是指阳明，或者说正宗的阳明就叫正阳。正阳应该有它专门的含义，这个含义我们可以从文字的角度来了解。《康熙字典》载云：“四月亦曰正月。《诗·小雅》‘正月繁霜’，《笺》：‘夏之四月，建巳之月。’《疏》：‘谓之正月者，以乾用事，正纯阳之月。’又《杜预左传昭十七年》注：‘谓建巳正阳之月也。’”所以，正阳就是乾阳，就是建巳之月。建巳为四月，夏气开始用事。夏气是什么呢？就是火热之气。火热之气最容易施于阳明而导致阳明病，因为火热之性炎上，正好与阳明主降的性用相反，所以，火施阳明是导致阳明病最常见的一个原因。火热也就是正阳之气，由火施阳明所致的阳明病，当然就可以叫做正阳阳明。因此，正阳阳明是有所指的，并非不兼太阳、少阳就是正阳阳明。对于正阳的上述含义，除了文字的证明以外，我们还可以从条文本身来说明。大家看 168 条的白虎加人参汤，在它的方后注里有这样一段话：“此方立夏后，立秋前乃可服。”白虎加人参汤是阳明病的主方之一，为什么要限定在立夏后至立秋前这段时间服用呢？这段时间刚好是夏三月，夏三月火热用事，正阳用事，这个时段里最容易导致火施阳明的正阳阳明病。白虎加人参汤要规定在“立夏后，立秋前乃可服”，这就反过来证明我们对正阳阳明的解释是恰当的。
（3）胃家实
正阳阳明又叫做胃家实，下面我们一起来看胃家实的意义。
① 胃
胃代表什么呢？首先是我们常识上的这个胃府。除此之外，《素问·阴阳应象大论》对胃还有一个很重要的概括：“六经为川，肠胃为海。”六经与胃之间的关系，就是川与海的关系。川与海是个什么关系呢？俗话说：“海纳百川，百川归海。”百川归海，说明川与海要么有直接联系，要么有间接的联系。没有联系，川中的水怎么会汇集到海里呢？川海之间的这样一种关系，证明了六经与肠胃是相通的。六经的疾病便可以通过适当的方式引聚到肠胃中来，然后泻之使出。下法为什么能够祛治百病呢？道理就在这里。前面我们提到“下法的现代思考”这样一个议题。从这个川与海的关系，从这个六经与肠胃的关系，我们知道上述的这样一种思考完全是有可能的，完全是可以实现的。六经网络全身，无处不到，所以，就可以通过上面的关系把全身的疾病，甚至是很严重的疾病引聚到肠胃中来，引聚到海里来，然后清除掉。我们上面这个思考的一个重要基础，就是建立在六经与肠胃这个特殊关系上的。华龄出版社于 1992年出版了一本《治癌秘方》，作者叫孙秉严。这部书是他34年治癌经验的写照。所谓“治癌秘方”，这个“秘方”归纳起来就是一个下法，当然是各种不同的下法。孙医生的经验十分可贵，而一旦放进阳明篇里，一旦放到“六经为川，肠胃为海”的这样一个关系里去思考，理论上的问题就会很容易地得到解决。困难就在我们怎么形成一个阳明的局面，在没有形成阳明这个局面的时候就轻易地使用下法，决定是会利少弊多，甚至是有害无益。这是使用下法必须注意的一个问题。也就是说下法必须有它的指征。邪在少阴，你怎么把它引到阳明来？邪在厥阴，你怎么把它引到阳明来？引到什么程度才算是形成阳明的局面。这些都应该有具体指标，这些就牵涉到很具体的技术问题。解决这些问题我们可以参考古人和今人的经验，我们也可以创立新的思路，形成新的方法。我以为这样的一些思考是很有意义的，从某种角度讲，这才符合中医现代化的内涵。另外一个方面，胃不仅仅是藏象学上的一个概念，它还是天文学的一个概念。胃是二十八宿中的一宿，更具体地说胃是西方七宿亦即白虎宿中的一宿。西方主降，白虎主降，胃主降，阳明主降。为什么治疗阳明病的主要代表方要叫白虎汤？为什么胃刚好在西方白虎这一宿而不在其他青龙、朱雀、玄武这些宿？为什么阳明病要叫做“胃家实”？这一连串的为什么思考清楚了，你就会有豁然贯通的感觉，你就会从心底里认识到中医是成体系的，上至天文，下至地理，中及人事。如果仅仅是一门经验医学，有不有可能建立起这样一个庞大的体系？显然是不可能的。胃为西方七宿之一，《史记·天官书》云：“胃为天仓。”其注云：“胃主仓廪，五谷之府也，明则天下和平，五谷丰稔。”《素问·灵兰秘典论》云：“脾胃者，仓廪之官，五味出焉。”可见西方七宿之一的“胃”并非假借的虚词，它是有实义的，这个实义正好与脾胃所主的仓廪相符。天人相应，更具体一点就是星宿与藏府相应。胃为天仓，胃明则天下和平，五谷丰稔；脾胃为仓廪之官，脾胃健则身体康泰，五味出焉。星宿的胃与藏府的胃，它们之间的这样一种关系值得我们认真地思考与研究。前些日子，一位长者也是一位领导从关心和鼓励的角度告诫我说：“在中医学院范围内，能像你这样深入经典的确实很少，但是，有一个问题却需要注意，就是经典里面有精华也有糟粕，要取其精华，弃其糟粕。”这位长者的意思很清楚，一方面对我钻研经典的精神表示赞叹，另一方面又担心我错将糟粕当精华。这个意见提得很好，而且提得很普适。不但搞经典应该这样，搞任何一门学问都应该这样。都要取其精华，弃其糟粕。现代科学里就只有精华，没有糟粕吗？非也！现代科学里也有糟粕。而就目前的情况看，而就中医界的现状看，将经典中的糟粕当成精华的情况并不严重，严重的是在很多人眼里，特别是在相当多的高层次群体眼里，经典中并没有多少精华可取。没精华可取，那当然就可以不屑一顾了。博士们之所以只朝现代看，只朝分子生物学看，只朝实验室看，而很少朝经典里看，恐怕与上面这个认识有关。有谁愿去吃力而不讨好呢？所以，中医当务之急，不是良莠不分，不是我们过多地把糟粕当成了精华，而是我们很多人从骨子里失去了对它的信心，从骨子里没把它当成宝库。像星宿胃和藏府胃这样一个问题，我们是把它当糟粕迷信呢？还是设法从多方面去研究它。二十八宿中，使用藏府名来命名的还有心。心位于东方七宿，心宿的定位是否与先天八卦离位东方有关，这一点值得我们研究。为什么在二十八宿的命名中五藏它选一个心，六府它选一个胃？心为五藏之主，胃为六府之主。为什么要选用这个藏府之主来为星宿作命名？这个问题亦值得我们深思。
② 胃家
保持和发扬传统特色，走现代化道路。这是两全其美的事，这是非常值得赞叹的事。但，弄不好这又是一厢情愿的事。传统和现代化有些时候就像一个悖论，你抓住了这头就会失去那头，你抓了那头就会失去这头。不信大家往现实中看一看，有几个人能一头钻进实验室里，而另一头又埋在《内经》里？有几个人一手抓分子生物学，一手又抓《黄帝内经》？像现在的两个文明一样，两手都要抓，两手都要硬。很少有人能做到这一点。极大多数的人是抓了分子生物学就丢了《黄帝内经》。我在第一章里曾经提到过，在博士这个群体里，为什么有那么多的人不再光顾《内经》？不再光顾《伤寒论》？可见“此事两难全”。就像我一样，一头埋在《内经》、《伤寒》了，就再腾不出另一头放到实验室里。不过，我对现代是非常关注的，也在不时地运用现代思维来思考传统的问题。经过长期的关注与思考，使我得出了两个基本的看法：第一个看法，中医的现代化首先是思想上的现代化，思维上的现代化，表述上的现代化，应该急于进行思维上的现代化实验，而不宜急于小白鼠的实验；第二个看法，传统与现代的结合，应该是传统精英与现代精英的结合，只有这样的结合才能有成效，才会出硕果。过去这些年里我们把这个路子合起来了，想在一个人身上同时打造出两个精英，然后实现两个精英的自然结合。现在看来，这是欲速而不达。这个路子必须分开来走。对于现代精英的造就并不困难，因为现在整个世界，整个时代都在致力于这个精英的培养。而要培养一个传统精英，却是困难重重。因此，要实现传统与现代的结合，要实现中医的现代化，我们应该把很大的一部分精力放在传统上，放在传统精英的打造上。我想这是一个十分重要的前提。中医能不能用现代的这些手段，能不能用CT、核磁共振，当然能用。现代的一切手段我想中医都能用，但是，大家不要误以为这就是中医的现代化。如果你把这些当作中医现代化，那从内涵上和逻辑上都是讲不通的。从目前的情况看，运用现代化的这些手段，不能叫中医现代化，充其量只能算中医用现代化。中医不必老是长袍马褂，中医也可以穿西装革履，但并不意味穿上西装这个中医就改变了，中医没有改变，中医还是那个中医。这是两个不同的概念，希望大家能够分清楚。
第一章中我们谈到，先师用大量的陈皮、白芷、玉竹、大枣治疗血气胸，服药以后出现大量泻下，泻后胸腔的血气很快吸收。泻一泻肚，胸腔的血气就没有了。是胸腔的血气通过一个突然开放的通道直接转移到大肠里去了呢？还是被血液直接吸收了？为什么肠炎的拉肚子起不到这个作用？在这里先师为什么不用大小承气汤来泻下？而要用这些平常都不会引起泻下作用的药物来泻下？肺的问题，胸腔的问题，可以通过肺与大肠的这个表里关系直接转送到大肠，然后排泄出去。那么，其他地方的病是不是也可通过经络之间的互相联系，通过一个中转，也转送到大肠里，也转移到阳明里，然后排泄出去呢？如果这样的路子可行，那么很多疑难病症就有了解决的办法。我们学习这一条条文时，如果能够这样来思维，这就为我们今后的研究，为我们传统的研究，为我们现代的研究，留出了一大片空间，提出了一大堆研究课题。这样的一个思维过程难道就不是现代化吗？对于现代化的理解我们不应该太机械、太死板，应该把眼光放远一点。有些问题是很确凿的，二千年的历史都点头了，干吗一定还要小白鼠点头才行。
2.脾约
脾约就是太阳阳明，怎么叫做脾约呢？我们看六版《伤寒论》教材的词解：“脾约：胃热肠燥津伤而致的便秘。”有的则释为胃热津伤，脾之功能为胃热所约，致不能为胃行其津液，故致肠燥便秘者，是为脾约。对于上面这些解释，以及其他类似的许多解释，我一直感到难以信服。如果是这样的一个便秘，古人完全可以叫一个其他的名字，或者叫“津伤”，或者叫“燥肠”，或者叫“胃热”都行。干吗一定要叫这个不相干的脾约呢？脾约与太阳阳明有什么关联？如果这样来解释，至少在逻辑上我们看不出它与太阳阳明的关联。脾约的表现是肠中燥，便硬结，这一点是可以肯定的。问题是这个肠燥便秘为什么要叫脾约？而且为什么要太阳阳明才叫脾约？其实这个问题既复杂又简单，说它复杂是一千多年没能得出一个令人信服的说法，说它简单确实简单，你只要把它放进燥湿里去考虑，就很容易地解决了。有关燥湿的关系我们刚刚讨论过，就脾胃而言，脾属湿，胃属燥。约是什么意思呢？约就是约束的意思。脾约就等于把湿约束起来了，脾湿一约，胃燥自然就显现，自然就有肠燥便秘的现象。这好像是在做文字游戏，但是这个游戏很有意思。湿一约，当然就燥了，脾约就是这么一回事情。但为什么一定要太阳阳明才叫脾约呢？我们看 247条：“趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则硬，其脾为约，麻子仁丸主之。”这一条讲脾约点出了小便数、大便硬，是小便数导致这个肠中燥、大便硬，是小便数导致这个阳明，所以它叫太阳阳明。为什么叫太阳阳明？因为小便由膀胱所主，由太阳所主。由小便数所导致的这个阳明，那当然就可以叫做太阳阳明。可是为什么小便数一定要牵扯到脾约上来呢？这就是一个水土之间的关系问题。正常情况下土克水，土约水，现在土的自身功能受约制了，那当然就不能制水，那当然就会小便数。所以，太阳阳明就与脾约很有关联。另外，除了小便数大便因硬的情况外，临床上还可以见到汗出过多大便亦硬的情况。汗为腠理所司，亦为太阳所主。汗出过多所致的胃中干燥大便硬，是不是也可以叫做太阳阳明？是不是也可以按照脾约的方法去治疗？这个问题也希望大家共同来思考。
3.正阳阳明
（1）历代医家之释对于正阳阳明的释义，历代不尽相同。如六版教材云：“外邪入里，直犯阳明而形成，叫做正阳阳明”；尤在泾则以“邪热入胃，糟粕内结，阳明自病”为正阳阳明；有以阳明本燥，故阳明病燥结者，是其本气之病，故谓正阳阳明，如张锡驹即本此；有以不兼太阳、少阳的阳明病为正阳阳明，如汪琥即持此观点。对于以上各家的观点，大家可以参考。
（2）正阳本义
正阳这个词在《伤寒论》中没有单独使用，它只是与阳明搭配而成“正阳阳明”。正阳是否就是指太阳、少阳之外的阳明？或者正阳这个词还有其他的含义？这个问题上述的这些释义似乎都没有提出来。我们认为正阳不见得就是指阳明，或者说正宗的阳明就叫正阳。正阳应该有它专门的含义，这个含义我们可以从文字的角度来了解。《康熙字典》载云：“四月亦曰正月。《诗·小雅》‘正月繁霜’，《笺》：‘夏之四月，建巳之月。’《疏》：‘谓之正月者，以乾用事，正纯阳之月。’又《杜预左传昭十七年》注：‘谓建巳正阳之月也。’”所以，正阳就是乾阳，就是建巳之月。建巳为四月，夏气开始用事。夏气是什么呢？就是火热之气。火热之气最容易施于阳明而导致阳明病，因为火热之性炎上，正好与阳明主降的性用相反，所以，火施阳明是导致阳明病最常见的一个原因。火热也就是正阳之气，由火施阳明所致的阳明病，当然就可以叫做正阳阳明。因此，正阳阳明是有所指的，并非不兼太阳、少阳就是正阳阳明。对于正阳的上述含义，除了文字的证明以外，我们还可以从条文本身来说明。大家看 168 条的白虎加人参汤，在它的方后注里有这样一段话：“此方立夏后，立秋前乃可服。”白虎加人参汤是阳明病的主方之一，为什么要限定在立夏后至立秋前这段时间服用呢？这段时间刚好是夏三月，夏三月火热用事，正阳用事，这个时段里最容易导致火施阳明的正阳阳明病。白虎加人参汤要规定在“立夏后，立秋前乃可服”，这就反过来证明我们对正阳阳明的解释是恰当的。
（3）胃家实
正阳阳明又叫做胃家实，下面我们一起来看胃家实的意义。
① 胃
胃代表什么呢？首先是我们常识上的这个胃府。除此之外，《素问·阴阳应象大论》对胃还有一个很重要的概括：“六经为川，肠胃为海。”六经与胃之间的关系，就是川与海的关系。川与海是个什么关系呢？俗话说：“海纳百川，百川归海。”百川归海，说明川与海要么有直接联系，要么有间接的联系。没有联系，川中的水怎么会汇集到海里呢？川海之间的这样一种关系，证明了六经与肠胃是相通的。六经的疾病便可以通过适当的方式引聚到肠胃中来，然后泻之使出。下法为什么能够祛治百病呢？道理就在这里。前面我们提到“下法的现代思考”这样一个议题。从这个川与海的关系，从这个六经与肠胃的关系，我们知道上述的这样一种思考完全是有可能的，完全是可以实现的。六经网络全身，无处不到，所以，就可以通过上面的关系把全身的疾病，甚至是很严重的疾病引聚到肠胃中来，引聚到海里来，然后清除掉。我们上面这个思考的一个重要基础，就是建立在六经与肠胃这个特殊关系上的。华龄出版社于 1992年出版了一本《治癌秘方》，作者叫孙秉严。这部书是他34年治癌经验的写照。所谓“治癌秘方”，这个“秘方”归纳起来就是一个下法，当然是各种不同的下法。孙医生的经验十分可贵，而一旦放进阳明篇里，一旦放到“六经为川，肠胃为海”的这样一个关系里去思考，理论上的问题就会很容易地得到解决。困难就在我们怎么形成一个阳明的局面，在没有形成阳明这个局面的时候就轻易地使用下法，决定是会利少弊多，甚至是有害无益。这是使用下法必须注意的一个问题。也就是说下法必须有它的指征。邪在少阴，你怎么把它引到阳明来？邪在厥阴，你怎么把它引到阳明来？引到什么程度才算是形成阳明的局面。这些都应该有具体指标，这些就牵涉到很具体的技术问题。解决这些问题我们可以参考古人和今人的经验，我们也可以创立新的思路，形成新的方法。我以为这样的一些思考是很有意义的，从某种角度讲，这才符合中医现代化的内涵。另外一个方面，胃不仅仅是藏象学上的一个概念，它还是天文学的一个概念。胃是二十八宿中的一宿，更具体地说胃是西方七宿亦即白虎宿中的一宿。西方主降，白虎主降，胃主降，阳明主降。为什么治疗阳明病的主要代表方要叫白虎汤？为什么胃刚好在西方白虎这一宿而不在其他青龙、朱雀、玄武这些宿？为什么阳明病要叫做“胃家实”？这一连串的为什么思考清楚了，你就会有豁然贯通的感觉，你就会从心底里认识到中医是成体系的，上至天文，下至地理，中及人事。如果仅仅是一门经验医学，有不有可能建立起这样一个庞大的体系？显然是不可能的。胃为西方七宿之一，《史记·天官书》云：“胃为天仓。”其注云：“胃主仓廪，五谷之府也，明则天下和平，五谷丰稔。”《素问·灵兰秘典论》云：“脾胃者，仓廪之官，五味出焉。”可见西方七宿之一的“胃”并非假借的虚词，它是有实义的，这个实义正好与脾胃所主的仓廪相符。天人相应，更具体一点就是星宿与藏府相应。胃为天仓，胃明则天下和平，五谷丰稔；脾胃为仓廪之官，脾胃健则身体康泰，五味出焉。星宿的胃与藏府的胃，它们之间的这样一种关系值得我们认真地思考与研究。前些日子，一位长者也是一位领导从关心和鼓励的角度告诫我说：“在中医学院范围内，能像你这样深入经典的确实很少，但是，有一个问题却需要注意，就是经典里面有精华也有糟粕，要取其精华，弃其糟粕。”这位长者的意思很清楚，一方面对我钻研经典的精神表示赞叹，另一方面又担心我错将糟粕当精华。这个意见提得很好，而且提得很普适。不但搞经典应该这样，搞任何一门学问都应该这样。都要取其精华，弃其糟粕。现代科学里就只有精华，没有糟粕吗？非也！现代科学里也有糟粕。而就目前的情况看，而就中医界的现状看，将经典中的糟粕当成精华的情况并不严重，严重的是在很多人眼里，特别是在相当多的高层次群体眼里，经典中并没有多少精华可取。没精华可取，那当然就可以不屑一顾了。博士们之所以只朝现代看，只朝分子生物学看，只朝实验室看，而很少朝经典里看，恐怕与上面这个认识有关。有谁愿去吃力而不讨好呢？所以，中医当务之急，不是良莠不分，不是我们过多地把糟粕当成了精华，而是我们很多人从骨子里失去了对它的信心，从骨子里没把它当成宝库。像星宿胃和藏府胃这样一个问题，我们是把它当糟粕迷信呢？还是设法从多方面去研究它。二十八宿中，使用藏府名来命名的还有心。心位于东方七宿，心宿的定位是否与先天八卦离位东方有关，这一点值得我们研究。为什么在二十八宿的命名中五藏它选一个心，六府它选一个胃？心为五藏之主，胃为六府之主。为什么要选用这个藏府之主来为星宿作命名？这个问题亦值得我们深思。
② 胃家
Maintain and carry forward traditional characteristics, and follow the path of modernization. This is a win-win situation, a matter highly worthy of praise. However, if handled improperly, it could become a case of wishful thinking. Tradition and modernization sometimes resemble a paradox: grasping one end means losing the other; grasping the other end means losing this one. If you do not believe me, look at reality: how many people can immerse themselves in a laboratory with one hand while burying their heads in the *Neijing* (Classic of Internal Medicine) with the other? How many people can grasp molecular biology with one hand and the *Huangdi Neijing* (Yellow Emperor's Inner Canon) with the other? Just as we must grasp both civilizations today, we must grasp both hands firmly. Very few people can achieve this. The vast majority grasp molecular biology and lose the *Huangdi Neijing*. As I mentioned in Chapter One, why do so many PhDs no longer frequent the *Neijing*? Why do they no longer visit the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases)? It is evident that "this matter cannot be perfectly fulfilled." Like myself, once immersed in the *Neijing* and *Shanghan*, there is no room left for the other hand to enter the laboratory. Nevertheless, I pay close attention to modernity and frequently use modern thinking to ponder traditional issues. Through long-term observation and reflection, I have arrived at two basic views: The first view is that the modernization of Traditional Chinese Medicine (TCM) is primarily about the modernization of thought, thinking, and expression. We should urgently conduct experiments in the modernization of thinking rather than hastily resort to experiments on white mice. The second view is that the integration of tradition and modernity should be the integration of traditional elites and modern elites. Only such an integration can be effective and yield fruitful results. In recent years, we have merged these paths, attempting to forge two elites within one person and then achieve a natural combination between them. Now it appears that this approach leads to haste and ineffectiveness. These paths must be walked separately. The cultivation of modern elites is not difficult, as the entire world and era are dedicated to cultivating such elites. However, cultivating a traditional elite is fraught with difficulties. Therefore, to achieve the integration of tradition and modernity and realize the modernization of TCM, we should devote a significant portion of our energy to tradition, specifically to the forging of traditional elites. I believe this is a very important prerequisite. Can TCM utilize modern tools such as CT scans and MRI? Of course it can. I believe TCM can utilize all modern means, but do not mistake this for the modernization of TCM itself. If you consider this to be the modernization of TCM, it makes no sense either in connotation or logic. From the current perspective, utilizing these modern means cannot be called the modernization of TCM; at best, it can only be described as TCM using modernization. TCM does not need to always wear long gowns and mandarin squares; it can also wear suits and leather shoes. However, wearing a suit does not mean TCM has changed; TCM remains unchanged, still the same TCM. These are two different concepts, and I hope everyone can distinguish between them.
In Chapter One, we discussed how my late master used large doses of Chenpi (Aged Tangerine Peel), Baizhi (Angelicae Dahuricae Radix), Yuzhu (Polygonati Odorati Rhizoma), and Dazao (Jujube Fruit) to treat hemopneumothorax. After taking the medicine, massive purgation occurred, and the blood and gas in the thoracic cavity were rapidly absorbed afterward. A simple bowel movement eliminated the blood and gas from the thoracic cavity. Did the blood and gas in the thoracic cavity transfer directly to the large intestine through a suddenly opened channel, or were they directly absorbed by the blood? Why does diarrhea caused by enteritis not produce this effect? Why did my late master not use Dachengqi Tang (Major Yellow Dragon Decoction) or Xiaochengqi Tang (Minor Yellow Dragon Decoction) for purgation here, but instead used these ordinary drugs that usually do not cause purgation? Problems of the lung and the thoracic cavity can be transferred directly to the large intestine through the exterior-interior relationship between the lung and the large intestine, and then excreted. Could diseases in other parts of the body also be transferred to the large intestine, and then to the Yangming stage, and excreted through the mutual connections of the meridians via a transit point? If this path is feasible, then many difficult and complicated cases would have solutions. If we can think in this way when studying this clause, it leaves us a vast space for future research, for traditional research, and for modern research, and raises numerous research topics. Is such a thinking process not modernization? Our understanding of modernization should not be too mechanical or rigid; we should broaden our horizons. Some issues are quite conclusive; two thousand years of history have nodded in agreement. Why must we insist on getting approval from white mice?
2. Pi Yue (Spleen Confinement)
Pi Yue refers to Taiyang-Yangming. What is meant by Pi Yue? Looking at the glossary in the sixth edition textbook of *Shanghan Lun*: "Pi Yue: Constipation caused by stomach heat, intestinal dryness, and fluid injury." Others interpret it as stomach heat injuring fluids, where the function of the spleen is constrained by stomach heat, rendering it unable to distribute fluids to the stomach, thus causing intestinal dryness and constipation; this is Pi Yue. Regarding the above explanations and many similar ones, I have always found them unconvincing. If it were merely such constipation, the ancients could have easily given it another name, such as "Fluid Injury," "Dry Intestine," or "Stomach Heat." Why must it be called this unrelated term, Pi Yue? What is the connection between Pi Yue and Taiyang-Yangming? If explained this way, at least logically, we cannot see its connection to Taiyang-Yangming. The manifestation of Pi Yue is dryness in the intestines and hard stools; this point is certain. The question is, why is this intestinal dryness and constipation called Pi Yue? And why is it specifically called Pi Yue only in the context of Taiyang-Yangming? Actually, this problem is both complex and simple. It is complex because for over a thousand years, no convincing explanation has been reached; it is simple because if you consider it in terms of dryness and dampness, it is easily resolved. We just discussed the relationship between dryness and dampness. Regarding the spleen and stomach, the spleen belongs to dampness, and the stomach belongs to dryness. What does "Yue" (constrain) mean? "Yue" means to constrain. Pi Yue is equivalent to constraining dampness. Once spleen-dampness is constrained, stomach-dryness naturally manifests, leading naturally to intestinal dryness and constipation. This may seem like wordplay, but it is interesting. Once dampness is constrained, dryness ensues; this is what Pi Yue is about. But why must it be Taiyang-Yangming to be called Pi Yue? Let us look at Clause 247: "The Fuyang pulse is floating and choppy. Floating indicates strong stomach qi; choppy indicates frequent urination. When floating and choppy interact, the stool becomes hard. The spleen is confined; Maziren Wan (Hemp Seed Pill) governs it." This clause discussing Pi Yue points out frequent urination and hard stools. Frequent urination causes intestinal dryness and hard stools; frequent urination causes this Yangming condition, hence it is called Taiyang-Yangming. Why is it called Taiyang-Yangming? Because urination is governed by the Bladder and the Taiyang stage. The Yangming condition caused by frequent urination can naturally be called Taiyang-Yangming. But why must frequent urination be linked to Pi Yue? This is a matter of the relationship between Earth and Water. Normally, Earth controls Water, and Earth constrains Water. Now, if the self-function of Earth is constrained, it naturally cannot control Water, leading to frequent urination. Thus, Taiyang-Yangming is closely related to Pi Yue. Additionally, besides cases where frequent urination leads to hard stools due to dryness, clinically we can also see cases where excessive sweating leads to hard stools. Sweat is controlled by the Couli (pores) and is also governed by the Taiyang stage. Does stomach dryness and hard stool caused by excessive sweating also constitute Taiyang-Yangming? Can it also be treated according to the method for Pi Yue? I hope everyone will contemplate this issue together.
(1) Interpretations by Physicians of Past Dynasties regarding Zhengyang Yangming vary across dynasties. For example, the sixth edition textbook states: "When external pathogens enter the interior and directly attack Yangming, forming the disease, it is called Zhengyang Yangming." You Zaijing considers "pathogenic heat entering the stomach, waste products accumulating internally, and Yangming becoming diseased on its own" as Zhengyang Yangming. Some argue that since Yangming inherently possesses dryness, those with Yangming disease presenting with dryness and accumulation are suffering from a disease of its intrinsic Qi, hence termed Zhengyang Yangming; Zhang Xiju holds this view. Others define Yangming disease that does not involve Taiyang or Shaoyang as Zhengyang Yangming; Wang Hu holds this viewpoint. Readers may refer to the viewpoints of these various schools.
(2) Original Meaning of Zhengyang
The term "Zhengyang" is not used alone in the *Shanghan Lun*; it only appears paired with Yangming as "Zhengyang Yangming." Does Zhengyang simply refer to Yangming distinct from Taiyang and Shaoyang? Or does Zhengyang have other meanings? It seems none of the aforementioned interpretations address this issue. We believe Zhengyang does not necessarily refer to Yangming, nor does it mean orthodox Yangming is called Zhengyang. Zhengyang should have its specific meaning, which we can understand from a philological perspective. The *Kangxi Dictionary* records: "The fourth month is also called Zhengyue. In *Xiaoya* of the *Book of Songs*, 'Frost abounds in Zhengyue,' the commentary notes: 'The fourth month of summer, the month of Jian Si.' The subcommentary states: 'It is called Zhengyue because Qian (Heaven/Pure Yang) is in operation, making it the month of pure Yang.' Also, Du Yu’s commentary on the *Zuo Zhuan*, Year 17 of Duke Zhao, notes: 'Referring to the month of Jian Si, the month of Zhengyang.'" Therefore, Zhengyang is Qian Yang, corresponding to the month of Jian Si. Jian Si is the fourth month, when Summer Qi begins to operate. What is Summer Qi? It is the Qi of fire and heat. Fire and heat Qi most easily affect Yangming, leading to Yangming disease, because the nature of fire and heat flares upward, which is exactly opposite to the descending nature and function of Yangming. Therefore, fire affecting Yangming is the most common cause of Yangming disease. Fire and heat are essentially Zhengyang Qi. Yangming disease caused by fire affecting Yangming can naturally be called Zhengyang Yangming. Thus, Zhengyang Yangming has a specific reference; it does not mean that Yangming disease without Taiyang or Shaoyang involvement is Zhengyang Yangming. Regarding the above meaning of Zhengyang, besides textual proof, we can also illustrate it through the clauses themselves. Look at Clause 168 involving Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction). In the post-prescription notes, there is a passage: "This decoction can be taken after Lixia (Start of Summer) and before Liqiu (Start of Autumn)." Baihu Jia Renshen Tang is one of the main formulas for Yangming disease. Why is its use limited to the period from Start of Summer to Start of Autumn? This period coincides with the three months of summer, when fire and heat Qi operate, and Zhengyang Qi operates. During this time, Zhengyang Yangming disease caused by fire affecting Yangming is most likely to occur. The regulation that Baihu Jia Renshen Tang should be taken "after Lixia and before Liqiu" serves as reverse proof that our interpretation of Zhengyang Yangming is appropriate.
(3) Weijia Shi (Stomach Family Excess)
Zhengyang Yangming is also called Weijia Shi. Let us examine the meaning of Weijia Shi together below.
① Wei (Stomach)
What does Wei represent? First, it is the Stomach Fu organ in our common sense. In addition, the *Suwen: Yin Yang Ying Xiang Da Lun* provides another important generalization regarding the Stomach: "The Six Meridians are rivers, and the intestines and stomach are the sea." The relationship between the Six Meridians and the Stomach is the relationship between rivers and the sea. What is the relationship between rivers and the sea? As the saying goes: "The sea accepts hundreds of rivers; hundreds of rivers return to the sea." Hundreds of rivers returning to the sea indicate that rivers and the sea either have a direct connection or an indirect one. Without connection, how could water from the rivers gather into the sea? Such a relationship between rivers and the sea proves that the Six Meridians and the intestines/stomach are connected. Diseases of the Six Meridians can be gathered into the intestines and stomach through appropriate methods and then expelled via purgation. Why can the purgative method cure hundred diseases? The reason lies here. Previously, we raised the topic of "Modern Reflections on Purgation." From the relationship between rivers and the sea, and between the Six Meridians and the intestines/stomach, we know that the aforementioned thinking is entirely possible and achievable. The Six Meridians network the whole body, reaching everywhere. Therefore, through the aforementioned relationships, diseases of the entire body, even severe ones, can be gathered into the intestines and stomach, into the sea, and then cleared away. An important foundation for our above thinking is built upon the special relationship between the Six Meridians and the intestines/stomach. In 1992, Hualing Publishing House published a book titled *Secret Recipes for Treating Cancer*, authored by Sun Bingyan. This book reflects his 34 years of experience in treating cancer. The so-called "secret recipe" can be summarized as a purgative method, albeit various forms of purgation. Dr. Sun's experience is extremely valuable. Once placed within the Yangming chapter and considered within the relationship of "Six Meridians are rivers, intestines and stomach are the sea," theoretical problems can be easily resolved. The difficulty lies in how we form a Yangming pattern. Using purgation lightly before forming a Yangming pattern would result in more harm than good, or even be purely harmful. This is a crucial point to note when using purgation. That is, purgation must have its indications. If pathogens are in Shaoyin, how do you draw them to Yangming? If pathogens are in Jueyin, how do you draw them to Yangming? To what extent constitutes forming a Yangming pattern? These should have specific indicators, involving very technical details. To solve these problems, we can refer to the experiences of ancients and contemporaries, or we can create new lines of thought and form new methods. I believe such reflections are very meaningful; from a certain perspective, this conforms to the connotation of TCM modernization. On the other hand, Wei (Stomach) is not only a concept in Zang-Fang theory but also an astronomical concept. Wei is one of the Twenty-Eight Mansions, specifically one of the Seven Mansions of the West, also known as the White Tiger Mansion. The West governs descent; the White Tiger governs descent; the Stomach governs descent; Yangming governs descent. Why is the main representative formula for treating Yangming disease called Baihu Tang (White Tiger Decoction)? Why is the Stomach located in the Western White Tiger mansion and not in other mansions like Azure Dragon, Vermilion Bird, or Black Tortoise? Why is Yangming disease called "Weijia Shi"? If you think clearly through this series of whys, you will feel a sudden enlightenment. You will recognize from the bottom of your heart that TCM is a systematic whole, extending from astronomy above, geography below, to human affairs in between. If it were merely an empirical medicine, is it possible to establish such a grand system? Obviously, it is impossible. Wei is one of the Seven Mansions of the West. The *Records of the Grand Historian: Book of Astronomy* states: "Wei is the Heavenly Granary." Its annotation says: "Wei governs granaries and storehouses, the repository of the five grains. If Wei is bright, the world will be peaceful, and the five grains will be abundant." The *Suwen: Linglan Midian Lun* states: "The Spleen and Stomach are the officials of granaries and storehouses, from which come the five flavors." Thus, the "Wei" among the Seven Mansions of the West is not a borrowed empty term; it has substantial meaning, which coincides with the granary function governed by the Spleen and Stomach. Heaven and humanity correspond; more specifically, stellar mansions correspond to Zang-Fang organs. Wei is the Heavenly Granary; if Wei is bright, the world is peaceful and grains abound; Spleen and Stomach are officials of granaries; if Spleen and Stomach are healthy, the body is robust, and the five flavors emerge. The relationship between the stellar Wei and the Zang-Fang Wei deserves serious contemplation and research. Recently, an elder who is also a leader advised me from a perspective of care and encouragement: "Within the scope of the TCM college, few delve into classics as deeply as you do. However, one issue needs attention: classics contain both essence and dross; take the essence and discard the dross." The elder's intent was clear: on one hand, expressing admiration for my spirit of studying classics; on the other, worrying that I might mistake dross for essence. This opinion is well-taken and universally applicable. Not only should classic studies proceed this way, but any field of learning should. Take the essence, discard the dross. Does modern science contain only essence and no dross? No! Modern science also has dross. Judging from the current situation and the status quo of the TCM community, mistaking dross in classics for essence is not serious. The serious issue is that in the eyes of many, especially among a considerable number of high-level groups, there is little essence in the classics worth taking. If there is no essence worth taking, it is naturally dismissed with disdain. The reason PhDs only look toward modernity, molecular biology, and laboratories, and rarely look into classics, is likely related to this perception. Who would want to engage in effort without reward? Therefore, the urgent task for TCM is not failing to distinguish good from bad, nor is it that we have mistaken too much dross for essence. Rather, it is that many have lost confidence in it from the bone, failing to regard it as a treasure trove from the core. Regarding an issue like the stellar Wei and the Zang-Fang Wei, should we treat it as superstitious dross, or should we strive to study it from multiple aspects? Among the Twenty-Eight Mansions, Xin (Heart) is also named using a Zang organ name. Xin is located in the Seven Mansions of the East. Whether the positioning of Xin Mansion is related to the Li position in the East of the Prior Heaven Bagua is a point worth researching. Why, in the naming of the Twenty-Eight Mansions, did it select one Heart among the Five Zang, and one Stomach among the Six Fu? The Heart is the master of the Five Zang; the Stomach is the master of the Six Fu. Why select these masters of Zang and Fu to name stellar mansions? This question also deserves deep contemplation.
② Weijia (Stomach Family)