少阳病的要素清楚以后，我们来看少阳时相的欲解时。少阳病为什么要在寅卯辰这样一个时相欲解呢？我想很重要的一点就是寅卯辰时相所蕴涵的要义能够有效地帮助解决少阳病的上述问题。寅卯辰从年上讲属春三月，属木，木性条达舒畅。条达了、舒畅了，少阳枢机就可以活泼泼的转动；条达了，舒畅了，少阳的木火性用便不会遏郁。另一方面，我们讨论六经时相，讨论三阴三阳时相，应该时刻不忘与五行时相进行参合。阴阳与五行是两门，合起来其实就是一个。为什么这么说呢？大家回顾前面几章讨论的内容就应该很清楚。木是什么？木就是阳气处于升发的这个状态，当然这个时候的升发还不是全升发，它还有一丝二丝阴气在束缚；到了火的时候，阳气全升发了，全开放了，阳气不完全开放，大家想一想会不会有火产生？绝对不会有火产生；那么到金呢？到金的时候阳气已经由开放转入到收藏，或者说阳气渐渐进入到阴的状态了；更进一步到水的时候，阳气完全处于收藏。大家可以想一想，阳气要是不完全收藏，怎么会有冰雪产生呢？现在全球的气候逐渐变暖，北极及内陆的冰川逐渐在消融，这说明什么呢？这说明整个世界的阳气收藏在逐渐变弱，而开放却在逐渐加强。我们所处的这个时代就是不断开放的时代，成天都在强调开放，而不强调收藏，那冰川怎么会不逐渐消融？我想这是很必然的事情。用中医的理论，用五行的理论来看上面这个问题，是非常清楚的。所以，我们讲金木水火，实际讲的是什么呢？它讲的完全就是阴阳的不同状态。因此，讲五行离开了阴阳，你很难讲到点子上，你很难对这门学问有真实的受用。那么五行中的“土”是什么呢？它代表了阴阳的哪个状态？它代表了阴阳的一个很特殊的状态。因为这个特殊，所以董仲舒在《春秋繁露》中把它称为五行之主。五行的金木水火如果没有土都不能成就其所用。阴阳要从水的状态，收藏的状态进入到木的状态，升发的状态，它靠什么？就是靠这个土。同理，从木到火，从火到金，从金到水也都离不开这个土。阴阳要变化，阴阳要流转，阴阳要周而复始，都必须落实到土上。因此，土在中医的作用就显得非常重要，非常特殊。我们为什么要把脾胃当作后天之本，《素问》言脉为什么要讲“有胃则生，无胃则死”？这些都与土有非常密切的关系，值得我们认真研究。五行表述的是阴阳的不同状态，而五行的每一行在不同的时间区域内又有旺、相、休、囚、绝的不同变化过程，这便构成了五行时相的重要内容。所谓旺，就是旺盛的意思，某一行，或者说阴阳的某一个特殊状态，在某一个特殊的时区内最当时，最旺盛；相，就是促成旺的因素，是达到旺的状态所必须经历的阶段；休，就是旺的状态已经衰退；囚，旺的状态衰退，但较之休的程度略好；绝，完全衰退的状态。以火为例，火旺于夏，相于春，休于立春、立夏、立秋、立冬前各十八天，囚于秋，绝于冬。春为寅卯辰，火相于春，即火相于寅卯辰。又，相者助也，上述关系反过来称，即春为相火，寅卯辰为相火。由上可见，一个寅卯辰已然将少阳的性用，相火的性用充分地体现出来。少阳发生病变，少阳的性用失掉了，遇到寅卯辰就很有可能重新恢复过来。因此，少阳病当然就欲解于寅卯辰。
4.少阳持方要义
少阳病的主方是大家熟悉的小柴胡汤。现在我们就来看小柴胡汤的治方要义是不是符合我们上面讨论的这些内容。
（1）象数层面
小柴胡汤用药七味，所以，我们先从七来入手。七是什么数？七是火数。故河图云：地二生火，天七成之。学中医的对河图、洛书这两个图要记得很清楚，这两个图很关键，传统的数学就包含在这两图之中。现代科学如果没有数学，那就称不上科学。没有数学语言表述，怎么能登大雅之堂？其实中医也是这样，中医同样需要数学，所以也就离不了上述这两图。《内经》也好，《伤寒》也好，都用到这两个图。孙思邈说：“不知易不足以为大医。”我们且不要说知易，了解一点总是应该的。小柴胡汤用药七味，这说明它用的是火的格局，这就与相火相应了。接下来我们看具体的用药，小柴胡汤用药七味，第一味就是柴胡。我们看《伤寒论》的方应该注意它药物排列的次第，谁先谁后，这个是很有讲究的，随便不得。排第一位的往往就是君药，第二的往往是臣药，排后面的当然就是佐使药。现在开方往往不管这些，先记哪味就先写哪味。开一个小柴胡汤他可能把人参写第一、生姜写第一，这就乱套了。“行家一出手，便知有没有。”你这样来处一个方，不用说人家就知道你的家底。柴胡位属第一，是当然的君药，黄芩位于第二，是为臣药。我们看君药臣药的用量是多少呢？柴胡用八两，黄芩用三两。一个三、一个八，正好是东方之数，正好是寅卯辰之数。单就一个君臣药的用量，就把整个少阳的性用烘托出来，就把少阳病的欲解时相烘托出来。可见张仲景的东西是非常严谨的。不是你想怎么样就怎么样。如果开一个小柴胡汤，柴胡不用八两，黄芩不用三两，它还是小柴胡汤吗？它已然不是小柴胡汤了。再用它作为少阳病的主方，那就会出问题。又如桂枝汤，如果把桂枝的用量加上去，由原来的三两变成五两，这个就不再是桂枝汤。它变成了治奔豚的桂枝加桂汤。这一变就由群方之祖，由至尊之位，沦为草民了。所以，中医的用量重不重要呢？确实很重要！当然这个量更重要的是在数的方面。
天津南郊有一位盲医，善治多种疑难病证，远近的许多人都慕名去求医。既然是盲医，当然就不能望而知之，他主要靠问诊和切诊来诊断疾病。疾病诊断出来以后，开什么“药”呢？他开的“药”来来去去都是我们日用的食品。像绿豆、红豆、葡萄干、黄花菜等。不管你什么病，他都用这些东西。惟一的区别就在这个数上。张三的病，他用二十颗绿豆，二十颗葡萄干，李四的病，他用二十一颗绿豆，二十一颗葡萄干。按照现代人的理解，二十颗绿豆与二十一颗绿豆有什么区别呢？熬出来的不都是绿豆汤吗？要是按照现在的成分来分析，它确实没有什么差别。而且如果不严格计较绿豆的大小，二十一颗绿豆与二十颗绿豆的重量也可能完全相同。但，为什么在中医这里会有这么大的差别呢？这就要联系到我们从前提到过的象数这门学问了。
上述这位盲医善于用数来治病，而我们循流探源地追溯上去，张仲景才真正是中医用数的鼻祖。
大家单看《伤寒论》中大枣的用量就很有意思。桂枝汤大枣用十二枚，小柴胡汤大枣也用十二枚，十枣汤大枣用十枚，炙甘草汤大枣用三十枚，当归四逆汤大枣用二十五枚。前面的十二枚，十枚好像还容易理解。到了炙甘草汤和当归四逆汤，大枣为什么要用三十枚和二十五枚呢？三十枚大枣代表着什么？二十五枚大枣又代表着什么？这个问题提出来，即使你不回答，恐怕也能够感受到它的不寻常。炙甘草汤是太阳篇的煞尾方，用于治疗“脉结代，心动悸”。80年代初，《上海中医药》杂志曾连载柯雪帆教授所著的《医林辍英》。后来，《医林辍英》出了单行本。该书是采用章回小说的形式写就的，即有医理医案，也有故事情节。其中有一章就专门谈到炙甘草汤的运用。
炙甘草汤是一张治疗心律失常的良方，特别是一些顽固性的心律失常像房颤这一类心律失常，用之得当，往往都可以将失常的心律转复正常。这个得当包括两方面，第一方面当然是辨证得当，你要搞清楚炙甘草汤适应哪一类证。我们姑且不论它什么心律失常，你得先从阴阳去分，看看它适应阴证还是阳证。更具体一些，适应阴虚证还是阳虚证。我们一分析方剂的组成，《伤寒论》中的养阴药几乎都集中在这一方中。因此，它适应于阴虚证应该没有疑问。然而就是这样一个在《伤寒论》中集养阴之大成的方子，它还是要加进桂枝、生姜、清酒这些阳的成分。我们去看太极阴阳的画面时，你很能感受出阴中有阳，阳中有阴来。而我们回过来看炙甘草汤，阴阳的这层涵义亦活脱脱地呈现出来。炙甘草汤适用于阴虚类的心律失常，这个是辨证得当但是仅仅有这个条件还不够，还必须用量得当。这一点是柯教授专门谈到的问题。你看这个房颤，各方面的条件都符合炙甘草汤证，可是用下去就是没有应验。问题出在哪呢？就出在用量上。
道门炼丹有一句行话，叫做“传药不传火”。药可以告诉你，可是火候不轻易告诉你。为什么呢？因为它太重要了。一炉丹能不能炼成，有时就看这个火候的把握。中医的方子可以告诉你，可是量却不轻传。为什么呢？量者火候也！火候才是成败的关键，那当然不能轻传。可是张仲景不同，他是医界的孔圣，既是孔圣，那就应该“吾无隐乎尔！”所以，张仲景不但传方、传药，而且连用量也和盘托出。讨论《伤寒论》的用量，应该注意两个问题，一个是重量，一个是数量。这两个问题有联系，但在本质上又有差别。重量不同，量变了会发生质变；而数不同，同样的也可以发生质变。对于第一个质变，我们容易理解，现代用药的剂量就是这个涵义。而对于第二个质变，由数而引起的质变，我们往往不容易理解，也不容易相信。有关《伤寒论》的用药重量，现在的教科书都以3克算一两，而药典所规定的剂量也与这个差不多。但是，柯雪帆等根据大量出土的秦汉铜铁权及现存于中国历史博物馆的东汉“光和大司农铜权”的实测结果，东汉时期的一两应折合为现在的15.625克。一两合3克与一两合15.625克，这个差别太大了，直差五倍有余。像炙甘草汤中的生地黄用量为一斤，如果照一两3克算，只是48克，若按东汉铜权的实测结果，则应是250克。正好相当于现在的半斤。《伤寒论》成书于东汉末年，这是一个公认的事实。既然是东汉的著作，那这个用量理所当然地应该按东汉时的重量来折合。可是这一折合，问题就弄大了。生地黄可以用半斤，麻黄可以用93.75克（按大青龙汤麻黄用六两来折合），这就大大超过了《中华人民共和国药典》所规定的用量。你按东汉的剂量治好一千个人没你的事，但只要有一个人出了问题，那你就吃不了兜着走。你就要变胡万林。为什么呢？因为药典不支持你，你没有法律依据。所以，柯老先生尽管知道《伤寒论》的剂量就应该是东汉时的那个剂量（这个“知道”不但有考古的依据，而且还有临床实际的依据。何以见得？因为炙甘草汤你按照现在一两3克的常规用量，这个房颤就是转不过来。而一旦你用回东汉时的剂量，生地用250克了，炙甘草汤还是这个炙甘草汤，剂量一变，火候不同，房颤很快就转复成正常的心律），可是，柯老先生还是要强调一句：“应以中国药典所规定的用量与中药学教科书所规定的常用量为依据。”（见柯雪帆主编的《伤寒论选读》上海科技出版社，1996 年3月版）不强调这一句，出问题打官司，10个柯老也不济事。剂量问题是一个大问题，如果这个问题含糊了，那《伤寒论》的半壁江山就有可能会丢失。你的证辨得再准，你的方药用得再准，可是量没有用准，火候没有用准，这个疗效能不打折扣吗？而最后怪罪下来，还是中医不好，还是中医没疗效。对剂量的问题我是有很深体会的，记得1990年暑期，我的爱人赵琳怀孕40 天时，突发宫外孕破裂出血。当时由于诸多因素，我们选择了中医保守治疗。并立即将情况电话告知南宁的师父（即先师李阳波）。师父于电话中口述一方，并嘱立刻购用，即藏红花10克，水煎服。师言藏红花治疗内出血，诚天下第一药也。次日，师父亲临桂林。诊脉后，处方如下：白芍180克、淫羊藿30克、枳实15克，水煎服，每日一剂。经用上述两方，至第三日B超复查，不但出血停止，腹腔原有出血大部分吸收，且意外发现宫内还有一个胎儿。我与妻子不禁抚额庆幸，要是选择手术治疗，还会有我们今天的女儿吗？每思及此事，都免不了要增添几分对先师的思念及感激之情。先师所用第二方，药皆平平，为什么会有如此神奇的效果呢？看来奥妙就在这个用量上。我们平常用白芍，也就10来克、20克，至多也不过30-50克。用到180克，真有些惊世骇俗。但是，不用这个量就解决不了问题。因此，用量的问题确实是一个关系至大的问题，值得大家来认真地思考与研究，尤其应该由国家来组织攻关。个人来研究这个课题，充其量是你个人的看法，它不能作为法律依据。如果大家公认了，东汉的用量确实就是柯雪帆教授研究出的这个量，那我们就应该想一想，对于《伤寒论》的许多问题，对于中医的许多问题，是不是就要重新来认识和评价呢？
在少阳病的要素明确之后，我们来看少阳病欲解的时辰。为什么少阳病要在寅、卯、辰这三个时辰（凌晨3点至上午9点）欲解呢？我认为很重要的一点是，寅、卯、辰时相所蕴含的要义能够有效地帮助解决少阳病的上述问题。从年份上讲，寅、卯、辰属于春季三个月，五行属木，木的特性是条达舒畅。如果条达了、舒畅了，少阳枢机就可以活泼地转动；如果条达了、舒畅了，少阳的木火性用就不会被遏郁。另一方面，我们在讨论六经时相和三阴三阳时相时，应该时刻不忘与五行时相进行参合。阴阳和五行是两门学问，合起来其实就是一个整体。为什么这么说呢？大家回顾前面几章讨论的内容就应该很清楚。什么是木？木就是阳气处于升发的状态，当然这个时候的升发还不是完全升发，它还有一丝二丝的阴气在束缚；到了火的时候，阳气完全升发了，完全开放了，如果阳气不完全开放，大家想一想会不会有火产生？绝对不会有火产生；那么到金呢？到金的时候，阳气已经由开放转入到收藏，或者说阳气渐渐进入到阴的状态了；更进一步到水的时候，阳气完全处于收藏状态。大家可以想一想，如果阳气要不完全收藏，怎么会有冰雪产生呢？现在全球气候逐渐变暖，北极及内陆的冰川逐渐消融，这说明什么呢？这说明整个世界的阳气收藏在逐渐变弱，而开放却在逐渐加强。我们所处的这个时代就是不断开放的时代，成天都在强调开放，而不强调收藏，那冰川怎么会不逐渐消融？我想这是很必然的事情。用中医的理论，用五行的理论来看上面这个问题，是非常清楚的。所以，我们讲金、木、水、火，实际讲的是什么呢？它讲的完全就是阴阳的不同状态。因此，讲五行离开了阴阳，你很难讲到点子上，你很难对这门学问有真实的受用。那么五行中的“土”是什么呢？它代表了阴阳的哪个状态？它代表了阴阳的一个很特殊的状态。因为这个特殊，所以董仲舒在《春秋繁露》中把它称为五行之主。五行的金、木、水、火如果没有土都不能成就其所用。阴阳要从水的状态（收藏的状态）进入到木的状态（升发的状态），它靠什么？就是靠这个土。同理，从木到火，从火到金，从金到水也都离不开这个土。阴阳要变化，阴阳要流转，阴阳要周而复始，都必须落实到土上。因此，土在中医的作用就显得非常重要，非常特殊。我们为什么要把脾胃当作后天之本，《素问》言脉为什么要讲“有胃则生，无胃则死”？这些都与土有非常密切的关系，值得我们认真研究。五行表述的是阴阳的不同状态，而五行的每一行在不同的时间区域内又有旺、相、休、囚、绝的不同变化过程，这便构成了五行时相的重要内容。所谓旺，就是旺盛的意思，某一行，或者说阴阳的某一个特殊状态，在某一个特殊的时区内最当时，最旺盛；相，就是促成旺的因素，是达到旺的状态所必须经历的阶段；休，就是旺的状态已经衰退；囚，旺的状态衰退，但较之休的程度略好；绝，完全衰退的状态。以火为例，火旺于夏，相于春，休于立春、立夏、立秋、立冬前各十八天，囚于秋，绝于冬。春为寅、卯、辰，火相于春，即火相于寅、卯、辰。又，相者助也，上述关系反过来称，即春为相火，寅、卯、辰为相火。由上可见，一个寅、卯、辰已然将少阳的性用，相火的性用充分地体现出来。少阳发生病变，少阳的性用失掉了，遇到寅、卯、辰就很有可能重新恢复过来。因此，少阳病当然就欲解于寅、卯、辰。
4. 少阳持方要义
少阳病的主方是大家熟悉的小柴胡汤。现在我们就来看小柴胡汤的治方要义是不是符合我们上面讨论的这些内容。
（1）象数层面
小柴胡汤用药七味，所以，我们先从七来入手。七是什么数？七是火数。故河图云：地二生火，天七成之。学中医的对河图、洛书这两个图要记得很清楚，这两个图很关键，传统的数学就包含在这两图之中。现代科学如果没有数学，那就称不上科学。没有数学语言表述，怎么能登大雅之堂？其实中医也是这样，中医同样需要数学，所以也就离不了上述这两图。《内经》也好，《伤寒论》也好，都用到这两个图。孙思邈说：“不知易不足以为大医。”我们且不要说知易，了解一点总是应该的。小柴胡汤用药七味，这说明它用的是火的格局，这就与相火相应了。接下来我们看具体的用药，小柴胡汤用药七味，第一味就是柴胡。我们看《伤寒论》的方应该注意它药物排列的次第，谁先谁后，这个是很有讲究的，随便不得。排第一位的往往就是君药，第二的往往是臣药，排后面的当然就是佐使药。现在开方往往不管这些，先记哪味就先写哪味。开一个小柴胡汤他可能把人参写第一、生姜写第一，这就乱套了。“行家一出手，便知有没有。”你这样来处一个方，不用说人家就知道你的家底。柴胡位属第一，是当然的君药，黄芩位于第二，是为臣药。我们看君药臣药的用量是多少呢？柴胡用八两，黄芩用三两。一个三、一个八，正好是东方之数，正好是寅、卯、辰之数。单就一个君臣药的用量，就把整个少阳的性用烘托出来，就把少阳病的欲解时相烘托出来。可见张仲景的东西是非常严谨的。不是你想怎么样就怎么样。如果开一个小柴胡汤，柴胡不用八两，黄芩不用三两，它还是小柴胡汤吗？它已然不是小柴胡汤了。再用它作为少阳病的主方，那就会出问题。又如桂枝汤，如果把桂枝的用量加上去，由原来的三两变成五两，这个就不再是桂枝汤。它变成了治奔豚的桂枝加桂汤。这一变就由群方之祖，由至尊之位，沦为草民了。所以，中医的用量重不重要呢？确实很重要！当然这个量更重要的是在数的方面。
天津南郊有一位盲医，善治多种疑难病证，远近的许多人都慕名去求医。既然是盲医，当然就不能望而知之，他主要靠问诊和切诊来诊断疾病。疾病诊断出来以后，开什么“药”呢？他开的“药”来来去去都是我们日用的食品。像绿豆、红豆、葡萄干、黄花菜等。不管你什么病，他都用这些东西。惟一的区别就在这个数上。张三的病，他用二十颗绿豆，二十颗葡萄干，李四的病，他用二十一颗绿豆，二十一颗葡萄干。按照现代人的理解，二十颗绿豆与二十一颗绿豆有什么区别呢？熬出来的不都是绿豆汤吗？要是按照现在的成分来分析，它确实没有什么差别。而且如果不严格计较绿豆的大小，二十一颗绿豆与二十颗绿豆的重量也可能完全相同。但，为什么在中医这里会有这么大的差别呢？这就要联系到我们从前提到过的象数这门学问了。
上述这位盲医善于用数来治病，而我们循流探源地追溯上去，张仲景才真正是中医用数的鼻祖。
大家单看《伤寒论》中大枣的用量就很有意思。桂枝汤大枣用十二枚，小柴胡汤大枣也用十二枚，十枣汤大枣用十枚，炙甘草汤大枣用三十枚，当归四逆汤大枣用二十五枚。前面的十二枚，十枚好像还容易理解。到了炙甘草汤和当归四逆汤，大枣为什么要用三十枚和二十五枚呢？三十枚大枣代表着什么？二十五枚大枣又代表着什么？这个问题提出来，即使你不回答，恐怕也能够感受到它的不寻常。炙甘草汤是太阳篇的煞尾方，用于治疗“脉结代，心动悸”。80年代初，《上海中医药》杂志曾连载柯雪帆教授所著的《医林辍英》。后来，《医林辍英》出了单行本。该书是采用章回小说的形式写就的，即有医理医案，也有故事情节。其中有一章就专门谈到炙甘草汤的运用。
炙甘草汤是一张治疗心律失常的良方，特别是一些顽固性的心律失常像房颤这一类心律失常，用之得当，往往都可以将失常的心律转复正常。这个得当包括两方面，第一方面当然是辨证得当，你要搞清楚炙甘草汤适应哪一类证。我们姑且不论它什么心律失常，你得先从阴阳去分，看看它适应阴证还是阳证。更具体一些，适应阴虚证还是阳虚证。我们一分析方剂的组成，《伤寒论》中的养阴药几乎都集中在这一方中。因此，它适应于阴虚证应该没有疑问。然而就是这样一个在《伤寒论》中集养阴之大成的方子，它还是要加进桂枝、生姜、清酒这些阳的成分。我们去看太极阴阳的画面时，你很能感受出阴中有阳，阳中有阴来。而我们回过来看炙甘草汤，阴阳的这层涵义亦活脱脱地呈现出来。炙甘草汤适用于阴虚类的心律失常，这个是辨证得当但是仅仅有这个条件还不够，还必须用量得当。这一点是柯教授专门谈到的问题。你看这个房颤，各方面的条件都符合炙甘草汤证，可是用下去就是没有应验。问题出在哪呢？就出在用量上。
道门炼丹有一句行话，叫做“传药不传火”。药可以告诉你，可是火候不轻易告诉你。为什么呢？因为它太重要了。一炉丹能不能炼成，有时就看这个火候的把握。中医的方子可以告诉你，可是量却不轻传。为什么呢？量者火候也！火候才是成败的关键，那当然不能轻传。可是张仲景不同，他是医界的孔圣，既是孔圣，那就应该“吾无隐乎尔！”所以，张仲景不但传方、传药，而且连用量也和盘托出。讨论《伤寒论》的用量，应该注意两个问题，一个是重量，一个是数量。这两个问题有联系，但在本质上又有差别。重量不同，量变了会发生质变；而数不同，同样的也可以发生质变。对于第一个质变，我们容易理解，现代用药的剂量就是这个涵义。而对于第二个质变，由数而引起的质变，我们往往不容易理解，也不容易相信。有关《伤寒论》的用药重量，现在的教科书都以3克算一两，而药典所规定的剂量也与这个差不多。但是，柯雪帆等根据大量出土的秦汉铜铁权及现存于中国历史博物馆的东汉“光和大司农铜权”的实测结果，东汉时期的一两应折合为现在的15.625克。一两合3克与一两合15.625克，这个差别太大了，直差五倍有余。像炙甘草汤中的生地黄用量为一斤，如果照一两3克算，只是48克，若按东汉铜权的实测结果，则应是250克。正好相当于现在的半斤。《伤寒论》成书于东汉末年，这是一个公认的事实。既然是东汉的著作，那这个用量理所当然地应该按东汉时的重量来折合。可是这一折合，问题就弄大了。生地黄可以用半斤，麻黄可以用93.75克（按大青龙汤麻黄用六两来折合），这就大大超过了《中华人民共和国药典》所规定的用量。你按东汉的剂量治好一千个人没你的事，但只要有一个人出了问题，那你就吃不了兜着走。你就要变胡万林。为什么呢？因为药典不支持你，你没有法律依据。所以，柯老先生尽管知道《伤寒论》的剂量就应该是东汉时的那个剂量（这个“知道”不但有考古的依据，而且还有临床实际的依据。何以见得？因为炙甘草汤你按照现在一两3克的常规用量，这个房颤就是转不过来。而一旦你用回东汉时的剂量，生地用250克了，炙甘草汤还是这个炙甘草汤，剂量一变，火候不同，房颤很快就转复成正常的心律），可是，柯老先生还是要强调一句：“应以中国药典所规定的用量与中药学教科书所规定的常用量为依据。”（见柯雪帆主编的《伤寒论选读》上海科技出版社，1996年3月版）不强调这一句，出问题打官司，10个柯老也不济事。剂量问题是一个大问题，如果这个问题含糊了，那《伤寒论》的半壁江山就有可能会丢失。你的证辨得再准，你的方药用得再准，可是量没有用准，火候没有用准，这个疗效能不打折扣吗？而最后怪罪下来，还是中医不好，还是中医没疗效。对剂量的问题我是有很深体会的，记得1990年暑期，我的爱人赵琳怀孕40天时，突发宫外孕破裂出血。当时由于诸多因素，我们选择了中医保守治疗。并立即将情况电话告知南宁的师父（即先师李阳波）。师父于电话中口述一方，并嘱立刻购用，即藏红花10克，水煎服。师言藏红花治疗内出血，诚天下第一药也。次日，师父亲临桂林。诊脉后，处方如下：白芍180克、淫羊藿30克、枳实15克，水煎服，每日一剂。经用上述两方，至第三日B超复查，不但出血停止，腹腔原有出血大部分吸收，且意外发现宫内还有一个胎儿。我与妻子不禁抚额庆幸，要是选择手术治疗，还会有我们今天的女儿吗？每思及此事，都免不了要增添几分对先师的思念及感激之情。先师所用第二方，药皆平平，为什么会有如此神奇的效果呢？看来奥妙就在这个用量上。我们平常用白芍，也就10来克、20克，至多也不过30-50克。用到180克，真有些惊世骇俗。但是，不用这个量就解决不了问题。因此，用量的问题确实是一个关系至大的问题，值得大家来认真地思考与研究，尤其应该由国家来组织攻关。个人来研究这个课题，充其量是你个人的看法，它不能作为法律依据。如果大家公认了，东汉的用量确实就是柯雪帆教授研究出的这个量，那我们就应该想一想，对于《伤寒论》的许多问题，对于中医的许多问题，是不是就要重新来认识和评价呢？
After the elements of Shaoyang disease (Shaoyang syndrome) are clear, let us look at the time when Shaoyang disease is likely to resolve. Why should Shaoyang disease be resolved during the Yin, Mao, and Chen hours (3:00 AM to 9:00 AM)? I think an important point is that the essential meaning contained in the Yin, Mao, and Chen time phases can effectively help solve the aforementioned problems of Shaoyang disease. From the perspective of the year, Yin, Mao, and Chen belong to the three months of spring, correspond to Wood (Mu), and Wood has the nature of smooth growth and free flow. If it is smooth and free-flowing, the pivot mechanism of Shaoyang can rotate vividly; if it is smooth and free-flowing, the Wood-Fire functional activity of Shaoyang will not be suppressed. On the other hand, when discussing the time phases of the Six Channels (Liu Jing) and the time phases of Three Yin and Three Yang, we should always bear in mind the integration with the Five Elements (Wu Xing) time phases. Yin-Yang and Five Elements are two disciplines, but together they form one whole. Why do I say this? Everyone should understand clearly by reviewing the content discussed in the previous chapters. What is Wood? Wood is the state where Yang Qi (vital energy) is ascending. Of course, the ascending at this time is not complete; there is still a trace or two of Yin Qi binding it. When it reaches Fire (Huo), Yang Qi ascends completely and opens fully. If Yang Qi does not open fully, think about it, can Fire be produced? Absolutely not. Then what about Metal (Jin)? When it reaches Metal, Yang Qi has shifted from opening to storing, or rather, Yang Qi gradually enters the state of Yin. Further, when it reaches Water (Shui), Yang Qi is completely in a state of storage. Think about it, if Yang Qi were not completely stored, how could ice and snow be produced? Currently, the global climate is gradually warming, and glaciers in the Arctic and inland areas are melting. What does this indicate? It indicates that the storage of Yang Qi in the entire world is gradually weakening, while openness is gradually strengthening. The era we live in is an era of constant openness, emphasizing openness all day long without emphasizing storage. How could glaciers not melt gradually? I think this is inevitable. Looking at the above problem using TCM theory and Five Elements theory makes it very clear. Therefore, what are we actually talking about when we discuss Metal, Wood, Water, and Fire? We are talking entirely about the different states of Yin and Yang. Thus, if you discuss Five Elements apart from Yin-Yang, it is difficult to hit the point, and it is difficult to gain real benefit from this knowledge. So, what is "Earth" (Tu) among the Five Elements? Which state of Yin-Yang does it represent? It represents a very special state of Yin-Yang. Because of this特殊性, Dong Zhongshu called it the "Master of the Five Elements" in *Chunqiu Fanlu* (Luxuriant Dew of the Spring and Autumn Annals). Without Earth, the Metal, Wood, Water, and Fire of the Five Elements cannot achieve their functions. For Yin-Yang to move from the state of Water (storage) to the state of Wood (ascending), what does it rely on? It relies on this Earth. Similarly, from Wood to Fire, from Fire to Metal, and from Metal to Water, none can do without this Earth. For Yin-Yang to change, circulate, and cycle repeatedly, everything must be grounded in Earth. Therefore, the role of Earth in TCM appears extremely important and special. Why do we consider the Spleen and Stomach as the Foundation of Post-Heaven (Houtian Ben)? Why does *Suwen* (Basic Questions) state in the pulse chapter, "With Stomach Qi, there is life; without Stomach Qi, there is death"? All these are closely related to Earth and deserve serious study. Five Elements express the different states of Yin-Yang, and each of the Five Elements undergoes different processes of Wang (Prosperous), Xiang (Assisting), Xiu (Resting), Qiu (Imprisoned), and Jue (Extinct) in different time regions, which constitutes an important part of the Five Elements time phase content. "Wang" means prosperous; it refers to a certain element, or a specific state of Yin-Yang, being most timely and vigorous in a specific time region. "Xiang" means assisting; it is the factor promoting prosperity and the stage that must be experienced to reach a prosperous state. "Xiu" means the prosperous state has declined. "Qiu" means the prosperous state has declined, but slightly better than Xiu. "Jue" means completely extinct. Taking Fire as an example, Fire is Wang in Summer, Xiang in Spring, Xiu eighteen days before Lichun, Lixia, Liqiu, and Lidong, Qiu in Autumn, and Jue in Winter. Spring consists of Yin, Mao, and Chen hours. Fire is Xiang in Spring, i.e., Fire is Xiang in Yin, Mao, and Chen hours. Furthermore, Xiang means assist. Reversing the above relationship, Spring is called Ministerial Fire (Xiang Huo), and Yin, Mao, and Chen hours are Ministerial Fire. From the above, it can be seen that Yin, Mao, and Chen hours fully embody the nature and function of Shaoyang and Ministerial Fire. When Shaoyang develops pathology, its nature and function are lost, but encountering Yin, Mao, and Chen hours makes it very likely to recover. Therefore, Shaoyang disease naturally tends to resolve during Yin, Mao, and Chen hours.
4. Essential Meaning of the Main Formula for Shaoyang
The main formula for Shaoyang disease is the well-known Xiaochaihu Tang (Minor Bupleurum Decoction). Now let us see if the therapeutic essence of Xiaochaihu Tang conforms to the contents we discussed above.
(1) Image and Number Level
Xiaochaihu Tang uses seven herbs. Therefore, we start with the number seven. What kind of number is seven? Seven is the number of Fire. Thus, Hetu (River Map) states: "Earth generates Fire at 2, Heaven completes it at 7." Students of TCM must remember Hetu and Luoshu (Lo River Chart) clearly; these two diagrams are crucial, and traditional mathematics is contained within them. Modern science cannot be called science without mathematics. Without mathematical language expression, how can it enter the hall of elegance? Actually, TCM is the same; TCM also needs mathematics, so it cannot do without these two diagrams. Both *Neijing* (Inner Canon) and *Shanghan Lun* (Treatise on Cold Damage) use these two diagrams. Sun Simiao said, "One who does not understand Yi (Book of Changes) cannot become a great physician." Let alone understanding Yi, having some knowledge is always advisable. Xiaochaihu Tang uses seven herbs, indicating it employs the pattern of Fire, which corresponds to Ministerial Fire. Next, let us look at the specific herbs. Among the seven herbs in Xiaochaihu Tang, the first is Chaihu (Bupleuri Radix). When examining formulas in *Shanghan Lun*, one should pay attention to the order of herb arrangement, who comes first and who comes second; this is significant and cannot be arbitrary. The first listed is often the Jun (Monarch) herb, the second is often the Chen (Minister) herb, and those listed later are Zuo (Assistant) and Shi (Envoy) herbs. Nowadays, when prescribing, people often ignore this, writing whichever herb they remember first. In prescribing Xiaochaihu Tang, one might list Renshen (Ginseng Radix) or Shengjiang (Zingiberis Rhizoma Recens) first, causing chaos. "An expert's skill reveals itself immediately upon action." If you prescribe a formula this way, others will know your proficiency without saying anything. Chaihu is listed first, making it the natural Jun herb, while Huangqin (Scutellariae Radix) is second, serving as the Chen herb. What are the dosages of the Jun and Chen herbs? Chaihu uses 8 liang, and Huangqin uses 3 liang. Three and eight correspond exactly to the number of the East, and exactly to the Yin, Mao, and Chen numbers. Just by the dosage of the Jun and Chen herbs, the entire nature and function of Shaoyang are highlighted, as well as the resolving time phase of Shaoyang disease. This shows that Zhang Zhongjing's work is extremely rigorous. It is not something you can do whatever you like. If prescribing Xiaochaihu Tang, Chaihu is not used at 8 liang, and Huangqin is not used at 3 liang, is it still Xiaochaihu Tang? It is no longer Xiaochaihu Tang. Using it as the main formula for Shaoyang disease would cause problems. Similarly, in Guizhi Tang (Cinnamon Twig Decoction), if the dosage of Guizhi (Cinnamomi Ramulus) is increased from the original 3 liang to 5 liang, it is no longer Guizhi Tang. It becomes Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon Twig) for treating Ben Tun (rushing qi attack). This change demotes it from the ancestor of all formulas and the supreme position to that of a commoner. So, is the dosage in TCM important? Indeed, it is! More importantly, this quantity lies in the aspect of numbers.
There was a blind doctor in the southern suburbs of Tianjin, skilled in treating various difficult and complicated diseases, attracting many patients from near and far. Being a blind doctor, he obviously could not diagnose through observation (Wang); he mainly relied on inquiry (Wen) and palpation (Qie) to diagnose diseases. After diagnosing the disease, what "medicine" did he prescribe? His prescribed "medicines" were invariably daily food items. Like mung beans, red beans, raisins, daylily buds, etc. Regardless of the disease, he used these things. The only difference lay in the number. For Zhang San's illness, he used twenty mung beans and twenty raisins; for Li Si's illness, he used twenty-one mung beans and twenty-one raisins. According to modern understanding, what is the difference between twenty mung beans and twenty-one mung beans? Isn't the boiled result just mung bean soup? If analyzed according to current composition standards, there is indeed no difference. Moreover, if the size of mung beans is not strictly calculated, the weight of twenty-one mung beans and twenty mung beans might be exactly the same. But why is there such a big difference here in TCM? This must be linked to the study of Images and Numbers (Xiang Shu) mentioned earlier.
The aforementioned blind doctor was good at using numbers to treat diseases, and tracing back to the source, Zhang Zhongjing is truly the founder of using numbers in TCM.
Just looking at the dosage of Dazao (Jujubae Fructus) in *Shanghan Lun* is interesting. Guizhi Tang uses twelve dates, Xiaochaihu Tang also uses twelve dates, Shizao Tang (Ten Date Decoction) uses ten dates, Zhigancao Tang (Honey-Prepared Licorice Decoction) uses thirty dates, and Danggui Sini Tang (Angelica Sinensis Decoction for Cold-Numbing Extremities) uses twenty-five dates. The preceding twelve and ten seem easy to understand. However, for Zhigancao Tang and Danggui Sini Tang, why use thirty and twenty-five dates respectively? What does thirty dates represent? What does twenty-five dates represent? Even if you do not answer this question raised, you probably feel its unusualness. Zhigancao Tang is the concluding formula of the Taiyang Chapter, used to treat "knotted and intermittent pulse, palpitations." In the early 1980s, the journal *Shanghai Journal of Traditional Chinese Medicine* serialized Professor Ke Xuefan's *Yilin Zhuoying* (Brilliance in the Medical Forest). Later, *Yilin Zhuoying* was published as a standalone book. The book is written in the form of chapter novels, containing both medical principles/cases and story plots. One chapter specifically discusses the application of Zhigancao Tang.
Zhigancao Tang is an excellent formula for treating arrhythmia. Particularly for stubborn arrhythmias like atrial fibrillation, when used appropriately, it can often restore abnormal heart rhythms to normal. Appropriateness includes two aspects. First, obviously, appropriate syndrome differentiation (Bian Zheng); you must clarify which type of syndrome Zhigancao Tang suits. Let us not discuss what kind of arrhythmia it is; you must first distinguish by Yin-Yang, seeing whether it suits Yin syndromes or Yang syndromes. More specifically, whether it suits Yin deficiency syndromes or Yang deficiency syndromes. Once we analyze the composition of the formula, almost all Yin-nourishing herbs in *Shanghan Lun* are concentrated in this formula. Therefore, there is no doubt that it suits Yin deficiency syndromes. However, even such a formula that gathers the essence of Yin nourishment in *Shanghan Lun* still adds Yang components like Guizhi, Shengjiang, and Qingjiu (clear wine). When viewing the image of Taiyin Yin-Yang, you can easily feel Yin within Yang and Yang within Yin. Returning to Zhigancao Tang, this layer of meaning of Yin-Yang is vividly presented. Zhigancao Tang is suitable for Yin-deficiency type arrhythmias. This is appropriate syndrome differentiation, but merely having this condition is not enough; appropriate dosage is also required. This is a point specially discussed by Professor Ke. Look at this atrial fibrillation; all conditions fit the Zhigancao Tang syndrome, but taking it yields no response. Where is the problem? It lies in the dosage.
In Daoist alchemy, there is a saying: "Transmit the medicine, but not the fire." You can tell someone the medicine, but the fire control (huohou) is not easily revealed. Why? Because it is too important. Whether a furnace of pills can be successfully refined sometimes depends on grasping this fire control. TCM formulas can be told to you, but dosages are not lightly transmitted. Why? Dosage is fire control! Fire control is the key to success or failure, so it certainly cannot be lightly transmitted. However, Zhang Zhongjing is different. He is the Confucius of the medical field. Since he is the Confucius, he should have "nothing hidden from you!" Therefore, Zhang Zhongjing not only transmitted formulas and medicines but also revealed the dosages completely. When discussing the dosages in *Shanghan Lun*, two issues should be noted: weight and quantity. These two issues are connected but essentially different. Different weights mean quantitative changes lead to qualitative changes; different numbers can also cause qualitative changes under the same circumstances. For the first qualitative change, we understand it easily; this is the meaning of modern medication dosages. For the second qualitative change, qualitative changes caused by numbers, we often find it hard to understand or believe. Regarding the medication weights in *Shanghan Lun*, current textbooks calculate 1 liang as 3 grams, and the dosage specified in the Pharmacopoeia is similar. However, based on extensive unearthed Qin and Han bronze and iron weights, and the actual measurement results of the Eastern Han "Guanghe Grand Minister of Agriculture Bronze Weight" existing in the National Museum of Chinese History, Ke Xuefan et al. determined that 1 liang in the Eastern Han period should be converted to 15.625 grams today. The difference between 1 liang equating to 3 grams and 1 liang equating to 15.625 grams is too large, more than five times. For example, the dosage of Shengdihuang (Rehmanniae Radix) in Zhigancao Tang is 1 jin. If calculated at 3 grams per liang, it is only 48 grams. According to the actual measurement results of the Eastern Han bronze weight, it should be 250 grams, exactly equivalent to half a jin today. It is a recognized fact that *Shanghan Lun* was completed in the late Eastern Han Dynasty. Since it is a work of the Eastern Han, this dosage should naturally be converted according to the weight of the Eastern Han period. However, once converted, the problem becomes huge. Shengdihuang can use half a jin, and Mahuang (Ephedrae Herba) can use 93.75 grams (converted based on Dahqinglong Tang using 6 liang of Mahuang), which greatly exceeds the dosage stipulated in the *Pharmacopoeia of the People's Republic of China*. If you cure a thousand people using Eastern Han dosages, it is none of your business, but if even one person has a problem, you will face severe consequences. You would become like Hu Wanlin. Why? Because the Pharmacopoeia does not support you; you lack legal basis. Therefore, although Mr. Ke knows that the dosage in *Shanghan Lun* should be that of the Eastern Han period (this "knowledge" has not only archaeological basis but also clinical practical basis. How do we know? Because if you use the conventional dosage of 3 grams per liang for Zhigancao Tang, this atrial fibrillation will not convert. But once you return to the Eastern Han dosage, using 250 grams of Shengdi, Zhigancao Tang remains Zhigancao Tang. With a change in dosage and different fire control, atrial fibrillation quickly converts to normal heart rhythm), Mr. Ke still emphasizes: "The dosage stipulated by the Chinese Pharmacopoeia and the commonly used dosage stipulated by TCM pharmacology textbooks should be taken as the basis." (See *Selected Readings on Shanghan Lun* edited by Ke Xuefan, Shanghai Science and Technology Publishing House, March 1996 edition). Without emphasizing this sentence, if problems arise and lawsuits follow, ten Mr. Kes would be of no avail. Dosage is a major issue. If this issue is vague, half of *Shanghan Lun* might be lost. No matter how accurately you differentiate the syndrome, no matter how accurately you use the formula and herbs, if the dosage is not accurate and the fire control is not accurate, will the therapeutic effect not be discounted? And ultimately, the blame falls on TCM being ineffective. I have deep experiences regarding dosage issues. I remember in the summer of 1990, my wife Zhao Lin, at 40 days pregnant, suddenly suffered from ruptured ectopic pregnancy bleeding. Due to various factors, we chose conservative TCM treatment. I immediately informed my master in Nanning (the late Master Li Yangbo) by phone. My master orally prescribed a formula over the phone and instructed immediate purchase and use: Zanghonghua (Saffron) 10 grams, decocted in water and taken orally. The master stated that Zanghonghua is truly the number one medicine for internal bleeding. The next day, my master personally came to Guilin. After pulse diagnosis, the prescription was as follows: Baishao (Paeoniae Radix Alba) 180 grams, Yinyanghuo (Epimedii Folium) 30 grams, Zhishi (Aurantii Fructus) 15 grams, decocted in water, one dose daily. After using the above two formulas, by the third day, ultrasound re-examination showed not only that bleeding stopped and most of the original abdominal bleeding was absorbed, but also unexpectedly discovered another fetus in the uterus. My wife and I couldn't help but sigh with relief. If we had chosen surgical treatment, would we have our daughter today? Every time I think of this, I inevitably add a bit of longing and gratitude towards my late master. The second formula used by my late master consisted of ordinary herbs, yet why did it have such miraculous effects? It seems the mystery lies in this dosage. Usually, we use Baishao, about 10 to 20 grams, at most 30-50 grams. Using 180 grams is truly shocking. However, without this dosage, the problem cannot be solved. Therefore, the issue of dosage is indeed a matter of utmost importance, worthy of serious thinking and research by everyone, especially organized by the state for tackling key problems. Individual research on this topic amounts to at best personal opinion and cannot serve as a legal basis. If everyone agrees that the Eastern Han dosage is indeed the amount researched by Professor Ke Xuefan, then we should think about whether many issues in *Shanghan Lun* and many issues in TCM need to be re-understood and evaluated.