\r司天在泉图\ps61a3.bmp\r
司天在泉，四间气者，客气之六步也。凡主岁者为司天，位当三之气。司天之下，相对
者为在泉，位当终之气。司天之左，为天之左间，右为天之右间。每岁客气，始于司天前二
位，乃地之左间，是为初气，以至二气三气，而终于在泉之六气。每气各主一部。然司天通
主上半年，在泉通主下半年，故又曰岁半以前天气主之，岁半以后，地气主之也。
子午少阴为君火，丑未太阴临湿土，寅申少阳相火旺，卯酉阳明燥金所，辰戌太阳寒水
边，巳亥厥阴风主木。初气起地之左间，司天在泉对面数。
谚云∶不读五运六气，检遍方书何济。所以稍涉医理者，动以“司运”为务。曷知“天
元纪”等篇，本非《素问》原文，王氏取阴阳大论补入经中，后世以为古圣格言，孰敢非之
，其实无关于医道也。况论中明明，时有常位，而气无必然，犹谆谆详论者，不过穷究其理而
已。纵使胜复有常，而政分南北，四方有高下之殊，四序有非时之化，百步之内，晴雨不同
，千里之外，寒暄各异。岂可以一定之法，而执非常之变耶。若熟之以资顾问则可，苟奉为
治病之法，则执一不通矣。
伤寒病不全表证。然太阳为寒水之经，主一身之表，凡病从太阳始者，皆名伤寒，其病
头痛，项强，发热，恶寒，若初起有汗，用桂枝汤，无汗用麻黄汤，治之得法，一解表则无
余事矣。然太阳主表中之表，而阳明主肌亦表也，其证身热，目痛而鼻干，不得卧，时法用
升麻葛根汤，少阳主胸胁，亦表也，其证胸胁痛，目眩，口苦而耳聋，《伤寒论》用小柴胡
汤加减。是三阳皆属于表，故列于表证。
（经义）《素问·热病论》曰∶“人之伤于寒也，则为病热。”此主六气之相传而言也，始
终皆为热病。仲景宗六气之说，从对面，旁面参出大旨，取三阳三阴无形之气，验于有形之
皮肤，肌络，形骸，以及五脏六腑之虚实寒热，合经权常变而立言，集隘不能登之。余着有
《伤寒论浅注》，最宜熟玩。
【司天在泉图】
司天、在泉以及四间气，属于客气运行的六个阶段。凡是主管全年气候的称为“司天”，其位置对应六步中的第三步（三之气）。在司天的对面相对的位置称为“在泉”，其位置对应第六步（终之气）。司天的左侧，称为天之左间气；右侧，称为天之右间气。每年的客气运行，始于司天前两位的地之左间气，这被称为初气，依次经过二气、三气，最终到达在泉的第六气。每一气各自主管相应的时段或部位。然而，司天主管上半年的气候，在泉主管下半年的气候，所以又说：岁半之前由天气主导，岁半之后由地气主导。
子年和午年，少阴君火司天；丑年和未年，太阴湿土司天；寅年和申年，少阳相火司天；卯年和酉年，阳明燥金司天；辰年和戌年，太阳寒水司天；巳年和亥年，厥阴风木司天。初气从地的左间气开始，按照司天与在泉相对的方位来推算。
谚语说：“如果不学习五运六气，即使翻遍方书又有什么用呢？”因此，稍微涉猎医理的人，动不动就把研究“司运”当作首要任务。哪里知道《天元纪》等篇章，本来就不是《素问》的原文，是王冰选取《阴阳大论》的内容补入经文中的，后世人将其视为古代圣人的格言，谁敢指责它呢？其实这些内容与实际的医疗之道关系不大。况且文中明明提到，时令有固定的位置，但气候没有必然的规律，像这样详尽论述，不过是穷究其理论罢了。纵使胜气和复气有一定的规律，但政令分南北，四方有高下地势的差异，四季也有非时节的化育变化，百步之内，晴雨可能不同，千里之外，冷暖也可能各异。怎么能用固定不变的方法，去拘泥于非常规的变化呢？如果熟记这些知识以备咨询询问是可以的，但如果奉为治病的具体方法，那就是固执一端、不通变通了。
伤寒病并不完全表现为表证。然而，太阳经属于寒水之经，主管全身的体表。凡是疾病从太阳经开始的，都称为伤寒，其症状包括头痛、项强（颈项僵硬）、发热、恶寒。如果在发病初期有汗，使用桂枝汤；如果没有汗，使用麻黄汤进行治疗。只要治疗方法得当，一旦解除了表证，就没有其他事情需要处理了。但是，太阳经主管体表的表层，而阳明经主管肌肉，也属于表证范畴，其症状为身体发热、眼睛疼痛、鼻子干燥、无法安卧，此时通常采用升麻葛根汤治疗。少阳经主管胸胁部，也属于表证范畴，其症状为胸胁疼痛、目眩、口苦和耳聋，《伤寒论》中采用小柴胡汤进行加减治疗。这三阳经都属于表证，所以被列在表证之中。
（经文义理）《素问·热病论》说：“人受到寒邪侵袭，就会发生热病。”这是主要论述六气相互传变而言的，从头到尾都归结为热病。张仲景遵循六气的学说，从对面、旁面参悟出大意，取三阳和三阴无形的气，验证于有形的皮肤、肌络、形体骸骨，以及五脏六腑的虚实寒热，结合经权和常变来立论，篇幅所限不能全部登载。我著有《伤寒论浅注》，最适合仔细研读玩味。
[Chart of Si Tian and Zai Quan]
Si Tian (Heavenly Ruler), Zai Quan (Earthly Ruler), and the four interstitial Qi (Jian Qi) constitute the six steps of Ke Qi (Hostile/Periodic Qi). That which governs the year is called Si Tian, positioned at the third step (San Zhi Qi). Opposite to Si Tian is Zai Quan, positioned at the final step (Zhong Zhi Qi). To the left of Si Tian is the Left Interstitial Qi of Heaven; to the right is the Right Interstitial Qi of Heaven. The Ke Qi of each year begins at the Earth's Left Interstitial Qi, two positions preceding Si Tian, which is designated as the First Qi (Chu Qi), proceeding through the Second and Third Qi, finally reaching the Sixth Qi of Zai Quan. Each Qi governs its respective segment. However, Si Tian generally governs the first half of the year, and Zai Quan generally governs the second half of the year. Thus, it is said: before the mid-year, Heavenly Qi governs; after the mid-year, Earthly Qi governs.
In the Zi and Wu years, Shao Yin Jun Huo (Ministerial Fire) rules Si Tian; in Chou and Wei years, Tai Yin Shi Tu (Damp Earth) rules Si Tian; in Yin and Shen years, Shao Yang Xiang Huo (Ministerial Fire) rules Si Tian; in Mao and You years, Yang Ming Zao Jin (Dry Metal) rules Si Tian; in Chen and Xu years, Tai Yang Han Shui (Cold Water) rules Si Tian; in Si and Hai years, Jue Yin Feng Mu (Wind Wood) rules Si Tian. The First Qi starts from the Earth's Left Interstitial Qi, counted according to the opposing positions of Si Tian and Zai Quan.
The proverb says: "If one does not study the Five Movements and Six Qi, what use is it to search through all medical formularies?" Therefore, those who dabble in medical principles often take studying "Si Yun" (Ruling Movements) as their primary task. Little do they know that chapters such as *Tian Yuan Ji* were originally not part of the *Su Wen* (Basic Questions); Wang Bing selected content from the *Yin Yang Da Lun* (Great Treatise on Yin and Yang) to supplement the classic. Later generations regarded these as sayings of ancient sages, daring not to criticize them. In reality, they have little relevance to actual medical practice. Moreover, the text explicitly states that while seasons have fixed positions, Qi has no absolute certainty. Such detailed discussion serves only to exhaustively explore the theory. Even if there are regular patterns of Sheng (Overcoming) and Fu (Rebounding) Qi, policies differ between North and South, terrain varies in height and depth across the four directions, and seasonal transformations may occur out of time. Within a hundred paces, weather conditions may differ; a thousand miles away, cold and warmth may vary. How can one apply rigid methods to accommodate extraordinary changes? Memorizing this for consultation purposes is acceptable, but regarding it as a fixed method for treating diseases leads to rigidity and lack of flexibility.
Shang Han (Cold Damage) disease does not present solely with exterior syndromes. However, the Tai Yang (Greater Yang) channel belongs to Cold Water and governs the exterior of the body. Any disease originating from the Tai Yang channel is named Shang Han. Its symptoms include headache, neck stiffness, fever, and aversion to cold. If sweating is present at the onset, Gui Zhi Tang (Cinnamon Twig Decoction) is used; if no sweating is present, Ma Huang Tang (Ephedra Decoction) is used. If treated correctly, once the exterior syndrome is resolved, no further treatment is needed. However, Tai Yang governs the outermost layer of the exterior, while Yang Ming (Yang Brightness) governs the muscles, which also belongs to the exterior category. Its symptoms include body heat, eye pain, nasal dryness, and insomnia; typically, Sheng Ma Ge Gen Tang (Kudzu Root and Rhizoma Cimicifugae Decoction) is employed. Shao Yang (Lesser Yang) governs the chest and hypochondrium, also belonging to the exterior category. Its symptoms include chest and hypochondriac pain, vertigo, bitter taste in the mouth, and deafness; *Shang Han Lun* employs Xiao Chai Hu Tang (Minor Bupleurum Decoction) with modifications. Since the Three Yang channels all belong to the exterior, they are listed under exterior syndromes.
(Interpretation of Classic Text) The *Su Wen · Re Bing Lun* (Treatise on Febrile Diseases in the Basic Questions) states: "When humans are injured by Cold, they develop febrile diseases." This refers primarily to the transmission of the Six Qi, where the condition remains a febrile disease from beginning to end. Zhang Zhongjing followed the theory of Six Qi, deriving the main principles from opposite and lateral perspectives. He correlated the formless Qi of the Three Yang and Three Yin with the有形 (form/solid) skin, muscle meridians, skeletal structure, and the deficiency-excess and cold-heat conditions of the five zang and six fu organs, establishing his discourse based on standard procedures and adaptive variations. Due to space limitations, not all can be included here. I have authored *Shang Han Lun Qian Zhu* (Light Commentary on the Treatise on Cold Damage), which is highly suitable for careful study.