以周身言,则躯壳为表,脏腑为里。而以躯壳言,则皮肤为表,骨肉为里。以
脏腑言,则腑为表,脏为里也。以经脉言,太阳阳明为表,三阴为里,少阳为半表
半里。而于表中又分表里,则太阳乃表之表,阳明乃表之里。于里中又分表里,则
太阴为里之表,少阴为里之中,厥阴为里之里也。故伤寒传经之次,首太阳,次
阳明,次少阳,次太阴,次少阴,次厥阴。按太阳之腑为膀胱,阳明之腑为胃,二
腑皆贮物,泻而不藏,外通出表,故其经脉属表。太阴之藏脾,少阴之藏肾,
厥阴之藏肝,皆贮精,藏而不泻,不能外出,故其经脉属里。少阳之府胆,
所贮精汁,类于物,则似腑也,然亦藏而不泻,则又似脏,故其经脉属半表半里,
此无可疑。独肾位肝下,最属深藏,其经脉应为里之里,乃反为里之中,此则不能
无疑。岂经脉虽连系于脏腑,而其表里层次,自以其行于肌肤之浅深分,不照脏腑
之部位为次序耶?且此止言足经耳,若手经之次第,亦有可得而言者耶?窃疑《内
经·热病论》论伤寒传经之次,乃仿运气,厥阴为一阴,少阴为二阴,太阴为三
阴,少阳为一阳,阳明为二阳,太阳为三阳之说以为言。然此乃言客气之次第,恐
未可为病机之据也。且运气之说,亦谬而不足信矣。
从全身整体来看,躯壳属于表,脏腑属于里。而在躯壳内部来说,皮肤属于表,骨肉属于里。在脏腑内部来说,六腑属于表,五脏属于里。从经脉的角度来看,太阳经和阳明经属于表,三阴经(太阴、少阴、厥阴)属于里,少阳经属于半表半里。而在“表”的范畴内又细分表里,则太阳经是表中之表,阳明经是表中之里。在“里”的范畴内又细分表里,则太阴经是里中之表,少阴经是里中之中,厥阴经是里中之里。所以伤寒病传变的次序,首先是太阳经,其次是阳明经,再次是少阳经,接着是太阴经,然后是少阴经,最后是厥阴经。
考察太阳经对应的腑是膀胱,阳明经对应的腑是胃,这两个腑都贮存水谷糟粕,特点是泻而不藏,向外通达排出体外,所以它们的经脉归属于表。太阴经对应的脏是脾,少阴经对应的脏是肾,厥阴经对应的脏是肝,这些脏都贮存精气,特点是藏而不泻,精气不能外泄,所以它们的经脉归属于里。少阳经对应的腑是胆,胆所贮存的是精汁(胆汁),类似于物,看似属于腑;但胆也是藏而不泻,这又类似脏,所以它的经脉归属于半表半里,这是没有疑问的。
唯独肾脏位于肝脏之下,位置最深藏,其经脉理应属于“里中之里”,但实际上却处于“里之中”,这一点让人不能不怀疑。难道经脉虽然连接脏腑,但其表里的层次划分,是根据经脉在肌肤中循行的深浅来区分的,而不是按照脏腑在体内的解剖部位顺序来确定的吗?况且这里只讨论了足经的次序,如果讨论手经的次序,是否也有规律可言呢?我私下怀疑,《黄帝内经·热病论》中论述伤寒传变次序,是模仿五运六气理论,认为厥阴是一阴,少阴是二阴,太阴是三阴,少阳是一阳,阳明是二阳,太阳是三阳的说法来进行论述的。然而,这说的是客气(非主时的异常气候之气)的次序,恐怕不能作为疾病机理的依据。而且,五运六气的学说,也是荒谬且不足为信的。
Speaking of the whole body, the exterior shell (body surface) is considered *biao* (exterior), while the internal organs (*zang-fu*) are considered *li* (interior). Speaking within the context of the exterior shell, the skin and hair are *biao*, while bones and muscles are *li*. Within the context of the internal organs, the fu-organs (hollow organs) are *biao*, and the zang-organs (solid organs) are *li*. From the perspective of meridians, the Taiyang meridian and Yangming meridian belong to *biao*, the three Yin meridians belong to *li*, and the Shaoyang meridian belongs to half-*biao* and half-*li*. Furthermore, within *biao*, there is a further distinction: Taiyang is the *biao* of *biao*, and Yangming is the *li* of *biao*. Within *li*, there is also a distinction: Taiyin is the *biao* of *li*, Shaoyin is the middle of *li*, and Jueyin is the *li* of *li*. Therefore, in the sequence of transmission for cold damage diseases (*shanghan*), it begins with Taiyang, followed by Yangming, then Shaoyang, then Taiyin, then Shaoyin, and finally Jueyin.
Examining the corresponding fu-organs, the bladder corresponds to Taiyang, and the stomach corresponds to Yangming. Both these fu-organs store substances, function by draining rather than storing, and connect outwardly to expel waste; thus, their meridians are classified as *biao*. The spleen corresponds to Taiyin, the kidney corresponds to Shaoyin, and the liver corresponds to Jueyin. These zang-organs store essence, function by storing rather than draining, and cannot expel outward; thus, their meridians are classified as *li*. The gallbladder corresponds to Shaoyang. It stores bile (refined fluid), which resembles substances like those in fu-organs, suggesting it is a fu-organ; however, it also stores without draining, resembling a zang-organ. Therefore, its meridian is classified as half-*biao* and half-*li*, which is beyond doubt.
However, the kidney is located below the liver, being the most deeply stored organ. Its meridian should theoretically be the *li* of *li*, yet it is actually positioned as the middle of *li*. This raises doubts. Could it be that although meridians are connected to zang-fu organs, their classification into *biao* and *li* levels is determined by the depth of their course through the skin and muscles, rather than by the anatomical position of the organs themselves? Moreover, this discussion only addresses the foot meridians. Is there also a sequence for the hand meridians that can be discussed? I suspect that the discussion on the sequence of transmission in cold damage diseases in the "Treatise on Heat Diseases" chapter of the *Huangdi Neijing* (Yellow Emperor's Inner Canon) imitates the theory of Five Movements and Six Qi (*yunqi*). It posits that Jueyin is one Yin, Shaoyin is two Yin, Taiyin is three Yin, Shaoyang is one Yang, Yangming is two Yang, and Taiyang is three Yang. However, this refers to the sequence of "guest qi" (abnormal climatic factors), which may not serve as a basis for disease mechanisms. Furthermore, the theory of Five Movements and Six Qi is erroneous and unreliable.