下面举一个病例，三四年前，江南无线电厂的一位女工找我看病，西医的诊断是肾结石、肾积水，病情比较重，中西医都看过，但是，效果不显。经一位老病友的介绍到我这里来就诊，按照常规，结石、积水就要排石利水，但是，我首先没有考虑这些，而是静静地听病人讲诉病情，一边听一边思考，其实就是为了抓主证。当病人讲到这一个月都在拉肚子，心很烦躁，睡觉也睡不好时，就是这一刹那，我把主证抓住了。我给她开了猪苓汤原方，没有加什么排石药。为什么开猪苓汤？因为 319 条说得很清楚：“少阴病，下利六七日，咳而呕渴，心烦不得眠者，猪苓汤主之。”这里很明确地讲到，下利然后又有心烦不得眠的，就可以用猪苓汤。而这个病人兼而有之，这就使你很快考虑到这个上面来。你不必管它是结石还是积水，它的主证符合猪苓汤，你就用猪苓汤。药开好后，病人走了，从此再没有回来复诊。大概过了半年多，她又介绍另一位病人来找我，从这个病人的口里，才知道服药以后症状很快消失，不到半个月再作检查，结石没啦，积水也消除了。这例病案给我的感受很深，使我隐隐约约地揣摸到了刘老“抓主证”的涵义。上过临床的人都知道，有些病人的病情是非常复杂的，特别是一些上年纪的人，她可以给你诉说半天的病情，等到后面的讲完了，前面的也忘记了。对于这类病人，你更要抓主证，你要静静地听，那么多的东西中，总是有一句话或一个证或一个脉对你有启发，这个就是主证。前些天我看一位同学的母亲，她的主要情况就是感冒发烧，反反复复已经十来天，还是没有解决。感冒发烧在伤寒来说，应该属于太阳病。太阳病不管你是什么原因引起，脉都应该浮。可是这位病人的脉却很沉，表证而现沉脉，这就是反常，这就是一个关键点，这个就是主证。说明她是太少两感，用一般感冒的药对她肯定没有好处。我给她开了两剂麻黄细辛附子汤，服汤以后，烧很快就退了。所以，临床治病，只要主证抓得好，确实可以效如桴鼓。那么，如何才能抓好主证呢？这一方面是经验，另外就是要注意三点，这里有六个字送给大家。第一，明理。比如少阴病始得之，反发热，脉沉者，为什么会出现这样的情况，出现这样的情况为什么要用麻黄细辛附子汤，这个道理你必须搞清楚，道理清楚了，你才能举一反三地运用在其他方面，这才有灵活可言；第二，熟记。为什么我们一再强调学伤寒应该背诵呢？如果你想当一个好中医，不背不行。即便不能一字不漏的背，起码对条文你应该熟悉，特别是有方有证的条文，你必须熟悉，任何时候都能想起它大概说什么。只有做到这一点，《伤寒论》你才能真正用起来。不熟悉条文，临证怎么抓主证？主证抓不住，经方用起来就不灵；第三，多用。学以致用，我们学过太阳篇，就要你看看我，我看看你，看看有没有太阳证。老是躲在深闺不识人，那起不到作用。如果自己感冒了，你要辨一辨，看到底是太阳还是少阳还是太少两感。学中医的人，特别是学过《伤寒论》以后，碰到感冒还是复方感冒灵，还是 Vc银翘，那你白学了，你恐怕永远是下工。应该记住，不管是什么病，你都要凭脉辨证，有这样的脉证才用这样的方法，也就是要有的放矢。这就是我要给大家谈的治病法要。大家应该牢牢记住，上工是一个怎样的概念，下工是一个怎样的概念。虽然，我们不能马上成为上工，但，既定的目标应该有。大家应该处处注意养成上工的习惯，处处注意避免下工的行为。不要这个肿瘤病来了，你就满脑子想的白花蛇舌草、半枝莲这些抗癌药，我想这个不是中医，充其量是半吊子中医。既然是中医，你就要有中医的思路，你就要临证察机。也只有这样，你才容易有体会，你才容易有感受。否则，这个病人治好了，你不知道是怎么治好的，治差了你也不知道怎么回事，当了一辈子中医自己还是糊涂虫，岂不可怜！要是这样做中医，那真的没意思。所以，希望大家都能成为上工，至少成一个准上工。我想只要按照我们上面的这些方法去操作，我们在形式上就已经成为上工了。在正式进入太阳篇的讨论前，这个引导过程是很有必要的。
第五章 太阳病纲要
一、篇题讲解
读太阳篇我们首先要看这个篇题，就像读书首先要读书名一样。这个习惯大家应该养成，特别是一些需要精读的书，那是一个字也不能放过。读经典必须弄清三义，即字义、句义、总义。三义清楚了，没有读不懂的经典。我们首先从总义的角度来看这个篇题：“辨太阳病脉证并治”，它讲的是什么内容呢？它主要讨论辨别与判断与太阳相关的病名、病机、脉、证及其相关的治疗这样一个问题。透过这样一个题目的分析，我们就能把握中医的一些性质。现在有一种思潮，认为中医只讲辨证不讲辨病，或者详于辨证略于辨病，所以，要与西医相结合，要辨病加上辨证。对于持这样一个看法的人，我常常说他们根本没有读过《伤寒论》，不能算是中医说的话。你读过《伤寒论》你就知道，中医怎么不辨病呢？中医首先是辨病然后才是辨证。辨病是首位，辨证是次位。你不首先确定是太阳病，你怎么去进一步肯定它是中风还是伤寒。所以，说中医没有辨病，那是个天大的误解。
1.辨释
首先释第一个辨字，辨字比较简单。《说文》曰：判也。《广韵》说：别也。合起来就是一个判断、区别之义。《康熙字典》载《礼学记》注云：“辨谓考问得其定也。”又载《周礼天官书》注云：“辨谓辨然于事分明无有疑惑也。”综合以上诸义，辨就是将通过各种途径所获取的这些材料进行综合的分析判断思维，然后得出一个很确定，很清楚的东西，这个过程就叫作辨。结合中医来说，就是根据四诊的材料，进行综合分析思维，然后得出明确的诊断，辨就是讲的这个过程。
2.太阳释
（1）太阳本义
太阳有些什么意义呢？我们先来看它的本义，就是原来的意，这个意我们通称为日。将日通称为太阳，或者将太阳通称为日，这都是大家知道的。其次就是《灵枢·九针十二原》说的“阳中之太阳，心也”，这里把心喻作太阳，为什么呢？张介宾说：“心为阳中之阳，故曰太阳。”太阳从它的内涵去看，也就是阳气很盛大之义，所以，王冰说：“阳气盛大，故曰太阳。”
（2）太阳经义
以往研究《伤寒论》的人，有的认为六经就是讲经络，有的认为除了经络还有藏府，有的认为六经是讲界面，这就告诉我们，六经的概念内涵很丰富，它不是一个方面，它是多方面的。这里我们只从经络的角度看看太阳的意义。太阳的经络有手足太阳经，特别是足太阳经非常重要，这一点我们在前面已经强调过。足太阳具有什么特色呢？ 足太阳起于睛明，上额交巅，然后下项夹脊，行于背后，沿着人的身后、腿后，最后到达至阴。我们比较十二正经，足太阳是最长的一条。它的分布区域在十二经中是最长最广的，特别是布局于整个身后这一点非常有意义。大家也许有过这样的经验，特别是对风比较敏感的人，如果风从前面吹来，你会觉得无所谓，要是风从后面吹来，你会马上不舒服。为什么呢？明枪易躲，暗箭难防。《内经》一再强调“圣人避风如避矢石”，所以，对这个风大家不要小看了。在《内经》的时代，能够远距离，并且在不知不觉中伤人的有什么呢？就是这个矢石。而矢石从前面发过来，你还容易察觉，容易躲过去，如果矢石从后面打来，那就不容易躲过了。有几个人真能像金庸小说里写的，脑后生目，辨器听声呢？圣人把风比作矢石，可见风对于人体的危害之大。而前面来的风我们容易察觉，后面来的风就比较困难了。这个风从后面来，偷偷摸摸的，所以，又叫贼风。人体靠什么对付从后而来的贼风呢？这就要靠太阳。太阳居后的意义正在于此。前人把太阳比作六经藩篱，就与太阳居后有很大的关系，并不是说太阳经的位置最浅表。对于经络循行的这样一些部位，大家要很留心，伤寒的六经辨证有很大一部分与这个相关。病人的腿痛，或者其他的什么地方痛，你要问得很具体，不是光问一个腿痛就了事，是前面痛还是后面痛？是外侧痛还是内侧痛？如果是后面痛，胋窝的地方痛，那肯定与太阳有关，你要从太阳去考虑它的治疗，这就很自然地把你带入了六经辨证。所以，要学好伤寒，弄清楚经络的意义是很重要的。
（3）太阳府义
太阳府有足太阳膀胱府，手太阳小肠府。“膀胱者，州都之官，津液藏焉，气化则能出矣。”所以，膀胱是津液之府，是水府。那么，这样一个水府为什么要跟太阳相连呢？这个连接正好昭示了水与气化的密切关系。一个水、一个气化，太阳篇的许多内容都与这个相关。另外就是手太阳小肠府，小肠府与太阳篇的关系虽然没有膀胱那么直接，但是，它的内涵值得在此一提。《素问·灵兰秘典论》云：“小肠者，受盛之官，化物出焉。”对于这个“受盛”，王冰解释说：“承奉胃司，受盛糟粕，受已复化，传入大肠，故云受盛之官，化物出焉。”而张介宾则云：“小肠居胃之下，受盛胃中水谷而分清浊，水液由此而渗于前，糟粕由此而归于后，脾气化而上升，小肠化而下降，故曰化物出焉。”以上王张的两个解释，都将“受盛”作复词看，这个看法未必恰当。因为受即承纳、接受之义，已经具备了上述的复词意义，盛呢？《说文》云：“黍稷在器中以祀者也。”故盛的本义原非盛受，而是置于器中以备祭祀用的谷物。“盛”是用来作祭祀用的，王冰把受盛释作“受盛糟粕”，而张介宾虽然未全作糟粕讲，可是也有糟粕的成分，这怎么可能呢？古人祭祀所用，必是精挑细选的上好佳品，怎么可能是糟粕？因此，王张的这个解释值得怀疑。盛为祭祀用的精细谷物，这与小肠接纳经胃熟化、细化的水谷甚为相合。另外一个方面，盛是作祭祀供奉用的，在这里小肠承纳的“盛”用于供奉什么呢？当然是供奉五藏，因为五藏乃藏神之所。用水谷之精微来营养藏神的五藏，这不就是一种祭祀供奉吗？这样的解释才基本符合“受盛之官”的涵义。从这个涵义我们看到，古人若不知道小肠是吸收营养的主要场所，决不会用“受盛”这个词。
（4）太阳运气义
谈过了太阳的本义、经义、府义，下面来看太阳在运气方面的意义。在运气里，太阳在天为寒，在地为水，合起来就是太阳寒水。太阳为阳中之阳，为什么要与寒水相配呢？我们可以从以下这些方面来思考。
① 水义释
下面举一个病例。三四年前，江南无线电厂的一位女工来找我看病，西医诊断为肾结石、肾积水，病情较重，虽然中西医都看过，但效果不明显。经一位老病友介绍到我这里就诊。按照常规，治疗结石和积水应当采用排石利水的方法，但我首先没有考虑这些，而是静静地听病人讲述病情，一边听一边思考，其实就是为了抓住主证（主要证候）。当病人讲到这一个月都在拉肚子，心里很烦躁，睡觉也睡不好时，就在这一刹那，我抓住了主证。我给她开了猪苓汤原方，没有加什么排石药。为什么开猪苓汤？因为《伤寒论》第319条说得很清楚：“少阴病（少阴经受邪所致的病证），下利六七日，咳而呕渴，心烦不得眠者，猪苓汤主之。”这里很明确地讲到，下利然后又有心烦不得眠的，就可以用猪苓汤。而这个病人兼而有之，这就使你很快考虑到这个上面来。你不必管它是结石还是积水，它的主证符合猪苓汤，你就用猪苓汤。药开好后，病人走了，从此再没有回来复诊。大概过了半年多，她又介绍另一位病人来找我，从这个病人的口里，才知道服药以后症状很快消失，不到半个月再作检查，结石没啦，积水也消除了。这例病案给我的感受很深，使我隐隐约约地揣摸到了刘老“抓主证”的涵义。上过临床的人都知道，有些病人的病情是非常复杂的，特别是一些上年纪的人，她可以给你诉说半天的病情，等到后面的讲完了，前面的也忘记了。对于这类病人，你更要抓主证，你要静静地听，那么多的东西中，总是有一句话或一个证或一个脉对你有启发，这个就是主证。前些天我看一位同学的母亲，她的主要情况就是感冒发烧，反反复复已经十来天，还是没有解决。感冒发烧在伤寒来说，应该属于太阳病。太阳病不管你是什么原因引起，脉都应该浮（脉搏轻取即得）。可是这位病人的脉却很沉（脉搏重按始得），表证而现沉脉，这就是反常，这就是一个关键点，这个就是主证。说明她是太少两感（太阳与少阴同时受邪），用一般感冒的药对她肯定没有好处。我给她开了两剂麻黄细辛附子汤，服汤以后，烧很快就退了。所以，临床治病，只要主证抓得好，确实可以效如桴鼓（疗效迅速显著）。那么，如何才能抓好主证呢？这一方面是经验，另外就是要注意三点，这里有六个字送给大家。第一，明理。比如少阴病始得之，反发热，脉沉者，为什么会出现这样的情况，出现这样的情况为什么要用麻黄细辛附子汤，这个道理你必须搞清楚，道理清楚了，你才能举一反三地运用在其他方面，这才有灵活可言；第二，熟记。为什么我们一再强调学伤寒应该背诵呢？如果你想当一个好中医，不背不行。即便不能一字不漏的背，起码对条文你应该熟悉，特别是有方有证的条文，你必须熟悉，任何时候都能想起它大概说什么。只有做到这一点，《伤寒论》你才能真正用起来。不熟悉条文，临证怎么抓主证？主证抓不住，经方用起来就不灵；第三，多用。学以致用，我们学过太阳篇，就要你看看我，我看看你，看看有没有太阳证。老是躲在深闺不识人，那起不到作用。如果自己感冒了，你要辨一辨，看到底是太阳还是少阳还是太少两感。学中医的人，特别是学过《伤寒论》以后，碰到感冒还是复方感冒灵，还是 Vc银翘，那你白学了，你恐怕永远是下工（医术低下的医生）。应该记住，不管是什么病，你都要凭脉辨证，有这样的脉证才用这样的方法，也就是要有的放矢。这就是我要给大家谈的治病法要。大家应该牢牢记住，上工（医术高明的医生）是一个怎样的概念，下工是一个怎样的概念。虽然，我们不能马上成为上工，但，既定的目标应该有。大家应该处处注意养成上工的习惯，处处注意避免下工的行为。不要这个肿瘤病来了，你就满脑子想的白花蛇舌草、半枝莲这些抗癌药，我想这个不是中医，充其量是半吊子中医。既然是中医，你就要有中医的思路，你就要临证察机（观察疾病发生发展的机理）。也只有这样，你才容易有体会，你才容易有感受。否则，这个病人治好了，你不知道是怎么治好的，治差了你也不知道怎么回事，当了一辈子中医自己还是糊涂虫，岂不可怜！要是这样做中医，那真的没意思。所以，希望大家都能成为上工，至少成一个准上工。我想只要按照我们上面的这些方法去操作，我们在形式上就已经成为上工了。在正式进入太阳篇的讨论前，这个引导过程是很有必要的。
第五章 太阳病纲要
一、篇题讲解
读太阳篇我们首先要看这个篇题，就像读书首先要读书名一样。这个习惯大家应该养成，特别是一些需要精读的书，那是一个字也不能放过。读经典必须弄清三义，即字义、句义、总义。三义清楚了，没有读不懂的经典。我们首先从总义的角度来看这个篇题：“辨太阳病脉证并治”，它讲的是什么内容呢？它主要讨论辨别与判断与太阳相关的病名、病机（疾病发生、发展与变化的机制）、脉、证及其相关的治疗这样一个问题。透过这样一个题目的分析，我们就能把握中医的一些性质。现在有一种思潮，认为中医只讲辨证不讲辨病，或者详于辨证略于辨病，所以，要与西医相结合，要辨病加上辨证。对于持这样一个看法的人，我常常说他们根本没有读过《伤寒论》，不能算是中医说的话。你读过《伤寒论》你就知道，中医怎么不辨病呢？中医首先是辨病然后才是辨证。辨病是首位，辨证是次位。你不首先确定是太阳病，你怎么去进一步肯定它是中风还是伤寒。所以，说中医没有辨病，那是个天大的误解。
1.辨释
首先释第一个辨字，辨字比较简单。《说文》曰：判也。《广韵》说：别也。合起来就是一个判断、区别之义。《康熙字典》载《礼学记》注云：“辨谓考问得其定也。”又载《周礼天官书》注云：“辨谓辨然于事分明无有疑惑也。”综合以上诸义，辨就是将通过各种途径所获取的这些材料进行综合的分析判断思维，然后得出一个很确定，很清楚的东西，这个过程就叫作辨。结合中医来说，就是根据四诊的材料，进行综合分析思维，然后得出明确的诊断，辨就是讲的这个过程。
2.太阳释
（1）太阳本义
太阳有些什么意义呢？我们先来看它的本义，就是原来的意，这个意我们通称为日。将日通称为太阳，或者将太阳通称为日，这都是大家知道的。其次就是《灵枢·九针十二原》说的“阳中之太阳，心也”，这里把心喻作太阳，为什么呢？张介宾说：“心为阳中之阳，故曰太阳。”太阳从它的内涵去看，也就是阳气很盛大之义，所以，王冰说：“阳气盛大，故曰太阳。”
（2）太阳经义
以往研究《伤寒论》的人，有的认为六经就是讲经络，有的认为除了经络还有藏府，有的认为六经是讲界面，这就告诉我们，六经的概念内涵很丰富，它不是一个方面，它是多方面的。这里我们只从经络的角度看看太阳的意义。太阳的经络有手足太阳经，特别是足太阳经非常重要，这一点我们在前面已经强调过。足太阳具有什么特色呢？ 足太阳起于睛明，上额交巅，然后下项夹脊，行于背后，沿着人的身后、腿后，最后到达至阴。我们比较十二正经，足太阳是最长的一条。它的分布区域在十二经中是最长最广的，特别是布局于整个身后这一点非常有意义。大家也许有过这样的经验，特别是对风比较敏感的人，如果风从前面吹来，你会觉得无所谓，要是风从后面吹来，你会马上不舒服。为什么呢？明枪易躲，暗箭难防。《内经》一再强调“圣人避风如避矢石”，所以，对这个风大家不要小看了。在《内经》的时代，能够远距离，并且在不知不觉中伤人的有什么呢？就是这个矢石。而矢石从前面发过来，你还容易察觉，容易躲过去，如果矢石从后面打来，那就不容易躲过了。有几个人真能像金庸小说里写的，脑后生目，辨器听声呢？圣人把风比作矢石，可见风对于人体的危害之大。而前面来的风我们容易察觉，后面来的风就比较困难了。这个风从后面来，偷偷摸摸的，所以，又叫贼风。人体靠什么对付从后而来的贼风呢？这就要靠太阳。太阳居后的意义正在于此。前人把太阳比作六经藩篱，就与太阳居后有很大的关系，并不是说太阳经的位置最浅表。对于经络循行的这样一些部位，大家要很留心，伤寒的六经辨证有很大一部分与这个相关。病人的腿痛，或者其他的什么地方痛，你要问得很具体，不是光问一个腿痛就了事，是前面痛还是后面痛？是外侧痛还是内侧痛？如果是后面痛，胋窝的地方痛，那肯定与太阳有关，你要从太阳去考虑它的治疗，这就很自然地把你带入了六经辨证。所以，要学好伤寒，弄清楚经络的意义是很重要的。
（3）太阳府义
太阳府有足太阳膀胱府，手太阳小肠府。“膀胱者，州都之官，津液藏焉，气化则能出矣。”所以，膀胱是津液之府，是水府。那么，这样一个水府为什么要跟太阳相连呢？这个连接正好昭示了水与气化的密切关系。一个水、一个气化，太阳篇的许多内容都与这个相关。另外就是手太阳小肠府，小肠府与太阳篇的关系虽然没有膀胱那么直接，但是，它的内涵值得在此一提。《素问·灵兰秘典论》云：“小肠者，受盛之官，化物出焉。”对于这个“受盛”，王冰解释说：“承奉胃司，受盛糟粕，受已复化，传入大肠，故云受盛之官，化物出焉。”而张介宾则云：“小肠居胃之下，受盛胃中水谷而分清浊，水液由此而渗于前，糟粕由此而归于后，脾气化而上升，小肠化而下降，故曰化物出焉。”以上王张的两个解释，都将“受盛”作复词看，这个看法未必恰当。因为受即承纳、接受之义，已经具备了上述的复词意义，盛呢？《说文》云：“黍稷在器中以祀者也。”故盛的本义原非盛受，而是置于器中以备祭祀用的谷物。“盛”是用来作祭祀用的，王冰把受盛释作“受盛糟粕”，而张介宾虽然未全作糟粕讲，可是也有糟粕的成分，这怎么可能呢？古人祭祀所用，必是精挑细选的上好佳品，怎么可能是糟粕？因此，王张的这个解释值得怀疑。盛为祭祀用的精细谷物，这与小肠接纳经胃熟化、细化的水谷甚为相合。另外一个方面，盛是作祭祀供奉用的，在这里小肠承纳的“盛”用于供奉什么呢？当然是供奉五藏，因为五藏乃藏神之所。用水谷之精微来营养藏神的五藏，这不就是一种祭祀供奉吗？这样的解释才基本符合“受盛之官”的涵义。从这个涵义我们看到，古人若不知道小肠是吸收营养的主要场所，决不会用“受盛”这个词。
（4）太阳运气义
谈过了太阳的本义、经义、府义，下面来看太阳在运气方面的意义。在运气里，太阳在天为寒，在地为水，合起来就是太阳寒水。太阳为阳中之阳，为什么要与寒水相配呢？我们可以从以下这些方面来思考。
① 水义释
Below is a case study. Three or four years ago, a female worker from the Jiangnan Wireless Factory came to see me for treatment. The Western medical diagnosis was kidney stones and hydronephrosis. The condition was relatively severe; although she had consulted both Western and Chinese medicine practitioners, the effects were not obvious. Introduced by an old patient friend, she came to my clinic. According to conventional practice, treating stones and fluid retention requires methods to expel stones and promote diuresis. However, I did not initially consider these approaches. Instead, I listened quietly to the patient describe her condition, thinking as I listened, essentially aiming to grasp the *zhuzheng* (main syndrome). When the patient mentioned that she had been suffering from diarrhea for the past month, felt very irritable, and could not sleep well, in that instant, I grasped the main syndrome. I prescribed the original formula of *Zhu Ling Tang* (Polyporus Decoction) without adding any stone-expelling herbs. Why prescribe *Zhu Ling Tang*? Because Article 319 of the *Shanghan Lun* states clearly: "In Shaoyin disease (disease caused by pathogenic invasion of the Shaoyin channel), if there is diarrhea for six or seven days, accompanied by cough, vomiting, thirst, irritability, and inability to sleep, *Zhu Ling Tang* should be used." It is explicitly stated here that if there is diarrhea combined with irritability and insomnia, *Zhu Ling Tang* can be used. This patient presented with both, which quickly led me to this consideration. You do not need to worry about whether it is stones or hydronephrosis; if the main syndrome matches *Zhu Ling Tang*, you use *Zhu Ling Tang*. After the prescription was prepared, the patient left and never returned for follow-up. About half a year later, she introduced another patient to me. From this new patient's account, I learned that after taking the medicine, her symptoms disappeared rapidly. Less than half a month later, upon re-examination, the stones were gone, and the hydronephrosis had resolved. This case deeply moved me and allowed me to vaguely comprehend the meaning of Liu Laoshi's concept of "grasping the main syndrome." Those with clinical experience know that some patients' conditions are extremely complex, especially among the elderly. They may talk about their condition for a long time, forgetting what they said earlier by the time they finish speaking. For such patients, one must grasp the main syndrome even more carefully. You must listen quietly; amidst so much information, there will always be one sentence, one syndrome, or one pulse that inspires you. This is the main syndrome. A few days ago, I treated the mother of a student. Her primary issue was a cold with fever, which had persisted intermittently for over ten days without resolution. In the context of *Shanghan Lun*, a cold with fever should belong to Taiyang disease (disease caused by pathogenic invasion of the Taiyang channel). Regardless of the cause of Taiyang disease, the pulse should be floating (superficial). However, this patient's pulse was deep (deep). A superficial syndrome presenting with a deep pulse is abnormal; this is a key point and the main syndrome. It indicates she suffered from simultaneous invasion of Taiyang and Shaoyin (Tai-Shao Liang Gan). Using ordinary cold medicines would certainly not benefit her. I prescribed two doses of *Mahuang Xixin Fuzi Tang* (Ephedra, Asarum, and Prepared Aconite Decoction). After taking the decoction, her fever subsided quickly. Therefore, in clinical treatment, if the main syndrome is grasped well, the efficacy can be as immediate as striking a drumhead (*xiao ru fu gu*). So, how can one grasp the main syndrome well? This relies partly on experience and partly on paying attention to three points, summarized in six characters. First, understand the principles. For example, in Shaoyin disease at the onset, if there is contrary fever and a deep pulse, why does this situation occur, and why is *Mahuang Xixin Fuzi Tang* used? You must clarify this principle. Once the principle is clear, you can apply it flexibly to other situations. Second, memorize thoroughly. Why do we repeatedly emphasize memorizing the *Shanghan Lun*? If you want to be a good TCM practitioner, memorization is indispensable. Even if you cannot recite it word for word, you must be familiar with the articles, especially those containing formulas and corresponding syndromes, so that you can recall their general content at any time. Only by doing this can you truly utilize the *Shanghan Lun*. Without familiarity with the articles, how can you grasp the main syndrome during clinical practice? If the main syndrome is not grasped, classical formulas will not work effectively. Third, use frequently. Apply what you have learned. After studying the Taiyang chapter, you should observe each other to see if there are Taiyang syndromes. Hiding away prevents application. If you catch a cold yourself, you should differentiate whether it is Taiyang, Shaoyang, or simultaneous Tai-Shao invasion. TCM students, especially those who have studied the *Shanghan Lun*, who still rely on compound cold remedies or Vitamin C Yinqiao when facing a cold, have wasted their studies and will likely remain lower-level practitioners (*xia gong*) forever. Remember, regardless of the disease, you must differentiate based on pulse and syndrome, using methods appropriate to the specific pulse and syndrome presentation—this is shooting the arrow at the target. These are the essential principles of treatment I wish to share. Everyone should firmly remember the concepts of upper-level practitioners (*shang gong*) and lower-level practitioners (*xia gong*). Although we may not become *shang gong* immediately, we should have this set goal. Everyone should cultivate the habits of an *shang gong* everywhere and avoid the behaviors of a *xia gong*. Do not let the arrival of a tumor case fill your mind only with anti-cancer herbs like *Baihua She She Cao* (Hedyotis diffusa) and *Ban Zhi Lian* (Scutellaria barbata). I think this is not TCM; at best, it is amateurish TCM. Since it is TCM, you must have TCM thinking and observe the mechanisms of disease progression clinically. Only then can you easily gain insights and feelings. Otherwise, if a patient is cured, you won't know how; if the treatment fails, you won't know why. Being a TCM practitioner for a lifetime while remaining confused is pitiful! Practicing TCM this way is truly meaningless. Therefore, I hope everyone can become an *shang gong*, or at least a quasi-*shang gong*. I believe that if we operate according to the methods mentioned above, we have already become *shang gong* in form. Before formally entering the discussion of the Taiyang chapter, this introductory process is very necessary.
Chapter Five: Outline of Taiyang Disease
I. Explanation of the Chapter Title
When reading the Taiyang chapter, we must first look at its title, just as we read the book title before reading a book. This habit should be cultivated, especially for books requiring close reading, where not a single character should be overlooked. Reading classics requires clarifying three meanings: literal meaning, sentence meaning, and overall meaning. Once these three are clear, no classic is unreadable. Let us first look at the chapter title from the perspective of overall meaning: "Differentiating Taiyang Disease, Pulse, Syndrome, and Treatment." What content does it discuss? It mainly discusses the differentiation and judgment of disease names, pathogenesis, pulse, syndrome, and related treatments associated with Taiyang. Through the analysis of such a title, we can grasp certain characteristics of TCM. Currently, there is a trend believing that TCM only focuses on syndrome differentiation (*bian zheng*) and neglects disease differentiation (*bian bing*), or emphasizes syndrome differentiation while downplaying disease differentiation. Therefore, it is argued that TCM should integrate with Western medicine, combining disease differentiation with syndrome differentiation. To those holding this view, I often say they have never read the *Shanghan Lun* and their words do not represent TCM. If you have read the *Shanghan Lun*, you will know: how can TCM fail to differentiate diseases? TCM differentiates disease first, and syndrome second. Disease differentiation is primary; syndrome differentiation is secondary. If you do not first determine it is Taiyang disease, how can you further confirm whether it is Wind Strike (*Zhong Feng*) or Cold Damage (*Shang Han*)? Thus, saying TCM lacks disease differentiation is a huge misunderstanding.
1. Explanation of "Bian" (Differentiate)
First, explain the character "Bian". It is relatively simple. *Shuowen Jiezi* says: "Pan ye" (to judge/divide). *Guangyun* says: "Bie ye" (to distinguish). Combined, it means judgment and distinction. *Kangxi Dictionary* cites the commentary on *Liji Xueji*: "Bian refers to examining and questioning to reach a definitive conclusion." It also cites the commentary on *Zhouli Tianguan Shu*: "Bian means clearly distinguishing matters without doubt." Synthesizing these meanings, "Bian" is the process of comprehensively analyzing and judging materials obtained through various channels to arrive at a definite and clear result. In the context of TCM, it refers to comprehensively analyzing materials from the Four Diagnostic Methods to reach a clear diagnosis. "Bian" describes this process.
2. Explanation of "Taiyang"
(1) Original Meaning of Taiyang
What are the meanings of Taiyang? Let us first look at its original meaning, commonly referred to as "Sun" (Ri). Referring to the Sun as Taiyang, or Taiyang as Ri, is common knowledge. Secondly, *Lingshu Jiuzhen Shieryuan* states: "The Great Yang within Yang is the Heart." Here, the Heart is metaphorically compared to the Sun. Why? Zhang Jiebin said: "The Heart is Yang within Yang, therefore it is called Great Yang." Looking at its connotation, Taiyang implies the abundance of Yang Qi. Thus, Wang Bing said: "Because Yang Qi is abundant, it is called Great Yang."
(2) Meridian Meaning of Taiyang
Previous researchers of the *Shanghan Lun* have held various views: some believe the Six Channels refer only to meridians, others include Zang-Fu organs, and some view them as interfaces. This tells us that the concept of the Six Channels is rich and multi-faceted. Here, we only examine the meaning of Taiyang from the meridian perspective. The Taiyang meridians include the Hand and Foot Taiyang meridians, with the Foot Taiyang being particularly important, as emphasized previously. What are the characteristics of the Foot Taiyang? It originates at Jingming (BL1), goes up to the forehead, crosses the vertex, descends to the nape, runs alongside the spine, travels along the back and posterior legs, and finally reaches Zhiyin (BL67). Comparing the Twelve Regular Meridians, the Foot Taiyang is the longest. Its distribution area is the longest and broadest among the Twelve Meridians, especially its layout along the entire back, which is highly significant. Many people have experienced this: those sensitive to wind feel indifferent if wind comes from the front, but immediately uncomfortable if it comes from behind. Why? Open spears are easy to dodge, hidden arrows are hard to guard against. *Neijing* repeatedly emphasizes that "Sages avoid wind as they avoid arrows and stones." Therefore, do not underestimate wind. In the era of *Neijing*, what could injure people from a distance and imperceptibly? Arrows and stones. Arrows coming from the front are easy to detect and dodge; those from behind are difficult to evade. How many people can truly see behind their heads and hear sounds, as written in Jin Yong's novels? By comparing wind to arrows and stones, Sages highlighted the great harm wind poses to the human body. Frontal wind is easy to detect, but rear wind is difficult. Coming stealthily from behind, it is called "Thief Wind." What does the human body rely on to counter Thief Wind from behind? It relies on Taiyang. This is the significance of Taiyang being located at the back. Ancients compared Taiyang to the fence of the Six Channels, largely due to its posterior position, not merely because it is the most superficial. One must pay close attention to these meridian pathways. Much of the Six-Channel differentiation in *Shanghan Lun* relates to this. If a patient has leg pain or pain elsewhere, ask specifically: is it anterior or posterior pain? Medial or lateral pain? If it is posterior pain, specifically in the popliteal fossa, it is definitely related to Taiyang, and treatment should be considered from the Taiyang perspective. This naturally leads you into Six-Channel differentiation. Therefore, to master *Shanghan Lun*, understanding the significance of meridians is crucial.
(3) Fu Organ Meaning of Taiyang
The Taiyang Fu organs are the Foot Taiyang Bladder Fu and the Hand Taiyang Small Intestine Fu. "The Bladder is the official of the reservoir, storing fluids; through Qi transformation, they can be excreted." Thus, the Bladder is the Fu organ of fluids, the Water Fu. Why is this Water Fu connected to Taiyang? This connection reveals the close relationship between water and Qi transformation. Water and Qi transformation are central to much of the content in the Taiyang chapter. Additionally, the Hand Taiyang Small Intestine Fu, while less directly related to the Taiyang chapter than the Bladder, deserves mention. *Suwen Linglan Midian Lun* states: "The Small Intestine is the official of reception and storage, transforming substances and producing output." Regarding "reception and storage," Wang Bing explained: "It receives from the Stomach, accepts waste, transforms it again, and transmits it to the Large Intestine; thus it is called the official of reception and storage, transforming substances and producing output." Zhang Jiebin stated: "The Small Intestine resides below the Stomach, receiving and storing food and drink from the Stomach to separate the clear from the turbid. Fluids seep forward from here, and dregs return backward. Spleen Qi transforms and rises, Small Intestine transforms and descends; thus it is said to transform substances and produce output." Both Wang and Zhang treat "Shou Sheng" (Reception and Storage) as a compound word, which may not be appropriate. "Shou" means acceptance/reception, already possessing the compound meaning. What about "Sheng"? *Shuowen* says: "Millet and rice in vessels for sacrifice." Thus, the original meaning of "Sheng" was not "storage/acceptance," but rather grains placed in vessels for sacrificial offerings. "Sheng" was used for sacrifices. Wang Bing interpreted "Shou Sheng" as "accepting waste," and although Zhang Jiebin did not fully interpret it as waste, his explanation included waste components. How is this possible? Sacrificial offerings used by ancients were carefully selected fine products, not waste. Therefore, Wang and Zhang's explanations are questionable. "Sheng" as fine grain for sacrifice aligns well with the Small Intestine accepting and refining food and drink processed by the Stomach. Furthermore, since "Sheng" is used for sacrificial offering, what does the Small Intestine offer? Naturally, it offers to the Five Zang Organs, as the Zang Organs store the Spirit. Nourishing the Zang Organs that store the Spirit with the essence of food and drink is a form of sacrificial offering. This explanation basically fits the meaning of "Official of Reception and Storage." From this meaning, we see that if ancients did not know the Small Intestine was the main site of nutrient absorption, they would never have used the term "Shou Sheng."
(4) Climate/Phase Meaning of Taiyang
Having discussed the original, meridian, and Fu organ meanings of Taiyang, let us now look at its meaning in terms of Climate/Phase (Yunqi). In Yunqi, Taiyang corresponds to Cold in Heaven and Water in Earth, combined as Taiyang Cold-Water. Taiyang is Yang within Yang; why is it paired with Cold-Water? We can ponder this from the following aspects.
① Explanation of Water Meaning