传承用现代的词语说就是教育，我们首先来看一看现代的中医教育。什么是现代中医教育呢？这个“现代”的界限应该是中医高等院校建立以后的这么一个年限。中医高等院校是 1956年开始筹办的，那么到现在已经四十多年了。回顾中医所走过的这四十多年的教育，我们能够看到她的一些利和弊。首先从形式上来说，大家在这么一个高等学府里学习，我们所采用的教育形式、教育方法，基本上与医科大学没有什么差别。大家现在同时学两套，既学中又学西，从在中医传承形式上大家想想有什么区别呢？没有什么区别。所以，所谓的现代中医教育，实际上是模仿了现代医学的一种教育。现代教育有些什么特色呢？教育这个问题是与学科相关的，学科的性质决定了教育应该采用一种什么样的模式。前面第一部分，杨振宁教授曾谈到现代科学有别于传统文化的一个很特殊的方面，就是它的数理逻辑体系，它的推演体系。这个逻辑体系是很严密的，而且公理性很强，透明度很大，所以，在教育的时候就有很容易趋于接受的一面。另外一个有区别的方面，就是现代科学是一门中介性科学，它是现代科学的一个非常显著的特点。中介具有储存的功用，具有复制的功用。人类的思维，人类的智慧都可以聚集在这样一些中介体上，如电脑这样一个中介体。然后再由中介来认识事物，改造事物，服务人类。所以，我们把现代科学叫做中介科学。有了这个中介，就有了复制的可能。我们的电脑从“板块”设计出来以后，就可以批量生产。这就是复制的过程，而不再需要我们一台一台地重新设计，重新制造。所以，它的复制性很强，复制性就决定了它的规模性。现代教育之所以有这样大的规模，就是与现代科学这个特性相应的。还有另外一个方面，就是现代科学的分科非常精细，这也决定了现代教育的分科性极强的特性。近现代科学的这些特征，也充分体现在西方文化的各方面，比如绘画艺术，我们看到西方的一幅油画，它给我们一种什么感受呢？它给我们一种实实在在的感觉，比如画人体，它是裸露的，整个人体充分暴露在你的面前，有时甚至每个毛孔也清晰可见，而反过来看中国画呢？中国画不画人体，展开一幅通常的国画山水画，总给人一种烟雨蒙蒙、飘飘渺渺的感觉，就像《老子》说的“恍兮、惚兮，其中有象”。用行家的话说，西洋画重写实，中国画重写意。一个一目了然，一个朦胧可见。这就构成了中西文化的差别，亦正是这样一个差别，促使我们去思考，中西文化的教育，中医西医的教育应不应该有所区别？从现代中医的教育，我们看到她的分科愈趋精细，有的甚至尝试将一本《中基》划分为数个学科，将针灸也分为经的问题、络学、俞穴学、灸刺学。这种学科的分化是否提高了原本这些学科的教学质量与教学效果呢？从规模上讲，中医教育确实步入了历史上前所未有的时期，培养出了大批专科生、本科生、研究生。特别是现在许多中医院校相继升级为大学，——规模上去了，教育的内涵上去了没有呢？这些年都有大四的学生在实习前请我作讲座，讲什么题目呢？还是讲前面的“如何学好中医”，为什么呢？因为他们对中医还是觉得困惑，还是觉得不清楚，不知道用什么去对付实习？4年的时间应不算短，过去学医3年出师，像蒲辅周那样，15岁随祖父学习，3年后即独立开业行医。我们现在4年了，还困惑，还糊涂，问题出在什么上面呢？是不是出在教育的路子上？这是我们很自然就想到的原因。前面我们提到学科的性质决定教育的模式，我们是否充分考虑了这个问题。
以下我们从内涵结构的角度继续上面的问题，现代文化明确地将世界划分为两个，一个是物质世界，一个是精神世界。现代科学研究的范围主要限于物质世界，对精神世界的东西涉及并不多，所以，唯物主义肯定物质是第一性，精神是第二性。那么，这个物质世界又是属于一个什么范畴的东西呢？这一点我们可以暂时放下，而先来看一看古人对这个世界的划分。在古代有这么一个“形而上与形而下”的区别，“形而上者谓之道，形而下者谓之器”。注意：这里就分一个形而上，一个形而下，一个道，一个器。什么是所谓的器呢？器就是有形质的东西，有结构的东西，所以叫做形而下。很显然，现代科学所探讨的物质世界，就是这个形而下的器世界。所以，现代科学所探讨的范畴就是这个“形而下”的范畴。那么，什么是形而上呢？有形之上的东西，那当然就是无形的东西了。这个无形的“形而上”的东西，就称之为道。道世界的东西是否就是精神世界呢？这个问题还有待三思。但，至少在范畴上有相近的地方。上述的这个区别，关键在于“形”。《素问》里面对这个“形”有很具体的描述，那就是“气合而有形”，或者说“气聚而成形”。形是怎么构成的呢？气聚而成形，气合而有形。气聚合以后就可以构成有形质的东西，形而下的东西，器世界的东西。那么，气还没有聚合以前呢？这是一个什么状态呢？显然这就是一个无形的，形而上的状态。所以，按照上述的这个划分，现代科学讨论的领域，实际上是气聚合以后的这个领域。比如物理学，她探讨物质的结构、物质的组成。因此，就有基本粒子这样一个概念。物质是由什么构成的呢？由分子，分子又由原子，原子又由原子核、电子，后面又有质子、中子、介子，介子后面又是什么呢？是夸克！夸克是现代科学目前所发现的物质最微细的结构，尽管它很微细，但它仍属于形而下的这个层面。夸克这个名字起得相当幽默，它反映了科学家们对寻找物质最终结构的一种心态。夸克原本是西方神话中的一种神鸟，这种鸟的叫声就像“夸克”、这个鸟平常不轻易叫，它一叫太阳就要落山，大地就一片漆黑，什么也看不见了。科学家们对现今发现的物质的最细微结构赋予了“夸克”的名字，看起来他们不愿再寻找下去了，再寻找下去又有什么结果呢？太阳落山了，天黑了，什么也看不见了。在这一点上，大家可以想象，如果按照这样一个模式去寻找物质的最终结构，我们什么时候能够找到这个结构呢？看来遥遥无期！在这个遥遥无期，难有希望的问题上，古人没有驻足，他只讲“夫有形者生于无形”，而不去追究这个最有形的东西，最形而下的东西。所以，《老子》讲：“天下万物生于有，有生于无。”前面我们谈到现代科学的研究领域大概属于“形而下”的范围，也就是“有”的范围。那么，中医呢？中医属于一个什么范围呢？很显然，她既有形而上的成分，又有形而下的成分。她是道器合一的学问。所以，《老子》也好，《内经》也好，都强调要形神合一，形气合一，要形与神俱。所以，中医所探讨的，既有夸克以前的东西，又有夸克以后的东西。中医是不是一门道器合一的学问，这一点有太多太多的证明，就以五藏而言，在五藏的心、肝、脾、肺、肾中，我们不难发现，它有一个很重大的区别，就是肝、肾、脾、肺都有一个月旁结构，而心没有这个结构。“月”这个部首，《说文》把它归在“肉”部，“肉”当然是有形质的东西。所以，古人对肝肾脾肺的定位是非常明确的，它属于形而下这个范畴，属于一个形器结构。那么，心呢？心就不同了，它没有这个,心的定位不“肉”部，也就是说它没有这个“形器”，它是形而上的东西，但是对中医五藏的这个定位，不是一个简单的定位，也不是一个轻松的定位，实在的，它是对整个中医的定位，是对整个传统文化的定位。这个定位我们也可以从五行联系中去认识，像金、木、水、土这些都是有形有质的东西，这些东西都是往下走的，因为它有一个重量，都受万有引力的作用，都属于器的范围。而火呢？惟独这个火，我们很难用形质去描述；惟独这个火，你放开后它是往上走的，难道它没有重量？难道它不受引力作用？这就是所谓的“形而上”，这就是道。 现在我们知道了，中医光讲肝、肾、脾、肺行不行呢？不行！还要讲心。所以，中医肯定是一门既讲形而下，又讲形而上的学问。那么在这两者之间有没有一个轻重的区别呢？这个答案也是很明确的。我们看一看《素问·灵兰秘典论》就可以知道，《论》中说：“心者君主之官，神明出焉。”“君主”意味着什么呢？我想大家应该很清楚的。而《灵兰秘典论》的另外一段话，也很值得引出来供大家参考：“凡此十二官者，不得相失也。故主明则下安，以此养生则寿，殁世不殆，以为天下则大昌。主不明则十二官危，使道闭塞而不通，形乃大伤，以此养生则殃，以为天下者，其宗大危，戒之戒之！”从这个五藏的关系，从这个十二官的关系中，我们可以看到，传统文化、传统中医，虽然的确是道器合一的统一体，虽然，它强调要形气相依，形神合一，但是，总的侧重却在道的一面，神的一面，气的一面。所以，她是一门以道御器，以神御形，以形而上御形而下的学问。有关上述这个侧重的问题，我们还可以用一个更实际的例子来说明，就是医生的等级。《内经》里将医生划分为两个等级，即上工与下工。上工指的是非常高明的医生；下工呢？当然就是非常普通，非常一般的医生了。上工、下工怎样从更内在的因素去加以区别呢？《灵枢》在这方面给出了一个很具体的指标，就是“上工守神，下工守形”。神是什么？神是无形的东西，属于道的范畴，属于形而上的范畴，上工守的就是这个。换句话说，就是能够守持这样一个范畴的东西，能够从这样一个层面去理解疾病，治疗疾病，那就有可能成为上工。反之，如果守持已经成形的东西，从形而下的这样一个层面去理解疾病，治疗疾病，那只能成为一个下工。所以，《素问·四气调神大论》说：“是故圣人不治已病治未病，不治已乱治未乱，此之谓也。夫病已成而后药之，乱已成而后治之，譬犹渴而穿井，斗而铸锥，不亦晚乎！” 守神就是治未病，未病就是尚未成形的病，在未成形的时候你拿掉它，不是轻而易举的事吗！等成形了，甚至等它牢不可破了，你再想拿掉它，那就不容易了，那就会吃力不讨好。任何疾病的发生都是从未病到已病，从未成形到已成形。按照西医的说法，就是任何一个器质性的病变都是从非器质性的阶段发展而来。在非器质性的阶段治疗是比较容易的，而一旦进入器质性的阶段，治疗就困难多了。因此，为医者不但要善于治病更要善于识病。疾病在未病的阶段，在未成形的阶段，你能否发现它，截获它，使它消于无形。像扁鹊望齐侯之色一样，病还在皮肤就发现了，在皮肤就进行治疗，应该不费吹灰之力。而张仲景为侍中大夫王仲宣诊病，提前 20 年作出诊断，并提出相应的治疗措施。这就是见微知著的功夫，这就是防微杜渐的功夫。等到晚期癌症了你才发现它，又有多少意义呢？目前现代医学的诊断技术从总体上来说还是处于诊断已病的水平阶段，也就是说这个诊断技术再先进，也只是诊断出那些已成形的病，对于未病，对于尚未成形的病，现代的诊断还无能为力。但是，到了基因诊断，检查婴儿，甚至胎儿的基因，就能发现将来的疾病，到了这个阶段，就应该是知未病了。所以现代医学从总体上说，还是向传统中医这样一个方向发展。现在大多数人对中医的认识，都是从已病的这个层次上去认识，都是从形而下的这个层次去认识。从这个层次上去认识中医，当然觉得中医处处不如西医。我经常打一个比方，比如一个心梗的病人，心梗发生了，你会往哪个医院送呢？是往中医院送，还是往西医院送？我看 100 个人会有 100个人要往西医院送，也许就是张仲景再世，他也会建议你送医科大附院，而不送中医学院附院。凭着这个，搞西医的人个个挺胸抬头，搞中医的人个个垂头丧气，以为中医确实糟糕，自己入错了行。如果这样比较，那中医确实不怎么样，要甘拜下风。但是，如果我们换一个角度去思考，我治的这个病人，我治的这个冠心病，根本就不发生心梗，乃至根本就不发生冠心病，我是使它不发生，你是发生了以后去救治，这两个如何比较呢？对社会，对国家，对家庭，对患者个人，哪一个更有利益？我想 100 个人里，也会有 100个人是赞成我的。如果我们从这样一个角度去比较，也许中医的认识我们就会有信心。中医讲究治未病，张仲景在《金匮要略》的开首就指出“上工不治已病治未病”，我们这门医学的出发点，它的宗旨是治未病，是未渴而穿井，未斗而铸锥的，可现在许多人偏偏要在已病的行列跟西医较劲，搞什么中医急救医学，这就叫做不自量力，这就叫做以己之短击人之长。渴而穿井，斗而铸锥，你怎么可能和现代的速度相比？所以，上面这个问题是一个十分严重的问题。中医是这样的一门医学，它整个地是偏向于形而上的一面，是以形而上统形而下，是以治未病统治已病。而我们现在却在完完全全地用形而下的眼光去看待它，把它当作一门完完全全的形而下的学问，治已病的学问。
传承用现代的词语说就是教育，我们首先来看一看现代的中医教育。什么是现代中医教育呢？这个“现代”的界限应该是中医高等院校建立以后的这么一个年限。中医高等院校是 1956年开始筹办的，那么到现在已经四十多年了。回顾中医所走过的这四十多年的教育，我们能够看到她的一些利和弊。首先从形式上来说，大家在这么一个高等学府里学习，我们所采用的教育形式、教育方法，基本上与医科大学没有什么差别。大家现在同时学两套，既学中又学西，从在中医传承形式上大家想想有什么区别呢？没有什么区别。所以，所谓的现代中医教育，实际上是模仿了现代医学的一种教育。
现代教育有些什么特色呢？教育这个问题是与学科相关的，学科的性质决定了教育应该采用一种什么样的模式。前面第一部分，杨振宁教授曾谈到现代科学有别于传统文化的一个很特殊的方面，就是它的数理逻辑体系，它的推演体系。这个逻辑体系是很严密的，而且公理性很强，透明度很大，所以，在教育的时候就有很容易趋于接受的一面。另外一个有区别的方面，就是现代科学是一门中介性科学，它是现代科学的一个非常显著的特点。中介具有储存的功用，具有复制的功用。人类的思维，人类的智慧都可以聚集在这样一些中介体上，如电脑这样一个中介体。然后再由中介来认识事物，改造事物，服务人类。所以，我们把现代科学叫做中介科学。有了这个中介，就有了复制的可能。我们的电脑从“板块”设计出来以后，就可以批量生产。这就是复制的过程，而不再需要我们一台一台地重新设计，重新制造。所以，它的复制性很强，复制性就决定了它的规模性。现代教育之所以有这样大的规模，就是与现代科学这个特性相应的。还有另外一个方面，就是现代科学的分科非常精细，这也决定了现代教育的分科性极强的特性。
近现代科学的这些特征，也充分体现在西方文化的各方面，比如绘画艺术，我们看到西方的一幅油画，它给我们一种什么感受呢？它给我们一种实实在在的感觉，比如画人体，它是裸露的，整个人体充分暴露在你的面前，有时甚至每个毛孔也清晰可见，而反过来看中国画呢？中国画不画人体，展开一幅通常的国画山水画，总给人一种烟雨蒙蒙、飘飘渺渺的感觉，就像《老子》说的“恍兮、惚兮，其中有象”。用行家的话说，西洋画重写实，中国画重写意。一个一目了然，一个朦胧可见。这就构成了中西文化的差别，亦正是这样一个差别，促使我们去思考，中西文化的教育，中医西医的教育应不应该有所区别？
从现代中医的教育，我们看到她的分科愈趋精细，有的甚至尝试将一本《中基》划分为数个学科，将针灸也分为经的问题、络学、俞穴学、灸刺学。这种学科的分化是否提高了原本这些学科的教学质量与教学效果呢？从规模上讲，中医教育确实步入了历史上前所未有的时期，培养出了大批专科生、本科生、研究生。特别是现在许多中医院校相继升级为大学，——规模上去了，教育的内涵上去了没有呢？这些年都有大四的学生在实习前请我作讲座，讲什么题目呢？还是讲前面的“如何学好中医”，为什么呢？因为他们对中医还是觉得困惑，还是觉得不清楚，不知道用什么去对付实习？4年的时间应不算短，过去学医3年出师，像蒲辅周那样，15岁随祖父学习，3年后即独立开业行医。我们现在4年了，还困惑，还糊涂，问题出在什么上面呢？是不是出在教育的路子上？这是我们很自然就想到的原因。前面我们提到学科的性质决定教育的模式，我们是否充分考虑了这个问题。
以下我们从内涵结构的角度继续上面的问题，现代文化明确地将世界划分为两个，一个是物质世界，一个是精神世界。现代科学研究的范围主要限于物质世界，对精神世界的东西涉及并不多，所以，唯物主义肯定物质是第一性，精神是第二性。那么，这个物质世界又是属于一个什么范畴的东西呢？这一点我们可以暂时放下，而先来看一看古人对这个世界的划分。在古代有这么一个“形而上与形而下”的区别，“形而上者谓之道，形而下者谓之器”。注意：这里就分一个形而上，一个形而下，一个道，一个器。什么是所谓的器呢？器就是有形质的东西，有结构的东西，所以叫做形而下。很显然，现代科学所探讨的物质世界，就是这个形而下的器世界。所以，现代科学所探讨的范畴就是这个“形而下”的范畴。
那么，什么是形而上呢？有形之上的东西，那当然就是无形的东西了。这个无形的“形而上”的东西，就称之为道。道世界的东西是否就是精神世界呢？这个问题还有待三思。但，至少在范畴上有相近的地方。上述的这个区别，关键在于“形”。《素问》里面对这个“形”有很具体的描述，那就是“气合而有形”，或者说“气聚而成形”。形是怎么构成的呢？气聚而成形，气合而有形。气聚合以后就可以构成有形质的东西，形而下的东西，器世界的东西。那么，气还没有聚合以前呢？这是一个什么状态呢？显然这就是一个无形的，形而上的状态。所以，按照上述的这个划分，现代科学讨论的领域，实际上是气聚合以后的这个领域。比如物理学，她探讨物质的结构、物质的组成。因此，就有基本粒子这样一个概念。物质是由什么构成的呢？由分子，分子又由原子，原子又由原子核、电子，后面又有质子、中子、介子，介子后面又是什么呢？是夸克！夸克是现代科学目前所发现的物质最微细的结构，尽管它很微细，但它仍属于形而下的这个层面。
夸克这个名字起得相当幽默，它反映了科学家们对寻找物质最终结构的一种心态。夸克原本是西方神话中的一种神鸟，这种鸟的叫声就像“夸克”、这个鸟平常不轻易叫，它一叫太阳就要落山，大地就一片漆黑，什么也看不见了。科学家们对现今发现的物质的最细微结构赋予了“夸克”的名字，看起来他们不愿再寻找下去了，再寻找下去又有什么结果呢？太阳落山了，天黑了，什么也看不见了。在这一点上，大家可以想象，如果按照这样一个模式去寻找物质的最终结构，我们什么时候能够找到这个结构呢？看来遥遥无期！在这个遥遥无期，难有希望的问题上，古人没有驻足，他只讲“夫有形者生于无形”，而不去追究这个最有形的东西，最形而下的东西。所以，《老子》讲：“天下万物生于有，有生于无。”前面我们谈到现代科学的研究领域大概属于“形而下”的范围，也就是“有”的范围。那么，中医呢？中医属于一个什么范围呢？很显然，她既有形而上的成分，又有形而下的成分。她是道器合一的学问。
所以，《老子》也好，《内经》也好，都强调要形神合一，形气合一，要形与神俱。所以，中医所探讨的，既有夸克以前的东西，又有夸克以后的东西。中医是不是一门道器合一的学问，这一点有太多太多的证明，就以五藏而言，在五藏的心、肝、脾、肺、肾中，我们不难发现，它有一个很重大的区别，就是肝、肾、脾、肺都有一个月旁结构，而心没有这个结构。“月”这个部首，《说文》把它归在“肉”部，“肉”当然是有形质的东西。所以，古人对肝肾脾肺的定位是非常明确的，它属于形而下这个范畴，属于一个形器结构。那么，心呢？心就不同了，它没有这个,心的定位不“肉”部，也就是说它没有这个“形器”，它是形而上的东西，但是对中医五藏的这个定位，不是一个简单的定位，也不是一个轻松的定位，实在的，它是对整个中医的定位，是对整个传统文化的定位。
这个定位我们也可以从五行联系中去认识，像金、木、水、土这些都是有形有质的东西，这些东西都是往下走的，因为它有一个重量，都受万有引力的作用，都属于器的范围。而火呢？惟独这个火，我们很难用形质去描述；惟独这个火，你放开后它是往上走的，难道它没有重量？难道它不受引力作用？这就是所谓的“形而上”，这就是道。 现在我们知道了，中医光讲肝、肾、脾、肺行不行呢？不行！还要讲心。所以，中医肯定是一门既讲形而下，又讲形而上的学问。
那么在这两者之间有没有一个轻重的区别呢？这个答案也是很明确的。我们看一看《素问·灵兰秘典论》就可以知道，《论》中说：“心者君主之官，神明出焉。”“君主”意味着什么呢？我想大家应该很清楚的。而《灵兰秘典论》的另外一段话，也很值得引出来供大家参考：“凡此十二官者，不得相失也。故主明则下安，以此养生则寿，殁世不殆，以为天下则大昌。主不明则十二官危，使道闭塞而不通，形乃大伤，以此养生则殃，以为天下者，其宗大危，戒之戒之！”从这个五藏的关系，从这个十二官的关系中，我们可以看到，传统文化、传统中医，虽然的确是道器合一的统一体，虽然，它强调要形气相依，形神合一，但是，总的侧重却在道的一面，神的一面，气的一面。所以，她是一门以道御器，以神御形，以形而上御形而下的学问。
有关上述这个侧重的问题，我们还可以用一个更实际的例子来说明，就是医生的等级。《内经》里将医生划分为两个等级，即上工与下工。上工指的是非常高明的医生；下工呢？当然就是非常普通，非常一般的医生了。上工、下工怎样从更内在的因素去加以区别呢？《灵枢》在这方面给出了一个很具体的指标，就是“上工守神，下工守形”。神是什么？神是无形的东西，属于道的范畴，属于形而上的范畴，上工守的就是这个。换句话说，就是能够守持这样一个范畴的东西，能够从这样一个层面去理解疾病，治疗疾病，那就有可能成为上工。反之，如果守持已经成形的东西，从形而下的这样一个层面去理解疾病，治疗疾病，那只能成为一个下工。
所以，《素问·四气调神大论》说：“是故圣人不治已病治未病，不治已乱治未乱，此之谓也。夫病已成而后药之，乱已成而后治之，譬犹渴而穿井，斗而铸锥，不亦晚乎！” 守神就是治未病，未病就是尚未成形的病，在未成形的时候你拿掉它，不是轻而易举的事吗！等成形了，甚至等它牢不可破了，你再想拿掉它，那就不容易了，那就会吃力不讨好。任何疾病的发生都是从未病到已病，从未成形到已成形。按照西医的说法，就是任何一个器质性的病变都是从非器质性的阶段发展而来。在非器质性的阶段治疗是比较容易的，而一旦进入器质性的阶段，治疗就困难多了。因此，为医者不但要善于治病更要善于识病。疾病在未病的阶段，在未成形的阶段，你能否发现它，截获它，使它消于无形。像扁鹊望齐侯之色一样，病还在皮肤就发现了，在皮肤就进行治疗，应该不费吹灰之力。而张仲景为侍中大夫王仲宣诊病，提前 20 年作出诊断，并提出相应的治疗措施。这就是见微知著的功夫，这就是防微杜渐的功夫。等到晚期癌症了你才发现它，又有多少意义呢？
目前现代医学的诊断技术从总体上来说还是处于诊断已病的水平阶段，也就是说这个诊断技术再先进，也只是诊断出那些已成形的病，对于未病，对于尚未成形的病，现代的诊断还无能为力。但是，到了基因诊断，检查婴儿，甚至胎儿的基因，就能发现将来的疾病，到了这个阶段，就应该是知未病了。所以现代医学从总体上说，还是向传统中医这样一个方向发展。现在大多数人对中医的认识，都是从已病的这个层次上去认识，都是从形而下的这个层次去认识。从这个层次上去认识中医，当然觉得中医处处不如西医。
我经常打一个比方，比如一个心梗的病人，心梗发生了，你会往哪个医院送呢？是往中医院送，还是往西医院送？我看 100 个人会有 100个人要往西医院送，也许就是张仲景再世，他也会建议你送医科大附院，而不送中医学院附院。凭着这个，搞西医的人个个挺胸抬头，搞中医的人个个垂头丧气，以为中医确实糟糕，自己入错了行。如果这样比较，那中医确实不怎么样，要甘拜下风。但是，如果我们换一个角度去思考，我治的这个病人，我治的这个冠心病，根本就不发生心梗，乃至根本就不发生冠心病，我是使它不发生，你是发生了以后去救治，这两个如何比较呢？对社会，对国家，对家庭，对患者个人，哪一个更有利益？我想 100 个人里，也会有 100个人是赞成我的。如果我们从这样一个角度去比较，也许中医的认识我们就会有信心。
中医讲究治未病，张仲景在《金匮要略》的开首就指出“上工不治已病治未病”，我们这门医学的出发点，它的宗旨是治未病，是未渴而穿井，未斗而铸锥的，可现在许多人偏偏要在已病的行列跟西医较劲，搞什么中医急救医学，这就叫做不自量力，这就叫做以己之短击人之长。渴而穿井，斗而铸锥，你怎么可能和现代的速度相比？所以，上面这个问题是一个十分严重的问题。中医是这样的一门医学，它整个地是偏向于形而上的一面，是以形而上统形而下，是以治未病统治已病。而我们现在却在完完全全地用形而下的眼光去看待它，把它当作一门完完全全的形而下的学问，治已病的学问。
Inheritance, in modern terms, is education. Let us first examine contemporary Traditional Chinese Medicine (TCM) education. What constitutes this "modern" TCM education? The boundary of "modern" should be defined as the period following the establishment of higher education institutions for TCM. Preparations for these institutions began in 1956; thus, over forty years have passed since then. Looking back at the educational journey of TCM over these four decades, we can observe its advantages and disadvantages. Formally speaking, students studying in such higher education institutions follow educational forms and methods that are basically indistinguishable from those of medical universities. Students currently study two systems simultaneously: both TCM and Western medicine. Considering the form of TCM inheritance, what difference is there? There is no difference. Therefore, so-called modern TCM education is essentially an imitation of modern medical education.
What are the characteristics of modern education? Education is related to disciplines; the nature of a discipline determines the model education should adopt. In the first part, Professor Yang Chen-ning mentioned a special aspect where modern science differs from traditional culture: its mathematical-logical system and its deductive system. This logical system is rigorous, highly axiomatic, and transparent, making it easy to accept during education. Another distinguishing feature is that modern science is a mediating science, a very significant characteristic of modern science. Mediation possesses the functions of storage and replication. Human thought and wisdom can be aggregated onto such mediators, like computers. Then, through mediation, one recognizes, transforms, and serves humanity. Thus, we call modern science a mediating science. With this mediator, replication becomes possible. Once our computers are designed based on "modules," they can be mass-produced. This is the process of replication, eliminating the need to redesign and remanufacture each unit individually. Hence, its replicability is strong, and replicability determines its scale. The large scale of modern education corresponds to this characteristic of modern science. Furthermore, the fine subdivision of modern science determines the highly specialized nature of modern education.
These features of modern science are fully reflected in various aspects of Western culture, such as painting art. When we view a Western oil painting, what feeling does it give us? It gives a sense of reality; for example, when depicting the human body, it is exposed, fully revealing the entire body before you, sometimes even every pore is clearly visible. Conversely, looking at Chinese paintings, Chinese art does not depict the human body. Unfolding a typical landscape painting evokes a misty, ethereal feeling, as described in the *Laozi*: "Vague and elusive, yet within lies an image." As experts say, Western painting emphasizes realism, while Chinese painting emphasizes artistic conception (Xieyi). One is clear at a glance, the other is hazy and perceptible. This constitutes the difference between Chinese and Western cultures, prompting us to consider whether the education of Chinese and Western cultures, and TCM and Western medicine, should differ.
From modern TCM education, we see that disciplinary subdivisions are becoming increasingly refined. Some even attempt to divide a single textbook on *Zhongji* (Fundamentals of TCM) into several disciplines, and further subdivide acupuncture into issues of meridians (Jing), collaterals (Luo), acupoints (Shuxue), and moxibustion/acupuncture techniques (Jiuci). Does this differentiation improve the teaching quality and effectiveness of these original disciplines? In terms of scale, TCM education has indeed entered an unprecedented period in history, cultivating a large number of junior college graduates, undergraduates, and postgraduates. Especially now, many TCM colleges and universities have upgraded to universities. While the scale has increased, has the connotation of education improved? In recent years, fourth-year students have invited me to give lectures before their internships. What is the topic? Still "How to Learn TCM Well." Why? Because they remain confused and unclear about how to handle their internships. Four years is not a short time. In the past, three years of study led to apprenticeship completion; for instance, Pu Fuzhou studied under his grandfather at age fifteen and practiced independently after three years. We have spent four years and are still confused. Where is the problem? Is it in the educational approach? This is a natural conclusion. We previously mentioned that the nature of a discipline determines the educational model; have we fully considered this issue?
2. Metaphysical and Physical
Below, continuing from the perspective of internal structure, modern culture explicitly divides the world into two: the material world and the spiritual world. Modern scientific research is mainly limited to the material world, involving little of the spiritual world. Therefore, materialism affirms that matter is primary and spirit is secondary. What category does this material world belong to? We can set this aside for now and look at how the ancients divided the world. In ancient times, there was a distinction between "that which is above form" and "that which is below form": "That which is above form is called Dao (Way/Principle); that which is below form is called Qi (Vessel/Object)." Note here the division: above form, below form, Dao, and Qi. What is meant by Qi? Qi refers to things with form and substance, things with structure, hence called "below form." Obviously, the material world explored by modern science is this world of Qi (objects) "below form." Thus, the scope explored by modern science falls within the category of "below form."
So, what is "above form"? That which is above form must be formless. This formless "above form" entity is called Dao. Are the things of the Dao world the same as the spiritual world? This question requires careful consideration. However, at least in terms of categories, they are similar. The key to the above distinction lies in "form" (Xing). The *Suwen* provides a specific description of "form": "When Qi combines, form arises," or "Qi gathers to become form." How is form constituted? Qi gathers to become form; Qi combines to create form. After Qi aggregates, it constitutes tangible entities, things "below form," objects of the Qi world. What state exists before Qi aggregates? Clearly, this is a formless, "above form" state. Therefore, according to this classification, the domain discussed by modern science is actually the realm after Qi aggregation. For example, physics explores the structure and composition of matter. Thus, the concept of fundamental particles arises. What is matter composed of? Molecules, atoms, atomic nuclei, electrons, protons, neutrons, mesons... and behind mesons? Quarks! Quarks are the finest structures of matter discovered by modern science so far. Although extremely minute, they still belong to the level of "below form."
The name "quark" is quite humorous, reflecting scientists' mindset in searching for the ultimate structure of matter. Quark originally referred to a mythical bird in Western mythology. Its cry sounds like "quark"; this bird rarely cries, but when it does, the sun sets, the earth plunges into darkness, and nothing can be seen. Scientists named the finest structures of matter "quarks," seemingly indicating they do not wish to search further. What would be the result if they continued? The sun sets, it gets dark, and nothing is visible. At this point, imagine: if we follow this pattern to find the ultimate structure of matter, when will we ever find it? It seems hopeless! Faced with this hopeless prospect, the ancients did not stop. They only stated, "That which has form is born from that which is formless," without pursuing the most tangible, most "below form" thing. Thus, the *Laozi* says: "All things in the world are born from Being (You); Being is born from Non-being (Wu)." We previously discussed that the research field of modern science roughly belongs to the range of "below form," i.e., "Being." So, what about TCM? What range does TCM belong to? Obviously, it contains both metaphysical ("above form") and physical ("below form") components. It is a unity of Dao and Qi (Vessel/Object).
Therefore, both the *Laozi* and the *Neijing* emphasize the unity of form and spirit, form and Qi, requiring form and spirit to coexist. Thus, what TCM explores includes both pre-quark and post-quark elements. Whether TCM is a unity of Dao and Qi is proven by numerous examples. Taking the Five Zang Organs as an example, among the Heart, Liver, Spleen, Lung, and Kidney, we easily find a major difference: the Liver, Kidney, Spleen, and Lung all have the radical "moon" (which denotes flesh/meat in Chinese characters), whereas the Heart does not. The "moon" radical is classified under the "flesh" department in the *Shuowen Jiezi*; "flesh" naturally implies tangible substance. Thus, the ancients' positioning of the Liver, Kidney, Spleen, and Lung is very clear; they belong to the "below form" category, constituting physical structures. But the Heart is different; it lacks this radical. The Heart's positioning is not in the "flesh" department, meaning it lacks this "physical vessel"; it is "above form." However, this positioning of the Five Zang Organs in TCM is not a simple or casual positioning; rather, it represents the positioning of TCM as a whole and of traditional culture as a whole.
We can also understand this positioning through the Five Elements. Metal, Wood, Water, and Earth are all tangible substances. These tend to move downward because they have weight and are subject to gravity, belonging to the category of Qi (vessels/objects). But Fire? Only Fire is difficult to describe with form and substance; only Fire, when released, moves upward. Does it lack weight? Does it not obey gravity? This is what is meant by "above form"; this is Dao. Now we know: is it sufficient for TCM to discuss only the Liver, Kidney, Spleen, and Lung? No! One must also discuss the Heart. Therefore, TCM is undoubtedly a discipline that discusses both "below form" and "above form."
Is there a difference in importance between the two? The answer is clear. By examining the *Suwen: Linglan Midian Lun* (Treatise on the Secret Canon of Spiritual Orchid), we see: "The Heart is the official of the Sovereign, from whom Shen (Spirit/Mind) emerges." What does "Sovereign" imply? I think everyone understands. Another passage from the *Linglan Midian Lun* is worth quoting for reference: "These twelve officials must not lose harmony. If the Ruler is enlightened, the subordinates are peaceful; using this for health preservation leads to longevity, safety throughout life, and great prosperity for the world. If the Ruler is not enlightened, the twelve officials are endangered, the pathways become blocked, the form suffers greatly; using this for health preservation brings disaster, and for the world, the lineage faces great peril. Beware, beware!" From the relationship of the Five Zang and the Twelve Officials, we can see that although traditional culture and TCM are indeed a unity of Dao and Qi, emphasizing the interdependence of form and Qi, and the unity of form and spirit, the overall emphasis lies on the side of Dao, Spirit, and Qi. Thus, it is a discipline that uses Dao to control Qi (vessels), Spirit to control Form, and the "above form" to govern the "below form."
Regarding this emphasis, we can use a more practical example: the hierarchy of doctors. The *Neijing* divides doctors into two grades: Shang Gong (Superior Doctors) and Xia Gong (Inferior Doctors). Shang Gong refers to highly skilled physicians; Xia Gong refers to ordinary ones. How to distinguish them internally? The *Lingshu* provides a specific indicator: "Shang Gong guards Shen (Spirit); Xia Gong guards Xing (Form)." What is Shen? Shen is formless, belonging to the category of Dao and "above form." Shang Gong guards this. In other words, one who can guard this category, understand disease, and treat disease from this level, may become a Shang Gong. Conversely, if one guards already formed things, understanding and treating disease from the "below form" level, one can only become a Xia Gong.
Thus, the *Suwen: Siqi Tiaoshen Dalun* states: "Therefore, the sage treats disease before it arises, and disorder before it occurs. To treat disease after it has formed, or disorder after it has occurred, is like digging a well when thirsty, or forging weapons when battle has begun. Is this not too late?" Guarding Shen means treating disease before it arises. "Pre-disease" (Wei Bing) is disease that has not yet taken form. Removing it before it takes form is easy. Once it has formed, or even become entrenched, removing it is difficult and unrewarding. The occurrence of any disease proceeds from pre-disease to established disease, from unformed to formed. According to Western medicine, any organic lesion develops from a non-organic stage. Treatment is easier at the non-organic stage; once entering the organic stage, treatment becomes much harder. Therefore, practitioners must not only be good at treating disease but also at recognizing it. Can you discover, intercept, and eliminate disease in its pre-disease, unformed stage? Like Bian Que observing the complexion of Duke Huan of Qi, discovering the disease while it was still in the skin and treating it there should require no effort. Zhang Zhongjing diagnosed Wang Zhongxuan, a Minister of Ceremonies, twenty years in advance and proposed corresponding treatments. This is the skill of seeing the subtle to know the manifest, of preventing trouble before it arises. Discovering late-stage cancer only at its end stage holds little significance.
Currently, modern medical diagnostic technology, overall, remains at the level of diagnosing established disease. No matter how advanced, it only diagnoses formed diseases; it is powerless against pre-disease or unformed conditions. However, with gene diagnosis, checking the genes of infants or fetuses, future diseases can be detected. At this stage, one knows pre-disease. Thus, modern medicine, overall, is developing in the direction of traditional TCM. Most people's current understanding of TCM is from the level of established disease, i.e., "below form." Understanding TCM from this level naturally makes one feel TCM is inferior to Western medicine in every way.
I often use an analogy: if a patient suffers a myocardial infarction (heart attack), which hospital would you send them to? A TCM hospital or a Western medicine hospital? I believe 100 out of 100 people would choose the Western medicine hospital. Even if Zhang Zhongjing were alive, he might advise sending the patient to a university-affiliated Western medicine hospital rather than a TCM hospital. Based on this, Western medicine practitioners stand tall, while TCM practitioners hang their heads in shame, believing TCM is indeed poor and that they chose the wrong profession. If compared this way, TCM indeed falls short and must concede defeat. However, if we change our perspective: I treat a patient with coronary heart disease such that they never suffer a heart attack, or never develop coronary heart disease at all. I prevent it; you treat it after it occurs. How do we compare these? Which benefits society, the nation, the family, and the patient more? I think 100 out of 100 would agree with me. Comparing from this angle, perhaps we can gain confidence in TCM.
TCM emphasizes treating pre-disease. Zhang Zhongjing pointed out at the beginning of the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet): "The superior doctor does not treat established disease but treats pre-disease." The starting point and purpose of our medicine is to treat pre-disease, to dig wells before thirst strikes and forge weapons before battle begins. Yet, many people insist on competing with Western medicine in the realm of established disease, engaging in "TCM Emergency Medicine." This is overestimating oneself and attacking strength with weakness. Digging wells when thirsty, forging weapons when fighting—how can you compete with modern speed? Thus, the above issue is serious. TCM is a medicine that leans entirely toward the "above form," governing the "below form" with the "above form," and ruling established disease with the treatment of pre-disease. Yet, we currently view it completely through a "below form" lens, treating it as a purely physical discipline focused on established disease.