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《中醫學》（節選）翻譯實踐報告
發布時間：2023-03-16 10:37
Table of Contents
摘要 III
Abstract IV
Chapter one Introduction 1
1.1Background of the Translation Task 1
1.2Purpose and Significance of the Task 1
1.3Outline of the Report 2
Chapter Two Task Description 3
2.1Contents of the Source Text 4
2.2Stylistic Features of the ST 4
2.3Requirements of the Translation 5
Chapter Three Translation Process 6
3.1Preparation before Translation 6
3.1.1Reviewing the Original Text 6
3.1.2Glossary Building 6
3.2Preparation of the Skopostheorie 8
3.2.1Summarization of Skopostheorie 8
3.2.2Three Rules of Skopostheorie 9
3.2.3Skopostheorie's Significance in Guiding Medical Translation 9
3.3Quality Control 10
Chapter Four Case Analysis 12
4.1Lexical- Level Analysis 12
4.1.1Abbreviations 12
4.1.2Translation of Chinese Medical Terms 13
4.1.3Translation of Non-medical Terms 15
4.2Syntactic- Level Analysis 17
4.2.1Subject-Prominent Sentences 17
4.2.2Long and Complex Sentences 19
4.2.3Translation into Classical Chinese Sentences 20
4.3Textual-Level Analysis 20
4.3.1Realization of Cohesion 21
4.3.2Structure Rearrangement 21
Conclusion 22
Bibliography 24
Appendices 26
Appendix 1 26
Appendix 2 67
攻讀碩士學位期間取得的學術成果 107
Acknowledgments 108
Chapter One Intr oduction
1.1Background of the Tr anslation Task
Now, China has entered a new era of more active development, and the government highly valued the development of the soft power. In the tide of globalization, the cultural soft power is playing an increasingly important role in the international competition. As a characteristic feature of Chinese civilization, traditional Chinese medicine (TCM) has made a significant contribution to the nation's procreation and the country's prosperity. The State Council released a white paper Traditional Chinese Medicine in China to promote the exchange and dissemination of TCM culture in 2016. It is an exchange course which has great significance to introduce the TCM abroad while the western medical science is also proposed to China. China has a profound history of medical translation. As medical translation is of great importance in EST, namely English for Science and Technology, there are massive language workers and studies researching it. Psychosomatic medicine has become a relatively independent sub-discipline in medical science because of its rapid development in the past decades.
Meanwhile, TCM has a successive profound tradition as well as rich knowledge and experience on psychosomatic medicine. That's why some scholars deem psychosomatic medicine as the intersection of TCM and western medicine. (Chen Shesheng, 2016) Therefore, the effective translation of related contents is quite essential for cultural and medical exchange. According to the reasons above, the author translated Traditional Chinese Medicine and summing up the entire translation process.
1.2Pur pose and Significance of the Task
The analysis of the translation is made from the perspective of Skopos theory, aiming to conclude the translation methods adopted during the translation process of the Traditional Chinese Medicine. It is of great importance to make a detailed analysis of the translation focusing on what translation methods should be used and how various translation strategies should be adopted to improve the translation quality. Firstly, the translation of this medical material has great practical significance in that it can make more foreign people get to know TCM's Psychosomatic Medicine knowledge after reading, which could expand the thought for human beings to comprehensively learn the law of disease occurrence and development as well as its influencing factors, and open up new perspectives and approaches for recovery. Also, it can help to provide a means of culture promotion for TCM in the world.
Secondly, the translation of the selected text is helpful to make a summary of the problems and also the countermeasures of the translation project. During the translation process, the author referenced many parallel documents and translation theory books, which are very helpful for solving the translation difficulties that the author would possibly encounter in the future. Thirdly, the translation of the selected text is different from the translation of other medical articles because of the distinctive features of TCM materials. Besides, the spread of Chinese medicine culture has been highly valued by the Chinese government in recent years. Thus, the discussion over the translation strategies used in this project will hopefully be helpful to shed some light on the translation of other TCM materials.
1.3Outline of the Repor t
There are five parts to this paper. The first section is the introduction, introducing the background and significance of the translation. Moreover, it will also introduce the framework of the thesis. The second section analysis about the stylistic features and content of the source text and target text. The third chapter presents a review about the translation process, focusing on the preparation before translation, the translation introduces and quality control. Afterward, it presents an analysis of Skopos theory and also its significance in this translation project. The fourth section analyzes the translation difficulties at the lexical level, syntactical level, and textual level and also corresponding solutions. At last, it presents a conclusion about the discussions which have been made in the previous part.
Chapter Two Task Descr iption
2.1Contents of the Sour ce Text
This book was published by Shanghai Scientific & Technical Publishers in 2017. Its editor-in-chief is Professor Ni Hongmei from Shanghai University of Traditional Chinese Medicine. The source text includes eight parts to enable the foreign people to get more acquainted with traditional Chinese medical theories and general medical skills. The author extracts and translates Chapter Two. Following the previous chapter which compared the understandings of relations in China and foreign countries, these excerpts emphasized sorting out the principles of considering both physical and mental factors amid TCM diagnosis and treatment and put forward the psychosomatic theories in TCM. The extracted part is a critical transitional chapter in the entire book. It is also the theoretical foundation of TCM for discussing doctor-patient communication in clinical treatment in subsequent chapters.
2.2Stylistic Featur es of the ST
The selected text contains many terms peculiar to TCM, such as “acupuncture,” “Yin,” “Yang,” “Qi,” “Hun,” “Po,” “Tao” as well as the names of various classic medical books. When the author translated these terms and titles of books, the author consulted numerous TCM books and dictionaries to understand them well. In this project, most of the sentences are compound sentences, which requires the translator to deal with them flexible. As for the sentence structure, some short sentences are used to express the related information in the source text. However, according to the research in the parallel texts, it has been found that medical English has more long sentences, the logic of which is better shown through these long sentences. Therefore, it is of great importance to pay attention to the sentence structure during the translation process. Additionally, due to the specific features of the text, such as objectivity, scientization, and precision, translators cannot add special meaning when translating such text(Li Zhaoguo, 1997). In other
words, translators cannot amplify the meaning. They need to reproduce the theme and style of the source text faithfully. The words should be chosen correctly, while the definition needs to be delivered completely.
2.3Requir ements of the Tr anslation
Because of the dramatic differences of the stylistic features between the source and target texts, it is of great importance to get rid of the habits of Chinese sentence structures during the translation process. Also, there are some requirements to be satisfied during this process. First of all, it is crucial to follow the scientific principle of medical translation. The translation of medical text does not have to follow the “elegance” role as what it requires in literary translation (Huang Yanning, 2007). However, the translation needs to be accurate. It is significant to make sure that it will not violate the scientific principles. Also, it needs to be consistent with the facts (Chen Shesheng, 2012). Secondly, it is essential to guarantee the accuracy of medical terms. The primary characteristic of the source text of a medical document is that it includes a lot of TCM terms as many concepts do not exist in English. Thirdly, the translation should be guaranteed to be faithful to the source text. It can be found that the source of the medical version is very cohesive and reliable. It is essential to conform to the expression habits of the target language to make it more equivalent to the source language.
Chapter Thr ee Tr anslation Pr ocess
3.1 Pr epar ation befor e Tr anslation
Preparations made before translation include acquiring background knowledge of traditional Chinese medicine from relevant books and news, building a glossary that contains technical terms with high frequency, and learning Skopos theory that is the guidance of tackling translation difficulties. All these preparations make contributions to the translation process.
3.1.1Reviewing the Original Text
It is of great importance to have pre-translation preparation as it impacts the translation afterward. After finishing the selection of the text which needs to be translated, it was found that the document was difficult to explain, especially the names of some classic medical books and also the medical terms. Thus, during the translation process, the author took many medical documents as the reference. The translation of medical texts aims to convey information. Therefore, some medical English parallel texts have been collected and hence to make sure that the translation will be consistent with the diction of medical English. Afterward, the author also searched many documents regarding the text types and even translation theories to decide translation strategies better.
3.1.2Glossar y Building
Attention should be paid to making sure the translation of a certain terminology or abbreviation is consistent in the whole translation. After identifying the corresponding meaning of terminologies and abbreviations mentioned in the material by consulting dictionaries, a glossary (see in Table 3.1) is built, making it convenient for the translator to find their meanings. If a terminology or abbreviation mentioned already appears again, the translator can look for its meaning in the glossary, not only making sure its meaning
is consistent in the whole translation but also improving the efficiency of the translation process.
Table 3.1 Glossary
the whole concept 整體觀
syndrome differentiation and treatment 辨證論治
opposition of yin and yang 陰陽對立制約
wane and Wax between yin and yang 陰陽消長平衡
explanation of pathogenesis 闡釋病理變化
relative decline of yin or yang 陰陽偏衰
the five elements property 五行特性
five Zang-organs and six fu-organs 五臟六腑
pectoral qi 宗氣
the physiological functions 生理功能
body fluid 津液
the production and transportation and metabolism of body fluid 津液的生成、輸布和排泄
the physiological functions of qi, blood and body fluid 氣、血、津液的功能
governing blood 主血脈
controlling the mind 主神志
governs the vessels 在體合脈
opens into the tongue 開竅于舌
external manifestation on the face 其華在面
fixating function 固攝作用
concept of six pathogenic factors 六淫的概念
cold tends to impair yang 易傷陽氣
cold tends to coagulate 寒性凝滯
summer-heat often complicated by dampness 暑多夾濕
dryness consume the body fluid 燥易傷津
blood stasis 瘀血
imbalance between yin and yang 陰陽失調
the pathogenic characters of the seven emotions 七情致病的特點
asthenia and sthenia differentiation of Syndromes 虛實辨證
abidance by individuality, locality and seasons 三因制宜
Chinese Medicinal Herbs 中藥
four properties 四氣
five flavors 五味
the action of lifting, lowering, floating and sinking 升降浮沉
channel tropism 歸經
toxicity 毒性
heat syndromes 熱證
asthenia Syndromes 虛證
sthenia Syndromes 實證
clinical character and difference 臨床特點
syndromes differentiation with eight principles 八綱辨證
syndrome differentiation with qi, blood and body fluid 氣血津液辨證
exterior-interior relationship of the twelve channels 十二經脈表里絡屬關系
Needling methods (insertion methods, Needling manipulation methods) 刺法（針法）
heat(fire) tends to flame up 其性炎上
arrival of Qi 得氣
management of possible accidents (emphasize acupuncture techniques) 針刺意外和防治處理
moxibustion 灸法
contraindication and Compatibility of Chinese Medicinal Herbs 中藥的配伍、用藥禁忌
dosage of Chinese Medicinal Herbs 中藥的劑量
dampness tends to move downward ， attack the lower and inside parts 濕性趨下, 易襲陰位
3.2Pr epar ation of the Skopostheorie
In the middle and late 20th century, German functional school gradually developed and expanded, changing the situation that the previous translation theory is always based on linguistics. With the continuous development of the technical school, the development of translation theory had a new direction in which the target language text began to attract the attention of scholars, while the source language text no longer occupies the dominant position as before. German functional school has many outstanding scholars. There are four representative personages, namely Katharina Reiss, Hans Vermeer, Justa Holz-Manttari, and Christiane Nord. Skopostheorie is proposed by Vermeer and has become the representative theory of functional school.
3.2.1Summar ization of Skopostheor ie
First of all, through years of research and practice, Reiss discovered that in practical translation, it is difficult for translators to pursue equivalence between the target text and the original text. Then, Vermeer put forward the Skopostheorie, which means the purpose of translation determines the translation of the text. Thus the initial thought of the Skopostheorie came into being. Then, Vermeer put forward the Skopostheorie, which means the purpose of translation determines the translation method used in the specific situation (Nord, 2001, p.29). It is of great importance to the formal formation and further development of Skopostheorie. In 1984, Manttari put forward the theory of translation action in Translation Action-Theory and Method. She specifically emphasized that "translation action" is different from "translation." Translation action is a broader sense of the concept, which not only includes translation but also includes everything related to translation (Xie, 2008, p.137). In the end, Nord proposed the theory of "function plus loyalty." She introduced "loyalty" in the right field into Skopostheorie, aiming to show clearly the relationship among various roles in the process of translation action. (such as translators, authors, readers, commissioners.) (Xie, 2008, p.176).
3.2.2Three Rules of Skopostheor ie
In 1978. Vermeer first proposed Skopostheorie in his dissertation "The Framework of Ordinary Translation Theory", and elaborated three principles of guiding translation: Skopos Rule, Coherence Rule, and Fidelity Rule. (Ma & Miao, 2009, p82)
The relationship among the above three rules is that Fidelity Rule is subordinate to Coherence Rule, and both of them are subordinate to Skopos Rule (Jia, 2012, p40). In the process of the actual translation, the translator should first ensure that the target text must be guided by Skopos Rule, and then Coherence Rule and Fidelity Rule can be taken into consideration.
3.2.3Skopostheor ie's Significance in Guiding Medical Tr anslation
Skopostheorie emphasizes the purpose of the translation. The realization of purpose means the realization of text function. It has specific guiding significance for the translation of different types of texts. The original practical text emphasizes information content. The core content is the introduction of professional traditional Chinese medicine knowledge to readers so that traditional Chinese medicine will be known to a broader group. The original text is a standard medical English text which has characteristics in terms of vocabulary, syntax, and discourse. Skopostheorie can be combined with features of medical text, which has a particular guiding significance for text translation.
3.3Quality Contr ol
3.3.1Establishment of Ter base
The source text contains a lot of medical terms. In order to ensure the consistency of medical terms' translation, the author used Trados software to select these terms and made a C-E termbase which facilitated the translation process. With the help of Trados, the translation process can be more efficient. The same word once appears again, can be translated automatically. This can greatly boost the efficiency. Examples are as follows. 身心醫學 Psychosomatic Medicine 針灸 acupuncture and moxibustion 臟腑 Zang-fu viscera 經絡 meridians and collaterals 氣 Qi 生理 學 physiology 上焦 upper-jiao 熱 癥 fever 病 變 lesion 穴 位 acupoint 辯 證 syndrome differentiation 病 機 pathogenesis 體 征 physical sign 藏 象 viscera state 病 因 學 etiology 七 情 seven emotions.
3.3.2Consultation of Exper ts of TCM
It is very fortunate to have the help from doctors who are professional TCM physicians in Chinese medicine hospital in Linyi City. Without their proficiency in TCM, it would be impossible to finish this project.
3.3.3Feedbacks from Native Speaker s in the Field of Medicine
The author visited medical teachers working in JiangXi University of Traditional Chinese Medicine who came from the US, after a face-to-face communication, the author communicated with them via emails to get feedback. When the translation is finished, with the help of native speakers in the field of medicine, the translation work is revised again from various perspectives. By proofreading, it mainly focuses on whether the translation has reasonable logical relationship and also whether the sentence structure is translated according to the expression habits of English language.
Chapter Four Case Analysis
The chosen material is a standard TCM text. Translating TCM text is considered to be difficult because of its distinctive characteristics. To achieve a proper translation, it is imperative for the translator to get a better understanding of the source text and be clear about its features.
4.1 Lexical- Level Analysis
At the lexical level, examples of abbreviations, Chinese medical terms, and non-medical terms will be given, and translation techniques adopted will also be introduced.
4.1.1Abbr eviations
Abbreviations have a high frequency in the source text, especially in Chapter 10, most of which represent names of international organizations or books. When translating abbreviations, the purpose of the translator is to pass on the specific meanings of them faithfully. So abbreviations are translated under the guidance of loyalty rule. Meanwhile, these abbreviations are new to the translator, and that's why she decides to look them up in dictionaries. However, not all abbreviations have explanations in dictionaries, so the translator adopts other methods, such as reading parallel texts, to see if those abbreviations whose meanings cannot be found in dictionaries are mentioned. It turns out that reading parallel texts is an excellent way to solve such a problem.
For example, an abbreviation, CNMA mentioned in Zhen Qi (Wei Qi) : the middle, is an abbreviation of China Nonprescription Medicines Association. And it appeared 3 times in the source text. The translator found its meaning in a book called China Nonprescription Medicines Association written by Wang Shou where it is translated into “中國非處方藥協會”.
Other abbreviations mentioned and their translations are shown in Table 4.1.
Table 3.1 Other abbreviations mentioned and their translations
IPCC 藥品評價
CMA 中華醫學會
CP 《中國藥典》
CPA 中國藥學會
CPMA 中華預防醫學會
CDE （國家食品藥品監督管理局）藥品審評中心
CNAO 中華人民共和國審計署
CDR （國家食品藥品監督管理局）藥品評價中心
DIC 藥品信息中心
DUR 藥物利用評價
IRC 國際紅十字會
ICH 國際（藥品注冊）協調會議
MOH 中華人民共和國衛生部
MOST 中華人民共和國科學技術部
IMIC 國際醫學信息中心
4.1.2Translation of Chinese Medical Terms
Chinese medical terms are expected to be translated in a way that their meanings can be conveyed accurately. Therefore, loyalty rule is mainly followed by the translator when translating medical terms so as to achieve a proper translation.
Example 1: Summer-heat tends to disperse and elevate, consume the qi and body fluid.
Translation:暑性升散，耗氣傷津。
Analysis: This is an example of Chinese Medical words. The most accurate and professional information of technical words is expected to be conveyed. To reach this goal, the translator decides to look them up in Eudic online dictionary first; then she uses the meanings acquired from the dictionary as keywords to search online to check whether the meanings are the most accurate, enabling that the translation is by the requirement of loyalty rule.
Example 2: TCM considers that a human being is made of four main resources: Jing (Essence), Qi (Energy), Shen (Spirit or Mental) and Xing (Body structure). These constituents will produce Zhen Qi. Zhen Qi is responsible for the movements of transformation and transportation which maintain a state of balance (and health) in the body when it is functioning “normally”. The notion of “normality” does not necessarily mean “ideal balance”, it means that, at that particular time, the body functions without the interference of a pathogenic factor. This function of Zhen Qi is called “Qi Ji”： it tells us about the dynamics existing between the different substances, which is essential to diagnosis.
Translation: 中醫認為人又四種主要資源組成，即精氣神形。這些成分將產生真 氣，真氣負責轉換和運輸的工作，它幫助機體保持在一個動態平衡中“從容”運轉。
“從容”地概念不是指理想化的平衡，它指的是在特定的時間內，身體機能不受邪 氣干擾。真氣的機能被稱為“氣機”：它告訴我們在診斷的基礎之上，不同物質之 間的動態關系。
Analysis: The Collins Dictionary shows that “ pathogenic” means “致病的； 病原的；發病的.” This meaning is often used in common situations. And “pathogenic” also means “ causing or capable of causing disease” according to Oxford Advanced Learner's English-Chinese Dictionary, which seems proper due to its specific relevance to TCM. In TCM, the reason that was causing disease is called “邪氣入侵,” so the author translated it into “邪氣” in this condition.
Example 3: acupuncture and moxibustion
Translation: 針灸。
Analysis: 針灸 is a prevalent concept in TCM, which is a combination of 針刺 and 艾灸 . Acupuncture is already a favorite word in English culture, and it correctly means “針刺,” but westerners often interpreted “acupuncture” as acupuncture directly to “ 針 灸,” and they sometimes ignore the existence of moxibustion, which means “艾灸.” They are two things which should not be mixed. The translator analyzed the origin of these two English words from a rigorous perspective. Translation of acupuncture consists of two Latin morphemes, including “acu” and “punctra.” Both of these two parts do exist in Latin. However, the combination of them, which is acupuncture, actually does not exist in Latin. By “acu,” it refers to needles while by “punctra,” it refers to thorn. The combination of these two parts, “acupuncture” is a new word. It fits both the word-building rule of the blending of the western language and also the grammar rule of Latin language. When the word is created, it is used commonly. At the same time, other words formed in this same method may not have such popularity. Different from acupuncture, moxibustion, the translation of “ 艾 灸 ” is adopted in another way. Actually, “ 艾 ” is translated based on the pronunciation of “moxi” in Japanese. Thus, “moxi” is a result of transliteration while “bustion” refers to “burn.” Moxibustion is the combination of both the meaning and also the pronunciation, which has already been used for many centuries. People are quite familiar with their connotative meanings. Therefore, people will think of the connotative meaning of “moxibustion” when they see the word “艾灸.” The above example illustrates that the target text should be kept within the strict scope of TCM terms when translating from English to Chinese, to ensure the functional equivalence of the target text.
Generally, medical terms themselves are in a complex medical system with many unique features. Since the purpose of medical literature translation is to transfer medical knowledge, the author should pay attention to cultural communication through various translation means while attaching importance to medical education.
4.1.3Translation of Non-medical Terms
Although the source text is a standard TCM text with a large number of Chinese medical terms, the translation of non-medical terms is of equal importance to ensure the accuracy and readability of the translation. And the word-to-word translation should be avoided due to differences between Chinese and English caused by thinking. The purpose of the translator, when translating non-medical terms is to present the translation understandably and acceptable. What's more, the translation should make sense in the target language and culture. And such purpose is following the requirement of coherence rule. That's why the translator utilizes three kinds of translation techniques, including amplification, omission, and conversion, to fulfill her purpose under the guidance of coherence rule.
Example 4: Superior medical worker treats a patient's mental activities: considering both physical and psychological conditions during diagnosis and treatment.
Translation:.上工守神:診療中的身心兼顧思想。
Analysis: The tricky part of this sentence is “Superior medical worker,” It does not mean a person or a job but refers to some metaphysical categories, indicating something wise or advanced. Therefore, the translator turn to the Classic TCM book Miraculous Pivot （《靈樞經》, getting the paralleled meaning in Chinese “上工.” The context of this sentence is “上工守神，下工守形,” in which “上工守神” means a superior medical worker is protecting the patients from getting an illness. Actually, in TCM, “superior medical worker” is intangible, usually referring to the spirit and vitality of an individual. It relates to Yin and Yang. Then, it would not be challenging to apply “intangible” and “spirit” to the Chinese character “神.”
Example 5: Frightened convulsion leads to separating the blood and Qi, and disorder Yin and Yang.
Translation:大驚卒恐，則氣血分離,陰陽破散。
Analysis: Collocation is important in both English and Chinese. In English ， “separating” can be used as an object of “the blood and Qi” which is a verb, while in Chinese, we often say “氣血分離” rather than “使氣血分開”. As a result, the translation is acceptable and readable, and thus meets the requirements of coherence rule.
Example 6: DysfUnction of the Zang-fu viscera.
Translation:臟腑系統功能紊亂。
Analysis: Western medicine and TCM belong to different medical systems and the understandings of pathologic and physiological functions of the internal organs, and the physical body is not consistent with each other. Here “Zang-fu viscera” means 臟腑 系統. There is an absolute deviation between“Zang-fu viscera” and “Zang-fu organ” that Chinese medicine wants to express. “Zang-fu viscera” system is a very profound theory in traditional Chinese medicine. It is challenging to include the essence of this theory in translation in a simple term. The term "viscera" comes from the western medical system. It was borrowed to make the reading more straightforward for the reader to understand. From the view of translation, translating Zang-fu viscera into “臟腑系統” can achieve equivalence.
4.2Syntactic- Level Analysis
4.2.1Subject-Pr ominent Sentences
English is a subject-prominent language (Lian Shuneng, 2006). A subject must be contained in an English sentence. Different from Chinese, the TCM materials, as a part of classical Chinese, are characterized by zero-subject sentences at the syntactic level. Sometimes, there may no subject in a Chinese sentence. Therefore, usually, translators have troubles in E-C translation of sentences about casting aside the issue. When translating sentences as the above case, the author has used typical skills below. In a specific context, we can present the Chinese translation version as an imperative sentence. In this case, it is more consistent with the expression habits of Chinese and makes the translation more concise and easy to understand.
Example 7: Activate and cultivate the patient's mind, pay attention to the patient's characteristics and mental process.
Translation:動其神，養其性，重視患者的個性特征和心理過程。
Analysis: Imperatives in English can indicate suggestions, orders, requests, or advice, and most of them also do not have a subject. From this aspect, the translation of English imperative sentences into Chinese can be done in formal equivalence. And the translation of this kind of sentence pattern is also widely fit for Chinese zero-subject sentences. Sometimes, when it comes to translation, the object of the source sentence can be changed into the subject of the translated sentence.
Example 8: The removal of stimulation and stabilization of emotion should be put at the top of the list.
Translation: 應把去除心理刺激和穩定情緒放在首要地位。
Analysis: Through comparison, it can be found that the active voice is more suitable in the translation sometimes, mainly when the subject of the original sentence is of great importance. It can be found that in the translation, the subject “the removal of stimulation and stabilization of emotion” has been changed into the object “去除心理刺激和穩定情 緒,” which can be better understood by the target language readers.
Example 9: Treatment is a complex practice process involving many people, and certain principles must be followed to achieve good effects.
Translation: 治療是一個有多人參與的復雜的實踐過程,想要治療卓有成效,必須 遵循一定的原則。
Analysis: The subject of this sentence is “Treatment is a complex practice process,” and “involving many people, and certain principles must be followed to achieve good effects”furtherexplains“Treatment.”Thewholesentenceislogicallyrigorous.However, when translating into Chinese, we should consider the characteristic of TCM. The translator loosens the sentence and changes the passive voice of the first clause into the active voice. The word order of "certain principles must be followed to achieve good effects" has been adjusted. In Chinese thinking, to achieve a good effect, one must follow an absolute principle. The original text is composed of three clauses from a complete sentence, each of which has its subject. If the translator translates it into a whole sentence according to the expression habit of English, the corresponding issue should be removed relatively, thus increasing the difficulty of translation.
Example 10: There are various underlying principles of TCM for general physical treatment, such as the principle of searching for the primary cause of disease in treatment, applying proper therapeutic measure in line with the season, local conditions and individuality, regulating the viscera function, adjusting Yin and Yang, etc.
Translation: 中醫有許多基本治則，治病求本，因時、因地、因人制宜，調整臟 腑功能，調整陰陽等。
Analysis: In the example 8, noun phrases like “applying proper therapeutic measure in line with the season, local conditions and individuality,” “regulating the viscera function,” and “adjusting Yin and Yang” in the sentence is quite commonly used in English. Usually, every English sentence we know has a subject. However, in many cases, the translator will sometimes need to adjust the translation appropriately according to the needs of the Chinese sentence structure of the target text, so that the translation will not appear tedious and consistent with the characteristics of concise and smooth medical translation. Therefore, the translator translated these noun phrases into subject clauses, such as “治病求本,” “因時、因地、因人制宜,” “調整臟腑功能,” and “調整陰 陽 ,” and so on. This translation form is a combination of several complex clauses into one long sentence.
4.2.2Long and Complex Sentences
Division means to divide a long and complex sentence into several short sentences. And it's highly adopted in translating English into Chinese. Two examples are introduced below to show how long and complex sentences in the source text are translated by the translation technique—division.
Example 11: In fact Qi is the constituent ofthe whole universe and the human body interests with it at all levels (sex, social relations, money, nature...) everything in the world can be considered a different form of Energy, and interactions are taking place all the time between these different aspects or “forms” ofQi, including human's Qi.
Translation: 實際上，氣是整個宇宙的組成部分，它會受到人類各個層面的影響，包 括性、社會關系、金錢、自然...世界上所有的一切都可以被認為是不同形式的能量， 而這些不同層次、不同形式的能量(包括人體的氣)之間又無時無刻不在互相作用和 影響。
Analysis: Apparently, the English sentence is only one sentence while the translation include two sentences. That's the result of division. The English sentence includes rich information of Qi. In the translation process, the subject “Qi” and predicate “is” of the sentence are what the translator first pays attention to, then the fact is noticed by her that although words including “of” “” “with” are adverbial modifiers, they need to be translated into short sentences in Chinese separately. Compared to English, reasons will be put before results in Chinese, so the translator changes the order.
4.2.3Translation into Classical Chinese Sentences
Sometimes, the original text is rich in vocabulary, and the literal meaning is relatively easy for the readers to understand. However, when translating these English originals into Chinese, especially when there is a need to fit for the text of traditional Chinese medicine, the standardization and strictness should be considered to make the translation more accurate and coherent. To some extent, some words or contents of the original text should be omitted according to the context inference, so that the meaning of the translation can be more accurately expressed. The purpose of omission, of course, is to convey information that has been clearly shown in the source text. Therefore, the translator is required to understand the original text accurately. Otherwise, such amplification may be compromised the translation. The translator will make a specific analysis of this translation task in the following paragraphs.
Example 12: Patients and the diseases are the root causes, doctors and the treatments are the temporary solutions, if the answers are not appropriate for the root causes, the evil pathogen cannot be treated.
Translation:病為本，工為標，標本不得，邪氣不服。
Analysis: In the source text, “patients and the diseases” means “病,” and “doctors and the treatments” means “工.” Due to the English meaning of the original text and the presentation of the Chinese classical book, a certain degree of information omission is carried out during the translation, making the target language more consistent with the ancient TCM expression, and readers will not find it difficult to understand the information.
4.3Textual-Level Analysis
Languages have different features. According to Qin Hongwu and Wang Kefei (2010), English is featured by hypotaxis, indicating that cohesion is essential for English speakers. At the same time, the most prominent feature of the Chinese language is parataxis, meaning that the different parts in the sentence are usually loose and unclear. Operative words are adopted in English to ensure the cohesion of clauses. However, Chinese sentences are typically connected by meaning.
4.3.1Realization of Cohesion
The aim of original writing can be achieved by making a complete analysis of the original script and selecting proper translation strategies. Translators need to fully understand the original English sentences first when they do the translation grasping the logic of different parts of the sentences. These sentences are connected to guarantee the coherence and cohesion ofthe discourse better.
Example 13: Acupuncture and medication are the methods, but ifthe patient's mind is not activated and treated, the diseases will not be cured.
Translation: 針石，道也。精神不進，志意不治，故病不可愈。
Analysis: Cohesion can be understood as the links between different parts in the lexical level and also at the grammatical level. Coherence is of great importance as it connects the meaning and sequences ofideas.
4.3.2Str ucture Rearr angement
When it comes to the translation of long sentences in the medical documents, it is inevitable to have structure rearrangement, through which we can make a better analysis of the sentence structure and hence to recompose the sentence through proper cohesion means. As for Chinese expression habit, there are many loose clauses and phrases in the Chinese sentences; it requires translators to reflect this Chinese characteristic in translation.
Example 14: Treatment for the mind and internal injuries must follow the principles of “treatments that are suited to diseases can harmonize the mood, and treat the diseases.” Harmony of patients and doctors refers to the guidance and collaborative doctor-patient relationship with mutual communication and gains, and the aspect of doctors plays a leading role in building this relationship.
Translation: 治療情志內傷之癥，必“病與醫相得，則情能相浹，才能勝任，庶 乎得濟而病無不愈”。所謂病醫相得，就是指醫患間相互溝通、互有所得、指導與 合作型的醫患關系，而要建立這種關系，主導方面往往在于醫家。
Analysis: For translation, structure rearrangement is the most challenging part. It requires the translators to change from the English thinking pattern into Chinese thinking pattern. This example is mainly composed of two sentences, the first sentence of the original is more compact, from which we can see "treatments that are suited to diseases can harmonize the mood, and treat the diseases" is the further elaboration for “principle.” Its literal meaning is relatively easy to understand, which is “適合疾病的治療可以調和 情緒，治療疾病,” but to more accord with TCM expression habit, it becomes a "病與醫 相得，則情能相浹，才能勝任，庶乎得濟而病無不愈," which also conforms to the characteristics of Chinese more loosen clauses. Also, when translating "Must follow," the use of "必"instead of "必須遵循"also plays a role in simplifying the sentence. The "所 謂" in the second sentence serves as a link between the preceding and the following in Chinese, making it more consistent with Chinese expression habits. The target reader, therefore, is more likely to accept it. Generally, all the translation strategies adopted above at the textual, syntactical, and lexical levels are used to make the translation more logical and natural as much as possible. This will also make the translation more comfortable to be understood by the reader.
Conclusion
This translation report focus on analyzing the translation strategies of medical English from the perspective of the Skopostheorie. It mainly solves two significant problems. First, it confirms that the Skopostheorie can be combined with medical texts, and it can be deeply combined with the translation in the levels of vocabulary, syntax, and discourse. Second, through the guidance of the Skopostheorie, the reporter summarizes some guiding methods for translating medical texts, which are mainly embodied in three levels. In the lexical level, the translation of medical vocabulary should be guided by Fidelity Rule. Some words can be obtained directly through dictionaries and parallel texts. The other vocabularies can be translated through the method of conversion based on Skopos Rule and Coherence Rule. In the syntactic level, the translation of long and complicated sentences mainly follows the Skopos Rule and Coherence Rule. The methods of direct translation, reversing, cutting, and embedding can be used synthetically. In terms of passive sentences, there are mainly three translation methods, such as translation into active sentences, passive sentences, and sentences without a subject. In discourse level, this report uses coherence Rule and Fidelity Rule, thus ensuring the readability ofthe target text.
The translation is skilled work. One minute on the stage needs ten years of hardworking. Only if you usually work harder, you could complete the translation project quickly and accurately. A qualified translator should be proficient in translation strategies and skills, language features of Chinese and English, and differences of thinking and culture between Chinese and foreigners. Also, translators should also be generalists in many fields. Ir this case, translations can be done with high proficiency. A large number of medical passages of English and Chinese should be read to be familiar with writing styles and professional terms. Through reading, translators can broaden their minds and enrich their imaginations so that they don't have to be scrambling to keep up with an urgent project when receiving translation tasks. Learning never stops.
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Appendices
Appendix 1
原文
Claudine: Li Xin, in the first chapter of this book,could you describe your vision of TCM and your understanding of the physiology of the human being: what is it made of, how does it work and how does it become ill or out of balance?
Li Xin: TCM considers that a human being is made of four main resources: Jing (Essence), Qi (Energy), Shen (Spirit or Mental) and Xing (Body structure). These constituents will produce Zhen Qi. Zhen Qi is responsible for the movements of transformation and transportation which maintain a state of balance (and health) in the body when it is functioning “normally”. The notion of “normality” does not necessarily mean “ideal balance”, it means that, at that particular time, the body functions without the interference of a pathogenic factor. This function of Zhen Qi is called “Qi Ji”(氣機):it tells us about the dynamics existing between the different substances, which is essential to diagnosis.
Ifa pathogenic factor (Xie Qi 邪氣) interferes with the normal function ofthe body, there will be a “fight” (Bing Ji 病機), translated by symptoms.
It is very important to understand what are the four main resources ofthe body, and what Zhen Qi, Qi Ji (氣機) and Bing Ji (病機) represent.
C: This is a vision shared by every by every standard teaching book.
LX ： Yes, of course, as far as the understanding of TCM physiology is concerned. But, too often, standard teaching books base their theory and therapeutic strategy on disease, Ancient books base their theory and
therapeutic strategy on disease. Ancient books base their theory and therapeutic strategy on the energy state of the patient. Having understood the energy state of the patient, we can then act as “the second doctor”, observe, provoke, or assist “the first doctor” who is nothing other than the patient's own body and Qi. If treatment is disease based, there is a risk of taking the “first doctor's” place and acting in a wrong direction.
C:Then, what are the four resources or substances of the body: Jing, Qi, Shen, and Xing?
LX: The four main constituents (resources) are:
---XING(形)，the structure of the body (affected by exercises, injuries...)
---JING(精)，the Essence, dependant on two main factors:
''' our genetic factors, or the potential which we born,
'''a balanced and healthy way of life,which can help preserve Jing in quality and quantity, and thus, give us a longer and healthier life. '''Jingis,infact,thebasisofQi,ShenandXing.
---QI(氣),Energy, dependant on our environment (food and air), and on our interaction with nature, money, people, power, and beliefs. In usual modern teaching books, it is said that human Qi comes from three main parts: kidney Jing, Stomach Qi, and Lung Qi. This is a question ofterminology. InfactQiis the constituent of the whole universe and the human body interests with it at all levels (sex, social relations, .money, nature...) Everything in the world can be considered a different form of Energy, and interactions are taking place all the time between these different aspects or “forms” of Qi, including human's Qi.
---SHEN(神)，Spirit, has two aspects:
'''it reflects our state ofmind and mental activity
'''it reflects ourintuition, our natural abilities, and the way ourbody works.
Jing produces Qi, Qi produces Shen but Shen influences Jing and Qi.
Jing produces Yuan Qi, which can be considered as the Yang part of Jing. Yuan Qi together with Wei Qi (stomach Qi or middle Qi) and Qing Qi (lung Qi or air Qi) assist in the production ofZhen Qi (or “true Qi”) which will then circulate in the channels (figure 1).
C: So, Zhen Qi represents the energy directly usable by the body?
LX:Zhen Qi is the energy which helps the body perform, it is the energy which sustains all functions of transportation and transformation. It is divided into, Wei Qi(衛氣 the defense energy), Ying Qi (營氣 the nutritive Qi), channel Qi (經絡之氣) and Zang and Fu Qi (organs Qi 臟腑之氣), like liver Qi, or bladder Qi,etc. As we said, Zhen Qi comes mainly from Yuan Qi (元氣) and stomach Qi (胃氣 Wei Qi). But Zhen Qi is also part of the energy of the Universe. Human beings are like a container which is filled with this energy.
Each individual will absorb energy and live on a different level according to his own way of life. Eating habits are important (some people eat a lot of food and will absorb less Qi from another sourse of energy); social interactions :love, power, money, discussions and talks can all be nourishing or depleting. Nature and environment may fill someone with strong positive energy (mountains, countryside, pure fresh air) or deplete it (polluted atmosphere of large cities). The practice of meditation and living a spiritual life replenishes energy. There are different ways ofmaking up Zhen Qi!
Zhen Qi is the result of the resources of the body which are the necessary support, or substratum (the “Yin” part ofQi), for the body function (Yang part ofQi). Figure 1 explains how Zhen Qi comes into being.
To appreciate the quality of Zhen Qi, we use the first step in the diagnosis method detailed in the next chapter.
C:Zhen Qi would be like our “current account” in the “bank of Qi”. We can add to it or spend it.
LX:Quite right! In the “bank of Qi, Jing (精) Yuan Qi (元氣) is our “capital”, Zhen Qi is our “current account”. Everyday we eat food, and nourish stomach Qi, and thus, add “cash “to the current account for everyday use. If we damage stomach Qi, Zhen Qi will be weak. It will be difficult to perform daily exchanges without digging into the “capital”, Yuan Qi. Then, Yuan Qi will be damaged, and consequently Jing will be affected. This is why Chinese doctors pay great attention to stomach Qi.
C: Can you tell us more about Qi Ji (氣機) ?
LX:Qi Ji (氣機) corresponds to the normal movements of Qi in the normal body. It is the way Zhen Qi transports, transforms, communicates and
circulates Jing, Qi and Shen.
Zhen Qi is what we can use to live.
Qi Ji will bring Zhen Qi to the surface and defend the body against pathogenic factors coming from outside. It will also be responsible for bowel movements （middle Qi strong enough and open）, and for sweating and urination （by insuring a good function ofSanjiao 三焦）.
Finally it has an important role in the system of Chanels and Collaterals, providing a good circulation ofQi, and thus nourishing the whole body.
When we talk about Qi Ji（氣機）it means the normal performance of Zhen Qi.
The body is not disturbed by pathogenic factors ofany kind.
In ancient China, it was called the original state of the body. In the Taoist's classic “Dao De Jing （道德經）, it is said that only babies and great masters who have been practising meditation for a long time in a secluded life, away from society and any influence, can keep their Qi Ji pure. Meaning by this that nobody is really healthy, we, human beings are all sick!
In ICM, keeping Qi Ji in good order, requires that Shen is in a normal state, soft, tender, relaxed and concentrated, with not too many thoughts and desires. Jing is strong enough and stored in kidneys. Stomach Qi is normal, and the Channels and Collaterals are open. There are no pathogenic factors inside the body, no blockage at any level, no deficiency or excess at any level. This is what we call “Chang”，“normal”（常）
Nowadays, people use their brain too much: this is the main reson for Qi consumption and disturbed Qi Ji.
C: Qi ji corresponds to he normal movement of Zhen Qi in a normal state of the body. You mentioned the role of Zhen Qi on the surface, in bowel movements, sweating and urination. Does this indicate the main directions of Qi Ji used by Zhen Qi?
LX: Right. When we are talking about general movement of Qi, it is based on the principle of “Shen Jiang Chu Ru (升降出入)” = “floating, down, outwards and inwards”. These are the four possible directions of the movement of Qi in the body (Qi Ji). In different pathological situations, the body adjusts the balance naturally by moving Zhen Qi in one or another of these four directions. This is very important to understand, as it will determine the whole strategy for treatment. The prescription should follow the direction naturally chosen by the body.
One should also remember that the first principle of life is: “He-Kai ( 合 - 開 )”=”gather-disperse”. For example, at night, energy (Qi Ji) automatically gather inside (He 合) and during the day it disperses (kai 開).
To appreciate the way Qi Ji works, we use the second step (san jiao or “3 levels”), in the diagnosis method detailed in the next chapter.
C: Before we go any further, could you please clarify one point? What is what we usually refer to as “liver Qi”, “Spleen Qi”, “Bladder Qi”...etc, in relation to Zhen Qi and QI Ji?
LX:If we just consider the functional aspect of Zang and Fu, we talk about, Zong Qi 宗氣 (which insures heart function, blood circulation and breathing), Fei Qi 肺氣 (lung Qi), and Gan Qi 肝氣 (liver Qi)...etc. It means that we can use the word “Qi” to refer to any function of any part of the body (this is what modern teaching books do),or the supportive substance ofthefunctionof any part of the body. So it can be confusing. What I think is important, is the dynamic relationship between the different resources of Qi, what we call Qi Ji. So I usually pay attention to Yuan Qi, Wei Qi (stomach Qi),Qing Qi (lung Qi), Jing Qi...,the resources of the body, rather than the functions of Zang and Fu （Fei Qi, Gan Qi...）， which, in fact will result in the production of Zhen Qi. Paying attention to the function of the Zang-Fu is more related to a western way of thinking.
C: Thank you Li Xing, this expains why we shall not heat much about the functions of Zang-Fu in this book!
We have now assessed the four substances, Zhen Qi and Qi Ji. We understand the “normal energy state” of the patient. According to the Huang Di Nei Jing, “Know the normal, then you know the abnormal”, it should then be easy to understand Bing Ji.
LX:Bing Ji is the result of the fight between Zhen Qi and pathogenic factor. This pathogenic factor maybe external （cold, heat, wind, dryness, humidity） and causes imbalance or blockages of Qi or Xue （blood） at some level of the body. Bing Ji will manifest itseld in symptoms. Sometimes, Xie Qi, （邪氣） is very strong and can influence Qi Ji.
To appreciate the strength of Bing Ji, and where it is taking place, we use the 8 principles method of diagnosis, described in the next chapter.
C; How do you proceed to establish a diagnosis, to have a clear idea about what you call “the normal energy state” ofa patient and his reaction as a “first doctor”?
Fir st step: the r esour ces
LX: In this first step we appreciate the quality of “the base”, or centre: Jing （精） and Yuan Qi （元氣）, and the quality of the middle: Zhen Qi Wei Qi （胃 氣）
Jing&Yuan Qi: the centre （base）
Jing&Yuan Qi belong to kidney,water, sexual activity, and govern Shen Qi （spirit）. It cannot be in excess. In case of deficiency, there will be a sensation of emptiness or cold in the abdomen, dry skin, thin hair, poor eye sight, painful or cold lower back, urinary frequency at night; for women a watery discharge, short periods with thin little blood; for men sexual deficiency.
If Jing Qi & Yuan Qi are low, they cannot control Qi and there will be watery eyes, or clear nasal discharge. Jing deficiency induces Shen Qi deficiency leading to poor memory, &poor concentration, sensitivity and irritability.
On examination, the abdomen feels empty with no “bounce” and it gives a sensation of cold. Sometimes, the flesh appears “hollow” on both sides of the ankles or in the hands （between thumb and index fingers）. There is no “glow”on the face, the colour of the skin is dull. The tongue is thin, pale, soft, sinking with no strength ro move. Coating is normal.
The pulse is tight, weak and thin.
To regulate Jing we use sweet, sour or salty herbs, and animal products. If the condition is not too cold, we use herbs like, Bajitian （巴戟天）, Duzhong （杜 仲）, Tusizi （菟絲子）, Roucong rong （肉蓯蓉）. If it is really cold, we use Fuzi （附子）, Rougui （肉桂）, Yinyanghuo （淫羊藿）. In general, we nourish by using the “Wei”aspect of the herbs using herbs which have more “wei” than “Qi”, or using more dosage, a longer cooking time, dark colour, heavier products （see chapter: “treatment with herbal medicine”）
To regulate Yuan Qi, we use herbs like Renshen （人參）, Zaoxintu （灶心土）
Zhen Qi (Wei Qi)(胃氣):the middle
When we treat a patient, we mainly treat at the “Wei Qi” (Stomach Qi) level, the “current account”level. Wei Qi is related to Jing Qi, and to the “fighting Qi”.Everyday, it provides nourishment to all the organs and channels. It is the main support of Zhen Qi. This is why we assimilate Wei Qi and Zhen Qi in our method of dianosis to appreciate “the middle”.
Wei Qi (Zhen Qi) can be in a state ofexcess ofdeficiency.
If Wei Qi (Zhen Qi) is deficient, there will be: poor appetite, loose stools or diarhoea, aversion to cold drinks or food, the tongue might be normal or “ flabby” in case ofa long term disease.
If Wei Qi (Zhen Qi) is in excess, there will be a strong appetite, constipation, gas, a desire for cold drinks, sometimes a bad smell in the mouth, or even an infection in the mouth or throat, which is sign of“fire,” or pimples on the face. The tongue will have a thick dirty yellowwish coating.
Pulse is also important when looking at Qi level. It appears weak when deficient, thin and tight when seriously deficient.
An impression of fullness in the abdomen can be found in both excess and deficiency.
To regulate Wei Qi, we use herbs which are slightly pungent (not too much) and bitter, “xiang” 香 (flavour) herbs, whose direction of action is not too much out and not too much down. We never use decoctions, dark, thick, or with a strong taste at Qi level.
In case of deficiency: use Baizhu （白術）, Fuling （茯苓）, Chenpi （陳皮）. If really weak: Dangshen （黨參）, Huangqi （黃芪） Lianzi （蓮子）
Ifcold （cannot drink cold water） : Ganjiang （干姜）, Shufuzi （熟附子）. Ifthere are loose stools, Lianzi （蓮子）, Biandou （扁豆）
In case of excess: if constipation, use Dafupi （大腹皮）, Houpo （厚樸）, and if thick coating and bad smell, use Dahuang （大黃）. In case of general excessive heat, use Shigao （石膏）, or Huashi （滑石）, which, unlike it usually believe, do not damage Wei Qi, as they have no taste.
Channels have a transportation role and when we treat Pi （spleen）, we have to insure that transportation is possible. Make sure that hands and feet are not cold, and that perspiration is normal. If not, use herbs to open the surface or the channels （ see next paragraph ）
Note: hands and feet can be the result of either Yang Qi deficiency or blockage of the surface or channels. Check the pulse on the left side to appreciate Kidney Yin. If Jing is deficient （pulse tight, thin and weak）, do not open strong.
Second step: Qi Ji or the San Jiao
This is the function level to appreciate.
The different functions of Zhen Qi can be assessed at three levels. The three levels allow us to understand how “the first doctor” is functioning. They provide us with three important pieces ofinformation.
---how is Zhen Qi function （or how is Qi Ji0
---what is the body's reaction when Zhen Qi and Xie Qi （pathogenic factor）
are struggling (Bing Ji) and where this is taking place.
---are the channels and the surface open or not.
The Huang Di Nei Jing says “謹查病機之所在而調之” which means:” We have to make clear where the Bing Ji is.” Looking at the three levels,is using a systematic way of diagnosis, to know where “Bing Ji” ( or fight) is taking place (surface, channels, Fu organs, Zang organs), and in which direction it is going. If the direction is clear ( up: sweating, fear of cold, or down: diarrhoea) it means that the resources are good, the channels are not seriously blocked and we just assist the process. If the direction is not clear, we have to provoke “Ji” by tonify and opening out ( if Bing Ji is at Qi level) or opening down (if Bing Ji is at xue level).
---sweating, which reflects the surface level (Shang Jiao)
---bowel movement, which gives us information about the level of the Fu organs (Zhong Jiao : is the middle open or blocked)
--- urination, which reflects of the Zang organs(Xia Jiao), the way YuanQi is moving in the San Jiao.
C: Can you elaborate upon these three levels? It seems that we look at it from “Biao Li”( 表里 ) perspective (superficial, middle and deep levels) rather than a distinction between upper, middle and lower parts of the body with their corresponding organs?
LX: Yes, and this is one aspect of what we call “San Jiao”. But “Biao”, is also upper Jiao (lung), middle Jiao (stomach, liver, spleen) is more “li” and lower Jiao (kidney) is even more “li”. In this perspective, lung, stomach, liver, spleen and kidney are not seen as an anatomical structure but as a name for the different levels of the body's operative system (Biao or Li),(see Fig, 2 and
4)
To evaluate each level we ask very simple key questions:
Level 1---Surface level (Shang Jiao): is there sweating or not? Are the fingers and toes warm or not?
If there is no sweating, from a “Qi Ji” perspective, it means that the surface level is closed, or the resources ofthe function of sweating (blood, body fluids and jing ) are not sufficient. From a “Bing Ji” perspective, it means that the pathogenic factor cannot go away from the surface, which is not open. We have to open the surface by using pungent, warm or cold herbs (zai qi) or slightly bitter herbs (zai xue)
Figure 4 : The movement ofZhen Qi in the six levels ofthe body.
---ifthe person has a strong constitution （Jing Qi, 精氣, Yuan Qi 元氣， and Wei Qi 胃氣 strong）, use strong herbs like Mahuang （麻黃）, Xixin （細辛）
---if the person has an average constitution, use Fangfeng（防風），Jingjie（荊芥） with a light wei,味
---if the person has a weak constitution, use Suye（蘇葉）,Huoxiang （藿香）, Xiangru （香薷）, whose xing 性 and wei 味 are light.
Another way to open the surface is to do exercises, use foot massage, cupping, gua sha （scraping）
If the fingers are cold, at this level it means that the surface is closed, but it may also be due to kidney yang deficiency. To find out, we refer to the first step of diagnosis and the evaluation ofJing and Yuan Qi.
C: What is your definition of sweating?
LX: “sweating” could be spontaneous sweating, night sweating, more or less sweating than usual for a particular person, more or less sweating than somebody else in the same situation. They all have different significations. It is a good symptom to assess the progress of a disease. At surface level we are not considering spontaneous or night sweating.
Level 2---Fu level （Zhong Jiao） : is there constipation or not?
In case of constipation, from a “Qi ji” perspective, Fu level is closed, the middle is blocked.
From a “Bing Ji” perspective, the way down for Xie Xue level, we have to open this level, as it might be the best exit for Xie Qi. At this level, we do not consider the function of transformation, taking place in the middle, already assessed with “Zhen Qi”, we only consider the function of transportation via the Fu organs and the meridians and collaterals. But a block age could be due to stomach Qi (Zhen Qi) deficiency:---If the person is strong, use Dahuang (大黃), Houpo, Dachengqi,Xiaochengqi.
---If the person is not so strong, use Houpo, Dafupi, Baizhu, Fuling, Chenpi. From a “Bing Ji” perspective, the way down for Xie Qi to be evacuated is not open. If Bing Ji is at Qi or Xue level, we have to open this level, as it might be the best exit for Xie Qi. At this level, we do not consider the function of transformation, taking place in the middle, already assessed with “Zhen Qi” ； we only consider the function of transportation via the Fu organs and the meridians and collaterals. But a blockage could be due to stomach Qi (Zhen Qi) deficiency.
一If the person is strong, use Dahuang (大黃),Houpo (厚 樸),Da chengqi
(大承氣),Xiaochengqi (小承氣)
Level 3 — Zang level (Xia Jiao): How is urination?
From a “Qi Ji” perspective, urination is a reflection of Yuan Qi (strong enough or not), and San Jiao (open or not): this is what we call “Shui Dao”水 道 or “water metabolism”. At this level, we are deep in the body; there is a process of both transformation and transportation taking place (involving Yuan Qi, Zang organ's function + deep meridians and collaterals). Zhen Qi splits into Wei Qi (defence energy) and Ying Qi (nourishing energy), and circulates in the whole body via the meridian system.
“Shui Dao” can be compared to a central heating system.Yuan Qi is the boiler in charge of heating the water (from food and Jin and Ye), transforming it into steam: “Shui Qi” 水 氣 (Essence of water or water Energy), and pumping it into the piping system of San Jiao (the surface, the channels and collaterals). The heating, transforming and pumping actions, are called “Qi Hua” 氣 化 ， which can be translated as: the transformation of water and food, from their original material form, into energy, ready to be used by the Zang —Fu, and distributed by the meridian system.The Huang Di Nei jing says: “the essence of water (or food) in the stomach should be transported to the lung by the spleen and from the lung to the Shui Dao, all the channels and the whole body”.
This “central heating system” has another function: not only to nourish the whole body, but, by the move of water-energy exchange (at, what we would call, “cell level” in western medicine), clear it of negative energy.
C : As a “central heating system”，qould we say that San Jiao and Yuan Qi are also responsible for the regulation of body temperature ? Like a good central heating system provides the optimum temperature for a comfortable environment ?
LX : I cannot answer this question clearly. But we know that people with Yuan Qi deficiency have a low temperature. I can also recall several cases of patients with acute high fever which could not be controlled by Shigao or Huanglian, Huangqin or any western medicine and responded to Fuzi, Rougui, Wumei, Shengdi, Shudi, Renshen, all meant to gather and restore Yuan Qi.
C : San Jiao is sometimes called the “triple heater” and sometimes called “the triple warmer” ； what does it mean?
LX : Chinese people do not use these expressions. We just call it “San Jiao”. The Huang Di Nei jing says: “Shang Jiao Ru Wu, Zhong Jiao Ru Ou, Xia Jiao
Ru Du” (上 焦 如 拜 、中 焦 如 漚 、下 焦 如 瀆 )which means: “the Upper Jiao is like a fog (spread over the surface), Middle Jiao is like a fermentation pot, (food and water can be digested in it), Lower Jiao is like a dram (getting rid of dirty water via urination). San Jiao, from this perspective, in a unit, which gives three possible directions to Qi Ji : go up to the surface, gather in the middle, go down via bowel movement and urination, with the help of the meridian system, the surface (skin), digestive tract and urinary tract. But it is also a unit of, reception, heating, and transformation of Qi (the fermentation pot), with the help ofthe function of Zang-Fu, see fig.3.
The expression “triple heater” might refer to the Yang part of San Jiao in charge of the reception of “raw” energy, the movements of Qi Ji and the transfer of Ying Qi and Wei Qi into the meridian system. The expression “triple warmer” might refer to the Yin aspect of San Jiao, the functions of heating and transforming Qi, with the help of the function of the Zang- Fu (fermentation pot)
But this distinction is not necessary. We just need to know that San Jiao is a unit covering, from the periphery to the centre, the whole function of the body: reception, heating and transforming Qi, transferring Yang Qi and Wei Qi to the meridian system, and getting rid ofwaste. It is the body's “factory”, where Zhen Qi is manufactured before being transferred to the meridian system as Yang Qi and Wei Qi. If the “factory” (San Jiao) is not open, no new energy can come in and no manufactured product or waste can come out. The factory cannot operate. These two aspects: communication with the outside, and transformation inside, have to be in good order. Our second step in the method of diagnosis enables us to see if San Jiao is in good order, and if not, where we can help it (surface, middle or urination).
C: Can you give me any practical applications ofSan Jiao seen as a unit?
LX: Let's look at three ancient principles, as an application of San Jiao's work.
Since water metabolism is linked to the surface by Fei Qi （lung qi）, opening the surface is sometimes used to promote urination or vice versa.
In the Qing dynasty, The “Wen Bing Xue Shuo”（a medical school for treating diseases with high fever） stated: “Tong Yang bu zai wen, er zai li xiao bian 通陽不在溫，而在利小便 “Opening the Yang qi （of San Jiao）, or the channels is not always achieved by the use of warm herbs, but also with herbs that promote urination".
To treat water retention or oedema, another possibility is: “Ti hu jie gai 提 壺揭蓋” which means: “open the lid （Fei Qi, surface） to help the water out.” If you choose to open Fei Qi （surface）, in order to opeii urination, use Mahuang （麻黃）,Suye （蘇葉）,Xing ren （杏仁）
The Huang Di Nei jing also says : “Da xiao bu li, ji zhe 也 i qi biao” 大 小 不利，急則治其標 if bowels and urination are not open, themost urgent is to open them “huan zhe zhi qi ben 緩 則 治 其 本 ” i f the condition is not an emergency, at a deeper level, treat me root”.
Sometimes, the patient has no difficulty with urination, but it looks as ifYang Qi is blocked, the metabolism is not good, with symptoms of cold limbs, a heavy feeling in the body, tiredness, and the use of tonifying medicine causes heat. We can, then, use the principle of Tong Yang bu zai wen, er zai li xiao bian 通陽不在溫， 而在利小便 , and prescribe Cheqiancao （車 前 草 ） ， Huashi （滑石）,Fuling （茯苓）,Huashi（滑石）,Fuling （茯
苳 )，to promote urination and consequently open Yang Qi.
In practice, if there is a urination problem, first stimulate urination, then tonify kidney.
C : What about “Bing Ji” at this level ?
LX : From a “Bing Ji” perspective, if the Zang organs' function is disturbed, transformation and transportation will be disturbed and this will be reflected in the water metabolism and urination.
Urination is also a way out for dampness blocked in the channels and internal organs. Cystitis and kidney stones might be a manifestation.
C : Making sure that the inner channels (reflected by bowel movement and urination), and the surface are open seems to be the number one therapeutic principle ?
LX : Yes, as discussed before. Only when Jing is deficient, we need to gather first and I would like to add: tonify the middle (stomach qi) and pacify Shen are also fundamental if required. If Shen is not stable, patients will have many “fake” symptoms that we do not need to address.
C : At this deeper level, the treatment needs a longer time to act than in the two previous levels, where changes appear within a few days oftreatment.
LX : Yes because at this level we are dealing with a combination of factors and we have to “catch ji” (seize the right opportunity), and treat; this will clarify the situation, then we “catch it” again, treat ...and so on till we have reached the root ofthe problem! Ofcourse, it can take some time!
Thir d step: Shen or the balance of Yin and Yang
C : We haven't talked about Shen in the method of diagnosis! And it takes such a large place in the patient's life! Is there a third step?
LX : Absolutely, and we are just coming to it. We'll start again with Huang Di Nei jing: “Tian Dan Xu Wu, Zhen Qi Cong Zhi, Jing Shen Nei Shou, Bing An Cong Lai",恬淡虛無，真氣從之，精神內守，病安從來，“if people lived in a happy, quiet, detached state, without excessive will power, Zhen Qi will follow it's original course; ifJing and Shen are gathered and concentrated, diseases cannot develop”. So Shen is a “way ofbeing”. Good harmonisation of the operations taking place in steps one and two depends on Shen and allows Qi Ji to move in the direction of Nature, in the books, it is called: Yin & Yang Ping Heng, the balance of Yin and Yang.The simple question to ask is : how is the patient's sleep ?
（Difficulty falling asleep, waking up frequently, hav- ing vivid dreams, waking up early in the morning）
The balance of Yin & Yang is reflected in sleep and its quality. When the surface is open and the pathogenic factor gone, we can restore the balance of Yin & Yang, we can "rebuild”.When somebody has difficulty falling asleep, it means that Yang Qi （or Shen Qi） cannot descend to the Yin-Xue level, either because, Yin-Xue is deficient or Yang Qi is too strong （ over worked, overuse of computer, long time habit of going to sleep late, too many thoughts） in this case: we have to start treatment by using minerals to lower Yang Qi: Muli （牡蠣） ， Huashi （滑 宕 ） ， Shengshigao （生 石 膏 ） ,Cishi （磁石 ） .Waking up early usually happens when one doesn't have a solution for a problem perceived as important: Qi is under stress. The mind needs relaxing. So we use light and slightly sweet and sour herbs, Zhuye （竹 葉 ） Zhuru （竹 茄 ） ， Wumei （烏 梅 ）
Vivid dreams means that the spirit is confused. The patient is doing too much, meeting too many people, thinking too much with no direction for his actions and thoughts. Use heavy stones, bitter, astringent strong herbs. Shengtieluo (生 鐵 落 ) ， Zishiying (紫 石 英 ) ， Daizheshi (代 赭 石 ).
C : So, Shen and the balance of Yin and Yang are interdependent. If Yin and Yang are off balance, Shen will be disturbed and vice-versa ? The quality of sleep is one way to appreciate Shen but what other ways do we have?
LX : If Yin and Yang are off balance, Shen will be disturbed, and vice-versa. Shen is the spiritual part of the body, the balance of Yin and Yang is just an indicator of the body's function. There are many symptoms reflecting the state of Shen: nervousness, anxiety, depression, lack of concentration, beingover sensitive, feeling easily scared... All these symptoms denote a disturbed Shen. But the feeling that the doctor senses from the patient's Shen is probably the most important diagnosis factor. We shall discuss this in more detail in the chapter concerning Acupuncture.C : We have talked about Jing, Qi, Shen, Zhen Qi, Qi Ji, what about Xing?
LX : Imagine that we are in a theatre, watching a play, with a fight at the centre of the play. Xing is the stage, Zhen Qi and Xie Qi are the two main actors (powers in presence). The symptoms areAthe performance which is taking place on stage (appearing on the body or Xing). On stage, things are constantly changing. You can choose only to look attach symptom happening on stage (Xing) and concentrate on the details of the performance, but you will then easily lose track ofthe general “plot”, the intention ofthe author, the situation of the play (in place and time), which is “Bing Ji”. If you grasp “Bing Ji” ， you can then follow the mind of the author (“first doctor”)and predict the outcome. You should ask yourself these questions: where is the fight happening ? what is the direction, the normal direction being Qi Ji ? Does the patient have enough resources to follow the normal direction ? This depends on Jing, pi, Shen, and stomach Qi, the condition ofthe channpjs, the San liao. If the patient has a problem, the fight might develop in the wrong direction. Is this due to lack of resources ? If it is the case, we tonify and.support the resources ofthe patient, which is quite easy.
But disease are seldom as simple as that!
But diseases are seldom as simple as that! We have to find out if there is a pathogenic factor, fighting at which level: Qi, Xue, Channels, Zang or Fu organ? Then we follow the body's direction by supporting the resources or inducing sweating, bowel movement, or urination. If there is no pathogenic factor, but just imbalance of Qi or Xue, we can also help to readjust them. This is quite easy: we make sure that the resources are not deficient, and that the patient has good digestion, normal sweating, normal bowel movement, urination, and sleep.
C . Very interesting play indeed, and a good way to summarise the whole process of diagnosis! It shows clearly how one can concentrate on the details of the performance on stage (Xing) and use symptomatic treatment, or understand the dynamics of the play and act as a “director” in the traditional way of the old classics.
Now, what do “Body Fluids” (Jin and Ye) mean to you?
LX : The Body Fluids (津液)(Jin and Ye) belong to the Yin aspect of Jing and stomach Qi. It is not so important to discuss these terms in TCM physiology, as they are directly dependant on Jing and Stomach Qi.
Likewise, an ancient text says: “Jing Xue Tong Yuan, Gan Shen Tong Yuan” 精 血 同 源 ， 肝 腎 同 源 “Jing and Xue are the same, Jing belongs to Shen (kidney), Xue belongs to Gan (liver).”
For exemple, blood deficiency is not a basic problem it is the result of either middle Qi (Zhong Jiao or stomach Qi) Xu or Xia Jiao Jing Xu (Jing deficiency), or a blockage in Zhong Jiao, or a blockage in the channels or the microcirculation. We have to find out what is the primary problem.
C: After the first three steps, we know what are the resources of the patient (strong or weak Jing Qi and Zhen Qi), where the fight with Xie Qi (if any) is taking place (surface, middle, Fu, Zang), and in which direction the “first doctor” wants to fight (upwards by sweating, downwards via bowel movements or urination) What do “the 8 principles” add to the picture ?
Fouth step: The eight pr inciples of diagnosis of disease
LX : Ba Gang Bian Zhen 八 綱辨 證， or the 8 principles of diagnosis of disease are:
1.Xu-Shi (deficiency- excess) 虛實
2.Han-Re (cold- warm) 寒熱
3.Biao-Li ( exterior- interior) 表里
4.Yin-Yang ( zai qi-zai xue ) 陰陽
This method of diagnosis enables us to find out more about Bing Ji : where it takes place ( biao-li), if the fight is strong or weak ( shi- xu) and if it belongs to Yang or Yin (zai qi, zai xue)
Is it a xu (deficiency) or shi (excess) condition? Is there a fight or not? How strong is the fight?
Does it take place at Qi level (zai qi ,surface, yang) or blood level (zai xue, deep, Yin). With a common cold, a “zai qi” condition will be: sneezing, feeling cold, rhinitis, cough with or without phlegm, fever. A “Zai xuf， condition will be: red skin, pimples, rash, swollen tonsils, pneumonia, fever.
Does it belong to biao (external disease) or li (internal disease). This/;covers two meanings: does “Bing Ji” belong to the exterior or interior (zai qi or zai xue), and is the fight heading towards the exterior or the interior (progression or potential of the disease). It does not care whether the pathogenic factor comes from the exterior or the interior, as the aggression might have happened in the past, sometimes a long time ago. The important thing is now, at this moment or during this period, where is the fight, and is the direction normal or abnormal ?
Istheconditionofacold(han)orawarm(re)nature?Thisisnotsoimportant. It is just another detail of the performance of “the play” ， like turning the volume of the sound up or down. In most cases, the condition is cool and warm herbs are used. If Zhen Qi and Xie Qi (pathogenic factor) are both strong, the condition will often be hot, and we use cool herbs until the condition reverts to “Du” (balance). Cold herbs such as Shigao (石 膏 )，are used only in cases ofhigh fever.
The identification of patterns according to the 8 principles was already discussed in Huang Di Nei jing ( 黃 帝 內 經 )and in Shang Han Lun (傷 寒 論 ).It is the theoratical basis for all method of diagnosis and is applicable in every case. It helps us to simplify the various manifestations of disease to the relevant essentials.
C: Could you give us a clinical example to illustrate these three steps of diagnosis: evaluation of the resources (Jing, Yuan Qi and Zhen Qi), the three levels or “ San Jiao” step and the eight principles?
LX: We could take the example ofarthritis, commonly seen in practice:
Acute and chronic phases can transform into each other. They are two different aspects ofone river.
In an acute phase with swollen, hot, red and painful joints, the problem appears local but it reflects the condition of the whole body and will affect the whole body. It is not so important to determine if the pathogenic factor “ Xie Qi” is wind, heat, cold, dampness, or phlegin or if there is Qi or blood stagnation. To look at how the whole body works is a more direct approach. We evaluate Jing Qi and Zhen Qi （ as described earlier on ）, then we find out if the condition is:
1.Xu or Shi （deficiency or excess）: generally in an acute stage, it is a “shi” condition, but it can be, xu. We look at how long the,fight can be sustained. If there are already signs of “xu”（either stomach Xu or kidney Xu） we use, 5% tonifying herbs: sweet or sour, and cool or warm.
2.Han or Re: in our example it is a “Re” condition.We use cool or cold herbs: in a zai qi situation, we use，Huashi （滑石），Shen Shigao （生石膏）, Cishi
（磁石）;in a zai xue situation, we use Huanglian（黃連）,Huangbai （黃柏）, Dahuang （大黃，
3.Biao or Li: if there is constipation, a menstruation problem, if the joints are swollen, and the condition has beAn there for many years, it is Li. If there is neck stiffness, rhinitis, aversion tn cold if the joints are stiff and a little painful :it is “biao”. In presence of both “biao” and “li” we first address “biao” （which usually represents at least 60%） Biao means that we have to open, and pungent herbs are essential.
4.zai qi or zai xue: it is more likely to be “zai xue” when joints are swollen. In a zai xue situation, we use bitter herbs.
In a chronic phase: we have sometimes a “shi” but mostly a “xu” condition. The other parameters would be more or less the same as in the acute stage, but the “fight”is not strong.
Treatment: we are in the presence of a “re”, “zai xue” condition, so we use cool bitter herbs.
If it seems that “ the first doctor” wants to open up onto the surface （symptoms of “biao”） we have to help him first with pungent herbs, herbal bath, Jing Luo massage. If one of the main symptoms is constipation, we open down, choosing herbs according to the state of Zhen Qi and Jing Qi. If the joints are very swollen and hot and there are general symptoms of heat in the body (fever, desire for cold drinks...), we use Shigao (石膏), Dahuang (大黃), Cishi(磁石),Huashi(滑石).if there are signs of “xu”，we use 5% tonifying herbs (to promote kidney or stomach Qi according to symptoms). in general, it is beneficial to use Baizhu(白術)and Fuling(茯苓)together with cold bitter herbs to protect the stomach. In case of Jing deficiency, we use cool or warm tonigying herbs. If the condition is han (cold), there is no fight, no serious pain, no swollen joints, it is a case ofdeficiency herbs, but control the possible secondary manifestations.
The second, third and fourth steps of diagnosis (the San Jiao, Shen and the 8 principles), seem to overlap in practice, one adding more information to the other. Don't we come back to the utmost importance of the 8 principles as a basisofallTCMdiagnosis?
IX : The 8 principles, constitute the best method of diagnosis to understand and treat Bing Ji. It is the best “software” when facing an abnormal situation. Any disease or imbalance can be clarified by this method, which is certainly the basis of all TCM diagnosis. It may seem very simple, but in practice, it is not so easy to make it clear.
Xu-shi (deficiency-excess) indicates how powerful Zhen Qi is, Han-re (cold-warm) tells us if, at a given moment, the condition of the patient is in excess or not.
Biao-li (exterior- interior) helps us decide if we are going to use more pungent or bitter, heavy or light herbs.
Yin-Yang: follows from the above principles: biao-re-shi belong to Yang, li-han-xu belong to Yin, but it is more important to pay attention to the “zai qi-zai xue: zai qi belongs to Yang, zai xue belongs to Yin.
C; Is it to simplify, or because you use a more direct approach, that you do not differed syndromes according to the theory of Zang-Fu? In other words, can we “simplify” (like a mathematical equation) the theory of Zang-Fu into the eight principles? Or do you consider that the theory of Zang-Fu leads to a “disease” based approach rather than an “energy state” approach?
IX : We can “simplify” the theory of Zang-Fu into the eight principles and the four substances. For example: liver yin xu comes from Jing xu; liver qi stagnation is the consequence of zhong jiao excess; liver fire comes either from heart fire or kidney fire, which comes back to Jing deficiency or a Sheh being too strong. I think that Zang-Fu differentiation of syndromes is over rated in practice. In my opinion, it is not the best theory that TCM has to offer and it is not the best way to practice, because it leads to a “disease” based approach, easy to follow with a symptomatic treatment. Using the Zang-Fu differentiation of syndromes, we treat “isolated islands”: using the eight principles we have a comprehensive picture of the ocean and its underlying relief.
C: Do tlje,Huang Di Neijing or the Shang Han Lun actually describe the Zang-Fu and their physiological functions in details ?
LX: Yes, they describe the normal and abnormal functions of the Zang-Fu but did not invent the Zang-Fu Bian Zhen (differentiation of diseases according to the Zang-Fu). They pay more attention to Ji 機 (opportunity) ， Shi 勢 (direction), Du 度 (proper manifestation, balance) Jhe theory of Zang-Fu Bian ' Zhen comes from the Ming Dynasty.
C: I would like to go back to the notion ofdisease and its etiology.
First, I would say that disease comes from a struggled beWeen Zhen Qi (which is the reflection of structure, essence, social interactions, state of mind， balance with our environment)， and the pathetic factors: the 6 evils (climatic factors) and the emotions: Xie Qi and Qi Qing 七情.
-If Zhen Qi is strong and the pathogenic factor is strong, it creates a “shi”;condition (excess); Bing ji is strong. We have to sedate.
If Zhen Qi is strong and the pathogenic factor weak: the disease is mild. We wait and ,Watch. Or，ifnecessary, we assist the action taking place according to the level where it is . taking place, using, for example, cool, bitter or fragrant herbs.
If Zhen Qi is weak and the pathogenic factor strong, this creates a serious condition ofboth xu (deficiency) and shi (excess): we have to tonify and at the same time open, control and sedate excess pathogenic factors.
If Zhen Qi is weak and the pathogenic factor is weak:it creates a xu condition, withnofight.Wehave to provoke “ji”，create a crisis, in order to solve the problem and return to a normal state 0 Du” (balance). The pathogenic factor will first manifest as an aggravation ofthe symptoms which we can then treat. Next, I would like to emphasize the role ofShen in the cause ofdiseases: The Huang Di Nei jing says: “Shen bu shi (神不使), Shen you yu (神有余)” If Shen is too weak, it cannot control the situation, Qi stagnates (Shen bu shi). If Shen is too strong, it is over controlling, Qi moves too fast and cqpsumes Jing(Shen youyu). Negative thoughts aggravate a state of“shen youyu”.
In general, Shen bing (disease of Shen) induces Qi bing (disease ofQi) which in turn will induce Jing bing (disease of Jing). Serious diseases are due to Shen bing. They are difficult to treat. Shen could often be compared to an inadapted and saturated software filled with old family traumas, professional problems, emotional difficulties. This software is unsuitable and cannot circulate new information. It needs to be changed. Serious diseases occur when one cannot change the software. If Shen changes then Qi changes and one can recover a state of balance.
In all cases of cancer, the channels are blocked not only by a pathogenic factor but also by an overcontrolling and unbalanced Shen.
It is easy to tonify or open, but not easy to treat Shen (meditation, psychotherapy)
C : How do you regard acute or chronic disease ?
LX : In chronic diseases, there is no fight because Zhen Qi is weak. Pathogenic factors stay in the body: maybe on the surface, maybe at blood level, maybe in the channels, or possibly in other parts of the body like the large back muscles, or deeper, in the internal organs (lungs, liver, stomach, or intestines). The patient will not feel any uncomfortable symptoms..But when Zhen Qi, improves with time, place, relationships, change of mind, food, medicines, etc., then there will be a fight between the old pathogenic factors and Zhen Qi, and symptoms will appear at the place where the pathogenic factors were blocked or in the direction of the fight.
For example, every year, there are many patients suffering from chronic bronchitis, with cough, phlegm, fever and a high level of white blood cells. This usually happens when their Zhen Qi is getting stronger. In TCM theory, it is the result of an uncompleted fight taking place. The doctor should: first, and most importantly, catch ji (機)，take advantage of the new strength of Zhen Qi, help the fight towards completion and treat the root ; second, follow the “Shi”(勢)，the direction taken by the fight: to the surface or down (bowel movement): third, control the reaction of the body, and keep the fight within an acceptable level. Fever, cough, phlegm, and sweating, are all side effects of the fight; it is a normal reaction, and it will disappear at the end of the fight. What we should not do is to stop all the reactions, suppress all thesymptoms: this would give a wrong direction to the treatment, it would disturb the “Shi” and loose the ji (機)what we can do is control,fhe reaction of the body, keep the fight under an acceptable level (Hua Shi and Shi gao are good to that effect); the first doctor is doing it's job, the body has it's own wiAom. We should respect it. We should just have a clear under-f standing of what is the “Shi”， the “Ji” and the “Du”.
In most chronic diseases,.we need to create a chance, provoke the fight, wake,up the “first doctor” by using warm， opening and activating herbs. When there is a fight， “Shi”， “Ji and “Du” will be clear, then it's easy to move the pieces on the chessboard !”
This principle is commonly used in the treatment of chronic skin diseases and chronic infections of the muscles. Doctors will use “Fuzi 附 子 ” ， “Huangqi 黃 芪”， “Dangshen 黨參”， “Mahuang 麻黃” to create a fight. It is called: “Yin Zheng Zhuan Yang”（陰證轉 陽）,which means: “Help the Yin condition change into a Yang condition" （enough Qi and Xue, fighting symptoms are active and the direction ofthe fight is clear）.
C : Another way to look at this is to observe flu-like symptoms. Are they due to “catching cold recently, or can they reflect the reactivation ofan old fight?
LX: Both are possible. It is interesting to note that many manifestations of “flu like symptoms” are not necessarily due “catching cold” but could also be due to food stagnation, too much dampness or cold in the muscles, or any chronic disease when the “Xie Qi” is escaping from a “trapped inside" situation to a moving out situation, which is a good sign that Zhen Qi has improved or the channels are opening. Whether the problem comes from food, mindAinside or outside, when “the first doctor” is “activated”, he will manifest himself with flu like symptoms, ifthe direction leads to the surface.
“Catching cold” can be the manifestation ofthe beginning ofany disease. Any disease will have a chance to fight at the surface level. In a chronic condition, to fight at the surface means that there is a charlce to help the pathogenic factors trapped inside, get out. In “Wen Bing” 溫 病 theory, they say that when the heat is at Ying/Xue 營血 level, we should use herbs like “Qinghao 青蒿”, “Bohe 薄荷”, ”Suye 蘇葉”, to help the heat leave the body through the surface. This principle is called: “Tou Re Zhuan Qi”（ 透熱轉氣 ） So, “Catching cold” is sometimes the chance to “Catch Ji” in an unclear situation. TCM treats the “normal state”, which should be communicating with outside.
Open the surface is then the first step to treat a patient unless he suffers, from serious kidney Jing or Qi deficiency or strong blockage in the middle ( use Dahuang 大黃) . All the herbs working at surface level are not necessarily used to treat Xie Qi ( pathogenic factor) on the surface and help sweating, but can be used to open, as a first step to treat any disease; Chaihu (柴胡) is one ofthem.
Many books referring to “San Jiao” say that: sweating is to open San Jiao from the surface, and bowel movement is to open San Jiao from the middle. Urination is also to open San Jiao, but at Qi level; it connects to the surface and internal organs. Choosing the level where you want to open depends on the direction taken by the “first doctor”.
C : How do you recognise ifa disease is serious or mild ?
LX: The Huang Di Nei jing talks about “Chang” 常 , a normal reaction and “Ni” 逆 , an abnormal reaction. For example, if after catching cold, the direction of Bing Qi is towards the surface, Zhen Qi is strong enough, the fight will follow Chang,and the disease will subside by itself. If the direction of Bing Qi is not following Qi Ji, it is what we call Ni an abnormal reaction. For example a cold with bronchitis, or even, pyelonephritis and cystitis indicates that Xie Qi is excess. The fight will not follow “Chang”, the disease will appear as a deficiency of Zhen Qi, when, in reality, it is an excess of Xie Qi. The doctor should find out what is the right direction (open the surface), treat at the suitable level to help evacuate the pathogenic factors and pay attention to the body resources: Jing and Qi. This is more difficult to treat and more serous.
Chapter 4 :Examination of the patient
C: We have seen that questioning the patient is fundamental to establish a diagnosis, according to the three steps and eight principles. What about examination of the patient. What is the most important : observation of the colour, palpation of the abdomen and of the channels, examination of the tongue, or pulse diagnosis ?
LX : The most important thing, before you ask for details, is to have an idea ,of the patient's condition. The patient comes in, complaining of uncomfortable feelings and tells you about his symptoms and medical history; you are watching and listening, quiet and concentrated; you can then have a comprehensive feeling of“Shen 神， Qi 氣， and Jing 精， ofthefightbetween Zhen Qi 真氣 and Xie Qi 邪氣 ， and its direction ;you know if it is an uncompleted fight or a new one. When you have already sensed the situation, with your first impression, you can then confirm your diagnosis by using the four steps method of diagnosis, to ensure that your strategy and treatment will be more precise.
C : The Huang Di Nei jing says: “Du qi se, cha qi mu, zhi qi san fu; yi qi xing, yin qi dongjing, zhi qi xie zheng”睹其色，察其目，知其散復；一其形，因 其動靜，知其邪正， which can be translated as “Watch the colour ofthe Skin, watch the eyes, you will know ifQi is spread out or gathered; watch the body， if it is still or moving, you will recognise evil Qi and Zhen Qi”. Can you explain what it means ?
LX: When you observe the patient's face, you look at the colour and \he glow oftheskin,andyoulookattheeyes：dotheyshineornot?
The “glow” of the skin and eyes is very important: if it is good, the patient has “Shen”， the Qi is spread out, the problem is not severe: we are in a “Change situation. If the skin is dull without a glow ， it is a long term problem, the reaction of Zhen Qi is not strong enough, the “Shen” is low and Qi is abdormally gathered. We are in a “Ni” situation. It is much more difficult to
treat.
The colour of the skin gives more indications about Qi Ji and Xie Qi. White indicates cold, pain or Qi-xu; dark blue means cold, pain, or blood stagnation; redish means heat or Qi shi (excess); black means cold, water retention or Qi moving slowly; yellow means Qi xu, Spleen or Stomach xu (deficiency).
If the colour looks as if concentrated in one spot, Qi is gathered, in the corresponding area. I have observed that when there is a dark spot in between the eyes,there is a heart problem (angina); .if the tip of the nose is dark, there is cold in the stomach: dark rings under the eyes mean Jing deficiency or liver and kidney channels are tight; a child with a pale face and no I glow is usually suffering from spleen or kidney deficiency; a child with blue rings under the eyes and in between the eyes is .usually very sensitive, scared at night with a weak Shen. Nowadays, .people who use computers all the time will first appear with a very shine face, which means that Shen and Jing are going out. then with a dark and dry face' which means Jing deficiency.
If the colour of the palms of the hands is yellowish and dull, it indicates Jing deficiency. If the muscles are tight. Qi is strongly gathered but the inner channels are not well open.
If the patient does not move and has a withdrawn posture, Zhen Qi is probably deficient and Shen low If he is agitated, it is more likely to be due to heat in the internal organs or to the presence of Xie Qi. These are good examples illustrating what the Huang Di Nei jing wanted to say, but, in your opinion, the general feeling emanating from a person is more important than the detailed description ofthe colour ofthe skin or eyes.
LX : Yes, It is a “shortcut” based on experience but it is of course the result of a detailed observation!
C : Can you say something about tongue diagnosis ?
LX : Tongue is a very good observation tool: it is a mirror of the body's condition and not necessarily the pathogenic factors. It is a good reflection of a “xu or shi” condition rather than a “han or re” condition.
In general, the tongue's shape is the mirror ofthe internal organs and the deep level of the body (xue level). If the tongue is weak and small, it reflects deficiency, or overgathered resources: if it is quite big, as if immersed in water for a long time, it looks pale and: slightly swollen (teeth marks), it means water retenion: most of the time it corresponds to Yang deficiency but sometimes to Qi stagnation or Jing deficiency- it is the picture of “emptiness” ，ungathered resources. When the tongue appears weak, then the Carnal organs and the deep muscles might be in the same state.
The coating of the tongue reflects the recent condition of Qi Ji: if the coating is thick, it means that Qi is blotted: it might be due to a dysfunction of the stomach, or the presence of cold blocking the surface and also blocking the circulation ofSan Jiao. The circulation ofSan Jiao may also be blocked due to Qi deficiency. So, when you see a heavy coating, it only means that San Jiao's circulation is blocked. Further examination of the patient will reveal why. It is not necessarily due to heat, cold or a stomach problem. It does not always reflect the presence of a pathogenic factor.
C : But I thought that the colour and the thickness of the coating were a good indication of the presence of a pathogenic factor: thick and white indicates cold, thick and yellow indicates heat, thick and black indicates extreme cold or heat depending on whether the tongue is wet or not.
LX: The tongue reflects the condition of the body and the way it functions: the Qi Ji. The shape of the tongue indicates the basic condition of the body; the coating indicates recent changes in Qi Ji. Never try to diagnose pathogenic factors by just looking at the tongue.
C: This is something to remember! And last, but not least, pulse diagnosis.
LX: When examining the pulse, we should bear in mind the three levels of the pulse (Tian, Di and Ren) 天、地、人 and the two principles (Du-Ji 度-機, and Xiang Ying 相應).
The three levels.
1.Tian=heaven,itvariesaccordingtotime,andinparticularthefourseasons, or the day and night cycle. It is important to appreciate if the patient's pulse is following the right time and the right season. It might be the first thing to correct. In Huang Di Nei Jing it is written” Mai de si shi zhi shun, yue bing wu ta; mai fan si shi, yue nan ji” 脈得四時之順，曰病無他；脈反四時，曰 難 已 = “If the pulse follows the four seasons, in case of disease, it is not a problem; if the pulse does not follow the four seasons, (in case of disease) it cannot recover.
In spring time, the pulse should be long and soft;
In summer time, it should be like a fish floating at the surface of the water, with the feeling ofbeing open.
In autumn, it is sinking in;
In winter, it should be deep, and give a feeling ofgathering.
In the day time, it is more superficial than at night.
1.Di = earth, it varies according to the place: for example, people from the South of the China will have a soft and fast pulse, while people from the North will have a strong and deep pulse.
Ren = people. There are two states at this level;
In a healthy state, the pulse will vary according to gender, age and constitution. Women have a deeper pulse than men; older people have a weaker pulse than the young; an overweight person has a slow, deep and strong pulse (like a “winter pulse”), a thin one has a fast, floating and light pulse (like a “summer pulse”).
In a state of disease, the pulse should be in tune with the type of disease. For example, ifone catches a cold or fever, the pulse should be floating and strong; this is a normal reaction as the Qi goes up and out to the surface. If it is weak and deep it is an abnormal reaction, and the disease is more serious. In case of diarrhoea, the pulse should be deep and weak as the Qi goes down and out. If the pulse is strong and superficial, it means that Yang Qi is going out and the
essence is lost: the person will be in danger.
Two principles:
The first principle is Ji -Du 機-度
Ji 機 is in relation with time and space: now, where and what; it means that it should be as expected at a particular time or in a particular relationship. Du 度 is what is actually taking place in the particular situation (or relationship); it should be balanced, not too strong, not too weak, not too much and not too little.
For example: we are in a room discussing TCM, if the teacher is talking and the student listening, there is Ji, but if the student is giving the lecture or if the teacher talks about cooking we loose Ji, or if the teacher talks too much, or not enough, we loose Du.
The second principle is : xiang Ying 相應
If in a special Ji there is proper Du 度,then we have Xiang Ying, or harmony, coordination. For example if one catches a cold and the pulse is floating and strong, there is “Xiang Ying”. Or, as we mentioned above, if an overweight person has a slow, deep and strong pulse (like a “winter pulse), this is Xiang Ying.
C: In practice, when taking the pulse, do you feel it is a whole? Do you pay attention to each location of the pulse (the 12 pulses), each one giving you information about the energy state ofthe corresponding organ?
LX :The pulse needs to be interpreted dynamically rather than mechanically. Feeling the pulse is like listening to a musical concert, we should be able to appreciate what is in harmony, what is not, how Qi is flowing, what is the relationship between Yin and Yang. Every one has his own normal state, and is changing constantly: Zhen Qi and Xie Qi fight, and in this “Ji” there is
"Xiang Ying" or not (“bu xiang ying”).
The diagnostic approach consists of knowing what the normal state of a patient (point zero) is and then appreciating how the actual state differs from it:” zhi chang da bian” 知常達變
It is important to appreciate the pulse globally than at each location：
-is it strong or weak, this will indicate if a fight is happening or not, or if Zhen Qi is strong or not
-is it superficial or deep at the surface level or not, and will also show the direction ofthe fight,
-is it tight or relaxed, this will indicate if the fight is strong or not if the resources are enough or not and if the channels are blocked or not. It is important to remember that in general, if the right side is tight, it means that there is cold or Zhen Qi is in s state of deficiency. If the left side is tight, it means that Jing Qi is deficiency.
-isitfastorslow,sometimesitindicatesifitisawarmorcoldcondition. Taking the pulse, one should always think of these thtee aspects: Tian- Di Ren, Ji- Du, global examination of the pulse. But pulse examination is only one tool ; it is not everything in the diagnosis process. Symptoms and observation of the patient can give us a feeling of the patient's condition and the pulse examination will then add more information. We should always combine the four methods of examination techniques: questioning, listening, observation, and palpation to reach the right conclusion.
C : So, Li Xin, how do you “feel” a patient, what do you rely on ? In the clinic, it looks as though “you know” more or less right away what's going on, as soon as the patient comes in!
LX : I feel and examine the patient in four steps.
When the patient comes in, before he says anything about his symptoms, I have already a feeling of his basic condition. I feel if the Shen is stable or not, if Jing is strong enough, and if Qi ji is in a normal condition, if it is following the direction of Bing Ji or not. Then I feel if there is Xie Qi: cold, dampness, blood stagnation, food stagnation, fire...and where it stays: inside or outside at surface level.
Then I start asking questions and watch his appearance, his response, the state of his spirit. I talk with the patient to confirm my feeling about his Shen and Jing , ask him about his sleep, appetite, sweating, bowel movement and urination, which will give me information about QiJi and Bing Ji.
I ask questions about the history of the disease: all the symptoms and feelings will help reconstruct the story like following a river from the source, observing the force of the current, the changes of direction, the progression of the fignt.
This will, take us to the present situation: how are the resources, are they strong enough to continue fighting ? Are the channels open or not, what kind pathogenic factor is fighting ? This will determine the strategy of the treatment: open or gather, tonify or sedate, open the channels at which level ? And according to the pathogenic factor: induce sweating (if cold), sweating and urination (ifdampness), diarrhoea (if damp-heat or food stagnation)
To be able to “know” at different levels (feeling, examination, questioning), one needs practise, not only in the clinic but within oneself. It is important to “clean” oneself well enough to become a mirror of what is happening and then everything will appear clearly. Meditation is the key to clarity.
Summary of the first part.
C: To sum up this first part on the theory ofTCM, we could say that we talked about:
1.How to understand the normal energy state of a patient, and appreciate the four substances: (Xing 形,Qi 氣，Shen 神 and Jing 精),Zhen Qi 真氣 and Qi Ji 氣機 with the first (resources) and second (San Jiao) steps of diagnosis.
2.What is taking place in the presence of a pathogenic factor, and how to appreciate Xie Qi 邪氣 and Bing Ji with the second (San jiao 三焦)， and third (Shen 神) steps of diagnosis and the eight principles.
3.How to, examine a patient, feel the pulse, and feel "the atmosphere”
You also gave us a few about how to tackle the difficulties of treatment. Before we go on in detail with herbal treatment and acupuncture in the next parts of the book, what are the main general principles of treatment in TCM, that every practitioner should definitily keep in mind?
LX: Some ofmy favourite quotes are:
---"Ding Qi Shen 定其神，Shen Qi Shi 審其勢”,“WoQiDu 握其度”，“Li Qi Xing 利其行”， “Gu Qi Ben 固其本 ” ="help the spirit to stay stable” “help the first doctor and follow the direction that he wants to take”， “Help control the reaction of the body, keep the fight at an acceptable level", “help speed up the fight”， “Strengthen the root (at least 5% to 8%).
---Tong Yin Tong Yong 通 因通用 ” =if the body wants to open, we have to open (ex: use Dahuang 大黃 in case of diarrhoea, when there is a blockage in the middle and the direction is to open from the middle)
---“Se Yin Se Yong 塞 因塞 用” =if there is blockage (like constipation) because ofdeficiency ofmiddle Qi or Jing, we use tonifying methods.
---“Qi Zai Biao Zhe, Han Er Fa Zhi 其在表者，汗而發之'' =ifevil is at the surface level, and the right direction of the fight is opening up, it will disappear by sweating
---“Qi Zai Li Zhe, Gong Er Xia Zhi” 其在里者，攻而下之=if Bing Ji is inside, we have to open down vigourously.
---Da_xiao bu li, ji zhe zhi qi biao, 大 小 不 利 ， 急 治 其 標 ” =if bowels and urination are not open, the emergency is first to open them, “huan zhe zhiqi ben 緩則治其本” =at a deeper level, treat the root.
---BiaoJieLiZiHe 表解里自和 = if you open the surface, the interior will automatically open.
---If the condition lies in both biao and li. In general address biao first (but biao and li are just the two sides ofa coin).
--Li Jie Biao Zi He 里 解表自 和” if you open the interior, the surface will automatically clear up.
---“Fu Di Chou Xin 釜底抽薪 = if there is not enough water in the pot, take off wood (fire), (for eg : induce diarrhoea, in case of high fever due to a blockage,in the intestine, food stagnation, heat, and dampness).
---Wei bu he ze wo bu an 胃不和則臥不安= if the middle is not good, shen and sleep are not good.
---Yin Re Xia Xing .引熱下行，If there is fire inside with a strong blockage open the surface too much, it will increase the manifestation of fire, but open down via urination or bowel movement (follow the principle “Li Jie Biao Zi He”).
C : They all talk about direction ?
LX : Yes, acting in the right direction is the key to success ! Herbs should be used according to their qualities (qi 氣 or wei D未)which give the direction of their action; needles will guide energy in one direction or another. It is more important to pay attention to the direction of the disease than individual
symptoms.
Chapter 1 : History and fundamental classic books ofherbal medicine
C : Shall we start with some historical background ? Which books do you consider the main fundamental classics discussing herbal medicine ?
LX : There are three fundamental classics discussing herbal medicine:
---The Huang Di Nei jing 黃 帝 內 經， (Yellow emperor's Inner Classic), in two parts: the Su Wen 素 問,(Basic Questions) and the Ling Shu 靈樞， (Spiritual Axis)
一 The Shennong Ben Cao Jing 神農本草經，(Shen- nong's classic ofherbal medicine)
一 The Shang Han Za Bing Lun 傷寒雜病論，(Discussion of Cold induced Disorders and Miscellaneous Diseases), in two parts: Shang Han Lun 傷 寒 論，(Discussion of Cold induced Disorders) and Jin Gui Yao Lue 金匱要略， (Synopsis ofprescriptions ofthe golden chamber).
But we can also add two interesting small books “Pi Wei Lun” 脾胃 論 (Treatise of the spleen and stomach) and “Wen Bing Tiao Bian” 溫病條辨 (differentiation of treatment offebrile diseases).
C : Shennong 神農，and Huang Di 黃帝，、were two emperors, considered to embody the early memories of ancient China, As often in Chinese stories, historical facts and legends intermingle. From what I have read and heard, Shennong and Huang Di appear to h mythical figures and we don't really know who wrote their books. They could be a compilation written by few different doctors.
According to the legend, Shennong was the Emperor of the Vans who lived near the Yellow River. One day a Phoenix was flying over the country and dropped plant with nine ears. Shennong picked it up and planted it. It grew a beautiful fruit and everyone who ate it became much stronger. So Shennong started cultivating the plant and it was called “cereal”. This is how the Yan Emperor changed his name to "Shen- nong” which means “the Great Cultivator”. He was very famous for his contribution to agriculture and medicine. But we cannot find anything written about him in historical archives. His book might well be a compilation of several works from Doctors of Qin and Han dynasties.
LX : Yes, this is true and explains why these very ancient books are sometimes quite obscure, and written in an allegoric way difficult to decrypt! On the other hand, Shang Han Lun 傷寒論 is a practical handbook written after Huang Di Neijing 黃帝內經， and Shennong Ben Cao Jing 神農本草經： It is written in a comprehensible way like a “recipe book”.
Appendix 2
譯文
中醫學理論
了解正常人的能量狀態，當邪氣入侵或真氣失衡時人體的反應模式
第一章：概念討論：關于四個層次（精氣神形）、真氣、氣機、病機
C：李辛，在本書第一章中，你能描述一下你對中醫的看法以及你對人體生理的 理解嗎？它是由什么構成的？它是如何運作的？它又是如何變成病態或失去平衡 的？
LX：中醫認為人又四種主要資源組成，即精氣神形。這些成分將產生真氣，真氣 負責轉換和運輸的工作，它幫助機體保持在一個動態平衡中“從容”運轉。“從 容”地概念不是指理想化的平衡，它指的是在特定的時間內，身體機能不受邪氣 干擾。真氣的機能被稱為“氣機”：它告訴我們在診斷的基礎之上，不同物質之 間的動態關系。
如果一個正常運轉的機體遭遇邪氣入侵，將會發生一場遭遇戰（病機），這就是所 謂的“癥狀”。認識人體的四種主要資源、真氣、病機、氣機分別是什么非常重 要。
C：對于標準教科書來說，這是富有想象力的分享。
LX：是的，當然，這只是我個人對中醫生理學的理解。但是，很多時候，標準教 科書都是建立在以疾病為中心的治療策略上。而古書，則是以病人的氣機格局為 基礎提出的治療方案。了解了病人的氣機格局后，我們就可以作為第二個醫生觀 察、鼓舞、協助“第一個醫生”，而“第一個醫生”只不過是患者自己的正氣， 如果治療以疾病為中心，那么采取的治療方案可能與“第一個醫生”的立場背道 而馳，這是存在風險的。
C：那么人體的四種物質或者說資源是什么？
LX：這四種主要成分（資源）是
——形，人體結構。（受運動、外傷等影響）
——精,人體精華。取決于兩個主要因素：①遺傳因素或者說我們與生俱來的潛 能。②一個平衡而健康的生活方式可以幫助提升精的質量和數量，從而使我們的
生活更長久、健康。精實際上是形氣神的基礎。 ——氣，能量，取決于我們的環境（食物與空氣），取決于我們與自然、金錢、人、 權力和信仰的互動。
一般地，我們的現代教科書里，人體的氣來自三個主要部分。1.腎精。2.胃氣。3. 肺氣。這是一個學術問題。實際上，氣是整個宇宙的組成部分，人類的各個層面（性、 社會關系、金錢、自然...）都會影響到氣。世界上所有的一切都可以被認為是不同 形式的能量，而這些不同層次、不同形式的能量（包括人體的氣）之間又無時無刻 不在互相作用和影響。
——神：兩個方面：它反映了我們的精神狀態和精神活動。它反映了我們的覺知 能力，我們的自然本能和身體的運作方式。精生氣，氣生神，但是神又影響精和 氣。精生元氣，元氣可堪稱是精的陽面，元氣、胃氣、清氣共同創造了真氣。然 后再渠道中流通（如圖 1）。
c：所以，真氣直接代表了人體可用的能量？
LX：真氣是幫助身體進行運轉的能量，維持所有運輸和轉化機能的能量。它分為 衛氣、營氣、經絡之氣、臟腑之氣，如膀胱氣、肝氣等等。就像我們說的，真氣 主要來自元氣和胃氣。但是真氣也是宇宙能量的一部分，人體就像一個裝滿了這 股能量的容器。我們每一個人都會吸收能量，按照自己的生活方式在不同層面上 生活。吃的習慣非常重要，有的人吃很多食物（從另一種能量來源吸收較少的氣）。 社會關系：愛、權力、金錢、討論與談話都可能是一種滋養或消耗。自然和環境 可以使人充滿強烈的陽性的、積極的能量（山、村莊、新鮮空氣），也可以使人耗 盡能量（大城市中被污染的空氣）。冥想練習和精神生活的實踐可以補充能量。這 是補充真氣的不同的方式。真氣是人體資源的結果，真氣是人體機能（氣的陽面） 的必要支撐或基礎（氣的陰面）。如圖 1 展現了人體的真氣是如何形成的。為了評 價真氣的質量，我們將會在下一章詳細介紹診斷方法的第一步。
C：真氣就像我們在“真氣銀行”中存入的活期賬戶。我們可以往里存錢也可以 支出。
LX：完全正確！在“真氣銀行”中，精、元氣是我們的本錢，真氣是我們的活期 賬戶。我們每天都要攝入食物，滋養胃氣，因此，增加現金到活期賬戶中以供日 常使用。如果我們傷害了胃氣，真氣將會變得虛弱。如果進一步透支“本錢”（元 氣），人體將難以維持日常性資金周轉。這樣，元氣將會受到傷害，精也會因此受 到影響。這就是為什么中國醫生特別重視保護胃氣的原因。
C：可以告訴我們更多關于氣機的事情嗎？
LX：氣機與身體本氣的自然運動相對應。這是真氣運輸、轉換、交流和精氣神之 間的循環（circulate）方式。真氣是我們用來生活的。氣機把真氣帶到表面并保護身 體不受外界邪氣傷害。它也將負責我們的排便（中氣是否足夠強和通暢而開放）和 出汗與排尿（三焦氣機運轉是否良好）。最后，它在經絡系統中起到了重要作用， 它提供了很好的氣機循環，從而滋養了整個身體。
當我們談到氣機，它意味著真氣的正常表現，人體不受任何種類邪氣干擾。 在中國古代，這被稱為身體的原始狀態，道家經典《道德經》指出只有嬰兒和長 期在一個遠離社會喧囂、與世隔絕的地方長期打坐才可能保持他們氣機的純凈， 也就是說，沒有一個人是真正健康的。我們人類全部都已經在病里了。
中醫認為，保持氣機在一個良好的狀態下，需要神處于正常的狀態，即柔軟、溫 和、放松和專注，沒有太多雜念和欲望，精足夠強并儲存在腎里。胃氣正常，經 絡通暢，體內沒有邪氣，沒有任何程度的阻塞或虛或實。這就是我們說的“常”。 現在，人們用腦過度，這是氣被消耗和氣機失調的主要原因。
C：氣機對應的真氣是正常狀態下的正常運動。你提到真氣在人體的表面運作， 體現在大便、小便與出汗。這是否體現了真氣調動氣機的主要方向？
LX：是的。當我們談到氣的一般運動時，它基于的原則是“升降出入”。這是氣 機在體內運動的四個可能的去向。在不同的病態中，人體通過真氣的四個運動方 向中的一個或兩個方向來調回陰陽自和的自然平衡態，我們要這么來理解人體， 這很非常重要。因為它將決定醫者的整個治療思路，處方的擬制應該遵循人體自 然選擇的方向。
永遠記住一個定律，開闔。比如說，到了夜晚，天地的能量（氣機）會自然地往里 闔，到了白天，天地的能量（氣機）會發散出來。為了體會氣機的運動方式，第二 章（三焦）的部分將會很受用，下一章將詳細介紹診斷方法。
C：在進一步討論之前，你能否給我一點提示？什么是我們通常說的肝氣、脾氣、 膀胱氣等，它們和真氣、氣機有怎樣的聯系？
LX：如果我們只考慮到臟與腑的功能層面，我們就說宗氣（保障心臟功能的運轉, 血液循環和呼吸），肺氣和肝氣等。我們可以用氣這個詞來取代，身體任何部分的 功能（這就是現代教科書所做的），或者身體任何部分功能的支持性物質。所以它 很讓人困惑。我認為這里的重點是氣的不同資源之間的動態關系，我們稱之為氣 機。所以我們通常關注的是元氣、胃氣、清氣、精氣，這四種人體資源。而不是 臟腑的功能（肺氣、肝氣），實際上這四者會導致真氣產生相應的結果。重視臟腑 功能和西方思維模式有更大的聯系。
C：感謝你，李辛。這就解釋了為什么我們在這本書中不會聽到太多關于臟腑功 能的描述！我們現在已經對這四種物質進行了評估，分別是真氣和氣機。我們理 解了病人的正常能量狀態。《黃帝內經》有一句話說的是“知常達變”，那么現 在我們是不是比較容易理解病機了呢？
LX：病機是正邪斗爭的結果。這個致病因素可能是外部的風寒暑濕燥火，我們稱 之為“邪氣” ，也可能是內部的（常見的是因情緒而起的），導致身體某一層次的 失衡或氣血堵塞。病機會在癥狀中表現出來。有的時候，邪氣非常強，它會牽制 并影響氣機。我們要體會病機的力量和它發生的地點，我們用的方法是下一章會 描述的八綱辨證。
第二章：診斷步驟
C：你是如何建立診斷的，對于你所說的正常能量狀態和他作為第一個醫生的反 應，如何理清它們的概念？
第一步：機體的資源
LX：第一步，我們要體會基礎質量或中心：精、元氣、中氣。
精和元氣屬于腎，水，性能量和屬腎氣（精神）。它不能過量。當腎氣不足時，腹 部會有空洞或寒冷的感覺，皮膚干燥，頭發稀疏，視力低下，下肢冷痛，夜間尿 頻，對于女性而言是水樣分泌物，月經量少周期短。對于男性而言是性能力不足。 如果精氣和元氣不足，他們就不能控制氣，會出現一直流眼淚和鼻涕的現象。精 虛引起神氣虛，會造成記憶力減退，注意力不集中，敏感而易怒。腹診可感覺到 小肚子空空的沒有彈性且冷。有時，腳踝兩側的肉和拇指與食指之間的肉看上去 是空心的，面色無光，膚色暗沉。舌頭很瘦，蒼白，軟塌塌地睡在口中，無力移 動。舌苔正常。
脈緊而細弱。如果要調理精，我們要用甘、酸、咸的草藥和動物要。如果體質不 是特別冷的，我們可以用巴戟天、杜仲、菟絲子、肉蓯蓉。如果真的很冷，我們 用附子、肉桂、淫羊藿。一般情況下，滋補藥取其味的層次多于氣的層次，選用 的草藥大多為味重于氣，或者使用更大劑量，更長的煎煮時間，更深的色澤，更 厚重的湯藥（參考“中藥治療學” 一章）。如果要控制（regulate）元氣，我們可以用人 參、灶心土。
當我們治療一個病人，我們主要在胃氣的層次上治療，這是在“活期賬戶”的水 平。胃氣與精氣有關，這直接決定了衛氣的強弱。每天它為所有的器官和渠道提 供營養。它是真氣的主要支柱。這就是為什么我們在辯證方法中選擇了胃氣和真 氣以體察中焦層次的能量。
胃氣（真氣）可能處于不足或有余的狀態。如果胃氣（真氣）不足，會出現食欲低下， 便溏或腹瀉，對形寒飲冷非常反感，舌頭可能是正常的，如果病程較長，舌頭可 能是松弛的。
如果胃氣有余，會出現食欲旺盛，便秘，脹氣，有強烈地想喝冷飲的欲望，有時 口臭或甚至口腔發炎或喉嚨發炎，這是火的跡象，或臉上的丘疹。舌苔是厚而臟 的。從氣的角度看，脈也非常重要，中氣不足的表現為脈弱，嚴重時表現為緊而 細。
腹滿的感覺在虛證和實證中均有可能出現。
為了調節胃氣，我們選用微辛、苦和香藥，它的作用方向不會開得太過或降地太
厲害。如果希望讓藥物在氣分運作，我們將不會選擇很厚重的藥物。
對于中焦不足的證，我們用白術、茯苓、陳皮。如果到了虛的程度，我們用黨參、 黃芪、蓮子。如果有寒（不能喝冷飲），我們用干姜、熟附子。如果大便綿軟，我 們用蓮子、白扁豆。
對于中焦有余的，如果便秘，用大腹皮，厚樸，如果有厚苔和口臭，用大黃。一 般地，如果熱過盛，用石膏或滑石，這兩味藥并不像人們通常以為的會傷害胃氣， 這是因為它們沒有味道。
加強真氣的方法有艾灸、熱敷、內功按摩，打坐或睡覺。 經常檢查身體的表面和通道是否通暢。
通道有運輸的作用，當我們治脾的時候，我們要確保渠道的通暢，讓脾的運化成 為可能。確保手腳是溫暖的，出汗正常。如果不是，我們需要用草藥去打開表面 或渠道。
注意：手腳冷也可以是陽氣不足或表氣封閉或渠道堵塞的原因，檢查左邊的脈以 體察腎陰。如果精虛（脈緊細弱），不要使用強烈的開。
第二步：氣機或真氣的功能
這是一個在功能層次去體會氣機的過程。根據真氣的不同功能，我們劃分出了三 個層次。這三個層次可以幫助我們了解“第一個醫生”是怎么運作的。它們為我 們提供了三個層次的重要信息。
一、 真氣是如何運作的？
二、 正邪相爭時人體是如何反應的？正邪相爭的病位在哪里？
三、 人體的通道和表面是否打開。
《黃帝內經》說：謹察陰陽之所在而調之。它說的是我們必須清楚病機發生在哪 里。我們采用系統的辯證方法來觀察這三個層次，去知道病機在哪，發生在哪個 層次（表面，渠道，臟，腑），走的方向。如果方向很清楚（向上：汗出、怕冷；向 下：腹瀉）這指的是資源尚可，渠道沒有嚴重堵塞，我們需要幫助這個過程。如果 方向不清晰，我們必須用補益的藥向外開（如果病機在氣的層次）或向下開（如果病 機在血的層次）以挑起這個機。
•上焦：以汗為指征，表
•中焦：以大便為指征，腑
•下焦：以小便為指征，臟
C：你可以闡述一下這三個層次嗎？這看起來好像是我們尋找它來自于表里透視,
（淺的表面的，中間的，深層的）而不是找出上中下焦所對應人體器官的區別？ LX：是的，這是三焦的一個方面。但是表也是上焦（肺），中焦（胃，肝，脾）是更偏 里，下焦（腎）甚至更里。從這個角度來看，肺、胃、肝、脾和腎不是解剖結構， 它只是一個名相，用來區分不同層次的人體操作系統（表或里）罷了。（如圖 2-4）
為了評估各個層次的情況，我們會問一些非常簡單的問題： 第一個層次：淺層（上焦）：有沒有汗出？手腳是不是冷的？ 如果沒有汗，從氣機的角度來看，這意味著表面的層次是封閉的，或者支撐人體 出汗功能的資源（血、津液和精）不足。
因為表面沒有被打開。我們必須用辛藥打開表面，或溫或涼的草藥（在氣分）或者 微苦藥（在血分）。
如果這個人體質很強（精氣，元氣，胃氣強）用剛烈的藥如麻黃、細辛。 如果這個人體質相對中等，用防風，荊芥這類味薄的藥。 如果這個人體質很弱，用蘇葉、藿香、香薷這類性味皆薄的藥。 另一個打開表面的方法是運動，用足底按摩，拔火罐，刮痧或經絡推拿。 如果手指是冷的，在這個層次意味著表面是封閉的，但是這也有可能是由于腎陽 不足引起。為了澄清這一癥狀，我們需要參考第一步的診斷方法，來評價這個病 人的精與元氣的情況。
第二個層次：腑的層次（中焦）：有沒有便秘？ 如果有便秘，從氣機的角度看，腑的層次是封閉的，中間層次是堵塞的。從病機 的角度來看，邪氣向下疏散的通道沒有打開。如果病機在氣或血的層次，我們必 須打開這個層次，因為這可能是邪氣最好的出口。在這個層次上，我們不用考慮 中焦的運化功能，我們已經評估了“真氣”；我們只要考慮運化過程中腑臟和經 脈、絡脈之間的渠道是否暢通即可，但是中焦堵塞也可能是由于胃氣（真氣）不足 導致的。
如果這個人很強壯，可以用大黃，厚樸，大承氣湯，小承氣湯。 如果這個人不是那么強壯，可以用厚樸，大腹皮，白術，茯苓，陳皮。 如果這個人很弱，兼有氣虛，可以用黨參，大棗，黃芪。
如果這個人很弱，兼有精虛，用巴戟天，肉蓯蓉，熟地黃，因為它們的味厚，擅 長補精。
為了打開腑的層次，我們可以通過運動，足底按摩，經絡推拿來達成這個目的。
C：你之前說，當我們治療病人時我們總是必須確保表面和中間是打開的。你的 意思是為了達到這個效果，你是站在整體的角度上用藥嗎？
LX：當病人非常虛時，我們不能僅僅只是打開表面和腑的層次，我們的首要任務 應當是聚集能量，然后，這時我們可以僅僅使用補益藥來打開表面和腑臟。另一 方面，打開表面和腑臟可以給邪氣一個出口，至于是選擇哪一個方向，這就由“第 一個醫生”來決定。臨證中，慢性病人體內的三焦就像一塊封閉的盒子，只有當 我們打開這個盒子的時候我們才可以觸及體內封閉已久的邪氣，有時這個封閉時 間長達數年！但是有一點要注意的就是，我們需要足夠強大的力量來打開這個蓋 子。
第三個層次：臟的層次：排尿如何? 來自氣機的看法，排尿是元氣強弱和三焦通暢與否的反映。這就是我們說的水道 或新陳代謝。這個層次是我們的身體最深入的層次；轉換和運輸的過程同時發生 在這個層次（涉及元氣、臟腑經絡，包括深層的細微脈）。真氣分離出衛氣（保衛的 能量）和營氣（滋養的能量），接著通過經絡系統在全身周流。
“水道”就好比中央供暖系統。元氣是負責加熱水（來自食物和津與液）的鍋爐， 把它轉換成水的精華或者說是水的能量。然后把水抽入三焦管道系統（表面，通道 和經絡）中。暖氣設備、轉換和抽水動作，我們稱之為“氣化”，可以被翻譯為： 把水和食物以源材料形式傳化為能量，通過經絡散布和分配到各個臟腑為它們所 用。黃帝內經說：“飲入于胃，游溢精氣，上輸于脾。脾氣散精，上歸于肺，通 調入道，下輸膀胱。水精四布，五經并行，合于四時五臟陰陽，揆度以為常也。” 這個中央供暖系統有其他的功能：不僅僅是滋養全身，而且是通過水液運動來完 成能量交換（西醫說的在細胞層次的交換），以清理水液中不好的能量。
C：就拿中央供暖系統來講，我們可以稱三焦和元氣同時負責體溫調節嗎？就像 一臺性能優良的“中央供暖系統”可以給室內空間提供舒適的環境一樣？
LX：我不能很清楚地回答這個問題。但是我知道人的元氣不足將會出現較低的溫 度。我還記得有幾個病人得過嚴重高燒，連黃連、石膏、黃芩、任何西藥都無法 控制，唯獨在使用附子、肉桂、烏梅、生地黃、熟地黃、人參時有效，這些藥都 有闔與恢復元氣的作用。
C：三焦在有的時候被稱之為“三個層次的加熱器”或“三個層次的溫暖爐”， 這指的是什么？
LX：中國人不用這些表達方式，我們只是稱它為“三焦”。黃帝內經說：“上焦 如霧，中焦如漚，下焦如瀆”。意思是：“上焦像霧一樣，有一種可以蔓延到外 表面的感覺，中焦就像一個發酵罐，水與食物在里頭可以被消化，下焦就像下水 道，通過排尿排出臟的水。從這個角度看，三焦好比是一個模塊，它給了氣機三 種可能的運動方向：向上到外表面，聚闔在中焦，通過大便和小便向下，在經絡 系統的幫助下，它可以到達表面（皮膚）、消化道、尿道，但是它同時也是一個氣（發 酵鍋）的接收、加熱、轉換單元，以幫助臟腑功能正常運轉。”（如圖 3） 這表達了三層加熱器可能指的是三焦的陽面，即主要負責接收原始的能量，氣機 的運動和將營氣、衛氣輸布進入經絡系統三個層次的溫暖爐這種翻譯方式可能主 要針對三焦的陰面，加熱的職能和轉換氣，用來幫助臟腑的功能（發酵爐）。
但是區別地這么細致沒有必要，我們僅僅需要知道“三焦是一個模塊、單元的代 名詞，從外而內，從整個機體的運作來說，它負責氣的接收、加熱、轉換，將營 氣和衛氣輸布到經絡中，把臟東西排掉”就可以。
如果三焦是封閉的，新的能量無法進來，產品無法生產，臟東西也無法排除出去。 那么這個工廠將無法運轉，有兩個方面：外界的溝通，內在轉變，必須保持良好 的秩序。我們在辯證方法的第二步中已經講過了，如何分析三焦的狀態，如果哪 里狀態不好，我們可以在哪里幫它一把（表面，中間，排尿）。
C：你可以給我們舉一些臨床上的應用案例來幫助大家理解三焦就像一個模塊 嗎？
LX：讓我們看看古人的治療原則，作為一個三焦運轉和工作的運用。 肺氣負責把水代謝帶到表面，打開表氣以利尿是我們常用的治療思路，反之亦然。 清朝的溫病學說指出：“通陽不在溫，而在利小便。”我們去治療水飲或水腫問 題時，另外一個思路是“提壺揭蓋”，指的是“我們可以用打開肺氣（表氣）的方 法來幫助水排出體外。”如果你選擇用這種方法，那么你可以用麻黃、蘇葉、杏 仁。
《黃帝內經》說：“大小不利，急則治其標。”指的是“如果大便和小便還是封 閉的，那么當務之急是打開它們。”“緩則治其本”指的是“如果情況緊急，就 處理它的根（更深的層面）。
有時，患者沒有小便難，但是如果察明其有陽氣堵塞的情況，他的代謝系統不太 好，并伴有手腳冰冷，自覺身重，乏力，用補益藥又會燥熱。我們可以用“通陽 不在溫，而在利小便”的原則，開車前草、滑石、茯苓來通陽。臨證當中，如果 有排便的問題，第一步是幫助排便，第二步才是補腎。
C：這個層次下的病機是怎樣的？
LX：從病機的角度看，如果臟器的功能受到干擾，轉換和運輸的機能也會受到干 擾，這會反映在水液代謝和排尿上。 因濕氣導致的渠道淤滯和內部堵塞，也可以通過排尿的方法來疏通。肌腱炎和腎 結石可能只是一種表現、癥狀罷了。
C：我們治療的第一原則是時刻確保內部通道和表面是暢通的（反映在大小便上）， 可以這么理解嗎？
LX：是的，就像前面我講的。除非是這個人精虛，我們需要先闔然后加一些比如 說補中氣、胃氣和安神定志的藥，畢竟神定是療愈的最基本的條件。如果神不定， 病人會出現很多假的癥狀，我們不需要處理。
C：我們在治療更深的層次時，所花費的精力和時間要比相對淺層的兩個層次要 多的多。病情在治療后的幾天內就會發生變化。
LX：是的，因為在這個層次，我們考慮和處理的是整體因素，我們必須抓住合適 的機遇（抓機）予以治療；這就需要我們要澄清患者的情況，然后我們再一次抓機 治療，再過一段時間，我們就可以找到問題的根源。當然，這需要一些時間。 第三步：神，陰陽的平衡：以睡眠為指征
C：我們還沒有談論過神的辯證方法！而這又直接決定了一個人的生活質量！那 么這就是第三步嗎？
LX：沒錯，我們接著就來講講這個問題。黃帝內經說：“恬淡虛無，真氣從之， 精神內守，病安從來。”“如果一個人生活的很開心，安靜，超然而放松，沒有 意志過用和過多的壓力，他的真氣會隨著氣機最原始自然的通道走，如果精與神 聚集并且專注，疾病將不會在這個人身上發展。”所以神是“存在方式”。好的 操盤手可以協調好身體的各個紐帶，這是第一步，第二步則取決于神，只有神定 的人才能讓氣機隨著常道自然運行。在書中，著被稱為“陰陽平衡”“陰陽自和”。 問一個簡單的問題：“病人的睡眠怎么樣？”
（入睡難，容易被驚醒，夢境十分逼真，早醒） 陰陽平衡在睡眠質量上可以反映出來，當我們的表面是打開的，邪氣離開了，我 們可以恢復陰陽平衡，我們稱之為“重建”。
當有的病人難以入睡，這指的是陽氣或者說神氣無法沉降到陰分、血分的層次， 或是因為陰分、血分不足，或是由于陽氣過盛（過度工作、意志過用，長時間熬夜 晚睡，過度思考）。這種情況下，我們不得不使用礦物質來治療，讓陽氣得以沉降， 比如牡蠣、滑石、生石膏、磁石。
早醒的現象通常發生在當一個人對一個自認為是非常重要的問題沒有得到解決 時，氣處在壓力之下，心靈需要放松。我們使用輕靈的、味薄的甘酸藥，竹茹、 竹葉、烏梅。
夢境生動而逼真意味著精神混亂，這個病人太忙了，轉得太快了，見了太多的人， 思慮過度，對他的行為和思想無意義的思考與雜念太多。用質量重的石頭，苦、 澀，味厚的藥，生鐵落，紫石英，代赭石。
C：所以，神和陰陽平衡相互依存。如果陰陽失衡，神會受到干擾，反之亦然嗎？ 提升睡眠質量是一種收神的方法，但是就沒有其他方法了嗎？
LX：如果陰陽失衡，神將會受到干擾，反之亦然。神是人體精神層次的存在，陰 陽平衡僅僅是身體機能的指標，還有很多其他癥狀可以反映神的狀態。如緊張、 焦慮、抑郁、注意力不集中、過度敏感、容易恐懼與害怕等等。所有這一切癥狀 都展示了神的不安。但醫生從患者的神中體察到的感覺可能是最重要的診斷因素。 我們將在有關針灸的章節中更詳細地討論這個問題。
C：我們已經談過精、氣、神、真氣、氣機，那么形呢？
LX：想象一下，我們在一個劇院看戲，演員在劇場中央打架。形就是舞臺，真氣 和邪氣是兩個主要演奏者。癥狀就是他們在舞臺上的表演（出現在身體中或形上）。 舞臺中的劇情跌宕起伏，你可以選擇只看舞臺上發生的各種癥狀（形）并專注于表 演的細節，但是你很容易因此忘了整個“情節”。作者的意圖，劇本的情節（地點 和時間），這就是“病機”。如果你掌握了“病機”，你就可以隨著作者的思路與 想法預測結果。你應該問自己這些問題：這場戰役發生在哪里？方向是什么？正 常的方向是哪里？患者是否有足夠的資源來跟隨正常的方向？這取決于精、氣、 神、胃氣、三焦通道的情況。如果患者有問題，戰斗可能會朝著錯誤的方向發展。 這是因為缺乏資源嗎？如果是這樣的話，我們就會幫助患者補充體內資源，這很 容易。但疾病很少這么簡單！我們必須找出是否有邪氣，在哪個水平上作斗爭： 氣，血，通道，痰或器官？然后我們尊重身體的方向，補充資源或發汗或排便或 排尿。如果沒有邪氣，只是有一些氣血不平衡，那么我們也可以重新調整它們。
這很容易：我們確保資源不會不夠用，患者有良好的消化，正常的出汗，正常的 排便，排尿和睡眠。
C：非常有趣，這是概括整個診斷過程的好方法！它清楚地表明你如何能夠專注 于舞臺上表演的細節（形）并辯證施治，或者將戲劇和表演的動機以傳統古典經典 方式理解為“導演”。現在，你眼中的“津液”（津和液）是什么？
LX：津液（津和液）屬于精和胃氣的陰。在傳統中醫理論中討論這些術語并沒有那 么重要，因為它們直接依賴于精和胃氣。同樣地，古話說：“精血同源，肝腎同 源”=“精與血都一樣，精屬于腎，血屬于肝。”例如，血液不足不是一個根本 原因。這是中氣或胃氣虛或下焦精虛的結果，或中焦有堵塞，或通道、微循環中 有堵塞。我們必須找出主要矛盾。
C：經過前三步的診斷之后，我們了解了患者的資源（或強或弱的精氣和真氣），正 邪（如果有的話）斗爭所在的層次（表面，中間，腑，臟），“第一位醫生”驅逐邪氣 時希望走的方向（通過出汗向上，通過排便、排尿向下）。你在圖片中添加了哪“8 條原則”？
第四步：八綱與病機
LX：八綱辨證，即八條辯證原則
對疾病的診斷有：
1.虛實（不足-過量）
2.寒熱（冷-暖）
3.表里
4.陰陽（在氣-在血） 這種診斷方法使我們能夠找到更多關于病機，包括，斗爭發生的地點（表里），正 氣抗爭的強弱（虛實），屬于陰還是陽（在氣在血）？ 正氣是虛（缺乏）還是實（多余）？是否有戰斗？戰斗有多激烈？ 是否發生在氣分（在氣，表面，陽）或血分（在血，深層，陰）。就感冒來說，“在氣” 則癥見噴嚏，感覺冷，鼻炎，咳嗽伴有痰或無痰，發燒。“在血”則癥見皮膚紅， 小膿皰，皮疹，扁桃體重大，肺炎，發燒。疾病是否屬于表或里，這包含了兩層 含義：病機屬于外部或內部（在氣或在血），斗爭趨勢朝外或內（病之進退）。中醫并 沒有那么關注邪氣是在自于外部還是內部，因為侵略可能發生在過去，有時是很 久以前。重要的是，現在，當下，時刻，戰斗發生在哪里，方向正不正常？患者 本身的體質是寒還是熱？這并不重要。這只是“戲劇”表演的一個細節，就像上 下調節音量。在大多數情況下，使用寒熱并用。如果正邪斗爭激烈，癥狀往往偏 熱，我們使用涼藥直到癥狀趨于平衡（度）。根據《黃帝內經》我們已經討論過的 八綱辨證和《傷寒論》的原則，諸如石膏等寒涼藥只能用于高熱。這是所有診斷 方法的理論基礎，它適用于各種情況。它有助于我們根據相關要素簡化疾病的各 種表現形式。
C：你能給我們演示一下這三個步驟的診斷嗎？舉一些按照三個層次、“三焦” 的步驟或八綱辨證來評估資源（精，元氣和真氣）的臨床案例。
LX：我們可以以關節炎為例。在臨證中，我們常常會看到：急性和慢性階段可以 相互轉化。它們是一條河流的兩面。在一個關節紅腫熱痛的階段，問題出現在局 部，但它反映了整個身體的狀況，并將影響整個身體。揪出邪氣是風、寒、熱、 濕、痰、氣滯或血瘀沒有那么重要，更直接的方法是看看整個身體是如何工作的。 我們評估了精氣和真氣（如前所述），然后我們發現情況是：
1.虛實（缺乏或過量）：一般在一個急性階段，它是一個“實”的狀態，但它可以是 虛。我們看看戰斗還能持續多久。如果已經有證據表明是虛（或中焦虛或下焦虛）。 我們用 5％的補藥：或甘或酸，或涼或溫。
2.寒熱：在我們的例子中，它是一個熱證。我們使用寒涼藥：在氣的情況下，我 們使用，滑石、生石膏、磁石；在血的情況下，我們使用黃連、黃柏、大黃。
3.表里：如果有便秘和月經問題，如果關節腫脹，并且病情已經持續多年，那就 是里。如果有項強，鼻炎，怕冷，如果關節僵硬而微疼：這是表。如果表里兼有， 我們首先解決“表”（用藥上通常至少體現 60％），這意味著我們必須開，辛藥是 必不可少的。
4.在氣或在血：當關節腫脹時，它更可能是在血分。在血分的情況下，我們使用 苦藥。
在一個慢性階段：我們有時會出現“實”，但是大多數情況下是“虛”的情況。 其他特征與急性期大同小異，但是“斗爭”并不劇烈。
治療：癥狀偏“熱”或“在血”的情況下，我們用苦寒藥。如果“第一個醫生” 看上去想要打開表面（有“表”的癥狀），我們必須首先用辛藥，藥浴，經絡推拿。 如果主要癥狀之一包含便秘，我們向下開，根據真氣和精氣的狀態靈活選用藥物。 如果關節非常腫脹和熱，周身能見熱證（發燒，對冷飲的渴望...），我們使用石膏， 大黃，磁石，滑石。如果有虛的跡象，我們使用 5％的補藥（根據癥狀補腎氣或中 氣）。一般來說，使用白術和茯苓與苦寒藥并用以保護胃氣是有好處的。如果是精 虛，我們使用或涼或溫的補藥。如果情況偏冷，沒有戰斗，沒有嚴重的疼痛，關 節并不腫。我們應該通過使用補藥來挑起戰斗，但我們要控制可能的副作用。
C：在臨證中，第二步，第三步和第四步（三焦，神和八綱辨證）的診斷是重復的， 這給彼此增加了更多的信息量。我們是不是應該把最重要的八綱辨證作為所有中 醫診斷的基礎？
LX：八綱辨證是理解和治療病機的最佳診斷方法。當面臨異常情況時，它是最好 的“軟件”。這種方法可以澄清任何疾病或不平衡，這當然是所有傳統中醫診斷 的基石。這看起來很簡單，但是在實踐當中，要說清楚并不容易。虛實（缺乏-過 量）表明正氣的力量，寒熱告訴我們，在刻診的當下，患者的反應是否過度。表里 （內-外）幫助我們決定是否要使用更辛或苦味，重或輕的藥。
陰陽：遵循以上原則：表-熱-實屬于陽，里-寒-虛屬于陰，但更重要的是要注意 在氣或在血：在氣屬陽，在血屬陰。
C：你沒有根據臟腑理論來對癥狀做分類，而是用了更直接的方法，這是出于簡 化的目的嗎？ 換句話說，我們可不可以“簡化”它，就像數學等式一樣，將臟腑理論納入八綱 辨證？或者你認為臟腑理論只是一種導致“疾病”產生的理論解釋，而不是用來 分析“能量狀態”的方法？
LX：我們可以將“臟腑”的理論“簡化”為八綱辨證和四種物質。例如：肝陰虛 來自精虛，肝氣郁結是中焦有余的結果，肝火來自心火或腎火，這可以回到了精 虛或者神過于強。我認為，臨證種，臟腑辯證的細分化程度過高。在我看來，這 不是傳統中醫能夠提供的最好理論。并且在臨證中，它不是最好用的辯證方式， 因為它會容易導致醫者陷入以“疾病”為中心的辯證誤區。采用臟腑辯證，我們 治療的是一座座孤島；采用八綱辨證，我們相當于掌握了整片海洋的衛星圖紙， 這是一個全觀的了解。
C：《黃帝內經》或《傷寒論》是否真的詳細描述了臟腑及其生理功能？
LX：是的，他們描述了正常和異常臟腑的功能卻沒有發明臟腑辯證（針對臟腑而進 行的辯證細分化過程）。《黃帝內經》和《傷寒論》關注的重點是機（機會）、勢（方 向）、度（適度的反應、平衡）。臟腑辯證理論出自明代。
第三章：關于病機的深入討論
C：我想說回到病及病因的概念。
LX：首先，我們說疾病來自于正（“正”反映在我們的形體、精、社會關系、心智 模式、人與周遭生態的平衡程度）邪（六淫，即氣候因素；七情）斗爭。 下面談談七情六欲：
如果正邪雙方都很強，會產生實（有余）證，病機也很強烈。我們需要瀉。 如果正強邪弱，則病情輕微。我們拭目以待。或者，如果有必要，我們會根據斗 爭所在的層次協助采取行動，例如使用涼藥，苦藥或香藥。
如果正弱邪強，則會同時出現虛和實的嚴重情況。我們必須補的同時開，控制并 瀉掉多余的邪氣。
如果正邪雙方都很弱，它會形成一個虛的格局，沒有戰斗，沒有癥狀。為了解決 問題并恢復到“度” （平衡）的正常狀態，我們必須挑起“機” ，制造一場危機。 邪氣將首先表現為癥狀加重，這是我們可以治療的。
接下來，我想強調神在疾病痊愈過程中的角色。《黃帝內經》說：“神不使，神 有余。”。如果神太弱，它將無法控制病情，氣滯（神不使）。如果神太強，則會 過度控制，氣機運動太快而且消耗精（神有余）。消極的思想加重了“神有余”的 格局。
一般來說，神病誘發氣病，氣病會反過來會引起神炳（精病）。嚴重的疾病是由于 神病引起，他們很難治療。所以這種神可以拿來和一款不適應與無法兼容的軟件 相比較，充滿了神的家庭創傷，專業問題，情感困難。這個軟件是不適合、不能 傳播新的信息。它需要改變。當一個人無法改變軟件時會發生嚴重的疾病。如果 神轉變了，那么氣也會跟著變化，人才能回到平衡的狀態中來。
在所有癌癥病例中，通道不僅受到邪氣的阻斷，而且受到過度控制且不平衡的神 的阻斷。補或開是容易的，但是治療神的病則不太容易（冥想，心理療法）。
C：您如何看待急性或慢性疾病？
LX：急性和慢性疾病之間的差異存在誤導性，一個急性的病到一個慢性階段是時 刻在不斷變化的，反之亦然。就像陰轉陽，陽轉陰。當陰陽失衡，我們可能可以 抓住機會采取行動，讓氣機回歸平衡狀態。這被稱為抓機（可能的轉變機遇）。用 瀉或補（根據人體的陰陽格局）使氣機回到平衡狀態（或度）。有時，氣機處在一個假 的平衡狀態。身體已經習慣了它的存在，而且不再為了找回一個陰陽平衡的狀態 而嘗試戰斗（就像人在腰痛時采取彎曲姿勢以止痛）。“第一位醫生”已經放棄了！ 這時，我們可以用比如說使用非常溫熱或非常燥的藥。這將把問題揭露，解決它 并將氣機推向一種“真實”的新平衡狀態。但是“抓機”非常難。前提是醫者必 須對人體不同層次的理解不僅僅停留在理論知識層面，更要有著精微、細膩的體 會。《傷寒論》時代的醫生非常擅長“抓機”，這體現在當時創造的方劑之中。 中醫藥治療急性和慢性疾病是有效的。在急性期，衛氣上升到表面，而元氣和精 氣停留在體內深處，這個局勢很容易控制。
C：你是說，為了恢復慢性病的“勢”（正確的氣機運動方向），為了治療，我們應 該“抓機”（創造機會），挑起戰斗，喚醒“第一個醫生”。然后真正的問題才能 呈現出來，病人才可以得到有效的治療。
LX：是的。在慢性疾病中，由于正氣虛弱，沒有戰斗。邪氣停留在體內，可能在 表面，也可能在血液層次，也許是在渠道中，也可能在身體的其他部位，如大背 部肌肉，或更深層的在內臟層次（肺，肝，胃或腸）。患者不會感到任何不舒服的 癥狀，但是，當正氣隨著時間，地點，思維，心靈的變化，食物，藥物等的調整 有所回升，潛伏中的邪氣和真氣之間就會發生戰爭，癥狀會出現在邪氣阻塞的地 方或者是戰斗的方向。例如，每年都有很多慢性支氣管炎患者，伴有咳嗽，痰多， 發燒和白細胞偏高。這通常發生在他們的正氣越來越強大時。在中醫理論中，這 是一場未完成的斗爭的結果。作為醫生，最重要的是： 第一，抓住機，利用真氣新的力量，幫助戰斗朝著氣機圓滿和治本的方向發展； 第二，遵循“勢”，戰斗所采取的方向：向表面或向下（排便）； 第三，控制身體的反應，并使戰斗保持在可接受的范圍內。
發燒，咳嗽，痰和出汗都是戰斗的副作用；這是一個正常的反應，它在戰斗結束 時會消失。我們不能壓制這些反應，抑制這些反應的癥狀：將把治療方向引向謬 誤，它會干擾“勢”，并會失去“機”。我們能做的是控制身體的反應并使戰斗 保持在可接受的范圍內（滑石和石膏有助于控制這個反應）；第一個醫生正在做它 的工作，身體有自己的智慧。我們應該尊重它。我們應該對“機”、“勢”和“度” 有明確而清晰的理解。在大多數慢性疾病中，我們需要創造機會，挑起戰斗，并 通過使用溫、辛開的藥喚醒“第一個醫生”。當戰斗打響時，“勢”，“機”和 “度”將會很清楚，這很容易。“將棋子移到棋盤上！”這個原則通常用于治療 慢性皮膚病和慢性肌肉感染。醫生將使用附子，黃芪，黨參和麻黃創造一場戰斗。 它被稱為：“陰證轉陽”，意思是：“幫助機體從陰性的狀態轉入陽性的狀態”（充 足的氣血，戰斗的癥狀是積極的，戰斗的方向是明確的）
C：另一種評估方法是觀察“流感樣”癥狀。因為癥狀與“感冒”類似，還是說 它們反映了一場舊的戰斗被重新激活呢？
LX：兩者都有可能。值得注意的是，許多“流感樣癥狀”不一定是由于“感冒”， 它也可能是由于食積，過多的濕氣或寒邪位于肌肉腠理層，或任何慢性疾病，當 “邪氣”從一個“困在內部”的情況到“發越而出”的情況，這是一個好的跡象， 真氣有所改善或渠道變得開放起來。
不管最初問題是來自食物，心靈，內部因素還是外部因素，當“第一個醫生”被 “激活”時，如果方向指向表面，它將表現出類似流感的癥狀。
“感冒”可能是任何疾病開始的表現。任何疾病都有可能在表面水平上進行。在 慢性病中，出現在表面作戰的癥狀就意味著我們有機會將困在里面的邪氣發越出 去。
“溫病”理論中認為，當熱在營血時，我們應該用類似青蒿，薄荷，蘇葉這些藥， 幫助熱量通過表面離開身體。這個原則叫做“透熱轉氣”。所以，在抓機的情況 不明朗時，一場感冒有時是機遇。中醫是調常的，正常的人體需要與周遭交換信 息。打開表面是治療患者的第一步，除非他患有嚴重的腎精虛或氣虛或中焦有嚴 重的堵塞（應用大黃）。我們使用在表面處理的草藥不一定是用于治療表面的邪氣， 使用它們不是為了發汗，而是用來“開”，這也是治療任何一個疾病的第一步； 柴胡就是其中之一。很多涉及三焦的書都說：出汗是從表面打開三焦，大便是從 中焦打開三焦，排尿也是打開三焦，但是是在氣的層次；它連接了表面和內臟。 選擇打開的層次與方式取決于“第一個醫生”所采取的方向。
C：你如何辨別一個疾病是重還是輕？
LX：《黃帝內經》講的是“常”（正常的反應）和“逆”（異常的反應）。常的情況不 會很嚴重，逆的情況將更難以治療，有時甚至是致命的。如果病氣的方向跟隨氣 機，我們稱為“常”，這是正常的反應。例如感冒，病氣的方向朝向表面，真氣 足夠強大，戰斗將跟隨“常”，疾病將自行消退。如果病氣的方向不跟隨氣機， 那就是“逆”，我們稱之為異常的反應。感冒與支氣管炎，甚至腎炎和膀胱炎， 這提示邪氣過量了。戰斗不會跟隨“常”，實際上，這種疾病會在真氣虛且邪氣 過量時發生。醫生應該找出正確的方向（打開表氣），在適當的層次治療，以幫助 疏散邪氣并關注身體資源：精與氣。這是更難治療且更嚴重的。
第四章：診斷方法 C：根據三步八綱的辯證基礎，我們已經看到患者身上存在的問題。那么如何對 患者下診斷？什么才是最重要的：察顏觀色、腹診、循經觸診、舌診或脈診？ LX：在您詢問細節之前，最重要的是了解患者的病情。患者來了之后會抱怨不舒 服的感覺并告訴你他的癥狀和服藥經歷；你專注而安靜的望和聞，對于患者的“神， 氣，精，正邪斗爭及其方向”，你會有一個整體感覺。你知道這是一場未完成的 斗爭還是一場新戰役。如果通過你的第一印象，你已經察覺到這個情況時，你可 以通過使用四步法診斷確認你的診斷，確保你的策略和治療更加精確。
C：《黃帝內經》說：“睹其色，察其目知其散復，一其形，因其動靜，知其 邪正。”可譯為“觀察皮膚的顏色，觀察眼睛，你會知道氣之聚散；望一眼身體， 看看是動還是靜，你會知道這是邪氣和正氣”。你可以解釋一下這是什么意思嗎？ LX：當你觀察病人的臉部時，你會看到皮膚的顏色和光澤，然后看著眼睛：它們 是否發光？皮膚和眼睛的“發光”非常重要：如果它是有光澤的，說明患者有“神”， 氣是散出來的，問題不是很嚴重：這屬于“常”。如果皮膚沒有發光，這是一個 長期的問題，真氣的反應不夠強，“神”光稀微，氣處于異常聚集的狀態。此為 逆也。這更難以治療。
皮膚的顏色提供了更多關于氣機和邪氣的指示。白色主寒，痛或氣虛；色暗主寒， 痛或血瘀；紅色主熱或氣盛（有余）；黑色主寒，水滯或氣機運動緩慢；黃色主氣 虛，脾虛或腎虛。
如果氣機和顏色聚集在某一個區域，我發現當眼睛之間有一個暗點的病人存在心 臟問題（心絞痛）；如果鼻頭發暗，說明胃里有寒；眼睛下方暗說明神不足或精虛 或肝腎傳輸緊張。一個面色無華的孩子通常有脾腎虛的問題；一個眼睛下方和眼 睛之間有藍色環的孩子通常神弱且非常敏感，到了晚上容易害怕。現在，一直使 用計算機的人將首先出現非常有光澤的臉，這意味著神和精將要外散，下一步將 會呈現一張暗黑而干燥的臉，這是精虛的表現。如果手掌的顏色暗淡無光表示精 虛。如果肌肉緊繃，氣機的聚集能力將會比較強，但是內部通道會容易淤堵。如 果患者不動并且有退縮的姿勢，則可能是氣虛且神不足；如果他變得煩躁不安， 則更可能是由于內臟發熱或邪氣的存在而引發。這些例子很好的說明了《黃帝內 經》想要說的東西，但是，在您看來，一個人整體呈現出來的感覺比去抓皮膚或 眼睛色澤的詳細描述重要得多。
LX：是的，這是一個基于經驗的“捷徑”，但它必須是詳細觀察的結果！
C：你能談談舌診嗎？
LX：舌頭是一種非常好的觀察工具：它是身體狀況的一面鏡子，反映的不一定是 邪氣。它反映了人體的虛實而不是寒熱。一般來說，舌頭的形狀是內部器官和人 體深層（血分）的鏡子。如果舌頭弱而小，它反映了缺乏或過度的資源；如果它很 大，就好像長時間浸泡在水中，舌體看起來比較蒼白，略微腫脹（齒痕），這意味 著有水濕，大多數時候它是陽虛證，也有的時候這是氣滯證和精虛證。這是一個
“空”之象，未被聚集的資源之象。當舌頭變弱時，內臟和深部肌肉可能處于相 同的狀態。舌苔反映了近期氣機的情況：舌苔厚，意味著氣滯；這可能是由于胃 的功能紊亂，或者表面存在寒氣阻隔，也阻礙了三焦的循環。由于氣虛，三焦循 環也可能受阻。所以，當你看到舌苔厚時，它只能說明三焦的流通受阻。對患者 進行進一步檢查將揭示原因。它不一定是由于熱或冷或胃的問題。它并不總是能 反映邪氣的存在。
C：但我認為舌苔的顏色和厚度是造成邪氣存在的一個很好的跡象：白厚表示寒,
黃厚表示熱，厚而黑表示極冷或極熱，取決于舌體是否潮濕。
LX：舌頭反映了身體的狀況和它的運作方式：氣機。舌頭形狀表明身體的基本狀 況；舌苔表明最近的氣機變化。不要試圖僅僅通過舌頭來判斷邪氣。
C：這是值得記住的事情！最后是脈診，它是望聞問切的最后一條，但并不是說 脈診是不重要的診斷。
LX：脈診時，我們應該記住脈沖的三個等級（天地人）和兩個原則（度與機，陰陽相 應） 這三個層次：
1.天
隨著時間變化而變化，特別是四季或晝夜循環。重要的是要了解患者的脈搏是否 順應刻診的時間和季節。這可能是第一件要糾正的事情。在《黃帝內經》中寫的 是“脈得四時之順，日病無他脈反四時，曰難已。”意思是，“如果脈搏順應四 季，那么出現的疾病癥狀不會是什么大問題；如果脈搏沒有順應四季，（如果有疾 病癥狀）它不會痊愈。
在春季，脈應長而軟；在夏季，脈應像漂浮在水面上的魚，有開而透的感覺；在 秋天，脈正在下沉；在冬天，脈應該是深的，并給人一種聚闔的感覺。白天，它 的位置比晚上更淺。
2.地 根據地域不同的，脈象也會有不同。比如，中國南方人的脈應該軟而快，中國北 方人的脈應該強而深沉。
3.人：在這個層次上有兩種狀態
①在健康狀態下，脈搏會根據性別，年齡和體質而變化。女性的脈比男性深一些； 老年人的脈搏比年輕人弱一些；胖子的脈偏緩慢，偏深沉而強烈（如“冬季脈”）， 瘦子的脈偏快，偏浮動而輕透（如“夏季脈”）。
②在疾病狀態下，脈搏應與疾病類型一致（此為常也）。如果感冒或發燒，那么脈 應該是浮動的和強烈的：這是一種正常的反應，因為它的勢應該是升向外偏表面。 如果脈是弱而深的，則是一種異常的反應（此為逆也）。在腹瀉的情況下，隨著氣 機下沉，脈應該是深沉而無力的（此為常也）。如果脈強而淺，則意味著陽氣將要 外逃，腎精已經流散：此人將處于危險之中（失常、逆）。
兩個原則：
第一個原則是：機-度 機與時間和空間有關：現在，在哪里，是什么；它意味著應該在特定時間或特定 關系中如預期的那樣。
度實際上是處在特定的情況（或關系）中；它應該是平衡的，不會太強或太弱，太 多或太少。
例如：我們在一個房間里討論中醫：如果老師在說話，那么學生在聽。這是機， 但是如果學生在低下竊竊私語，或者老師去講烹飪知識了，我們也會失去“機”。
或者如果老師講得過多或不夠。我們就失去了“度”。 第二個原則是：陰陽相應
如果在一個特殊的機遇下，把握適當的度，那么我們就會有相應，或和諧，協調。 例如，如果一個人感冒，脈浮而強，就有“相應”。或者，正如我們前面提到的， 如果一個胖子有一個緩慢，深沉和強的脈（如“冬季脈搏”），這就是相應。
C：實際上，在搭脈時，你覺得它是一個整體嗎？你會留意脈沖的每一個位置（十 二種脈象）、，每個包含能量狀態信息的脈是否與器官相應的？
LX：脈需要動態地來解釋而不是僵化地解釋。把脈就像聽音樂會一樣，我們應該 學會欣賞和諧，不和諧，氣機是如何流動的，它們的陰和陽之間的關系是什么？ 每個人都有自己的正常狀態，并且在不斷變化：真氣與邪氣斗爭，而在這個“機” 中有“相應”或“不相應”。 診斷方法包括了解患者的正常狀態（原點）是什么，然后了解現實狀態與正常狀態 的差異在哪：“知常達變”。
體察脈的整體狀態比體察每一個具體位置的脈更加重要。 它是強還是弱，這表明一場戰斗是否發生，或者正氣是否強大。
它是在表還是里，這將表明戰斗是否發生在表面層次，以及將展示戰斗的方向。 它是緊還是松，這將表明戰斗是否強大，資源是否充分，是否有通道被阻礙。這 是非常重要的。
要記住，一般情況下，如果右脈緊，則意味著有寒或者正氣虛。如果左脈緊，則 意味著精氣虛。
它是快還是慢，有時它表明它提示的是溫或涼。 我們應該思考這三個方面：天地人，機度，脈的全觀體察。但是脈診只是一種檢 查工具；它不是診斷的一切。
患者呈現的癥狀和對于患者的觀察可以讓醫者體察到患者的病情，脈診會增加更 多信息。
我們應該使用四診合參（望聞問切）來得出正確的結論。
C：那么，李辛，你怎么“體察” 一個病人的，你依靠的是什么？在診所里隨你 跟診時，我覺得看起來好像在病人進來的當下，你就已經“知道”病人身上發生 的事情了一樣！
LX：我會區分四步來體察病人。當患者進來時，在他說出癥狀之前，我已經感覺 到了他的基本情況。我會體察他的精神是否穩定，如果精足夠強，那么看氣機是 否處于正常狀態，看看它是不是遵循的是病機的方向。然后我會體察它是否存在 邪氣：寒，濕，血瘀，食積，火...，以及邪氣停留的位置：在內部或在外部。然 后我開始提問并觀察他的表現，他的反應，他的精神狀態。我和病人交談，以確 認我對他的神和精的感覺。我向他詢問他的睡眠，胃口，汗的情況，二便，這將 給我提供有關氣機和病機的信息。我要求了解病人的病史：觀察當前的力量，方 向的變化，斗爭的進展。所有的癥狀和感受都有助于重建這段患病的心路歷程， 就像跟隨著河流的來勢來到河流的源頭一樣。
這將把我們帶到當下的情況：資源如何，它是否足夠強大并繼續戰斗？是否有足 夠敞開的渠道？是什么樣的邪氣在戰斗？這將決定治療的策略：開或闔。補或瀉。
打開哪個層次的渠道？并根據邪氣：（如果是寒邪）發汗，（如果是濕邪）利尿，（如果 是濕熱或食積）排便。
要想獲得不同層次上的感覺（感受，檢查，質疑），我們需要練習，不僅僅是在診 所出診，更是基于自身的內在訓練。這是一個非常重要的方法，如果說醫者是一 面鏡子，那么打坐就像給鏡子做日常保養一樣，經常打坐可以讓這一切變得逐漸 清晰，才能體察到周遭發生的一切，打坐冥想是體察一切的重要一環。
本章總結
C：關于第一部分的中醫理論，我們談論了一下幾點：
1.如何理解病人的正常能量狀態和運用第一步（資源）和第二步（三焦）的辯證方法體 察四種物質（精氣形神）、真氣和氣機
2.邪之所在發生了什么，如何在第二步（三焦層次）體察邪氣和病機，以及第三步（神） 的八綱辨證。
3.如何檢查患者，把脈和感受“氛圍” 你還給了我們一些關于如何解決治療中遇到的困難的??“提示”。在我們詳細介 紹草藥治療和針灸治療之前，你有哪些主要的治療原則要讓臨床醫生銘記于心的 呢？
LX：我最喜歡的一些名言是：
“定其神”，“審其勢”，“握其度”，“利其行”，“固其本”=“幫助精神 保持穩定”，“幫助第一位醫生并遵循他想要的方向”，“幫助控制身體的反應， 讓戰斗保持在可控范圍內”，“幫助加速戰斗進程”，“強化根基（至少使用 5％ 到 8％）”
“通因通用”=“如果身體要打開，我們就打開”（例如：在腹瀉的情況下使用大 黃，當中間有堵塞，方向是從中間打開）
“塞因塞用”=“如果有堵塞（如便秘）因為中焦氣分不足或精不足，我們使用補法。” “其在表者，汗而發之”=“如果邪氣位于表面，斗爭的正確方向是開，它將會 消失”
“其在里者，攻而下之”=“如果病機在里面，我們必須使勁向下開。” “大小不利，急治其標”=“如果大便和排尿不通暢，當務之急是先打開它們。” “緩則治其本”=“病位于更深的層次時，治療它的根。”
“表解里自和”=“如果你打開了表面，內部會被自動打開。”
如果呈現的癥狀表里兼有，一般來說，首先處理表。（但是表和里只是硬幣的兩面）
“里解表自和”=“如果打開內部，表面會自動被清理干凈。”
“釜底抽薪”=“當鍋里沒有足夠的水時，拿掉柴火。”（例如：因腸道阻塞導致 的高熱誘發腹瀉、食積、濕熱）。
“胃不和則臥不安”=“如果中焦不好，神和睡眠將不會好。”
“引熱下行”=“如果內部有淤火伴有強烈的堵塞，打開表面時不要太強烈，它 會增加多余的熱量，但是這些熱量可以通過利尿或排便向下開散。 （遵循原則：
“里解表自和”）。
C：這些講的都是方向嗎？
LX：是的，朝著正確的方向行動是成功的關鍵！用藥應該根據它們的性來使用。 性（氣與味）指的是特定的行動方向。針灸將引導能量在一個方向或另一個方向。 把注意力聚焦在疾病的大方向上是非常重要的，相比之下，局部癥狀就顯得沒有 那么重要了。
中藥治療學
第一章：中藥的歷史和經典著作
C：我們要從一些歷史背景開始呢？你認為哪些書是主要的中醫經典？
LX：有三個基本的經典。
草藥：《黃帝內經》，分為兩部分：素問（基本問題）和靈樞（精神層次的軸） 《神農本草經》（神農氏們的經典嘗藥體會錄）《傷寒雜病論》（討論由于寒邪引發 的疾病和雜病），分兩部分：《傷寒論》（討論感冒引起的疾病）和《金匱要略》（儲 藏在金柜子里的處方概要）但我們還可以添加兩本有趣的小書：《脾胃論》和《溫 病條辨》
C：神農和黃帝是兩個皇帝，被認為是體現中國古代的早期記憶，和古代中醫歷 史一樣，正史和神話傳說常常混雜在一起。據我所知，神農和黃帝似乎是神話人 物，我們真的不知道是誰寫了他們的書。他們可能是由幾位不同的醫生撰寫并匯 編而成的。根據傳說，神農是生活在黃河附近的炎黃。有一天，一只鳳凰飛過了 全國，掉了一只九個耳朵的植物。神農把它撿起來種在了土里。它長出了一朵美 麗的果實，每個吃了它的人都變得更加強壯起來。所以神農開始種植這種植物， 它被稱為“谷物”。這就是炎帝改名為“神農”的原因，指的是“偉大的耕作者”， 他因為對農業和醫學的貢獻而聞名，但我們在歷史檔案中找不到任何關于他的文 章。他的書很可能是秦漢醫生幾部作品的匯編。
LX：是的，這就解釋了為什么這些非常古老的書籍有時候描述地十分晦澀，并且 作者以寓言的方式書寫的，想要解密十分困難！另一方面，《傷寒論》是在《黃 帝內經》和《神農本草經》之后寫的實用手冊。它用很好理解的方式寫得像一本 “食譜書”。
C：你能先告訴我們更多有關《黃帝內經》的信息嗎？
LX：《黃帝內經》是黃帝和他的私人醫生之間的對話：岐伯，雷公等。成書于秦 漢末期（公元 1世紀或 2世紀）。它有兩個主要部分：素問和靈樞。素問（基本問題） 由王冰醫生在唐代整理而成，在此之前，它一直對公眾保密，只有非常特殊的弟 子才能得到大師傳承。這本書講的是中醫生理學。身體的正常能量狀態以及古代 人過去的生活方式，順應大自然，與周圍環境和諧共生。它還討論了當病理因素 發作時身體如何反應，草藥和針灸的治療原則，脈法和治療原則。
靈樞（精神層面的軸）直到宋朝才成書，當時宋史崧發現了一本自漢朝以來一直存 在于他家中的書！然后他把它交給了醫學專家，它有 81 個章節，主要是關于穴位 和通道，并談論疾病和針灸治療。（有關《黃帝內經》，《靈樞》的更多細節，見 附件 2）。
C：這本書對草藥治療有什么看法？有哪些特別的地方對你產生了影響（思維方式 上）呢？
LX：在素問的第5章中，《黃帝內經》描述了草藥的特點，它們的“氣”和“味”， 這些性質如何決定它們的作用方向及其與陰陽的關系。簡而言之，“氣”是草藥 的本質：寒熱溫涼；味是它的味道：甘苦酸辛咸。草藥的特性是基于它的味。它 具有補氣，瀉氣，向上，向下，闔或開的能力，取決于味的厚薄。 正如我之前所說，對我來說，這是處方的基礎，也是處方的秘密鑰匙。
C：我對黃帝和神農的工作了解不多，他們的教導有什么特別之處？
LX：根據傳說，神農是第一個開發和撰寫農業、畜牧業和醫學的皇帝。
可能他生活的時代在黃帝之前，但不太確定！《神農本草經》的歷史可以追溯到 公元前 206 至公元 23 年。古老的傳說為我們講述了中醫的起源，它是如何被發現 和檢驗的。這些信息不是來自謀生存過程中的試錯，而是來自神農個人的草藥實 驗，它逐一品嘗。有傳說指出他一天可以品嘗 70 味藥！神農有能力感受和描述他 們對自己的“氣”和“味”的影響。他品嘗了很多藥，傳說談到“神農嘗百草”。 但本書最有趣的是分類，它將草藥分為三類：“上品”，“中品”和“下品”。
“上品”常被作為“君”藥和“臣”藥使用，“下品”則被作為“佐”藥和“使” 藥使用。古代“君臣佐使”的隱喻和現代書籍中提到的隱喻不同。在中醫歷史上 的不同時期，這些隱喻以儒家思想為原則，用不同方式解釋的。按照神農的分類 法，同一味藥在不同處方中既可以是“君”也可以是“助手”。
對這種特殊分類的有趣的點在于，它能讓我們清楚地了解特定藥物的安全性，處 方可以開多久，任何副作用和作用方向。它描述地很簡單，并且不會給每種草藥 賦予太多的適應癥。至今，它的適應癥仍然非常準確。
C：你能為我們描述一個這三類藥嗎？
LX：首先是上藥。它由120個君藥組成，它們的特點是：
“主養命以應天”=“負責滋養生命，順應天道” “無毒，多服久服不傷人”=“無毒，可長期服用也不會傷人” “欲輕身益氣不老延年者，本上經”=“想要讓身體更清澈，延年益壽，用這 120 種草藥。” 重要的是要記住“上品”與“養命”（保全生命）有關。命也意味著生命的本質。 它會有長期滋養作用，可以長期服用。在這個類別中，我們發現草藥，它們有更 多的氣或味，這取決于草藥本身，但不是太強。大多數情況下，他們有聚精和恢 復精的能力，甚至他們可以在某種程度上開，基本功能是聚集和保全。我認為最 有用的是： 巴戟天，白蒺藜，白術，蒼術，菖蒲，大棗，丹參，地膚子，地黃，冬瓜仁，杜 仲，阿膠，防風，茯苓，甘草，枸杞子，龜板，滑石，黃連，黃芪紅景天，菊花， 決明子，靈芝，龍膽草，龍骨，蘿卜，麥冬，芒硝，牡蠣，牛膝，女貞子，藕節， 蒲黃，人參，肉蓯蓉，桑寄生，桑螵蛸，沙參，山藥，麝香，石斛，酸棗仁，天 冬，天麻，菟絲子，五味子，細辛，茵陳，薏苡仁，玉竹，澤瀉，紫石英。 接下來，中藥的組合：由 120種臣藥組成，它們的特點是： “主養性以應人，無毒，有毒，斟酌其宜”=“隨著人的本性，負責滋補體質； 或有毒或無毒；必要時可以使用它們。”
“欲過病補虛羸者，本中經”=“控制疾病，以補充嚴重的不足，使用中藥” 中藥與養性（人的本性）有關。只有在必要的情況下，我們才用這類藥材來平衡人 體的能量。他們的“氣和味”強于“上藥”組。它們大多在不同的層次開。基本 的功能是瀉和流通。在這組中，我們會發現： 白茅根，百合，白芷，白鮮皮，貝母，萆薢，鱉甲，柴胡，磁石，當歸，地榆， 防己，葛根，藁本，干姜，枸杞子，栝樓，海藻，核桃仁，厚樸，黃柏，黃芩， 款冬花，苦參，羚羊角，龍眼，鹿茸，麻黃，牡丹皮，秦九，青皮，瞿麥，白皮， 山茱萸，芍藥，川芎，石膏，蜀椒，通草，五加皮，烏梅，吳茱萸，杏仁，玄參， 陽起石，淫羊霍，澤蘭，紫苑，知母，積實，梔子，豬苓。
最后，“下藥”組：它由125 個“佐”藥和“使”藥（助手和使者）組成，它們是： “主治病以應地，多毒，不可久服”=“用于治療疾病，從屬于地，大多是有毒 的（氣味皆強），不能長時間服用。”
“欲除寒熱邪氣，破積聚，愈疾者，本下經。”“如果你想驅散冷熱邪氣并打開 淤堵（在形，在血，位于深層次），治愈疾病，遵循下藥”。
下藥與治病有關，這意味著它們將正面攻擊病灶。下藥有毒，它們行動迅猛，驅 邪的同時也會傷到身體正氣，它們不能久服。它們比前兩類藥強而厚重得多。舉 一些這組藥的例子：
白頭翁，白芨，半夏，扁蓄，大黃，大鹽，代赭石，附子，桔梗，連翹，生鐵落， 水蛭，天雄，葶藶子，蜈蚣，五靈脂，烏頭，夏枯草
C：確實非常有趣，我也很驚訝地發現了一些意想不到的草藥！我想到的是龍膽 草和細辛，這是我從未想過可以歸屬于上品藥，可以安全地長期服用的藥。或者 半夏，桔梗如此毒！你仍然相信這個分類可靠嗎？
LX：神農皇帝對草藥的分類遵循道家思想，以神和氣為基礎。 “上品”給人神氣安定的感覺，我們發現許多石頭和草藥補精，在這一類中，它 們用來讓人恢復正常的基本狀態，以保持精和神的穩定。
“中品”調節氣與血的關系，補瀉病氣，遵循氣血方向，屬于調節層次的藥。 “下品”改變了氣機的方向，攻擊致病因素。它治療的層次在“實質性”層次， 它們掀起了一場“革命”。它們動作剛猛而快速，但有毒副作用。
這也許就是為什么我們會在某些類別中發現一些意想不到的草藥的原因吧？我也 不知道。
我仍然會描述《神農本草經》中我所嘗過的藥！例如，現在麥冬被認為是“微寒” 的性質。《神農本草經》將其描述為“溫”。嘗藥后，我也覺得它具有溫暖的性 質。如今，醫生使用藥物的依據不是它們的性味，而是它們的功能（驅寒，逐熱， 排毒，利尿，通便，止咳，活血...）。
古代醫生不像現代醫生這樣行醫。他們懂得望氣。他們知道正常的氣機運動應該 是怎樣的，并且能發現異常氣機（病機）正在發生的地方。他們的診斷和治療策略 基于：虛實，升降，氣分或血分，開闔...因此，對于他們來說，重要的是要知道 草藥的厚薄，動靜，升降，開闔，在表面起作用或是在深層次起作用，溫涼。這 些屬性由氣與味以及每種藥物的劑量表示。《神農本草經》告訴我們：“凡欲治 病，先察其源，先候病機，五臟未虛，六腑未竭，血脈未亂，精神未散，服藥必 活，若病已成，可得半愈，病勢已過，命將難全。”=“在治療病人時，首先體 察基本面，并觀察病機。如果五臟六腑沒有嚴重虧虛，渠道沒有嚴重失衡，精神 安定，如果病已深入很深的層次，成為身體和精神的一部分，那么可能會有 50％ 的機會治愈。如果疾病的“勢”已丟失，則很難治療，病人可能會死。”
C： “病勢已過”是什么意思？
LX： “勢”指的是病人的實際情況，以及正邪斗爭地方向。當我們談到一種疾病 丟失了“勢”時，就意味著彈盡糧絕（精氣神），患者無法恢復，醫生沒有足夠時 間和余地去做任何事情來幫助他們。
C：那么現在我們來講《傷寒雜病論》吧！
LX：《傷寒雜病論》是由醫圣張仲景在東漢末期撰寫的。它由兩本書組成：描述 外邪致病的《傷寒論》，以及《金匱要略》，（黃金般的處方集合）描述的是本氣 自病。張仲景醫生用藥特別厲害，他能根據疾病的層次（氣血精）靈活使用藥物的 “氣味”之厚薄。他住在中國北方（河南省），著名的《傷寒論》意思是“討論因 寒邪引起的疾病”，“描述了體內疾病滲透的六個階段。”六個階段分別是：太 陽-陽明-少陽（陽面）-太陰-少陰-厥陰（陰面）。如果疾病停留在三陽水平，則意味 著真氣沒有缺乏，致病因素位于表面和陽的層次，身體的斗爭和反應是積極正面 的。如果邪氣滲透到了三個陰的水平，則意味著真氣不足，治病因素在深層的陰 分，身體的反抗和反應都很弱。不同的病人有著不同的癥狀和反應，于是張醫生 使用了太陽-陽明-少陽和太陰-少陰-厥陰的分類，便于醫者作出明確診斷，在疾 病的各個階段調整勢（方向），機（機會）和度（平衡），適當的氣、味和藥的劑量。《傷 寒論》是一本非常實用和清楚的書，與《黃帝內經》相比，更具寓意。告訴我們 到底要做什么，何時以及如何精準地做到這一點（詳見附件 3）。如果你去學《傷寒 論》，你將清楚地了解疾病的不同滲透程度以及身體的反應。如果您也明白草藥 的“氣和味”，那么你將能夠清楚地了解其他所有醫生的思路，這是一個分析處 方的“捷徑”。大多數有名氣的處方都來自個人經驗。如果你了解《傷寒論》， 你將會立即明白他們背后的邏輯。
C：你還提到《脾胃論》是你最珍貴的書之一！
LX：是的，這是李東垣醫生（約14世紀）在元朝時期寫的。李東垣醫生是張元素醫 生的徒弟，他是第一位清楚地表達藥物的氣和味是如何調常之原理的醫生。這在 早期的書中有很好的描述（比如《黃帝內經》），但從未真正作為主要原則來使用。 張仲景寫了“珍珠囊”。李東垣學習中醫是因為他的母親經過多次誤治后死亡， 他想找到替代療法。他寫了一本很短的書“脾胃論”，基本上說的是：“當中氣 很弱時，身體能量會失去原來的方向并向上（低熱）出汗或向下（腹瀉，腰痛）。“當 時的中國，戰亂頻繁，因此，人們營養不良，脾胃虛弱。李東垣醫生在“強化中 焦”的基礎上開創了一個思想流派。他的主要理論是：“升降浮沉”，意思是： “升降開闔（在中焦）”。他還以草藥的氣和味為重要的治療原則，要留意疾病的 方向，而不是局部的癥狀。這雖然已經在《黃帝內經》中提到過，但是他相信草 藥的“個性”以及如何使用它。臨證中，他也擅長針灸和艾灸。因此，他自己的 身體不強壯，他的處方通常也是溫和的，但是卻有很好的藥物搭配。目前他的處 方主要用于脾胃虛弱的老年人，如“補中益氣湯”。
C：《溫病條辨》的貢獻是什么？
LX：《溫病條辨》由吳鞠通醫生撰寫。它教給我們以簡單的方式治療發燒疾病。 在他之前，醫生并不是真的知道如何治療發燒。他們使用的是辛溫藥（麻黃、荊芥、 防風、石膏）并加入黃連，黃芩，黃柏。基于這個原理的處方溫而苦，味過厚重， 不會走表，只會沉入深層陰分，并且在治療濕熱方面沒有效果。溫病條辨描述了 另一種方式：“微苦微辛”。“選擇涼而輕靈口感和輕薄的劑量將很好地調整氣 味。”如果使用的草藥太苦太辛，就像以前的醫生既定的那樣，必須添加更多草 藥以抵消副作用，并且處方會變得非常復雜。“微苦微辛”這個原則很簡單，隨 順病機和氣機。這四本書編在一起出版并稱為《中醫四部經典》或《中醫四經》。 他們都描述了如何以同樣的方式使用草藥的“氣和味”。《傷寒論》專門治療由 于身體感受寒邪引起的疾病，《溫病條辨》是治療由于身體感受熱邪引起的疾病。 如果你掌握了這些書中描述的原則，你可以治療所有疾病的外在和內在，遵循身 體的動態系統。我也應該提一下《難經》，這是一本非常簡短的經典著作。它描 述的是《黃帝內經》中關于中醫各種方向的 81 個問答，特別是脈診。我不會特別 強調它，因為它出自《黃帝內經》。
第二章：草藥的性味
C：如果我只掌握這兩個原則：如何使用草藥的氣和味，遵循氣機和病機，我相 信我會成為一名優秀的中醫師！上一章，你告訴過我們關于氣機和病機的事情， 讓我們現在談談“氣和味”！
LX：中醫使用的每種草藥都有兩個部分：“氣”和“味”
“氣”指的是活躍的部分，屬于陽面，氣分，草藥中輕薄的部分。它也指草藥的 性質“寒熱溫涼”。藥物小劑量使用，只煮很少的時間，有時在快出鍋時才放入 湯劑或用酒制，以獲得草藥“氣”的層面。它的作用是活血，打開通道，升提氣。
“味”指的是藥物的陰面，有著厚重的味道（酸苦甘辛咸），顏色深，煎煮時間長 而濃縮。它的作用是補精和補血。 （如：地黃，肉蓯蓉，巴戟天），補瀉內部能量， 帶領氣機向下。
C：所以某種藥的“氣”和“味”取決于“自己的個性”（性質和味道）以及煎煮的
方法？
LX：確實，我想要添加一些重要的：每種具有類似“氣”和“味”的藥可以相互 替代。這給我們寫處方帶來很大彈性，特別是在我們無法使用所有藥時，我們要 想到這一點！
C：氣厚者打開通道，活血活氣，味厚者補且闔”還可以帶領能量降下來。 那么礦物藥和動物藥呢？我們也來談談它們的氣和味。
LX：是的。大多數動物藥比植物藥有著更厚的“味”；它們治療精和血的層次。 有的滋補藥同時也有活血和清理血中毒素的功能。所有的礦物藥和貝殼都能調氣 和調神（例如：磁石，牡蠣，滑石，石膏，朱砂，代赭石，灶心土），我們取其氣， 有一個理論認為礦物質傷胃，這不是真的。事實上，如果它們以粉末形式使用， 且不是在水中煮熟，可能會損害胃氣。但如果在煎劑中加入煎煮是不會損害胃氣 的。
C：草藥的“氣”和“味”給了我們指明了藥物的方向：來到表面，向下，闔， 開等。處方也有“氣”和“味”嗎？
LX：是的。病人會描述處方的味道，你會知道它的大方向，而不需要看方子組成!
C：基于草藥的“氣”和“味”，一般的原則有用嗎？
LX：我會引用《黃帝內經》（素問）的話。這是第一本談論“氣和味”的書。“形 不足者，溫之以氣”=“如果身形偏薄，取用藥物的氣分溫之。”我們使用在氣 分工作的藥，我們使用他們的陽面，小劑量，10g-15g,煎煮時間少一些。
“精不足者，補之以味”=“如果精不足，取用草藥的味的層次補之，不論它是 寒是熱。”我們使用更大的劑量，煮更長時間，使用厚重的部位，如根、動物藥、 種子、顏色暗或黑色藥。
“陽化氣，陰成形”=“凡是陽面屬性的，都是偏流通，偏動，偏升氣。凡是陰 面屬性的，都是偏守，偏制造，偏闔。”
“陽為氣，陰為味”=“藥物氣的層次屬于陽，味的層次屬于陰。” “味歸形，形歸氣，氣歸精，精歸化”=“（草藥方面）味歸屬于形（形體結構），形 益氣，氣益精，最后，精會進行運輸和改造（因為精生氣）。”
“味傷氣，氣傷精”=“（在草藥中）過厚的味會傷到氣；（在草藥中）氣過厚會傷到
精。”
“陰味出下竅，陽氣出上竅”（在草藥中）陰的部分將從下面的出口（肛門與尿道）出 來。（在草藥中）陽氣向上打開，從上腔出來。”
“清陽發腠理，濁陰走五臟” = “氣” （陽）將打開表面，用“味” （陰）浸入并聚在 五臟。
或“清陽實四肢，濁陰歸六腑”=“清陽（或氣）將強化四肢（同時意味著會打開表面） 濁陰（味）推動六腑（浸入并聚合）。
“味厚者，為陰，薄者為陰中之陽”
“厚則泄，薄則通，氣薄則發泄，厚則發熱”=“味厚的藥主要是向下開（例如： 大黃，芒硝），味薄的打開內外的通道（例如：柴湖）。氣薄的打開表面和內部（引發 汗出，如茯苓）。氣厚則溫熱（例如：附子）”。“辛甘發散為陽，酸苦涌泄為陰， 咸味涌泄為陰，淡味滲泄為陽”=“所有辛甘藥或者有向外部發越的功能的藥都 屬于陽，所有會引發嘔吐和下利的酸苦藥都屬于陰，所有會引發嘔吐和下利的咸 藥都屬于陰，所有淡味滲泄的藥都屬于陽”。
我想補充一些不是《黃帝內經》的引用，但也非常有用：
“大方向”=“明確處方的方向是最重要的事情”
“高巔之上，唯風可及”=“對于身體頂部的疾病，只有風（辛辣）藥可以觸及” “不傳之秘，在于劑量”=“最核心的秘密在于方劑中每種藥物的比例和劑量” “開合之道”=“開或闔是方劑的基本方向”
“厚薄之用”=“草藥或方劑的基本特征是厚與薄”。
第三章：李辛的草藥分類
C：神農皇帝給我們分了三組草藥：“上藥，中藥，下藥”。根據神農的說法， 讀者如果對常用草藥的詳盡描述感興趣，可以參考附件 1。現在，在我們開始討 論方藥之前，你能否給我們一個你自己心目中的草藥分類，當然，根據你常用草 藥的“氣和味”和方向，這將幫助我們了解處方的勢。
LX：我的看法是以一種表格形式的指南呈現的，它遵循理論描述中的診斷步驟， 并告訴我們在哪個層次使用什么，（上焦，中焦和下焦）在哪個方向。 在每一個層次中，我將根據它們的布散層次和方向區分草藥，并給予他們每個人 獨特的個性。如果我們對一個人的資源、氣機、病機的狀態有一個清晰概念，那 么在這些表的幫助下，很容易開出一個處方。
但是，我再重復一遍，這是一本個人實用指南，并不是說要取代現有的分類或它 的描述更詳盡！每種藥的使用將取決于患者自身的敏感度。例如，川楝子可以在 氣的層次作用，但對于一個較弱的病人，它可以直接達到血分！對于一個脾胃虛 弱而神氣敏感的病人，我們用茯苓，佛手，荷葉（氣機）。而不是香附子，萊菔子， 厚樸，這些藥雖然也會在氣的層次作用，但是它們對于一個較弱的病人來說會直 接到達很深的層次。
•下焦的層次 我們有兩組藥：闔的藥和開的藥。 闔的藥細分有三個子區：聚精，聚陰，聚氣。 開的藥細分有三個子區：開整個身體，開深層的血分，利尿。 作用在下焦層次的藥，支持資源，深入到根部聚和開，帶領氣機下行。
•中焦的層次 在這組中，我們區分四個類別：聚集在中焦的藥，打開中焦的藥，具有強烈向下 的藥和具有提升效果的藥（向上）。
在每一組中，我們列出了作用在氣分的藥，作用在血分的藥。 我們列出了在氣的層次作用的藥，以及在血的層次作用的藥。 作用在中焦層次的藥具有運輸，運化食物與水的作用，并幫助氣機升降運動。
•上焦的層次 在上焦，我們分為氣分（純表面作用）和血分（深層表面）。雖然第二組藥屬于氣的層 次，但是也可以作用于血的層次。
每一組中，我們都有溫開的藥，而涼開的藥少。 作用在上焦的藥，具有打開和保護的作用，連接外部和內部，帶領氣機向上。
c：總結一下，我們可以這樣說： 在上焦，打開表面我們取草藥的氣多于味，用辛或淡的味道。 在中焦，為了增強真氣，我們用甘苦溫的藥，或者微苦微辛，取其氣多于味。如 果用藥過苦則偏于固守，它會直入腸腑。如果太辛辣，它會升浮過度。如果血分 有堵塞，去開瀉它，我們用辛苦藥，取其味多于氣，味道辛辣或清淡。如果氣分 有堵塞，我們用藥，取其氣多于味。一般地，中焦層次的藥比上焦層次的藥味道 偏厚。
在下焦，我們用的藥味偏厚，甘酸苦或咸，它們聚在血分或在血分有微微的流動 作用。溫藥適用于腎陽不足（附子，肉桂），涼藥適合腎陰不足，性平或至少不溫 的藥適合精虛。
LX：是的，這讓我們清楚地了解了草藥在三個層面的用途：上焦，中焦和下焦。
C：你最喜歡的草藥是什么？
LX：中醫師需要掌握的四種主要中藥有：人參，麻黃，大黃和附子。
人參增加了“公司”的現金流；如果有足夠的資金，公司就會很強大；麻黃就像 一個龐大公關公司（開）在做廣告；大黃消除債務，精簡工作效率低下的員工；附 子就像一管提升公司活力的雞血和它也是公司創造力和靈感的源泉。我也喜歡使 用四種溫藥：附子，肉桂（或桂枝），干姜和淫羊藿。附子的作用通行于全身，它 可以廣泛推廣中心，它主要作用在下焦。肉桂也在作用在下焦，但效果更溫和； 這對心陽有好處。干姜在中焦和肺部工作。淫羊藿在中焦和下焦工作，它可以打 開并且到達表面。
C：我們如何治療“神” ？我們在調理中焦和下焦時是否會加入礦物類藥，如龍 骨、牡蠣？
LX：是的。神的平衡取決于精和真氣。我們可以添加重的礦物質來鎮靜并壓低能 量。但我們也可以使用針灸，心理治療和冥想來達到這個效果。這個表總結了我 們可以用來治療神的主要用藥。
闔精■毛 礦楊質 凈化心'靈 傑護神不奐外邪
或貝殼 干擾：治療恐懼
五味子 生龍骨 生鐵落 生紫石英
山茱萸 灶心土 石決明 代赭石
菟絲子 生牡蠣 珍珠母 朱砂
人參 厚樸 紫貝齒
菖蒲
靈芝
艾葉
木香
桂枝
附子
第四章：處方
c：著名的經典方劑可以按照類似的分類嗎？
LX：當然！我想提出一個方劑的分類，只有四個類別，根據方劑的作用啟動點， 方劑作用的補瀉，偏表面和偏水的代謝（三焦）。按照我們理論的四個步驟來選擇 合適的方劑。我在歷代著名方劑中選擇了一些方劑，不僅限于“經典”的時間。 但是，根據《黃帝內經》的說法，我會根據方劑的味道而不是他們的功效來向大 家展示它們的行動方向。我們將看到藥物的劑量是多么重要。我知道有一位當代 醫生，他面對任何條件都幾乎只開小柴胡湯。根據病人的獨特情況，他只修改藥 物的劑量，做一些加減！他的一些學生沒有注意到這些劑量上的變化。他們顯得 十分不安，并且無法理解老師是如何在不同的條件下總能開出相同處方并取得良 好效果的！最后，我們應該永遠記住，所有這些方子都是出自不同朝代的醫生， 他們使用著不同的計量單位：“銖，兩，分，錢，斤，斗，升，合”。在每個朝 代，這些計量并不總是代表著相同的數值：這是混亂的來源。方劑還有不同的劑 型：丸丹散湯。在方劑的描述中，我首先使用古代書籍的原始劑量作為指標，而 括號內則是以克為單位的現代劑量，便于現代醫者使用。在任何情況下，它們表 示的是方劑中每種成分的比例，以幫助中醫執業者建立自己的處方。你會注意到 所有以丸、丹、散為劑型的劑量遠遠高于湯藥，因為它們經常被提前準備好，一 劑使用三個月。如果是丸或散，這些成分會在一起接觸制作成1-3g粉末或6-9g 丸作為一劑來使用，它們通常需要使用溫水送服。
下焦的層次
C：首先，讓我們來看看下焦的基礎。
LX：如果我們想治療下焦層次，在我們的下焦方子排列中，色偏薄、味偏厚的方 子偏陰，色偏淡薄、氣和味更均衡的方子偏陽。這部分偏陽的方子只專注于補陽。 在這兩個組中，我們將進行細分，我們將詳細了解其最具代表性的處方。
1.處方用于鞏固下焦陰分
陰虛陽亢：
這類方子的基礎是：六味地黃丸 最初它出自于《小兒藥證直訣》，這是錢乙醫生在宋代寫的。那時，它被用來瀉 腎。有一個方法可以瀉每個臟：“瀉腎散”六味地黃丸，用來瀉腎，“瀉白散”， 用來瀉肺，“瀉青散”，用來瀉肝，“瀉黃散”，用來瀉脾。如今，我們用“六 味地黃丸”來補腎。
它有：熟地黃8錢(24g)，(苦酸寒)山藥4錢(12g)(甘平)，山茱萸4錢(12g)(酸溫)， 茯苓3錢(9g)(平)，澤瀉3錢(9g)(咸，涼)，牡丹皮3錢(9g)(苦辛) 這個方子整體性寒味厚，而且方向向下。它補并聚在下焦(丹田)并開始排尿。在 傳統理論中，要想不精，我們應該使用涼苦的藥。如果我們使用溫藥，它會耗精， 而不會是補。六味地黃丸的改良版：知母地黃丸：六味地黃丸+知母(6-9)g(甘寒) 和黃柏6-9g(苦寒)：與六味相同的功能和比它具備更強向下的力和聚合在下焦的 力。它通過其聚合力和更強的沉降的力以對治虛熱證。
杞菊地黃丸：
六味地黃丸+枸杞子9g和菊花6g：微溫。
都氣丸：
六味地黃丸+五味子9g：更助聚力。
這些處方不能用于脾胃虛弱的人(腹瀉，不能食冷，食欲不振，消化不良，面色蒼 白，四肢冰冷)因為它們的味濃郁，性十分涼。
他說：“脾為后天之本，腎為先天之本”=“脾之根是后天(后天氣)，腎是先天之 根(前天氣)。”
根據經驗，如果有人是“先天不足”，我們必須首先糾正“后天”，因為用來糾 正“先天”的草藥會導致腸道松弛，胃部不適，會出現局部上火癥狀。在使用處 方來補充孩子之前，我們必須調整和打開中焦并通暢渠道，牡丹皮，澤瀉，茯苓 被用于此。
陰精兩虛：
這類處方可強化了基礎物質(精和陰)，但總的來說，它們的流通性不強。三個主 要的代表是：二至丸，五子衍宗丸，左歸丸。
左歸丸
出自明代張景岳醫生的《景岳全書》。
它有：
熟地黃8兩(240g)，山藥4兩(120g)，山茱萸4兩(120g)，牛膝3兩(90g)，菟絲子4 兩(120g)，枸杞子4兩(120g)，鹿角4兩(120g)，龜膠4兩(120g) 熟地、牛膝、菟絲子、枸杞子、鹿角、龜膠都是溫暖的草藥。它們可以固澀精。 牛膝也在血或精的層次作用，有著強烈的向下降的力量。
山藥在氣分作用，可以補腎氣和益脾氣。這個方子味很厚重，補氣和收納的效果 甚至比六味地黃丸還要強。但如果要用這個方子，這個人必須要有一個強烈的氣： “味重”的配方必須由強大的氣來帶動它。這個人的胃氣應該是不錯的，而且通 道必須是敞開通暢的(即使他有虛的問題)。這個方子特別適合腿部較弱的人，因 為他的力量會沉降入腳。六味地黃丸的力量只能到達丹田而不是腳。它是一種濃 縮丸(powder)，這就解釋了它為什么比前面方子的劑量相對較高的原因。
二至丸
出自清代汪昂醫生的《醫方集解》=“醫學方劑的解讀”。它只有2種草藥：女 貞子和旱蓮草(無固定劑量)。它們都是“陰中之陰”和涼的藥。它們具有長期保 持，支持和補精的作用，具有強烈向下的動作。有時，桑葚(也是陰中之陰)會被 添加到方子中。它通常用于中年婦女。
五子衍宗丸
出自明代王肯堂醫生的《證治準繩》 它由五種種子組成：
五味子1兩(30g)，車前子2兩(60g)，菟絲子8兩(240g)，枸杞子8兩(240g)，覆盆 子4兩(120g)。
所有藥都可收納腎氣并且很溫。
我們還可以在《傷寒論》中加入兩個處方：
黃連阿膠湯：(寒、益 tonify 陰)
其中有：
黃連4兩(120g)，黃芩2兩(60g)，阿膠3兩(90g)，芍藥2兩(60g)，雞子黃2個。 這是五個處方中最寒的。
豬膚湯：(平、滋、陰)豬皮1斤(250g)，蜂蜜1升(200毫升)，小麥粉5合(90g)
氣陰兩虛： 這個類別的處方有益于陰和精，但也有不同方向上的流通性和移動能力。有許多 著名的處方可以達到這個效果，并解決各種各樣的案例。
金鎖固精丸
出自清代汪昂醫生的《醫方集解》
沙苑蒺藜2兩(60g)，芡實2兩(60g)——聚腎 蓮子2兩(60g)——聚脾
龍骨1兩(30g)，牡蠣1兩(30g)，蓮須2兩(60g)——單純聚 這個方子從內到外都有強烈的固澀作用，所有的藥都可以固澀精 在古代，它被用于非常虛弱的男性陽痿，慢性遺精和腰痛。
如果病人不是十分虛弱，不能控制和把持陰與精，但同時又有火，用知柏地黃丸。 天王補心丹
出自明代洪基醫生的《攝生秘剖》
這個方子有：
人參5錢(15g)，茯苓5錢(15g) 作用在氣分
生地4兩(120g),五味子5錢(15g),麥冬2兩(60g),天冬2兩(60g),柏子仁2兩(60g)， 酸棗仁2兩(60g)——作用在陰分
當歸2兩(60g),丹參5錢(15g),玄參5錢(15g)——作用在陰分 遠志5錢(15g),桔梗5錢(15g)——打開渠道 這個方子作用于中焦(氣血)和下焦(陰陽)。這是一個溫而闔在下焦，開中焦氣和血， 以行使陰之用。
天麻鉤藤飲 出自胡光慈醫生的《中醫內科雜病證治新義》=“對疾病治療的新認識”，成書 于 1958 年。
這個方子非常經典，雖被歸入“鎮肝熄風”的類別中，但它也有許多藥可以固澀 精。
它有：
石決明18g,朱茯神9g——礦物質具備向下降的力量； 梔子9g,黃芩9g 苦降，打開微循環。梔子也可以利尿；
益母草9g,杜仲9g,桑寄生9g,牛膝12g,夜交藤9g 溫，固精
天麻9g，鉤藤12g：強烈地降，清理多余的想法和恢復精神活力，保持頭腦清醒 總的來說，這個處方固精，在氣的層次有強烈的降的力量。如果精虛，神將不受 控制，這會導致頭痛，高血壓，失眠，焦慮...它常用于中年婦女。
代替梔子的藥，我們可以用味涼苦且向下開的藥，如菊花、夏枯草 如果有水腫，我們可以加：威靈仙、澤瀉、蒼術。 如果有氣虛，我們可以加：黃芪，黨參 如果有濕，我們可以加：防風，白芷，荊芥(基于“風能勝濕”的古老原理) 如果我們想要更好的鎮定安神醒腦的效果，我們可以用生鐵落。 在《黃帝內經》中，生鐵落被用于治療躁郁癥。它作用于氣分，不會損傷內部。 當歸六黃湯
出自《蘭室秘藏》，由李東垣醫生在金元(13-14世紀)撰寫
它有：
當歸，生地黃，熟地黃，黃芩，黃連，黃柏(每種藥物劑量均等，9-15g)，黃芪(雙 倍劑量)。
它與知柏地黃丸相似，但更苦更涼，聚陰和益)陰。 當歸在內部打開，黃芪在與其他藥并用時也會聚。這個方子并不常用。 石斛夜光丸
出自元代倪維德醫生的《原機啟微》=“回到體悟真理的機緣” 它有四組草藥：
人參2兩(60g)，茯苓2兩(60g),山藥7.5錢(23g)，甘草0.5兩(15g)——打開中焦并 補氣；
防風0.5兩(15g),菊花7.5錢(23g)(辛涼)，杏仁7.5錢(23g)(辛苦溫，開到表面和肺), 白蒺藜0.5兩(15g)(辛苦)，枳殼0.5兩(15g)(苦辛涼，作用在氣分)——這些草藥打 開表面并引導方子向上；
天冬2兩(60g),麥冬1兩(30g),熟地1兩(30g),生地1兩(30g),菟絲子7.5錢(23g)， 枸杞子7.5錢(23g),五味子0.5兩(15g),石斛0.5兩(15g),肉蓯蓉0.2兩(15g)—— 這些藥在精的層次工作，補腎陰和腎陽(“委中”)；
黃連0.5兩(15g),犀角0.5兩(15g),羚羊角0.5兩(15g)——苦涼藥向下行，作用于 血分。
這個方子經常被用于視力模糊，非常經典。古代觀點認為，視力問題大多數是由 于火造成的。它不一定是整個身體內部的火，它也可能是由于情緒問題引起的火， 或由于過度用眼(電腦，電視等)引起的“氣虛火”。最后一組藥(黃連，犀角，羚 羊角)從頭腦和經絡通道中清火。
第二組帶領處方向上。
除了視覺障礙，這個方子可以治療許多問題。 如果胃氣強，我們可以去掉第一組藥。
七寶美髯丹
出自清代汪昂醫生的《醫方集解》
它有：
何首烏(紅色和白色)各1斤(480g),茯苓8兩(240g),牛膝8兩(240g),枸杞子8兩 (240g),菟絲子8兩(240g),補骨脂4兩(120g)(補腎陽“激活丹田火”)，當歸8兩 (240g)
這是一個很溫的方子。
補骨脂，通過激活丹田內的火來協助其他藥物發揮聚合效果。如果沒有必要，我 們可以用五味子代替。
龔樹生教授(來自北京中醫藥大學藥理系)對這個方子進行了大量研究，得出的結 論是，可以幫助中年婦女應對荷爾蒙失調問題。它比六味地黃丸更有效。 烏梅丸
出自《傷寒論》(厥陰層次)
它有：
烏梅300個(480g),細辛6兩(180g),干姜10兩(300g),黃連16兩(480g),當歸4 兩(120g),附子6兩(180g),蜀椒4兩(120g),桂枝6兩(180g),人參6兩(180g),黃 柏 6 兩；(180g)
這個方子首先是闔：烏梅，附子，人參，干姜。 然后在下焦層次打開陽氣：細辛，桂枝，當歸。 黃連和黃柏(苦)鞏固了前幾味草藥的效果，它們并不是用來治療熱的。
根據它對應條文所描述的情況，發熱的問題不是由于存在邪氣而是由于嚴重陰虛， 這就導致了陽的外脫，由于陰陽失衡產生的熱量不能通過堵塞的渠道出去，所以 會導致喉嚨痛，為了治療它，我們需要收集和打開下焦層次。將所有藥物研磨成 粉末，然后用蜂蜜制成藥丸。每天服用 2-3 次，每次劑量為 9g。
攻讀碩士學位期間取得的學術成果
Acknowledgement
At first, I feel honored to express my greatest gratitude to my supervisor—Prof. Jianke Zhang with whose guidance I could have worked out this thesis. He has provided me with valuable ideas, suggestions and criticisms with his profound knowledge and rich research experience. His patience and kindness are greatly appreciated. Besides, He always gives high priority on our thesis writing and is willing to discuss with me anytime available. I have learnt from him a lot about thesis writing and the professional ethics. I am obliged to his efforts of helping me complete my thesis. Secondly, I would take the chance to thank professors who are professional TCM physicians in Jiangxi University of Traditional Chinese Medicine in Nanchang city. Without their proficiency in TCM, it would be impossible to finish this project. Last but not least, I would like to thank my family for their support all the way from the very beginning of my study. I am thankful to all my family members for their thoughtfulness and encouragement.
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