泰国中医师总会副会长 陈悦彬

 

Discussion on the Structure of TCM Prescriptions from the Perspective of Harmony between Man and Nature       


 

       陈悦彬中医师是广东省普宁市人，出身于中医世家，自幼好学中医，得祖父引导，在家乡施医赠药。后得名师指导，将阴阳学术理论：人体是个小天地运用到临床，天人合一辨证治病，经验丰富，侨居泰国3O余年，任泰国中医师总会副会长等职务；湖北中医药大学硕士；桐发中医院内科主任。

       中华文化，历史悠久，阴阳二字，变化生万物，天上阴阳是日月，地上阴阳是昼夜，人间阴阳是男女（夫妇）正配，四时阴阳是吉凶。混沌时代，天地未开，阴阳未判，天地朦胧，人文之始祖伏羲氏圣址大门写道：《一畵开天，文明笔始》，是天父地母带子媳[根据下文，为儿子和女儿，为保持行文统一，故将“子媳”翻译为“儿女”]之意。

       China is a country proud of its time-honored history. The changes of Yin and Yang breed everything in the universe, including the Sun and Moon as Yin and Yang in the sky, the day and night as Yin and Yang on the ground, men and women (couples) as Yin and Yang in the society, as well as the good or ill luck as Yin and Yang for the four periods in a day. In the era of chaos when the Heaven and the Earth had not been separated, Yin and Yang not identified and the universe not cleared, Chinese cultural ancestor Fu Xi wrote on his gate that "a line unveils the universe and initiates the civilization," which took the Heaven as father and the Earth as the mother, with their sons and daughters accompanied.
 

 

       龙马负图之处有点。一白六黑在背近尾。七白二黑在背近头。三白八黒在背之左。九白四黑在背之右。五白十黑在背之中。羲皇与大挠氏定以一六在下，合于北而生水，亥子属焉。二七在上，合于南而生火，巳午属焉。三八在左，合于东而生木，寅卯属焉。四九在右，合于西而生金，申酉属焉。五十在中，为土，而辰，戌，丑，未属焉。此八字地支之数所由始也，续自图南先生。慨易道之不明，乃以人生造葬，修整，嫁娶。年月日时支干配同洛书取数而后知天地所赋之厚薄及演五行变化阴阳，惟阴阳之错综是以大易之道灿然复明，祸福微分毫。毕着后之学者苟玩索，夫有得焉，则终身相之有不能尽者之矣。

       The chart was spotted on the back of the Dragon Horse. On the back, one white and six black spots were located near the tail, seven white and two black spots near the head, three white and eight black spots on the left side, nine white and four black spots on the right side, while five white and ten black spots in the center. Fu Xi and Da Nao cooperated together and located one white and six black spots below, which corresponded to the north and water and covered Hai and Zi; two black and seven white spots above, which corresponded to the south and fire and covered Si and Wu; three white and eight black spots left, which corresponded to the east and wood and covered Yin and Mao; four black and nine white spots right, which corresponded to the west and gold and covered Shen and You; five white and ten black spots in the center, which represented earth and covered Chen, Xu, Chou and Wei. From this originated the Earthly Branches in the Eight Characters, which was then continued by Mr. Tunan (the style name of Chen Tuan). Out of the intangibility of ideas in the Book of Changes, concrete principles were set up, such as those for the construction of resting places for the live and the dead, the repair and maintenance, as well as the wedding affairs. The Heavenly Stems and Earthly Branches in the Eight Characters were combined with the measure of the Inscription of the River Luo, thus distinguishing between the good and bad endowed by the Universe and deducing Yin-Yang changes in the Five Elements. The subtle changes of Yin and Yang revealed the brilliancy of the theory in the Book of Changes and finally allowed to get a glimpse of the weal and woe. The scholars of later generations tried their best to appreciate and explore, and part of the splendid whole would cost their lifelong hard work, though even this tiny part could not be thoroughly explained. 

 

       河图之用自北而东生旋而相生。然对待之位则北方一六水尅南方二七火，西方四九金尅东方三八木，而相尅者寓乎相生之中，盖造化之理，生而不尅，则生者无从而载，则其河图生尅之妙有如此乎。天一生水，地六成之。地二生火，天七成之。天三生木，地八成之。地四生金，天九成之。天五生土，地十成之。

       For the use of this chart, the clockwise rotation explained the generation of one from the predecessor. However, the opposite positions were restricted. Specifically, the north (one-six; water) restricted the south (two-seven; fire), and the west (four-nine; gold) restricted the east (three-eight; wood). Nevertheless, the relative restricted ones lay in relative generation, which explained the principle of creation: ceaseless generation without restriction would finally leave no room for new generation. How subtle the generation-restriction relationship in the chart is! The Heaven represented by one white spot bred water, and the Earth represented by six black spots completed it. The Earth represented by two black spots bred fire, and the Heaven represented by seven white spots completed it. The Heaven represented by three white spots bred wood, and the Earth represented by eight black spots completed it. The Earth represented by four black spots bred gold, and the Heaven represented by nine  white spots completed it. The Heaven represented by five white spots bred earth, and the Earth represented by ten black spots completed it.

 

       天河龟负书者，非龟也，其背所有之文。有一长畵，二短畵，一白点近尾，九紫点近头，二黑点在背之右，三碧点在背之左，六白点在足之右，四绿点在胁之左，七赤点在胁之右，五黄点在背之中，凡九而七色焉，于是则九位以定方，因一画近左而生爻，以一白近尾为坎，二黑在右肩属坤，左三碧属震，四绿在左肩属巽，六白近右足属干，七赤在右属兑，八白近左足属艮，九紫近头属离，五数属脾胃居中，此神龟出洛书之表象焉。大禹则洛书以钗畴，尤其中之五者立极也。一五行而二五事，三八政而四五纪，则各有钗而不乱矣，六二德而七稽疑，八庶微而九福极，则各有条而不紊矣。然三者有合焉。洛书而虚其中则太极也。奇偶各居二十则亦两则也。一二三四合九八七六纵横十五而五，为七八九六则亦四象也，四方之正为震兑坎离，四隅之宿为乾坤艮巽，则亦天卦也，山是洛书吉乃明。

       The so-called turtle bearing the inscription in the Celestial River was actually not a turtle,which carried lines and spots on its back. There were one long line,two short lines,one white spot near the tail, nine purple spots near the head, two black spots on the right shoulder,three greenish spots on the left back,six white spots on the right foot, four green spots on the left shoulder,seven red spots on the right trunk,five yellow spots in the back center.There were a total of seven colors in these nine regions,which were applied to identify the location.The one line was on the left and taken as trigram line;one white near the tail was defined as Kan (Water),two black spots on the right shoulder as Kun (Earth),three greenish spots on the left back as Zhen (Thunder),four green spots on the left shoulder as Xun (Wind),six white spots on the right foot as Qian (Heaven),seven red spots on the right trunk as Dui (Lake),eight white spots on the left foot as Gen (Mountain),nine purple spots near the head as Li (Fire),five spots representing the spleen and stomach in the center.This is the perceptual image for the Inscription of the River Luo borne by the sacred turtle.Based on the Inscription of the River Luo,Yu the Great set his Nine Principles;the center region represented by five spots was considered to be supreme:the first came the five elements,the second the five affairs,the third the eight administrations,and the fourth the five chronologies;these four ranked front and in definite order;the sixth came the three virtues,the seventh the resolution of suspicions, the eighth various symptoms,and the ninth the five fortunes and six misfortunes,which ranked behind and in good arrangement.Nevertheless, the three parts were,in fact,integrated. In the Inscription of the River Luo,the unoccupied center represented the Supreme Ultimate.Either the odd numbers or the even numbers counted twenty,which represented the two extremes.One,two,three,four corresponded to the nine, eight,seven,six;each row equaled to fifteen and could be divided as seven-eight or nine-six,which represented the four phenomena.The four straight directions were Zhen, Dui, Kan and Li,while the four inclined directions were Qian, Kun, Gen and Xun,which were also the eight trigrams. Here,the Inscription of the River Luo became clear in front of us. 

 

       洛书之序，自北而西，右辅而相尅，然对待之位，则东南四九金，生西北一六水，东北三八木，生西南二七火，而相生者已寓乎相尅之中。盖造化之理，尅而不生，则所尅者有时而间断，其洛书尅生之妙，有而此乎。戴九履一，左三右七，二四为肩，六八为足，五十居中。

       For the order of this inscription, the clockwise rotation indicated successive restriction. However, the opposite positions indicated successive generation. Specifically, the Four and Nine featured by attribute gold in the southeast generated the One and Six featured by attribute water in the northwest; the Three and Eight featured by attribute wood in the northeast generated the Two and Seven featured by attribute fire in the southwest. The relative generating ones lay in relative restriction, which explained the principle of creation: ceaseless restriction without generation would lead to the transitory and intermittent existence of the restricted ones. How subtle the restriction-generation in the inscription was! The location of the ten numbers were nine on the head and one on the tail, three on the left and seven on the right, two and four on the shoulders, six and eight on the feet, while five and ten in the center. 
 

       人禀天地，气属五行，氤氲交感，精血生成，此乃先天定位。人有六脉，左手心肝肾，右手肺脾命，各分三部九候。岐黄曰：“有下部，中部，有上部，部各有三候。三候者，有天，有地，有人也。必指而导之，乃以为真。”

       Human beings are endowed by the Heaven and Earth with their Qi belonging to the five elements; their interaction and communication leads to the generation of vital energy and blood. This is the congenital location. A person has six meridians with the left arm bearing the meridians of heart, liver and spleen and the right arm bearing the meridians of lung, spleen and lifeline, each of them is divided into three sections and nine divisions. The Yellow Emperor and Qi Bo divided them into "lower, middle and upper sections, and each section contained three divisions, i.e., the Heaven, the Earth and the Man. All they should be identified and guided to run in the normal way."

       夫人生于地，悬命于天，天地合气，命之曰人。是以一身之中有三部，一部之中而各有天地人。不知三部者，阴阳不别，天地不分，以实为虚，以邪为真，绝人长命，予人夭殃，故必扪循三部九候之盛虚而调之，乃以为刺法之真。

       Born on the earth with life suspended to the heaven, man is named when the Heaven and Earth join each other in harmony, which explains why there are Heaven, Earth and Man in each of the three sections. Without clear knowledge about the three sections, one cannot distinguish between Yin and Yang, Heaven and Earth; he might confuse deficiency and excess, evil and regularity, thus damage patients' life and bring them misfortune. Therefore, the treatment must be performed according to three sections and nine divisions, which should be taken as the standards for acupuncture.

       上部天，两额之动脉；在额頬分，上循于顶，足太阳膀胱脉也。太阳为诸阳主气，故主上部天。

       The upper section-Heaven corresponds to arteries beside foreheads; it is located at the boundary with the cheek and travels to the head top, known as the Urinary Bladder Meridian of Foot-Taiyang (Greater Yang). The Greater Yang dominates all different Yang Qi and therefore is taken the upper section-Heaven.

       上部地，两额之主脉；在鼻两旁，近于巨髎之分，足阳明胃脉也。二阳之气而主动，故为上部之地。

       The upper section-Earth corresponds to arteries beside foreheads; it is located on both sides of the nose and near the acupoint Juliao, known as the Stomach Meridian of Foot-Yangming. Qi of this meridian governs movement and therefore is taken the upper section-Earth.

       上部人，耳前之动脉；在耳前颊车下陷中，手太阳小肠脉也。夫心主血而小肠为之使，人之所以生成者，血脉也，故主上部人，此阳气之在上也。“天主气，足太阳诸 阳主气也；地应肉，足阳明胃土之主肌肉也；人主血脉，手太阳与少阴相为表里也。”

       The upper section-Man corresponds to arteries before the ears; it is located in the sunken area of the acupoint Jiache before the ears, known as the Small Intestine Meridian of Hand-Taiyang. The heart governs blood and the small intestine serves it; the life of human beings relies on blood circulation, which is thereby taken as the upper section-Man and implies the upper position of Yang Qi. "The Heaven governs Qi, so the Foot-Taiyang and other Yang govern Qi; the earth responds to the flesh, so the earth-attribute stomach of the Foot-Yangming governs muscles; the Man governs blood circulation, so the Hand-Taiyang and -Taiyin function as the exterior and interior."

       中部天，手太阴也；两手气口之动脉，手太阴脉也。五脏之应天者，肺。然脏为阴，故主中部天。“中部天，故能主周身之气。”

       The middle section-Heaven is the Hand-Taiyin; it corresponds to the radial artery touched at the position of Qikou (Pulse Point) and belongs to the Hand-Taiyin Meridian. Of the five internal organs, the lungs match the Heaven. This organ is defined as Yin and thereby taken as the middle section-Heaven. "The middle section-Heaven can govern the Qi circulation in the body. "

       中部地，手阳明也；在大指次指岐骨间，合骨之分，动应于手，手阳明大肠脉也，阳明居中土，故主中部地。

       The middle section-Earth is the Hand-Yangming; it is located at the acupoint Hegu, the bone juncture of the thumb and index finger; its movement can be reflected in the hand and belongs to the Large Intestine Meridian of Hand-Yangming. Since Yangming is positioned in the center and has the attribute of earth, it is taken as the middle section-Earth.

       中部人，手少阴也；在锐骨端之动脉，手少阴脉也。三以应人，人主血脉，心藏血脉之气，故主中部人。

       The middle section-Man is the Hand-Shaoyin; it is refers to the arteries at the end of capitulum ulnae and belongs to the Hand-Shaoyin Meridian. The third implies Man, which governs blood circulation. Since the heart stores the Qi of blood circulation, it is taken as the middle section-Man. 

       下部天，足厥阴也；在毛际之外，气冲下，五里之分，动应于手，足厥阴肝脉也。厥阴为阴中之少阳，主春生之气，故主下部天。

       The lower section-Heaven is the Foot-Jueyin; it is located beyond the suprapubic hair margin with Qi travelling downwards; with the position at the acupoint Wuli, its movement can be reflected in the hand and it belongs to the Liver Meridian of Foot-Jueyin. Jueyin acts as the lesser Yang in the Yin and governs spring-related Qi and thereby is taken as the lower section-Heaven. 

       下部地，足少阴也；在足内踝后，太溪之分，动脉应手，足少阴肾脉也。肾为牝脏而居下，故主下部地。

       The lower section-Earth is the Foot-Shaoyin; it is located behind the foot malleolus medialis and at the acupoint Taixi, with the artery corresponding to the hand; it belongs to the Kidney Meridian of Foot-Shaoyin. As the Yin organ, the kidneys are located below and thereby taken as lower section-Earth. 

       下部人，足太阴也；在鱼腹上越筋间，箕门之分，动脉应手，足太阴脾脉也；脾为阴脏而居中，故主下部人。

       The lower section-Man is the Foot-Taiyin; it is located above the acupoint Yufu, between tendons and at the acupoint Jimen, with the artery corresponding to the hand; it belongs to the Spleen Meridian of Foot-Taiyin. As the Yin organ, the spleen is located in the middle and thereby taken as lower section-Man. 

       故“下部之天以候肝，地以候肾，人以候脾胃之气。”此以下部之三候，以候膈下之三神脏焉。上部地以候阳明之气 ，所谓阳明者，胃之悍气，上冲头 目，循咽，上走孔窍，下客主人，合阳胃并下人迎，此胃气别走于阳明者也。所谓胃气者，乃水谷柔和之气，与阳热慓悍之气有别，故以下部之脾脉候之。然营卫气血，皆由胃气之所资生，故以脾脉兼候胃气，曰脾之本脉，亦可候胃气耶，此雌雄相应耳。先论从下而上，次论从上而下，此又从下而上，以见天地人三者，上下交互之妙，阳明悍气上定于头，阳明宗气积于胸中。

       Therefore, "the lower section-Heaven can be used for pulse-takings of the liver, the Earth for the kidneys, and the Man for the spleen and stomach. These three divisions work for the pulse-takings of the three spiritual viscera below the diaphragm. The upper section-Earth can be used for pulse-takings of the Qi of Yangming, which is the stomach's fierce Qi. It travels upwards to the head and eyes via the pharynx and ends in apertures; for the downwards direction to the acupoint Kezhuren, it integrates with stomach's Yang Qi and runs to the acupoint Renying. This stomach Qi deviates to the Qi of Yangming. The so-called stomach Qi is a kind of gentle Qi generated by water and grain, which differs from the fierce Qi featured by Yang heat. Therefore, it is diagnosed via the Spleen Meridian in the lower section. However, the four stages in the course of an epidemic febrile disease, namely, Ying, Wei, Qi and Xue, are all produced by stomach Qi, which explains why the Spleen Meridian is used to judge the stomach Qi. The fact that this intrinsic meridian of the spleen is also used to judge the stomach Qi is realized through a sort of correspondence between male and female natures. The first comes the direction from bottom up, then the direction from top down, and again the direction from bottom up, which demonstrates that the subtle interactions among the Heaven, Earth and Man. The fierce Qi of Yangming attacks the head while the pectoral Qi of Yangming is stored in the chest. 

       《中部之候奈何》，《亦有天，亦有地，亦有人。天以候肺，地以候胸中之气，人以候心》。肺属《干》金而主气，故天以候肺；心主血脉而居肺之下，故人以候心；胸中膻中也，宗气之所聚也。宗气者，阳明水谷之所资生，故地以候胸中之气。此以中部之三候，以候膻上之二神脏中土二形脏焉。“地以候胸中之气者，言中部之候，亦兼候阳明之胃气也。知三部之中，而皆有阳明之胃气焉。”大肠小肠皆于胃，故候大肠之脉，兼可以候胃气。太阳之脉下入缺盆，络肺则膈，故以候胸中。

       "What about the pulse-takings for the middle section?" "The middle section also contains the Heaven,Earth and Man, where the Heaven can be used for pulse-takings of the lungs, the Earth for Qi in the chest,and the Man for the heart."The lungs with the attribute gold governs Qi,which explains why it corresponds to the Heaven;the heart governs blood circulation and lies below the lungs,which explains why it corresponds to Man;pectoral qi gathers at the acupoint of Tanzhong in the chest and is produced by the water and grain featured Yangming, which explains why it corresponds to the Earth."The Earth can can be used for pulse-takings of Qi in the chest and reflect those symptoms of the middle section as well as the stomach Qi of Yangming.It can be thus known that the stomach Qi of Yangming exists in all three sections." Both the large intestine and the small intestine are associated with the stomach, so the pulse-taking of the large intestine can also be used to check the stomach Qi.The Meridian of Taiyang goes downwards to the supraclavicular fossa, connects the lungs and regulate the diaphragm, so its pulse-taking can diagnose the chest. 

       《上部以何候之》，《亦有天，亦有地，亦有人》。 《天以候头角之气，地以候口齿之气，人以候耳目之气》。太阳为诸阳主气，其经脉上额交巅，会于脑，出于颈，故天以候头角之气；足阳明之气，胃腑之所生也，其经脉起于鼻交頞中，上入齿中，还出夹口，环唇下，故地以候口齿之气；手太阳者，少阴心脏之腑也，其经脉上目锐眦，入耳中，为听宫，故人以候耳目之气，此以膺喉头首，以候三形脏焉。盖阳脏之气在上也。“阳明之脉，起于鼻交頞中，手太阳之脉抵鼻，是上部之三候，以候耳目口鼻之七窍者也，所谓七者，星也，星者，人之七窍也，合腰尻下窍，共为九窍，故曰其气九州九窍，皆通乎天气，人齿面目应星盖谓人面七孔，以应七星也”。天上星星数不清，惟有日月九星四余统摄三界四面八方。

       "What about the pulse-takings for the upper section?" "The upper section also contains the Heaven,Earth and Man." "The Heaven is used for the pulse-taking of Qi of head and foreheads, he Earth for Qi of mouth and teeth,and the Man for Qi of ears and eyes."The Taiyang dominates all Yang Qi,whose meridian travels upwards through the foreheads and head top,meets the brain and ends at the neck,which explains why the Heaven can work for the pulse-taking of Qi of head and foreheads.The Qi of Foot-Yangming is generated by the stomach;its meridian starts from the acupoint of Bijiao'ezhong,travels upwards to the teeth, come out via the corner of the mouth and then runs downwards along the lips, which explains why the Earth can work for the pulse-taking of Qi of mouth and teeth.The Hand-Taiyang is associated with the heart of Shaoyin.This meridian travels upwards to the outer corner of lids and then into the ears to the acupoint Tinggong,which explains why the Man can work for the pulse-taking of Qi of ears and eyes. They covers the chest, throat and head and can work for the pulse-takings of the three physical viscera,because Qi of the Yang organs stays above. "The Meridian of Yangming starts from the acupoint of Bijiao'ezhong;the Meridian of Hand-Taiyang reaches the nose and works for the pulse-takings of the three divisions of the upper section,which specifically includes the seven apertures, i.e. ears, eyes, mouth and nose.These seven apertures are considered as stars;the addition of the two apertures below human waist makes the number to nine, which represents the nine continents and the communication with the Qi of nature. The state that human teeth,face and eyes corresponds to stars actually refers to the seven apertures that correspond to the seven stars."Though there are countless stars in the sky,the true rulers of the three realms and all directions are only nine stars like the Sun and the Moon and the four spare stars. 

       加味理中汤主治寒客中焦（张仲景）方，温中除寒，治理中焦脾胃虚寒作用。炙甘草二钱，人参一钱，或代（党参三钱），白术三钱，黑干姜一钱半，加炮附子五分，肉桂五分。人参补气益脾，白术健脾燥湿，炙甘草和中补脾，黑干姜温胃散寒，附子温胃去寒，肉桂温脾阳，所以合起来治疗由于脾胃受寒邪所伤，发生呕吐，下痢，腹痛，口不渴等中焦阳虚寒盛症候。脾胃虚寒累及肺金，于是木乘土虚，水旺土垮；方用人参（君）生土之气，树立纲纪，明照四方得以温朐周身！白术（臣）健脾燥湿，黑干姜，附子（臣）温胃去寒，肉桂（佐）温脾阳，升地气，甘草（臣）和中补脾以制水流，肺（使）受君相二（火），臣（土）之权以制木煞（肝）。中医结构用药是隔一位，疗二位也，方药虽简，效验如神。究一理而察 万端，明片言以通万物。

       Modified Center-Rectifying Decoction is a prescription made by Zhang Zhongjing and used to treat the Middle Burner attacked by cold. It can warm the center to remove cold,thus exerting an effect of regulating deficiency-cold of the spleen and stomach in the Middle Burner.The composition includes 10g of fried licorice root,5g of ginseng (or replaced with 15g of radix codonopsis),15g of atractylodes macrocephala Koidz.,7.5g of black dried ginger,2.5g of radix aconiti praeparatae,and 2.5g of cinnamon.Of them, ginseng can nourish Qi and benefit the spleen,atractylodes macrocephala Koidz.can invigorate the spleen and eliminate dampness,fried licorice root can regulate the middle warmer and replenish the spleen,black dried ginger can warm the stomach and dispel cold,radix aconiti can warm the stomach and remove cold,and cinnamon can warm the spleen Yang.With their synergistic effect,this prescription can be used to treat the Yang-deficiency and cold-excess syndrome in the Middle Burner,which is caused by the pathogenic cold attacking the spleen and stomach and manifested with vomiting,diarrhea, abdominal pain, and no desire for drinking. The deficiency-cold of the spleen and stomach may involve the lungs featured by attribute gold,leading to the excess of wood and deficiency of earth and further the flourishing of water and the fall of earth.In the prescription, ginseng (as the monarch) can breed Qi of attribute earth and establish the discipline,thus emitting warm through the whole body! Atractylodes macrocephala Koidz.(as the servant) can invigorate the spleen and eliminate dampness;black dried ginger and radix aconiti (as the servants) can warm the stomach and remove cold;cinnamon (as the assistant) can warm the spleen Yang and ascending the Qi of earth attribute;licorice root (as the servant) can regulate the middle warmer and replenish the spleen to control water circulation; with the monarch and ministerial fires and the power of servant (earth),the lungs can suppress the wood evil (liver).The structure of TCM medication gives the highest priority to isolation and then to treatment. The prescription may be simple,but its effect can be surprising. Therefore,the adherence to one universe principle helps to clarify various specific embodiments,and the grasp of one truth helps to understand multifarious phenomena. 

       《参考文献》：《黄帝内经 ，素问》、《易经》。

        References: The Inner Canon of Huangdi; Plain Questions; Book of Changes.