\r附足三里穴图\pt68a16.bmp\r
三里二穴。图经云。土也。在膝下三寸。 骨外廉。两筋间当举足取之。类经云。坐而竖膝低跗取之。足阳明之所
入。为合。可刺五分。留七呼。此穴主泻胃中之热。天星秘诀云。兼期门。治伤寒过经。不出汗增治法云。治热病汗不
出。喜呕。口干并宜针。不宜灸。
以上太阳病传入阳明经可刺证一条。（自原论中第二卷太阳治法上集附于此）
资生经云风池治伤寒头痛。又主烦满汗不出又主温病汗不出。目眩。苦头疼。
琥按上主疗云云。此必是太阳头痛也。仲景云。太阳病。初服桂枝汤。反烦不解者。先刺两风池。又主温病汗不
出。愚以春气多温。此即是春时伤寒也。又主目眩苦头疼。此必是太少合病。以足太阳之脉。起目内 。少阳之脉。起
目锐 故也。
千金方云。江南诸师。秘仲景要方不传。灸法。初得病。或先头痛。身寒热。或涩涩。欲守火或腰背强直。面目如
饮酒状。此伤寒一二日。但烈火灸两风池。又肝俞百壮。
琥按上灸法。大误之极。彼孙氏岂以涩。涩守火为真寒证邪。夫曰头痛。面目如饮酒状。其为热病无疑矣。热病
用灸法。是以火济火。此与仲景法。大相背谬而千金录之。其害多矣。
类经云风府主伤风头痛。项急。不得回顾。目眩。反视。一云。主泻胸中之热。又云。阳明二日寻风府。
琥按上主疗云。伤风头痛。当即是仲景云。太阳中风证也。太阳者。经名巨阳。巨阳者。诸阳之属也。其脉连于
风府。故云。治项急等证。又云。主泻胸中之热。胸中者。胃之部分。故云阳明二日。寻风府也。仲景但云太阳病。服
桂枝汤后。反烦不解。刺风池风府。今则兼主阳明。以泻胸中之热。谓非发仲景未发之旨邪。
资生经云。期门治妇人伤寒。过经不解。当针期门使经不传。
琥按仲景法。刺期门。但治妇人热入血室。兹则兼治妇人伤寒。过经不解。此为善用仲景之法者矣。
许学士治一妇人患伤寒。热入血室。医者不识。用补血调气药。治之数日。遂成血结胸。许公曰。小柴胡已迟。不
可行也。无已。刺期门穴。予不能针请善针者针之。如言而愈。或问热入血室。何为而成结胸也。许曰。邪气传入经络。
与正气相搏。上下流行。遇经水适来适断。邪气乘虚。入于血室。血为邪所迫。上入肝经。肝受邪。则谵语而见鬼。复
入膻中。则血结于胸矣。妇人平居血养肝。犹水养木。方未受孕。则下行之为月水。既孕则中蓄之以养胎。及已产。则
上壅之以为乳。皆血也。今邪逐血并归于肝经。聚于膻中。结于乳下。故手触之则痛。非药可及。故当刺期门也。
琥按上许氏云云。实发仲景未发之义。仲景论妇人热入血室证。但云胸胁下满。如结胸状。此则直云。聚于膻中。
结于乳下。以手触之则痛。遂成血结胸。学人试为思之。此与仲景用大小陷胸汤之结胸。其状何别。余曾细审其证。仲
景云。结胸者。乃邪热乘虚而入于府。故以手按之。其痛在胃脘之中。许氏云血结胸。乃邪热乘虚而入于经脉。其痛止
在两乳之下。是以别也。且仲景言妇人中风。热入血室。第二条证云。其血必结。此是血尚未结也。法当用小柴胡主之。
今者许氏所云即仲景言妇人中风。热入血室。第一条证。为血既结。故云小柴胡已迟。当刺期门。此非深探仲景论中之
理。其孰能知之。
资生经云。大椎。主伤寒热盛烦呕类经一云。能泻胸中之热。
琥按仲景云。刺大椎。治头项强痛。眩冒。时如结胸。心下痞硬。此则云。热盛烦呕。又能泻胸中之热。大都是
太阳邪热未尽。欲传阳明。故胸中热作烦呕。刺大椎者。谓能泄太阳之邪热。使不传阳明。病可自愈故也。
千金方云。诸烦热时气温病。灸大椎百壮。刺三分泻之。
（按先灸后刺。是引热气入经络矣。岂不大误。）
类经云肺俞。肝俞。俱主泻五脏之热。
琥按经云刺中肺。三日死。中肝。五日死。二穴宁勿刺之。若虚寒病。用灸法。则甚稳。
附足三里穴图
足三里有两个穴位。《图经》记载：属土。位于膝盖下方三寸，胫骨外侧边缘，两筋之间，抬起脚时取穴。《类经》记载：坐着并竖起膝盖，脚背放低时取穴。这是足阳明胃经的合穴，可针刺五分深，留针七次呼吸的时间。此穴主要用来泻除胃中的热邪。《天星秘诀》记载：配合期门穴，治疗伤寒病经过传变周期后仍不出汗的情况。《增治法》记载：治疗热病汗不出、喜欢呕吐、口干等症状，都适宜针刺，不适宜艾灸。
以上是一条关于太阳病传入阳明经时可进行针刺治疗的证候。（从原论第二卷太阳治法中收集并附于此）
《资生经》记载：风池穴治疗伤寒引起的头痛。又主治烦闷、汗不出；又主治温病汗不出、目眩、剧烈头痛。
王琥按：上述主治症状，这必定是太阳经头痛。张仲景说：太阳病，初次服用桂枝汤后，反而出现烦闷不解的症状，应当先针刺双侧风池穴。又主治温病汗不出。我认为春季气候多温热，这即是春季的伤寒病。又主治目眩、剧烈头痛，这必定是太阳与少阳合病。因为足太阳膀胱经的脉气起于目内眦，足少阳胆经的脉气起于目外眦的缘故。
《千金方》记载：江南地区的各位医师，将张仲景的要方保密而不传授。灸法方面：刚得病时，或者先出现头痛、身体寒热交替，或者感觉涩滞不适、想要靠近火源取暖，或者腰背强直僵硬，面目红赤如同饮酒后的样子。这是伤寒发病的一两天内，应当用烈火灸双侧风池穴，再灸肝俞穴一百壮。
王琥按：上述灸法，错误至极。孙思邈难道认为那种涩滞、想守着火的感觉是真寒证吗？既然提到头痛、面目红赤如饮酒状，这无疑是热病。热病使用灸法，是以火助火，这与张仲景的方法大相径庭而违背。《千金方》收录了这种方法，危害很大。
《类经》记载：风府穴主治伤风头痛、项部拘急、不能回顾、目眩、反张直视。另一种说法：主治泻除胸中的热邪。又说：阳明病第二天寻找风府穴。
王琥按：上述主治症状，伤风头痛，应当就是张仲景所说的太阳中风证。太阳经，经脉名称为巨阳。巨阳，是诸阳经的统领。其脉气连接于风府，所以说治疗项部拘急等证候。又说：主治泻除胸中的热邪。胸中，是胃所属的部位，所以说阳明病第二天，寻找风府穴。张仲景只说太阳病，服用桂枝汤后，反而烦闷不解，针刺风池和风府。现在则兼治阳明经，以泻除胸中的热邪，这难道不是阐发张仲景未曾阐发的旨意吗？
《资生经》记载：期门穴治疗妇人伤寒，病过传变周期仍未解除。应当针刺期门穴，使病邪不再传变。
王琥按：张仲景的方法中，针刺期门穴，只治疗妇人热入血室。这里则兼治妇人伤寒，病过传变周期仍未解除，这是善于运用张仲景方法的人啊。
许学士治疗一位患伤寒的妇人，热入血室。医生不认识此证，使用补血调气的药物，治疗数日后，遂形成血结胸。许公说：小柴胡汤已经迟了，不可再使用了。不得已，针刺期门穴。我（许学士自称）不会针灸，请擅长针灸的人来针刺。按照这个方法治愈了。有人问：热入血室，为什么会形成结胸呢？许公说：邪气传入经络，与正气相搏争，上下流行，遇到月经刚好来潮或刚断绝，邪气乘虚而入，进入血室。血液被邪气逼迫，向上进入肝经。肝脏受邪，就会谵语、看见鬼怪。再次进入膻中，血液就凝结在胸部了。妇人在平时，血液滋养肝脏，就像水滋养树木一样。在未受孕时，血液下行成为月经；既已受孕，则蓄积在中部以滋养胎儿；及至产后，则上壅化为乳汁，这些都是血。现在邪气追逐血液，并归于肝经，聚集于膻中，凝结在乳下，所以手触摸时会疼痛，药物无法到达，所以应当针刺期门穴。
王琥按：上述许氏的说法，确实阐发了张仲景未曾阐发的义理。张仲景论述妇人热入血室证，只说胸胁下满，像结胸的样子。这里则直接说：聚集于膻中，凝结在乳下，用手触摸则痛，遂成血结胸。学者们试着思考一下。这与张仲景使用大小陷胸汤治疗的结胸，症状有什么区别呢？我曾仔细审察这个证候。张仲景说：结胸证，是邪热乘虚而入于腑，所以用手按压，疼痛在胃脘之中。许氏说血结胸，是邪热乘虚而入于经脉，疼痛只在两乳之下。这就是区别所在。而且张仲景言妇人中风，热入血室，第二条证候说：其血必结，这是血尚未凝结的状态。治法应当用小柴胡汤主之。现在许氏所说的情况，即张仲景言妇人中风，热入血室的第一条证候，是因为血已经凝结，所以说小柴胡汤已经迟了，应当针刺期门穴。这不是深入探求张仲景论著中的道理，谁能知道这些呢？
《资生经》记载：大椎穴，主治伤寒热盛、烦闷呕吐。《类经》一种说法：能泻除胸中的热邪。
王琥按：张仲景说：针刺大椎，治疗头项强痛、眩晕冒昧、时常像结胸、心下痞硬。这里说：热盛烦闷呕吐，又能泻除胸中的热邪。大都是太阳经邪热未尽，欲传向阳明经，所以胸中热作导致烦闷呕吐。针刺大椎，是说能够泄除太阳经的邪热，使其不传向阳明经，病就可以自愈了。
《千金方》记载：各种烦热、时气、温病，灸大椎穴一百壮。针刺三分，用泻法。
（按：先灸后刺，是将热气引入经络了，岂不大大错误。）
《类经》记载：肺俞穴、肝俞穴，都主治泻除五脏的热邪。
王琥按：经文说：刺中肺，三天死；刺中肝，五天死。这两个穴位宁可不要针刺。如果是虚寒病，使用灸法，则非常稳妥。
Appendix: Diagram of Zusanli (ST36) Acupoint
There are two Zusanli (ST36, Three Li) acupoints. *Tu Jing* (Illustrated Classic) states: It belongs to Earth. It is located three cun below the knee, on the lateral margin of the tibia, between the two tendons; it should be located by lifting the foot. *Lei Jing* (Classified Classic) states: It should be located while sitting with the knee upright and the dorsum of the foot lowered. It is the He-Sea point where the Foot-Yangming Stomach Meridian enters. It can be needled to a depth of five fen, and retained for seven breaths. This acupoint primarily serves to drain heat from the stomach. *Tian Xing Mi Jue* (Secrets of the Heavenly Star) states: When combined with Qimen (LR14), it treats Shanghan (Cold Damage) that has passed its transmission cycle but still fails to sweat. *Zeng Zhi Fa* (Supplementary Treatment Methods) states: It treats febrile diseases with anhidrosis, frequent retching, and dry mouth; acupuncture is suitable, while moxibustion is not.
The above is one indication for acupuncture when Taiyang disease transmits into the Yangming meridian. (Collected from Volume 2 of the original treatise on Taiyang treatment methods and appended here.)
*Zi Sheng Jing* (Classic of Nourishing Life) states: Fengchi (GB20, Wind Pool) acupoint treats headache caused by Shanghan. It also mainly treats irritability and fullness with anhidrosis; it also mainly treats febrile diseases with anhidrosis, vertigo, and severe headache.
Wang Hu notes: Regarding the aforementioned indications, this must be Taiyang headache. Zhang Zhongjing said: In Taiyang disease, if after initially taking Guizhi Tang (Cinnamon Twig Decoction), there is反而 (instead) irritability without resolution, one should first needle both Fengchi (GB20) acupoints. It also treats febrile diseases with anhidrosis. I believe that spring qi is often warm; this is essentially Shanghan occurring in spring. It also treats vertigo and severe headache; this must be a concurrent disease of Taiyang and Shaoyang. This is because the Foot-Taiyang Bladder Meridian originates at the inner canthus of the eye, and the Foot-Shaoyang Gallbladder Meridian originates at the outer canthus of the eye.
*Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) states: Various masters in Jiangnan kept the essential prescriptions of Zhang Zhongjing secret and did not transmit them. Regarding moxibustion methods: At the initial onset of disease, or if headache appears first, accompanied by alternating chills and fever, or a sensation of stagnation and desire to stay near fire, or stiffness and rigidity of the waist and back, and a face red as if intoxicated. This occurs within one or two days of Shanghan. One should use intense fire to moxa both Fengchi (GB20) acupoints, and then moxa Ganshu (BL18, Liver Shu) acupoint for one hundred zhuang.
Wang Hu notes: The aforementioned moxibustion method is extremely erroneous. Did Mr. Sun [Si Miao] consider the sensations of stagnation and desire to stay near fire as signs of true cold syndrome? Since headache and a face red as if intoxicated are mentioned, this is undoubtedly a heat disease. Using moxibustion for a heat disease is using fire to assist fire. This is greatly contrary to the methods of Zhang Zhongjing. That *Qian Jin Fang* records this causes much harm.
*Lei Jing* (Classified Classic) states: Fengfu (GV16, Wind Mansion) acupoint treats headache due to wind injury, neck stiffness, inability to look back, vertigo, and retroversion of the eyes. Another view states: It treats draining heat from the chest. It also says: On the second day of Yangming disease, seek the Fengfu acupoint.
Wang Hu notes: Regarding the aforementioned indications, headache due to wind injury should be what Zhang Zhongjing calls the Taiyang Wind Strike syndrome. Taiyang is the meridian name Ju Yang (Giant Yang). Ju Yang refers to the affiliation of all Yang meridians. Its meridian connects to the Fengfu acupoint, hence it is said to treat neck stiffness and other syndromes. It also says: It treats draining heat from the chest. The chest is the region belonging to the stomach, hence it is said that on the second day of Yangming disease, one seeks the Fengfu acupoint. Zhang Zhongjing only stated that in Taiyang disease, if after taking Guizhi Tang there is irritability without resolution, one needles Fengchi and Fengfu. Now it also treats Yangming, to drain heat from the chest. Is this not expounding upon the principles Zhang Zhongjing had not yet expounded?
*Zi Sheng Jing* (Classic of Nourishing Life) states: Qimen (LR14, Period Door) acupoint treats women with Shanghan that has passed its transmission cycle without resolution. One should needle Qimen to prevent further transmission.
Wang Hu notes: In Zhang Zhongjing's methods, needling Qimen treats only "Heat Entering the Blood Chamber" in women. Here it additionally treats women with Shanghan that has passed its transmission cycle without resolution. This demonstrates someone who skillfully applies Zhang Zhongjing's methods.
Scholar Xu treated a woman suffering from Shanghan with Heat Entering the Blood Chamber. The physician failed to recognize the condition and used blood-nourishing and qi-regulating medicines. After several days of treatment, it developed into Blood Binding Chest Syndrome (Xue Jie Xiong). Scholar Xu said: Xiaochaihu Tang (Minor Bupleurum Decoction) is now too late and cannot be used. If forced, needle the Qimen (LR14) acupoint. I am unable to needle; please ask a skilled practitioner to do so. Following this advice, she was cured. Someone asked: Why does Heat Entering the Blood Chamber result in Chest Syndrome? Scholar Xu said: The pathogenic factor enters the collaterals and struggles with healthy qi, circulating up and down. If it encounters menstruation just starting or just ending, the pathogen takes advantage of the deficiency and enters the Blood Chamber. The blood is forced by the pathogen to ascend into the Liver Meridian. When the Liver is affected by the pathogen, delirium and hallucinations occur. If it re-enters the Danzhong (Conception Vessel area/Chest), the blood binds in the chest. Normally, women's blood nourishes the Liver, like water nourishing wood. Before pregnancy, blood descends as menstrual flow; during pregnancy, it is stored centrally to nourish the fetus; after childbirth, it ascends to become milk. All are forms of blood. Now, the pathogen chases the blood, which returns to the Liver Meridian, gathers at Danzhong, and binds below the breasts. Thus, touching it causes pain. Medicine cannot reach it, so one must needle Qimen.
Wang Hu notes: The aforementioned statements by Scholar Xu truly expound upon meanings Zhang Zhongjing had not expounded. Zhang Zhongjing's discussion on Heat Entering the Blood Chamber in women only mentions fullness under the chest and hypochondrium, resembling Chest Syndrome. Here it directly states: Gathering at Danzhong, binding below the breasts, causing pain upon touch, thus forming Blood Binding Chest Syndrome. Scholars should ponder this. How does this differ from the Chest Syndrome treated by Zhang Zhongjing using Da Xie Xiong Tang (Major Draining the Chest Decoction) or Xiao Xie Xiong Tang (Minor Draining the Chest Decoction)? I have carefully examined the syndrome. Zhang Zhongjing said: In Chest Syndrome, pathogenic heat enters the Fu organs due to deficiency; thus, upon palpation, the pain is in the epigastrium. Scholar Xu said Blood Binding Chest Syndrome results from pathogenic heat entering the meridians due to deficiency; the pain is confined to below the breasts. This is the distinction. Furthermore, regarding the second syndrome description of Women's Wind Strike with Heat Entering the Blood Chamber in Zhang Zhongjing, it says "the blood will bind," indicating the blood has not yet bound. The method should employ Xiaochaihu Tang. What Scholar Xu describes corresponds to the first syndrome description of Women's Wind Strike with Heat Entering the Blood Chamber in Zhang Zhongjing, where the blood has already bound. Hence he says Xiaochaihu Tang is too late and one should needle Qimen. Unless one deeply explores the principles in Zhang Zhongjing's treatise, who could know this?
*Zi Sheng Jing* (Classic of Nourishing Life) states: Dazhui (GV14, Great Vertebra) acupoint mainly treats severe heat in Shanghan, irritability, and vomiting. One version of *Lei Jing* states: It can drain heat from the chest.
Wang Hu notes: Zhang Zhongjing said: Needling Dazhui treats stiff and painful head and neck, vertigo, occasional sensation of Chest Syndrome, and hardness below the heart. Here it states: Severe heat, irritability, and vomiting, and ability to drain heat from the chest. This is mostly due to residual pathogenic heat in the Taiyang meridian attempting to transmit to Yangming, causing heat in the chest leading to irritability and vomiting. Needling Dazhui means it can vent the pathogenic heat of Taiyang, preventing transmission to Yangming, allowing the disease to heal spontaneously.
*Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) states: For various irritations, heat, seasonal epidemics, and febrile diseases, moxa Dazhui (GV14) for one hundred zhuang. Needle three fen and use the reducing method.
(Note: Moxibustion followed by needling introduces heat qi into the meridians. Is this not a great error?)
*Lei Jing* (Classified Classic) states: Feishu (BL13, Lung Shu) and Ganshu (BL18, Liver Shu) acupoints both treat draining heat from the five Zang organs.
Wang Hu notes: The classics state: If one pierces the Lung, death occurs in three days; if one pierces the Liver, death occurs in five days. These two acupoints should preferably not be needled. If treating deficiency-cold syndromes, using moxibustion is very safe.