或曰∶食盛填塞于胸中,胸中为之窒塞也,令吐以去其所伤之物,物去则安。胸中者,太阴肺之分野;
木郁者,遏于厥阴肝木于下,故以吐伸之,以舒畅阳和风木之气也,此吐乃泻出太阴之塞。何谓木郁?请闻
其说。答曰∶此大神灵之间,非演说大道,不能及于此。
天地之间,六合之内,惟水与火耳!火者阳也,升浮之象也,在天为体,在地为用;水者阴
也,降沉之象也,在地为体,在天为殒杀收藏之用
也。其气上下交,则以成八卦矣。以医书言之,则是升浮降沉,温凉寒热四时也,以应八卦。若天火
在上,地水在下,则是天地不交,阴阳不相辅也,是万物之道,大《易》之理绝灭矣,故经言独阳不生,
独阴不长,天地阴阳何交会矣?故曰阳本根于阴,阴本根于阳,若不明根源,是不明道。故六阳之气生
于地,则曰阳本根于阴。以人身言之,是六腑之气,生发长散于胃土之中也。既阳气鼓舞万象有形质之物
于天,为浮散者也;物极必反,阳极变阴,既六阳升浮之力在天,其力尽,是阳道终矣,所以鼓舞六
阴有形之阴水在天,在外也。上六无位,必归于下,此老阳变阴之象也,是五脏之源在于天者也。
天者,人之肺以应之,故曰阴本源于阳,水出高源者是也。人之五脏,其源在肺,肺者背也,背在天也,
故足太阳膀胱寒生长,其源在申,故阴寒自此而降,以成秋收气寒之渐也。降至于地下,以成冬藏,
伏诸六阳在九泉之下者也。故五脏之气生于天,以人身,是五脏之气,收降藏沉之源出于肺气之
上,其流下行,既阴气下行沉坠,万化有形质之物皆收藏于地,为降沉者也;物极必反,阴极变阳,既六
阴降沉之力在地,其力既尽,是阴道终矣,是老阴变阳,乃初九无位,是一岁四时之气,终而复
始,为上下者也,莫知其纪,如环无端。
且太阴者,肺金收降之气,当居下体,今反在于上,抑遏厥阴风木反居于下,是不得上升也,故曰
木郁,故令其吐出窒塞有形土化之物,使太阴秋肺收于下体,复其本以衰之,始上升手足厥阴之木,元
气以伸,其舒畅上升之志得其所矣。又况金能克木,以吐伐之,则金衰矣。金者,其道当降,是塞因塞
用,归其本矣。居于上则遏其木,故以吐伸之,乃泻金以助木也。遍考《内经》中所说木郁则达之之义,
止是食伤太阴有形之物,窒塞于胸中,克制厥阴木气伏潜于下,不得舒伸于上,止此耳,别无异说,以六
淫有余运气中论之。仲景《伤寒论》云∶懊 烦躁不得眠,不经汗下,谓之实烦,瓜蒂散主之;曾经妄
汗、妄吐、妄下,谓之虚烦者,栀子豉汤主之。
老夫欲令医者治阴阳之证,补泻不至错误,病家虽不知医,明晓所得之病,当补当泻之法,将《黄帝针
经》第二卷第五篇说形气有余不足当补当泻之理,录之于前,予自注者附之。
“黄帝曰∶形气之逆顺奈何?岐伯答曰∶形气不足,病气有余,是邪胜也,急当泻之;形气有余,
病气不足,急当补之。形气不足,病气不足,此阴阳气俱不足也,不可刺之;刺之则重不足,重不足则
阴阳俱竭,血气皆尽,五脏空虚,筋骨髓枯,老者绝灭,壮者不复矣。形气有余,病气有余,此谓阴阳俱有余也,
急泻其邪,调其虚实。故曰有余者泻之,不足者补之,此之谓也。
“故曰∶刺不知逆顺,真邪相搏,满者补之,则阴阳四溢,肠胃充廓,肝肺内 ,阴阳相错;虚而泻
之,则经脉空虚,血气枯竭,肠胃HT 辟,皮肤薄着,毛腠夭焦,予之死期。故曰∶用针之要,在于知调阴
与阳;调阴与阳,精气乃光,合形与气,使神内藏。
故曰∶上工平气,中工乱脉,下工绝气危生。故曰∶下工不可不慎也,必审五脏变化之病,五脉之
应,经络之实虚,皮肤之柔粗,而后取之也。”
圣人垂慈之心已详矣,不合立言。老夫诚恐市
井庄农山野间人,不知文理,故以俚语开解之云。但病来潮作之时,病气精神增添者,是为病气有余,乃
邪气胜也,急泻之,以寒凉酸苦之剂;若病来潮作之时,神气困弱者,为病气不足,乃真气不足也,急补
之,以辛甘温热之剂。不问形气有余并形气不足,只取病气有余不足也,不足者补之,有余者泻之。假令病
气有余者,当急泻之,以寒凉之剂,为邪气胜也;病气不足者,急当补之,以辛甘温热之剂,此真气不足也。
夫形气者,气,谓口鼻中气息也;形,谓皮肤筋骨血脉也。形胜者为有余,消瘦者为不足。其气者,
审口鼻中气,劳役如故,为气有余也;若喘息气促气短,或不足以息者,为不足也。故曰形气也,乃人之
身形中气血也,当补当泻,全不在于此,只在病势潮作之时,病气增加者,是邪气胜也,急当泻之;如潮
作之时,精神困弱,语言无力,及懒语者,是真气不足也,急当补之。若病患形气不足,病来潮作之时,
病气亦不足,此乃阴阳俱不足也。禁用针;宜补之以甘药,不可以尽剂;不灸弗已,脐下一寸五分气海穴是也。
凡用药,若不本四时,以顺为逆。四时者,是春升、夏浮、秋降、冬沉,乃天地之升浮化降沉,化
者,脾土中造化也,是为四时之宜也。但宜补之以辛甘温热之剂,及味之薄者,诸风药是也,此助春夏之升
浮者也,此便是泻秋收冬藏之药也,在人之身,乃肝心也;但言泻之以酸苦寒凉之剂,并淡味渗泄之
药,此助秋冬之降沉者也,在人之身,是肺肾也。用药者,宜用此法度,慎毋忽焉!
有人问道:“饮食积滞充塞于胸中,导致胸中窒闷堵塞,此时令患者呕吐以排出损伤之物,物去则身体安宁。胸中,是太阴肺经所主的区域;木气郁结,是因为厥阴肝木之气在下受到遏制,所以用催吐的方法来舒展它,以畅达阳气、调和风木之气,这吐法实际上是泻出太阴的壅塞。什么是木郁?请听其解说。”回答说:“这是深奥灵妙的道理,如果不阐述大道的真谛,无法触及此境界。
天地之间,六合之内,唯有水与火罢了!火属于阳,具有上升和浮散的特性,在天表现为本体,在地表现为功用;水属于阴,具有下降和沉降的特性,在地表现为本体,在天表现为肃杀收藏的功用。水火二气上下交通,从而形成八卦。从医书的角度来看,这就是升浮降沉、温凉寒热四时变化,以对应八卦。如果天火在上,地水在下,则是天地不交,阴阳不能相辅相成,万物的生长之道和大《易经》的道理就断绝了。所以经文说‘独阳不生,独阴不长’,天地阴阳如何交会呢?所以说阳本源于阴,阴本源于阳,如果不明白根源,就是不明白道。因此六阳之气生于地,就说阳本根于阴。以人体而言,就是六腑之气在胃土中生发、长养、散布。既然阳气鼓舞万象有形质的物体在天,成为浮散的状态;物极必反,阳极变阴,既然六阳升浮之力在于天,当这种力量耗尽,阳道也就终结了,所以鼓舞六阴有形之阴水在天、在外。上六爻无位,必然归于下,这是老阳变阴的现象,说明五脏之源在于天。天,对应人的肺,所以说阴本源于阳,所谓‘水出高源’即是此理。人的五脏,其源头在肺,肺位于背部,背属天,所以足太阳膀胱的寒生、长养,其源头在申(地支),所以阴寒从此而降,形成秋收气寒的渐进过程。降至地下,形成冬藏,潜伏于九泉之下的六阳之中。所以五脏之气生于天,以人体而言,就是五脏之气收降、藏沉的源头出于肺气之上,其气流向下行,既然阴气下行沉坠,万物有形质的物体都收藏于地,成为降沉的状态;物极必反,阴极变阳,既然六阴降沉之力在于地,当这种力量耗尽,阴道也就终结了,这是老阴变阳,乃初九爻无位,是一岁四时之气,终而复始,为上下循环,没有尽头,如环无端。
况且太阴是肺金收降之气,应当居于下体,现在反而居于上,抑制遏止厥阴风木反而居于下,使其不得上升,所以叫作木郁。因此令其吐出窒塞的有形土化之物,使太阴秋肺收于下体,恢复其本性以削弱其亢盛,从而使手足厥阴之木得以伸展,元气得以伸张,其舒畅上升的志向得以实现。更何况金能克木,用吐法攻伐它,则金气衰败。金的本性应当降,这是‘塞因塞用’,使其回归本源。居于上则遏制其木,所以用吐法来舒展它,乃是泻金以助木。遍考《内经》中所说的‘木郁则达之’的含义,仅仅是指食伤太阴有形之物,窒塞于胸中,克制厥阴木气伏潜于下,不得舒伸于上,仅此而已,没有其他异说,这是从六淫有余运气角度论述的。仲景《伤寒论》说:心中懊憹、烦躁不得眠,未经过汗法和下法的,叫作实烦,用瓜蒂散主治;曾经经过错误的发汗、催吐、泻下,叫作虚烦的,用栀子豉汤主治。
老夫希望让医生治疗阴阳证候时,补泻不至出错,即使病家不懂医学,也要让他们明了所患疾病,知道应当补或应当泻的方法。现将《黄帝针经》第二卷第五篇中关于形气有余不足、应当补泻的道理录在前面,我自己做的注解附在后面。
‘黄帝说:形气的逆顺是怎样的?岐伯回答说:形气不足,病气有余,这是邪气胜,应当急泻;形气有余,病气不足,应当急补。形气不足,病气不足,这是阴阳气都不足,不可针刺;针刺则会加重不足,加重不足则阴阳俱竭,血气皆尽,五脏空虚,筋骨髓枯,老年人会死亡,强壮的人也不能恢复。形气有余,病气有余,这叫阴阳俱有余,应当急泻其邪气,调理虚实。所以说有余者泻之,不足者补之,就是这个意思。
‘所以说:针刺不知道逆顺,真气与邪气相搏,实证用补法,则阴阳四溢,肠胃充盈扩张,肝肺内胀,阴阳错乱;虚证用泻法,则经脉空虚,血气枯竭,肠胃收缩闭塞,皮肤薄着,毛发焦枯,给予死亡期限。所以说:用针的要领,在于知道调节阴与阳;调节阴与阳,精气才能光明,结合形与气,使神内藏。
所以说:上工平调气机,中工扰乱脉象,下工断绝生气危及生命。所以说:下工不可不谨慎,必须审察五脏变化的病证,五脉的应合,经络的虚实,皮肤的柔粗,然后才取穴施治。’
圣人垂示慈爱之心已经详尽,不合乎立言的原则。老夫实在担心市井、庄农、山野间的人,不懂文理,所以用通俗的语言开解他们说。但疾病发作如潮水般涌来时,病气和精神增加的,这是病气有余,是邪气胜,应当急泻,用寒凉酸苦的药物;如果疾病发作时,神气困弱的,是病气不足,是真气不足,应当急补,用辛甘温热的药物。不问形气有余还是形气不足,只取病气有余不足,不足者补之,有余者泻之。假如病气有余,应当急泻,用寒凉药物,因为邪气胜;病气不足,应当急补,用辛甘温热药物,这是真气不足。
所谓形气,气,指口鼻中的气息;形,指皮肤筋骨血脉。形胜为有余,消瘦为不足。其气者,审察口鼻中的气,劳役如常,为气有余;如果喘息气促气短,或者呼吸不足以息的,为不足。所以说形气,是人体身形中的气血,应当补泻,全不在于此,只在病势发作之时,病气增加的,是邪气胜,应当急泻;如果如发作之时,精神困弱,语言无力,以及懒于说话的,是真气不足,应当急补。如果病患形气不足,疾病发作时,病气也不足,这是阴阳俱不足。禁用针刺;宜用甘药补益,不可以用尽剂;不灸不止,脐下一寸五分的气海穴即是。
凡用药,如果不根据四时,就是以顺为逆。四时,是春升、夏浮、秋降、冬沉,这是天地升浮化降沉的变化,化,是脾土中的造化,这是四时的适宜法则。但宜用辛甘温热药物及味薄的药物,即各种风药,这是助春夏升浮的,这便是泻秋收冬藏的药;在人体,对应肝心;只说用酸苦寒凉药物及淡味渗泄的药,这是助秋冬降沉的,在人体,对应肺肾。用药者,应当用此法度,切勿忽视!”
A question was raised: "When food accumulation fills and blocks the chest, causing stagnation and obstruction there, inducing vomiting to expel the damaged substances will bring peace once the substances are gone. The chest is the domain of the Taiyin Lung meridian; Wood depression (Wood Qi stagnation) occurs when Jueyin Liver Wood Qi is suppressed below. Therefore, vomiting is used to extend it, to smooth and diffuse Yang Qi and harmonize Wind-Wood Qi. This vomiting method essentially drains the stagnation of Taiyin. What is meant by Wood depression? Please explain." The answer was: "This is a profound and spiritual principle. Without expounding on the Great Dao, one cannot reach this understanding.
Between heaven and earth, within the six directions, there are only Water and Fire! Fire belongs to Yang, representing ascending and floating qualities; in Heaven it manifests as substance, and on Earth as function. Water belongs to Yin, representing descending and sinking qualities; on Earth it manifests as substance, and in Heaven as the function of withering and storing. When their Qi interacts above and below, the Eight Trigrams are formed. From the perspective of medical texts, this corresponds to ascending/descending and warm/cool/cold/hot seasonal changes, aligning with the Eight Trigrams. If Heavenly Fire is above and Earthly Water is below, Heaven and Earth do not interact, and Yin and Yang cannot support each other. The way of all things and the principles of the Great *I Ching* would be extinguished. Thus, the classics state that 'Yang alone does not generate, Yin alone does not grow.' How can Heaven and Earth Yin and Yang intersect? It is said that Yang originates from Yin, and Yin originates from Yang. If one does not understand the root, one does not understand the Dao. Therefore, the Qi of the Six Yang meridians arises from the Earth, hence 'Yang originates from Yin.' In the human body, this means the Qi of the Six Fu organs grows, develops, and disperses within the Stomach Earth. Since Yang Qi inspires all tangible phenomena in Heaven, becoming floating and dispersed; when things reach their extreme, they reverse, and Yang transforms into Yin. Once the power of the Six Yang's ascending and floating reaches Heaven and exhausts itself, the Way of Yang ends. Consequently, it inspires the Six Yin's tangible Yin Water in Heaven and outside. The top line (Shang Liu) has no position and must return downward; this is the image of Old Yang transforming into Yin, indicating that the source of the Five Zang organs lies in Heaven. Heaven corresponds to the human Lung, hence 'Yin originates from Yang,' as stated in 'Water flows from its high source.' The source of the human Five Zang organs is the Lung. The Lung is located on the back, and the back corresponds to Heaven. Thus, the Cold growth of the Foot-Taiyang Bladder meridian has its source in Shen (the earthly branch), so Yin Cold descends from here, forming the gradual coldness of Autumn harvest. Descending to the ground, it forms Winter storage, hiding within the Nine Springs beneath the Six Yang meridians. Therefore, the Qi of the Five Zang organs arises in Heaven. In the human body, the source of the descending and storing Qi of the Five Zang organs comes from above the Lung Qi. Its flow moves downward. Since Yin Qi descends and sinks, all tangible phenomena are stored in the Earth, becoming sinking. When things reach their extreme, they reverse, and Yin transforms into Yang. Once the power of the Six Yin's descending and sinking reaches the Earth and exhausts itself, the Way of Yin ends. This is Old Yin transforming into Yang. The first nine (Chu Jiu) has no position. The Qi of the four seasons in a year ends and begins again, moving up and down without end, like a circle without beginning or end.
Moreover, Taiyin represents the descending Qi of Lung Metal, which should reside in the lower body. Now it resides in the upper body instead, suppressing Jueyin Wind Wood, which is forced to reside below, unable to ascend. Hence it is called Wood depression. Therefore, vomiting is induced to expel the obstructing tangible Earth-transformed substances, allowing the Taiyin Autumn Lung to descend and store in the lower body, restoring its original nature to subdue excess, thereby enabling the Hand and Foot Jueyin Wood to extend. Yuan Qi (Original Qi) stretches, and its desire for smooth upward diffusion finds its proper place. Furthermore, Metal controls Wood. By using vomiting to attack it, Metal Qi weakens. The nature of Metal is to descend. This is 'treating obstruction with obstruction' (using a blocking method to treat blockage), returning to the root. Residing above, it suppresses Wood; thus, vomiting is used to extend it. This is draining Metal to assist Wood. Examining the meaning of 'Wood depression should be reached' (Mu Yu Ze Da Zhi) in the *Nei Jing*, it refers solely to food damaging Taiyin tangible substances, obstructing the chest, suppressing Jueyin Wood Qi to hide below, preventing it from extending above. There is no other interpretation, discussed from the perspective of excess conditions caused by the Six Exogenous Pathogens. Zhang Zhongjing's *Shanghan Lun* states: "Regretful irritability and inability to sleep, without prior sweating or purging, is called Real Irritability, treated with Geng Ti San (Melon Seed Powder); if it follows erroneous sweating, vomiting, or purging, it is called Deficiency Irritability, treated with Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction)."
The old man wishes for physicians to treat Yin-Yang syndromes without error in tonification and drainage. Even if patients do not understand medicine, they should clearly know their disease and whether tonification or drainage is indicated. I have recorded the principles regarding excess and deficiency of Form and Qi, and the indications for tonification and drainage, from Volume 2, Chapter 5 of the *Huangdi Zhenjing* (Yellow Emperor's Classic of Acupuncture) at the front, with my own annotations attached.
"The Yellow Emperor asked: 'What is the reversal and順 (shun/compliance) of Form and Qi?' Qibo answered: 'If Form and Qi are deficient but Pathogenic Qi is excessive, this indicates pathogen victory; urgent drainage is required. If Form and Qi are excessive but Pathogenic Qi is deficient, urgent tonification is required. If both Form/Qi and Pathogenic Qi are deficient, this indicates deficiency of both Yin and Yang Qi; acupuncture must not be used. Acupuncture would cause double deficiency, leading to exhaustion of Yin and Yang, depletion of Blood and Qi, emptiness of the Five Zang organs, withering of sinews, bones, and marrow. The elderly would perish, and even the robust would not recover. If both Form/Qi and Pathogenic Qi are excessive, this indicates excess of both Yin and Yang; urgent drainage of the pathogen is required to regulate deficiency and excess. Thus, it is said: Drain what is excessive, Tonify what is deficient. This is what is meant.
"It is said: If acupuncture fails to distinguish reversal and compliance, True Qi and Pathogenic Qi clash. Tonifying fullness causes Yin and Yang to overflow, intestines and stomach to distend, Liver and Lung to become internally distended, and Yin and Yang to become confused. Draining deficiency causes meridians to become empty, Blood and Qi to枯竭 (dry up), intestines and stomach to contract, skin to become thin and adherent, hair and pores to wither, and death to be hastened. Thus, it is said: The essence of acupuncture lies in knowing how to regulate Yin and Yang. Regulating Yin and Yang makes Jing Qi radiant, combining Form and Qi to keep Shen (Spirit) contained within.
"It is said: Superior practitioners level Qi, intermediate practitioners disrupt Mai (Pulse/Vessels), inferior practitioners sever Qi and endanger life. Thus, inferior practitioners must be extremely cautious. They must examine diseases of the Five Zang changes, responses of the Five Pulses, excess and deficiency of meridians, and texture of skin before selecting points."
The sage's benevolent heart has been detailed sufficiently, making further words unnecessary. However, fearing that people in markets, farms, and mountains may not understand literary language, I use vernacular terms to explain them. When a disease surges like a tide, if the Pathogenic Qi and spirit increase, this is Pathogenic Qi excess, indicating pathogen victory; urgent drainage is needed using cold, cool, sour, and bitter agents. If during the surge, the spirit and Qi are fatigued and weak, this is Pathogenic Qi deficiency, indicating True Qi deficiency; urgent tonification is needed using acrid, sweet, warm, and hot agents. Regardless of whether Form/Qi is excessive or deficient, one only considers whether Pathogenic Qi is excessive or deficient. Deficient is tonified, excessive is drained. For example, if Pathogenic Qi is excessive, urgent drainage with cold agents is needed because the pathogen is strong; if Pathogenic Qi is deficient, urgent tonification with acrid, sweet, warm, and hot agents is needed because True Qi is deficient.
Form (Xing) refers to the physical body: skin, sinews, bones, and blood vessels. Excess form is excess; emaciation is deficiency. Qi refers to breath in the nose and mouth. If labor is performed as usual, Qi is excessive. If panting, shortness of breath, or insufficient respiration occurs, Qi is deficient. Thus, Form and Qi refer to Blood and Qi in the body. Indications for tonification and drainage do not depend solely on this, but on the disease state during its peak. If Pathogenic Qi increases during the peak, it is pathogen victory, requiring urgent drainage. If spirit is weak, speech is powerless, or the patient is reluctant to speak during the peak, it is True Qi deficiency, requiring urgent tonification. If a patient has deficient Form/Qi and also deficient Pathogenic Qi during the surge, this indicates deficiency of both Yin and Yang. Acupuncture is contraindicated; tonification with sweet herbs is appropriate, but not with heavy doses. Moxibustion should not cease until effective; the Qihai (Sea of Qi) point, 1.5 cun below the umbilicus, is used.
In using herbs, one must follow the Four Seasons; otherwise, compliance becomes reversal. The Four Seasons are Spring Ascension, Summer Floating, Autumn Descent, and Winter Sinking. These are the transformations of Heaven and Earth's ascending/floating and descending/sinking. Transformation occurs in Spleen Earth, representing the appropriateness of the Four Seasons. One should use acrid, sweet, warm, and hot herbs, and those with thin flavors, such as various Wind herbs, to assist Spring Ascension and Summer Floating. These herbs drain Autumn Harvest and Winter Storage. In the human body, they correspond to Liver and Heart. Conversely, sour, bitter, cold, and cool herbs, along with bland-draining herbs, assist Autumn Descent and Winter Sinking, corresponding to Lung and Kidney in the human body. Practitioners should adhere to these methods and not neglect them!"