邪在肺。则病皮肤痛。寒热。上气。喘汗出。咳动肩背。取之膺中外 。背三节五脏之傍。以手疾按之快然乃刺之。
取之缺盆中以越之。邪在肝。则两胁中痛。寒中。恶血在内行。善掣节。时脚肿。取之行间以引胁下。补三里以温胃中。
取血脉以散恶血。取耳间青脉以去其掣。邪在脾胃。则病肌肉痛。阳气有余。阴气不足。则热中善饥。阳气不足。阴气
有余。则寒中肠鸣腹痛。阴阳俱有余。若俱不足。则有寒有热。皆调于三里。邪在肾。则病骨痛。阴痹。阴痹者。按之
而不得。腹胀。腰痛。大便难。肩背颈项痛。时眩。取之涌泉昆仑。视有血者。尽取之。邪在心。则病心痛。喜悲。时
眩仆。视有余不足而调之其输也。(以一也字退出五项)
五项直起直结。经文常格。妙在每项中间皆有曲笔。遂觉行间字字皆有生气。
皮寒热者。不可附席。毛发焦。鼻槁。腊不得汗。(腊皮肤干燥也)取三阳之络。以补手太阴。肌寒热者。肌痛。毛
发焦。而唇槁。腊不得汗。取三阳于下以去其血者。补足太阴以出其汗。骨寒热者。病无所安。汗注不休。齿未槁。取
其少阴于阴股之络。齿已槁。死不治。骨厥亦然痹骨。举节不用而痛。汗注。烦心。取三阴之经补之。身有所伤。血出
多及中风寒。若有所堕坠。四肢懈惰不收。名曰体惰。取其小腹脐下三结交。三结交者。阳明太阴也。脐下三寸。关元
也。厥痹者。厥气上及腹。取阴阳之络。视主病者。泻阳补阴也。颈侧之动脉人迎。人迎。足阳明也。在婴筋之前。婴
筋之后。手阳明也。名曰扶突。次脉。足少阳脉也。名曰天牖。次脉。足太阳也。名曰天柱。腋下动脉。臂太阴也。名
曰天府。阳迎(迎当作逆)头痛。胸满不得息。取之人迎。暴喑。气 。取扶突与舌本。出血。暴聋。气蒙。耳目不明。
取天牖。暴挛。痫眩。足不任身。取天柱。HT 瘅。内逆。肝肺相搏。血溢鼻口。取天府。此为天牖五部。(以上从寒热搭
到骨厥即接叙骨痹体惰厥痹之证治各不相顾之中自有草蛇灰线之妙其笔致之顺逆向背亦无情而有情也以下诸篇皆当以此
意读之看似平铺直叙其中自具开合断续之体)臂阳明有入 遍齿者。名曰大迎。下齿龋。取之臂。恶寒。补之。不恶寒。
泻之。足太阳有入 遍齿者。名曰角孙。上齿龋。取之在鼻与 前。方病之时。其脉盛。盛则泻之。虚则补之。一曰取
之出鼻外。足阳明有挟鼻入于面者。名曰悬颅。属口。对入。系目本。视有过者取之。损有余。益不足。反者益甚。足
太阳有通项入于脑者。正属目本。名曰眼系。头目苦痛。取之在项中两筋间。入脑。乃别阴跷阳跷。阴阳相交。阳入阴。
阴出阳。交于目锐 。阳气盛则 目。阴气盛则瞑目。(以上叙阳明太阳二经齿痛目痛之证治而末条又带叙二跷偏胜有关
于目之事是板中有活也)热厥。取足太阴少阳。皆留之。寒厥。取足阳明少阴于足。皆留之。舌纵涎下。烦 。取足少
阴。振寒洒洒。鼓颔。不得汗出。腹胀。烦 。取手太阴。刺虚者刺其去也。刺实者刺其来也。春取络脉。夏取分腠。
秋取气口。冬取经输。凡此四时。各以其时为齐络脉治皮肤。分腠治肌肉气口。治筋脉经输。治骨髓五脏。(以上叙热厥
寒厥证治也收句整肃与上节同)身有五部。伏兔一。腓二。腓者 也。背三。五脏之 四。项五。此五部有痈疽者死。
病始手臂者。先取手阳明太阴而汗出。病始头首者。先取项太阳而汗出。病始足胫者。先取足阳明而汗出。臂太阴。可
汗出。足阳明。可汗出。故取阴而汗出甚者止之于阳。取阳而汗出甚者止之于阴。凡刺之。害中而不去。则精泄不中而
去。则致气精泄。则病甚。而 致气。则生为痈疽也。(以上叙痈疽之证治笔力爽健非常曰汗出者所谓汗之则疮已是治疮
疽之例也其论阴阳止汗之义尤精以药则桂枝汤生脉散之辨也)
自此以下四篇及杂病篇皆叙事文体。须玩其整散断续。错综变化之妙各项毫不相顾。而自然不形支节。其故由于笔
势顺逆向背。相承相激。行间勃有生气也。
邪气侵犯肺脏,就会出现皮肤疼痛、恶寒发热、气逆上冲、喘息、出汗、咳嗽时牵引肩背作痛的症状。治疗时应取膺中部的穴(指云门、中府等穴)和背部第三椎旁五脏俞穴附近的地方,用手快速按压患者感到舒适的地方下针。
再取缺盆中的穴位以宣泄邪气。
邪气侵犯肝脏,就会出现两侧胁肋部疼痛、内脏受寒、恶血停滞在体内运行不畅、容易牵掣关节、时常脚肿的症状。治疗时应取行间穴以引导胁下的气机,补足三里穴以温养胃中阳气。
再选取血脉以消散恶血,取耳后青色的脉络以去除关节的牵掣感。
邪气侵犯脾胃,就会出现肌肉疼痛。如果阳气有余、阴气不足,就会表现为胃中有热、容易饥饿;如果阳气不足、阴气有余,就会表现为胃中有寒、肠鸣腹痛。无论阴阳俱有余还是俱不足,出现有寒有热的症状,都可以通过调理足三里穴来治疗。
邪气侵犯肾脏,就会出现骨骼疼痛、阴痹(阴分痹证)。所谓阴痹,是指按压时感觉不到痛点,伴有腹胀、腰痛、大便困难、肩背颈项疼痛、时常头晕目眩的症状。治疗时应取涌泉穴和昆仑穴,观察是否有瘀血,若有则全部刺破放血。
邪气侵犯心脏,就会出现心痛、喜欢悲伤、时常头晕跌倒的症状。根据虚实情况,调节其输穴即可。(此处用“以一也字退出五项”表示经文结构上的收束)
这五项论述直起直结,是经文的常规格式,妙处在于每项中间都有曲折之笔,使得行间文字字字充满生气。
皮寒热病,患者身体僵硬不能贴近席子,毛发焦枯,鼻腔干枯,皮肤干燥无汗。(注:腊指皮肤干燥)治疗应取三阳经的络穴,并补益手太阴肺经。
肌寒热病,肌肉疼痛,毛发焦枯,嘴唇干枯,皮肤干燥无汗。治疗应在下部取三阳经穴位以祛除瘀血,并补足太阴脾经以发汗。
骨寒热病,患者坐卧不安,汗水淋漓不止。如果牙齿尚未干枯,可取其少阴肾经在大腿内侧的络穴进行治疗;如果牙齿已经干枯,则属于死症,无法治愈。骨厥病也是如此。
痹证导致骨骼病变,关节活动受限且疼痛,汗水淋漓,心烦意乱。治疗应取三阴经的经脉进行补法。
身体曾经受伤,失血过多,或者中风寒,或者有跌坠损伤,导致四肢懈怠无力、不能收持,这种病症叫做体惰。治疗应取小腹脐下三结交穴。所谓三结交,是指足阳明胃经和足太阴脾经交汇之处,位于脐下三寸的关元穴。
厥痹病,厥气上逆波及腹部。治疗应取阴阳之络穴,视主要病位所在,泻阳经而补阴经。
颈侧的动脉是人迎穴。人迎穴属足阳明胃经,位于婴筋(胸锁乳突肌)之前。婴筋之后是手阳明大肠经,名为扶突穴。再往后的脉是足少阳胆经,名为天牖穴。再往后的脉是足太阳膀胱经,名为天柱穴。腋下的动脉是臂太阴肺经,名为天府穴。
因气逆(原文“迎”当作“逆”)导致的头痛、胸满、呼吸困难,取人迎穴治疗。
突然失音、气机阻滞,取扶突穴和舌根部出血治疗。
突然耳聋、气机蒙蔽、耳目不明,取天牖穴治疗。
突然拘挛、癫痫眩晕、双脚不能支撑身体,取天柱穴治疗。
瘅热病,气机内逆,肝肺之气相搏,血液从鼻口溢出,取天府穴治疗。以上这些被称为天牖五部。(以上部分从寒热病过渡到骨厥,接着叙述骨痹、体惰、厥痹的证治,各篇看似不相顾,实则自有草蛇灰线之妙,笔致顺逆向背亦有情有理。以下诸篇皆当以此意读之,看似平铺直叙,其中自具开合断续之体。)
足阳明经有进入牙齿的分支,名为大迎穴。下齿龋齿疼痛,取手臂上的穴位治疗。若伴有恶寒,用补法;若不恶寒,用泻法。
足太阳经有进入牙齿的分支,名为角孙穴。上齿龋齿疼痛,取位于鼻子和颧骨前方的穴位。刚发病时,脉象盛大,盛大则用泻法;脉象虚弱则用补法。另一种说法是取鼻孔外的穴位。
足阳明经有挟鼻进入面部的分支,名为悬颅穴,归属于口,对着入口,联系目本。观察有过盛的部位予以治疗,损其有余,补其不足,反之则病情加重。
足太阳经有通项入脑的分支,正对目本,名为眼系。头目剧烈疼痛,取位于项中两筋间的穴位,深入脑部,分别连接阴跷脉和阳跷脉。阴阳二气相交,阳入于阴,阴出于阳,交汇于目锐眦。阳气盛则睁眼,阴气盛则闭眼。(以上叙述阳明、太阳二经齿痛、目痛的证治,最后一条又附带叙述了二跷脉偏胜与眼睛的关系,这是板滞中有灵活之处。)
热厥,取足太阴、足少阳经,均留针。寒厥,取足阳明、足少阴经于足部,均留针。
舌纵缓流涎、心烦意乱,取足少阴经治疗。
战栗发冷、下巴打颤、不能出汗、腹胀、心烦意乱,取手太阴经治疗。
针刺虚证,要刺其经气离去的方向;针刺实证,要刺其经气到来的方向。
春季取络脉,夏季取分腠,秋季取气口,冬季取经输。这四时的取穴原则,各自顺应时令。络脉治疗皮肤疾病,分腠治疗肌肉疾病,气口治疗筋脉疾病,经输治疗骨髓及五脏疾病。(以上叙述热厥、寒厥的证治,结尾整肃,与上一节相同。)
身体有五处要害部位:伏兔为一,腓肠肌为二,腓即小腿肚,背部为三,五脏之俞为四,颈部为五。这五处发生痈疽的,都会死亡。
疾病始于手臂的,先取手阳明、手太阴经使汗出。疾病始于头首的,先取项部太阳经使汗出。疾病始于足胫的,先取足阳明经使汗出。手臂太阴经可令汗出,足阳明经可令汗出。所以,取阴经而汗出过多的,停止于阳经;取阳经而汗出过多的,停止于阴经。
凡是针刺,如果误中要害而未及时拔出,精气就会泄漏;如果没有误中却过早拔针,就会导致邪气滞留。精气泄漏,则病情加重;邪气滞留,则会产生痈疽。(以上叙述痈疽的证治,笔力爽健非常。说“汗出”,即是所谓“汗之则疮已”,这是治疗疮疽的法则。其论阴阳止汗的道理尤为精妙,如同用药时桂枝汤与生脉散的辨析一样。)
从此以下的四篇及杂病篇都是叙事文体,必须玩味其整散、断续、错综变化之妙。各项内容看似毫不相顾,却自然不显支离破碎。其原因在于笔势的顺逆向背、相承相激,行间勃发着生气。
When pathogenic factors invade the Lung, symptoms include pain in the skin, aversion to cold with fever (Han Re), upward rushing of Qi, panting, sweating, and coughing that pulls on the shoulders and back. Treatment should involve needling points in the anterior chest region (Ying Zhong Wai, referring to points like Yunmen and Zhongfu) and near the five Zang Shu points beside the third thoracic vertebra on the back. Press quickly with the hand until the patient feels relief, then needle.
Additionally, select points in the Clavicular Fossa (Que Pen) to vent the pathogen.
When pathogenic factors invade the Liver, symptoms include pain in both hypochondriac regions, internal cold, stagnation of evil blood within, frequent pulling sensations in the joints, and occasional swelling of the feet. Treatment involves selecting Xingjian (LR2) to guide Qi from the hypochondrium, tonifying Zusanli (ST36) to warm the Stomach middle, selecting blood vessels to disperse evil blood, and selecting blue veins behind the ear to remove joint pulling sensations.
When pathogenic factors invade the Spleen and Stomach, symptoms include muscle pain. If Yang Qi is excessive and Yin Qi deficient, there is heat in the middle jiao and frequent hunger; if Yang Qi is deficient and Yin Qi excessive, there is cold in the middle jiao with borborygmus and abdominal pain. Whether both Yin and Yang are excessive or both are deficient, resulting in alternating cold and heat, all can be regulated via Zusanli (ST36).
When pathogenic factors invade the Kidney, symptoms include bone pain, Yin Bi (Bi syndrome affecting Yin channels). Yin Bi is characterized by tenderness that cannot be pinpointed by pressure, abdominal distension, lower back pain, difficulty defecating, pain in the shoulders, back, neck, and nape, and occasional dizziness. Treatment involves selecting Yongquan (KI1) and Kunlun (BL60). Observe for blood stasis; if present, drain it completely.
When pathogenic factors invade the Heart, symptoms include heart pain, a tendency toward sadness, and occasional dizziness leading to fainting. Regulate their Shu points based on excess or deficiency patterns. (The text notes that these five items follow a direct structure, typical of the classic, but possess subtle variations that give vitality to the text.)
In Skin Cold-Heat disease, the patient cannot lie flat on the mat, hair becomes dry and brittle, the nose dries up, and the skin is dry without sweat ("La" refers to dry skin). Treatment involves selecting the Luo-connecting points of the Three Yang meridians and tonifying the Hand Taiyin Lung meridian.
In Muscle Cold-Heat disease, there is muscle pain, dry/brittle hair, dry lips, and dry skin without sweat. Treatment involves selecting points below on the Three Yang meridians to remove blood stasis, and tonifying the Foot Taiyin Spleen meridian to induce sweating.
In Bone Cold-Heat disease, the patient finds no comfort in any position, with continuous profuse sweating. If the teeth are not yet dry/cracked, select the Luo-connecting points of the Shaoyin meridian in the inner thigh. If the teeth are already dry/cracked, it is a fatal condition untreatable. Gujue (Bone Jue) presents similarly.
Bi syndrome affecting bones causes limited joint movement with pain, profuse sweating, and vexation. Treatment involves tonifying the Jing-river points of the Three Yin meridians.
If the body has suffered injury, excessive blood loss, wind-cold invasion, or falls/trauma, leading to flaccidity and inability to control the limbs, this is called Body Languor (Ti Duo). Treatment involves selecting the San Jie Jiao point below the umbilicus. The San Jie Jiao is the intersection of the Foot Yangming Stomach and Foot Taiyin Spleen meridians, located three cun below the umbilicus at Guanyuan (CV4).
Jue Bi (Jue Bi Syndrome) involves Jue Qi rising to the abdomen. Treatment involves selecting the Luo-connecting points of Yin and Yang meridians, treating the primary affected area by draining Yang and tonifying Yin.
The arterial pulse on the side of the neck is Renying (ST9). Renying belongs to the Foot Yangming Stomach meridian, located anterior to the sternocleidomastoid muscle ("Ying Jin"). Posterior to the Ying Jin is the Hand Yangming Large Intestine meridian, named Futu (LI18). The next pulse is the Foot Shaoyang Gallbladder meridian, named Tianyou (TB16). The next is the Foot Taiyang Bladder meridian, named Tianzhu (BL10). The axillary artery is the Arm Taiyin Lung meridian, named Tianfu (LU3).
Headache due to rebellious Qi (Ying should be Ni), chest fullness, and dyspnea: select Renying (ST9).
Sudden aphonia and Qi obstruction: bleed Futu (LI18) and the base of the tongue.
Sudden deafness, mental clouding, and unclear vision/hearing: select Tianyou (TB16).
Sudden spasms, epilepsy, dizziness, and inability of the legs to support the body: select Tianzhu (BL10).
Dan heat syndrome with internal rebellious Qi, where Liver and Lung Qi clash causing bleeding from nose and mouth: select Tianfu (LU3). These constitute the Five Regions of Tianyou. (This section transitions from Cold-Heat to Gujue, then discusses Gu Bi, Ti Duo, and Jue Bi. Though seemingly unrelated, there is a subtle continuity. Read subsequent chapters with this understanding of structural flow.)
The Foot Yangming meridian has a branch entering the teeth, named Daying (ST5). For lower tooth decay/pain, select points on the arm. If accompanied by aversion to cold, use tonification; if not, use sedation.
The Foot Taiyang meridian has a branch entering the teeth, named Jiaosun (SI18). For upper tooth decay/pain, select points between the nose and cheekbone. At onset, if the pulse is full/excessive, use sedation; if deficient, use tonification. Alternatively, select points outside the nostrils.
The Foot Yangming meridian has branches flanking the nose into the face, named Xuanlu (GB21 - *Note: Text says Xuanlu but describes GB21 location/function often associated with other points, strictly translating text*), belonging to the mouth, opposite the entrance, connecting to the root of the eye. Treat areas of excess. Reduce excess, tonify deficiency; reversing this worsens the condition.
The Foot Taiyang meridian has a branch passing through the neck into the brain, directly connecting to the root of the eye, named Yanxi (Eye System). For severe head and eye pain, select points between the two tendons in the neck, penetrating into the brain, distinguishing between Yin Qiao and Yang Qiao meridians. Yin and Yang intersect; Yang enters Yin, Yin exits Yang, intersecting at the outer canthus. Excess Yang leads to open eyes; excess Yin leads to closed eyes. (This section covers tooth and eye pain related to Yangming and Taiyang, ending with the influence of Qiao meridians on vision.)
For Reversible Heat Jue (Re Jue), select Foot Taiyin and Foot Shaoyang meridians, retaining the needles. For Reversible Cold Jue (Han Jue), select Foot Yangming and Foot Shaoyin meridians in the foot, retaining the needles.
Tongue deviation with drooling and vexation: select Foot Shaoyin.
Shivering, chattering teeth, inability to sweat, abdominal distension, and vexation: select Hand Taiyin.
To treat deficiency, needle in the direction the Qi departs; to treat excess, needle in the direction the Qi arrives.
In Spring, select Luo-connecting points; in Summer, select Fen Cou (interstices); in Autumn, select Qikou (Radial artery); in Winter, select Jing-Well and Shu-Stream points. These four seasonal methods correspond to their respective times. Luo points treat the skin; Fen Cou treats muscles; Qikou treats sinews/tendons; Jing-Shu points treat bones and the Five Zang organs. (This concludes the discussion on Re Jue and Han Jue with a structured summary.)
There are five critical parts of the body: Futu (Vast Rabbit) is one; the calf (Fei) is two; the back is three; the Shu points of the Five Zang are four; the neck is five. Carbuncles and sores occurring in these five parts are fatal.
Diseases starting in the arms: first select Hand Yangming and Hand Taiyin to induce sweating.
Diseases starting in the head: first select Neck Taiyang to induce sweating.
Diseases starting in the lower legs: first select Foot Yangming to induce sweating.
Arm Taiyin and Foot Yangming can induce sweating. Therefore, if sweating induced by Yin meridians is excessive, stop/supplement via Yang meridians; if sweating induced by Yang meridians is excessive, stop/supplement via Yin meridians.
In needling, if harm strikes the vital area and the needle is not removed immediately, essence will leak. If the needle is removed before striking the vital area, pathogenic Qi may accumulate. Essence leakage worsens the disease; accumulated Qi generates carbuncles and sores. (This section discusses carbuncle treatment. "Inducing sweat" refers to the principle "sweat them, and the sore heals." The discussion on Yin-Yang regulation of sweating is profound, analogous to the differentiation between Guizhi Tang and Shengmai San in herbal medicine.)
From here onwards, the four chapters and miscellaneous disease chapters are narrative texts. One must appreciate the beauty of their structured and free-flowing, interrupted and continuous, intricate changes. Although items seem unrelated, they naturally avoid fragmentation. This is due to the flow, reversal, and interaction of the writing style, generating vitality throughout the lines.