〔垣〕针经云∶陷下则灸之。天地间无他，惟阴与阳二气而已。阳在外在上，阴在内在下。今言陷下者，
阳气下陷入阴血之中，是阴反居其上而覆其阳，脉证俱见。寒在外者，则灸之。《异法方宜论》云∶北方之人，宜
灸也，为冬寒大旺。伏阳在内，皆宜灸之。以至理论之，则肾主藏，藏阳气在内，冬三月主闭藏是也。太过
则病，固宜灸 ，此阳火陷入阴水之中是也。《难经》云∶热病在内，取会之气穴；为阳陷入阴中，取阳气通天
之窍穴，以火引火而导之，此宜灸 也。若将有余之病，一概灸之，岂不误哉。仲景云∶微数之脉，慎不可灸。
因火为邪，则为烦逆。追虚逐实，血散脉中，火气虽微，内攻有力，焦骨伤筋，血难复也。又云∶脉浮，宜以
汗解，用火灸之，邪无从出，因火而盛，病从腰以下，必重而痹，名火逆也。脉浮热甚，而反灸之，此为实。
实而虚治，因火而动，必咽燥唾血。又云∶身之穴三百六十有五，其三十六穴灸之有害，七十九穴刺之为灾，
并中髓也。（仲景伤寒例第三十）
按《明堂》《针经》各条下所说禁忌明矣。《内经》云∶脉之所见，邪之所在。脉沉者邪气在内，脉浮者
邪气在表。世医只知脉之说，不知病症之禁忌。若表见寒证，身汗出，身常清，数栗而寒，不渴，欲覆浓
衣，常恶寒，手足厥，皮肤燥枯，其脉必沉细而迟。但有一二症，皆宜灸之，阳气下陷故也。若身热恶热，
时见躁作，或面赤面黄，咽干，嗌干，口干，舌上黄赤，时渴，咽嗌痛，皆热在外也。但有一二症，皆不
宜灸。其脉必浮数，或但数而不浮，亦不可灸，灸之则灾害立生。若有鼻不闻香臭，鼻流清涕，眼睑时痒，
或欠或嚏，恶寒，其脉必沉，是脉证相应也。或轻手得弦紧者，是阴伏其阳血，虽面赤，宜灸之，不可拘
于面赤色而禁之也。更有脑痛恶寒者，虽面赤，亦宜灸风府一穴。若带偏脑痛，更恶风者，邪在少阳，宜
灸风池，无灸风府。然艾炷不宜大，但如小麦粒一七壮足矣。若多灸、艾炷大，防损目。《四十五难》曰∶
八会者何也？然，府会太仓，藏会季胁，筋会阳陵泉，髓会绝骨，血会膈俞，骨会大杼，脉会太渊，气会
三焦外一筋宜两乳内也。热病在内者，取其会之气穴，东垣辨之矣。《内经》中说热病在内，取会之气穴皆
陷下者，灸之，从阴引阳于背 。府会太仓，太仓者中脘也，是六腑六阳之总称也。藏会季胁者，脾之募
也，在腰背腹募之间，与脐平，是两仪之间也。五脏六腑阳陷者，皆取脾胃，是万物有余，皆出于土也。
脾者五脏之总称也，带脉者脾之附经血，又其别称也。血会鬲俞，鬲俞者背之上也。骨会大杼，大杼者背
也。髓会绝膏，绝骨者是骨名也，在足外踝上也，乃是少阳之分。筋会阳陵泉，阳陵泉者，足少阳经中膝
下外侧也。脉会太渊，太渊者两寸脉也。气会膻中，膻中者两乳是也。热病在内，取会之气穴者，谓热陷
于内，故取百会之穴以灸伸之。此为陷下者炙之，非太过不及。本经所生自病中它邪者，乃以经取之也。
恐后学所疑，复明其理以证之。陷者皮毛不任风寒，知阳气下陷也。其脉中得必细弦而紧小，或沉涩覆其
上，知其热火陷下也。虽脉八九至甚数，而阴脉覆其上者，皆可灸。阴脉者，细弦紧小沉涩如上说是也。
头维禁不可灸。承光禁不可灸。脑户禁不可灸。风府禁不可灸。（灸之不幸使人喑。）喑门禁不可灸。
（灸之使人喑。）耳门
耳中有脓不可灸。下关耳中有干HT 不可灸。人迎禁不可灸。丝竹空禁不可灸。（灸之不幸使人目小及盲。）
承泣禁不可灸。脊中禁不可灸。白环俞禁不可灸。乳中禁不可灸。石门女子禁不可灸。气冲灸之不得息。
渊液禁不可灸。鸠尾禁不可灸。阴市禁不可灸。阳关禁不可灸。天府禁不可灸。（使人逆气。）伏兔禁不
可灸。地会五禁不可灸。（使人瘦。） 脉禁不可灸。经渠禁不可灸。（伤人神）
【李东垣说】《针经》记载：脉象沉陷无力的，应当施灸。天地之间没有别的，只有阴气和阳气这两种气罢了。阳气在外、在上，阴气在内、在下。现在所说的“陷下”，是指阳气下陷并陷入阴血之中，这是阴气反而居于上方而覆盖住阳气，脉象和证候都表现出来。如果寒邪在体表，就应当施灸。《素问·异法方宜论》说：北方的人，适宜施灸，因为冬季寒气大盛。阳气潜伏在体内，都适宜施灸。用理论来推究，肾主闭藏，将阳气藏于体内，冬季三个月主司闭藏是这种道理。如果阳气太过就会生病，本来就应该施灸，这就是阳火陷入阴水之中的缘故。《难经》说：热病在体内的，取会穴的气穴；因为阳气陷入阴中，要取与阳气上通天的窍穴，用火引导火而疏导它，这也是适宜施灸的。如果把有余的病（实证），一概都用灸法治疗，难道不是错误吗？张仲景说：脉象微数，千万不可施灸。因为火成为邪气，就会导致烦闷逆乱。追补虚损、追逐实邪，导致血液散乱于脉中，火气虽然微弱，但内攻的力量很大，会焦骨伤筋，血液难以恢复。又说：脉浮，应当用发汗的方法解表，如果用火灸，邪气无从排出，反而因火而亢盛，疾病从腰部以下，一定会沉重且麻木不仁，这叫作火逆。脉浮且热势很盛，反而施灸，这属于实证。实证却用虚治（误治），因火而动血，必然导致咽喉干燥、唾血。又说：身上的穴位共有三百六十五个，其中三十六个穴位施灸会有害处，七十九个穴位针刺会造成灾祸，这是因为刺中了髓。（出自《伤寒例》第三十）
按：《明堂》《针经》各条目下所说的禁忌已经很明确了。《内经》说：脉象所反映的地方，就是邪气所在之处。脉沉，说明邪气在体内；脉浮，说明邪气在体表。世间的医生只知道脉象的说法，却不知道病症的禁忌。如果在体表出现寒证，身体出汗，身体经常清冷，频繁战栗发冷，不口渴，想要覆盖厚衣服，经常怕冷，手脚冰凉，皮肤干燥枯槁，其脉象必定沉细而迟。只要有一两个症状，都适宜施灸，这是因为阳气下陷的缘故。如果身体发热、怕热，时常烦躁发作，或者面色红赤或发黄，咽喉干燥，食道干燥，口干，舌苔黄赤，时常口渴，咽喉疼痛，这些都是热邪在体表。只要有一两个症状，都不适宜施灸。其脉象必定浮数，或者只是数而不浮，也不可以施灸，施灸的话灾害立刻产生。如果有鼻子闻不到香臭，流清鼻涕，眼睑时常发痒，或者打哈欠或打喷嚏，怕冷，其脉象必定沉，这是脉证相应的情况。或者轻手就能摸到弦紧脉的，这是阴伏住了阳血，虽然面色红赤，也适宜施灸，不可以拘泥于面色红赤而禁止施灸。更有头痛且怕冷的，虽然面色红赤，也适宜灸风府一穴。如果是偏侧头痛，更怕风的，邪气在少阳经，适宜灸风池，不要灸风府。然而艾炷不宜过大，只要像小麦粒大小，灸七壮就够了。如果多灸、艾炷过大，担心损伤眼睛。《难经·四十五难》说：八会穴是什么？回答说：腑会太仓，脏会季胁，筋会阳陵泉，髓会绝骨，血会膈俞，骨会大杼，脉会太渊，气会三焦外一筋，位于两乳内侧。热病在体内的，取其会穴的气穴，李东垣已经辨析过了。《内经》中说热病在体内，取会穴的气穴，凡是陷下的，都施灸，这是从阴引阳于背部。腑会太仓，太仓就是中脘穴，这是六腑和六阳经的总称。脏会季胁，是脾的募穴，在腰背腹募穴之间，与肚脐平齐，这是两仪之间。五脏六腑阳气下陷的，都取脾胃经，这是万物有余，都出于土的道理。脾是五脏的总称，带脉是脾的附经之血，又是它的别称。血会膈俞，膈俞在背部上方。骨会大杼，大杼在背部。髓会绝骨，绝骨是骨名，在足外踝上方，乃是少阳经的分野。筋会阳陵泉，阳陵泉在足少阳经膝盖下方外侧。脉会太渊，太渊是两手寸口脉。气会膻中，膻中在两乳之间。热病在体内，取会穴的气穴，是说热邪陷入体内，所以取百会穴来施灸以伸展它。这就是“陷下者灸之”，并非太过或不及。本经自生疾病或其他邪气侵袭，乃是以经取之。恐怕后学产生疑惑，再次阐明其理来证明它。陷下是指皮毛不能承受风寒，知道是阳气下陷。其脉象中得必细弦而紧小，或者沉涩覆于其上，知道是热火下陷。虽然脉象八九至非常数急，但阴脉覆于其上的，都可以施灸。阴脉，就是细、弦、紧、小、沉、涩，如上所说。头维穴禁止不可施灸。承光穴禁止不可施灸。脑户穴禁止不可施灸。风府穴禁止不可施灸。（施灸不幸使人失音。）喑门穴禁止不可施灸。（施灸使人失音。）耳门穴，耳中有脓不可施灸。下关穴，耳中有干耵聍不可施灸。人迎穴禁止不可施灸。丝竹空穴禁止不可施灸。（施灸不幸使人眼睛变小及失明。）承泣穴禁止不可施灸。脊中穴禁止不可施灸。白环俞穴禁止不可施灸。乳中穴禁止不可施灸。石门穴女子禁止不可施灸。气冲穴施灸不得呼吸。渊液穴禁止不可施灸。鸠尾穴禁止不可施灸。阴市穴禁止不可施灸。阳关穴禁止不可施灸。天府穴禁止不可施灸。（使人气逆。）伏兔穴禁止不可施灸。地会五穴禁止不可施灸。（使人消瘦。）脉禁穴禁止不可施灸。经渠穴禁止不可施灸。（伤害人的神气）
[Li Dongyuan said] The *Zhen Jing* (Classic of Acupuncture) states: When the pulse is sunken and depressed, moxibustion should be applied. There is nothing else in heaven and earth except Yin Qi and Yang Qi. Yang Qi is external and superior; Yin Qi is internal and inferior. What is now referred to as "sunken and depressed" means that Yang Qi has sunk and fallen into the Yin blood. This indicates that Yin has reversedly occupied the upper position and covered the Yang, with both pulse and symptoms manifesting. If cold pathogen is at the exterior, moxibustion should be applied. The *Su Wen: Yi Fa Fang Yi Lun* (Treatise on Different Methods and Regions) states: People in the North are suitable for moxibustion because winter cold is dominant. Yang Qi is latent within, and all such cases are suitable for moxibustion. Theoretically speaking, the Kidney governs storage, keeping Yang Qi inside; the three months of winter govern closure and storage, which is this principle. If there is excess, it leads to disease, and moxibustion is indeed indicated; this is when Yang fire falls into Yin water. The *Nan Jing* (Classic of Difficult Issues) states: For heat diseases located internally, select the Qi-acupoints of the Eight Hui points; because Yang has fallen into Yin, select acupoints that connect Yang Qi to Heaven, using fire to guide fire and direct it; this is also suitable for moxibustion. However, if one applies moxibustion indiscriminately to all conditions of excess, would this not be a mistake? Zhang Zhongjing stated: With a faint and rapid pulse, moxibustion must strictly be avoided. Because fire becomes a pathogen, it causes irritability and rebellion. Pursuing deficiency and chasing excess scatters blood within the vessels; although the fire energy is slight, its internal attack is powerful, scorching bones and injuring sinews, making blood difficult to restore. He further stated: When the pulse is floating, sweating should be used to resolve the exterior. If moxibustion is applied with fire, the pathogen has no way to exit, and due to fire, the condition intensifies. From the waist down, the body will become heavy and numb, named Fire Reversal (Huo Ni). If the pulse is floating with severe heat, but moxibustion is counterproductively applied, this constitutes an Excess pattern. Treating excess as deficiency, driven by fire, will inevitably cause dry throat and hemoptysis. He also stated: There are 365 acupoints on the body; thirty-six are harmful if moxibusted, and seventy-nine are disastrous if needled, as they may penetrate the Marrow. (From *Shanghan Li*, Chapter 30)
According to the *Ming Tang* and *Zhen Jing*, the contraindications listed under each item are clear. The *Nei Jing* states: Where the pulse manifests, there lies the pathogen. A sunken pulse indicates pathogen inside; a floating pulse indicates pathogen at the exterior. Physicians of the world only know the theory of pulses but ignore the contraindications of symptoms. If exterior Cold patterns appear, with sweating, frequent feeling of coldness, frequent shivering and chills, no thirst, desire to cover with thick clothing, constant aversion to cold, cold limbs, and dry/withered skin, the pulse will necessarily be deep, fine, and slow. If even one or two of these symptoms are present, moxibustion is suitable, because Yang Qi has sunk. Conversely, if there is body heat, aversion to heat, occasional restlessness, red or yellow complexion, dry throat/pharynx, dry mouth, yellow-red tongue coating, occasional thirst, and sore throat, these are Heat pathogens at the exterior. If even one or two of these symptoms are present, moxibustion is unsuitable. The pulse will necessarily be floating and rapid, or merely rapid without floating; moxibustion must not be applied, as disaster will arise immediately. If there is anosmia, runny nose, itchy eyelids, yawning or sneezing, and aversion to cold, the pulse will necessarily be deep, indicating correspondence between pulse and symptoms. Or if a wiry-tight pulse is felt lightly, this indicates Yin suppressing Yang blood; even with a red face, moxibustion is suitable, and one must not rigidly forbid it based solely on facial redness. Furthermore, for headache with aversion to cold, even with a red face, Fengfu (DU16) is suitable for moxibustion. If it is unilateral headache with greater aversion to wind, the pathogen is in the Shaoyang channel; Fengchi (GB20) is suitable, but Fengfu (DU16) should not be used. However, the moxa cone should not be large; size like a wheat grain, seven moxibustions, is sufficient. Too much moxibustion or large cones risks damaging the eyes. The *Nan Jing, Difficulty 45* asks: What are the Eight Hui Points? The answer is: Fu-Hui is Taicang (Zhongwan, CV12), Zang-Hui is Jixie, Jin-Hui is Yanglingquan (GB34), Sui-Hui is Juegu (Xuanzhong, GB39), Xue-Hui is Geshu (BL17), Gu-Hui is Dazhu (BL11), Mai-Hui is Taiyuan (LU9), Qi-Hui is outside the Sanjiao, one tendon between the two breasts (Shanzhong, CV17). For heat diseases internally, select the Qi-acupoints of the Hui points; Li Dongyuan has analyzed this. The *Nei Jing* states that for heat diseases internally, selecting Hui Qi-acupoints applies to all sunken cases, where moxibustion draws Yang from Yin via the back. Fu-Hui Taicanger refers to Zhongwan (CV12), the general term for Six Fu organs and Six Yang channels. Zang-Hui Jixie refers to the Front-Mu point of the Spleen, located between the lumbar/dorsal/abdominal Mu points, level with the umbilicus, representing the space between the Two Powers. For sinking of Yang in Zang-Fu, one selects the Spleen and Stomach, as all surplus in the ten thousand things originates from Earth. The Spleen is the general term for the Five Zang organs; the Dai Mai (Girdle Vessel) is the attached meridian of Spleen blood, also known by another name. Xue-Hui Geshu is on the upper back. Gu-Hui Dazhu is on the back. Sui-Hui Juegu (Juegu/Xuanzhong) is a bone name above the lateral malleolus, belonging to the Shaoyang division. Jin-Hui Yanglingquan is on the lateral side below the knee of the Foot-Shaoyang Gallbladder channel. Mai-Hui Taiyuan is the Cun-kou pulse of both wrists. Qi-Hui Shanzhong is between the two breasts. For heat diseases internally, taking the Hui Qi-acupoint means that since heat has sunk internally, one takes Baihui (DU20) to moxa and extend it. This is "moxa for sunken conditions," neither excessive nor insufficient. For diseases arising from the meridian itself or other pathogens, one treats according to the meridian. Fearing doubt among later learners, I clarify the principle again to prove it. Sunken means the skin and hair cannot withstand Wind-Cold, indicating Yang Qi sinking. The pulse will be fine, wiry, tight, small, or deep and choppy covering the surface, indicating Fire-Heat sinking. Even if the pulse is very rapid (8-9 beats per breath), if Yin pulse covers it from above, moxibustion can be applied. Yin pulse refers to fine, wiry, tight, small, deep, and choppy as described above. Touwei (ST8) is forbidden for moxibustion. Chengguang (EX-HN6) is forbidden. Naohu (DU17) is forbidden. Fengfu (DU16) is forbidden. (Unfortunate moxibustion causes aphonia.) Yimen (EX-HN7) is forbidden. (Moxibustion causes aphonia.) Ermen (TE21): If there is pus in the ear, do not moxa. Xiaguan (ST7): If there is dry cerumen in the ear, do not moxa. Renying (ST9) is forbidden. Sizhukong (SJ23) is forbidden. (Unfortunate moxibustion causes microphthalmia and blindness.) Chengqi (ST1) is forbidden. Jizhong (DU9) is forbidden. Bairian Shu (BL42) is forbidden. Ruzhong (RN17) is forbidden. Shimen (CV5) is forbidden for women. Qichong (ST30): Moxibustion prevents breathing. Yuanli (SI12) is forbidden. Jiutui (CV15) is forbidden. Yinshi (ST33) is forbidden. Yangguan (EX-B7) is forbidden. Tianfu (LU3) is forbidden. (Causes rebellious Qi.) Futu (ST32) is forbidden. Dihui Wu (Five Di-hui points) are forbidden. (Causes emaciation.) Maixin (Pulse prohibition point) is forbidden. Jingqu (LU8) is forbidden. (Damages Shen/Spirit).