黄帝曰∶灸不三分,是谓徒冤,炷务大也。小弱乃小作之。又曰∶小儿七日以上,
周年以还,炷如雀粪。
《明堂下经》云∶凡灸欲炷下广三分,若不三分,则火气不达,病未能愈,则是
灸炷欲其大,惟头与四肢欲小耳。《明堂上经》乃曰∶艾炷根据小箸头作,其病脉粗细,
状如细线,但令当脉灸之。雀粪大炷,亦能愈疾。又有一途,如腹胀、疝瘕、 癖、伏梁
气等,须大艾炷。故《短剧》曰∶腹背烂烧,四肢但去风而已,大宜大炷。如巨阙、鸠
尾,灸之不过四七壮,炷根据竹箸头大,但令正当脉上灸之,艾炷若大,复灸多,其人永无
心力。如头上灸多,令人失精神,背脚灸多,令人血脉枯竭,四肢细而无力,既失精神,
又加细节,令人短寿。王节斋云∶面上灸炷须小,手足上犹可粗。
《明堂下经》曰∶古来灸病,忌松、柏、枳、橘、榆、枣、桑、竹八木火,切宜避
之。有火珠耀日,以艾承之,得火为上;次有火镜耀日,亦以艾引得火,此火皆良。诸蕃
部用镔铁击 石得火,以艾引之。凡仓卒难备,则不如。无木火,清麻油点灯上烧艾茎,
点灸,兼滋润灸疮,至愈不疼,用腊烛更佳。
《千金》云∶凡言壮数者,若丁壮病根深笃,可倍于方数,老少羸弱可减半。扁鹊
灸法,有至三五百壮、
千壮,此亦太过。曹氏灸法,有百壮、五十壮。《短剧》诸方亦然。惟《明堂本经》
云∶针入六分,灸三壮,更无余治。故后人不准,惟以病之轻重而增损之。凡灸头
项,止于七壮,积至七七壮止。《铜人》治风,灸上星、前顶、百会,至二百壮,腹
背灸五百壮。若鸠尾、巨阙,亦不宜多灸,灸多则四肢细而无力。《千金方》于足三
里穴,乃云多至三百壮。心俞禁灸。苦中风,则急灸至百壮。皆视其病之轻重而用之,
不可泥一说,而不通其变也。
黄帝说:艾灸时艾炷底部直径若不足三分,就是白白让患者受苦,因此艾炷务必做得大一些。对于体质虚弱的人,则应适当减小艾炷。又说:出生七天以上、一周岁以内的婴儿,艾炷大小应如麻雀粪粒般小。
《明堂下经》记载:凡是施灸,要求艾炷底部宽度达到三分;如果不足三分,火气就无法到达病所,疾病不能痊愈。所以艾灸的艾炷应当做大,只有头部和四肢部位的艾炷应当做小。《明堂上经》却说:艾炷的大小应根据细筷子头来制作,针对那些脉象粗细、形状像细线一样的病症,只要对准经脉施灸即可。用如麻雀粪大小的艾炷,也能治愈疾病。还有一种情况,比如腹胀、疝气、积聚、伏梁气等病症,必须使用大的艾炷。所以《短剧》中说:腹部和背部可以烧灼至皮肤溃烂,而四肢只需祛除风邪即可,这非常适宜使用大艾炷。例如巨阙穴、鸠尾穴,施灸不超过二十八壮(四七壮),艾炷大小根据竹筷子头,只要对准经脉施灸即可;如果艾炷过大且施灸次数过多,这个人就会永远失去心力和精神。如果在头部施灸过多,会使人丧失精神;在背部和脚部施灸过多,会使人的血脉枯竭,四肢纤细无力,既失去了精神,又增加了细小的症状,使人短寿。王节斋说:面部的艾炷必须小,手足上的艾炷还可以稍粗。
《明堂下经》说:自古以来治疗疾病进行艾灸时,忌讳使用松、柏、枳、橘、榆、枣、桑、竹这八种木材燃烧的火,务必避开。如果有火珠在阳光下聚焦取火,用艾草承接引燃,这是最好的火源;其次是用火镜在阳光下聚焦,也用艾草引火,这些火都是良火。各个蕃部地区用镔铁敲击石头取火,用艾草引燃。凡是在紧急情况下难以准备上述火源时,就不如不用。如果没有木柴生火,可以用清麻油点灯,在灯芯上烧艾茎,用来点灸,同时能滋润灸疮,直到愈合且不疼痛,使用蜡烛更好。
《千金方》说:凡是提到壮数的,如果是身强力壮、病根深固的患者,艾炷数量可以是常规方剂数量的两倍;老人、小孩及身体瘦弱的人,可以减少一半。扁鹊的灸法,有的多达三五百壮甚至千壮,这也太过分了。曹氏的灸法,有一百壮、五十壮。《短剧》中的各方也是如此。只有《明堂本经》说:针刺入六分深,艾灸三壮,没有其他治疗方法。所以后人没有固定的标准,只是根据病情的轻重来增减壮数。凡是艾灸头部和颈部,最多七壮,累计到四十九壮(七七壮)为止。《铜人腧穴针灸图经》治疗风病,灸上星穴、前顶穴、百会穴,多达二百壮,腹部和背部灸五百壮。如果是鸠尾穴、巨阙穴,也不宜多灸,灸多了会导致四肢纤细无力。《千金方》对于足三里穴,却说可以多至三百壮。心俞穴禁止艾灸。如果苦于中风,则紧急施灸至一百壮。这都是视病情的轻重来决定用量,不可拘泥于一种说法,而不通晓其变化。
Huangdi said: If the base diameter of the moxa cone is less than three fen during moxibustion, it is a futile suffering for the patient; therefore, the moxa cones must be made large. For those with weak constitutions, the cones should be made smaller. It is also stated that for infants older than seven days but under one year old, the moxa cones should be as small as sparrow droppings.
The *Mingtang Xiajing* (Lower Classic of the Bright Hall) records: In all cases of moxibustion, the base width of the moxa cone should reach three fen. If it does not reach three fen, the fire qi will not penetrate to the disease site, and the illness cannot be cured. Thus, moxa cones should generally be made large, except for those on the head and limbs, which should be small. The *Mingtang Shangjing* (Upper Classic of the Bright Hall), however, states: The size of the moxa cone should be based on the head of a thin chopstick. For conditions where the pulse is fine and thread-like, one need only apply moxibustion directly onto the meridian. Even moxa cones as small as sparrow droppings can cure diseases. There is another category of conditions, such as abdominal distension, hernia, accumulations (*Ji Ju*), and *Fuliang* Qi (a type of abdominal mass), which require large moxa cones. Therefore, the *Duanju* (Short Treatise) says: The abdomen and back can be burned until the skin ulcerates, while the limbs only need wind expelled; this situation greatly suits the use of large moxa cones. For example, at Jueque (CV14) and Jiutui (CV15), moxibustion should not exceed 28 sessions (4 times 7). The moxa cone should be the size of a bamboo chopstick head, applied precisely on the meridian. If the moxa cone is too large and the number of sessions is excessive, the person will permanently lose heart energy and spirit. Excessive moxibustion on the head causes loss of spirit; excessive moxibustion on the back and feet causes exhaustion of blood vessels, resulting in thin and powerless limbs. This leads to both loss of spirit and the addition of minor symptoms, shortening lifespan. Wang Jiezhai said: Moxa cones on the face must be small, while those on the hands and feet can be slightly thicker.
The *Mingtang Xiajing* states: Since ancient times, when treating diseases with moxibustion, one must avoid the fire from eight types of wood: pine, cypress, zanthoxylum, citrus, elm, jujube, mulberry, and bamboo. One must strictly avoid these. Using a crystal lens to focus sunlight to ignite moxa is the best method. Secondly, using a bronze mirror to focus sunlight to ignite moxa is also good; both are considered auspicious fires. Various foreign tribes strike bing iron against stone to create sparks and ignite moxa. In emergencies when these are unavailable, it is better not to perform moxibustion. Without wood fire, one can light a lamp with pure hemp oil, burn the moxa stem on the wick, and use it for point moxibustion; this also moistens the moxibustion sore, ensuring healing without pain. Using a candle is even better.
The *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) states: Regarding the number of "zhuang" (sessions/cones), if the patient is robust and the disease root is deep and severe, the number can be double that prescribed in standard formulas. For the elderly, children, and the emaciated/weak, the number should be halved. Bian Que’s moxibustion methods included up to 300–500 or even 1,000 zhuang, which is excessive. Cao’s moxibustion methods included 100 or 50 zhuang. The prescriptions in the *Duanju* are similar. Only the *Mingtang Benjing* states: Insert needle six fen deep, apply 3 zhuang of moxibustion, with no other treatments mentioned. Therefore, later generations had no fixed standard, adjusting the number of zhuang according to the severity of the disease. For moxibustion on the head and neck, limit to 7 zhuang, accumulating up to 49 zhuang (7 times 7). The *Tongren* (Bronze Man) text treats wind diseases by applying moxibustion to Shangxing (GV23), Qiangding (GV21), and Baihui (GV20) up to 200 zhuang, and 500 zhuang on the abdomen and back. However, Jiuwei (CV15) and Jueque (CV14) should not be excessively moxibusted; excessive application leads to thin and powerless limbs. The *Qianjin Fang* states that for Zusanli (ST36), one may apply up to 300 zhuang. Xinshu (BL15) is contraindicated for moxibustion. In cases of acute stroke, emergency moxibustion up to 100 zhuang is indicated. All these depend on the severity of the disease; one must not rigidly adhere to a single theory but understand its flexibility.