越人曰∶阳维、阴维者,维络于身,溢蓄不能环流,灌溉诸经者也。故阳维起于诸阳之会,阴维起于
诸阴之交。阳维维于阳,阴维维于阴,阴阳不能自相维,则怅然失志,溶溶不能自收持。又曰∶阳维为病
苦寒热,阴维为病苦心痛。(溶溶,缓慢貌)
张洁古曰∶卫为阳,主表,阳维受邪为病在表,故苦寒热;营为阴,主里,阴维受邪为病在里,故苦心
痛。阴阳相维,则营卫和谐矣;营卫不谐,则怅然失志,不能自收持矣。何以知之?仲景云∶病常自汗,
是卫气不与营气和也,宜桂枝汤和之。又云∶服桂枝反烦不解,先刺风池、风府,却与桂枝汤。此二穴,
乃阳维之会也,谓桂枝后,尚自汗发热恶寒,其脉寸浮尺弱而反烦,为病在阳维,故先针此二穴。仲景
又云∶脏无他病时,发热自汗出而不愈,此卫气不和
也,桂枝汤主之。
又曰∶阴维为病苦心痛,治在三阴之交。太阴证则理中汤,少阴证则四逆汤,厥阴证则当归四逆汤、
吴茱萸汤主之。
李濒湖曰∶阳维之脉,与手足三阳相维,而足太阳,少阳,则始终相联附者。寒热之证,惟二经有之,故
阳维为病亦苦寒热。盖卫气昼行于阳,夜行于阴,阴虚则内热,阳虚则外寒,邪气在经,内与阴争而恶寒,
外与阳争而发热。则寒热之在表而兼太阳证者,有汗当用桂枝、无汗当用麻黄;寒热之在半表半里而兼少阳证
者,当用小柴胡加减治之。若夫营卫 卑,而病寒热者,黄 建中及八物汤之类主之。洁古独以桂枝一证属之
阳维,似未扩充。至于阴维为病主心痛,洁古独以三阴温里之药治之,则寒中二阴者宜矣,而三阴热厥作痛,似
未备矣。盖阴维之脉,虽交三阴而行,实与任脉同归,故心痛多属少阴、厥阴、任脉之气上冲而然。暴痛无热,
久痛无寒,按之少止者为虚,不可接近者为实。凡寒痛,兼少阴及任脉者,四逆汤;兼厥阴者,当归四逆汤;
兼太阴者,理中汤主之。凡热痛,兼少阴及任脉者,金铃散、延胡索散;兼厥阴者,失笑散。兼太阴者,承气汤
主之。若营血内伤,兼夫任、冲、手厥阴者,则宜四物汤、养营汤、妙香散之类。因病药之,如此则阴阳虚实,
庶乎其不瘥矣。
王叔和脉经曰∶寸口脉,从少阴斜至太阳,是阳维脉也,动苦肌肉痹痒,皮肤痛,下部不仁,汗出而
寒;又苦颠仆羊鸣,手足相引,甚者失音不能言,宜
取客主人。(在耳前起骨上廉,开口有空。乃手足少阳、阳明之会)
又曰∶寸口脉,从少阳斜至厥阴,是阴维脉也。动苦癫 僵仆羊鸣,又苦僵仆失音,肌肉痹痒,应时
自发汗出,恶风身洗洗然也。取阳白、金门、(见前)仆参。(见阳跷)
濒湖曰∶王叔和以癫 属阴维阳维,灵枢经以癫 属阴跷阳跷,二说义异旨同。盖阳维由外踝而上,
循阳分而至肩肘,历耳额而终行于卫分诸阳之会;阴维由内踝而上,循阴分而上胁至咽,行于营分诸阴之交。
阳跷起于跟中,循外踝上行于股外,至胁肋肩 ,行于一身之左右,而终于目内 ;阴跷起于跟中,循内踝上
行于股内、阴器,行于一身之左右,至咽喉,会任脉,而终于目内 。邪在阴维、阴跷,则发癫邪;在阳维、
阳跷,则发 。 动而属阳,阳脉主之。癫静而属阴,阴脉主之。大抵二疾当取之四脉之穴,分其阴阳而已。
王叔和曰∶诊得阳维脉浮者,暂起目眩,阳盛实者,苦肩息,洒洒如寒。
诊得阴维脉沉大而实者,苦胸中痛,胁下支满,心痛。其脉如贯珠者,男子两胁下实,腰中痛;女子
阴中痛,如有疮状。
素问腰痛论曰∶阳维之脉,令人腰痛,痛上怫然肿。刺阳维之脉与太阳合 间,去地一尺。
王启玄曰∶阳维起于阳,则太阳之所生,并行而上至 ,下复与太阳合而上也。去地一尺,乃承山穴也。在锐
之下,分肉间陷中,可刺七分。
肉里之脉,令人腰痛,不可以咳。咳则筋缩急。刺肉里之脉为二 ,在太阳之外、少阳绝骨之后。
王启玄曰∶肉里之脉,少阳所生,阳维脉气所发,绝骨之后,阳维所过分肉穴也。在足外踝直上绝骨之端,
如后二分筋肉分间,刺可五分。
飞阳之脉,令人腰痛,痛拂拂然,甚则悲以恐。
启玄曰∶此阴维之脉也,去内踝上五寸 分中,并少阴经而上也,刺飞阳之脉,在内踝上一寸,少阴之前,
与阴维之会,筑宾穴也。甲乙经云,太阳之络,别走少阴者,名曰飞阳。
《难经》说:阳维脉和阴维脉,维系联络全身,若气血溢出蓄积而不能环绕流动、灌溉各条经脉。所以阳维脉起于各阳经交会之处,阴维脉起于各阴经交汇之地。阳维脉维系诸阳经,阴维脉维系诸阴经,如果阴阳不能互相维系,就会感到惆怅失意,身体软弱无力,无法自我控制。(溶溶,形容缓慢无力的样子)
又说:阳维脉生病时,痛苦于寒热往来;阴维脉生病时,痛苦于心痛。(溶溶,指缓慢貌)
张洁古说:卫气属阳,主司体表,阳维脉受邪致病在表,所以表现为寒热;营气属阴,主司体内,阴维脉受邪致病在里,所以表现为心痛。阴阳互相维系,则营卫和谐;营卫不和谐,就会惆怅失意,无法自我控制。怎么知道呢?张仲景说:病人经常自汗出,这是卫气不与营气相协调,适宜用桂枝汤来调和它。又说:服用桂枝汤后反而出现烦闷不解,应先针刺风池穴、风府穴,然后再给予桂枝汤。这两个穴位,是阳维脉的交会穴。意思是说,服用桂枝汤后,仍然有自汗、发热、恶寒的症状,且脉象寸部浮、尺部弱并伴有烦闷,这是因为病在阳维脉,所以先针刺这两个穴位。张仲景又说:内脏没有其它疾病时,发热且自汗出而不好转,这是卫气不和,以桂枝汤为主治方剂。
又说:阴维脉生病痛苦于心痛,治疗应取三阴经的交会穴。太阴证则用理中汤,少阴证则用四逆汤,厥阴证则用当归四逆汤、吴茱萸汤主治。
李濒湖(李时珍)说:阳维脉,与手足三阳经相维系,其中足太阳膀胱经、足少阳胆经,则是从头到尾相互关联依附的。寒热的病症,只有这两条经脉会出现,所以阳维脉生病也痛苦于寒热。大概卫气白天行于阳分,夜晚行于阴分,阴虚则产生内热,阳虚则产生外寒,邪气在经脉中,向内与阴气争则恶寒,向外与阳气争则发热。那么寒热在表兼有太阳经证的,有汗应当用桂枝汤,无汗应当用麻黄汤;寒热在半表半里兼有少阳经证的,应当用小柴胡汤加减治疗。如果营卫虚弱,而患寒热病的,用黄芪建中汤及八物汤之类主治。张洁古唯独将桂枝汤这一证候归属于阳维脉,似乎不够全面。至于阴维脉生病主要痛苦于心痛,张洁古唯独用温补三阴的药物来治疗,这对于寒邪侵犯二阴的情况是适宜的,但对于三阴经的热厥引起的疼痛,似乎准备不足。大概阴维脉虽然交于三阴经而行,实际上与任脉同归一处,所以心痛多属于少阴经、厥阴经、任脉之气上冲所致。突发疼痛而无热象,久痛而无寒象,按压后疼痛稍减的是虚证,不可触碰的是实证。凡是寒性疼痛,兼有少阴经及任脉的,用四逆汤;兼有厥阴经的,用当归四逆汤;兼有太阴经的,用理中汤主治。凡是热性疼痛,兼有少阴经及任脉的,用金铃子散、延胡索散;兼有厥阴经的,用失笑散;兼有太阴经的,用承气汤主治。如果是营血内伤,兼有任脉、冲脉、手厥阴心包经的,则适宜用四物汤、养营汤、妙香散之类。因病用药,像这样,对于阴阳虚实的治疗,大概就不会出差错了。
王叔和《脉经》说:寸口脉,从少阴斜向至太阳,这是阳维脉,跳动时痛苦于肌肉痹阻瘙痒,皮肤疼痛,下部麻木不仁,出汗且怕冷;又痛苦于癫痫发作、羊叫声,手足抽搐牵引,严重的失音不能说话,适宜取客主人穴。(在耳前骨头隆起处的上缘,张口有空隙。是手足少阳经、阳明经的交会穴)
又说:寸口脉,从少阳斜向至厥阴,这是阴维脉。跳动时痛苦于癫痫僵仆、羊叫声,又痛苦于僵仆失音,肌肉痹阻瘙痒,适时自发汗出,怕风身体瑟瑟发抖。取阳白穴、金门穴、(见前文)仆参穴。(见阳跷脉章节)
李濒湖说:王叔和认为癫痫归属于阴维脉和阳维脉,《灵枢经》认为癫痫归属于阴跷脉和阳跷脉,两种说法义理不同但宗旨相同。大概阳维脉由外踝上行,循行阳分到达肩肘,经过耳额最终行于卫分诸阳经的交会处;阴维脉由内踝上行,循行阴分而上达胁部至咽喉,行于营分诸阴经的交汇之处。阳跷脉起于脚跟中部,循行外踝上行于大腿外侧,到达胁肋肩背,行于身体左右两侧,最终止于目内眦;阴跷脉起于脚跟中部,循行内踝上行于大腿内侧、阴器,行于身体左右两侧,到达咽喉,会合任脉,最终止于目内眦。邪气在阴维脉、阴跷脉,则发癫症;在阳维脉、阳跷脉,则发痫症。痫症动而属阳,由阳脉主之;癫症静而属阴,由阴脉主之。大体上这两种疾病应当取用这四条经脉的穴位,区分其阴阳即可。
王叔和说:诊得阳维脉浮的,暂时起身时头晕目眩,阳盛实者,痛苦于肩部呼吸急促,洒洒然如寒冷感。
诊得阴维脉沉大而实的,痛苦于胸中痛,胁下支撑胀满,心痛。其脉象如贯珠般的,男子两胁下实,腰部疼痛;女子阴中痛,如有疮疡状。
《素问·腰痛论》说:阳维脉的病变,使人腰痛,疼痛部位浮肿。针刺阳维脉与太阳经合并的间隙,距离地面一尺。
王启玄说:阳维脉起于阳分,即太阳经所生,并行而上至项部,向下再与太阳经合并而上。距离地面一尺,就是承山穴。在腓肠肌下端的下方,分肉间的凹陷处,可刺入七分。
肉里之脉,使人腰痛,不可以咳嗽。咳嗽则筋脉收缩紧急。针刺肉里之脉分为两处,在太阳经之外、少阳经绝骨穴之后。
王启玄说:肉里之脉,是少阳经所生,也是阳维脉气发出的地方,绝骨穴之后,是阳维脉经过的分肉穴。在足外踝直上绝骨端后方二分处的筋肉间隙,可刺入五分。
启玄说:这是阴维脉,在内踝上五寸半处,并足少阴经而上行。针刺飞阳脉,在内踝上一寸,足少阴经之前,与阴维脉交会的地方,即筑宾穴。《甲乙经》说,足太阳经的络脉,别走足少阴经的,名叫飞阳。
Nan Jing (Classic of Difficult Issues) states: Yang Wei Mai (Yang Linking Vessel) and Yin Wei Mai (Yin Linking Vessel) link and connect the body. If Qi and Blood overflow and accumulate without circulating in a ring, they cannot irrigate the twelve regular meridians. Therefore, Yang Wei Mai originates from the convergence of all Yang meridians, and Yin Wei Mai originates from the intersection of all Yin meridians. Yang Wei Mai links the Yang meridians, and Yin Wei Mai links the Yin meridians. If Yin and Yang cannot mutually link each other, one feels despondent and lost, with a flaccid weakness unable to control oneself. (Rongrong describes a slow, weak appearance.)
It is also said: When Yang Wei Mai is diseased, the patient suffers from aversion to cold and fever; when Yin Wei Mai is diseased, the patient suffers from heart pain.
Zhang Jiegu states: Wei Qi (Defensive Qi) belongs to Yang and governs the exterior. When Yang Wei Mai is affected by pathogens, the disease is at the exterior, hence suffering from aversion to cold and fever. Ying Qi (Nutritive Qi) belongs to Yin and governs the interior. When Yin Wei Mai is affected by pathogens, the disease is at the interior, hence suffering from heart pain. When Yin and Yang mutually link, Ying and Wei harmonize; when Ying and Wei do not harmonize, one becomes despondent and unable to control oneself. How do we know this? Zhang Zhongjing says: When a patient frequently sweats spontaneously, it indicates that Wei Qi does not harmonize with Ying Qi; Gui Zhi Tang (Cinnamon Twig Decoction) should be used to harmonize them. It is also said: If after taking Gui Zhi Tang, vexation persists and is not resolved, first puncture Feng Chi GB20 (Wind Pool) and Feng Fu GV16 (Wind Mansion), then administer Gui Zhi Tang again. These two acupoints are intersections of Yang Wei Mai. This means that if spontaneous sweating, fever, and aversion to cold persist after taking Gui Zhi Tang, and the pulse is floating at Cun (inch) and weak at Chi (cubit) accompanied by vexation, the disease lies in Yang Wei Mai, so these two acupoints should be punctured first. Zhang Zhongjing further says: When there are no internal organ diseases but fever and spontaneous sweating persist without improvement, this is due to disharmony of Wei Qi, and Gui Zhi Tang is the primary treatment.
It is also said: When Yin Wei Mai is diseased, the patient suffers from heart pain. Treatment should target the intersection of the three Yin meridians. For Tai Yin syndrome, Li Zhong Tang (Regulate the Middle Decoction) is used; for Shao Yin syndrome, Si Ni Tang (Frigid Extremities Decoction) is used; for Jue Yin syndrome, Dang Gui Si Ni Tang (Angelica Decocture for Reversing Cold Hands and Feet) and Wu Zhu Yu Tang (Evodia Decoction) are used.
Li Binhu (Li Shizhen) states: Yang Wei Mai links with the three Yang meridians of the hand and foot, among which Tai Yang Bladder Meridian and Shao Gallbladder Meridian are continuously connected from beginning to end. The syndrome of aversion to cold and fever occurs only in these two meridians, so Yang Wei Mai disease also manifests as aversion to cold and fever. Generally, Wei Qi travels through the Yang aspects during the day and the Yin aspects at night. Yin deficiency generates internal heat, while Yang deficiency generates external cold. When pathogens are in the meridians, fighting internally with Yin causes aversion to cold, and fighting externally with Yang causes fever. Thus, for aversion to cold and fever at the exterior accompanied by Tai Yang symptoms, if there is sweating, Gui Zhi Tang should be used; if there is no sweating, Ma Huang Tang (Ephedra Decoction) should be used. For aversion to cold and fever at half-exterior half-interior accompanied by Shao Yang symptoms, Xiao Chai Hu Tang (Minor Bupleurum Decoction) modified should be used. If Ying and Wei are deficient and the patient suffers from aversion to cold and fever, Huang Qi Jian Zhong Tang (Astragalus Decoction to Establish the Middle) or Ba Wu Tang (Eight Substance Decoction) should be used. Zhang Jiegu exclusively attributed the Gui Zhi Tang syndrome to Yang Wei Mai, which seems incomplete. Regarding Yin Wei Mai disease primarily causing heart pain, Zhang Jiegu exclusively used warming medicines for the three Yin meridians, which is suitable for cold invading the two Yin meridians, but insufficient for pain caused by heat reversal in the three Yin meridians. Although Yin Wei Mai intersects with the three Yin meridians, it actually returns with Ren Mai (Conception Vessel). Therefore, heart pain mostly belongs to the upward rushing of Qi from Shao Yin, Jue Yin, and Ren Mai. Sudden pain without heat, chronic pain without cold, and pain relieved by pressure indicate deficiency; pain intolerable to touch indicates excess. For cold pain combined with Shao Yin and Ren Mai, Si Ni Tang is used; combined with Jue Yin, Dang Gui Si Ni Tang is used; combined with Tai Yin, Li Zhong Tang is used. For heat pain combined with Shao Yin and Ren Mai, Jin Ling San (Golden Bell Powder) and Yan Hu Suo San (Corydalis Powder) are used; combined with Jue Yin, Shi Xiao San (Sorrow-Dispelling Powder) is used; combined with Tai Yin, Cheng Qi Tang (Descending Qi Decoction) is used. If Ying and Blood are internally injured, combined with Ren Mai, Chong Mai (Penetrating Vessel), and Hand Jue Yin Pericardium Meridian, Si Wu Tang (Four Substance Decoction), Yang Ying Tang (Nourish Ying Decoction), or Miao Xiang San (Wonderful Fragrance Powder) should be used. Prescribing medicine according to the disease, such management would likely avoid errors in treating Yin-Yang and deficiency-excess.
Wang Shuhe's Mai Jing (Pulse Classic) states: At the Cun Kou (Inkouse) pulse position, if the pulse slants from Shao Yin towards Tai Yang, it is Yang Wei Mai. Palpation reveals suffering from muscle bi-syndrome with itching, skin pain, numbness in the lower part, sweating with cold; also suffering from epilepsy with falling and bleating like a sheep, convulsion of hands and feet, and in severe cases, aphonia. Ke Chu Ren ST7 (Guest Commander) should be selected. (Located above the upper border of the bone rising before the ear, with a gap when opening the mouth. It is the intersection of Foot-Shao Yang and Foot-Yang Ming meridians.)
It also states: At the Cun Kou pulse position, if the pulse slants from Shao Yang towards Jue Yin, it is Yin Wei Mai. Palpation reveals suffering from epilepsy with stiff falling and bleating like a sheep, stiff falling with aphonia, muscle bi-syndrome with itching, spontaneous sweating at times, aversion to wind, and a shivering sensation over the body. Select Yang Bai GB14 (Yang White), Jin Men BL63 (Gold Gate), and Pu Shen BL60 (Servant Participate).
Li Binhu states: Wang Shuhe attributes epilepsy to Yin Wei and Yang Wei, while Ling Shu (Spiritual Pivot) attributes epilepsy to Yin Qiao and Yang Qiao. The theories differ but the purport is the same. Yang Qiao Mai starts from the outer malleolus, ascends along the Yang aspect to the shoulder and elbow, passes through the ear and forehead, and ends at the convergence of Wei Qi and all Yang meridians. Yin Qiao Mai starts from the inner malleolus, ascends along the Yin aspect to the hypochondrium and throat, and runs at the intersection of Ying Qi and all Yin meridians. Yang Qiao Mai originates in the middle of the heel, ascends along the outer malleolus to the lateral thigh, reaches the hypochondrium, ribs, and shoulder blade, runs on both sides of the body, and ends at the inner canthus of the eye. Yin Qiao Mai originates in the middle of the heel, ascends along the inner malleolus to the medial thigh and genitalia, runs on both sides of the body, reaches the throat, meets Ren Mai, and ends at the inner canthus of the eye. Pathogens in Yin Wei and Yin Qiao cause Dian syndrome (epilepsy with quietness); pathogens in Yang Wei and Yang Qiao cause Xian syndrome (epilepsy with movement). Xian is active and belongs to Yang, governed by Yang meridians. Dian is quiet and belongs to Yin, governed by Yin meridians. Generally, these two diseases should be treated by selecting acupoints from these four vessels, distinguishing their Yin and Yang.
Wang Shuhe states: Diagnosing a floating Yang Wei Mai indicates temporary dizziness upon standing up. In cases of excessive Yang excess, the patient suffers from shoulder breathing (labored respiration involving shoulders) and a chilly sensation as if cold.
Diagnosing a deep, large, and solid Yin Wei Mai indicates suffering from chest pain, fullness and distension under the hypochondrium, and heart pain. If the pulse resembles beads strung together, men suffer from fullness in the bilateral hypochondrium and waist pain; women suffer from pain in the vagina, resembling an ulcer.
Su Wen (Basic Questions) - Treatise on Lower Back Pain states: Disease of Yang Wei Mai causes lower back pain with swelling at the painful site. Puncture the junction where Yang Wei Mai combines with Tai Yang, one chi above the ground.
Wang Qixuan states: Yang Wei Mai originates from Yang, generated by Tai Yang, running parallel upwards to the nape, and downwards combining again with Tai Yang to ascend. One chi above the ground corresponds to Cheng Shan BL57 (Support Mountain). Located below the gastrocnemius muscle, in the depression between the muscle bellies, it can be needled seven fen deep.
The Rou Li (Muscle Interior) vessel causes lower back pain, making coughing impossible. Coughing causes tendon contraction and urgency. Puncture the Rou Li vessel in two locations, outside Tai Yang and behind Jue Gu (Absence of Bone) of Shao Yang.
Wang Qixuan states: The Rou Li vessel is generated by Shao Yang and is where Yang Wei Mai Qi emerges. Behind Jue Gu is the point where Yang Wei Mai passes through the muscle compartment. Located two fen posterior to the end of Jue Gu directly above the lateral malleolus, in the intermuscular space, it can be needled five fen deep.
Fei Yang (Flying Yang) vessel causes lower back pain, with a dull discomfort, progressing to sorrow and fear in severe cases.
Qixuan states: This is Yin Wei Mai, located five cun and half-cun above the medial malleolus, ascending along with Shao Yin Meridian. To puncture Fei Yang, locate one cun above the medial malleolus, anterior to Shao Yin, at the intersection with Yin Wei Mai, which is Zhu Bin KI9 (Building Guest). Jia Yi Jing (Systematic Classic of Acupuncture and Moxibustion) states that the Luo-connecting vessel of Tai Yang diverging to Shao Yin is named Fei Yang.