帝曰∶人之耳鸣者,何气使然?岐伯曰∶耳者,宗脉之所聚也,故胃中空则宗脉虚,虚则下溜,脉有所竭
者,故耳鸣。补客主人,手大指爪甲上与肉交者也。
耳目为视听之灵窍,故皆宗脉所聚而通于心,宗脉者,宗气所行之脉也。清阳积于胸中,名曰宗气,由先
天元气、后天谷气会合而升者也。故胃中空虚,其气下溜,而上升之脉气竭,空窍乏清灵之气,清不升则浊不
降,浊不降则阳郁而内动,故耳鸣矣。经又云∶胃之大络,名曰虚里。出于左乳下,其动应衣,脉宗气也。是
故宗脉之气生于胃,胃虚其脉有所竭者也。客主人胆经之穴,手大指爪甲上肺经少商穴也。肺主一身之气,胆
经入于耳中,补二经以通阳助气,使之上达也。
帝曰∶人之自啮舌者,何气使然?岐伯曰∶此厥逆走上,脉气辈至也。少阴气至则啮舌,少阳气至则啮颊,
阳明气至则啮唇矣。视主病者,则补之。
经脉之气,升降循环,如其不调而厥逆走上,则其气至之处,经脉盛胀,与齿相碍,故不觉自啮。少阴脉
气至舌,故啮
舌;少阳脉气至颊,故啮颊;阳明脉气至唇,故啮唇矣。盛于上者,虚于下也,补其下,则气平矣。
上古之人,德性浑浓,气质坚强,而无内伤之病。或感外邪,客于肌表,故治宜针砭,而少用汤液之法。
后世气化渐薄,人欲日滋,禀质既弱,邪易入内,故针砭多有不宜。自汉张仲景本《内经》之理,立论制方,
为方脉之祖,于是各分专科,习方脉者,不谙针砭之法也。良以阴阳气血,由脏腑而出经络,周行于身,是故
不独内伤虚证,必需汤药,而经络外邪,汤药可以自内达外而祛之,故近世针砭之法罕用,而精其术者鲜矣。
然治虽分科,而理法则一,要必洞明阴阳五行气化之道,脏腑经络浅深之分,营卫气血流行之度,以及禀质
强弱、外邪刚柔、天时寒热、地势高下,无不详审而尽知,然后以望闻问切,辨其病证而施治法,方无错误,
故方脉为诸科之纲领也。针灸须识经穴,而有补泻不同,其法亦细。若汤方,必明药性气味,而有寒热温
凉、浮沉升降、轻重浓薄之别,或入脏腑,或行经络,或走气分,或走血分,或收或散,或泄或攻,或补或
泻,全在配合得宜,故有君臣佐使之分,奇偶大小之制,而其理法,比之针灸诸科,精细而神妙,下咽即入
于内,错误不能挽回,故其利害,亦比诸科甚重,本非易为之事也。夫君子以济世为心,达则兼善天下,善天
下,当为相;穷则独善其身,不可不知医,知医未始不可以兼善。虽然,若强不知以为知,不如不知之为善,
何也?不知医,不能自善而已;强不知以为知者,始而害人,终于自害,斯报应必然之道也。虽其本心,原欲
愈人之病,而学术不明,肆意自用,杀人于冥冥中而不觉,乌得无罪?薄乎云尔!日积月累,薄者浓矣,故曰
择术不可不慎也。欲求寡过,非潜心力究圣经理法不可。经曰∶上工治病十全九,下工治病十全六。迨今之世,
有能十全六者,亦可以功过相抵,吾将称之为上工也。古之所谓上工者,不可得而见之矣。以故汇集经语,以
为方脉家治法准则。苟志于仁者,当三复而不可忽也。自今以后,惟方制之法为最要矣。然病变万端,药必
因病而施,倘辨证不明,方有何用?无益反害,则有方不如无方也。是故辨证尤在论治之先,当于四诊、疾病
诸门究之。欲善其身,不可不知此事;欲善其事者,可不利其器哉!
黄帝问道:人出现耳鸣的症状,是什么气导致的?岐伯回答:耳部是众多经脉汇聚的地方,所以胃中空虚时,汇聚的经脉就会虚弱,经脉之气下陷,导致某些经脉的气血枯竭,因此发生耳鸣。治疗应补益客主人穴(即上关穴),以及手大拇指指甲角与肉交接处的少商穴。
耳目是视听功能的灵敏窍道,所以都是宗脉汇聚之处,并且与心相通。所谓宗脉,就是运行宗气的经脉。清阳之气积聚在胸中,称为宗气,它是由先天元气和后天水谷之气会合而上升形成的。所以胃中空虚,其气下陷,导致上升的脉气衰竭,空窍缺乏清灵之气,清气不升则浊气不降,浊气不降则阳气郁结而内动,因此发生耳鸣。经文又说:胃的大络,名叫虚里,位于左乳下方,搏动可透衣可见,这是反映宗气的脉搏。因此宗脉之气生于胃,胃虚则脉气有所枯竭。客主人穴属于胆经,手大拇指指甲上的穴位是肺经的少商穴。肺主一身之气,胆经进入耳中,补益这两条经脉以通阳助气,使气能够上达。
黄帝问道:人自己咬伤舌头,是什么气导致的?岐伯回答:这是因为厥逆之气向上走窜,脉气随之到达相应部位。如果是少阴经气到达,就会咬伤舌头;少阳经气到达,就会咬伤面颊;阳明经气到达,就会咬伤嘴唇。观察主要病变的经脉,就对该经进行补法治疗。
经脉之气升降循环,如果不协调而发生厥逆向上走窜,那么气到达的部位,经脉就会盛满胀大,与牙齿相抵触,所以不知不觉地自咬。少阴脉气到达舌部,所以咬伤舌头;少阳脉气到达颊部,所以咬伤面颊;阳明脉气到达唇部,所以咬伤嘴唇。上部邪气盛实,下部正气就虚弱,补益下部,气机就能平复。
上古时期的人,道德淳厚,体质坚强,没有内伤的疾病。即使感受外邪,也停留在肌表,所以治疗适宜用针砭,很少使用汤药的方法。后世人体气化逐渐薄弱,人的欲望日益滋长,禀赋体质既已虚弱,邪气容易侵入体内,所以针砭疗法多有不宜。自从汉代张仲景依据《内经》的道理,立论制定方剂,成为方脉学的始祖,于是各分专科,学习方脉的人,就不精通针砭之法了。确实因为阴阳气血,由脏腑发出进入经络,周行于全身,所以不仅内伤虚证需要汤药,对于经络的外邪,汤药也可以从内部到达外部将其祛除,因此近代针砭之法很少使用,精通此术的人也就少了。
然而治疗虽然分科,但理法原则是一致的,必须透彻明白阴阳五行气化的道理,脏腑经络深浅的区别,营卫气血流行的规律,以及禀赋体质的强弱、外邪性质的刚柔、天时气候的寒热、地势高低的影响,无不详细审察并完全知晓,然后用望闻问切,辨别病证并施治法,才不会出错,所以方脉学是各科的纲领。针灸需要认识经穴,且有补泻手法的不同,其方法也很细致。至于汤药方剂,必须明了药物的性味,而有寒热温凉、浮沉升降、轻重浓薄的区别,有的入脏腑,有的行经络,有的走气分,有的走血分,有的收敛,有的发散,有的泄下,有的攻逐,有的补益,有的泻实,全在于配合得当,所以有君臣佐使的分工,奇偶大小方的制度,而其理法,比起针灸等科,更加精细神妙,药物入口即进入体内,一旦错误无法挽回,所以其利害关系,也比其他科室严重得多,本不是轻易能做的事。君子以救济世人为心意,显达时就兼善天下,兼善天下应当做宰相;困顿时就独善其身,不可不懂医学,懂医学未尝不可以兼善天下。虽然如此,如果不懂装懂,不如不懂为好,为什么呢?不懂医学,只是不能保全自己罢了;不懂装懂的人,开始伤害别人,最终伤害自己,这是必然的报应之道。虽然他们的本心,原本是想治愈别人的病,但因为学术不明,肆意自用,在不知不觉中杀人,怎么能没有罪过呢?这不过是轻微的责备罢了!日积月累,薄弱的变得浓厚了,所以说选择职业不可不谨慎。想要减少过失,除非潜心研究圣人的经理法不可。经文说:高明的医生治病十次能治好九次,低劣的医生治病十次只能治好六次。到了现在的时代,能有治好六次的,也可以功过相抵,我将称他为高明医生了。古代所谓的高明医生,已经看不到了。因此汇集经文语句,作为方脉家的治法准则。如果有志于仁爱的人,应当反复诵读而不可忽视。从今以后,只有方制之法最为重要。然而病变千头万绪,药物必须根据病情施用,如果辨证不明确,方子有什么用?不仅无益反而有害,那有方子还不如没有方子。所以辨证尤其要在论治之前,应当在四诊、疾病各门类中深入研究。想要保全自身,不可不懂这件事;想要做好事情的人,难道能不磨快工具吗!
Huangdi asked: What qi causes tinnitus in humans? Qibo replied: The ears are the gathering place of the Zong Mai (Major Meridians). Therefore, when the Stomach is empty, the Zong Mai becomes deficient. Deficiency leads to sinking downward, and when the meridians experience exhaustion of Qi and Blood, tinnitus occurs. Treatment should involve tonifying the Kerenren acupoint (Shangguan, GB19), as well as the Shaoshang acupoint (LU11) located at the junction of the nail and flesh on the thumb.
The eyes and ears are the sensitive orifices for vision and hearing; thus, they are both gathering places of the Zong Mai and connect with the Heart. The Zong Mai refers to the meridians through which Zong Qi (Gathering Qi) circulates. Clear Yang Qi accumulates in the chest and is named Zong Qi, formed by the convergence and ascending movement of congenital Yuan Qi (Original Qi) and postnatal Gu Qi (Grain Qi). Therefore, when the Stomach is empty, its Qi sinks downward, causing the ascending meridian Qi to exhaust. The orifices lack clear and spiritual Qi; if Clear Qi does not ascend, Turbid Qi cannot descend. If Turbid Qi does not descend, Yang Qi becomes depressed and moves internally, resulting in tinnitus. The Classic further states: The great collateral of the Stomach is named Xuli (CV17), located below the left breast, where pulsation can be seen through clothing; this reflects the Zong Qi. Thus, the Qi of the Zong Mai originates from the Stomach; when the Stomach is deficient, the meridian Qi is exhausted. Kerenren belongs to the Gallbladder Meridian, while the acupoint on the thumb nail is Shaoshang (LU11) of the Lung Meridian. The Lung governs the Qi of the whole body, and the Gallbladder Meridian enters the ear. Tonifying these two meridians helps unblock Yang and assist Qi, enabling it to reach the upper regions.
Huangdi asked: What qi causes a person to bite their own tongue? Qibo replied: This is due to Jue Ni (Rebellious Qi) moving upward, with meridian Qi arriving at specific locations. When Shao Yin (Lesser Yin) Qi arrives, the tongue is bitten; when Shao Yang (Lesser Yang) Qi arrives, the cheek is bitten; when Yang Ming (Bright Yang) Qi arrives, the lips are bitten. Observe the primary affected meridian and apply the tonification method.
The Qi of the meridians ascends, descends, and circulates cyclically. If it becomes disordered and Jue Ni moves upward, the meridians at the site of Qi arrival become full and distended, interfering with the teeth, leading to unconscious biting. When Shao Yin meridian Qi reaches the tongue, the tongue is bitten; when Shao Yang meridian Qi reaches the cheek, the cheek is bitten; when Yang Ming meridian Qi reaches the lips, the lips are bitten. Excess in the upper part implies deficiency in the lower part; tonifying the lower part will calm the Qi.
In ancient times, people possessed profound virtue and strong constitution, free from internal injuries. Even if exposed to external pathogens, they remained on the muscle surface; thus, treatment favored acupuncture and Bian stone therapy, with little use of decoctions. In later generations, human Qi transformation gradually weakened, desires increased, and constitutions became frail, allowing pathogens to easily enter the interior. Consequently, acupuncture and Bian stone therapies were often unsuitable. Since the Han Dynasty, Zhang Zhongjing established theories and formulated prescriptions based on the principles of the *Neijing* (Classic of Internal Medicine), becoming the ancestor of Formula and Pulse studies. Specialized disciplines emerged, and those studying formulas and pulses neglected acupuncture techniques. Indeed, Yin-Yang, Qi, and Blood originate from the Zang-Fu organs, enter the meridians, and circulate throughout the body. Therefore, not only are decoctions necessary for internal injuries and deficiency syndromes, but they can also expel external pathogens from the interior to the exterior via the meridians. Hence, acupuncture has been rarely used in recent times, and few masters excel in it.
Although treatments are divided into specialties, the underlying principles remain unified. One must thoroughly understand the Dao of Yin-Yang, Five Elements, and Qi transformation; the depth and superficiality of Zang-Fu organs and meridians; the circulation patterns of Ying (Nutritive) and Wei (Defensive) Qi and Blood; as well as the strength of constitution, the nature of external pathogens (rigid or soft), seasonal climate (cold or hot), and geographical elevation. All these must be carefully examined and fully known. Only then, using Wang (Inspection), Wen (Auscultation and Olfaction), Wen (Inquiry), and Qie (Palpation) to differentiate syndromes and apply treatments, can errors be avoided. Thus, Formula and Pulse studies serve as the guideline for all disciplines. Acupuncture requires knowledge of acupoints and involves different tonification and sedation methods, making its techniques detailed. Regarding herbal formulas, one must understand drug properties and flavors, distinguishing between cold, hot, warm, cool; floating, sinking; ascending, descending; heavy, light; thick, thin. Drugs may enter Zang-Fu, travel through meridians, move in the Qi level, or move in the Blood level; they may gather or scatter, drain or attack, tonify or sedate. Success depends entirely on proper combination, following the roles of Jun (Sovereign), Chen (Minister), Zuo (Assistant), and Shi (Envoy), and the systems of odd/even and large/small formulas. Its principles and methods are more refined and miraculous than acupuncture. Once swallowed, drugs enter the interior; errors cannot be reversed, so the stakes are much higher than in other disciplines, making it no easy task. A gentleman aims to save the world; when successful, he benefits all under heaven, ideally serving as a minister; when unsuccessful, he cultivates his own virtue. One must know medicine, as knowing medicine allows one to benefit others. However, pretending to know what one does not know is worse than ignorance. Why? Ignorance of medicine only fails to protect oneself; pretending to know harms others initially and oneself finally, which is inevitable retribution. Although their original intent was to cure disease, lack of academic clarity and arbitrary self-will lead to unknowing killing, for which there is guilt. This is merely a mild rebuke! Over time, weakness accumulates into thickness; hence, choosing a profession requires caution. To minimize faults, one must devote oneself to studying the classics and principles. The Classic states: An expert physician cures nine out of ten cases; an inferior physician cures six out of ten. In today's world, curing six out of ten is sufficient to balance merits and faults, and I would call such a person an expert. True experts of antiquity are now unseen. Therefore, I have collected classical statements as guidelines for formula physicians. Those committed to Ren (Benevolence) should review them repeatedly and not neglect them. From now on, prescription formulation is paramount. However, diseases vary infinitely, and medicines must be applied according to the condition. If syndrome differentiation is unclear, what use is a formula? It brings no benefit but harm; having a formula is worse than having none. Thus, syndrome differentiation precedes treatment discussion and must be studied in the chapters on Four Diagnostic Methods and various diseases. To preserve oneself, one must know this; to do things well, one must sharpen one's tools!