倪氏论臌,有气、血、虫、水、单是也,论胀,有寒、热、虚、实、湿、食、瘀、积、肝、肾是也。方家必分五臌
若何?十胀若何?余谓∶臌胀在上,灸于上脘,在中;灸于中脘;在下,灸于下脘,或灸气海。至若胀及两胁者,灸于
期门。胀及背腰者,灸于胃俞。胀至两腿者,灸足三里。胀至两足者,灸行间可也。
上脘(见劳伤。)
中脘(见喘症。)
下脘(脐上二寸。)
气海(见劳伤。)
期门(见喘症。)
胃俞(十一节下,各开二寸。)
足三里(见痿症。)
行间(见尸厥。)
先圣曰∶诸湿肿满,皆属于脾。盖脾主水谷,虚而失运,水谷停留,故成肿满也。后贤分而为四∶一曰水肿,皮薄
色嫩,按之成凹也,一曰气肿,皮浓色苍,按之即起也;一曰风肿,走注肿疼,皮肤麻木也;一曰瘀肿,肿而红亮,有
血缕痕也。以上诸肿,宜灸内庭。如罔验者,行间、大敦皆可灸之。
内庭、行间、大敦(三穴皆见尸厥。)
症有七,蚊、蛇、鳖、虱、肉、米,发也。瘕有八,青、黄、燥、血、脂、狐、蛇、鳖也。其实症者,征也,有块
可征。瘕者,假也,假物成形。总之不外乎气血交滞。倘因气滞而成者,灸气海。因血凝而致者,灸天枢可耳。
气海、天枢(并见劳伤。)
倪氏论述臌胀病,认为臌分为气、血、虫、水、单五种;论述胀病,认为有寒、热、虚、实、湿、食、瘀、积、肝、肾等类型。医家必定要区分什么是五臌,什么是十胀。我认为:臌胀部位在上焦的,灸上脘穴;在中焦的,灸中脘穴;在下焦的,灸下脘穴,或者灸气海穴。至于胀满波及两胁部的,灸期门穴。胀满波及背腰部的,灸胃俞穴。胀满至两腿部的,灸足三里穴。胀满至两足部的,灸行间穴即可。
上脘穴(参见劳伤章节)。
中脘穴(参见喘症章节)。
下脘穴(位于脐上二寸处)。
气海穴(参见劳伤章节)。
期门穴(参见喘症章节)。
胃俞穴(位于第十一椎节下,旁开二寸处)。
足三里穴(参见痿症章节)。
行间穴(参见尸厥章节)。
先圣说:各种因湿邪引起的浮肿和胀满,都归属于脾。因为脾主运化水谷,若脾气虚弱导致运化失职,水谷停滞体内,所以形成肿满。后世贤者将其分为四类:一是水肿,皮肤薄嫩,按压后出现凹陷;二是气肿,皮肤厚而色苍,按压后立即弹起;三是风肿,肿胀疼痛游走不定,皮肤麻木;四是瘀肿,肿胀且红亮,有血丝痕迹。以上各种肿胀,适宜灸内庭穴。如果无效,也可以灸行间穴和大敦穴。
症有七种,即蚊、蛇、鳖、虱、肉、米瘕,这是发作时的表现。瘕有八种,即青、黄、燥、血、脂、狐、蛇、鳖瘕。所谓的“症”,是征象的意思,指腹部有肿块可以触摸到确切的征象。“瘕”是假的意思,指假借外物或病理产物成形。总之,不外乎气血交结阻滞。如果是因气滞而形成的,灸气海穴。如果是因血凝而导致的,灸天枢穴即可。
Ni's discussion on鼓胀 (Gu Zhang, abdominal distension with fluid accumulation) states that Gu is categorized into five types: Qi, Blood, Parasite, Water, and Single; while Zhang (abdominal distension) includes Cold, Heat, Deficiency, Excess, Dampness, Food retention, Stasis, Accumulation, Liver, and Kidney. Physicians must distinguish what constitutes the Five Gues and the Ten Zhangs. I propose: for Gu/Zhang located in the upper jiao, moxa the Shangwan (CV13); in the middle jiao, moxa the Zhongwan (CV12); in the lower jiao, moxa the Xiawan (CV10) or Qihai (CV6). If distension extends to both hypochondria, moxa Qimen (LR14). If it extends to the back and waist, moxa Weishu (BL21). If it reaches both legs, moxa Zusanli (ST36). If it reaches both feet, moxing Xingjian (LR2) is appropriate.
Shangwan (see Lao Shang).
Zhongwan (see Chuan Zheng).
Xiawan (two cun above the umbilicus).
Qihai (see Lao Shang).
Qimen (see Chuan Zheng).
Weishu (below the 11th thoracic vertebra, two cun lateral).
Zusanli (see Wei Zheng).
Xingjian (see Shi Jue).
The Ancient Sage said: "All dampness-induced swelling and fullness belong to the Spleen." The Spleen governs the transformation and transportation of water and grain. When deficient and failing to transport, water and grain stagnate, thus forming swelling and fullness. Later sages divided this into four categories: First, Shui Zhong (Water Edema), where skin is thin and tender, leaving an indentation upon pressure; Second, Qi Zhong (Qi Edema), where skin is thick and pale, rebounding immediately after pressure; Third, Feng Zhong (Wind Edema), characterized by wandering swelling and pain with numbness of the skin; Fourth, Yu Zhong (Blood Stasis Edema), characterized by red and bright swelling with visible blood vessel traces. For all aforementioned swellings, moxa Neiting (ST44). If ineffective, Xingjian (LR2) and Dadun (LR1) may also be moxed.
Neiting, Xingjian, Dadun (all three points see Shi Jue).
Zheng (masses) have seven types: Mosquito, Snake, Turtle, Louse, Meat, Rice, and others manifesting as attacks. Jia (floating masses) have eight types: Green, Yellow, Dry, Blood, Fat, Fox, Snake, and Turtle. Essentially, Zheng refers to tangible signs, having palpable masses. Jia implies falsity, taking shape from external factors or pathological products. In summary, these do not exceed the obstruction of Qi and Blood interaction. If caused by Qi stagnation, moxa Qihai (CV6). If caused by Blood coagulation, moxa Tianshu (ST25) suffices.
Qihai, Tianshu (both see Lao Shang).