(素问异法方宜论 全)
黄帝问曰∶医之治病也,一病而治各不同,皆愈何也?(治各不同,如下文砭石、毒药、灸KT 、九针、导引按跷
之类。)岐伯对曰∶地势使然也。(地势不同,则气习有异,故治法亦随而不一也。)
故东方之域,天地之所始生也,(天地之气,自东而升,为阳生之始,故发生之气始于东方,而在时则为春。)鱼盐
之地,海滨傍水。(地不满东南,故东南低下而多水。鱼盐海滨,皆傍水之地利也。)其民食鱼而嗜咸,皆安其处,美其
食,得鱼盐之利,故居安食美。)鱼者使人热中,(鱼,麟虫也。鱼生水中,水体外阴而内阳,故能热中。然水从寒化,
亦脾寒者所忌。)盐者胜血,(食咸者渴,胜血之征也。义详气味类三及疾病类二十五。)故其民皆黑色疏理,其病皆为痈
疡。(血弱故黑色疏理。热多故为痈疡。)其治宜砭石,故砭石者亦从东方来。(砭石,石针也,即磁锋之属。山海经曰∶
高氏之山,有石如玉,可以为针。亦此类也。东方之民疏理而痈疡,其病在肌表,故用砭石,砭石者其治在浅。凡后世
所用砭石之法,亦自东方来也。砭音边。)
西方者,金玉之域,沙石之处,天地之所收引也。(地之刚在西方,故多金玉砂石。然天地之气,自西而降,故为天
地之收引,而在时则应秋。)其民陵居而多风,水土刚强,(陵居,高处也,故多风。金气肃杀,故水土刚强。)其民不衣
而褐荐,其民华食而脂肥,(不衣,不事服饰也。褐,毛布也。荐,草茵也。华,浓浓也,谓酥酪膏肉之类。饮食华浓,
故人多脂肥。)故邪不能伤其形体,其病生于内。(水土刚强,饮食肥浓,肌肉充实,肤腠闭密,故邪不能伤其外,而惟
饮食男女七情,病多生于内也。)其治宜毒药,故毒药者亦从西方来。(病生于内,故非针灸按导所能治,而宜用毒药也。
毒药者,总括药饵而言,凡能除病者,皆可称为毒药。如五常政大论曰,大毒治病十去其六,常毒治病十去其七,小毒
治病十去其九之类是也。凡后世所用毒药之法,亦自西方来也。)
北方者,天地所闭藏之域也,(天之阴在北,故其气闭藏,而在时则应冬。)其地高陵居,风寒冰冽。(地高陵居,西
北之势也。风寒冰冽,阴气胜也。)其民乐野处而乳食,脏寒生满病。(野处乳食,北人之性,胡地至今犹然。地气寒,
乳性亦寒,故令人脏寒。脏寒多滞,故生胀满等病。)其治宜灸KT ,故灸KT 者亦从北方来。(灸KT ,艾灸火灼也,
亦火针之属,今北人多用之。故后世所用灸KT 之法,亦自北方来也。KT ,如瑞切。)
南方者,天地所长养,阳之所盛处也,(天之阳在南,故万物长养,而在时则应夏。)其地下,水土弱,雾露之所聚
也。(南方低下而湿,故水土弱而多雾露。)其民嗜酸而食 ,( ,腐也。物之腐者,如豉 曲酱之属是也。嗜音示。
音父。)故其民皆致理而赤色,其病挛痹。(嗜酸者收,食 者湿,故其民致理而挛痹。挛痹者,湿热盛而病在筋骨也。
南方属火,故其色赤致密也。挛,闾员切,又去声。痹音秘。)其治宜微针,故九针者亦从南方来。(病在经络,故宜用
九针。凡后世所用针法,亦自南方来也。)
中央者其地平以湿,天地所以生万物也众。(土体平,土性湿。土王于四方之中,而为万物之母,故其生物也众。)
其民食杂而不劳,(四方辐辏,万物所归,故民食杂。土性和缓,故不勤劳也。)故其病多痿厥寒热。(土气通脾而主四肢,
故湿滞则为痿,寒热则为厥。中央者,四方之气交相集,故或寒或热也。)其治宜导引按跷,故导引按跷者亦从中央出也。
(导引,谓摇筋骨,动肢节,以行气血也。按,捏按也。跷,即阳跷阴跷之义。盖谓推拿溪谷跷穴以除疾病也。病在肢
节,故用此法。凡后世所用导引按摩之法,亦自中州出也。跷音乔,又极虐切。)
故圣人杂合以治,冬得其所宜。故治所以异而病皆愈者,得病之情,知治之大体也。(杂合五方之治而随机应变,则
各得其宜矣。故治法虽异,而病无不愈,知通变之道者,即圣人之能事也。)
《素问·异法方宜论》(全文)
黄帝问道:医生治疗疾病,同样的病却采用不同的治疗方法,结果都痊愈了,这是为什么呢?(治疗方法各不相同,如下文提到的砭石、毒药、灸焫、九针、导引按跷等方法。)岐伯回答说:这是因为地理环境不同造成的。(地势不同,导致各地气候和风俗习惯有差异,因此治疗方法也随之不同。)
所以,东方地区,是天地阳气开始生发的地方,(天地之气,从东方升起,是阳气初生的开始,所以发生之气始于东方,在季节上对应春季。)这里是盛产鱼盐的地方,靠近海滨和水边。(大地东南方低洼,所以那里地势低下且多水。鱼盐产地在海滨,都是傍水之地,具有傍水的便利。)那里的百姓以吃鱼为主,喜欢吃咸味,安于居住在那里,以当地的食物为美,得到了鱼盐的便利,所以居住安定,饮食美味。)吃鱼容易使人产生内热,(鱼属于鳞虫类。鱼生长在水中,水体外表阴冷而内部阳热,所以吃鱼容易导致体内积热。然而水性属寒,这也是脾脏虚寒者所忌讳的。)吃盐过多会耗伤血液,(吃咸的人容易口渴,这是耗伤血液的表现。详细义理参见气味类第三篇及疾病类第二十五篇。)所以那里的百姓肤色发黑,皮肤纹理疏松,他们患的病多是痈疡。(因为血弱导致肤色黑、皮肤纹理疏松。因为内热多,所以容易患痈疡。)治疗这类疾病适宜用砭石,所以砭石疗法也是从东方传来的。(砭石,就是石针,即磁锋之类的东西。《山海经》说:高氏的山,有像玉一样的石头,可以做针。也是这一类。东方百姓皮肤纹理疏松且易患痈疡,病位在肌表,所以使用砭石,砭石的疗效在于浅表。凡是后世所用的砭石方法,也都源自东方。砭,音边。)
西方地区,是金玉出产的地方,沙石遍布之处,是天地之气收敛收缩的地方。(大地的刚劲之气在西方,所以多金玉砂石。然而天地之气,从西方下降,所以是天地收敛的季节,在时间上对应秋季。)那里的百姓住在山陵高处,风多,水土性质刚强,(住高处,所以风多。金气肃杀,所以水土刚强。)那里的百姓不穿丝绸衣物而穿毛布草席,他们的饮食华丽丰盛且身体脂肪丰满,(不衣,指不讲究服饰穿戴。褐,是毛布。荐,是草垫。华,指浓厚,指酥酪膏肉之类。饮食浓厚丰富,所以人多脂肪丰满。)所以外邪不能伤害他们的形体,他们的病多生于内脏。(水土刚强,饮食肥浓,肌肉充实,腠理致密,所以外邪不能伤害体表,只有饮食、男女之情及七情致病,病多生于内部。)治疗这类疾病适宜用毒药,所以毒药疗法也是从西方传来的。(病生于内部,所以不是针灸按摩导引所能治疗的,而适宜用药饵。毒药,泛指所有药物,凡能祛除疾病的,都可以称为毒药。如《五常政大论》所说,用大毒的药物治病,去其病六分;常毒的药物治病,去其病七分;小毒的药物治病,去其病九分等就是这种情况。凡是后世所用的毒药方法,也都源自西方。)
北方地区,是天地闭藏之气所在的地方,(天之阴气在北方,所以其气闭藏,在时间上对应冬季。)那里地势高,居民住在山陵,风寒凛冽冰天雪地。(地势高,位于山陵,是西北的地势特征。风寒冰冽,是因为阴气旺盛。)那里的百姓喜欢野外生活,以喝乳食为主,容易因脏腑寒冷而产生胀满病。(野外生活和乳食,是北方人的习性,至今胡地仍然如此。地气寒冷,乳汁性也寒,所以使人脏腑寒冷。脏腑寒冷多停滞,所以产生胀满等疾病。)治疗这类疾病适宜用灸焫,所以灸焫疗法也是从北方传来的。(灸焫,是用艾火烧灼,也属于火针一类,现在北方人多用这种方法。所以后世所用的灸焫方法,也都源自北方。焫,音瑞切。)
南方地区,是天地长养万物、阳气最旺盛的地方,(天之阳气在南方,所以万物生长养育,在时间上对应夏季。)那里地势低洼,水土柔弱,是雾露聚集的地方。(南方地势低洼潮湿,所以水土柔弱且多雾露。)那里的百姓喜欢吃酸味食物和发酵腐臭的食物,(腐,指发酵或腐败。物的发酵品,如豆豉、酒曲、酱之类。嗜,音示。腐,音父。)所以那里的百姓皮肤纹理致密且面色红润,他们患的病多是筋脉拘挛和痹证。(爱吃酸味有收敛作用,吃发酵食物湿气重,所以百姓皮肤纹理致密且易患挛痹。挛痹,是湿热盛而病在筋骨所致。南方属火,所以面色赤红且纹理致密。挛,音闾员切,又读去声。痹,音秘。)治疗这类疾病适宜用微针,所以九针疗法也是从南方传来的。(病在经络,所以适宜用九针。凡是后世所用的针刺方法,也都源自南方。)
中央地区,地势平坦且潮湿,天地在这里孕育万物众多。(土体平坦,土性湿润。土旺于四方之中,作为万物的母亲,所以这里生物众多。)那里的百姓饮食杂乱且不从事劳累工作,(四方物产汇聚,万物归集于此,所以百姓饮食杂。土性和缓,所以不勤劳。)所以他们的病多是痿证、厥证以及寒热往来。(土气通于脾而主四肢,所以湿气停滞则成痿证,寒热不调则成厥证。中央地区,是四方之气交汇的地方,所以或寒或热。)治疗这类疾病适宜用导引按跷,所以导引按跷疗法也是从中央地区传出的。(导引,是指摇动筋骨,活动肢节,以通行气血。按,指捏按。跷,指阳跷脉和阴跷脉的含义。大概是指推拿溪谷跷穴以去除疾病。病在肢节,所以使用这种方法。凡是后世所用的导引按摩方法,也都源自中原地区。跷,音乔,又音极虐切。)
所以圣人综合各种治疗方法,根据各自适宜的地理环境来运用。因此治疗方法虽然不同,但病都能痊愈,这是因为掌握了病情的实情,了解了治疗的总体原则。(综合五方的治疗方法并随机应变,就能各得其宜。所以治疗方法虽异,但没有治不好的病,懂得变通之道的人,就是圣人的本事。)
*Suwen: Yi Fa Fang Yi Lun* (Full Text)
The Yellow Emperor asked, "When physicians treat diseases, the same disease is treated with different methods, yet all result in recovery. Why is this?" (The treatment methods vary as described below, such as bian stones, toxic drugs, moxibustion, nine needles, and daoyin anqiao.) Qibo replied, "It is caused by geographical conditions." (Different terrains lead to variations in climate and customs, so treatment methods also differ accordingly.)
Therefore, the Eastern region is where the Qi of Heaven and Earth begins to generate. (The Qi of Heaven and Earth rises from the East, marking the beginning of Yang generation; thus, the generating Qi starts in the East, corresponding to Spring in the seasons.) It is a land of fish and salt, near the seashore and waters. (The earth is lower in the southeast, hence low-lying and watery. Places for fish and salt are near the sea, benefiting from proximity to water.) The people there eat fish and favor salty flavors, are content with their dwellings, and delight in their food, enjoying the benefits of fish and salt; thus, they live securely and enjoy good food. Eating fish tends to cause heat in the interior. (Fish belong to the scaled creatures. Fish live in water; water bodies are Yin on the outside and Yang on the inside, thus causing internal heat. However, water transforms into cold, which is contraindicated for those with Spleen cold.) Excessive consumption of salt depletes the blood. (Those who eat salty foods become thirsty, a sign of blood depletion. For detailed meaning, see *Qi Wei Lei* Chapter 3 and *Ji Bing Lei* Chapter 25.) Therefore, the people there have dark skin and loose skin texture, and their diseases are mostly carbuncles and ulcers. (Blood deficiency leads to dark skin and loose texture. Heat excess leads to carbuncles and ulcers.) Treatment for these conditions is suitable for bian stones; thus, bian stone therapy also originated from the East. (Bian stones are stone needles, similar to magnetic edges. The *Shan Hai Jing* states: 'On Mount Gao, there are stones like jade that can be made into needles.' This is of the same kind. People in the East have loose skin textures and suffer from carbuncles; their disease is in the muscle and surface, so bian stones are used, whose effect is superficial. All subsequent bian stone methods also come from the East. Bian sounds like 'bian'.)
The Western region is an area of gold and jade, full of sand and stones, where the Qi of Heaven and Earth gathers and contracts. (The firm Qi of the earth is in the West, hence abundant in gold, jade, sand, and stones. However, the Qi of Heaven and Earth descends from the West, representing the gathering and contracting phase, corresponding to Autumn in the seasons.) The people there live on hills and experience much wind; the water and soil are firm and strong. (Living on high ground means more wind. The Metal Qi is肃杀 [solemn and killing], hence the water and soil are firm and strong.) The people do not wear fine clothes but use coarse wool cloth and straw mats; their diet is rich and luxurious, and they are fat and plump. ('Bu yi' means not caring about clothing adornment. He refers to wool cloth. Jian refers to straw mats. Hua means rich and thick, referring to butter, cheese, fat, and meat. Rich and thick diets lead to many people being fat and plump.) Thus, external pathogens cannot harm their physical form; their diseases arise internally. (Firm water and soil, rich and fatty diet, solid muscles, and closed pores mean external pathogens cannot harm the exterior; only diseases from diet, sexual activity, and seven emotions arise internally.) Treatment for these conditions is suitable for toxic drugs; thus, drug therapy also originated from the West. (Diseases arising internally cannot be treated by acupuncture, massage, or daoyin alone, but require medicinal herbs. 'Toxic drugs' generally refers to all medicinal herbs; anything that can remove disease can be called a toxic drug. As stated in *Wu Chang Zheng Da Lun*, using highly toxic drugs removes six-tenths of the disease, commonly toxic drugs remove seven-tenths, and slightly toxic drugs remove nine-tenths. All subsequent drug methods also come from the West.)
The Northern region is where the Qi of Heaven and Earth is stored and hidden. (The Yin Qi of Heaven is in the North, so its Qi is stored and hidden, corresponding to Winter in the seasons.) The terrain is high, people live on hills, and the wind and cold are freezing. (High terrain on hills is characteristic of the Northwest. Freezing wind and cold indicate excessive Yin Qi.) The people prefer living in the wild and consume dairy products; they suffer from abdominal fullness due to cold viscera. (Wild living and dairy consumption are characteristics of Northerners, still seen in Hu lands today. Cold earth qi and cold milk nature cause cold viscera. Cold viscera often stagnate, leading to abdominal fullness and other diseases.) Treatment for these conditions is suitable for moxibustion; thus, moxibustion therapy also originated from the North. (Moxibustion involves burning mugwort, belonging to fire needle types, widely used in the North today. Hence, subsequent moxibustion methods also come from the North. Ruo sounds like 'rui'.)
The Southern region is where Heaven and Earth nurture and grow things, and where Yang Qi is most abundant. (The Yang Qi of Heaven is in the South, so all things are nurtured and grown, corresponding to Summer in the seasons.) The terrain is low, the water and soil are weak, and it is an area where fog and dew gather. (The South is low and damp, hence weak water and soil and much fog and dew.) The people favor sour flavors and eat fermented/putrid foods. (Fu means fermented or putrefied. Fermented foods include soybean paste, yeast, and sauces. Shi sounds like 'shi'. Fu sounds like 'fu'.) Therefore, the people there have dense skin texture and reddish color, and their diseases are mainly spasms and bi-syndrome. (Sour flavor has an astringent effect; fermented foods carry dampness, leading to dense skin texture and spasms/bi. Spasms and bi occur when Damp-Heat is excessive and affects sinews and bones. The South belongs to Fire, hence red color and dense texture. Luan sounds like 'lü yuan' cut, also read as departing tone. Bi sounds like 'mi'.) Treatment for these conditions is suitable for fine needles; thus, the nine needles therapy also originated from the South. (Diseases in the meridians are suitable for nine needles. All subsequent acupuncture methods also come from the South.)
The Central region is flat and damp, where Heaven and Earth produce abundant myriad things. (Earth body is flat, Earth nature is damp. Earth prospers in the center of the four directions, serving as the mother of all things, thus producing abundant life.) The people there have diverse diets and do not engage in hard labor. (Convergence of the four directions makes all things return here, so people's diets are diverse. Earth Qi is mild, so they are not industrious.) Therefore, their diseases are mostly wei syndrome, jue syndrome, and alternating chills and fever. (Earth Qi connects to the Spleen and governs the four limbs; damp stagnation leads to wei syndrome, and cold-heat imbalance leads to jue syndrome. The Central region is where Qi of the four directions intersects, hence alternating cold and heat.) Treatment for these conditions is suitable for daoyin and anqiao; thus, daoyin and anqiao therapy also originated from the Central region. (Daoyin refers to shaking sinews and bones, moving joints to circulate Qi and Blood. An refers to kneading and pressing. Qiao refers to the meanings of Yang Qiao and Yin Qiao meridians. It generally means massaging valleys and qiao acupoints to remove disease. Diseases in limbs and joints use this method. All subsequent daoyin and massage methods also come from the Central Plains. Qiao sounds like 'qiao', also 'ji nüe' cut.)
Therefore, the Sages combine various treatments according to their appropriate suitability. Thus, although treatment methods differ, all diseases recover because one understands the true condition of the disease and grasps the general principles of treatment. (Combining treatments from the five regions and adapting flexibly ensures each is appropriate. Thus, although methods differ, no disease remains untreatable; those who understand the way of change possess the abilities of the Sages.)