(《素问·刺志论》全)
黄帝问曰∶愿闻虚实之要。岐伯对曰∶气实形实,气虚形虚,此其常也,反此者病。(形立于外,气充于内,形气相
合,是谓和平。故气实者形实,气虚者形虚,此禀赋之常也。若形气相反,则偏虚偏实之病生矣。)谷盛气盛,谷虚气虚,
此其常也。反此者病。(人受气于谷,谷入于胃以传于肺,五脏六腑皆以受气,此气生于谷也,是谓谷气。故谷气盛衰,
候当相应,不应则为病矣。)脉实血实,脉虚血虚,此其常也,反此者病。(脉之盛衰者,所以候血气之虚实也。故脉之
与血,相应者为常,不相应者反而病也。)帝曰∶如何而反?岐伯曰∶气虚身热,此谓反也。(此以下即所以释上文也。
气虚者阳虚也,当为身寒,而反病热者,阴气虚于内,阳邪盛于外也。形气相逆,故谓之反。按∶下文云气盛身寒,得
之伤寒,则此节亦当有气盛身寒四字,必脱简也。)谷入多而气少,此谓反也。(二阳有余,三阴不足也。)谷不入而气多,
此谓反也。(胃腑受邪,及于肺也。)脉盛血少,此谓反也。脉少血多,此谓反也。(脉盛血少者,阳实阴虚也。脉少血多
者,阳虚阴实也。)气盛身寒,得之伤寒。气虚身热,得之伤暑。(气盛身寒,得之伤寒者,寒伤形也。气虚身热,得之
伤暑者,暑伤气也。愚按∶《热论篇》曰∶人之伤于寒也,则为病热。本节复以身寒者为伤寒,身热者为伤暑,其说若乎
相反。不知四时皆有伤寒,而伤暑惟在夏月,病不同时者,自不必辨。惟于夏至之后,有感寒暑而同时为病者,则不可
不察其阴阳也。盖阴邪中人,则寒集于表,气聚于里,故邪气盛实而身本因寒也。暑邪中人,则热触于外,气伤于中,
故正气疲困而因热无寒也。此夏月寒暑之明辨,故以二者并言于此,非谓凡患伤寒者,皆身寒无热也。)谷入多而气少者,
得之有所脱血,湿居下也。(谷入多者,胃热善于消谷也。脱血者,亡其阴也。湿居下者,脾肾之不足,亦阴虚也。阴虚
则无气,故谷虽入多而气则少也。)谷入少而气多者,邪在胃及与肺也。(邪在胃则不能食,故谷入少。邪在肺则息喘满,
故气多。)脉小血多者,饮中热也。(脉小者血应少,而反见其多,必或酒或饮,中于热而动之也。)脉大血少者,脉有风
气,水浆不入,此之谓也。(风为阳邪,居于脉中,故脉大。水浆不入,则中焦无以生化,故血少。)夫实者气入也,虚
者气出也。(此下言虚实寒热之因,用针补泻之法也。气入者充满于内,所以为实。气出者漏泄于中,所以为虚。)气实
者热也,气虚者寒也。(气为阳,气实则阳实,故热。气虚则阳虚,故寒。)入实者右手开针空也,入虚者左手闭针空也。
(入实者,刺实也。以右手持针,摇大其道,是右手开针空也。入虚者,刺虚也。出针之后,以左手推阖其门,是左手
闭针空也。开则邪气去,故实者可泻;闭则神气存,故虚者可补也。空,孔同。)
(《素问·刺志论》全文)
黄帝问道:我想了解虚实的关键所在。岐伯回答说:气实则形体充实,气虚则形体虚弱,这是正常的规律,与此相反的就是病态。(形体表现于外,气充养于内,形与气相合,这就叫做平和。所以气实的人形体就充实,气虚的人形体就虚弱,这是禀赋的正常情况。如果形与气相反,就会产生偏虚或偏实的疾病。)饮食充足则气盛,饮食不足则气虚,这是正常的规律。与此相反的就是病态。(人从饮食中摄取精气,饮食进入胃后传送给肺,五脏六腑都从中获得精气,这种气称为谷气。所以谷气的盛衰,应当与身体状况相应,如果不相应就是病了。)脉象实则血液充实,脉象虚则血液亏虚,这是正常的规律,与此相反的就是病态。(脉象的盛衰,是用来候察血气虚实的方法。所以脉与血相应是正常的,不相应就是病了。)黄帝说:怎样才算是相反呢?岐伯说:气虚而身体发热,这叫做反常。(以下即用来解释上文。气虚是指阳气虚,应当表现为身体寒冷,反而出现发热的症状,是因为阴气在内虚损,阳邪在外亢盛。形与气相逆,所以称为反常。按:下文提到“气盛身寒,得之伤寒”,那么这一节也应该有“气盛身寒”四字,可能是脱简了。)饮食摄入多但气却少,这叫做反常。(二阳有余,三阴不足。)饮食摄入少但气却多,这叫做反常。(胃腑受邪,波及到肺。)脉象盛大但血液少,这叫做反常。脉象细小但血液多,这叫做反常。(脉盛血少,是阳实阴虚。脉小血多,是阳虚阴实。)气盛而身体寒冷,是由于感受伤寒所致。气虚而身体发热,是由于感受伤暑所致。(气盛身寒,是由于感受伤寒,寒邪损伤形体。气虚身热,是由于感受伤暑,暑邪损伤气机。我按:《热论篇》说:人感受寒邪,就会发生热病。本节又说身体寒冷的是伤寒,身体发热的是伤暑,说法似乎相反。不知道四季都有伤寒,而伤暑只在夏季发生,病情不同自然不必争辩。只有在夏至之后,有人同时感受寒邪和暑邪而发病时,就必须仔细辨别阴阳。因为阴邪中人,寒气聚集在体表,气聚积在体内,所以邪气盛实而身体本来因寒而冷。暑邪中人,热气接触体表,气在中焦受损,所以正气疲困而因热无寒。这是夏季寒暑的明确区分,所以将两者并提于此,并不是说凡是患伤寒的人都身体寒冷而没有发热。)饮食摄入多但气却少的,是由于失血或湿邪居下所致。(饮食摄入多,说明胃热善于消化食物。失血,是亡失了阴液。湿邪居下,是脾肾不足,也是阴虚。阴虚则无气生成,所以虽然饮食摄入多,但气却少。)饮食摄入少但气却多的,是邪气在胃和肺。(邪气在胃则不能进食,所以饮食摄入少。邪气在肺则呼吸喘促胸满,所以气多。)脉象小但血液多的,是饮酒或饮水中热所致。(脉象小,血液应该少,反而见其多,必定是饮酒或饮水,其中热邪扰动血液所致。)脉象大但血液少的,是脉中有风气,且水浆不入,说的就是这种情况。(风为阳邪,居于脉中,所以脉大。水浆不入,则中焦无法生化气血,所以血液少。)所谓实证,是气向内入;所谓虚证,是气向外出。(以下讲述虚实寒热的原因及针刺补泻的方法。气向内充满于内,所以为实。气向外漏泄于中,所以为虚。)气实则表现为热,气虚则表现为寒。(气属阳,气实则阳实,所以热。气虚则阳虚,所以寒。)治疗实证,右手要张开针孔;治疗虚证,左手要闭合针孔。(治疗实证,是刺泻实邪。用右手持针,摇大针孔,这就是右手开针孔。治疗虚证,是刺补虚损。出针之后,用左手推阖针孔,这就是左手闭针孔。开则邪气去,所以实证可泻;闭则神气存,所以虚证可补。空,同孔。)
(Full text of "Ci Zhi Lun" [Discourse on Needling and the Sense of Qi] from *Suwen* [Basic Questions])
The Yellow Emperor asked, saying: I wish to hear about the essentials of deficiency and excess. Qibo replied: When Qi is excessive, the form is substantial; when Qi is deficient, the form is emaciated. This is the normal state. Deviation from this indicates disease. (Form manifests externally, while Qi nourishes internally. When form and Qi are in harmony, it is called peace. Thus, when Qi is excessive, the form is substantial; when Qi is deficient, the form is emaciated. This is the normal constitution due to endowment. If form and Qi are contrary, diseases of partial deficiency or excess arise.) Abundant food intake leads to abundant Qi; scanty food intake leads to scanty Qi. This is the normal state. Deviation from this indicates disease. (Humans derive Qi from food. Food enters the stomach and is transmitted to the lungs, so that all five zang and six fu organs receive Qi. This Qi is generated from food, hence called Gu Qi (Grain Qi). Therefore, the abundance or scarcity of Gu Qi should correspond accordingly; if not, disease occurs.) Excessive pulse indicates abundant blood; deficient pulse indicates scarce blood. This is the normal state. Deviation from this indicates disease. (The flourishing or declining pulse serves to observe the deficiency or excess of Xue (Blood) and Qi. Thus, correspondence between pulse and blood is normal; non-correspondence indicates disease.) The Emperor said: How does one deviate? Qibo said: Qi deficiency with body heat is called deviation. (The following explains the above. Qi deficiency refers to Yang deficiency, which should manifest as cold body. Instead, fever occurs because Yin Qi is deficient internally and Yang pathogenic factors are excessive externally. Form and Qi are contrary, hence called deviation. Note: The following text mentions "Qi excess with cold body, caused by Cold Injury," so this section likely originally contained the phrase "Qi excess with cold body," which may be a lacuna.) Abundant food intake but scanty Qi is called deviation. (Excess in Two Yang, insufficiency in Three Yin.) Scanty food intake but excessive Qi is called deviation. (Pathogenic factors in the Stomach Fu affecting the Lung.) Excessive pulse but scarce blood is called deviation. Small pulse but abundant blood is called deviation. (Excessive pulse with scarce blood indicates Yang excess and Yin deficiency. Small pulse with abundant blood indicates Yang deficiency and Yin excess.) Qi excess with cold body is caused by Shang Han (Cold Damage). Qi deficiency with body heat is caused by Shang Shu (Summerheat Injury). (Qi excess with cold body is caused by Shang Han, where Cold damages the form. Qi deficiency with body heat is caused by Shang Shu, where Summerheat damages Qi. My note: The "Re Lun" [Discourse on Fever] states: "When humans are injured by Cold, they develop febrile disease." This section again states that cold body indicates Shang Han and hot body indicates Shang Shu, which seems contradictory. However, Shang Han occurs in all four seasons, whereas Shang Shu occurs only in summer. Since the diseases occur at different times, there is no need to debate. Only after the Summer Solstice, when one might simultaneously contract Cold and Summerheat, must one carefully distinguish Yin and Yang. When Yin pathogens invade, Cold gathers at the exterior and Qi aggregates in the interior, so pathogenic factors are excessive and the body is inherently cold due to Cold. When Summerheat pathogens invade, Heat touches the exterior and Qi is damaged in the middle, so healthy Qi is exhausted and the body becomes hot without cold. This is the clear distinction between Cold and Summerheat in summer, hence both are mentioned here together. It does not mean that all patients with Shang Han have cold bodies without fever.) Abundant food intake but scanty Qi is caused by blood loss or Dampness residing below. (Abundant food intake indicates Stomach Heat capable of digesting food. Blood loss implies loss of Yin. Dampness residing below indicates insufficiency of Spleen and Kidney, also Yin deficiency. Yin deficiency leads to lack of Qi generation, so although food intake is abundant, Qi is scanty.) Scanty food intake but excessive Qi is caused by pathogenic factors in the Stomach and Lung. (Pathogens in the Stomach prevent eating, so food intake is scanty. Pathogens in the Lung cause panting and chest fullness, so Qi is excessive.) Small pulse but abundant blood is caused by heat in beverages. (A small pulse should indicate scarce blood, but instead it appears abundant; this must be due to alcohol or drinks containing Heat that agitate the blood.) Large pulse but scarce blood is caused by Wind Qi in the pulse and inability to take fluids. This is what is meant. (Wind is a Yang pathogen residing in the pulse, hence the pulse is large. Inability to take fluids means the Middle Jiao cannot generate substances, hence blood is scarce.) What is called Excess is Qi entering inward; what is called Deficiency is Qi exiting outward. (The following discusses the causes of deficiency/excess and cold/heat, and the methods of needle tonification and sedation. Qi entering fills the interior, thus constituting Excess. Qi exiting leaks in the middle, thus constituting Deficiency.) Qi excess manifests as Heat; Qi deficiency manifests as Cold. (Qi belongs to Yang. Qi excess means Yang excess, hence Heat. Qi deficiency means Yang deficiency, hence Cold.) For treating Excess, the right hand opens the needle aperture; for treating Deficiency, the left hand closes the needle aperture. (Treating Excess involves sedating excess. Holding the needle with the right hand and rocking it to enlarge the channel is opening the needle aperture with the right hand. Treating Deficiency involves tonifying deficiency. After withdrawing the needle, pushing and closing the aperture with the left hand is closing the needle aperture with the left hand. Opening allows pathogenic factors to exit, so Excess can be sedated; closing preserves Shen Qi, so Deficiency can be tonified. Kong is synonymous with Kong [hole/aperture].)