(《素问·脉要精微论》)
帝曰∶诸痈肿筋挛骨痛,此皆安生?(此言诸病痈肿而有兼筋挛骨痛者也。诸家以痈肿、筋挛、骨痛,释为三证,
殊失经意。观下文曰此寒气之肿,则其所问在肿,义可知矣。)岐伯曰∶此寒气之肿,八风之变也。(惟风寒之变在经,
所以兼筋骨之痛。今有病大项风、虾蟆瘟之属,或为头项咽喉之痈,或为肢节肌肉之肿,正此类也。八风义,详运气类
三十五。)帝曰∶治之奈何?岐伯曰∶此四时之病,以其胜治之愈也。(四时之病,实时气也。治之以胜,如《至真要大
论》曰∶治诸胜复,寒者热之,热者寒之,温者清之,清者温之,散者收之,抑者散之,燥者润之,急者缓之,坚者软
之,脆者坚之,衰者补之,强者泻之,各安其气,必清必静,则病气衰去。此之谓也。)
(《素问·病能论》)
黄帝问曰∶人病胃脘痈者,诊当何如?岐伯对曰∶诊此者当候胃脉,其脉当沉细,沉细者气逆,(胃脉见于右关,所
谓中附上,右外以候胃也。胃为多气多血之腑,脉当洪大,而反见沉细,故为胃气之逆。脘音管。)逆者人迎甚盛,甚盛
则热。(胃气逆而人迎盛,逆在脏而热在经也,即《终始》等篇所云人迎三盛病在阳明之谓。)人迎者胃脉也,(人迎在结
喉旁,足阳明动脉也。)逆而盛,则热聚于胃口而不行,故胃脘为痈也。(阳明气逆而盛,则热邪聚于胃脘,故留结为痈。)
帝曰∶有病颈痈者,或石治之,或针灸治之而皆已,其真安在?(其真安在,言孰为正治之法也。)岐伯曰∶此同名
异等者也。(颈痈之名虽同,而证则有异,故治亦各有所宜。)夫痈气之息者,宜以针开除去之;(息,止也。痈有气结而
留止不散者,治宜用针以开除其气,气行则痈愈矣。)夫气盛血聚者,宜石而泻之,此所谓同病异治也。(欲泻其血,宜
用砭石,血泄则气衰而痈亦愈,此病同而治异也。)
(出自《素问·脉要精微论》)
黄帝问道:各种痈肿、筋脉拘挛、骨骼疼痛,这些病症都是如何产生的?(这里说的是各种痈肿病兼见筋挛和骨痛的情况。各家将痈肿、筋挛、骨痛解释为三种独立的证候,特别违背了经文的本意。看下文说“这是寒气导致的肿胀”,那么所问的重点在于肿胀,含义就清楚了。)
岐伯回答说:这是寒气引起的肿胀,以及八方风气变化所致。(只有风寒的变化影响经络,所以兼有筋骨疼痛。现在有大项风、虾蟆瘟等病,有的表现为头项咽喉的痈肿,有的表现为肢节肌肉的肿胀,正是这一类情况。关于八风的含义,详见运气类第三十五篇。)
黄帝问道:治疗它们该怎么办?
岐伯回答说:这是四时发生的疾病,用克制它的治法就能痊愈。(四时的疾病,就是时令邪气。用相胜的方法治疗,如《至真要大论》所说:治疗各种偏胜和复气的病,寒证用热药,热证用寒药,温证用清法,清证用温法,散漫的用收敛法,郁结的用发散法,干燥的用滋润法,拘急的用缓急法,坚硬的用软化法,脆弱的用坚固法,虚弱的用补益法,强盛的用泻法,使各脏腑之气安和,必须保持清明宁静,这样病气就会衰退去除。说的就是这个道理。)
(出自《素问·病能论》)
黄帝问道:人患胃脘痈的病,诊察应该怎样进行?
岐伯回答说:诊察这种病应当观察胃脉,其脉象应当是沉细的,脉象沉细表示气机逆乱,(胃脉出现在右关部,所谓中附上,右手外侧候胃。胃是多气多血的腑,脉象应当洪大,反而出现沉细,所以是胃气上逆。脘音管。)气机逆乱则人迎脉非常盛大,人迎脉盛大则表示有热。(胃气上逆而人迎脉盛,逆在脏而热在经,即《终始》等篇所说的人迎脉大三倍,病在阳明经的意思。)人迎脉属于胃脉,(人迎穴在结喉旁,是足阳明胃经的动脉。)气逆且盛大,则热邪聚集在胃口而不能运行,所以胃脘发生痈肿。(阳明经气逆且盛大,则热邪聚积于胃脘,所以停留凝结形成痈肿。)
黄帝问道:有人患颈痈,有的用砭石治疗,有的用针灸治疗,都治愈了,其中真正的正治方法是什么?(“其真安在”,意思是哪一种才是正确的治疗方法。)
岐伯回答说:这是名称相同但病情轻重程度不同的病。(颈痈的名称虽然相同,但证候则有差异,所以治疗方法也各有适宜之处。)对于痈气停滞不行的,适宜用针具刺开并去除它;(息,停止的意思。痈有气结而留止不散的,治疗适宜用针来疏通其气,气行则痈自愈。)对于气盛血聚的,适宜用砭石放血以泻之,这就是所说的同病异治。(想要泻除瘀血,适宜用砭石,血泄出则气衰而痈也就好了,这是病名相同而治疗方法不同。)
(From *Suwen: Pulse Essentials and Subtle Discussions*)
The Yellow Emperor asked: How are various swellings (Yongzhong, carbuncles and sores), tendon spasms (Jinluan, contracture of tendons), and bone pain (Gutong, pain in bones) generated? (This passage refers to cases where swelling is accompanied by tendon spasms and bone pain. Various schools interpret these as three separate syndromes, which significantly deviates from the original meaning of the classic. Observing the subsequent text stating "this is swelling caused by cold pathogen," it is clear that the inquiry focuses on swelling, revealing its true intent.)
Qibo replied: These are swellings caused by cold qi and changes induced by the eight winds. (Only when wind and cold affect the meridians do they manifest with accompanying bone and tendon pain. Currently, diseases such as "Da Xiang Feng" and "Hamawen" (mumps-like epidemic disease) occur; some present as carbuncles in the head, neck, or throat, while others present as swelling in limbs, joints, or muscles. These belong to this category. The meaning of the eight winds is detailed in Section 35 of the Climate and Qi chapter.)
The Yellow Emperor asked: How should they be treated?
Qibo replied: These are diseases occurring in the four seasons; they can be cured by treating them with their counteracting method. (Diseases of the four seasons refer to seasonal pathogens. Treating them by their counteracting principle, as stated in *Zhi Zhen Yao Da Lun*: "To treat all conditions of excess and recurrence: for cold, use heat; for heat, use cold; for warmth, use clearing; for coolness, use warming; for dispersion, use astringency; for depression, use dispersal; for dryness, use moistening; for tension, use relaxation; for hardness, use softening; for fragility, use strengthening; for deficiency, use tonification; for excess, use purgation. Each organ's qi is stabilized, maintaining clarity and tranquility, so that the pathogenic qi declines and departs. This is what is meant.")
(From *Suwen: Disease Capabilities*)
The Yellow Emperor asked: When a person suffers from a gastric carbuncle (Weiwuan Yong, carbuncle of the stomach region), how should the diagnosis be conducted?
Qibo answered: In diagnosing this condition, one must observe the Stomach pulse. The pulse should be deep and fine (Chenxi). A deep and fine pulse indicates rebellious qi. (The Stomach pulse is located at the Right Guan position, referred to as 'Zhong Fu Shang', where the right lateral side corresponds to the Stomach. The Stomach is an organ abundant in qi and blood, so its pulse should typically be surging and large. Conversely, appearing deep and fine indicates rebellion of Stomach qi. 'Wan' is pronounced 'guan'.) Rebellious qi causes the Renying pulse to become extremely full; if extremely full, it indicates heat. (When Stomach qi rebels and the Renying pulse is full, the rebellion is in the zang organs while the heat is in the meridians, which corresponds to the statement in chapters like *Zhong Shi* that a Renying pulse three times larger than normal indicates disease in the Yangming meridian.) The Renying pulse belongs to the Stomach meridian. (The Renying acupoint is beside the laryngeal prominence and is the arterial pulse of the Foot-Yangming Meridian.) If the qi rebels and becomes full, heat gathers at the stomach opening but cannot circulate, thus causing a carbuncle in the gastric region. (When Yangming qi rebels and becomes full, heat pathogens gather in the gastric region, stagnating and condensing to form a carbuncle.)
The Yellow Emperor asked: Some patients suffer from cervical carbuncles (Jingyong); some are treated with stone therapy (Bianshi, bian stones/lithotherapy), while others are treated with acupuncture and moxibustion, and both recover. What is the true correct treatment method? ("What is the true correct treatment?" asks which method is the proper standard treatment.)
Qibo replied: These are conditions with the same name but different stages/severity. (Although named "cervical carbuncle," the syndromes differ, so treatments vary according to suitability.) For carbuncles where qi stagnates and stops without dissipating, needle therapy should be used to open and remove the stagnation. ('Xi' means stop. When a carbuncle involves qi knotting and stagnating without dispersing, treatment should utilize needles to unblock the qi; once qi flows, the carbuncle heals.) For conditions where qi is excessive and blood has gathered, lithotherapy (bian stones) should be used to drain/excrete. This is known as "treating the same disease differently." (To drain the blood, bian stones are appropriate; once blood is released, qi subsides and the carbuncle heals. This illustrates treating the same disease name with different methods.)