(《灵枢·玉版篇》)
黄帝曰∶病之生时,有喜怒不测,饮食不节,阴气不足,阳气有余,营气不行,乃发为痈疽;阴阳不通,两热相搏,
乃化为脓,小针能取之乎?(喜怒不测,则气有所逆;饮食不节,则脏有所伤;阴气不足,故营有不行;阳气有余,故
热从而聚,皆足以致痈疽也。)岐伯曰∶圣人不能使化者,为之邪不可留也。故两军相当,旗帜相望,白刃陈于中野者,
此非一日之谋也。能使其民令行禁止,士卒无白刃之难者,非一日之教也,须臾之得也。夫至使身被痈疽之病,脓血之
聚者,不亦离道远乎?夫痈疽之生,脓血之成也,不从天下,不从地出,积微之所生也。故圣人自治于未有形也,愚者
遭其已成也。(邪在天下则为乱,邪在人身则为病,及其已成,则虽圣人不能使之化,是以邪不可留也。譬之用兵者,必
有夙教,必有定谋,而后可保其无危。人之治身,可素无调养之道乎?故惟圣人乃能自治于未形,愚者每遭其患矣。)黄
帝曰∶其已形不予遭,脓已成不予见,为之奈何?岐伯曰∶脓已成十死一生,故圣人弗使已成,而明为良方,着之竹帛,
使能者踵而传之后世,无有终时者,为其不予遭也。(此言兆庶之多,千古之邈,安得人人遭遇以救其疾苦,故惟有着之
竹帛,以遗教将来,正为人之不予遭也。)黄帝曰∶其已有脓血而后遭乎,不道之以小针治乎?岐伯曰∶以小治小者其功
小,以大治大者多害,故其已成脓血者,其唯砭石铍锋之所取也。(针小者功小,无济于事;针大者多害,恐有所伤。故
惟砭石及铍针锋针,皆可以取痈疽之脓血。针义详针刺类二。砭,标兼切。铍音披。)黄帝曰∶多害者其不可全乎?岐伯
曰∶其在逆顺焉。黄帝曰∶愿闻逆顺。岐伯曰∶以为伤者,其白眼青黑,眼小,是一逆也;内药而呕者,是二逆也;腹
痛渴甚,是三逆也;肩项中不便,是四逆也;音嘶色脱,是五逆也。除此五者为顺矣。(又《寒热病篇》曰∶五脏身有五
部∶伏兔一,腓二,背三,五脏之 四,项五。此五部有痈疽者死。是亦五逆之属也。详针刺类五十四。内,纳同。嘶
音西,声破损也。)
(出自《灵枢·玉版篇》)
黄帝说:疾病发生之初,往往是因为喜怒无常、饮食不规律,导致阴气不足、阳气偏盛,营气运行不畅,从而引发痈疽;阴阳之气不通畅,两股热邪相互搏结,于是化生为脓血,这种情况能用小针来治疗吗?(喜怒无常,会导致气机逆乱;饮食不节,会损伤脏腑;阴气不足,所以营气不能正常运行;阳气有余,所以热邪随之聚集,这些都足以导致痈疽的发生。)
岐伯回答说:即使是圣人,对于已经形成且无法化解的病变,也无法使其消散,因为邪气一旦停留就无法去除。这就好比两军对垒,旗帜相望,白刃在野外陈列,这并非是一天就能谋划好的。能让百姓令行禁止,士兵免受白刃之害的,也不是一天能教化成功的,而是长期积累的结果。如果等到身体已经遭受痈疽之病,脓血积聚,那岂不是离治病的正道太远了吗?痈疽的产生,脓血的形成,不是从天上掉下来,也不是从地里长出来,而是由微小的因素逐渐积累而成的。所以圣人能在病变尚未显现时就进行调理,而愚者则等到病变已经形成才遭遇祸患。(邪气在天下就是动乱,邪气在人身就是疾病,等到病变已经形成,即使是圣人也不能使其化解,因此邪气不可留滞。比如用兵打仗,必须有平时的教导和固定的谋略,然后才能保全没有危险。人修养身心,难道可以平时没有调养的方法吗?所以只有圣人能在未病时自我调理,愚者常常遭受祸患。)
黄帝说:如果病变已经显现而没有及时察觉,脓血已经形成而没有及时发现,该怎么办呢?
岐伯回答说:脓血已经形成的,十个人中死九个,只有一线生机,所以圣人不会让病情发展到这一步,而是明确制定良方,写在竹简丝帛上,让有能力的后人继承并传给后世,没有终结的时候,正是为了应对那些未能及时察觉的情况。(这里说的是百姓众多,年代久远,怎么能让人人都能遇到医生来救治他们的疾苦呢?所以只有将方法写在竹帛上,留给后世的教诲,正是为了人们未能及时察觉的情况。)
岐伯回答说:用小针治疗大病,功效甚微;用大针治疗大病,往往会造成更多伤害。所以对于已经形成脓血的,只能用砭石或铍锋针来刺破排脓。(小针功效小,无济于事;大针容易造成伤害,恐有所伤。所以只有砭石以及铍针、锋针,都可以用来取出痈疽的脓血。关于针具的意义详见针刺类二。砭,读音biao兼切。铍,读音pi。)
黄帝说:造成更多伤害的话,就不能痊愈了吗?
岐伯回答说:这取决于是否属于“逆证”。
黄帝说:我想听听什么是逆证和顺证。
岐伯回答说:如果认为是伤者(指正气受损严重),出现眼睛白眼珠部分呈现青黑色、眼裂变小,这是第一逆;服药后反而呕吐,这是第二逆;腹部疼痛且极度口渴,这是第三逆;肩部和颈部活动不便,这是第四逆;声音嘶哑、面色枯槁脱色,这是第五逆。除了这五种情况外,其余的为顺证。(另外《寒热病篇》说:五脏在体表有五个部位:伏兔穴所在处为一,小腿肚腓肠肌处为二,背部为三,五脏俞穴处为四,颈部为五。这五个部位如果有痈疽,就会死亡。这也属于五逆的范畴。详见针刺类五十四。内,通“纳”,意为接纳/服用。嘶,读音si,指声音破损。)
(From *Ling Shu: Yu Ban Pian*)
Huangdi said: At the onset of disease, there are often uncontrolled emotions (anger and joy), irregular diet, insufficiency of Yin Qi, excess of Yang Qi, and stagnation of Ying Qi (Nutritive Qi). These factors lead to the development of carbuncles and ulcers. When Yin and Yang are not communicating, and two types of heat pathogenic factors collide, pus is formed. Can this be treated with small needles? (Uncontrolled emotions cause Qi rebellion; irregular diet damages the Zang organs; insufficiency of Yin Qi leads to the failure of Ying Qi circulation; excess Yang Qi causes heat to gather. All these can result in carbuncles and ulcers.)
Qibo replied: Even a sage cannot resolve lesions that have already solidified and cannot be transformed, because once pathogens remain, they cannot be eliminated. This is like two armies facing each other, flags visible to one another, and white blades arrayed in the open field; such a situation does not arise from a plan made in a single day. To enable the people to obey orders and prohibit violations, and for soldiers to avoid the danger of white blades, requires more than a day's instruction; it is the result of long-term cultivation. If one waits until the body suffers from carbuncles and ulcers, with accumulation of pus and blood, is this not far from the correct path of treatment? The generation of carbuncles and ulcers, and the formation of pus and blood, do not fall from the sky nor emerge from the earth; they arise from the gradual accumulation of minor factors. Therefore, sages regulate themselves before any form appears, while fools encounter disaster only after the condition has fully developed. (When pathogens exist in the world, they cause chaos; when they exist in the human body, they cause disease. Once the pathology has fully manifested, even a sage cannot transform it, hence pathogens must not remain. Just as military strategy requires prior training and established plans to ensure safety without danger, how can one manage their body without daily nourishment and regulation? Thus, only sages can self-regulate before illness manifests, whereas fools often suffer misfortune.)
Huangdi asked: What if the pathological changes have already manifested but were not noticed, and pus and blood have already formed but were not seen? How should we proceed?
Qibo answered: When pus and blood have already formed, the mortality rate is extremely high (nine out of ten die, with only one chance of survival). Therefore, sages prevent conditions from reaching this stage. They clearly formulate effective prescriptions, inscribe them on bamboo slips and silk, so that capable successors may inherit and transmit them to future generations without end. This is precisely to address cases where timely detection was missed. (This refers to the vast number of people and the remoteness of time across millennia; how can everyone encounter a physician to relieve their suffering? Thus, methods are recorded on bamboo and silk to leave instructions for the future, specifically for those who fail to detect early signs.)
Huangdi asked: If pus and blood have already formed and we encounter the patient, can we treat it using small needles?
Qibo replied: Using small needles to treat large lesions yields little effect; using large needles on large lesions often causes harm. Therefore, for conditions where pus and blood have already formed, only bi stones (stone scalpels) or pi-feng needles (large-bladed needles) should be used to drain the abscess. (Small needles have limited efficacy and are useless here; large needles may cause injury. Thus, only bi stones, pi needles, and feng needles can be used to extract pus and blood from carbuncles and ulcers. For details on needle principles, see Category 2 of Acupuncture. 'Bi' is pronounced bīan jiān qiē. 'Pi' is pronounced pī.)
Huangdi asked: If it causes more harm, can it still be completely cured?
Qibo answered: It depends on whether the case presents as "Ni" (Rebellious/Ominous) or "Shun" (Favorable/Smooth).
Huangdi said: I wish to hear about the Rebellious and Favorable patterns.
Qibo said: If the injury is severe, and the patient exhibits white sclera with blue-black discoloration around the eyes and constricted palpebral fissures, this is the First Rebellious sign. If vomiting occurs after taking medicine, this is the Second Rebellious sign. If abdominal pain is accompanied by extreme thirst, this is the Third Rebellious sign. If there is stiffness and inconvenience in the shoulders and neck, this is the Fourth Rebellious sign. If hoarseness and pallor (loss of facial luster) are present, this is the Fifth Rebellious sign. Apart from these five conditions, the rest are considered Favorable. (Additionally, the *Han Re Bing Pian* chapter states: There are five regions on the body corresponding to the Five Zang organs: Region 1 is the Fubu area, Region 2 is the calf (Fei), Region 3 is the back, Region 4 is the Back-Shu points of the Zang organs, and Region 5 is the neck. If carbuncles and ulcers occur in any of these five regions, death ensues. This also belongs to the category of the Five Rebellious signs. See Category 54 of Acupuncture. 'Nei' is interchangeable with 'Na', meaning to take/administer. 'Si' is pronounced sī, referring to damaged voice.)