(灵枢卫气失常篇)
黄帝问于伯高曰∶人之肥瘦大小寒温,有老壮少小,别之奈何?(寒温者,言禀有阴阳也。)伯高对曰;人年五十以
上为老,二十以上为壮,十八以上为少,六岁以上为小。黄帝曰∶何以度知其肥瘦?伯高曰∶人有肥有膏有肉。(肥者,
即下文所谓脂也。)黄帝曰∶别此奈何?伯高曰∶ 肉坚,皮满者,肥。 肉不坚,皮缓者,膏。皮肉不相离者,肉。(
肉,肉之聚处也。此言伟壮之人,而有脂膏肉三者之异∶脂者紧而满,故下文曰肉坚身小;膏者泽而大,故下文曰肉淖
垂腴;皮肉连实而上下相应者曰肉,故下文曰身体容大。 ,劬允切。)黄帝曰∶身之寒温何如?伯高曰∶膏者其肉淖,
而粗理者身寒,细理者身热。脂者其肉坚,细理者热,粗理者寒。(淖,柔而润也。膏者肉淖,脂者肉坚。若其寒热,则
粗理者皆寒,细理者皆热。淖音闹。)黄帝曰∶其肥瘦大小奈何?伯高曰∶膏者,多气而皮纵缓,故能纵腹垂腴。肉者,
身体容大。脂者,其身收小。(纵,宽纵也。腴,脂肥也。膏者纵腹垂腴,脂者其身收小,是膏肥于脂也。肉为皮肉连实,
自与脂膏者有间。纵,去声。腴,音俞。)黄帝曰∶三者之气血多少何如?伯高曰∶膏者多气,多气者热,热者耐寒。肉
者多血则充形,充形则平。脂者其血清,气滑少,故不能大。此别于众人者也。(膏者多气,气为阳,故质热而耐寒也。
肉者多血。血养形,故形充而气质平也。脂者血清而气滑少,故不能大。若此三者,虽肥盛皆别于众人,而脂者之气血,
似不及乎膏肉也。愚按∶世传肥白之人多气虚,而此云膏者多气,不无相左。若据余闻见之验,则苍瘦之气虚者,固不
减于肥白,是以不宜胶柱也。)黄帝曰∶众人奈何?伯高曰∶众人皮肉脂膏不能相加也,血与气不能相多,故其形不小不
大,各自称其身,命曰众人。(众人者,言三者之外,众多之常人也。其皮肉脂膏血气各有品格,故不能相加,亦不能相
多,而形体大小皆相称而已。)黄帝曰∶善。治之奈何?伯高曰∶必先别其三形,血之多少,气之清浊,而后调之,治无
失常经。(三形既定,血气既明,则宜补宜泻,自可勿失常经矣。)是故膏人纵腹垂腴,肉人者上下容大,脂人者虽脂不
能大也。(此重言其详也。)
《灵枢·卫气失常篇》
黄帝向伯高问道:人的肥瘦、大小、寒热,以及老、壮、少、小的区别,该如何辨别呢?(所谓寒热,是指人体禀赋有阴和阳的不同。)
伯高回答说:人年五十岁以上称为“老”,二十岁以上称为“壮”,十八岁以上称为“少”,六岁以上称为“小”。
黄帝问:如何判断一个人的肥瘦呢?
伯高说:人有“肥”、“膏”、“肉”三种类型。(所谓的“肥”,就是下文所说的“脂”。)
黄帝问:如何区分这三种情况呢?
伯高说:肌肉坚实,皮肤丰满的,是“肥”(脂)。肌肉不坚实,皮肤松弛的,是“膏”。皮与肉紧密结合不易分离的,是“肉”。(所谓“肉”,是指肌肉聚结之处。这里说的是体格魁梧的人,在“脂”、“膏”、“肉”三者之间的差异:所谓“脂”,肌肉紧致且饱满,所以下文说肌肉坚实身体较小;所谓“膏”,肌肉润泽且体型宽大,所以下文说肌肉柔润下垂腹部脂肪;所谓“肉”,是皮肉连实且上下相应的,所以下文说身体容纳得很大。)
黄帝问:身体的寒热情况是怎样的呢?
伯高说:“膏”型的人肌肉柔润,如果纹理粗糙则身体怕冷,纹理细腻则身体怕热。“脂”型的人肌肉坚实,如果纹理细腻则身体怕热,纹理粗糙则身体怕冷。(所谓“淖”,意为柔润。膏型的人肌肉柔润,脂型的人肌肉坚实。至于寒热方面,纹理粗糙的都怕冷,纹理细腻的都怕热。淖音同闹。)
黄帝问:他们的肥瘦大小又是怎样的呢?
伯高说:“膏”型的人多气,皮肤纵缓,所以能腹部松弛下垂脂肪。“肉”型的人,身体显得宽大。“脂”型的人,身形收敛较小。(所谓“纵”,指宽纵松弛。所谓“腴”,指脂肪肥厚。膏型的人腹部松弛下垂脂肪,脂型的人身形收敛较小,这说明膏比脂更肥盛。肉是皮肉连实,自然与脂、膏有所不同。纵去声,腴音俞。)
伯高说:“膏”型的人多气,多气的人体质偏热,热性体质的人耐寒。“肉”型的人多血,血液充盈形体,所以气质平和。“脂”型的人血液清稀,气行滑利而量少,所以不能长得很大。这是与普通大众的区别。(膏型的人多气,气属阳,所以体质偏热而耐寒。肉型的人多血,血滋养形体,所以形体充实而气质平和。脂型的人血液清稀且气少滑利,所以不能长得很大。像这三类人,虽然都肥胖盛大,但都与普通人不同,其中脂型人的气血,似乎不如膏型和肉型人丰富。我按语道:世间流传的说法认为肥胖白皙的人多气虚,但这里说膏型人多气,似乎有些矛盾。若依据我的见闻验证,那么苍瘦之人中气虚的,并不少于肥胖白皙之人,因此不宜拘泥固执。)
黄帝问:普通大众是什么样子的呢?
伯高说:普通大众的皮、肉、脂、膏比例适中,不相加增,血与气也不相过多,所以他们的形体不大不小,各自与身体相称,这就叫做“众人”。(所谓“众人”,是指在上述三类之外的大多数常人。他们的皮、肉、脂、膏、血、气各有常态,所以不会相互叠加,也不会相互过多,而形体大小都恰好相称罢了。)
黄帝说:好。该如何治疗呢?
伯高说:必须先辨别这三种形体,明确血的多少、气的清浊,然后进行调理,治疗就不会违背常规法则了。(三种形体既定,气血状况既明,那么该补还是该泻,自然可以不失常规法则了。)
因此,“膏人”腹部松弛下垂脂肪,“肉人”上下显得宽大,“脂人”虽然脂肪多但身形不能很大。(这是再次详细阐述这些内容。)
*Huangdi Neijing Lingshu: Chapter on the Abnormalities of Wei Qi*
The Yellow Emperor asked Bo Gao, "How can one distinguish between people in terms of fatness and thinness, size, cold and heat, as well as old age, prime, youth, and childhood? (By 'cold and heat,' it refers to the innate constitution being either Yin or Yang.)"
Bo Gao replied, "Those above fifty years of age are considered 'old' (Lao), those above twenty are 'prime' (Zhuang), those above eighteen are 'young' (Shao), and those above six are 'small/children' (Xiao)."
The Yellow Emperor asked, "How does one assess their fatness and thinness?"
Bo Gao said, "People can be categorized into three types: 'Fei' (Fat/Lipid), 'Gao' (Piaf/Adipose), and 'Rou' (Muscle/Flesh). ('Fei' here refers to what is later described as 'Zhi'.)"
The Yellow Emperor asked, "How are these distinguished?"
Bo Gao said, "If the muscles are firm and the skin full, it is 'Fei' (Zhi). If the muscles are not firm and the skin is lax, it is 'Gao'. If the skin and flesh are tightly adhered and inseparable, it is 'Rou'. ('Rou' refers to the accumulation of muscle tissue. This passage describes the differences among tall and sturdy individuals regarding these three types: 'Zhi' is tight and full, hence described later as having firm muscles and a smaller body; 'Gao' is moist and large, hence described later as having soft muscles with hanging abdominal fat; 'Rou' is characterized by solid adherence between skin and flesh with correspondence from top to bottom, hence described later as having a body that appears voluminous.)"
The Yellow Emperor asked, "What about the cold and heat conditions of the body?"
Bo Gao said, "In 'Gao' types, the muscles are soft and moist; if the skin texture is coarse, the body feels cold; if fine, the body feels hot. In 'Zhi' types, the muscles are firm; if the skin texture is fine, the body feels hot; if coarse, the body feels cold. ('Nao' means soft and moist. For Gao types, muscles are soft; for Zhi types, muscles are firm. Regarding temperature, those with coarse textures feel cold, and those with fine textures feel hot. Nao sounds like 'nao'.)"
The Yellow Emperor asked, "What about their fatness, thinness, and size?"
Bo Gao said, "'Gao' types have abundant Qi, with lax and relaxed skin, thus allowing the abdomen to hang down with fat. 'Rou' types have bodies that appear large and voluminous. 'Zhi' types have compact and smaller bodies. ('Zong' means loose and relaxed. 'Yu' means fatty adipose tissue. Since Gao types have hanging abdominal fat while Zhi types are compact, Gao is fatter than Zhi. Rou involves solid connection of skin and flesh, distinct from Zhi and Gao. Zong is pronounced with a falling tone; Yu sounds like 'yu'.)"
The Yellow Emperor asked, "What is the difference in the quantity of Qi and Blood among these three?"
Bo Gao said, "'Gao' types have abundant Qi; those with abundant Qi tend to be hot and can tolerate cold. 'Rou' types have abundant Blood, which fills the form, resulting in a balanced temperament. 'Zhi' types have clear/thin Blood and smooth but scanty Qi, thus they cannot grow large. This distinguishes them from the general population. (Gao types have abundant Qi; Qi belongs to Yang, so their constitution is hot and they tolerate cold. Rou types have abundant Blood; Blood nourishes the form, so the form is filled and the temperament is balanced. Zhi types have thin Blood and scanty smooth Qi, so they cannot become large. Although these three types are all obese and distinct from ordinary people, the Qi and Blood of Zhi types seem inferior to those of Gao and Rou types. My commentary notes: It is commonly believed that fat, fair-skinned people often have Qi deficiency, whereas this text states Gao types have abundant Qi, which seems contradictory. However, based on my observations, lean, dark-skinned people also suffer from Qi deficiency no less than fat, fair-skinned ones; therefore, one should not adhere rigidly to fixed notions.)"
The Yellow Emperor asked, "What characterizes the general population?"
Bo Gao said, "In the general population, the proportions of skin, flesh, lipid, and adipose tissue do not exceed normal limits, nor do Blood and Qi become excessive. Thus, their bodies are neither too small nor too large, but proportionate to themselves. This is called the 'general population' (Zhongren). (By 'general population,' it refers to the majority of ordinary people outside the previous three categories. Their skin, flesh, lipid, adipose tissue, Blood, and Qi each maintain their own characteristics, neither adding up excessively nor lacking, so their body sizes are appropriately proportional.)"
The Yellow Emperor said, "Excellent. How should they be treated?"
Bo Gao said, "One must first distinguish these three body types, clarify the amount of Blood and the clarity/turbidity of Qi, and then regulate them. Treatment will not deviate from standard principles. (Once the three body types are identified and the state of Qi and Blood is understood, whether to tonify or drain can be determined without violating standard therapeutic principles.)"
Therefore, 'Gao-ren' (people of the Gao type) have hanging abdominal fat; 'Rou-ren' (people of the Rou type) appear large both above and below; 'Zhi-ren' (people of the Zhi type) may have fat but cannot appear large. (This reiterates the details previously mentioned.)