凡言锉如麻豆大者，与 咀同意。夫 咀古之制也。古人无铁刀，以口咬细，令如麻豆，为药煎之，使
药水清，饮于肠中，则易升易散。今人以刀锉如麻豆大，此 咀之易成也。
古秤惟有铢两，而无分名。今则以十黍为一铢（每铢约今四分一厘七毫），六铢为一分（去声），四分成
一两，十六两为一斤（李杲曰∶六铢为一分，即今二钱半也，二十四铢为一两。古云三两即今之一两，云二两
即今之六钱半也）。
今方家云等分者，非分两之分，谓诸药斤两多少皆同尔，多是丸散用之。
丸散云刀圭者，十分（平声）方寸匕之一，准如梧桐子大也。方寸匕者，作匕正方一寸，抄散取不落为
度。五匕者，即今五铢钱边五字者，抄之不落为度。一撮者，四刀圭也（匕即匙也）。
药以升合分者，谓药有虚实轻重，不得用斤两，则以升平之。十撮为一勺，十勺为一合，十合为一升。
升方作上径一寸，下径六分，深八分，纳散药物，按仰之正尔，微动令平尔（李时珍曰∶古之一升，即今之二
合半也）。
凡方云巴豆若干枚者，粒有大小，当去心皮柞之，以一分准十六枚。附子、乌头若干枚者，去皮毕，以
半两准一枚。枳实若干枚者，去穣毕，以一分准二枚。橘皮一分准
三枚。枣大小三枚准一两。干姜一累者，以一两为正。
凡方云半夏一升者，洗毕称五两为正。蜀椒一升，三两为正。吴茱萸一升，五两为正。菟丝子一升，九两
为正。 子一升，四两为正。蛇床子一升，三两半为正。地肤子一升，四两为正。其子各有虚实轻重，不可
称准者，取平升为正。
凡方云半夏一升者，洗毕称五两为正。蜀椒一升，三两为正。吴茱萸一升，五两为正。菟丝子一升，九两
为正。 子一升，四两为正。蛇床子一升，三两半为正。地肤子一升，四两为正。其子各有虚实轻重，不可
称准者，取平升为正。
凡方云用桂一尺者，削去皮，重半两为正。甘草一尺者，二两为正。云某草一束者，三两为正。云一把者，
二两为正。
凡煎汤药，初欲微火令小沸，其水数根据方多少；大略药二十两用水一斗者，煮取四升，以此为难。然利汤
欲生，少水而多取汁；补汤欲熟，多水而少取汁。服汤宜小沸，热则易下，冷则呕涌。
凡云分再服三服者，要令势令相及，并视人之强弱羸瘦，病之轻重，为之进退增减。不必局于方说，则活
泼泼地也。
凡丸药云如细麻者，即胡麻也，不必扁扁，略相称尔！黍粟亦然。云如大麻子者，准三细麻也。如胡豆者，
即今青斑豆也，以二大麻准之。如小豆者，今赤小豆也，以三大麻准之。如大豆者，以二小豆准之。如梧桐子
者，以二大豆准之。如弹丸及鸡子黄者，以四十梧子准之。
凡方云蜜一斤者，有七合。猪膏一斤者，有一升二合也。
附∶三阳三阴经脉各图
膀胱足太阳之脉，起于目内 ，上额交巅，其直者，从巅入络脑，还出别下项，循肩膊内，侠脊抵腰中，
入循膂，络肾属膀胱；其直者，从腰中下侠脊，贯臀入 中；其支者，从膊内左右别，下贯胛，侠脊内，过髀
枢，循髀外，从后廉，下合 中，以下贯 内，出外踝之后，循京骨，至小趾外侧。
\r足太阳膀胱经图\ps101a1.bmp\r
胃足阳明之脉，起于鼻之交 中，旁约太阳之脉，下循鼻外，入上齿中，还出侠口，环唇，下交承浆，
却循颐后下廉，出大迎，循颊车，上耳前，过客主人，循发际至额颅；其支者，从大迎前，下人迎，循喉咙，
入缺盆。下膈，属胃，络脾；其直者，从缺盆下乳内廉，下挟脐，入气街中；其支者，起于胃下口。循腹里，
下至气街中，而合以下髀关，抵伏兔，下膝膑中，下循胫外廉，下足跗，入中趾外间；其支者，下廉穴三寸，而别下入
中趾外间；其支者，别跗上入大趾间，出其端。
\r足阳明胃经图\ps101a2.bmp\r
胆足少阳之脉，起于目锐 ，上抵头角，下耳后，循颈，行手少阳之前，至肩上，却交出手少阳之后，入
缺盆；其支者，从耳后入耳中，出走耳前，至目锐 后；其支者，别锐 ，下大迎，合手少阳，抵于 ，下加
颊车，下颈合缺盆，以下胸中，贯膈，络肝，属胆，循胁里，出气街，绕毛际，横入髀厌中，其直者，从缺盆
下腋，循胸过季胁，下合髀厌中，以下循髀阳，出膝外廉，下外辅骨之前，直下抵绝骨之端，下出外踝之前，
循足跗上，入小趾次趾之间；其支者，别跗上，入大趾之间，循大歧骨内出其端，还贯爪甲，出三毛。
\r足少阳胆经图\ps101a3.bmp\r
脾足太阴之脉，起于大趾之端，循趾内侧白肉际，过核骨后，上内踝前廉，上 内，循胫骨后，交出厥阴
之前，上膝股内前廉，入腹，属脾，络胃，上膈，挟咽，连舌本，散舌下；其支者，复从胃别上膈，注心中。
\r足太阴脾经图\ps101a4.bmp\r
肾足少阴之脉，起于小趾之下，斜趋足
心之涌泉穴，出于然谷之下，循内踝之后，别入跟中，以上 内，出 内廉，上股内后廉，贯脊，属肾，络膀
胱；其直者，从肾上贯肝膈，入肺中，循喉咙，挟舌本；其支者，从肺出络心，注胸中。
\r足少阴肾经图\ps101a5.bmp\r
肝足厥阴之脉，起于大趾聚毛之上，上循足跗上廉，去内踝一寸，上踝八寸，交出太阴之后，上 内廉，
循股阴，入毛中，过阴器，抵小腹，侠胃，属肝，络胆，上贯膈，布胁，循喉咙之后，上入颃颡，连目系，上
出额，与督脉会于巅；其支者，从目系，下颊里，环唇内；其支者，复从肝别贯膈，上注肺。
\r足厥阴肝经图\ps101a6.bmp\r
附∶伤寒刺灸等穴图
太阳病，初服桂枝汤，反烦不解者，先刺风池、风府，却与桂枝汤则愈。
【按】风池穴在颞 后。颞 ，脑空穴也。后者，谓挟玉枕傍，骨下发际内，大筋外陷中，按之引耳中是
也。足少阳、阳维之会，宜刺三分，肌肉浓者可五分，留七呼，禁灸。风府一穴，在项发际上一寸，大筋内宛
宛中，疾言其肉立起，言休立下，是其穴也。督脉、阳维之会，宜刺三分，肌肉薄者只二分，候病患呼气即出，
禁灸。太阳之邪，刺足少阳、督脉者，何也？盖以风府在头部中行，风池在第三行，太阳在第二行，则风池、
风府实挟太阳经而行者也，况二穴皆为阳维之会。阳维者，谓诸阳之总也。刺之，诸阳之气得泄，何患太阳之
邪不去哉！
\r太阳刺风池、风府穴图\ps101a7.bmp\r
太阳病，头痛至七日以上自愈者，以行其经尽故也。若欲作再经者，针足阳明，使经不传则愈。
【按】仲景云∶针足阳明，成注未明指其
穴。考之庞氏《总病论》云∶补足阳明上三里穴。推其意，得补则经气实而不传，殊不知仲景之意，针足阳明
为迎而夺之，以泄其经之热，使热邪得泄，不至再传他经，故云愈也。庞氏不明用针之理，以泄为补，恐误矣。
又考张氏《缵论》云∶刺足阳明冲阳穴。冲阳者，即仲景所谓趺阳脉也，有诊法而不言刺，张氏之言，实本史
氏《伤寒论注》，不足法也。三里二穴，在膝眼下三寸， 骨外廉两筋间宛宛中，坐而竖膝，低跗取之，极重
按之，则跗上动脉即止，是其穴也，可刺五分，留七呼。
\r太阳针足阳明三里穴图\ps101a8.bmp\r
伤寒，腹满谵语，寸口脉浮而紧，此肝乘脾也，名曰纵，刺期门。
伤寒发热，啬啬恶寒，大渴欲饮水，其腹必满，自汗出，小便利，其病欲解，此肝乘肺也，名曰横，刺期门。
妇人中风，发热恶寒，经水适来，得之七八日，热除而脉迟身凉，胸胁下满，如结胸状，谵语者，此为
热入血室也，当刺期门，随其实而泻之。
阳明病，下血谵语者，此为热入血室，但头汗出者，刺期门，随其实而泻之， 然汗出则愈。
太阳与少阳并病，头项强痛或眩冒，时如结胸，心下痞硬者，当刺大椎第一间肺俞、肝俞，慎不可发汗，
发汗则谵语。脉弦，五六日谵语不止，当刺期门。
【按】《图经》云∶期门二穴，在不容傍一寸五分，乳直下，第二肋骨端，近腹处，是其穴也，第二肋
者，从下数至第二肋也。肋骨端者，在软肋骨末之端也。刺四分，肥人量之。
\r太阳、阳明、少阳刺期门穴图\ps101a9.bmp\r
太阳与少阳并病，头项强痛或眩冒，时如结胸，心下痞硬者，当刺大椎第一间、肺俞、肝俞，慎不可发汗，
发汗则谵语。脉弦，五六日谵语不止，当刺期门。
太阳、少阳并病。心下硬，颈项强而眩者，当刺大椎、肺俞、肝俞，慎勿下之。
【按】《图经》云∶督脉大椎穴，在第一椎上陷中，可刺五分，留三呼，泄五吸。肺俞二穴，在第三椎下，
两傍相去各一寸五分，可刺三分，留七呼，得气即泄，肥人可刺五分。肝俞二穴，在第九椎下，两傍相去各一
寸五分，可刺三分，留六呼。仲景太阳少阳并病，及合邪也，故刺大椎、肺俞、肝俞，亦合泄之法也。
\r太阳、少阳并病刺大椎、肺俞、肝俞穴图\ps101a10.bmp\r
少阴病，得之二三日，口中和，其背恶寒者，当灸之，附子汤主之。
【按】当灸之，仲景未言灸何穴。常器之云∶当是足太阳膈关二穴，专灸背恶寒。其穴在第七椎下，两傍
相去各三寸陷中，正坐取之，可灸五壮。盖以太阳为少阴之表，故外灸膈关以温其表，内用附子以温其里也。
\r少阴灸膈关穴图\ps101a11.bmp\r
少阴病吐利，手足不厥冷，反发热者，不死。脉不至，灸少阴七壮。
【按】灸少阴七壮，仲景未言灸何穴。常器之云∶当灸少阴太溪二穴。经曰∶肾之原出于太溪，其穴在内
踝后跟骨，动脉陷中。
\r少阴灸太溪穴图\ps101a12.bmp\r
少阴病，下利便脓血者，可刺。
【按】可刺，仲景未言可刺何穴。常器之云∶可刺足少阴幽门、交信。郭雍曰∶可灸。考幽门二穴，在鸠
尾下一寸，巨阙两傍各五分陷者中，治泻利脓血，刺五分灸五壮。交信二穴，在内踝上二寸，少阴前太阴后，
廉筋骨间，治泻利赤白，刺四分留五呼，灸三壮。两说皆是。
\r少阴刺灸幽门、交信穴图\ps101a13.bmp\r
少阴病，下利脉微涩，呕而汗出，必数更衣，反少者，当温其上，灸之。
【按】灸之，仲景未言当灸何穴。常器之云∶灸太冲。郭雍云∶灸太溪。此穴皆不治呕而汗出，里急下利，
惟幽门主治干哕、呕吐、里急、下利，亦当灸幽门为是。
伤寒六七日，脉微，手足厥冷，烦躁，灸厥阴，厥不还者死。
【按】灸厥阴，仲景未言当灸何穴。常器之云∶可灸太冲。以太冲二穴，为足厥阴之所注，凡病诊太冲脉，
可决人之生死。其穴在足大趾本节后二寸，跗间陷者中，动脉应手，是其穴也，灸三壮。
\r厥阴灸太冲穴图\ps101a14.bmp\r
伤寒脉促，手足厥逆者，可灸之。
【按】可灸之，仲景未言当灸何穴。常器之云∶太冲穴。前条手足厥逆，灸太冲；此条亦手足厥逆，亦当
灸太冲。
凡是说将药物锉成如麻子、豆子大小的，与“咀”的意思相同。“咀”是古代的制度。古人没有铁刀，用口咬碎药物，使其像麻子、豆子一样大小，以便煎煮，使药液清澈，服用后在肠道中容易升发和散开。现在的人用刀将药物锉成如麻子、豆子大小，这是“咀”的简便做法。
古代的秤只有铢、两的单位，没有“分”的名称。现在则以十粒黍米重为一铢（每铢约合现在的四分一厘七毫），六铢为一分（去声），四分为一两，十六两为一斤（李杲说：六铢为一分，即现在的二钱半；二十四铢为一两。古书说的三两相当于现在的一两，说的二两相当于现在的六钱半）。
现在的方剂学家所说的“等分”，不是指重量单位的“分”，而是指各种药物的斤两数量都相同，这多用于制作丸剂和散剂。
丸剂和散剂中提到的“刀圭”，是方寸匕的十分之一，其量大约相当于梧桐子的大小。方寸匕，是指制作成正方形一寸的匕，舀取散剂以不掉落为标准。五匕，是指现在五铢钱边缘刻有“五铢”字样的钱币，舀取散剂以不掉落为标准。一撮，等于四个刀圭（匕就是匙）。
药物按升、合计算的，是因为药物有虚实轻重之分，不能用斤两称量，就用升来平量。十撮为一勺，十勺为一合，十合为一升。升的形状是上口直径一寸，下底直径六分，深八分，装入散药时，保持端正，轻轻震动使其平整即可（李时珍说：古代的一升，相当于现在的二合半）。
凡是方剂中说使用巴豆若干枚的，因为颗粒有大有小，应当去掉心、皮和壳，以一分重准十六枚。附子、乌头若干枚的，去掉皮后，以半两重准一枚。枳实若干枚的，去掉瓤后，以一分重准二枚。橘皮一分重准三枚。大枣，三枚中等大小的准一两。干姜一“累”（束）的，以一两为准。
凡是方剂中说半夏一升的，洗净后称重，以五两为准。蜀椒一升，以三两为准。吴茱萸一升，以五两为准。菟丝子一升，以九两为准。葶苈子一升，以四两为准。蛇床子一升，以三两半为准。地肤子一升，以四两为准。这些种子各有虚实轻重，无法准确称量的，取平升为准。
（注：原文此处重复了一段关于半夏、蜀椒等的文字，翻译时予以合并处理，避免冗余）
凡是方剂中说使用桂枝一尺的，削去外皮，以半两重为准。甘草一尺的，以二两为准。说某草一束的，以三两为准。说一把的，以二两为准。
凡是煎煮汤药，开始时要用微火让水微微沸腾，用水量根据方剂的多少而定；大致上，药二十两用水一斗的，煮取四升，以此作为难点掌握。然而，治疗腹泻的汤药希望保留生性，用水少而取汁多；补益的汤药希望煮得熟透，用水多而取汁少。服用汤药宜温热，热则容易咽下，冷则会引起呕吐。
凡是说分两次或三次服用的，要根据病势的缓急，并结合病人的强弱瘦弱、病情的轻重，灵活进退增减。不必拘泥于方书的说法，这样才能灵活运用。
凡是丸药说如细麻大小的，就是胡麻，不必完全扁平，大致相当即可！黍米、粟米也是如此。说如大麻子大小的，相当于三个细麻。如胡豆大小的，就是现在的青斑豆，相当于两个大麻子。如小豆大小的，就是现在的赤小豆，相当于三个大麻子。如大豆大小的，相当于两个小豆。如梧桐子大小的，相当于两个大豆。如弹丸及鸡蛋黄大小的，相当于四十个梧桐子。
凡是方剂中说蜜一斤的，相当于七合。猪膏一斤的，相当于一升二合。
附录：三阳三阴经脉各图
足太阳膀胱经的脉气，起于目内眦，向上至额部，交会于头顶。其直行者，从头顶入络脑，复出下行别走项部，沿肩膊内侧，夹脊柱到达腰中，进入循行于脊里，联络肾脏，属于膀胱；其直行者，从腰中下行夹脊柱，贯穿臀部，进入腘窝中；其分支，从肩膊内侧左右分开，向下贯穿肩胛，夹脊柱内侧，经过髋关节，沿大腿外侧，从后侧下行，汇入腘窝中，再向下穿过小腿肚，出于外踝后方，沿京骨穴，到达小趾外侧。
足阳明胃经的脉气，起于鼻翼两侧，交于鼻根中，旁侧约略与足太阳经相交，向下沿鼻外侧，进入上齿龈中，复出环绕口唇，向下交会于承浆穴，然后沿腮后下方，出大迎穴，沿颊车穴，上行耳前，过客主人穴，沿发际到达额颅；其分支，从大迎穴前下行到人迎穴，沿喉咙，进入缺盆；向下穿过膈肌，属于胃，联络脾脏；其直行者，从缺盆下行沿乳内侧，向下挟脐两旁，进入气街中；其分支，起于胃的下口，沿腹里下行至气街中，与前脉会合，以下行经过髀关，抵伏兔穴，下行至膝髌中，沿胫骨外侧下行，至足背，进入中趾外侧；其分支，从膝下三寸的廉泉穴处分出，下行进入中趾外侧；其另一分支，从足背分出，进入大趾之间，出于其端。
足少阳胆经的脉气，起于目锐眦，向上到达头角，下行耳后，沿颈部，行于手少阳经之前，至肩上，交叉出手少阳经之后，进入缺盆；其分支，从耳后入耳中，出走耳前，到达目锐眦后；其分支，从目锐眦处分出，下行至大迎穴，与手少阳经会合，到达目眶下，下行加于颊车穴，下行颈部与缺盆会合，以下进入胸中，穿过膈肌，联络肝脏，属于胆，沿胁肋内部，出于气街，绕阴毛际，横向进入髋关节中；其直行者，从缺盆下行腋下，沿胸侧过季胁，下行与髋关节中的脉气会合，以下沿大腿外侧，出膝外侧，下行外辅骨之前，直下抵绝骨之端，下行出于外踝之前，沿足背，进入第四趾之间；其分支，从足背分出，进入大趾之间，沿大歧骨内侧出于其端，回贯爪甲，出于丛毛处。
足太阴脾经的脉气，起于大趾末端，沿大趾内侧白肉际，经过核骨后，上行至内踝前缘，上行小腿内侧，沿胫骨后，交出足厥阴肝经之前，上行膝股内侧前缘，进入腹部，属于脾脏，联络胃腑，向上穿过膈肌，夹咽喉，连舌本，散于舌下；其分支，又从胃部分出，上穿膈肌，注入心中。
足少阴肾经的脉气，起于小趾之下，斜趋足心的涌泉穴，出于然谷穴之下，沿内踝之后，别入跟中，以上行于小腿内侧，出内踝后廉，上行股内侧后缘，贯穿脊柱，属于肾脏，联络膀胱；其直行者，从肾脏上行贯穿肝脏和膈肌，进入肺部，沿喉咙，夹舌本；其分支，从肺部分出，联络心脏，注入胸中。
足厥阴肝经的脉气，起于大趾丛毛之上，上行沿足背外侧，距内踝一寸，上行至踝上八寸处，交出足太阴脾经之后，上行至大腿内侧，沿阴股进入阴毛中，过生殖器，抵小腹，夹胃两旁，属于肝脏，联络胆腑，向上穿过膈肌，分布胁肋，沿喉咙之后，上行进入颃颡，连系目系，上行出于额部，与督脉会于头顶；其分支，从目系下行至颊里，环绕口唇内；其另一分支，再从肝部分出，贯穿膈肌，上注于肺。
附录：伤寒刺灸等穴图
太阳病，初服桂枝汤后，反而出现烦闷不解的，先针刺风池、风府穴，然后再给予桂枝汤，病就会痊愈。
【按语】风池穴在颞顳后。颞顳，即脑空穴所在。所谓后，是指在玉枕骨旁，骨下发际内，大筋外的凹陷中，按压时感觉引动耳中，这就是该穴。此穴为足少阳经与阳维脉的交会穴，宜刺三分，肌肉丰厚者可刺五分，留针七次呼吸的时间，禁止艾灸。风府穴一个，在项部发际上一寸，大筋内的凹陷中，快速说话时肌肉隆起，停止说话时肌肉落下，这就是该穴。此穴为督脉与阳维脉的交会穴，宜刺三分，肌肉薄者只刺二分，待病人呼气时出针，禁止艾灸。太阳经的邪气，为什么要刺足少阳经和督脉呢？因为风府在头部正中线上，风池在第三侧线上，太阳经在第二侧线上，那么风池、风府实际上是夹着太阳经而行的，况且这两个穴位都是阳维脉的交会处。阳维脉，是诸阳经的总汇。针刺它们，诸阳之气得以宣泄，何愁太阳经的邪气不去除呢！
太阳病，头痛持续七天以上自行痊愈的，是因为邪气在经络中运行完毕的缘故。如果想要传入下一经（再经），针刺足阳明经，使邪气不传变就能痊愈。
【按语】张仲景说：针刺足阳明经，成无己注解未明确指出是哪个穴位。考证庞氏《总病论》说：补足阳明经的上三里穴。推究其意，认为补法能使经气充实而不传变，殊不知张仲景的本意，针刺足阳明经是为了“迎而夺之”，以泄去经中的热邪，使热邪得以宣泄，不再传变他经，所以说痊愈。庞氏不明白用针的道理，把泻法当作补法，恐怕是错误的。又考证张氏《缵论》说：刺足阳明经的冲阳穴。冲阳穴，就是张仲景所说的趺阳脉，这里讲的是诊法而非刺法，张氏的说法，实际上源于史氏《伤寒论注》，不值得效法。三里穴有两个，在膝眼下三寸，胫骨外侧两筋间的凹陷中，坐着竖起膝盖，放低足背取穴，用力按压，如果足背动脉停止跳动，那就是穴位所在，可刺五分，留针七次呼吸的时间。
伤寒，腹部胀满，说胡话，寸口脉浮而紧，这是肝气乘袭脾脏，名叫“纵”，针刺期门穴。
伤寒发热，啬啬恶寒，极度口渴想喝水，腹部必然胀满，自汗出，小便通利，病情将要解除，这是肝气乘袭肺脏，名叫“横”，针刺期门穴。
妇人患中风，发热恶寒，月经适来，患病七八天后，热退脉迟身凉，胸胁下满，像结胸的样子，说胡话，这是热入血室，应当针刺期门穴，随其实证而泻之。
阳明病，下血说胡话的，这是热入血室，只有头部出汗的，针刺期门穴，随其实证而泻之，周身濈然汗出就会痊愈。
太阳与少阳并病，头项强痛或眩晕冒昧，有时像结胸，心下痞硬，应当针刺大椎第一间、肺俞、肝俞，千万不要发汗，发汗就会导致说胡话。脉弦，五六天后说胡话不止，应当针刺期门穴。
【按语】《图经》说：期门穴有两个，在不容穴旁一寸五分，乳头直下，第二肋骨端，靠近腹部处，就是该穴。第二肋，是从下数到第二肋。肋骨端，是在软肋骨末端的尖端。刺四分，肥胖之人酌情测量。
太阳与少阳并病，头项强痛或眩晕冒昧，有时像结胸，心下痞硬，应当针刺大椎第一间、肺俞、肝俞，千万不要发汗，发汗就会导致说胡话。脉弦，五六天后说胡话不止，应当针刺期门穴。
太阳、少阳并病。心下硬，颈项强而眩晕，应当针刺大椎、肺俞、肝俞，千万不要攻下。
【按语】《图经》说：督脉的大椎穴，在第一椎上方的凹陷中，可刺五分，留针三次呼吸的时间，泻法吸五次。肺俞穴有两个，在第三椎下方，两旁相距各一寸五分，可刺三分，留针七次呼吸的时间，得气即泻，肥胖之人可刺五分。肝俞穴有两个，在第九椎下方，两旁相距各一寸五分，可刺三分，留针六次呼吸的时间。张仲景所说的太阳少阳并病，以及合邪的情况，所以针刺大椎、肺俞、肝俞，也是符合泻法的原则。
少阴病，得病二三天，口中平和不燥，背部怕冷的，应当施灸，用附子汤主治。
【按语】“应当施灸”，张仲景未说明灸哪个穴位。常器之说：应当是足太阳经的膈关穴，专门灸治背恶寒。该穴在第七椎下方，两旁相距各三寸的凹陷中，正坐取穴，可灸五壮。这是因为太阳经是少阴经的表经，所以外灸膈关以温其表，内用附子以温其里。
少阴病吐利，手足不厥冷，反而发热的，不会死亡。脉搏摸不到，灸少阴经七壮。
【按语】“灸少阴七壮”，张仲景未说明灸哪个穴位。常器之说：应当灸少阴经的太溪穴。经书说：肾的原穴出于太溪，该穴在内踝后跟骨处的动脉凹陷中。
【按语】“可以针刺”，张仲景未说明可刺哪个穴位。常器之说：可刺足少阴经的幽门、交信穴。郭雍说：可以灸。考证幽门穴有两个，在鸠尾下一寸，巨阙穴两旁各五分深的凹陷中，治疗泻利脓血，刺五分灸五壮。交信穴有两个，在内踝上二寸，少阴经前太阴经后，筋骨间的廉骨旁，治疗泻利赤白，刺四分留五呼，灸三壮。两种说法都有道理。
少阴病，下利脉微涩，呕吐而汗出，必定频繁上厕所，但排便量少，应当温其上焦，施灸。
【按语】“施灸”，张仲景未说明当灸哪个穴位。常器之说：灸太冲穴。郭雍说：灸太溪穴。这两个穴位都不能治疗呕吐而汗出、里急后重下利的症状，只有幽门穴主治干呕、呕吐、里急、下利，所以也应当灸幽门穴才对。
伤寒六七天，脉微，手足厥冷，烦躁，灸厥阴经，厥冷不还的死亡。
【按语】“灸厥阴”，张仲景未说明当灸哪个穴位。常器之说：可灸太冲穴。因为太冲穴是两个，为足厥阴经所注，凡病诊太冲脉，可以决断人的生死。该穴在足大趾本节后二寸，足背间的凹陷中，动脉应手，就是该穴，灸三壮。
【按语】“可以灸治”，张仲景未说明当灸哪个穴位。常器之说：太冲穴。前一条手足厥逆，灸太冲；这一条也是手足厥逆，也应当灸太冲。
Wherever it is stated that herbs should be cut into pieces the size of hemp seeds or beans, it is synonymous with "chewing" (Ju). "Chewing" was an ancient practice. In ancient times, without iron knives, people used their teeth to crush herbs until they were the size of hemp seeds or beans for decoction, ensuring the medicinal liquid remained clear and was easily absorbed and dispersed in the intestines after ingestion. Today, people use knives to cut herbs into pieces the size of hemp seeds or beans, which is a simplified method of "chewing".
Ancient scales only had units of Zhu (铢) and Liang (两), with no unit called "Fen" (分). Currently, ten grains of millet weigh one Zhu (each Zhu is approximately 0.17 milligrams), six Zhu make one Fen (falling tone), four Fen make one Liang, and sixteen Liang make one Jin (Li Gao stated: Six Zhu equal one Fen, which is equivalent to 2.5 Qian today; twenty-four Zhu equal one Liang. Ancient texts stating three Liang refer to one Liang today, and two Liang refer to 6.5 Qian today).
When modern practitioners say "equal parts" (Deng Fen), they do not mean the weight unit "Fen", but rather that the quantity of each herb in terms of Liang is identical. This is mostly used for preparing pills and powders.
In preparations of pills and powders, "Dao Gui" (a measure of volume) refers to one-tenth of a "Fang Cun Bi" (square-inch spoon), roughly equivalent in volume to a Sophora japonica seed. A "Fang Cun Bi" is a spoon shaped as a square inch, where the amount of powder scooped is defined by what does not fall off. "Wu Bi" refers to using the edge of a contemporary five-Zhu coin inscribed with "Wu Zhu", scooping powder until it does not fall off. One "Cuo" (pinch) equals four Dao Gui (Bi is synonymous with spoon).
For herbs measured by Sheng (升) and He (合), this is because herbs vary in density and weight, making scale measurement inaccurate; thus, volume measurement is used. Ten Cuo make one Shao (勺), ten Shao make one He, and ten He make one Sheng. A Sheng vessel has an upper diameter of one cun, a lower diameter of six fen, and a depth of eight fen. When filling with powdered herbs, keep it level and gently shake to flatten (Li Shizhen stated: One ancient Sheng is equivalent to 2.5 He today).
Whenever a prescription specifies a certain number of Ba Dou (Crotonis Fructus, 巴豆), due to variations in size, the heart, skin, and husk should be removed, with one Fen weighing sixteen pieces. For Fu Zi (Aconiti Lateralis Radix Praeparata, 附子) and Wu Tou (Aconiti Radix, 乌头), after removing the skin, half a Liang weighs one piece. For Zhi Shi (Aurantii Fructus Immaturus, 枳实), after removing the pith, one Fen weighs two pieces. For Ju Pi (Citri Reticulatae Pericarpium, 橘皮), one Fen weighs three pieces. Three medium-sized Da Zao (Jujubae Fructus, 大枣) weigh one Liang. One bundle (Lei) of Gan Jiang (Zingiberis Rhizoma, 干姜) weighs one Liang.
Whenever a prescription specifies Ban Xia (Pinelliae Rhizoma, 半夏) as one Sheng, after washing, it should weigh five Liang. Shu Jiao (Zanthoxyli Pericarpium, 蜀椒) one Sheng weighs three Liang. Wu Zhu Yu (Evodiae Fructus, 吴茱萸) one Sheng weighs five Liang. Tu Si Zi (Cuscutae Semen, 菟丝子) one Sheng weighs nine Liang. Ting Li Zi (Lepidii Semen, 葶苈子) one Sheng weighs four Liang. She Chuang Zi (Cnidii Fructus, 蛇床子) one Sheng weighs three and a half Liang. Di Fu Zi (Kochiae Fructus, 地肤子) one Sheng weighs four Liang. Since these seeds vary in density and weight, if precise weighing is difficult, a level Sheng is taken as standard.
(Note: The original text repeats a paragraph regarding Ban Xia, Shu Jiao, etc.; this translation consolidates them to avoid redundancy.)
Whenever a prescription specifies Gui Zhi (Cinnamomi Ramulus, 桂枝) as one chi, after peeling, it should weigh half a Liang. Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草) one chi weighs two Liang. One bundle of unspecified grass weighs three Liang. One handful weighs two Liang.
When decocting herbal soups, initially use low heat to bring the water to a gentle boil. The amount of water depends on the prescription. Generally, for twenty Liang of herbs, use one Dou of water to reduce to four Sheng; this is the critical point to master. However, for purgative soups, raw potency is desired, so use less water to extract more juice; for tonic soups, thorough cooking is desired, so use more water to extract less juice. Herbal soups should be taken warm; hot liquids are easier to swallow, while cold ones may induce vomiting.
When instructed to divide the dose into two or three servings, adjust based on the progression of the disease, the patient's strength or emaciation, and the severity of the illness. Do not rigidly adhere to the prescription; flexibility is key.
When pill sizes are described as "fine hemp," it refers to Sesamum indicum seeds (Hu Ma); they need not be perfectly flat, just roughly comparable. Millet and broomcorn millet are similar. "Large hemp seeds" correspond to three fine hemp seeds. "Hu Dou" refers to Vigna unguiculata subsp. sesquipedalis (Qing Ban Dou), corresponding to two large hemp seeds. "Small beans" refer to Phaseolus angularis (Chi Xiao Dou), corresponding to three large hemp seeds. "Large beans" correspond to two small beans. "Sophora japonica seeds" (Wu Tong Zi) correspond to two large beans. "Bullet pellets or egg yolks" correspond to forty Sophora japonica seeds.
One Jin of Mi (Honey, 蜜) equals seven He. One Jin of Zhu Gao (Porcine Adipose Tissue, 猪膏) equals one Sheng and two He.
Appendix: Diagrams of the Three Yang and Three Yin Meridians
The Foot-Taiyang Bladder Meridian originates at the inner canthus, ascends to the forehead, and intersects at the vertex. Its straight branch enters the brain from the vertex, emerges, descends separately along the nape, runs along the medial shoulder blade, parallel to the spine to the loins, enters the back muscles, connects with the Kidney, and belongs to the Bladder. Another straight branch descends from the loins, parallel to the spine, through the buttocks into the popliteal fossa. A collateral branch separates from the shoulder medially, passes through the scapula, runs parallel to the spine, crosses the hip joint, follows the lateral thigh, descends along the posterior aspect, merges into the popliteal fossa, descends through the calf muscle, emerges behind the lateral malleolus, follows the Jinggu point, and reaches the lateral side of the little toe.
The Foot-Yangming Stomach Meridian originates at the side of the nose, crosses at the root of the nose, runs alongside the Taiyang meridian, descends along the lateral nose, enters the upper gum, emerges around the lips, meets at Chengjiang below the lower lip, follows the post-mental groove down to the mandible, emerges at Daying, follows Jiache, ascends anterior to the ear, passes through Guanchong, follows the hairline to the forehead. A collateral branch descends from before Daying to Renying, follows the throat, and enters the Supraclavicular Fossa. It descends through the diaphragm, belongs to the Stomach, and connects with the Spleen. A straight branch descends from the Supraclavicular Fossa along the medial breast, down beside the umbilicus, into the Qi Street. A collateral branch originates from the lower opening of the stomach, runs inside the abdomen to the Qi Street, where it joins the main channel, descends through Biguan, reaches Futu, descends to the knee patella, follows the lateral tibia, reaches the dorsum of the foot, and enters the lateral space of the second toe. A collateral branch descends three cun below the knee to Lianquan, entering the lateral space of the second toe. Another branch separates from the dorsum, enters the space between the great toe, emerges at its tip.
The Foot-Shaoyang Gallbladder Meridian originates at the lateral canthus, ascends to the temporal angle, descends behind the ear, follows the neck, runs anterior to the Hand-Shaoyang meridian, reaches the shoulder, crosses behind the Hand-Shaoyang meridian, and enters the Supraclavicular Fossa. A collateral branch enters the ear from behind, emerges anterior to the ear, and reaches the lateral canthus. Another branch separates from the lateral canthus, descends to Daying, merges with the Hand-Shaoyang meridian, reaches the infraorbital region, descends to Jiache, follows the neck to merge with the Supraclavicular Fossa, descends into the chest, pierces the diaphragm, connects with the Liver, belongs to the Gallbladder, follows the hypochondrium, emerges at the Qi Street, surrounds the pubic region, and transversely enters the hip joint. A straight branch descends from the Supraclavicular Fossa under the axilla, follows the chest past the costal margin, merges with the hip joint channel, follows the lateral thigh, emerges at the lateral knee, descends anterior to the fibula, reaches the end of the Juegu bone, emerges anterior to the lateral malleolus, follows the dorsum of the foot, and enters the space between the fourth and fifth toes. A collateral branch separates from the dorsum, enters the space between the great and second toes, follows the medial aspect of the metatarsals, emerges at the tip, penetrates the nail bed, and emerges at the hair tuft.
The Foot-Taiyin Spleen Meridian originates at the tip of the great toe, follows the medial white flesh border, passes behind the medial malleolus (He Gu), ascends anterior to the medial malleolus, ascends the medial leg, follows the posterior tibia, crosses anterior to the Foot-Jueyin meridian, ascends the medial knee and thigh, enters the abdomen, belongs to the Spleen, connects with the Stomach, ascends through the diaphragm, flanks the pharynx, connects with the base of the tongue, and spreads under the tongue. A collateral branch separates from the stomach, ascends through the diaphragm, and pours into the Heart.
The Foot-Shaoyin Kidney Meridian originates below the little toe,斜趋 (diagonally approaches) the Yongquan point in the center of the sole, emerges below RanGu, follows the posterior medial malleolus, enters the heel, ascends the medial calf, emerges at the medial tibial border, ascends the posterior medial thigh, pierces the spine, belongs to the Kidney, and connects with the Bladder. A straight branch ascends from the Kidney, pierces the Liver and diaphragm, enters the Lung, follows the throat, and flanks the base of the tongue. A collateral branch emerges from the Lung, connects with the Heart, and pours into the chest.
The Foot-Jueyin Liver Meridian originates above the hair tuft of the great toe, ascends along the lateral dorsum of the foot, one cun from the medial malleolus, ascends eight cun above the ankle, crosses posterior to the Foot-Taiyin meridian, ascends the medial thigh, enters the pubic region, passes around the genitalia, reaches the lower abdomen, flanks the Stomach, belongs to the Liver, connects with the Gallbladder, ascends through the diaphragm, distributes in the hypochondrium, follows the posterior throat, ascends to the Ying-Sang, connects with the eye system, ascends to the forehead, and intersects with the Du Meridian at the vertex. A collateral branch descends from the eye system to the cheek interior, circles the inner lips. Another branch separates from the Liver, pierces the diaphragm, and pours into the Lung.
Appendix: Acupuncture and Moxibustion Points for Shanghan
In Taiyang disease, if after taking Guizhi Tang (Cinnamon Twig Decoction) there is increased irritability without relief, first puncture Fengchi (GB20) and Fengfu (GV16), then administer Guizhi Tang for cure.
[Commentary] Fengchi (GB20) is located posterior to the temporal region. The temporal region refers to the Nangkong area. "Posterior" means adjacent to the Yuzhen bone, within the hairline at the back, in the depression outside the large tendon, where pressure induces sensation in the ear. It is the intersection of the Foot-Shaoyang and Yangwei Mai meridians. Puncture 3 cun (depth); for thick muscle, 5 cun. Retain needle for 7 breaths. Moxibustion is prohibited. Fengfu (GV16) is located one cun above the nuchal hairline, in the depression within the large tendons. Rapid speech causes muscle elevation; cessation causes it to drop. It is the intersection of the Du Mai and Yangwei Mai meridians. Puncture 3 cun; for thin muscle, 2 cun. Remove needle upon patient's exhalation. Moxibustion is prohibited. Why puncture Foot-Shaoyang and Du Mai for Taiyang pathogen? Fengfu is on the midline, Fengchi on the third lateral line, Taiyang on the second. Thus, Fengchi and Fengfu flank the Taiyang meridian. Moreover, both intersect the Yangwei Mai, the commander of all Yang meridians. Puncturing them allows Yang Qi to vent, dispelling Taiyang pathogens.
If Taiyang headache persists beyond seven days and resolves spontaneously, it is because the pathogen has exhausted its course in the meridian. If it threatens to transmit to the next meridian ("Zai Jing"), puncture the Foot-Yangming meridian to prevent transmission and ensure cure.
[Commentary] Zhang Zhongjing states "puncture Foot-Yangming" but Cheng Wuji did not specify the point. Pang Ha's *Zong Bing Lun* suggests tonifying Shangsanli (ST36). The logic implies tonification strengthens meridian Qi to prevent transmission. However, Zhang Zhongjing's intent was likely "Ying Er Duo Zhi" (meeting and reducing), i.e., draining Heat from the meridian to prevent transmission. Pang Ha’s confusion of draining with tonifying is erroneous. Zhang Xuan’s *Zuan Lun* suggests puncturing Chongyang (ST42), which corresponds to the Fuyang pulse mentioned by Zhang Zhongjing for diagnosis, not treatment. Zhang’s view derives from Shi Zan’s commentary and is not authoritative. ST36 is located three cun below the knee, between the tendons lateral to the tibia. With the knee bent and foot lowered, deep pressure stops the dorsal pedal artery, confirming the point. Puncture 5 cun, retain for 7 breaths.
In Shanghan, abdominal fullness and delirium with a floating and tight Cun Kou pulse indicate Liver overacting on Spleen, named "Zong" (Vertical). Puncture Qimen (LR14).
Shanghan with fever, aversion to cold, extreme thirst for water, abdominal fullness, spontaneous sweating, and free urination indicates impending resolution. This is Liver overacting on Lung, named "Heng" (Horizontal). Puncture Qimen (LR14).
In women with Wind Strike, fever and aversion to cold, with menstruation occurring, if after seven to eight days the fever subsides, pulse becomes slow, body cools, but hypochondriac fullness resembles Jie Xiong syndrome and delirium occurs, this is Heat entering the Blood Chamber. Puncture Qimen (LR14) to drain excess.
In Yangming disease, bleeding and delirium indicate Heat entering the Blood Chamber. If only head sweats, puncture Qimen (LR14) to drain excess; generalized sweating indicates cure.
In concurrent Taiyang and Shaoyang disease, with stiff neck/headache, dizziness, intermittent Jie Xiong-like symptoms, and epigastric hardness, puncture Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). Strictly avoid sweating therapy; sweating leads to delirium. If the pulse is wiry and delirium persists for five to six days, puncture Qimen (LR14).
[Commentary] *Tu Jing* states Qimen (LR14) is located 1.5 cun lateral to Burong (ST19), directly below the nipple, at the end of the second rib near the abdomen. The "second rib" is counted from below. The rib end is the tip of the costal cartilage. Puncture 4 cun; adjust for obesity.
In concurrent Taiyang and Shaoyang disease, with stiff neck/headache, dizziness, intermittent Jie Xiong-like symptoms, and epigastric hardness, puncture Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). Strictly avoid sweating therapy; sweating leads to delirium. If the pulse is wiry and delirium persists for five to six days, puncture Qimen (LR14).
In concurrent Taiyang and Shaoyang disease, with epigastric hardness, stiff neck, and dizziness, puncture Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). Strictly avoid purgation.
[Commentary] *Tu Jing* states Dazhui (GV14) is in the depression above the first thoracic vertebra. Puncture 5 cun, retain 3 breaths, drain via 5 inhalations. Feishu (BL13) is bilateral, 1.5 cun lateral to the spinous process of the third thoracic vertebra. Puncture 3 cun, retain 7 breaths, drain upon arrival of Deqi; obese patients may receive 5 cun. Ganshu (BL18) is bilateral, 1.5 cun lateral to the spinous process of the ninth thoracic vertebra. Puncture 3 cun, retain 6 breaths. Zhang Zhongjing’s indication for concurrent Taiyang-Shaoyang disease involves combined pathogens, hence puncturing Dazhui, Feishu, and Ganshu aligns with draining principles.
In Shaoyin disease, two to three days after onset, with normal mouth sensations and aversion to cold on the back, moxibustion is indicated, followed by Fuzi Tang (Aconite Decoction).
[Commentary] "Moxibustion" does not specify the point. Chang Qizi suggests Ge Guan (BL17) on the Foot-Taiyang meridian, specifically for back aversion to cold. Located below the seventh thoracic vertebra, 3 cun bilateral. Sit upright to locate. Moxa 5 cones. Since Taiyang is the exterior of Shaoyin, external moxa warms the exterior, while internal Fuzi warms the interior.
In Shaoyin disease with vomiting and diarrhea, if hands and feet are not cold but feverish, prognosis is good. If the pulse is absent, moxa the Shaoyin meridian for 7 cones.
[Commentary] "Moxa Shaoyin" does not specify the point. Chang Qizi suggests Taixi (KI3). The classics state the Yuan source of the Kidney is Taixi, located in the depression behind the medial malleolus where the artery beats.
In Shaoyin disease with diarrhea and pus/blood in stool, acupuncture is permissible.
[Commentary] "Acupuncture" does not specify points. Chang Qizi suggests Youmen (KI21) and Jiaoxin (KI8) of the Foot-Shaoyin meridian. Guo Yong suggests moxibustion. Youmen (KI21) is one cun below Jiawei (CV15), 0.5 cun lateral to Juque (CV14), in the depression. Treats dysentery with pus/blood. Puncture 5 cun, moxa 5 cones. Jiaoxin (KI8) is two cun above the medial malleolus, anterior to Shaoyin, posterior to Taiyin, between the tibia and tendon. Treats bloody/white dysentery. Puncture 4 cun, retain 5 breaths, moxa 3 cones. Both views are valid.
In Shaoyin disease with diarrhea, faint and choppy pulse, vomiting, sweating, frequent defecation with scant output, warm the upper jiao with moxibustion.
[Commentary] "Moxibustion" does not specify the point. Chang Qizi suggests Taichong (LR3). Guo Yong suggests Taixi (KI3). Neither treats vomiting/sweating with urgency/diarrhea effectively. Youmen (KI21) treats dry heaving, vomiting, urgency, and diarrhea, making it the appropriate choice.
In Shanghan, six to seven days later, with faint pulse, cold hands/feet, and irritability, moxa the Jueyin meridian. If coldness does not return, death ensues.
[Commentary] "Moxa Jueyin" does not specify the point. Chang Qizi suggests Taichong (LR3). As the invested point of Foot-Jueyin, Taichong pulse determines life/death. Located two cun distal to the metatarsophalangeal joint of the great toe, in the dorsal depression where the artery is palpable. Moxa 3 cones.
In Shanghan with rapid pulse and cold hands/feet, moxibustion is permissible.
[Commentary] "Moxibustion" does not specify the point. Chang Qizi suggests Taichong (LR3). Since the previous case of cold extremities used Taichong, this case of cold extremities should also use Taichong.