问∶灸穴须按经取穴,其气易连而其病易除,然人身三百六十五络,皆归于头,头可多
灸欤?灸良已,间有不发者,当用何法发之?
尝谓穴之在人身也,有不一之名,而灸之在吾人也,有至一之会。盖不知其名,则昏谬
无措,无以得其周身之理,不观其会,则散漫靡要,何以达其贯通之原。故名也者,所以尽
乎周身之穴也,固不失之太繁;会也者,所以贯乎周身之穴也,亦不失之太简。人而知乎此
焉,则执简可以御繁,观会可以得要,而按经治疾之余,尚何疾之有不愈,而不足以仁寿斯
执事发策,而以求穴在乎按经,首阳不可多灸及所以发灸之术,下询承学,是诚究心于
民瘼者。愚虽不敏,敢不掇述所闻以对。尝观吾人一身之气,周流于百骸之间,而统之则有
其宗,犹化工一元之气,磅因礴于乾坤之内,而会之则有其要。故仰观于天,其星辰之奠丽,
不知其几也,而求其要,则惟以七宿为经,二十四曜为纬;俯察于地,其山川之流峙,不知
其几也,而求其要则惟以五岳为宗,四渎为委,而其他咸弗之求也。天地且然,而况人之一
身?内而五脏六腑,外而四体百形,表里相应,脉络相通,其所以生息不穷,而肖形于天地
者,宁无所网维统纪于其间耶!故三百六十五络,所以言其烦也,而非要也;十二经穴,所
以言其法也,而非会也。总而会之,则人身之气有阴阳,而阴阳之运有经络,循其经而按
之,则气有连属,而穴无不正,疾无不除。譬之庖丁解牛,会则其凑,通则其虚,无假斤斫
之劳,而顷刻无全牛焉。何也?彼固得其要也。故不得其要,虽取穴之多,亦无以济人;苟
得其要,则虽会通之简,亦足以成功,惟在善灸者加之意焉耳。自今观之,如灸风而取诸风
池、百会,灸劳而取诸膏肓、百劳;灸气而取诸气海;灸水而取诸水分;欲去腹中之病,则
灸三里;欲治头目之疾,则灸合谷;欲愈腰腿,则取环跳、风市;欲拯手臂,则取肩
、曲池。其他病以人殊,治以疾异,所以得之心而应之手者,罔不昭然,有经络在焉。而得
之则为良医,失之则为粗工,凡以辨诸此也。至于首为诸阳之会,百脉之宗,人之受病固多
,而吾之施灸宜别,若不察其机而多灸之,其能免夫头目旋眩、还视不明之咎乎?不审其地
而并灸之,其能免夫气血滞绝、肌肉单薄之忌乎?是百脉之皆归于头,而头之不可多灸,尤
按经取穴者之所当究心也。若夫灸之宜发,或发之有速而有迟,固虽系于人之强弱不同,而
吾所以治之者,可不为之所耶?观东垣灸三里七壮不发,而复灸以五壮即发,秋夫灸中脘九
壮不发,而渍以露水,熨以热履, 以赤葱,即万无不发之理,此其见之《图经》《玉
枢》诸书,盖班班具载可考而知者。吾能按经以求其原,而又多方以致其发,自无患乎气之
不连,疾之不疗,而于灼艾之理,斯过半矣。抑愚又有说焉,按经者法也,而所以神明之者
心也。苏子有言∶一人饮食起居,无异于常人,而愀然不乐,问其所苦,且不能自言,此庸
医之所谓无足忧,而扁鹊、仓公之所望而惊焉者。彼惊之者何也?病无显情,而心有默识,
诚非常人思虑所能测者。今之人徒曰∶吾能按经,吾能取穴。而不于心焉求之,譬诸刻舟而
求剑,胶柱而鼓瑟,其疗人之所不能疗者,吾见亦罕矣。然则善灸者奈何?静养以虚此心,
观变以运此心,旁求博采以旷此心,使吾心与造化相通,而于病之隐显,昭然无遁情焉。则
由是而求孔穴之开合,由是而察气候之疾徐,由是而明呼吸补泻之宜,由是而达迎随出入之
机,由是而酌从卫取气,从荣置气之要,不将从手应心,得鱼兔而忘筌蹄也哉!此又岐黄之
秘术,所谓百尺竿头进一步者,不识执事以为何如?
问:施灸取穴必须依据经络来选取,这样经气容易连通,疾病也容易去除。然而人体三百六十五络脉都汇聚于头部,头部可以多次施灸吗?如果施灸后穴位没有发泡(发灸),应当用什么方法使其发泡?
我曾说,穴位在人体上有不同的名称,而施灸在医者心中,有至为统一的要领。如果不了解穴位的名称,就会昏乱谬误、无所适从,无法掌握全身经络的道理;如果不观察其统会之处,就会散漫而没有重点,如何能通达贯通的根源呢?所以,“名”是用来穷尽全身穴位的,固然不会过于繁杂;“会”是用来贯通全身穴位的,也不会过于简略。人如果能明白这一点,就能执简驭繁,观会得要,那么在按照经络治疗疾病之余,还有什么病治不好呢?不足以达到仁寿的境界吗?
您提出这个策问,要求求穴必须按经络,强调头部不可多灸以及促使艾灸发泡的方法,询问后学,这确实是关心百姓疾苦的表现。我虽然不聪敏,怎敢不陈述我所听到的来回答。
我曾经观察我们一身的之气,周流于百骸之间,而统领它则有它的宗主,就像造化的一元之气,磅礴于天地之内,而汇聚它则有它的要点。所以仰观天空,星辰的分布不知有多少,但寻求要点,只以七宿为经线,二十四星宿为纬线;俯察大地,山川的流动与耸立不知有多少,但寻求要点,只以五岳为宗主,四渎为支流,其他的都不去深究了。天地尚且如此,何况人的身体?内而五脏六腑,外而四肢形体,表里相应,脉络相通,之所以生生不息,并效法天地形成身形,难道中间没有网维统纪的东西吗!所以三百六十五络,是来说明其繁杂的,而不是要点;十二经穴,是来说明其法则的,而不是统会。总括起来看,人身之气有阴阳,而阴阳的运行有经络,顺着经络去按压,那么气就有连属关系,穴位没有不正的,疾病没有不除去的。这就好比庖丁解牛,顺应筋骨缝隙,疏通空隙,不需要斧斤砍伐的劳力,顷刻间整头牛就分解了。为什么呢?因为他得到了关键。所以得不到关键,即使取穴很多,也无法救人;如果得到关键,即使统会简略,也足以成功,只在于善于施灸的人多加注意罢了。
从目前的观点来看,如灸风邪取风池、百会穴,灸虚劳取膏肓、百劳穴;灸气病取气海穴;灸水病取水分子穴;想要去除腹中的病,就灸足三里;想要治疗头目的疾病,就灸合谷穴;想要治愈腰腿病,就取环跳、风市穴;想要拯救手臂病,就取肩髃、曲池穴。其他病症因人而异,治疗因疾病而异,所以心中领悟而手上应验,无不明显,因为有经络存在。掌握了这些就是良医,失去了这些就是粗工,凡是以此来辨别的。至于头部是诸阳经交会的地方,百脉的宗主,人受病固多,而我们施灸应该有所区别,如果不考察其机理而多灸头部,能避免头目眩晕、视物不清的过错吗?不审察部位而一起施灸,能避免气血滞绝、肌肉单薄的忌讳吗?因此百脉都归于头,而头部不可多灸,更是按经取穴者所应当深入研究的。
至于艾灸适宜发泡,或者发泡有快有慢,固然系于人的强弱不同,但我们治疗的方法,难道不可以采取措施吗?观察李东垣灸足三里七壮不发,又加灸五壮即发泡;秋夫灸中脘九壮不发,就用露水浸泡,用热鞋熨烫,再用赤葱捣烂敷贴,就没有不发泡的道理。这些见于《图经》《玉枢》等书,大概都记载得清清楚楚可以考证知道。我能按经络探求其本源,又用多种方法来促使发泡,自然不用担心气不连通、疾病不愈,而对于灼艾的道理,也就掌握过半了。
此外我还有说法,按经络施灸是法则,而使之神妙运用的在于心。苏子曾说:一个人饮食起居与常人无异,却忧愁不乐,问他哪里不舒服,他自己也说不出,这是庸医认为不足担忧,而扁鹊、仓公看到却惊讶的原因。他们惊讶什么呢?病情没有显露的情状,而心里有默默的识别,这确实不是常人思虑所能测度的。现在的人只说:我能按经络,我能取穴。而不从心上寻求,这就好比刻舟求剑、胶柱鼓瑟,能治疗别人不能治疗的病,我也见得很少了。那么善于施灸的人该怎么办呢?静养以使内心虚空,观察变化以运用内心,广泛求索采择以开阔内心,使我的心与造化相通,对于病的隐显,清楚地没有隐藏的情状。那么由此而求孔穴的开合,由此而察气候的疾徐,由此而明呼吸补泻的适宜,由此而达迎随出入的机巧,由此而斟酌从卫取气、从荣置气的要点,不就会做到手应于心,得鱼忘筌吗!这又是岐黄之术的秘术,所谓百尺竿头更进一步的人,不知道您认为怎么样?
Question: Moxibustion acupoints must be selected according to the meridians, so that the Qi can easily connect and the disease can be easily eliminated. However, all 365 collaterals of the human body converge at the head; can the head be frequently moxibusted? If the moxa does not blister after application, what method should be used to induce blistering?
I have said that acupoints on the body have various names, while for the practitioner performing moxibustion, there is a supreme unity in understanding. If one does not know the names, one becomes confused and at a loss, unable to grasp the principles of the whole body; if one does not observe their convergence, one becomes scattered and misses the essentials, how can one reach the source of integration? Therefore, "names" are used to exhaustively cover all acupoints of the body, without being overly complex; "convergence" is used to integrate all acupoints of the body, without being overly simple. If one understands this, one can manage complexity with simplicity and grasp essentials through convergence. Thus, beyond treating diseases according to the meridians, what disease would remain incurable, failing to achieve benevolence and longevity?
You raise this inquiry, emphasizing that acupoint selection must follow the meridians, stressing that the head should not be frequently moxibusted, and asking about methods to induce blistering from moxibustion, questioning scholars. This truly reflects a concern for the people's ailments. Though I am not intelligent, how dare I not recount what I have heard in response?
I have observed that the Qi of our body circulates among the hundred bones, yet it has a central master; just as the primordial Qi of creation surges within heaven and earth, its convergence has key points. Looking up at the sky, the distribution of stars is countless, but seeking the essence, we take the Seven Mansions as the longitude and the Twenty-four Lunar Lodges as the latitude. Looking down at the earth, the flow and standing of mountains and rivers are countless, but seeking the essence, we take the Five Great Mountains as the center and the Four Rivers as the tributaries, ignoring others. Even heaven and earth are thus, let alone the human body! Internally, the Zang-Fu organs; externally, the four limbs and forms. The exterior and interior correspond, and the meridians connect. Why do they generate endlessly and mirror heaven and earth? Is there no network or discipline governing them? Thus, the 365 collaterals describe complexity, not essence; the twelve meridian acupoints describe rules, not convergence. Summarizing, the Qi of the body has Yin and Yang, and the movement of Yin and Yang involves the meridians. Following the meridians and pressing them ensures Qi connectivity and correct acupoint placement, eliminating diseases. It is like Cook Ding carving an ox: following the natural gaps, he needs no axe, and in an instant, the ox is disassembled. Why? Because he grasped the essence. Without the essence, even many acupoints cannot save people; with the essence, even simple convergence suffices for success. It depends only on the skilled moxibustionist paying attention.
From current perspectives: for wind, select Fengchi (GB20) and Baihui (GV20); for consumptive disorders, select Gao Huang (BL43) and Bailao (EX-B1); for Qi disorders, select Qihai (CV6); for Water disorders, select Shuifen (CV9); to remove abdominal diseases, moxify Zusanli (ST36); to treat head and eye diseases, moxify Hegu (LI4); to cure waist and leg issues, select Huantiao (GB30) and Fengshi (GB31); to rescue arm issues, select Jianliao (TE14/SJ14) and Quchi (LI11). Other diseases vary by person and treatment varies by illness. What is understood in the mind manifests in the hand, clearly due to the meridians. Grasping this makes one a good physician; losing it makes one a crude worker. As for the head being the convergence of all Yang meridians and the ancestor of all vessels, although diseases are numerous, our moxibustion should be distinct. If one does not examine the mechanism and frequently moxibusts the head, can one avoid dizziness and blurred vision? If one does not examine the location and applies moxibustion indiscriminately, can one avoid the taboos of stagnant Qi and blood and thin muscles? Therefore, although all vessels converge at the head, the head should not be frequently moxibusted, which is what those selecting acupoints by meridians should study deeply.
Regarding the induction of blistering, whether fast or slow depends on the patient's strength, but our treatment methods should not be neglected. Li Dongyuan moxified Zusanli (ST36) for seven burns without blistering, then added five more burns, causing blistering. Qiufu moxified Zhongwan (CV12) for nine burns without blistering, then soaked it in dew, warmed it with hot shoes, and applied crushed red scallions, ensuring blistering. These are recorded in *Tu Jing* and *Yu Shu*, clearly documented and verifiable. If I seek the origin according to the meridians and use various methods to induce blistering, I need not worry about unconnected Qi or untreated diseases, mastering half the principles of moxibustion.
Furthermore, I have another view: following meridians is the rule, but the mind is what makes it divine. Su Zi said: A person lives normally but is sorrowful; asking where they hurt, they cannot say. This is considered harmless by mediocre physicians but alarming to Bian Que and Cang Gong. Why alarming? The disease has no obvious signs, but the mind recognizes it silently, beyond ordinary thought. Now people say: I can follow meridians, I can select acupoints. But they do not seek in the mind. This is like carving the boat to find the sword or gluing the tuning pegs to play the lute. Rarely do I see them curing what others cannot. So what should a skilled moxibustionist do? Cultivate stillness to empty the mind, observe changes to utilize the mind, and seek widely to broaden the mind. Let the mind connect with creation, clearly perceiving the hidden and manifest aspects of disease. Then, by seeking the opening and closing of acupoints, observing the speed of climate/Qi, clarifying the appropriateness of respiratory tonification and sedation, reaching the mechanism of following and opposing insertion, and weighing the essentials of taking Qi from Wei and placing Qi from Ying, will one not achieve hand-mind correspondence and forget the trap after catching the fish? This is the secret art of Qi Bo and Huang Di, stepping forward from the top of a hundred-foot pole. I wonder what you think?