夫人之常数太阳常多血少气少阳常少血多气阳明常多气多血(后天之数从太而少)少阴常
少血
多气厥阴常多血少气太阴常多气少血(先天之数白少而太)足太阳与少阴为表里少阳与厥阴为
表里阳明与太阴为表里 手太阳与少阴为表里少阳与心主为表里阳明与太阴为表里 今知手
足阴阳所苦凡治病必先去其血乃去其所苦伺之所欲(窥伺其欲散欲 欲缓欲收欲坚之意)然后
泻有余补不足 形乐志苦病生于脉治之以灸刺(形乐身无劳也志苦心多虑也心主脉深思过虑
则脉病矣当治经络故宜灸刺之)形乐志乐病生于肉治之以针石(饱食终日无所运用多伤于脾。
脾主肌肉病则或为卫气留或为脓血聚故当用针石以取之)形苦志乐病生于筋治之以熨引(劳则
伤筋宜用药熨导引之法)形苦志苦病生于咽嗌治之以甘药(形苦志苦必多忧思忧伤肺思伤脾脾
肺之脉上循咽嗌如人之悲忧过度则喉咙哽咽食饮难进思虑过度则上焦痞隔咽中核塞是也因损
于藏当以甘药调之。)形数惊恐。经络不通。病生于不仁。治之以按摩醪药(不仁。顽痹 弱
。也按摩者。导气行血也。醪药。药酒也○灵枢九针论同。)
凡刺之真。必先治神。(正气也。)五脏已定。九候已备后乃存针众脉不见众凶弗闻。外内相
得。无以形先。可玩往来。乃施于人。人有虚实。五虚勿近。五实勿远。(虚病不利于针。
实邪最所当肘)至其当发。间不容 。(发出针也。 。瞬同。言针发有期或迟或速。在气机
之顷不可以瞬息误也)手动若务。(动。用针也。务。专其务而心无二也。)针耀而匀。(耀。
精洁也匀。举措从容也。)静意视义。观适之变。(适至也变虚实之变也。观之以静。察变之
道也)是谓冥冥。(幽隐也)莫知其形。(言血气之变。不形于外。惟明者能察有与无。)
刺虚者须其实。(补虚须纳其气而实之。)刺实者须其虚。(泻实须泄其气而虚之)经气已
至慎守勿失深浅在志。远近若一。如临深渊手如握虎神无营于众物。(详在针解篇)
人的生理常数中,太阳经通常多血少气,少阳经通常少血多气,阳明经通常多气多血(这是后天生成的数量规律,从太到少);少阴经通常少血多气,厥阴经通常多血少气,太阴经通常多气少血(这是先天禀赋的数量规律,由少而太)。足太阳膀胱经与足少阴肾经互为表里,足少阳胆经与足厥阴肝经互为表里,足阳明胃经与足太阴脾经互为表里;手太阳小肠经与手少阴心经互为表里,手少阳三焦经与手厥阴心包经互为表里。现在了解了手足阴阳经脉的病理特点,凡是治病,必须先祛除瘀血以去除其痛苦,观察患者的意愿(窥探患者想要发散、舒缓、收敛或坚固的意图),然后泻其有余,补其不足。
形体安逸而精神苦恼的疾病,病生于脉,治疗用灸法和刺法(形体安逸指身体无劳损,精神苦恼指心中多思虑,心主脉,深思过虑则导致脉病,应当治疗经络,所以适宜用灸刺);形体安逸而精神快乐的疾病,病生于肌肉,治疗用针石(饱食终日无所运动,多损伤脾胃,脾主肌肉,发病时或是卫气滞留,或是脓血聚集,所以应当用针石来取治);形体劳苦而精神快乐的疾病,病生于筋,治疗用熨法和导引法(劳倦会损伤筋脉,适宜用药熨和导引的方法);形体劳苦而精神苦恼的疾病,病生于咽喉,治疗用甘味药物(形体劳苦且精神苦恼,必然多有忧思,忧伤肺,思伤脾,脾肺之脉上行循行于咽喉,如人悲伤过度则喉咙哽咽、饮食难进,思虑过度则上焦痞塞、咽中有核阻塞,这是因为损伤了脏腑,应当用甘药来调理)。经常受惊恐的人,经络不通畅,病生于麻木不仁,治疗用按摩和药酒(不仁即顽痹弱也,按摩的作用是引导气机、运行血液,醪药即药酒。此条与《灵枢·九针论》相同)。
凡针刺的真谛,必先调治神志(正气所在)。五脏状况已明确,三部九候脉象已具备,然后才施针。如果各种脉象未见异常,各种凶险征象未闻,内外相合,不以形体表象为先,可以玩味气血往来的变化,然后施针于人。人有虚实之分,五虚证不要靠近(虚证不利于针刺),五实证不要远离(实邪最应当处理)。到了应当发针的时候,时机不容许有一瞬间的延误(发出针具,瞬同,言发针有时期,或迟或速,在于气机的一刹那,不可以因瞬息之差而误事)。手法动作要专注(动指用针,务指专心致志而心无二用)。针具要光亮且进针均匀(耀指精洁,匀指举措从容)。静心观察义理,观察适应性的变化(适指至,变指虚实的变化,以静观之,察知变化的道理)。这叫做冥冥之中(幽隐之意),没有人能知道其形迹(指气血的变化不显露于外,只有高明的人才能察觉有无)。
刺虚证必须等到正气充实(补虚须纳入其气使其充实)。刺实证必须等到邪气衰退(泻实须泄出其气使其虚衰)。经气已经到来,谨慎守护不要失误,深浅在意念之中,远近原则一致,如同面临深渊,手像握着老虎一样谨慎,精神不被外界事物所干扰(详细内容见《针解篇》)。
The physiological constants of the human body are as follows: The Taiyang (Greater Yang) channel usually has abundant blood and deficient qi; the Shaoyang (Lesser Yang) channel usually has deficient blood and abundant qi; the Yangming (Bright Yang) channel usually has abundant qi and abundant blood (this is the postnatal numerical pattern, decreasing from Tai). The Shaoyin (Lesser Yin) channel usually has deficient blood and abundant qi; the Jueyin (Terminal Yin) channel usually has abundant blood and deficient qi; the Taiyin (Greater Yin) channel usually has abundant qi and deficient blood (this is the prenatal numerical pattern, increasing from Shao to Tai). The Foot-Taiyang Bladder channel and the Foot-Shaoyin Kidney channel are exterior-interior pairs; the Foot-Shaoyang Gallbladder channel and the Foot-Jueyin Liver channel are exterior-interior pairs; the Foot-Yangming Stomach channel and the Foot-Taiyin Spleen channel are exterior-interior pairs. The Hand-Taiyang Small Intestine channel and the Hand-Shaoyin Heart channel are exterior-interior pairs; the Hand-Shaoyang Sanjiao (Triple Burner) channel and the Hand-Jueyin Pericardium channel are exterior-interior pairs; the Hand-Yangming Large Intestine channel and the Hand-Taiyin Lung channel are exterior-interior pairs. Now that we understand the pathological tendencies of the hand and foot yin-yang channels, in treating any disease, one must first remove blood stasis to alleviate suffering, observe the patient's desires (to disperse, to relax, to consolidate, or to firm up), and then drain the excess and tonify the deficiency.
Diseases arising from physical comfort but mental distress originate in the vessels; they are treated with moxibustion and acupuncture (Physical comfort means no bodily labor; mental distress means excessive mental worry. The Heart governs the vessels; deep thinking and over-worry cause vessel pathology, so treating the meridians with moxibustion and acupuncture is appropriate). Diseases arising from physical comfort and mental joy originate in the muscles; they are treated with needles and stone tools (Constant eating without movement damages the Spleen. The Spleen governs the muscles; pathology may involve stagnation of Wei Qi or accumulation of pus and blood, thus requiring needle or stone treatment). Diseases arising from physical toil and mental joy originate in the tendons; they are treated with hot compresses and Daoyin exercises (Toil injures the tendons, so herbal hot compresses and guiding exercises are suitable). Diseases arising from physical toil and mental distress originate in the throat and epiglottis; they are treated with sweet herbs (Physical toil and mental distress lead to excessive sorrow and thought. Sorrow injures the Lung; thought injures the Spleen. The Spleen and Lung meridians ascend along the throat. Excessive sorrow causes choking and difficulty swallowing; excessive thought causes upper jiao blockage and a sensation of a lump in the throat. Since the zang organs are damaged, sweet herbs should be used to regulate them). Frequent fright and terror cause meridian obstruction and numbness (Bu Ren); these are treated with massage and medicinal wine (Numbness refers to stubborn bi syndrome and weakness. Massage guides qi and moves blood; medicinal wine refers to medicated wine. This corresponds to the *Ling Shu: Nine Needles Chapter*).
The true essence of acupuncture requires first regulating Shen (Spirit/Mind) (where Zheng Qi resides). Once the condition of the Five Zang organs is determined and the Nine Pulses are fully assessed, one may then insert the needle. If no abnormal pulses are seen and no ominous signs are heard, and there is harmony between interior and exterior, do not let the physical form precede the diagnosis. One must study the flow and return of Qi before applying treatment to the patient. There are deficiency and excess conditions in people; avoid needling the Five Deficiency patterns (deficiency conditions are unfavorable for needling), and do not stay away from the Five Excess patterns (excess pathogens are precisely what should be addressed). When the time for needle insertion arrives, there is not even a blink's delay (inserting the needle; 'Shun' is synonymous with 'blink'. It means the timing of needle insertion varies or is precise, depending on the moment of Qi mechanism, and cannot be mistaken by a split second). The hand movements must be focused (Movement refers to using the needle; Focus means dedicating oneself to the task with a single-minded heart). The needle must be bright and clean, and the manipulation uniform (Bright refers to cleanliness; Uniform refers to calm and measured execution). Quietly contemplate the principles, observing the changes of adaptation (Adaptation refers to arrival; Change refers to the shift between deficiency and excess. Observe with stillness to perceive the way of change). This is called "Ming Ming" (obscure and hidden). No one can see its form (referring to changes in blood and qi that do not manifest externally; only the wise can perceive their presence or absence).
When needling deficiency, wait until the Qi becomes solid (tonifying deficiency requires introducing Qi to make it substantial). When needling excess, wait until the condition becomes deficient (draining excess requires releasing Qi to make it empty). Once the Jing Qi has arrived, guard it carefully and do not lose it. Depth and distance should be consistent in intent. Approach the procedure as if standing at the edge of an abyss, holding the needle as if grasping a tiger, keeping the Spirit unengaged with external distractions (For details, see the *Needle Explanation Chapter*).