或曰。病有宜灸者。有不宜灸者。可得闻欤。
曰。大抵不可刺者。宜灸之。一则沉寒痼冷。二则无脉。知阳绝也。三则腹皮急而阳陷
也。舍此三者。余皆不可灸。盖恐致逆也。
针经云。陷则灸之。天地间无他。惟阴与阳二气而已。阳在外在上。阴在内在下。今言
陷下
病有邪气陷下者。有正气陷下者。邪气陷下者。是经虚气少邪入。故曰感虚乃陷下也。故诸
邪陷下在经者。宜灸之。正气陷下。宜药升之。如补中益气之类。）
经曰。北方之人。宜灸 也。为冬寒大旺。伏阳在内。皆宜灸之。以至理论。则肾主藏
。藏阳气在内。冬三月。主闭藏是也。若太过则病。固宜灸 。此阳明陷入阴水之中是也。
难经云。热病在内。取会之气穴。为阳陷入阴中。取阳气通天之窍穴。以火引火而导之
。此
。则为烦逆。追虚逐实。血散脉中。火气虽微。内攻有力。焦骨伤筋。血难复也。又云。脉
浮。宜以汗解。用火灸之。邪无从出。因火而盛。病从腰以下必重而痹。名火逆也。脉浮热
甚而灸之。此为实实。因火而动。必咽燥唾血。又云。身之穴三百六十有五。其三十穴灸之
有害。七十九穴刺之为灾。并中髓也。 经之所见。邪之所在。脉沉者。邪气在内。脉浮者
。邪气在表。世医只知脉之说。不知病证之禁忌。若表见寒证。身汗出。身常清。数栗而寒
。不渴。欲覆浓衣。常恶寒。手足厥。皮肤干枯。其脉必沉细而迟。但有一二证。皆宜灸之
。阳气下陷故也。若身热恶热。时见躁作。或面赤面黄。嗌干咽干口干。舌上黄赤。时渴。
咽嗌痛。皆热在外也。但有一二证。皆不宜灸。其脉必浮数。或但数。亦不可灸。灸之。灾
患立生。若有鼻不闻香臭。鼻流清涕。眼睑时痒。或欠或嚏。恶寒。其脉必沉。是脉证相
应也。或轻手得弦紧者。是阴伏其阳也。虽面赤亦宜灸。不可拘于面赤也。机按。素难诸书
。皆言阳气陷下者。脉沉迟也。脉证俱见寒在外者。冬月阴寒大旺。阳明陷入阴水之中者。
并宜灸之。设脉浮者。阳气散于肌表者。皆不宜灸。丹溪亦曰。夏月阳气尽浮于表。今医灼
艾。多在夏月。宁不犯火逆之戒乎。或者因火而生热胀发黄腰痹咽燥唾血者。往往有之。尚
不知为火逆所致。宁甘心于命运所遭。悲夫。经曰。春夏养阳。以火养阳。安有是理。论而
至是。虽愚亦当有知者焉。
或曰。嗽病多灸肺俞、风门何如。
曰。肺主气属金。行秋之令。喜清而恶热。受火所制。为华盖。居四藏之端。饮食入胃
。热
嗽。其痰少者。肺火抑郁。不得宣通为咳。咳形属火。痰形属湿。风门、肺俞二穴。明堂、
铜人皆云治嗽。今人见有痰而嗽。无痰而咳。一概于三伏中灸之。不计壮数。二穴切近华盖
。而咳与嗽本因火乘其金。兹复加以艾火燔灼。金欲不伤得乎。况三伏者。火旺金衰。故谓
之伏。平时且不可灸。而况于三伏乎。夫治嗽。当看痰与火孰急。无痰者。火旺金衰。十死
七八。泻火补金。间或可生。痰多者。湿盛也。降火下痰。其嗽自愈。纵灸肺俞、风门。不
过三壮五壮。泻其热气而已。固不宜多灸。三伏之中。更不宜灸也。
或曰。头目之疾。灸之何如。
曰。手之三阳。从手至头。足之三阳。从头走足。督脉自尾闾抵脊。上头至人中。头者
。手足三阳与督脉所会之地。故冬月之寒。头无所畏。美酒之饮。面为之赤。是皆诸阳所致也。
今有头风头晕。中风发致眼目耳鼻等疾。辄于头部诸穴。多灼艾炷。是犹抱薪救火。安能济
耶。当看病在气分血分。分类施治。庶得其宜。纵使应灸。亦不过三壮五壮。以泻热气而已
。眼目疼痛。多由血热。岂宜妄灸助热。以伤其血哉。
或曰。人言无病而灸。以防生病何如。
曰。人之有病。如国之有盗。须用兵诛。其兵出于不得已也。针灸治病。亦不得已而用
之。
然。夫一穴受灸。则一处肌肉为之坚硬。果如船之有钉。血气到此。则涩滞不能行矣。昔有
病跛者。邪在足少阳分。自外踝以上。循经灸者数穴。一医为针临泣。将欲接气过其病所。
才至灸瘢。止而不行。始知灸火之坏人经络也。或有急证。欲通其气。则无及矣。邪客经络
。为其所苦。灸之不得已也。无病而灸。何益于事。
或曰。膏肓治百病。而诸家取穴之法不同。何欤。
曰。高下各去胛骨一侧指许是穴。不可失之狭。狭则内犯大筋。不可失之阔。阔则外犯
胛骨
量则。分作八寸。以比横寸之则。量之于背。盖人有生而背突者。背常阔。而胸常狭。胸突
者。胸常阔。而背常狭。安能保其无过与不及焉。又有儿时偏卧一边。以致背有边阔边狭者
。亦不可以边之阔狭为拘。但当随其一边阔狭。相去胛骨一侧指许为正也。人之项。有二
大筋。夹脊而下。两筋外空。为第二行穴俞。穴俞外。又有二大筋。大筋外空。为第三行穴
俞。膏肓系在三行魄户之下。神堂之上。若点穴。不出胛骨一侧指许。则伤筋骨。非真穴也
。世人又有四肋三间之说。揣按自大椎至三节之下。四节之上。准望于三四柱间定穴。指为
四肋三间。用之不疑。瘦人椎骨分晓。用之可也。肥人揣按实难。又以指节寸量开三寸取穴
。背高而狭者。全不合四肋三间之说矣。尝是灸一骨立之人。用侧指许法点之。方大悟四肋
三间之妙。盖人之胛骨。微有少曲。胛骨下廉上廉四肋之内。自有三间。膏肓正在四肋三间
之中。即非脊骨三四椎之间也。世人多灸之者。盖膏肓神明所居。或为邪干。则脂膏销铄。
肓膜瘦薄。灸之而病或安者。以三焦主气。为诸阳之府。气病则阳虚而阴不得相附。膏肓在
三焦部分。气之所聚而行于诸阳。宜其主于气病也。若治血病。吾未见其可者。晋侯梦二竖
子在膏肓间。非秦缓不能灸也。以阳气将绝。邪得专之故也。
或曰。古谓痈疽始发。灸之可使轻浅。何谓也。
丹溪曰。用火以畅达拔引郁毒。此从治之意。惟头为诸阳所聚。艾炷宜小而少。若身上
痛则灸至不痛。不痛须灸至痛。有因灸而死者。盖虚甚孤阴将绝。其脉必浮数而大且鼓。精
神必短而昏。无以抵当火气。宜其危也。
或曰。灸之不发何如。
罗氏曰。覃公四十九岁病脐腹冷疼。完谷不化。足跗寒逆。精神困弱。脉沉细微。灸气
海、
而愈。针书曰。凡用针。气不至不效。灸之亦不发。大抵血气空虚。不能作脓。失其所养故
也。加以不慎。邪气加之。病必不退。或曰。覃公所养。无不如意。何谓失其所养。曰。君
言所养。口体者也。此论所养。性命者也。覃公壮年得志。务快其心。血气空虚。以致此耳
或曰。灸有补写乎。
经曰。以火补者。无吹其火。须自灭也。以火写者。疾吹其火。传其艾。须其火灭也。
虞氏
灸之。使实邪随火气而发散也。寒者灸之。使其气复温也。热者灸之。引郁热之气外发。火
就燥之义也。
或曰。周身经络。及穴俞相去分寸。经穴起止。十二经纳支干等条。古有歌括。亦可读
否。
安可不读。歌曰。手太阴肺中焦生。下络大肠出贲门。上膈属肺从肺系。系横出腋 中行。
肘臂寸口上鱼际。大指内侧爪甲根。支络还从腕后出。接次指属阳明经。 阳明之脉手大阳
。次指内侧起商阳。循指上廉出合谷。两筋岐骨循臂肪。入肘外廉循 外。肩端前廉柱骨旁
。从肩下入缺盆内。络肺下膈属大肠。支从缺盆直上颈。斜贯颊前下齿当。环出人中交左右
。上夹鼻孔注迎香。 胃足阳明交鼻起。下循鼻外入上齿。还出侠口绕承浆。颐后大迎颊车
里。耳前发际至额颅。支下人迎缺盆底。下膈入胃络脾宫。直者缺盆下乳内。一支幽门循腹
里。下行直合气冲中。遂由髀关抵膝膑。 跗中指内关同。一支下膝注三里。前出中指外间
通。一支别走足跗趾。大趾之端经尽矣。 太阴脾起足大趾。上循内侧白肉际。核骨之后内
踝前。上 循 经膝里。股内前廉入腹中。属脾络胃与膈通。侠咙连舌散舌下。支络从胃注
心宫。手少阴脉起心中。下膈直与小肠通。支者还从心系走。直上喉咙系目瞳。直者上肺出
腋下。 后肘内少海从。臂内后廉抵掌中。兑骨之端注少冲。 手太阳经小肠脉。小指之端
起少泽。循手外侧出踝中。循臂骨出肘内侧。上循 外出后廉。直过肩解绕肩胛。交肩下入缺
盆内。向腋络心循咽嗌。下膈抵胃属小肠。一支缺盆贯颈颊。至目兑 却入耳。复从耳前仍
上
耳角。直者从巅脑后悬。络脑还出别下项。仍循肩膊侠脊边。抵腰膂肾膀胱内。一支下与后
阴连。贯臀斜入委中穴。一支膊内左右别。贯胛侠脊过髀枢。臀内后廉 中合。下贯 内外
踝后。京骨之下指外侧。 足经肾脉属少阴。小指斜趋涌泉心。然谷之下内踝后。别入跟中
内侵。出 内廉上股内。贯脊属肾膀胱临。直者属肾贯肝膈。入肺循喉舌本寻。支者从肺
络心内。仍至胸中部分深。 手厥阴心主起胸。属包下膈三焦宫。支者循胸出胁下。胁下连
腋三寸同。仍上抵腋循 内。太阴少阴两经中。指透中冲支者别。小指次指络相通。 手
经少阳三焦脉。起自小指次指端。两指岐骨手腕表。上出臂外两骨间。肘后 外循肩上。少
阳之后交别传。下入缺盆膻中分。散络心包膈里穿。支者膻中缺盆上。上项耳后耳角旋。屈
下至颐仍注颊。一支出耳入耳前。却从上关交曲颊。至目内 乃尽焉。 足脉少阳胆之经。
始从两目锐 生。抵头循角下耳后。脑空风池次第行。手少阳前至肩上。交少阳右上缺盆。
支者耳后贯耳内。出走耳前锐 循。一支锐 大迎下。合手少阳抵项根。下加颊车缺盆合。
入胸贯膈络肝经。属胆仍从胁里过。下入气街毛际萦。横入髀厌环跳内。直者缺盆下腋膺。
过季胁下髀厌内。出膝外廉是阳陵。外辅绝骨踝前过。足跗小趾次趾分。一支别从大趾去。
三毛之际接肝经。 厥阴足脉肝所终。大趾之端毛际丛。足跗上廉太冲分。踝前一寸入中封
。上踝交出太阴后。循 内廉阴股冲。环绕阴器抵少腹。侠胃属肝络胆逢。上贯膈里布胁肋
。侠喉颃颡目系同。脉上巅会督脉出。支者还生目系中。下络颊里环唇内。支者便从膈肺通
有人问：疾病中有适合艾灸的，也有不适合艾灸的，能讲给我听吗？
回答说：大抵上，那些不适合针刺治疗的病症，适宜用艾灸。主要有三种情况：一是沉寒痼冷（深伏体内的寒冷病邪）；二是无脉，这是阳气绝灭的表现；三是腹部皮肤紧绷而阳气下陷。除了这三种情况，其余都不宜艾灸，大概是担心导致逆证（病情恶化或出现变证）。
《针经》说：“陷下则灸之。”天地间没有别的，只有阴气和阳二气罢了。阳气在外、在上，阴气在内、在下。现在所说的“陷下”，是指疾病有邪气陷下的，也有正气陷下的。邪气陷下，是因为经脉空虚、气少，邪气乘虚而入，所以说“感虚乃陷下”。因此，凡是邪气陷在经脉中的，适宜艾灸。如果是正气陷下，应当用药升提，比如补中益气汤之类的方剂。
《内经》说：北方的人，适宜艾灸。因为冬季寒气大盛，阳气伏藏于体内，都适宜艾灸。从理论上来讲，肾主收藏，将阳气藏于体内，冬三月正是主闭藏的季节。如果阳气太过（指寒邪太盛逼迫阳气内伏），就会生病，固宜艾灸，这就是阳明经陷入阴水之中的情况。
《难经》说：热病在内，取会穴之气穴。这是因为阳气陷入阴中，要取通连阳气的窍穴，用火引火来引导它。……（此处原文有缺漏或语意中断，结合下文语境理解为对误治后果的描述）……如果误治，就会导致烦闷逆乱，追虚逐实（使虚者更虚，实者更实），血液散乱于脉中。火气虽然微弱，但内攻的力量很强，会导致焦骨伤筋，血液难以恢复。又说：脉浮，适宜用发汗的方法解表，如果用火灸，邪气无处可出，反而因火而炽盛，病从腰部以下必定沉重且麻木不仁，这叫“火逆”。脉浮且热甚而施以艾灸，这叫“实实”（实证用实证治法，加重病情），因火而动血，必定会出现咽干、唾血。又说：全身穴位共有三百六十五个，其中三十个穴位艾灸会有害处，七十九个穴位针刺会造成灾祸，并可能刺中脊髓。
《内经》所见，邪气所在之处，脉沉的，邪气在内；脉浮的，邪气在表。世间的医生只知道脉象的说法，不知道病证的禁忌。如果表面呈现寒证，身体出汗，身体常觉清冷，频繁战栗发冷，口不渴，想要覆盖厚衣服，经常怕冷，手脚冰凉，皮肤干枯，其脉必然沉细而迟。只要有一两个症状，都适宜艾灸，这是阳气下陷的缘故。如果身体发热、恶热，时常烦躁发作，或者面色红赤或发黄，咽喉干燥、口干，舌苔黄赤，时常口渴，咽喉疼痛，这些都是热邪在外的表现。只要有一两个症状，都不适宜艾灸。其脉必然浮数，或者只是数脉，也不可以艾灸。如果艾灸，灾难和祸患立刻产生。如果有鼻子闻不到香臭，流清鼻涕，眼睑时常发痒，或者打哈欠、打喷嚏，怕冷，其脉必沉，这是脉证相应的表现。或者轻按得弦紧脉，这是阴伏其阳（阴寒内盛格拒阳气于外），即使面赤也适宜艾灸，不可拘泥于面赤这一症状。汪机按语：《素问》、《难经》等书，都说阳气陷下的，脉象是沉迟的。脉证都显示寒邪在外的，冬季阴寒大盛的，阳明陷入阴水中的，都适宜艾灸。假如脉浮的，是阳气散布在肌表的，都不适宜艾灸。朱丹溪也说：夏季阳气完全浮越于体表，现在的医生多在夏季灼艾，难道不违反火逆的戒律吗？有的人因为火灸而产生热胀、发黄、腰痹、咽干、唾血等症状，往往有这种情况，却还不知道这是火逆所致，宁愿甘心认为是命运遭遇，可悲啊。《内经》说：春夏养阳，用火来养阳，哪里有这个道理？论述到这种地步，即使是愚笨的人也应当有所知晓了。
回答说：肺主气，属金，行秋季的政令，喜欢清肃而厌恶燥热。受到火的制约，肺为华盖，居于五脏之上端。饮食入胃，若生热嗽，痰少的，是肺火郁结，不得宣通而致咳。咳的形态属火，痰的形态属湿。风门、肺俞这两个穴位，《明堂》、《铜人》针灸书都说治疗咳嗽。现在的人见到有痰而嗽，无痰而咳，一概在三伏天进行艾灸，不计较灸的壮数。这两个穴位切近华盖（肺），而咳与嗽本因火邪乘袭肺金，这里又加上艾火焚烧灼烧，肺金能不受伤吗？况且三伏天，火旺金衰，所以称为“伏”，平时尚且不可以艾灸，何况在三伏天呢？治疗咳嗽，应当看痰与火哪个急迫。无痰的，是火旺金衰，十死七八，泻火补金，间或可以存活。痰多的，是湿盛，降火化痰，咳嗽自然痊愈。即使灸肺俞、风门，也不过三壮五壮，只是为了泻去热气罢了，本来就不宜多灸，在三伏天之中，更不宜艾灸。
有人问：头目方面的疾病，艾灸怎么样？
回答说：手部的三条阳经，从手走向头；足部的三条阳经，从头走向足；督脉从尾闾沿脊柱上行，到头至人中。头部，是手足三阳经与督脉交会的地方。所以冬天的寒气，头部无所畏惧；美酒饮用后，面部为之发红，这都是诸阳经的作用所致。现在有头风、头晕，中风引发眼目耳鼻等疾病，就随意在头部各个穴位大量灼烧艾炷，这就像抱着柴草去救火，怎么能救济呢？应当看病是在气分还是血分，分类施治，这样才能得当。纵使应该艾灸，也不过三壮五壮，只是为了泻去热气罢了。眼目疼痛，多由血热引起，哪里可以妄加艾灸助长热势，从而损伤血液呢？
有人问：人们说没病的时候艾灸，以防生病，怎么样？
回答说：人得病，就像国家有盗贼，必须用兵诛讨。出兵是出于不得已。针灸治病，也是不得已才使用。然而，一个穴位受灸，那一处的肌肉就会变得坚硬，果然像船上有钉子一样，气血到这里，就会涩滞不能通行。过去有个跛脚的病人，邪气在足少阳经分，从外踝以上，沿着经络灸了几个穴位。一位医生准备针刺临泣穴，想要接气通过病所，才走到灸过的瘢痕处，气血停止而不前行，这才知道灸火损坏了经络。如果有急症，想要通畅气血，那就来不及了。邪气客居经络，被其所苦，艾灸是不得已而为之。没病而艾灸，对事情有什么益处呢？
回答说：穴位高下各距离胛骨一侧约一指宽的地方，不可取得太窄，取窄了内部会侵犯大筋；不可取得太宽，取宽了外部会侵犯胛骨。测量方法：分为八寸，以此作为横寸的标准。量之于背部，大概人有天生背突的，背部通常宽阔而胸部狭窄；胸突的，胸部通常宽阔而背部狭窄，怎么能保证没有过与不及呢？又有儿时偏卧一边，导致背部一边宽一边窄的，也不能拘泥于一边的宽窄。只应当随着一边宽窄的情况，距离胛骨一侧一指宽为正位。人的颈部，有两条大筋，夹脊而下，两筋之外的空隙，是第二行穴俞。穴俞之外，又有两条大筋，大筋之外的空隙，是第三行穴俞。膏肓穴位于第三行的魄户穴之下，神堂穴之上。如果点穴，不出胛骨一侧一指宽的范围，就会伤及筋骨，那不是真穴。世人又有“四肋三间”的说法，揣测按压自大椎往下第三节之下，第四节之上，准望于三四椎柱之间定穴，指为四肋三间，使用毫不怀疑。瘦人椎骨分明，可以使用这种方法。肥人揣测按压确实困难，又以指节寸量开三寸取穴。背部高而狭的人，完全不符合四肋三间的说法。曾经灸过一个骨瘦如柴的人，用侧一指许的方法点穴，才恍然大悟四肋三间的妙处。大概人的胛骨，微有少许弯曲，胛骨下缘上缘之间的四肋之内，自然有三间，膏肓穴正是在四肋三间之中，即不是脊骨三四椎之间。世人多灸这个穴位，大概因为膏肓是神明所居之处，如果被邪气干扰，则脂膏销铄，肓膜瘦薄，艾灸后病或许能安，是因为三焦主气，是诸阳之府，气病则阳虚而阴不能依附，膏肓在三焦部分，是气之所聚而行于诸阳，适宜主治气病。如果要治疗血病，我没见过可行的。晋侯梦见两个小孩在膏肓之间，不是秦缓（医和）不能治愈，是因为阳气将要绝灭，邪气得以专横的缘故。
有人问：古时候说痈疽刚开始发作时，艾灸可以使病情减轻变浅，这是什么意思？
朱丹溪说：用火来畅达拔引郁毒，这是从治（顺从其病势而治）的意思。惟独头部是诸阳汇聚之处，艾炷宜小而少。如果身上痛就灸到不痛，不痛须灸到痛。有因艾灸而死的，大概是因为虚损严重，孤阴即将绝灭，其脉必然浮数而大且鼓动，精神必然短促而昏沉，无法抵挡火气，所以危险。
罗氏说：覃公四十九岁时患脐腹冷痛，完谷不化（大便中有未消化的食物），足背寒逆，精神困弱，脉沉细微。灸气海、关元等穴而痊愈。针灸书说：凡是用针，气不至则无效，艾灸也不发（不化脓）。大抵是因为血气空虚，不能作脓，失去了它所滋养的根本。再加上不慎，邪气加之，病必定不退。有人说：覃公所保养的，无不如意，为什么说失去所养？回答说：您所说的保养，是指口腹之欲；这里论述的保养，是指性命根本。覃公壮年得志，务求快心，导致血气空虚，以致于此。
《内经》说：用火补法，不要吹火，须让它自己熄灭。用火泻法，快速吹火，传递艾火，须让它很快熄灭。虞氏说：灸之，使实邪随火气而发散。寒者灸之，使其气复温。热者灸之，引郁热之气外发，这是“火就燥”的道理。
有人问：周身经络，以及穴俞相距分寸，经穴起止，十二经纳支干等条目，古代有歌诀，也可以读吗？
回答说：怎么可以不读？歌诀说：手太阴肺经从中焦生出，向下联络大肠，出贲门，向上穿过膈肌，属于肺，从肺系（气管喉咙部）横行出腋下，沿上臂内侧前缘，下行肘窝内侧，再下行寸口，上至鱼际，止于大拇指内侧爪甲根旁。支脉从腕后分出，走向食指内侧端，交接于手阳明大肠经。手阳明大肠经起于食指内侧端商阳穴，循手指上缘出合谷，在两筋歧骨间循臂外侧前缘，入肘外侧，循臂外侧上肩，至肩峰前缘，沿柱骨（颈椎）旁，从肩下入缺盆内，络肺，向下穿过膈肌，属于大肠。支脉从缺盆直上颈部，斜贯颊前，下入下齿中，环绕口唇，交于人中，左右交叉，上夹鼻孔，注入迎香穴，与足阳明胃经相接。足阳明胃经交鼻而起，下循鼻外，入上齿中，还出挟口，环绕承浆，向后沿大迎、颊车，耳前发际至额颅。支脉下行人迎、缺盆底，下膈入胃，络脾。直行者从缺盆下乳内侧，一支沿幽门，循腹里下行，直合于气冲。遂由髀关抵膝膑，下至足跗中指内关同。一支下膝注三里，前出中指外间通。一支别走足跗趾，至大趾之端经尽矣。足太阴脾经起于足大趾，上循内侧白肉际，核骨之后内踝前，上腨循胫经膝里，股内前廉入腹中，属脾络胃，与膈通，侠咽连舌，散舌下。支络从胃注心宫。手少阴心经起心中，下膈直与小肠通。支者还从心系走，直上喉咙系目瞳。直者上肺出腋下，臑后肘内少海从。臂内后廉抵掌中，兑骨之端注少冲。手太阳小肠经，小指之端起少泽，循手外侧出踝中，循臂骨出肘内侧，上循臑外出后廉，直过肩解绕肩胛，交肩下入缺盆内，向腋络心循咽嗌，下膈抵胃属小肠。一支缺盆贯颈颊，至目锐眦却入耳，复从耳前仍上耳角。直者从巅脑后悬，络脑还出别下项，仍循肩膊侠脊边，抵腰膂肾膀胱内。一支下与后阴连，贯臀斜入委中穴。一支膊内左右别，贯胛侠脊过髀枢，臀内后廉腘中合，下贯内外踝后，京骨之下指外侧。足经肾脉属少阴，小指斜趋涌泉心，然谷之下内踝后，别入跟中内侵，出内廉上股内，贯脊属肾膀胱临。直者属肾贯肝膈，入肺循喉舌本寻。支者从肺络心内，仍至胸中部分深。手厥阴心包经起胸，属包下膈三焦宫。支者循胸出胁下，胁下连腋三寸同。仍上抵腋循臑内，太阴少阴两经中。指透中冲支者别，小指次指络相通。手少阳三焦经，起自小指次指端，两指岐骨手腕表，上出臂外两骨间，肘后臑外循肩上，少阳之后交别传，下入缺盆膻中分，散络心包膈里穿。支者膻中缺盆上，上项耳后耳角旋，屈下至颐仍注颊，一支出耳入耳前，却从上关交曲颊，至目内眦乃尽焉。足脉少阳胆之经，始从两目锐眦生，抵头循角下耳后，脑空风池次第行。手少阳前至肩上，交少阳右上缺盆。支者耳后贯耳内，出走耳前锐眦循。一支锐眦大迎下，合手少阳抵项根。下加颊车缺盆合，入胸贯膈络肝经。属胆仍从胁里过，下入气街毛际萦。横入髀厌环跳内，直者缺盆下腋膺。过季胁下髀厌内，出膝外廉是阳陵。外辅绝骨踝前过，足跗小趾次趾分。一支别从大趾去，三毛之际接肝经。足厥阴肝经所终，大趾之端毛际丛，足跗上廉太冲分，踝前一寸入中封。上踝交出太阴后，循胫内廉阴股冲，环绕阴器抵少腹，侠胃属肝络胆逢。上贯膈里布胁肋，侠喉颃颡目系同。脉上巅会督脉出，支者还生目系中，下络颊里环唇内，支者便从膈肺通。
A question was asked: "In diseases, some are suitable for moxibustion, while others are not. Could you explain this to me?"
The answer was: "Generally speaking, conditions that are unsuitable for acupuncture are suitable for moxibustion. There are three main scenarios: first, deep-seated cold and chronic cold (Shenhan Guoleng); second, absence of pulse, which indicates the extinction of Yang Qi; third, abdominal skin tension with sinking of Yang Qi. Apart from these three situations, moxibustion should not be used for other conditions, primarily to avoid inducing adverse reactions (Ni Zheng).
The *Zhen Jing* (Classic of Acupuncture) states: 'For sinking conditions, use moxibustion.' In the universe, there is nothing but Yin and Yang Qi. Yang Qi is external and superior, while Yin Qi is internal and inferior. The term 'sinking' mentioned here refers to diseases where either pathogenic factors sink or healthy Qi sinks. Pathogenic sinking occurs due to meridian deficiency and scanty Qi, allowing pathogens to enter vacuously; thus it is said that 'feeling vacuity leads to sinking.' Therefore, for pathogens sinking in the meridians, moxibustion is appropriate. For sinking of healthy Qi, medicinal elevation is required, such as using formulas like Buzhong Yiqi Tang.
The *Neijing* (Inner Canon) says: People in the north are suitable for moxibustion. This is because winter cold is intense, and Yang Qi is hidden within the body, making moxibustion suitable for all. Theoretically, the Kidney governs storage, keeping Yang Qi inside; the three months of winter govern closure and storage. If Yang becomes excessive (due to severe cold forcing Yang inward), illness ensues, and moxibustion is indeed indicated; this is the situation where the Yangming Mermaid sinks into Yin Water.
The *Nan Jing* (Classic of Difficult Issues) states: For internal heat diseases, select Qi-Acups at Hui meetings. This is because Yang Qi has sunk into Yin; one should select acupoints connecting to Yang Qi to guide it out using fire to lead fire... [Text gap/fragment] ...If treated incorrectly, it leads to irritability and rebellion, chasing vacuity and pursuing reality (exacerbating deficiency and excess), scattering blood in the vessels. Although fire energy is weak, its internal attack is powerful, leading to scorched bones and injured sinews, making blood difficult to restore. It also states: When the pulse is floating, sweating is the appropriate method for release. Using fire moxibustion prevents pathogens from exiting, causing them to flourish due to fire. The disease will become heavy and numb below the waist, named 'Fire Rebellion' (Huo Ni). If the pulse is floating and heat is severe, applying moxibustion constitutes 'making the excess more excess' (Shi Shi). Due to fire moving blood, dry throat and spitting blood will inevitably occur. It further states: There are 365 acupoints on the body; thirty are harmful if moxibusted, and seventy-nine are disastrous if needled, potentially piercing the spinal marrow.
As seen in the classics, where pathogens reside: a sinking pulse indicates internal pathogens; a floating pulse indicates external pathogens. Physicians of the world only know pulse theory but ignore disease contraindications. If surface symptoms show cold signs—sweating, feeling constantly cold, frequent chills, no thirst, desire for thick clothing, aversion to cold, cold limbs, dry skin—the pulse must be deep, fine, and slow. If even one or two of these symptoms appear, moxibustion is suitable due to sinking Yang Qi. Conversely, if the body is hot, averse to heat, occasionally restless, face red or yellow, dry throat/mouth, yellow-red tongue coating, occasional thirst, sore throat—these indicate heat outside. If even one or two such symptoms appear, moxibustion is unsuitable. The pulse will be floating and rapid, or merely rapid; moxibustion is forbidden. Moxibustion will immediately cause disaster. If the nose cannot smell odors, runs clear mucus, eyelids itch, yawning or sneezing occurs, and aversion to cold exists, the pulse must be deep, indicating correspondence between pulse and syndrome. Or, if light pressure yields a string-tight pulse, it indicates Yin hiding Yang (Yin cold suppressing Yang outward); even with a red face, moxibustion is suitable, not restricted by facial redness. Wang Ji notes: Books like *Suwen* and *Nanjing* state that sinking Yang presents with deep-slow pulses. Syndromes showing external cold, intense winter Yin cold, or Yangming sinking into Yin water are all suitable for moxibustion. If the pulse is floating, indicating Yang dispersed in the muscle layer, moxibustion is unsuitable. Zhu Danxi also said: In summer, Yang floats entirely to the surface. Modern physicians often perform moxibustion in summer; do they not violate the warning against Fire Rebellion? Many suffer from heat bloating, jaundice, lumbar bi, dry throat, and spitting blood due to fire, yet fail to recognize it as Fire Rebellion, resigning themselves to fate. How sad! The *Neijing* says: Nourish Yang in spring and summer. To nourish Yang with fire—where is the logic? Discussing this to such an extent, even the foolish should understand.
Another question: "Is it advisable to frequently moxa Feishu (BL13) and Fengmen (BL12) for cough?"
The answer: "The Lung governs Qi and belongs to Metal, executing Autumn's command. It prefers clarity and abhors heat. Constrained by fire, the Lung acts as the Canopy, residing at the top of the four Zang organs. Food enters the stomach; if heat-cough arises with little phlegm, it is Lung Fire depression failing to diffuse, causing cough. Cough form belongs to Fire; phlegm form belongs to Dampness. Both Fengmen and Feishu are recorded in *Mingtang* and *Tongren* to treat cough. Nowadays, people indiscriminately moxa these points during the Sanfu (Dog Days) for both phlegm-cough and dry-cough, ignoring the number of moxa cones. These points are close to the Canopy (Lung). Since cough originates from Fire attacking Metal, adding moxa fire burns the Metal; can the Lung remain uninjured? Moreover, Sanfu days feature strong Fire and weak Metal, hence called 'Hidden'. Moxibustion is inadvisable even normally, let alone during Sanfu. Treating cough requires assessing whether Phlegm or Fire is urgent. Without phlegm, Fire is strong and Metal weak; death rate is high. Clearing Fire and tonifying Metal may offer survival. With much phlegm, Dampness is abundant; descending Fire and resolving phlegm cures the cough naturally. Even if moxa Feishu/Fengmen, limit to 3-5 cones just to clear heat; excessive moxibustion is unsuitable, especially in Sanfu.
Another question: "How about moxibustion for head and eye diseases?"
The answer: "The three Hand-Yang meridians go from hand to head; the three Foot-Yang meridians go from head to foot. The Du Mai (Governing Vessel) goes from the tailbone up the spine to the head and Renzhong. The head is the convergence point of Hand/Foot Yang and Du Mai. Thus, the head fears winter cold least; drinking wine reddens the face—all due to Yang meridians. For headache, dizziness, stroke-induced eye/ear/nose issues, burning many moxa cones on head points is like carrying firewood to save a fire; how can it help? One must distinguish whether the disease is in Qi or Blood levels and treat accordingly. Even if moxibustion is indicated, limit to 3-5 cones to clear heat. Eye pain is mostly due to Blood Heat; why blindly moxa to assist heat and injure Blood?
Another question: "People say moxibustion without disease prevents illness. What do you think?"
The answer: "Disease in humans is like thieves in a state; military force is needed to suppress them, used only when necessary. Acupuncture and moxibustion are also last resorts. However, once a point is moxed, the local muscle hardens, like a nail in a boat; Qi and Blood stagnate there. Once, a lame patient had pathogens in the Gallbladder Meridian. After moxa on several points above the lateral malleolus, a physician attempted to needle Linqi (GB41) to connect Qi past the lesion. At the moxa scar, Qi stopped. Only then did he realize moxa fire damages meridians. In emergencies requiring Qi flow, it would be too late. Pathogens lodging in meridians cause suffering; moxibustion is不得已 (forced necessity). Moxibusting without disease benefits nothing.
Another question: "Gaohuang (BL43) treats hundred diseases, yet extraction methods vary. Why?"
The answer: "The point is located approximately one finger-width lateral to the scapula. Too narrow invades large tendons; too wide hits the scapula. Measure eight Cun horizontally. Bodies vary: some have convex backs (wide back, narrow chest); others convex chests (wide chest, narrow back). Ensuring accuracy is hard. Some have asymmetrical backs from childhood sleeping habits. Do not rely solely on width; measure one finger-width from the scapula edge on the wider side. The neck has two large tendons flanking the spine; the space outside is the second row of Shu points. Outside those tendons is the third row. Gaohuang is in the third row, below Pohu (BL42) and above Shentang (BL44). Points within one finger-width of the scapula injure bone/tendon and are false. Others use the 'Fourth Rib, Three Spaces' method: measuring from Dazhui (GV14) down to below the 3rd vertebra and above the 4th. This works for thin people with clear vertebrae but is difficult for obese individuals. Measuring 3 Cun from finger joints fails for high/narrow backs. I once treated a emaciated person using the lateral finger-width method and realized the subtlety. Scapulae curve slightly; within the fourth ribs above/below the scapula edges lie three spaces. Gaohuang lies exactly in the middle of the fourth rib spaces, not between vertebral bodies 3 and 4. People moxa it often because Gaohuang houses Spirit/Mind. If disturbed by pathogens, fat melts, and Huang membrane thins. Moxa helps because the Sanjiao governs Qi and is the mansion of Yang. Qi disease causes Yang deficiency, preventing Yin attachment. Gaohuang, in the Sanjiao region, gathers Qi for Yang meridians, thus treating Qi diseases. I have never seen it effective for Blood diseases. Duke Jing of Jin dreamed of two children in Gaohuang; only Qin Huan (Yi He) could cure him, as Yang Qi was nearly extinct, allowing pathogens dominance.
Another question: "Ancients said moxibustion at the onset of carbuncles/ulcers lightens them. What does this mean?"
Zhu Danxi said: "Using fire to unblock and draw out stagnant toxins follows the principle of 'treating according to the disease nature' (Cong Zhi). The head is the gathering of Yang; moxa cones should be small and few. For body pain, moxa until pain stops; for non-painful areas, moxa until pain appears. Some die from moxa due to extreme deficiency, isolated Yin nearing extinction. Pulse is floating, rapid, large, and drum-like; spirit is short and confused, unable to withstand fire energy, hence critical.
Another question: "What if moxibustion does not produce suppuration (fa)?"
Luo said: "Mr. Qin, aged 49, suffered umbilical/abdominal cold pain, undigested food in stool, cold feet, weak spirit, and deep-fine pulse. He recovered after moxa Qihai (CV6) and Guanyuan (CV4). Acupuncture texts say: Needling fails if Qi does not arrive; moxa fails if it does not 'develop' (suppurate). Generally, empty Blood/Qi cannot form pus due to lack of nourishment. Negligence allows pathogens to persist, preventing recovery. Someone asked: Mr. Qin lived comfortably; why 'lack of nourishment'? Reply: You refer to physical comfort; we refer to vital essence. Mr. Qin sought pleasure in his prime, depleting Blood/Qi.
Another question: "Does moxibustion have Tonification (Bu) and Sedation (Xie)?"
The Classics state: For Fire Tonification, do not blow the fire; let it extinguish naturally. For Fire Sedation, blow quickly to transmit heat; let it extinguish fast. Yu stated: Moxa disperses excess pathogens via fire. Cold conditions benefit from warming Qi. Heat conditions benefit from guiding stagnant heat outward, following the principle of 'fire seeks dryness.'
Another question: "Can one study ancient songs regarding meridians, point distances, origins/terminations, and Twelve Meridians mapping to Earthly Branches?"
Reply: "One must read them. The song begins: Hand-Taiyin Lung starts in Middle Jiao, connects to Large Intestine, exits Bei Gate, passes Diaphragm, belongs to Lung, emerges from Lung system, crosses armpit, runs along arm inner front, reaches Elbow/Cubit, passes Cun Kou, rises to Yuji, ends at thumb inner nail root. Branch returns from wrist, meets Index Finger, connects to Yangming. Hand-Yangming Large Intestine starts at Shangyang (Index inner), follows finger upper edge, exits Hegu, between two tendons, up arm outer front, elbow outer edge, shoulder front, near Collarbone, enters Quepen, connects Lung, passes Diaphragm, belongs to Large Intestine. Branch from Quepen goes up neck, crosses cheek, lower teeth, circles lips, crosses Renzhong, meets Yingxiang at nose. Foot-Yangming Stomach starts at nose, goes down outer nose, upper teeth, circles mouth, Chengjiang, Daying, Jiache, ear hairline, forehead. Branch goes down Renying/Quepen, Diaphragm, Stomach, connects Spleen. Straight line from Quepen down breast, Ulcer/Hanyuan, abdomen, Qichong. From Biguan to knee cap, to foot Zhongzi inner. Branch to Zusanli, outer middle toe. Branch to foot toes, ends at big toe. Foot-Taiyin Spleen starts big toe, inner white flesh, behind metatarsal head, inner ankle front, calf/knee inner front, thigh inner front, abdomen, Spleen/Stomach/Diaphragm, throat/tongue. Branch from Stomach to Heart. Hand-Shaoyin Heart starts Heart, Diaphragm, Small Intestine. Branch from Heart System to throat/eye pupil. Straight line Lung/armpit, Naohou/Elbow Shaohai, arm inner back, palm, Shaochong at knuckle. Hand-Taiyang Small Intestine starts Xiaozé (Little finger), outer hand, ankle, arm bone, elbow inner, upper arm outer back, shoulder blade, Quepen, Armpit/Heart/Throat, Diaphragm/Stomach/Small Intestine. Branch neck/cheek, eye corner, Ear, Ear horn. Straight line vertex/back, Brain, Neck, Shoulder/Spine, Waist/Kidney/Bladder. Branch perineum, Gluteus, Weizhong. Branch arm inner, Scapula/Spine, Hip pivot, Gluteus inner back, Popliteal, Ankle, Jinggu, Little/Index toe. Foot-Shaoyin Kidney starts Yongquan (Little toe slant), RanGu inner ankle back, heel, Inner edge, Thigh inner, Spine/Kidney/Bladder. Straight Kidney/Liver/Diaphragm/Lung/Throat/Tongue. Branch Lung/Heart/Chest. Hand-Jueyin Pericardium starts Chest, Pericardium/Diaphragm/Sanjiao. Branch chest/hypochondrium/Axilla 3 Cun, Armpit, Arm inner between Taiyin/Shaoyin, Zhongchong, connects Little/Index fingers. Hand-Shaoyang Sanjiao starts Little/Index finger end, between bones, wrist, arm outer between bones, Elbow posterior, Shoulder, Quepen/Shanzhong, Pericardium/Diaphragm. Branch Shanzhong/Quepen, Neck/Ear/Eye corner, Chin/Jaw, Ear front, Shangguan/Cheek, Inner canthus. Foot-Shaoyang Gallbladder starts Outer canthus, Head/Angle/Ear back, Naokong/Fengchi, Shoulder, Quepen, Ear inner/outner, DaYing/Neck, Jaw/Quepen, Chest/Diaphragm/Liver/Gallbladder, Hypochondrium, Qijie/Pubic hair, Biyan/Huantiao, Quepen/Axilla/Chest, Costal margin/Biyan, Yanglingquan (Knee outer), Fibula/Ankle, Foot Little/Index toe. Branch Big toe, Liver connection. Foot-Jueyin Liver ends Big toe hair, Foot outer arch Taichong, Ankle Zhongfeng, crosses Taiyin, Shin inner/Thigh, Genitals/Lower Abdomen, Stomach/Liver/Gallbladder, Diaphragm/Hypochondrium, Throat/Rhomboid/Eye system. Vertex/Du Mai, Eye system, Cheek/Lips, Diaphragm/Lung."