谓尺中所动之气血。从五里之脉外而来者也。上节论阳气之上下。以应天
气之升降。此论血气之出入。以应天地之精水。布云气于天下。复通贯于地中。(按皮肤之气血从
手足之指井溜注于脉中而合于肘膝间故曰尺动脉在五里五输之禁也)
肺合大肠。大肠者。传道之府。心合小肠。小肠者。受盛之府。肝合胆。胆者中精之府。脾合
胃。胃者五谷之府。肾合膀胱。膀胱者。津液之府也。少阳属肾。肾上连肺。故将两脏。三焦者。
中渎之府也。水道出焉。属膀胱。是孤之腑也。是六腑之所与合者。(盛叶成道同导)
此论六脏六腑阴阳相合。藏货物曰腑。六腑受盛水谷。传化糟粕。受藏精汁。故名曰腑。大
肠者。传道之官。变化出焉。故为传道之府。小肠者。受盛之官。化物出焉。故为受盛之府。胆主
藏精汁。故为中精之府。胃为仓廪之官。主受纳水谷。故为五谷之府。膀胱者。州都之官。津液
藏焉。故为津液之府。少阳。三焦也。水热穴论曰。肾者至阴也。至阴者。盛水也。肺者。太阴
也。少阴者。冬脉也。故其本在肾。其脉在肺。皆积水也。是一肾配少阳而主火。一肾上连肺而
主水。故肾将两脏也。三焦之脉。出于中胃。入络膀胱。约下焦而主决渎。故为中渎之府。
水道出焉。而下属膀胱。夫三焦者。少阳之气。水中之生阳也。手厥阴包络之相火。出于右肾。
归于心下之包络而为一脏。三焦为之腑。是两肾以膀胱为腑。三焦归于中胃。为包络之腑。故为
孤之腑也。夫两肾者。主天一之水。地二之火。分而论之。犹两仪也。故少阳属肾。肾上连肺而
为两脏。合而论之。阴阳相贯。水火互交。并主藏精而为生气之原。故皆以膀胱为腑。三焦上合
包络。而为孤之腑也。再按三焦乃少阳之气。发于肾脏。游行于上下。通会于腠理。乃无形之
气也。上焦出胃上口。中焦亦并胃中。下焦者。别回肠。此三焦所归之
部署也。故平脉篇曰。三焦不归其部。上焦不归者。噫而酢吞。中焦不归者。不能消谷引食。下
焦不归者。则遗溲。是三焦之气。生于肾脏。而归于中胃之间。本经论三焦所出之处。即平脉篇所
归之部署也。本无形之气。故能游行出入。归于有形之部。故为一腑而有经穴也。手厥阴包络之
气。地二之阴火也。发原于肾脏。而归于包络。包络正在心下。包裹心主所生之血。为君主之相。
代君行血于脉中。其气本于肾。心下有形之包络。亦所归之部署也。故以先天之气论之。则少阳
属肾。肾将两脏。以后天有形之脏腑论之。包络正在心下。三焦居中胃之间。而为一脏一腑也。
春取络脉诸荥。大筋分肉之间。甚者深取之。间者浅取之。夏取诸输。孙络肌肉皮肤之上。秋取
诸合。余如春法。冬取诸井诸输之分。故深而留之。此四时之序。气之所处。病之所舍。脏之所
宜。转筋者。立而取之。可令遂已。痿厥者。张而刺之。可令立快也。
此论阴阳气血。又随四时之生长收藏。而浅深出入者也。春时天气始开。人气在脉。故宜取
络脉。夏气在孙络。长夏气在肌肉。故宜取孙络肌肉皮肤之上。此春夏之气。从内而外也。秋
气降收。故如春法。盖复从孙络而入于络脉也。冬气收藏。故欲深而留之。此四时出入之序。人气
之所处。病之所舍。五脏应五时之所宜也。春取荥。夏取输。秋取合。冬取井。皆从子以行母气也。
转筋者。病在筋。痿者。两臂不举。厥者。两足厥逆也。张者。仰卧而张大其四肢。立之张之。应
天地之上下四旁。四时之气。得以往来流行而无阻滞矣。故伸舒其四体。则筋脉血气之厥逆者。
可令立快也。此言人之气血。随四时之气流行。阻则为挛厥之病。故当伸舒四体。以顺四时之气焉。
所谓尺部脉动的气血,是从五里穴所在的经脉外侧流注而来的。上一节论述了阳气的上下运行,以对应天气的升降;这一节论述了血气的出入,以对应天地间的精微之水,如同云气散布于天下,又贯通于地中。(按:皮肤中的气血从手足井穴流入并注入脉中,汇聚于肘膝之间,所以说尺部动脉在五里穴及五输穴的禁忌范围内。)
肺与大肠相合,大肠是传导之腑;心与小肠相合,小肠是受盛之腑;肝与胆相合,胆是中精之腑;脾与胃相合,胃是五谷之腑;肾与膀胱相合,膀胱是津液之腑。少阳经隶属于肾,肾向上连接肺,所以肾能统摄这两脏。三焦是中渎之腑,水道由此而出,隶属于膀胱,它是孤独的腑。这是六腑中与五脏相配合的情况。
本节论述了六脏六腑阴阳相合的关系。收藏货物的称为腑。六腑接受和盛纳水谷,传导和化生糟粕,接受和储藏精汁,所以称为腑。大肠是传导的官职,变化由此产生,所以称为传导之腑。小肠是受盛的官职,化物由此产生,所以称为受盛之腑。胆主要储藏精汁,所以称为中精之腑。胃是仓廪的官职,主要接受和容纳水谷,所以称为五谷之腑。膀胱是州都的官职,津液在此储藏,所以称为津液之腑。少阳即三焦。《水热穴论》说:肾是至阴,至阴就是盛水的地方;肺是太阴;少阴是冬脉。所以病的根本在肾,脉象表现在肺,都是积水所致。这是一肾配属少阳而主火,一肾上连肺而主水,所以肾能统摄两脏。三焦的经脉,出于中焦胃部,入络于膀胱,约束下焦而主管决渎(疏通水道),所以称为中渎之腑。水道由此而出,向下隶属于膀胱。夫三焦,是少阳之气,是水中之生发之阳。手厥阴心包络的相火,出于右肾,归于心下的包络而成为一脏,三焦作为它的腑。这样,两肾以膀胱为腑,三焦归于中焦胃间,作为心包络的腑,所以称为孤腑。夫两肾,主宰天一之水、地二之火,分开论述,犹如两仪。所以少阳隶属于肾,肾上连肺而成为两脏。合并论述,则阴阳相互贯穿,水火相互交济,共同主宰藏精,作为生气的本源。所以都以膀胱为腑,三焦上合心包络,而成为孤腑。再按:三焦乃是少阳之气,发源于肾脏,游行于上下,通会于腠理,乃是无形的元气。上焦出于胃的上口,中焦也并行于胃中,下焦则别出回肠,这是三焦所归属的部署部位。所以《平脉篇》说:三焦不归其部,上焦不归者,会出现嗳气和吞酸;中焦不归者,不能消化谷物和引食;下焦不归者,则会遗尿失禁。是三焦之气,生于肾脏,而归聚于中焦胃之间。本经论述三焦所出的位置,即《平脉篇》所说归聚的部署部位。三焦本是无形之气,所以能游行出入,归聚于有形的部位,因此作为一个腑而有经络穴位。手厥阴心包络之气,是地二的阴火,发源于肾脏,而归聚于心包络。心包络正位于心下,包裹着心主所生的血液,作为君主的宰相,代替君主在脉中运行血液。其气根源于肾,心下有形的心包络,也是它所归聚的部署部位。所以从先天之气来论述,则少阳隶属于肾,肾统摄两脏;以后天有形之脏腑来论述,心包络正位于心下,三焦居中焦胃之间,从而形成一脏一腑的关系。
春季取络脉的各荥穴,以及大筋分肉之间,病重的深刺,病轻的浅刺;夏季取各输穴,以及孙络、肌肉、皮肤之上;秋季取各合穴,其余方法同春季;冬季取各井穴和各输穴的部位,所以刺得深且留针时间长。这是四时的次序,气所处的位置,病邪所停留的地方,脏腑所适宜的治疗。发生转筋者,站立着取穴针刺,可以使病立即痊愈;发生痿厥者,仰卧并张开四肢进行针刺,可以使病立即缓解。
本节论述了阴阳气血,又随着四时生长收藏的变化,而有深浅出入的不同。春季天气开始开通,人气在脉,所以适宜取络脉;夏季气在孙络,长夏气在肌肉,所以适宜取孙络、肌肉、皮肤之上。这是春夏之气,从内向外发散。秋季气降而收敛,所以像春季的方法一样,大概是从孙络而入于络脉。冬季气收藏,所以想要深刺且留针。这是四时出入的次序,人气所处的位置,病邪停留的地方,五脏适应五时的适宜治法。春取荥穴,夏取输穴,秋取合穴,冬取井穴,都是从子行母气。转筋,是病在筋;痿,是两臂不能举起;厥,是两足厥冷逆乱。张,是仰卧并张大其四肢。立和张,对应天地的上下四方,使四时之气得以往来流行而无阻滞。所以伸展舒活其四肢,那么筋脉血气厥逆的病症,就可以立即缓解。这说的是人的气血,随着四时之气流行,受阻滞就会成为挛急厥逆的病,所以应当伸展舒活四肢,以顺应四时之气。
The Qi and Blood moving in the Chi (尺) position are said to flow from the exterior of the Wuli (Five Miles) vessel. The previous section discussed the ascending and descending of Yang Qi, corresponding to the rising and falling of Heavenly Qi; this section discusses the entering and exiting of Blood and Qi, corresponding to the essence-water of Heaven and Earth, spreading cloud-qi throughout the world and penetrating through the earth. (Note: The Qi and Blood in the skin flow from the Jing-Well points of the hands and feet into the vessels and converge between the elbows and knees; therefore, it is stated that the arterial movement at Chi is within the contraindications of the Wuli point and the Five Shu points.)
The Lung combines with the Large Intestine; the Large Intestine is the Fu Organ of Transmission (Dao Dao). The Heart combines with the Small Intestine; the Small Intestine is the Fu Organ of Reception and Accumulation (Shou Sheng). The Liver combines with the Gallbladder; the Gallbladder is the Fu Organ of Essence-Bile (Zhong Jing). The Spleen combines with the Stomach; the Stomach is the Fu Organ of the Five Grains. The Kidney combines with the Bladder; the Bladder is the Fu Organ of Fluids (Jin Ye). Shaoyang belongs to the Kidney, and the Kidney connects upward to the Lung; thus, the Kidney governs these two Zang organs. The San Jiao (Triple Burner) is the Fu Organ of Middle Ducts (Zhong Du), where water passages emerge, belonging to the Bladder; it is the solitary Fu Organ. These are the combinations of the six Fu Organs with the five Zang organs.
This section discusses the Yin-Yang combination of the six Zang and six Fu organs. Those that store goods are called Fu. The six Fu organs receive and hold food and drink, transmit and transform waste, and receive and store essence-bile, hence named Fu. The Large Intestine is the official of transmission, where changes occur; thus, it is the Fu Organ of Transmission. The Small Intestine is the official of reception, where transformation occurs; thus, it is the Fu Organ of Reception. The Gallbladder primarily stores essence-bile; thus, it is the Fu Organ of Essence-Bile. The Stomach is the official of granaries, primarily receiving and accepting food and drink; thus, it is the Fu Organ of the Five Grains. The Bladder is the official of the provincial metropolis, where fluids are stored; thus, it is the Fu Organ of Fluids. Shaoyang refers to the San Jiao. *Shui Re Xue Lun* states: The Kidney is Extreme Yin; Extreme Yin means storing water. The Lung is Taiyin. Shaoyin is the Winter pulse. Therefore, the root is in the Kidney, and the pulse manifests in the Lung; both involve water accumulation. This indicates one Kidney paired with Shaoyang governing Fire, and one Kidney connecting upward to the Lung governing Water; thus, the Kidney governs two Zang organs. The meridian of the San Jiao emerges from the middle Stomach, enters and networks with the Bladder, constrains the Lower Jiao, and governs dredging (Jue Du); thus, it is the Fu Organ of Middle Ducts. Water passages emerge from it and descend to belong to the Bladder. The San Jiao is the Qi of Shaoyang, the generating Yang within water. The Ministerial Fire of the Hand Jueyin Pericardium emerges from the right Kidney, returns to the Pericardium below the Heart to form one Zang organ, with the San Jiao as its Fu. Thus, the two Kidneys take the Bladder as their Fu, and the San Jiao returns to the middle Stomach, serving as the Fu of the Pericardium; hence, it is called the Solitary Fu. The two Kidneys govern the Water of Tian Yi and the Fire of Di Er; discussed separately, they resemble the Two Powers (Liang Yi). Thus, Shaoyang belongs to the Kidney, and the Kidney connects upward to the Lung to form two Zang organs. Discussed collectively, Yin and Yang interpenetrate, Water and Fire interact, jointly governing the storage of essence as the source of Sheng Qi. Thus, all take the Bladder as their Fu, and the San Jiao combines upward with the Pericardium to become the Solitary Fu. Furthermore, the San Jiao is the Qi of Shaoyang, originating from the Kidney, traveling up and down, and converging in the Cou Li (interstices); it is formless Qi. The Upper Jiao emerges from the upper orifice of the Stomach, the Middle Jiao also runs alongside the Stomach, and the Lower Jiao separates from the Ileum; these are the deployments where the San Jiao resides. Thus, *Ping Mai Pian* states: If the San Jiao does not return to its department, if the Upper Jiao does not return, there will be belching and acid regurgitation; if the Middle Jiao does not return, there will be an inability to digest grains and draw food; if the Lower Jiao does not return, there will be urinary incontinence. The Qi of the San Jiao is born in the Kidney and returns to the region of the middle Stomach. The location where the San Jiao emerges, as discussed in this classic, corresponds to the deployment where it returns in *Ping Mai Pian*. Being originally formless Qi, it can travel and enter/exit, returning to formed parts; therefore, as one Fu organ, it has meridians and acupoints. The Qi of the Hand Jueyin Pericardium is the Yin Fire of Di Er, originating from the Kidney and returning to the Pericardium. The Pericardium is located exactly below the Heart, wrapping the blood generated by the Heart Master, acting as the minister to the sovereign,代君行血 (acting on behalf of the sovereign to circulate blood in the vessels). Its Qi originates from the Kidney, and the formed Pericardium below the Heart is also a place of return. Thus, discussing from the perspective of Pre-Heaven Qi, Shaoyang belongs to the Kidney, and the Kidney governs two Zang organs; discussing from the perspective of Post-Heaven formed Zang-Fu organs, the Pericardium is located below the Heart, and the San Jiao is between the middle Stomach, forming one Zang and one Fu.
In Spring, select the Ying-Spring points of the collaterals and the spaces between large tendons and muscles; for severe cases, needle deeply; for mild cases, needle superficially. In Summer, select the Shu-Stream points, and the Sun-Luo (fine collaterals), muscles, and above the skin. In Autumn, select the He-Sea points, following the method of Spring. In Winter, select the Jing-Well and Shu-Stream points; therefore, needle deeply and retain the needle. This is the order of the four seasons, the location of Qi, the abode of disease, and the suitability of the Zang organs. For muscle cramps (Zhuan Jin), needle while standing, which can lead to immediate recovery. For Wei-Jue (flaccidity and cold limbs), needle while lying supine with limbs spread, which can lead to immediate relief.
This section discusses how Yin-Yang, Qi, and Blood undergo superficial/deep and entering/exiting changes according to the growth, flourishing,收 (harvest/convergence), and storage of the four seasons. In Spring, Heavenly Qi begins to open, and Human Qi is in the vessels; thus, it is suitable to select collateral vessels. In Summer, Qi is in the Sun-Luo; in Chang Xia (Late Summer), Qi is in the muscles; thus, it is suitable to select the area above the Sun-Luo, muscles, and skin. This represents the Qi of Spring and Summer moving from inside to outside. In Autumn, Qi descends and converges, so follow the method of Spring, likely re-entering from Sun-Luo to collaterals. In Winter, Qi stores and hides, so one desires deep needling and retention. This is the order of entering and exiting in the four seasons, the location of Human Qi, the abode of disease, and the suitability of the five Zang organs adapting to the five seasons. Select Ying-Spring in Spring, Shu-Stream in Summer, He-Sea in Autumn, and Jing-Well in Winter; all proceed from Zi (Water) to perform the Qi of Mu (Mother). Zhuan Jin (cramps) involves disease in the sinews; Wei (flaccidity) involves inability to raise both arms; Jue (cold limbs) involves cold reversal in both feet. Zhang (spread) means lying supine and spreading the limbs wide. Standing and spreading correspond to the upper/lower and four directions of Heaven and Earth, allowing the Qi of the four seasons to flow freely without obstruction. Thus, extending and relaxing the four limbs allows the reversal of Qi and Blood in the sinews and vessels to be immediately relieved. This states that Human Qi and Blood flow with the Qi of the four seasons; when obstructed, they become diseases of cramping and reversal; therefore, one should extend and relax the four limbs to comply with the Qi of the four seasons.