黄帝问曰∶医之治病也,一病而治各不同,皆愈何也?岐伯对曰∶地势使然也。故东方之域,天
地之所始生也,鱼盐之地,海滨傍水,其民食鱼而嗜咸,皆安其处,美其食,鱼者使人热中,盐者胜血,
故其民皆黑色疏理,其病皆为痈疡,其治宜砭石,故砭石者,亦从东方来。西方者,金玉之域,沙石之处,
天地之所收引也,其民陵居而多风,水土刚
强,其民不衣而褐荐,其民华食而脂肥,故邪不能伤其形体,其病生于内,其治宜毒药,故毒药者,亦从西方
来。北方者,天地所闭藏之域也,其地高陵居,风寒冰冽,其民乐野处而乳食,脏寒生满病,其治宜灸 。
故灸 者,亦从北方来。南方者,天地所长养,阳之所盛处也,其地下,水土弱,雾露之所聚也,其民嗜酸
而食 。故其民皆致理而赤色,其病挛痹,其治宜微针。故九针者,亦从南方来。中
央者,其地平以湿,天地所以生万物也众,其民食杂而不劳,故其病多痿厥寒热,其治宜导引按跷,故导引按
跷者,亦从中央出也。故圣人杂合以治,各得其所宜,故治所以异而病皆愈者,得病之情,知治之大体也。
黄帝问曰∶余闻古之治病,惟其移精变气,可祝由而已。今世治病,毒药治其内,针石治其外,或愈或
不愈,何也?岐伯对曰∶往古人居禽兽之间,动作以避寒,阴居以避暑,内无眷慕之累,外无伸宦之形,
此恬 之世,邪不能深入也。故毒药不能治其
内,针石不能治其外,故可移精祝由而已。当今之世不然,忧患缘其内,苦形伤其外,又失四时之从,逆寒暑
之宜,贼风数至,虚邪朝夕,内至五脏骨髓,外伤空窍肌肤,所以小病必甚,大病必死,故祝由不能已也。
帝曰∶善。余欲临病患,观死生,决嫌疑,欲知其要,如日月光,可得闻乎?岐伯曰∶色脉者,上帝之所贵也,
先师之所传也。上古使僦贷季,理色脉而通神明,合之金木水火土四时八风六合,不离其常,变化相移,以观
其妙,以知其要,欲知其要,则色脉是矣。色以应日,脉以应月,常求其要,则其要也。夫色之变化,以应
四时之脉,此上帝之所贵,以合于
神明也,所以远死而近生。生道以长,命曰圣王。中古之治病,至而治之,汤液十日,以去八风五痹之
病,十日不已,治以草苏草 之枝,本末为助,标本已得,邪气乃服。暮世之治病也则不然,治不本四
时,不知日月,不审逆从,病形已成,乃欲微针治其外,汤液治其内,粗工凶凶,以为可攻,故病未已,新
病复起。帝曰∶愿闻要道。岐伯曰∶治之要极,无失色脉,用之不惑,治之大则。逆从倒行,标本不得,
亡神失国。去故就新,乃得真人。帝曰∶余闻其
要于夫子矣,夫子言不离色脉,此余之所知也。岐伯曰∶治之极于一。帝曰∶何谓一?岐伯曰∶一者因得之。
帝曰∶奈何?岐伯曰∶闭户塞牖,系之病者,数问其情,以从其意,得神者昌,失神者亡。帝曰∶善。
黄帝问道:医生治疗疾病,同样的病却采用不同的治疗方法,结果都痊愈了,这是为什么呢?岐伯回答说:这是因为地理环境不同造成的。
所以,东方地区,是天地阳气开始生发的地方,盛产鱼盐,靠近海边和水边。那里的百姓喜欢吃鱼且口味偏咸。他们安于当地的生活,以食物为美。但吃鱼容易使人产生内热,吃盐过多则会损伤血液。因此,那里的百姓皮肤多呈黑色,毛孔粗疏,他们的疾病多为痈疡(化脓性疮疡),治疗适宜用砭石(一种石器,用于切开排脓或放血)。所以,砭石疗法也是从东方传来的。
西方地区,是金玉矿产丰富、沙石遍布的地方,是天地之气收敛闭藏的区域。那里的百姓住在山陵高处,风大,水土性质刚强。百姓不穿丝绸衣物而穿粗布草席做的衣服,饮食精细丰盛且身体脂肪丰厚。因此,外邪难以伤害他们的形体,疾病多生于体内。治疗适宜使用毒药(指具有较强偏性的药物,非今义之毒物)。所以,药物治疗也是从西方传来的。
北方地区,是天地之气闭藏的区域。那里地势高峻,百姓居住在山陵,气候寒冷,风寒凛冽。百姓喜欢野外生活并以乳制品为食。因为内脏寒凉,容易产生胀满类的疾病。治疗适宜用艾灸。所以,艾灸疗法也是从北方传来的。
南方地区,是天地阳气生长旺盛、阳气最盛的地方。那里地势低洼,水土柔弱,是雾露聚集的地方。百姓喜欢吃酸味食物且喜好发酵食品(如醋、酱等)。因此,那里的百姓皮肤纹理致密且面色红润,他们的疾病多为筋脉拘挛和痹证(关节疼痛、麻木等)。治疗适宜用微针(九针中的细针)。所以,九针疗法也是从南方传来的。
中央地区,地势平坦且潮湿,天地所生的万物众多。百姓饮食混杂且不从事重体力劳动。因此,他们的疾病多为痿证(肢体萎软无力)、厥证(四肢逆冷)以及寒热往来的病症。治疗适宜用导引按跷(类似现在的保健体操和按摩推拿)。所以,导引按跷疗法也是从中央地区发展出来的。
因此,圣人综合各种疗法进行治疗,使每种疗法都得到其适宜的应用。所以治疗方法虽然不同,但疾病都能痊愈,这是因为掌握了病情的实情,了解了治疗的总体原则。
黄帝问道:我听说古代治病,只要通过移精变气(改变精神情志,调节气血运行),可以用祝由(古代的一种心理疗法,通过祝说病由来治病)就可以了。现在的人治病,用药物治内部,用针石治外部,有的痊愈,有的不痊愈,这是为什么呢?岐伯回答说:远古时候,人们生活在禽兽之间,通过活动来躲避寒冷,居住在阴凉处来躲避暑热。内心没有眷恋思慕的劳累,外表没有奔走官场的形役之苦。这是一个恬淡虚无的时代,邪气不能深入体内。所以,毒药不能治其内,针石不能治其外,因此只需通过移精变气和使用祝由疗法即可。
现在的时代就不是这样了,忧患缠绕在心中,苦累的形体损伤了体表,又违背了四时气候的变化,逆乱了寒暑的适宜规律。贼风频繁来袭,虚邪贼风早晚侵袭,向内深入五脏骨髓,向外损伤空窍肌肤。所以小病一定会加重,大病一定会致死,因此祝由疗法也不能治愈了。
黄帝说:好。我想要面对病患,观察生死,决断疑难,想要掌握其中的要领,像日月之光一样明亮,可以讲给我听吗?岐伯说:望色和切脉,是上帝所重视的,也是先师所传授的。上古时期,黄帝派遣僦贷季,整理色脉理论并通晓神明之道,将其与金木水火土五行、四时、八风、六合相合,不离常道,观察其变化推移,以探求奥妙,掌握要领。想要掌握要领,就要从色脉入手。面色对应太阳,脉象对应月亮,经常探究其要领,就能掌握关键。面色的变化,应合四时的脉象,这是上帝所重视的,用以契合神明之道,从而远离死亡,接近生存。生命之道得以长久,这就称为圣王。
中古时代治病,病邪来了就进行治疗,先用汤液十天,以去除八风五痹的疾病;如果十天不好转,再用草茎、草根的枝条治疗,标本兼治,标本兼顾,邪气才能被制服。
近古时代(暮世)治病就不是这样了,治疗不根据四时气候变化,不了解日月运行规律,不审察病证的顺逆。等到病形已经形成,才想用微针治其外,汤液治其内。庸医慌张忙乱,以为可以攻伐,结果旧病未愈,新病又起。
黄帝说:我希望听听治病的关键道理。岐伯说:治病的最高准则,不要忽视色脉,运用它而不迷惑,这是治疗的根本法则。如果逆从颠倒行事,标本不分,就会导致神气丧失,甚至国家危亡。摒弃旧的错误方法,追求新的正确方法,才能成为真正的真人(得道之人)。
黄帝说:我从夫子您这里听到了治病的要领,夫子说治病不离色脉,这是我已知的。岐伯说:治病的极致在于“一”。黄帝说:什么叫“一”?岐伯说:“一”就是因患者具体情况而获得病因(即通过问诊了解病情)。黄帝说:怎么做呢?岐伯说:关上门窗,专注于病人,详细询问他的情况,顺从他的意愿去引导他说出真情,得到神气充盛的则昌盛,失去神气的则死亡。黄帝说:好。
Huangdi asked, "When physicians treat diseases, the same disease is treated with different methods, yet all are cured. Why is this?" Qibo replied, "It is caused by the differences in geographical terrain."
Therefore, in the Eastern regions, where heaven and earth begin to generate life, producing fish and salt near the seashores and waters, the people eat fish and prefer salty flavors. They are content with their dwellings and delight in their food. However, eating fish tends to cause heat to accumulate internally, while excessive salt consumption damages the blood. Consequently, the people of these areas typically have dark skin and loose skin texture. Their diseases are mostly carbuncles and ulcers (suppurative sores), which are best treated with Bian stones (stone tools used for lancing or draining). Thus, Bian stone therapy originated from the East.
In the Western regions, rich in metals, jade, sand, and rocks, where heaven and earth gather and condense energy, the people live on hills and face strong winds. The water and soil are hard and strong. The people wear coarse cloth and grass mats instead of silk, and their diet is refined and rich, leading to obesity. Therefore, external pathogenic factors find it difficult to damage their physical bodies, and diseases arise internally. These are best treated with 'Du Yao' (medicines with strong therapeutic properties/potency). Thus, medicinal treatment originated from the West.
In the Northern regions, where heaven and earth store and conceal energy, the terrain is high and hilly, and the climate is cold with biting wind and ice. The people enjoy living in the open countryside and consume dairy products. Due to internal coldness, they suffer from fullness and distension diseases. These are best treated with moxibustion. Thus, moxibustion originated from the North.
In the Southern regions, where heaven and earth nurture and grow, and yang energy is abundant, the terrain is low, and the water and soil are weak. It is an area where fog and dew gather. The people prefer sour flavors and fermented foods. Consequently, the people have tight skin textures and reddish complexions. Their diseases are mainly spasms and bi-syndrome (painful obstruction syndromes involving joints and muscles). These are best treated with fine needles (the nine needles). Thus, needle therapy originated from the South.
In the Central regions, the terrain is flat and damp, and heaven and earth produce a vast variety of things. The people have mixed diets and do not engage in heavy labor. Therefore, their diseases are often atrophy syndromes (limb weakness), jue syndromes (cold extremities), and alternating chills and fever. These are best treated with Daoyin Anqiao (guiding and pulling exercises combined with massage and manipulation). Thus, Daoyin Anqiao therapy originated from the Center.
Therefore, the sages combine various treatments, applying each according to its suitability. Although the treatments differ, the diseases are all cured because the physician understands the true nature of the disease and grasps the general principles of treatment.
Huangdi asked, "I have heard that in ancient times, treating diseases only required shifting spirit and changing qi (altering mental state and regulating qi flow), which could be achieved through Zhuyou (a form of psychological therapy involving incantations explaining the cause of illness). Today, however, diseases are treated internally with medicines and externally with needles and stones; some are cured, others are not. Why is this?" Qibo replied, "In ancient times, people lived among beasts, moving about to avoid cold and dwelling in shaded places to avoid heat. Internally, they had no burdens of longing or attachment; externally, they had no strain from official duties. This was an era of tranquility and emptiness, where pathogenic factors could not penetrate deeply. Therefore, medicines were not needed for internal treatment, nor needles and stones for external treatment; shifting spirit and using Zhuyou were sufficient.
The world today is different. Worries and anxieties burden the interior, and physical hardship damages the exterior. People fail to follow the changes of the four seasons and go against the appropriate rhythms of cold and heat. Treacherous winds strike frequently, and empty evils invade morning and night, penetrating inward to the five zang organs and bone marrow, and outwardly damaging the orifices and skin. Hence, minor illnesses become severe, and major illnesses lead to death; therefore, Zhuyou alone cannot cure them."
Huangdi said, "Excellent. I wish to examine patients, observe signs of life and death, resolve doubts, and grasp the essentials clearly as if illuminated by the sun and moon. May I hear how?" Qibo replied, "Observing complexion and palpating pulses are highly valued by Heaven and transmitted by ancient masters. In ancient times, Huangdi dispatched Jiu Daiji to organize the study of complexion and pulses, connecting them to spiritual insights, integrating them with the Five Elements (Metal, Wood, Water, Fire, Earth), the Four Seasons, Eight Winds, and Six Directions, adhering to constant principles while observing their dynamic changes to understand their subtleties and essentials. To grasp the essentials, one must focus on complexion and pulses. Complexion corresponds to the Sun, and pulses correspond to the Moon. By constantly seeking their essence, one grasps the key. Changes in complexion should correspond to the pulses of the four seasons. This is what Heaven values, aligning with spiritual wisdom, thereby avoiding death and promoting life. Following this path leads to longevity, and such rulers are called Sage Kings.
In middle antiquity, when disease arrived, it was treated immediately. Decoctions were administered for ten days to eliminate diseases caused by the Eight Winds and Five Bi syndromes. If there was no improvement after ten days, branches of herbs (stems and roots) were used, supporting both root and branch. Once root and branch were addressed, the pathogenic factor was subdued.
In later antiquity, treatment was different. Treatment did not follow the four seasons, ignored the cycles of the sun and moon, and failed to assess compliance or deviation. Only after the disease form had fully developed did they attempt to treat the exterior with fine needles and the interior with decoctions. Incompetent physicians acted hastily, believing aggressive attack was necessary. Consequently, the original disease persisted, and new diseases arose.
Huangdi said, "I wish to hear the essential principles." Qibo replied, "The ultimate principle of treatment is not to neglect complexion and pulses. Using them without confusion is the great rule of treatment. Reversing compliance and deviation, or failing to distinguish root and branch, leads to the loss of spirit and even the fall of the state. Abandoning the old and embracing the new allows one to become a True Person (Zhenren)."
Huangdi said, "I have heard the essentials from you, Master. You stated that treatment does not depart from complexion and pulses; this is what I know." Qibo said, "The pinnacle of treatment lies in 'One' (Unity/Singularity)." Huangdi asked, "What is meant by 'One'?" Qibo replied, "'One' means obtaining the cause through inquiry (specifically, understanding the patient's specific condition)." Huangdi asked, "How is this done?" Qibo replied, "Close the doors and windows, focus entirely on the patient, ask many questions about their situation, and follow their intent to elicit the truth. Those who retain their Shen (Spirit) will prosper; those who lose their Shen will perish." Huangdi said, "Excellent."