(《灵枢·逆顺肥瘦篇》全)
黄帝问于岐伯曰∶余闻针道于夫子众多毕悉矣,夫子之道,应若失而据未有坚然者也,夫子之问学熟乎?将审察于
物而心生之乎?(应若失而据未有坚然者,言随应而解,若无坚据之难破者也。)岐伯曰∶圣人之为道者,上合于天,下
合于地,中合于人事,必有明法,以起度数法式检押,乃后可传焉。故匠人不能释尺寸而意短长,废绳墨而起平水也;
工人不能置规而为圆,去矩而为方。知用此者,固自然之物,易用之 ,逆顺之常也。(检押,规则也。有法有则以防其
错乱,乃可传于后世焉。物之平者,莫过于水,故曰平水。此言圣人之道,合于三才,工匠之巧,成于规矩,固皆出于
自然之理。知自然之妙者,是谓易用之 ,逆顺之常也。)黄帝曰∶愿闻自然奈何?岐伯曰∶临深决水,不用功力而水可
竭也,循掘决冲而经可通也,此言气之滑涩,血之清浊,行之逆顺也。(水有通塞,气有滑涩,血有清浊,行有逆顺。决
水通经,皆因其势而利导之耳。宜通宜塞,必顺其宜,是得自然之道也。)黄帝曰∶愿闻人之白黑肥瘦小长,各有数乎?
(人之形质不同,刺法亦有异也。)岐伯曰∶年质壮大,血气充盈,肤革坚固,因加以邪,刺此者深而留之,此肥人也。
(年大者气血正盛,故与肥壮之人同其法。)广肩腋项,肉薄浓皮而黑色,唇临临然,其血黑以浊,其气涩以迟,其为人
也,贪于取与,刺此者深而留之,多益其数也。(临临,下垂貌,唇浓质浊之谓。多益其数,即久留也。)黄帝曰∶刺瘦
人奈何?岐伯曰∶瘦人者皮薄色少,肉廉廉然,薄唇轻言,其血清气滑,易脱于气,易损于血,刺此者浅而疾之。(廉,
薄也。薄唇轻言,肉瘦气少也。若此者,刺不宜过,恐其脱损气血,故必浅入其针而速去之也。)黄帝曰∶刺常人奈何?
岐伯曰∶视其白黑,各为调之。其端正敦浓者,其血气和调,刺此者无失常数也。(常人者,不瘦不肥之人也。视其白黑
者,白色多清,宜同瘦人,黑色多浊,宜同肥人,而调其数也。其端正敦浓者,是即常人之度,当调以常数。《经水篇》
曰∶足阳明刺深六分,留十呼。足太阳深五分,留七呼。足少阳深四分,留五呼。足太阴深三分,留四呼。足少阴深二
分,留三呼。足厥阴深一分,留二呼。手之阴阳,其受气之道近,其气之来疾,其刺深者皆无过二分,其留皆无过一呼。
其少长大小肥瘦,以心撩之。此即常数之谓,而用当酌其宜也。)黄帝曰∶刺壮士真骨者奈何?岐伯曰∶刺壮士真骨,坚
肉缓节监监然。此人重则气涩血浊,刺此者深而留之,多益其数;劲则气滑血清,刺此者浅而疾之。(壮士之骨多坚刚,
故曰真骨。监监,坚固貌。壮士之辨有二∶若坚肉缓节、不好动而安重者,必气涩血浊,此宜深刺久留,同肥人之数也;
若劲急易发者,必气滑血清,此宜浅刺疾去之,同瘦人之数也。)黄帝曰∶刺婴儿奈何?岐伯曰∶婴儿者,其肉脆血少气
弱,刺此者以毫针,浅刺而疾发针,日再可也。(婴儿血少气弱,故但宜毫针。以浅而速,若邪有未尽,宁日加再刺,不
可深而久也。)黄帝曰∶临深决水奈何?岐伯曰∶血清气浊,疾泻之则气竭焉。(浊当作滑。血清气滑者,犹临深决水,
泄之最易,宜从缓治可也。若疾泻之,必致真气皆竭矣。)黄帝曰∶循掘决冲奈何?岐伯曰∶血浊气涩,疾泻之则经可通
也。(血浊气涩者,犹循掘决冲,必借人力,但疾泻之,其经可通也。)黄帝曰∶脉行之逆顺奈何?岐伯曰∶手之三阴,
从脏走手;手之三阳,从手走头。足之三阳,从头走足;足之三阴,从足走腹。(手之三阴从脏走手者,太阴肺经,从脏
出中腑,而走大指之少商;少阴心经,从脏出极泉,而走小指之少冲;厥阴心主经,从脏出天池,而走中指之中冲也。
手之三阳从手走头者,阳明大肠经,从次指商阳而走头之迎香;太阳小肠经,从小指少泽而走头之听宫;少阳三焦经,
从名指关冲而走头之丝竹空也。足之三阳从头走足者,太阳膀胱经,从头之睛明而走足小趾之至阴;阳明胃经,从头之
承泣而走足次趾之厉兑;少阳胆经,从头之瞳子 而走足四趾之窍阴也。足之三阴从足走腹者,太阴脾经,从大趾隐白
走腹而上于大包;少阴肾经,从足心涌泉走腹而上于俞府;厥阴肝经,从足大趾大敦而走腹之期门也。凡手之三阴,自
脏走手为顺,自手而脏则逆;手之三阳,自手走头为顺,自头而手则逆。足之三阴,自足走腹为顺,自腹而足则逆;足
之三阳,自头走足为顺,自足而头则逆。此经之所以有逆顺,而刺之所以有迎随也。)黄帝曰∶少阴之脉独下行何也?(足
之三阴,从足走腹,皆自下而上;独少阴之脉若有下行者,乃冲脉也。详如下文。)岐伯曰∶不然。夫冲脉者,五脏六腑
之海也,五脏六腑皆禀焉。其上者,出于颃颡,渗诸阳,灌诸精。(冲脉起于胞中,为十二经精血之海,故五脏六腑皆禀
焉。其上行者,输在于大抒,足太阳经也,故出于颃颡,主渗灌诸阳之精。)其下者,注少阴之大络,出于气街,循阴股
内廉,入 中,伏行 骨内,下至内踝之后属而别,其下者并于少阴之经渗三阴;(其下行者,并少阴之大络,出阳明之
气街,由股入足,至内踝之后属。其别而下者,自少阴以渗及肝脾二经,是为三阴,此其所以下行也。 音干,胫骨也。)
其前者伏行出跗属下,循跗入大趾间,渗诸络而温肌肉。(跗属,足掌属也。渗诸络而温肌肉,动输篇作注诸络以温足胫。
上三节与动输篇大同,详经络类十三。)故别络结则跗上不动,不动则厥,厥则寒矣。(冲脉为十二经之海,故能温肌肉,
温足胫,皆冲脉之气也。若冲脉之络因邪而结,则跗上之经不动而为厥为寒者,亦冲脉之所致也。)黄帝曰∶何以明之?
岐伯曰∶以言导之,切而验之,其非必动,然后乃可明逆顺之行也。(何以明者,恐人因厥而疑畏也。故必先导以言,次
切其脉,其有素所必动而今则非者,如冲阳太溪太冲等脉,当动不动,乃可知其不动者为逆,动者为顺,而其厥逆微甚
可以明矣。)黄帝曰∶窘乎哉圣人之为道也!明于日月,微于毫厘,其非夫子,孰能道之也?
(Full text of *Ling Shu: Ni Shun Fei Shou Pian*)
Huangdi asked Qibo: I have learned extensively from you the principles of acupuncture, and they are now comprehensive. Your medical skill responds to changes as if losing its target, yet it has no rigid or fixed criteria. Is this because you have mastered your studies through diligence, or did you generate these insights in your mind by carefully observing phenomena? (The phrase "responds as if losing its target yet has no rigid criteria" means that one explains and treats according to the changing condition, appearing as if there is no difficult barrier to break.)
Qibo replied: The Way established by sages aligns with Heaven above, Earth below, and Human affairs in between. There must be clear laws to establish measurements, standards, and regulations, so that they can be transmitted. Therefore, a carpenter cannot abandon standard measurements to arbitrarily judge length and shortness, nor discard the ink line to measure levelness; a craftsman cannot dispense with the compass to draw circles, nor remove the square ruler to draw squares. Those who understand how to use these rules grasp the nature of natural things, making them easy to apply, and understanding the general patterns of compliance and opposition. ("Jianya" refers to rules. Having methods and principles prevents confusion, allowing transmission to future generations. Among objects, water is the most stable, hence the term "level water." This states that the Sage's Way conforms to the Three Powers [Heaven, Earth, Human]; the skill of craftsmen is achieved through compasses and squares. All stem from natural principles. One who knows the subtlety of nature is said to easily apply them and master the constants of compliance and opposition.)
Huangdi said: I wish to hear what constitutes the Way of Nature.
Qibo said: Facing a deep pool and opening a dike, water can be drained without exerting effort; following a dug channel to break through an obstruction, meridians can be unblocked. This illustrates the slippery versus sluggish nature of Qi, the clear versus turbid nature of Blood, and the compliant versus opposing directions of their flow. (Water has blockage and flow; Qi has slipperiness and sluggishness; Blood has clarity and turbidity; movement has compliance and opposition. Opening water and unblocking meridians are all about guiding according to the trend. What should be unblocked or blocked must suit the situation; this is obtaining the Way of Nature.)
Huangdi said: I wish to know if people of different skin colors (white/black), body types (fat/thin), and sizes (small/tall) each have specific acupuncture parameters? (Since human physical constitutions differ, acupuncture methods also vary.)
Qibo said: If a person is mature and robust, with abundant Qi and Blood, and firm skin and flesh, and has been invaded by pathogenic factors, such individuals require deep insertion and retention of the needle. This applies to fat people. (Those who are older and physically strong have vigorous Qi and Blood, so the method is the same as for robust/fat individuals.)
If a person has broad shoulders, thin flesh but thick subcutaneous fat in the armpits and neck, dark skin, thick and drooping lips, black and turbid blood, sluggish and slow-moving Qi, and a personality greedy in giving and taking, such individuals also require deep insertion and retention of the needle, with increased retention time (i.e., longer duration). ("Linlin" describes a drooping appearance, referring to thick lips and turbid constitution. "Increasing the number" refers to long retention.)
Huangdi said: How does one needle thin people?
Qibo said: Thin people have thin skin, pale complexion, lean muscles, thin lips, and speak lightly. Their blood is clear and Qi is slippery; their Qi is easily depleted, and their Blood is easily damaged. Such individuals require shallow insertion and rapid withdrawal of the needle. ("Lian" means thin. Thin lips and light speech indicate lean muscles and scant Qi. For such persons, deep needling is unsuitable as it risks depleting Qi and Blood; thus, needles must be inserted shallowly and removed quickly.)
Huangdi said: How does one needle ordinary people?
Qibo said: Adjust based on their skin color (white or black). Those who are upright and sturdy have harmonious Qi and Blood; needle them without deviating from standard parameters. (Ordinary people are neither thin nor fat. Regarding skin color: those predominantly white tend toward clarity and should be treated like thin people; those predominantly black tend toward turbidity and should be treated like fat people, adjusting the depth and retention accordingly. Those who are upright and sturdy represent the standard for ordinary people and should be regulated by standard measures. The *Jing Shui* chapter states: Foot Yangming stomach meridian depth 6 fen, retention 10 breaths; Foot Taiyang bladder meridian depth 5 fen, retention 7 breaths; Foot Shaoyang gallbladder meridian depth 4 fen, retention 5 breaths; Foot Taiyin spleen meridian depth 3 fen, retention 4 breaths; Foot Shaoyin kidney meridian depth 2 fen, retention 3 breaths; Foot Jueyin liver meridian depth 1 fen, retention 2 breaths. For Hand Yin and Yang meridians, the pathway for receiving Qi is close, and Qi arrives swiftly; needle depth should not exceed 2 fen, and retention should not exceed 1 breath. For the young and old, small and large, fat and thin, one must consider them mentally. This is the so-called constant measure, used with discretion.)
Huangdi said: How does one needle robust men with solid bones?
Qibo said: When needling robust men with solid bones, observe if their muscles are firm while joints are relaxed and their demeanor is solid. If such a person is heavy-set, their Qi is sluggish and Blood is turbid; needle deeply and retain, increasing retention time. If they are agile and powerful, their Qi is slippery and Blood is clear; needle shallowly and withdraw rapidly. (Robust men often have hard and rigid bones, hence "solid bones." "Jianjian" means solid. There are two types of robust men: if muscles are firm, joints relaxed, inactive, and steady, Qi is sluggish and Blood is turbid; this requires deep needling and long retention, similar to fat people. If they are quick-tempered and agile, Qi is slippery and Blood is clear; this requires shallow needling and rapid withdrawal, similar to thin people.)
Huangdi said: How does one needle infants?
Qibo said: Infants have fragile flesh, little Blood, and weak Qi. Use fine needles (hao zhen), insert shallowly, and withdraw rapidly. Treatment may be performed twice daily. (Infants have little Blood and weak Qi, so only fine needles are suitable. Due to shallow insertion and rapid withdrawal, if pathogens remain, it is better to increase frequency to twice daily rather than using deep needling and long retention.)
Huangdi said: What does "facing a deep pool and opening a dike" mean?
Qibo said: If Blood is clear and Qi is slippery, rapid draining will cause Qi to exhaust completely. (The character "turbid" in the original text should be read as "slippery." For those with clear Blood and slippery Qi, like opening a dike at a deep pool, drainage is easiest; treatment should be gradual. Rapid draining would inevitably exhaust true Qi.)
Huangdi said: What does "following a dug channel to break through an obstruction" mean?
Qibo said: If Blood is turbid and Qi is sluggish, rapid draining can unblock the meridians. (For those with turbid Blood and sluggish Qi, like breaking through an obstruction in a dug channel, human effort is required; however, rapid draining can unblock the meridians.)
Huangdi said: What is the compliance and opposition in the flow of pulses?
Qibo said: The three Yin meridians of the Hand travel from the Zang organs to the hands; the three Yang meridians of the Hand travel from the hands to the head. The three Yang meridians of the Foot travel from the head to the feet; the three Yin meridians of the Foot travel from the feet to the abdomen. (Hand Three Yin from Zang to Hand: Taiyin Lung Meridian travels from the Zang via Zhongfu to Shaoshang on the thumb; Shaoyin Heart Meridian travels from the Zang via Jiquan to Shaochong on the little finger; Jueyin Pericardium Meridian travels from the Zang via Tianchi to Zhongchong on the middle finger. Hand Three Yang from Hand to Head: Yangming Large Intestine Meridian travels from Shangyang on the index finger to Yingxiang on the head; Taiyang Small Intestine Meridian travels from Shaoze on the little finger to Tinggong on the head; Shaoyang Sanjiao Meridian travels from Guanchong on the ring finger to Sizhukong on the head. Foot Three Yang from Head to Foot: Taiyang Bladder Meridian travels from Jingming on the head to Zhiyin on the fifth toe; Yangming Stomach Meridian travels from Chengqi on the head to Lidui on the second toe; Shaoyang Gallbladder Meridian travels from Tongziliao on the head to Qiaoyin on the fourth toe. Foot Three Yin from Foot to Abdomen: Taiyin Spleen Meridian travels from Yinbai on the big toe to Dabao in the abdomen; Shaoyin Kidney Meridian travels from Yongquan on the sole to Shufu in the abdomen; Jueyin Liver Meridian travels from Dadun on the big toe to Qimen in the abdomen. Generally, Hand Three Yin traveling from Zang to Hand is compliant (Shun); from Hand to Zang is opposing (Ni). Hand Three Yang traveling from Hand to Head is compliant; from Head to Hand is opposing. Foot Three Yin traveling from Foot to Abdomen is compliant; from Abdomen to Foot is opposing. Foot Three Yang traveling from Head to Foot is compliant; from Foot to Head is opposing. This is why meridians have compliance and opposition, and why acupuncture employs Ying [against] and Sui [with] techniques.)
Huangdi said: Why does the Foot Shaoyin meridian alone descend? (The three Yin meridians of the Foot all travel from Foot to Abdomen, ascending from bottom to top; only the Shaoyin meridian seems to descend, which actually refers to the Chong Mai. Details follow.)
Qibo said: Not so. The Chong Mai is the Sea of the Five Zang and Six Fu organs; all Zang and Fu organs receive from it. Its ascending branch emerges from the nasopharynx (hang sang), seeps into the Yang meridians, and nourishes essence. (The Chong Mai originates in the uterus/blood chamber and is the sea of essence and blood for the twelve meridians, so all Zang and Fu organs rely on it. Its ascending part transmits to Dashu, belonging to the Foot Taiyang Bladder Meridian, thus emerging from the nasopharynx to primarily seep and irrigate the essence of the Yang meridians.) Its descending branch pours into the large collateral of Foot Shaoyin, emerges at Qichong, follows the medial aspect of the thigh, enters the popliteal fossa, runs deep within the tibia, descends behind the medial malleolus where it branches off; the lower branch merges with the Foot Shaoyin meridian and seeps into the Three Yin meridians. (Its descending part joins the large collateral of Foot Shaoyin, emerges at the Qichong point of Yangming, goes from thigh to foot, to behind the medial malleolus. Its divergent lower branch seeps from Shaoyin into the Liver and Spleen meridians, forming the Three Yin, which is why it descends. "Gan" refers to the tibia.) Its anterior branch runs deep emerging below the dorsum of the foot, follows the dorsum into the space between the big toes, seeps into various collaterals to warm the muscles. (Dorsum belongs to the sole. Seeping into collaterals to warm muscles is described in the *Dong Shu* chapter as pouring into collaterals to warm the calves. These three sections are largely consistent with the *Dong Shu* chapter; see Classifications of Meridians, Chapter 13.) Therefore, if collaterals become knotted, the pulse on the dorsum of the foot becomes immobile; immobility leads to Jue (reversal/cold extremities), and Jue leads to coldness. (The Chong Mai is the Sea of the Twelve Meridians, thus capable of warming muscles and calves. If the Chong Mai's collaterals knot due to pathogens, the meridians on the dorsum become immobile, leading to Jue and coldness, caused by the Chong Mai.)
Huangdi said: How can this be verified?
Qibo said: By verbal guidance and palpation verification. Identify areas that should move but do not; only then can the flow of compliance and opposition be clarified. (The question "How to clarify?" addresses fear of doubt due to Jue. Thus, one must first guide verbally, then palpate the pulse. If places that normally pulse—such as Chongyang, Taixi, Taichong—fail to pulse when they should, one knows that non-pulsation is Ni (opposing) and pulsation is Shun (compliant), clarifying the severity of the Jue reversal.)
Huangdi said: Profound indeed is the Way established by sages! Bright as the sun and moon, subtle as a hair's breadth. Without you, Master, who could expound upon it?