骨痹举节不用而痛,汗注烦心,取三阴之经补之。
风痹者,厥气上攻腹,取阳之络,视主病者,泻阳补阴经也。
痹,会阴及太渊消泺照海主之。
骨痹烦满,商丘主之。
足下热,胫疼不能久立,湿痹不能行,三阴交主之。
足大趾搏伤,下车 地,通臂指端伤为筋痹,解溪主之。
痹胫重,足跗不收跟痛,巨虚下廉主之。
胫疼足缓失履,湿痹足下热,不能久立,条口主之。
膝寒痹不仁,痿不屈伸,髀关主之。
肤痛痿痹,外丘主之。
膝外廉痛,不可屈伸,胫痹不仁,阳关主之。
髀痹引膝股外廉痛,不仁筋急,阳陵泉主之。
寒气在分肉间痛,上下痹不仁,中渎主之。
腰胁相引痛急,髀筋螈,胫痛不可屈伸,痹不仁,环跳主之。
风痹从足小趾起,脉痹上下,带胸胁痛无常处,至阴主之。
黄帝治热之穴,五十九 ,头上五行,行五,谓督脉所过者,上星囟会前顶百会后顶,
共五穴为一行,两旁各一行,谓五处承光通天络却玉枕各二,共十穴,又次两旁各一行,谓
临泣目窗正营承灵脑空等各二,共十穴,凡二十五穴,以越诸阳之热逆也。
大柱膺 ,缺盆背 ,此八者以泻胸中之热也,大柱属足太阳,膺 即中府,属手太阴
,缺盆在肩上,属手阳明,背 即风门热府,属足太阳,气街三里巨虚上下廉,此八者,以
泻胃中之热也,八穴并属足阳明经。
云门 骨委中髓空,此八者以泻四肢之热也,云门系手太阴,髀骨即肩KT ,系手阳
明跷脉之会,委中在 中央,系足太阳,髓空即腰俞,系督脉。
五脏俞旁五,此十者,以泻五脏之热也,谓魄户神堂魂门意舍志室等各二,系足太阳经
也,右五十九穴者,皆热之左右也,故热病则刺之,又有刺热之法,肝热则刺足厥阴少阳,
心热则刺手少阴太阳,脾热则刺足太阴阳明,肺热则刺手太阴阳明,肾热则刺足少阴太阳,
凡热病未发,但见赤色来,皆热诊也,在颜为心热,在颐为肾热,在鼻为脾热,在左颊为肝
热,在右颊为肺热,见赤当急色刺之,审其井荥经俞补之分,在则阴阳泻阴,在阳则补阴泻
阳,刺热之大法也,热穴之外,别有遗法者,备载于后。
热病汗不出,上星主之,先取 ,后取天牖风池,热病汗不出而苦呕烦心,承光主之。
热病汗不出,天柱及风池商阳关冲液门主之。
伤寒热盛烦呕,大椎主之。
身热头痛,进退往来,神道主之。
热病汗不出,上髓孔最主之。(千金云臂厥热病汗不出皆灸刺之此穴可以出汗)
热病头痛引目外 而急,烦满汗不出,引颔齿面赤皮痛,悬颅主之。
热病偏头痛引目外 ,悬厘主之。
热病胸中澹澹,腹满暴痛,恍惚不知人,手清少腹满,螈 ,心痞满不得息,巨阙主之。
热病烦心心闷而汗不出,掌中热心痛,身热如火浸淫,烦满舌本痛,中冲主之。
热病发热,满而欲呕哕,三日以往,不得汗,怵惕,胸胁痛,不可反侧,咳满溺赤。大
便血,衄不止,呕吐,血气逆,噫不止,嗌中痛,食不下,善渴,口中烂,掌中热,劳宫主
之。
热病烦心善哕,胸中澹澹善动,间使主之。
伤寒寒热头痛,哕衄,肩不举,温留主之。
伤寒余热不尽,曲池主之。
热病汗不出,胁痛不得息,颈颔肿,寒热耳鸣,聋无所闻,阳谷主之。
热病满闷不得卧,太白主之。(千金云不得卧身重骨痛热中少气厥寒灸之热去)
热病汗不出,善噫腹胀满,胃热谵言,解溪主之,初得病,或先头痛身寒热,或涩涩欲
守火,或腰背强直,面目如饮酒状,此伤寒初得一二日,但灸心下三处,第一处,去心下一
寸,名巨阙,第二处,去心下二寸,名上脘,第三处,去心下三寸,名胃脘,各灸五十壮,
然或人形大小不同,恐寸数有异,可绳度,随其长短寸数最佳,取绳从心头骨名鸠尾,头度
取脐孔中,屈绳取半,当绳头名胃脘,又中屈半绳,更分为二分,从胃脘向上度一分,即是
上脘,又上度取一分,即是巨阙,大人可灸五十壮,小儿三壮,亦随年灸之,大小以意斟量,
若病者三四日以上,宜先灸胸上二十壮,以绳度鼻正上尽发际,中屈绳断去半,便从发际入
发中,灸绳头,又灸两颞 ,又灸两风池,又灸肝俞百壮,余处各二十壮,又灸太冲三十壮。
凡温病可针刺五十九穴,又身之穴三百六十有五,其三十六穴,灸之有害,七十九穴,
刺之为灾。
骨痹表现为关节活动受限且疼痛,伴有汗出如注、心烦意乱,治疗应选取足三阴经的穴位进行补法操作。
风痹表现为厥逆之气上攻腹部,治疗应选取阳经的络穴,观察主要病变部位,采用泻阳经、补阴经的方法。
足底发热,小腿疼痛无法久站,湿痹导致行动不便,三阴交穴为主治穴位。
足大趾因跌打损伤(如下车时脚触地),或手臂手指末端受伤导致筋痹,解溪穴为主治穴位。
痹证导致小腿沉重,足背弛缓无力,脚跟疼痛,巨虚下廉穴为主治穴位。
小腿疼痛,足部弛缓无力难以穿鞋行走,湿痹致足底发热,无法久站,条口穴为主治穴位。
髀部痹痛牵引至膝股外侧疼痛,麻木且筋脉拘急,阳陵泉穴为主治穴位。
寒气在分肉之间引起疼痛,上下肢体痹痛麻木,中渎穴为主治穴位。
腰胁相互牵引疼痛紧急,大腿肌肉抽搐,小腿疼痛不能屈伸,肢体痹痛麻木,环跳穴为主治穴位。
风痹从足小趾开始,脉痹上下蔓延,伴有胸胁疼痛且位置不固定,至阴穴为主治穴位。
黄帝记载的治疗热病的五十九个穴位:头部五行,每行五个穴位,指的是督脉经过的部位,即上星、囟会、前顶、百会、后顶,共五穴为第一行;两旁各有一行,指五处、承光、通天、络却、玉枕,各双侧共十穴;再往两旁各有一行,指临泣、目窗、正营、承灵、脑空,各双侧共十穴,共计二十五穴,用于发散诸阳经的热邪逆气。
大杼、膺俞、缺盆、背俞,这八个穴位用于泻除胸中的热邪,其中大杼属于足太阳膀胱经,膺俞即中府穴,属于手太阴肺经,缺盆位于肩上,属于手阳明大肠经,背俞即风门穴(又称热府),属于足太阳膀胱经。气街、三里、巨虚上廉、巨虚下廉,这八个穴位用于泻除胃中的热邪,这八穴均属于足阳明胃经。
云门、髀骨(此处指肩髃)、委中、髓空(此处指腰俞),这八个穴位用于泻除四肢的热邪,其中云门属于手太阴肺经,髀骨即肩髃穴,是手阳明大肠经与跷脉的交会穴,委中位于腘窝中央,属于足太阳膀胱经,髓空即腰俞穴,属于督脉。
五脏俞旁各五个穴位,共十个穴位,用于泻除五脏的热邪,指魄户、神堂、魂门、意舍、志室,各双侧共十穴,均属于足太阳膀胱经。上述右侧五十九个穴位,都是治疗热病的常用穴位,所以热病应当针刺这些穴位。此外还有刺热的具体方法:肝热则针刺足厥阴肝经和足少阳胆经,心热则针刺手少阴心经和手太阳小肠经,脾热则针刺足太阴脾经和足阳明胃经,肺热则针刺手太阴肺经和手阳明大肠经,肾热则针刺足少阴肾经和足太阳膀胱经。凡是热病尚未发作,但见面部出现赤色,都属于热诊的表现:面色赤在颜部为心热,在颐部为肾热,在鼻部为脾热,在左颊为肝热,在右颊为肺热。见到赤色应当立即针刺,仔细辨别井、荥、经、俞、合五输穴的补泻原则,病在阴经则泻阴经补阳经,病在阳经则补阴经泻阳经,这是刺热的大法。除了热穴之外,另有遗留的治疗方法,详细记载于后文。
热病汗不出,上星穴为主治穴位,先取膻中穴,后取天牖、风池穴。热病汗不出且痛苦呕吐、心烦意乱,承光穴为主治穴位。
热病汗不出,上髓、孔最穴为主治穴位。(《千金方》记载臂厥热病汗不出均可灸刺此穴以发汗)
热病头痛牵引眼外角且拘急,烦闷汗不出,牵引下颌、牙齿,面部发红,皮肤疼痛,悬颅穴为主治穴位。
热病心中悸动不安,腹部胀满突然疼痛,神志恍惚不知人事,手脚清冷,小腹满胀,肌肉抽搐,心下痞满呼吸困难,巨阙穴为主治穴位。
热病心烦胸闷且汗不出,掌心发热心痛,身体发热如火焰浸淫,烦闷舌根疼痛,中冲穴为主治穴位。
热病发热,腹胀欲呕呃逆,病程三日以上不得汗出,恐惧惊惕,胸胁疼痛,不能翻身侧卧,咳嗽气满,小便赤黄,大便出血,鼻衄不止,呕吐,气血逆乱,嗳气不止,咽喉疼痛,饮食不下,容易口渴,口腔糜烂,掌心发热,劳宫穴为主治穴位。
热病汗不出,胁痛呼吸困难,颈部和下颌肿胀,寒热耳鸣,耳聋听不见声音,阳谷穴为主治穴位。
热病胀闷不能卧床休息,太白穴为主治穴位。(《千金方》记载不得卧、身重骨痛、热中少气、厥寒均可灸此穴以去热)
热病汗不出,易嗳气腹胀满,胃热谵语,解溪穴为主治穴位。初得病时,或先出现头痛身寒热,或瑟瑟发抖想靠近火源,或腰背强直,面目像喝醉酒的样子,这是伤寒初起一两天内的症状,只需灸心下三个部位:第一处,距心下一寸,名为巨阙;第二处,距心下二寸,名为上脘;第三处,距心下三寸,名为胃脘。每处灸五十壮。然而人的体型大小不同,恐怕一寸的距离有差异,可用绳子测量,根据长短确定最佳尺寸。取绳从心头骨(名为鸠尾)量到脐孔中间,弯曲绳子取一半,当绳头的位置即为胃脘;再将半绳对折,分为两份,从胃脘向上量一份,即是上脘;再向上量一份,即是巨阙。成人可灸五十壮,小儿灸三壮,也随年龄而定,大小酌情衡量。如果病人患病三四日以上,宜先灸胸部上方二十壮,用绳子量鼻子正上方直到发际线,将绳子对折去掉一半,便从发际进入头发中,灸绳头位置;又灸两侧颞部;又灸两侧风池穴;又灸肝俞穴一百壮,其余部位各灸二十壮;又灸太冲穴三十壮。
Bone Bi (Bi syndrome affecting the bones) presents with joint immobility and pain, profuse sweating, and vexation. Treatment involves selecting the meridians of the Three Yin (Taiyin, Shaoyin, Jueyin) and applying tonification.
Wind Bi is characterized by rebellious Qi attacking the abdomen. Treatment involves selecting the collaterals of the Yang meridians, observing the primary pathological site, and applying dispersion to the Yang meridians and tonification to the Yin meridians.
For Bi syndrome, Huian (CV1), Taiyuan (LU9), Xiaoluo (GB34), and Zhaohai (KI6) are indicated.
For Bone Bi with vexation and fullness, Shangqiu (SP5) is indicated.
For heat in the soles, pain in the shins, inability to stand for long periods, and Damp-Bi causing immobility, Sanyinjiao (SP6) is indicated.
For trauma to the big toe (e.g., striking the ground when alighting from a carriage), or injury to the ends of the arms and fingers resulting in Sinew Bi, Jiexi (ST41) is indicated.
For Bi syndrome causing heaviness in the shins, flaccidity of the dorsum of the foot, and heel pain, Xialian (ST39) is indicated.
For pain in the shins, flaccidity of the feet making walking difficult, Damp-Bi with heat in the soles, and inability to stand for long periods, Tiaokou (ST38) is indicated.
For cold Bi with numbness at the knee, and Wei syndrome with inability to flex or extend, Biguan (ST31) is indicated.
For skin pain and Wei-Bi, Waiqiu (GB36) is indicated.
For pain at the lateral aspect of the knee, inability to flex or extend, and Bi with numbness in the shins, Yangguan (GB33) is indicated.
For Bi of the thigh radiating to pain at the lateral aspect of the knee and thigh, numbness, and sinew tension, Yanglingquan (GB34) is indicated.
For pain caused by Cold Qi between the muscle layers, and Bi with numbness above and below, Zhongdu (GB37) is indicated.
For drawing pain between the waist and hypochondrium, spasms of the thigh sinews, pain in the shins preventing flexion and extension, and Bi with numbness, Huantiao (GB30) is indicated.
For Wind Bi starting from the little toe, Mai Bi spreading up and down, and intermittent pain in the chest and hypochondrium, Zhiyin (BL67) is indicated.
The Yellow Emperor described fifty-nine acupoints for treating Heat: Five rows on the head, five points per row. These refer to the points along the Du Meridian: Shangxing (GV23), Xinhui (GV22), Qian Ding (GV21), Baihui (GV20), and Houding (GV19). This constitutes one row of five points. On each side, there is another row: Wuchu (GB8), Chengguang (GB7), Tongtian (GV7), Luoque (GV9), and Yuzhen (GV17), two on each side, totaling ten points. Further laterally, on each side, is another row: Linqi (GB15), Mucuang (GB16), Zhengying (GB17), Chengling (GV18), and Naokong (GB13), two on each side, totaling ten points. In total, twenty-five points are used to dissipate rebellious Heat from the Yang meridians.
Dazhu (BL11), Ying Shu (Zhongfu LU1), Quepen (LI12), and Bei Shu (Fengmen BL12) are these eight points used to drain Heat from the chest. Dazhu belongs to the Foot-Taiyang Bladder Meridian; Ying Shu refers to Zhongfu (LU1), belonging to the Hand-Taiyin Lung Meridian; Quepen is on the shoulder, belonging to the Hand-Yangming Large Intestine Meridian; Bei Shu refers to Fengmen (BL12), also known as Re Fu, belonging to the Foot-Taiyang Bladder Meridian. Qijie (ST30), Zusanli (ST36), Shanglian (ST37), and Xialian (ST39) are these eight points used to drain Heat from the Stomach. All eight points belong to the Foot-Yangming Stomach Meridian.
Yunmen (LU2), Bigu (Jianyu LI15), Weizhong (BL40), and Suikong (Yaoshu GV2) are these eight points used to drain Heat from the four limbs. Yunmen belongs to the Hand-Taiyin Lung Meridian; Bigu refers to Jianyu (LI15), which is the intersection of the Hand-Yangming Large Intestine Meridian and the Qiao Mai; Weizhong is in the center of the popliteal fossa, belonging to the Foot-Taiyang Bladder Meridian; Suikong refers to Yaoshu (GV2), belonging to the Du Meridian.
Wushu (Bladder Shu points) plus five adjacent points on each side, totaling ten points, are used to drain Heat from the Five Zang organs. These refer to Pohu (BL42), Shentang (BL44), Hunmen (BL47), Yishe (BL48), and Zhishi (BL52), two on each side, all belonging to the Foot-Taiyang Bladder Meridian. The aforementioned fifty-nine points on the right side are all points for treating Heat; thus, they should be needled in Heat diseases. There are also specific methods for needling Heat: For Liver Heat, needle the Foot-Jueyin Liver Meridian and Foot-Shaoyang Gallbladder Meridian; for Heart Heat, needle the Hand-Shaoyin Heart Meridian and Hand-Taiyang Small Intestine Meridian; for Spleen Heat, needle the Foot-Taiyin Spleen Meridian and Foot-Yangming Stomach Meridian; for Lung Heat, needle the Hand-Taiyin Lung Meridian and Hand-Yangming Large Intestine Meridian; for Kidney Heat, needle the Foot-Shaoyin Kidney Meridian and Foot-Taiyang Bladder Meridian. Generally, if Heat disease has not yet fully manifested but redness appears on the face, it indicates Heat diagnosis: Redness on the forehead indicates Heart Heat; on the chin, Kidney Heat; on the nose, Spleen Heat; on the left cheek, Liver Heat; on the right cheek, Lung Heat. Upon seeing redness, immediate needling is required. Carefully determine the Bu (tonify) and Xie (disperse) principles of the Jing-River-Shu-Yuan-He Five Shu Points. If the pathogen is in Yin, disperse Yin and tonify Yang; if in Yang, tonify Yin and disperse Yang. This is the general principle for treating Heat. Besides these Heat points, other residual methods are detailed in the following text.
For Heat disease with anhidrosis (absence of sweating), Shangxing (GV23) is indicated. First select Danzhong (CV17), then Tianyou (TE16) and Fengchi (GB20). For Heat disease with anhidrosis accompanied by painful vomiting and vexation, Chengguang (GB7) is indicated.
For Heat disease with anhidrosis, Tianzhu (BL10), Fengchi (GB20), Shangyang (LI1), Guanchong (TE1), and Yemen (SJ2) are indicated.
For Shanghan (Cold Damage) with intense Heat, vexation, and vomiting, Dazhui (GV14) is indicated.
For body Heat, headache, and alternating chills and fever, Shendao (GV11) is indicated.
For Heat disease with anhidrosis, Shangsui (DU22? Note: Text says Shang Sui, likely a variant or typo for a point on Du or local area, kept as Shang Sui) and Kongzui (LU6) are indicated. (*Qianjin Fang* states that for Arm Jue Heat disease with anhidrosis, moxibustion or needling this point can induce sweating.)
For Heat disease with headache radiating to the outer canthus with stiffness, vexation, fullness, anhidrosis, radiation to the mandible and teeth, facial redness, and skin pain, Xuanlu (GB5) is indicated.
For Heat disease with lateral headache radiating to the outer canthus, Xuanli (GB5) is indicated.
For Heat disease with palpitations, abdominal fullness and sudden pain, mental confusion/unconsciousness, cold hands and feet, lower abdominal fullness, spasms, epigastric oppression, and difficulty breathing, Juque (CV14) is indicated.
For Heat disease with vexation, chest tightness, anhidrosis, heat in the palms, heart pain, body Heat like immersion in fire, vexation, fullness, and root-of-tongue pain, Zhongchong (PC9) is indicated.
For Heat disease with fever, fullness, desire to vomit/hiccup, lasting more than three days without sweating, fearfulness, chest and hypochondriac pain, inability to turn sideways, cough, fullness, dark urine, bloody stool, persistent epistaxis, vomiting, rebellious Qi and Blood, persistent belching, throat pain, inability to eat, excessive thirst, oral ulcers, and heat in the palms, Laogong (PC8) is indicated.
For Heat disease with vexation and frequent hiccups, and palpitations in the chest, Jianshi (PC5) is indicated.
For Shanghan with chills and fever, headache, hiccups, epistaxis, and inability to raise the shoulder, Wenliu (LI7) is indicated.
For residual Heat after Shanghan, Quchi (LI11) is indicated.
For Heat disease with anhidrosis, hypochondriac pain, difficulty breathing, swelling of the neck and mandible, chills and fever, tinnitus, deafness, and hearing loss, Yanggu (SI5) is indicated.
For Heat disease with fullness, oppression, and inability to lie down, Taibai (SP3) is indicated. (*Qianjin Fang* states that for inability to lie down, heavy body, bone pain, internal Heat with shortness of breath, and Jue Cold, moxibustion removes the Heat.)
For Heat disease with anhidrosis, frequent belching, abdominal fullness, Stomach Heat with delirious speech, Jiexi (ST41) is indicated. At the onset of illness, symptoms may include headache, chills and fever, shivering with a desire for warmth, or stiff back and waist, with a flushed face resembling drunkenness. These are early signs of Shanghan (first one to two days). Only moxibustion on three points below the heart is needed: The first point, one cun below the heart, named Juque (CV14); the second point, two cun below the heart, named Shangwan (CV13); the third point, three cun below the heart, named Weiwuan (CV12). Moxa fifty cones (zhuang) at each point. However, since body sizes vary, the measurement of one cun may differ. Use a rope to measure for the best fit. Take a rope from the heart's xiphoid process (named Jiutui/CV15) to the navel, fold it in half. The end of the rope marks Weiwuan. Fold this half again into two parts. From Weiwuan, measure upward one part to mark Shangwan. Measure upward another part to mark Juque. Adults receive fifty cones; children receive three cones, adjusted by age. Adjust size and quantity according to judgment. If the patient has been ill for three to four days, first moxa twenty cones on the upper chest. Measure from the tip of the nose to the hairline, fold the rope in half, remove half, and insert the remaining length into the hairline to moxa the end of the rope. Also moxa both temples, both Fengchi (GB20), Gaishu (BL17) for one hundred cones, and other areas twenty cones each. Also moxa Taichong (LR3) for thirty cones.
All Warm Disease cases can be treated by needling the fifty-nine Heat points. Additionally, there are 365 acupoints on the body; among them, thirty-six are harmful if moxaed, and seventy-nine are disastrous if needled.