颔痛;甲乙甚,戊己大汗,气逆则甲乙死。刺足太阴、阳明。
脾病头先重者。脾属湿土,性重,经谓湿之中
人也,首如裹,故脾病头先重也。颊,少阳部也,土之与木,此负则彼胜,土病而木病亦见也。烦心,
脾脉注心也。颜青欲呕,亦木病也。腰痛不可用俯仰,腰为肾之府,脾主制水,肾为司水之神,脾病
不能制水,故腰痛;再脾病胃不能独治,阳明主合同束而利机关,故痛而至于不可用俯仰也。腹满泄,
脾经本病也。颔痛,亦木病也。
十三、肺热病者,先淅然厥,起毫毛,恶风寒,
舌上黄,身热;热争则喘咳,痛走胸膺背,不得太息,头痛不堪,汗出而寒;丙丁甚,庚辛大汗,气逆
则丙丁死。刺手太阴、阳明,出血如大豆,立已。
肺病先恶风寒者,肺主气,又主皮毛,肺病则
气贲郁不得捍卫皮毛也。舌上黄者,肺气不化则湿热聚而为黄苔也(按苔字,方书悉作胎。胎乃胎
包之胎,特以苔生舌上,故从肉旁。不知古人借用之字甚多。盖湿热蒸而生苔,或黄、或白、或青、或
黑。皆因病之深浅、或寒、或热、或燥、或湿而然,如春夏间石上土 之阴面生苔者然。故本论苔字。
悉从草不从肉)。喘,气郁极也。咳,火克金也。胸膺,背之府也,皆天气主之,肺主天气,肺气郁
极,故痛走胸膺背也,走者,不定之词。不得太息,气郁之极也。头痛不堪,亦天气贲郁之极也。汗
出而寒,毛窍开,故汗出,汗出卫虚,故恶寒,又肺本恶寒也。
十四、肾热病者,先腰痛, 酸,苦渴数饮,身热;热争则项痛而强, 寒且酸,足下热,不欲
言,其逆则项痛,员员澹澹然;戊己甚,壬癸大汗。气逆则戊己死。刺足少阴、太阳。
肾病腰先痛者,腰为肾之府,又肾脉贯脊会于督之长强穴。 ,肾脉入跟中,以上 内,太阳
之脉亦下贯 内,即 也;酸,热烁液也。苦渴数饮,肾主五液而恶燥,病热则液伤而燥,故苦渴而
饮水求救也。项,太阳之脉,从巅入络脑,还出别下项∶肾病至于热争,脏病甚而移之腑,故项痛而
强也。 寒且酸, 义见上,寒,热极为寒也;酸,热烁液也。足下热,肾脉从小指之下,斜趋足心涌泉
穴,病甚而热也。不欲言,心主言,肾病则水克火也。员员澹澹,状其痛之甚而无奈也。
十五、肝热病者,左颊先赤;心热病者,颜先赤;脾热病者,鼻先赤;肺热病者,右颊先赤;肾热
病者,颐先赤。病虽未发,见赤色者刺之,名曰治未病。
此节言五脏欲病之先,必各现端绪于其部分,示人早治,以免热争则病重也。
十六、《热论篇》∶帝曰∶热病已愈,时有所遗者,何也?岐伯曰∶诸遗者,热甚而强食之,故有所
遗也。若此者,皆病已衰而热有所藏,因其谷气相薄,两热相合,故有所遗也。帝曰∶治遗奈何?岐
伯曰∶视其虚实,调其逆从,可使必已也。帝曰∶病热当何禁之?岐伯曰∶病热少愈,食肉则复,多食
则遗,此其禁也。
此节言热病之禁也,语意自明。大抵邪之着
人也,每借有质以为根据附,热时断不可食,热退必须少食,如兵家坚壁清野之计,必俟热邪尽退,
而后可大食也。
十七、《刺法论》∶帝曰∶余闻五疫之至,皆相染
易,无问大小,病状相似,不施救疗,如何可得不相移易者?岐伯曰∶不相染者,正气存内,邪不可干。
此言避疫之道。
按此下尚有避其毒瓦斯若干言,以其想青气想白气等,近于祝由家言,恐后人附会之词,故节之,要亦不能外“正气
存内、邪不可干”二句之理,语意已尽,不必滋后学之惑也。
十八、《玉板论要》曰∶病温虚甚死。
病温之人,精血虚甚,则无阴以胜温热,故死。
十九、《平人气象论》曰∶人一呼脉三动,一吸脉三动而躁,尺热曰病温,尺不热脉滑曰病风,脉
涩曰痹。
呼吸俱三动,是六、七至脉矣,而气象又躁急,
若尺部肌肉热,则为病温。盖温病必伤金水二脏之津液,尺之脉属肾,尺之穴属肺也,此处肌肉热,
故知为病温。其不热而脉兼滑者,则为病风,风之伤人也,阳光受之,尺为阴,故不热也。如脉动躁
而兼涩,是气有余而血不足,病则为痹矣。
下颌疼痛;在甲日、乙日病情加重,在戊日、己日大汗出,若出现气逆则甲日、乙日死亡。针刺足太阴脾经、足阳明胃经。
脾病头部先感到沉重者。脾属湿土,性质重浊,经典记载湿气中人,头感觉像被包裹一样,所以脾病头部先感到沉重。颊部是少阳胆经所主部位,土与木的关系,一方受克则另一方亢盛,脾土有病则肝木之病也会显现。心烦,是因为脾脉注于心。面色发青且想呕吐,也是肝木为病的表现。腰痛不能俯仰,腰是肾的府库,脾主制约水液,肾是主管水液的脏器,脾病不能制约水液,所以腰痛;再者脾病时胃也不能单独治理,阳明经主司合拢约束并利于关节运动,所以疼痛以至于不能俯仰。腹部胀满、泄泻,是脾经的本病。下颌疼痛,也是肝木为病的表现。
十三、肺热病患者,先感到寒冷战栗,毫毛竖起,恶风怕寒,舌苔发黄,身体发热;正邪相争则气喘咳嗽,疼痛游走于胸膺背部,不能深长呼吸,头痛剧烈,出汗后反而怕冷;在丙日、丁日病情加重,在庚日、辛日大汗出,若出现气逆则丙日、丁日死亡。针刺手太阴肺经、手阳明大肠经,放出如大豆大小的血,立刻痊愈。
肺病先恶风怕寒的,肺主气,又主皮毛,肺病则气机壅滞郁结,不能捍卫皮毛。舌苔发黄的,肺气不化则湿热聚积形成黄苔(按“苔”字,医方书都写作“胎”。胎是胎包的胎,特意因为苔生在舌上,所以从肉旁。不知道古人借用的字很多。大概湿热蒸腾而生苔,或黄、或白、或青、或黑,都是因病情的深浅、或寒、或热、或燥、或湿而形成的,就像春夏季节石头泥土背阴面生苔一样。所以本论中的“苔”字,全部从草字头不从肉字旁)。喘,是气郁极致的表现。咳,是火克金的表现。胸膺是背的府库,都由天气所主,肺主天气,肺气郁结到极致,所以疼痛游走于胸膺背部,“走”是不固定的意思。不能深长呼吸,是气郁极致的表现。头痛剧烈,也是天气壅滞郁结极致的表现。出汗后怕冷,毛孔张开所以出汗,出汗后卫气虚弱所以恶寒,而且肺本身也厌恶寒冷。
十四、肾热病患者,先腰痛,腘窝酸软,口苦口渴多次饮水,身体发热;正邪相争则项痛且僵硬,恶寒且酸软,足心发热,不想说话,若气逆则项痛,头晕目眩心神不安;在戊日、己日病情加重,在壬日、癸日大汗出。若出现气逆则戊日、己日死亡。针刺足少阴肾经、足太阳膀胱经。
肾病腰部先痛的,腰是肾的府库,另外肾脉贯穿脊柱会合于督脉的长强穴。腘窝,肾脉进入脚跟中,向上至腘内,太阳膀胱经的脉也向下贯穿腘内,即腘窝处;酸软,是热邪灼伤津液所致。口苦口渴多次饮水,肾主五液且厌恶燥热,生病发热则津液受伤而干燥,所以口苦口渴而饮水自救。项部,太阳膀胱经的脉,从头顶入络脑,复出别行下项;肾病至于正邪相争,脏病严重而移及腑,所以项痛且僵硬。恶寒且酸软,酸软的含义见上文,恶寒,是热极似寒的表现;酸软,是热邪灼伤津液所致。足心发热,肾脉从小趾之下,斜趋足心涌泉穴,病重而热。不想说话,心主言语,肾病则水克火。员员澹澹,形容疼痛非常严重且无可奈何的样子。
十五、肝热病患者,左脸颊先发红;心热病患者,面部中央先发红;脾热病患者,鼻子先发红;肺热病患者,右脸颊先发红;肾热病患者,下巴先发红。病虽然还没发作,见到红色就针刺治疗,这叫做治未病。
这一节讲五脏将要发病之前,必定各自在其对应部位显露端倪,提示人们早治,以免正邪相争时病情加重。
十六、《热论篇》:黄帝问:热病已经痊愈,但有时还有余热遗留,为什么呢?岐伯答:凡是余热遗留的,都是因为热势很盛却强行进食,所以有遗留。像这种情况,都是病势已衰但热邪有所潜藏,因为食物谷气与残余热邪相互搏结,两热相合,所以有遗留。黄帝问:治疗余热遗留怎么办?岐伯答:观察其虚实,调理其逆顺,可以使病必愈。黄帝问:患热病应当禁忌什么?岐伯答:患热病稍有好转,吃肉就会复发,多吃就会遗留余热,这就是禁忌。
这一节讲热病的禁忌,语意自然明白。大致来说,邪气附着于人,往往借助有形的物质作为依附基础,发热时绝对不可进食,热退后必须少吃,如同兵家坚壁清野的策略,必须等到热邪完全退去,才可以大量进食。
十七、《刺法论》:黄帝问:我听说五疫之气到来,都会相互传染,无论老少,症状相似,如果不施救疗,怎样才能做到不相互传染呢?岐伯答:不相互传染的原因,在于正气存在于体内,邪气就不能侵犯。
这是讲预防疫病的方法。
按:此下还有若干言关于避开毒气的描述,比如想象青色之气、白色之气等,近于祝由科的说法,恐怕是后人附会的文字,所以节略掉,总之也不外乎“正气存内,邪不可干”这两句的道理,语意已尽,不必增加后学的困惑。
十八、《玉板论要》说:患温病且精气极度虚弱的会死亡。
患温病的人,精血极度虚弱,就没有阴液来制约温热邪气,所以死亡。
十九、《平人气象论》说:人每呼一次脉跳动三次,每吸一次脉跳动三次且躁急,尺部肌肉发热叫作温病,尺部不发热脉滑叫作风病,脉涩叫作痹证。
一呼一吸各跳动三次,就是六到七次的脉率了,而且脉象又躁急,如果尺部肌肉发热,就是温病。大概温病必然损伤肺金和肾水的津液,尺脉属于肾,尺肤穴位属于肺,此处肌肉发热,所以知道是温病。如果不发热而脉兼滑,就是风病,风邪伤人,阳气受之,尺部属阴,所以不发热。如果脉动躁急且兼涩,是气有余而血不足,生病则为痹证。
Mandibular pain; the condition worsens on Jia (Wood) and Yi (Wood) days, profuse sweating occurs on Wu (Earth) and Ji (Earth) days, and if Qi rebellion occurs, death ensues on Jia or Yi days. Acupuncture of Foot-Taiyin (Spleen) and Foot-Yangming (Stomach).
In Spleen disease, heaviness in the head is the initial symptom. The Spleen belongs to Wet Earth, its nature is heavy. The Classics state that when Dampness invades the human body, the head feels as if wrapped, thus in Spleen disease, heaviness in the head appears first. The cheek is the region of Shaoyang (Gallbladder). In the relationship between Earth and Wood, if one is defeated, the other prevails; thus, when Spleen Earth is diseased, Liver Wood pathology also manifests. Vexation in the heart occurs because the Spleen meridian connects to the Heart. Cyan complexion and desire to vomit are also signs of Liver Wood pathology. Lower back pain with inability to bend or extend: the lower back is the mansion of the Kidney. The Spleen controls water, while the Kidney is the deity governing water. When Spleen disease fails to control water, lower back pain results. Furthermore, when the Spleen is diseased, the Stomach cannot function independently. Yangming governs conjunction and binding, facilitating joint movement; thus, pain becomes severe enough to prevent bending or extending. Abdominal fullness and diarrhea are primary diseases of the Spleen meridian. Mandibular pain is also a manifestation of Liver Wood pathology.
13. In Lung Heat Disease, the patient first experiences shivering chills, erection of hair follicles, aversion to wind and cold, yellow coating on the tongue, and fever. During the struggle between Heat and Healthy Qi, asthma and cough occur, pain radiates to the chest, hypochondrium, and back, deep breathing is difficult, headache is unbearable, sweating occurs followed by chills. The condition worsens on Bing (Fire) and Ding (Fire) days, profuse sweating occurs on Geng (Metal) and Xin (Metal) days, and if Qi rebellion occurs, death ensues on Bing or Ding days. Acupuncture of Hand-Taiyin (Lung) and Hand-Yangming (Large Intestine), releasing blood drops the size of soybeans brings immediate relief.
In Lung disease, aversion to wind and cold appears first. The Lung governs Qi and the skin/hair. In Lung disease, Qi becomes congested and stagnant, failing to defend the skin and hair. A yellow tongue coating indicates that failure of Lung Qi transformation leads to the accumulation of Damp-Heat forming a yellow coating. (Note: In medical texts, "Tai" [moss] is often written as "Tai" [embryo/fetus]. Fetus refers to the sac of an embryo. Specifically because moss grows on the tongue, it uses the flesh radical. However, ancients borrowed characters frequently. Generally, Damp-Heat steaming produces moss, which may be yellow, white, cyan, or black, depending on the depth of disease and whether it is Cold, Heat, Dryness, or Dampness, similar to moss growing on the shaded side of stones in spring and summer. Therefore, in this treatise, the character for moss always uses the grass radical, not the flesh radical.) Asthma represents extreme Qi stagnation. Cough represents Fire overcoming Metal. The chest and hypochondrium are the mansions of the back, governed by Heaven's Qi. The Lung governs Heaven's Qi; extreme stagnation of Lung Qi causes pain radiating to the chest, hypochondrium, and back. "Radiating" implies unpredictability. Inability to take a deep breath signifies extreme Qi stagnation. Severe headache also signifies extreme congestion and stagnation of Heaven's Qi. Sweating followed by chills: pores open causing sweating; after sweating, Wei Qi (Defensive Qi) becomes deficient, causing aversion to cold; moreover, the Lung inherently dislikes cold.
14. In Kidney Heat Disease, lower back pain appears first, soreness in the popliteal fossa, bitter taste, thirst with frequent drinking, and fever. During the struggle between Heat and Healthy Qi, neck pain and stiffness occur, aversion to cold and soreness, heat in the soles of the feet, and reluctance to speak. If Qi rebels, neck pain occurs accompanied by dizziness and palpitations. The condition worsens on Wu (Earth) and Ji (Earth) days, profuse sweating occurs on Ren (Water) and Gui (Water) days. If Qi rebellion occurs, death ensues on Wu or Ji days. Acupuncture of Foot-Shaoyin (Kidney) and Foot-Taiyang (Bladder).
In Kidney disease, lower back pain appears first. The lower back is the mansion of the Kidney. Additionally, the Kidney meridian penetrates the spine and converges at Changqiang (GV1) of the Du Meridian. The popliteal fossa: the Kidney meridian enters the heel and ascends into the popliteal fossa; the Taiyang Bladder meridian also descends through the popliteal fossa. Soreness is caused by Heat scorching fluids. Bitter taste and thirst with frequent drinking: the Kidney governs the five fluids and dislikes dryness. In heat disease, fluids are damaged leading to dryness, hence the bitter taste, thirst, and drinking to seek relief. The neck: the Taiyang Bladder meridian enters the brain from the vertex and emerges to descend behind the neck. In Kidney disease progressing to the struggle of Heat, Zang disease becomes severe and transfers to Fu organs, causing neck pain and stiffness. Aversion to cold and soreness: soreness is explained above; aversion to cold is the manifestation of extreme Heat transforming into Cold; soreness is caused by Heat scorching fluids. Heat in the soles of the feet: the Kidney meridian runs from below the little toe, slanting towards Yongquan (KI1) in the sole of the foot; severe disease generates heat. Reluctance to speak: the Heart governs speech; in Kidney disease, Water overcomes Fire. "Yuan yuan dan dan" describes severe, helpless pain.
15. In Liver Heat Disease, redness appears first on the left cheek. In Heart Heat Disease, redness appears first on the center of the face. In Spleen Heat Disease, redness appears first on the nose. In Lung Heat Disease, redness appears first on the right cheek. In Kidney Heat Disease, redness appears first on the chin. Even if the disease has not yet fully manifested, if redness is seen, acupuncture should be applied. This is called treating disease before it arises.
This section states that before the Five Zang organs become diseased, they inevitably show preliminary signs in their corresponding regions, indicating early treatment to prevent worsening during the struggle of Heat and Healthy Qi.
16. From *Re Lun Pian* (Treatise on Heat): The Yellow Emperor asked: Heat disease has healed, but sometimes residual symptoms remain. Why? Qibo answered: All cases of residual symptoms occur because the patient eats strongly while Heat is still intense. Thus, residual symptoms arise. In such cases, the pathogenic factor has declined but Heat is still hidden. The Qi from food grains clashes with the residual Heat, and the two heats combine, causing residual symptoms. The Yellow Emperor asked: How to treat residual symptoms? Qibo answered: Observe deficiency and excess, regulate reversal and normalcy, and the disease can surely be cured. The Yellow Emperor asked: What should be prohibited in heat disease? Qibo answered: When heat disease slightly improves, eating meat causes recurrence, and overeating causes residual symptoms. These are the prohibitions.
This section discusses prohibitions in heat disease, the meaning being clear. Generally, pathogens attach to the body relying on substantial matter. During fever, eating must absolutely be avoided. After fever subsides, food intake must be minimal, akin to the military strategy of clearing fields and fortifying walls. Only after the Heat pathogen has completely retreated can large meals be consumed.
17. From *Ci Fa Lun* (Treatise on Needling Methods): The Yellow Emperor asked: I have heard that the arrival of the Five Plagues causes mutual infection, regardless of age, with similar symptoms. If no treatment is provided, how can one avoid transmission? Qibo answered: Those who do not get infected do so because Healthy Qi exists within, preventing pathogens from invading.
This speaks to the way to avoid plagues.
Note: Below this, there are further words about avoiding toxic vapors, such as visualizing green or white Qi, which resemble Zhu You (incantation) practices. These are likely later interpolations, so they are omitted. Ultimately, they do not exceed the principle of "Healthy Qi exists within, pathogens cannot invade." The meaning is complete; there is no need to confuse students.
18. From *Yu Ban Lun Yao*: "Those suffering from Warm Disease with extreme deficiency die."
Patients with Warm Disease who have extreme deficiency of Essence and Blood lack Yin to overcome the Warm-Heat, leading to death.
19. From *Ping Ren Qi Xiang Lun* (Treatise on Normal People's Pulse Images): "If a person's pulse beats three times per exhalation and three times per inhalation, and is rapid, with heat in the Chi position, it is Warm Disease. If the Chi position is not hot but the pulse is slippery, it is Wind Disease. If the pulse is choppy, it is Bi Syndrome."
Three beats per exhalation and three per inhalation constitute a pulse rate of six to seven beats per cycle, which is rapid. If the muscles at the Chi position are hot, it indicates Warm Disease. Generally, Warm Disease damages the fluids of the Metal (Lung) and Water (Kidney) organs. The Chi pulse belongs to the Kidney, and the Chi skin area relates to the Lung. Heat in this muscle area indicates Warm Disease. If not hot but the pulse is slippery, it is Wind Disease. Wind pathogens affect Yang Qi; Chi is Yin, hence not hot. If the pulse is rapid and choppy, there is excess Qi and insufficient Blood, resulting in Bi Syndrome.