诸本无篇字。马云。内有五禁、五夺、五过、五逆、九宜等法。然以五禁为首。故名篇。
五过 张云。补之过度。资其邪气。泻之过度。竭其正气。是五过也。
介按、疏五过论曰。不知病情。治之一过也。不知补泻。治之二过也。工不知诊。治之三过也。病不能
医。治之四过也。医不能明。治之五过也。
甲乙日自乘(止)是谓五禁 马云。天干之应人身。头为甲乙。肩喉为丙丁。戊己为手足。四
肢合辰戌丑未之四季。庚辛应股膝。壬癸应足胫。故凡天干自乘之日。皆无刺之。发 振埃。俱刺法名目。见
本经刺节真邪篇。张云。日自乘者。言其日之所直也。简案、据刺节真邪篇。发 之刺。治耳目之病。即头面
之病。振埃之刺。治咳喘胸满。肩息上气等之病。即肩喉兼全之病。去爪之刺。刺关节脉络四肢之病。
即泻脾土之水。
是五夺也 张云。此五夺者。皆元气之大虚者也。若再泻之。必置于殆。不惟针刺。用药亦然。
热病脉静(止)是谓五逆也 甲乙无下血 三字。张云。热病脉静。阳证得阴脉也。汗已出。脉躁
盛。真阴败竭也。病泄脉宜静。而反洪大者。孤阳邪胜也。着痹破 。身热而脉偏绝者。元有所脱也。淫而夺
形。身热下血 者。精血去而亡阴发热也。寒热夺形。而脉坚搏者。脾阴大伤。而真脏见也。凡此五逆者。皆
阴虚之病。故本神篇曰。阴虚则无气。无气则死矣。是皆不可刺者也。马云。其身热脉宜洪盛。今已偏绝。盖
偏则一手全无。绝则二手全无也。淫者好淫也。志云。淫者酷虐之邪。夺形者。邪伤形也。如但热不寒之疟气。
内藏于心。而外淫于分肉之间。令人消烁肌肉。简案、马偏绝及淫字之解。恐非也。伤寒论云。脉阴阳俱盛。
大汗出。不解者死。成氏注云。若汗出不解。则邪气内胜。正气外脱。故死。内经云。汗出而脉尚躁盛者死。
千金云。热病已得汗。脉尚躁盛。此阳脉之极也。死。
各版本中均无“篇”字。马云认为,书中包含五禁、五夺、五过、五逆、九宜等法则,然而以“五禁”列为首要,因此命名为该篇。
五过:张云指出,补益过度,会助长邪气;泻法过度,会耗竭正气,这就是五过。
介按(丹波元简按语):《素问·疏五过论》中说:不了解病情而治疗,是第一种过失;不懂得补泻原则而治疗,是第二种过失;医生不懂诊脉,是第三种过失;疾病无法治愈而强行治疗,是第四种过失;医生不能明察病机,是第五种过失。
甲乙日自乘(止)是谓五禁:马云说,天干与人体相应,头部对应甲乙,肩喉对应丙丁,手足对应戊己,四肢合于辰戌丑未这四个季节之末的月份,股膝对应庚辛,足胫对应壬癸。所以凡是天干自相重叠(即天干值日与其五行属性相同)的日子,都不可针刺。“发汗”和“振埃”都是刺法的名称,见于本经《灵枢·刺节真邪》篇。张云说,“日自乘”是指日子所直临的天干。简案(丹波元简案语):根据《刺节真邪》篇,“发汗”刺法,治疗耳目之病,即头面部的疾病;“振埃”刺法,治疗咳嗽气喘、胸满、抬肩呼吸、气逆上冲等病,即肩喉兼有的疾病;“去爪”刺法,治疗关节脉络及四肢的疾病,即泻除脾土的水湿。
是五夺也:张云说,这五种“夺”,都是元气极度虚弱的表现。如果再使用泻法,必然导致危险。不仅针刺如此,用药也是如此。
热病脉静(止)是谓五逆也:《甲乙经》中没有“下血”二字。张云说,热病而脉象静止,这是阳证得了阴脉;出汗后,脉象反而躁动盛大,这是真阴败竭的表现;患泄泻病,脉象宜静,反而洪大,这是孤阳邪胜的表现;着痹导致肌肉破溃,身体发热而脉搏偏绝,这是元气有所脱失的表现;淫邪导致形体消瘦,身体发热并伴有下血,这是精血流失而亡阴发热的表现;寒热交替导致形体消瘦,而脉搏坚劲搏指,这是脾阴大伤而真脏脉现的表现。这五种“逆”,都是阴虚的病证,所以《本神》篇说:“阴虚则无气,无气则死。”这些都是不可针刺的情况。马云说,身体发热时脉象宜洪盛,现在却偏绝。所谓“偏”,是指一只手完全无脉;所谓“绝”,是指两只手完全无脉。“淫”指好色纵欲。志云:“淫者酷虐之邪。”“夺形”指邪气损伤形体。例如但热不寒的疟疾之气,内藏于心,外淫于分肉之间,使人肌肉消烁。简案:马云对“偏绝”和“淫”字的解释,恐怕不正确。《伤寒论》说:“脉阴阳俱盛,大汗出,不解者死。”成无己注解说:“若汗出不解,则邪气内胜,正气外脱,故死。”《内经》说:“汗出而脉尚躁盛者死。”《千金方》说:“热病已得汗,脉尚躁盛,此阳脉之极也,死。”
None of the extant versions contain the character "Pian" (Chapter). Ma Yun stated that the text contains methods such as the Five Prohibitions, Five Depletions, Five Errors, Five Reversals, and Nine Suitabilities. However, since the "Five Prohibitions" are listed first, the chapter is named accordingly.
Five Errors: Zhang Yun pointed out that excessive tonification will nourish pathogenic factors, while excessive purgation will exhaust healthy Qi; these constitute the Five Errors.
Jie's Note (Danbo Yuanjian's commentary): The *Suwen: Shu Wu Guo Lun* states: Treating without understanding the condition is the first error; treating without knowing the principles of tonification and purgation is the second error; a physician who does not know pulse diagnosis is committing the third error; treating a disease that cannot be cured is the fourth error; a physician who fails to clarify the pathology is committing the fifth error.
"Jia and Yi days self-multiplying (up to this point) are called the Five Prohibitions": Ma Yun said that the Heavenly Stems correspond to the human body: the head corresponds to Jia and Yi, the shoulders and throat to Bing and Ding, the hands and feet to Wu and Ji, the four limbs combine with the last months of the four seasons (Chen, Xu, Chou, Wei), the thighs and knees correspond to Geng and Xin, and the lower legs correspond to Ren and Gui. Therefore, on days when the Heavenly Stem self-multiplies (i.e., the stem coincides with its elemental nature), acupuncture should not be performed. "Fa Han" (Inducing Sweating) and "Zhen Ai" (Shaking Off Dust) are names of needling techniques, found in the *Lingshu: Ci Jie Zhen Xie* chapter. Zhang Yun said that "day self-multiplying" refers to the Heavenly Stem presiding over that day. Jian's Note (Danbo Yuanshou's commentary): According to the *Ci Jie Zhen Xie* chapter, the "Fa Han" technique treats diseases of the ears, eyes, and mouth, i.e., disorders of the head and face; the "Zhen Ai" technique treats coughs, asthma, chest fullness, shoulder breathing, and rebellious Qi, i.e., disorders involving both the shoulders/throat; the "Qu Zhua" (Removing Claws) technique treats diseases of the joints, collaterals, and four limbs, which involves draining dampness from the Spleen Earth.
These are the Five Depletions: Zhang Yun said that these five types of "Depletion" all represent extreme deficiency of Yuan Qi (Original Qi). If one were to apply purgative methods again, it would inevitably lead to danger. This applies not only to acupuncture but also to herbal medicine.
"Heat disease with quiet pulse (up to this point) are called the Five Reversals": The *Jiayi Jing* lacks the three characters "xia xue" (lower bleeding). Zhang Yun said: Heat disease with a quiet pulse indicates that a Yang syndrome has received a Yin pulse; after sweating, if the pulse is still restless and vigorous, it indicates the exhaustion of True Yin; in cases of diarrhea, the pulse should be quiet, but if it is instead洪大 (Hong Da / large and forceful), it indicates solitary Yang and victorious pathogens; in Zhu Bi (Fixed Bi-syndrome) with muscle erosion, if the body is hot and the pulse is biasedly absent, it indicates the loss of Yuan Qi; if pathogenic influence causes emaciation, accompanied by body heat and lower bleeding, it indicates the loss of essence and blood leading to Yin collapse and fever; if alternating cold and heat cause emaciation, and the pulse is firm and beating strongly, it indicates severe injury to Spleen Yin and the appearance of the Zang-organ pulse. All these five "Reversals" are diseases of Yin deficiency. Thus, the *Ben Shen* chapter states: "Yin deficiency leads to lack of Qi; lack of Qi leads to death." These are all conditions where acupuncture is contraindicated. Ma Yun said: When the body is hot, the pulse should be Hong Sheng (large and vigorous); now it is Pian Jue (biasedly absent). "Pian" means one hand has no pulse at all; "Jue" means both hands have no pulse at all. "Yin" refers to licentiousness. Zhi said: "Yin refers to cruel and tyrannical pathogens." "Duo Xing" means pathogens damaging the form. For example, malaria characterized by heat without chills stores internally in the Heart and externally invades the interstices of muscles, causing the flesh to waste away. Jian's Note: Ma's interpretation of "Pian Jue" and "Yin" is likely incorrect. The *Shanghan Lun* states: "If the pulses at the Yin and Yang positions are both vigorous, and profuse sweating occurs without resolution, death ensues." Cheng Wuji commented: "If sweating does not resolve the condition, then pathogenic factors prevail internally while healthy Qi collapses externally, hence death." The *Neijing* states: "If sweating occurs and the pulse remains restless and vigorous, death ensues." The *Qianjin Fang* states: "In heat disease, if sweating has occurred but the pulse remains restless and vigorous, this is the extreme of Yang pulses, indicating death."