坐炷下火时,令患人一根据点穴时,正坐伸臂、头、项、肩、背、手、足、腕、膝不得少
有欹
侧,伸缩改易。即及臂中举按用力轻重,亦常令匀。若一事稍异于前,胛骨便辄相近,覆闭
灸穴艾炷,即在骨上;或胛骨开而相远,动争寸余,火气不入穴窍,徒受苦楚,无所益也。
若不失其穴,灸至数壮,觉胛骨中通热而不甚痛,意自快畅(石用之云∶当觉臂中习习然也
。)至数十壮后,或若腕中酸辛,若以机支,或用软帛于肘上腕中连束二臂,令缓急得所,
亦能少助。盖手欲按而臂欲举,故腕中费力,或少休顷刻亦无害,但要安顿身体四肢一如前
耳。如日灸五十壮,累至数百为佳。《千金方》云∶灸六百壮,至千壮,当觉气下砻砻然如
流水状,亦当有所下,其治疾之效甚众且敏(有上气喘满,实时平减者,有妇人经候不通已
八月,灸两日而下者,如此之类甚多。)穴至在上而最能下气,非它穴药石之比,而又无所
不治,有疾者宜留意焉。
\r坐点坐灸法图\p06-d16a15.bmp\r
石藏用,字用之,京师大医也。其治疗方术一从古法,亦多为人灸此穴。其取穴法∶令
患人
床榻上盘膝正坐,随人之肥瘠大小,置栲栳或垫枕之类,以衾絮冒之。令两臂相交,平伏其
上,余亦相同。乃用《千金方》不能久坐伸臂使伏衣袱上之意也。其用坚物云,欲大小高下
常定胜于衣袱。但臂之伸屈,与古异耳,其治皆效。盖医者意也,随事增损,初无定方。孙
真人笑秦缓之拙,不能求得此穴,但知针药之不及,不知火气之能彻,则求之浸巧,是不为
过也。
绍兴已未岁,余守武昌时。总领邵户部玉云∶少时病瘵得泉州僧为灸膏肓,令伏于栲栳
上,
僧以指节极力按寻其穴,令病者觉中指麻乃是穴。若指不麻,或虽麻而非中指者,皆非也。
已而求得之,遂一灸而愈。壬戌四月,增记于此。
\r石藏用取穴别法图\p06-d16a16.bmp\r
【坐点坐灸法】
当在穴位上放置艾炷并点燃施灸时,要求患者根据指定的取穴方法,端正坐姿,伸直手臂、头部、颈部、肩部、背部、手部、足部、腕部和膝盖,身体不得有任何倾斜或侧歪,也不得随意伸缩改变姿势。此时,手臂中举按用力的轻重程度,也应当保持均匀一致。如果某一环节与之前的要求稍有差异,肩胛骨就会随之靠近,导致覆盖并封闭了灸穴和艾炷,使艾炷直接置于骨骼之上;或者肩胛骨张开而距离变远,变动超过一寸多,导致火气无法进入穴位窍道,只是徒然让患者受苦,没有任何益处。
如果没有偏离穴位,施灸达到一定的壮数后,会感觉到肩胛骨中间有热感但并不十分疼痛,内心自然感到畅快舒适(石藏用说:应当感觉到手臂中有微微的麻痒感)。施灸到几十壮之后,可能会感觉手腕处酸胀辛痛,这就像是用机械支撑一样。可以用柔软的丝帛将两臂在肘部和腕部捆绑在一起,使松紧适度,也能起到一定的辅助作用。这是因为手想要按压而手臂想要举起,所以手腕处费力,如果稍作片刻休息也没有害处,但关键在于安置好身体和四肢,使其与之前保持一致。例如每天施灸五十壮,累积达到数百壮为佳。《千金方》中说:施灸六百壮,甚至一千壮,应当感觉到气向下流动,像流水一样顺畅,同时也会有病邪排出,其治疗疾病的功效非常多且迅速(例如:有的上气喘满的患者,灸后立刻平复;有的妇女月经不通已经八个月,灸两天后经血便通下,此类情况很多)。膏肓穴位于上部却最能降气,不是其他穴位和药物所能比拟的,而且没有它治不好的病,患有疾病的人应该留意这一点。
【石用之取穴别法】
石藏用,字用之,是京城的大医。他的治疗方术完全遵循古法,也经常为人灸治此穴。他的取穴方法是:让患者在床榻上盘膝正坐,根据人的胖瘦大小,放置栲栳(一种圆形竹器)或垫枕之类的物品,并用被褥棉絮包裹住。让两臂交叉,平稳地伏在上面,其余部分与前述方法相同。这是采用了《千金方》中不能久坐伸臂,而是使手臂伏在衣袱上的意思。他使用坚硬物体的说法,是为了让高低大小始终保持固定,胜过使用衣袱。只是手臂的伸展弯曲方式与古法不同,但治疗效果都是一样的。大概医者重在心意,随事情增减变化,本来就没有固定的程式。孙思邈嘲笑秦越人(秦缓)笨拙,不能求得这个穴位,只知道针灸药物达不到效果,不知道火气能够透彻深入,那么追求这种方法的精巧,并不算过分。
绍兴己未年,我担任武昌太守时。总领邵户部玉云说:他年轻时患痨病(肺结核),得到泉州一位僧人为他灸治膏肓穴,让他伏在栲栳上,僧人用手指节极力按压寻找穴位,让病人感觉到中指发麻才是正确的穴位。如果手指不麻,或者虽然麻但不是中指发麻,都不是正确的穴位。后来找到了穴位,于是灸了一次就痊愈了。壬戌年四月,在此补充记录。
[Method of Sitting and Pointing for Moxibustion]
When placing moxa cones on the acupoints and igniting them, the patient is instructed to follow the specific point-location method: sitting upright with arms, head, neck, shoulders, back, hands, feet, wrists, and knees extended. The body must not tilt or slant in any way, nor should it flex, extend, or change position arbitrarily. The force applied when raising and pressing the arms should remain consistent. If any aspect deviates even slightly from these requirements, the scapulae will move closer together, covering and obstructing the moxibustion point and the moxa cone, causing the cone to rest directly on the bone. Conversely, if the scapulae open and separate by more than one cun, the heat energy will fail to penetrate the acupoint orifice, resulting in suffering without benefit.
If the point is located accurately, after a certain number of moxa cones (zhuang) are burned, a sensation of heat will be felt between the scapulae without significant pain, bringing a sense of mental comfort and ease (Shi Zhiyong stated: one should feel a tingling sensation in the arm). After dozens of zhuang, there may be a sore or stinging sensation in the wrist, similar to mechanical strain. Binding both arms together at the elbows and wrists with soft silk cloth, ensuring appropriate tension, can provide some assistance. This occurs because the hand presses down while the arm lifts, straining the wrist; resting briefly is harmless, provided the body and limbs are positioned exactly as before. For instance, burning fifty zhuang per day, accumulating to several hundred, is considered ideal. *Qianjin Fang* states: "Burn six hundred zhuang, up to one thousand zhuang. One should feel Qi descending smoothly like flowing water, and pathological factors will be expelled. The therapeutic efficacy is numerous and rapid" (e.g., patients with asthma and chest fullness experience immediate relief; women with amenorrhea for eight months resume menstruation after two days of treatment; such cases are common). The Gaohuang acupoint, though located superiorly, is most effective in directing Qi downward, surpassing other acupoints and medicinal herbs, and is capable of treating virtually all ailments. Patients should pay close attention to this.
[Alternative Method of Shi Yongzhi for Locating Acupoints]
Shi Cangyong, courtesy name Yongzhi, was a prominent physician in the capital. His therapeutic methods strictly adhered to ancient traditions, and he frequently performed moxibustion on this acupoint. His method for locating the point is as follows: The patient sits upright with legs crossed on a bed or couch. Depending on the patient's body size and build, a bamboo basket (kaolao) or pillow is placed and wrapped in quilts or cotton padding. The arms are crossed and laid flat upon this support, while the rest of the posture remains consistent with previous descriptions. This approach aligns with the intent in *Qianjin Fang* to avoid prolonged sitting with extended arms, instead allowing the arms to rest on a cloth pad. Shi advocated using a firm object to ensure stable height and dimensions, which is superior to using a soft cloth pad. Although the extension and flexion of the arms differ from ancient methods, the therapeutic outcomes remain identical. Essentially, medical practice relies on clinical judgment; adjustments are made according to circumstances, as there is no fixed formula. Sun Simiao mocked Qin Huan (Bian Que) for his inability to locate this acupoint, noting that while acupuncture and herbal medicine might be insufficient, fire therapy could penetrate deeply. Thus, pursuing such refined techniques is justified.
In the Jiwei year of the Shaoxing era, while I served as the Prefect of Wuchang, Shao Yuyun, Minister of Revenue, recounted: In his youth, he suffered from consumption (phthisis/tuberculosis). A monk from Quanzhou treated him by moxibusting the Gaohuang acupoint. The patient was instructed to lie prone on a bamboo basket. The monk pressed firmly with his finger joints to locate the point, instructing the patient to identify the correct location by the sensation of numbness in the middle finger. If there was no numbness, or if the numbness was not in the middle finger, the location was incorrect. Upon correctly locating the point, a single session of moxibustion resulted in a cure. This account was added in the fourth month of the Renxu year.