用先截量下同身六寸蜡纸或篾,横置脊骨第五 上中央,墨圈定处。令寸数界尽当墨圈
中心
两头,平直各三寸,勿令展缩,于纸篾两头尽处,以墨圈之。令圈大小直径三分(《千金方
》云∶黄帝曰,灸不三分,是谓徒灸。炷务大也,小弱炷乃小作,以意商度之。小谓小儿,
弱谓虚弱之人也。)一半在纸篾头内,一半在纸篾头外,令与脊中第五 二墨圈定高下处。
三圈相直,以为两穴相去远近之准。
定穴相去远近之图
\r艾炷大小样式\p06-d16a11.bmp\r
又用前量同身寸纸篾,自脊中第五 上中央,墨所圈处,照脊骨端直向下,比量四寸,
至第
七,以墨点记。自墨点却两边向上斜量至灸穴圈中心,使各恰当同身寸之五寸,以为两穴
高下平直之准。
\r钩股取穴之图\p06-d16a12.bmp\r
\r钩股按穴取平法图\p06-d16a13.bmp\r
令患人平身正坐,自以右手从右肩上住附项,伸指直搭背上,以墨记其中指指头所及处
。左
手亦然,记之。又以胛骨上角摸索至胛骨下头,其间当有四肋三间(其四肋自胛骨横排至脊
骨上,用力按摩。如觉隐指,是筋而非骨。《千金方》谓,筋间空处,疑四肋肋字为误。而
王唯一于《铜人灸经》中,又并改筋间为肋间,及以右手从右肩上住亦同。《千金翼》改为
左肩上住,若以右手搭左肩,则指之所及在第五椎下,去穴甚远,皆非是,当以方为正也。
)灸穴当三间之中。根据胛骨下容侧指许,摩KT 肉之表,于筋间空处穴上按之。自觉牵引胸肩
中,(《千金翼》云∶牵引肩中,石藏用人用篦子或筋头按穴欲其坚实,令患人易觉也。)及
照
所圈灸穴,在先记患人指所及处之下,或旁侧指不可及处,以验穴之是非。然指有短长,肤
有丰瘦,若相合固善。如不合,即不可以此一端,遂废余法。亦有人胛骨去脊骨相远,过同
身寸三寸以上者,即难用脊 两旁各三寸之法,但求四肋三间之中,根据胛骨下容侧指许为穴
可也。
\r参验求穴法\p06-d16a14.bmp\r
使用预先截取的、长度等同于同身寸六寸的蜡纸或竹篾,横向放置在脊柱第五胸椎(第五椎)上缘的中央位置,用墨汁圈定该处。使这六寸的长度界限正好位于墨圈的中心,两端各延伸三寸,不要使其伸展或收缩。在纸片或竹篾两端的尽头处,再用墨汁圈出标记。要求这两个新圈的直径为三分(《千金方》记载:黄帝说,艾灸时艾炷底部直径若不足三分,称为徒灸,即无效之灸。艾炷务必做大些;如果艾炷过小虚弱,则适当减小,需根据具体情况斟酌衡量。“小”指小儿,“弱”指身体虚弱之人)。让这两个新圈的一半位于纸片或竹篾的头部内侧,一半位于外侧,使其与脊柱第五椎上下两个墨圈所定的高低位置对齐。这三个圈在一条直线上,以此作为确定左右两个穴位之间远近距离的标准。
[插图:定穴相去远近之图]
[插图:艾炷大小样式]
另外,使用前文制作的等同身寸的纸片或竹篾,从脊柱第五椎上缘中央被墨圈标记的地方开始,沿着脊柱骨端垂直向下测量四寸,到达第七胸椎(第七椎)的位置,用墨点做记号。从这个墨点向两侧向上斜着测量至艾灸穴位的墨圈中心,使每一侧的距离恰好等于同身寸五寸,以此作为确定左右两个穴位高低平齐的标准。
[插图:钩股取穴之图]
[插图:钩股按穴取平法图]
让患者端正平坐,自己用右手搭在右肩上按住颈部,手指伸直平放在背上,用墨汁标记中指指尖所触及的位置。左手也这样做,并做标记。然后再用手摸索肩胛骨的上角至肩胛骨的下端,其间应当有四根肋骨和三个间隙(这四根肋骨是从肩胛骨横排至脊柱上方的,用力按摩。如果感觉是指腹陷入的是筋而非骨,《千金方》认为,筋之间的空处,怀疑“四肋”的“肋”字是误写。而王唯一在《铜人灸经》中,又将“筋间”改为“肋间”,以及让右手搭在右肩上的方法也是相同的。《千金翼》改为搭在左肩上,如果用右手搭左肩,那么手指触及的位置在第五椎下方,距离穴位很远,都不正确,应当以本书的方法为准。)艾灸穴位应当位于这三个间隙的中间。依据肩胛骨下端,留出容纳侧放一指的空间,触摸肌肉表面,在筋间的空处穴位上进行按压。自觉有牵引感通向胸部和肩部(《千金翼》记载:牵引感在肩部,石藏人使用篦子或筋头按压穴位,目的是使其坚实,让患者更容易感觉到),并且对照之前圈出的艾灸穴位,该位置应在先前标记的患者手指触及处的下方,或者在旁边手指不可及的地方,以此来验证穴位的准确性。然而,人的手指有长短之分,皮肤有丰瘦之别,如果相符固然好。如果不符,就不能仅凭这一条标准就废弃其他方法。也有的人肩胛骨距离脊柱较远,超过同身寸三寸以上的,这就难以使用脊柱两旁各三寸的方法,只需寻找四根肋骨三个间隙的中间,依据肩胛骨下端留出容纳侧放一指的空间作为穴位即可。
[插图:参验求穴法]
Use a strip of wax paper or bamboo slip, pre-cut to a length equivalent to six *cun* (Chinese inches) of the patient's own body measurement. Place it horizontally across the center of the upper margin of the fifth thoracic vertebra (T5). Mark this position with an ink circle. Ensure that the six-*cun* length is centered within this ink circle, extending three *cun* on each side without stretching or shrinking. At the extreme ends of the paper strip or bamboo slip, mark two additional ink circles. The diameter of these circles should be three *fen* (one-tenth of a *cun*) (The *Qianjin Fang* records: The Yellow Emperor said, "If moxibustion cones are not at least three *fen* in diameter, the moxibustion is futile." Moxa cones should generally be large; if they are small or weak, reduce them appropriately based on judgment. "Small" refers to children, and "weak" refers to individuals with deficient constitutions.) Position these two new circles so that half lies inside the head of the paper strip/bamboo slip and half outside, aligning vertically with the high and low points defined by the upper and lower ink circles at T5. These three circles form a straight line, serving as the standard for determining the distance between the left and right acupoints.
[Diagram: Determining the Distance Between Acupoints]
[Diagram: Styles of Moxa Cone Sizes]
Furthermore, use the previously prepared paper strip or bamboo slip calibrated to the patient's *cun*. Starting from the ink-marked center at the upper margin of T5, measure vertically downward along the spine four *cun* to the level of the seventh thoracic vertebra (T7), and mark this point with ink. From this ink mark, measure diagonally upward toward the center of the ink circle marking the moxa application site on both sides. Each diagonal measurement should equal five *cun* of the patient's body measurement. This establishes the standard for the vertical alignment and levelness of the two acupoints.
[Diagram: Gougu Method for Locating Acupoints]
[Diagram: Diagram of the Gougu Method for Leveling Acupoints]
Instruct the patient to sit upright and steady. Have them place their right hand over the right shoulder, anchoring it against the neck, and extend their fingers flat against the back. Mark the location touched by the tip of the middle finger with ink. Repeat the same procedure with the left hand. Next, palpate from the superior angle of the scapula down to its inferior border. There should be four ribs and three intercostal spaces in between (These four ribs extend horizontally from the scapula to the spine; apply firm pressure during massage. If what feels like depression under the finger is tendon rather than bone, the *Qianjin Fang* suggests that the character "rib" in "four ribs" might be an error, referring instead to the space between tendons. Wang Yiwang, in the *Tongren Jiujing*, corrected "space between tendons" to "intercostal space." The method of placing the right hand over the right shoulder is consistent. The *Qianjin Yi* suggests placing the right hand over the left shoulder; however, doing so would cause the finger to touch below T5, far from the actual acupoint, which is incorrect. One should adhere to the method described here.) The moxa acupoint should be located in the middle of these three intercostal spaces. Based on the inferior border of the scapula, leave space sufficient for inserting one finger sideways, palpate the surface of the muscle tissue, and press upon the acupoint located in the space between the tendons. The patient should perceive a pulling sensation radiating to the chest and shoulder (The *Qianjin Yi* notes: "The sensation pulls to the shoulder." Shicang Ren used a comb or tendon-tip to press the acupoint to make it firmer, making it easier for the patient to perceive.) Compare this location with the previously circled moxa site; it should be below or to the side of the initial finger-touch mark, in areas unreachable by the finger, to verify the accuracy of the acupoint. However, finger lengths vary, and skin thickness differs. If they coincide, it is ideal. If they do not match, do not discard other methods based solely on this criterion. In cases where the scapula is significantly distant from the spine, exceeding three *cun*, the method of locating points three *cun* lateral to the spine may be difficult. Instead, simply locate the middle of the four ribs and three intercostal spaces, using the space beside the inferior scapular border accommodating one finger as the guide for the acupoint.
[Diagram: Verification Method for Locating Acupoints]