令患人用墩椅正坐,两足平蹋至地,膝与髀股高下俱平,两足相并,足趾前齐,尽脱去
上体
衣服(若不尽脱,则衣袖束臂,不能使胛骨相离,取穴不得。若气怯畏寒,则反着衣,以臂
穿袖,令领在胸前颈下,以襟交覆腰间,墨点定穴。灸时更着背心,以带束近穴处,勿令与
坐炷下火相碍。)曲脊伸臂,以两手按膝上,令中指当膝盖中,两大指紧相并,指头与膝盖
骨前齐,微用力直举。腕中勿令斜屈动摇(段彦聪仲谋大夫云∶石藏用谓以左手按右膝,右
手按左膝,则胛骨开。尝试用其说,则两手相交,腕有高下胛骨亦蹈之,偏侧当止,如旧法
以左手按左膝为是。)
\r正坐伸臂法图\p06-d16a7.bmp\r
令患人正坐,曲脊伸臂。以指揣项后脊骨,自第一 至第五 (更有大 ,在第一 上
宛宛
陷中,非有骨也。有骨处即是第一 ,二字《千金方》古方并作“椎”。王唯一校定《明堂
经》改木旁为佳。)逐 以墨点记之,令上下端直分明(墨点讫,便以蛤粉 干,即免有擦
动。)自第四 至第五 ,更以蜡纸或篾,比量两 上下相去远近,折为三分,亦以墨
界脊上 间,取第四 下二分微多,第五 上一分微少,用浓墨圈定,此是灸穴。相去六寸
之中,以为两穴高下远近之准(《千金方》谓穴近第五 ,用准望取之,故谓 上三分之一
也。)更量两 ,相去则同身寸一寸三分七厘微缩。有无大段,长短不同,以参合《甲乙经
》自大 至脊 并二十一 ,共长三尺之法,若 骨分明,纵有不同,穴以 数为定。
若以大 至尾 骨三尺法校之,则令其人平身正立,用劲直杖子,以地比度至脐中心截
断,
回杖子于背上,当脊骨中杖子尽处,即是第十四 下,第十五 上,当中命门穴也。又自命
门穴上,以同身寸量一尺三寸五分,即是第四 下九分七厘,第五 上四分,其两旁各三寸
,乃膏肓 穴也。若自第一 比向下,则当同身寸五寸一分有余是也。然人身上下停长短各
自不同,大概当以 骨为定也。王冰注《素问》云∶脊节为椎,脊穹为 。
\r揣椎骨定穴高下法\p06-d16a8.bmp\r
\r量脐心法\p06-d16a9.bmp\r
\r量命门穴上尺寸法\p06-d16a10.bmp\r
让患者坐在方凳上,身体端正坐直,双脚平稳踏地,膝盖与大腿的高度保持一致,两脚并拢,脚趾前端对齐。完全脱去上身衣物(如果无法完全脱下,则将衣袖束在手臂上,这样能使肩胛骨分开,便于取穴;若患者气虚怯弱、怕冷,则可以重新穿上衣服,将手臂穿过袖子,使衣领位于胸前颈部下方,用衣襟交叉覆盖腰部,用墨点标记穴位位置。施灸时再穿上背心,用带子束紧靠近穴位处,以免妨碍艾炷燃烧时的火焰。)弯曲脊柱,伸直双臂,双手按在膝盖上,让中指对准膝盖正中,两个大拇指紧紧并拢,指头与膝盖骨前缘齐平,微微用力向上抬起。手腕中间不要倾斜弯曲或动摇。(段彦聪仲谋大夫说:石藏用认为,用左手按住右膝,右手按住左膝,肩胛骨就会张开。我尝试使用这种方法,发现两手交叉时,手腕会有高低不平,肩胛骨也会随之倾斜偏侧,不如旧法用左手按住左膝来得准确。)
让患者端正坐直,弯曲脊柱,伸直双臂。用手指触摸项部后面的脊骨,从第一椎到第五椎(还有大杼穴,位于第一椎上方的凹陷处,并非骨骼。有骨头的地方就是第一椎,“椎”字在《千金方》的古方中均写作“椎”。王唯一校订《明堂经》时改为木字旁的“椎”为正确写法。)逐节用墨点做记号,使上下端点正直分明(墨点标记完后,立即用蛤粉吸干,以避免擦拭移动。)从第四椎到第五椎之间,再用蜡纸或竹篾,测量两椎上下之间的距离,将其分为三等分,也用墨线在脊背上界出椎间位置,取第四椎下二分略多,第五椎上一分略少的位置,用浓墨圈定,这就是灸治的穴位。在这相距六寸的范围之内,作为确定两个穴位高低远近的标准(《千金方》说穴位靠近第五椎,用望诊定位的方法,所以称为椎上三分之一处。)再测量两椎之间的距离,则相当于同身寸一寸三分七厘左右。虽然人体有大体长短的不同,但可以参考《甲乙经》从大椎到尾骶骨共二十一椎,总长三尺的方法,如果脊椎骨界限分明,即使长度有所不同,穴位仍以椎数为准。如果用从大椎到尾骶骨三尺的方法来校正,就让患者平身正立,用一根坚直的杖子,以地面比量至肚脐中心处截断,将杖子放回背部,当脊骨中间杖子尽头之处,即是第十四椎之下,第十五椎之上,正中的命门穴。再从命门穴向上,用同身寸量一尺三寸五分,即是第四椎下九分七厘,第五椎上四分,其两旁各三寸处,就是膏肓腧穴。如果从第一椎向下比量,则相当于同身寸五寸一分有余。然而人身上下长短比例各不相同,大体上应当以脊椎骨为定准。王冰注释《素问》时说:脊节的骨头称为椎,脊背的穹隆部分称为俞。
Instruct the patient to sit upright on a square stool, with both feet flat on the ground, knees and thighs at the same level, legs together, and toes aligned forward. Remove all upper body clothing (if it cannot be fully removed, bind the sleeves around the arms so that the scapulae can separate, allowing for accurate point location; if the patient has weak Qi and fears cold, they may put clothes back on, passing their arms through the sleeves, keeping the collar below the neck in front of the chest, and crossing the lapels over the waist. Mark the points with ink. During moxibustion, wear a vest and tie a belt close to the affected area to prevent interference with the flame from the moxa cone.) Bend the spine and extend the arms. Place both hands on the knees, aligning the middle fingers with the center of the kneecaps. Press the thumbs tightly together, with the fingertips aligned with the anterior edge of the patella. Apply slight upward force. Do not allow the wrists to bend obliquely or shake. (Duan Yancong, Physician Zhongmou, stated: Shi Cangyong believed that pressing the right knee with the left hand and the left knee with the right hand would cause the scapulae to open. I tried this method and found that when the hands cross, the wrists become uneven, and the scapulae tilt laterally. It is better to follow the old method of pressing the left knee with the left hand.)
Have the patient sit upright, bend the spine, and extend the arms. Use fingers to palpate the vertebral column behind the neck, from the first vertebra to the fifth vertebra (there is also Dazhu BL11, located in the depression above the first vertebra, which is not bone. The bony part is indeed the first vertebra; the character "Zhui" [vertebra] was written as "Chui" in ancient texts of *Qianjin Fang*. Wang Yiwei corrected *Mingtang Jing*, changing the radical to wood, which is considered correct.) Mark each vertebra sequentially with ink, ensuring the upper and lower ends are straight and distinct (After marking with ink, dry it immediately with clam powder to prevent smudging.) Between the fourth and fifth vertebrae, use wax paper or a bamboo strip to measure the distance between the two vertebrae, divide it into three equal parts, and mark the interspace on the spine with ink. Take slightly more than two-thirds down from the fourth vertebra and slightly less than one-third up from the fifth vertebra. Circle this area with thick ink; this is the moxibustion point. Within this six-cun span, establish the standard for the vertical and horizontal positioning of the two points (*Qianjin Fang* states the point is near the fifth vertebra, determined by visual estimation, hence referred to as the upper one-third of the vertebra.) Measure the distance between the two vertebrae again, which corresponds approximately to 1.37 cun of the "same-body inch." Although individuals vary significantly in height, reference the method in *Jia Yi Jing*: from Dazhu BL11 to the sacrococcygeal joint, there are 21 vertebrae totaling three chi in length. If the vertebral boundaries are clear, regardless of slight length variations, locate points based on vertebral count. To verify using the three-chi method from Dazhu to the coccyx, have the person stand upright. Use a straight rod, measuring from the ground to the center of the umbilicus, then cut the rod. Place the rod against the back along the midline of the spinal column. The end of the rod corresponds to the lower border of the fourteenth vertebra and the upper border of the fifteenth vertebra, where the Mingmen GV4 point is located. From Mingmen GV4, measure upward 1 chi 3 cun 5 fen using the same-body inch. This location is 9.7 fen below the fourth vertebra and 4 fen above the fifth vertebra. Three cun lateral to this midpoint on both sides is the Gaohuang BL43 acupoint. Measuring downward from the first vertebra, this corresponds to approximately 5.1 cun of the same-body inch. However, since human proportions vary, the vertebral column should generally serve as the primary reference. Wang Bing, in his commentary on *Su Wen*, stated: "The segmented bones of the spine are called Zhui [vertebrae], and the convex curve of the back is called Shu [acupoints/regions]."