(《灵枢邪气脏腑病形篇》)
黄帝问于岐伯曰∶邪气之中人也奈何?岐伯答曰∶邪气之中人高也。(风寒中人,上先受之也。)黄帝曰∶高下有度
乎?岐伯曰∶身半已上者,邪中之也;身半已下者,湿中之也。(阳受风气阴受湿气也。)故曰∶邪之中人也无有常,中
于阴则溜于腑,中于阳则溜于经。(详如下文。)黄帝曰∶阴之与阳也,异名同类,上下相会,经络之相贯,如环无端。
邪之中人,或中于阴,或中于阳,上下左右,无有恒常,其故何也?(经脉相贯合一,本同类也;然上下左右部位各有
所属,则阴阳之名异矣。)岐伯曰∶诸阳之会,皆在于面。中人也,方乘虚时,及新用力,若饮食汗出腠理开,而中于邪。
中于面则下阳明,中于项则下太阳,中于颊则下少阳。(此言邪之中于阳经也。手足六阳,俱会于头面,故为诸阳之会。
凡足之三阳,从头走足,故中于面,则自胸腹下行于阳明经也。中于项,则自脊背下行于太阳经也。中于颊,则自胁肋
下行于少阳经也。脉遍周身者,惟足六经耳,故但言足也。)其中于膺背两胁,亦中其经。(膺在前,阳明经也。背在后,
太阳经也。两胁在侧,少阳经也。中此三阳经与上同。)
黄帝曰∶其中于阴奈何?岐伯答曰∶中于阴者,常从臂 始。夫臂与 ,其阴皮薄,其肉淖泽,故俱受于风,独伤
其阴。(此言邪之中于阴经也。 ,足胫也。淖泽,柔润也。臂 内廉曰阴,手足三阴之所行也,其皮薄,其肉柔,故邪
中于此,则伤其阴经。 音杭,又形敬切。淖音闹。)黄帝曰∶此故伤其脏乎?岐伯答曰∶身之中于风也,不必动脏。故
邪入于阴经,则其脏气实,邪气入而不能客,故还之于腑。故中阳则溜于经,中阴则溜于腑。(邪中阴经,当内连五脏,
因问故伤其脏也。然邪入于阴而脏气固者,邪不能客,未必动脏,则还之于腑,仍在表也,故邪中阳者溜于三阳之经,
邪中阴者溜于三阴之腑。如心之及小肠,脾之及胃,肝之及胆,包络之及三焦,肾之及膀胱,此以邪中三阴,亦有表证,
明者所当察也。溜,力救切。)
黄帝曰∶邪之中人脏奈何?岐伯曰∶愁忧恐惧则伤心。形寒寒饮则伤肺,以其两寒相感,中外皆伤,故气逆而上行。
(此下言邪之中于五脏也。然必其内有所伤,而后外邪得以入之。心脏神,忧愁恐惧则神怯,故伤心也。肺合皮毛,其
脏畏寒,形寒饮冷,故伤肺也。若内有所伤,而外复有感,则中外皆伤,故气逆而上行,在表则为寒热疼痛,在里则为
喘咳呕哕等病。本病论曰∶忧愁思虑即伤心;饮食劳倦即伤脾;人坐湿地,强力入水即伤肾;恚怒气逆,上而不下即伤
肝。详运气类四十四。)有所堕坠,恶血留内,若有所大怒,气上而不下,积于胁下则伤肝。(肝藏血,其志为怒,其经
行胁下也。)有所击仆,若醉入房,汗出当风则伤脾。(脾主肌肉,饮食击仆者,伤其肌肉。醉后入房,汗出当风者,因
于酒食,故所伤皆在脾。)有所用力举重,若入房过度,汗出浴水则伤肾。(肾主精与骨,用力举重则伤骨,入房过度则
伤精,汗出浴水,则水邪犯其本脏,故所在肾。)黄帝曰∶五脏之中风奈何?岐伯曰∶阴阳俱感,邪乃得往。黄帝曰∶善
哉。(此承上文而言五脏之中风者,必由中外俱感,而后邪乃得往。往,言进也。)
黄帝曰∶邪之中人,其病形何如?(同前篇。)岐伯曰∶虚邪之中身也,洒淅动形。正邪之中人也微,先见于色,不
知于身,若有若无,若亡若存,有形无形,莫知其情。黄帝曰∶善哉。(此节与官能篇大同,详针刺类十。又八正神明论
详言虚邪正邪之义,见针刺十三。)
(出自《灵枢·邪气脏腑病形篇》)
黄帝向岐伯问道:邪气侵袭人体是怎样的情况?岐伯回答说:邪气侵袭人体,是从上部开始的。(风寒之邪侵袭人体,上部先受邪。)黄帝问:这种高下有规律吗?岐伯说:身体半以上的部位,风邪容易侵袭;身体半以下的部位,湿邪容易侵袭。(阳经受风气,阴经受湿气。)所以说:邪气侵袭人体没有固定的规律,侵入阴经则流注于腑,侵入阳经则流注于经。(详细内容见下文。)黄帝说:阴与阳,名称不同但同类,上下交会,经络相互贯通,如圆环一样没有端点。邪气侵袭人体,有时侵入阴,有时侵入阳,上下左右,没有恒常的规律,这是什么原因呢?(经脉相互贯通合为一体,本来属于同类;然而上下左右各个部位各有归属,所以阴阳的名称就不同了。)岐伯说:所有阳经的交会处,都在面部。人受到邪气侵袭,往往是在正气虚弱之时,以及刚刚用力之后,或者饮食后出汗、腠理(皮肤毛孔及皮下组织间隙)开放的时候,从而被邪气所中。邪气中于面部,则下行至阳明经;中于项部,则下行至太阳经;中于颊部,则下行至少阳经。(这是说邪气侵袭阳经的情况。手足六条阳经,都汇聚于头面部,所以称为诸阳之会。凡是足部的三条阳经,都是从头部走向足部,所以中于面部,邪气就从胸腹下行进入阳明经;中于项部,邪气就从脊背下行进入太阳经;中于颊部,邪气就从胁肋下行进入少阳经。脉气遍布周身的主要是足部的六条经脉,所以这里只谈论足经。)邪气中于胸膺、背部和两胁,也是侵袭相应的经脉。(胸膺在前,属阳明经;背部在后,属太阳经;两胁在侧面,属少阳经。侵袭这三条阳经与上述情况相同。)
黄帝问:邪气侵袭阴经是怎样的情况?岐伯回答说:邪气侵袭阴经,通常从手臂和小腿内侧开始。手臂和小腿内侧,它们的皮肤薄,肌肉柔润,所以都容易受风邪侵袭,唯独损伤其阴经。(这是说邪气侵袭阴经的情况。“胕”,指小腿肚。淖泽,意为柔润。手臂和小腿内侧称为阴,是手足三阴经循行的部位,皮肤薄,肌肉柔嫩,所以邪气中于此,就会损伤阴经。“胕”音杭,又读形敬切。淖音闹。)黄帝问:这一定会损伤内脏吗?岐伯回答说:身体受到风邪侵袭,不一定都会触动内脏。所以邪气进入阴经,如果脏气充实,邪气进入后不能停留,就会返还到腑。所以侵入阳经则流注于经,侵入阴经则流注于腑。(邪气中于阴经,按理应当内连五脏,所以询问是否损伤了脏。然而邪气进入阴经而脏气坚固者,邪气不能客居,未必会动脏,就会返还到腑,仍然在表,所以邪气中于阳者流注于三阳经,邪气中于阴者流注于三阴腑。比如心与小肠相表里,脾与胃相表里,肝与胆相表里,心包络与三焦相表里,肾与膀胱相表里,这是因为邪气中于三阴经,也会有表证,明察的人应当注意这一点。“溜”,音力救切。)
黄帝问:邪气侵袭内脏是怎样的情况?岐伯说:愁忧恐惧会伤心。形体受寒、喝冷饮会伤肺,因为内外两种寒气相互感应,内外都受伤,所以气逆而上行。(以下讲邪气侵袭五脏的情况。然而必须内部先有损伤,然后外邪才能侵入。心脏藏神,忧愁恐惧则神气怯弱,所以伤心。肺合皮毛,其脏畏寒,形体受寒、饮用冷物,所以伤肺。如果内部已有损伤,外部又感受邪气,那么内外都受伤,所以气逆而上行,在表则表现为寒热疼痛,在里则表现为喘咳呕哕等疾病。《本病论》说:忧愁思虑即伤心;饮食劳倦即伤脾;人坐湿地,强力入水即伤肾;愤怒气逆,上而不降即伤肝。详见运气类第四十四。)如果有坠落创伤,恶血留滞体内,或者大怒,气上冲而不下降,积聚在胁下,就会伤肝。(肝藏血,其志为怒,其经脉行于胁下。)如果有击打跌倒,或者醉酒后行房事,出汗时当风,就会伤脾。(脾主肌肉,因饮食或击打跌倒,损伤的是肌肉。醉后行房,出汗当风,由于酒食所致,所以所伤的都在脾。)如果有用力举重,或者房事过度,出汗后洗澡,就会伤肾。(肾主精与骨,用力举重则伤骨,房事过度则伤精,出汗后洗澡,则水邪侵犯其本脏,所以伤肾。)黄帝问:邪气侵袭五脏是怎样的情况?岐伯说:阴阳都受到邪气侵袭,邪气才能深入。黄帝说:说得好啊。(这是承接上文来说五脏受风邪的情况,必须由内外俱感,然后邪气才能深入。往,意思是进。)
黄帝问:邪气侵袭人体,病症表现是怎样的?(同前篇。)岐伯说:虚邪侵袭身体,使人洒淅恶寒,身形动摇。正邪侵袭人体很轻微,首先表现在面色上,身体感觉不明显,若有若无,似亡似存,有形无形,没有人能知道它的确切情状。黄帝说:说得好啊。(这一节与《官能篇》大体相同,详见针刺类第十。另外《八正神明论》详细论述了虚邪和正邪的含义,见针刺第十三。)
(From "Ling Shu: Pathogenic Factors and Zang-Fu Diseases")
Huangdi asked Qibo, "How do pathogenic factors invade the human body?" Qibo replied, "Pathogenic factors invade from the upper part." (Wind-cold pathogens invade the upper part first.) Huangdi asked, "Is there a measure or pattern to this high-low distinction?" Qibo said, "For the upper half of the body, wind pathogens invade; for the lower half of the body, dampness pathogens invade." (Yang meridians receive wind Qi, Yin meridians receive dampness Qi.) Therefore it is said: "Pathogenic factors invading the body have no fixed pattern. If they invade the Yin, they flow into the Fu organs; if they invade the Yang, they flow into the Jing meridians." (Detailed below.) Huangdi said, "Yin and Yang are different in name but similar in category. They meet above and below, and the Jing-Luo meridians interconnect like a circle without beginning or end. When pathogenic factors invade, sometimes they invade Yin, sometimes Yang, up and down, left and right, with no constancy. What is the reason for this?" (The meridians interconnect as one, originally belonging to the same category; however, since each location above, below, left, and right has its specific domain, the names of Yin and Yang differ.) Qibo said, "All Yang meridians converge at the face. When invaded, it is often when the body is deficient, or after new exertion, or after eating/drinking with sweating and opening of the Couli (skin pores and interstitial spaces), allowing pathogens to strike. If the pathogen strikes the face, it descends to the Yangming Meridian; if it strikes the nape, it descends to the Taiyang Meridian; if it strikes the cheek, it descends to the Shaoyang Meridian." (This refers to pathogens invading Yang meridians. The six Yang meridians of the hand and foot all converge on the head and face, hence called 'convergence of all Yang'. All three Foot-Yang meridians run from head to foot; thus, invasion of the face leads downward to the Yangming Meridian via the chest and abdomen; invasion of the nape leads downward to the Taiyang Meridian via the back; invasion of the cheek leads downward to the Shaoyang Meridian via the flanks. The meridians circulating throughout the body are primarily the six Foot meridians, so only these are mentioned here.) If pathogens strike the chest, back, and flanks, they also invade their respective meridians. (The chest is anterior, belonging to Yangming; the back is posterior, belonging to Taiyang; the flanks are lateral, belonging to Shaoyang. Invasion of these three Yang meridians is the same as described above.)
Huangdi asked, "How does invasion of the Yin occur?" Qibo answered, "Invasion of the Yin usually begins at the arms and legs. The skin of the arms and inner calves is thin, and the flesh is soft and moist, so both are susceptible to wind pathogens, uniquely injuring the Yin." (This refers to pathogens invading Yin meridians. 'Fu' refers to the calf muscle. 'Naoze' means soft and moist. The inner aspect of the arm and leg is called Yin, where the three Yin meridians of the hand and foot travel. Since the skin is thin and the flesh soft, pathogens striking here injure the Yin meridians. 'Fu' is pronounced 'hang', also 'xingjing qie'. 'Nao' is pronounced 'nao'.) Huangdi asked, "Does this necessarily damage the Zang organs?" Qibo said, "When the body is invaded by wind pathogens, it does not necessarily disturb the Zang organs. Thus, when pathogens enter the Yin meridians, if the Zang Qi is solid, the pathogens cannot lodge, and they return to the Fu organs. Therefore, invasion of Yang flows into the meridians, and invasion of Yin flows into the Fu organs." (Pathogens invading Yin meridians should theoretically connect internally to the five Zang organs, hence the question of whether the Zang is damaged. However, if pathogens enter Yin meridians and the Zang Qi is firm, the pathogens cannot lodge, nor will they necessarily disturb the Zang; instead, they return to the Fu organs, remaining at the exterior level. Thus, pathogens invading Yang flow into the three Yang meridians, while those invading Yin flow into the three Yin Fu organs. For example, the Heart connects to the Small Intestine, Spleen to Stomach, Liver to Gallbladder, Pericardium to Sanjiao, and Kidney to Bladder. Because pathogens invading the three Yin meridians can present with exterior symptoms, discerning individuals must observe this. 'Liu' is pronounced 'lijiu qie'.)
Huangdi asked, "How do pathogens invade the Zang organs?" Qibo said, "Sorrow, worry, and fear damage the Heart. Physical cold exposure and cold drinks damage the Lungs, because the two types of cold interact, damaging both interior and exterior, causing Qi to rebel and move upward." (Below discusses pathogens invading the five Zang organs. However, internal injury must exist first before external pathogens can enter. The Heart houses the Shen (Spirit); sorrow and fear weaken the Shen, thus damaging the Heart. The Lungs combine with the skin and hair, and the organ fears cold; physical cold and cold drinks damage the Lungs. If there is internal injury and subsequent external contraction, both interior and exterior are damaged, causing Qi to rebel upward. At the exterior, this manifests as chills, fever, and pain; at the interior, as wheezing, coughing, vomiting, and hiccuping. The *Ben Bing Lun* states: Sorrow and overthinking damage the Heart; dietary irregularities and fatigue damage the Spleen; sitting on wet ground or forcing entry into water damages the Kidneys; anger with rebellious Qi that fails to descend damages the Liver. See Yunqi Category 44 for details.) Falling injuries with retained evil blood, or extreme anger causing Qi to rush upward without descending and accumulating under the flanks, damage the Liver. (The Liver stores Blood, its emotion is Anger, and its meridian travels through the flanks.) Blows, falls, sexual intercourse after drunkenness, sweating followed by wind exposure, damage the Spleen. (The Spleen governs muscles; blows and falls injure the muscles. Sexual activity after drunkenness with sweating and wind exposure, due to alcohol and food, results in injury to the Spleen.) Excessive lifting, excessive sexual activity, sweating followed by bathing in water, damage the Kidneys. (The Kidneys govern Essence and bones; heavy lifting injures bones, excessive sex injures Essence, and bathing in water while sweating allows Water pathogens to attack the root organ, thus damaging the Kidneys.) Huangdi asked, "How do pathogens invade the five Zang organs?" Qibo said, "Only when both Yin and Yang are affected can the pathogen advance." Huangdi said, "Well said!" (This continues the previous discussion regarding wind invasion of the five Zang organs: only through simultaneous internal and external contraction can the pathogen advance. 'Wang' means to enter/advance.)
Huangdi asked, "What are the clinical manifestations of pathogenic invasion?" (Same as the previous chapter.) Qibo said, "When Xu Xie (deficiency pathogens) invade the body, they cause shivering and trembling of the form. Zheng Xie (correct/pathogenic factors) invading the body is subtle; it first appears in the complexion, is not felt in the body, seeming to be there and not there, existing and yet perishing, having form and yet formless, such that no one knows its true nature." Huangdi said, "Well said!" (This section is largely identical to the *Guan Neng* chapter, see Acupuncture Category 10. Additionally, the *Ba Zheng Shen Ming Lun* details the meanings of Xu Xie and Zheng Xie, see Acupuncture 13.)