(《素问·病能论》)
帝曰∶有病厥者,诊右脉沉而紧,左脉浮而迟,不然病主安在?(此言厥逆而为腰痛者,其病在肾也。右脉左脉,
皆以两尺为言。不然,《甲乙经》作不知,于义为妥,当从之。)岐伯曰∶冬诊之,右脉固当沉紧,此应四时;左脉浮而
迟,此逆四时。(冬气伏藏,故沉紧者为应时,浮迟者为逆,逆则为厥矣。)在左当主病在肾,颇关在肺,当腰痛也。(在
左者当主病在肾,此正以尺为言也。然浮者为肺脉,故云颇关在肺。)帝曰∶何以言之?岐伯曰∶少阴脉贯肾络肺,今得
肺脉,肾为之病,故肾为腰痛之病也。(肾脉本络于肺,今以冬月而肺脉见于肾位,乃肾气不足,故脉不能沉而见浮迟,
此非肺病,病在肾也。腰为肾之府,故肾气逆者,当病为腰痛。)
(《素问·腹中论》)
帝曰∶有病膺肿颈痛,胸满腹胀,此为何病?何以得之?(膺,胸之两旁高处也。颈,项前也。)岐伯曰∶名厥逆。
(膺肿颈痛,胸满腹胀,皆在上中二焦,此以阴并于阳,下逆于上,故病名厥逆。)帝曰∶治之奈何?岐伯曰∶灸之则喑,
石之则狂,须其气并,乃可治也。(喑,失音也。石,总针石而言。)帝曰∶何以然?岐伯曰∶阳气重上,有余于上,灸
之则阳气入阴,入则喑;(阳气有余于上而复灸之,是以火济火也。阳极乘阴,则阴不能支,故失声为喑。)石之则阳气
虚,虚则狂;(阳并于上,其下必虚,以石泄之,则阳气随刺而去,气去则上下俱虚,而神失其守,故为狂也。)须其气
并而治之,可使全也。(气并者,谓阴阳既逆之后,必渐通也。盖上下不交,因而厥逆,当其乖离而强治之,恐致偏绝。
故必须其气并,则或阴或阳,随其盛衰,察而调之,可使保全也。)
黄帝问道:患有厥逆病的人,诊察其右手脉象沉而紧,左手脉象浮而迟,那么这疾病主要在哪里呢?(这段文字论述的是因厥逆导致的腰痛,病位在肾脏。这里所说的右脉和左脉,都是指两尺部的脉象。“不然”二字,《甲乙经》作“不知”,在义理上更为妥当,应当遵从这一说法。)岐伯回答说:如果在冬季诊察,右手脉象本应沉紧,这是顺应四时变化的;左手脉象浮而迟,这是违背四时规律的。(冬季气候寒冷,阳气潜藏,所以脉象沉紧是顺应时令的表现,脉象浮迟则是违背时令,违背时令就会发生厥逆。)左手脉象异常,说明疾病主要在肾脏,但也与肺脏有关,患者会出现腰痛的症状。(左手脉象异常,说明疾病主要在肾脏,这里正是以尺脉而言。然而浮脉是肺的脉象,所以说也与肺脏有关。)黄帝问道:为什么这样说呢?岐伯回答说:足少阴肾经贯穿肾脏并联络肺脏,现在在肾脉的位置出现了肺的脉象,这是因为肾脏发生了病变,所以肾脏是导致腰痛的原因。(肾脉本来联络于肺,如今在冬季,肺的脉象出现在肾脉的部位,这是由于肾气不足,导致脉象不能沉潜反而出现浮迟,这并不是肺脏有病,而是肾脏有病。腰部是肾脏的外府,所以肾气逆乱,就会导致腰痛。)
黄帝问道:有人出现胸膺部肿胀、颈部疼痛、胸部胀满、腹部胀满,这是什么病?是怎么得的呢?(膺,是指胸廓两侧隆起的部分。颈,是指项部前方。)岐伯回答说:这种病名叫厥逆。(胸膺肿胀、颈部疼痛、胸部胀满、腹部胀满,这些症状都位于上焦和中焦,这是因为阴气并入阳气,下部之气逆乱上行,所以病名叫做厥逆。)黄帝问道:如何治疗呢?岐伯回答说:如果用艾灸治疗,会导致失音;如果用砭石泻法治疗,会导致发狂,必须等到阴阳之气调和贯通之后,才可以进行治疗。(喑,即失音。石,泛指砭石等针刺工具。)黄帝问道:为什么会这样呢?岐伯回答说:阳气亢盛于上部,上部阳气有余,如果此时施以艾灸,会使阳气陷入阴分,陷入则会导致失音;(上部阳气已经有余,如果再施以艾灸,就是火上浇油。阳极盛而乘袭阴分,阴气无法支撑,所以会失去声音成为喑哑。)如果用砭石泻法,会使阳气更虚,虚极则会导致发狂;(阳气并聚于上部,下部必然虚弱,如果用砭石泻法,会使阳气随着针刺而耗散,气机耗散则上下俱虚,神志失去守持,所以会导致发狂。)必须等到阴阳之气调和贯通后再进行治疗,才能使病人痊愈。(所谓气并,是指阴阳之气逆乱之后,逐渐恢复通畅。因为上下气机不交,因而导致厥逆,在其气机乖离之时强行治疗,恐怕会导致偏废或断绝。所以必须等待其气机调和,然后观察阴阳的盛衰情况,随其虚实进行调理,这样才能保全病人的生命。)
The Yellow Emperor asked: In cases of Jue-ni (Jue syndrome characterized by cold extremities and Qi rebellion), if the pulse on the right side is deep and tight, while the pulse on the left side is floating and slow, where is the disease primarily located? (This passage discusses lumbar pain caused by Jue-ni, indicating that the pathology lies in the Kidney. The terms "right pulse" and "left pulse" here refer specifically to the Chi position of both wrists. The phrase "Bu Ran" [Otherwise] is written as "Bu Zhi" [Do not know] in the *Jia Yi Jing*, which makes more logical sense and should be adopted.)
Qibo replied: If diagnosed in winter, the right pulse being naturally deep and tight corresponds to the seasonal changes; however, a left pulse that is floating and slow goes against the seasonal rhythm. (Winter energy is hidden and stored, so a deep and tight pulse is in accordance with the season, whereas a floating and slow pulse is contrary to it. Contrary to the season leads to Jue.) An abnormality in the left pulse indicates that the disease primarily resides in the Kidney, but also involves the Lung, manifesting as lumbar pain. (An abnormality in the left pulse points to the Kidney as the primary site, referring here to the Chi position. However, a floating pulse is characteristic of the Lung, hence it is said to involve the Lung.)
The Yellow Emperor asked: Why do you say so? Qibo replied: The Shaoyin (Kidney) meridian passes through the Kidney and connects with the Lung. Now, seeing the Lung pulse at the Kidney's position indicates that the Kidney is diseased, thus causing lumbar pain. (The Kidney meridian originally connects with the Lung. In winter, if the Lung pulse appears at the Kidney's position, it signifies insufficient Kidney Qi, preventing the pulse from sinking and resulting in a floating and slow presentation. This is not a Lung disease, but a Kidney disease. The waist is the mansion of the Kidney; therefore, when Kidney Qi rebels, it causes lumbar pain.)
The Yellow Emperor asked: A patient presents with swelling of the chest wall (Ying), neck pain, chest fullness, and abdominal distension. What disease is this, and how did it arise? (Ying refers to the high areas on both sides of the chest. Neck refers to the front of the nape.)
Qibo replied: This disease is named Jue-ni. (Swelling of the Ying, neck pain, chest fullness, and abdominal distension all occur in the Upper and Middle Jiao. This results from Yin merging into Yang, with lower Qi rebelling upward, hence the name Jue-ni.)
The Yellow Emperor asked: How should it be treated? Qibo replied: Moxibustion will cause aphonia (loss of voice); stone therapy (Bian shi) will cause mania. One must wait until the Qi harmonizes and merges before treatment can proceed. (Aphonia means loss of voice. Stone refers generally to Bian stones or acupuncture tools.)
The Yellow Emperor asked: Why is this so? Qibo replied: Yang Qi is heavy and ascends, becoming excessive in the upper body. If moxibustion is applied, Yang Qi enters the Yin, leading to aphonia. (Since Yang Qi is already excessive above, applying fire is like adding fuel to the fire. Extreme Yang attacks Yin, causing Yin to fail to support, resulting in loss of voice.) If stone therapy is used, Yang Qi becomes deficient; deficiency leads to mania. (Yang Qi has merged in the upper part, implying deficiency below. Using stone therapy to drain will cause Yang Qi to dissipate with the needle. When Qi dissipates, both upper and lower become deficient, and the Shen loses its residence, causing mania.) Treatment should only commence after the Qi has merged and harmonized, ensuring complete recovery. (Merging of Qi refers to the gradual restoration of flow after Yin and Yang have rebelled. Since the upper and lower do not communicate, Jue-ni occurs. Forcing treatment during this state of separation may lead to paralysis or severance. Therefore, one must wait for the Qi to merge, then observe the excess or deficiency of Yin or Yang, and regulate accordingly to ensure preservation of health.)