(《灵枢·五乱篇》全)
黄帝曰∶经脉十二者,别为五行,分为四时,何失而乱?何得而治?岐伯曰∶五行有序,四时有分,相顺则治,相
逆则乱。黄帝曰∶何谓相顺?岐伯曰∶经脉十二者,以应十二月;十二月者,分为四时;四时者,春秋冬夏,其气各异。
营卫相随,阴阳已和,清浊不相干,如是则顺之而治。(此下言一时血气之错乱,非宿疾有因之谓。气本五行,故曰五乱。)
黄帝曰∶何谓逆而乱?岐伯曰∶清气在阴,浊气在阳,营气顺脉,卫气逆行,清浊相干,乱于胸中,是谓大 。(清气属
阳而升,在阴则乱。浊气属阴而降,在阳则乱。营气阴性精专,行常顺脉。卫气阳性 悍,昼当行阳,夜当行阴。若卫
气逆行,则阴阳相犯,表里相干,乱于胸中而为 闷,总由卫气之为乱耳。 ,母本切。)故气乱于心,则烦心密嘿,俯
首静伏;乱于肺则俯仰喘喝,接手以呼;乱于肠胃,则为霍乱;(气乱于内者,上则在心肺,下则在肠胃也。嘿,默同。
俯,俯同,又音免。)乱于臂胫,则为四厥;乱于头,则为厥逆,头重眩仆。(气乱于外者,下在于四肢,上在于头也。)
黄帝曰∶五乱者,刺之有道乎?岐伯曰∶有道以来,有道以去,审知其道,是谓身宝。(道,言所由也。邪之来去,必有
其道,知其道则取病甚易,是谓保身之宝也。按∶此四句,虽以针刺为言,然实治法之要领,不可不知也。大凡疾病之
生,必有所自,是有道以来也。知其所自而径拔之,是有道以去也。能审其道,则自外而入者,自表而逐之;自内而生
者,自里而除之。自上来者可越之,自下来者可竭之。自热来者不远寒,自寒来者不远热。自虚而实者,先顾其虚,无
实则已;自实而虚者,先去其实,无虚则已。皆来去之道也。俗云来处来,去处去。此言虽浅,殊有深味,诚足为斯道
之法。)黄帝曰∶善。愿闻其道。岐伯曰∶气在于心者,取之手少阴、心主之输。(手少阴之输,神门也。心主之输,手
厥阴大陵也。)气在于肺者,取之手太阴荥、足少阴输。(手太阴之荥,鱼际也。足少阴之输,太溪也。气在肺而取肾者,
以少阴脉贯肾络肺也。)气在于肠胃者,取之足太阴、阳明,不下者取之三里。(取足太阴之输,太白也。足阳明之输,
陷谷也。三里亦足阳明穴。)气在于头者,取之天柱、大杼;不知,取足太阳荥、输。(天柱、大杼,俱足太阳经穴。不
知,不应也。当复取其荥、输二穴,通谷、束骨也。)气在于臂足,取之先去血脉,后取其阳明、少阳之荥、输。(臂足
之络有血者,必先去其血。在手者取手,在足者取足。手阳明之荥、输,二间、三间也。手少阳之荥、输,液门、中渚
也。足阳明之荥、输,内庭、陷谷也。足少阳之荥、输,侠溪、临泣也。)黄帝曰∶补泻奈何?岐伯曰∶徐入徐出,谓之
导气。补泻无形,谓之同精。(凡行针补泻,皆贵和缓,故当徐入徐出,在导气复元而已。然补者导其正气,泻者导其邪
气,总在保其精气耳,故曰补泻无形,谓之同精。)是非有余不足也,乱气之相逆也。(言本篇之法,非为有余不足而设,
特以乱气相逆,但宜导治之如是耳。此因帝问补泻,故复及之以明其义也。)黄帝曰∶允乎哉道,明乎哉论,请着之玉版,
命曰治乱也。
黄帝问道:十二经脉,分别对应五行,分为四季,是什么因素导致紊乱?又是什么因素使其恢复治疗?岐伯回答说:五行运行有序,四季各有分界,顺应则正常,违背则紊乱。黄帝问:什么叫顺应?岐伯说:十二经脉,对应十二月;十二月,分为四季;四季,即春、秋、冬、夏,它们的气机各不相同。营气与卫气相随,阴阳已经调和,清气与浊气不相干扰,像这样就是顺应而恢复正常。(此处下文讲的是某一时刻气血的错乱,并非指有宿疾病因的情况。气本源于五行,所以称为五乱。)
黄帝问:什么叫违背而紊乱?岐伯说:清气在阴分,浊气在阳分,营气顺行于脉中,卫气逆行,清浊之气相互干扰,扰乱于胸中,这叫做大悗(mèn,烦闷)。清气属阳而应上升,若在阴分则生乱。浊气属阴而应下降,若在阳分则生乱。营气阴性精专,常顺行于脉中。卫气阳性剽悍,白天应当行于阳分,夜晚应当行于阴分。如果卫气逆行,就会阴阳相犯,表里相干,扰乱于胸中而产生烦闷,总归是由卫气紊乱所致。因此,气乱于心,就会心烦意乱、沉默不语,低头静伏;气乱于肺,就会坐卧不安、喘息有声,双手按胸以助呼吸;气乱于肠胃,就会发生霍乱;气乱于手臂和小腿,就会发生四肢厥冷;气乱于头部,就会发生厥逆,头重眩晕跌倒。(气乱在内者,上在于心肺,下在于肠胃。嘿,通默。俯,同俯,又音免。气乱在外者,下在于四肢,上在于头部。)
黄帝问:对于五乱,针刺有法则吗?岐伯说:邪气有来路,就有去路,仔细知晓这个法则,就称为身体的珍宝。(道,指途径。邪气的来去,必定有其途径,知晓这个途径则治疗疾病很容易,这称为保身的法宝。按语:这四句,虽然说的是针刺,但实际上是治疗方法的要领,不可不知道。大凡疾病的产生,必定有所由来,这就是有道而来。知道它的由来并直接去除它,这就是有道而去。能够审察这个道,那么从外而入的,就从体表驱逐;从内而生的,就从体内清除。从上面来的可以超越它,从下面来的可以竭尽它。从热来的不远离寒法,从寒来的不远离热法。由虚转实的,先顾护其虚,没有实邪也就好了;由实转虚的,先去其实邪,没有虚象也就好了。这些都是来去的法则。俗语说“从哪里来,到哪里去”。这话虽然浅显,却很有深意,确实足以作为这一学说的法则。)黄帝说:好。希望听您讲讲这个法则。岐伯说:气在心部的,取用手少阴心经和手厥阴心包经的输穴。(手少阴心的输穴,是神门穴。心包的输穴,是手厥阴的大陵穴。)气在肺部的,取用手太阴肺经的荥穴和足少阴肾经的输穴。(手太阴肺的荥穴,是鱼际穴。足少阴肾的输穴,是太溪穴。气在肺却取肾经穴位,是因为足少阴肾经贯穿肾脏联络肺脏。)气在肠胃的,取用足太阴脾经和足阳明胃经,如果不见效,取用足三里穴。(取足太阴脾的输穴,是太白穴。足阳明胃的输穴,是陷谷穴。三里也是足阳明胃经的穴位。)气在头部的,取用天柱穴和大杼穴;如果无效,取用足太阳膀胱经的荥穴和输穴。(天柱、大杼,都是足太阳膀胱经的穴位。不知,指无效。应当再取用荥穴、输穴这两个穴位,即通谷穴、束骨穴。)气在手臂和足部的,取用时先去血脉瘀血,后取用足阳明胃经和足少阳胆经的荥穴和输穴。(手臂和足部的络脉如果有瘀血,必须先去除瘀血。在手部取手部穴位,在足部取足部穴位。手阳明大肠的荥穴、输穴,是二间穴、三间穴。手少阳三焦的荥穴、输穴,是液门穴、中渚穴。足阳明胃的荥穴、输穴,是内庭穴、陷谷穴。足少阳胆的荥穴、输穴,是侠溪穴、临泣穴。)黄帝问:补法和泻法怎么做?岐伯说:缓慢进入,缓慢退出,叫做导气。补法和泻法没有固定的形态区别,叫做同精。(凡是施行针刺补泻,都贵在平和舒缓,所以应当徐入徐出,旨在引导气机恢复元气。然而补法是引导正气,泻法是引导邪气,总在于保护精气,所以说补泻无形,称为同精。)这并不是因为有余或不足,而是乱气相互逆乱。(说明本篇的方法,不是为有余或不足而设,特别针对乱气相逆,只宜像这样进行导治。这是因为黄帝询问补泻,所以再次提及以阐明其义理。)黄帝说:真是高明的道啊,明晓的论述,请把它写在玉版上,命名为《治乱篇》。
Huangdi asked: The twelve meridians correspond to the Five Elements and are divided into the Four Seasons. What causes disorder? What leads to recovery and treatment? Qibo replied: The Five Elements operate in order, and the Four Seasons have distinct divisions. Following these principles results in health; violating them results in disorder. Huangdi asked: What does it mean to follow? Qibo said: The twelve meridians correspond to the twelve months; the twelve months are divided into the Four Seasons; the Four Seasons—Spring, Autumn, Winter, and Summer—have different Qi characteristics. Ying (Nutritive) Qi and Wei (Defensive) Qi follow each other, Yin and Yang are harmonized, and Clear Qi and Turbid Qi do not interfere with each other. In such a state, following these principles leads to recovery. (The following text discusses the disarray of Qi and Blood at a specific time, not referring to chronic diseases with underlying causes. Since Qi originates from the Five Elements, it is called "Five Disorders".)
Huangdi asked: What does it mean to violate and become disordered? Qibo said: Clear Qi resides in the Yin aspect, while Turbid Qi resides in the Yang aspect. Ying Qi flows smoothly within the vessels, but Wei Qi moves in reverse. Clear and Turbid Qi interfere with each other, causing chaos in the chest, which is called Da Men (severe oppression/stifling sensation). Clear Qi belongs to Yang and should ascend; if it resides in Yin, it becomes chaotic. Turbid Qi belongs to Yin and should descend; if it resides in Yang, it becomes chaotic. Ying Qi is Yin in nature, refined and concentrated, and usually flows smoothly within the vessels. Wei Qi is Yang in nature, swift and fierce; during the day it should circulate in the Yang aspects, and at night in the Yin aspects. If Wei Qi moves in reverse, Yin and Yang will clash, and the interior and exterior will interfere with each other, causing chaos in the chest and resulting in stifling sensations. This is ultimately due to the disorder of Wei Qi. Therefore, when Qi is disordered in the Heart, there is mental restlessness, silence, and a posture of bowing the head and sitting quietly; when disordered in the Lungs, there is difficulty breathing with audible sounds, needing to place hands on the chest to breathe; when disordered in the Stomach and Intestines, Huoluan (cholera-like vomiting and diarrhea) occurs; when disordered in the arms and shins, Si Jue (cold extremities) occurs; when disordered in the head, Jue Ni (reversal of Qi leading to fainting) occurs, accompanied by heavy head, dizziness, and falling. (Qi disordered internally affects the upper part—Heart and Lungs—and the lower part—Stomach and Intestines. Hei is synonymous with Mo [silence]. Fu is synonymous with Fu [bowing], pronounced mian. Qi disordered externally affects the lower part—four limbs—and the upper part—the head.)
Huangdi asked: Is there a principle for treating the Five Disorders through acupuncture? Qibo said: There is a way for pathogenic factors to enter, and a way for them to exit. Understanding this way thoroughly is considered the treasure of the body. (Dao refers to the pathway. Pathogenic factors must have a specific pathway for entry and exit; knowing this pathway makes treating the disease easier, thus serving as a treasure for preserving health. Note: Although these four sentences refer to acupuncture, they actually represent the essential principles of treatment methods, which must be understood. Generally, the emergence of any disease has its origin, which is the "way of entry." Knowing the origin and removing it directly is the "way of exit." By examining this way, pathogens entering from outside can be expelled from the surface, and those generated from inside can be eliminated from the interior. Those coming from above can be transcended, and those coming from below can be exhausted. Those originating from heat should not be treated far from cold methods, and those from cold should not be treated far from heat methods. When deficiency transforms into excess, first protect the deficiency until the excess resolves; when excess transforms into deficiency, first eliminate the excess until the deficiency resolves. These are all ways of entry and exit. The common saying is "come from where it came, go to where it goes." Though simple, this statement holds deep meaning and serves as a valid principle for this discipline.) Huangdi said: Excellent. I wish to hear about this principle. Qibo said: When Qi is disordered in the Heart, select the Shu-Stream points of the Hand-Shaoyin (Heart) Meridian and the Hand-Jueyin (Pericardium) Meridian. (The Shu-Stream point of the Heart is Shenmen; the Shu-Stream point of the Pericardium is Daling.) When Qi is disordered in the Lungs, select the Ying-Spring point of the Hand-Taiyin (Lung) Meridian and the Shu-Stream point of the Foot-Shaoyin (Kidney) Meridian. (The Ying-Spring point of the Lung is Yuji; the Shu-Stream point of the Kidney is Taixi. Selecting the Kidney meridian for lung disorders is because the Foot-Shaoyin Kidney Meridian passes through the Kidney and connects to the Lungs.) When Qi is disordered in the Stomach and Intestines, select the Foot-Taiyin (Spleen) and Foot-Yangming (Stomach) meridians; if ineffective, select Zusanli. (The Shu-Stream point of the Spleen is Taibai; the Shu-Stream point of the Stomach is Xangu. Zusanli is also a point on the Foot-Yangming Stomach Meridian.) When Qi is disordered in the Head, select Tianzhu and Dazhu; if ineffective, select the Ying-Spring and Shu-Stream points of the Foot-Taiyang (Bladder) Meridian. (Tianzhu and Dazhu are both points on the Foot-Taiyang Bladder Meridian. "Ineffective" means no response. One should then select the Ying-Spring and Shu-Stream points, Tonggu and Shugu.) When Qi is disordered in the arms and legs, first remove blood stasis from the collaterals, then select the Ying-Spring and Shu-Stream points of the Foot-Yangming (Stomach) and Foot-Shaoyang (Gallbladder) meridians. (If there is blood stasis in the collaterals of the arms or legs, the blood must be removed first. For hand issues, select hand points; for foot issues, select foot points. The Ying-Spring and Shu-Stream points of the Hand-Yangming Large Intestine are Erjian and Sanjian. The Ying-Spring and Shu-Stream points of the Hand-Shaoyang Sanjiao are Yemen and Zhongzhu. The Ying-Spring and Shu-Stream points of the Foot-Yangming Stomach are Neiting and Xangu. The Ying-Spring and Shu-Stream points of the Foot-Shaoyang Gallbladder are Xiaxi and Linqi.) Huangdi asked: How should tonification and sedation be performed? Qibo said: Slow insertion and slow withdrawal is called Dao Qi (guiding Qi). Tonification and sedation without fixed forms are called Tong Jing (same essence). (Acupuncture tonification and sedation should always be gentle and slow, so one should insert and withdraw slowly to guide Qi back to its original state. However, tonification guides healthy Qi, while sedation guides pathogenic Qi; both aim to preserve essence. Thus, it is said that tonification and sedation are formless, referred to as Tong Jing.) This method is not intended for conditions of excess or deficiency, but specifically for the reversal of disordered Qi. (This explains that the methods in this chapter are not designed for excess or deficiency per se, but specifically for guiding reversed disordered Qi. This mention of tonification and sedation arises from Huangdi's question to clarify the rationale.) Huangdi said: Truly profound is this Dao, and truly clear is this theory. Please inscribe it on the jade tablet and name it "Zhi Luan" (Treating Disorder).