(《灵枢·邪气脏腑病形篇》)
黄帝曰∶余闻五脏六腑之气,荥输所入为合,令何道从入?入安连过?愿闻其故。(五脏六腑皆有五 ,五 之所入
为合,即各经之合穴也。然手之三阳,复有连属上下、气脉相通者,亦谓之合,故此以入安连过为问。)岐伯答曰∶此阳
脉之别入于内,属于腑者也。(此下言六阳之经,内属于腑,因以明手之三阳,下合在足也。)黄帝曰∶荥输与合,各有
名乎?岐伯答曰∶荥输治外经,合治内腑。(荥 气脉浮浅,故可治外经之病。合则气脉深入,故可治内腑之病。)黄帝
曰∶治内腑奈何?岐伯曰∶取之于合。黄帝曰∶合各有名乎?岐伯答曰∶胃合于三里,(胃,足阳明也。三里,本经所入
为合也。)大肠合入于巨虚上廉,(大肠,手阳明也。本经之合在曲池,其下 则合于足阳明之巨虚上廉。)小肠合入于巨
虚下廉,(小肠,手太阳也。本经之合在小海,其下 则合于足阳明之巨虚下廉。)三焦合入于委阳,(三焦,手少阳也。
本经之合在天井,其下 则合于足太阳之委阳穴。按∶大肠小肠三焦,皆手三阳之经。然大小肠为下焦之腑,连属于胃,
其经虽在上,而气脉不离于下,故合于足阳明之巨虚上下廉。三焦为孤独之腑,其于三部九候无所不统,故经之在上者
属手, 之在下者居足。所以十二经中,惟此手之三阳,乃有下 。故《本输篇》曰∶大肠小肠,皆属于胃。三焦下 ,
在于足小趾之前,少阳之后,出于 中外廉,名曰委阳。即此谓也。详经络类十六。)膀胱合入于委中央,(膀胱,足太
阳也。委中,即本经之合。)胆合入于阳陵泉。(胆,足少阳也。阳陵泉,即本经之合。)黄帝曰∶取之奈何?岐伯答曰∶
取之三里者,低跗取之;巨虚者,举足取之;委阳者,屈伸而索之;(委阳在承扶下六寸。屈伸索之者,屈其股以察承扶
之阴纹,伸其足以度委阳之分寸也。)委中者,屈而取之;阳陵泉者,正竖膝予之齐,下至委阳之阳取之;(正竖膝予之
齐,谓正身蹲坐,使两膝齐也。委阳之阳,当作委中之阳,盖委中之外廉,即阳陵泉之次也。竖,上主切,又去声。)取
诸外经者,揄申而从之。(揄,引也。申,明也。取外经者在荥输,然亦必引正详明,方可从而治也。揄音余。)黄帝曰∶
愿闻六腑之病。岐伯答曰∶面热者足阳明病,鱼络血者手阳明病,两跗之上脉竖陷者足阳明病,此胃脉也。(足阳明之脉
行于面,故为面热。手阳明之脉行于手鱼之表,故为鱼络血。足面为跗,两跗之上脉,即冲阳也。竖者坚而实,陷者弱
而虚,皆足阳明胃脉之病。观下文云大肠病者与胃同候,则此胃脉也,盖兼手阳明而言。)大肠病者,肠中切痛而鸣濯濯,
冬曰重感于寒即泄,当脐而痛,不能久立,与胃同候,取巨虚上廉。(曰当作月。大肠属胃,故与胃同候。巨虚上廉,大
肠合也,故当取之。)胃病者,腹 胀,胃脘当心而痛,上支两胁,膈咽不通,饮食不下,取之三里也。(三里乃阳明之
合,故胃病者当取之。 音嗔。)小肠病者,小腹痛,腰脊控睾而痛,时窘之后,当耳前热,若寒甚,若独肩上热甚,及
手小指次指之间热,若脉陷者,此其候也,手太阳病也,取之巨虚下廉。(小肠气化于小腹,后附腰脊,下引睾丸,故为
诸痛及不得大小便而时窘之后,盖即疝之属也。耳前、肩上、小指次指之间,皆手太阳之经,故其病如此。其候则脉有
陷者。巨虚下廉,小肠合也,故当取之。睾音高,阴丸也。)三焦病者,腹气满,小腹尤坚,不得小便,窘急,溢则水留
即为胀,候在足太阳之外大络,大络在太阳少阳之间,亦见于脉,取委阳。(三焦受病,则决渎之官失其职,水道不利,
故为腹坚满,为小便窘急,为溢则水留而胀也。委阳为三焦下 ,故当取而治之。)膀胱病者,小便偏肿而痛,以手按之,
即欲小便而不得,肩上热若脉陷,及足小趾外廉及胫踝后皆热若脉陷,取委中央。(此皆膀胱之腑病。取委中央者,足太
阳经之合也。)胆病者,善太息,口苦呕宿汁,心下澹澹,恐人将捕之,嗌中 然数唾,在足少阳之本末,亦视其脉之
陷下者灸之,其寒热者取阳陵泉。(澹澹,失意貌。 然,有声也。本末者,在腑为本,在经为末也。其脉之陷下者为
不足,故宜灸。其寒热者为有邪,故宜取之阳陵泉,即足少阳经之合也。嗌音益。 音介。)黄帝曰∶刺之有道乎?岐伯
答曰∶刺此者必中气穴,无中肉节,中气穴则针染于巷,中肉节即皮肤痛。(经气所至,是谓气穴。肉有节界,是谓肉节。
染,着也。巷,道也。中其气穴则针着脉道而经络通,失其气穴则徒伤肉节而反为痛害矣。染,一本作游。)补泻反则病
益笃。中筋则筋缓,邪气不出,与其真相搏乱而不去,反还内着,用针不审,以顺为逆也。(补泻反用,病必益甚。不中
邪而中筋,邪必乘虚反与真气相乱,还着于内,皆以不审逆顺,用针者之罪也。)
(出自《灵枢·邪气脏腑病形篇》)
黄帝问道:我听说五脏六腑的经气,在荥穴、输穴之后流入并汇合于合穴,请问这些经气是从什么途径进入的?进入后又连接到哪里经过何处?希望听听其中的道理。(五脏六腑各有五个腧穴,五腧穴中经气所入的地方称为合,即各经的合穴。然而手部的三条阳经,还有上下连属、气脉相通的情况,也被称为合,所以这里用“从何处进入、连接经过何处”来提问。)
岐伯回答说:这是阳经别行的支脉深入体内,归属于六腑的。(下文讲述六条阳经内属于腑,借此说明手部的三条阳经的下合穴位于足部。)
岐伯回答说:荥穴、输穴治疗外经的病证,合穴治疗内腑的病证。(荥穴的气脉浮浅,所以可以治疗外经的疾病。合穴的气脉深入,所以可以治疗内腑的疾病。)
岐伯说:胃的下合穴是足三里。(胃,属于足阳明经。三里是本经经气汇入为合的地方。)大肠的下合穴在巨虚上廉。(大肠,属于手阳明经。本经的合穴在曲池,其下合穴则位于足阳明经的巨虚上廉。)小肠的下合穴在巨虚下廉。(小肠,属于手太阳经。本经的合穴在小海,其下合穴则位于足阳明经的巨虚下廉。)三焦的下合穴在委阳。(三焦,属于手少阳经。本经的合穴在天井,其下合穴则位于足太阳经的委阳穴。按语:大肠、小肠、三焦,都属于手三阳经。但大小肠属于下焦之腑,与胃相连属,它们的经脉虽然在上部,但气脉不离下部,所以下合穴在足阳明经的巨虚上、下廉。三焦是孤府,对三部九候无所不统,所以经脉在上部的属于手部,在下部的居于足部。因此在十二经脉中,只有手部的三条阳经才有下合穴。所以《本输篇》说:大肠、小肠都隶属于胃。三焦的下合穴,位于足小趾之前,少阳经之后,出于腓骨中外侧,名叫委阳。说的就是这种情况。详见经络类第十六节。)膀胱的下合穴在委中央(即委中)。(膀胱,属于足太阳经。委中,就是本经的合穴。)胆的下合穴是阳陵泉。(胆,属于足少阳经。阳陵泉,就是本经的合穴。)
黄帝问道:取穴的方法是怎样的?
岐伯回答说:取足三里时,要低俯脚背去取;取巨虚(上廉、下廉)时,要抬起脚去取;取委阳时,要屈伸腿部来寻找定位;(委阳在承扶穴下六寸。屈伸索之的意思是,屈曲大腿以观察承扶穴处的阴纹,伸直小腿以度量委阳穴的分寸。)取委中时,要屈膝去取;取阳陵泉时,身体端正竖立膝盖使其齐平,向下至委阳外侧的位置去取;(正竖膝予之齐,意思是端正身体蹲坐,使两膝高度一致。委阳之阳,应当是委中之阳,大概是指委中外侧,也就是阳陵泉所在的位置。竖,读音为上声主切,又读去声。)取外经穴位的人,要牵引舒展经脉从而顺其走向。(揄,意为引。申,意为明。取外经穴位在荥穴和输穴,但也必须引导端正、详细明确,才可以顺着它进行治疗。揄,读音同余。)
岐伯回答说:面部发热的,是足阳明经的病证;鱼际部位络脉血盛的,是手阳明经的病证;双脚背上方脉搏坚挺或陷下的,是足阳明经的病证,这就是胃的脉象。(足阳明经脉行于面部,所以表现为面部发热。手阳明经脉行于手鱼部的表面,所以表现为鱼际络脉血盛。脚面称为跗,两跗上方的脉搏,就是冲阳穴处。坚挺表示坚实而实,陷下表示虚弱而虚,这都是足阳明胃脉的病证。看下文说大肠病的表现与胃相同,那么这里的胃脉,大概兼指手阳明而言。)大肠有病,肠中剧烈疼痛且肠鸣漉漉,如果在冬季再次感受寒邪就会腹泻,疼痛在肚脐周围,不能久站,其表现与胃病相似,治疗应取巨虚上廉。(“曰”字应当作“月”。大肠隶属于胃,所以表现与胃相似。巨虚上廉是大肠的下合穴,所以应当取此穴。)
胃病的人,腹部胀满,胃脘当心而痛,向上支撑两侧胁肋,膈部和咽喉不通畅,饮食难以下咽,治疗应取足三里。(三里是阳明经的下合穴,所以胃病应当取此穴。嗔,音chēn。)
小肠有病,小腹疼痛,腰脊牵引睾丸而痛,时常窘迫想解大便,耳前发热,或者寒冷很甚,或者唯独肩部发热很甚,以及手小指和次指之间发热,或者脉搏陷下,这些都是其征候,属于手太阳经的病证,治疗应取巨虚下廉。(小肠的气化功能作用于小腹,后方连接腰脊,下方牵引睾丸,所以出现各种疼痛以及大小便不通而时常窘迫想解大便,这大概属于疝气的范畴。耳前、肩上、小指次指之间,都是手太阳经循行部位,所以病症如此。其征候则是脉搏有陷下的情况。巨虚下廉是小肠的下合穴,所以应当取此穴。睾,音gāo,指睾丸。)
三焦有病,腹部气机胀满,小腹尤其坚硬,小便不通,窘迫急迫,水液溢出停滞就会形成胀满,其征候反映在足太阳经外侧的大络,大络位于太阳经和少阳经之间,也可见于脉搏,治疗应取委阳。(三焦受病,则决渎之官失职,水道不利,所以出现腹部坚硬胀满,小便窘迫急迫,水液溢出停滞而形成胀满。委阳是三焦的下合穴,所以应当取此穴进行治疗。)
膀胱有病,小便偏侧肿胀而痛,用手按压,就想小便却排不出来,肩部发热或者脉搏陷下,以及足小趾外侧和胫骨踝后都发热或者脉搏陷下,治疗应取委中央。(这些都是膀胱腑的病证。取委中央,是因为它是足太阳经的合穴。)
胆有病的人,喜欢长叹气,口苦呕吐宿汁,心中悸动不安,好像被人要抓捕一样,咽喉中有异物感频繁吐唾沫,病位在足少阳经的本末之处,也要观察其脉搏陷下的地方进行艾灸,如果有寒热症状的,取阳陵泉。(澹澹,形容失意貌。嗌然,形容有声。本末,在腑为本,在经为末。其脉搏陷下的是不足,所以适宜艾灸。有寒热的是有邪气,所以适宜取阳陵泉,即足少阳经的合穴。嗌,音yì。嗌,音jiè。)
岐伯回答说:针刺这些穴位必须准确刺中气穴,不要刺中肉节。刺中气穴,针就像进入巷道一样通畅;刺中肉节,皮肤就会疼痛。(经气所到达的地方,叫做气穴。肌肉有分界界限,叫做肉节。染,附着的意思。巷,道路的意思。刺中气穴则针着于脉道而经络通畅,失掉气穴则徒然损伤肉节反而造成痛害。染,另一版本作游。)补法和泻法如果用反了,病情就会加重。刺中筋脉则会导致筋缓弛,邪气不能排出,邪气与真气相互混杂扰乱而不能去除,反而向内附着,这是因为用针不审慎,把顺逆搞错了。(补泻反用,病情必定更加严重。没有刺中邪气反而刺中筋脉,邪气必然乘虚与真气相乱,返回附着于内部,都是因为不审慎辨别顺逆,是用针者的罪过。)
(From *Ling Shu: Evil Qi, Zang-Fu Organs, and Disease Manifestations Chapter*)
Huangdi asked: I have heard that the Qi of the Zang and Fu organs flows into and converges at the He-Sea points after passing through the Ying-Spring and Shu-Stream points. By what pathway do they enter? Upon entering, where do they connect and pass through? I wish to hear the explanation. (Each of the five Zang and six Fu organs has five Shu points; the point where the Qi enters is called the He-Sea point, i.e., the He-Sea point of each meridian. However, the three Yang meridians of the hand also have connections between upper and lower parts with communicating Qi and vessels, which are also referred to as "He." Thus, the question here concerns the entry pathway and connection.)
Qibo replied: These are the divergent branches of the Yang meridians that enter internally and belong to the Fu organs. (The following text discusses how the six Yang meridians internally belong to the Fu organs, thereby clarifying that the lower He-Sea points of the three hand-Yang meridians are located on the feet.)
Huangdi asked: Do the Ying-Spring, Shu-Stream, and He-Sea points have specific names respectively?
Qibo replied: The Ying-Spring and Shu-Stream points treat diseases of the exterior meridians, while the He-Sea points treat diseases of the interior Fu organs. (The Qi at the Ying-Spring points is superficial, so it can treat diseases of the exterior meridians. The Qi at the He-Sea points penetrates deeply, so it can treat diseases of the interior Fu organs.)
Huangdi asked: How should one treat diseases of the interior Fu organs?
Qibo said: Select the He-Sea points for treatment.
Huangdi asked: What are the names of these He-Sea points?
Qibo said: The lower He-Sea point of the Stomach is Zusanli (ST36). (The Stomach belongs to the Foot-Yangming Meridian. Zusanli is the point where the meridian Qi converges as the He-Sea point.) The lower He-Sea point of the Large Intestine is Shangjuxu (ST37). (The Large Intestine belongs to the Hand-Yangming Meridian. The He-Sea point of this meridian is Quchi (LI11), but its lower He-Sea point is located at Shangjuxu (ST37) on the Foot-Yangming Meridian.) The lower He-Sea point of the Small Intestine is Xiajuxu (ST39). (The Small Intestine belongs to the Hand-Taiyang Meridian. The He-Sea point of this meridian is Xiaohai (SI8), but its lower He-Sea point is located at Xiajuxu (ST39) on the Foot-Yangming Meridian.) The lower He-Sea point of the Sanjiao (Triple Burner) is Weiyang (BL39). (The Sanjiao belongs to the Hand-Shaoyang Meridian. The He-Sea point of this meridian is Tianjing (TE10), but its lower He-Sea point is located at Weiyang (BL39) on the Foot-Taiyang Meridian. Note: The Large Intestine, Small Intestine, and Sanjiao all belong to the three hand-Yang meridians. However, the large and small intestines are Fu organs of the Lower Jiao and are connected to the Stomach. Although their meridians are in the upper body, their Qi and vessels do not depart from the lower body, hence their lower He-Sea points are on the Foot-Yangming Meridian at Shangjuxu and Xiajuxu. The Sanjiao is the solitary Fu organ, governing all aspects of the three divisions and nine inspections. Therefore, the part of the meridian in the upper body belongs to the hand, and the part in the lower body resides on the foot. Among the twelve meridians, only the three hand-Yang meridians have lower He-Sea points. Thus, the *Ben Shu* chapter states: "The Large Intestine and Small Intestine both belong to the Stomach." The lower He-Sea point of the Sanjiao is located anterior to the little toe of the foot, posterior to the Shaoyang meridian, emerging from the lateral side of the leg, named Weiyang. This refers to the aforementioned situation. See detailed discussion in the Meridians Category, Section 16.) The lower He-Sea point of the Bladder is Weizhong (BL40). (The Bladder belongs to the Foot-Taiyang Meridian. Weizhong is the He-Sea point of this meridian.) The lower He-Sea point of the Gallbladder is Yanglingquan (GB34). (The Gallbladder belongs to the Foot-Shaoyang Meridian. Yanglingquan is the He-Sea point of this meridian.)
Huangdi asked: What is the method for locating these points?
Qibo replied: When locating Zusanli, flex the foot dorsum to find it; when locating the Juxu points (Shangjuxu and Xiajuxu), elevate the foot to find them; when locating Weiyang, flex and extend the leg to search for it; (Weiyang is six cun below Chengfu (BL81). "Searching by flexion and extension" means flexing the thigh to observe the crease at Chengfu and extending the leg to measure the distance to Weiyang.) When locating Weizhong, flex the knee to find it; when locating Yanglingquan, sit upright with knees aligned horizontally, and locate the point laterally corresponding to Weiyang. (Sitting upright with knees aligned means sitting properly with both knees at the same height. "Laterality of Weiyang" likely refers to the lateral aspect of Weizhong, which corresponds to the position of Yanglingquan. "Shu" is pronounced with the rising tone or departing tone.) For locating points on the exterior meridians, guide and stretch the meridian to follow its course. ("Yu" means to draw/guide. "Shen" means clear/explicit. To treat exterior meridian diseases, one uses Ying-Spring and Shu-Stream points, but one must clearly guide and define the path before treating accordingly. "Yu" is pronounced like "yu".)
Huangdi said: I wish to hear about the diseases of the six Fu organs.
Qibo replied: Facial heat indicates a disease of the Foot-Yangming Meridian; blood engorgement in the collaterals of the thenar eminence (fish area) indicates a disease of the Hand-Yangming Meridian; vertical or depressed pulses on the dorsum of both feet indicate a disease of the Foot-Yangming Meridian, which is the pulse pattern of the Stomach. (The Foot-Yangming Meridian runs over the face, hence facial heat. The Hand-Yangming Meridian runs over the surface of the hand's thenar eminence, hence collateral engorgement there. The foot dorsum is called "Fu"; the pulses on the dorsum refer to Chongyang (ST42). Vertical implies firmness and excess; depressed implies weakness and deficiency. Both are pathological signs of the Foot-Yangming Stomach Meridian. As stated later, Large Intestine diseases present similarly to Stomach diseases, so this Stomach pulse pattern likely includes the Hand-Yangming Meridian.) In cases of Large Intestine disease, there is severe pain in the intestines with gurgling sounds; if exposed to cold in winter, diarrhea occurs, with pain around the umbilicus, and an inability to stand for long periods. The presentation is similar to Stomach disease; treatment should target Shangjuxu (ST37). ("Yue" should be read as "month". The Large Intestine is subordinate to the Stomach, hence similar presentations. Shangjuxu is the lower He-Sea point of the Large Intestine, so it should be selected.)
In cases of Stomach disease, there is abdominal distension, pain in the epigastrium centered behind the heart, radiation to both hypochondriac regions, obstruction in the diaphragm and pharynx, and difficulty swallowing food. Treatment should target Zusanli (ST36). (Zusanli is the He-Sea point of the Yangming Meridian, so it is indicated for Stomach disease.)
In cases of Small Intestine disease, there is pain in the lower abdomen, pain radiating from the lower back and spine to the testicles, frequent urgency to defecate, heat in front of the ears, severe cold, isolated intense heat on the shoulder, heat between the little finger and the ring finger, or depressed pulses. These are the signs of Hand-Taiyang Meridian disease; treatment should target Xiajuxu (ST39). (The Qi transformation of the Small Intestine acts on the lower abdomen, connects posteriorly to the lumbar spine, and draws downward to the testicles, causing various pains and urinary/fecal retention with urgency, resembling hernia conditions. The areas in front of the ears, on the shoulder, and between the fingers are pathways of the Hand-Taiyang Meridian, hence these symptoms. Depressed pulses are a sign. Xiajuxu is the lower He-Sea point of the Small Intestine, so it should be selected.)
In cases of Sanjiao (Triple Burner) disease, there is abdominal fullness due to Qi stagnation, particularly hardness in the lower abdomen, inability to urinate, urgency, and if water overflows and stagnates, distension ensues. The signs manifest in the large collaterals outside the Foot-Taiyang Meridian, located between the Taiyang and Shaoyang meridians, and may also be seen in the pulse. Treatment should target Weiyang (BL39). (When diseased, the Sanjiao loses its function as the official of drainage, leading to poor water passage, resulting in abdominal hardness/fullness, urinary urgency, and distension from fluid retention. Weiyang is the lower He-Sea point of the Sanjiao, so it should be treated.)
In cases of Bladder disease, there is unilateral swelling and pain in the urinary region; pressing with the hand creates the urge to urinate but results in nothing coming out. There may be heat on the shoulder or depressed pulses, as well as heat or depressed pulses at the lateral aspect of the little toe and posterior to the tibial malleolus. Treatment should target Weizhong (BL40). (These are all diseases of the Bladder Fu organ. Weizhong is selected because it is the He-Sea point of the Foot-Taiyang Meridian.)
In cases of Gallbladder disease, there is frequent sighing, bitter taste in the mouth, vomiting of old bile, palpitations/uneasiness in the heart region, fear of being captured, a sensation of obstruction in the throat with frequent spitting. The pathology lies at the root and branch of the Foot-Shaoyang Meridian. One should also examine for depressed pulses and apply moxibustion. For cases with chills and fever, target Yanglingquan (GB34). ("Dandan" describes a state of unease. "Ai ran" describes a sound. Root and branch refer to the Fu organ as the root and the meridian as the branch. Depressed pulses indicate deficiency, suitable for moxibustion. Chills and fever indicate pathogenic factors, suitable for needling Yanglingquan, the He-Sea point of the Foot-Shaoyang Meridian.")
Huangdi asked: Is there a principle for needling?
Qibo replied: When needling these points, one must accurately penetrate the Qi-Acups (Qi points) and avoid striking the flesh joints. Penetrating the Qi-Acup allows the needle to flow smoothly like a channel; striking the flesh joint causes skin pain. (Where meridian Qi arrives is called the Qi-Acup. Where muscle fibers have boundaries is called the flesh joint. "Ran" means adhering. "Xiang" means path/channel. Hitting the Qi-Acup connects the needle to the vessel pathway, unblocking the meridians; missing it merely injures the flesh joint, causing pain. "Ran" is alternatively written as "You".) If tonification and sedation are reversed, the illness will worsen. Needling the sinews leads to flaccidity; the pathogenic evil cannot exit. Instead, it mixes with the true Qi, creating chaos and remaining inside, attaching internally. This results from imprecise needling, confusing the correct and incorrect approaches, which is the fault of the practitioner. (Reversing tonification and sedation inevitably exacerbates the disease. Missing the evil and hitting the sinew allows the evil to exploit the deficiency, mixing with true Qi and returning inward. All these errors stem from failing to carefully discern the correct and incorrect methods, constituting the practitioner's fault.)