(《灵枢·大惑论》)
黄帝问于岐伯曰∶余尝上于清冷之台,中阶而顾,匍匐而前,则惑。余私异之,窃内怪之,独瞑独视,安心定气,
久而不解。独博独眩,被发长跪,俯而视之,后久之不已也。卒然自上,何气使然?(台之高者其气寒,故曰清冷之台。
凡人登高博望,目见非常之处,无不神魂惊荡而心生眩惑,故特借此以问其由然也。匍音蒲。匐,伏、HT
二音。眩音玄,
又去声。)岐伯对曰∶五脏六腑之精气,皆上注于目而为之精。(为之精,为精明之用也。义如脉色类三十。)精之窠为眼,
(窠者,窝穴之谓。眼者,目之总称。五脏六腑之精气皆上注于目,故眼为精之窠而五色具焉。窠音科。)骨之精为瞳子,
(瞳子,眸子也。骨之精,主于肾,肾属水,其色玄,故瞳子内明而色正黑。瞳音同。眸音谋。)筋之精为黑眼,(黑,
眼黑珠也。筋之精,主于肝,肝色青,故其色浅于瞳子。)血之精为络,(络,脉络也。血脉之精,主于心,心色赤,故
络之色皆赤。)其窠气之精为白眼。(窠气者,言目窠之气也。气之精,主于肺,肺属金,故为白眼。)肌肉之精为约束,
裹撷筋骨血气之精,而与脉并为系,上属于脑,后出于项中。(约束,眼胞也。能开能阖,为肌肉之精,主于脾也。脾属
土,所以藏物,故裹撷筋骨血气四脏之精,而并为目系,以上出于脑项之间。撷,爻结切,以衣衽收物谓之撷。)故邪中
于项,因逢其身之虚,其入深则随眼系以入于脑,入于脑则脑转,脑转则引目系急,目系急则目眩以转矣,邪其精,其
精所中不相比也则精散,精散则视岐,视岐见两物。(前邪字,邪气也。后邪字,与斜同。邪气中于风府、天柱之间,乘
其虚则入脑连目,目系急则目眩睛斜,故左右之脉互有缓急,视岐失正,则两睛之所中于物者,不相比类而各异其见,
是以视一为两也。此承帝问而先发邪气之中人者如此,以明下文之目见非常者,亦犹外邪之属耳。)目者,五脏六腑之精
也,营卫魂魄之所常营,神气之所生也。(脏腑营卫魂魄所至者皆神气也,故目为神气之所生。)故神劳则魂魄散,志意
乱。是故瞳子黑眼法于阴,白眼赤脉法于阳也,故阴阳合传而精明也。(阴阳,即精神之本,故阴阳合传而成精明之用。)
目者心使也,心者神之舍也,故神精乱而不转,卒然见非常处,精神魂魄散不相得,故曰惑也。(精神虽统于心,而外用
则在目,故目为心之使,心为神之舍,所以目见非常于外,则神魂眩惑于心也。)黄帝曰∶余疑其然。余每之东苑,未曾
不惑,去之则复,余唯独为东苑劳神乎?何其异也?(每之东苑,未曾不惑,谓虽不登高,其惑亦然,故疑异也。)岐伯
曰∶不然也。心有所喜,神有所恶,卒然相感则精气乱,视误故惑,神移乃复。(偶为游乐,心所喜也。忽逢奇异,神则
恶之。夫神有所恶,则志有不随,喜恶相感于卒然,故精气为乱。去之则神移,神移则复矣。)是故间者为迷,甚者为惑。
(间者,言其未甚也,亦足相迷;况其甚者,能无惑乎?)
黄帝曰∶人之善忘者,何气使然?岐伯曰∶上气不足,下气有余,肠胃实而心肺虚,虚则营卫留于下,久之不以时
上,故善忘也。(下气有余,对上气不足而言,非谓下之真实也。心肺虚于上,营卫留于下,则神气不能相周,故为善忘,
阳衰于上之兆也。)
黄帝曰∶人之善饥而不嗜食者,何气使然?岐伯曰∶精气并于脾,热气留于胃,胃热则消谷,谷消故善饥。胃气逆
上则胃脘寒,故不嗜食也。(胃气逆上而不能营运,即其寒也。脾胃热而胃脘寒,所以虽饥而不欲食。本论诸邪有总治之
法,曰先其脏腑,诛其小过,后调其气,盛者泻之,虚者补之,必先明知其形志之苦乐,定乃取之,一节。详后八十三。
盖彼此同出一论,今类从于彼,所当参用。嗜音示。)
(出自《灵枢·大惑论》)
黄帝向岐伯问道:我曾经登上清冷台,走到台阶中间回头张望,或者趴着身子向前爬行,就会感到头晕目眩。我心里暗自觉得奇怪,内心对此感到困惑,独自闭眼或睁眼,安心定气,许久都不能消除这种眩晕感。独自远望或近看时出现眩晕,披散头发长时间跪坐,俯身注视地面,过了很久症状仍不消失。这种突然产生的眩晕,是什么气导致的呢?(注:高台的空气寒冷,所以称为清冷台。凡是人登高望远,看到非同寻常的景象,无不神魂惊动而产生眩晕迷惑,因此特意借此来询问其中的原因。“匍”音蒲,“匐”有伏、HT二音。“眩”音玄,又读去声。)
岐伯回答说:五脏六腑的精气,都向上灌注于眼睛,从而形成视觉的清明。(所谓“为之精”,是指发挥明察秋毫的作用,含义如同脉色类第三十篇所述。精气汇聚之处称为眼窠,)(眼窠,即窝穴的意思。眼,是眼睛的总称。五脏六腑的精气都上注于目,所以眼睛是精气的汇聚之所,且具备五色之象。“窠”音科。)骨的精气表现为瞳子,(瞳子,即黑眼球。骨的精气由肾主宰,肾属水,其色为黑,所以瞳子内部明亮而颜色纯正发黑。“瞳”音同,“眸”音谋。)筋的精气表现为黑眼珠(即虹膜部分),(黑色,指黑眼球周围的部分。筋的精气由肝主宰,肝色青,所以这部分的颜色比瞳子浅。)血的气血精华表现为络脉,(络,即脉络。血脉的精气由心主宰,心色赤,所以络脉的颜色都是红色的。)气的气血精华表现为白眼(即巩膜部分),(所谓“窠气”,是指眼睑内的气。气的精气由肺主宰,肺属金,所以呈现白色。)肌肉的精气表现为约束(即眼睑),(约束,指眼睑。它能开合,属于肌肉的精气,由脾主宰。脾属土,具有容纳万物的特性,所以包裹摄取筋骨血气四脏的精气,并汇合并成为目系,向上连接至脑部,向后出于项中。“撷”音爻结切,用衣襟收物叫做撷。)
因此,如果邪气侵袭颈部,恰好遇到人体正气虚弱,邪气深入就会随着目系进入脑部。进入脑部后会导致脑转(头脑晕旋),脑转则会牵引目系紧张,目系紧张就会导致眼睛眩晕转动。邪气扰乱精气,使得被邪气侵入的精气与正常精气不相协调,从而导致精气涣散;精气涣散就会出现视一为二的复视现象,看东西变成两个物体。(前一个“邪”字指邪气,后一个“邪”字通“斜”。邪气中风府、天柱穴之间,趁着人体虚弱进入脑部并连及眼睛,目系紧张导致眼睛眩晕且视线偏斜,因此左右经脉互有缓急,视物失真,双眼所看到的物体不相一致而各自不同,所以看一个物体却看成两个。这是承接黄帝的提问,先阐述邪气伤人的情况,以说明下文提到的看见非常景象,也类似于外邪致病的情况。)
眼睛,是五脏六腑精气的汇聚处,也是营卫、魂魄经常循行之处,更是神气产生所在。(脏腑、营卫、魂魄到达的地方都有神气,所以眼睛是神气产生的地方。)因此,精神过度劳累会导致魂魄离散,意志混乱。所以,瞳子和黑眼球效法阴,白眼球和赤色脉络效法阳,阴阳结合传递才能产生明亮的视觉功能。(阴阳,即精神的根本,所以阴阳结合传递才能形成明察的功能。)
眼睛是心的使者,心是神的居所,所以如果精神紊乱不能正常运转,突然看到非同寻常的景象,精神、魂魄分散而不能相互协调,这就叫做“惑”。(精神虽然统摄于心,但外在表现则在眼睛,所以眼睛是心的使者,心是神的居所,因此眼睛在外看到异常景象,心神就会受到眩惑。)
黄帝说:我怀疑确实是这样。但我每次去东苑,没有不感到眩晕的,离开那里就好了。难道只有我去东苑才会劳神吗?为什么会有这样的差异呢?(每次去东苑,没有不眩晕的,即使不登高也是这样,所以感到疑惑诧异。)
岐伯说:不是这样的。心中有所喜好,神有所厌恶,突然受到感应就会导致精气紊乱,因为视觉错误所以感到迷惑,当精神转移后就会恢复。(偶然进行游乐活动,是心里喜欢的;忽然遇到奇异景象,神则厌恶它。既然神有所厌恶,意志就不能随之而动,喜恶在突然之间相互感应,所以精气混乱。离开那里后精神转移,精神转移后症状就恢复了。)因此,轻微的叫“迷”,严重的叫“惑”。(“间者”,指病情未严重,但也足以使人迷惑;何况那些严重的,能不让人迷惑吗?)
黄帝问:人容易健忘,是什么气导致的?
岐伯说:上部之气不足,下部之气有余,肠胃充实而心肺虚弱。虚弱则营卫之气滞留于下部,久而久之不能按时上行,所以容易健忘。(“下气有余”是相对于“上气不足”而言,并非指下部真的实证。心肺在上部虚弱,营卫滞留于下部,导致神气不能周流全身,所以容易健忘,这是阳气衰微于上部的征兆。)
黄帝问:人容易感到饥饿但不想吃东西,是什么气导致的?
岐伯说:精气汇聚于脾,热气停留于胃。胃热则能消化食物,食物消化得快所以容易感到饥饿。但是胃气逆乱向上,导致胃脘部寒冷,所以不想吃东西。(胃气逆乱向上而不能正常运化,这就是寒的表现。脾胃有热而胃脘部寒冷,所以虽然饥饿但不想吃东西。本篇各种邪气有总的治法,即先确定病变脏腑,纠正小的过失,然后调理气机,实证用泻法,虚证用补法,必须先明确病人的形体和心理的苦乐状况,再决定治疗方法,详见第八十三节。因为彼此出自同一理论,现在归类于此,应当参考使用。“嗜”音示。)
(From *Ling Shu: Da Huo Lun*)
Huangdi asked Qibo: I once ascended the Qingleng Terrace. When I looked back while halfway up the stairs, or crawled forward on my hands and knees, I felt dizzy and confused. I privately found this strange and internally questioned it. Whether keeping my eyes closed or open alone, calming my mind and regulating my breath, the dizziness persisted for a long time. Whether gazing far or near, with hair loose and kneeling for a long time, or looking down at the ground, the symptoms did not cease even after a long period. What qi causes this sudden onset? (Note: The air at high terraces is cold, hence called Qingleng Terrace. Whenever people climb high to look afar, seeing extraordinary sights, their spirit and soul are startled, leading to dizziness and confusion; thus, this question uses this scenario to inquire about the cause. "Pu" is pronounced 'pu'. "Fu" has pronunciations 'fu' and 'HT'. "Xuan" is pronounced 'xuan', also read as a departing tone.)
Qibo replied: The essence of the five zang organs and six fu organs all ascend to the eyes, thereby forming visual clarity. (The phrase "to form clarity" refers to the function of acute vision, as explained in Chapter 30 of the Pulse and Color category. The gathering place of essence is the eye socket,) (The "socket" refers to a hollow or cavity. "Eye" is the general term for the eyes. Since the essence of the five zang and six fu organs ascends to the eyes, the eyes serve as the repository of essence, manifesting the five colors. "Ke" is pronounced 'ke'.) The essence of bone manifests as the pupil, (The pupil is the black part of the eye. The essence of bone is governed by the Kidney, which belongs to Water and its color is black; therefore, the pupil is bright inside and purely black. "Tong" is pronounced 'tong', "Mou" is pronounced 'mou'.) The essence of sinew manifests as the iris (the black part surrounding the pupil), (The black part refers to the area around the black pupil. The essence of sinew is governed by the Liver, whose color is green; thus, its color is lighter than that of the pupil.) The essence of blood manifests as the collaterals, (Collaterals refer to the vascular network. The essence of blood vessels is governed by the Heart, whose color is red; therefore, the color of the collaterals is red.) The essence of Qi manifests as the white of the eye (sclera), (The term "Qi of the socket" refers to the Qi within the eyelid. The essence of Qi is governed by the Lung, which belongs to Metal; thus, it appears white.) The essence of muscle manifests as the "Yueshu" (eyelids), (Yueshu refers to the eyelids. They can open and close and belong to the essence of muscle, governed by the Spleen. The Spleen belongs to Earth and has the property of containing things; thus, it envelops and gathers the essence of the four organs (bone, sinew, blood, Qi) and merges them into the Eye Meridian, ascending to connect with the brain and exiting posteriorly at the neck. "Xie" is pronounced 'yao jie qie', meaning to gather items using one's garment hem.)
Therefore, if pathogenic factors invade the neck and coincide with deficiency in the body, they will penetrate deeply along the Eye Meridian into the brain. Once in the brain, it causes cerebral rotation (dizziness/vertigo); cerebral rotation pulls the Eye Meridian taut, and tautness of the Eye Meridian leads to visual vertigo and spinning. Pathogenic factors disrupt the essence, causing the invaded essence to be incompatible with normal essence, leading to the dispersion of essence; dispersed essence results in diplopia (seeing double), where one object appears as two. (The first "xie" character means pathogenic factor; the second "xie" character is interchangeable with "xie" meaning oblique/slant. Pathogenic factors strike between Fengfu and Tianzhu acupoints, entering the brain and connecting to the eyes due to deficiency. Tautness of the Eye Meridian causes visual vertigo and slanted gaze. Thus, the meridians on left and right have varying tension, distorting vision, so the objects seen by both eyes are inconsistent, resulting in seeing one thing as two. This addresses Huangdi's question by first explaining how pathogenic factors injure the human body, illustrating that seeing extraordinary sights mentioned later is also akin to external pathogenic diseases.)
The eyes are the repository of the essence of the five zang and six fu organs, the frequent dwelling place of Ying-Qi and Wei-Qi, Hun and Po, and the source of Shen-Qi. (Wherever zang-fu, Ying-Wei, Hun, and Po reach, there is Shen-Qi; thus, the eyes are the source of Shen-Qi.) Therefore, mental fatigue causes Hun and Po to scatter and Zhi-Yi (will/intention) to become chaotic. Consequently, the pupils and irises emulate Yin, while the sclera and red vessels emulate Yang. The integration and transmission of Yin and Yang produce clear vision. (Yin and Yang are the root of Spirit; thus, their integration produces the function of clarity.)
The eyes are the emissaries of the Heart, and the Heart is the residence of Shen. Therefore, if Shen becomes disordered and fails to circulate properly, and one suddenly sees extraordinary sights, the Spirit, Hun, and Po scatter and fail to coordinate, which is termed "Huo" (confusion/delusion). (Although Spirit is unified in the Heart, its external expression lies in the eyes. Thus, the eyes are the emissaries of the Heart, and the Heart is the residence of Spirit. Seeing abnormalities externally causes the spirit and soul to be confused internally.)
Huangdi said: I suspect this is true. However, every time I go to Dongyuan, I invariably feel dizzy, but it resolves when I leave. Am I the only one who fatigues my spirit in Dongyuan? Why is there such a difference? (Going to Dongyuan always causes dizziness, even without climbing high, hence the suspicion of difference.)
Qibo said: Not so. If the heart has preferences and the spirit has aversions, sudden stimulation causes disorder of Jing-Qi, leading to erroneous vision and confusion. When the spirit shifts away, recovery occurs. (Occasional recreation is what the heart likes; encountering strange phenomena is what the spirit dislikes. Since the spirit dislikes it, the will does not follow. The interaction of like and dislike suddenly disturbs Jing-Qi. Leaving the place allows the spirit to shift, and upon shifting, recovery ensues.) Therefore, mild cases are called "Mi" (bewilderment), and severe cases are called "Huo" (confusion). ("Jian zhe" refers to mild cases, which are sufficient to bewilder; let alone severe cases, which inevitably cause confusion.)
Huangdi asked: What qi causes people to be prone to forgetfulness?
Qibo said: Upper Qi is insufficient, Lower Qi is excessive. The intestines and stomach are full, while the heart and lungs are deficient. Deficiency causes Ying-Qi and Wei-Qi to remain in the lower body, failing to ascend to the upper body in a timely manner over time, leading to forgetfulness. ("Lower Qi excessive" is relative to "Upper Qi insufficient," not implying a true excess in the lower body. Deficiency of Heart and Lung above, and retention of Ying-Wei below, prevents the circulation of Shen-Qi throughout the body, causing forgetfulness; this is a sign of Yang deficiency in the upper body.)
Huangdi asked: What qi causes people to feel hungry frequently but lack appetite?
Qibo said: Jing-Qi converges in the Spleen, and Heat-Liu (stagnant heat) remains in the Stomach. Stomach heat promotes digestion, food digests quickly, hence frequent hunger. However, Stomach Qi rebels upward, causing cold in the epigastrium, hence lack of appetite. (Stomach Qi rebelling upward and failing to transport and transform constitutes cold. There is heat in the Spleen and Stomach but cold in the epigastrium, so although hungry, one desires no food. The general treatment principle for various pathogens in this treatise is: first determine the affected zang-fu, correct minor errors, then regulate Qi; excess conditions are drained, deficiency conditions are tonified. One must first understand the physical and psychological state of the patient before selecting treatment methods. See Section 83 for details. Since these theories originate from the same source and are classified here, they should be used in conjunction. "Shi" is pronounced 'shi'.)