承光 哑门 风府 天柱 素 临泣 睛明 攒竹 迎香 禾 丝竹空 白环 颧 头维
下阙 脊中 肩贞 心 天之牖 人迎 乳中 周荣 天府 中冲 阳关 阳池 隐白 漏谷 地五会
阴陵泉 条口犊 阴市 伏兔 髀关 委中 殷门 申脉 承扶(凡四十五穴。)
《内经》云∶脉之所见,邪之所在。脉沉者,邪气在内;脉浮者,邪气在表。世医只知脉之说,不知病症
之禁忌。若表见寒症,身汗出,身常偎缩,栗而寒,不渴,欲覆浓衣,常恶寒,手足厥,皮肤干枯,其脉必
沉细而迟。但有一二症,皆宜灸之,阳气下陷故也。若身热恶热,时见躁作,或面赤面黄,咽干嗌干口干,舌
上黄赤,时渴咽嗌痛,皆热在外也。但有一二症,皆不可灸。其脉必浮数,或但数亦不可灸,灸之 害立生。
若有鼻不闻香臭,鼻流清涕,眼脸时痒,或欠或嚏,恶寒,其脉必沉,是脉症相应也。或轻手得弦紧者,是阴
伏其阳也,虽面赤宜灸之,不可拘于面色赤而禁之也。(刘纯。)
五十九刺者,为头上五行,以克越诸阳之热也。大杼膺 缺盆 背 (此八者,以泻胸中之热也。)
气冲 三里 巨虚 上下廉(此八者,以泻胃中之热也。)云门 髀骨 委中 髓空(此八者,以泻四肢之热也。)
用针八法
用针八法者∶迎随一也,转针二也,手指三也,转针头四也,虚实五也,阴阳六也,提按七也,呼吸八也。
补泻损益虚实,在此八法。
针用五门分主客
针用五门者,井荥 经合也。春刺井,夏刺荥,秋刺经,冬刺合,季月刺 ,以有五门。一月亦同,一日
亦有五门。同年宾客为邪气,主人乃正气。知者刺之,无不效也。
定针象木
针刺可曲可斜,可直可正。故定数以象木性之曲直也。
口藏比火
凡用针,先以针含口内令温,调补荣卫,以火性炎上,即升降旋转左右而下也。
常山阎氏曰∶口温针暖,不惟滑利而少痛,亦借己之和气,与患人荣卫无寒温之争,便得相从。若不先温
针暖,与血气相逆,寒温交争,而成疮者多矣。
灸刺分午前卯后离左酉南
午前卯后者,乃卯、辰、巳三时也。阳中之老阳,可灸刺万病之虚寒。离左酉南者,乃午未、申三时也。
阳中之少阴,可灸刺万病之烦躁。重蒸之劳热而泻之,灸以吹之。灸时丈夫用室女,妇人用童男,吹之呵之,
反作清凉之气也。呵吹者,灸之泻法也。
接气通经法
凡欲取偏枯久患荣卫诸疾,多是愈而复作者,始由气不接而其经不通流,虽有临时之快,客气胜真,病当
未愈也。当此乃令上接而下引。呼吸多少,经脉长短,各有定数。立法手三阳而九呼,过经四寸;手三阴接而
七呼,过经五寸;足之三阳接而一十四呼,过经四寸;足之三阴接而一十二呼,过经五寸,重者倍之,吸亦同
数。此接气通经,呼吸长短之法也。(阎广明。)
灸分阴阳上下多少
凡灸当先阳后阴,言从头面向左而渐下,次后从头向右而渐下,先上后下。《明堂》云∶先灸于上,后灸
于下,先灸于少,后灸于多,皆宜审之。(王执中医科即叔权。)
针灸须药
《千金》云∶病有须针者,即针刺以补泻之。不宜针者,直尔灸之。然灸之大法,其孔穴与针无忌,即下
白针,或温针讫,乃灸之,此为良医。其香港脚一病,最宜针灸并施。若针而不灸,灸而不针,非良医也。针灸
而药,药而不针灸,亦非良医也。但恨下里间知针者鲜尔。所以学人须解用针灸,温针白针皆须妙解。知针知
药,固是良医,此言针灸与药之相须也。今人或但知针而不知灸,知灸而不知针,或惟用药而不知针灸者,皆
犯孙真人所戒也。今世所谓医者,则但知有药而已,针灸则未尝过而问焉。人或告之,则曰∶是外科也,业贵
精,不贵杂也。否则曰∶富贵之家,未必肯针灸也,皆自文其过耳。吾故详着《千金》之说,以示人云。
避人神说
《千金》云∶欲行针灸,先知行年宜忌,及人神所在,不与禁忌相应即可,故男忌除,女忌破,男忌戊,
女忌己。有日神忌,有每月忌,有十二时忌,有四季人神,有十二部人神,又有所谓血支血忌之类。凡医者,
不能知此避忌,若逢病患厄,会男女气怯,下手至困,通神达士,岂拘此哉?若遇急卒暴患,不拘此法。许希
亦云∶若病卒暴,宜急灸疗,亦不拘此。一日之间,止忌一时是也。
又云∶痈疽疔肿、喉痹客忤尤为急。凡作汤药不可避凶日,觉病须臾,即宜便治。又云∶凡人卒暴得风,
或中时气,凡百所苦,须臾灸疗,渐久后皆难愈。此论甚当。夫急难之际,命在须臾,若必待吉日而后治,已
沦于鬼录矣。此所以不可拘避忌也。惟平居治病于未形,选天德月德等日,服药针灸可也。
论灸
灸有补泻,不可轻议。大率沉结寒冷之症,施之为宜。盖阴寒湿气凝留血脉,汤剂熨引,不能独治。方是
时,惟火艾足以烁其势,岂非火能营运阳气,驱逐阴邪,其效有速于药石者?即老壮不同,强弱异禀,灼治之
法,夫岂一端?故多有逾于数百壮,少或止于三五七九之数,要皆详审而行之。若夫阳病灸之,则为大逆。是
以论伤寒者,谓微数之脉,既汗之后,脉浮,热甚,三者悉不可灸。惟少阴皆恶寒,吐利,脉不足,与夫脉
从手足厥之类,三者为可灸焉。通明乎此,触类以往,又安有灸 之妄也?故曰∶不须灸而强与之灸者,令人
火邪入腹,干错五脏,重其烦躁。须灸而不与之灸,使冷结重凝,久而弥固,气上冲心,无地消散,可不鉴哉!
论刺
其病挛痹,其治宜微针。形乐志苦,病生于脉,治以灸刺。明九针之用,经络补泻之法也。故荣卫异刺,
以分血气之虚实。井荣异刺,以分五行之子母。募 异刺,以分背腹之阴阳。春夏异刺,以分人气之浅深。大
抵虚补实泻,无过不及之伤,以辅其平者,刺法之大要也。然有病势未深,可刺而即愈者,所谓病之始起,可
刺而已。或痹不仁,肿痛,可灸刺而去之是也。有病传诸经,必上下俱刺者,所谓刺热刺疟,病甚,为五十九
刺是也。然刺之为言,同于击刺之刺,以为利也,害在其中。黄帝谓徐人安静,手巧而心审谛者,可使行针艾。
张机谓针能杀生人,不能起死人,凡以用之,不可不慎也。况九针异体,取病有殊,十二节异法,用有轻重。
必明日月星辰,四时八正之在天;寒暑燥湿,经水盈虚之在地;肥瘠壮弱,虚实盛衰之在人。然后呼吸补泻,
出入迎随,惟意之从,岂特知募 部分,皮肉筋骸,饥饱劳逸而已哉?故曰∶见微得过,用之不殆。(雄按∶方阅此
篇,适闻陈汉题令媳,为关琴楚之女孙,患疾赴越,就陈某治之,针入而血流不止,须臾而逝,
益见仲圣之言为不诬也。)
论砭石
上古针法垂布于天下,制砭石有小大者,乃随病所宜。用石代针,一曰针石,二曰砭石,三曰 石,其实
一也。破坚决肉,砭射肿热者,则决之以砭石。良由邪气暴戾,则微针不能及。况又病有气血盛实,逆于肉里
蓄结痈肿之类,非砭石则不能射之,此所谓血实宜决之。又形乐志乐,病生于内者,治之以砭石。东方之民,
多病痈疡,其治宜砭石。砭石之来,始自于此。扁鹊有云∶病在脉血者,治之以砭石。是故一切肿疾,悉宜镰
割足小指下横纹间。肿在左则割左,在右则割右,血少出则瘥。以至疔肿、痈疡、丹毒、瘭疽、代指KT 病、气痛
流肿之类,皆须出血者,急以砭石砭之。大抵砭石之用,其法必泻。若在冬时,人气闭塞,则用药而少针石。
所谓少针石者,非痈疽之谓也。痈疽不得顷时回,苟缓于针石,则毒瓦斯内攻,腐坏筋骨,穿通脏腑矣。治石疔
疮,则忌瓦砾砖石之类。治刀镰疔疮,则忌铁刀伤割。若是者,可以药治也。《素问》又曰∶人病颈痈,或石治
之,或针灸治之而皆已,此盖同病异治也。夫痈疽之气弱者,宜针开除去之,气盛血聚者,宜石而泻之。若然,
则砭石九针之用,各有所利。善治血脉之变,痈疽之病者,当审轻重而制之。(并《圣济总录》,自王执中下。)
承光、哑门、风府、天柱、素髎、临泣、睛明、攒竹、迎香、禾髎、丝竹空、白环俞、颧髎、头维,(以下)缺失。脊中、肩贞、心俞、天之牖、人迎、乳中、周荣、天府、中冲、阳关、阳池、隐白、漏谷、地五会、阴陵泉、条口、犊鼻、阴市、伏兔、髀关、委中、殷门、申脉、承扶。(共计四十五个穴位。)
《内经》说:脉象显现之处,就是邪气所在的地方。脉象沉的,说明邪气在体内;脉象浮的,说明邪气在体表。世间的医生只知道脉象的说法,却不懂得病症的禁忌。如果表证出现寒症,身体出汗,身体常常蜷缩,战栗发冷,不口渴,想要覆盖厚衣服,经常怕冷,手脚冰凉,皮肤干枯,其脉象必定沉细而迟。只要具备其中一两个症状,都适宜用灸法治疗,这是因为阳气下陷的缘故。如果身体发热、怕热,时常烦躁发作,或者面色红赤或发黄,咽喉干燥、口腔干燥,舌苔黄赤,时常口渴且咽喉疼痛,这都是热邪在体表的缘故。只要具备其中一两个症状,都不可用灸法。其脉象必定浮数,或者仅仅数脉也不可用灸法,如果施灸,危害立刻产生。如果有鼻子闻不到香味和臭味,流清鼻涕,眼睑时常发痒,或者打哈欠或打喷嚏,怕冷,其脉象必定沉,这是脉象与症状相应的表现。或者轻取脉象弦紧的,这是阴邪潜伏而阳气被郁遏的表现,虽然面色红赤也适宜施灸,不可拘泥于面色红赤就禁止施灸。(刘纯)
五十九刺法,是指头部五行穴位,用来克制并清除诸阳经的热邪。大杼、膺窗、缺盆、背俞(这八个穴位),用来泻除胸中的热邪。气冲、足三里、上巨虚、下巨虚(这八个穴位),用来泻除胃中的热邪。云门、髀骨、委中、髓空(这八个穴位),用来泻除四肢的热邪。
用针八法
所谓用针八法:一是迎随补泻,二是转针手法,三是手指运用,四是针头转动,五是辨别虚实,六是区分阴阳,七是提插手法,八是配合呼吸。补泻、损益、虚实的变化,都包含在这八种方法中。
针刺运用五门分主客
针刺运用五门,指的是井、荥、经、合穴。春天刺井穴,夏天刺荥穴,秋天刺经穴,冬天刺合穴,季月(每季最后一个月)刺输穴,因为有五门之分。一个月中也同样适用,一天之中也有五门之分。当年的太岁为宾客代表邪气,值年的地支为主人代表正气。懂得这个道理的人去施治,没有不有效的。
定针象木
针刺可以弯曲也可以倾斜,可以笔直也可以端正。所以确定的针数象征着木性曲直的特性。
口藏比火
凡是使用针具,先要把针含在口中使其温热,以调和营卫之气。因为火的性质是炎上的,这样能使气机升降旋转,向左向右然后下行。
常山阎氏说:将针在口中温暖,不仅使进针滑利且疼痛减少,也是借助自身的温和之气,与患者的营卫之气没有寒温之争,从而能够顺从相合。如果不先将针温暖,就会与血气相逆,寒温相互争斗,导致形成疮疡的情况就多了。
灸刺分午前卯后离左酉南
午前卯后,指的是卯、辰、巳三个时辰。这是阳中之老阳,可以施灸刺治疗各种虚寒病症。离左酉南,指的是午、未、申三个时辰。这是阳中之少阴,可以施灸刺治疗各种烦躁病症。对于像重蒸一样的劳热而需要泻除的,可以用灸法配合吹气来治疗。施灸时,男性患者由处女吹气,女性患者由童男吹气,通过吹气和呵气,反而产生清凉之气。呵气和吹气,是灸法的泻法。
接气通经法
凡是想要治疗偏枯以及长期患有的营卫疾病,这些病多是好了又复发,起初是因为气不相接续而导致经脉不通畅流动,虽然当时有暂时的缓解,但客气胜过了真气,病实际上并未痊愈。在这种情况下,应当让上部的气接引而下部引导。呼吸的次数多少,经脉的长短,都有固定的数量。立法规定:手三阳经接气需九次呼吸,过经四寸;手三阴经接气需七次呼吸,过经五寸;足三阳经接气需十四次呼吸,过经四寸;足三阴经接气需十二次呼吸,过经五寸。病情重的加倍计算,吸气也遵循同样的数量。这就是接气通经,关于呼吸长短的方法。(阎广明)
灸分阴阳上下多少
凡是施灸应当先阳后阴,说法是从头面部向左逐渐向下,其次从头面向右逐渐向下,先上后下。《明堂》说:先灸上部,后灸下部,先灸少壮者,后灸多者,这些都应当仔细审察。(王执中,字叔权)
针灸须药
《千金方》说:有病需要针刺的,就用针刺来进行补泻。不适宜针刺的,直接进行艾灸。然而艾灸的大法,其孔穴与针刺没有禁忌,即先下白针(普通针刺),或者温针结束后,再进行艾灸,这才是良医的做法。那种脚气病,最适宜针灸并用。如果只针刺不艾灸,或只艾灸不针刺,都不是良医。只针灸不用药,或只用药不针灸,也不是良医。只是遗憾乡野之间懂针刺的人很少。所以学习者必须懂得使用针灸,温针和白针都必须妙解精通。既懂针刺又懂药物,固然是良医,这是说针灸与药物的相互依存关系。现在的人有的只知道针刺而不知道艾灸,知道艾灸而不知道针刺,或者只用药物而不知道针灸的,都犯了孙真人所告诫的错误。当今所谓的医生,则只知道有药物而已,针灸则从未曾过问。有人告诉他们,他们就说:那是外科的事,行业贵在专精,不在杂乱。否则就说:富贵人家,未必肯接受针灸治疗,这都是为自己掩饰过错罢了。所以我详细记载《千金方》的说法,以此示人。
避人神说
《千金方》说:想要施行针灸,先要知晓行年宜忌,以及人神所在的位置,不与禁忌相应就可以了,所以男子忌讳“除”日,女子忌讳“破”日,男子忌讳戊日,女子忌讳己日。有日神禁忌,有每月禁忌,有十二时辰禁忌,有四季人神,有十二部位人神,又有所谓的血支、血忌之类。凡是医生,如果不能知晓这些避忌,如果遇到病患厄运,恰逢男女气弱,下手就会非常困难。通达神明之士,难道会拘泥于此吗?如果遇到紧急突然的暴病,不拘泥于此法。许希也说:如果病势突然暴烈,适宜紧急施灸治疗,也不拘泥于此。一天之中,只忌讳一个时辰罢了。
又说:痈疽疔肿、喉痹客忤尤为急症。凡是制作汤药不可避开凶日,感觉生病片刻,就应当立即治疗。又说:凡人突然暴感风邪,或者中受时气,凡是一切痛苦,片刻间施灸治疗,拖延久了以后就难以治愈。这种论述很恰当。在急难之际,生命就在片刻之间,如果一定要等待吉日而后治疗,就已经进入鬼录了。这就是不可以拘泥避忌的原因。只有在平时治病于未形之时,选择天德、月德等吉日,服药针灸是可以的。
论灸
灸法有补泻之分,不可轻易议论。大抵沉结寒冷之症,施灸为宜。因为阴寒湿气凝滞留滞在血脉中,汤剂熨引,不能单独治愈。在这个时候,只有火艾足以烧灼其势头,岂不是火能营运阳气,驱逐阴邪,其效果比药物金石还要迅速吗?即使年老体壮不同,强弱禀赋各异,灼治的方法,难道只有一种吗?所以有的超过数百壮,少的仅止于三五七九的数量,都要详细审慎地施行。如果是阳病施灸,就是大逆。因此讨论伤寒的人说,微数的脉象,已经发汗之后,脉浮,热甚,这三种情况都不可施灸。只有少阴病皆恶寒,吐利,脉不足,以及脉象伴随手足厥冷等情况,这三种情况是可灸的。通晓明白这一点,触类旁通,哪里还有妄施灸法的呢?所以说:不需要灸而强行给他施灸的,会让人火邪入腹,干扰错乱五脏,加重烦躁。需要灸而不给他施灸的,会使冷结再次凝滞,时间久了更加坚固,气上冲心,无处消散,可不引以为鉴吗!
论刺
那些痉挛痹阻的病,治疗适宜用微针。形体安乐但精神苦闷,病生于脉,治疗用灸刺。明确九针的用途,是经络补泻的方法。所以营卫异刺,以分辨血气的虚实。井荥异刺,以分辨五行之子母关系。募俞异刺,以分辨背腹之阴阳。春夏异刺,以分辨人气之浅深。大抵虚则补实则泻,不超过不及的伤害,以辅助平衡,这是刺法的大要。然而有病势未深的,可刺而即刻痊愈的,所谓病刚开始起,可刺而止。或者痹症麻木不仁,肿痛,可用灸刺去除它。有病传变至诸经,必须上下俱刺的,所谓刺热刺疟,病重,用五十九刺法。然而“刺”这个字,同于击刺的刺,以为有利,害在其中。黄帝说动作缓慢安静、手巧而心思审慎的人,可以使他施行针艾。张机说针能杀生人,不能起死人,凡是使用它,不可不谨慎啊。何况九针形态各异,取病有不同,十二节法不同,用法有轻重。必须明了日月星辰、四时八正在天象;寒暑燥湿、经水盈虚在地势;肥瘦强壮、虚实盛衰在人身上。然后呼吸补泻,出入迎随,随心所欲,岂仅仅是知道募俞部分,皮肉筋骸,饥饱劳逸而已呢?所以说:见微知著,发现过失,使用它就不会有危险。(按语:刚才阅读这篇,恰好听说陈汉题令媳,是关琴楚的女儿孙女,患病赴越,找陈某治疗,针入后血流不止,片刻就去世了,更可见仲圣的话是不虚假的。)
论砭石
上古针法流传天下,制作的砭石有小大之分,乃是随着病情适宜而定。用石头代替针,一种叫针石,一种叫砭石,一种叫镵石,其实是一回事。破除坚硬积聚的肉,砭射肿热的,就用砭石决破。由于邪气暴戾,微针不能达到。况且又有病气血盛实,逆乱于肌肉里蓄结痈肿之类,不用砭石就不能射除它,这就是所谓血实宜决破。又有形体安乐精神快乐,病生于内部的,用砭石治疗。东方之民,多患痈疡,治疗适宜用砭石。砭石的来源,开始于此。扁鹊说:病在脉血的,用砭石治疗。所以一切肿疾,都适宜镰割足小指下横纹间。肿在左边就割左边,在右边就割右边,血流出少就好了。以至疔肿、痈疡、丹毒、瘭疽、代指KT病、气痛流肿之类,都需要出血的,急忙用砭石砭刺。大抵砭石的使用,其法必然是泻法。如果在冬季,人气闭塞,则用药而少用针石。所谓少用针石,不是指痈疽而言。痈疽不得片刻回转,如果迟缓于针石,则毒瓦斯内攻,腐坏筋骨,穿通脏腑了。治疗石疔疮,则忌讳瓦砾砖石之类。治疗刀镰疔疮,则忌讳铁刀伤割。像这样的,可以用药物治疗。《素问》又说:人患颈痈,有的用石治好的,有的用针灸治好的而都痊愈了,这大概是同病异治吧。夫痈疽之气弱的,适宜针开除去它,气盛血聚的,适宜石而泻之。既然这样,那么砭石九针的使用,各有所利。善于治疗血脉变化、痈疽疾病的,应当审察轻重而制定方案。(均出自《圣济总录》,自王执中以下。)
Chenguang (Chéngguāng), Yamen (Yāmén), Fengfu (Fēngfǔ), Tianzhu (Tiānzhù), Suliao (Sùliáo), Linqi (Línqì), Jingming (Jīngmíng), Cuanzhu (Cuánzhú), Yingxiang (Yíngxiāng), Heliao (Héliáo), Sizhukong (Sīzhúkōng), Baihuan (Báihuán), Quanliao (Quánliáo), Touwei (Tóuwéi), (below) missing. Jizhong (Jīzhōng), Jianzhen (Jiānzhēn), Xinshu (Xīnshù), Tianzhiyou (Tiānzhīyǒu), Renying (Rényíng), Ruzhong (Rúzhōng), Zhourong (Zhōuróng), Tianfu (Tiānfǔ), Zhongchong (Zhòngchōng), Yangguan (Yángguān), Yangchi (Yángchí), Yinbai (Yǐnbái), Lougu (Lòugǔ), Diwuhui (Dìwǔhuì), Yinlingquan (Yīnlíngquán), Tiaokou (Tiáokǒu), Dubi (Dúbí), Yinshi (Yínshì), Furu (Fútù), Biguan (Bìguān), Weizhong (Wěizhōng), Yinmen (Yīnmén), Shenmai (Shēnmài), Chengfu (Chéngfú). (Total forty-five acupoints.)
The *Neijing* (Yellow Emperor's Inner Canon) states: Where the pulse is visible, there lies the pathogenic factor. A deep pulse indicates that the pathogen is within; a floating pulse indicates that the pathogen is at the exterior. Physicians of the world only understand the theory of pulses but fail to grasp the contraindications of symptoms. If exterior cold syndrome manifests with sweating, frequent curling up of the body, shivering and coldness, absence of thirst, desire for thick clothing, aversion to cold, cold limbs, and dry skin, the pulse will necessarily be deep, fine, and slow. If one or two of these symptoms are present, moxibustion is suitable because yang qi has sunk. If the body is hot and averse to heat, occasionally restless, or if the face is red or yellow, the throat and mouth are dry, the tongue coating is yellow and red, thirst occurs frequently accompanied by sore throat, this indicates heat at the exterior. If one or two of these symptoms are present, moxibustion must not be used. The pulse will necessarily be floating and rapid, or merely rapid; in either case, moxibustion is contraindicated, as harm will arise immediately. If there is anosmia, runny nose, itchy eyelids, yawning or sneezing, and aversion to cold, the pulse will be deep, indicating correspondence between pulse and symptoms. Or, if the pulse is wiry and tight upon light palpation, this indicates yin pathogen suppressing yang qi; even if the face is red, moxibustion is suitable, and one should not forbid it solely based on facial redness. (Liu Chun)
The Fifty-Nine Needle Points refer to the five rows of points on the head, used to overcome and clear heat from all yang meridians. Dazhu (Dàzhù), Yingchuang (Yīngchuāng), Quepen (Quēpén), Beishu (Bèishū) — these eight points, are used to drain heat from the chest. Qichong (Qìchōng), Zusanli (Zúsānlǐ), Shangjuxu (Shàngjǔxū), Xiajuxu (Xiàjǔxū) — these eight points, are used to drain heat from the stomach. Yunmen (Yúnmén), Bigu (Bīgǔ), Weizhong (Wěizhōng), Suikong (Suǐkōng) — these eight points, are used to drain heat from the four limbs.
Eight Methods of Needling
The so-called Eight Methods of Needling are: first,迎着 and following (Yingsui); second, rotating the needle; third, manipulation of fingers; fourth, rotation of the needle head; fifth, distinguishing deficiency and excess; sixth, differentiating yin and yang; seventh, lifting and thrusting; eighth, coordinating with respiration. Tonification, reduction, benefit, loss, deficiency, and excess are contained within these eight methods.
Five Gates of Needling: Master and Guest
The Five Gates of Needling refer to the Jing-Well, Ying-Spring, Jing-River, and He-Sea points. In spring, puncture Jing-Well points; in summer, Ying-Spring points; in autumn, Jing-River points; in winter, He-Sea points; in the last month of each season, puncture Shu-Stream points, due to the existence of five gates. This applies equally to each month and each day. The Tai Sui of the year represents the guest and corresponds to pathogenic factors; the Earthly Branch of the year represents the host and corresponds to healthy qi. Those who understand this principle achieve efficacy without fail.
Fixed Needling Resembles Wood
Needling can be bent or slanted, straight or upright. Thus, the fixed number of needles symbolizes the curving and straightening nature of wood.
Mouth Storage Compared to Fire
When using needles, first hold the needle in the mouth to warm it, thereby regulating Ying and Wei qi. Since fire tends to flare upward, this facilitates the ascending, descending, rotating, and lateral movement of qi before it descends.
Yan Shi of Changshan stated: Warming the needle in the mouth not only makes insertion smoother and less painful but also borrows one's own harmonious qi, avoiding conflict of temperature with the patient's Ying and Wei qi, allowing them to follow together. If the needle is not warmed beforehand, it conflicts with blood and qi, causing cold and heat to struggle, leading to many cases of ulcer formation.
Moxibustion and Needling Divided by Morning/Afternoon and Mao/Hou, Li/Zuo, You/Nan
"Mao Hou" refers to the Mao, Chen, and Si hours. This is the "Old Yang" within yang, suitable for moxibustion and needling to treat various deficiency-cold syndromes. "Li Zuo You Nan" refers to the Wu, Wei, and Shen hours. This is the "Young Yin" within yang, suitable for moxibustion and needling to treat various irritability syndromes. For labor heat resembling double steaming requiring drainage, moxibustion combined with blowing can be used. During moxibustion, a virgin girl blows for male patients, and a boy blows for female patients; through blowing and exhaling ("he"), a cooling sensation is generated. Blowing and exhaling constitute the draining method of moxibustion.
Method of Connecting Qi and Unblocking Meridians
To treat hemiplegia and chronic disorders of Ying and Wei qi, which often recur after apparent recovery, the initial cause is usually disconnected qi leading to blocked meridian flow. Although there may be temporary relief, the exogenous pathogen overcomes true qi, and the disease remains unresolved. In such cases, one should connect qi from above and guide it downward. The number of breaths and the length of meridians have fixed numbers. The established rule is: Hand Three Yang meridians require nine breaths to traverse four cun; Hand Three Yin meridians require seven breaths to traverse five cun; Foot Three Yang meridians require fourteen breaths to traverse four cun; Foot Three Yin meridians require twelve breaths to traverse five cun. For severe cases, double these numbers; inhalation follows the same count. This is the method of connecting qi and unblocking meridians regarding respiration length. (Yan Guangming)
Moxibustion Divided by Yin/Yang, Upper/Lower, and Quantity
Generally, moxibustion should proceed from yang to yin, starting from the head and face moving leftward and downward, then from the head moving rightward and downward, prioritizing upper then lower. The *Mingtang* states: Moxa the upper first, then the lower; moxa the fewer applications first, then the more; all should be carefully considered. (Wang Zhizhong, courtesy name Shuquan)
Needling and Moxibustion Require Medicine
The *Qianjin Fang* states: For diseases requiring needling, use needles for tonification and drainage. For those unsuitable for needling, apply moxibustion directly. However, the general principle of moxibustion allows the same acupoints as needling without contraindication; thus, applying plain needles (Baizhen) or warming needles before moxibustion is the practice of a good physician. The condition known as "Hongjiao" (foot qi/podagra) is most suitable for combined needling and moxibustion. To needle without moxa, or moxa without needling, is not the practice of a good physician. To use only acupuncture/moxa without medicine, or only medicine without acupuncture/moxa, is also not the practice of a good physician. It is regrettable that few in rural areas understand needling. Therefore, students must master both needling and moxibustion, including warming and plain needles. Knowing both needling and medicine constitutes a good physician; this highlights the interdependence of acupuncture, moxibustion, and pharmacology. Today, some know only needling but not moxibustion, or vice versa, or rely solely on medicine while ignoring acupuncture and moxibustion; all commit the error warned against by Sun Simiao. Modern so-called physicians know only of medicine and never inquire about acupuncture and moxibustion. When informed, they claim: "That is surgery; excellence lies in specialization, not eclecticism." Or they say: "Wealthy families may not consent to acupuncture and moxibustion." These are excuses to cover their faults. I therefore detail the words of *Qianjin Fang* to instruct others.
Avoiding Human Spirits Theory
The *Qianjin Fang* states: Before performing acupuncture and moxibustion, one must know the auspicious and inauspicious years and the location of Human Spirits (Renshen), ensuring no conflict with taboos. Men avoid "Chu" days, women avoid "Po" days; men avoid Wu days, women avoid Ji days. There are Day Spirit taboos, monthly taboos, twelve-hour taboos, seasonal Human Spirits, and twelve-part Human Spirits, as well as Blood Branch and Blood Taboo categories. Physicians who do not know these taboos may encounter difficulties when treating patients during periods of misfortune or when the patient's qi is weak. Enlightened masters, however, are not bound by these rules. In cases of sudden acute illness, these methods are not restricted. Xu Xi also stated: If the disease is sudden and violent, urgent moxibustion is appropriate, without restriction. Only one hour per day is taboo.
It is further stated: Carbuncles, furuncles, throat bi, and external shock are especially urgent. When preparing decoctions, one should not avoid inauspicious days; treatment should begin immediately upon feeling ill. It is also said: If a person suddenly contracts wind or seasonal pathogens, suffering from any distress, immediate moxibustion is required; delaying makes cure difficult. This argument is sound. In emergencies, life hangs in the balance; waiting for an auspicious day means death. Thus, one should not be rigidly bound by taboos. However, for preventive treatment before disease manifests, selecting days of Heavenly Virtue or Monthly Virtue for medication and acupuncture/moxibustion is acceptable.
On Moxibustion
Moxibustion involves tonification and drainage and should not be discussed lightly. Generally, it is suitable for deep, knotted, and cold syndromes. When yin-cold and dampness stagnate in the blood vessels, decoctions and hot compresses cannot cure alone. At such times, only moxa can burn away the pathogen. Does fire not circulate yang qi and expel yin pathogens, achieving effects faster than herbs and minerals? Whether old or young, strong or weak, the method of burning varies. Some receive hundreds of moxa cones, while others receive only three, five, seven, or nine; all must be performed with careful deliberation. Applying moxibustion to yang syndromes is a major violation. Therefore, in discussions of Cold Damage, it is stated that a fine-rapid pulse, post-sweating floating pulse, and intense heat are three conditions where moxibustion is contraindicated. Only Shaoyin syndromes characterized by aversion to cold, vomiting/diarrhea, deficient pulse, or cold limbs associated with pulse characteristics are suitable for moxibustion. Understanding this thoroughly allows one to apply it universally, preventing reckless moxibustion. Thus: forcing moxibustion when unnecessary introduces fire pathogen into the abdomen, disturbs the five zang organs, and worsens irritability. Withholding moxibustion when necessary causes cold coagulation to harden over time, with qi rushing to the heart and nowhere dissipating; one must take warning!
On Needling
For spasms and bi-syndromes, micro-needles are suitable. For those physically comfortable but mentally distressed, with disease arising in the vessels, moxibustion and needling are treatments. Understanding the Nine Needles clarifies meridian tonification and drainage. Different needling for Ying and Wei distinguishes blood and qi deficiency/excess. Different needling for Jing-Well and Ying-Spring distinguishes the mother-child relationship of the Five Elements. Different needling for Mu and Shu points distinguishes back-abdominal yin-yang. Different needling for spring/summer distinguishes the depth of human qi. Generally, tonifying deficiency and draining excess without exceeding limits restores balance; this is the essence of needling. However, for shallow diseases, needling leads to immediate cure, as stated: "At the onset, needling suffices." For numbness, pain, and swelling caused by bi, moxibustion and needling remove them. For diseases transmitting to multiple meridians requiring upper and lower needling, such as treating malaria with heat or severe cases using the Fifty-Nine Needles, specific protocols apply. The term "Ci" (puncture) implies striking; while beneficial, harm lies within. Huangdi stated that those who are calm, skilled, and prudent may perform acupuncture and moxa. Zhang Ji stated that needles can kill the living but cannot revive the dead; thus, their use requires utmost caution. Moreover, the Nine Needles differ in form and indication; the Twelve Methods vary in weight and application. One must understand celestial bodies, seasons, solar terms, terrestrial climate, water levels, body constitution, and qi/blood status. Then, through respiration, tonification/drainage, entering/following, and intention, one acts freely. Is it merely knowing Mu-Shu locations, skin/muscle/tendon/bone, hunger/fullness, and labor/rest? Thus: observing subtle changes prevents danger. (Note: While reading this chapter, I heard that the daughter-in-law of Magistrate Chen Han, granddaughter of Guan Qin Chu, traveled to Yue for treatment by Mr. Chen. After needle insertion, bleeding did not stop, and she died shortly after. This confirms the truth of Zhongjing's words.)
On Bian Stones
Ancient needle techniques spread throughout the world. Bian stones were made in various sizes according to the disease. Using stone instead of needles, they are called Zhen Stone, Bian Stone, or Chan Stone; essentially, they are the same. To break hard accumulations and pierce swollen heat, Bian stones are used for lancing. Because pathogenic factors are violent, micro-needles cannot reach. Furthermore, for conditions with abundant qi and blood, counterflow in muscles, and accumulated carbuncles, only Bian stones can lance them; this is what is meant by "blood excess should be lanced." For those physically and mentally content with internal diseases, Bian stones are the treatment. People in the East often suffer from carbuncles and ulcers, treated suitably with Bian stones. Thus, Bian stones originated here. Bian Que said: For diseases in the blood vessels, use Bian stones. Therefore, all swellings are suitable for incision at the transverse crease below the little toe. Left swelling is cut on the left, right on the right; slight bleeding leads to recovery. This applies to furuncles, carbuncles, erysipelas, phagedenic gangrene, dystrophic nails, Qi-pain swelling, etc., all requiring bloodletting via urgent Bian stone application. Generally, Bian stone usage employs draining methods. In winter, when human qi is closed, medicine is preferred over needles/stones. "Few needles/stones" does not refer to carbuncles. Carbuncles cannot wait; delay allows toxin to attack internally, rotting bones and tendons, piercing viscera. For stone furuncles, avoid brick/rubble. For knife-cut furuncles, avoid iron knives. Such cases are treated with medicine. The *Suwen* states: Neck carbuncles cured by stone or by acupuncture/moxibustion demonstrate treating the same disease differently. For carbuncles with weak qi, needling to open and remove is suitable; for those with abundant qi and pooled blood, stone lancing to drain is suitable. Thus, Bian stones and Nine Needles each have advantages. Skilled practitioners of blood vessel changes and carbuncles assess severity to determine treatment. (All from *Shengji Zonglu*, from Wang Zhizhong onwards.)