黄帝问曰∶五脏相通,移皆不次。五脏有病,则各传其所胜,不治法三月,若六月
若三日,若六日,传五脏而当死(《素问》下有是顺传所胜之次)。故曰∶别于阳者,知病从
来;别于阴者,知死生之期,言至其所困而死者也,是故风者,百病之长也。今风寒客于人,
使人毫毛毕直,皮肤闭而为热。当是之时,可汗而发。或痹不仁,肿痛,当是之时,可汤熨
,及(一本作足字)火灸,刺而去,弗治,病入舍于肺,名曰肺痹,发咳上气。弗治,肺即传
而行之肝,病名曰肝痹,一名曰厥,胁痛出食。当是之时,可按可刺。弗治,肝传之脾,病
名曰脾风,发瘅,腹中热,烦心汗出,黄瘅(《素问》无汗瘅二字),当此之时,可汗可药
可烙(一本作浴)。弗治,脾传之肾,病名曰疝瘕,少腹烦冤而痛,汗出(《素问》作出白),一
名曰蛊。当此之时,可按可药。弗治,肾传之心,病筋脉相引而急,名之曰 ,当此之时,
可灸可药。弗治,十日法当死。肾传之心,心即复反传而之肺,发寒热,法当三岁死。此病
之次也。然其卒发者,不必治。其传化有不以次者,忧恐悲喜怒令不得以其次,故令人大
病矣。因而喜,大虚则肾气乘矣,怒则肝气乘矣,悲则肺气乘矣,恐则脾气乘矣,忧则心
气乘矣,此其道也。故病有五,五五二十五变及其传化。传,乘之名也。
大骨枯槁,大肉陷下,胸中气满,喘息不便,其气胜形,期六月死;真脏脉见,乃予之
期日。大骨枯槁,大肉陷下,胸中气满,喘息不便,内痛引肩项,期一月死;真脏脉见,乃
予之期日。大骨枯槁,大肉陷下,胸中气满,喘息不便,内痛引肩项,痛热,脱肉破 ,
真脏脉见,十月之内死。大骨枯槁,大肉陷下,胸中气满,腹内痛,心中不便,肩项身热,
破脱肉,目眶陷,真脏脉见,目不见人立死;其见人者,至其所不胜之时而死。急
虚中身卒至,五脏闭绝,脉道不通,气不往来,譬之堕溺,不可为期。其脉绝不来,若一息
五六至,其形肉不脱,真脏虽不见,犹死。
真肝脉至,中外急,如循刀刃责责然,如按琴瑟弦,色青白不泽,毛折,乃死。
真心脉至,紧(一本作坚)而搏,如循薏苡子累累然,色赤黑不泽,毛折,乃死。
真肺脉至,大而虚,如以毛羽中人肤,色赤白不泽,毛折,乃死。
真脾脉至,弱而乍疏乍数,色青黄不泽,毛折,乃死。
真肾脉至,搏而绝,如指弹石辟辟然,色黑黄不泽,毛折,乃死。诸真脏脉见者,皆死
不治。
曰∶寒热瘰 在于颈腋者,何气所生?曰∶此皆鼠 ,寒热之毒瓦斯,稽于脉而不去者
也。(《灵枢》稽作堤字)。鼠 之本,皆在于脏,其末上出颈腋之间。其浮于胸中,未着
于肌肉而外为脓血者,易去也。曰∶去之奈何?曰∶请从其本,引其末,可使衰去而绝
其寒热,审按其道以予之,徐往徐来以去之,其小如麦者,一刺知,三刺已。决其死生,反
其目视之,其中有赤脉从上下贯瞳子者,见一脉一岁死,见一脉半一岁半死,见二脉二岁死
,见二脉半二岁半死,见三脉三岁死,赤脉不下贯瞳子者可治。
曰∶人有善病寒热者,何以候之?曰∶小骨弱肉者,善病寒热。颧骨者,骨之本也,颧
大则骨大,颧小则骨小。皮薄而肉弱无 ,其臂懦懦然,其地色 然,不与天地同色
污然独异,此其候也。然臂薄者,其髓不满,故善病寒热。风感则为寒热。皮寒热,皮不可
附席,毛发焦,鼻槁腊,不得汗,取三阳之络,补手太阳。肌寒热,病肌痛,毛发焦。唇槁
腊,不得汗,取三阳于下以去其血者,补太阴以去其汗。骨寒骨热,痛无所安,汗注不休
,齿本槁痛,取其少阴于阴股之络,齿色槁,死不治。骨厥亦然。男子如蛊,女子如阻,身
体腰脊如解,不欲食,先取涌泉见血,视跗上盛者,尽出血。灸寒热之法∶先取项大椎以
年为壮数,次灸撅骨以年为壮数,视背俞陷者灸之,举臂肩上陷者灸之,两季胁之间灸之
,外踝上绝骨之端灸之,足小指、次指之间灸之, 上陷脉灸之,外踝后灸之,缺盆骨上
切之坚动如筋者灸之,膺中陷骨间灸之,掌束骨下灸之,脐下关元三寸灸之,毛际动脉灸
之,脐下二寸分间灸之,足阳明跗上动脉灸之,巅上一灸之,取犬所啮处灸之,即以犬伤病
法三炷灸之,凡当灸二十九处。
寒热头痛,喘喝,目不能视,神庭主之;其目泣出头不痛
者,听会主之。寒热头痛如破,目痛如脱,喘逆烦满,呕吐,流汗难言,头维主之;寒热,
刺脑户。
黄帝问道:五脏之间是相互贯通的,病气的转移并不按固定的次序。五脏发生病变时,就会各自传给它所克制的那一脏。如果不进行治疗,有的三个月后死亡,有的六个月后死亡,有的三天后死亡,有的六天后死亡,按照这种传变规律传到相应的脏腑时就会死亡(《素问》在此处补充说明这是顺次传变其所克之脏的顺序)。所以说:善于辨别阳分病变的人,能知道疾病从何而来;善于辨别阴分病变的人,能预知生死的时间界限,指的是病情发展到其受困的脏腑时就会死亡。因此,风邪是各种疾病的先导。当风寒邪气侵袭人体时,会使人的毫毛竖立,皮肤毛孔闭塞从而产生发热。在这个时候,可以通过发汗的方法来治疗。如果导致痹证、麻木不仁或肿痛,在这个时候,可以通过热敷、艾灸或针刺来祛除病邪。如果不治疗,病邪就会深入内舍于肺,称为肺痹,出现咳嗽和气逆的症状。如果不治疗,肺病就会传变到肝,称为肝痹,又名厥证,表现为胁痛和呕吐食物。在这个时候,可以通过按摩或针刺治疗。如果不治疗,肝病就会传变到脾,称为脾风,出现黄疸、腹中发热、心烦出汗等症状(《素问》中没有“汗”字),此时可以通过发汗、服药或烙法治疗(另一版本作洗浴)。如果不治疗,脾病就会传变到肾,称为疝瘕,表现为小腹部烦闷疼痛(《素问》作排出白色分泌物),又名蛊病。在这个时候,可以通过按摩或服药治疗。如果不治疗,肾病就会传变到心,表现为筋脉牵引拘急,称为痫证(原文此处有缺字,据文意推测为痫或类似痉挛病症),在这个时候,可以通过艾灸或服药治疗。如果不治疗,十天后应当死亡。肾病传变到心后,心又会反过来传变到肺,出现寒热症状,按照规律三年后死亡。这就是疾病传变的次序。然而,如果是突然发作的疾病,不一定需要按照这个规律治疗。如果疾病的传变不按次序进行,是因为忧、恐、悲、喜、怒等情志因素导致气机紊乱,不能按照正常的次序传变,所以使人患上重病。例如,过度喜悦会导致心气虚弱,肾气就会乘虚侵犯;愤怒会导致肝气亢盛,乘虚侵犯其他脏腑;悲伤会导致肺气受损,乘虚侵犯;恐惧会导致脾气受损,乘虚侵犯;忧虑会导致心气受损,乘虚侵犯。这就是其中的道理。所以疾病有五种基本类型,五五二十五种变化及其传变规律。“传”就是“乘”的意思,即相克之气过盛而侵犯。
如果出现大骨枯槁、大肉陷下、胸中气满、呼吸喘促困难、身形消瘦而气逆上冲的现象,预计六个月后死亡;如果见到真脏脉,就可以给出确切的死期日期。如果出现大骨枯槁、大肉陷下、胸中气满、呼吸喘促困难、内部疼痛牵引肩颈,预计一个月后死亡;如果见到真脏脉,就可以给出确切的死期日期。如果出现大骨枯槁、大肉陷下、胸中气满、呼吸喘促困难、内部疼痛牵引肩颈、身体发热、肌肉脱失、骨骼外露,见到真脏脉,预计十个月内死亡。如果出现大骨枯槁、大肉陷下、胸中气满、腹内疼痛、心中烦闷不适、肩颈身体发热、肌肉脱失、眼眶凹陷,见到真脏脉,若看不见人则立即死亡;若还能看见人,则会在其不胜的时辰死亡。如果是急虚证,身体突然衰竭,五脏功能闭绝,脉道不通,气机停止往来,就像从高处坠落或溺水一样,无法预测具体的死亡时间。如果脉搏完全消失,或者一呼一吸间脉搏跳动五六次,虽然形体肌肉没有脱失,真脏脉也没有显现,仍然会死亡。
真肝脉出现的表现是:脉象中外紧急,像触摸刀刃那样锐利,又像按压琴瑟弦那样紧绷,面色青白无光泽,毫毛干枯折断,这时就会死亡。
真心脉出现的表现是:脉象紧硬而搏动有力,像触摸薏苡子那样颗粒累累,面色赤黑无光泽,毫毛干枯折断,这时就会死亡。
真肺脉出现的表现是:脉象大而空虚,像羽毛中人肌肤那样轻浮无力,面色赤白无光泽,毫毛干枯折断,这时就会死亡。
真脾脉出现的表现是:脉象微弱且忽快忽慢,面色青黄无光泽,毫毛干枯折断,这时就会死亡。
真肾脉出现的表现是:脉象搏动强劲而断绝,像手指弹石那样辟辟作响,面色黑黄无光泽,毫毛干枯折断,这时就会死亡。凡是见到真脏脉的,都是死症,无法治愈。
有人问道:颈部和腋下出现寒热交作的瘰疬(淋巴结结核),这是什么气产生的?回答是:这都是鼠瘰(一种以颈部肿块为特征的疾病),是寒热毒气滞留于经脉而不消散所致。(《灵枢》中“稽”作“堤”字)。鼠瘰的根本在于内脏,其末梢表现在颈部和腋下之间。如果病邪浮游在胸中,尚未附着于肌肉而外部化为脓血的,容易去除。又问:如何去除它?回答是:请顺着病根,引导末梢的病气,可以使病气衰退并断绝寒热,仔细审察经络之道给予治疗,进针缓慢,出针缓慢以祛除病邪。如果肿块小如麦粒,刺一次见效,刺三次痊愈。判断预后生死,观察眼睛,如果有赤色的脉络从上向下贯穿瞳孔,见一条赤脉一年死,见半条赤脉一年半死,见两条赤脉两年死,见两条半赤脉两年半死,见三条赤脉三年死。赤色脉络不向下贯穿瞳孔的可以治疗。
有人问道:有些人容易患寒热病,如何诊察?回答是:骨骼细小、肌肉软弱的人,容易患寒热病。颧骨是骨骼的根本,颧骨大则骨骼大,颧骨小则骨骼小。皮肤薄而肌肉软弱无力,手臂松弛无力,地阁颜色晦暗,不与天地正常色泽相同,显得污浊独异,这是其征候。然而手臂薄弱的人,骨髓不满,所以容易患寒热病。感受风邪就会引发寒热。皮寒热,表现为皮肤不能贴靠席子,毛发焦枯,鼻孔干燥萎缩,无汗,应取三阳经的络穴,补手太阳经。肌寒热,表现为肌肉疼痛,毛发焦枯,嘴唇干燥萎缩,无汗,应取下部的三阳经穴位放血以去瘀滞,补太阴经以发汗。骨寒热,表现为疼痛无处安放,汗水淋漓不止,齿根干枯疼痛,应取足少阴经在大腿内侧的络穴;如果牙齿颜色干枯,则是死症,无法治愈。骨厥也是同样的情况。男子患病像蛊病,女子患病像阻滞,身体腰脊像散架一样,不想吃东西,先取涌泉穴放血,观察足背动脉盛满之处,全部放血。治疗寒热的灸法:先取项部的大椎穴,根据年龄决定壮数(每岁一壮),其次灸尾骨端的撅骨穴,根据年龄决定壮数,观察背部俞穴凹陷的地方进行艾灸,举起手臂时在肩上凹陷处艾灸,两肋侧之间艾灸,外踝上绝骨端艾灸,足小趾和第二趾之间艾灸,腘窝上凹陷处的脉艾灸,外踝后方艾灸,锁骨上切按时坚硬跳动如筋的部位艾灸,胸部凹陷骨间艾灸,手掌束骨下方艾灸,脐下关元穴三寸处艾灸,阴毛际动脉处艾灸,脐下二寸分肉间艾灸,足阳明经足背动脉处艾灸,头顶上一穴艾灸,取被狗咬过的地方艾灸,即用治犬伤的方法用三壮艾灸,总共应当灸二十九处。
对于寒热头痛、喘息有声、眼睛不能视物的症状,神庭穴主治;对于流泪但头部不痛的,听会穴主治。对于寒热头痛剧烈如破裂、眼痛如脱出、气喘逆乱、心烦胀满、呕吐、出汗困难、言语不利,头维穴主治;对于寒热,针刺脑户穴。
Huangdi asked: The five zang organs are mutually connected, and the transmission of pathogenic qi does not follow a fixed sequence. When disease occurs in the five zang organs, it transmits to the organ it overcomes (Wood overcomes Earth, Earth overcomes Water, etc.). If left untreated, death may occur after three months, six months, three days, or six days; when transmitted to the respective organ according to this sequence, death ensues (Suwen adds that this is the order of sequential transmission to the overcome organ). Therefore it is said: One who distinguishes Yang-level disorders knows the origin of the disease; one who distinguishes Yin-level disorders knows the timing of life and death, referring to death occurring when the disease reaches its point of exhaustion. Thus, Wind is the leader of all diseases. When Wind-Cold invades the human body, it causes the hair follicles to stand erect and the skin pores to close, resulting in fever. At this stage, treatment by sweating (Diaphoresis) is appropriate. If Bi syndrome (Obstruction Syndrome), numbness, swelling, or pain occur, treatment with hot compresses, moxibustion, or acupuncture is appropriate at this stage. If untreated, the pathogen enters the Lung, named Lung Bi (Lung Obstruction), manifesting as cough and Qi rebellion. If untreated, the Lung disease transmits to the Liver, named Liver Bi (Liver Obstruction), also called Jue syndrome, manifesting as hypochondriac pain and vomiting food. At this stage, massage or acupuncture is appropriate. If untreated, the Liver disease transmits to the Spleen, named Spleen Wind, manifesting as jaundice, heat in the abdomen, vexation, and sweating (Suwen omits "sweating"). At this stage, sweating, herbal medicine, or cauterization (or bathing, per another version) is appropriate. If untreated, the Spleen disease transmits to the Kidney, named Shan Jia (Hernia Mass), manifesting as irritability and pain in the lower abdomen (Suwen reads "discharge of white fluid"), also known as Gu disease. At this stage, massage or herbal medicine is appropriate. If untreated, the Kidney disease transmits to the Heart, manifesting as pulling and acute spasms of sinews and vessels, named Xi (Seizure/Spasm). At this stage, moxibustion or herbal medicine is appropriate. If untreated, death should occur within ten days. After Kidney transmits to Heart, the Heart reversely transmits to the Lung, manifesting as chills and fever, with death expected within three years according to the pattern. This is the sequence of disease transmission. However, sudden onset diseases need not be treated according to this rule. If transmission does not follow the sequence, it is due to emotional disturbances—worry, fear, sorrow, joy, anger—that disrupt the orderly transmission, leading to severe illness. For instance, excessive joy causes Heart Qi deficiency, allowing Kidney Qi to invade; anger causes Liver Qi to invade; sorrow causes Lung Qi to invade; fear causes Spleen Qi to invade; worry causes Heart Qi to invade. This is the principle. Thus, there are five types of diseases, yielding twenty-five variations and their transmissions. "Transmission" is synonymous with "Overcoming" (Cheng).
If the large bones are emaciated, the large muscles are sunken, the chest is full of Qi, breathing is labored and difficult, and the rebellious Qi exceeds the physical form, death is expected in six months; if the Zang-True Pulse appears, the exact date of death can be predicted. If the large bones are emaciated, the large muscles are sunken, the chest is full of Qi, breathing is labored and difficult, internal pain radiates to the shoulders and neck, death is expected in one month; if the Zang-True Pulse appears, the exact date of death can be predicted. If the large bones are emaciated, the large muscles are sunken, the chest is full of Qi, breathing is labored and difficult, internal pain radiates to the shoulders and neck, accompanied by heat, muscle wasting, and bone exposure, and the Zang-True Pulse appears, death is expected within ten months. If the large bones are emaciated, the large muscles are sunken, the chest is full of Qi, abdominal pain, heart vexation, shoulder/neck/body heat, muscle wasting, and sunken eye sockets appear, and the Zang-True Pulse appears, if the patient cannot see people, death is immediate; if they can see people, death occurs during the time element they cannot overcome. In cases of acute deficiency where the body suddenly collapses, the five Zang organs close and seal off, the pulse channels become blocked, and Qi ceases to circulate, resembling falling from a height or drowning, the time of death cannot be predicted. If the pulse is absent, or if there are five to six beats per respiration, even if the flesh has not wasted away and the Zang-True Pulse is not yet visible, death will still occur.
The True Liver Pulse arrives tight and urgent inside and out, like touching the edge of a knife, sharp and rasping, or like pressing a lute string; the complexion is blue-white without luster, hair breaks, and then death occurs.
The True Heart Pulse arrives tight and hard with strong beating, like touching clusters of Job's tears seeds; the complexion is red-black without luster, hair breaks, and then death occurs.
The True Lung Pulse arrives large and empty, like a feather penetrating the skin; the complexion is red-white without luster, hair breaks, and then death occurs.
The True Spleen Pulse arrives weak and intermittently slow and rapid; the complexion is green-yellow without luster, hair breaks, and then death occurs.
The True Kidney Pulse arrives forceful but interrupted, like fingers striking stone, crisp and distinct; the complexion is black-yellow without luster, hair breaks, and then death occurs. All appearances of Zang-True Pulses indicate terminal conditions that are untreatable.
It was asked: What generates scrofula (Luoli, lymph node tuberculosis) characterized by chills and fever located in the neck and axilla? It is answered: These are all Shu Lu (Mouse Scrofula), caused by toxic factors of cold and heat stagnating in the meridians and not dispersing. The root of Shu Lu lies in the Zang organs, while its branches emerge between the neck and axilla. If the pathogen floats in the chest, has not adhered to the muscles, and externally manifests as pus and blood, it is easy to remove. It was asked: How to remove it? It is answered: Follow the root and guide the branch, so that the pathogenic Qi declines and the cold-heat is cut off. Carefully examine the meridian pathways to treat it; insert the needle slowly and withdraw it slowly to dispel the pathogen. If the nodule is small like a wheat grain, one insertion brings improvement, three insertions cure it. To determine life and death, observe the eyes: if red vessels run vertically through the pupil, one vessel indicates death in one year, half a vessel in one and a half years, two vessels in two years, two and a half vessels in two and a half years, three vessels in three years. Red vessels that do not penetrate the pupil downward are treatable.
It was asked: Some people are prone to chills and fever; how to diagnose them? It is answered: Those with small bones and weak flesh are prone to chills and fever. The cheekbones are the root of the bones; large cheekbones indicate large bones, small cheekbones indicate small bones. Thin skin and weak flesh without substance, arms that are flaccid, and a dark, muddy complexion different from the normal colors of heaven and earth are signs of this predisposition. Arms that are thin indicate insufficient marrow, hence prone to chills and fever. Contracting Wind leads to chills and fever. Skin Chills-Fever presents as inability to lie on the mat, scorched hair, dry and shriveled nose, and anhidrosis; treat by taking the collateral of the Three Yang meridians and supplementing Hand Taiyang. Muscle Chills-Fever presents as muscle pain, scorched hair, dry and shriveled lips, and anhidrosis; treat by taking the lower Three Yang meridians to remove blood stasis and supplementing Taiyin to induce sweating. Bone Chills-Fever presents as pain with no comfortable position, profuse sweating, and dry, painful tooth roots; take the collateral of Foot Shaoyin in the inner thigh. If teeth are dry and withered, it is untreatable death. Bone Jue follows the same pattern. Men suffer like Gu disease, women suffer like obstruction; the body and spine feel as if dislocated, appetite is lost. First, puncture Yongquan (KI1) until bleeding; observe the dorsum of the foot for full pulses and bleed them completely. Methods for moxibustion in chills and fever: First, moxa Dazhui (GV14) in the neck, using one moxa cone per year of age; second, moxa the tip of the coccyx (Jugu), using one moxa cone per year of age; moxa any depressed Back-Shu points on the back; moxa the depression above the shoulder when the arm is raised; moxa the space between the two costal margins; moxa the end of Juegu (GB39) above the lateral malleolus; moxa between the first and second toes of the foot; moxa the pulse in the depression above the popliteal fossa; moxa behind the lateral malleolus; moxa the area above the clavicle that feels hard and tendon-like upon pressure; moxa the depression between the bones in the chest; moxa below the metacarpals in the palm; moxa Guan Yuan (CV4), three cun below the umbilicus; moxa the arterial pulse at the pubic hairline; moxa the space two cun below the umbilicus; moxa the arterial pulse on the dorsum of the foot (Foot Yangming); moxa one point on the vertex; moxa the site bitten by a dog, treating it with three cones as per dog-bite injury protocols. Total of twenty-nine sites for moxibustion.
For chills, fever, headache, wheezing, and inability to see, Shenting (GV24) is indicated; for tearing but without headache, Tinghui (GB2) is indicated. For severe chills, fever, headache feeling like splitting, eye pain feeling like protrusion, wheezing with vexation and fullness, vomiting, difficulty speaking due to sweating, Touwei (ST8) is indicated; for chills and fever, needle Naohu (GV16).