北方者,天地所闭藏之域也,其地高陵居,风寒冰冽,其民乐野处而乳食,脏寒生满病
。其治宜灸 ,故灸 者,亦从北方来。
气盛则泻之,虚则补之。以火补者,毋吹其火,须自灭也。以火泻者,疾吹其火,传其
艾,
须其火灭也。络满经虚,灸阴刺阳,经满络虚,刺阴灸阳。陷下则灸之。针所不为,灸之所
宜,阴阳皆虚,火自当之。经陷下者,火则当之。经络坚系,火所治之。
灸寒热之法,先灸大椎,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,足小趾次趾间灸之, 下陷脉灸之,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,脐下关元三寸灸之,毛际动
脉灸之,膝下三寸分间灸之,足阳明跗上动脉灸之,巅上一灸之。
王脏痈发,四五日逞灸之。
犬啮,犬所啮处灸之三壮,即以犬伤病法灸之,当灸二十九处。
伤食灸之。形乐志苦,病生于脉,治之以灸刺。
背中大俞在杼骨之端,肺俞在三焦之间,心俞在五焦之间,鬲俞在七焦之间,肝俞在九
焦之
间,脾俞在十一焦之间,肾俞在十四焦之间,皆挟脊相去三寸所。则欲得而验之,按其处,
应其中而痛解,乃其俞也。灸之则可,刺之则不可。武按∶血气形志论、及遗篇刺法论,并
载五脏俞刺,而此云可灸不可刺。故沧州翁谓《素问》非出于一时之言,非成于一人之手。
焦当作椎。又按∶华陀传彭城樊阿皆从陀学,凡医咸言背及胸脏之间,不可妄针,针之不过
四分,而阿针背入一二寸,巨阙胸脏乃五六寸,而病皆瘳。是知《素问》立言致谨之道,而
明医纵横变化,不拘于常法,而卒与法会也。
北方地区,是天地闭藏之气汇聚的地方。那里地势高峻,居民多居住在山陵地带,气候寒冷,风寒凛冽,百姓习惯于野外生活并以乳制品为主食,因此容易因内脏受寒而产生胀满类疾病。所以治疗适宜采用艾灸,这也说明艾灸之法起源于北方。
气盛则用泻法,气虚则用补法。用火进行补法时,不要吹灭火焰,必须让艾火自然熄灭。用火进行泻法时,要快速吹旺火焰,迅速更换艾炷,直到艾火熄灭为止。如果络脉邪气盛而经脉正气虚,应灸阴经(里)而刺阳经(表);如果经脉邪气盛而络脉正气虚,应刺阴经(里)而灸阳经(表)。阳气下陷的病症应当施灸。针刺无法奏效的地方,正是艾灸适宜之处;阴阳两虚的病症,应当由艾灸来担当治疗重任。经脉下陷的,应当用艾灸治疗。经络拘急紧束的,也是艾灸所主治的范围。
治疗寒热病的方法:先灸大椎穴,根据患者年龄决定施灸壮数(如一岁一壮),多次施灸于撅骨(尾骨端)处,同样按年龄决定壮数。多次观察背部俞穴中凹陷的部位并施灸,抬起手臂时肩上凹陷处施灸,两侧季胁之间施灸,外踝上绝骨(腓骨小头)末端施灸,足小趾与次趾(第二趾)之间施灸,[此处原文可能有脱漏,指某处]下凹陷的脉管处施灸,外踝后方施灸,缺盆骨上方切按,若感觉坚硬跳动如筋脉状则施灸,胸膺中骨骼间凹陷处施灸,脐下关元穴三寸处施灸,阴毛边缘动脉搏动处施灸,膝下三寸分肉间隙处施灸,足阳明胃经足背上的动脉处施灸,头顶正中一处施灸。
发于胁部的痈肿,名叫“败疵”,这是女子特有的疾病,应当施灸。
被狗咬伤,在被咬处施灸三壮,随即按照治犬伤的方法施灸,总共应当灸二十九个部位。
饮食积滞所致之病,应当施灸。形体安逸但精神痛苦,病生于血脉,治疗可用艾灸和针刺结合。
背部的大俞穴位于脊柱旁开的位置,肺俞穴在三焦(此处指脊椎节段,一说为第三、四胸椎之间)之间,心俞在五焦之间,膈俞在七焦之间,肝俞在九焦之间,脾俞在十一焦之间,肾俞在十四焦之间,这些穴位都夹在脊柱两旁,相互距离约三寸。想要验证取穴是否准确,可以按压该处,若感到疼痛缓解或酸胀感传导至病所,那就是正确的俞穴。这些穴位只宜施灸,不宜针刺。高武按语:《血气形志论》及《素问遗篇·刺法论》,都记载了五脏俞穴的针刺方法,而这里却说可灸不可刺。所以沧州的老翁认为《素问》并非出自同一时期之言,也非出自一人之手。“焦”字应当作“椎”(脊椎)。另外按:华佗传记中提到彭城人樊阿跟随华佗学习,凡是医生都说背部及胸脏之间,不可随意深针,针刺深度不超过四分,而樊阿针刺背部可达一二寸,巨阙穴(胸腹部穴位)针刺可达五六寸,但病情都痊愈了。由此可知,《素问》立言谨慎严谨的道理,同时也明白高明医生能够纵横变化,不拘泥于常规法则,但最终仍会与医理相契合。
The Northern region is the domain where Heaven and Earth’s Qi are closed and stored. The terrain is high, with people dwelling on hills and mountains; the climate is cold, with biting wind and freezing ice. The inhabitants are accustomed to living in open fields and consuming dairy products, which often leads to internal cold causing distension-type diseases. Therefore, treatment is suitable for moxibustion, indicating that the practice of moxibustion also originated from the North.
When Qi is excessive, apply the draining method; when Qi is deficient, apply the tonifying method. For tonification with fire, do not blow on the flame; allow it to extinguish naturally. For draining with fire, blow vigorously to intensify the heat, quickly replace the moxa cone, and allow the fire to extinguish. If collateral vessels are full (excess) while meridians are empty (deficiency), moxa the Yin [interior] and needle the Yang [exterior]. If meridians are full while collaterals are empty, needle the Yin [interior] and moxa the Yang [exterior]. In cases of sinking [Yang Qi deficiency], apply moxibustion. Where acupuncture cannot achieve the desired effect, moxibustion is appropriate. In cases of simultaneous deficiency of both Yin and Yang, fire therapy [moxibustion] should be employed. For sunken meridians, fire therapy is indicated. For stiff and bound meridians, fire therapy is also the treatment of choice.
The method for treating cold-heat disorders: First, moxa the Dazhui (GV14) point, using one moxa cone per year of age. Frequently moxa the Jugu (coccyx tip) area, again using one cone per year of age. Observe and moxa any sunken areas among the Back-Shu points on the back. Moxa the depression above the shoulder when the arm is raised. Moxa between the two hypochondriac regions. Moxa the end of the Juegu (fibular head) above the lateral malleolus. Moxa between the little toe and the second toe. Moxa the sunken pulse below [the text implies a specific location, likely related to the lower leg or foot]. Moxa behind the lateral malleolus. Palpate above the Keyuan (supraclavicular fossa) bone; if it feels hard and pulsating like a tendon, moxa it. Moxa the depression between the bones in the chest. Moxa 3 cun below the umbilicus at the Guanyuan (CV4) point. Moxa the arterial pulse at the pubic hairline. Moxa the space between muscles three cun below the knee. Moxa the arterial pulse on the dorsum of the foot belonging to the Stomach Meridian of Foot-Yangming. Moxa one cone on the vertex of the head.
An abscess occurring in the hypochondriac region is named "Baici" (Failed Beauty/Defect). This is a disease specific to women and should be treated with moxibustion.
For carbuncles arising in the Five Zang organs, after four or five days, apply moxibustion.
For dog bites, apply three cones of moxa at the site of the bite, and subsequently treat according to the methods for canine injuries, moxa-ing a total of twenty-nine locations.
For diseases caused by food stagnation, apply moxibustion. For those whose bodies are comfortable but whose minds are distressed, where the disease arises in the vessels, treatment involves both moxibustion and acupuncture.
The major Shu points on the back are located at the ends of the spinous processes. The Feishu (BL13) is between the third and fourth thoracic vertebrae (referred to as 'San Jiao' in this context, likely meaning the vertebral segment); Xinshu (BL15) is between the fifth and sixth; Geshushu (BL17) is between the seventh and eighth; Ganshu (BL18) is between the ninth and tenth; Pishu (BL20) is between the eleventh and twelfth; and Shenshu (BL23) is between the fourteenth and fifteenth. All these points flank the spine, approximately three cun apart. To verify the correct location, press the area; if pain is relieved or sensation radiates appropriately, it is the correct Shu point. These points are suitable for moxibustion but not for needling. Gao Wu notes: The *Lun on Blood, Qi, Form, and Spirit* and the *Lost Chapter on Needling Methods* in the *Suwen* both record needling techniques for the Five Zang Shu points, yet here it states they are suitable for moxibustion but not needling. Thus, an old scholar from Cangzhou argued that the *Suwen* was not spoken in one period nor written by one person. The character "Jiao" (scorched/burned) should be read as "Zhui" (vertebra/spine). Furthermore, according to the Biography of Hua Tuo, Fan A from Pengcheng studied under Hua Tuo. Physicians generally stated that the back and chest/abdominal viscera should not be needled recklessly, with a maximum depth of four fen. However, Fan A needled the back to a depth of one or two cun, and the Juque (CV14) point to five or six cun, resulting in complete recovery. This demonstrates the cautious nature of the statements in the *Suwen*, while also showing that skilled physicians can adapt flexibly, not strictly bound by conventional methods, yet ultimately aligning with medical principles.