刺胸腹者,必以布HT 着之乃从单布上刺,刺之不愈复刺。
先病而后逆者治其本。先逆而后病者治其本,先寒而后生病者治其本,先病而后生寒者
治其
本,先热而后生病者治其本,先泄而后生他病者治其本,必且调之,乃治其他病。先病而后
中满者治其标,先病而后泄者治其本,先中满而后烦心者治其本,人有客气,有同气。大小
便不利治其标,大小便利治其本。病发而有余,本而标之,先治其本,后治其标。病发而不
足,标而本之,先治其标,后治其本。谨详察间甚,以意调之,间者并行,甚为独行。先大
小便不利而后生他病者,治其本也。
明目者可使视色,聪耳者可使听音,建辞疾语者可使传论。语徐而安静,手巧而心审谛
者,
可使行针艾,理血气而调诸逆顺,察阴阳而兼诸方。缓节柔筋,而心和调者,可使导引行气
。疾毒言语轻人者,可使唾痈 病。爪苦手毒,为事善伤者,可使按积抑痹,各得其能,方
乃可行,其名乃彰。不得其人,其功不成其师无名,故曰得其人乃言,非其人弗传,此之谓
也。手毒者可使按龟,置龟于器下,而按其上,五十日而死矣。手甘者,复生如故也。
凡刺之法,必候日月星辰,四时八正之气,气定乃刺之。是故天温日明,则人血淖泽而
卫气
浮,故血易泻,气易行。天寒日阴,则人血凝泣而卫气沉,月始生则血气始精,卫气始行,
月郭满则血气实,肌肉坚;月郭空则肌肉减,经络虚,卫气去,形独居,是以因天时而调血
气也,是以天寒无刺,天温无凝,月生无泻,月满无补,月郭空无治,是谓得时而调之也。
因天之时,盛虚之时,移光定位,正时而待之,故曰月空而泻,是谓藏虚;月满而补,血气
扬波,络有留血,命曰重实;月郭空而治,是谓乱经。阴阳相错,真邪不别,沉以留止,外
虚内乱,淫邪乃起。帝曰∶星辰八正何候?岐伯曰∶星辰者,所以候日月之行也;八正者,
所以候八风虚邪以时至者也;四时者,所以分春夏秋冬之气所在以调之也。八正之虚邪,避
之勿犯也。是故春气在经脉,夏气在孙络,长夏气在肌肉,秋气在皮肤,冬气在骨髓中。春
者天气始开,地气始泄,冻解冰释,水道经通,故人气在脉。夏者经满气溢,孙络受血,皮
肤充实。长夏者经络皆盛,内溢肌中。秋者天气始收,腠理闭塞,皮肤引急。冬者盖藏,血
气在中,内着骨髓,通于五脏。是故邪气者,常随四时之气血而入客也。故用针之服者必有
法,则上视天光,下司八正,以避奇邪,而观百姓,审于虚实,毋犯其邪。是得天之露,遇
岁之虚,救而不胜,反受其殃。故曰必知天忌,乃言针意。春刺散俞,及与分理,血出而止
,甚者传气,间者环也。夏刺络俞,见血而止,尽气闭环,痛病必下,秋刺皮肤,循理上下
,同法神变而止。冬刺俞窍于分理,甚者直下,间者散下。春夏秋冬,各有所刺,法其所在
。春者木始治,肝气始生,其风病急,经脉常深,其气不能深入,故取络脉分肉间。夏者火
始治,心气始强,脉瘦气弱,阳气溜溢,热董分腠,内至于经,故取盛经,分腠绝肤,而病
去者,邪气浅也。所谓盛经,阳脉也。秋者金始治,肺将收杀,金得胜火,阳气在合,故阴
气初胜,湿气及体,阴气未盛,未能深入,故取俞以泻阴邪,取合以虚阳邪,阳气始衰,故
取于合。冬者水始治,肾方闭,阳气衰少,阴气坚盛,巨阳伏沉,阳脉乃去,故取井以下阴
逆,取荥以实阳气,故曰冬取井荥,春不鼽衄。正月二月三月,人气在左,无刺左足之阳;
四月五月六月,人气在右,无刺右足之阳;七月八月九月,人气在右,无刺右足之阴;十月
十一月十二月,人气在左,无刺左足之阴。甲乙日自乘无刺头,无发蒙于耳内;丙丁日自乘
无振挨于肩喉廉泉;戊己日乘四季,无刺足去爪泻水;庚申日自乘无刺关骨于股膝;壬癸日
自乘无刺足胫。随日之长短,各以为纪而刺之,谨候其时,病可与期。失时反候者,百病不
治。故曰∶刺实者,刺其来也;刺虚者,刺其去也。此言气存亡之时,以候虚实而刺则之,
候气之所在而刺之,是谓逢时。病在于三阳,必候其气在于阳而刺之;病在三阴,必候其气
在于阴而刺之。
刺胸腹部时,必须用布巾覆盖在施术部位上,然后隔着这层单布进行针刺;如果一次针刺后病未愈,可以再次针刺。
先患病而后出现气血逆乱(如厥逆)的,治疗其根本病因;先出现气血逆乱而后引发其他病症的,也治疗其根本病因;先有寒邪而后生病的,治疗其根本病因;先有病而后产生寒象的,治疗其根本病因;先有热邪而后生病的,治疗其根本病因;先有泄泻而后引发其他病症的,必须先调理好泄泻,然后再治疗其他病症。先患病而后出现胸腹胀满(中满)的,治疗其标症(胸腹胀满);先患病而后发生泄泻的,治疗其根本病因;先有胸腹胀满而后出现心烦的,治疗其根本病因(胸腹胀满)。人体既有感受外界客气(六淫邪气),也有内生同气(脏腑病变)。大小便不利的,治疗其标症(通利二便);大小便通畅的,治疗其根本病因。疾病发作表现为邪气有余(实证)的,先治其本,后治其标;疾病发作表现为正气不足(虚证)的,先治其标,后治其本。务必详细察看病情的轻重缓急,用心加以调治:病情轻浅的,标本兼治;病情严重的,单独治标或单独治本。先有大、小便不利而后引发其他病症的,治疗其根本原因(即通利二便为本)。
视力敏锐的人,可以让他辨别颜色;听力灵敏的人,可以让他听取声音;言辞清晰、善于表达的人,可以让他传达医理。言语缓慢而神情安静,手法灵巧而心思周密细致的人,可以让他施行针艾疗法,调理血气及各种逆顺失常的情况,观察阴阳变化并综合运用各方治法。关节舒缓、筋脉柔和,且心境平和协调的人,可以让他从事导引行气(如气功、按摩导引)的治疗。言语恶毒、轻视他人的人,可以让他用吹火疗法治疗痈肿等疾病。指甲坚硬、手法狠毒,做事容易损伤人的,可以让他按压积聚、抑制痹症。让每个人发挥其特长,才能取得疗效,医术名声才能彰显。如果不得其人,功效就无法达成,师承名声也无法确立。所以说,得到合适的人才才传授医术,得不到合适的人就不传授,说的就是这个道理。手劲狠毒的人可以用来练习按龟之术:将龟放在容器下,用手按压龟背上方,五十天后龟就会死亡;手劲温和甘柔的人,龟则会恢复生机如初。
大凡针刺的方法,必须观察日月星辰的运行和四时八正节气的气候变化,待气候稳定后再进行针刺。因此,天气温暖、阳光明亮时,人的血液滑润泽畅,卫气浮于体表,所以血液容易泻出,气机容易运行。天气寒冷、阴雨昏暗时,人的血液凝滞涩少,卫气沉伏于内。月亮初生时,人气血始精微,卫气始运行;月亮圆满时,气血充实,肌肉坚实;月亮亏空时,肌肉减损,经络空虚,卫气离去,形体独存。因此要根据天时来调节气血。所以,天气严寒时不要针刺,天气温暖时不要使气血凝滞,月亮初生时不要用泻法,月亮圆满时不要用补法,月亮亏空时不要进行治疗,这就叫做顺应天时来调治气血。根据天时的盛衰变化,通过观察日影位置来确定时间,等待合适的时机再施治。所以说,月亮亏空时泻之,称为脏气虚弱;月亮圆满时补之,会使血气波动加剧,络脉中有留血,这叫重实;月亮亏空时进行治疗,会扰乱经脉。导致阴阳错乱,真邪不分,邪气沉伏停留,外虚内乱,淫邪由此而起。黄帝问:星辰和八正节气如何候察?岐伯回答:星辰是用来候察日月运行的;八正是用来候察八方虚邪之风按时到来的;四时是用来区分春夏秋冬之气所在以进行调治的。对于八正节气的虚邪,应避开不要触犯。因此,春气在经脉,夏气在孙络,长夏气在肌肉,秋气在皮肤,冬气在骨髓中。春季,天气开始开通,地气开始发散,冰雪融化,水道畅通,所以人气在脉中。夏季,经脉气血满溢,孙络受血,皮肤充实。长夏季节,经络气血皆盛,内溢于肌肉之中。秋季,天气开始收敛,腠理闭塞,皮肤紧张。冬季,万物闭藏,气血在中焦,内注于骨髓,通达五脏。所以邪气常常随着四时气血的变化而入客体内。因此使用针法的人必须有法则,上要观察天光,下要考察八正节气,以避开奇邪,并观察百姓情况,审察虚实,不侵犯邪气。如果遇到天露(指运气不及之年)、岁虚(指岁运衰弱之时),救治而不能胜任,反而会受到祸殃。所以说,必须懂得天时的禁忌,才能谈论针刺的意旨。春季针刺散俞穴及分肉纹理,见血就停止,病情重的引导气机,病情轻的环周调治。夏季针刺络俞穴,见血就停止,尽气闭环,痛病必除。秋季针刺皮肤,顺着纹理上下操作,同样依据神变而止。冬季针刺俞窍于分肉之间,病情重的直下进针,病情轻的分散进针。春夏秋冬,各有其针刺部位,遵循气所在之处。春季木气始主令,肝气始生,风气病急,经脉常深,但春气不能深入,所以取络脉和分肉之间。夏季火气始主令,心气始强,脉瘦气弱,阳气流溢,热熏分腠,内至于经,所以取盛经(阳脉),穿透分腠皮肤,病邪浅则病去。所谓盛经,就是阳脉。秋季金气始主令,肺将收敛肃杀,金胜火,阳气在合穴,所以阴气初胜,湿气及体,阴气未盛,不能深入,所以取俞穴以泻阴邪,取合穴以虚阳邪,阳气始衰,故取于合穴。冬季水气始主令,肾方闭藏,阳气衰少,阴气坚盛,巨阳(太阳经)伏沉,阳脉乃去,所以取井穴以下阴逆,取荥穴以实阳气,所以说冬季取井穴、荥穴,春季就不会发生鼻衄。正月、二月、三月,人气在左侧,不要针刺左足的阳经;四月、五月、六月,人气在右侧,不要针刺右足的阳经;七月、八月、九月,人气在右侧,不要针刺右足的阴经;十月、十一月、十二月,人气在左侧,不要针刺左足的阴经。根据日期的长短,各自作为准则来针刺,谨慎等候其时机,病就可以预期治愈。错过时机、违背时令的,百病难治。所以说:刺实证,是刺其气之来盛;刺虚证,是刺其气之去衰。这是说气的存亡时机,用以候察虚实而施刺,候察气所在的部位而刺之,这就叫做逢时。病在三阳经,必须候察其气在阳分时再刺;病在三阴经,必须候察其气在阴分时再刺。
When needling the chest and abdomen, one must cover the area with a cloth and needle through this single layer of cloth; if the illness does not resolve after one session, needling may be repeated.
If an illness occurs first followed by Qi reversal (Ni, e.g., cold limbs or syncope), treat its root (Ben). If Qi reversal occurs first followed by other illnesses, also treat its root. If cold precedes the illness, treat its root. If an illness precedes the manifestation of cold, treat its root. If heat precedes the illness, treat its root. If diarrhea occurs first followed by other illnesses, one must first regulate the diarrhea before treating other ailments. If fullness in the middle jiao (Zhongman) occurs after an initial illness, treat its branch (Biao). If diarrhea occurs after an initial illness, treat its root. If fullness in the middle jiao is followed by vexation, treat its root (the fullness). The human body is subject to external pathogenic factors (Keqi) and internal pathological changes (Tongqi). When there is difficulty in urination or defecation, treat the branch (to promote unobstructed excretion); when urination and defecation are normal, treat the root. When a disease manifests with excess (Youyu), treat the root first and the branch later. When a disease manifests with deficiency (Buzu), treat the branch first and the root later. Carefully observe the severity and mildness of the condition and adjust treatment accordingly: for mild conditions, treat both root and branch simultaneously; for severe conditions, treat either the root or the branch exclusively. If difficulty in urination or defecation precedes other illnesses, treat the root (i.e., restore excretory function).
Those with keen vision can be employed to distinguish colors; those with acute hearing can be employed to discern sounds; those with clear speech and eloquence can be employed to convey medical theories. Those who speak slowly and calmly, possess dexterous hands, and have careful, attentive minds can be employed to perform acupuncture and moxibustion, regulating blood and Qi, adjusting reversals and smooth flows, observing Yin and Yang, and integrating various prescriptions. Those with flexible joints and soft tendons, and a harmonious mind, can be employed to guide Daoist exercises and circulate Qi. Those who speak harshly and contemptuously can be employed to use fire-lancing techniques to treat carbuncles. Those with hard nails and forceful hands, who tend to cause injury in their work, can be employed to press upon accumulations and suppress bi-syndrome (painful obstruction). By assigning tasks according to individual capabilities, efficacy can be achieved, and professional reputation established. If the wrong person is chosen, success will not be attained, and the teacher’s name will not be honored. Thus it is said: teach only when you find the right person; do not teach if the person is unsuitable. This is what is meant. Those with forceful hands can practice pressing on turtles: place a turtle under a vessel and press on its shell; the turtle will die in fifty days. Those with gentle hands will revive the turtle as if nothing had happened.
In general, the method of needling requires observing the movements of the sun, moon, and stars, and the Qi of the four seasons and eight solar terms. Needling should only commence when the atmospheric Qi is stable. Therefore, when the weather is warm and sunny, human blood is fluid and lubricated, and Wei-Qi (Defensive Qi) floats superficially; thus, blood is easily released, and Qi moves freely. When the weather is cold and cloudy, human blood is stagnant and sluggish, and Wei-Qi sinks deep. When the moon is waxing, Qi and blood begin to refine and flow; when the moon is full, Qi and blood are abundant, and muscles are firm; when the moon is waning, muscles diminish, meridians become empty, Wei-Qi departs, and only the form remains. Hence, one must regulate blood and Qi according to heavenly timing. Therefore, do not needle in extreme cold; do not allow Qi stagnation in warmth; do not use draining methods during the waxing moon; do not use tonifying methods during the full moon; do not treat during the waning moon. This is called regulating according to timely opportunities. Based on the abundance or deficiency of heavenly timing, observe the shadow positions to determine the correct time and wait for it. Thus, draining during the waning moon is called "viscera deficiency"; tonifying during the full moon causes blood and Qi to surge, and if there is retained blood in collaterals, it is called "double excess." Treating during the waning moon disrupts the meridians, causing Yin and Yang to cross, true Qi and pathogenic factors to become indistinguishable, pathogens to sink and linger, leading to external deficiency and internal chaos, allowing pernicious pathogens to arise. The Yellow Emperor asked: How are the stars and eight solar terms observed? Qibo replied: The stars are used to observe the movement of the sun and moon; the eight solar terms are used to observe the arrival of deficient evils from the eight directions at their proper times; the four seasons are used to distinguish the locations of Spring, Summer, Late Summer, Autumn, and Winter Qi for regulation. One should avoid the deficient evils of the eight solar terms and not offend them. Thus, Spring Qi resides in the main meridians, Summer Qi in the collateral vessels, Late Summer Qi in the muscles, Autumn Qi in the skin, and Winter Qi in the bone marrow. In Spring, Heaven’s Qi opens, Earth’s Qi disseminates, ice melts, and water channels flow; thus, human Qi is in the vessels. In Summer, meridian Qi is full and overflows, collateral vessels receive blood, and the skin is substantial. In Late Summer, both meridians and collaterals are abundant, overflowing into the muscles. In Autumn, Heaven’s Qi begins to gather, pores close, and the skin becomes tight. In Winter, things are concealed; Qi and blood remain in the interior, penetrating the bone marrow and connecting to the five zang organs. Therefore, pathogenic factors often enter and lodge within the body following the changes of seasonal Qi and blood. Thus, practitioners of needling must have rules: look up to observe the light of heaven, look down to monitor the eight solar terms, avoid strange pathogens, observe the people, examine deficiency and excess, and do not offend the pathogens. If one encounters celestial dew (insufficient annual luck) or year deficiency (weak annual fortune) and fails to cure, one suffers misfortune. Thus it is said: one must know the taboos of heaven to discuss the principles of needling. In Spring, needle scattered Shu points and intermuscular spaces; stop when blood appears; for severe cases, transmit Qi; for mild cases, circulate Qi. In Summer, needle collateral Shu points; stop when blood appears; exhaust Qi and close the loop; painful diseases will subside. In Autumn, needle the skin, follow the textures up and down, and stop based on spiritual changes. In Winter, needle Shu apertures in the intermuscular spaces; for severe cases, insert directly; for mild cases, disperse insertion. Each season has specific needling sites, following where the Qi resides. In Spring, Wood governs, Liver Qi generates, wind diseases are urgent, and meridians are deep; since Spring Qi cannot penetrate deeply, take from between the collateral vessels and muscles. In Summer, Fire governs, Heart Qi strengthens, pulses are thin, Qi is weak, Yang Qi flows and overflows, heat steams the intermuscular spaces, entering the meridians; thus, take from the Full Meridians (Yang meridians), penetrate the intermuscular spaces and skin, and the disease leaves because the pathogen is shallow. The so-called Full Meridian refers to Yang meridians. In Autumn, Metal governs, Lung Qi gathers and kills; Metal overcomes Fire, Yang Qi is at the He-Sea points; thus, Yin Qi initially prevails, dampness affects the body, but Yin Qi is not yet strong and cannot penetrate deeply; thus, take Shu points to drain Yin pathogens, and He-Sea points to empty Yang pathogens. Since Yang Qi begins to decline, take from the He-Sea points. In Winter, Water governs, Kidney closes, Yang Qi is scarce, Yin Qi is solid and abundant, Taiyang (Greatest Yang) sinks and hides, and Yang meridians depart; thus, take Jing-Well points to descend inverted Yin, and Ying-Spring points to strengthen Yang Qi. Thus it is said: taking Jing-Well and Ying-Spring points in Winter prevents nasal bleeding in Spring. From the first to the third month, human Qi is on the left; do not needle the Yang meridians of the left foot. From the fourth to the sixth month, human Qi is on the right; do not needle the Yang meridians of the right foot. From the seventh to the ninth month, human Qi is on the right; do not needle the Yin meridians of the right foot. From the tenth to the twelfth month, human Qi is on the left; do not needle the Yin meridians of the left foot. According to the length of the days, establish rules for needling, carefully awaiting the appropriate time, so the disease can be expected to heal. Missing the time or violating the season means hundred diseases cannot be treated. Thus it is said: to needle excess, needle the coming Qi; to needle deficiency, needle the departing Qi. This refers to the timing of Qi’s presence or absence, used to observe deficiency and excess for needling. Observing where the Qi resides and needling accordingly is called "meeting the time." If the disease is in the Three Yang meridians, one must wait until the Qi is in the Yang phase to needle; if the disease is in the Three Yin meridians, one must wait until the Qi is in the Yin phase to needle.