(此论五脏之邪)
邪在肺则病皮肤痛。寒热。上气喘。汗出。咳动肩臂。(一作背)取之膺中外俞。(云门
中府
等穴。)背三节之旁。(肺俞○一本三节下有五节二字)以手疾按之。快然乃刺之。(按其处觉
快爽者是穴。)取之缺盆中(胃经穴。)以越之。邪在肝。则两胁中痛。寒中。恶血在内。行
善掣节。时脚肿。取之行间以引胁下。补三里以温胃中。取血脉以散恶血。(刺肝经血络外
见者
。)取耳间青脉以去其掣。(音彻)邪在脾胃。则病肌肉痛。阳气有余。阴气不足。则热中善
饥。阳气不足。阴气有余。则寒中。肠鸣腹痛。阴阳俱有余。(脾胃之邪气皆盛。)若俱不足
。(脾胃之正气皆虚)则有寒有热。皆调于三里。邪在肾。则病骨痛阴痹阴痹者。按之而不得
。腹胀腰痛。大便难。肩背颈项痛。时眩。取之涌泉昆仑。视有血者尽取之。邪在心。则病
心痛。喜悲。时眩仆。视有余不足。而调之其输也。(应补应泻。皆当取手厥阴俞太陵少阴
俞神门)
(此主外感言)
皮寒热者。不可附席。(邪在外。故畏于近席。)毛发焦。鼻槁腊。(音昔干也。)不得汗
。取
三阳之络。(太阳经飞扬穴。)以补手太阴。(太渊) 肌寒热者。肌痛。毛发焦而唇槁腊。不
得汗。取三阳于下。以去其血者。(俱刺络穴。)补足太阴。以出其汗。(大都太白) 骨寒热
者。病无所安汗注不休。齿未槁。取少阴之络。(大钟)齿已槁。死不治。骨厥亦然。(骨寒
而厥。)
身有所伤。血出多。及中风寒。若有所堕坠。四肢懈惰不收。名曰体惰。取其小腹脐下
三结交。三结交者。阳明太阴也。脐下三寸关元也。
阳迎头痛。胸满不得息。取之人迎。(迎逆也。阳邪逆于阳经而为头痛胸满者。当刺足
阳明
人迎穴。)暴喑气梗。取扶突。与舌本出血。暴聋气蒙。耳目不明。取天牖。暴挛痫眩。足
不任身。取天柱。暴瘅(热也)内逆。肝肺相搏。血溢鼻口。取天府。此为天牖五部。(总结
上文五穴。天牖五部者举一穴以统前后上下而言也。)臂阳明有入 遍齿者名曰大迎。下齿
龋取之臂。(商阳二间三间皆治齿痛。)恶寒补之不恶寒泻之。足太阳有入 遍齿者名曰角孙
。上齿龋。取之在鼻与 前。方病之时其脉盛。盛则泻之。虚则补之。一曰取之出鼻外。(
地仓巨 等穴。)足阳明有挟鼻入于面者。名曰悬颅属口对入系目本。视有过者取之。损有
余。盖不足。反者益甚。其足太阳有通项入于脑者正属目本。名曰眼系。头目苦痛。取之在
项中两筋间。(王枕穴)入脑乃别。阴跷阳跷。阴阳相交。阳入阴。阴出阳。交于目锐 。阳
气盛。则 目。阴气盛则瞑目。热厥。(阳邪有余阴气不足)取足太阴(补)少阳。(泻)皆留之
。寒厥。(阴邪有余阳气不足。)取足阳明(补)少阴。(泻)皆留之。(此言补脾胃二经以实四
肢。泻水火二经以泄邪气。)舌纵。涎下。烦 。取足少阴。振寒洒洒。鼓颔。不得汗出。
腹胀。烦 。取手太阴。(此二节。皆兼寒热二厥言。)刺虚者。刺其去也。(乘其气之去而
随之如候呼内针也。)刺实者。刺其来也。(乘其气之来而迎之。如候吸内针也。)
五脏。身有五部。(言五脏在内要害系于外者有五。)伏兔一。腓二腓者。 也。背三。
五脏
。病始头面者先取项太阳而汗出。病始足胫者。先取足阳明而汗出(此三节当与刺热篇参看)
臂太阴可汗出。(取鱼际太渊)足阳明可汗出(取内庭陷谷)故取阴而汗出甚者。止之于阳。取
阳而汗出甚者止之于阴。(阴阳平而汗自止也。当与热病篇热病而汗且出一节参看。)凡刺之
害中而不去则精泄。(针已中病。即当去针。)不中而去则致气。(针未中病而去针邪气仍致
。)精泄则病甚而 。(病益甚而 羸也。)致气则生为痈疽也。
(本节论述五脏受邪的情况)
邪气侵犯肺脏,则出现皮肤疼痛、寒热往来、上气喘促、出汗、咳嗽时牵引肩臂作痛(一说为背部)。治疗应取胸前的中府、云门等穴。在背部第三椎节旁开处(即肺俞穴,有的版本在“三节”下有“五节”二字),用手快速按压该处,患者感到舒适爽快的地方即是穴位,然后进行针刺。也可取缺盆穴(属足阳明胃经的穴位),以宣散邪气。
邪气侵犯肝脏,则两侧胁肋部疼痛,伴有内脏寒冷感,恶血停滞在体内,行走时容易牵掣关节,时常脚肿。治疗应取行间穴以疏导胁下之气,补足三里穴以温煦胃中,刺破血脉以消散恶血(刺肝经血络外现者)。取耳间青色脉络以去除肢体牵掣之症。
邪气侵犯脾胃,则出现肌肉疼痛。若阳气有余、阴气不足,则表现为胃中发热、容易饥饿;若阳气不足、阴气有余,则表现为胃中寒冷、肠鸣腹痛。若阴阳俱有余(指脾胃的邪气都旺盛),或阴阳俱不足(指脾胃的正气都虚弱),则既有寒证又有热证,这些情况都应调理三里穴。
邪气侵犯肾脏,则出现骨痛、阴痹。所谓阴痹,是指按压患处却找不到痛点,伴有腹胀、腰痛、大便困难、肩背颈项疼痛、时常头晕。治疗应取涌泉穴和昆仑穴,观察是否有瘀血,若有则全部刺出。
邪气侵犯心脏,则出现心痛、喜欢悲伤、时常头晕跌倒。应根据虚实情况进行辨证,并调治其输穴(应当补泻的,都应取手厥阴心包经的太陵穴和手少阴心经的神门穴)。
(本节主要论述外感寒热病)
皮寒热病患者,身体不能贴近席子(因为邪气在外,所以畏惧靠近席子)。毛发焦枯,鼻孔干燥萎缩,无汗。治疗应取太阳经的飞扬穴作为络穴,并补手太阴肺经的太渊穴。
肌寒热病患者,肌肉疼痛,毛发焦枯且嘴唇干燥萎缩,无汗。治疗应在下部取三阳经的穴位以放去瘀血(均刺络穴),并补足太阴脾经的大都、太白穴以发汗。
骨寒热病患者,身体无处安宁,汗水淋漓不止。如果牙齿尚未干枯,可取足少阴肾经的络穴大钟穴;如果牙齿已经干枯,则属于死证,无法治愈。骨厥证也是如此(因骨寒而致厥逆)。
身体受到外伤,出血过多,以及感受中风寒邪,或者有堕坠损伤,导致四肢懈怠无力、不能收持,这种病症称为“体惰”。治疗应取小腹脐下三寸的“三结交”穴。“三结交”指的是足阳明胃经与足太阴脾经相交之处,即关元穴。
阳气逆乱引起的头痛、胸满、呼吸不畅,应取足阳明胃经的人迎穴进行治疗(“迎”意为逆,阳邪逆于阳经导致头痛胸满,应当刺足阳明胃经的人迎穴)。突然失音、气机梗塞,应取扶突穴,并刺舌根部出血。突然耳聋、气机蒙蔽、耳目不明,应取天牖穴。突然痉挛、癫痫眩晕、足部无力支撑身体,应取天柱穴。突然热毒内逆,肝肺二气相搏,血液从鼻口溢出,应取天府穴。以上这五个穴位合称为“天牖五部”(总结上文提到的五个穴位,“天牖五部”是举出一个穴位来统领前后上下而言的)。
手阳明大肠经有进入牙齿的分支,名为大迎穴。下齿龋齿疼痛取此穴治疗(商阳、二间、三间穴都能治疗齿痛)。怕冷的用补法,不怕冷的用泻法。足太阳膀胱经有进入牙齿的分支,名为角孙穴。上齿龋齿疼痛,取位于鼻翼前方与颧骨之间的穴位。发病时脉象盛大,盛大则用泻法,虚则用补法。另一种说法是取鼻外的地仓、巨髎等穴。足阳明胃经有挟鼻入面的分支,名为悬颅穴,归属于口部,向内连系目本。观察有病邪的部位进行针刺。损害有余的邪气,补充不足的正气,如果反其道而行,病情会更加严重。
足太阳膀胱经有通达颈部进入脑部的分支,正属于目本,名为眼系。头部和眼睛剧烈疼痛,取位于项部两筋之间的王枕穴。进入脑部后分开,分别与阴跷脉和阳跷脉相连。阴阳二跷脉相交,阳跷入阴,阴跷出阳,交汇于目锐眦。阳气盛则睁眼,阴气盛则闭眼。
热厥证(阳邪有余,阴气不足),取足太阴脾经(用补法)和足少阳胆经(用泻法),都要留针。寒厥证(阴邪有余,阳气不足),取足阳明胃经(用补法)和足少阴肾经(用泻法),都要留针。(这是说通过补益脾胃二经来充实四肢,泻除水火二经以排泄邪气。)
舌体纵缓、流涎、心烦,取足少阴肾经。战栗发冷、下巴抖动、无汗、腹胀、心烦,取手太阴肺经。(这两节内容,都是兼论寒热两种厥证。)
针刺虚证时,要顺着经气离去的方向刺(趁着经气离去的时候跟随它,如等待呼气时进针)。针刺实证时,要迎着经气来的方向刺(趁着经气来的时候迎击它,如等待吸气时进针)。
五脏在体内,体表有五个对应的重要部位(意思是五脏在内,要害联系于外,共有五个部位)。一是伏兔穴,二是腓肠肌部位,三是背部。疾病起始于头面部的,先取项部的太阳经穴位使其出汗;疾病起始于足胫部的,先取足阳明经穴位使其出汗(这三节内容应当与《刺热篇》参看)。手太阴肺经可以使其出汗(取鱼际、太渊穴)。足阳明胃经可以使其出汗(取内庭、陷谷穴)。所以,取阴经穴位而汗出过多的,就停止在阳经穴位;取阳经穴位而汗出过多的,就停止在阴经穴位。(阴阳平衡,汗自然停止,应当与《热病篇》中“热病且欲出汗”一节参看。)
凡是针刺的危害:如果针已中病而不及时拔出,会导致精气泄漏(针已中病,就应当拔针)。如果没有中病就拔针,会导致邪气滞留(针未中病而拔针,邪气依然聚集)。精气泄漏会使病情加重而形体消瘦。邪气滞留则会生痈疽。
(This section discusses the pathogenic factors affecting the five Zang organs.)
When pathogenic factors invade the Lung, symptoms include pain in the skin, aversion to cold with fever (han re), panting and upward rushing of Qi, sweating, and coughing that pulls on the shoulders and arms (or back). Treatment should involve needling the Shu points in the anterior chest, such as Yunmen (Cloud Gate) and Zhongfu (Central Treasury). On the back, beside the third vertebral segment (Feishu BL-13; some texts add "fifth segment" after "third"), press quickly with the hand. The spot where the patient feels a sense of relief or comfort is the acupoint; then needle it. Alternatively, take Qimen (Dipper), an acupoint of the Foot-Yangming Stomach Meridian, to disperse the pathogen.
When pathogenic factors invade the Liver, symptoms include pain in both hypochondriac regions, internal cold, retention of evil blood within, frequent pulling sensations in the joints during movement, and occasional swelling of the feet. Treatment should involve taking Xingjian (Moving Between) LR-2 to guide Qi from the hypochondrium, tonifying Zusanli ST-36 to warm the middle Jiao (stomach/spleen), and pricking the blood vessels to dissipate evil blood (prick visible collateral vessels of the Liver meridian). Take the blue veins between the ears to remove the pulling sensation.
When pathogenic factors invade the Spleen and Stomach, symptoms include muscle pain. If Yang Qi is excessive and Yin Qi is deficient, there is heat in the middle Jiao and frequent hunger. If Yang Qi is deficient and Yin Qi is excessive, there is cold in the middle Jiao, borborygmus (intestinal rumbling), and abdominal pain. If both Yin and Yang are excessive (both Spleen-Stomach pathogens are strong), or if both are deficient (both Spleen-Stomach righteous Qi are weak), there will be both cold and heat syndromes. All these conditions should be regulated via Zusanli ST-36.
When pathogenic factors invade the Kidney, symptoms include bone pain and Yin Bi (obstruction). Yin Bi is characterized by the inability to find tenderness upon pressing, abdominal distension, lower back pain, difficulty in defecation, pain in the shoulders, back, neck, and nape, and occasional vertigo. Treatment should involve taking Yongquan KI-1 and Kunlun BL-60. Observe for blood stasis; if present, bleed all visible vessels.
When pathogenic factors invade the Heart, symptoms include heart pain, a tendency toward sadness, and occasional vertigo leading to fainting. Assess excess or deficiency and regulate the Shu points accordingly (tonification or reduction should target Taoling PC-4 of the Pericardium meridian and Shenmen HT-7 of the Heart meridian).
(This section primarily discusses external contraction of cold and heat.)
For Pi Han Re (Skin Cold-Heat syndrome), the patient cannot lie close to the mat (because the pathogen is exterior, they fear proximity to the mat). Hair becomes scorched, the nose dries and shrivels, and there is no sweat. Treatment involves taking the Luo-connecting point of the Taiyang meridian, Feiyang BL-58, and tonifying the Hand-Taiyin Lung meridian's Taiyuan LU-9.
For Ji Han Re (Muscle Cold-Heat syndrome), there is muscle pain, scorched hair, dried and shriveled lips, and no sweat. Treatment involves taking points on the lower part of the three Yang meridians to remove blood stasis (all are Luo-connecting points needing bleeding) and tonifying the Foot-Taiyin Spleen meridian's Dadu SP-2 and Taibai SP-3 to induce sweating.
For Gu Han Re (Bone Cold-Heat syndrome), the patient has nowhere to rest comfortably, and sweat pours down incessantly. If the teeth have not yet become dry/shriveled, take the Luo-connecting point of the Shaoyin meridian, Dazhong KI-4. If the teeth are already shriveled, it is a death case and untreatable. Gu Jue (Bone Jue) is similar (Jue due to bone cold).
If the body has suffered injury with excessive blood loss, or contracted wind-cold, or suffered a fall/drop injury, resulting in flaccidity and weakness of the four limbs unable to hold themselves, this condition is called Ti Duo (Body Languor). Treatment involves taking the San Jie Jiao (Three Intersections) located three cun below the umbilicus. The San Jie Jiao refers to the intersection of the Yangming and Taiyin meridians, which is Guanyuan CV-4.
Headache caused by rebellious Yang Qi, accompanied by chest fullness and dyspnea, should be treated by taking Renying ST-9 (Renying means 'rebellious'; when Yang pathogen rebels in the Yang meridians causing headache and chest fullness, needle the Foot-Yangming Renying point). Sudden aphonia with Qi obstruction should be treated by taking Futu LI-18 and bleeding the base of the tongue. Sudden deafness with Qi stagnation/misting, causing unclear hearing and vision, should be treated by taking Tianyou TE-16. Sudden spasms, epilepsy, vertigo, and inability of the feet to support the body should be treated by taking Tianzhu BL-10. Sudden severe heat toxicity reversing internally, with Liver and Lung Qi clashing causing blood effusion from nose and mouth, should be treated by taking Tianfu LU-6. These five points are collectively known as the "Five Regions of Tianyou" (Summarizing the previous five points; "Five Regions of Tianyou" uses one point to represent the upper, lower, front, and back).
The Hand-Yangming Large Intestine meridian has a branch entering the teeth, named Daying. For lower tooth decay/pain, treat using arm points (Shangyang LI-1, Erjian LI-2, and Sanjian LI-3 all treat toothache). Use tonification for aversion to cold, and reduction for absence of aversion to cold. The Foot-Taiyang Bladder meridian has a branch entering the teeth, named Jiaosun. For upper tooth decay/pain, take points between the nose and the cheekbone. At the onset of illness, if the pulse is full/excessive, use reduction; if deficient, use tonification. Another method suggests taking points outside the nose, such as Dicang ST-4 and Juliao SI-18. The Foot-Yangming Stomach meridian has branches flanking the nose entering the face, named Xuanlu, belonging to the mouth area, connecting inwardly to the root of the eye. Needle where pathology is observed. Reduce excess and tonify deficiency; reversing this principle will worsen the condition.
The Foot-Taiyang Bladder meridian has a pathway through the neck into the brain, directly connecting to the root of the eye, named Yanxi (Eye System). For severe headache and eye pain, take Wangzhen BL-59 located between the two tendons in the neck. Upon entering the brain, it separates into the Yin Qiao and Yang Qiao vessels. The Yin and Yang Qiao vessels intersect; Yang enters Yin, Yin exits Yang, intersecting at the outer canthus of the eye. When Yang Qi is excessive, the eyes open; when Yin Qi is excessive, the eyes close.
For Re Jue (Heat Jue syndrome: Yang pathogen excess, Yin Qi deficiency), take the Foot-Taiyin Spleen meridian (tonify) and Foot-Shaoyang Gallbladder meridian (reduce). Retain the needles. For Han Jue (Cold Jue syndrome: Yin pathogen excess, Yang Qi deficiency), take the Foot-Yangming Stomach meridian (tonify) and Foot-Shaoyin Kidney meridian (reduce). Retain the needles. (This explains tonifying the Spleen and Stomach meridians to fill the four limbs, and reducing the Water and Fire meridians to drain pathogenic factors.)
For Tong Zong (Languid tongue) with drooling and irritability, take the Foot-Shaoyin Kidney meridian. For chills, shivering, jaw quivering, inability to sweat, abdominal distension, and irritability, take the Hand-Taiyin Lung meridian. (These two sections discuss both Cold and Heat Jue syndromes together.)
When needling deficiency patterns, needle along the direction of departing Qi (follow the Qi as it leaves, like inserting the needle during exhalation). When needling excess patterns, needle against the direction of arriving Qi (meet the Qi as it arrives, like inserting the needle during inhalation).
The Five Zang organs correspond to five important regions on the body (indicating that the internal Zang organs connect to five critical external areas). One is Futu ST-32; two is the calf (Pi); three is the back. If disease begins in the head and face, first needle the Taiyang points in the neck to induce sweating. If disease begins in the lower legs, first needle the Foot-Yangming points to induce sweating (these three sections should be cross-referenced with the Ci Re Pian chapter). Hand-Taiyin can induce sweating (take Yuji LU-10 and Taiyuan LU-9). Foot-Yangming can induce sweating (take Neiting ST-44 and Xianggu BL-65). Therefore, if inducing sweating via Yin meridians causes excessive sweating, stop at Yang meridian points; if inducing sweating via Yang meridians causes excessive sweating, stop at Yin meridian points. (When Yin and Yang are balanced, sweating stops naturally; refer to the Re Bing Pian chapter regarding "heat disease about to sweat".)
The harm of needling: If the needle hits the target but is not withdrawn promptly, Jing (Essence) will leak (once the needle hits the disease site, it should be removed). If the needle does not hit the target but is withdrawn, it leads to Qi stagnation/pathogen accumulation (if the needle misses the disease site and is removed, pathogenic Qi remains). Essence leakage causes the disease to worsen and the body to emaciate. Pathogen accumulation leads to the formation of carbuncles and sores.