七十六难曰∶何谓补泻?当补之时,何所取气?当泻之时,何所置气?
然∶当补之时,从卫
取气,当泻之时,从荣置气。其阳气不足,阴气有余,当先补其阳,而后泻其阴;阴气不足,阳
气有余,当先补其阴,而后泻其阳。荣卫通行,此其要也。
卫为阳而主气,乃阳明水谷之悍气,合经脉中出诸气街之气血,散入孙络,缠布周身,以充
肤热肉,澹渗毫毛者也。营为阴而主血,乃奉心化出之血气,由心至胞室,循行十二经脉,日
夜五十周,以应呼吸漏下者也。《灵枢·卫气篇》曰∶浮气之不循经者,为卫气,其精气之行于
经者为营气是也。此言用针取何气为补,而其所泻之气,则置之何地也。答辞谓补则从卫取气,
盖取浮气之不循经者以补虚处,泻则从营置气,置犹弃置之置,盖从营置其气而不用也。然人
之病情不一,补泻之法,尤当审其阴阳虚实也。若卫虚而营实者,以阳气不足,阴气有余,则
先补阳而后泻阴以和之。若营虚而卫实者,以阴气不足,阳气有余,则先补阴而后泻阳以和之。
如此补泻之法,先后有序,则阴阳得其平,营卫之气,自然通畅流行矣。终始篇曰∶阴盛而阳
虚,先补其阳,后泻其阴而和之;阴虚而阳盛,先补其阴,后泻其阳而和之。所谓盛则泻之,
虚则补之,此其义也。
第七十六难问道:什么叫补法和泻法?在应当进行补法的时候,从何处获取气机?在应当进行泻法的时候,将气机置于何处?
回答说:在应当进行补法的时候,从卫气(行于脉外、具有温养作用的气)处获取气机;在应当进行泻法的时候,从营气(行于脉中、具有营养作用的气)处安置气机。如果阳气不足,阴气有余,应当先补其阳,而后泻其阴;如果阴气不足,阳气有余,应当先补其阴,而后泻其阳。使营气和卫气通行无阻,这是治疗的关键要点。
卫气属阳而主司气,它是阳明胃腑受纳水谷所化生的剽悍之气,与经脉中出于各气街部位的气血相合,散布进入孙络(最细小的络脉),遍布全身,以充实皮肤、温暖肌肉、润泽毫毛。营气属阴而主司血,它是奉心火气化而生出的血气,由心脏到达胞宫,循行于十二经脉之中,昼夜循环五十周次,以对应呼吸漏刻的节律。《灵枢·卫气篇》说:“浮散而不循经脉运行的气,称为卫气;其精气运行于经脉之中的,称为营气。”这就是所说的用针刺时取何种气来补益,以及所泻之气放置何处的道理。回答的意思是,补法是从卫气处取气,大概是取那些浮散不循经的气来补益虚损之处;泻法是从营气处置气,“置”即弃置的意思,大概是从营气中将其气弃置不用。然而人的病情各不相同,补泻的方法,尤其应当审慎辨别阴阳的虚实状况。如果是卫气虚而营气实的情况,因为阳气不足、阴气有余,就先补阳而后泻阴以调和它。如果是营气虚而卫气实的情况,因为阴气不足、阳气有余,就先补阴而后泻阳以调和它。像这样补泻的方法,先后有序,那么阴阳就能得到平衡,营卫之气自然通畅流行。《灵枢·终始篇》说:“阴气盛而阳气虚,先补其阳,后泻其阴以调和它;阴气虚而阳气盛,先补其阴,后泻其阳以调和它。”所谓“盛则泻之,虚则补之”,就是这个含义。
Chapter 76 asks: What are tonification and sedation? When tonification is indicated, from where is qi obtained? When sedation is indicated, where is qi placed?
The answer states: When tonification is indicated, qi is obtained from Wei Qi (Defensive Qi); when sedation is indicated, qi is placed from Ying Qi (Nutritive Qi). If Yang Qi is deficient and Yin Qi is excessive, one should first tonify Yang and then sedate Yin; if Yin Qi is deficient and Yang Qi is excessive, one should first tonify Yin and then sedate Yang. Ensuring the free flow of Ying and Wei Qi is the essential principle.
Wei Qi belongs to Yang and governs Qi. It is the fierce Qi derived from water and grain processed by the Stomach (Yangming), combining with Qi and Blood exiting from the Qi Passages within the meridians, dispersing into the Sun Luo (Minute Collaterals), spreading throughout the body to fill the skin, warm the muscles, and moisten the hair. Ying Qi belongs to Yin and governs Blood. It is the Qi and Blood transformed by the Heart, traveling from the Heart to the Uterus, circulating through the Twelve Primary Meridians, completing fifty cycles day and night, corresponding to the rhythm of respiration and water clocks. The *Ling Shu · Wei Qi Chapter* states: "Qi that floats and does not follow the meridians is called Wei Qi; its essence moving within the meridians is called Ying Qi." This explains which Qi is taken for tonification via acupuncture and where the sedated Qi is placed. The response implies that tonification involves obtaining Qi from Wei Qi, specifically utilizing the floating Qi that does not follow the meridians to tonify deficiency. Sedation involves placing Qi from Ying Qi; "placing" here means discarding or rendering ineffective, implying withdrawing Qi from Ying Qi so it is no longer utilized. However, patient conditions vary, and the methods of tonification and sedation must carefully assess the excess or deficiency of Yin and Yang. In cases where Wei Qi is deficient and Ying Qi is excessive—meaning Yang is insufficient and Yin is excessive—one first tonifies Yang and then sedates Yin to harmonize. In cases where Ying Qi is deficient and Wei Qi is excessive—meaning Yin is insufficient and Yang is excessive—one first tonifies Yin and then sedates Yang to harmonize. By following this orderly sequence of tonification and sedation, Yin and Yang achieve balance, and Ying and Wei Qi naturally flow smoothly. The *Ling Shu · Zhong Shi Chapter* states: "When Yin is excessive and Yang is deficient, first tonify Yang, then sedate Yin to harmonize; when Yin is deficient and Yang is excessive, first tonify Yin, then sedate Yang to harmonize." This illustrates the principle that "excess is sedated, deficiency is tonified."