黄帝问于少俞曰。筋骨之强弱。肌肉之坚脆。皮肤之浓薄。腠理之疏密。各下同。其于针石火
之痛如何。肠胃之浓薄坚脆亦不等。其于毒药何如。愿尽闻之。少俞曰。人之骨强筋弱肉缓皮肤浓
者耐痛。其于针石之痛。火 亦然。黄帝曰。其耐火 者。何以知之。少俞答曰。加以黑色而美
骨者耐火 。黄帝曰。其不耐针石之痛者。何以知之。少俞曰。坚肉薄皮者。不耐针石之痛。于火
亦然。( 热同)
此承上文复申明人之皮肉筋骨。皆藉少阴阳明之所资生而资养者也。少阴秉先天之精气。阳明化
水谷之精微。是以筋骨之强弱。肌肉之坚脆。皮肤之浓薄。腠理之疏密。皆秉气于少阴阳明者也。黑
色而美骨者。少阴之血气盛也。肉缓皮肤浓者。阳明之血气盛也。莫子曰。肾为水脏。故少阴之气盛
者。能耐火 。阳明秉秋金之气。故气弱则不能耐针石火 矣。
黄帝曰。人之病。或同时而伤。或易已。或难已。其故何如。少俞曰。同时而伤。其身多热者易
已。多寒者难已。
此分论少阴之气。少阴者。至阴也。而为生气之原。故其身多热者。少阴之生气盛也。多寒者。
少阴之生气虚也。人之形气。生于后天之水谷。始于先天之阴阳。形气盛则邪散。形气虚则邪留。是
以病之难易已者。由少阴生气之盛衰也。朱氏曰。少阴先天之精气。藉后天水谷以资培。两火并合。
故曰阳明。阳明秉燥热之气者也。其身多热者。少阴之气盛也。少阴之气盛。受阳明之所资也。此节
论少阴受阳明之气以资培。下节论阳明受少阴之气以合化。
黄帝曰。人之胜毒。何以知之。少俞曰。胃浓色黑。大骨及肥者。皆胜毒。故其瘦而薄胃者。皆
不胜毒也。(胜平声)
此复论少阴与阳明之相合也。阳明居中土。主受纳水谷。藉少阴之气上升。戊癸相合。化大火土
之气。而后能蒸泌水谷之精微。是以胃浓色黑。大骨及肥者。少阴阳明之气并盛。故皆能胜毒。倪氏
曰。中下二焦。互相资生。然后筋骨强坚。肌肉丰浓。此注与素问厥论合看。
黄帝向少俞问道:人的筋骨强弱、肌肉坚实或脆弱、皮肤厚薄、腠理疏密,各不相同。他们对针石和火熨(一种温热疗法)的疼痛耐受程度如何呢?肠胃的厚薄坚脆也不相等,他们对药物的耐受程度又如何呢?希望听您详尽讲解。
少俞回答说:骨骼强壮、筋脉柔和、肌肉松弛、皮肤厚实的人,能够耐受疼痛。他们对针石的刺痛和火熨的热痛也能耐受。
少俞回答说:如果一个人面色黑且骨骼形态美好,就能耐受火熨的热痛。
少俞回答说:肌肉坚硬而皮肤薄的人,不能耐受针石的刺痛,对火熨的热痛也不能耐受。(注:此处“火”字后原文有脱漏,据上下文及括号内注释,意指火熨之热痛)。
这段文字承接上文,再次阐明人的皮肉筋骨,都依赖少阴经和阳明经的气血滋养。少阴经禀受先天的精气,阳明经化生水谷的精微。因此,筋骨的强弱、肌肉的坚脆、皮肤的厚薄、腠理的疏密,都是由少阴和阳明二经的气血状况决定的。面色黑且骨骼美好,说明少阴经的血气旺盛;肌肉松弛且皮肤厚实,说明阳明经的血气旺盛。莫子说:肾是水脏,所以少阴经之气旺盛的人,能耐受火熨的热痛。阳明经禀受秋季金气,所以气弱的人就不能耐受针石和火熨了。
黄帝问:人患病时,有的同时受伤(指感受邪气),有的容易痊愈,有的难以痊愈,这是什么原因呢?
少俞回答说:同时感受邪气,身体发热多的容易痊愈,身体发寒多的难以痊愈。
这段文字分别论述少阴经的气机。少阴经属于至阴,却是生气的根源。所以身体发热多,说明少阴经的生气旺盛;身体发寒多,说明少阴经的生气虚弱。人的形体和气机,生于后天水谷精微,始于先天阴阳。形气旺盛则邪气消散,形气虚弱则邪气滞留。因此,疾病难易痊愈的原因,在于少阴经生气的盛衰。朱氏说:少阴经的先天精气,借助后天水谷来资助培育,两火相合,所以称为阳明。阳明经禀受燥热之气。身体发热多,是因为少阴经之气旺盛。少阴经之气旺盛,是受到了阳明经的资助。这一节论述少阴经接受阳明经之气以资培,下一节论述阳明经接受少阴经之气以化合。
黄帝问:人谁能耐受药物的毒性,怎么判断呢?
少俞回答说:胃壁厚、面色黑、骨骼大且身体肥胖的人,都能耐受药物毒性。所以消瘦且胃壁薄的人,都不能耐受药物毒性。(注:“胜”读平声,意为承受、耐受)。
这段文字再次论述少阴经与阳明经的相互配合。阳明经居中焦属土,主受纳水谷,借助少阴经之气上升,戊癸相合,化生大火土之气,然后才能蒸腾泌别水谷的精微。所以胃壁厚、面色黑、骨骼大且身体肥胖的人,是少阴经和阳明经的气血都旺盛,因此都能耐受药物毒性。倪氏说:中焦和下焦互相资助生成,然后筋骨强坚,肌肉丰浓。此注解可与《素问·厥论》结合阅读。
Huangdi asked Shaoyu, "The strength of sinews and bones, the firmness or fragility of muscles, the thickness of skin, and the density of interstices (Cou Li) vary among individuals. How do they differ in their tolerance for pain from acupuncture needles and stones, as well as moxibustion/fire therapy? The thickness and firmness of the stomach and intestines also vary; how does this affect their tolerance for medicinal drugs? I wish to hear your complete explanation."
Shaoyu replied, "Individuals with strong bones, flexible sinews, relaxed muscles, and thick skin can tolerate pain. They are also tolerant of the pain caused by acupuncture needles and stones, as well as the heat from fire therapy (Huo Jiu)."
Huangdi asked, "How can we identify those who can tolerate the heat of fire therapy?"
Shaoyu answered, "Those with a dark complexion and beautiful bone structure can tolerate fire therapy."
Huangdi asked, "How can we identify those who cannot tolerate the pain of acupuncture needles and stones?"
Shaoyu replied, "Those with firm muscles and thin skin cannot tolerate the pain of acupuncture needles and stones, nor can they tolerate the heat of fire therapy." (Note: The original text implies 'fire' refers to the heat of moxibustion/fire therapy).
This passage reiterates that the skin, flesh, sinews, and bones rely on the nourishment provided by the Shaoyin (Lesser Yin) and Yangming (Bright Yang) meridians. Shaoyin inherits the essence-qi of congenital origin, while Yangming transforms the refined essences of food and drink. Therefore, the strength of sinews and bones, the firmness of muscles, the thickness of skin, and the density of interstices are all determined by the qi of Shaoyin and Yangming. A dark complexion and beautiful bone structure indicate abundant blood and qi in Shaoyin. Relaxed muscles and thick skin indicate abundant blood and qi in Yangming. Mozi stated, "The Kidney is the water organ; thus, those with vigorous Shaoyin qi can tolerate the heat of fire therapy." Yangming inherits the qi of Autumn Metal; therefore, those with weak qi cannot tolerate acupuncture needles or fire therapy.
Huangdi asked, "When people contract diseases, some suffer simultaneous injury, some recover easily, and others recover with difficulty. What is the reason for this?"
Shaoyu replied, "When injured simultaneously, those with more heat in their bodies recover easily, while those with more cold recover with difficulty."
This section discusses the qi of Shaoyin separately. Shaoyin is the Ultimate Yin but serves as the source of generating qi. Thus, having more heat indicates vigorous generating qi in Shaoyin, while having more cold indicates deficient generating qi in Shaoyin. Human form and qi are generated from postnatal food and drink and originate from congenital Yin and Yang. When form and qi are vigorous, pathogenic factors dissipate; when they are deficient, pathogenic factors remain. Therefore, the ease or difficulty of recovery depends on the prosperity or decline of the generating qi in Shaoyin. Zhu stated, "The congenital essence-qi of Shaoyin relies on postnatal food and drink for nourishment. The combination of two fires gives rise to Yangming. Yangming inherits dry and hot qi. Having more heat indicates vigorous Shaoyin qi. Vigorous Shaoyin qi receives support from Yangming. This section discusses Shaoyin receiving qi from Yangming for nourishment; the next section discusses Yangming receiving qi from Shaoyin for transformation."
Huangdi asked, "How can we determine who can tolerate the toxicity of medicines?"
Shaoyu replied, "Those with thick stomach walls, dark complexions, large bones, and robust physiques can all tolerate drug toxicity. Conversely, those who are emaciated and have thin stomach walls cannot tolerate drug toxicity." (Note: 'Sheng' is pronounced with the level tone, meaning to bear or tolerate.)
This section further discusses the interaction between Shaoyin and Yangming. Yangming resides in the center, belonging to Earth, governing the reception of food and drink. It relies on the ascending qi of Shaoyin. The combination of Wu (Yang Earth) and Gui (Yin Water) transforms into the qi of Great Fire and Earth, thereby enabling the steaming and separating of refined essences from food and drink. Therefore, individuals with thick stomach walls, dark complexions, large bones, and robust physiques possess abundant qi and blood in both Shaoyin and Yangming, allowing them to tolerate drug toxicity. Ni stated, "The Middle and Lower Jiao mutually nourish each other, resulting in strong sinews and bones and abundant muscles." This commentary should be read in conjunction with the *Su Wen* chapter on "Jue Lun" (Treatise on Reversal).