Shanghai Journal of Acupuncture and Moxibustion English Edition Primary Issue ·83·
LITERATURES RESEARCH
Comment on Treatment of Heat Syndrome with Moxibustion Stated by the Monography on Moxibustion Therapy
Li, Yangzheng
The Second Hospital Attached To Wannan Medical College 241000
THERE are many statements on the treatment of heat syndrome with moxibustion. It has been a long debate issue if heat syndrome can be or cannot be treated with moxibustion. Some people say it can be, some say it cannot and others say that it can be used to treat any disease. Some people indicate it mustn’t be, but in fact, they somehow advocate it can be. Wu Yiding is one of them. So this paper will give some comments on the statements by Wu about the treatment of heat syndrome with moxibustion.
Theoretic recognition of the treatment of heat syndrome with moxibustion
1. The treatment of heat syndrome with moxibustion is a contrary treatment
Plain Question On The Most Important Quintessence of The Doctriness states: “Normal therapy signifies the adoption of methods and drugs with opposite nature to the disease, and contrary treatment signifies the adoption of methods and drugs with the same nature as the disease.” The treatment of heat syndrome with moxibustion is a contrary treatment used to treat heat syndromes with warm therapy, characterized by the nature of the pathologic conditions to exert eff. In Diagnosis and Treatment of Surgical Diseases, Wu said: “All sores and carbuncles can be treated with moxibustion. If painful it is moxibusted till the pain is alleviated; if painless it is moxibusted till the pain is induced. In this way, the pathogenic factors will be eliminated by moxibustion. This is contrary treatment and very effective.” There are two implications here: One is that in treating painless numb sores of yin nature, moxibustion can turn yin syndrome into yang and dissipate pathogen at the same time. Another is in treating serious sores and carbuncles of yang nature, moxibustion therapy can not only stop the pain but also dissipate the pathogens with high efficacy. Clearly, the treatment of heat syndromes by moxibustion is a contrary treatment characterized by treating heat syndromes with warm therapy, agreeing with the principle of contrary treatment elucidated in Neijing and signifying a practical application of “pyretic stagnation requiring dissipation”
2. The Treatment of heat syndrome with moxibustion can draw heat to dissipate pathogens
The treatment of heat syndrome with moxibustion is significantly effective because moxibustion can draw heat out and dissipate pathogens. In Diagnosis and Treatment of Surgical Diseases, Wu said, “Skin and external diseases are due to heart-fire stagnation to form pathogens so when the diseases are treated with moxibustion, the heart-fire is dissipated and pathogens are gone. This is always effective." Skin and external diseases are often of yang syndrome, improper treatment may lead to fatal consequences, while moxibustion can dissipate heart-fire and pathogens and bring the dying back to life. It is clear that the treatment of heat syndrome with moxibustion has marvelous effects. No wonder Wu named the book “Marvelous Moxibustion”.
The treatment of heat syndrome can draw pathogens out, which also embodies the idea of prevention first and early treatment. In Diagnosis and Treatment of Surgical Diseases, Wu said: "sores and carbuncles at the incipient stage (less than 7 days) are treated with moxibustion which can soften the mass and draw pathogens out from the deep to the shallow. The effect is better than drugs”. Dissipation is key to the treatment of sores and carbuncles, so early moxibustion will result in better effects. Meanwhile, it pointed out again that the mechanism of the moxibustion therapy lay in the fact that “the moxibustion can soften the mass and draw pathogens out from the deep to the shallow". Thus he expounded in theory on the mechanism of the treatment of heat syndrome with moxibustion.
The treatment of heat syndrome with moxibustion is applied extensively
Wu stated that the treatment of heat syndrome with moxibustion was practiced in clinics extensively. The book mentions over a hundred heat syndromes of which sthenia pyrosyndromes are nearly a hundred and asthenia pyrosyndromes are over ten. They are expounded respectively in the following.
1. Sthenia pyrosyndrome in clinical application
In nearly 100 excessive heat syndromes, they are widely concerned in internal medicine, external medicine, gynaecology, pediatrics, opthalmology, NT (nose-throat), stomatology, etc. There are some examples in internal medicine in treating malaria with moxibustion of Dazhui (Du14), Yixi (B45), Zhangmen (Liv13), Huantiao (GB30),, Chenshan (B57), Kunlun (B60), Feiyang (B58), Gongsun (Sp4), Hegu (LI4); Jaundice with moxibustion of Gongsun (Sp4), Zhiyang (Du9), Pishu (B20), Weishu (B21): Cough due to heat evil with moxibustion of Feishu (B13), Tanzhong (Ren17), Chize (L5), Taixi (K3); Phlegm-fire with moxibustion of Baihui (Du20) and Gaohuang (B43): Painful micturition with moxibustion of Leique (L7), Zhongfeng (Liv4), Geshu (B17), Shenshu (B23), Qihai (Ren6), etc. It is said in the Article on Cholera Morbus: "These diseases are treated much more effectively by moxibustion than by herbal decoction." Diarrhea with blood and mucus is treated with moxibustion of Changqiang (Du1) and Mingmen (Du4). It is said in the Article on Dysentry: “Dysentry is caused by excessive heat stagnation and body fluid exhaustion ….... Moxibustion doctor treats it by selecting points to draw the fire out through warming yang, and it is quite different from abusing hot-natured drugs to 'fight fire with fire’ regardless of a gastrointestinal condition." The mechanism for the treatment of heat syndrome with moxibustion is “drawing heat out through warming yang”, not treating heat syndrome with heat drugs. There are other examples in external medicine in treating carbuncle on the nape with moxibustion of Shenmen (H7): pulmonary abscess is treated with moxibustion of Tanzhong (Ren17), Feishu (B13), Zhigou (SI6), Daling (P7), Shenshu (B23), Hegu (LI4), Taiyuan (L9): furnuncle with garlic moxibustion on it. All the heat syndromes such as furnuncle, carbuncle can be treated with moxibustion, heat hemorrhoids with moxibustion on painful regions. It is said: "To put some fresh ginger slices on the painful furnuncle region with moxibustion of three cones, the yellow liquid flows out and symptoms disappear … very effective.” Breast carbuncle of gynecology is treated with moxibustion of Lingdao (H4), Tiaokou (S38), Zusanli (S36); breast swelling with moxibustion of Shaoze (SI1) and Zulinqi (GB41): The women with heat evil attacking the blood chamber are treated with moxibustion of Qimen (Liv14); red and white leukorrhea with moxibustion of Shenshu (B23), Xuchai (Sp9), Daimai (GB26), Zhongfeng (Liv4), Sanyinjiao (Sp6), etc. It is also said, “Moxibustion of Cui’s Sihua points treat red and white leukorrhea very effectively”. It is cited from Wang Haizang: “Leukorrhea is caused by dysfunction of the spleen, which is with moxibustion of Zhangmen (Liv13), with the wheat-particle-like cones, very effective.” Acute and chronic infantile convulsion is treated with moxibustion of Baihui (Du20), Shuigou (Du26), Hegu (L14), Dadun (Liv1), Xingjian (Liv2), Chize (L5), ete: diarrhea with moxibustion of Weishu (B21), Shuifen (Ren9), Tianshu (S25), Shenque (Ren8): painful red and swelling eyes due to unclear cause in ENTT is treated with moxibustion of Hegu (LI4), Eriian (LI2), Ganshu (B18), Zusanli (S36); belpharitis marginailis due to wind-evil with moxibustion of Ganshu (B18), Danshu(B19), Juegu (GB39), Guangming (GB37); nasosinusitis with Shangxing (Du23), Quchai(B4), Fengmen(B12), Hegu(LI4); sore throat with Yangxi (LI5), Shaohai (H3), Yemen (SJ2); toothache and eczema all over the body due to infantile malnutrition with Chengjing (Ren24). All the examples mentioned above repeatedly prove the treatment of heat syndrome with moxibustion has miraculous effect, and aslo indicate the treatment of heat syndrome with moxibustion is different from the treatment of heat syndrome with heat drugs. This is because the moxibustion therapy can draw the fire out through warming yang and dissipate the pathogens.
2. Asthenia pyrosyndrome in clinical application
They are the examples in asthenia pyrosyndrome in treating hematemesis due to asthenic diseases with moxibustion of Shangwan (Ren23), Feishu (B13), Pishu (B20), Shenshu (B23), Daling (P7), Waiguan (SJ5); night sweat with moxibustion of Feishu (B13), Fuliu (K7), Yixi (B45): diabetes with moxibustion of Chengjiang (Ren24), Zhizheng (SJ7), Yangchi (SJ4), Zhaohai (K6), Shenshu (B23), Xiaochangshu (B27) and digitus mininus points of hand and foot (that is finger-tip); heat-foot caused by exhaustion of kidney yin or downward flow of damp-heat with moxibustion of Yongquan (K1) and Rangu (K2); fever due to consumption with moxibustion of Qihai (Ren6), Guanyuan (Ren4), Gaohuangshu (B43), Zusanli (S36), Neiguan (P6), Cui's Sihua points (EX-CA): pulmonary tuberculosis with moxibustion of Guiyan (that is Yaoyan, EX-CA), Gaohuangshu (B43), Sanzhuigushang (EX-CA). It is said, “Pulmonary tuberculosis is very difficult to be cured and can only be treated with moxibustion." It is clear pulmonary tuberculosis due to yin deficiency and lung-heat is treated much more effectively with moxibustion than drugs. This is repeatedly proved by many cases later.
It is ambiguous whether heat syndrome can be or cannot be treated with moxibustion
The Monography on Moxibustion Therapy is compiled by Wu Yiding who collected previous statements on moxibustion. It is not clear if heat syndrome can be or cannot be treated with moxibustion. He advocated treating heat syndrome with moxibustion, but meanwhile, he was against the treatment of heat syndrome with moxibustion when others against. So there are many contradictory statements in the book. In the Article of Moxibustion Forbidden, it says: “Moxibustion is not suitable for one with superficial, rapid and excessive pulse condition and one with dysphoria, dry mouth, sore throat, red complexion due to excessive fire, just after sweating and fever due to yin deficiency, etc.” In Zhongshenzhenglun, it is said: “One with superficial, surging, scattered pulse and fire syndromes cannot be treated with moxibustion in case the fire syndromes are treated with fire, which will aggravate the condition." But in clinic application "exogenous febrile diseases with headache and fever are treated with moxibustion of Eriian (LI2), Hegu (LI4), Fengchi (B12), Qimen (Liv14)" and other points: “exogenous febrile diseases with fever, dysphoria, dry mouth with moxibustion of Quze (P3) and Yingiao (EX-CA)": “fever all over the body with moxibustion of Bailao (EX-CA)": “fever due to consumption with moxibustion of Qihai (Ren6), Guanyuan (Ren4), Gaohuangshu (B43), Zusanli (S36), etc". Of course if can be inferred from “fever all over the body”, his pulse condition is superficial, surging, rapid and excessive, and has red complexion. So this almost repudiates some articles that moxibustion therapy is forbidden for heat syndromes. In the articles that exogenous febrile diseases are forbidden with moxibustion therapy, there are 5 statements, which are also contradictory in comparison with other articles. An example is “superficial pulse should be treated with sweating. If it is treated with moxibustion, the pathogens cannot go out because it is excessive due to fire”. When a superficial pulse is treated with sweating, there is certainly no sweating. In Marvelous Moxibustion, it is said: “One with the exogenous febrile disease has no sweating, eye red, deafness, chest pain, swelling of the maxillary region, Koujin (lockjaw unable to open the mouth), he is treated with moxibustion of Xiaxi (GB43) and Fuliu (K7)", etc. While Wu was against the treatment of heat syndrome with moxibustion, he definitely advocated the treatment of heat syndrome with moxibustion, and there are some contradictory statements mentioned above.
Although Wu said heat syndrome mustn't be treated with moxibustion or advocated that heat syndrome can be treated with moxibustion, there are many contradictory statements in the book, the Monography on Moxibustion Therapy recognizes heat syndrome is suitable for moxibustion, which can draw heat out and dissipate pathogens. It is not heat syndrome treated wrongly with heat drugs, but it is the principle of contrary treatment from Neijing and it is the practical application of “fire stagnation requiring dissipation”. This is also applied extensively in clinics, concerning internal medicine, external medicine, gynaccology, pediatrics, ophthalmology, NT (nose-throat), stomatology, etc. The book gives over 100 cases of sthenia pyrosyndrome and asthenia pyrosyndrome treated with moxibustion points and methods, which indicates heat syndrome is suitable for moxibustion therapy, “whose treatment effect is better than drugs” and "it always has miraculous effect”. Therefore the book is still important literature in treating heat syndrome and acute symptoms with moxibustion. It is worthwhile for us to learn, analyze and testify to the statements from the book. Thus we will broaden the range of moxibustion therapy and make the way for the treatment of heat syndrome and acute symptoms with moxibustion.
Translator: Ding Ninnqing
《上海针灸杂志》扬缜论文英译本
自动翻译如下：
上海针灸杂志英文版第83期
文献研究
评《灸法专著》所载的灸法治疗热证
李扬缜
皖南医学院第二附属医院241000
艾灸治疗热证的论述较多。热证可否艾灸治疗一直是一个争论不休的问题。有人说它可以，有人说它不能，还有人说它可以用来治疗任何疾病。有些人指出，它不一定是，但事实上，他们以某种方式主张它可以是。吴就是其中之一。因此，本文拟对吴先生关于灸法治疗热证的论述予以评述。
艾灸治疗热证的理论认识
1.艾灸治疗热证是一种相反的疗法
关于《内经》最重要精髓的简单问题指出:“正常治疗意味着采用与疾病性质相反的方法和药物，相反的治疗意味着采用与疾病性质相同的方法和药物。”艾灸治疗热证是温病治疗热证的相反疗法，其特点是根据病理情况的性质发挥作用。吴在《外科疾病的诊治》中说:“疮痈皆可用艾灸治疗。如果疼痛，就要一直坚持到疼痛减轻；如果无痛的话，它会被磨掉，直到疼痛被诱发。这样，通过艾灸就可以消除致病因素。这是相反的治疗，非常有效。”这里有两层含义:一是艾灸在治疗阴质无痛性疮疡时，可将阴证化为阳，同时祛邪。二是在治疗阳虚型重症疮痈时，艾灸既能止痛又能祛邪，疗效高。由此可知，艾灸治疗热证是一种以温热疗法治疗热证为特征的逆治，符合《内经》阐明的逆治原则，是“热滞散结”的实际运用
2.艾灸治疗热证可吸热散邪
艾灸能吸热散邪，治疗热证疗效显著。吴在《外科疾病的诊断与治疗》中说:“皮肤及外感之病，皆因心火郁结而成邪气，故以灸治之，则心火消散，邪气消散。这总是有效的。”皮肤及外感疾病多属阳气虚证，治疗不当可致命，而艾灸可消散心火及邪气，起死回生。显然，艾灸治疗热证疗效显著。难怪吴把这本书命名为《神奇的灸法》。
热证的治疗可以将病源引出，也体现了预防为主、早期治疗的理念。吴在《外科疾病的诊断与治疗》中说:“疮痈初期(不足七日)以艾灸为主，可软坚散结，由深及浅吸引邪气。效果比药物要好”。散结是治疗疮痈的关键，早期灸法疗效更好。同时，再次指出灸法的作用机制在于“灸可软质，引邪由深入浅”。从而从理论上阐述了艾灸治疗热证的作用机制。
艾灸治疗热证应用广泛
吴称，灸法治疗热证在临床上应用广泛。该书提到了一百多种热证，其中实热证近一百种，虚热证十多种。下面分别对它们进行阐述。
1.焦实证在临床中的应用
在近百种热证中，广泛见于内科学、外科学、妇科、儿科、眼科、耳鼻喉科、口腔科等。艾灸大椎(Du14)、艺兮(B45)、章门(Liv13)、还条(GB30)、陈山(B57)、昆仑(B60)、杨妃(B58)、公孙(Sp4)、合谷(LI4)等治疗疟疾在内科也有实例；公孙(Sp4)、智阳(Du9)、脾俞(B20)、舒威(B21)灸治黄疸:舒菲(B13)、痰浊(Ren17)、赤泽(L5)、太溪(K3)灸治热毒咳嗽；艾灸百会、黄高痰火:艾灸雷que (L7)、中峰(Liv4)、舒歌(B17)、肾俞(B23)、气海(Ren6)等治疗尿痛。《霍乱弧菌》上有一篇文章说:“艾灸治疗这些疾病比中药汤剂有效得多。”艾灸肠腔(督1)、命门(督4)治疗血黏液腹泻。“入不敷出”篇曰:“入不敷出，因热壅盛，津液竭……艾灸医生通过温阳取穴引火来治疗，无论胃肠状况如何，都与滥用热毒“以火攻火”有很大不同。”艾灸治疗热证的作用机制为“温阳取热”，而非热药治疗热证。摘要:艾灸神门(H7)治疗项上痈，外用药亦有例:肺脓肿采用艾灸痰中(仁17)、舒菲(B13)、直沟(SI6)、大岭(P7)、肾俞(B23)、合谷(LI4)、太原(L9)治疗:以大蒜灸项上痈。凡须根、痈等热证均可艾灸治疗，热痔疮可艾灸患处。相传:“用三锥灸把一些生姜片放在患处，黄液流出，症状消失……非常有效。”艾灸灵道(H4)、条口(S38)、足三里(S36)治疗妇科乳腺痈；芍泽、祖琳琪灸治疗乳房肿胀:热毒袭血行者，用祁门灸治疗(liv 14)；艾灸肾俞(B23)、须柴(Sp9)、代脉(GB26)、中峰(Liv4)、三阴交(Sp6)等治疗红白带。又有“崔穴灸治疗赤白带十分有效”之说。引自王海藏:“白带乃脾功能失调所致，此与章门灸(Liv13)同用，其内有麦粒状锥体，颇为有效。”艾灸百会(督20)、水沟(督26)、合谷(L14)、大墩(Liv1)、醒酒(Liv2)、赤泽(L5)治疗急慢性小儿惊厥等:艾灸舒威(B21)、水粉(Ren9)、天枢(S25)、神阙(Ren8)腹泻:艾灸合谷(LI4)、埃里安(LI2)、肝俞(B18)、足三里(S36)；用肝俞(B18)、胆俞(B19)、厥骨(GB39)、光明(GB37)灸治风邪引起的睑缘炎；鼻窦炎伴上兴(毒23)、曲柴(B4)、风门(B12)、合谷(LI4)；咽喉肿痛伴阳西(LI5)、绍海(H3)、亦门(SJ2)；牙痛和湿疹全身由于婴儿营养不良与景程(伦24)。以上诸例反复印证了艾灸治疗热证的神奇功效，也说明艾灸治疗热证不同于热药治疗热证。这是因为艾灸疗法可以通过温阳引火，消散邪气。
2.虚火证的临床应用
如艾灸上宛(仁23)、舒菲(B13)、脾俞(B20)、肾俞(B23)、大岭(P7)、外关(SJ5)治疗虚劳性呕血证；艾灸舒菲(B13)、符留(K7)、艺兮(B45)盗汗:艾灸澄江(仁24)、郑智(SJ7)、阳池(SJ4)、赵海(K6)、肾俞(B23)、小柴胡(B27)、趾(指端)最小穴治疗糖尿病；用涌泉(K1)、顾然(K2)灸治肾阴亏损或湿热下注所致的热足；艾灸气海(仁6)、关元(仁4)、高皇俞(B43)、足三里(S36)、内关()、崔的穴(EX-CA)致虚热:艾灸桂烟(即EX-CA)、高皇俞(B43)、三株禽肉上(EX-CA)致肺结核。相传“肺结核难医，只能以灸治之。”显然，艾灸治疗阴虚肺热型肺结核比药物治疗效率高。这一点后来被许多案例反复证明。
热证是否可以艾灸治疗目前尚无定论
《灸疗学专著》是吴收集前人关于灸疗学论述而编纂的。热证可否艾灸治疗目前尚不明确。他主张以灸治热证，但与此同时，有人反对，他也反对以灸治热证。所以书中有许多矛盾的陈述。《禁灸条》云:“脉象表浅、急、多，心烦口干、咽痛、火盛面色红、汗后即起、阴虚发热等，不适宜灸法。”《中山正伦》云:“表里不一，脉冲散，火证者，若以火治火，则不能以灸治之，使病情加重。”但在临床应用上“外感热病头痛发热，以埃里亚(LI2)、合谷(LI4)、风池(B12)、祁门(Liv14)”等穴灸治；“曲泽(P3)、阴交(EX-CA)灸治外感热病发热、烦躁、口干”)；“白劳(EX-CA)灸治全身发热”:“气海(仁6)、关元(仁4)、高皇枢(B43)、足三里(S36)等灸治虚热”当然如果可以从“全身发热”来推断，他的脉象是浅表的、汹涌的、急促的和过度的，并且有发红的面色。所以这几乎否定了一些热证禁止灸法的文章。《伤寒论》中禁止艾灸治疗外感热病的条款有5条，与其他条款相矛盾。举个例子就是“浅脉宜以汗治之。若以艾灸治疗，因火盛而邪不能出”。当用出汗治疗浅表性脉搏时，肯定没有出汗。《妙灸》云:“患外感热病者，无汗、红眼、耳聋、胸痛、上颚肿胀、口津(锁颚不能张口)，以灸下颔(GB43)和伏苓(K7)”等治之。吴反对艾灸治疗热证，但明确主张艾灸治疗热证，上述说法存在矛盾。
吴虽言热证不可灸治，或主张热证可灸治，但书中有许多矛盾的表述，《艾灸治疗论》则认为热证宜灸，可吸热散邪。不是热药误治热证，而是《内经》的逆治原则，是“火郁散结”的实际运用。临床应用广泛，涉及内科学、外科学、妇科、儿科、眼科、耳鼻喉科、口腔科等。该书列举艾灸穴位和方法治疗实热虚热100余例，说明热证适用于艾灸治疗，“其治疗效果优于药物”，“其总有奇效”。故该书仍是艾灸治疗热证及急性症状的重要文献。对我们来说，学习、分析和证明书中的陈述是值得的。从而拓宽灸法的治疗范围，为灸法治疗热证、急性症状让路。
【相关】
