仲景云。凡治温病。可刺五十九穴。（正文已见前第二卷伤寒论例中。成注云。五十九刺者。以泻诸经之温热。针经
云。热病。取之诸阳五十九穴。刺以泻其热。而出其汗。实其阴而补其不足。所谓五十九刺。两手外内侧各三。凡十二
。五指间各一。凡八 。足亦如是头入发际一寸旁三分。各三。凡六 。更入发三寸边五。凡十 。耳前后。口下者
各一。项中一。凡六 。巅上一。囟会一。发际一。廉泉一。风池二。天柱二。以上云云。见灵枢热病第二十三。又内
经曰。热俞五十九。头上五行。行五者。以泻诸阳之热逆也。大杼。膺俞。缺盆背俞。此八者。以泻胸中之热也。气冲。
三里。巨虚。上下廉。此八者。以泻胃中之热也。云门。 骨。委中。髓空。此八者。以泻四肢之热也。五脏俞旁五。
此十者。以泻五脏之热也。凡此五十九者。皆热之左右也。以上云云。见素问水热穴论篇第六十一）
琥按仲景云五十九穴。而成注两引内经。其穴各有不同。使用针家。何所适从。盖尝考之甲乙经云。按上灵枢素问
二经之言。虽有不同。皆刺热之要穴也。资生经但云。温病。可针刺五十九穴。而不明言其处。以江南诸师。秘仲景要
方而不传故也。马玄台注灵枢。特辩成氏注伤寒两入之误。且云。水热论中五十九穴。与灵枢刺热病五十九穴不同者。
以彼则刺水病。此则刺热病。病有不同。穴因以异。既治伤寒。当从灵枢。不宜入。以治水之穴矣。或问水热穴论。水
俞凡五十七穴。前半篇已详言之。末后言热病五十九俞。乃治伤寒之法也。何为而独不从之乎。余答云。末后言治热病
五十九俞。乃人病风水。水寒之气郁于内。则变而为热。故刺五十九俞。以泻表里脏腑之热。其理譬之人伤于寒。寒盛
则生热。非直云。伤寒病也。马氏所言。实为不易之论。余因就灵枢中文。辩注其穴于后。
灵枢所谓五十九刺者。两手外内侧各三。凡十二 。（手太阳少泽穴。在手小指外侧端。去爪甲下一分陷中。可刺入
一分。手阳明商阳穴。在手大指次指内侧。去爪甲角如韭叶。可刺入一分。留一呼。手少阳关冲穴。在手小指次指之端。
去爪甲角如韭叶。可刺入一分。手太阴少商穴。在手大指端内侧。去爪甲角如韭叶。以三棱针刺之。微出血。手少阴少
冲穴。在手小指内廉之端。去爪甲角如韭叶。可刺入一分。手厥阴中冲穴。在手中指端去爪甲如韭叶陷中。可刺入一分。
计六井穴。左右手共十二 。 者。刺疮也。有刺必有瘢。故即以 为数。）
五指间各一。凡八 。（手太阳后溪穴。在手小指外侧。本节后陷中。可刺入一分。手阳明三间穴。在手大指次指本
节之后。内侧陷中。可刺入三分。留三呼。手少阳中渚穴。在手小指次指本节后间陷中。可刺入二分。手少阴少府穴。
在手小指本节后陷中。可刺入二分。手之六经。厥阴本节后无穴。太阴本节后有鱼际穴。其脉实散腕中。而不在指间。
计四经左右。共八 也。）
足亦如是。（足太阳束骨穴。在足小指本节后陷中。可刺入三分。足阳明陷谷穴。在足大指次指之间。本节后陷中。
可刺入三分。留七呼。足少阳临泣穴。在足小指次指本节后间陷中。可刺入二分。足太阴大都穴。在足大指本节后陷中。
可刺入三分。足之六经。少阴脉不行于指。厥阴本节后上二寸。有太冲脉。而其穴亦不在指间。计四经左右。亦八 也。）
头入发一寸旁三分。各三。凡六 。（头入发一寸旁。即督脉上星穴之次。其旁之穴。分而为三。则足太阳之五处穴。在
上星旁一寸五分。可刺三分。留七呼。承光穴。在五处后一寸五分。可刺入三分。通天穴。在承光后一寸三分。可刺入
三分。留七呼。左右各三穴。故凡六 。此偃伏头部。第二行穴也。穴皆由前发际。上而至后。）更入发三寸边五。凡十
。（更入发者。自上星之次向后也。三寸边五者。去中行三寸许。两边各五也。即足少阳之临泣穴。在目上直入发际五
分陷中。可刺入三分。留七呼。得气。即泻目窗穴。在临泣后一寸。可刺入三分。正营穴。在目窗后一寸。可刺入三分。
承灵穴。在正营后一寸五分。可刺入三分。一云禁针。脑空穴。在承灵后一寸。五分。挟玉枕骨下陷中。可刺四分。得
气。即泻。左右共凡十 。乃偃伏头部第三行穴也。）耳前后。口下者。各一。项中一。凡六 （耳前者听会穴也。在耳
前陷中。开口有空。可刺入七分。留三呼。得气即泻。乃侧面部穴也。耳后者。完骨穴也。在耳后入发际四分。可刺三
分。留七呼。乃侧头部穴也。俱属足少阳经。左右各一。凡四穴。口下者。任脉之承浆穴也。在唇下宛宛中。可刺入三
分。得气即泻。在面部中行。止一穴。项中者。督脉之哑门也。在项中央。入发际。五分宛宛中。可刺入二分。不可深。
在偃伏头部中行。止一穴。共凡六 。）巅上一。（百会穴也。在前顶后一寸五分。顶中央旋毛中。可容豆。督脉足太阳
交会于巅上。手足少阳。足厥阴。俱会于此。可刺入二分。得气即泻。）囟会一。（囟会督脉穴名。在上星后一寸。陷中。
可容豆。可刺二分。留三呼。得气即泻）发际一。（前发际谓神庭穴。在鼻直上入发际五分。发高者。发际是穴。发低者。
加二三分。督脉足太阳阳明三脉之会。铜人等书皆云。禁不可针。针即发狂。甲乙经云。令人癫疾。目失精。马氏灵枢
注引之。欲足五十九穴之数。误矣。后发际谓风府穴。已见前。以上四穴。俱在偃伏头部中行。）廉泉一。（廉泉任脉穴
名。在颔下。结喉上中央。舌本下。仰而取之。阴维任脉之会。可刺三分。得气即泻。乃正面部中行穴也。）风池二（穴
与刺法已见前）天柱二。（天柱。足太阳经穴名挟项后发际。大筋外廉陷中。可刺五分。得气即泻。乃偃伏头部第二行穴
也。）
（琥）按上五十九穴。皆可刺。惟前发际神庭一穴。禁不可刺。则是可刺之穴。实止五十八矣。或云发际止一穴。
而廉泉有二穴。当是舌根下之左右泉脉。为足少阴之会。斯言出类经图翼。姑订入之。以备参考。
Zhang Zhongjing stated: "In the treatment of warm diseases (Wen Bing), one may needle fifty-nine acupoints." (The main text has been seen in the second volume of the *Lü* section of the *Shanghan Lun*. Cheng Wuji's commentary states: The so-called 'fifty-nine pricks' are used to drain the heat and warmth from all meridians. The *Zhen Jing* (Needle Classic) says: For heat diseases, select the fifty-nine points from the Yang meridians; needle them to drain the heat and induce sweating, thereby filling the Yin and supplementing deficiencies. This is what is meant by the 'fifty-nine pricks.' Specifically: Three points on each side of the outer and inner aspects of both hands, totaling twelve. [Original text missing character, referring to Jing-Well points]. One point between each of the five fingers, totaling eight. [Original text missing character, referring to Ying-Spring points]. The feet are similar. On the head, entering one cun into the hairline and three fen lateral to the midline, three points on each side, totaling six. [Original text missing character, referring to Shu-Stream points]. Moving further back three cun into the hairline along the edges, five points on each side, totaling ten. [Original text missing character, referring to Jing-River points]. One point each at the front and back of the ears, one below the mouth, and one in the middle of the neck, totaling six. [Original text missing character, referring to He-Sea points]. One point at the vertex, one at Xinhui, one at the hairline, one at Lianquan, two at Fengchi, and two at Tianzhu. As mentioned above, see *Ling Shu*, Chapter 23, 'Heat Disease'. Furthermore, the *Nei Jing* states: There are fifty-nine heat Shu points. Five rows of five points on the head are used to drain the rebellious heat of the Yang meridians. Dazhu, Ying Shu, Quepen, and Bei Shu, these eight points, are used to drain the heat in the chest. Qichong, Zusanli, Shangjuxu, and Xiajuxu, these eight points, are used to drain the heat in the stomach. Yunmen, Yugu (likely referring to a bone-related point), Weizhong, and Suikong, these eight points, are used to drain the heat in the four limbs. Five points beside each of the Back-Shu points of the five Zang organs, totaling ten points, are used to drain the heat of the five Zang organs. In total, these fifty-nine points are the left and right pairs for treating heat. As mentioned above, see *Su Wen*, Chapter 61, 'Discussion on Water Acupoints')."
Wang Hu notes: Zhang Zhongjing mentions fifty-nine points, but Cheng Wuji's commentary cites the *Nei Jing* twice, with different points listed, leaving acupuncture practitioners unsure which to follow. I have examined the *Jia Yi Jing*, which states: According to the *Ling Shu* and *Su Wen*, although there are differences, they are all important points for needling to treat heat diseases. The *Zi Sheng Jing* only states that for warm diseases, one may needle fifty-nine points without specifying their locations, because teachers in Jiangnan kept Zhang Zhongjing's essential formulas secret and did not transmit them. Ma Xuantai, in his commentary on the *Ling Shu*, specifically refutes Cheng's error of conflating the two texts, stating that the fifty-nine points in the 'Water Heat Acupoints' discussion differ from the fifty-nine points for needling heat disease in the *Ling Shu* because the former treats water diseases while the latter treats heat diseases; since the diseases differ, the points differ. Since we are treating cold damage (Shang Han), we should follow the *Ling Shu* and not include points used for treating water diseases. Someone asked: In the 'Water Heat Acupoints' chapter, there are fifty-seven water Shu points detailed in the first half, and the end mentions fifty-nine heat Shu points as a method for treating cold damage. Why not follow this? I reply: The fifty-nine heat Shu points mentioned at the end refer to cases where patients suffer from wind-water, where cold-damp qi stagnates internally and transforms into heat. Thus, needling these fifty-nine points drains the heat from the exterior, interior, zang, and fu organs. The principle is akin to a person injured by cold; excessive cold generates heat, which is not directly called a cold damage disease. Ma's statement is indeed an unchangeable truth. I therefore analyze and annotate these points based on the text of the *Ling Shu* below.
The 'fifty-nine pricks' mentioned in the *Ling Shu*: Three points on each side of the outer and inner aspects of both hands, totaling twelve. (Shaose, Small Intestine Meridian of Hand-Taiyang, at the ulnar end of the little finger, one fen from the nail corner in the depression; needle depth one fen. Shangyang, Large Intestine Meridian of Hand-Yangming, on the radial side of the index finger, one fen from the nail corner like the width of a leek leaf; needle depth one fen, retain needle for one breath. Guanchong, Sanjiao Meridian of Hand-Shaoyang, at the tip of the ring finger, one fen from the nail corner; needle depth one fen. Shaoshang, Lung Meridian of Hand-Taiyin, at the radial tip of the thumb, one fen from the nail corner; puncture with a three-edged needle until slight bleeding occurs. Shaochong, Heart Meridian of Hand-Shaoyin, at the ulnar tip of the little finger, one fen from the nail corner; needle depth one fen. Zhongchong, Pericardium Meridian of Hand-Jueyin, at the tip of the middle finger, in the depression one fen from the nail corner; needle depth one fen. These are the six Jing-Well points, twelve in total for both hands. The original text has a missing character here, implying the formation of scars or lesions from needling; since needling leaves scars, this serves as the count.)
One point between each of the five fingers, totaling eight. (Houxi, Small Intestine Meridian of Hand-Taiyang, on the ulnar side of the little finger, in the depression behind the metacarpophalangeal joint; needle depth one fen. Sanjian, Large Intestine Meridian of Hand-Yangming, on the radial side of the index finger, in the depression behind the metacarpophalangeal joint; needle depth three fen, retain needle for three breaths. Zhongzhu, Sanjiao Meridian of Hand-Shaoyang, in the depression between the metacarpophalangeal joints of the ring and little fingers; needle depth two fen. Shaofu, Heart Meridian of Hand-Shaoyin, in the depression behind the metacarpophalangeal joint of the little finger; needle depth two fen. Among the six hand meridians, the Jueyin meridian has no point behind the metacarpophalangeal joint. The Taiyin meridian has Yuji behind the joint, but its pulse disperses in the wrist, not between the fingers. Counting four meridians on both sides, there are eight points. The original text has a missing character here, implying the formation of scars.)
The feet are similar. (Shugu, Bladder Meridian of Foot-Taiyang, in the depression behind the metatarsophalangeal joint of the little toe; needle depth three fen. Xiangu, Stomach Meridian of Foot-Yangming, between the big and second toes, in the depression behind the metatarsophalangeal joint; needle depth three fen, retain needle for seven breaths. Linqi, Gallbladder Meridian of Foot-Shaoyang, in the depression between the metatarsophalangeal joints of the fourth and fifth toes; needle depth two fen. Dadu, Spleen Meridian of Foot-Taiyin, in the depression behind the metatarsophalangeal joint of the big toe; needle depth three fen. Among the six foot meridians, the Shaoyin meridian does not run to the toes. The Jueyin meridian has Taichong two cun above the metatarsophalangeal joint, but its point is not between the toes. Counting four meridians on both sides, there are also eight points. The original text has a missing character here, implying the formation of scars.)
On the head, entering one cun into the hairline and three fen lateral to the midline, three points on each side, totaling six. (The area one cun into the hairline laterally refers to the side of the Du Meridian point Shangxing. The points beside it are divided into three, which are Wuchu of the Bladder Meridian of Foot-Taiyang, located one cun five fen lateral to Shangxing; needle depth three fen, retain needle for seven breaths. Chengguang, one cun five fen posterior to Wuchu; needle depth three fen. Tongtian, one cun three fen posterior to Chengguang; needle depth three fen, retain needle for seven breaths. Three points on each side, totaling six. The original text has a missing character here, implying the formation of scars. These are the second row of points on the supine head. The points extend from the anterior hairline upwards to the back.) Moving further back three cun into the hairline along the edges, five points on each side, totaling ten. ('Moving further back' means posterior to the side of Shangxing. 'Three cun edge five' means approximately three cun from the midline, five points on each side. These are Linqi of the Gallbladder Meridian of Foot-Shaoyang, in the depression five fen into the hairline directly above the eye; needle depth three fen, retain needle for seven breaths. Upon obtaining Qi, immediately drain Muwang, one cun posterior to Linqi; needle depth three fen. Zhengying, one cun posterior to Muwang; needle depth three fen. Chengling, one cun five fen posterior to Zhengying; needle depth three fen. Some say it is contraindicated. Naokong, one cun five fen posterior to Chengling, in the depression under the occipital bone; needle depth four fen, obtain Qi and then drain. Ten points in total for both sides. These are the third row of points on the supine head.) One point each at the front and back of the ears, one below the mouth, and one in the middle of the neck, totaling six. (The point in front of the ear is Tinghui, in the depression anterior to the ear, open the mouth to find the space; needle depth seven fen, retain needle for three breaths, obtain Qi and then drain. This is a lateral facial point. The point behind the ear is Wanggu, four fen into the hairline behind the ear; needle depth three fen, retain needle for seven breaths. This is a lateral head point. Both belong to the Gallbladder Meridian of Foot-Shaoyang, one on each side, totaling four points. The point below the mouth is Chengjiang of the Ren Meridian, in the depression below the lower lip; needle depth three fen, obtain Qi and then drain. It is on the midline of the face, only one point. The point in the middle of the neck is Yamens of the Du Meridian, in the center of the neck, five fen into the hairline in the depression; needle depth two fen, do not needle deeply. It is on the midline of the supine head, only one point. Six points in total. The original text has a missing character here, implying the formation of scars.) One point at the vertex. (Baihui, one cun five fen posterior to Qian Ding, in the whorl of hair at the center of the vertex. The Du Meridian and Bladder Meridian of Foot-Taiyang intersect here, as do the Hand and Foot Shaoyang meridians and the Foot Jueyin meridian; needle depth two fen, obtain Qi and then drain.) One point at Xinhui. (Xinhui is the name of a Du Meridian point, one cun posterior to Shangxing in the depression; needle depth two fen, retain needle for three breaths, obtain Qi and then drain.) One point at the hairline. (The anterior hairline refers to Shenting, five fen into the hairline directly above the nose. For those with high hairlines, the hairline itself is the point; for low hairlines, add two to three fen. This is the intersection of the Du, Foot-Taiyang, and Foot-Yangming meridians. Books such as the *Tong Ren* state it is contraindicated to needle, as it may cause madness. The *Jia Yi Jing* states it may cause epilepsy and loss of vision. Ma cited this in his *Ling Shu* commentary to reach the count of fifty-nine points, which was an error. The posterior hairline refers to Fengfu, mentioned earlier. The above four points are all on the midline of the supine head.) One point at Lianquan. (Lianquan is the name of a Ren Meridian point, below the mandible, central above the larynx, below the root of the tongue. Take the point with the head tilted back. It is the intersection of the Yin Wei and Ren meridians; needle depth three fen, obtain Qi and then drain. It is a point on the midline of the anterior face.) Two points at Fengchi (Acupoints and needling methods were mentioned earlier). Two points at Tianzhu. (Tianzhu is the name of a Bladder Meridian of Foot-Taiyang point, lateral to the posterior hairline of the neck, in the depression outside the large tendons; needle depth five fen, obtain Qi and then drain. It is a point on the second row of the supine head.)
Wang Hu notes: Of the aforementioned fifty-nine points, all can be needled, except for Shenting at the anterior hairline, which is contraindicated. Therefore, the number of points that can actually be needled is fifty-eight. Some say there is only one point at the hairline, but two points at Lianquan, suggesting they should be the left and right Quan vessels below the tongue root, which are intersections of the Foot-Shaoyin meridian. This statement comes from the *Lei Jing Tu Yi*. I tentatively correct and record it here for reference.