热病体重，肠中热，取之以第四针，于其 及下诸
指间，孛气于胃络，得气也。
此邪热在手足阳明经也，阳明在肌肉中，故体重，肠中热。既取其 及手足指，又索胃络之气以泄其邪也。
热病挟脐急痛，胸胁满，取之涌泉与阴陵泉，取之第四针，针嗌里。
此邪热在脾肾两经，故取脾肾两经之穴以治之。
热病而汗且出，及脉顺可汗者，取之鱼际、太渊、大都、太白，泻之则热去，补之则汗出，汗出太甚，取
内踝上横脉以止之。
此从肺脾两经而治之也。
热病已得汗，而脉尚躁盛，此阴脉之极也，死；其得汗而脉静者，生。
此言热邪盛而阴精涸极也。以人迎为阳脉，寸口为阴脉，寸口躁盛，故谓阴脉之极而死。即上所云邪胜而
精却也。脉静则精存，故生。
热病脉尚躁而不得汗者，此阳脉之极也，死；脉盛躁，得汗静者，生。
此言津液涸而不能作汗，阳邪亢极，故谓阳脉之极而死，以人迎脉更盛躁也。如得汗后，脉静则生，义与
上同。
热病不可刺者有九∶一曰汗不出，大颧发赤，哕者死；二曰泄而腹满甚者死；三曰目不明，热不已者死；
四曰老人婴儿，热而腹满者死；五曰汗不出，呕，下血者死；六曰舌本烂，热不已者死；七曰咳而衄，汗不
出，出不至足者死；八曰髓热者死；九曰热而痉者死，腰折，螈 ，齿噤 也。凡此九者，不可刺也。
颧为骨本，肾主骨，邪热盛，肾水枯，故颧赤；邪气上冲脾胃则哕，古名呃逆为哕，今时或以空呕为哕，
而呃逆更为败证也；泄泻则邪热应去，而腹满反甚者，脾败而邪仍在也；目不明者，热伤五脏精气，而热不已
则精竭也；老人气血衰，婴儿气血弱，腹满而热，则邪结土败也；汗不出，表气不通，邪热内伤脾胃，呕且下
血，本元脱矣；舌本烂者，邪热遍灼三阴，脏真败矣；咳而衄，邪热伤肺，汗不出及出不至足，营卫经络不
通，邪无出路也；髓热者，上条之证也；热而痉，腰折、螈 、齿噤 者，热极生风，筋脉拘急，角弓反张，
肝肾阴涸也。凡此九证，皆死不可刺，则药亦不可治也。
In febrile diseases presenting with heavy body weight and heat in the intestines, treat using the fourth needle (Feng Zhen, sharp needle) at points between the elbows/knees and the fingers/toes, to guide Qi from the Stomach collaterals and achieve De Qi (arrival of Qi).
This indicates pathogenic heat in the Hand and Foot Yangming meridians. Since Yangming traverses the muscles, the body feels heavy and there is heat in the intestines. By selecting points distal to the elbows/knees and on the fingers/toes, one also draws upon the Qi of the Stomach collaterals to drain the pathogen.
In febrile diseases accompanied by urgent pain around the navel and fullness/distension in the chest and hypochondrium, select Yongquan (KI 1) and Yinlingquan (SP 9), use the fourth needle, and needle into the throat region.
This indicates pathogenic heat in the Spleen and Kidney meridians; therefore, points from these two meridians are selected for treatment.
In febrile diseases where sweat is about to appear, and the pulse is smooth indicating suitability for sweating therapy, select Yuji (LU 10), Taiyuan (LU 9), Dada (SP 2), and Taibai (SP 3). Applying reducing method will eliminate heat; applying reinforcing method will induce sweating. If sweating is excessive, select the transverse vessel above the medial malleolus (typically Ran Gu or nearby vessels) to stop it.
This treatment approach addresses the Lung and Spleen meridians.
If a patient with febrile disease has sweated but the pulse remains rapid and vigorous, this represents the extreme depletion of Yin pulses, indicating death; if the pulse becomes calm after sweating, it indicates survival.
This describes a state where pathogenic heat is exuberant and Yin essence is exhausted. Renying (carotid artery) represents Yang pulses, and Cunkou (radial artery) represents Yin pulses. Vigorous Cunkou pulse signifies extreme Yin depletion leading to death, as mentioned earlier regarding pathogen excess and essence deficiency. A calm pulse implies preserved essence, hence survival.
If the pulse in febrile disease remains rapid and vigorous without sweating, this represents the extreme depletion of Yang pulses, indicating death; if the pulse is rapid and vigorous but becomes calm after sweating, it indicates survival.
This describes a state where body fluids are exhausted and cannot generate sweat, with Yang pathogen reaching extremity, leading to death due to extreme Yang pulse depletion (Renying pulse being more rapid and vigorous). Survival occurs if the pulse calms after sweating, consistent with the previous explanation.
There are nine conditions in febrile disease that are unsuitable for acupuncture:
1. No sweating, redness of the cheekbones, and hiccups indicate death.
2. Diarrhea with severe abdominal fullness indicates death.
3. Unclear vision with persistent fever indicates death.
4. Elderly people and infants with fever and abdominal fullness indicate death.
5. No sweating, vomiting, and hematochezia/hematemesis indicate death.
6. Ulceration of the tongue root with persistent fever indicates death.
7. Coughing with epistaxis, no sweating, or sweating that does not reach the feet indicate death.
8. Marrow heat indicates death.
9. Fever with spasms (opisthotonos, convulsions, trismus) indicates death.
All nine conditions are unsuitable for acupuncture.
The cheekbones are the root of the bones; the Kidney governs bones. Exuberant pathogenic heat depletes Kidney Water, causing redness of the cheekbones. Pathogenic Qi rushing upward to the Spleen and Stomach causes hiccups (Yue/Eryngma); historically called "Yue," now sometimes referring to empty retching, while hiccups represent a critical failure syndrome. Diarrhea should expel heat, but severe abdominal fullness suggests Spleen failure with lingering pathogen. Unclear vision results from heat damaging the Essence of the Five Zang organs; persistent fever leads to essence exhaustion. The elderly have deficient Qi and Blood; infants have weak Qi and Blood. Fever with abdominal fullness indicates pathogen stagnation and Earth element failure. No sweating indicates blocked exterior Qi; internal damage to Spleen/Stomach by heat causes vomiting and bleeding, signifying collapse of Yuan Qi (Original Qi). Tongue root ulceration indicates heat scorching all three Yin meridians and failure of Zang True Qi. Cough with epistaxis indicates lung injury; lack of sweating or insufficient sweating reflects blockage of Ying-Wei (Nutritive-Defensive) and collaterals, leaving no exit for pathogens. Marrow heat corresponds to the aforementioned condition. Fever with spasms, opisthotonos, convulsions, and trismus results from extreme heat generating wind, tendon-pulse tension, and depletion of Liver-Kidney Yin. All nine syndromes are fatal and unsuitable for acupuncture; thus, herbal medicine is also ineffective.