马云。志者。记也。篇内。言虚实之要。及泻实补虚之法。当记之不忘。故名篇。吴改虚实要论。云。
旧作刺志论。今以篇内之言无当。僭改。简按篇首论虚实。而篇末结以针法补泻之义。斯为刺志也。改易篇名。
却无谓矣。
气实形实气虚形虚 马云。凡气与形。谷与气。脉与血相称者为常。而相反者为病也。气者。人身
之气也。（如营气卫气。是也。）形者。人之形体也。（次节。岐伯以身字代形字。）气实则形实。气虚则形
虚。此其相称者为常。而相反则为病矣。然此气之虚实。必于脉而验之。但不可即谓气为脉也。观下文有血脉
对举者可知。王注引阴阳应象大论之形归气。以验其虚实之同。甚有见。至以气为脉气。则非矣。
气虚身热 马吴高并根据甲乙。气字上。补气盛身寒四字。是。
脉少血多 吴。少。作小。马云。少。当作小。张云。脉盛血少者。阳实阴虚也。脉少血多者。
阳虚阴实也。简按血之多少。盖察面而知之。
得之伤寒 马云。此伤寒者。初时所感之寒。至于日久。则寒亦为热矣。故热论曰。凡热病者。皆
伤寒之类也。水热
穴论。帝曰。人伤于寒。而传于热。何也。岐伯曰。夫寒感则身热。张云。按热论篇曰。人之伤于寒也。则为
病热。本节。复以身寒者为伤寒。身热者为伤暑。其说若乎相反。不知四时皆有伤寒。而伤暑惟在夏月。病不
同时者。自不必辨。惟于夏至之后。有感寒暑。而同时为病者。则不可不察其阴阳也。盖阴邪中人。则寒集于
表。气聚于里。故邪气盛实。而身本因寒也。暑邪中人。则热触于外。气伤于中。故正气疲困。而因热无寒也。
此夏月寒暑之明辨。故以二者。并言于此。非谓凡患伤寒者。皆身寒无热也。
得之有所脱血湿居下也 张云。谷入多者。胃热善于消谷也。脱血者。亡其阴也。湿居下者。脾肾之
不足。亦阴虚也。阴虚则无气。故谷虽入多。而气则少也。高云。夫谷入多。而气反少者。其内则得之有所脱
血。或湿邪居下之病。简按血脱液干。水湿归下。并胃中津乏。故消谷善饥。与伤寒论。抵当汤治证。其理略
同。王注。以脱血湿居下为一事。恐非。
谷入少而气多 张云。邪在胃。则不能食。故谷入少。邪在肺。则息喘满。故气多。
胃及与肺 吴删与字。
饮中热也 吴云。有痰饮者。脉来弦小。有中热者。血出必多。张云。脉小者。血应少。而反见其
多。必或酒或饮。中于热。而动之也。高云。夫脉小血反多者。其内必饮酒中热之病。酒行络脉。故血多行于
外。而虚于内。故脉小。昂云。按灵素皆无痰字。惟此处有饮字。简按中。读如字。高注义长。
脉有风气水浆不入 张云。风为阳邪。居于脉中。故脉大。水浆不入。则中焦无以生化。故血少。
吴云。此上。皆
释反者为病之词。
入实者左手开针空也 吴云。空。上声。马云。大凡用针之法。右手持针。左手掐穴。方其入针泻实
之时。则左手掐穴。开针空以泻之。及其去针补虚之时。则左手闭穴。闭针空以补之。张云。入实者。刺实也。
入虚者。刺虚也。简按据上文。虚者。气出也。入虚。当是出虚。滑吴张志高。并作右手开针空。非也。当仍
王及马注。
Ma Yun stated: "Zhi" (Record/Memory) means to remember. This chapter discusses the essentials of deficiency and excess, as well as the methods of draining excess and tonifying deficiency, which should be remembered without fail; hence the chapter title *Ci Zhi Lun* (Treatise on Needling and Memory). Wu Kun changed the title to *Xu Shi Yao Lun* (Essential Treatise on Deficiency and Excess), stating: "The old title was *Ci Zhi Lun*, but since the content does not match the title, I arbitrarily changed it." Danbo Jian commented: The beginning of the chapter discusses deficiency and excess, while the end concludes with the meaning of needle manipulation for tonification and sedation; this constitutes "Ci Zhi" (Needling and Memory). Arbitrarily changing the chapter title is meaningless.
Qi Excess corresponds to Form Excess; Qi Deficiency corresponds to Form Deficiency. Ma Yun stated: When Qi and form, Gu Qi (Grain Qi) and Yuan Qi, and pulse and blood are in correspondence, it is normal; when they are contrary, it is pathological. "Qi" refers to the Qi of the human body (such as Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi)). "Form" refers to the physical body (in the next section, Qibo uses the character "Shen" (Body) to substitute "Xing" (Form)). When Qi is excessive, the form is substantial; when Qi is deficient, the form is weak. This correspondence is normal, while contradiction indicates disease. However, the deficiency or excess of Qi must be verified through the pulse, but one cannot simply equate Qi with the pulse. As seen later in the text where "Blood Vessel" (Mai) and "Blood" (Xue) are mentioned together, this is evident. Wang Bing's commentary cites *Yin Yang Ying Xiang Da Lun* (Great Treatise on Yin-Yang Correspondences) stating "Form returns to Qi" to verify the consistency of deficiency and excess, which is insightful. However, equating Qi directly with Mai Qi (Pulse Qi) is incorrect.
Qi Deficiency with Body Heat. Ma Shi, Wu Kun, and Gao Shishi all followed the *Jia Yi Jing* (Classic of A-Bian Acupuncture and Moxibustion), adding the four characters "Qi Sheng Shen Han" (Excessive Qi with Cold Body) before the character "Qi". This is correct.
Few Pulse, Abundant Blood. Wu Kun interpreted "Shao" (Few) as "Xiao" (Small). Ma Yun stated: "Shao" should be read as "Xiao". Zhang Jingyue stated: When the pulse is vigorous but blood is scant, it indicates Yang Excess and Yin Deficiency. When the pulse is small/scant but blood is abundant, it indicates Yang Deficiency and Yin Excess. Danbo Jian commented: The abundance or scarcity of blood can generally be known by observing the complexion.
Caused by Shang Han (Cold Damage). Ma Yun stated: The "Shang Han" here refers to the cold pathogen contracted initially. After a long duration, the cold transforms into heat. Thus, *Re Lun* (Treatise on Heat) states: "All heat diseases belong to the category of Shang Han." In *Shui Re Xue Lun* (Treatise on Water-Heat Acupoints), the Yellow Emperor asked: "Why does contracting cold transform into heat?" Qibo answered: "Contracting cold leads to body heat." Zhang Jingyue noted: *Re Lun* states: "When humans are injured by cold, they develop heat diseases." This section states that those with cold bodies suffer from Shang Han, while those with hot bodies suffer from Shang Shu (Summerheat Injury). These statements seem contradictory. One must understand that Shang Han occurs in all four seasons, whereas Shang Shu occurs only in summer. Since the diseases occur at different times, there is no need to debate them. However, after the Summer Solstice, if one contracts both cold and summerheat simultaneously and becomes ill, one must distinguish their Yin and Yang natures. Generally, when Yin pathogens invade, cold gathers at the exterior, and Qi aggregates internally, resulting in pathogenic excess and a body naturally cold due to cold. When summerheat pathogens invade, heat touches the exterior, and Qi is damaged internally, resulting in righteous Qi exhaustion and a body hot without cold. This is a clear distinction between summer cold and summerheat, so both are discussed here. It does not mean that all patients with Shang Han have cold bodies without fever.
Caused by Blood Loss, Dampness residing below. Zhang Jingyue stated: Eating much indicates Stomach Heat capable of digesting food. Blood loss implies the loss of Yin fluids. Dampness residing in the lower part indicates insufficiency of the Spleen and Kidney, which is also Yin Deficiency. Yin Deficiency leads to Qi deficiency; thus, although food intake is high, Qi is scarce. Gao Shishi stated: When food intake is high but Qi is low, the internal cause is either a condition of blood loss or dampness pathogen residing in the lower part. Danbo Jian commented: Blood loss and fluid dryness, water-dampness gathering below, combined with a lack of stomach fluids, lead to rapid digestion and hunger. This logic is similar to the indications for Didang Tang (Lower Jiao Stasis-Decoction) in the *Shang Han Lun* (Treatise on Cold Damage). Wang Bing’s commentary treats "blood loss" and "dampness residing below" as a single event, which is likely incorrect.
Little Food Intake but Much Qi. Zhang Jingyue stated: When pathogen is in the Stomach, one cannot eat, so food intake is low. When pathogen is in the Lung, there is panting and chest fullness, so Qi is excessive.
Stomach and Lung. Wu Kun deleted the character "Yu" (And).
Drinking with Internal Heat. Wu Kun stated: Those with Phlegm-Fluids (Tan Yin) have a string-like and small pulse; those with Internal Heat will bleed profusely. Zhang Jingyue stated: A small pulse suggests blood should be scant, but seeing abundant blood implies it was triggered by alcohol or dietary heat. Gao Shishi stated: When the pulse is small but blood is abundant, the internal condition must be drinking-induced internal heat. Alcohol travels through the collaterals, causing blood to flow abundantly externally while being deficient internally, hence the small pulse. Ang Yun noted: Neither *Ling Shu* nor *Su Wen* contains the character "Tan" (Phlegm); only this section has "Yin" (Drink/Fluid). Danbo Jian commented: "Zhong" (Middle/Internal) is read as its original meaning. Gao Shishi’s interpretation is superior.
Pulse with Wind Pathogen, No Fluid Intake. Zhang Jingyue stated: Wind is a Yang pathogen residing in the vessels, causing a large pulse. If fluids cannot enter, the Middle Jiao lacks the source for transformation and generation, resulting in little blood. Wu Kun stated: The above explanations clarify why "contraries indicate disease."
For Treating Excess, Open the Needle Aperture with the Left Hand. Wu Kun stated: "Kong" (Aperture/Hole) is pronounced with the falling tone. Ma Yun stated: Generally, in acupuncture, the right hand holds the needle, and the left hand presses the acupoint. When inserting the needle to drain excess, the left hand presses the point to open the aperture for draining. When withdrawing the needle to tonify deficiency, the left hand closes the aperture for tonifying. Zhang Jingyue stated: "Ru Shi" (Enter Excess) means treating excess syndromes; "Ru Xu" (Enter Deficiency) means treating deficiency syndromes. Danbo Jian commented: According to the preceding text, "Xu" refers to the exit of Qi. "Ru Xu" should be interpreted as "Chu Xu" (Exit Deficiency). Hua Shou, Wu Kun, Zhang Zhicong, and Gao Shishi all state "Open the needle aperture with the right hand," which is incorrect. One should follow the commentaries of Wang Bing and Ma Shi.