马云。内言病有虚实。宜善调其经。
神有余 甲乙。神下。有有字。下文。气下。血下。形下。志下。并同。
精气 王引针经。见灵决气篇。云。腠理发泄。汗出溱溱。是谓津。谷入气满。淖泽注于骨。骨
属屈伸 泽。补益脑髓。皮肤润泽。是谓液。文少异。易系辞云。精气为物。疏。阴阳向导之气。氤氲积聚。
而为万物也。春秋繁露云。气之清者为精。治身者。以积精为宝。
十六部 志云。十六部之经脉也。手足经脉十二。 脉二。督脉一。任脉一。共十六部。高云。
谓两肘两臂两 两股。身之前后左右。头之前后左右也。简按高胜于旧注。
脾藏肉 高云。脾藏身形之肉。则形有余不足。脾所主也。
而此成形 吴。此。作各。
志意通 甲乙。通下。有达字。吴补调字。
成身形五脏 甲乙。无身字。及五脏二字。
五脏之道皆出于经隧 吴云。道。路也。隧。田间之水
道也。谓之经隧者。经脉流行之道也。简按王据于左传杜注。阙地通道曰隧。吴本于周礼隧人职。义并通。
血气未并 张云。并。偏聚也。邪之中人。久而不散。则或并于气。或并于血。病乃甚矣。
神之微 张云。此外邪之在心经也。浮浅微邪。在脉之表。神之微病也。
出血 吴删二字。
勿之深斥 吴云。斥。刺也。张云。斥。弃除也。高云。斥。开拓也。简按今从高注。
按而致之 吴云。以按摩致气于其虚络。
勿释 吴云。勿。已也。
着针勿斥 志云。着针者。如以布HT 着之。乃从单布上刺。谓当刺之极浅。而勿推内其针。简按
此谓着针于病处。勿开拓而泄其气也。王注为是。
移气于不足 高云。微泄其邪。移气于不足之气而补。简按新校正。引甲乙太素。删不字。马云。移
邪气于不足。立非。
息利少气 马云。本神篇。言肺虚则鼻息不利少气。即本文之少气也。实则喘喝。胸盈仰息。即本文
之喘咳上气也。高云。息利。鼻气出入也。
白气微泄 高云。犹言微虚也。
泻其经隧 张云。泻其经隧者。谓察其有余之脉。泻其邪气而已。志云。经隧。大络也。高云。通经
脉之隧道。故必无伤其经。简按杨注似是。
适人必革 张云。适。至也。革。变也。先行按摩之法。欲皮肤之气流行也。次出针而视之曰。我将
深之。欲其恐惧。而精神内伏也。适人必革者。谓针之至人。必变革前说。而
刺仍浅也。如是则精气既伏于内。邪气散乱。无所止息。而泄于外。故真气得其所矣。志云。出针。出而浅之
也。视之。视其浅深之义也。曰我将深之。适人之邪。浅客于皮。必与正气相格。庶邪散而正气不泄。故曰。
我将深之。谓将持内之。而使精气自伏。复放而出之。令邪无散乱。迎之随之。以意和之。无所休息。使邪气
泄于皮毛腠理。而真气乃相得。复于肌表。此用针浅深之妙法也。简按张注本。杨志注似允当。然其旨未明晰。
今亦仍杨义。
精气自伏 高云。精气退伏。不濡空窍也。邪气散乱者。散乱于经。邪无从出也。无所休息者。正虚
邪盛。病无已时也。惟刺之极浅。使邪气泄于腠理。从腠理而外泄。故真气乃相得。简按此与旧注相乖。不可从。
不足则恐 今甲乙。作不足则慧。
孙络水溢 甲乙。水。作外。
脉大疾出其针 吴云。脉大者。留针之久。气至而脉渐大也。简按高。疾字下句。非。
泾溲 吴云。泾。水行有常也。溲。溺溲也。泾溲不利。言常行之小便不利也。简按诸注并误。（详
见于厥论。）
微风 吴云。肌肉蠕动。肌肉间如虫行动也。风为动物。故动者命曰微风。高云。风邪入于肌肉。则
肌肉蠕动。命曰微风。言微风在肌肉也。
腹胀飧泄 张云。肾藏志。水之精也。水化寒。故肾邪有余。则寒气在腹。而为腹胀飧泄。肾气不足。
则阴虚阳胜。而为厥逆上冲。本神篇曰。肾藏精。精舍志。肾气虚则厥。实则胀。
骨节有动 甲乙。动。作伤。吴。此下。补则骨节有微风六字。
泻然筋血者 马吴张并云。然筋。当作然谷。志云。然。谓然谷穴。在足踝下之两经间。（高作筋间。）
故曰然筋。简按本输篇云。肾溜于然谷然骨之下者也。缪刺论云。刺足内踝之下。然骨之前出血。据此则杨注为是。
刺未并 高云。血气未并。五脏安定。骨节有动。故问刺未并奈何。
邪所乃能立虚 简按不必从甲乙改字。王注义通。
气血以并 以。甲乙。作已。以。已同。
阴阳相倾 张云。并。偏胜也。倾。倾陷也。气为阳。故乱于卫。血为阴。故逆于经。阴阳不和。则
气血离居。故实者偏实。虚者偏虚。彼此相倾也。
血并于阴气并于阳 吴云。血并于阴脏。是为重阴。气并于阳腑。是为重阳。惊狂。癫狂也。志云。
此言血分气分之为阴阳也。脉外气分为阳。脉内血分为阴。阴血满之于外。阳气注于脉中。是为阴阳匀平。如
血并居于阴。则阴盛而血实。心主血脉。故阴盛则惊。气并于阳。则阳盛而气实。阳盛则发狂也。
血并于阳气并于阴 吴云。血并于阳。则表寒。气并于阴。则里热。炅中。热中也。
心烦惋 惋。甲乙。作闷。吴云。心火为阴邪所蔽。故烦惋。
善怒 吴云。阳并于下部。则肝木为阳所炙。故善怒。
善忘 张云。血并于下。则阴气不升。气并于上。则阳气不降。阴阳离散。故神乱而喜忘。志云。灵
枢经曰。清浊之气相干。乱于胸中。是为大 。伤寒论曰。其人喜忘者。必有蓄血。宜抵当汤下之。
如是血气离居何者为实 高本。作如血气离居。是何者
为实。注云。旧本如是二字相连。今改。简按不必改字。义自通。
消而去之 马云。温则消释而易行。高云 消。不凝也。去。流也。
络之与孙脉 吴。作孙络。注云。络。正络也。孙络。支络也。志云。络者。经脉之支别也。孙脉
者。乃孙络之脉别经者。简按今仍志。
俱输于经 输。甲乙。作注。
大厥 张云。上文。言血与血并。气与气并。偏虚偏实也。此言血与气并。并者为实。不并者为虚
也。血气并走于上。则上实下虚。下虚则阴脱。阴脱则根本离绝。而下厥上竭。是为大厥。志云。气复反则生。
谓复归于下也。盖阳气生于下。而升于上。血气并逆。则气机不转而暴死。反则旋转而复生。
何道从来 高云。从何道来。简按天真论。病安从来。字法同。
皆有俞会 吴云。经穴有俞有会也。马云。六阳经六阴经。皆有俞穴所会。志云。俞者。谓三百六
十五俞穴。乃血脉之所流注。会者。谓三百六十五会。乃神气之所游行。皆阴阳血气之所输会者也。高云。俞
会者。五五二十五俞。六六三十六俞。与周身阴阳血气。相会合也。
阴阳匀平 甲乙。作 平。简按 。音旬。说文。圜采也。义不相协。
得之风雨寒暑 简按据下文。宜云风雨寒湿。
输于大经脉 马云。皮部论云。邪客于皮。则腠理开。开则邪入客于络脉。络脉满。则注于经脉。经
脉满。则入舍于腑脏也。缪刺论云。邪之客于形也。必先合于皮毛。留而
不去。入舍于孙脉。留而不去。入舍于络脉。留而不去。入舍于经脉。义同。
皮肤不收 吴云。不收者。肌肤虚浮。不收敛也。此由湿胜所致。张云。皮肤不收。而为纵缓。肌肉
坚紧。而为削瘦。高云。不收。汗出而不闭密也。简按寒主收敛。此云不收。则与肌肉紧紧相反。甲乙太素近是。
聂辟气不足 马云。乃肌肉僻积之意。根结篇。有肠胃聂辟。是主肠胃而言。张云。凡言语轻小曰聂。
足弱不能行曰辟。志云。聂。HT 同。辟。积也。高云。肌肉皮肤。聂聂然而辟动也。简按聂辟。褶襞也。仪礼。
者以褶。礼记。衣有襞折曰褶。通作 。一切经音义云。 皱。之涉知猎二反。褶。犹褶叠也。亦细褶。王
注义同。甲乙。不足下。有血涩二字。
喜怒不节 张云。按下文。以喜则气下为虚。而此节所重在怒。故曰实也。观阴气上逆之意。言怒可
知。又举痛论曰。怒则气上。正此之谓。简按下文云。喜则气下。则此喜字衍。新校正为是。淮南精神训云。
人大怒伤阴。大喜坠阳。
熏满 简按今仍甲乙。作动脏。
形气衰少 吴云。形气。阴气也。衰少。虚也。
谷气不盛 马云。形气衰少。而饮食随减。所以谷气不盛也。志云。饮食劳倦则伤脾。脾主肌肉。故
形气衰少也。水谷入胃。由脾气之转输。脾不营运。则谷气不盛矣。
下脘不通 志云。上焦不能宣五谷之味。下焦不能受水谷之津。高云。上焦不能宣五谷味。故上焦不
行。下脘不能化谷之精。故下脘不通。
热气熏胸中 甲乙。无热气二字。
玄府不通 志云。玄府。毛窍之汗空也。毫毛之腠理闭
塞。则卫气不得泄越。而为热矣。
故外热 张云。上焦之气。主阳分也。故外伤寒邪。则上焦不通。肌表闭塞。卫气郁聚。无所流行。
而为外热。所谓人伤于寒。则病为热。此外感证也。昂云。此即今人外感伤寒之症。
独留则血凝泣 吴。留下。更增一留字。
凝则脉不通 吴。凝上。增一泣字。脉。甲乙。作腠理。似是。
脉盛大以涩 张云。寒留中焦。阳气乃去。经脉凝滞。故盛大而涩。盖阳脉流利多滑。不滑则无阳
可知。简按厥气上逆。故脉盛大。血凝泣。故脉涩。马云。此节。脉若作外诊之脉。理宜沉涩。今曰盛大而涩。
恐是在中之脉。非外见者。昂云。按阴盛中寒血涩之人。何以反得盛大之脉。并误。
血气以并病形以成 甲乙。以。作已。次节并同。
用形哉 吴云。言因其形之长短阔狭肥瘦。而施刺法也。志云。用。以也。言当以调其形。形者。
皮肤肌肉。哉者。未尽之辞。虽曰用形哉。必因天之四时。简按今仍吴注。
多少高下 吴云。如曰以月生死为 数。（缪刺论）多少之谓也。春时俞在颈项。夏时俞在胸胁。
秋时俞在肩背。冬时俞在腰股。（金匮真言论。）高下之谓也。
如利其户 简按如。而同。下文如利其路之如亦同。诸家措而不释。何诸。
必切而出 吴云。切。切脉之切。谓以指轻按。而亲切之。所以散其正气也。张云。必切中其疾。
而后出针。高云。切。按也。必切而出。谓右手持针。左手必切其穴。而使之外出。
大气乃屈 马云。大邪之气也。见热论中。高云。大气。
即相并之盛气也。
持针勿置 吴云。言持针勿使放置也。志云。持针在手。勿置之意外。以定其迎随之意。
气出针入 吴云。人气呼出之时。则阳气升于表。于此时内针者。欲其致气易也。
热不得还 吴云。热。针下所致之气热也。简按志以为热邪。非。
动气候时 张云。动气者。气至为故也。候时者。如待所贵。不知日暮也。马云。离合真邪论。与此
篇所论。补泻之法。联属成文。庶几学人熟读熟玩。又与官针篇第六节参看。其讲解之辞。见八正神明论。
言虚实者有十 马云。神气血肉志。各有虚实。是计之有十也。
络三百六十五节 张云。所谓节者。神气之所会也。以穴俞为言。志云。乃筋骨之会。
必被经脉 吴云。被。及也。
故得六腑 通雅云。故固古通。周语。咨于故实。史世家。作固实。
调之络 张云。痈疽篇曰。血和则孙脉充满溢。乃注于络脉。而后注于经脉。百病始生篇曰。阳络伤
则血外溢。阴络伤则血内溢。本论曰。孙络外溢。则经有留血。故病在血者。当调之络也。
燔针劫刺 熊音。燔。音烦。烧焚也。马云。见经筋篇。吴。燔上。补病在筋三字。注云。燔针者。
内针之后。以火燔之暖耳。不必赤也。高云。治痹证也。经筋篇。有十二筋痹证。皆治以燔针劫刺。痹发于阴。
故刺其下也。及与急者。谓筋痹也。
针药熨 吴云。 针者。用火先赤其针。而后刺。不但暖也。此治寒痹之在骨也。张同。简按玉篇。
火入水谓之 。史天官书。火与水合为 。然则 针。烧针而入水者乎。官针篇云。 刺者。刺燔针则取痹也。
王注燔针。则云烧针。注 针。则云火针。知是燔针 针。即火针也。（荀子解蔽篇注。 。灼也。）千金方
云。火针。亦用锋针。油火烧之。务在猛热。不热即于人有损也。针灸聚英云。经曰 针者。以麻油满盏。灯
草令多。如大指许。丛其灯火烧针。频以麻油蘸其针。烧令通红。用方有功。若不红者。反损于人。又有煨针
温针。意与火针有少异。吴云。药熨者。以药之辛热者。熨其处也。筋骨病有浅深之殊。故古人治法。亦因以异。
病不知所痛 吴云。病不知所痛者。湿痹为患。而无寒也。故湿胜为痹。寒胜为痛。今不知所痛。湿
痹明矣。高云。痹病在五脏之外合者必痛。若痹病不知所痛。则从奇经之脉而上。故曰两跷为上。
两跷为上 马云。刺两跷之上。张云。二穴俱当取之。故曰为上。简按志高并从马。非也。
谨察其九候 简按上文云。九候若一。命曰平人。若不一则为病脉。故谨察之。前后贯串。以明九候
之不可不察也。
Ma Yun states: The text mentions that diseases manifest as deficiency or excess syndromes, and one should skillfully regulate the meridians.
Excess of Shen (Spirit): In the *Jia Yi Jing* (Classic of Jia Yi), the character "You" (Having/Excess) appears after "Shen", and similarly in the following text after "Qi" (Vital Energy), "Xue" (Blood), "Xing" (Form), and "Zhi" (Will).
Essence and Qi (Jing-Qi): Wang Bing cites the *Zhen Jing* (Needle Classic), found in the *Ling Shu · Jue Qi* chapter, stating: "When interstices open and sweat flows profusely, this is called Jin (Thin Fluids); when grain enters and qi fills, moistening and nourishing the bones, allowing flexion and extension, replenishing the brain marrow, and moisturizing the skin, this is called Ye (Thick Fluids)." The wording varies slightly. The *Xi Ci* (Commentary on the Appended Statements) of the *I Ching* says: "Essence and qi condense to form things." The commentary explains: "The guiding qi of Yin and Yang, swirling and accumulating, becomes all things." The *Chun Qiu Fan Lu* (Luxuriant Deeds of Spring and Autumn) says: "The clear part of qi is called Jing (Essence)." Those who cultivate themselves regard the accumulation of essence as a treasure.
Sixteen Departments (Meridians): The *Sui Shu · Jing Ji Zhi* (Book of Sui · Bibliography) records the sixteen departments of meridians: the twelve meridians of the hands and feet, plus two Qiao meridians (Penetrating Vessels), one Du Meridian (Governing Vessel), and one Ren Meridian (Conception Vessel), totaling sixteen. Gao Shishi states: This refers to the left and right elbows, arms, thighs, and the anterior/posterior and left/right aspects of the body and head. Commentary: Gao's explanation is superior to older annotations.
Spleen Stores Flesh: Gao Shishi states that the spleen governs the flesh of the body; therefore, excess or deficiency of form is under the spleen's domain.
And Here Forms [Each]: Wu Kun suggests that "Ci" (This) should be read as "Ge" (Each).
Zhi and Yi are Unblocked: The *Jia Yi Jing* adds the character "Da" (Reach) after "Tong" (Unblocked). Wu Kun supplements the character "Tiao" (Regulate).
Forms the Body and Five Zang Organs: The *Jia Yi Jing* lacks the characters "Shen" (Body) and "Wu Zang" (Five Zang Organs).
The Pathways of the Five Zang Organs All Emerge from the Jing Sui (Meridian Tunnels): Wu Kun states: "Dao" means path; "Sui" means irrigation ditch in fields. It is called Jing Sui because it is the channel through which meridian qi and blood flow. Commentary: Wang Bing relies on Du Yu's commentary on the *Zuo Zhuan*, where digging a passage through the ground is called Sui. Wu Kun relies on the *Zhou Li · Sui Ren Zhi*. Both interpretations are valid.
Qi and Blood Have Not Yet Merged: Zhang Jingyue states: "Bing" means gathering to one side. When pathogenic factors invade the human body and remain unresolved for a long time, they may merge with either Qi or Blood, causing the disease to worsen.
Subtle Disorder of Shen: Zhang Jingyue states: This refers to external pathogens affecting the Heart Meridian. Floating, superficial, and subtle pathogens reside on the surface of the vessels, constituting a subtle disorder of Shen.
[Let] Blood Flow Out: Wu Kun deleted the two characters "Chu Xue" (Let blood flow out).
Do Not Deeply Expel [the Needle]: Wu Kun states: "Chi" means to pierce. Zhang Jingyue states: "Chi" means to discard/expel. Gao Shishi states: "Chi" means to open up/explore. Commentary: We now follow Gao's annotation.
Press and Guide Qi: Wu Kun states: Use massage to guide Qi to its deficient collaterals.
Do Not Release: Wu Kun states: "Wu" (Do not) is synonymous with "Yi" (Stop/Finish).
Insert the Needle Without Expelling: The *Sui Shu · Jing Ji Zhi* states: "Zhuo Zhen" (Placing the needle) is like covering it with cloth, then piercing through the single layer of cloth, meaning the needle should be inserted extremely shallowly without pushing it deep. Commentary: This refers to placing the needle at the lesion site without opening up and draining the Zheng Qi (Upright Qi). Wang Bing's note is correct.
Transfer Qi to Deficiency: Gao Shishi states: Slightly drain the pathogen, transferring Qi to the deficient Qi for tonification. Commentary: The New Corrections cite the *Jia Yi Jing* and *Tai Su*, deleting the character "Bu" (Not). Ma Yun states that transferring pathogenic Qi to deficiency is incorrect.
Clear Breathing but Shortness of Qi: Ma Yun states: The *Ben Shen* chapter says lung deficiency leads to obstructed nasal breathing and shortness of qi, which is the "shortness of qi" mentioned here. Excess manifests as wheezing and chest fullness requiring仰息 (breathing with head thrown back), which corresponds to the "wheezing, coughing, and rising qi" mentioned here. Gao Shishi states: "Xi Li" means smooth entry and exit of nasal breath.
Slight Drainage of White Qi: Gao Shishi states: This implies slight deficiency.
Drain the Jing Sui: Zhang Jingyue states: Draining the Jing Sui means observing the pulse of excess and draining the pathogenic Qi therein. The *Sui Shu · Jing Ji Zhi* states: Jing Sui refers to the large collaterals. Gao Shishi states: It is the tunnel passing through the meridians, so it must not damage the main meridians. Commentary: Yang Shangshan's note seems plausible.
When Treating the Patient, One Must Change [One's Approach]: Zhang Jingyue states: "Shi" means arrival; "Ge" means change. First, apply massage to promote the flow of Qi in the skin. Then, withdraw the needle and look at the patient, saying, "I will insert it deeply," intending to induce fear so that Spirit remains inward. "When treating the patient, one must change" means that a proficient acupuncturist will alter their previous statement while actually keeping the insertion shallow. In this way, Jing Qi retreats inward, pathogenic Qi scatters and has no place to rest, thus draining outward, allowing True Qi to find its proper place. The *Sui Shu · Jing Ji Zhi* states: Withdrawing the needle means withdrawing it shallowly. Looking at it means observing the principle of depth. Saying "I will insert it deeply" addresses the fact that pathogenic Qi resides superficially in the skin and conflicts with Zheng Qi; only when pathogenic Qi scatters and Zheng Qi is not drained can we say "I will insert it deeply," meaning preparing to hold and insert the needle to make Jing Qi naturally retreat, then releasing it to scatter pathogenic Qi, following and welcoming it, harmonizing it with intention, leaving no room for pathogenic Qi to rest, allowing it to drain from the skin and interstices, so that True Qi meets and returns to the muscle surface. This is the profound method of shallow and deep needling. Commentary: Zhang Jingyue's notes based on Yang Shangshan and the *Sui Shu · Jing Ji Zhi* seem appropriate, but the core meaning is not entirely clear. We still adhere to Yang Shangshan's interpretation.
Jing Qi Naturally Retreats: Gao Shishi states: Jing Qi retreats and fails to moisten the orifices. Pathogenic Qi scatters within the meridians, having no outlet. "No place to rest" means Zheng Qi is deficient and Pathogenic Qi is excessive, so the disease persists. Only by inserting the needle extremely shallowly can pathogenic Qi drain from the interstices and escape outward, allowing True Qi to harmonize. Commentary: This contradicts older notes and should not be followed.
Deficiency Leads to Fear: The current version of the *Jia Yi Jing* reads "Deficiency leads to Wisdom/Clear-headedness" (Hui).
Collateral Vessels Overflow with Water: The *Jia Yi Jing* reads "Wai" (External) instead of "Shui" (Water).
If the Pulse is Large, Quickly Withdraw the Needle: Wu Kun states: A large pulse results from prolonged needle retention until Qi arrives and the pulse gradually enlarges. Commentary: Gao Shishi argues that "Ji" (Quickly) belongs to the next sentence, which is incorrect.
Jing Sou (Urination): Wu Kun states: "Jing" means water flowing with constancy; "Sou" means urine. Obstruction of Jing Sou refers to chronic difficulty in urination. Commentary: All previous annotations are mistaken (see detailed discussion in the *Jue Lun* chapter).
Micro-Wind: Wu Kun states: Muscle twitching, as if insects are moving within the muscles. Wind is dynamic, hence movement is termed Micro-Wind. Gao Shishi states: When wind pathogen enters the muscles, causing twitching, it is called Micro-Wind, indicating the presence of micro-wind in the muscles.
Abdominal Distension and Undigested Stool Diarrhea: Zhang Jingyue states: Kidney stores Zhi (Will) and is the essence of Water. Water transforms into Cold; thus, Kidney excess leads to Cold Qi in the abdomen, causing abdominal distension and undigested stool diarrhea. Kidney deficiency leads to Yin deficiency and Yang hyperactivity, causing cold extremities and upward rushing. The *Ben Shen* chapter states: Kidney stores Essence, Essence houses Will. Kidney Qi deficiency causes cold extremities; excess causes distension.
Movement at the Bone Joints: The *Jia Yi Jing* reads "Shang" (Injury) instead of "Dong" (Movement). Wu Kun adds six characters here: "Ze Gu Jie You Wei Feng" (Then there is micro-wind at the bone joints).
Drain the Blood of Ran Jin: Ma Yun, Wu Kun, and Zhang Jingyue all state that "Ran Jin" should be "Ran Gu". The *Sui Shu · Jing Ji Zhi* states: Ran refers to the Ran Gu acupoint, located between the two meridians below the ankle joint. (Gao Shishi writes "between the tendons"). Hence it is called Ran Jin. Commentary: The *Ben Shu* chapter states: Kidney Liu drains to below Ran Gu and Ran Gu bone. The *Miao Ci Lun* states: Pierce below the medial malleolus, before Ran Gu, to let blood flow. Based on this, Yang Shangshan's annotation is correct.
Piercing Before Merger: Gao Shishi states: When Qi and Blood have not yet merged, the Five Zang organs are stable, but there is movement at the bone joints; hence the question arises regarding how to pierce before merger.
Only at the Site of Pathogen Can Emptiness Be Established: Commentary: There is no need to change the text according to the *Jia Yi Jing*. Wang Bing's interpretation is coherent.
Qi and Blood Merge: In the *Jia Yi Jing*, "Yi" is written as "Yi" (Already). Yi and Yi are synonymous.
Yin and Yang Tip Over Each Other: Zhang Jingyue states: "Bing" means partial victory/excess; "Qing" means collapse/inclination. Qi is Yang, so it disrupts Wei (Defensive Qi); Blood is Yin, so it rebels within the meridians. When Yin and Yang are disharmonious, Qi and Blood separate from their proper locations. Thus, the excess becomes relatively more excess, and the deficiency becomes relatively more deficient, tipping over each other.
Blood Merges with Yin, Qi Merges with Yang: Wu Kun states: Blood merging with Yin organs constitutes Heavy Yin; Qi merging with Yang organs constitutes Heavy Yang. This leads to惊狂 (Fright and Mania). The *Sui Shu · Jing Ji Zhi* states: This discusses Blood and Qi divisions into Yin and Yang. Qi outside the vessels is Yang; Blood inside the vessels is Yin. If Yin Blood fills the exterior and Yang Qi flows into the vessels, Yin and Yang are balanced. If Blood merges into Yin, Yin becomes abundant and Blood becomes solid. Since the Heart governs Blood vessels, Yin abundance leads to Fright. If Qi merges into Yang, Yang becomes abundant and Qi becomes solid. Yang abundance leads to Mania.
Blood Merges with Yang, Qi Merges with Yin: Wu Kun states: Blood merging with Yang leads to exterior Cold; Qi merging with Yin leads to interior Heat. "Jiong Zhong" refers to internal heat.
Vexation and Oppression in the Heart: "Wan" is written as "Men" (Oppressed/Stuffy) in the *Jia Yi Jing*. Wu Kun states: Heart Fire is obscured by Yin pathogen, leading to vexation and oppression.
Prone to Anger: Wu Kun states: Yang merges with the lower part, heating Liver Wood, leading to irritability.
Forgetfulness: Zhang Jingyue states: Blood merging downward prevents Yin Qi from ascending; Qi merging upward prevents Yang Qi from descending. Yin and Yang separate, causing Spirit disorder and forgetfulness. The *Sui Shu · Jing Ji Zhi* cites the *Ling Shu*: "Clear and turbid Qi interfere with each other, chaotic in the chest, causing great confusion." It also cites the *Shang Han Lun*: "A person prone to forgetfulness likely has accumulated Blood; treat with Didang Tang to purge."
If Qi and Blood Separate, Which is Excess?: Gao Shishi's edition reads: "If Qi and Blood separate, which is excess?" Note: Old editions linked "Ru Shi" (Like this) together; now corrected. Commentary: No correction is needed; the meaning is clear.
Eliminate and Remove Them: Ma Yun states: Warmth eliminates stagnation and facilitates flow. Gao Shishi states: "Xiao" means not congealing; "Qu" means flowing.
Collaterals and Sun Collaterals: Wu Kun writes "Sun Luo". Note: Luo refers to principal collaterals; Sun Luo refers to branch collaterals. The *Sui Shu · Jing Ji Zhi* states: Luo are branches of the meridians; Sun Mai are distinct branches of the Sun Luo. Commentary: We follow the *Sui Shu · Jing Ji Zhi*.
All Transport to the Main Meridians: "Shu" is written as "Zhu" (Pour/Inject) in the *Jia Yi Jing*.
Great Jue (Syncope): Zhang Jingyue states: The previous text discussed Blood merging with Blood and Qi merging with Qi, representing partial deficiency and excess. This section discusses Blood merging with Qi; the merged aspect is excess, the unmerged is deficiency. When Blood and Qi surge upward together, the upper becomes excess and the lower deficient. Lower deficiency leads to Yin collapse. Yin collapse severs the root, causing lower cold and upper exhaustion, known as Great Jue. The *Sui Shu · Jing Ji Zhi* states: If Qi returns, the patient lives, meaning returning to the lower. Yang Qi originates in the lower and ascends to the upper. If Blood and Qi rebel together, Qi mechanism stops abruptly, causing sudden death; if it reverses, rotation resumes, and life is restored.
From What Path Does It Come?: Gao Shishi states: From what path does it come? Commentary: The phrasing matches "Where does illness come from?" in the *Tian Zhen Lun*.
All Have Shu and Hui Points: Wu Kun states: Acupoints include both Shu (Transport) and Hui (Meeting) points. Ma Yun states: The six Yang and six Yin meridians all have Shu points where Qi gathers. The *Sui Shu · Jing Ji Zhi* states: Shu refers to the 365 Shu points, where blood vessels flow and inject; Hui refers to the 365 Hui points, where Shen Qi travels. These are where Yin-Yang, Blood, and Qi transport and meet. Gao Shishi states: Shu and Hui refer to five sets of twenty-five Shu points and six sets of thirty-six Shu points, meeting with the body's Yin-Yang, Blood, and Qi.
Yin and Yang Balanced: The *Jia Yi Jing* reads "Jun Ping" (Evenly Balanced). Commentary: "Jun" sounds like "Xun"; *Shuo Wen* defines it as round harvesting, which does not fit semantically.
Acquired from Wind, Rain, Cold, and Summer-Heat: Commentary: Based on the following text, it should likely read "Wind, Rain, Cold, and Dampness".
Transported to the Large Meridians: Ma Yun cites the *Pi Bu Lun*: "When pathogen attacks the skin, interstices open; once open, pathogen enters collaterals; when collaterals fill, it pours into meridians; when meridians fill, it enters the Fu and Zang organs." The *Miao Ci Lun* states: "Pathogen attacking the body first combines with hair and skin; if lingering, it enters Sun collaterals; if lingering, it enters Luo collaterals; if lingering, it enters the main meridians." The meaning is identical.
Skin Fails to Contract: Wu Kun states: Failure to contract means flaccid, floating skin that does not tighten. This is caused by dampness excess. Zhang Jingyue states: Skin fails to contract, becoming lax, while muscles become tight and emaciated. Gao Shishi states: Failure to contract means sweating without closing tightly. Commentary: Cold governs contraction; stating failure to contract contrasts with tight muscles. The *Jia Yi Jing* and *Tai Su* are closer to the truth.
Nie Pi (Folding/Contracting) with Qi Deficiency: Ma Yun states: This implies muscle contraction and accumulation. The *Gen Jie* chapter mentions intestinal Nie Pi, referring to the intestines. Zhang Jingyue states: Speaking softly is Nie; weak legs unable to walk is Pi. The *Sui Shu · Jing Ji Zhi* states: Nie is synonymous with "Nie" (fluttering); Pi means accumulation. Gao Shishi states: Muscles and skin flutter and contract. Commentary: Nie Pi refers to folds/wrinkles. The *Yi Li* mentions pleats; the *Li Ji* mentions clothing folds as "Zhe". It is commonly written as "Zhe". *Yiqie Jing Yinyi* states: Zhe means wrinkle. Pronunciation details follow. Zhe means folding or fine pleats. Wang Bing's note agrees. The *Jia Yi Jing* adds "Xue Se" (Blood Stasis) after "Deficiency".
Unregulated Joy and Anger: Zhang Jingyue states: According to the following text, Joy causes Qi to descend (deficiency), but this section emphasizes Anger, hence it is excess. Observing the intent of Yin Qi rebelling upward clarifies this. The *Ju Tong Lun* states: Anger causes Qi to rise, which is exactly this case. Commentary: The following text says "Joy causes Qi to descend," implying the character "Joy" here is superfluous. The New Corrections are correct. The *Huainanzi · Jing Shen Xun* states: Great anger injures Yin; great joy causes Yang to fall.
Smoldering Fullness: Commentary: We follow the *Jia Yi Jing*, reading "Dong Zang" (Agitating the Zang Organs).
Decline and Scarcity of Form and Qi: Wu Kun states: Xing Qi refers to Yin Qi; shuai shao means deficiency.
Grain Qi is Not Abundant: Ma Yun states: Due to decline in Form and Qi, dietary intake decreases, so Grain Qi is not abundant. The *Sui Shu · Jing Ji Zhi* states: Diet and fatigue injure the Spleen; Spleen governs muscles, hence Form and Qi decline. Food enters the stomach and is transported by Spleen Qi; if Spleen fails to operate, Grain Qi becomes insufficient.
Lower Wan (Stomach) is Blocked: The *Sui Shu · Jing Ji Zhi* states: Upper Jiao cannot disseminate the flavor of grains; Lower Jiao cannot receive the fluids of food and water. Gao Shishi states: Upper Jiao cannot disseminate grain flavors, so Upper Jiao function stops; Lower Wan cannot transform grain essence, so Lower Wan is blocked.
Hot Qi Smolders in the Chest: The *Jia Yi Jing* omits the characters "Re Qi" (Hot Qi).
Xuan Fu (Mysterious Mansion) is Blocked: The *Sui Shu · Jing Ji Zhi* states: Xuan Fu refers to sweat pores in hair follicles. If hair follicle interstices are blocked, Wei Qi cannot vent outward, generating heat.
Thus Exterior Heat: Zhang Jingyue states: Upper Jiao Qi governs the Yang aspect. External Cold invasion blocks Upper Jiao, closes muscle surface, stagnates Wei Qi, preventing circulation, resulting in exterior heat. As stated, injury from Cold leads to Heat disease; this is an exterior contraction syndrome. Ang states: This corresponds to modern exterior contracted cold syndrome.
Remaining Alone Causes Blood to Congeal: Wu Kun adds another "Liu" (Remain) after "Liu Xia" (Remaining below).
Congealing Causes Vessels to Block: Wu Kun adds "Qi" (Congeal/Dry up) above "Ning" (Congeal). "Mai" (Vessel) is written as "Cou Li" (Interstices) in the *Jia Yi Jing*, which seems plausible.
Pulse is Large, Vigorous, and Choppy: Zhang Jingyue states: Cold remaining in the Middle Jiao drives away Yang Qi, causing vessel stasis, resulting in a large and choppy pulse. Yang pulses are usually slippery; lack of slipperiness indicates absence of Yang. Commentary: Jue Qi rebelling upward causes a large pulse; Blood congealing causes a choppy pulse. Ma Yun states: If this pulse is diagnosed externally, it should logically be deep and choppy. Describing it as large and choppy suggests it is an internal pulse, not externally visible. Ang states: How can a person with Yin excess, middle cold, and blood stasis obtain a large pulse? Both are mistaken.
Qi and Blood Merge, Disease Form Takes Shape: In the *Jia Yi Jing*, "Yi" is written as "Yi" (Already). The same applies to subsequent sections.
Use Form?: Wu Kun states: This means applying needling methods according to the patient's form—length, width, fatness, and thinness. The *Sui Shu · Jing Ji Zhi* states: "Yong" means "using". It means regulating the form. Form refers to skin and muscles. "Zai" is an incomplete particle. Although it says "use form," one must also consider the four seasons of Heaven. Commentary: We follow Wu Kun's note.
More or Less, High or Low: Wu Kun states: For example, using the waxing and waning of the moon to determine numbers (*Miao Ci Lun*) refers to "More or Less". In spring, Shu points are in the neck and nape; in summer, in the chest and hypochondrium; in autumn, in the shoulders and back; in winter, in the waist and thighs (*Jin Gui Zhen Yan Lun*). This refers to "High or Low".
Like Opening a Door: Commentary: "Ru" is synonymous with "Er" (And). The "Ru" in the following "Like opening a road" is also the same. Previous commentators omitted explanation. Why?
Must Press and Then Withdraw: Wu Kun states: "Qie" refers to palpating the pulse. Lightly pressing with fingers to feel closely, thereby dispersing Zheng Qi. Zhang Jingyue states: Must accurately locate the disease before withdrawing the needle. Gao Shishi states: "Qie" means press. "Bi Qie Er Chu" means holding the needle with the right hand, the left hand must press the acupoint to facilitate withdrawal.
Major Qi is Subdued: Ma Yun states: This is the Major Pathogenic Qi, mentioned in the *Re Lun*. Gao Shishi states: Major Qi is the abundant Qi of merger.
Hold the Needle Without Placing It Down: Wu Kun states: Do not let go of the needle. The *Sui Shu · Jing Ji Zhi* states: Hold the needle in hand, do not place it aside arbitrarily, to fix the intention of welcoming and following.
Qi Exhales, Needle Enters: Wu Kun states: When the patient exhales, Yang Qi rises to the exterior. Inserting the needle at this time facilitates Qi arrival.
Heat Cannot Return: Wu Kun states: "Re" refers to the heat generated by Qi under the needle. Commentary: The *Sui Shu · Jing Ji Zhi* interprets it as Heat Pathogen, which is incorrect.
Move Qi and Wait for the Time: Zhang Jingyue states: "Dong Qi" means Qi arrival. "Hou Shi" means waiting for the auspicious time, like waiting for a valued guest, forgetting the time. Ma Yun states: The *Li He Zhen Ye Lun* and this chapter discuss tonification and reduction methods coherently, encouraging students to study them thoroughly. Cross-reference with Section 6 of the *Guan Zhen* chapter. Explanations are found in the *Ba Shen Shen Ming Lun*.
Speaking of Deficiency and Excess, There Are Ten: Ma Yun states: Shen, Qi, Xue, Rou (Flesh), and Zhi each have deficiency and excess, totaling ten categories.
Collaterals and Three Hundred Sixty-Five Nodes: Zhang Jingyue states: The term "node" refers to where Shen Qi gathers, speaking of acupoints. The *Sui Shu · Jing Ji Zhi* states: They are gatherings of sinews and bones.
Must Extend to the Meridians: Wu Kun states: "Bei" means to reach/affect.
Thus Obtaining the Six Fu Organs: *Tong Ya* states: "Gu" was anciently interchangeable with "Gu" (Indeed/Solid). *Zhou Yu*: "Consult solid facts." *Shi Jia Jia*: Written as "Gu Shi".
Regulate the Collaterals: Zhang Jingyue states: The *Yong Ju* chapter says: When Blood is harmonious, Sun vessels fill and overflow into Luo vessels, then into main meridians. The *Bai Bing Shi Sheng* chapter says: Injury to Yang Luo causes external bleeding; injury to Yin Luo causes internal bleeding. This chapter says: Overflow from Sun Luo leaves residual Blood in meridians. Therefore, for Blood diseases, one should regulate the collaterals.
Burn Needles and Robbing Piercing: Xiong Yin: "Fan" sounds like "Fan", meaning burning. Ma Yun states: Found in the *Jing Jin* chapter. Wu Kun adds "Bing Zai Jin" (Disease in Sinew) above "Fan". Note: Burn needle means warming with fire after insertion, not necessarily red-hot. Gao Shishi states: Treats Bi syndrome. The *Jing Jin* chapter lists twelve sinew Bi syndromes, all treated with burn needles and robbing piercing. Bi originating in Yin is pierced below. "Ji" (Cramping) refers to sinew Bi.
Cui Needles and Herbal Warming: Wu Kun states: Cui needle means heating the needle red-hot before piercing, not just warming. This treats Cold Bi in bones. Zhang Jingyue agrees. Commentary: *Yu Pian* defines "Cui" as fire entering water. *Shi Ji · Tian Guan Shu* states fire and water combine to form Cui. Thus, Cui needle might mean heating the needle and dipping it in water? The *Guan Zhen* chapter says: Cui piercing uses burn needles to treat Bi. Wang Bing notes Burn Needle as "burning needle" and Cui Needle as "fire needle". Knowing Burn Needle and Cui Needle are both fire needles. (*Xun Zi · Jie Bi* commentary: Cui means scorch.) *Qian Jin Fang* states: Fire needles use sharp needles, burned in oil lamp,务必 fierce heat; insufficient heat harms the person. *Zhen Jiu Ju Ying* states: The classic says Cui needle involves filling a cup with sesame oil, placing many lamp wicks like a thumb, clustering the flame to burn the needle, frequently dipping in oil until red-hot. Only then is it effective; if not red-hot, it harms the person. There are also baked needles and warm needles, slightly different from fire needles. Wu Kun states: Herbal warming involves applying pungent and hot herbs to the area. Diseases of sinews and bones vary in depth, so ancient treatments differed accordingly.
Disease Where Pain Location is Unknown: Wu Kun states: Unknown pain location indicates Wet Bi without Cold. Dampness excess causes Bi; Cold excess causes pain. Unknown pain clearly indicates Wet Bi. Gao Shishi states: Bi in the external connections of the Five Zang organs must hurt. If Bi has unknown pain, it follows the extraordinary meridians upward, hence "Two Qiao are Superior".
Two Qiao are Superior: Ma Yun states: Pierce the upper parts of the Two Qiao. Zhang Jingyue states: Both acupoints should be selected, hence "Superior". Commentary: The *Sui Shu · Jing Ji Zhi* and Gao Shishi follow Ma Yun, which is incorrect.
Carefully Observe the Nine Pulses: Commentary: The previous text states: If the nine pulses are uniform, it is called a healthy person; if not uniform, it is a diseased pulse. Hence, carefully observe them. This connects前后 (front and back) to clarify why the nine pulses must not be ignored.