高云。灵枢官针篇云。刺有十二节。刺节真邪论云。刺有五节。长。犹广也。所以广五节十二节之刺。
故曰长刺节。高本。删论字。简按长者。触类而长之之长。（易系辞）高注为是。马吴以为长于刺法之义。误。
刺家不诊 张云。善刺者。不必待诊。但听病者之言。则发无不中。此以得针之神者为言。非谓
刺家概不必诊也。十二原篇又曰。凡将用针。必先诊脉。视气之剧易。乃可以治。其义为可知矣。
听病者言 吴云。听病者其所苦。而刺之。
头疾痛 高云。因病在头。卒然而痛也。
为藏针之 马云。言头痛者。其病在脑。脑。即骨也。乃深入其针。如藏物然。张云。藏。言里
也。即深入其针之谓。志云。藏。隐也。谓隐针而藏刺之也。盖头之皮肉最薄。易至于骨。故至骨而无伤骨。
简按藏字未详。吴根据全本删之。似是。
上无伤骨肉及皮 吴。上。作止。连上句。是。
皮者道也 马云。皮乃经脉往来之路。不可伤也。简按王注是。
阴刺 马云。按官针篇云。五曰阳刺。（灵枢。作扬。）阳刺者。正纳一。旁纳四。而浮之。以治寒
气之博大者也。十曰阴刺。
阴刺者。左右率刺之。以治寒厥。足踝后。少阴也。今本篇阴刺之法。乃是阳刺。则阳误作阴。张高同。
大脏 吴作本脏。注云。寒热之气深。而专于一脏者。求其本脏而刺之。简按马张并根据王为五脏。是。
脏会 吴云。刺俞之迫脏者。以其为脏气所会集也。
与刺之要 高本。寒热去下句。刺之下句。注云。止与刺者。中病即止之意。下凡言止者。皆止与刺
也。无论阳刺阴刺。大要发针之时。贵浅出其血。以通络脉也。简按与字未妥。高注稍通。
血小者 甲乙。作而一字。今从之。
深之 马云。深。当作浅。吴云。腐肿。外肿也。大为阳毒。其患浅。小为阴毒。其患深。刺者亦视
其小大深浅。而刺之也。张同。高云。多血。多脓血也。大痈多血。当浅刺之。小者。小痈也。痈小未溃。毒
气在内。当深刺之。简按血小者三字。据甲乙。改作而一字。义自分明。不须费解。
皮HT 马云。内经中。有应用肉旁者。每以骨旁代之。有应用骨旁者。每以肉旁代之。则HT 可作
。左传桓公六年。随季梁谏追楚师。而公言牲 肥 。 亦肥意。皮 原非穴名。愚意自少腹之皮肥浓以下。
尽其少腹内。取穴而止。张云。当作皮 。 。骨端也。盖谓足厥阴之章门期门二穴。皆在横皮肋骨之端也。
及下至小腹而止者。如足阳明之天枢归来。足太阴之府舍冲门。足少阴之气穴四满。皆主奔豚积聚等病。吴亦
作。注云。当是肋骨之端。大包穴之分。简按HT 。字书无所考。熊音。徒骨切。盖以为 字。（ 。音突。）
马说本此。志高并同。新校正。引释者。作皮 苦末反。今考卷末释音。光抹切。张注从之。 。集韵。骨端
也。今仍张注。
两旁四椎间 马云。乃手厥阴心包络之俞也。张高同。吴云。当是膏肓之穴处。志同。简按千金方。
厥阴俞。在第四椎下。两旁各一寸半。甲乙不载。故王云。据经无俞。知古经无此穴。
髂 熊音。上口亚反。腰骨也。下力条反。诸注并根据王义云。居 穴也。简按髂。又作KT 。玉
篇。腰骨也。王履小易赋云。腰当监骨之上兮。监骨下则尻椎可度。腰骨曰腽。（乌老切）腽上曰KT 。程序
医彀云。尻上横者。为腰蓝骨。蓝骨上为腰骨。一名腽。（音袄）腽上为KT 。沈彤释骨云。 之上。挟脊十
七节。至二十节起骨。曰腰髁骨。曰两踝。其旁临两股者。曰监骨。曰大骨。曰髂。今根据玉篇及王注。沈说为
是。甲乙。居 。在章门下八寸三分。监骨上。（当作下字。误。）陷者中。
季胁肋间 马引王注京门。作章门。志仍之。恐误。甲乙云。京门。在监骨下。（当作上字。误。）
腰中挟脊季肋下一寸八分。
导腹中气 吴云。导。引也。导引腹中热气。下入少腹。则病已也。
少腹两股间 高云。冲门穴也。简按甲乙云。冲门上。去大横五寸。在府舍下。横骨两端约文中。
诸注不指言穴名。为肝肾穴者是。
腰髁骨间 马本。无骨字。张云。凡腰中在后在侧之成片大骨。皆曰髁骨。在后者。足太阳之所行。
在侧者。足少阳之所行。高云。背十三椎下外旁。肓门穴也。简按高注非是。
病起筋炅 志云。筋舒而病起。筋热而病已。高云。刺之得宜。则病起筋热。病起筋热则病已。病
已而止刺也。简按高注义通。吴删病起二字。
大分小分 马云。气穴论曰。肉之大会为谷。则合谷阳谷等。为大分。肉之小会为溪。则解溪侠溪等。
为小分。
痈发若变 灵官针篇云。疾浅针深。内伤良肉。皮肤为痈。吴云。变其常也。马云当发痈。而有他变也。
诸分且寒且热 高云。病在诸阳脉。而且寒且热。则邪气乘于经脉矣。诸分而且寒且热。则邪气乘于
分肉矣。分肉之邪。经脉之邪。两相交并。病名曰狂。简按上文且寒且热四字。疑衍。
名曰狂 张云。且寒且热者。皆阳邪乱其血气。热极则生寒也。故病为狂。
岁一发不治 张云。阴胜则为癫病。岁一发月一发者。气深道远。有宿本也。故不易治。月四五发者。
暴疾耳。其来速其去亦速。此为可治者也。
其无寒者 马云。若至于无寒。则为病已之兆。张云。若其无寒者。则癫疾亦有阳邪。或泻或补。当
用针调之也。按甲乙经曰。刺诸分。其脉尤寒者。以针补之。是乃言为阴证。
病风且寒且热 马云。此即风论之所谓寒热证也。吴云。炅汗出者。寒去独热。而汗出也。数过。数
次也。刺诸分理络脉者。贵乎多刺也。汗既出。而犹寒热。则邪盛而患深。非可以旦夕除者。必三日一刺。百
日始已。
大风 马云。即风论。及灵四时气篇。皆谓之疠也。疠。音癞。
刺肌肉 张云。所以泄阳分之毒。风从汗散也。
刺骨髓 张云。所以泄阴分之风毒也。
须眉生而止针 吴云。风毒去尽。营卫皆复。须眉重生。而止针矣。高云。凡二百日。则天干二十周。
须眉生。而止针。
Gao Shixi's commentary: The *Ling Shu: Guan Zhen* chapter states, "There are twelve categories of needling." The *Ling Shu: Ci Jie Zhen Xie* chapter states, "There are five categories of needling." "Chang" (Long/Extensive) means extensive. Thus, it is used to extensively discuss the needling methods of the five and twelve categories, hence called "Chang Ci Jie" (Chapter on Extensive Needling Categories). The Gao edition deleted the character "Lun". Danbo Jian'an notes: Here, "Chang" refers to the "Chang" in "chu lei er zhang zhi" (extending by analogy), as found in the *I Ching: Xi Ci*. Gao Shixi's annotation is correct. Ma Shi and Wu Kun interpreted it as meaning "superior in needling techniques," which is incorrect.
"Doctors who needle do not diagnose": Zhang Jingyue commented: Those skilled in needling do not necessarily have to wait for pulse diagnosis; by merely listening to the patient's account, their needle insertions will invariably hit the mark. This statement speaks from the perspective of mastering the divine efficacy of needling, and does not imply that all practitioners of needling generally dispense with diagnosis. The *Ling Shu: Jiu Zhen Er Shi Er Yuan* chapter further states, "Whenever one intends to use needles, one must first diagnose the pulse, observe the severity and ease of the Qi condition, and only then can treatment proceed." The principle here is clear.
"Listening to the patient's words": Wu Kun commented: Listen to the symptoms causing the patient's suffering, and then perform needling.
"Headache and pain": Gao Shixi commented: Because the pathology is located in the head, sudden pain occurs.
"To hide the needle within": Ma Shi commented: Regarding headache, the pathology lies in the brain. The brain is bone. Therefore, one must insert the needle deeply, as if hiding an object. Zhang Jingyue commented: "Zang" (Hide) means interior. It refers to inserting the needle deeply. Zhang Zhicong commented: "Zang" means concealed. It implies concealing the needle and performing hidden needling. Generally, the skin and flesh of the head are thinnest, easily reaching the bone; thus, one reaches the bone without damaging it. Danbo Jian'an notes: The meaning of the character "Zang" is unclear. Wu Kun deleted it based on the complete text, which seems plausible.
"Upper: Do not injure bone, flesh, or skin": Wu Kun noted: "Shang" (Upper) functions as "Zhi" (Stop). Connecting to the previous sentence, this is correct.
"The skin is the pathway": Ma Shi commented: The skin is the pathway where meridians and vessels traverse; it must not be injured. Danbo Jian'an notes: Wang Bing's annotation is correct.
"Yin Needling": Ma Shi commented: According to the *Ling Shu: Guan Zhen* chapter, "The fifth is Yang Needling" (*Ling Shu* writes "Yang"). Yang Needling involves inserting one needle centrally and four needles laterally, superficially, to treat widespread cold pathogenic factors. The tenth is Yin Needling. Yin Needling involves simultaneous needling on both left and right sides to treat Cold Jue (Cold Reversal). The posterior aspect of the ankle is where the Shaoyin meridian resides. The method of Yin Needling described in this chapter is actually the method of Yang Needling; thus, "Yang" was erroneously written as "Yin" in the original text. Zhang Jingyue and Gao Shixi share this view.
"Great Zang": Wu Kun's version reads "Ben Zang" (Root Zang). The commentary states: When cold-heat pathogens are deep and focus exclusively on one Zang organ, one should seek its root Zang for needling. Danbo Jian'an notes: Ma Shi, Zhang Jingyue, etc., following Wang Bing, interpret this as the Five Zang organs, which is correct.
"Gathering Point of Zang": Wu Kun commented: Needling acupoints proximate to the Zang organs, because these points are where Zang Qi gathers.
"The essence of combining and needling": The Gao edition moved "Han Re Qu" (Cold-Heat depart) to the next sentence and "Ci Zhi" (Needle it) to the next sentence. The commentary states: "Zhi Yu Ci Zhe" means stopping when the disease is addressed. Wherever "Zhi" (Stop) appears below, it refers to stopping the needling. Whether Yang or Yin needling, the general principle is that upon withdrawing the needle, one should aim for superficial extraction of blood to unblock the collaterals. Danbo Jian'an notes: The character "Yu" is inappropriate. Gao Shixi's explanation is somewhat coherent.
"Small amount of blood": The *Jia Yi Jing* reads "Er" (And). We follow the *Jia Yi Jing*.
"Deep insertion": Ma Shi commented: "Shen" (Deep) should be "Qian" (Superficial). Wu Kun commented: Fuzhong (Putrid swelling) refers to external swelling. Large indicates Yang toxin, with shallow pathology; small indicates Yin toxin, with deep pathology. Needling should also be guided by the size and depth of the lesion. Zhang Jingyue agrees. Gao Shixi commented: "Duo Xue" (Much blood) refers to abundant pus and blood. Large abscesses have much blood and should be needled superficially. Small ones are small abscesses. If the abscess is small and unruptured, the toxic qi is internal, so deep needling is required. Danbo Jian'an notes: Changing "Xue Xiao Zhe" (Small amount of blood) to "Er" (And) based on the *Jia Yi Jing* makes the meaning clear without needing complex interpretation.
"Pifu HT": Ma Shi commented: In the *Nei Jing*, characters with the "meat" radical are often replaced by those with the "bone" radical, and vice versa. Thus, "HT" can be read as "Juan". In *Zuo Zhuan*, Duke Huan VI, Sui Ji Liang advised against pursuing the Chu army, but the Duke spoke of sacrificial animals being "Tu Fei" (fat/plump). "Tu" also means fat. "Pifu Juan" was originally not an acupoint name. My opinion is that from the thick and fleshy skin of the lower abdomen downwards, one should take points within the lower abdomen until the end. Zhang Jingyue commented: It should be "Pi Bi". "Bi" means bone end. This likely refers to the Zhangmen and Qimen acupoints of the Foot Jueyin Liver Meridian, both located at the ends of the transverse ribs. Points extending down to the lower abdomen include Tianshu and Guilai of the Foot Yangming Stomach Meridian, Fushhe and Chongmen of the Foot Taiyin Spleen Meridian, and Qixue and Siman of the Foot Shaoyin Kidney Meridian, all treating Ben Tun (running piglet) and accumulations. Wu Kun also reads "Juan", commenting that it should be the end of the ribs, the domain of the Dabao point. Danbo Jian'an notes: "HT" cannot be verified in dictionaries. Xiong Zongli's pronunciation is "Tu Gu Qie", likely corresponding to the character "Juan" (pronounced Tu). Ma Shi's theory is based on this. Zhang Zhicong agrees. The New Correction cites commentators reading it as "Pifu Juan" with the rhyme "Ku Mo Fan". Examining the pronunciation notes at the end of the volume, it is "Guang Mo Qie". Zhang Jingyue follows this. "Juan" in *Ji Yun* means bone end. We retain Zhang Jingyue's annotation.
"Between the fourth vertebrae on both sides": Ma Shi commented: These are the Back-Shu points of the Hand Jueyin Pericardium. Zhang Jingyue and Gao Shixi agree. Wu Kun commented: They should be the location of the Gaohuang acupoints. Zhang Zhicong agrees. Danbo Jian'an notes: The *Qian Jin Fang* records that Jueyin Shu is below the fourth thoracic vertebra, 1.5 cun lateral to both sides. The *Jia Yi Jing* does not record this, so Wang Bing stated: Based on the classic, there is no such Shu point, indicating it did not exist in ancient classics.
"Qia": Xiong Zongli's pronunciation: Upper tone "Ya Fan" refers to the lumbar bone; lower tone "Liao Fan" refers to the Juliao acupoint, according to Wang Bing's meaning. Danbo Jian'an notes: "Qia" is also written as "KT". *Yu Pian* defines it as the lumbar bone. Wang Lv's *Xiao Yi Fu* says: "The waist is above the Jian bone; below the Jian bone, the coccygeal vertebrae can be measured." The lumbar bone is called Wan (Wu Lao Qie). Above Wan is KT. Cheng Ying's *Yi Gou* states: The horizontal bone above the coccyx is the Yao Lan bone. Above the Yao Lan bone is the Yao bone, also named Wan (Yao sound). Above Wan is KT. Shen Tong's *Shi Gu* states: Above the sacrum, flanking the spine from the 17th to the 20th segment where bones arise, it is called the Yao Ke bone, also called Liang Huai. Adjacent to the thighs on the sides are the Jian bone, Da Gu, and Qia. Following *Yu Pian* and Wang Bing's note, Shen Tong's theory is correct. The *Jia Yi Jing* records: Juliao is 8.3 cun below Zhangmen, above the Jian bone. (Should be "below", error for "above"). In the depression.
"Intercostal space of the costal margin": Ma Shi cited Wang Bing's note on Jingmen, writing Zhangmen. Zhang Zhicong followed this, which may be erroneous. The *Jia Yi Jing* states: Jingmen is below the Jian bone. (Should be "above", error for "below"). One cun eight fen below the costal margin, flanking the spine in the waist.
"Guiding Qi in the abdomen": Wu Kun commented: Dao means to guide. Guiding the hot Qi in the abdomen downward into the lower abdomen will cure the disease.
"Between the lower abdomen and the thighs": Gao Shixi commented: Chongmen acupoint. Danbo Jian'an notes: The *Jia Yi Jing* states: Chongmen is 5 cun above Daheng, below Fushhe, between the two ends of the Genggu bone. Commentators do not specify the acupoint name, identifying them as Liver and Kidney meridian points.
"Between the lumbar ke bones": Ma's edition lacks the character "Gu". Zhang Jingyue commented: Any large, flat bone in the posterior or lateral waist is called a Ke bone. The posterior ones are traversed by the Foot Taiyang Bladder Meridian; the lateral ones by the Foot Shaoyang Gallbladder Meridian. Gao Shixi commented: Lateral to the exterior below the 13th thoracic vertebra, the Huangmen acupoint. Danbo Jian'an notes: Gao Shixi's annotation is incorrect.
"Disease arises, tendons become hot": Zhang Zhicong commented: When tendons relax, the disease arises; when tendons become hot, the disease resolves. Gao Shixi commented: Proper needling causes the disease to arise and tendons to become hot. When tendons become hot due to the disease arising, the disease resolves. Stop needling when the disease resolves. Danbo Jian'an notes: Gao Shixi's explanation is coherent. Wu Kun deleted the characters "Bing Qi".
"Large Fen and Small Fen": Ma Shi commented: The *Qi Xue Lun* states: "The great convergence of flesh is called Gu"; thus He Gu, Yang Gu, etc., are Large Fen. "The small convergence of flesh is called Xi"; thus Jie Xi, Xia Xi, etc., are Small Fen.
"Abscess arises or changes": The *Guan Zhen* chapter states: "If needling is too deep for a superficial disease, it damages healthy flesh internally, causing the skin to form an abscess." Wu Kun commented: Changing the normal state. Ma Shi commented: An abscess should arise, but other changes occur.
"All Fen areas alternating cold and heat": Gao Shixi commented: If the disease is in the Yang meridians and alternates cold and heat, the pathogenic factor has invaded the meridians. If the Fen areas alternate cold and heat, the pathogenic factor has invaded the muscle intervals. The pathogen in the muscle intervals and the pathogen in the meridians combine, and the disease is named Kuang (Mania). Danbo Jian'an notes: The four characters "Qie Han Qie Re" (Alternating cold and heat) in the preceding text are suspected to be interpolations.
"Named Kuang": Zhang Jingyue commented: Alternating cold and heat indicates Yang pathogens disturbing Blood and Qi; extreme heat generates cold. Thus, the disease manifests as Kuang (Mania).
"One attack per year, untreatable": Zhang Jingyue commented: Excess Yin leads to Dian disease. Attacks once a year or once a month indicate deep Qi and distant pathways, with a rooted cause, making it difficult to treat. Attacks four or five times a month are acute diseases; they come quickly and leave quickly, and are treatable.
"If there is no cold": Ma Shi commented: If there is no cold, it is a sign of recovery. Zhang Jingyue commented: If there is no cold, the Dian disease still involves Yang pathogens; one should use tonification or sedation with needles to regulate it. According to the *Jia Yi Jing*: When needling various Fen areas, if the pulse is particularly cold, use the tonifying needle method. This refers to Yin syndromes.
"Suffering from Wind, alternating cold and heat": Ma Shi commented: This corresponds to the Cold-Heat syndrome described in the *Feng Lun*. Wu Kun commented: Jin (Hot) sweating indicates that cold has departed, leaving only heat, resulting in sweating. Shuo guo means several times. Needling the Fen areas and collateral vessels requires multiple insertions. If sweating occurs but cold and heat persist, the pathogen is strong and the pathology is deep, unable to be resolved in a day or night. One must needle every three days for one hundred days until resolution.
"Great Wind": Ma Shi commented: Also called Li (Leprosy/Malignant Wind) in the *Feng Lun* and the *Si Shi Qi* chapter of *Ling Shu*. Li sounds like Lai (Leprosy).
"Needle the muscle": Zhang Jingyue commented: To drain toxicity from the Yang division, allowing wind to scatter through sweat.
"Needle the bone marrow": Zhang Jingyue commented: To drain wind-toxicity from the Yin division.
"Stop needling when eyebrows and beard grow": Wu Kun commented: When wind-toxicity is exhausted and Ying and Wei Qi are restored, eyebrows and beard regrow, and needling stops. Gao Shixi commented: After two hundred days, completing twenty cycles of the Heavenly Stems, when eyebrows and beard grow, stop needling.