四时刺逆从者，春刺经脉，夏刺孙络，长夏刺肌肉，秋刺皮肤，冬刺骨髓，四时各有所刺，刺之从也。
刺不知四时之经，正气内乱，中伤五脏，死之有期，刺之逆也。四时合五行，六气亦合五
行，故论四时刺逆从，先论六气有余不足滑涩之病也。
厥阴有余病阴痹，不足病生热痹；滑则病狐疝，风涩则病少腹积气。
四时合五行，六气亦合五行，故岐伯论四时之刺，先论六气之有余不足也。厥阴，木也。木，四时
之春也。厥阴有余，则阳气不足，故病阴痹∶厥阴不足，则阳气有余，故病生热痹。痹，闭也，
不和也。气病为疝，血病为积。滑主气盛，涩主少血，故厥阴脉滑，则病狐疝。又曰风者，气动风生，风
主气也，下文肺风脾风心风肾风肝风，皆气动风生之义。厥阴脉涩，则病少腹当有积气。
少阴有余病皮痹隐轸，不足痛肺痹；滑则病肺风疝，涩则病积溲血。
轸， 同。少阴，火也。火，四时之夏也。少阴有余，则火气外炎，故病皮痹隐轸；少阴不足，则
火气内虚，故病肺痹。气病为疝，故少阴脉滑则病肺风疝；血病为积，故少阴脉涩则病积、溲血。
太阴有余病肉痹寒中，不足病脾痹；滑则病脾风疝，涩则病积，心腹时满。
太阴，土也。土，四时之长夏也。太阴有余，则土气壅滞，故病肉痹寒中；太阴不足，则上气不运，故
病脾痹。气病为疝，故太阴脉滑则病脾风疝；血病为积，故太阴脉涩则病积、心腹时满。
阳明有余病脉痹，身时热，不足病心痹；滑则病心风疝，涩则病积、时善惊。
阳明，金也。金，时之秋也。阳明有余，则气燥而热，故病脉痹、身时热；阳明不足，则胃络不通
于心包，故病心痹。气病为疝，故阳明脉滑则病心风疝；血病为积，故阳明脉涩则病积、时善惊。
太阳有余病骨痹、身重，不足病肾痹；滑则病肾风疝，涩则病积、善时巅疾。
太阳，水也。水，时之冬也。太阳有余则水寒气盛，故病骨痹、身重；太阳不足，则水气虚竭，故
病肾痹。气病为疝，故太阳脉滑，则病肾风疝；血病为积，故太阳脉涩，则病积、善时巅疾。
少阳有余病筋痹胁满，不足病肝痹；滑则病肝风疝，涩则病积，时筋急目痛。
少阳，火也，亦时之春也。六气之中有二火，所以合于五行也。少阳厥阴，相为表里，少阳有余，则
肝木之气亦有余，故病筋痹胁满；少阳不足，则肝木之气亦不足，故病肝痹。气病为疝，故
少阳脉滑，则病肝风疝；血病为积，故少阳脉涩，则病积、时筋急目痛。
是故春气在经脉，夏气在孙络，长夏气在肌肉，秋气在皮肤，冬气在骨髓中。
四时之气，合于人身。春气发生，行于周身，是故春时之气在经脉。夏气开张，浮泛于外，故夏时之
气在孙络。土气敦浓，居时之中，故长夏之气在肌肉。秋气肃杀，化暑为凉，故秋时之气在皮
肤。冬气闭藏，深伏于内，故冬时之气在骨髓中。
帝曰，余愿闻其故。
愿闻春夏秋冬，所以在经脉络脉肌肉皮肤骨髓之故。
岐伯曰∶春者，天气始开，地气始泄，冻解冰释，水行经通，故人气在脉。
春气之所以在经脉者，盖以春者因冬之藏，其时天气始开，地
气始泄，冻始解，冻始释，水行而经通，故人气在经脉。
夏者，经满气溢，入孙络受血，皮肤充实。
夏气之所以在孙络者，盖以夏者盛大于外，经满气溢，外入孙络而受血，皮肤充实，故夏气在孙络。
长夏者，经络皆盛，内溢肌中。
长夏之所以在肌肉者，盖以长夏者，夏时经络皆盛，长夏则内溢肌中，故长夏之气在肌肉。
秋者，天气始收，腠理闭塞，皮肤引急。
秋气之所以在皮肤者，盖以秋者，天时之气始收，人之腠理闭塞，皮肤内引而急，故秋气在皮肤。
冬者，盖藏，血气在中，内着骨髓，通于五脏。
上藏，如字。冬气之所以在骨髓者，盖以冬者，气机盖藏，血气在中，内着骨髓，通于五脏。脏
者，藏也。惟冬主藏，故通五脏，而冬气在骨髓。
是故邪气者，常随四时之气血而入客也，至其变化不可为度，
然必从其经气，辟除其邪，除其邪，则乱气不生。
人身经络肌肉皮肤骨髓，各主其时，是故邪气者，常随四时所主之气血内虚而入客也。四时主气，
各有常度，至其邪气变化，不可为度，然必从其经脉之正气，经气充足，辟除其邪，除其邪，则
乱气不生，而合于常度也。
帝曰，逆四时而生乱气奈何？
上文云∶从其经气，则乱气不生。从则乱气不生，逆则生乱，故问逆四时而生乱气奈何？
岐伯曰∶春刺络脉，血气外溢，令人少气；春刺肌肉，血气环
逆，令人上气；春刺筋骨，血气内着，令人腹胀。
人身络脉经脉肌肉筋骨，本于血气，合于四时，刺失其宜，则血气内逆而生乱也。春气在经脉，宜刺
其经脉。若春刺络脉肌肉筋骨，刺失其宜，则血气外溢，血气环逆，血气内着，而令人生病
也。筋连于骨，故曰筋骨。刺络脉经脉肌肉筋骨，必由皮肤而入，故不言皮肤。但举四时，故不言长夏也。
夏刺经脉，血气乃竭，令人解 ；夏刺肌肉，血气内却，令人
善恐；夏刺筋骨，血气上逆，令人善怒。
夏气在孙络，宜刺其孙络。若夏刺经脉肌肉筋骨，则血气乃
竭，血气内却，血气上逆，而令人生病也。
秋刺经脉，血气上逆，令人善忘，秋刺络脉，气不外行，令人
卧，不欲动；秋刺筋骨，血气内散，令人寒栗。
秋气在皮肤，宜刺其皮肤。若秋刺经脉络脉筋骨，则血气上逆，气不外行，血气内散，而令人生病
也。四时刺逆，不及皮肤，但举四时，不及长夏，故上文不言皮肤，此宜刺皮肤，则不言长夏之肌肉也。
冬刺经脉，血气皆脱，令人目不明；冬刺络脉，内气外泄，留
为大痹；冬刺肌肉，阳气竭绝，令人善忘。
冬气在骨髓，宜刺其骨髓。若冬刺经脉络脉肌肉，则血气皆脱，内气外泄，阳气竭绝，而令人生病也。
凡此四时刺者，大逆之病，不可不从也。反之，则生乱气，相淫病焉。
总承上文，而言凡四时之刺者。刺失其从，若大逆之病，不可不从也。大逆之病而反刺之，则生乱
气，乱气生则相淫而为病焉。
故刺不知四时之经，病之所生，以从为逆，正气内乱，与精相薄。
四时之刺，各有其经。故刺不知四时之经，及病之所生，若以从为逆，必致以逆为从，正气内乱，邪
气乃生，而与精相薄矣。
必审九候，正气不乱，精气不转。
欲知四时经病之生，从逆之道，必审九候。人身上中下三部，各有天地人三候，而为九候也。审九候，
所谓正气内乱者，而正气不乱矣。所谓与精相薄者，而精气不转矣。不转，内存也。
帝曰。善。刺五脏中心一日死，其动为噫。中肝三日死，其动为语。中肺五日死，其动为
咳。中肾六日死，其动为嚏欠。中脾十日死，其动为吞。刺伤人五脏必死，其动，则根据其脏之所
变，候知其死也。
中，俱去声。三日五日今改正。刺失其宜，是为刺逆，知其逆，则知其从，帝故善之。复举刺禁论
岐伯之言，以明刺伤五脏，各有死期，各有动病。其死者，刺失其宜，伤人五脏必死。其动
者，则根据其脏之所变病，以候其动，候其动，而知其死也。
The concept of "following and opposing the four seasons in acupuncture" refers to: in Spring, needling the meridians; in Summer, needling the collateral vessels (smaller network vessels); in Late Summer (the transition between summer and autumn), needling the muscles; in Autumn, needling the skin; and in Winter, needning the bone marrow. Each of the four seasons has its appropriate site for needling; adhering to this pattern is termed "following" (Cong).
If one does not understand the meridian Qi changes according to the four seasons during needling, it will cause internal disorder of the healthy Qi (Zheng Qi), subsequently damaging the Zang organs, with death occurring within a fixed period. This violation of the pattern is termed "opposing" (Ni). The four seasons correspond to the Five Elements, and the Six Qi also correspond to the Five Elements. Therefore, when discussing the following and opposing of needling according to the four seasons, one first discusses the diseases caused by the excess or deficiency of the Six Qi, manifested as slippery or choppy pulses.
When the Jueyin channel Qi is in excess, Yin Bi (Yin obstruction) occurs; when deficient, Re Bi (Heat obstruction) occurs. A slippery pulse indicates Hu Shan (Fox Hernia); a choppy pulse combined with Wind pathogen indicates accumulation of Qi in the lower abdomen.
The four seasons correspond to the Five Elements, and the Six Qi also correspond to the Five Elements. Thus, when Qibo discusses needling according to the four seasons, he first discusses the excess and deficiency of the Six Qi. Jueyin corresponds to Wood and to Spring among the four seasons. When Jueyin is in excess, Yang Qi is relatively deficient, resulting in Yin Bi; when Jueyin is deficient, Yang Qi is relatively excessive, resulting in Re Bi. "Bi" means obstruction and disharmony. Qi disorders manifest as hernias, while Blood disorders manifest as accumulations. A slippery pulse indicates abundant Qi, and a choppy pulse indicates scanty Blood. Therefore, if the Jueyin pulse is slippery, Hu Shan occurs. It is also stated that Wind arises from Qi movement; Wind governs the movement of Qi. The Lung Wind, Spleen Wind, Heart Wind, Kidney Wind, and Liver Wind mentioned later all imply the generation of Wind from Qi movement. If the Jueyin pulse is choppy, there will be accumulation of Qi in the lower abdomen.
When the Shaoyin channel Qi is in excess, Pi Bi (Skin obstruction) and Yin Zhen (hidden rashes/urticaria) occur; when deficient, Tong Bi (Painful obstruction) and Fei Bi (Lung obstruction) occur. A slippery pulse indicates Fei Feng Shan (Lung Wind Hernia); a choppy pulse indicates accumulation and hematuria.
Zhen is synonymous with Zhen (rash). Shaoyin corresponds to Fire and to Summer among the four seasons. When Shaoyin is in excess, Fire Qi flares outward, causing Pi Bi and Yin Zhen; when Shaoyin is deficient, Fire Qi is internally deficient, causing Fei Bi. Qi disorders manifest as hernias, so if the Shaoyin pulse is slippery, Fei Feng Shan occurs; Blood disorders manifest as accumulations, so if the Shaoyin pulse is choppy, accumulation and hematuria occur.
When the Taiyin channel Qi is in excess, Rou Bi (Muscle obstruction) and Han Zhong (Cold in the interior) occur; when deficient, Pi Bi (Spleen obstruction) occurs. A slippery pulse indicates Pi Feng Shan (Spleen Wind Hernia); a choppy pulse indicates accumulation accompanied by occasional abdominal fullness.
Taiyin corresponds to Earth and to Late Summer among the four seasons. When Taiyin is in excess, Earth Qi becomes stagnant, causing Rou Bi and Han Zhong; when Taiyin is deficient, Upper Jiao Qi fails to circulate, causing Pi Bi. Qi disorders manifest as hernias, so if the Taiyin pulse is slippery, Pi Feng Shan occurs; Blood disorders manifest as accumulations, so if the Taiyin pulse is choppy, accumulation and occasional abdominal fullness occur.
When the Yangming channel Qi is in excess, Mai Bi (Vessel obstruction) and intermittent body heat occur; when deficient, Xin Bi (Heart obstruction) occurs. A slippery pulse indicates Xin Feng Shan (Heart Wind Hernia); a choppy pulse indicates accumulation accompanied by frequent fright.
Yangming corresponds to Metal and to Autumn among the four seasons. When Yangming is in excess, Qi becomes dry and hot, causing Mai Bi and intermittent body heat; when Yangming is deficient, the Stomach collaterals fail to connect to the Pericardium, causing Xin Bi. Qi disorders manifest as hernias, so if the Yangming pulse is slippery, Xin Feng Shan occurs; Blood disorders manifest as accumulations, so if the Yangming pulse is choppy, accumulation and frequent fright occur.
When the Taiyang channel Qi is in excess, Gu Bi (Bone obstruction) and heavy body occur; when deficient, Shen Bi (Kidney obstruction) occurs. A slippery pulse indicates Shen Feng Shan (Kidney Wind Hernia); a choppy pulse indicates accumulation accompanied by occasional Dian Ji (diseases of the vertex/crown).
Taiyang corresponds to Water and to Winter among the four seasons. When Taiyang is in excess, Cold Water Qi is prevalent, causing Gu Bi and heavy body; when Taiyang is deficient, Water Qi is exhausted, causing Shen Bi. Qi disorders manifest as hernias, so if the Taiyang pulse is slippery, Shen Feng Shan occurs; Blood disorders manifest as accumulations, so if the Taiyang pulse is choppy, accumulation and occasional Dian Ji occur.
When the Shaoyang channel Qi is in excess, Jin Bi (Tendon obstruction) and hypochondriac fullness occur; when deficient, Gan Bi (Liver obstruction) occurs. A slippery pulse indicates Gan Feng Shan (Liver Wind Hernia); a choppy pulse indicates accumulation accompanied by occasional tendon spasms and eye pain.
Shaoyang corresponds to Fire and also to Spring among the four seasons. Among the Six Qi, there are two Fires, which align with the Five Elements. Shaoyang and Jueyin are exterior-interior pairs. When Shaoyang is in excess, Liver Wood Qi is also in excess, causing Jin Bi and hypochondriac fullness; when Shaoyang is deficient, Liver Wood Qi is also deficient, causing Gan Bi. Qi disorders manifest as hernias, so if the Shaoyang pulse is slippery, Gan Feng Shan occurs; Blood disorders manifest as accumulations, so if the Shaoyang pulse is choppy, accumulation, occasional tendon spasms, and eye pain occur.
Therefore, Spring Qi resides in the meridians, Summer Qi in the collateral vessels, Late Summer Qi in the muscles, Autumn Qi in the skin, and Winter Qi in the bone marrow.
The Qi of the four seasons corresponds to the human body. Spring Qi generates and circulates throughout the body, so Spring Qi resides in the meridians. Summer Qi opens up and floats on the exterior, so Summer Qi resides in the collateral vessels. Earth Qi is thick and dense, residing in the middle of the seasons, so Late Summer Qi resides in the muscles. Autumn Qi is肃杀 (solemn and killing/astringent), transforming heat into coolness, so Autumn Qi resides in the skin. Winter Qi closes and stores, hiding deeply within, so Winter Qi resides in the bone marrow.
The Yellow Emperor said: I wish to hear the reasons behind this.
I wish to understand the reasons why Spring, Summer, Autumn, and Winter Qi reside in the meridians, collaterals, muscles, skin, and bone marrow respectively.
Qibo said: In Spring, Heaven Qi begins to open, and Earth Qi begins to diffuse. Ice freezes and melts, water flows, and meridians become unobstructed. Therefore, Human Qi resides in the vessels.
The reason Spring Qi resides in the meridians is that Spring follows the storage of Winter. At this time, Heaven Qi begins to open, Earth Qi begins to diffuse, ice and snow begin to melt and dissolve, water flows, and meridians become unobstructed. Therefore, Human Qi resides in the meridians.
In Summer, Meridian Qi is full and overflows, entering the collateral vessels to receive blood, making the skin firm and充实 (substantial).
The reason Summer Qi resides in the collateral vessels is that Summer expands outward. Meridian Qi is full and overflows, entering the collateral vessels externally to receive blood, making the skin substantial. Therefore, Summer Qi resides in the collateral vessels.
In Late Summer, both meridian and collateral Qi are prosperous, overflowing inward into the muscles.
The reason Late Summer Qi resides in the muscles is that during Late Summer, the Qi of the meridians and collaterals from Summer remains prosperous, and it overflows inward into the muscles. Therefore, Late Summer Qi resides in the muscles.
In Autumn, Heaven Qi begins to gather, the interstices (Cou Li) close, and the skin contracts and tightens.
The reason Autumn Qi resides in the skin is that in Autumn, the Heavenly Qi begins to gather, the human interstices close, and the skin draws inward and tightens. Therefore, Autumn Qi resides in the skin.
In Winter, Qi is covered and stored. Blood and Qi remain in the center, penetrating the bone marrow and connecting to the five Zang organs.
"Cang" (store) is pronounced as written. The reason Winter Qi resides in the bone marrow is that in Winter, the mechanism of Qi is covered and stored. Blood and Qi remain in the center, penetrating the bone marrow and connecting to the five Zang organs. Zang means to store. Only Winter governs storage, thus connecting to the five Zang organs, and Winter Qi resides in the bone marrow.
Therefore, pathogenic Qi often enters and lodges in the body following the changes of Qi and Blood according to the four seasons. Although the extent of these changes cannot be predicted, one must follow the Jing Qi (Meridian Qi) to repel and eliminate the pathogen. Once the pathogen is eliminated, chaotic Qi will not arise.
The meridians, muscles, skin, and bone marrow each govern their respective seasons. Therefore, pathogenic Qi often enters and lodges internally due to the deficiency of Qi and Blood governed by the four seasons. The governing Qi of the four seasons has its regular limits. However, the changes of pathogenic Qi cannot be measured by these limits. One must follow the healthy Qi of the meridians. When Jing Qi is sufficient, it repels and eliminates the pathogen. Once the pathogen is eliminated, chaotic Qi will not arise, thereby conforming to the regular limits.
The Yellow Emperor said: How does violating the four seasons lead to the generation of chaotic Qi?
The text above states: Following the Jing Qi prevents the generation of chaotic Qi. Following prevents chaotic Qi; opposing generates it. Thus, the question asks how violating the four seasons leads to the generation of chaotic Qi.
Qibo said: Needling the collateral vessels in Spring causes Qi and Blood to overflow outward, leading to shortness of breath. Needling the muscles in Spring causes Qi and Blood to reverse cyclically, leading to upward rushing of Qi. Needling the sinews and bones in Spring causes Qi and Blood to stagnate internally, leading to abdominal distension.
The collateral vessels, meridians, muscles, sinews, and bones originate from Qi and Blood and correspond to the four seasons. Improper needling causes internal reversal of Qi and Blood, generating chaos. Spring Qi resides in the meridians, so it is appropriate to needle the meridians. If one needles the collateral vessels, muscles, or sinews/bones in Spring, improper needling causes Qi and Blood to overflow outward, reverse cyclically, or stagnate internally, leading to disease. Sinews connect to bones, hence "sinews and bones." Needling collateral vessels, meridians, muscles, and sinews/bones necessarily passes through the skin, so the skin is not explicitly mentioned here. Only the four seasons are listed, so Late Summer is not mentioned.
Needling the meridians in Summer exhausts Qi and Blood, leading to lethargy. Needling the muscles in Summer causes Qi and Blood to retreat inward, leading to fearfulness. Needling the sinews and bones in Summer causes Qi and Blood to rush upward, leading to irritability.
Summer Qi resides in the collateral vessels, so it is appropriate to needle the collateral vessels. If one needles the meridians, muscles, or sinews/bones in Summer, Qi and Blood are exhausted, retreat inward, or rush upward, leading to disease.
Needling the meridians in Autumn causes Qi and Blood to rush upward, leading to forgetfulness. Needling the collateral vessels in Autumn prevents Qi from circulating outward, leading to drowsiness and reluctance to move. Needling the sinews and bones in Autumn causes Qi and Blood to scatter inward, leading to chills.
Autumn Qi resides in the skin, so it is appropriate to needle the skin. If one needles the meridians, collateral vessels, or sinews/bones in Autumn, Qi and Blood rush upward, Qi fails to circulate outward, or Qi and Blood scatter inward, leading to disease. Regarding the four seasons' improper needling, the skin is not emphasized, only the four seasons are listed, excluding Late Summer. Thus, the previous text did not mention the skin. Here, since the skin should be needled, Late Summer's muscles are not mentioned.
Needling the meridians in Winter causes depletion of Qi and Blood, leading to blurred vision. Needling the collateral vessels in Winter causes internal Qi to leak outward, remaining as large Bi (Obstruction). Needling the muscles in Winter exhausts Yang Qi, leading to forgetfulness.
Winter Qi resides in the bone marrow, so it is appropriate to needle the bone marrow. If one needles the meridians, collateral vessels, or muscles in Winter, Qi and Blood are depleted, internal Qi leaks outward, or Yang Qi is exhausted, leading to disease.
All such improper needling according to the four seasons constitutes major violations. One must not disregard them. Violating these principles generates chaotic Qi, which mixes and causes disease.
Summarizing the above, regarding all needling according to the four seasons: If needling violates the principle of following, it is like a major violation. If one needles against these major violations, chaotic Qi is generated. Once chaotic Qi arises, it mixes and causes disease.
Therefore, if one does not understand the meridians according to the four seasons and the origin of diseases, treating "following" as "opposing," the healthy Qi will become disordered internally, clashing with Essence (Jing).
One must carefully examine the Nine Pulses (Jiu Hou). If the healthy Qi is not disordered, Essence will not be depleted.
To understand the origin of diseases related to the four seasons' meridians and the principles of following and opposing, one must carefully examine the Nine Pulses. The upper, middle, and lower parts of the body each have Heaven, Earth, and Man pulses, forming the Nine Pulses. By examining the Nine Pulses, one ensures that the healthy Qi does not become disordered internally, and Essence is not depleted. "Not depleted" means Essence remains stored internally.
The Yellow Emperor said: Excellent. Needling the Heart results in death within one day, with the sign being belching (Yi). Needling the Liver results in death within three days, with the sign being talking excessively (Yu). Needling the Lung results in death within five days, with the sign being coughing (Ke). Needling the Kidney results in death within six days, with the sign being sneezing and yawning (Ti Qian). Needling the Spleen results in death within ten days, with the sign being swallowing motions (Tun). Needling and injuring the five Zang organs inevitably leads to death. The abnormal movements observed correspond to the transformations of the specific Zang organ, allowing one to predict death based on these signs.
"Zhong" (strike/injure) is pronounced with the falling tone. The days (three, five, etc.) have been corrected in modern texts. Improper needling is called "Ni" (opposition). Knowing opposition allows one to know compliance, which is why the Yellow Emperor praised it. He further cited Qibo's words from the *Su Wen* chapter on Acupuncture Taboos to clarify that injuring the five Zang organs through needling has specific fatal periods and associated abnormal movements. Those who die do so because improper needling injures the five Zang organs fatally. The abnormal movements are based on the pathological changes of the specific Zang organ. Observing these movements allows one to predict death.