秋深久疟，胸中无物，又无痰癖，腹高而食少，俗谓疟气入腹，宜苍术汤主之。
苍术（四两） 草乌头（一钱） 杏仁（三十个）
上为粗末，起作一服，水三升，煎至一半，均作三服，一日服尽。
产后疟疾，多由污血挟寒热而作，大法宜柴胡四物汤调之。热多者，宜服草果饮子。
半夏（汤泡七次） 赤茯苓 草果（煨，去皮） 甘草（炙） 陈皮 川芎 白芷（各一钱二分） 紫苏
良姜 青皮（各六分） 干姜（二钱四分）
上 咀，分二帖，水二盏，姜五片，枣二枚，煎至八分，当发日早连进三服，无不效者。
寒多者，宜服生熟饮子。
肉豆蔻 草果仁 浓朴 半夏 陈皮 甘草 大枣（去核） 生姜（各二钱半）
上 咀，分二分，一半生，一半以湿纸裹煨香熟和匀，分作二帖，水二盏，煎八分，空心一服，食后一服，
二渣并煎，午前一服。
〔《灵》〕小针之要，易陈而难入。（《针解》云∶易陈者，易言也。难入者，难着于人也。）粗守形，上守神。
（粗守形者，守刺法也。上守神者，守人之血气，有余不足可补泻也。）神乎神，客在门。（神客者，正邪共会也。神者。
正气也。
客者，邪气也。在门者，
邪循正气之所出入也。）未睹其疾，恶知其原。（未睹其疾者，先知邪正何经之疾也。恶知其原者，先知何经之病
所取之处也。）刺之微，在速迟。（速迟者，疾徐之意也。）粗守关，上守机。（粗守关者，守四肢而不知血气正邪之往来也。
上守机者，知守气也。）机之动，不离其空。（知气之虚实，用针之疾徐也。）空中之机，清净以微。
（针以得气密，意守气勿失也。）其来不可逢，（气盛不可补也。）其往不可追，（气虚不可泻也。）知机之道者，不可挂
以发。（言气易失也。）不知机道，叩之不发。（言不知补泻之意，血气已尽，而气不下也。）知其往来，要与之期。
（知其往来者，知气之逆顺盛虚也。要与之期者，知气之可取之时也。）粗之暗乎，（冥冥不知气之微密也。）妙哉，上独
有之者。（尽知针意也。）往者为逆，（言气之虚而小。小者，逆也。）来者为顺，（言气之平。平者，
顺也。）明知逆顺，正行无问。（言知所取之处也。）迎而夺之，恶得无虚，追而济之，恶得无实，迎之随之，以意和之，
针道毕矣。（迎而夺之者泻也，追而济之者补也。《难经》云∶所谓迎随者，知荣卫之流行，经脉之往来，随其逆顺而取
之，故曰迎随。又云∶迎而夺之者，泻其子也，追而济之者，补其母也。假令心病，泻手心主俞，是谓迎而夺之也，补
手心主井者，是谓随而济之也）凡用针者，虚则实之。（气口虚而当补之也。《素》云∶针下热也，气实乃热也。谨按∶
针下，犹言针后也。）
满则泄之，（气口盛而当泻之也。《素》云∶针下寒也，气虚乃寒也。）宛陈则除之，（去血脉也。《素》云∶出恶血也。
）邪盛则虚之，（诸经有盛者，皆泻其邪也。《素》云∶出针勿按。）《大要》曰∶徐而疾则实，（徐内而疾出也。《素》云∶
徐出针而疾按之。）疾而徐则虚，（疾内而徐出也《素》云∶疾出针而徐按之。）言实与虚，若有若无。（言实者有气，虚
者无气也。《素》云∶言实与虚者，寒温气多少也。有若无者，疾不可知也。）察后与先，若亡若存。（言气之虚实，补泻
之先后也。察其气之已下与常存也。）为虚与实，若得若失。（言补者 然若有得也，泻则恍然若有失也，《难经》
云∶气未实牢者为得，濡虚者为失，故曰若得若失。《素》云∶为虚与实者，工勿失其法。若得若失者，离其法也。）虚实之要，
九针最妙。（《素》云∶为其各有一宜也。）补泻之时，以针为之。（《素》云∶补泻之时者，与气开闭相合也。）
泻曰迎之，必持而内之，放而出之，排阳得针，邪气得泄。按而引针，是谓内温，血不得散，气不得出也。
补曰随之，意若忘之，若行若按，如蚊虻止，如留如还，去如弦绝，令左属右，其气故止，外门已闭，中气乃
实，必无留血，急取诛之。持针之道，坚者为宝。正指直刺，无针左右。神在秋毫，属意病者。审视血脉者，
刺之无殆。方刺之时，必在悬阳，及与两卫，神属勿去，知病存亡。血脉者在 横居，视之独澄，切之独坚。
刺之而气之不至，无问其数。刺之而气至，乃去之，勿复针。针各有所宜，各不同形，各任其所为刺之要，气
至而有效，效之信，若风之吹云，明乎若见苍天，刺之道毕矣。邪气来也紧而疾，谷气来也徐而和。（并见九针十二
原并小针解。）
凡刺之属，三刺至谷气，邪僻妄合，阴阳易居，逆顺相反，浮沉异处，四时不得，稽留淫 ，须针而去。
故一刺则阳邪出，再刺则阴邪出，三刺则谷气至，谷气至而止。所谓谷气至者，已补而实，已泻而虚，故以知
谷气至也。所谓三刺则谷气出者，先浅刺绝皮，以出阳邪；再刺则阴邪出者，少益深绝皮，致肌肉，未入分肉
间也；已入分肉之间，则谷气出。故刺法曰∶始浅刺之，以逐邪气，而来血气。后刺深之，以致阴气之邪。最
后刺极深之，以下谷气，此之谓也。故用针者，不知年之所加，气之盛衰，虚实之所起，不可以为工也。（并见终
始、官针二篇）
上候气有二∶一曰邪气，二曰谷气。凡刺气至则候邪气尽，尽则谷气至，至则止针矣。所谓邪气者，曰
紧而疾，曰补而未实，泻而未虚也。所谓谷气者，曰徐而和，曰补而已实，泻而已虚也。
睹其色，察其目，知其散，复一其形，听其动静。（上工知相五色于目，有知调尺寸小大缓急滑涩以言所病也。）
知其邪正者，（知论虚邪与正邪之风也。）右主推之，左持而御之者。（言持针而出入也。）气至而去之。
（言补泻气调而去之也。）
以上见针解。凡将用针必先诊视脉气之剧易，乃可以治也。
〔《素》〕五脏已定，九候已备，后乃存针。（王注云∶先定五脏之脉，次循九候之诊，然后乃存意于用
针之法。）黄帝问曰∶经言气之盛衰，左右倾移，以上调下，以左调右，有余不足，补泻于荥俞，余知之矣。
此皆荣卫之倾移，虚实之所生，
非邪气从外入于经也。余愿闻邪气之在经也，其病患何如？取之奈何？岐伯对曰∶夫圣人之起度，必应于天地。
故天有宿度，地有经水，人有经脉。天地温和，则经水安静。天寒地冻，则经水凝泣。天暑地热，则经水沸溢。
卒风暴起，则经水波涌而陇起。夫邪之入于脉也，寒则血凝泣，暑则气淖泽，虚邪因而入客，亦如经水之得风
也。经之动脉，其至也亦时陇起，其行于脉中循循燃，其至寸口中手也时大时小，大则邪至，小则平。其行无
常处，在阴与阳，不可为度。从而察之，三部九候，卒然逢之，早遏其路。帝曰∶候气奈何？岐伯曰∶夫邪
去络入于经也，舍于血脉之中，其寒温未相得，如涌波之起也，时来时去，故不常在。故曰∶方其来也，必按
而止之，止而取之，无逢其冲而泻之。真气者，经气也，经气太虚，故曰其来不可逢，此之谓也。（《灵枢》云∶其
来不可逢者，气盛不可补也。）故曰∶候邪不审，大气已过，泻之则真气脱，脱则不复。邪气复至，而病益蓄。
故曰其往不可追，此之谓也。（《灵枢》云∶其往不可追者，气虚不可泻也。）不可挂以发者，待邪之至时而发
针泻矣。（不可挂以发者，言气易失也。）若先若后者，血气已尽，其病不可下。故曰∶知其可取如发机，不
知其取如叩锥。故曰知机道者，不可挂以发；不知机者，扣之不发，此之谓也。帝曰∶补泻奈何？岐伯曰∶此
攻邪也，疾出以去盛血，而复其真气，此邪新客，溶溶未有定处也。推之则前，引之则止，逆而刺之，温血也。
刺出其血，其病立已。邪之新客来也，未有定处，推之则前，引之则止，逢而泻之，其病立已。（俱离合真邪论）
上候邪气新客经脉而取之之法也。言邪之初客经脉，其寒温未相搏，如涌波之起也，时来时去，故不常
在。欲取之者，必于三部九候之间，诊察以待之。傥于一部一候，见其如涌波之来，则按而止之，然后取
之，不可逢其冲来便泻之，故曰∶其来不可逢。其或候气不审，至于涌波之大气已过去而泻之，则真气脱，
邪气复至，而病益蓄，故曰∶其往不可追也。凡诊三部九候而待邪至之机以发刺者，必专心致意，故曰∶
知机道者，不可挂以发也。所谓涌波者，脉浮大也。三部九候，非寸关尺，乃面有三部，手有三部，足有
三部，合三部为九部也。
帝曰∶善。然真邪已合，波陇不起，候之奈何？岐伯曰∶审扪循三部九候之盛虚而调之，察其左右上下相
失及相减者，审其病藏以期之。不知三部者，阴阳不别，天地不分。地以候地，天以候天，人以候人，调之中
府，以定三部。故曰∶刺不知三部九候病脉之处，虽有大过且至，工不能禁也。诛罚无过，命曰大惑。反乱大
经，真不可复。用实为虚，以邪为真。用针无义，反为气贼。夺人正气，以从为逆。荣卫散乱，真气已失。邪
独内着，绝人长命，予人夭殃。不知三部九候，故不能长久，因不知合之四时五行，因加相胜，释邪攻正，绝
人长命。（离合真邪论）
上候邪客已久，真邪已合，而取之之法也。言取邪之新容者，但候波陇之脉来处取之。今其邪已合，波
陇不起，而不知邪客之处也，故又必当扪循三部九候之盛虚，视其盛处泻之，虚处补之。左右相失，而左
大右细者，泻左补右。上下相失，而上大下小者，泻上部补下部。上小下大者，补上部泻下部。左右上下
皆相减而细者，审其何脏之减，以其减脏日时之衰者补其所减经，减脏日时之盛者泻其所胜经，候邪去真
复而止。故曰∶刺不知三部九候病脉之处，则诛罚无过，反乱大经，用实为虚，以邪为真，真气已失，邪
独内着，绝人长命也。
上工救其萌芽，必先见三部九候之气，尽调不败而救之，故曰上工。下工救其已成，救其已败。救其已成
者，言不知三部九候之相失，因病而败之也。知其所在者，知诊三部九候之病脉处而治之，故曰守其门户，莫
知其情，而见邪形也。（八正神明论）
〔《难》〕言上工治未病，中工治已病者，何谓也？然，所谓治未病者，见肝之病，则知肝当传之于脾，故
先实其脾气，无令得受肝之邪也。故曰治未病焉。中工见肝之病，不晓相传，但一心治肝，故曰已病也。
（七十七难）自篇首至此，乃察病用针切要之旨。学人当潜心体认之。医而不知此，非工也。噫，今世稍知穴
法，便自骄满，由不知粗守形上守神之论也，可慨哉。
〔《灵》〕夫气之在脉也，邪气在上。（针解云∶言邪气之中人也高，故邪气在上也。）浊气在中。（
言水谷皆入于胃其精气上注于肺，浊溜于肠胃。若寒暑不适，饮食不节而病生于肠胃，故命曰浊气在中也。
）清气在下。（言清湿地气之中人也，必从足始，故曰清气在下。）针陷脉则邪气出。（取之
上。）针中脉则邪气出。（取之阳明合也。）针大深则邪气反沉。（言浮浅之病不欲深刺也，深则邪气从之入，故曰
反沉。）皮肉筋脉各有所处，（言经络各有所主也。）病各有所宜，《甲乙经》“宜”字作“合”。）
各不同形，各以任其所宜。（见小针解及九针十二原）
〔《素》〕病有浮沉，刺有深浅，各至其理，无过其道。过之则内伤，不及则生外壅，壅则邪从之，浅深不
得，反为大贼，内动五脏，后生大病。故曰∶病有在毫毛腠理者，有在皮肤者，有在肌肉者，有在脉者，有在
筋者，有在骨者，有在髓者云云。（刺要论） 病在脉调之血，病在血调之络，病在气调之卫，病在肉调之分肉，病在
筋调之筋，病在骨调之骨。燔针劫刺其下及与急者，（王注云∶调筋法也。）病在骨， 针药熨，（调骨法也。）
病不知所痛，两跷为上，身形有痛，九候莫病，则缪刺之。（刺络脉也。）痛在于左而右脉病者，巨刺之。（刺经脉也。见调经论篇）
〔《灵》〕手屈而不伸者，其病在筋。伸而不屈者，其病在骨。在骨守骨，在筋守筋。（终始篇）
〔《难》〕言刺荣无伤卫，刺卫无伤荣，何谓也？然，针阳者卧针而刺之，刺阴者先以左手摄按所针荣俞之
处，气散乃纳针，是谓刺荣无伤卫，刺卫无伤荣也。（见七十一难）
〔《素》〕刺骨者无伤筋，刺筋者无伤肉，刺肉者无伤脉，刺脉者无伤皮，刺皮者无伤肉，刺肉者无伤筋，
刺筋者无伤骨。刺骨无伤筋者，针至筋而去，不及骨也。刺筋无伤肉者，至肉而去，不及筋也。刺肉无伤脉者，
至脉而去，不及肉也。刺脉无伤皮者，至皮而去，不及脉也。（林注云∶此谓浅深不至所当刺之处也。）所谓刺皮无
伤肉者，病在皮中，针入皮中，无伤肉也。刺肉无伤筋者，过肉中筋也。刺筋无伤骨者，过筋中骨也。此之谓
反也。（戒其太深也。刺齐论）
秋末时节，疟疾迁延日久，患者胸中无积滞，也无痰饮癖块，但腹部胀高而进食减少，民间称之为“疟气入腹”，适宜用苍术汤治疗。
将上述药材捣碎成粗末，作为一剂服用量。加水三升，煎煮至剩余一半药液，平均分为三份服用，一天内服完。
产后患疟疾，多由瘀血夹杂寒热邪气引发，治疗大法适宜用柴胡四物汤进行调理。若热象较重者，适宜服用草果饮子。
半夏（用热水浸泡七次） 赤茯苓 草果（煨制，去皮） 甘草（炙烤） 陈皮 川芎 白芷（各一钱二分） 紫苏
良姜 青皮（各六分） 干姜（二钱四分）
将上述药材切碎，分为两帖。加水两盏，生姜五片，大枣二枚，煎煮至剩余八分药液。在疟疾发作当日早晨连续服用三帖，没有不生效的。
若寒象较重者，适宜服用生熟饮子。
肉豆蔻 草果仁 浓朴 半夏 陈皮 甘草 大枣（去核） 生姜（各二钱半）
将上述药材切碎，分为两份。一半生用，一半用湿纸包裹煨至香熟，混合均匀。分为两帖，加水两盏，煎煮至剩余八分药液。空腹时服用一帖，饭后服用一帖，
将两次煎煮后的药渣合并再煎，中午前服用一帖。
〔《灵枢》〕小针（指九针中的微针）的要领，容易陈述却难以被人掌握。（《针解篇》说：容易陈述，是指言语浅显易懂；难以掌握，是指难以让人领会并付诸实践。）粗劣的医生只拘泥于形体表象，高明的医生则注重神气的变化。
（所谓粗劣医生拘泥于形体，是指只死守刺法操作；高明医生注重神气，是指观察人的气血，根据有余或不足来决定补泻。）神妙啊神妙，正气与邪气交会于腧穴之门。（所谓神客，是指正气与邪气共同汇聚之处。神，指正气；客，指邪气。在门，指邪气顺着正气出入的路径进入。）尚未看清疾病，怎么知道其根源？（尚未看清疾病，是指先要辨别邪气和正气侵犯的是哪条经脉的病证。怎么知道其根源，是指先要知道哪条经脉患病以及应该选取的治疗部位。）针刺的精微之处，在于速度的快慢。（速迟，即疾徐的意思，指针刺进出的速度。）粗劣的医生只关注四肢关节，高明的医生则把握气机变化的枢纽。（粗劣医生关注关节，是指只守四肢而不知气血中正邪的往来变化。高明医生把握枢纽，是指懂得守持经气。）经气的变动，不离腧穴空窍。（了解经气的虚实，运用针刺的疾徐手法。）空窍中的气机变化，清净而细微。
（针刺得气后，意念要紧密守持经气，不要使其流失。）经气盛来时不可迎而补之，（经气盛实，不可用补法。）经气虚去时不可追而泻之，（经气虚弱，不可用泻法。）懂得气机变化规律的人，不会因丝毫差错而失误。（意思是经气容易流失。）不懂得气机之道，就像敲击石头发不出声音一样。（意思是不知道补泻的意旨，血气已耗尽，而经气仍不能下行。）了解经气的往来，要把握恰当的时机与之相合。
（了解往来，是知道经气的逆顺盛虚。把握时机，是知道经气可取的时刻。）粗劣的医生昏暗不明，（冥冥之中不知经气的微妙严密。）高明医生独自精通此道。（完全通晓针刺意旨。）经气离去为逆，（指经气虚弱微小。微小，即为逆。）经气到来为顺，（指经气平和。平和，即为顺。）明确知道逆顺，正确施治无需疑惑。（意思是知道该选取的部位。）迎着经气来势而夺其盛实，怎么能不虚呢？追着经气去势而济其虚弱，怎么能不实呢？迎着或随着经气施治，以意念调和它，针刺的道理就完备了。（迎着而夺之，是泻法；追着而济之，是补法。《难经》说：所谓迎随，是知道营卫的运行和经脉的往来，顺着其逆顺而取穴，所以叫迎随。又说：迎着而夺之，是泻其子经；追着而济之，是补其母经。例如心病，泻手厥阴心包经的俞穴，这叫迎着而夺之；补手厥阴心包经的井穴，这叫随着而济之。）凡是使用针刺的人，对于虚证要用补法使其充实。（寸口脉虚，应当用补法。《素问》说：针下发热，是因为经气充实才发热。谨按：针下，犹言针后。）
对于实证要用泻法使其泄除，（寸口脉盛，应当用泻法。《素问》说：针下发凉，是因为经气虚弱才发凉。）血脉中有瘀血陈积的要去除它，（去除瘀阻的血脉。《素问》说：排出恶血。）邪气盛实的要用泻法使其虚衰，（各经有邪气盛实的，都要泻其邪气。《素问》说：出针后不要按压针孔。《大要》说：缓慢进针快速出针可使正气充实，（缓慢进针，快速出针。《素问》说：缓慢出针并迅速按压针孔。）快速进针缓慢出针可使邪气虚衰，（快速进针，缓慢出针。《素问》说：快速出针并缓慢按压针孔。）谈论实证与虚证，有时感觉有气，有时感觉无气。（说实证有气感，虚证无气感。《素问》说：谈论实与虚，是指寒温之气多少。有若无，是指疾徐手法难以察觉。）观察补泻的先后顺序，如同气之存亡一般微妙。（指经气的虚实，补泻操作的先后次序。观察经气是否已下行或依然存在。）处理虚证与实证，补法时好像有所得，泻法时好像有所失。（说补法时患者感觉若有得，泻法时恍然若有失。《难经》说：经气未充实牢靠为得，濡软虚弱为失，所以说若得若失。《素问》说：处理虚实，医生不要违背法则。若得若失，是指背离了法则。）虚实的关键，九种针具最为奇妙。（《素问》说：因为每种针都有其适宜的用途。）补泻的时机，要通过针具来体现。（《素问》说：补泻的时机，要与经气的开闭相符合。）
泻法叫做迎之，必须持针深入，放出血液后拔出，推开阳部取得针位，使邪气得泄。按压并引导出针，这叫内温，血液不得散逸，经气不得外出。
补法叫做随之，意念仿佛遗忘，如同行走或按压，像蚊虻叮咬停留，似留似还，出针时像弓弦断裂般迅速，使左手属右，经气自然停止，外门已闭，中气乃实，必定不留瘀血，急取诛伐之法。持针的原则，坚实稳固最为宝贵。正对穴位直刺，针身不偏左右。精神集中在毫毛皮肤之间，意念专注在病人身上。审视血脉，针刺就没有危险。正在针刺的时候，必须注意患者的阳气及两卫（卫气），精神专注不要离开，以此判断疾病的存亡。血脉在皮下横居，看它特别清澈，摸它特别坚硬。
针刺后经气未到，不要问次数多少。针刺后经气已到，就停止针刺，不要再扎。各种针各有其适宜病症，形状各不相同，各自承担其特定的作用。针刺的要领，经气到达才有疗效，疗效的确切表现，就像风吹云散，明朗地看见苍天一样，针刺的道理就完备了。邪气来的时候，脉象紧而急；谷气（正气）来的时候，脉象徐缓平和。（均见于《九针十二原》和《小针解》。）
凡是针刺的类别，经过三次针刺达到谷气，邪气妄乱结合，阴阳位置颠倒，逆顺相反，浮沉异处，四季气候失调，邪气稽留淫溢，需要针刺将其去除。
所以第一次针刺则阳邪外出，第二次针刺则阴邪外出，第三次针刺则谷气到来，谷气到来就停止针刺。所谓谷气到来，是指已经补过而变得充实，已经泻过而变得虚衰，因此知道谷气已至。所谓三次针刺则谷气出，是先浅刺穿透表皮，以排出阳邪；第二次针刺稍加深穿透表皮，到达肌肉层，但未进入分肉之间；一旦进入分肉之间，则谷气出现。所以刺法说：开始浅刺，以驱逐邪气，招来血气。后来深刺，以引出阴分之邪。最后极深刺，以下达谷气，说的就是这些。所以使用针刺的人，如果不了解每年岁运加临、经气盛衰、虚实产生的原因，就不能成为好医生。（均见于《终始》、《官针》两篇）
以上候气有两种：一是邪气，二是谷气。凡是针刺经气到达，就要等候邪气尽，邪气尽了谷气就到了，到了就停止针刺。所谓邪气，表现为脉紧而急，补了而未实，泻了而未虚。所谓谷气，表现为脉徐而和，补了而已实，泻了而已虚。
观察病人的面色，察视眼睛，知道精气散聚，复归于一形，听其动静。（上工知道从眼睛观察五色，有知识通过调察尺寸脉的大小缓急滑涩来判断所患疾病。）知道邪正的情况，（知道论述虚邪与正邪之风。）右手推针深入，左手持针御守。（指持针进出。）经气到达后就起针。
（指补泻后气机调和就起针。）
以上是《针解篇》的内容。凡是准备用针，必须先诊视脉气的剧烈或容易程度，然后才可以治疗。
〔《素问》〕五脏脉象已确定，九候诊法已具备，然后才考虑用针。（王冰注说：先定五脏之脉，次循九候之诊，然后才专心于用针之法。）黄帝问道：经文说气的盛衰，左右倾移，以上调下，以左调右，有余不足，在荥穴和俞穴进行补泻，我已经知道了。这些都是营卫的倾移，虚实所产生的，并非邪气从外部侵入经脉。我希望了解邪气在经脉中的情况，它的病患表现如何？如何取穴治疗？岐伯回答说：圣人制定度量标准，必然顺应天地。所以天有星宿度数，地有江河水流，人有经脉。天地温和，则经水安静。天寒地冻，则经水凝涩。天暑地热，则经水沸腾溢出。卒然风暴兴起，则经水波涛汹涌隆起。邪气侵入脉中，寒冷则血液凝涩，暑热则气液淖泽，虚邪趁机侵入，也像经水遇到风一样。经脉动脉，其搏动也时而隆起，其在脉中运行缓缓燃烧，其到达寸口时的手感，有时大有时小，大则邪气至，小则平和。其运行无常处，在阴在阳，不可固定为度。顺着脉象察视，三部九候，突然逢遇邪气，要及早阻断其路径。黄帝问：如何候气？岐伯说：邪气从络脉进入经脉，停留在血脉之中，其寒温尚未相搏，像涌波兴起，时来时去，所以不常在。所以说，当它来的时候，必须按压以阻止它，止住后取穴针刺，不要迎着其冲盛之时而泻之。真气，即经气，经气太虚，所以说其来不可逢，就是这个意思。（《灵枢》说：其来不可逢，是指气盛不可补。）所以说：候邪若不审慎，大气已过，泻之则真气脱失，脱失则不能恢复。邪气再次到来，而病更加蓄积。所以说其往不可追，就是这个意思。（《灵枢》说：其往不可追，是指气虚不可泻。）不可挂以发，是指等待邪气到达时发针泻之。（不可挂以发，意思是气易失。）如果先刺或后刺不当，血气已尽，其病不可治。所以说知道可取之机如发弩机，不知道取机如叩击锥子。所以说懂得机道的人，不会因丝毫差错而失误；不懂机道的人，叩之不发，就是这个意思。黄帝问：补泻怎么做？岐伯说：这是攻邪的方法，快速出针以去除盛血，从而恢复真气，这是邪气新近客居，溶溶未有定处。推之则向前，引之则停止，逆而刺之，刺出温血。刺出其血，其病立即痊愈。邪气新近客居而来，未有定处，推之则向前，引之则停止，逢其来势而泻之，其病立即痊愈。（均见于《离合真邪论》）
以上是候邪气新客经脉而取穴的方法。说邪气初客经脉，其寒温尚未相搏，像涌波兴起，时来时去，所以不常在。想要取之，必须在三部九候之间，诊察以待之。倘若在一部一候，见到其如涌波之来，则按压以阻止它，然后取穴，不可迎着其冲来便泻之，所以说：其来不可逢。或者候气不审，至于涌波之大邪气已经过去而泻之，则真气脱失，邪气再次到来，而病更加蓄积，所以说其往不可追。凡诊察三部九候而等待邪气到达之机以发刺者，必须专心致意，所以说：知机道者，不可挂以发。所谓涌波，指脉浮大。三部九候，非指寸关尺，而是面部有三部，手部有三部，足部有三部，合三部为九部。
黄帝说：好。然而真邪已合，波浪不起，如何候察？岐伯说：仔细扪循三部九候的盛虚而调治之，察视其左右上下相失及相减的情况，审察其病变脏腑以期待其愈。不知道三部者，阴阳不分，天地不明。地以候下部，天以候上部，人以候中部，调和中府，以确定三部。所以说：针刺不知道三部九候病脉之处，即使有大邪气将至，医生也不能禁止。诛罚无过，名叫大惑。反乱大经，真气不可恢复。用实为虚，以邪为真。用针无义，反为气贼。夺人正气，以从为逆。营卫散乱，真气已失。邪独内着，断人长命，给人夭殃。不知道三部九候，所以不能长久，因为不知道合之四时五行，因而加上相胜，释放邪气攻击正气，断人长命。（《离合真邪论》）
以上是候邪客已久，真邪已合，而取穴的方法。说取邪之新容者，只候波浪之脉来处取之。现在邪已合，波浪不起，而不知道邪客之处，所以又必须扪循三部九候的盛虚，视其盛处泻之，虚处补之。左右相失，而左大右细者，泻左补右。上下相失，而上大下小者，泻上部补下部。上小下大者，补上部泻下部。左右上下皆相减而细者，审察是何脏之减，以其减脏日时之衰者补其所减经，减脏日时之盛者泻其所胜经，候邪去真复而止。所以说：针刺不知道三部九候病脉之处，则诛罚无过，反乱大经，用实为虚，以邪为真，真气已失，邪独内着，绝人长命。
上工救治于萌芽阶段，必先见三部九候之气，全部调匀不败而救之，所以上工。下工救治于已成阶段，救治于已败阶段。救治于已成阶段，是说不知道三部九候的相失，因病而败坏。知道病所在之处，知道诊察三部九候的病脉处而治之，所以叫守其门户，没有人知道病情，而能看见邪形。（《八正神明论》）
〔《难经》〕说上工治未病，中工治已病，是什么意思？答：所谓治未病，看到肝病，就知道肝当传之于脾，所以先充实脾气，不让其受肝之邪。所以叫治未病。中工看到肝病，不懂相传，只一心治肝，所以叫已病。（第七十七难）自篇首至此，乃是察病用针切要的旨意。学人应当潜心体认。医而不知此，不是好医生。唉，当今世上稍微知道穴法，便自骄满，由于不知道粗守形上守神的议论，可悲啊。
〔《灵枢》〕气在脉中，邪气在上。（《针解》说：邪气中人位置高，所以邪气在上。）浊气在中。（说水谷都入胃，其精气上注于肺，浊溜于肠胃。若寒暑不适，饮食不节而病生于肠胃，所以叫浊气在中。）清气在下。（说清湿地气中人，必从足始，所以叫清气在下。）针刺陷脉则邪气出。（取上部。）针刺中脉则邪气出。（取阳明合穴。）针刺过深则邪气反沉。（说浮浅之病不欲深刺，深则邪气从之入，所以叫反沉。）皮肉筋脉各有所处，（说经络各有所主。）病各有所宜，《甲乙经》“宜”字作“合”。）各不同形，各以任其所宜。（见《小针解》及《九针十二原》）
〔《素问》〕病有浮沉，刺有深浅，各至其理，无过其道。过之则内伤，不及则生外壅，壅则邪从之，浅深不得，反为大贼，内动五脏，后生大病。所以说：病有在毫毛腠理的，有在皮肤的，有在肌肉的，有在脉的，有在筋的，有在骨的，有在髓的等等。（《刺要论》）病在脉调之血，病在血调之络，病在气调之卫，病在肉调之分肉，病在筋调之筋，病在骨调之骨。燔针劫刺其下及与急者，（王冰注说：调筋法。）病在骨， 针药熨，（调骨法。）病不知所痛，两跷为上，身形有痛，九候莫病，则缪刺之。（刺络脉。）痛在于左而右脉病者，巨刺之。（刺经脉。见《调经论》篇）
〔《灵枢》〕手屈而不伸者，其病在筋。伸而不屈者，其病在骨。在骨守骨，在筋守筋。（《终始》篇）
〔《难经》〕说刺荣无伤卫，刺卫无伤荣，是什么意思？答：针阳者卧针而刺之，刺阴者先以左手摄按所针荣俞之处，气散乃纳针，这叫刺荣无伤卫，刺卫无伤荣。（见第七十一难）
〔《素问》〕刺骨者无伤筋，刺筋者无伤肉，刺肉者无伤脉，刺脉者无伤皮，刺皮者无伤肉，刺肉者无伤筋，刺筋者无伤骨。刺骨无伤筋者，针至筋而去，不及骨也。刺筋无伤肉者，至肉而去，不及筋也。刺肉无伤脉者，至脉而去，不及肉也。刺脉无伤皮者，至皮而去，不及脉也。（林亿注说：此谓浅深不至所当刺之处。）所谓刺皮无伤肉者，病在皮中，针入皮中，无伤肉也。刺肉无伤筋者，过肉中筋也。刺筋无伤骨者，过筋中骨也。这叫反刺。（戒其太深。《刺齐论》）
In late autumn, for malaria persisting for a long time, where there is no accumulation in the chest and no phlegm-fluid retention, but the abdomen is distended and high with reduced food intake, commonly referred to as "malaria qi entering the abdomen," Cangzhu Tang (Caulis Atractylodis Macrocephalae Decoction) is indicated.
Cangzhu (Atractylodis Macrocephalae Rhizoma, 4 liang), Caowutou (Aconiti Kusnezoffii Radix, 1 qian), Xingren (Armeniacae Semen Amarum, 30 pieces)
Grind the above into coarse powder. Take one dose at a time. Add three sheng of water, decoct until half remains, divide equally into three doses, and consume all within one day.
Malaria occurring postpartum is mostly caused by foul blood mixed with cold and heat pathogens. The general principle is to regulate it with Chaihu Siwu Tang (Bupleurum Four Substances Decoction). If heat predominates, Caoguo Yinzi (Tsaoko Fruit Infusion) is indicated.
Banxia (Pinelliae Rhizoma, soaked in hot water seven times), Chi Fuling (Poria with Red Wood, 1 qian 2 fen), Caoguo (Tsaokos Fructus, roasted and peeled, 1 qian 2 fen), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 qian 2 fen), Chenpi (Citri Reticulatae Pericarpium, 1 qian 2 fen), Chuanxiong (Ligustici Chuanxiong Rhizoma, 1 qian 2 fen), Baizhi (Angelicae Dahuricae Radix, 1 qian 2 fen), Zisu (Perillae Folium, amount appropriate), Liangjiang (Alpiniae Officinarum Rhizoma, 6 fen), Qingpi (Citri Reticulatae Pericarpium Viride, 6 fen), Ganjiang (Zingiberis Rhizoma, 2 qian 4 fen)
Cut the above into small pieces, divide into two portions. Add two zhan of water, five slices of Shengjiang (Zingiberis Rhizoma Recens), and two dates. Decoct until eight parts remain. On the day of malaria onset, take three doses consecutively in the morning; this method is invariably effective.
If cold predominates, Shengshu Yinzi (Raw and Cooked Infusion) is indicated.
Roudoukou (Myristicae Semen, 2 qian 5 fen), Caoguoren (Tsaokos Fructus Seed, 2 qian 5 fen), Nongpu (Magnoliae Officinalis Cortex, 2 qian 5 fen), Banxia (Pinelliae Rhizoma, 2 qian 5 fen), Chenpi (Citri Reticulatae Pericarpium, 2 qian 5 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian 5 fen), Dazao (Jujubae Fructus, pitted, 2 qian 5 fen), Shengjiang (Zingiberis Rhizoma Recens, 2 qian 5 fen)
Cut the above into small pieces, divide into two portions. Half is used raw, half is wrapped in wet paper and roasted until fragrant and cooked, then mixed evenly. Divide into two portions. Add two zhan of water, decoct until eight parts remain. Take one dose on an empty stomach, and one dose after meals. Combine the dregs from both decoctions and decoct again, taking one dose before noon.
[From *Lingshu*] The essence of minor needles is easy to state but difficult to master. (*Zhijie* says: Easy to state means easy words; difficult to master means difficult to implant in people.) Crude practitioners guard form, while superior practitioners guard spirit.
(Crude practitioners guarding form refers to guarding needling techniques. Superior practitioners guarding spirit refers to observing the person's Qi and Blood, determining sufficiency or deficiency for tonification or sedation.) Spirit! Spirit! The guest resides at the gate. (Spirit and guest refer to the convergence of righteous Qi and pathogenic Qi. Spirit denotes righteous Qi. Guest denotes pathogenic Qi. At the gate means the pathogen follows the pathways of righteous Qi's entry and exit.) Before perceiving the disease, how can one know its origin? (Before perceiving the disease means first knowing which meridian suffers from pathogenic or righteous Qi imbalance. Knowing the origin means first knowing which meridian is diseased and where to needle.) The subtlety of needling lies in speed and slowness. (Speed and slowness refer to rapid and slow movements.) Crude practitioners guard joints, while superior practitioners guard mechanisms. (Crude practitioners guarding joints refers to guarding the four limbs without knowing the coming and going of righteous Qi and pathogens. Superior practitioners guarding mechanisms refers to knowing how to guard Qi.) The movement of Qi does not depart from the acupoint void. (Knowing the emptiness or fullness of Qi, using rapid or slow needling techniques.) The mechanism within the void is pure, clear, and subtle. (After obtaining Deqi with the needle, mentally guard the Qi so as not to lose it.) When Qi arrives, do not meet it with tonification. (When Qi is abundant, do not use tonification.) When Qi departs, do not pursue it with sedation. (When Qi is deficient, do not use sedation.) Those who understand the way of Qi mechanisms cannot be delayed by even a hair. (Meaning Qi is easily lost.) Those who do not understand Qi mechanisms are like striking something that does not produce sound. (Meaning not knowing the intent of tonification and sedation, the Qi and Blood are exhausted, yet Qi does not descend.) Knowing its coming and going, aim for the right timing. (Knowing coming and going means knowing the reversals, smoothness, abundance, and deficiency of Qi. Aiming for timing means knowing when Qi can be accessed.) Crude practitioners are obscure, (Unaware of the subtleties of Qi.) while superior practitioners alone possess mastery. (Fully comprehending the meaning of needling.) What has gone is reversal, (Referring to deficient and small Qi. Small implies reversal.) what is coming is smoothness. (Referring to balanced Qi. Balanced implies smoothness.) Clearly knowing reversal and smoothness, proceed correctly without doubt. (Meaning knowing the points to select.) Meet it and seize it, how can it not become deficient? Pursue it and assist it, how can it not become full? Meeting and following, harmonize with intent, and the Dao of needling is complete. (Meeting and seizing is sedation; pursuing and assisting is tonification. *Nanjing* says: Regarding meeting and following, knowing the circulation of Ying and Wei and the flow of meridians, following their reversals and smoothness to select points is called meeting and following. It also says: Meeting and seizing sedates the son meridian; pursuing and assists the mother meridian. For example, in heart disease, sedating the Shu point of the Hand Jueyin Pericardium is meeting and seizing; tonifying the Jing-Well point of the Hand Jueyin Pericardium is following and assisting.) In all cases of using needles, if deficient, make it full. (If the pulse at the Cun Kou is deficient, tonify it. *Suwen* says: Heat under the needle indicates Qi fullness. Note: 'Under the needle' refers to after needling.) If full, drain it. (If the pulse at the Cun Kou is excess, sedate it. *Suwen* says: Cold under the needle indicates Qi deficiency.) If there are stasis and old blood, remove them. (Remove obstructed blood vessels. *Suwen* says: Expel evil blood.) If pathogenic Qi is excessive, make it deficient. (For any meridian with excess pathogenic Qi, sedate the pathogen. *Suwen* says: Do not press the needle hole upon withdrawal. *Da Yao* says: Slow insertion and rapid withdrawal result in fullness. (Slow insertion, rapid withdrawal. *Suwen* says: Withdraw the needle slowly and press quickly.) Rapid insertion and slow withdrawal result in emptiness. (Rapid insertion, slow withdrawal. *Suwen* says: Withdraw the needle rapidly and press slowly.) Discussing fullness and emptiness, it seems as if there is Qi or as if there is none. (Saying fullness has Qi sensation, emptiness has no Qi sensation. *Suwen* says: Discussing fullness and emptiness refers to the degree of cold or warm Qi. 'Seeming as if there is none' means the manipulation is imperceptible.) Observe the sequence, as if existing or perishing. (Referring to the emptiness or fullness of Qi, and the sequence of tonification and sedation. Observing whether Qi has descended or persists.) Treating emptiness and fullness, it feels as if gaining or losing. (Tonification feels as if gaining; sedation feels as if losing. *Nanjing* says: Qi not yet firm and solid is gaining; soft and deficient is losing. Hence, 'as if gaining or losing.' *Suwen* says: Regarding emptiness and fullness, doctors must not lose the method. 'As if gaining or losing' means deviating from the method.) The key to emptiness and fullness lies in the Nine Needles. (*Suwen* says: Because each has its specific suitability.) The timing of tonification and sedation is determined by the needle. (*Suwen* says: The timing of tonification and sedation corresponds with the opening and closing of Qi.) Sedation is called meeting; hold and insert, release and withdraw, push away Yang to obtain the needle position, allowing pathogenic Qi to escape. Press and guide the needle out; this is internal warming, preventing blood dispersion and Qi exit.
Tonification is called following; mentally forget, moving or pressing as if walking, like a mosquito bite lingering, staying or returning, withdrawing like a breaking bowstring, causing Left to belong to Right, stopping Qi naturally, closing the external gate, filling the central Qi, ensuring no retained blood, urgently applying punitive methods. The way of holding the needle values firmness. Point straight and needle vertically, avoiding left-right deviation. Focus spirit on the haomao (fine hairs/skin level), attend to the patient. Examine blood vessels; needling will then be safe. During needling, focus on Xuanyang (suspended Yang) and the Two Weis (Wei Qi), keeping spirit attached without departing, knowing the survival or demise of the disease. Blood vessels lie horizontally beneath the skin; they appear distinctly clear to the eye and feel distinctively firm to touch.
If Qi does not arrive after needling, do not ask about the number of manipulations. If Qi arrives, remove the needle and do not needle again. Each needle has its specific indications and different shapes, each performing its designated function. The essence of needling is that efficacy occurs when Qi arrives. The certainty of efficacy is like wind blowing away clouds, clearly revealing the blue sky; thus, the Dao of needling is complete. Pathogenic Qi arrives tight and rapid; Gu Qi (Grain Qi/Righteous Qi) arrives slow and harmonious. (Both seen in *Jiuzhen Shier Yuan* and *Xiaozhen Jie*.)
Among all types of needling, three insertions reach Gu Qi. When pathogenic deviations combine wrongly, Yin and Yang exchange places, reversals and smoothness oppose, floating and sinking differ in location, and the four seasons fail to align, with Qi stagnating and overflowing, needles are required to remove it.
Thus, the first insertion expels Yang pathogens; the second expulsion expels Yin pathogens; the third insertion brings Gu Qi. Stop when Gu Qi arrives. What is meant by Gu Qi arriving is that after tonification, fullness is achieved; after sedation, emptiness is achieved. Thus, we know Gu Qi has arrived. What is meant by three insertions yielding Gu Qi is: first, shallow insertion piercing the skin to expel Yang pathogens; second, slightly deeper insertion piercing the skin to reach muscle, but not entering the intermuscular spaces; once entering the intermuscular spaces, Gu Qi emerges. Therefore, the needling method states: Start with shallow insertion to drive out pathogenic Qi and attract Blood and Qi. Then insert deeply to draw out Yin-pathogenic Qi. Finally, insert extremely deeply to bring down Gu Qi. This is what is meant. Thus, those who use needles, without knowing the annual influences, the prosperity and decline of Qi, and the origins of emptiness and fullness, cannot be skilled practitioners. (Both seen in *Zhongshi* and *Guanzhen* chapters.)
Above, awaiting Qi involves two types: one is Pathogenic Qi, the other is Gu Qi. Whenever Qi arrives during needling, await until Pathogenic Qi is exhausted; when exhausted, Gu Qi arrives; when it arrives, stop needling. Pathogenic Qi is described as tight and rapid, where tonification fails to create fullness and sedation fails to create emptiness. Gu Qi is described as slow and harmonious, where tonification achieves fullness and sedation achieves emptiness.
Observe the complexion, examine the eyes, know the dispersion, restore unity of form, listen to movement and stillness. (Superior physicians know the five colors in the eyes, and know how to adjust the Cun Kou and Chi Kou pulses—small/large, slow/fast, slippery/rough—to diagnose diseases.) Knowing pathogenic and righteous Qi, (Understanding the discussion of Deficient Pathogens and Righteous Pathogens winds.) Push forward with the right hand, hold and defend with the left. (Referring to inserting and withdrawing the needle.) Remove the needle when Qi arrives.
(Referring to removing the needle after Qi is harmonized through tonification and sedation.)
The above is from *Zhijie*. In all cases of preparing to use needles, one must first diagnose the severity or ease of the pulse Qi before treatment can proceed.
[From *Suwen*] Once the Five Zang organs are determined and the Nine Probes are prepared, then consider the needle. (Wang Bing's commentary: First determine the pulses of the Five Zang, then follow the diagnosis of the Nine Probes, and only then focus intention on the method of using needles.) Yellow Emperor asked: The classics speak of the prosperity and decline of Qi, shifting left and right, regulating below by above, regulating right by left, surplus and insufficiency, tonifying and sedating at Ying and Shu points. I understand this. These are shifts of Ying and Wei, arising from emptiness and fullness, not pathogenic Qi entering from outside into the meridians. I wish to hear about pathogenic Qi residing in the meridians; what are its pathological manifestations? How should it be treated? Qibo replied: The sage establishes measures, responding to Heaven and Earth. Thus, Heaven has stellar degrees, Earth has rivers and waters, and humans have meridians. When Heaven and Earth are mild and warm, river waters are calm. When Heaven is cold and Earth frozen, river waters congeal and flow sluggishly. When Heaven is hot and Earth warm, river waters boil and overflow. When sudden storms arise, river waters surge and rise in waves. When pathogenic Qi enters the vessels, cold causes blood to congeal and flow sluggishly; heat makes Qi fluid and moist. Deficient pathogens take advantage to invade, just as river waters react to wind. The arterial pulses of meridians also rise in waves at times; they move steadily within the vessels. Their arrival at the Cun Kou feels sometimes large, sometimes small. Large indicates pathogen arrival; small indicates peace. Their movement has no fixed location, alternating between Yin and Yang, defying fixed measurement. Following and examining them, across the Three Regions and Nine Probes, if suddenly encountered, block their path early. The Emperor asked: How to await Qi? Qibo said: When pathogenic Qi moves from collaterals into meridians, it lodges in blood vessels. Its cold and warmth have not yet interacted, like rising waves, coming and going, thus not constant. Therefore, when it comes, press and stop it, then treat it. Do not meet its peak surge to sedate. True Qi is Meridian Qi. If Meridian Qi is too deficient, it is said 'do not meet its arrival,' which is what this means. (*Lingshu* says: 'Do not meet its arrival' means when Qi is abundant, do not tonify.) Therefore, it is said: If awaiting pathogens is unexamined, and the major Qi has already passed, sedating will cause True Qi to escape; if it escapes, it cannot recover. Pathogenic Qi returns, and the disease accumulates further. Therefore, it is said 'do not pursue its departure,' which is what this means. (*Lingshu* says: 'Do not pursue its departure' means when Qi is deficient, do not sedate.) 'Cannot be delayed by a hair' means waiting for the pathogen to arrive before issuing the needle for sedation. ('Cannot be delayed by a hair' means Qi is easily lost.) If treating before or after improperly, Blood and Qi are exhausted, and the disease cannot be cured. Therefore, knowing the correct moment is like triggering a crossbow; not knowing it is like striking a cone. Therefore, those who know the Dao of mechanisms cannot be delayed by a hair; those who do not know, though struck, do not respond. This is what is meant. The Emperor asked: How to tonify and sedate? Qibo said: This is attacking pathogens. Withdraw rapidly to remove excess blood, thereby restoring True Qi. This applies when pathogens have newly invaded, flowing freely without fixed location. Pushing advances them; pulling stops them. Pricking against their flow extracts warm blood. Extracting the blood cures the disease immediately. When pathogens have newly invaded and arrived, without fixed location, pushing advances them, pulling stops them. Meeting them and sedating them cures the disease immediately. (All from *Lihe Zhenxie Lun*.)
The above describes the method of awaiting newly invaded pathogenic Qi in meridians and selecting points. It states that when pathogens first invade meridians, their cold and warmth have not yet clashed, like rising waves, coming and going, thus not constant. To treat them, one must examine between the Three Regions and Nine Probes and wait. If in one region or probe, one sees them coming like waves, press and stop them, then treat. Do not sedate merely because they surge forth. Hence, 'do not meet its arrival.' Or if awaiting Qi is unexamined, and the wave-like major pathogenic Qi has already passed, sedating causes True Qi to escape, pathogens return, and disease accumulates. Hence, 'do not pursue its departure.' In all cases of diagnosing the Three Regions and Nine Probes to await the opportunity of pathogen arrival for needling, one must concentrate fully. Hence, 'those who know the Dao of mechanisms cannot be delayed by a hair.' What is meant by waves is a floating and large pulse. The Three Regions and Nine Probes do not refer only to Cun, Guan, Chi, but rather three regions on the face, three on the hands, and three on the feet, combining to nine regions.
The Emperor said: Good. However, when True and Pathogenic Qi have merged, and waves do not rise, how to await? Qibo said: Carefully palpate the Three Regions and Nine Probes for excess and deficiency to regulate them. Observe losses and reductions between left/right and upper/lower. Examine the affected Zang organ to anticipate recovery. Not knowing the Three Regions means failing to distinguish Yin and Yang, Heaven and Earth. Earth probes the lower, Heaven probes the upper, Humanity probes the middle. Regulate the Central Palace to define the Three Regions. Therefore, it is said: If needling ignores the locations of the Three Regions and Nine Probes disease pulses, even if great excesses approach, the physician cannot prevent them. Punishing the innocent is called great confusion. Reversing the great meridians makes True Qi irrecoverable. Treating fullness as emptiness, mistaking pathogen for truth. Using needles without righteousness becomes a thief of Qi. Depriving people of righteous Qi, treating compliance as rebellion. Ying and Wei scatter and disorder, True Qi is lost. Pathogen alone lodges internally, cutting off long life, bringing premature disaster. Not knowing the Three Regions and Nine Probes prevents longevity, because one does not integrate them with the Four Seasons and Five Elements, adding mutual overcoming, releasing pathogen to attack Zheng, cutting off long life. (*Lihe Zhenxie Lun*)
The above describes the method of treating when pathogens have resided long, and True and Pathogenic Qi have merged. It states that for newly encountered pathogens, one only awaits the wave-like pulse to locate and treat. Now that pathogens have merged and waves do not rise, and the location of pathogen invasion is unknown, one must palpate the Three Regions and Nine Probes for excess and deficiency, sedating excess areas and tonifying deficient areas. If left and right are mismatched, with left larger and right finer, sedate left and tonify right. If upper and lower are mismatched, with upper larger and lower smaller, sedate upper and tonify lower. If upper smaller and lower larger, tonify upper and sedate lower. If left, right, upper, and lower are all diminished and fine, examine which Zang is diminished. Tonify the meridian of the diminished Zang according to its time of decline, and sedate the meridian it overcomes according to its time of prosperity. Wait until pathogens leave and True Qi recovers to stop. Therefore, it is said: If needling ignores the locations of the Three Regions and Nine Probes disease pulses, one punishes the innocent, reverses the great meridians, treats fullness as emptiness, mistakes pathogen for truth, loses True Qi, allows pathogen to lodge internally, and cuts off long life.
Superior physicians intervene at the sprouting stage. They must see the Qi of the Three Regions and Nine Probes, ensure it is fully regulated and not defeated, then intervene. Hence, they are called superior. Inferior physicians intervene at the formed stage, intervening at the defeated stage. Intervening at the formed stage means not knowing the mismatch of the Three Regions and Nine Probes, leading to defeat due to disease. Knowing the location means knowing where to diagnose the disease pulses of the Three Regions and Nine Probes to treat. Hence, guarding the gates, others do not know the condition, yet one sees the pathogenic form. (*Bazheng Shenming Lun*)
[From *Nanjing*] Speaking of superior physicians treating disease before it arises, and medium physicians treating disease after it arises, what does this mean? Answer: Treating disease before it arises means seeing liver disease, knowing the liver will transmit to the spleen, thus first strengthening Spleen Qi so it does not receive Liver pathogens. Hence, treating disease before it arises. Medium physicians see liver disease, do not understand transmission, and focus solely on treating the liver. Hence, treating disease after it arises. (Chapter 77) From the beginning of this section to here lies the essential purport of examining disease and using needles. Students should ponder and recognize this deeply. Medicine without knowing this is not skilled practice. Alas, in today's world, those who slightly know acupoint methods become arrogant and complacent, due to ignorance of the discourse on crude practitioners guarding form and superior practitioners guarding spirit. How lamentable.
[From *Lingshu*] Qi in the vessels: Pathogenic Qi is in the upper. (*Zhijie* says: Pathogens strike humans from high positions, hence Pathogenic Qi is in the upper.) Turbid Qi is in the middle. (Water and grain enter the Stomach; their essence ascends to the Lungs, while turbidity lingers in the intestines and stomach. If exposed to inappropriate cold or heat, or irregular diet, disease arises in the intestines and stomach, hence called Turbid Qi in the middle.) Clear Qi is in the lower. (Damp and cold earthy Qi strikes humans, necessarily starting from the feet, hence Clear Qi is in the lower.) Needling Xian Mai expels Pathogenic Qi. (Select upper points.) Needling Zhong Mai expels Pathogenic Qi. (Select Yangming He-Sea points.) Deep needling causes Pathogenic Qi to sink反而. (Shallow diseases should not be needled deeply; deep needling allows Pathogenic Qi to enter, hence 'sink instead'.) Skin, flesh, sinews, and vessels each have their locations. (Meridians and collaterals each govern specific areas.) Diseases each have their appropriateness. (*Jiayi Jing* reads 'Yi' as 'He'.) Each differs in shape, each assumes its appropriate function. (See *Xiaozhen Jie* and *Jiuzhen Shier Yuan*.)
[From *Suwen*] Diseases have floating and sunken levels; needling has shallow and deep depths. Each must reach its proper principle, exceeding the path is wrong. Exceeding causes internal injury; falling short causes external obstruction. Obstruction allows pathogens to enter. Incorrect depth becomes a great thief, disturbing the Five Zang internally, later generating serious disease. Therefore, it is said: Diseases may reside in hair follicles and couli, in the skin, in the muscles, in the vessels, in the sinews, in the bones, in the marrow, etc. (*Ciyao Lun*) Disease in vessels regulates Blood; disease in Blood regulates Collaterals; disease in Qi regulates Wei Qi; disease in flesh regulates Fenrou (intermuscular spaces); disease in sinews regulates Sinews; disease in bones regulates Bones. Burning needles and劫刺 (seizing/stabbing) below and in acute conditions. (Wang Bing commentary: Method for regulating sinews.) Disease in bones, use needle and medicinal moxibustion/warming. (Method for regulating bones.) Disease with unknown pain location, use Du Mai and Ren Mai (Two Qiao) as primary. (Needle collateral vessels.) Pain on the left but disease in the right pulse, use Ju Ci. (Needle main meridians. See *Tiaojing Lun* chapter.)
[From *Lingshu*] Hand flexed but unable to extend: disease in sinews. Extended but unable to flex: disease in bones. In bone, guard bone; in sinew, guard sinew. (*Zhongshi* chapter.)
[From *Nanjing*] Speaking of needling Ying without injuring Wei, and needling Wei without injuring Ying, what does this mean? Answer: For needling Yang, insert the needle horizontally. For needling Yin, first use the left hand to press and stabilize the Ying-Shu point area; once Qi disperses, insert the needle. This is called needling Ying without injuring Wei, and needling Wei without injuring Ying. (See Chapter 71.)
[From *Suwen*] Needling bone should not injure sinew; needling sinew should not injure flesh; needling flesh should not injure vessel; needling vessel should not injure skin; needling skin should not injure flesh; needling flesh should not injure sinew; needling sinew should not injure bone. 'Needling bone without injuring sinew' means the needle reaches the sinew and is withdrawn, not penetrating to the bone. 'Needling sinew without injuring flesh' means reaching the flesh and withdrawing, not penetrating to the sinew. 'Needling flesh without injuring vessel' means reaching the vessel and withdrawing, not penetrating to the flesh. 'Needling vessel without injuring skin' means reaching the skin and withdrawing, not penetrating to the vessel. (Lin Yi commentary: This refers to not reaching the intended depth of needling.) 'Needling skin without injuring flesh' means disease is in the skin; insert needle into the skin without injuring flesh. 'Needling flesh without injuring sinew' means passing through the flesh into the sinew. 'Needling sinew without injuring bone' means passing through the sinew into the bone. This is called reverse needling. (Warning against being too deep. *Ciqi Lun*.)