太阳病，初服桂枝汤，反烦不解者，先刺风池、风府，却与桂枝汤则愈。
【按】
风池穴在颞□后，颞□脑空穴也。后者，谓侠玉枕傍，骨下发际内，大筋外陷中，按
之引耳中是也。足少阳、阳维之会，宜刺三分，肌肉厚者可五分，留七呼，禁灸。风
府一穴，在项发际上一寸，大筋内宛宛中，疾言其肉立起，言休立下，是其穴也。督
脉、阳维之会，宜刺三分肌肉薄者只二分，候病人呼气即出，禁灸。太阳之邪，刺足
少阳督脉者，何也？盖以风府在头部中行，风池在第三行，太阳在第二行，则风池、
风府实侠太阳经而行者也，况二穴皆为阳维之会，阳维者，谓诸阳之总也。刺之，诸
阳之气得泄，何患太阳之邪不去哉。
（图）
太阳病，头痛至七日以上自愈者，以行其经尽故也。若欲作再经者，针足阳明，使经
不传则愈。
【按】
仲景云：针足阳明，成注未明指其穴。考之庞氏『总病论』云：补足阳明上三里穴。
推其意，得补则经气实而不传，殊不知仲景之意，针足阳明为迎而夺之，以泄其经之
热，使热邪得泄，不至再传他经，故云愈也。庞氏不明用针之理，以泄为补，恐误矣
。又考张氏缵论云：刺足阳明冲阳穴，冲阳者，即仲景所谓趺阳脉也，有诊法而不言
刺，张氏之言，实本史氏『伤寒论注』，不足法也。三里二穴，在膝眼下三寸，胻骨
外廉两筋间宛宛中，坐而竖膝，低跗取之，极重按之，则跗上动脉即止，是其穴也，
可刺五分，留七呼。
（图）
伤寒，腹满□语，寸口脉浮而紧，此肝乘脾也，名曰纵，刺期门。
伤寒发热，涩涩恶寒，大渴欲饮水，其腹必满，自汗出，小便利，其病欲解，此肝乘
肺也，名曰横，刺期门。
妇人中风，发热恶寒，经水适来，得之七、八日，热除而脉迟身凉，胸□下满，如结
胸状，□语者，此为热入血室也，当刺期门，随其实而泻之。
阳明病，下血□语者，此为热入血室，但头汗出者，刺期门，随其实而泻之，濈然汗
出则愈。太阳与少阳并病，头项强痛或眩冒，时如结胸，心下痞□者，当刺大椎第一
间肺俞、肝俞，慎不可发汗，发汗则□语脉弦，五、六日□语不止，当刺期门。
【按】
『图经』云：期门二穴，在不容傍一寸五分，乳直下，第二肋骨端，近腹处，是其穴
也。第二肋者，从下数至第二肋也。肋骨端者，在软肋骨末之端也。刺四分，肥人量
之。
（图）
太阳与少阳并病，头项强痛或眩冒，时如结胸，心下痞□者，当刺大椎第一间肺俞、
肝俞，慎不可发汗，发汗则□语脉弦，五、六日□语不止，当刺期门。
太阳、少阳并病，心下□，颈项强而眩者，当刺大椎、肺俞、肝俞，慎勿下之。
【按】
『图经』云：督脉大椎穴，在第一椎上陷中，可刺五分，留三呼，泄五吸。肺俞二穴
，在第三椎下，两傍相去各一寸五分，可刺三分，留七呼，得气即泄，肥人可刺五分
。肝俞二穴，在第九椎下，两傍相去各一寸五分，可刺三分，留六呼。仲景太阳少阳
并病，乃合邪也，故刺大椎、肺俞、肝俞，亦合泄之法也。
（图）
少阴病，得之二、三日，口中和，其背恶寒者，当灸之，附子汤主之。
【按】
当灸之，仲景未言灸何穴。常器之云：当是足太阳鬲关二穴，专灸背恶寒。其穴在第
七椎下，两傍相去各三寸陷中，正坐取之，可灸五壮。盖以太阳为少阴之表，故外灸
鬲关以温其表，内用附子以温其里也。
（图）
少阴病吐利，手足不厥冷，反发热者，不死，脉不至，灸少阴七壮。
【按】
灸少阴七壮，仲景未言灸何穴。常器之云：当灸少阴太溪二穴。经曰：肾之原出于太
溪，其穴在内踝后跟骨，动脉陷中。
（图）
少阴病，下利便脓血者，可刺。
【按】
可刺，仲景未言可刺何穴。常器之云：可刺足少阴幽门、交信。郭壅曰：可灸。考幽
门二穴，在鸠尾下一寸，巨阙两傍各五分陷者中，治泻利脓血，刺五分灸五壮。交信
二穴，在内踝上二寸，少阴前太阴后，廉筋骨间，治泻利赤白，刺四分留五呼，灸三
壮。两说皆是。
（图）
少阴病，下利脉微涩，呕而汗出，必数更衣，反少者，当温其上，灸之。
【按】
灸之，仲景未言当灸何穴。常器之云：灸太冲。郭雍云：灸太溪。此穴皆不治呕而汗
出，里急下利，惟幽门主治干哕，呕吐，里急，下利，亦当灸幽门为是。
伤寒六、七日，脉微，手足厥冷，烦躁，灸厥阴，厥不还者死。
【按】
灸厥阴，仲景未言当灸可穴。常器之云：可灸太冲。以太冲二穴，为足厥阴之所注，
凡病诊太冲脉，可决人之生死。其穴在足大指本节后二寸，跗间陷者中，动脉应手，
是其穴也，灸三壮。
（图）
伤寒脉促，手足厥者 ，可灸之。
【按】
可灸之，仲景未言当灸何穴，常器之云：太冲穴。前条手足厥逆，灸太冲；此条亦手
足厥逆，亦当灸太冲。
2 <>清·吴谦等编··医宗金鉴(订正仲景全书金匮要略注)
太阳病，初次服用桂枝汤后，反而出现烦闷且症状未解除的，应当先针刺风池穴、风府穴，然后再给予桂枝汤治疗，即可痊愈。
【按语】
风池穴位于颞部后方，即颞骨与脑空穴所在之处。所谓“后方”，是指位于玉枕骨旁侧，骨骼下方发际线以内，大筋外侧的凹陷中，按压时感觉牵引至耳中，这就是该穴位。此穴为足少阳胆经与阳维脉的交会穴，适宜进针三分深，若肌肉丰厚者可进针五分深，留针七次呼吸的时间，禁止施灸。风府穴一个，位于项部发际线上一寸处，大筋内侧的凹陷中，快速说话时肌肉会立即隆起，停止说话时肌肉随即落下，这就是该穴位。此穴为督脉与阳维脉的交会穴，适宜进针三分深，肌肉薄弱者只进针二分深，待病人呼气时出针，禁止施灸。为什么太阳病的邪气要针刺足少阳胆经和督脉呢？因为风府穴在头部正中线上，风池穴在第三侧行线上，而太阳经在第二侧行线上，那么风池、风府实际上就是夹持着太阳经而行的穴位，况且这两个穴位都是阳维脉的交会穴，阳维脉被称为诸阳之脉的总汇。针刺它们，可以使诸阳之气得以宣泄，还担心太阳经的邪气不能去除吗？
（图）
太阳病，头痛持续七天以上自行痊愈的，是因为邪气在经络中运行已尽的缘故。如果邪气想要传入下一经（再经），针刺足阳明胃经的穴位，使邪气不传变则能痊愈。
【按语】
张仲景说：针刺足阳明胃经，成无己的注解没有明确指出具体穴位。考证庞安时的《总病论》说：补益足阳明胃经的上三里穴。推测其意，得到补益则经气充实而不传变，却不知道张仲景的本意是，针刺足阳明胃经是为了“迎而夺之”（泻法），以泄去该经的热邪，使热邪得以宣泄，不再传变到其他经，所以说痊愈。庞氏不明白用针的道理，将泻法当作补法，恐怕是错误的。又考证张元素《伤寒直格》说：刺足阳明胃经的冲阳穴，冲阳穴，就是张仲景所说的趺阳脉，有诊断方法但没有提及针刺，张氏的说法，实际上源自史氏的《伤寒论注》，不值得效法。三里穴两个，在膝眼下三寸，胫骨外侧两筋之间的凹陷中，坐着竖起膝盖，低脚背取穴，用力重按，如果足背动脉停止跳动，那就是穴位所在，可进针五分深，留针七次呼吸的时间。
（图）
伤寒病，腹部胀满、胡言乱语，寸口脉浮而紧，这是肝木乘脾土，名叫“纵”，针刺期门穴。
伤寒发热，瑟瑟恶寒，极度口渴想喝水，腹部必然胀满，自汗出，小便通利，病情将要解除，这是肝木乘肺金，名叫“横”，针刺期门穴。
妇女患中风，发热恶寒，月经适来，经过七八天，热退而脉迟身凉，胸胁下胀满，像结胸证的样子，胡言乱语的，这是热入血室，应当针刺期门穴，根据其实证情况采用泻法。
阳明病，便血、胡言乱语的，这是热入血室，只有头部出汗的，针刺期门穴，根据其实证情况采用泻法，全身濈然汗出则痊愈。太阳病与少阳病并病，头项强痛或眩晕昏冒，时常像结胸证，心下痞塞不通的，应当针刺大椎第一间、肺俞、肝俞，千万不要发汗，发汗则会出现胡言乱语、脉弦，五、六天后胡言乱语不止，应当针刺期门穴。
【按语】
《图经》说：期门穴两个，在不容穴旁边一寸五分处，乳头直下，第二肋骨端，靠近腹部处，就是该穴位。第二肋，是从下往上数到第二根肋骨。肋骨端，是在软肋骨末端的尖端。进针四分深，肥胖的人酌情调整。
（图）
太阳病与少阳病并病，头项强痛或眩晕昏冒，时常像结胸证，心下痞塞不通的，应当针刺大椎第一间、肺俞、肝俞，千万不要发汗，发汗则会出现胡言乱语、脉弦，五、六天后胡言乱语不止，应当针刺期门穴。
太阳、少阳并病，心下痞塞，颈项强直而眩晕的，应当针刺大椎、肺俞、肝俞，千万不要攻下。
【按语】
《图经》说：督脉的大椎穴，在第一椎骨上方的凹陷中，可进针五分深，留针三次呼吸的时间，泻法配合五次吸气。肺俞穴两个，在第三椎骨下方，两旁相距各一寸五分，可进针三分深，留针七次呼吸的时间，得气后即出针，肥胖的人可进针五分深。肝俞穴两个，在第九椎骨下方，两旁相距各一寸五分，可进针三分深，留针六次呼吸的时间。张仲景所说的太阳少阳并病，是合邪所致，所以针刺大椎、肺俞、肝俞，也是符合泻法的原理。
（图）
少阴病，发病二、三天，口中平和不苦，背部怕冷的，应当施灸，用附子汤主治。
【按语】
应当施灸，张仲景没有说明灸哪个穴位。常器之说：应当是足太阳膀胱经的膈关穴两个，专门灸治背部怕冷。该穴位在第七椎骨下方，两旁相距各三寸的凹陷中，正坐取穴，可灸五壮。因为太阳经是少阴经的表里关系，所以外灸膈关以温煦其表，内用附子以温煦其里。
（图）
少阴病呕吐腹泻，手足不冰冷，反而发热的，不会死亡，脉搏摸不到，灸少阴经穴位七壮。
【按语】
灸少阴经七壮，张仲景没有说明灸哪个穴位。常器之说：应当灸少阴肾经的太溪穴两个。经文说：肾的原穴出于太溪，该穴位在内踝后方跟骨处的动脉凹陷中。
（图）
少阴病，腹泻伴有脓血的，可以针刺。
【按语】
可以针刺，张仲景没有说明可以针刺哪个穴位。常器之说：可以针刺足少阴肾经的幽门、交信穴。郭雍说：可以施灸。考证幽门穴两个，在鸠尾穴下一寸，巨阙穴两旁各五分深的凹陷中，治疗泻痢脓血，进针五分深，灸五壮。交信穴两个，在内踝上二寸，少阴经之前太阴经之后，廉筋骨之间，治疗泻痢赤白，进针四分深，留针五次呼吸的时间，灸三壮。两种说法都有道理。
（图）
少阴病，腹泻脉象微涩，呕吐且出汗，必定频繁更衣，但排便量少，应当温其上部的穴位，施灸。
【按语】
施灸，张仲景没有说明应当灸哪个穴位。常器之说：灸太冲穴。郭雍说：灸太溪穴。这些穴位都不能治疗呕吐出汗、里急后重和下利，只有幽门穴主治干呕、呕吐、里急、下利，所以应当灸幽门穴才是正确的。
伤寒六、七天，脉象微弱，手足冰冷，烦躁，灸厥阴经穴位，如果厥逆不回转的就会死亡。
【按语】
灸厥阴经，张仲景没有说明应当灸哪个穴位。常器之说：可以灸太冲穴。因为太冲穴两个，是足厥阴肝经所注的穴位，凡是疾病诊察太冲脉，可以判断人的生死。该穴位在足大趾本节后二寸，足背间的凹陷中，动脉应手，就是该穴位，灸三壮。
（图）
伤寒脉促，手足冰冷的，可以施灸。
【按语】
可以施灸，张仲景没有说明应当灸哪个穴位，常器之说：太冲穴。前一条手足厥逆，灸太冲；这一条也是手足厥逆，也应当灸太冲。
Taiyang disease, after initially taking Guizhi Tang (Cinnamon Twig Decoction), if there is contrary irritability and the condition does not resolve, first puncture Fengchi (GB20) and Fengfu (GV16), then administer Guizhi Tang (Cinnamon Twig Decoction) to achieve recovery.
[Commentary]
Fengchi (GB20) is located posterior to the temporal region, corresponding to the area of the temporal bone and Naokong (EX-HN19). "Posterior" refers to the depression lateral to the Yuzhen bone, inside the hairline below the bone, outside the large tendon, where pressure induces a sensation radiating to the ear; this is the acupoint. It is the intersection of the Foot-Shaoyang Gallbladder Meridian and the Yang-Wei Vessel. It is suitable for puncturing 3 cun deep; if the muscle is thick, 5 fen deep. Retain the needle for seven breaths. Moxibustion is contraindicated. The Fengfu (GV16) acupoint is located one cun above the nape hairline, in the depression inside the large tendon. When speaking quickly, the muscle rises immediately; when speech ceases, it falls immediately; this is the acupoint. It is the intersection of the Du Mai (Governing Vessel) and the Yang-Wei Vessel. It is suitable for puncturing 3 fen deep; if the muscle is thin, only 2 fen deep. Withdraw the needle upon the patient's exhalation. Moxibustion is contraindicated. Why puncture the Foot-Shaoyang Gallbladder Meridian and the Du Mai (Governing Vessel) for Taiyang pathogenic factors? Because Fengfu (GV16) is on the midline of the head, Fengchi (GB20) is on the third lateral line, while the Taiyang Meridian is on the second lateral line. Thus, Fengchi (GB20) and Fengfu (GV16) actually flank the Taiyang Meridian. Moreover, both points are intersections with the Yang-Wei Vessel, which is considered the master of all Yang meridians. Puncturing them allows the Qi of all Yang meridians to be vented; how could one worry that the Taiyang pathogen would not be expelled?
(Figure)
In Taiyang disease, headache persisting for seven days or more may resolve spontaneously because the pathogen has exhausted its course in the meridian. If there is a desire for the pathogen to transmit to the next meridian (re-transmission), puncture the Foot-Yangming Stomach Meridian to prevent transmission, thereby achieving recovery.
[Commentary]
Zhang Zhongjing stated: "Puncture the Foot-Yangming Stomach Meridian." Cheng Wuji's commentary did not specify the acupoint. Examining Pang Anshi's *Zong Bing Lun* (General Discussion on Diseases), it states: "Tonify the Shangsanli (Upper Three Li) point of the Foot-Yangming Stomach Meridian." Inferring the intent, tonification makes the meridian Qi substantial and prevents transmission. However, this misunderstands Zhang Zhongjing's intent. Puncturing the Foot-Yangming Stomach Meridian is intended for "meeting and seizing" (Ying Er Duo Zhi, a reducing method) to vent the heat of the meridian. By venting the pathogenic heat, it prevents transmission to other meridians, hence "recovery." Pang Shi did not understand the principle of acupuncture, mistaking reduction for tonification, which is likely erroneous. Furthermore, examining Zhang Yuansu's *Shanghan Zhilun*, it states: "Puncture Chongyang (ST42) of the Foot-Yangming Stomach Meridian." Chongyang (ST42) is what Zhang Zhongjing referred to as the Fuyang Pulse. There is a diagnostic method but no mention of puncture. Zhang's statement is actually based on Shi's *Shanghan Lun Zhu*, which is not worthy of emulation. The Sanli (ST36) acupoints are two, located three cun below the knee, in the depression between the two tendons on the lateral side of the tibia. Sit with knees upright, lower the foot dorsum to locate. Press heavily; if the dorsal arterial pulse stops, that is the acupoint. Puncture 5 fen deep, retain for seven breaths.
(Figure)
In Shanghan (Cold Damage) disease, abdominal fullness and delirium, with the Cun Kou pulse floating and tight, indicate Liver Wood overacting on Spleen Earth, named "Zong" (Vertical Transmission). Puncture Qimen (LR14).
In Shanghan disease, fever, shivering aversion to cold, extreme thirst desiring water, abdominal fullness, spontaneous sweating, and free urination indicate the disease is about to resolve. This is Liver Wood overacting on Lung Metal, named "Heng" (Horizontal Transmission). Puncture Qimen (LR14).
In women with Wind Strike, fever and aversion to cold, with menstruation just beginning, after seven or eight days, if the heat subsides, the pulse becomes slow, the body cools, there is subcostal fullness resembling Jie Xiong (Chest Binding), and delirium, this is Heat entering the Blood Chamber. One should puncture Qimen (LR14), following the excess pattern to apply reduction.
In Yangming disease, bleeding from the rectum and delirium indicate Heat entering the Blood Chamber. If only the head sweats, puncture Qimen (LR14), following the excess pattern to apply reduction. If generalized sweating ensues, recovery occurs. In concurrent Taiyang and Shaoyang disease, with stiff and painful head and neck, dizziness or vertigo, occasional sensation resembling Chest Binding, and epigastric stuffiness, one should puncture Dazhui (GV14) [first interspace], Feishu (BL13), and Ganshu (BL18). Caution against inducing sweating; inducing sweating leads to delirium and a string-taut pulse. If delirium persists for five or six days, puncture Qimen (LR14).
[Commentary]
*Tujing* states: Qimen (LR14) consists of two acupoints, located 1.5 cun lateral to Burong (ST19), directly below the nipple, at the end of the second rib, near the abdomen. This is the acupoint. "Second rib" counts from the bottom up to the second rib. "Rib end" refers to the tip of the costal cartilage. Puncture 4 fen deep; adjust for obese individuals.
(Figure)
In concurrent Taiyang and Shaoyang disease, with stiff and painful head and neck, dizziness or vertigo, occasional sensation resembling Chest Binding, and epigastric stuffiness, one should puncture Dazhui (GV14) [first interspace], Feishu (BL13), and Ganshu (BL18). Caution against inducing sweating; inducing sweating leads to delirium and a string-taut pulse. If delirium persists for five or six days, puncture Qimen (LR14).
In concurrent Taiyang and Shaoyang disease, with epigastric stuffiness, stiff neck, and dizziness, one should puncture Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). Caution against purgation.
[Commentary]
*Tujing* states: The Dazhui (GV14) acupoint of the Du Mai (Governing Vessel) is in the depression above the first thoracic vertebra. Puncture 5 fen deep, retain for three breaths, reduce during five inhalations. The Feishu (BL13) acupoints are two, located below the third thoracic vertebra, 1.5 cun lateral on each side. Puncture 3 fen deep, retain for seven breaths, withdraw upon obtaining Deqi (arrival of Qi); for obese individuals, puncture 5 fen deep. The Ganshu (BL18) acupoints are two, located below the ninth thoracic vertebra, 1.5 cun lateral on each side. Puncture 3 fen deep, retain for six breaths. Zhang Zhongjing's concurrent Taiyang and Shaoyang disease involves combined pathogens; thus, puncturing Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) also conforms to the method of reduction.
(Figure)
In Shaoyin disease, occurring two or three days after onset, with a normal mouth feel and aversion to cold in the back, moxibustion should be applied, and Fuzi Tang (Aconite Decoction) should be administered as the primary formula.
[Commentary]
"Moxibustion should be applied," Zhang Zhongjing did not specify the acupoint. Chang Qizi stated: It should be the Ge Guan (BL17) acupoints of the Foot-Taiyang Bladder Meridian, specifically for treating back aversion to cold. These acupoints are located below the seventh thoracic vertebra, 3 cun lateral on each side in the depression. Locate in a sitting position. Apply 5 moxa cones. Since the Taiyang Meridian is the exterior counterpart of the Shaoyin Meridian, external moxibustion on Ge Guan (BL17) warms the exterior, while internal administration of Aconite warms the interior.
(Figure)
In Shaoyin disease with vomiting and diarrhea, if the hands and feet are not cold but instead feverish, death will not occur. If the pulse is absent, moxa seven cones on the Shaoyin acupoints.
[Commentary]
"Moxa seven cones on the Shaoyin acupoints," Zhang Zhongjing did not specify the acupoint. Chang Qizi stated: One should moxa the Taixi (KI3) acupoints of the Shaoyin Kidney Meridian. The Classic states: The Yuan-Source point of the Kidney emerges at Taixi (KI3). This acupoint is located behind the medial malleolus, in the depression of the posterior tibial artery.
(Figure)
In Shaoyin disease with diarrhea and pus/blood in the stool, puncture is permissible.
[Commentary]
"Puncture is permissible," Zhang Zhongjing did not specify the acupoint. Chang Qizi stated: One may puncture Youmen (KI21) and Jiaoxin (KI8) of the Foot-Shaoyin Kidney Meridian. Guo Yong stated: Moxibustion is permissible. Examining Youmen (KI21), there are two acupoints, located one cun below Jiutui (CV15), 0.5 cun lateral to Juque (CV14) in the depression. It treats dysentery with pus and blood. Puncture 5 fen deep, moxa 5 cones. Jiaoxin (KI8) consists of two acupoints, located 2 cun above the medial malleolus, anterior to the Shaoyin Meridian and posterior to the Taiyin Meridian, between the fascia and bone. It treats dysentery with red and white discharge. Puncture 4 fen deep, retain for five breaths, moxa 3 cones. Both statements are valid.
(Figure)
In Shaoyin disease with diarrhea, a faint and choppy pulse, vomiting, and sweating, with frequent defecation attempts but small volume, one should warm the upper acupoints and apply moxibustion.
[Commentary]
"Apply moxibustion," Zhang Zhongjing did not specify the acupoint. Chang Qizi stated: Moxa Taichong (LR3). Guo Yong stated: Moxa Taixi (KI3). Neither of these acupoints treats vomiting with sweating, tenesmus, and diarrhea. Only Youmen (KI21) treats dry retching, vomiting, tenesmus, and diarrhea. Therefore, moxa on Youmen (KI21) is correct.
In Shanghan (Cold Damage) disease, six or seven days later, with a faint pulse, cold hands and feet, and restlessness, moxa the Jueyin acupoints. If the cold limbs do not return, death ensues.
[Commentary]
"Moxa the Jueyin acupoints," Zhang Zhongjing did not specify the acupoint. Chang Qizi stated: One may moxa Taichong (LR3). Because Taichong (LR3) consists of two acupoints, they are the Shu-Stream points of the Foot-Jueyin Liver Meridian. In any disease, diagnosing the Taichong pulse can determine life or death. This acupoint is located two cun distal to the metatarsophalangeal joint of the great toe, in the depression between the metatarsals, where the arterial pulse is palpable. This is the acupoint; moxa 3 cones.
(Figure)
In Shanghan (Cold Damage) disease, with a rapid and intermittent pulse and cold hands and feet, moxibustion is permissible.
[Commentary]
"Moxibustion is permissible," Zhang Zhongjing did not specify the acupoint. Chang Qizi stated: Taichong (LR3) acupoint. The previous clause mentioned cold limbs and moxa on Taichong; this clause also mentions cold limbs, so one should also moxa Taichong (LR3).