诸本无篇字。马云。篇内所言诸病不一。然论热病更多。故名篇。
偏枯（止）乃可复也 志云。经曰虚邪偏客于身半。其入深。内居荣卫。荣卫稍衰。故真气去。邪气独
留。故为偏枯。（案出刺节真邪论）是风寒之邪。偏中于形身。则身偏不用而痛。夫心主言。肾藏志。言不变。
志不乱。此病在于分腠之间。而不伤于内也。以巨针取之。益其正气之不足。损其邪气之有余。而偏伤之正气。
乃可复也。巨针、大针也。取大气不出关节。大气虚风也。巨针取之。千金作温卧取汗。
痱之为病也（止）不可治也 简案、据巢源、外台、痛下衍者字。张云。痱、亦风寒属。犹言废也。上节
言身偏不用而痛。此言身不知痛。而四肢不收。是偏枯痱病之辨也。智乱不甚。其言微有知者。神气未为全去。
犹可治也。神失则无能为矣。圣济总录云。字书谓病痱而废。肉非其肉者。以身体无痛。四肢不收。而无所用
也。楼氏纲目云。右内经论中风之浅深也。其偏枯。身偏痛。而言不变。志不乱者。邪在分腠之间。即仲景、
东垣所谓邪中腑是也。痱病无痛。手足不收。而言喑志乱者。邪入于里。即仲景、东垣所谓邪中脏是也。痱、
废也。痱即偏枯之邪气深者。痱与偏枯是二疾。以其半身无气荣运。故名偏枯。以其手足废而不收。或名痱。
或偏废。或全废。皆曰痱也。（楼又云中风世俗之称也其症卒然仆倒口眼 斜半身不遂或舌强不言唇吻不收是
也然名各有不同其卒然仆倒者经称为击仆世又称为中乃国中风时如此也其口眼 斜半身不遂者经称为偏枯世又
称为左瘫右痪及 腿风乃中倒后之证邪之浅者如此也其舌强不言唇吻不收者经称为痱病世又称为风懿风气亦中
倒后之症邪之深者如此也）
病先起于阳（止）浮而取之 甲乙。净而取之。作必审其气之净沉而取之。张云。此治必先其本也。病
先起于阳分。故当先刺其表。浮而取之。而后取其阴。此下不言先起于阴者。然病始于阴。直中脏也。多不可
治。故不复言之。
介按、吴鞠通曰。实其阴以补其不足。此一句实治温热之吃紧大纲。盖热病未有不耗阴者。其耗之未尽则
生。尽则阳无留恋。必脱而死也。而叶子雨谓吴注颇明析。治温暑。保津液。固为第一义。知泻其阳之有余。
即所以补其阴之不足。则进乎道矣。
热病三日（止）以补其不足者 张云。此下所言热病。即伤寒时疫也。热病三日。邪犹居表。若气口
静而人迎躁者。正病在三阳。而未入阴分。故当取诸阳经。为五十九刺。以泻阳邪之实。仍补三阴之不足也。
身热甚（止）有死征也 张云。身热甚而阴阳之脉皆静者。阳证得脉阴也。故不宜刺。若察其可刺者。
当急取之。虽不汗出。则邪亦从而泄矣。此言勿刺者。以其脉证相反。有死征也。下文皆然。
脉口动喘而短（止）浅刺手大指间 甲乙。短、作眩。张从一本作弦。马云。其脉口之脉甚动。证则
喘而短气。当急取手太阴肺经之少商。张云。热病七八日。邪必深至阴分。故脉口之脉当动。疾如喘而且弦。
志云。按素问有喘脉。喘而短者。谓脉之喘动于寸口。而不及于尺。故知其可汗解也。王师曰。喘者喘滑如珠
也。简案、据下文喘且复热。又喘甚者死。及甲乙喘即证而非脉也。
脉微小（止）一日死 张云。脉微小者。正气虚也。溲血口中干者。伤其阴也。皆为死证。若脉来变乱
失常。是为代脉。其死尤促。
热病已得汗出（止）喘甚者死 甲乙。勿刺肤、作勿庸刺。张云。热病已得汗。邪当退矣。若脉尚躁。
气尚喘。身复热者。是谓不为汗衰。乃反证也。故勿刺其肤。刺而重伤其气。若喘甚者。则必死也。
躁不散数（止）勿腠刺之 甲乙。腠刺之、作庸刺。巢源同。马云。脉虽不躁。然亦不散且带数。是邪
尚未退。当再过三日之中。宜有汗出而愈。若不汗出。乃正气衰而不能为汗。至于四日当死也。且未曾汗出。
勿刺其肤腠。刺之无益也。张云。脉犹不躁。则阴之类也。即有躁意。而力不散大。至不数疾。皆正气衰微。
不能鼓动。亦阴之类也。必且未能解散。故当再俟三日。庶得有汗。若三日不汗。又逾四日。则病在旬日外矣。
阴阳不应期。当死也。志云。热病七八日。脉不躁者。外已解也。脉即躁而不散数。此邪热虽未去。而正气不
伤。后三日乃再经之十一日。此复傅于里阴。必得阴液之汗而解。故未曾汗者。勿腠刺之。当取汗于阴也。若
三日不汗。乃阳热盛而阴气已绝。故至四日而死。简案、三说未知孰是。志注似允当。
窒鼻充面（止）五十九 甲乙九下有刺字。下并同。马云。肺属金。其合在皮。今热病之始。肤痛鼻塞。
而亦充然而浮。乃病在于皮也。当取之皮以泻之。所谓刺皮无伤肉之义也。用第一针。名 针者。以刺五十九
穴之皮。
苛轸鼻（止）火者心也 甲乙。苛轸鼻、作苛鼻干。注。灵枢作诊鼻干。马云。轸、当作 。海篇有此
字。身体苛重。鼻上生疹。皆皮病也。此其求之于皮。即所以求之于肺也。如刺之而病不得退。则当求之于火。
所谓火者心也。补其心经。以致火王则金衰。肺热自可退耳。张云。苛、深也。轸、车上前后两端横木也。言
鼻窒之甚。内外不通。亦犹轸之横塞也。简案、苛轸谓小疹也。苛、疥也。本小草之谓。故假为疥之义。礼记、
疾痛苛养。素问苛疾肉苛。义并同。轸、本作胗。见释名。又作 。病源多用轸字。乃瘾疹之疹也。张注尤误。
身涩倚（止）水者肾也 甲乙。倚、作烦。 、作闷。干唇口嗌、作唇嗌干。马张志。取之皮、作取
之脉是也。马云。其身涩滞。倚着而热。心则烦闷。唇口与嗌皆干。乃病在于脉也。当取之脉以泻之。所谓刺
脉无伤皮也。用第一针名曰 针者。以刺五十九穴之脉。正以肤胀、口干、冷汗出。皆脉病也。此其求之于脉。
即所以求之于心也。如刺之而病不得退。则当求之于水。所谓水者肾也。补其肾经。致水王则火衰。心热自可
退耳。张云。涩、燥涩也。倚、身无力也。简案、涩倚未详其义。千金有伤寒 涩语。巢源作 啬。亦不知何谓。
热病嗌干（止）水者肝也 甲乙。目 青、作目 赤。马云。热病而嗌干故多饮。且善惊悸。四肢懈
倦。卧不能起。乃病在于肉也。当取之肤肉以泻之。所谓刺肉无伤筋也。用第六针名曰圆利针者。以刺五十九
穴之肉。正以目 色青。乃木来克土。主肉病也。此其求之于肉。即所以求之于脾也。如刺之而病不得退。则
当求之于木。所谓木者肝也。补其肝木。以致木王则土衰。脾热自可退耳。志云。此当以第四针取肤肉。
面青脑痛（止）金者肺也 甲乙。面青脑、作而胸胁。第四针下更有针字。张云。热病面青。肝色见也。
脑痛。厥阴肝经与督脉会于巅也。手足躁者。肝之荣在爪。木病在四末也。皆肝经之病。故当取之筋结之间。
用第四针曰锋针者。以泻其四逆等证。四逆者。肝邪盛而四肢厥也。筋 者。足不能行也。目浸者。泪出不收
也。皆为肝病。肝属木。其合在筋。故但求之于筋。即所以求于肝也。若求肝不得其效。则当求之于金。金者
肺也。补肺之气。则金能胜木。而肝热可平矣。简案、手足躁。其义未详。马云。以脾主四肢。而
肝热有余。四肢热也。志云。肝主筋。诸筋皆起于四肢之指井并经。而循于形身。故手足为之躁扰。志注稍通。
数惊（止）木者肾也 志云。心病热。故数惊。本经曰。心脉急甚为 。心气实则狂也。当取之脉。
以第四针急泻其血络之有余者。癫疾、脉癫疾也。发者、血之余。若癫疾而毛发去。当索血于心。不得索之水。
水者、肾也。取肾水之气以胜制其心火。
身重（止）土者脾也 甲乙。耳青、作耳青赤。志云。肾为生气之原。热伤气。故身重。肾主骨。故
骨痛也。骨开窍于耳。肾气逆。故耳聋。病在少阴。故欲寐也。当取之骨。以第四针为五十九刺之法以刺骨。
若病而不欲食者。肾气实也。经曰。肾是动。病饥不欲食。 齿者。热盛而切牙也。齿者骨之余。耳者肾之窍。
若齿耳青。当索骨于肾。不得索之土。土者脾也。取脾土之气。以胜制其水焉。夫五脏者。形藏也。五行者。
五脏之气也。病气出于外。合之皮肉筋骨。故先治其外。不得。故复内索于五脏五行之气焉。简案、刺字下句。
热病不知所痛（止）死不可治 甲乙。痛、作病。张云。凡热病有痛而不得其所。耳聋寂无所闻。体重
不能收持。口液干涸。值阳胜之时则热甚。阴胜之时颇有寒者。此以邪居阴分。热深在髓。乃死证之。简案、
阴阳、马以为阴经阳经。志以为内外。并非。
颞 目HT 脉痛（止）寒热痔 甲乙无HT 。字。痛、作紧痔。下注云。一作痛。脉经作病。张云。颞
即足少阳脑空穴。一曰鬓骨也。（案见广韵又集韵耳前动也）目HT 脉痛。目脉抽掣而痛也。衄、鼻血也。厥、
热病。热逆于上也。取以第三针 针也。视有余不足。察所病之经脉虚实而为补泻也。寒热痔三字。
于上下文义不相续。似为衍文。
热病体重（止）得气也 甲乙。胳、作络。马云。胳、音各。释文云。腋下也。胃之经脉。与腋下无
着。疑当作络。张云。脾主肌肉四肢。邪在脾故体重。大肠小肠皆属于胃。邪在胃则肠中热。故当用第四针曰
锋针者。取脾胃二经之 。曰太白、曰陷谷也。及下诸指间者。谓在足诸 也。下文曰五指间各一。凡八 。
足亦如是者。其义即此。索气于胃胳得气者。阳明之络曰丰隆。别走太阴。故取此可以得脾气。胳、当作络。
热病挟脐急（止）针嗌里 张云。挟脐急痛。足少阴肾经取行也。胸胁满。足太阴脾经取行也。故在
少阴则取涌泉。在太阴则取阴陵泉。用第四针曰锋针者刺之。针嗌里者。以少阴太阴之脉。俱上络咽嗌。即下
文所谓廉泉也。
热病而汗且出（止）以止之 张云。热病阳气外达。脉躁盛者。汗且出也。阳证得阳脉者。脉之顺也。
皆为可汗。当取手太阴之鱼际、太渊。足太阴之大都、太白。泻之则热可去。补之则汗可出也。若汗出太甚。
则当取内踝上横脉。即脾经之三阴交也。泻之则汗自止矣。上三节所言胃胳、涌泉、阴陵泉、鱼际、太渊、大
都、内踝、上横脉。凡十四穴。皆不在下文五十九穴之数内者。故特表见于此也。
热病已得汗（止）脉静者生 张云。热病已得汗。则邪当退。脉当静矣。如汗后脉尚躁盛者。孤阳不
敛也。此以阴脉之虚极。有阳无阴耳。乃为逆证。若汗后即脉静者。邪去正复也。乃为顺证。得逆者死。得顺
者生。
热病者脉尚盛躁（止）静者生 甲乙、外台引九卷。尚、作常。静上有而脉二字。张云。热病脉尚
躁盛者。必当邪解汗出也。若脉虽盛而汗不得出。以阳脉之亢极。而阴虚不能
外达也。故死。若得汗而静。则为顺证。故生。按、此二节。一曰阴极。一曰阳极。义若有二。然脉之躁盛者。
皆阳胜之候也。汗者液之所化。其发在阳。其原在阴也。若既得汗而脉犹躁盛者。以阳无所归。由阴虚也。脉
躁盛而汗不得出者。以阴竭于中。亦阴虚也。故脉之盛与不盛。当责其阳。汗之出与不出。当责之阴。观本神
篇曰。阴虚则无气。无气则死矣。其所重者。正此阴字。阴为生气之本。无根则气脱。故必死也。简案、张注
虽如此。然以理推之。前节阴脉之极胃亡阳。阴寒之极。反见躁盛之脉。本节阳脉之极谓亡阴。阳热之极。尚
见盛躁之脉。盖二证有冰炭之别矣。
热病不可刺者有九 甲乙及外台引九卷。作热病死候有九。外台注太素云。不可刺者九。
一曰（止）哕者死 甲乙注太素云。汗不出。大颧发赤者。必不反而死。外台引九卷作汗不出。大灌
发者死。注太素云。汗不出大灌发赤。哕者死。张云。汗不得出。阴无力也。大灌发赤。谓之戴阳。面戴阳者。
阴不足也。哕者。邪犯阳明。胃虚甚也。本原亏极。难乎免矣。
二曰 外台注。甚、一作黄。张云。以邪伤太阴。脾气败也。故死。
三曰 张云。五脏六腑之精气。皆上注于目而为之精。目不明者。脏腑之精气竭也。热不已者。表
里之阴气竭也。故死。
四曰 张云。邪伤脾脏也。老人婴儿。尤以脾气为本。故犯之者死。志云。夫老人者。外内之血气
已衰。婴儿者。表里之阴阳未足。腹满者。热逆于中。不得从外内散也。
五曰 张云。汗不出者。阴之亏也。再或呕而下血。阴伤尤甚。
六曰 张云。心、肝、脾、肾、之脉。皆系于舌本。舌本烂。加之热不已者。三阴俱损也。故不免
于死。
七曰 张云。邪在肺经。动阴血也。汗不出或出。不至足。尤为真阴溃竭。故死。
八日 张云。髓者至阴之精。骨之充也。邪入最深。乃为髓热。肾气败竭。故死。简案、热在髓。见前。
九曰（止）齿噤 也 甲乙腰下有反字。外台同。张云。痉、风强病也。凡脊背反张曰腰折。肢体抽
各版本中均无“篇”字。马云说：此篇中所论述的各种疾病虽不单一，但关于热病的论述更多，因此命名为“篇”。
偏枯（直到）是可以恢复的。张志聪注云：《内经》说，虚邪偏侧地客居于身体的一半，侵入较深，内部滞留于营卫之中。营卫之气逐渐衰弱，所以真气离去，只有邪气独自留存。因此形成偏枯。（按语：出自《刺节真邪论》）这是风寒之邪，偏中于形体半身，导致半身不能活动且疼痛。心主管言语，肾藏志。如果言语不变、意志不乱，说明病位在分腠之间，而没有伤及内脏。用巨针来治疗，补益正气的不足，削减邪气的有余，那么偏侧受损的正气，就可以恢复了。巨针，就是大针。取大气，即取虚风。用巨针取之，《千金方》作“温卧取汗”。
痱这种病（直到）不可治愈。简案：根据《诸病源候论》和《外台秘要》，在“痛”字下衍生了“者”字。张云：痱，也是属于风寒类疾病，意思就是废用。上一节说的是身体偏侧不能活动且疼痛，这一节说的是身体不知道疼痛，而四肢无法收持。这是偏枯与痱病的区别。如果神志混乱不严重，说话还稍微有点知觉，说明神气没有完全丧失，还可以治疗。如果神气丧失，就无法救治了。《圣济总录》说：字书中称病痱而废用，肉非其肉，是因为身体没有疼痛，四肢无法收持，而没有用处。楼氏《纲目》说：以上《内经》论述了中风的深浅。偏枯，身体偏侧疼痛，言语不变，意志不乱，是邪气在分腠之间，就是张仲景、李东垣所说的邪中腑。痱病没有疼痛，手足不能收持，言语喑哑，神志混乱，是邪气入里，就是张仲景、李东垣所说的邪中脏。痱，就是废。痱就是偏枯中邪气较深的情况。痱与偏枯是两种病，因为半身没有气血运行，所以叫偏枯；因为手足废用不能收持，或者叫痱，或者叫偏废，或者全废，都叫痱。（楼氏又说：中风是世俗的称呼，其症状是突然仆倒，口眼歪斜，半身不遂，或者舌强不语，唇吻不收。但是名称各有不同。那些突然仆倒的，经书称为击仆，世人又称为中，这是中风发作时的状况。那些口眼歪斜、半身不遂的，经书称为偏枯，世人又称为左瘫右痪及腿风，这是中倒之后的证候，邪气较浅的情况如此。那些舌强不语、唇吻不收的，经书称为痱病，世人又称为风懿风气，也是中倒之后的症候，邪气较深的情况如此。）
病先从阳分起（直到）浮取。《甲乙经》作“净而取之”，意为必须审察气机的清浊沉浮而取之。张云：治疗必须先治其根本。病先从阳分起，所以应当先刺其表，浮取，然后再取其阴。下文没有说先起于阴的，然而病始于阴，是直中脏腑，大多不可治愈，所以不再赘述。
介按：吴鞠通说：“实其阴以补其不足”，这一句确实是治疗温热病的关键大纲。大概热病没有不耗伤阴液的。耗伤未尽则生，耗尽则阳气无所留恋，必然脱失而死。叶子雨认为吴注颇为明析，治疗温暑，保津液，固然是第一要义，但知道泻其阳之有余，就是补其阴之不足，这就进入道的境界了。
热病三天（直到）用以补其不足者。张云：以下所言的热病，就是伤寒时疫。热病三天，邪气还在体表，如果气口脉静而人迎脉躁动，正气病在三阳，而未入阴分，所以应当取诸阳经，行五十九刺法，以泻阳邪之实，同时补三阴之不足。
身热甚（直到）有死征。张云：身热甚而阴阳之脉都静的，是阳证得阴脉，所以不宜针刺。如果观察可以针刺的，应当急取之，即使不出汗，邪气也会随之泄出。这里说不要刺，是因为脉证相反，有死征。下文都是这样。
脉口动喘而短（直到）浅刺手大指间。《甲乙经》中，“短”作“眩”。张从一本作“弦”。马云：其脉口的脉很动，证候则是喘而短气，应当急取手太阴肺经的少商穴。张云：热病七八日，邪气必定深入阴分，所以脉口的脉当动，疾速如喘而且弦。张志聪注云：按《素问》有喘脉，喘而短，是指脉在寸口喘动，而不及于尺部，所以知道可以用汗法解。王师说：喘是指脉滑如珠。简案：根据下文“喘且复热”、“又喘甚者死”，以及《甲乙经》中喘即证而非脉，可知此处喘为证候。
脉微小（直到）一日死。张云：脉微小的，是正气虚。溲血、口中干的，是伤了阴。都是死证。如果脉来变乱失常，这是代脉，死期尤其急促。
热病已经出汗（直到）喘甚的死。《甲乙经》：“勿刺肤”作“勿庸刺”。张云：热病已经出汗，邪气应当退去。如果脉还躁动，气还喘，身体又发热，这叫不为汗衰，是反证。所以不要刺其皮肤，刺了会重伤其气。如果喘得很厉害，就一定死了。
躁不散数（直到）不要刺其腠理。《甲乙经》：“腠刺之”作“庸刺”。巢元方同。马云：脉虽然不躁，但也散且带数，是邪气尚未退去，应当再过三日之中，应该有汗出而愈。如果不汗出，就是正气衰而不能发汗，到了第四天就会死。况且未曾汗出，不要刺其肤腠，刺了也没有益处。张云：脉还不躁，就是阴之类。即使有躁意，但力不散大，至不数疾，都是正气衰微，不能鼓动，也是阴之类。必定未能解散，所以应当再等三日，希望能有汗。如果三日不汗，又过四日，病就在旬日之外了。阴阳不应期，当死。张志聪注云：热病七八日，脉不躁，说明外已解。脉即躁而不散数，此邪热虽未去，而正气不伤，后三日乃再经的十一日，此复传于里阴，必得阴液之汗而解。所以未曾汗出的，不要刺其腠理，应当取汗于阴。如果三日不汗，就是阳热盛而阴气已绝，所以到第四天死。简案：三种说法不知谁对，志注似乎恰当。
窒鼻充面（直到）五十九。《甲乙经》九下有“刺”字。下并同。马云：肺属金，其合在皮。现在热病开始，肤痛鼻塞，而且充然浮起，是病在皮。应当取之皮以泻之，所谓刺皮无伤肉的意思。用第一针，名镵针，用来刺五十九穴的皮。
苛轸鼻（直到）火者心也。《甲乙经》：“苛轸鼻”作“苛鼻干”。注：《灵枢》作“诊鼻干”。马云：轸，当作疹。海篇有此字。身体沉重，鼻上生疹，都是皮病。这是求之于皮，也就是求之于肺。如果刺了病不退，就应当求之于火，所谓火者心也。补其心经，以致火旺则金衰，肺热自然可退。张云：苛，深也。轸，车上前后两端横木也。言鼻窒之甚，内外不通，也犹如轸之横塞。简案：苛轸谓小疹也。苛，疥也。本小草之谓，故假为疥之义。《礼记》：“疾痛苛养”，《素问》：“苛疾肉苛”，义并同。轸，本作胗，见《释名》。又作疹。《病源》多用轸字，乃是瘾疹之疹。张注尤其错误。
身涩倚（直到）水者肾也。《甲乙经》：“倚”作“烦”，“ ”作“闷”，“干唇口嗌”作“唇嗌干”。马、张注：“取之皮”作“取之脉”是错的。马云：其身涩滞，倚着而热，心则烦闷，唇口与咽都干，是病在脉。应当取之脉以泻之，所谓刺脉无伤皮。用第一针名曰镵针，用来刺五十九穴的脉。正因为肤胀、口干、冷汗出，都是脉病。这是求之于脉，也就是求之于心。如果刺了病不退，就应当求之于水，所谓水者肾也。补其肾经，致水旺则火衰，心热自然可退。张云：涩，燥涩也。倚，身无力也。简案：涩倚未详其义。《千金》有伤寒 涩语，《巢源》作 啬，也不知何谓。
热病嗌干（直到）水者肝也。《甲乙经》：“目 青”作“目 赤”。马云：热病而嗌干所以多饮，且善惊悸，四肢懈倦，卧不能起，是病在肉。应当取之肤肉以泻之，所谓刺肉无伤筋。用第六针名曰圆利针，用来刺五十九穴的肉。正因为目 色青，是木来克土，主肉病。这是求之于肉，也就是求之于脾。如果刺了病不退，就应当求之于木，所谓木者肝也。补其肝木，以致木旺则土衰，脾热自然可退。张志聪注云：这应当用第四针取肤肉。
面青脑痛（直到）金者肺也。《甲乙经》：“面青脑”作“而胸胁”。第四针下更有“针”字。张云：热病面青，是肝色现。脑痛，厥阴肝经与督脉会于巅顶。手足躁动，肝之荣在爪，木病在四末。都是肝经的病，所以应当取之筋结之间。用第四针曰锋针，用来泻其四逆等证。四逆，是肝邪盛而四肢厥冷。筋 ，是足不能行。目浸，是泪出不收。都是肝病。肝属木，其合在筋，所以但求之于筋，也就是求于肝。如果求肝不得其效，就应当求之于金，金者肺也。补肺之气，则金能胜木，而肝热可平。简案：手足躁，其义未详。马云：以脾主四肢，而肝热有余，四肢热也。张志聪注云：肝主筋，诸筋皆起于四肢之指井并经，而循于形身，故手足为之躁扰。志注稍通。
数惊（直到）木者肾也。张志聪注云：心病热，所以数惊。本经说：心脉急甚为 ，心气实则狂。应当取之脉，以第四针急泻其血络之有余者。癫疾，脉癫疾也。发者，血之余。如果癫疾而毛发去，当索血于心，不得索之水。水者，肾也。取肾水之气以胜制其心火。
身重（直到）土者脾也。《甲乙经》：“耳青”作“耳青赤”。张志聪注云：肾为生气之原，热伤气，所以身重。肾主骨，所以骨痛。骨开窍于耳，肾气逆，所以耳聋。病在少阴，所以欲寐。应当取之骨，以第四针为五十九刺之法以刺骨。如果病而不欲食，是肾气实。经说：肾是动，病饥不欲食。 齿，是热盛而切牙。齿者骨之余，耳者肾之窍。如果齿耳青，当索骨于肾，不得索之土。土者脾也。取脾土之气，以胜制其水焉。夫五脏者，形藏也。五行者，五脏之气也。病气出于外，合之皮肉筋骨，所以先治其外。不得，故复内索于五脏五行之气焉。简案：刺字下句。
热病不知所痛（直到）死不可治。《甲乙经》：“痛”作“病”。张云：凡热病有痛而不得其所，耳聋寂无所闻，体重不能收持，口液干涸，值阳胜之时则热甚，阴胜之时颇有寒者，这是邪居阴分，热深在髓，是死证。简案：阴阳，马以为阴经阳经，志以为内外，都不是。
颞 目HT 脉痛（直到）寒热痔。《甲乙经》无HT 。字。“痛”作“紧痔”。下注云：一作痛。《脉经》作病。张云：颞即足少阳脑空穴，一说鬓骨也。（按语：见《广韵》又《集韵》耳前动也）目HT 脉痛，目脉抽掣而痛。衄，鼻血也。厥，热病，热逆于上也。取以第三针 针。视有余不足，察所病之经脉虚实而为补泻。寒热痔三字，于上下文义不相续，似为衍文。
热病体重（直到）得气也。《甲乙经》：“胳”作“络”。马云：胳，音各。《释文》云：腋下也。胃之经脉，与腋下无着，疑当作络。张云：脾主肌肉四肢，邪在脾故体重。大肠小肠皆属于胃，邪在胃则肠中热，所以应当用第四针曰锋针，取脾胃二经之腧，曰太白、曰陷谷。及下诸指间者，谓在足诸腧也。下文曰五指间各一，凡八腧。足亦如是者，其义即此。索气于胃胳得气者，阳明之络曰丰隆，别走太阴，所以取此可以得脾气。胳，当作络。
热病挟脐急（直到）针嗌里。张云：挟脐急痛，足少阴肾经取行也。胸胁满，足太阴脾经取行也。所以在少阴则取涌泉，在太阴则取阴陵泉。用第四针曰锋针刺之。针嗌里者，以少阴太阴之脉，俱上络咽嗌，即下文所谓廉泉也。
热病而汗且出（直到）以止之。张云：热病阳气外达，脉躁盛者，汗且出也。阳证得阳脉者，脉之顺也。皆为可汗，应当取手太阴之鱼际、太渊，足太阴之大都、太白，泻之则热可去，补之则汗可出。如果汗出太甚，就应当取内踝上横脉，即脾经之三阴交，泻之则汗自止矣。上三节所言胃胳、涌泉、阴陵泉、鱼际、太渊、大都、内踝上横脉，凡十四穴，都不在下文五十九穴之数内，所以特别表见于此。
热病已得汗（直到）脉静者生。张云：热病已得汗，则邪当退，脉当静。如果汗后脉还躁盛，是孤阳不敛。这是因为阴脉之虚极，有阳无阴，是为逆证。如果汗后即脉静，是邪去正复，是为顺证。得逆者死，得顺者生。
热病者脉尚盛躁（直到）静者生。《甲乙经》、《外台》引九卷：“尚”作“常”。静上有“而脉”二字。张云：热病脉还躁盛，必定当邪解汗出。如果脉虽盛而汗不得出，是以阳脉之亢极，而阴虚不能外达，故死。如果得汗而静，则为顺证，故生。按：此二节，一曰阴极，一曰阳极，义若有二。然脉之躁盛者，皆阳胜之候也。汗者液之所化，其发在阳，其原在阴。如果既得汗而脉犹躁盛，是以阳无所归，由阴虚。脉躁盛而汗不得出，是以阴竭于中，亦阴虚。所以脉之盛与不盛，当责其阳。汗之出与不出，当责之阴。观《本神》篇说：阴虚则无气，无气则死矣。其所重者，正是此阴字。阴为生气之本，无根则气脱，故必死。简案：张注虽如此，但以理推之，前节阴脉之极胃亡阳，阴寒之极，反见躁盛之脉。本节阳脉之极谓亡阴，阳热之极，尚见盛躁之脉。大概二证有冰炭之别。
热病不可刺者有九。《甲乙经》及《外台》引九卷，作“热病死候有九”。《外台》注《太素》云：不可刺者九。
一曰（直到）哕者死。《甲乙经》注《太素》云：汗不出，大颧发赤者，必不反而死。《外台》引九卷作“汗不出，大灌发者死”。注《太素》云：汗不出大灌发赤，哕者死。张云：汗不得出，阴无力。大灌发赤，谓之戴阳。面戴阳者，阴不足。哕者，邪犯阳明，胃虚甚。本原亏极，难乎免矣。
二曰。《外台》注：甚，一作黄。张云：以邪伤太阴，脾气败，故死。
三曰。张云：五脏六腑之精气，皆上注于目而为之精。目不明者，脏腑之精气竭。热不已者，表里之阴气竭，故死。
四曰。张云：邪伤脾脏。老人婴儿，尤以脾气为本，故犯之者死。张志聪注云：夫老人者，外内之血气已衰。婴儿者，表里之阴阳未足。腹满者，热逆于中，不得从外内散。
六曰。张云：心、肝、脾、肾之脉，皆系于舌本。舌本烂，加之热不已，三阴俱损，故不免于死。
七曰。张云：邪在肺经，动阴血。汗不出或出，不至足，尤为真阴溃竭，故死。
In all versions, the character "Pian" (Chapter) is absent. Ma Yun states: Although this chapter discusses various diseases, it focuses more on febrile diseases; hence, it is named a "Chapter."
Pian Ku (Hemiplegia/Paralysis of one side) ... can be restored. Zhang Zhicong notes: The Classic says, when empty pathogens invade half of the body deeply and reside internally within Ying and Wei, Ying and Wei gradually decline. Consequently, the True Qi departs, leaving only the pathogenic factor. This results in Pian Ku. (Note: Derived from the *Ling Shu* chapter "Ci Jie Zhen Xie Lun"). This refers to Wind-Cold pathogens striking one side of the body, causing paralysis and pain on that side. Since the Heart governs speech and the Kidneys store Zhi (Will), if speech remains unchanged and Zhi is not disordered, the disease is located between the Fen Li (interstices) and has not injured the interior organs. Using a Ju Zhen (Large Needle) to treat it supplements the deficiency of Zheng Qi and reduces the excess of pathogenic factors, thereby restoring the damaged Zheng Qi. The Ju Zhen is also known as the Da Zhen. "Qu Da Qi" refers to extracting Xu Feng (Deficiency Wind). The *Qian Jin Fang* reads "Wen Wo Qu Han" (Warm lying to induce sweating).
Fei disease ... cannot be treated. Simplified analysis: According to *Zhu Bing Yuan Hou Lun* and *Wai Tai Mi Yao*, the character "Zhe" is an interpolation after "Tong". Zhang Yun: Fei belongs to Wind-Cold, meaning "useless" or "paralyzed". The previous section described hemiparalysis with pain; this section describes insensitivity to pain with inability to control the limbs. This distinguishes Pian Ku from Fei. If mental confusion is slight and speech retains some awareness, Shen Qi has not completely departed, and treatment is possible. If Shen Qi is lost, no action can be taken. *Sheng Ji Zong Lu* states: In dictionaries, Fei implies disability due to lack of pain and limb control. Lou's *Gang Mu* explains: The above *Nei Jing* text discusses the depth of stroke. Pian Ku involves hemipain with intact speech and will, indicating pathogen in the Fen Li, corresponding to Zhang Zhongjing and Li Dongyuan's "Pathogen entering the Fu organs". Fei involves no pain, limb paralysis, aphasia, and mental confusion, indicating pathogen entering the interior, corresponding to "Pathogen entering the Zang organs". Fei means disability. Fei is a deeper stage of Pian Ku. They are distinct conditions: Pian Ku is named for lack of Qi and Blood circulation in half the body; Fei is named for paralyzed limbs. Whether partial or total paralysis, it is called Fei. (Lou adds: Stroke is a common term; symptoms include sudden collapse, facial deviation, hemiplegia, tongue stiffness, or lip retraction. Terms vary: sudden collapse is "Ji Pu" or "Zhong"; facial deviation/hemiplegia is "Pian Ku", "Left Tan Right Huan", or "Tui Feng" (shallow pathogen); tongue stiffness/lip retraction is "Fei Bing" or "Feng Yi" (deep pathogen)).
Disease starting in Yang ... Floating extraction. *Jia Yi Jing* reads "Jing Er Qu Zhi" (Calmly extract), implying careful assessment of Qi's clarity and depth. Zhang Yun: Treatment must address the root. Disease starting in Yang requires first treating the exterior via floating extraction, then addressing Yin. The text omits cases starting in Yin because direct invasion of Zang organs is often untreatable.
Jie An: Wu Juzhong states, "Solidify Yin to supplement deficiency," which is crucial for treating warm-heat diseases. Febrile diseases invariably consume Yin. Survival depends on whether Yin consumption is incomplete; complete consumption leads to Yang detachment and death. Ye Ziyu praises Wu's annotation: Preserving fluids is primary, but understanding that draining excess Yang supplements deficient Yin elevates the practice to the Dao.
Febrile disease on the third day ... To supplement deficiencies. Zhang Yun: The following febrile diseases refer to cold damage and epidemics. On the third day, pathogen remains at the exterior. If the Qi Kou pulse is calm while the Ren Ying pulse is restless, the disease is in the Three Yang meridians and has not entered Yin. One should puncture the Yang meridians using the Fifty-Nine Acupoints method to drain Yang excess and supplement Yin deficiency.
Severe body heat ... Signs of death. Zhang Yun: Severe heat with calm Yin and Yang pulses indicates a Yang syndrome presenting with Yin pulse, making acupuncture inadvisable. If acupuncture is deemed appropriate, urgent extraction may release the pathogen even without sweating. The instruction "do not puncture" applies when pulse and symptoms contradict, indicating impending death. This pattern repeats below.
Pulse at Qi Kou moves with panting and shortness ... Superficial puncture between the thumb digits. *Jia Yi Jing* reads "Xuan" (dizziness) for "Duan". Zhang Congyi reads "Xian" (wiry). Ma Yun: Active Qi Kou pulse with panting and shortness of breath requires urgent puncture of Shaoshang (LU-11) on the Lung meridian. Zhang Yun: By days 7-8, pathogen reaches Yin, causing active Qi Kou pulse resembling panting and wiriness. Zhang Zhicong notes: *Su Wen* mentions "Chuan Mai" (Panting Pulse). Panting and shortness indicate pulsation at Cun Kou without reaching Chi, suggesting resolution via sweating. Master Wang defines Chuan as slippery like pearls. Simplified analysis: Based on subsequent texts ("panting with recurrent fever" and "severe panting leads to death") and *Jia Yi Jing* classifying panting as a symptom rather than pulse, it is a clinical sign.
Pulse minute and fine ... Death within one day. Zhang Yun: Minute and fine pulses indicate deficient Zheng Qi. Hematuria and dry mouth indicate Yin injury. Both are fatal signs. Irregular, chaotic pulses indicate Dai Mai (Intermittent Pulse), leading to rapid death.
After sweating in febrile disease ... Severe panting leads to death. *Jia Yi Jing* reads "Wu Yong Ci" (Do not needlessly puncture) for "Wu Ci Fu". Zhang Yun: Sweating should resolve the pathogen. Persistent restlessness, panting, and fever despite sweating indicate failure of resolution ("Bu Wei Han Shuai"), a reverse sign. Puncturing skin would further injure Qi. Severe panting indicates certain death.
Restlessness but not scattered or rapid ... Do not puncture Cou Li. *Jia Yi Jing* reads "Yong Ci" for "Cou Ci Zhi". Ma Yun: Though not restless, a scattered and rapid pulse indicates lingering pathogen. Recovery with sweating is expected within three days. Lack of sweating indicates Zheng Qi failure; death occurs by day four. Do not puncture Cou Li as it is ineffective. Zhang Yun: Non-restless pulses belong to Yin. Restlessness without scattering or rapidity indicates weak Zheng Qi unable to mobilize, also Yin-type. Resolution is delayed; wait three days for sweating. Failure by day four implies Yin-Yang mismatch and death. Zhang Zhicong notes: Non-restless pulse by days 7-8 suggests exterior resolution. Restlessness without scattering/rapidness indicates pathogen heat persists but Zheng Qi is intact; recovery via Yin-fluid sweating is expected by day eleven. Do not puncture Cou Li; seek sweating from Yin. Failure by day three indicates extreme Yang heat and exhausted Yin, leading to death by day four. Simplified analysis: Zhang Zhicong's interpretation seems most appropriate.
Bi Nas Chong Mian ... Fifty-nine. *Jia Yi Jing* adds "Ci" (puncture) after nine. Ma Yun: Lung belongs to Metal and governs Skin. Early febrile disease with skin pain, nasal congestion, and floating sensation indicates pathology in the Skin. Treat via skin to drain, adhering to "puncture skin without injuring flesh." Use the Chan Zhen (Needle with sharp point) to puncture the fifty-nine acupoints' skin layers.
Ke Zhen Bi ... Fire corresponds to Heart. *Jia Yi Jing* reads "Ke Bi Gan" (Dry nose) for "Ke Zhen Bi". Note: *Ling Shu* reads "Zhen Bi Gan". Ma Yun: "Zhen" should be "Zhen" (Rash). Body heaviness and nasal rash are skin diseases, corresponding to Lung. If ineffective, treat Fire (Heart). Supplement Heart to strengthen Fire, weakening Metal and resolving Lung heat. Zhang Yun: "Ke" means deep; "Zhen" refers to transverse beams blocking passage, describing severe nasal obstruction. Simplified analysis: "Ke Zhen" refers to small rashes. "Ke" relates to scabies/rash etymology. "Zhen" originally "Zhen" (rash). Zhang's interpretation is erroneous.
Shen Se Yi ... Water corresponds to Kidney. *Jia Yi Jing*: "Yi" as "Fan" (Vexation), " " as "Men" (Stifling), "Gan Chun Kou Yi" as "Chun Yi Gan". Ma/Zhang note: "Qu Zhi Pi" should be "Qu Zhi Mai". Ma Yun: Stiffness, leaning heat, cardiac vexation, and dry lips/throat indicate vessel pathology. Treat vessels to drain, adhering to "puncture vessels without injuring skin." Use Chan Zhen for the fifty-nine vessel points. Skin distension, dry mouth, and cold sweat are vessel issues, corresponding to Heart. If ineffective, treat Water (Kidney). Supplement Kidney to strengthen Water, weakening Fire and resolving Heart heat. Zhang Yun: "Se" is dryness; "Yi" is weakness. Simplified analysis: Meaning unclear. *Qian Jin* and *Chao Yuan* have similar terms with unknown meanings.
Yi Gan (Throat dryness) ... Water corresponds to Liver. *Jia Yi Jing*: "Mu Qing" as "Mu Chi" (Red eyes). Ma Yun: Throat dryness, polydipsia, palpitations, limb fatigue, and inability to rise indicate muscle/flesh pathology. Treat flesh to drain, adhering to "puncture flesh without injuring tendons." Use Yuan Li Zhen (Round Sharp Needle) for the fifty-nine flesh points. Greenish eye color indicates Wood overcoming Earth, affecting flesh. Corresponds to Spleen. If ineffective, treat Wood (Liver). Supplement Liver to strengthen Wood, weakening Earth and resolving Spleen heat. Zhang Zhicong notes: Fourth needle should be used for flesh.
Mian Qing Nao Tong ... Metal corresponds to Lung. *Jia Yi Jing*: "Mian Qing Nao" as "Er Xiong Xie". Adds "Zhen" after fourth needle. Zhang Yun: Facial cyanosis indicates Liver color. Headache involves Jueyin Liver and Du meridians converging at vertex. Limb restlessness reflects Liver essence in nails and Wood pathology in extremities. All are Liver meridian issues. Treat tendon knots using Feng Zhen (Sharp Needle) to drain Si Ni (Four Reversals/Cold limbs), Jin Suo (Tendon contraction/inability to walk), and Mu Jin (Excessive tearing). Liver belongs to Wood, governing tendons. Seek Liver via Tendons. If ineffective, treat Metal (Lung). Supplement Lung Qi to overcome Wood and calm Liver heat. Simplified analysis: "Limb restlessness" meaning unclear. Ma Yun: Spleen governs limbs; Liver heat causes limb heat. Zhang Zhicong: Liver governs tendons originating in limbs; restlessness follows. His note is plausible.
Frequent Fright ... Wood corresponds to Kidney. Zhang Zhicong notes: Heart heat causes frequent fright. Classic: Rapid Heart pulse indicates convulsion; Excess Heart Qi causes mania. Puncture vessels, use fourth needle to drain excess blood collaterals. Dian Ji (Epilepsy) relates to pulse. Hair is surplus of blood. Epilepsy with hair loss requires seeking blood in Heart, not Water. Water is Kidney. Extract Kidney Water Qi to control Heart Fire.
Shen Zhong (Body heaviness) ... Earth corresponds to Spleen. *Jia Yi Jing*: "Er Qing" as "Er Qing Chi" (Blue-red ears). Zhang Zhicong notes: Kidney is source of vital Qi; heat injures Qi causing heaviness. Kidney governs bones causing bone pain. Bones open into ears; rebellious Kidney Qi causes deafness. Shaoyin disease causes drowsiness. Treat bones using fourth needle and fifty-nine method. Aversion to food indicates Kidney excess. Classic: Kidney movement disorder causes hunger without appetite. Chi Ke (Teeth grinding) indicates intense heat. Teeth are bone surplus; ears are Kidney orifices. Cyanotic teeth/ears require seeking Bone in Kidney, not Earth. Extract Spleen Earth Qi to control Water. Five Zang are Form Stores; Five Xing are Zang Qi. Pathogens manifest externally in skin/flesh/bones/tendons; treat exterior first. If ineffective, seek internal Zang/Xing Qi. Simplified analysis: Sentence structure after "Ci" unclear.
Re Fei Bu Zhi Tong ... Death, untreatable. *Jia Yi Jing*: "Tong" as "Bing" (Disease). Zhang Yun: Febrile disease with unlocalized pain, deafness, body heaviness, dry saliva, exacerbated heat during Yang phases, and chills during Yin phases indicates pathogen in Yin, deep heat in Marrow—a fatal sign. Simplified analysis: Ma interprets Yin/Yang as meridians; Zhang as interior/exterior; both incorrect.
Nie Mu HT Mai Tong ... Cold-Heat Hemorrhoids. *Jia Yi Jing* lacks "HT". "Tong" as "Jin Zhi" (Tight hemorrhoids). Note: One version "Tong". *Mai Jing* "Bing". Zhang Yun: Nie is Naokong (GB-20) or zygomatic bone. Eye vessel pain indicates spasmodic pain. Nu is epistaxis. Jue is febrile reversal with upward heat. Use San Zhen (Filiform Needle) based on excess/deficiency for tonification/draining. "Cold-Heat Hemorrhoids" seem interpolated.
Re Fei Shen Zhong ... Obtaining Qi. *Jia Yi Jing*: "Ge" as "Luo" (Collateral). Ma Yun: Ge sounds like "Ge", meaning axilla. Stomach meridian does not connect to axilla; likely "Luo". Zhang Yun: Spleen governs muscles/limbs; pathogen in Spleen causes heaviness. Large/Small Intestines belong to Stomach; pathogen in Stomach causes intestinal heat. Use Feng Zhen (Fourth Needle) at Taidai (SP-3) and Xiangu (ST-43). "Below toes" refers to foot acupoints. Text mentions eight points between five toes. Similar for feet. Seeking Qi in Stomach Luo obtains Spleen Qi via Fenglong (ST-40), connecting to Taiyin. "Ge" should be "Luo".
Re Fei Jia Qi Ji ... Puncture Yi Li. Zhang Yun: Pain flanking navel involves Shaoyin Kidney meridian. Chest/flank fullness involves Taiyin Spleen meridian. For Shaoyin, puncture Yongquan (KI-1); for Taiyin, Yinlingquan (SP-9). Use Feng Zhen. "Puncture Yi Li" refers to Lianquan (CV-23), where Shaoyin/Taiyin meridians connect to throat.
Re Fei Er Han Qie Chu ... To stop it. Zhang Yun: External Yang reach with restless pulse indicates impending sweating. Yang syndrome with Yang pulse is favorable for sweating. Puncture Yuji (LU-10), Taiyuan (LU-9), Dadu (SP-2), Taibai (SP-3). Drain to reduce heat; tonify to induce sweating. Excessive sweating requires Neihuai Shang Heng Mai (Sanyinjiao SP-6); drain to stop sweating. The fourteen points mentioned (Weige, Yongquan, Yinlingquan, Yuji, Taiyuan, Dadu, Neihuai Shang Heng Mai) are outside the fifty-nine list and thus highlighted here.
Re Fei Yi De Han ... Calm pulse indicates life. Zhang Yun: Post-sweating should bring pathogen retreat and calm pulse. Restless pulse post-sweating indicates isolated Yang failing to consolidate due to extreme Yin deficiency (Yang without Yin)—a reverse sign. Calm pulse indicates pathogen departure and Zheng restoration—favorable. Reverse leads to death; favorable leads to life.
Re Fei Zhe Mai Shang Sheng Zao ... Calm pulse indicates life. *Jia Yi Jing/Wai Tai*: "Shang" as "Chang" (Constant). Adds "Er Mai" before "Jing". Zhang Yun: Restless pulse requires pathogen resolution via sweating. Restless pulse without sweating indicates extreme Yang亢 (Hyperactivity) and Yin deficiency preventing external release—death. Sweating with calm pulse is favorable—life. Analysis: These sections discuss Yin extreme and Yang extreme. Restless pulse indicates Yang excess. Sweat originates from Yin fluid but manifests in Yang. Post-sweating restlessness indicates Yang lacking return due to Yin deficiency. Restless pulse without sweating indicates Yin exhaustion internally—also Yin deficiency. Pulse strength relates to Yang; sweating relates to Yin. *Ben Shen* states: Yin deficiency leads to Qi absence and death. Yin is root of vitality; rootless Qi detaches—death. Simplified analysis: Zhang's note contrasts Yin extreme (Cold generating false heat/restless pulse) vs. Yang extreme (Heat generating Yin exhaustion/restless pulse). Distinction exists.
Nine Untreatable Febrile Conditions. *Jia Yi Jing/Wai Tai*: "Nine Fatal Signs of Febrile Disease". *Wai Tai* notes *Tai Su*: Nine untreatable conditions.
One ... Hiccups lead to death. *Jia Yi Jing* notes *Tai Su*: No sweating, red cheekbones, irreversible death. *Wai Tai*: "Da Guan Fa Chi". *Tai Su*: No sweating, red face, hiccups—death. Zhang Yun: No sweating indicates Yin weakness. Red face (Dai Yang) indicates Yin insufficiency. Hiccups indicate pathogen attacking Yangming with severe Stomach deficiency. Root depletion makes survival unlikely.
Two. *Wai Tai*: "Shen" as "Huang" (Yellow). Zhang Yun: Pathogen injures Taiyin, spleen Qi fails—death.
Three. Zhang Yun: Essence of Zang-Fu ascends to eyes. Blurred vision indicates essence exhaustion. Unrelenting heat indicates exterior-interior Yin exhaustion—death.
Four. Zhang Yun: Pathogen injures Spleen. Elderly/infants rely on Spleen Qi; infection is fatal. Zhang Zhicong: Elderly have depleted Qi/Blood; infants have immature Yin/Yang. Abdominal fullness indicates internal heat rebellion unable to dissipate.
Five. Zhang Yun: No sweating indicates Yin deficit. Vomiting and bleeding exacerbate Yin injury.
Six. Zhang Yun: Heart/Liver/Spleen/Kidney meridians connect to tongue root. Ulcerated tongue root with unrelenting heat indicates Three Yin damage—fatal.
Seven. Zhang Yun: Pathogen in Lung meridian disturbs Yin blood. Sweating (or lack thereof) not reaching feet indicates true Yin collapse—death.
Eight. Zhang Yun: Marrow is essence of Extreme Yin, filling bones. Deep pathogen invasion causes Marrow Heat, Kidney Qi exhaustion—death. Note: Marrow heat mentioned previously.
Nine ... Jaw lock. *Jia Yi Jing* adds "Fan" (Reverse) after "Yao". *Wai Tai* same. Zhang Yun: Jing is wind-stiffness disease. Spinal extension is Yao Zhe. Limb convulsions...