马云。末有着之玉版。以为重宝。故名篇。素问有玉版论。亦着之玉版也。诸本无篇字。
五兵者（止）其孰小乎 马云。按管子曰。蚩尤受卢山之铜。而作五兵。则黄帝时即有五兵。一
弓、二 、三矛、四戈、五戟。一云东方矛。南方弩。中央剑。西方戈。北方铩也。张云。五兵即五刃。刀剑
矛戟矢也。五兵虽大。但备杀戮之用。置之死者也。小针虽小。能疗万民之病。保其生者也。夫天地之间。唯
人最重。故为天地之镇。而治人之生。则又唯针最先。盖针之为用。从阳则上合乎天。从阴则下合乎地。从中
则变化其间。而动合乎人。此针道之所以合乎三才。功非小补。较之五兵。其孰大孰小。为可知矣。简案、周
礼、夏官司兵。掌五兵。郑注。五兵者。戈 戟酋矛。 、音殊。
两热相搏 甲。乙两、作而。搏、作薄。简案、两热未详。甲乙为是。
圣人不能使化者（止）遭其已成也 张云。邪在天下则为乱。邪在人身则为病。及其已成。则
虽圣人不能使之化。是以邪不可留也。譬之用兵者。必有夙教。必有定谋。而后可保其无危。人之治身。可素
无调养之道乎。故惟圣人。乃能自治于未形。愚者每遭其患矣。余伯荣云。按本经及素问论。所生痈疽。多因
于风寒外邪。有伤荣卫。留积而成痈脓。此
因内伤喜怒饮食。故曰不从天下。不从地出。
其以形（止）奈何 诸本。以、作已。甲乙十六字作其已有形。脓已成。为之奈何。十一字。
故圣人（止）为其不予遭也 张云。此言兆庶之多。千古之邈。安得人人遭遇。以救其疾苦。故惟有着
之竹帛。以遗教将来。正为人之不予遭也。志云。圣人勿使已成。而明为良方。着之竹帛。使后学之能者。踵
而传之。后世无有终时者。为其不予遭而成十死一生之证也。遭、遇也。言其已形而不予遭。脓已成而不予见。
此痈生于脏腑之间。而不与我见。乃多死少生之候也。
其已有脓血（止）以小针治乎 甲乙无而后遭乎不道之七字。以上有可字。简案、据甲乙文义尤通。
以小治小者（止）铍锋之所取也 甲乙治大者下。有其功大以小治大者八字。害下有大字。铍、作 。
张云。针少者功小。无济于事。针大者多害。恐有所伤。故惟砭石及铍针锋针。皆可以取痈疽之脓血。简案、
原文义难通。得甲乙其旨甚晰。盖以大治大。谓以砭石铍针。取大脓血也。
以为伤者（止）为顺矣 马云。白眼属肺。今反青。是肝邪侮所不胜。当为肺气衰也。黑眼者。即眼之
睛也。属于肝。今反小。乃肝气衰也。纳药而呕。乃脾气衰也。腹痛者邪甚。渴甚者火盛。肩属手之三阳。项
属手足六阳及督脉经。今肩项不便。是阳盛阴虚也。音嘶者。肺衰也。色脱者。五脏衰也。志云。太阳为诸阳
主气。肩项中不便。阳气伤也。在心主言。心之合脉也。其荣色也。音嘶色脱。心脏伤也。犯此五逆者死。除
此五者为顺矣。张云。寒热病篇曰。五脏身有五部。伏兔一、腓二、背三、五脏之 四、项五。此五部有痈疽
者死。是亦五逆之属也。内、纳同。嘶、音西。声破损
也。巢源云。凡破痈溃脓之后。有逆有顺云云。是为五逆。皆死候。
诸病 志云。谓凡病多生于荣卫血气之不调。非独痈脓也。
腹胀身热（止）五逆也 张云。身热脉大。而加以腹胀。表里之邪俱盛也。是为一逆也。腹鸣而满。
四肢清冷而兼后泄。阴证也。脉不宜大而大者。脉证相反。是为二逆。鼻衄在阴。脉大为阳。阳实阴虚。是为
三逆。咳而溲血脱形者。正气已衰。脉小而急者。邪气仍在。邪正不能相当。是为四逆。脱形身热。真阴卫亏。
而火犹不清也。其脉细小疾数。正邪盛正衰之候。是为五逆。
不过十五日而死矣 张云。一节之更。时移气易。客强主弱。则不能胜。故不过十五日而死。
其腹大胀（止）是五逆也 甲乙。脉搏、作喘一字。张云。此下言五逆之急证也。腹大胀者。最忌
中虚。若见四肢清冷而脱形泄甚者。脾元败而阳气去也。故为一逆也。腹胀便血。阴病也。脉大时绝。孤阳将
脱也。故为二逆。咳而溲血者。气血俱病。形肉脱者败在脾。脉搏者真脏也。败在胃气。故为三逆。呕血胸满
引于背者。脏气连乎背也。脉见细小疾数。则真元大亏矣。故为四逆。上为呕咳。中为胀满。下为飧泄。三焦
俱病。而脉至于绝者。有邪无正也。故为五逆。
不及一时而死 马云。一时者一周时也。乃一日之意。张云。不及一时。谓不能周一日之时也。
是谓逆治 张云。病不可治而强治之。非惟无益。适以资害。是谓逆治。
甚骏 张云。骏、大也。简案、诗、商颂。为下国骏 。毛传。骏、大也。
二十八会 马云。手足十二经。左右相同。共有二十四脉。加以两跷督任。共为二十八会也。
能杀生人 不能起死者也 简案、外台明堂序云。经脉阴阳。各随其类。故汤药攻其内。以灸攻
其外。则病无所逃。知火艾之切。过半于汤药矣。其针法古来以为深奥。今人卒不可解。经云。针能杀生人。
不能起死人。若欲录之。恐伤性命。今并不录此。根据本节之义而立言也。玉函经总例云。针能杀生人。亦能起
死人。亦同。
其如刀剑（止）犹可知矣 张云。言不善用针者。徒能杀生人。不能起死者。正如以刀剑加人则死。
以酒饮人则醉。此理之必然。自不待诊而可知者也。
人之所受气者（止）夺之而已矣 马云。试观海之行云气者。本于地气上为云。而后云气行于天之
下也。胃之有气血。本于谷气所化。而后血气行于十二经之隧也。是经隧者。诚为五脏六腑之大脉络耳。迎其
气之来而有以夺之。则能杀生人矣。
上下有数乎（止）夺其天气者也 张云。上下、谓手足经也。五里、手阳明经穴。此节指手之五里。
即经隧之要害。若迎而夺之。则脏气败绝。必致中道而止。且一脏之气。大约五至而已。针凡五往以迎之。则
一脏之气已尽。若夺至二十五至。则五脏之输气皆竭。乃杀生人。此所谓夺其天真之气也。气穴论云。大禁二
十五。在天府下五寸。即此之谓。志云。至者迎其气之至也。往者追其气之行也。故五至而迎其五脏之气至即
已。若五往而追之。则五脏之气尽泄于外矣。
非能绝其命 而倾其寿者也 张云。不知刺禁。所以杀人。针非绝人之命。倾人之寿者也。志云。
非由命之自绝。
寿之自绝。实所以杀生人也。
窥门（止）死于堂上 马云。吾窥门而见其刺。其人当死于家中。吾入门而见其刺。其人当死于堂
上。死之最易。又如是耶。张云。门即生气。通天等论。所谓气门之门也。 门而刺。言犹浅也。浅者害迟。
故死于家中。入门而刺。言其深也。深则害速。故死于堂上。志云。 者。窥俟其所出也。门首。卫气篇之所
谓契绍之门户。乃气血从孙络而出于皮肤之门也。故俟其气之出门而刺之者。稍缓而死于家中。入门而逆刺于
络内者。即死于医者之堂上也。夫天气一日一夜。绕地环转一周。逆则不过一周而死。况针刺之伤乎。简案、
三家所取义各异。未知孰是。
马云说：“末有着之玉版，以为重宝。”因此以“玉版”命名此篇。《素问》中有《玉版论》，也是记载在玉版上的。各版本中都没有“篇”字。
五兵（古代五种兵器）之中，哪一种最小呢？马云说：按《管子》记载，蚩尤获取了卢山的铜，制作了五兵，那么在黄帝时代就已经有五兵了。一种弓，二种殳（shū，长杆无刃的兵器），三种矛，四种戈，五种戟。另一种说法是：东方为矛，南方为弩，中央为剑，西方为戈，北方为铩（shā，长矛）。张景岳说：五兵即五刃，指刀、剑、矛、戟、矢。五兵虽然威力大，但只具备杀戮的用途，置于死者身上。小针虽然微小，却能治疗万民的疾病，保全他们的生命。天地之间，只有人最尊贵，所以人是天地的镇守者。而治疗人的生命，又以针刺最为优先。大概针刺的作用，顺应阳则上合于天，顺应阴则下合于地，处于中间则变化于其间，且动态符合于人。这就是针道之所以符合天、地、人三才之道，功效并非微小。与五兵相比，哪个大哪个小，就可以知道了。简案：《周礼·夏官·司兵》掌管五兵，郑玄注解说：五兵是指戈、殳、酋矛、夷矛。殳，音同“殊”。
两股热邪相互搏击。甲乙经将“甲乙两”改为“作而”，将“搏”改为“薄”。简案：“两热”含义不明，以甲乙经的说法为是。
圣人也不能使已经形成的病邪化解（直到）遭遇其已经形成。张景岳说：邪气在天下就是祸乱，邪气在人身就是疾病。等到邪气已经形成，即使是圣人也不能使其化解。因此邪气不可留滞。譬如用兵的人，必须有平时的教导，必须有固定的谋略，然后才可以保证没有危险。人的养生，难道可以平时没有调养的方法吗？所以只有圣人，能在病形未显之前自我调理；愚者常常遭受这种祸患。余伯荣说：按本经及《素问》论述，所生的痈疽，多因风寒外邪，损伤营卫，留滞积聚而成痈脓。这是因为内伤于喜怒饮食，所以说不是从天下降下，也不是从地底生出。
其以形（直到）怎么办？诸本中，“以”写作“已”。甲乙经十六字写作“其已有形”，“脓已成，为之奈何”十一字。
所以圣人（直到）因为不让他遭遇。张景岳说：这里说的是百姓众多，千古遥远，怎能让人人都能遇到（良医）来拯救他们的疾苦？所以只有将其写在竹帛上，以教导后来的人，正是为了人们不能随意遭遇（良医）。张志聪说：圣人不要使病情发展到已成阶段，而是明确制定良方，写在竹帛上，使后学中有能力的人，跟随并传承它。后世没有终结的时候，是因为不让患者遭遇那些已成十死一生的证候。“遭”，是遇见的意思。说病情已显现而不让他遇见（良医），脓已形成而不让他看见（医生）。这痈生于脏腑之间，而不与我相见，是多死少生的征候。
其已有脓血（直到）用小针治疗吗？甲乙经没有“而后遭乎不道之”七字。以上有“可”字。简案：根据甲乙经的文义更加通顺。
用小治小（直到）铍锋所取。甲乙经在“治大者”下有“有其功大以小治大者”八字，“害”下有大字。“铍”写作“鉟”。张景岳说：针具少则功效小，无济于事；针具大则危害多，恐有所伤。所以只有砭石及铍针、锋针，都可以用来取出痈疽的脓血。简案：原文义理难通，得到甲乙经后旨意非常清晰。所谓以大治大，是指用砭石、铍针取出大量脓血。
以为是伤者（直到）算是顺证了。马云说：白眼属肺，现在反而发青，这是肝木邪气侮乘肺金（所不胜），应当是肺气衰败。黑眼者，即眼珠，属于肝，现在反而变小，乃是肝气衰败。服药而呕吐，乃是脾气衰败。腹痛者是邪气盛，口渴严重者是火盛。肩属手三阳经，项属手足六阳经及督脉经，现在肩项不便，是阳盛阴虚。声音嘶哑者是肺衰。面色脱失者是五脏衰败。张志聪说：太阳经为诸阳主气，肩项中不便，是阳气受伤。在心主而言，心合脉，其荣华表现在面色，声音嘶哑、面色脱失，是心脏受伤。犯这五逆证的会死，除去这五种情况就算顺证了。张景岳说：《寒热病篇》说：五脏身有五部，伏兔一、腓二、背三、五脏之腧四、项五。这五部有痈疽的会死，这也是五逆的一类。内，同纳。嘶，音西，声破损。巢元方说：凡是破痈溃脓之后，有逆有顺等等，称为五逆，都是死候。
腹胀身热（直到）五逆证。张景岳说：身热脉大，再加上腹胀，表里邪气都盛。这是一逆。腹鸣而胀满，四肢清冷并且兼有后泄，是阴证。脉不应该大却大了，脉证相反，这是二逆。鼻衄（鼻出血）在阴分，脉大为阳，阳实阴虚，这是三逆。咳嗽而小便带血、形体脱失，正气已衰，脉小而急，邪气仍在，邪正不能相当，这是四逆。形体脱失身热，真阴卫气亏损，而火热仍未清除。脉细小疾数，是正邪盛、正气衰的征候，这是五逆。
不超过十五日就会死亡。张景岳说：一节气的更替，时间推移，气候改变，客邪强盛而主气虚弱，就不能胜任，所以不超过十五日而死。
其腹大胀（直到）是五逆证。甲乙经中，“脉搏”写作“喘”一字。张景岳说：下面讲的是五逆的急证。腹大胀，最忌讳中焦虚损，如果见到四肢清冷和形体脱失、泄泻严重，是脾元败坏而阳气离去，所以为一逆。腹胀便血，是阴病。脉大时而断绝，是孤阳即将脱失，所以为二逆。咳嗽而小便带血，是气血俱病，形体肌肉脱失是脾败，脉搏急促是真脏脉现，败在胃气，所以为三逆。呕血、胸满牵引背部，是脏气连及背部。脉见细小疾数，是真元大亏，所以为四逆。上部为呕咳，中部为胀满，下部为飧泄（完谷不化的腹泻），三焦都病了，而脉至于绝，是有邪无正，所以为五逆。
不到一个时辰就会死亡。马云说：一时是一周时，也就是一天的意思。张景岳说：不及一时，谓不能满一周日之时。
这叫逆治。张景岳说：病不可治而强行治疗，不仅无益，反而增加危害，这叫逆治。
很盛大。张景岳说：骏，是大。简案：《诗经·商颂》：“为下国骏厖”。毛传：骏，大也。
二十八会。马云说：手足十二经，左右相同，共有二十四脉，加上两跷脉、督脉、任脉，共为二十八会。
能杀生人，不能起死者。简案：《外台秘要明堂序》说：经脉阴阳，各随其类，所以汤药攻其内，灸法攻其外，则病无处可逃。知道火艾的切要，超过汤药一半了。其针法古来认为深奥，今人突然无法理解。经文说：针能杀生人，不能起死人。如果要记录它，恐怕伤害性命，现在都不记录这些。是根据本节之义而立言。《玉函经总例》说：针能杀生人，也能起死人，也是同样的意思。
其如刀剑（直到）还可以知道了。张景岳说：说不善用针的人，只能杀生人，不能起死人。正如用刀剑加于人则死，用酒饮人则醉。这是必然的道理，自然不用诊断就可以知道。
人所受的气（直到）夺其气而已。马云说：试看海上的行云气，本于地气上升为云，然后云气行于天下。胃中有气血，本于谷气所化，然后血气行于十二经的隧络。这经隧，确实是五脏六腑的大脉络。迎着气的到来而有以夺之，就能杀生人了。
上下有定数吗（直到）夺其天气。张景岳说：上下，谓手足经。五里穴，是手阳明经穴。这一节指手的五里穴，即经隧的要害。如果迎着而夺之，则脏气败绝，必致中途停止。而且一脏之气，大约五至而已。针凡五往以迎之，则一脏之气已尽。若夺至二十五至，则五脏的输气皆竭，乃杀生人。这就是所谓夺其天真之气。《气穴论》说：大禁二十五，在天府下五寸，就是这个意思。张志聪说：至者，迎其气之至也；往者，追其气之行也。所以五至而迎其五脏之气至就已停止。若五往而追之，则五脏之气尽泄于外。
并不是能断绝其命，而是使其寿命倾倒。张景岳说：不知刺禁，所以杀人。针不是断绝人之命，倾覆人之寿的东西。张志聪说：不是由命自绝，而是寿之自绝，实在所以杀生人也。
窥视门缝（直到）死于堂上。马云说：我窥视门缝看到他的刺法，其人应当死在家中；我进门看到他的刺法，其人应当死在堂上。死得最容易，又像是这样吗？张景岳说：门即生气，《通天》等篇所说的“气门”之门。“窥”门而刺，言犹浅也。浅者害迟，故死在家中。“入门”而刺，言其深也。深则害速，故死于堂上。张志聪说：“窥”者，窥俟其所出也。门首，是《卫气篇》所谓的“契绍之门户”，乃气血从孙络而出于皮肤之门。所以俟其气之出门而刺之者，稍缓而死于家中。“入门”而逆刺于络内者，即死于医者之堂上。夫天气一日一夜，绕地环转一周，逆则不过一周而死，何况针刺之伤呢？简案：三家所取的义理各异，不知道谁是对的。
Ma Yun stated: "The Jade Tablet (Yùbǎn, a jade tablet for recording important texts) is placed at the end and regarded as a precious treasure. Hence the chapter name." The *Suwen* contains the "Treatise on the Jade Tablet" (*Yùbǎn Lùn*), which was also recorded on a jade tablet. None of the extant versions include the character "Chapter" (*Piān*).
Among the Five Weapons (*Wǔbīng*, ancient military weapons), which is the smallest? Ma Yun said: According to the *Guanzi*, Chiyou obtained copper from Mount Lu and manufactured the Five Weapons; thus, the Five Weapons existed even in the time of the Yellow Emperor. They are: one, bow; two, *Shu* (a long polearm without a blade); three, spear; four, *Ge* (dagger-axe); five, *Ji* (halberd). Another account states: East corresponds to the spear, South to the crossbow, Center to the sword, West to the *Ge*, and North to the *Sha* (a long spear). Zhang Jingyue stated: The Five Weapons refer to the Five Blades (*Wǔrèn*), namely the knife, sword, spear, *Ge*, and arrow. Although the Five Weapons are powerful, they serve only for killing and are associated with death. In contrast, the small needle (*Xiǎozhēn*), though minute, can treat the illnesses of all people and preserve their lives. Among all things between Heaven and Earth, humans are the most valued, serving as the anchor of Heaven and Earth. In treating human life, acupuncture is paramount. The function of the needle aligns with Yang to reach up to Heaven, with Yin to reach down to Earth, and operates within the middle, harmonizing with humanity. This is why the Dao of Acupuncture conforms to the Three Powers (*Sāncái*: Heaven, Earth, Human), and its efficacy is significant. Compared to the Five Weapons, it is clear which is greater and which is smaller. Commentary: In the *Rites of Zhou* (*Zhōulǐ*), under the Ministry of War, the Official of Five Weapons (*Sībīng*) manages the Five Weapons. Zheng Xuan’s commentary notes that the Five Weapons are the *Ge*, *Shu*, *Choumáo* (chief spear), and *Yímáo*. *Shu* is pronounced "shū".
When two heats contend with each other. In the *Jia Yi Jing* (*Jiǎyǐ Jīng*), "Jia Yi Liang" is changed to "Zuo Er", and "Bo" is changed to "Bo" (thin/close). Commentary: The meaning of "Liang Re" (two heats) is unclear; the reading in the *Jia Yi Jing* is preferred.
Even a sage cannot transform [the disease] once it has formed. Zhang Jingyue stated: When evil Qi spreads throughout the world, it causes chaos; when it enters the human body, it causes disease. Once the pathogen has fully formed, even a sage cannot dissolve it. Therefore, evil Qi must not be allowed to linger. Just as a commander must have prior training and fixed strategies to ensure safety, how can one manage their health without daily nourishing methods? Thus, only sages can regulate themselves before symptoms appear, while fools often suffer such disasters. Yu Borong stated: According to this classic and the *Suwen*, abscesses and carbuncles (*Yōngjū*) often arise from external wind-cold pathogens damaging the Ying and Wei (Defensive) levels, leading to stagnation and accumulation forming pus. This is due to internal injury from anger, joy, or diet. Hence, it is said that these do not fall from the sky nor emerge from the earth.
[Regarding] its manifestation... what should be done? Most editions read "Yi" as "Yi" (already). The *Jia Yi Jing* reads sixteen characters as "Qi Yi You Xing" (its form has already appeared) and eleven characters as "Nong Yi Cheng, Wei Zhi Nai He" (pus has formed, what should be done?).
Therefore, the sage... because he does not let them encounter [it]. Zhang Jingyue stated: This passage discusses the multitude of people and the vastness of history; how can everyone encounter a healer to save them from suffering? Thus, teachings are inscribed on bamboo slips and silk to instruct future generations, precisely because people cannot always encounter healers. Zhang Zhicong stated: Sages prevent diseases from reaching an advanced stage and formulate effective prescriptions, inscribing them so that capable students may inherit and transmit them. This ensures that later generations do not face incurable conditions characterized by ten deaths for every one survival. "Zao" means encounter. It implies that if the disease manifests but the patient does not encounter a healer, or if pus forms but the doctor does not see it, the abscess arising within the organs and not visible externally indicates a prognosis of mostly death and few survivals.
[If] pus and blood have already formed... can it be treated with a small needle? The *Jia Yi Jing* omits the seven characters "Er Hou Zao Hu Bu Dao". There is a "Ke" character above. Commentary: The meaning is more coherent according to the *Jia Yi Jing*.
Using small [needles] for small [problems]... is taken by the tip of the Pi needle. The *Jia Yi Jing* adds eight characters after "Zhi Da Zhe": "You Qi Gong Da Yi Xiao Zhi Da Zhe" (there is great merit in using large [methods] for large [problems]), and adds a "Da" character after "Hai". "Pi" is written as "Ping". Zhang Jingyue stated: Few needles yield little effect and are useless; large needles cause much harm and risk injury. Therefore, only stone blades (*Bianshi*) and Pi needles (*Pizhen*) or Feng needles (*Fengzhen*) can be used to drain the pus and blood of abscesses. Commentary: The original text is difficult to understand; the *Jia Yi Jing* clarifies the intent. Treating large problems with large methods refers to using stone blades and Pi needles to extract large amounts of pus and blood.
Considering it as injury... it is considered a favorable sign. Ma Yun stated: The white part of the eye belongs to the Lung; if it turns green, it indicates Liver Wood insulting Lung Metal (the unconquered element), suggesting Lung Qi deficiency. The black pupil belongs to the Liver; if it shrinks, it indicates Liver Qi deficiency. Vomiting after taking medicine indicates Spleen Qi deficiency. Abdominal pain suggests excessive evil; severe thirst suggests excessive fire. The shoulder belongs to the Hand Triple Burner Yang meridians; the neck belongs to the Foot and Hand Six Yang meridians and the Du Mai (Governing Vessel). Inconvenience in the shoulder and neck indicates Excess Yang and Deficiency Yin. Hoarseness indicates Lung decline. Loss of complexion indicates Five Zang organ decline. Zhang Zhicong stated: The Taiyang meridian governs the Qi of all Yang meridians; inconvenience in the shoulder and neck indicates Yang Qi injury. Regarding the Heart Master, the Heart governs the vessels, and its luster appears in the complexion. Hoarseness and loss of color indicate Heart injury. Those who exhibit these Five Reverse signs (*Wuni*) will die. Excluding these five cases constitutes a favorable progression. Zhang Jingyue stated: The "Chapter on Cold-Heat Diseases" mentions five parts of the body corresponding to the Five Zang: Futu (ST32), Calves, Back, Shu points of the Five Zang, and Neck. Carbuncles in these five areas result in death; this is also a category of the Five Reverses. "Nei" is identical to "Na". "Si" means voice broken. Chao Yuanfang stated: After rupturing abscesses and draining pus, there are reverse and favorable signs, etc., called the Five Reverses, all indicating death.
Various diseases. Zhang Zhicong stated: All diseases often arise from disharmony of Ying, Wei, Blood, and Qi, not just abscesses.
Abdominal distension and fever... [constitute] the Five Reverses. Zhang Jingyue stated: Fever with a large pulse, compounded by abdominal distension, indicates both exterior and interior pathogens are exuberant. This is the First Reverse. Borborygmus and fullness, cold limbs, and diarrhea constitute a Yin syndrome. A pulse that should not be large but is large indicates a contradiction between pulse and symptoms; this is the Second Reverse. Epistaxis in a Yin condition, with a large pulse (Yang), indicates Yang excess and Yin deficiency; this is the Third Reverse. Cough with hematuria and emaciation indicate depleted righteous Qi; a small and rapid pulse indicates lingering pathogenic Qi, where pathogen and righteousness are mismatched; this is the Fourth Reverse. Emaciation with fever indicates depletion of True Yin and Defensive Qi, yet fire remains unquenched. A fine, small, rapid, and frequent pulse indicates excess pathogen and deficiency of righteousness; this is the Fifth Reverse.
Death will occur within fifteen days. Zhang Jingyue stated: With the change of a solar term, time shifts and Qi alters. If the guest (pathogen) is strong and the host (righteous Qi) weak, victory is impossible; thus, death occurs within fifteen days.
Abdominal distension... [constitute] the Five Reverses. The *Jia Yi Jing* reads "Mai Bo" as "Chuan" (panting). Zhang Jingyue stated: The following describes acute cases of the Five Reverses. Severe abdominal distension fears Middle Jiao deficiency. If accompanied by cold limbs, emaciation, and severe diarrhea, it indicates failure of Spleen Yuan and departure of Yang Qi; this is the First Reverse. Abdominal distension with bloody stool is a Yin disease. A large pulse that intermittently ceases indicates impending collapse of solitary Yang; this is the Second Reverse. Cough with hematuria indicates disease of both Qi and Blood. Emaciation indicates Spleen failure. A rapid pulse indicates the arrival of the True Zang pulse, showing Stomach Qi failure; this is the Third Reverse. Hematemesis with chest fullness radiating to the back indicates Zang Qi connecting to the back. A fine, small, rapid, and frequent pulse indicates massive depletion of True Yuan; this is the Fourth Reverse. Upper vomiting/cough, middle distension/fullness, lower undigested diarrhea indicate disease of the Triple Burner. A pulse that ceases indicates presence of pathogen but absence of righteousness; this is the Fifth Reverse.
Death will occur in less than one shichen (two hours). Ma Yun stated: One shichen is a cycle, implying a day. Zhang Jingyue stated: "Less than one shichen" means unable to complete a full day's cycle.
This is called Reverse Treatment. Zhang Jingyue stated: Treating an incurable disease forcibly is not only futile but harmful; this is called Reverse Treatment.
Very grand. Zhang Jingyue stated: "Jun" means large. Commentary: In the *Book of Songs* (*Shijing*), Shang Ode: "For the subordinate states, Jun Mang". Mao's Commentary: "Jun" means large.
Twenty-eight Convergences (*Ershiba Hui*). Ma Yun stated: The twelve meridities of the hands and feet, left and right being identical, total twenty-four vessels. Adding the Two Qiao (Shadow) vessels, Du Mai, and Ren Mai makes twenty-eight convergences.
Can kill living people, cannot revive the dead. Commentary: The Preface to the *Mingtang* in *Waitai Miyao* states: Meridians and Yin-Yang follow their respective categories; thus, herbal decoctions attack internally, and moxibustion attacks externally, leaving no escape for disease. Knowing the precision of mugwort surpasses herbs by half. Acupuncture techniques were historically considered profound and incomprehensible to moderns. The Classic states: "Acupuncture can kill living people but cannot revive the dead." To record this might endanger lives, so it is not recorded here. This statement is based on the context of this section. The General Rules of the *Yuhan Jing* state: "Acupuncture can kill living people and also revive the dead," which is consistent.
Like swords and knives... it can be understood. Zhang Jingyue stated: Those who misuse needles can only kill the living, not revive the dead. This is like using swords and knives on someone causing death, or giving wine causing drunkenness. This is inevitable logic, knowable without diagnosis.
What humans receive as Qi... is merely depleted. Ma Yun stated: Observe clouds over the sea; they originate from Earth Qi rising into clouds, then moving across the sky. The Qi and Blood in the Stomach originate from Grain Qi transformation, then flow through the tunnels of the Twelve Meridians. These tunnels are indeed the major collaterals of the Five Zang and Six Fu organs. Meeting the incoming Qi and depleting it can kill living people.
Are there fixed numbers above and below... [it is] depleting their Heavenly Qi. Zhang Jingyue stated: "Above and below" refers to hand and foot meridians. Wuli (LI13) is an acupoint on the Hand Yangming Meridian. This section refers to the hand Wuli point, a critical point of the meridian tunnel. If met and depleted, Zang Qi collapses, leading to mid-course cessation. The Qi of one Zang typically lasts about five pulses. Needling five times to meet it exhausts the Qi of one Zang. Depleting up to twenty-five pulses exhausts the transport Qi of all Five Zangs, killing the person. This is depleting their True Primal Qi. The *Qixue Lun* states: The Great Taboo is twenty-five, located five cun below Tianfu; this refers to it. Zhang Zhicong stated: "Zhi" means meeting the arrival of Qi; "Wang" means pursuing the movement of Qi. Thus, meeting the arrival of Zang Qi after five pulses is sufficient. Pursuing it for five movements causes all Zang Qi to leak out externally.
It does not sever their life, but shortens their lifespan. Zhang Jingyue stated: Ignorance of acupuncture taboos leads to death. Needles do not sever life or shorten lifespan inherently. Zhang Zhicong stated: Life is not severed by fate itself, but by the self-severing of longevity, effectively killing the living.
Peeking through the door... dying in the hall. Ma Yun stated: If I peek through the door crack and see the needling, the person dies at home. If I enter the door and see the needling, the person dies in the hall. Death comes so easily, is it not so? Zhang Jingyue stated: "Door" refers to the "Vital Gate" mentioned in chapters like *Tongtian*. Peeking through the door to needle implies shallow insertion. Shallow harm is slow, hence death at home. Entering the door to needle implies deep insertion. Deep harm is rapid, hence death in the hall. Zhang Zhicong stated: "Peek" means waiting for the exit. The doorway is the "Gate of Qi" mentioned in the *Weiqi Pian*, where Qi exits from collateral vessels to the skin. Waiting for Qi to exit before needling results in slower harm and death at home. Entering the door and needling against the flow within the collaterals results in immediate death in the physician's hall. Heavenly Qi circles the Earth once in a day and night; reversing it causes death within one circle, let alone needle injury. Commentary: The three scholars interpret the meaning differently; it is unknown which is correct.