篇中所言，皆真热也。热蓄于内，则证见于外，故首言五脏之证。证见则色自异，故次言五脏之色。既验
其色，又辨其证，则知病之所在，而可以刺而去之矣，故又次言五十九刺及诸应刺之穴，乃以刺热名篇焉。
肝热病者，小便先黄，腹痛，多卧，身热。（肝之脉环阴器，抵少腹而上，故小便不通先黄，腹痛多卧也。
寒薄生热，身故热焉。）热争，则狂言及惊，胁满痛，手足躁，不得安卧。（经络虽已受热，而神藏犹未纳邪，
邪正相薄，故云争也。肝之脉，从少腹上挟胃，贯膈，布胁肋，循喉咙之后，络舌本，故狂言胁满痛也。肝性
静而主惊骇，故病则惊，手足躁，卧不得安。）庚辛甚，甲乙大汗，气逆则庚辛死。（肝主木，庚辛为金，金
克木，故甚于庚辛也。甲乙为木，故大汗于甲乙。）刺足厥阴少阳。（厥阴肝脉，少阳胆脉。）其逆则头痛员
员，脉引冲头也。（肝之脉，自舌本循喉咙之后，上出额，会于巅，故头员员然，脉引冲于头中也。员员谓
似急也。按∶本篇所言热病，皆实证也，与诸篇之兼虚实者不同。气逆非喘逆，谓病甚而气溃乱也。）心热病
者，先不乐，数日乃热。（按∶不乐者，谓起居不适意也。心为火脏，其气本热，心病则火不安其位而热形
焉。故心之见热病，其热未遽见也，必先有所苦，而后病乃见于数日之后。）热争则心卒痛，烦闷善呕，头痛
面赤，无汗。（心手少阴脉，起于心中。其支别者，从心系上挟咽。小肠之脉，直行者，循咽下膈抵胃。其支
别者，从缺盆，循颈上颊，至目锐 。故卒心痛，烦闷善
呕，头痛面赤也。心在液为汗，今病热，故无汗以出。）壬癸甚，丙丁大汗，气逆则壬癸死。（按∶火畏水，
故甚而死。自得其位，故大汗。）刺手少阴太阳。（少阴，心脉；太阳，小肠脉。）脾热病者，先头重，颊痛，
烦心，颜青，欲呕，身热。（胃之脉起于鼻交 中，下循鼻外，入上齿中，还出挟口环唇，下交承浆，却循颐
后下廉，出大迎，循颊车，上耳前，过客主人，循发际，至额颅，故先头重颊痛颜青也。脾之脉，支别者，
复从胃，上膈注心中。其直行者，上膈挟咽。故烦心欲呕而身热也。按∶新校正云∶“甲乙经、太素云脾热病
者先头重颜痛，无颜青二字。”）热争则腰痛不可用俯仰，腹满泄，两颔痛。（胃之脉，支别者，起胃下口，
循腹里，下至气街中而合以下髀。气街者，腰之前，故腰痛也。脾之脉，入腹属脾络胃。又胃之脉，自交承浆，
却循颐后下廉，出大迎，循颊车。故腹满泄而两颔痛。）甲乙甚，戊己大汗，气逆则甲乙死。（按∶木伐土，
故甚而死。土得气，故大汗。）刺足太阴阳明。（太阴，脾脉；阳明，胃脉。）肺热病者，先淅然厥，起毫毛，
恶风寒，舌上黄，身热。（肺主皮肤，外养于毛，故热中之，则淅然恶风寒，起毫毛也。肺之脉，起于中焦，
下络大肠，还循胃口，今肺热入胃，胃热上升，故舌上黄而身热。）热争则喘咳，痛走胸膺背，不得太息，头
痛不堪，汗出而寒。（肺居膈上，气主胸膺，在变动为咳，又藏气而主呼吸，复为胸中之府，故喘咳，痛走胸
膺背，不得太息也。肺之络脉，上会耳中，今热气上熏，故头痛不堪，汗出而寒。）丙丁甚，庚辛大汗，气逆
则丙丁死。（按∶火烁金，故甚而死。金得气，故大汗。）刺手太阴阳明，出血如大豆，立已。（太阴，肺脉；
阳明，大肠脉。其络脉盛者，乃刺而出之。）肾热病者，先腰痛， ，苦渴，数饮，身热。（膀胱之脉，从
肩内，挟脊抵腰中，又腰为肾之府，故先腰痛也。又肾之脉，自循内踝之后，上 内，出 内廉。又直行者，
从肾上贯肝膈，入肺
中，循喉咙，挟舌本。故 苦渴数饮身热。）热争则项痛而强， 寒且酸，足下热，不欲言。（膀胱之脉，从脑出
别下项。又肾之脉，起于小趾之下，斜趋足心，出于然骨之下，循内踝之后，别入跟中，以上 内。又其直行
者，从肾上贯肝膈，入肺中，循喉咙，挟舌本。故病如是也。）其逆则项痛员员淡淡然。（肾之筋，循脊内挟
膂，上至项，结于枕骨，与膀胱之筋合。膀胱之脉，又并下于项。故项痛员员然也。淡淡，似欲不定也。）戊己
甚，壬癸大汗，气逆则戊己死。（按∶土刑水，故甚而死。水得气，故大汗。）刺足少阴太阳。（少阴，肾脉；
太阳，膀胱脉。按∶五脏气逆之证，经文止有肝肾，而心脾肺注谓经阙文，恐未必然也。盖五脏之位，肝肾居下，
气逆则病自下而上，故肝则头痛，肾则项痛也。若心肺脾，位本在上，头面之证已见，故不必更言气逆病也。
非阙文。其五脏各言气逆则死者，谓至所不胜之日则病甚，气必溃乱而死也。）诸汗者，至其所胜日汗出也。
（气王日为所胜，王则胜邪，故各当其王日汗。按∶此总结以上所言汗日也。有汗而愈者，有汗而未必愈者，
而要之汗必见于其所胜之日也。）
肝热病者，左颊先赤；（肝气合木，木气应春，南面正理之，则其左颊也。）心热病者，颜先赤；（心气
合火，火气炎上，指象明候，故候于颜。颜，额也。）脾热病者，鼻先赤；（脾气合土，土王于中，鼻处面中，
故占鼻也。）肺热病者，右颊先赤；（肺气合金，金气应秋，南面正理之，则其右颊也。）肾热病者，颐先赤。
（肾气合水，水惟润下，指象明候，故候于颐也。）病虽未发，见色赤者刺之，名曰治未病。（按∶病未发而
色先见，于此治之，重可使轻，危者得安，是所贵乎上工也。）热病从部所起者，至期而已；（按∶部谓如上
所言面中部分也。期谓五脏所主之日期，如肝主甲乙，心主丙丁之类也。热起何部，按部寻经，早为施治，或
汗而表其邪，或寒而清其火，
至其应王之期，自无不愈也。）其刺之反者，三周而已；（按∶刺之为道，补泻而已。如应补而反泻，应泻而
反补，皆反也。刺之既反，病必牵缠难愈。三周，言重复也。）重逆则死。（先刺已反，病气流传，又反刺之，
是为重逆。一逆刺之，尚至三周乃已，况其重逆而得生耶。）诸治热病，以饮之寒水，乃刺之，必寒衣之，
居止寒处，身寒而止也。（按∶是所谓治热以寒也。身寒犹身凉，谓热退也。言诚饮寒衣寒，居处于寒，则身
热退而病止也。）热病先胸胁痛，手足躁，刺足少阳，补足太阴，（足少阳木病，而泻足少阳之木气，补足太
阴之土气者，恐木传于土也。按∶新校正云∶“详足太阴，全元起本及太素作手太阴。杨上善云∶‘手太阴上
属肺，出腋下，故胸胁痛。’又按灵枢经云∶‘热病而胸胁痛，手足躁，取之筋间，以第四针，索筋于肝，不
得，索之于金。金，肺也。’以此决知作手太阴者为是。”此作手太阴者，是补金以平木也。注恐木传土，
故补土，亦是也。今两存之。）病甚者，为五十九刺。五十九刺者，谓头上五行行五者，以越诸阳之热逆也。
大杼、膺俞、缺盆、背俞，此八者，以泻胸中之热也。气街、三里、巨虚上、下廉，此八者，以泻胃中之热也。
云门、 骨、委中、髓空，此八者，以泻四肢之热也。五脏俞旁五，此十者，以泻五脏之热也。凡此五十九穴
者，皆热之左右也，故病甚则尔刺之。然头上五行者，当中行谓上星、囟会、前顶、百会、后顶，次两旁谓
五处、承光、通天、络却、玉枕，又次两旁谓临泣、目窗、正营、承灵、脑空也。上星在颅上，直鼻中央，入
发际一寸，陷者中，容豆，刺四分。（按∶新校正云∶“甲乙经四分作三分，水热穴论注亦作三分，当改从之，
上星刺入三分，囟会刺入四分。”）囟会在上星后一寸，陷者中，刺如上星法。前顶在囟会后一寸五分，骨间
陷者中，刺如囟会法。百会在前顶后一寸五分，顶中央旋毛中，陷容指，督脉、足太阳脉之交会，刺如上星法。
后顶在百会后一寸五分，枕骨上，刺如囟会法。然是五者，皆督脉气所发也。上星留六呼，灸五壮。次两旁穴∶
五处在上星两旁一寸五分，承光在五处后一寸，通天在承光后一寸五分，络却在通天后一寸五分，玉枕在络却
后七分。
然是五者，并足太阳脉气所发。刺三分，五处、通天各留七呼，络却留五呼，玉枕留三呼，灸三壮。（按∶新
校正云∶“甲乙经，承光不可灸，玉枕刺入二分。”）又次两旁∶临泣在头直目，上入发际五分，足太阳少阳阳
维三脉之会。目窗、正营，递相去一寸。承灵、脑空，递相去一寸五分。然是五者，并足少阳阳维二脉之会。
脑空一穴刺四分，余并可刺三分，临泣留七呼，灸五壮。大杼在项第一椎下两旁，相去各一寸半，陷者中，督
脉别络、足太阳、手太阳三脉气之会。刺三分，留七呼，灸五壮。膺俞，膺中俞也，正名中府，在胸中行两旁，
相去六寸，云门下一寸，乳上三肋间动脉应手，陷者中，仰而取之，手足太阴脉之会。刺三分，留五呼，灸五
壮。缺盆在肩上横骨陷者中，手阳明脉气所发。刺二分，留七呼，灸三壮。背俞当是风门热府，在第二椎下两
旁，各一寸半，督脉足太阳之会。刺五分，留七呼，灸五壮。验今明堂中诰图经不言背俞，未详果何处也。
（按∶新校正云∶“王注水热穴论，以风门热府为背俞；又注气穴论，以大杼为背俞；此注云未详。三注不同，
盖疑之也。”）气街在腹齐下横骨两端，鼠鼷上一寸，动应手，足阳明脉气所发。刺三分，留七呼，灸五壮。
三里在膝下三寸， 外廉，两筋肉分间，足阳明脉之所入也。刺一寸，留七呼，灸三壮。巨虚上廉，足阳明与
太阳合，在三里下三寸，足阳明脉气所发。刺八分，灸三壮。巨虚下廉，足阳明与少阳合，在上廉下三寸，足
阳明脉气所发。刺三分，灸三壮。云门在巨骨下，胸中行两旁，（按∶新校正云∶“气穴论注，胸中行两旁作
挟任脉旁，横去任脉，文虽异，穴之处所则同。”）相去六寸，动脉应手，中府当其下一寸，云门手太阴脉气
所发，举臂取之。刺七分，灸五壮。验今明堂中诰图经，不载 骨穴，寻其穴以泻四肢之热，恐是肩 穴。穴
在肩端两骨间，手阳明跷脉之会，刺六分，留六呼，灸三壮。委中在足膝后屈处， 中央，约文中动脉，足太
阳之所入也。刺五分，留七呼，灸三壮。髓空者，正名腰俞，在脊中第二十一椎节下间，督脉气所发。刺二分，
（按∶甲乙经作二寸，热穴论注亦作二寸，恐太深。当以气府论注、水穴论注及此注作二分为近理也。）留七
呼，灸三壮。五脏俞旁五者，谓魄户、神堂、魂门、意舍、志室五穴也。在挟脊两旁，各相去三寸，并足太阳
脉气所发也。
魄户在第三椎下两旁，正坐取之，刺五分，灸五壮。神堂在第五椎下两旁，刺三分，灸五壮。魂门在第九椎
下两旁，正坐取之，刺五分，灸三壮。意舍在第十一椎下两旁，正坐取之，刺五分，灸三壮。志室在第十四椎
下两旁，正坐取之，刺五分，灸三壮。是所谓此经之五十九刺法也。若针经五十九刺则殊与此不同，虽俱治
热病之要穴，然合用之，理全向背，犹当以病候形症，所应经法，即随所证而刺之。热病始手臂痛者，刺手
阳明太阴而汗出止。（手臂痛，列缺主之。列缺者，手太阴之络，去腕上一寸半，别走阳明者也。刺三分，留
三呼，灸五壮。欲出汗，商阳主之。商阳者，手阳明脉之井，在手大指次指内侧，去爪甲角如韭叶，手阳明脉
之所出也。刺一分，留一呼，灸三壮。）热病始于头首者，刺项太阳而汗出止。（天柱主之。天柱在侠项后，发
际大筋外廉，陷者中，足太阳脉气所发。刺二分，留六呼，灸三壮。）热病始于足胫者，刺足阳明而汗出止。
（按∶新校正云∶“此条素问本无，太素亦无，今按甲乙经添入。”）热病先身重骨痛，耳聋好瞑，刺足少阴。
（据经无正主穴，当补泻井荥尔。按∶新校正云∶“灵枢经云∶热病而身重骨痛，耳聋而好瞑，取之骨，以第
四针，索骨于肾，不得，索之土。土者，脾也。”）病甚，为五十九刺。（如古法。）热病先眩冒而热，胸胁
满，刺足少阴少阳。（亦井荥也。）太阳之脉色荣颧，骨热病也。（荣，饰也，谓赤色见于颧骨，如荣饰也。
颧骨谓目下当外 也。太阳合火，故见赤色。按∶新校正云∶“杨上善云∶‘赤色荣颧者，骨热病也。’与王
氏之注不同。”）荣未交，（按∶甲乙经、太素并作荣未夭，似是，但与下文争见义不切，不若交字为妥。）曰
今且得汗，待时而已。（荣一为营，字之误也。曰者，引古经法之端由也。言色虽明盛，但阴阳之气不交错者，
故法云今且得汗之而已。待时者，谓肝病待甲乙，心病待丙丁，脾病待戊己，肺病待庚辛，肾病待壬癸，是谓
待时而已。所谓交者次如下文。）与厥阴
脉争见者死，期不过三日。（……外见太阳之赤色，内应厥阴之弦脉。然太阳受病，当传入阳明，今反厥阴之脉
本篇所论述的，都是真正的热病。热邪蕴结于体内，症状就会表现在外部，所以首先论述五脏的热证。症状出现后，面色自然会有所不同，所以接着论述五脏对应的面色。既然观察了面色，又辨别了症状，就能知道病邪所在的位置，从而可以通过针刺来祛除病邪，所以又接着论述五十九穴刺法及应当针刺的其他穴位，因此以“刺热”作为篇名。
肝发生热病时，小便先变黄，腹痛，嗜睡，身体发热。（足厥阴肝经环绕生殖器，抵少腹而上行，所以小便不利先见黄色，腹痛且嗜睡。寒邪郁遏化生热邪，所以身体发热。）热邪与正气相争，就会出现胡言乱语和惊骇，胁肋部胀满疼痛，手足躁动不安，无法安稳躺卧。（经络虽然已经受热，但神志之脏尚未完全接纳邪气，邪正相互搏结，所以称为“争”。足厥阴肝经，从少腹上行挟胃，穿过膈肌，分布于胁肋，沿着喉咙后方，联络舌根，所以出现胡言乱语、胁肋胀满疼痛。肝性喜静而主惊骇，所以患病则惊骇，手足躁动，卧不安稳。）在庚辛日病情加重，在甲乙日大汗出，若出现气逆则庚辛日死亡。（肝属木，庚辛属金，金克木，所以在庚辛日加重。甲乙属木，是肝的本气，所以在甲乙日大汗出。）针刺足厥阴肝经和足少阳胆经。（厥阴指肝脉，少阳指胆脉。）如果气逆，则头痛眩晕，因为经脉之气上冲头部。（足厥阴肝经，从舌根沿喉咙后方，上行出于额部，会合于头顶，所以头部眩晕，经脉之气上冲头部。“员员”形容头晕目眩的样子。按：本篇所说的热病，都是实证，与其他篇章中兼有虚实的不同。气逆不是指气喘，而是指病势严重导致气机溃乱。）
心发生热病时，先感到心情不愉快，几天后才发热。（按：不乐，是指起居不适意。心为火脏，其气本热，心病则火不能安守其位而表现出热象。所以心见热病，其热不会立即显现，必定先有痛苦感觉，然后病症才在几天后表现出来。）热邪与正气相争，则心脏突然疼痛，烦闷，容易呕吐，头痛，面红，无汗。（手少阴心经，起于心中。其支脉，从心系上行挟咽。手太阳小肠经，直行者，沿咽下膈抵胃。其支脉，从缺盆，沿颈上颊，至目外眦。所以突发心痛，烦闷易呕，头痛面赤。心在液为汗，现在患热病，所以无汗。）在壬癸日病情加重，在丙丁日大汗出，若出现气逆则壬癸日死亡。（按：火畏水，所以在壬癸日加重甚至死亡。自得其位（丙丁火），所以大汗出。）针刺手少阴心经和手太阳小肠经。（少阴，心脉；太阳，小肠脉。）
脾发生热病时，先头重，脸颊痛，心烦，面色发青，想呕吐，身体发热。（足阳明胃经，起于鼻翼旁交鼻梁中，向下沿鼻外侧，入上齿中，复出挟口环唇，下交承浆，却循腮后下廉，出大迎，循颊车，上耳前，过客主人，循发际，至额颅，所以先头重、颊痛、面色发青。足太阴脾经，其支脉，又从胃上膈注心中。其直行者，上膈挟咽。所以心烦、欲呕且身热。按：新校正说：“《甲乙经》、《太素》说脾热病者先头重颜痛，没有‘颜青’二字。”）热邪与正气相争，则腰痛不可俯仰，腹部胀满泄泻，两侧下颌疼痛。（足阳明胃经，其支脉，起于胃下口，循腹里，下至气街中而合以下大腿。气街处，在腰之前，所以腰痛。足太阴脾经，入腹属脾络胃。另外足阳明胃经，自交承浆，却循腮后下廉，出大迎，循颊车。所以腹部胀满泄泻且两侧下颌疼痛。）在甲乙日病情加重，在戊己日大汗出，若出现气逆则甲乙日死亡。（按：木克土，所以在甲乙日加重甚至死亡。土得气（戊己土），所以大汗出。）针刺足太阴脾经和足阳明胃经。（太阴，脾脉；阳明，胃脉。）
肺发生热病时，先淅然恶寒，毫毛竖起，怕风怕冷，舌苔发黄，身体发热。（肺主皮肤，外养于毫毛，所以热邪侵入，则淅然恶风寒，毫毛竖起。手太阴肺经，起于中焦，下络大肠，还循胃口，现在肺热入胃，胃热上升，所以舌苔黄且身热。）热邪与正气相争，则气喘咳嗽，疼痛游走于胸膺背部，不能深呼吸，头痛剧烈，出汗后怕冷。（肺居膈上，气主胸膺，在变动为咳，又藏气而主呼吸，复为胸中之府，所以气喘咳嗽，疼痛游走于胸膺背部，不能深呼吸。手太阴肺经的络脉，上会耳中，现在热气上熏，所以头痛剧烈，出汗后怕冷。）在丙丁日病情加重，在庚辛日大汗出，若出现气逆则丙丁日死亡。（按：火克金，所以在丙丁日加重甚至死亡。金得气（庚辛金），所以大汗出。）针刺手太阴肺经和手阳明大肠经，出血如大豆大小，病立愈。（太阴，肺脉；阳明，大肠脉。如果是络脉盛实，就针刺使其出血。）
肾发生热病时，先腰痛，小腿酸软无力，口渴苦饮，多次饮水，身体发热。（足太阳膀胱经，从肩内，挟脊抵腰中，又腰为肾之府，所以先腰痛。另外足少阴肾经，自循内踝之后，上腨内，出腨内廉。另外直行者，从肾上贯肝膈，入肺中，循喉咙，挟舌本。所以小腿酸软、口渴多饮且身热。）热邪与正气相争，则项部疼痛且僵硬，小腿寒冷且酸痛，足底发热，不想说话。（足太阳膀胱经，从脑出别下项。另外足少阴肾经，起于小趾之下，斜趋足心，出于然骨之下，循内踝之后，别入跟中，以上腨内。另外其直行者，从肾上贯肝膈，入肺中，循喉咙，挟舌本。所以病症如此。）如果气逆，则项部疼痛眩晕，神情恍惚不定。（足少阴肾经的筋，循脊内挟膂，上至项，结于枕骨，与足太阳膀胱经的筋相合。足太阳膀胱经，又并下行于项。所以项部疼痛眩晕。“淡淡”，形容神情恍惚不定的样子。）在戊己日病情加重，在壬癸日大汗出，若出现气逆则戊己日死亡。（按：土克水，所以在戊己日加重甚至死亡。水得气（壬癸水），所以大汗出。）针刺足少阴肾经和足太阳膀胱经。（少阴，肾脉；太阳，膀胱脉。按：五脏气逆的症状，经文只提到了肝肾，而心和脾肺的注释认为经文有缺文，恐怕不一定如此。大概五脏的位置，肝肾居下，气逆则病自下而上，所以肝病则头痛，肾病则项痛。至于心肺脾，位置本来在上，头面的症状已经见到，所以不必再讲气逆的病证。并非缺文。这里各脏都说气逆则死，是指到了不胜我（克制我）的日子则病势严重，气必溃乱而死。）
凡是出汗的，都是在其所胜之日出汗。（气旺之日为所胜，旺则胜邪，所以各在其王日出汗。按：这是总结以上所说的出汗日期。有汗出而愈的，有汗出而未必愈的，但总之汗必见于其所胜之日。）
肝热病的人，左颊先发红；（肝气合木，木气应春，面向南端正理之，则对应左颊。）心热病的人，额头先发红；（心气合火，火气炎上，指象明显，所以候于额头。颜，指额头。）脾热病的人，鼻子先发红；（脾气合土，土王于中，鼻处面部中央，所以占鼻。）肺热病的人，右颊先发红；（肺气合金，金气应秋，面向南端正理之，则对应右颊。）肾热病的人，下巴先发红。（肾气合水，水惟润下，指象明显，所以候于下巴。）
病虽未发作，但见面色发红就针刺它，这叫做“治未病”。（按：病未发作而色先见，在此治疗，重的可使轻，危的可得安，这是上工所珍贵的。）热病从面部相应部位起始的，到相应的日期就会痊愈；（按：部指如上所说面部各个部分。期指五脏所主的日期，如肝主甲乙，心主丙丁之类。热起何部，按部寻经，早为施治，或发汗以解表邪，或用寒凉清其火热，到其应王之期，自然无不痊愈。）如果针刺方法相反，经过三个周期才能痊愈；（按：针刺的道理，在于补泻而已。如应补而反泻，应泻而反补，都叫反。针刺既已相反，病必牵缠难愈。三周，指重复三次。）再次逆刺则会死亡。（先一次刺反，病气流传，又再次逆刺，这叫重逆。一次逆刺，尚且要经过三个周期才愈，何况重逆还能活吗？）
所有治疗热病的方法，要喝冷水，然后针刺，必须穿凉衣服，居住在凉爽的地方，直到身体凉爽为止。（按：这就是所谓“治热以寒”。身寒犹身凉，指热退。意思是确实喝凉水、穿凉衣、居凉处，则身热退而病止。）
热病先胸胁痛，手足躁动的，针刺足少阳胆经，补足太阴脾经。（足少阳属木病，泻足少阳之木气，补足太阴之土气，是防止木传于土。按：新校正说：“详考足太阴，《全元起本》及《太素》作手太阴。杨上善说：‘手太阴上属于肺，出腋下，故胸胁痛。’又按《灵枢经》说：‘热病而胸胁痛，手足躁，取之筋间，用第四针，索筋于肝，不得，索之于金。金，肺也。’以此决知作手太阴的是正确的。”此处作手太阴，是补金以平木。注释恐木传土，故补土，也是对的。现在两存之。）病严重的，用五十九刺法。五十九刺，是指头上五行，每行五穴，用来发散诸阳经的热邪逆乱。大杼、膺俞、缺盆、背俞，这八个穴位，用来泻胸中之热。气街、三里、巨虚上廉、巨虚下廉，这八个穴位，用来泻胃中之热。云门、髃骨（疑为肩髃）、委中、髓空，这八个穴位，用来泻四肢之热。五脏俞旁五穴，这十个穴位，用来泻五脏之热。凡这五十九个穴位，都是治疗热的左右配穴，所以病重则这样针刺。然而头上五行者，当中行指上星、囟会、前顶、百会、后顶，次两旁指五处、承光、通天、络却、玉枕，又次两旁指临泣、目窗、正营、承灵、脑空。上星在颅上，直鼻中央，入发际一寸，陷者中，容豆，刺四分。（按：新校正说：“《甲乙经》四分作三分，《水热穴论》注亦作三分，当改从之，上星刺入三分，囟会刺入四分。”）囟会在上星后一寸，陷者中，刺法同于上星。前顶在囟会后一寸五分，骨间陷者中，刺法同于囟会。百会在前顶后一寸五分，顶中央旋毛中，陷容指，督脉、足太阳脉之交会，刺法同于上星。后顶在百会后一寸五分，枕骨上，刺法同于囟会。但这五个穴位，都是督脉气所发。上星留针六呼，灸五壮。次两旁穴：五处在上星两旁一寸五分，承光在五处后一寸，通天在承光后一寸五分，络却在通天后一寸五分，玉枕在络却后七分。但这五个穴位，并足太阳脉气所发。刺三分，五处、通天各留七呼，络却留五呼，玉枕留三呼，灸三壮。（按：新校正说：“《甲乙经》，承光不可灸，玉枕刺入二分。”）又次两旁：临泣在头直目，上入发际五分，足太阳、少阳、阳维三脉之会。目窗、正营，递相去一寸。承灵、脑空，递相去一寸五分。但这五个穴位，并足少阳、阳维二脉之会。脑空一穴刺四分，其余均可刺三分，临泣留七呼，灸五壮。大杼在项第一椎下两旁，相去各一寸半，陷者中，督脉别络、足太阳、手太阳三脉气之会。刺三分，留七呼，灸五壮。膺俞，即膺中的俞穴，正名中府，在胸中行两旁，相去六寸，云门下一寸，乳上三肋间动脉应手，陷者中，仰而取之，手足太阴脉之会。刺三分，留五呼，灸五壮。缺盆在肩上横骨陷者中，手阳明脉气所发。刺二分，留七呼，灸三壮。背俞应当是风门热府，在第二椎下两旁，各一寸半，督脉足太阳之会。刺五分，留七呼，灸五壮。验今《明堂中诰图经》不言背俞，不知果在何处。（按：新校正说：“王注《水热穴论》，以风门热府为背俞；又注《气穴论》，以大杼为背俞；此注云未详。三注不同，盖疑之也。”）气街在腹齐下横骨两端，鼠鼷上一寸，动应手，足阳明脉气所发。刺三分，留七呼，灸五壮。三里在膝下三寸，胻外廉，两筋肉分间，足阳明脉之所入也。刺一寸，留七呼，灸三壮。巨虚上廉，足阳明与太阳合，在三里下三寸，足阳明脉气所发。刺八分，灸三壮。巨虚下廉，足阳明与少阳合，在上廉下三寸，足阳明脉气所发。刺三分，灸三壮。云门在巨骨下，胸中行两旁，（按：新校正说：“《气穴论》注，胸中行两旁作挟任脉旁，横去任脉，文虽异，穴之处所则同。”）相去六寸，动脉应手，中府当其下一寸，云门手太阴脉气所发，举臂取之。刺七分，灸五壮。验今《明堂中诰图经》，不载髃骨穴，寻其穴以泻四肢之热，恐是肩髃穴。穴在肩端两骨间，手阳明跷脉之会，刺六分，留六呼，灸三壮。委中在足膝后屈处，腘中央，约文中动脉，足太阳之所入也。刺五分，留七呼，灸三壮。髓空者，正名腰俞，在脊中第二十一椎节下间，督脉气所发。刺二分，（按：《甲乙经》作二寸，《热穴论》注亦作二寸，恐太深。当以《气府论》注、《水穴论》注及此注作二分为近理也。）留七呼，灸三壮。五脏俞旁五者，谓魄户、神堂、魂门、意舍、志室五穴也。在挟脊两旁，各相去三寸，并足太阳脉气所发也。魄户在第三椎下两旁，正坐取之，刺五分，灸五壮。神堂在第五椎下两旁，刺三分，灸五壮。魂门在第九椎下两旁，正坐取之，刺五分，灸三壮。意舍在第十一椎下两旁，正坐取之，刺五分，灸三壮。志室在第十四椎下两旁，正坐取之，刺五分，灸三壮。是所谓此经之五十九刺法也。若《针经》五十九刺则与此不同，虽俱治热病之要穴，然合用之，理全向背，犹当以病候形症，所应经法，即随所证而刺之。
热病始手臂痛的，刺手阳明、手太阴经而汗出止。（手臂痛，列缺主之。列缺者，手太阴之络，去腕上一寸半，别走阳明者也。刺三分，留三呼，灸五壮。欲出汗，商阳主之。商阳者，手阳明脉之井，在手大指次指内侧，去爪甲角如韭叶，手阳明脉之所出也。刺一分，留一呼，灸三壮。）热病始于头首的，刺项部太阳经而汗出止。（天柱主之。天柱在侠项后，发际大筋外廉，陷者中，足太阳脉气所发。刺二分，留六呼，灸三壮。）热病始于足胫的，刺足阳明经而汗出止。（按：新校正说：“此条《素问》本无，《太素》亦无，今按《甲乙经》添入。”）热病先身重骨痛，耳聋好瞑的，刺足少阴经。（据经无正主穴，当补泻井荥尔。按：新校正说：“《灵枢经》云：‘热病而身重骨痛，耳聋而好瞑，取之骨，以第四针，索骨于肾，不得，索之土。土者，脾也。’”）病甚，用五十九刺。（如古法。）热病先眩冒而热，胸胁满的，刺足少阴、足少阳经。（亦井荥也。）
太阳之脉色荣颧，是骨热病也。（荣，饰也，谓赤色见于颧骨，如荣饰也。颧骨谓目下当外眦也。太阳合火，故见赤色。按：新校正说：“杨上善云：‘赤色荣颧者，骨热病也。’与王氏之注不同。”）荣未交，（按：《甲乙经》、《太素》并作荣未夭，似是，但与下文争见义不切，不若交字为妥。）曰今且得汗，待时而已。（荣一为营，字之误也。曰者，引古经法之端由也。言色虽明盛，但阴阳之气不交错者，故法云今且得汗之而已。待时者，谓肝病待甲乙，心病待丙丁，脾病待戊己，肺病待庚辛，肾病待壬癸，是谓待时而已。所谓交者次如下文。）与厥阴脉争见者死，期不过三日。（……外见太阳之赤色，内应厥阴之弦脉。然太阳受病，当传入阳明，今反厥阴之脉）
The discussions in this chapter all pertain to true Heat diseases (Re Bing, febrile diseases caused by pathogenic heat). When Heat accumulates internally, symptoms manifest externally; therefore, the manifestations of the Five Zang organs are discussed first. Once symptoms appear, the complexion naturally changes; thus, the complexions corresponding to the Five Zang organs are discussed next. Having observed the complexion and differentiated the symptoms, one can ascertain the location of the disease and employ acupuncture to eliminate it. Consequently, the fifty-nine acupoints for needling and other relevant points are discussed subsequently, giving the chapter its title, "Needling Heat" (Ci Re).
In Liver Heat disease, urination turns yellow first, accompanied by abdominal pain, excessive sleepiness, and body fever. (The Foot Jueyin Liver meridian circles the genitalia and ascends to the lower abdomen; hence, dysuria with yellow urine, abdominal pain, and lethargy occur. Cold constrained generates Heat, resulting in body fever.) During a struggle between Heat and healthy Qi (Zheng), delirious speech and惊骇 (fright/panic) occur, along with distension and pain in the hypochondrium, restlessness of the hands and feet, and inability to lie down peacefully. (Although the meridians have been affected by Heat, the Spirit stores have not yet fully accepted the pathogen; the struggle between pathogen and healthy Qi is termed "struggle." The Foot Jueyin Liver meridian ascends from the lower abdomen, flanks the stomach, pierces the diaphragm, distributes over the hypochondrium, follows the posterior aspect of the throat, and connects with the root of the tongue; hence, delirium, hypochondriac distension, and pain occur. The Liver nature is quiet but governs fright; thus, the disease manifests as fright, restlessness, and restless sleep.) The condition worsens on Geng-Xin days (Metal days) and profuse sweating occurs on Jia-Yi days (Wood days). If Qi rebellion (Qi Ni) occurs, death ensues on Geng-Xin days. (The Liver belongs to Wood; Geng-Xin belong to Metal, which controls Wood, hence worsening on these days. Jia-Yi belong to Wood, the Liver's own element, hence profuse sweating on these days.) Needling the Foot Jueyin and Foot Shaoyang meridians. (Jueyin refers to the Liver meridian; Shaoyang refers to the Gallbladder meridian.) In cases of Qi rebellion, there is headache and vertigo due to meridian Qi rushing to the head. (The Liver meridian ascends from the tongue root, follows the throat, emerges at the forehead, and converges at the vertex; hence, vertigo and upward rushing of Qi. "Yuan yuan" describes dizziness.) Note: The heat diseases described here are all excess patterns, differing from other chapters that include deficiency-excess combinations. Qi rebellion here does not refer to asthma but to severe illness causing chaotic Qi dynamics.
In Heart Heat disease, there is initially a sense of unhappiness, followed by fever after several days. (Note: Unhappiness refers to physical discomfort. The Heart is a Fire organ with inherently hot Qi; when diseased, Fire fails to maintain its position, manifesting as Heat. Thus, Heat does not appear immediately but is preceded by distress, appearing days later.) During the struggle, sudden heart pain, vexation, fullness, propensity to vomit, headache, facial redness, and anhidrosis occur. (The Hand Shaoyin Heart meridian originates in the heart; its branch ascends alongside the pharynx. The Hand Taiyang Small Intestine meridian descends through the diaphragm to the stomach; its branch ascends from the supraclavicular fossa along the neck to the cheek and outer canthus; hence, sudden heart pain, vexation, vomiting, headache, and red face. The Heart governs sweat; in heat disease, sweat cannot be excreted.) The condition worsens on Ren-Gui days (Water days) and profuse sweating occurs on Bing-Ding days (Fire days). If Qi rebellion occurs, death ensues on Ren-Gui days. (Note: Fire fears Water, hence worsening/death on Water days. Self-receiving its position (Bing-Ding Fire), hence profuse sweating.) Needling the Hand Shaoyin and Hand Taiyang meridians. (Shaoyin, Heart meridian; Taiyang, Small Intestine meridian.)
In Spleen Heat disease, there is initially heavy head, cheek pain, heart vexation, bluish-green complexion of the face, desire to vomit, and body fever. (The Foot Yangming Stomach meridian originates at the nose, enters the upper teeth, circles the lips, and ascends to the forehead; hence, heavy head, cheek pain, and greenish hue. The Foot Taiyin Spleen meridian branches from the stomach to the heart and ascends alongside the pharynx; hence, heart vexation, vomiting, and fever. Note: New Correction states that *Jia Yi Jing* and *Tai Su* mention heavy head and cheek pain but omit "greenish hue.") During the struggle, lower back pain preventing flexion and extension, abdominal fullness, diarrhea, and bilateral mandibular pain occur. (Stomach meridian branch descends to the Qichong point, anterior to the waist, causing back pain. Spleen meridian enters the abdomen to connect with the Spleen and Stomach. Stomach meridian passes through the jaw; hence, abdominal fullness, diarrhea, and jaw pain.) The condition worsens on Jia-Yi days (Wood days) and profuse sweating occurs on Wu-Ji days (Earth days). If Qi rebellion occurs, death ensues on Jia-Yi days. (Note: Wood overacts on Earth, hence worsening/death on Wood days. Earth receiving its Qi, hence profuse sweating.) Needling the Foot Taiyin and Foot Yangming meridians. (Taiyin, Spleen meridian; Yangming, Stomach meridian.)
In Lung Heat disease, there is initially chills, piloerection, aversion to wind and cold, yellow coating on the tongue, and body fever. (The Lung governs skin and hair; Heat invasion causes chills and piloerection. The Lung meridian originates in the middle jiao, connects with the Large Intestine, and loops around the stomach; Lung Heat entering the Stomach causes rising Stomach Heat, resulting in yellow tongue coating and fever.) During the struggle, wheezing, coughing, pain radiating to the chest, epigastrium, and back, inability to take deep breaths, severe headache, and sweating with chills occur. (The Lung resides above the diaphragm, governs the chest, and is associated with cough and respiration; hence, wheezing, coughing, radiating pain, and dyspnea. Lung collateral vessels ascend to the ear; rising Heat causes headache and post-sweat chills.) The condition worsens on Bing-Ding days (Fire days) and profuse sweating occurs on Geng-Xin days (Metal days). If Qi rebellion occurs, death ensues on Bing-Ding days. (Note: Fire melts Metal, hence worsening/death on Fire days. Metal receiving its Qi, hence profuse sweating.) Needling the Hand Taiyin and Hand Yangming meridians until blood oozes like a soybean, leading to immediate relief. (Taiyin, Lung meridian; Yangming, Large Intestine meridian. If collateral vessels are full, needle to bleed.)
In Kidney Heat disease, there is initially lower back pain, soreness and weakness of the calves, bitter thirst with frequent drinking, and body fever. (Bladder meridian descends along the spine to the waist; the waist is the mansion of the Kidney, hence back pain. Kidney meridian ascends from the medial malleolus through the calf; its main trunk ascends through the Liver and Diaphragm to the Lung, following the throat to the tongue root; hence, calf soreness, thirst, and fever.) During the struggle, stiff and painful neck, cold and sore calves, hot soles, and reluctance to speak occur. (Bladder meridian descends from the brain to the nape. Kidney meridian originates at the sole, ascends behind the medial malleolus, and up the calf; its main trunk ascends to the Lung and throat; hence, these symptoms.) In case of Qi rebellion, there is stiff, dizzy neck pain and mental instability. (Kidney sinews ascend along the spine to the nape, connecting with Bladder sinews; hence, neck pain and dizziness. "Dan dan" describes mental instability.) The condition worsens on Wu-Ji days (Earth days) and profuse sweating occurs on Ren-Gui days (Water days). If Qi rebellion occurs, death ensues on Wu-Ji days. (Note: Earth controls Water, hence worsening/death on Earth days. Water receiving its Qi, hence profuse sweating.) Needling the Foot Shaoyin and Foot Taiyang meridians. (Shaoyin, Kidney meridian; Taiyang, Bladder meridian. Note: The text mentions only Liver and Kidney Qi rebellion in the classic, but commentators suggest missing text for Heart, Spleen, and Lung. However, since Liver and Kidney are inferior, rebellion causes upward pathology (headache/neck pain). Heart, Lung, and Spleen are superior, so head/facial symptoms are already present, making specific "rebellion" descriptions redundant. It is not missing text. "Death upon Qi rebellion" means death occurs on the day of the controlling element when Qi becomes chaotic.)
Profuse sweating occurs on the day the organ is victorious (its ruling day). (When Qi is prosperous, it defeats pathogens; thus, sweating occurs on the ruling day. Note: This summarizes the sweating days. Sweating may or may not lead to cure, but it invariably appears on the victorious day.)
In Liver Heat disease, the left cheek reddens first. (Liver corresponds to Wood/Spring; facing south, left corresponds to the left cheek.) In Heart Heat disease, the forehead reddens first. (Heart corresponds to Fire; Fire flames upward, manifesting on the forehead. Yan refers to the forehead.) In Spleen Heat disease, the nose reddens first. (Spleen corresponds to Earth; Earth rules the center, and the nose is central on the face.) In Lung Heat disease, the right cheek reddens first. (Lung corresponds to Metal/Autumn; facing south, right corresponds to the right cheek.) In Kidney Heat disease, the chin reddens first. (Kidney corresponds to Water; Water moistens downward, manifesting on the chin.)
Even if the disease has not manifested clinically, if redness is seen in the complexion, acupuncture should be applied; this is called "Treating Disease Before It Arises" (Zhi Wei Bing). (Note: Treating when color changes precede symptoms prevents severity and ensures safety, valued by expert physicians.) Heat diseases originating from specific facial zones resolve by their corresponding time. (Zone refers to facial areas; Time refers to ruling days, e.g., Liver Jia-Yi. Locate the meridian based on the zone and treat early; whether by sweating to release exterior pathogens or cooling to clear fire, resolution occurs by the ruling day.) If needling is contraindicated or incorrect, recovery takes three cycles. (Note: Needling principles involve tonification and sedation. Incorrect application leads to prolonged illness. Three cycles imply repetition.) Double violation (Chong Ni) leads to death. (Incorrect needling allows pathogen spread; repeating errors is fatal.)
All treatments for heat diseases involve drinking cold water, followed by needling, wearing cool clothing, and residing in cool places, until the body cools. (Note: This is "treating heat with cold." Body cooling indicates fever subsidence.)
For heat disease starting with chest/hypochondriac pain and hand/foot restlessness, needle the Foot Shaoyang and tonify the Foot Taiyin. (Foot Shaoyang is Wood; sedating Wood and tonifying Earth (Spleen) prevents Wood transmitting to Earth. Note: New Correction suggests Hand Taiyin (Lung) in some texts to tonify Metal to control Wood. Both interpretations are preserved.) For severe cases, use the fifty-nine needling points. These include five rows of five points on the head to dissipate rebellious Heat from Yang meridians. Dazhu, Yingshu (Zhongfu), Quepen, and Beishu (Fengmen) – eight points – drain Chest Heat. Qichong, Zusanli, Shangjuxu, and Xiajuxu – eight points – drain Stomach Heat. Yunmen, Jianyu, Weizhong, and Yaoshu (Yaoshu/Yaoyu) – eight points – drain Limb Heat. Five points beside the Five Shu points of the Zang organs – ten points – drain Zang Heat. These fifty-nine points are used for severe heat.
Specific head points: Upper Star (Shangxing), Xinhui, Qian Ding, Baihui, and Hou Ding (Du Meridian). Wuchu, Chengguang, Tongtian, Luoque, and Yuzhen (Foot Taiyang). Linqi, Mucuang, Zhengying, Chengling, and Naokong (Foot Shaoyang/Yangwei). Specific depths and moxibustion doses are detailed for each.
For heat disease starting with arm pain, needle Hand Yangming and Hand Taiyin to induce sweating. (Lieque and Shangyang points specified.) For heat disease starting with head pain, needle Neck Taiyang (Tianzhu) to induce sweating. For heat disease starting with leg pain, needle Foot Yangming to induce sweating. For heat disease with heaviness, bone pain, deafness, and desire to close eyes, needle Foot Shaoyin. (Note: *Ling Shu* suggests seeking Bone/Kidney or Earth/Spleen.) For severe cases, use fifty-nine points. For heat disease with vertigo, fever, and chest fullness, needle Foot Shaoyin and Shaoyang.
If the Taiyang meridian color adorns the zygomatic arch, it is Bone Heat disease. (Redness on the zygoma indicates Fire/Taiyang involvement.) If the color has not yet crossed (interacted), it is said that sweating may occur now, waiting for the appropriate time to resolve. (Waiting for the ruling day: Liver Jia-Yi, Heart Bing-Ding, etc.) If Taiyang color competes with Jueyin pulse manifestation, death occurs within three days. (External Taiyang Redness with internal Jueyin Wiry Pulse indicates transmission to the controlling organ, leading to death.)