真气邪气有离有合，他篇亦言之矣，而此特以名篇者，盖谓针之为用，去邪存真而已，欲去病邪，必究其
所以合，与其所以离，乃可耳。篇中辞义重杂，似亦缀集成文者。
黄帝问曰∶余闻九针九篇，夫子乃因而九之，九九八十一篇，余尽通其意矣。经言气之盛衰，左右倾移，
以上调下，以左调右，有余不足，补泻于荥输，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∶夫圣人之起度数，必应于天地。故天有宿度，地有经
水，人有经脉。（宿谓二十八宿。度谓天之三百六十五度也。经水谓海水、渎水、渭水、湖水、沔水、汝水、
江水、淮水、漯水、河水、漳水、济水也，以其内合经脉，故名之经水。经脉谓手足三阴三阳之脉。所以言者，
以内外参合，人气应通，故言之也。按∶新校正云∶“甲乙经云∶足阳明外合于海水，内属于胃；足太阳外合
于渎水，内属于膀胱；足少阳外合于渭水，内属于胆；足太阴外合于湖水，内属于脾；足厥阴外合于沔水，内
属于肝；足少阴外合于汝水，内属于肾；手阳明外合于江水，内属于大肠；手太阳外合于淮水，内属于小肠；
手少阳外合于漯水，内属于三焦；手太阴外合于河水，内属于肺；手心主外合于漳水，内属于心包；手少阴外合
于济水，内属于心。”）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。（人经脉亦应之。
按∶凝涩谓寒而滞也，沸溢则浮而动矣。波，波浪，水之激也。陇，丘陇，地之坟也。水激地坟，皆风卒暴之所
至。陇同垄。）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，循循然。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。（按∶水得风而动，脉随邪而异。脉中，周身脉络之中也。循循，隐而未见也。寸口，寸关尺
脉。中手，脉应于手而分大小之殊，以别邪之有无也。邪行无一定之所，故脉象随阴阳而移。）从而察之，三
部九候。卒然逢之，早遏其路。（脉之三部，医必以九候察之者，盖以邪之循经，亦犹人之行路，路有远近之分，
经有浅深之别，人卒感邪，初或浅近，若不遏绝，势必深远而难治矣。此邪入之路，不可以不遏，而遏之尤贵乎
早者，上工治未病之义也。）
吸则内针，无令气忤。静以久留，无令邪布。吸则转针，以得气为故。候呼引针，呼尽乃去。大气皆出，故
命曰泻。（引谓引出，去谓离穴，候呼而引至其门，呼尽而乃离穴户，则经气审以平定，邪气无所勾留，故大邪
之气随针而出也。呼谓气出，吸谓气入，转谓转动也。大气谓大邪之气，错乱阴阳者也。按∶此论用针补泻之道
也。凡人之病，有余不足二者而已。有余者邪气实，不足者正气虚，虚者宜补。然苟非泻其有余之邪，则正气虽
虚，补之必为邪格而不效。此经所以先吸后呼以泻其邪，然后呼尽候吸以补其正也。）
帝曰∶不足者补之奈何？岐伯曰∶必先扪而循之，切而散之，推而按之，弹而怒之，抓而下之，通而取之，
外引其门，以闭其神。（扪循谓手摸，切谓指按也。扪而循之，欲气舒缓。切而散之，使经脉宣散。推而按之，
排蹙其皮也。弹而怒之，使气脉 满也。抓而下之，置针准也。通而取之，以常法也。外
引其门以闭其神，则推而按之者也，谓蹙按穴外之皮，令当应针之处，盖其所刺之门不开，则神气内守，故云
以闭其神也。按∶抓，侧交切，以爪甲刮针也。）呼尽内针，静以久留，以气至为故。如待所贵，不知日暮。
其气以至，适而自护。（呼尽内针，亦同吸也，言必以气至而为去针之故，不以息之多数而便去针也。针经曰∶
刺之而气不至，无问其数。刺之气至，去之勿复针。此之谓也。暮，晚也。适，调适也。护，慎守也。言气已
平调，则当慎守，勿令改变，使疾更生也。）候吸引针，气不得出，各在其处。推阖其门，令神气存。大气留
止，故命曰补。（正言也。外门已闭，神气复存，候吸引针，大气不泄，补之为义，断可知焉。然此大气，谓
大经之气流行荣卫者。）
帝曰∶候气奈何？（按∶谓既针而其气之至与未至，何以候之。）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。（按∶言邪气初入，由浅转深，其寒温去来，尚无定
所。）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。（按∶冲，注作应水刻数之平气，恐未确。详味此节，文义难通，盖真气者之上，经气太虚之
下，必有脱误故也。）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。（……按∶不审谓认病不详细也。大气，大邪之气。不复谓真气脱而难复也。正气虚则邪气盛，邪气
退则正气复，若不泻之于邪盛之时，而反泻之于既退之后，则真气脱而邪气复至，病更缠绵不解矣，此戒攻邪
贵乎早，而刻削之剂不可过用也。）
帝曰∶补泻奈何？岐伯曰∶此攻邪也，疾出以去盛血而复其真气。（按∶邪不去则真不复，故必用针以去其血。
前论补泻以气至为主，此言补泻以去血为急也。）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。（按∶溶溶，水动貌。逆犹迎也。新邪入客，如水之流动，其血尚温，而未至于
冰凝，故当迎而刺出其血，病必自除矣。）
帝曰∶善！然真邪以合，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，审其病脏以期之。（……按真邪以合，谓邪入于经而与真气相合也。波陇不起，谓初合之时，尚
未变动，何以候而治之也。伯言治此之法，须详审以抚其身之肥瘠，循切以辨其脉之盛衰，而知病在何脏，愈于
何日也。）诛伐无过，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，故不能久长。（……
按∶此重言不知三部九候者之为害也。）
真气与邪气既有分离也有结合，其他篇章也曾论述过这一点，但本篇特别以此命名，是因为认为针刺的作用，在于祛除邪气、保存真气。想要去除病邪，必须深入研究邪气为何会与人体结合，以及为何会分离，这样才能做到。本篇文字含义重复繁杂，似乎也是由不同内容拼凑而成的。
黄帝问道：我听说九针分为九篇，先生又将其推演为九倍，共八十一篇，我都通晓其意了。经书中说气的盛衰变化，左右偏倾移易，可以通过上部的调治来影响下部，通过左侧的调治来影响右侧，对于有余和不足的病症，在荥穴和输穴上进行补泻，这些我都知道了。但这都是营卫之气的偏倾移易，是虚实产生的原因，并非邪气从外部侵入经脉所致。我希望了解邪气在经脉中的情况，它引起的病症表现如何？应当如何取穴治疗？岐伯回答说：圣人制定医疗法则，必定与天地相应。所以天有星宿度数，地有江河水流，人有十二经脉。（宿指二十八宿。度指天体的三百六十五度。经水指海水、渎水、渭水、湖水、沔水、汝水、江水、淮水、漯水、河水、漳水、济水，因为它们内合于经脉，所以称为经水。经脉指手足三阴三阳之脉。之所以这样讲，是因为内外参合，人气相通，所以这样说。按：新校正注解说：“《甲乙经》说：足阳明外合于海水，内属于胃；足太阳外合于渎水，内属于膀胱；足少阳外合于渭水，内属于胆；足太阴外合于湖水，内属于脾；足厥阴外合于沔水，内属于肝；足少阴外合于汝水，内属于肾；手阳明外合于江水，内属于大肠；手太阳外合于淮水，内属于小肠；手少阳外合于漯水，内属于三焦；手太阴外合于河水，内属于肺；手心主外合于漳水，内属于心包络；手少阴外合于济水，内属于心。”）天地温和，则经水安静；天气寒冷大地冻结，则经水凝滞涩滞；天气炎热地热升腾，则经水沸腾溢出；突然刮起暴风，则经水波浪涌起而隆起。（人的经脉也与之相应。按：凝涩指寒邪导致气血滞涩，沸溢指气血浮越而动。波，指波浪，是水受激动的样子。陇，同垄，指丘陵高地，是地面的坟起。水激地坟，都是风势暴烈所造成的结果。陇同垄。）邪气侵入脉中，遇寒则血液凝滞涩滞，遇暑则气机淖泽滑利，虚邪趁机侵入客居体内，也像经水遇到风吹一样。经脉的动脉，其搏动有时也会像水波一样隆起。它在脉中运行，隐隐约约。当诊察寸口脉时，脉搏有时大有时小，脉大表示邪气至，脉小表示病情平复。邪气在脉中运行没有固定位置，或在阴分或在阳分，不可拘泥于常规标准。（按：水得风而动，脉随邪气而变化。脉中，指周身脉络之中。循循，指隐微未见。寸口，指寸关尺三部脉。中手，指脉象应指而分大小之殊，以辨别邪气的有无。邪气运行无一定之处，所以脉象随阴阳而移动。）因此要仔细诊察，运用三部九候诊法。如果突然遇到邪气侵袭，要尽早阻断其路径。（脉之三部，医生必须用九候诊法来察验，大概因为邪气沿经脉传播，也如同人行路，路有远近之分，经脉有浅深之别，人突然感受邪气，起初可能较浅近，如果不加以遏制，势必深入深远而难以治疗。这是邪气进入的路径，不可以不遏制，而遏制尤其贵在早，这符合上工治未病的道理。）
吸气时进针，不要使正气逆乱。静留针一段时间，不要使邪气扩散。吸气时转动针具，以得气为目的。呼气时引出针具，呼尽时才拔针。大邪之气随之排出，所以称为泻法。（引指出针，去指离开穴位，候呼气时将针引出至穴门，呼尽时才离穴，则经气得以平定，邪气无处勾留，故大邪之气随针而出。呼指气出，吸指气入，转指转动针具。大气指大邪之气，即错乱阴阳的邪气。按：此处论述用针补泻之道。凡人之病，不过有余和不足两种。有余者邪气实，不足者正气虚，虚证宜补。然而如果不先泻其有余之邪，则正气虽虚，补益必被邪气格拒而不效。此经所以先吸后呼以泻其邪，然后呼尽候吸以补其正。）
黄帝问：正气不足如何补益？岐伯说：必须先用手抚摸并顺着经脉推拿，用手指切按并分散郁结，推动并按压皮肤，弹击穴位使血脉充盈，用爪甲刮刺以引导经气下行，疏通经脉以取气，向外牵引穴周皮肤，以闭合神气门户。（扪循指用手摸，切指指按。扪而循之，欲使气机舒缓。切而散之，使经脉宣散。推而按之，排蹙其皮肉。弹而怒之，使气脉充满。抓而下之，放置针具准备施针。通而取之，依常法进行。外引其门以闭其神，即推而按之的动作，谓按压穴外之皮，令当应针之处封闭，盖其所刺之门不开，则神气内守，所以说以闭其神。按：抓，音侧交切，用指甲刮拭针柄或皮肤。）呼气尽时进针，静留针一段时间，以气至为目的。如同等待尊贵客人，不知日暮时分。气已到达，适当调护。（呼尽内针，也与吸气时类似，言必须以气至作为去针的标准，不以呼吸次数多少就轻易去针。《针经》说：刺之而气不至，不问其数；刺之气至，去之勿复针。说的就是这个意思。暮，晚也。适，调适也。护，慎守也。言气已平调，则当慎守，勿令改变，使疾病再生。）候吸气时出针，气不得外出，各安其处。推阖其穴门，令神气存留。大气留止，所以称为补法。（正言也。外门已闭，神气复存，候吸气时出针，大气不泄，补法的意义，断然可知。然而此大气，指大经之气流行荣卫者。）
黄帝问：如何候气？（按：谓既已下针，而其气之至与未至，如何候察？）岐伯说：邪气由络脉传入经脉，舍居于血脉之中，其寒温尚未相得，如涌波兴起一般，时来时去，所以不常在固定位置。（按：言邪气初入，由浅转深，其寒温去来，尚无定所。）所以说：当邪气刚来的时候，必须按压以阻止其势，止住后随即取穴施治，不要逢迎其冲盛之时而泻之。真气，即经气，经气太虚，所以说邪气来势不可逢迎强攻，说的就是这个意思。（按：冲，注家作应水刻数之平气，恐不准确。详味此节，文义难通，盖“真气者”之上，“经气太虚”之下，必有脱误之处。）候察邪气若不审慎，大邪之气已过，此时若泻之则真气脱失，脱失则难以恢复，邪气复至而病情更加蓄积，所以说邪气已去不可追，说的就是这个意思。（……按：不审谓认病不详细。大气，大邪之气。不复谓真气脱而难复。正气虚则邪气盛，邪气退则正气复，若不泻之于邪盛之时，而反泻之于既退之后，则真气脱而邪气复至，病更缠绵不解矣，此戒攻邪贵乎早，而刻削之剂不可过用也。）
黄帝问：补泻如何操作？岐伯说：这是攻邪之法，疾出针以去除盛血，从而恢复真气。（按：邪不去则真不复，故必用针以去其血。前论补泻以气至为主，此言补泻以去血为急也。）此邪气新近客居，流动不定，推之则前行，引之则停止，逆其流向而刺之，放出温血，刺出其血，病立即可愈。（按：溶溶，水流动貌。逆犹迎也。新邪入客，如水之流动，其血尚温，而未至于冰凝，故当迎而刺出其血，病必自除矣。）
黄帝说：好！然而真邪相合，脉象如波浪隆起不明显，如何候察？岐伯说：仔细诊察三部九候的盛虚而调治之，察其左右上下脉气相失及相减的情况，审察病变脏腑以预测预后。（……按真邪以合，谓邪入于经而与真气相合也。波陇不起，谓初合之时，尚未变动，何以候而治之也。伯言治此之法，须详审以抚其身之肥瘠，循切以辨其脉之盛衰，而知病在何脏，愈于何日也。）诛伐无过，称为大惑，反而扰乱大经，真气不可恢复，将实证误作虚证，将邪气误作真气，用针无义理，反成为气之贼，夺人正气，以顺为逆，营卫散乱，真气已失，邪独内着，绝人长命，予人夭殃，皆因不知三部九候，故不能久长。（……按：此重言不知三部九候者之为害也。）
True Qi (Zhenqi, 真气) and Pathogenic Factors (Xieqi, 邪气) have both separation and combination, as mentioned in other chapters. However, this chapter is specifically named after this concept because it emphasizes that the function of acupuncture lies solely in eliminating pathogenic factors and preserving true Qi. To remove disease-causing pathogens, one must thoroughly investigate why they combine with the body and why they separate; only then can treatment be effective. The text of this chapter appears repetitive and complex, seemingly compiled from various sources.
The Yellow Emperor asked: I have heard that the Nine Needles are divided into nine chapters, and you further multiplied them by nine to create eighty-one chapters, which I have fully understood. The Classics state that the fluctuation of Qi's abundance and deficiency, and its shifting left and right, can be regulated by treating the upper to affect the lower, or the left to affect the right. For conditions of excess and deficiency, tonification and sedation are applied at the Ying-Spring (Yingxue, 荥穴) and Shu-Stream (Shuxue, 输穴) points, all of which I know. These refer to the shifting of Ying (Nutritive) Qi (Yingqi, 营气) and Wei (Defensive) Qi (Weiqi, 卫气), arising from deficiency and excess, not from external pathogens entering the meridians. I wish to hear about the presence of pathogenic factors within the meridians: what are their clinical manifestations? How should they be treated?
Qibo replied: The sage establishes medical principles corresponding to Heaven and Earth. Thus, Heaven has celestial degrees (stars and movements), Earth has major rivers, and humans have twelve primary meridians. (Note: 'Su' refers to the Twenty-Eight Mansions; 'Du' refers to the 365 degrees of the celestial sphere. 'Jingshui' refers to major rivers such as the Sea, Du, Wei, Hu, Mian, Ru, Yangtze, Huai, Luo, Yellow River, Zhang, and Ji waters. They are called 'Meridian Waters' because they correspond internally to the human meridians. The meridians refer to the three Yin and three Yang meridians of the hands and feet. This analogy is used because internal and external aspects correlate, and human Qi resonates with nature.) When Heaven and Earth are mild and warm, the meridian waters are calm; when cold and frozen, the meridian waters become stagnant and sluggish; when hot and scorching, the meridian waters boil and overflow; when sudden storms arise, the meridian waters surge and rise like waves. (Human meridians respond similarly. Note: Stagnation implies coldness and blockage; boiling implies floating and movement. 'Long' means mound or hillock. Water agitation and earth mounds are caused by violent winds.)
When pathogenic factors enter the vessels, cold causes blood to coagulate and stagnate, while heat makes Qi fluid and lubricated. Deficient pathogens take advantage of this to invade, similar to how wind affects meridian waters. The arterial pulse in the meridines may occasionally rise like a wave. Within the vessels, it moves subtly and invisibly. At the Cun Kou (Inch Port, 寸口) pulse point, the pulse may appear large or small; a large pulse indicates the arrival of pathogenic factors, while a small pulse indicates peace/normality. Pathogens move without fixed location, alternating between Yin and Yang, defying standard measurement. (Note: Water moves with wind; the pulse changes with pathogens. 'Cun Kou' refers to the radial pulse positions. 'Zhong shou' means the pulse responds to touch, varying in size to distinguish presence of pathogens. Since pathogens move unpredictably, pulse images shift with Yin-Yang dynamics.) Therefore, one must examine carefully using the Three Regions and Nine Palpations (Sanbu Jiuhou, 三部九候). If pathogenic invasion is detected suddenly, its pathway must be blocked early. (The physician must use the Nine Palpations to detect pathogens spreading along meridians, akin to travelers on roads of varying distances. Early intervention prevents deep penetration, reflecting the principle of "treating disease before it arises.")
During inhalation, insert the needle without causing Qi rebellion. Retain the needle quietly for a period to prevent pathogenic spread. During inhalation, rotate the needle until De Qi (arrival of Qi, 得气) is achieved. During exhalation, withdraw the needle, removing it completely only after exhalation ends. The major pathogenic Qi exits, hence this is called Sedation (Xie, 泻). (Note: 'Yin' means withdrawal; 'Qu' means leaving the acupoint. Withdrawing during exhalation allows pathogenic Qi to exit freely. 'Da Qi' here refers to major pathogenic factors disrupting Yin-Yang balance. This describes sedation technique: first eliminate excess pathogens, then tonify deficiency.)
The Yellow Emperor asked: How to tonify deficiency? Qibo said: First, palpate and stroke along the meridian, press and disperse, push and compress, flick to engorge vessels, scratch to guide Qi downward, unblock to obtain Qi, draw outward to close the spirit gate. (Note: Palpation soothes Qi; pressing disperses stagnation; pushing compresses skin; flicking engorges vessels; scratching prepares insertion; closing the gate retains Shen/Spirit. This sequence prepares the area for tonification.) Insert the needle at the end of exhalation, retain quietly until De Qi is achieved. Wait patiently as if for a noble guest, ignoring the passage of time. Once Qi arrives, maintain appropriate care. (Note: Tonification relies on Qi arrival, not just breath count. As stated in the Classic: if Qi does not arrive, continue needling; if it arrives, stop. 'Shi hu' means careful guarding. This preserves balanced Qi.) Withdraw the needle during inhalation so Qi does not escape. Push the skin to close the acupoint, retaining Spirit and Qi. Major Qi remains inside, hence this is called Tonification (Bu, 补). (Note: Closing the pore prevents leakage of healthy Qi, fulfilling the purpose of tonification.)
The Yellow Emperor asked: How to monitor Qi arrival? Qibo said: When pathogens move from collaterals to meridians and reside in blood vessels, their temperature sensation is inconsistent, rising and falling like waves, thus not staying in one place. (Note: Early pathogenic invasion shifts depth; symptoms fluctuate.) Therefore, when the pathogen arrives, press to stop its momentum and treat immediately. Do not attack when the pathogen is at its peak. True Qi is Meridian Qi; if Meridian Qi is too deficient, do not confront the pathogen aggressively. (Note: Textual corruption suspected here. The meaning implies avoiding strong sedation when True Qi is weak.) If monitoring is imprecise and the major pathogenic Qi has passed, sedation will deplete True Qi, making recovery difficult. Pathogens will return, worsening the condition. Hence, once pathogens depart, do not chase them. (Note: Late sedation harms True Qi. Early intervention is crucial.)
The Yellow Emperor asked: How to perform tonification and sedation? Qibo said: This is an attack on pathogens. Withdraw the needle quickly to remove stagnant blood and restore True Qi. (Note: Here, removing blood is urgent to restore Qi, differing from previous emphasis on De Qi.) For newly arrived pathogens, which flow like water without fixed position, pushing advances them, pulling stops them. Pierce against their flow to release warm blood. Removing this blood cures the disease immediately. (Note: 'Rong rong' describes flowing water. New pathogens are like warm, flowing blood, not yet congealed. Piercing against the flow releases this blood, curing the disease.)
The Yellow Emperor said: Excellent! But when True Qi and pathogens combine, and no wave-like pulse elevation occurs, how to monitor? Qibo said: Carefully assess the fullness and emptiness of the Three Regions and Nine Palpations to regulate treatment. Observe discrepancies in left/right and upper/lower pulses, identify the affected Zang organs, and predict recovery timing. (Note: Subtle pathogenic integration requires detailed physical examination and pulse diagnosis to locate the organ involved.) Punishing the innocent (healthy tissue/Qi) is called great confusion. It disrupts the Great Meridians, making True Qi irrecoverable. Mistaking excess for deficiency, or pathogens for True Qi, renders acupuncture meaningless. It becomes a thief of Qi, scattering Ying and Wei, losing True Qi, allowing pathogens to dominate, shortening life, and causing premature death. All result from ignorance of the Three Regions and Nine Palpations, leading to poor longevity. (Note: Reiteration of the dangers of neglecting comprehensive pulse diagnosis.)