病有有余不足，调者，抑其有余而补其不足也。然有余不足，各有
其经，故欲治病，必用调经，盖就既病而言也。若先事预防，莫过于守经隧焉。
黄帝问曰∶余闻刺法言，有余泻之，不足补之。何谓有余？何谓不足？岐伯对曰∶有余有五，不足亦有五，
帝欲何问？帝曰∶愿尽闻之。岐伯曰∶神有余有不足，气有余有不足，血有余有不足，形有余有不足，志有余
有不足。凡此十者，其气不等也。（神属心，气属肺，血属肝，形属脾，志属肾。以各有所宗，故不等也。）
帝曰∶人有精气、津液、四肢、九窍、五脏、十六部、三百六十五节，乃生百病，百病之生，皆有虚实。今夫
子乃言有余有五，不足亦有五，何以生之乎？（按，十六部，注谓手足、九窍、五脏合为十六部也。三百六十
五节，注谓非骨节，是神气出入之处。按本篇后言“夫十二经脉者，皆络三百六十五节，节有病，必被经脉”，
其为骨节，居然无疑。且果非骨节，何以言络也。）岐伯曰∶皆生于五脏也。夫心藏神，肺藏气，肝藏血，脾
藏肉，肾藏志，而此成形。……五脏之道，皆出于经隧，以行血气。血气不和，百病乃变化而生，是故守经隧
焉。（隧，潜道也，经脉伏行而不见，故谓之经隧焉。血气者人之神，邪侵之则血气不正，血气不正，故变化
而百病乃生矣。按∶经隧者，血脉营运之道路也。正气所由出，邪气所由入。故欲防其入，而慎气，实则喘喝
胸凭仰息也。）帝曰∶补泻奈何？岐伯曰∶气有余则泻其经隧，无伤其经，无出其血，无泄其气。不足则补其
经隧，无出其气。（……按∶杨上善云∶“经隧者，手太阴之别，从手太阴走手阳明，乃是手太阴向手阳明之
道。欲导脏腑阴阳，故补泻皆从正经别走之络，泻其阴经别走之路，不得伤其正经
也。”）帝曰∶善！血有余不足奈何？岐伯曰∶血有余则怒，不足则恐。（……肝之藏也。针经曰∶“肝藏血。
肝气虚则恐，实则怒。”按∶甲乙经、太素、全元起本，恐并作悲。）帝曰∶补泻奈何？岐伯曰∶血有余
则泻其盛经出其血，不足则视其虚经内，针其脉中久留之血。（按∶王本久留而视，甲乙经与太素并作久留之血，
从之。）脉大，疾出其针，无令血泄。（按∶脉大则气虚，气既虚矣，若针之太久，则气散而不能摄血，故当
疾出其针，庶血不致于过动也。注作两截解，误矣。）帝曰∶刺留血奈何？岐伯曰∶视其血络，刺出其血，无
令恶血得入于经，以成其疾。（按∶血不流动，则留滞而成恶血矣。恶血在络，若不刺出，必入于经而为病也。
按心肺脾肾俱有微证刺法，而此肝脏独以刺留血为解，或者以肝主藏血故也。）帝曰∶善！形有余不足奈何？
岐伯曰∶形有余则腹胀，泾溲不利。不足则四肢不用。（……脾之藏也。针经曰∶“脾气虚则四肢不用，五
脏不安。实则腹胀，泾溲不利。”泾，大便也。溲，小便也。按∶杨上善云∶“泾作经，妇人月经也。”亦通。）
帝曰∶补泻奈何？岐伯曰∶形有余则泻其阳经，不足则补其阳络。（……并胃之经络。）帝曰∶善！志有余不
足奈何？岐伯曰∶志有余则腹胀飧泄，不足则厥。（……肾之藏也。针经曰∶“肾藏精，精舍志，肾气虚则厥，
实则胀。”胀谓胀起，厥谓逆行上冲也。足少阴脉下行，今气不足，故随冲脉逆行而上冲也。）帝曰∶补泻奈
何？岐伯曰∶志有余则泻然筋血者，（按∶新校正云∶“按甲乙经及太素云∶‘泻然筋血者，出其血。’杨
上善云∶‘然筋，当是然谷下筋。’再详诸处，引然谷者，多云然谷之前血者。疑少‘谷之’二字，前字误
作筋字也。”不足则补其复溜。……然谓然谷，足少阴荥也，在
内踝之前，大骨之下，陷者中。血络盛则泻之，刺三分，留三呼，灸三壮。复溜，足少阴经也，在内踝上二寸
陷者中。刺三分，留三呼，灸五壮。）
帝曰∶善！余已闻虚实之形，不知其何以生？岐伯曰∶气血以并，阴阳相倾，气乱于卫，血逆于经，血
气离居，一实一虚。（卫生脉外，故气乱于卫。血行经内，故血逆于经。血气不和，故一虚一实。）血并于阴，
气并于阳，故为惊狂。（气并于阳，则阳气外盛，故为惊狂。）血并于阳，气并于阴，乃为炅中。（气并于阴，
则阳气内盛，故为热中。炅，热也。按∶炅音景。）血并于上，气并于下，心烦惋善怒。血并于下，气并于上，
乱而善忘。（按∶气血营运，上下循环，乃为无病。并则偏于一，而病起矣。血者生于心而藏于肝，血并于上，
则血偏盛而气自并于下，下冲其上，心与肝动，故令烦惋善怒也。气者蓄于丹田，则神自清而精自摄；今并于
上，则气尽升而血自并于下，上离乎下，精神涣散，故令乱而喜忘也。）
帝曰∶血并于阴，气并于阳，如是血气离居，何者为实？何者为虚？岐伯曰∶血气者喜温而恶寒，寒则泣
不能流，温则消而去之。（泣谓如雪在水中，凝住而不行。按∶寒则凝，温则行。涩不能流者，凝也。消而去
之者，行也。）是故气之所并为血虚，血之所并为气虚。（按∶气并于上，则血虚而并于下；血并于上，则气
虚而并于下。）帝曰∶人之所有者，血与气耳。今夫子乃言血并为虚，气并为虚，是无实乎？岐伯曰∶有者为
实，无者为虚，故气并则无血，血并则无气。今血与气相失，故为虚焉。（气并于血则血失其气，血并于气则气
失其血，故曰血与气相失。按∶并则血与气相失而虚实分焉。是故惟并则有，惟有则实。惟有有有实，故有无有
虚也。相失者，虚实悬殊也。）络之与孙脉俱输于经，血与气并，则为实焉。血之与气并走于上，则为大厥，
厥则暴死，气复反则生，不反则死。（按∶是则血与气共并于上者之为害也。）帝曰∶实者何道从来？虚者何
道从去？虚实之要，愿闻其故。岐伯曰∶夫阴与阳皆有俞会。阳注于阴，阴满之外，阴阳匀平，以充其形，
九候若一，命曰平人。夫邪之生也，或生于阴，或生于阳。其生于阳者，得之风雨寒暑；其生于阴者，得之饮
食……喜怒。（按∶阴主内，阳主外。风雨寒暑者，外感之邪也，故云生于阳。饮食喜怒者，内伤也，故云生于阴。）
帝曰∶风雨之伤人奈何？岐伯曰∶风雨之伤人也，先客于皮肤，传入于孙脉，孙脉满则传入于络脉，络脉满则
输于大经脉，血气与邪并，客于分腠之间，其脉坚大，故曰实。实者外坚充满，不可按之，按之则痛。（按∶
是谓外感之实邪，所当攻发者也。）帝曰∶寒湿之伤人奈何？岐伯曰∶寒湿之中人也，皮肤收，（按∶王本皮肤
不收。不收者，缓散也。下文云肌肉坚紧，寒湿中人，理宜坚紧。其云不收，误也。按甲乙经及太素俱无不字，
是也，今删之。）肌肉坚紧，荣血泣，卫气去，故曰虚。虚者聂辟气不足，按之则气足以温之，故快然而不痛。
（按∶聂辟，怯弱也。寒束肌腠，荣涩卫去，气血虚寒。按之则血动气行，转寒为温，故快然而不痛也。）
帝曰∶善！阴之生实奈何？岐伯曰∶喜怒不节，则阴气上逆，上逆则下虚，下虚则阳气走之，故曰实矣。
帝曰？阴之生虚奈何？岐伯曰∶喜则气下，悲则气消，消则脉虚空，因寒饮食寒气熏满，则血泣气去，
故曰虚矣。（按∶阴阳之病，并有虚实，此但言阴而不言阳者，以阳之虚实，显形于外，惟阴之生病，或实或
虚，变而难测也。生，犹变也。喜怒悲者，五志之三也。三者过极，则气上浮而入于阳分之中，有似于实矣。
抑或气消散而降于下，则气虚寒而不能化食，血涩气去，因之愈虚矣。此病之由阴而变为他证之大凡，与阳分
之变不同也。）
帝曰∶经言阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒，余已闻之矣，不知其所由然也。岐伯曰∶
阳受气于上焦，以温皮肤分肉之间。今寒气在外，则上焦不通，上焦不通，则寒气独留于外，故寒栗。（按∶
阳盛则气足以卫外，虚则邪袭肌肤之间而寒矣。）帝曰∶阴虚生内热奈何？岐伯曰∶有所劳倦，形气衰少，
谷气不盛，上焦不行，下脘不通，（按∶甲乙经作下焦不通。）胃气热，热气熏胸中，故内热。（甚用其力，
致劳倦也。贪役不食，故谷气不盛也。按∶劳倦则气弱而不能化食，故二焦不通，以致胃热蓄积，热盛于内，
此劳倦饮食，内伤其阴分，阴虚内热之轻证也。若夫证之重者，请更得而申论之∶夫所谓阴者，水也。水者，
天一之所生，乃真阴也。水为阴，阴中之阳，精也；阴中之阴，血也。精与血皆水之所化，人言阴但言血而不
言精者，从其纯阴而言，故与阳对称，必曰气血也。人自禀赋以来，气血本应均平，其或父母之气，偏阳偏阴，
抑或情识初开，早肆雕琢，更有中年之人，禀素不弱，止因过用乏竭，精血渐少，以致火日盛，水日亏，真阴
耗散，而阴为之虚矣。然阴水者，所以配阳而制火者也。水愈亏则火愈炽，火寡所畏而热于内，是火之热于内
也，非真火气有余也。阴虚水涸不能制火，故火独盛，如劳瘵之证是也。昧者不解其故，每以苦寒治火。间有
少知读书者，则又以桂附引火归源。噫！岂知此证正治固非所宜，即从治之法亦不可用。盖内热原本于阴虚，
下已无水，故令火升。若用桂附以降火，火既独盛，无水相济，随降
随升，其火益炽矣。与至真要大论所言从治反治，阴证似阳之可以引火归源者不同。惟宜纯阴补水之剂，滋阴
以降火，使真阴渐充，浮焰自息。王太仆曰∶“壮水之主以制阳光。”诚千古不易之治法也。奈何今之治劳瘵
者，不知其为下无水而火上升，竟错认为内真寒而外假热，妄投姜桂，更用参附，不壮水而反益火，使轻者转
重，重者立毙，抱薪救火，殊可叹也！）帝曰∶阳盛生外热奈何？岐伯曰∶上焦不通利，则皮肤致密，腠理闭
塞不通，（按∶王本玄府不通，甲乙经无玄府二字，今去之。）卫气不得泄越，故外热。（外伤寒毒，内薄诸阳，
寒外盛则皮肤收，皮肤收则腠理密，故卫气 聚无所流行矣。寒气外薄，阳气内争，积火内燔，故生外热也。）
帝曰∶阴盛生内寒奈何？岐伯曰∶厥气上逆，寒气积于胸中而不泻，不泻则温气去，寒独留，则血凝泣，凝则
脉不通，（按∶甲乙经作腠理不通。）其脉盛大以涩，故中寒……。（温气，谓阳气也。阴逆内满，则阳气去
于皮外也。）
帝曰∶夫子言虚实者有十，生于五脏。五脏，五脉耳。夫十二经脉，皆生百病，（按∶王本生其病，甲乙
经作生百病，从之。）今夫子独言五脏。夫十二经脉者，皆络三百六十五节，节有病必被经脉，经脉之病皆
有虚实，何以合之？岐伯曰∶五脏者，……六腑与为表里，经络支节，各生虚实，其病所居，随而调之。病在
脉，调之血。（脉者血之府，脉实血实，脉虚血虚，由此脉病而调之血也。按∶甲乙经作病在血，调之脉。疑与
下文意重，不若王本为妥。）病在血，调之络。（按∶注云血病则络脉易，殊欠明快。盖血荣一身，不独络也。
调之络者，谓血之流行由络走经，故病在血分，必调其经络也。）病在气，调之卫。（卫主气，故气病而调之卫也。）
病在肉，调之分肉。（按∶拥护一身者，肉也。然而前后左右各有部分，故
曰分肉，肉之所分，经络系焉。观其病在何部，则知其内属何经，然后或用药或用针也。）病在筋，调之筋，
病在骨，调之骨，……淬针药熨。（按∶此调筋骨法也。淬，火针。药熨，谓制药以熨患处也。注分筋骨，误矣。）
病不知所痛，两跷为上。（阴跷之脉，出于照海。阳跷之脉，出于申脉。）身形有痛，九候莫病，则缪刺之。
（……莫病，谓无病也。缪刺者，刺络脉，左痛刺右，右痛刺左。按∶脉无病而身有痛，其病在外，但缪刺之，
而其痛自止也。）
疾病有有余和不足两种情况，所谓“调”，就是抑制有余的邪气，补益不足的正气。然而，有余和不足各有其所属的经脉，所以想要治病，必须运用调理经脉的方法，这是针对已经发生的疾病而言的。如果是为了事先预防，没有比守护经隧（经脉）更好的方法了。
黄帝问道：我听说刺法中说，有余就泻它，不足就补它。什么叫有余？什么叫不足？岐伯回答说：有余有五种，不足也有五种，陛下想问哪方面的呢？黄帝说：希望听您详尽地讲解。岐伯说：神有余、神不足，气有余、气不足，血有余、血不足，形有余、形不足，志有余、志不足。这十种情况，它们的气机是不平衡的。（注：神归属于心，气归属于肺，血归属于肝，形归属于脾，志归属于肾。因为各自有所主宰，所以气机不平衡。）
黄帝说：人有精气、津液、四肢、九窍、五脏、十六部、三百六十五节，从而产生百病，百病的产生，都有虚和实。现在先生却说有余有五种，不足也有五种，这是怎么产生的呢？（按语：十六部，注释说是手、足、九窍、五脏合为十六部。三百六十五节，注释说不是骨节，而是神气出入的地方。按本篇后文说“十二经脉，都联络三百六十五节，节有病，必定波及经脉”，这显然是骨节，毫无疑问。况且如果真不是骨节，为什么说“络”呢？）岐伯说：都生于五脏。心藏神，肺藏气，肝藏血，脾藏肉，肾藏志，从而形成形体。……五脏的运行通道，都出于经隧，用来运行血气。血气不和，百病就变化而生，所以要守护经隧。（注：隧，是潜行的道路，经脉伏行于体内看不见，所以叫经隧。血气是人的神气根本，邪气侵犯它，血气就不正，血气不正，所以变化而百病生。按语：经隧，是血脉运行的道路。正气由此出，邪气由此入。所以要防止邪气侵入，就要谨慎对待气，如果气实则会出现喘喝、胸满、仰面呼吸的症状。）
黄帝说：补泻怎么做？岐伯说：气有余就泻它的经隧，但不要损伤经脉本身，不要放出血液，不要泄掉正气。气不足就补它的经隧，不要泄出正气。（……按语：杨上善说：“经隧，是手太阴肺经的别络，从手太阴走向手阳明大肠经，这是手太阴通向手阳明的道路。为了引导脏腑阴阳，所以补泻都从正经别走的络脉进行，泻阴经别走的路径，不得损伤正经。”）
黄帝说：好！血有余和不足怎么办？岐伯说：血有余则易怒，不足则恐惧。（……这是肝脏所藏的。针经说：“肝藏血。肝气虚则恐，肝气实则怒。”按语：甲乙经、太素、全元起本中，“恐”字都作“悲”。）
黄帝说：补泻怎么做？岐伯说：血有余就泻充盛的经脉并放出血液，血不足就观察虚弱的经脉，将针刺入脉中久留以留住血液。（按语：王本作“久留而视”，甲乙经与太素都作“久留之血”，依从后者。脉象盛大时，迅速拔出针，不要让血液过多流失。（按语：脉大说明气虚，气既然已虚，如果针刺时间太久，气就会散失而不能摄血，所以应当迅速拔针，使血液不至于过度耗动。注释将其分为两截解释，是错误的。）
黄帝说：刺除留滞之血怎么做？岐伯说：观察血络，刺破放出血液，不要让恶血进入经脉，以免形成疾病。（按语：血液不流动，就会停滞成为恶血。恶血在络脉中，如果不刺出，必定进入经脉而致病。按语：心肺脾肾都有轻微的刺法，唯独肝脏以刺除留血来解释，或许是因为肝主藏血的原因吧。）
黄帝说：好！形有余和不足怎么办？岐伯说：形有余则腹胀，大小便不利。不足则四肢不能活动。（……这是脾脏所藏的。针经说：“脾气虚则四肢不用，五脏不安。脾实则腹胀，大小便不利。”泾，指大便。溲，指小便。按语：杨上善说：“泾作经，指妇女月经。”也通。）
黄帝说：补泻怎么做？岐伯说：形有余就泻阳经，不足就补阳络。（……包括胃的经络。）
黄帝说：好！志有余和不足怎么办？岐伯说：志有余则腹胀、完谷不化的泄泻，不足则厥逆。（……这是肾脏所藏的。针经说：“肾藏精，精舍志，肾气虚则厥，肾实则胀。”胀指胀起，厥指逆行上冲。足少阴肾经下行，现在气不足，所以随冲脉逆行而上冲。）
黄帝说：补泻怎么做？岐伯说：志有余就泻然谷穴处的血液，（按语：新校正说：“按甲乙经及太素说：‘泻然筋血者，出其血。’杨上善说：‘然筋，应当是然谷下的筋。’再详细考察各处，引用然谷的，多说然谷之前的血。怀疑缺少‘谷之’二字，前字误作筋字。”）志不足就补复溜穴。（……然指然谷，是足少阴经的荥穴，在内踝前方，大骨之下，凹陷处。血络盛则泻之，刺三分，留针三呼的时间，灸三壮。复溜，是足少阴经穴，在内踝上二寸凹陷处。刺三分，留针三呼的时间，灸五壮。）
黄帝说：好！我已经知道了虚实的表现，不知道它们是怎么产生的？岐伯说：气血相并，阴阳偏倾，气乱于卫分，血逆于经脉，血气分离居住，一实一虚。（卫气行于脉外，所以气乱于卫。血行于经内，所以血逆于经。血气不和，所以一虚一实。）血并于阴分，气并于阳分，所以出现惊狂。（气并于阳分，则阳气外盛，所以出现惊狂。）血并于阳分，气并于阴分，就成为热中。（气并于阴分，则阳气内盛，所以为热中。炅，即热。按语：炅音景。）血并于上部，气并于下部，心烦闷且易怒。血并于下部，气并于上部，神志混乱且健忘。（按语：气血运行，上下循环，才是无病。相并则偏于一方，病就产生了。血生于心而藏于肝，血并于上，则血偏盛而气自然并于下，下气冲上，心肝动摇，所以令人烦闷易怒。气蓄于丹田，则神清精摄；现在气并于上，则气尽升而血自并于下，上离乎下，精神涣散，所以令人混乱健忘。）
黄帝说：血并于阴，气并于阳，像这样血气分离居住，什么是实？什么是虚？岐伯说：血气喜欢温暖而厌恶寒冷，寒冷则凝涩不能流动，温暖则消散而去。（泣同涩，谓如雪在水中，凝结住而不行。按语：寒则凝，温则行。涩不能流，是凝滞的意思。消而去之，是运行的意思。）所以气并之处则为血虚，血并之处则为气虚。（按语：气并于上，则血虚而并于下；血并于上，则气虚而并于下。）
黄帝说：人所拥有的，不过是血和气罢了。现在先生说血并导致虚，气并导致虚，难道就没有实了吗？岐伯说：有的地方充实就是实，没有的地方就是虚，所以气并则那里无血，血并则那里无气。现在血与气相失，所以称为虚。（气并于血则血失其气，血并于气则气失其血，所以说血与气相失。按语：并则血与气相失而虚实分开。所以只有并才有虚实之分。惟有并则有实，故无并则有虚。相失，是指虚实悬殊。）络脉与孙脉都输送到经脉，血与气相并，就变成实证。血与气一起向上走，就发生大厥，厥则突然死亡，气若返回则生，不返回则死。（按语：这就是血与气共同并于上的危害。）
黄帝说：实证从哪里来？虚证到哪里去？虚实的要领，希望能听听其中的缘故。岐伯说：阴与阳都有腧会穴。阳注入阴，阴满溢于外，阴阳匀平，以充盈形体，三部九候脉象一致，叫做平人。邪气的产生，有的生于阴，有的生于阳。生于阳的，得之于风雨寒暑；生于阴的，得之于饮食……喜怒。（按语：阴主内，阳主外。风雨寒暑是外感之邪，所以说生于阳。饮食喜怒是内伤，所以说生于阴。）
黄帝说：风雨伤人怎么样？岐伯说：风雨伤人，先客于皮肤，传入孙脉，孙脉满则传入络脉，络脉满则输于大经脉，血气与邪气相并，客于分肉腠理之间，脉象坚大，所以叫实。实证外部坚硬充满，不可按压，按压则痛。（按语：这叫外感的实邪，应当攻发。）
黄帝说：寒湿伤人怎么样？岐伯说：寒湿中人，皮肤收缩，（按语：王本皮肤不收。不收，指缓散。下文说肌肉坚紧，寒湿中人，理应坚紧。说不收，是错误的。按甲乙经及太素俱无不字，是对的，今删去“不”字。）肌肉坚紧，营血凝涩，卫气离去，所以叫虚。虚证表现为怯弱气不足，按压则气足以温之，所以舒适而不痛。（按语：聂辟，指怯弱。寒束肌腠，营涩卫去，气血虚寒。按压则血动气行，转寒为温，所以舒适而不痛。）
黄帝说：好！阴分产生实证怎么样？岐伯说：喜怒不节制，则阴气上逆，上逆则下部虚，下部虚则阳气走之，所以叫实。
黄帝说：阴分产生虚证怎么样？岐伯说：喜则气下，悲则气消，消则脉虚空，加上吃冷食寒气熏满，则血涩气去，所以叫虚。（按语：阴阳的病，都有虚实，这里只说阴而不言阳，是因为阳的虚实显形于外，只有阴生病，或实或虚，变化难测。生，犹变也。喜怒悲是五志中的三种。这三种过极，则气上浮而入于阳分之中，看似实。或者气消散而降于下，则气虚寒而不能化食，血涩气去，因此更虚。这是病由阴变为他证的概况，与阳分的变不同。）
黄帝说：经文说阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒，我已经听说了，不知道其中的道理。岐伯说：阳受气于上焦，以温煦皮肤分肉之间。现在寒气在外，则上焦不通，上焦不通，则寒气独留于外，所以寒栗。（按语：阳盛则气足以卫外，虚则邪袭肌肤之间而寒矣。）
黄帝说：阴虚生内热怎么样？岐伯说：有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，（按语：甲乙经作下焦不通。）胃气热，热气熏胸中，所以内热。（甚用其力，致劳倦也。贪役不食，故谷气不盛也。按语：劳倦则气弱而不能化食，故二焦不通，以致胃热蓄积，热盛于内，这是劳倦饮食，内伤其阴分，阴虚内热的轻证。若证之重者，请更申论：所谓阴，是水。水是天一所生，乃真阴。水为阴，阴中之阳为精；阴中之阴为血。精与血皆水之所化，人言阴但言血而言精者，从其纯阴而言，故与阳对称，必曰气血。人自禀赋以来，气血本应均平，或其父母之气偏阳偏阴，抑或情识初开，早肆雕琢，更有中年之人，禀素不弱，止因过用乏竭，精血渐少，以致火日盛，水日亏，真阴耗散，而阴为之虚矣。然阴水者，所以配阳而制火者也。水愈亏则火愈炽，火寡所畏而热于内，是火之热于内也，非真火气有余也。阴虚水涸不能制火，故火独盛，如劳瘵之证是也。昧者不解其故，每以苦寒治火。间有少知读书者，则又以桂附引火归源。噫！岂知此证正治固非所宜，即从治之法亦不可用。盖内热原本于阴虚，下已无水，故令火升。若用桂附以降火，火既独盛，无水相济，随降随升，其火益炽矣。与至真要大论所言从治反治，阴证似阳之可以引火归源者不同。惟宜纯阴补水之剂，滋阴以降火，使真阴渐充，浮焰自息。王太仆曰：“壮水之主以制阳光。”诚千古不易之治法也。奈何今之治劳瘵者，不知其为下无水而火上升，竟错认为内真寒而外假热，妄投姜桂，更用参附，不壮水而反益火，使轻者转重，重者立毙，抱薪救火，殊可叹也！）
黄帝说：阳盛生外热怎么样？岐伯说：上焦不通利，则皮肤致密，腠理闭塞不通，（按语：王本玄府不通，甲乙经无玄府二字，今去之。）卫气不得泄越，所以外热。（外伤寒毒，内薄诸阳，寒外盛则皮肤收，皮肤收则腠理密，故卫气聚无所流行矣。寒气外薄，阳气内争，积火内燔，故生外热也。）
黄帝说：阴盛生内寒怎么样？岐伯说：厥气上逆，寒气积于胸中而不泻，不泻则温气去，寒独留，则血凝涩，凝则脉不通，（按语：甲乙经作腠理不通。）其脉盛大以涩，所以中寒……。（温气，谓阳气也。阴逆内满，则阳气去于皮外也。）
黄帝说：先生说的虚实有十种，生于五脏。五脏，对应五脉而已。十二经脉，都产生百病，（按语：王本生其病，甲乙经作生百病，依从后者。）现在先生独言五脏。十二经脉，都联络三百六十五节，节有病必定波及经脉，经脉的病都有虚实，怎么合起来看？岐伯说：五脏，……与六腑互为表里，经络支节，各生虚实，病所在的位置，随之调理。病在脉，调之血。（脉是血的府库，脉实血实，脉虚血虚，由此脉病而调之血。按语：甲乙经作病在血，调之脉。疑与下文意重，不如王本妥帖。）病在血，调之络。（按语：注释说血病则络脉易，殊欠明快。盖血荣一身，不独络也。调之络者，谓血之流行由络走经，故病在血分，必调其经络也。）病在气，调之卫。（卫主气，故气病而调之卫也。）病在肉，调之分肉。（按语：拥护一身者，肉也。然而前后左右各有部分，故曰分肉，肉之所分，经络系焉。观其病在何部，则知其内属何经，然后或用药或用针也。）病在筋，调之筋，病在骨，调之骨，……淬针药熨。（按语：此调筋骨法也。淬，火针。药熨，谓制药以熨患处也。注分筋骨，误矣。）病不知所痛，取两跷脉为上。（阴跷之脉，出于照海。阳跷之脉，出于申脉。）身形有痛，九候莫病，则缪刺之。（……莫病，谓无病也。缪刺者，刺络脉，左痛刺右，右痛刺左。按语：脉无病而身有痛，其病在外，但缪刺之，而其痛自止也。）
Diseases manifest as either excess (Shi, 实证) or deficiency (Xu, 虚证). "Regulation" (Tiao, 调) refers to suppressing the excess and tonifying the deficiency. However, both excess and deficiency are associated with specific meridians; therefore, to treat disease, one must regulate the meridians. This applies to diseases that have already occurred. For prevention prior to illness onset, nothing is better than guarding the Jing Sui (Meridian Passages, 经隧).
Huangdi asked: I have heard from acupuncture methods that excess should be drained (Xie, 泻) and deficiency should be tonified (Bu, 补). What constitutes excess? What constitutes deficiency? Qibo replied: There are five types of excess and five types of deficiency. Which aspect does Your Majesty wish to inquire about? Huangdi said: I wish to hear them all in detail. Qibo said: There is excess and deficiency of Shen (Spirit, 神), Qi (Vital Energy, 气), Xue (Blood, 血), Xing (Form/Body, 形), and Zhi (Will/Fear, 志). These ten conditions involve an imbalance of Qi. (Note: Shen belongs to the Heart, Qi to the Lungs, Blood to the Liver, Form to the Spleen, and Zhi to the Kidneys. Because each has its own master, their Qi is imbalanced.)
Huangdi said: Humans possess Jing Qi (Essence and Qi, 精气), Jin Ye (Body Fluids, 津液), four limbs, nine orifices, five Zang organs, sixteen parts, and three hundred and sixty-five joints, through which a hundred diseases arise. The generation of these diseases involves both deficiency and excess. Now you speak of five types of excess and five of deficiency; how do they arise? (Commentary: The "sixteen parts" refer to the combination of hands, feet, nine orifices, and five Zang organs. The "three hundred and sixty-five joints" are described in some notes as places where Shen Qi enters and exits, not bone joints. However, later in this chapter it states, "The twelve main meridians connect with the three hundred and sixty-five joints; if a joint is diseased, the meridian is affected," confirming they are indeed bone joints. If they were not bone joints, why use the term "connect"? ) Qibo said: They all originate from the Five Zang Organs. The Heart stores Shen, the Lungs store Qi, the Liver stores Xue, the Spleen stores flesh, and the Kidneys store Zhi, thereby forming the physical body. ... The pathways of the Five Zang Organs all emerge from the Jing Sui to circulate Xue and Qi. When Xue and Qi are disharmonious, a hundred diseases arise through transformation; thus, one must guard the Jing Sui. (Commentary: Sui means a hidden passage. Meridians run deep and are invisible, hence called Jing Sui. Xue and Qi are the spirit of humans; when pathogenic factors invade, Xue and Qi become disordered, leading to disease. Commentary: Jing Sui is the pathway for blood circulation. Healthy Qi exits here, while pathogenic factors enter. To prevent invasion, one must be cautious with Qi. If Qi is excessive, symptoms include panting, chest fullness, and仰息 (breathing with difficulty lying on back).)
Huangdi said: How should tonification and drainage be performed? Qibo said: For excess Qi, drain the Jing Sui without damaging the main meridian itself, without releasing blood, and without leaking Qi. For deficient Qi, tonify the Jing Sui without leaking Qi. (Commentary: Yang Shangshan stated: "Jing Sui refers to the collateral branches of the Hand Taiyin Lung Meridian running towards the Hand Yangming Large Intestine Meridian. To guide Yin and Yang of the Zang-Fu, tonification and drainage should be performed via these collateral branches, draining the divergent paths of the Yin meridians without harming the main meridians.")
Huangdi said: Excellent! How about excess and deficiency of Xue? Qibo said: Excess Xue leads to anger; deficient Xue leads to fear. (Commentary: This relates to the Liver. The Classic of Acupuncture states: "The Liver stores Xue. Deficient Liver Qi causes fear; Excess Liver Qi causes anger." Note: In the Jia Yi Jing, Tai Su, and Quan Yuanqi's version, "fear" is written as "sadness".)
Huangdi said: How should tonification and drainage be performed? Qibo said: For excess Xue, drain the full meridians and release blood. For deficient Xue, observe the deficient meridians, insert the needle into the vessel, and retain it for a long time to preserve blood. (Commentary: Wang Bing's text says "retain and observe"; Jia Yi Jing and Tai Su say "retain blood". We follow the latter. If the pulse is large, remove the needle quickly to prevent excessive blood loss. Commentary: A large pulse indicates Qi deficiency. If needling is too prolonged, Qi will scatter and fail to control blood, so the needle should be removed quickly. The note interpreting this as two separate actions is incorrect.)
Huangdi said: How to puncture retained blood? Qibo said: Observe the blood collaterals, puncture to release blood, preventing evil blood from entering the meridians and causing disease. (Commentary: Stagnant blood becomes evil blood. If not released from collaterals, it enters meridians and causes pathology. Commentary: While Heart, Lung, Spleen, and Kidney have minor puncturing methods, the Liver is specifically addressed regarding retained blood, likely because the Liver governs the storage of blood.)
Huangdi said: Excellent! How about excess and deficiency of Xing (Form)? Qibo said: Excess Xing leads to abdominal distension and difficult urination and defecation. Deficiency leads to inability to use the four limbs. (Commentary: This relates to the Spleen. The Classic of Acupuncture states: "Deficient Spleen Qi leads to inability to use the four limbs and unrest of the five Zang organs. Excess Spleen leads to abdominal distension and difficult urination/defecation." Jing refers to stool; Sou refers to urine. Commentary: Yang Shangshan noted "Jing" can mean menstruation, which is also valid.)
Huangdi said: How should tonification and drainage be performed? Qibo said: For excess Xing, drain the Yang meridians; for deficiency, tonify the Yang collaterals. (Including the stomach's meridians and collaterals.)
Huangdi said: Excellent! How about excess and deficiency of Zhi (Will)? Qibo said: Excess Zhi leads to abdominal distension and undigested diarrhea; deficiency leads to Jue (Cold extremities/reversal). (Commentary: This relates to the Kidneys. The Classic of Acupuncture states: "The Kidneys store Essence, Essence houses Zhi. Deficient Kidney Qi leads to Jue; Excess Kidney leads to distension." Distension refers to swelling; Jue refers to rebellious upward rushing. The Foot Shaoyin Kidney Meridian descends; due to Qi deficiency, it reverses along the Chong Mai and rushes upward.)
Huangdi said: How should tonification and drainage be performed? Qibo said: For excess Zhi, drain the blood at Ran Gu (然谷穴); for deficiency, tonify Fu Liu (复溜穴). (Commentary: Xin Zheng Jiao notes: "Jia Yi Jing and Tai Su state 'drain the blood at Ran Gu'. Yang Shangshan says 'Ran Jin' should be 'the tendon below Ran Gu'. Further investigation suggests 'Gu Zhi' might be missing, and 'Qian' might be miswritten as 'Jin'.) Ran Gu is the Ying-Spring point of the Foot Shaoyin Meridian, located anterior to the medial malleolus, below the large bone, in the depression. If blood vessels are full, drain them; needle 0.3 cun, retain for three breaths, moxa 3 cones. Fu Liu is on the Foot Shaoyin Meridian, 2 cun above the medial malleolus in the depression. Needle 0.3 cun, retain for three breaths, moxa 5 cones.)
Huangdi said: Excellent! I have heard of the forms of deficiency and excess, but not how they arise. Qibo said: When Qi and Xue merge (Bing, 并), Yin and Yang incline unevenly. Qi becomes chaotic in the Wei Qi (Defensive Qi, 卫气), and Xue rebels in the meridians. Xue and Qi separate and dwell apart, resulting in one area of excess and one of deficiency. (Wei Qi moves outside the vessels, so Qi chaos occurs there. Blood moves inside the meridians, so blood rebellion occurs there. Disharmony leads to deficiency and excess.) When Xue merges into Yin and Qi merges into Yang, it results in Jing Kuang (Startled Mania, 惊狂). (Qi merging into Yang causes external Yang excess, leading to mania.) When Xue merges into Yang and Qi merges into Yin, it results in Jiong Zhong (Heat in the Middle, 炅中). (Qi merging into Yin causes internal Yang excess, leading to heat. Jiong means heat. Note: Pronounced Jing.) When Xue merges into the upper part and Qi merges into the lower part, it causes mental distress and irritability. When Xue merges into the lower part and Qi merges into the upper part, it causes confusion and forgetfulness. (Commentary: Normal health requires circular flow of Qi and Xue between upper and lower. Merging creates bias and disease. Blood is born in the Heart and stored in the Liver. Blood merging upward causes blood excess and Qi sinking downward; lower Qi rushing up agitates Heart and Liver, causing distress. Qi accumulates in the Dantian, clarifying Spirit. Qi merging upward causes all Qi to rise and blood to sink; separation of upper and lower scatters Spirit, causing confusion.)
Huangdi said: When Xue merges into Yin and Qi merges into Yang, with Xue and Qi separated, what is excess and what is deficiency? Qibo said: Xue and Qi prefer warmth and dislike cold. Cold causes stagnation and immobility; warmth causes dispersion and movement. (Stagnation is like snow in water freezing; movement is like melting.) Therefore, where Qi merges, Xue is deficient; where Xue merges, Qi is deficient. (Commentary: Qi merging upward leaves Xue deficient below; Xue merging upward leaves Qi deficient below.)
Huangdi said: Humans possess only Xue and Qi. You say merging leads to deficiency; is there no excess? Qibo said: Presence constitutes excess, absence constitutes deficiency. Thus, where Qi merges, Xue is absent; where Xue merges, Qi is absent. Since Xue and Qi lose each other, it is called deficiency. (Commentary: Qi merging with Xue makes Xue lose its Qi; Xue merging with Qi makes Qi lose its Xue. Merging creates separation, defining deficiency and excess. Only merging creates the condition of "having" (excess) and "not having" (deficiency). Loss implies a great disparity.) Collaterals and Sun Collaterals transport to the main meridians. When Xue and Qi merge, it becomes excess. If Xue and Qi both rush upward, it causes Da Jue (Great Reversal/Syncope, 大厥), sudden death. If Qi returns, life is preserved; if not, death ensues. (Commentary: This highlights the danger of simultaneous merging of Xue and Qi upward.)
Huangdi said: Where does excess come from? Where does deficiency go? I wish to hear the principle. Qibo said: Yin and Yang both have Shu-Hui points. Yang flows into Yin, Yin overflows outward. When Yin and Yang are balanced, the form is filled, and the Nine Pulses are uniform, called a Ping Ren (Healthy Person, 平人). Pathogens arise from Yin or Yang. Those arising from Yang come from Wind, Rain, Cold, and Heat (external pathogens). Those arising from Yin come from Diet... and Joy/Anger (internal pathogens). (Commentary: Yin governs interior, Yang governs exterior. Wind/Rain/Cold/Heat are external, hence from Yang. Diet/Joy-Anger are internal injuries, hence from Yin.)
Huangdi said: How do Wind and Rain injure the body? Qibo said: Wind and Rain first lodge in the skin, then transmit to Sun Collaterals. When Sun Collaterals are full, they transmit to Luo Collaterals. When Luo Collaterals are full, they transmit to Main Meridians. Xue and Qi merge with pathogens in the Fen Cou (Interstices, 分腠). The pulse is firm and large, hence called Excess. Excess manifests as external hardness and fullness, painful upon pressure. (Commentary: This is external excess pathogen, requiring dispersal.)
Huangdi said: How do Cold and Dampness injure the body? Qibo said: Cold and Dampness cause skin contraction, muscles to become firm and tight, Ying Blood to stagnate, and Wei Qi to depart, hence called Deficiency. Deficiency manifests as timidity and Qi insufficiency. Pressure generates Qi to warm the area, bringing comfort and relieving pain. (Commentary: Nie Pi means timid/weak. Cold binds the muscle interstices, Ying stagnates, Wei departs. Pressure activates blood and Qi, transforming cold to warmth.)
Huangdi said: Excellent! How does Yin generate Excess? Qibo said: Unregulated Joy and Anger cause Yin Qi to rebel upward. Upward rebellion causes lower deficiency; lower deficiency allows Yang Qi to rush in, hence called Excess.
Huangdi said: How does Yin generate Deficiency? Qibo said: Joy causes Qi to descend; Grief causes Qi to dissipate. Dissipation leaves vessels empty. Combined with cold food/drink, cold Qi fills the interior, causing blood stagnation and Qi departure, hence called Deficiency. (Commentary: Yin/Yang diseases have both excess/deficiency, but here only Yin is discussed because Yang's patterns are obvious externally, while Yin's are subtle and variable. Joy/Anger/Grief are three of the Five Emotions. Extremes cause Qi to float up (appearing like excess) or sink/dissipate (causing deficiency/cold). This describes Yin transforming into other syndromes.)
Huangdi said: The classics state: Yang deficiency causes external cold; Yin deficiency causes internal heat; Yang excess causes external heat; Yin excess causes internal cold. I have heard this, but not the mechanism. Qibo said: Yang receives Qi from the Upper Jiao to warm the skin and muscles. Now, if Cold is external, the Upper Jiao is blocked. Blockage prevents warming, leaving Cold alone externally, causing shivering. (Commentary: Yang excess provides sufficient defense; deficiency allows pathogen attack, causing cold.)
Huangdi said: How does Yin deficiency generate internal heat? Qibo said: Fatigue deforms Qi and reduces vitality; Grain Qi is insufficient. The Upper Jiao fails to function, and the Lower Wan (Stomach outlet) is blocked. Stomach Qi becomes hot, steaming the chest, causing internal heat. (Commentary: Overwork causes fatigue; neglecting food causes insufficient Grain Qi. Fatigue weakens Qi, failing to transform food, blocking Jiao, accumulating Stomach heat. This is mild Yin deficiency internal heat from fatigue/diet. Severe cases: Yin refers to Water, generated by Tian Yi, the True Yin. Water contains Yin-Yang: Essence is Yang within Yin; Blood is Yin within Yin. People often equate Yin with Blood. Originally, Qi and Blood are balanced. Parental constitution or early indulgence may cause imbalance. Middle-aged people may exhaust Essence/Blood through overuse, causing Fire to rise and Water to decline, depleting True Yin. Water controls Fire. As Water declines, Fire flares internally. This internal heat is not true Fire excess, but lack of Water to control it, similar to consumption diseases. Ignorant practitioners use bitter-cold herbs. Some use Gui Zhi Tang (Cinnamon Twig Decoction) or Fu Zi Li Zhong Wan (Aconite Root Pill to Restore the Middle) to guide fire back to its source. Alas! Neither orthodox nor counter-treatment is suitable here. Internal heat stems from Yin deficiency; lower water is exhausted, allowing fire to rise. Using Gui Zhi/Fu Zi to suppress fire when water is absent causes fire to rise again. This differs from guiding fire back in Yin-excess resembling Yang. One should use pure Yin-water tonics to nourish Yin and suppress fire, allowing True Yin to fill and floating flames to subside. Wang Bing said: "Strengthen the master of Water to control the sunlight." This is an eternal method. Modern practitioners mistake this for true cold/false heat, using Ginger/Cinnamon and Ginseng/Aconite, adding fire instead of water, turning mild cases severe and fatal. It is like throwing wood on a fire!)
Huangdi said: How does Yang excess generate external heat? Qibo said: If the Upper Jiao is unsmooth, skin becomes dense, pores close, and Wei Qi cannot vent, causing external heat. (Commentary: External cold toxins constrain Yang. Cold contracts skin/pores, trapping Wei Qi. Cold presses externally, Yang contends internally, accumulating fire, causing external heat.)
Huangdi said: How does Yin excess generate internal cold? Qibo said: Jue Qi rebels upward, Cold accumulates in the chest without discharge. Lack of discharge causes Warm Qi to depart, leaving Cold alone. Blood stagnates, vessels block, pulse is large and choppy, causing internal cold. (Commentary: Wen Qi refers to Yang Qi. Yin rebellion fills the interior, driving Yang Qi outwards.)
Huangdi said: You mentioned ten types of excess/deficiency from the Five Zang. The Five Zang correspond to five pulses. The twelve meridians generate a hundred diseases. Why focus only on the Five Zang? The twelve meridians connect with 365 joints; joint disease affects meridians, which have excess/deficiency. How do they integrate? Qibo said: The Five Zang... have Yiu-Fu partners. Meridians and joints generate excess/deficiency. Treat according to location. Disease in Pulse, regulate Blood. (Pulse is the house of Blood; pulse excess reflects blood excess, etc. Note: Jia Yi Jing says "Disease in Blood, regulate Pulse", which may duplicate the next line. Wang Bing's version is preferred.) Disease in Blood, regulate Collaterals. (Commentary: Blood nourishes the whole body, not just collaterals. Regulating collaterals addresses blood flow from collaterals to meridians.) Disease in Qi, regulate Wei Qi. (Wei governs Qi.) Disease in Flesh, regulate Fen Rou (Muscle Intervals, 分肉). (Flesh covers the body; regions correspond to meridians. Identify the meridian based on location, then use medicine or needles.) Disease in Sinews, regulate Sinews. Disease in Bone, regulate Bone... using Cui Zhen (Fire Needles, 淬针) and Yao Wei (Medicated Compresses, 药熨). (Commentary: This treats sinew/bone. Cui is fire needle; Yao Wei is medicated compress. The note dividing sinew/bone is incorrect.) Disease with unknown pain location, prioritize the Two Qiao Vessels. (Yin Qiao originates at Zhao Hai; Yang Qiao at Shen Mai.) Body pain with normal Nine Pulses, use Miao Ci (Mistaken Puncture/Lateral Puncture, 缪刺). (Commentary: Miao Ci involves puncturing collaterals, left pain treated on right, right on left. If pulse is normal but body hurts, the disease is superficial; lateral puncture stops the pain.)