马云。志者。记也。篇内。言虚实之要。及泻实补虚之法。当记之不忘。故名篇。吴改虚实要论。云。
旧作刺志论。今以篇内之言无当。僭改。简按篇首论虚实。而篇末结以针法补泻之义。斯为刺志也。改易篇名。
却无谓矣。
气实形实气虚形虚 马云。凡气与形。谷与气。脉与血相称者为常。而相反者为病也。气者。人身
之气也。（如营气卫气。是也。）形者。人之形体也。（次节。岐伯以身字代形字。）气实则形实。气虚则形
虚。此其相称者为常。而相反则为病矣。然此气之虚实。必于脉而验之。但不可即谓气为脉也。观下文有血脉
对举者可知。王注引阴阳应象大论之形归气。以验其虚实之同。甚有见。至以气为脉气。则非矣。
气虚身热 马吴高并根据甲乙。气字上。补气盛身寒四字。是。
脉少血多 吴。少。作小。马云。少。当作小。张云。脉盛血少者。阳实阴虚也。脉少血多者。
阳虚阴实也。简按血之多少。盖察面而知之。
得之伤寒 马云。此伤寒者。初时所感之寒。至于日久。则寒亦为热矣。故热论曰。凡热病者。皆
伤寒之类也。水热
穴论。帝曰。人伤于寒。而传于热。何也。岐伯曰。夫寒感则身热。张云。按热论篇曰。人之伤于寒也。则为
病热。本节。复以身寒者为伤寒。身热者为伤暑。其说若乎相反。不知四时皆有伤寒。而伤暑惟在夏月。病不
同时者。自不必辨。惟于夏至之后。有感寒暑。而同时为病者。则不可不察其阴阳也。盖阴邪中人。则寒集于
表。气聚于里。故邪气盛实。而身本因寒也。暑邪中人。则热触于外。气伤于中。故正气疲困。而因热无寒也。
此夏月寒暑之明辨。故以二者。并言于此。非谓凡患伤寒者。皆身寒无热也。
得之有所脱血湿居下也 张云。谷入多者。胃热善于消谷也。脱血者。亡其阴也。湿居下者。脾肾之
不足。亦阴虚也。阴虚则无气。故谷虽入多。而气则少也。高云。夫谷入多。而气反少者。其内则得之有所脱
血。或湿邪居下之病。简按血脱液干。水湿归下。并胃中津乏。故消谷善饥。与伤寒论。抵当汤治证。其理略
同。王注。以脱血湿居下为一事。恐非。
谷入少而气多 张云。邪在胃。则不能食。故谷入少。邪在肺。则息喘满。故气多。
胃及与肺 吴删与字。
饮中热也 吴云。有痰饮者。脉来弦小。有中热者。血出必多。张云。脉小者。血应少。而反见其
多。必或酒或饮。中于热。而动之也。高云。夫脉小血反多者。其内必饮酒中热之病。酒行络脉。故血多行于
外。而虚于内。故脉小。昂云。按灵素皆无痰字。惟此处有饮字。简按中。读如字。高注义长。
脉有风气水浆不入 张云。风为阳邪。居于脉中。故脉大。水浆不入。则中焦无以生化。故血少。
吴云。此上。皆
释反者为病之词。
入实者左手开针空也 吴云。空。上声。马云。大凡用针之法。右手持针。左手掐穴。方其入针泻实
之时。则左手掐穴。开针空以泻之。及其去针补虚之时。则左手闭穴。闭针空以补之。张云。入实者。刺实也。
入虚者。刺虚也。简按据上文。虚者。气出也。入虚。当是出虚。滑吴张志高。并作右手开针空。非也。当仍
王及马注。
马云说：“志”，就是记忆的意思。本篇论述了虚实的关键，以及泻实补虚的方法，应当牢记不忘，所以篇名叫《刺志论》。吴崑将篇名改为《虚实要论》，他说：“旧题为《刺志论》，现在因为篇中的内容与题目不符，擅自更改。”丹波简按：篇首论述虚实，篇末总结针刺补泻的意义，这才是“刺志”的含义。随意更改篇名，却毫无意义。
气实形实，气虚形虚。马云说：凡是气与形体、水谷之气与元气、脉象与血液相互匹配的，属于正常；相反的就是病态。气，指人身之气（如营气、卫气等）。形，指人的形体（下一节岐伯用“身”字代替“形”字）。气实则形体充实，气虚则形体虚弱，这是相互匹配的正常状态，相反则为病态。然而这种气的虚实，必须通过脉象来验证，但不能直接说气就是脉。看下文有“血脉”对举的情况就可以知道。王冰注引用《阴阳应象大论》中“形归气”的说法，来验证虚实的一致性，很有见地。但把气等同于脉气，就不对了。
气虚而身体发热。马莳、吴崑、高世栻都依据《甲乙经》，在“气”字上补入“气盛身寒”四字，这样是正确的。
脉少血多。吴崑认为，“少”通“小”。马云说：“少”应当作“小”。张景岳说：脉盛血少，是阳实阴虚；脉小血多，是阳虚阴实。丹波简按：血的多少，大概可以通过观察面色得知。
得之伤寒。马云说：这里的“伤寒”，是指初感时的寒邪，到了日久，寒邪也会化为热邪。所以《热论》说：“凡热病者，皆属伤寒之类。”《水热穴论》中，黄帝问：“人受寒邪侵袭，为什么会传变为热病？”岐伯回答：“感受寒邪就会身体发热。”张景岳按：《热论》篇说：“人伤于寒，则为病热。”本节又说，身体发冷的是伤寒，身体发热的是伤暑，说法似乎相反。不知道四时都有伤寒，而伤暑只在夏季发生。疾病不同时期，自然不必辩驳。只有在夏至之后，有人同时感受寒邪和暑邪而发病，才不可不辨别其阴阳属性。大概阴邪中人，寒邪聚集于体表，气聚于体内，所以邪气盛实，而身体本来因寒而冷。暑邪中人，热邪触于外，正气伤于内，所以正气疲困，因热而无寒。这是夏季寒暑的明确分辨，所以在此一并言及二者。并不是说凡是患伤寒的人，都身体寒冷而没有发热。
得之有所脱血，湿居下也。张景岳说：进食多，是胃热善于消化食物。脱血者，丧失阴液。湿气居于下部，是脾肾不足，也是阴虚。阴虚则无气，所以虽然进食多，但气却少。高世栻说：进食多而气反而少，内部原因是得了脱血之症，或者是湿邪居于下部的病证。丹波简按：血脱液干，水湿归于下部，加上胃中津液匮乏，所以消谷善饥，这与《伤寒论》抵当汤治疗的证候，道理大致相同。王冰注将“脱血”和“湿居下”视为一件事，恐怕不对。
谷入少而气多。张景岳说：邪气在胃，就不能进食，所以进食少；邪气在肺，就会呼吸急促、胸闷，所以气多。
胃及与肺。吴崑删去了“与”字。
饮中热也。吴崑说：有痰饮的人，脉象来势弦小；有中热的人，出血必然很多。张景岳说：脉小，血应该少，反而见到血多，必定是因为饮酒或饮食中热，而动血所致。高世栻说：脉小血反而多，内部必然是饮酒中热的病证。酒行络脉，所以血多行于外部，而内部空虚，所以脉小。昂云（疑为某注家）说：按《灵枢》《素问》都没有“痰”字，只有此处有“饮”字。丹波简按：“中”字读如本字，高世栻的注解义理更长。
脉有风气，水浆不入。张景岳说：风为阳邪，居于脉中，所以脉大。水浆不能入口，则中焦无法生化，所以血少。吴崑说：以上这些，都是解释“相反者为病”的词句。
入实者左手开针空也。吴崑说：“空”读去声（kòng）。马云说：大凡用针的方法，右手持针，左手掐穴。正当进针泻实的时候，左手掐穴，张开针孔以泻实；等到退针补虚的时候，左手闭合穴位，闭合针孔以补虚。张景岳说：“入实”，就是刺实证；“入虚”，就是刺虚证。丹波简按：根据上文，“虚”指气出，“入虚”应当是“出虚”。滑寿、吴崑、张志聪、高世栻都说是“右手开针空”，这是错误的。应当仍依王冰和马莳的注释。
Ma Yun stated: "Zhi" (Record/Memory) means to remember. This chapter discusses the essentials of deficiency and excess, as well as the methods of draining excess and tonifying deficiency, which should be remembered without fail; hence the chapter title *Ci Zhi Lun* (Treatise on Needling and Memory). Wu Kun changed the title to *Xu Shi Yao Lun* (Essential Treatise on Deficiency and Excess), stating: "The old title was *Ci Zhi Lun*, but since the content does not match the title, I arbitrarily changed it." Danbo Jian commented: The beginning of the chapter discusses deficiency and excess, while the end concludes with the meaning of needle manipulation for tonification and sedation; this constitutes "Ci Zhi" (Needling and Memory). Arbitrarily changing the chapter title is meaningless.
Qi Excess corresponds to Form Excess; Qi Deficiency corresponds to Form Deficiency. Ma Yun stated: When Qi and form, Gu Qi (Grain Qi) and Yuan Qi, and pulse and blood are in correspondence, it is normal; when they are contrary, it is pathological. "Qi" refers to the Qi of the human body (such as Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi)). "Form" refers to the physical body (in the next section, Qibo uses the character "Shen" (Body) to substitute "Xing" (Form)). When Qi is excessive, the form is substantial; when Qi is deficient, the form is weak. This correspondence is normal, while contradiction indicates disease. However, the deficiency or excess of Qi must be verified through the pulse, but one cannot simply equate Qi with the pulse. As seen later in the text where "Blood Vessel" (Mai) and "Blood" (Xue) are mentioned together, this is evident. Wang Bing's commentary cites *Yin Yang Ying Xiang Da Lun* (Great Treatise on Yin-Yang Correspondences) stating "Form returns to Qi" to verify the consistency of deficiency and excess, which is insightful. However, equating Qi directly with Mai Qi (Pulse Qi) is incorrect.
Qi Deficiency with Body Heat. Ma Shi, Wu Kun, and Gao Shishi all followed the *Jia Yi Jing* (Classic of A-Bian Acupuncture and Moxibustion), adding the four characters "Qi Sheng Shen Han" (Excessive Qi with Cold Body) before the character "Qi". This is correct.
Few Pulse, Abundant Blood. Wu Kun interpreted "Shao" (Few) as "Xiao" (Small). Ma Yun stated: "Shao" should be read as "Xiao". Zhang Jingyue stated: When the pulse is vigorous but blood is scant, it indicates Yang Excess and Yin Deficiency. When the pulse is small/scant but blood is abundant, it indicates Yang Deficiency and Yin Excess. Danbo Jian commented: The abundance or scarcity of blood can generally be known by observing the complexion.
Caused by Shang Han (Cold Damage). Ma Yun stated: The "Shang Han" here refers to the cold pathogen contracted initially. After a long duration, the cold transforms into heat. Thus, *Re Lun* (Treatise on Heat) states: "All heat diseases belong to the category of Shang Han." In *Shui Re Xue Lun* (Treatise on Water-Heat Acupoints), the Yellow Emperor asked: "Why does contracting cold transform into heat?" Qibo answered: "Contracting cold leads to body heat." Zhang Jingyue noted: *Re Lun* states: "When humans are injured by cold, they develop heat diseases." This section states that those with cold bodies suffer from Shang Han, while those with hot bodies suffer from Shang Shu (Summerheat Injury). These statements seem contradictory. One must understand that Shang Han occurs in all four seasons, whereas Shang Shu occurs only in summer. Since the diseases occur at different times, there is no need to debate them. However, after the Summer Solstice, if one contracts both cold and summerheat simultaneously and becomes ill, one must distinguish their Yin and Yang natures. Generally, when Yin pathogens invade, cold gathers at the exterior, and Qi aggregates internally, resulting in pathogenic excess and a body naturally cold due to cold. When summerheat pathogens invade, heat touches the exterior, and Qi is damaged internally, resulting in righteous Qi exhaustion and a body hot without cold. This is a clear distinction between summer cold and summerheat, so both are discussed here. It does not mean that all patients with Shang Han have cold bodies without fever.
Caused by Blood Loss, Dampness residing below. Zhang Jingyue stated: Eating much indicates Stomach Heat capable of digesting food. Blood loss implies the loss of Yin fluids. Dampness residing in the lower part indicates insufficiency of the Spleen and Kidney, which is also Yin Deficiency. Yin Deficiency leads to Qi deficiency; thus, although food intake is high, Qi is scarce. Gao Shishi stated: When food intake is high but Qi is low, the internal cause is either a condition of blood loss or dampness pathogen residing in the lower part. Danbo Jian commented: Blood loss and fluid dryness, water-dampness gathering below, combined with a lack of stomach fluids, lead to rapid digestion and hunger. This logic is similar to the indications for Didang Tang (Lower Jiao Stasis-Decoction) in the *Shang Han Lun* (Treatise on Cold Damage). Wang Bing’s commentary treats "blood loss" and "dampness residing below" as a single event, which is likely incorrect.
Little Food Intake but Much Qi. Zhang Jingyue stated: When pathogen is in the Stomach, one cannot eat, so food intake is low. When pathogen is in the Lung, there is panting and chest fullness, so Qi is excessive.
Stomach and Lung. Wu Kun deleted the character "Yu" (And).
Drinking with Internal Heat. Wu Kun stated: Those with Phlegm-Fluids (Tan Yin) have a string-like and small pulse; those with Internal Heat will bleed profusely. Zhang Jingyue stated: A small pulse suggests blood should be scant, but seeing abundant blood implies it was triggered by alcohol or dietary heat. Gao Shishi stated: When the pulse is small but blood is abundant, the internal condition must be drinking-induced internal heat. Alcohol travels through the collaterals, causing blood to flow abundantly externally while being deficient internally, hence the small pulse. Ang Yun noted: Neither *Ling Shu* nor *Su Wen* contains the character "Tan" (Phlegm); only this section has "Yin" (Drink/Fluid). Danbo Jian commented: "Zhong" (Middle/Internal) is read as its original meaning. Gao Shishi’s interpretation is superior.
Pulse with Wind Pathogen, No Fluid Intake. Zhang Jingyue stated: Wind is a Yang pathogen residing in the vessels, causing a large pulse. If fluids cannot enter, the Middle Jiao lacks the source for transformation and generation, resulting in little blood. Wu Kun stated: The above explanations clarify why "contraries indicate disease."
For Treating Excess, Open the Needle Aperture with the Left Hand. Wu Kun stated: "Kong" (Aperture/Hole) is pronounced with the falling tone. Ma Yun stated: Generally, in acupuncture, the right hand holds the needle, and the left hand presses the acupoint. When inserting the needle to drain excess, the left hand presses the point to open the aperture for draining. When withdrawing the needle to tonify deficiency, the left hand closes the aperture for tonifying. Zhang Jingyue stated: "Ru Shi" (Enter Excess) means treating excess syndromes; "Ru Xu" (Enter Deficiency) means treating deficiency syndromes. Danbo Jian commented: According to the preceding text, "Xu" refers to the exit of Qi. "Ru Xu" should be interpreted as "Chu Xu" (Exit Deficiency). Hua Shou, Wu Kun, Zhang Zhicong, and Gao Shishi all state "Open the needle aperture with the right hand," which is incorrect. One should follow the commentaries of Wang Bing and Ma Shi.