天气始方 吴云。方。谓气方升也。岁方首也。人事方兴也。高云。方。犹位也。正月二月。天气从
阴而阳。故天气始位。简按广雅。方。大也。正也。王注盖本此。
天气正方 吴云。正方者。以时正暄也。生物正升也。岁事正兴也。高云。天气由东而南。始正其位。
水伏 宋本作冰复。诸本同。吴云。冰复者。冰而复冰。凝寒之极也。志云。冰复者。一阳也。高云。
复。犹伏也。水冰气伏。故冰复。简按王注伏藏于水。明是古本作水伏。
地气合 吴云。合。闭而密也。志云。地出之阳。复归
于地。而与阴合也。
散俞 马云。各经分散之穴也。四时刺逆从论云。春气在经脉。此散俞者。即经俞也。以义推之。春
之经脉。当在肝胆经也。肝之经穴。在中封穴。胆之经穴。在阳辅穴。张云。即诸经之散穴也。简按马注恐拘。
高云。络脉之散俞。盖与王意同。
分理 马云。纹理也。亦肝胆经之分理也。吴云。谓黑白分肉之理。高云。分肉之腠理也。
甚者传气间者环也 吴云。病甚者。久留其针。待其传气日一周天而止。少瘥而间者。暂留其针。伺
其经气环一周身而止。张云。传。布散也。环。周也。病甚者。针宜久留。故必待其传气。病稍间者。
但候其气行一周于身。约二刻许。可止针也。简按王马以传气。为传其所胜之义。高以间为虚实相间之谓。并误。
络俞 张云。谓诸经浮络之穴。以夏气在孙络也。
尽气闭环 吴云。扪闭其穴。伺其经气循环。一周于身。约二刻许。张云。闭环。谓去针闭穴。须
气行一周之顷也。高云。夏气开张。故浅刺络俞。若尽传其气。反闭其环转之机。而痛病必下入矣。简按高注非是。
痛病必下 吴云。盖夏气在头。刺之而下移也。
循理 吴云。循理。以指循其肌肉之分理也。高云。循皮肤之纹而刺之。简按王注为是。
刺俞窍于分理 于。马本作于。注云。于字。当与字。张云。孔穴之深者曰窍。冬气在骨髓中。故
当深取俞窍于分理间也。志云。分理者。分肉之腠理。乃溪谷之会。溪谷属骨。而外连于皮肤。是以春刺分理
者。外连皮肤之腠理也。冬刺俞窍于分理者。近筋骨之腠理也。简按不必于作与。
散下 吴云。以指按之。散其表气。而后下针。张云。或左右上下。散布其针。而稍宜缓也。简按张
仍王注。是。
法其所在 马云。正以法其人气之所在。以为刺耳。
入淫骨髓 高云。春刺夏分。心气妄伤。心合脉。故脉乱。脉乱则气无所附。故气微。脉乱气微。邪
反内入。故入淫骨髓。志云。少阳主骨。厥阴不从。标本从少阳中见之化。故入淫骨髓也。○简按以下四时刺
逆之变。犹是月令春行夏政等之灾异。不过示禁戒于人耳。
不嗜食又且少气 高云。夫脉乱必令人不嗜食。盖食气入胃。浊气归心。淫精于脉也。不但气微。又
且少气。
筋挛逆气环为咳嗽 高云。春刺秋分。肺气妄伤。筋挛。肝病也。筋挛逆气。肝病而逆于肺也。张云。
逆气者。肝气上逆也。环。周也。秋应肺。故气周及肺。为咳嗽也。
时惊又且哭 张云。肝主惊。故时惊。肺主悲忧。故又且哭。
邪气着脏 张云。冬应肾。肾伤则邪气内侵而着脏。故令人胀。马云。着。着同。高云。着。旧本讹
着。今改。简按着。着俗字。
又且欲言语 志云。肝主语。故欲言语也。简按宣明五气篇曰。五气所病。肝为语。
解堕 马云。解。懈同。堕。惰同。
心中欲无言 吴云。肺主声。刺秋分而伤肺。故欲无言。
惕惕如人将捕之 吴云。恐也。恐为肾志。肺金受伤。肾失其母。虚而自恐也。
少气时欲怒 张云。夏伤其肾。则精虚不能化气。故令人少气。水亏则木失所养。而肝气强急。故欲
怒也。志云。阳气外张。故令人少气善怒也。
惕然欲有所为起而忘之 张云。伤肝气也。心失其母。则神有不足。故令人惕然。且善忘也。志云。
秋主下降。刺春分。是反导其血气上行。故令人惕然。且善忘也。
洒洒时寒 志云。冬主闭藏。而反伤之。则血气内散。故令人寒栗也。简按志注本于四时刺逆从论。为是。
眠而有见 马云。而。当作如。张云。肝藏魂。肝气受伤。则神魂散乱。故令人欲卧不能眠。或眠而
有见。谓怪异等物也。简按而如古通。如诗小雅垂带而厉。笺云。而。如也。春秋。星陨如雨。是也。不必改字。
环死 吴云。心为天君。不可伤损。刺者误中其心。则经气环身一周。而人死矣。凡人一日一夜。营
卫之气。五十度周于身。以百刻计之。约二刻。而经气循环一周也。简按诸注以环为环周一日之义。然据上文
间者环也。则吴义似长矣。○张云。按刺禁论所言。五脏死期。尤为详悉。但与本节。稍有不同。此节止言四脏。
独不及肝。必脱简耳。
中鬲者皆为伤中 张云。鬲膜。前齐鸠尾。后齐十一椎。心肺居于鬲上。肝肾居于膈下。脾居在下。
近于鬲间。鬲者。所以鬲清浊分上下。而限五脏也。五脏之气。分主四季。若伤其鬲。则脏气阴阳相乱。是为
伤中。故不出一年死。
知逆从也 张云。知而避之者为从。不知者为逆。是谓反也。
布 马云。 。当作HT 。布巾也。张吴本作HT 。高作缴。志云。 。定也。以布定着于胸腹。
滑云。HT 。如缠缴也。简按字书。HT 。又作缴。音皎。玉篇。胫行HT 也。集韵。胫布也。本草有缴脚布。
李时珍云。即裹脚布。古名行HT 。乃滑注似是。字书无 字。志聪根据王注形定之解。牵强。
熊音。 。胡计反。 。子用反。马云。反折
。谓手足身体反张。而或急为 。或缓为 。高云。手足抽掣也。简按 又作螈。玉机真藏论曰。筋脉相引
而急。病名曰螈。王注。筋脉受热。而自跳掣。故名曰螈。熊音。尺世反。 同。说文。螈。小儿 病也。
又HT 。引纵曰HT 。别作 。汉艺文志。有金创螈 方。王符潜夫论。掣纵。皆与此同义。明理论云。 者。筋
脉急也。 者。筋脉缓也。急者则引而缩。缓者则纵而伸。或缩或伸。动而不止者。名曰 。俗谓之搐者。
是也。此说得之。
其色白 吴本。白。作黑。志云。色白者。亡血也。津液外脱。则血内亡矣。张云。灵终始篇曰。
其色白绝皮。乃绝汗。
目HT 绝系 马云。目HT 者。犹俗云眼圈也。其所谓系者。即大惑篇之所谓系也。吴。HT 。作
环。注云。目环。转旁视也。高作寰。注云。谓目之寰字。与眼系相绝。不相维系也。简按HT 。音释。音琼。
说文作HT 。目惊视也。（韵会。葵营切。音琼。）张志并根据王注。为是。
先青白 高云。刺禁论云。刺中胆者。一日半死。色先青白者。日半之前。先见木受金刑之色。乃死矣。
口目动作 张云。牵引歪斜也。志高同。简按王注。目 。（字典晶荧貌。韩愈东方半明诗。太
白 。）而鼓颔也。未详何义。
善惊 阳明脉解篇云。阳明之病。闻木音则惕然惊。
不仁 吴云。不知疼痛。若不仁爱其身者。高云。不仁者。身冷肤硬。马云。不知痛痒也。简按王注
痹论云。不仁者皮顽不知有无也。程氏遗书云。医家以不认痛痒。谓之不仁。人以不知觉。不认义理。为不仁。
譬最近。马注本于程子。
上下不通 吴云。肾开窍于二阴。故令闭。既胀且闭。
则上不得食。下不得便。上下不通。心肾隔绝而终矣。高云。手经足经。不相贯通。则上下不通。简按当从吴义。
腹胀闭 张云。足太阴脉。入腹属脾。故为腹胀闭。手太阴脉。上膈属肺。而主呼吸。故为不得息。
胀闭则升降难。不得息则气道滞。故为噫为呕。呕则气逆于上。故为面赤。不逆则痞塞于中。故为上下不通。
不逆则上下不通 张云。不逆则痞塞于中。故为上下不通。脾气败则无以制水。故黑色见于面。
中热 据王注。谓胸热也。
此十二经之所败也 张云。手足六经。各分表里。是十二经也。灵终始篇文与此同。
天气开始上升。吴崑说：方，指气刚开始升发。岁首之时。高世栻说：方，通“位”，指位置。正月二月，天气从阴转阳，所以天气开始处于阳气之位。简按《广雅》记载：方，意为大、正。王冰的注大概依据于此。
天气正盛。吴崑说：正方，指时令正当温暖，万物生长正当升发，一年之事正当兴起。高世栻说：天气由东向南，开始端正其方位。
水结冰。宋本作“冰复”。各版本相同。吴崑说：冰复，指冰上加冰，是凝寒到了极点。张志聪说：冰复，指一阳初生（此处解释有误，原文意指极寒）。高世栻说：复，通伏，指潜伏。水结冰气潜伏，所以叫冰复。简按王冰注说“伏藏于水”，明显古本原作“水伏”。
地气闭合。吴崑说：合，指闭藏而严密。张志聪说：地中发出的阳气，又回归到地下，与阴气相合。
散俞穴。马莳说：各经分散的穴位。《四时刺逆从论》说：春气在经脉。这散俞穴，就是经穴。依义理推断，春季的经脉，应当在肝胆经。肝的经穴在中封穴，胆的经穴在阳辅穴。张景岳说：即诸经的散穴。简按马莳的注恐怕拘泥。高世栻说：络脉的散俞，大概与王冰的意思相同。
分理。马莳说：纹理。也是肝胆经的分理。吴崑说：指黑白分肉的纹理。高世栻说：分肉的腠理。
病重者待气传遍，病轻者待气环行一周。吴崑说：病重的，久留针，等待其传气日行一周天而止针；病情稍减而间歇的，暂留针，等候其经气环行一周身而止针。张景岳说：传，布散；环，周。病重的，针宜久留，所以必须等待其传气；病稍轻的，只需等候其气行一周于身，约二刻左右，可止针。简按王冰、马莳以“传气”为传其所胜之义，高世栻以“间”为虚实相间之谓，都错了。
尽气闭环。吴崑说：扪闭其穴，等候其经气循环一周于身，约二刻左右。张景岳说：闭环，指出针后闭穴，须等气行一周的时间。高世栻说：夏气开张，所以浅刺络俞。如果尽传其气，反而关闭了其环转的机制，痛病必然下陷深入了。简按高世栻的注不对。
痛病必下陷。吴崑说：因为夏气在头，针刺导致气向下移。
循理。吴崑说：循理，用手指顺着肌肉的分理。高世栻说：顺着皮肤的纹路而刺。简按王冰的注是对的。
在分理间刺入俞窍。于字，马莳本作“于”，注云：“于”字当作“与”。张景岳说：孔穴深的叫窍。冬气在骨髓中，所以应当深取俞窍于分理之间。张志聪说：分理，是分肉的腠理，乃溪谷的会合处。溪谷属骨，外连皮肤。所以春刺分理，是外连皮肤的腠理；冬刺俞窍于分理，是近筋骨之腠理。简按不必将“于”改为“与”。
散下。吴崑说：用手指按压，散其表气，然后下针。张景岳说：或左右上下散布其针，稍微宜缓。简按张景岳仍依王冰注，是对的。
法其所在。马莳说：正是为了效法人气所在的位置，以此决定刺哪里。
邪气侵入骨髓。高世栻说：春刺夏之分，心气妄受损伤。心合脉，所以脉乱。脉乱则气无所依附，所以气微。脉乱气微，邪气反而内入，所以侵入骨髓。张志聪说：少阳主骨，厥阴不从，标本从少阳中见之化，所以侵入骨髓。○简按以下四时刺逆的变化，就像是月令中春行夏政等的灾异，不过是向人示以禁戒罢了。
不想吃东西并且气少。高世栻说：脉乱必定使人不想吃东西。盖食气入胃，浊气归心，淫精于脉。不但气微，而且气少。
筋挛、逆气、环转为咳嗽。高世栻说：春刺秋之分，肺气妄受损伤。筋挛，是肝病。筋挛逆气，是肝病而逆于肺。张景岳说：逆气，是肝气上逆。环，周。秋应肺，所以气周及肺，形成咳嗽。
时常惊恐并且哭泣。张景岳说：肝主惊，所以时常惊恐。肺主悲忧，所以又且哭泣。
邪气附着于脏。张景岳说：冬应肾，肾伤则邪气内侵而附着于脏，所以令人胀。马莳说：着，同“著”。高世栻说：着，旧本讹作“着”，今改。简按“着”是“著”的俗字。
又想说话。张志聪说：肝主语，所以想说话。简按《宣明五气篇》说：五气所病，肝为语。
懈怠堕落。马莳说：解，同“懈”。堕，同“惰”。
恐惧得像有人要捕捉自己。吴崑说：恐也。恐为肾之志。肺金受伤，肾失其母（金生水），虚而自恐。
气少且时常想发怒。张景岳说：夏伤其肾，则精虚不能化气，所以令人气少。水亏则木失所养，而肝气强急，所以想发怒。张志聪说：阳气外张，所以令人气少善怒。
惶恐想要做什么，起来却忘记了。张景岳说：伤肝气。心失其母（水生木），则神有不足，所以令人惶恐且善忘。张志聪说：秋主下降，刺春分，是反导其血气上行，所以令人惶恐且善忘。
时时洒洒恶寒。张志聪说：冬主闭藏，而反伤之，则血气内散，所以令人寒栗。简按张志聪的注本于《四时刺逆从论》，是对的。
睡觉且有幻觉。马莳说：而，当作“如”。张景岳说：肝藏魂，肝气受伤，则神魂散乱，所以令人想睡不能眠，或者睡而有见，指怪异等物。简按“而”、“如”古通用，如《诗·小雅·垂带而厉》，笺云：而，如也。《春秋》星陨如雨，是也。不必改字。
环死。吴崑说：心为天君，不可伤损。刺者误中其心，则经气环身一周，人就死了。凡人一日一夜，营卫之气五十度周于身。以百刻计之，约二刻，经气循环一周。简按各家注以“环”为环周一日之义，然而据上文“间者环也”，则吴崑的解释似乎更合理。○张景岳说：按《刺禁论》所言五脏死期，尤为详细，但与本节稍有不同。此节只言四脏，独不及肝，必定是脱简了。
中鬲膜的都是伤中。张景岳说：鬲膜，前齐鸠尾，后齐第十一椎。心肺居于鬲上，肝肾居于膈下，脾居在下，近于鬲间。鬲，是用来隔开清浊，分上下，并限制五脏的。五脏之气，分主四季。如果伤了鬲，则脏气阴阳相乱，这是伤中，所以不出一年就会死。
知道逆从。张景岳说：知而避之的为从，不知的为逆，这叫反。
布巾。马莳说：字当作“缴”，布巾也。张景岳、吴崑本作“缴”。高世栻作“缴”。张志聪说：定也。用布固定于胸腹。滑寿说：缴，像缠缴一样。简按字书，“缴”又作“缴”，音皎。《玉篇》：胫行缴也。《集韵》：胫布也。本草有缴脚布，李时珍说：即裹脚布，古名行缴，所以滑寿的注似是。字书无“ ”字。张志聪根据王注形定之解，牵强。
螈 。熊季廉注音： ，胡计反。 ，子用反。马莳说：反折 ，指手足身体反张，或者急为 ，或者缓为 。高世栻说：手足抽掣。简按 又作“螈”。《玉机真藏论》说：筋脉相引而急，病名曰螈。王冰注：筋脉受热，而自跳掣，故名曰螈。熊季廉注音：尺世反。 同。《说文》：螈，小儿 病也。又 引纵曰 。别作 。《汉艺文志》有金创螈 方。王符《潜夫论》：掣纵，皆与此同义。《明理论》说： 者，筋脉急也。 者，筋脉缓也。急者则引而缩，缓者则纵而伸。或缩或伸，动而不止者，名曰 。俗谓之搐者，是也。此说得之。
其色白。吴崑本，白，作黑。张志聪说：色白者，亡血也。津液外脱，则血内亡矣。张景岳说：《灵枢·终始篇》说：其色白绝皮，乃绝汗。
目睛直视，绝系。马莳说：目 者，犹俗云眼圈也。其所谓系者，即《大惑论》之所谓系也。吴崑， 作环，注云：目环，转旁视也。高世栻作寰，注云：谓目之寰字，与眼系相绝，不相维系也。简按 ，音释音琼。《说文》作 ，目惊视也。（《韵会》葵营切，音琼。）张志聪并根据王冰注，是对的。
先青后白。高世栻说：《刺禁论》说：刺中胆者，一日半死。色先青白者，日半之前，先见木受金刑之色，乃死矣。
口目动作。张景岳说：牵引歪斜也。张志聪、高世栻同。简按王冰注：目 （字典晶荧貌。韩愈《东方半明》诗：太白 ）。而鼓颔也。未详何义。
不仁。吴崑说：不知疼痛。若不仁爱其身者。高世栻说：不仁者，身冷肤硬。马莳说：不知痛痒也。简按王冰注《痹论》说：不仁者皮顽不知有无也。程氏遗书说：医家以不认痛痒，谓之不仁。人以不知觉，不认义理，为不仁。比喻最近。马莳的注本于程子。
则上不得食，下不得便。上下不通，心肾隔绝而终了。高世栻说：手经足经，不相贯通，则上下不通。简按应当遵从吴崑的解释。
腹胀闭。张景岳说：足太阴脉，入腹属脾，所以为腹胀闭。手太阴脉，上膈属肺，而主呼吸，所以为不得息。胀闭则升降难，不得息则气道滞，所以为噫为呕。呕则气逆于上，所以为面赤。不逆则痞塞于中，所以为上下不通。
The heavenly qi begins to rise. Wu Kun states: "Fang" (方) refers to the qi beginning to ascend. It is the beginning of the year. Gao Shishi states: "Fang" is synonymous with "Wei" (位), referring to position. In the first and second lunar months, the heavenly qi transitions from yin to yang; thus, the heavenly qi begins to occupy its position in yang. Commentary notes that *Guangya* defines "fang" as great and correct. Wang Bing's annotation likely derives from this.
The heavenly qi reaches its peak. Wu Kun states: "Zheng fang" (正方) means the season is properly warm, living things are properly ascending, and annual affairs are properly flourishing. Gao Shishi states: The heavenly qi moves from east to south, beginning to rectify its position.
Water freezes. The Song edition reads "Bing fu" (冰复). All other editions agree. Wu Kun states: "Bing fu" means ice upon ice, indicating extreme cold and condensation. Zhang Zicong states: "Bing fu" indicates the emergence of one yang line (this interpretation is considered erroneous in context). Gao Shishi states: "Fu" (复) is equivalent to "Fu" (伏), meaning latent. Water freezes and qi becomes latent, hence called "ice upon ice." Commentary notes that Wang Bing's annotation "latent within water" clearly indicates the ancient text originally read "Shui fu" (水伏, water lies latent).
Earthly qi closes. Wu Kun states: "He" (合) means closing and sealing tightly. Zhang Zicong states: Yang qi emerging from the earth returns to the earth and combines with yin qi.
Scattered Shu points. Ma Shi states: These are the scattered acupoints of each meridian. *Si Shi Ci Ni Cong Lun* states: "Spring qi resides in the meridians." Therefore, these scattered Shu points are the Meridian-Shu points. By reasoning, the spring meridians should belong to the Liver and Gallbladder channels. The Liver meridian point is Zhongfeng (LR4), and the Gallbladder meridian point is Yangfu (GB38). Zhang Jingyue states: They are the scattered points of all meridians. Commentary notes that Ma Shi's annotation may be too rigid. Gao Shishi states: The scattered points of the collaterals, which aligns with Wang Bing's intent.
Muscle separations (Fenli). Ma Shi states: Texture or grain. Also the fenli of the Liver and Gallbladder meridians. Wu Kun states: Refers to the texture separating black and white muscles. Gao Shishi states: The interstices of the muscle layers.
In severe cases, wait for qi transmission; in mild cases, wait for qi circulation. Wu Kun states: For severe illness, retain the needle for a long time, waiting for the qi to transmit through the body cycle once before withdrawing. For intermittent or milder conditions, temporarily retain the needle, waiting for the meridian qi to circulate around the body once before withdrawing. Zhang Jingyue states: "Chuan" (传) means dissemination; "Huan" (环) means circle. For severe disease, needle retention should be prolonged, so one must wait for qi transmission. For slightly milder disease, one only needs to wait for qi to circulate once around the body, approximately two ke (time units), then withdraw the needle. Commentary notes that Wang Bing and Ma Shi interpreted "chuan qi" as transmitting to the overcoming element, and Gao Shishi interpreted "jian" (间) as alternating deficiency and excess; both are incorrect.
Luo-Shu points. Zhang Jingyue states: Refers to the acupoints of the floating collaterals of all meridians, because summer qi resides in the sun-meridians (Sunluo).
Exhaust qi and close the ring. Wu Kun states: Press and close the acupoint, waiting for the meridian qi to circulate once around the body, approximately two ke. Zhang Jingyue states: "Bi huan" (闭环) means closing the acupoint after needle withdrawal, requiring the time for qi to complete one cycle. Gao Shishi states: Summer qi is open and expansive, so shallow needling of Luo-Shu points is used. If one exhausts the transmitted qi, it reversely closes the mechanism of circulation, causing pain and pathology to sink inward. Commentary notes that Gao Shishi's annotation is incorrect.
Pathology will sink downward. Wu Kun states: Because summer qi resides in the head, needling causes qi to shift downward.
Following the texture. Wu Kun states: Following the texture involves using fingers to trace the muscle separations. Gao Shishi states: Needling along the skin lines. Commentary notes that Wang Bing's annotation is correct.
Needle the Shu cavities within the muscle separations. The character "Yu" (于), Ma Shi's edition reads "Yu" (与), annotating that "Yu" should be "Yu". Zhang Jingyue states: Deep cavities are called "Qiao" (窍). Winter qi resides in the bone marrow, so one should deeply needle the Shu cavities within the muscle separations. Zhang Zicong states: Fenli refers to the interstices of muscle separation, which is the convergence of streams and valleys. Streams and valleys belong to bone and connect externally to the skin. Thus, needling fenli in spring targets the interstices connecting externally to the skin; needling Shu cavities in fenli in winter targets the interstices near tendons and bones. Commentary notes there is no need to change "Yu" to "Yu".
Disperse and descend. Wu Kun states: Press with fingers to disperse superficial qi, then insert the needle. Zhang Jingyue states: Disperse the needle insertion left, right, up, and down, slightly slowing the process. Commentary notes Zhang Jingyue follows Wang Bing's annotation, which is correct.
Follow its location. Ma Shi states: Precisely follow the location of the patient's qi to determine where to needle.
Evil qi invades the bone marrow. Gao Shishi states: Needling the summer division during spring wrongly damages Heart qi. The Heart governs vessels, so vessels become chaotic. When vessels are chaotic, qi has no attachment, becoming weak. Chaotic vessels and weak qi allow evil to enter internally, thus invading the bone marrow. Zhang Zicong states: Shaoyang governs bone; Jueyin does not comply. The root and branch follow the transformation of Shaoyang's intermediate view, thus invading the bone marrow. ○ Commentary notes that the following variations of improper four-season needling are akin to disasters like implementing summer policies in spring according to the *Yueling*, serving merely as warnings.
Loss of appetite and shortness of breath. Gao Shishi states: Chaotic vessels inevitably cause loss of appetite. Food qi enters the stomach, turbid qi returns to the Heart, and essence floods into the vessels. Not only is qi weak, but there is also shortness of breath.
Tendon spasms, counterflow qi, and circular cough. Gao Shishi states: Needling the autumn division during spring wrongly damages Lung qi. Tendon spasms indicate Liver disease. Tendon spasms with counterflow qi indicate Liver disease affecting the Lung. Zhang Jingyue states: Counterflow qi refers to Liver qi rebelling upward. "Huan" means circle. Autumn corresponds to the Lung, so qi circles the Lung, causing cough.
Frequent fright and weeping. Zhang Jingyue states: The Liver governs fright, hence frequent fright. The Lung governs sorrow and grief, hence weeping.
Evil qi adheres to the Zang organs. Zhang Jingyue states: Winter corresponds to the Kidney. If the Kidney is injured, evil qi invades internally and adheres to the Zang, causing distension. Ma Shi states: "Zhuo" (着) is identical to "Zhuo" (著). Gao Shishi states: "Zhuo" was erroneously written as "Zhe" (着) in old editions, now corrected. Commentary notes "Zhe" is a vulgar variant of "Zhuo".
Desire to speak. Zhang Zicong states: The Liver governs speech, hence the desire to speak. Commentary notes *Xuan Ming Wu Qi Pian* states: Among diseases caused by five qi, the Liver manifests as speech.
Flaccidity and lethargy. Ma Shi states: "Jie" (解) is identical to "Xie" (懈); "Duo" (堕) is identical to "Duo" (惰).
Heart desires silence. Wu Kun states: The Lung governs voice. Needling the autumn division injures the Lung, hence the desire for silence.
Fearful as if someone were catching them. Wu Kun states: Fear. Fear is the emotion of the Kidney. Lung metal is injured, losing its mother (Kidney water), leading to deficiency and spontaneous fear.
Shortness of breath and frequent anger. Zhang Jingyue states: Summer injury to the Kidney results in essence deficiency failing to transform qi, causing shortness of breath. Water deficiency leads to Wood lacking nourishment, making Liver qi strong and urgent, hence anger. Zhang Zicong states: Yang qi expands outward, causing shortness of breath and irritability.
Restlessness, wanting to act, but forgetting upon rising. Zhang Jingyue states: Injury to Liver qi. The Heart loses its mother (Liver wood), resulting in Shen insufficiency, causing restlessness and forgetfulness. Zhang Zicong states: Autumn governs descending. Needling the spring division reversely guides blood and qi upward, causing restlessness and forgetfulness.
Chilly shivers. Zhang Zicong states: Winter governs storage and concealment. Reversely injuring it scatters blood and qi internally, causing chills. Commentary notes Zhang Zicong's annotation derives from *Si Shi Ci Ni Cong Lun* and is correct.
Sleeping with visual hallucinations. Ma Shi states: "Er" (而) should be "Ru" (如). Zhang Jingyue states: The Liver stores Hun. Liver qi injury scatters Hun and Shen, causing drowsiness without sleep, or sleeping with visions, referring to strange objects. Commentary notes "Er" and "Ru" are interchangeable in ancient texts, e.g., *Shi Jing* and *Chun Qiu*. No character change is needed.
Death after one cycle. Wu Kun states: The Heart is the Heavenly Monarch and cannot be damaged. If a practitioner mistakenly pierces the Heart, the person dies after the meridian qi completes one cycle around the body. In one day and night, Ying and Wei qi circulate fifty times around the body. Calculated by hundred ke, it takes approximately two ke for meridian qi to complete one cycle. Commentary notes most annotations interpret "huan" as a daily cycle, but based on the earlier text "mild cases wait for a cycle," Wu Kun's interpretation seems more plausible. ○ Zhang Jingyue states: According to *Ci Jin Lun*, the death periods for five Zang organs are detailed, differing slightly from this section. This section mentions only four Zang organs, omitting the Liver, suggesting a missing slip of bamboo.
Piercing the diaphragm constitutes injury to the Middle Jiao. Zhang Jingyue states: The diaphragm membrane aligns anteriorly with Jiutui and posteriorly with the eleventh thoracic vertebra. Heart and Lung reside above the diaphragm; Liver and Kidney below; Spleen resides lower, near the diaphragm. The diaphragm separates clear from turbid, divides upper and lower, and limits the five Zang organs. Zang qi governs the four seasons respectively. Injury to the diaphragm causes chaos between Zang qi yin and yang, constituting injury to the Middle Jiao, leading to death within a year.
Knowing reversal and compliance. Zhang Jingyue states: Knowing and avoiding is compliance; not knowing is reversal, which is termed contradiction.
Cloth bandage. Ma Shi states: The character should be "Jiao" (缴), meaning cloth bandage. Zhang Jingyue and Wu Kun editions use "Jiao". Gao Shishi uses "Jiao". Zhang Zicong states: Fixation. Securing with cloth to chest and abdomen. Hua Shou states: Jiao, like wrapping bands. Commentary notes dictionaries define "Jiao" as leg cloth. Li Shizhen states it is foot-wrapping cloth, ancient name Xingjiao, so Hua Shou's note is likely correct. The character does not exist in dictionaries. Zhang Zicong's derivation from Wang Bing's shape-based annotation is forced.
Convulsions. Xiong Jilian provides phonetic readings. Ma Shi states: Reverse flexion, referring to opisthotonos or limb convulsions, either tense or relaxed. Gao Shishi states: Limb twitching. Commentary notes the character is also written as "Yuan" (螈). *Yu Ji Zhen Zang Lun* states: Tendons and vessels pulling and tightening is named Yuan. Wang Bing annotates: Heat in tendons and vessels causes jumping and twitching, hence Yuan. Xiong Jilian provides phonetic reading. The character is identical. *Shuo Wen* states: Yuan is a pediatric disease. Another form is "Chi" (瘛), meaning stretching and relaxing. *Han Yi Wen Zhi* mentions formulas for traumatic Yuan. Wang Fu's *Qian Fu Lun* uses similar meanings. *Ming Li Lun* states: Chi refers to tendon/vessel tension; Zhuo refers to relaxation. Tension pulls and shrinks; relaxation stretches and extends. Uncontrolled movement is named Chi, commonly known as convulsion. This explanation is accurate.
Complexion turns white. Wu Kun edition reads "Black" instead of "White". Zhang Zicong states: White complexion indicates blood loss. External depletion of fluids leads to internal blood loss. Zhang Jingyue states: *Ling Shu · Zhong Shi Pian* states: White complexion at the skin surface indicates absolute sweat (Jue Han).
Eyes staring straight, severing the connection. Ma Shi states: Eyes staring refers to the eye sockets. The "connection" refers to that in *Da Huo Lun*. Wu Kun reads the character as "Huan" (环), annotating: Eyes turning sideways. Gao Shishi reads "Huan" (寰), annotating: The eye's globe severs connection with the eye system, losing support. Commentary notes the character is pronounced "Qiong". *Shuo Wen* writes it as eyes staring in fright. Zhang Zicong follows Wang Bing's annotation, which is correct.
First cyan, then white. Gao Shishi states: *Ci Jin Lun* says piercing the Gallbladder causes death in one and a half days. Complexion first cyan then white indicates seeing the color of Wood suffering Metal punishment before death.
Facial distortion. Zhang Jingyue states: Pulling and deviation. Zhang Zicong and Gao Shishi agree. Commentary notes Wang Bing's annotation regarding eye appearance and jaw trembling is unclear.
Susceptibility to fright. *Yang Ming Mai Jie Pian* states: Yangming disease causes sudden fright upon hearing wooden sounds.
Numbness. Wu Kun states: Insensitivity to pain. Gao Shishi states: Numbness implies cold body and hard skin. Ma Shi states: Insensitivity to pain and itch. Commentary notes Wang Bing's annotation in *Bi Lun*: Numbness is skin insensitivity to presence/absence. Cheng Hao's *Yi Shu* states: Physicians call insensitivity to pain/itch "numbness"; people calling ignorance of principles "numbness" is an apt analogy. Ma Shi's note derives from Cheng Zi.
Upper and lower blockage. Wu Kun states: Kidney opens into the two yin orifices, causing closure. Both distension and closure occur.
Thus, unable to eat above, unable to defecate below. Upper and lower blockage leads to Heart-Kidney isolation and death. Gao Shishi states: Hand and foot meridians not connecting causes upper-lower blockage. Commentary notes Wu Kun's interpretation should be followed.
Abdominal distension and closure. Zhang Jingyue states: Foot Taiyin meridian enters abdomen and belongs to Spleen, causing abdominal distension/closure. Hand Taiyin meridian ascends through diaphragm and belongs to Lung, governing respiration, causing inability to breathe. Distension/closure hinders ascent/descent; inability to breathe stagnates airway, causing belching and vomiting. Vomiting causes qi rebellion upward, leading to red face. Without rebellion, stagnation occurs in the middle, causing upper-lower blockage.
Without rebellion, upper-lower blockage. Zhang Jingyue states: Without rebellion, stagnation occurs in the middle, causing upper-lower blockage. Spleen qi failure fails to control Water, leading to black complexion.
Internal heat. According to Wang Bing's annotation, this refers to chest heat.
This is the defeat of the twelve meridians. Zhang Jingyue states: Hand and foot six meridians, each divided into interior-exterior pairs, constitute the twelve meridians. This text matches *Ling Shu · Zhong Shi Pian*.