黄帝问曰∶气为上鬲。上鬲者，食入而还出，余已知之矣。虫为下鬲，下鬲者，食
时乃出，未得其意，愿卒闻之？岐伯对曰∶喜怒不适，食饮不节，寒温不时，则寒汁留
于肠中，留则虫寒，虫寒则积聚，守于下脘，守下脘则肠胃充郭，胃气不营，邪气居之。人
食则虫上食，虫上食则下脘虚。下脘虚则邪气胜，胜则积聚以留，留则痈成，痈成则下脘约。
其痈在脘内者，则沉而痛深；其痈在脘外者，则痈外而痛浮，痈上皮热。按其痈，视气所
行，先浅刺其傍，稍内益深，还而刺之，无过三行，察其浮沉，以为浅深，已刺必熨，令热
入中，日使热内，邪气益衰，大痈乃溃，互以参禁，以除其内，恬淡无为，乃能行气，后服酸
苦，化谷乃下鬲矣。曰∶有病胃脘痈者，诊当何如？曰∶诊此者，当候胃脉，其脉当沉涩（《
素问》作细）。沉涩者气逆，气逆者则人迎甚盛，甚盛则热。人迎者，胃脉也，逆而盛则热
聚于胃口而不行，故胃脘为痈。肝满肾满肺满皆实，则为 。肺痈喘而两胫（《素问》作
）满；肝痈两胁（《素问》作 ）下满，卧则惊，不得小便；肾痈 （《素问》
作脚）下至少腹满，胫有大小，髀胫跛易偏枯。
黄帝问曰∶肠胃受谷，上焦出气，以温分肉，以养骨节，通腠理。中焦出气如雾，上注
溪谷而渗孙脉，津液和调，变化赤而为血，血和则孙络先满，乃注于络脉，络脉皆盈，乃注
于经脉。阴阳乃张，因息而行，行有经纪，周有道理，与天协议，不得休止。切而调之，从
虚去实，泻则不足，疾则气减，留则先后，从实去虚，补则有余，血气已调，神气乃持。余
已知血气之至与不至，未知痈疽之所从生，成败之时，死生之期，或有远近，何以度之？曰
∶经脉流行不止，与天同度，与地合纪，故天宿失度，日月薄蚀，地经失纪，水道流溢，草
萤不成，五谷不殖，经纪不通，民不往来，巷聚邑居，别离异处。血气犹然，请言其故。夫
血脉营卫，周流不休，上应天宿，下应经数。寒邪客经络之中则血泣，血泣则不通，不通则
卫气归之，不得复反，故痈肿也。寒气化为热，热胜则肉腐，肉腐则为脓，脓不泻则筋烂，
筋烂则骨伤，骨伤则髓消，不当骨空，不得泄泻，则筋骨枯空，枯空则筋骨肌肉不相亲，经络
败漏，熏于五脏，脏伤则死矣。
黄帝问道：气逆导致上膈（指胸膈以上部位，此处指食入即吐的病症）。所谓上膈，就是食物吃进去又吐出来，我已经知道了。至于虫积导致下膈（指幽门或肠道阻滞，此处指进食后很久才吐出），对于其机理我还不太明白，希望能听您详细讲讲？
岐伯回答说：如果喜怒情绪失调，饮食没有节制，寒暖不适时，那么寒冷的津液就会滞留于肠中。滞留久了，寄生虫受寒，寄生虫受寒则积聚不动，停留在下脘（胃的下口处）。停留在下脘，就会导致肠胃胀满充实，胃气无法正常运行，邪气便占据其中。人进食时，寄生虫向上觅食，寄生虫向上移动则下脘变得空虚。下脘空虚则邪气亢盛，邪气亢盛则积聚停留，停留久了就形成痈肿。痈肿形成后，下脘就会狭窄闭塞。如果痈肿在胃脘内部，脉象表现为沉而疼痛位置深；如果痈肿在胃脘外部，则体表可见红肿且疼痛位置浅，皮肤表面发热。按压痈肿部位，观察气血运行的情况，先在旁边浅刺，然后逐渐加深，反复针刺，不超过三次。观察痈肿的浮沉，以此决定针刺的深浅。针刺完毕后必须用熨法热敷，使热力进入体内，每天让热气内入，邪气就会日益衰减，大痈才能溃破。同时配合参禁（一种针灸禁忌或辅助疗法）来清除体内的病邪，保持心境恬淡无为，这样才能行气通畅，之后服用酸苦味的药物，谷物得以消化下行，下膈之症就好了。
岐伯说：诊断这种人，应当诊察胃脉，其脉象应当表现为沉涩（《素问》中作“细”）。脉象沉涩表示气机逆乱，气机逆乱则人迎脉（颈侧动脉，反映胃气盛衰）非常盛大，盛大则表示有热。人迎脉是胃脉的反映，气逆且盛大则热气聚集在胃口而不能运行，所以胃脘形成痈肿。肝脏、肾脏、肺部出现“满”（指邪气盛实）且脉象坚实，就会发生痈证。肺痈表现为气喘且双侧小腿（《素问》作“胫”）胀满；肝痈表现为双侧胁肋（《素问》作“胁”）下方胀满，睡眠时易惊悸，小便不通畅；肾痈表现为脚部（《素问》作“足”）至小腹部胀满，小腿粗细不一，大腿和小腿行动不便，容易偏瘫枯瘦。
黄帝问道：肠胃受纳水谷，上焦宣发卫气，用来温煦肌肉，滋养骨节，疏通腠理。中焦如雾露般蒸腾气化，向上注入溪谷（指肌肉间的空隙），渗入孙络（最细小的络脉），津液调和，变化为赤色的血液。血液调和则孙络先充盈，然后注入络脉，络脉都充盈后，再注入经脉。阴阳之气由此张布，随着呼吸而运行，运行有一定的规律，周流有一定的道理，与天地自然相协调，不停止休息。切按脉搏以调治疾病，从虚证去除实证，泻法则使不足者更虚（此处意指泻其实邪，若误用则致不足，原文语境为泻法操作要点：疾出针则气减，留针则先后有序，需结合上下文理解，通常解释为：泻法要快出针以减弱邪气，留针时间要恰当以调节先后天之气；或者指通过泻法去其实，补法补其虚。根据下文“血气已调”，此处主要讲调理原则），疾速出针则邪气减退，留针则调节先后天之气；从实证去除虚证，补法则使有余者更实（此处意指补其正气，若误用则致有余，通常解释为：补法要慢出针以保留正气，或指补法操作）。血气已经调和，神气就能维持稳定。我已经知道了血气到来的情况以及未到来的情况，但还不知道痈疽是从哪里产生的，成功与失败的时间，死亡与生存的期限，有的远有的近，如何判断呢？
岐伯说：经脉中的气血流行不止，与天体的度数相同，与大地的纪律相合。所以天体星宿失去常度，日月就会发生蚀亏；大地经线失去纪律，水道就会泛滥，草木萤火不能生长，五谷不能种植，交通经络不通，百姓不能往来，村落城邑分离，各自居住。气血的运行也是如此，请让我说明其中的缘故。血脉和营卫之气，周流不息，上应天体星宿，下应大地经数。寒邪客居于经络之中，则血液凝涩，血液凝涩则不通畅，不通畅则卫气归附于此，不能再返回原位，所以形成痈肿。寒气转化为热，热邪亢盛则肌肉腐烂，肌肉腐烂则化为脓液。脓液不排出则筋脉烂损，筋脉烂损则骨骼受伤，骨骼受伤则骨髓消减。如果不发生在骨空之处，不得排泄脓液，则筋骨枯空。筋骨枯空则筋骨肌肉不再相亲附，经络败坏漏泄，熏灼五脏，五脏受损则死亡。
Huangdi asked, "Qi rebellion causes obstruction in the Upper Jiao (Upper Diaphragm). The so-called Upper Jiao obstruction refers to the condition where food is ingested and immediately regurgitated; I am already aware of this. As for parasites causing Lower Jiao obstruction (Lower Diaphragm), where food is expelled only after a long time, I do not fully understand its mechanism and wish to hear it explained thoroughly."
Qibo replied, "If emotions such as joy and anger are not regulated, diet and drinking are not moderated, and exposure to cold and heat is not timely, then cold fluids will remain in the intestines. If they remain, the parasites become cold; if the parasites become cold, they accumulate and stay at the Xiaowan (lower opening of the stomach). Staying at the Xiaowan causes the stomach and intestines to become distended and full, preventing the Wei Qi (Stomach Qi) from circulating, allowing pathogenic factors to reside there. When a person eats, the parasites move upward to feed; when they move upward, the Xiaowan becomes empty. Emptiness of the Xiaowan allows pathogenic factors to prevail; when they prevail, accumulation remains, leading to the formation of an abscess. Once the abscess forms, the Xiaowan becomes constricted. If the abscess is inside the stomach wall, the pulse is deep and the pain is profound; if the abscess is outside the stomach wall, the swelling is external and the pain is superficial, with hot skin over the abscess. By pressing the abscess and observing the flow of Qi, one should first prick shallowly around it, then gradually deepen the insertion, repeating the pricking no more than three times. Observe whether the swelling is superficial or deep to determine the depth of needling. After needling, apply moxibustion or warming therapy to ensure heat penetrates inward. Daily application of internal heat will cause pathogenic factors to decline, allowing the large abscess to rupture. Simultaneously use Canjin (a specific acupuncture contraindication or auxiliary method) to remove internal pathogens. Maintain a state of tranquility and non-action to allow Qi to flow freely. Afterwards, administer sour and bitter herbs to facilitate digestion and downward movement of grain, resolving the Lower Jiao obstruction."
Huangdi asked, "What is the diagnostic approach for a patient suffering from a gastric abscess?"
Qibo said, "In diagnosing this condition, one must examine the Stomach pulse. The pulse should be Deep and Choppy (Xi), described as Fine (Xi) in the Suwen. A Deep and Choppy pulse indicates Qi rebellion. Qi rebellion causes the Renying point (carotid artery, reflecting Stomach Qi) to appear very full and rapid, indicating Heat. The Renying pulse reflects Stomach Qi; rebellion and fullness cause Heat to gather at the stomach opening without circulating, thus forming a gastric abscess. Fullness and excess in the Liver, Kidney, and Lung meridians lead to abscesses. Lung abscess presents with wheezing and fullness in both calves (legs); Liver abscess presents with fullness below both hypochondria, waking with fright during sleep, and inability to urinate; Kidney abscess presents with fullness from the feet to the lower abdomen, asymmetry in calf size, limping, and predisposition to hemiplegia or wasting."
Huangdi asked, "The intestines and stomach receive grain. The Upper Jiao releases Qi to warm the muscles, nourish the joints, and open the interstices. The Middle Jiao releases Qi like mist, pouring into the muscle valleys and penetrating the Sun collaterals (finest network vessels). Fluids are harmonized, transforming into red blood. Harmonized blood fills the Sun collaterals first, then enters the Luo collaterals. When Luo collaterals are full, it enters the Jing meridians. Yin and Yang expand and move with respiration, following regular pathways and principles, coordinating with Heaven, never ceasing. Palpating and regulating the pulse involves treating deficiency by removing excess: draining reduces excess, but improper technique may cause deficiency; retaining needle time regulates the sequence of Qi. Treating excess by tonifying deficiency: tonification adds to sufficiency. When Blood and Qi are regulated, Shen Spirit is maintained. I know the arrival and non-arrival of Blood and Qi, but I do not know the origin of carbuncles and ulcers, the timing of success and failure, the periods of life and death, which may be near or far. How can we estimate them?"
Qibo said, "The circulation of meridians does not cease, matching the degrees of Heaven and the records of Earth. Thus, if celestial bodies lose their order, eclipses occur; if earthly channels lose their discipline, waterways overflow, grass and fireflies fail to grow, and grains do not multiply. If communication lines are blocked, people cannot travel, and villages separate. Blood and Qi operate similarly. Let me explain the reason. Blood vessels, Ying (Nutrient) Qi, and Wei (Defensive) Qi circulate endlessly, corresponding above to celestial stars and below to earthly measures. When Cold Evil lodges in the meridians, Blood becomes viscous and stagnant. Stagnation prevents flow, causing Wei Qi to gather there and unable to return. Thus, swelling and abscesses form. Cold transforms into Heat; excessive Heat rots flesh, turning it into pus. If pus is not drained, tendons rot; if tendons rot, bones are injured; if bones are injured, marrow diminishes. If not located at bone openings for drainage, the tendons and bones become withered and empty. Withered tendons and bones lose their connection to muscles. Meridians decay and leak,薰 (smoking/burning) the Zang organs. Damage to the Zang organs leads to death."