人之骨强筋弱，肉缓皮肤浓者耐痛，其于针石之痛火 亦然。黑色而美骨者耐火 ，坚
肉薄皮者不耐针石之痛，于火 亦然。
帝曰∶余闻刺有五逆，曰病与脉相逆。热病脉静，汗已出脉盛躁，是一逆也。病泄脉洪
大，
二逆也。着脾不移， 肉破，身热脉偏绝，三逆也。淫而夺形，身热色夭然白，及后下血
，血 笃重，四逆也。寒热夺形，脉坚搏，五逆也。
一刺则阳邪出，再刺则阴邪出，三刺则谷气至。谷气至而止，所谓谷气至者，已补而实
，已泻而虚，故已知谷气至也。
肝热病者，小便先黄，腹痛多卧，身热，热争则狂言及惊，胁满痛，手足躁，不得安卧
，庚
辛甚，甲乙大汗，气逆则庚辛死，刺足厥阴少阳。其逆则头痛员员，脉引冲头也。心热病者
，先不乐数曰乃热，热争则卒心痛，烦闷善呕，头痛面赤无汗，壬癸甚，丙丁大汗，气逆则
壬癸死，刺手少阴太阳。脾热病者，先头重，颊痛烦心，颜青欲呕，身热，热争则腰疼不可
用俯仰，腹满泄，两颔痛，甲乙甚，戊己大汗，气逆则甲乙死，刺足太阴阳明。肺热病者，
先淅然厥气毫毛，恶风寒。舌上黄，身热，热争则喘咳，痛走胸膺背，不得大息，头痛不堪
，汗出而寒，丙丁甚，戊己大汗，气逆则甲丁死，刺手太阴阳明出血，如大豆立已。肾热病
者，先腰痛 酸，苦渴数饮身热，热争则项痛而强， 寒且酸，足下热，不欲言，其逆则项
痛员员澹澹然，戊己甚，壬癸大汗，气逆则戊己死，刺足少阴太阳，诸汗者，至其所胜日汗
出也。肝热病者，左颊先赤；心热病者，颜先赤；脾热病，鼻先赤；肺热病者，右颊先赤；
肾热病者，颐先赤，病虽未发，见赤色者刺之，名曰治未病。热病从部所起者，至期而已，
其刺之反者，三周而已，重逆则死。诸当汗者，至其所胜日，汗大出也。诸治热病，以饮之
寒水，乃刺之，必寒衣之，居止寒处，身寒而止也。热病先胸胁痛，手足躁，刺足少阳，补
足太阴，病甚者为五十九刺。热病始手臂痛者，刺手阳明太阴，而汗出止。热病始于头首者
，刺项太阳而汗出止。热病始于足胫者，刺足阳明而汗出止。热病先身重骨痛，耳聋好冥，
刺足少阴，病甚为五十九刺。热病先眩冒而热，胸胁满，刺足少阴少阳。太阳之脉色荥颧骨
，热病也。荣未交，曰今且得汗，待时而已，与厥阴脉争见者，死期不过三日。其热病内连
肾，少阳之脉色也，少阳之脉色荣颊前，热病也，荣未交，曰今且得汗，待时而已，与少阴
脉争见者，死期不过三日。热病气穴三椎下间，主胸中热；四椎下间，主鬲中热；五椎下间
，主肝热；六椎下间，主脾热；七椎下间，主肾热。荣在 也，项上三椎陷者中也，颊下逆
颧为大瘕，下牙车为腹满，颧后为胁痛，颊上鬲上也。头上五行，行五者以泄诸阳之热逆也
。大杼、膺、俞、缺盆、背俞，此八者，以泻胸中之热也。气冲、三里、巨虚、上下廉，此
八者以泻胃中之热也。云门、髁骨、委中、髓空，此八者，以泻四肢之热也。五脏俞傍五者
，此十者，以泻五脏六热也。热病不可刺者
九，一日汗不出，大颧发赤，哕者死。二曰泄而腹满，甚者死。三曰目不明，热不已者死。
四曰婴儿热而腹满死。五曰汗不出，呕下血者死。六曰舌本烂，热不已者死。七曰咳而衄，
汗不出，出不至足者死。八曰髓热者死。九曰热而痉者死。腰折螈 ，齿噤龈也。凡此九者
，不可刺也。
人的骨骼强健、筋脉柔弱、肌肉松弛且皮肤厚密的人，能够耐受疼痛；对于针刺和艾灸的疼痛也是如此。面色黑而骨骼健美的人，能够耐受火灸；肌肉坚实而皮肤薄的人，不能耐受针刺和艾灸的疼痛，对火灸也是如此。
黄帝说：我听说针刺有五种逆证，是指病情与脉象相违背。患热病而脉象沉静，这是第一种逆证；出汗后脉象盛大躁动，这是第二种逆证；患泄泻病而脉象洪大，这是第三种逆证；脾脏受邪导致身体消瘦、肌肉溃破、身体发热而一侧脉搏断绝，这是第四种逆证；因房事过度导致形体衰败、身体发热、面色枯白无华，以及随后便血、血液凝滞沉重，这是第五种逆证；寒热交作导致形体衰败、脉象坚硬搏指，这也是逆证。
第一次针刺，阳分之邪气排出；第二次针刺，阴分之邪气排出；第三次针刺，谷气（正气）到来。谷气到来就停止针刺。所谓谷气到来，是指补法之后正气充实，泻法之后邪气虚弱，因此可以知道谷气已至。
肝发生热病时，小便先变黄，腹痛、嗜睡、身体发热；热邪与正气相争，则出现胡言乱语和惊悸，胁肋胀满疼痛，手足躁扰，不能安卧；在庚辛日病情加重，在甲乙日大汗出后可愈，若气机逆乱则在庚辛日死亡，治疗应刺足厥阴肝经和足少阳胆经。若热邪上逆，则头痛晕眩，脉气上冲头部。心发生热病时，先心情不悦，数日后才发热；热邪与正气相争，则突然心痛，烦闷、容易呕吐、头痛、面红、无汗；在壬癸日病情加重，在丙丁日大汗出后可愈，若气机逆乱则在壬癸日死亡，治疗应刺手少阴心经和手太阳小肠经。脾发生热病时，先头重、脸颊痛、心烦、面色发青、想呕吐、身体发热；热邪与正气相争，则腰痛不能俯仰，腹部胀满、泄泻、两侧下颌疼痛；在甲乙日病情加重，在戊己日大汗出后可愈，若气机逆乱则在甲乙日死亡，治疗应刺足太阴脾经和足阳明胃经。肺发生热病时，先感到淅淅恶风、毫毛竖起、怕冷怕风，舌苔发黄，身体发热；热邪与正气相争，则气喘咳嗽，疼痛游走于胸膺背部，不能深呼吸，头痛难忍，出汗后怕冷；在丙丁日病情加重，在戊己日大汗出后可愈，若气机逆乱则在甲丁日死亡，治疗应刺手太阴肺经和手阳明大肠经并放出少量血液，像大豆大小，立即见效。肾发生热病时，先腰痛且酸软，口渴想多喝水，身体发热；热邪与正气相争，则项部疼痛且僵硬，怕冷且酸痛，足心发热，不想说话；若热邪上逆，则项部疼痛晕眩、心神不安；在戊己日病情加重，在壬癸日大汗出后可愈，若气机逆乱则在戊己日死亡，治疗应刺足少阴肾经和足太阳膀胱经。凡是应当出汗的热病，到了其所胜之日就会大汗出。肝热病患者，左颊先发赤；心热病患者，颜面先发赤；脾热病患者，鼻头先发赤；肺热病患者，右颊先发赤；肾热病患者，下巴颏先发赤。病虽未发作，但见到这些部位发红，就进行针刺，这叫做“治未病”。热病从特定部位起始的，到相应的日期就会痊愈；如果针刺方法相反，则需要三个周期才能痊愈，若再次逆治则会死亡。凡是应当出汗的，到了其所胜之日，会大汗出。所有治疗热病的方法，是让患者喝冷水，然后进行针刺，必须让患者穿凉快的衣服，居住在凉爽的地方，直到身体冷却为止。热病首先表现为胸胁疼痛、手足躁扰的，刺足少阳胆经，补足太阴脾经，病情严重的采用五十九刺法。热病始于手臂疼痛的，刺手阳明大肠经和手太阴肺经，出汗即止。热病始于头部的，刺项部太阳经，出汗即止。热病始于小腿足的，刺足阳明胃经，出汗即止。热病首先身体沉重、骨痛、耳聋、喜静默的，刺足少阴肾经，病情严重的采用五十九刺法。热病首先眩晕昏冒且发热、胸胁胀满的，刺足少阴肾经和足少阳胆经。太阳经脉的气色反映在颧骨部位，是热病的表现。如果营气尚未交合，说明今天将会出汗，等待时机即可痊愈；如果与厥阴脉的气色同时出现，死亡期限不超过三天。热病内连肾脏，脉色反映在少阳经脉，少阳经脉的气色反映在脸颊前方，是热病的表现。如果营气尚未交合，说明今天将会出汗，等待时机即可痊愈；如果与少阴脉的气色同时出现，死亡期限不超过三天。治疗热病的穴位：第三椎下间隙，主治胸中热；第四椎下间隙，主治膈中热；第五椎下间隙，主治肝热；第六椎下间隙，主治脾热；第七椎下间隙，主治肾热。荣气运行于此处，项上第三椎陷窝处是重要穴位。下巴下方逆着颧骨方向是大瘕（积聚病），向下到牙车穴是腹满，颧骨后方是胁痛，脸颊上方对应膈肌以上部位。头上有五行，每行五个穴位，用以宣泄诸阳经的热逆之气。大杼、膺窗、俞府、缺盆、背俞，这八个穴位，用来泻除胸中的热邪。气冲、三里、巨虚上下廉，这八个穴位，用来泻除胃中的热邪。云门、髁骨、委中、髓空，这八个穴位，用来泻除四肢的热邪。五脏俞穴旁边各五穴，共十个穴位，用来泻除五脏六腑的热邪。热病有九种不可针刺的情况：一是汗不出，大颧发赤，呃逆的，死；二是泄泻且腹部胀满，严重的，死；三是眼睛不明亮，热势不退的，死；四是婴儿发热且腹部胀满的，死；五是汗不出，呕血或便血的，死；六是舌根腐烂，热势不退的，死；七是咳嗽且流鼻血，汗不出，或者汗出不到足部的，死；八是髓热的，死；九是发热且痉挛的，死。症状表现为腰身反折、抽搐、牙齿紧闭、牙龈收缩。凡此九种情况，都不可针刺。
Individuals with strong bones, weak sinews, loose muscles, and thick skin can tolerate pain; the same applies to the pain from acupuncture and moxibustion. Those with a dark complexion and well-formed bones can tolerate fire therapy (moxibustion). Those with firm muscles and thin skin cannot tolerate the pain of needles and stones (acupuncture), nor can they tolerate fire therapy.
The Yellow Emperor said: I have heard that there are five adverse conditions in acupuncture, where the disease contradicts the pulse. In heat diseases, if the pulse is quiet, this is the first adverse condition. If the pulse becomes rapid and restless after sweating, this is the second adverse condition. In diarrhea, if the pulse is surging and large, this is the third adverse condition. If spleen pathology causes immobility, muscle wasting, body heat, and an absent pulse on one side, this is the fourth adverse condition. If excessive sexual activity leads to emaciation, body heat, pale and lifeless complexion, followed by bloody stool that is heavy and difficult to pass, this is the fifth adverse condition. If alternating chills and fever lead to emaciation and a firm, bounding pulse, this is also an adverse condition.
The first puncture expels pathogenic factors from the Yang aspect; the second puncture expels pathogenic factors from the Yin aspect; the third puncture brings about the arrival of Gu Qi (Grain Qi/Healthy Qi). Stop needling when Gu Qi arrives. The arrival of Gu Qi means that after tonification, the healthy Qi is solidified, and after sedation, the pathogenic factor is depleted; thus, it is known that Gu Qi has arrived.
In Liver Heat Disease, urination turns yellow first, accompanied by abdominal pain, lethargy, and body heat. When heat struggles with healthy Qi, there may be delirium and fright, distension and pain in the hypochondrium, restlessness of the hands and feet, and inability to lie down peacefully. Symptoms worsen on Geng-Xin days, and profuse sweating on Jia-Yi days indicates recovery. If Qi rebels, death occurs on Geng-Xin days. Treatment involves puncturing the Foot-Jueyin (Liver) and Foot-Shaoyang (Gallbladder) meridians. If the rebellion ascends, it causes dizzy headaches due to pulse qi rushing to the head.
In Heart Heat Disease, there is initial dissatisfaction, followed by fever after several days. When heat struggles with healthy Qi, sudden heart pain, irritability, frequent vomiting, headache, red face, and absence of sweat occur. Symptoms worsen on Ren-Gui days, and profuse sweating on Bing-Ding days indicates recovery. If Qi rebels, death occurs on Ren-Gui days. Treatment involves puncturing the Hand-Shaoyin (Heart) and Hand-Taiyang (Small Intestine) meridians.
In Spleen Heat Disease, there is initial heaviness of the head, cheek pain, mental distress, bluish complexion, desire to vomit, and body heat. When heat struggles with healthy Qi, severe lower back pain preventing flexion and extension, abdominal fullness, diarrhea, and pain in both mandibles occur. Symptoms worsen on Jia-Yi days, and profuse sweating on Wu-Ji days indicates recovery. If Qi rebels, death occurs on Jia-Yi days. Treatment involves puncturing the Foot-Taiyin (Spleen) and Foot-Yangming (Stomach) meridians.
In Lung Heat Disease, there is initial aversion to wind, bristling of hair, fear of cold and wind, yellow tongue coating, and body heat. When heat struggles with healthy Qi, wheezing and coughing, pain radiating to the chest, epigastrium, and back, difficulty taking deep breaths, unbearable headache, and sweating followed by chills occur. Symptoms worsen on Bing-Ding days, and profuse sweating on Wu-Ji days indicates recovery. If Qi rebels, death occurs on Jia-Ding days. Treatment involves puncturing the Hand-Taiyin (Lung) and Hand-Yangming (Large Intestine) meridians and releasing blood (like the size of a soybean) for immediate relief.
In Kidney Heat Disease, there is initial lower back pain and soreness, bitter thirst with frequent drinking, and body heat. When heat struggles with healthy Qi, stiff and painful neck, chills with soreness, heat in the soles of the feet, and reluctance to speak occur. If the rebellion ascends, it causes dizzy neck pain and palpitations. Symptoms worsen on Wu-Ji days, and profuse sweating on Ren-Gui days indicates recovery. If Qi rebels, death occurs on Wu-Ji days. Treatment involves puncturing the Foot-Shaoyin (Kidney) and Foot-Taiyang (Bladder) meridians. For all cases requiring sweating, sweating will occur profusely on the day corresponding to the element that overcomes the diseased organ.
In Liver Heat Disease, redness appears first on the left cheek; in Heart Heat Disease, on the forehead; in Spleen Heat Disease, on the nose tip; in Lung Heat Disease, on the right cheek; in Kidney Heat Disease, on the chin. Even if the disease has not fully manifested, puncturing these areas upon seeing redness is called "treating the disease before it arises." Heat diseases originating from specific regions resolve by their designated time. If treated incorrectly, resolution takes three cycles; repeated mismanagement leads to death. All cases requiring sweating will exhibit profuse sweating on the overcoming day.
All treatments for heat diseases involve giving the patient cold water to drink, followed by needling. The patient must wear cool clothing and reside in a cool place until the body temperature cools.
For heat diseases starting with chest/hypochondriac pain and hand/foot restlessness, puncture the Foot-Shaoyang (Gallbladder) meridian and tonify the Foot-Taiyin (Spleen) meridian. Severe cases require the 59-point method. For heat diseases starting with arm pain, puncture the Hand-Yangming (Large Intestine) and Hand-Taiyin (Lung) meridians until sweat appears. For heat diseases starting with head symptoms, puncture the Neck Taiyang (Bladder) meridian until sweat appears. For heat diseases starting with leg/calf symptoms, puncture the Foot-Yangming (Stomach) meridian until sweat appears. For heat diseases starting with body heaviness, bone pain, deafness, and preference for silence, puncture the Foot-Shaoyin (Kidney) meridian; severe cases require the 59-point method. For heat diseases starting with dizziness, vertigo, and fever with chest/hypochondriac fullness, puncture the Foot-Shaoyin (Kidney) and Foot-Shaoyang (Gallbladder) meridians.
If the Taiyang pulse color manifests on the zygomatic bone, it indicates heat disease. If Ying Qi (Nutritive Qi) has not yet intersected, sweating will occur today, and waiting for the appropriate time leads to recovery. If it competes with the Jueyin pulse signs, death will occur within three days. If heat disease internally connects to the Kidney and shows Shaoyang pulse colors, or if Shaoyang pulse colors appear on the front of the cheeks indicating heat disease, and Ying Qi has not yet intersected, sweating will occur today, and waiting leads to recovery. If it competes with the Shaoyin pulse signs, death will occur within three days.
Acupoints for treating heat diseases: The space below the 3rd thoracic vertebra governs chest heat; below the 4th, diaphragmatic heat; below the 5th, liver heat; below the 6th, spleen heat; below the 7th, kidney heat. Ying Qi flows here. The depression at the 3rd cervical vertebra in the neck is a key point. Below the chin against the zygoma indicates Da Jia (large accumulation); down to the jaw indicates abdominal fullness; behind the zygoma indicates hypochondriac pain; above the cheek corresponds to the area above the diaphragm. Five rows of five points on the head are used to vent rebellious heat from all Yang meridians. Dazhu, Yingchu, Shufu, Quepen, and Back-Shu points (eight points) vent chest heat. Qichong, Zusanli, Shangjuxu, and Xiajuxu (eight points) vent stomach heat. Yunmen, Kugu, Weizhong, and Suikong (eight points) vent limb heat. The five points beside each of the Five Zang Back-Shu points (ten points total) vent heat from the Five Zang and Six Fu organs.
There are nine types of heat disease that should not be needled:
1. No sweat, red zygomatic bones, and hiccups indicate death.
2. Diarrhea with abdominal fullness, especially if severe, indicates death.
3. Clouded vision with persistent heat indicates death.
4. Infantile heat with abdominal fullness indicates death.
5. No sweat with vomiting or bleeding indicates death.
6. Ulcerated tongue base with persistent heat indicates death.
7. Coughing with epistaxis, no sweat, or sweat failing to reach the feet indicates death.
8. Marrow heat indicates death.
9. Heat with spasms indicates death. Symptoms include opisthotonos, convulsions, clenched teeth, and retracted gums. None of these nine conditions should be needled.