素问注云。按经云。皆先补真气。乃泻其邪也。何以言之。补法呼尽内针。静以久留。
此段
一。则先补之义。昭然可知。拔萃云。呼不过三。吸不过五。明堂云。当补之时。候气至病
。更用生成之息数。令病患鼻中吸气出。自觉热矣。当泻之时。候气至病。更用生成之息数
。令病患鼻中出气。口中吸气。按所病脏腑之数。自觉清凉矣。
素问遗篇补肾俞注曰。用圆利针。临刺时咒曰。五帝上真。六甲玄灵。气符至阴。百邪
闭理
气三次。又可定神魂者也。泻脾俞注曰。欲下针时咒曰。帝扶天形。护命成灵。诵之三遍。
乃刺三分。留七呼。动气至。而急出其针。
按咒法非素问意。补注又王氏辈为之。未足信。但针工念咒。则一心在针。故曰。如待
所贵。不知日暮也。
济生拔萃云。泻法先以左手揣按得穴。以右手置针于穴上。令病患咳嗽一声。捻针入腠
理得
手转针头向病所。以手循经络扪循至病所。以合手以回针。引气过针三寸。随呼徐徐出针。
勿闭其穴。命之曰泻。补法先以左手揣按得穴。以右手置针于穴上。令病患咳嗽一声。捻针
入腠理得穴。令病患呼气一口。将尽纳针至八分。觉针沉紧。复退一分许。如更觉沉紧。仰
手转针头向病所。根据前循扪其病所。气至病已。随吸而走出针。速按其穴。命之曰补。又曰
。夫行针者。当刺之时。口温针暖。先以左手揣按所针荥俞之处。弹而怒之。爪而下之。扪
而循之。通而取之。随病患咳嗽一声。右手持针而刺之。春夏二十四息。秋冬三十六息。徐
出徐入。气来如动脉之状。补者随经脉推而内之。左手闭针孔。徐出针而疾按之。泻者。迎
经脉动而伸之。左手开针孔。疾出针而徐按之。虚羸气弱痒麻者补之。丰肥坚硬疼痛者泻之
按素问云。候呼内针。又曰。候呼引针。候。伺候也。言医工持针。等候病患之呼吸而
用针
矣。谬之甚也。此补泻尚得素难意。
明堂注云。寒热补泻。假令补冷。先令病患咳嗽一声得入腠理。复令吹气一口。随吹下
针至
四分及心肺之部。又令病患吸气内针。捻针使气下行至病所。却外捻针使气上行。直过所针
穴一二寸。乃吸而外捻。针出以手速按其穴。此为补。夫病热者。治之以寒何如。须其寒者
。先刺入阳之分。候得气。推内至阴之分。后令病患地气入而天气出。谨按生成之息数足。
其病患自觉清凉矣。夫病恶寒者。治之以热也何如。须其热者。先刺入阴之分。候得气。徐
引针至阳之分。后令病患天气入而地气出。亦谨按生成之息数足。其病自觉和暖矣。
《素问》注解说：“按照经文所说，都要先补益真气，然后才泻除邪气。”为什么这样说呢？补法是在呼气结束时进针，安静地长时间留针。这一段的意思，先补益的义理就显而易见了。
《拔萃》说：“呼气不超过三次，吸气不超过五次。”《明堂》说：“在应当补的时候，等待气到达病所，再使用‘生成之息’（即一呼一吸为一息，天地之数）的次数，让病人用鼻子吸气、嘴巴呼气，自觉有热感即可。在应当泻的时候，等待气到达病所，再使用‘生成之息’的次数，让病人用鼻子呼气、嘴巴吸气，根据所患病脏腑的数量，自觉有清凉感即可。”
《素问遗篇》关于补肾俞的注解说：“使用圆利针，临刺时念咒语：‘五帝上真，六甲玄灵，气符至阴。’这样操作三次，可以安定神魂。”关于泻脾俞的注解说：“下针时要念咒语：‘帝扶天形，护命成灵。’诵读三遍，然后针刺三分，留针七次呼吸的时间，待气至后迅速出针。”
我认为念咒的方法不符合《素问》的本意，这些补注又是王冰等人所作，不足以采信。但是针灸工匠念咒，能使一心专注于针，所以古人说：“像对待尊贵的客人一样等待气至，忘记了时间的流逝。”
《济生拔萃》说：“泻法先用左手揣按找到穴位，右手将针置于穴上，让病人咳嗽一声，捻针进入腠理，转动针头指向病所，用手循经络扪按至病所，合手回旋针柄，引导气过针身三寸，随着呼气徐徐出针，不要闭合针孔，这叫做泻。补法先用左手揣按找到穴位，右手将针置于穴上，让病人咳嗽一声，捻针进入腠理找到穴位，让病人呼出一口气，将尽时纳针至八分深，感觉针下沉紧，再退出一分左右，如果再次感觉沉紧，仰手转动针头指向病所，依照前面所述循经扪按病所，气至病愈，随着吸气走出针，迅速按压针孔，这叫做补。”又说：“施针的人，在针刺时应用口温针使其温暖，先用左手揣按所针荥穴、俞穴之处，弹击使经脉充盈，指甲切下定位，扪按循经，通达而取气，随着病人咳嗽一声，右手持针刺入。春夏季节二十四息，秋冬季节三十六息，徐进徐出，气来如动脉跳动之状。补法顺着经脉推而内之，左手关闭针孔，慢出针而快按之；泻法迎着经脉动势而伸之，左手打开针孔，快出针而慢按之。身体虚弱消瘦、气弱、发痒麻木的用补法；身体丰肥、坚硬、疼痛的用泻法。”
按《素问》说：“候呼内针”，又说“候呼引针”。“候”是伺候、等待的意思，说的是医工持针，等候病人的呼吸而用针。这种说法谬误得很。这里的补泻方法尚且符合《素问》和《难经》的本意。
《明堂》注解说：“寒热补泻，假如治疗虚冷证用补法，先让病人咳嗽一声，针入腠理，再让病人吹气一口，随吹气将针下至四分及心肺部位。又让病人吸气时进针，捻针使气下行至病所，然后向外捻针使气上行，直过所针穴一二寸，于是吸气时向外捻，出针后用迅速按压针孔，这叫补。如果是热病，用寒凉法治如何？需要产生寒凉感时，先刺入阳分，等到得气，推进深入至阴分，然后让病人地气入而天气出，谨慎按照生成之息的次数足数，病人自觉清凉了。如果是恶寒的病，用温热法治如何？需要产生热感时，先刺入阴分，等到得气，慢慢引针至阳分，然后让病人天气入而地气出，也谨慎按照生成之息的次数足数，病人自觉和暖了。”
The commentary on the *Suwen* states: "According to the classic, one must first tonify the Zhenqi (True Qi) before draining the pathogenic factors." Why is this so? The tonification method involves inserting the needle at the end of exhalation and retaining it quietly for a long time. The meaning of "tonifying first" in this passage is thus clearly evident.
The *Bacui* states: "Exhalation should not exceed three times, inhalation should not exceed five times." The *Mingtang* states: "When tonification is indicated, wait for the Deqi (arrival of Qi) at the disease site, then use the number of 'Shengxi' (breaths corresponding to the generative numbers of heaven and earth). Instruct the patient to inhale through the nose and exhale through the mouth until they feel warmth. When drainage is indicated, wait for Deqi at the disease site, then use the number of 'Shengxi'. Instruct the patient to exhale through the nose and inhale through the mouth according to the number corresponding to the affected Zang-Fu organs until they feel coolness."
The commentary on the *Suwen Yipian* regarding Kidney Shu (BL23) states: "Use a Yuanli needle. At the time of needling, recite the incantation: 'Wudi Shangzhen, Liujia Xuanling, Qifu Zhiyin.' Doing this three times can stabilize the Hun and Shen (Spirit)." The commentary regarding Spleen Shu (BL20) states: "Before inserting the needle, recite the incantation: 'Di Fu Tianxing, Huming Chengling.' Recite it three times, then insert the needle to a depth of 0.3 cun, retain it for seven breaths, and rapidly withdraw the needle once Qi arrives."
I consider that the method of reciting incantations does not align with the intent of the *Suwen*. These tonification commentaries were written by Wang Bing and others, and are not entirely trustworthy. However, when acupuncturists recite incantations, their mind focuses solely on the needle. Hence, it is said: "Wait as if awaiting a noble guest, forgetting the passing of the day."
The *Jisheng Bacui* states: "For the drainage method, first use the left hand to palpate and locate the acupoint. Place the needle on the point with the right hand. Ask the patient to cough once, twirl the needle into the Couli (interstitial spaces), turn the needle head towards the disease site, and use the hand to follow and press along the meridians to the disease site. Rotate the handle back and forth to guide Qi beyond the needle by three Cun. Withdraw the needle slowly during exhalation without closing the hole; this is called drainage. For the tonification method, first use the left hand to palpate and locate the acupoint. Place the needle on the point with the right hand. Ask the patient to cough once, twirl the needle into the Couli to locate the point. Ask the patient to exhale fully, then insert the needle to a depth of 0.8 cun. When heaviness and tightness are felt, retreat the needle by about 0.1 cun. If heaviness and tightness are felt again, rotate the needle head upwards towards the disease site. Follow the previous method of following and pressing the disease site. Once Qi arrives, the disease resolves. Withdraw the needle during inhalation and quickly press the hole; this is called tonification." It further states: "The practitioner should warm the needle with their mouth before insertion. First, use the left hand to palpate the Ying and Shu points, flick them to make the vessels full, mark with nails, press and follow along the meridians to access Qi. Upon the patient's cough, insert the needle with the right hand. In spring and summer, use twenty-four breaths; in autumn and winter, use thirty-six breaths. Insert and withdraw slowly. The arrival of Qi feels like a pulsating artery. For tonification, push the needle inward following the direction of the meridian flow; close the needle hole with the left hand, withdraw slowly, and press quickly. For drainage, pull the needle outward against the direction of the meridian flow; open the needle hole with the left hand, withdraw quickly, and press slowly. Tonify cases of emaciation, weak Qi, itching, and numbness. Drain cases of obesity, hardness, and pain."
Regarding the *Suwen* saying "insert the needle upon exhalation" and "withdraw the needle upon exhalation," "hou" means to wait or attend to. This implies the practitioner waits for the patient's respiration to manipulate the needle. This interpretation is highly erroneous. Nevertheless, these tonification and drainage methods still conform to the intent of the *Suwen* and *Nanjing*.
The commentary on the *Mingtang* states: "For cold-heat tonification and drainage: Suppose treating deficiency-cold with tonification. First, ask the patient to cough once to enter the Couli. Then ask the patient to blow air out once, and while doing so, insert the needle to a depth of 0.4 cun in the regions of the Heart and Lungs. Then ask the patient to inhale to insert the needle, twirl to guide Qi downward to the disease site, then externally twirl to guide Qi upward, passing one or two Cun beyond the needled point. Finally, upon inhalation, externally twirl, withdraw the needle, and quickly press the hole with the hand; this is tonification. If treating heat diseases with cold methods, how should one proceed? To induce a sensation of cold, first insert into the Yang layer. Wait for Deqi, then push deeper into the Yin layer. Then instruct the patient to let Earth Qi enter and Heaven Qi exit. Carefully count the 'Shengxi' (generative breaths) until the patient feels cool. If treating aversion-to-cold with heat methods, how should one proceed? To induce a sensation of heat, first insert into the Yin layer. Wait for Deqi, then slowly draw the needle up to the Yang layer. Then instruct the patient to let Heaven Qi enter and Earth Qi exit. Also carefully count the 'Shengxi' until the patient feels warm."