偏枯身偏不用而痛。言不变。志不乱。病在分腠之间。巨针取之。益其不足。损其有余
。乃可复也。痱之为病也。身无痛者。四肢不收。(痱亦风属犹言废也。上节言身偏不用而痛。
此言身不知痛而四肢不收。此偏枯。痱病之辨也。○痱。肥沸二音。)智乱不甚。其言微知
可治。(其言微有知者。神气未为全去。)甚则不能言。不可治也。(神失则无能为矣。)病先
起于阳。后入于阴者先取其阳。后取其阴。浮而取之。(当刺其表也。若病始于阴直中脏也
。多不可治。故不复言之。)
风痉。(强直也。)身反折。(反张向后此风症在膀胱经也。)先取足太阳及 中。(京骨
。及委中。)及血络出血。(又刺浮浅之络。皆出其血。)中有寒。取三里(若中气有寒。当取
足阳明之三里温补胃气而风寒可除也。○此节本在后。)
热病三日而气口静。人迎躁者。(病在三阳。)取之诸阳五十九刺。以泻其热而出其汗。
实其
阴以补其不足者。(泻阳邪之实。仍补三阴之不足也。五十九刺法如下文。)身热甚。阴阳皆
静者。勿刺也。其可刺者急取之。不汗出则泄。所谓勿刺者。有死征也。(阳症得阴脉故不
宜刺若察其可刺者。当急取之。虽不汗出。则邪亦从而泄矣。此言勿刺者。以其脉症相反有
死征也。下文皆然)热病七日八日。脉口动喘。而弦者。急刺之。汗且自出。浅刺手大指间(
少商穴○弦一本作短。)热病七日八日。脉微小。(正气虚也。)病者溲血。口中干。(伤其阴
也。)一日半而死。脉代者。一日死。(脉要精微论吴氏注。五来一止。七来一止。曰代脉)
热病已得汗出。而脉尚躁。(气)喘。且复热。勿刺其肤。(刺则重伤其气)喘甚者死。热病七
日八日。脉不躁。躁不散数。后三日中有汗。三日不汗。四日死。未曾汗者。勿腠刺之。(
脉躁盛。为将汗之兆。入热病七日八日而脉犹不躁即有躁意。而力不散大。至不数疾皆正气
衰微。不能鼓动。故当再俟三日。庶得有汗若三日不汗。又逾四日。阴阳不应期当死也。凡
若此者。既不得汗。其气必虚故勿为肤腠之刺。)热病先肤痛。窒鼻。充面。取之皮。以第
一针五十九。(邪在肤腠。肺经病也。当用 针以刺五十九穴之皮部。)苛疹鼻。索皮于肺。
不得索之火。火者心也。(苛疥也轸当作疹鼻上生疹。皆属于肺。求之于皮。即所以求于肺
也
属邪火烁金。治肺不应故泻心火以泄热。)热病先身涩倚而热。烦 。干唇口嗌。取之脉。以
第一针五十九。肤胀口干。寒汗出。索脉于心。不得。索之水。水者肾也。(涩燥涩也。倚
身无力也。兼之热而烦闷唇口与嗌俱干者。邪在血脉。心经病也。故当用 针以刺五十九穴
之脉分。肤胀口干令汗出。亦皆脉病。求之于脉即所以求于心也。如刺此而不得效则当求之
于水。水旺足以制火。而心热自退矣。)热病嗌干多饮善惊。卧不能起。取之肤肉。以第六
针五十九。目 青。索肉于脾。不得。索之木。木者肝也。(邪在肤肉脾经病也。当用员利
针以刺五十九穴之肉。分也，若目 青者。木气乘土。亦为脾病。求之于肉即所以求于脾也
。
如刺此而不得。效则当补。其肝木。木能胜土而脾热当自平矣。)热病面青。(肝色。)脑痛
。(厥阴肝经与督脉会于巅。)手足躁。(木病在四未。)取之筋间。(筋结之间。)以第四针于
四逆。(用锋针泻其四逆等症。)筋 。(足不能行。)目浸。(泪出不收。)索筋于肝不得。索
之金金者肺也。(此皆肝病。其合在筋。故但求之于筋。即所以求于肝也。如刺此而不得效
则当补其肺金。金能胜木。而肝热可平矣。)热病数惊。螈 而狂取之脉以第四针。(锋针)
急泻有余者癫疾毛发去索血于心不得索之水水者肾也。(此皆心经病也。若阳极阴虚而病癫
疾发为血余。故毛发亦去。心主血脉。求之于血即所以求于心也。如刺此而不得效。当补肾
水以制火。真阴自复矣。)热病身重骨痛耳聋而好瞑取之骨以第四针五十九刺骨病不食啮齿
耳青索骨于肾不得索之土土者脾也。(肾经之病。故当用锋针以刺五十九穴之骨分。其不食
者。阴邪盛也。啮齿。耳青皆为肾病肾属水。其合在骨。故但求之于骨。即所以求于肾也。
如刺此而不得效当补。脾气之肉分。则土能胜水。而肾邪可平矣。)热病不知所痛。耳聋不
能自收口干阳热甚阴颇寒者。(阴胜之时)热在髓死不可治 热病头痛颞 目螈脉痛。(足少
阳脉连目脉抽掣而痛。)善衄。(鼻血)厥热病也。(热逆于上。)取之以第三针。( 针也)视
有余不足。热病体重肠中热取之以第四针于其 。(脾胃二经之俞太白陷谷)及下诸指间。(
又如膀胱束骨。胆临泣。详在后。)索气于胃胳得气也。(胳当作络。阳明之络曰丰隆，别走
太阴故取此可以得气。)热病挟脐急痛。(肾经所行)胸胁满。(脾经所行。)取之涌泉与阴陵
泉取以第四针。针嗌里。(少阴太阴之脉俱上络咽嗌。即下支所谓廉泉也。)热病而汗且出。
及脉顺。可汗者取之鱼际太渊大都太白。泻之则热去。补之则汗出。汗出太甚取内踝上横脉
。(三阴交。)以止之。(寒热病篇。臂太阴可汗出一节当参看。)热病已得汗。而脉尚躁盛。
此阴脉之极也。死其得汗而脉静者生。热病者。脉尚盛躁而不得汗者。此阳脉之极也。死脉
盛躁。得汗。静者生。热病不可刺者有九。一曰汗不出。大颧发赤。哕者。死。(汗不得出
。面戴阳者。皆阴不足也。岁属邪犯阳明胃虚甚也)二曰泄而腹满甚者。死。(脾衰)三曰目
不明。热不已者。死。(目不明。脏腑之精气竭也。热不已。表里之阴气竭也。)四曰老人婴
热而腹满者。死。(邪伤脾藏也。)五曰汗不出。呕下血者。死(邪盛阴伤也。)六曰舌本烂
热不已者。死。(心肝脾肾之脉皆系于舌本。舌本烂。加之热不已。三阴俱损也)七曰咳而衄
。(邪在肺。)汗不出。(或)出不至足者死。(真阴溃竭也。)八曰髓热者。死。(邪入最深。
乃为髓热肾气败竭也。)九曰热而痉者死。(热极生风)腰折螈 。(抽掣)齿噤 也。(牙关不
开曰噤。切齿。曰 。皆痉之谓也。○ 音解。)所谓五十九刺者。两手外内侧各三。凡
十二 。(六经井穴。)五指间各一。凡八 。足亦如是。(此言。本节之后各一穴也。如手
经则太阳之后 。少阳之中渚。阳明之三间。少阴之少府。左右共八 也。足亦如是者。太
阳之束骨。少阳之临泣。阳明之陷谷。太阴之太白。左右又共八穴也)头入发一寸旁三分各
三。凡六 。(五处承光通天。)更入发三寸边五。凡十 。(自上星之次向后。去中三寸两
边各五。即足少阳之临泣目窗正营。承灵脑空。左右共十穴也)耳前后。口下者各一。(听会
完骨承浆。共五穴)项中一。(哑门)凡六 巅上一。(百会)囟会一。发际一。(前发际神庭后
发际风府。凡二 。)廉泉一。风池二。天柱二。(按此篇热病五十九俞。与素问水热穴论热病
五十九俞惟十八穴相合。其余皆异。然本篇所言者。多在四肢。盖以泻热之本也。水热穴论
所言者。多随邪之所在。盖以泻热之标也当总求二篇之义。各随其宜而取用之。)
气满胸中喘息取足太阴大指之端。(隐白)寒则留之。热则疾之。气下乃止。心疝暴痛。
取足
廉痛不可及头。取(关冲)目中赤痛。从内 始取之阴跷。(照海穴)
癃。取之阴跷。及三毛上。(肝经大敦。)及血络出血。(肾与膀胱为表里肝经行于少腹
故当取此二经。若其有血络者皆刺出血。)男子如蛊。女子如 。身体腰脊如解。不欲饮食。先
取涌泉见血。视跗上盛者。尽见血也。(蛊。如犯蛊毒胀闷也。马注 。疑当作疽类经注
当作胎。如蛊如胎无是病而形相似也，身体腰脊如解。倦散不收也。跗上足面也。以阳明经
为言。凡其盛者。皆当刺出其血。)
偏枯病表现为身体一侧肢体无法活动且伴有疼痛。患者言语功能正常，神志清醒，说明病邪位于分肉与腠理之间。治疗应使用巨针进行针刺，补益正气之不足，祛除邪气之有余，这样病情才可以恢复。
痱病（风痱）的症状是身体没有疼痛感，但四肢弛缓无力、不能收持。（注：痱亦属风邪所致，意为废用。上一节讲的是半身不用而痛，这一节讲的是身不知痛而四肢不收，这是偏枯与痱病的鉴别点。○痱，读音同“肥”或“沸”。）如果智力混乱不严重，说话还能让人听懂一部分，是可以治疗的。（因为神气尚未完全丧失。）如果严重到不能说话，就无法治疗了。（因为神气已失，无能为力。）
疾病如果先从阳分发起，随后传入阴分，治疗时应先取阳经穴位，后取阴经穴位，并采用浅刺法。（应当刺其体表。如果病始于阴分，直中脏腑，大多不可治愈，所以不再赘述。）
风痉（表现为身体强直），身体向后反折。（这是风症在膀胱经的表现。）先取足太阳经的京骨穴和委中穴，以及血络放血。（又刺浮浅的络脉，放出血液。）如果是中寒证，取足三里穴。（如果是中气有寒，应当取足阳明胃经的三里穴来温补胃气，风寒即可消除。○这一节原本在后文。）
热病三天，气口脉象平静，人迎脉象躁动。（说明病在三阳经。）取诸阳经的五十九刺法，以泻除热邪并使其出汗，充实阴液以补其不足。（这是泻阳邪之实，同时补三阴之不足。五十九刺法如下文所述。）如果身体发热很严重，但寸口和人迎脉象都平静，不要针刺。对于可以针刺的情况，要紧急取穴，如果不通过发汗解表，就通过泄下法。所谓“不要针刺”，是因为出现了死征。（阳证出现阴脉，所以不宜针刺。如果观察发现尚可救治，应当紧急取穴，即使不出汗，邪气也会随之泄出。这里说勿刺，是因为脉症相反，有死征。下文情况类似。）
热病七天或八天，脉口跳动急促且呈弦象，要紧急针刺，汗会自然流出，浅刺手大指间的少商穴。（注：弦字，有的版本作短。）热病七天或八天，脉象微小。（说明正气虚。）患者尿血，口中干燥。（说明损伤了阴液。）一天半后会死亡。如果出现代脉，一天内就会死亡。（《脉要精微论》吴氏注：脉来五次停一次，或七次停一次，称为代脉。）
热病已经出汗，但脉象仍然躁动，气喘，并且再次发热，不要刺皮肤。（因为针刺会重伤正气。）气喘严重的会死亡。热病七天或八天，脉象不再躁动，虽然躁动但不散漫疾数，再过三天会有汗出；如果三天仍无汗，第四天会死亡。从未出汗的，不要刺皮部。（脉象躁盛是将要出汗的征兆。到了热病第七八天，脉象如果不躁动，或者虽有躁意但力量不散大、至数不快，都是正气衰微、不能鼓动的表现，所以应当再等待三天，希望能有汗出。如果三天仍无汗，又过了四天，阴阳之气不应期，将会死亡。凡是这种情况，既然不能出汗，正气必然虚弱，所以不要进行肤腠之刺。）
热病首先出现皮肤疼痛，鼻塞，面色发红。取皮部，用第一号针（镵针）刺五十九穴。（邪气在肤腠，属于肺经病变。应当用镵针刺五十九穴的皮部。）如果有顽固性皮疹生于鼻上，向肺求治（索皮于肺）。如果无效，向心火求治（不得索之火，火者心也）。（苛疹即疥疮，鼻上生疹都属于肺。求之于皮，就是求之于肺。如果属于邪火烁金，治肺无效，故泻心火以泄热。）
热病首先感觉身体涩滞、倚靠无力且发热，心烦，嘴唇和咽喉干燥。取血脉，用第一号针（镵针）刺五十九穴。如果皮肤肿胀、口干、出冷汗，向心求治（索脉于心）。如果无效，向肾水求治（不得，索之水，水者肾也）。（涩即燥涩，倚身无力。兼有发热、烦闷、唇口与咽喉干燥，说明邪气在血脉，属于心经病变。故当用镵针刺五十九穴的脉分。皮肤肿胀、口干、令汗出，也都是脉病。求之于脉，就是求之于心。如果针刺此法无效，则应当求之于水，水旺足以制火，心热自然消退。）
热病咽喉干燥，多饮，容易惊恐，躺下不能起身。取肌肉，用第六号针（圆利针）刺五十九穴。如果眼睛周围发青，向脾求治（索肉于脾）。如果无效，向肝木求治（不得，索之木，木者肝也）。（邪气在肌肉，属于脾经病变。应当用圆利针刺五十九穴的肉分。如果目睛周围发青，是木气乘土，也是脾病。求之于肉，就是求之于脾。如果针刺此法无效，则应当补肝木，木能胜土，脾热自然平息。）
热病面部发青（肝色），头痛（厥阴肝经与督脉会于头顶），手足躁动（木病在四肢末端）。取筋间，用第四号针（锋针）治疗四逆等症。如果脚不能行走，流泪不止。向肝求治（索筋于肝）。如果无效，向肺金求治（不得，索之金，金者肺也）。（这些都是肝病，其合在筋，所以只求之于筋，就是求之于肝。如果针刺此法无效，则应当补肺金，金能胜木，肝热可平。）
热病多次惊悸，抽搐且狂乱，取血脉，用第四号针（锋针）急泻有余之邪。如果患癫疾，毛发脱落，向心求治（索血于心）。如果无效，向肾水求治（不得，索之水，水者肾也）。（这都是心经病变。如果阳极阴虚而患癫疾，发为血余，所以毛发也脱落。心主血脉，求之于血，就是求之于心。如果针刺此法无效，应当补肾水以制火，真阴自然恢复。）
热病身体沉重，骨痛，耳聋，喜欢闭眼。取骨，用第四号针（锋针）刺五十九穴。如果骨病导致不进食、咬齿、耳朵发青，向肾求治（索骨于肾）。如果无效，向脾土求治（不得，索之土，土者脾也）。（这是肾经病变，故当用锋针刺五十九穴的骨分。不进食是因为阴邪盛。咬齿、耳青皆为肾病。肾属水，其合在骨，所以只求之于骨，就是求之于肾。如果针刺此法无效，应当补脾气之肉分，则土能胜水，肾邪可平。）
热病不知道哪里疼痛，耳聋，不能自主控制身体，口干，阳气热甚，阴气颇寒（阴胜之时）。热在髓的会死亡，不可治疗。
热病头痛，颞部疼痛，眼睛抽搐疼痛（足少阳脉连目，脉抽掣而痛），容易流鼻血（善衄）。这是厥热病（热逆于上）。取第三号针（鍉针）治疗。视有余和不足的情况而定。
热病身体沉重，肠中热，取第四号针治疗其腧穴（脾胃二经的俞穴太白、陷谷）以及下肢各指间。（又如膀胱经的束骨，胆经的临泣，详见后文。）向胃络求气（索气于胃胳，得气也）。（“胳”当作“络”，阳明之络叫丰隆，别走太阴，所以取此穴可以得到气。）
热病挟脐部急痛（肾经所行），胸胁满（脾经所行）。取涌泉穴和阴陵泉穴，用第四号针。针刺咽部里的廉泉穴。（少阴和太阴的经脉都上行联络咽嗌，即下面所说的廉泉穴。）
热病将要出汗，且脉象顺，可以发汗的，取鱼际、太渊、大都、太白穴。泻这些穴位则热去，补这些穴位则汗出。如果汗出太多，取内踝上的横脉（三阴交）来止汗。（《寒热病篇》提到臂太阴可汗出一节，应当参看。）
热病已经出汗，但脉象仍然躁盛，这是阴脉的极点，会死亡。如果出汗后脉象平静，则会生存。热病患者，脉象仍然盛大躁动但不能出汗，这是阳脉的极点，会死亡。脉象盛大躁动，出汗后平静，则会生存。
热病不可针刺的情况有九种：
一曰：不出汗，两颧发赤，呃逆的，死亡。（汗不得出，面戴阳，都是阴不足。岁属邪犯阳明，胃虚甚。）
二曰：腹泻且腹部胀满严重的，死亡。（脾衰。）
三曰：眼睛不明，热势不退的，死亡。（眼睛不明，是脏腑精气竭绝。热势不退，是表里阴气竭绝。）
四曰：老人和婴儿患热病且腹部胀满的，死亡。（邪伤脾脏。）
五曰：不出汗，呕血或便血的，死亡。（邪盛阴伤。）
六曰：舌根腐烂，热势不退的，死亡。（心、肝、脾、肾的经脉都系于舌本。舌根腐烂，加之热势不退，三阴俱损。）
七曰：咳嗽且流鼻血，不出汗，或者汗出不到足的，死亡。（真阴溃竭。）
八曰：髓热的，死亡。（邪入最深，成为髓热，肾气败竭。）
九曰：发热且痉挛的，死亡。（热极生风。）腰背反折，抽搐，牙关紧闭（齿噤），切齿（皆痉之谓。○ 音解）。
所谓五十九刺，包括：两手内外侧各三个，共十二个穴位。（六经井穴。）五指间各一个，共八个穴位。足部也是这样。（这指的是本节之后各有一个穴位。如手经，则太阳经的后溪，少阳经的中渚，阳明经之三间，少阴经之少府，左右共八穴。足部也是这样，太阳经的束骨，少阳经的临泣，阳明经的陷谷，太阴经的太白，左右又共八穴。）头部入发际一寸，旁开三分各三个，共六个穴位。（五处、承光、通天。）再入发际三寸，边五各五个，共十个穴位。（从上星穴次向后，去中线三寸，两边各五，即足少阳经的临泣、目窗、正营、承灵、脑空，左右共十穴。）耳前、耳后、口下各一个。（听会、完骨、承浆，共五穴。）项中一个。（哑门。）凡六个。巅上一个。（百会。）囟会一个，发际一个。（前发际神庭，后发际风府，凡二穴。）廉泉一个，风池两个，天柱两个。（按：本篇热病五十九俞，与《素问·水热穴论》热病五十九俞只有十八穴相合，其余都不同。然而本篇所说的，多在四肢，大概是以泻热为本。《水热穴论》所说的，多随邪气所在，大概是以泻热为标。应当综合两篇的意义，各自根据适宜情况取用。）
气满胸中喘息，取足太阴隐白穴之端。寒证留针，热证疾刺。气下行后再停止。心疝暴痛，取足少阳关冲穴。疼痛剧烈不可抬头。取照海穴（阴跷）。目中赤痛，从内侧开始取阴跷穴（照海穴）。
癃闭，取阴跷穴及足大趾外侧的大敦穴（肝经）。以及血络放血。（肾与膀胱为表里，肝经行于少腹，故当取此二经。如果有血络，都刺出血。）男子像蛊病（腹胀闷），女子像胎病（疑当作疽或胎），身体腰脊像解散一样无力，不想饮食。先取涌泉穴见血，观察足背上盛满的血络，全部刺出血。（蛊，像中了蛊毒，胀闷。马注认为“如”疑当作“疽”，《类经》注认为当作“胎”。像蛊像胎，是没有这种病但形状相似。身体腰脊像解散，是疲倦散漫不收。跗上是足面。以阳明经而言，凡是盛满的，都应当刺出其血。）
Hemiplegia (Pian Gu) manifests as paralysis and pain on one side of the body. The patient's speech remains unchanged, and their mind is not confused, indicating that the disease is located between the muscles and interstices (fen cou). Treatment should employ a large needle to tonify deficiency and reduce excess, thereby restoring health.
Fei disease (Wind Fei) is characterized by the absence of body pain but with flaccidity and inability to control the four limbs. (Note: Fei also belongs to wind pathogens, meaning "uselessness". The previous section described hemiplegia with pain; this section describes lack of pain sensation with limb flaccidity, which distinguishes Pian Gu from Fei. ○ Fei is pronounced like "fei" or "fei".) If mental confusion is slight and speech is partially intelligible, it is treatable. (Because the spirit qi has not completely departed.) If severe enough to cause aphasia, it is untreatable. (Because the spirit qi is lost, rendering treatment ineffective.)
If a disease originates in the Yang aspect first and then enters the Yin aspect, treatment should first target the Yang meridians and subsequently the Yin meridians, using superficial needling. (One should needle the exterior. If the disease originates in the Yin and directly affects the zang organs, it is mostly untreatable, so it is not discussed further.)
Wind Jing (spasticity), manifesting as opisthotonos (body bent backward). This indicates a wind syndrome affecting the Bladder Meridian. First, needle Jinggu (BL64) and Weizhong (BL40) of the Foot-Taiyang Meridian, along with blood vessels for bleeding. (Also needle superficial collaterals to release blood.) For Cold invasion, needle Zusanli (ST36). (If there is cold in the middle jiao, needle Zusanli of the Foot-Yangming Meridian to warm and tonify stomach qi, eliminating wind-cold. ○ This section originally appeared later.)
In Heat Disease after three days, if the Qi Kou pulse is calm while the Ren Ying pulse is restless, (indicating the disease is in the Three Yang meridians), apply the Fifty-Nine Acupoints for needling from all Yang meridians to drain heat and induce sweating, while filling the Yin to tonify deficiency. (This drains the excess of Yang pathogens and tonifies the deficiency of the Three Yin meridians. The method of the Fifty-Nine Acupoints is detailed below.) If body heat is severe but both Yin and Yang pulses are calm, do not needle. For cases suitable for needling, act urgently; if sweating does not occur, use purgation. The instruction "do not needle" refers to signs of death. (Yang symptoms with Yin pulses are unsuitable for needling. If judged treatable, urgent needling is required; even without sweating, pathogens will be drained. Here, "do not needle" implies contradictory pulse and symptoms indicating death. The same applies to subsequent sections.)
In Heat Disease after seven or eight days, if the Pulse Kou is rapid and wiry, needle urgently to induce spontaneous sweating, superficially needling the space between the thumb and index finger (Shaoshang, LU11). (Note: Some versions read "short" instead of "wiry".) In Heat Disease after seven or eight days, if the pulse is minute and small, (indicating deficiency of righteous qi), and the patient has hematuria and dry mouth, (indicating Yin injury), they will die within one and a half days. If a Dai pulse (intermittent pulse) appears, they will die within one day. (Commentary from Wu on *Mai Yao Jing Wei Lun*: A pulse stopping every five beats or every seven beats is called Dai.)
In Heat Disease, if sweat has been produced but the pulse remains restless, accompanied by panting and recurrent fever, do not needle the skin. (Needling would severely damage qi.) Severe panting leads to death. In Heat Disease after seven or eight days, if the pulse is no longer restless, or if restless but not scattered or rapid, sweat may appear after three days. If no sweat occurs after three days, death ensues on the fourth day. For those who have never sweated, do not needle the cuticle. (A restless pulse indicates impending sweating. By the seventh or eighth day of Heat Disease, if the pulse is not restless, or lacks strength/scattering/rapidity, it signifies deficiency of righteous qi unable to drive pathogens out. Thus, wait three more days hoping for sweat. If still no sweat after three days, exceeding four days means Yin and Yang fail to correspond, leading to death. In such cases, since sweating is absent, qi must be deficient; therefore, avoid needling the cuticle.)
If Heat Disease begins with skin pain, nasal obstruction, and facial flushing, needle the skin layer using the first type of needle (Chan needle) at the Fifty-Nine Acupoints. (Pathogen is in the skin and interstices, involving the Lung Meridian. Use the Chan needle to needle the skin regions of the Fifty-Nine Acupoints.) For stubborn rashes on the nose, seek treatment in the Lung (skin). If ineffective, seek treatment in the Heart Fire. (Rashes on the nose belong to the Lung. Seeking the skin seeks the Lung. If due to pathogenic fire destroying Metal, treating the Lung fails, so drain Heart Fire to clear heat.)
If Heat Disease begins with a sensation of stiffness, weakness leaning on support, fever, irritability, and dry lips/throat, needle the vessels using the first type of needle (Chan needle) at the Fifty-Nine Acupoints. If skin distension, dry mouth, and cold sweat occur, seek treatment in the Heart (vessels). If ineffective, seek treatment in Kidney Water. (Stiffness indicates dryness; weakness indicates inability to stand. Fever, irritability, and dry lips/throat indicate pathogen in blood vessels, involving the Heart Meridian. Use the Chan needle to needle the vessel divisions of the Fifty-Nine Acupoints. Skin distension, dry mouth, and sweating are vessel diseases. Seeking vessels seeks the Heart. If ineffective, seek Water, as Water controls Fire, cooling the Heart.)
If Heat Disease involves dry throat, polydipsia, frequent fright, and inability to rise from bed, needle the flesh using the sixth type of needle (Yuanli needle) at the Fifty-Nine Acupoints. If the eyes appear blue/green, seek treatment in the Spleen (flesh). If ineffective, seek treatment in Liver Wood. (Pathogen in flesh involves the Spleen Meridian. Use the Yuanli needle to needle the flesh divisions of the Fifty-Nine Acupoints. Blue/green eyes indicate Wood overacting on Earth, also a Spleen issue. Seeking flesh seeks the Spleen. If ineffective, tonify Liver Wood, as Wood controls Earth, calming Spleen heat.)
If Heat Disease presents with a blue face (Liver color), headache (Jueyin Liver Meridian meets Du Mai at the vertex), and restlessness of hands/feet (Wood disease in extremities), needle between the tendons using the fourth type of needle (Feng needle) for Si Ni conditions. If legs cannot walk and tears flow uncontrollably, seek treatment in the Liver (tendons). If ineffective, seek treatment in Lung Metal. (These are Liver diseases, associated with tendons. Seeking tendons seeks the Liver. If ineffective, tonify Lung Metal, as Metal controls Wood, calming Liver heat.)
If Heat Disease involves frequent惊悸 (palpitations/fright), convulsions, and mania, needle the vessels using the fourth type of needle (Feng needle) to urgently drain excess. If Epilepsy occurs with hair loss, seek treatment in the Heart (blood). If ineffective, seek treatment in Kidney Water. (These are Heart Meridian diseases. Extreme Yang and Yin deficiency causing Epilepsy and hair loss. Heart governs blood vessels; seeking blood seeks the Heart. If ineffective, tonify Kidney Water to control Fire, restoring True Yin.)
If Heat Disease involves heavy body, bone pain, deafness, and desire to keep eyes closed, needle the bones using the fourth type of needle (Feng needle) at the Fifty-Nine Acupoints. If bone disease causes anorexia, teeth grinding, and blue ears, seek treatment in the Kidney (bones). If ineffective, seek treatment in Spleen Earth. (Kidney Meridian disease. Anorexia indicates excessive Yin evil. Teeth grinding and blue ears are Kidney signs. Kidney belongs to Water, associated with bones. Seeking bones seeks the Kidney. If ineffective, tonify Spleen Earth, as Earth controls Water, calming Kidney pathogens.)
If Heat Disease involves unknown pain location, deafness, inability to self-control, dry mouth, extreme Yang heat, and significant Yin cold (excess Yin), Heat entering the Marrow leads to death and is untreatable.
If Heat Disease involves headache, temporal pain, eye twitching/pain (Shao Yang meridian connects to eyes, causing pulling pain), and frequent epistaxis, this is Jue Re Bing (Heat reversing upward). Use the third type of needle (Di needle) based on excess or deficiency patterns.
If Heat Disease involves heavy body and intestinal heat, use the fourth type of needle at Shu points (Taibai SP3, Xianggu ST41) and between toes. (Also Shugu BL65, Linqi GB41, see below.) Seek Qi in the Stomach Collateral (Fenglong ST40) to obtain De Qi.
If Heat Disease involves urgent pain around the navel (Kidney Meridian pathway) and chest/hypochondriac fullness (Spleen Meridian pathway), needle Yongquan (KI1) and Yinlingquan (SP9) using the fourth type of needle. Needle Lianquan (CV23) inside the throat. (Shaoyin and Taiyin meridians connect to the throat.)
If Heat Disease involves impending sweat and favorable pulses, inducing sweat is appropriate. Needle Yuji (LU10), Taiyuan (LU9), Dadu (SP2), Taibai (SP3). Reducing these clears heat; tonifying them induces sweat. If sweat is excessive, needle the transverse vessel above the medial malleolus (Sanyinjiao SP6) to stop it. (*Han Re Bing* chapter notes Arm Taiyin can induce sweat; refer to that section.)
If Heat Disease has produced sweat but the pulse remains rapid and strong, this is the extreme of Yin pulses, leading to death. If sweat occurs and the pulse calms, survival is indicated. If Heat Disease patients have strong, restless pulses but cannot sweat, this is the extreme of Yang pulses, leading to death. If pulses are strong/restless but calm after sweating, survival is indicated.
There are nine types of Heat Disease unsuitable for needling:
1. No sweat, red cheeks, and hiccups indicate death. (Lack of sweat and facial flushing indicate Yin deficiency. Pathogen attacks Yangming, severe stomach deficiency.)
2. Diarrhea with severe abdominal fullness indicates death. (Spleen failure.)
3. Unclear vision with persistent heat indicates death. (Unclear vision indicates exhaustion of organ essence; persistent heat indicates exhaustion of Yin in interior/exterior.)
4. Elderly or infants with Heat Disease and abdominal fullness indicate death. (Pathogen damages Spleen.)
5. No sweat, vomiting blood, or bloody stool indicate death. (Excess pathogen damaging Yin.)
6. Ulcerated tongue root with persistent heat indicates death. (Heart, Liver, Spleen, Kidney meridians connect to the tongue root. Ulceration plus persistent heat indicates damage to all Three Yin.)
7. Cough with epistaxis, no sweat, or sweat not reaching the feet indicate death. (Collapse of True Yin.)
8. Marrow heat indicates death. (Pathogen penetrates deepest, causing Marrow heat and Kidney Qi exhaustion.)
9. Heat with spasm indicates death. (Extreme heat generates wind.) Opisthotonos, convulsions, trismus (closed jaw), and teeth grinding are spasms.
The "Fifty-Nine Acupoints" include:
- Twelve points on the inner and outer sides of both hands (Six Jing-Well points).
- Eight points between the fingers of both hands. Feet follow similarly. (Specifically: Hand Shaoyang Houxi SI3, Shaoyang Zhongzhu TE3, Yangming Sanjian LI3, Shaoyin Shaofu HT8; Left/Right total 8. Foot Shaoyang Shugu BL65, Shaoyang Linqi GB41, Yangming Xianggu ST41, Taiyin Taibai SP3; Left/Right total 8.)
- Six points on the head, one cun into the hairline, three fen lateral to midline (Wuchu EX-HN4, Chengguang BL3, Tongtian BL3).
- Ten points three cun into the hairline, five fen lateral (Linqi GB41, Mucuang GB15, Zhengying GB17, Chengling BL9, Naokong GB13; Left/Right total 10).
- One point each in front of ear, behind ear, and below mouth (Tinghui GB2, Wanggu BL1, Chengjiang CV24; Total 5).
- One point in the neck (Yamen GV15). Total 6 including top of head.
- One point on the vertex (Baihui GV20).
- One point at Xinhui GV22, one at hairline (Shenting GV24, Fengfu GV16; Total 2).
- One point Lianquan (CV23), two Fengchi (GB20), two Tianzhu (BL10).
(Note: The 59 points in this chapter overlap with only 18 points in *Su Wen: Shui Re Xue Lun*. This chapter focuses on limbs (root of draining heat), while *Shui Re Xue Lun* focuses on pathogen location (branch of draining heat). Combine meanings and apply appropriately.)
For Qi fullness in chest with panting, needle Yinbai (SP1) at the tip of the great toe. Retain needle for Cold, quick withdraw for Heat. Stop when Qi descends.
For acute Heart疝 (Cold contraction) pain, needle Guanchong (TE1).
For pain too severe to lift the head, needle Zhaohai (KI6, Yin Qiao Mai).
For red painful eyes starting from the inner canthus, needle Yin Qiao Mai (Zhaohai KI6).
For strangury (Long), needle Yin Qiao Mai (Zhaohai KI6) and Dachun (LR1) on the pubic hair area. Also bleed blood vessels. (Kidney/Bladder are exterior-interior; Liver meridian runs through lower abdomen. Bleed collaterals if present.)
For men resembling Gu disease (abdominal distension/toxic swelling) and women resembling fetal disease (or abscess), with body/waist/spine feeling loose/uncontrolled and anorexia, first needle Yongquan (KI1) until blood appears. Observe dorsal foot vessels; bleed all prominent ones. (Gu resembles toxic swelling. Body/spine loose indicates fatigue/disarray. Dorsal foot relates to Yangming. Bleed all full vessels.)