病有浮沉刺有浅深。各至其理。无过其道过之则内伤。不及则生外壅。壅则邪从之浅深
不得
。反为大贼内动五脏后生大病。故曰病有在毫毛腠理者。有在皮肤者。有在肌肉者。有在脉
者。有在筋者。有在骨者。有在髓者。是故刺毫毛腠理无伤皮。皮伤则内动肺。肺动则秋病
温疟。淅淅然寒栗。刺皮无伤肉。肉伤则内动脾。脾动则七十二日四季之月病腹胀。烦不嗜
食。刺肉无伤脉。脉伤则内动心。心动则夏病心痛。刺脉无伤筋。筋伤则内动肝。肝动则春
病热而筋弛。刺筋无伤骨。骨伤则内动肾。肾动则冬病胀腰痛。刺骨无伤髓。髓伤则消铄
酸体解 然不去矣。(病解 者懈怠困弱。阴之虚也。阴虚则气虚气虚则不能举动是谓不去
也○解。音懈。 。音迹。吴注音亦。)
(齐者刺各有所宜也。)
刺骨无伤筋者。针至筋而去不及骨也。(如病骨髓酸痛之类直当刺骨若针至筋分。不及
于骨
针至肉分。不及于筋是伤肉也。)刺肉无伤脉者至脉而去。不及肉也。(如病肌肤尽痛之类直
宜刺肉若针至脉分。不及于肉是伤脉也)刺脉无伤皮者。至皮而去。不及脉也。(如病血脉不
通诸症直当刺脉若针至皮分。不及于脉。是伤皮也○此四节言当深不深之为害也)所谓刺皮
无伤肉者。病在皮中无伤肉也。(无过深中肉)刺肉无伤筋者。过肉中筋也。(病在肉。无过
肉而伤筋。)刺筋无伤骨者。过筋中骨也。(病在筋。无过筋而伤骨○此三节。言不当深而深
者之害也)此谓之反也。
疾病有表浅与深重的区别,针刺也有浅刺与深刺之分。针刺必须达到相应的层次,不可超过应有的深度。如果针刺过深,就会损伤内脏;如果针刺过浅,则会导致体表气血壅滞。一旦壅滞,邪气便会乘虚而入。深浅不当,反而会成为严重的伤害,扰动五脏,随后引发大病。所以说,病邪有的在毫毛和腠理(皮肤纹理及汗孔),有的在皮肤,有的在肌肉,有的在脉,有的在筋,有的在骨,有的在髓。因此,刺毫毛和腠理时不要伤及皮肤,若伤及皮肤,就会内动肺脏。肺脏受扰,到了秋季易患温疟(一种以寒热往来为特征的疟疾),表现为瑟瑟发抖、畏寒战栗。刺皮肤时不要伤及肌肉,若伤及肌肉,就会内动脾脏。脾脏受扰,在四季末各十八天(共七十二日)易患腹胀、心烦、食欲不振的病。刺肌肉时不要伤及血脉,若伤及血脉,就会内动心脏。心脏受扰,到了夏季易患心痛。刺血脉时不要伤及筋腱,若伤及筋腱,就会内动肝脏。肝脏受扰,到了春季易患发热且筋脉弛缓的病。刺筋腱时不要伤及骨骼,若伤及骨骼,就会内动肾脏。肾脏受扰,到了冬季易患腹胀和腰痛。刺骨骼时不要伤及骨髓,若伤及骨髓,身体会消瘦、酸痛、肢体懈怠无力而不能恢复。(所谓“不去”,是指懈怠困弱,这是阴气虚弱的表现。阴虚则气虚,气虚则不能举动,所以称为“不去”。○“解”音同“懈”,意为懈怠。“铄”音同“迹”。吴崑注音亦同。)
(“齐”的意思是针刺各有其适宜的深浅标准。)
所谓“刺骨无伤筋”,是指针应到达筋骨处但不应停留在筋上而不及于骨。(例如骨髓酸痛的病症,应当直刺至骨;如果针只到筋的分层,却未达于骨,或者针到肉的分层而未达于筋,这就属于伤及了肉。)所谓“刺肉无伤脉”,是指针应到达血脉处但不应停留在脉上而不及于肉。(例如肌肤全身疼痛的病症,适宜刺肉;如果针只到脉的分层,却未达于肉,这就属于伤及了脉。)所谓“刺脉无伤皮”,是指针应到达皮肤处但不应停留在皮上而不及于脉。(例如血脉不通的各种症状,应当直刺血脉;如果针只到皮的分层,却未达于脉,这就属于伤及了皮。○这四节讲的是当深不深所带来的危害。)所谓“刺皮无伤肉”,是指病在皮中,不要伤及肉。(即不要刺得过深进入肌肉。)所谓“刺肉无伤筋”,是指病在肉中,不要越过肉而伤及筋。(即病在肉,不要刺过肉而伤筋。)所谓“刺筋无伤骨”,是指病在筋中,不要越过筋而伤及骨。(即病在筋,不要刺过筋而伤骨。○这三节讲的是不当深而深所带来的危害。)这叫做反其道而行之。
Diseases present with superficial or deep locations, and acupuncture needling involves shallow or deep insertion. The needle must reach the appropriate anatomical level without exceeding the proper depth. Exceeding the depth causes internal injury; falling short leads to external stagnation (Wai Yong). Stagnation allows pathogenic factors to invade. Improper depth becomes a major toxin, disturbing the Zang-organs internally and subsequently giving rise to severe diseases. Thus, it is said that pathogens may reside in the hair follicles and Couli (pores and interstitial spaces), in the skin, in the muscles, in the vessels, in the sinews, in the bones, or in the marrow. Therefore, when needling the hair follicles and Couli, do not injure the skin. If the skin is injured, the Lung (Fei) is disturbed internally. Disturbance of the Lung leads to Warm-Malaria (Wen Nue) in autumn, characterized by shivering and aversion to cold. When needling the skin, do not injure the flesh. If the flesh is injured, the Spleen (Pi) is disturbed internally. Disturbance of the Spleen leads to abdominal distension, vexation, and loss of appetite during the last eighteen days of each season (totaling seventy-two days). When needling the flesh, do not injure the vessels. If the vessels are injured, the Heart (Xin) is disturbed internally. Disturbance of the Heart leads to heart pain in summer. When needling the vessels, do not injure the sinews. If the sinews are injured, the Liver (Gan) is disturbed internally. Disturbance of the Liver leads to heat and flaccidity of the sinews in spring. When needling the sinews, do not injure the bones. If the bones are injured, the Kidney (Shen) is disturbed internally. Disturbance of the Kidney leads to abdominal distension and lower back pain in winter. When needling the bones, do not injure the marrow. Injury to the marrow results in emaciation, soreness, and a sense of bodily slackness and weakness that does not resolve. (The term "bu qu" refers to slackness and weakness, indicating deficiency of Yin. Yin deficiency leads to Qi deficiency; Qi deficiency prevents movement, hence it is called "not resolving." ○ "Jie" is pronounced like "Xie," meaning slackness. "Shuo" is pronounced like "Ji.")
(The term "Qi" implies that needling has specific appropriate depths.)
"To needle the bone without injuring the sinew" means the needle should reach the level of the sinew but not stop there if the target is the bone. (For conditions such as bone marrow soreness and pain, one should needle directly to the bone. If the needle stops at the level of the sinew without reaching the bone, or stops at the level of the muscle without reaching the sinew, this constitutes injury to the muscle.) "To needle the muscle without injuring the vessel" means the needle should reach the level of the vessel but not stop there if the target is the muscle. (For conditions such as generalized pain of the skin and flesh, needling the muscle is appropriate. If the needle stops at the level of the vessel without reaching the muscle, this constitutes injury to the vessel.) "To needle the vessel without injuring the skin" means the needle should reach the level of the skin but not stop there if the target is the vessel. (For conditions involving obstruction of blood vessels, needling the vessel is appropriate. If the needle stops at the level of the skin without reaching the vessel, this constitutes injury to the skin. ○ These four sections discuss the harm caused by failing to needle deeply enough.) "To needle the skin without injuring the muscle" means the disease is in the skin, so do not injure the muscle. (Do not needle too deeply into the muscle.) "To needle the muscle without injuring the sinew" means the disease is in the muscle, so do not pass through the muscle to injure the sinew. (If the disease is in the muscle, do not needle past the muscle to injure the sinew.) "To needle the sinew without injuring the bone" means the disease is in the sinew, so do not pass through the sinew to injure the bone. (If the disease is in the sinew, do not needle past the sinew to injure the bone. ○ These three sections discuss the harm caused by needling too deeply when unnecessary.) This is referred to as acting contrary to the principle.