。邪气在门者。邪循正气之所出入也。）未睹其疾。恶知其原。（先知邪正。何经之疾。然后乃
知所取之处也。）刺之微。在速迟。（徐疾之意也）粗守关。（守四肢而不知血气邪正之往来也
）上守机。（知守气也）机之动。不离其空。（知气之虚实。用针之疾徐也。）空中之机。清静
而
也）知机之道者。不可挂以发。（言气易失也）不知机道。叩之不发。（言不知补写之意。血气
已尽。邪气不下也。）知其往来。（知气之逆顺盛虚也）要与之期。（知气之可取之时也）粗之
暗乎。（冥冥不知气之微密也。）妙哉。工独有之。（尽知针意也）往者为逆。（言气之虚小。
小者。逆也。）来者为顺。（言形气之平。平者。顺也。）明知逆顺。正行无问。（言知所取之
处也）迎而夺之。（写也）恶得无虚。追而济之。（补也）恶得无实。迎之随之。以意和之。虚
则实之。（言气口虚而当补也）满则写之。（言气口盛而当写也○针解曰。气虚则实之者。针
下热也。气实乃热也。满而写之者。针下寒也。气虚亦寒也。）宛陈则除之。（去血脉也）邪
胜则虚之。（言诸经有盛者。皆写其邪也。○针解曰。出针勿按穴。俞且开。故得经虚。邪
气发泄也。）徐而疾则实。（言徐内而疾出也。○针解曰。徐出。谓得经气已久。乃出之疾。
按谓针出穴已疾。速按之。则真气不泄。经脉气全。故实。）疾而徐则虚。（言疾内而徐出
也。○针解曰。疾出。谓针入穴已至于经脉。则疾出之。徐按。谓针出穴已徐缓。按之则邪
气得泄。精气复间。故虚。） 言实与虚。若有若无。（言实者。有气。虚者。无气也。○针
解曰。言实与虚者。寒温气多少也。寒温谓经脉阴阳之气。若无若有者。疾不可知也。言其
冥昧不可即而知也。不可即知。故若无。慧然神悟。故若有也。）察后与先。若亡若存。（言
气之虚实。补写之先后也。察其气之以下与常存也。）为虚与实。（针解曰。为虚与实者。工
勿失其法。）若得若失。（言补则秘然若有得。写则恍然若有失也。○针解曰。若得失者。离
其法也。妄为补写。离乱大经。误补实者。转令若得。误写虚者。转令若失也。○难经曰。
实之与虚者。牢濡之意。气来实牢者为得。濡虚者为失。气来实牢濡虚。以随济迎夺而为得
失也。言实与虚若有若无者。谓实者有气。虚者无气也。言虚与实。若得若失。谓补者秘然
。若有得也。写者恍然。若有失也。得失有无。义实相同。故交举而互言之。）虚实之要。
九针最妙。（针解曰。为其各有所宜也。热在头身。宜 针。肉分气满。宜员针。脉气虚少
。宜 针。写热出血。发泄痼病。宜锋针。破痈肿。出脓血。宜铍针。调阴阳。去暴痹。宜
利员针。刺治经络中痛痹。宜毫针。痹深居骨解腰脊节凑之间者。宜长针。虚风舍于骨解皮
肤之间者。宜大针。此谓各有所宜也。）补写之时。（与气开阖相合也。气当时刻谓之开。已
过未至谓之阖）以针为之。（九针各不同形。长短锋颖不等。或补或写。宜随其疗而用之也。
○机按。此节示人当知圆机活法。不可守经无权。与夫邪正之所当别。虚实之所当知。补写
之所当审。皆针家之要务。学人不可不熟读也。）
写曰必持纳之。放而出之。排阳得针。邪气得写。按而引针。是谓内温。血不得散。气
不得出也。补曰随之随之。意若妄之。若行若按。如蚊虻止。如留如还。去如弦绝。令左属右
。其气故止。外门已闭。中气乃实。必无留血。急取诛之。持针之道。坚者为宝。正指直刺
。无针左右。神在秋毫。属意病者。审视血脉者。刺之无殆。方刺之时。必在悬阳。及与两
卫。神属勿去。知病存亡。血脉者。在输横居。视之独澄。切之独坚。（机按。上节文义不相
蒙。恐有脱误。且针解篇亦置之不释。可见非错简则衍文。）
问曰。灵枢首篇。多有脱误。既闻命矣。其中云。悬阳两卫。亦有义乎否乎。
曰。此节文义。亦不甚莹。今姑随文释义。以俟明哲正焉。悬者。悬远也。谓皮肤浮浅
之气
卫之阴。故曰两卫。总而言之。悬阳两卫。同一气也。分而言之。皮肤者为悬阳。肌肉者为卫
之
者。筋骨为阴。皮肤为阳。故曰病在阴之阴者。刺阴之荥俞。病在阳之阳者。刺阳之合。病
在阳之阴者。刺阴之经。病在阴之阳者。刺络脉是也。神属勿去者。正气犹相附属也。经曰
。身居静处。占神往来。又曰。入脏者死。以神去也。存亡者。死生也。血脉在 横居者。
言邪入血脉。注于穴 。则横逆也。经曰。血气扬溢是也。澄者。静而明也。经曰。沉而留
止。又曰。病深专者。刺大脏是也。坚者。强而急也。经曰。察其脉之缓急。肉之坚脆。而
病形定矣是也。盖谓工之用针。当知气之邪正。病之生死也。初则浅之。以候皮肤之气。次
则深之。以候肌肉之气。又次则深之。以候筋骨之气。若邪虽内舍。而神犹附属者。则病尚
可以生也。或邪入血脉。注于经 而横逆者。则神将去矣。邪之横逆。审而视之。则渊澄而可
见。切而按之。则劲急而可辨。用针之际。岂可不谨候乎。
邪气停留在腧穴门户的时候，是邪气顺着正气出入的通道而进入的。）在没有观察到疾病表现之前，怎么能知道它的病因呢？（必须先辨别邪正盛衰，明确是哪一经的疾病，然后才能确定针刺的部位。）针刺的精微之处，在于进针和出针的速度快慢。（即徐疾补泻的含义。）粗疏的医生只拘泥于四肢关节等局部穴位，（固守四肢穴位，而不懂得气血邪正的往来变化。）高明的医生则善于把握经气变化的时机。（懂得守护经气的变化。）经气机动的规律，不离腧穴的空隙。（懂得判断经气的虚实，从而决定用针的徐疾。）腧穴中的经气变化之机，清静微妙而难以捉摸。（此处原文有缺漏，意指其变化细微难测。）懂得经气变化之道的人，不能有一丝一毫的差错。（因为经气容易流失。）不懂得经气变化之道的人，即使叩击询问，也不会得到回应。（指不懂补泻之意，导致血气耗尽，邪气反而深入。）了解经气的往来顺逆。（懂得经气的逆顺、盛虚情况。）要把握恰当的施治时机。（懂得经气可取之时。）粗疏的医生昏暗不明，（冥冥之中不知经气的微妙细节。）精妙啊，只有技艺高超的医生才具备这种能力。（完全通晓针刺的要义。）经气离去为逆。（指经气虚弱微小，小者即为逆。）经气到来为顺。（指形气平和，平者即为顺。）明知逆顺的道理，施行针刺时就不会有疑问。（懂得选取合适的部位。）迎而夺之，是泻法。（泻法）怎么会不虚损呢？追而济之，是补法。（补法）怎么会不充实呢？迎随结合，用心调和。虚证则使之充实。（指气口脉虚应当用补法）实证则使之泻除。（指气口脉盛应当用泻法○《灵枢·九针十二原》解曰：气虚而实之，是指针下产生热感；气实则热也（此处原文可能有误，通常气实泻之则寒，或指补后气实）。满而泻之，是指针下产生寒感；气虚亦寒也（此处原文逻辑似有混淆，通常指泻后邪去正安）。去除瘀血陈积。（祛除血脉中的瘀滞）邪气亢盛则用泻法。（指各经有盛邪者，都应当泻除其邪气○《灵枢·九针十二原》解曰：出针后不按闭针孔，腧穴开放，从而使经脉之气虚，邪气得以发泄。）缓慢进针快速出针可使正气充实。（指缓慢进针，快速出针○《灵枢·九针十二原》解曰：徐出，指得经气已久，然后快速出针；按，指针出穴后迅速按压，这样真气不泄，经脉之气保全，故为实。）快速进针缓慢出针可使邪气虚衰。（指快速进针，缓慢出针○《灵枢·九针十二原》解曰：疾出，指针入穴已至于经脉，则快速出针；徐按，指针出穴后缓慢按压，这样邪气得泄，精气复归，故为虚。）谈论实与虚，好像有又好像无。（实者有气，虚者无气○《灵枢·九针十二原》解曰：言实与虚，指寒温之气的多少。寒温指经脉阴阳之气。若无若有，指变化迅速不可即刻知晓。因其冥昧不可立即得知，所以看似若无；慧然神悟，所以看似若有。）观察治疗的先后顺序，好像消失又好像存在。（指经气的虚实，以及补泻的先后次序。观察其气之消长与常存。）针对虚证与实证施治。（《灵枢·九针十二原》解曰：为虚与实，医生不要违背其法则。）好像得到了又好像失去了。（补法时感觉秘然如有所得，泻法时感觉恍然如有所失○《灵枢·九针十二原》解曰：若得失，指背离了法则。妄为补泻，扰乱大经。误补实证，反而令其若有得（更实）；误泻虚证，反而令其若有失（更虚）○《难经》说：实与虚，指脉搏的牢濡之意。气来实牢者为得，濡虚者为失。气来实牢濡虚，通过随济迎夺而产生得失。言实与虚若有若无，指实者有气，虚者无气。言虚与实若得若失，指补者秘然若有得，泻者恍然若有失。得失有无，意义实际相同，所以交错列举互文见义。）虚实的关键，九针最为奇妙。（《灵枢·九针十二原》解曰：因为各种针各有适宜之处。热在头身，宜用镵针；肉分气满，宜用员针；脉气虚少，宜用鍉针；泻热出血，发泄痼病，宜用锋针；破痈肿，出脓血，宜用铍针；调阴阳，去暴痹，宜用利针（注：原文“利员针”疑为衍文或异本，通常指圆利针或利针）；刺治经络中痛痹，宜用毫针；痹深居骨解腰脊节凑之间者，宜用长针；虚风舍于骨解皮肤之间者，宜用大针。这叫各有所宜。）补泻的时机，（要与经气的开阖相符合。气当时刻称为开，已过未至称为阖）用针来进行操作。（九针形状各不相同，长短锋颖不等，或补或泻，应根据治疗需要选用○汪机按：此节教导人们应当懂得圆机活法，不可死守经文而无权变，以及邪正应当辨别，虚实应当知晓，补泻应当审慎，这些都是针灸家的要务，学习者不可不熟读。）
泻法必须持针纳入，放手而出针，推开阳分以纳针，使邪气得泻。按压并引导出针，这叫内温，血液不得散逸，气不得外泄。补法随之而行，意念仿佛若无其事。如行如按，像蚊虻叮咬般轻微，似留似还，出针时像弓弦断绝一样迅速。令左手属右，经气因此停止，外门已闭，中气乃实，必然没有留血，急取诛伐邪气。持针的原则，坚实稳固最为宝贵。正指直刺，针体不左右偏斜，精神专注在秋毫般的细微处，意念关注病人，审视血脉，针刺就没有危险。在针刺之时，必须注意悬阳及两卫，精神专一勿去，以此知病之存亡。血脉在腧穴处横居，视之独澄澈，切之独坚硬。（汪机按：上节文义不相连贯，恐怕有脱漏错误，且《灵枢·针解篇》也未对此进行解释，可见不是错简就是衍文。）
问：《灵枢》首篇，多有脱漏错误，既然已经听您说明了，其中提到的“悬阳两卫”，也有含义吗？
答：这一节的文义，也不甚清晰明白。现在暂且随文释义，以等待明哲之士纠正。悬，是悬远的意思，指皮肤浮浅之气。卫，分为卫之阳和卫之阴，故称两卫。总而言之，悬阳两卫，同属于一气。分开来说，皮肤者为悬阳，肌肉者为卫之阳，筋骨者为卫之阴。所以说病在阴之阴者，刺阴之荥俞；病在阳之阳者，刺阳之合；病在阳之阴者，刺阴之经；病在阴之阳者，刺络脉。神属勿去，指正气仍然相附属。经书说：身居静处，占神往来。又说：入脏者死，是因为神去了。存亡，指死生。血脉在腧穴横居，指邪入血脉，注于穴道，则横逆。经书说：血气扬溢是也。澄，是静而明。经书说：沉而留止。又说：病深专者，刺大脏是也。坚，是强而急。经书说：察其脉之缓急，肉之坚脆，而病形定矣是也。大概意思是说，医生用针，应当知道气的邪正，病的生死。起初浅刺，以候皮肤之气；其次深刺，以候肌肉之气；又次更深刺，以候筋骨之气。如果邪气虽然内舍，而神犹附属，则病尚可以生。或者邪入血脉，注于经脉而横逆，则神将去矣。邪气的横逆，审而视之，则渊澄而可见；切而按之，则劲急而可辨。用针之际，岂可不谨慎等候呢？
When pathogenic factors reside at the gate of acupoints, they enter along the pathways where healthy qi enters and exits. Before observing the disease manifestations, how can one know its origin? (One must first distinguish between pathogenic and healthy qi, identify which meridian is affected, and then determine the appropriate needling site.) The subtlety of needling lies in the speed of insertion and withdrawal (i.e., the meaning of slow and rapid techniques). Crude practitioners only guard the joints of the limbs, (sticking to local acupoints on the four limbs without understanding the circulation of blood, qi, pathogenic, and healthy qi.) Superior practitioners guard the mechanism (understanding how to secure the movement of qi). The movement of the mechanism does not depart from the empty space of the acupoint (knowing the deficiency or excess of qi to determine the speed of needling). The mechanism within the acupoint is clear, quiet, and subtle (the original text has a gap here, implying its changes are minute and hard to grasp). Those who understand the way of the mechanism cannot afford even a hair's breadth of error (because qi is easily lost). Those who do not understand the way of the mechanism, even if they knock and ask, will receive no response (referring to ignorance of tonification and sedation, leading to exhaustion of blood and qi, while pathogenic factors deepen). Knowing the coming and going (understanding the reversal, smoothness, excess, and deficiency of qi). One must seize the opportune moment (knowing when qi is available for treatment). Crude practitioners are obscure and dark, (in the dark, unaware of the subtleties of qi.) How wonderful! Only skilled artisans possess this (having fully mastered the intent of needling). What goes is reverse (referring to weak and small qi; smallness is reverse). What comes is smooth (referring to balanced form and qi; balance is smooth). Clearly knowing reverse and smooth, one acts correctly without doubt (knowing the appropriate sites). Meeting and seizing it is sedation (sedation technique). How could it not be deficient? Chasing and assisting it is tonification (tonification technique). How could it not be full? Meeting and following, harmonizing with intent. Deficiency is made full (referring to deficiency at the radial pulse requiring tonification). Fullness is sedated (referring to excess at the radial pulse requiring sedation ○ *Lingshu: Nine Needles and Twelve Origins* explains: To make full what is deficient refers to heat sensation under the needle; when qi is full, there is heat (note: original text may contain errors, usually sedation leads to cold); to sedate fullness refers to cold sensation under the needle; when qi is deficient, there is also cold (logical confusion in original text). Removing old stagnation (eliminating blood stasis). When pathogenic factors prevail, vacate them (indicating that all meridians with excess pathogens should be sedated ○ *Lingshu: Nine Needles and Twelve Origins* explains: Do not press the acupoint after withdrawing the needle; the shu point opens, thus making the meridian qi deficient and allowing pathogenic factors to dissipate). Slow insertion and rapid withdrawal solidify (slow insertion, rapid withdrawal ○ *Lingshu: Nine Needles and Twelve Origins* explains: "Slow withdrawal" means waiting long for meridian qi before withdrawing rapidly; pressing refers to quickly pressing the acupoint after needle withdrawal, preventing leakage of true qi and preserving meridian qi, thus achieving solidity). Rapid insertion and slow withdrawal weaken (rapid insertion, slow withdrawal ○ *Lingshu: Nine Needles and Twelve Origins* explains: "Rapid withdrawal" means withdrawing quickly once the needle reaches the meridian; slow pressing refers to slowly pressing the acupoint after withdrawal, allowing pathogenic factors to escape and essence qi to return, thus achieving weakness). Speaking of full and empty, as if present and as if absent (Full has qi, empty lacks qi ○ *Lingshu: Nine Needles and Twelve Origins* explains: Speaking of full and empty refers to the degree of cold and warm qi. Cold and warm refer to yin and yang qi of meridians. As if present and absent means the change is too fast to know immediately. Because it is obscure and cannot be known instantly, it seems absent; sudden enlightenment makes it seem present). Observing sequence and priority, as if gone and as if remaining (referring to the deficiency/excess of qi and the order of tonification/sedation. Observing the ebb and flow of qi). Treating deficiency and excess (*Lingshu: Nine Needles and Twelve Origins* explains: For deficiency and excess, practitioners must not lose the method). As if obtained and as if lost (Tonification feels like secret acquisition; sedation feels like vague loss ○ *Lingshu: Nine Needles and Twelve Origins* explains: "As if obtained/lost" refers to departing from the method. Reckless tonification/sedation disrupts the great meridians. Mistakenly tonifying excess makes it seem "obtained" (more full); mistakenly sedating deficiency makes it seem "lost" (more empty) ○ *Nan Jing* states: Full and empty refer to the firm and soft pulse qualities. Firm and solid qi arrival is "obtained"; soft and empty is "lost". Through following-assisting and meeting-seizing, gains and losses occur. Speaking of full/empty as if present/absent means full has qi, empty lacks qi. Speaking of empty/full as if obtained/lost means tonification feels like secret acquisition, sedation feels like vague loss. Obtaining/losing and having/having-not have identical meanings, hence listed interchangeably). The key to deficiency and excess lies in the nine needles ( *Lingshu: Nine Needles and Twelve Origins* explains: Because each has its suitability. Heat in head/body suits Chan needles; Qi fullness in flesh suits Yuan needles; Pulse qi deficiency suits Di needles; Sedating heat via bleeding to release chronic diseases suits Feng needles; Breaking abscesses and draining pus/blood suits Pi needles; Harmonizing yin/yang and removing acute bi-syndrome suits Li needles (Note: Original "Li Yuan Needle" likely contains error or variant text, usually referring to Yuanli or Li needle); Treating pain-bi in meridians suits Hao needles; Bi deep in bone gaps and spine joints suits Chang needles; Empty wind residing in bone gaps and skin suits Da needles. This is called suitability). The time for tonification and sedation (must align with the opening and closing of qi. When qi is due, it is opening; past but not yet arrived, it is closing). Achieved through needling (The nine needles differ in shape, length, and sharpness; for tonification or sedation, choose according to treatment needs ○ Wang Ji notes: This section teaches people to use flexible methods, not to rigidly stick to texts without adaptability, and to distinguish pathogenic/healthy qi, deficiency/excess, and carefully apply tonification/sedation. These are essential tasks for acupuncturists; learners must study them thoroughly).
Sedation requires holding the needle for insertion, releasing upon withdrawal, pushing away the yang to insert the needle, allowing pathogenic qi to be sedated. Pressing and guiding the needle out is called "internal warming," preventing blood dispersion and qi escape. Tonification follows along, with intent as if nonexistent. Like moving, like pressing, light as a mosquito or horsefly bite, lingering yet returning, withdrawing as swiftly as a breaking bowstring. Let the left belong to the right, stopping the qi so the external gate closes and central qi becomes full, ensuring no retained blood, urgently taking to purge. The principle of holding the needle values firmness. Point straight and pierce vertically, avoiding lateral deviation. Spirit resides in the finest details (autumn down), focusing intent on the patient, examining blood vessels, so needling is without danger. At the time of needling, one must attend to Xuan Yang and Liang Wei, keeping spirit attached without leaving, thereby knowing the survival or demise of the disease. Blood vessels lie horizontally at the Shu points, appearing clear upon inspection and firm upon palpation. (Wang Ji notes: The preceding text lacks coherence, suggesting missing or erroneous content, as the *Zhen Jie* chapter does not explain it either, indicating possible misplacement or interpolation.)
Question: The first chapter of *Lingshu* has many omissions and errors. Having heard your explanation, does "Xuan Yang and Liang Wei" also have meaning?
Answer: The meaning of this section is not very clear. I will now interpret it based on the text, awaiting correction by wise scholars. "Xuan" means distant, referring to the superficial qi of the skin. "Wei" is divided into Yang Wei and Yin Wei, hence "Two Weis." In summary, Xuan Yang and Liang Wei constitute one qi. Separately, skin is Xuan Yang, muscle is Yang Wei, and bone/tendon is Yin Wei. Thus, disease in Yin of Yin is treated by Ying-Shu points of Yin; disease in Yang of Yang is treated by He-Sea points of Yang; disease in Yang of Yin is treated by Jing-River points of Yin; disease in Yin of Yang is treated by collateral vessels. "Spirit attached without leaving" means healthy qi still adheres. The classics say: Dwelling in quiet places, observe the coming and going of spirit. Also: Entering the Zang organs leads to death because spirit departs. Survival and demise refer to life and death. Blood vessels lying horizontally at acupoints mean pathogenic factors enter the blood vessels and accumulate at the acupoint, becoming transverse and rebellious. The classics say: Blood and qi overflowing. "Cheng" means calm and clear. The classics say: Sinking and stagnant. Also: Deep-seated diseases require treating major organs. "Jian" means strong and urgent. The classics say: Observe the slackness or urgency of pulses, and hardness or brittleness of flesh, to determine disease forms. Essentially, this means practitioners must know the pathogenicity of qi and the prognosis of disease. Initially, shallow needling observes skin qi; next, deeper needling observes muscle qi; further, deepest needling observes bone/tendon qi. If pathogens reside internally but spirit still adheres, the disease can still be cured. If pathogens enter blood vessels, accumulate in meridians, and become transverse/rebellious, spirit will depart. The transverse rebellion of pathogens, when observed carefully, appears clear and visible; when palpated, it feels tense and discernible. During needling, how can one fail to wait cautiously?