帝曰形气之逆顺奈何岐伯曰形气不足病气有余是邪胜也急泻之形气有余病气不足急补之
形气
不足病气不足此阴阳俱不足也不可刺之刺之重不足重不足则阴阳俱竭血气皆尽五脏空虚筋骨
髓枯老者绝灭壮者不复矣形气有余病气有余此谓阴阳俱有余也急泻其邪调其虚实故曰有余者
泻之不足者补之此之谓也(灵枢)○刺不知逆顺其邪相搏满而补之则阴阳四溢肠胃充郭肝肺内
阴阳相错虚而泻之则经脉空虚血气枯竭肠胃HT 僻皮肤薄着毛腠夭焦子之死期故曰用针之要在
于
知调阴与阳调阴与阳精气乃光合形与气使神内藏故曰上工平气中工气脉下工绝气危生故曰下
工不可不慎也(灵枢)
帝曰何谓五夺岐伯曰形肉已脱是一夺也大失血之后是二夺也大汗出之后是三夺也大泄之
后是四夺也新产下血之后五夺也皆不可针泻(灵枢)
针刺虽有补泻之法予恐但有泻而无补焉经谓泻者迎而夺之以针迎其经脉之来气而出之
固可以
泻实也谓补者随而济之以针随其经脉之去气而留之未必能补虚也不然内经何以曰无刺 之
热
无刺浑浑之脉无刺漉漉之汗无刺大劳人无刺大饥人无刺大渴人无刺新饱人无刺大惊人又曰形
气
不足病气不足此阴阳皆不足不可刺刺之则重竭其气老者绝灭壮者不复矣若此等语皆有泻无补
之谓也凡虚损危病久病俱不宜用针(入门)
岐伯答：形体正气不足而病邪之气有余，这是邪气盛的表现，应当急用泻法；形体正气有余而病邪之气不足，应当急用补法。
如果形体正气不足，病邪之气也不足，这说明阴阳两虚，不可施针。如果误刺，会导致更加虚弱，阴阳俱竭，血气耗尽，五脏空虚，筋骨骨髓枯槁，老年人会因此死亡，强壮的人也无法恢复。
如果形体正气有余，病邪之气也有余，这叫做阴阳俱有余，应当急泻其邪气，调和虚实。所以说：“有余者用泻法，不足者用补法”，就是这个道理。（出自《灵枢》）
如果针刺时不知道逆顺原则，邪气就会相互搏结。实证反而用补法，会导致阴阳之气四溢，肠胃胀满，肝肺内部阴阳错乱；虚证反而用泻法，会导致经脉空虚，血气枯竭，肠胃痞塞，皮肤薄弱，毛腠焦枯，加速死亡。所以说，用针的关键在于懂得调和阴阳，调和阴阳则精气光明，使形与神相合，精神内守。所以说：上等的医生能平调气血，中等的医生调理脉象，下等的医生断绝生气、危及生命。所以说下等医生不可不谨慎。（出自《灵枢》）
黄帝问：什么叫“五夺”？
岐伯答：形体肌肉已经脱失，这是一夺；大失血之后，是二夺；大汗出之后，是三夺；大泄之后，是四夺；新产后出血，是五夺。这五种情况都不可用泻法针刺。（出自《灵枢》）
虽然针刺有补法和泻法，但我担心实际上只有泻法而没有补法。经书说，泻法是迎着经脉来气之时而夺取它，用针迎其经脉之来气而出之，固然可以泻实；所谓补法是随着经脉去气之时而济助它，用针随其经脉之去气而留之，未必能补虚。不然的话，《内经》为什么说要避免在发高热时针刺，避免在脉象浑浊混乱时针刺，避免在大汗淋漓时针刺，避免在大劳倦后针刺，避免在大饥饿时针刺，避免在大口渴时针刺，避免在刚吃饱时针刺，避免在大惊恐后针刺？又说：“形体正气不足，病邪之气也不足，这是阴阳皆不足，不可针刺，针刺则会使其气更加衰竭，老年人会死亡，强壮的人无法恢复。”像这样的话，都是有泻无补的说法。凡是虚损、危重、久病的患者，都不适宜用针刺。（出自《医学入门》）
The Yellow Emperor asked: What is the relationship of reversal and順 (shun, smooth/normal) between Xingqi (Form-Qi) and Bingqi (Pathogenic-Qi)?
Qibo replied: When Xingqi (Form-Qi, the body's constitutional energy) is insufficient while Bingqi (Pathogenic-Qi, the pathogenic factor's strength) is excessive, this indicates an excess of pathogenic factors; one should urgently apply the reducing method (Xie). When Xingqi (Form-Qi) is excessive while Bingqi (Pathogenic-Qi) is insufficient, one should urgently apply the reinforcing method (Bu).
If both Xingqi (Form-Qi) and Bingqi (Pathogenic-Qi) are insufficient, this signifies a deficiency of both Yin and Yang. Needling should not be performed. If needled, it will cause severe deficiency. Severe deficiency leads to the exhaustion of both Yin and Yang, the depletion of blood and Qi, emptiness of the five Zang organs, and withering of sinews, bones, marrow, and tendons. The elderly will perish, and even the robust will fail to recover.
If both Xingqi (Form-Qi) and Bingqi (Pathogenic-Qi) are excessive, this is termed an excess of both Yin and Yang. One should urgently reduce the pathogenic factors and regulate the excesses and deficiencies. Thus it is said: "For excess, use reduction; for deficiency, use reinforcement." This is what is meant (from *Ling Shu*).
If one does not understand the principles of reversal and shun (smooth/normal) in needling, pathogenic factors will contend with each other. Applying reinforcement to an excess condition causes Yin and Yang energies to scatter excessively, leading to distension and fullness of the intestines and stomach, and internal disorder of Yin and Yang in the liver and lungs. Applying reduction to a deficiency condition causes emptiness in the meridians, depletion of blood and Qi, stagnation in the intestines and stomach, thinning of the skin, withering of hair and pores, and accelerates death. Therefore, the key to using needles lies in knowing how to harmonize Yin and Yang. Harmonizing Yin and Yang makes Jingqi (Essential-Qi) bright; combining form and Qi allows Shen (Spirit) to be stored within. Thus it is said: The superior physician regulates Qi; the average physician regulates pulses; the inferior physician cuts off Qi and endangers life. Therefore, the inferior physician must be extremely cautious (from *Ling Shu*).
The Yellow Emperor asked: What are the "Five Deprivations" (Wu Duo)?
Qibo replied: Emaciation and loss of flesh and muscle constitute the first deprivation. Following massive blood loss constitutes the second deprivation. Following profuse sweating constitutes the third deprivation. Following severe diarrhea constitutes the fourth deprivation. Postpartum bleeding constitutes the fifth deprivation. In all these cases, needle reduction (Xie) must not be used (from *Ling Shu*).
Although needling possesses methods of reinforcement and reduction, I fear that in practice there may only be reduction without true reinforcement. The classics state that reduction involves meeting the incoming Qi of the meridian and seizing it; by inserting the needle against the direction of the meridian's incoming Qi and withdrawing it, one can indeed reduce excess. It is said that reinforcement involves following the outgoing Qi of the meridian and retaining the needle; however, by following the meridian's outgoing Qi and retaining it, one may not necessarily tonify deficiency. Otherwise, why does the *Nei Jing* (Inner Canon) say: Do not needle when there is high fever; do not needle when the pulse is chaotic and confused; do not needle when there is profuse dripping sweat; do not needle after great labor; do not needle when greatly hungry; do not needle when greatly thirsty; do not needle immediately after a full meal; do not needle after great fright? It also states: "When Xingqi (Form-Qi) is insufficient and Bingqi (Pathogenic-Qi) is insufficient, this means both Yin and Yang are deficient, and needling is contraindicated. Needling will cause further exhaustion of Qi; the elderly will perish, and the robust will not recover." Such statements refer to the concept of having reduction but no reinforcement. Generally, patients with deficiency, critical illness, or chronic disease are not suitable for needling (from *Yi Men Ru Men*).