七十一难曰∶经言刺荣无伤卫、刺卫无伤荣、何谓也？
然∶针阳者，卧针而刺之；刺阴者，先
以左手摄按所针荣俞之处，气散乃内针。是谓刺荣无伤卫，刺卫无伤荣也。
营卫者，血气之道路，以阴阳而分表里者也。营为阴，卫为阳，营行脉中属里，卫行脉外属
表，若营卫有病，各中其所，不得诛伐无过也。《素问·刺齐论》曰∶刺骨无伤筋，刺筋无伤肉，
刺肉无伤脉、刺脉无伤皮；刺皮无伤肉，刺肉无伤筋，刺筋无伤骨，亦此义也。卫为外表，阳
行于脉外，欲其浅，故刺卫者，宜卧针而刺之，以阳气轻浮，过之恐伤营也。营为里，阴行于
脉中，欲其深过卫，始可至营也，故刺营者，先以左手摄按所刺之穴良久，使卫气渐散离其处，
然后内针，则针得至营，而不伤卫矣。此刺阳刺阴之道也。
七十二难曰∶经言能知迎随之气，可令调之，调气之方，必在阴阳，何谓也？
然∶所谓迎随
者，知荣卫之流行，经脉之往来也。随其逆顺而取之，故曰迎随。
经言，《灵枢·终始篇》曰∶阳受气于四末，阴受气于五脏，故泻者迎之，补者随之，知迎知
随，气可令和，和气之方，必通阴阳，是迎随之法，补泻之道也。阳经主外，故从四末始，阴
经主内，故从五脏始。迎者，针锋迎其气之方来而未盛，以夺之也。随者，针锋随其气之方去
而未虚，以济之也。然必知营卫之流行，经脉之往来，知之而后可察病之阴阳逆顺，随其所当
而施补泻也。
调气之方，必在阴阳者，知其内外表里，随其阴阳而调之，故曰∶调气之方，必在阴阳。
调气之方，必在阴阳者，在，察也。内为阴而主里，外为阳而主表，察其病在阴在阳，是虚
是实，而补之泻之，或从阳引阴，或从阴引阳，或阳病治阴，或阴病治阳，而令其调和也。杨
氏曰∶阴虚阳实者，则补阴泻阳，阳虚阴实者，则补阳泻阴。或阳并于阴，阴并于阳，或阴阳
俱虚，或阴阳俱实，皆随其病之所在而调之，则病无不已也。
按∶针法言补，不可深泥，丹溪亦常论之，非无谓也。《素问·阴阳应象大论》曰∶形不足者，
温之以气，精不足者，补之以味。针乃砭石所制，既无气，又无味，破皮损肉，发窍于身，气
皆从窍而出，何得为补？经谓气血阴阳俱不足，勿取以针，和以甘药者是也。然《内》《难》凿
言补泻之法者何耶？夫读书贵乎融贯，不可胶刻。迎而夺之，因属泻其实邪，随其济之，亦可
去其虚邪。盖邪去则正安，去邪即所以补正，非针法之补，能生长血气也。仲景治虚劳伤其营
卫者，以大黄 虫丸主之，方中多属攻药，以瘀血去，肺气利，则新血自生，正气自复，而营
卫行，营卫行则肌肉充，而虚劳补矣。此先圣后贤，其意一也。将谓针法之补，可代参地，则
《灵枢·根结篇》何以有营气不足，病气不足，此阴阳气俱不足也，不可刺之，刺之则重不足，
重不足则阴阳俱竭，血气皆尽，五脏空虚，筋骨髓枯，老者绝灭，壮者不复之说。若明乎此，
补泻非可以一法尽，岂独针刺之无误，即汤药亦不致南辕北辙矣。
第七十一难说：医经中说“刺荣不要伤卫，刺卫不要伤荣”，这是什么意思呢？
回答说：针刺阳分（卫气所在），要平卧针身进行刺入；针刺阴分（营气所在），先用左手按压所要针刺的荣穴部位，待局部气机散开后，再将针插入。这就叫做刺荣不伤卫，刺卫不伤荣。
营气和卫气，是血气运行的通道，以阴阳来区分表里关系。营属阴，行于脉中而归属于里；卫属阳，行于脉外而归属于表。如果营卫发生病变，应当各针对其病所进行治疗，不能诛伐无辜的健康部分。《素问·刺齐论》中说：“刺骨不要伤筋，刺筋不要伤肉，刺肉不要伤脉，刺脉不要伤皮；刺皮不要伤肉，刺肉不要伤筋，刺筋不要伤骨”，也是这个道理。卫气位于体表，阳气运行于脉外，治疗时宜浅刺，所以刺卫气时，适宜平卧针身刺入，因为阳气轻浮，若刺得太深恐怕会损伤营气。营气位于体内，阴气运行于脉中，需要深入越过卫气层，才能到达营气所在，所以刺营气时，先用左手按压穴位良久，使卫气逐渐消散离开该处，然后再进针，这样针就能到达营气所在，而不损伤卫气了。这就是刺阳分和刺阴分的要领。
第七十二难说：医经中说“懂得迎随补泻的气机变化，就可以调和气血，调和气血的方法，关键在于阴阳”，这是什么意思呢？
回答说：所谓迎随，就是了解营卫之气的流行规律和经脉气血的往来走向。顺着或逆着气血的流向进行取穴施治，所以称为迎随。
医经指出，《灵枢·终始篇》说：“阳经之气受纳于四肢末端，阴经之气受纳于五脏”，所以泻法要迎着气来的方向（迎），补法要跟着气去的方向（随）。懂得迎随之法，气血就可以平和。调和气血的方法，必须通达阴阳的道理，这就是迎随补泻的原则。阳经主司体表，所以从四肢末端开始；阴经主司体内，所以从五脏开始。迎法，是指针尖迎着邪气方来而未盛之时，以削弱其实邪；随法，是指针尖随着正气方去而未虚之时，以资助其不足。然而必须了解营卫的流行和经脉的往来，了解了这些之后，才能察看病证的阴阳逆顺，根据具体情况施行补泻。
调和气血的方法，关键在于阴阳，意思是明了内外表里的关系，顺应阴阳的变化来调和它，所以说“调和气血的方法，关键在于阴阳”。这里的“在”，意为审察。内为阴而主里，外为阳而主表，审察病位在阴还是在阳，是虚证还是实证，从而施行补法或泻法，或者从阳引阴，或者从阴引阳，或者阳病治阴，或者阴病治阳，从而使机体恢复调和。杨氏说：阴虚阳实的，就补阴泻阳；阳虚阴实的，就补阳泻阴。或者是阳并入阴，阴并入阳，或者阴阳俱虚，或者阴阳俱实，都随着病邪所在的部位进行调理，那么疾病就没有不痊愈的。
按语：关于针刺补法的说法，不可拘泥死板，朱丹溪也常论述这一点，并非没有道理。《素问·阴阳应象大论》说：“形体虚弱不足的，用气来温养它；精气虚弱不足的，用味来滋补它。”针是由砭石制成的，既没有气也没有味，它会破皮伤肉，在身体上开启孔窍，导致气从孔窍中泄出，怎么能起到补益作用呢？经文说气血阴阳都不足的，不要用针刺治疗，而应用甘缓的药物来调和，就是这个意思。然而《内经》和《难经》为何明确记载补泻的方法呢？读书贵在融会贯通，不可固执刻板。迎着邪气夺其有余，属于泻除实邪；随着正气济其不足，也可以祛除虚邪。大概邪气去除则正气安宁，去除邪气也就是扶助正气，并不是针刺这种物理方法能直接生长血气。张仲景治疗虚劳损伤营卫的情况，用大黄䗪虫丸为主方，方中多属攻逐瘀血之药，因为瘀血去除，肺气宣利，新血自然生成，正气自然恢复，营卫得以运行，营卫运行则肌肉充实，虚劳也就治愈了。这是先圣后贤，用意是一致的。如果说针刺的补法可以代替人参、地黄等药物，那么《灵枢·根结篇》为什么会有“营气不足，病气不足，这是阴阳之气都不足，不可针刺，针刺则会加重不足，严重不足则阴阳俱竭，血气耗尽，五脏空虚，筋骨骨髓枯槁，老年人会死亡，强壮的人也不能恢复”的说法呢？如果明白这个道理，就知道补泻不能只用一种方法，不仅针刺不会出错，即使是使用汤药，也不会出现南辕北辙的错误了。
Chapter 71 states: The classic texts say, "When penetrating Ying (Nutrient) [Ying Qi, the nutrient aspect of vital energy circulating within the vessels], do not injure Wei (Defensive) [Wei Qi, the defensive aspect of vital energy circulating outside the vessels]; when penetrating Wei, do not injure Ying." What does this mean?
Reply: When needling Yang aspects (where Wei Qi resides), insert the needle horizontally (lying flat against the skin); when needling Yin aspects (where Ying Qi resides), first use the left hand to press and hold the acupoint designated for Ying penetration. Once the local Qi has dispersed, then insert the needle. This is what is meant by "penetrating Ying without injuring Wei, and penetrating Wei without injuring Ying."
Ying and Wei are the pathways through which Blood and Qi circulate, distinguished by Yin and Yang as interior and exterior respectively. Ying belongs to Yin, circulates within the vessels, and is associated with the Interior; Wei belongs to Yang, circulates outside the vessels, and is associated with the Exterior. If Ying or Wei becomes diseased, treatment should target the specific location of the pathology, avoiding harm to healthy tissues. *Su Wen · Ci Qi Lun* states: "When needling bone, do not injure tendon; when needling tendon, do not injure flesh; when needling flesh, do not injure vessel; when needling vessel, do not injure skin; when needling skin, do not injure flesh; when needling flesh, do not injure tendon; when needling tendon, do not injure bone." This illustrates the same principle. Wei is superficial, and Yang Qi circulates outside the vessels, requiring shallow needling. Therefore, when needling Wei, it is appropriate to insert the needle horizontally, because Yang Qi is light and floating; excessive depth might injure Ying. Ying is deep, and Yin Qi circulates within the vessels. One must penetrate deeply, passing through the Wei layer, to reach Ying. Thus, when needling Ying, one first presses the acupoint firmly with the left hand for a prolonged period to allow Wei Qi to gradually disperse from that area. Only then is the needle inserted, allowing it to reach Ying without injuring Wei. This is the method for needling Yang and Yin aspects.
Chapter 72 states: The classic texts say, "If one understands the Qi of Ying (meeting/opposing) and Sui (following), one can regulate it. The method for regulating Qi must lie in Yin and Yang." What does this mean?
Reply: By "Ying" and "Sui," we refer to understanding the circulation of Ying and Wei Qi and the flow of Jing Mai (Meridians). Following or opposing the direction of flow allows for selection of points, hence the term Ying Sui.
The classics state: *Ling Shu · Zhong Shi Pian* says, "Yang Jing receive Qi from the four extremities, while Yin Jing receive Qi from the Zang organs." Therefore, the reducing method (Xie) involves opposing the Qi (Ying), and the reinforcing method (Bu) involves following the Qi (Sui). Knowing Ying and Sui allows the Qi to harmonize. The method for harmonizing Qi must communicate with Yin and Yang; this is the method of Ying Sui and the path of Bu Xie (reinforcing and reducing). Yang Jing govern the exterior, so they begin at the four extremities; Yin Jing govern the interior, so they begin at the Zang organs. "Ying" means the needle tip opposes the direction where Qi is arriving but has not yet become excessive, thereby draining excess. "Sui" means the needle tip follows the direction where Qi is departing but has not yet become deficient, thereby assisting insufficiency. However, one must know the circulation of Ying and Wei and the flow of Jing Mai. Only after knowing these can one observe the Yin-Yang and reverse/forward nature of the disease and apply Bu or Xie according to what is appropriate.
"The method for regulating Qi must lie in Yin and Yang" means understanding the interior and exterior, and regulating according to Yin and Yang. Hence, "the method for regulating Qi must lie in Yin and Yang." Here, "lie in" implies examination. The interior is Yin and governs the Interior; the exterior is Yang and governs the Exterior. Examine whether the disease is in Yin or Yang, whether it is deficiency or excess, and apply Bu or Xie accordingly. Or draw Yin from Yang, or draw Yang from Yin; treat Yin diseases via Yang, or treat Yang diseases via Yin, to achieve harmony. Master Yang said: In cases of Yin deficiency and Yang excess, tonify Yin and reduce Yang; in cases of Yang deficiency and Yin excess, tonify Yang and reduce Yin. Whether Yang merges into Yin, Yin merges into Yang, both Yin and Yang are deficient, or both are excessive, regulate according to the location of the disease, and the illness will surely be cured.
Commentary: Regarding the theory of needle reinforcement, one should not adhere rigidly to it. Zhu Danxi often discussed this, and his remarks were not without merit. *Su Wen · Yin Yang Ying Xiang Da Lun* states: "For those lacking form, warm them with Qi; for those lacking essence, tonify them with Flavor." Needles are made from Bian stones; they possess neither Qi nor Flavor. They break the skin and damage flesh, opening apertures on the body, causing Qi to exit through these apertures. How can this constitute tonification? The classics state that when Qi, Blood, Yin, and Yang are all insufficient, one should not use needles, but rather harmonize with sweet medicines. This is correct. Then why do *Nei Jing* and *Nan Jing* explicitly describe methods of Bu and Xie? Reading requires integration, not rigidity. Opposing and draining belongs to reducing excess pathogens; following and assisting can also eliminate deficiency pathogens. Generally, when pathogens are removed, Zheng Qi (Upright Qi) is secured; removing pathogens is itself a way of supporting Zheng Qi. It is not that needle techniques can directly generate Blood and Qi. Zhang Zhongjing treated Xu Lao (Consumptive Disease) damaging Ying and Wei using Da Huang Zhe Chong Wan. The formula contains many attacking drugs; once blood stasis is removed and Lung Qi is unobstructed, new Blood generates naturally, Zheng Qi recovers, Ying and Wei circulate, Ying and Wei circulation fills the muscles, and Xu Lao is cured. The intent of ancient sages and later experts is consistent. If one claimed that needle reinforcement could replace herbs like Renshen (Ginseng Root) and Dihuang (Rehmannia Root), how could one explain *Ling Shu · Gen Jie Pian*, which states: "When Ying Qi is insufficient and Bing Qi (Pathogenic Qi) is insufficient, this indicates insufficiency of both Yin and Yang Qi, which cannot be needled. Needling such cases leads to repeated insufficiency; repeated insufficiency leads to exhaustion of both Yin and Yang, depletion of Blood and Qi, emptiness of the Five Zang, withering of tendons and marrow, death for the elderly, and inability to recover even for the strong." If one understands this, one realizes that Bu and Xie cannot be reduced to a single method. Not only will needle techniques avoid error, but even decoction therapy will not go astray.