经曰∶不能治其虚，何问其余，此之谓也。（言治金虚之法当如此，不可止取一经以为补泻也。若此义不明，则治虚
之法且不能，安能治他病乎？二语经文无考。）
七十六难曰∶何谓补泻？当补之时，何所取气？当泻之时，何所置气？（言取何气以为补；而其所泻之气，则置之
何地也。）
然∶当补之时，从卫取气；当泻之时，从营置气。（卫主气，故取气于卫。其法详下七十八难中。从营置气，
谓散其气于营中也。）其阳气不足，阴气有余，当先补其阳，而后泻其阴；阴气不足，阳气有余，当先补其阴，而后泻其
阳。（此承上文而言补泻之法，尤当审其阴阳虚实也。卫为阳，营为阴，卫虚而营实，则补阳泻阴；营虚而卫实，则补阴
泻阳，而其补泻之法，则又有先后也。《灵·终始篇》云∶“阴盛而阳虚，先补其阳，后泻其阴而和之；阴虚而阳盛，先
补其阴，后泻其阳而和之。”此其说之所本也。）营卫通行，此其要也。（阴阳得其平，则营卫之气通畅流行矣。要，谓要
法也。）
七十七难曰∶经言上工治未病，中工治已病者，何谓也？
然∶所谓治未病者，见肝之病，则知肝当传之与脾，（木旺
侮土也。）故先实其脾气，无令得受肝之邪，（补其脾气，则能御肝，不受克贼也。）故曰治未病焉。中工治已病者，见肝
之病，不晓相传，但一心治肝，（专治肝而肝邪入脾，则脾又病，经所谓“故病未已，新病复起”者也。）故曰治已病也。
七十八难曰∶针有补泻，何谓也？
然∶补泻之法，非必呼吸出内针也。（《素·离合真邪论》云∶“吸则内针，无令气
忤，……候呼引针，呼尽乃去，大气皆出，故命曰泻。……呼尽内针，静以久留，以气至为故，……候吸引针，气不得
出，各在其处，推合其门，令神气存，大气留止，故命曰补。”此呼吸出内之法，越人以为其道不尽于此，当如下文所云
也。）知为针者，信其左；不知为针者，信其右。（信其左，谓其法全在善用其左手，如下文所云是也。信其右，即上呼
吸出内针也。持针以右手，故曰信其右。）当刺之时，（一本有必字）先以左手厌按所针荥、俞之处，弹而努之，（弹，指
击也。努，揉也。）爪而下之，（以爪掐至肉中也。）其气之来，如动脉之状，（动其血气，则气来聚如脉口之动，此左手
所候之气也。）顺针而刺之，得气，（谓气至针，此针下所候之气也。）因推而内之，（推入其针，气亦从之入也。）是谓补；
动而伸之，（谓摇动而引出其气也。）是谓泻。不得气，乃与男外女内；（男则候之于卫之外，女则候之于营之内。）不得
气，是谓十死不治也。（候气而气不至，则营卫已脱，针必无功。十死，言无一生也。）
七十九难曰∶经言迎而夺之，安得无虚？随而济之，安得无实？虚之与实，若得若失；实之与虚，若有若无，何谓
也？
然∶迎而夺之者，泻其子也；随而济之者，补其母也。（迎随，解见七十二难。经语见《灵·九针十二原篇》。按此
子母即以本经井、俞所属五行生克言，非如七十五难指五脏所属子母也。）假令心病，泻手心主俞，是谓迎而夺之者也；
补手心主井，是谓随而济之者也。（心病属火，本当取荥。阴受气于五脏，其经气从俞及荥、及井，泻俞则迎其来处而夺
之，俞属土，心之子也；补井则随其去处而济之，井属木，心之母也。）
所谓实之与虚者，牢濡（一作濡牢）之意也。气来实牢者为得，濡虚者为失，故曰若得若失也。（气，指针下之气也。
其气来而充实坚牢为得，濡弱虚微为失，言得失则有无在其中矣。）
八十难曰∶经言有见如入，有见如出者，何谓也？（二句经文无考）
然∶所谓有见如入者，谓左手见气来至，乃内
针，（即七十八难所谓“动脉之状”是也。滑氏谓∶“有见如入下当欠有见如出四字。”）针入见气尽，乃出针。（气尽，其
气来而复散也。）是谓有见如入，有见如出也。（滑氏《本义》∶“如读若‘而'”，古字通用。）
八十一难曰∶经言无实实，无虚虚，损不足而益有余，（言实者宜泻，而反补之；虚者宜补，而反泻之；不足者，反
损之；有余者，反益之，皆误治也。经文见《灵·九针十二原篇》。）是寸口脉耶？将病自有虚实耶？（一作也。言所谓
虚实者，不知其指脉言，抑指病言也。）其损益奈何？（言其损益之法，将何如而得也。）
然∶是病，非谓寸口脉也，谓
病自有虚实也。假令肝实而肺虚，肝者木也，肺者金也，金木当更相平，（说详七十五难中。）当知金平木。（言当泻南方、
补北方也。）假令肺实而（一作故知两字。）肝虚，微少气，用针不补其肝，而反重实其肺，（如此则肺益甚，而肝益虚矣。）
故曰实实虚虚，损不足而益有余。此者，中工之所害也。（害，谓不惟不能治其病，而反害其人也。）
《难经》中说：不能治疗虚证，还谈什么其他病症？说的就是这个意思。（意思是治疗肺金虚损的方法应当如此，不能只针对某一条经脉进行补泻。如果这个道理不明白，那么连治疗虚证的方法都掌握不了，又怎么能治疗其他疾病呢？这两句经文在原文中已无法考证。）
第七十六难问：什么是补法、什么是泻法？当使用补法时，要摄取哪里的正气？当使用泻法时，要把邪气放置到哪里？（意思是摄取何种正气来作为补益；而所泻出的邪气，则将其消散到何处。）
回答说：当使用补法时，从卫分摄取正气；当使用泻法时，从营分散失邪气。（卫气主管气，所以从卫分摄取正气。具体方法详见下文第七十八难。从营分散失邪气，是指将邪气消散在营分之中。）如果阳气不足，阴气有余，应当先补其阳，而后泻其阴；如果阴气不足，阳气有余，应当先补其阴，而后泻其阳。（这是承接上文来说明补泻的方法，尤其应当审察阴阳的虚实情况。卫属阳，营属阴，卫虚而营实则补阳泻阴；营虚而卫实则补阴泻阳，而其补泻的顺序又有先后之分。《灵枢·终始篇》说：“阴盛而阳虚，先补其阳，后泻其阴以调和之；阴虚而阳盛，先补其阴，后泻其阳以调和之。”这种说法就是依据这一理论。）营卫之气通畅运行，这是关键所在。（阴阳达到平衡，那么营卫之气就能通畅流行。所谓“要”，指的是关键的方法。）
第七十七难问：经书说上工（高明的医生）治未病，中工（一般的医生）治已病，这是什么意思？
回答说：所谓治未病，是看到肝脏有病，就知道肝病会传变给脾脏，（因为肝木旺盛会克制脾土。）所以预先使脾气充实，不让脾脏受到肝邪的侵害，（补益脾气，就能抵御肝木的克制。）所以称为治未病。中工治已病，是看到肝脏有病，不懂得脏腑相传的道理，只是一心治疗肝脏，（专门治疗肝脏，导致肝邪传入脾脏，脾脏又生病，这就是经书所说的“旧病未愈，新病又起”。）所以称为治已病。
第七十八难问：针刺有补法和泻法，是什么意思？
回答说：补泻的方法，不一定非要在呼吸进出针。（《素问·离合真邪论》说：“吸气时进针，不要让正气逆乱，……等到呼气时引针，呼尽时才拔针，大气随之排出，所以称为泻。……呼气时进针，安静地长时间留针，以得气为度，……等到吸气时拔针，气不得外出，各守其位，推合针孔，使神气留存，大气留止，所以称为补。”这种随呼吸进出针的方法，越人认为其道并不仅限于此，应当像下文所说的那样。）懂得针刺的人，信赖左手；不懂针刺的人，信赖右手。（信赖左手，是指方法全在于善用左手，如下文所述。信赖右手，即上述随呼吸进出针的方法。持针用右手，所以叫信赖右手。）当针刺的时候，（有的版本有“必”字）先用左手按压所针的荥穴、俞穴部位，弹击并揉按，（弹，指敲击。努，揉按。）用指甲掐切至肉中，（用指甲掐入肌肉深处。）此时手下感觉气的到来，如同动脉跳动一样，（触动血气，气汇聚而来如脉搏跳动，这是左手所候察到的气。）顺着针势刺入，得气，（指气至针下，这是针下所候察的气。）于是推进针身，（推入针具，气也随着进入体内。）这叫做补；摇动并拔出针身，（指摇动并将气引出体外。）这叫做泻。如果不得气，就根据男女区别对待；（男性则在卫分之外候气，女性则在营分之内候气。）如果仍不得气，这就叫做十死不治。（候气而气不至，说明营卫之气已脱失，针刺必然无效。十死，是说没有一生还的可能。）
第七十九难问：经书说迎而夺之，怎么会不虚？随而济之，怎么会不实？虚与实，好像得到又好像失去；实与虚，好像存在又好像不存在，这是什么意思？
回答说：迎而夺之，是泻其子穴；随而济之，是补其母穴。（迎随的含义，解释见第七十二难。经文出处见《灵枢·九针十二原篇》。按此处的子母是指本经井、荥、输、经、合五输穴所属五行的生克关系，不像第七十五难那样指五脏之间的子母关系。）例如心病，泻手厥阴心包经的俞穴，这叫迎而夺之；补手厥阴心包经的井穴，这叫随而济之。（心病属火，本当取荥穴。阴经受气于五脏，其经气从俞穴流向荥穴、再流向井穴，泻俞穴是迎着气来的方向而夺之，俞穴属土，是心的子穴；补井穴是顺着气去的方向而济之，井穴属木，是心的母穴。）
所谓实与虚，是指针下感觉坚实或濡软的意思。气感来得坚实牢靠的是得气，濡弱虚微的是失气，所以说好像得到又好像失去。（气，指针下的气感。气感来而充实坚牢为得，濡弱虚微为失，言得失则有无之意包含其中了。）
第八十难问：经书说有见如入，有见如出，是什么意思？（这两句经文在原文中已无法考证）
回答说：所谓有见如入，是指左手见到气来至，才进针，（即第七十八难所说的“如动脉之状”。滑寿先生认为：“有见如入下面应当欠‘有见如出’这四个字。”）针入后见到气散尽，才出针。（气尽，指气来而复散。）这叫做有见如入，有见如出。（滑寿《难经本义》：“如”通读作“而”，古字通用。）
第八十一难问：经书说不要实实，不要虚虚，损伤不足的，增加有余的，（意思是实证应该泻，却反而补它；虚证应该补，却反而泻它；不足的，反而损伤它；有余的，反而增益它，这都是误治。经文出处见《灵枢·九针十二原篇》。）这是指寸口脉而言吗？还是指疾病本身自有虚实呢？（一作“也”。意思是所谓的虚实，不知道是指脉象而言，还是指疾病而言。）其损益的方法是怎样的？（意思是其补益和削减的方法，究竟如何操作才能正确？）
回答说：这是指疾病，不是指寸口脉，而是指疾病本身自有虚实。例如肝实而肺虚，肝属木，肺属金，金木应当互相制约平衡，（详细说明见第七十五难。）应当知道金能平木。（意思是应当泻南方之火、补北方之水，以制衡肝木。注：此处徐灵胎注疏有误，通常金平木指泻肺补肝或直泻肝木，但原文语境结合前文五行生克，此处徐氏注疏意在解释如何通过五行调节达到平衡，具体操作需结合上下文理解，此处仅翻译原文及注疏内容）。例如肺实而（一作“故知”）肝虚，气息微弱，用针不补其肝，反而加重补益其肺，（这样则肺更实，而肝更虚。）所以叫做实实虚虚，损伤不足而增加有余。这是中工（一般医生）造成的危害。（害，指不仅不能治病，反而伤害病人。）
The Classic says: "If one cannot treat deficiency, what is the point of discussing other conditions?" This refers to this principle. (It means that the method for treating Lung Metal deficiency should be as follows; one should not merely focus on tonifying or draining a single meridian. If this principle is not understood, then one cannot even master the methods for treating deficiency, let alone other diseases. These two sentences from the classic text are untraceable.)
Difficulty 76 asks: What are tonification and sedation? When tonifying, where should one draw Qi from? When sedating, where should one disperse the Qi? (This refers to drawing which Qi for tonification; and where the sedated Qi should be dispersed.)
The answer is: When tonifying, draw Qi from the Wei (Defensive) level; when sedating, disperse Qi into the Ying (Nutritive) level. (Wei governs Qi, so Qi is drawn from Wei. The method is detailed in Difficulty 78 below. Dispersing Qi into Ying means dissipating the pathogenic Qi within the Ying level.) If Yang Qi is insufficient and Yin Qi is excessive, one should first tonify Yang and then sedate Yin; if Yin Qi is insufficient and Yang Qi is excessive, one should first tonify Yin and then sedate Yang. (This continues the discussion on tonification and sedation methods, emphasizing the need to carefully assess the excess and deficiency of Yin and Yang. Wei is Yang, Ying is Yin. If Wei is deficient and Ying is excess, tonify Yang and sedate Yin; if Ying is deficient and Wei is excess, tonify Yin and sedate Yang. The order of tonification and sedation has precedence. The *Ling Shu · Zhong Shi Pian* states: "When Yin is excess and Yang is deficient, first tonify Yang, then sedate Yin to harmonize; when Yin is deficient and Yang is excess, first tonify Yin, then sedate Yang to harmonize." This theory is based on this principle.) The free circulation of Ying and Wei Qi is the key. (When Yin and Yang are balanced, the Qi of Ying and Wei flows smoothly. "Key" refers to the essential method.)
Difficulty 77 asks: The classics state that superior physicians treat disease before it arises, while average physicians treat disease after it has arisen. What does this mean?
The answer is: Treating disease before it arises means seeing Liver disease and knowing that the Liver will transmit the pathogen to the Spleen. (Excessive Liver Wood insults Spleen Earth.) Therefore, one first strengthens the Spleen Qi to prevent it from receiving the Liver pathogen. (Tonifying Spleen Qi enables it to resist Liver overacting.) Thus, it is called treating disease before it arises. Average physicians treat disease after it has arisen by seeing Liver disease but failing to understand the transmission between organs, focusing solely on treating the Liver. (Specializing only in treating the Liver allows Liver pathogen to enter the Spleen, causing Spleen disease, which is what the classics refer to as "the old disease is not yet resolved, a new disease arises.") Thus, it is called treating disease after it has arisen.
Difficulty 78 asks: Acupuncture has tonification and sedation methods. What do they mean?
The answer is: The methods of tonification and sedation do not necessarily rely on respiration for inserting and withdrawing the needle. (*Su Wen · Li He Zhen Xie Lun* states: "Insert the needle during inhalation... withdraw during exhalation... this is called sedation... Insert during exhalation... retain quietly until Qi arrives... withdraw during inhalation... this is called tonification." Yu Bo Yue considered that the method of respiration-based insertion/withdrawal was not exhaustive and should follow the description below.) Those who understand acupuncture trust the left hand; those who do not understand acupuncture trust the right hand. (Trusting the left hand means the technique relies entirely on skillful use of the left hand, as described below. Trusting the right hand refers to the respiration-based method mentioned above. Holding the needle with the right hand is why it is called trusting the right hand.) At the time of needling, (some versions have the character "bi" [must]) first press the Ying and Shu points with the left hand, flick and rub them, (Flick means tapping. Rub means kneading.) press down with fingernails, (pressing nails into the flesh.) The arrival of Qi feels like a pulsating artery, (Stirring blood and Qi causes Qi to gather like a pulse at the wrist, which is the Qi sensed by the left hand.) insert the needle along this direction, obtain Deqi, (Qi arriving at the needle, which is the Qi sensed under the needle.) then push the needle inward, (Pushing the needle in, Qi enters with it.) this is called tonification; move and extend the needle, (Shaking and withdrawing to draw out Qi,) this is called sedation. If Deqi is not obtained, differentiate by gender; (For men, await Qi outside the Wei level; for women, await Qi inside the Ying level.) If Deqi is still not obtained, it is termed "ten deaths, untreatable." (If Qi does not arrive upon awaiting, Ying and Wei Qi have departed, and acupuncture will be ineffective. "Ten deaths" implies no chance of survival.)
Difficulty 79 asks: The classics say "Attack and deprive," how can it not result in deficiency? "Follow and assist," how can it not result in excess? Deficiency and excess seem like gaining and losing; excess and deficiency seem like existing and non-existing. What does this mean?
The answer is: "Attack and deprive" refers to sedating the Son element; "Follow and assist" refers to tonifying the Mother element. (The meaning of Follow and Attack is explained in Difficulty 72. The classic quote is from *Ling Shu · Jiu Zhen Er Shi Yuan Pian*. Note that here, Mother and Son refer to the Five Elements generation and restriction relationships of the Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points of the same meridian, unlike Difficulty 75 which refers to the Mother-Son relationship between Zang organs.) For example, in Heart disease, sedating the Shu point of the Pericardium meritory is called "Attack and deprive"; tonifying the Jing-Well point of the Pericardium meridian is called "Follow and assist." (Heart disease belongs to Fire, and typically the Ying-Spring point should be selected. Yin Qi is received by the Zang organs, and its meridian Qi flows from Shu to Ying-Spring to Jing-Well. Sedating the Shu point attacks the source of incoming Qi; Shu belongs to Earth, the Son of Heart Fire. Tonifying the Jing-Well point follows the outgoing Qi; Jing-Well belongs to Wood, the Mother of Heart Fire.)
The terms "excess" and "deficiency" refer to the sensation of firmness or softness under the needle. A firm and solid Qi sensation indicates success (Deqi); a soft and weak sensation indicates failure. Hence, it is said to be like gaining and losing. (Qi refers to the sensation under the needle. Firm and solid Qi arrival is success; soft and weak Qi arrival is failure. Discussing gain and loss encompasses existence and non-existence.)
Difficulty 80 asks: The classics mention "See and enter, see and exit." What does this mean? (These two sentences from the classic text are untraceable.)
The answer is: "See and enter" means that when the left hand senses the arrival of Qi, the needle is inserted. (This is the "pulsating artery" sensation mentioned in Difficulty 78. Hua Shi stated: "Under 'see and enter,' the four characters 'see and exit' should be missing.") After the needle is inserted, when the Qi sensation dissipates, the needle is withdrawn. (Qi dissipation means the Qi comes and then scatters.) This is called "see and enter, see and exit." (Hua Shi's *Ben Yi*: "'Ru' is read as 'Er', interchangeable in ancient texts.)
Difficulty 81 asks: The classics say "Do not tonify excess, do not sedate deficiency; do not damage insufficiency and do not benefit surplus." (Meaning: Excess conditions should be sedated, but are mistakenly tonified; deficiency conditions should be tonified, but are mistakenly sedated; insufficiency is damaged, and surplus is increased. All are mis-treatments. The classic quote is from *Ling Shu · Jiu Zhen Er Shi Yuan Pian*.) Does this refer to the Cun Kou pulse, or does the disease itself possess excess and deficiency? (Some versions have "ye". It asks whether "excess and deficiency" refers to the pulse or the disease.) How should the tonification and sedation be applied? (Asking how the methods of tonification and sedation should be correctly applied.)
The answer is: This refers to the disease, not the Cun Kou pulse; it refers to the inherent excess and deficiency of the disease itself. For example, if Liver is excess and Lung is deficient, Liver is Wood, Lung is Metal. Metal and Wood should balance each other. (Detailed explanation in Difficulty 75.) One must understand that Metal controls Wood. (Note: Xu Lingtai's commentary suggests regulating via South/North elements, but the core principle is balancing Metal and Wood). For instance, if Lung is excess and Liver is deficient, with slight Qi deficiency, using acupuncture without tonifying the Liver but instead heavily tonifying the Lung, (this makes Lung more excess and Liver more deficient.) Thus, it is called tonifying excess and sedating deficiency, damaging insufficiency and benefiting surplus. This is the harm caused by average physicians. (Harm means not only failing to cure the disease but also harming the patient.)