六十九难曰。经言虚者补之。实者泻之。不实不虚。以经取之。何谓也。然。虚者补其母。实者泻其子。当先补之。
然后泻之。不实不虚。以经取之者。是正经自生病。不中他邪也。当自取其经。故言以经取之。
丁曰。此经先立井荥俞经合配象五行。即以十二经中各有子母。递相生养。然后言用针补泻之法也。假令足厥阴肝
之络中虚。即补其足厥阴经合。是母也。实即泻足厥阴经荥。是子也。如无他邪。即当自取其经。故言以经取之也。杨
曰。春得肾脉为虚邪。是肾虚不能传气于肝。故补肾。肾有病则传之于肝。肝为肾子。故曰补其母也。春得心脉为实邪。
是心气盛实。逆来乘肝。故泻心。心平则肝气通。肝为心母。故曰泻其子也。不实不虚。是诸脏不相乘也。春得弦多及
但弦者。皆是肝脏自病也。则自于足厥阴少阳之经而补泻焉。当经有金木水火土。随时而取之也。
七十难曰。经言春夏刺浅。秋冬刺深者。何谓也。然。春夏者。阳气在上。人气亦在上。故当浅取之。秋冬者。阳
气在下。人气亦在下。故当深取之。
丁曰。春夏刺浅。秋冬刺深者。经言春夏剌井荥。从肌肉浅薄之处。秋冬刺经合。从肌肉深浓之处。此是因时随所
在刺之也。杨曰。经言春气在毫毛。夏气在皮肤。秋气在分肉。冬气在筋骨。此四时之气也。其四时受病。亦各随正气
之深浅。故用针者治病。各根据四时气之深浅而取之也。
春夏各致一阴。秋冬各致一阳者。何谓也。然。春夏温必致一阴者。初下针。沉之。至肾肝之部。得气引持之。阴
也。
虞曰。经言春夏养阳。言取一阴之气以养于阳。虑成孤阳。致者、都也。及也。言到于肾肝。引持一阴之气。肝肾
乃阴也。
秋冬寒必致一阳者。初内针。浅而浮之。至心肺之部。得气推内之。阳也。
虞曰。经言秋冬养阴。言至阴用事。无阳气以养其阴。故取一阳之气以养于阴。免成孤阴也。心肺。乃阳也。故言
至心肺之部也。
是谓春夏必致一阴。秋冬必致一阳。
杨曰。入皮三分。心肺之部。阳气所行也。入皮五分。肾肝之部。阴气所行也。阳为卫。阴为荣。春夏病行于阳。
故引阴以和阳。秋冬病行于阴。故内阳以和阴也。虞曰。杨氏所注言三分为心肺之部。五分为肝肾之部。此乃玄珠密语。
分天地气而言之。故有三分五分之说也。丁曰。人之肌肤。皆有浓薄之处。但皮肤之上。为心肺之部。阳气所行。肌肉
之下。为肾肝之部。阴气所行。其春夏阳气上胜。所用针沉。手内针至肾肝之部。得气引持阴气。以和其阳气。故春夏
必致一阴也。秋冬阴气下降。所用针浮。手至心肺之部。得气推内针入。引持阳气。以和其阴气也。故秋冬必致一阳也。
所以经云。春夏必致一阴。秋冬必致一阳也。
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。先以左手摄按所针荥俞
之处。气散乃内针。是谓刺荣无伤卫。刺卫无伤荣也。
丁曰。人之荣为阴。卫为阳。二者为之表里。其卧针取之。恐伤于荣也。针荣先以左手摄按所刺之穴。令阳散而内
针者。盖恐伤于卫也。杨曰。入皮三分为卫气。病在卫。用针则浅。故卧针而刺之。恐其深伤荣气故也。入皮五分为荣
气。故先按所针之穴。待气散乃内针。恐伤卫气故也。虞曰。三阴三阳。各主气血。至有多少不同。故圣人说行针之道。
无令至有伤于荣卫也。血气形志篇曰。太阳多血少气。少阳少血多气。阳明多气多血。厥阴多血少气。少阴多气少血。
太阴多气少血。启玄子注曰。血气多少。天之常数。故用针之道。常泻其多也。
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。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。
丁曰。夫荣卫通流。散行十二经之内。即有始有终。其始自中焦注手太阴一经一络。然后手阳明注一经一络。其经
络有二十四。日有二十四时。皆相合。此凡气始至而用针取之。名曰迎而夺之。其气流注终而内针。出而扪其穴。名曰
随而济之。又补其母亦名曰随而补之。泻其子亦名曰迎而夺之。又随呼吸出内其针。亦曰迎随也。此者是调阴阳之法。
故曰必在阴阳也。杨曰。荣气者。常行不已。卫气者。昼行于身体。夜行于脏腑。迎者、逆也。随者、顺也。谓卫气逆
行。荣气顺行。病在阳。必候荣卫。行至于阳分而刺之。病在阴。必候荣卫行至于阴分而刺之。是迎随之意也。又迎者、
泻也。随者、补也。故经曰迎而夺之。安得无虚。言泻之则虚也。随而济之。安得无实。言补之则实也。调气之方。必
在阴阳者。阴虚阳实。则补阴泻阳。阳虚阴实。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
病所往。而调其阴阳。则病无不已。虞曰。迎、取也。乃五行六气。各有胜复。假令木气有余之年。于王前先泻其化源。
玄珠密语曰。木之行胜也。苍埃先见于林木。木乃有声。宫音失调。 虫不滋。湿雨失合。先于十二月泻其化源。故曰
迎也。不足之年。补于化源。故曰随也。调气之方。必在阴阳者。言引外至内。引内至外也。谓月生无泻。月满无补。
定人之呼吸。观日之寒温。从阳引阴。从阴引阳。春夏致一阴。秋冬致一阳。故曰调气之方。必在阴阳也。知其内外表
里者。谓察脉之浮沉。识病之虚实。以外知内。视表如里。故曰。知其内外表里也。随其阴阳而调之者。谓各随病在何
阴阳脉中而调治之也。
七十三难曰。诸井者。肌肉浅薄。气少。不足使也。刺之奈何。然。诸井者、木也。荥者、火也。火者木之子。当
刺井者。以荥泻之。故经言补者不可以为泻。泻者不可以为补。此之谓也。
丁曰。诸井在手足指梢。故言肌肉浅薄也。井为木。是火之母。荥为火。是木之子。故肝木实。泻其荥。肝木气虚
不足。补其合。泻之复不能补。故言不可以为补也。杨曰。冬刺井。病在脏。取之应井。刺井者。则泻其荥。以去其病。
故经曰。冬阴气紧。阳气伏。故取井以下阴气。逆取荥以通阳气也。虞曰。不至而至。故春乃泻荥也。
七十四难曰。经言春刺井。夏刺荥。季夏刺俞。秋刺经。冬刺合者。何谓也。然。春刺井者邪在肝。夏刺荥者邪在
心。季夏刺俞者邪在脾。秋刺经者邪在肺。冬刺合者邪在肾。
丁曰。其言春刺井者。谓邪在肝。无令肝木邪害于脾土。故刺诸井也。夏刺荥者。谓邪在心。无令心火邪害于肺金。
故刺诸荥也。季夏刺俞者。谓邪在脾。无使脾土邪害于肾水。故刺诸俞也。秋刺经者。谓邪在肺。无令肺金邪害于肝木。
故刺诸经也。冬刺合者。谓邪在肾。无令肾水邪害于心火。故刺诸合也。此是断五邪之原法也。杨曰。用针微妙。法无
穷。若不深达变通。难以救疾者矣。至如此说。则是变通之义也。经云。冬刺井。春刺荥。此乃云春刺井。夏刺荥。理
极精奇。特宜留思。不可固守以一概之法也。虞曰。春刺井。夏刺荥。季夏刺俞。秋刺经。冬刺合。乃经之大法也。七
十三难。以言春刺于荥。此乃休王未毕。火夺木王。法曰实邪。故泻之于荥。所以经言泻者不可以为补也。
其肝、心、脾、肺、肾、而系于春夏秋冬者。何也。然。五脏一病辄有五也。假令肝病。色青者。肝也。臊臭者。
肝也。喜酸者。肝也。喜呼者。肝也。喜泣者。肝也。其病众多。不可尽言也。四时有数而并系于春夏秋冬者也。针之
要妙。在于秋毫者也。
丁曰。人之五脏系于四时。五脏一病辄有五者。谓五声、五色、五味、五液、五香、（按此二字疑衍。）五臭。若持
针者。皆能断其五邪。令中病原。故知针之要妙。在于秋毫。不可不通也。杨曰。五脏六腑病。各有形证。今略举肝家
一脏以为法尔。虽言春刺井。夏刺荥。若一脏有病。脉亦随之。诊而取之。假令肝自病。实则取肝中火泻之。虚则取肝
中木补之。余皆仿此。即秋毫微细之意也。言用针微细若秋毫矣。虞曰。五脏各有声色臭味液。以为形证。以合四时井
荥俞经合。而行补泻之法也。微妙之理。若秋毫之在目也。
七十五难曰。经言东方实。西方虚。泻南方。补北方。何谓也。然。金木水火土。当更相平。东方、木也。西方、
金也。木欲实。金当平之。火欲实。水当平之。土欲实。木当平之。金欲实。火当平之。水欲实。土当平之。东方肝也。
则知肝实。西方肺也。则知肺虚。泻南方火。补北方水。南方火。火者、木之子也。北方水。水者、木之母也。水胜火。
子能令母实。母能令子虚。故泻火补水。欲令金不得平木也。经曰。不能治其虚。何问其余。此之谓也。
丁曰。四方者。五行之正位也。其王应四时。即春应东方木。夏应南方火。秋应西方金。冬应北方水。长夏应中央
土。南方火实胜西方金。即北方水来复胜。火水且待争。反害于肺。今当先泻南方火。实即还北方水。肺金得平也。平
者、调四方虚实之法也。杨曰。五行以胜相加。故木胜土。金胜木。木、肝也。金、肺也。肺气虚弱。肝气强实。木反
凌金。金家不伏。欲来平木。金木若战。二脏则伤。故用针者。诊知其候。则须泻心。心气既通。肝气则复。又补于肾。
肾家得气。传而养肝。肝气已定。则肺不复来平肝。然后却补脾气。脾是肺母。母气传子。子便安定。故曰不能治其虚。
何问其余。此之谓也。一本说杨氏曰。金克木。今据肝家一条以例五脏。假令东方木肝实。西方金肺虚。肝木实凌肺金
虚。金本克木。木伏金。肝欲制肺。肺乃不伏。二脏争胜。反害于火。宜泻其心。心属火。火者木之子。子气既通。肝
虚则伏。肝气既复。则肺不复来。然后补其脾。脾是肺母。母气授子。子气便实。故言母能令子实。子能令母虚。不能
治其虚。何问其余。虞曰。五脏五行。更相平伏。宜凭补泻以调治之。素问曰。邪气盛则实。真气夺则虚。以下凡有虚
实。皆准此也。经言木实金虚。泻火补水也。夫木实者。谓木有余。则土遥畏之。土畏之。则金无所养而令金虚也。若
不泻火。火必盛而烁金。金乃仇雠于木。金木相胜。而致两相刑克。故泻火。火者木之子。子合母气。木亦不实。火亦
不平。金土亦无所畏。乃行气养于金也。金虚者。乃补水御火。补水养木。御火火不平金。养木木亦安复。故曰子能令
母实也。木有余。则土乃畏木。土不能传气与金。金乃虚。故曰母能令子虚也。
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。然。当补之时。从卫取气。
虞曰。肺行五气。溉灌五脏。通注六经。归于百脉。凡取气须自卫取气。得气乃推内针于所虚之经脉浅深分部之。
所以补之。故曰。当补之时。从卫取气。此之谓也。
当泻之时。从荣置气。
虞曰。邪在荣分。故内针于所实之经。待气引针而泻之。故曰。当泻之时。从荣置气。置者、取也。迎也。
其阳气不足。阴气有余。当先补其阳。而后泻其阴。
虞曰。假令胆不足。肝有余。先补足少阳。而后泻足厥阴也。
阴气不足。阳气有余。当先补其阴。而后泻其阳。
虞曰。反于上法。
荣卫通行。此其要也。
杨曰。此是阴阳更虚更实之变。须通荣卫。病则愈也。丁曰。其当补之时。从卫取气。卫者、阳也。故从卫取气。
方其补也。当泻之时。从荣置气。荣者。阴也。故从荣置气。置荣而后泻之。阴阳有余不足。当先补其不足。然后泻其
有余。故得荣卫通行。即是持针之要妙。故言其要也。
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。故先
实其脾气。无令得受肝之邪。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。故曰治已病也。
丁曰。素问曰。春胜长夏。长夏胜冬。冬胜夏。夏胜秋。秋胜春。此四时五行相胜之理也。人之五脏有余者行胜。
不足者受邪。上工先补不足。无令受邪。而后泻有余。此是治未病也。中工持针。即便泻有余。故言治已病也。杨曰。
五脏得病。皆传其所胜。肝病传脾之类是也。若当其王时。则不受传。即不须行此方也。假令肝病当传脾。脾以季夏王。
正王则不受邪。故不须实脾气也。若非季夏。则受肝邪。盒饭预令实脾气。勿令得受肝邪也。如此者。谓之上工。工、
犹妙也。言妙达病源者也。其中工未能全解。故止守一脏而已。
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。
杨曰。补者呼则出针。泻者吸则内针。故曰呼吸出内针也。虞曰。谓用针补泻之法。呼吸取生成之数为之。
然知为针者信其左。不知为针者信其右。当刺之时。必先以左手厌按所针荣俞之处。弹而努之。爪而下之。其气之
第六十九难说：医经上说，虚证用补法，实证用泻法，不虚不实则取本经治疗。这是什么意思呢？回答说：虚证补其母穴，实证泻其子穴。应当先补后泻。所谓不虚不实而取本经治疗的，是指本经自身发病，没有受到其他邪气侵袭。应当直接取本经穴位治疗，所以说“以经取之”。
丁氏说：这一难首先确立井、荥、输、经、合五腧穴与五行配属的关系，从而说明十二经脉中各有子母关系，依次相生养育，然后才论述针刺补泻的方法。例如足厥阴肝经的络脉出现虚证，就补足厥阴经的合穴，这是母穴；如果是实证，就泻足厥阴经的荥穴，这是子穴。如果没有其他邪气，就应当自取本经治疗，所以说“以经取之”。
杨氏说：春季诊得肾脉为虚邪，这是因为肾虚不能将精气传送给肝，所以补肾。肾病会传变到肝，肝是肾的子脏，所以说“补其母”。春季诊得心脉为实邪，这是因为心气盛实，逆而乘袭肝脏，所以泻心。心气平和则肝气通畅，肝是心的母脏，所以说“泻其子”。不虚不实，是指各脏腑之间没有相乘的关系。春季诊得弦脉多或仅见弦脉，都是肝脏自身的病变，则应在足厥阴经和足少阳经上进行补泻。因为经脉中有金、木、水、火、土五行之气，应随季节不同而选取相应的穴位。
第七十难说：医经上说春夏针刺宜浅，秋冬针刺宜深，这是什么意思呢？回答说：春夏时节，阳气在上，人体人气也偏于上部，所以应当浅刺；秋冬时节，阳气在下，人体人气也偏于下部，所以应当深刺。
丁氏说：春夏浅刺、秋冬深刺，医经上说是春夏刺井穴、荥穴，从肌肉浅薄之处进针；秋冬刺经穴、合穴，从肌肉深厚之处进针。这是因时制宜，根据气血所在部位进行针刺。
杨氏说：医经说春气在毫毛，夏气在皮肤，秋气在分肉，冬气在筋骨。这是四时的气候特点。人体在这四个季节受病，也都随着正气深浅的不同而各异。所以使用针刺治病，应根据四时之气的深浅来选取穴位。
春夏各需引入一阴（指阴气），秋冬各需引入一阳（指阳气），这是什么意思呢？回答说：春夏气温热，必须引入一阴，初下针时，重按至肾肝所在的深层部位，得气后牵引持守，这就是阴气。
虞氏说：医经说春夏养阳，意思是取一阴之气来涵养阳气，防止形成孤阳。致，意为到达、涉及。说到达肾肝部位，引持一阴之气，肝肾属于阴。
秋冬气温寒，必须引入一阳，初进针时，轻浮浅按至心肺所在的浅层部位，得气后推内进针，这就是阳气。
虞氏说：医经说秋冬养阴，意思是阴气主事时，若无阳气来涵养阴气，就会形成孤阴，所以要取一阳之气来涵养阴气。心肺属于阳，所以说到达心肺所在的部位。
这就叫春夏必引入一阴，秋冬必引入一阳。
杨氏说：入皮三分，是心肺所在的部位，是阳气运行的地方；入皮五分，是肾肝所在的部位，是阴气运行的地方。阳为卫气，阴为营气。春夏病行于阳分，所以引阴气来调和阳气；秋冬病行于阴分，所以纳阳气来调和阴气。
虞氏说：杨氏注解中说三分是心肺之部，五分是肝肾之部，这出自《玄珠密语》，是从天地之气划分的角度而言的，所以有三分、五分之说。
丁氏说：人的肌肤都有厚薄之处。皮肤之上，是心肺之部，阳气所行；肌肉之下，是肾肝之部，阴气所行。春夏阳气上升胜越，所用针法沉潜，手内进针至肾肝之部，得气后引持阴气，以调和阳气，所以春夏必引入一阴。秋冬阴气下降，所用针法轻浮，手至心肺之部，得气后推内进针，引持阳气，以调和阴气，所以秋冬必引入一阳。因此医经说：“春夏必致一阴，秋冬必致一阳。”
第七十一难说：医经上说刺营气不要伤及卫气，刺卫气不要伤及营气，这是什么意思呢？回答说：刺阳分（卫）的，要卧针斜刺；刺阴分（营）的，先用左手按压所针的荥穴、俞穴处，待气散后再进针，这就叫刺营不伤卫，刺卫不伤营。
丁氏说：人的营气属阴，卫气属阳，二者互为表里。卧针斜刺，是怕伤及营气。针刺营气前先用左手按压穴位，使卫气消散再进针，是怕伤及卫气。
杨氏说：入皮三分是卫气所在，病在卫分，用针宜浅，所以卧针斜刺，是怕深刺伤及营气。入皮五分是营气所在，所以先按压穴位，待气散后进针，是怕伤及卫气。
虞氏说：三阴三阳，各自主管气血，但多少有所不同。所以圣人阐述行针之道，不要让气血受到损伤。《灵枢·九针论》说：太阳经多血少气，少阳经少血多气，阳明经多气多血，厥阴经多血少气，少阴经多气少血，太阴经多气少血。启玄子注解说：气血多少是天的常数，所以用针之道，常泻其多者。
第七十二难说：医经上说能掌握迎随之气，就可以调和治疗。调气的方法，必然在于阴阳，这是什么意思呢？回答说：所谓迎随，就是知道营卫的流行和经脉的往来。顺着或逆着经脉走向取穴，所以叫迎随。调气的方法必然在于阴阳，就是知道内外表里的关系，随着阴阳的变化来调治，所以叫调气的方法必然在于阴阳。
丁氏说：营卫流通，散布在十二经之内，有始有终。起始于中焦注入手太阴一经一络，然后手阳明注入一经一络。经络共有二十四条，一天有二十四个时辰，都相互吻合。凡是在气刚开始流注时用针取穴，名叫“迎而夺之”；当气流注终结时进针，出针后按住穴位，名叫“随而济之”。补母穴也叫“随而补之”，泻子穴也叫“迎而夺之”。另外配合呼吸进出针，也称为迎随。这是调和阴阳的方法，所以说“必在阴阳”。
杨氏说：营气常行不止，卫气白天行于身体，夜晚行于脏腑。迎，即逆；随，即顺。指卫气逆行，营气顺行。病在阳分，必须候察营卫运行至阳分时刺之；病在阴分，必须候察营卫运行至阴分时刺之。这就是迎随的意思。又，迎即泻，随即补。所以经说“迎而夺之”，怎么会不虚呢？意思是泻之则虚。“随而济之”，怎么会不实呢？意思是补之则实。调气的方法必然在于阴阳，如果阴虚阳实，就补阴泻阳；阳虚阴实，就补阳泻阴。或者阳并入阴，阴并入阳，或者阴阳俱虚，或者阴阳俱实，都随着病情的变化，来调和阴阳，那么病就没有不好的了。
虞氏说：迎，即取。五行六气各有胜复。假如木气有余的年份，在王气之前先泻其化源。《玄珠密语》说：木之行胜，苍埃先见于林木，木乃有声，宫音失调，虫不滋长，湿雨失合，先在十二月泻其化源，所以叫“迎”。不足之年，补于化源，所以叫“随”。调气的方法必然在于阴阳，意思是引外至内，引内至外。谓月生时不泻，月满时不补，定人的呼吸，观察日之寒温，从阳引阴，从阴引阳，春夏致一阴，秋冬致一阳，所以说调气的方法必然在于阴阳。知道内外表里，是指诊察脉象的浮沉，识别病的虚实，以外知内，视表如里，所以说“知其内外表里”。随着阴阳调治，是指各随病在何阴阳脉中而调治。
第七十三难说：诸井穴，肌肉浅薄，气少，不足以施用，该怎么刺呢？回答说：诸井穴属木，荥穴属火，火是木之子。当刺井穴时，应用荥穴来泻之。所以经上说补法不可以当作泻法，泻法不可以当作补法，就是这个道理。
丁氏说：诸井穴在手足指梢，所以说肌肉浅薄。井属木，是火之母；荥属火，是木之子。所以肝木实证，泻其荥穴；肝木气虚不足，补其合穴。泻法不能用来补，所以说“不可以为补”。
杨氏说：冬季刺井穴，病在脏，取应井穴。刺井穴，则泻其荥穴以去除疾病。所以经说：冬阴气紧束，阳气潜伏，故取井穴以下降阴气，逆取荥穴以通阳气。
第七十四难说：医经上说春刺井，夏刺荥，季夏刺输，秋刺经，冬刺合，这是什么意思呢？回答说：春刺井，是因为邪在肝；夏刺荥，是因为邪在心；季夏刺输，是因为邪在脾；秋刺经，是因为邪在肺；冬刺合，是因为邪在肾。
丁氏说：所谓春刺井，是说邪在肝，不让肝木邪气伤害脾土，所以刺诸井穴。夏刺荥，是说邪在心，不让心火邪气伤害肺金，所以刺诸荥穴。季夏刺输，是说邪在脾，不让脾土邪气伤害肾水，所以刺诸输穴。秋刺经，是说邪在肺，不让肺金邪气伤害肝木，所以刺诸经穴。冬刺合，是说邪在肾，不让肾水邪气伤害心火，所以刺诸合穴。这是断绝五邪根源的方法。
杨氏说：用针微妙，法无穷尽，如果不深达变通，难以救疾。像这种说法，就是变通的意义。经云：冬刺井，春刺荥。这里却说春刺井，夏刺荥，道理极其精奇，特别应该深思，不可固执地守以一概之法。
虞氏说：春刺井，夏刺荥，季夏刺输，秋刺经，冬刺合，是经书的大法。第七十三难说春刺于荥，这是因为休王之气未毕，火夺木王之位，法曰实邪，所以在荥穴泻之。所以经说泻者不可以为补。
肝、心、脾、肺、肾与春夏秋冬相联系，为什么呢？回答说：五脏一旦生病就会有五种表现。例如肝病，面色青的是肝，气味臊的是肝，喜酸味的是肝，喜欢呼喊的是肝，喜欢哭泣的是肝。病情众多，不可尽言。四季各有定数并联系于春夏秋冬。针刺的要妙，在于细微如秋毫。
丁氏说：人的五脏系于四时，五脏一病辄有五者，指五声、五色、五味、五液、五香、五臭（按此二字疑衍）。若持针者，都能断其五邪，令中病原，所以知针的要妙在于秋毫，不可不通晓。
杨氏说：五脏六腑的病，各有形证，现在略举肝家一脏作为法则。虽然说是春刺井，夏刺荥，如果一脏有病，脉象也随之变化，诊察而取之。例如肝自病，实证取肝中火穴泻之，虚证取肝中木穴补之，其余都仿照此例，这就是秋毫微细的意思。言用针微细若秋毫。
虞氏说：五脏各有声色臭味液，作为形证，以合四时井荥输经合，而行补泻之法。微妙之理，若秋毫之在目。
第七十五难说：医经上说东方实，西方虚，泻南方，补北方，这是什么意思呢？回答说：金木水火土，应当互相平衡。东方属木，西方属金。木欲实，金当平之；火欲实，水当平之；土欲实，木当平之；金欲实，火当平之；水欲实，土当平之。东方属肝，则知肝实；西方属肺，则知肺虚。泻南方火，补北方水。南方火，火是木之子；北方水，水是木之母。水胜火，子能令母实，母能令子虚。所以泻火补水，是想让金不得平木。经说：“不能治其虚，何问其余。”就是这个意思。
丁氏说：四方是五行的正位。其旺气对应四时，即春应东方木，夏应南方火，秋应西方金，冬应北方水，长夏应中央土。南方火实胜西方金，则北方水来复胜。火水暂且争斗，反害于肺。现在应当先泻南方火，实则还归北方水，肺金得以平复。平，就是调四方虚实的方法。
杨氏说：五行以胜相加，所以木胜土，金胜木。木属肝，金属肺。肺气虚弱，肝气强实，木反凌金，金家不服，欲来平木。金木若战，二脏则伤。所以用针者，诊知其候，则须泻心。心气既通，肝气则复。又补于肾，肾家得气，传而养肝。肝气已定，则肺不复来平肝。然后却补脾气。脾是肺母，母气传子，子便安定。所以说“不能治其虚，何问其余”。
另一版本杨氏说：金克木。现据肝家一条以例五脏。假如东方木肝实，西方金肺虚。肝木实凌肺金虚。金本克木，木伏金。肝欲制肺，肺乃不伏。二脏争胜，反害于火。宜泻其心。心属火，火者木之子。子气既通，肝虚则伏。肝气既复，则肺不复来。然后补其脾。脾是肺母，母气授子，子气便实。所以说母能令子实，子能令母虚。不能治其虚，何问其余。
虞氏说：五脏五行，更相平伏，宜凭补泻以调治之。《素问》说：邪气盛则实，真气夺则虚。以下凡有虚实，皆准此。经言木实金虚，泻火补水。夫木实者，谓木有余，则土遥畏之。土畏之，则金无所养而令金虚也。若不泻火，火必盛而烁金，金乃仇雠于木。金木相胜，而致两相刑克。故泻火。火者木之子，子合母气，木亦不实，火亦不平，金土亦无所畏，乃行气养于金也。金虚者，乃补水御火。补水养木，御火火不平金，养木木亦安复。故曰子能令母实也。木有余，则土乃畏木，土不能传气与金，金乃虚，故曰母能令子虚也。
第七十六难说：什么叫补泻？当补的时候，取什么气？当泻的时候，置什么气？回答说：当补的时候，从卫分取气。
虞氏说：肺行五气，灌溉五脏，通注六经，归于百脉。凡取气须自卫分取气，得气后推内针于所虚之经脉浅深分部之中，所以补之。所以说：“当补之时，从卫取气。”就是这个意思。
当泻的时候，从营分置气。
虞氏说：邪在营分，所以内针于所实之经，待气引针而泻之。所以说：“当泻之时，从营置气。”置，即取，即迎。
虞氏说：与上述方法相反。
营卫通行，这是关键。
丁氏说：当补的时候，从卫取气。卫属阳，所以从卫取气。当泻的时候，从营置气。营属阴，所以从营置气。置营而后泻之。阴阳有余不足，应当先补其不足，然后泻其有余。所以得营卫通行，即是持针的要妙，所以说“其要”。
第七十七难说：医经上说上工治未病，中工治已病，这是什么意思呢？回答说：所谓治未病，见到肝病，就知道肝当传之于脾，所以先实其脾气，不让其受肝之邪，所以叫治未病。中工治已病，见到肝病，不懂传变规律，只一心治肝，所以叫治已病。
丁氏说：《素问》说：春胜长夏，长夏胜冬，冬胜夏，夏胜秋，秋胜春。这是四时五行相胜的道理。人之五脏有余者行胜，不足者受邪。上工先补不足，不让受邪，而后泻有余。这是治未病。中工持针，即便泻有余，所以叫治已病。
杨氏说：五脏得病，皆传其所胜。肝病传脾之类是也。若当其王时，则不受传，即不须行此方也。假如肝病当传脾，脾以季夏王，正王则不受邪，故不须实脾气也。若非季夏，则受肝邪，盒饭预令实脾气，勿令得受肝邪也。如此者，谓之上工。工，犹妙也。言妙达病源者也。其中工未能全解，故止守一脏而已。
第七十八难说：针有补泻，是什么意思呢？回答说：补泻之法，不一定非要配合呼吸进出针。
杨氏说：补者在呼气时出针，泻者在吸气时进针，所以说呼吸出内针。
然而懂得针刺的人信赖左手，不懂得针刺的人信赖右手。当刺的时候，必须先以左手按压所针的荣俞之处，弹而努之，爪而下之，其气之
Difficulty 69 states: The classic texts say that deficiency syndromes are treated with tonification, excess syndromes with sedation, and neither-deficiency-nor-excess syndromes are treated by selecting points from the affected meridian. What does this mean? The answer is: For deficiency, tonify its mother point; for excess, sedate its child point. One should tonify first, then sedate. "Neither-deficiency-nor-excess treated by selecting points from the affected meridian" means the meridian itself has become diseased without being invaded by external pathogenic factors. Therefore, one should directly select points from that meridian, hence the phrase "selecting points from the affected meridian."
Ding says: This difficulty first establishes the correspondence between the Five Shu points (Jing-Well, Ying-Spring, Shu-Stream, Jing-River, He-Sea) and the Five Elements. It explains that each of the Twelve Meridians has mother-child relationships governed by mutual generation. Only after this foundation is laid does it discuss acupuncture tonification and sedation techniques. For example, if the collateral of the Foot-Jueyin Liver Meridian is deficient, one should tonify the He-Sea point of the Foot-Jueyin Meridian, which is the mother point. If it is in excess, one should sedate the Ying-Spring point, which is the child point. If there are no other pathogens, one should treat the meridian itself, hence "selecting points from the affected meridian."
Yang says: In spring, obtaining a Kidney pulse indicates a false deficiency syndrome. This is because Kidney deficiency fails to transmit Qi to the Liver. Thus, one tonifies the Kidney. Since Kidney disease transmits to the Liver, and the Liver is the child of the Kidney, it is said "tonify its mother." In spring, obtaining a Heart pulse indicates a false excess syndrome. This is because Heart Qi is excessive and counter-attacks the Liver. Thus, one sedates the Heart. When Heart Qi is balanced, Liver Qi flows freely. Since the Liver is the mother of the Heart, it is said "sedate its child." Neither-deficiency-nor-excess means there is no pathological overacting among the Zang organs. In spring, a pulse that is predominantly wiry or merely wiry indicates a self-originating disease of the Liver. Treatment should involve tonification and sedation on the Foot-Jueyin and Foot-Shaoyang meridians. Since the meridians contain Metal, Wood, Water, Fire, and Earth energies, points should be selected according to the season.
Difficulty 70 states: The classic texts say that in spring and summer, needling should be shallow, while in autumn and winter, it should be deep. What does this mean? The answer is: In spring and summer, Yang Qi is superior and resides in the upper body, and human Qi also tends upward. Therefore, needling should be shallow. In autumn and winter, Yang Qi descends and resides in the lower body, and human Qi also tends downward. Therefore, needling should be deep.
Ding says: Shallow needling in spring/summer and deep needling in autumn/winter refers to the classic statement that in spring and summer, one needles the Jing-Well and Ying-Spring points at shallow muscular areas, while in autumn and winter, one needles the Jing-River and He-Sea points at deeper muscular areas. This is adapting to the time and the location of Qi.
Yang says: The classic texts state that Spring Qi is in the hair follicles, Summer Qi in the skin, Autumn Qi in the muscle layers, and Winter Qi in the sinews and bones. These are the characteristics of the Four Seasons' Qi. Diseases contracted during these seasons vary according to the depth of the healthy Qi. Therefore, when using acupuncture, one must select points based on the depth of the seasonal Qi.
"In spring and summer, one must introduce Yin Qi; in autumn and winter, one must introduce Yang Qi." What does this mean? The answer is: In the warm seasons of spring and summer, one must introduce Yin Qi. Upon initial insertion, press deeply to the level of the Kidney and Liver regions. Upon obtaining Deqi (arrival of Qi), hold and draw back slightly; this engages Yin Qi.
Yu says: The classic texts say "nourish Yang in spring and summer," meaning one takes Yin Qi to nourish Yang, preventing the formation of isolated Yang. "Zhi" (introduce/reach) means to arrive at or involve. Reaching the Kidney and Liver levels allows one to engage the Yin Qi, as the Liver and Kidneys belong to Yin.
In the cold seasons of autumn and winter, one must introduce Yang Qi. Upon initial insertion, press lightly and superficially to the level of the Heart and Lung regions. Upon obtaining Deqi, push the needle inward; this engages Yang Qi.
Yu says: The classic texts say "nourish Yin in autumn and winter." When Yin Qi is dominant, without Yang Qi to nourish it, isolated Yin may form. Therefore, one takes Yang Qi to nourish Yin. The Heart and Lungs belong to Yang, hence reaching their levels.
This is called "in spring and summer, one must introduce Yin Qi; in autumn and winter, one must introduce Yang Qi."
Yang says: Insertion to a depth of three fen corresponds to the Heart and Lung regions, where Yang Qi circulates. Insertion to five fen corresponds to the Kidney and Liver regions, where Yin Qi circulates. Yang represents Wei (Defensive) Qi, and Yin represents Ying (Nutritive) Qi. In spring and summer, diseases manifest in the Yang aspect, so one introduces Yin to harmonize Yang. In autumn and winter, diseases manifest in the Yin aspect, so one introduces Yang to harmonize Yin.
Yu says: Yang's annotation regarding three fen for Heart/Lung and five fen for Kidney/Liver comes from the *Xuanzhu Mi Yu* (Mysterious Pearl Secret Language), discussing the division of Heaven and Earth Qi, hence the theory of three and five fen.
Ding says: Human flesh and skin have varying thicknesses. Above the skin lies the Heart and Lung region, the pathway of Yang Qi. Below the muscle lies the Kidney and Liver region, the pathway of Yin Qi. In spring and summer, Yang Qi rises and dominates; the needle technique involves deep insertion ("chen") to the Kidney/Liver level. Upon obtaining Deqi, one draws back to engage Yin Qi to harmonize Yang Qi, hence "spring and summer must introduce Yin Qi." In autumn and winter, Yin Qi descends; the needle technique involves superficial insertion ("fu") to the Heart/Lung level. Upon obtaining Deqi, one pushes the needle in to engage Yang Qi to harmonize Yin Qi, hence "autumn and winter must introduce Yang Qi." Thus the classic text says: "Spring and summer must introduce Yin Qi; autumn and winter must introduce Yang Qi."
Difficulty 71 states: The classic texts say "Needle the Ying [Nutritive] without injuring the Wei [Defensive]; needle the Wei without injuring the Ying." What does this mean? The answer is: To needle Yang (Wei), use a horizontal (oblique) insertion. To needle Yin (Ying), first press the Ying-Stream or Shu-Stream point with the left hand until the Qi disperses, then insert the needle. This is "needling Ying without injuring Wei, and needling Wei without injuring Ying."
Ding says: Ying is Yin, Wei is Yang; they are exterior-interior pairs. Horizontal needling avoids injuring Ying. Pressing the acupoint with the left hand before needling Ying disperses Wei Qi to avoid injuring it.
Yang says: Three fen depth is where Wei Qi resides. If the disease is in Wei, needling should be shallow, hence horizontal insertion, to avoid deep injury to Ying Qi. Five fen depth is where Ying Qi resides. One presses the point first and waits for Qi to disperse before inserting, to avoid injuring Wei Qi.
Yu says: The Three Yin and Three Yang meridians govern Qi and Blood, but their quantities vary. Thus, the Sages taught needling methods to ensure no injury to Ying and Wei. The *Lingshu* chapter "Blood, Qi, Form, and Spirit" states: Taiyang has much blood and little Qi; Shaoyang has little blood and much Qi; Yangming has much Qi and much blood; Jueyin has much blood and little Qi; Shaoyin has much Qi and little blood; Taiyin has much Qi and little blood. Qixuanzi notes that the quantity of Qi and Blood is a constant of Heaven. Therefore, in needling, one often sedates the excess.
Difficulty 72 states: The classic texts say "To know the Qi of Ying (meeting/opposing) and Sui (following) allows for regulation." What does this mean? The answer is: "Ying Sui" refers to knowing the circulation of Ying and Wei and the flow of the meridians. Selecting points against or with the direction of flow is called Ying Sui. Regulation of Qi must lie in Yin and Yang. Knowing the interior/exterior and superficial/deep relationships, and regulating according to Yin and Yang, is why it is said "regulation of Qi must lie in Yin and Yang."
Ding says: Ying and Wei circulate through the Twelve Meridians, having a beginning and an end. Flow starts from the Middle Jiao into the Hand-Taiyin meridian, then to Hand-Yangming. There are twenty-four meridians corresponding to twenty-four hours of the day. Needling at the start of Qi flow is called "Ying Er Duo Zhi" (Opposing and Depriving/Sedating). Needling at the end of Qi flow, pressing the point upon withdrawal, is called "Sui Er Ji Zhi" (Following and Assisting/Tonifying). Tonifying the mother is also "Sui Er Bu Zhi"; sedating the child is "Ying Er Duo Zhi." Coordinating needle movement with respiration is also Ying Sui. This is the method of regulating Yin and Yang, hence "must lie in Yin and Yang."
Yang says: Ying Qi circulates continuously. Wei Qi travels the body by day and the Zang organs by night. "Ying" means opposing (against); "Sui" means following (with). Wei Qi moves against the flow, Ying Qi moves with the flow. If the disease is in Yang, wait for Ying and Wei to reach the Yang aspect before needling. If in Yin, wait for them to reach the Yin aspect. This is the meaning of Ying Sui. Furthermore, Ying means sedation, and Sui means tonification. Hence, "Ying Er Duo Zhi" leads to emptiness (sedation causes deficiency); "Sui Er Ji Zhi" leads to fullness (tonification causes excess). Regulating Qi lies in Yin and Yang: if Yin is deficient and Yang is excess, tonify Yin and sedate Yang; if Yang is deficient and Yin is excess, tonify Yang and sedate Yin. Whether Yang merges into Yin, Yin into Yang, both deficient, or both excess, one regulates Yin and Yang according to the disease's progression, ensuring recovery.
Yu says: "Ying" means to take. The Five Elements and Six Qi have winning and overcoming cycles. In a year of excess Wood Qi, one sedates the source of transformation before the ruling season. *Xuanzhu Mi Yu* states: When Wood overacts, dust appears on trees, wood makes sound, Gong pitch is discordant, insects fail to thrive, and rain is imbalanced. One sedates the source in the twelfth month, hence "Ying." In years of deficiency, one tonifies the source, hence "Sui." Regulating Qi lies in Yin and Yang, meaning guiding from outside to inside and inside to outside. Do not sedate during moon waxing; do not tonify during moon waning. Regulate breath, observe temperature, guide Yin from Yang and Yang from Yin, introduce Yin in spring/summer and Yang in autumn/winter. Knowing interior/exterior means observing pulse floating/sinking and disease deficiency/excess, knowing the inside from the outside, seeing the surface as the interior. Regulating according to Yin and Yang means treating based on which Yin/Yang meridian is affected.
Difficulty 73 states: The Jing-Well points are in thin flesh with little Qi, insufficient for treatment. How should they be needled? The answer is: Jing-Well points belong to Wood; Ying-Spring points belong to Fire. Fire is the child of Wood. When needling a Jing-Well point, one should sedate via the Ying-Spring point. Thus, the classic text says tonification cannot be used as sedation, nor sedation as tonification.
Ding says: Jing-Well points are at the tips of fingers and toes, hence thin flesh. Jing is Wood, mother of Fire; Ying is Fire, child of Wood. If Liver Wood is excess, sedate its Ying point. If Liver Wood is deficient, tonify its He-Sea point. Sedation cannot tonify, hence "cannot be used as tonification."
Yang says: Winter needling of Jing-Well points treats Zang diseases. Needling Jing requires sedating the Ying point to remove the disease. Winter Yin Qi is tight, Yang Qi is latent. Jing points descend Yin Qi; Ying points (counter-flow) open Yang Qi.
Yu says: "Not arriving yet arriving," hence sedating Ying in spring.
Difficulty 74 states: The classic texts say "Spring needle Jing-Well, Summer needle Ying-Spring, Late Summer needle Shu-Stream, Autumn needle Jing-River, Winter needle He-Sea." What does this mean? The answer is: Spring needling of Jing-Well targets pathogens in the Liver; Summer Ying-Spring targets the Heart; Late Summer Shu-Stream targets the Spleen; Autumn Jing-River targets the Lungs; Winter He-Sea targets the Kidneys.
Ding says: Spring Jing-Well prevents Liver Wood from harming Spleen Earth. Summer Ying-Spring prevents Heart Fire from harming Lung Metal. Late Summer Shu-Stream prevents Spleen Earth from harming Kidney Water. Autumn Jing-River prevents Lung Metal from harming Liver Wood. Winter He-Sea prevents Kidney Water from harming Heart Fire. This cuts off the origin of the Five Pathogens.
Yang says: Acupuncture is subtle and infinite. Without understanding variation, one cannot cure disease. This approach reflects adaptability. The classic text mentions "Winter Jing, Spring Ying," but here it says "Spring Jing, Summer Ying." The logic is exquisite; one must ponder it and not rigidly adhere to a single method.
Yu says: Spring Jing, Summer Ying, etc., are major principles. Difficulty 73 mentions sedating Ying in spring because the Wood ruling phase is ending and Fire is taking over (excess pathogen), so one sedates at Ying. Hence, sedation cannot be tonification.
Why are Liver, Heart, Spleen, Lung, and Kidney linked to Spring, Summer, Late Summer, Autumn, and Winter? The answer is: Each Zang organ disease manifests in five ways. For example, Liver disease: green color indicates Liver; fishy odor indicates Liver; craving sour taste indicates Liver; desire to shout indicates Liver; desire to weep indicates Liver. Diseases are numerous. The Four Seasons have fixed numbers linked to the seasons. The essence of needling lies in subtlety like an autumn down feather.
Ding says: The Five Zang are linked to the Four Seasons. "Five manifestations per disease" refer to voice, color, taste, fluid, fragrance, and smell. A skilled practitioner can diagnose the Five Pathogens and hit the source. Thus, the essence of needling is in the minutiae.
Yang says: Each Zang/Fu has specific signs. Taking Liver as an example: although Spring needles Jing and Summer needles Ying, if one Zang is diseased, the pulse changes accordingly. Diagnose and treat accordingly. If Liver is self-diseased, excess requires sedating Fire within Liver; deficiency requires tonifying Wood within Liver. This applies to others, reflecting the "autumn down feather" subtlety.
Yu says: The Five Zang have voice, color, smell, taste, and fluids as signs, corresponding to the Five Shu points across seasons for tonification/sedation. The profound principle is like seeing an autumn down feather clearly.
Difficulty 75 states: The classic texts say "East is Excess, West is Deficient; Sedate South, Tonify North." What does this mean? The answer is: Metal, Wood, Water, Fire, and Earth should balance each other. East is Wood; West is Metal. If Wood is excess, Metal should balance it. If Fire is excess, Water should balance it. If Earth is excess, Wood should balance it. If Metal is excess, Fire should balance it. If Water is excess, Earth should balance it. East is Liver (Excess); West is Lung (Deficient). Sedate South (Fire), Tonify North (Water). Fire is the child of Wood; Water is the mother of Wood. Water overcomes Fire. The child can make the mother excess; the mother can make the child deficient. Thus, sedating Fire and tonifying Water aims to prevent Metal from balancing Wood. The classic says: "If you cannot treat the deficiency, what else is there to ask?"
Ding says: The Four Directions are the proper positions of the Five Elements. Spring-East-Wood, Summer-South-Fire, Autumn-West-Metal, Winter-North-Water, Late Summer-Center-Earth. If South Fire is excess and overcomes West Metal, North Water should counter-act. Fire and Water contend, harming the Lung. Therefore, first sedate South Fire. Once excess is resolved, North Water returns, and Lung Metal is balanced. "Balancing" is the method of regulating directional excess/deficiency.
Yang says: Five Elements interact via overcoming. Wood overcomes Earth; Metal overcomes Wood. Metal (Lung) is weak; Wood (Liver) is strong. Wood bullies Metal. Metal refuses to submit and tries to balance Wood. If Metal and Wood war, both organs are injured. The acupuncturist diagnoses and sedates the Heart. Once Heart Qi flows, Liver Qi recovers. Then tonify the Kidney. Kidney Qi nourishes Liver. Once Liver is stable, Lung no longer attacks. Finally, tonify the Spleen. Spleen is Lung's mother; Mother transmits to Child, stabilizing the Child. Hence, "If you cannot treat the deficiency..."
Another version of Yang says: Metal overcomes Wood. Using Liver as an example: East Wood (Liver) is excess; West Metal (Lung) is deficient. Wood bullies Metal. Metal normally overcomes Wood, but Wood subdues Metal. Liver wants to control Lung, but Lung resists. They contend, harming Fire. Sedate Heart (Fire, child of Wood). Once Child Qi flows, Liver becomes deficient/subdued. Once Liver recovers, Lung stops attacking. Tonify Spleen (Mother of Lung). Mother transmits to Child, making Child excess. Hence, "Mother makes Child excess; Child makes Mother deficient."
Yu says: The Five Zang and Five Elements balance each other via tonification/sedation. *Suwen* states: "Excess of pathogenic Qi is Excess; loss of True Qi is Deficiency." All deficiency/excess follow this. "Wood excess, Metal deficient" means treating via sedating Fire and tonifying Water. Wood excess means Wood is surplus, causing Earth to fear it. Earth fears Wood, so Metal lacks nourishment and becomes deficient. If Fire is not sedated, it burns Metal. Metal becomes hostile to Wood. Metal and Wood clash, damaging both. Sedating Fire (child of Wood) combines with Mother Qi, reducing Wood's excess. Fire is no longer unbalanced. Metal and Earth are no longer feared, allowing Qi to nourish Metal. Metal deficiency requires tonifying Water to control Fire. Tonifying Water nourishes Wood. Controlling Fire prevents it from harming Metal; nourishing Wood stabilizes Wood. Hence, "Child makes Mother excess." Wood excess makes Earth fear Wood; Earth cannot transmit Qi to Metal, causing Metal deficiency. Hence, "Mother makes Child deficient."
Difficulty 76 states: What is tonification and sedation? When tonifying, where is Qi taken? When sedating, where is Qi placed? The answer is: When tonifying, take Qi from Wei (Defensive).
Yu says: Lung distributes Five Qi to nourish the Five Zang and six Fu meridians. Taking Qi must begin from Wei. Upon obtaining Deqi, push the needle into the deficient meridian at the appropriate depth for tonification. Hence, "When tonifying, take Qi from Wei."
When sedating, place Qi in Ying (Nutritive).
Yu says: Pathogens are in the Ying level. Insert the needle into the excess meridian. Wait for Qi to guide the needle to sedate. Hence, "When sedating, place Qi in Ying." "Zhi" means to take or oppose.
If Yang is deficient and Yin is excess, tonify Yang first, then sedate Yin.
Yu says: For example, Gallbladder deficiency and Liver excess: first tonify Foot-Shaoyang, then sedate Foot-Jueyin.
If Yin is deficient and Yang is excess, tonify Yin first, then sedate Yang.
Yu says: Reverse the above method.
The free circulation of Ying and Wei is the key.
Yang says: This is the variation of alternating Yin/Yang deficiency and excess. One must understand Ying and Wei for recovery.
Ding says: When tonifying, take Qi from Wei (Yang). When sedating, place Qi in Ying (Yin). Place in Ying then sedate. For Yin/Yang excess/deficiency, tonify deficiency first, then sedate excess. This ensures Ying and Wei circulation, the essence of holding the needle. Hence, "the key."
Difficulty 77 states: The classic texts say "Superior physicians treat disease before it arises; average physicians treat disease after it has arisen." What does this mean? The answer is: Treating before it arises means seeing Liver disease and knowing it will transmit to the Spleen, so one first strengthens Spleen Qi to prevent Spleen from receiving Liver pathogens. This is "treating before it arises." Average physicians see Liver disease, do not understand transmission, and only treat the Liver. This is "treating after it has arisen."
Ding says: *Suwen* states the cycle of Five Elements overcoming. Organs with excess overcome; organs with deficiency receive pathogens. Superior physicians tonify deficiency first to prevent pathogen reception, then sedate excess. This is treating before it arises. Average physicians immediately sedate excess, treating after it has arisen.
Yang says: Diseased Zang organs transmit to those they overcome (e.g., Liver to Spleen). If the target organ is in its ruling season, it does not receive transmission, and this method is unnecessary. If Liver disease transmits to Spleen, and Spleen rules in Late Summer, it is immune. If not Late Summer, Spleen receives Liver pathogens; one must pre-strengthen Spleen Qi. This is a "Superior Physician" (one who profoundly understands disease origins). Average physicians lack this understanding and treat only the affected Zang.
Difficulty 78 states: Acupuncture has tonification and sedation. What does this mean? The answer is: Tonification and sedation methods do not necessarily rely on respiration and needle withdrawal/insertion.
Yang says: Tonification involves withdrawing the needle on exhalation; sedation involves inserting the needle on inhalation. Hence, "respiration and needle movement."
Yu says: Respiration is used to determine the numerical values of generation and completion in needling techniques.
However, a skilled acupuncturist relies on the left hand, while an unskilled one relies on the right hand. At the time of needling, one must first press the Ying-Stream or Shu-Stream point with the left hand, tap and distend it, mark it with the nail, and then insert. The arrival of Qi...