来。如动脉之状。顺针而刺之。得气因推而内之。是谓补。动而伸之。是谓泻。不得气乃与。男外女内。不得气。是谓
十死不治也。
杨曰。凡欲下针之法。先知穴处。便以左手按之。乃以右手弹其所接之处。脉动应在左手之下。仍即以左手指按之。
然后循针而刺之。待气应于针下。因推入荣中。此是补也。若得气便摇转而出之。此是泻也。若久留针而待气不至。则
于卫中留针。待气久不得。又内入于荣中。久留待气。如其三处气候不应于针者。谓阴阳俱尽。不可复针。如此之候。
十人十死。故云十死不治。卫为阳。阳为外。故云男外。荣为阴。阴为内。故云女内也。虞曰。自卫得气。推之以所虚
之分。开穴出针。曰补也。自卫取气。引针开穴出针。曰泻也。候吸内。针呼尽出针。曰先补后泻。反此行之。则曰先
泻后补也。玄珠密语称其补泻法云。按之得气。内于天部。天部得气。推之至地部。天地气相接则出针曰泻。反此行之
曰补。与此义相反。丁曰。知为针者。信其左。谓左手先按所刺之穴。以其气来。如动脉而应其手。即内其针。亦是迎
而夺之。为之泻气过而顺针而刺之。是为随而济之也。其男子阳气行于外。女人阴气行于内。男子则轻手按其穴。女子
则重手按其穴。过时而气不至。不应其左手者。皆不可刺之也。刺之则无功。谓气绝。故十死不治也。何待留针而候气
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。假令心病。泻手心主俞。
虞曰。心病却泻手心主俞。心者法不受病。受病者、心包络也。手心主者、则手厥阴心包络也。包络中俞者、土也。
心、火也。土是火子。乃泻其俞。此乃泻子也。
是谓迎而夺之者也。
虞曰。迎谓取气。夺谓泻气也。
补手心主井。是谓随而济之者也。
虞曰。心火井木。今补心主之井。谓补母也。木者、火之母也。随谓自卫取气。济谓补不足之经。
所谓实之与虚者。牢濡之意也。
虞曰。牢濡。虚实之意也。
气来牢实者为得。濡虚者为失。故曰若得若失也。
杨曰。此是当脏自病。而行斯法。非五脏相乘也。丁曰。五脏虚即补其母。是谓随而济之。实则泻其子。是谓迎而
夺之。况欲行其补泻。即先候其五脏之脉。及所刺穴中如气来牢实者。可泻之。虚濡者。可补之。若持针不能明其牢濡
者。故若得若失也。
八十难曰。经言有见如入。有见如出者。何谓也。然。所谓有见如入者。（滑氏本义云。有见如入下。当欠有见如出
四字。）谓左手见气来至。乃内针。针入。见气尽。乃出针。是谓有见如入。有见如出也。
丁曰。欲刺人脉。先以左手候其穴中之气。其气来而内针。候气尽乃出其针者。非迎随泻补之穴也。谓不虚不实。
自取其经。施此法也。杨曰。此还与弹而努之、爪而下之相类也。
八十一难曰。经言无实实虚虚。损不足而益有余。是寸口脉耶。将病自有虚实耶。其损益奈何。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。当知金平木。假令肺实而肝虚。
微少气。用针不泻其肝。而反重实其肺。故曰。实实虚虚。损不足而益有余。此者中工之所害也。
丁曰。中者、伤也。谓昧学之工。不能明其五脏之刚柔。而针药误投。所以反增其害。十人全八。能知二脏也。令
肝虚肺实二脏之病。全六反增其害也。杨曰。上工治未病。知其虚实之原。故补泻而得其宜。中工未审传病之本。所治
反增其害也。
（气至）像动脉搏动的样子。顺着针势刺入。得气后顺势将针推进去，这叫做补法。得气后摇动并退出针，这叫做泻法。如果不得气，就根据男女区别操作：男子取外（卫），女子取内（营）。如果始终不得气，这就称为“十死不治”。
杨氏说：凡是下针的方法，先要知道穴位所在，然后用左手按压穴位，接着用右手弹击所接触的部位，脉动应在左手之下感应到，随即仍以左手指按压穴位，然后顺着针势刺入。等待气感应于针下，顺势推入营分，这是补法。如果得气就摇转针体并拔出，这是泻法。如果久留针而气不至，则在卫分留针，等待气来。如果久久不得气，又深入至营分，久留以候气。如果在卫、营、中间这三处气候都不应针，称为阴阳之气俱尽，不可再针刺。这种状况，十人中有十人必死，所以说“十死不治”。卫属阳，阳在外，所以说是“男外”；营属阴，阴在内，所以说是“女内”。
虞氏说：从卫分得气，顺势推向所虚的分部，开穴出针，叫做补法。从卫分取气，引针开穴出针，叫做泻法。候吸气时进针，候呼气尽时出针，叫做先补后泻。反此操作，则叫做先泻后补。《玄珠密语》称其补泻法为：按压得气，内针于天部（浅层）。天部得气，推之至地部（深层），天地之气相接则出针，这叫泻法。反此操作叫补法。这与上述意义相反。
丁氏说：懂得针刺的人，信赖左手的作用。谓左手先按所刺之穴，感觉气来，如动脉般应手，即内针，这也是“迎而夺之”，为之泻法。气已过，顺针势而刺之，这是“随而济之”。男子的阳气行于外，女人的阴气行于内。男子则轻手按其穴，女子则重手按其穴。过时气不至，不应左手者，都不可刺。刺之则无功，称为气绝，所以十死不治。何必等待留针而候气呢？
第七十九难说：经文说“迎而夺之，安得无虚；随而济之，安得无实”。虚实的变化，好像得到又好像失去；实的状态和虚的状态，好像有又好像没有。这是什么意思呢？回答说：“迎而夺之”，是泻其子经；“随而济之”，是补其母经。假使是心病，泻手厥阴心包经的俞穴。
虞氏说：心病却泻手厥阴心包经的俞穴。心本身不受病，受病的是心包络。手厥阴心包络中的俞穴，五行属土。心属火，土是火之子，所以泻其俞穴，这就是泻子。
这叫做“迎而夺之”。
虞氏说：心火的井穴属木，现在补心主之井穴，谓之补母。木是火之母。“随”谓从卫分取气，“济”谓补不足之经。
虞氏说：“牢”、“濡”是虚实的意思。气来牢实者为得气，濡软虚细者为失气，所以说“若得若失”。
杨氏说：这是当脏自病，而行此法，并非五脏相乘所致。
丁氏说：五脏虚即补其母，这叫“随而济之”；实则泻其子，这叫“迎而夺之”。况且欲行补泻，应先候其五脏之脉，及所刺穴中，如气来牢实者，可泻之；虚濡者，可补之。若持针不能明辨牢濡，故曰“若得若失”。
第八十一难说：经文说“有见如入，有见如出”，这是什么意思呢？回答说：所谓“有见如入”，谓左手见到气来至，乃内针；针入后，见到气尽，乃出针。这叫做“有见如入，有见如出”。
丁氏说：欲刺人脉，先以左手候其穴中之气，其气来而内针，候气尽乃出其针者，这不是迎随泻补之穴，而是谓不虚不实，自取其经，施此法也。
杨氏说：这还与弹而努之、爪而下之的方法相类似。
第八十一难说：经文说“无实实，无虚虚，损不足而益有余”，这是指寸口脉吗？还是病自有虚实呢？其损益如何呢？回答说：这是病自有虚实，并非指寸口脉。假令肝实而肺虚，肝属木，肺属金，金木应当更相平，应当知金平木。假令肺实而肝虚，微少气，用针不泻其肝，而反重实其肺，所以说：“实实虚虚，损不足而益有余”。这是中等水平的医生所造成的危害。
丁氏说：“中”者，伤也。谓愚昧学习的医生，不能明其五脏之刚柔，而针药误投，所以反而增加其害。十人中能保全八人，能知晓两脏关系的很少。令肝虚肺实二脏之病，全六反增其害。
(When the Qi arrives), it resembles the pulsation of a moving artery. Insert the needle following the direction of the Qi flow. Once Deqi (arrival of Qi) is obtained, push the needle inward; this is called the Tonification method. If Deqi is obtained, rock and withdraw the needle; this is called the Sedation method. If Deqi is not obtained, differentiate by gender: for males, target the Exterior (Wei Qi); for females, target the Interior (Ying Qi). If Deqi cannot be obtained under any circumstances, it is termed "ten deaths, untreatable."
Master Yang states: Regarding the general method of inserting needles, one must first know the location of the acupoint. Then, use the left hand to press the area, and with the right hand, flick or tap the contacted spot. The pulse movement should be felt beneath the left hand. Maintain pressure with the left finger, then insert the needle along the meridian's path. Wait for Qi to manifest at the needle tip, then push it into the Ying (Nutritive) level; this constitutes Tonification. If Deqi is obtained, rotate the needle and withdraw it; this constitutes Sedation. If the needle remains for a long time without Deqi, retain it in the Wei (Defensive) level to await Qi. If Qi still does not arrive after a long wait, deepen the insertion to the Ying level and retain it longer to await Qi. If the Qi response fails to occur in all three levels (Wei, Ying, and intermediate), it indicates that both Yin and Yang Qi are exhausted, and further needling is contraindicated. In such a condition, ten out of ten will die; hence it is said "ten deaths, untreatable." Wei belongs to Yang, and Yang is exterior, hence "male exterior." Ying belongs to Yin, and Yin is interior, hence "female interior."
Master Yu states: Obtaining Qi from the Wei level and pushing it toward the deficient sector, then opening the acupoint to withdraw the needle, is called Tonification. Taking Qi from the Wei level and drawing the needle out while opening the acupoint is called Sedation. Inserting the needle during inhalation and withdrawing it at the end of exhalation is called "Tonification followed by Sedation." Doing the reverse is called "Sedation followed by Tonification." The *Xuanzhu Mi Yu* describes its tonification and sedation methods as follows: Press to obtain Deqi, insert the needle into the Heaven Level (superficial). When Qi arrives at the Heaven Level, push it to the Earth Level (deep). When Heaven and Earth Qi connect, withdraw the needle; this is Sedation. Doing the reverse is Tonification. This contradicts the previous meaning.
Master Ding states: A skilled practitioner relies on the left hand. The left hand presses the acupoint first; when Qi arrives, feeling like a moving artery against the hand, the needle is inserted. This is also "Meeting and Depriving" (Ying Er Duo Zhi), used for Sedation. When the Qi has passed, inserting the needle following its course is "Following and Assisting" (Sui Er Ji Zhi). Male Yang Qi circulates in the exterior, while female Yin Qi circulates in the interior. For males, press the acupoint lightly; for females, press heavily. If Qi does not arrive within the expected time and does not respond to the left hand, needling is contraindicated. Needling would yield no effect, indicating Qi exhaustion, thus "ten deaths, untreatable." Why wait for Qi retention?
Chapter 79 states: The classic says, "Meeting and depriving, how can there be no deficiency? Following and assisting, how can there be no repletion?" The changes between deficiency and repletion seem like gaining and losing; the states of repletion and deficiency seem like existing and non-existing. What does this mean? The answer is: "Meeting and deprying" refers to draining the Son organ/channel; "Following and assisting" refers to tonifying the Mother organ/channel. For example, in Heart disease, drain the Shu (Stream) point of the Pericardium (Hand Jueyin).
Master Yu states: In Heart disease, we drain the Shu point of the Hand Jueyin Pericardium. The Heart itself does not typically receive pathogenic factors; the Pericardium receives them instead. The Hand Jueyin Pericardium's Shu point corresponds to the Earth element. The Heart corresponds to Fire. Since Earth is the Son of Fire, draining the Shu point is draining the Son.
This is called "Meeting and Depriving."
Master Yu states: "Meeting" means obtaining Qi; "Depriving" means draining Qi.
Tonifying the Jing-Well point of the Hand Jueyin Pericardium is called "Following and Assisting."
Master Yu states: The Jing-Well point of Heart Fire corresponds to Wood. Now, tonifying the Jing-Well point of the Pericardium is tonifying the Mother. Wood is the Mother of Fire. "Following" means taking Qi from the Wei level; "Assisting" means tonifying the deficient channel.
The phrase "Repletion and Deficiency" refers to the sensation of the pulse being firm/solid (Lao) or soft/deficient (Ru).
Master Yu states: "Lao" (firm/solid) and "Ru" (soft/deficient) indicate repletion and deficiency respectively. Qi arriving firmly indicates successful acquisition (De); Qi feeling soft and deficient indicates failure (Shi). Hence, "seeming to gain and seeming to lose."
Master Yang states: This applies to diseases originating within the Zang organ itself, employing this method, rather than inter-organ overacting cycles.
Master Ding states: When a Zang is deficient, tonify its Mother; this is "Following and Assisting." When replete, drain its Son; this is "Meeting and Depriving." Furthermore, before performing tonification or sedation, one must palpate the pulses of the five Zang organs and the sensation at the acupoint. If the Qi feels firm and solid, it can be drained; if soft and deficient, it can be tonified. If the practitioner cannot clearly distinguish between firm and soft sensations while holding the needle, it results in the ambiguity described as "seeming to gain and seeming to lose."
Chapter 81 states: The classic says, "There is seeing upon entry, there is seeing upon exit." What does this mean? The answer is: "Seeing upon entry" means observing with the left hand that Qi has arrived, then inserting the needle. Upon insertion, observing that the Qi sensation has dissipated, then withdrawing the needle. This is called "seeing upon entry and seeing upon exit."
Master Ding states: To needle a person's meridians, first use the left hand to monitor the Qi in the acupoint. Insert the needle when Qi arrives, and withdraw it when the Qi sensation ends. This method is not for specific tonification/sedation points but is applied to channels that are neither deficient nor replete, targeting the channel itself.
Master Yang states: This is similar to the methods of flicking/tapping and scratching/nailing down.
Chapter 81 states: The classic says, "Do not reinforce repletion or tonify deficiency; do not damage what is insufficient to benefit what is already excessive." Does this refer to the Cun Kou pulse, or does the disease inherently possess repletion and deficiency? How should the reinforcement and reduction be handled? The answer is: This refers to the inherent repletion and deficiency of the disease, not merely the Cun Kou pulse. For instance, assume Liver Repletion and Lung Deficiency. The Liver is Wood, the Lung is Metal. Metal and Wood should balance each other; one should understand that Metal controls Wood. Assume Lung Repletion and Liver Deficiency, with slight Qi insufficiency. Using needles, if one fails to drain the Liver and instead excessively tonifies the Lung, it is said: "Reinforcing repletion and tonifying deficiency, damaging the insufficient to benefit the excessive." This is the harm caused by average physicians.
Master Ding states: "Zhong" (average/middle) implies injury. It refers to ignorant practitioners who fail to understand the hardness and softness of the five Zang organs, leading to erroneous needle and herb administration, thereby increasing harm. Among ten people, only eight might be saved, and few understand the relationship between two organs. In cases of Liver Deficiency and Lung Repletion, treating six aspects might反而 increase harm.
Master Yang states: Superior physicians treat disease before it arises, understanding the origin of repletion and deficiency, thus applying tonification and sedation appropriately. Average physicians fail to examine the root of disease transmission, and their treatment inadvertently increases harm.