者，气无所行；淫溢反流，内伤五脏，不可灸也。平按∶三倍以上《甲乙》作四倍以上，注∶《灵
枢》作三倍。注当尔，尔字袁刻作诊。）凡刺之道，气调而止，补阴泻阳，夫泻阴为易，补阴为
难，补阳为易，泻阳为难，刺法补阴泻阳，二气和者，即可停止也。（平按∶注泻阴，阴字袁刻误
作阳。）音气并章，耳目聪明，反此者，血气不行身中。（阴阳和者，言音清朗，吐纳和畅，故
曰并章。七窍开通，所以耳目聪明；反此为逆，故血气不行也。平按∶音气并章《灵枢》作音气
益彰，《甲乙》作音声益彰。
《灵枢》、《甲乙》无身中二字。注为逆袁刻作者逆。）所谓气至而有效者，（针入肤肉，转而
待气，气至行补泻而得验者，谓有效也。平按∶效《甲乙》作效。）泻则益虚，虚者脉大如其故
而不坚也，坚如其故者，适虽言快，病未去也。（以其有实，所以须泻，泻者益虚损实。其实损
者，其脉大如故而脉中不坚，即为损实也。若泻已脉大如故、脉中仍坚者，去针适虽以损称快，
病未除也。平按∶快《灵枢》作故。）补则益实，实者脉大如其故而益坚也，大如其故而不坚者，
适虽言快，病未去也。（以其有虚，所以须补，补者补虚益实者也。其得实者，脉大如故而脉中
坚，即为得实。若补已脉大如故、脉不中坚，去针适虽快，病未愈也。）故补则实，泻则虚，痛
虽不随针，病必衰去。（故补则补虚令实，泻则泻实令虚，补泻未尽其工，去针适虽言瘥，病未
除也；若补泻穷理，其痛虽不随针去，病必衰去也。平按∶针下《甲乙》有减字。）必先通十二经
脉之所生病，而后可得传于终始矣。（十二经病所由通之者，知诸邪气得之初始，亦知万病所瘥
之终，是以可得传于终始，贻诸后代也。平按∶经下《甲乙》无脉字，传上无得字。）故阴阳不相
移，虚实不相倾，取之其经。（是故学人须知阴阳虚实不相倾移者，可取十二经脉行补泻也。平按∶
倾袁刻误作颀，注同。）
黄帝问于岐伯曰∶人病胃管痈者，诊当何如？岐伯曰∶诊此者当得胃脉，其脉当沉细，沉细
者气逆，逆者人迎甚盛，盛则热，人迎者胃脉也，逆而盛，则热聚于胃口而不行，故胃管为痈。
黄帝曰∶善。（胃管痈者，胃口有热，胃管生痈也。得胃脉者，寸口脉也。寸口者，脉之大会手
太阴
之动也，故五脏六腑十二经脉之所终始也。平人手之寸口之中，胃脉合浮与大也。今于寸口之中，
诊得沉细之脉，即知胃有伤寒逆气，故寸口之脉沉细，上之人迎洪盛者也，盛则胃管热也。上人迎
者，在喉两边，是足阳明胃脉者也。胃气逆者，则手之寸口沉细，喉边人迎盛大，故知热聚胃口不
行为痈。纡恭反，肿也。平按∶胃管《素问》、《甲乙》作胃脘。沉细《甲乙》作沉涩，《素问》
新校正云∶《太素》作沉细。）
安卧，小便黄赤、脉小而涩者，不嗜食。（安卧，小便黄赤，脉小涩，脾病，故不嗜食也。平
按∶涩《灵枢》作涩。）人病，其寸口之脉与人迎之脉，大小及其浮沉等者，病难已也。（寸口，
即脉口也。人病，寸口之脉，秋浮冬沉，人迎之脉，春小夏大，纵病易已；四时大小浮沉皆同，即
四时脉乱，故难已也。平按∶《灵枢》大小作小大等三字。）
如果脉象超过正常四倍以上，说明气机运行受阻；邪气淫溢反流，内伤五脏，此时不可使用灸法。（平按：《甲乙经》中“三倍以上”作“四倍以上”，注解说：《灵枢》作“三倍”。注解说应当如此，“尔”字在袁刻本中误作“诊”。）
大凡针刺的原则，以气机调和为停止标准。补阴泻阳，其中泻阴容易而补阴困难，补阳容易而泻阳困难。针刺时采用补阴泻阳的方法，若阴阳二气调和，即可停止针刺。（平按：注文中“泻阴”，“阴”字在袁刻本中误作“阳”。）
声音和气息都通畅明亮，耳目聪明，与此相反的情况，则是血气在体内运行不畅。（阴阳调和，表现为声音清朗，呼吸和畅，所以称为“并章”。七窍开通，因此耳目聪明；与此相反即为逆证，所以血气不能正常运行。平按：《灵枢》中“音气并章”作“音气益彰”，《甲乙经》作“音声益彰”。《灵枢》、《甲乙经》中没有“身中”二字。注文中“为逆”在袁刻本中误作“作者逆”。）
所谓“气至而有效”，是指（针入肌肤后，转动针具等待得气，气至后进行补泻操作并取得疗效，这就叫做有效。平按：《甲乙经》中“效”字同）。
泻法之后更加虚弱，虚证的脉象虽然宽大如故但搏动不坚实，如果脉象依然宽大且坚实，虽然患者感觉舒适，但病邪并未去除。（因为体内有实邪，所以需要泻法，泻法旨在进一步损伤实邪。当实邪被损伤时，脉象虽大如旧但脉管内部不坚实，这就是实邪已损的表现。如果泻法之后脉象依然宽大且内部坚实，即使出针后患者自述感到轻松舒适，疾病也未痊愈。）
补法之后更加充实，实证的脉象虽然宽大如故但搏动更加坚实，如果脉象宽大但不坚实，虽然患者感觉舒适，但病邪并未去除。（因为体内有虚损，所以需要补法，补法旨在填补虚损使其充实。当获得充实感时，脉象宽大如旧且脉管内部坚实，这就是得实的表现。如果补法之后脉象宽大但内部不坚实，即使出针后患者感到舒适，疾病也未痊愈。）
所以，补法使虚者变实，泻法使实者变虚。疼痛虽然不一定随针立止，但疾病必定会衰退。（所以补法是使虚者变实，泻法是使实者变虚。如果补泻未能尽善尽美，出针后虽然患者说好转了，但病未除；如果补泻合乎道理，即使疼痛没有随着针刺立即消失，疾病也一定会衰退。平按：《甲乙经》中“针下”有“减”字。）
必须先通晓十二经脉所发生的病变，然后才能掌握疾病的终始传变规律。（十二经病的由来，在于知晓各种邪气侵袭的初始阶段，也知晓万病痊愈的最终结局，因此可以传授给后代关于疾病终始的知识。平按：《甲乙经》中“经”下无“脉”字，“传”上无“得”字。）
所以，阴阳不相移易，虚实不相倾覆，治疗应选取相应的经脉。（因此学习者必须知道，对于阴阳虚实不相移易的情况，可以取用十二经脉进行补泻操作。平按：“倾”字在袁刻本中误作“颀”，注文相同。）
黄帝问岐伯说：人患胃脘痈肿，诊察脉象应当如何？岐伯回答说：诊察此病应当得到胃脉，其脉象应当沉细。沉细的脉象表示气机逆乱，气机逆乱则人迎脉非常盛大，盛大则代表热盛。人迎脉是胃脉，气机逆乱且盛大，则热气聚集于胃口而不能通行，所以胃脘发生痈肿。
黄帝说：好。（胃脘痈，是指胃口有热，导致胃脘生痈。得到胃脉，是指寸口脉。寸口脉，是脉之大会，属于手太阴肺经的动脉，因此是五脏六腑十二经脉气血终结和起始的地方。正常人手的寸口脉中，胃脉通常呈现浮大的特征。现在在寸口中诊察到沉细的脉象，就知道胃中有伤寒逆气，所以寸口脉沉细，而上部的人迎脉洪盛。上部的人迎脉，位于喉咙两边，是足阳明胃经的脉位。胃气逆乱，则手上的寸口脉沉细，喉边的人迎脉盛大，因此知道热气聚集在胃口不能通行从而形成痈肿。纡恭反切，意为肿胀。平按：《素问》、《甲乙经》中“胃管”作“胃脘”。《甲乙经》中“沉细”作“沉涩”，《素问》新校正云：《太素》作“沉细”。）
嗜睡，小便黄赤，脉象小而涩的，是不想进食。（嗜睡，小便黄赤，脉小且涩，这是脾病，所以不想进食。平按：《灵枢》中“涩”字同。）
人患病时，如果他的寸口脉与人迎脉的大小及其浮沉程度相等，这种病难以治愈。（寸口，即脉口。人患病时，寸口脉秋季浮冬季沉，人迎脉春季小夏季大，即使生病也容易治愈；如果四季脉象的大小浮沉都相同，即四时脉象紊乱，所以难以治愈。平按：《灵枢》中“大小”作“小大等”三字。）
If the pulse exceeds the normal level by more than four times, it indicates that Qi circulation is obstructed; pathogenic factors overflow and flow backward, damaging the five Zang organs internally, and moxibustion should not be used at this time. (Ping An: "Exceeds by three times" in *Jia Yi Jing* is written as "exceeds by four times"; the annotation states: *Ling Shu* writes "three times". The annotation implies this is correct, and the character "Er" was erroneously printed as "Zhen" in Yuan's edition.)
In general, the principle of acupuncture is to stop when Qi is harmonized. Tonifying Yin and draining Yang: draining Yin is easy, while tonifying Yin is difficult; tonifying Yang is easy, while draining Yang is difficult. In acupuncture methods, if Yin and Yang are harmonized through tonifying Yin and draining Yang, the procedure may be stopped. (Ping An: In the annotation "Drain Yin", the character "Yin" was erroneously printed as "Yang" in Yuan's edition.)
When voice and breath are both clear and resonant, and hearing and vision are acute, the opposite condition indicates that Blood and Qi do not circulate smoothly within the body. (Harmony of Yin and Yang manifests as clear voice and smooth respiration, hence termed "Bing Zhang" [mutually manifest]. With the seven orifices open, hearing and vision become acute; the opposite is considered adverse, thus Blood and Qi fail to circulate. Ping An: "Yin Qi Bing Zhang" in *Ling Shu* is written as "Yin Qi Yi Zhang", and in *Jia Yi Jing* as "Sheng Yin Yi Zhang". *Ling Shu* and *Jia Yi Jing* lack the characters "Shen Zhong". In the annotation, "Wei Ni" [is adverse] was erroneously printed as "Zuo Zhe Ni" in Yuan's edition.)
The phrase "Qi arrives and there is efficacy" refers to (after inserting the needle into the skin and flesh, rotating it to await Qi arrival, performing tonification or reduction upon Qi arrival, and obtaining verification, this is called efficacy. Ping An: "Xiao" [efficacy] in *Jia Yi Jing* is the same).
After reduction (draining), deficiency increases; in a deficient state, the pulse may be large as before but not firm. If the pulse remains large and firm, although the patient feels comfortable after removing the needle, the disease has not been eliminated. (Because there is excess, reduction is required to further damage the excess. When the excess is damaged, the pulse is large like before but not firm inside, indicating the excess has been reduced. If after reduction the pulse is still large and firm inside, even if the patient reports feeling better after needle removal, the disease persists.)
After tonification, fullness increases; in an excessive state, the pulse may be large as before but becomes firmer. If the pulse is large but not firm, although the patient feels comfortable, the disease has not been eliminated. (Because there is deficiency, tonification is required to fill the deficiency and increase fullness. When fullness is achieved, the pulse is large like before and firm inside, indicating success. If after tonification the pulse is large but not firm inside, even if the patient feels comfortable after needle removal, the disease is not cured.)
Therefore, tonification makes the deficient solid, and reduction makes the excessive empty. Although pain may not cease immediately with the needle, the disease will certainly recede. (Thus, tonification makes the deficient solid, and reduction makes the excessive empty. If tonification and reduction are not performed thoroughly, even if the patient says they feel better after needle removal, the disease is not removed; if tonification and reduction follow proper principles, even if pain does not disappear immediately with the needle, the disease will surely recede. Ping An: *Jia Yi Jing* has the character "Jian" [reduce] under "Zhen Xia" [under the needle].)
One must first understand the diseases occurring in the twelve meridians, and only then can one grasp their transmission from beginning to end. (The origin of diseases in the twelve meridians lies in knowing the initial stage of various pathogenic invasions, and also knowing the final outcome of the cure for all diseases; thus, one can transmit knowledge of disease beginnings and endings to future generations. Ping An: *Jia Yi Jing* lacks the character "Mai" [pulse] after "Jing" [meridian], and lacks the character "De" [obtain] before "Chuan" [transmit].)
Therefore, when Yin and Yang do not shift, and deficiency and excess do not incline, treatment should select the corresponding meridians. (Therefore, students must know that for conditions where Yin/Yang and Deficiency/Excess do not shift or incline, one can apply tonification and reduction to the twelve meridians. Ping An: "Qing" [inclined] was erroneously printed as "Qi" in Yuan's edition, and the annotation is the same.)
Huang Di asked Qi Bo: If a person suffers from a carbuncle in the stomach region, how should the pulse be diagnosed? Qi Bo replied: Diagnosing this condition requires finding the Stomach pulse, which should be deep and fine. A deep and fine pulse indicates rebellious Qi. Rebellious Qi causes the Ren Ying pulse (Stomach Meridian pulse at the neck) to be very vigorous. Vigor indicates heat. The Ren Ying pulse belongs to the Stomach meridian; when Qi is rebellious and vigorous, heat gathers at the stomach opening without circulating, thus causing a carbuncle in the stomach region.
Huang Di said: Excellent. (A carbuncle in the stomach region means heat at the stomach opening causes a carbuncle in the stomach tube. Finding the Stomach pulse refers to the Cun Kou pulse. Cun Kou is the great convergence of pulses, belonging to the movement of the Hand Taiyin Lung meridian, and thus is the termination and beginning of the five Zang and six Fu organs and the twelve meridians. In a healthy person, the Stomach pulse at the Cun Kou typically appears floating and large. Now, diagnosing a deep and fine pulse at the Cun Kou indicates cold damage and rebellious Qi in the Stomach; therefore, the Cun Kou pulse is deep and fine, while the upper Ren Ying pulse is surging and vigorous. The upper Ren Ying pulse is located on both sides of the throat and is the pulse of the Foot Yangming Stomach meridian. When Stomach Qi is rebellious, the hand's Cun Kou pulse is deep and fine, and the Ren Ying pulse at the side of the throat is vigorous; thus, we know heat gathers at the stomach opening and fails to circulate, forming a carbuncle. Yu Gong fan qie [phonetic transcription], meaning swelling. Ping An: *Su Wen* and *Jia Yi Jing* write "Wei Guan" as "Wei Wan". *Jia Yi Jing* writes "Shen Xi" [deep and fine] as "Shen Se" [deep and choppy]; *Su Wen* Xin Jiao Zheng states: *Tai Su* writes "Shen Xi".)
Lethargy, yellow and red urine, and a small and choppy pulse indicate a lack of appetite. (Lethargy, yellow and red urine, small and choppy pulse are signs of Spleen disease, hence the lack of appetite. Ping An: "Se" [choppy] in *Ling Shu* is the same.)
When a person is ill, if the size and floating/sinking characteristics of their Cun Kou pulse and Ren Ying pulse are equal, the disease is difficult to cure. (Cun Kou is the Mai Kou. When ill, the Cun Kou pulse floats in autumn and sinks in winter; the Ren Ying pulse is small in spring and large in summer. Even if ill, it is easy to cure; if the size and floating/sinking are identical across all four seasons, the four-season pulses are chaotic, hence difficult to cure. Ping An: *Ling Shu* writes "Xiao Da Deng" [small, large, equal] instead of "Da Xiao" [large, small].)