平按∶此篇自篇首至末，见《素问》卷十七第六十二《调经论》篇，与上编相接，又见《甲乙
经》卷六第三，亦接上编。
黄帝曰∶余以闻虚实之形，不知其何以生？（形，状也。虚实之状，已闻于上，虚实所生，
犹未知之，故复请也。平按∶《素问》以闻作已闻。《甲乙》无余以闻三字。）岐伯对曰∶气血
以并，阴阳相倾，气
乱于卫，血留于经，（十二经气乱卫气也。十二经血留于营经也。或曰血流也。平按∶《素问》、
《甲乙》血留作血逆。）血气离居，一实一虚。（血气相并，离于本居处，故各有虚实也。夫血
气者，异名同类，相得成和。今既相并，一实一虚，虚实所生，是所由者也。）血并于阴，（血并足
太阴脉及足少阴脉也。）气并于阳，乃为惊狂。（气并足阳明脉及足太阳脉也。血气皆盛，故发
惊狂也。）血并于阳，气并于阴，乃为炅中。（血并足阳明，气并足太阴，为热中病也。炅，热
也。）血并于上，气并于下，心烦 喜怒。（血盛上冲心，故心烦闷而喜怒。 则闷同也。平按∶
《素问》作惋，《甲乙》作闷。喜《素问》、《甲乙》作善。）血并于下，气并于上，气乱心
善忘。（气盛乱心，故善忘也。平按∶气乱心善忘《甲乙》作乱而喜忘，注云∶“《素问》作善
忘。”今本《素问》仍作乱而喜忘。）黄帝曰∶血并于阴，气并于阳，于是血气离居，何者为实？
何者为虚？（血气离居相并，未知二经虚实何定也。平按∶于是《素问》、《甲乙》作如是。）
岐伯对曰∶血气者喜温而恶寒，寒则泣不能流，温则消而去之，是故气之所并为血虚，血之所并
为气虚也。（血之与气，皆恶于寒，故脉有寒则泣而不流者，温则消释而去。是以气寒则血来并
之，以为血虚，则气为实也；若血寒则气来并之，以为气虚，则血为实也。平按∶是故，故字袁
刻作知。）黄帝曰∶人之所有者，血与气耳。今夫子乃言血并为虚，气并为虚，是毋实乎？（人
之所生，唯血与气。今夫子但言血气有虚，不言其实，是为人之血气不足，请申其意也。）岐伯
对曰∶有者为实，毋者为虚，故气并则毋血，血并则毋气，今血与气相失，故为虚焉。（血并则
血有气毋，气并则气有血毋，是以言虚不无其实，论实不废其虚，故在身未曾无血气也。所言虚
者，血气相
并相失为虚，相得为实耳。）络之与孙脉俱输于经，（大络孙络，俱输血气入于大经，则大经血
气俱实者也。平按∶输《甲乙》作注 注云∶一作输。）血与气并，则为实焉。血与气并走于上，
则为大厥，厥则暴死，复反则生，不反则死。（大经血气皆实，走膈以上，以下无气，故手足逆
冷卒暴死也。手足还暖复生，不还则死也。平按∶复反上《素问》、《甲乙》皆有气字。）黄帝曰∶
实者何道从来？虚者何道从去？虚实之要，愿闻其故。（血气何道来入此经为实，何道而去此经
为虚也。）岐伯对曰∶夫阴与阳，皆有输会，阳注于阴，阴满之外，（脏腑阴阳之脉，皆有别走
输会相通。如足阳明从丰隆之穴，别走足太阴，太阴从公孙之穴，别走足阳明，故曰外也。）阴
阳旬平，以充其形，（甲子一日一迎为旬。旬，迎也。阴阳之脉五十迎无多少者，名曰旬平。旬
平和气，以充其身形也。平按∶旬平《素问》作匀平，《甲乙》作 平。）九候如一，命曰平人。
（九候之动不先后，又不相反，故曰若一。和气若一，故人得和平。平按∶注九候袁刻作九脉。）
夫邪之至生也，（平按∶《素问》无至字，《甲乙》作所。）或生于阴，或生于阳。其生于阳者，
得之风雨寒暑；其生于阴者，得之饮食起居，阴阳喜怒。（阴，五脏也。阳，六腑也。风雨寒暑
外邪，从外先至六腑，故曰生于阳也。饮食起居，男女喜怒，内邪生于五脏，故曰生于阴也。）
黄帝曰∶风雨寒暑之伤人奈何？（平按∶《素问》、《甲乙》无寒暑二字。）岐伯对曰∶风雨之
伤人也，先客于皮肤，传入于孙脉，孙脉满则传入于络脉，络脉满乃输于大经脉，血气与邪并客
于分腠之间，其脉坚大，故曰实。（此先言风雨二邪也。人因饥虚汗出，腠理开发，风雨之气，
因客腠理，次入孙络，次入大络，次入大经。客腠理时，所客之脉坚而且大，故
得称实也。平按∶乃输《素问》作则输，《甲乙》作乃注。）实者，外坚充满，不可按，按之则
痛。（所客之处外坚，按之则痛，以其气实故也。平按∶不可按《素问》作不可按之。）黄帝曰∶
寒湿之气伤人奈何？（平按∶《素问》、《甲乙》无气字。）岐伯对曰∶寒湿之中人也，皮肤收，
肌肉坚，营血泣，卫气去，故曰虚也。（次论寒湿之气也。雨气上侵，湿气下入，有斯异也，略
不言暑耳。寒湿中人，致虚有四∶皮肤收者，言皮肤急而聚也；肌肉坚者，肌肉坚而不迎也；营
血泣者，邪气至于脉中，故营血泣也；卫气去者，邪气至于脉外，卫气不行，故曰去也。卫去之
处，即为虚也。平按∶皮肤收《素问》作皮肤不收，新校正云∶“全元起云∶不收，不仁也。《甲
乙》及《太素》作皮肤收，无不字。”坚下《素问》、《甲乙》有紧字。注故曰去也，袁刻去误
作涩。）虚者，慑辟气不足，血泣。（慑，纸辄反。分肉间无卫气，谓气不足也。平按∶慑《素
问》作聂，新校正云∶“《甲乙》作摄，《太素》作慑。”《素问》无血泣二字，《甲乙》作血
涩。）按之则气足以温之，故快然而不痛，黄帝曰∶善。（分肉之间既无卫气故寒，按之益损，
所以气足又温，故快然也。）
黄帝曰∶阴之生实奈何？岐伯对曰∶喜怒不节，则阴气上逆，上逆则下虚，下虚则阳气走之，
故曰实。（人有喜怒不能自节，故怒则阴气上，阴气上则上逆，或呕血，或不能食。阴气既上则是下
虚，下虚则阳气乘之，故名曰阴实也。平按∶《素问》新校正云∶“经文喜怒不节则阴气上逆，疑
剩喜字。”玩下文喜则气下自知。）黄帝曰∶阴之生虚奈何？岐伯对曰∶喜则气下，（天寒则气
聚，温则气散，怒则气上，喜则气下，此物理之常也。喜则气和志达，营卫之行通利，故缓而下
也。）悲则气消，消则脉虚，因寒饮食，寒气熏脏，
则血泣气去，故曰虚。（夫人悲者，则心系急，肺布叶举，两焦不通，营卫不行，热气在中，故
正气消散，经络空虚也。又因寒饮寒食，寒气熏脏，脏之血泣，其气移去，故为虚也。平按∶脉
虚《素问》、《甲乙》作脉空虚。熏脏《素问》作熏满，《甲乙》作动脏。注两焦，两字袁刻误
作雨。）黄帝曰∶经言阳虚则外寒，阴虚则内热，（经言，八十一篇经也。腑脉虚者，阴气乘之，
故外寒也。脏脉虚，阳气乘之，故内热也。）阳盛则外热，阴盛则内寒，余以闻之矣，不知其所
由然。（六腑主外为阳，故阳盛外热也。五脏主内为阴，故阴盛为寒。余已前闻，然未知所由然
也。）岐伯对曰∶阳受气于上焦，以温皮肤分肉之间，今寒气在外，则上焦不通，不通则寒独留
于外，故寒 。（阳，卫气也。卫出上焦，尽行阳二十五周，以温皮肤分肉之间。今阳虚阴乘留
于外，故外寒也。平按∶注尽行二十五周，考前经《卫五十周》云∶卫气之行，一日一夜五十周
于身，昼日行于阳二十五周。据此，则尽字疑是昼字传写之误。）黄帝曰∶阴虚生内热奈何？岐
伯对曰∶有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，胃热熏中，故内热。（内热之
病，所由有五∶一则有所劳倦致虚，二则形体及气不足，三则胃中无食，四则上焦卫气不行，五
则肠胃不得相通。脘，古缓反，胃腑也。下脘，胃下口也。由此五种，卫热熏中，故内热也。平
按∶下脘《甲乙》作下焦。胃热熏中《素问》作胃气热热气熏胸中，《甲乙》作胃气热熏胸中。
注由此袁刻作有此。）黄帝曰∶阳盛而外热奈何？岐伯对曰∶上焦不通利，皮肤致密，腠理闭塞
不通，卫气不得泄越，故外热。（外热之所由有三∶上焦出气之处不通利，一也；皮肤致而腠闭，
二也；卫气不得泄于腠理，三也。有此所由，故外热也。平按∶闭塞下《素问》有玄府二字，新
校正云∶“《甲乙》、《太
素》无玄府二字。”）黄帝曰∶阴盛而生内寒奈何？岐伯对曰∶厥气上逆，寒气积留于胸中而不泻，
不泻则温气去，寒独留，则血 泣，血 泣则脉不通，其脉盛大以涩，故中寒。（寒中有四∶一
则寒厥积胸，二则温去寒留，三则血凝脉壅，四则脉大汗涩。有此所由，故寒中也。平按∶积下
《素问》、《甲乙》无留字。 泣《素问》、《甲乙》作凝泣。脉不通《甲乙》作腠理不通。）黄
帝曰∶阴之与阳，血气以并，病形以成，刺之奈何？（问疗已成之病。平按∶阴之与阳《素问》
作阴与阳并。）岐伯对曰∶刺此者，取之经隧，取血于营，取气于卫，用形哉，因四时多少高下。
（刺已成病法有三别∶一则刺于大经别走之道，隧，道也，别走之道通阴阳道也；二则刺于脉中
营血；三则刺于脉外卫气。用针之状，须因四时之气，观病轻重，发针多少；又须量病高下所在，
取之令中，不同刺微之易也。平按∶经隧《甲乙》作经渠。）黄帝曰∶血气以并，病形以成，阴
阳相倾，补泻奈何？岐伯对曰∶泻实者，气盛乃内针，（夫泻者，以其邪气实盛，故须泻也。仍
以掐之令下，然后刺之。不盛何泻，故譬无击逄逄之阵者也。平按∶以并、以成，《甲乙》以作
已。）针与气俱内，以开其门如利其户，针与气俱出，精气不伤，邪气乃下，外门不闭，以出其
病，摇大其道如利其路，是谓大泻，必切而出，大气乃屈。（人之吸气，身上有孔闭处，皆入聚
于肾肝；呼气之时，有孔开处，气皆从心肺而出，比囊之呼吸也。针开孔时，病患吸气，故针与
气俱入内也。针得入已，摇大其穴，因呼出针，故针与邪气俱出，勿伤正气也。平按∶以出其病
《素问》、《甲乙》病作疾。）黄帝曰∶补虚奈何？岐
伯对曰∶持针勿置，以定其意，（持针勿置于肉中，先须安神定意，然后下针。若医者志意散乱，
针下气之虚实有无皆不得知，故须定意也。平按∶注安神定意，袁刻意作志。）候呼内针，（人
之呼气，身上有孔，其气皆出，故所针孔气出之时内针，欲令有气从针而入，不使气泄，所以候
呼内针者也。）气出针入，针空四塞，精无从去，（呼气出时针入穴者，欲使针空四塞，不泄正气
也。平按∶注入穴，袁刻穴作空。）方实而疾出针，气入针出，（方，正也。候气正实疾出针。）热
不得环，（夫虚者多寒，得热为补。环，转也。疾出针，使针下热气不得转也。平按∶《素问》、
《甲乙》环作还。）闭塞其门，邪气布散，精气乃得存，动无后时，（出针已去，纵邪不出尽，
自然布散消亡，精气独在，无病动于后时也。平按∶动无后时《素问》作动气候时。）近气不入，
远气乃来，是谓追之。（行补之时，非其补处近气不失，远气亦来至此集也。已虚之气引令实，故
曰追也。）黄帝曰∶夫子言虚实有十，生于五脏，五脏，五脉耳，夫十二经脉皆生百病，今夫子
独言五脏。夫十二经脉者，皆络三百六十五节，节有病必被经脉，经脉之病皆有虚实，何以合之？
（节，即气穴也。但十二经脉被三百六十五穴，则三百六十五穴所生之病甚多，非唯五脏五脉独
生十种虚实者。平按∶皆生百病《素问》作皆生其病，新校正云∶《甲乙》云∶皆生百病。《太
素》同。）岐伯对曰∶五脏者，故得六腑与为表里，经络支节，各生虚实，（内有五脏，外有六
腑，腑脏经络表里诸支节，是生虚实，其亦甚多，不相违也。）视其病所居，随而调之。病在血，
调之脉；病在气，调之卫；病在肉，调之分肉；病在筋，调之筋，燔针劫刺其下及与急者；（视
三百六十五节所生病处，量其虚实，随而调之。调者，调于五脏所主脉、卫、分肉、筋、骨
也。平按∶《素问》其病上无视字，病在血调之脉作病在脉调之血，新校正云∶“全元起及《甲乙》
作病在血调之脉。”检今本《甲乙》仍作病在脉调之血。又《素问》、《甲乙》病在气上有“病
在血调之络”六字，调之筋下有“病在骨调之骨”六字。）病在骨，卒针药熨；（卒，穷也。痛
痹在骨，穷针深之至骨，出针以药熨之，以骨病痛深故也。熨法，上经已说也。平按∶卒《素问》、
《甲乙》作 。）病不知其所痛，两跷为上。（诸骨病不定知于病之所在者，可取足少阴两阴跷。
两阴跷是足少阴别，足少阴脉主骨者也。上者，胜也。平按∶《素问》、《甲乙》无其字。注诸
骨，诸字袁刻作痛。）身形有痛者，九候莫病，则缪刺之。（审三部九候竟无病状，然身形有痛
者，此络左右有病，可缪刺也。平按∶《素问》、《甲乙》无者字。）病在于左而右脉病者，则巨
【平按】本篇从篇首到结尾，见于《素问》卷十七第六十二篇《调经论》，与上编相接，又见于《甲乙经》卷六第三篇，也承接上编。
黄帝说：我已经听闻了虚实的外在表现，但不知道它们是如何产生的？（形，指形态、状态。虚实的状态，上面已经听说了，但虚实产生的原因，还不知道，所以再次请教。平按：《素问》将“闻”写作“已闻”。《甲乙经》没有“余以闻”三个字。）岐伯回答说：气和血相互偏并，阴阳相互倾侧，气在卫分紊乱，血在经脉中留滞，（十二经的气乱于卫气。十二经的血留滞在营经中。也有说法认为是血流。平按：《素问》、《甲乙经》中“血留”写作“血逆”。）气血分离居住，一处实一处虚。（气血相并，离开原本的位置，所以各自有虚实。夫血和气，名称不同但同类，相互协调才能和谐。现在既然相并，一实一虚，虚实产生，就是由此而来的。）血偏并于阴分，（血并足太阴脉和足少阴脉。）气偏并于阳分，就会发生惊狂。（气并足阳明脉和足太阳脉。血气都盛，所以发生惊狂。）血偏并于阳分，气偏并于阴分，就会发生热中病。（血并足阳明，气并足太阴，形成热中病。炅，就是热。）血偏并于上部，气偏并于下部，就会心烦易怒。（血盛向上冲心，所以心烦闷且喜怒无常。 同闷字。平按：《素问》作“惋”，《甲乙经》作“闷”。喜，《素问》、《甲乙经》作“善”。）血偏并于下部，气偏并于上部，气乱于心，就会健忘。（气盛扰乱心神，所以容易忘记事情。平按：“气乱心善忘”，《甲乙经》作“乱而喜忘”，注云：“《素问》作‘善忘’。”现在的《素问》版本仍作“乱而喜忘”。）黄帝说：血偏并于阴，气偏并于阳，于是气血分离居住，哪一个是实？哪一个是虚？（气血分离相并，不知道这两经的虚实如何确定。平按：“于是”，《素问》、《甲乙经》作“如是”。）岐伯回答说：气血喜欢温暖而厌恶寒冷，寒冷则凝涩不能流动，温暖则消散而去，所以气所偏并的地方血就虚，血所偏并的地方气就虚。（血和气，都厌恶寒冷，所以脉中有寒则凝涩不流，温暖则消释而去。因此气寒则血来并之，造成血虚，那么气就为实；如果血寒则气来并之，造成气虚，那么血就为实。平按：“是故”，“故”字袁刻本作“知”。）黄帝说：人拥有的东西，只是血和气罢了。现在先生您却说血并导致虚，气并导致虚，难道就没有实了吗？（人生存依靠的，只有血和气。现在先生只说血气有虚，不说其实，这是认为人的血气不足，请阐明您的意思。）岐伯回答说：有的存在叫实，没有的叫虚，所以气并则无血，血并则无气，现在血与气相失，所以称为虚。（血并则血有气无，气并则气有血无，所以说虚并不是没有实，论实也不废弃其虚，所以在身体中从未没有血气。所说的虚，是指血气相并相失为虚，相得为实。）络脉和孙脉都输送到大经脉，（大络孙络，都输血气进入大经，那么大经的血气就都实了。平按：“输”，《甲乙经》作“注”，注云：一作“输”。）血与气相并，就成为实证。血与气一起向上走，就会发生大厥，厥证则突然死亡，如果气血能返回则生，不能返回则死。（大经血气都实，走向膈以上，以下无气，所以手足逆冷突然死亡。手足回暖则生，不回温则死。平按：“复反上”，《素问》、《甲乙经》都有“气”字。）黄帝说：实证是从什么道路来的？虚证是从什么道路去的？虚实的要领，希望听听其中的缘故。（血气从什么道路进入此经为实，从什么道路离开此经为虚呢？）岐伯回答说：阴和阳，都有腧穴交会，阳注入阴，阴满溢于外，（脏腑阴阳的经脉，都有别走腧穴相通。如足阳明从丰隆穴，别走足太阴，太阴从公孙穴，别走足阳明，所以叫外。）阴阳匀平，以充实身形，（甲子日一天一迎为旬。旬，迎也。阴阳之脉五十次迎接无多无少的，名叫旬平。旬平和气，以充实体型。平按：“旬平”，《素问》作“匀平”，《甲乙经》作“平”。）九候一致，名叫平人。（九候的跳动不先后，又不相反，所以叫若一。和气若一，所以人得到和平。平按：注“九候”，袁刻本作“九脉”。）邪气到来的时候，（平按：《素问》无“至”字，《甲乙经》作“所”。）或者生于阴，或者生于阳。那些生于阳的，是由于风雨寒暑；那些生于阴的，是由于饮食起居、阴阳喜怒。（阴，指五脏。阳，指六腑。风雨寒暑是外邪，从外先到达六腑，所以叫生于阳。饮食起居，男女喜怒，内邪生于五脏，所以叫生于阴。）黄帝说：风雨寒暑伤害人是怎么回事？（平按：《素问》、《甲乙经》无“寒暑”二字。）岐伯回答说：风雨伤害人，先客居于皮肤，传入孙脉，孙脉满则传入络脉，络脉满乃输送到大经脉，血气与邪气相并客居在分腠之间，其脉坚大，所以叫实。（这里先讲风雨二邪。人因为饥饿虚弱出汗，腠理开发，风雨之气，趁机客居腠理，依次进入孙络，依次进入大络，依次进入大经。客居腠理时，所客居的脉坚硬而且大，所以得以称为实。平按：“乃输”，《素问》作“则输”，《甲乙经》作“乃注”。）实证，外部坚硬充满，不可按压，按压则痛。（所客居之处外部坚硬，按压则痛，因为气实的原因。平按：“不可按”，《素问》作“不可按之”。）黄帝说：寒湿之气伤害人是怎么回事？（平按：《素问》、《甲乙经》无“气”字。）岐伯回答说：寒湿中人，皮肤收缩，肌肉坚实，营血凝涩，卫气离去，所以叫虚。（其次论述寒湿之气。雨气上侵，湿气下入，有这种差异，简略不提暑邪。寒湿中人，导致虚有四方面：皮肤收缩，是说皮肤紧急聚拢；肌肉坚实，是说肌肉坚硬而不柔顺；营血凝涩，是邪气到了脉中，所以营血凝涩；卫气离去，是邪气到了脉外，卫气不行，所以叫去。卫气离去的地方，就是虚。平按：“皮肤收”，《素问》作“皮肤不收”，新校正云：“全元起云：不收，是不仁。《甲乙经》及《太素》作‘皮肤收’，无不字。”坚下《素问》、《甲乙经》有“紧”字。注“故曰去也”，袁刻本“去”误作“涩”。）虚证，怯惧畏缩气不足，血凝涩。（慑，纸辄反切音。分肉间没有卫气，叫气不足。平按：“慑”，《素问》作“聂”，新校正云：“《甲乙经》作‘摄’，《太素》作‘慑’。”《素问》无“血泣”二字，《甲乙经》作“血涩”。）按压则气足以温之，所以舒适而不痛，黄帝说：好。（分肉之间既没有卫气所以寒，按压增加损伤，所以气足又温，所以舒适。）
黄帝说：阴分产生实证是怎么回事？岐伯回答说：喜怒不节制，则阴气上逆，上逆则下部虚，下部虚则阳气走之，所以叫实。（人有喜怒不能自我节制，所以怒则阴气上，阴气上则上逆，或者呕血，或者不能进食。阴气既上则是下部虚，下部虚则阳气乘之，所以名叫阴实。平按：《素问》新校正云：“经文‘喜怒不节则阴气上逆’，疑剩‘喜’字。”玩味下文‘喜则气下’自然知道。）黄帝说：阴分产生虚证是怎么回事？岐伯回答说：喜则气下，（天寒则气聚，温暖则气散，怒则气上，喜则气下，这是物理的常理。喜则气和志达，营卫之行通利，所以缓而下也。）悲则气消，消则脉虚，因寒饮食，寒气熏脏，则血凝涩气去，所以叫虚。（人悲伤时，则心系急，肺布叶举，两焦不通，营卫不行，热气在中，所以正气消散，经络空虚。又因寒饮寒食，寒气熏脏，脏之血凝涩，其气移去，所以为虚。平按：“脉虚”，《素问》、《甲乙经》作“脉空虚”。熏脏，《素问》作“熏满”，《甲乙经》作“动脏”。注“两焦”，两字袁刻误作“雨”。）黄帝说：经上说阳虚则外寒，阴虚则内热，（经言，指八十一篇经。腑脉虚者，阴气乘之，所以外寒。脏脉虚，阳气乘之，所以内热。）阳盛则外热，阴盛则内寒，我已经听说了，但不知道其中的缘由。（六腑主外为阳，所以阳盛外热。五脏主内为阴，所以阴盛为寒。我之前已听说，然而不知道其中的缘由。）岐伯回答说：阳受气于上焦，以温皮肤分肉之间，现在寒气在外，则上焦不通，不通则寒独留于外，所以寒。（阳，指卫气。卫出上焦，尽行阳二十五周，以温皮肤分肉之间。现在阳虚阴乘留于外，所以外寒。平按：注“尽行二十五周”，考前经《卫五十周》云：卫气的运行，一日一夜五十周于身，昼日行于阳二十五周。据此，则“尽”字疑是“昼”字传写之误。）黄帝说：阴虚生内热是怎么回事？岐伯回答说：有所劳倦，形体气衰少，谷气不盛，上焦不行，下脘不通，胃热熏中，所以内热。（内热病的由来有五种：一则有所劳倦致虚，二则形体及气不足，三则胃中无食，四则上焦卫气不行，五则肠胃不得相通。脘，古缓反切音，胃腑也。下脘，胃下口也。由此五种，卫热熏中，所以内热。平按：“下脘”，《甲乙经》作“下焦”。胃热熏中，《素问》作“胃气热热气熏胸中”，《甲乙经》作“胃气热熏胸中”。注“由此”，袁刻本作“有此”。）黄帝说：阳盛而外热是怎么回事？岐伯回答说：上焦不通利，皮肤致密，腠理闭塞不通，卫气不得泄越，所以外热。（外热的由来有三：上焦出气之处不通利，一也；皮肤致密而腠闭，二也；卫气不得泄于腠理，三也。有此由来，所以外热。平按：“闭塞”下《素问》有“玄府”二字，新校正云：“《甲乙经》、《太素》无‘玄府’二字。”）黄帝说：阴盛而生内寒是怎么回事？岐伯回答说：厥气上逆，寒气积留于胸中而不泻，不泻则温气去，寒独留，则血凝涩，血凝涩则脉不通，其脉盛大以涩，所以中寒。（寒中有四：一则寒厥积胸，二则温去寒留，三则血凝脉壅，四则脉大汗涩。有此由来，所以寒中。平按：“积”下《素问》、《甲乙经》无“留”字。 泣，《素问》、《甲乙经》作“凝泣”。脉不通，《甲乙经》作“腠理不通”。）黄帝说：阴与阳，血气相并，病形已成，针刺怎么办？（问治疗已成之病。平按：“阴之与阳”，《素问》作“阴与阳并”。）岐伯回答说：刺此者，取之经隧，取血于营，取气于卫，用形哉，因四时多少高下。（刺已成病法有三别：一则刺于大经别走之道，隧，道也，别走之道通阴阳道也；二则刺于脉中营血；三则刺于脉外卫气。用针之状，须因四时之气，观病轻重，发针多少；又须量病高下所在，取之令中，不同刺微之易也。平按：“经隧”，《甲乙经》作“经渠”。）黄帝说：血气相并，病形已成，阴阳相倾，补泻怎么办？岐伯回答说：泻实者，气盛乃内针，（夫泻者，以其邪气实盛，故须泻也。仍掐之令下，然后刺之。不盛何泻，故譬无击逄逄之阵者也。平按：“以并”、“以成”，《甲乙经》“以”作“已”。）针与气俱内，以开其门如利其户，针与气俱出，精气不伤，邪气乃下，外门不闭，以出其病，摇大其道如利其路，是谓大泻，必切而出，大气乃屈。（人之吸气，身上有孔闭处，皆入聚于肾肝；呼气之时，有孔开处，气皆从心肺而出，比囊之呼吸也。针开孔时，病患吸气，故针与气俱入内也。针得入已，摇大其穴，因呼出针，故针与邪气俱出，勿伤正气也。平按：“以出其病”，《素问》、《甲乙经》“病”作“疾”。）黄帝说：补虚怎么办？岐伯回答说：持针勿置，以定其意，（持针勿置于肉中，先须安神定意，然后下针。若医者志意散乱，针下气之虚实有无皆不得知，故须定意也。平按：注“安神定意”，袁刻意作“志”。）候呼内针，（人之呼气，身上有孔，其气皆出，故所针孔气出之时内针，欲令有气从针而入，不使气泄，所以候呼内针者也。）气出针入，针空四塞，精无从去，（呼气出时针入穴者，欲使针空四塞，不泄正气也。平按：注“入穴”，袁刻“穴”作“空”。）方实而疾出针，气入针出，（方，正也。候气正实疾出针。）热不得环，（夫虚者多寒，得热为补。环，转也。疾出针，使针下热气不得转也。平按：《素问》、《甲乙经》“环”作“还”。）闭塞其门，邪气布散，精气乃得存，动无后时，（出针已去，纵邪不出尽，自然布散消亡，精气独在，无病动于后时也。平按：“动无后时”，《素问》作“动气候时”。）近气不入，远气乃来，是谓追之。（行补之时，非其补处近气不失，远气亦来至此集也。已虚之气引令实，故曰追也。）黄帝说：先生您说虚实有十种，生于五脏，五脏，五脉而已，夫十二经脉都生百病，现在先生只说五脏。夫十二经脉，都联络三百六十五节，节有病必被经脉，经脉之病皆有虚实，怎么合起来看？（节，即气穴也。但十二经脉被三百六十五穴，则三百六十五穴所生之病甚多，非唯五脏五脉独生十种虚实者。平按：“皆生百病”，《素问》作“皆生其病”，新校正云：《甲乙经》云：皆生百病。《太素》同。）岐伯回答说：五脏者，本来与六腑互为表里，经络支节，各生虚实，（内有五脏，外有六腑，腑脏经络表里诸支节，是生虚实，其亦甚多，不相违也。）视其病所居，随而调之。病在血，调之脉；病在气，调之卫；病在肉，调之分肉；病在筋，调之筋，燔针劫刺其下及与急者；（视三百六十五节所生病处，量其虚实，随而调之。调者，调于五脏所主脉、卫、分肉、筋、骨也。平按：《素问》其病上无“视”字，病在血调之脉作“病在脉调之血”，新校正云：“全元起及《甲乙经》作‘病在血调之脉’。”检今本《甲乙经》仍作“病在脉调之血”。又《素问》、《甲乙经》病在气上有“病在血调之络”六字，调之筋下有“病在骨调之骨”六字。）病在骨，卒针药熨；（卒，穷也。痛痹在骨，穷针深之至骨，出针以药熨之，以骨病痛深故也。熨法，上经已说也。平按：“卒”，《素问》、《甲乙经》作“ ”。）病不知其所痛，两跷为上。（诸骨病不定知于病之所在者，可取足少阴两阴跷。两阴跷是足少阴别，足少阴脉主骨者也。上者，胜也。平按：《素问》、《甲乙经》无“其”字。注“诸骨”，诸字袁刻作“痛”。）身形有痛者，九候莫病，则缪刺之。（审三部九候竟无病状，然身形有痛者，此络左右有病，可缪刺也。平按：《素问》、《甲乙经》无“者”字。）病在于左而右脉病者，则巨
[Ping An] This chapter, from the beginning to the end, is found in *Suwen* (Basic Questions), Volume 17, Chapter 62, "Tiaojing Lun" (Discourse on Regulating the Channels), connecting with the previous compilation. It also appears in *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion), Volume 6, Chapter 3, also connecting with the previous compilation.
Huangdi said: I have heard of the manifestations of deficiency and excess, but do not know how they arise. (Xing refers to form or state. The states of deficiency and excess have been heard above, but the causes of their generation remain unknown, hence the further inquiry. Ping An: *Suwen* writes "wen" as "yi wen". *Jiayi Jing* lacks the three characters "yu yi wen".) Qibo replied: When Qi and Blood merge and crowd together, Yin and Yang incline towards each other; Qi becomes chaotic in the Wei (Defensive) level, while Blood stagnates in the Channels. (The Qi of the twelve channels becomes chaotic in the Wei Qi. The Blood of the twelve channels stagnates in the Ying (Nutritive) channels. Alternatively, it is said to be blood flow. Ping An: *Suwen* and *Jiayi Jing* write "xue liu" as "xue ni".) When Blood and Qi separate from their original locations, one becomes excess and the other deficiency. (When Blood and Qi merge, they leave their original dwellings, thus each having aspects of deficiency and excess. Blood and Qi, though named differently, are of the same origin and must harmonize to maintain balance. Now that they have merged, resulting in one excess and one deficiency, this is the source of deficiency and excess.) When Blood crowds into the Yin, (Crowding into the Foot Taiyin and Foot Shaoyin channels,) and Qi crowds into the Yang, (Crowding into the Foot Yangming and Foot Taiyang channels,) it leads to惊狂 (fright and mania). (Since both Blood and Qi are excessive, fright and mania occur.) When Blood crowds into the Yang, and Qi crowds into the Yin, it leads to Jiongzhong (Heat-in-the-Middle disease). (Blood crowds into Foot Yangming, Qi crowds into Foot Taiyin, forming Heat-in-the-Middle disease. Jiong means heat.) When Blood crowds into the Upper, and Qi crowds into the Lower, it results in vexation and irritability. (Excessive Blood rushes upward to the Heart, causing mental vexation and mood swings. [Character] is synonymous with men. Ping An: *Suwen* writes "wan", *Jiayi Jing* writes "men". Xi, *Suwen* and *Jiayi Jing* write "shan".) When Blood crowds into the Lower, and Qi crowds into the Upper, Qi becomes chaotic in the Heart, leading to forgetfulness. (Excessive Qi disturbs the Heart Spirit, causing forgetfulness. Ping An: "Qi chaotic in Heart and forgetfulness", *Jiayi Jing* writes "chaotic and prone to forgetting", with a note stating "*Suwen* writes 'prone to forgetting'." Current versions of *Suwen* still read "chaotic and prone to forgetting".) Huangdi asked: When Blood crowds into Yin and Qi crowds into Yang, causing Blood and Qi to separate from their dwellings, which is excess and which is deficiency? (Regarding the separation and merging of Blood and Qi, it is unclear how to determine the excess and deficiency of these two categories. Ping An: "Yu shi", *Suwen* and *Jiayi Jing* write "ru shi".) Qibo replied: Blood and Qi prefer warmth and dislike cold. Cold causes them to congeal and cease flowing, while warmth causes them to dissipate and move away. Therefore, where Qi crowds, Blood becomes deficient; where Blood crowds, Qi becomes deficient. (Both Blood and Qi dislike cold. Thus, when there is cold in the vessels, they congeal and do not flow; when warm, they dissipate. Hence, if Qi is cold, Blood moves to join it, resulting in Blood deficiency and Qi excess; if Blood is cold, Qi moves to join it, resulting in Qi deficiency and Blood excess. Ping An: "Shi gu", the character "gu" is written as "zhi" in Yuan's edition.) Huangdi said: What humans possess is merely Blood and Qi. Now you say that crowding of Blood leads to deficiency and crowding of Qi leads to deficiency; does this mean there is no excess? (Human life relies solely on Blood and Qi. You only speak of deficiency in Blood and Qi, not mentioning excess, implying that human Blood and Qi are insufficient. Please clarify your meaning.) Qibo replied: That which exists is Excess; that which is absent is Deficiency. Therefore, when Qi crowds, Blood is absent; when Blood crowds, Qi is absent. Since Blood and Qi are now separated and lost, it is called Deficiency. (When Blood crowds, Qi is absent; when Qi crowds, Blood is absent. Thus, speaking of deficiency does not negate the existence of excess, and discussing excess does not discard its deficiency. There is never a complete absence of Blood and Qi in the body. The term "deficiency" here refers to the state where Blood and Qi are merged yet separated/lost, whereas "excess" refers to their harmonious presence.) Collaterals and Sun collaterals all transport Qi and Blood into the Major Channels. (Large and small collaterals transport Blood and Qi into the major channels, making the Blood and Qi in the major channels excessive. Ping An: "Shu", *Jiayi Jing* writes "Zhu", note says: alternatively "Shu".) When Blood and Qi crowd together, it constitutes an Excess syndrome. If Blood and Qi both rush upward, it results in Da Jue (Great Reversal), characterized by sudden death-like collapse. If the Qi returns, the patient lives; if it does not return, the patient dies. (When Blood and Qi in the major channels are excessive and rush above the diaphragm, leaving nothing below, the limbs become cold and reverse, leading to sudden collapse. If the limbs warm up, the patient lives; if not, the patient dies. Ping An: "Fu fan shang", *Suwen* and *Jiayi Jing* include the character "Qi".) Huangdi asked: From what pathway does Excess come? From what pathway does Deficiency go? I wish to hear the principles behind deficiency and excess. (From what pathway do Blood and Qi enter this channel to become excess, and from what pathway do they leave to become deficiency?) Qibo replied: Yin and Yang both have Shu (Transporting) points and Hui (Meeting) points. Yang injects into Yin, and Yin overflows outward. (The meridians of Zang-Fu organs and Yin-Yang have distinct pathways connecting through Shu and Hui points. For example, Foot Yangming connects to Foot Taiyin via the Fenglong point, and Foot Taiyin connects to Foot Yangming via the Gongson point; thus it is called "outward".) When Yin and Yang are balanced, they fill the形体 (body form). (A cycle of ten days is called Xun. Xun means welcome. When the Yin and Yang meridians meet fifty times without excess or deficiency, it is called Xun Ping (Balanced Cycle). The harmonious Qi of Xun Ping fills the body. Ping An: "Xun Ping", *Suwen* writes "Yun Ping", *Jiayi Jing* writes "Ping".) When the Nine Palpations are consistent, the person is called a Ping Ren (Healthy Person). (The movements of the Nine Palpations are neither delayed nor contradictory, hence described as "one". With harmonious Qi being uniform, the person achieves peace. Ping An: Note "Jiu Hou", Yuan edition writes "Jiu Mai".) When pathogenic factors arrive, (Ping An: *Suwen* lacks the character "Zhi", *Jiayi Jing* writes "Suo".) they may originate from Yin or from Yang. Those originating from Yang result from Wind, Rain, Cold, and Summer-Heat. Those originating from Yin result from Diet, Lifestyle, and Emotional fluctuations (Joy and Anger). (Yin refers to the Five Zang organs. Yang refers to the Six Fu organs. Wind, rain, cold, and summer-heat are external pathogens that first reach the Six Fu organs from the exterior, hence called "originating from Yang". Diet, lifestyle, sexual activity, and emotions like joy and anger are internal pathogens generated within the Five Zang organs, hence called "originating from Yin".) Huangdi asked: How do wind, rain, cold, and summer-heat injure the human body? (Ping An: *Suwen* and *Jiayi Jing* lack the characters "Han Shu".) Qibo replied: Wind and rain injuries first lodge in the skin, then transmit to the Sun collaterals. When Sun collaterals are full, they transmit to the Luo collaterals. When Luo collaterals are full, they transport to the Major Channels. Blood and Qi merge with the pathogen and lodge between the Fen Cou (interstices). The pulse becomes firm and large, hence it is called Excess. (This first discusses the pathogens of Wind and Rain. Due to hunger, weakness, and sweating, the pores open. Wind and Qi lodge in the interstices, then enter Sun collaterals, then large collaterals, then major channels. When lodging in the interstices, the affected vessels become firm and large, thus termed Excess. Ping An: "Nai Shu", *Suwen* writes "Ze Shu", *Jiayi Jing* writes "Nai Zhu".) Excess syndromes present with external firmness and fullness; they cannot be pressed, and pressing causes pain. (The area where the pathogen lodges is externally firm; pressing causes pain because Qi is excessive. Ping An: "Bu ke an", *Suwen* writes "bu ke an zhi".) Huangdi asked: How does Cold-Dampness injure the human body? (Ping An: *Suwen* and *Jiayi Jing* lack the character "Qi".) Qibo replied: When Cold-Dampness invades the human body, the skin contracts, muscles become firm, Ying Blood congeals, and Wei Qi departs, hence it is called Deficiency. (Next, discussing Cold-Dampness. Rain Qi invades from above, Dampness enters from below; there is this difference, briefly omitting Summer-Heat. Cold-Dampness invading leads to four types of deficiency: Skin contraction means the skin tightens and gathers; Muscle firmness means muscles are hard and unyielding; Ying Blood congealing means pathogens have reached the vessels, causing Ying Blood to congeal; Wei Qi departing means pathogens have reached outside the vessels, causing Wei Qi to stop moving, hence called "departing". Where Wei Qi departs, there is Deficiency. Ping An: "Pi Fu Shou", *Suwen* writes "Pi Fu Bu Shou", Xin Zheng Jiao notes: "Quan Yuanqi says: Bu Shou means numbness. *Jiayi Jing* and *Taisu* write 'Pi Fu Shou', without 'Bu'. Below 'Jian', *Suwen* and *Jiayi Jing* have 'Jin'. Note 'Gu Yue Qu Ye', Yuan edition misprints 'Qu' as 'Se'.") Deficiency syndromes present with timidity and Qi insufficiency, with congealed Blood. (She, pronounced 'zhi zhe fan'. Lack of Wei Qi in the muscle intervals is called Qi insufficiency. Ping An: "She", *Suwen* writes "Nie", Xin Zheng Jiao notes: "*Jiayi Jing* writes 'She', *Taisu* writes 'She'. *Suwen* lacks 'Xue Qi' characters, *Jiayi Jing* writes 'Xue Se'.) Pressing generates sufficient Qi to warm the area, resulting in comfort and absence of pain. Huangdi said: Excellent. (Since there is no Wei Qi in the muscle intervals, it is cold. Pressing adds damage, so Qi becomes sufficient and warm, hence comfortable.)
Huangdi asked: How does Yin generate Excess? Qibo replied: Unregulated Joy and Anger cause Yin Qi to rebel upward. Upward rebellion causes deficiency in the Lower, and when the Lower is deficient, Yang Qi rushes to fill it, hence it is called Excess. (Humans cannot regulate their emotions. Anger causes Yin Qi to rise; rising Yin Qi rebels. This may cause vomiting blood or inability to eat. Once Yin Qi rises, the Lower becomes deficient. When the Lower is deficient, Yang Qi takes advantage, hence named Yin Excess. Ping An: *Suwen* Xin Zheng Jiao notes: "The text 'Unregulated Joy and Anger causes Yin Qi to rebel upward' likely has an extra 'Joy' character." Observing the later text 'Joy causes Qi to descend' clarifies this.) Huangdi asked: How does Yin generate Deficiency? Qibo replied: Joy causes Qi to descend. (In cold weather, Qi gathers; in warmth, Qi disperses. Anger causes Qi to rise; Joy causes Qi to descend. This is the natural law. Joy brings harmony to Qi and clarity to the Will, allowing Ying and Wei to flow freely, hence slowing and descending.) Sorrow causes Qi to dissipate. Dissipation leads to empty pulses. If combined with cold diet, cold Qi steams the Zang organs, causing Blood to congeal and Qi to depart, hence it is called Deficiency. (When a person is sorrowful, the Heart Tie tightens, Lung leaves elevate, causing blockage in the Upper and Middle Jiao, stopping Ying and Wei flow. Heat remains in the center, causing righteous Qi to dissipate and meridians to become empty. Additionally, cold drinks and food cause cold Qi to steam the Zang organs, congealing Zang Blood and displacing Qi, hence Deficiency. Ping An: "Mai Xu", *Suwen* and *Jiayi Jing* write "Mai Kong Xu". Xun Zang, *Suwen* writes "Xun Man", *Jiayi Jing* writes "Dong Zang". Note "Liang Jiao", the character 'Liang' is misprinted as 'Yu' in Yuan edition.) Huangdi said: The Classics state: Yang deficiency leads to external cold; Yin deficiency leads to internal heat. (The Classics refer to the eighty-one chapters. Deficiency in Fu organ pulses allows Yin Qi to invade, causing external cold. Deficiency in Zang organ pulses allows Yang Qi to invade, causing internal heat.) Yang excess leads to external heat; Yin excess leads to internal cold. I have heard this, but do not know the mechanism. (Six Fu organs govern the exterior and are Yang, hence Yang excess causes external heat. Five Zang organs govern the interior and are Yin, hence Yin excess causes cold. I have heard this before, but do not understand the reason.) Qibo replied: Yang receives Qi from the Upper Jiao to warm the skin and muscle intervals. Now, if cold Qi is outside, the Upper Jiao becomes blocked. Blockage causes cold to remain exclusively on the exterior, hence external cold. (Yang refers to Wei Qi. Wei Qi originates from the Upper Jiao and circulates twenty-five cycles during the day to warm the skin and muscles. Now, due to Yang deficiency, Yin invades and remains on the exterior, hence external cold. Ping An: Note "Jin Xing Er Shi Wu Zhou", referring to the earlier chapter *Wei Wu Shi Zhou*: Wei Qi circulates fifty cycles in a day and night, twenty-five during the day in Yang. Thus, the character "Jin" is suspected to be a transcription error for "Zhou" (Day).) Huangdi asked: How does Yin deficiency generate internal heat? Qibo replied: Fatigue and overwork cause the Form and Qi to decline, Grain Qi to become weak, the Upper Jiao fails to function, and the Lower Wan (stomach outlet) becomes blocked. Stomach heat steams the interior, hence internal heat. (There are five causes of internal heat: First, fatigue and overwork lead to deficiency; Second, Form and Qi are insufficient; Third, the stomach lacks food; Fourth, Upper Jiao Wei Qi does not circulate; Fifth, the intestines and stomach fail to communicate. Wan, pronounced 'gu huan fan', refers to the stomach腑. Lower Wan is the lower opening of the stomach. These five factors cause Wei heat to steam the interior, hence internal heat. Ping An: "Xia Wan", *Jiayi Jing* writes "Xia Jiao". Wei Re Xun Zhong, *Suwen* writes "Wei Qi Re Re Qi Xun Xiong Zhong", *Jiayi Jing* writes "Wei Qi Re Xun Xiong Zhong". Note "You Ci", Yuan edition writes "You Ci".) Huangdi asked: How does Yang excess generate external heat? Qibo replied: The Upper Jiao is not smooth, the skin is dense, and the Culi (pores) are closed and blocked. Wei Qi cannot vent and escape, hence external heat. (There are three causes of external heat: First, the exit of Qi from the Upper Jiao is not smooth; Second, the skin is dense and pores are closed; Third, Wei Qi cannot vent into the Culi. These causes result in external heat. Ping An: Below "Bi Sai", *Suwen* has the character "Xuan Fu". Xin Zheng Jiao notes: "*Jiayi Jing* and *Taisu* lack 'Xuan Fu'.") Huangdi asked: How does Yin excess generate internal cold? Qibo replied: Jue Qi rebels upward. Cold Qi accumulates in the chest and is not discharged. Without discharge, Warm Qi departs, leaving Cold alone. Blood becomes congealed, vessels become blocked, the pulse is large and choppy, hence internal cold. (There are four aspects of cold: First, Cold Jue accumulates in the chest; Second, Warmth departs and Cold remains; Third, Blood coagulates and vessels are obstructed; Fourth, the pulse is large and choppy. These causes result in internal cold. Ping An: Below "Ji", *Suwen* and *Jiayi Jing* lack "Liu". Qi, *Suwen* and *Jiayi Jing* write "Ning Qi". Mai Bu Tong, *Jiayi Jing* writes "Culi Bu Tong".) Huangdi asked: Regarding Yin and Yang, when Blood and Qi merge and the disease form is established, how should acupuncture be performed? (Asking about treating established diseases. Ping An: "Yin Zhi Yu Yang", *Suwen* writes "Yin Yu Yang Bing".) Qibo replied: To treat this, select the Jing Sui (Channel Tunnels), draw Blood from the Ying, and draw Qi from the Wei. Use the needle according to the body type, adjusting quantity and depth based on the seasons and the location of the disease. (There are three distinctions in treating established diseases: First, puncture the pathways of the major channels where they diverge; Sui means path, connecting Yin and Yang; Second, puncture the Ying Blood in the vessels; Third, puncture the Wei Qi outside the vessels. The use of the needle must follow the Qi of the four seasons, observe the severity of the disease to determine the number of needles, and measure the height/depth of the disease to ensure accurate placement, which differs from treating mild conditions. Ping An: "Jing Sui", *Jiayi Jing* writes "Jing Qu".) Huangdi asked: When Blood and Qi merge, the disease form is established, and Yin and Yang incline, how should tonification and sedation be applied? Qibo replied: To sedate Excess, insert the needle when the Qi is excessive. (Sedation is used because pathogenic Qi is excessive. One should press down before needling. Why sedate if not excessive? It is like attacking an enemy formation. Ping An: "Yi Bing", "Yi Cheng", *Jiayi Jing* writes "Yi" as "Yi".) Insert the needle along with the Qi, opening the gate like opening a door. Withdraw the needle along with the Qi, sparing the Essence Qi and expelling the Pathogenic Qi. Do not close the outer gate, allowing the disease to exit. Widen the pathway like clearing a road; this is called Great Sedation. Must press at the exit, and the excessive Qi will be subdued. (During inhalation, pores close and Qi gathers in Liver and Kidney; during exhalation, pores open and Qi exits from Heart and Lung, like a bellows. When inserting the needle, the patient inhales, so the needle enters with the Qi. After insertion, widen the acupoint and withdraw the needle during exhalation, so the needle and pathogenic Qi exit together, sparing the righteous Qi. Ping An: "Yi Chu Qi Bing", *Suwen* and *Jiayi Jing* write "Bing" as "Ji".) Huangdi asked: How to tonify Deficiency? Qibo replied: Hold the needle without placing it, to stabilize the mind. (Hold the needle without inserting it into the flesh; first calm the spirit and stabilize the mind before needling. If the practitioner's mind is scattered, one cannot perceive the deficiency or excess of Qi under the needle, hence stabilization is required. Ping An: Note "An Shen Ding Yi", Yuan edition writes "Zhi".) Wait for exhalation to insert the needle. (During exhalation, pores open and Qi exits. Insert the needle when Qi exits from the acupoint, intending to let Qi enter through the needle and prevent Qi leakage, hence waiting for exhalation to insert.) As Qi exits, the needle enters. Seal the needle hole on all sides, preventing Essence from escaping. (Inserting the needle during exhalation aims to seal the hole and prevent loss of righteous Qi. Ping An: Note "Ru Xue", Yuan edition writes "Kong".) When the Qi feels substantial, quickly withdraw the needle. As Qi enters, the needle exits. (Fang means correct/proper. Wait until the Qi feels proper and substantial, then quickly withdraw.) Prevent the heat from circulating. (Deficient patients often have cold; receiving heat is tonification. Huan means rotate. Quickly withdrawing prevents the heat under the needle from rotating. Ping An: *Suwen* and *Jiayi Jing* write "Huan" as "Huan".) Close the gate. Pathogenic Qi disperses, and Essence Qi is preserved. Movement is timely. (After withdrawing the needle, even if pathogenic Qi is not fully expelled, it naturally disperses and vanishes, leaving only Essence Qi, preventing future illness. Ping An: "Dong Wu Hou Shi", *Suwen* writes "Dong Qi Hou Shi".) Near Qi does not enter; Far Qi arrives. This is called Pursuit. (During tonification, if the tonification site is not near, Near Qi does not escape, and Far Qi comes to gather here. The already deficient Qi is guided to become substantial, hence called Pursuit.) Huangdi said: You mentioned ten types of deficiency and excess arising from the Five Zang organs, which correspond to the Five Pulses. However, the Twelve Primary Meridians give rise to hundreds of diseases. Now you only speak of the Five Zang. The Twelve Meridians connect to the 365 joints/acupoints. Diseases at the joints inevitably affect the meridians, and meridian diseases all have deficiency and excess. How do we reconcile this? (Joint refers to Qi Acupoint. The Twelve Meridians contain 365 acupoints, so the diseases generated at these 365 points are numerous, not just the ten types of deficiency and excess from the Five Zang and Five Pulses. Ping An: "Jie Sheng Bai Bing", *Suwen* writes "Jie Sheng Qi Bing". Xin Zheng Jiao notes: *Jiayi Jing* says "Jie Sheng Bai Bing". *Taisu* agrees.) Qibo replied: The Five Zang organs originally have the Six Fu organs as their interior-exterior pairs. The meridians, branches, and joints each generate deficiency and excess. (Inside are the Five Zang, outside are the Six Fu. The Zang-Fu meridians, interior-exterior relationships, and various branches/joints generate deficiency and excess, which are numerous and not contradictory.) Observe where the disease resides and adjust accordingly. If the disease is in Blood, adjust the Pulse; if in Qi, adjust the Wei; if in Flesh, adjust the Fen Rou (muscle intervals); if in Sinews, adjust the Sinews, using burning needle and rapid puncture below and at sites of tension. (Observe the diseases at the 365 joints, assess deficiency and excess, and adjust accordingly. Adjustment refers to regulating the pulses, Wei, Fen Rou, sinews, and bones governed by the Five Zang. Ping An: *Suwen* lacks "Shi" before "Qi Bing". "Bing Zai Xue Tiao Zhi Mai" is written as "Bing Zai Mai Tiao Zhi Xue". Xin Zheng Jiao notes: "Quan Yuanqi and *Jiayi Jing* write 'Bing Zai Xue Tiao Zhi Mai'." Checking current *Jiayi Jing*, it still reads "Bing Zai Mai Tiao Zhi Xue". Also, *Suwen* and *Jiayi Jing* have six characters "Bing Zai Xue Tiao Zhi Luo" before "Bing Zai Qi", and six characters "Bing Zai Gu Tiao Zhi Gu" after "Tiao Zhi Jin".) If the disease is in Bone, use deep needling and herbal moxibustion/warming. (Cu means exhaustive. Painful Bi in bone requires exhausting needling deeply to the bone. Withdraw the needle and apply herbal warming, because bone diseases are deep. Warming methods were discussed in previous chapters. Ping An: "Cu", *Suwen* and *Jiayi Jing* write " ".) If the disease location of pain is unknown, prioritize the Two Qiao (Vessels). (For bone diseases where the location is uncertain, select the two Yin Qiao vessels of Foot Shaoyin. The two Yin Qiao are branches of Foot Shaoyin, which governs bone. Shang means superior/victorious. Ping An: *Suwen* and *Jiayi Jing* lack "Qi". Note "Zhu Gu", the character 'Zhu' is misprinted as 'Tong' in Yuan edition.) If the body shape has pain but the Nine Palpations show no disease, use Miao Ci (Contralateral Puncture). (After examining the Three Parts and Nine Palpations and finding no pathological signs, yet the body has pain, this indicates pathology in the left and right collaterals, suitable for Contralateral Puncture. Ping An: *Suwen* and *Jiayi Jing* lack "Zhe".) If the disease is on the left but the pulse on the right is diseased, then Ju...