平按∶此篇自篇首至末，见《灵枢》卷八第五十五《逆顺》篇。自刺法曰无刺 之热至不
治已病，见《甲乙经》卷五第一。自伯高曰兵法无迎逄逄之气至与脉相逆者，又见日本《医心方》
卷一。
黄帝问伯高曰∶余闻气有逆顺，脉有盛衰，刺有大约，可得闻乎？（设此三问，为调气之要
也。）伯高对曰∶气之逆顺者，所以应天下阴阳四时五行也。（一，知逆顺，谓知四时五行逆顺
之气，根据而刺也。平按∶《灵枢》天下作天地。）脉之盛衰者，所以候血气之虚实有余不足。（二，
知候脉，谓候寸口人迎血气虚实也。）刺之大约者，必明知病之可刺，与其未可刺，与其已不可
刺也。三知刺法，谓知
此病可刺、此未可刺、此不可刺也。约，法也。黄帝曰∶候之奈何？伯高曰∶兵法∶无迎逄逄之
气，（逄，蒲东反，兵气盛也。平按∶《医心方》兵法下有曰字。）无击堂堂之陈。刺法曰∶无
刺 之热，（ ，呼笃反，热炽盛也。堂堂，兵盛貌。兵之气色盛者，未可即击，待其衰然后
击之。刺法亦尔，邪气盛者，消息按摩，折其大气，然后刺之，故曰无刺 热也。）无刺漉漉之
汗，（漉漉者，血气泄甚大虚，故不可刺之也。）无刺浑浑之脉，（浑浑，浊乱也。凡候脉浊乱者，
莫知所病，故不可刺也。）无刺病与脉相逆者。（形病脉不病，脉病形不病，名曰相反。逆，反
也。）黄帝曰∶候其可刺奈何？伯高曰∶上工，刺其未生者也；（内外二邪虽有，未起病形，刺
之以为上工也。）其次，刺其未盛者也；（已成微病，未为盛者，刺之以为上工者也。平按∶未
盛《甲乙》作未成。）其次，刺其已衰者；（病虽已衰，未即能愈，刺之以为中工者也。）下工，
刺其方袭也，与其形之盛者也，与其病之与脉相逆者也。（方，正方。袭，重也。正病重叠，病形
复盛，病脉相反，刺之以为下工者也。）故曰∶方其盛也，勿敢毁伤，刺其已衰，事必大昌。（言
工有损益也。）故曰∶上工治不病，不治已病。此之谓也。（不病，未病之病也。已病，已成病也。
平按∶治不病《灵枢》、《甲乙》作未病。《甲乙》无此之谓也四字。）
平按：本篇从开头到结尾，见于《灵枢》卷八第五十五篇《逆顺》。从“刺法曰无刺熇熇之热”到“不治已病”，见于《甲乙经》卷五第一卷。从“伯高曰兵法无迎逢逢之气”到“与脉相逆者”，又见于日本《医心方》卷一。
黄帝问伯高说：我听说气有逆顺之分，脉有盛衰之别，针刺有大概的原则，可以讲给我听吗？（提出这三个问题，是为了阐述调气的关键。）伯高回答说：气的逆顺，是用来对应天下阴阳、四时和五行的。（第一点，知晓逆顺，是指知晓四时五行中逆顺的气机，据此进行针刺。平按：《灵枢》中“天下”作“天地”。）脉的盛衰，是用来候察血气的虚实有余不足的。（第二点，知晓候脉，是指候察寸口和人迎穴处血气的虚实情况。）针刺的大概原则，必须明确知道疾病是可以针刺的，还是不可以针刺的，或者是已经不可针刺的了。第三点知晓刺法，是指知晓此病可刺、此病未可刺、此病不可刺。约，即法则。黄帝说：如何候察呢？伯高说：兵法说：不要迎击气势正盛的军队，（逢，音蒲东反，指兵气强盛。平按：《医心方》在“兵法”下有“曰”字。）不要攻击阵容严整的敌军。针刺法则说：不要针刺高热炽盛的患者，（熇，音呼笃反，指热势炽盛。堂堂，形容军队盛大貌。兵气色盛的时候，不能立即攻击，要等待其衰退然后攻击。针刺法则也是如此，邪气盛的时候，通过调节按摩，折损其大气，然后再针刺，所以说不要针刺熇熇之热。）不要针刺大汗淋漓不止的患者，（漉漉，指气血泄出甚多导致极度虚弱，所以不可针刺。）不要针刺浑浊混乱的脉象，（浑浑，指脉象浊乱。凡是候察到脉象浊乱的，不知道是什么病，所以不可针刺。）不要针刺病症表现与脉象相逆的患者。（形病而脉不病，或脉病而形不病，称为相反。逆，就是反的意思。）黄帝说：如何候察可以针刺的情况呢？伯高说：上等的医生，在疾病尚未发生时就进行针刺；（内外二邪虽然存在，但尚未形成病症表现，此时针刺称为上工。）其次，在疾病尚未盛发时进行针刺；（已经形成轻微病症，但还未达到盛发阶段，此时针刺称为上工。平按：《甲乙经》中“未盛”作“未成”。）其次，在疾病已经衰退时进行针刺；（疾病虽然已经衰退，但还不能立即痊愈，此时针刺称为中工。）下等的医生，在病邪正侵袭人体时，或在病情正盛发时，或在病症与脉象相逆时进行针刺。（方，指正方形，引申为正对、正当。袭，指重复、重叠。正值病邪重叠，病形再次盛发，病证与脉象相反，此时针刺称为下工。）所以说：当邪气正盛时，不敢轻易损伤正气，要在邪气衰退后针刺，事情必定大吉。（说明医生水平有优劣损益之分。）所以说：上工治疗未病，不治疗已病。说的就是这个道理。（未病，指尚未发病的疾病状态。已病，指已经形成的疾病。平按：《灵枢》、《甲乙经》中“治不病”作“治未病”。《甲乙经》没有“此之谓也”这四个字。）
Ping An: This section, from the beginning to the end of the chapter, is found in Volume 8, Chapter 55, "Ni Shun" (Reversal and Compliance) of the *Ling Shu* (Spiritual Pivot). From "Ci fa yue wu ci he he zhi re" (The acupuncture method states: do not puncture when the heat is blazing) to "bu zhi yi bing" (do not treat established disease), it is found in Volume 5, Chapter 1 of the *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion). From "Bo Gao yue bing fa wu ying pang pang zhi qi" (Bo Gao said: In military strategy, do not confront the surging qi) to "yu mai xiang ni zhe" (those where the disease contradicts the pulse), it is also found in Volume 1 of the Japanese *I Shin Ho* (Medical Heart Mirror).
Huang Di asked Bo Gao: I have heard that Qi has aspects of reversal and compliance, pulses have distinctions of fullness and deficiency, and there are general principles for acupuncture. May I ask you to explain them? (These three questions are posed to highlight the key to regulating Qi.) Bo Gao replied: The reversal and compliance of Qi correspond to the Yin and Yang, the Four Seasons, and the Five Phases under Heaven. (First, knowing reversal and compliance means understanding the Qi of the Four Seasons and Five Phases that are in reversal or compliance, and puncturing according to this. Ping An: In the *Ling Shu*, "under Heaven" is written as "Heaven and Earth".) The fullness and deficiency of pulses are used to observe the excess and deficiency, surplus and insufficiency of Blood and Qi. (Second, knowing how to observe the pulse means observing the excess and deficiency of Blood and Qi at the Cun Kou and Ying acupoints.) The general principles of acupuncture require clearly knowing whether a disease is suitable for puncture, not yet suitable for puncture, or no longer suitable for puncture. Third, knowing the methods of puncture means knowing which diseases can be punctured, which cannot yet be punctured, and which cannot be punctured. "Yue" refers to rules or laws. Huang Di said: How should one observe this? Bo Gao said: Military strategy states: Do not confront an army with surging momentum, (Pang, pronounced 'Pu Dong', indicates strong military momentum. Ping An: The *I Shin Ho* adds the character "yue" after "bing fa".) Do not attack an enemy formation that is solid and imposing. The acupuncture method states: Do not puncture patients with blazing high fever, (He, pronounced 'Hu Du', indicates intense heat. Tang tang describes the imposing appearance of a large army. When military momentum is strong, one does not attack immediately but waits for it to decline before striking. Similarly, in acupuncture, when pathogenic Qi is strong, one uses regulation and massage to reduce its overwhelming force before puncturing; hence, it is said not to puncture when the heat is blazing.) Do not puncture patients with profuse sweating (Lu lu indicates severe depletion of Blood and Qi leading to extreme deficiency, so puncture is contraindicated.), Do not puncture patients with turbid and chaotic pulses (Hun hun indicates turbidity and disorder. When observing such chaotic pulses, the disease cannot be determined, so puncture is contraindicated.), Do not puncture patients whose symptoms contradict their pulse patterns. (When the physical symptoms do not match the pulse, or vice versa, it is called contradiction. Ni means contrary.) Huang Di said: How does one observe the conditions suitable for puncture? Bo Gao said: Superior practitioners puncture before the disease arises; (Even if internal and external pathogens exist, if no clinical signs have appeared, puncturing at this stage is considered superior practice.) Next, they puncture before the disease becomes excessive; (If a minor illness has formed but has not yet become severe, puncturing at this stage is considered superior practice. Ping An: The *Jia Yi Jing* writes "wei sheng" as "wei cheng".) Next, they puncture after the disease has declined; (Although the disease has declined, it may not resolve immediately; puncturing at this stage is considered intermediate practice.) Inferior practitioners puncture when the pathogen is actively invading, when the condition is at its peak, or when the symptoms contradict the pulse. (Fang refers to facing directly or being in the midst of; Xi refers to repetition or accumulation. When the disease accumulates, symptoms flare up again, and the clinical picture contradicts the pulse, puncturing at this stage is considered inferior practice.) Therefore, it is said: When the pathogen is strong, do not rashly damage the healthy Qi; puncture only after it has declined, and success is guaranteed. (This illustrates the difference in efficacy between skilled and unskilled practitioners.) Therefore, it is said: Superior practitioners treat disease before it manifests, and do not treat established disease. This is what is meant. (Wei bing refers to the state of disease before onset. Yi bing refers to established disease. Ping An: The *Ling Shu* and *Jia Yi Jing* write "zhi bu bing" as "zhi wei bing". The *Jia Yi Jing* omits the four characters "ci zhi wei ye".)