黄帝问于岐伯曰。夫四时之气。各不同形。百病之起。皆有所生。灸刺之道。何者为定。岐伯
答曰。四时之气。各有所在。灸刺之道。得气穴为定。故春取经。血脉分肉之间。甚者深取之。间
者浅刺之。夏取盛经孙络。取分间。绝皮肤。秋取经俞。邪在腑。取之合。冬取井荥。必深之留
之。（间去声）
此篇论四时之气。出入于皮肤脉络。而皮肉筋骨。乃六腑之外合。故百病之起。有因于在外
之皮肤脉肉筋骨。而及于内之六腑者。有因病六腑之气。而及于外合之形层者。内因外因。皆有
所生。知其气之出入。则知所以治矣。四时之气。各有所在。故春取经脉于分肉之间。夏取盛经
孙络。分肉皮肤。盖春夏之气。从内而外也。秋取经俞。邪在腑。取之合。此秋气之复从外而内也。
冬取井荥。必深而留之。谓冬气之藏于内也。此人气之出入。应天地之四时。是以灸刺之道。得
气穴为定。按、本藏篇曰。肺合大肠。大肠者皮其应。心合小肠。小肠者脉其应。肝合胆。胆者
筋其应。脾合胃。胃者肉其应。肾合三焦膀胱。三焦膀胱者。腠理毫毛其应。乃脏合腑
而腑合于形层。是以有病温疟皮水之在外者。有肠中不便。腹中常鸣之在腑者。
温疟汗不出。为五十九 。
此外因之邪。病在于骨髓也。素问疟论曰。温疟者。得之冬中于风寒。气藏于骨髓之中。至春
则阳气大发。邪气不能自出。因遇大暑。脑髓烁。肌肉消。腠理发泄。或有所用力。邪气与汗皆出。
此病藏于肾。其气先从内出之于外也。是以汗不出。则邪不能去。当为五十九 。以第四针五十九
刺骨。
风 肤胀。为五十七 。取皮肤之血者尽取之。（ 即水以水为疾也）
此外因之邪。病在于皮肤也。 、水病也。因汗出遇风。风水之邪。留于皮肤。而为肿胀也。
为五十七 。取皮肤之血者尽取之。盖邪在皮肤。当从肤表而出。五十七 。详素问水热穴论。
飧泄。补三阴之上。补阴陵泉。皆久留之。热行乃止。（飧叶孙）
此内因之病。在脾而为肿泄也。脾为湿土。乃阴中之至阴。脾气虚寒。则为飧泄。故当补三阴
之上。补阴陵泉。皆久留之。候热气行至乃止。三阴之上。足三阴交穴。阴陵泉。脾之合穴也。
朱济公问曰。经义只病在六腑。奚又有脾脏之飧泄。曰阳明不从标本。从中见太阴之化。脾与胃
以膜相运。阴阳相合。为脏腑血气之生原。是以下编论五脏病。而兼论胃。此篇论六腑病而有脾。
转筋于阳治其阳。转筋于阴治其阴。皆卒刺之。（卒 同）
筋有阴阳。以应四时十二月。故转筋于阳治其阳。转筋于阴治其阴。 刺者。烧针劫刺。以取筋痹。
徒。先取环谷下三寸。以铍针针之。已刺而 之。而内之。入而复之。以尽其水。必坚。来缓
则烦闷。来急则安静。间日一刺之。 尽乃止。饮闭药。方刺之时。徒饮之。方饮无食。方食无饮。
无食他食。百三十五日。（ 音桶内音讷）
此内因脾胃虚寒。而水溢于肉理也。徒众也。土位中央。主灌溉于四旁。土气虚。则四方之众
水。反乘侮其土而为水病也。夫 谷有三百六十五穴会。肉之大会为谷。大会者。手足股肱之大肉
也。环谷者。取手足之分肉以泻其水也。 、筒也。以如筒之针而内之。入而复出。以尽其水。水肿
于肌肉。则浮而软。水尽则肉必坚矣。来缓则烦闷。来急则安静也。水虽在于肌腠。而其原在内也。
饮闭药者。谓水乃尽。当饮充实脾土之药。勿使水之复乘也。方刺之时。欲使水尽出于外。故徒饮
之。盖脾主肌肉。 病之因本于脾。脾水尽而后能土气充实也。夫饮入于胃。上输于脾肺。食气入
胃。淫散于心肝。饮食并入。藉三焦之气。蒸化精微。济泌别汁。中焦气虚。则水谷不能分别矣。
是以方饮无食。方食无饮。盖言土气虚而水聚于中者。由三焦元气虚也。三焦者。通会元真于肌腠。
三焦元真之气虚。则肤腠空疏。而水溢于内矣。无食他食者。惟食谷食以养土气也。土之成数在十。
而分旺于四时八节。调养百三十五日者。逾九节候而土气复也。
着痹不去。久寒不已。卒取其三里。
此邪留于骨节而为痹也。素问痹论曰。湿胜为着痹。盖湿流于关节。故久寒不已。当卒取其三
里。取阳明燥热之气。以胜其寒湿也。沈亮宸曰。 谷属骨。此承上文肌腠未尽之水。流于关节。
则为着痹。故取阳明之三里。从腑以泻脏也。
骨为干。
沈亮宸曰。此承上文而言骨之为病。在骨之髓节也。干者。如木干之坚劲。是故温疟之邪。藏于
骨髓。湿痹之气。流于关节。其骨如干。而不受邪之所伤。莫云从曰。五营运论云。肾生骨髓。髓生
肝。骨空论论骨节之交。皆有髓空。以渗精髓。盖邪害空窍。而直骨坚劲。不受邪伤。即骨之 痛。
病在髓节。而应于骨也。
肠中不便。取三里。盛泻之。虚补之。
沈亮宸曰。此病在三焦。而为肠中不便也。三焦之气。蒸化水谷。济泌别汁。水谷者。常并居
于胃中。成糟粕而俱下于大肠。是以肠中不便者。三焦之气虚也。三焦之部署。在胃腑上中下之间。
故独取足阳明之三里。邪盛者泻之。正虚者补之。
厉风者。素刺其肿上。已刺。以锐针针其处。按出其恶气。肿尽乃止。常食方食。无食他食。
此邪病之在脉也。素问风论曰。风寒客于脉而不去。名曰厉风。肿者。脉中之营热。出于跗肉
而为肿也。恶气者。恶厉之邪。留而不去。则使其鼻柱坏而色败。皮肤疡溃。故当出其恶气。肿尽
乃止。常食方食。无食他食者。谓当恬淡其饮食。无食他方之异品也。
腹中常鸣。气上冲胸。喘不能久立。邪在大肠。刺肓之原。巨虚上廉三里。（肓音荒）
此邪在大肠而为病也。大肠为传导之官。病则其气反逆。是以腹中常鸣。气上冲胸。喘不能久
立。膏肓即脏腑之募原。膏在上而肓在下。肓之原在脐下一寸五分。名曰脖 。乃大肠之分。巨虚
上廉。在三里下三寸。取巨虚三里者。大肠属胃也。
小肠控睾。引腰脊上冲心。邪在小肠者。连睾系属于脊。贯肝肺。络心系。气盛则厥逆。上冲
肠胃熏肝。散于肓。结于脐。故取之肓原以散之。刺太阴以予之。取厥阴以下之。取巨虚下廉以去
之。按其所过之经以调之。（睾音高）
沈亮宸曰。控睾引腰脊上冲心者。小肠之疝气也。肓乃肠外之脂膜。故取肓之原以散之。刺手太
阴以夺之。取足厥阴以下之。取巨虚下廉。以去小肠之邪。按其所过之经以调其气。
善呕。呕有苦。长太息。心中 。恐人将捕之。邪在胆。逆在胃。胆液泄。则口苦。胃气逆。
则呕苦。故曰呕胆。取三里以下。胃气逆。则刺少阳血络。以闭胆逆。却调其虚实。以去其邪。
此邪在胆而为病也。呕有苦。胆气逆在胃也。胆气欲升。故长太息以伸之。病则胆气虚。故心
中 。恐人将捕之。病在胆。逆在胃者。木邪乘土也。胆汁通于廉泉玉英。故胆液泄。则口苦。
胆邪在胃。故胃气逆。则呕苦也。取三里以下胃气之逆。刺少阳经之血络。以闭胆逆。调其虚实。
以去其邪。
饮食不下。膈塞不通。邪在胃脘。在上脘则刺抑而下之。在下脘则散而去之。
此邪在胃脘而为病也。食饮不下。膈塞不通。如邪在上脘。则不能受纳水谷。故当抑而下之。
如邪在下脘。则不能传化糟粕。故当散而去之。沈亮宸曰。食饮不下。膈塞不通。病在上也。然下
焦阻塞。则上焦亦为之不利。盖水谷入口。则胃实而肠虚。食下。则肠实而胃虚。如下气闭而食不
下。则胃实而上焦膈塞矣。是以经文总言其病。而治分上下。学人体会毋忽。
小腹痛肿。不得小便。邪在三焦约。取之太阳大络。视其络脉。与厥阴小络。结而血者。肿上
及胃脘。取三里。
此邪在膀胱而为病者。三焦下俞。出于委阳。并太阳之正。入络膀胱。约下焦。实则闭癃。虚
则遗溺。小腹肿痛。不得小便。邪在三焦约也。故当取足太阳之大络。小络。孙络也。足太阳厥
阴之络。交络于跗 之间。视其结而血者去之。盖肝主疏泄。结在厥阴之络。亦不得小便矣。如小
腹肿。上及胃脘。取足三里。
睹其色。察其以。知其散复者。视其目色。以知病之存亡也。一其形。听其动静者。持气口人
迎。以视其脉。坚且盛且滑者病日进。脉软者病将下。诸经实者。病三日已。气口候阴。人迎候
阳也。
睹其色者。分别五行之色也。如色青者。内病在胆。外病在筋。色赤者。内病在小肠。外病
在脉也。察其以者。察其所以然之病。或病因于外。或病因于内。或因于外而病及于内者。或因
于内而病及于外者。散者。邪散而病已也。复者。病在外而复及于内。病在内而复及于外也。视其
目色者。察其血色也。盖在外之皮肉筋骨。内应于六腑。六腑内合五脏。外内之病。皆本于五行之
色。而五脏之血色。皆见于目。故视其目色。以知病之存亡也。一其形者。静守其神。形与神俱也。
听其动静者。持气口人迎。以视脉之坚滑软静。而知病之进退也。诸经实者。邪在经脉也。气口人
迎。候三阴三阳之气也。沈亮宸曰。五脏六腑。应天之五运六气。五运主中。六气主外。五运主
岁。六气主时。五脏内合六腑。六腑外应六气。阴阳相合。外内交通。故本篇首定四时。末论脏
腑阴阳血气。乃人与天地相参。阴阳离合之大道也。
黄帝向岐伯问道：四季的气候，各有不同的形态。各种疾病的发生，都有其产生的根源。艾灸和针刺的治疗原则，以什么为定准呢？
岐伯回答说：四季的气候，各自有所归属的部位。艾灸和针刺的原则，以取得气穴为准。所以春季取经脉，在血脉与分肉之间；病情重的深刺，病情轻的浅刺。夏季取盛满经气的经脉和孙络，选取肌肉纹理间的空隙，刺破皮肤。秋季取经穴（五输穴中的俞穴），如果邪气在六腑，则取合穴。冬季取井穴和荥穴，必须深刺并留针。
这一篇论述了四季之气，出入于皮肤脉络之中，而皮、肉、筋、骨，分别是六腑的外在对应部位。因此，百病的发生，有因外部的皮肤、脉、肉、筋骨受邪，进而影响到内部的六腑；也有因内部六腑之气病变，进而波及到外部对应的形体层次。内因和外因，都有导致疾病的原因。知道了气的出入规律，就知道如何治疗了。四季之气，各自有所在的部位，所以春季在分肉之间取经脉之气，夏季取盛经和孙络，涉及分肉和皮肤。这是因为春夏季的气，是从内部向外运行的。秋季取经穴，邪在六腑则取合穴，这是秋季的气从外部向内部回归。冬季取井穴和荥穴，必须深刺并留针，这是说冬季的气收藏于内部。人体的气之出入，顺应天地的四季变化，所以艾灸和针刺的原则，以得气穴为准。
按《本藏》篇说：肺合大肠，大肠应皮毛；心合小肠，小肠应血脉；肝合胆，胆应筋；脾合胃，胃应肌肉；肾合三焦和膀胱，三焦和膀胱应腠理毫毛。这是脏与腑相合，腑与形体层次相合。因此，有的病如温疟、皮水等在外部的形体，有的病如肠中不便、腹中常鸣等在六腑。
这是外因的邪气，病在骨髓。《素问·疟论》说：温疟，是冬天感受风寒，寒气藏在骨髓中，到了春天阳气大发，邪气不能自行排出，如果遇到大暑天气，脑髓被灼热，肌肉消瘦，腠理开泄，或者用力劳作，邪气随着汗液一起排出。这种病根藏于肾，其气先从内部出于外部。所以如果汗不出，邪气就不能去除，应当用五十九穴刺法，用第四种针（锋针）刺骨以泻邪。
风瘅肤胀，用五十七穴刺法。取皮肤下的血络，全部刺尽。（瘅即水病，以水为疾）。
这是外因的邪气，病在皮肤。瘅是水病。因为出汗时遇到风，风水邪气留在皮肤，导致肿胀。用五十七穴刺法，取皮肤下的血络全部刺尽。因为邪气在皮肤，应当从体表发散出去。五十七穴的具体内容详见《素问·水热穴论》。
飧泄（完谷不化的腹泻），补三阴交穴，补阴陵泉穴，都要久留针，直到热气行至才停止。
这是内因的病，在脾，表现为飧泄。脾属湿土，是阴中之至阴。脾气虚寒，就会导致飧泄。所以应当补三阴之上（足三阴交穴），补阴陵泉（脾的合穴），都要久留针，等待热气行至才停止。
朱济公问道：经文只讲病在六腑，怎么又有脾脏的飧泄呢？回答说：阳明经不从标本，而从从中见太阴的化生。脾与胃通过膜相连，阴阳相合，是脏腑气血生成的本源。所以下编论述五脏病时兼论胃，这篇论述六腑病时却有脾。
转筋如果在阳经，就治阳经；转筋如果在阴经，就治阴经，都用卒刺法。（卒同猝，指快速刺入）。
筋有阴阳之分，对应四时十二月。所以转筋在阳经治阳经，在阴经治阴经。卒刺，是用烧红的针进行劫刺，以治疗筋痹。
徒（通“筒”，指一种类似筒状的针具，用于放水），先取环谷下三寸处，用铍针刺入，刺后插入针体，进入再退出，以排尽积水，必须等到肌肉变硬。如果感觉迟缓则烦闷，感觉急促则安静。隔一天刺一次，直到水排尽为止。之后服用封闭水液的药。在针刺的时候，同时让患者饮水。刚喝完水不要吃东西，刚吃完东西不要喝水。不要吃其他食物，调养一百三十五天。（筒音桶，纳音讷）。
这是内因脾胃虚寒，导致水液溢于肌肉纹理之间。徒众也，指水液众多。土位中央，主管灌溉四方。土气虚弱，则四周的水液反乘侮脾土，导致水病。夫谷有三百六十五个穴位交会之处，肌肉的大聚会称为谷，大会是指手足大腿手臂的大块肌肉。环谷，是选取手足的分肉处以泻水。筒，指像筒一样的针，插入再拔出，以排尽水液。水肿在肌肉中，则浮软；水排尽后肌肉必然变硬。来缓则烦闷，来急则安静。水虽然在于肌腠，但其根源在内。饮闭药，是说水排尽后，应当服用充实脾土的药物，防止水液再次乘侮。在针刺时，为了让水液完全出于体外，所以让患者饮水。因为脾主肌肉，水病的根本在于脾，只有脾水排尽后，土气才能充实。饮食进入胃，上输于脾肺；食气进入胃，散布于心肝。饮食并入，借助三焦之气，蒸化精微，分别清浊。中焦气虚，则水谷不能分别。所以刚饮水不要进食，刚进食不要饮水。这是说土气虚而水聚于中，是由于三焦元气虚。三焦通会元真之气于肌腠，三焦元真之气虚，则肤腠空疏，水液溢于体内。不吃其他食物，只吃谷物以养土气。土的成数是十，旺于四季八节。调养一百三十五天，超过九个节气后土气恢复。
这是邪气停留在骨节导致痹证。《素问·痹论》说：湿胜为着痹。湿气流注关节，所以久寒不已。应当突然取三里穴，取阳明燥热之气，以战胜寒湿。沈亮宸说：谷属骨，这是承接上文肌腠未尽之水，流于关节，成为着痹。所以取阳明经的三里穴，从腑以泻脏。
骨为干。
沈亮宸说：这是承接上文而言骨作为疾病的主体，在骨的髓节。干，像木干一样坚劲。所以温疟的邪气，藏在骨髓；湿痹的气，流于关节。其骨如干，不受邪气伤害。莫云说：《五运行大论》说：肾生骨髓，髓生肝。《骨空论》论及骨节之交，皆有髓空，以渗精髓。邪害空窍，而骨直坚劲，不受邪伤。即骨的疼痛，病在髓节，而应于骨。
沈亮宸说：此病在三焦，导致肠中不便。三焦之气，蒸化水谷，分别清浊。水谷常在胃中，变成糟粕后一起下行到大肠。所以肠中不便，是三焦之气虚。三焦的部署，在胃腑的上中下之间。所以独取足阳明经的三里穴。邪盛者泻之，正虚者补之。
厉风（麻风），素刺其肿处，刺完后，用锐针刺该处，按压排出恶气，直到肿胀消退为止。常吃正常的食物，不吃其他异品食物。
这是邪气在脉。《素问·风论》说：风寒客于脉而不离去，名叫厉风。肿，是脉中的营热，出于跗肉而为肿。恶气，是恶厉之邪，停留不去，会导致鼻柱塌陷、面色败坏、皮肤溃疡。所以应当排出恶气，直到肿胀消退。常吃正常食物，不吃其他异品食物，是说应当清淡饮食，不吃其他地方的奇特食品。
腹中常鸣，气上冲胸，喘促不能久立，邪在大肠。刺肓之原（脖胦），巨虚上廉，三里。（肓音荒）。
这是邪在大肠导致的病。大肠是传导之官，生病则气机逆乱，所以腹中常鸣，气上冲胸，喘促不能久立。膏肓即脏腑的募原，膏在上，肓在下。肓之原在脐下一寸五分，名叫脖胦，是大肠的分野。巨虚上廉，在三里下三寸。取巨虚和三里，是因为大肠属胃。
小肠疝气，牵引睾丸，牵连腰脊，气上冲心。邪在小肠的，连系睾丸，属于脊柱，贯穿肝肺，联络心系。气盛则厥逆，上冲肠胃，熏蒸肝脏，散于肓，结于脐。所以取肓之原以消散它，刺手太阴经以给予正气，取足厥阴经以下降气机，取巨虚下廉以去除邪气。按其经过的经络以调理它。（睾音高）。
沈亮宸说：控睾引腰脊上冲心，是小肠的疝气。肓是肠外的脂膜，所以取肓之原以消散它。刺手太阴经以夺其邪，取足厥阴经以下降气机，取巨虚下廉以去除小肠的邪气。按其经过的经络以调理气机。
善呕吐，呕出苦水，经常叹气，心中悸动，害怕别人抓捕，邪在胆，逆在胃。胆液泄漏，则口苦。胃气逆，则呕苦。所以叫呕胆。取三里穴以降胃气逆。胃气逆，则刺少阳经的血络，以遏制胆气逆乱，从而调理虚实，去除邪气。
这是邪在胆导致的病。呕出苦水，是胆气逆在胃。胆气欲升，所以长叹以舒展它。生病则胆气虚，所以心中悸动，害怕别人抓捕。病在胆，逆在胃，是木邪乘土。胆汁通于廉泉玉英，所以胆液泄漏则口苦。胆邪在胃，所以胃气逆则呕苦。取三里以降胃气之逆，刺少阳经的血络以闭胆逆，调其虚实以去其邪。
饮食不下，膈塞不通，邪在胃脘。在上脘则刺抑而下之，在下脘则散而去之。
这是邪在胃脘导致的病。饮食不下，膈塞不通。如果邪在上脘，则不能受纳水谷，所以应当抑制使其下行。如果邪在下脘，则不能传化糟粕，所以应当消散使其离去。沈亮宸说：饮食不下，膈塞不通，病在上部。然而下焦阻塞，上部也不利。水谷入口，则胃实而肠虚；食下，则肠实而胃虚。如果下气闭塞而食不下，则胃实而上焦膈塞。所以经文总言其病，而治疗分上下，学者体会不可疏忽。
小腹痛肿，不得小便，邪在三焦约束。取太阳经的大络，观察其络脉，与厥阴经的小络，结而有血的，在肿处及胃脘处取三里穴。
这是邪在膀胱导致的病。三焦的下俞，出于委阳，并太阳经的正脉，入络膀胱，约束下焦。实则闭癃，虚则遗尿。小腹肿痛，不得小便，是邪在三焦约束。所以应当取足太阳经的大络。小络，即孙络。足太阳和厥阴的络脉，交络于跗阳之间。观察其结而有血的，去除它。因为肝主疏泄，结在厥阴之络，也会导致不得小便。如果小腹肿，上及胃脘，取足三里。
观察患者的面色，察知其病因，知道病邪的消散或复发，是通过观察眼睛的颜色，来知道病的存亡。统一其身形，听其动静，持握气口和人迎脉，以观察脉象。脉坚硬且盛且滑的，病日进；脉软的，病将退。诸经实的，病三日愈。气口候阴，人迎候阳。
观察面色，是分辨五行之色。如色青，内病在胆，外病在筋；色赤，内病在小肠，外病在脉。察知其病因，是察知所以然之病。或病因于外，或病因于内，或因外而病及于内，或因内而病及于外。散，是邪散而病已。复，是病在外而复及于内，病在内而复及于外。视其目色，是察其血色。因为在外的皮肉筋骨，内应于六腑，六腑内合五脏。内外之病，皆本于五行之色，而五脏的血色，皆见于目。所以视其目色，以知病之存亡。一其形，是静守其神，形与神俱。听其动静，是持握气口和人迎，以观察脉之坚滑软静，而知病之进退。诸经实，是邪在经脉。气口和人迎，候三阴三阳之气。沈亮宸说：五脏六腑，应天之五运六气。五运主中，六气主外。五运主岁，六气主时。五脏内合六腑，六腑外应六气。阴阳相合，外内交通。所以本篇首定四时，末论脏腑阴阳血气，乃人与天地相参，阴阳离合的大道。
Huangdi asked Qibo: The qi of the four seasons has different forms. The onset of all diseases arises from specific causes. What is the fixed principle for moxibustion and acupuncture?
Qibo replied: The qi of the four seasons resides in specific locations. The principle of moxibustion and acupuncture is determined by obtaining Qi at the acupoints. Therefore, in spring, one selects the meridians between the blood vessels and the muscle intervals; for severe cases, deep insertion is used, while for mild cases, shallow insertion is applied. In summer, one selects the full meridians and the sun collateral vessels, targeting the spaces between muscles and piercing the skin. In autumn, one selects the Shu (Stream) points; if the pathogen is in the fu organs, the He (Sea) points are selected. In winter, one selects the Jing (Spring) and Ying (Well) points, requiring deep insertion and retention of the needle.
This chapter discusses how the qi of the four seasons enters and exits the skin and collaterals. The skin, flesh, sinews, and bones are the external correspondences of the six fu organs. Thus, the onset of diseases may originate from external pathogens affecting the skin, vessels, flesh, sinews, and bones, subsequently involving the internal six fu organs; or it may originate from dysfunction within the six fu organs, extending to their external corresponding structural layers. Both internal and external factors contribute to disease. Understanding the entry and exit of qi allows one to determine the treatment. Since the qi of the four seasons resides in specific locations, spring treatments target the meridians within the muscle intervals; summer treatments target the full meridians and sun collaterals, involving the muscle intervals and skin. This is because the qi of spring and summer moves from the interior to the exterior. Autumn treatments target the Shu points, and when the pathogen is in the fu organs, the He points are selected, reflecting the return of autumn qi from the exterior to the interior. Winter treatments target the Jing and Ying points with deep insertion and retention, indicating that winter qi stores within the interior. The movement of human qi follows the four seasons of heaven and earth; thus, the principle of moxibustion and acupuncture is fixed by obtaining Qi at the acupoints.
According to the *Ben Cang* chapter: The Lung combines with the Large Intestine, which corresponds to the skin and hair; the Heart combines with the Small Intestine, which corresponds to the vessels; the Liver combines with the Gallbladder, which corresponds to the sinews; the Spleen combines with the Stomach, which corresponds to the flesh; the Kidney combines with the San Jiao and Bladder, which correspond to the interstices and body hair. This illustrates the combination of zang and fu organs, and the correspondence of fu organs to structural layers. Consequently, some diseases, such as warm malaria and cutaneous edema, remain in the external structures, while others, such as intestinal obstruction and frequent abdominal borborygmi, reside in the fu organs.
For warm malaria with no sweating, use the fifty-nine acupoint needling method.
This refers to external pathogens affecting the bone marrow. The *Su Wen: Malaria Theory* states: Warm malaria results from wind-cold contracted in winter, hiding in the bone marrow. When yang qi expands greatly in spring, the pathogen cannot exit spontaneously. If exposed to intense summer heat, the brain marrow is scorched, muscles waste away, pores open, or physical exertion occurs, the pathogen exits with sweat. This disease roots in the Kidney, with its qi moving from the interior to the exterior. Therefore, if sweat does not occur, the pathogen cannot be expelled. One should use the fifty-nine acupoint method, employing the fourth type of needle (sharp needle) to puncture the bone and drain the pathogen.
For Feng Dan (wind-induced distension), use the fifty-seven acupoint needling method. Select all blood vessels in the skin and pierce them completely. (Dan refers to water disease).
This refers to external pathogens affecting the skin. Dan is a water disease caused by wind striking during sweating, causing wind-water pathogens to remain in the skin, leading to swelling. Use the fifty-seven acupoint method, selecting and piercing all blood vessels in the skin. Since the pathogen is in the skin, it should be dispersed from the surface. See the *Su Wen: Water-Heat Acupoint Theory* for details on the fifty-seven acupoints.
For Sundry diarrhea (undigested food in stool), tonify the intersection of the three yin meridians (Sanyinjiao SP6) and the He-Sea point of the Spleen (Yinlingquan SP9). Retain the needles for a long time until warm qi arrives, then remove them.
This is an internal pathology involving the Spleen, manifesting as sundry diarrhea. The Spleen belongs to damp earth and is the extreme yin within yin. Deficiency and cold of Spleen qi lead to sundry diarrhea. Therefore, one should tonify the intersection of the three yin meridians (Zusanli ST36 is often cited in other contexts, but here specifically Sanyinjiao SP6 is implied by "intersection of three yin") and Yinlingquan SP9 (the He-Sea point of the Spleen), retaining the needles until warm qi arrives.
Zhu Jigong asked: The classics only discuss diseases in the six fu organs; why is there mention of sundry diarrhea related to the Spleen organ? The answer is: The Yangming meridian does not follow the standard or root principles but transforms according to the Taiyin aspect seen within. The Spleen and Stomach are connected by membranes, combining yin and yang, serving as the source of qi and blood for the zang and fu organs. Hence, the lower chapters discuss diseases of the five zang organs while also mentioning the Stomach; this chapter discusses diseases of the six fu organs while including the Spleen.
For spasms in yang meridians, treat the yang meridians; for spasms in yin meridians, treat the yin meridians. Use sudden needling (cu ci).
Sinews have yin and yang aspects, corresponding to the twelve months of the four seasons. Therefore, spasms in yang meridians are treated via yang meridians, and those in yin meridians via yin meridians. Sudden needling involves using a red-hot needle to rapidly puncture, treating sinew bi syndrome.
For Tu (water accumulation), first select the area three cun below Huangu, puncture with a Bi needle, insert the needle, withdraw and re-insert repeatedly to drain all accumulated fluid. The tissue must become firm. If the sensation is slow, there will be irritability; if rapid, there will be calmness. Puncture once every other day until the fluid is exhausted. Then administer medicine to close the pathways. While needling, drink water. Do not eat immediately after drinking, and do not drink immediately after eating. Avoid other foods. Regulate for 135 days.
This is an internal pathology due to deficiency-cold of the Spleen and Stomach, causing water to overflow into the muscle texture. Tu implies abundance. Earth resides in the center and irrigates the four directions. When earth qi is deficient, water from the four directions overacts upon the earth, causing water disease. There are 365 intersections in the valleys. Large gatherings of muscle are called valleys, referring to the large muscles of the limbs. Huangu refers to selecting the muscle intervals of the limbs to drain water. Tong refers to a tube-like needle inserted and withdrawn to drain fluid. Edema in the muscles is soft; after drainage, the muscles become firm. Slow sensation causes irritability; rapid sensation brings calmness. Although water lies in the interstices, its origin is internal. "Drinking closing medicine" means that after water is drained, one should take herbs to strengthen the Spleen earth to prevent water recurrence. Drinking water during needling helps expel water externally. Since the Spleen governs the muscles, the root of water disease is the Spleen. Only after spleen water is drained can earth qi be replenished. Food enters the Stomach, transports to the Spleen and Lungs; food qi disperses to the Heart and Liver. With the aid of San Jiao qi, essence is steamed and refined, separating clear from turbid. Deficiency of middle jiao qi prevents separation of water and grain. Hence, do not eat after drinking, nor drink after eating. This indicates that deficiency of earth qi leads to water accumulation in the center due to deficiency of San Jiao yuan qi. The San Jiao circulates yuan qi through the interstices; deficiency leads to loose pores and internal water overflow. Eating only grains nourishes earth qi. The completion number of earth is ten, flourishing in the eight solar terms. Regulating for 135 days exceeds nine solar terms, allowing earth qi to recover.
For persistent Zhe Bi (heavy bi syndrome) with chronic cold, suddenly select Zusanli ST36.
This is pathogen retention in the joints causing bi syndrome. The *Su Wen: Bi Syndrome Theory* states: Excess dampness causes Zhe Bi. Dampness flows into the joints, causing chronic cold. One should suddenly select Zusanli ST36 to utilize the dry-heat qi of Yangming to overcome cold-dampness. Shen Liangchen notes: Valleys belong to bones. This continues the previous discussion on residual water in the interstices flowing into joints, becoming Zhe Bi. Thus, Zusanli of the Yangming meridian is selected to drain the zang via the fu.
Bone serves as the trunk.
Shen Liangchen states: This continues the discussion on bone diseases, located in the marrow nodes of the bone. Trunk implies hardness and strength like a tree trunk. Thus, warm malaria pathogens hide in the bone marrow; damp-bi qi flows into the joints. The bone acts as a trunk, resisting pathogenic injury. Mo Yun states: The *Wu Yun Da Lun* says: Kidney generates bone marrow; marrow generates Liver. The *Gu Kong Lun* discusses joint intersections where marrow emptiness exists to seep essence. Pathogens harm the orifices, but straight, hard bones resist injury. Pain in the bone relates to the marrow node and corresponds to the bone.
For intestinal obstruction, select Zusanli ST36. Drain excess, tonify deficiency.
Shen Liangchen states: This disease involves the San Jiao, causing intestinal obstruction. San Jiao qi steams and digests water and grain, separating clear from turbid. Water and grain reside in the Stomach, turning into feces and descending to the Large Intestine. Thus, intestinal obstruction results from San Jiao qi deficiency. The San Jiao is distributed in the upper, middle, and lower parts of the stomach region. Therefore, only Zusanli of the Foot-Yangming meridian is selected. Drain excess pathogen, tonify deficient healthy qi.
For Li Feng (leprosy), use Su needling on the swelling. After needling, use a sharp needle at the site, press to expel evil qi, stopping only when the swelling subsides. Eat regular meals; avoid exotic foods.
This is a pathogen in the vessels. The *Su Wen: Wind Theory* states: Wind-cold lodging in vessels without departing is called Li Feng. Swelling is due to nutritive heat in the vessels exiting into the dorsal flesh. Evil qi is the malignant pathogen remaining in place, causing collapse of the nasal bridge, discoloration, and skin ulcers. Thus, evil qi must be expelled until swelling resolves. Regular diet avoids exotic foods, implying bland dietary habits.
For frequent abdominal borborygmi, qi rushing to the chest, panting unable to stand long, the pathogen is in the Large Intestine. Puncture the Yuan source of Huang (Boning/Nebo), Juxu Shanglian, and Zusanli.
This is disease in the Large Intestine. The Large Intestine is the official of transmission; disease causes qi reversal, leading to borborygmi, qi rushing to the chest, and panting. Gaohuang refers to the mu-yuan of the zang-fu. Gao is above, Huang is below. The Yuan source of Huang is 1.5 cun below the umbilicus, named Bobo, belonging to the Large Intestine. Juxu Shanglian is 3 cun below Zusanli. Selecting these points is because the Large Intestine belongs to the Stomach.
For Small Intestine hernia, pulling the testis, connecting to the waist and spine, qi rushing to the heart. Pathogen in the Small Intestine connects to the testis, attaches to the spine, penetrates the Liver and Lung, and links to the Heart system. Excess qi causes reversal, rushing to the stomach and intestines, steaming the Liver, scattering to Huang, and knotting at the umbilicus. Select the Yuan source of Huang to disperse it. Puncture the Hand-Taiyin to support it. Select the Foot-Jueyin to descend it. Select Juxu Xialian to remove it. Adjust according to the meridians passed.
Shen Liangchen states: Hernia pulling the testis and qi rushing to the heart is Small Intestine hernia. Huang is the fat membrane outside the intestines; thus, the Yuan source of Huang is selected to disperse it. Puncture Hand-Taiyin to drain the pathogen. Select Foot-Jueyin to descend qi. Select Juxu Xialian to remove Small Intestine pathogen. Adjust qi according to the meridians traversed.
For frequent vomiting with bitter taste, frequent sighing, palpitations, fear of being caught, the pathogen is in the Gallbladder, with rebellion in the Stomach. Leakage of gall fluid causes bitter taste. Reversal of Stomach qi causes bitter vomiting. This is called "Gallbladder Vomiting." Select Zusanli to descend Stomach qi rebellion. If Stomach qi rebels, puncture the blood collaterals of the Shaoyang meridian to close Gallbladder rebellion. Balance deficiency and excess to eliminate the pathogen.
This is disease in the Gallbladder. Bitter vomiting indicates Gallbladder qi rebelling in the Stomach. Gallbladder qi desires to ascend, hence sighing to stretch. Disease causes Gallbladder qi deficiency, leading to palpitations and fear. Disease in the Gallbladder, rebellion in the Stomach, represents Wood overacting on Earth. Gallbladder fluid connects to Lianquan and Yuying; leakage causes bitter taste. Gallbladder pathogen in the Stomach causes Stomach qi rebellion and bitter vomiting. Select Zusanli to descend Stomach qi. Puncture Shaoyang blood collaterals to stop Gallbladder rebellion. Balance deficiency/excess to remove pathogen.
For inability to swallow food, chest blockage, pathogen in the Wei Wan (Stomach region). If in the Upper Wan, puncture to suppress and direct downward. If in the Lower Wan, disperse and remove.
This is disease in the Stomach region. Inability to swallow and chest blockage. If pathogen is in the Upper Wan, it cannot accept food/water; thus, suppress and direct downward. If in the Lower Wan, it cannot transform feces; thus, disperse and remove. Shen Liangchen states: Blockage is in the upper part. However, lower jiao obstruction affects the upper jiao. Food entering makes the Stomach full and Intestines empty; food descending makes the Intestines full and Stomach empty. If lower qi is blocked and food cannot enter, the Stomach becomes full and upper jiao blocks. Thus, the text generalizes the disease, but treatment distinguishes upper and lower. Scholars must appreciate this.
For lower abdominal pain and swelling, inability to urinate, pathogen in the San Jiao constraint. Select the Great Collateral of the Taiyang meridian. Observe collaterals connecting with the Jueyin small collaterals showing blood stasis. At the swelling and Wei Wan, select Zusanli.
This is disease in the Bladder. The lower shu of San Jiao emerges at Weiyang, joins the Taiyang main channel, enters the Bladder, and constrains the lower jiao. Excess causes retention; deficiency causes enuresis. Lower abdominal pain/swelling and urinary retention indicate San Jiao constraint. Select the Great Collateral of Foot-Taiyang. Small collaterals refer to Sun collaterals. Foot-Taiyang and Jueyin collaterals intersect at Fuyang. Remove blood stasis where knots exist. The Liver governs free flow; knots in Jueyin collaterals also cause urinary retention. If swelling extends to the Wei Wan, select Zusanli.
Observe complexion, investigate causes, know dispersion or recurrence. Observe eye color to know disease survival. Unify form, listen to movement. Hold Qi Kou and Ren Ying pulses to observe pulse quality. Hard, full, and slippery pulses indicate disease progression. Soft pulses indicate disease retreat. Full pulses in all meridians indicate recovery in three days. Qi Kou observes yin; Ren Ying observes yang.
Observing complexion distinguishes the five elements' colors. Green indicates internal disease in the Gallbladder and external disease in sinews. Red indicates internal disease in the Small Intestine and external disease in vessels. Investigating causes determines whether disease originates externally or internally, or transfers between them. Dispersion means pathogen disperses and disease ends. Recurrence means disease moves from external to internal or vice versa. Observing eye color examines blood color. External structures correspond internally to the six fu organs, which combine with the five zang organs. All diseases root in the five elements' colors, visible in the eyes. Thus, eye color reveals disease status. Unifying form means guarding spirit, uniting form and spirit. Listening to movement involves holding Qi Kou and Ren Ying to judge pulse qualities (hard, smooth, soft, quiet) and disease progression. Full pulses in meridians indicate pathogen in the meridians. Qi Kou and Ren Ying observe the qi of the three yin and three yang meridians. Shen Liangchen states: The five zang and six fu organs correspond to Heaven's Five Movements and Six Qi. Five Movements govern the interior; Six Qi govern the exterior. Five Movements govern the year; Six Qi govern the season. Zang organs combine internally with Fu organs; Fu organs correspond externally to Six Qi. Yin and Yang combine, facilitating internal-external communication. Thus, this chapter begins with the four seasons and ends with zang-fu yin-yang qi and blood, illustrating the great dao of human-heaven participation and yin-yang separation/combination.