黄帝曰。余以小针为细物也。夫子乃言上合之于天。下合之于地。中合之于人。余以为过针之意
矣。愿闻其故。岐伯曰。何物大于天乎。夫大于针者。惟五兵者焉。五兵者。死之备也。非生之具。
且夫人者。天地之镇也。其不可不参乎。夫治民者。亦惟针焉。夫针之与五兵。其孰小乎。
此章论充溢于皮肤分肉之气血。从脏腑之大络而出于孙络皮肤。应天气之出于地中。而布散于天
下。逆之则伤其所出之机。胜五兵之杀人矣。大络者。手太阴之络。名曰列缺。手少阴之络。名曰
通里。手心主之络。名曰内关。手太阳之络。名曰支正。手阳明之络。名曰偏历。手少阳之络。名曰
外关。足太阳之络。名曰飞扬。足
少阳之络。名曰光明。足阳明之络。名曰丰隆。足太阴之络。名曰公孙。足少阴之络。名曰大钟。
足厥阴之络。名曰蠡沟。此十二脏腑之大络。阳走阴而阴走阳。左注右而右注左。与经脉缪处。其气
血布散于四末。溢于皮肤分肉间。不入于经俞。以应天气之营运于天表。故曰所谓夺其天气。夫九针
之道。一者天。二者地。三者人。小针。微针也。亦所以合于天地人者也。且夫人者。天地之镇也。
其不可不参乎。故治天下之万民者。亦惟针道所合之三才而已。余伯荣曰。上章论卫气从阳明之脉络。
而出于皮肉筋骨之间。此章论皮肤分肉之血气。从胃之经隧脏腑之大络。而出于外。即与卫气相将
之营气也。营卫血气。虽皆生于胃腑水谷之精。然外内出入之道路不一。学人非潜心玩索。不易得
也。按管子曰。蚩尤受卢山之铜。而作五兵。是黄帝时即有五兵矣。一弓。二 。三矛。四戈。五戟。
一云。东方矛。南方弩。中央剑。西方戈。北方锻。
黄帝曰。病之生时。有喜怒不测。饮食不节。阴气不足。阳气有余。营气不行。乃发为痈疽。阴
阳不通。两热相搏。乃化为脓。小针能取之乎。岐伯曰。圣人不能使化者。为其邪不可留也。故两军
相当。旗帜相望。白刃陈于中野者。此非一日之谋也。能使其民令行禁止。士卒无白刃之难者。非一日
之教也。须臾之得也。夫至使身
被痈疽之病。脓血之聚者。不亦离道远乎。夫痈疽之生。脓血之成也。不从天下。不从地出。积微之
所生也。故圣人自治于未有形也。愚者遭其已成也。黄帝曰。其已形不予遭。脓已成不予见。为之
奈何。岐伯曰。脓已成。十死一生。故圣人勿使已成。而明为良方。着之竹帛。使能者踵而传之后世。
无有终时者。为其不予遭也。
此言皮肤分肉之气血。从内而出于外。少有留滞。则渐积而成痈脓。如发于外而小者易愈。大者
多害。若留
积在内。成痈脓而不见者。十死一生也。喜怒不测。饮食不节。内因之所伤也。是以痈疽之生。脓
血之成。不从天地之风寒暑湿。乃积微之所生也。是犹两军相当。旗帜相望。白刃陈于中野者。此非
一日之谋也。能使其民令行禁止。士卒无白刃之难者。非一日之教也。非须臾之可得也。故圣人勿使
已成。而明为良方。着之竹帛。使后学之能者。踵而传之后世。无有终时者。为其不予遭而成十死一
生之证也。遭、遇也。言其已形而不予遭。脓已成而不予见。此痈生于脏腑之间。而不与我见。乃多
死少生之候也。余伯荣曰。按本经及素问论所生痈脓。多因于风寒外邪。有伤营卫。留积而成痈脓。
此因内伤喜怒饮食。故曰不从天下。不从地出。
黄帝曰。其已有脓血。而后遭乎。不道之以小针治乎。岐伯曰。以小治小者。其功小。以大治
大者多害。故其已成脓血者。其惟砭石铍锋之所取也。
余伯荣曰。此言痈发于外而予见者。有大小之难易也。痈小而以小针治之者。其功小而易成。痈
大而以大针治之者。多有逆死之害。故其已成脓血者。其惟砭石铍锋之所取也。盖小而浅者。以砭石
取脓。大而深者。以铍锋取之。铍锋大针也。
黄帝曰。多害者。其不可全乎。岐伯曰。其在逆顺焉。黄帝曰。愿闻逆顺。岐伯曰。以为伤者。
其白眼青。黑眼小。是一逆也。内药而呕者。是二逆也。腹痛渴甚。是三逆也。肩项中不便。是四逆
也。音嘶色脱。是五逆也。除此五者为顺矣。（内叶讷）
此言痈发于外而大者。有逆顺死生之分焉。夫皮脉肉筋骨。五脏之外合也。痈发于皮肉筋骨之间。
其气外
行者为顺。若反逆于内。则逆伤其脏矣。如白眼青。黑眼小。肺肝肾三脏之气伤也。内药而呕。胃气
败也。脾主为胃行其津液。腹痛渴甚。脾气绝也。外阳为诸阳主气。肩项中不便。阳气伤也。在心主言。
心之合脉也。其荣色也。音嘶色脱。心脏伤也。犯此五逆者死。除此五者为顺矣。
黄帝曰。诸病皆有逆顺。可得闻乎。岐伯曰。腹胀身热脉大。是一逆也。腹鸣而满。四肢清泄。
其脉大。是二逆也。衄而不止。脉大。是三逆也。咳且溲血。脱形。其脉小劲。是四逆也。咳。脱形
身热。脉小以疾。是谓五逆也。如是者不过十五日而死矣。
此言血气之逆于经脉者。不过半月而死也。夫血气留滞而成痈脓者。积微之所生。其所由来者渐
矣。若失其旋转之机。又不待成痈。而有遄死之害。诸病者。谓凡病多生于营卫血气之不调。非独痈
脓也。如腹胀身热脉大者。逆伤于脾也。腹鸣而满。四肢清泄。其脉大者。逆伤于肾也。肝主藏血。衄而
不止。逆伤肝也。肺朝百脉。输精于皮毛。咳而溲血形脱。其脉小劲。逆伤肺也。夫心主血脉。肺者
心之盖。咳。形脱身热。脉小以疾。逆伤心也。夫血脉者。五脏之所生也。血气逆。则失其旋转之机。
而反伤其脏真矣。经脉应地之经水。水以应月。不过十五日而死者。随月之盈虚而死。不能终周天之数
矣。王子方曰。堪舆家凿井。度月影以取泉。
其腹大胀。四末清。形脱泄甚。是一逆也。腹胀便血。其脉大。时绝。是二逆也。咳溲血。形肉脱。
脉搏。是三逆也。呕血。胸满引背。脉小而疾。是四逆也。咳呕腹胀。且飧泄。其脉绝。是五逆也。如是
者。不过一时而死矣。工不察此者而刺之。是谓逆治。（飧叶孙）
此言气血之逆于气分者。不过一周时而死矣。夫皮肤分肉之气血。从胃腑而注于脏腑之大络。从
大络而出于孙络。从孙络而外渗于皮肤。如腹大胀。四肢清。形脱泄甚。是逆于胃之大络。不得出于
皮肤。充于四体也。腹胀便血。其脉大时绝。逆于肾络也。咳溲血。形肉脱。脉搏逆于肺络也。呕血
胸满引背。脉小而疾。逆于心络也。咳呕腹胀。且飧泄。其脉绝。逆于肝脾之络也。夫胃者。水谷血气
之海也。五脏之大络。海之所以行云气于天下之道路也。水天之气。上下相通。一昼一夜。绕地环转一
周。如逆而不行。则开阖已息。是以不过一周而死矣。夫人皮以应天。皮肤之气血。逆而不行。不过一
周而死。工不察此天运之大道。如逆伤其气。迟则死于家中。速则死于堂上矣。任谷庵曰。以上论人之
气血。参合天地之道。营运无息者也。少有留滞。或渐积而成痈脓。或一息不续。即为霄壤之判。
黄帝曰。夫子之言针甚骏。以配天地。上数天文。下度地纪。内则五脏。外次六腑。经脉二十八
会。尽有周纪。能杀生人。不能起死者。子能反之乎。岐伯曰。能杀生人。不能起死者也。黄帝曰。
余闻之则为不仁。然愿闻其道。弗行于人。岐伯曰。是明道也。其必然也。其如刀剑之可以杀人。如饮
酒使人醉也。虽勿胗犹可知矣。黄帝曰。愿卒闻之。岐伯曰。人之所受气者谷也。谷之所注者胃也。
胃者。水谷气血之海也。海之所行云气者。天下也。胃之所出气血者。经隧也。经隧者。五脏六腑之
大络也。迎而夺之而已矣。黄帝曰。上下有数乎。岐伯曰。迎之五里。中道而止。五至而已。五往而
脏之气尽矣。故五五二十五而竭其输矣。此所谓夺其天气者也。非能绝其命而倾其寿者也。黄帝曰。
愿卒闻之。岐伯曰。 门而刺之者。死于家中。入门而刺之者。死于堂上。黄帝曰。善乎方。明哉道。
请着之玉版。以为重宝。传之后世。以为刺禁。令民勿敢犯也。（ 窥同）
此言胃腑所生之气血。如云气之布散于天下者。从脏腑之经隧。布于四末。充于皮肤分肉之间。
不入于经俞者也。骏、大也。言针道之大。配乎天地也。上数天文。应天之数也。下度地纪。应地之
经也。内别五脏。应五运之在中也。外次六腑。应六气之在外也。经脉二十八会。脉度之十六丈二尺
也。此言小针者。上合于天。下合于地。中合于人。通其经脉。调其血气。营其顺逆。出入之会。可
传于后世。无有终时者。若不察此三才之大道。反逆伤其旋转之机。又胜五兵之杀人矣。大络者。十
二脏腑之经别也。五里者。手阳明之穴。在肘上三寸。盖脏腑之大络。与经相干。而布于四末。手阳
明之大络。与手阳明之经相干。循五里而散于尺肤。夫脏为阴。腑为阳。经脉为阴。皮肤为阳。手阳
明者。手太阴之腑也。五脏之血气。行于脉中者。因胃气而至于手太阴。以应尺寸之脉。五脏之气血。
行于脉外者。因胃气而出于手阳明之络。以应于尺肤。是以脉急者。尺之皮肤亦急。脉缓者。尺之皮
肤亦缓。善调尺者。不待于寸。此十二脏腑之血气。行于经脉皮肤之外内者。大会于手太阴阳明也。故
迎之五里。中道而止。至者。迎其气之至也。往者。追其气之行也。故五至而迎其五脏之气至即已。
若五往而追之。则五脏之气。尽泄于外矣。五脏各有五输。五五二十五输。若皆取之。则竭其输矣。
此所谓夺其天气者也。非由命之自绝。寿之自倾。实所以杀生人也。窥者。窥俟其所出也。门者。卫气
篇之所谓契绍之门户。乃气血从孙络而出于皮肤之门也。故俟其气之出门而刺之者。稍缓而死于家中。
入门而逆刺于络内者。即死于医者之堂上也。夫天气一日一夜。绕地环转一周。逆则不过一周而死。
况针刺之伤乎。是以着
之玉版。以为重宝。传之后世。以为刺禁。令民勿敢犯也。任谷庵曰。人之皮表以应天。经脉应地
之经水。天气营运于地之外。而复通贯于地中。升降出入。环转无端。而人亦应之。肤表之气血。从
五脏之大络。而出于皮肤分肉之外。复从手足之指井而溜于荥。注于输。行于经。而与经脉中之血气。
相合于肘膝之间。此人合天地阴阳。环转出入之大道也。故曰五往而脏之气尽矣。谓迎之五里。复五
往而追之。则五脏之气。尽泄于外。盖谓皮肤之气血。由五脏之所出也。五五二十五而竭其输。此谓
夺其天气。谓手足五输之气血。从皮肤之所入也。若尽取其五脏之五输。则竭其输中之血。而夺其皮
表之天气也。血气之生始出入。参合天地阴阳。乃端本澄源之学。大有裨于治道。学人当以为首务焉。
余伯荣曰。按内经论经脉之血气。曰藏之金匮。论皮肤分肉之血气。曰着之玉版。盖因金玉之黄白。而
分血气之阴阳也。类而推之。如金银花王不留行花开黄白。陶隐君即用之以行气血。张仲祖以鸡卵黄治
血。卵白治气。此皆体先圣之遗意。学人引而伸之。触类而长之。天下事物之理。用之不穷矣。
黄帝说：我认为小针是细微之物。先生却说它上合于天，下合于地，中合于人。我认为这超出了对小针本意的理解。希望听听其中的缘故。岐伯说：有什么东西比天更大呢？比针更大的，只有五种兵器（弓、弩、矛、戈、戟）。五种兵器，是死亡的准备，不是生存的工具。况且人，是天地间的镇重之物，难道不可以参配天地吗？治理百姓的人，也只依靠针道罢了。针与五兵相比，哪个更小呢？
这一章论述充溢在皮肤和分肉之间的气血，从脏腑的大络脉发出，通过孙络到达皮肤，应验天气从地中生出而布散于天下的道理。如果逆乱这种气血，就会损伤其生发的机理，其危害胜过五兵杀人。大络，是指手太阴肺经的络脉，名叫列缺；手少阴心经的络脉，名叫通里；手厥阴心包经的络脉，名叫内关；手太阳小肠经的络脉，名叫支正；手阳明大肠经的络脉，名叫偏历；手少阳三焦经的络脉，名叫外关；足太阳膀胱经的络脉，名叫飞扬；足少阳胆经的络脉，名叫光明；足阳明胃经的络脉，名叫丰隆；足太阴脾经的络脉，名叫公孙；足少阴肾经的络脉，名叫大钟；足厥阴肝经的络脉，名叫蠡沟。这十二脏腑的大络，阳经走向阴经，阴经走向阳经，左侧注流右侧，右侧注流左侧，与经脉交错分布。它们的气血布散于四肢末端，溢出在皮肤和分肉之间，不进入经脉腧穴，以应验天气在天表运行营运的道理。所以说这是所谓“夺其天气”（剥夺人的生机）。九针的道理，一者对应天，二者对应地，三者对应人。小针，就是微针，也用来配合天地人三才。况且人，是天地间的镇重之物，难道不可以参配吗？所以治理天下万民的人，也只依靠针道所符合的三才之道罢了。余伯荣说：上一章论述卫气从阳明经的脉络，出于皮肉筋骨之间。这一章论述皮肤分肉之间的血气，从胃的经隧和脏腑的大络，出于体外，这就是与卫气相随行的营气。营气和卫气、血和气，虽然都产生于胃腑水谷的精微，但是内外出入的道路不同。学者如果不潜心钻研探索，是不容易掌握的。按《管子》记载：蚩尤接受卢山的铜，制作了五兵，这说明黄帝时代就已经有五兵了。一种说法是：一弓，二弩，三矛，四戈，五戟。另一种说法是：东方矛，南方弩，中央剑，西方戈，北方锻。
黄帝说：疾病产生的时候，有喜怒无常，饮食不节制，导致阴气不足，阳气有余，营气运行不畅，于是发为痈疽。阴阳之气不通畅，两热相互搏结，于是化为脓液。小针能治疗这种情况吗？岐伯说：圣人也不能使已经化脓的疾病痊愈，因为邪气已经停留不去。这就好比两军对垒，旗帜相望，白刃陈列在原野之中，这不是一天的谋划就能形成的。能使百姓令行禁止，士兵没有白刃相伤的危险，也不是一天的教化就能做到的，而是长期积累的结果。等到身体遭受痈疽之病，脓血积聚，不也是离大道很远了吗？痈疽的产生，脓血的形成，不是从天上掉下来，也不是从地里长出来，而是由微小因素逐渐积累而成的。所以圣人是在疾病尚未形成时就加以治理，愚者则是等到疾病已经形成后才遭遇祸患。黄帝说：如果疾病已经成形我没有遇到，脓已经形成我没有看见，该怎么办呢？岐伯说：脓已经形成，十个人死九个，只有一个能活。所以圣人防止疾病发展到已成脓血的地步，并明确制定良方，写在竹帛上，让有才能的人继承并传给后世，使其没有终结的时候，是因为担心人们遇不到早期治疗的机会。
这一段话讲皮肤分肉之间的气血，从体内向体外发散，稍有留滞，就逐渐积累而成痈脓。如发于体表且较小的容易治愈，较大的多有危害。如果留积在体内，形成痈脓而不显露出来的，十个人死九个，只有一个能活。喜怒无常，饮食不节，是内因造成的伤害。因此痈疽的产生，脓血的形成，不是由于天地之风寒暑湿，而是由微小因素逐渐积累而成的。这就好比两军对垒，旗帜相望，白刃陈列在原野之中，这不是一天的谋划就能形成的。能使百姓令行禁止，士兵没有白刃相伤的危险，也不是一天的教化就能做到的，不是一瞬间可以得到的。所以圣人防止疾病发展到已成脓血的地步，并明确制定良方，写在竹帛上，让后学中有才能的人继承并传给后世，使其没有终结的时候，是因为担心人们遇不到早期治疗的机会，从而变成十死一生的证候。“遭”，就是遇见的意思。说疾病已经成形而没有遇到，脓已经形成而没有看见，这种痈生于脏腑之间，而不被我所见，是多死少生的征候。余伯荣说：按《本经》及《素问》论述所生的痈脓，多因风寒外邪，损伤营卫，留积而成痈脓。这里是因为内伤喜怒和饮食，所以说“不从天下，不从地出”。
黄帝说：如果已经有脓血，然后再去诊治吗？不用小针来治疗吗？岐伯说：用小针治小病，功效小；用大针治大病，多有危害。所以对于已经形成脓血的，只能用砭石或铍锋（手术刀）来切开排脓。
余伯荣说：这段话讲痈发于体表且能被看到的，有大小难易的区别。痈小而用小针治疗的，功效小且容易成功。痈大而用大针治疗的，多有逆乱致死的危害。所以对于已经形成脓血的，只能用砭石或铍锋来切开排脓。小的且浅表的，用砭石取脓；大的且深部的，用铍锋切开。铍锋是大针。
黄帝说：危害大的，难道就不能保全性命吗？岐伯说：这取决于顺证还是逆证。黄帝说：希望听听什么是逆证和顺证。岐伯说：作为伤者，如果白眼青黑，黑眼珠变小，这是一逆。服药即呕吐，这是二逆。腹痛且极度口渴，这是三逆。肩项部活动不便，这是四逆。声音嘶哑，面色枯槁脱色，这是五逆。除了这五种情况外，其余为顺证。（内叶讷注）
这段话讲痈发于体表且较大的，有逆顺死生的区别。皮、脉、肉、筋、骨，是五脏的外合。痈发于皮肉筋骨之间，其气向外发散为顺。如果反而逆乱向内，就会逆伤五脏。如白眼青，黑眼小，是肺、肝、肾三脏之气受伤。服药即呕吐，是胃气败坏。脾主为胃运行津液，腹痛且极度口渴，是脾气绝断。外阳为诸阳之主气，肩项部活动不便，是阳气受伤。在心主而言，心合脉，其荣华表现在面色，声音嘶哑，面色枯槁脱色，是心脏受伤。犯这五逆证的会死亡，除了这五逆证的就是顺证。
黄帝说：各种疾病都有逆顺之分，可以说给我听吗？岐伯说：腹胀，身热，脉大，是一逆。腹鸣且腹部胀满，四肢清冷，泄泻，脉大，是二逆。鼻出血不止，脉大，是三逆。咳嗽且小便带血，形体消瘦，脉小而劲急，是四逆。咳嗽，形体消瘦，身热，脉小且疾数，是谓五逆。像这样的，不超过十五天就会死亡。
这段话讲血气在经脉中逆乱的，不过半月就会死亡。血气留滞而成痈脓的，是由微小因素逐渐积累而成的，其由来是渐进的。如果失去了旋转运行的机理，又不待成痈，就有迅速死亡的害处。所谓的“诸病”，指凡是病大多生于营卫血气不调，不仅仅是痈脓。如腹胀身热脉大，是逆伤于脾。腹鸣且腹部胀满，四肢清冷泄泻，脉大，是逆伤于肾。肝主藏血，衄血不止，是逆伤肝。肺朝百脉，输精于皮毛，咳嗽且小便带血，形体脱失，脉小劲急，是逆伤肺。心主血脉，肺是心的华盖，咳嗽，形体脱失，身热，脉小且疾数，是逆伤心。血脉，是五脏所产生的。血气逆乱，就失去旋转的机理，反而伤害脏真。经脉应验地上的经水，水应验月亮，不超过十五天而死，是随着月亮的盈亏而死，不能完成周天之数了。王子方说：堪舆家凿井，测量月影来寻找泉水。
腹部胀大，四肢清冷，形体消瘦，泄泻严重，是一逆。腹胀便血，脉大，时而断绝，是二逆。咳嗽小便带血，形体肌肉脱失，脉搏躁动，是三逆。呕血，胸部满闷牵引背部，脉小而疾数，是四逆。咳嗽呕吐，腹胀，且完谷不化的泄泻，脉绝，是五逆。像这样的，不超过一个时辰就会死亡。医生不考察这些情况而施针刺，这叫逆治。（飧叶孙注）
这段话讲气血在气分中逆乱的，不超过一周时（一天一夜）就会死亡。皮肤分肉之间的气血，从胃腑注入脏腑的大络，从大络出于孙络，从孙络外渗于皮肤。如腹大胀，四肢清冷，形体消瘦泄泻严重，是逆乱于胃的大络，不能出于皮肤，充养四肢。腹胀便血，脉大时而断绝，是逆乱于肾络。咳嗽小便带血，形体肌肉脱失，脉搏躁动，是逆乱于肺络。呕血，胸满牵引背部，脉小而疾数，是逆乱于心络。咳嗽呕吐，腹胀，且完谷不化的泄泻，脉绝，是逆乱于肝脾之络。胃是水谷气血的海，五脏的大络，海之所以行云气于天下的道路。水天之气，上下相通，一昼一夜，绕地环转一周。如果逆乱而不运行，则开阖已停止，所以不超过一周就会死亡。人的皮肤应验天，皮肤的气血，逆乱而不运行，不超过一周就会死亡。医生不考察这天运的大道，如逆乱伤害其气，迟则死在家中，快则死在堂上。任谷庵说：以上论述人的气血，参合天地的道理，营运不息。稍有留滞，或逐渐积累而成痈脓，或一息不断续，就为天壤之别。
黄帝说：先生的言论关于针道非常宏大，配合天地，上数天文，下度地纪，内则五脏，外次六腑，经脉二十八会，尽有周纪。能杀生人，不能起死回生。您能反过来（起死回生）吗？岐伯说：能杀生人，不能起死回生。黄帝说：我听说这个就觉得不仁德。然而希望听听这个道理，不要在人身上实行。岐伯说：这是明道，是必然的。就像刀剑可以杀人，就像饮酒使人醉一样，即使不诊察也可以知道。黄帝说：希望详尽地听听。岐伯说：人所受的气来源于谷，谷所注入的是胃。胃是水谷气血的海。海之所以行云气于天下的，是指经络。胃所出的气血，在于经隧。经隧，是五脏六腑的大络。迎而夺之就可以了。黄帝说：上下有定数吗？岐伯说：迎取五里穴，中途而止。刺五次就够了。五次往复，五脏之气就耗尽了。所以五五二十五次，就竭尽了腧穴之气。这就是所谓“夺其天气”。并不是能断绝人的性命和缩短寿命，而是这样操作确实能杀死活人。黄帝说：希望详尽地听听。岐伯说：在门户之外刺入的，患者死在家中；入门之后刺入的，患者死在堂上。黄帝说：好的方术，明白的道理，请刻在玉版上，作为重宝，传给后世，作为针刺禁忌，让百姓不敢冒犯。（窥同注）
这段话讲胃腑所生的气血，如云气布散于天下，从脏腑的经隧，布于四肢末端，充于皮肤分肉之间，不进入经脉腧穴。骏，是大。言针道之大，配合天地。上数天文，应验天的数。下度地纪，应验地的经。内别五脏，应验五运在中。外次六腑，应验六气在外。经脉二十八会，脉度十六丈二尺。这话讲小针，上合于天，下合于地，中合于人，通其经脉，调其血气，营其顺逆，出入之会，可传于后世，没有终结的时候。如果不考察这三才的大道，反而逆乱伤害其旋转的机理，又胜过五兵杀人。大络，是十二脏腑的经别。五里穴，是手阳明大肠经的穴位，在肘上三寸。大概脏腑的大络，与经脉相交，而布于四肢末端。手阳明的大络，与手阳明经相交，循行五里而散于尺肤。脏为阴，腑为阳，经脉为阴，皮肤为阳。手阳明，是手太阴的腑。五脏的血气，行于脉中的，因胃气而至于手太阴，以应寸口脉。五脏的气血，行于脉外的，因胃气而出于手阳明的络，以应于尺肤。所以脉急的，尺肤也急；脉缓的，尺肤也缓。善于调尺肤的，不待于寸口。这十二脏腑的血气，行于经脉皮肤之外内的，大会于手太阴和手阳明。所以迎取五里穴，中途而止。“至”，是迎其气之至。“往”，是追其气之行。所以五次至而迎其五脏之气至即可。若五次往而追之，则五脏之气，尽泄于外。五脏各有五输，五五二十五输，若都取之，则竭其输。这就是所谓“夺其天气”。并非由命自绝，寿自倾，实则是杀生人。窥，是窥俟其所出。门，是《卫气篇》所说的契绍之门户，乃气血从孙络出于皮肤的门户。所以俟其气出门而刺之者，稍缓而死在家中。入门而逆刺于络内者，即死于医者之堂上。夫天气一日一夜，绕地环转一周，逆则不过一周而死，何况针刺的伤害呢。所以刻在玉版上，作为重宝，传给后世，作为针刺禁忌，让百姓不敢冒犯。任谷庵说：人的皮表应验天，经脉应验地的经水。天气营运于地之外，而复通贯于地中，升降出入，环转无端，而人也应验之。肤表的气血，从五脏的大络，出于皮肤分肉之外，复从手足之指井穴而溜于荥穴，注于输穴，行于经穴，而与经脉中的血气，相合于肘膝之间。此人合天地阴阳，环转出入的大道。所以说“五往而脏之气尽矣”，谓迎取五里，复五次往而追之，则五脏之气，尽泄于外。盖谓皮肤的气血，由五脏所出。五五二十五而竭其输，此谓“夺其天气”，谓手足五输的气血，从皮肤所入。若尽取其五脏的五输，则竭其输中之血，而夺其皮表之天气。血气的生始出入，参合天地阴阳，乃是端本澄源之学，大有裨于治道。学者应当以此为首要任务。余伯荣说：按《内经》论经脉的血气，曰藏之金匮；论皮肤分肉的血气，曰着之玉版。大概因金玉的黄白，而分血气的阴阳。类推之，如金银花、王不留行花开黄白，陶隐君即用之以行气血，张仲景以鸡卵黄治血，卵白治气。这都是体悟先圣的遗意。学者引而伸之，触类而长之，天下事物之理，用之不穷矣。
Huangdi said: I consider the small needle to be a minute object. Yet you, Master, say it corresponds to Heaven above, Earth below, and Humanity in between. I believe this exceeds the intended meaning of the needle. I wish to hear the reason. Qibo said: What is greater than Heaven? Among things greater than the needle, there are only the Five Weapons (bows, crossbows, spears, ge halberds, ji halberds). The Five Weapons are instruments of death, not tools for life. Moreover, humanity is the stabilizing force between Heaven and Earth; can it not be considered in correspondence with them? Those who govern the people rely solely on the way of the needle. Compared to the Five Weapons, which is smaller, the needle or the weapons?
This chapter discusses the qi and blood overflowing in the skin and intermuscular spaces, emerging from the large collaterals of the zang-fu organs, passing through the sun-branches (fine branches) to reach the skin, mirroring how heavenly qi emerges from the earth and spreads throughout the world. If one opposes this flow, one damages the mechanism of its emergence, causing harm that surpasses that of the Five Weapons killing people. The large collaterals refer to: the collateral of the Hand-Taiyin Lung Meridian, named Lieque (LU7); the collateral of the Hand-Shaoyin Heart Meridian, named Tongli (HT5); the collateral of the Hand-Jueyin Pericardium Meridian, named Neiguan (PC6); the collateral of the Hand-Taiyang Small Intestine Meridian, named Zhizheng (SI7); the collateral of the Hand-Yangming Large Intestine Meridian, named Pianli (LI6); the collateral of the Hand-Shaoyang Sanjiao Meridian, named Waiguan (TE5); the collateral of the Foot-Taiyang Bladder Meridian, named Feiyang (BL58); the collateral of the Foot-Shaoyang Gallbladder Meridian, named Guangming (GB37); the collateral of the Foot-Yangming Stomach Meridian, named Fenglong (ST40); the collateral of the Foot-Taiyin Spleen Meridian, named Gongsun (SP4); the collateral of the Foot-Shaoyin Kidney Meridian, named Dazhong (KI4); and the collateral of the Foot-Jueyin Liver Meridian, named Ligou (LR5). These twelve large collaterals of the zang-fu organs allow Yang meridians to connect with Yin meridians, and Yin with Yang; left flows to right, and right to left, intersecting with the main meridians. Their qi and blood spread to the four extremities, overflowing into the skin and intermuscular spaces, without entering the main meridian acupoints, thereby corresponding to the operation of heavenly qi on the surface of the heavens. Thus it is said that this constitutes "snatching heavenly qi" (depriving the vital energy). The principle of the Nine Needles involves one corresponding to Heaven, two to Earth, and three to Humanity. The small needle, also known as the micro-needle, serves to harmonize with Heaven, Earth, and Humanity. Since humanity is the stabilizer of Heaven and Earth, it must be taken into account. Therefore, those who govern the myriad people of the world rely only on the Needle Way, which aligns with the Three Powers (Heaven, Earth, Humanity). Yu Borong stated: The previous chapter discussed Wei Qi (Defensive Qi) emerging from the meridians of the Yangming channel into the spaces between skin, flesh, sinew, and bone. This chapter discusses the blood and qi in the skin and intermuscular spaces, emerging from the stomach's channels and the large collaterals of the zang-fu organs to the exterior. This is the Ying Qi (Nutritive Qi) that accompanies Wei Qi. Although Ying and Wei, blood and qi, all originate from the essence of water and grain produced by the Stomach, their pathways of internal and external circulation differ. Scholars who do not devote themselves to deep study will find it difficult to grasp. According to the *Guanzi*: Chiyou received copper from Mount Lu and crafted the Five Weapons, indicating that the Five Weapons existed even during the time of Huangdi. One version lists them as: 1. Bow, 2. Crossbow, 3. Spear, 4. Ge Halberd, 5. Ji Halberd. Another version states: East Spear, South Crossbow, Central Sword, West Ge Halberd, North Anvil/Forge.
Huangdi said: When diseases arise, they result from unpredictable emotions (excess joy or anger), irregular diet, insufficiency of Yin Qi, excess of Yang Qi, and stagnation of Ying Qi, leading to the development of carbuncles and ulcers (Yong Ju). When Yin and Yang channels are blocked, and two heats clash, pus is formed. Can the small needle treat this? Qibo said: Even the Sage cannot cure diseases where pus has already formed, because the pathogenic factor has become entrenched. This is like two armies facing each other, banners visible, and white blades arrayed in the open field; such a situation does not develop in a single day's planning. To enable the people to obey orders and prohibit actions, and for soldiers to avoid the danger of blades, requires more than a day's teaching; it is the result of long-term accumulation. To let the body suffer from carbuncles and ulcers, with accumulation of pus and blood, is indeed to be far from the Great Dao. The generation of carbuncles and ulcers, and the formation of pus and blood, do not fall from the sky nor emerge from the ground; they arise from the gradual accumulation of minute factors. Therefore, the Sage treats conditions before they take form, while the foolish encounter disaster after the condition has fully developed. Huangdi said: What if the disease has already taken form and I have not encountered it early, or the pus has already formed and I have not seen it? How should I proceed? Qibo said: Once pus has formed, nine out of ten patients die, and only one survives. Thus, the Sage prevents the disease from reaching the stage of formed pus and explicitly establishes effective prescriptions, inscribing them on bamboo slips and silk, so that capable successors may transmit them to future generations without end. This is done because we fear that people will miss the opportunity for early treatment.
This section explains that qi and blood in the skin and intermuscular spaces move from the interior to the exterior. If there is slight stagnation, it gradually accumulates into carbuncles and pus. If the lesion appears on the exterior and is small, it is easy to heal; if large, it causes much harm. If the stagnation remains internal, forming carbuncles and pus that are not visible externally, nine out of ten patients die, and only one survives. Unpredictable emotions and irregular diet are injuries caused by internal factors. Therefore, the generation of carbuncles and ulcers, and the formation of pus and blood, are not due to wind, cold, heat, or dampness from Heaven and Earth, but arise from the gradual accumulation of minute factors. This is akin to two armies facing each other, banners visible, and white blades arrayed in the open field; such a situation does not develop in a single day's planning. To enable the people to obey orders and prohibit actions, and for soldiers to avoid the danger of blades, requires more than a day's teaching; it cannot be achieved in an instant. Thus, the Sage prevents the disease from reaching the stage of formed pus and explicitly establishes effective prescriptions, inscribing them on bamboo slips and silk, so that capable students may transmit them to future generations without end. This is because we fear that people will miss the opportunity for early treatment, resulting in a prognosis of nine deaths to one survival. "Zao" (encounter) means to meet. Saying "the disease has taken form and I did not encounter it, the pus has formed and I did not see it" refers to carbuncles arising within the zang-fu organs, hidden from view, which indicate a prognosis of many deaths and few survivals. Yu Borong stated: According to the *Classic of Difficulties* and the *Suwen*, carbuncles and pus often arise from external pathogens like wind-cold damaging Ying and Wei, leading to stagnation and pus formation. Here, however, the cause is internal injury from emotions and diet, hence it is said "not from Heaven, not from Earth."
Huangdi said: If pus and blood have already formed, should we then seek treatment? Should we not use the small needle? Qibo said: Using a small needle for a small problem yields small results; using a large needle for a large problem causes much harm. Therefore, for cases where pus and blood have already formed, one should only use Bian stones (lithotribe/lancet) or Pi Feng (scalpel-like needle) for incision and drainage.
Yu Borong stated: This passage discusses carbuncles appearing on the exterior and being visible, noting differences in size and difficulty. For small carbuncles treated with small needles, the effect is small but success is easy. For large carbuncles treated with large needles, there is much risk of adverse reactions and death. Therefore, for cases where pus and blood have already formed, one should only use Bian stones or Pi Feng for incision and drainage. Small and superficial lesions are drained with Bian stones; large and deep lesions are incised with Pi Feng. Pi Feng is a large needle.
Huangdi said: Regarding those with great harm, is it impossible to preserve life? Qibo said: It depends on whether the signs are Shun (favorable/compliant) or Ni (adverse/rebellious). Huangdi said: I wish to hear what constitutes Ni and Shun. Qibo said: In a patient with a wound, if the whites of the eyes are blue-green and the pupils are small, this is the First Adverse sign (Ni). If taking medicine induces vomiting, this is the Second Adverse sign. If there is abdominal pain and extreme thirst, this is the Third Adverse sign. If the shoulders and neck are stiff and immobile, this is the Fourth Adverse sign. If the voice is hoarse and the complexion is pale and depleted, this is the Fifth Adverse sign. Apart from these five, the rest are Shun (favorable). (Note by Nei Yene)
This section explains that for large carbuncles appearing on the exterior, there is a distinction between favorable (Shun) and adverse (Ni) prognoses regarding life and death. Skin, vessels, flesh, sinews, and bones are external correspondences of the Zang organs. When a carbuncle arises between skin, flesh, sinews, and bones, if the qi moves outward, it is Shun (favorable). If it reverses inward, it adversely injures the Zang organs. Blue-green whites of the eyes and small pupils indicate injury to the Qi of the Lung, Liver, and Kidney. Vomiting after taking medicine indicates failure of Stomach Qi. The Spleen governs transporting fluids for the Stomach; abdominal pain and extreme thirst indicate exhaustion of Spleen Qi. External Yang is the master of all Yang Qi; stiffness in the shoulders and neck indicates injury to Yang Qi. Regarding the Heart Master, the Heart correlates with vessels, and its flourishing is shown in the complexion; hoarse voice and depleted complexion indicate injury to the Heart. Violating these Five Adverse signs leads to death; apart from these, it is Shun.
Huangdi said: All diseases have distinctions of Shun and Ni. May I hear about them? Qibo said: Abdominal distension, fever, and a large pulse constitute the First Adverse sign. Abdominal borborygmus and fullness, cold limbs, diarrhea, and a large pulse constitute the Second Adverse sign. Unstopping epistaxis (nosebleed) with a large pulse constitutes the Third Adverse sign. Coughing with hematuria (blood in urine), emaciation, and a small, forceful pulse constitute the Fourth Adverse sign. Coughing, emaciation, fever, and a small, rapid pulse constitute the Fifth Adverse sign. In such cases, death occurs within fifteen days.
This section explains that when blood and qi rebel within the meridians, death occurs within half a month. Carbuncles and pus formed by stagnation of blood and qi arise from gradual accumulation of minute factors; their origin is progressive. If the mechanism of rotation and circulation is lost, death can occur rapidly even before carbuncles form. The term "various diseases" refers to illnesses generally arising from disharmony of Ying, Wei, blood, and qi, not just carbuncles and pus. Abdominal distension, fever, and large pulse indicate adverse injury to the Spleen. Abdominal borborygmus, fullness, cold limbs, diarrhea, and large pulse indicate adverse injury to the Kidney. The Liver stores blood; unstopping epistaxis indicates adverse injury to the Liver. The Lung receives all vessels and transmits essence to the skin and hair; coughing with hematuria, emaciation, and small, forceful pulse indicate adverse injury to the Lung. The Heart governs blood vessels; the Lung is the canopy of the Heart. Coughing, emaciation, fever, and small, rapid pulse indicate adverse injury to the Heart. Blood vessels are generated by the Five Zang organs. When blood and qi rebel, the mechanism of rotation is lost, and the true Qi of the Zang is injured. Meridians correspond to river waters on Earth; water corresponds to the moon. Death within fifteen days follows the waxing and waning of the moon, failing to complete the cycle of the celestial sphere. Wang Zifang stated: Geomancers digging wells measure the moon's shadow to find spring water.
Abdominal distension with large volume, cold extremities, severe emaciation, and profuse diarrhea constitute the First Adverse sign. Abdominal distension with bloody stool, large pulse that intermittently disappears, constitute the Second Adverse sign. Coughing with hematuria, emaciation of flesh, and pulsating pulse constitute the Third Adverse sign. Hematemesis (vomiting blood), chest fullness radiating to the back, and small, rapid pulse constitute the Fourth Adverse sign. Coughing, vomiting, abdominal distension, and undigested food diarrhea (Sun Xie), with an absent pulse, constitute the Fifth Adverse sign. In such cases, death occurs within one diurnal cycle (24 hours). If physicians fail to observe these and apply acupuncture, it is called "Adverse Treatment." (Note by Sun Xie)
This section explains that when Qi rebels within the Qi level, death occurs within one diurnal cycle. Qi and blood in the skin and intermuscular spaces flow from the Stomach into the large collaterals of the Zang-Fu, from large collaterals to Sun-branches, and from Sun-branches exuding into the skin. Abdominal distension, cold extremities, severe emaciation, and profuse diarrhea indicate rebellion in the large collateral of the Stomach, preventing exit to the skin and nourishment of the limbs. Abdominal distension, bloody stool, large pulse with intermittent disappearance indicate rebellion in the Kidney collateral. Coughing with hematuria, emaciation, pulsating pulse indicate rebellion in the Lung collateral. Hematemesis, chest fullness radiating to the back, small rapid pulse indicate rebellion in the Heart collateral. Coughing, vomiting, abdominal distension, undigested food diarrhea, absent pulse indicate rebellion in the Liver and Spleen collaterals. The Stomach is the Sea of Water and Grain and the source of Qi and Blood. The large collaterals of the Five Zang are the pathways by which the Sea distributes Qi and Clouds throughout the world. The Qi of Water and Heaven connects above and below, circling the earth once in a day and night. If it rebels and fails to circulate, opening and closing cease, so death occurs within one cycle. Human skin corresponds to Heaven. If Qi and blood in the skin rebel and fail to circulate, death occurs within one cycle. Physicians who do not investigate this Great Dao of Heavenly Movement, and instead rebel against and injure the Qi, will see patients die at home if slow, or in the hall if fast. Ren Gu'an stated: The above discussion relates human Qi and Blood to the Dao of Heaven and Earth, circulating without rest. Slight stagnation may gradually accumulate into carbuncles and pus; or if breath ceases for an instant, the difference becomes as vast as Heaven and Earth.
Huangdi said: Your words on acupuncture are grand, matching Heaven and Earth, counting astronomical phenomena above, measuring terrestrial coordinates below, internalizing the Five Zang, externalizing the Six Fu, and encompassing the twenty-eight meridians with their complete cycles. It can kill living people, but cannot revive the dead. Can you reverse this? Qibo said: It can kill living people, but cannot revive the dead. Huangdi said: Hearing this makes me feel it is inhumane. Yet I wish to hear the principle, provided it is not practiced on humans. Qibo said: This is the clear Dao, and it is inevitable. It is like swords and knives killing people, or wine intoxicating people; even without diagnosis, one can know this. Huangdi said: I wish to hear it in detail. Qibo said: The Qi received by humans comes from grain; grain enters the Stomach. The Stomach is the Sea of Water, Grain, Qi, and Blood. The distribution of Qi and Clouds from the Sea corresponds to the world. The Qi and Blood exiting the Stomach travel through the Jing-Tui (Meridian Channels). The Jing-Tui are the large collaterals of the Five Zang and Six Fu. One merely needs to "Welcome and Deprive" (Ying Er Duo Zhi). Huangdi said: Are there specific numbers above and below? Qibo said: Welcoming at Wuli (LI24) and stopping midway. Five thrusts are sufficient. After five withdrawals, the Qi of the Zang organs is exhausted. Thus, five times five equals twenty-five extractions, exhausting the Shu points. This is called "Snatching Heavenly Qi." It does not mean one can directly sever life or shorten longevity, but rather that such practice kills living people. Huangdi said: I wish to hear it in detail. Qibo said: Puncturing at the "Gate" causes death at home; puncturing upon "Entering the Door" causes death in the hall. Huangdi said: Excellent technique, clear principle. Please inscribe it on the Jade Tablet as a precious treasure, transmit it to future generations as Acupuncture Taboos, so that people dare not violate them. (Kui Tong note)
This section explains that Qi and Blood generated by the Stomach distribute like clouds throughout the world, flowing from the Jing-Tui of the Zang-Fu to the four extremities and filling the skin and intermuscular spaces, without entering the main meridian acupoints. "Jun" means great. It speaks of the greatness of the Needle Way, matching Heaven and Earth. Counting astronomy above corresponds to the numbers of Heaven; measuring terrestrial coordinates below corresponds to the meridians of Earth. Differentiating the Five Zang internally corresponds to the Five Movements within; ordering the Six Fu externally corresponds to the Six Qi outside. The twenty-eight meridians correspond to the pulse length of sixteen zhang and two chi. This teaches that the small needle corresponds to Heaven above, Earth below, and Humanity in between, unblocking meridians, regulating Qi and Blood, managing compliance and rebellion, and governing entry and exit. It can be transmitted to future generations without end. However, if one fails to investigate the Great Dao of the Three Powers and instead rebels against and injures the mechanism of rotation, the harm surpasses that of the Five Weapons. The "Large Collaterals" refer to the Jing-Bie (Branch Meridians) of the twelve Zang-Fu. Wuli (LI24) is an acupoint of the Hand-Yangming Large Intestine Meridian, located three cun above the elbow. Generally, the large collaterals of the Zang-Fu intersect with the meridians and distribute to the four extremities. The large collateral of the Hand-Yangming intersects with the Hand-Yangming meridian, following Wuli and dispersing into the cubital region. Zang is Yin, Fu is Yang; Meridians are Yin, Skin is Yang. The Hand-Yangming is the Fu organ of the Hand-Taiyin. The Qi and Blood of the Five Zang traveling within the vessels reach the Hand-Taiyin via Stomach Qi, corresponding to the Cun-Kou pulse. The Qi and Blood of the Five Zang traveling outside the vessels exit via the collateral of the Hand-Yangming via Stomach Qi, corresponding to the Chi-skin (forearm skin). Therefore, if the pulse is urgent, the Chi-skin is tight; if the pulse is slack, the Chi-skin is loose. One skilled in adjusting the Chi-skin need not rely on the Cun-pulse. The Qi and Blood of the twelve Zang-Fu traveling inside and outside the meridians and skin converge at the Hand-Taiyin and Hand-Yangming. Thus, welcoming at Wuli and stopping midway: "Zhi" (arrival) means welcoming the arrival of Qi; "Wang" (departure) means pursuing the movement of Qi. Therefore, five arrivals suffice to welcome the Qi of the Five Zang. If one pursues five departures, the Qi of the Five Zang will be entirely leaked outward. Each Zang has five Shu points; five Zangs times five points equals twenty-five Shu points. If all are extracted, the Shu Qi is exhausted. This is called "Snatching Heavenly Qi." It is not that life ends naturally or longevity shortens itself, but that this action kills living people. "Kui" means waiting for the exit point. "Men" (Gate) refers to the "Qi-Suo" portal mentioned in the *Wei Qi Chapter*, the gateway where Qi and Blood exit the Sun-branches to the skin. Therefore, puncturing when waiting for Qi to exit the gate causes death at home if delayed; puncturing inward upon entering the door causes death immediately in the physician's hall. Heavenly Qi circles the earth once in a day and night; if rebellious, death occurs within one cycle. How much more so with needle injury? Thus, it is inscribed on the Jade Tablet as a precious treasure, transmitted as Acupuncture Taboos, so people dare not violate it. Ren Gu'an stated: Human skin corresponds to Heaven; meridians correspond to earthly rivers. Heavenly Qi circulates outside the Earth and penetrates within, ascending, descending, entering, and exiting in endless rotation, and humans correspond to this. Qi and Blood on the body surface emerge from the large collaterals of the Five Zang to the exterior of skin and intermuscular spaces, then flow from the Jing points of the fingers and toes to the Ying points, enter the Shu points, travel through the Jing points, and merge with the Qi and Blood in the meridians between the elbows and knees. This is the Great Dao of humans matching Heaven and Earth, Yin and Yang, rotating and entering/exiting. Thus it is said "Five withdrawals exhaust the Qi of the Zang," referring to welcoming Wuli and pursuing five withdrawals, causing the Qi of the Five Zang to leak entirely outward. This implies that Qi and Blood in the skin originate from the Five Zang. "Twenty-five extractions exhaust the Shu" refers to "Snatching Heavenly Qi," meaning the Qi and Blood of the Five Shu points on the hands and feet enter from the skin. If one extracts all Five Shu points of the Five Zang, one exhausts the blood in the Shu and snatches the Heavenly Qi of the skin surface. The birth, entry, and exit of Qi and Blood, matching Heaven and Earth and Yin and Yang, is the study of addressing the root and clearing the source, greatly benefiting medical practice. Scholars should make this their primary task. Yu Borong stated: In the *Neijing*, the Qi and Blood of the meridians are said to be stored in the Golden Cabinet; the Qi and Blood of the skin and intermuscular spaces are said to be inscribed on the Jade Tablet. This likely distinguishes the Yin and Yang of Qi and Blood based on the yellow and white colors of gold and jade. By analogy, flowers like Honeysuckle (*Lonicerae Japonicae Flos*) and Goji Berry (*Lycii Fructus*) bloom yellow and white; Tao Hongjing used them to promote Qi and Blood circulation. Zhang Zhongjing used egg yolk to treat blood and egg white to treat Qi. These embody the legacy of the Sages. Scholars should extend and expand upon these principles; the logic of all things in the world will be inexhaustible in application.