于五脏之情志。而成上中下三部之积也。按五脏只曰生病。而不曰积。盖五脏之病积。在气而非有形
也。难经所谓在肝曰肥气。在肺曰息奔。在心曰伏梁。在脾曰痞气。在肾曰奔豚。此乃无形之气积。
而非有形之血积也。倪仲玉曰。忧思忿怒伤气。故积在气。
黄帝曰善。治之奈何。岐伯答曰。察其所痛。以知其应。有余不足。当补则补。当泻则泻。毋逆
天时。是谓至治。痛者。为积之痛于内也。察其所痛。知其所应者。如着于孙络之积。则外应于手
臂之孙络。着于阳明之经积。则外应于光明。着于肠胃募原之积。则外应于 谷之穴会。着于伏冲之积。
则外应于气冲大赫。着于膂筋之积。则应于足少阴太阳之筋。结于缓筋之积。则应于足太阴阳明之筋。
成于六输之积。则外应于内关外
关。通里列缺。支正偏历。积于空郭之中。则外应于阳明之五里。臂腕之尺肤。积于五脏。察其左右
上下。则外应于五脏之经俞。审其有余不足。当补则补。当泻则泻。随四时之序。气之所处。病之
所舍。脏腑之所宜。毋逆天时。是谓至治。倪仲玉曰。外因之积应于形。内因之积应于脉。
黄帝问于岐伯曰。余闻九针于夫子。而行之于百姓。百姓之气血。各不同形。或神动而气先针行。
或气与针相逢。或针已出。气独行。或数刺乃知。或发针而气逆。或数刺病亦剧。凡此六者。各不
同行。愿闻其方。
此承前章论刺阴阳之人。而行针之不同也。夫五音之人多阴。左右太少之人多阳。百姓者。天下
之大众。盖天地之间。六合之内。不离于五。而人亦应之。百姓之气血。各不同形者。谓形中之血
气。有盛有少也。六者。谓重阳之人。阳中有阴之人。阴阳和平之人。多阴之人。阴中有阳之人。及
粗工之所败也。倪仲玉曰。此篇论刺形。故提二形字。末结一形字。
岐伯曰。重阳之人。其神易动。其气易往也。黄帝曰。何谓重阳之人。岐伯曰。重阳之人。
高高。言语善疾。举足善高。心肺之脏气有余。阳气滑盛而扬。故神动而气先行。
此言重阳之人。神气之易行也。夫五脏内合五行。外合五音。三阴之所主也。心肺居上为阳。肝
肾脾居下为阴。阴中之有阳也。重阳之人者。手足左右太少之三阳。及心肺之脏气有余者也。 高高。
手三阳之在上也。言语善疾。阴中之阳在中也。举足善高。足三阳之在下也。心藏神。肺主气。心肺之脏气有余。
阳气滑盛而扬。故神动而气先行也。
黄帝曰。重阳之人。而神不先行者何也。岐伯曰。此人颇有阴者也。黄帝曰。何以知其颇有阴
也。岐伯曰。多阳者多喜。多阴者多怒。数怒者易解。故曰颇有阴。其阴阳之离合难。故其神不能
先行也。心为阳中之太阳。肝为阴中之少阳。心主喜。肝主怒。心藏神。肝藏魂。魂随神以往来者也。
神动而气先行者。神魂之相离也。重阳而颇有阴者。阴阳之相合也。阴阳之离合难。故神与魂合。则
其神不能先行矣。上文曰气先行。此则曰神。不能先行。盖气行则神行。神行则气行。神气之相随也。
夫行针者。贵在得神取气。然而神有易动。气有易往。是以数刺而病益甚者。反伤其神气也。仇汝
霖曰。喜为心志。怒为肝志。数怒者易解。言其人易怒而易解者。重阳之人颇有阴也。盖多阴者多怒。
此阳中之阴。故易怒而易解也。
黄帝曰。其气与针相逢奈何。岐伯曰。阴阳和调。而血气淖泽滑利。故针入而气出疾而相逢也。
徐振公曰。此言阴阳和平之人。血气淖泽滑利。故气出疾而与针相逢也。倪仲玉曰。谓阴阳之
气。皆应于针。
黄帝曰。针已出而气独行者。何气使然。岐伯曰。其阴气多而阳气少。阴气沉而阳气浮。沉者内
藏。故针已出。气乃随其后。故独行也。
徐振公曰。此言多阴之人。针已出。而阴气独行也。其阴气多而阳气少者。阴气沉而阳气浮。阴
阳之相离也。
故针已出。则微阳之气。随针外泄。阴气独行于内。此阴阳不和。不能交相 守。而微阳之易脱也。
黄帝曰。数刺乃知。何气使然。岐伯曰。此人之多阴而少阳。其气沉而气往难。故数刺乃知也。
徐振公曰。此言阴中有阳之人。数刺而始知也。阴中有阳者。多阴而少阳。其气沉而难于往来。
故数刺乃知。此阴阳 守于内也。二节言多阴少阳之人。有阴阳之相离者。有相守者。阴阳离合之道。
行针者不可不知。仇汝霖曰。多阴少阳。故阴阳不合。阴中有阳。故阴阳相和。盖阳生于阴也。
黄帝曰。针入而气逆者。何气使然。岐伯曰。其气逆。与其数刺病益甚者。非阴阳之气。浮沉之
势也。此皆粗之所败。工之所失。其形气无过焉。
徐振公曰。重阳之人。其神易动。其气易往。神气之易散也。多阴之人。气随针出。微阳之易脱
也。阴阳有离有合。气之有浮有沉。粗工不知浮沉离合之道而失之。以致数刺而病益甚也。夫五音之形。
阴气多而阳气少。左右太少之形。阳气多而阴气少。故善用针者。调其阴阳。而使形气之无过焉。
仇汝霖曰。神气者。五脏之神气也。重阳之人。使神气外弛。则愈亡其阴矣。多阴少阳之人。使阳气随
针而出。则愈亡其阳矣。此皆粗之所败。工之所失也。
关于五脏的情志变化，从而形成上、中、下三部的积证。按：五脏只说生病，而不说成积。大概五脏的病积，在于气机而非有形的实质病变。《难经》所说的在肝称为肥气，在肺称为息贲，在心称为伏梁，在脾称为痞气，在肾称为奔豚，这些都是无形的气机郁结，而不是有形的血瘀积块。倪仲玉说：忧思忿怒损伤气机，所以积证在于气分。
黄帝说：好。如何治疗呢？岐伯回答说：观察疼痛的部位，以推断其对应的内在病变。根据邪气的有余或不足，应当补益的就补益，应当泻除的就泻除，不要违背天时规律，这叫做最高明的治疗。疼痛，是积证在体内产生的痛感。观察疼痛部位，知道其对应关系，例如：积滞附着于孙络，则外部对应手臂的孙络；积滞附着于阳明经，则外部对应光明穴；积滞附着于肠胃募原，则外部对应足三里等穴位交会处；积滞附着于伏冲之脉，则外部对应气冲穴和大赫穴；积滞附着于脊背筋脉，则对应足少阴和足太阳的筋脉；结聚于缓筋的积证，则对应足太阴和足阳明的筋脉；形成于六输穴的积证，则外部对应内关、外关、通里、列缺、支正、偏历等穴；积滞于胸腹空廓之中，则外部对应阳明经的五里穴及手腕部的尺肤；积滞于五脏，观察其左右上下位置，则外部对应五脏的经络腧穴。审察邪气的有余或不足，应当补益的就补益，应当泻除的就泻除，顺应四季时序，依据气机所在、病邪停留之处以及脏腑的适宜状态，不违背天时，这叫做最高明的治疗。倪仲玉说：外因导致的积证应验于形体，内因导致的积证应验于脉象。
黄帝问岐伯说：我从您那里学到了九针之法，并在百姓身上施行。百姓的气血形态各不相同。有的人神气先动而气随针先行；有的人气与针同时相逢；有的人针已拔出，气才独行；有的人经过多次针刺后才见效；有的人出针后气机逆乱；有的人经过多次针刺后病情反而加重。以上六种情况，行针反应各不相同，希望听听其中的道理。
这是承接上一章论述刺灸阴阳不同体质之人，行针反应不同的内容。五音之人多属阴，左右太少之人多属阳。百姓是指天下大众。大概天地之间，六合之内，不离于五行，人也相应于此。百姓的气血形态各不相同，是指形体中的气血有盛有衰。所谓“六者”，是指重阳之人、阳中有阴之人、阴阳和平之人、多阴之人、阴中有阳之人，以及被粗工治坏的人。倪仲玉说：本篇论述刺灸形体，所以提出两个“形”字，最后归结为一个“形”字。
岐伯说：重阳之人，他的神气容易发动，气机容易运行。黄帝说：什么是重阳之人？岐伯说：重阳之人，举止高傲，说话语速快，抬脚动作高扬，这是因为心肺的脏气有余，阳气滑利旺盛而飞扬，所以神一动而气就先行。
这是说重阳之人，神气容易运行的原因。五脏内部合于五行，外部合于五音，这是三阴所主。心肺居于上部为阳，肝肾脾居于下部为阴，这是阴中之阳。所谓重阳之人，是指手足左右太少三阳经气盛，以及心肺脏气有余的人。“高高”，指手三阳经气在上部；“言语善疾”，指阴中之阳在中部；“举足善高”，指足三阳经气在下部。心藏神，肺主气，心肺脏气有余，阳气滑利旺盛而飞扬，所以神一动而气就先行。
黄帝说：重阳之人，为什么神气不先行呢？岐伯说：这种人颇有阴气。黄帝说：怎么知道他颇有阴气呢？岐伯说：阳气多的人多喜，阴气多的人多怒。经常发怒但容易平息的人，所以说他颇有阴气。因为他的阴阳离合困难，所以神不能先行。心是阳中之太阳，肝是阴中之少阳。心主喜，肝主怒。心藏神，肝藏魂。魂是随着神往来活动的。神动而气先行，是因为神魂相离。重阳而颇有阴，是阴阳相合。阴阳离合困难，所以神与魂相合，那么神就不能先行了。上文说气先行，这里说神不能先行，大概气行则神行，神行则气行，神气是相互跟随的。行针的关键在于得神取气，然而神有易动的，气有易往的，因此如果多次针刺导致病情加重，反而是损伤了神气。仇汝霖说：喜是心的情志，怒是肝的情志。经常发怒但容易平息，是说这个人容易发怒也容易平息，属于重阳之人颇有阴的情况。大概阴多的人多怒，这是阳中之阴，所以容易发怒也容易平息。
黄帝说：气与针同时相逢是怎么回事？岐伯说：阴阳调和，血气滋润滑利，所以针一进入气就出来，迅速相逢。徐振公说：这是说阴阳和平之人，血气滋润滑利，所以气出得快而与针相逢。倪仲玉说：意思是阴阳之气都响应针的刺激。
黄帝说：针已拔出而气才独行，是什么气使然？岐伯说：这种人气多而阳少，阴气沉潜而阳气浮越。沉潜的在内脏，所以针拔出后，气才跟随其后，所以独行。
徐振公说：这是说多阴之人，针拔出后，阴气独行。气多而阳少的，阴气沉潜而阳气浮越，这是阴阳分离的状态。
所以针拔出后，微弱的阳气随针外泄，阴气独自在内运行，这是阴阳不和，不能互相守持，导致微弱阳气容易脱失。
黄帝说：多次针刺后才见效，是什么气使然？岐伯说：这种人阴多阳少，气机沉潜而气机往来困难，所以多次针刺后才见效。
徐振公说：这是说阴中有阳之人，多次针刺后才见效。阴中有阳的人，阴多阳少，气机沉潜而难以往来，所以多次针刺后才见效，这是阴阳相守于内的表现。这两节讲多阴少阳之人，有的阴阳分离，有的阴阳相守。阴阳离合的道理，行针者不可不知。仇汝霖说：阴多阳少，所以阴阳不合；阴中有阳，所以阴阳相和。大概阳生于阴。
黄帝说：针入后气机逆乱是怎么回事？岐伯说：气机逆乱，以及多次针刺后病情加重的，并不是阴阳之气浮沉的趋势所致。这都是粗工治疗失败、良医失误造成的，患者的形气并没有过错。
徐振公说：重阳之人，神气容易发动，气机容易运行，这是神气容易散失。多阴之人，气随针外出，微弱的阳气容易脱失。阴阳有离有合，气有浮有沉。粗工不知道浮沉离合的道理而失误，以致多次针刺后病情加重。五音之形，阴气多而阳气少；左右太少之形，阳气多而阴气少。所以善于用针的人，要调和阴阳，使形气没有过错。
仇汝霖说：神气是五脏的神气。重阳之人，如果使神气外弛，就会更加亡失阴气。多阴少阳之人，如果使阳气随针而出，就会更加亡失阳气。这都是粗工治疗失败、良医失误造成的。
Regarding the emotional states of the five Zang organs, accumulations (masses) in the upper, middle, and lower three regions are formed. Note: The text mentions that diseases of the five Zang organs are described as "illness" rather than "accumulation." This is because the accumulation in the five Zang organs lies in Qi (vital energy) rather than in有形 (tangible/physical form). As stated in *Nan Jing* (Classic of Difficult Issues), an accumulation in the Liver is called Fei Qi (Fatty Mass); in the Lung, Xi Ben (Panting Rush); in the Heart, Fu Liang (Hidden Beam); in the Spleen, Pi Qi (Stagnant Mass); and in the Kidney, Ben Tun (Rushing Pig). These are accumulations of formless Qi, not tangible blood stasis. Ni Zhongyu stated: Worry, thought, anger, and resentment injure Qi; therefore, the accumulation resides in the Qi aspect.
Huang Di said: Excellent. How should it be treated? Qi Bo replied: Observe the site of pain to know its corresponding internal condition. Based on excess or deficiency, apply tonification when appropriate and sedation when appropriate. Do not go against the timing of Heaven (seasonal patterns). This is called supreme treatment. Pain refers to the pain caused by accumulation within. By observing the pain and knowing its correspondence: if the accumulation adheres to the Sun Luo (branch collaterals), it externally corresponds to the Sun Luo of the arms; if it adheres to the Yangming meridian, it externally corresponds to Guang Ming (GB37); if it adheres to the Mu Yuan (marginal origin) of the intestines and stomach, it externally corresponds to the intersection of acupoints such as Zu San Li (ST36); if it adheres to the Fu Chong (hidden surge) vessel, it externally corresponds to Qi Chong (ST30) and Da He (KI12); if it adheres to the Lu Jin (back muscles/tendons), it corresponds to the tendons of Shaoyin and Taiyang of the legs; if it knots in the Huan Jin (relaxed tendons), it corresponds to the tendons of Taiyin and Yangming of the legs; if it forms at the Six Shu (transport) points, it externally corresponds to Nei Guan (PC6), Wai Guan (TE5), Tong Li (HT5), Lie Que (LU7), Zhi Zheng (SI7), and Pian Li (SI6); if it accumulates in the empty spaces of the torso, it externally corresponds to Wu Li (ST25) of the Yangming meridian and Chi Fu (skin of the wrist); if it accumulates in the five Zang organs, observe their left/right and up/down positions, which externally correspond to the Jing-Shu points of the five Zang meridians. Examine excess and deficiency; tonify when needed, sedate when needed. Follow the order of the four seasons, the location of Qi, the abode of disease, and the suitability of the Zang-Fu organs. Do not go against the timing of Heaven. This is called supreme treatment. Ni Zhongyu stated: Accumulations due to external causes manifest in the形体 (body/form); accumulations due to internal causes manifest in the pulse.
Huang Di asked Qi Bo: I have learned the Nine Needles from you and practiced them among the common people. The Qi and Blood of the common people vary in shape and form. Sometimes Shen (spirit/mind) moves and Qi travels before the needle; sometimes Qi meets the needle simultaneously; sometimes after the needle is withdrawn, Qi travels alone; sometimes it takes several punctures to perceive the effect; sometimes upon withdrawing the needle, Qi becomes rebellious; sometimes after several punctures, the disease worsens. All these six situations involve different reactions to needling. I wish to hear the principles behind them.
This continues the discussion from the previous chapter regarding the different needling reactions of Yin and Yang constitutions. People associated with the Five Tones are mostly Yin; those associated with Left/Right and Tai/Shao are mostly Yang. "Common people" refers to the general populace. Within the universe and the six directions, nothing exists outside the Five Phases, and humans correspond to this. The phrase "Qi and Blood of common people vary in shape" means that the Qi and Blood within the body have varying degrees of abundance and scarcity. The "six situations" refer to: people with Repeated Yang constitution, people with Yang containing Yin, people with balanced Yin and Yang, people with abundant Yin, people with Yin containing Yang, and those ruined by incompetent practitioners. Ni Zhongyu stated: This section discusses needling based on the body/form, hence mentioning the character "Xing" (form) twice, and concluding with one "Xing".
Qi Bo said: In people with a Repeated Yang constitution, their Shen is easily activated, and their Qi easily moves. Huang Di asked: What is meant by a person with a Repeated Yang constitution? Qi Bo replied: Such individuals appear aloof ("Gao Gao"), speak rapidly, and lift their feet high. This is because the Qi of the Heart and Lung organs is in excess; Yang Qi is smooth, vigorous, and soaring. Therefore, when Shen moves, Qi precedes it.
This explains why the Shen and Qi of Repeated Yang individuals move easily. The five Zang organs internally harmonize with the Five Phases and externally with the Five Tones, governed by the Three Yin. The Heart and Lung reside in the upper part as Yang; the Liver, Kidney, and Spleen reside in the lower part as Yin, representing Yang within Yin. A person with Repeated Yang constitution has excessive Qi in the Three Yang meridians (Taiyang, Shaoyang, Yangming) on the hands and feet, left and right, and excessive organ Qi in the Heart and Lung. "Gao Gao" refers to the Upper Jiao where Hand-Yang meridians reside; "speaking rapidly" refers to Yin containing Yang in the Middle Jiao; "lifting feet high" refers to the Lower Jiao where Foot-Yang meridians reside. The Heart stores Shen, and the Lung governs Qi. With excess Heart and Lung organ Qi, Yang Qi is smooth, vigorous, and soaring, so when Shen moves, Qi precedes it.
Huang Di asked: Why does Shen not precede in some Repeated Yang individuals? Qi Bo replied: This person possesses considerable Yin. Huang Di asked: How do you know they possess considerable Yin? Qi Bo replied: Those with much Yang tend toward joy; those with much Yin tend toward anger. Those who get angry frequently but resolve it quickly are said to possess considerable Yin. Because their separation and combination of Yin and Yang are difficult, their Shen cannot precede. The Heart is the Supreme Yang within Yang; the Liver is the Lesser Yang within Yin. The Heart governs joy; the Liver governs anger. The Heart stores Shen; the Liver stores Hun (Ethereal Soul). Hun accompanies Shen in its movements. When Shen moves and Qi precedes, it is because Shen and Hun are separated. In Repeated Yang with considerable Yin, Yin and Yang are combined. Because the separation and combination of Yin and Yang are difficult, Shen and Hun merge, thus Shen cannot precede. The earlier text mentioned Qi preceding; here it says Shen cannot precede. Generally, when Qi moves, Shen moves; when Shen moves, Qi moves; Shen and Qi follow each other. The key to needling lies in obtaining Shen and capturing Qi. However, Shen can be easily moved, and Qi can easily travel. Therefore, if multiple punctures cause the disease to worsen, it is because Shen and Qi are injured. Qiu Rulin stated: Joy is the emotion of the Heart; anger is the emotion of the Liver. Getting angry frequently but resolving it quickly indicates that the person is prone to anger and quick to calm down, characteristic of a Repeated Yang constitution with considerable Yin. Generally, those with much Yin are prone to anger; this is Yin within Yang, hence prone to anger and quick to resolve it.
Huang Di asked: What happens when Qi meets the needle simultaneously? Qi Bo replied: When Yin and Yang are harmonized, and Blood and Qi are moist, lubricated, and smooth, Qi emerges rapidly upon needle insertion and meets the needle. Xu Zhengong stated: This describes people with balanced Yin and Yang, whose Blood and Qi are moist and smooth, so Qi emerges quickly to meet the needle. Ni Zhongyu stated: It means the Qi of Yin and Yang both respond to the needle.
Huang Di asked: What makes Qi travel alone after the needle is withdrawn? Qi Bo replied: In this case, Yin Qi is abundant and Yang Qi is scarce. Yin Qi is sinking, while Yang Qi is floating. The sinking nature resides in the interior organs. Therefore, after the needle is withdrawn, Qi follows behind, traveling alone.
Xu Zhengong stated: This describes people with abundant Yin, where Yin Qi travels alone after needle withdrawal. Abundant Yin and scarce Yang mean Yin sinks and Yang floats, representing the separation of Yin and Yang.
Thus, after needle withdrawal, slight Yang Qi escapes outward with the needle, while Yin Qi travels alone internally. This indicates Yin and Yang are not harmonized and cannot guard each other, leading to the easy loss of slight Yang Qi.
Huang Di asked: What causes the effect to be perceived only after several punctures? Qi Bo replied: This person has abundant Yin and scarce Yang. Their Qi is deep/sinking, making the movement of Qi difficult. Therefore, it takes several punctures to perceive the effect.
Xu Zhengong stated: This describes people with Yin containing Yang, who perceive effects only after several punctures. Those with Yin containing Yang have abundant Yin and scarce Yang; their Qi is deep and difficult to move back and forth, so effects are perceived only after several punctures. This represents Yin and Yang guarding each other internally. These two sections discuss people with abundant Yin and scarce Yang: some have separated Yin and Yang, others have guarded Yin and Yang. The principle of Yin-Yang separation and combination must be known by needlers. Qiu Rulin stated: Abundant Yin and scarce Yang lead to non-harmony of Yin and Yang; Yin containing Yang leads to harmony of Yin and Yang. Generally, Yang is born from Yin.
Huang Di asked: What causes Qi to become rebellious upon needle insertion? Qi Bo replied: Rebellious Qi, and the worsening of disease after several punctures, are not caused by the floating or sinking trends of Yin and Yang Qi. These are failures of incompetent practitioners and errors of skilled physicians; the patient's Form and Qi are not at fault.
Xu Zhengong stated: In Repeated Yang individuals, Shen moves easily and Qi travels easily, meaning Shen and Qi are prone to dispersion. In abundant Yin individuals, Qi exits with the needle, and slight Yang Qi is prone to loss. Yin and Yang have separation and combination; Qi has floating and sinking. Incompetent practitioners fail to understand the principles of floating, sinking, separation, and combination, causing errors, leading to worsening disease after several punctures. Individuals of the Five Tones have abundant Yin and scarce Yang; individuals of Left/Right and Tai/Shao have abundant Yang and scarce Yin. Therefore, skilled needlers harmonize Yin and Yang to ensure no error in Form and Qi.
Qiu Rulin stated: Shen and Qi are the Shen and Qi of the five Zang organs. For Repeated Yang individuals, allowing Shen and Qi to relax outward will further deplete Yin. For individuals with abundant Yin and scarce Yang, allowing Yang Qi to exit with the needle will further deplete Yang. These are all failures of incompetent practitioners and errors of skilled physicians.