气从下而上也。此节先言膺俞。而末言其病在骨。谓数之成于五而归于一。复从上而下也。
补须一方实。深取之。稀按其 。以极出其邪气。一方虚。浅刺之。以养其脉。疾按其 。无
使邪气得入。邪气来也紧而疾。谷气来也徐而和。脉实者深刺之。以泄其气。脉虚者浅刺之。使精
气得出。以养其脉。独出其邪气。刺诸痛者。其脉皆实。
此论身形之应四方也。一方实深取之。一方虚浅刺之。脉实者深刺之。脉虚者浅刺之。此论四方
之虚实也。经云气伤痛。诸痛者。其脉皆实。言四方之气归于中央而为实也。
故曰从腰以上者。手太阴阳明皆主之。从腰以下者。足太阴阳明皆主之。
手太阴阳明主天。足太阴阳明主地。身半以上为天。身半以下为地。故曰。承上文而言。言人
之形气。生于六合之内。应天地之上下四旁。故曰天地为生化之宇。
病在上者下取之。病在下者高取之。病在头者取之足。病在腰者取之 。
此言形身之上下。应天地之气交。六微旨论曰。天气下降。气流于地。地气上升。气腾于天。
上下相召。升降相因。是以病在上者下取之。病在下者高取之。因气之上下升降也。邪客篇曰。天
圆地方。人头圆足方以应之。病在头者取之足。以头足之应天地也。病在腰者取之 。以肾脏膀
胱之水气。应天泉之上下也。夫谨奉天道。请言终始。知血气之生始出入。应天地之五运六气。上
下四旁。天道毕矣。
病生于头者头重。生于手者臂重。生于足者足重。治病者先刺其病所从生者也。
上节论上下之气交。此论天地之定位。头以应天。足以应地。手足应四旁。盖天地四方之气。
各有所生之本位。故生于头者头重。生于足者足重。随其所生而取之。重者。守而不动也。开之
曰。前节论四方之气流行。故有一方实。一方虚。如金行乘木。则东方实而西方虚矣。此论上下
四方之定位。故生于手者臂重。生于足者足重。
春气在毛。夏气在皮肤。秋气在分肉。冬气在筋骨。刺此病者。各以其时为齐。故刺肥人者。
以秋冬之齐。刺瘦人者。以春夏之齐。
此言三阴三阳之气。应天地之四时。皮肉筋骨。脉外之气分也。阴阳之气。始于肤表。从外
而内。与经脉之出入不同。故春气在毛。夏气在皮肤。秋气在分肉。冬气就筋骨。盖始于皮毛而
入于筋骨。自外而内也。肥人之皮肤涩。分肉不解。气留于阴久。故刺肥人者。以秋冬之齐。深
取之也。瘦人之皮肤滑。分肉解。气留于阳久。故刺瘦人者。以春夏之齐。浅取之也。齐者。与时
一之也。开之曰。首六句论四时。谓气之从外而入。后四句论肥
瘦。谓气之从内而出。盖六气虽营运于肤表。然本于内之所生。张应略曰。从外而内。天之气也。
从内而生。人之气也。人与天地相合。故或从外。或从内。外内出入者也。
病痛者阴也。痛而以手按之不得者。阴也。深刺之。病在上者。阳也。病在下者。阴也。痒
者阳也。浅刺之。
此论表里上下之阴阳。夫表为阳。里为阴。身半以上为阳。身半以下为阴。病在阳者名曰风。
故痒者阳也。病在皮肤之表阳也。病在阴者名曰痹。痹者痛也。故病痛者阴也。以手按之不得者。
留痹之在内也。此言表里之为阴阳也。病在上者为阳。病在下者为阴。以形身之上下分阴阳也。
病先起阴者。先治其阴。而后治其阳。病先起阳者。先治其阳。而后治其阴。
此承上文而言表里。上下阴阳之气。交相贯通。故有先后之分焉。内经云。阳病者上行极而
下。阴病者下行极而上。从内之外者。先调其内。从外之内者。先治其外。
刺热厥者。留针反为寒。刺寒厥者。留针反为热。刺热厥者。二阴一阳。刺寒厥者。二阳一
阴。所谓二阴者。二刺阴也。一阳者。一刺阳也。
此论寒热之阴阳厥热也。刺热厥者留针。俟针下寒。乃去针也。刺寒厥者留针。俟针下热。乃
去针也。二阴一阳。二阳一阴者。谓寒热阴阳之气。互相交通。故不独取阳而独取阴也。开之曰。
一二者。阴阳水火之生数。
久病者。邪气入深。刺此病者。深纳而久留之。间日而复刺之。必先调其左右。去其血脉。
刺道毕矣。（纳讷同间去声）
人之卫气昼行于阳。夜行于阴。应天道之绕地一周。昼明夜晦。病久者邪气入深。邪与正争。
则气留于阴。间日而后出于阳。是以间日复刺之者。俟气至而取之也。左右者。阴阳之道路也。经脉者。
所以行
气血而荣阴阳也。此篇论终始之道。本于五行六气。五行应神机之出入。六气应天道之右旋。行针
之士。能顺上下之营运。并左右之间气。去血脉之宛陈。刺道毕矣。
凡刺之法。必察其形气。形肉未脱。少气而脉又躁。躁厥者。必为缪刺之。散气可收。聚气可
布。深居静处。占神往来。闭户塞牖。魂魄不散。
此言针刺之法。必察其病者之形气。占其精神。而后乃行针也。形肉未脱。形气相得也。夫气
生于下。脉从足而手。少气者。气聚于下也。躁者。阴之动象。厥逆也。脉又躁厥者。血气不调和。
而反躁逆于上也。缪刺者。左刺右。右刺左。阳取阴。阴取阳。和其血气。调其阴阳。使经脉之散
气可收。在下之聚气可布。深居静处。养其气也。闭户塞牖。无外其志也。魂魄不散。精神内守也。
此言治病者。必使病患之血气调和。精神内守。而后可以行针。
专意一神。精气之分。毋闻人声。以守其精。必一其神。令志在针。浅而留之。微而浮之。以
移其神。气至乃休。男内女外。坚拒勿出。谨守勿纳。是谓得气。
此言医者当自守其神。令志在针也。夫肾主藏精。开窍于耳。精气之分。惑于听闻。是以毋闻
人声。以收其精。必一其神。令志在针。神志之专一也。浅而留之。微而浮之。以移其病者之神。
候针下之气至而休。盖以己之精神。合病者之神气也。男为阳。女为阴。阳在外。故使之内。阴
在内。故引之外。谓和调外内阴阳之气也。坚拒
其正气。而勿使之出。谨守其邪气。而勿使之入。是谓得气。
凡刺之禁。新内勿刺。已刺勿内。已醉勿刺。已刺勿醉。新怒勿刺。已刺勿怒。新劳勿刺。
已刺勿劳。已饱勿刺。已刺勿饱。已饥勿刺。已刺勿饥。已渴勿刺。已刺勿渴。大惊大恐。必定其
气乃刺之。乘车来者。卧而休之。如食顷。乃刺之。出行来者。坐而休之。如行十里顷。乃刺之。凡
此十二禁者。其脉乱气散。逆其荣卫。经气不次。因而刺之。则阳病入于阴。阴病出于阳。则邪气
复生。粗工勿察。是谓伐身。形体淫 。乃消脑髓。津液不化。脱其五味。是谓失气也。
此论刺有十二禁也。内者。入房也。新内则失其精矣。酒者。热谷之液。其气 悍。已醉则
气乱矣。肝主藏血。怒则气上。新怒则气上逆。而血妄行矣。烦劳则神气外张。精气内绝矣。脉要
精微论曰。饮食未进。经脉未盛。络脉调匀。血气未乱。故乃可诊有过之脉。是以已饱勿刺。平脉
篇曰。谷入于胃。脉道乃行。水入于经。其血乃成。是又已饥勿刺。已渴勿刺也。惊伤神。恐伤精。
故必定其气乃刺之。则存养其精气神矣。久坐伤肉。故乘车来者卧而休之。久行伤筋。故出行来
者坐而休之。凡此十二禁者。其脉乱气散。荣卫逆行。经气不次。因而刺之。则阳病入于阴。阴病
出于阳。邪气复生。是谓戕伐其身。而形体淫 矣。脑为精髓之海。津液者。补益脑髓。润泽皮肤。
濡养筋骨。犯此禁者。则津液不化。而脑髓消铄矣。五味入口。藏于肠胃。味有所藏。以养五气。
气和而生。津液相成。神乃自生。针刺之道。贵在得神致气。犯此禁者。则脱其五味所生之神气。
是谓失气也。
太阳之脉。其终也。戴眼反折。 。其色白绝皮。乃绝汗。绝汗则终矣。少阳终者耳聋。
百节尽纵。目系绝。目系绝。
一日半则死矣。其死也。色青白乃死。阳明终者。口目动作。喜惊妄言。色黄。其上下之经。盛
而不行。则终矣。少阴终者。面黑。齿长而垢。腹胀闭塞。上下不通而终矣。厥阴终者。中热嗌干。
喜溺。心烦。甚则舌卷。卵上缩而终矣。太阴终者。腹胀HT 。不得息。气噫善呕。呕则逆。逆则
面赤。不逆则上下不通。上下不通。则面黑皮毛焦而终矣。（HT 闭同）
此归结终始之道。始于五行。而终于六气也。太阳之脉。起目内 。上额交巅。从巅入络脑。
还出别下项。挟脊抵腰中。太阳乃津液之府。而为诸阳主气。血气绝而不能荣养筋脉。则筋脉急
而戴眼反折也。精明五色者。气之华也。太阳之气主皮毛。气绝于皮。则色白而绝汗出也。少阳
之脉。起目锐 。入耳中。耳聋者。少阳之脉绝也。少阳主骨。百节尽纵。少阳之气绝也。少阳
属肾。肾藏志。目系绝者志先死。志先死则一日半死矣。阳明之脉。起于鼻。交 中。入齿中。
还出挟口环唇。下交承浆。口目动作者。阳明之经气欲绝也。喜惊妄言色黄。阳明之神气外出也。
上下经者。谓手足阳明之经。盛者盛于外而绝于内也。夫阳明太阴之言上下者。谓从腰以上。手
太阴阳明皆主之。从腰以下。足太阴阳明皆主之。上下之经盛而不通则终者。天地阴阳之气。不交
而绝也。少阴之脉。属肾络膀胱。上贯肝膈。入肺中。从肺出络心。腹胀闭塞者。少阴之脉绝不
通也。面黑者。气色外脱也。齿长者。骨气不藏也。上下不通者。水火不交也。夫少阴之言上下者。
少阴之上。君火主之。谓水火阴阳之气绝也。厥阴之脉。循阴股。入毛中。通阴器。循喉咙。入
颃颡。舌卷卵缩。厥阴之脉绝也。厥阴从中见少阳之火化。中热嗌干心烦者。化气上出也。肝主
疏泄。喜溺者。肝气下泄也。太阴之脉。上阴股。入腹上膈。挟咽连舌本。散舌下。复从胃注心中。
太阴之脉绝不通。是以腹胀不得息。太阴之气上走心为噫。气噫善呕。呕则
逆。逆则面赤者。从胃而心。心而外脱也。夫上逆于心。则见此证。如不逆。则手足二经皆绝。
而上下不通矣。上下不通。则土败而水气乘之。而色黑矣。手太阴之气绝。而皮毛夭焦矣。此六气
终而经脉绝也。盖气终则脉终。脉绝则气绝。譬如人之兄弟。生则俱生。急则俱死矣。夫经脉本
于脏腑五行之所生。而外合阴阳之六气。故首言终始之道。五脏为纪。末结六经之终。谓生于五行
而终于六气也。张开之曰。神在天为风。风生木。木生肝。是天之六气。化生地之五行。五行生
五脏。五脏生六经。六经合六气。盖原本于天之六气所生。故终于六经。而复归于天也。
气从下向上运行。这一节先论述胸部的腧穴，最后说明病在骨骼。意思是数的生成始于五而回归于一，又从上向下运行。
补法必须根据一方的虚实情况：若一方实证，应深刺，少按压针孔，以彻底排出邪气；若一方虚证，应浅刺，以养护经脉，快速按压针孔，防止邪气侵入。邪气来时感觉紧促而急疾，谷气（正气）来时感觉徐缓而调和。脉象实证的，深刺以泄其气；脉象虚证的，浅刺使精气外达，以养护经脉，单独排出邪气。针刺各种痛症，其脉象皆属实。
这里论述身体形态对应四方。一方实则深刺，一方虚则浅刺。脉实则深刺，脉虚则浅刺。这是论述四方的虚实。经文说“气导致疼痛”，各种痛症，其脉象皆属实。是说四方的气归于中央而成为实证。
所以说，腰部以上，手太阴肺经和手阳明大肠经主治；腰部以下，足太阴脾经和足阳明胃经主治。
手太阴、手阳明经主天，足太阴、足阳明经主地。身体上半部分为天，下半部分为地。所以这样说。承接上文而言，人的形体和气，生于六合之内，对应天地的上下四方。所以说天地是化生万物的宇宙。
病在上部者，取下部穴位治疗；病在下部者，取上部穴位治疗。病在头部者，取足部穴位；病在腰部者，取骶骨部位（尻部）穴位。
这是说形身的上下，对应天地之气的交合。《六微旨大论》说：“天气下降，气流于地；地气上升，气腾于天。”上下相互感召，升降互为因果。因此病在上部者取之下部，病在下部者取之上部。这是顺应气的上下升降规律。《邪客篇》说：“天圆地方，人头圆足方以应之。”病在头部取足部穴位，是以头足对应天地。病在腰部取骶骨部位穴位，是以肾脏膀胱的水气，对应天泉的上下。恭敬地奉行天道，请允许我讲述终始之道。知晓血气的生起、起始、出入，对应天地的五运六气，涵盖上下四方，天道便完备了。
病生于头部者，头部沉重；病生于手部者，手臂沉重；病生于足部者，足部沉重。治病者，先针刺病邪产生的部位。
上一节论述上下之气的交合，这一节论述天地的定位。头对应天，足对应地，手足对应四方。大概天地四方之气，各有其生成的本位。所以病生于头者头重，病生于足者足重。随其所生的部位而取穴。“重”的意思是守持不动。张开之说：前一节论述四方之气的流行，所以有一方实、一方虚，如金行乘木，则东方实而西方虚。这一节论述上下四方的定位，所以病生于手者臂重，病生于足者足重。
春气在毫毛，夏气在皮肤，秋气在分肉，冬气在筋骨。针刺这些病症，要根据季节作为深浅的标准。所以针刺肥胖的人，用秋冬的标准（深刺）；针刺瘦弱的人，用春夏的标准（浅刺）。
这是说三阴三阳之气，对应天地的四季。皮、肉、筋、骨，是脉外的气分。阴阳之气，始于肤表，由外向内，与经脉的出入不同。所以春气在毫毛，夏气在皮肤，秋气在分肉，冬气在筋骨。大概是从皮毛开始进入筋骨，由外向内。肥胖人的皮肤涩滞，分肉不解，气留于阴分日久，所以针刺肥胖人，用秋冬的标准，深刺。瘦弱人的皮肤滑利，分肉疏松，气留于阳分日久，所以针刺瘦弱人，用春夏的标准，浅刺。“齐”就是与时令一致的意思。张开之说：前六句论述四季，谓气由外而入；后四句论述肥瘦，谓气由内而出。大概六气虽然营运于肤表，但根本在于体内所生。张应略说：由外而入，是天之气；由内而生，是人之气。人与天地相合，所以或从外，或从内，是外内出入的关系。
病痛属于阴。疼痛且用手按压找不到固定部位的，属于阴，需深刺。病在上部的，属于阳；病在下部的，属于阴。发痒属于阳，需浅刺。
这是论述表里上下的阴阳。体表为阳，体内为阴；身体半部以上为阳，半部以下为阴。病在阳分的名为风，所以发痒属于阳，因为病在皮肤的表层阳分。病在阴分的名为痹，痹就是痛。所以病痛属于阴。用手按压找不到固定部位的，是留痹在内。这是说表里即为阴阳。病在上者为阳，病在下者为阴，是以形身的上下来分阴阳。
病先从阴分起者，先治其阴，而后治其阳；病先从阳分起者，先治其阳，而后治其阴。
这是承接上文论述表里。上下阴阳之气，交相贯通，所以有先后之分。《内经》说：“阳病者上行极而下，阴病者下行极而上。”病从内到外的，先调理内部；病从外到内的，先治疗外部。
针刺热厥，留针直到针下感觉寒冷，然后去针；针刺寒厥，留针直到针下感觉发热，然后去针。针刺热厥，取二阴一阳；针刺寒厥，取二阳一阴。所谓二阴，是刺两次阴经；一阳，是刺一次阳经。
这是论述寒热的阴阳厥热。针刺热厥留针，等待针下产生寒感，才去针。针刺寒厥留针，等待针下产生热感，才去针。二阴一阳、二阳一阴，是说寒热阴阳之气互相交通，所以不独取阳也不独取阴。张开之说：一二，是阴阳水火的生数。
久病者，邪气深入。针刺这类病，要深纳针并久留针，隔日再刺。必须先调理左右气血，去除血脉中的瘀滞，针刺的道理就完备了。（“纳”同“讷”，“间”读去声）
人的卫气白天行于阳分，夜晚行于阴分，对应天道绕地一周，昼明夜暗。病久者邪气入深，邪气与正气相争，则气留于阴分，隔日后才出于阳分。所以隔日复刺，是等待气至而取之。左右，是阴阳的道路。经脉，是用来运行气血而营养阴阳的。本篇论述终始之道，本于五行六气。五行对应神机的出入，六气对应天道的右旋。行针的人，能顺应上下营运，兼及左右间气，去除血脉中的瘀陈，针刺的道理就完备了。
凡是针刺的方法，必须观察病人的形气。如果形体肌肉未脱失，但气少而脉象躁动，出现躁厥症状的，必须用缪刺法。这样可以收敛散乱之气，布聚聚集之气。医生应深居静处，观察神气的往来，关好门户窗户，使魂魄不散。
这是说针刺之法，必须观察病人的形气，占测其精神，然后才行针。形体肌肉未脱失，说明形气相得。气生于下部，脉从足到手。气少，说明气聚于下部。躁，是阴的动象，即厥逆。脉又躁厥，说明血气不调和，反而躁逆于上。缪刺，是左病刺右，右病刺左，阳取阴，阴取阳，调和血气，调匀阴阳，使经脉中散乱之气可收，在下部聚集之气可布。深居静处，是为了养气。关闭门户窗户，是为了不让志意外驰。魂魄不散，是为了精神内守。
这是说治病者，必须使病患的血气调和，精神内守，然后才可以行针。
专心一意，守住精气，不要听到人声，以守护其精。必须使精神专一，令意志集中在针上。浅刺而留针，轻微提插浮取，以转移病人的神气，待气至后再休息。男子宜固摄精气勿出，女子宜引导精气勿入，谨慎坚守勿使漏泄，这叫做得气。
这是说医者应当自我保守精神，令意志集中在针上。肾主藏精，开窍于耳。精气分散，容易被听闻所惑，所以要不听人声，以收敛其精。必须使精神专一，令意志集中在针上，这是神志的专一。浅刺而留针，轻微提插浮取，以转移病人的神气，等候针下气至再休息。大概是用自己的精神，合于病人的神气。男属阳，女属阴。阳在外，所以使其内守；阴在内，所以使其外引，这是调和内外阴阳之气。坚固拒绝正气外出，谨慎守护邪气不入，这叫做得气。
凡是针刺的禁忌：新近房事者勿刺，已刺者勿行房事；已醉者勿刺，已刺者勿饮酒；新近发怒者勿刺，已刺者勿发怒；新近劳累者勿刺，已刺者勿劳累；已饱食者勿刺，已刺者勿饱食；已饥饿者勿刺，已刺者勿饥饿；已口渴者勿刺，已刺者勿口渴。大惊大恐者，必须安定其气后再刺。乘车来者，让其躺下休息，约一顿饭的时间，再刺。步行来者，让其坐下休息，约行走十里路所需的时间，再刺。凡此十二种禁忌，若违反则脉乱气散，逆乱营卫，经气无序。因而刺之，则阳病入于阴，阴病出于阳，邪气复生。粗疏的医生不加考察，这叫伐伤身体。形体淫乱耗损，以致脑髓消减，津液不化，脱失五味所生之神气，这叫失气。
这是论述针刺有十二禁。内，指房事。新近房事则失精。酒是热谷之液，其气悍烈。已醉则气乱。肝主藏血，怒则气上。新近发怒则气上逆，血妄行。烦劳则神气外张，精气内绝。《脉要精微论》说：“饮食未进，经脉未盛，络脉调匀，血气未乱，故乃可诊有过之脉。”所以已饱勿刺。《平人气象论》说：“谷入于胃，脉道乃行；水入于经，其血乃成。”所以已饥勿刺，已渴勿刺。惊伤神，恐伤精，所以必须安定其气再刺，以存养精气神。久坐伤肉，所以乘车来者让其躺下休息。久行伤筋，所以步行来者让其坐下休息。凡此十二禁，若违反则脉乱气散，营卫逆行，经气无序。因而刺之，则阳病入于阴，阴病出于阳，邪气复生，这叫戕伐其身，导致形体淫乱。脑是精髓之海。津液，补益脑髓，润泽皮肤，濡养筋骨。犯此禁忌，则津液不化，脑髓消铄。五味入口，藏于肠胃，味有所藏，以养五气，气和而生，津液相成，神乃自生。针刺之道，贵在得神致气。犯此禁忌，则脱失五味所生之神气，这叫失气。
太阳经的脉气终结时，表现为两眼上视，角弓反张，拘挛。其面色苍白，皮肤干枯，出现绝汗。绝汗出现则死亡。少阳经终结时，耳聋，全身关节松弛纵缓，目系断绝。目系断绝，一日半后死亡。其死时，面色青白而死。阳明经终结时，口眼抽动，易受惊吓，胡言乱语，面色黄。手足阳明经气盛而不行，则终结。少阴经终结时，面色黑，牙齿显得长且垢秽，腹胀闭塞，上下不通而死。厥阴经终结时，心中热，咽喉干燥，喜小便，心烦，严重时舌卷缩，睾丸上缩而死。太阴经终结时，腹胀满，呼吸困难，嗳气，容易呕吐，呕吐则气逆，气逆则面赤，若不逆则上下不通，上下不通则面色黑，皮毛焦枯而死。（“HT”同“闭”）
这是归结终始之道，始于五行，终于六气。太阳之脉，起于目内眦，上额交巅，从巅入络脑，还出别下项，挟脊抵腰中。太阳是津液之府，为诸阳主气。血气绝而不能荣养筋脉，则筋脉急而戴眼反折。精明五色，是气的荣华。太阳之气主皮毛，气绝于皮，则色白而绝汗出。少阳之脉，起于目锐眦，入耳中。耳聋，是少阳之脉绝。少阳主骨，百节尽纵，是少阳之气绝。少阳属肾，肾藏志。目系绝，是志先死。志先死则一日半死。阳明之脉，起于鼻，交頞中，入齿中，还出挟口环唇，下交承浆。口目动作者，是阳明经气欲绝。喜惊妄言色黄，是阳明之神气外出。上下经，指手足阳明之经。盛者盛于外而绝于内。夫阳明太阴之言上下者，谓从腰以上，手太阴阳明皆主之；从腰以下，足太阴阳明皆主之。上下之经盛而不通则终，是天地阴阳之气不交而绝。少阴之脉，属肾络膀胱，上贯肝膈，入肺中，从肺出络心。腹胀闭塞，是少阴之脉绝不通。面黑，是气色外脱。齿长，是骨气不藏。上下不通，是水火不交。夫少阴之言上下者，少阴之上，君火主之，谓水火阴阳之气绝。厥阴之脉，循阴股，入毛中，通阴器，循喉咙，入颃颡。舌卷卵缩，是厥阴之脉绝。厥阴从中见少阳之火化，中热嗌干心烦，是化气上出。肝主疏泄，喜溺，是肝气下泄。太阴之脉，上阴股，入腹上膈，挟咽连舌本，散舌下，复从胃注心中。太阴之脉绝不通，是以腹胀不得息。太阴之气上走心为噫，气噫善呕，呕则逆，逆则面赤者，是从胃而心，心而外脱。夫上逆于心，则见此证。如不逆，则手足二经皆绝，而上下不通矣。上下不通，则土败而水气乘之，而色黑矣。手太阴之气绝，而皮毛夭焦矣。此六气终而经脉绝也。盖气终则脉终，脉绝则气绝。譬如人之兄弟，生则俱生，急则俱死矣。夫经脉本于脏腑五行之所生，而外合阴阳之六气。故首言终始之道，五脏为纪，末结六经之终，谓生于五行而终于六气也。张开之说：神在天为风，风生木，木生肝，是天之六气化生地之五行，五行生五脏，五脏生六经，六经合六气。盖原本于天之六气所生，故终于六经，而复归于天也。
The Qi moves from below upwards. This section first discusses the acupoints of the chest (Ying Shu), and finally states that the disease is in the bones. It means that numbers originate from five and return to one, and then move from above downwards.
For tonification, one must assess the excess or deficiency of a specific area: If an area is in an Excess state, puncture deeply, press the needle hole sparingly, to thoroughly expel the pathogenic Qi. If an area is in a Deficiency state, puncture superficially to nourish the meridians, and press the needle hole quickly to prevent pathogenic Qi from entering. When pathogenic Qi arrives, it feels tight and rapid; when Grain Qi (Healthy Qi) arrives, it feels slow and harmonious. For Excess pulse conditions, puncture deeply to drain the Qi; for Deficient pulse conditions, puncture superficially to allow Essence Qi to emerge, thereby nourishing the meridians and exclusively expelling pathogenic Qi. When puncturing various pain syndromes, the pulses are all Excess.
This discusses how the body's form corresponds to the four directions. If one direction is Excess, puncture deeply; if Deficient, puncture superficially. For Excess pulses, puncture deeply; for Deficient pulses, puncture superficially. This discusses the Excess and Deficiency of the four directions. The Classic states, "Qi causes pain." In cases of pain, the pulses are all Excess. This indicates that the Qi of the four directions converges at the center, resulting in an Excess condition.
Therefore, it is said that for the upper half of the body, the Hand Taiyin Lung Meridian and Hand Yangming Large Intestine Meridian govern. For the lower half of the body, the Foot Taiyin Spleen Meridian and Foot Yangming Stomach Meridian govern.
The Hand Taiyin and Hand Yangming meridians correspond to Heaven; the Foot Taiyin and Foot Yangming meridians correspond to Earth. The upper half of the body is Heaven; the lower half is Earth. Thus it is said. Continuing from the previous text, it states that human form and Qi are born within the Six Directions (Heaven, Earth, and the Four Quarters), corresponding to the Heaven-Earth vertical and horizontal axes. Thus, Heaven and Earth are the universe of generation and transformation.
For diseases located in the upper part, treat by selecting points in the lower part. For diseases located in the lower part, treat by selecting points in the upper part. For diseases in the head, select points on the feet. For diseases in the waist, select points on the sacrum (Kao).
This explains that the upper and lower parts of the body correspond to the intersection of Heaven and Earth Qi. The *Suwen: Treatise on the Six Micro Principles* states: "Heavenly Qi descends and flows into the Earth; Earthly Qi ascends and rises to Heaven." Upper and lower mutually attract, and ascent and descent are interdependent. Therefore, for diseases in the upper part, treat the lower part; for diseases in the lower part, treat the upper part. This follows the ascending and descending movement of Qi. The *Xieke Chapter* states: "Heaven is round, Earth is square; the human head is round and feet are square to correspond." Selecting foot points for head diseases corresponds to the Head-Feet relationship with Heaven and Earth. Selecting sacral points for waist diseases corresponds to the Water Qi of the Kidney and Bladder with the Heaven Spring above and below. Reverently following the Way of Heaven, I will speak of the Beginning and End. Knowing the origin, start, entry, and exit of Blood and Qi, which correspond to the Five Movements and Six Qi of Heaven and Earth, covering the upper, lower, and four sides, the Way of Heaven is complete.
Diseases originating in the head cause heaviness in the head; those originating in the hands cause heaviness in the arms; those originating in the feet cause heaviness in the feet. To treat diseases, first puncture the site where the disease originated.
The previous section discussed the intersection of upper and lower Qi; this section discusses the fixed positions of Heaven and Earth. The head corresponds to Heaven, the feet to Earth, and the hands and feet to the four quarters. The Qi of Heaven, Earth, and the four quarters each has its own root position of origin. Thus, diseases originating in the head cause head heaviness, and those in the feet cause foot heaviness. Select points according to their place of origin. "Heavy" here means stable and unmoving. Zhang Kaizhi says: The previous section discussed the circulation of Qi in the four directions, hence there is Excess in one direction and Deficiency in another, e.g., Metal overcoming Wood leads to Excess in the East and Deficiency in the West. This section discusses the fixed positions of upper/lower and four directions, hence diseases in the hands cause arm heaviness, and in the feet cause foot heaviness.
Spring Qi resides in the hair follicles; Summer Qi in the skin; Autumn Qi in the muscle intervals; Winter Qi in the sinews and bones. When puncturing these diseases, use the seasonal depth as the standard. Therefore, for obese persons, use the Autumn/Winter standard (deep puncture); for emaciated persons, use the Spring/Summer standard (superficial puncture).
This explains how the Three Yin and Three Yang Qi correspond to the four seasons. Skin, flesh, sinews, and bones represent the Qi outside the meridians. Yin and Yang Qi begin at the surface, moving from outside to inside, differing from the entry and exit of the meridians. Thus, Spring Qi is in the hair, Summer in the skin, Autumn in the muscles, and Winter in the sinews and bones. Generally, it enters from the skin/hair into the sinews/bones, from outside to inside. Obese persons have tight skin and bound muscles, causing Qi to remain in the Yin aspect for a long time; thus, puncture them deeply using the Autumn/Winter standard. Emaciated persons have smooth skin and loose muscles, causing Qi to remain in the Yang aspect for a long time; thus, puncture them superficially using the Spring/Summer standard. "Qi" (standard/measurement) means aligning with the season. Zhang Kaizhi says: The first six sentences discuss the four seasons, describing Qi entering from outside; the last four discuss obesity/emaciation, describing Qi emerging from inside. Although the Six Qi circulate on the surface, they originate from within. Zhang Yinglue says: Entering from outside is Heaven's Qi; generating from inside is Human Qi. Humans harmonize with Heaven and Earth, so Qi may enter from outside or emerge from inside; it is a matter of internal-external exchange.
Pain belongs to Yin. Pain without a fixed point upon palpation belongs to Yin and requires deep puncture. Diseases in the upper part belong to Yang; diseases in the lower part belong to Yin. Itching belongs to Yang and requires superficial puncture.
This discusses the Yin-Yang of exterior-interior and upper-lower. The exterior is Yang, the interior is Yin; the upper half of the body is Yang, the lower half is Yin. Diseases in the Yang aspect are named Wind; thus, itching is Yang because the disease is in the superficial Yang of the skin. Diseases in the Yin aspect are named Bi (Obstruction); Bi means pain. Thus, pain is Yin. Pain without a fixed point upon palpation indicates Bi obstruction retained internally. This explains that exterior-interior constitutes Yin-Yang. Disease in the upper is Yang, in the lower is Yin, dividing Yin-Yang by the upper and lower body forms.
If a disease originates in the Yin aspect first, treat the Yin first, then the Yang. If it originates in the Yang aspect first, treat the Yang first, then the Yin.
This continues the discussion on exterior-interior. The Qi of upper-lower and Yin-Yang intersects and connects, hence there is a sequence of treatment. The *Neijing* states: "Yang diseases ascend to the extreme and then descend; Yin diseases descend to the extreme and then ascend." For diseases moving from inside to outside, regulate the inside first. For diseases moving from outside to inside, treat the outside first.
When puncturing Heat Jue (Cold Extremities due to Heat), retain the needle until a cold sensation is felt, then remove it. When puncturing Cold Jue, retain the needle until a warm sensation is felt, then remove it. For Heat Jue, puncture two Yin meridians and one Yang meridian. For Cold Jue, puncture two Yang meridians and one Yin meridian. "Two Yin" means puncturing Yin twice; "One Yang" means puncturing Yang once.
This discusses the Yin-Yang of Cold-Heat and Jue-Reversal. Retaining the needle for Heat Jue until cold is felt, then removing it, addresses the heat. Retaining for Cold Jue until warmth is felt, then removing it, addresses the cold. Two Yin/One Yang and Two Yang/One Yin indicate that Cold-Heat and Yin-Yang Qi interact; thus, one does not puncture only Yang or only Yin. Zhang Kaizhi says: One and Two are the generative numbers of Yin-Yang and Water-Fire.
In chronic diseases, pathogenic Qi has penetrated deeply. Puncture these diseases by inserting the needle deeply and retaining it for a long time, repeating puncture every other day. First, regulate the Left and Right Qi, and remove blood stasis. The principles of puncture are now complete. ("Na" is synonymous with "Ne"; "Jian" is pronounced with the departing tone.)
The Body's Wei Qi circulates in the Yang aspect during the day and the Yin aspect at night, corresponding to the Heavenly Dao circling the Earth, with day bright and night dark. In chronic disease, pathogenic Qi penetrates deeply. When pathogen and Healthy Qi contend, Qi remains in the Yin aspect and emerges to the Yang aspect after a day. Hence, puncturing every other day waits for the Qi to arrive. Left and Right are the pathways of Yin and Yang. The meridians transport Blood and Qi to nourish Yin and Yang. This chapter discusses the Way of Beginning and End, based on the Five Elements and Six Qi. The Five Elements correspond to the entry and exit of Shen Ji (Spirit Mechanism); the Six Qi correspond to the rightward rotation of the Heavenly Dao. The practitioner who can follow the upward-downward circulation, incorporate the intervening Qi of the left-right, and remove blood stasis, has mastered the art of puncture.
In all puncture methods, one must observe the patient's Form and Qi. If the flesh has not wasted away, but Qi is deficient and the pulse is restless, indicating Restless Jue, Miao Puncture (Cross Puncture) must be used. This can gather scattered Qi and distribute aggregated Qi. The physician should dwell in quiet places, observe the coming and going of Spirit, close doors and windows, and keep Hun and Po from scattering.
This states that puncture method requires observing the patient's Form and Qi, assessing their Spirit, before applying the needle. Flesh not wasted indicates Form and Qi are compatible. Qi generates from below; pulses travel from foot to hand. Deficient Qi indicates Qi aggregates below. Restlessness is the dynamic image of Yin, i.e., Jue Ni (Reversal). A restless and Jue pulse indicates Blood and Qi are unharmonious and rebelliously rising. Miao Puncture involves puncturing the left side for right-sided disease and vice versa, taking Yang from Yin and Yin from Yang, to harmonize Blood and Qi and balance Yin-Yang, allowing scattered meridian Qi to gather and aggregated lower Qi to distribute. Dwelling quietly nourishes Qi. Closing doors/windows prevents mental distraction. Keeping Hun and Po intact ensures Spirit remains inward.
This states that treating diseases requires harmonizing the patient's Blood and Qi and keeping Spirit inward before puncturing.
Focus your mind and spirit, divide your Essence and Qi, do not listen to human voices to guard your Jing. Unify your Spirit, let your intention focus on the needle. Puncture shallowly and retain; manipulate slightly and float. Use this to shift the patient's Spirit. Rest when Qi arrives. For men, conserve Jing internally and reject outward flow; for women, guide Jing externally and prevent inward leakage. Carefully guard and do not allow escape; this is called De Qi (Arrival of Qi).
This states that the physician must guard their own Spirit and focus intention on the needle. The Kidney stores Jing and opens into the ears. Jing and Qi can be confused by hearing; thus, avoiding noise gathers Jing. Unifying Spirit focuses intention on the needle, achieving mental concentration. Shallow puncture with retention and slight floating manipulation shifts the patient's Spirit. Wait for Qi arrival to rest. This combines the physician's Spirit with the patient's Qi. Men are Yang, Women are Yin. Yang is external, so guide it inward; Yin is internal, so guide it outward. This harmonizes internal-external Yin-Yang Qi. Firmly reject healthy Qi from exiting; carefully guard pathogenic Qi from entering. This is De Qi.
Prohibitions for puncture: Do not puncture recently after intercourse; do not have intercourse after puncture. Do not puncture when drunk; do not drink after puncture. Do not puncture when newly angry; do not get angry after puncture. Do not puncture when newly fatigued; do not exert yourself after puncture. Do not puncture when full; do not eat heavily after puncture. Do not puncture when hungry; do not starve after puncture. Do not puncture when thirsty; do not become dehydrated after puncture. For sudden fright or great fear, stabilize the Qi before puncturing. For those arriving by carriage, let them lie down and rest for about the time it takes to eat a meal, then puncture. For those arriving on foot, let them sit and rest for the time it takes to walk ten li, then puncture. These twelve prohibitions: violating them causes chaotic pulses and scattered Qi, reversing Ying and Wei, and disrupting meridian order. Puncturing under these conditions causes Yang diseases to enter Yin, Yin diseases to emerge from Yang, and pathogenic Qi to regenerate. Ignorant physicians fail to observe this, calling it damaging the body. Physical indulgence consumes brain marrow, stops fluid metabolism, and loses the Spirit generated by the Five Flavors. This is called Loss of Qi.
This discusses the Twelve Prohibitions of Puncture. "Nei" refers to sexual intercourse. Recent intercourse causes loss of Jing. Wine is liquid from hot grains, with fierce Qi. Drunkenness causes Qi chaos. The Liver stores Blood; anger causes Qi to rise. Recent anger causes rebellious Qi and reckless Blood flow. Fatigue causes Spirit to scatter outward and Jing to exhaust internally. The *Mai Yao Jing Wei Lun* states: "Before food intake, meridians are not full, collaterals are balanced, Blood and Qi are not disturbed; thus, one can diagnose abnormal pulses." Hence, do not puncture when full. The *Ping Ren Qi Xiang Lun* states: "Grain enters the Stomach, pulse channels flow; water enters the meridians, Blood forms." Hence, do not puncture when hungry or thirsty. Fright injures Spirit; Fear injures Jing. Thus, stabilize Qi before puncturing to preserve Jing, Qi, and Spirit. Sitting too long injures flesh; hence, car passengers lie down. Walking too long injures sinews; hence, walkers sit. Violating these twelve prohibitions causes chaotic pulses, reversed Ying-Wei, and disordered meridian Qi. Puncturing then causes Yang diseases to enter Yin, Yin to emerge from Yang, and pathogen regeneration, termed injuring the body and causing physical indulgence. The Brain is the Sea of Marrow. Fluids nourish brain marrow, moisten skin, and feed sinews. Violating prohibitions stops fluid metabolism and melts brain marrow. Five Flavors enter the mouth, store in intestines/stomach, nourish Five Qi. Harmonious Qi generates, fluids form, and Spirit arises. Puncture values obtaining Spirit and Qi. Violating prohibitions loses the Spirit generated by Five Flavors, termed Loss of Qi.
At the termination of the Taiyang Meridian, symptoms include eyes staring upward, opisthotonos, and convulsions. The complexion is white, skin is dry, and absolute sweat appears. With absolute sweat, death ensues. At the termination of the Shaoyang Meridian, deafness occurs, joints go limp, and the eye system severs. With eye system severance, death occurs in one and a half days. Death presents with blue-white complexion. At the termination of the Yangming Meridian, mouth and eyes twitch, fearfulness, delirium, and yellow complexion occur. The upper and lower meridians are full but stagnant, leading to termination. At the termination of the Shaoyin Meridian, black complexion, elongated and dirty teeth, abdominal distension, and blockage occur, with no communication between upper and lower, leading to death. At the termination of the Jueyin Meridian, internal heat, dry throat, frequent urination, and irritability occur. Severe cases present with curled tongue and retracted testicles, leading to death. At the termination of the Taiyin Meridian, abdominal distension, dyspnea, belching, and vomiting occur. Vomiting leads to rebellion, causing red face. If not rebelling, upper and lower communication ceases; lack of communication leads to black face and scorched skin/hair, ending in death. ("HT" is synonymous with "Bi" - closure).
This concludes the Way of Beginning and End, starting with Five Elements and ending with Six Qi. The Taiyang Meridian begins at the inner canthus, crosses the vertex, enters the brain network, exits to the neck, runs along the spine to the waist. Taiyang is the mansion of fluids and master of all Yang Qi. When Blood and Qi cease, sinews and vessels cannot be nourished, becoming tight, causing upward-gazing eyes and opisthotonos. Clarity and five colors are the splendor of Qi. Taiyang Qi governs skin and hair; Qi cessation at the skin causes white color and absolute sweat. The Shaoyang Meridian begins at the outer canthus and enters the ear. Deafness indicates Shaoyang Meridian cessation. Shaoyang governs bones; joint laxity indicates Shaoyang Qi cessation. Shaoyang connects to the Kidney, which stores Zhi (Will). Eye system severance indicates Zhi dies first; Zhi death leads to death in 1.5 days. The Yangming Meridian begins at the nose, crosses the bridge, enters the teeth, circles the lips, meets at Chengjiang. Mouth-eye twitching indicates Yangming Qi nearing cessation. Fear, delirium, and yellow color indicate Yangming Spirit Qi exiting outward. "Upper and lower meridians" refer to Hand and Foot Yangming. Fullness externally indicates cessation internally. Regarding Yangming/Taiyin upper/lower: Upper waist is governed by Hand Taiyin/Yangming; lower waist by Foot Taiyin/Yangming. Cessation of fullness without flow indicates Heaven-Earth Yin-Yang Qi failing to intersect. The Shaoyin Meridian connects to Kidney/Bladder, passes through Liver/Diaphragm, enters Lungs, connects to Heart. Abdominal distension/blockage indicates Shaoyin Meridian cessation. Black color indicates external collapse of Qi color. Elongated teeth indicate failure to store Bone Qi. Lack of upper-lower communication indicates Water-Fire non-interaction. Regarding Shaoyin upper/lower: Above Shaoyin, Minister Fire governs, indicating Water-Fire Yin-Yang cessation. The Jueyin Meridian follows the inner thigh, enters pubic region, connects to genitalia, follows throat, enters pharynx. Tongue curling and testicular retraction indicate Juevin Meridian cessation. Jueyin reveals Shaoyang Fire transformation; internal heat, dry throat, irritability indicate transforming Qi rising. Liver governs dispersion; frequent urination indicates Liver Qi descending. The Taiyin Meridian follows inner thigh, enters abdomen/diaphragm, follows throat/connects tongue base, spreads under tongue, returns from Stomach to Heart. Taiyin Meridian cessation causes distension and dyspnea. Taiyin Qi rising to Heart causes belching and vomiting. Vomiting leads to rebellion, causing red face, indicating movement from Stomach to Heart to external collapse. If not rebelling, both Hand and Foot meridians cease, and upper-lower communication stops. Lack of communication causes Earth failure and Water Qi invasion, leading to black color. Hand Taiyin Qi cessation causes skin/hair withering. This is the termination of Six Qi and cessation of meridians. When Qi terminates, meridians terminate; when meridians cease, Qi ceases. Like brothers, they live together and die together. Meridians originate from Zang-Fu and Five Elements, externally combining with Yin-Yang Six Qi. Thus, the chapter begins with the Way of Beginning and End, using Five Zang as the record, and ends with the termination of the Six Meridians, stating birth from Five Elements and end in Six Qi. Zhang Kaizhi says: Spirit in Heaven is Wind; Wind generates Wood; Wood generates Liver. This is Heaven's Six Qi generating Earth's Five Elements. Five Elements generate Five Zang; Five Zang generate Six Meridians; Six Meridians combine with Six Qi. Originating from Heaven's Six Qi, it ends in Six Meridians and returns to Heaven.