黄帝问于伯高曰。余闻气有逆顺。脉有盛衰。刺有大约。可得闻乎。伯高曰。气之逆顺者
。所以应天地阴阳四时五行也。脉之盛衰者。所以候血气之虚实有余不足也。刺之大约者。必明知
病之可刺。与其未可刺。与其已不可刺也。
余伯荣曰。此论病气亦随血气出入于皮肤经脉之外内而刺之有法也。气有逆顺者。谓经脉外内
之气。交相逆顺而行。所以应天地阴阳。四时五行之升降出入。脉有盛衰者。谓经脉外内之血气。有
出有入。是以有虚有实。有有余有不足也。刺之大约者。必明知病之方来之可刺也。与其方盛之未
可刺也。与其已过之不可刺也。
黄帝曰。候之奈何。伯高曰。兵法曰。无迎逢逢之气。无击堂堂之阵。刺法曰。无刺 之热。
无刺漉漉之汗。无刺浑浑之脉。无刺病与脉相逆者。黄帝曰。候其可刺奈何。伯高曰。上工刺其未生者
也。其次刺其未盛者也。其次
刺其已衰者也。下工刺其方袭者也。与其形之盛者也。与其病之与脉相逆者也。故曰方其盛也。勿
敢毁伤。刺其已衰。事必大昌。故曰上工治未病。不治已病。此之谓也。（逢叶彭）
此言刺法有如兵法。当避其来锐。击其惰归。按史记轩辕之时。神农时世衰。诸侯相侵伐。及蚩
尤作乱。轩辕乃习用干戈。以征不享。故即以用兵之法。而为刺之大约。夫战。勇气也。一鼓作气。
再而衰。三而竭。是以无迎逢逢之气。无击堂堂之阵。俟其气衰阵乱。然后击之。无有不克者矣。
之热。热盛于皮肤也。漉漉之汗。邪盛在肌腠也。浑浑之脉。邪入于经脉也。病与脉相逆者。真
邪相攻也。离合真邪论曰。夫邪去络入于经也。舍于血脉之中。其寒温未相得。如涌波之起也。时
来时去。方其来也。必按而止之。无逢其冲而泻之。知机之道。不可挂以发。盖邪之方盛不可迎。邪
之以往不可追。俟其来去之时。如发机之速。不可差之毫发者也。刺其未生者。未生于脉中也。未盛
者。邪来之未盛。已衰者。邪去之已衰。故曰方其盛也。勿敢毁伤。谓邪气方盛。则真气大虚。故勿
敢泻邪以伤正气。刺其已衰。事必大昌。上工治未病者。未病于脉中也。盖传溜于血脉。则有入腑干
脏之患矣。余伯荣曰。按此篇篇名逆顺。而伯高曰。气之逆顺。所以应天地阴阳。四时五行也。
是虽论刺之大约。而重在气之逆顺。夫天道右迁。地道左转。四时之气。寒往则暑来。暑往则寒来。
升降出入于天地之外内者也。五脏者。生长化收藏之气。此皆阴阳相贯。环转无端。夫人皮以应天。
肌肉应地。血脉应地之经水。气之逆顺。谓气之环转于经脉皮肤之外内。交相逆顺而行。以应天地阴
阳。四时五行之气。是以下工刺其方袭者。谓病之方袭于脉中也。与其形之盛者。谓病之盛于皮腠。
而为 之热。漉漉之汗也。与其病
之与脉相逆者。谓病邪始入于脉也。盖脉气之出于皮肤。从经而脉。脉而络。络而孙。孙络绝而后
出于气街。邪之入于经脉。去皮肤而入于络。去络而入于经。是以病与脉之相逆也。夫邪去络入于经
也。如涌波之起。时来时去。无有常在。其病气已衰。则顺脉而行矣。故曰刺其已衰。事必大昌。
此篇重在知人气之逆顺。应天地四时五行。则知邪病之盛虚出入矣。
黄帝向伯高问道：我听说气有逆顺之分，脉有盛衰之别，针刺有大致原则，可以讲给我听吗？伯高回答说：气的逆顺，是用来对应天地阴阳及四季五行的变化的。脉的盛衰，是用来诊察血气的虚实、有余或不足的情况的。针刺的大致原则，必须明确知道疾病在什么情况下可以针刺，什么情况下不可以针刺，以及什么情况下已经不可再针刺。
余伯荣说：这一段论述的是病气随着血气出入于皮肤经脉的内外部，因此针刺有其特定的法则。所谓“气有逆顺”，是指经脉内外的气，相互交错地以逆或顺的方式运行，以此来顺应天地阴阳、四季五行升降出入的变化。所谓“脉有盛衰”，是指经脉内外的血气，有出有入，因此有虚有实，有多余和不足的情况。所谓“针刺的大致原则”，是一定要知道病气正在来袭时是可以针刺的，病气正旺盛时是不可以针刺的，病气已经过去时是不可针刺的。
黄帝问：如何候察这些情况呢？伯高说：兵法上说：不要迎击气势正盛的敌军，不要攻击阵容严整的敌阵。针刺法则说：不要刺高热炽盛的患者，不要刺大汗淋漓的患者，不要刺脉象浑乱无序的患者，不要刺病症与脉象相逆的患者。黄帝问：如何候察可以针刺的时机呢？伯高说：高明的医生在疾病尚未发生时就进行针刺；其次是在病势尚未亢盛时进行针刺；再次是在病势已经衰退时进行针刺。低劣的医生却在病气正侵袭人体时进行针刺，或在患者形体邪气正盛时进行针刺，或在病症与脉象相逆时进行针刺。所以说，当病气正盛时，不敢妄加攻伐损伤正气；在病气衰退后针刺，治疗必然大吉大利。所以说，高明的医生治理未发生的疾病，而不是治理已发生的疾病，说的就是这个道理。（注：“逢”通“彭”，意为盛大）
这段文字说明针刺法则如同兵法，应当避开敌人锐气正盛之时，攻击其懈怠撤退之际。据《史记》记载，轩辕氏时期，神农氏的时代衰落，诸侯之间互相侵伐。等到蚩尤作乱，轩辕氏便习用兵器，征讨不朝贡者。因此，将用兵的方法作为针刺的大致原则。作战，靠的是勇气。第一次击鼓能振作士气，第二次击鼓士气就衰退了，第三次击鼓士气就耗尽了。所以不要迎击气势正盛的军队，不要攻击阵容严整的阵地，等待他们气衰阵乱，然后攻击，没有不胜利的。
“之热”，指热邪炽盛于皮肤。“漉漉之汗”，指邪气盛于肌腠之间。“浑浑之脉”，指邪气已进入经脉。病症与脉象相逆，指真气与邪气相互交争。《离合真邪论》说：邪气从络脉进入经脉，停留在血脉之中，此时寒温之气尚未调和，像波涛涌起一样，时而到来，时而离去。当它来的时候，必须按压并制止它，不要迎着它的冲势而泻法。掌握开合的机道，不能有一丝一毫的差错。大概邪气正盛时不可迎击，邪气已去时不可追击，要等待它来去的时机，像弩机发射一样迅速，不能有丝毫偏差。
“刺其未生者”，是指在邪气尚未侵入经脉之前进行干预。“未盛者”，是指邪气刚来但尚未亢盛。“已衰者”，是指邪气已经衰退。所以说“方其盛也，勿敢毁伤”，意思是邪气正盛时，真气大虚，因此不敢通过泻法祛邪而伤害正气。“刺其已衰，事必大昌”，高明的医生治理未病（指邪气尚未在经脉中形成病变），因为如果邪气传溜于血脉，就会有传入腑脏危害五脏的祸患。
余伯荣说：按照本篇篇名“逆顺”，伯高说气的逆顺是用来对应天地阴阳、四季五行的。这虽然论述的是针刺的大致原则，但重点在于气的逆顺。天道向右迁移，地道向左旋转，四季之气，寒冷过去暑热就来，暑热过去寒冷就来，这是在天地内外升降出入的气。五脏是生长化收藏的气，这些都是阴阳相互贯通，循环运转没有终点的。人的皮肤对应天，肌肉对应地，血脉对应地上的河流。气的逆顺，是指气在经脉和皮肤的内外之间环转，交错地以逆或顺的方式运行，以顺应天地阴阳、四季五行的气。所以下劣的医生在病气正侵袭经脉时进行针刺，这是指病气刚刚侵入经脉。在患者形体邪气正盛时进行针刺，这是指病邪在皮腠间炽盛，表现为高热和大汗。在病症与脉象相逆时进行针刺，这是指病邪刚开始进入经脉。大概邪气从络脉进入经脉，就像波涛涌起，时而来时而去，没有固定常态。当病气衰退时，就会顺着脉气运行。所以说“刺其已衰，事必大昌”。本篇重在知晓人气之逆顺，以应天地四时五行，从而了解邪病的盛虚出入变化。
Huangdi asked Bo Gao: I have heard that Qi has the aspects of reversal and compliance (Ni Shun), pulses have the states of fullness and deficiency, and acupuncture has general principles. May I ask you to explain them? Bo Gao replied: The reversal and compliance of Qi correspond to the Yin and Yang of Heaven and Earth, as well as the changes of the Four Seasons and Five Elements. The fullness and deficiency of pulses are used to observe the excess or deficiency, surplus or insufficiency of Blood and Qi. The general principles of acupuncture require one to clearly know when a disease is suitable for needling, when it is not suitable, and when it is no longer suitable for needling.
Yu Borong stated: This section discusses how pathogenic Qi moves in and out of the skin and meridians along with Healthy Qi, establishing specific methods for needling. "Qi has reversal and compliance" refers to the Qi inside and outside the meridians moving in alternating patterns of reversal and compliance, thereby corresponding to the ascending, descending, exiting, and entering movements of Heaven and Earth's Yin and Yang, the Four Seasons, and the Five Elements. "Pulses have fullness and deficiency" refers to the Blood and Qi inside and outside the meridians having exits and entries, resulting in states of emptiness and fullness, surplus and insufficiency. "The general principles of needling" means one must clearly understand that needling is permissible when pathogenic Qi is approaching, impermissible when it is at its peak, and contraindicated after it has passed.
Huangdi asked: How should these be observed? Bo Gao said: As military strategy states, do not confront an army with overwhelming momentum, and do not attack a formation that is solid and formidable. Acupuncture principles state: Do not needle patients with intense heat; do not needle those with profuse sweating; do not needle those with chaotic and turbid pulses; do not needle cases where the symptoms contradict the pulse. Huangdi asked: How does one observe the appropriate time for needling? Bo Gao said: A superior practitioner needles before the disease arises; a secondary practitioner needles when the pathogenic factor is not yet flourishing; a third-tier practitioner needles when the pathogenic factor has already declined. An inferior practitioner needles when the pathogenic factor is just invading, when the physical manifestation is flourishing, or when the disease contradicts the pulse. Therefore, it is said: When the pathogen is flourishing, do not dare to damage [the healthy Qi]; needle after it has declined, and the outcome will surely be prosperous. Thus, it is said that a superior practitioner treats disease before it arises, rather than treating it after it has arisen. This is what is meant by this statement. (Note: "Feng" is interchangeable with "Peng", meaning grand or vigorous.)
This passage illustrates that acupuncture principles are akin to military strategy: one should avoid the enemy's sharp vigor and strike when they are weary or retreating. According to the *Records of the Grand Historian*, during the time of Xuanyuan (Yellow Emperor), the era of Shennong was declining, and feudal lords were invading each other. When Chiyou rebelled, Xuanyuan practiced the use of weapons to punish those who did not pay tribute. Thus, military tactics were adopted as the general principles for needling. Warfare relies on courage. The first drumbeat rouses the spirit; the second causes it to decline; the third exhausts it. Therefore, one does not confront vigorous armies nor attack solid formations, but waits until their morale declines and formation breaks, then attacks, ensuring victory.
"Intense heat" refers to heat flourishing in the skin. "Profuse sweating" indicates pathogenic factors flourishing in the muscle interstices. "Chaotic pulses" signify that pathogens have entered the meridians. Disease contradicting the pulse indicates the conflict between True Qi and Pathogenic Factors. The *Treatise on Separating and Combining True and Evil* states: When evil travels from the collaterals into the meridians, it resides in the blood vessels. At this stage, cold and warmth are not yet harmonized, rising like waves, coming and going intermittently. When it arrives, one must press and restrain it, avoiding the surge to apply draining techniques. Understanding the timing of opening and closing requires precision without any deviation. Generally, one should not confront evil when it is flourishing, nor chase it once it has departed. One must wait for its arrival and departure with the speed of a trigger mechanism, allowing no error.
"Needling before the disease arises" refers to intervention before the pathogen enters the meridians. "Not yet flourishing" refers to the pathogen arriving but not yet strong. "Already declined" refers to the pathogen having weakened. Thus, "when flourishing, do not dare to damage" means that when pathogenic Qi is strong, True Qi is greatly deficient, so one dares not drain the pathogen and harm the healthy Qi. "Needling after it has declined ensures prosperity." A superior practitioner treats disease before it manifests in the meridians, because if the pathogen transmits through the blood vessels, it risks entering the Fu organs and damaging the Zang organs.
Yu Borong stated: Although the chapter title is "Reversal and Compliance," Bo Gao emphasizes that the reversal and compliance of Qi correspond to Heaven and Earth's Yin and Yang and the Four Seasons and Five Elements. While discussing general needling principles, the focus is on the reversal and compliance of Qi. The Way of Heaven moves rightward, the Way of Earth moves leftward. In the Four Seasons, as cold departs, heat arrives; as heat departs, cold arrives. These are the ascensions, descents, exits, and entries within and outside Heaven and Earth. The Five Zang organs govern the Qi of growth, transformation, and storage. All these involve the continuous circulation of Yin and Yang, turning in a cycle without end. Human skin corresponds to Heaven, muscles to Earth, and blood vessels to the rivers of the Earth. The reversal and compliance of Qi refer to the circular movement of Qi inside and outside the meridians and skin, moving in alternating patterns to correspond to the Qi of Heaven and Earth's Yin and Yang, the Four Seasons, and the Five Elements. Therefore, an inferior practitioner needles when the disease is just invading the meridians, meaning the pathogen has just entered. They needle when the physical form is flourishing, meaning the pathogen is strong in the skin and interstices, manifesting as intense heat and profuse sweating. They needle when disease contradicts the pulse, meaning the pathogen has just entered the meridians. Generally, when evil travels from collaterals to meridians, it rises like waves, coming and going without constancy. When the disease Qi declines, it follows the flow of the pulse. Hence, "needling after it has declined ensures prosperity." This chapter emphasizes understanding the reversal and compliance of human Qi corresponding to Heaven, Earth, the Four Seasons, and Five Elements, thereby knowing the fluctuations, deficiency, and movement of pathogenic diseases.