\r大椎肺俞肝俞穴图\pt68a15.bmp\r
大椎（本作 ）一穴。图经云。在第一椎上。陷中。手足三阳督脉之会。可刺入五分。留三呼。泻五吸。
琥按仲景云。刺大椎第一间。当是此穴。成注不明。而条辩尚论等书。皆不言及。此不知仲景刺大椎法。与太阳
病刺风府之义。实相同耳。故余于上图补出。以备后学参考。
琥又按仲景刺大椎一穴者。此并太少之邪而合泻之也。合泻之。而病邪不已。则分泻之。故又刺肺俞与肝俞焉。
肺俞二穴。图经云。在第三椎下。两旁相去各一寸五分。足太阳脉气所发。可刺入三分。留七呼。得气即泻。肥人。
可刺入五分。不可灸。
肝俞二穴。图经云在第九椎下。两旁相去各一寸五分。可刺入三分。留六呼。不可灸。
琥按上四穴。非禁灸。但灸非热病所宜耳。
太阳少阳并病心下硬。颈项强而眩者。当刺大椎。肺俞。肝俞。慎勿下之。（此条与上条之证相同。上条云慎不可发
汗。此条云。慎勿下之。正以下为少阳所。禁且太阳病。邪犹在经。亦不可下。愚于前注。已明言不可下之义。大抵以
上两条证。乃互文以见意也。愚按成注云。刺大椎肺俞。以泻太阳之邪。刺肝俞。以泻少阳之邪。则是成氏终不知大椎
一穴。实合太少而齐泻。诸家注皆不明用针之理。竟置大椎而不论。大误之极。）
以上太少相并可刺病二条（自原论中第四卷太阳治法下集附于此）
（重出例）太阳病。头痛。至七日以上。（云云）若欲作再经者。针足阳明。使经不传。则愈。（此条病注已见前第
三卷太阳上编但仲景云。针足阳明成注未明指其穴。考之庞氏总病论云。补足阳明上三里穴。推庞氏之意。以足三里
穴得补。则经气实而不传。殊不知成注云。针足阳明为迎而夺之。以泄其经中之热。使热邪得泄。不至再传他经。故云。
愈也。庞氏不明用针之理。竟以泻为补。误极误极。又考张氏缵论云。刺冲阳穴。按冲阳。即仲景所谓趺阳脉也。在足
跗上五寸。高骨间动脉。愚以仲景有诊趺阳法。而不言刺。张氏之言。实本史氏伤寒论注。不足法也。今止就足三里穴。
附图于后。）
大椎穴（原文此处有缺字，据《图经》补全），共一穴。《针灸图经》记载：位于第一胸椎上方凹陷处，是手足三阳经与督脉的交会穴。可针刺五分深，留针三呼的时间，采用泻法，配合患者吸气时进针或行针五次。
王琥按语：张仲景曾说“刺大椎第一间”，指的应当就是此穴。成无己的注解不够明确，而条辨、尚论等书籍也都未提及这一点。这是因为他们不了解张仲景刺大椎的方法，与太阳病刺风府穴的意义实际上是相同的。所以我在此图上补充列出，以备后学参考。
王琥又按语：张仲景只刺大椎这一穴，是为了同时疏泄太阳经和少阳经的病邪。如果同时疏泄后病邪仍未消除，则分别疏泄各经之邪，所以又针刺肺俞和肝俞。
肺俞穴，左右各一，共二穴。《针灸图经》记载：位于第三胸椎下方，两旁距离脊柱各一寸五分，是足太阳膀胱经脉气所发之处。可针刺三分深，留针七呼的时间，得气后立即施行泻法。体型肥胖者，可针刺五分深，不可艾灸。
肝俞穴，左右各一，共二穴。《针灸图经》记载：位于第九胸椎下方，两旁距离脊柱各一寸五分。可针刺三分深，留针六呼的时间，不可艾灸。
王琥按语：上述四个穴位并非禁止艾灸，只是艾灸不适合热性病罢了。
太阳经与少阳经并病，表现为心下痞硬、颈项强直且头晕目眩者，应当针刺大椎、肺俞、肝俞穴。务必禁止使用攻下法。（此条症状与上一条相同。上一条说“慎不可发汗”，此条说“慎勿下之”。攻下法是少阳病的禁忌，且太阳病邪气仍在经络，也不可用下法。我在前面的注释中已经明确说明了不可用下法的道理。大致以上两条条文是互文见义的手法。我按语认为：成无己注解说，刺大椎、肺俞是为了疏泄太阳经的邪气，刺肝俞是为了疏泄少阳经的邪气。这说明成氏始终不知道大椎这一穴实际上可以同时齐泻太阳和少阳两经的邪气。各家注解都不明白用针的道理，竟然忽略大椎穴而不加讨论，这是极大的错误。）
以上关于太阳、少阳相并可刺穴位病症的两条（从原论第四卷太阳治法下篇收集附于此）
（重复出现的例子）太阳病，头痛，到了七天以上……（省略号内容略）。如果打算让病邪传入下一经，针刺足阳明经，使经脉之气不传变，则病愈。（此条病症的注释已见于前第三卷太阳上编。但张仲景说“针足阳明”，成无己的注解没有明确指出是哪个穴位。考证庞安时的《总病论》说：补足阳明经的上三里穴。推测庞安时的意思，认为补足三里穴能使经气充实而不传变。殊不知成无己注解说：“针足阳明”是“迎而夺之”的泻法，以泄除经中的热邪，使热邪得以宣泄，不再传变他经，所以说病愈。庞安时不明白用针的道理，竟然把泻法当作补法，错误至极。又考证张元素《伤寒缵论》说：刺冲阳穴。按冲阳穴即张仲景所说的趺阳脉所在，在足背上方五寸，高骨之间的动脉处。我认为张仲景有诊察趺阳脉的方法，但并未提及针刺。张元素的言论，实际上源自史氏的《伤寒论注》，不值得效法。现在仅就足三里穴，附图于后。）
Diagram of Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) Acupoints
Dazhui (GV14): One acupoint. The *Jiuzhi Zhenjiu Tujing* (Illustrated Manual of Nine Needle Acupuncture) states: It is located in the depression above the first thoracic vertebra, and is the meeting point of the Hand and Foot Three Yang Meridians and the Du Meridian. It can be needled to a depth of 5 fen, retained for three "hu" (breaths), using the reducing method coordinated with five inhalations.
Wang Hu notes: Zhang Zhongjing stated, "Needle the first interval of Dazhui," which refers to this acupoint. Cheng Wuji's commentary was unclear, and books such as *Tiaobian* and *Shanglun* did not mention it. This is because they did not understand that Zhang Zhongjing's method of needling Dazhui is essentially identical in meaning to needling Fengfu (GV16) in Taiyang disease. Therefore, I have added it to the diagram above for reference by future students.
Wang Hu further notes: When Zhang Zhongjing needled only the Dazhui acupoint, it was to simultaneously reduce pathogenic factors from both the Taiyang and Shaoyang meridians. If the pathogenic factors persist after simultaneous reduction, they are reduced separately; hence, Feishu (BL13) and Ganshu (BL18) are also needled.
Feishu (BL13): Two acupoints (left and right). The *Jiuzhi Zhenjiu Tujing* states: Located below the third thoracic vertebra, 1.5 cun lateral to the midline on both sides. It is where the Qi of the Foot-Taiyang Bladder Meridian manifests. It can be needled to a depth of 3 fen, retained for seven "hu", and the reducing method should be applied immediately upon obtaining Deqi (arrival of qi). In obese individuals, it can be needled to a depth of 5 fen. Moxibustion is contraindicated.
Ganshu (BL18): Two acupoints (left and right). The *Jiuzhi Zhenjiu Tujing* states: Located below the ninth thoracic vertebra, 1.5 cun lateral to the midline on both sides. It can be needled to a depth of 3 fen, retained for six "hu". Moxibustion is contraindicated.
Wang Hu notes: The four acupoints mentioned above are not strictly contraindicated for moxibustion, but moxibustion is not suitable for febrile diseases.
In cases of concurrent Taiyang and Shaoyang disease presenting with hardness below the heart, stiffness and rigidity of the neck, and dizziness, one should needle Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). Strictly avoid purgation methods. (The symptoms in this clause are identical to the previous one. The previous clause stated "caution against sweating," while this one states "strictly avoid purgation." Purgation is forbidden for Shaoyang, and since the pathogen in Taiyang disease remains in the channels, purgation is also inappropriate. I have already clearly explained the rationale against purgation in my previous annotations. Essentially, these two clauses use intertextual rhetoric to convey their meaning. In my opinion: Cheng Wuji commented that needling Dazhui and Feishu reduces Taiyang pathogens, and needling Ganshu reduces Shaoyang pathogens. This indicates that Cheng never understood that the Dazhui acupoint itself can simultaneously reduce pathogens from both Taiyang and Shaoyang. Other commentators failed to grasp the principles of acupuncture, ignoring Dazhui entirely, which is a grave error.)
The above two clauses regarding concurrent Taiyang-Shaoyang conditions treatable by acupuncture (Collected from the lower section of Taiyang Treatment Methods in Volume 4 of the original treatise and attached here).
(Example of repeated content): Taiyang disease, headache, persisting for more than seven days... (omitted). If the disease is about to transmit to the next meridian, needle the Foot-Yangming Meridian to prevent transmission, and the patient will recover. (The annotation for this condition appears in the upper section of Taiyang in Volume 3. However, Zhang Zhongjing said "needle the Foot-Yangming Meridian," and Cheng Wuji's commentary did not specify the acupoint. Examining Pang Anshi's *Zongbing Lun*, it says: Tonify the Shangsanli acupoint of the Foot-Yangming Meridian. Pang's intention seems to be that tonifying Shangsanli strengthens the channel Qi to prevent transmission. Little does he know that Cheng Wuji stated: "Needling the Foot-Yangming Meridian" employs the "meet-and-rob" (Ying Er Duo Zhi) reducing method to drain heat from the channel, allowing the heat pathogen to dissipate and preventing transmission to other meridians, thus stating recovery. Pang misunderstood the principles of acupuncture, mistaking reduction for tonification, an extreme error. Furthermore, examining Zhang Yuansu's *Shanghan Zuankan*, it says: Needle Chongyang (ST42). Chongyang corresponds to the Fuyang pulse mentioned by Zhang Zhongjing, located 5 cun above the dorsum pedis, in the arterial pulse between the high bone. I believe Zhang Zhongjing had methods for diagnosing the Fuyang pulse but did not mention needling. Zhang's statement is actually derived from Shi's *Shanghan Lun Zhu* and is not worthy of emulation. Here, we simply provide a diagram for the Zusanli (ST36) acupoint below.)