黄帝曰。脉之应于寸口。如何而胀。岐伯曰。其脉大坚以涩者。胀也。黄帝曰。何以知脏腑之胀也。岐伯曰。阴为
脏阳为腑。黄帝曰。夫气之令人胀也在于血脉之中邪。脏腑之内乎。岐伯曰。三者皆存焉。然非胀之舍也。黄帝曰。愿
闻胀之舍。岐伯曰。夫胀者。皆在于脏腑之外。排脏腑而郭胸胁胀。皮肤故命曰胀。黄帝曰。脏腑之在胸胁腹裹之内也。
若匣匮之藏禁器也。各有次舍异名而同处。一域之中。其气各异。愿闻其故。黄帝曰。未解其意。再问。岐伯曰。夫胸
腹。脏腑之郭也。膻中者。心主之宫城也。胃者。太仓也。咽喉小肠者。传送也。胃之五窍者。闾里门户也。廉泉玉英
者。津液之道也。故五脏六腑者。各有畔界。其病各有形状。营气循脉。卫气逆行。为脉胀。卫气并脉循分。为肤胀。
三里而泻。近者一下。远者三下。无问虚实。工在疾泻。黄帝曰。愿闻脏腑之胀形也。岐伯曰。夫心胀者。烦心短气。
卧不安。肺胀者。虚满而喘咳。肝胀者。胁下满而痛。引少腹脾胀者。善哕。四肢烦 。体重。不能胜衣。卧不安。肾
胀者。腹满引背。央央然。腰髀痛。六腑胀。胃胀者。腹满。胃脘痛。鼻闻焦臭。妨于食。大便难。大肠胀者。肠鸣而
痛。濯濯冬日重感于寒则飧泄不化。小肠胀者。少腹 胀。引腰而痛。膀胱胀者。少腹满而气癃。三焦胀者。气满于皮
肤中。轻轻然而不坚。胆胀者。胁下痛胀。口中苦。善太息。凡此诸胀者。其道在一。明知逆顺。针数不失。泻虚补实。
神去其室。致邪失正。真不可定。粗之所败。谓之天命。补虚泻实。神归其室。久塞其空。谓之良工。黄帝曰。胀者焉
生。何因而有。岐伯曰。卫气之在身也。常然并脉。循分肉行有逆顺阴阳相随。乃得天和。五脏更始四时循序。五谷乃
化。然后厥气在下。营卫留止。寒气逆上真邪相攻。两气相搏。乃合为胀也。黄帝曰。善。何以解惑。岐伯曰。合之于
真。三合而得。帝曰。善。夫子言无问虚实。工在疾泻。近者一下。远者三下。今有其三而不下者。其过焉在。岐伯对
曰。此言陷于肉肓而中气穴者也。不中气穴。则气内闭。针不陷肓。则气不行上越。中肉。则卫气相乱。阴阳相逐。其
于胀也。当泻不泻。气故不下。三而不下。必更其道。气下乃止。不下复始。可以万全。乌有殆者乎。其于胀也。必审
其胗。当泻则泻。当补则补。如鼓应桴。恶有不下者乎。（胗即诊也诊即证也即指五脏六腑之胀形也）
通篇俱以逆取势。不独起笔也。乍读似杂乱无次。细寻皆衔接而下。其清在骨。其雄在神。
黄帝说：脉象在寸口部的表现，是如何反映出胀病的？岐伯说：如果脉象大而坚实且涩滞，就是胀病。黄帝问：怎样知道脏腑的胀病呢？岐伯说：阴经对应脏，阳经对应腑。黄帝问：导致人发生胀病的气，是在血脉之中吗？还是在脏腑之内呢？岐伯说：这三者（血脉、脏腑、皮肤腠理）都存有气，然而它们并不是胀病的居所（病位）。黄帝说：我希望了解胀病的居所在哪里。岐伯说：所谓的胀病，都位于脏腑之外，排挤脏腑，扩张胸胁，使皮肤绷紧，所以命名为“胀”。黄帝说：脏腑存在于胸腹内部，就像匣子和柜子里收藏着珍贵的器物一样。它们各有固定的位置和不同的名称，虽然处于同一个区域之中，但各自的气机不同。我希望了解其中的原因。黄帝说：我还没完全理解您的意思，想再请教一下。岐伯说：胸腹，是脏腑的外廓；膻中（心包），是心脏的宫城；胃，是太仓（储藏粮食的地方）；咽喉和小肠，负责传导输送；胃的五窍（指胃与外界相通的孔道及关联部位），如同里巷的门户；廉泉和玉英（穴位名，任脉穴），是津液运行的通道。因此，五脏六腑都有各自的边界，它们的病变也各有不同的形态表现。营气沿着经脉运行，卫气则逆向而行，这就形成了脉胀；卫气并入经脉，循行于分肉之间，这就形成了肤胀。治疗时取足三里穴进行泻法，病程短的一下针即效，病程长的需下针三次。不论虚实，关键在于迅速泻邪，医生的技艺在于快速泻实。黄帝说：我希望了解脏腑胀病的形态特征。岐伯说：心胀的病人，心中烦闷，呼吸短促，睡眠不安；肺胀的病人，胸部虚满且喘息咳嗽；肝胀的病人，胁下胀满且疼痛，牵引少腹部；脾胀的病人，经常呃逆，四肢烦扰沉重，身体困重，连衣服的重量都承受不了，睡眠不安；肾胀的病人，腹部胀满并牵引背部，感到郁闷不舒，腰部和髋部疼痛。六腑的胀病：胃胀的病人，腹部胀满，胃脘疼痛，闻到焦臭味，饮食受阻，大便困难；大肠胀的病人，肠鸣且疼痛，如果在冬天再次感受寒邪，就会发生完谷不化的泄泻；小肠胀的病人，小腹胀满，牵引腰部疼痛；膀胱胀的病人，小腹胀满且小便不通畅；三焦胀的病人，气充满于皮肤之中，轻轻鼓胀但不坚硬；胆胀的病人，胁下疼痛胀满，口苦，喜欢叹气。大凡这些各种胀病，其道理在于一个“逆”字。明确知晓气机的逆顺，针刺的次数就不会失误。对于虚证用补法，对于实证用泻法。如果神气离失其舍，就会导致邪气深入，正气受损，真气无法安定。这是粗劣医生造成的败坏，却归咎于天命。如果是补其虚而泻其实，使神气回归其舍，长久地充实空虚之处，这就称为良工。黄帝说：胀病是怎么产生的？是什么因素导致的？岐伯说：卫气在人身中，通常伴随经脉，循行于分肉之间，有逆有顺，阴阳相随，才能符合自然的和谐。五脏功能更替有序，四时循序变化，五谷才能正常消化。然后厥逆之气在下，营气和卫气停留止息，寒气逆上，真气和邪气相互攻伐，两气相搏结，于是合成为胀病。黄帝说：好。怎样才能解除疑惑？岐伯说：将理论与真气相合，通过三种结合（指形、气、神或天地人等综合判断）而获得真理。黄帝说：好。先生曾说不要问虚实，关键在于迅速泻邪，近病一下，远病三下。现在有的人针刺三次仍然没有效果，过错在哪里？岐伯回答说：这是因为针刺陷入了肌肉间的脂膜（肓），而没有准确刺中气穴。如果没有刺中气穴，气就会在内闭阻；如果针刺没有陷入肓膜，气就不能上行外越；如果只刺中肌肉，就会扰乱卫气，导致阴阳相互追逐冲突。对于胀病，应当泻而不泻，气自然不能下行。针刺三次无效，必须改变针刺的方法，直到气机下行才停止。如果气未下行又重新开始，这样可以保证万全，哪里有危险的呢？对于胀病，必须仔细诊察，应当泻的就泻，应当补的就补，就像鼓槌敲击鼓面立刻回应一样，怎么会有不下效的呢？（注：“胗”通“诊”，“诊”即“证”，这里指五脏六腑的胀病形态。）
整篇文章都以逆势取势的手法写作，不仅仅是开头如此。乍读起来似乎杂乱无章，仔细寻找发现都是衔接而下。其清劲在于骨力，其雄浑在于神韵。
Huangdi said: How do the pulses at the cunkou (inch position) reflect distension? Qibo replied: When the pulse is large, firm, and choppy, it indicates distension. Huangdi asked: How can one know about distension of the zang and fu organs? Qibo replied: The yin meridians correspond to the zang organs, and the yang meridians correspond to the fu organs. Huangdi asked: Does the qi that causes distension reside within the blood vessels, or inside the zang and fu organs? Qibo replied: Qi exists in all three places (vessels, organs, and skin/fascia), but these are not the dwelling place of distension. Huangdi said: I wish to hear where the dwelling place of distension is. Qibo replied: Distension occurs outside the zang and fu organs, pressing against them and expanding the chest and hypochondrium, causing the skin to tense; therefore, it is named "distension." Huangdi said: The zang and fu organs reside within the chest and abdomen, like precious artifacts stored in boxes and cabinets. Each has its specific location and distinct name, yet they share the same region while possessing different qi dynamics. I wish to understand the reason behind this. Huangdi said: I have not fully grasped your meaning and would like to ask again. Qibo replied: The chest and abdomen serve as the outer casing for the zang and fu organs. Danzhong (Pericardium) is the palace city of the Heart. The Stomach is the Grand Granary. The pharynx and Small Intestine are responsible for transmission and transportation. The five openings of the Stomach act like gates and doors of neighborhoods. Lianquan and Yuying (acupoints) are the pathways for fluids and juices. Thus, the five zang and six fu organs each have their boundaries, and their diseases present with distinct shapes. Ying (Nutritive) qi circulates along the meridians, while Wei (Defensive) qi moves in reverse, resulting in Mai Distension (Vessel Distension). When Wei qi merges with the meridians and circulates among the muscle intervals, it results in Fu Distension (Skin/Flesh Distension). Treatment involves reducing at Zusanli (ST36). For recent cases, one needle insertion suffices; for distant/chronic cases, three insertions are needed. Regardless of deficiency or excess, the key lies in rapid reduction. The physician's skill depends on swift reduction. Huangdi said: I wish to learn the manifestations of distension in the zang and fu organs. Qibo replied: In Heart Distension, there is mental restlessness, shortness of breath, and restless sleep. In Lung Distension, there is a sensation of emptiness and fullness accompanied by wheezing and coughing. In Liver Distension, there is fullness and pain under the hypochondrium radiating to the lower abdomen. In Spleen Distension, there is frequent hiccups, heaviness and irritability in the four limbs, inability to bear the weight of clothing, and restless sleep. In Kidney Distension, there is abdominal fullness radiating to the back, a feeling of oppression, and pain in the waist and hips. Regarding Fu organ distension: In Stomach Distension, there is abdominal fullness, epigastric pain, aversion to foul odors, difficulty eating, and constipation. In Large Intestine Distension, there is borborygmus and pain; if exposed to cold in winter, it leads to undigested diarrhea. In Small Intestine Distension, there is lower abdominal fullness radiating to the waist with pain. In Bladder Distension, there is lower abdominal fullness and urinary retention. In Sanjiao (Triple Burner) Distension, qi fills the subcutaneous tissue, causing slight swelling without hardness. In Gallbladder Distension, there is pain and fullness under the hypochondrium, bitter taste in the mouth, and frequent sighing. All these types of distension follow one principle: understanding the reversal and smooth flow of qi ensures accurate needle manipulation. One should tonify deficiency and reduce excess. If the Shen (Spirit) leaves its residence, evil qi will invade, true qi will be lost, and stability cannot be achieved. This failure is due to incompetent physicians who blame fate. Conversely, tonifying deficiency and reducing excess allows the Shen to return to its residence and fills the void, which defines a skilled physician. Huangdi asked: How does distension arise? What is its cause? Qibo replied: Normally, Wei qi follows the meridians and circulates through the muscle layers, with reverse and forward movements, yin and yang following each other, achieving harmony with nature. The five zang organs function in rotation, the four seasons proceed in order, and grains are digested properly. However, when Jue (Rebellious) qi arises below, Ying and Wei qi stagnate, cold qi rebels upward, and true qi clashes with pathogenic factors, the two qi interact and combine to form distension. Huangdi said: Excellent. How can confusion be resolved? Qibo replied: By aligning with the True Qi and achieving synthesis through three aspects. Huangdi said: Excellent. You previously stated not to distinguish between deficiency and excess, focusing on rapid reduction, one insertion for recent cases, three for distant ones. Now, some patients do not improve after three insertions. Where is the error? Qibo answered: This occurs when the needle penetrates into the muscular fat (huang) but misses the Qi-acupoint. Missing the acupoint causes internal qi closure. Failing to penetrate the huang prevents qi from ascending and dispersing superficially. Puncturing only muscle disturbs Wei qi and causes yin and yang to chase each other chaotically. In distension, if reduction is indicated but not performed, qi will not descend. If three insertions fail, the method must be changed until qi descends. If it does not descend, restart the process correctly. This ensures safety and efficacy; danger is avoidable. For distension, one must carefully diagnose (Zhen/Zheng refers to the forms of zang and fu distension). Reduce when indicated, tonify when indicated, responding as instantly as a drumbeat struck by a mallet. How could it fail to work?
The entire passage employs a strategy of countering rebellion, starting from the beginning. At first glance, it may seem disordered, but upon close inspection, the connections are seamless. Its clarity lies in its structural bone, and its power lies in its spirit.