〔《素》〕曰∶刺法言有余泻之，不足补之，何谓有余？何谓不足？岐伯对曰∶神有有余有不足，气有有余
有不足，血有有余有不足，形有有余有不足，志有有余有不足。夫心藏神，肺藏气，肝藏血，脾藏肉，肾藏志，
而此成形。志意通，内连骨髓，而成身形五脏。五脏之道，皆出于经隧，以行血气，血气不和，百病乃变化而
生，是故守经隧焉。神有余则笑不休，神不足则悲。血气未并，五脏安定，邪客于形，洒淅起于毫毛，未入于
经络也，故命曰神之微。神有余，则泻其小络之血出血，勿之深斥。（斥，推也。小络，孙络也。《针经》曰∶经
脉为里，支而横者为络，络之别者为孙络也。）无中其大经，神气乃平。神不足者，视其虚络，按而致之，刺而
利之，无出其血，无泄其气，以通其经，神气乃平。帝曰∶刺微奈何？曰∶按摩勿释，着针勿斥，移气于不足，
神气乃得复。气有余则喘咳上气，不足则息利少气。血气未并，五脏安定，皮肤微病，命曰白气微泄。气有
余则泻其经隧，无伤其经，无出其血，无泄其气。不足则补其经隧，无出其气。问曰∶刺微奈何？对曰∶
按摩勿释，出针视之曰∶我将深之，适人必革，精气自伏，邪气散乱，无所休息，气泄腠理，真气乃相
得。血有余则怒，不足则恐，血气未并，五脏安定，孙络水溢，则经有留血，血有余则泻其盛经，出其血。
不足则视其虚经，内针其脉中，久留而视，脉大，疾出其针，无令血泄。问曰∶刺留血奈何？对曰∶
视其血络，刺出其血，毋令恶血得入于经，以成其疾。
形有余则腹胀，泾溲不利，不足则四肢不用。血气未并，五脏安定，肌肉蠕动，命曰微风。形有余则泻其阳经，
不足则补其阳络。问曰∶刺微奈何？对曰∶取分肉间，无中其经，无伤其络，卫气得复，邪气乃索。志有余则
腹胀飧泄，不足则厥。血气未并，五脏安定，骨节有动。志有余则泻然筋血者，不足则补其复溜。（然筋即然谷穴。）问
曰∶刺未并奈何？对曰∶即取之，无中其经，邪所乃能立虚。问曰∶虚实之形，不知其何以生？对曰∶血气已
并，阴阳相倾，气乱于卫，血逆于经，血气离居，一实一虚。（夫五脏之虚实，皆生于血气之离并耳。有余者，
血气并入其募，盛而实也。不足者，血气离去其脏，衰而虚也。经气未并，五脏安定者，五脏之血气未并为实，
未离为虚者，安定其所，而阴阳均平。久留者，一邪初客之时，故当即治。若其初不治，则渐并渐离，而虚脏
所离之血气有并归于实脏，所以阴阳相倾而不均乎，卫乱荣逆而三候不一，实脏自实，虚脏自虚，而一实一虚也。
然所谓一盛一虚者，不独五脏也，凡阴阳表里上下经络皆然也。故病有阳盛阴虚，阴盛阳虚者，有表盛里虚，
里盛表虚者，有上盛下虚，下盛上虚者，有经满络虚，络满经虚者，所谓无实实虚虚损不足益有余者。海藏所
谓上热未除中寒复生之类，皆治一实一虚之戒，学人宜究心焉。）血并于阴，气并于阳，故为惊狂。血并于
阳，气并于阴，乃为炅中。（炅即热也。）血并于上，气并于下，心烦惋善怒。血并于下，气并于上，乱而善忘。问
曰∶血并于阴，气并于阳，如是血气离居，何者为实？何者为虚？对曰∶血气者，喜温而恶寒，寒则泣不能流，
温则消而去之。是故气之所并为血虚，血之所并为气虚。间曰∶人之所有者，血与气耳。今夫子乃言血并为虚，
气并为虚，是无实乎？对曰∶有者为实，无者为虚。故气并则无血，血并则无气，今血与气相失，故为虚焉。
络之与孙脉，俱输于经，血与气并，则为实焉。血之与气，并走于上，则为大厥，厥则暴死。气复反则生，不
反则死。问曰∶实者何道从来？虚者何道从去，虚实之要，愿闻其故？对曰∶夫阴与阳，皆有俞会，阳注于阴，
阴满之外，阴阳均平，以充其形，九候若一，命曰平人。夫邪之生也，或生于阴，或生于阳。其生于阳者，得
之风雨寒暑。其生于阴者，得之饮食居处，阴阳喜怒。问曰∶风雨之伤人也奈何？对曰∶风雨之伤人也，先客
于皮肤，传入于孙脉，孙脉满则传入于络脉，络脉满则输于大经脉，血气与邪并客于分腠之间，其脉坚大，故
曰实。实者外坚充满，不可按之。按之则痛。问曰∶寒湿之伤人也奈何？对曰∶寒湿之中人也，皮肤不收，肌
肉坚紧，荣血泣，卫气去，故曰虚，虚者聂辟。（聂谓聂皱，辟谓辟叠也。）气不足，按之则气足以温之，故
快然而不痛。
问曰∶阴之生实奈何？对曰∶喜怒不节，则阴气上逆，上逆则下虚，下虚则阳气走之，故曰实矣。问曰∶阴之
生虚奈何？对曰∶喜则气下，悲则气消，消则脉虚空，因寒饮食，寒气充满，则血泣气去，故曰虚矣。问曰∶
阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒，予已闻之矣，不知其所由然也。对曰∶阳受气于上焦，
以温皮肤分肉之间，今寒气在外，则上焦不通，上焦不通，则寒气独留于外，故寒栗。问曰∶阴虚生内热奈何？
对曰∶有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，胃气热，热气熏胸中，故内热。问曰∶阳盛生
外热奈何？对曰∶上焦不通利，则皮肤致密，腠理闭塞，玄府不通，卫气不得泄越，故外热。问曰∶阴盛生内
寒奈何？对曰∶厥气上逆，寒气积于胸中而不泻，不泻则温气去，寒独留，则血凝泣，凝则脉不通，其脉盛大
以涩，故中寒。问曰∶阴与阳并，血气以并，病形以成，刺之奈何？对曰∶刺之者，取之经隧，取血于营，取
气于卫，用形哉，因四时多少高下。问曰∶血气以并，病形以成，阴阳相倾，补泻奈何？对曰∶泻实者，气盛
乃内针，针与气俱内，以开其门，如利其户，针与气俱出，精气不伤，邪气乃下，外门不闭，以出其疾，摇大
其道，如利其路，是谓大泻。必切而出，大气乃屈。问曰∶补虚奈何？对曰∶持针勿置，以定其意，候呼内针，
气出针入，针空四塞，精无从去，方实而疾出针，气入针出，热不得还，闭塞其门，邪气布散，精气乃得存，
动气候时，近气不失，远气乃来，是谓追之。（调经论）
〔《素》〕帝曰∶不足者补之奈何？岐伯曰∶必先扪而循之，切而散之，推而按之，弹而怒之，抓而下之，
通而取之，外引其门，以闭其神，呼尽内针，静以久留，以气至为故，如待所贵，不知日暮，其气以至，适而
自护，候吸引针，气不得出，各在其处，推阖其门，令神气存，大气留止，故命曰补。吸则内针无令气忤，
静以久留，无令邪布，吸则转针，以得气故，候呼引针，针尽乃去，大气皆出，故命曰泻。（离合真邪论）
补法，左手掐穴，右手置针于穴上，令病患咳嗽一声，捻针入透于腠理，后令病患呼气一口，随呼针至分
寸，待针沉紧时转针头向病所，以手循扪经络，觉气至却因针头向下，觉针沉紧，令病患吸气一口，急出其针，
急闭其穴，虚羸气弱痒麻者补之。
泻法，先以左手掐穴，右手置针于穴上，令病患咳嗽一声，捻针入于腠理，复令病患吸气一口，随吸气入
针至分寸，觉针沉紧，转针头向病所，若觉气退便转针头向下，以手循取经络，觉针沉闷，令病患吹气一口，
徐出其针，不闭其穴，命之曰泻，丰肥坚硬疼痛者泻之。
上以病患气之呼吸，医人针之出纳，分补泻。令病患吸气而入针，气与针同入为补。令呼气出针，针与
气同出为泻。呼气气出而入针为泻，吸气气入而出针为补也。
〔《难》〕何谓补泻？当补之时，何所取气？当泻之时，何所置气？然，当补之时，从卫取气。当泻之时，
从荣置气。其阳气不足，阴气有余，当先补其阳而后泻其阴。阴气不足，阳气有余，当先补其阴而后泻其阳。
荣卫通行，此其要也。（七十六难）
针有补泻，何谓也？然，补泻之法，非必呼吸出内针也。然知其为针者信其左，不知为针者，信其右，当
刺之时，必先以左手压按其所，针荣 之处，弹而努之，抓而下之，其气之来，如动脉之状，顺针而刺之。得
气，因推而内之，是谓补。动而伸之，是谓泻。不得气，乃与男外女内不得气，是谓十死不治也。（七十难）
上以针之推内动伸分补泻也。从卫取气者，谓浅内针，待卫气至，渐渐推内进至深也。从荣置气者，谓
深内针，待荣气至，却渐动伸退至浅也。盖补者针入腠理，得气后渐渐作三次推内，进至分寸，经所谓徐
内疾出，世所谓一退三飞，热气荣荣者是也。泻者宜针入分寸，得气后渐渐作三次动伸，退出腠理，经所
谓疾内徐出，世所谓一飞三退，冷气沉沉者是也。
经言能知迎随之气，可令调之，调气之方，必在阴阳，何谓也？然，所谓迎随者，知荣卫之流行经脉之
往来也，随其逆顺而取之，故曰迎随。调气必在阴阳者，知其内外表里，随其阴阳而调之。故曰∶调气之方，
必在阴阳。（七十二难）
上以迎随分补泻也。然迎随之法有三，此法以针头迎随经脉之往来，一也。又泻子为迎而夺之，补母为
随而济之，二也。又随前法呼吸出纳针，亦名迎随，三也。又针头之随者，调荣卫之流行，经脉之往来，
手之三阴从胸走手，手之三阳从手走头，足之三阳从头走足，足之三阴从足走腹也。迎者以针头斜迎三阴
三阳之来处针去也，随者以针头斜随三阴三阳之往处针去也。
夫行针者，当刺之时，口温针暖，先以左手揣按其所针荥俞之气，弹而努之，抓而下之，扪而循之，通而
取之，随病患咳嗽一声，右手持针而刺之，春夏二十四息，秋冬三十六息，徐出徐入，气来如动脉之状。补者
随经脉推而内之，左手闭针孔，徐出针而疾按之。泻者迎经脉动而伸之，左手闭针孔，疾出针而徐按之。随而
济之，是谓补。迎而夺之，是谓泻。
上合迎随推内动静二法言补泻也。
〔《灵》〕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 ，毋使
邪气得入。脉实者深刺之，以泄其气。脉虚者浅刺之，使精气无得出，以养其脉，独出其邪气。（终始篇）
上以浅深分补泻，浅为补，深为泻也。
〔窦〕凡补泻非必呼吸出内，而在乎手指，何谓也？故动摇进退搓盘弹捻指循扪摄按抓切者是也。动者，
如气不行，将针伸提而已。退者，为补泻欲出针时，各先退一头许，然后却留针，方可出之，此谓之退也。搓
者，凡令病患觉热外向卧，针似搓线之状，勿转太紧，治寒向里卧，根据前转法，以为搓也。进者，凡不得气，
男外女内者，及春夏秋冬各有进退之理，此谓之进也。盘者，为如针腹部，于穴内轻盘摇而已，此谓之盘也。
摇者，凡泻时欲出针，必须动摇而出者是也。弹者，凡补时用大指甲轻弹针，使气疾行，如泻不可用也。捻者，
以手捻针也，务要记左右，左为外，右为内也。循者，凡下针于所部分经络之处，用手上下循之，使气血往来。
经云∶推之则行，引之则止。扪者，凡补者出针时，用手扪闭其穴是也。摄者，下针时如气涩滞，随经络上用
大指甲上下切，其气血自得通行也。按者，以手按针，无得进退，如按切之状也。抓者，凡下针用手指作力，
置针有准也。切者，凡欲下针，必先用大指甲左右于穴切之，令气血宣散，然后下针，是不伤荣卫故也。
问∶穴各有两，如补泻，只刺病所耶？两穴俱刺耶？曰∶不然，随病左右而补泻之，左则左补，右则右补。
问∶《针经》云∶灸几壮，针讫而后灸，何也？曰∶针则针，灸则灸，若针而弗灸，若灸而弗针。
〔《难》〕言有见如入，有见如出者，何谓也？曰∶谓左手见气来至乃内针，针入见气尽乃出针，是谓有见
加入，有见如出也。（王注谓此法取有其经者未然。见八十难）
〔《灵》〕所谓气至而有效者，泻则益虚，虚者，脉大如其故而不坚也，坚如其故者，适虽言故病未去
也。补则益实，实者，脉大如其故而益坚也，大如其故而不坚者，适虽言快，病未去也。故补则实，泻则
虚，痛虽不随针，病必衰去。（终始篇）
〔《素》〕刺虚者须其实，刺实者须其虚。（针解云∶刺实须其虚者，为针阴气隆至针下寒，乃去针也。
刺虚须其实者，为针阳气隆至针下热，乃去针也。王注云∶要以气至而有效也。）
〔《灵》〕三脉动于足大指之间，必审其实虚。虚而泻之，是谓重虚，重虚者病益甚。凡刺此者，以指按之，
脉动而实且疾者，疾泻之，虚而徐者，则补之，反此者病益甚。其动也，阳明在上。（冲阳脉也。）厥阴在中。
（太冲脉也。）少阴在下。（太溪脉也。）
〔《难》〕言东方实，西方虚，泻南方，补北方，何谓也？然，金木水火土，当更相平。东方木也，西方金
也，木欲实金当平之，火欲实水当平之，土欲实木当平之，金欲实火当平之，水欲实土当平之。东方者肝也，
则知肝实。西方者肺也，则知肺虚。泻南方火，补北方水。南方火，火者木之子也。北方水，水者木之母也。
【《黄帝内经·素问》】说：针刺法则指出，实证用泻法，虚证用补法。什么是实证？什么是虚证？岐伯回答说：神有有余和不足，气有有余和不足，血有有余和不足，形体有有余和不足，志有有余和不足。心藏神，肺藏气，肝藏血，脾主肌肉（形），肾藏志，这些构成了人的身形。意志通畅，内连骨髓，从而形成身形和五脏。五脏的通道，都出于经络隧道，用来运行血气。如果血气不和，百病就会由此产生变化而生发，所以要守护好经络隧道。
神有余，则表现为笑个不停；神不足，则表现为悲伤。此时血气尚未偏聚，五脏功能安定，邪气刚刚侵袭形体，使人洒淅恶寒、毫毛竖起，但尚未进入经络，所以称为“神的轻微病变”。对于神有余，应当刺破其小络脉出血，但不要深刺。（斥，意为推开。小络，即孙络。《针经》说：经脉在里，分支横出的为络，络的分支为孙络。）不要伤及大经脉，神气就能恢复平衡。对于神不足，观察其虚弱的络脉，用手按压以引导正气，针刺以疏通经气，不要使其出血，也不要泄其正气，以此疏通经络，神气就能恢复平衡。
黄帝问：如何治疗这种轻微的病变？回答说：按摩时不要松手，进针时不要用力推按，将正气移至不足之处，神气就能恢复。
气有余，则表现为气喘、咳嗽、气逆上冲；气不足，则表现为呼吸顺畅但气息微弱。此时血气尚未偏聚，五脏安定，皮肤出现轻微病变，称为“白气的轻微外泄”。气有余，应当泻其经隧，但不要损伤经脉，不要使其出血，不要泄其正气。气不足，应当补其经隧，不要泄出其气。
问：如何治疗这种轻微的病变？回答说：按摩时不要松手，出针后注视针孔，说：“我要再深刺。”病人必然改变体位，精气自然潜伏，邪气散乱，无处停留，气从腠理泄出，真气就能相合。
血有余，则表现为易怒；血不足，则表现为恐惧。此时血气尚未偏聚，五脏安定，孙络中水湿溢出，导致经脉中有瘀血滞留。血有余，应当泻其盛满的经脉，放出瘀血。血不足，应当观察其虚弱的经脉，将针刺入脉中，长时间留针并观察，如果脉搏变大，迅速出针，不要让血流出。
问：如何治疗瘀血滞留？回答说：观察其血络，刺破放出瘀血，不要让恶血进入经脉，以免形成疾病。
形体有余，则表现为腹胀、大小便不利；形体不足，则表现为四肢不能随意运动。此时血气尚未偏聚，五脏安定，肌肉跳动，称为“微风”。形体有余，应当泻其阳经；形体不足，应当补其阳络。
问：如何治疗这种轻微的病变？回答说：取分肉之间，不要刺中经脉，不要损伤络脉，卫气得以恢复，邪气乃消散。
志有余，则表现为腹胀、完谷不化的腹泻；志不足，则表现为四肢厥冷。此时血气尚未偏聚，五脏安定，骨节有颤动。志有余，应当刺然谷穴出血；志不足，应当补复溜穴。（然筋即然谷穴。）
问：如何治疗血气尚未偏聚时的病变？回答说：立即取穴针刺，不要刺中经脉，邪气所在之处就能立刻变虚。
问：虚实形成的形态，不知道它是如何产生的？回答说：血气已经偏聚，阴阳相互倾轧，气乱于卫分，血逆于经脉，血气分离居住，一处实一处虚。（五脏的虚实，都源于血气的离居与偏聚。有余，是血气并入其募穴，盛大而实。不足，是血气离去其脏，衰弱而虚。经气未并，五脏安定的情况，是指五脏的血气未并成实，未离成虚，处于安定状态，阴阳均衡。久留针，是因为邪气初客之时，所以应当立即治疗。如果起初不治疗，就会逐渐偏聚、逐渐离去，导致虚脏所离的血气重新并入实脏，所以阴阳倾轧而不均衡，卫气紊乱、营血逆行，三部九候不一致，实脏自实，虚脏自虚，从而形成一实一虚的局面。然而所谓的一盛一虚，不仅仅局限于五脏，凡是阴阳、表里、上下、经络都是如此。所以有病证表现为阳盛阴虚、阴盛阳虚，表盛里虚、里盛表虚，上盛下虚、下盛上虚，经满络虚、络满经虚等。这就是所谓的“不要使实证更实，不要使虚证更虚”，以免损害不足而增益有余。海藏所说的“上热未除，中寒复生”之类，都是治疗一实一虚证的禁忌，学者应当深入研究。）
血偏聚于阴分，气偏聚于阳分，所以表现为惊狂。血偏聚于阳分，气偏聚于阴分，就表现为内热（炅中）。（炅即热。）血偏聚于上部，气偏聚于下部，表现为心烦意乱、容易发怒。血偏聚于下部，气偏聚于上部，表现为神志混乱、容易健忘。
问：血并于阴，气并于阳，像这样血气分离居住，哪一个是实？哪一个是虚？回答说：血和气，喜欢温暖而厌恶寒冷。寒冷则血液凝涩不能流动，温暖则血液消散流通。因此，气偏聚的地方血就虚，血偏聚的地方气就虚。
间曰：人所拥有的，不过是血和气罢了。现在您却说血并则虚，气并则虚，难道就没有实证了吗？回答说：有者为实，无者为虚。所以气并则此处无血，血并则此处无气，现在血与气分离失守，所以表现为虚。络脉和孙脉，都输送血液到经脉，血与气合并，就表现为实。血与气一起向上冲逆，就发生大厥，厥证发作就像暴死一样。如果气能回复，就能生存；如果不回复，就会死亡。
问：实证是从哪里来的？虚证是到哪里去的？虚实的关键，希望听听其中的缘故？回答说：阴和阳，都有腧穴交会。阳气注入阴分，阴分充满后溢出到外，阴阳均衡平和，以充实身形，三部九候脉象一致，称为平人。邪气的产生，有的生于阴，有的生于阳。生于阳的，得之于风雨寒暑。生于阴的，得之于饮食起居、喜怒情绪。
问：风雨伤人是如何发生的？回答说：风雨伤人，先客居于皮肤，传入孙脉，孙脉满溢则传入络脉，络脉满溢则输注到大经脉，血气与邪气共同客居于分肉腠理之间，脉象坚实盛大，所以称为实。实证表现为外部坚实充满，不可按压，按压则疼痛。
问：寒湿伤人是如何发生的？回答说：寒湿中人，皮肤松弛不收，肌肉坚紧，营血凝涩，卫气离去，所以称为虚。虚证表现为皮肤聂辟（聂指皮肤皱缩，辟指皮肤折叠）。气不足，按压可以使气聚集以温煦局部，所以舒适而不痛。
问：阴分产生实证是怎么回事？回答说：喜怒不节制，则阴气上逆，上逆则下部虚，下部虚则阳气走注填补，所以称为实了。
问：阴分产生虚证是怎么回事？回答说：喜则气缓而下陷，悲则气消减，消减则脉道虚空，再加上吃冷的饮食，寒气充满，则血液凝涩、卫气离去，所以称为虚了。
问：阳虚则体表寒冷，阴虚则体内发热，阳盛则体表发热，阴盛则体内寒冷，我已经听说了，但不知道其中的原理。回答说：阳气从上焦受气，以温煦皮肤分肉之间。现在寒气在外，则上焦不通畅，上焦不通畅，则寒气独自留在体表，所以寒战。
问：阴虚产生内热是怎么回事？回答说：由于劳倦过度，形体之气衰少，谷气不盛，上焦不通行，下脘不通利，胃气郁热，热气熏蒸胸中，所以产生内热。
问：阳盛产生外热是怎么回事？回答说：上焦不通利，则皮肤致密，腠理闭塞，玄府不通，卫气不得宣泄越出，所以产生外热。
问：阴盛产生内寒是怎么回事？回答说：厥气上逆，寒气积聚于胸中而不能排泄，不排泄则温气离去，寒气独留，则血液凝涩，凝涩则脉道不通，脉象盛大而涩，所以产生内寒。
问：阴与阳并，血与气并，病形已成，如何针刺？回答说：针刺时，取用经隧，从营分取血，从卫分取气，根据病人的形体差异，以及四季的变化来决定针刺的深浅和多少。
问：血气已并，病形已成，阴阳相倾，如何进行补泻？回答说：泻实的方法，是在气盛时进针，针随气一同进入，以打开门户，如同打开窗户；针随气一同退出，精气不受伤，邪气随之排出，外门不闭，以排出疾邪，摇大针孔，如同疏通道路，这叫做“大泻”。必须切按脉口而出针，大气才能屈折消退。
问：补虚的方法是怎样的？回答说：持针不要放置，以安定心神，在呼气时进针，气出针入，针孔四周密闭，精气无从流失，待针下感觉充实时迅速出针，气入针出，热气不得返还，关闭针孔，邪气布散，精气得以保存，动静合乎时机，近处的精气不失，远处的精气乃来，这叫做“追之”。（出自《调经论》）
【《黄帝内经·素问》】黄帝说：虚证如何补？岐伯说：必须先用手扪摸、循按、切散、推按、弹努、抓捏，以疏通经络并引导气血，向外牵引其门户，以闭合神气。在呼气尽时进针，安静地长时间留针，以得气为度，如同等待尊贵的人到来，不知日暮。当气至时，适当保护，在吸气时拔针，使气不得外出，各归其处，推合其门户，令神气留存，大气留止，所以称为补。
在吸气时进针，不让气逆乱，安静地长时间留针，不让邪气布散，吸气时转针，以得气为目的，在呼气时引针，针尽乃去，大气皆出，所以称为泻。（出自《离合真邪论》）
补法：左手掐定穴位，右手置针于穴上，让病人咳嗽一声，捻针进入透达腠理，然后让病人呼出一口气，随着呼气将针推进至分寸深度，等到针下沉紧时，转动针头朝向病所，用手循抚经络，感觉到气至，却因针头向下，感觉针沉紧，让病人吸一口气，迅速出针，迅速闭合穴口。适用于虚羸气弱、痒麻等症状的病人进行补法。
泻法：先用左手掐定穴位，右手置针于穴上，让病人咳嗽一声，捻针进入腠理，再让病人吸一口气，随着吸气将针推进至分寸深度，感觉针下沉紧，转动针头朝向病所，如果感觉气退，便转动针头向下，用手循取经络，感觉针沉闷，让病人吹出一口气，缓慢出针，不闭合穴口，这称为泻法。适用于身体丰肥、坚硬、疼痛等症状的病人进行泻法。
以上是根据病人的呼吸，医生针的进出，来区分补泻。让病人吸气时进针，气与针同入为补。让病人呼气时出针，针与气同出为泻。呼气时气出而入针为泻，吸气时气入而出针为补。
【《难经》】什么是补泻？当补的时候，取什么气？当泻的时候，置什么气？回答：当补的时候，从卫分取气。当泻的时候，从营分置气。如果阳气不足，阴气有余，应当先补阳而后泻阴。如果阴气不足，阳气有余，应当先补阴而后泻阳。营卫通行，这是关键。（出自第七十六难）
针有补泻，是什么意思呢？回答：补泻之法，不一定在于呼吸进出针。懂得针刺的人信赖左手，不懂针刺的人信赖右手。当针刺时，必须先用左手压按所针之处，在荣穴之处，弹而努之，抓而下之，其气来临，如动脉之状，顺针而刺之。得气后，因推而内之，这叫补。动而伸之，这叫泻。如果不得气，对于男子取外侧，女子取内侧；如果男女都不得气，这叫十死不治。（出自第七十难）
上面是用针的推内和动伸来区分补泻。从卫取气，是说浅刺进针，等待卫气至，渐渐推内进至深处。从营置气，是说深刺进针，等待营气至，却渐渐动伸退至浅处。补法是将针插入腠理，得气后渐渐作三次推内，进至分寸，经文所说“徐内疾出”，世人所说“一退三飞”，热气融融就是这种情况。泻法宜将针插入分寸，得气后渐渐作三次动伸，退出腠理，经文所说“疾内徐出”，世人所说“一飞三退”，冷气沉沉就是这种情况。
经文说能知道迎随的气，可以调和它，调和气的方法，必须在阴阳，这是什么意思呢？回答：所谓迎随，是知道营卫的流行和经脉的往来，顺着或逆着它们的方向取穴，所以叫迎随。调和气必须在阴阳，是知道内外表里，顺着阴阳而调和它。所以说：调和气的方法，必须在阴阳。（出自第七十二难）
上面是用迎随来区分补泻。然而迎随的方法有三种：此法是以针头迎着或顺着经脉的往来，这是一。又泻子穴为迎而夺之，补母穴为随而济之，这是二。又随着前面的方法，配合呼吸进出针，也叫迎随，这是三。又针头的随，是调营卫的流行，经脉的往来。手之三阴从胸走手，手之三阳从手走头，足之三阳从头走足，足之三阴从足走腹。迎者以针头斜迎着三阴三阳的来处针刺而去，随者以针头斜随着三阴三阳的去处针刺而去。
施行针法的人，当针刺时，口中温热针具，先以左手揣按所针荥俞穴的气，弹而努之，抓而下之，扪而循之，通而取之，随着病人咳嗽一声，右手持针而刺之。春夏二十四息，秋冬三十六息，徐出徐入，气来如动脉之状。补者顺着经脉推而内之，左手闭合针孔，慢出针而快按之。泻者迎着经脉动而伸之，左手闭合针孔，快出针而慢按之。随而济之，是谓补。迎而夺之，是谓泻。
【《灵枢》】补法必须在一方实的情况下，深取之，稀按其孔，以极出其邪气。一方虚的情况下，浅刺之，以养其脉，疾按其孔，不要让邪气得入。脉实的，深刺之，以泄其气。脉虚的，浅刺之，使精气无得出，以养其脉，只出其邪气。（出自《终始篇》）
上面是以浅深来区分补泻，浅为补，深为泻。
【窦汉卿】凡补泻不一定在于呼吸进出，而在于手指的操作，是什么？就是动摇、进退、搓、盘、弹、捻、指循、扪、摄、按、抓、切等方法。动者，如气不行，只是将针伸提而已。退者，为补泻欲出针时，各自先退一头许，然后却留针，方可出之，这叫做退。搓者，凡是让病人觉得热而向外卧，针似搓线之状，不要转太紧；治寒向里卧，根据前转法，作为搓。进者，凡是不得气，男外女内的情况，以及春夏秋冬各有进退的道理，这叫做进。盘者，如针腹部，在穴内轻盘摇而已，这叫做盘。摇者，凡是泻时欲出针，必须动摇而出的是。弹者，凡是补时用大指甲轻弹针，使气疾行，如泻不可用也。捻者，以手捻针也，务要记左右，左为外，右为内。循者，凡是下针于所部分经络之处，用手上下循之，使气血往来。经文说：推之则行，引之则止。扪者，凡是补者出针时，用手扪闭其穴是。摄者，下针时如气涩滞，随经络上用大指甲上下切，其气血自得通行也。按者，以手按针，无得进退，如按切之状也。抓者，凡是下针用手指作力，置针有准也。切者，凡是欲下针，必先用大指甲左右于穴切之，令气血宣散，然后下针，是不伤荣卫故也。
问：穴各有两个，如补泻，只刺病所耶？两穴俱刺耶？答：不是，随病左右而补泻之，左则左补，右则右补。
问：《针经》说：灸几壮，针讫而后灸，为什么？答：针则针，灸则灸，若针而不灸，若灸而不针……
【《难经》】说有见如入，有见如出，是什么意思？答：谓左手见到气来至才内针，针入见到气尽才出针，是谓有见加入，有见如出也。（王冰注认为此法取其经者不对。见第八十难）
【《灵枢》】所谓气至而有效，泻则益虚，虚者，脉大如其故而不坚也，坚如其故者，适虽言故病未去也。补则益实，实者，脉大如其故而益坚也，大如其故而不坚者，适虽言快，病未去也。故补则实，泻则虚，痛虽不随针，病必衰去。（出自《终始篇》）
【《素问》】刺虚者须其实，刺实者须其虚。（《针解》云：刺实须其虚者，为针阴气隆至针下寒，乃去针也。刺虚须其实者，为针阳气隆至针下热，乃去针也。王冰注云：要以气至而有效也。）
【《灵枢》】三脉动于足大指之间，必审其实虚。虚而泻之，是谓重虚，重虚者病益甚。凡刺此者，以指按之，脉动而实且疾者，疾泻之，虚而徐者，则补之，反此者病益甚。其动也，阳明在上。（冲阳脉也。）厥阴在中。（太冲脉也。）少阴在下。（太溪脉也。）
【《难经》】言东方实，西方虚，泻南方，补北方，何谓也？答：金木水火土，当更相平。东方木也，西方金也，木欲实金当平之，火欲实水当平之，土欲实木当平之，金欲实火当平之，水欲实土当平之。东方者肝也，则知肝实。西方者肺也，则知肺虚。泻南方火，补北方水。南方火，火者木之子也。北方水，水者木之母也。
[From the *Suwen* (Basic Questions)] it is said: The acupuncture methods state that excess should be drained and deficiency should be tonified. What constitutes excess? What constitutes deficiency? Qibo replied: Shen (Spirit) has excess and deficiency; Qi (Vital Energy) has excess and deficiency; Blood has excess and deficiency; Xing (Form/Body) has excess and deficiency; Zhi (Will) has excess and deficiency. The Heart stores Shen, the Lungs store Qi, the Liver stores Blood, the Spleen governs the muscles (Xing), and the Kidneys store Zhi, thereby forming the body shape. When Zhiyi (Will and Intention) are smooth, they connect internally to the Marrow, forming the body shape and the Five Zang Organs. The pathways of the Five Zang Organs all emerge from the Jing-Sui (Meridian Tunnels) to circulate Blood and Qi. If Blood and Qi are disharmonious, myriad diseases arise from changes, hence one must guard the Jing-Sui.
If Shen has excess, laughter will not cease; if Shen has deficiency, sorrow will prevail. At this stage, Blood and Qi have not yet gathered, the Five Zang Organs are stable, and pathogenic factors have only invaded the form, causing chills and goosebumps, but have not yet entered the meridians. This is termed "minor disorder of Shen." For Shen excess, drain the blood from its small collaterals until bleeding occurs, but do not puncture deeply. ("Chi" means to push. Small collaterals refer to Sun-Luo [Fine Collaterals]. The *Zhenjing* states: Meridians are internal; branches crossing horizontally are Luo-Collaterals; branches of Luo-Collaterals are Sun-Luo.) Do not injure the major meridians, and the Shen Qi will return to balance. For Shen deficiency, observe the deficient collaterals, press to guide Qi, needle to facilitate flow, do not cause bleeding, and do not drain Qi. By unblocking the meridians, the Shen Qi will return to balance.
The Emperor asked: How to treat such minor disorders? He replied: Massage without releasing, insert the needle without pushing hard, transfer Qi to the deficient area, and the Shen Qi will recover.
If Qi has excess, there will be panting, coughing, and rebellious Qi ascending; if Qi has deficiency, breathing will be smooth but with shortness of breath. At this stage, Blood and Qi have not yet gathered, the Five Zang Organs are stable, and the skin suffers minor ailments, termed "minor leakage of White Qi." For Qi excess, drain the Jing-Tui (Meridian Passages), but do not injure the meridian, do not cause bleeding, and do not drain Qi. For Qi deficiency, tonify the Jing-Tui, and do not drain Qi.
Question: How to treat such minor disorders? Answer: Massage without releasing; upon withdrawing the needle, gaze at it and say, "I will insert it deeper." The patient will inevitably change posture, Essence-Qi will naturally subside, pathogenic Qi will scatter, having no place to rest, Qi will leak through the Cou-Li (interstices), and True Qi will harmonize.
If Blood has excess, anger will prevail; if Blood has deficiency, fear will prevail. At this stage, Blood and Qi have not yet gathered, the Five Zang Organs are stable, water overflows in the Sun-Luo, causing stagnant Blood in the main meridians. For Blood excess, drain the full Jing-Mai (Main Meridians) and release the blood. For Blood deficiency, observe the deficient Jing-Mai, insert the needle into the pulse, retain it for a long time while observing; if the pulse becomes large, withdraw the needle quickly to prevent blood loss.
Question: How to treat stagnant Blood? Answer: Observe the Xue-Luo (Blood Collaterals), prick them to release blood, preventing evil blood from entering the meridians to form disease.
If Xing (Form) has excess, there will be abdominal distension and difficulty urinating or defecating; if Xing has deficiency, the four limbs will be unusable. At this stage, Blood and Qi have not yet gathered, the Five Zang Organs are stable, and muscles twitch, termed "Minor Wind." For Xing excess, drain the Yang-Jing (Yang Meridians); for Xing deficiency, tonify the Yang-Luo (Yang Collaterals).
Question: How to treat such minor disorders? Answer: Select points between the muscle bundles, do not puncture the meridians, do not injure the collaterals. When Wei-Qi (Defensive Qi) recovers, pathogenic Qi will dissipate.
If Zhi (Will) has excess, there will be abdominal distension and undigested stool diarrhea; if Zhi has deficiency, there will be cold extremities (Jue). At this stage, Blood and Qi have not yet gathered, the Five Zang Organs are stable, and bone joints tremble. For Zhi excess, drain the blood at Ran-Gu (Ranjin); for Zhi deficiency, tonify Fu-Liu. (Ranjin refers to the acupoint Ran-Gu.)
Question: How to treat disorders where Blood and Qi have not yet gathered? Answer: Immediately select the point and needle, do not puncture the meridians, so that the location of the pathogen can immediately become empty (deficient).
Question: Regarding the forms of excess and deficiency, how do they arise? Answer: When Blood and Qi have gathered, Yin and Yang tilt against each other, Qi becomes chaotic in the Wei layer, Blood rebels in the Jing-Mai, Blood and Qi separate and dwell apart, resulting in one area being excess and another deficiency. (The excess and deficiency of the Five Zang Organs all arise from the separation and gathering of Blood and Qi. Excess means Blood and Qi have gathered into their Mu-Alarms, becoming full and solid. Deficiency means Blood and Qi have left their Zang Organs, becoming weak and empty. When Jing-Qi has not gathered and the Five Zang Organs are stable, it means the Blood and Qi of the Five Zang have not gathered into excess nor separated into deficiency; they remain stable, and Yin and Yang are balanced. Retaining the needle for a long time is because when pathogenic factors first invade, immediate treatment is required. If not treated initially, they gradually gather and separate, causing the Blood and Qi leaving the deficient Zang to re-gather into the excess Zang, leading to tilting and imbalance of Yin and Yang, chaos of Wei and rebellion of Ying, and inconsistency of the three pulses. The excess Zang remains excess, the deficient Zang remains deficient, creating a state of one excess and one deficiency. However, this "one excess, one deficiency" applies not only to the Five Zang but also to Yin/Yang, interior/exterior, upper/lower, and meridians/collaterals. Thus, diseases may present as Yang-excess/Yin-deficiency, Yin-excess/Yang-deficiency, exterior-exterior/interior-deficiency, interior-excess/exterior-deficiency, upper-excess/lower-deficiency, lower-excess/upper-deficiency, Jing-full/Luo-empty, or Luo-full/Jing-empty. This is what is meant by "do not reinforce excess or drain deficiency," which would harm the deficient and benefit the excess. Cases like "heat above unresolved, cold below arising," as described by Hai-Zang, are warnings against treating one excess and one deficiency improperly; scholars should study this carefully.)
When Blood gathers in Yin and Qi gathers in Yang, it results in fright and mania. When Blood gathers in Yang and Qi gathers in Yin, it results in internal heat (Jiong). When Blood gathers in the upper and Qi gathers in the lower, it causes heart vexation and irritability. When Blood gathers in the lower and Qi gathers in the upper, it causes confusion and forgetfulness.
Question: When Blood gathers in Yin and Qi gathers in Yang, with Blood and Qi separated, which is excess and which is deficiency? Answer: Blood and Qi prefer warmth and dislike cold. Cold causes coagulation and stagnation, preventing flow; warmth causes dispersion and resolution. Therefore, where Qi gathers, Blood is deficient; where Blood gathers, Qi is deficient.
Jian asked: What humans possess is merely Blood and Qi. Now you say Blood gathering leads to deficiency and Qi gathering leads to deficiency; is there no excess? Answer: That which is present is excess; that which is absent is deficiency. Thus, where Qi gathers, Blood is absent; where Blood gathers, Qi is absent. Since Blood and Qi have lost each other, it manifests as deficiency. When collateral vessels and fine collaterals transport Blood and Qi to the meridians, and Blood and Qi gather together, it manifests as excess. If Blood and Qi rush upward together, it results in Da-Jue (Great Syncope), appearing as sudden death. If Qi returns, life is preserved; if it does not return, death ensues.
Question: Where does excess come from? Where does deficiency go? I wish to hear the essence of excess and deficiency. Answer: Yin and Yang both have Shu-Acups (Transporting Points). Yang flows into Yin, and Yin fills and overflows outward. When Yin and Yang are balanced, filling the form, and the nine pulses are consistent, it is called a healthy person. Pathogens arise either from Yin or from Yang. Those arising from Yang result from wind, rain, cold, and heat. Those arising from Yin result from diet, living conditions, and emotions (Yin/Yang joy and anger).
Question: How do wind and rain injure humans? Answer: Wind and rain first lodge in the skin, then transmit to the Sun-Luo. When Sun-Luo are full, they transmit to the Luo-Collaterals. When Luo-Collaterals are full, they transport to the major Jing-Meridians. Blood and Qi combine with pathogens and lodge between the Fen-Rou (muscle intervals) and Cou-Li. The pulse becomes firm and large, hence termed "excess." Excess manifests as external firmness and fullness, untouchable; touching causes pain.
Question: How do cold and dampness injure humans? Answer: When cold and dampness attack, the skin relaxes and fails to contract, muscles become firm and tight, Ying-Blood stagnates, and Wei-Qi departs. Hence, it is termed "deficiency." Deficiency manifests as Nie-Pi (skin wrinkling and folding). Due to Qi deficiency, pressing gathers Qi to warm the area, bringing comfort and absence of pain.
Question: How does Yin generate excess? Answer: Unregulated joy and anger cause Yin Qi to rebel upward. Upward rebellion leads to lower deficiency. Lower deficiency causes Yang Qi to flow towards it, thus termed "excess."
Question: How does Yin generate deficiency? Answer: Joy causes Qi to sink; grief causes Qi to dissipate. Dissipation leads to empty pulses. Combined with cold food and drink, cold Qi fills the body, causing Blood stagnation and Qi departure. Hence, it is termed "deficiency."
Question: Yang deficiency causes external cold, Yin deficiency causes internal heat, Yang excess causes external heat, Yin excess causes internal cold. I have heard this, but do not understand the mechanism. Answer: Yang receives Qi from the Upper Jiao to warm the skin and muscle intervals. Now, cold Qi is outside, blocking the Upper Jiao. When the Upper Jiao is blocked, cold Qi remains alone on the exterior, causing shivering.
Question: How does Yin deficiency generate internal heat? Answer: Due to labor and fatigue, the form and Qi decline, Gu-Qi (Grain Qi) is insufficient, the Upper Jiao fails to function, and the Lower Wan (stomach outlet) is blocked. Stomach Qi becomes hot, and hot Qi steams the chest, causing internal heat.
Question: How does Yang excess generate external heat? Answer: When the Upper Jiao is not smooth, the skin becomes dense, Cou-Li closes, Xuan-Fu (pores) are blocked, and Wei-Qi cannot vent. Hence, external heat arises.
Question: How does Yin excess generate internal cold? Answer: Jue-Qi rebels upward, cold Qi accumulates in the chest without discharge. Without discharge, warming Qi departs, leaving cold alone. Blood coagulates and stagnates, blocking the pulses. The pulse becomes large and choppy, hence internal cold arises.
Question: When Yin and Yang gather, Blood and Qi gather, and the disease form is established, how to needle? Answer: In needling, utilize the Jing-Tui, extract Blood from Ying, extract Qi from Wei. Consider the patient's constitution and adjust depth and quantity according to the four seasons.
Question: When Blood and Qi gather, disease form is established, and Yin and Yang tilt, how to apply tonification and drainage? Answer: To drain excess, insert the needle when Qi is abundant. The needle enters with the Qi, opening the gate like a door. Withdraw the needle with the Qi, sparing the Essence-Qi and allowing pathogenic Qi to exit. Keep the outer gate open to expel the disease, widening the channel like clearing a road. This is called "Great Drainage." Press the pulse before withdrawal to subdue the Great Qi.
Question: How to tonify deficiency? Answer: Hold the needle without placing it down, stabilize the mind. Insert the needle during exhalation; as Qi exits, the needle enters. Seal the needle space so Essence-Qi cannot escape. When the needle feels substantial, withdraw it quickly; as Qi enters, the needle exits, preventing heat from returning. Close the gate, disperse pathogenic Qi, and preserve Essence-Qi. Move and wait for the appropriate time, retaining local Qi and attracting distant Qi. This is called "Pursuing." (From *Tiao Jing Lun*)
[From the *Suwen*] The Emperor asked: How to tonify deficiency? Qibo answered: First, palpate, follow, cut, scatter, push, press, flick, and grasp to unblock and obtain Qi. Draw out the gate externally to close the Shen. Insert the needle at the end of exhalation, retain quietly for a long time until Qi arrives, like waiting for a noble guest, ignoring the passing day. When Qi arrives, protect it appropriately. Withdraw the needle during inhalation so Qi does not escape. Each stays in its place. Push and close the gate, letting Shen Qi remain and Great Qi stay. This is called tonification.
Insert the needle during inhalation to avoid Qi conflict. Retain quietly to prevent pathogenic spread. Rotate the needle during inhalation to achieve Deqi. Withdraw the needle during exhalation. As the needle leaves, Great Qi exits. This is called drainage. (From *Li He Zhen Xie Lun*)
Tonification method: The left hand presses the acupoint, the right hand places the needle on the point. Ask the patient to cough once, twist the needle into the Cou-Li. Then ask the patient to exhale fully, advancing the needle to the cun depth following the exhalation. When the needle feels heavy and tight, rotate the needle head toward the disease site. Use the hand to follow and palpate the meridians. When Qi arrives, keep the needle head downward. Feeling the heaviness, ask the patient to inhale once, withdraw the needle quickly, and immediately close the acupoint. Used for deficiency, emaciation, Qi weakness, itching, and numbness.
Drainage method: First, the left hand presses the acupoint, the right hand places the needle. Ask the patient to cough once, twist the needle into the Cou-Li. Then ask the patient to inhale once, advancing the needle to the cun depth following the inhalation. Feeling the heaviness, rotate the needle head toward the disease site. If Qi retreats, rotate the needle head downward. Palpate the meridians. Feeling the needle feel heavy and dull, ask the patient to blow air once, withdraw the needle slowly, and leave the acupoint open. This is called drainage. Used for obesity, hardness, and pain.
The above distinguishes tonification and drainage based on the patient's respiration and the physician's needle insertion/extraction. Inhalation with insertion is tonification (Qi and needle enter together). Exhalation with extraction is drainage (Needle and Qi exit together). Exhalation with insertion is drainage. Inhalation with extraction is tonification.
[From the *Nanjing*] What are tonification and drainage? When tonifying, what Qi is taken? When draining, what Qi is placed? Answer: When tonifying, take Qi from the Wei layer. When draining, place Qi in the Ying layer. If Yang Qi is deficient and Yin Qi is excessive, tonify Yang first, then drain Yin. If Yin Qi is deficient and Yang Qi is excessive, tonify Yin first, then drain Yang. Smooth circulation of Ying and Wei is the key. (Chapter 76)
Acupuncture has tonification and drainage. What does this mean? Answer: The method of tonification and drainage does not necessarily rely on respiration and needle movement. A skilled acupuncturist relies on the left hand; an unskilled one relies on the right. When needling, first press the area with the left hand, flick and distend the Ying point, grasp and descend. When Qi arrives, resembling a pulsating artery, insert the needle smoothly. Upon obtaining Deqi, push the needle inward; this is tonification. Move and extend the needle; this is drainage. Failure to obtain Deqi, regardless of gender-specific lateral/medial approaches, indicates ten deaths incurable. (Chapter 70)
The above distinguishes tonification and drainage by pushing inward vs. moving/extending. "Taking Qi from Wei" means shallow insertion, waiting for Wei Qi to arrive, then gradually pushing deeper. "Placing Qi in Ying" means deep insertion, waiting for Ying Qi to arrive, then gradually moving and extending to shallower depths. Tonification involves inserting into the Cou-Li, and after obtaining Deqi, gradually pushing inward three times to the cun depth. This corresponds to the classic "slow insertion, quick withdrawal" and the folk term "one retreat, three flights," generating warm Qi. Drainage involves inserting to the cun depth, and after obtaining Deqi, gradually moving and extending three times to withdraw from the Cou-Li. This corresponds to the classic "quick insertion, slow withdrawal" and the folk term "one flight, three retreats," generating cold Qi.
The classics state that knowing the Qi of Ying and Sui allows regulation. The method of regulating Qi must lie in Yin and Yang. What does this mean? Answer: Ying and Sui refer to knowing the circulation of Ying and Wei and the flow of meridians. Following or opposing their direction determines the technique, hence Ying and Sui. Regulating Qi requires understanding Yin and Yang, knowing interior/exterior and surface/depth, and adjusting according to Yin and Yang. Hence, the method of regulating Qi lies in Yin and Yang. (Chapter 72)
The above distinguishes tonification and drainage by Ying and Sui. There are three methods of Ying and Sui: 1. Aligning the needle head with the flow of meridians. 2. Draining the Son element (Ying/Du) and tonifying the Mother element (Sui/Ji). 3. Combining the above with respiratory needle manipulation. Also, "Sui" regulates Ying-Wei circulation and meridian flow. Hand-Yin meridians flow from chest to hand; Hand-Yang from hand to head; Foot-Yang from head to foot; Foot-Yin from foot to abdomen. "Ying" means inserting the needle obliquely against the incoming direction of the Three Yin and Three Yang meridians. "Sui" means inserting the needle obliquely following the outgoing direction.
When performing acupuncture, warm the needle in the mouth. First, palpate the Qi of the Ying-Shu points with the left hand, flick, distend, grasp, descend, palpate, follow, and obtain Qi. Upon the patient's cough, insert with the right hand. In spring and summer, twenty-four breaths; in autumn and winter, thirty-six breaths. Slow withdrawal, slow insertion. Qi arrival resembles a pulsating artery. Tonification follows the meridian flow, pushing inward; the left hand closes the needle hole, withdraw slowly, press quickly. Drainage opposes the meridian movement, extending outward; the left hand closes the needle hole, withdraw quickly, press slowly. Following and assisting is tonification. Opposing and seizing is drainage.
The above combines Ying-Sui, pushing/inward, and movement/stillness to discuss tonification and drainage.
[From the *Ling Shu*] Tonification requires identifying a site of excess, needling deeply, rarely pressing the hole, to exhaust the pathogenic Qi. Identifying a site of deficiency, needle superficially to nourish the pulse, quickly pressing the hole to prevent pathogenic entry. For full pulses, needle deeply to drain Qi. For empty pulses, needle superficially to prevent Essence-Qi loss, nourishing the pulse, extracting only pathogenic Qi. (From *Zhong Shi Pian*)
The above distinguishes tonification and drainage by depth: superficial is tonification, deep is drainage.
[Dou Hanqing] Tonification and drainage do not necessarily depend on respiration and needle movement, but on finger techniques. What are these? They are shaking, advancing/retreating, rubbing, rotating, flicking, twisting, following, palpating, grasping, pressing, grabbing, and cutting. "Shaking" means lifting and lowering the needle when Qi does not move. "Retreating" means pulling back slightly before withdrawing for tonification/drainage, then retaining before withdrawal. "Rubbing" mimics twisting thread; for heat symptoms, the patient lies outward; for cold, inward. "Advancing" refers to techniques for obtaining Deqi, varying by gender and season. "Rotating" involves gentle oscillation in abdominal points. "Shaking" is required when withdrawing for drainage. "Flicking" uses the thumb nail to stimulate Qi for tonification, not used for drainage. "Twisting" is manual rotation; note left/right orientation. "Following" involves stroking along meridians to promote Qi/Blood flow. "Palpating" closes the acupoint upon withdrawal for tonification. "Grasping/Cutting" uses the nail to cut around the point to disperse Qi/Blood before insertion, protecting Ying and Wei.
Question: Acupoints are bilateral. For tonification/drainage, do we needle only the diseased side or both? Answer: No. Treat according to the side of the disease. Left disease, tonify left; right disease, tonify right.
Question: The *Zhenjing* says moxa moxibustion after needling. Why? Answer: Needling is needling, moxibustion is moxibustion. One should not neglect moxibustion after needling, nor needling after moxibustion.
[From the *Nanjing*] What is "seeing as entering, seeing as exiting"? Answer: It means inserting the needle only when the left hand perceives Qi arrival, and withdrawing only when Qi departure is perceived. (Wang Bing notes this interpretation regarding acquiring Jing Qi is incorrect. See Chapter 80.)
[From the *Ling Shu*] "Qi arrival brings efficacy": Drainage makes it more empty. Empty means the pulse is large as before but not firm. If firm as before, although the patient feels better, the disease persists. Tonification makes it more solid. Solid means the pulse is large as before and becomes firmer. If large but not firm, although the patient feels relief, the disease persists. Thus, tonification creates solidity, drainage creates emptiness. Even if pain does not vanish instantly with needling, the disease will surely diminish. (From *Zhong Shi Pian*)
[From the *Suwen*] Needle deficiency to achieve solidity; needle excess to achieve emptiness. (*Zhen Jie* commentary: Needle excess to achieve emptiness means waiting for Yin Qi to arrive, feeling cold under the needle, then withdrawing. Needle deficiency to achieve solidity means waiting for Yang Qi to arrive, feeling heat under the needle, then withdrawing. Wang Bing notes: The key is efficacy upon Qi arrival.)
[From the *Ling Shu*] Three pulses move between the big toes; examine their excess or deficiency. Draining deficiency is called "double deficiency," worsening the disease. Press with fingers: if the pulse moves, is full, and rapid, drain quickly. If empty and slow, tonify. Reversing this worsens the disease. The movements are: Yangming above (Chongyang pulse), Jueyin middle (Taichong pulse), Shaoyin below (Taixi pulse).
[From the *Nanjing*] "East is excess, West is deficiency; drain South, tonify North." What does this mean? Answer: Metal, Wood, Water, Fire, Earth should balance each other. East is Wood, West is Metal. If Wood desires excess, Metal should level it. If Fire desires excess, Water should level it. If Earth desires Wood, Wood should level it. If Metal desires excess, Fire should level it. If Water desires excess, Earth should level it. East is Liver, indicating Liver excess. West is Lung, indicating Lung deficiency. Drain South (Fire), tonify North (Water). South is Fire, the Son of Wood. North is Water, the Mother of Wood.