春夏必致一阴。秋冬必致一阳者。何也。然。春夏温。必致一阴者。初下针。沉之至肾肝之
部。得气。引持之阴也。秋冬寒必致一阳者。初内针。浅而浮之。至心肺之部。得气。推而内之
阳也。是谓春夏必致一阴。秋冬必致一阳也。
上文言用针得气之理。此言用针致气之法。以顺四时阴阳之义。谓春夏初内针深。至肾肝之
部。得其一阴之气。即持针引至心肺之部而留之。秋冬初内针浅。至心肺之部。得其一阳之气。
然后推之至肾肝之部而留之也。
七十一难曰。经言刺荣无伤卫。刺卫无伤荣。何谓也。然。针阳者。卧针而刺之。刺阴者。
先以左手摄按所针荥输之处。气散乃内针。是谓刺荣无伤卫。刺卫无伤荣也。
此言用针浅深之法。卧针者。卧其针而刺之。则浅而不伤荣血也。以左手摄按者。令卫气散而
内针。则深而不伤卫气也。
七十二难（误列八十难）曰。经言有见如入。有见如出者。何谓也。然。所谓有见如入者。谓左
手见气来至。乃内针。针入见气尽。乃出针。是谓有见如入。有见如出也。
此言候气到而内针。候气尽而出针之义。如入如出如字。同而字。古通用。
七十三难曰。诸井者。肌肉浅薄。气少不足使也。刺之奈何。然。诸井者。木也。荥者火也。
火者。木之子。当刺井者。以荥泻之。故经言。补者不可以为泻。泻者不可以为补。此之谓也。
井属木。是火之母。荥属火。是木之子。比如肾实。当泻井木。而井木之穴。在手足指梢。
肉薄气少。不足施治。于是刺荥。所谓泻子令母虚。若舍荥而刺输。则土虚不能制水。肾邪更实
矣。若刺经。则金生水。肾邪必反甚矣。故曰。当刺井者。以荥泻之。故经言补者不可以为泻。
泻者不可以为补也。
七十四难曰。经言春刺井。夏刺荥。季夏刺输。秋刺经。冬刺合者。何也。然。春刺井者。
邪在肝。夏刺荥者。邪在心。季夏刺输者，邪在脾。秋刺经者。邪在肺。冬刺合者。邪在肾。其
肝心脾肺肾。而系于
春夏秋冬者。何也。然。五脏一病。辄有五也。假令肝病。色青者肝也。臊臭者肝也。喜酸者肝
也。喜呼者肝也。喜泣者肝也。其病众多。不可尽言也。四时有数。而并系于春夏秋冬者也。
针之要妙。在于秋毫者也。
此章言春夏秋冬之刺井荥输经合。非必春刺井。其邪在肝者。刺井也。井属木。春也。故
云春刺井也。余脏皆然。又问肝心脾肺肾何故系于春夏秋冬。故复举肝木之青臊酸呼泣。以明五
脏六腑之病众多。而并统于金木水火土之所属。如四时之有数。而并系于春夏秋冬之所属也。
然其要妙在分别脏腑。如察秋毫。故下章又明脏腑阴阳之义。
七十五难（误列五十一难）曰。病有欲得温者。有欲得寒者。有欲见人者。有不欲见人者。
而各不同。病在何脏腑也。然。病欲得寒而欲见人者。病在腑也。病欲得温而不欲见人者。病在
脏也。何以言之。腑者阳也。阳病欲得寒。又欲见人。脏者阴也。阴病欲得温。又欲闭户独处。恶
闻人声。故以别知脏腑之病也。
前三卷以脉别脏腑。切脉而治病也。此以所欲别脏腑。问情而针病也。
七十六难（误列七十八难）曰。针有补泻。何谓也。然。补泻之法。非必呼吸出内针也。
何以言之（坊本脱此四字）
呼内吸出为补。吸内呼出为泻。此章言不但此也。必以得气为主。义在下文。
然。知为针者。信其左。不知为针者。信其右。当刺之时。必先以左手。厌按所针荥输之处。
弹而努之。爪而下之。其气之来。如动脉之状。顺针而刺之。得气。推而内之。是谓补。动而伸
之。是谓泻。不得气。乃与男外女内。又不得气。是谓十死不治也。（厌与压同）
知为针者。善针之人也。左手厌按荥输。知肌肉浓薄。筋骨腠会。取穴分明。于左手指下
。然后以右手内针。不知为针者反是。凡用针之时。必先以左手弹之。使气脉努聚若动脉之状。
爪按真穴刺之。待气应于针。
因而推至当止之分。此谓补。若得气即摇动伸提。此谓泻。若久留针而气不至。则浮针于卫
分。左转以待其气。不至。又沉内于荣分。右转以待其气。若又不至。为阴阳俱绝。不治也。言
男女。即左右。
七十七难（误列七十六难）曰。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。（阳气即卫气阴气即荣
气）
此言补泻用针之法也。欲补。从卫取气浅针之。俟得气乃推内针于所虚之处。欲泻。从荣置
气深针之于所实之处。俟得气引针泄之。此补泻大要也。
七十八难（误列十二难）曰。经言五脏脉已绝于内。用针者反实其外。五脏脉已绝于外。用针者
反实其内。内外之绝。何以别之。然。五脏脉已绝于内者。肾肝脉绝于内也。而医者反补其心肺
。五脏脉已绝于外者。心肺脉绝于外也。而医者反补其肾肝。阳绝补阴。阴绝补阳。是谓实实虚
虚。损不足而益有余。如此死者。医杀之耳。
此言脉者。谓针刺脉络之脉。非寸关尺之脉也。绝者。气不至也。曰外内者。即荣卫阴阳上
下也。此言不知补泻之法。足以杀人。下文详言其法也。
七十九难曰。经言迎而夺之。安得无虚。随而济之。安得无实。虚之与实。若得若失。实之与
虚。若有若无。何谓也。（义在下文）
然。迎而夺之者。泻其子也。随而济之者。补其母也。假令心病。泻手心主输。（胞络之大
陵穴）是谓迎而夺之者也。补手心主井。（胞络之中冲穴）是谓随而济之者也。所谓实之与虚者
。濡牢之意也。气来实牢者为得。濡虚者为失。故曰若得若失也。
输属土。心病泻之。是泻子也。井属木。心病补之。是补母也。濡犹软也。牢犹 也。得失
。即有无也。心病。即胞络病也。
八十难（误列七十二难）曰。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。调气之方。必在阴阳
者。知其内外表里。随其阴阳而调之。故曰调气之方。必在乎阴阳。
此言迎随之气。随其逆顺而针之。调气之方。审其阴阳表里用药而调之也。
八十一难曰。经言无实实。无虚虚。损不足而益有余。是寸口脉耶。将病自有虚实也。其损
益奈何。然。是病非谓寸口脉也。谓病自有虚实也。假令肝实而肺虚。肝者木也。肺者金也
。金木当更相平。当知金平木。假令肺实。故知肝虚微少气。用针不补其肝。而反重实其肺。故
曰实实虚虚。损不足而益有余。此者中工之所害也。
此章虽承上而言针刺之补泻。其实为总结全部大法。而寓反复丁宁之意也。然特举经言无实实
虚虚。
损不足而益有余为问者。具见医理最严虚实之戒。虚实稍误。害如反掌。故设此谆谆垂训之辞也
。如上卷之言动脉会于寸口以下。十二经之脏腑。定寸关尺之脉位。以弦钩毛石之象。合四时之
盛衰。而又推展命门三焦。奇经络脉。阴乘阳乘。覆溢关格。六甲旺脉。损至脉症。五邪五泄。
伤寒积聚。厥痛狂癫。无一不极详且备。而犹虑后人不知五脏自有生克。以平为度之法。故云此非寸口脉也。谓病自有
虚实也。即此
自有虚实一句。乃示人以法外之法也。得乎此。即经所谓不治已病。治未病之法亦得矣。凡人脉
之虚实。必因病而见。未有病见虚实。而脉不见虚实者也。今言自有虚实。乃五脏自有相制之虚
实。不同于脉之虚实论也。如肝实而肺虚。肝木受制于肺金者也。因肺虚不能制肝。所以谓之
肝实。若治肝之实。非矣。医当补肺金之虚。则肝之实。肺自能制之也。如肺实肝虚。肺乃制肝者
也。肺既实则制肝太过。若徒补肝之虚。而不治其致虚之源。亦非矣。医当泻肺金之实。则肝木自
能条达也。若不能治其致虚之源。苟能知虚知实。犹不至于大谬。更有不知相制之虚实。反补其
实而泻其虚。损不足而益有余。使轻证必重。重证必死。所谓中工之害也。举肝肺则他脏俱可类
推。学人能不惕然知警乎。或问难经至八十一难而止。取何义耶。余曰。此越人悉体轩岐之旨。
而寓尊经之义乎。如素问九卷。而分八十一篇。灵枢九卷。亦分八十一篇。共一十八卷。后人析
十二卷。二十四卷。此皆变乱古圣之旨。大失尊经之义。今即以灵素证之可明矣。考素问离合真
邪论。黄帝问曰。余闻九针九篇。夫子乃因而九之。九九八十一篇。余尽通其意矣。又灵枢九针
论。岐伯曰。夫圣人之起天地之数也。一而九之。故以立九野。九九八十一。以起黄钟之数焉。若
此者。乃知天地大德曰生。重阳九之数也。故轩岐作内经。亦体天地阳生之道。而符此九九之数
也。今难经之八十一难。乃合内经而一贯之。首尾相应。全体通灵。岂非越人悉体轩岐之旨。而寓尊
经之义乎。
中峰云。余见难经各家之注多矣。皆不能探作者之心。不过随文敷衍。并无一语道及全体通灵之妙
。今阅是注。知越人引灵素一十八卷之义。尊其序而该其要。会通一贯。作此八十一条之大文
。学人能玩索研求。则一十八卷之灵素。莫不头头是道矣。乃近世张介宾以内经分类各门。名曰类
经。以备医者易于查对。犹夫吾儒之五经。时下亦有分门类叙以供便览。无非欲开浅学摘用之
窦。殊不知气脉不贯。头绪全无。临文之际。究无益也。因悟难经之妙。不易内经之次序。能运
内经之全神。必轩岐假手于越人。而作此合璧之书也。然三千年来。实无人道。乃得是注而始明
。又何莫非越人之假手于先生乎。
春夏季节必须引导产生一阴之气，秋冬季节必须引导产生一阳之气，这是为什么呢？回答说：春夏气候温暖，必须引导产生一阴之气，是因为初下针时，将针深刺至肾肝所在的深层部位，得气后，持针向左（或向下）牵引以引导阴气。秋冬气候寒冷，必须引导产生一阳之气，是因为初进针时，浅刺并浮提于心肺所在的浅层部位，得气后，推针向内以引导阳气。这就叫做春夏必致一阴，秋冬必致一阳。
上文论述的是用针时获得经气的原理，这里论述的是用针时引导经气的方法，旨在顺应四时阴阳变化的规律。意思是说，春夏初进针要深，到达肾肝所在的深层部位，得到其一阴之气，然后持针引向心肺所在的浅层部位并留针；秋冬初进针要浅，到达心肺所在的浅层部位，得到其一阳之气，然后将针推入肾肝所在的深层部位并留针。
第七十一难说：医经上说，刺荣分不要伤及卫分，刺卫分不要伤及荣分，这是什么意思呢？回答说：针刺阳分（卫分），要卧针斜刺；针刺阴分（荣分），先用左手捏按所针的荥穴和输穴，待卫气散开后再进针。这就叫做刺荣分不伤卫分，刺卫分不伤荣分。
这里论述的是用针深浅的方法。卧针而刺，针身倾斜，则进针浅而不伤荣血。用左手捏按，使卫气分散后再进针，则进针深而不伤卫气。
第七十二难（误列为第八十难）说：医经上有“有见如入，有见如出”的说法，这是什么意思呢？回答说：所谓“有见如入”，是指左手感觉到经气到来时，才进针；针入后，感觉到经气已尽，才出针。这就叫做“有见如入，有见如出”。
这里论述的是候气得气后进针、候气尽后出针的意义。“如”字与“而”字古时通用。
第七十三难说：所有的井穴，肌肉浅薄，经气少而不足以施用泻法，该怎么办呢？回答说：所有的井穴属木，荥穴属火，火是木的子行。当需要刺井穴时，应当刺荥穴来泻之。所以医经上说：“补法不能当作泻法用，泻法不能当作补法用。”就是这个道理。
井穴属木，是火之母；荥穴属火，是木之子。比如肾实证，应当泻井木穴，但井木穴位于手足指端梢部，肉薄气少，不足以施治。于是改刺荥穴，这就是所谓的“泻子令母虚”。如果舍弃荥穴而刺输穴，则土气虚弱不能制约水气，肾邪反而更盛了。如果刺经穴，则金生水，肾邪必然更加严重。所以说，当刺井穴时，应以荥穴来泻之。因此医经上说：“补者不可以为泻，泻者不可以为补。”
第七十四难说：医经上说，春刺井，夏刺荥，季夏刺输，秋刺经，冬刺合，这是为什么呢？回答说：春刺井，是因为邪在肝；夏刺荥，是因为邪在心；季夏刺输，是因为邪在脾；秋刺经，是因为邪在肺；冬刺刺合，是因为邪在肾。这五脏（肝心脾肺肾）为什么分别对应春夏秋冬呢？回答说：五脏患一种病，往往表现出五种征象。例如肝病，面色青是肝的表现，气味臊臭是肝的表现，喜食酸味是肝的表现，喜欢呼喊是肝的表现，喜欢哭泣是肝的表现。其病症众多，不可尽言。四季各有定数，并且都归属于春夏秋冬。针刺的要妙，在于像观察秋毫一样细致入微。
这一章论述春夏秋冬刺井、荥、输、经、合的道理，并非一定春天只刺井穴，而是邪在肝时才刺井穴。井穴属木，对应春季，所以说春刺井。其他脏腑也是如此。又问肝心脾肺肾为何分别对应春夏秋冬，于是再次列举肝木的青色、臊味、酸味、呼喊、哭泣等表现，以说明五脏六腑的病症众多，但都统属于金木水火土的五行归属，就像四季有定数并归属于春夏秋冬一样。然而其关键精妙之处在于分辨脏腑，如同察视秋毫般清晰，所以下一章又阐明脏腑阴阳的意义。
第七十五难（误列为第五十一难）说：有的病人想要温暖，有的病人想要凉爽，有的病人想见人，有的病人不想见人，各不相同，病在哪个脏腑呢？回答说：病人想要凉爽且想见人的，病在腑；病人想要温暖且不想见人的，病在脏。为什么这样说呢？腑属阳，阳病想要凉爽，又想见人；脏属阴，阴病想要温暖，又想关上门独自居住，厌恶听到人声。所以以此区别脏腑的病。
前三卷通过脉象来辨别脏腑，是通过切脉来治病。这里通过病人的欲望来辨别脏腑，是通过询问情志来治疗疾病。
第七十六难（误列为第七十八难）说：针刺有补法和泻法，是什么意思呢？回答说：补泻的方法，不一定非要在呼吸进出针上讲究。
呼时进针、吸时出针为补法，吸时进针、呼时出针为泻法。本章说的不仅仅是这些，必须以得气为主，意义在下文。
回答说：懂得针刺的人，信赖左手；不懂针刺的人，信赖右手。当针刺时，必须先以左手按压所针的荥穴和输穴，弹击穴位使其隆起，用指甲掐按定位。经气到来时，状如动脉跳动，顺着针势刺入。得气后，推针深入，这叫补法；摇动针身向外提伸，这叫泻法。如果不得气，就根据男女不同采用外内不同的手法；如果再不得气，就是十死不治的绝症。（“厌”通“压”）
懂得针刺的人，是善于用针的人。左手按压荥输穴，了解肌肉的厚薄、筋骨腠理的结构，取穴准确，然后在左手的配合下，再用右手进针。不懂针刺的人则相反。凡是用针时，必须先以左手弹击穴位，使气血汇聚如动脉搏动之状，用指甲掐按确定真穴再刺入，等待经气应针而至。
因而推针至应当停止的深度，这叫补法。如果得气后立即摇动提伸，这叫泻法。如果久留针而经气不至，则将浮针置于卫分，左转以待其气；若仍不至，又将针沉入荣分，右转以待其气。如果仍然不至，说明阴阳之气俱绝，无法治疗。文中所说的男女，即指左右手。
第七十七难（误列为第七十六难）说：什么叫补泻？当补的时候，从哪里获取经气？当泻的时候，把经气放置在哪里？回答说：当补的时候，从卫分获取经气；当泻的时候，从荣分排出经气。如果阳气不足，阴气有余，应当先补阳，后泻阴；如果阴气不足，阳气有余，应当先补阴，后泻阳。荣卫之气通行，这是关键。（阳气即卫气，阴气即荣气）
这里论述的是补泻用针的方法。想要补，从卫分取气，浅刺，等到得气后将针推入虚损的部位；想要泻，从荣分置气，深刺于实盛的部位，等到得气后引针泄出。这是补泻的大要。
第七十八难（误列为第十二难）说：医经上说，五脏脉气在内已绝，用针的人反而充实其外；五脏脉气在外已绝，用针的人反而充实其内。内外之绝，如何区分呢？回答说：五脏脉气在内已绝，是指肾肝脉气在内已绝，而医生反而补益心肺；五脏脉气在外已绝，是指心肺脉气在外已绝，而医生反而补益肾肝。阳绝补阴，阴绝补阳，这就叫做“实实虚虚”，损害不足的，增加有余的。这样导致死亡的，是医生杀死了他。
这里说的脉，是指针刺脉络的脉，不是寸关尺的脉。绝，是指气不至。所说的内外，即指荣卫阴阳上下。这里论述的是不懂得补泻之法，足以致人死亡。下文详细论述其方法。
第七十九难说：医经上说“迎而夺之，安得无虚；随而济之，安得无实”，以及“虚之与实，若得若失；实之与虚，若有若无”，这是什么意思？（意义在下文）
回答说：“迎而夺之”，是泻其子穴；“随而济之”，是补其母穴。例如心病，泻手心主输穴（心包络的大陵穴），这叫“迎而夺之”；补手心主井穴（心包络的中冲穴），这叫“随而济之”。所谓“实之与虚”，是指濡软与坚牢的意思。经气来势实牢，是为得气；经气来势濡虚，是为失气。所以说“若得若失”。
输穴属土，心病泻之，是泻子；井穴属木，心病补之，是补母。濡，犹软也；牢，犹硬也。得失，即有无。心病，即心包络病。
第八十难（误列为第七十二难）说：医经上说“能知迎随之气，可令调之；调气之方，必在阴阳”，这是什么意思？回答说：所谓“迎随”，是知道荣卫的流行、经脉的往来，顺着或逆着经脉走向取穴，所以叫迎随。调气的方法，必须在阴阳上下功夫，是知道内外表里，顺着阴阳虚实来调理，所以叫调气之方必在乎阴阳。
这里论述的是迎随之气，顺着逆顺而针刺；调气的方法，审察阴阳表里用药来调理。
第八十一难说：医经上说“无实实，无虚虚，损不足而益有余”，这是指寸口脉吗？还是病本身自有虚实？其损益情况是怎样的？回答说：这不是指寸口脉，而是指病本身自有虚实。例如肝实而肺虚，肝属木，肺属金，金木应当互相平衡。应当知道金平木。假如肺实，所以知道肝虚微少气。如果用针不补肝，反而重实其肺，这就叫做“实实虚虚”，损不足而益有余。这是中等水平医生的危害。
这一章虽然承接上文谈论针刺的补泻，其实是总结全部大法，并寓有反复叮咛之意。特别引用医经中“无实实，虚虚，损不足而益有余”作为提问，充分可见医理最严谨，对虚实的告诫最为重要。虚实稍有错误，危害如反掌之间。所以设立此谆谆教诲之辞。如上卷提到的动脉会于寸口以下，十二经的脏腑，定寸关尺的脉位，以弦钩毛石的脉象，结合四时的盛衰，而又推展命门三焦、奇经络脉、阴乘阳乘、覆溢关格、六甲旺脉、损至脉症、五邪五泄、伤寒积聚、厥痛狂癫等，无一不详尽完备。但仍担心后人不知道五脏自有生克、以平为度的法则，所以说“此非寸口脉也，谓病自有虚实也”。即这“自有虚实”一句，乃是示人以法外之法。懂得了这个，也就得到了医经所说的“不治已病，治未病”的方法。凡是人的脉之虚实，必定因病而显现，没有病见虚实而脉不见虚实的。现在说自有虚实，乃是指五脏自有相互制约的虚实，不同于脉之虚实论。如肝实而肺虚，是肝木受制于肺金。因肺虚不能制肝，所以谓之肝实。若治肝之实，就错了。医生应当补肺金之虚，则肝之实，肺自能制之。如肺实肝虚，肺是制肝者。肺既实则制肝太过，若徒补肝之虚，而不治其致虚之源，也不对。医生应当泻肺金之实，则肝木自能条达。如果不能治其致虚之源，苟且知道虚知实，还不至于大错。更有不知道相制之虚实，反而补其实而泻其虚，损不足而益有余，使轻证必重，重证必死，这就是所谓中等水平医生的危害。举肝肺为例，其他脏腑皆可类推。学医者能不警惕知警吗？有人问《难经》到第八十一难而止，取什么义理呢？我说：这是扁鹊完全体悟轩辕岐伯的宗旨，而寓含尊重经典的意义。如《素问》九卷，分为八十一篇；《灵枢》九卷，也分为八十一篇，共一十八卷。后人将其析分为十二卷、二十四卷，这都是变乱古圣旨意，大失尊重经典之义。现在即以《灵》《素》验证就可以明白。考《素问·离合真邪论》，黄帝问道：“我听说九针九篇，先生于是乘以九，九九八十一篇，我都通晓其意了。”又《灵枢·九针论》，岐伯说：“圣人建立天地之数，一而九之，故以立九野，九九八十一，以起黄钟之数。”像这样，就知道天地大德曰生，重阳九之数。所以轩辕岐伯作《内经》，也是体悟天地阳生之道，而符合此九九之数。如今《难经》的八十一难，乃与《内经》一贯相通，首尾相应，全体通灵，难道不是扁鹊完全体悟轩辕岐伯的宗旨，而寓含尊重经典之义吗？
中峰先生说：我见过《难经》各家注释很多，都不能探求作者的心意，不过是随文敷衍，没有一句话道及全体通灵之妙。今天阅读这个注释，知道扁鹊引用《灵》《素》一十八卷的意义，尊重其次序而概括其要点，会通一贯，作成这八十一条的大文。学人能玩索研求，则一十八卷的《灵》《素》，无不头头是道。近代张介宾将《内经》分类各门，名为《类经》，以备医者易于查对，犹如我们儒家的五经，时下也有分门类叙以供便览，无非是想给浅学者提供摘用的方便，殊不知气脉不贯通，头绪全无，临文之际，终究无益。由此领悟《难经》之妙，不易《内经》之次序，能运用《内经》之全神，必然是轩辕岐伯借扁鹊之手，而作成这合璧之书。然而三千年来，实在无人道破，直到得到这个注释才开始明白，这难道又不是扁鹊借先生之手吗？
In spring and summer, one must necessarily elicit a Yin qi; in autumn and winter, one must necessarily elicit a Yang qi. Why is this? The answer is: In spring and summer, when the climate is warm, one must elicit a Yin qi. This is because upon initial needle insertion, the needle is thrust deeply to the regions of the Kidney and Liver (Shèn Gān). Upon obtaining Deqi (arrival of Qi), the needle is held and drawn towards the Yin aspect. In autumn and winter, when the climate is cold, one must elicit a Yang qi. This is because upon initial needle insertion, the needle is inserted shallowly and floated to the regions of the Heart and Lung (Xīn Fèi). Upon obtaining Deqi, the needle is pushed inward to elicit the Yang aspect. This is what is meant by "in spring and summer, one must necessarily elicit a Yin qi; in autumn and winter, one must necessarily elicit a Yang qi."
The preceding text discusses the principle of obtaining Qi during needling; this text discusses the method of guiding Qi during needling, aiming to conform to the principles of Yin and Yang changes across the four seasons. It means that in spring and summer, the initial needle insertion should be deep, reaching the deep regions of the Kidney and Liver, to obtain their Yin Qi, after which the needle is held and guided to the superficial regions of the Heart and Lung for retention. In autumn and winter, the initial needle insertion should be shallow, reaching the superficial regions of the Heart and Lung, to obtain their Yang Qi, after which the needle is pushed into the deep regions of the Kidney and Liver for retention.
Difficulty 71 states: The medical classics say, "When penetrating Ying (Nutrient) vessels, do not injure Wei (Defensive) vessels; when penetrating Wei vessels, do not injure Ying vessels." What does this mean? The answer is: To needle Yang aspects (Wei vessels), the needle should be laid horizontally (oblique insertion). To needle Yin aspects (Ying vessels), use the left hand first to press and knead the acupoints of the Ying and Shu categories where the needle is to be inserted. Once the Qi has dispersed, insert the needle. This is called "penetrating Ying without injuring Wei, and penetrating Wei without injuring Ying."
This passage discusses the methods of needle depth. Horizontal needling implies an oblique angle, resulting in shallow insertion that does not injure Ying blood. Pressing with the left hand disperses Wei Qi before insertion, allowing for deep insertion that does not injure Wei Qi.
Difficulty 72 (erroneously listed as Difficulty 80) states: The medical classics mention "Ru You Ru Ru" (Entering as seen) and "Ru You Ru Chu" (Exiting as seen). What does this mean? The answer is: By "Ru You Ru Ru," it means that when the left hand perceives the arrival of Qi, the needle is inserted. After the needle is inserted, when it is perceived that the Qi has exhausted, the needle is withdrawn. This is called "Ru You Ru Ru" and "Ru You Ru Chu."
This explains the meaning of inserting the needle upon waiting for Qi to arrive and withdrawing it upon waiting for Qi to exhaust. The character "Ru" (as/if) was commonly used interchangeably with "Er" (and) in ancient times.
Difficulty 73 states: All Jing-Well points have thin muscle and scarce Qi, insufficient for treatment. How should they be needled? The answer is: All Jing-Well points belong to Wood, and all Ying-Spring points belong to Fire. Fire is the child of Wood. When one needs to needle a Jing-Well point, one should needle the Ying-Spring point to drain it. Thus, the classics say, "Tonification cannot be used as drainage, and drainage cannot be used as tonification." This refers to this principle.
Jing-Well points belong to Wood, which is the mother of Fire. Ying-Spring points belong to Fire, which is the child of Wood. For example, in cases of Kidney Excess, one should drain the Jing-Well Wood point. However, Jing-Well Wood points are located at the tips of the fingers and toes, where flesh is thin and Qi is scarce, making them unsuitable for direct treatment. Therefore, one needles the Ying-Spring point. This is known as "draining the child to make the mother deficient." If one were to abandon the Ying-Spring point and needle the Shu-Stream point instead, Earth Qi would become deficient and fail to control Water Qi, causing Kidney pathogenic factors to become even more excessive. If one were to needle the Jing-River point, Metal generates Water, and Kidney pathogenic factors would inevitably worsen. Hence, it is said that when needling a Jing-Well point, one should use the Ying-Spring point to drain it. Therefore, the classics state, "Tonification cannot be used as drainage, and drainage cannot be used as tonification."
Difficulty 74 states: The medical classics say, "In spring, needle Jing-Well; in summer, needle Ying-Spring; in late summer, needle Shu-Stream; in autumn, needle Jing-River; in winter, needle He-Sea." Why is this? The answer is: Spring needling of Jing-Well points addresses pathogens in the Liver; Summer needling of Ying-Spring points addresses pathogens in the Heart; Late Summer needling of Shu-Stream points addresses pathogens in the Spleen; Autumn needling of Jing-River points addresses pathogens in the Lung; Winter needling of He-Sea points addresses pathogens in the Kidney. Why are these five Zang organs (Liver, Heart, Spleen, Lung, Kidney) associated with spring, summer, late summer, autumn, and winter respectively? The answer is: A disease in one Zang organ often manifests with five signs. For instance, in Liver disease, a green complexion indicates the Liver; a fishy odor indicates the Liver; preference for sour taste indicates the Liver; a tendency to shout indicates the Liver; a tendency to weep indicates the Liver. There are many such symptoms, impossible to list entirely. The four seasons have their respective numbers and are all associated with spring, summer, late summer, autumn, and winter. The subtlety of needling lies in being as meticulous as observing the finest down of autumn.
This chapter discusses the needling of Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points according to the four seasons. It does not mean that one *only* needles Jing-Well points in spring, but rather that when the pathogen is in the Liver, one needles the Jing-Well point. Since Jing-Well points belong to Wood and correspond to Spring, it is said that "Spring needles Jing-Well." The same applies to other organs. The question arises why the Liver, Heart, Spleen, Lung, and Kidney correspond to spring, summer, late summer, autumn, and winter. Thus, the manifestations of Liver Wood—green color, fishy odor, sour taste, shouting, and weeping—are cited again to clarify that although diseases of the five Zang and six Fu organs are numerous, they are all unified under the Five Elements (Metal, Wood, Water, Fire, Earth), just as the four seasons have fixed numbers and are associated with spring, summer, late summer, autumn, and winter. However, the key subtlety lies in distinguishing the Zang organs, as clearly as observing autumn down. Therefore, the next chapter further clarifies the principles of Yin and Yang of the Zang organs.
Difficulty 75 (erroneously listed as Difficulty 51) states: Some patients desire warmth, some desire cold, some wish to see people, and some do not wish to see people. These desires differ. Which Zang or Fu organ is diseased? The answer is: Patients who desire cold and wish to see people have disease in the Fu organs. Patients who desire warmth and do not wish to see people have disease in the Zang organs. Why is this so? Fu organs belong to Yang; Yang diseases desire cold and wish to see people. Zang organs belong to Yin; Yin diseases desire warmth and wish to close doors and stay alone, detesting human voices. Thus, one distinguishes Zang and Fu diseases by these preferences.
The first three volumes distinguished Zang and Fu organs through pulse diagnosis, treating disease by palpating the pulse. This volume distinguishes Zang and Fu organs through patient desires, treating disease by inquiring about emotional states.
Difficulty 76 (erroneously listed as Difficulty 78) states: Needling involves tonification and drainage. What does this mean? The answer is: The methods of tonification and drainage do not necessarily depend on respiration during needle insertion and withdrawal.
(Insertion during exhalation and withdrawal during inhalation is tonification; insertion during inhalation and withdrawal during exhalation is drainage.) This chapter states that it is not merely about this, but primarily about obtaining Deqi. The meaning follows in the subsequent text.
The answer is: One who understands needling trusts the left hand; one who does not understand needling trusts the right hand. At the time of needling, one must first use the left hand to press and knead the Ying-Spring and Shu-Stream acupoints, flick the area to make it prominent, and mark it with fingernails. When Qi arrives, resembling the pulsation of an artery, insert the needle along its direction. Upon obtaining Deqi, push the needle inward; this is tonification. Shake and extend the needle outward; this is drainage. If Deqi is not obtained, apply different techniques for males and females. If Deqi is still not obtained, it indicates ten incurable conditions. ("Yan" is synonymous with "Ya," meaning press.)
One who understands needling is a skilled practitioner. Using the left hand to press Ying-Spring points allows knowledge of muscle thickness, bone-tendon structures, and clefts, ensuring accurate point selection. Then, using the right hand, the needle is inserted. One who does not understand needling does the opposite. Whenever needling, one must first flick with the left hand to gather Qi and pulses until they resemble arterial pulsation. Mark the true point with nails and insert the needle, waiting for Qi to respond.
Then, push the needle to the appropriate depth; this is tonification. If Deqi is obtained, immediately shake and lift the needle; this is drainage. If Qi does not arrive after prolonged retention, float the needle in the Wei level, rotate left to await Qi. If it still does not arrive, sink the needle into the Ying level, rotate right to await Qi. If it still does not arrive, it indicates exhaustion of both Yin and Yang Qi, which is incurable. The terms male and female here refer to left and right hands.
Difficulty 77 (erroneously listed as Difficulty 76) states: What are tonification and drainage? When tonifying, from where is Qi taken? When draining, where is Qi placed? The answer is: When tonifying, take Qi from the Wei level; when draining, place Qi from the Ying level. If Yang Qi is deficient and Yin Qi is excessive, one must first tonify Yang and then drain Yin. If Yin Qi is deficient and Yang Qi is excessive, one must first tonify Yin and then drain Yang. The free circulation of Ying and Wei Qi is the essence. (Yang Qi is equivalent to Wei Qi; Yin Qi is equivalent to Ying Qi.)
This discusses the methods of tonification and drainage in needling. To tonify, take Qi from the Wei level with shallow needling. Wait for Deqi, then push the needle into the deficient area. To drain, place Qi from the Ying level with deep needling into the excess area. Wait for Deqi, then withdraw the needle to release it. This is the major principle of tonification and drainage.
Difficulty 78 (erroneously listed as Difficulty 12) states: The medical classics say, "When the pulse of the five Zang organs is exhausted internally, the practitioner mistakenly reinforces the exterior. When the pulse of the five Zang organs is exhausted externally, the practitioner mistakenly reinforces the interior." How are internal and external exhaustion distinguished? The answer is: Internal exhaustion of the five Zang pulses refers to the exhaustion of Kidney and Liver pulses internally. If the physician mistakenly tonifies the Heart and Lung, and external exhaustion refers to the exhaustion of Heart and Lung pulses externally, if the physician mistakenly tonifies the Kidney and Liver, tonifying Yin when Yang is exhausted and tonifying Yang when Yin is exhausted, this is called "reinforcing excess and depleting deficiency," damaging what is insufficient and adding to what is already excessive. Death resulting from this is caused by the physician.
The "pulse" mentioned here refers to the meridians needled, not the Cun-Guan-Chi pulse positions. "Exhausted" means Qi does not arrive. "Internal and external" refer to Ying/Wei, Yin/Yang, upper/lower. This warns that ignorance of tonification and drainage methods can lead to death. The following text details these methods.
Difficulty 79 states: The medical classics say, "Attacking and seizing [pathogens], how can there not be deficiency? Following and assisting [Qi], how can there not be excess?" Also, "Deficiency and excess are like gaining or losing; excess and deficiency are like having or not having." What does this mean? (Meaning follows below.)
The answer is: "Attacking and seizing" refers to draining the Child element. "Following and assisting" refers to tonifying the Mother element. For example, in Heart disease, draining the Shu-Stream point of the Pericardium (Daling, PC-7) is called "attacking and seizing." Tonifying the Jing-Well point of the Pericardium (Zhongchong, PC-9) is called "following and assisting." The phrase "excess and deficiency" refers to the sensations of firmness and softness. A Qi response that is firm and solid indicates successful acquisition (Deqi); a soft and empty sensation indicates failure. Hence, it is said, "like gaining or losing."
Shu-Stream points belong to Earth; draining them in Heart disease drains the Child. Jing-Well points belong to Wood; tonifying them in Heart disease tonifies the Mother. "Ru" (soft) implies softness; "Lao" (firm) implies hardness. Gain and loss equate to having and not having. Heart disease here refers to Pericardium disease.
Difficulty 80 (erroneously listed as Difficulty 72) states: The medical classics say, "If one knows the Qi of Attacking and Following, regulation can be achieved. The method of regulating Qi must lie in Yin and Yang." What does this mean? The answer is: "Attacking and Following" means knowing the flow of Ying and Wei Qi and the course of the meridians. Taking points according to their reverse or forward directions is called Attacking and Following. The method of regulating Qi must lie in Yin and Yang means understanding internal/external and interior/exterior, and regulating according to Yin and Yang imbalances. Hence, it is said that the method of regulating Qi depends on Yin and Yang.
This discusses regulating Qi by needling according to reverse or forward directions. Regulating Qi involves examining Yin/Yang and interior/exterior to administer medication or treatment.
Difficulty 81 states: The medical classics say, "Do not reinforce excess, do not deplete deficiency; do not damage the insufficient and benefit the excessive." Does this refer to the Cun-Kou pulse, or does disease inherently possess excess and deficiency? How are these damages and benefits manifested? The answer is: This does not refer to the Cun-Kou pulse, but to the inherent excess and deficiency of the disease itself. For example, Liver Excess and Lung Deficiency. The Liver belongs to Wood, and the Lung belongs to Metal. Metal and Wood should balance each other. One must understand that Metal controls Wood. Suppose the Lung is Excess; thus, the Liver is known to be slightly deficient in Qi. If needling is used to tonify the Liver, but instead the Lung is heavily reinforced, this is called "reinforcing excess and depleting deficiency," damaging the insufficient and benefiting the excessive. This is the harm caused by average physicians.
Although this chapter continues the discussion on needling tonification and drainage, it actually summarizes the entire major principles, implying repeated caution. Specifically citing the classic warning against "reinforcing excess, depleting deficiency, damaging the insufficient, and benefiting the excessive" highlights the strictness of medical theory regarding excess and deficiency. Errors in excess and deficiency carry immediate dangers. Hence, this earnest admonition is provided. As discussed in earlier volumes regarding arterial convergence at Cun-Kou, the twelve meridians' Zang-Fu associations, Cun-Guan-Chi pulse positions, pulse qualities (string-like, hook, hair, stone) corresponding to seasonal fluctuations, and extensions to Mingmen, Sanjiao, extraordinary vessels, Yin/Yang invasions, Fu-Yi/Guan-Ge patterns, Six-Jia flourishing pulses, damage/reduction pulse symptoms, five evils/five turbidities, Shaoyang accumulation, Jue pain, mania, epilepsy, etc., are all detailed comprehensively. Yet, fearing that later generations may not understand the innate generation and restriction cycles of the five Zang organs, aiming for balance, it states, "This is not about the Cun-Kou pulse, but that disease has its own excess and deficiency." This phrase "disease has its own excess and deficiency" reveals a method beyond standard methods. Grasping this aligns with the classic principle of "treating disease before it arises." Generally, pulse excess/deficiency manifests due to disease; there is no case where disease shows excess/deficiency but the pulse does not reflect it. Now, saying "inherent excess and deficiency" refers to the mutual restraint dynamics within the five Zang organs, distinct from pulse-based excess/deficiency analysis. For instance, Liver Excess and Lung Deficiency imply Liver Wood is constrained by Lung Metal. Because Lung Deficiency fails to constrain Liver, Liver appears Excess. Treating Liver Excess directly would be wrong. The physician should tonify Lung Metal Deficiency, allowing the Lung to naturally constrain the Liver. Conversely, if Lung Excess and Liver Deficiency exist, the Lung (which constrains Liver) over-constrains the Liver. Merely tonifying Liver Deficiency without addressing its source is also incorrect. The physician should drain Lung Metal Excess, allowing Liver Wood to flourish freely. If one cannot address the source of deficiency, merely knowing excess and deficiency avoids major errors. However, those who ignore mutual restraint dynamics and mistakenly tonify excess while draining deficiency, damaging the insufficient and benefiting the excessive, will turn mild cases severe and severe cases fatal. This is the harm of average physicians. Using Liver and Lung as examples, other organs can be inferred. Should not students be vigilant and alert? Someone asks: Why does the *Nanjing* end at Difficulty 81? I reply: Bian Que fully embodies the intent of Xuanyuan (Yellow Emperor) and Qibo, respecting the classics. The *Suwen* (Nine Volumes) is divided into 81 chapters; the *Lingshu* (Nine Volumes) is also divided into 81 chapters, totaling 18 volumes. Later scholars split them into 12 or 24 volumes, disrupting the ancients' intent and disrespecting the classics. Verification with *Lingshu* and *Suwen* confirms this. In *Suwen: Li He Zhen Xie Lun*, the Yellow Emperor asks: "I heard of nine needles and nine chapters. Sir multiplied nine by nine, resulting in eighty-one chapters. I have understood their meaning." In *Lingshu: Jiu Zhen Lun*, Qibo says: "The sage establishes the numbers of heaven and earth. One becomes nine, establishing the Nine Fields. Nine times nine is eighty-one, initiating the number of Huangzhong." Thus, one knows that Heaven and Earth's great virtue is life, valuing the number nine repeatedly. Therefore, Xuanyuan and Qibo composed the *Neijing*, embodying the way of heavenly Yang birth, conforming to the number eighty-one. The eighty-one difficulties of the *Nanjing* integrate seamlessly with the *Neijing*, responding head to tail, possessing complete spiritual coherence. Is this not Bian Que fully embodying the intent of Xuanyuan and Qibo, respecting the classics?
Master Zhongfeng stated: I have seen many commentaries on the *Nanjing*, none of which probed the author's mind, merely elaborating on the text without mentioning the profound coherence. Reading this commentary, I realize Bian Que drew upon the meanings of the eighteen volumes of *Lingshu* and *Suwen*, respecting their order and summarizing their essentials, integrating them into these eighty-one difficulties. Students who study this thoroughly will find the eighteen volumes of *Lingshu* and *Suwen* logically consistent. Zhang Jibin of recent times classified the *Neijing* into sections named *Leijing* for easy reference, similar to儒家 classifications of the Five Classics for convenience. This aims to facilitate quick lookup for beginners, unaware that without continuous Qi and pulse connection, the threads are disjointed, offering little help during clinical practice. From this, I perceive the brilliance of the *Nanjing*: it preserves the *Neijing*'s sequence, utilizing its full spirit. It seems Xuanyuan and Qibo used Bian Que as a medium to create this complementary book. For three thousand years, no one had elucidated this until this commentary clarified it. Is this not also Bian Que using this master as a medium?