(一)熟读歌赋，继承前人经验按症取穴，这是针灸疗法的特点，也是古今针灸家的一贯传统。如「肚腹三里留」。凡肠胃道疾病，如腹痛、腹胀、肠鸣、泄泻等等，都可取用三里穴治疗。这里就涉及到熟读背诵针灸歌赋的基本功问题。各种歌赋，多是前人临床经验的总结，便于记忆，其文流畅，朗朗上口，结构清晰，言筒意肱。如「四总穴」即是筒单易诵的四旬歌诀，其中「面口合谷收」一语，就说明合谷穴常用治疗口腔、颜面部的疾病。即针刺合谷不但常用止牙痛，且对口腔和颜面部的炎性疾患，也有显著效果。故我在治疗面瘫早期伴神经炎症患者时，每加针合谷而收良效。曾有一例齿龈出血患者，长期服用维生素c、K等无效，经我针刺合谷十次后，霍然而愈。此外，曾遇一倒血吸虫繁衍地区的农民，肝肿大至脐旁，一日突然剧痛，延我针治。当时我还是首次见到这种肝脏剧痛病人，遂按《通玄指要赋》中「胁下肋痛者，刺阳陵而即止」和《标幽赋》中「胸满腹痛针内关」等记载，选取右侧阳陵泉与内关穴，进针得气后，痛即缓解，留针十分钟后，完全恢复正常。
在前人针灸歌赋的基础上，结合自己多年的临床体会，自撰了「治疗总穴歌」，作为临证的重点用穴，现录如下，供作参考：
面口合谷收，曲池配穴优；如遇头痛时，风池效可奏。胸胁内关谋，可向外关透。肚腹三里求，上腹中脘搜，下腹加关元，天枢治脐周。腰背委中求，殷门亦可收，陀脊按部加，斜向脊柱透；下腰大肠俞，上腰肾俞揉。上肢取曲池，合谷肩髑施，下肢阳陵泉，环跳绝骨刺，月身节骱病，疼痛取阿是，避开大血管，胸背禁深刺。
(=)重视操作，掌握针刺手法针刺手法，是针球治疗法中的重要环节。熟读各种针灸歌赋，虽可继承前人的临证选穴经验，但在针刺疗法中，常困操作手法的不同，而在同样疾病、同样穴位的情况下，其所得的临床效应也不同。因此不论古今针灸学者，皆非常重视针刺的操作手法。这种手法的目的，古代称为补泻，即「虚则补之」、「实则泻之」。现代称补泻手法为兴奋与抑制凡是体质机能减退的应予兴奋的方法，体质机能亢进的应予抑制的方法。因此，一般多认为古代所称的针刺补法，即是现代的轻刺激兴奋法}古代的泻法，就是现代的强刺激抑制法。但是二者实际上是否完全符合，却是值得商榷的，下文将淡及这一问题。
1．学习经典，要融会贯通。关于针刺补泻手法的阐述，当推《内经》为最早。如「徐疾补泻」、「迎随补泻」、「呼吸补泻」、「开闺补泻」等，均源于此典。嗣后历代医家在这基础上加以发展，创立了「捻转补驾」、「提插补泻」以及「平补平泻」等补泻手法。由于古代文字深奥，经典所述又多为原则性的理论，若不加阐释，不结合l临床体验，则往往难以学深学透，且易犯理解片面、断简残编之弊。例如「徐疾补泻」法，是以《灵枢·九针十二原》的「徐而疾则实，疾而徐则虚」与《小针解》的「徐而疾则实者，言徐内而疾出也}疾而徐则虚者，言疾内而徐出也」为根据的。起初我亦理解为以进、出针的快慢分别补泻法，然而通过经文的互相印证和临床体验后，看法就深化了。考《九针十二原》中早有「剌之要，气至而有效」的记载，说明要产生针刺效应就必须先得气。这样就不能把徐疾补泻法的操作全程仅仅理解为进出针的快慢。因为将针快刺进穴、慢退出穴，或慢刺进穴、快退出穴，简单地一次即能达到「得气」和「补泻」的效应，显然是难以想象的。为此，对《小针解》这段文字中的「出」、「内」二字，尤其是「出」字的含义当细细玩味、反复推敲。我认为，「出」者应对「内」而言，「出」、「内」二宇联系起来，就是由浅及深、由内而外、互相往来的意思。因此，徐疾补泻的针刺操作全程应理解为：将针进入穴内后，由浅部徐缓地微捻纳入深部，再由深部疾速捻退至浅部，上下往来，以气调为度，这样可导致阳气内交，所以称之为补法，反之，由浅部疾速捻入探部．再由深部徐缓地微捻退至浅部，上下往来，以气词为度，这样可引导阴气出外，所以称之为泻法。嫩灵枢官能》中「明于调气，补泻所在，徐疾之意」及《小针解》的「刺之微在数迟者，徐疾之意也」，就是这个意思。由此推而广之，可认为「呼吸补泻」即是在徐疾补泻基础上，结合患者呼吸时机分补泻的一种方法，而不能机械地把它理解成仅以「呼气时进针，吸气时出针为补吸气时进针，呼气时出针为泻」。至于「开圈补泻」的「出针后于穴位．．卜．速加揉按，促使针孔闭塞，不令经气外泄为补}反之，出针时摇大针孔，不加揉按而令邪气外泄为泻」，是针刺全过程中的后阶段，当与其它补泻手法配合为用，而不能单独使用，故「开圉补泻」实际上不是一种独立的补泻手法，只是徐疾补泻的一／卜组成部分而已。诚如《灵枢·邪客》所谓：「先知虚实，而行徐疾。」《内经》所载针刺补泻法，基本上均以徐疾补泻法为基础，离开了徐疾，也就无从言补泻。
2．博览群书，应互相印证。在学习经典的同时，还应广泛阅读历代名家的著述，互相对照，同中求异，异中求同，以此列彼，互相印证。如对于「迎随补泻」，现今多遵张世贤氏《图注难经》中对《难经·七十二难》的解说，理解成以针尖对经脉的顺逆朝向分补泻，即以针尖迎着经脉来向而刺的是「迎」，为泻法，随着经脉去向而刺的是「随」，为补法。然而考《内经》原著关于「迎随」的阐述有《灵枢·终始》的「泻者迎之，补者随之，知迎知随，气可令和，和气之方，必通阴阳」』《九针十二原》的「往者为逆，来者为顺，明知逆顺，正行无问，迎而夺之，恶得无虚，追而济之，恶得无实}迎之随之，以意和之，针道毕矣」}又「补日随之，随之意，若妄之，若行若按，如蚊虻止，如留如还，去如弦绝(明·马莳氏解作：即始徐而终疾也)」。若能仔细推敲这几段经文，并结合《小针解》「……迎而夺之者，泻也，追而济之者，补也』的论述，则不难看出：「迎」指泻法，「随」指补法，「迎随」实乃补泻手法的统称。故马莳氏亦谓徐疾补泻为「迎随」。
此外，如陈瑞孙氏的《难经辨疑》认为：「迎者，迎其气之方来而未盛也，以泻之，随者，随其气之方往而未虚也，以补之」；滑寿氏在《难经本义》中谓：「迎随之法，补泻之道也。」高武氏亦同意陈、滑二氏「迎」是泻法，「随」是补法的见解，故他赞同张洁古氏的「呼吸出纳，亦名迎随也」之说。汪机氏在《针灸问对》中除同意陈氏之见外，还批判了以顺逆经分补泻的说法：「迎者迎其气之方来而未盛也，泻之以遏其冲，何尝以逆其经为迎；随者随其气之方往而将虚也，补之以助其行，何尝以顺其经为随。所言若是，其诞妄可知矣，岂可示法于人哉」。
由此看来，张世贤氏的《图注难经》中对《难经·七十二难》的解释是值得商榷的。张氏认为「迎随补泻」是以针尖对经脉顺逆朝向分补泻的一种操作手法，这是不甚妥当的。正如《医学大辞典》对该书所评价的那样；「……其注亦循文敷衍，未造深微。」
(三)研究手法，提高针刺疗效如上所述，在针刺的临床实践中，常困操作手法的不同，而致取效每有佳逊之差异。现今针灸界对针刺补泻手法中的「提插补泻」、「捻转补泻」、「平补平泻」以及「烧山火」、「透天凉」等复式手法均较常用。对于这些针刺操作手法，我是这样理解与运用的；
1．提插补泻。按照机体的内外，深浅分阴阳，即以外部的皮肤为阳，内部的肌肉为阴。《针灸大成》
云：「夫荣卫者，阴阳也。经言阳受气于四末，阴受气于五脏，故泻者先深而后浅，从内引持而出之，补者先浅而后深，从外推内而入之，乃是因其阴阳内外而进退针耳。」从这段阐述可以看出，调整荣卫内外阴阳之气，即为提插补泻的主要目的。此外，在《问针灸补泻如何》中有：「得气推而内之，是谓补，动而伸之，是谓泻夫实者气入也，虚者气出也；从阳生于外故入，阴生于内故出。」这更进一步说明了：「提插补泻」中，补法的先浅后深，紧按慢提，其目的是为了把体表的阳气「从外推内而入之」；泻法的先深后浅，紧提慢按，则是为了把体内的阴气「从内引持而出之」。根据这个原理，我在临床取用躯干部脏器体表的穴位时，多用此种操作手法。这不仅符合上述观点，而且运针时不会同捻转补泻手法那样，易使患者产生针下牵引性难忍或疼痛的感应。即使将针误触及脏器时，也不致造成破坏性的实质损伤(如同进行肝穿刺操作不带有捻转动作)。至于补、泻法的具体应用，则应按照中医辨证。凡是属于虚证的，概用提插补法，如用治阳痿病，疗效堪称满意；属于实证的，则用提插泻法，如对便秘症的治疗，虽按中医辨证有虚实之分，但无论属虚、属实，总以通润大便为治则，这就含有泻的意义，故我概用提插泻法，效果亦颇理想。
若结合现代的针下感应强度(刺激量)来分析，则在针刺得气基础上，凡将针重插轻提的(补法),其针下感应就强(但未超过患者的耐受程度)，反之，用轻插重提的(泻法)，针下感应则相对的较轻。这样就不符合现代的轻刺激是古代的补法、强刺激是泻法之说，且对泻便的作用也难以理解。从现代医学观点来分析，便秘的原因(不论属虚属实)，主要是由于大肠运动的减弱，因此只有运用轻刺激的提插泻法以促使肠蠕动增强，方能使大便通行。反之，若施以所谓强刺激即泻法，则会起到肠运动更加抑制的作用。
2．捻转补泻。在历代文献中，方法各殊，繁简不一，众说纷纭，奠衷一是。目前针灸界对捻转补泻的操作「以捻转较重，角度较大者为泻法」，「捻转较轻，角度较小者为补法」。这是根据高武氏在《针灸聚英》中对以捻转方向分补泻提出「捻针左右，已非《素问》意矣，而人身左右不同，谬之甚也」的尖锐批判后，而以高氏建立的「其泻者有『凤凰展翅』，用右手大指食指揲针头，如飞腾之象，一捻一放……其补者有『饿马摇铃』，用右手大指食指撩针头，如饿马无力之状，缓缓前进则长，后退则短」的手法演化而来的。
关于捻转补泻法的应用，古代文献中虽无明确规定，但从《针灸太成》「言荣卫者，是内外之气出入；言经脉者，是上下之气往来，各随所在顺逆而为刺也」的文字来理解，前者是言提插补泻法调和荣卫之气的内外出入，而后者是指捻转补泻法调和经脉之气的上下往来。也就是说，捻转补弼法的主要目的在于通凋经脉气阻。据此，我在临床上对于运动系统的疾病，在取用四肢部位的穴位时，多用捻转补泻手法为治。凡经辨证属邪盛有余而呈疼痛或痉挛的，概用泻法}反之，属正虚不足而现麻术或痿软的，概用补法。
临床疗效表明，以上病症施行捻转补泻法较提插补泻者为佳。再就针刺感应强度来看，本法虽然符合「轻刺激为兴奋法，即古代的补法}强刺激称抑制法，即古代的泻法」之说。但从其适应范围来说，本法似以运动系疾病较为适宜，不同于兴奋、抑制法那样不分系统地适用，此系立法观点不同所致。由此涉及到一个问题，即古代补泻法的内容，并不能仅以「刺激量」来理解、阐述或包括。这也是有待予今后进一步探讨研究的课题之一。
3．平补平泻。现今应用的平补平泻法，是以强调手法运用中的一个「平」字命名的。它与《神应经》及(《针灸大成·问刺有大小净中所说的「阻同一穴位，既施有补法，又施有泻法」而名的平补平泻法的操作方法完全不同。它立法于《灵枢·五乱》中「徐入徐出，谓之导气，补泻无形，谓之同精，是非有余不足也，乱气之相逆也」的记载，仅以不快不慢，均匀地提插捻针，为其具体操作手法。虽然这种「徐入徐出」(不快不慢均匀提插捻针)的导气法，并不像其它补泻法那样有一定的操作形式(如针刺的浅深、捻动的快慢、幅度的大小、指力的轻重等)，但对诱导邪气外出，导引正气恢复，同样有泻邪补正的作用，都是以保护精气为最终目的，这种治法叫作「同精」。由于这种操作手法强调徐入徐出的提插捻针，为针对「乱气之相逆」，亦即一时性的气血紊乱而呈现的虚实不太显著或虚实兼有的病证而设，所以目前针灸界就将这种导气法称为「平补平泻」。
从针刺感应强度来衡量这种以导气法为立法依据的「平补平泻」手法，其针下感应则最多只能达到中等度的刺激量，当属于兴奋法的范畴。若以兴奋法就是古代的补法，抑制法就是古代的泻法的观点来联系对照，那么，这种平补平泻的操作，只能起到平补的作用，而没有平泻的作用。
(一) 熟读歌赋，继承前人经验
按症取穴是针灸疗法的特点，也是古今针灸家的一贯传统。例如“肚腹三里留”。凡是肠胃道疾病，如腹痛、腹胀、肠鸣、泄泻等，都可以取用足三里穴治疗。这里就涉及到熟读背诵针灸歌赋的基本功问题。各种歌赋多是前人临床经验的总结，便于记忆，其文流畅，朗朗上口，结构清晰，言简意赅。例如“四总穴”就是简单易诵的四句歌诀，其中“面口合谷收”一语，说明合谷穴常用于治疗口腔、颜面部的疾病。即针刺合谷不但常用于止牙痛，而且对口腔和颜面部的炎性疾患也有显著效果。因此我在治疗面瘫早期伴有神经炎症患者时，每加针合谷而收到良好疗效。曾有一例齿龈出血患者，长期服用维生素C、K等无效，经我针刺合谷十次后，霍然而愈。此外，曾遇到一位生活在血吸虫繁衍地区的农民，肝脏肿大至脐旁，一日突然剧痛，请我针治。当时我还是首次见到这种肝脏剧痛病人，于是按照《通玄指要赋》中“胁下肋痛者，刺阳陵泉而即止”和《标幽赋》中“胸满腹痛针内关”等记载，选取右侧阳陵泉与内关穴，进针得气后，疼痛即缓解，留针十分钟后，完全恢复正常。
在前人针灸歌赋的基础上，结合自己多年的临床体会，自撰了“治疗总穴歌”，作为临证的重点用穴，现录如下，供作参考：
面口合谷收，曲池配穴优；如遇头痛时，风池效可奏。胸胁内关谋，可向外关透。肚腹三里求，上腹中脘搜，下腹加关元，天枢治脐周。腰背委中求，殷门亦可收，驼脊按部加，斜向脊柱透；下腰大肠俞，上腰肾俞揉。上肢取曲池，合谷肩髃施，下肢阳陵泉，环跳绝骨刺，身躯关节病，疼痛取阿是，避开大血管，胸背禁深刺。
(二) 重视操作，掌握针刺手法
针刺手法是针灸疗法中的重要环节。熟读各种针灸歌赋，虽可继承前人的临证选穴经验，但在针刺疗法中，常因操作手法的不同，而在同样疾病、同样穴位的情况下，其所得的临床效应也不同。因此不论古今针灸学者，皆非常重视针刺的操作手法。这种手法的目的，古代称为补泻，即“虚则补之”、“实则泻之”。现代称补泻手法为兴奋与抑制。凡是体质机能减退的应予兴奋的方法，体质机能亢进的应予抑制的方法。因此，一般多认为古代所称的针刺补法，即是现代的轻刺激兴奋法；古代的泻法，就是现代的强刺激抑制法。但是二者实际上是否完全符合，却是值得商榷的，下文将谈及这一问题。
1. 学习经典，要融会贯通。关于针刺补泻手法的阐述，当推《内经》为最早。如“徐疾补泻”、“迎随补泻”、“呼吸补泻”、“开阖补泻”等，均源于此典。嗣后历代医家在这基础上加以发展，创立了“捻转补泻”、“提插补泻”以及“平补平泻”等补泻手法。由于古代文字深奥，经典所述又多为原则性的理论，若不加阐释，不结合临床体验，则往往难以学深学透，且易犯理解片面、断章取义之弊。例如“徐疾补泻”法，是以《灵枢·九针十二原》的“徐而疾则实，疾而徐则虚”与《小针解》的“徐而疾则实者，言徐内而疾出也；疾而徐则虚者，言疾内而徐出也”为根据的。起初我亦理解为以进、出针的快慢分别补泻法，然而通过经文的互相印证和临床体验后，看法就深化了。考《九针十二原》中早有“刺之要，气至而有效”的记载，说明要产生针刺效应就必须先得气。这样就不能把徐疾补泻法的操作全程仅仅理解为进出针的快慢。因为将针快刺进穴、慢退出穴，或慢刺进穴、快退出穴，简单地一次即能达到“得气”和“补泻”的效应，显然是难以想象的。为此，对《小针解》这段文字中的“出”、“内”二字，尤其是“出”字的含义当细细玩味、反复推敲。我认为，“出”者应对“内”而言，“出”、“内”二字联系起来，就是由浅及深、由内而外、互相往来的意思。因此，徐疾补泻的针刺操作全程应理解为：将针进入穴内后，由浅部徐缓地微捻纳入深部，再由深部疾速捻退至浅部，上下往来，以气调为度，这样可导致阳气内交，所以称之为补法；反之，由浅部疾速捻入探部，再由深部徐缓地微捻退至浅部，上下往来，以气调为度，这样可引导阴气出外，所以称之为泻法。《灵枢·官能》中“明于调气，补泻所在，徐疾之意”及《小针解》的“刺之微在数迟者，徐疾之意也”，就是这个意思。由此推而广之，可认为“呼吸补泻”即是在徐疾补泻基础上，结合患者呼吸时机分补泻的一种方法，而不能机械地把它理解成仅以“呼气时进针，吸气时出针为补；吸气时进针，呼气时出针为泻”。至于“开阖补泻”的“出针后于穴位上速加揉按，促使针孔闭塞，不令经气外泄为补；反之，出针时摇大针孔，不加揉按而令邪气外泄为泻”，是针刺全过程中的后阶段，当与其它补泻手法配合为用，而不能单独使用，故“开阖补泻”实际上不是一种独立的补泻手法，只是徐疾补泻的一个组成部分而已。诚如《灵枢·邪客》所谓：“先知虚实，而行徐疾。”《内经》所载针刺补泻法，基本上均以徐疾补泻法为基础，离开了徐疾，也就无从言补泻。
2. 博览群书，应互相印证。在学习经典的同时，还应广泛阅读历代名家的著述，互相对照，同中求异，异中求同，以此列彼，互相印证。如对于“迎随补泻”，现今多遵张世贤氏《图注难经》中对《难经·七十二难》的解说，理解成以针尖对经脉的顺逆朝向分补泻，即以针尖迎着经脉来向而刺的是“迎”，为泻法，随着经脉去向而刺的是“随”，为补法。然而考《内经》原著关于“迎随”的阐述有《灵枢·终始》的“泻者迎之，补者随之，知迎知随，气可令和，和气之方，必通阴阳”；《九针十二原》的“往者为逆，来者为顺，明知逆顺，正行无问，迎而夺之，恶得无虚，追而济之，恶得无实；迎之随之，以意和之，针道毕矣”；又“补曰随之，随之意，若妄之，若行若按，如蚊虻止，如留如还，去如弦绝（明·马莳氏解作：即始徐而终疾也）”。若能仔细推敲这几段经文，并结合《小针解》“……迎而夺之者，泻也，追而济之者，补也”的论述，则不难看出：“迎”指泻法，“随”指补法，“迎随”实乃补泻手法的统称。故马莳氏亦谓徐疾补泻为“迎随”。
此外，如陈瑞孙氏的《难经辨疑》认为：“迎者，迎其气之方来而未盛也，以泻之，随者，随其气之方往而未虚也，以补之”；滑寿氏在《难经本义》中谓：“迎随之法，补泻之道也。”高武氏亦同意陈、滑二氏“迎”是泻法，“随”是补法的见解，故他赞同张洁古氏的“呼吸出纳，亦名迎随也”之说。汪机氏在《针灸问对》中除同意陈氏之见外，还批判了以顺逆经分补泻的说法：“迎者迎其气之方来而未盛也，泻之以遏其冲，何尝以逆其经为迎；随者随其气之方往而将虚也，补之以助其行，何尝以顺其经为随。所言若是，其诞妄可知矣，岂可示法于人哉”。
由此看来，张世贤氏的《图注难经》中对《难经·七十二难》的解释是值得商榷的。张氏认为“迎随补泻”是以针尖对经脉顺逆朝向分补泻的一种操作手法，这是不甚妥当的。正如《医学大辞典》对该书所评价的那样：“……其注亦循文敷衍，未造深微。”
(三) 研究手法，提高针刺疗效
如上所述，在针刺的临床实践中，常因操作手法的不同，而致取效每有佳逊之差异。现今针灸界对针刺补泻手法中的“提插补泻”、“捻转补泻”、“平补平泻”以及“烧山火”、“透天凉”等复式手法均较常用。对于这些针刺操作手法，我是这样理解与运用的：
1. 提插补泻。按照机体的内外、深浅分阴阳，即以外部的皮肤为阳，内部的肌肉为阴。《针灸大成》云：“夫荣卫者，阴阳也。经言阳受气于四末，阴受气于五脏，故泻者先深而后浅，从内引持而出之，补者先浅而后深，从外推内而入之，乃是因其阴阳内外而进退针耳。”从这段阐述可以看出，调整营卫内外阴阳之气，即为提插补泻的主要目的。此外，在《问针灸补泻如何》中有：“得气推而内之，是谓补，动而伸之，是谓泻。夫实者气入也，虚者气出也；从阳生于外故入，阴生于内故出。”这更进一步说明了：“提插补泻”中，补法的先浅后深，紧按慢提，其目的是为了把体表的阳气“从外推内而入之”；泻法的先深后浅，紧提慢按，则是为了把体内的阴气“从内引持而出之”。根据这个原理，我在临床取用躯干部脏器体表的穴位时，多用此种操作手法。这不仅符合上述观点，而且运针时不会同捻转补泻手法那样，易使患者产生针下牵引性难忍或疼痛的感应。即使将针误触及脏器时，也不致造成破坏性的实质损伤（如同进行肝穿刺操作不带有捻转动作）。至于补、泻法的具体应用，则应按照中医辨证。凡是属于虚证的，概用提插补法，如用治阳痿病，疗效堪称满意；属于实证的，则用提插泻法，如对便秘症的治疗，虽按中医辨证有虚实之分，但无论属虚、属实，总以通润大便为治则，这就含有泻的意义，故我概用提插泻法，效果亦颇理想。
若结合现代的针下感应强度（刺激量）来分析，则在针刺得气基础上，凡将针重插轻提的（补法），其针下感应就强（但未超过患者的耐受程度），反之，用轻插重提的（泻法），针下感应则相对的较轻。这样就不符合现代的轻刺激是古代的补法、强刺激是泻法之说，且对通便的作用也难以理解。从现代医学观点来分析，便秘的原因（不论属虚属实），主要是由于大肠运动的减弱，因此只有运用轻刺激的提插泻法以促使肠蠕动增强，方能使大便通行。反之，若施以所谓强刺激即泻法，则会起到肠运动更加抑制的作用。
2. 捻转补泻。在历代文献中，方法各殊，繁简不一，众说纷纭，莫衷一是。目前针灸界对捻转补泻的操作“以捻转较重，角度较大者为泻法”，“捻转较轻，角度较小者为补法”。这是根据高武氏在《针灸聚英》中对以捻转方向分补泻提出“捻针左右，已非《素问》意矣，而人身左右不同，谬之甚也”的尖锐批判后，而以高氏建立的“其泻者有‘凤凰展翅’，用右手大指食指捏针头，如飞腾之象，一捻一放……其补者有‘饿马摇铃’，用右手大指食指撩针头，如饿马无力之状，缓缓前进则长，后退则短”的手法演化而来的。
关于捻转补泻法的应用，古代文献中虽无明确规定，但从《针灸大成》“言营卫者，是内外之气出入；言经脉者，是上下之气往来，各随所在顺逆而为刺也”的文字来理解，前者是言提插补泻法调和营卫之气的内外出入，而后者是指捻转补泻法调和经脉之气的上下往来。也就是说，捻转补泻法的主要目的在于通畅经脉气阻。据此，我在临床上对于运动系统的疾病，在取用四肢部位的穴位时，多用捻转补泻手法为治。凡经辨证属邪盛有余而呈疼痛或痉挛的，概用泻法；反之，属正虚不足而现麻木或痿软的，概用补法。
临床疗效表明，以上病症施行捻转补泻法较提插补泻者为佳。再就针刺感应强度来看，本法虽然符合“轻刺激为兴奋法，即古代的补法；强刺激称抑制法，即古代的泻法”之说。但从其适应范围来说，本法似以运动系疾病较为适宜，不同于兴奋、抑制法那样不分系统地适用，此系立法观点不同所致。由此涉及到一个问题，即古代补泻法的内容，并不能仅以“刺激量”来理解、阐述或包括。这也是有待于今后进一步探讨研究的课题之一。
3. 平补平泻。现今应用的平补平泻法，是以强调手法运用中的一个“平”字命名的。它与《神应经》及《针灸大成·问刺有大小》中所说的“同一穴位，既施有补法，又施有泻法”而名的平补平泻法的操作方法完全不同。它立法于《灵枢·五乱》中“徐入徐出，谓之导气，补泻无形，谓之同精，是非有余不足也，乱气之相逆也”的记载，仅以不快不慢，均匀地提插捻针，为其具体操作手法。虽然这种“徐入徐出”（不快不慢均匀提插捻针）的导气法，并不像其它补泻法那样有一定的操作形式（如针刺的浅深、捻动的快慢、幅度的大小、指力的轻重等），但对诱导邪气外出，导引正气恢复，同样有泻邪补正的作用，都是以保护精气为最终目的，这种治法叫作“同精”。由于这种操作手法强调徐入徐出的提插捻针，为针对“乱气之相逆”，亦即一时性的气血紊乱而呈现的虚实不太显著或虚实兼有的病证而设，所以目前针灸界就将这种导气法称为“平补平泻”。
从针刺感应强度来衡量这种以导气法为立法依据的“平补平泻”手法，其针下感应则最多只能达到中等度的刺激量，当属于兴奋法的范畴。若以兴奋法就是古代的补法，抑制法就是古代的泻法的观点来联系对照，那么，这种平补平泻的操作，只能起到平补的作用，而没有平泻的作用。
(I) Familiarize oneself with rhyming formulas and inherit the experience of predecessors
Selecting acupoints based on symptoms is a characteristic of acupuncture therapy and has been a consistent tradition among acupuncturists from ancient to modern times. For example, "For abdominal issues, leave Zusanli (ST-36)." For any gastrointestinal diseases, such as abdominal pain, abdominal distension, borborygmus, diarrhea, etc., one can select Zusanli (ST-36) for treatment. This involves the basic skill of familiarizing oneself with and reciting acupuncture rhyming formulas. Various formulas are mostly summaries of clinical experiences from predecessors, making them easy to memorize. Their language is fluent, catchy, structurally clear, and concise yet comprehensive. For instance, the "Four General Acupoints" consists of four simple and easy-to-recite lines. The phrase "For face and mouth issues, Hegu (LI-4) collects them" indicates that Hegu (LI-4) is commonly used to treat diseases of the oral cavity and facial region. Needling Hegu (LI-4) is not only commonly used to relieve toothache but also has significant effects on inflammatory diseases of the oral cavity and face. Therefore, when treating patients with early-stage facial paralysis accompanied by nerve inflammation, I often add needling Hegu (LI-4) and achieve good results. There was once a patient with gingival bleeding who had taken Vitamin C and K for a long time without effect. After being needled at Hegu (LI-4) ten times by me, he recovered suddenly. Additionally, I once encountered a farmer living in an area where Schistosoma japonicum proliferated. His liver was enlarged to the side of the umbilicus, and one day he suffered sudden severe pain and sought my acupuncture treatment. At that time, it was my first time seeing such a patient with severe liver pain. I therefore followed the records in *Tongxuan Zhiyao Fu* ("For pain under the ribs and in the hypochondrium, needle Yanglingquan [GB-34] and it will stop immediately") and *Biao You Fu* ("For chest fullness and abdominal pain, needle Neiguan [PC-6]") to select the right-side Yanglingquan (GB-34) and Neiguan (PC-6). After inserting the needles and achieving Deqi (arrival of Qi), the pain relieved immediately. After retaining the needles for ten minutes, he returned completely to normal.
Based on the acupuncture rhyming formulas of predecessors and combined with my own years of clinical experience, I composed the "Song of General Treatment Acupoints" as key acupoints for clinical practice. It is recorded below for reference:
For face and mouth, Hegu (LI-4) is collected; Quchi (LI-11) paired with it is excellent. If headache occurs, Fengchi (GB-20) can produce efficacy. For chest and hypochondrium, seek Neiguan (PC-6); it can penetrate to Waiguan (TE-5). For abdomen and intestines, seek Zusanli (ST-36); for upper abdomen, search Zhongwan (CV-12); for lower abdomen, add Guanyuan (CV-4); Tianshu (ST-25) treats around the umbilicus. For waist and back, seek Weizhong (BL-40); Yinmen (BL-37) can also collect. For hunchback, add according to the segment; obliquely penetrate towards the spine. For lower back, Da Changshu (BL-25); for upper back, knead Shenshu (BL-23). For upper limbs, take Quchi (LI-11); apply Hegu (LI-4) and Jianyu (LI-15). For lower limbs, Yanglingquan (GB-34); pierce Huantiao (GB-30) and Jiexi (ST-41). For body joint diseases, take Ashi points for pain; avoid large blood vessels; deep needling is forbidden in chest and back.
(II) Emphasize manipulation and master acupuncture techniques
Acupuncture manipulation is an important link in acupuncture therapy. Although familiarizing oneself with various acupuncture rhyming formulas allows one to inherit the experience of predecessors in selecting acupoints for clinical practice, in acupuncture therapy, due to differences in manipulation techniques, the clinical effects obtained can differ even under the same disease and same acupoint conditions. Therefore, whether ancient or modern, acupuncturists all attach great importance to acupuncture manipulation techniques. The purpose of these techniques was called Bu-Xie (Tonification and Purging) in ancient times, i.e., "Tonify deficiency, purge excess." Modern terminology refers to tonification and purging techniques as excitation and inhibition methods. Methods that should excite are those for individuals with decreased physical function; methods that should inhibit are those for individuals with hyperactive physical function. Therefore, it is generally believed that the ancient tonification method of acupuncture corresponds to the modern light stimulation excitation method, while the ancient purging method corresponds to the modern strong stimulation inhibition method. However, whether the two actually correspond completely is worthy of discussion, which will be addressed below.
1. Study classics and achieve integration. Regarding the exposition of acupuncture tonification and purging techniques, the *Neijing* (Classic of Internal Medicine) is considered the earliest source. Techniques such as "Xu-Ji Tonification and Purging," "Ying-Sui Tonification and Purging," "Respiration Tonification and Purging," and "Open-Close Tonification and Purging" all originate from this classic. Subsequently, physicians of successive dynasties developed upon this foundation, creating tonification and purging techniques such as "Twirling-Rotating Tonification and Purging," "Upward-Thrusting/Downward-Pressing Tonification and Purging," and "Neutral Tonification and Purging." Since ancient texts are profound and the theories described in classics are mostly principled, if not explained and combined with clinical experience, it is often difficult to learn deeply and thoroughly, and one may easily fall into the trap of one-sided understanding or taking fragments out of context. For example, the "Xu-Ji Tonification and Purging" technique is based on the record in *Lingshu · Nine Needles and Twelve Origins*: "Slow insertion and rapid withdrawal makes solid (tonify); rapid insertion and slow withdrawal makes empty (purge)," and from *Xiao Zhen Jie*: "What 'slow insertion and rapid withdrawal makes solid' means is slow insertion and rapid withdrawal; what 'rapid insertion and slow withdrawal makes empty' means is rapid insertion and slow withdrawal." Initially, I also understood this as distinguishing tonification and purging methods by the speed of needle insertion and withdrawal. However, after cross-referencing the scriptures and through clinical experience, my view deepened. Examining *Jiu Zhen Shi Er Yuan*, there is an early record: "The essence of needling is that when Qi arrives, there is efficacy." This indicates that to produce an acupuncture effect, one must first achieve Deqi (arrival of Qi). Thus, one cannot understand the entire operation of Xu-Ji Tonification and Purging merely as the speed of insertion and withdrawal. Because simply inserting the needle quickly and withdrawing slowly, or inserting slowly and withdrawing quickly, to achieve "Deqi" and "Tonification/Purging" effects in one go, is obviously unimaginable. Therefore, the meanings of the characters "Chu" (withdrawal/out) and "Na" (insertion/in), especially "Chu," in this passage of *Xiao Zhen Jie* should be carefully pondered and repeatedly scrutinized. I believe that "Chu" corresponds to "Na." Connecting "Chu" and "Na" implies moving from shallow to deep, from inside to outside, and mutual interaction. Therefore, the entire process of Xu-Ji Tonification and Purging manipulation should be understood as: after entering the needle into the acupoint, slowly and gently twirl and insert from the shallow part to the deep part, then rapidly twirl and withdraw from the deep part to the shallow part, moving up and down, regulated by the adjustment of Qi. This leads to the internal intersection of Yang Qi, hence it is called the Tonification method. Conversely, rapidly twirl and insert from the shallow part to the deep part, then slowly and gently twirl and withdraw from the deep part to the shallow part, moving up and down, regulated by the adjustment of Qi, this guides Yin Qi outward, hence it is called the Purging method. The statement in *Lingshu · Guan Neng*: "Understand the regulation of Qi, the location of tonification and purging, the meaning of Xu-Ji," and in *Xiao Zhen Jie*: "The subtlety of needling lies in frequency and slowness, which is the meaning of Xu-Ji," expresses this idea. Extending this reasoning, one can consider "Respiration Tonification and Purging" as a method that combines the timing of the patient's respiration with Xu-Ji Tonification and Purging, rather than mechanically understanding it as "inserting during exhalation and withdrawing during inhalation for tonification; inserting during inhalation and withdrawing during exhalation for purging." As for "Open-Close Tonification and Purging," where "after withdrawing the needle, quickly rub and press the acupoint to close the needle hole and prevent the leakage of Jing Qi for tonification; conversely, shake the needle hole wide upon withdrawal, do not rub or press, and allow pathogenic Qi to escape for purging," this belongs to the later stage of the entire needling process. It should be used in conjunction with other tonification and purging techniques and cannot be used alone. Thus, "Open-Close Tonification and Purging" is essentially not an independent tonification/purging technique but a component of Xu-Ji Tonification and Purging. As stated in *Lingshu · Xie Ke*: "First know deficiency and excess, then perform Xu-Ji." The acupuncture tonification and purging methods recorded in the *Neijing* are basically based on Xu-Ji Tonification and Purging; without Xu-Ji, there is no talk of tonification and purging.
2. Read widely and cross-reference. While studying classics, one should also extensively read the works of famous physicians from successive dynasties, compare them with each other, seek differences within similarities, seek similarities within differences, and use one to verify another. For example, regarding "Ying-Sui Tonification and Purging," current practice mostly follows Zhang Shixian's *Tu Zhu Nan Jing* (Illustrated Commentary on the Classic of Difficult Issues) interpretation of *Nan Jing · Chapter 72*, understanding it as distinguishing tonification and purging by the direction of the needle tip relative to the meridian flow. That is, piercing against the incoming direction of the meridian is "Ying" (Opposing), which is the Purging method; piercing following the outgoing direction of the meridian is "Sui" (Following), which is the Tonification method. However, examining the original text of the *Neijing* regarding "Ying-Sui," we find in *Lingshu · Zhong Shi*: "Purge by opposing, tonify by following; knowing opposing and following, Qi can be harmonized. The method of harmonizing Qi must pass through Yin and Yang"; *Jiu Zhen Shi Er Yuan*: "Going forward is reverse, coming forward is smooth. Clearly knowing reverse and smooth, proceed without doubt. Oppose and seize it, how can it not become empty? Pursue and assist it, how can it not become solid? Oppose and follow, harmonize with intention, and the Way of the Needle is complete." Also: "Tonify by following. The intention of following is like being careless. Move as if walking or pressing, like a mosquito or horsefly stopping, like staying and returning, departing like a bowstring snapping (Ming dynasty physician Ma Shi interpreted this as: starting slow and ending fast)." If one carefully scrutinizes these passages and combines them with the discussion in *Xiao Zhen Jie*: "...Opposing and seizing is purging; pursuing and assisting is tonifying," it becomes clear that "Ying" refers to the Purging method, "Sui" refers to the Tonification method, and "Ying-Sui" is actually a general term for tonification and purging techniques. Thus, Ma Shi also referred to Xu-Ji Tonification and Purging as "Ying-Sui."
Additionally, Chen Ruisun in *Nan Jing Bian Yi* (Doubts Clarified on the Classic of Difficult Issues) believes: "Ying is to oppose the Qi as it is coming but not yet vigorous, to purge it; Sui is to follow the Qi as it is going but not yet deficient, to tonify it." Hua Shou in *Nan Jing Ben Yi* (Original Meaning of the Classic of Difficult Issues) states: "The method of Ying-Sui is the way of tonification and purging." Gao Wu also agreed with Chen and Hua that "Ying" is the Purging method and "Sui" is the Tonification method, so he endorsed Zhang Jiegu's saying: "Respiration intake and output is also named Ying-Sui." Wang Ji in *Zhen Jiu Wen Dui* (Questions and Answers on Acupuncture and Moxibustion), besides agreeing with Chen's view, also criticized the theory of distinguishing tonification and purging by meridian flow direction: "Ying is to oppose the Qi as it is coming but not yet vigorous, to purge it by restraining its momentum; how could opposing the meridian be Ying? Sui is to follow the Qi as it is going and about to become deficient, to tonify it by assisting its movement; how could following the meridian be Sui. If words are said thus, their absurdity is known; how can they be shown as rules to others?"
From this, it appears that Zhang Shixian's explanation of *Nan Jing · Chapter 72* in *Tu Zhu Nan Jing* is worthy of discussion. Zhang believed that "Ying-Sui Tonification and Purging" is an operation technique distinguishing tonification and purging by the direction of the needle tip relative to the meridian flow, which is not quite appropriate. As evaluated by *Yi Xue Da Ci Dian* (Medical Dictionary) regarding this book: "...Its commentary also elaborates on the text superficially, failing to reach profound depths."
(III) Research techniques to improve acupuncture efficacy
As mentioned above, in clinical acupuncture practice, due to differences in manipulation techniques, the efficacy often varies significantly. Currently, the acupuncture community frequently uses techniques such as "Upward-Thrusting/Downward-Pressing Tonification and Purging," "Twirling-Rotating Tonification and Purging," "Neutral Tonification and Purging," as well as compound techniques like "Burn Mountain Fire" and "Penetrate Heaven Coolness." My understanding and application of these acupuncture manipulation techniques are as follows:
1. Upward-Thrusting/Downward-Pressing Tonification and Purging. According to the body's interior/exterior and depth/shallowness dividing Yin and Yang, the external skin is Yang, and the internal muscles are Yin. *Zhen Jiu Da Cheng* (Great Compendium of Acupuncture and Moxibustion) states: "Ying and Wei are Yin and Yang. The classics state that Yang receives Qi from the four extremities, and Yin receives Qi from the five zang organs. Therefore, for purging, one inserts deeply first and withdraws shallowly, drawing from the inside out; for tonification, one inserts shallowly first and goes deeper, pushing from the outside in. This is advancing and retreating the needle according to the Yin-Yang and interior-exterior nature." From this exposition, it can be seen that adjusting the Ying-Wei Qi and the Yin-Yang Qi of the interior and exterior is the main purpose of Upward-Thrusting/Downward-Pressing Tonification and Purging. Furthermore, in *Wen Zhen Jiu Bu Xie Ru He* (Asking How Acupuncture Tonification and Purging Works): "After achieving Deqi, push and insert it, this is called tonification; move and extend it, this is called purging. In excess, Qi enters; in deficiency, Qi exits; Yang is born externally, so it enters; Yin is born internally, so it exits." This further explains that in "Upward-Thrusting/Downward-Pressing Tonification and Purging," the tonification method of shallow-first then deep, firm pressing and slow lifting, aims to push the Yang Qi of the body surface "from outside inward"; the purging method of deep-first then shallow, firm lifting and slow pressing, aims to draw the Yin Qi of the interior "from inside outward." Based on this principle, when selecting acupoints on the body surface of trunk organs in clinical practice, I mostly use this manipulation technique. This not only conforms to the above viewpoint but also avoids the unbearable traction sensation or pain that patients might feel with Twirling-Rotating Tonification and Purging. Even if the needle accidentally touches an organ, it will not cause destructive substantive damage (similar to liver puncture operations without twisting movements). Regarding the specific application of tonification and purging methods, it should follow TCM syndrome differentiation. For all deficiency syndromes, generally use Upward-Thrusting/Downward-Pressing Tonification; for example, treating impotence yields satisfactory results. For excess syndromes, use Upward-Thrusting/Downward-Pressing Purging; for example, in treating constipation, although TCM differentiation distinguishes between deficiency and excess, regardless of deficiency or excess, the treatment principle is always to moisten and unblock the stool, which contains the meaning of purging. Therefore, I generally use Upward-Thrusting/Downward-Pressing Purging, and the effect is quite ideal.
If analyzed in terms of modern needle sensation intensity (stimulation dose), on the basis of achieving Deqi, whenever the needle is thrust heavily and lifted lightly (Tonification method), the needle sensation is strong (but does not exceed the patient's tolerance); conversely, using light thrusting and heavy lifting (Purging method), the needle sensation is relatively lighter. This does not conform to the theory that modern light stimulation is the ancient tonification method and strong stimulation is the purging method, nor is it easy to understand its role in relieving constipation. From a modern medical perspective, the cause of constipation (whether deficiency or excess) is mainly due to weakened large intestine motility. Therefore, only by applying light stimulation Upward-Thrusting/Downward-Pressing Purging to enhance peristalsis can stool passage be achieved. Conversely, applying so-called strong stimulation, i.e., the purging method, would further inhibit intestinal movement.
2. Twirling-Rotating Tonification and Purging. In historical documents, methods vary, some complex and some simple, with many differing opinions and no consensus. Currently, the acupuncture community operates Twirling-Rotating Tonification and Purging as: "Heavier twirling and larger angles are the Purging method; lighter twirling and smaller angles are the Tonification method." This evolved from Gao Wu's sharp criticism in *Zhen Jiu Ju Ying* (Gathering of Acupuncture and Moxibustation Brilliance) against distinguishing tonification and purging by twirling direction: "Twirling the needle left and right is already not the intent of *Su Wen*, and since human bodies differ on left and right, this error is very serious." It is based on the techniques established by Gao: "His purging method has 'Phoenix Spreading Wings,' using the thumb and index finger of the right hand to pinch the needle head, resembling flying motion, one twist one release... His tonification method has 'Hungry Horse Shaking Bell,' using the thumb and index finger of the right hand to flick the needle head, resembling a weak hungry horse, slowly advancing makes it long, retreating makes it short."
Regarding the application of Twirling-Rotating Tonification and Purging, although ancient documents have no explicit regulations, understanding the text from *Zhen Jiu Da Cheng*: "Speaking of Ying and Wei is about the entry and exit of Qi inside and outside; speaking of meridians is about the coming and going of Qi up and down, piercing according to the local smooth or reverse direction," the former refers to Upward-Thrusting/Downward-Pressing Tonification and Purging regulating the entry and exit of Ying-Wei Qi inside and outside, while the latter refers to Twirling-Rotating Tonification and Purging regulating the coming and going of Meridian Qi up and down. That is to say, the main purpose of Twirling-Rotating Tonification and Purging is to unblock meridian Qi obstruction. Accordingly, in my clinical practice for diseases of the motor system, when selecting acupoints on the limbs, I mostly use Twirling-Rotating Tonification and Purging techniques. For all cases differentiated as having excessive pathogenic factors presenting with pain or spasms, generally use the Purging method; conversely, for cases differentiated as having insufficient healthy Qi presenting with numbness or flaccidity, generally use the Tonification method.
Clinical efficacy shows that for the above diseases, applying Twirling-Rotating Tonification and Purging is better than Upward-Thrusting/Downward-Pressing Tonification and Purging. Looking at needle sensation intensity again, although this method conforms to the saying "Light stimulation is excitation method, i.e., ancient tonification; strong stimulation is inhibition method, i.e., ancient purging," in terms of its scope of application, this method seems more suitable for motor system diseases, unlike excitation and inhibition methods which apply indiscriminately across systems. This is due to different legislative viewpoints. This involves a problem: the content of ancient tonification and purging methods cannot be understood, expounded, or included solely by "stimulation dose." This is also one of the topics awaiting further exploration and research in the future.
3. Neutral Tonification and Purging. The currently applied Neutral Tonification and Purging method is named emphasizing the character "Ping" (Neutral/Even) in the application of techniques. It is completely different from the operational method of Neutral Tonification and Purging named in *Shen Ying Jing* and *Zhen Jiu Da Cheng · Wen Ci You Da Xiao* (Asking Whether Needling Has Great and Small Degrees), which says "At the same acupoint, both tonification and purging methods are applied." Its theoretical basis comes from *Lingshu · Wu Luan*: "Slow entry and slow exit is called Guiding Qi; tonification and purging without form is called Same Essence. This is neither excess nor deficiency, but chaotic Qi reversing each other." It only uses steady, even upward-thrusting/downward-pressing and twirling-rotating as its specific operational technique. Although this "Slow Entry Slow Exit" (steady, even upward-thrusting/downward-pressing and twirling-rotating) Guiding Qi method does not have certain operational forms like other tonification/purging methods (such as depth of needling, speed of twirling, amplitude size, strength of finger force, etc.), it still has the effect of expelling pathogens and tonifying healthy Qi by inducing pathogenic Qi outward and guiding healthy Qi to recover. Both aim to protect Essence and Qi as the final goal. This treatment method is called "Same Essence." Because this operational technique emphasizes steady entry and exit of upward-thrusting/downward-pressing and twirling-rotating, it is designed for "chaotic Qi reversing each other," i.e., conditions showing insignificant deficiency/excess or mixed deficiency/excess due to temporary Qi and Blood disorder. Therefore, the current acupuncture community calls this Guiding Qi method "Neutral Tonification and Purging."
Measuring this "Neutral Tonification and Purging" technique, which takes Guiding Qi as its legislative basis, by needle sensation intensity, its needle sensation can at most reach a medium-level stimulation dose, belonging to the category of excitation methods. If connecting this with the viewpoint that excitation method is ancient tonification and inhibition method is ancient purging, then this Neutral Tonification and Purging operation can only play a neutral-tonifying role, without a neutral-purging role.