灵枢经云。刺诸热者如以手探汤（一）。刺寒清者如人不欲行（一）。此即继起者用
透天凉烧山火之两手法。
针灸家师承有云。提针为热。插针为寒。内转为泻。外转为补。补泻之法。可停针
候气。迟迟转之。提插之法。不可偏用。盖尽量插之。而至于骨。则不可再插。尽量提
之。而针以外出。则不能再用。故定为三提一插。提针呼气。插针吸气。为烧山火。盖
提数多。则气之出于卫分者多振振恶寒（二）之证。用此手法。阳日用偶数。阴日用奇
数。必能使之发热。反言之。三插一提。插针吸气。提针呼气。为透天凉。盖插数多。
则气之入于营分者多蒸蒸发热（二）之证。用此手法。阳日用奇数。阴日用偶数。必能使其热退。
除寒退热。乃针灸家必要之手法。故灵枢针经列于第一篇九针十二原之末。等于冠
诸本输篇之首也。
以上所言烧山火透天凉之正法。乃男用于午前。女子用于午后。如男子午后。有大
寒证大热证。当用烧山火透天凉者。则反而用之。如女子午前有大寒证大热证。当用烧
山火透天凉者。亦反而用之。
歌曰 三插一提凉透天。三提一插火烧山。
提针吹气插针吸。女午后兮男午前。
五运有太过与不及。五气倾移。有常有变。卒然而动者谓之变。顺应四时。阴阳往
复。寒暑迎随谓之常。根据时取穴。合乎运常。但不能应变。内经气交变大论篇云。应常
不应卒。此之谓也。故刺法论中之升降手法欲发郁而升之者。均须待时。如当折其胜散
其郁而降之者。勿须待时（一）。试分析如后。
五脏藏气上升之法
肝木之气。郁而不升。当刺足厥阴之井（大敦）。乙庚日酉时开。
心火之气。郁而不升。当刺包络之荥（劳宫）。丙辛日未时开。
脾土之气。郁而不升。当刺足太阴之俞（太白）。丙辛日丑时开。己日酉时过。
肺金之气。郁而不升。当刺手太阴之经（经渠）。丙辛日卯时开。
肾水之气。郁而不升。当刺足少阴之合（阴谷）。丙辛日巳时开。
以上所言。上升取穴。须待时之正例。欲气上行。则用右手大指甲上括针柄。左手
指根据经导之。使气上行。续用补法。或多补少泻法。
五脏藏气下降之法
肝木之气。欲降而不下。当折其所胜。刺手太阴肺之井穴（少商）。手阳明大肠之合
穴（曲池）。
心火之气。降而不下。当折其所胜。刺足少阴之井穴（涌泉）。足太阳膀胱之合穴
（委中）。
脾土之气。降而不下。当折其所胜。刺足厥阴肝之井穴（大敦）。足少阳赡之合穴
（阳陵泉）。
肺金之气。降而不下。当折其所胜。刺心包络之井穴（中冲）。手少阳三焦之合穴
（天井）。
肾水之气。降而不下。当折其土。刺足太阴脾之井穴（隐白）。足阳明胃之合穴
（下陵三里）。
以上所言下降取穴。勿须待时之正例。欲气下行。用右手大指甲下括针柄。使气下
行。纯用泻法。如病在六腑。邪实过胜者。当取手少阳合穴者。用足太阳络委阳穴代
之。当取手阳明合穴者。用足阳明巨虚上廉代之。当取手太阳合穴者。用足阳明巨虚下
廉代之。此根据灵枢经本输篇大肠合于巨虚上廉。小肠合于巨虚下廉。三焦下俞。出于
中外廉。名曰委阳。阴有阳疾。实则泻之之正例。
《灵枢经》说：针刺各种热证，手法要像手伸进热水里一样迅速（一）；针刺寒证，手法要像人不想行走那样缓慢（一）。这就是继起者使用的“透天凉”和“烧山火”两种手法。
针灸家的师承口诀说：提针产生热感，插针产生寒感。向内转是泻法，向外转是补法。补泻的方法，可以停针等待气至，慢慢地运针。提插的手法，不可偏废使用。因为如果尽量向下插直到骨头，就不能再插了；如果尽量向上提直到针体完全退出体外，就不能再用了。所以规定为“三提一插”。提针时呼气，插针时吸气，这叫做“烧山火”。因为提的次数多，卫分之气振奋，会出现振振恶寒的症状，用这种手法，阳日使用偶数次，阴日使用奇数次，必然能使患者发热。反过来说，“三插一提”，插针时吸气，提针时呼气，这叫做“透天凉”。因为插的次数多，营分之气内入，会出现蒸蒸发热的症状，用这种手法，阳日使用奇数次，阴日使用偶数次，必然能使热退。除了祛寒退热，这是针灸家必要的手法，所以《灵枢·九针十二原》篇将其列在末尾，地位等同于《本输》篇之首。
以上所说的烧山火、透天凉的正规用法，是男子在午前使用，女子在午后使用。如果男子在午后出现大寒证或大热证，应当使用烧山火或透天凉时，就反过来使用。如果女子在午前出现大寒证或大热证，应当使用烧山火或透天凉时，也反过来使用。
歌诀说：三插一提凉透天，三提一插火烧山。提针吹气插针吸，女午后兮男午前。
五运有太过与不及，五气有倾移，有常规也有变化。突然发生的变动叫做变，顺应四时阴阳往复、寒暑交替的规律叫做常。根据时辰选取穴位，符合运气常规，但不能应对突发变化。《内经·气交变大论》篇说：“应常不应卒”，说的就是这个道理。所以《素问·刺法论》中的升降手法，想要发散郁结而升提气的，都必须等待时机；如果要抑制其胜气、疏散其郁结而降气的，则不需要等待时机。分析如下：
五脏藏气上升的方法：
肝木之气，郁结而不能上升，应当刺足厥阴肝经的井穴（大敦）。乙日和庚日的酉时开穴。
心火之气，郁结而不能上升，应当刺心包络的荥穴（劳宫）。丙日和辛日的未时开穴。
脾土之气，郁结而不能上升，应当刺足太阴脾经的俞穴（太白）。丙日和辛日的丑时开穴，己日的酉时已过（此处原文逻辑似指特定时间条件，按字面翻译）。
肺金之气，郁结而不能上升，应当刺手太阴肺经的经穴（经渠）。丙日和辛日的卯时开穴。
肾水之气，郁结而不能上升，应当刺足少阴肾经的合穴（阴谷）。丙日和辛日的巳时开穴。
以上所说的上升取穴，必须等待时机的正例。想要使气上行，就用右手大拇指指甲刮动针柄，左手手指顺着经络引导，使气上行。接着使用补法，或多补少泻法。
五脏藏气下降的方法：
肝木之气，想降而不能降，应当折抑其所胜之脏，刺手太阴肺经的井穴（少商），手阳明大肠经的合穴（曲池）。
心火之气，想降而不能降，应当折抑其所胜之脏，刺足少阴肾经的井穴（涌泉），足太阳膀胱经的合穴（委中）。
脾土之气，想降而不能降，应当折抑其所胜之脏，刺足厥阴肝经的井穴（大敦），足少阳胆经的合穴（阳陵泉）。
肺金之气，想降而不能降，应当折抑其所胜之脏，刺心包络的井穴（中冲），手少阳三焦经的合穴（天井）。
肾水之气，想降而不能降，应当折抑土脏，刺足太阴脾经的井穴（隐白），足阳明胃经的合穴（下陵三里，即足三里）。
以上所说的下降取穴，不需要等待时机的正例。想要使气下行，用右手大拇指指甲向下刮动针柄，使气下行。纯用泻法。如果病在六腑，邪气实盛，应当取手少阳三焦经合穴的，用足太阳膀胱经络穴委阳穴代替；应当取手阳明大肠经合穴的，用足阳明胃经上巨虚穴代替；应当取手太阳小肠经合穴的，用足阳明胃经下巨虚穴代替。这是依据《灵枢经·本输》篇：大肠合于巨虚上廉，小肠合于巨虚下廉，三焦的下俞出于中外廉，名叫委阳。阴病有阳疾，实证用泻法的正例。
The *Ling Shu* (Spiritual Pivot) states: When needling various heat syndromes, the technique should be swift, like a hand dipping into hot water (1). When needling cold syndromes, the technique should be slow, like a person unwilling to walk (1). This refers to the two techniques of "Tou Tian Liang" (Penetrating Heaven Coolness) and "Shao Shan Huo" (Burning Mountain Fire) used for subsequent conditions.
Acupuncture masters' oral transmission says: Lifting the needle generates heat; inserting the needle generates cold. Rotating inward is reducing method; rotating outward is tonifying method. For tonification and reduction, one may pause the needle to await Qi arrival and rotate slowly. However, lifting and inserting methods cannot be used exclusively. Because if one inserts fully until the bone, insertion cannot continue; if one lifts fully until the needle exits the body completely, lifting cannot continue. Therefore, it is prescribed as "three lifts and one insertion." Lifting while exhaling, inserting while inhaling constitutes "Shao Shan Huo" (Burning Mountain Fire). Since many lifts cause Qi in the Wei (Defensive) level to surge, leading to symptoms of shivering and aversion to cold, this technique is applied using even numbers on Yang days and odd numbers on Yin days, which will inevitably induce heat generation. Conversely, "three insertions and one lift," inserting while inhaling and lifting while exhaling, constitutes "Tou Tian Liang" (Penetrating Heaven Coolness). Since many insertions cause Qi in the Ying (Nutritive) level to enter, leading to symptoms of steaming heat, this technique is applied using odd numbers on Yang days and even numbers on Yin days, which will inevitably reduce fever. Besides dispelling cold and reducing heat, these are essential techniques for acupuncturists. Thus, in the *Ling Shu*, they are listed at the end of the first chapter "Nine Needles and Twelve Source Points," equivalent to being placed at the beginning of the "Ben Shu" (Principal Acupoints) chapter.
The orthodox method for Shao Shan Huo and Tou Tian Liang mentioned above applies to men before noon and women after noon. If a man presents with severe cold or severe heat syndromes in the afternoon requiring Shao Shan Huo or Tou Tian Liang, the application should be reversed. Similarly, if a woman presents with severe cold or severe heat syndromes in the morning requiring these techniques, the application should also be reversed.
A rhyme states: Three insertions and one lift cool the heavens; three lifts and one insertion burn the mountain. Lift while blowing air, insert while inhaling; women after noon, men before noon.
The Five Movements have excess and deficiency; the Five Qi shift, having both constancy and variation. Sudden movement is called variation; adapting to the four seasons, the recurrence of Yin and Yang, and the alternation of cold and heat is called constancy. Selecting acupoints according to time aligns with the constant movements of Qi, but cannot adapt to sudden changes. The *Nei Jing* (Inner Canon), Chapter "Qi Jiao Bian Da Lun" (Great Treatise on Changes in the Intersection of Qi), states: "Respond to constancy, not to suddenness." This is what is meant. Therefore, in the "Ci Fa Lun" (Chapter on Needling Methods), the ascending and descending techniques intended to disperse stagnation and ascend Qi must wait for the appropriate time. However, to suppress excessive Qi and dissipate stagnation by descending Qi, there is no need to wait for time. The analysis follows below.
Methods for Ascending the Qi of the Five Zang Organs:
When the Qi of Liver Wood is stagnant and fails to ascend, needle the Jing-Well point of the Foot Jueyin Liver Meridian (Dadun, LR1). It opens at You hour on Yi and Geng days.
When the Qi of Heart Fire is stagnant and fails to ascend, needle the Ying-Spring point of the Pericardium (Laogong, PC8). It opens at Wei hour on Bing and Xin days.
When the Qi of Spleen Earth is stagnant and fails to ascend, needle the Shu-Stream point of the Foot Taiyin Spleen Meridian (Taibai, SP3). It opens at Chou hour on Bing and Xin days; You hour on Ji day has passed.
When the Qi of Lung Metal is stagnant and fails to ascend, needle the Jing-River point of the Hand Taiyin Lung Meridian (Jingqu, LU8). It opens at Mao hour on Bing and Xin days.
When the Qi of Kidney Water is stagnant and fails to ascend, needle the He-Sea point of the Foot Shaoyin Kidney Meridian (Yingu, KI10). It opens at Si hour on Bing and Xin days.
The above describes the orthodox example of ascending point selection, which requires waiting for time. To make Qi ascend, use the thumbnail of the right hand to scrape the needle handle, and use fingers of the left hand to guide along the meridian, causing Qi to ascend. Subsequently apply tonification method, or more tonification less reduction method.
Methods for Descending the Qi of the Five Zang Organs:
When the Qi of Liver Wood desires to descend but cannot, suppress its conquering organ. Needle the Jing-Well point of the Hand Taiyin Lung Meridian (Shaoshang, LU11) and the He-Sea point of the Hand Yangming Large Intestine Meridian (Quchi, LI11).
When the Qi of Heart Fire desires to descend but cannot, suppress its conquering organ. Needle the Jing-Well point of the Foot Shaoyin Kidney Meridian (Yongquan, KI1) and the He-Sea point of the Foot Taiyang Bladder Meridian (Weizhong, BL40).
When the Qi of Spleen Earth desires to descend but cannot, suppress its conquering organ. Needle the Jing-Well point of the Foot Jueyin Liver Meridian (Dadun, LR1) and the He-Sea point of the Foot Shaoyang Gallbladder Meridian (Yanglingquan, GB34).
When the Qi of Lung Metal desires to descend but cannot, suppress its conquering organ. Needle the Jing-Well point of the Pericardium (Zhongchong, PC9) and the He-Sea point of the Hand Shaoyang Sanjiao Meridian (Tianjing, TE10).
When the Qi of Kidney Water desires to descend but cannot, suppress the Earth organ. Needle the Jing-Well point of the Foot Taiyin Spleen Meridian (Yinbai, SP1) and the He-Sea point of the Foot Yangming Stomach Meridian (Xialing Sanli, i.e., Zusanli, ST36).
The above describes the orthodox example of descending point selection, which does not require waiting for time. To make Qi descend, use the thumbnail of the right hand to scrape downward on the needle handle, causing Qi to descend. Apply pure reduction method. If the disease is in the Six Fu Organs and pathogenic factors are excessive, when the He-Sea point of the Hand Shaoyang Sanjiao Meridian should be taken, substitute it with the Luo-Connecting point Weiyang (BL38) of the Foot Taiyang Bladder Meridian. When the He-Sea point of the Hand Yangming Large Intestine Meridian should be taken, substitute it with Shangjuxu (ST37) of the Foot Yangming Stomach Meridian. When the He-Sea point of the Hand Taiyang Small Intestine Meridian should be taken, substitute it with Xiajuxu (ST39) of the Foot Yangming Stomach Meridian. This follows the orthodox example from the *Ling Shu* Chapter "Ben Shu": Large Intestine combines with Shangjuxu, Small Intestine combines with Xiajuxu, the lower Shu of Sanjiao emerges from Zhongwailian, named Weiyang. Yin diseases with Yang pathogens, excess patterns use reduction.