诸本无篇字。马云前论刺有五节。后论有真气有邪气。故名篇。
二曰发 甲乙。 、作蒙。下文并同。
振埃者（止）相倾移也 张云。振埃者。犹振落尘埃。故取其外经。可以去阳病也。发 者。犹开
发 。故刺其腑输。可以治腑病也。去爪者。犹脱去余爪。故取关节肢络。可以治血道不通之病也。彻衣者。
犹彻去衣服。故当尽刺诸阳之奇输也。解惑者。犹解其迷惑。故在尽知阴阳。调其虚
实。可以移易其病也。志云。奇输者六腑之别络也。
愤 甲乙作愤 。是。志本同。
大气逆上 志云。大气、宗气也。阳气大逆。故愤 肩息。大气逆上。故喘喝坐伏也。简案、千金奔
气汤。治大气上奔。胸膈中诸病。发时迫满。短气不得卧。剧者 欲死。盖此证也。
坐伏 马云。坐伏不常。
病恶埃烟KT 不得息 甲乙。恶埃烟KT 四字。作咽噎二字。是。张云。如埃如烟。KT 不得息。
KT、古噎字。简案、张注未允。当从甲乙玉篇。KT 、音噎。食不下也。说文。饭窒也。辨脉篇云。水得
寒气。冷必相搏。其人即KT 。
天容 志云。手太阳小肠之经。刺之以通阳气之逆。
穷 马云。穷屈胸痛。张云。 、音屈。不伸也。志云。 者语塞也。
廉泉 马云。系任脉经穴。志云。通肾脏之逆气。
无过一里 甲乙作深无一里。注云。里字疑误。马云。无过人行一里。
发 马云。礼。仲尼燕居篇云。于太子昭然若发 。注云。若目不明。为人所发。而有所见也。
于日中刺其听宫 甲乙。日上有白字。马云。手太阳小肠经之听宫穴。张云。日中、阳王气行之时也。
中其眸子 张云。其脉与目相通。故能中其眸子。刺之而声应于耳。乃其穴也。志云。眸子、耳中之
珠。刺耳之听宫。尚疾于发目之 。是耳窍与目窍之相通也。简案、眸、说文。目童子也。孟子云。存乎人者。
莫良于眸子。志以为耳中之珠者何。
坚按其两鼻窍而疾偃 张云。此验声之法也。刺其穴
以手坚按鼻孔。而疾为偃卧。其声则应于针也。志云。疾偃其声。闭其口窍也。简案、志注近是、盖偃、HT 通。
HT、怒腹也。又作 。巢源有小儿 啼候。玉篇。 体、怒腹也。
此所谓（止）相得者也 马云。此所谓彼虽弗见所为。而不必以有目以为视。吾能见而取之。真有神明
相得之妙也。张云。谓病无形见。有不必相见而取者。真有神明相得之妙也。
刺节言去爪（止）津液之道也 甲乙。爪、作衣。下同。肢胫、作股 。无管以二字。垂、作睾。张
云。腰脊所以立身。故为身之大关节。肢胫所以趋翔。故为人之管。管、键也。茎垂者。前阴宗筋也。命门元
气盛衰。具见于此。故为身中之机。精由此泄。故可以候阴精而为津液之道也。志云。手足肢胫之骨节。人之
管以趋翔。盖津液淖泽于肢胫。则筋骨利而胫能步趋。肢能如翼之翔也。简案、荀子儒效篇。圣人也者。道之
管也。注。管、枢要也。
故饮食不节（止）命曰去爪 甲乙。溢、作流。血道、作水道。日大不怵、作炅不休息。常、作裳。
诸本不怵、作不休。此本误。当改。张云。饮食不节。病在太阴阳明。喜怒不时。病在少阴厥阴。故其津液内
溢。则下留于睾。为日大不休。不可蔽匿等证。盖即 疝之类。治之者当察在何经。以取其关节肢络。故命曰
去爪者。犹去其赘疣也。睾、音高。阴丸也。楼氏云。内经刺久 疝共四法。其一节。此篇文所谓铍石取睾囊
中水液者是也。其法今世人亦多能之。睾丸囊大如斗者。中藏秽液。必有数升。信知此。出古法也。铍针如刀
状。马云。荥然有水。凝蓄不行。集韵云。荥、小水貌。
内热相搏 甲乙。作两热相薄。
外畏绵帛近（止）又不可近席 甲乙。作衣热不可近身。
身热不可近席。
腊干 甲乙作HT 一字。注。黄帝古针经。作稿腊。（检字书HT 字无考）
饮食不让美恶 甲乙。作欲饮二字。张云。滋味不能辨也。
取之于其天府大杼（止）疾于彻衣 甲乙。稀、作 。张云。天府、手太阴经穴。大杼、中膂俞。俱足
太阳经穴。刺此皆可以去热。又补足太阴脾经。手太阴肺经。以出其汗。热去汗出而病除。其速有如彻衣。此
盖伤寒邪热之类也。志云。或不必尽刺诸阳之奇输。取之于其天府、大杼、三 。使膀胱所藏之津液。外濡于
皮毛。又刺太阳经之中膂。通津液。上滋于心脏。以去其热。肺主皮毛。脾主为胃行其津液。故当补足手太阴。
以出其汗也。简案、甲乙载之六经受病发热。伤寒热病篇。张注。有所据。
大风在身（止）甚于迷惑 张云。风邪在身。血脉必虚。正不胜邪。故为轻重倾侧等病。以其颠倒无常。
故曰甚于迷惑。此即中风之类也。马云。其虚者为不足而轻。其实者为有余而重。大体当倾侧宛伏。虽四方上
下。皆已反复颠倒。简案、宛、郁同。甲乙载之阳受病发风篇。张注为是。
有容大者 有狭小者 甲乙。无容字狭字。
五章 马云。汉史约法三章。犹言五事也。张云。五条也。
痹热 诸本作瘅热。张独作痹。误。
凡刺痈邪（止）泻之 甲乙。脆、作越。过痈者。作遇痈所者四字。马云。陇、隆同。生气通天论。有
日中而阳气隆。本经营卫生会篇。作陇。古盖陇隆互用。道去声。此承上文而言。肿聚散亡之法也。凡刺痈邪。
无迎其气之来隆。所谓
避其来锐者是也。如易风俗。如移性情相似。须缓以待之。若不得脓。则揉以脆之。导以行之。去其痈肿之乡。
彼当不安处所。乃自散亡矣。凡诸阴阳经之有病生痈者。取其本经之输穴以泻之。如手太阴输穴太渊之类。张
云。脆、柔脆溃坚之谓。凡痈毒不化则不得脓。故或托其内。或温其外。或刺以针。或灸以艾。务化其毒皆脆。
道更行也。乡、向也。安、留聚也。去其毒瓦斯所向。不使安留处所。乃自消散矣。故于诸阴经阳经。但察其过
于壅滞者。皆当取输穴以泻其锐气。是即所谓去其乡也。简案、志云。气壅而肿。非痈脓也。又云。脆道、肌
肉之理路也。并非。
凡刺大邪（止）刺诸阳分肉间 甲乙作凡刺大邪用锋针。曰剽、作标。通、作道。肌肉上有于字。无亲
字。反其真、作乃自直道四字。张云。大邪、实邪也。邪气盛大。难以顿除。日促小之。自可渐去。去其有余。
实者虚矣。此释上文。大者必去也。剽、砭刺也。通病气所由之道也。针无妄用。务中其邪。邪正脉色。必当
亲切审视。若以小作大。则反其真。盛大实邪。多在三阳。故宜刺诸阳分肉间。简案、剽、砭刺也。出说文。
凡刺小邪（止）刺分肉间 甲乙。日、作曰。费作贵。马云。费、废同。张云。小邪、虚邪也。虚邪补
之。则正气日大。而邪自退也。不足而补。乃可无害。若泻其虚。斯不免矣。此释上文小者益阳也。迎之界者。
迎其气行之所也。先补不足之经。后泻有余之经。邪去正复。则远近之真气尽至。邪气不得外侵。则必费散无
留矣。小邪随在可刺。故但取分肉间也。志云。侵、渐进也。费、用也。
凡刺热邪（止）病乃已 甲乙。热邪下有用 针三字。苍、作沧。开通、作开道。道下有平字。马云。
此承上文。而详
言瘅热消灭之法也。凡刺热邪。其热盛则神志外越。而意气苍茫。若出游不归。乃欲无病。当开辟之。张云。
越、发扬也。苍、卒疾也。出游、行散也。归、还也。凡刺热邪者。贵于速散。散而不复。乃无病矣。开通壅
滞。辟其门户。以热邪之宜泻也。简案、苍、作沧为是。沧、说文。寒也。枚乘传。欲汤之沧。一人吹之。百
人扬之。无益也。刺热邪。宜发越而沧之也。
凡刺寒邪（止）其气存也 日以温、甲乙。日、作曰。马志。温、作除。非。甲乙。来、作去。其
气、作真气。张云。温者温其正气也。徐往徐来。欲和缓也。致其神者。致其阳气。则寒邪自除。此释上文。
寒痹益温也。补其虚则门户闭而气不泄。故虚实可调。真气可存。此邪寒之宜温也。志云。上节论开辟门户以
去邪。此论门户已闭乃存正。
刺痈者（止）用毫针也 马云。此承上文而言刺五邪之针。各有所宜用也。九针论。五曰铍针。主
大痈脓。两热争者也。故此曰。刺痈者用铍针。又四曰锋针。主痈热出气。故此曰刺大者用锋针。又六曰圆利
针。主取远痹者也。故此曰刺小者用圆利针。一曰 针。主热在头身。故此曰刺热者用 针。又七曰毫针。主
寒热。痛痹在络。故此曰刺寒者用毫针。
介按、考痈疽刺法。其轻重徐疾。自有一定。在人心度量用之。不可乱施。盖皮薄针深。反伤好肉。肉
浓针浅。毒又难出。大抵肿高而软者在肌肉。针四五分。肿下而坚者在筋脉。针六七分。肿平肉色不变者。附
于骨也。宜针寸许。若毒生背腹肋胁等处。宜扁针斜入。以防透膜。针既透脓。视疮口必有脓意如珠。斯时欲
大开口。则将针斜出。欲小开口。则将针直出。所谓逆而夺之。顺而取之也。
解论 张云。解结之论也。人与天地相参应。必知其
道。斯可与言解结矣。
下有渐洳 上生苇蒲 张云。渐洳、伏泉也。下有渐洳。则上生苇蒲。内外之应。理所皆然。人之
表里。可察盛衰。亦犹是也。志云。渐洳、濡湿之地。苇蒲生于水中。其质柔弱。中抽坚茎。名曰蒲槌。内刚
外柔。为坚心之坎水。以比人之元阳。生于精水之中。故曰此所以知形气之多少也。谓充于形中之气。生于天
一水中。知所秉之浓薄。则知气有多少矣。简案、志注甚凿。以苇蒲为一物。非也。然渐洳之解。为是。洳、
说文作HT 。渐湿也。诗。魏风。彼汾沮洳。集韵。渐洳、湿貌也。
血气减 甲乙。减、作盛。
热则滋雨而在上 马云。暑热则地气上蒸。而滋雨气在于上。所以物之气。亦不在下而在上。其根
当少汁。
治厥者（止）以解结者也 张云。此治厥之法。倘天时未温。而必欲用针。则必藉火气以熨调其经。
凡掌腋肘脚项脊之间。皆溪谷大节之交会。故当熨之温之。则火气通而血脉行。然后视其病脉。淖泽者。卫气
浮也。故可刺而平之。坚紧者。邪气实也。故当破而散之。厥逆除而宗气下。乃可止针矣。结者邪之所聚。刺
去其邪。即解结之谓也。
用针之类（止）弗能取之 甲乙。留于海、作留积在海。张云。凡用针者。必在调气。人受气于谷。
故气积于胃。然气义有三。曰营气。曰卫气。曰宗气。清者为营。营在脉中。浊者为卫。卫在脉外。故各行其
道也。宗气、大气也。大气者。留止于上下之气海。其下者。蓄于丹田。注足阳明之气街。而下行于足。其上
者。积于胸中。出于息道而为呼吸。凡此三者。皆所谓气。当各求其属而调之者也。（按气街义如卫气篇曰知
六腑之气街者能知解结契绍于门户当与此参阅）厥者逆也。阴寒之气也。
厥逆在足。则阳道不行。故宗气不下。而血脉凝滞。不以火温。不能取也。
视其应动者 乃后取之而下之 马云。视其气之来应而动者。然后取其穴而下针焉。斯可也。张云。
视其气之应手而动者。其微其甚。则虚实可知。然后用法取之。而气自下矣。
六经调者（止）解结也 甲乙。视而泻之下。有通而决之一句。马云。手足各有三阴三阳。谓之六经
也。六经之脉各调和者。谓之不病。内有一经之脉。上实下虚而不通。此则足经之气。厥逆而上。故上实而下
虚。其在外必有横络之脉。盛加于大经之中。令其不通。乃视之可见者也。当视而泻之。此亦所谓解结之法也。
上寒下热（止）上之者也 甲乙注。一本合、作冷。张云。上寒下热者。阳虚于上。而实于下也。当
先刺项间。足太阳经大杼、天柱、等穴。久当其针而补之。仍温熨肩项之间。候其气至。上热与下相合。乃止
其针。此所谓推其下者。而使之上也。
上热下寒（止）下之者也 甲乙。陷之、作陷下。马云。凡上热下冷者。视其下脉之虚而陷之于经络
者补之。使上之气下乃止。此其热在于上者。若引而下之。所谓引而下之之法也。
大热遍身（止）散之者也 甲乙。因其、作因令。诸本。切之、作切推。马志与此本同。甲乙作切推
之下。至缺盆中。马云。上文上寒下热。上热下寒。其热非遍身者也。今大热遍身。狂而闻见言语。以无为有。
则热之极也。足阳明经多气多血。为五脏六腑之海。故当视其足阳明之大络取之。虚则补之。血而实者则泻之。
又必因病患偃卧之际。医工居其
头前。以两手各用大指食指共四指。挟其颈之动脉而按之。即人迎、大迎、处也。又久而持之。又卷而切之。
下至缺盆之中而后止。又如前法行之。候其热去乃止。此所谓推而散之之法也。张云。盖三阳在头。故可独取
人迎。而推散其热也。卷、 同。
一脉 张云。犹言一经也。
各版本中无“篇”字。马莳认为，前文论述针刺有五种节次，后文论述真气与邪气，因此命名为此篇。
第二种是“振埃”。《甲乙经》中，“ ”写作“蒙”，下文相同。
所谓“振埃”，是指消除外邪的倾覆转移。张景岳说：振埃，就像抖落尘埃一样，所以取用体表经络，可以治疗阳分病证。“发 ”，就像开发疏通一样，所以刺其六腑的输穴，可以治疗腑病。“去爪”，就像脱去多余的指甲一样，所以取用关节和肢体络脉，可以治疗血道不通的病证。“彻衣”，就像脱下衣服一样，所以应当尽刺诸阳经的奇输穴。“解惑”，就像解开迷惑一样，所以要完全了解阴阳，调和虚实，就可以改变疾病的状态。张志聪说：奇输，是六腑的别络。
“愤 ”，《甲乙经》写作“愤 ”，这是正确的。志本（张志聪注本）相同。
“大气逆上”，张志聪说：大气，就是宗气。阳气大逆，所以出现愤 肩息（愤怒、喘息抬肩）。大气逆上，所以出现喘喝坐伏（喘息有声，坐卧不安）。简案：《千金方》中的奔气汤，治疗大气上奔，胸膈部的各种病证。发作时胸部胀满，短气不能平卧，严重的甚至感觉快要死了。这大概就是这种证候。
“坐伏”，马莳说：坐伏不定，指坐立不安。
“病恶埃烟KT 不得息”，《甲乙经》中，“恶埃烟KT”四字，写作“咽噎”二字，这是正确的。张景岳说：像埃如烟，KT 不得息。KT，是古“噎”字。简案：张注不恰当，应当遵从《甲乙经》和《玉篇》，KT ，音同噎，指食物不下。《说文解字》说：饭窒也（吃饭受阻）。《辨脉篇》说：水遇到寒气，冷必相互搏结，那人就会KT （噎塞）。
“天容”，张志聪说：手太阳小肠经的穴位。刺此穴以通调阳气的逆乱。
“穷 ”，马莳说：穷屈胸痛。张景岳说： ，音屈，指不伸展。张志聪说： 者，语塞也（说话受阻）。
“廉泉”，马莳说：属于任脉经穴。张志聪说：通调肾脏的逆气。
“无过一里”，《甲乙经》作“深无一里”，注云：“里”字疑似有误。马莳说：不超过人行走一里的深度。
“发 ”，马莳说：《礼记·仲尼燕居》篇说：“于太子昭然若发 ”。注云：像眼睛不明亮，被人启发而有所看见。
“于日中刺其听宫”，《甲乙经》中，“日”上有“白”字。马莳说：手太阳小肠经的听宫穴。张景岳说：日中，是阳气旺盛、气机运行的时候。
“中其眸子”，张景岳说：其经脉与目相通，所以能中其眸子（眼球）。刺之而声音应验于耳，这才是该穴。张志聪说：眸子，是耳中的珠（指耳窍）。刺耳中的听宫，比发出眼中的 还要快。这是耳窍与目窍相通的表现。简案：眸，《说文解字》说：目童子也（瞳孔）。孟子说：存乎人者，莫良于眸子。张志聪认为是耳中之珠，为什么？
“坚按其两鼻窍而疾偃”，张景岳说：这是验证声音的方法。刺其穴位时，用手用力按住鼻孔，并迅速仰卧，其声音则会应验于针。张志聪说：疾偃其声，是闭其口窍。简案：志注接近正确。盖“偃”与“HT”通。“HT”，指怒腹（腹部因愤怒而鼓起）。又写作“ ”。巢元方《诸病源候论》有小儿 啼候。《玉篇》： 体，怒腹也。
“此所谓（止）相得者也”，马莳说：此所谓虽然彼方看不见所为，但不一定非要有眼睛才能看。我能看见并取法它，真有神明相得的妙处。张景岳说：谓病无形可见，有的不必相见就能取法，真有神明相得的妙处。
“刺节言去爪（止）津液之道也”，《甲乙经》中，“爪”作“衣”，下同。“肢胫”作“股 ”。无“管以”二字。“垂”作“睾”。张景岳说：腰脊用来站立身体，所以是身体的大关节。肢胫用来行走飞翔，所以是人的管。管，就是键（关键）。茎垂者，是前阴宗筋。命门元气的盛衰，都显现于此，所以是身体中的机关。精由此泄出，所以可以观察阴精而作为津液之道。张志聪说：手足肢胫的骨节，是人的管，用来行走飞翔。大概津液滋润于肢胫，则筋骨利而胫能步趋，肢能如翅膀般飞翔。简案：《荀子·儒效》篇：圣人也者，道之管也。注：管，枢要也。
“故饮食不节（止）命曰去爪”，《甲乙经》中，“溢”作“流”。“血道”作“水道”。“日大不怵”作“炅不休息”。“常”作“裳”。诸本“不怵”作“不休”，此本误，应当改正。张景岳说：饮食不节，病在太阴、阳明；喜怒不时，病在少阴、厥阴。所以其津液内溢，则下留于睾，导致睾丸日渐肿大不休，不可遮蔽隐匿等证候。这大概就是疝气之类。治疗者应当察看在哪条经，以取其关节肢络，所以命名为去爪，就像去除赘疣一样。睾，音高，指阴丸。楼氏说：《内经》刺久 疝共有四法，其一节，即此篇文中所说的“铍石取睾囊中水液”的方法。此法现在世人也多能施行。睾丸囊肿大如斗者，中间藏有秽液，必有数升。确实知道这一点，可知出自古法。铍针如刀状。马莳说：荥然有水，凝蓄不行。《集韵》说：荥，小水貌。
“内热相搏”，《甲乙经》作“两热相薄”。
“外畏绵帛近（止）又不可近席”，《甲乙经》作“衣热不可近身”。
“身热不可近席”。
“腊干”，《甲乙经》作“HT”一字。注：《黄帝古针经》作“稿腊”。（检字书“HT”字无考）
“饮食不让美恶”，《甲乙经》作“欲饮”二字。张景岳说：滋味不能辨别。
“取之于其天府大杼（止）疾于彻衣”，《甲乙经》中，“稀”作“ ”。张景岳说：天府，手太阴经穴；大杼，足太阳经穴（注：原文注云中膂俞，俱足太阳经穴，此处可能有误，大杼确为足太阳，但中膂俞亦属足太阳，需结合上下文，通常天府为大杼并列提及多为肺与膀胱经配合）。刺此皆可以去热。又补足太阴脾经、手太阴肺经，以出其汗。热去汗出而病除，其速度有如脱衣。这大概是伤寒邪热之类的病证。张志聪说：或许不必尽刺诸阳之奇输，取之于天府、大杼、三焦俞。使膀胱所藏的津液，外濡于皮毛。又刺太阳经的中膂俞，通津液，上滋于心脏，以去其热。肺主皮毛，脾主为胃行其津液，所以应当补足手太阴，以出其汗。简案：《甲乙经》记载于六经受病发热、伤寒热病篇。张注有所依据。
“大风在身（止）甚于迷惑”，张景岳说：风邪在身，血脉必虚，正气不胜邪气，所以出现轻重倾侧等病。因其颠倒无常，所以说比迷惑还严重。这就是中风之类。马莳说：其虚者为不足而轻，其实者为有余而重。大体应当倾侧宛伏，虽四方上下，都已反复颠倒。简案：宛，同郁。《甲乙经》记载于阳受病发风篇。张注是正确的。
“有容大者”、“有狭小者”，《甲乙经》无“容”字、“狭”字。
“五章”，马莳说：汉史约法三章，犹言五事。张景岳说：五条。
“痹热”，诸本作“瘅热”。张景岳独作“痹”，错误。
“凡刺痈邪（止）泻之”，《甲乙经》中，“脆”作“越”。“过痈者”作“遇痈所者”四字。马莳说：陇，同隆。《生气通天论》有“日中而阳气隆”。《本经营卫生会》篇作“陇”。古时大概陇、隆互用。道，去声。这是承接上文而言肿聚散亡的方法。凡刺痈邪，不要迎着其气来势正盛的时候（所谓避其来锐）。如同易风俗、移性情相似，须缓慢等待。如果不得脓，则揉搓使其溃破，导引使其运行，离开痈肿所在之处，那里自然不安稳，于是自行消散了。凡诸阴阳经有病生痈的，取其本经的输穴以泻之，如手太阴输穴太渊之类。张景岳说：脆，指柔脆溃坚。凡痈毒不化则不得脓，所以或托其内，或温其外，或刺以针，或灸以艾，务必化其毒，都是使之脆软，道路更行。乡，向也。安，留聚也。去掉毒瓦斯所向之处，不使其安留，于是自行消散。所以在诸阴经阳经，只要察看过于壅滞的，都当取输穴以泻其锐气，这就是所谓的“去其乡”。简案：张志聪说：气壅而肿，不是痈脓。又说：脆道，肌肉的理路。都不对。
“凡刺大邪（止）刺诸阳分肉间”，《甲乙经》作“凡刺大邪用锋针”。“曰剽”作“标”。“通”作“道”。肌肉上有“于”字。无“亲”字。“反其真”作“乃自直道”四字。张景岳说：大邪，实邪。邪气盛大，难以立刻清除，逐渐缩小它，自然可以渐去。去掉有余，实者变虚。这是对上文“大者必去”的解释。剽，砭刺。通，病气所由之道。针无妄用，务必中其邪。邪正脉色，必须亲切审视。若以小作大，则反其真。盛大实邪，多在三阳，所以宜刺诸阳分肉间。简案：剽，砭刺。出自《说文》。
“凡刺小邪（止）刺分肉间”，《甲乙经》中，“日”作“曰”。“费”作“贵”。马莳说：费，废同。张景岳说：小邪，虚邪。虚邪补之，则正气日大，而邪自退。不足而补，才可无害。若泻其虚，则不免受害。这是对上文“小者益阳”的解释。迎其界，是迎其气行之所。先补不足之经，后泻有余之经。邪去正复，则远近的真气尽至，邪气不得外侵，则必费散无留。小邪随在可刺，所以只取分肉间。张志聪说：侵，渐进。费，用。
“凡刺热邪（止）病乃已”，《甲乙经》中，“热邪”下有用“针”三字。“苍”作“沧”。“开通”作“开道”。“道”下有“平”字。马莳说：这是承接上文，详细论述瘅热消灭的方法。凡刺热邪，其热盛则神志外越，意气苍茫，像出游不归，想无病是不可能的。应当开辟它。张景岳说：越，发扬。苍，卒疾。出游，行散。归，还。凡刺热邪，贵在速散。散而不复，才无病。开通壅滞，辟其门户，因为热邪宜泻。简案：苍，作沧为是。沧，《说文》：寒。枚乘传：欲汤之沧，一人吹之，百人扬之，无益。刺热邪，宜发越而沧之。
“凡刺寒邪（止）其气存也”，“日以温”，《甲乙经》中，“日”作“曰”。马莳、志本，“温”作“除”，不对。《甲乙经》中，“来”作“去”。“其气”作“真气”。张景岳说：温，是温其正气。徐往徐来，想要和缓。致其神，是致其阳气，则寒邪自除。这是对上文“寒痹益温”的解释。补其虚则门户闭而气不泄，所以虚实可调，真气可存。这是邪寒宜温的道理。张志聪说：上节论开辟门户以去邪，此节论门户已闭乃存正。
“刺痈者（止）用毫针”，马莳说：这是承接上文而言刺五邪的针，各有适宜使用的。《九针论》：五曰铍针，主大痈脓，两热争。所以这里说：刺痈者用铍针。又四曰锋针，主痈热出气，所以这里说：刺大者用锋针。又六曰圆利针，主取远痹，所以这里说：刺小者用圆利针。一曰 针，主热在头身，所以这里说：刺热者用 针。又七曰毫针，主寒热，痛痹在络，所以这里说：刺寒者用毫针。
介按：考察痈疽刺法，其轻重徐疾，自有定规，在于人心度量使用，不可乱施。大概皮薄针深，反而伤好肉；肉浓针浅，毒又难出。大抵肿高而软者在肌肉，针四五分；肿下而坚者在筋脉，针六七分；肿平肉色不变者，附于骨，宜针寸许。若毒生背腹肋胁等处，宜扁针斜入，以防透膜。针既透脓，视疮口必有脓意如珠，此时欲大开口，则将针斜出；欲小开口，则将针直出。所谓逆而夺之，顺而取之。
“解论”，张景岳说：解结的论述。人与天地相参应，必须知道其道，才可以谈论解结。
“下有渐洳 上生苇蒲”，张景岳说：渐洳，伏泉。下有渐洳，则上生苇蒲。内外相应，道理皆然。人之表里，可察盛衰，也是如此。张志聪说：渐洳，濡湿之地。苇蒲生于水中，其质柔弱，中抽坚茎，名曰蒲槌。内刚外柔，为坚心之坎水，以比人之元阳，生于精水之中，所以说这是知道形气多少的方法。谓充于形中之气，生于天一水中，知所秉之浓薄，则知气有多少。简案：志注很穿凿，把苇蒲当作一物，不对。然而渐洳的解释，是对的。洳，《说文》作“HT”，渐湿。《诗·魏风》：彼汾沮洳。《集韵》：渐洳，湿貌。
“血气减”，《甲乙经》中，“减”作“盛”。
“热则滋雨而在上”，马莳说：暑热则地气上蒸，而滋雨气在于上。所以物的气，也不在下而在上，其根应当少汁。
“治厥者（止）以解结者也”，张景岳说：这是治厥的方法。倘若天时未温，而一定要用针，则必须借火气以熨调其经。凡掌腋肘脚项脊之间，都是溪谷大节的交会，所以应当熨之温之，则火气通而血脉行。然后视其病脉，淖泽者，卫气浮，所以可刺而平之；坚紧者，邪气实，所以当破而散之。厥逆除而宗气下，才可以停针。结者，邪之所聚，刺去其邪，就是解结的意思。
“用针之类（止）弗能取之”，《甲乙经》中，“留于海”作“留积在海”。张景岳说：凡用针者，必须在调气。人受气于谷，所以气积于胃。然而气义有三：曰营气，曰卫气，曰宗气。清者为营，营在脉中；浊者为卫，卫在脉外。所以各行其道。宗气，即大气。大气，留止于上下之气海。其下者，蓄于丹田，注足阳明之气街，下行于足；其上者，积于胸中，出于息道而为呼吸。凡这三者，都叫气，应当各求其属而调之。（按气街之义如《卫气》篇说：知六腑之气街者，能知解结契绍于门户，当与此参阅。）厥，逆也，阴寒之气。厥逆在足，则阳道不行，所以宗气不下，而血脉凝滞，不以火温，不能取。
“视其应动者 乃后取之而下之”，马莳说：视其气之来应而动者，然后取其穴而下针，才可以。张景岳说：视其气之应手而动者，其微其甚，则虚实可知，然后用法取之，而气自下了。
“六经调者（止）解结也”，《甲乙经》中，“视而泻之下”有“通而决之”一句。马莳说：手足各有三阴三阳，谓之六经。六经之脉各调和者，谓之不病。内有一经之脉，上实下虚而不通，这是足经之气，厥逆而上，所以上实而下虚。其在外必有横络之脉，盛加于大经之中，令其不通，乃视之可见。应当视而泻之，这也是所谓的解结之法。
“上寒下热（止）上之者也”，《甲乙经》注：一本“合”作“冷”。张景岳说：上寒下热，是阳虚于上，而实于下。应当先刺项间足太阳经的大杼、天柱等穴，久留其针而补之，仍温熨肩项之间，候其气至，上热与下相合，乃止其针。此所谓推其下者，而使之上。
“上热下寒（止）下之者也”，《甲乙经》中，“陷之”作“陷下”。马莳说：凡上热下冷者，视其下脉之虚而陷之于经络者补之，使上之气下乃止。此其热在于上者，若引而下之，所谓引而下之的方法。
“大热遍身（止）散之者也”，《甲乙经》中，“因其”作“因令”。诸本“切之”作“切推”。马莳与此本同。《甲乙经》作“切推之下，至缺盆中”。马莳说：上文上寒下热、上热下寒，其热非遍身。今大热遍身，狂而闻见言语，以无为有，则是热之极。足阳明经多气多血，为五脏六腑之海，所以应当视其足阳明之大络取之，虚则补之，血而实者则泻之。又必因病患偃卧之际，医工居其头前，以两手各用大指食指共四指，挟其颈之动脉而按之，即人迎、大迎处。又久而持之，又卷而切之，下至缺盆之中而后止。又如前法行之，候其热去乃止。此所谓推而散之的方法。张景岳说：盖三阳在头，所以可独取人迎，而推散其热。卷，同 。
“一脉”，张景岳说：犹言一经。
There is no character "Pian" (Chapter) in various editions. Ma Shi states that the preceding text discusses five categories of acupuncture, and the following text discusses true Qi and pathogenic Qi; hence it is named this chapter.
The second category is "Zhen Ai" (Shaking off Dust). In the *Jia Yi Jing* (Systematic Classic of Acupuncture and Moxibustion), the character " " is written as "Meng", and the same applies to the subsequent text.
"Zhen Ai" refers to eliminating the overturning and shifting of external pathogens. Zhang Jingyue explains: Zhen Ai is like shaking off dust; therefore, selecting the exterior meridians can treat diseases of the Yang aspect. "Fa " (Opening/Releasing) is like opening and unblocking; thus, puncturing the Shu points of the Fu organs can treat Fu organ diseases. "Qu Zhua" (Removing Claws) is like removing excess nails; therefore, selecting the joints and collateral vessels of the limbs can treat disorders of blood flow obstruction. "Che Yi" (Removing Clothes) is like taking off clothes; therefore, one should puncture all the Qi Shu points of the Yang meridians. "Jie Huo" (Resolving Confusion) is like resolving confusion; thus, by fully understanding Yin and Yang and regulating deficiency and excess, one can alter the state of the disease. Zhang Zhicong states: Qi Shu refers to the divergent collaterals of the Six Fu organs.
"Fen " is written as "Fen " in the *Jia Yi Jing*, which is correct. The version annotated by Zhicong is consistent.
"Da Qi Ni Shang" (Reverse Flow of Great Qi): Zhang Zhicong states: Da Qi is Zong Qi (Gathering Qi). When Yang Qi reverses severely, it manifests as Fen Shen Xi (anger and panting with raised shoulders). When Da Qi reverses upward, it manifests as Chuan He Zuo Fu (panting with audible sound, restlessness in sitting or lying). Note: The Ben Qi Tang (Rushing Qi Decoction) in the *Qian Jin Fang* treats the upward rush of Da Qi, causing various chest and diaphragm disorders. During attacks, there is chest fullness, shortness of breath preventing supine position, and in severe cases, a sensation of impending death. This likely corresponds to such a syndrome.
"Zuo Fu" (Restlessness in Sitting/Lying): Ma Shi states: Restlessness in sitting and lying, indicating inability to remain still.
"Bing Wu Ai Yan KT Bu De Xi" (Disease dislikes dust and smoke, KT prevents breathing): In the *Jia Yi Jing*, the four characters "Wu Ai Yan KT" are written as "Yan Ye" (Choking/Gagging), which is correct. Zhang Jingyue states: Like dust and smoke, KT prevents breathing. KT is the ancient character for "Ye" (Choking). Note: Zhang's annotation is not appropriate; one should follow the *Jia Yi Jing* and *Yu Pian*. KT sounds like "Ye", meaning food cannot go down. The *Shuo Wen Jie Zi* states: Obstruction in eating. The *Bian Mai Pian* states: When water meets cold qi, the cold must contend, and the person will experience KT (choking/obstruction).
"Tian Rong": Zhang Zhicong states: A point on the Hand Taiyang Small Intestine meridian. Puncturing this point unblocks the reverse flow of Yang Qi.
"Qiong " (Stiffness/Inability to Extend): Ma Shi states: Qiong Qu chest pain. Zhang Jingyue states: , pronounced "Qu", means unable to extend. Zhang Zhicong states: Refers to speech obstruction.
"Lian Quan": Ma Shi states: An acupoint of the Ren Mai (Conception Vessel). Zhang Zhicong states: Unblocks the reverse Qi of the Kidney.
"Wu Guo Yi Li" (Not exceeding one Li): The *Jia Yi Jing* reads "Shen Wu Yi Li" (Depth does not exceed one Li), with a note suggesting "Li" might be an error. Ma Shi states: Not exceeding the depth reached by walking one Li.
"Fa " (Enlightenment/Revealing): Ma Shi cites the *Li Ji* (Book of Rites), *Zhong Ni Yan Ju* chapter: "For the crown prince, it is clear as if 'Fa '". The annotation states: Like eyesight being unclear, being revealed by others so that one sees.
"Puncture Ting Gong at Noon": In the *Jia Yi Jing*, there is a character "Bai" above "Ri". Ma Shi states: Ting Gong is a point on the Hand Taiyang Small Intestine meridian. Zhang Jingyue states: Noon is when Yang Qi is prosperous and its movement is active.
"Hit its Ming Zi" (Pupil/Eye): Zhang Jingyue states: Its meridians connect with the eye, so it can affect the pupil. Puncturing it causes the sound to resonate in the ear, which indicates the correct point. Zhang Zhicong states: Ming Zi refers to the pearl in the ear (referring to the ear orifice). Puncturing Ting Gong in the ear acts faster than revealing the in the eye. This shows the connection between the ear and eye orifices. Note: Ming Zi, according to *Shuo Wen Jie Zi*, refers to the pupil. Mencius says: What resides in a person is best seen in the pupils. Why did Zhang Zhicong consider it the pearl in the ear?
"Press firmly both nasal cavities and quickly lie prone": Zhang Jingyue states: This is a method to verify sound resonance. While puncturing the point, press the nostrils firmly with the hand and quickly assume a prone position; the sound will resonate with the needle. Zhang Zhicong states: The sound of quickly lying prone involves closing the oral orifice. Note: Zhicong's annotation is close to correct. "Yan" is interchangeable with "HT". HT refers to abdominal distension due to anger. It is also written as " ". Chao Yuanfang's *Zhu Bing Yuan Hou Lun* mentions infant crying due to HT. The *Yu Pian* states: Ti refers to abdominal distension due to anger.
"This is what is called... mutual attunement": Ma Shi states: This implies that although the other party cannot see the action performed, vision is not strictly required to perceive. I can perceive and utilize it, possessing the profound wonder of divine mutual attunement. Zhang Jingyue states: The disease has no visible form, yet some aspects can be addressed without direct visual encounter, truly embodying the wonder of divine mutual attunement.
"The Chapter on Acupuncture Categories mentions Removing Claws... the way of fluids": In the *Jia Yi Jing*, "Zhua" is written as "Yi". "Zhi Jing" is written as "Gu ". The characters "Guan Yi" are absent. "Chui" is written as "Gao". Zhang Jingyue states: The waist and spine support the body, thus serving as the major joints of the body. The limbs and shins enable walking and flying, thus serving as the "guan" (keys/bars) of humans. Guan means key. The penis and scrotum are the Zong Jin (tendons) of the anterior yin. The prosperity or decline of the Primordial Qi of the Gate of Life is manifested here, making them the mechanism of the body. Essence is discharged from here, so they can serve as indicators of Yin essence and the pathway of body fluids. Zhang Zhicong states: The bone joints of the hands, feet, limbs, and shins are the guan of humans, used for walking and flying. Essentially, when body fluids moisten the limbs and shins, the sinews and bones become flexible, allowing the shins to walk and the limbs to fly like wings. Note: In the *Xunzi*, *Ru Xiao* chapter: "The sage is the guan of the Dao." Annotation: Guan means pivot or key.
"Therefore, irregular diet... is called Removing Claws": In the *Jia Yi Jing*, "Yi" is written as "Liu". "Xue Dao" is written as "Shui Dao". "Ri Da Bu Chu" is written as "Jiong Bu Xiu Xi". "Chang" is written as "Shang". Most editions read "Bu Xiu" instead of "Bu Chu"; this edition is erroneous and should be corrected. Zhang Jingyue states: Irregular diet leads to disease in the Taiyin and Yangming meridians; improper emotions lead to disease in the Shaoyin and Jueyin meridians. Thus, body fluids overflow internally and accumulate downward in the Gao (testicles), causing daily enlargement without cessation, and symptoms such as inability to conceal. This is likely related to hernia syndromes. The practitioner should determine the affected meridian and select the joint and collateral vessels of the limbs. Hence it is called "Removing Claws," akin to removing warts. Gao, pronounced "Gao", refers to the testicle. Lou氏 states: There are four methods in the *Nei Jing* for treating chronic hernia. One is described in this chapter as using a Pi Stone to drain fluid from the scrotal sac. This method is still known today. When the testicular sac is enlarged like a bushel, it contains foul fluid, amounting to several sheng. Knowing this reveals ancient techniques. The Pi Needle is knife-shaped. Ma Shi states: Ying Ran indicates accumulated small amounts of water that do not flow. The *Ji Yun* states: Ying refers to the appearance of small streams.
"Internal heat contends": The *Jia Yi Jing* writes "Liang Re Bo" (Two heats contend).
"Fear of cotton and silk near the body... and cannot lie on mats": The *Jia Yi Jing* writes "Clothing heat cannot approach the body".
"Body heat cannot approach mats".
"La Gan" (Dry/Withered): The *Jia Yi Jing* writes "HT" as one character. Note: The *Huangdi Gu Zhen Jing* writes "Gao La". (Dictionary check finds no record for "HT").
"Diet does not distinguish good or bad taste": The *Jia Yi Jing* writes "Yu Yin" (Desire to drink). Zhang Jingyue states: Inability to discern flavors.
"Select Tian Fu and Da Zhu... faster than Removing Clothes": In the *Jia Yi Jing*, "Xi" is written as " ". Zhang Jingyue states: Tian Fu is a point on the Hand Taiyin Lung meridian; Da Zhu is a point on the Foot Taiyang Bladder meridian (Note: Text mentions Zhong Lv Shu, also Foot Taiyang). Puncturing these can eliminate heat. Additionally, tonify the Spleen (Foot Taiyin) and Lung (Hand Taiyin) meridians to induce sweating. When heat is eliminated and sweat is released, the disease resolves, as swiftly as removing clothes. This likely pertains to exogenous pathogenic heat. Zhang Zhicong states: Perhaps it is not necessary to puncture all Qi Shu points of the Yang meridians; selecting Tian Fu, Da Zhu, and San Jiao Shu allows the fluids stored in the Bladder to moisten the skin and hair externally. Puncturing Zhong Lv Shu of the Taiyang meridian unblocks fluids, nourishing the Heart upwards to remove heat. The Lung governs skin and hair; the Spleen transports fluids for the Stomach. Therefore, one should tonify the Hand Taiyin to induce sweating. Note: Recorded in the *Jia Yi Jing* under Fever caused by Disease of the Six Meridians and Cold Damage Heat Disease chapter. Zhang's annotation has basis.
"Great Wind in the body... worse than confusion": Zhang Jingyue states: When wind pathogen is in the body, blood vessels must be deficient. Righteous Qi cannot overcome the pathogen, leading to diseases of lightness/heaviness and tilting. Due to its erratic nature, it is said to be worse than confusion. This belongs to stroke syndromes. Ma Shi states: Deficiency manifests as lightness; excess manifests as heaviness. Generally, there is tilting and depression, with reversal in all directions. Note: Wan is synonymous with Yu (stagnation). Recorded in the *Jia Yi Jing* under Wind Caused by Disease of Yang Receiving Pathogens. Zhang's annotation is correct.
"Those with large capacity" and "Those with small capacity": The *Jia Yi Jing* omits the characters "Rong" and "Xia".
"Wu Zhang" (Five Chapters/Categories): Ma Shi states: Similar to the Han history's "Three Articles of Law," referring to five matters. Zhang Jingyue states: Five items.
"Biyre" (Bi-Heat): Most editions write "Danre" (Cancer-Heat). Zhang Jingyue alone writes "Bi", which is incorrect.
"Generally puncture Yong Xie... drain it": In the *Jia Yi Jing*, "Cui" is written as "Yue". "Guo Yong Zhe" is written as "Yu Yong Suo Zhe" (Four characters). Ma Shi states: Long is synonymous with Long (Prosperous). The *Sheng Qi Tong Tian Lun* mentions "Yang Qi is prosperous at noon." The *Ben Cao Ying Wei Hui* chapter writes "Long". Anciently, Long and Long were likely interchangeable. Dao, pronounced with departing tone. This follows the previous text regarding the method of swelling gathering and dispersing. Generally, when puncturing Yong Xie (Abscess Pathogen), do not confront the peak of its incoming Qi (avoiding its sharpness). It is like changing customs or temperament; one must wait patiently. If pus does not form, knead to soften/collapse it, guide to move it, and leave the area of the abscess. The pathogen will feel uncomfortable and disperse naturally. For any Yin or Yang meridian disease producing abscesses, select the Shu point of the affected meridian to drain it, such as Taiyuan (LU9) for the Hand Taiyin. Zhang Jingyue states: Cui refers to softening and collapsing hardness. If abscess toxin does not resolve, pus will not form. Thus, either tonify internally, warm externally, puncture with needles, or moxa with mugwort, aiming to transform the toxin into a soft state, allowing the pathway to reopen. Xiang means Xiang (Direction). An means staying/gathering. Remove the direction where the toxin gathers, preventing it from staying, so it disperses naturally. Therefore, for any Yin or Yang meridian, if observing excessive stagnation, select the Shu point to drain its sharp Qi. This is the so-called "Qu Qi Xiang" (Remove its location). Note: Zhang Zhicong states: Qi stagnation and swelling is not necessarily an abscess/pus. Also, Cui Dao refers to muscle fiber paths. Both are incorrect.
"Generally puncture Da Xie... puncture between Yang muscle layers": The *Jia Yi Jing* writes "Generally puncture Da Xie using Feng Zhen". "Yue Piao" is written as "Biao". "Tong" is written as "Dao". There is a character "Yu" on the muscle layer. No character "Qin". "Fan Qi Zhen" is written as "Nai Zi Zhi Dao" (Four characters). Zhang Jingyue states: Da Xie is Excess Pathogen. The pathogen is vigorous and difficult to remove instantly; gradually reduce it, and it will slowly disappear. Removing the excess makes the excess become deficiency. This explains the previous text "Large ones must be removed." Piao refers to Bian Ci (stone needle puncture). Tong refers to the pathway of pathogenic Qi. Needles should not be used recklessly; one must hit the pathogen accurately. Pathogenic and righteous pulse colors must be carefully examined. If mistaking small for large, one reverses the truth. Vigorous excess pathogens mostly reside in the Three Yang meridians, so it is suitable to puncture between the muscle layers of the Yang meridians. Note: Piao, stone needle puncture, comes from *Shuo Wen*.
"Generally puncture Xiao Xie... puncture between muscle layers": In the *Jia Yi Jing*, "Ri" is written as "Yue". "Fei" is written as "Gui". Ma Shi states: Fei is synonymous with Fei (Abandon). Zhang Jingyue states: Xiao Xie is Deficient Pathogen. Tonifying deficient pathogen increases righteous Qi daily, causing the pathogen to retreat. Tonifying deficiency causes no harm. If draining deficiency, harm is inevitable. This explains the previous text "Small ones benefit Yang." Ying Qi Jie means welcoming the realm of Qi movement. First tonify the deficient meridian, then drain the excess meridian. When the pathogen leaves and righteousness returns, the true Qi from near and far arrives completely, and the pathogen cannot invade externally, thus dispersing without leaving. Xiao Xie can be punctured anywhere, so only select the muscle layers. Zhang Zhicong states: Qin means gradual invasion. Fei means use.
"Generally puncture Re Xie... the disease ceases": In the *Jia Yi Jing*, three characters "Zhen" are added after "Re Xie". "Cang" is written as "Cang". "Kai Tong" is written as "Kai Dao". There is a character "Ping" after "Dao". Ma Shi states: This continues the previous text, detailing the method of eliminating Danre (Cancer-Heat). Generally, when puncturing Re Xie, if the heat is severe, the spirit wanders outward, and the Qi/Yi becomes vast and hasty, like traveling abroad and not returning. To avoid disease, one must open it up. Zhang Jingyue states: Yue means expand/rise. Cang means sudden/hasty. You Lu means dispersing travel. Gui means return. Generally, when puncturing Re Xie, speed in dispersing is prized. Dispersed and not recurring, there is no disease. Unblock stagnation, open the gates, because Re Xie should be drained. Note: Writing Cang as Cang is correct. Cang, *Shuo Wen*: Cold. Mei Cheng's Biography: Wanting the soup to be cold, one blows, a hundred fan; it is useless. Puncturing Re Xie should involve expanding and cooling it.
"Generally puncture Han Xie... the Qi remains": "Ri Yi Wen", In the *Jia Yi Jing*, "Ri" is written as "Yue". Ma Shi and Zhicong versions write "Wen" as "Chu", which is incorrect. In the *Jia Yi Jing*, "Lai" is written as "Qu". "Qi" is written as "Zhen Qi". Zhang Jingyue states: Wen means warming the righteous Qi. Slow entry and slow withdrawal aim for gentleness. Zhi Qi Shen means directing Yang Qi, so Han Xie self-eliminates. This explains the previous text "Han Bi benefits from warmth." Tonifying deficiency closes the gates and prevents Qi leakage, so deficiency and excess are regulated, and True Qi is preserved. This is why Han Xie should be warmed. Zhang Zhicong states: The previous section discussed opening gates to expel pathogens; this section discusses preserving righteousness after gates are closed.
"Puncturing Yong... use Hao Zhen": Ma Shi states: This continues the previous text regarding the needles suitable for puncturing the Five Pathogens. The *Jiu Zhen Lun* states: The fifth is Pi Zhen,主治大痈脓 (mainly for large abscesses and pus), dealing with two contending heats. Hence it says: Puncturing Yong uses Pi Zhen. The fourth is Feng Zhen,主治痈热出气 (mainly for abscess heat releasing Qi), hence it says: Puncturing Da (Excess) uses Feng Zhen. The sixth is Yuan Li Zhen,主治远痹 (mainly for distant Bi), hence it says: Puncturing Xiao (Deficient/Small) uses Yuan Li Zhen. The first is Chen Zhen (character missing/obscured),主治热在头身 (mainly for heat in head and body), hence it says: Puncturing Re (Heat) uses Chen Zhen. The seventh is Hao Zhen,主治寒热痛痹在络 (mainly for cold-heat and painful Bi in collaterals), hence it says: Puncturing Han (Cold) uses Hao Zhen.
Jie notes: Examining the acupuncture methods for abscesses and ulcers, their severity, slowness, and speed have fixed rules, relying on the practitioner's judgment. Do not apply randomly. Generally, if the skin is thin and the needle is deep, it damages healthy flesh; if the flesh is thick and the needle is shallow, the toxin is hard to exit. Roughly, if the swelling is high and soft, it is in the muscle; needle 4-5 fen. If the swelling is low and hard, it is in the sinews/tendons; needle 6-7 fen. If the swelling is flat and skin color unchanged, it adheres to the bone; needle about 1 cun. If the toxin arises in areas like the back, abdomen, ribs, or flanks, use a flat needle obliquely to prevent penetrating membranes. Once the needle penetrates the pus, observe the wound; if the pus looks like a bead, to make a large opening, withdraw the needle obliquely; to make a small opening, withdraw it straight. This is called "Ni Er Duo Zhi" (Oppose and seize) and "Shun Er Qu Zhi" (Follow and take).
"Jie Lun" (Explanation of Untying Knots): Zhang Jingyue states: This is the discussion on untying knots. Humans correspond to Heaven and Earth; one must know the Dao to discuss untying knots.
"Below there are seeping springs, above grow reeds and rushes": Zhang Jingyue states: Jian Ru refers to hidden springs. Below there are hidden springs, so above grow reeds and rushes. Internal and external correspondence is logical. Human interior and exterior can observe prosperity and decline, similarly. Zhang Zhicong states: Jian Ru refers to damp/wet land. Reeds and rushes grow in water; their texture is soft, but they draw out a hard stem inside, named Pu Chui. Hard inside, soft outside, representing Kan Water (Water trigram) with a firm heart, compared to human Primordial Yang born within Essence Water. Hence it says this is how to know the quantity of Form and Qi. It means the Qi filling the Form is born from Tian Yi Water. Knowing the thickness/thinness of what is endowed allows knowing the quantity of Qi. Note: Zhicong's annotation is too pedantic, treating reeds and rushes as one thing, which is incorrect. However, the explanation of Jian Ru is correct. Ru, *Shuo Wen*: HT, gradually wet. *Shi Jing*, Wei Feng: Bi Fen Ju Ru. *Ji Yun*: Jian Ru, appearance of dampness.
"Blood and Qi decrease": The *Jia Yi Jing* writes "Jian" as "Sheng" (Increase).
"Heat causes rain to nourish from above": Ma Shi states: Summer heat causes earth Qi to evaporate upward, and nourishing rain Qi is located above. Thus, the Qi of things is also not below but above, and their roots should have less juice.
"Treat Jue... by untying knots": Zhang Jingyue states: This is the method for treating Jue. If the weather is not yet warm but one must use acupuncture, one must rely on fire Qi to warm and regulate the meridians. Areas like palms, axillae, elbows, feet, neck, and spine are intersections of large valleys and joints, so they should be warmed and moxa'd. Then fire Qi flows and blood vessels move. Then observe the disease pulse: if soft/moist, Wei Qi is floating, so it can be punctured to calm it; if hard/tight, pathogen is excess, so it should be broken and dispersed. When Jue Ni is removed and Zong Qi descends, the needle can be stopped. Jie refers to the gathering of pathogen; puncturing away the pathogen is untying the knot.
"Categories of using needles... cannot be taken": In the *Jia Yi Jing*, "Liu Yu Hai" is written as "Liu Ji Zai Hai". Zhang Jingyue states: Generally, using needles requires regulating Qi. Humans receive Qi from grain, so Qi accumulates in the Stomach. However, Qi has three meanings: Ying Qi, Wei Qi, and Zong Qi. Clear becomes Ying, residing in the vessels; turbid becomes Wei, residing outside the vessels. Thus, each follows its own path. Zong Qi is Da Qi. Da Qi stays in the Qi Hai (Sea of Qi) above and below. The lower part accumulates in the Dantian, pours into the Qi Jie of Foot Yangming, and descends to the foot. The upper part accumulates in the Chest Middle, exits via the Xi Dao for respiration. All three are called Qi and should be regulated according to their respective affiliations. (Note: The meaning of Qi Jie is like in the *Wei Qi* chapter: Knowing the Qi Jie of the Six Fu allows knowing how to untie knots and connect doors; refer to this together.) Jue means reverse, Yin-Cold Qi. If Jue Ni is in the foot, the Yang pathway does not function, so Zong Qi does not descend, and blood vessels stagnate. Without warming with fire, it cannot be treated.
"Observe those responding with movement, then select and descend": Ma Shi states: Observe where Qi responds and moves, then select the point and insert the needle. This is acceptable. Zhang Jingyue states: Observe where Qi responds to touch and moves; its slightness or severity reveals deficiency or excess. Then apply methods to select, and Qi will descend naturally.
"Six Meridians harmonized... untying knots": In the *Jia Yi Jing*, "Shi Er Xie Zhi Xia" has the phrase "Tong Er Jue Zhi". Ma Shi states: Hands and feet each have three Yin and three Yang, called Six Meridians. If the pulses of the Six Meridians are harmonious, it is called non-diseased. If one meridian internally has excess above and deficiency below without flow, this is because Qi of the Foot Meridian reverses upward, causing excess above and deficiency below. Externally, there must be transverse collaterals overflowing into the main meridians, causing blockage, visible upon observation. One should observe and drain it. This is also the method of untying knots.
"Cold above, Heat below... raise it": Note in *Jia Yi Jing*: One version writes "He" as "Leng". Zhang Jingyue states: Cold above, Heat below means Yang deficiency above and excess below. One should first puncture points like Da Zhu and Tian Zhu on the Foot Taiyang meridian in the neck, retain the needle for a long time, and tonify. Still warm-moxa the shoulder and neck. Wait for Qi arrival, when upper heat combines with lower, then stop the needle. This is pushing from below to make it rise.
"Heat above, Cold below... lower it": In the *Jia Yi Jing*, "Xian Zhi" is written as "Xian Xia". Ma Shi states: For Heat above and Cold below, observe the deficiency and sinking of the lower pulses in the meridians and tonify them, causing the Qi above to descend, then stop. This is the method of drawing Heat downward.
"Great Heat throughout the body... disperse it": In the *Jia Yi Jing*, "Yin Qi" is written as "Yin Ling". Most editions write "Qie Zhi" as "Qie Tui". Ma Shi agrees with this edition. *Jia Yi Jing* writes "Qie Tui Zhi Xia, Zhi Que Pen Zhong". Ma Shi states: The previous texts on Cold above/Heat below and Heat above/Cold below did not describe heat throughout the body. Now, great heat throughout the body, mania with hallucinations and speech, perceiving nothing as something, indicates extreme heat. Foot Yangming has abundant Qi and Blood, the Sea of the Five Zang and Six Fu organs. Therefore, observe the large collaterals of Foot Yangming and select them; tonify if deficient, drain if blood is excess. Furthermore, while the patient lies prone, the physician stands at the head, using thumbs and index fingers of both hands (four fingers total) to clamp and press the carotid artery of the neck, i.e., Ren Ying and Da Ying points. Hold for a long time, then roll and press, descending to the center of Que Pen, then stop. Repeat the previous method until heat dissipates. This is the method of pushing and dispersing. Zhang Jingyue states: Since the Three Yang converge at the head, one can solely select Ren Ying to push and disperse the heat. Juan is synonymous with .
"One Meridian": Zhang Jingyue states: Equivalent to saying "One Meridian".