诸本无篇字。
为定 甲乙。定、作实。下同。
春取经 马云。经、当作络。义见素问水热穴论。张云。春取经。即本输篇。大经分肉之间也。
夏取盛经孙络 马云。水热穴论云。夏取盛经分腠。又曰。绝肤而病去者。邪居浅也。盖言夏气在表。
故病在表。止于皮肤。绝而不深入以刺之。正以邪之所居。为甚浅也。又曰。所谓盛经者。阳经也。则止取手
足六阳经之经穴耳。
取之合 马云。水热穴论曰。取合以虚阳邪。则知是六阳经之合穴也。
冬取井荥 马云。水热穴论云。取井以泻阴逆。则阴经当刺井穴。如手太阴肺经少商为井之类。取荥
以实阳气。则阳经当刺荥穴。如手阳明大肠经二间为荥之类。
温疟 素疟论云。先伤于风。而后伤于寒。故先热而后寒也。亦以时作。故曰温疟。
五十九刺 详后热病篇。刺、诸本作 。唯张作刺。
风 肤胀 马云。 、即水。以水为疾。故加以疾之首。风水、见素奇病论。水热穴论。评热论。本经
论疾诊尺篇。肤胀者。即本经水胀论之所谓肤胀也。简案、外台引肘后方云。疗卒大腹 病诸方。此病本由水
来。应水字而经方皆水为病。故施疾状。此乃与马说符矣。吴音水。病貌。集韵贰类切。音税。肿病并非。
五十七 详见素水热穴论。
三阴之上 甲乙。之、作交。马云。补三阴之上者。补三阴交。乃足三阴血气之所交。宜补之。因有
二穴。故用
二补字。及有一皆字。张志同。
热行 马云。候针下热行。乃止针。张云。阳气至而热行。热行则泄止矣。
转筋于阳（止）卒刺之 马云。卒、猝同。凡手足之外廉。皆属阳经。若转筋于阳。则治其阳经。凡手
足之内廉。皆属阴经。若转筋于阴。则治其阴经。皆当猝然刺之。张云。卒、病也。故不必拘于时日。但随其
病而卒刺之。志云。卒、猝同。淬刺者。烧针劫刺。以取筋痹。简案、楼氏纲目亦作淬、盖本于经筋篇。亦当
备一说。
徒 张云。徒、但也。有水无风。故曰徒水。简案、马云。徒、但也。上文言风水者。有风有水也。
此曰徒水。则有风无水也。若无水。则下文何得云 尽乃止。必是字之误。志云。徒、众也。土为中央之灌溉
于四旁。土气虚。则四方之众水。反乘侮其土而为水病也。此解尤为牵强。
环谷 马云。按各经无环谷穴。止足少阳胆经有环跳穴。今曰下三寸。意者风市穴乎。理亦甚的。张
同。志云。环谷者。取手足之分肉。以泻其水也。溪谷有三百六十五穴。会肉之大会为谷。大会者。手足股肱
之大肉也。简案、据志注。则三寸二字。竟不稳妥。
马云。 、直也。已刺而直其针以纳之。张云。筒、箭室也。已刺而筒之。而内之。入而复之。
以尽其 。谓用针如箭之归筒。出入频复。开通其道。以尽其水也。志云。 、筒也。以如筒之针而内之。入
而复出。简案、筒之义。诸注未明。九针论。圆针筒。其身如是。 、筒同。又楼氏纲目载本节文云。筒针、
针中有空窍。如筒出水也。今据志以筒释之。盖此似言以筒纳针孔内。使水自筒中泄出者。世有用此术得效者。
然不可妄施。张云。针要曰。凡水气。
惟得针水沟。若针余穴。水尽即死。是又不可不知也。
必坚来缓则烦俯 来急则安静 马云。必欲尽去其水。水力尽时。其肉必坚。且水来缓。则内必烦
闷。来急。则内必安静。张云。 在肤中。其候必坚。志云。水肿于肌肉。则浮而软。水尽则肉必坚矣。余与
马同。简案、徒 以下。其义未详。甲乙文有异同。然亦未明晰。录左备考。甲乙云。徒水先取环谷下三寸。
以排针刺之而藏之。引而内之。入而复出。以尽其水。必坚束之。束缓则烦闷。束急则安静。
饮闭药 马云。必饮通闭之药。以利其水。防其再肿。志云。谓水乃尽。当饮充实脾土之药。勿使水
之复乘也。简案、马为是。
方饮无食（止）百三十五日 张云。药食不宜相混。混则难于取效。水肿既消。当忌伤脾发湿等物。
至一百三十五日之外。方保其不复矣。
着痹不去 张云。痹论云。湿气胜者为着痹。谓其重着难动。故云不去。若寒湿相搏。久而不已。当
猝取足阳明之三里穴。温补胃气。则寒湿散而痹可愈也。沈亮宸曰。溪谷、属骨。此承上文肌腠未尽之水。流
于关节则为着痹。故取阳明之三里。从腑以泻脏也。
骨为干 马云。此句与上下文不相蒙。意者乃经脉篇之说简欤。沈亮宸云。此承上文而言。骨之为病。
在骨之髓节也。干者、如木干之坚劲。是故温疟之邪。藏于骨髓。湿痹之气。流于关节。其骨如干。而不受邪
之所伤。简案、今仍马注。
肠中不便 张云。小肠不便者。不能化物。大肠不便者。不能传道。大肠小肠。皆属于胃。故当取
足阳明之三里穴。邪气盛则泻之。正气虚则补之。
疠风者（止）无食他食 甲乙。素、作索。锐针针三字作吮一字。恶气之气作血。马云。疠、癞同。此
言刺厉风之法也。按、素问风论云。疠者有营卫热腑。其气不清。故使鼻柱坏而色败。皮肤疡溃。风寒客于脉
而不去。名曰疠风。骨空论、长刺节论。皆谓之大风也。张云。食得其法。谓之方食。无食他食。忌动风发毒
等物也。
介按、疠风即癞病。又名麻风。属于慢性传染病。故凡传染之后。要过数年。方才显露。其病状则遍体麻
木不仁。甚至四肢周身。逐渐毁灭。先由手指。继而足趾。终至鼻柱。均现毁坏。面上状若顽癣。搔破则流稠
水。其未破之处。皮肤片片脱落。奇痒难当。此病可分二种。如面部臀部四肢等处。俱发红色结节。继即溃穿。
后且知觉麻痹。毛窍脱落。容貌奇丑者。斑纹癞也。如初则神经过敏。发神经痛。后则知觉渐次脱失。营养障
害。神经肥浓。面部麻痹者。神经癞也。
腹中常鸣 气上冲胸（止）三里 甲乙。常、作雷。上、作常。志云。此邪在大肠而为病也。大肠为传
导之官。病则其气反逆。是以腹中常鸣。气上冲胸。张云。九针十二原篇曰。肓之原出于脖 。即任脉之下。
气海也。巨虚、上廉、三里。皆足阳明经穴。按、本输篇曰。大肠属上廉。此以邪在大肠。故当刺巨虚、上廉。
若下文之邪在小肠者。则当取巨虚、下廉也。
小肠控睾（止）以调之 甲乙。熏肝下有肺字。简案、据下文刺太阴。甲乙似是。沈亮宸云。控睾引腰
脊。上冲心者。小肠之疝气也。张云。控、引也。睾、阴丸也。小肠连于小腹。若其邪盛。则厥逆自下上冲心
肺。熏于肝胃。引于腰脊。下及肓脐睾系之间也。取肓原以散之。散脐腹之结也。刺太
阴以予之。补肺经之虚也。取厥阴以下之。泻肝经之实也。取巨虚、下廉以去之。求小肠之所属也。按其所过
之经。谓察其邪之所在以调之也。
长太息 志云。胆气欲升。故长太息以伸之。
张云。心虚貌。简案、马释为静。误。
呕苦 甲乙、千金、苦下有汁字。
则刺少阳血络 马云。则、当作侧。胆之经络。在肋之后旁。故曰侧。张云。又刺足少阳血络以平
其木。千金无则字。
闭胆逆 马云。闭者止也。孟子云。陈善闭邪。朱注云。闭、止也。
在上脘则刺（止）去之 马云。则、侧同。胃脘。上下脘之总名。如在上脘。卧针刺之。当抑而下之。
即本经上膈篇之所谓气为上膈。故治之者如此。如在下脘。则刺下脘。当散而去之。即上膈篇之所谓虫为下膈。
故治之者如此。张云。刺抑而下之。谓刺上脘以泻其至高之食气。散而去之。谓温下脘以散其停积之寒滞也。
邪在三焦约（止）取三里 志云。此邪在膀胱而为病也。三焦下俞。出于委阳。并太阳之正。入络
膀胱约下焦。实则闭癃。虚则遗溺。小腹肿痛。不得小便。邪在三焦约也。故当取足太阳之大络。（即取大络
之委阳大络经脉也）小络。孙络也。足太阳厥阴之络。交络于跗 之间。视其结而血者去之。盖肝主疏泄。结
在厥阴之络。亦不得小便矣。如小腹肿。上及胃脘。取足三里。圣济总录云。黄帝三部针灸经。言少腹肿痛。
不得小便。邪在三焦。病名曰三焦约。营卫不调。风邪入客。则决渎之官。约而不通。所以不得大小便也。刺
法取足少阴太阳之经。辅以汤剂。则三焦疏导。清浊判矣。方载枳壳丸
等六首。（方中多用大黄牵牛郁李之类）简案、本节三焦。即指膀胱。上文列六腑之病。而不及膀胱。知是三
焦为膀胱明矣。千金云。三焦名中清之腑。别号玉海。水道出。属膀胱是也。（详见素问识灵兰秘典注）盖约
即脾约之约。而乔世宁校本千金。以约字属下句。亦似有理。张云。太阳大络。飞阳穴也。考甲乙。委阳、三
焦下辅俞也。在足太阳之前。少阳之后云云。此足太阳之别络也。则志注为是。
睹其色 察其目 以知其散复 诸本无目字。但张本有焉。马云。以、为也。论语云。视其所以。
志云。察其以者。察其所以然之病。简案、张补目字。据九针十二原小针解。今从之。
一其形 马云。曰一者。肥瘦各相等否。志云。静守其神形。与、俱也。
病将下 张云。下、退也。
诸经实者 病三日已 张云。凡邪气未解者。最忌脉弱无力。如平人气象论曰。病在中。脉虚。玉
机真藏论曰。病在外。脉不实坚者。皆难治。邪客篇曰。虚而细者久以持。皆不实之谓也。若病在诸经。而脉
实有力者。邪将外达也。故可三日而已矣。
气口候阴 人迎候阳也 张云。气口在手太阴。肺脉也。气口独为五脏主。故以候阴。人迎在头。阳
明胃脉也。胃为六腑之大源。故以候阳。
各版本中均无“篇”字。
根据《甲乙经》定为第十九篇。“定”字，有的版本作“实”。意思相同。
春季针刺取络脉。马莳认为，“经”字应当作“络”。义理见《素问·水热穴论》。张景岳认为，春季取经，即指《灵枢·本输》篇中所述的大经脉行于分肉之间的部位。
夏季针刺盛经和孙络。马莳认为，《水热穴论》说：“夏季取盛经分腠。”又说：“穿透皮肤而病愈的，是因为邪气居处浅表。”这说的是夏季人气在体表，所以病也在体表，仅在皮肤层面，不深入刺之。正是因为邪气所在之处非常浅表。又说：“所谓盛经，是指阳经。”因此只取手足六条阳经的经穴。
取合穴。马莳认为，《水热穴论》说：“取合穴以泻除阳邪。”由此可知这是指六条阳经的合穴。
冬季针刺井穴和荥穴。马莳认为，《水热穴论》说：“取井穴以泻除阴逆。”那么阴经应当刺井穴，例如手太阴肺经的少商穴是井穴之类。取荥穴以充实阳气，那么阳经应当刺荥穴，例如手阳明大肠经的二间穴是荥穴之类。
温疟。《素问·疟论》说：“先感受风邪，后感受寒邪，所以先发热后发冷。也按时发作，所以称为温疟。”
五十九刺。详见后文《热病》篇。“刺”字，各版本多作缺漏或异体字，只有张景岳本作“刺”。
风水、肤胀。马莳认为，“ ”字即“水”字。因为是以水为疾病，所以在前面加上“疾”字。风水，见于《素问·奇病论》、《水热穴论》、《评热论》及本篇《论疾诊尺》篇。肤胀，即本篇《水胀》篇中所说的肤胀。简案：《外台秘要》引用《肘后方》说，治疗突然大腹病的各种方剂，此病原本由水引起，应写作“水”字，但经文方剂都写“水”为病，所以施用了“疾”状描述。这与马莳的说法相符。“ ”读音吴音同“税”，意为病貌。并非指肿病。
五十七穴。详见《素问·水热穴论》。
三阴之上。《甲乙经》中，“之”字作“交”。马莳认为，补三阴之上，即补三阴交穴，这里是足三阴经气血交汇之处，适宜用补法。因为有两个穴位，所以用了两个“补”字，以及一个“皆”字。张志聪观点相同。
热行。马莳认为，等候针下产生热感，才停止进针。张景岳认为，阳气到达而产生热感，热感出现则泄泻停止。
转筋在阳面（立即）猝刺之。马莳认为，“卒”通“猝”。凡是手足外侧，都属于阳经。如果转筋在阳面，就治疗其阳经。凡是手足内侧，都属于阴经。如果转筋在阴面，就治疗其阴经。都应当突然刺之。张景岳认为，“卒”意为病。所以不必拘泥于时日，只要随着病情突然刺之。张志聪说，“卒”通“猝”。淬刺，是烧针劫刺，用来治疗筋痹。简案：楼氏《纲目》也作“淬”，大概基于《经筋》篇。这也应当作为一种说法备查。
徒水。张景岳认为，“徒”意思是“只”。有水无风，所以叫徒水。简案：马莳认为，“徒”意思是“只”。上文说风水，是有风有水。这里说徒水，则是无风有水（注：此处原文逻辑可能有误，通常徒水指无水之风或单纯水肿，但依马注逻辑推导）。若无水，下文怎么说“尽乃止”？必定是字形错误。张志聪认为，“徒”意为众。土为中央灌溉四方。土气虚弱，则四方的众水反而乘侮土气而成为水病。这种解释尤为牵强。
环谷。马莳认为，按各经没有环谷穴，只有足少阳胆经有环跳穴。现在说下三寸，推测是风市穴吗？道理也很确切。张景岳观点相同。张志聪认为，环谷，是选取手足的分肉，以泻除水气。溪谷有三百六十五个穴位。会合肌肉的大部称为谷。大会，是指手足大腿手臂的大块肌肉。简案：根据志注，那么“三寸”二字就不稳妥了。
。马莳认为，“ ”意思是直。已经刺入后将针放直以纳入体内。张景岳认为，“筒”是箭室。已经刺入后像射箭一样筒入，然后内收。进入再退出，以排尽水气。谓使用针具像箭归入筒中，出入频繁重复，开通其道，以排尽水气。张志聪认为，“ ”即“筒”。用如筒状的针纳入体内，进入再退出。简案：“筒”的含义，各家注释都不明确。《九针论》说圆针“筒其身如是”。“ ”与“筒”同。另外楼氏《纲目》记载本节文字说：“筒针，针中有空窍，如筒出水。”现在依据志注以“筒”解释，大概这是说将针纳入筒内，使水从筒中流出。世上有用此术见效的。然而不可妄加施用。张景岳认为，《针要》说：凡是水气，只有针刺水沟穴有效。如果针刺其他穴位，水排尽人就会死。这也是不可不知道的。
必坚来缓则烦俯 来急则安静。马莳认为，必须彻底去除水气。当水力尽时，肌肉必然坚硬。而且水气来势缓，则内部必然烦闷；来势急，则内部必然安静。张景岳认为，“ ”在皮肤肌肉之间，其征象必然坚硬。张志聪认为，水肿在肌肉中，则浮而软。水气排尽则肌肉必然坚硬。我同意马莳的观点。简案：从“徒水”以下，意义不详。《甲乙经》文字有异同，但也未明晰。记录左侧以备考证。《甲乙经》说：徒水先取环谷下三寸，用排针刺入并留置。牵引并内收，进入再退出，以排尽水气。必须坚固束扎。束扎松则烦闷，束扎紧则安静。
饮闭药。马莳认为，必须饮用通闭的药物，以利水气，防止再次肿胀。张志聪认为，是说水气已尽，应当饮用充实脾土的药物，不要让水气再次侵犯。简案：马莳是对的。
方饮无食（至）一百三十五日。张景岳认为，药食不宜混杂。混杂则难以取效。水肿既消，应当忌口伤脾发湿等食物。到一百三十五日之外，才能保证不再复发。
着痹不去。张景岳认为，《痹论》说：“湿气胜者为着痹。”指其沉重难动，所以说“不去”。如果寒湿相搏，久而不愈，应当突然取足阳明胃经的三里穴，温补胃气，则寒湿散而痹症可愈。沈亮宸说：溪谷属骨。这是承接上文肌腠未尽的水气，流注于关节则成为着痹。所以取阳明经的三里穴，从腑以泻脏。
骨为干。马莳认为，此句与上下文不相连贯。猜想可能是《经脉》篇的说法遗漏了吗？沈亮宸说：这是承接上文而言。骨之为病，在于骨的髓节。干者，像木干一样坚劲。所以温疟的邪气，藏于骨髓；湿痹的气，流于关节。其骨如干，而不受邪气的伤害。简案：现在仍采用马注。
肠中不便。张景岳认为，小肠不便，是不能化物；大肠不便，是不能传道。大肠小肠，都归属于胃。所以应当取足阳明胃经的三里穴。邪气盛则泻之，正气虚则补之。
疠风者（至）无食他食。《甲乙经》中，“素”作“索”。“锐针针”三字作“吮”一字。“恶气”的“气”作“血”。马莳认为，“疠”通“癞”。这是说刺厉风的方法。按：《素问·风论》说：“疠者有营卫热腑，其气不清。所以使鼻柱坏而色败，皮肤溃疡。风寒客于脉而不去，名叫疠风。”《骨空论》、《长刺节论》都称之大风。张景岳认为，饮食得其法，叫做方食。无食他食，是忌食动风发毒等物。
介按：疠风即癞病，又名麻风，属于慢性传染病。所以凡传染之后，要过数年，方才显露。其病状则遍体麻木不仁，甚至四肢周身，逐渐毁灭。先由手指，继而足趾，终至鼻柱，均现毁坏。面上状若顽癣，搔破则流稠水，其未破之处，皮肤片片脱落，奇痒难当。此病可分二种，如面部臀部四肢等处，俱发红色结节，继即溃穿，后且知觉麻痹，毛窍脱落，容貌奇丑者，斑纹癞也。如初则神经过敏，发神经痛，后则知觉渐次脱失，营养障碍，神经肥浓，面部麻痹者，神经癞也。
腹中常鸣 气上冲胸（至）三里。《甲乙经》中，“常”作“雷”，“上”作“常”。张志聪认为，这是邪气在大肠而为病。大肠为传导之官，病则其气反逆，所以腹中常鸣，气上冲胸。张景岳认为，《九针十二原》篇说：“肓之原出于脖 ，即任脉之下，气海穴。”巨虚上廉、三里，都是足阳明经穴。按：《本输》篇说：“大肠属上廉。”这是以邪在大肠，所以当刺巨虚上廉。如果下文说邪在小肠者，则当取巨虚下廉。
小肠控睾（至）以调之。《甲乙经》中，熏肝下有“肺”字。简案：据下文刺太阴，《甲乙经》似是。沈亮宸说：控睾引腰脊，上冲心者，是小肠的疝气。张景岳认为，控，牵引也。睾，阴丸也。小肠连于小腹，若其邪盛，则厥逆自下上冲心肺，熏于肝胃，引于腰脊，下及肓脐睾系之间。取肓原以散之，散脐腹之结。刺太阴以予之，补肺经之虚。取厥阴以下之，泻肝经之实。取巨虚下廉以去之，求小肠之所属。按其所过之经，谓察其邪之所在以调之。
长太息。张志聪认为，胆气欲升，所以长太息以伸之。
。张景岳认为是心虚的样子。简案：马莳解释为静，错误。
呕苦。《甲乙经》、《千金方》中，“苦”下有“汁”字。
则刺少阳血络。马莳认为，“则”当作“侧”。胆之经络，在肋之后旁，所以叫侧。张景岳认为，又刺足少阳血络以平其木气。《千金方》无“则”字。
闭胆逆。马莳认为，闭的意思是止。《孟子》说：“陈善闭邪。”朱熹注说：“闭，止也。”
在上脘则刺（至）去之。马莳认为，“则”同“侧”。胃脘，是上脘、下脘的总名。如果在上脘，卧位针刺，应当抑而下之。即本篇《上膈》篇所说的“气为上膈”，所以治疗者如此。如果在下脘，则刺下脘，应当散而去之。即《上膈》篇所说的“虫为下膈”，所以治疗者如此。张景岳认为，刺抑而下之，谓刺上脘以泻其至高之食气。散而去之，谓温下脘以散其停积之寒滞。
邪在三焦约（至）取三里。张志聪认为，这是邪气在膀胱而为病。三焦下俞，出于委阳，并太阳之正，入络膀胱，约束下焦。实则闭癃，虚则遗溺，小腹肿痛，不得小便，邪在三焦约也。所以当取足太阳之大络。（即取大络之委阳大络经脉也）。小络，孙络也。足太阳厥阴之络，交络于跗 之间。视其结而血者去之。盖肝主疏泄，结在厥阴之络，亦不得小便矣。如小腹肿，上及胃脘，取足三里。《圣济总录》说：《黄帝三部针灸经》言少腹肿痛，不得小便，邪在三焦，病名曰三焦约。营卫不调，风邪入客，则决渎之官，约而不通，所以不得大小便也。刺法取足少阴太阳之经，辅以汤剂，则三焦疏导，清浊判矣。方载枳壳丸等六首。（方中多用大黄、牵牛、郁李之类）。简案：本节三焦，即指膀胱。上文列六腑之病，而不及膀胱，知是三焦为膀胱明矣。《千金方》说：三焦名中清之腑，别号玉海，水道出，属膀胱是也。（详见《素问识·灵兰秘典注》）。盖“约”即脾约之约，而乔世宁校本《千金》，以“约”字属下句，也似有理。张景岳认为，太阳大络，飞阳穴也。考《甲乙经》，委阳，三焦下辅俞也，在足太阳之前，少阳之后云云。此足太阳之别络也，则志注为是。
睹其色 察其目 以知其散复。诸本无“目”字，只有张景岳本有焉。马莳认为，“以”是“为”的意思。《论语》说：“视其所以。”张志聪认为，察其以者，察其所以然之病。简案：张景岳补“目”字，依据《九针十二原》小针解，现在采纳它。
一其形。马莳认为，曰一者，指肥瘦各相等否。张志聪认为，静守其神形，与……俱也。
病将下。张景岳认为，下，退也。
诸经实者 病三日已。张景岳认为，凡邪气未解者，最忌脉弱无力。如《平人气象论》说：“病在中，脉虚。”《玉机真藏论》说：“病在外，脉不实坚者，皆难治。”《邪客》篇说：“虚而细者久以持。”皆是不实之谓。若病在诸经，而脉实有力者，邪将外达也。所以可三日而已矣。
气口候阴 人迎候阳也。张景岳认为，气口在手太阴肺脉。气口独为五脏主，故以候阴。人迎在头，阳明胃脉也。胃为六腑之大源，故以候阳。
There is no character "Pian" (Chapter) in various editions.
According to the *Jia Yi Jing* (Systematic Classic of Acupuncture and Moxibustion), it is designated as Chapter 19. The character "Ding" (Determine/Definite) is written as "Shi" (Solid/Real) in some versions. The meaning is the same.
In spring, needle the Luo-connecting vessels. Ma Shi believes that the character "Jing" (Channel/Meridian) should be read as "Luo" (Connecting Vessel). The rationale can be found in *Su Wen: Shui Re Xue Lun* (Treatise on Water and Heat Acupoints). Zhang Jingyue states that taking the Jing in spring refers to the large channels described in *Ling Shu: Ben Shu* (Original Channels), which run between the muscle intervals.
In summer, needle the Sheng-jing (Abundant Channels) and Sun-luo (Fine Connecting Vessels). Ma Shi cites *Shui Re Xue Lun*: "In summer, take the Sheng-jing and Fen-rou (muscle intervals)." It also says: "Those who are cured by penetrating the skin have pathogens residing superficially." This indicates that in summer, Qi is at the body surface, so the disease is also at the surface, confined to the skin, without deep needling. This is precisely because the pathogen resides in a very superficial location. It further states: "What is called Sheng-jing refers to the Yang channels." Therefore, only the Jing-acupoints of the six Yang channels of the hands and feet are selected.
Select the He-sea points. Ma Shi notes that *Shui Re Xue Lun* says: "Taking the He-sea points empties Yang pathogens." From this, we know these refer to the He-sea points of the six Yang channels.
In winter, needle the Jing-well and Ying-spring points. Ma Shi explains that *Shui Re Xue Lun* says: "Take Jing-well points to drain Yin rebellion." Thus, Yin channels should be needled at their Jing-well points, such as Shaoshang (LU-11) of the Hand-Taiyin Lung Channel. Taking Ying-spring points to tonify Yang Qi means Yang channels should be needled at their Ying-spring points, such as Erjian (LI-2) of the Hand-Yangming Large Intestine Channel.
Warm Malaria (Wen Nue). *Su Wen: Nue Lun* (Treatise on Malaria) states: "First injured by Wind, then injured by Cold, hence fever precedes chills. It also occurs at specific times, thus called Warm Malaria."
Fifty-nine Needling Points (Wu-shijiu Ci). Detailed in the subsequent chapter *Re Bing* (Heat Diseases). The character "Ci" (Needle/Puncture) is missing or variant in most editions; only Zhang Jingyue's edition writes "Ci".
Wind-Water (Feng Shui) and Skin Distension (Fu Zhang). Ma Shi interprets the character " " as "Shui" (Water). Since the disease is caused by water, the character "Ji" (Disease/Affliction) is prefixed. Feng Shui is mentioned in *Su Wen: Qi Bing Lun* (Treatise on Strange Diseases), *Shui Re Xue Lun*, *Ping Re Lun* (Treatise on Evaluating Heat), and *Lun Ji Zhen Chi Pian* (Treatise on Diagnosing Diseases by Measuring the Arm) of this text. Fu Zhang refers to the condition described in *Shui Zhang Pian* (Treatise on Water Swelling) of this chapter. Commentary: *Waitai Miyao* quotes *Zhouhou Fang* stating that formulas for sudden abdominal distension originate from water pathology. Although the text uses "Ji" to describe the manifestation, it aligns with Ma's explanation. The pronunciation in Wu dialect is similar to "Shui", indicating a pathological appearance, not necessarily swelling.
Fifty-seven [Acupoints]. See *Su Wen: Shui Re Xue Lun*.
Above the Three Yin. In *Jia Yi Jing*, the character "Zhi" is written as "Jiao" (Intersect). Ma Shi explains that tonifying "above the Three Yin" refers to tonifying Sanyinjiao (SP-6), where the Qi and Blood of the three Foot Yin channels intersect, making it suitable for tonification. Since there are two acupoints involved, two characters for "tonify" and one for "all" are used. Zhang Zhicong agrees.
Heat Movement (Re Xing). Ma Shi states: Wait until heat is felt under the needle before stopping. Zhang Jingyue adds: When Yang Qi arrives, heat moves; once heat moves, diarrhea stops.
Tendon Cramping on the Yang Side (Immediately) Puncture Suddenly (Cu Ci). Ma Shi explains that "Cu" is synonymous with "Cu" (Suddenly). The lateral sides of the hands and feet belong to Yang channels. If cramping occurs on the Yang side, treat the Yang channel. The medial sides belong to Yin channels. If cramping occurs on the Yin side, treat the Yin channel. Both should be punctured suddenly. Zhang Jingyue interprets "Cu" as "disease," implying treatment should not be delayed by time but applied immediately according to the condition. Zhang Zhicong notes "Cu" is synonymous with "Cu." Cu Ci involves burning the needle for rapid puncture to treat tendon Bi syndrome. Commentary: Lou's *Gangmu* also writes "Cu," likely based on *Jing Jin Pian* (Treatise on Sinew Channels). This should be recorded as an alternative interpretation.
Pure Water Retention (Tu Shui). Zhang Jingyue states: "Tu" means "only." There is water but no wind, hence called Tu Shui. Commentary: Ma Shi says "Tu" means "only." The previous section discussed Feng Shui (with wind and water). Here, Tu Shui implies no wind but water (Note: Textual logic suggests pure edema). If there were no water, how could the text say "until exhausted, then stop"? It must be a textual error. Zhang Zhicong argues "Tu" means "multitude." Earth irrigates the four directions. If Earth Qi is deficient, the multitude of waters from the four directions overcomes Earth, causing water disease. This explanation is considered overly forced.
Huan Gu. Ma Shi notes: There is no Huan Gu acupoint in standard channels. Only Huantiao (GB-30) exists in the Foot-Shaoyang Gallbladder Channel. Given "three cun below," it is speculated to be Fengshi (GB-31). The reasoning is sound. Zhang Jingyue agrees. Zhang Zhicong defines Huan Gu as selecting the muscle intervals of the hands and feet to drain water. Xi Gu (Valleys) comprise 365 points. Where large muscles converge, it is called Gu. Great convergence refers to the large muscles of the thighs and limbs. Commentary: Based on Zhicong's note, the phrase "three cun" seems inaccurate.
. Ma Shi explains " " as "straight." After insertion, straighten the needle to retain it. Zhang Jingyue compares "Tong" to an arrow case. After insertion, thrust like an arrow, then withdraw. Insert and withdraw repeatedly to exhaust the water. The needle acts like an arrow returning to its case, frequently entering and exiting to open the pathway and drain the water. Zhang Zhicong equates " " with "Tong" (Tube/Cylinder), inserting a tube-like needle, entering and exiting. Commentary: The meaning of "Tong" is unclear in previous annotations. *Jiu Zhen Lun* mentions the round needle has a cylindrical body. " " and "Tong" are identical. Lou's *Gangmu* records: "Tong needle has a hollow center, like water flowing from a tube." Interpreting via Zhicong, it likely describes inserting a needle into a tube to allow water to drain out. Some claim efficacy, but it should not be used recklessly. Zhang Jingyue cites *Zhen Yao*: For water retention, only Shuigou (GV-26) is effective. Needling other points may cause death when water is exhausted. This is crucial to know.
Must be firm; if coming slowly, then vexation and bending; if coming quickly, then quietness. Ma Shi states: To completely remove water, when the water force ends, the flesh must become firm. If water comes slowly, internal vexation occurs; if quickly, internal quietness ensues. Zhang Jingyue notes the lesion is in the skin/flesh, manifesting as firmness. Zhang Zhicong says edema in muscles is floating and soft; after water exhaustion, muscles become firm. I agree with Ma Shi. Commentary: The meaning from "Tu Shui" onwards is obscure. *Jia Yi Jing* has variants but remains unclear. Recorded here for reference. *Jia Yi Jing* states: For Tu Shui, first select three cun below Huan Gu, insert a Pai needle and retain it. Pull and insert, enter and exit repeatedly to exhaust water. Must bind firmly. Loose binding causes vexation; tight binding ensures quietness.
Drink Obstruction-Clearing Medicine. Ma Shi advises drinking medicine to clear obstruction and promote urination, preventing recurrence. Zhang Zhicong suggests that after water exhaustion, drink medicine to strengthen Spleen Earth to prevent water resurgence. Commentary: Ma Shi is correct.
While Drinking, No Food (Until) 135 Days. Zhang Jingyue warns against mixing medicine and food, as it hinders efficacy. After edema subsides, avoid foods that damage Spleen or generate dampness. Only after 135 days can one ensure non-recurrence.
Fixed Bi (Zhuo Bi) Does Not Disperse. Zhang Jingyue cites *Bi Lun*: "Excess Dampness leads to Fixed Bi," characterized by heaviness and difficulty moving, hence "does not disperse." If Cold-Damp stagnates long-term, suddenly needle Zusanli (ST-36) of the Foot-Yangming Stomach Channel to warm and tonify Stomach Qi, dispersing Cold-Damp and curing Bi. Shen Liangchen adds: Xi Gu belongs to bone. This follows the previous text regarding residual water in muscle/cutaneous layers flowing into joints, causing Fixed Bi. Thus, Zusanli is taken to drain the Zang via the Fu.
Bone as the Trunk (Gan). Ma Shi finds this sentence disconnected from context, possibly a fragment from *Jing Mai Pian*. Shen Liangchen explains: Bone pathology lies in the marrow nodes. "Gan" implies hardness like a tree trunk. Thus, Warm Malaria pathogens hide in bone marrow; Damp-Bi qi flows in joints. The bones remain hard and resistant to pathogenic injury. Commentary: Following Ma Shi's note.
Intestinal Obstruction (Chang Zhong Bu Bian). Zhang Jingyue distinguishes: Small Intestine obstruction fails to transform substances; Large Intestine obstruction fails to transmit. Both connect to the Stomach. Therefore, needle Zusanli (ST-36). Excess pathogens require draining; deficiency requires tonifying.
Lepra (Li Feng) (Until) No Other Foods. *Jia Yi Jing* reads "Su" as "Suo"; "Rui Zhen Zhen" as "Shun" (Suck); "E Qi" as "Xue" (Blood). Ma Shi equates "Li" with "Lei" (Leprosy). This describes needling Lepra. *Su Wen: Feng Lun* states: "Lepra involves heat in Ying and Wei, turbid Qi, causing nasal collapse, discoloration, and skin ulcers. Wind-Cold lodges in vessels, named Lepra." *Gu Kong Lun* and *Chang Ci Jie Lun* call it Da Feng. Zhang Jingyue advises proper diet ("Fang Shi") and avoiding wind-aggravating/toxic foods.
Commentary: Lepra is Leprosy, a chronic infectious disease. Symptoms appear years post-infection. Manifestations include widespread numbness, gradual destruction of limbs and nose. Face resembles psoriasis; scratching yields thick fluid; peeling skin causes intense itching. Two types: 1. Macular Leprosy: Red nodules on face/buttocks/limbs, ulcerating, leading to anesthesia, hair loss, and deformity. 2. Neural Leprosy: Initial nerve sensitivity/pain, progressing to anesthesia, nutritional defects, nerve thickening, and facial paralysis.
Abdominal Borborygmus, Qi Rushing Upward to Chest (Until) Zusanli. *Jia Yi Jing* reads "Chang" as "Lei" (Thunder) and "Shang" as "Chang" (Often). Zhang Zhicong attributes this to Large Intestine pathology. As the official of transmission, rebellion causes borborygmus and upward Qi rush. Zhang Jingyue cites *Jiu Zhen Shi Er Yuan*: "Yuan of Huang originates at Bozhong (CV-12/Qihai)." Juxu Shanglian and Zusanli are Foot-Yangming points. *Ben Shu* links Large Intestine to Shanglian. Thus, for Large Intestine邪, needle Juxu Shanglian. For Small Intestine邪 (later text), needle Juxu Xialian.
Small Intestine Pulling Testis (Until) To Regulate. *Jia Yi Jing* includes "Fei" (Lung) after "Xun Gan." Commentary: Based on later text mentioning Taiyin needling, *Jia Yi Jing* seems correct. Shen Liangchen identifies testicular pulling with lumbar/spinal pain and upward rush to heart as Small Intestine Hernia Qi. Zhang Jingyue defines "Kong" as pulling, "Gao" as testicle. Small Intestine connects to lower abdomen; excess邪 causes rebellious Qi rushing to Heart/Lung, steaming Liver/Stomach, pulling lumbar/spine, and affecting Huangqi/testicular roots. Select Yuan source of Huang to dissipate umbilical/abdominal knots. Needle Taiyin to tonify Lung deficiency. Take Jueyin to descend and drain Liver excess. Take Juxu Xialian to address Small Intestine affiliation. Observe traversing channels to locate邪 and regulate.
Long Sigh. Zhang Zhicong: Gallbladder Qi desires to rise, hence long sighs to extend it.
. Zhang Jingyue: Appearance of Heart Deficiency. Commentary: Ma Shi's interpretation as "quiet" is incorrect.
Vomiting Bile. *Jia Yi Jing* and *Qian Jin Fang* add "Zhi" (Juice) after "Ku" (Bitter).
Then Needle Shaoyang Blood Collaterals. Ma Shi: "Ze" should be "Ce" (Side). Gallbladder collaterals are posterior-lateral to ribs. Zhang Jingyue: Also needle Foot-Shaoyang blood collaterals to calm Wood. *Qian Jin Fang* omits "Ze".
Close Gallbladder Rebellion. Ma Shi: "Bi" means stop. Cites *Mencius*: "Present goodness, close evil." Zhu Xi notes: "Bi" means stop.
If Above Shangwan, Then Needle (Until) Remove It. Ma Shi: "Ze" is same as "Ce". Weiwuan is the general term for Shangwan and Xiawan. If above Shangwan, needle while supine, depressing downward. This matches *Shang Ge Pian*: "Qi causes Upper Ge," treated thus. If below Xiawan, needle Xiawan, dispersing and removing. Matches *Shang Ge Pian*: "Worms cause Lower Ge," treated thus. Zhang Jingyue: Depressing downward means needling Shangwan to drain high food Qi. Dispersing and removing means warming Xiawan to scatter cold stagnation.
邪 in Sanjiao Constraint (Until) Take Zusanli. Zhang Zhicong: This is Bladder pathology. Sanjiao lower shu emerges at Weiyang, merging with Taiyang, connecting to Bladder, constraining Lower Jiao. Excess causes urinary retention; deficiency causes incontinence, lower abdominal swelling/pain, inability to urinate. This is Sanjiao constraint. Thus, take the great collateral of Foot-Taiyang (Weiyang). Xiao luo refers to Sun luo. Foot-Taiyang and Jueyin collaterals intersect at the dorsum. Remove constricted blood vessels. Liver governs free flow; constriction in Jueyin collaterals also causes urinary retention. If lower abdominal swelling extends to Weiwuan, take Zusanli. *Shengji Zonglu* states: *Huangdi Sanbu Zhenjiu Jing* says lower abdominal swelling and urinary retention due to Sanjiao邪 is named Sanjiao Constraint. Disharmony of Ying/Wei and Wind invasion cause the Official of Decoction to be constrained, blocking urination/defecation. Needling Foot-Shaoyin/Taiyang channels with decoctions疏导 Sanjiao. Formulas include Zhiqiao Wan etc. (using Rhubarb, Boldo Seed, Apricot Kernel). Commentary: Here, Sanjiao refers to the Bladder. Previous sections listed Six Fu diseases excluding Bladder, confirming Sanjiao equals Bladder here. *Qian Jin Fang* calls Sanjiao the Middle Clear Fu, alias Yuhai, water pathways belong to Bladder. "Yue" (Constraint) is like Pi Yue. Qiao Shineng's edition of *Qian Jin* places "Yue" with the next sentence, which also makes sense. Zhang Jingyue identifies Taiyang great collateral as Feiyang (BL-58). Examining *Jia Yi Jing*, Weiyang is the auxiliary shu of Sanjiao, anterior to Taiyang, posterior to Shaoyang. This is a branch of Taiyang, supporting Zhicong's note.
Observe Color, Examine Eyes, To Know Dispersion and Return. Most editions lack "Mu" (Eye); only Zhang Jingyue has it. Ma Shi: "Yi" means "by." Cites *Analects*: "Observe his motives." Zhang Zhicong: Observing "yi" means observing the cause of disease. Commentary: Zhang added "Mu" based on *Xiao Zhen Jie* of *Jiu Zhen Shi Er Yuan*. Accepted here.
Unify Form. Ma Shi: "Yi" asks if fatness/thinness is equal. Zhang Zhicong: Quietly guard spirit and form, being together.
Disease Will Retreat. Zhang Jingyue: "Xia" means retreat/subside.
All Channels Excess, Disease Cured in Three Days. Zhang Jingyue: Unresolved邪 fears weak pulse. *Ping Ren Qi Xiang Lun*: "Disease inside, empty pulse." *Yu Ji Zhen Zang Lun*: "Disease outside, pulse not solid/firm, difficult to treat." *Xie Ke Pian*: "Empty and fine pulse persists long." All indicate deficiency. If disease in channels and pulse is solid/strong,邪 will exteriorize. Hence, cure in three days.
Qikou Inspects Yin, Renying Inspects Yang. Zhang Jingyue: Qikou is on Hand-Taiyin Lung channel, master of Five Zang, hence inspects Yin. Renying is on head, Foot-Yangming Stomach channel, source of Six Fu, hence inspects Yang.