解张注尺之五里尺泽后之五里也）马云。尺泽之上三寸。有动脉。即肘上三寸向里大脉之中央。名五里穴。属
手阳明大肠经。志云。按皮肤之气血。从手足之指井。溜注于脉中。而合于肘膝间。故曰尺动脉。右五里五
之禁也。简案、逆夺之凡五至井荣俞经合。五 之血气
尽。故言五 之禁也。详见素气穴论。本经玉版论。
传道之腑 马云。道、导同。凡小肠已化之物。从此传导而下也。志云。此节止论五脏所合之六
腑者。本篇论十二经脉之所出。从井而入于合。盖自外而内也。
中精之腑 甲乙作清净之腑。马云。他腑之所受者。皆至浊之物。而唯胆则受五脏之精汁也。
少阳属肾 甲乙作少阴。马云。少阳三焦也。三焦之正脉至项散胸中。而肾脉亦上连于肺。三焦
之下 。属于膀胱。而膀胱为肾之合。故三焦亦属乎肾也。
故将两脏 张云。三焦为中渎之腑。膀胱为津液之腑。肾以水脏而领水腑。理之当然。故肾得兼
将两脏。将、领也。两脏腑亦可以言脏也。本脏篇曰。肾合三焦膀胱。其义即此。
中渎之腑 张云。谓如川如渎。源流皆出其中也。即水谷之入于口。出于便。自上而下。必历三
焦。故曰中渎之腑。水道出焉。膀胱受三焦之水。而当其疏泄之道。气本相根据。体同一类。故三焦下 出于少
阳。并太阳之正。入络膀胱。约下焦也。
孤之腑也 简案。肺合大肠。心合小肠。肝合胆。脾合胃。肾合膀胱。而三焦唯属膀胱。无所配
合。故谓孤之腑也。萧吉五行大义云。三焦处五脏之中。通上下行气。故为中渎腑也。又引河图云。三焦孤立。
为内渎之腑。并与本节之旨符矣。而此所言三焦。专指下焦。张氏质疑录。论之详也。（素问识灵兰秘典六节
藏象论注举数证当参考）
春取络脉 张云。十二经之大络。如手太阴列缺之类是也。
诸荥 张云。十二经之用穴。如手太阴鱼际之类是也。
分肉之间 水热穴论曰。春者木始治。肝气始生。肝气急。其风疾。经脉常深。其气少。不能深入。
故取络脉分肉之间。简案、四时之刺。诸篇所说有异同。甲乙类例通会。殆为明备。当参考。
诸 孙络 张云。诸 者十二经之 穴。如手太阴经太渊之类是也。络之小者为孙络。皆应夏气。
夏以老阳之令。阳盛于外。故宜浅刺于诸 。孙络、及肌肉、皮肤之上也。
诸合 张云。十二经之合穴。如手太阴尺泽之类是也。诸合应秋。故宜取之秋。以少阴之令。将降
未降。气亦在中。故余如春法。谓亦宜中取于大经分肉之间。而可浅可深也。
诸井 张云。十二经之井穴。如手太阴少商之类是也。
诸 井云。即前太渊三间之类。张云。脏腑之 。如肺 、心 、之类是也。非上文五 之谓。
诸井诸脏。皆主冬气。冬以老阴之令。阳气伏藏。故宜取井 。欲其深而久留之也。简案、二说各异。未知孰是。
气之所处 张云。处、上声。谓气之所居也。
转筋者（止）快也 张云。转筋者必拘挛。立而取之。故筋可舒也。痿厥者必体废。张其四肢而
取之。故血气可令立快也。志云。张者、仰卧而张大其四肢。
解张注：尺之五里，是指尺泽穴后方五里的位置。马云说：在尺泽穴上方三寸处，有动脉跳动，即肘上三寸向内侧大脉的中央，名为五里穴，归属于手阳明大肠经。张志聪说：按压皮肤下的气血，从手足指端的井穴开始，流入注入脉中，汇聚于肘膝之间，所以称为尺动脉。这是关于右臂五里穴针刺禁忌的论述。简案：逆夺其血气，凡五次至井、荥、俞、经、合五输穴，该经脉的血气就会耗尽，所以说有五输穴的禁忌。详见《素问·气穴论》和《本经·玉版论》。
传道之腑：马云说：“道”与“导”同义。凡是小肠已经消化后的食物残渣，从此传导向下排出。张志聪说：这一节只论述五脏所配合的六腑。本篇论述十二经脉的起源，从井穴进入，到达合穴，大概是从体表向内深入的过程。
中精之腑：《甲乙经》作“清净之腑”。马云说：其他腑所承受的都是浑浊之物，唯独胆接受五脏的精汁。
少阳属肾：《甲乙经》作“少阴”。马云说：这里指的是少阳三焦。三焦的正脉到达颈部散入胸中，而肾脉也向上连接于肺。三焦的下部，属于膀胱，而膀胱是肾的配合脏腑，所以三焦也归属于肾。
故将两脏：张景岳说：三焦是中渎之腑，膀胱是津液之腑。肾作为水脏而统领水腑，这是理所当然的，所以肾得以兼领这两脏。“将”，意为统领。这两腑也可以称为脏。《本脏篇》说：肾合三焦和膀胱，其中的含义就是如此。
中渎之腑：张景岳说：意思是像河流和沟渠一样，水源和流向都出自其中。即水谷从口进入，从大便排出，自上而下，必然经过三焦，所以称为中渎之腑。水道由此而出。膀胱接受三焦的水液，并处于疏泄的道路之上，气机原本相互依托，形体同类，所以三焦下行出于少阳，并入太阳经的正脉，进入络脉联系膀胱，约束下焦。
孤之腑也：简案：肺合大肠，心合小肠，肝合胆，脾合胃，肾合膀胱，而三焦唯独配合膀胱，没有其他配合，所以称为孤腑。萧吉在《五行大义》中说：三焦位于五脏之中，贯通上下运行气机，所以称为中渎腑。又引用《河图》说：三焦孤立，为内渎之腑，这与本节的主旨相符。而此处所说的三焦，专指下焦。张氏《质疑录》对此论述得很详细。（《素问识》中《灵兰秘典论》和《六节藏象论》的注释列举了多个证据，应当参考）
春取络脉：张景岳说：十二经的大络，如手太阴肺经的列缺穴之类就是。
诸荥：张景岳说：十二经的用穴，如手太阴肺经的鱼际穴之类就是。
分肉之间：《水热穴论》说：春季木气开始主事，肝气开始生发。肝气急迫，风气疾速，经脉通常较深，但此时人气尚浅，不能深入，所以取络脉和分肉之间的穴位。简案：四季的刺法，各篇所说有异同，《甲乙经》的分类通会，几乎最为明备，应当参考。
诸孙络：张景岳说：诸“腧”者，指十二经的腧穴，如手太阴肺经的太渊穴之类就是。络脉的小者为孙络，都对应夏季之气。夏季以老阳的时令为主，阳气盛于体表，所以适宜浅刺于诸腧、孙络以及肌肉、皮肤之上。
诸合：张景岳说：十二经的合穴，如手太阴肺经的尺泽穴之类就是。诸合穴对应秋季，所以适宜在秋季取用。因为此时处于少阴的时令，气将降未降，气机也在中间，所以其余情况如同春季的方法，谓也适宜中等深度地取在大经的分肉之间，可浅可深。
诸井：张景岳说：十二经的井穴，如手太阴肺经的少商穴之类就是。
诸腧：（原文此处可能有脱漏或排版错误，结合上下文推测为讨论腧穴）。云：即前文提到的太渊、三间之类。张景岳说：脏腑的腧穴，如肺腧、心腧之类就是。不是上文所说的五输穴中的“腧”位。
诸井诸脏：皆主冬气。冬季以老阴的时令为主，阳气伏藏，所以适宜取井穴和脏穴，想要使其深刺并久留针。简案：两种说法各异，不知道哪一个是正确的。
气之所处：张景岳说：“处”读上声，意为气所居住的地方。
转筋者（止）快也：张景岳说：转筋的人必定拘挛，站立着取穴，所以筋可以舒展。痿厥的人必定身体废用，张开四肢来取穴，所以血气可以立刻通畅。张志聪说：“张”的意思是仰卧并张大其四肢。
Jie Zhang's annotation: "Wuli at the Chi level" refers to the location five li posterior to Chize (Lake at the Elbow). Ma Yun states: Three cun above Chize, there is a pulsating artery, which is the center of the large vessel on the medial side three cun above the elbow, named Wuli (Five Li) acupoint. It belongs to the Hand-Yangming Large Intestine Meridian. Zhang Zhicong states: Pressing the qi and blood under the skin, they flow from the Jing-Well points at the tips of the hands and feet into the vessels and converge between the elbows and knees; hence it is called the radial artery pulse. This section discusses the contraindications for needling the right Wuli point. Jian An notes: If one forcibly depletes the qi and blood by needling the Five Shu points (Jing-Well, Ying-Spring, Shu-Stream, Jing-River, He-Sea) five times, the qi and blood of that meridian will be exhausted; thus, there are contraindications regarding the Five Shu points. For details, see *Suwen: Qi Xue Lun* and *Benjing: Yu Ban Lun*.
The Official of Transmission: Ma Yun states: "Dao" (path/way) is synonymous with "Dao" (to guide). Whatever has been digested in the Small Intestine is transmitted downward from here. Zhang Zhicong states: This section only discusses the Six Fu organs paired with the Five Zang organs. This chapter discusses the origins of the Twelve Meridians, entering from the Jing-Well points and reaching the He-Sea points, generally moving from the exterior inward.
The Official of Refined Essence: The *Jia Yi Jing* reads "Official of Purity and Clarity." Ma Yun states: Other Fu organs receive turbid substances, but only the Gallbladder receives the refined essence of the Five Zang organs.
Shaoyang Belongs to the Kidney: The *Jia Yi Jing* reads "Shao Yin." Ma Yun states: This refers to the Shaoyang Sanjiao (Triple Burner). The main branch of the Sanjiao reaches the neck and disperses in the chest, while the Kidney meridian also ascends to connect with the Lung. The lower part of the Sanjiao belongs to the Bladder, and the Bladder is the paired organ of the Kidney; therefore, the Sanjiao also belongs to the Kidney.
Thus Commanding Two Organs: Zhang Jingyue states: The Sanjiao is the Official of Middle Ditches, and the Bladder is the Official of Fluids. As the Water Organ, the Kidney commands the Water Fu organs; this is logical. Thus, the Kidney can command these two organs together. "Jiang" means to command or lead. These two Fu organs can also be referred to as Zang. The *Ben Zang Pian* states: "The Kidney pairs with the Sanjiao and the Bladder," which implies this meaning.
The Official of Middle Ditches: Zhang Jingyue states: It is like rivers and ditches, where both the source and the flow originate within it. Food and drink enter through the mouth and exit via stool, passing through the Sanjiao from top to bottom; hence it is called the Official of Middle Ditches. Water pathways emerge from it. The Bladder receives water from the Sanjiao and serves as the pathway for its excretion. Their qi mechanisms rely on each other, and their forms are of the same category. Thus, the Sanjiao descends from Shaoyang, merges with the main branch of Taiyang, enters and connects with the Bladder, and regulates the Lower Jiao.
The Solitary Official: Jian An notes: The Lung pairs with the Large Intestine, the Heart with the Small Intestine, the Liver with the Gallbladder, the Spleen with the Stomach, and the Kidney with the Bladder. However, the Sanjiao pairs only with the Bladder and has no other pairing; hence it is called the Solitary Official. Xiao Ji in the *Wu Xing Da Yi* states: The Sanjiao is located among the Five Zang organs, connecting the upper and lower to circulate qi, thus it is called the Official of Middle Ditches. It also cites the *He Tu*: "The Sanjiao stands alone, being the Inner Ditch Official," which aligns with the purport of this section. The Sanjiao mentioned here specifically refers to the Lower Jiao. Zhang Shi's *Zhi Yi Lu* discusses this in detail. (Refer to the annotations in *Suwen Shi* for *Ling Lan Mi Dian Lun* and *Liu Jie Zang Xiang Lun*, which cite multiple evidences.)
Spring: Take the Collaterals: Zhang Jingyue states: The great collaterals of the Twelve Meridians, such as Lieque (LU7) of the Hand-Taiyin Lung Meridian, are examples.
All Ying-Spring Points: Zhang Jingyue states: These are the functional points of the Twelve Meridians, such as Yuji (LU10) of the Hand-Taiyin Lung Meridian.
Between the Muscle Intervals: The *Shui Re Xue Lun* states: In spring, Wood energy begins to govern, and Liver qi begins to generate. Liver qi is urgent, and wind is swift. The meridians are usually deep, but the body's qi is shallow and cannot penetrate deeply. Therefore, one should take points in the collaterals and between the muscle intervals. Jian An notes: The acupuncture methods for the four seasons vary across different chapters. The classification in the *Jia Yi Jing* is nearly complete and clear; reference is advised.
All Sun-Luo Points: Zhang Jingyue states: The term "Shu" here refers to the Shu-Stream points of the Twelve Meridians, such as Taiyuan (LU9) of the Hand-Taiyin Lung Meridian. The small branches of the collaterals are called Sun-Luo (Sun Collaterals), all corresponding to the summer qi. Summer operates under the authority of Old Yang, with yang energy abundant on the exterior; therefore, shallow needling is appropriate at the Shu points, Sun-Luo points, and upon the muscles and skin.
All He-Sea Points: Zhang Jingyue states: These are the He-Sea points of the Twelve Meridians, such as Chize (LU5) of the Hand-Taiyin Lung Meridian. The He-Sea points correspond to autumn, so they are suitable for needling in autumn. At this time, under the influence of Young Yin, the qi is about to descend but has not yet done so, remaining in the middle layer. Thus, the method is similar to spring: moderate depth is appropriate, taking points between the muscle intervals of the major meridians, allowing for either shallow or deep insertion.
All Jing-Well Points: Zhang Jingyue states: These are the Jing-Well points of the Twelve Meridians, such as Shaoshang (LU11) of the Hand-Taiyin Lung Meridian.
All Shu Points: (Text implies discussion of Shu points). It refers to points like Taiyuan and Sanjian mentioned earlier. Zhang Jingyue states: The Shu points of the Zang organs, such as Feishu (BL13) and Xinshu (BL15), are examples. This does not refer to the "Shu-Stream" position in the Five Shu points mentioned above.
All Jing-Well and All Zang Points: Both govern winter qi. Winter operates under Old Yin, with yang qi hidden and stored. Therefore, it is appropriate to select Jing-Well and Zang-Shu points, aiming for deep insertion and prolonged retention of the needle. Jian An notes: The two interpretations differ, and it is unknown which is correct.
Qi's Location: Zhang Jingyue states: "Chu" is pronounced with the rising tone, meaning the place where qi resides.
Tendon Cramps (Stop) Rapid Relief: Zhang Jingyue states: Patients with tendon cramps must have spasms. By standing and needling, the tendons can relax. Patients with flaccidity and cold limbs (Wei-Jue) must have bodily dysfunction. By extending the limbs and needling, the qi and blood can achieve immediate relief. Zhang Zhicong states: "Zhang" means lying supine with limbs extended wide.