马云。此与素问标本病传论相同。然凡病必先治其本。若中满与大小不利。则不分标本。而必先治之。
本经以本篇论标本。后论病传分为二篇。素问合标本病传论。共为一篇。（详义见于素问识当参考）
先病而后逆者治其本 马云。先病曰本。后病曰标。故凡先生初病。而后病势逆者。必先治其
初病之为本。若先病势逆而后生他病者。则必以病势逆之为本。而先治之也。
必且调之 素问必上有先热而后生中满者。治其标。一句。
先病而后中满者 素问。病、作热。志云。中满者。腹中胀满。脾胃之所生也。先病而后中满
者。因病而致中满也。则当先治中满之标病。而后治其本病。
有客气 有同气 马云。正以人之病气有二。病本不相同。而乃彼此相传者。谓之客气也。有二
病之气本相同类。而乃彼此相传者。谓之同气也。简案、素新校正云。全元起本。同、作司。近是。
间者（止）为独行 志云。间者邪正实虚之相间。故当并行其治。甚者又当独行其治。
先小便大便不利 诸本小下无便字。素问作先小大不利。
沉沉然 马云。头则昏沉而不能举。
KT KT 然 马云。KT 、音荒。目不明。
唇漯漯然 甲乙。作者肩中热。马云。其唇则漯漯然。而有涎出唾下之意。张云。肿起貌。病而在面
在胸及不能言者。以胃脉行于 颊。挟口环唇。循喉咙。下胸膈也。
厥气走喉（止）大便不利 志云。此邪病足少阴之气。而为厥逆也。足少阴肾脉。循喉咙挟舌本。厥气
上逆于喉。故不能言。肾为生气之原。气逆故手足清。肾开窍于二阴。故大便不利。
向向然（止）H HT 甲乙、向向作膨膨。HT HT 作 。（注云音最九墟作荣）马云。腹中向向
然。
而气喜走布且多有寒气。又HT HT 然而有声。张云。腹向向然。寒气滞于脾也。又HT HT 然。水谷不分之声也。
便溲难。脾脉聚于阴器也。简案、HT 、字典 同。水名。无他义。唯龙龛手鉴云。胡谷切。水声。志作谷。非。
嗌干（止）取足少阴 马云。嗌咽干燥。口中甚热。其津液如胶之稠。当取足少阴肾经之穴以补之。水
王则火衰也。
犊鼻 甲乙云。在膝下 上侠解大筋中。足阳明脉气所发。简案、骨空论。 骨空在辅骨之上端。
王注云。谓犊鼻穴也。
发而间之 马云。必发其针而又间刺之。非止一次而已也。
志云。音厘。牛尾也。（案出说文。）
刺膝无疑 马云。刺膝用之无疑也。
喉痹（止）取手阳明 张云。手足阳明之脉。皆循喉咙。
能言者轻。但取之上。不能言者重。当泻其下也。
疟不渴（止）取手阳明 甲乙云。疟不渴。间日而作。九卷曰。取足阳明。素问。刺太阴渴而间日作。
九卷曰。取手少阳。素问。刺足少阳。志云。疟气随经络。沉以内薄。间日而作者。其气舍深。内薄于阴而不
得出。足阳明之脉。属胃络脾。应地气之在下。其道远。故间日而作。地为阴。故不渴。手阳明之脉。属大肠
络肺。应天气之在上。其道近。故曰作天为阳。故渴也。
齿痛（止）取手阳明 甲乙。齿下有动字。张云。手足阳明之脉。皆入齿中。然胃经多实热。故不畏
寒饮者。当泻足阳明。大肠经多虚寒。故畏寒饮者。当补手阳明也。此与上文（寒热病篇）臂阳明节。义有所
关。当互求之。志云。足阳明主悍热之气。故不恶寒饮。手阳明主清秋之气。故恶寒饮。
聋而不痛（止）取手阳明 张云。足少阳之脉。下耳后支耳中出耳前。手阳明之别者。入耳。故当
分痛与不痛而补泻之。志云。阳明当作少阳。
衄而不止（止）出血 甲乙下 血上。有大衄二字。似是。马云。宛、腕同。鼻中出血曰衄。血至败恶
凝聚。其色赤黑者曰 。 血成流。则血去多而不止于 血也。当取足太阳膀胱经以刺之。其 中出血。仍是
膀胱经之委中穴也。若止曰 血。则不成流而去之似少也。当取手太阳小肠经穴以刺之。其腕骨下。即手少阴
心经之通里穴。正以心与小肠为表里也。
腰痛（止）取足少阳 刺腰痛论。上寒上热上并无痛字。张云。上寒上热。皆以上体言也。寒刺阳经。
去阳分之阴邪。热刺厥阴。去阴中之风热也。少阳脉行身之两侧。故俯仰不利者当刺之。
中热而喘（止）血络 张云。热在中上二焦也。取足少阴者。壮水以制火也。 中血络。即足太阳委中
穴。取之可以泻火。简案、刺腰痛论。中热而喘。刺足少阴。王注云。涌泉、大钟、悉主之。
喜怒（止）刺足少阳 甲乙。小、作少。足少阳、作足少阴。注云。太素作少阳。志云。暴怒伤肝。食
气入胃。散精于心肝。食饮下节。肝心气逆。故不欲食也。肝心气逆。则中气不舒。故言益小也。当取足太阴
以疏脾气。则食气得以转输。而音声益彰矣。肝主语而在志为怒。怒而多言。厥阴之逆气太甚。故当取足之少
阳。以疏厥阴之气。
痛（止）出血 甲乙 、作颔。下同。马云。 、颔同。手阳明当是商阳穴。 之盛脉。是胃经颊车穴。
简案、张以 为鬓前两太阳。未知何据。
项痛（止）刺手太阳也 马云。俯仰属背与腰。故曰足太阳。而顾则属肩与项。故曰手太阳也。
小腹满大（止）取足厥阴 甲乙。胃、作胃。淅淅、作索索然。张云。淅淅、寒肃貌。肝经之脉。抵小
腹挟胃。其支者从肝别贯膈。故为病如此。当取足厥阴经以刺之。
腹满（止）取足少阴 甲乙无亦字。及喘息二字。少阴作少阳。张云。肾开窍于二阴。其经脉从肾上贯
肝膈。入肺中循喉咙。故其为病如此。当取足少阴经以刺之。喝喝、喘急貌。
腹满（止）取足太阴 张云。脾失其职。则食不能化。腹满而鸣。气滞于中。大便不调。当取足太阴经
以刺之。
心痛（止）取足少阴 张云。此肾邪上逆也。
心痛（止）足太阴 甲乙、啬啬作涩涩。志云。啬啬、畏寒貌。太阴为阴中之至阴。阴寒故腹胀。而啬
啬然。大便不
化者。土气不化也。此足太阴之气厥而为心痛。故当取本经以疏逆气。
心痛（止）取手少阳 张云。足少阴之脉贯脊。故痛引于背。手少阳之脉布膻中。故不得息。宜刺此
二经也。
心痛（止）刺足厥阴 张云。足厥阴之脉抵小腹。结于阴器。凡心痛而下引小腹者。当刺之也。
心痛（止）刺手太阴 志云。肺主气而司呼吸。心系上连于肺。心痛但短气不足以息者。但逆在肺而
为心痛也。当刺手太阴以通肺气之逆。沈亮辰云。足太阴少阴厥阴而为心痛者。脏气上逆而为痛也。肺乃心之
盖。故但短气不足以息。此病在本脏而应于心也。四脏皆然。故无真心痛之死证。
心痛（止）得之立已 赵府本、张本。次之、作刺之。吴本。按已刺、作按已次。甲乙无此条。马云。
其痛当背。第九节以刺之。乃督脉经筋缩穴之处也。宜先按之。按已而刺。刺后按之。其痛当立已。如不已则
上而八椎。（无穴）下而十椎。（无穴）又复求之。其痛必立已矣。张云。上而手经。下而足经。求得其故而
刺之。则立已矣。
痛（止）立已 甲乙。 、作颔。按人迎于经。作按经刺人迎。马云。颔痛者。当取足阳明胃经颊
车穴以刺之。此穴在耳下曲颊端。动脉环绕一周。故曰曲周也。张云。以其周绕曲颊。故曰曲周。见血立已。
如不已。当按人迎于本经而浅刺之。可立已也。
气逆上（止）下胸动脉 甲乙。下胸、作胁下。马云。上刺膺中陷者中。即足阳明胃经膺窗穴也。及
下胸前之动脉。当是任脉经之膻中穴也。盖在中谓之胸。胸之旁为膺耳。张云。膺中陷者。足阳明之屋翳也。
下胸动脉。手太阴之中府也。盖在中曰胸。胸之旁即谓之下耳。简案、膻中无动脉。中
府不在下胸。可疑。
腹痛（止）立已 马云。当刺足阳明胃经之天枢穴。如不已。又刺本经之气冲也。张云。脐之左右动
脉。如足少阴之肓俞。足阳明之天枢。皆主腹痛。简案、二穴未有言有动脉者。可疑。
痿厥（止）病已止 甲乙。 、作闷。马云。凡痿病厥病。而手足四肢挛束缚乱。当刺四肢之穴以速
解之。张同。朱永年云。 、闷也。为四末束 者。束缚其手足。使满闷而疾解之。导其气之通达也。夫按之
束之。皆导引之法。犹尺蠼之欲信而先屈也。身半以上为阳。身半以下为阴。昼以前为阳。昼以后为阴。日二
者。使上下阴阳之气。表章而交通也。不仁者。荣血不行也。卜日者。阴数之周也。简案、朱注为是。简往往
亲睹痿疾。以布束缚四肢。经久复故者。尺蠼之喻。殆妙。
哕以草（止）亦可已 哕、诸本作岁。马不知其误。文云。疑作藏。唯张志作哕。张云。哕、呃逆也。
治之之法。用草刺鼻则嚏。嚏则气达而哕可以。此一法也。或闭口鼻之气。使之无息。乃迎其气而引散之。勿
令上逆。乃可立已。此二法也。又或以他事惊之。则亦可已。此治哕之三法也。志云。岁、作哕。哕、呃逆也。
言其发声如车銮之声。而有轮序。故名曰哕。（案诗小雅銮声哕哕毛传哕哕徐行有节也志注盖本于此然似牵强
说文哕气牾也）简案、哕、亦作 。十六难。掌中热而 。肘后方。治卒 不止。以物刺鼻中各一分。末少许
皂荚内鼻中。令嚏瘥。又但闭气仰引之是也。楼氏云。详此经文三法。正乃治吃逆之法。按、吃逆用纸捻刺鼻
便嚏。嚏则吃逆立止。或闭口鼻气。使之无息亦立已。或作冤盗贼。大惊骇之亦已。此予所以取成许二家之论。
哕为吃逆。为得经旨也。又云。有病伤
寒将愈。忽患吃逆。予与古人治吃逆之药殆遍。皆不愈。计出无药。遂用皂角末吹入鼻中。得嚏而吃逆止。少
时又吃。又与皂角末。嚏而止者凡数百次。其嚏时出痰涕渐多。自是吃逆渐疏。至二三日而止。此是合经刺鼻
嚏之法。故书之。
介按、哕者。呃忒也。因其呃呃连声。故今人以呃逆名之。朱丹溪谓气由脐下直升而上。出于口而作声也。
徐春甫谓其气由丹田而逆上。出于咽喉。如有系逆而然也。
马云说：这与《素问·标本病传论》的内容相同。然而，凡是疾病，必须先治疗其根本原因。如果是中满（腹部胀满）或大小便不通利，则不分标本先后，而必须优先治疗这些症状。
本经（《灵枢》）将讨论“标本”与“病传”的内容分为两篇，而《素问》则将二者合并为一篇。（详细义理可见于《素问识》，请参考。）
先发病而后出现气逆者，治疗其根本。马云说：先发的病称为“本”，后发的病称为“标”。所以凡是起初患病，随后病情逆乱者，必须先治疗初起之病作为根本。如果先是病情逆乱，随后产生其他病症，则必须以病情逆乱作为根本，并优先治疗它。
必须同时调理。《素问》在此句前有“先热而后生中满者，治其标”一句。
先发病而后出现中满者。《素问》原文作“热”。张志聪注云：“中满”是指腹中胀满，由脾胃功能失调所致。先发病而后出现中满者，是因原发病导致的中满。此时应当先治疗中满这一标病，然后再治疗其本病。
有客气，有同气。马云说：正因为人的病气有两种情况：一种是病因原本不同，却相互传染的，称为“客气”；另一种是两种病的病因性质相同类属，却相互传染的，称为“同气”。简案：《素问校勘记》指出，全元起本中，“同”字写作“司”，这种说法比较合理。
病轻者（止）单独施治。张志聪注云：“间”指邪气与正气虚实夹杂的情况，因此应当并行多种治疗方法。“甚”指病情严重，则应当单独使用一种主要治疗方法。
先出现小便、大便不利。各版本中“小”下无“便”字，《素问》作“先小大不利”。
嘴唇流涎貌。《甲乙经》原文作“肩中热”。马云说：此处嘴唇表现为漯漯然，有唾液流出之意。张景岳注：这是肿胀的样子。病变在面部、胸部且不能言语的，是因为胃经循行经过脸颊，夹口环唇，沿喉咙下行至胸膈。
厥气上冲咽喉（止）大便不利。张志聪注云：这是足少阴肾经之气发生邪病，导致厥逆。足少阴肾脉，循行喉咙，夹舌根。厥气上逆于喉，所以不能言语。肾为生气之源，气逆故手足寒冷。肾开窍于二阴，所以大便不利。
腹胀声。《甲乙经》中，“向向”写作“膨膨”。“HT HT”写作“ ”（注云音最，九墟本作“荣”）。马云说：腹中发出向向的声音。
并且气喜欢游走分布，且多有寒气，又发出HT HT的声音且有声响。张景岳注：腹中向向然，是寒气停滞于脾脏所致。又HT HT然，是水谷不分的肠鸣声。
小便和大便困难。因为脾经汇聚于阴器部位。简案：“HT”与字典中的“ ”同义，指水名，没有其他含义。只有《龙龛手鉴》云：胡谷切，形容水声。张志聪作“谷”，是不对的。
咽干（止）取足少阴经穴。马云说：咽喉干燥，口中非常热，津液像胶一样粘稠。应当取足少阴肾经的穴位来补益。因为水旺则火衰。
犊鼻穴。《甲乙经》云：位于膝盖下方，胫骨上端旁侧大筋之中。是足阳明胃经脉气所发之处。简案：《骨空论》中，髌骨空位于辅骨的上端。王冰注云：指的就是犊鼻穴。
发针并间隔针刺。马云说：必须进针后又间隔一段时间再刺，不是只刺一次而已。
志注云：音厘，指牛尾。（出自《说文解字》。）
刺膝部无疑。马云说：刺膝部用此法毫无疑问。
喉痹（止）取手阳明经。张景岳注：手阳明和足阳明经脉，都循行经过喉咙。
能言语的病证较轻，只取上部穴位即可。不能言语的病证较重，应当泻下部穴位。
疟疾不渴（止）取手阳明经。《甲乙经》云：疟疾不渴，隔日发作一次。《九卷》（即《灵枢》）说：取足阳明经。《素问》说：太阴经受邪，口渴且隔日发作。《九卷》说：取手少阳经。《素问》说：足少阳经受邪。张志聪注云：疟气随经络深入体内，隔日发作的，说明邪气潜伏较深，内迫于阴分而不能外出。足阳明胃经，属胃络脾，对应地气在下，路径遥远，所以隔日发作。地为阴，所以不渴。手阳明大肠经，属大肠络肺，对应天气在上，路径近，所以当天发作。天为阳，所以口渴。
齿痛（止）取手阳明经。《甲乙经》中有“动”字。张景岳注：手阳明和足阳明经脉，都进入牙齿中。但是胃经多实热，所以不畏寒饮者，应当泻足阳明经；大肠经多虚寒，所以畏寒饮者，应当补手阳明经。这与上文《寒热病篇》臂阳明节的义理有关联，应当互相参考。张志聪注：足阳明主悍热之气，所以不恶寒饮；手阳明主清秋之气，所以恶寒饮。
耳聋但不痛（止）取手阳明经。张景岳注：足少阳胆经，下行耳后，分支入耳中，出耳前。手阳明经的别络，进入耳中。所以应当根据疼痛与否来分别进行补泻。张志聪注：这里的“阳明”应当是“少阳”。
鼻出血不止（止）放血。《甲乙经》在“血”上有“大衄”二字，似乎更合理。马云说：“宛”通“腕”。鼻中出血称为“衄”。血液败坏凝聚，颜色赤黑的称为“ ”。如果血液成流，则失血多且不止于局部瘀血。应当取足太阳膀胱经进行针刺。其中出血点，仍然是膀胱经的委中穴。如果仅称为“ ”（局部瘀血），则不成血流而去之似乎较少。应当取手太阳小肠经的穴位进行针刺。在腕骨下方，即是手少阴心经的通里穴，这是因为心与小肠互为表里。
腰痛（止）取足少阳经。《刺腰痛论》中，没有“上寒上热上并无痛”这几个字。张景岳注：上寒上热，都是指上半身而言。寒证刺阳经，以去除阳分之阴邪；热证刺厥阴经，以去除阴中之风热。少阳经脉行于身体两侧，所以俯仰不便者应当针刺少阳经。
胸中热且气喘（止）刺血络。张景岳注：热在中焦和二焦。取足少阴经，是为了壮水以制火。刺中血络，即足太阳膀胱经的委中穴，取之可以泻火。简案：《刺腰痛论》中，胸中热而气喘，刺足少阴经。王冰注云：涌泉、大钟等穴主治此症。
喜怒（止）刺足少阳经。《甲乙经》中，“小”写作“少”。“足少阳”写作“足少阴”。注云：《太素》作“少阳”。张志聪注云：暴怒伤肝，食物入胃后，精微散布于心肝。饮食下行至下焦，导致肝心之气上逆，所以不想进食。肝心之气上逆，则中气不舒，所以说话声音变小。应当取足太阴脾经以疏理脾气，则食气得以转输，而声音就会更加响亮。肝主语言而在志为怒，怒则多言，这是厥阴经的逆气太盛，所以应当取足少阳经，以疏泄厥阴经之气。
下颌痛（止）放血。《甲乙经》中，“ ”写作“颔”，下同。马云说：“ ”通“颔”。手阳明经应当是商阳穴。 处的盛脉，是胃经的颊车穴。简案：张景岳认为 是指鬓前的两个太阳穴，不知依据何在。
项痛（止）刺手太阳经。马云说：俯仰属于背部和腰部，所以说足太阳经；回顾属于肩部和颈部，所以说手太阳经。
小腹满大（止）取足厥阴经。《甲乙经》中，“胃”写作“胃”。“淅淅”写作“索索然”。张景岳注：淅淅，是寒冷肃杀的样子。肝经的脉络，抵达小腹，挟胃而行。其支脉从肝脏分出，贯穿膈肌，所以生病会出现这种情况。应当取足厥阴肝经进行针刺。
腹满（止）取足少阴经。《甲乙经》中没有“亦”字和“喘息”二字。“少阴”写作“少阳”。张景岳注：肾开窍于二阴，其经脉从肾脏上行，贯穿肝脏和膈肌，进入肺部，循行喉咙，所以生病会出现这种情况。应当取足少阴肾经进行针刺。“喝喝”，是喘急的样子。
腹满（止）取足太阴经。张景岳注：脾脏失职，则食物不能消化，腹满且肠鸣，气滞于中，大便不调。应当取足太阴脾经进行针刺。
心痛（止）取足太阴经。《甲乙经》中，“啬啬”写作“涩涩”。张志聪注：啬啬，是畏寒的样子。太阴经是阴中之至阴，因阴寒所以腹胀，且啬啬然畏寒。大便不化者，是土气不运化所致。这是足太阴经之气厥逆而导致的心痛，所以应当取本经以疏泄逆气。
心痛（止）取手少阳经。张景岳注：足少阴肾经贯穿脊柱，所以疼痛牵引至背部。手少阳三焦经布散于膻中，所以呼吸不畅。适宜针刺这两条经脉。
心痛（止）刺足厥阴经。张景岳注：足厥阴肝经抵达小腹，结于阴器。凡心痛向下牵引小腹者，应当针刺足厥阴经。
心痛（止）刺手太阴经。张志聪注：肺主气而司呼吸，心系向上连接于肺。心痛但感觉短气不足以息者，仅是肺气上逆而导致的心痛。应当刺手太阴肺经以通调肺气之逆。沈亮辰云：足太阴、少阴、厥阴经导致的心痛，是脏气上逆引起的疼痛。肺是心的盖子，所以只是短气不足以息。此病在本脏而反映于心。其他四脏也是如此，所以没有真心痛的死证。
心痛（止）得之立已。赵府本、张本作“次之”写作“刺之”。吴本作“按已刺”写作“按已次”。《甲乙经》无此条。马云说：其疼痛应当在背部第九节处进行针刺，那是督脉经筋缩穴的位置。应当先按压，按完后针刺，刺后再按压，疼痛应当立即停止。如果不停，则向上寻找第八椎，向下寻找第十椎，再重新求取穴位。疼痛必定立即停止。张景岳注：向上取手经，向下取足经，找到病因所在而针刺，则疼痛立即停止。
下颌痛（止）立已。《甲乙经》中，“ ”写作“颔”。按人迎于经，写作“按经刺人迎”。马云说：颔痛者，应当取足阳明胃经的颊车穴进行针刺。此穴在耳下曲颊端，动脉环绕一周，所以称为曲周。张景岳注：因为其周绕曲颊，所以称为曲周。见血则立愈。如果不好，应当按本经的人迎穴而浅刺，可以立愈。
气逆向上（止）下胸动脉。《甲乙经》中，“下胸”写作“胁下”。马云说：上刺膺中陷者中，即足阳明胃经的膺窗穴。以及下胸前之动脉，应当是任脉经的膻中穴。大概中间称为胸，胸的旁边称为膺。张景岳注：膺中陷者，是足阳明胃经的屋翳穴。下胸动脉，是手太阴肺经的中府穴。大概中间叫胸，胸的旁边就称为下。简案：膻中穴没有动脉，中府穴不在下胸，值得怀疑。
腹痛（止）立已。马云说：应当刺足阳明胃经的天枢穴。如果不好，又刺本经的气冲穴。张景岳注：脐左右两侧的动脉，如足少阴肾经的肓俞、足阳明胃经的天枢，都主治腹痛。简案：这两个穴位从未听说有动脉，值得怀疑。
痿厥（止）病已止。《甲乙经》中，“ ”写作“闷”。马云说：凡是痿病厥病，出现手足四肢挛缩束缚混乱的情况，应当刺四肢的穴位以迅速解除。张景岳观点相同。朱永年云： 即闷也。所谓“四末束 ”，是束缚其手足，使其感到满闷而迅速解除，以引导气机通达。按之、束之，都是导引的方法，就像尺蠖想要伸展却先弯曲一样。身半以上为阳，身半以下为阴。昼以前为阳，昼以后为阴。日二者，使上下阴阳之气，彰显而交通。不仁者，是营血不行。卜日者，是阴数之周。简案：朱注是正确的。简往往亲眼目睹痿疾，用布束缚四肢，经久恢复正常的，用尺蠖比喻，确实精妙。
哕以草（止）亦可已。哕，诸本多误作“岁”，马云不知其误。文意疑当作“藏”，只有张志聪作“哕”。张景岳注：哕，即呃逆。治疗的方法，用草刺激鼻子引起喷嚏，喷嚏则气机通达，呃逆可以停止。这是一法。或者闭住口鼻之气，使之无呼吸，然后迎其气而引导疏散，不让其上逆，即可立愈。这是二法。或者用其他事情惊吓患者，也可以痊愈。这是治哕的三法。张志聪注：岁，作哕。哕，即呃逆。说其发声如车铃之声，而有轮序，故名曰哕。（案《诗经·小雅》：“銮声哕哕”，毛传：“哕哕，徐行有节也。”志注大概基于此，但似乎牵强。《说文》：“哕，气牾也。”）简案：哕，也写作 。《难经·十六难》：“掌中热而哕。”《肘后方》：“治卒哕不止，以物刺鼻中各一分，末少许皂荚内鼻中，令嚏瘥。”又但闭气仰引之也是。楼氏云：详考此经文三法，正是治疗呃逆的方法。按，呃逆用纸捻刺鼻便嚏，嚏则呃逆立止。或闭口鼻气，使之无息亦立已。或制造冤家盗贼的大惊骇，也可停止。这是我采纳成无己、许叔重两家论述的原因，认为哕为吃逆，符合经旨。又说：有病伤寒将要痊愈时，忽然患呃逆，我用了古人治呃逆的药几乎遍尝，都不见效。计策穷尽无药可用，于是用皂角末吹入鼻中，打喷嚏后呃逆停止。过一会儿又呃逆，又给皂角末，打喷嚏后停止，总共数百次。其嚏时痰涕渐多，从此呃逆逐渐稀疏，至二三日而止。这是符合经文中刺鼻嚏之法，所以记录下来。
介按：哕者，即呃忒也。因其呃呃连声，所以今人以呃逆命名。朱丹溪谓气由脐下直升而上，出于口而作声。徐春甫谓其气由丹田而逆上，出于咽喉，如有系逆而然也。
Ma Yun states: This content is identical to that in the *Suwen* chapter "Biao Ben Bing Zhuan Lun" (Treatise on Root and Branch, Disease Transmission). However, for all diseases, one must first treat the root cause. If there is abdominal fullness (Zhongman) or obstruction of urination and defecation, the distinction between root and branch is disregarded, and these symptoms must be treated first.
The *Lingshu* divides the discussion on "Root and Branch" and "Disease Transmission" into two chapters, whereas the *Suwen* combines them into one. (For detailed principles, refer to *Suwen Shi*.)
If a disease manifests initially followed by rebellious Qi (Ni), treat the root. Ma Yun explains: The initial disease is the "Root" (Ben), and the subsequent disease is the "Branch" (Biao). Therefore, if one falls ill initially and subsequently experiences rebellious Qi progression, the initial illness must be treated as the root. Conversely, if rebellious Qi occurs first followed by other diseases, the rebellious Qi is considered the root and must be treated first.
One must regulate both simultaneously. The *Suwen* contains the sentence preceding this: "If heat precedes and leads to abdominal fullness, treat the branch."
If a disease manifests initially followed by abdominal fullness (Zhongman). The *Suwen* text reads "heat". Zhang Zhicong annotates: "Zhongman" refers to abdominal distension caused by spleen and stomach dysfunction. When abdominal fullness arises secondary to an initial disease, one should first treat the fullness as the branch symptom, and then address the root disease.
There are "Guest Qi" (Ke Qi) and "Same Qi" (Tong Qi). Ma Yun explains: Human pathogenic Qi exists in two forms. When diseases with different origins transmit to each other, it is called "Guest Qi". When diseases with similar pathogenic natures transmit to each other, it is called "Same Qi". Jian An notes: The *Suwen* collation indicates that in Quanyuanqi's edition, "Tong" is written as "Si", which is likely correct.
Mild cases (stop) are treated independently. Zhang Zhicong annotates: "Jian" refers to the intermingling of excess pathogens and deficient healthy Qi, requiring concurrent treatments. Severe cases require independent, singular treatment.
Initial obstruction of urination and defecation. Most editions omit "bian" (stool) after "xiao" (urine); the *Suwen* reads "initial obstruction of urination and defecation".
Heaviness (Chenchen). Ma Yun states: The head feels heavy and cannot be lifted.
Blurred vision (Kuang Kuang). Ma Yun states: "Kuang" sounds like "Huang", indicating unclear vision.
Drooping lips (Luoluorun). The *Jiayi Jing* original text reads "heat in the shoulder". Ma Yun states: Here, the lips appear drooping, suggesting salivation. Zhang Jingyue annotates: This describes swelling. Lesions in the face and chest accompanied by inability to speak occur because the Stomach Meridian passes through the cheek, encircles the mouth and lips, follows the throat, and descends to the chest and diaphragm.
Rebellious Qi rushing to the throat (stop) with constipation. Zhang Zhicong annotates: This is an evil disease of the Foot Shaoyin Kidney channel causing Jue Ni (reversal cold). The Foot Shaoyin Kidney meridian follows the throat and clamps the base of the tongue. Rebellious Qi ascending to the throat causes aphonia. The Kidney is the source of vital Qi; Qi rebellion causes cold limbs. The Kidney opens into the two yin orifices, hence constipation.
Abdominal bloating sound. The *Jiayi Jing* writes "Xiang Xiang" as "Peng Peng". "HT HT" is written as " " (annotated as sound 'Zui', Jiuxu edition uses 'Rong'). Ma Yun states: The abdomen emits a "Xiang Xiang" sound.
Qi tends to wander and distribute, often accompanied by cold Qi, and produces "HT HT" sounds with noise. Zhang Jingyue annotates: Abdominal "Xiang Xiang" indicates cold Qi stagnating in the Spleen. "HT HT" indicates the sound of undigested food and water.
Difficulty in urination and defecation. Because the Spleen Meridian converges at the genitalia. Jian An notes: "HT" is synonymous with " " in dictionaries, referring to a water name, with no other meaning. Only the *Longkan Shoujian* defines it as "Hu Gu Qie", describing a water sound. Zhang Zhicong's use of "Gu" is incorrect.
Dry throat (stop) take points from the Foot Shaoyin Meridian. Ma Yun states: Dry throat and intense oral heat, with viscous saliva resembling glue. One should tonify using points from the Foot Shaoyin Kidney Meridian. When Water is abundant, Fire declines.
Dubi (ST-33). The *Jiayi Jing* states: Located below the knee, in the middle of the large tendon beside the upper tibia. It is where the Qi of the Foot Yangming Stomach Meridian emerges. Jian An notes: In the *Gukong Lun*, the hollow of the patella is at the upper end of the accessory bone. Wang Bing annotates: This refers to the Dubi point.
Insert needle and intersperse needling. Ma Yun states: One must insert the needle and then intersperse further needling; it is not a single insertion.
Zhi annotates: Pronounced 'Li', referring to the tail of an ox (from *Shuowen Jiezi*).
Needle the knee without doubt. Ma Yun states: Needling the knee with this method is undoubtedly correct.
Bi syndrome of the throat (stop) take points from the Hand Yangming Meridian. Zhang Jingyue annotates: Both the Hand Yangming and Foot Yangming meridians follow the throat.
Those who can speak have mild conditions; only upper points are needed. Those who cannot speak have severe conditions; lower points should be sedated.
Malaria without thirst (stop) take points from the Hand Yangming Meridian. The *Jiayi Jing* states: Malaria without thirst, occurring every other day. The *Jiu Juan* (*Lingshu*) says: Take the Foot Yangming Meridian. The *Suwen* says: Taiyin involvement causes thirst and every-other-day attacks. The *Jiu Juan* says: Take the Hand Shaoyang Meridian. The *Suwen* says: Foot Shaoyang involvement. Zhang Zhicong annotates: Malarial Qi follows the meridians and sinks internally. Every-other-day attacks indicate deep-seated Qi penetrating Yin but unable to exit. The Foot Yangming Stomach Meridian belongs to the Stomach and connects to the Spleen, corresponding to Earth Qi below; the path is distant, hence every-other-day attacks. Earth is Yin, hence no thirst. The Hand Yangming Large Intestine Meridian belongs to the Large Intestine and connects to the Lungs, corresponding to Heaven Qi above; the path is near, hence daily attacks. Heaven is Yang, hence thirst.
Toothache (stop) take points from the Hand Yangming Meridian. The *Jiayi Jing* includes the character "dong" (movement). Zhang Jingyue annotates: Both Hand and Foot Yangming meridians enter the teeth. However, the Stomach Channel often has excess heat; patients not fearing cold drinks should have the Foot Yangming sedated. The Large Intestine Channel often has deficiency cold; patients fearing cold drinks should have the Hand Yangming tonified. This relates to the Arm Yangming section in the *Hanre Bing Pian*; they should be cross-referenced. Zhang Zhicong annotates: Foot Yangming governs vigorous heat Qi, so no aversion to cold drinks. Hand Yangming governs clear autumn Qi, so aversion to cold drinks.
Deafness without pain (stop) take points from the Hand Yangming Meridian. Zhang Jingyue annotates: The Foot Shaoyall Gallbladder Meridian descends behind the ear, branches into the ear, and exits in front. The collateral of the Hand Yangming Meridian enters the ear. Thus, tonification or sedation depends on the presence of pain. Zhang Zhicong annotates: "Yangming" here should be "Shaoyang".
Epistaxis unceasing (stop) bloodletting. The *Jiayi Jing* adds "Da Nu" (severe epistaxis) before "Xue", which seems plausible. Ma Yun states: "Wan" is interchangeable with "Wan" (wrist). Bleeding from the nose is called "Nu". Coagulated, foul blood that is dark red or black is called " ". If blood flows freely, loss is significant and does not stop at local stasis. One should needle the Foot Taiyang Bladder Meridian. The bleeding site remains the Weizhong (BL-40) point of the Bladder Meridian. If merely termed " " (local stasis), the flow is less, and one should take points from the Hand Taiyang Small Intestine Meridian. Below the wrist bone lies Tongli (HT-5) of the Hand Shaoyin Heart Meridian, as the Heart and Small Intestine are exterior-interior pairs.
Lower back pain (stop) take points from the Foot Shaoyang Meridian. The *Ci Yaotong Lun* lacks the phrase "upper cold, upper heat, upper together, no pain". Zhang Jingyue annotates: Upper cold and heat refer to the upper body. Cold syndromes are treated by needling Yang channels to remove Yin evil from Yang. Heat syndromes are treated by needling Jueyin to remove wind-heat from Yin. The Shaoyang Meridian runs along both sides of the body; thus, difficulty in bending and extending requires needling the Shaoyang Meridian.
Heat in the chest with panting (stop) puncture blood vessels. Zhang Jingyue annotates: Heat is in the Middle and Upper Jiao. Taking Foot Shaoyin strengthens Water to control Fire. Puncturing blood vessels refers to Weizhong (BL-40) of the Foot Taiyang Bladder Meridian, which can drain fire. Jian An notes: In *Ci Yaotong Lun*, heat in chest with panting is treated by needling Foot Shaoyin. Wang Bing annotates: Yongquan (KI-1) and Dazhong (KI-4) primarily treat this.
Joy and anger (stop) needle Foot Shaoyang Meridian. The *Jiayi Jing* writes "Xiao" as "Shao" and "Foot Shaoyang" as "Foot Shaoyin". Note: *Taisu* reads "Shaoyang". Zhang Zhicong annotates: Violent anger injures the Liver. Food entering the Stomass spreads essence to the Heart and Liver. As food/drink moves downward, Liver and Heart Qi rebel, causing anorexia. Rebel Qi causes mid-Jiao stagnation, reducing speech volume. One should take Foot Taiyin Spleen Meridian to soothe Spleen Qi, allowing food transformation and restoring voice. The Liver governs speech and its emotion is anger; excessive talking in anger indicates severe Jueyin rebellion. Thus, one should take Foot Shaoyang to soothe Jueyin Qi.
Mandible pain (stop) bloodletting. The *Jiayi Jing* writes " " as "Han". Ma Yun states: " " is interchangeable with "Han". The Hand Yangming Meridian should refer to Shangyang (LI-1). The prominent vessel at Han is Jiache (ST-6) of the Stomach Meridian. Jian An notes: Zhang Jingyue identifies Han as the two Taiyang points at the temples, but the basis is unknown.
Nape pain (stop) needle Hand Taiyang Meridian. Ma Yun states: Bending and extending involve the back and waist, hence Foot Taiyang. Turning the head involves shoulders and nape, hence Hand Taiyang.
Fullness and enlargement of the lower abdomen (stop) take points from Foot Jueyin Meridian. The *Jiayi Jing* writes "Wei" as "Wei" (Stomach) and "Xixi" as "Suosuo Ran". Zhang Jingyue annotates: Xixi describes a cold, austere appearance. The Liver Meridian reaches the lower abdomen and flanks the Stomach. Its branch diverges from the Liver, pierces the diaphragm, causing such pathology. One should needle the Foot Jueyin Liver Meridian.
Abdominal fullness (stop) take points from Foot Shaoyin Meridian. The *Jiayi Jing* omits "Yi" and "Chuanxi". "Shaoyin" is written as "Shaoyang". Zhang Jingyue annotates: The Kidney opens into the two yin orifices. Its meridian ascends from the Kidney, passes through the Liver and Diaphragm, enters the Lungs, and follows the throat, causing such pathology. One should needle the Foot Shaoyin Kidney Meridian. "Hehe" describes rapid panting.
Abdominal fullness (stop) take points from Foot Taiyin Meridian. Zhang Jingyue annotates: Spleen dysfunction prevents food digestion, causing abdominal fullness and borborygmus, Qi stagnation in the center, and irregular bowel movements. One should needle the Foot Taiyin Spleen Meridian.
Heart pain (stop) take points from Foot Shaoyin Meridian. Zhang Jingyue annotates: This is due to Kidney evil rebelling upward.
Heart pain (stop) Foot Taiyin Meridian. The *Jiayi Jing* writes "Sese" as "Sese". Zhang Zhicong annotates: Sese describes aversion to cold. Taiyin is the ultimate Yin within Yin; cold causes abdominal fullness and Sese aversion. Undigested stool indicates failure of Earth Qi transformation. This heart pain results from Foot Taiyin Qi rebellion; thus, one should take the same meridian to soothe rebellious Qi.
Heart pain (stop) take points from Hand Shaoyang Meridian. Zhang Jingyue annotates: Foot Shaoyin penetrates the spine, so pain radiates to the back. Hand Shaoyang distributes to the Shanzhong, causing dyspnea. These two meridians should be needled.
Heart pain (stop) needle Foot Jueyin Meridian. Zhang Jingyue annotates: Foot Jueyin reaches the lower abdomen and knots at the genitalia. Heart pain radiating to the lower abdomen requires needling Foot Jueyin.
Heart pain (stop) needle Hand Taiyin Meridian. Zhang Zhicong annotates: The Lung governs Qi and respiration. The Heart connection links to the Lung. Heart pain with shortness of breath indicates Lung Qi rebellion causing heart pain. Needle Hand Taiyin to unblock Lung Qi. Shen Liangchen states: Heart pain from Foot Taiyin, Shaoyin, and Jueyin is caused by Zang Qi rebellion. The Lung is the canopy of the Heart; thus, only shortness of breath occurs. This disease originates in the Zang and reflects in the Heart. The same applies to the other four Zang organs, so there is no fatal "True Heart Pain".
Heart pain (stop) obtained, immediately resolved. Zhao Fu edition and Zhang edition write "Ci zhi" instead of "Ci zhi". Wu edition writes "An yi ci" instead of "An yi ci". *Jiayi Jing* lacks this entry. Ma Yun states: The pain should be needled at the 9th vertebra of the back, the location of Suo Gu (DU-8) of the Du Meridian. Press first, then needle, then press again; pain should cease immediately. If not, seek the 8th and 10th vertebrae. Pain will surely cease. Zhang Jingyue annotates: Seek Hand meridians above and Foot meridians below; find the cause and needle, and it will resolve immediately.
Mandible pain (stop) immediately resolved. The *Jiayi Jing* writes " " as "Han". "Press Renying on the meridian" is written as "Press meridian and needle Renying". Ma Yun states: For mandible pain, needle Jiache (ST-6) of the Foot Yangming Stomach Meridian. This point is at the angle of the jaw below the ear, where arteries circle, hence "Quzhou". Zhang Jingyue annotates: Because it circles the jaw, it is called Quzhou. Upon seeing blood, it resolves. If not, lightly needle Renying on the same meridian, and it will resolve immediately.
Rebellious Qi upward (stop) lower chest artery. The *Jiayi Jing* writes "Xia Xiong" as "Xie Xia". Ma Yun states: Upper needle into the depression of Yingzhong, which is Yingchuang (ST-15) of the Foot Yangming Stomach Meridian. The artery below the anterior chest is likely Danzhong (CV-17) of the Ren Meridian. Generally, the center is called Chest, and the sides are Ying. Zhang Jingyue annotates: The depression in Yingzhong is Wuyi (ST-14) of Foot Yangming. The lower chest artery is Zhongfu (LU-1) of Hand Taiyin. Generally, the center is Chest, and the sides are Lower. Jian An notes: Danzhong has no pulse; Zhongfu is not in the lower chest. This is doubtful.
Abdominal pain (stop) immediately resolved. Ma Yun states: Needle Tianshu (ST-25) of the Foot Yangming Stomach Meridian. If ineffective, needle Qichong (ST-30) of the same meridian. Zhang Jingyue annotates: Arteries left and right of the umbilicus, such as Huangshu (KI-17) of Foot Shaoyin and Tianshu (ST-25) of Foot Yangming, all treat abdominal pain. Jian An notes: Neither point is described as having a pulse in texts. This is doubtful.
Flaccidity and Jue (stop) stop when disease resolves. The *Jiayi Jing* writes " " as "Men". Ma Yun states: For Flaccidity and Jue diseases with limb contracture and confusion, needle limb points to resolve quickly. Zhang Jingyue agrees. Zhu Yongnian states: means Men (stifling). "Binding the four extremities" binds the limbs to create a stifling sensation, resolving it quickly to guide Qi circulation. Pressing and binding are Daoyin methods, like the centipede curling before stretching. Upper body is Yang, lower is Yin. Before noon is Yang, after noon is Yin. Day and night allow Yin-Yang Qi to communicate. Non-sensation (Ren) is due to non-circulating Ying Blood. Divination days relate to the cycle of Yin numbers. Jian An notes: Zhu's annotation is correct. I have personally witnessed flaccidity cases where binding limbs with cloth led to recovery over time; the centipede analogy is apt.
Hiccups with grass (stop) can also be cured. Hiccups (Yue), most editions mistakenly write "Sui". Ma Yun did not notice the error. The text likely implies "Cang" (storehouse), but Zhang Zhicong writes "Yue". Zhang Jingyue annotates: Yue is hiccup (E Ni). Treatment: Stimulate the nose with grass to induce sneezing; Qi then flows, and hiccups stop. Method 1. Or hold breath to stop respiration, then guide Qi downward to prevent rebellion; immediate resolution. Method 2. Or startle the patient with other matters; also effective. These are three methods for treating Yue. Zhang Zhicong notes: Sui should be Yue. Yue means hiccup, sounding like carriage bells with rhythm (referencing *Shi Jing*). *Shuowen* defines Yue as reversed Qi. Jian An notes: Yue is also written as . *Nanjing Ch. 16*: Heat in palm and Yue. *Zhouhou Fang*: Treat acute Yue by stimulating nose with soap pod powder to induce sneezing. Or hold breath and pull upward. Lou氏 states: These three methods precisely treat E Ni (hiccups). Using paper twist to stimulate nose induces sneezing, stopping hiccups instantly. Holding breath also works. Startling with fear also works. I adopt Cheng Wuji and Xu Chunpu's views that Yue is E Ni, aligning with classic intent. I once treated a typhoid recovery case with persistent hiccups. After exhausting herbal remedies, I used soap pod powder insufflated into the nose. Sneezing stopped the hiccups. Repeated hundreds of times, phlegm and mucus increased, hiccups gradually subsided, resolving in 2-3 days. This aligns with the classic nose-stimulation method, so I record it.
Jie An notes: Yue is E Te (hiccup). Named E Ni today due to continuous sound. Zhu Danxi states Qi rises straight from below the umbilicus to the mouth. Xu Chunpu states Qi rebels from the Dantian to the throat, as if tied and reversed.