表阳也。病在阴者名曰痹。痹者痛也。故病痛者阴也。以手按之不得者。留痹之在内也。此言表里之为阴阳也。
简案、四十八难曰。痒者为虚。痛者为实。义似相戾。
病先起阴者（止）治其阴 张云。此以经络部位言阴阳也。病之在阴在阳。起有先后。先者病之本。
后者病之标。治必先其本。即上文所谓先刺其病所从生之义。
热厥 寒厥 马云。素问明有厥论。本经寒热病篇。亦有刺寒热厥法。
二阴一阳（止）一刺阳也 张云。二刺阴。一刺阳者。谓补其阴经二次。泻其阳经一次。则阴气盛
而阳邪退。故可以治热厥。其二阳一阴者。亦犹是也。故可以治寒厥。
久病者（止）刺道毕矣 张云。久远之疾。其气必深。针不深。则隐伏之病不能及。留不久。则固
结之邪不得散也。一刺未尽。故当间日复刺之。再刺未尽。故再间日而又刺之。必至病除而后已。然当先察其
在经在络。在经者直刺其经。在络者缪刺其络。是谓调其左右。去其血脉也。志云。病久者邪气入深。邪与正
争。则气留于阴。间日而后出于阳。是以间日复刺之者。俟气至而取之也。
凡刺之法（止）聚气可布 甲乙。躁厥者。注云。一作疾字。张云。病少气而形肉未脱。其脉躁
急。其病躁而厥逆者。气虚于内。邪实于经也。当缪刺之。左病取右。右病取左。所刺在络。其用轻浅。则精
气之散者可收。邪气之聚者可散也。简案、躁厥、作躁疾是。
深居静处（止）气至乃休 马云。此言用针者。当预养其神以行针也。凡用针者。虽占病者之神
气往来。然必先自养其神气。故深居静处。闭户塞牖。魂魄、神意、精气、皆会于一。令志已在针。方浅而留
之。或微而浮之。以移病者之
神。候其真气已至。而乃止针也。
男内女外（止）是谓得气 张云。既刺之后。尤当戒慎。男子忌内。女子忌外。忌外者坚拒勿出。
忌内者谨守勿内。则邪气必去。正气必复。是谓得气。道藏本释音云。难经作男外女内。简案、七十八难云。
男外女内。乃言针法。与本篇之义自别。
出行来者 甲乙出、作步。
凡此十二禁者 简案、马张连男内女外为十二禁。然凡刺之禁有后节则必不然。甲乙无此十二三
字。盖古经之脱文也。
介按、凡十二禁者。如风雨晦明之四时。人之气血。凝滞不调。共计四禁也。大饱则气虚。五禁也。新
饱则气盛。六禁也。大醉则气乱。七禁也。大怒则气逆。八禁也。大渴则液少。九禁也。大劳则气乏。十禁也。
大惊则气散。十一禁也。人神所在之处。恐伤其生气。十二禁也。夫所谓人神所在之处。以四时言之。则春在
左胁。秋在右胁。冬在腰。夏在脐。此四者系是肝肺肾脾所司之时也。故亦须禁之。
淫 道藏本、甲乙、作淫泺。张云。淫 荡散也。（淫泺详于素问识骨空论）
脱其五味 志云。五味入口。藏于肠胃。味有所藏。以养五气。气和而生。津液相成。神乃自生。
针刺之道。贵在得神致气。犯此禁者。则脱其五味所生之神气。是谓失气也。
绝皮乃绝汗 太阳之脉以下。文与素问诊要经终论同。今特举其异同。不复诠释。诊要经终无绝
皮二字。作绝汗乃出。
不行 诊要经终。作不仁。
体表属阳。病在阴分的称为痹证。痹证就是疼痛。所以病痛属于阴。用手按压却找不到痛处的，是留滞的痹邪在体内。这是说明表里与阴阳的关系。
简注：《难经·四十八难》说：“痒属于虚，痛属于实。”这种说法似乎与此处相矛盾。
病先从阴分开始的（治疗）应治其阴分。张景岳说：这是从经络部位来论述阴阳。病在阴或在阳，发病有先后之分。先发的为病的根本，后发的为病的标象。治疗必须先治其根本，即上文所说的“先刺其病所从生”的意思。
热厥、寒厥。马莳说：《素问》中明确有《厥论》，本经《寒热病篇》也有针刺治疗寒热厥逆的方法。
二阴一阳（至）只刺阳经一次。张景岳说：所谓“二刺阴，一刺阳”，是指补益阴经两次，泻除阳经一次，这样阴气就会旺盛而阳邪退去，所以可以治疗热厥。至于“二阳一阴”的情况，也是同样的道理，所以可以治疗寒厥。
久病患者（至）针刺的原则就完备了。张景岳说：病程长久的疾病，邪气必然深入。针刺如果不深，就不能触及隐伏的病邪；留针时间如果不长，就不能使固结的邪气消散。如果一次针刺未能痊愈，所以应当隔日再刺。再次针刺仍未痊愈，所以再隔日又刺。必须等到病愈才停止。然而应当先察看病邪是在经还是在络。在经的，直接针刺其经穴；在络的，采用缪刺法刺其络脉。这叫做调和左右，去除血脉中的瘀滞。张志聪说：病久的邪气入里较深，邪气与正气相争，则气滞留于阴分，隔日后才出于阳分。所以隔日复刺，是等待气至而取之。
凡针刺的方法（至）聚集的气机可以布散。《甲乙经》中，“躁厥”一词，注释说有的版本作“疾字”。张景岳说：病人少气且形体肌肉未脱失，脉象躁急，病情表现为躁动而厥逆，这是内气虚弱，经中邪气实盛。应当采用缪刺法，左病取右，右病取左。所刺的部位在络脉，作用轻浅，那么散失的精气就可以收敛，聚结的邪气就可以消散。简注：“躁厥”作“躁疾”是正确的。
深居静室（至）气至方可休息。马莳说：这是说用针者，应当预先调养自己的神气以施行针刺。凡是使用针具，虽然要观察病人的神气往来，但施术者必须先自我调养神气。所以要深居静处，关窗闭门，使魂魄、神意、精气都汇聚于一处，让意念专注于针下，然后浅刺并留针，或微提针使其浮起，以转移病人的神气，候待真气已至，然后停针。
男忌内女忌外（至）这叫做得气。张景岳说：针刺之后，尤其应当谨慎。男子忌讳房事在内，女子忌讳外出在外。忌讳外出的要坚决拒绝出门，忌讳房事的要谨守勿行，这样邪气必去，正气必复，这就叫作得气。《道藏》本的解释音注说：《难经》作“男外女内”。简注：《难经·七十八难》说“男外女内”，那是讲针法，与本篇的意义自然不同。
出行归来者。《甲乙经》中“出”字，作“步”字。
以上十二条禁忌。简注：马莳和张景岳将“男内女外”列为十二禁之一。然而凡针刺的禁忌在后文还有，则必然不是这样。《甲乙经》中没有这“十二三”字，大概是古经文的脱漏。
介按：所谓的十二禁，如风雨晦明四季气候变化，导致人体气血凝滞不调，共计四种禁忌。大饱食则气虚，为第五种禁忌。新近饱食则气盛，为第六种禁忌。大醉则气乱，为第七种禁忌。大怒则气逆，为第八种禁忌。大渴则津液少，为第九种禁忌。大劳则气乏，为第十种禁忌。大惊则气散，为第十一种禁忌。人神所在之处，恐伤其生气，为第十二种禁忌。所谓人神所在之处，按四季来说，春天在左胁，秋天在右胁，冬天在腰部，夏天在脐部。这四者分别是肝、肺、肾、脾所主管的时节，所以也必须禁忌。
淫泺。《道藏》本、《甲乙经》作“淫泺”。张景岳说：淫泺意为荡散。（关于淫泺详见《素问识·骨空论》）
脱失其五味所生之神气。张志聪说：五味入口，藏于肠胃。味道有所蕴藏，用以滋养五气。五气和顺则生命活动产生，津液随之生成，神气自然而生。针刺之道，贵在得神致气。触犯这些禁忌的，就会脱失由五味所生的神气，这叫做失气。
断绝皮层乃断绝汗孔。太阳经脉以下的文字，与《素问·诊要经终论》相同。现在特别列举其异同，不再进行诠释。《诊要经终论》中没有“绝皮”二字，作“绝汗乃出”。
不行。《诊要经终论》作“不仁”。
The exterior belongs to Yang. Diseases located in the Yin aspect are termed Bi syndrome (Obstruction Syndrome). Bi syndrome refers to pain. Therefore, painful conditions belong to Yin. When pressing with the hand, if no specific point of tenderness can be found, it indicates that stagnant Bi pathogenic factors are retained within. This passage explains the relationship between interior/exterior and Yin/Yang.
Commentary: The *Nan Jing* (Classic of Difficult Issues), Chapter 48, states: "Itching belongs to Deficiency; Pain belongs to Excess." This interpretation seems contradictory to the present text.
If a disease originates first from the Yin aspect, treatment should target the Yin aspect. Zhang Jingyue stated: This discusses Yin and Yang in terms of meridian locations. Whether a disease is in Yin or Yang, its onset has a sequence. The initial manifestation is the root of the disease, while the subsequent manifestation is the branch. Treatment must address the root first, which aligns with the earlier statement regarding "first puncturing the source from which the disease arises."
Heat Jue (Rebellious Qi) and Cold Jue. Ma Shi stated: The *Su Wen* (Basic Questions) explicitly contains the *Jue Lun* (Treatise on Jue), and this classic's *Han Re Bing Pian* (Chapter on Cold and Heat Diseases) also details methods for puncturing cold-heat Jue patterns.
Two Yin and One Yang... only puncture the Yang meridian once. Zhang Jingyue explained: The phrase "two punctures of Yin, one puncture of Yang" means tonifying the Yin meridians twice and draining the Yang meridians once. This causes Yin Qi to become abundant while Yang pathogens recede, thus treating Heat Jue. The situation of "Two Yang and One Yin" follows the same logic, thereby treating Cold Jue.
For chronic diseases... the principles of needling are complete. Zhang Jingyue stated: In long-standing diseases, the pathogenic factor must be deep. If needling is not deep enough, it cannot reach the latent disease; if retention time is not long enough, consolidated pathogens cannot be dispersed. If one session does not cure the disease, it is necessary to puncture again after an interval of days. If two sessions are insufficient, puncture again after another interval. Continue until the disease is eradicated. However, one must first examine whether the pathogen is in the Jing (Main) Meridians or the Luo (Connecting) Vessels. If in the Jing Meridians, puncture the meridian directly; if in the Luo Vessels, employ Miao Puncture (Contralateral Puncture) on the vessels. This is called harmonizing the left and right, and removing blood stasis. Zhang Zhicong stated: In chronic diseases, pathogens enter deeply. When pathogens contend with Zheng Qi (Upright Qi), Qi remains in the Yin aspect and emerges into the Yang aspect after a day. Thus, puncturing at intervals waits for the arrival of Qi to extract it.
Regarding all needling methods... gathered Qi can be distributed. The *Jia Yi Jing* notes that "Zao Jue" is alternatively written as "Ji Zi". Zhang Jingyue stated: When a patient has shortness of Qi, flesh and muscles have not yet wasted away, the pulse is rapid and restless, and the condition presents as agitation with Jue, this indicates internal Qi Deficiency and Excess pathogens in the meridians. One should employ Miao Puncture: treat the left side by selecting points on the right, and the right side by selecting points on the left. Since the puncture site is in the Luo Vessels, the effect is light and superficial, allowing scattered Essence-Qi to be gathered and aggregated pathogens to be dispersed. Commentary: Reading "Zao Jue" as "Zao Ji" (Agitation and Rapidness) is correct.
Dwell in deep quiet places... rest only when Qi arrives. Ma Shi stated: This instructs the practitioner to nourish their Shen (Spirit) beforehand to perform needling. Although the practitioner observes the patient's Shen and Qi, they must first cultivate their own Shen and Qi. Therefore, dwelling in quiet places, closing doors and windows, allows Hun, Po, Shen, Yi, Jing, and Qi to converge. With the mind focused on the needle, insert shallowly and retain, or slightly lift to float it, thereby shifting the patient's Shen. Wait until the True Qi has arrived before withdrawing the needle.
Men avoid interior [sex], Women avoid exterior [going out]... this is termed De Qi (Arrival of Qi). Zhang Jingyue stated: After needling, extreme caution is required. Men must abstain from sexual intercourse indoors; women must avoid going outdoors. Those avoiding going out must firmly refuse to leave; those avoiding intercourse must guard strictly. Then pathogens will depart, and Zheng Qi will recover. This is called De Qi. The pronunciation annotation in the *Dao Zang* edition states that the *Nan Jing* reads "Men avoid exterior, Women avoid interior." Commentary: The *Nan Jing*, Chapter 78, states "Men avoid exterior, Women avoid interior," referring to needling techniques, which differs from the meaning in this chapter.
Those who have traveled or returned. The *Jia Yi Jing* writes "Chu" as "Bu" (Walk/Step).
These twelve prohibitions. Commentary: Ma Shi and Zhang Jingyue included "Men avoid interior, Women avoid exterior" as part of the twelve prohibitions. However, since there are further prohibitions in later sections, this classification is likely incorrect. The *Jia Yi Jing* lacks the characters "twelve three," suggesting these are textual omissions from ancient scriptures.
Jie noted: The so-called twelve prohibitions include four related to the four seasons (wind, rain, darkness, brightness) causing stagnation and disharmony of human Qi and Blood. Being overly full leads to Qi Deficiency (5th prohibition). Newly being full leads to Qi Excess (6th prohibition). Intoxication leads to chaotic Qi (7th prohibition). Great anger leads to rebellious Qi (8th prohibition). Thirst leads to scant fluids (9th prohibition). Great labor leads to depleted Qi (10th prohibition). Great fright leads to scattered Qi (11th prohibition). The location of the Ren Shen (Human Spirit) where injury might harm Sheng Qi (Vitality) is the 12th prohibition. Regarding the location of Ren Shen: in Spring, it is in the left hypochondrium; in Autumn, in the right hypochondrium; in Winter, in the waist; in Summer, at the umbilicus. These four correspond to the times governed by Liver, Lung, Kidney, and Spleen, respectively, and thus require prohibition.
Yin Luo (Laxity and Weakness). The *Dao Zang* and *Jia Yi Jing* editions read "Yin Luo". Zhang Jingyue stated: Yin Luo means dissipation and scattering. (See *Su Wen Shi* commentary on *Gu Kong Lun* for details on Yin Luo).
Loss of the Spirit generated by the Five Flavors. Zhang Zhicong stated: The five flavors enter the mouth and are stored in the stomach and intestines. Their essence is stored to nourish the Five Qi. Harmonized Qi generates life processes; fluids form together, and Shen naturally arises. The way of needling values attaining Shen and arriving at Qi. Violating these prohibitions results in the loss of the Shen and Qi generated by the five flavors, which is termed Loss of Qi.
Severing the skin severs the sweat pores. The text below the Taiyang Meridian is identical to the *Zhen Yao Jing Zhong Lun* (Essential Diagnosis of Meridian Termination) in the *Su Wen*. Here, differences are highlighted without further explanation. The *Zhen Yao Jing Zhong Lun* lacks the words "severing skin," reading instead "severing sweat pores then they emerge."
Does not move. The *Zhen Yao Jing Zhong Lun* reads "Numbseness" (Bu Ren).