诸本无篇字。
目不瞑不卧出者 甲乙。作目不得眠者五字。考下文答语。甲乙为是。马云。邪之感于人身。
令人目不得瞑。或不卧而出于外者。张云。令人寐无从生。故云不卧出也。
五谷入于胃也（止）行呼吸焉 甲乙。心脉、作心肺。张云。宗气、大气也。队、道也。糟粕之道。
出于下焦。津液之道。出于中焦。宗气之道。出于上焦。故分为三隧。喉咙为肺之系。而下贯于心。故通宗气
而行呼吸。（营气营运见营气篇五十营篇卫气之义见痹论及经脉篇）
夜行于阴 甲乙。阴下有其入于阴也一句。马云。大义见卫气行篇。
厥气客于五脏六腑 甲乙。厥、作邪。无六腑二字。
阳气盛则阳跷陷 甲乙。陷、作满。楼氏云。陷、当作满。汪云。大惑论作阳气满则阳跷盛。
盛字是。又曰。卫气盛于阴。不得行于阳则阴气盛。阴气盛。则阴跷满。阳气虚。故目闭也。（徐振公引大惑
论亦云此章陷字疑误）简案、张云。陷者受伤之谓。非也。
补其不足 泻其有余 张云。此刺治之补泻也。补其不足。即阴跷所出足少阴之照海也。泻其有余。
即阳跷所出足太阳之申脉也。若阴盛阳虚而多卧者。自当补阳泻阴矣。
饮以半夏汤 张云。谓既刺之后。仍当用药以治之。凡不卧之证。有邪实者。多属外因。有营
虚者。多属内因。此半夏汤一法。盖专为去邪者设耳。楼氏云。半夏汤去饮之剂也。
所谓 甲乙。谓、作以。简案、壅塞。盖水饮也。故以半夏汤决渎之。
阴阳和得 甲乙作得和。
其汤方（止）三饮而已也 置、甲乙作煮。李云。千里流水。取其流长源远。有疏通下达之义也。扬
之万遍。令水珠盈溢。为甘澜水。可以调和阴阳。炊以苇薪者。取其火烈也。治半夏犹言制过半夏也。味辛性
温。能下气化痰。用以为臣。张云。古今量数不同。大约古之黍量一斗。合今之铁斛数三升二合。然则云八升
者。即今之二升五合六勺。云五升者。即今之一升六合许耳。（简案物氏度量考云明一合今五勺七撮明一升今
五合七勺一撮）火沸者先以火沸其水。而后置药于中也。秫米、糯小米也。即黍米之类。而粒小于黍。可以作
酒。北人呼为小黄米。其性味甘粘微凉。能养营补阴。半夏味辛性温。能和胃散邪。除腹胀目不得瞑。故并用
之。秫米一升。约今之三合二勺。半夏五合。约今之一合六勺。炊至一升半。约今之四合八勺也。滓、音子。
也。汪云。半夏能和胃而通阴阳。今人率以为燥而不敢用。误矣。本草以秫为糯粟。疑是糯稻。楼氏云。按
本草秫米。即所谓糯米也。王子接云。北地之膏粱茄粟也。李时珍云。火用陈芦枯竹。取其不强。不损药力也。
（出芦火条）又云。秫即粱米之粘者。灵枢经。岐伯治阳盛阴虚。夜不得瞑。半夏汤中用之。取其益阴气而利
大肠也。大肠利则阳不盛矣。简案、尔雅。秫、粘粟也。一名糯粟。一名黄糯。楼说非也。千金方治虚烦不眠。
千里流水汤。三因方治胆寒。温胆汤。俱祖世方耳。
天圆地方 张云。圆者径一围三。阳奇之数。方者径一围四。阴偶之数。人首属阳居上。故圆而应
天。人足属阴居下。故方而应地。
地有九州 张云。九州者。荆、梁、雍、豫、徐、扬、青、兖、冀、也。简案、此本于禹贡。详见素
问识生气通天论。
天有风雨 张云。和风甘雨。天之喜。摧拉霖溃。天之怒。
天有六律 张云。六律者。黄钟、太簇、姑洗、蕤宾、夷则、无射、为六阳律。大吕、夹钟、仲吕、
林钟、南吕、应钟、为六阴律。
天有十日 张云。十日者。甲乙丙丁戊己庚辛壬癸。是谓天干。阴阳系日月篇云。腰以上为天。腰
以下为地。故天为阳。地为阴。故足之十二经脉。以应十二月。月生于水。故在下者为阴。手之十指以应十日。
日主火。故在上者为阳。
辰有十二（止）以抱人形 张云。十二辰者。子丑寅卯辰巳午未申酉戌亥。是谓地支。故应人之足
趾。
足趾惟十。并茎垂为十二。茎者宗筋也。垂者睾丸也。女子少此二节。故能以抱人形。抱者怀胎之义。如西北
称伏鸡为抱者是也。（见杨氏方言）
人有肩膝 张云。肩膝骨大而高。故以应山。
人有腋 张云。腋 深陷。故以应谷。
地有泉脉 张云。泉脉出于地下。卫气行于肉中。
地有草 张云。 荚、瑞草也。尧时生于庭。随月雕荣。朔后一日荚生。望后一日荚落。历得其分
度则 荚生。简案、张注本于帝王世纪。然无毫毛独应瑞草之理。尔雅。菥 大荠。郭注。荠叶细。俗呼之曰
老荠。李时珍云。荠与菥 一物也。但分大小二种耳。由此考之。盖荠之为草。随在易生。故草 乃对下文林
木。谓地上众草也。（ 荚之 音冥菥 之 音觅）集注。仇汝霖亦以上古 草释之。不可从。
人有牙齿 张云。齿牙疏朗。故象似列星。说文云。牙、牡齿也。一曰锐者为牙。齐者为齿。上古天
真论。以女子三七。男子三八。则真牙生而长极。是以后生之大者为牙也。女子七岁。男子八岁齿更。是以前
生之小者为齿也。故男子八月生齿。八岁而龀。女子七月生齿。七岁而龀。龀、毁齿也。
高骨 张云。颧肩膝踝之类。
募筋 张云。募者筋脉聚蓄之处。募、音暮。简案、募、当作幕。幕、膜同。痿论。肝主身之筋膜。
全元起注云。膜者人皮下肉上筋膜也。可以证矣。详见素问识疟论。
人有 肉 张云。 肉者。肉脂之聚处也。简案、聚邑者。聚落邑里也。
十二筋 张云。四肢各三节。是为十二节。简案、阴阳别论云。十二月应十二脉。本篇上文云。十二
脉应十二经水。
地有四时不生草 张云。地有不毛之地。人有不育之人。徐振公云。男子冲任不盛。宗筋不成。则须
不生。是以四时之草不生。以应人之无子。
纵舍 马云。或纵针而不必持。或舍针而不复用。张云。纵、言从缓。舍、言弗用也。
捍皮 马云。捍分其皮。以开其腠理。而入刺之也。张云。捍、说文忮也。谓恐刺伤其皮。而开腠理。
则奈之何也。简案、捍、为捍御之义。于本文难通。张注亦迂。考集韵与 同。以手伸物也。马捍分之解。似
略通。
焉至而出（止）闻其方 张云。出止徐疾入。即五输之义。别离之处。言经络之支别离合也。
手太阴之脉（止）屈折也 甲乙。内屈、作内侧。留、作
溜。外屈上于本节之下、作外屈本指以下。注云。一作本于上节。阴诸络、作诸阴络数脉。并注云。疑此处有
缺文。马云。屈、读为曲。壅骨、即掌后高骨也。张云。此下二节。皆言五 之屈折也。大指之端。少商井也。
内屈循白肉际。至本节之后。大渊 也。凡人身经脉阴阳。以紫白肉际为界。紫者在外属阳分。白者在内属阴
分。大概皆然。澹、水摇貌。脉至大渊而动。故曰留以澹也。从此外屈上于本节之下。内屈与诸阴络会于鱼际
荥也。诸阴皆会于此。故数脉并注。其气滑利。伏行掌后高骨之下。外屈出寸口而行经渠经也。上至肘内廉。
入于大筋之下。尺泽合也。乃由此内屈 阴入腋走肺。然肺经之脉。从脏走手为顺。此则从手数至脏。故为顺
行逆数之屈折。简案、澹、马志并为澹渗诸经之义。恐非也。数脉并注。义自分明。甲乙注为有缺文。误。沈
彤释骨云。手大指本节后。起骨曰壅骨。邪客篇云。云是壅骨。固在鱼际旁寸口前。旧说谓即掌后高骨。误。
心主之脉（止）络于心脉 甲乙。心脉、作心胞。马志作心肺。非。张云。中指之端。中、冲井也。内
屈循中指以上掌中劳宫。荥也。伏行两骨之间。外屈出两筋之间。骨肉之际。大陵 也。其气滑利上二寸外屈
出行两筋之间。间使经也。上至肘内廉。入于小筋之下留两骨之会者。曲泽合也。由此上入胸中。内络于心脉。
乃手厥阴经。顺行逆数之屈折。按本篇于十二经之屈折。独言手太阴心主二经者。盖欲引止下文少阴无 之义。
故单以膈上二经为言耳。诸经屈折详义。已具经脉本输等篇。故此不必详也。
少阴心脉也（止）故独无 焉 甲乙。大主也下。有为帝王三字。张云。手少阴心经也。手厥阴心包络
经也。经虽分二。脏实一原。但包络在外为心之卫。心为五脏六腑之大主。
乃精神之所居。其脏坚固。邪不可伤。伤及于心无不死者。故凡诸邪之在心者。皆在心外之包络耳。然心为居
主之官。而包络亦心所主。故称为心主。凡治病者。但治包络之 。即所以治心也。故少阴一经。所以独无
焉。详义出本输篇。
少阴独无 者（止）因天之序 甲乙。不病上有心字。外经下有脉字。张云。凡脏腑经络。有是脏则有
是经。脏居于内。经行于外。心脏坚固居内。邪弗能容。而经则不能无病。故少阴经病者。当取掌后锐骨之端。
即神门 也。其余脉之出入。屈折余疾。皆如手少阴心主之脉行者。言少阴心主之 。其行相似。故曰本 者。
言少阴本经之 。非上文皆在心包之谓也。然则邪在心包脏者。当治心主之 。邪在少阴经者。当治本经之 。
因其虚实以取之。则邪气去而真气固。乃不失诸经天道之序也。按本 篇。所载五脏五 。六腑六 。独手少
阴经无 。故此篇特以为问。正欲明心为大主。无客邪伤之义。然既曰无 。而此节复言取其经于掌后锐骨之
端。及如心主脉行本输等义。可见心脏无病。则治脏无 。少阴经有病。则治经有 。故甲乙经备载少阴之
云。少冲为井。少府为荥。神门为 。灵道为经。少海为合。于十二经之 。始全其义。盖本诸此。马云。外
经有病。独取其掌后锐骨之端神门穴耳。其余脉之出入曲折。所行之徐疾。皆如手厥阴心包络之脉行也。故本
经本输篇。谓治手少阴者。即治心包络经。皆调其气之虚实。疾徐以取之。是谓因邪气所冲而泻之。真气衰而
补之。如是者。则邪去而真固。有以循天道四时之序。简案、少阴无 云云。王冰三部九候论注引之云。灵枢
经持针纵舍。论曰乃知古篇名。与今本不同。
阴阳如一者病难治 马云。人迎气口若一。则脉为关格。病当难治。张云。表里俱伤。血气皆散者。
是为阴阳如
一。刺之必反甚。当舍而勿针也。志云。皮肤筋骨之浅深。皆病也。
其本末尚热者病尚在 甲乙。作察其本末上下。有热者病常在。马云。胸腹为本。四肢为末。凡本
末尚热者。其病尚在。张云。胸腹脏腑为本。经络四肢为末。尚热者。余邪未尽也。宜从缓治。其病亦去者。
可舍针也。
持其尺（止）寒热痛痹 志云。邪气脏腑病形篇曰。脉滑者尺之皮肤亦滑。脉涩者尺之皮肤亦涩。故
持其尺。察其尺肤之坚脆大小滑涩。以知皮肤分肉之寒热燥湿也。五脏之血色见于目。因视目之五色。以知五
脏。而决死生。盖病在脏者。半死半生也。视其血络。察其皮毛。以知痛痹之寒热也。皮部论曰。凡十二经络
脉者。皮之部也。其色多青则痛。多黑则痹。黄赤则热。多白则寒。五色皆见。则寒热也。
余未得其意也 张云。不惟病形轻重有纵舍。而持针之际。其进止退留。亦有纵舍。未得其详。因而复问。
持针之道（止）真气得居 甲乙。左指作左手。（赵熊道脏正脉张同）果、作裹。（马同）辅、
作转。邪下有气不二字。张云。持针之道。宜审而慎。必从和缓从容。庶可无误。故欲端以正。安以静。先知
病之虚实。以施疾徐之法。左手执之。右手循之。必中其穴。无中其肉。而与肉果。果、即裹也。泻者欲端以
正。补者必闭其肤。以手辅针。导引其气。必使邪气溃决而散。真气得复而居。然后可以去针。此持针纵舍之
道也。志云。无与肉果者。刺脉无伤肉也。简案、甲乙改字。似是。
因其分肉（止）邪气得去 马云。所谓 皮开腠理者。因其分肉之在何经而捍分其皮。以开其腠理而
入刺之也。先以左手别其皮肤。然后右手微纳其针。而徐徐端正其针以入之。斯乃捍皮开腠理之法。其神气自
然不散。而邪气乃得以去矣。
八虚 张云。即五脏生成篇。所谓八溪也。是皆筋骨之隙。气血之所流注者。故曰八虚。
肺心有邪 张云。人之五脏。惟肺与心居于膈上。其经属手。脾肝肾俱在膈下。其经属足。故肺心
有邪。乘虚而聚。其气必留于两肘。在肺则尺泽。在心则少海之次。
肝有邪 张云。肝与胆合。其经自足而上。皆行胁腋之间。故肝邪乘虚而聚者。其气当流于两腋。即
期门、渊腋、等穴之次。
脾有邪 张云。脾与胃合。其脉皆自胫股上出冲门、气冲之间。故邪气留髀 间者。知为脾经之病。
肾有邪 张云。肾与膀胱为表里。其经皆出膝后阴谷、委中、之间。故邪气留于两 者。知为肾经
之病。马云。前四留字。俱当作流。简案、肝独作流。余并作留。义俱通。
凡此八虚者（止）病挛也 甲乙。赵本。张本。病、作 。是。张云。机、枢机也。关、要会处也。
各版本中均无“篇”字。
关于“目不瞑不卧出者”这一句，出自《甲乙经》的表述为“目不得眠者”这五个字。考察下文的回答内容，《甲乙经》的说法是正确的。马莳说：邪气侵袭人体，导致人眼睛无法闭合入睡，或者不能安卧而起身活动在外。张景岳说：导致人睡眠无从产生，所以说“不卧出”。
五谷进入胃后（直到）进行呼吸运作：《甲乙经》中，“心脉”写作“心肺”。张景岳说：宗气就是大气。队通“隧”，即道路。糟粕的道路出于下焦，津液的通道出于中焦，宗气的通道出于上焦。因此分为三条隧道。喉咙是肺系的连接处，向下贯穿到心脏，所以能通行宗气并进行呼吸。（营气的运行见《营气篇》和《五十营篇》，卫气的含义见《痹论》及《经脉篇》）
夜间行于阴分：《甲乙经》在“阴”字下有“其入于阴也”一句。马莳说：大义见于《卫气行篇》。
厥气客居于五脏六腑：《甲乙经》中，“厥”写作“邪”，且没有“六腑”二字。
阳气盛则阳跷脉陷：《甲乙经》中，“陷”写作“满”。楼氏说：“陷”应当作“满”。汪昂说：《大惑论》中作“阳气满则阳跷盛”，“盛”字是对的。又说：卫气盛于阴分，不能行于阳分，则阴气盛。阴气盛，则阴跷脉满。阳气虚，所以眼睛闭合。（徐振公引用《大惑论》也说此章“陷”字疑似有误）。简评：张景岳说，“陷”是指受伤的意思，这是不对的。
补其不足，泻其有余：张景岳说：这是针刺治疗的补泻方法。补其不足，即阴跷脉所出的足少阴肾经的照海穴；泻其有余，即阳跷脉所出的足太阳膀胱经的申脉穴。如果是阴盛阳虚而多卧的人，自然应当补阳泻阴了。
饮以半夏汤：张景岳说：谓在针刺之后，仍然应当用药来治疗。凡是不卧的病证，有邪气实盛的，多属于外因；有营气虚弱的，多属于内因。这个半夏汤的方法，大概是专门为了祛除邪气而设立的。楼氏说：半夏汤是去除水饮的方剂。
所谓：《甲乙经》中，“谓”写作“以”。简评：壅塞，大概是指水饮。所以用半夏汤来疏通它。
阴阳和得：《甲乙经》作“得和”。
其汤方（直到）三饮而已也：“置”字，《甲乙经》作“煮”。李中梓说：千里流水，取它流长源远，有疏通下达的意义。扬之万遍，使水珠盈溢，称为甘澜水，可以调和阴阳。用芦苇做燃料烧火，取它火势猛烈。治半夏即指经过炮制的半夏。味辛性温，能下气化痰，用作臣药。张景岳说：古今度量标准不同。大约古代的黍量一斗，相当于现在的铁斛数三升二合。那么说八升的，就是现在的二升五合六勺；说五升的，就是现在的一升六合左右。（简评：物氏《度量考》说明代一合等于今五勺七撮，明代一升等于今五合七勺一撮）。火沸者，先用水煮沸，然后再放入药物中。秫米，是糯小米。也就是黍米一类，但颗粒比黍小，可以用来酿酒。北方人叫它小黄米。它的性质味甘、粘、微凉，能养营补阴。半夏味辛性温，能和胃散邪，消除腹胀和眼睛无法闭合的症状，所以两者并用。秫米一升，约合现在的三合二勺；半夏五合，约合现在的一合六勺。炊煮至一升半，约合现在的四合八勺。滓，音同“子”。汪昂说：半夏能和胃而通阴阳。现在的人大多认为它燥烈而不敢使用，这是错误的。《本草》以秫为糯粟，怀疑是糯稻。楼氏说：按《本草》，秫米就是所谓的糯米。王子接说：北方地产的膏粱茄粟。李时珍说：用火时用陈年的芦枯竹，取它火力不强，不损伤药力。（出自《芦火条》）又说：秫即粱米中粘性的一种。《灵枢经》中，岐伯治疗阳盛阴虚、夜里不能闭眼，在半夏汤中使用它，取它益阴气而利大肠的作用。大肠通畅则阳气不盛了。简评：《尔雅》说：秫，是粘粟。一名糯粟，一名黄糯。楼氏的说法不对。《千金方》治疗虚烦不眠用千里流水汤，《三因方》治疗胆寒用温胆汤，都效法前代的方子。
天圆地方：张景岳说：圆的直径是一，周长是三，这是阳奇之数。方的直径是一，周长是四，这是阴偶之数。人的头部属阳居上，所以圆而应天。人的脚部属阴居下，所以方而应地。
地有九州：张景岳说：九州是荆、梁、雍、豫、徐、扬、青、兖、冀。简评：这原本基于《禹贡》，详见《素问识·生气通天论》。
天有风雨：张景岳说：和风甘雨，是天的喜悦；摧拉霖溃（狂风暴雨），是天的愤怒。
天有六律：张景岳说：六律是黄钟、太簇、姑洗、蕤宾、夷则、无射，称为六阳律。大吕、夹钟、仲吕、林钟、南吕、应钟，称为六阴律。
天有十日：张景岳说：十日是甲、乙、丙、丁、戊、己、庚、辛、壬、癸，这叫天干。《阴阳系日月篇》说：腰以上为天，腰以下为地。所以天为阳，地为阴。所以足的十二经脉，对应十二月。月生于水，所以在下的为阴。手的十指对应十日。日主火，所以在上的为阳。
辰有十二（直到）以抱人形：张景岳说：十二辰是子、丑、寅、卯、辰、巳、午、未、申、酉、戌、亥，这叫地支。所以对应人的脚趾。
足趾只有十个，加上阴茎和睾丸共十二个。阴茎是宗筋，睾丸是垂体。女子缺少这两个部位，所以能以“抱”的姿态怀胎。“抱”的意思是怀胎，如西北地区称伏鸡孵蛋为“抱”一样。（见杨慎《方言》）
人有肩膝：张景岳说：肩部和膝盖骨头大而高，所以对应山。
人有腋：张景岳说：腋下深陷，所以对应谷。
地有泉脉：张景岳说：泉脉出于地下，卫气行于肌肉之中。
地有草：张景岳说：荚，是瑞草。尧帝时生长在庭院中，随着月亮盈亏而凋谢繁荣。朔日后一天荚生出，望日后一天荚落下。历法得其分寸度则荚生。简评：张注本于《帝王世纪》，但没有毫毛独应瑞草的道理。《尔雅》说：菥是大荠。郭璞注：荠叶细，俗呼之为老荠。李时珍说：荠与菥是一物，只是分大小两种罢了。由此考证，大概荠这种草随处容易生长，所以这里的草是对下文林木而言，指地上的众草。（“荚”音冥，“菥”音觅）。集注：仇汝霖也将上古的草解释为此，不可从。
人有牙齿：张景岳说：齿牙疏朗，所以像排列的星星。《说文》说：牙，是牡齿。一说锐利的叫牙，齐整的叫齿。《上古天真论》说，女子三七，男子三八，则真牙生而长极。所以后来生的大的叫牙。女子七岁，男子八岁换齿。所以以前生的小的叫齿。所以男子八月生齿，八岁换齿；女子七月生齿，七岁换齿。龀，是毁齿。
高骨：张景岳说：颧骨、肩、膝、踝之类。
募筋：张景岳说：募是筋脉聚蓄的地方。募，音暮。简评：募，应当作“幕”。幕、膜同义。《痿论》说：肝主身之筋膜。全元起注说：膜是人皮下肉上的筋膜。可以证明这一点。详见《素问识·疟论》。
人有肉腠：张景岳说：肉腠，是肉脂聚集的地方。简评：聚邑，是聚落邑里的意思。
十二节：张景岳说：四肢各三节，称为十二节。简评：《阴阳别论》说：十二月应十二脉。本篇上文说：十二脉应十二经水。
地有四时不生草：张景岳说：地有不毛之地，人有不育之人。徐振公说：男子冲任不盛，宗筋不成，则胡须不生。是以四时的草不生，以对应人的无子。
纵舍：马莳说：或者放纵针而不必持守，或者舍弃针而不再复用。张景岳说：纵，言从缓；舍，言弗用。
捍皮：马莳说：捍开其皮，以打开腠理，然后刺入。张景岳说：捍，《说文》解释为忮（嫉妒/刚愎）。谓恐怕刺伤其皮，而打开腠理，该怎么办呢？简评：捍，是捍卫的意思，于本文难以讲通。张注也迂腐。考《集韵》与“扞”同，用手伸物。马莳捍分之解，似乎略通。
焉至而出（直到）闻其方：张景岳说：出止徐疾入，即五输的含义。别离之处，言经络的支别离合。
手太阴之脉（直到）屈折也：《甲乙经》中，“内屈”作“内侧”，“留”作“溜”。“外屈上于本节之下”作“外屈本指以下”。注云：一作本于上节。“阴诸络”作“诸阴络数脉”，并注云：疑此处有缺文。马莳说：屈，读为曲。壅骨，即掌后高骨。张景岳说：此下两节，都是言五输的屈折。大拇指的末端，是少商井穴。内屈循白肉际，至本节之后，是大渊俞穴。凡人身经脉阴阳，以紫白肉际为界。紫色在外属阳分，白色在内属阴分。大概都是这样。澹，是水摇动的样子。脉至大渊而动，所以说“留以澹”。从此外屈上于本节之下，内屈与诸阴络会于鱼际荥穴。诸阴皆会于此，所以数脉并注。其气滑利，伏行掌后高骨之下，外屈出寸口而行经渠经穴。上至肘内廉，入于大筋之下，是尺泽合穴。乃由此内屈入阴入腋走肺。然而肺经之脉，从脏走手为顺，这里却从手数至脏，所以为顺行逆数的屈折。简评：澹，马志均为澹渗诸经的意义，恐怕不对。数脉并注，意义自分明。《甲乙经》注为有缺文，错误。沈彤《释骨》说：手大拇指本节后，起骨曰壅骨。《邪客篇》说：云是壅骨，固在鱼际旁寸口前。旧说谓即掌后高骨，错误。
心主之脉（直到）络于心脉：《甲乙经》中，“心脉”作“心胞”。马志作“心肺”，非。张景岳说：中指之端，是中冲井穴。内屈循中指以上掌中劳宫荥穴。伏行两骨之间，外屈出两筋之间，骨肉之际，是大陵俞穴。其气滑利上二寸外屈出行两筋之间，是间使经穴。上至肘内廉，入于小筋之下留两骨之会者，是曲泽合穴。由此上入胸中，内络于心脉，乃是手厥阴经，顺行逆数的屈折。按本篇对于十二经的屈折，独言手太阴、心主二经的原因，大概是想要引出下文少阴无俞的意义。所以单以膈上二经为言。诸经屈折详细意义，已具《经脉》《本输》等篇，所以此处不必详述。
少阴心脉也（直到）故独无俞焉：《甲乙经》中，“大主也”下有“有为帝王”三字。张景岳说：手少阴心经。手厥阴心包络经。经虽分二，脏实一原。但包络在外为心之卫，心为五脏六腑之大主，乃精神之所居。其脏坚固，邪不可伤。伤及于心无不死者。所以凡诸邪之在心者，都在心外之包络耳。然而心为君主之官，而包络亦心所主，故称为心主。凡治病者，只治包络之俞，即所以治心。所以少阴一经，所以独无俞。详细意义出《本输篇》。
少阴独无俞者（直到）因天之序：《甲乙经》中，“不病”上有心字，“外经”下有脉字。张景岳说：凡脏腑经络，有是脏则有是经。脏居于内，经行于外。心脏坚固居内，邪弗能容，而经则不能无病。所以少阴经病者，当取掌后锐骨之端，即神门俞穴。其余脉之出入、屈折余疾，皆如手少阴心主之脉行者，言少阴心主之俞，其行相似，故曰本输。言少阴本经之俞，非上文皆在心包之谓也。然则邪在心包脏者，当治心主之俞；邪在少阴经者，当治本经之俞。因其虚实以取之，则邪气去而真气固，乃不失诸经天道之序也。按《本输篇》，所载五脏五俞，六腑六俞，独手少阴经无俞，故此篇特以为问，正欲明心为大主，无客邪伤之义。然既曰无俞，而此节复言取其经于掌后锐骨之端，及如心主脉行本输等义，可见心脏无病，则治脏无俞；少阴经有病，则治经有俞。所以《甲乙经》备载少阴之俞：少冲为井，少府为荥，神门为俞，灵道为经，少海为合。于十二经之俞，始全其义。盖本诸此。马莳说：外经有病，独取其掌后锐骨之端神门穴耳。其余脉之出入曲折，所行之徐疾，皆如手厥阴心包络之脉行也。故本经本输篇，谓治手少阴者，即治心包络经，皆调其气之虚实，疾徐以取之。是谓因邪气所冲而泻之，真气衰而补之。如是者，则邪去而真固，有以循天道四时之序。简评：少阴无俞云云，王冰《三部九候论》注引之云：《灵枢经·持针纵舍》论曰乃知古篇名，与今本不同。
阴阳如一者病难治：马莳说：人迎气口若一，则脉为关格，病当难治。张景岳说：表里俱伤，血气皆散者，是为阴阳如一。刺之必反甚，当舍而勿针也。志云：皮肤筋骨之浅深，皆病也。
其本末尚热者病尚在：《甲乙经》作“察其本末上下，有热者病常在”。马莳说：胸腹为本，四肢为末。凡本末尚热者，其病尚在。张景岳说：胸腹脏腑为本，经络四肢为末。尚热者，余邪未尽也。宜从缓治。其病亦去者，可舍针也。
持其尺（直到）寒热痛痹：志云：《邪气脏腑病形篇》说：脉滑者尺之皮肤亦滑，脉涩者尺之皮肤亦涩。所以持其尺，察其尺肤之坚脆大小滑涩，以知皮肤分肉之寒热燥湿也。五脏之血色见于目，因视目之五色，以知五脏，而决死生。盖病在脏者，半死半生也。视其血络，察其皮毛，以知痛痹之寒热也。《皮部论》说：凡十二经络脉者，皮之部也。其色多青则痛，多黑则痹，黄赤则热，多白则寒。五色皆见，则寒热也。
余未得其意也：张景岳说：不惟病形轻重有纵舍，而持针之际，其进止退留，亦有纵舍，未得其详，因而复问。
持针之道（直到）真气得居：《甲乙经》中，“左指”作“左手”（赵熊道《脏正脉》张同）。“果”作“裹”（马同）。“辅”作“转”。邪下有“气不”二字。张景岳说：持针之道，宜审而慎。必从和缓从容，庶可无误。故欲端以正，安以静。先知病之虚实，以施疾徐之法。左手执之，右手循之。必中其穴，无中其肉，而与肉果。果，即裹也。泻者欲端以正，补者必闭其肤，以手辅针，导引其气。必使邪气溃决而散，真气得复而居，然后可以去针。此持针纵舍之道也。志云：无与肉果者，刺脉无伤肉也。简评：《甲乙经》改字，似是。
因其分肉（直到）邪气得去：马莳说：所谓捍皮开腠理者，因其分肉之在何经而捍分其皮，以开其腠理而入刺之也。先以左手别其皮肤，然后右手微纳其针，而徐徐端正其针以入之。斯乃捍皮开腠理之法。其神气自然不散，而邪气乃得以去矣。
八虚：张景岳说：即《五脏生成篇》所谓八溪也。是皆筋骨之隙，气血之所流注者。故曰八虚。
肺心有邪：张景岳说：人之五脏，惟肺与心居于膈上，其经属手。脾肝肾俱在膈下，其经属足。故肺心有邪，乘虚而聚，其气必留于两肘。在肺则尺泽，在心则少海之次。
肝有邪：张景岳说：肝与胆合，其经自足而上，皆行胁腋之间。故肝邪乘虚而聚者，其气当流于两腋，即期门、渊腋等穴之次。
脾有邪：张景岳说：脾与胃合，其脉皆自胫股上出冲门、气冲之间。故邪气留髀 间者，知为脾经之病。
肾有邪：张景岳说：肾与膀胱为表里，其经皆出膝后阴谷、委中之问。故邪气留于两 者，知为肾经之病。马莳说：前四个“留”字，俱当作“流”。简评：肝独作“流”，余并作“留”，义俱通。
凡此八虚者（直到）病挛也：《甲乙经》、赵本、张本，“病”作“痉”，是。张景岳说：机，枢机也。关，要会处也。
In all versions, the character "Pian" (Chapter) is absent.
Regarding the phrase "bu ming min bu wo chu zhe" (eyes unable to close, sleeplessness, and rising/moving out), the *Jia Yi Jing* (Systematic Classic of Acupuncture and Moxibustion) renders it as "mu bu de mian zhe" (five characters meaning eyes cannot sleep). Examining the subsequent answer, the *Jia Yi Jing* version is correct. Ma Shi states: When pathogenic factors invade the human body, they cause the eyes to be unable to close for sleep, or prevent peaceful rest, causing the person to rise and move about externally. Zhang Jingyue states: This causes sleep to fail to arise, hence the term "bu wo chu" (not lying down and going out).
When the five grains enter the stomach... until performing respiration: In the *Jia Yi Jing*, "xin mai" (Heart vessel) is written as "xin fei" (Heart and Lung). Zhang Jingyue states: Zong Qi (Gathering Qi) is also called Da Qi (Great Qi). "Dui" is a variant for "Sui" (tunnel/pathway). The pathway for dregs/feces issues from the Lower Jiao (Lower Burner); the pathway for fluids/jin ye issues from the Middle Jiao (Middle Burner); the pathway for Zong Qi issues from the Upper Jiao (Upper Burner). Thus, they are divided into three tunnels. The trachea/throat is the connection of the Lung, extending downward through to the Heart; therefore, it allows the circulation of Zong Qi and performs respiration. (The operation of Ying Qi/Nutritive Qi is seen in the *Ying Qi Pian* and *Wu Shi Ying Pian*; the meaning of Wei Qi/Defensive Qi is seen in the *Bi Lun* and *Jing Mai Pian*).
At night, [Wei Qi] travels within Yin: In the *Jia Yi Jing*, there is an additional sentence under "Yin": "qi ru yu yin ye" (its entry into Yin). Ma Shi states: The main principle is found in the *Wei Qi Xing Pian*.
Jue Qi (Rebellious Qi) lodges in the Five Zang and Six Fu organs: In the *Jia Yi Jing*, "Jue" is written as "Xie" (Pathogen), and the words "Liu Fu" (Six Fu organs) are absent.
When Yang Qi is excessive, the Yang Qiao vessel becomes deficient/full: In the *Jia Yi Jing*, "Xian" (deficient/sunken) is written as "Man" (full/excessive). Lou Shi says: "Xian" should be read as "Man". Wang Ang states: The *Da Huo Lun* writes "Yang Qi Man ze Yang Qiao Sheng" (When Yang Qi is excessive, the Yang Qiao vessel is vigorous), and the character "Sheng" is correct. He further adds: When Wei Qi is excessive in Yin and cannot travel to Yang, then Yin Qi becomes excessive. When Yin Qi is excessive, the Yin Qiao vessel becomes full. When Yang Qi is deficient, the eyes close. (Xu Zhengong cites the *Da Huo Lun*, stating that the character "Xian" in this chapter is likely erroneous). Commentary: Zhang Jingyue states that "Xian" means injured/damaged, which is incorrect.
Tonify its deficiency, drain its excess: Zhang Jingyue states: This refers to the tonification and drainage methods of acupuncture. Tonifying its deficiency refers to Zhaohai (KI6), the point where the Yin Qiao vessel originates from the Foot Shaoyin Kidney Meridian. Draining its excess refers to Shenmai (BL62), the point where the Yang Qiao vessel originates from the Foot Taiyang Bladder Meridian. If one suffers from excessive Yin and deficient Yang with hypersomnia (excessive sleeping), one should naturally tonify Yang and drain Yin.
Administer Banxia Tang (Pinellia Decoction): Zhang Jingyue states: This implies that after acupuncture, medication should still be used for treatment. For conditions of insomnia, those with excess pathogenic factors mostly belong to external causes; those with deficient Ying Qi mostly belong to internal causes. This method of Banxia Tang is specifically designed to eliminate pathogens. Lou Shi states: Banxia Tang is a formula to remove fluid retention.
So-called: In the *Jia Yi Jing*, "Wei" is written as "Yi" (by/with). Commentary: Obstruction, likely referring to water/fluid retention. Therefore, Banxia Tang is used to dredge it.
Yin and Yang harmonized and obtained: The *Jia Yi Jing* reads "De He" (obtained harmony).
Its decoction recipe... until drinking it three times: The character "Zhi" (place) is written as "Zhu" (boil) in the *Jia Yi Jing*. Li Zhongzi states: "Qianli Liushui" (flowing water from a thousand li) is chosen for its long flow and distant source, possessing the meaning of unblocking and directing downward. Stirring it ten thousand times until the water beads overflow creates "Ganlan Shui" (Sweet Ripple Water), which can harmonize Yin and Yang. Cooking with reed firewood is chosen because the fire is intense. "Zhi Banxia" refers to processed Pinellia. It is acrid in flavor and warm in nature, capable of descending Qi and resolving phlegm, used here as a minister herb. Zhang Jingyue states: Ancient and modern measurements differ. Approximately, one dou of ancient grain measurement equals roughly 3 sheng 2 he of modern iron measures. Thus, saying eight sheng corresponds to roughly 2 sheng 5 he 6 shao today; saying five sheng corresponds to roughly 1 sheng 6 he today. (Commentary: Wu Shi's *Du Liang Kao* states that one Ming dynasty he equals 5 shao 7 cuo today, and one Ming dynasty sheng equals 5 he 7 shao 1 cuo today). "Huo fei" means boiling the water first with fire before placing the herbs inside. "Shumi" is glutinous millet. It is similar to Shumi (broomcorn millet) but with smaller grains, and can be used to make wine. People in the North call it "Xiao Huang Mi" (small yellow millet). Its nature is sweet, sticky, and slightly cool; it can nourish Ying Qi and tonify Yin. Banxia is acrid and warm; it can harmonize the Stomach, scatter pathogens, and eliminate abdominal distension and inability to close the eyes. Therefore, both are used together. One sheng of Shumi is approximately 3 he 2 shao today; five he of Banxia is approximately 1 he 6 shao today. Cooked down to one and a half sheng, which is approximately 4 he 8 shao today. "Zi" (dregs) is pronounced "zi". Wang Ang states: Banxia can harmonize the Stomach and connect Yin and Yang. Modern people generally consider it drying and dare not use it, which is a mistake. The *Bencao* describes Shumi as glutinous broomcorn, suspecting it might be glutinous rice. Lou Shi states: According to the *Bencao*, Shumi is what is called Nuomi (glutinous rice). Wang Zijie states: It is the gao liang qie su produced in the North. Li Shizhen states: When using fire, aged reed dry bamboo is preferred because its heat is not too strong and does not damage the medicinal power. (From the section on Reeds Fire). He also states: Shumi is the sticky variety of Liangmi. In the *Ling Shu*, when Qibo treats Yang excess and Yin deficiency causing insomnia at night, he uses it in Banxia Tang, taking advantage of its ability to benefit Yin Qi and promote bowel movement. When the Large Intestine moves freely, Yang Qi will not be excessive. Commentary: The *Erya* states: Shumi is sticky broomcorn. Also known as Nuosuli or Huangnuo. Lou's theory is incorrect. The *Qianjin Fang* treats restless insomnia with Qianli Liushui Tang; the *San Yin Fang* treats Gallbladder cold with Wendan Tang; both emulate ancient formulas.
Heaven is round, Earth is square: Zhang Jingyue states: A circle has a diameter of one and circumference of three, representing the odd number of Yang. A square has a diameter of one and circumference of four, representing the even number of Yin. The human head belongs to Yang and resides above, thus round and corresponding to Heaven. The human feet belong to Yin and reside below, thus square and corresponding to Earth.
Earth has Nine Provinces: Zhang Jingyue states: The Nine Provinces are Jing, Liang, Yong, Yu, Xu, Yang, Qing, Yan, and Ji. Commentary: This originates from the *Yu Gong* (Tribute of Yu), detailed in *Su Wen Shi: Sheng Qi Tong Tian Lun*.
Heaven has Wind and Rain: Zhang Jingyue states: Gentle wind and sweet rain are Heaven's joy; destructive storms and heavy rains are Heaven's anger.
Heaven has Six Lu (Pitch Pipes): Zhang Jingyue states: The Six Lu are Huangzhong, Taisu, Guxian, Ruibin, Yize, and Wuyi, known as the Six Yang Lu. Dalv, Jiazhang, Zhonglv, Linzhong, Nanlv, and Yinglv are the Six Yin Lu.
Heaven has Ten Days: Zhang Jingyue states: The Ten Days are Jia, Yi, Bing, Ding, Wu, Ji, Geng, Xin, Ren, Gui, known as the Heavenly Stems. The *Yin Yang Xi Ri Yue Pian* states: Above the waist is Heaven, below the waist is Earth. Thus Heaven is Yang, Earth is Yin. Therefore, the twelve meridians of the feet correspond to the twelve months. The moon is born from water, so what is below is Yin. The ten fingers of the hands correspond to the ten days. The Sun governs Fire, so what is above is Yang.
Chen (Earthly Branches) have Twelve... to embrace the human form: Zhang Jingyue states: The Twelve Chen are Zi, Chou, Yin, Mao, Chen, Si, Wu, Wei, Shen, You, Xu, Hai, known as the Earthly Branches. Thus they correspond to the human toes.
There are only ten toes, plus the penis and scrotum making twelve. The penis is the Zong Jin (Gathering of Sinews); the scrotum contains the testicles. Women lack these two parts, thus they can "embrace" (carry) the human form. "Embrace" here means pregnancy, similar to how the Northwest calls a hen sitting on eggs "embracing". (See Yang Shen's *Fangyan*).
Humans have shoulders and knees: Zhang Jingyue states: The bones of the shoulders and knees are large and high, thus corresponding to mountains.
Humans have axillae: Zhang Jingyue states: The axillae are deeply sunken, thus corresponding to valleys.
Earth has spring veins: Zhang Jingyue states: Spring veins emerge from underground; Wei Qi travels within the muscles.
Earth has grass: Zhang Jingyue states: Jia is a auspicious grass. It grew in the courtyard during Emperor Yao's time, flourishing and withering with the moon. One day after the new moon, the leaves sprout; one day after the full moon, the leaves fall. Observing the lunar phases correctly allows the leaves to sprout. Commentary: Zhang's note is based on the *Diwang Shiji*, but there is no reason for hair-like structures to uniquely correspond to auspicious grass. The *Erya* states: Xi is Daqi (large shepherd's purse). Guo Pu's commentary: Shepherd's purse leaves are fine, commonly called Laoqi (old shepherd's purse). Li Shizhen states: Qi and Xi are the same thing, just divided into large and small varieties. From this, we can deduce that Qi is a grass that grows easily anywhere; thus "grass" here contrasts with the following "forests and trees," referring to common grasses on the ground. ("Jia" sounds like ming, "Xi" sounds like mi). Collected Notes: Qiu Rulin also interpreted the ancient grass this way, which should not be followed.
Humans have teeth: Zhang Jingyue states: Teeth are sparse and orderly, thus resembling arranged stars. The *Shuowen* states: Ya are the molars. Alternatively, sharp ones are Ya, and flat/even ones are Chi. The *Shanggu Tianzhen Lun* states: At age twenty-one for women and twenty-four for men, the wisdom teeth grow and growth reaches its peak. Hence, those grown later are larger and called Ya. At age seven for women and eight for men, teeth change. Hence, those grown earlier are smaller and called Chi. Thus, boys' teeth grow at eight months and change at eight years; girls' teeth grow at seven months and change at seven years. Chen refers to losing baby teeth.
High bones: Zhang Jingyue states: Cheekbones, shoulders, knees, ankles, etc.
Mu Jin (Sinew Gathering): Zhang Jingyue states: Mu is the place where sinews and vessels gather. Mu is pronounced mu. Commentary: Mu should be read as "Mu" (curtain/screen). Mu and Mo (membrane) are synonymous. The *Wei Lun* states: The Liver governs the body's fascia. Quan Yuanqi's commentary states: Mo is the fascia between the skin and flesh. This confirms it. See *Su Wen Shi: Nue Lun* for details.
Humans have Rou Cou (Muscle Clefts): Zhang Jingyue states: Rou Cou is the gathering place of muscle fat. Commentary: Ju Yi refers to settlements and villages.
Twelve Joints: Zhang Jingyue states: Each of the four limbs has three joints, totaling twelve joints. Commentary: The *Yin Yang Bie Lun* states: Twelve months correspond to twelve meridians. The upper part of this chapter states: Twelve meridians correspond to twelve rivers.
Earth has seasons where grass does not grow: Zhang Jingyue states: There are barren lands on Earth, and there are infertile people among humans. Xu Zhengong states: If a man's Chong and Ren vessels are not vigorous, and the Zong Jin do not form, beard hair will not grow. Thus, the grass of the four seasons does not grow, corresponding to a man's infertility.
Zong She (Release and Abandon): Ma Shi states: Either release the needle without holding it firmly, or abandon the needle without using it again. Zhang Jingyue states: Zong means to proceed slowly/carelessly; She means not to use.
Han Pi (Protect the Skin): Ma Shi states: Separate the skin to open the Cou Li (pores/striae) and insert the needle. Zhang Jingyue states: Han, according to *Shuowen*, means jealous/hostile. It implies fearing injury to the skin while opening the Cou Li, asking what to do. Commentary: Han means defense/protection, which is difficult to apply to this text. Zhang's note is also pedantic. Checking the *Jiyun*, it is the same as "Han" (to stretch with hand). Ma Shi's interpretation of separating the skin seems slightly more coherent.
Where does it arrive and exit... until hearing the method: Zhang Jingyue states: Exit stops, slow entry, fast exit. This is the meaning of the Five Shu points. Places of separation refer to the branching and joining of meridians.
The Meridian of Hand Taiyin... until bending and folding: In the *Jia Yi Jing*, "Nei Qu" is written as "Nei Ce" (inner side), "Liu" is written as "Liu" (slippery/flowing). "Wai Qu shang yu ben jie zhi xia" is written as "Wai Qu ben zhi yi xia". Note: One version says "Ben yu shang jie". "Yin Zhu Luo" is written as "Zhu Yin Luo Shu Mai", with a note: Suspect missing text here. Ma Shi states: Qu is read as Qu (curve). Yong Gu is the high bone behind the palm. Zhang Jingyue states: These two sections below discuss the bending and folding of the Five Shu points. The tip of the thumb is Shaoshang (Well point). Internally curving along the white flesh border to behind the proximal joint is Dayuan (Stream point). In the human body, Yin and Yang meridians are bounded by the purple-white flesh border. Purple is outside belonging to Yang; White is inside belonging to Yin. Generally, this is true. Dan refers to the trembling of water. The pulse moves at Dayuan, hence "Liu yi dan". Externally curving up below the proximal joint, internally curving to meet the Yin collaterals at Yuji (Spring point). All Yin meridians converge here, hence multiple pulses merge. The Qi is smooth and slippery, running hidden under the high bone behind the palm, externally curving out at Cun Kou to travel through Jingquan (River point). Up to the inner edge of the elbow, entering below the large tendon is Chize (Sea point). From here, it internally curves into Yin, enters the axilla, and travels to the Lung. However, the Lung meridian normally travels from Zang to Hand (smooth direction); here it goes from Hand to Zang, hence it is described as the bending/folding of reverse counting in the smooth direction. Commentary: Dan, in Ma's notes, means permeating the meridians, which is likely incorrect. The merging of multiple pulses is clear. The *Jia Yi Jing* note regarding missing text is wrong. Shen Tong's *Shi Gu* states: Behind the proximal joint of the thumb, the raised bone is Yong Gu. The *Xie Ke Pian* says Yong Gu is indeed beside Yuji and before Cun Kou. Old theories claiming it is the high bone behind the palm are wrong.
The Meridian of the Heart Master... until connecting to the Heart vessel: In the *Jia Yi Jing*, "Xin Mai" is written as "Xin Bao" (Pericardium). Ma's notes write "Xin Fei" (Heart Lung), which is incorrect. Zhang Jingyue states: The tip of the middle finger is Zhongchong (Well point). Internally curving along the middle finger up to Laogong in the palm (Spring point). Running hidden between two bones, externally curving out between two tendons at the boundary of bone and flesh is Daling (Stream point). Its Qi is smooth and slippery, moving up two cun, externally curving out between two tendons is Jianshi (River point). Up to the inner edge of the elbow, entering below the small tendon at the meeting of two bones is Quze (Sea point). From here it enters the chest internally and connects to the Heart vessel. This is the Pericardium Meridian of Hand Jueyin, the bending/folding of reverse counting in the smooth direction. Regarding the bending/folding of the twelve meridians in this chapter, only the Hand Taiyin and Heart Master meridians are mentioned. This is likely to introduce the meaning that Shaoyin has no Shu points later. Thus, only the two meridians above the diaphragm are discussed. Detailed meanings of other meridians' bending/folding are already in the *Jing Mai* and *Ben Shu* chapters, so no need to detail here.
Shaoyin is the Heart vessel... thus uniquely having no Shu points: In the *Jia Yi Jing*, under "Da Zhu Ye", there are three characters "You wei di wang" (There is the Emperor King). Zhang Jingyue states: Hand Shaoyin Heart Meridian. Hand Jueyin Pericardium Collateral Meridian. Although the meridians are divided into two, the Zang organ shares one origin. The Pericardium is outside, serving as the guard of the Heart. The Heart is the Great Master of the Five Zang and Six Fu organs, dwelling spirit and mind. Its organ is solid; pathogens cannot injure it. If injured, death is certain. Therefore, any pathogen affecting the Heart actually affects the Pericardium outside the Heart. Since the Heart is the Ruler, and the Pericardium is governed by the Heart, it is called Heart Master. In treating diseases, treating the Shu points of the Pericardium is equivalent to treating the Heart. Thus, the Shaoyin meridian uniquely lacks Shu points. Detailed meaning is in the *Ben Shu Pian*.
Shaoyin uniquely lacks Shu points... due to the order of Heaven: In the *Jia Yi Jing*, "Bu bing" has the character "Xin" above it; "Wai jing" has the character "Mai" below it. Zhang Jingyue states: For all Zang organs and meridians, if there is a Zang, there is a Meridian. The Zang resides internally; the Meridian travels externally. The Heart is solid and resides internally; pathogens cannot lodge there, but the Meridian can still become diseased. Therefore, when the Shaoyin Meridian is diseased, one should select the end of the sharp bone behind the palm, which is Shenmen (Shu point). The remaining exits, entries, bends, folds, and other ailments of the meridian are all like the Hand Shaoyin Heart Master meridian. This means the Shu points of the Shaoyin and Heart Master meridians are similar in function, hence called Ben Shu (Root Shu). It refers to the Shu points of the Shaoyin proper meridian, not implying everything is in the Pericardium as mentioned above. Thus, if pathogens are in the Pericardium Zang, treat the Heart Master Shu points; if pathogens are in the Shaoyin Meridian, treat the proper meridian's Shu points. Select based on deficiency and excess, so pathogens leave and True Qi remains firm, maintaining the order of Heaven in all meridians. According to the *Ben Shu Pian*, the Five Zang have five Shu points, the Six Fu have six Shu points, but the Hand Shaoyin uniquely lacks Shu points. This chapter asks specifically to clarify that the Heart is the Great Master and has no external pathogens injuring it. However, since it says "no Shu points," yet this section mentions selecting the meridian at the sharp bone behind the palm and similarities to the Heart Master meridian's Ben Shu, it shows that if the Heart Zang is healthy, treating the Zang requires no Shu points; if the Shaoyin Meridian is diseased, treating the Meridian requires Shu points. Thus, the *Jia Yi Jing* records the Shaoyin Shu points: Shaochong is Well, Shaofu is Spring, Shenmen is Shu, Lingdao is River, Shaohai is Sea. This completes the meaning of Shu points for the twelve meridians, originating from this. Ma Shi states: For external meridian disease, only select Shenmen at the sharp bone behind the palm. The remaining exits, entries, bends, and speeds are all like the Hand Jueyin Pericardium Collateral Meridian. Thus, the *Ben Shu Pian* of this classic states that treating Hand Shaoyin is treating the Pericardium Meridian, adjusting Qi deficiency/excess and speed to select points. This means draining due to pathogenic impact and tonifying when True Qi is weak. In this way, pathogens leave and True Qi remains firm, following the order of Heaven and the four seasons. Commentary: Regarding "Shaoyin lacks Shu points," Wang Bing's commentary on *San Bu Jiu Hou Lun* cites: The *Ling Shu Jing Chi Zong She* chapter says this reveals ancient chapter names differed from current versions.
Yin and Yang as one indicates difficult-to-treat disease: Ma Shi states: If Ren Ying and Qi Kou pulses are identical, the pulse indicates Guan Ge (Gate Grid), and the disease is difficult to treat. Zhang Jingyue states: When exterior and interior are both damaged, and Blood and Qi are scattered, this is Yin and Yang as one. Needling will worsen it; one should abandon needling. Zhi Yun states: Superficiality and depth of skin, tendons, and bones are all diseased.
If the root and extremities are still hot, the disease is still present: The *Jia Yi Jing* reads "Cha qi ben mo shang xia, you re zhe bing chang zai" (Examine root and extremities above and below; if hot, the disease persists). Ma Shi states: Chest and abdomen are root; limbs are extremities. If root and extremities are still hot, the disease is still present. Zhang Jingyue states: Chest, abdomen, and Zang organs are root; meridians and limbs are extremities. Still hot means residual pathogens remain. Treat slowly. If the disease also resolves, one may abandon needling.
Hold the Chi (forearm)... Cold, Heat, Pain, Bi: Zhi Yun states: The *Xie Qi Zang Fu Bing Xing Pian* says: If the pulse is slippery, the skin of the Chi is also slippery; if the pulse is choppy, the skin of the Chi is also choppy. Thus, holding the Chi and examining the hardness, fragility, size, smoothness, and roughness of the Chi skin allows knowing the cold, heat, dryness, and dampness of the skin and muscle layers. The blood color of the Five Zang appears in the eyes; observing the five colors of the eyes allows knowing the Five Zang and deciding life and death. Diseases in the Zang are half-dead, half-alive. Observing blood collaterals and checking the skin/hair allows knowing the cold and heat of Pain and Bi. The *Pi Bu Lun* states: The twelve meridian vessels are the departments of the skin. Many blue indicates pain; many black indicates Bi; yellow/red indicates heat; many white indicates cold. Seeing all five colors indicates mixed cold and heat.
I have not yet grasped its meaning: Zhang Jingyue states: Not only do disease severity and form involve releasing or abandoning needling, but also during needle handling, advancement, stopping, withdrawal, and retention involve releasing or abandoning. I have not grasped the details, hence asking again.
The Way of Holding the Needle... until True Qi takes residence: In the *Jia Yi Jing*, "Zuo zhi" is written as "Zuo shou" (Left hand) (Zhao Xiongdao's *Zang Zheng Mai*, Zhang agrees). "Guo" is written as "Guo" (Wrap) (Ma agrees). "Fu" is written as "Zhuan" (Turn). Under "Xie" are the characters "Qi bu" (Qi not). Zhang Jingyue states: The way of holding the needle should be careful and prudent. Must be gentle, slow, and composed, to avoid errors. Thus, desire straightness and correctness, peace and stillness. First know the deficiency and excess of the disease to apply fast/slow methods. Left hand holds it, right hand guides it. Must hit the acupoint, not the flesh, avoiding wrapping the flesh around the needle. Guo means wrap. For draining, desire straightness and correctness; for tonifying, must close the skin, using the hand to assist the needle and guide the Qi. Must ensure pathogens disperse and True Qi returns and resides, then the needle can be removed. This is the way of Zong She (Release and Abandon) in holding the needle. Zhi Yun states: "No wrapping flesh" means piercing the vessel without injuring the flesh. Commentary: The *Jia Yi Jing*'s character changes seem plausible.
According to the muscle layers... until pathogens depart: Ma Shi states: What is meant by protecting the skin and opening the Cou Li is: Because the muscle layers belong to specific meridians, protect/separate the skin to open the Cou Li and insert the needle. First separate the skin with the left hand, then gently insert the needle with the right hand, slowly and upright. This is the method of protecting skin and opening Cou Li. The Shen Qi naturally does not scatter, and pathogens can depart.
Ba Xu (Eight Empties): Zhang Jingyue states: These are the Eight Xi mentioned in the *Wu Zang Sheng Cheng Pian*. They are gaps between sinews and bones, where Qi and Blood flow and accumulate. Hence called Ba Xu.
Lung and Heart have pathogens: Zhang Jingyue states: Among the Five Zang, only the Lung and Heart reside above the diaphragm, their meridians belonging to the Hand. Spleen, Liver, and Kidney reside below the diaphragm, their meridians belonging to the Foot. Thus, when Lung and Heart have pathogens, they gather due to deficiency, and their Qi must stay in the two elbows. In the Lung, it is near Chize; in the Heart, it is near Shaohai.
Liver has pathogens: Zhang Jingyue states: The Liver combines with the Gallbladder; its meridian rises from the foot, traveling between the ribs and axillae. Thus, when Liver pathogens gather due to deficiency, their Qi flows to the two axillae, near points such as Qimen and Yuanye.
Spleen has pathogens: Zhang Jingyue states: The Spleen combines with the Stomach; their vessels emerge from between the Chongmen and Qichong areas of the lower leg and thigh. Thus, if pathogens stay in the thigh/groin area, it is known as a Spleen meridian disease.
Kidney has pathogens: Zhang Jingyue states: The Kidney and Bladder are interior-exterior pairs; their meridians emerge between Yin Gu and Weizhong behind the knee. Thus, if pathogens stay in the two popliteal fossae, it is known as a Kidney meridian disease. Ma Shi states: The previous four "Liu" (stay) characters should all be read as "Liu" (flow). Commentary: Only Liver uses "Liu" (flow); others use "Liu" (stay). Both meanings are acceptable.
All these Eight Xu... until disease of spasms: In the *Jia Yi Jing*, Zhao's edition, and Zhang's edition, "Bing" is written as "Jing" (Spasm), which is correct. Zhang Jingyue states: Ji means pivot/mechanism; Guan means key junction.