热病体重，肠中热，取之以第四针，于其 及下诸
指间，孛气于胃络，得气也。
此邪热在手足阳明经也，阳明在肌肉中，故体重，肠中热。既取其 及手足指，又索胃络之气以泄其邪也。
热病挟脐急痛，胸胁满，取之涌泉与阴陵泉，取之第四针，针嗌里。
此邪热在脾肾两经，故取脾肾两经之穴以治之。
热病而汗且出，及脉顺可汗者，取之鱼际、太渊、大都、太白，泻之则热去，补之则汗出，汗出太甚，取
内踝上横脉以止之。
此从肺脾两经而治之也。
热病已得汗，而脉尚躁盛，此阴脉之极也，死；其得汗而脉静者，生。
此言热邪盛而阴精涸极也。以人迎为阳脉，寸口为阴脉，寸口躁盛，故谓阴脉之极而死。即上所云邪胜而
精却也。脉静则精存，故生。
热病脉尚躁而不得汗者，此阳脉之极也，死；脉盛躁，得汗静者，生。
此言津液涸而不能作汗，阳邪亢极，故谓阳脉之极而死，以人迎脉更盛躁也。如得汗后，脉静则生，义与
上同。
热病不可刺者有九∶一曰汗不出，大颧发赤，哕者死；二曰泄而腹满甚者死；三曰目不明，热不已者死；
四曰老人婴儿，热而腹满者死；五曰汗不出，呕，下血者死；六曰舌本烂，热不已者死；七曰咳而衄，汗不
出，出不至足者死；八曰髓热者死；九曰热而痉者死，腰折，螈 ，齿噤 也。凡此九者，不可刺也。
颧为骨本，肾主骨，邪热盛，肾水枯，故颧赤；邪气上冲脾胃则哕，古名呃逆为哕，今时或以空呕为哕，
而呃逆更为败证也；泄泻则邪热应去，而腹满反甚者，脾败而邪仍在也；目不明者，热伤五脏精气，而热不已
则精竭也；老人气血衰，婴儿气血弱，腹满而热，则邪结土败也；汗不出，表气不通，邪热内伤脾胃，呕且下
血，本元脱矣；舌本烂者，邪热遍灼三阴，脏真败矣；咳而衄，邪热伤肺，汗不出及出不至足，营卫经络不
通，邪无出路也；髓热者，上条之证也；热而痉，腰折、螈 、齿噤 者，热极生风，筋脉拘急，角弓反张，
肝肾阴涸也。凡此九证，皆死不可刺，则药亦不可治也。
热病表现为身体沉重，肠道中有热邪，应使用第四种针法（锋针），在肘膝关节以下至手足十指之间的穴位施治，以引导胃络之气，达到得气的效果。
这是邪热在手足阳明经所致，阳明经行于肌肉之中，所以身体沉重，肠道有热。既然选取了肘膝以下及手足指的穴位，又需调动胃络之气来泄除邪热。
热病伴有肚脐周围拘急疼痛，胸胁部胀满，应取涌泉穴和阴陵泉穴，使用第四种针法，针刺咽喉内部相关部位。
这是邪热在脾、肾两经所致，因此选取脾、肾两经的穴位进行治疗。
热病患者汗液即将排出，且脉象顺随可发汗的情况，应取鱼际、太渊、大都、太白穴，采用泻法则热邪退去，采用补法则汗出；如果出汗过多，应取内踝上方的横脉（通常指然谷穴或附近血脉）以止汗。
这是从肺、脾两经进行治疗的方法。
热病已经出汗，但脉象仍然躁动盛大，这是阴脉衰竭至极的表现，主死；如果出汗后脉象平静，主生。
这是说热邪亢盛而阴精枯竭至极。以人迎脉为阳脉，寸口脉为阴脉，寸口脉躁动盛大，所以称为阴脉衰竭至极而死。即上文所说的邪气胜而精气亏损。脉象平静则精气尚存，所以能生。
热病脉象仍然躁动且不能出汗的，这是阳脉衰竭至极的表现，主死；脉象盛大躁动，出汗后脉象平静的，主生。
这是说津液枯竭而不能化汗，阳邪亢盛至极，所以称为阳脉衰竭而死，因为人迎脉更加盛大躁动。如出汗后脉象平静则生，道理与上文相同。
热病有九种不可针刺的情况：第一种是汗不出，两侧颧骨发红，呃逆的，主死；第二种是腹泻且腹部胀满严重的，主死；第三种是视力模糊，热势不退的，主死；第四种是老人和婴儿，发热且腹部胀满的，主死；第五种是汗不出，呕吐，便血的，主死；第六种是舌根溃烂，热势不退的，主死；第七种是咳嗽兼鼻出血，汗不出，或者汗出不到足部的，主死；第八种是髓热的，主死；第九种是发热并出现痉挛的，主死，表现为腰部反折，肢体抽搐，牙齿紧闭。以上这九种情况，都不可针刺。
颧骨是骨骼的根本，肾主骨，邪热亢盛导致肾水枯竭，所以颧骨发红；邪气上冲脾胃导致呃逆，古时候将呃逆称为哕，现在有时将空呕称为哕，而呃逆更是败坏之证；腹泻本应使邪热随之外去，反而腹部胀满严重，说明脾气败坏而邪气仍在；视力模糊，是因为热邪损伤五脏精气，热势不退则精气竭绝；老人气血衰弱，婴儿气血虚弱，发热且腹部胀满，说明邪气结聚、土气败坏；汗不出，表气不通，邪热内伤脾胃，呕吐且便血，说明元气脱失；舌根溃烂，说明邪热遍灼三阴经，脏腑真气败坏；咳嗽兼鼻出血，邪热伤肺，汗不出及汗出不到足部，说明营卫经络不通，邪气没有出路；髓热，属于上一条所述的证候；发热并痉挛，腰部反折、肢体抽搐、牙齿紧闭，是热极生风，筋脉拘急，角弓反张，肝肾阴液枯竭所致。以上这九种证候，都是死证不可针刺，那么药物也不可治疗。
In febrile diseases presenting with heavy body weight and heat in the intestines, treat using the fourth needle (Feng Zhen, sharp needle) at points between the elbows/knees and the fingers/toes, to guide Qi from the Stomach collaterals and achieve De Qi (arrival of Qi).
This indicates pathogenic heat in the Hand and Foot Yangming meridians. Since Yangming traverses the muscles, the body feels heavy and there is heat in the intestines. By selecting points distal to the elbows/knees and on the fingers/toes, one also draws upon the Qi of the Stomach collaterals to drain the pathogen.
In febrile diseases accompanied by urgent pain around the navel and fullness/distension in the chest and hypochondrium, select Yongquan (KI 1) and Yinlingquan (SP 9), use the fourth needle, and needle into the throat region.
This indicates pathogenic heat in the Spleen and Kidney meridians; therefore, points from these two meridians are selected for treatment.
In febrile diseases where sweat is about to appear, and the pulse is smooth indicating suitability for sweating therapy, select Yuji (LU 10), Taiyuan (LU 9), Dada (SP 2), and Taibai (SP 3). Applying reducing method will eliminate heat; applying reinforcing method will induce sweating. If sweating is excessive, select the transverse vessel above the medial malleolus (typically Ran Gu or nearby vessels) to stop it.
This treatment approach addresses the Lung and Spleen meridians.
If a patient with febrile disease has sweated but the pulse remains rapid and vigorous, this represents the extreme depletion of Yin pulses, indicating death; if the pulse becomes calm after sweating, it indicates survival.
This describes a state where pathogenic heat is exuberant and Yin essence is exhausted. Renying (carotid artery) represents Yang pulses, and Cunkou (radial artery) represents Yin pulses. Vigorous Cunkou pulse signifies extreme Yin depletion leading to death, as mentioned earlier regarding pathogen excess and essence deficiency. A calm pulse implies preserved essence, hence survival.
If the pulse in febrile disease remains rapid and vigorous without sweating, this represents the extreme depletion of Yang pulses, indicating death; if the pulse is rapid and vigorous but becomes calm after sweating, it indicates survival.
This describes a state where body fluids are exhausted and cannot generate sweat, with Yang pathogen reaching extremity, leading to death due to extreme Yang pulse depletion (Renying pulse being more rapid and vigorous). Survival occurs if the pulse calms after sweating, consistent with the previous explanation.
There are nine conditions in febrile disease that are unsuitable for acupuncture:
1. No sweating, redness of the cheekbones, and hiccups indicate death.
2. Diarrhea with severe abdominal fullness indicates death.
3. Unclear vision with persistent fever indicates death.
4. Elderly people and infants with fever and abdominal fullness indicate death.
5. No sweating, vomiting, and hematochezia/hematemesis indicate death.
6. Ulceration of the tongue root with persistent fever indicates death.
7. Coughing with epistaxis, no sweating, or sweating that does not reach the feet indicate death.
8. Marrow heat indicates death.
9. Fever with spasms (opisthotonos, convulsions, trismus) indicates death.
All nine conditions are unsuitable for acupuncture.
The cheekbones are the root of the bones; the Kidney governs bones. Exuberant pathogenic heat depletes Kidney Water, causing redness of the cheekbones. Pathogenic Qi rushing upward to the Spleen and Stomach causes hiccups (Yue/Eryngma); historically called "Yue," now sometimes referring to empty retching, while hiccups represent a critical failure syndrome. Diarrhea should expel heat, but severe abdominal fullness suggests Spleen failure with lingering pathogen. Unclear vision results from heat damaging the Essence of the Five Zang organs; persistent fever leads to essence exhaustion. The elderly have deficient Qi and Blood; infants have weak Qi and Blood. Fever with abdominal fullness indicates pathogen stagnation and Earth element failure. No sweating indicates blocked exterior Qi; internal damage to Spleen/Stomach by heat causes vomiting and bleeding, signifying collapse of Yuan Qi (Original Qi). Tongue root ulceration indicates heat scorching all three Yin meridians and failure of Zang True Qi. Cough with epistaxis indicates lung injury; lack of sweating or insufficient sweating reflects blockage of Ying-Wei (Nutritive-Defensive) and collaterals, leaving no exit for pathogens. Marrow heat corresponds to the aforementioned condition. Fever with spasms, opisthotonos, convulsions, and trismus results from extreme heat generating wind, tendon-pulse tension, and depletion of Liver-Kidney Yin. All nine syndromes are fatal and unsuitable for acupuncture; thus, herbal medicine is also ineffective.