（《素问·刺热篇》全）
肝热病者，小便先黄，腹痛多卧身热。（肝脉环阴器，故小便黄。抵少腹，故腹痛。肝主筋，筋热则软，故多卧。邪
在厥阴经，则行于股阴腹胁，故身热。按∶前篇《热论》所载者，悉言伤寒；此篇名刺热者，盖即所以治伤寒也。但前
篇分伤寒之六经，此篇详伤寒之五脏，正彼此相为发明耳。观后节之复言两感，概可知矣。凡欲察伤寒之理者，其毋忽
此篇之义及《灵枢·热病篇》治法。详针刺类四十。）热争则狂言及惊，胁满痛，手足躁，不得安卧。（热入于脏，则邪
正相胜故曰争。下同。气争于肝，则肝气乱，故狂言而惊，肝病主惊骇也。肝脉布胁肋，故胁为满痛。热极则生风，风
淫四末，故手足躁扰。木邪乘土，必及于胃，胃不和则卧不安。）庚辛甚，甲乙大汗，气逆则庚辛死。（庚辛属金，肝所
畏也，故甚而死。甲乙属木，肝所王也，故汗而愈。）刺足厥阴、少阳。（少阳为厥阴之表，皆可泻其热邪。）其逆则头痛
员员，脉引冲头也。（肝脉与督脉会于巅，故气逆于上，则头痛员员，脉引冲于头也。员员，靡定貌。）
心热病者，先不乐、数日乃热。（心者神明之所出，邪不易犯，犯必先觉之，故热邪将入于脏，则先有不乐之兆。）
热争则卒心痛，烦闷善呕，头痛面赤，无汗。（热与心气分争，故卒然心痛而烦闷。心火上炎，故善呕。头者精明之府，
手少阴之脉上出于面，故头痛面赤。汗为心液，心热则液亡，故无汗。卒，猝同。）壬癸甚，丙丁大汗，气逆则壬癸死。
（壬癸属水，心所畏也。丙丁属火，心之王也。）刺手少阴、太阳。（手太阳为少阴之表，故皆当刺之。）
脾热病者，先头重颊痛，烦心颜青，欲呕身热。（脾胃相为表里，脾病必及于胃也。阳明胃脉循颊车上耳前，至额颅，
故头重颊痛。脾脉注心中，故烦心。脾病则肝木乘之，故颜上色青。脾胃受邪，则饮食不纳，故欲呕。太阴阳明主肌肉，
故邪盛则身热。）热争则腰痛不可用 仰，腹满泄，两颔痛。（腰者肾之府，热争于脾则土邪乘肾，必注于腰，故为腰痛
不可 仰。太阴之脉入腹属脾络胃，故腹满而泄。阳明脉循颐后下廉出大迎，故两颔痛。 ，俯同。颔，何敢切。）甲乙
甚，戊己大汗，气逆则甲乙死。（甲乙木，脾所畏也。戊己土，脾之王也。）刺足太阴、阳明。（表里俱当取之，以去其热。）
肺热病者，先淅然厥，起毫毛，恶风寒，舌上黄，身热。（肺主皮毛，热则畏寒，故先淅然恶风寒，起毫毛也。肺脉
起于中焦，循胃口，肺热入胃，则胃热上升，故舌上黄而身热。）热争则喘咳，痛走胸膺背，不得太息，头痛不堪，汗出
而寒。（热争于肺，其变动则为喘为咳。肺者胸中之藏，背者胸中之府，故痛走胸膺及背，且不得太息也。喘逆在肺，气
不下行，则三阳俱壅于上，故头痛不堪。热邪在肺，则皮毛不敛，故汗出而寒。）丙丁甚，庚辛大汗，气逆则丙丁死。（丙
丁属火，克肺者也。庚辛属金，肺所王也。）刺手太阴阳明，出血如大豆，立已。（太阴阳明二经表里俱当刺之。出血者，
取其络脉之盛者也。）
肾热病者，先腰痛 ，苦渴数饮，身热。（足少阴之络贯腰脊，故先为腰痛。其脉循内踝之后以上 内，故为 。
又其直者循喉咙挟舌本，邪火耗伤肾水，故苦渴数饮。肾与太阳为表里，太阳之脉从巅下背，抵腰走足，故为身热。
音杭。 音酸。）热争则项痛而强， 寒且 ，足下热，不欲言。（热争在表，则太阳经也。太阳之脉别下项，故项痛而
强。热争在里，则少阴经也。少阴之脉斜走足心，上 内，挟舌本，故为 寒且 ，足热不言等病。）其逆则项痛员员澹
澹然。（员员，义见前。澹澹，精神短少貌。阴虚无气之候也。）戊己甚，壬癸大汗，气逆则戊己死。（戊己土，克肾者也。
壬癸水，肾所王也。）刺足少阴、太阳。（水脏之表里也。）诸汗者，至其所胜日汗出也。（气王之日，即所胜也。王则胜
邪，故汗出而病愈。）
肝热病者，左颊先赤；（此下言面部五脏之色也。肝属木，应在东方，故肝热者，左颊当先赤。）心热病者，颜先赤；
（心属火，其应南方。颜，额也，亦曰庭。）脾热病者，鼻先赤；（脾属土，其应中央，故鼻先赤。）肺热病者，右颊先赤；
（肺属金，其应在西，故右颊先赤。）肾热病者，颐先赤。（肾属水，应在北，故两颐先赤。）病虽未发，见赤色者刺之，
名曰治未病。（病虽未见，而赤色已见于五部，则为病之先兆，当求其脏而预治之，所谓防于未然也。）
热病从部所起者，至期而已；（此下言诸热病，并刺治之法也。从部所起者，至期而已，谓如肝色先见于左颊，至甲
乙日即当汗解之类是也。余脏义同。）其刺之反者，三周而已；（反，谓泻虚补实也。病而反治，其病必甚，其愈反迟。
三周者，谓三遇所胜之日而后已。）重逆则死。（一误者尚待三周，再误者焉得不死？）诸治热病，以饮之寒水乃刺之，
必寒衣之，居止寒处，身寒而止也。（先饮寒水而后刺，欲其阴气自内达表而热泄于外也，故必寒衣寒处，皆欲其避温就
凉耳。）热病先胸胁痛，手足躁，刺足少阳，补足太阴，（足少阳之脉下胸中，循胁里，故为胸胁痛。脾主四肢而甲木乘
之，则风淫末疾，故手足躁扰。木强土弱，所以当泻足少阳之实，补足太阴之虚。王氏注曰∶胸胁痛，丘墟主之。补足
太阴之脉，当于井荥取也。）病甚者为五十九刺。（五十九刺，义详针刺类三十九、四十。）热病始手臂痛者，刺手阳明太
阴而汗出止。（王氏曰∶手臂痛，列缺主之。列缺者，手太阴之络也。欲汗出，商阳主之。商阳者，手阳明之井也。）热
病始于头首者，刺项太阳而汗出止。（王氏曰∶天柱主之。）热病始于足胫者，刺足阳明而汗出止。（按∶《寒热病篇》曰∶
足阳明可汗出。当是内庭、陷谷二穴。详义见针刺类五十四。）热病先身重骨痛耳聋，好瞑，刺足少阴，病甚为五十九刺。
（肾主骨，在窍为耳，热邪居之，故为身重骨痛耳聋。热伤真阴，则志气昏倦，故好瞑。仲景曰∶少阴之为病，但欲寐
也。义与此同。刺足少阴者，如王氏曰∶据经无正主穴，当补泻井荥耳。若其病甚，则当用五十九刺如前。）热病先眩冒
而热，胸胁满，刺足少阴少阳。（头脑运转曰眩，脑者骨之充也，眼目蒙昧曰冒，瞳子者骨之精也，皆主于肾。又足少阳
之脉起目锐 ，循胁里，皆为此证。故当取足少阴少阳而刺之。王氏曰∶亦井荥也。）
太阳之脉，色荣颧骨，热病也。（此下言两感之脉色死期也。荣，发见也。太阳之脉起于目内 ，太阳之筋下结于 ，
故太阳热病者，赤色当荣于颧骨。）荣未交，曰今且得汗，待时而已。（此荣字与上节之荣不同，盖指营卫为言。按∶《平
人气象论》、《疟论》、《痹论》俱作荣，盖古所通用也。荣未交者，谓邪犹在卫，未交于荣，其气不深，故曰今且得汗，
可待时而已也。如肝待甲乙，心待丙丁，脾待戊己，肺待庚辛，肾待壬癸，病必已矣。）与厥阴脉争见者，死期不过三日。
（脉义有二∶以寸口之脉言，则太阳之脉浮，厥阴之脉弦而细；以经脉之病言，则太阳为头项痛、腰脊强，厥阴为烦满
而囊缩，今以太阳热病，与厥阴脉证争见者，阴阳俱病，当不过三日而死矣。何也？盖此言两感之邪也。按《热论篇》
曰∶两感于寒者，一日则巨阳、少阴俱病，二日则阳明、太阴俱病，三日则少阳、厥阴俱病。故六经热病之序，其始太
阳，其终厥阴。今终始争见，则六经两感俱已传遍，故当三日而死，证之下文，义尤明显。）其热病内连肾，少阳之脉色
也。（此承上文而详言两感也。上文言太阳热病，兼见厥阴之脉证，此言肾经热病，兼见少阳之脉色，皆两感也。盖太阳
与少阴为表里，少阳与厥阴为表里，以太阳而见厥阴，则未有不由少阴者，以肾病而见少阳，则未有不至厥阴者。详如
下文。）少阳之脉色，荣颊前，热病也。（足少阳之脉下颊车，故其热病，赤色当荣于颊前。）荣未交，曰今且得汗，待时
而已。（义如前。）与少阴脉争见者，死期不过三日。（少阳之脉弦，少阴之脉沉而微；少阳之证为胸胁痛而耳聋，少阴之
证为口燥舌干而渴。今以少阳热病而与少阴脉证争见者，亦当三日而死，皆两感传遍也。如上文言太阳厥阴争见者，太
阳为传表之始，厥阴为传里之终，自始而终也。此以少阳少阴争见者，少阳为传表之终，少阴为传里之始，自终而始也。
言始言终，则六经无不遍矣，故不必言阳明太阴之争见也。）
热病气穴∶三椎下间主胸中热，四椎下间主膈中热，五椎下间主肝热，六椎下间主脾热，七椎下间主肾热，荣在
也。（此总言治热之脏俞也。椎，脊骨节也。荣，阴气也。 ，尾 也，即督脉之长强穴。凡五脏俞旁之穴，三椎下者魄
户也，四椎下旁膏肓也，五椎下旁神堂也，六椎下旁 也，七椎下旁膈关也。盖既取阳邪于上，仍当补阴于下，故曰
荣在 也。按∶本节诸椎皆不合脏俞，而云主疗，义本难明，故王氏但曰未详。或以中行督脉之穴为言，尤无所据。考
之《水热穴论》云∶五脏俞旁五，此十者，以泻五脏之热也。盖指魄户、神堂等五穴为言。虽与本节椎穴未皆尽合，然
泻藏热之法必不外此，故引以为注，义详针刺类三十九，惟明者再正之。椎音槌。 音底。）项上三椎，陷者中也。（此
取脊椎之大法也。项上三椎者，乃项骨三节，非脊椎也。三椎之下陷者中，方是第一节，穴名大椎，由此而下数之，则
诸椎循次可得矣。）
颊下逆颧为大瘕，下牙车为腹满，颧后为胁痛，颊上者膈上也。（此以面部之色，察腹中之病也，然义莫详于五色篇，
见脉色类三十二。瘕，加、驾二音。）
（《素问·刺热篇》全文）
肝脏发生热病时，小便先变黄，腹痛，嗜睡，身体发热。（肝经脉络环绕生殖器，所以小便发黄。抵少腹部，所以腹痛。肝主筋，筋受热则松弛无力，所以多卧。邪气在厥阴经，循行于大腿内侧、腹部和胁肋部，所以身体发热。按：前一篇《热论》所述的都是伤寒；这一篇名为《刺热》，大概就是用针刺来治疗伤寒的方法。但前一篇将伤寒分为六经，这一篇详细论述了伤寒对五脏的影响，正是彼此互相阐明的关系。看后文再次提到“两感”，就可以知道了。凡是想要探究伤寒机理的人，不要忽视本篇的意义以及《灵枢·热病篇》的治法。详见针刺类第四十。）热邪与正气相争时，就会出现胡言乱语和惊骇，胁肋胀满疼痛，手足躁动不安，无法安稳躺卧。（热邪侵入脏腑，邪正相互斗争，所以称为“争”。以下同此意。气机在肝脏发生争斗，导致肝气紊乱，所以出现胡言乱语和惊骇，肝病主要表现为惊骇。肝经分布于胁肋，所以胁肋胀满疼痛。热极生风，风邪扰乱四肢末端，所以手足躁扰。木邪克制脾土，必然波及胃腑，胃不和则卧不安。）逢庚辛日病情加重，逢甲乙日大汗出而愈，若气机上逆则逢庚辛日死亡。（庚辛属金，是肝所畏惧的五行，所以病情加重甚至死亡。甲乙属木，是肝所旺盛的五行，所以大汗出而痊愈。）针刺足厥阴肝经和足少阳胆经。（少阳为厥阴之表，都可以泻除其热邪。）如果气机上逆，则出现头晕目眩的头痛，因为经脉之气上冲头部。（肝脉与督脉交会于头顶，所以气逆于上，则出现头晕目眩的头痛，经脉之气上冲头部。“员员”，形容不定貌。）
心脏发生热病时，先感到心情不愉快，几天后才发热。（心是神明发出的地方，邪气不易侵犯，一旦侵犯必先有感觉，所以当热邪将要进入脏腑时，先有不愉快的征兆。）热邪与正气相争时，突然心痛，烦闷，容易呕吐，头痛面赤，无汗。（热邪与心气分争，所以突然心痛且烦闷。心火上炎，所以容易呕吐。头是精明之府，手少阴心经上行出于面部，所以头痛面赤。汗为心之液，心热则津液耗伤，所以无汗。“卒”通“猝”。）逢壬癸日病情加重，逢丙丁日大汗出而愈，若气机上逆则逢壬癸日死亡。（壬癸属水，是心所畏惧的五行。丙丁属火，是心所旺盛的五行。）针刺手少阴心经和手太阳小肠经。（手太阳为手少阴之表，所以都应当针刺。）
脾脏发生热病时，先感到头重、脸颊痛，心烦，面色发青，想呕吐，身体发热。（脾胃互为表里，脾病必然波及胃。阳明胃经循行经过颊车穴向上至耳前，到达额颅，所以头重颊痛。脾经注入心中，所以心烦。脾病则肝木乘虚侵袭，所以面色发青。脾胃受邪，则饮食不能纳受，所以想呕吐。太阴和阳明主管肌肉，所以邪气盛则身体发热。）热邪与正气相争时，腰痛不能仰卧，腹部胀满腹泻，两侧下颌疼痛。（腰是肾之府，热邪在脾争斗则土邪乘袭肾脏，必然注于腰部，所以腰痛不能仰卧。太阴脾经入腹属脾络胃，所以腹部胀满而泄泻。阳明胃经循行经过下颌后方下行经过大迎穴，所以两侧下颌疼痛。“ ”同“俯”。“颔”，音何敢切。）逢甲乙日病情加重，逢戊己日大汗出而愈，若气机上逆则逢甲乙日死亡。（甲乙属木，是脾所畏惧的五行。戊己属土，是脾所旺盛的五行。）针刺足太阴脾经和足阳明胃经。（表里两经都应当取穴，以去除热邪。）
肺脏发生热病时，先感到寒冷战栗，毫毛竖起，恶风寒，舌苔发黄，身体发热。（肺主皮毛，热则畏寒，所以先感到寒冷战栗，毫毛竖起。肺经起于中焦，循行胃口，肺热传入胃，则胃热上升，所以舌苔发黄而身体发热。）热邪与正气相争时，气喘咳嗽，疼痛游走于胸膺背部，不能深吸气，头痛剧烈，出汗后怕冷。（热邪在肺争斗，其变化则为喘为咳。肺是胸中之藏，背是胸中之府，所以疼痛游走于胸膺及背部，且不能深吸气。喘逆在肺，气不下行，则三阳经气俱壅滞于上，所以头痛剧烈。热邪在肺，则皮毛不收敛，所以出汗后怕冷。）逢丙丁日病情加重，逢庚辛日大汗出而愈，若气机上逆则逢丙丁日死亡。（丙丁属火，是克制肺的五行。庚辛属金，是肺所旺盛的五行。）针刺手太阴肺经和手阳明大肠经，放出如大豆大小的血，病立刻停止。（太阴和阳明二经表里都应当针刺。出血，是取其络脉气血旺盛之处。）
肾脏发生热病时，先腰痛，口渴想多次饮水，身体发热。（足少阴肾经的络脉贯穿腰脊，所以先出现腰痛。其经脉循行内踝之后向上至腘窝内侧，所以出现腘窝酸痛。又其直行者循喉咙夹舌根，邪火耗伤肾水，所以口渴想多次饮水。肾与膀胱互为表里，太阳膀胱经从头顶下背部，抵腰部走足，所以身体发热。“ ”音杭。“ ”音酸。）热邪与正气相争时，项部疼痛且僵硬，时而发冷时而发热，足底发热，不想说话。（热邪在表争斗，则是太阳经病变。太阳经别下项，所以项痛且僵硬。热邪在里争斗，则是少阴经病变。少阴经斜行走向足心，上行至腘窝内侧，夹舌根，所以出现时而发冷时而发热、足热不想说话等病症。）如果气机上逆，则项部疼痛头晕，心神恍惚。（“员员”，意义见前文。“澹澹”，精神短少的样子。这是阴虚无气的征象。）逢戊己日病情加重，逢壬癸日大汗出而愈，若气机上逆则逢戊己日死亡。（戊己属土，是克制肾的五行。壬癸属水，是肾所旺盛的五行。）针刺足少阴肾经和足太阳膀胱经。（这是水脏的表里经。）所有出汗的情况，都是在其所胜之日出汗。（气旺之日，就是所胜之日。旺则胜邪，所以出汗而病愈。）
肝脏热病的人，左脸颊先发红；（下文讲述面部五脏对应的颜色。肝属木，对应东方，所以肝热者，左脸颊应当先发赤。）心脏热病的人，额头先发红；（心属火，对应南方。颜，指额头，也称庭。）脾脏热病的人，鼻子先发红；（脾属土，对应中央，所以鼻子先发赤。）肺脏热病的人，右脸颊先发红；（肺属金，对应西方，所以右脸颊先发赤。）肾脏热病的人，下巴先发红。（肾属水，对应北方，所以两侧下巴先发赤。）病虽然尚未发作，但见到红色者就进行针刺，这叫做“治未病”。（病虽然未见症状，但红色已见于五部，则是病的先兆，应当寻找所属脏腑预先治疗，这就是所谓防患于未然。）
热病从面部相应部位开始发展的，到相应的日期就会痊愈；（下文讲述各种热病并针刺治疗的方法。从相应部位开始发展，到相应日期痊愈，比如肝色先见于左颊，到甲乙日就应该汗解之类。其余脏腑的道理相同。）如果针刺方法相反，则需要三个周期才能痊愈；（“反”，指泻虚补实。病证反而被误治，病情必然加重，痊愈反而延迟。“三周”，指三次遇到所胜之日后才痊愈。）严重误治则会死亡。（一次误治尚需等待三个周期，再次误治怎能不死？）所有治疗热病的方法，是先让患者喝冷水然后再针刺，必须穿凉衣服，居住在凉爽的地方，直到身体变凉为止。（先喝冷水再针刺，是想让阴气从内部达于体表从而使热邪外泄，所以必须穿凉衣住凉处，都是为了避开温热趋向凉爽。）热病先出现胸胁痛，手足躁动，针刺足少阳胆经，补足太阴脾经；（足少阳胆经下行穿过胸中，循行胁肋内部，所以出现胸胁痛。脾主四肢，甲木乘袭脾土，则风邪扰乱四肢末端，所以手足躁扰。木强土弱，所以应当泻足少阳胆经的实证，补足太阴脾经的虚证。王冰注曰：胸胁痛，丘墟穴主治。补足太阴脾经，应当在井穴、荥穴取穴。）病情严重的采用“五十九刺”法。（“五十九刺”，意义详见针刺类第三十九、四十。）热病始于手臂痛的，针刺手阳明大肠经和手太阴肺经，出汗即止。（王冰注曰：手臂痛，列缺穴主治。列缺是手太阴肺经的络穴。欲使出汗，商阳穴主治。商阳是手阳明大肠经的井穴。）热病始于头首部的，针刺项部太阳经穴位，出汗即止。（王冰注曰：天柱穴主治。）热病始于足胫部的，针刺足阳明胃经，出汗即止。（按：《寒热病篇》说：足阳明经可发汗。应当是内庭、陷谷二穴。详细意义见针刺类第五十四。）热病先出现身体沉重、骨痛、耳聋、喜欢闭眼睡觉的，针刺足少阴肾经，病情严重的采用“五十九刺”法。（肾主骨，开窍于耳，热邪占据其中，所以出现身体沉重、骨痛、耳聋。热邪损伤真阴，则志气昏倦，所以喜欢闭眼睡觉。张仲景说：少阴病的特征是只想睡觉。道理与此相同。针刺足少阴肾经，如王冰注曰：根据经脉没有特定的主穴，应当在井穴、荥穴进行补泻。如果病情严重，则应当使用前文的“五十九刺”法。）热病先出现眩晕发热，胸胁满闷的，针刺足少阴肾经和足少阳胆经。（头脑运转不清称为眩，脑是骨髓充养之处；眼睛蒙昧不清称为冒，瞳孔是骨髓的精气所在，这些都由肾主宰。又足少阳胆经起于目锐眦，循行胁肋内部，都是这些证候的原因。所以应当取足少阴和足少阳经进行针刺。王冰注曰：也是取井穴、荥穴。）
太阳经的脉色反映在颧骨上，是热病。（下文讲述两感证的脉色和死期。“荣”，显现的意思。太阳经起于目内眦，太阳经筋向下结于 ，所以太阳热病患者，红色应当显现于颧骨。）如果营卫之气尚未交争，说今天可以得到汗解，等待相应的日期即可痊愈。（此处的“荣”字与上一节的“荣”不同，这里指营卫之气。按：《平人气象论》、《疟论》、《痹论》中都写作“荣”，大概是古时候通用的写法。“荣未交”，指邪气还在卫分，未进入营分，其气不深，所以说今天可以得到汗解，可以等待相应的日期痊愈。比如肝病待甲乙日，心病待丙丁日，脾病待戊己日，肺病待庚辛日，肾病待壬癸日，病必定痊愈。）如果与厥阴经的脉证同时出现，死期不超过三天。（脉义有两种解释：从寸口脉来说，太阳脉浮，厥阴脉弦而细；从经脉病症来说，太阳经病症是头项痛、腰脊强直，厥阴经病症是烦满和囊缩。现在太阳热病与厥阴脉证同时出现，阴阳俱病，应当不超过三天死亡。为什么呢？因为这说的是两感证。按《热论篇》说：两感于寒，第一天巨阳、少阴俱病，第二天阳明、太阴俱病，第三天少阳、厥阴俱病。所以六经热病的顺序，起始于太阳，终结于厥阴。现在终始同时出现，说明六经两感已经传遍，所以应当三天死亡，证候在下文中，意义更加明显。）热病内连肾脏，兼见少阳经的脉色。（这是承接上文详细讲述两感证。上文讲太阳热病兼见厥阴脉证，这里讲肾经热病兼见少阳脉色，都是两感证。盖因太阳与少阴为表里，少阳与厥阴为表里，以太阳见厥阴，则未有不由少阴引起的；以肾病见少阳，则未有不至厥阴的。详细见下文。）少阳经的脉色，显现于脸颊前方，是热病。（足少阳胆经下行经过颊车穴，所以其热病，红色应当显现于脸颊前方。）如果营卫之气尚未交争，说今天可以得到汗解，等待相应的日期即可痊愈。（道理同上。）如果与少阴经的脉证同时出现，死期不超过三天。（少阳脉弦，少阴脉沉而微；少阳经病症为胸胁痛和耳聋，少阴经病症为口燥舌干而渴。现在少阳热病与少阴脉证同时出现，也应当三天死亡，都是两感传遍的缘故。如上文言太阳厥阴争见，太阳为传表的开始，厥阴为传里的终结，自始而终。这里以少阳少阴争见，少阳为传表的终结，少阴为传里的开始，自终而始。言始言终，则六经无不传遍，所以不必再说阳明太阴争见的情形。）
热病的腧穴：第三椎下间隙主治胸中热，第四椎下间隙主治膈中热，第五椎下间隙主治肝热，第六椎下间隙主治脾热，第七椎下间隙主治肾热，阴气汇聚于 穴。（这里总述治疗五脏热的俞穴。“椎”，脊骨节。“荣”，阴气。“ ”，尾骶骨，即督脉的长强穴。凡五脏俞旁之穴，第三椎下旁是魄户，第四椎下旁是膏肓，第五椎下旁是神堂，第六椎下旁是 ，第七椎下旁是膈关。既然在上部取阳邪，仍应当在下部补阴，所以说阴气汇聚于 穴。按：本节所述的各椎穴与脏俞不完全吻合，且称主治，意义原本难以明白，所以王冰只说未详。有人以中行督脉之穴来解释，更无依据。考证《水热穴论》说：五脏俞旁五，这十个穴位，用来泻五脏之热。大概是指魄户、神堂等五个穴位。虽然与本节的椎穴不完全一致，但泻脏热的方法必然不出于此，所以引用作为注释，意义详见针刺类第三十九，只有明理者再行校正。“椎”音槌。“ ”音底。）项部上方第三椎，凹陷处即是。（这是选取脊椎的大法。项部上方第三椎，是指颈部骨骼三节，不是脊椎。第三椎之下的凹陷正中，才是第一节，穴名大椎，由此向下数，则诸椎依次可得。）
下巴下方逆行至颧骨为大瘕，下行至牙车为腹满，颧骨后方为胁痛，脸颊上方为膈上部。（这是通过面部色泽来察知腹中疾病，然而意义最详尽的见于五色篇，见脉色类第三十二。“瘕”，音加、驾二音。）
(Full text of "Ci Re Pian" from *Suwen*)
When the Liver suffers from Heat Disease, urination turns yellow first, accompanied by abdominal pain, excessive sleeping, and fever. (The Liver meridian circles the genitalia, hence the yellow urine. It reaches the lower abdomen, hence the abdominal pain. The Liver governs the sinews; when sinews are heated they become soft, hence the desire to lie down. When pathogenic factors are in the Jueyin Meridian, they travel along the medial thigh, abdomen, and hypochondrium, hence the fever. Note: The previous chapter "Re Lun" discusses all aspects of Cold Damage; this chapter titled "Ci Re" (Puncturing Heat) is essentially about treating Cold Damage with acupuncture. However, while the previous chapter divides Cold Damage into the Six Channels, this chapter details the impact of Cold Damage on the Five Zang organs, mutually illuminating each other. Observing the subsequent section reiterating "Liang Gan" (Double Exposure), this can be understood. Those wishing to examine the principles of Cold Damage should not neglect the meaning of this chapter and the treatment methods in "Ling Shu: Re Bing Pian". See Acupuncture Category 40.) When heat contends with healthy qi, delirious speech and fright occur, along with fullness and pain in the hypochondrium, restlessness of the hands and feet, and inability to lie down peacefully. (Heat entering the Zang organs causes a struggle between pathogenic and healthy qi, hence termed "contending". Same below. Qi contending in the Liver causes Liver Qi to become chaotic, hence delirium and fright, as Liver disease primarily manifests as fright and alarm. The Liver meridian distributes to the hypochondrium and ribs, hence fullness and pain there. Extreme heat generates wind; wind disorder affects the four extremities, hence restlessness of hands and feet. Wood pathogen overcoming Earth inevitably affects the Stomach; if the Stomach is disharmonious, sleep is disturbed.) On Geng-Xin days (Metal days), the condition worsens; on Jia-Yi days (Wood days), profuse sweating occurs and the patient recovers. If Qi rebels upward, death occurs on Geng-Xin days. (Geng-Xin belong to Metal, which the Liver fears, hence worsening or death. Jia-Yi belong to Wood, which the Liver prospers in, hence recovery through sweating.) Puncture the Foot Jueyin (Liver) and Foot Shaoyang (Gallbladder) meridians. (Shaoyang is the exterior counterpart to Jueyin; both can be punctured to drain heat pathogen.) If Qi rebels upward, it causes dizziness and headache, as the meridian Qi rushes to the head. (The Liver meridian meets the Du Meridian at the vertex; thus, rebellious Qi upwards causes dizzy headaches, as meridian Qi rushes to the head. "Yuan Yuan" describes an indeterminate or swirling sensation.)
When the Heart suffers from Heat Disease, one first feels unhappy; fever appears after several days. (The Heart is the residence of Shen (Spirit); pathogens do not easily invade. If they do, signs appear first. Thus, when heat pathogen is about to enter the Zang, there is a precursor sign of unhappiness.) When heat contends with healthy qi, sudden heart pain, vexation, frequent vomiting, headache, red face, and absence of sweat occur. (Heat contends with Heart Qi, causing sudden heart pain and vexation. Heart Fire flares upward, causing frequent vomiting. The head is the mansion of clarity; the Hand Shaoyin (Heart) meridian ascends to emerge on the face, hence headache and red face. Sweat is the fluid of the Heart; Heart heat consumes fluids, hence no sweat. "Cu" is synonymous with "Cu" (sudden).) On Ren-Gui days (Water days), the condition worsens; on Bing-Ding days (Fire days), profuse sweating occurs and the patient recovers. If Qi rebels upward, death occurs on Ren-Gui days. (Ren-Gui belong to Water, which the Heart fears. Bing-Ding belong to Fire, which the Heart prospers in.) Puncture the Hand Shaoyin (Heart) and Hand Taiyang (Small Intestine) meridians. (Hand Taiyang is the exterior counterpart to Hand Shaoyin, so both should be punctured.)
When the Spleen suffers from Heat Disease, one first feels heavy head and cheek pain, heart vexation, bluish complexion on the forehead, desire to vomit, and fever. (Spleen and Stomach are interior-exterior pairs; Spleen disease inevitably affects the Stomach. The Yangming Stomach meridian follows the Jiache acupoint up to the ear front and reaches the forehead, hence heavy head and cheek pain. The Spleen meridian injects into the Heart, hence heart vexation. In Spleen disease, Liver Wood overcomes it, hence bluish color on the forehead. When Spleen and Stomach receive pathogens, food intake is rejected, hence desire to vomit. Taiyin and Yangming govern muscles; thus, excess pathogen causes fever.) When heat contends with healthy qi, lower back pain prevents lying on the back, abdominal fullness and diarrhea, and pain in both mandibles occur. (The waist is the mansion of the Kidney; heat contending in the Spleen allows Earth pathogen to overcome Kidney, focusing on the waist, hence lower back pain preventing extension. The Taiyin meridian enters the abdomen, belongs to the Spleen, and connects to the Stomach, hence abdominal fullness and diarrhea. The Yangming meridian follows behind the chin, exits at Daying, hence pain in both mandibles. " " is synonymous with "Fu" (bend). "Han" is pronounced He-gan.) On Jia-Yi days (Wood days), the condition worsens; on Wu-Ji days (Earth days), profuse sweating occurs and the patient recovers. If Qi rebels upward, death occurs on Jia-Yi days. (Jia-Yi belong to Wood, which the Spleen fears. Wu-Ji belong to Earth, which the Spleen prospers in.) Puncture the Foot Taiyin (Spleen) and Foot Yangming (Stomach) meridians. (Both interior and exterior meridians should be selected to remove heat.)
When the Lung suffers from Heat Disease, one first experiences shivering, erection of body hair, aversion to wind and cold, yellow tongue coating, and fever. (The Lung governs skin and hair; heat causes aversion to cold, hence initial shivering and erecting of hair. The Lung meridian originates in the Middle Jiao, follows the stomach opening; Lung heat entering the Stomach causes Stomach heat to rise, hence yellow tongue coating and fever.) When heat contends with healthy qi, wheezing and coughing occur, pain radiates to the chest, epigastrium, and back, inability to take deep breaths, unbearable headache, sweating followed by chills. (Heat contending in the Lung changes into wheezing and coughing. The Lung is the Zang within the chest; the back is the mansion within the chest, hence pain radiating to the chest/epigastrium and back, and inability to breathe deeply. Wheezing rebellion in the Lung prevents Qi from descending, causing all Three Yang meridians to stagnate above, hence unbearable headache. Heat pathogen in the Lung fails to consolidate the skin and hair, hence sweating followed by chills.) On Bing-Ding days (Fire days), the condition worsens; on Geng-Xin days (Metal days), profuse sweating occurs and the patient recovers. If Qi rebels upward, death occurs on Bing-Ding days. (Bing-Ding belong to Fire, which controls the Lung. Geng-Xin belong to Metal, which the Lung prospers in.) Puncture the Hand Taiyin (Lung) and Hand Yangming (Large Intestine) meridians, releasing blood the size of soybeans; the illness stops immediately. (Both Taiyin and Yangming interior-exterior meridians should be punctured. Releasing blood targets the abundant collateral vessels.)
When the Kidney suffers from Heat Disease, one first experiences lower back pain, bitter thirst with frequent drinking, and fever. (The collateral of the Foot Shaoyin (Kidney) meridian passes through the lumbar spine, hence initial lower back pain. Its main channel ascends behind the medial malleolus to the popliteal fossa, hence soreness in that area. Its straight branch follows the throat and clamps the root of the tongue; evil fire consumes Kidney Water, hence bitter thirst and frequent drinking. The Kidney and Bladder are interior-exterior; the Taiyang Bladder meridian descends from the vertex over the back, reaches the waist, and goes to the foot, hence fever. " " is pronounced Hang. " " is pronounced Suan.) When heat contends with healthy qi, neck pain and stiffness, alternating chills and fever, hot soles, and reluctance to speak occur. (Heat contending on the exterior involves the Taiyang meridian. The Taiyang branch descends to the neck, hence neck pain and stiffness. Heat contending on the interior involves the Shaoyin meridian. The Shaoyin meridian斜行 (diagonally) walks to the sole of the foot, ascends to the popliteal fossa, and clamps the root of the tongue, hence symptoms like alternating chills/fever, hot soles, and reluctance to speak.) If Qi rebels upward, it causes neck pain, dizziness, and mental agitation. ("Yuan Yuan", see previous definition. "Dan Dan", appearance of shortness of spirit. This is a sign of Yin deficiency and lack of Qi.) On Wu-Ji days (Earth days), the condition worsens; on Ren-Gui days (Water days), profuse sweating occurs and the patient recovers. If Qi rebels upward, death occurs on Wu-Ji days. (Wu-Ji belong to Earth, which controls the Kidney. Ren-Gui belong to Water, which the Kidney prospers in.) Puncture the Foot Shaoyin (Kidney) and Foot Taiyang (Bladder) meridians. (These are the interior-exterior pair of the Water Zang.) All cases of sweating occur on the day the pathogen is overcome (the day of the controlling element). (On the day Qi prospers, it overcomes the pathogen, hence sweating leads to recovery.)
In Liver Heat Disease, the left cheek reddens first; (The following describes the colors of the Five Zang on the face. Liver belongs to Wood, corresponding to the East; thus, in Liver heat, the left cheek reddens first.) In Heart Heat Disease, the forehead reddens first; (Heart belongs to Fire, corresponding to the South. Yan refers to the forehead, also called Ting.) In Spleen Heat Disease, the nose reddens first; (Spleen belongs to Earth, corresponding to the Center; thus, the nose reddens first.) In Lung Heat Disease, the right cheek reddens first; (Lung belongs to Metal, corresponding to the West; thus, the right cheek reddens first.) In Kidney Heat Disease, the chin reddens first. (Kidney belongs to Water, corresponding to the North; thus, both sides of the chin redden first.) Even if the disease has not yet manifested clinically, puncture upon seeing redness; this is called "Treating Before Disease Occurs" (Zhi Wei Bing). (Although symptoms are absent, if redness appears in the five facial zones, it is a precursor of disease. One should identify the affected Zang and treat preemptively, i.e., prevent before it happens.)
Heat diseases originating from specific facial zones resolve by their corresponding time; (The following discusses treatment methods for various heat diseases. Originating from specific zones means resolution by the corresponding time, e.g., Liver color appearing on the left cheek resolves by Jia-Yi days via sweating. The principle applies to other Zang organs similarly.) If the puncture method is contrary (incorrect), recovery takes three cycles. ("Fan" refers to tonifying deficiency and draining excess incorrectly. Treating contrary to the syndrome worsens the disease and delays recovery. "Three cycles" means waiting for three occurrences of the overcoming day before recovery.) Severe contraindication leads to death. (One error requires waiting three cycles; repeated errors lead inevitably to death.) For all treatments of Heat Disease, have the patient drink cold water before puncturing; dress them in cool clothing, keep them in cool places, until the body cools down. (Drinking cold water before puncturing aims to bring Yin Qi from inside to the exterior to vent heat; thus, cool clothing and environment are used to avoid warmth and seek coolness.) If Heat Disease begins with chest/hypochondriac pain and restlessness of hands/feet, puncture Foot Shaoyang (Gallbladder) and tonify Foot Taiyin (Spleen). (Foot Shaoyang meridian descends through the chest and follows the hypochondrium, hence pain. Spleen governs the four limbs; when Jia Wood overcomes it, Wind disorder affects the extremities, hence restlessness. Wood is strong and Earth is weak, so drain the excess of Foot Shaoyang and tonify the deficiency of Foot Taiyin. Wang Bing notes: For chest/hypochondriac pain, Qiuxu is indicated. To tonify Foot Taiyin, select Jing-River and Ying-Spring points.) For severe cases, use the "Fifty-Nine Points" method. ("Fifty-Nine Points", see Acupuncture Categories 39-40.) If Heat Disease begins with arm/hand pain, puncture Hand Yangming (Large Intestine) and Hand Taiyin (Lung) to induce sweating and stop the pain. (Wang Bing notes: For arm/hand pain, Lieque is indicated. Lieque is the Luo-Connecting point of Hand Taiyin. To induce sweating, Shangyang is indicated. Shangyang is the Jing-Well point of Hand Yangming.) If Heat Disease begins with head/neck pain, puncture Taiyang points in the neck to induce sweating and stop the pain. (Wang Bing notes: Tianzhu is indicated.) If Heat Disease begins with leg/shin pain, puncture Foot Yangming (Stomach) to induce sweating and stop the pain. (Note: "Han Re Bing Pian" states Foot Yangming can induce sweating. These are likely Neiting and Xian Gu points. See Acupuncture Category 54.) If Heat Disease begins with heaviness, bone pain, deafness, and somnolence, puncture Foot Shaoyin (Kidney); for severe cases, use the "Fifty-Nine Points" method. (Kidney governs bones and opens into the ears; heat pathogen occupying these causes heaviness, bone pain, and deafness. Heat damages True Yin, causing mental fatigue, hence somnolence. Zhang Zhongjing states: The hallmark of Shaoyin disease is desire to sleep. The meaning is identical here. Regarding puncturing Foot Shaoyin, Wang Bing notes: There is no single primary acupoint on the meridian; use Jing-River points with tonification or reduction. If severe, use the aforementioned Fifty-Nine Points.) If Heat Disease begins with vertigo/dizziness and fever, and chest/hypochondriac fullness, puncture Foot Shaoyin (Kidney) and Foot Shaoyang (Gallbladder). (Vertigo involves spinning of the head; the brain is filled by marrow. Dazzlement involves cloudy vision; the pupil is the essence of bone. Both are governed by the Kidney. Additionally, Foot Shaoyang meridian originates at the outer canthus and follows the hypochondrium, causing these symptoms. Hence, puncture Foot Shaoyin and Shaoyang. Wang Bing notes: Also use Jing-River points.)
When the Taiyang meridian's color manifests on the zygomatic bone, it is a Heat Disease. (The following discusses pulse/color prognoses for Liang Gan [Double Exposure]. "Rong" means manifestation. The Taiyang meridian originates at the inner canthus; its sinews descend to connect at the perineum. Thus, in Taiyang Heat Disease, redness manifests on the zygomatic bone.) If Ying and Wei Qi have not yet intermingled, it says "sweat may be obtained today, wait for the time to recover." (This "Rong" differs from the previous section; it refers to Ying and Wei Qi. Note: "Ping Ren Qi Xiang Lun", "Nu Lun", and "Bi Lun" all write "Rong", indicating ancient usage. "Rong Wei Jiao" means pathogen is still in the Wei level, not yet entered Ying level; its Qi is shallow, hence sweat may be obtained today, waiting for the corresponding day to recover. E.g., Liver waits for Jia-Yi, Heart for Bing-Ding, Spleen for Wu-Ji, Lung for Geng-Xin, Kidney for Ren-Gui; the disease will surely resolve.) If it contends with Jueyin merpulse/symptoms, death occurs within three days. (There are two interpretations of pulse: From Cun Kou pulse perspective, Taiyang pulse is floating, Jueyin is wiry and fine; from meridian disease perspective, Taiyang presents with headache/stiff neck and stiff spine, Jueyin with vexation/fullness and retracted testicles. Now, Taiyang Heat Disease contending with Jueyin pulse/symptoms indicates both Yin and Yang are diseased, leading to death within three days. Why? This refers to Liang Gan (Double Exposure). As stated in "Re Lun": Double exposure to Cold on Day 1 affects Juyang and Shaoyin; Day 2, Yangming and Taiyin; Day 3, Shaoyang and Jueyin. Thus, the sequence of Six Channel Heat Disease starts with Taiyang and ends with Jueyin. Now, start and end contend simultaneously, meaning all Six Channels of Liang Gan have transmitted, hence death in three days. The meaning is even clearer in the subsequent text.) If Heat Disease internally connects to the Kidney, and Shaoyang meridian color is present. (This continues detailing Liang Gan. Previous text discussed Taiyang Heat Disease with Jueyin pulse/symptoms; this discusses Kidney meridian Heat Disease with Shaoyang pulse/color, both being Liang Gan. Since Taiyang and Shaoyin are interior-exterior, and Shaoyang and Jueyin are interior-exterior, seeing Jueyin with Taiyang implies Shaoyin involvement; seeing Shaoyang with Kidney disease implies Jueyin involvement. See detailed explanation below.) Shaoyang meridian color manifesting on the front of the cheek is Heat Disease. (Foot Shaoyang meridian descends to Jiache; thus, in its Heat Disease, redness manifests on the front of the cheek.) If Ying and Wei Qi have not yet intermingled, it says "sweat may be obtained today, wait for the time to recover." (Meaning as above.) If it contends with Shaoyin merpulse/symptoms, death occurs within three days. (Shaoyang pulse is wiry; Shaoyin is deep and faint. Shaoyang symptoms include chest/hypochondriac pain and deafness; Shaoyin symptoms include dry mouth/tongue and thirst. Now, Shaoyang Heat Disease contending with Shaoyin pulse/symptoms also leads to death in three days, as all Liang Gan transmissions are complete. As mentioned earlier regarding Taiyang/Jueyin contention, Taiyang is the start of transmitting to the exterior, Jueyin is the end of transmitting to the interior, from start to finish. Here, Shaoyang/Shaoyin contention, Shaoyang is the end of transmitting to the exterior, Shaoyin is the start of transmitting to the interior, from finish to start. Speaking of start and finish covers all Six Channels, hence no need to mention Yangming/Taiyin contention.)
Acupoints for Heat Disease: The space below the 3rd vertebra treats Chest Heat; below the 4th vertebra treats Diaphragm Heat; below the 5th vertebra treats Liver Heat; below the 6th vertebra treats Spleen Heat; below the 7th vertebra treats Kidney Heat; Ying (Yin Qi) resides at Changqiang. (This summarizes the Shu points for treating Heat in the Zang. "Zhui" refers to vertebral segments. "Rong" refers to Yin Qi. " " refers to the coccyx, specifically Changqiang of the Du Meridian. The acupoints beside the Five Zang Shu points are: below 3rd vertebra side is Pohu, below 4th is Gaohuang, below 5th is Shentang, below 6th is , below 7th is Ge Guan. Since Yang pathogen is taken from above, Yin must be tonified from below, hence "Yin Qi resides at ". Note: The vertebrae mentioned here do not perfectly align with Zang Shu points, and claiming they treat makes the meaning obscure, so Wang Bing simply said "unknown". Some interpret them as midline Du Meridian points, which lacks basis. Examining "Shui Re Xue Lun": "Five points beside the Five Zang Shu, these ten points, are used to drain Heat from the Five Zang." This likely refers to Pohu, Shentang, etc. Although not fully matching the vertebral points here, the method of draining Zang Heat certainly includes these, so cited as annotation. Meaning detailed in Acupuncture Category 39; please correct if necessary. "Zhui" sounds like Chui. " " sounds like Di.) The depression below the third vertebra from the nape is the location. (This is the general method for locating spinal vertebrae. The "third vertebra from the nape" refers to the three cervical bones, not the thoracic/lumbar spine. The depression below the third cervical vertebra is the first thoracic vertebra, acupoint Dazhui. Counting downwards from here, the other vertebrae can be identified sequentially.)
Reverse enlargement from below the chin to the zygoma is Da Jia (large mass); downward to the jaw angle is abdominal fullness; behind the zygoma is hypochondriac pain; above the cheek is the upper diaphragm. (This uses facial color to inspect abdominal diseases; however, the meaning is most detailed in the Wu Se Pian, see Pulse and Color Category 32. "Jia" sounds like Jia or Jia.)