针刺之义,远逊刺要、刺禁、八正神明等篇,存之以备篇目而已。其云长者,通篇专言刺法。节者,言刺
法之节略也。
刺家不诊,听病者言。(按∶针家以穴俞为准则,以员熟为巧妙,神而明之,变化无穷,固不恃乎区区诊
脉为也。盖善于诊脉而不善于用针,为未尽善,故经言不诊,非不必诊,以所重不专在诊也。乃后之从事于针
者,借口不诊之语,穴俞刺法,大略草草,绝不知病属何经,经应何穴,效与不效,听之而已,似皆不诊一语
误之也。是故针法之妙,诚不在脉,而要之真善针者,未有不知脉者也。)在头,头疾痛,为针之。(王本为
藏针之。全元起本无藏字,今改从之。)刺至骨,病已,上无伤肉及皮。皮者,道也。皮者针之道,故刺骨无
伤骨肉及皮也。阴刺,入一,旁四处,治寒热。(按∶新校正云∶“甲乙经云∶阳刺者,正内一,旁内四。
阴刺者,左右卒刺之。此阴刺疑是阳刺也。”又按自头疾起至此三段,王注俱作治头之法,误矣。盖段各一义,
本不相蒙,详味语气
自见,今厘正之。)深重者,刺大脏。(按∶凡病以腑为轻,以脏为重,故病若深重,必刺大脏乃愈也。注即
顶寒热,又误矣。)迫脏刺背,背俞也。(迫,近也。渐近于脏,则刺背五脏之俞也。)刺之迫藏,藏会,(按∶
藏会注未确,疑有脱误,存之。)腹中寒热去而止。与刺之要,发针而浅出血。(按∶此三处俱有脱误,
不敢过为强解。)治痈肿者,刺痈上,视痈小大深浅刺。(按∶旧本腐肿、腐上,全元起本及甲乙经,腐作痈,
今改从之。)刺大者多血,小者深之,必端内针为故止。(按∶甲乙经云∶“刺大者多而深之,必端内针为故
正也。”此云小者深之,疑有误,当以甲乙为是。内作纳。)病在少腹,有积,刺皮HT 以下至少腹而止,刺
挟脊两旁四椎间,刺两髂 季胁肋间,导腹中气,热下已。(少腹积,谓少腹之气结积也。皮HT 谓齐下五寸
横约文,审刺而勿过深之。刺禁论曰∶“刺少腹,中膀胱,溺出,令人少腹满。”由此故不可深之矣。挟脊四
椎之间,据经无俞,恐当云五椎间,五椎之下两旁,正当心俞,心应少腹,故当言五椎间也。髂为腰骨。 一
为髀,字形相近之误也, 谓居 ,腰侧穴也。季胁肋间,当是刺季肋之间京门穴也。按∶新校正云∶“释音,
皮HT 作皮 ,苦末反,是 误作HT 也。及遍寻篇韵中无HT 字,只有 字, ,骨端也。皮 者,盖谓脐
下横骨之端也。全元起本作皮髓,注云脐旁 起,亦未为得。”)病在少腹,腹痛不得大小便,病名曰疝,
得之寒。刺少腹两股间,刺腰髁骨间,刺而多之,尽炅,病已。(厥阴之脉,环阴器,抵少腹。冲脉与少阴
之络,皆起肾下,出于气街,循阴股。其后行者,自少腹以下骨中央,女子入系廷孔。其络循阴器,合篡间,
绕篡后,别绕臀,至少阴与巨阳中络者,合少阴,上股内后廉,贯脊属肾。其男子循茎下至篡,与女子等。故
刺少腹及两股间,又刺腰髁骨间也。腰髁骨者,腰房挟脊平立陷者中,按之有骨处也。疝为寒生,故多刺之,
少腹尽热乃止针。炅,
热也。按∶前言得之寒,末又言尽炅病已,经言似不相符,而注曾无所解,试为论之∶少腹者,肾之部,膀胱
之道路也。内本有热,外适感寒,寒闭其热,以致二便秘而痛。以其因于寒,故云得之寒。然因寒而热内着,
故必尽炅乃已也。炅音景。篡,初患切。)病在筋,筋挛节痛,不可以行,名曰筋痹。刺筋上为故,刺分肉间,
不可中骨也。(分谓肉分间有筋维络处也。刺筋无伤骨,故不可中骨也。)病起筋炅,病已止。(按∶此处又有
脱误。)病在肌肤,肌肤尽痛,名曰肌痹,伤于寒湿。刺大分小分,多发针而深之,以热为故。(大分谓大肉
之分,小分谓小肉之分。)无伤筋骨,伤筋骨,痈发若变。(针经曰∶“病浅针深,内伤良肉,皮肤为痈。”
又曰∶“针太深,则邪气反沉,病益甚。”伤筋骨则针太深,故痈发若变也。)诸分尽热,病已止。(热可消寒,
故病已则止。按∶分即部分,诸分谓大小分也。)病在骨,骨重不可举,骨髓酸痛,寒气至,名曰骨痹。深者
刺无伤脉肉为故,其道大分小分,骨热,病已止。(按∶有脱误,存之。)病在诸阳脉,且寒且热,诸分且寒
且热,名曰狂。(按∶癫狂之证并无寒热,此云且寒且热,盖寒热纷争,气溃乱而狂,伤寒之发狂是也。)
刺之虚脉,视分尽热,病已止。(按∶有脱误。)病初发岁一发,不治月一发,不治月四五发,名曰癫病。
刺诸分诸脉,其无寒者以针调之,病已止。(按∶似非脱误,然无甚精义可解。)病风,且寒且热,炅汗出,
一日数过。先刺诸分理络脉,汗出且寒且热,三日一刺,百日而已。(按∶风为阳邪,故令人寒热。风入毫窍,
则玄府开而汗屡出。然入之甚深,则汗虽出而寒热未遽去,必屡刺而至百日之久乃尽也。)病大风,骨节重,
须眉堕,名曰大风。刺肌肉为故,汗出百日,(泄卫气
之怫热。)刺骨髓,汗出百日,(泄荣气之怫热。)凡二百日,须眉生而止针。(怫热屏退,阴气内复,故多
汗出,须眉生也。按∶此所谓疠风也,针能治之,惜乎其法不传也。)
针刺的道理,远不如《刺要》、《刺禁》、《八正神明》等篇那样精妙,保留这篇只是为了备录篇目罢了。文中所说的“长”,是因为全篇专门论述针刺方法;“节”,是指针刺方法的节略概要。
从事针刺的医生不一定诊脉,而是听取病人的陈述。(按语:针灸医生以穴位为准则,以手法熟练为巧妙,神妙通达,变化无穷,本来就不依赖那区区诊脉之术。大概善于诊脉却不善于用针,算是未尽完善,所以经文说“不诊”,并非不必诊脉,而是重点不在于诊脉。然而后世从事针灸的人,借口经文中的“不诊”这句话,对穴位和刺法草率应付,完全不知道疾病属于哪条经络,该取哪个穴位,疗效如何听天由命,这似乎都是被“不诊”这句话误导了。因此,针刺的精妙之处确实不在脉象上,但真正擅长针刺的人,没有不懂脉理的。)
头部出现疾痛,进行针刺治疗。针刺要深达骨部,病就好了,但不要损伤肌肉和皮肤。皮肤是进针的途径,所以刺骨时不要伤及骨肉和皮肤。阴刺法,正中刺入一针,旁边刺入四针,用来治疗寒热往来。(按语:新校正说:“《甲乙经》记载:阳刺法是正中刺入一针,旁边刺入四针。阴刺法是左右交替快速刺入。这里的‘阴刺’怀疑是‘阳刺’之误。”又按语:从“头疾”开始到这三段,王冰注都解释为治疗头部的法则,这是错误的。因为每一段各有其义,原本互不相关,仔细体味语气自然明白,现在予以纠正。)病情深重的,针刺大脏。(按语:凡是疾病,腑病轻,脏病重,所以如果病情深重,必须针刺大脏才能痊愈。王冰注将其解释为头顶寒热,又是错误的。)病邪迫近内脏,针刺背部,即背部的五脏俞穴。(迫,就是靠近的意思。病邪逐渐逼近内脏,就针刺背部五脏的俞穴。)针刺迫近脏腑,在脏腑之气汇聚处施治,(按语:对“藏会”的注解不够确切,怀疑有脱漏或错误,暂且保留。)腹中的寒热症状消除即可停针。这与针刺的要领有关,出针时要让少量出血。(按语:这三处原文都有脱漏错误,不敢强行解释。)治疗痈肿,针刺痈肿部位,根据痈肿的大小和深浅进行针刺。(按语:旧本中写作“腐肿”、“腐上”,全元起本及《甲乙经》中,“腐”字作“痈”字,现在改正依从它。)对于大的痈肿,多放血;小的痈肿,针刺要深,必须端正地进针,以见到脓血排出为止。(按语:《甲乙经》说:“刺大的痈肿要多而深地刺,必须端正进针以引邪外出。”这里说“小者深之”,怀疑有误,应当以《甲乙经》为准。“内”通“纳”。)
疾病在小腹部,有积块,针刺从皮下至少腹的部位停止,针刺挟脊两旁第四椎间隙,针刺两侧髂骨与季胁肋间,引导腹中气机,热气下行则病愈。(少腹积,是指少腹之气结聚成块。皮HT指脐下五寸横纹处,应审慎针刺而不要过深。《刺禁论》说:“针刺少腹,若误中膀胱,尿液流出,会导致少腹胀满。”因此不可刺得太深。挟脊四椎之间,据经络理论此处无俞穴,恐怕应当说是第五椎间,第五椎之下两旁正当心俞穴,心对应少腹,所以应当说五椎间。髂是腰骨。“一”是“髀”字的形近误写,指位于髀部的腰侧穴位。季胁肋间,应当是针刺季肋之间的京门穴。按语:新校正说:“释音中,将‘皮HT’写作‘皮...’,读音为苦末反,说明‘...’误写成了‘HT’。遍寻篇韵中没有‘HT’字,只有‘...’字,‘...’意为骨端。‘皮...’,大概是指脐下横骨的末端。全元起本作‘皮髓’,注解说脐旁突起,也不够恰当。”)
疾病在小腹部,腹痛且大小便不通,病名叫做疝,这是由于受寒引起的。针刺少腹两股之间,针刺腰髁骨之间,多针刺几次,直到局部感到温热,病就好了。(厥阴经脉,环绕生殖器,抵于少腹。冲脉与少阴络脉,都起于肾下,出于气街,沿大腿内侧下行。其后行者,自少腹以下至骨中央,女子进入系廷孔。其络脉循行生殖器,合于篡间,绕篡后,别绕臀部,至少阴与巨阳的中络处,汇合少阴,上行大腿内侧后缘,贯穿脊柱属肾。男子循茎部下至篡,与女子相同。所以要针刺少腹及两股之间,又刺腰髁骨间。腰髁骨,是指腰部挟脊平立时的凹陷处,按压有骨头的地方。疝是由于寒邪产生,所以多针刺,直到少腹全部发热才拔针。炅,就是热。按语:前面说“得之寒”,最后又说“尽炅病已”,经文看似矛盾,而注释曾未作解释,试论述如下:少腹是肾的部位,也是膀胱的道路。体内本有热,外感寒邪,寒邪闭塞热邪,导致二便不通而疼痛。因为起因是寒,所以说“得之寒”。然而因寒致热内着,所以必须全身发热才能痊愈。炅音景。篡,初患切。)
疾病在筋,筋脉拘挛关节疼痛,不能行走,病名叫做筋痹。针刺筋部作为标准,针刺分肉之间,不可刺中骨头。(分指肉分之间有筋维络的地方。刺筋不要伤骨,所以不可刺中骨头。)病起于筋部发热,病好就停止。(按语:此处又有脱漏错误。)
疾病在肌肤,肌肤全部疼痛,病名叫做肌痹,是受寒湿所伤。针刺大分和小分,多扎针并深入,以局部发热为标准。(大分指大块肌肉的分界,小分指小块肌肉的分界。)不要伤及筋骨,如果伤及筋骨,会发生痈肿或其他变证。《针经》说:“病浅针深,内伤良肉,皮肤发为痈。”又说:“针刺太深,则邪气反而沉陷,病情加重。”伤及筋骨就是针刺太深,所以会发生痈肿变证。各个部位都感到发热,病好就停止。(热可以消散寒邪,所以病好就停止。按语:分即部分,诸分指大小分。)
疾病在骨,骨骼沉重抬不起来,骨髓酸痛,寒气侵袭,病名叫做骨痹。深刺而不伤血脉肌肉为标准,其道经过大分小分,骨部发热,病好就停止。(按语:有脱漏,暂且保留。)
疾病在诸阳脉,既怕冷又怕热,各个部位也既怕冷又怕热,病名叫做狂。(按语:癫狂病症通常没有寒热往来,这里说“且寒且热”,大概是寒热纷争,气机溃乱而发狂,如伤寒病导致的发狂。)针刺使脉气虚衰,视各部位都发热,病好就停止。(按语:有脱漏。)
病初发时一年发作一次,不治疗则一个月发作一次,再不治则一个月发作四五次,病名叫做癫病。针刺各个分肉和脉络,其中没有寒邪的,用针调理,病好就停止。(按语:似乎不是脱漏,但没有甚么精深的义理可解。)
患风病,既怕冷又怕热,出汗发热,一天多次发作。先针刺各个分理络脉,如果出汗且伴有寒热,三天针刺一次,一百天痊愈。(按语:风为阳邪,所以使人寒热。风侵入毫窍,则玄府开泄而汗液屡出。然而风邪入之很深,虽然出汗但寒热并未立即去除,必须屡次针刺直至百日之久才能除尽。)
患大风病,骨节沉重,眉毛胡须脱落,病名叫做大风。针刺肌肉作为标准,出汗一百天,(宣泄卫气的郁热。)针刺骨髓,出汗一百天,(宣泄营气的郁热。)总共二百天,眉毛胡须长出就停针。(郁热屏退,阴气内复,所以多出汗,眉毛胡须生长。按语:这就是所谓的疠风,针刺能治疗它,可惜这种方法没有流传下来。)
The principles of acupuncture are far inferior to those in chapters such as *Ci Yao* (Needling Essentials), *Ci Jin* (Needling Taboos), and *Ba Zheng Shen Ming* (Eight Regularities and Divine Illumination); this chapter is retained merely for the sake of completeness in the collection. The term "Chang" (Long) indicates that the entire chapter focuses specifically on needling techniques. The term "Jie" (Section/Summary) refers to the summarized or abbreviated nature of these needling methods.
Practitioners of acupuncture may not rely on pulse diagnosis but instead listen to the patient's complaints. (Note: Acupuncturists take acupoints as their standard and skillful manipulation as their subtlety; through divine understanding, they achieve infinite variations, relying not merely on the limited practice of pulse diagnosis. Generally, one who is skilled in pulse diagnosis but unskilled in needling is considered imperfect. Thus, when the Classic says "no diagnosis," it does not mean diagnosis is unnecessary, but rather that the emphasis is not solely on diagnosis. However, later practitioners used this phrase "no diagnosis" as an excuse to be careless with acupoints and techniques, failing to know which meridian a disease belongs to or which points should be selected, leaving outcomes to chance. This seems to be a misunderstanding caused by the phrase "no diagnosis." Therefore, while the subtlety of needling indeed lies not in the pulse, it is true that no master acupuncturist exists who does not understand the pulse.)
For pain and疾 (disease/pain) in the head, perform needling. Needle deeply until reaching the bone; once the disease is cured, ensure not to damage the flesh and skin. The skin is the pathway for the needle; thus, when needling the bone, avoid damaging the flesh and skin. Yin Needling involves inserting one needle centrally and four needles laterally, used to treat alternating cold and heat. (Note: The New Correction states: "*Jia Yi Jing* records: Yang Needling involves inserting one needle centrally and four laterally. Yin Needling involves rapid alternating needling on left and right sides. It is suspected that 'Yin Needling' here is a typo for 'Yang Needling.' Furthermore, regarding the three paragraphs starting from 'head disease,' Wang Bing's commentary incorrectly interprets them all as methods for treating the head. Each paragraph has its own distinct meaning and is unrelated to the others; careful reading reveals the truth. These have now been corrected.) For deep and severe conditions, needle the major Zang organs. (Note: Generally, Fu organ diseases are mild, while Zang organ diseases are severe. Thus, for deep and severe illnesses, one must needle the major Zang organs to achieve recovery. Wang Bing's note interpreting this as treating head cold/heat is erroneous.) When pathogenic factors press against the Zang organs, needle the back, specifically the Back-Shu points of the five Zang organs. ("Press" means approaching gradually; as the pathogen nears the Zang, needle the Back-Shu points of the five Zang organs on the back.) When needling near the Zang organs, target the Hui-Meeting points of the Zang. (Note: The annotation for "Zang Hui" is inaccurate; there may be textual corruption. Retained as is.) The alternating cold and heat in the abdomen will cease, and needling should stop. This relates to the essentials of needling: withdraw the needle allowing slight bleeding. (Note: There are textual lacunae in these three sections; forced interpretation is avoided.) To treat carbuncles and swellings, needle the site of the swelling, adjusting depth based on the size and depth of the lesion. (Note: Older editions use "Fu" (rotten), while Quan Yuanqi's edition and *Jia Yi Jing* use "Yong" (carbuncle). Corrected to follow the latter.) For large swellings, drain much blood; for small ones, needle deeply. Insert the needle straightly and stop when pus/blood is discharged. (Note: *Jia Yi Jing* states: "For large lesions, needle deeply and frequently, ensuring straight insertion to expel pathogens." The text here saying "small ones needle deeply" is suspected to be an error; *Jia Yi Jing* is likely correct. "Nei" is interchangeable with "Na".)
For diseases in the lower abdomen involving accumulations, needle from the subcutaneous layer down to the lower abdomen and stop. Needle the spaces between the fourth vertebrae flanking the spine, and the spaces between the two iliac bones and the costal margin, to guide Qi in the abdomen downward; the condition resolves when heat descends. (Accumulation in the lower abdomen refers to the knotting of Qi there. "Pi HT" refers to the horizontal crease five cun below the navel; needle carefully without going too deep. *Ci Jin Lun* warns: "If needling the lower abdomen hits the bladder, urine leakage causes lower abdominal fullness." Hence, deep needling is contraindicated. Regarding the space between the fourth vertebrae flanking the spine, there are no Shu points recorded in the meridians; it is likely the fifth intervertebral space. Below the fifth vertebra, on both sides, lie the Xin Shu points, corresponding to the lower abdomen, so "fifth vertebra" is probable. "Qia" refers to the lumbar bone. "Yi" is a graphic error for "Bi" (thigh), referring to a point on the side of the waist near the thigh. The space between the hypochondrium and ribs likely refers to the Jingmen point. Note: New Correction states: "Pronunciation notes write 'Pi HT' as 'Pi [character]', pronounced 'Ku Mo Fan', indicating '[character]' was miswritten as 'HT'. Searching the rhymes, 'HT' does not exist, only '[character]', meaning bone end. 'Pi [character]' likely refers to the end of the transverse bone below the navel. Quan Yuanqi reads 'Pi Sui', noting protrusions beside the navel, which is also inadequate.")
For diseases in the lower abdomen with abdominal pain and inability to urinate or defecate, the disease is named Shan (Hernia), caused by cold. Needle between the lower abdomen and the inner thighs, and between the sacroiliac joints. Perform multiple needle insertions until the area feels thoroughly warm, then the disease is cured. (The Jueyin meridian circles the genitalia and reaches the lower abdomen. The Chong Mai and Luo vessels of Shaoyin originate below the kidney, emerge at Qichuang, and follow the medial thigh. Posteriorly, from the lower abdomen to the central bone, in women, it enters the Ting Kong. Its Luo vessel circulates the genitalia, meets at the perineum, winds around the anus, passes the buttocks, joins the Shaoyin and Juyang mid-Luo vessels, merges with Shaoyin, ascends along the posterior-medial thigh, pierces the spine, and connects to the Kidney. In men, it follows the penis to the perineum, identical to women. Hence, needling the lower abdomen, inner thighs, and sacroiliac region is indicated. The sacroiliac bone refers to the depression flanking the spine when standing flat, where bone can be felt. Since Shan is caused by cold, frequent needling is required until the lower abdomen is entirely hot before withdrawing. "Jiong" means heat. Note: The text mentions "caused by cold" initially but "thoroughly hot" at the end, seeming contradictory. Commentary offers no explanation. Analysis: The lower abdomen is the domain of the Kidney and the pathway of the Bladder. Internal heat exists, but external cold closes it, causing constipation and pain. Because the cause is cold, it is called "caused by cold." However, cold trapping internal heat requires thorough warming (Jiong) for resolution. "Jiong" is pronounced Jing. "Cuan" is pronounced Chu Han.)
For diseases affecting the sinews, with sinew spasms and joint pain preventing walking, the disease is named Jin Bi (Sinew Bi). Needle the sinews as the target, inserting into the intermuscular spaces, avoiding the bone. (Muscle layers contain sinew connections. Needling sinews must not hit bone.) If the disease originates with heat in the sinews, stop when cured. (Note: Textual lacuna here.)
For diseases affecting the skin and muscle, with generalized pain, the disease is named Ji Bi (Muscle Bi), caused by cold-dampness. Needle the major and minor muscle divisions, using many needles inserted deeply, aiming for local heat. (Major division refers to large muscle masses; minor division to smaller muscle groups.) Do not injure tendons and bones; injury leads to carbuncles or other changes. *Zhen Jing* states: "Shallow disease with deep needling damages healthy flesh, causing skin carbuncles." And: "Excessively deep needling drives pathogens deeper, worsening the illness." Injury to tendons/bones results from excessive depth, leading to carbuncles. Stop when all divisions feel hot. (Heat dispels cold; stop when cured. Note: "Division" refers to anatomical parts; "all divisions" means major and minor.)
For diseases affecting the bones, with heavy limbs unable to lift, soreness in the marrow, and invasion by cold qi, the disease is named Gu Bi (Bone Bi). Deep needling should avoid damaging vessels and flesh, passing through major and minor muscle divisions, stopping when the bone feels hot. (Note: Lacuna present, retained.)
For diseases affecting the Yang meridians, characterized by alternating cold and heat in the meridians and various body parts, the disease is named Kuang (Mania). (Note: Dian-Kuang disorders typically lack alternating chills/fever. Here, "alternating cold and heat" suggests chaotic Qi due to conflicting cold/heat, similar to mania induced by Cold Damage.) Reduce the pulse via needling; stop when all divisions feel hot. (Note: Lacuna present.)
If the disease starts with annual attacks, untreated becomes monthly attacks, and further untreated becomes 4-5 attacks per month, it is named Dian Bing (Epilepsy/Mental Disorder). Needle various divisions and vessels; for those without cold, regulate with needles. Stop when cured. (Note: Not necessarily a lacuna, but lacks profound interpretive value.)
For Wind disease with alternating cold and heat and frequent sweating (multiple times a day), first needle the interstitial collaterals. If sweating persists with chills/fever, needle every three days for 100 days to cure. (Note: Wind is Yang pathogen, causing chills/fever. Wind entering hair follicles opens Xuan Fu pores, causing sweat. Deep penetration means sweat alone doesn't resolve chills/fever; repeated needling over 100 days is needed to clear it completely.)
For severe Wind disease (Leprosy/Pian Feng) with heavy joints and loss of eyebrows/beards, named Da Feng. Needle muscles until sweating occurs for 100 days (to vent Wei Qi stagnation), then needle the marrow until sweating occurs for another 100 days (to vent Ying Qi stagnation). Total 200 days; stop needling when eyebrows and beard regrow. (Stagnant heat clears, Yin Qi restores internally, causing sweat and regrowth. Note: This describes Leprosy (Pian Feng). Acupuncture can treat it, but unfortunately, the method is lost.)