此天之常数 马云。灵枢五音五味篇。谓少阴常多血少气。厥阴常多气少血。九针篇。谓太阴常多血少
气。与此不同。须知灵枢多误。当以此节为正。观末节出血气之多少。正与此节照应。岂得为讹。吴云。诸经之
血气多少。乃天之常数然也。简按气血多少。徐氏要旨。以运气释之。志高亦有解。率似傅会。此宜存而不论焉。
伺之所欲 马云。肝欲散。心欲软之类。吴云。如风寒暑湿燥火。病患有恶之者。有欲之黄。伺察其
所欲。则知其病在何经矣。简按诸注与马同。当以马为胜。
欲知背俞 张云。此亦取五脏之俞。而量之有法也。背俞。即五脏之俞。以其在足太阳经。而出于背。
故总称为背
俞。其度量之法。先以草横量两乳之间。中半折折之。又另以一草比前草。而去其半。取齐中折之数。乃竖立
长草。横置短草于下。两头相拄。象△三隅。乃举此草。以量其背。令一隅居上。齐脊中之大椎。其在下两隅。
当三椎之间。即肺俞穴也。
大椎 甲乙云。在第一椎陷者中。外台云。大椎。平肩斜齐高硕者。是也。仍不得侵项分取之。则非
也。上接项骨。下肩齐。在椎骨节上。是。余穴尽在节下。
复下一度心之俞也 张云。复下一度。谓以上隅。齐三椎肺俞之中央。其下两隅。即五椎之间。心之俞也。
复下一度左角肝之俞也 张云。复下一度。皆如前法。递相降也。简按马云。第五椎间。宜为膈俞穴。
今云然者误。此说却非。
是谓五脏之俞 吴云。此取五脏俞法。与甲乙经不合。盖古人别为一家者也。张云。此法。与灵枢背
篇。及甲乙经。铜人等书。皆不相合。其中未必无误。或古时亦有此别一家法也。仍当以背 篇。及甲乙等
书者为是。
病生于咽嗌 张云。形苦志苦。必多忧思。忧则伤肺。思则伤脾。脾肺气伤。则虚而不行。气必滞矣。
脾肺之脉。上循咽嗌。故病生于咽嗌。如人之悲忧过度。则喉咙哽咽。食饮难进。思虑过度。则上焦痞隔。咽
中核塞。即其征也。简按高云。咽纳水谷。嗌司呼吸。是误矣。咽嗌俱纳水谷。太阴阳明论云。喉主天气。嗌
主地气。可以证也。咽嗌。今本甲乙。作咽喝。注云。一作困竭。据形苦志苦。作困竭者极是。
百药 马云。此与灵枢九针论同。但彼曰甘药者是。而此曰百药者误。高云。灵枢终始篇云。阴阳
俱不足。补阳则
阴竭。泻阴则阳脱。如此者。可将以甘药。不可饮以至剂。即此义也。简按邪气脏腑病形篇云。阴阳形气俱不
足。勿取以针。而调以甘药也。益知上文咽嗌。为困竭之误。
形数惊恐 马云。世有形体劳苦。数受惊恐。则志亦不乐。其经络不通。而不仁之病生。高云。惊恐。
因惊致恐。志之苦也。经络不通。劳其经络。形之苦也。形数惊恐。经络不通。即上文形苦志苦也。简按形字
可疑。王吴张志并不注及。据马高注。形下添一苦字。义略通。
经络不通 九针论。作筋脉不通。
不仁 马云。谓 重而不知寒热痛痒也。张云。顽痹软弱也。简按不仁。即神农本经死肌。后世所谓
木是。 乃顽痹。后世所谓麻是。二证不同。然麻者必木。木者多麻。故王注以下。并以 痹释之。（当与诊
要经终篇参看。）
醪药 甲乙。药。作醴。
这是上天赋予的固定规律。马莳认为，《灵枢·五音五味篇》说少阴经通常多血少气，厥阴经通常多气少血；《九针十二原篇》说太阴经通常多血少气，这与本文不同。应当知道《灵枢》中多有错误，应以本节的记载为正确标准。看文末关于出血气多少的内容，正好与本节相互照应，怎么能说是讹误呢？吴崑认为，各经脉气血的多少，是上天的固定规律。丹波元简按语：关于气血多少的问题，徐大椿在《医宗要旨》中以五运六气来解释，志田高也有解说，但都像是牵强附会。这个问题应当存疑而不加讨论。
所谓“伺察其所欲”，马莳认为是指肝喜疏散、心喜柔软之类。吴崑认为，如风、寒、暑、湿、燥、火六淫邪气，患者有的厌恶它，有的喜好它（此处原文“欲之黄”疑为衍文或误字，意指有的患者反而觉得舒适或依赖）。通过观察患者所喜好的事物，就能知道病邪在哪条经络。丹波元简按语：各家注释与马莳相同，应当以马莳的说法为优。
想要了解背俞穴的定位方法，张景岳说：这也是取用五脏的背俞穴，但有特定的度量方法。“背俞”，即五脏的背俞穴，因为它们位于足太阳膀胱经，且出于背部，所以统称为背俞。其度量方法是：先用一根草横着测量两乳头之间的距离，将其对折；再另取一根草，长度比前一根草短一半，取其中点作为基准数。然后竖立长草，将短草横置于下方，两头相抵，形成三角形的三个角（象△三隅）。举起这组草具，用来测量背部，使一个角位于上方，对齐脊柱中的大椎穴；下方的两个角，应当位于第三椎骨之间，这里就是肺俞穴。
大椎穴，《针灸甲乙经》说在第一胸椎棘突下的凹陷中。《外台秘要》说，大椎穴的高度与肩膀斜方肌齐平。如果侵及颈部去取穴，那就错了。大椎穴上接项骨，下与肩齐，位于椎骨节之上，这是正确的。其余穴位都在椎骨节之下。
再向下移动一个单位距离，是心的背俞穴。张景岳说：“复下一度”，意思是以上面那个角的尖端，对齐第三椎骨处肺俞穴的中央，那么下面两个角的位置，就在第五椎骨之间，这里是心的背俞穴。
再向下移动一个单位距离，左侧角对应的是肝的背俞穴。张景岳说：“复下一度”，都像前面的方法一样，依次递减。丹波元简按语：马莳认为第五椎间应该是膈俞穴。现在文中这样说却是错误的。这种说法确实不对。
这就叫做五脏的背俞穴。吴崑说：这种方法取五脏俞穴的方式，与《针灸甲乙经》不合。大概是古人另有这一家流派吧。张景岳说：这种方法，与《灵枢·背俞篇》以及《针灸甲乙经》、《铜人腧穴针灸图经》等书都不相符。其中未必没有错误，或许古时也有这一家别法。但仍应当以《背俞篇》及《针灸甲乙经》等书的记载为准。
疾病生于咽喉部位。张景岳说：形体劳苦、精神忧苦，必然多忧思。忧愁则伤肺，思虑则伤脾。脾肺之气受伤，则虚弱而不能运行，气必然停滞。脾肺的经脉，向上循行经过咽喉，所以疾病生于咽喉。比如人悲伤过度，喉咙就会哽咽，饮食难进；思虑过度，上焦就会痞塞阻隔，咽中有异物感堵塞，这就是征象。丹波元简按语：高世栻说“咽纳水谷，嗌司呼吸”，这是错误的。咽和嗌都参与纳受水谷。《素问·阴阳应象大论》说：“喉主天气，嗌主地气”，可以证明这一点。另外，“咽嗌”一词，在今本《针灸甲乙经》中作“咽喝”，注解说“一作困竭”。根据上文“形苦志苦”的语境，作“困竭”是非常恰当的。
百药。马莳说：这与《灵枢·九针论》相同，只是那里说“甘药”是正确的，而这里说“百药”是错误的。高世栻说：《灵枢·终始篇》说：“阴阳俱不足，补阳则阴竭，泻阴则阳脱。如此者，可将以甘药，不可饮以至剂。”就是这个意思。丹波元简按语：《灵枢·邪气脏腑病形篇》说：“阴阳形气俱不足，勿取以针，而调以甘药也。”更加证实了上文“咽嗌”是“困竭”的误写。
形体屡受惊恐。马莳说：世间有形体劳苦，又屡次受到惊恐的人，那么精神也会不快乐。其经络不通畅，从而产生麻木不仁的疾病。高世栻说：惊恐，因惊致恐，是精神的痛苦。经络不通，劳损其经络，是形体的痛苦。“形数惊恐，经络不通”，就是上文的“形苦志苦”。丹波元简按语：“形”字值得怀疑。王冰、吴崑、张景岳都没有注释到这一点。根据马莳和高世栻的注释，如果在“形”字下添一个“苦”字，文义就大致通顺了。
经络不通。《灵枢·九针论》中作“筋脉不通”。
不仁。马莳说：指身体沉重而不知寒热痛痒。张景岳说：指顽痹软弱。丹波元简按语：“不仁”，即《神农本草经》所说的“死肌”，后世所谓的“木”。而“痹”则是顽痹，后世所谓的“麻”。这两种证候不同，然而麻木的人必定伴有木感，木感的人也多有麻木，所以王冰以下的注家，都以“痹”来解释。（应当与《素问·诊要经终论》参看。）
醪药。《针灸甲乙经》中，“药”字作“醴”。
This is the constant law of Heaven. Ma Shi states that *Ling Shu: Wu Yin Wu Wei Pian* says Shaoyin usually has abundant blood and deficient qi, while Jueyin usually has abundant qi and deficient blood; *Jiu Zhen Pian* says Taiyin usually has abundant blood and deficient qi, which differs from this text. One must know that *Ling Shu* contains many errors, and this section should be regarded as correct. The final section discussing the abundance and deficiency of blood and qi corresponds exactly with this section, so how can it be considered an error? Wu Kun states that the abundance and deficiency of blood and qi in the various meridians are the constant laws of Heaven. Danbo Yuanjian notes: Regarding the issue of blood and qi abundance, Xu Dachun explained it using the theory of Five Movements and Six Qi in his *Yi Zong Yao Zhi*, and Zhi Gao also provided interpretations, but these seem like forced associations. This matter should be preserved for discussion but not definitively resolved here.
"Sì" (observing/examining) refers to "what is desired." Ma Shi explains this as concepts such as the Liver desiring dispersion and the Heart desiring softness. Wu Kun explains that regarding the six pathogenic factors—Wind, Cold, Summer-heat, Dampness, Dryness, and Fire—some patients detest them, while others may favor them. By observing what the patient desires or dislikes, one can determine which meridian the disease resides in. Danbo Yuanjian notes: Various commentaries agree with Ma Shi, and Ma Shi’s interpretation is superior.
To understand the Back-Shu points, Zhang Jingyue states: This also involves taking the Back-Shu points of the five Zang organs, but there is a specific method for measurement. "Back-Shu" refers to the Back-Shu points of the five Zang organs. Because they are located on the Foot-Taiyang Bladder Meridian and emerge from the back, they are collectively called Back-Shu points. The method of measurement is as follows: First, take a stalk of grass and measure horizontally between the two nipples, then fold it in half. Take another stalk of grass, make it half the length of the previous one, and find its midpoint as the standard number. Then, stand the long grass vertically and place the short grass horizontally beneath it, with the two ends touching, forming a triangle (like three corners). Lift this grass assembly to measure the back, positioning one corner at the top, aligned with the Dazhui point on the spine. The two lower corners should fall between the third vertebrae, which is the Feishu (Lung Back-Shu) point.
Dazhui [GV14]: *Jia Yi Jing* states it is in the depression below the first thoracic vertebra. *Wai Tai Mi Yao* states that Dazhui is level with the height where the shoulder slopes. It must not be taken by encroaching into the neck region, otherwise it is incorrect. It connects above to the cervical bones and aligns with the shoulders below, situated on the vertebral joints. This is correct. All other points are located below the vertebral joints.
Moving down one unit distance again is the Back-Shu point of the Heart. Zhang Jingyue states: "Moving down one unit" means aligning the upper corner with the center of the Feishu point at the third vertebra; the two lower corners will then be between the fifth vertebrae, which is the Back-Shu point of the Heart.
Moving down one unit distance again, the left corner corresponds to the Back-Shu point of the Liver. Zhang Jingyue states: "Moving down one unit" follows the same method as before, descending sequentially. Danbo Yuanjian notes: Ma Shi argues that the space between the fifth vertebrae should be the Geshu (Diaphragm Back-Shu) point. The statement in the current text is therefore incorrect. This explanation is indeed wrong.
This is referred to as the Back-Shu points of the five Zang organs. Wu Kun states: This method for locating the Back-Shu points of the five Zang organs does not accord with *Jia Yi Jing*. It is likely that the ancients had a separate school of thought. Zhang Jingyue states: This method does not accord with *Ling Shu: Bei Shu Pian*, nor with *Jia Yi Jing*, *Tong Ren*, or other texts. There may well be errors within it, or perhaps there was indeed a separate ancient method. However, one should still regard the accounts in *Bei Shu Pian* and *Jia Yi Jing* as correct.
Diseases arising in the pharynx and esophagus. Zhang Jingyue states: Physical hardship and mental distress lead to excessive worry and overthinking. Worry injures the Lung, and overthinking injures the Spleen. When the Qi of the Spleen and Lung is injured, it becomes deficient and fails to circulate, causing Qi stagnation. The meridians of the Spleen and Lung ascend along the pharynx and esophagus; thus, diseases arise in the pharynx and esophagus. For example, when a person is excessively sad, the throat becomes choked, making eating and drinking difficult; when overthinking, the Upper Jiao becomes blocked, causing a sensation of a lump in the throat. These are the signs. Danbo Yuanjian notes: Gao Shishi claimed that the pharynx receives food and drink while the esophagus governs respiration, which is incorrect. Both the pharynx and esophagus receive food and drink. *Su Wen: Yin Yang Ying Xiang Da Lun* states: "The larynx governs Heavenly Qi, and the esophagus governs Earthly Qi," which serves as proof. Furthermore, in the current edition of *Jia Yi Jing*, "Yan Yi" (pharynx and esophagus) is written as "Yan He," with a note saying "alternatively read as Kun Jie" (exhaustion/depletion). Given the context of "physical hardship and mental distress," reading it as "Kun Jie" is highly appropriate.
Hundred Medicines. Ma Shi states: This is identical to *Ling Shu: Jiu Zhen Lun*, except that the latter says "Sweet Medicine" (Gan Yao), whereas here it says "Hundred Medicines," which is erroneous. Gao Shishi states: *Ling Shu: Zhong Shi Pian* says: "When both Yin and Yang are deficient, tonifying Yang leads to exhaustion of Yin, and draining Yin leads to depletion of Yang. In such cases, sweet medicine may be used, but strong/potent medicines should not be drunk." This conveys the same meaning. Danbo Yuanjian notes: *Ling Shu: Xie Qi Zang Fu Bing Xing Pian* states: "When Yin, Yang, Form, and Qi are all deficient, do not use needles, but regulate with sweet medicine." This further confirms that the earlier mention of "Yan Yi" was a textual error for "Kun Jie."
Form frequently subjected to fright and terror. Ma Shi states: There are people whose bodies endure physical hardship and who frequently suffer from fright and terror, leading to mental unhappiness. Their meridians become obstructed, giving rise to diseases of numbness and insensitivity. Gao Shishi states: Fright and terror, caused by fright leading to fear, constitute suffering of the Spirit (Zhi). Obstruction of the meridians and strain upon them constitute suffering of the Form. "Form frequently subjected to fright and terror, meridians obstructed" corresponds to the aforementioned "physical hardship and mental distress." Danbo Yuanjian notes: The character "Xing" (Form) is questionable. Wang Bing, Wu Kun, and Zhang Jingyue did not comment on it. Based on the annotations of Ma Shi and Gao Shishi, adding the character "Ku" (hardship/suffering) after "Xing" makes the meaning roughly coherent.
Meridians obstructed. *Jiu Zhen Lun* reads this as "Sinews and vessels obstructed."
Insensitivity (Bu Ren). Ma Shi states: It refers to heaviness of the body accompanied by a lack of sensation to cold, heat, pain, or itch. Zhang Jingyue states: It refers to stubborn bi-syndrome and weakness. Danbo Yuanjian notes: "Bu Ren" (insensitivity) refers to what *Shen Nong Ben Cao Jing* calls "dead flesh" (Si Ji), commonly known in later times as "Mu" (wood-like numbness). "Bi" (obstruction/pain) refers to stubborn bi-syndrome, commonly known in later times as "Ma" (tingling/numbness). These two conditions are different. However, those with tingling necessarily have wood-like numbness, and those with wood-like numbness often have tingling. Therefore, commentators following Wang Bing interpreted "Bi" broadly to cover both. (This should be cross-referenced with *Su Wen: Zhen Yao Jing Zhong Pian*.)
Lao Yao (Fermented medicinal wine). In *Jia Yi Jing*, the character "Yao" (medicine) is written as "Li" (sweet fermented wine).