六十二难曰∶藏井荥有五，府独有六者，何谓也？然∶府者，阳也。三焦行于诸阳，故置一俞，名曰
原。所以府有六者，亦与三焦共一气也。
共一气，谓亦行于诸阳，非谓其气皆出于三焦也。
六十三难曰∶《十变》言，五脏六腑荥合，皆以井为始者，何也？然∶井者，东方春也，万物之始生。
诸行喘息， 飞蠕动，当生之物，莫不以春生。故岁数始于春，日数始于甲，故以井为始也。
《灵·本输》篇∶脏之井皆属木，腑之井皆属金。此言脏腑之井皆属木，越人或另有所本。《难经》有
与《内经》互异之处，皆注明于每难之后，以俟考订。
六十四难曰∶《十变》又言，阴井木，阳井金，阴荥火，阳荥水；阴俞土，阳俞木；阴经金，阳经火；
阴合水，阳合土。阴阳皆不同，其意何也？然∶是刚柔之事也。阴井乙木，阳井庚金。阳井庚，庚者，乙之刚
也，阴井乙，乙者，庚之柔也。乙为木，故言阴井木也；庚为金，故言阳井金也。余皆仿此。
后半言阴阳配合之道，义颇精当。
六十五难曰∶经言所出为井，所入为合，其法奈何？然∶所出为井，井者，东方春也，万物之始生，故言
所出为井也。所入为合，合者，北方冬也，阳气入藏，故言所入为合也。
六十六难曰∶经言肺之原，出于太渊；心之原，出于大陵；肝之原，出于太冲；脾之原，出于大白；肾
之原，出于太溪；少阴之原，出于兑骨；胆之原，出于丘墟，胃之原，出于冲阳；三焦之原，出于阳池；膀胱
之原，出于京骨；大肠之原，出于合谷；小肠之原，出于腕骨。十二经皆以俞为原者，何也？然∶五脏俞者，
三焦之所行，气之所留止也。三焦所行之俞为原者，何也？然∶齐下肾间动气者，人之生命也，十二经之根本
也，故名曰原。三焦者，原气之别使也，主通行三气，经历于五脏六腑。
原者，三焦之尊号也，故所止辄为原。五脏六腑之有病者，皆取其原也。
《灵·本输》篇∶心出于中冲，为井木云云，乃以手厥阴包络之穴，为心所出入之处。因心为人身之
主，精神所舍，其脏坚固，邪弗能客，故邪在心者，皆在包络。故以大陵为心之原。然《甲乙经》以少冲为
心之井云云，是以心经，仍以本经之穴为井荥俞经合，实两经之所无。此以兑骨为少阴之原，或即甲乙之所本。
六十七难曰∶五脏募皆在阴，而俞皆在阳者，何谓也？然∶阴病行阳，阳病行阴。故令募在阴，俞在阳也。
六十八难曰，五脏六腑，皆有井荥俞经合，皆何所主？然∶经言所出为井，所流为荥，所注为俞，所行为
经，所入为合。井主心下满，荥主身热，俞主体重节痛，经主喘咳寒热，合主逆气
而泄。此五脏六腑井荥俞经合所主病也。
六十九难曰∶经言虚者补之，实者泻之，不实不虚，以经取之。何谓也？然∶虚者补其母，实者泻其子，
当先补之，然后泻之。不实不虚，以经取之者，是正经自生病，不中他邪也，当自取其经，故言以经取之。
《内经》补泻之法，或取本经，或取他经，或先泻后补，或先补后泻，或取一
经，或取三四经，其法不一。若概以补母泻子为定法，则未必然也。
七十难曰∶春夏刺浅，秋冬刺深者，何谓也？然∶春夏者，阳气在上，人气亦在上，故当浅取之；秋
冬者，阴气在下，人气亦在下，故当深取之。春夏各致一阴，秋冬各致一阳者，何谓也？然∶春夏温，必致一
阴者，初下针，沉之至肾肝之部，得气，引持之阴也。秋冬寒，必致一阳者，初内针，浅而浮之至
心肺之部，得气，推内之阳也。是谓春夏必致一阴，秋冬必致一阳。
七十一难曰∶经言刺荣无伤卫，刺卫无伤荣。何谓也？然∶针阳者，卧针而刺之；刺阴者，以左手摄按
所针荥俞之处，气散乃内针。是谓刺荣无伤卫，刺卫无伤荣也。
卧针即《灵·官针》篇浮刺之法。摄按散气，即《素问·离合真邪论》扪而循之等法。此取之以为刺
阴、刺阳之道，亦简当可法。
七十二难曰∶经言能知迎随之气，可令调之。调气之方，必在阴阳。何谓也？然∶所谓迎随者，知荣卫
之流行经脉之往来也。随其逆顺而取之，故曰迎随。调气之方，必在阴阳者，知其
内外表里，随其阴阳而调之，故曰调气之方，必在阴阳。
七十三难曰∶诸井者，肌肉浅薄，气少，不足使也，刺之奈何？然∶诸井者，木也；荥者，火也。
火者，木之子。当刺井者，以荥泻之。故经言补者不可以为泻，泻者不可以为补。此之谓也。
六十九难以别经为子母，此又以一经子母，义各殊而理极精。
七十四难曰∶经言春刺井，夏刺荥，季夏刺俞，秋刺经，冬刺合者，何谓也？然∶春刺井者，邪在肝；
夏刺荥者，邪在心；季夏刺俞者，邪在脾；秋刺经者，邪在肺；冬刺合者，邪在肾。其肝、心、脾、肺、肾，
而系于春、夏、秋、冬者，何也？然∶五脏一病，辄有五也。假令肝病∶色青者肝也，臊臭者肝也，喜
酸者肝也，喜呼者肝也，喜泣者肝也。其病众多，不可尽言也。四时有数，而并系于春夏秋冬者也。针之要
妙，在于秋毫者也。
七十五难曰∶经言东方实，西方虚，泻南方，补北方，何谓也？然∶金木水火土，当更相平。东方木
也，西方金也。木欲实，金当平之；火欲实，水当平之；土欲实，木当平之；金欲实，火当平之，水欲实，土
当平之。东方肝也，则知肝实；西方肺也，则知肺虚。泻南方火，补北方水。南方火，火者，
木之子也；北方水，水者，木之母也，水胜火。子能令母实，母能令子虚，故泻火补水，欲令金得平木也。
经曰∶不能治其虚，何问其余。此之谓也。
六十九难∶虚则补母，实则泻子。今实则泻子补母，虚则反补其子，未详何故。
七十六难曰∶何谓补泻？当补之时，何所取气？当泻之时，何所置气？然∶当补之时，从卫取气；当泻
之时，从荣置气。其阳气不足，阴气有余，当先补其阳，而后泻其阴。阴气不足，阳气有余，当先补其阴，而
后泻其阳。荣卫通行，此其要也。
七十七难曰∶经言上工治未病，中工治已病者，何谓也？然∶所谓治未病者，见肝之病，则知肝当传之与
脾，故先实其脾气，无令得受肝之邪，故曰治未病焉。中工者，见肝之病，不晓相传，但一心治肝，故曰治已病也。
《金匮要略》首篇云上工治未病节，与此正合，而不见于《灵》、《素》两
经。想仲景即引越人所说，而越人又另有所本也。
七十八难曰∶针有补泻，何谓也？然∶补泻之法，非必呼吸出内针也。知为针者信其左；不知为针者，
信其右。当刺之时，先以左手厌按所针荥俞之处，弹而努之，爪而下之，其气之来，如动脉之状，顺针而刺
之。得气因推而内之，是谓补；动而伸之，是谓泻。不得气，乃与男外女内。不得气，是为十死不治也。
呼吸出纳为补泻之法，即《素问·离合真邪论》所云是也。越人以为补泻之
法，不止于死，故以信左信右之说发挥之。
七十九难曰∶经言迎而夺之，安得无虚？随而济之，安得无实？虚之与实，若得若失；实之与虚，若有
若无。何谓也？然∶迎而夺之者，泻其子也；随而济之者，补其母也。假令心病，泻手心主俞，是谓迎而夺之
者也，补手心主井，是谓随而济之者也。所谓实之与虚者，牢濡之意也。气来实牢者为得，濡虚者为
失，故曰若得若失也。
《内经》针法，候其气之呼吸出入，及针锋之所向，以为补泻，是皆以一穴之顺逆为迎随。此则以针
本经来处之穴，为迎为泻，针去处之穴，为随为补，是以本穴之前后穴为迎随矣。义相近而法各殊。
八十难曰∶经言有见如入，有见如出者，何谓也？然∶所谓有见如入者，谓左手见气来至，乃内针，针
入见气尽，乃出针。是谓有见如入、有见如出也。
此节内如字皆读作而字，其义自明。
八十一难曰∶经言无实实虚虚，损不足而益有余。是寸口脉耶？将病自有虚实耶？其损益奈何？然∶
是病，非谓寸口脉也。谓病自有虚实也。假令肝实而肺虚，肝者木也，肺者金也，金木当更相平，当知金平
木。假令肺实而肝虚微少气，用针不补其肝，而反重实其肺，故曰实实虚虚，损不足而益有余。此者中工之所害也。
第六十二难说：五脏的井、荥穴各只有五个，而六腑却独有六个，这是什么意思呢？回答说：六腑属阳。三焦之气运行于诸阳经，所以增设一个原穴，名叫“原”。之所以六腑有六个输穴，是因为与三焦共有一气。所谓“共一气”，是指三焦之气也运行于诸阳经，并非指所有脏腑之气都完全出于三焦。
第六十三难说：《十变》中提到，五脏六腑的荥穴和合穴，都以井穴为起始，为什么呢？回答说：井穴对应东方春季，是万物开始生长的时节。凡是行走喘息、飞翔蠕动的生物，作为应当出生的事物，没有不随着春天而生的。所以岁数从春天开始计算，日数从甲日开始计算，因此以井穴为起始。
《灵枢·本输》篇中说：脏的井穴都属木，腑的井穴都属金。这里说脏腑的井穴都属木，可能是越人（秦越人/扁鹊）另有依据。《难经》中有与《内经》不同的地方，都在每难之后注明，以等待考证订正。
第六十四难说：《十变》又提到，阴经的井穴属木，阳经的井穴属金；阴经的荥穴属火，阳经的荥穴属水；阴经的俞穴属土，阳经的俞穴属木；阴经的经穴属金，阳经的经穴属火；阴经的合穴属水，阳经的合穴属土。阴阳五行属性都不同，其中的道理是什么呢？回答说：这是刚柔相配的道理。阴井穴属乙木，阳井穴属庚金。阳井穴的庚，庚是乙的刚；阴井穴的乙，乙是庚的柔。乙属木，所以说阴井属木；庚属金，所以说阳井属金。其余类推。后半段论述阴阳配合的道理，意义非常精当。
第六十五难说：经文说“所出为井，所入为合”，这种方法是怎么回事呢？回答说：所出为井，井对应东方春季，是万物开始生长的，所以说所出为井。所入为合，合对应北方冬季，阳气潜入收藏，所以说所入为合。
第六十六难说：经文说肺的原穴出于太渊；心的原穴出于大陵；肝的原穴出于太冲；脾的原穴出于太白；肾的原穴出于太溪；少阴的原穴出于兑骨（神门）；胆的原穴出于丘墟；胃的原穴出于冲阳；三焦的原穴出于阳池；膀胱的原穴出于京骨；大肠的原穴出于合谷；小肠的原穴出于腕骨。十二经脉都以俞穴作为原穴，为什么呢？回答说：五脏的俞穴，是三焦之气运行的部位，也是真气停留止聚的地方。为什么三焦运行的俞穴就是原穴呢？回答说：脐下肾间的动气，是人的生命根本，也是十二经脉的根本，所以名叫“原”。三焦是原气的别使，主要通行上、中、下三焦之气，经历于五脏六腑。原，是三焦的尊称，所以真气停留之处就称为原。五脏六腑如果有病，都要取用其原穴。
《灵枢·本输》篇说：心穴出于中冲，是井穴属木等等，这是将手厥阴心包络的穴位，当作心经出入的部位。因为心是人体的主宰，精神所居之处，其脏坚固，邪气不能侵犯，所以邪气在心者，实际上都在心包络。因此以大陵作为心的原穴。然而《甲乙经》说少冲是心的井穴等等，是以心经为本经，仍以本经的穴位作为井、荥、俞、经、合，这实际上是两条经脉都不存在的说法。这里以兑骨作为少阴的原穴，或许就是《甲乙经》的依据。
第六十七难说：五脏的募穴都在阴面（胸腹部），而俞穴都在阳面（背部），这是什么意思呢？回答说：阴病会反映在阳面，阳病会反映在阴面。所以令募穴在阴，俞穴在阳。
第六十八难说：五脏六腑，都有井、荥、俞、经、合五穴，它们各自主治什么病症呢？回答说：经文说所出为井，所流为荥，所注为俞，所行为经，所入为合。井穴主治心下满闷，荥穴主治身体发热，俞穴主治身体沉重和关节疼痛，经穴主治喘咳和寒热往来，合穴主治气逆和泄泻。这就是五脏六腑井、荥、俞、经、合五穴所主治的病症。
第六十九难说：经文说虚证用补法，实证用泻法，不虚不实则以本经取穴治疗。这是什么意思呢？回答说：虚证要补其母穴，实证要泻其子穴，应当先补后泻。不虚不实，以本经取穴治疗，是指正经自己生病，没有被其他邪气干扰，应当直接取本经穴位，所以说以经取之。
《内经》中的补泻方法，有的取本经，有的取他经，有的先泻后补，有的先补后泻，有的只取一经，有的取三四经，方法不一。如果一概以补母泻子作为固定法则，那未必正确。
第七十难说：春夏季节针刺浅，秋冬季节针刺深，这是什么意思呢？回答说：春夏季节，阳气在上，人气也在上，所以应当浅刺；秋冬季节，阴气在下，人气也在下，所以应当深刺。春夏各致一阴，秋冬各致一阳，这是什么意思呢？回答说：春夏气候温暖，必须致一阴，即初下针时，深刺至肝肾所在的深层部位，得气后，牵引持守以引入阴气。秋冬气候寒冷，必须致一阳，即初进针时，浅刺至心肺所在的浅层部位，得气后，推进深入以引出阳气。这就叫春夏必致一阴，秋冬必致一阳。
第七十一难说：经文说刺荣穴不要伤及卫气，刺卫穴不要伤及荣气。这是什么意思呢？回答说：刺阳分（卫）的穴位，要卧针斜刺；刺阴分（荣）的穴位，要用左手按压所针的荥俞穴处，待气散开后再进针。这就叫刺荣不伤卫，刺卫不伤荣。
卧针斜刺即《灵枢·官针》篇中的浮刺法。按压散气，即《素问·离合真邪论》中的扪而循之等方法。以此作为刺阴、刺阳的方法，也简便恰当可供效法。
第七十二难说：经文说能知道迎随的气机变化，就可以调理气血。调理气血的方法，必然在于阴阳。这是什么意思呢？回答说：所谓迎随，是指了解荣卫之气的流行和经脉气血的往来。顺着或逆着气血流向来取穴，所以叫迎随。调理气血的方法必然在于阴阳，是指明白内外表里的关系，顺应阴阳来调理，所以叫调理气血的方法必然在于阴阳。
第七十三难说：所有的井穴，肌肉浅薄，经气少，不足以施治，该怎么刺呢？回答说：所有的井穴属木；荥穴属火。火是木的子行。当需要刺井穴时，可以用荥穴来泻之。所以经文说补法不可以当作泻法，泻法不可以当作补法。说的就是这个道理。
第六十九难是用别经来区分子母，这里又是以一经内的子母关系来论述，含义各不相同但道理极其精妙。
第七十四难说：经文说春刺井，夏刺荥，季夏刺俞，秋刺经，冬刺合，这是什么意思呢？回答说：春刺井，是因为邪气在肝；夏刺荥，是因为邪气在心；季夏刺俞，是因为邪气在脾；秋刺经，是因为邪气在肺；冬刺刺合，是因为邪气在肾。肝、心、脾、肺、肾分别与春、夏、秋、冬相联系，为什么呢？回答说：五脏一旦生病，往往会有五种表现。例如肝病：面色青的是肝，气味臊臭的是肝，喜欢酸味的是肝，喜欢呼喊的是肝，喜欢哭泣的是肝。其病症众多，无法尽述。四季各有定数，并且都联系于春夏秋冬。针刺的要妙，在于细微如秋毫之处。
第七十五难说：经文说东方实，西方虚，泻南方，补北方，这是什么意思呢？回答说：金、木、水、火、土应当相互平衡。东方属木，西方属金。木欲实，金应当制约它；火欲实，水应当制约它；土欲实，木应当制约它；金欲实，火应当制约它；水欲实，土应当制约它。东方对应肝，则知肝实；西方对应肺，则知肺虚。泻南方的火，补北方的水。南方属火，火是木的子行；北方属水，水是木的母行，水能胜火。子能令母实，母能令子虚，所以泻火补水，目的是让金能够平抑木。经文说：不能治疗虚证，还问其他的干什么。说的就是这个道理。
第六十九难说：虚则补母，实则泻子。现在这里是实证泻子并补母，虚证反而补其子，不详是什么原因。
第七十六难说：什么叫补泻？当补的时候，从哪里获取气？当泻的时候，把气放置在哪里？回答说：当补的时候，从卫分取气；当泻的时候，从荣分置气。如果阳气不足，阴气有余，应当先补阳，而后泻阴。如果阴气不足，阳气有余，应当先补阴，而后泻阳。荣卫之气通行，这是关键所在。
第七十七难说：经文说上工治未病，中工治已病，这是什么意思呢？回答说：所谓治未病，是见到肝病，就知道肝会传变给脾，所以先充实脾气，不让脾受到肝邪的侵害，所以叫治未病。中工见到肝病，不懂传变规律，只是一心治疗肝，所以叫治已病。
《金匮要略》首篇关于上工治未病的章节，与此正相符合，但在《灵枢》、《素问》两经中没有看到。想是张仲景引用了越人的说法，而越人又有另外的依据。
第七十八难说：针刺有补泻，是什么意思呢？回答说：补泻的方法，不一定在于呼吸进出针。懂得针刺的人信赖左手；不懂得针刺的人，信赖右手。当针刺时，先用左手按压所针的荥俞穴处，弹击使其隆起，指甲切按向下，此时经气到来，像动脉搏动一样，顺着针势刺入。得气后向内推纳，这叫补；向外提引摇动，这叫泻。如果不得气，就根据男女区别对待（男外女内）。如果不得气，就是十死不治的情况。
呼吸进出针作为补泻的方法，就是《素问·离合真邪论》所说的内容。越人认为补泻的方法不止于此，所以用信赖左手、信赖右手的说法来发挥阐述。
第七十九难说：经文说迎而夺之，怎么会不虚？随而济之，怎么会不实？虚和实，好像得到又好像失去；实和虚，好像存在又好像不存在。这是什么意思呢？回答说：迎而夺之，是泻其子穴；随而济之，是补其母穴。例如心病，泻手厥阴心包络的俞穴，这叫迎而夺之；补手厥阴心包络的井穴，这叫随而济之。所谓实与虚，是指针感的牢固与濡软之意。气感坚实牢靠为得气，濡软虚弱为失气，所以说好像得到又好像失去。
《内经》的针法，观察气的呼吸出入以及针尖的方向，作为补泻，这些都是以一穴的顺逆作为迎随。这里是以本经来处的穴位为迎为泻，去处的穴位为随为补，是以本穴的前后穴位作为迎随。义理相近但方法不同。
第八十难说：经文说有见如入，有见如出，是什么意思呢？回答说：所谓有见如入，是指左手感觉到气来至，才进针；针入后见到气尽，才出针。这就叫有见如入、有见如出。
这一节中的“如”字都读作“而”字，其意义自然明了。
第八十一难说：经文说不要实实虚虚，损伤不足而增加有余。这是指寸口脉吗？还是疾病本身就有虚实？损益该怎么做呢？回答说：这是指疾病，不是指寸口脉。是说疾病本身有虚实。例如肝实而肺虚，肝属木，肺属金，金木应当相互平衡，应当知道用金来平木。例如肺实而肝虚，气息微弱，用针如果不补肝，反而加重肺的实证，这就叫实实虚虚，损伤不足而增加有余。这是中工造成的危害。
Difficulty 62 states: The Jing-Well and Ying-Spring acupoints of the Zang organs are only five in number, whereas the Fu organs have six. What is the reason for this? The answer is: The Fu organs belong to Yang. The San Jiao (Triple Burner) Qi circulates through all the Yang meridians; therefore, an additional Yuan-Source point is established, named "Yuan" (Source). The reason why the Fu organs have six points is that they share one Qi with the San Jiao. To "share one Qi" means that the Qi also circulates through the Yang meridians, not that all organ Qi originates solely from the San Jiao.
Difficulty 63 states: The *Shi Bian* (Ten Transformations) mentions that the Ying-Spring and He-Sea points of the Five Zang and Six Fu organs all begin with the Jing-Well point. Why is this? The answer is: The Jing-Well point corresponds to the East and Spring, the time when all things begin to grow. All creatures that walk, breathe, fly, or crawl, as well as all living things that come into existence, are born in accordance with Spring. Therefore, the year begins with Spring, and the days begin with Jia (the first Heavenly Stem); thus, treatment begins with the Jing-Well point.
The *Ling Shu · Ben Shu* chapter states: The Jing-Well points of the Zang organs belong to Wood, while those of the Fu organs belong to Metal. Here it says the Jing-Well points of both Zang and Fu belong to Wood, which may indicate that Yue Ren (Bian Que) had a different source. Differences between the *Nan Jing* and the *Nei Jing* are noted after each difficulty for future verification.
Difficulty 64 states: The *Shi Bian* further states: Yin Jing-Well points belong to Wood, Yang Jing-Well points to Metal; Yin Ying-Spring points to Fire, Yang Ying-Spring points to Water; Yin Shu-Stream points to Earth, Yang Shu-Stream points to Wood; Yin Jing-River points to Metal, Yang Jing-River points to Fire; Yin He-Sea points to Water, Yang He-Sea points to Earth. The Yin and Yang attributes differ completely. What is the meaning? The answer is: This concerns the relationship of Gang (Firm/Yang) and Rou (Soft/Yin). The Yin Jing-Well point is Yi Wood, and the Yang Jing-Well point is Geng Metal. Geng (Yang Metal) is the Gang aspect of Yi (Yin Wood), and Yi is the Rou aspect of Geng. Since Yi belongs to Wood, it is said that the Yin Jing-Well point is Wood; since Geng belongs to Metal, it is said that the Yang Jing-Well point is Metal. The rest follow this pattern. The latter part discusses the principles of Yin-Yang pairing with great precision.
Difficulty 65 states: The classic says, "What emerges is the Jing-Well, what enters is the He-Sea." How does this method work? The answer is: What emerges is the Jing-Well. The Jing-Well corresponds to the East and Spring, the beginning of all growth, hence "what emerges is the Jing-Well." What enters is the He-Sea. The He-Sea corresponds to the North and Winter, when Yang Qi enters and stores, hence "what enters is the He-Sea."
Difficulty 66 states: The classic says the Yuan-Source point of the Lung emerges at Taiyuan (LU 9); the Yuan-Source point of the Heart emerges at Daling (PC 7); the Yuan-Source point of the Liver emerges at Taichong (LR 3); the Yuan-Source point of the Spleen emerges at Taibai (SP 3); the Yuan-Source point of the Kidney emerges at Taixi (KI 3); the Yuan-Source point of the Shaoyin emerges at Duigu (Shenmen, HT 7); the Yuan-Source point of the Gallbladder emerges at Qiuxu (GB 40); the Yuan-Source point of the Stomach emerges at Chongyang (ST 42); the Yuan-Source point of the San Jiao emerges at Yangchi (TE 4); the Yuan-Source point of the Bladder emerges at Jinggu (BL 64); the Yuan-Source point of the Large Intestine emerges at Hegu (LI 4); the Yuan-Source point of the Small Intestine emerges at Wangu (SI 4). Why do all twelve meridians use the Shu-Stream point as the Yuan-Source point? The answer is: The Shu-Stream points of the Five Zang organs are where the Qi of the San Jiao travels and where the True Qi stays and stops. Why is the Shu-Stream point where the San Jiao travels considered the Yuan-Source? The answer is: The moving Qi between the kidneys below the navel is the root of human life and the foundation of the twelve meridians, hence it is called "Yuan" (Source). The San Jiao is the special envoy of the Yuan Qi, primarily responsible for circulating the Qi of the Upper, Middle, and Lower Burners through the Five Zang and Six Fu organs. Yuan is the honorific title of the San Jiao; therefore, wherever the Qi stops, it is called Yuan. When any of the Five Zang or Six Fu organs are diseased, their Yuan points should be selected.
The *Ling Shu · Ben Shu* chapter states: The Heart point emerges at Zhongchong, which is the Jing-Well point belonging to Wood, etc. This treats the acupoints of the Hand-Jueyin Pericardium meridian as the exit and entry points of the Heart. Because the Heart is the master of the body and the residence of the Spirit, its organ is solid and cannot be invaded by pathogens; thus, pathogenic factors affecting the Heart actually affect the Pericardium. Therefore, Daling is taken as the Yuan-Source point of the Heart. However, the *Jia Yi Jing* states that Shaochong is the Jing-Well point of the Heart, treating the Heart meridian itself as having its own Jing, Ying, Shu, Jing, and He points. This description does not exist in either of the two meridians. Taking Duigu as the Yuan-Source point of Shaoyin might be based on the *Jia Yi Jing*.
Difficulty 67 states: The Mu-Acupuncture points of the Five Zang organs are all on the Yin side (anterior trunk), while the Shu-Back points are all on the Yang side (back). What does this mean? The answer is: Yin diseases manifest on the Yang side, and Yang diseases manifest on the Yin side. Therefore, the Mu points are located on the Yin side, and the Shu points on the Yang side.
Difficulty 68 states: The Five Zang and Six Fu organs all have Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points. What do they govern? The answer is: The classic states: what emerges is the Jing-Well, what flows is the Ying-Spring, what pours is the Shu-Stream, what moves is the Jing-River, and what enters is the He-Sea. The Jing-Well governs fullness in the heart region; the Ying-Spring governs fever; the Shu-Stream governs heaviness of the body and pain in the joints; the Jing-River governs coughing, wheezing, chills, and fever; the He-Sea governs rebellious Qi and diarrhea. These are the diseases governed by the Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points of the Five Zang and Six Fu organs.
Difficulty 69 states: The classic states: tonify deficiency, sedate excess, and if neither deficient nor excess, treat according to the meridian. What does this mean? The answer is: Tonify the Mother in cases of deficiency, sedate the Child in cases of excess. One should tonify first, then sedate. "Neither deficient nor excess, treat according to the meridian" means the primary meridian is diseased itself without interference from external pathogens; thus, one should select points from that specific meridian directly, hence "treat according to the meridian."
The tonification and sedation methods in the *Nei Jing* vary: some take points from the same meridian, others from different meridians; some sedate first then tonify, others tonify first then sedate; some use one meridian, others three or four. The methods are not uniform. If one were to rigidly apply "tonify the Mother and sedate the Child" as a fixed rule, it would not necessarily be correct.
Difficulty 70 states: In spring and summer, puncture shallowly; in autumn and winter, puncture deeply. What is the reason? The answer is: In spring and summer, Yang Qi is above, and human Qi is also above, so one should puncture shallowly. In autumn and winter, Yin Qi is below, and human Qi is also below, so one should puncture deeply. What does "spring and summer each achieve one Yin, autumn and winter each achieve one Yang" mean? The answer is: Spring and summer are warm; to achieve one Yin, upon initial insertion, penetrate deeply to the level of the Liver and Kidney (deep layers), obtain Deqi, and hold/pull to draw in Yin Qi. Autumn and winter are cold; to achieve one Yang, upon initial insertion, place the needle superficially to the level of the Heart and Lungs (superficial layers), obtain Deqi, and push forward to bring out Yang Qi. This is called achieving one Yin in spring and summer, and one Yang in autumn and winter.
Difficulty 71 states: The classic states: when puncturing the Ying (Blood) aspect, do not injure the Wei (Defensive) aspect; when puncturing the Wei aspect, do not injure the Ying aspect. What does this mean? The answer is: To puncture the Yang aspect (Wei), insert the needle horizontally (obliquely); to puncture the Yin aspect (Ying), use the left hand to press and massage the Ying-Stream or Shu-Stream point being needled until the Qi disperses, then insert the needle. This is called puncturing Ying without injuring Wei, and puncturing Wei without injuring Ying.
Horizontal insertion refers to the Floating Needling method in the *Ling Shu · Guan Zhen* chapter. Pressing and massaging to disperse Qi refers to methods like palpating and rubbing described in the *Su Wen · Li He Zhen Xie Lun*. These serve as simple and appropriate methods for puncturing Yin and Yang.
Difficulty 72 states: The classic states: if one knows the Qi of Ying (meeting/opposing) and Sui (following), one can regulate it. The method of regulating Qi must lie in Yin and Yang. What does this mean? The answer is: "Ying and Sui" refers to knowing the circulation of Ying and Wei Qi and the flow of Qi and Blood in the meridians. By taking points against or with the direction of flow, it is called Ying and Sui. "The method of regulating Qi must lie in Yin and Yang" means understanding the interior/exterior and surface/depth relationships, and regulating according to Yin and Yang, hence "the method of regulating Qi must lie in Yin and Yang."
Difficulty 73 states: All Jing-Well points have thin muscle and little Qi, insufficient for treatment. How should they be punctured? The answer is: All Jing-Well points belong to Wood; Ying-Spring points belong to Fire. Fire is the Child of Wood. When one wishes to puncture the Jing-Well point, one should sedate using the Ying-Spring point. Thus, the classic states that tonification cannot be used as sedation, and sedation cannot be used as tonification. This is what is meant.
While Difficulty 69 distinguishes Mother and Child between different meridians, this difficulty uses the Mother-Child relationship within a single meridian. The meanings differ, but the logic is extremely refined.
Difficulty 74 states: The classic states: in Spring puncture Jing-Well, in Summer puncture Ying-Spring, in Late Summer puncture Shu-Stream, in Autumn puncture Jing-River, in Winter puncture He-Sea. What is the reason? The answer is: Puncturing Jing-Well in Spring because the pathogen is in the Liver; puncturing Ying-Spring in Summer because the pathogen is in the Heart; puncturing Shu-Stream in Late Summer because the pathogen is in the Spleen; puncturing Jing-River in Autumn because the pathogen is in the Lung; puncturing He-Sea in Winter because the pathogen is in the Kidney. Why are the Liver, Heart, Spleen, Lung, and Kidney associated with Spring, Summer, Autumn, and Winter? The answer is: When one of the Five Zang organs is diseased, there are usually five manifestations. For example, Liver disease: green complexion indicates Liver; fishy odor indicates Liver; preference for sour taste indicates Liver; desire to shout indicates Liver; desire to weep indicates Liver. The symptoms are numerous and cannot be fully listed. The four seasons have their numbers and are all associated with Spring, Summer, Autumn, and Winter. The subtlety of acupuncture lies in details as fine as autumn down.
Difficulty 75 states: The classic states: East is Excess, West is Deficiency; sedate South, tonify North. What does this mean? The answer is: Metal, Wood, Water, Fire, and Earth should balance each other. The East belongs to Wood, the West to Metal. If Wood becomes excessive, Metal should restrain it; if Fire becomes excessive, Water should restrain it; if Earth becomes excessive, Wood should restrain it; if Metal becomes excessive, Fire should restrain it; if Water becomes excessive, Earth should restrain it. The East corresponds to the Liver, indicating Liver Excess; the West corresponds to the Lung, indicating Lung Deficiency. Sedate the Southern Fire, tonify the Northern Water. The South belongs to Fire, which is the Child of Wood; the North belongs to Water, which is the Mother of Wood. Water overcomes Fire. The Child can make the Mother Excess, and the Mother can make the Child Deficient. Therefore, by sedating Fire and tonifying Water, the intention is to allow Metal to balance Wood. The classic says: "If you cannot treat the deficiency, what else is there to ask?" This is what is meant.
Difficulty 69 states: Deficiency is treated by tonifying the Mother, Excess by sedating the Child. Here, Excess is treated by sedating the Child and tonifying the Mother, while Deficiency is treated by tonifying the Child. The reason is unclear.
Difficulty 76 states: What are tonification and sedation? When tonifying, from where is Qi obtained? When sedating, where is Qi placed? The answer is: When tonifying, obtain Qi from the Wei (Defensive) layer; when sedating, place Qi in the Ying (Nutritive) layer. If Yang Qi is deficient and Yin Qi is excessive, one should first tonify Yang, then sedate Yin. If Yin Qi is deficient and Yang Qi is excessive, one should first tonify Yin, then sedate Yang. The free circulation of Ying and Wei Qi is the key.
Difficulty 77 states: The classic states: superior physicians treat disease before it arises (Zhi Wei Bing), while average physicians treat disease after it has arisen. What does this mean? The answer is: Treating disease before it arises means seeing Liver disease and knowing that the Liver will transmit to the Spleen; therefore, one first strengthens the Spleen Qi to prevent it from receiving the Liver pathogen. This is called treating disease before it arises. Average physicians see Liver disease, do not understand the transmission, and focus solely on treating the Liver; this is called treating disease after it has arisen.
The section on "Superior Physicians Treat Disease Before It Arises" in the first chapter of the *Jin Gui Yao Lue* aligns perfectly with this, yet it is not found in the *Ling Shu* or *Su Wen*. It is likely that Zhang Zhongjing cited Yue Ren's words, and Yue Ren himself had another source.
Difficulty 78 states: Acupuncture has tonification and sedation. What does this mean? The answer is: The method of tonification and sedation does not necessarily depend on respiration and needle withdrawal/insertion. A skilled acupuncturist relies on the left hand; an unskilled one relies on the right hand. At the time of needling, first use the left hand to press, massage, tap, and nail the Ying-Stream or Shu-Stream point. When the Qi arrives, resembling a pulsating artery, insert the needle along this sensation. Obtaining Deqi, pushing the needle inward is tonification; withdrawing and shaking the needle outward is sedation. If Deqi is not obtained, differentiate by gender (men: exterior/superficial manipulation; women: interior/deep manipulation). If Deqi is still not obtained, it indicates ten deaths and untreatable conditions.
Respiration-based insertion and withdrawal as tonification/sedation methods refer to the *Su Wen · Li He Zhen Xue Lun*. Yue Ren believed that tonification and sedation methods extend beyond this, hence elaborating on the reliance on the left versus right hand.
Difficulty 79 states: The classic states: Ying (opposing) and seizing it, how can it not become deficient? Sui (following) and assisting it, how can it not become excess? Deficiency and Excess seem like gaining and losing; Excess and Deficiency seem like existing and not existing. What does this mean? The answer is: Ying and seizing refers to sedating the Child point; Sui and assisting refers to tonifying the Mother point. For example, in Heart disease, sedating the Shu-Stream point of the Hand-Jueyin Pericardium is Ying and seizing; tonifying the Jing-Well point of the Hand-Jueyin Pericardium is Sui and assisting. Regarding Excess and Deficiency, it refers to the sensation of firmness vs. softness. A firm and solid Qi sensation indicates successful Deqi (gaining); a soft and weak sensation indicates failure (losing). Hence, "seeming to gain and seeming to lose."
The *Nei Jing* acupuncture methods observe respiration and needle direction for tonification and sedation, using the orientation of a single point as Ying and Sui. Here, points upstream in the same meridian are used for Ying (sedation), and points downstream for Sui (tonification), using adjacent points as Ying and Sui. The principle is similar, but the method differs.
Difficulty 80 states: The classic states: "See as entering, see as exiting." What does this mean? The answer is: "See as entering" means that when the left hand feels the Qi arriving, the needle is inserted. After insertion, when the Qi sensation dissipates, the needle is removed. This is called "see as entering" and "see as exiting."
In this section, the character "Ru" (as/if) is read as "Er" (and/then), making the meaning clear.
Difficulty 81 states: The classic states: Do not make Excess more Excess or Deficiency more Deficient; do not damage what is insufficient and add to what is already in excess. Does this refer to the Cun Kou pulse? Or does the disease itself have Excess and Deficiency? How should the tonification and sedation be applied? The answer is: This refers to the disease, not the Cun Kou pulse. It means the disease itself has Excess and Deficiency. For example, Liver Excess and Lung Deficiency: Liver is Wood, Lung is Metal. Metal and Wood should balance each other; one should know to use Metal to balance Wood. If the Lung is Excess and the Liver is slightly Deficient with shortness of breath, and the needle practitioner fails to tonify the Liver but instead reinforces the Lung Excess, this is called "making Excess more Excess and Deficiency more Deficient," damaging the insufficient and adding to the excessive. This is the harm caused by average physicians.