经言∶虚者补之，实者泻之，不虚不实，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。不虚不实，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。
经言∶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，阳气在下，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。
经言∶刺荣无伤卫，刺卫无伤劳，何谓也？然，刺阳者，卧针而刺之；刺阴者，先以左
手摄按所针荣俞之处，气散乃内针，是谓刺荣无伤卫，刺卫无伤荣也。
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。
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。
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。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，欲令金不得平木也。经曰∶不能治其虚，何问
其余。此之谓也。
金不得“不”字疑衍。谓泻火以抑木、补水以济金，欲令金得平木。一云∶泻火补水
，而旁治之，不得径以金平木。
\r补水泻火之图\pG-G16.bmp\r
火者木之子，子能令母实，谓子有余，则不食于母。今泻南方者，夺子之气，使之食
其母也。金者水之母，母能令子虚，谓母不足则不能荫其子。今补北方者，益子之气，则不
\x至食其母也。此与《八十一难》义正相发。其曰∶不能治其虚，安问其余，则隐然实实虚虚
经言∶上工治未病，中工治已病，何谓也？然，所谓治未病者，见肝之病，则知肝当传
之于脾，故先实其脾气，无令得受肝之邪，故曰治未病焉。中工见肝之病，不晓相传，但一
心治肝，故曰治已病也。
\r五脏传病之图\pG-G17.bmp\r
心病传肺，肺传肝，肝传脾，脾传肾，肾传心，心复传肺，七传者死，谓传其所胜也。
心病传脾，脾传肺，肺传肾，肾传肝，肝传心，间脏者生，谓传其子也。
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。
针有补泻，何谓也？然，补泻之法，非必呼吸出内针也。然，知为针者信其左，不知为
针者信其右。当刺之时，必先以左手压按所针荥俞之处，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，是谓十死不治也。
信其左，谓善针者，信用左手，不知针法者，自右手起也。
经言∶迎而夺之，恶得无虚？随而济之，恶得无实？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。
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。
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。
经文说：虚证用补法，实证用泻法，不虚不实之证，取本经穴位治疗，这是什么意思呢？回答是：虚证补其母穴，实证泻其子穴，应当先补后泻。不虚不实的证候，取本经穴位治疗，是指本经自生疾病，未受他经邪气侵袭，所以直接取本经穴位治疗，因此说“以经取之”。
经文说：春夏季节针刺宜浅，秋冬季节针刺宜深，这是什么意思呢？回答是：春夏时节，阳气上升于体表，人体正气也趋向于体表，所以应当浅刺。秋冬时节，阳气潜藏于体内，人体正气也沉伏于体内，所以应当深刺。
春夏各需引入一阴，秋冬各需引入一阳，这是什么意思呢？回答是：春夏气候温暖，必须引入一阴气的方法是：初下针时，将针深刺至肾、肝所在的深层部位，得气后牵引持守以获取阴气。秋冬气候寒冷，必须引入一阳气的方法是：初进针时浅刺并浮提，至心、肺所在的浅层部位，得气后推动内按以获取阳气。这就叫作春夏必致一阴，秋冬必致一阳。
经文说：刺荣分不要伤及卫分，刺卫分不要伤及荣分，这是什么意思呢？回答是：刺阳分（卫），要卧针斜刺；刺阴分（荣），先用左手按压所针的荣俞穴位处，待局部气血散开后再进针，这就叫作刺荣不伤卫，刺卫不伤荣。
经文说：懂得迎随补泻之气机，就可以调和气血，调和气血的方法，关键在于阴阳，这是什么意思呢？回答是：所谓迎随，是了解营卫之气的流行和经脉气血的往来，顺着或逆着气血运行的方向进行针刺，所以称为迎随。调和气血的方法，关键在于阴阳，是了解病位的内外表里，根据阴阳属性来调理，所以说是调和气血的方法，关键在于阴阳。
五腧穴中的井穴，位于肌肉浅薄之处，经气少而不足以施术。该如何针刺呢？回答是：诸井穴属木，荥穴属火。火是木之子，当刺井穴时，应用荥穴来泻之。所以说补法不能当作泻法用，泻法不能当作补法用，就是这个道理。
经文说：东方实（肝实），西方虚（肺虚），泻南方（心），补北方（肾），这是什么意思呢？回答是：金、木、水、火、土五行应当相互平衡。东方属木，西方属金，木欲实则金应制约它；水欲实则土应制约它。东方对应肝，故知肝实；西方对应肺，故知肺虚。泻南方火，补北方水。南方火，是木之子；北方水，是木之母。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（肺）得以制约木（肝）。经说：“不能治疗虚证，还问其余什么呢？”就是这个意思。
注：原文“金不得”后的“不”字疑为衍文。意为泻火以抑制木气、补水以资助金气，希望金能平抑木。另一种说法：泻火补水，旁路治疗，不能直接用金来平木。
[图：补水泻火之图]
火是木之子，子能令母实，意思是子气有余，则不消耗母气。现在泻南方（心火），是夺取子气，使其消耗母气（肝木）。金是水之母，母能令子虚，意思是母气不足则不能荫蔽子气。现在补北方（肾水），是增益子气，则不会去消耗母气（金）。这与《八十一难经》的意义正好互相阐发。其中说：“不能治其虚，安问其余”，则隐含了“实实虚虚”的错误。
经文说：上工（高明医生）治未病，中工（普通医生）治已病，这是什么意思呢？回答是：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，只一心治疗肝脏，所以叫治已病。
[图：五脏传病之图]
心病传肺，肺传肝，肝传脾，脾传肾，肾传心，心再传肺，这叫七传，预后不良（死），是指传其所克之脏。
心病传脾，脾传肺，肺传肾，肾传肝，肝传心，这叫间脏，预后良好（生），是指传其所生之脏。
什么是补泻？当补的时候，从哪里取得气？当泻的时候，把气置于哪里？回答是：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，后泻阴。如果阴气不足，阳气有余，应当先补阴，后泻阳。荣卫之气通畅运行，这是关键所在。
针刺有补泻之分，是什么意思呢？回答是：补泻的方法，不一定非要配合呼吸进出针。但是，懂针刺的人信赖左手，不懂针刺的人信赖右手。当针刺时，必须先以左手按压所针的荥俞穴位处，弹击使气血充盈，指甲切压定穴，感觉气至如动脉搏动状，顺针势刺入，得气后向内推纳，这叫补。向外提引摇动，这叫泻。如果不得气，则根据男女不同采取男外女内的方法（指左右手操作或深浅差异），若仍不得气，则是十死不治的危症。
“信其左”，意思是善于针刺者，信赖并使用左手；不懂针法者，只靠右手操作。
经文说：迎而夺之，怎么会不虚？随而济之，怎么会不实？虚与实的感觉，如同得到又失去。实与虚的状态，若有若无，这是什么意思呢？回答是：迎而夺之，是泻其子穴。随而济之，是补其母穴。例如心病泻手心主（心包）的输穴，这叫迎而夺之。补手心主的井穴，这叫随而济之。所谓实与虚，是指针下感觉的坚实与濡软。气感坚实牢固为得气（有效），濡软虚弱为失气（无效），所以说“若得若失”。
经文说：有见如入，有见如出，这是什么意思呢？回答是：所谓有见如入，是指左手感觉到气至，然后进针；针入后看到气尽（邪气退去或经气调匀），然后出针，这就叫有见如入，有见如出。
经文说：不要使实证更实，虚证更虚，不要损害不足的正气而增加有余的邪气。这是指寸口脉而言吗？还是指疾病本身有虚实？损益的方法是怎样的？回答是：这里说的不是指寸口脉，而是指疾病本身有虚实。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。假如肺实而肝虚且微少气，用针时不补肝，反而加重肺的实证，这就叫“实实虚虚”，损害不足而增加有余，这是中工造成的危害。
The classic states: "Tonify deficiency, sedate excess, and treat non-deficient/non-excess conditions by selecting points from the affected meridian." What does this mean? The answer is: For deficiency, tonify its mother point; for excess, sedate its child point. One should first tonify, then sedate. For conditions that are neither deficient nor excessive, treating by selecting points from the affected meridian means the disease originated within the meridian itself without invasion from other pathogenic factors. Therefore, one directly selects points from that meridian, hence the term "selecting from the meridian."
The classic states: "In spring and summer, needle shallowly; in autumn and winter, needle deeply." What does this mean? The answer is: In spring and summer, Yang Qi ascends to the exterior, and human Qi also tends toward the exterior; thus, shallow needling is appropriate. In autumn and winter, Yang Qi sinks to the interior, and human Qi also sinks to the interior; thus, deep needling is appropriate.
"In spring and summer, each introduces one Yin; in autumn and winter, each introduces one Yang." What does this mean? The answer is: Spring and summer are warm. To introduce one Yin: upon initial insertion, drive the needle deeply to the regions of the Kidney and Liver (Yin organs). Upon obtaining Deqi (arrival of Qi), draw and hold to acquire Yin Qi. Autumn and winter are cold. To introduce one Yang: initially insert the needle shallowly and lift it superficially to the regions of the Heart and Lungs (Yang organs). Upon obtaining Deqi, push and press inward to acquire Yang Qi. This is called introducing one Yin in spring and summer, and one Yang in autumn and winter.
The classic states: "When needling Ying (Nutrient) points, do not injure Wei (Defensive) Qi; when needling Wei points, do not injure Ying Qi." What does this mean? The answer is: When needling Yang aspects (Wei), use a horizontal or oblique insertion (lying needle). When needling Yin aspects (Ying), first use the left hand to press and knead the acupoint area until the local Qi disperses, then insert the needle. This ensures that needling Ying does not injure Wei, and needling Wei does not injure Ying.
The classic states: "Understanding the Qi of Ying (meeting/opposing) and Sui (following/supporting) allows for regulation. The method of regulating Qi must lie in Yin and Yang." What does this mean? The answer is: "Ying and Sui" refers to understanding the circulation of Ying and Wei Qi and the flow of meridians. By following or opposing these directions, one applies Ying and Sui techniques. Regulating Qi lies in Yin and Yang because one must understand the internal/external and superficial/deep locations, adjusting according to Yin-Yang characteristics. Hence, the method of regulating Qi relies on Yin and Yang.
Regarding the Jing-Well points: The flesh is thin and Qi is scarce, insufficient for standard manipulation. How should they be needled? The answer is: Jing-Well points belong to Wood, and Ying-Spring points belong to Fire. Fire is the child of Wood. When needling a Jing-Well point, one should sedate using the corresponding 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.
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. East corresponds to Wood, West to Metal. If Wood becomes excessive, Metal should restrain it. If Water becomes excessive, Earth should restrain it. East corresponds to the Liver (Excess); West corresponds to the Lung (Deficiency). Sedate South (Fire), Tonify North (Water). South is Fire, the child of Wood. North is Water, the mother of Wood. Water overcomes Fire. The child can make the mother full; the mother can make the child empty. Therefore, sedating Fire and tonifying Water aims to allow Metal (Lung) to properly restrain Wood (Liver). The classic says: "If you cannot treat deficiency, why ask about the rest?" This is the meaning.
(Note: The character "bu" (not) after "Jin bu de" is likely a typo. It implies sedating Fire to suppress Wood and tonifying Water to assist Metal, allowing Metal to balance Wood. Another view: Sedating Fire and tonifying Water treats indirectly, avoiding direct Metal-Wood confrontation.)
[Image: Diagram of Tonifying Water and Sedating Fire]
Fire is the child of Wood; the child making the mother full means if the child has surplus, it does not consume the mother's Qi. Now, sedating South (Heart Fire) deprives the child of Qi, forcing it to consume the mother (Liver Wood). Metal is the mother of Water; the mother making the child empty means if the mother is deficient, it cannot nourish the child. Now, tonifying North (Kidney Water) benefits the child's Qi, preventing it from consuming the mother (Metal). This aligns with the principles of Difficulty 81. The phrase "If you cannot treat deficiency, how can you ask about the rest" implicitly warns against the error of "making excess more excess and deficiency more deficient."
The classic states: "Superior physicians treat disease before it arises; 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 it will transmit to the Spleen. Therefore, one first strengthens the Spleen Qi to prevent it from receiving Liver pathogens. This is called treating before the disease arises. Average physicians see Liver disease but do not understand transmission, focusing only on treating the Liver. This is called treating after the disease has arisen.
[Image: Diagram of Five Zang Disease Transmission]
Heart disease transmitting to Lung, Lung to Liver, Liver to Spleen, Spleen to Kidney, Kidney to Heart, and Heart back to Lung is called Seven Transmissions, indicating death. This refers to transmission to the conquered organ.
Heart disease transmitting to Spleen, Spleen to Lung, Lung to Kidney, Kidney to Liver, and Liver back to Heart is called Interspersed Transmission, indicating survival. This refers to transmission to the generated organ.
What constitutes tonification and sedation? When tonifying, where is Qi taken from? When sedating, where is Qi placed? The answer is: During tonification, take Qi from the Wei (Defensive) level. During sedation, place Qi at the Ying (Nutrient) level. If Yang Qi is deficient and Yin Qi is excessive, first tonify Yang, then sedate Yin. If Yin Qi is deficient and Yang Qi is excessive, first tonify Yin, then sedate Yang. The free circulation of Ying and Wei Qi is the key.
Acupuncture involves tonification and sedation. What does this mean? The answer is: The methods of tonification and sedation do not necessarily require coordination with respiration or needle withdrawal. However, a skilled practitioner relies on the left hand, while an unskilled one relies on the right. At the time of needling, one must first use the left hand to press the acupoint, flick it to engorge Qi, mark it with the fingernail, and wait for the sensation of Qi arrival (like a pulsating artery). Insert the needle smoothly. Upon obtaining Deqi, push the needle inward—this is tonification. Withdraw and manipulate the needle outward—this is sedation. If Deqi is not obtained, apply different techniques for males and females (external vs. internal manipulation). If Deqi is still not obtained, the condition is considered incurable (ten deaths).
"Relying on the left" means a good practitioner trusts and uses the left hand; those unfamiliar with technique rely solely on the right hand.
The classic states: "Ying er duo zhi" (Meeting and seizing), how can it not result in deficiency? "Sui er ji zhi" (Following and assisting), how can it not result in excess? Deficiency and excess feel like loss and gain. Excess and deficiency seem present and absent. What does this mean? The answer is: "Ying er duo zhi" means sedating the child point. "Sui er ji zhi" means tonifying the mother point. For example, in Heart disease, sedating the Shu point of the Pericardium (Hand Jueyin) is "Ying er duo zhi." Tonifying the Jing-Well point of the Pericardium is "Sui er ji zhi." Regarding excess and deficiency, it refers to the sensation of firmness versus softness. A firm and solid sensation indicates successful Deqi (gain); a soft and weak sensation indicates failure (loss). Hence, "like gain and like loss."
The classic states: "Ru you jian ru ru, ru you jian ru chu" (Enter when seen, exit when seen). What does this mean? The answer is: "Enter when seen" means waiting until the left hand perceives the arrival of Qi before inserting the needle. "Exit when seen" means withdrawing the needle once the Qi sensation has dissipated (or the treatment effect is complete). This is the principle of entering and exiting based on Qi perception.
The classic states: "Do not reinforce excess or tonify deficiency; do not damage what is insufficient and add to what is already excessive." Does this refer to the Cun Kou pulse, or does the disease itself have deficiency and excess? How should tonification and sedation be applied? The answer is: This refers to the nature of the disease itself, not merely the Cun Kou pulse. For instance, if the Liver is Excess and the Lung is Deficient: Liver is Wood, Lung is Metal. Metal should restrain Wood. If the Lung is Excess and the Liver is slightly Deficient with shortness of breath, and the practitioner fails to tonify the Liver but instead reinforces the Lung, this results in "reinforcing excess and tonifying deficiency," damaging the insufficient and adding to the excessive. This is the harm caused by average physicians.