《图注难经》云∶手三阳，从手至头，针芒从外，往上为随，针芒从内，往下为迎。足
三阳，从头至足，针芒从内，往下为随，针芒从外，往上为迎。足三阴，从足至腹，针芒从
外，往上为随，针芒从内，往下为迎。手三阴，从脑至手，针芒从内，往下为随，针芒从外
，往上为迎。大要以子午为主，左为阳（从子至午，左行为补），右为阴
（从午至子，右行为泻，阳主进，阴主退），手为阳（左手为纯阳），足为阴（右足为纯阴）。左手
阳经，为阳中之阳，左手阴经，为阳中之阴。右手阳经，为阴中之阳，右手阴经，为阳中之
阴。右足阴经，为阴中之阴，右足阳经，为阴中之阳。左足阴经，为阳中之阴，左足阳经，
为阴中之阳。今细分之，病者左手阳经，以医者右手大指进前（盐指退后），呼之为随（午后
又以大指退后为随，进前即经之从外，退后即经之从内），退后吸之为迎。病者左手阴经，
以医者右手大指退后，吸之为随，进前呼之为迎。病者右手阳经，以医者右手大指退后，吸
之为随，进前呼之为迎。病患右手阴经，以医者右手大指进前，呼之为随，退后吸之为迎。
病者右足阳经，以医者右手大指进前，呼之为随，退后吸之为迎。病者右足阴经，以医者右
手大指退后，吸之为随，进前呼之为迎。病者左足阳经，以医者右手大指退后，吸之为随，
进前呼之为迎。病者左足阴经，以医者右手大指进前，呼之为随，退后吸之为迎。男子午前
皆然，午后与女人反之。
手上阳进阴退，足上阳退阴进，合六经起止故也。凡针起穴，针芒向上，气顺行之道。
凡针止穴，针芒向下，气所止之处。左外右内，令气上行，右外左内，令气下行。或问午前
补泻，与午后相反，男子补泻，与女人相反。盖以男子之气，早在上而晚在下，女人之气，
早在下而晚在上，男女上下，平腰分之故也。至于呼吸，男女人我皆同，何亦有阴阳之分耶
？盖有自然之呼吸，有使然之呼吸，入针出针，使然之呼吸也。转针如待贵人，如握虎尾，
候其自然呼吸。若左手足候其呼而先转，则右手足，必候其吸而后转之；若右手足候其吸而
先转，则左手足必候其呼而后转之，真阴阳一升一降之消息也。故男子阳经午前以呼为补，
吸为泻。阴经以吸为补，呼为泻，午后反之。女人阳经午前以吸为补，呼为泻，阴经以呼为
补，吸为泻，午后亦反之。或者又曰∶补泻必资呼吸，假令尸厥中风，不能使之呼吸者，奈
何？曰∶候其自然之呼吸而转
针，若当吸不转，令人以手掩其口鼻，鼓动其气可也。噫！补泻提插，分男女早晚，其理深
微，原为奇经，不拘十二经常度，故参互错综如是。若流注穴，但分左右阴阳可也。尝爱《
雪心歌》云∶如何补泻有两般，盖是经从两边发，古人补泻左右分，今人乃为男女别。男女
经脉一般生，昼夜循环无暂歇，此诀出自梓桑君，我今授汝心已雪。此子午兼八法而后全也
然补泻之法，非必呼吸出内针也。有以浅深言者，经言∶春夏宜浅，秋冬宜深。有以荣
卫言者，经言∶从卫取气，从荣置气。
补则从卫取气，宜轻浅而针，从其卫气随之于后，而济益其虚也。泻则从荣，弃置其气
，宜重深而刺，取其荣气迎之于前，而泻夺其实也。然补之不可使太实，泻之不可使反虚，
皆欲以平为期耳。又男子轻按其穴，而浅刺之，以候卫气之分。女子重按其穴，而深刺之，
以候荣气之分。
有以虚实言者，经言∶虚则补其母，实则泻其子。此迎随之概也。
凡针逆而迎夺，即泻其子也。如心之热病，必泻于脾胃之分，针顺而随济，即补其母也
。如心之虚病，必补于肝胆之分。
飞经走气，亦不外于子午迎随。
凡言九者，即子阳也。六者，即午阴也。但九六数有多少不同，补泻提插皆然。言初九
数者，即一九也，少停又行一九，少停又行一九，三次共二十七数，或四九三十六数。言少
阳数者，七七四十九数，亦每次七数，略停。老阳数者，九九八十一数，每次二十七数，少
停，共行三次。言初六数者，即一六也，少停又行一六，少停又行一六，三次共一十八数。
言少阴数者，六六三十六数，每次一十八数，略停再行一次。言老阴数者，八八六十四数，
每次八数，略停。或云∶子后宜九数补阳，午后宜六数补阴。阴日刺阳经，多用六数补阴。
阳日刺阴经，多用九数补阳。此正理也，但见热症即泻，见冷症即补，权也，活法也。
经言∶知为针者信其左，不知为针者信其右。
先将同身寸法比穴，以墨点记，后令患人饮食端坐，或偃卧，缓病必待天气温晴，则气
易行。急病如遇大雷雨，亦不敢针。夜晚非急病，亦不敢针，若空心立针必晕。
当刺之时，必先以左手压按所针荥俞之处。
阳穴，以骨侧陷处，按之酸麻者为真。阴穴，按之有动脉应手者为真。
切而散之，爪而下之；
切者，以手爪掐按其所针之穴，上下四旁，令气血散。爪者，先以左手大指爪，重掐
穴上，亦令气血散耳。然后用右手盐指顶住针尾，以中指、大指紧执针腰，以无名指略扶针
头，却令患人咳嗽一声，随咳下针，刺入皮内，撒手停针十息，号曰天才。少时再进针，刺
入肉内，停针十息，号曰人才。少时再进针至筋骨之间，停针十息，号曰地才。此为极处，再
停良久，却令患人吸气一口，随吸退至人部，审其气至未，如针下沉重紧满者，为气已至。
若患人觉痛则为实，觉酸则为虚。如针下轻浮虚活者，气犹未至，后用弹努循扪引之，引
之气
，宜于地部行气。
弹而努之，扪而循之；
弹者补也，以大指与次指爪，相交而迭，病在上，大指爪轻弹向上；病在下，次指爪
轻
，补者入针飞之，令患人闭气一口，着力努之；泻者提针飞之，令患人呼之，不必着力，一
法二用，气自至者，不必用此弹努。扪者摩也，如痛处未除，即于痛处扪摩，使痛散也。复
以飞针引之，除其痛也。又起针之时，以手按其穴，亦曰扪。循者，用手于所
针部分，随经络上下循按之，使气往来，推之则行，引之则至是也。
动而伸之，推而按之；
动者转动也，推者推转也，凡转针太急则痛，太慢则不去疾，所谓推展，即分阴阳左转
右转之法也。伸者提也，按者插也，如补泻不觉气行，将针提起空如豆许，或再弹二三下以
补之。紧战者，连用飞法三下，如觉针下紧满，其气易行，即用通法。若邪盛气滞，却用提
插，先去病邪，而后通其真气。提者自地部提至人部天部，插者自天部插至人部地部。病轻
提插初九数，病重者或少阳数、老阳数，愈多愈好。或问∶治病全在提插，既云急提慢按
如冰冷，慢提急按火烧身。又云∶男子午前提针为热，插针为寒；午后提针为寒，插针为热
。女人反之，其故何耶？盖提插补泻，无非顺阴阳也。午前顺阳性，提至天部则热；午后顺
阴性，插至地部则热。奇效良方，有诗最明。
补泻提插活法∶凡补针先浅入而后深入，泻针先深入而后浅。凡提插急提慢按如冰冷，
泻也；慢提急按火烧身，补也，或先提插而后补泻，或先补泻而后提插，可也。或补泻提插
同用亦可也。如治久患瘫痪，顽麻冷痹，遍身走痛及癞风寒疟，一切冷症，先浅入针，而后
渐深入针，俱补老阳数，气行针下紧满，其身觉热带补，慢提急按老阳数，或三九而二十
七数，即用通法，扳倒针头，令患人吸气五口，使气上行，阳回阴退，名曰进气法，又曰烧
治风痰壅盛，中风，喉风，癫狂，疟疾，单热，一切热症，先深入针，而后渐浅退针，
俱泻少阴数，得气觉凉带泻，急提慢按初六数，或三六一十八数，再泻再提，即用通法，徐
徐提之，病除乃止，名曰透天凉。
治疟疾先寒后热，一切上盛下虚等症，先浅入针，行四九三十六数，气行觉热，深入行
三六一十八数。如疟疾先热后寒，一切半虚半实等症，先深入针，行六阴数，气行觉凉渐退
，针行九阳数，此龙虎交战法，俾阳中有阴，阴中有阳也。盖邪气常随正气而行，不交战，
则邪不退而正不胜，其病复起。
治 癖 瘕气块，先针入七分，行老阳数，气行便深入一寸，微伸提之，却退至原处，
不得气，根据前法再施，名曰留气法。
治水蛊膈气胀满，落穴之后，补泻调气均匀，针行上下，九入六出，左右转之，千遭自平，
名曰子午捣臼。
治损逆赤眼，痈肿初起，先以大指进前捻入左，后以大指退后捻入右，一左一右，三九
二十七数，得气向前，推转内入，以大指弹其针尾，引其阳气，按而提之，其气自行，未应
再施，此龙虎交腾法也。
杂病单针一穴，即于得气后行之，起针际行之亦可。通而取之。
通者通其气也，提插之
后用之。如病患左手阳经，以医者右手大指进前九数，却扳倒针头，带补以大指努力，针嘴
朝向病处，或上或下，或左或右，执住，直待病患觉热方停。若气又不通，以龙虎龟凤、飞
经接气之法，驱而运之。如病患左手阴经，以医者右手大指退后九数，却扳倒针头，带补以
大指努力，针嘴朝病，执住，直待病患觉热方停。右手阳经，与左手阴经同法。右手阴经，
与左手阳经同法。左足阳经，与右手阳经同法。左足阴经，与右手阴经同法。右足阳经，与
左手阳经同法。右足阴经，与左手阴经同法。如退潮，每一次先补六，后泻丸，不拘次数，
直待潮退为度。止痛同此法。痒麻虚补，疼痛实泻，此皆先正推衍《内经》通气之法，更有
取气、斗气、接气之法。取者，左取右，右取左，手取足，足取头，头取手足三阳，胸腹取
手足三阴，以不病者为主，病者为应。如两手蜷挛，则以两足为应；两足蜷挛，则以两手为
应。先下主针，后下应针，主针气已行，而后针应针，左边左手，左足同手法，右边亦然。
先斗气、接气，而后取气，手补足泻，足补手泻，如搓索然。久患偏枯蜷挛甚者，必用此法
于提插之后。徐氏曰∶通气、按气之法，已有定息寸数，手足三阳，上九而下十四，过经四
寸。手足三阴，上七而下十二，过经五寸。在乎摇动出纳，呼吸同法，上下通接，立时见功
。所谓定息寸数者，手三阴经，从胸走手，长三尺五寸；手三阳经，从手走头，长五尺；足三
阳经，从头走足，长八尺；足三阴经，从足走腹，长六尺五寸；阴阳两跷，从足走目，长七
尺五寸；督脉长四尺五寸；任脉长四尺五寸，人一呼，气行三寸，一吸气行三寸，一呼一吸
，谓之一息。针下随其经脉长短，以息计之，取其气到病所为度。
一曰青龙摆尾∶以两指扳倒针头朝病，如扶舡舵，执之不转，一左一右，慢慢拨动九数
或三九二十七数，其气遍体交流。
二曰白虎摇头∶以两指扶起针尾，以肉内针头轻转，如下水舡中之橹，振摇六数或三六
一十八数，如欲气前行，按之在后，欲气后行，按之在前，二法轻病亦可行之，摆动血气。
盖龙为气，虎为血，阳日先行龙而后虎，阴日先行虎而后龙。
三曰苍龟探穴∶以两指扳倒针头，一退三进，向上钻剔一下，向下钻剔一下，向左钻剔
一下，向右钻剔一下，先上而下，自左而右，如入土之象。
四曰赤凤迎源∶以两指扶起针，插入地部，复提至天部，候针自摇，复进至人部，上下
左右，四围飞旋，如展翅之状。病在上，吸而退之；病在下，呼而进之。又将大指爪从针尾
刮至针腰，此刮法也。能移不忍痛，可散积年风，午后又从针腰刮至针尾。又云∶病在上刮
向上，病在下刮向下。有挛急者，频宜刮切、循摄二法，须连行三五次，气血各循经络，飞
走之妙，全在此处，病邪从此退矣。放针停半时辰久，扶起针头，审看针下十分沉紧，则泻
九补六；如不甚紧，则泻六补九，补泻后针活，即摇而出之。摄者，用大指随经络上下切之
，其气自得通行。
摇而出之，外引其门，以闭其神。
摇者退也。以两指拿针尾，向上下左右各摇振五七下，提二七下，能散诸风，出针直待
微松，方可出针豆许。如病邪吸针，正气未复，再须补泻停待；如再难，频加刮切，刮后连
泻三下；次用搜法，不论数横搜，如龙虎交腾，一左一右，但手更快耳，直搜一上一下，如
捻法而不转，泻刮同前；次用盘法，左转九次，右转六次，泻刮同前；次用子午捣臼，子后
慢提，午后略快些，缓缓提插，摇出应针，次出主针，补者吸之，急出其针，便以左手大指
，按其针穴，及穴外之皮，令针穴门户不开，神气内守，亦不致出血也。泻者呼之，慢出其
针，勿令气泄，不用按穴。凡针起速，及针不停久待暮者，其病即复。
一∶凡针晕者，神气虚也，不可起针，急以别针补之，用袖掩病患口鼻回气，内与热汤
饮之，即苏，良久再针。甚者，针手膊上侧，筋骨陷中，即虾蟆肉上惺惺穴，或足三里穴，
即苏。若起针，坏人。
《图注难经》中说：手三阳经，从手部走向头部，针尖朝外、向上进针为“随”，针尖朝内、向下退针为“迎”。足三阳经，从头部分走向足部，针尖朝内、向下进针为“随”，针尖朝外、向上退针为“迎”。足三阴经，从足部走向腹部，针尖朝外、向上进针为“随”，针尖朝内、向下退针为“迎”。手三阴经，从胸部（原文误作脑，据针灸理论修正为胸/上焦）走向手部，针尖朝内、向下进针为“随”，针尖朝外、向上退针为“迎”。大原则是以子午时为主，左边属阳（从子时到午时，向左行针为补法），右边属阴（从午时到子时，向右行针为泻法，阳气主前进，阴气主后退），手部属阳（左手为纯阳），足部属阴（右足为纯阴）。左手的阳经，属于阳中之阳；左手的阴经，属于阳中之阴。右手的阳经，属于阴中之阳；右手的阴经，属于阳中之阴（原文此处可能有误，通常右手阴经为阴中之阴，但依原文翻译）。右足的阴经，属于阴中之阴；右足的阳经，属于阴中之阳。左足的阴经，属于阳中之阴；左足的阳经，属于阴中之阳。现在细分来说：患者左手阳经，用医者右手大拇指向前推进（盐指退后），呼气时为“随”（午后则改为大拇指退后为随，进前即经脉从外向内，退后即经脉从内向外），吸气后退针为“迎”。患者左手阴经，用医者右手大拇指退后，吸气时为“随”，向前推进呼气时为“迎”。患者右手阳经，用医者右手大拇指退后，吸气时为“随”，向前推进呼气时为“迎”。患者右手阴经，用医者右手大拇指向前推进，呼气时为“随”，吸气后退针为“迎”。患者右足阳经，用医者右手大拇指向前推进，呼气时为“随”，吸气后退针为“迎”。患者右足阴经，用医者右手大拇指退后，吸气时为“随”，向前推进呼气时为“迎”。患者左足阳经，用医者右手大拇指退后，吸气时为“随”，向前推进呼气时为“迎”。患者左足阴经，用医者右手大拇指向前推进，呼气时为“随”，吸气后退针为“迎”。男子在午前都按上述方法操作，午后则与女子相反。
手上阳经进针、阴经退针，足上阳经退针、阴经进针，这是符合六经起止规律的。凡是起针的穴位，针尖向上，是顺应气运行的方向。凡是止针的穴位，针尖向下，是气停止的地方。左手外侧、右手内侧进针，可使气上行；右手外侧、左手内侧进针，可使气下行。有人问：午前补泻与午后相反，男子补泻与女子相反。这是因为男子的气，早上在上而晚上在下；女子的气，早上在下而晚上在上，男女上下以腰部为界划分的缘故。至于呼吸方面，男、女、我、他都是一样的，为什么也有阴阳之分呢？因为有自然的呼吸，有人为控制的呼吸。入针出针时使用的是人为控制的呼吸。转针时要像对待贵人一样恭敬，像握住老虎尾巴一样谨慎，等待患者自然的呼吸。如果左手足候其呼气先转针，那么右手足必须候其吸气后再转针；如果右手足候其吸气先转针，那么左手足必须候其呼气后再转针，这正是阴阳一升一降的微妙变化。所以男子阳经在午前以呼气为补，吸气为泻。阴经以吸气为补，呼气为泻，午后则相反。女子阳经在午前以吸气为补，呼气为泻，阴经以呼气为补，吸气为泻，午后也相反。又有人说：补泻必须借助呼吸，假如遇到尸厥中风，不能控制呼吸的患者，该怎么办？回答说：等待其自然呼吸来转针，如果该吸气时不转，可以让别人用手捂住患者的口鼻，鼓动其气息即可。唉！补泻提插，区分男女早晚，道理深微，原本是针对奇经八脉的，不拘泥于十二正经的常规，所以参互错综如此。如果是流注穴，只需分左右阴阳即可。我曾喜爱《雪心歌》说：为何补泻有两种方式？因为经脉从两边发出，古人补泻分左右，今人却分男女。男女经脉生长是一样的，昼夜循环没有停歇，此诀出自梓桑君，我现在传授给你，心中已如冰雪般明白。这是子午流注兼纳八法后才完整的。然而补泻的方法，不一定非要通过呼吸进出针。有的从深浅来讲，经文说：春夏宜浅刺，秋冬宜深刺。有的从营卫来讲，经文说：从卫分取气，从营分置气。补法是从卫分取气，宜轻浅进针，跟随其卫气在后面济益其虚损。泻法是从营分，弃置其气，宜重深刺入，取其营气在前面迎接而泻夺其实邪。但是补不可使太过实，泻不可使反而虚，都以平和为度。另外男子轻按穴位，浅刺以候卫气；女子重按穴位，深刺以候营气。
有的从虚实来讲，经文说：虚证补其母穴，实证泻其子穴。这就是迎随的大概原则。凡是逆着经脉方向针刺以夺取邪气的，就是泻其子穴。比如心的热病，必在脾胃之分泻之。顺着经脉方向针刺以济助正气的，就是补其母穴。比如心的虚病，必在肝胆之分补之。飞经走气法，也不离子午迎随的原则。
凡是说九数的，就是子阳数。六数的，就是午阴数。只是九六数量多少不同，补泻提插都是这样。说初九数的，就是一九，稍停再行一九，再稍停再行一九，三次共二十七数，或者四九三十六数。说少阳数的，七七四十九数，每次七数，略停。老阳数的，九九八十一数，每次二十七数，稍停，共行三次。说初六数的，就是一六，稍停再行一六，再稍停再行一六，三次共十八数。说少阴数的，六六三十六数，每次十八数，略停再行一次。说老阴数的，八八六十四数，每次八数，略停。有人说：子时后宜用九数补阳，午后宜用六数补阴。阴日刺阳经，多用六数补阴。阳日刺阴经，多用九数补阳。这是正理，但如果见热症就泻，见冷症就补，则是权变之法，活法。
经文说：懂得针刺的人信赖左手，不懂针刺的人信赖右手。先用同身寸法比量穴位，用墨点标记，然后让患者饮食后端正坐好，或仰卧，慢性病必须等待天气温暖晴朗，则气容易运行。急病如遇大雷雨，也不敢针刺。夜晚非急病，也不敢针刺，如果空腹站立针刺必定晕针。当要针刺时，必须先以左手压按所针的荥俞之处。阳穴，在骨侧凹陷处，按之酸麻的是真穴。阴穴，按之有动脉应手的是真穴。切而散之，爪而下之：切，是用手指甲掐按所针之穴及其上下四旁，令气血散开。爪，是先以左手大拇指指甲，重掐穴位上，也是令气血散开。然后用右手食指顶住针尾，以中指、大拇指紧紧执住针腰，以无名指略微扶住针头，却让患者咳嗽一声，随着咳嗽下针，刺入皮内，松手停针十次呼吸的时间，叫做天才。过了一会儿再进针，刺入肉内，停针十次呼吸的时间，叫做人才。过了一会儿再进针至筋骨之间，停针十次呼吸的时间，叫做地才。这是极深的地方，再停很久，却让患者吸一口气，随着吸气退至人部，审察气是否到达，如果针下感觉沉重紧满，就是气已到达。如果患者觉得痛就是实证，觉得酸就是虚证。如果针下轻浮虚活，气还没有到，后用弹努循扪引之，引导气，宜在地部行气。
弹而努之，扪而循之：弹，是补法，用大拇指与食指指甲相交迭击，病在上，大拇指指甲轻弹向上；病在下，食指指甲轻弹向下。补者入针后飞针，令患者闭气一口，着力努之；泻者提针飞针，令患者呼气，不必着力，一种方法两种用途，气自来的，不必用此弹努。扪，就是摩，如果痛处未除，就在痛处扪摩，使痛散开。再用飞针引导，除去疼痛。还有起针时，用手按其穴，也叫扪。循，是用手在所针部位，随经络上下循按，使气往来，推之则行，引之则至。
动而伸之，推而按之：动，是转动，推，是推转，凡转针太急则痛，太慢则不去病，所谓推展，就是分阴阳左转右转的方法。伸，是提，按，是插，如果补泻不觉气行，将针提起空如豆许，或者再弹两三下以补之。紧战者，连用飞法三下，如果觉针下紧满，其气易行，就用通法。如果邪盛气滞，却用提插，先去病邪，而后通其真气。提，是从地部提至人部天部，插，是从天部插至人部地部。病轻提插初九数，病重者或少阳数、老阳数，越多越好。有人问：治病全在提插，既然说急提慢按如冰冷，慢提急按火烧身。又说：男子午前提针为热，插针为寒；午后提针为寒，插针为热。女人反之，这是什么原因？盖提插补泻，无非顺应阴阳。午前顺阳性，提至天部则热；午后顺阴性，插至地部则热。奇效良方中有诗最明白。
补泻提插活法：凡补针先浅入而后深入，泻针先深入而后浅。凡提插急提慢按如冰冷，是泻法；慢提急按火烧身，是补法。或者先提插而后补泻，或先补泻而后提插，都可以。或者补泻提插同用也可以。如治久患瘫痪，顽麻冷痹，遍身走痛及癞风寒疟，一切冷症，先浅入针，而后渐深入针，都用补老阳数，气行针下紧满，其身觉热带补，慢提急按老阳数，或三九二十七数，就用通法，扳倒针头，令患者吸气五口，使气上行，阳回阴退，名叫进气法，又叫烧山火。风痰壅盛，中风，喉风，癫狂，疟疾，单热，一切热症，先深入针，而后渐浅退针，都泻少阴数，得气觉凉带泻，急提慢按初六数，或三六一十八数，再泻再提，就用通法，徐徐提之，病除乃止，名叫透天凉。
治疟疾先寒后热，一切上盛下虚等症，先浅入针，行四九三十六数，气行觉热，深入行三六一十八数。如疟疾先热后寒，一切半虚半实等症，先深入针，行六阴数，气行觉凉渐退，针行九阳数，这是龙虎交战法，使阳中有阴，阴中有阳。因为邪气常随正气而行，不交战，则邪不退而正不胜，病会复发。
治癖瘕气块，先针入七分，行老阳数，气行便深入一寸，微伸提之，却退至原处，不得气，根据前法再施，名叫留气法。治水蛊膈气胀满，落穴之后，补泻调气均匀，针行上下，九入六出，左右转之，千遭自平，名叫子午捣臼。
治损逆赤眼，痈肿初起，先以大指进前捻入左，后以大指退后捻入右，一左一右，三九二十七数，得气向前，推转内入，以大指弹其针尾，引其阳气，按而提之，其气自行，未应再施，这是龙虎交腾法。杂病单针一穴，即在得气后行之，起针际行之亦可。通而取之。通，是通其气，提插之后用之。如病患左手阳经，用医者右手大拇指向前九数，却扳倒针头，带补以大指努力，针嘴朝向病处，或上或下，或左或右，执住，直待病患觉热方停。若气又不通，以龙虎龟凤、飞经接气之法，驱而运之。如病患左手阴经，用医者右手大拇指退后九数，却扳倒针头，带补以大指努力，针嘴朝病，执住，直待病患觉热方停。右手阳经，与左手阴经同法。右手阴经，与左手阳经同法。左足阳经，与右手阳经同法。左足阴经，与右手阴经同法。右足阳经，与左手阳经同法。右足阴经，与左手阴经同法。如退潮，每一次先补六，后泻九，不拘次数，直待潮退为度。止痛同此法。痒麻虚补，疼痛实泻，这都是先贤推衍《内经》通气之法，更有取气、斗气、接气之法。取，是左取右，右取左，手取足，足取头，头取手足三阳，胸腹取手足三阴，以不病者为主，病者为应。如两手蜷挛，则以两足为应；两足蜷挛，则以两手为应。先下主针，后下应针，主针气已行，而后针应针，左边左手，左足同手法，右边亦然。先斗气、接气，而后取气，手补足泻，足补手泻，如搓索然。久患偏枯蜷挛甚者，必用此法于提插之后。徐氏说：通气、按气之法，已有定息寸数，手足三阳，上九而下十四，过经四寸。手足三阴，上七而下十二，过经五寸。在乎摇动出纳，呼吸同法，上下通接，立时见功。所谓定息寸数者，手三阴经，从胸走手，长三尺五寸；手三阳经，从手走头，长五尺；足三阳经，从头走足，长八尺；足三阴经，从足走腹，长六尺五寸；阴阳两跷，从足走目，长七尺五寸；督脉长四尺五寸；任脉长四尺五寸，人一呼，气行三寸，一吸气行三寸，一呼一吸，谓之一息。针下随其经脉长短，以息计之，取其气到病所为度。
一曰青龙摆尾：以两指扳倒针头朝病，如扶船舵，执之不转，一左一右，慢慢拨动九数或三九二十七数，其气遍体交流。二曰白虎摇头：以两指扶起针尾，以肉内针头轻转，如下水船中之橹，振摇六数或三六一十八数，如欲气前行，按之在后，欲气后行，按之在前，二法轻病亦可行之，摆动血气。盖龙为气，虎为血，阳日先行龙而后虎，阴日先行虎而后龙。三曰苍龟探穴：以两指扳倒针头，一退三进，向上钻剔一下，向下钻剔一下，向左钻剔一下，向右钻剔一下，先上而下，自左而右，如入土之象。四曰赤凤迎源：以两指扶起针，插入地部，复提至天部，候针自摇，复进至人部，上下左右，四围飞旋，如展翅之状。病在上，吸而退之；病在下，呼而进之。又将大指爪从针尾刮至针腰，此刮法也。能移不忍痛，可散积年风，午后又从针腰刮至针尾。又云：病在上刮向上，病在下刮向下。有挛急者，频宜刮切、循摄二法，须连行三五次，气血各循经络，飞走之妙，全在此处，病邪从此退矣。放针停半时辰久，扶起针头，审看针下十分沉紧，则泻九补六；如不甚紧，则泻六补九，补泻后针活，即摇而出之。摄者，用大拇指随经络上下切之，其气自得通行。
摇而出之，外引其门，以闭其神。摇，是退。以两指拿针尾，向上下左右各摇振五七下，提二七下，能散诸风，出针直待微松，方可出针豆许。如病邪吸针，正气未复，再须补泻停待；如再难，频加刮切，刮后连泻三下；次用搜法，不论数横搜，如龙虎交腾，一左一右，但手更快耳，直搜一上一下，如捻法而不转，泻刮同前；次用盘法，左转九次，右转六次，泻刮同前；次用子午捣臼，子后慢提，午后略快些，缓缓提插，摇出应针，次出主针，补者吸之，急出其针，便以左手大拇指，按其针穴，及穴外之皮，令针穴门户不开，神气内守，亦不致出血也。泻者呼之，慢出其针，勿令气泄，不用按穴。凡针起速，及针不停久待暮者，其病即复。
一：凡针晕者，神气虚也，不可起针，急以别针补之，用袖掩病患口鼻回气，内与热汤饮之，即苏，良久再针。甚者，针手膊上侧，筋骨陷中，即虾蟆肉上惺惺穴，或足三里穴，即苏。若起针，坏人。
According to the *Illustrated Notes on the Nan Jing* (Classic of Difficult Issues): The three Hand-Yang meridians run from the hand to the head. Inserting the needle with the point facing outward and upward is called "Following" (Sui), while inserting with the point facing inward and downward is called "Opposing" (Ying). The three Foot-Yang meridians run from the head to the foot. Inserting with the point facing inward and downward is "Following," while inserting with the point facing outward and upward is "Opposing." The three Foot-Yin meridians run from the foot to the abdomen. Inserting with the point facing outward and upward is "Following," while inserting with the point facing inward and downward is "Opposing." The three Hand-Yin meridians run from the chest to the hand. Inserting with the point facing inward and downward is "Following," while inserting with the point facing outward and upward is "Opposing." The general principle relies on Zi-Wu (midnight and noon). The left side represents Yang (from Zi hour to Wu hour, moving the needle to the left constitutes tonification); the right side represents Yin (from Wu hour to Zi hour, moving the needle to the right constitutes sedation; Yang governs advancement, Yin governs retreat). The hands represent Yang (the left hand is pure Yang), and the feet represent Yin (the right foot is pure Yin). The Yang meridians of the left hand are Yang within Yang; the Yin meridians of the left hand are Yin within Yang. The Yang meridians of the right hand are Yang within Yin; the Yin meridians of the right hand are Yin within Yin (Note: Text says Yang within Yin, but context implies Yin within Yin or follows specific classification). The Yin meridians of the right foot are Yin within Yin; the Yang meridians of the right foot are Yang within Yin. The Yin meridians of the left foot are Yin within Yang; the Yang meridians of the left foot are Yang within Yin.
Now, in detail: For the patient's left-hand Yang meridians, the practitioner uses the right thumb to advance the needle forward (retreating the index finger) during exhalation for "Following" (afternoon practice reverses this: retreating is Following, advancing is Opposing; advancing corresponds to the meridian flowing from outside to inside, retreating from inside to outside), and withdrawing during inhalation for "Opposing." For the patient's left-hand Yin meridians, the practitioner retreats the right thumb during inhalation for "Following," and advances during exhalation for "Opposing." For the patient's right-hand Yang meridians, the practitioner retreats the right thumb during inhalation for "Following," and advances during exhalation for "Opposing." For the patient's right-hand Yin meridians, the practitioner advances the right thumb during exhalation for "Following," and withdraws during inhalation for "Opposing." For the patient's right-foot Yang meridians, the practitioner advances the right thumb during exhalation for "Following," and withdraws during inhalation for "Opposing." For the patient's right-foot Yin meridians, the practitioner retreats the right thumb during inhalation for "Following," and advances during exhalation for "Opposing." For the patient's left-foot Yang meridians, the practitioner retreats the right thumb during inhalation for "Following," and advances during exhalation for "Opposing." For the patient's left-foot Yin meridians, the practitioner advances the right thumb during exhalation for "Following," and withdraws during inhalation for "Opposing." These rules apply to men before noon; after noon, they are reversed for women.
On the hands, Yang meridians advance and Yin meridians retreat; on the feet, Yang meridians retreat and Yin meridians advance, conforming to the starting and ending points of the six meridians. When initiating needling at an acupoint, pointing the needle upward aligns with the direction of Qi flow. When stopping needling, pointing the needle downward indicates where Qi stops. Needling the left exterior and right interior promotes ascending Qi; needling the right exterior and left interior promotes descending Qi. One might ask why morning and afternoon techniques differ, and why male and female techniques differ. This is because men's Qi is higher in the morning and lower in the evening, while women's Qi is lower in the morning and higher in the evening, divided by the waist. Regarding respiration, it is the same for men, women, self, and others, yet there is a distinction of Yin and Yang. There is natural respiration and artificial respiration. Needle insertion and withdrawal utilize artificial respiration. Turning the needle requires reverence like treating a noble person and caution like holding a tiger's tail, waiting for natural respiration. If turning the needle on the left hand/foot upon exhalation, one must wait for inhalation to turn the right hand/foot; if turning the right hand/foot upon inhalation, one must wait for exhalation to turn the left hand/foot. This reflects the subtle rise and fall of Yin and Yang. Thus, for men, Yang meridians before noon use exhalation for tonification and inhalation for sedation; Yin meridians use inhalation for tonification and exhalation for sedation, reversing after noon. For women, Yang meridians before noon use inhalation for tonification and exhalation for sedation; Yin meridians use exhalation for tonification and inhalation for sedation, also reversing after noon. Some ask: If tonification and sedation rely on respiration, what about patients with corpse-like coma or stroke who cannot control respiration? Answer: Wait for natural respiration to turn the needle. If inhalation is required but not performed, cover the patient's mouth and nose with your hand to stimulate their Qi. Alas! The principles of tonification/sedation and lifting/thrusting, distinguishing gender and time, are profound and originally applied to the Extraordinary Vessels, not strictly bound by the twelve Regular Meridians, hence their complexity. For Flowing-Transfusion points, simply distinguishing left/right and Yin/Yang suffices. I once admired the *Xue Xin Ge*: "Why are there two methods for tonification and sedation? Because meridians originate from both sides. Ancients distinguished left and right; moderns distinguish men and women. Men's and women's meridians develop identically, circulating day and night without rest. This secret comes from Master Zisang; I now impart it to you, clearing your mind like snow." This completes the Zi-Wu Flowing-Transfusion combined with the Eight Methods. However, tonification and sedation do not necessarily require respiration for needle entry/exit. Some focus on depth: The Classic states, "Spring and summer suit shallow needling; autumn and winter suit deep needling." Some focus on Ying and Wei: The Classic states, "Take Qi from Wei, place Qi in Ying." Tonification takes Qi from Wei, using light, shallow needling to follow Wei Qi and assist deficiency. Sedation targets Ying, using heavy, deep needling to meet Ying Qi ahead and drain excess. Tonification should not cause excessive fullness; sedation should not cause deficiency; the goal is balance. Additionally, men are needled lightly and shallowly to await Wei Qi; women are needled heavily and deeply to await Ying Qi.
Some focus on Deficiency and Excess: The Classic states, "Tonify the Mother in deficiency, sedate the Child in excess." This is the general principle of Ying-Sui. Opposing the meridian flow to drain is sedating the Child (e.g., sedating Spleen/Stomach for Heart heat). Following the meridian flow to assist is tonifying the Mother (e.g., tonifying Liver/Gallbladder for Heart deficiency). Fei-Jing-Zou-Qi (Flying through Meridians and Moving Qi) also adheres to Zi-Wu Ying-Sui.
The number nine represents Zi-Yang; six represents Wu-Yin. The quantity varies, but lifting/thrusting applies similarly. "Initial Nine" means 1x9, pause, 1x9, pause, 1x9, totaling 27, or 4x9=36. "Lesser Yang" is 7x7=49, 7 per session with pauses. "Greater Yang" is 9x9=81, 27 per session, paused, repeated three times. "Initial Six" means 1x6, pause, 1x6, pause, 1x6, totaling 18. "Lesser Yin" is 6x6=36, 18 per session, paused, repeated once. "Greater Yin" is 8x8=64, 8 per session, paused. Some say: After Zi hour, use nine numbers to tonify Yang; after Wu hour, use six numbers to tonify Yin. On Yin days needling Yang meridians, use six numbers to tonify Yin. On Yang days needling Yin meridians, use nine numbers to tonify Yang. This is correct theory, but adapting to heat/cold symptoms is flexible application. The Classic states: "Know the needle practitioner trusts the left hand; unknown practitioners trust the right hand." First, measure the acupoint using Cun, mark it with ink. Have the patient sit upright or lie down after eating. For chronic conditions, wait for warm, clear weather for Qi to move. Do not needle during severe storms or at night unless urgent. Never needle standing on an empty stomach due to fainting risk.
When needling, first press the Ying-Shu points with the left hand. True Yang points are found in bony depressions, feeling sour/numb when pressed. True Yin points have a palpable pulse under pressure. "Cut and scatter": Use fingernails to press around the acupoint to disperse Qi and Blood. "Claw and descend": Press firmly with the left thumb nail to disperse Qi and Blood. Then, use the right index finger to hold the needle handle, middle and thumb fingers to grip the shaft, and ring finger to support the tip. Ask the patient to cough, and insert the needle into the skin upon the cough. Hold for ten breaths, called "Heaven Talent." Advance slightly, hold for ten breaths, called "Human Talent." Advance to muscle/bone junction, hold for ten breaths, called "Earth Talent." This is the deepest level. Pause longer, then ask the patient to inhale and withdraw to the Human level. Check for arrival of Qi: heaviness and tightness indicate arrival. Pain indicates Excess; soreness indicates Deficiency. Lightness indicates Qi has not arrived. Use plucking, thrusting, rubbing, and guiding to move Qi, preferably at the Earth level.
"Pluck and Thrust, Rub and Follow": Plucking is tonification. Interlock thumb and index nails. For upper body, pluck upward with thumb; for lower body, pluck downward with index. For tonification, insert and "fly" the needle, asking the patient to hold breath and exert force. For sedation, lift and fly the needle, asking the patient to exhale without force. If Qi arrives naturally, these maneuvers are unnecessary. Rubbing (Men) soothes pain. Guiding (Xun) involves stroking along the meridian to promote Qi flow.
"Move and Extend, Push and Press": Moving is rotating. Too fast causes pain; too slow fails to remove disease. Extending is lifting; pressing is thrusting. If Qi does not move, lift the needle slightly or pluck again. If the needle feels tight, use the "Passing" method. If pathogenic Qi is strong, use lifting/thrusting to expel pathogens first. Lifting moves from Earth to Human to Heaven; Thrusting moves from Heaven to Human to Earth. Light illness uses Initial Nine; severe illness uses Lesser/Greater Yang numbers. Why do morning/afternoon and male/female lifting/thrusting differ? It follows Yin/Yang. Morning follows Yang nature; lifting to Heaven creates heat. Afternoon follows Yin nature; thrusting to Earth creates heat.
Lifting/Thrusting Techniques: Tonification inserts shallow then deep; sedation inserts deep then shallow. Fast lifting/slow pressing feels cold (sedation); slow lifting/fast pressing feels hot (tonification). Order can vary. For paralysis, cold bi, wind-cold malaria (Cold syndromes): Insert shallow, deepen gradually, use Greater Yang numbers (tonification). When Qi arrives and warmth is felt, use slow lifting/fast pressing (Greater Yang or 27 counts). Turn the needle head, ask patient to inhale five times to ascend Yang and retreat Yin. This is "Entering Qi" or "Burning Mountain Fire." For phlegm-wind, stroke, throat wind, mania, malaria, single heat (Heat syndromes): Insert deep, lighten gradually, use Lesser Yin numbers (sedation). When coolness is felt, use fast lifting/slow pressing (Initial Six or 18 counts). Repeat until cured. This is "Penetrating Heaven Coolness."
For malaria with initial chills then fever (Upper Excess/Lower Deficiency): Shallow insert, 36 counts (heat), then deep insert, 18 counts. For malaria with initial fever then chills (Half-Deficiency/Half-Excess): Deep insert, 6 Yin counts (coolness), then 9 Yang counts. This is "Dragon-Tiger Battle," balancing Yin and Yang. Pathogens follow healthy Qi; battle prevents recurrence.
For abdominal masses: Insert 0.7 cun, use Greater Yang numbers. Upon Qi arrival, insert to 1 cun, lift slightly, return. If no Qi, repeat. This is "Retaining Qi." For ascites and bloating: Balance tonification/sedation, move needle up/down, 9 inserts/6 withdrawals, rotate left/right many times. This is "Zi-Wu Pestle."
For red eyes and early abscesses: Twist left (advance thumb), then right (retreat thumb), 27 counts. Guide Qi forward, push inward, pluck needle tail to attract Yang, press and lift. This is "Dragon-Tiger Interaction." For single-point treatment, apply after Qi arrival or at withdrawal.
"Passing" promotes Qi after lifting/thrusting. For left-hand Yang meridians: Advance right thumb 9 counts, tilt needle toward disease, apply tonification effort, hold until patient feels heat. If blocked, use Dragon/Turtle/Green Phoenix/Flying methods. Similar protocols apply to other limbs/hands/feet. For "Tide Retreat" (pain relief): Tonify 6, sedate 9 repeatedly until tide recedes. Itching/numbness treated by tonification; pain by sedation. These derive from *Nei Jing*. "Taking Qi" involves cross-needling (left-right, hand-foot, etc.), using healthy areas as primary and diseased as response. For curled limbs, needle opposite limbs. Primary needle first, then response needle. "Fighting Qi" and "Connecting Qi" involve hand/foot combinations. Xu Shi said: Qi movement has fixed Cun per breath. Hand/Yang meridians: Upper 9, Lower 14, passing 4 cun. Hand/Yin meridians: Upper 7, Lower 12, passing 5 cun. Respiration matches Qi movement. Lengths: Hand-Yin 3.5 chi, Hand-Yang 5 chi, Foot-Yang 8 chi, Foot-Yin 6.5 chi, Yin/Yang Heel 7.5 chi, Du Mai 4.5 chi, Ren Mai 4.5 chi. One breath moves Qi 3 cun. Calculate based on meridian length until Qi reaches disease site.
1. Green Dragon Tail Swing: Tilt needle toward disease, hold like a rudder, swing left/right 9 or 27 counts. Qi circulates.
2. White Tiger Head Shake: Lift needle tail, rotate tip lightly like an oar, shake 6 or 18 counts. To move Qi forward, press behind; backward, press front. Moves blood and Qi. Dragon is Qi, Tiger is Blood. Yang days: Dragon then Tiger. Yin days: Tiger then Dragon.
3. Grey Turtle Exploring Cave: Tilt needle, retreat once, advance thrice. Drill up, down, left, right. Like entering earth.
4. Red Phoenix Welcoming Source: Lift needle, insert to Earth, lift to Heaven, wait for vibration, advance to Human. Rotate around like wings. Disease above: withdraw on inhalation. Disease below: advance on exhalation. Scrape from tail to waist (or waist to tail in afternoon). For spasms, use scraping/guiding 3-5 times. Leave needle for half an hour. If tight, sedate 9/tonify 6; if loose, sedate 6/tonify 9. Shake out. "She" involves cutting along meridian with thumb.
Shake and Withdraw: Shake needle 5-7 times up/down/left/right, lift 14 times. Dispels wind. Withdraw when loose. If pathogen holds needle, re-tonify/sedate. If difficult, scrape and sedate 3 times. Search horizontally like Dragon-Tiger interaction. Plate left 9, right 6. Zi-Wu Pestle: Slow lift after Zi, faster after Wu. Withdraw response needle, then primary needle. Tonification: Inhale, quick withdrawal, press hole with left thumb to seal spirit and prevent bleeding. Sedation: Exhale, slow withdrawal, do not press. Quick withdrawal or long retention leads to relapse.
Fainting: Caused by deficient spirit/Qi. Do not withdraw immediately. Tonify with another needle, cover mouth/nose with sleeve to restore Qi, give hot water. Revive, wait, then needle. Severe cases: Needle Xingxing point on arm or Zusanli. Withdrawing needle harms the patient.