黄帝问曰∶病热有所痛者，何也？岐伯对曰∶病热者阳脉也，以三阳之盛也。人迎一
盛在少阳，二盛在太阳，三盛在阳明。夫阳入于阴，故病在头与腹，乃 胀而头痛也。
曰∶病身热汗出而烦满不解者何也？曰∶汗出而身热者风也，汗出而烦满不解者厥也，
病名曰风厥。太阳为诸阳主气（《素问》作巨阳主气），故先受邪。少阴其表里也，得热则上
从，上从则厥。治之表里刺之，饮之服汤。曰∶温病汗出，辄复热而脉躁疾者，不为汗衰，
狂言不能食，病名曰何？曰∶名曰阴阳交，交者死。人所以汗出者，皆生于谷，谷生于精。
今邪气交争于骨肉而得汗者，是邪退精胜，精胜则当能食而不复热。复热者邪气也，
汗者精气也，今汗出而辄复热者，是邪胜也，不能食者，精无裨也，热而留者，寿可立而
倾也。夫汗出而脉躁盛者死，今脉不与汗相应，此不胜其病，其死明矣。狂言者是失志，
失志者死。此有三死，不见一生，虽愈必死。病风且寒且热，炅汗出，一日数欠，先刺诸
分理络脉。汗出且寒且热，三日一刺，百日而已。
曰∶何谓虚实？曰∶邪气盛则实，精气夺则虚。重实者内（《素问》作言）大热，病气热
脉满，是谓重实。曰∶经络俱实何如？曰∶经络皆实，是寸脉急而尺缓也，皆当俱治。故
曰滑则顺，涩则逆。夫虚实者，皆从其物类治（《素问》作始），故五脏骨肉滑利，可以久
长。寒气暴上，脉满而实，实而滑顺则生，实而逆则死。尽满者，脉急大坚，尺满（一作
涩）而不应也。如是者，顺则生，逆则死。所谓顺者手足温，所谓逆者手足寒也。曰∶
何谓重虚？曰∶脉虚气虚尺虚，是谓重虚也。所谓气虚者言无常也，尺虚者行步
然也，脉虚者不象阴也。如此者，滑则生，涩则死，气虚者肺虚也，气逆者足寒也。
非其时则生，当其时则死，余脏皆如此也。脉实满，手足寒，头热（一作痛）者，春秋则生，
冬
春夏为顺，治主病者。经虚络满者，尺热满，脉口寒涩，春夏死，秋冬生。络满经虚，灸阴
刺阳；经满络虚，刺阴灸阳。
曰∶秋冬无极阴，春夏无极阳者，何谓也？曰∶无极阳者，春夏无数虚阳明，阳明虚则
狂；无极阴者，秋冬无数虚太阴，太阴虚则死。春极治经络，夏极治经俞，秋极治六腑，冬
则闭塞，治用药而少针石。所谓少针石者，非痈疽之谓也。
热病始手臂者，先取手阳明、太阴而汗出。始头首者，先取项太阳而汗出。始足胫者
，先取足阳明而汗出。臂太阴，（《灵枢》作阳）可出汗，足阳明可出汗。取阴而汗出甚者止
之阳，取阳而汗出甚者止之阴。振寒凄凄，鼓颔不得汗出，腹胀烦闷，取手太阴。热病三日，
气口静，人迎躁者，取之诸阳五十九刺，以泻其热，而出其汗，实其阴，以补其不足。身
热甚，阴阳皆静者，勿刺之。其可刺者，急取之，不汗则泄。所谓勿刺，皆有死征也。热病
七日八日，脉口动喘而眩者，急刺之，汗且自出，浅刺手大指间。热病七日、八日，脉微
小，病者溲血，口中干，一日半而死，脉代者一日死。热病已得汗而脉尚躁（一本作盛），
喘且复热，勿庸（一本作肤）刺，喘盛者必死。热病七日、八日，脉不躁，不散数，后三日
中有汗，三日不汗，四日死。未汗勿庸刺。热病先肤痛，窒鼻充面，取之皮，以第一针五十
九刺。苛鼻干（《灵枢》作诊鼻干）索于皮肺，不得索之于火，火者心也。热病先身涩
烦而热，烦闷唇嗌干，取之皮，以第一针五十九刺。热病肤胀，口干，寒，汗出，索脉于心
，不得索之于水。水者肾也。热病嗌干，多饮善惊，卧不能安，取之肤肉，以第六针五
十九刺。目 赤（《灵枢》作青），索肉于脾，不得索之于木，木者肝也。热病而胸胁痛
（《灵枢》作面青胸痛），手足躁，取之筋间，以第四针，针于四逆。筋 目浸，索筋于
肝，不得索之于金，金者肺也。热病数惊，螈 而狂，取之脉，以第四针急泻有余者。
癫疾毛发去，索血于心，不得索之于肾，肾者，水也。热病身重骨痛，耳聋好瞑，取之骨
，以第四针五十九刺。骨病不食，啮齿耳青赤，索骨于肾，不得索之于土，土者，脾也。
热病不知所病，耳聋，不能自收，口干，阳热甚，阴颇有寒者，热在髓也，死不治。热病头
痛颞 ，目脉紧（一本作 ），善衄，厥热病也。取之以第三针，视有余不足。寒热痔（一作
痛）。热病体重，肠中热，取之以第四针于其俞及下诸指间，索气于胃络得气也。热病侠脐
急痛，胸胁满，取之涌泉与阴陵泉，以第四针针嗌里。热病而汗且出，及脉顺可汗者，取
鱼际、太渊、大都、太白，泻之则热去，补之则汗出。汗出太甚，取内踝上横脉以止之。热
病已得汗而脉尚躁盛者，此阴脉之极也死；其得汗而脉静者生。热病脉常躁盛而不得汗者
，此阳脉之极也死；其脉躁盛得汗而脉静者生。厥，侠脊而痛，主头项KT KT ，目KT KT
然，腰脊强，取足太阳 中血络。嗌干口热如胶，取足少阳（此条出《素问》刺腰
痛篇，宜在后刺腰痛内）。热病死候有九∶一曰汗不出，大颧发赤者死（《太素》云∶汗不出，
大颧发赤者，必不反而死）。二曰泄而腹满甚者死。三曰目不明，热不已者死。四曰老人婴
儿热而腹满者死。五曰汗不出呕血（《灵枢》作呕下血）者死。六曰舌本烂，热不已者死。七
曰咳而衄，汗出，出不至足者死。八曰髓热者死。九曰热而 者死。热而 者，腰反
折螈 ，齿噤 也。凡此九者，不可刺也。
所谓五十九刺者，两手内外侧各三，凡十二 ；五指间各一，凡八 ；足亦如
是；头入发际一寸傍三分（《灵枢》无分字）各三，凡六 ；更入发际三寸边五，凡十
；耳前后口下（《灵枢》作以下）者各一，项中一，凡六 ；颠上一，囟会一，
发际一，廉泉一，风池二，天柱二（《甲乙经》原缺囟会至天柱诸穴，今按《灵枢》经文补
之）。
素问曰∶五十九者，头上五行行五者，以越诸阳之热逆也。大杼、膺俞、缺盆、
背椎，此八者，以泻胸中之热（一作阳）。气冲、三里、巨虚、上下廉，此八者，以泻胃中
之热。云门、 骨、委中、髓空，此八者，以泻四肢之热。五脏俞傍五，此十者，以泻五
脏之热。凡此五十九者，皆热之左右也。（按二经虽不同，皆泻热之要穴也）
头脑中寒，鼻衄目泣出（《千金》作寒热头痛），神庭主之。头痛身热，鼻窒，喘息不利
，烦满汗不出，曲差主之。头痛目眩，颈项强急，胸胁相引，不得倾侧，本神主多。热病（
《千金》下有烦满二字）汗不出，上星主之，先取噫嘻，后取天牖、风池。热病汗
不出而苦呕烦心，承光主之。头项痛重，暂起僵仆，鼻窒鼽衄，喘息不得通，通天主之。头
项，恶风，汗不出，凄厥恶寒，呕吐，目系急，痛引 ，头重项痛，玉枕主之。颊清（
《千金》作喜啮颊），不得视，口沫泣出，两目眉头痛，临泣主之。脑风头痛，恶见风寒，
鼽衄鼻窒，喘息不通，承灵主之。头痛身热，引两颔急（一作痛），脑空主之。醉酒风热发，
两角（一作两目）眩痛，不能饮食。烦满呕吐，率谷主之（《千金》以此条置风门）。项强刺喑
门。热病汗不出，天柱及风池、商阳、关冲、腋门主之。颈痛项不得顾，目泣出，多
眵，鼻鼽衄，目内 赤痛，气厥耳目不明，咽喉偻引项筋挛不收，风池主之。伤寒热
盛，烦呕，大椎主之。头重目瞑凄厥，寒热，汗不出，陶道主之。身热头痛，进退往来，
神道主之。头痛如破，身热如火，汗不出，螈 （《千金》作头痛），寒热，汗不出，恶寒，
里急，腰腹相引痛，命门主之。颈项痛不可以俯仰，头痛振寒，螈 ，气实则胁满，侠脊有
寒气，热，汗不出，腰背痛，大杼主之。风眩头痛，鼻不利，时嚏，清涕自出，风门主之。
凄凄振寒，数欠伸，鬲俞主之。热病汗不出，上 及孔最主之。（《千金》作臂厥热病
汗不出，皆灸刺之，此穴可以出汗）。肩 间急，凄厥恶寒，魄户主之。项背痛引颈，魄
户主之。肩痛胸腹满，凄厥脊背急强，神堂主之。喘逆鼽衄，肩胛内廉痛，不可俯仰，
季胁引少腹而痛胀，噫嘻主之。背痛恶寒，脊强俯仰难，食不下，呕吐多涎，
鬲俞（《千金》作阳关）主之。热病头痛身重，悬颅主之。胸胁胀满，背痛恶风寒，饮食
不下，呕吐不留住，魂门主之。善嚏，头痛身热，颔厌主之。热病头痛，引目外 而急，烦
满汗不出，引颔齿，面赤皮痛，悬厘主之。热病偏头痛，引目外 ，悬厘主之。头目瞳子痛
，不可以视，挟项强急，不可以顾，阳白主之。头风痛，鼻鼽衄，眉头痛，善嚏，目如
饮脱，汗出寒热，面赤颊中痛，项椎不可左右顾
，目系急，螈 ，攒竹主之。寒热凄厥鼓颔，承浆主之。身热痛，胸胁痛不可反侧，颅息
主之。肩背痛，寒热，瘰 绕颈，有大气，暴聋气蒙瞀，耳目不开，头颔痛，泪出鼻
衄，不得息，不知香臭，风眩喉痹，天牖主之。热病胸中淡淡，腹满暴痛，恍惚不知人，
手清
（《千金》作烦满汗不出），上脘主之。身寒热，阴都主之。热病象疟，振栗鼓颔，腹胀睥睨
，喉中鸣，少商主之。寒厥及热烦心，少气不足以息，阴湿痒，腹痛不可以食饮，肘挛
支满，喉中焦干渴，鱼际主之。热病振栗鼓颔，腹满阴萎，咳引尻溺出，虚也。鬲中虚，食
饮呕，身热汗不出，数唾血下，肩背寒热，脱色，目泣出，皆虚也。刺鱼际补之。病温
身热，五日以上，汗不出，刺太渊。留针一时，取之。若未满五日，禁不可刺也。热
病先手臂螈 ，唇口聚鼻张，目下汗出如转珠，两乳下二寸坚，胁满，悸，列缺主之。
黄帝问道：患热病且伴有疼痛的，是什么原因呢？岐伯回答说：患热病属于阳脉的表现，这是由于三阳经气旺盛的缘故。人迎脉搏动比寸口快一倍，病在少阳；快两倍，病在太阳；快三倍，病在阳明。阳气侵入阴分，所以病位在头部和腹部，出现腹胀和头痛的症状。
（黄帝）问：身体发热、出汗但心中烦闷胀满症状不缓解的，是什么原因呢？（岐伯）说：出汗而身体发热的，是风邪所致；出汗后心中烦闷胀满仍不缓解的，是厥逆所致，这种病名叫风厥。太阳经主管诸阳之气（《素问》中作“巨阳主气”），所以首先受到邪气侵袭。少阴经与太阳经互为表里，当受到热邪时，少阴之气会向上从属太阳，向上从属则导致气机逆乱形成厥证。治疗时应表里同治，进行针刺，并服用汤药。
（黄帝）问：温病患者出汗后，随即再次发热，且脉搏躁动急疾，出汗并不能使病情减轻，胡言乱语且不能进食，这叫什么病？（岐伯）说：这叫阴阳交，阴阳交争者预后不良，多致死。人之所以能出汗，是因为津液来源于水谷精微，水谷精微又化生于精气。现在邪气在骨肉之间与正气交争，如果能出汗，说明邪气退却而精气占上风，精气占上风就应当能够进食且不再发热。如果再次发热，那是邪气仍在；出汗的是精气，现在出汗后随即再次发热，这是邪气胜过精气；不能进食，精气就无法得到补充；热邪滞留体内，生命随时可能终结。凡是出汗后脉搏依然躁盛有力的，预示死亡。现在脉搏与汗出情况不相适应，这说明正气不能战胜疾病，其死亡是显而易见的。胡言乱语是神志丧失的表现，神志丧失者多死。这里有三种死征，看不到一线生机，即使暂时看似痊愈，最终也必死无疑。
患有风病，既怕冷又发热，身体燥热出汗，一天多次打哈欠，应先针刺各个分肉之间的络脉。出汗且忽冷忽热的，每隔三天针刺一次，一百天后即可痊愈。
（黄帝）问：什么是虚证和实证？（岐伯）说：邪气亢盛就是实证，精气耗损就是虚证。重实证表现为体内大热，病势炽盛，脉象充实有力，这就叫重实证。
（黄帝）问：经络都呈现实象是怎样的？（岐伯）说：经络皆实，表现为寸口脉急促而尺部脉缓弱，这种情况下应当同时进行治疗。所以说脉滑利为顺，脉涩滞为逆。虚实之证，都要根据事物的属性来治疗（《素问》作“始”），如果五脏和骨肉滑利通畅，就可以长久健康。寒气突然上逆，脉象充实而盛大，如果脉实而滑利顺畅则生，脉实而逆乱则死。如果脉象极度充盈，脉象急大而坚牢，尺部脉满（一说为涩）且与寸口不应相合。像这样的情况，脉顺则生，脉逆则死。所谓顺，是指手足温暖；所谓逆，是指手足寒冷。
（黄帝）问：什么是重虚证？（岐伯）说：脉象虚弱、气息虚弱、尺部脉虚弱，这就叫重虚证。所谓气虚，表现为言语无常；尺部脉虚，表现为行走不稳；脉虚，表现为缺乏阴血之象。像这样的情况，脉滑则生，脉涩则死。气虚实际上是肺虚，气逆则足部寒冷。如果不是对应的季节则生，如果是相应的季节则死，其他脏腑的情况也都与此类似。脉象实而满，手足寒冷，头部发热（一说为头痛）的，在春秋两季可生，因为冬夏对于此类病症而言，春夏为顺，应治疗主要病变的脏腑。经脉虚而络脉实的，尺部发热且满，脉口处寒冷且涩滞，春夏季节死，秋冬季节生。络脉实而经脉虚的，应灸阴经、刺阳经；经脉实而络脉虚的，应刺阴经、灸阳经。
（黄帝）问：秋冬不要过度耗伤阴气，春夏不要过度耗伤阳气，这是什么意思？（岐伯）说：不要过度耗伤阳气，是指在春夏季节不要无故使阳明经气虚弱，阳明经气虚弱会导致狂症；不要过度耗伤阴气，是指在秋冬季节不要无故使太阴经气虚弱，太阴经气虚弱会导致死亡。春季极致的病要治疗经络，夏季极致的病要治疗经穴，秋季极致的病要治疗六腑，冬季则气血闭塞，治疗以用药为主，少用针石。所谓少用针石，并不是指痈疽这类疾病。
热病起始于手臂的，先取手阳明、手太阴经穴使其出汗。起始于头部的，先取项部太阳经穴使其出汗。起始于足小腿的，先取足阳明经穴使其出汗。手太阴经（《灵枢》作手阳明）可以发汗，足阳明经也可以发汗。如果在取阴经穴位发汗过多，就停止针刺并改取阳经穴位；如果在取阳经穴位发汗过多，就停止针刺并改取阴经穴位。
患者战栗恶寒，咬牙打颤但不能出汗，腹部胀满烦闷，取手太阴经穴。热病第三天，气口脉平静，人迎脉躁动的，取诸阳经的五十九个穴位进行针刺，以泻除热邪，促使出汗，充实阴气，以补其不足。如果身体高热，但寸口和人迎脉都平静无波，不要针刺。那些可以针刺的，要紧急取穴，如果不发汗就会泄泻。所谓不要针刺，是因为这些情况都有死亡的征兆。热病第七八天，脉口脉搏动急促且眩晕的，要紧急针刺，汗将会自然流出，浅刺手大拇指指甲角旁。热病第七八天，脉象微小，病人尿血，口中干燥，一天半后死亡；脉象代绝的，一天后死亡。热病已经出汗但脉搏仍然躁盛，气喘且再次发热，不要随意针刺，气喘严重的必定死亡。热病第七八天，脉搏不躁动，不散乱不数急，如果后三天中有汗出，若三天不出汗，第四天就会死亡。未出汗前不要随意针刺。
热病起初皮肤疼痛，鼻塞面赤，取皮部，使用第一号针（镵针）配合五十九刺法。鼻干（《灵枢》作诊鼻干）应向肺脏求治于皮部，不可向火脏（心）求治，因为火对应心。热病起初身体涩滞烦热，烦闷嘴唇咽喉干燥，取皮部，使用第一号针配合五十九刺法。热病皮肤肿胀，口干，怕冷，出汗，应向心脏求治于脉，不可向水脏（肾）求治，因为水对应肾。热病咽喉干燥，多饮易惊，卧不安稳，取肌肉部，使用第六号针（毫针）配合五十九刺法。眼睛发红（《灵枢》作青），应向脾脏求治于肌肉，不可向木脏（肝）求治，因为木对应肝。热病胸胁疼痛（《灵枢》作面青胸痛），手足躁动，取筋间，使用第四号针（锋针），针刺四逆穴。筋脉拘挛，眼睛昏蒙，应向肝脏求治于筋，不可向金脏（肺）求治，因为金对应肺。热病多次惊悸，抽搐且狂乱，取血脉，使用第四号针紧急泻除有余之邪。癫疾毛发脱落，应向心脏求治于血，不可向肾脏求治，因为肾属水。热病身体沉重骨痛，耳聋喜闭目，取骨骼，使用第四号针配合五十九刺法。骨病不能进食，咬齿耳廓青赤，应向肾脏求治于骨，不可向土脏（脾）求治，因为土对应脾。热病不知病痛所在，耳聋，不能自主收摄，口干，阳热甚盛，阴分颇有寒意，这是热邪在骨髓，属于死证，无法治疗。热病头痛颞部疼痛，眼脉络紧（一本作疏），容易流鼻血，这是厥热病。取第三号针（鍉针），视有余不足进行调治。伴有寒热痔疮（一作痛）。热病身体沉重，肠中热，取第四号针在其俞穴及下肢各指间施针，向胃络求气以得气。热病脐旁急痛，胸胁满闷，取涌泉穴和阴陵泉穴，使用第四号针刺入咽内深处。热病将要出汗，以及脉象顺遂可以发汗的，取鱼际、太渊、大都、太白穴，泻法则热去，补法则汗出。如果出汗太多，取内踝上方的横脉（然谷附近）以制止出汗。
热病已经出汗但脉搏仍然躁盛的，这是阴脉的极端表现，预后不良致死；如果出汗后脉搏平静的，预后良好可生。热病脉搏常躁盛但不能出汗的，这是阳脉的极端表现，预后不良致死；如果脉躁盛而出汗后脉搏平静的，预后良好可生。
厥证，疼痛沿脊柱两侧，主要症状为头项强直不适，眼睛昏花不明，腰脊强直，取足太阳膀胱经的血络放血。咽喉干燥，口中热如胶结，取足少阳胆经穴（此条出自《素问·刺腰痛篇》，适宜放在后文刺腰痛篇内）。
热病的死候有九种：一曰不出汗，两颧骨部位发红的死（《太素》云：不出汗，两颧骨发红的，必然不能恢复而死亡）。二曰腹泻且腹部胀满严重的死。三曰眼睛视物不清，热势不退的死。四曰老人和婴儿患热病且腹部胀满的死。五曰不出汗且呕血的死（《灵枢》作呕下血）。六曰舌根腐烂，热势不退的死。七曰咳嗽且流鼻血，出汗但汗不到足部的死。八曰骨髓热的死。九曰热病且抽搐僵直的死。热病且抽搐僵直的，腰部反折，肢体抽搐，牙齿紧闭。以上九种情况，都不宜针刺。
所谓五十九刺，是指两手内外侧各三个穴位，共十二个；五指间各一个，共八个；足部也是如此；头部入发际一寸处，旁开三分（《灵枢》无分字）各三个，共六个；再入发际三寸处，边侧五个，共十个；耳前后、口下（《灵枢》作以下）各一个，项中一个，共六个；头顶正中一个，囟会一个，发际一个，廉泉一个，风池两个，天柱两个（《甲乙经》原缺囟会至天柱诸穴，今按《灵枢》经文补之）。
《素问》说：五十九穴中，头上五行每行五个，用来发散诸阳经的热邪逆乱。大杼、膺俞、缺盆、背椎，这八个穴位，用来泻胸中之热（一作阳）。气冲、三里、巨虚上下廉，这八个穴位，用来泻胃中之热。云门、髀骨、委中、髓空，这八个穴位，用来泻四肢之热。五脏俞穴旁边各五个，共十个穴位，用来泻五脏之热。以上这五十九个穴位，都是泻热的重要穴位。（按：这两部经典记载虽有所不同，但都是泻热的重要穴位。）
头脑中受寒，鼻出血，眼泪流出（《千金方》作寒热头痛），由神庭穴主治。头痛身热，鼻塞，呼吸不利，烦闷不出汗，由曲差穴主治。头痛目眩，颈项强直，胸胁相互牵引，不能倾斜侧身，由本神穴主治。热病（《千金方》下有烦满二字）不出汗，由上星穴主治，先取噫嘻穴，后取天牖、风池穴。热病出汗不出且苦于呕吐心烦，由承光穴主治。头项沉重，突然起身跌倒，鼻塞流涕鼻出血，喘息不通，由通天主治。头项强痛，怕风，不出汗，凄惨恶寒，呕吐，眼系紧张，疼痛牵引至颞部，头重项痛，由玉枕穴主治。脸颊清冷（《千金方》作喜啮颊），不能视物，口沫泪出，两眼眉骨头痛，由临泣穴主治。脑风头痛，怕见风寒，流涕鼻塞，喘息不通，由承灵穴主治。头痛身热，牵引两侧下颌紧张（一作痛），由脑空穴主治。醉酒后感冒风热发作，两角（一作两目）眩晕疼痛，不能饮食。烦闷呕吐，由率谷穴主治（《千金方》将此条置于风门）。项强伴失音，刺喑门穴。热病不出汗，由天柱及风池、商阳、关冲、腋门穴主治。颈部疼痛转头困难，流泪，眼屎多，鼻塞流涕鼻出血，目内眦红痛，气厥致耳目不明，咽喉拘急牵引项部筋脉挛缩不收，由风池穴主治。伤寒热盛，烦闷呕吐，由大椎穴主治。头重目眩凄惨恶寒，寒热往来，不出汗，由陶道穴主治。身热头痛，进退往来，由神道穴主治。头痛如破，身热如火，不出汗，抽搐（《千金方》作头痛），寒热，不出汗，恶寒，里急，腰腹相互牵引疼痛，由命门穴主治。颈项痛不能俯仰，头痛恶寒，抽搐，气实则胁满，夹脊有寒气，发热，不出汗，腰背痛，由大杼穴主治。风眩头痛，鼻窍不利，时常打喷嚏，清涕自出，由风门穴主治。凄惨振寒，多次打哈欠伸懒腰，由膈俞穴主治。热病不出汗，由上廉及孔最穴主治。（《千金方》作臂厥热病不出汗，皆灸刺之，此穴可以出汗）。肩胛间拘急，凄惨恶寒，由魄户穴主治。项背痛牵引颈部，由魄户穴主治。肩痛胸腹满，凄惨脊背急强，由神堂穴主治。喘逆鼻塞，肩胛内侧疼痛，不能俯仰，季胁牵引少腹疼痛胀满，由噫嘻穴主治。背痛恶寒，脊强俯仰困难，饮食不下，呕吐多涎，由膈俞穴主治（《千金方》作阳关）。热病头痛身重，由悬颅穴主治。胸胁胀满，背痛恶风寒，饮食不下，呕吐不留食，由魂门穴主治。善打喷嚏，头痛身热，由颔厌穴主治。热病头痛，牵引目外眦而紧张，烦闷不出汗，牵引下颌牙齿，面赤皮肤痛，由悬厘穴主治。热病偏头痛，牵引目外眦，由悬厘穴主治。头目瞳孔疼痛，不能视物，挟持项部强直，不能回头，由阳白穴主治。头风痛，鼻塞流涕鼻出血，眉骨头痛，善打喷嚏，眼睛像要脱出，出汗寒热，面赤颊中痛，项椎不能左右顾盼，眼系紧张，抽搐，由攒竹穴主治。寒热凄惨咬牙打颤，由承浆穴主治。身热痛，胸胁痛不能翻身，由颅息穴主治。肩背痛，寒热，瘰疬绕颈，有大肿块，暴聋气闷昏厥，耳目不开，头颔痛，流泪鼻出血，呼吸不畅，不知香臭，风眩喉痹，由天牖穴主治。热病胸中淡淡不适，腹部胀满突发疼痛，恍惚不知人事，手脚清冷（《千金方》作烦满不出汗），由上脘穴主治。身寒热，由阴都穴主治。热病像疟疾一样，振栗咬牙，腹胀睥睨，喉中鸣响，由少商穴主治。寒厥及热烦心，少气不足以呼吸，阴部湿痒，腹痛不能饮食，肘部挛缩支满，喉中焦干枯渴，由鱼际穴主治。热病振栗咬牙，腹部胀满阳痿，咳嗽牵引尻部溺出，这是虚证。膻中虚，饮食呕吐，身热不出汗，频繁唾血便血，肩背寒热，面色脱色，流泪，都是虚证。针刺鱼际穴用补法。温病身热，五天以上，不出汗，刺太渊穴。留针一时辰，取效。如果未满五天，禁止针刺。热病起初手臂抽搐，嘴唇聚拢鼻孔张开，眼下出汗如转珠，两乳下二寸坚硬，胁满，心悸，由列缺穴主治。
Huangdi asked: In cases of heat disease accompanied by pain, what is the cause? Qibo replied: Heat disease manifests in Yang pulses, due to the exuberance of the San Yang (Three Yang) channels. If the Renying pulse (pulse at the carotid artery) is one degree faster than the Cunkou pulse, the disease is in Shaoyang (Lesser Yang); two degrees faster, it is in Taiyang (Greater Yang); three degrees faster, it is in Yangming (Yang Brightness). When Yang Qi enters Yin, the disease affects the head and abdomen, resulting in distension and headache.
(Huangdi) asked: What causes body heat, sweating, yet persistent vexation and fullness that does not resolve? (Qibo) said: Sweating with body heat indicates Wind pathogen; sweating with persistent vexation and fullness indicates Jue (reversal) syndrome. This disease is named Feng Jue (Wind Reversal). Taiyang governs the Qi of all Yang channels (Suwen refers to it as Ju Yang), so it is the first to be invaded by pathogens. Shaoyin, being the interior-exterior pair of Taiyang, follows the heat upward when affected. Following upward leads to reversal. Treatment requires simultaneous needling of both exterior and interior channels, along with administering decoctions.
(Huangdi) asked: In warm disease patients who sweat but immediately develop fever again, with rapid and restless pulses, where sweating does not alleviate the condition, and who speak deliriously and cannot eat, what is this disease called? (Qibo) said: It is called Yin-Yang Intersection (Yin Yang Jiao). Intersection implies death. Humans sweat because fluids originate from grain (food), which transforms into essence (Jing). Now, if pathogens contend with healthy Qi in the flesh and bones, and sweating occurs, it means pathogens are retreating and essence prevails. If essence prevails, the patient should be able to eat and not have recurrent fever. Recurrent fever indicates lingering pathogens. Sweat represents essence. Now, sweating followed immediately by fever indicates pathogen victory. Inability to eat means essence receives no nourishment. With heat lingering, life can end instantly. Death is predicted when sweating is accompanied by a rapid and full pulse. If the pulse does not correspond with sweating, it shows the body cannot overcome the disease, making death evident. Delirious speech indicates loss of Zhi (Will/Shen). Loss of Will leads to death. There are three signs of death here, with no sign of life; even if recovery seems possible, death is inevitable.
For wind disease presenting with alternating chills and fever, dry heat sweating, and frequent yawning, initially needle the collateral vessels in the intermuscular spaces. For sweating with alternating chills and fever, needle once every three days until cured after one hundred days.
(Huangdi) asked: What defines Deficiency (Xu) and Excess (Shi)? (Qibo) said: Exuberance of pathogenic factors constitutes Excess; depletion of healthy essence constitutes Deficiency. A Heavy Excess pattern presents with intense internal heat, hot pathological state, and full pulses.
(Huangdi) asked: What if both meridians and collaterals are Excess? (Qibo) said: Both meridians and collaterals being Excess manifests as a rapid Cunkou pulse and a slow Chi (wrist) pulse. Both should be treated simultaneously. Thus, slippery pulses indicate favorable prognosis, while choppy pulses indicate unfavorable prognosis. Deficiency and Excess patterns should be treated according to their corresponding categories (Suwen says "begin"). If the five Zang organs and bones/flesh are smooth and free, longevity is possible. Sudden upward surging of Cold Qi with full and excess pulses leads to survival if the pulse is slippery and smooth, but death if it is reverse and choppy. If the pulse is extremely full, rapid, large, and firm, and the Chi pulse is full (or choppy) and unresponsive, survival depends on whether the pulse is favorable or reverse. Favorable means warm extremities; reverse means cold extremities.
(Huangdi) asked: What is Heavy Deficiency? (Qibo) said: Weak pulse, weak Qi, and weak Chi pulse constitute Heavy Deficiency. "Weak Qi" refers to irregular speech; "Weak Chi" refers to unsteady gait; "Weak Pulse" lacks the image of Yin. In such cases, a slippery pulse indicates survival, while a choppy pulse indicates death. Qi deficiency corresponds to Lung deficiency; Qi reversal leads to cold feet. Survival is possible if it occurs out of season, but death if it occurs in the corresponding season. The same applies to other Zang organs. If the pulse is full and solid with cold extremities and a hot head, survival is possible in Spring and Autumn, as Winter and Summer are contrary to this pattern; treat the primary diseased organ. If meridians are deficient and collaterals are excess, with heat and fullness at the Chi and cold/choppy pulses at the Mai Kou, death occurs in Spring and Summer, but survival in Autumn and Winter. If collaterals are excess and meridians deficient, moxa the Yin channels and needle the Yang channels; if meridians are excess and collaterals deficient, needle the Yin channels and moxa the Yang channels.
(Huangdi) asked: Why should one not exhaust Yin in Autumn/Winter and not exhaust Yang in Spring/Summer? (Qibo) said: Not exhausting Yang means not unnecessarily weakening Yangming in Spring/Summer; Yangming weakness leads to mania. Not exhausting Yin means not unnecessarily weakening Taiyin in Autumn/Winter; Taiyin weakness leads to death. Extreme conditions in Spring are treated via meridians/collaterals; in Summer via meridian-shu points; in Autumn via Six Fu organs; in Winter, when Qi and Blood are closed, treatment relies on herbs with minimal acupuncture/moxibustion. "Minimal acupuncture" does not refer to carbuncles and sores.
For heat disease starting in the arm, first needle Hand Yangming and Hand Taiyin to induce sweating. For heat disease starting in the head, first needle Neck Taiyang to induce sweating. For heat disease starting in the lower leg, first needle Foot Yangming to induce sweating. Hand Taiyin (Lingshu says Hand Yangming) can induce sweating; Foot Yangming can also induce sweating. If excessive sweating occurs after needling Yin points, stop and switch to Yang points; if excessive sweating occurs after needling Yang points, stop and switch to Yin points.
For shivering, teeth chattering, inability to sweat, abdominal distension, and vexation, needle Hand Taiyin. On the third day of heat disease, if the Cunkou pulse is calm and the Renying pulse is restless, needle the 59 points of the Yang channels to drain heat, induce sweating, tonify Yin, and address deficiencies. If body heat is severe but both Yin and Yang pulses are calm, do not needle. For those suitable for needling, act urgently; if no sweat occurs, diarrhea may follow. "Do not needle" applies to cases with signs of impending death. On the 7th-8th day of heat disease, if the Mai Kou pulse is rapid with dizziness, needle urgently; sweat will likely occur spontaneously. Superficially needle the space between the thumb fingers. On the 7th-8th day, if the pulse is minute, the patient has hematuria and dry mouth, death occurs within 1.5 days; if the pulse is intermittent (Dai), death occurs within one day. If heat disease patient sweats but the pulse remains rapid/restless, with wheezing and recurrent fever, do not casually needle; severe wheezing indicates certain death. On the 7th-8th day, if the pulse is not rapid, scattered, or rapid-frequency, and sweat occurs within three days, but no sweat occurs after three days, death occurs on the fourth day. Do not casually needle before sweating.
If heat disease begins with skin pain, nasal congestion, and facial flushing, treat the skin layer using the First Needle (Chan needle) and the 59-point method. For dry nose (Lingshu says diagnose dry nose), seek treatment in the Lung (Skin), not in Fire (Heart). If heat disease begins with body stiffness, vexation, and heat, with chest distress and dry lips/throat, treat the skin layer using the First Needle and the 59-point method. For heat disease with skin swelling, dry mouth, chills, and sweating, seek treatment in the Heart (Pulse), not in Water (Kidney). For heat disease with dry throat, polydipsia, fright, and restlessness, treat the flesh layer using the Sixth Needle (Hao needle) and the 59-point method. For red eyes (Lingshu says green), seek treatment in the Spleen (Flesh), not in Wood (Liver). For heat disease with chest/hypochondriac pain (Lingshu says facial green/chest pain) and restless extremities, treat the sinew layer using the Fourth Needle (Feng needle) at Si Ni points. For sinew spasms and dim vision, seek treatment in the Liver (Sinew), not in Metal (Lung). For heat disease with frequent惊悸 (palpitations/fright), convulsions, and mania, treat the vessels using the Fourth Needle to urgently drain excess. For epilepsy with hair loss, seek treatment in the Heart (Blood), not in the Kidney (Water). For heat disease with heavy body, bone pain, deafness, and desire to close eyes, treat the bone layer using the Fourth Needle and the 59-point method. For bone disease with anorexia, teeth grinding, and cyanotic ears, seek treatment in the Kidney (Bone), not in Earth (Spleen). For heat disease with unknown location, deafness, inability to control movements, dry mouth, extreme Yang heat, and Yin cold, the heat is in the Marrow; this is incurable and fatal. For heat disease with headache, temporal pain, tight eye vessels (or loose), and frequent epistaxis, this is Jue Heat Disease. Use the Third Needle (Di needle) based on excess/deficiency. Accompanied by cold/heat hemorrhoids. For heat disease with heavy body and intestinal heat, use the Fourth Needle at Shu points and between toes, seeking Qi in the Stomach collaterals. For heat disease with urgent pain beside the navel and chest/hypochondriac fullness, use Yongquan and Yinlingquan, inserting the Fourth Needle deeply near the throat. For heat disease about to sweat, or with favorable pulses allowing sweating, use Yuji, Taiyuan, Dadu, and Taibai; draining reduces heat, tonifying induces sweat. For excessive sweating, use the transverse vessel above the medial malleolus to stop it.
If heat disease patient sweats but the pulse remains rapid/full, this is the extreme of Yin pulses and indicates death; if the pulse becomes calm after sweating, survival is indicated. If the pulse is constantly rapid/full without sweating, this is the extreme of Yang pulses and indicates death; if the pulse calms after sweating, survival is indicated.
For Jue syndrome with pain along the spine, stiff neck/head, blurry vision, and strong lumbar/spine, bleed the blood collaterals of Foot Taiyang. For dry throat and sticky oral heat, use Foot Shaoyang points (This section comes from Suwen's Waist Pain chapter and should be placed there).
There are nine fatal signs in heat disease: 1. No sweat with red cheeks (Tai Su notes: no sweat + red cheeks = certain death). 2. Diarrhea with severe abdominal fullness. 3. Unclear vision with unrelenting heat. 4. Elderly or infants with heat and abdominal fullness. 5. No sweat with vomiting blood (Lingshu says vomiting lower blood). 6. Rotting tongue root with unrelenting heat. 7. Coughing with epistaxis, sweating that does not reach the feet. 8. Marrow heat. 9. Heat with convulsions/stiffness. Heat with convulsions involves backward arching of the waist, limb spasms, and locked jaw. These nine conditions are not suitable for needling.
The "59 Points" consist of: 12 points on the inner and outer sides of both hands (3 each); 8 points between the five fingers (1 each); similarly on the feet; 6 points one cun inside the hairline, 0.3 cun lateral (Lingshu omits 'fen'); 10 points three cun inside the hairline laterally; 6 points around ears, front/back of mouth (Lingshu says below mouth), and neck center; 1 point on the vertex, Xinhui, hairline, Lianquan, 2 Fengchi, 2 Tianzhu (Xinhui to Tianzhu missing in Jiayi Jing, supplemented from Lingshu).
Suwen states: The five rows of five points on the head disperse rebellious heat from all Yang channels. Dazhu, Ying Shu, Quepen, and Back Vertebrae (8 points) drain chest heat. Qichong, Zusanli, Shangjuxu, and Xiajuxu (8 points) drain stomach heat. Yunmen, Bitong, Weizhong, and Suikong (8 points) drain limb heat. Five points beside each of the Five Zang Shu points (10 points total) drain Zang heat. All 59 are key points for draining heat.
For cold in the head, epistaxis, and tearing, Shenting treats it. For headache, fever, nasal obstruction, dyspnea, vexation, and no sweat, Qucha treats it. For headache, vertigo, stiff neck, chest/hypochondriac traction, and inability to tilt, Benshen treats it. For heat disease (Suwen adds vexation/fullness) with no sweat, Shangxing treats it; first needle Yexi, then Tianyou and Fengchi. For heat disease with no sweat, bitter vomiting, and heart vexation, Chengguang treats it. For heavy head/neck, sudden collapse, nasal obstruction, rhinorrhea, epistaxis, and dyspnea, Tongtian treats it. For head/neck pain, aversion to wind, no sweat, chills, vomiting, tight eye system, pain radiating to temples, heavy head, and stiff neck, Yuzhen treats it. For clear cheeks (Qianjin says biting cheeks), inability to see, drooling, brow/eye pain, Linqi treats it. For brain wind headache, aversion to wind/cold, rhinorrhea, nasal obstruction, and dyspnea, Chengling treats it. For headache, fever, and tension in the mandible (or pain), Naokong treats it. For post-drunken wind-heat, temporal/eye vertigo, and anorexia with vexation/vomiting, Lvgu treats it (Qianjin places this under Fengmen). For stiff neck with aphasia, Anmen is needled. For heat disease with no sweat, Tianzhu, Fengchi, Shangyang, Guanchong, and Yimen treat it. For neck pain preventing turning, tearing, excessive discharge, rhinorrhea, epistaxis, inner canthus redness/pain, Qi Jue causing ear/eye dullness, and throat/neck tendon spasm, Fengchi treats it. For severe cold damage with heat, vexation, and vomiting, Dazhui treats it. For heavy head, dizzy eyes, chills, cold/heat alternation, and no sweat, Daodao treats it. For feverish headache coming and going, Shendao treats it. For splitting headache, burning fever, no sweat, convulsions (Qianjin says headache), cold/heat, aversion to cold, interior urgency, and waist/abdominal traction pain, Mingmen treats it. For neck pain preventing flexion/extension, headache with chills, convulsions, Qi excess with hypochondriac fullness, cold Qi along the spine, fever, no sweat, and back/waist pain, Dazhu treats it. For wind vertigo headache, nasal obstruction, sneezing, and clear rhinorrhea, Fengmen treats it. For chilling tremors and frequent yawning, Geshu treats it. For heat disease with no sweat, Shanglian and Kongzui treat it (Qianjin says Arm Jue heat disease with no sweat, moxa/needle these points to induce sweat). For shoulder blade stiffness and chills, Pohu treats it. For neck/back pain radiating to the neck, Pohu treats it. For shoulder pain, chest/abdominal fullness, chilling back stiffness, Shentang treats it. For wheezing, rhinorrhea, scapular medial pain, inability to bend/bow, costal pain radiating to the lower abdomen, Yexi treats it. For back pain, aversion to cold, stiff spine, dysphagia, vomiting with saliva, Geshu (Qianjin says Yangguan) treats it. For heat disease with headache and heaviness, Xuanlu treats it. For chest/hypochondriac distension, back pain, aversion to wind/cold, anorexia, and non-retained vomiting, Hunmen treats it. For frequent sneezing, headache, and fever, Hanyan treats it. For heat disease headache radiating to the outer canthus with tension, vexation, no sweat, mandibular/tooth pain, red face, and skin pain, Xuanli treats it. For heat disease lateral headache radiating to the outer canthus, Xuanli treats it. For eye/pupil pain, blindness, stiff neck preventing turning, Yangbai treats it. For head wind headache, rhinorrhea, brow pain, sneezing, bulging eyes, sweating with cold/heat, red face, cheek pain, immobile neck, tight eye system, and convulsions, Zanzhu treats it. For cold/heat chills and teeth chattering, Chengjiang treats it. For body pain, chest/hypochondriac pain preventing turning, Luxi treats it. For shoulder/back pain, cold/heat, cervical lymphadenopathy, large masses, sudden deafness, mental confusion, open eyes/ears difficulty, head/jaw pain, tearing, epistaxis, breathing difficulty, anosmia, wind vertigo, and throat bi, Tianyou treats it. For heat disease with vague chest discomfort, acute abdominal pain, mental confusion, and cold limbs (Qianjin says vexation/no sweat), Shangwan treats it. For body cold/heat, Yindu treats it. For heat disease resembling malaria with tremors, teeth chattering, abdominal distension, and throat sounds, Shaoshang treats it. For cold Jue, heat vexation, shortness of breath, genital dampness/itching, abdominal pain preventing eating/drinking, elbow contracture, fullness, and dry throat/thirst, Yuji treats it. For heat disease with tremors, teeth chattering, abdominal distension, impotence, cough radiating to the sacrum, and urinary leakage (Deficiency pattern); emptiness in the chest, vomiting food, fever, no sweat, frequent hemoptysis/hematochezia, shoulder/back cold/heat, pallor, and tearing (all Deficiency), tonify Yuji. For warm disease with fever lasting over five days and no sweat, needle Taiyuan. Retain needles for one Shichen. If less than five days, do not needle. For heat disease beginning with arm convulsions, puckered lips, flared nostrils, pearl-like sweat under eyes, hardness two cun below nipples, hypochondriac fullness, and palpitations, Lieque treats it.