帝曰∶愿闻人之黑白肥瘦小长,各有数乎?岐伯曰∶年质壮大,血气充盈,肤革坚固,
因加
以邪,刺此者深而留之,此肥人也。广肩腋,项肉薄,浓皮而黑色,唇临临然,其血黑以浊
,其气涩以迟,其为人也,贪于取兴,刺此者深而留之,多益其数也。瘦人皮薄色少,肉廉
廉然,薄唇轻言,其血气清,易脱于气,易损于血,刺此者浅而疾之。刺肥人者以秋冬之齐
,刺瘦人者以春夏之齐。
曰刺常人奈何?视其白黑,各为调之。其端正敦浓者,其血气和调,刺此者无失常数也
。
帝曰∶夫王公大人,血气之君,身体柔脆,肌肉软弱,血气 悍滑利,其刺之浅深疾徐
多少
何如?岐伯曰∶膏粱藿菽之味,何可同也!气滑即疾出,其气涩则出迟,气悍则针小而入浅,
气涩则针大而入深,深则欲留,浅则欲疾,以此观之。刺布衣者深而留之,刺大人者微以徐
之,此皆因其 悍滑利也。寒痹内热,刺布衣以火 之,刺大人以药熨之。
帝曰∶刺壮士真骨者奈何?岐伯曰∶刺壮士真骨坚肉缓节,监监然,此人重则气涩血浊
,刺此者深而留之,多益其数,劲则气滑血清,刺此者浅而疾之。
曰∶刺婴儿奈何?曰∶婴儿者,其肉脆血少气弱,刺此者以毫针,浅刺而疾发针,日再
可也。
脉实者深刺之,以泄真气,脉虚浅刺之,使精气无得出,以养其脉,独出其邪气。刺阴
者深
而留之,刺阳者浅而疾之。脉浅者勿刺,按其脉乃刺之,无令精出,独出其邪气耳。脉之所
居,深不见者,勿按其脉而刺之,微内针而久留之,以致其孔脉气也。
黄帝说:我想听听关于人的肤色黑白、体型肥瘦高矮,是否各有相应的针刺规律?岐伯回答说:如果一个人年富力强、体格壮实,血气充盈,皮肤坚韧坚固,又感受了外邪,针刺这种人应当深刺并留针,这是针对肥胖之人的治法。这类人通常肩腋宽阔,颈部肌肉薄弱,皮肤厚实且颜色黑,嘴唇丰厚下垂,他们的血液颜色黑而浑浊,气机运行涩滞且缓慢。这类人性格贪婪且喜好享乐,针刺他们应当深刺并留针,同时增加针刺的次数。
消瘦的人皮肤薄、面色少华,肌肉单薄,嘴唇薄且言语轻快,他们的血气清稀,容易耗散正气,也容易损伤阴血,针刺这种人应当浅刺并快速出针。针刺肥胖之人要顺应秋冬季节的深浅规律(指秋冬阳气内敛,宜深刺),针刺消瘦之人要顺应春夏季节的深浅规律(指春夏阳气外浮,宜浅刺)。
那么如何针刺普通人呢?观察其肤色黑白,分别进行调理。那些形体端正、敦厚稳重的人,血气和调,针刺他们不要违背常规的针刺法则。
黄帝说:那些王公大人,身为血气之主,身体柔嫩脆弱,肌肉软弱,但血气剽悍滑利,对他们的针刺在深浅、疾徐、多少方面应该如何把握?岐伯回答说:食用膏粱厚味与粗茶淡饭的人,体质怎能相同呢!血气滑利的出针要快,血气涩滞的出针要慢;血气剽悍的用小针浅刺,血气涩滞的用大针深刺,深刺就要留针,浅刺就要快出,根据这些情况来观察判断。针刺平民百姓应当深刺并留针,针刺王公大人则应轻微缓慢地操作,这都是因为他们的血气剽悍滑利所致。对于寒痹伴有内热的情况,针刺平民百姓用火针疗法,针刺王公大人则用药物熨烫疗法。
黄帝说:如何针刺骨骼强壮、筋骨坚实的壮士呢?岐伯回答说:针刺壮士时,若见其骨骼坚实、肌肉舒缓、关节有力,这类人若体质厚重,则气涩血浊,针刺应当深刺并留针,增加针刺次数;若体质劲健,则气滑血清,针刺应当浅刺并快速出针。
那么如何针刺婴儿呢?回答说:婴儿肌肉脆嫩,血少气弱,针刺要用毫针,浅刺并快速出针,每天可以针刺两次。
脉象实的,深刺以泄去邪气(注:原文“真气”在此语境下多指邪气或过盛之气,结合后文“养其脉”,此处按常规中医理论理解为泻实,但忠实原文翻译为泄去真气/邪气,通常教材解释为泻其实);脉象虚的,浅刺以使精气不致外泄,从而滋养经脉,单独祛除邪气。针刺阴分病变的,深刺并留针;针刺阳分病变的,浅刺并快速出针。脉搏表浅的不要直接深刺,应先按压脉搏再施针,不要使精气外泄,只祛除邪气即可。脉搏位置深在、肉眼看不见的,不要按压脉搏就直接针刺,微微进针并长时间留针,以引导经气到达穴位。
The Yellow Emperor said: I wish to hear whether there are specific rules for needling people of different skin colors (black and white), body constitutions (fat and thin), and sizes (small and tall). Qibo replied: If a person is in their prime, robust in physique, with abundant Qi and Blood, and firm and tough skin, and has been affected by pathogenic factors, needling such individuals requires deep insertion and retention of the needle. This applies to fat people. Such individuals typically have broad shoulders and axillae, thin flesh on the neck, thick skin, and dark complexion; their lips are full and protruding. Their blood is dark and turbid, and their Qi flow is sluggish and slow. In terms of temperament, they are greedy and pleasure-seeking. When needling them, one should insert deeply, retain the needle, and increase the number of needles or repetitions.
Thin people have thin skin, lackluster complexion, lean muscles, thin lips, and speak lightly. Their Qi and Blood are clear and pure, but they are prone to Qi depletion and Blood damage. When needling them, one should insert shallowly and withdraw quickly. When needling fat people, follow the depth principles of autumn and winter; when needling thin people, follow the depth principles of spring and summer.
How should normal people be needled? Observe their skin color (white or black) and adjust accordingly. Those who are upright and dignified have harmonious Qi and Blood; when needling them, do not deviate from the standard rules.
The Yellow Emperor said: Regarding kings and nobles, who are masters of Qi and Blood, with soft and fragile bodies and weak muscles, yet whose Qi and Blood are fierce and slippery, how should the depth, speed, and quantity of needling be determined? Qibo replied: One cannot treat those who consume rich foods (gao liang) and those who eat coarse grains (huo shu) in the same way! If the Qi is slippery, withdraw the needle quickly; if the Qi is sluggish, withdraw it slowly. If the Qi is fierce, use small needles and insert shallowly; if the Qi is sluggish, use large needles and insert deeply. Deep insertion requires retention, while shallow insertion requires quick withdrawal. Based on this observation: commoners should be needled deeply with retention, whereas nobles should be needled gently and slowly. This is all due to their fierce and slippery Qi and Blood. For cold bi syndrome with internal heat, needling commoners involves fire therapy (moxibustion/fire needle), while needling nobles involves herbal compress therapy.
The Yellow Emperor said: How should vigorous men with solid bones be needled? Qibo replied: Vigorous men have solid bones, relaxed muscles, and strong joints. If such a person is heavy-set, their Qi is sluggish and blood is turbid; needling requires deep insertion, retention, and an increased number of needles. If they are agile and strong, their Qi is slippery and blood is clear; needling requires shallow insertion and quick withdrawal.
How should infants be needled? Infants have fragile flesh, little blood, and weak Qi. Use fine needles (hao zhen), insert shallowly, and withdraw quickly. Treatment can be performed twice a day.
When the pulse is excess, insert deeply to drain the pathogenic factor (note: original text says "zhen qi", contextually implies draining excess); when the pulse is deficiency, insert shallowly to prevent the loss of essential Qi, thereby nourishing the vessels and expelling only the pathogenic factor. Needling Yin disorders requires deep insertion and retention; needling Yang disorders requires shallow insertion and quick withdrawal. Do not needle superficial pulses directly; press the pulse first before needling to avoid losing essence and to expel only the pathogen. For pulses located deeply and invisibly, do not press; insert slightly and retain the needle for a long time to guide the vessel Qi.