千金云。凡言壮数者。若丁壮病根深笃。可倍于方数。老少羸弱。可减半。又曰。小儿
七日
壮。短剧诸方亦然。惟明堂本经云。针入六分。灸三壮。更无余治。故后人不准。惟以病之
轻重而增损之。凡灸头项。止于七壮。积至七七壮止。（铜人）若治风则灸上星、前顶、百会
至二百壮。腹背宜灸五百壮。若鸠尾、巨阙亦不宜多灸。但去风邪。不宜多灸。灸多则四肢
细而无力。（明堂）千金方于足三里穴乃云。多至三二百壮。心俞禁灸。若中风。则急灸至百
壮。皆视其病之轻重而用之。不可泥一说。而不知其又有一说也。下经只云。若是禁穴。明
堂亦许灸一壮至三壮。恐未尽也。
千金云。凡宦游吴蜀。体上常须三两处灸之。勿令疮暂瘥。则瘴疠温疟毒瓦斯不能着人。
故吴
痛处。即云阿是。灸刺皆验。故云阿是穴。
资生云。凡着艾得疮发。所患即瘥。不得发。其病不愈。甲乙经云。灸疮不发者。用故
履底
疮三日自发。予见人灸疮不发者。频用生麻油渍之而发。亦有用皂角煎汤。候冷频点之而
发。亦有恐气血衰不发。于灸前后煎四物汤服。以此汤滋养气血故也。不可一概论也。予常
灸三里各七壮。数日过不发。再各灸二壮。右足发。左足不发。更灸左足一壮遂发。亦在人以
意取之。若顺其自然。则终不发矣。此人事所当尽也。按宝鉴云。气不至而不效。灸之亦不发
。盖十二经应十二时。其气各以时而至。故不知经络气血多少。应至之候而灸之者。则疮不
发。世医莫之知也。惜哉。若壮实人。不候时而灸亦发。
《千金方》说：凡是提到灸的壮数，如果是身体强壮、病根深重的患者，灸量可以加倍于常规处方规定的数量；如果是老人、儿童或体质虚弱者，灸量可以减少一半。又说：小儿七岁可灸七壮，《短剧诸方》等医书也是同样的说法。只有《明堂本经》记载：针刺入六分，艾灸三壮，没有其他治疗方法。所以后人没有统一的标准，只是根据病情的轻重来增减灸量。
凡是灸头项部位，最多不超过七壮，累计达到七七四十九壮为止（据《铜人腧穴针灸图经》）。如果治疗风疾，则灸上星、前顶、百会穴，可达二百壮；腹部和背部适宜灸五百壮。如果灸鸠尾、巨阙穴也不宜过多，只要祛除风邪即可，不宜多灸。灸量过多会导致四肢细弱无力（据《明堂》）。《千金方》在足三里穴上说，可以多灸到二三百壮。心俞穴禁止施灸，但如果发生中风，则紧急灸至一百壮。这些都是根据病情的轻重来决定用量，不可拘泥于一种说法，而不知道还有另一种说法。《下经》只说：如果是禁灸穴，《明堂》也允许灸一到三壮，恐怕这种说法并不全面。
《千金方》说：凡是外出游历吴蜀地区的人，身上常需在三两处穴位施灸，不要让灸疮暂时愈合，这样瘴气、疠气、温疟等毒气就不能侵袭人体。所以遇到疼痛的地方，就说“阿是”，无论是灸还是刺都有效，因此称为“阿是穴”。
《资生经》说：凡是施灸后能起疮发脓的，所患疾病就能痊愈；如果不能发疮，疾病就不会好。《甲乙经》说：灸疮不发者，用旧的鞋底敷在疮口上，三天后自然会发。我见过灸疮不发的情况，频繁用生麻油浸泡患处使其发出来；也有用皂角煎汤，待冷却后频繁点涂使其发出来的；也有担心气血衰弱导致不发，在灸前后服用四物汤，以此汤滋养气血的缘故。不能一概而论。我曾经灸两侧足三里各七壮，几天后都不发，再各灸两壮，右足发了，左足没发，又给左足加灸一壮才发。这也在于医者用心斟酌取穴施治。如果顺其自然，最终也不会发。这是人力应当尽力做到的。按《扁鹊心书》（注：此处宝鉴指窦汉卿《针经指南》或相关著作，通常指代针灸权威典籍）所说：气不至则无效，灸之也不发疮。因为十二经脉对应十二时辰，经气各自按时辰到达。所以如果不了解经络气血的多少，不在经气应至之时施灸，那么疮就不会发。世间的医生大多不知道这一点，可惜啊。如果是身体壮实的人，不候时辰而灸也能发。
The *Qianjin Fang* (Prescriptions Worth a Thousand Gold) states: Whenever the number of moxa cones (Zhuang, 壮) is mentioned, if the patient is robust with a deep-seated disease, the dosage may be doubled compared to the standard prescription. For the elderly, children, or those who are frail and weak, the dosage may be halved. It further states that for a seven-year-old child, seven Zhuang should be applied; other texts such as *Duanju Zhufang* (Various Formulas from Short Dramas) adhere to this principle. Only the *Mingtang Benjing* (Classic of the Bright Hall) records: "Needle insertion depth of six fen, moxibustion of three Zhuang," with no other treatments mentioned. Consequently, later practitioners lacked a uniform standard, adjusting the moxibustion dosage up or down based on the severity of the illness.
For moxibustion on the head and neck, limit it to seven Zhuang, accumulating up to forty-nine Zhuang (7 x 7) at most (according to the *Tongren Shuxue Zhenjiu Tujing* [Illustrated Manual of Acupoints for Moxibustion and Acupuncture]). If treating wind disorders, moxibustion on Shangxing (GV23), Qian Ding (GV21), and Baihui (GV20) can reach two hundred Zhuang. The abdomen and back are suitable for five hundred Zhuang. However, moxibustion on Jiwei (CV15) and Jueque (CV14) should not be excessive; one need only dispel wind pathogens, avoiding excessive application. Excessive moxibustion may result in thin and weak limbs (according to the *Mingtang*). The *Qianjin Fang* notes regarding Zusanli (ST36) that one may apply up to two or three hundred Zhuang. Xinshu (BL15) is contraindicated for moxibustion; however, in cases of stroke (Zhongfeng, 中风), emergency moxibustion of one hundred Zhuang is indicated. These applications depend on the severity of the condition and should not be rigidly adhered to as a single rule, ignoring alternative perspectives. The *Xiajing* (Lower Classic) merely states that for contraindicated acupoints, the *Mingtang* permits one to three Zhuang, which seems incomplete.
The *Qianjin Fang* states: For those traveling through the regions of Wu and Shu, it is necessary to apply moxibustion to two or three locations on the body and prevent the moxa sores from healing temporarily. This ensures that miasma, pestilence, warm malaria, and toxic vapors cannot afflict the person. Therefore, when pain is felt, one says "A-shi" (Ah-Yes), indicating that both moxibustion and acupuncture are effective at that spot, hence the term "Ashi Acupoint."
The *Zisheng Jing* (Scripture of Nourishing Life) states: If moxibustion induces a sore (Chuangfa, 疮发), the disease will heal; if no sore develops, the disease will not resolve. The *Jiayi Jing* (Classics of Systematic Classification) states: To induce a non-developing moxa sore, apply an old shoe sole to the sore; it will naturally develop within three days. I have observed cases where moxa sores did not develop; frequent application of raw sesame oil (Sheng Mayou, 生麻油) to the area induced development. Others used decoctions of Gleditsia sinensis (Zaojiao, 皂角), cooling the liquid and applying it frequently to induce development. Some feared Qi and Blood deficiency prevented development, so they administered Sigewu Tang (Four Substances Decoction) before and after moxibustion to nourish Qi and Blood. These methods cannot be generalized. I once applied seven Zhuang to both Zusanli (ST36) points. After several days, neither developed. I added two Zhuang to each; the right foot developed, but the left did not. I then added one Zhuang to the left foot, which finally developed. This depends on the practitioner's discernment. If one leaves it to nature, it may never develop. This represents the extent of human effort required. According to the *Baojian*, if Qi does not arrive, there is no effect, and moxibustion will not induce a sore. The twelve meridians correspond to the twelve double-hours (Shichen, 时辰); Qi arrives at specific times. Therefore, those who do not understand the volume of Qi and Blood in the meridians and fail to moxibustate when the Qi is due will find that sores do not develop. Most contemporary physicians are unaware of this, which is regrettable. However, for robust individuals, moxibustion without waiting for the appropriate time may still induce a sore.