冲脉任脉皆起于胞中。上循背里为经络之海。其浮而外者循腹右上行。会于咽喉。别而
络唇口
。血气盛则充肤热肉。血独盛则澹渗皮肤。生毫毛。妇人有余于气不足于血以其数脱血也冲
任之脉不荣口唇。故须髭不生。
阴阳和调。而血气淖泽滑利。故针入而气出。疾而相逢也。多阴而少阳。其气沉而气往
难。
失(营气主沉。卫气主浮。刺卫当浅。刺营当深。针入而气逆者特以宜浅反深。宜深反浅也
气为上膈者。食饮入而还出。(因于气。则病在上。故食饮一入实时还出夫气有虚实实
而气壅。则食无所容虚而气寒则食不得化。皆令食入即出也。)虫为下膈下膈者。食 时乃出(因
于虫则病在下。下文详言之。)喜怒不适。食饮不节。寒温不时。则寒汁流于肠中。流于肠
中则虫寒。虫寒则积聚守。于下管(脘同)则肠胃充廓。卫气不营。邪气居之。(凡疡胃气则
阳虚而寒汁流于肠中。虫寒不行。则聚于下脘。而肠胃充满也。卫气脾气也脾气不能营运。
故邪得聚而居之)人食则虫上食虫上食。则下管虚下管虚则邪气胜之积聚以留留则痈(壅同)
成痈成则下管约。(邪气乘虚留聚。以致壅于下脘要约不行。则亦因阳气之虚于下故食入周
时
复出也。)其痈在管内者。即而痛深其痈在外者。则痈外而痛深。痈上皮热。(管之内外。即
言下脘也。邪伏于中。故热见于皮肉之上。)微按其痈视气所行。(察其气所必由。以刺之也
)先浅刺其旁。稍内益深还而刺之。毋过三行。(先以泄其流行之邪。后刺其所病之正穴。以
拔其积聚之本。但至再三而止不可过也。)察其浮沉。以为深浅。已刺必熨令热入中。日使
热内。邪气益衰。大痈乃溃。(散也。)伍以参禁以除其内恬 无为。乃能行气。(几食息起
居。必参伍宜否。守其禁以除内之再伤。又必恬 无为以养其气。则正气乃行。而邪气可散
。盖膈症最为难愈。故当切戒如此)后以咸苦化。谷乃下矣(咸从水化。可以润下软坚。苦从
火化。可以温胃。故皆能下谷也。○下膈一症。有食入周日复出而不止 时者。有不因虫壅
。而下焦不通者矣。此篇特言虫壅者。盖亦下膈之一症耳。)
冲脉和任脉都起源于胞宫。向上沿着脊柱内部运行，成为经络之海。其中浮行于体表的分支，沿着腹部右侧上行，汇聚于咽喉部位，再分出支脉联络口唇。当气血旺盛时，能充盈肌肤、温暖肌肉；若血气特别盛，则渗入皮肤，生长毫毛。妇女由于经常失血，导致气有余而血不足，冲脉和任脉不能滋养口唇，所以胡须不生。
阴阳调和，气血滋润滑利，所以针刺时经气迅速外出，针与气很快相遇。如果人体阴多阳少，经气沉潜且运行困难，就会出现“气为上膈”的情况，即饮食进入后立刻吐出。（这是因为病气在上部，所以食物刚入口就立即吐出。气有虚实之分：实证则气机壅滞，食物无处容纳；虚证则气寒，食物无法消化，都会导致食入即出。）如果是虫积导致的“下膈”，则是进食一段时间后才吐出（因为虫积导致病位在下部，下文将详细论述）。喜怒失调，饮食不节制，寒温不适，会导致寒湿汁液流注于肠中。寒湿流注肠中则使寄生虫受寒，虫受寒则积聚停留于下脘（胃下部），导致肠胃扩张充盈，卫气不能正常营运，邪气占据其间。（凡是损伤胃气，就会导致阳虚，寒湿流注肠中，寄生虫因寒而不行，积聚于下脘，致使肠胃充满。卫气即脾气，脾气不能营运，所以邪气得以聚结停留。）人进食时，寄生虫向上觅食，导致下脘空虚，邪气乘虚而入并积聚停留，停留久了就会形成痈脓。痈脓形成后，下脘狭窄拘急。（邪气乘虚留聚，导致壅塞于下脘，气机不畅，也因为下焦阳气虚弱，所以食物摄入一周时间后又复出。）如果痈脓在体内深处，按压时疼痛深重；如果痈脓在体表较浅处，则痈肿在外而疼痛深重，痈上部的皮肤发热。（这里的管内体外，指的就是下脘部位。邪气伏藏于中，所以热象显现于皮肉之上。）轻轻按压痈处，观察气血运行的方向。（考察气血必经之路，以便进行针刺。）先在旁边浅刺，逐渐加深，反复针刺，不要超过三次。（先以浅刺泄去流行的邪气，后刺病变的正穴，以拔除积聚的根本，但只到两三次为止，不可过度。）根据邪气的浮沉来决定针刺的深浅。针刺后必须用熨法使其发热，让热力深入体内，每天使热气内入，邪气日益衰退，大痈才能溃破消散。（伍，通“五”，指参伍合宜；禁，指禁忌。通过参伍合宜的禁忌来消除体内的病因，保持心境恬淡无为，才能使气机运行。（饮食起居，必须参伍适宜与否，遵守禁忌以避免再次内伤，又必须恬淡无为以养气，这样正气才能运行，邪气才能消散。膈症最为难治，所以要特别告诫如此。）随后用咸味和苦味的药物化解，谷物就能下行。（咸味属水，可以润下软坚；苦味属火，可以温胃，所以都能帮助谷物下行。○下膈这一病症，有的食物摄入一周后复出不止，有的并非因虫积壅塞，而是下焦不通。本篇专门讲述虫积壅塞的情况，这不过是下膈病症中的一种表现罢了。）
The Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) both originate from the Bao Zhong (uterus/central cavity). They ascend along the interior of the spine, serving as the Sea of the Meridians. The branches that float outward follow the right side of the abdomen upward, converging at the throat, where they branch off to connect with the lips and mouth. When Qi and Blood are abundant, they fill the skin and warm the flesh; when Blood is particularly excessive, it seeps into the skin, generating fine hair. Women have an excess of Qi but a deficiency of Blood due to frequent blood loss; consequently, the Chong and Ren vessels fail to nourish the lips and mouth, resulting in the absence of facial hair.
When Yin and Yang are harmonious, and Qi and Blood are moist, lubricated, and smooth, needle insertion causes Qi to emerge rapidly, meeting the needle quickly. If there is an excess of Yin and deficiency of Ying Qi (Nutritive Qi), which is deep, while Wei Qi (Defensive Qi), which is superficial, is dominant, the movement of Qi is difficult. This leads to "Qi blocking the upper Jiao," where food and drink are regurgitated immediately upon entry. (This occurs because the pathogenic factor is located in the upper part, so food is expelled instantly. Qi can be either Excess or Deficiency: in Excess patterns, Qi stagnation prevents food from being retained; in Deficiency patterns, Cold Qi fails to digest food. Both result in immediate regurgitation.) If parasites cause "blocking of the lower Jiao," food is vomited after some time. (This occurs because the pathology caused by parasites is located in the lower part, as detailed later.) Irregular emotions, unregulated diet, and improper exposure to cold and heat cause cold fluids to flow into the intestines. These cold fluids chill the parasites, causing them to accumulate and stay in the Xia Wan (lower stomach). This results in distension and fullness of the intestines and stomach, preventing the normal circulation of Wei Qi (Defensive Qi), allowing pathogenic factors to reside there. (Damage to Stomach Qi leads to Yang deficiency and the flow of cold fluids into the intestines. Chilled parasites cease movement and accumulate in the lower stomach, filling the gastrointestinal tract. Wei Qi is synonymous with Spleen Qi; if Spleen Qi cannot circulate, pathogens gather and reside.) When a person eats, parasites move upward to feed, leaving the lower stomach empty. Pathogenic factors then invade this emptiness and accumulate. Prolonged accumulation leads to the formation of abscesses. Once formed, the lower stomach becomes constricted. (Pathogens accumulate due to deficiency, causing obstruction in the lower stomach and impeding Qi movement, often due to Yang deficiency in the lower Jiao, leading to regurgitation after a period.) If the abscess is deep within, palpation elicits deep pain; if superficial, the abscess is visible externally but pain remains deep, with heat on the skin above the lesion. (The terms "inside" and "outside" refer to the lower stomach. Pathogens hide internally, manifesting heat on the surface.) Gently palpate the abscess to observe the direction of Qi flow. (Identify the pathway of Qi for acupuncture.) Begin with shallow needling around the area, gradually increasing depth, repeating no more than three times. (First, use shallow needling to drain circulating pathogens; then needle the primary point of the disease to remove the root of accumulation, stopping after two or three sessions to avoid excess.) Determine needle depth based on the floating or sunken nature of the pathogen. After needling, apply moxibustion or warming therapy to generate heat, penetrating inward daily to weaken pathogens until the large abscess ruptures and dissipates. Combine five appropriate precautions to eliminate internal causes. Maintain tranquility and non-action to allow Qi to flow. (Diet and lifestyle must be adjusted according to the Five Elements and seasonal appropriateness, observing taboos to prevent internal injury. Tranquility nourishes Qi, allowing righteous Qi to flow and pathogens to disperse. Since obstructive disorders are difficult to cure, such caution is essential.) Subsequently, use salty and bitter substances to transform and descend grain. (Salty flavors, associated with Water, soften hardness and promote downward movement; bitter flavors, associated with Fire, warm the Stomach. Both facilitate the descent of food. ○ Regarding lower Jiao obstruction, some cases involve prolonged regurgitation not caused by parasite blockage but by lower Jiao不通 (blockage). This chapter specifically addresses parasite-induced blockage, which is merely one type of lower Jiao obstruction.)