(输。 。俞。占通用。)
春取络脉诸荥大经分肉之间甚者深取之。闲者浅取之。(春以少阳之令。将升未升。其
气在中。故刺可深可浅。络脉十二经之大络。如列缺之类。诸荣。如鱼际之类)夏取诸 孙络肌
肉皮肤之上。(夏以老阳之令。阳盛于仲。故宜浅刺诸 。如太渊之类。孙络详在后经脉篇
中。)秋取诸合。(如尺泽之类)余如春法(秋以少阴之令。将降未降。其气在中。故亦宜中取
于大经分肉之间。可浅可深也。)冬取诸井诸 之分。欲深而留之。(冬以老阴之令。阳气伏
藏。诸井如少商之类诸 。谓脏腑之 。如肺 之类。其气深皆主冬气。故曰欲深而留之也
。)此四时之序气之所处病之所舍藏之所宜(此节言经络浅深。兼诸 而分主四时也。宜与素
问四时刺逆。从论参其义。)
诸急者多寒。(紧急之脉多风寒。而气化从乎肝也。)缓者多热。(纵缓之脉多中絷而气
化从
乎脾胃也。)大者多气少血。(脉大为汤有余。气实血虚。而气化从乎心也。)小者血气皆少
。(小者。近于微细。在阳为阳虚。在阴为阴弱。脉体属阴。而气化从乎肾也)滑者阳气盛
。
微有热(滑脉为阳。从乎胃也。)涩者多血少气。微有寒。(涩为气滞。为血少。气血俱虚。
则阳气不足。故微有寒也。仲景曰。涩者荣气不足亦血少之谓而此曰多血必有误观下文刺涩
者无令其血出血少可知矣。涩脉近毛。故气化从乎肺也)是故。刺急者。深内。而久留之。
刺缓者。浅内而疾发针。以去其热。刺大者。微泻其气。无出其血。刺滑者。疾发针而浅内
之。以泻其阳气。而去其热。刺涩者。必中其脉随其逆顺而久留之。必先按而循之。已发针
。疾按其 。无令其血出。以和其脉。诸小者阴阳形气俱不足。勿取以针。而调以甘药也。
荥输治外经。合治内府(荥俞气脉浮浅可治外经之病合则气脉深入。可治内府之病)胃合
里。(胃足阳明也。三里为合。)大肠合于巨墟上廉。(大肠手阳明也合在曲池。其下俞则合
于足阳明之巨墟上廉。)小肠合于巨墟下廉(小肠。手太阳也。合在小海。其下俞则合于足阳
明之巨墟下廉。)三焦合入于委阳(三焦。手少阳也合在天井。其下俞则合于足太阳之委中。
)膀胱合入于委中央。(膀胱足太阳也委中为合。)胆合于阳陵泉。(胆。足少阳也。阳陵泉为合。)
面热者。足阳明病。(其脉行于面。)鱼络血。手阳明病。(其脉行于手鱼之表)两跗上脉
竖陷
胃脉之病此胃脉也。兼下文手阳明而言。)大肠病者。肠中切痛而鸣濯濯。冬月重感于寒即
泄。当脐而痛。不能久立。与胃同候。取巨墟上廉。(大肠属胃。故取足阳明之穴。)胃病者
腹胀胃脘当心而痛。上支两胁。膈咽不通。食饮不下。取之三里也。小肠病者。小腹痛。
腰脊控睾(音高○阴丸也)而痛。时窘之后。当耳前热。若寒甚。若独肩上热甚。及手小指次
指之间热。若脉陷者。此其候也。(其候则脉有陷者)手太阳病也。取之巨虚下廉。三焦病者
。腹气满。小腹尤坚。不得小便。窘急。溢则水留即为胀候在足太阳之外大络。大络在太阳
少阳之间。亦见于脉取委阳。膀胱病者。小腹偏肿而痛。以手按之即欲小便而不得。肩上热
。若脉陷。(凡大杼等穴脉有陷者)及足小指外廉。及胫踝后皆热。若脉陷。(义如上)取委中
央。胆病者善太息。口苦呕宿汁。心下澹澹。恐人将捕之嗌中 然(有声)数唾在足少阳之
本末。亦视其脉之陷下者灸之。其寒热者。取阳陵泉。刺此者。必中气穴。(经气所。至)无
中肉节。中气穴。则针游于巷。(巷。街也。气脉相通之义)中肉节。即皮肤痛。补泻反则病
益笃。中筋。则筋缓邪气不出。与其真相搏乱而不去。反还内着。用针不审以顺为逆也。
春季针刺，选取络脉及各荥穴、大经分肉之间。病情严重的深刺，病情轻浅的浅刺。（这是因为春季少阳之气当令，阳气将升未升，气机处于半表半里之中，所以针刺深度可深可浅。这里的“络脉”指十二经的大络，如列缺穴等；“诸荥”指各经的荥穴，如鱼际穴等。）
夏季针刺，选取各孙络及肌肉皮肤之上。（这是因为夏季老阳之气当令，阳气极盛于外，所以适宜浅刺各腧穴，如太渊穴等。关于孙络的详细论述见后文《经脉》篇中。）
秋季针刺，选取各合穴。（如尺泽穴等）其余遵循春季的法则。（这是因为秋季少阴之气当令，阳气将降未降，气机处于半表半里之中，所以也适宜中等深度地刺于大经分肉之间，深浅皆可。）
冬季针刺，选取各井穴及腧穴的分野部位，要求深刺并长时间留针。（这是因为冬季老阴之气当令，阳气伏藏于内。各井穴如少商穴等，“诸腧”指脏腑的腧穴，如肺俞穴等。这些穴位的气机深沉，皆主应冬气，所以说要深刺且久留针。）
这是四时的顺序，气机所处的位置，病邪所停留的地方，以及脏腑所适宜的（治疗原则）。（这一节讲的是经络深浅，兼论各腧穴分别主应四时。应当与《素问·四时刺逆从论》参互理解其义理。）
脉象紧急的多为寒证。（脉象紧急多因风寒所致，气化功能归属于肝。）脉象弛缓的多为热证。（脉象纵缓多因湿热阻滞，气化功能归属于脾胃。）脉象大的多为气盛血虚。（脉大表示阳气有余，气实血虚，气化功能归属于心。）脉象小的多为气血俱少。（脉小接近微细，在阳分属阳虚，在阴分属阴弱。脉体属阴，气化功能归属于肾。）脉象滑的多为阳气盛，微有热。（滑脉属阳，气化功能归属于胃。）脉象涩的多为血少气滞，微有寒。（涩脉表示气滞血少，气血俱虚则阳气不足，所以微有寒。张仲景说：“涩者，营气不足，也是血少的意思。”但此处说“多血”，必定有误。看下文刺涩脉时说“不要使其出血，因为血已少”，可知这一点。涩脉近于皮毛表层，所以气化功能归属于肺。）
因此，刺紧急的脉，要深进针并长久留针。刺弛缓的脉，要浅进针并快速出针，以去除热邪。刺大的脉，轻微泻其气，不要放出血液。刺滑的脉，快速进针并浅刺，以泻去阳气，去除热邪。刺涩的脉，必须准确刺中血脉，顺着或逆着血流方向长久留针。必须先用手按压循按经脉，出针后迅速按压针孔，不要让血液流出，以调和经脉。凡是脉象小的，阴阳形气都不足，不要用针刺治疗，而要用甘味药物来调补。
荥穴和输穴主治外经的病，合穴主治内腑的病。（荥穴、输穴的气脉浮浅，可以治疗外经的疾病；合穴的气脉深入，可以治疗内腑的疾病。）
胃的合穴在足三里。（足阳明胃经。三里即足三里，为合穴。）大肠的下合穴在巨虚上廉。（手阳明大肠经。其本经合穴在曲池，但其下合穴则在足阳明胃经的巨虚上廉。）小肠的下合穴在巨虚下廉。（手太阳小肠经。其本经合穴在小海，但其下合穴则在足阳明胃经的巨虚下廉。）三焦的下合穴入于委阳。（手少阳三焦经。其本经合穴在天井，但其下合穴则在足太阳膀胱经的委阳。）膀胱的下合穴入于委中央。（足太阳膀胱经。委中即为合穴。）胆的下合穴在阳陵泉。（足少阳胆经。阳陵泉为合穴。）
面部发热，是足阳明胃经的病。（其经脉行于面部。）手掌大鱼际处络脉充血，是手阳明大肠经的病。（其经脉行于手鱼部表面。）双侧足背动脉搏动处竖陷不起，是胃脉的病。（这是指胃脉，兼及以下手阳明大肠经的内容。）
大肠有病，肠中剧烈疼痛且肠鸣漉漉，若在冬天再次感受寒邪就会腹泻，痛在脐周，不能久立。这与胃病症状相同，取巨虚上廉穴治疗。（大肠与胃相表里，故取足阳明胃经的穴位。）
胃病，表现为腹胀，胃脘当心而痛，向上支撑两胁，膈咽不通，饮食不下。取足三里穴治疗。
小肠有病，小腹痛，腰脊牵引睾丸而痛，时常窘迫想大便。耳前发热，或者寒冷严重，或者仅肩部发热严重，以及手小指和无名指之间发热，或者脉象陷下的，这些都是其征候。（如果脉象有陷下的，就是其征候。）这是手太阳小肠经的病，取巨虚下廉穴治疗。
三焦有病，腹部胀满，小腹尤其坚硬，小便不通，窘迫急迫，水液溢出停滞就形成胀病。征候出现在足太阳膀胱经之外的大络，大络位于太阳经和少阳经之间，也可见于脉象。取委阳穴治疗。
膀胱有病，小腹偏侧肿胀而痛，用手按压就想小便却解不出。肩部发热，或者脉象陷下。（凡是大杼等穴，脉象有陷下的情况。）以及足小指外侧，以及小腿踝关节后方都发热，或者脉象陷下。（含义同上。）取委中央穴治疗。
胆有病，喜欢叹气，口苦，呕吐宿汁，心中悸动不安，好像有人要捕捉自己一样，咽喉中有声音，频频吐唾沫。病位在足少阳胆经的本末，也要观察脉象是否有陷下的地方，如有则用灸法。如果有寒热往来症状的，取阳陵泉穴治疗。
针刺这些穴位，必须刺中气穴。（经气所至之处。）不要刺中肉节。如果刺中气穴，针感就像在巷道中游走一样畅通。（巷，指街道，意为气脉相通。）如果刺中肉节，皮肤会疼痛。补泻手法反了，疾病会更加加重。如果刺中筋，会导致筋弛缓，邪气不能排出，与正气相互搏结，混乱而不能去除，反而向内附着。使用针刺如果不审慎，把顺治当作逆治，就会出错。
(Shu and Shu points are often used interchangeably in ancient texts.)
In spring, needle the collaterals, various Ying-Spring points, and between the muscles of the main meridians. For severe conditions, needle deeply; for mild conditions, needle superficially. (This is because the Shaoyang Qi governs in spring. The Yang Qi is about to rise but has not yet risen, so the Qi is located in the middle [half-exterior/half-interior]. Therefore, needling depth can be deep or shallow. "Collaterals" refer to the great collaterals of the twelve meridians, such as Lieque (LU7); "various Ying-Spring points" refer to the Ying-Spring points of the meridians, such as Yuji (LU10).)
In summer, needle the various Sun-Luo (branch collaterals) on the skin and muscles above. (This is because the Lao-Yang [Extreme Yang] Qi governs in summer. Yang Qi is abundant externally, so it is appropriate to needle superficially at various Shu points, such as Taiyuan (LU9). Detailed discussions on Sun-Luo can be found in the subsequent chapter "Jing-Mai".)
In autumn, needle the various He-Sea points. (Such as Chize (LU5).) Follow the method of spring otherwise. (This is because the Shaoyin Qi governs in autumn. The Qi is about to descend but has not yet descended, so the Qi is located in the middle. Therefore, it is also appropriate to needle at a medium depth between the muscles of the main meridians, either shallow or deep.)
In winter, needle the Jing-Well points and the areas of the Shu points. Needle deeply and retain the needle for a long time. (This is because the Lao-Yin [Extreme Yin] Qi governs in winter. Yang Qi is hidden and stored internally. Various Jing-Well points, such as Shangyang (LI1), and "various Shu points" refer to the Back-Shu points of the Zang-Fu organs, such as Feishu (BL13). Their Qi is deep and all correspond to Winter Qi. Hence, it is said to needle deeply and retain.)
These are the sequence of the four seasons, the location of the Qi, where the pathogenic factors reside, and what is suitable for the Zang organs. (This section discusses the depth of the meridians and assigns various Shu points to the four seasons. Its meaning should be understood by cross-referencing with the *Suwen: Treatise on Four Seasons Needling Reversals and Conformities*.)
Tight pulses indicate much cold. (Tight pulses are mostly due to wind-cold, and the Qi transformation relates to the Liver.) Lax pulses indicate much heat. (Lax pulses indicate dampness obstruction, and the Qi transformation relates to the Spleen and Stomach.) Large pulses indicate excess Qi and deficient Blood. (A large pulse indicates excess Yang Qi, excess Qi, and deficient Blood, and the Qi transformation relates to the Heart.) Small pulses indicate deficiency of both Qi and Blood. (Small pulses are close to minute and fine. In the Yang aspect, it is Yang deficiency; in the Yin aspect, it is Yin weakness. The pulse body belongs to Yin, and the Qi transformation relates to the Kidney.) Slippery pulses indicate abundance of Yang Qi with slight heat. (Slippery pulses belong to Yang, and the Qi transformation relates to the Stomach.) Choppy pulses indicate much blood deficiency and Qi stagnation with slight cold. (Choppy pulses indicate Qi stagnation and blood deficiency. When both Qi and Blood are deficient, Yang Qi is insufficient, hence slight cold. Zhang Zhongjing said, "Choppy means Ying Qi is insufficient, which is also called blood deficiency." But here it says "much blood," which must be an error. Looking at the following text regarding needling choppy pulses: "do not let blood come out, because blood is already scarce," this confirms it. Choppy pulses are near the hair level, so the Qi transformation relates to the Lung.)
Therefore, when needling tight pulses, insert deeply and retain for a long time. When needling lax pulses, insert superficially and withdraw quickly to dispel heat. When needling large pulses, slightly drain the Qi without releasing blood. When needling slippery pulses, insert quickly and superficially to drain Yang Qi and remove heat. When needling choppy pulses, one must accurately hit the vessel, follow the direction of flow (with or against), and retain for a long time. First, press and massage along the meridian. After withdrawing the needle, press the acupoint quickly to prevent bleeding and harmonize the meridian. For all small pulses, where Yin-Yang, Form, and Qi are all deficient, do not use needles; instead, regulate with sweet medicines.
Ying-Spring and Shu points treat diseases of the exterior meridians; He-Sea points treat diseases of the interior Fu organs. (The Qi and vessels of Ying-Spring and Shu points are superficial and can treat exterior meridian diseases. The Qi and vessels of He-Sea points penetrate deeply and can treat interior Fu organ diseases.)
The He-Sea point of the Stomach is Zusanli. (Foot-Yangming Stomach Meridian. Zusanli is the He-Sea point.) The lower He-Sea point of the Large Intestine is Shangliu (ST36). (Hand-Yangming Large Intestine Meridian. Its own He-Sea point is Quchi (LI11), but its lower He-Sea point is Shangliu on the Foot-Yangming Stomach Meridian.) The lower He-Sea point of the Small Intestine is Xiabai (ST37). (Hand-Taiyang Small Intestine Meridian. Its own He-Sea point is Xiaohai (SI8), but its lower He-Sea point is Xiabai on the Foot-Yangming Stomach Meridian.) The lower He-Sea point of the Sanjiao enters Weiyang (BL39). (Hand-Shaoyang Sanjiao Meridian. Its own He-Sea point is Tianjing (SJ10), but its lower He-Sea point is Weiyang on the Foot-Taiyang Bladder Meridian.) The lower He-Sea point of the Bladder enters Weizhong (BL40). (Foot-Taiyang Bladder Meridian. Weizhong is the He-Sea point.) The He-Sea point of the Gallbladder is Yanglingquan (GB34). (Foot-Shaoyang Gallbladder Meridian. Yanglingquan is the He-Sea point.)
Heat in the face indicates disease of the Foot-Yangming Meridian. (Its meridian runs over the face.) Blood in the collaterals of the fish margin (thenar eminence) indicates disease of the Hand-Yangming Meridian. (Its meridian runs on the surface of the hand fish margin.) Vertical depression of the pulses on both dorsum pedis indicates disease of the Stomach meridian. (This refers to the Stomach meridian, combined with the following content on the Hand-Yangming meridian.)
Disease of the Large Intestine involves cutting pain in the intestines with gurgling sounds. If exposed to cold again in winter, diarrhea occurs, pain is around the umbilicus, and the patient cannot stand for long. This shares symptoms with Stomach disease; treat by taking Shangliu (ST36). (Large Intestine is paired with Stomach, so take the acupoint of the Foot-Yangming Stomach Meridian.)
Disease of the Stomach involves abdominal distension, pain in the epigastrium centered at the heart, radiating upward to support both hypochondriac regions, blockage in the diaphragm and pharynx, and inability to eat or drink. Treat by taking Zusanli (ST36).
Disease of the Small Intestine involves pain in the lower abdomen, pain radiating from the lumbar spine to the testicles, frequent urgency to defecate. Heat in front of the ears, or severe cold, or excessive heat only in the shoulder, or heat between the little finger and ring finger of the hand, or depressed pulses are all signs. (If the pulse is depressed, it is a sign.) This is disease of the Hand-Taiyang Small Intestine Meridian; treat by taking Xiabai (ST37).
Disease of the Sanjiao involves abdominal fullness, especially hardness in the lower abdomen, inability to urinate, urgency. Overflow leads to water retention causing distension. Signs appear in the great collateral outside the Foot-Taiyang meridian. The great collateral is between the Taiyang and Shaoyang meridians and may also be seen in the pulse. Treat by taking Weiyang (BL39).
Disease of the Bladder involves unilateral swelling and pain in the lower abdomen. Pressing with the hand creates the urge to urinate but results in none. Heat in the shoulder, or depressed pulses. (For acupoints like Dazhu, if the pulse is depressed...) Heat in the lateral side of the little toe of the foot, and behind the ankle of the leg, or depressed pulses. (Meaning as above.) Treat by taking Weizhong (BL40).
Disease of the Gallbladder involves frequent sighing, bitter taste, vomiting of old bile, palpitations in the chest, fear that people will capture them, sound in the throat, frequent spitting. The disease is at the root and extremity of the Foot-Shaoyang meridian. Also observe if there are depressed pulses; if so, apply moxibustion. For cases with alternating chills and fever, take Yanglingquan (GB34).
When needling these points, one must accurately hit the Qi Acupoint. (Where the meridian Qi arrives.) Do not hit the flesh joints. Hitting the Qi Acupoint allows the needle sensation to travel freely through the channels. (A "lane" implies connected pathways.) Hitting the flesh joint causes skin pain. If tonification and sedation are reversed, the disease worsens. Hitting the tendon causes flaccidity. Pathogenic factors will not exit; they contend with the healthy Qi, become chaotic and remain, and then attach internally. Unprudent needling, treating compliance as rebellion, leads to error.