春者。天气始开。地气始泄。冻解冰释水行经通。故人气在脉(即经脉也)夏者。经满气
溢入
孙络。孙络受血。皮肤充实(人气在孙络。)长夏者经络皆盛。内溢肌中。(人气在肌肉中。)
秋者天气始收。腠理闭塞。皮肤引急(人气在皮肤)冬者盖藏血气在中。内着骨髓。通于五脏
(人
气在骨髓中。)是故。邪气者常随四时之气血而入客也。至其变化。不可为度然必从其经气
辟除其邪。除其邪。则乱气不生。春刺络脉血气外溢。令人少气。(春刺夏分。气未至而误
刺之故少气)春刺肌肉血气环逆。令人上气(木旺则土虚复。刺肌肉是为重虚。血气环周皆逆
不相营运故上气)春刺筋骨血气内着令人腹胀(春气发越。而复深取筋骨。以伤其阴故血气
内
着而腹胀)夏刺经脉。血气乃竭。令人解 。(气不在经脉而误刺之故血气内竭形迹困倦)夏
刺肌肉。血气内却令人善恐(长夏未至而先夺其气血气却弱。故令善恐)夏刺筋骨。血气上逆
。令人善怒(夏刺冬分。则阴虚于内阳胜于外。故血气逆而为怒)秋刺经脉血气上逆。令人善
忘(心主脉误刺经脉则心气虚故善忘)秋刺络脉气不卫外令人卧不欲动(气已去络而复刺之则
气虚不能卫外故卧不欲动)秋刺筋骨血气内散令人寒栗。(气未至筋骨而误刺之则血气内散而
中气虚故寒栗)冬刺经脉血气皆脱。令人目不明(气未至而先夺之故血气脱而目不明也)冬刺
络脉。内气外泄留为大痹(当阳气伏藏之时刺其阳分。则阳气外泄经脉□滞是生大痹。)冬刺
肌肉。阳气竭绝令人善忘(冬时而刺夏分。则阳气竭绝阳气者精则养神。阳虚则神衰。故善
忘。)凡此四时刺者。大逆之病。不可不从也。反之则生乱气相淫病焉。(刺失四时。是为大
逆。此时气之不可不从也。若反常法。必生乱气。互相淫 为病矣)凡刺不知四时之经。病
之所生以从为逆。正气内乱。与精相搏。(从。顺也。搏。邪正相迫也。)必审九候。正气不
乱精气不转。(九候各有其部。所以审明病之所在从而刺之。庶正气不乱。精气不致转变矣
春季，天气开始升发，地气开始疏泄，冻土解冻、冰层消融，水流畅通，经脉气血运行无阻。因此，人体正气存在于经脉（即经脉）之中。夏季，经脉气血充盈满溢，流入孙络（细小的络脉）。孙络接受血液，皮肤变得充实（此时人体正气存在于孙络中）。长夏季节，经络气血都旺盛，向内溢注于肌肉之中（此时人体正气存在于肌肉中）。秋季，天气开始收敛，腠理（皮肤纹理及汗孔）闭塞，皮肤收缩紧张（此时人体正气存在于皮肤中）。冬季，万物闭藏，血气潜藏于体内深处，内着于骨髓，通达五脏（此时人体正气存在于骨髓中）。
因此，邪气常常随着四季气血的变化而侵入人体客居。至于邪气发生的变化，无法用固定的标准来衡量，但必须顺应经气的变化来祛除邪气。祛除了邪气，就不会产生紊乱的气机。
如果在春季针刺络脉，会导致血气外溢，使人少气（这是因为在春季误刺了夏季所主的部位，气尚未到达该处所致，故出现少气症状）。如果在春季针刺肌肉，会导致血气环周逆乱，使人上气（春季木气旺盛则脾土虚弱，再针刺肌肉属于双重虚损，血气环周逆行，不相营运，所以导致上气）。如果在春季针刺筋骨，会导致血气内着，使人腹胀（春气主发散，如果反而深取筋骨，会损伤阴气，导致血气内着而产生腹胀）。
如果在夏季针刺经脉，会导致血气枯竭，使人懈惰（因为气不在经脉而误刺之，导致血气内竭，表现为形体困倦懈怠）。如果在夏季针刺肌肉，会导致血气内却，使人容易恐惧（长夏未到而先夺取其气血，气机退却虚弱，所以使人易恐）。如果在夏季针刺筋骨，会导致血气上逆，使人容易发怒（夏季误刺冬季所主的部位，则阴虚于内，阳胜于外，所以血气逆乱而发怒）。
如果在秋季针刺经脉，会导致血气上逆，使人容易健忘（心主血脉，误刺经脉则心气虚弱，所以容易健忘）。如果在秋季针刺络脉，会导致卫外之气不足，使人嗜卧不想活动（气已离开络脉而再次误刺，导致气虚不能卫护体表，所以嗜卧不欲动）。如果在秋季针刺筋骨，会导致血气内散，使人寒战栗冷（气未到达筋骨而误刺，导致血气内散且中气虚弱，所以寒战栗冷）。
如果在冬季针刺经脉，会导致血气皆脱，使人视力不明（气未至而先被剥夺，导致血气脱失，所以视力不明）。如果在冬季针刺络脉，会导致内气外泄，留滞成为大痹证（当阳气伏藏之时，若刺其阳分，则阳气外泄，经脉阻滞，从而生成大痹证）。如果在冬季针刺肌肉，会导致阳气竭绝，使人容易健忘（冬季误刺夏季所主的部位，则阳气竭绝。阳气精纯则养神，阳虚则神衰，所以容易健忘）。
以上这些四季误刺的情况，都是严重的逆乱之病，不可不谨慎对待。如果违背了这些原则，就会产生乱气，互相侵淫而导致疾病。凡是不了解四时经脉规律，治病顺从错误的方法，就是逆治。这会导致正气在内混乱，与精气相互搏结。（“从”意为顺从，“搏”意为邪正相迫。）必须审慎诊察九候（三部九候脉法），使正气不乱，精气不致转变。
In spring, the heavenly qi begins to ascend, and the earthly qi begins to disperse. The frozen earth thaws, ice melts, water flows freely, and the meridians become unobstructed. Therefore, the human *zhengqi* (Upright Qi) resides in the *jingmai* (Meridians). In summer, the meridian qi is full and overflows into the *sunluo* (Sun Collaterals, fine collateral vessels). The sunluo receive blood, and the skin becomes firm and filled (at this time, human qi resides in the sunluo). In late summer, both the meridians and collaterals are abundant; the qi overflows inward into the muscles (at this time, human qi resides in the muscles). In autumn, the heavenly qi begins to contract, the *coulī* (Pores and interstices) close, and the skin becomes tight and contracted (at this time, human qi resides in the skin). In winter, things are covered and stored; blood and qi remain within, settling in the bone marrow and connecting with the five zang organs (at this time, human qi resides in the bone marrow).
Thus, pathogenic qi often follows the changes of the four seasons' blood and qi to invade and reside in the body. Regarding its transformations, there is no fixed measure. However, one must follow the meridian qi to dispel the pathogen. Once the pathogen is removed, chaotic qi will not arise.
If one punctures the collaterals in spring, blood and qi overflow outward, causing *shaoqi* (Deficiency of Qi/Shortness of breath) (This is because one mistakenly punctures the region governed by summer before the qi has arrived, resulting in shaoqi). If one punctures the muscles in spring, the blood and qi circulate in reverse, causing *shangqi* (Rebellious Qi/Uplifted Qi) (When Wood qi is excessive, Earth qi is deficient; puncturing the muscles constitutes a double deficiency. The blood and qi circulate reversely without nourishing each other, hence shangqi). If one punctures the sinews and bones in spring, the blood and qi settle internally, causing abdominal distension (Spring qi is expansive; deep puncture of sinews and bones damages Yin, causing blood and qi to settle internally and result in abdominal distension).
If one punctures the meridians in summer, the blood and qi become exhausted, causing *xiechuo* (Laziness and lethargy) (Since the qi is not in the meridians, mistaken puncture causes internal exhaustion of blood and qi, manifesting as physical fatigue and lethargy). If one punctures the muscles in summer, the blood and qi retreat inward, causing timidity/fear (Before late summer arrives, prematurely depleting the qi causes it to retreat and weaken, leading to fear). If one punctures the sinews and bones in summer, the blood and qi rebel upward, causing irritability/anger (Puncturing the region governed by winter in summer causes Yin deficiency internally and Yang excess externally, so blood and qi rebel, leading to anger).
If one punctures the meridians in autumn, the blood and qi rebel upward, causing forgetfulness (The Heart governs the vessels; mistaken puncture of the meridians weakens Heart Qi, leading to forgetfulness). If one punctures the collaterals in autumn, the defensive qi fails to protect the exterior, causing drowsiness and reluctance to move (The qi has already left the collaterals; further puncture causes Qi deficiency and inability to defend the exterior, hence drowsiness and reluctance to move). If one punctures the sinews and bones in autumn, the blood and qi scatter internally, causing chills and trembling (Puncturing before the qi reaches the sinews and bones causes internal scattering of blood and qi and deficiency of Middle Qi, leading to chills and trembling).
If one punctures the meridians in winter, both blood and qi are depleted, causing blurred vision (Depleting the qi before it arrives causes depletion of blood and qi, leading to poor vision). If one punctures the collaterals in winter, internal qi leaks outward, remaining as a major *bi* syndrome (Major Obstruction/Painful Obstruction) (When Yang qi is hidden, puncturing the Yang aspect causes Yang qi to leak outward and meridians to stagnate, generating major bi syndrome). If one punctures the muscles in winter, Yang qi is exhausted, causing forgetfulness (Puncturing the region governed by summer in winter exhausts Yang qi. Yang qi, when refined, nourishes the spirit; Yang deficiency leads to spirit decline, hence forgetfulness).
All these cases of mistiming punctures according to the seasons constitute major rebellious diseases and must be strictly avoided. Violating them generates chaotic qi that mutually invades and causes disease. One who does not understand the meridians of the four seasons and treats by following incorrect methods acts against nature. This causes internal disorder of upright qi, which contends with essence. ("Cong" means to follow/comply; "Bo" means contention/clashing between pathogenic and upright qi.) One must carefully examine the nine pulses (Nine Palpation Positions) to ensure upright qi remains orderly and essence does not undergo pathological transformation.