天温日明则人血淖液而卫气浮故血易泻气易行天寒日阴则人血凝涩而卫气沉月始生则血
气始
精卫气始行月廓满则血气实肌肉坚月廓空则肌肉减经络虚卫气去形独居是以因天时而调血气
也是以天寒无刺天温无凝月生无泻月满无补月廓空无治是谓得时而调之故日月生而泻是谓脏
虚月满而补血气扬溢络有留血命日重实月廓空而治是谓乱经阴阳相错真邪不别沉以留止外虚
内乱淫邪乃起(内经)
必先度其形之肥瘦以调其气之虚实实则泻之虚则补之必先去血脉而后调之无问其病以平
为期
(内经)○补虚者必先扪而循之切而散之推而按之弹而怒之抓而下之通而取之外引其门以闭其
神呼尽纳针静而久留以气至为故候吸引针气不得出各在其处推阖其门令神气存大气留止命曰
补○泻实者吸则纳针无令气忤静以久留无令邪布吸
则转针以得气为故候呼引针呼尽乃去大气皆出故命曰泻(内经)○知为针者信其左不知为针者
信其右当刺之时必先以左手厌按其所针荣 之处弹而怒之抓而下之其气之来如动脉之状顺针
而刺之得气因推而纳之是谓补动而伸之是谓泻(难经)○补者随经脉推而纳之左手闭针孔徐出
针而疾按之泻者迎经脉动而伸之左手闭针孔疾出针而徐按之髓而济之是谓补迎而夺之是谓泻
(难经)○刺虚者须其实刺实者须其虚解云刺实须其虚者为针阴气隆至针下寒乃去针也
刺虚须其实者为针阳气隆至针下热乃去针也注云要以气
至而有效也(内经)○候气有二一曰邪气二曰谷气邪气来也紧而疾谷气来也徐而和紧而疾者
补而未实泻而未虚也徐而和者补而已实
(已当作易)泻而已虚也○脉实者深刺之以泄其气脉虚者浅刺之使精气无得出以养其脉独出其
邪气也(灵枢)○左手重而切按欲令气散右手轻而徐入不痛之因也(纲目)
天气温暖、阳光明媚时，人的血液稀薄流畅，卫气浮越于体表，因此血液容易泻出，气机容易运行；天气寒冷、日光阴暗时，人的血液凝滞涩少，卫气沉伏于体内。月亮初生时，血气开始精纯，卫气开始运行；月亮圆满时，血气充实，肌肉坚实；月亮亏空时，肌肉减损，经络空虚，卫气离去，形体独自存在。因此要根据天时的变化来调节血气。所以，天气寒冷时不要针刺，天气温暖时不要使气血凝滞（注：此处原文“无凝”在语境中通常指避免不当操作导致的气血异常，或指顺应天时不强行干预，结合后文“得时而调之”，意指顺应气候），月亮初生时不要用泻法，月亮圆满时不要用补法，月亮亏空时不要进行治疗。这叫做顺应天时来调节血气。如果在日月初生时进行泻法，这叫做使脏腑更虚；在月亮圆满时进行补法，会使血气扬溢，络脉中有留血，这叫做重实；在月亮亏空时进行治疗，这叫做扰乱经脉，导致阴阳错乱，真邪不分，病邪沉伏停留，造成外虚内乱，淫邪于是兴起。（出自《内经》）
必须先衡量患者形体的肥瘦，以调节其气的虚实。实证用泻法，虚证用补法。一定要先去除血脉中的瘀滞，然后再进行调理，不论是什么疾病，都以平衡为准则。（出自《内经》）○补益虚证的方法：必须先用手抚摸并顺着经脉循行方向推按，切压并散开郁结，推动并按摩穴位，弹击穴位使其充血隆起，抓捏皮肤向下按压，疏通经气以取效，向外牵引毛孔以收敛神气。在患者呼气结束时进针，安静地长时间留针，以得气为目的。候气得气后，引导吸气时出针，使气不出穴，各在其处，推合针孔，使神气留存，大气留止，这叫做补法。○泻除实证的方法：在患者吸气时进针，不让气机逆乱。安静地长时间留针，不让邪气扩散。在吸气时转针，以得气为目的。候气得气后，引导呼气时出针，呼气结束时完全拔出，使大气全部排出，这叫做泻法。（出自《内经》）○懂得针刺的人信赖左手，不懂针刺的人信赖右手。当要针刺时，必须先用左手按压所针的荣俞之处，弹击使其充血隆起，抓捏向下按压。经气到来的时候，像动脉搏动一样。顺着针势刺入，得气后推进针身深入，这叫做补法；提插摇动退出针身，这叫做泻法。（出自《难经》）○补法：顺着经脉走向将针推入，左手闭合针孔，缓慢出针并迅速按压针孔。泻法：迎着经脉走向提插摇动退出针身，左手闭合针孔，快速出针并缓慢按压针孔。顺其势而济助它，这叫做补法；迎其势而夺去它，这叫做泻法。（出自《难经》）○针刺虚证需要等到正气充实（针下产生温热感等反应），针刺实证需要等到邪气衰退（针下产生寒凉感等反应）。解释说：针刺实证需要使其变虚，是因为阴气隆盛到达针下，感到寒凉才去针。针刺虚证需要使其充实，是因为阳气隆盛到达针下，感到温热才去针。注释说：关键在于得气才能见效。（出自《内经》）○候察经气有两种：一是邪气，二是谷气。邪气到来时，脉象紧促而急疾；谷气到来时，脉象徐缓而柔和。紧促而急疾的，说明补而未实，泻而未虚。徐缓而柔和的，说明补而易实，泻而易虚。（原文“已”当作“易”）○脉象实的，深刺以泄出其邪气；脉象虚的，浅刺以使精气不外泄，从而滋养经脉，只排出邪气。（出自《灵枢》）○左手重重地切按，是为了使经气分散；右手轻轻且缓慢地进针，是不痛的缘故。（出自《针灸大成·纲目》）
When the weather is warm and the sun is bright, human blood becomes thin and fluid, and Wei Qi (Defensive Qi) floats on the surface; therefore, blood is easily discharged, and Qi movement is smooth. When the weather is cold and the sky is overcast, human blood becomes coagulated and sluggish, and Wei Qi sinks within. When the moon begins to wax, Blood and Qi begin to become refined, and Wei Qi starts to circulate. When the moon is full, Blood and Qi are abundant, and muscles are firm. When the moon wanes and becomes empty, muscles diminish, meridians and collaterals become deficient, Wei Qi departs, and the form exists alone. Therefore, one must regulate Blood and Qi according to the changes in heavenly timing. Thus, when the weather is cold, do not apply acupuncture; when the weather is warm, avoid causing stagnation (or: do not interfere with natural flow); when the moon is waxing, do not use reducing methods; when the moon is full, do not use tonifying methods; when the moon is empty, do not treat. This is called regulating according to the proper time. If reducing methods are used during the waxing moon, it is said to further deficiency of the Zang organs. If tonifying methods are used during the full moon, Blood and Qi will overflow, and stagnant blood will remain in the collaterals; this is called "double excess." If treatment is performed during the empty moon, it is said to disrupt the meridians, causing Yin and Yang to be confused, true pathogenic factors and evil pathogens indistinguishable, leading to deep retention and external deficiency with internal chaos, allowing excessive pathogens to arise. (From *Neijing*)
One must first assess the patient's body fatness or emaciation to regulate the deficiency or excess of Qi. For excess patterns, apply reduction; for deficiency patterns, apply tonification. One must first remove blood stasis from the vessels before regulating, regardless of the disease, aiming for balance. (From *Neijing*) ○ To tonify deficiency: First, palpate and follow the meridian pathway, press and disperse, push and massage, flick to make the area protrude, grasp and press down, unblock to obtain Qi, draw outward to close the pores and calm the Shen (Spirit). Insert the needle at the end of expiration, retain it quietly for a long time until Deqi (arrival of Qi) is achieved. Upon obtaining Qi, guide the patient to inhale while withdrawing the needle, ensuring Qi does not escape, keeping it at the site, pushing and closing the needle hole so that Shen Qi remains and substantial Qi stays; this is called tonification. ○ To reduce excess: Insert the needle during inspiration, preventing Qi rebellion. Retain it quietly for a long time to prevent the spread of pathogens. Rotate the needle during inspiration until Deqi is achieved. Upon obtaining Qi, guide the patient to exhale while withdrawing the needle, removing it completely at the end of expiration so that substantial Qi exits; this is called reduction. (From *Neijing*) ○ A skilled acupuncturist relies on the left hand, while an unskilled one relies on the right hand. At the time of needling, first use the left hand to press and anchor the Ying-Shu point, flick to make it protrude, and grasp to press down. When Qi arrives, it feels like a pulsating artery. Needle along the direction of Qi arrival. After Deqi, push the needle deeper; this is tonification. Move and withdraw the needle; this is reduction. (From *Nanjing*) ○ Tonification: Follow the meridian direction to insert the needle. The left hand closes the needle hole upon withdrawal, exiting slowly and pressing quickly. Reduction: Oppose the meridian direction, move and withdraw the needle. The left hand closes the needle hole upon withdrawal, exiting quickly and pressing slowly. Following the trend to assist is tonification; opposing the trend to deprive is reduction. (From *Nanjing*) ○ Needling deficiency requires achieving fullness (warmth/sensation of Qi arrival); needling excess requires achieving emptiness (coolness/sensation of Qi departure). Explanation: Needling excess to achieve emptiness means waiting for Yin Qi to arrive at the needle tip, feeling cold, then removing the needle. Needling deficiency to achieve fullness means waiting for Yang Qi to arrive at the needle tip, feeling warm, then removing the needle. Note: The key is effectiveness through Deqi. (From *Neijing*) ○ Observing Qi has two types: one is Pathogenic Qi, the other is Grain Qi (Genuine Qi). Pathogenic Qi arrives tight and rapid; Grain Qi arrives slow and harmonious. Tight and rapid indicates tonification has not yet made it solid, or reduction has not yet made it empty. Slow and harmonious indicates tonification has easily made it solid, or reduction has easily made it empty. ○ For a solid pulse, needle deeply to drain Qi; for a deficient pulse, needle shallowly to prevent Essence-Qi from escaping and to nourish the meridians, expelling only the pathogenic Qi. (From *Lingshu*) ○ Heavy pressing with the left hand disperses Qi; light and slow insertion with the right hand prevents pain. (From *Zhenjiu Dacheng*)