阴。秋冬致一阳。其事似同。然彼以四时阴阳升降之道言之。此乃以一经增减之法言之。阳气不足。阴气有余。当先补
阳泻阴云云数语。即灵枢所云阴盛而阳虚。先补其阳。后泻其阴而和之。阴虚而阳盛。先补其阴。后泻其阳而和之之义。
先虚后实者。是针家予夺之道。若误先实后虚。则恐暗脱漏正气。故戒其先后如此。
（第七十四旧七十八）难曰。针有补泻。何谓也。然。补泻之法。非必呼吸出内针（法）也。知为（行）针者。信
其左（手）不知为行针者。信其右（手）当刺之时。先以左手厌按所（可）针荣俞之（穴）处。弹而努之。（手法）爪而
下之。（手法）其气之来。如动脉之状。顺（流）针而刺之。得（针下）气因推而内之。是谓补。（法）动（摇）而（引）
伸之。是谓泻。（法）不得（针下）气。乃与（授）男外（卫）女内。（营○再取之法）不得（针下）气。是谓十死不治
也。
按候吸内针。候呼出针。曰泻。以呼内针。以吸出针。曰补。是呼吸出内之针也。内经诸篇数言之。故此篇唯言左
右手法。以辨补泻。所谓厌按所针。弹而努之。爪而下之者。皆谓用左手之法。如此而气来至。则遂直刺之。而随其针
下得气。徐以深之。此即补之之法也。动而伸之。是谓泻。疑似前后文有脱漏。何者。补既言入针之法。而不言出焉。
泻既言出法。而不言内焉。由此考之。则补之出针。当不动而伸之。泻之入针。必当不须左手厌按之法。然则非有阙漏。
盖互文言之。不得气。乃与男外女内。灵枢云。男内女外。坚拒勿出。仅守勿内。是谓得气。内外字与此倒置者。盖彼
有男禁内。女禁外之义。观下文二句。可以见已。此篇内外。即直言与者。授与施与之义。在男持针于卫外。以待气之
至。在女推针于营内。以待气之至。文异而义同耳。如此亦气不至。则为死必矣。故曰十死不治也。
经言。有见（音现下同）如（训而下同古字通用）入。有见如出者。何谓也。然。所谓有见如入出（旧本脱出字今
从滑注补之）者。谓左手（厌按）见气来至。乃内针。针入见气（至）尽乃出针。是谓有见如入。有见如出也。
此承前节再言补法出入之针。前所谓补者。唯谓内针。而未言出针。故举经言。再谓其义如此。所谓左手见气者。
前既缕缕尽之。候其针下所得之气。至尽而出针者。至此乃言之。若夫泻者。上文既言动而伸之。则何待其见气来尽乎。
盖针法补之为难。故令王焘虞搏辈。发有泻无补之疑。且此篇于补一法。丁宁反复不止者。以其难故尔。于泻则略之。
以其易故尔。此一节出于旧本第八十篇。详其文义。全与前段互相发。故联一篇。
（第七十五旧七十二）难曰。经言能知迎随之（经）气。可令调之。调气之方（术）必在（在察也如书舜典在璇玑
玉衡之在）阴（平）阳（秘）何谓也。然。所谓迎随者。知荣卫之流。（脉中）行（脉外）经脉之往来（自太阴始而终于
厥阴是也）也。随其逆顺而取之。故曰迎（夺之）随。（济之）调气之方。必在阴阳者。知其内（女）外（男）表（浅）
里（深）。随其阴（经）阳（经）而调（和）之。（气血）故曰调气之方。必在阴阳。
按谓迎随者。所谓为补泻之术也。然其法不一。所谓和荣卫之流行。经脉之往来也者。荣行脉中。昼夜五十度。从
漏水与息数而流。且卫气昼行诸阳。夜行诸阴。是谓荣卫流行也。手三阳从手至头。足三阳从头至足。手三阴从腹至手。
足三阴从足至腹。是谓经脉往来也。滑注以二句为一义者。粗矣。随其逆顺而取之者。假如足三阳从头下行至足。将泻
之。则先使针锋逆其流而向上。谓之迎。将补之。则使针顺流而向下。谓之随。如手三阳从手上行至头。将泻之。则亦
逆流向下。谓之迎。将补之。则顺流向上。谓之随。余可推知。此篇所言。即逆顺之迎随是矣。调气之法。必在阴阳者。
即前篇所谓与男外女内。暨素问应象论所言。以表知里。从阳引阴。以左治右等事。率皆调气之术。而此所谓知其内外
表里。随其阴阳而调之是矣。素问曰。调气之方。必别阴阳。定其中外。各守其乡。内者内治。外者外治。滑注所引谢
坚白说得之。宜参考。
（第七十六旧七十九）难曰。经（灵枢第一篇）言迎而夺之。（泻）安得无（邪）虚。随而济之。（补）安得无（正）
实。虚（正）之与实。（邪）若得（正气）若失。（邪气）实（邪）之与虚。（正）若有（邪气）若无。（正气）何谓也。
然迎而夺之者。泻其子也。（取之于前）随而济之者。补其母也。（取之于后）假令心病泻手心主俞。（太陵属土）是谓迎
而夺之者也。补手心主井（中冲属木）是谓随而济之者也。所谓实（兼正邪二实）之与虚（兼二虚）者。牢（实）濡（虚）
之意也。（此言经气之虚实非言脉之牢濡）气（针下所得者）来实牢者（正气濡虚者随补则变为实牢）为得。（言补）濡
虚者（邪气实牢者迎泻则变为濡虚）为失。（言泻）故曰。若得若失也。
按灵枢小针解曰。言实与虚。若有若无者。言实者有气。虚者无气也。为虚与实。若得若失者。言补者 然。若有
得也。泻则恍然。若有失也。所谓有无者。指病之所在而言。邪气实处。是谓之有。正气虚处。是谓之无。所谓得失者。
指行针之事而言。虚主聚气。是谓之得。实主散邪。是谓之失。盖此篇所言子母迎随。而与前篇义已为异。即灵枢所云
察后与先。若存若亡者。言气之虚实补泻之先后也。此篇虚实二字。尤有深意存焉。乃知朝三暮四。更为朝四暮三。根据
违两岐。未可以定。故曰。实与虚者。牢濡之意也。所谓牢为邪实。则濡为正虚。濡为邪虚。则牢为正实。互文言之。
读者莫为等闲看。
（第七十七旧六十九）难曰。经（灵枢第十篇）言虚者补之。实者泻之。不虚不实。以经取之。何谓也。然。（正）
虚者补其（经）母。（穴）（邪）实者泻其（经）子（穴）当先补之。然后泻之。（前言先补后泻之意）不虚不实。以经取
之者。是正（本）经自生。病不中他（经）邪也。当自取其经。（本经所属穴）故言以经取之。
按此承前篇。再发问答。以断灵素所言。不虚不实。以经取之之语。审其立问之意。子母补泻之义。前既已悉。言
则非所发。疑唯议补泻之外。别有经刺一法耳。盖补法为随。泻法为迎。若夫以经取之。则非刺子母而刺属己者。且夫
谓母能令子虚。则补母者。治其本也。其病从母及子也。谓子能令母实。则泻子者治其末也。其病从子加母也。是皆他
邪所为者尔。正经自病者。本经之气失常。则流行错乱。故用针治其经气而已。是其非有虚。又非有实。有何迎随之施
哉。余观本邦 近之世。用针治病。率皆经刺一法。而未尝闻有全行迎随子母法。况若前诸篇所载。取五输法。亦唯廑
廑参星。殆几乎熄。悲夫。古昔圣贤。苦口丁宁。垂教万世。徒存方策。被蠹鱼害。噫。
（第七十八旧七十五）难曰。经言东方实。（言肝重实）西方虚。（言肺重虚）泻南方。（心从肝有余）补北方。（肾
从肺不足）何谓也。然。金木水火土。当更相平。（举五行相制常例）东方（肝）木也。西方（肺）金也。木欲实。金当
平之。（金克木）火欲实。水当平之。（水克火）土欲实。木当平之。（木克土）金欲实。火当平之。（火克金）水欲实。
土当平之。（土克水）东方肝也。则知肝实。（非等闲实）西方肺也。则知肺虚。（非寻常虚）泻南方（心）火。补北方（肾）
水。南方火。火者木之子也。北方水。水者木之母也。（二句起下病因与治法要语）子（心）能令母（肝）实。母（肾）
能令子（肝）虚。水胜火。（一句处方大关系旧本误出于前故今移此）故泻（心）火补（肾）水。欲令（肺）金不得平（肝）
木也。经曰。不能治其虚。（治如是虚者非通变则不能）何问其余。（他病）此之谓也。
按东实西虚。即谓肝木实。肺金虚。皆是病之所在焉。泻南补北。即谓泻心火。补肾水。皆是治之所归焉。此乃发
难之端也。答辞先举五行相制者。表其常例。火者木之子。水者木之母二句。此篇一大关系。乃树下文分病因与治法之
帜。盖肝之亢极。本因心火有余。子有余则不食母气。肝木所以盛实。肾之衰竭。原关肺金不足。母不足则无助子气。
肺金所以太虚。以五行相制之常。为之治则。当补肺泻肝而平之。今乃弃东西而治南北者。非经常之法。犹之儒家有权。
兵法有奇乎。所谓子能令母实一句。言病因子者心。母者肝。母能令子虚一句。言治法。母者肾。子者肝。或问如果其
说之是。则心之有余。既令肝实。则肝之有余。亦当令肾实。然则肾胡为虚乎。曰心令肝实者。其气逆而为邪也。夫木
生火者。顺道也。今心有余。而不食母气。故木气不达而反逆。所以溯洄为邪焉。肾之为虚。既失母气。夫水生木者。
亦顺道也。虽然。其气不足。故将通于彼。则不可以逮。何逆流之有。且自心而传于肝者。邪气也。从肾而通于肝者。
正气也。辟诸水流。其末窒碍不通。则逆。逆则贲激。激则混浊。本源为之沸腾。是岂水之性哉。肝之所以有实也。源
既细微。则其流不长。纵使堤防在其下流。势已微。则不能达中道而涸。遂委泥沙。何奔逆之有。肾之所以有虚也。或
又问泻火补水。此两药并行乎。将所谓先补后泻邪。曰否。苟以针石言之。即应补阴泻阳而可。若夫汤液。则不必然。
唯其补阴是务。观水胜火一句。可以见已。是亦此篇一大要语。不可忽略。熟察答意。此证原因。中气虚而脾不能散精。
上归于肺。肺乏主气。此肺一虚。肺气不行。则肾阴不足。阴不足。则阴中之阳动焉。故肝木逆上。并于心。此肝一实。
心气有余已极。则不食母气。而传道不通。肝邪益炽。此肝重实。心气有余。则上克肺。此肺重虚。至其施治。则肺虚
者。置而不取。辟犹齐问菁茅。讨南巡而崇衰周之朝焉。补肾则阴气自盛。而心失其势。取援于母。则肝实日减。辟犹
晋假道于虞以代虢。其实则晋不在虢而在虞焉。所谓欲令金不得平木。及不能治其虚。何问其余。是此之谓欤。余释此
难之义。旁通陈廷芝王安道孙一奎三子之说。各有所取舍。盖历代诸家。纷纷未有定论。王氏当 近之世。勃然独得此
篇之旨。然至于以不一字为衍。则千虑一失。实可惜乎。陈孙二氏。存不字以立其义。则独得其本旨。何者。此篇本论
应变之治。故从旁补其不足。一举以立两全之功。若八十篇所言。则补肺泻肝。直取其常制之法。固有彼此常变之分。
若以去不字。则与下编混为一意。岂合扁鹊之旨乎。学人审诸。
（第七十九旧七十七）难曰。经（逆顺篇）言上工治未病。（邪未传处）中工治已病（病既所在）者。何谓也。然。
所谓治未病者。见肝之病。则知肝当传之（指邪）与脾。故先实其脾气。（邪将传）无令得受肝之邪。（将克之势）故曰
治未病焉。中工治已病者。见肝之病。不晓相传。（邪气）但一心治肝。（病所在）故曰治已病也。
按谓未病者。指其所未受邪。已病者。指已所病。凡诸脏病动辄传其所克。假令上工治未病。则当先望视其横与纵
之所在。预防其蚕食。盖有绸缪牖户之渐焉。中工治已病。无有远虑。胡祛近患。坐执一故尔。灵枢第五十五篇云。上
工刺其未生者也。下工刺其方袭者也。此篇之旨。率由斯文。素问第二篇所言。未病已病。义与此异。彼谓未病者。指
无病患。言不可混同。前篇所谓泻南补北。是上工之治未病也。故承上而言。上中二工。各有阶级也。
（第八十旧八十一）难曰。经言无实（指真）实（指假）虚（指真）虚。（指假）损不足而益有余。（谓治之害）是
寸口脉（见之）邪。将病（证）自（然）有虚实邪。其损（不足）益（有余）奈何。然。是病（二字滑注以为衍孙一奎
断为古言之法今从孙氏）非谓寸口脉也。（在脉自见其真而不见其假）谓病自其（假）虚（假）实也。假令肝（真）实而
肺（真）虚。肝者木也。肺者金也。金木当更相平。（是言常例）当知金平木。（是言常治法）假令肺（真）实而肝（真）
虚。（此肺动辄见假虚肝见假实）用针不补其肝。（真虚）微少气。（三字旧本误在用针上今考文义以移诸此）而反重实其
肺。（真实）故曰实实虚虚。损不足而益有余。此者中工之所害也。
按病有虚实。虚实有真假。其真焉者。合于脉象而知之。故亡论已。至于假焉。则中工之徒。动误其诊。故引经言
戒之曰。无实实虚虚。言勿以假为真而治焉。若有实实虚虚。而真假相错。则不足者愈损。有余者愈益。若夫寸口脉。
则虚自见虚。实自见实。故鲜有失诊之误矣。故曰非谓寸口之脉也。谓病自有虚实也。所谓虚实者。言假虚假实也。若
阴气与阳气在秋冬季节都趋向于收敛合一，表面看似相同。然而，前者是从四季阴阳升降的规律来论述的，后者则是从某一经脉气血增减的方法来论述的。当阳气不足、阴气有余时，应当先补阳后泻阴等说法，就是《灵枢》中所说的：阴盛而阳虚，先补其阳，后泻其阴以调和；阴虚而阳盛，先补其阴，后泻其阳以调和。所谓“先虚后实”，是针刺医生运用补泻的手法。如果错误地先实行补法（使正气充实）而后实行泻法，恐怕会暗中耗损正气，因此告诫必须按照这样的先后顺序进行。
（第七十四篇，旧本为第七十八篇）问：针刺有补法和泻法，这是什么意思呢？答：补泻的方法，并不一定在于呼吸时进出针。懂得行针的人，信赖左手（按压穴位），不懂得行针的人，只信赖右手（持针）。在进针的时候，先用左手按压将要针刺的荥穴或俞穴部位，用手指弹击使穴位隆起，然后用指甲切按向下进针。感觉到经气到来时，其感觉如同动脉搏动一般，顺着针势刺入。得气后，顺势将针推进深入，这叫做补法。摇动并引伸针体向外退出，这叫做泻法。如果不得气，则根据性别不同采取不同策略：男性取卫分（属阳，在外），女性取营分（属阴，在内）。（这是再次取气的办法）。如果仍然不得气，这就称为“十死不治”的危重证候。
按语：等待吸气时进针，等待呼气时出针，称为泻法；等待呼气时进针，等待吸气时出针，称为补法。这就是关于呼吸进出针的说法。《内经》各篇多次提到这一点，所以本篇只谈论左右手的手法，用来辨别补泻。所谓按压穴位、弹击使其隆起、指甲切按向下进针，都是指使用左手的方法。这样操作后经气就会到来，于是直接刺入，随着针下得气，缓慢深入，这就是补法。摇动并引伸针体，称为泻法。这里似乎前后文有脱漏。为什么呢？讲补法时只说了进针的方法，却没有说出针的方法；讲泻法时只说了出针的方法，却没有说进针的方法。由此考证，补法的出针应当是不摇动也不引伸（即快速拔出或不扰动）；泻法的进针必定不需要左手按压的方法。但这并非有缺漏，而是采用了互文的修辞手法。如果不得气，就区分男女内外。《灵枢》说：“男内女外”，坚守勿出，仅守勿入，这叫做得气。“内外”二字在这里与《灵枢》倒置，是因为《灵枢》中有“男禁内，女禁外”的含义，看下文两句就可以明白。本篇中的“内外”，直接意思是给予、施予。对于男性，将针持于卫分之外，以等待经气到来；对于女性，将针推入营分之内，以等待经气到来。文字不同但意义相同。如果这样做经气仍不来，那就必然死亡了，所以说“十死不治”。
经文说：“有见如入，有见如出”，是什么意思呢？答：所谓“有见如入，有见如出”，是指左手按压看到经气到来，然后进针；针入后看到经气（至尽）消散，然后出针，这就叫“有见如入，有见如出”。
这是承接上一节再次说明补法进出针的道理。前文所说的补法，只讲了进针，而未说出针，所以引用经文，再次阐明其义。所谓“左手见气”，前文已经详细论述过。等候针下所得之气，直到尽头才出针，到这里才详细说明。至于泻法，上文既然说了摇动并引伸（出针），那还需要等到看见经气到来且耗尽吗？大概因为针刺中补法较难，所以像王焘、虞搏等人产生了“有泻无补”的疑问。而且本篇对补法这一环节，反复叮咛不止，正是因为其难。对于泻法则略写，因为其易。这一节出自旧本第八十篇，详察其文义，完全与前段互相阐发，所以连为一篇。
（第七十五篇，旧本为第七十二篇）问：经文说“能知迎随之气，可令调之”，调气的方法必定在于阴阳，这是什么意思呢？答：所谓迎随，是知道营气在脉中运行、卫气在脉外运行，以及经脉气血往来的规律（自太阴始而终于厥阴）。顺着或逆着气血的流向进行针刺，所以称为迎（夺其邪气）和随（济其正气）。调气的方法，必定在于阴阳，是指知道内（女/阴）外（男/阳）、表（浅）里（深），顺着阴经或阳经来调和气血。所以说调气的方法，必定在于阴阳。
按语：所谓迎随，就是指补泻的技术。然而这种方法不止一种。所谓调和营卫的流行、经脉的往来，是指营气行于脉中，昼夜循环五十度，随着漏刻和水滴及呼吸的次数流动；卫气白天行于诸阳经，夜晚行于诸阴经，这叫营卫流行。手三阳经从手走头，足三阳经从头走足，手三阴经从胸腹走手，足三阴经从足走腹，这叫经脉往来。滑寿注将这两句解释为同一个意思，太过粗略。所谓“随其逆顺而取之”，例如足三阳经从头下行至足，如果要泻它，就先让针尖逆着血流方向向上，这叫迎；如果要补它，就让针顺着血流方向向下，这叫随。如手三阳经从手上行至头，如果要泻它，也逆流向下，这叫迎；如果要补它，顺流向上，这叫随。其余类推。本篇所说的，就是这种逆顺的迎随之法。调气的方法，必定在于阴阳，就是前篇所说的对待男女内外，以及《素问·阴阳应象大论》所说的“以表知里，从阳引阴，以左治右”等事项，都属于调气之术，而这篇所说的“知其内外表里，随其阴阳而调之”正是此意。《素问》说：“调气之方，必别阴阳，定其中外，各守其乡。内者内治，外者外治。”滑寿引用的谢枋得（字君直，号叠山，此处疑为谢坚白或其他学者，原文作谢坚白）说得正确，应当参考。
（第七十六篇，旧本为第七十九篇）问：经文（《灵枢》第一篇）说“迎而夺之，安得不虚？随而济之，安得不实？”正气虚弱与邪气充实，若得到正气，若失去邪气，邪气充实与正气虚弱，好像有邪气又好像没有邪气，这是什么意思呢？答：“迎而夺之”，是泻其子穴（在前面的穴位取之）；“随而济之”，是补其母穴（在后面的穴位取之）。例如心病，泻心包经的俞穴（太陵穴属土），这叫迎而夺之；补心包经的井穴（中冲穴属木），这叫随而济之。所谓“实与虚”，兼指正气和邪气的虚实状态，也是指脉象牢实和濡软的意思。（这里说的是经气的虚实，不是指脉象的牢濡）。针下所得之气，如果来势实牢，（如果是正气虚，随补则变为实牢），这叫“得”（指补法成功）；如果来势濡虚，（如果是邪气实，迎泻则变为濡虚），这叫“失”（指泻法成功）。所以说“若得若失”。
按语：《灵枢·小针解》说：“言实与虚，若有若无者，言实者有气，虚者无气也。为虚与实，若得若失者，言补者惙然若有得也，泻则恍然若有失也。”所谓“有无”，是指病位的所在。邪气实处，谓之有；正气虚处，谓之无。所谓“得失”，是指行针的操作而言。虚证主聚气，谓之得；实证主散邪，谓之失。大概本篇讲的是子母迎随，与前篇的意义已有不同，即《灵枢》所说的“察后与先，若存若亡”，讲的是经气虚实补泻的先后次序。本篇中“虚实”二字，尤其含有深意，正如“朝三暮四”改为“朝四暮三”，根本违背了两歧的原则，不能随意确定。所以说“实与虚者，牢濡之意也”。所谓牢代表邪实，则濡代表正虚；濡代表邪虚，则牢代表正实。这是互文见义，读者不要轻视。
（第七十七篇，旧本为第六十九篇）问：经文（《灵枢》第十篇）说“虚者补之，实者泻之，不虚不实，以经取之”，这是什么意思呢？答：正气虚，补其母穴；邪气实，泻其子穴。应当先补后泻。（这是重申先补后泻的意思）。“不虚不实，以经取之”，是指本经自生疾病，病邪不波及他经。应当直接取本经的穴位治疗，所以说“以经取之”。
按语：这是承接前篇，再次发起问答，以判定《灵枢》和《素问》中“不虚不实，以经取之”这句话的含义。审视其立问之意，子母补泻的意义前文已经详尽，再说似乎不是所发之问，怀疑是在补泻之外，另有经刺这一种方法罢了。大概补法是随，泻法是迎。至于“以经取之”，就不是刺子母穴，而是刺属于本经的穴位。况且如果说“母能令子虚”，那么补母穴，是治其根本，病是从母传及子的；如果说“子能令母实”，那么泻子穴，是治其末梢，病是从子加于母的。这些都是由他经邪气所致。正经自病，是本经之气失常，导致流行错乱，所以用针刺调理本经经气而已。这既不是虚，也不是实，有什么迎随的施用呢？我观察我国近代，用针治病，大多采用经刺这一方法，却未曾听说完全施行迎随子母法的。况且像前几篇所载的取五输穴的方法，也只是零星参用，几乎要熄灭了，可悲啊！古代圣贤苦口婆心，谆谆教导，垂教万世，却只保存在书籍中，被蠹虫损害。唉！
（第七十八篇，旧本为第七十五篇）问：经文说“东方实，西方虚，泻南方，补北方”，这是什么意思呢？答：金、木、水、火、土五行，应当相互制约平衡。（列举五行相克的常规例子）。东方属肝木，西方属肺金。木欲实，金应当平抑它（金克木）；火欲实，水应当平抑它（水克火）；土欲实，木应当平抑它（木克土）；金欲实，火应当平抑它（火克金）；水欲实，土应当平抑它（土克水）。东方是肝，所以知道肝实（不是普通的实）；西方是肺，所以知道肺虚（不是普通的虚）。泻南方心火，补北方肾水。南方火，是木之子；北方水，是木之母。（这两句引出下文的病因与治法关键）。子（心）能令母（肝）实，母（肾）能令子（肝）虚。水胜火。（这是一句处方的大关系，旧本误置于前，故今移至此）。所以泻心火补肾水，目的是让肺金不能平抑肝木。经文说：“不能治其虚”，（治疗这种虚证如果不通变就不能治好），其余问题就不必问了。就是这个道理。
按语：东实西虚，就是指肝木实，肺金虚，这都是病的所在。泻南补北，就是指泻心火，补肾水，这都是治疗的归宿。这是提出疑难的开端。回答先列举五行相制，表明常规例子。“火者木之子，水者木之母”这两句，是本篇的一大关键，是下文分析病因与治法的旗帜。大概肝的亢极，本因心火有余，子有余则不消耗母气，肝木所以盛实。肾的衰竭，原关肺金不足，母不足则无助子气，肺金所以太虚。按照五行相制的常规，治疗方法应当补肺泻肝来平衡它。现在却放弃东西（肝肾）而去治南北（心肾），这不是常规之法，就像儒家有权变，兵法有奇正一样。所谓“子能令母实”一句，指病因为子（心），母（肝）；“母能令子虚”一句，指治法，母（肾），子（肝）。有人问：如果说法正确，那么心有余既令肝实，那么肝有余，也应当令肾实，为什么肾却是虚的呢？回答说：心令肝实，是因为气逆而为邪。木生火，是顺道。现在心有余，却不食母气，所以木气不达反而逆上，所以溯洄成为邪气。肾之所以虚，既失去了母气。水生木，也是顺道。虽然如此，但其气不足，所以要通向他处，就无法到达，哪里有逆流呢？况且从心传到肝的是邪气，从肾通到肝的是正气。好比水流，末端阻塞不通，就会逆流，逆流则奔激，激则混浊，本源为之沸腾，这难道是水的本性吗？这就是肝之所以有实的原因。源头既然细微，那么支流就不长，即使下游有堤防，势头已微弱，就不能到达中游而干涸，于是沉积泥沙，哪里有奔逆呢？这就是肾之所以有虚的原因。又有人问：泻火补水，这两者是并行呢，还是所谓先补后泻呢？回答说：不。如果用针石，就应该补阴泻阳即可。如果是汤药，则不一定。只要致力于补阴，看“水胜火”一句就可以明白了。这也是本篇的一大要点，不可忽略。熟察答复之意，此证的原因，是中气虚而脾不能散精，上归于肺，肺乏主气。此肺一虚，肺气不行，则肾阴不足。阴不足，则阴中之阳动，所以肝木逆上，并于心。此肝一实，心气有余已极，则不食母气，而传道不通，肝邪益炽。此肝重实，心气有余，则上克肺，此肺重虚。至于施治，则肺虚者，放置而不取，就像齐国询问菁茅，讨伐南巡而推崇衰周的朝廷一样。补肾则阴气自盛，而心失其势，取援于母，则肝实日减，就像晋国借道于虞以代替虢国，其实晋国不在虢而在虞。所谓“欲令金不得平木”，及“不能治其虚，何问其余”，就是这个意思。我解释此难的义理，旁通陈廷芝、王安道、孙一奎三人的说法，各有取舍。大概历代诸家，纷纷未有定论。王氏在近世，勃然独得本篇的宗旨。然而至于认为“不”字是衍文，则是千虑一失，实在可惜。陈、孙二氏，保留“不”字以确立其义，则独得其本旨。为什么呢？本篇本来论述应变的治疗，所以从旁补充其不足，一举而立两全之功。若第八十篇所言，则是补肺泻肝，直接取其常制之法，固有彼此常变之分。如果去掉“不”字，则与下编混为一意，岂合扁鹊的本旨乎？学人审慎考察。
（第七十九篇，旧本为第七十七篇）问：经文（《灵枢·逆顺》篇）说“上工治未病，中工治已病”，这是什么意思呢？答：所谓治未病，是见到肝病，就知道肝当传之于脾，所以先充实脾气，不让其受肝之邪（将克之势）。所以说治未病。中工治已病，是见到肝病，不懂相传的道理，只是一心治疗肝（病所在）。所以说治已病。
按语：所谓未病，指其尚未受邪的部位；已病，指已经患病的地方。凡各种脏腑的病，动辄传其所克。假如上工治未病，就应当先望视其横与纵的所在，预防其蚕食，早有绸缪牖户的准备。中工治已病，没有远虑，只顾祛除近患，固执一端罢了。《灵枢》第五十五篇说：“上工刺其未生者也，下工刺其方袭者也。”本篇的主旨，大都源于此文。《素问》第二篇所说的未病已病，意义与此不同。彼处谓未病者，指无病患之人，言不可混同。前篇所说的泻南补北，是上工的治未病，所以承接上文而言，上工和中工，各有等级差别。
（第八十篇，旧本为第八十一篇）问：经文说“无实实，无虚虚，损不足而益有余”，这是寸口脉见的邪气，还是病症自然有的虚实呢？其损不足益有余是怎么回事呢？答：这个病（“二字”滑注认为是衍文，孙一奎断定为古言之法，今从孙氏），不是指寸口脉，而是指病症本身的假虚假实现象。假如肝真实而肺真虚，肝属木，肺属金，金木应当相互平抑（这是说常规）。应当知道金平木（这是说常规治法）。假如肺真实而肝真虚（这里肺往往见假虚，肝见假实），用针不补其肝（真虚），微少气（“三字”旧本误放在“用针”之上，今考文义移至此处），反而重实其肺（真实）。所以说“实实虚虚，损不足而益有余”。这是中工造成的危害。
按语：病有虚实，虚实有真假。真的方面，结合脉象就能知道，所以不论了。至于假的方面，中工这类人，动不动就误诊，所以引用经文告诫说：不要“实实虚虚”，意思是不要把假当作真来治疗。如果有实实虚虚，而真假相错，那么不足的就更加受损，有余的就更加增益。至于寸口脉，则虚自见虚，实自见实，所以很少有诊断失误的错误。所以说“非谓寸口之脉也”，而是说病症自有虚实。所谓的虚实，是指假虚假实。如果……
Yin and yang qi both tend to converge and unite in autumn and winter, which appears similar on the surface. However, the former discusses the laws of rising and falling of yin and yang across the four seasons, while the latter discusses the method of increase and decrease of qi and blood in a specific meridian. When yang qi is insufficient and yin qi is in excess, one should first tonify yang and then drain yin, etc., as stated in the *Ling Shu* (Spiritual Pivot): when yin is excessive and yang is deficient, first tonify yang, then drain yin to harmonize; when yin is deficient and yang is excessive, first tonify yin, then drain yang to harmonize. The principle of "first deficiency, then repletion" refers to the manipulation techniques of tonification and reduction used by acupuncturists. If one erroneously applies tonification (to make righteous qi substantial) first and then reduction, it may secretly deplete righteous qi; therefore, it is warned that the sequence must be strictly followed.
(Chapter 74, Old Chapter 78) Question: Acupuncture has methods of tonification (Bu) and reduction (Xie). What do they mean? Answer: The methods of tonification and reduction do not necessarily depend on respiration during needle insertion and withdrawal. One who understands needle manipulation relies on the left hand, while one who does not understand relies solely on the right hand. At the time of insertion, first press the intended Ying-Shu point with the left hand, flick it to make the area protrude, and then use the fingernail to mark the spot for downward insertion. When the arrival of qi is felt, resembling the pulsation of an artery, insert the needle following this flow. Upon obtaining De Qi (needle sensation), push the needle deeper along its path; this is called tonification. Shake and draw the needle outward; this is called reduction. If De Qi is not obtained, apply different strategies based on gender: for males, target the Wei (Defensive) level (Yang, exterior); for females, target the Ying (Nutritive) level (Yin, interior). (This is a method to retrieve qi again). If De Qi is still not obtained, it is termed a critical condition of "ten deaths, untreatable."
Commentary: Inserting the needle upon inhalation and withdrawing upon exhalation is called reduction; inserting upon exhalation and withdrawing upon inhalation is called tonification. This refers to the method of needle movement related to respiration. The *Nei Jing* (Inner Canon) mentions this frequently in various chapters. Thus, this chapter focuses only on left-hand and right-hand techniques to distinguish tonification and reduction. Pressing the point, flicking to cause protrusion, and marking with nails refer to the use of the left hand. After such manipulation, if qi arrives, insert directly and slowly deepen the needle as De Qi is achieved; this is the method of tonification. Shaking and drawing out is reduction. There seems to be a textual omission here. Why? The discussion on tonification mentions insertion but not withdrawal; the discussion on reduction mentions withdrawal but not insertion. Investigating this, the withdrawal for tonification should involve no shaking or drawing (rapid withdrawal without disturbance); the insertion for reduction certainly does not require the left-hand pressing technique. This is not a loss but a rhetorical device known as "mutual text" (Hu Wen). If De Qi is not obtained, distinguish between male/female and interior/exterior. The *Ling Shu* states: "For males, retain internally; for females, release externally," holding firm without letting out, guarding without letting in, which constitutes obtaining qi. The terms "interior" and "exterior" are reversed here compared to the *Ling Shu* because the *Ling Shu* implies "males prohibited from internal retention, females prohibited from external release." This can be seen in the following sentences. In this chapter, "interior" and "exterior" literally mean giving or administering. For males, hold the needle at the exterior of the Wei level to await qi; for females, push the needle into the interior of the Ying level to await qi. The wording differs, but the meaning is the same. If qi still does not arrive despite this, death is certain, hence "ten deaths, untreatable."
The Classic states: "There is seeing as entering, there is seeing as exiting." What does this mean? Answer: "Seeing as entering, seeing as exiting" means that after the left hand presses and sees the arrival of qi, the needle is inserted; after the needle is inserted and sees the qi (at its peak/end) dissipate, the needle is withdrawn. This is called "seeing as entering, seeing as exiting."
This reiterates the principles of needle insertion and withdrawal for tonification from the previous section. The previous mention of tonification only covered insertion, not withdrawal, so the Classic is cited to clarify. "Seeing qi with the left hand" was detailed earlier. Waiting for the qi obtained under the needle to reach its end before withdrawing is explained here. As for reduction, since the previous text mentioned shaking and drawing out, why wait to see the qi arrive and exhaust? Probably because tonification in acupuncture is difficult, leading figures like Wang Tao and Yu Bo to doubt the existence of "reduction without tonification." This chapter repeatedly emphasizes tonification because of its difficulty, while briefly mentioning reduction due to its ease. This section originates from Old Chapter 80; its meaning complements the preceding paragraph, so they are combined.
(Chapter 75, Old Chapter 72) Question: The Classic says, "Knowing the direction of Ying and Sui qi allows for regulation. The method of regulating qi must lie in Yin and Yang." What does this mean? Answer: "Ying and Sui" refers to knowing the flow of Ying qi within the vessels and Wei qi outside the vessels, and the circulation of meridians (starting from Taiyin and ending at Jueyin). Following or opposing the flow of qi determines Ying (draining/subduing) and Sui (supporting/nourishing). Regulating qi lies in Yin and Yang, meaning knowing the interior (female/yin), exterior (male/yang), superficial (shallow), and deep (deep) aspects, and harmonizing Qi and Blood according to Yin or Yang meridians. Hence, "the method of regulating qi must lie in Yin and Yang."
Commentary: "Ying and Sui" refers to the techniques of tonification and reduction. However, these methods vary. Harmonizing the flow of Ying and Wei and the circulation of meridians means Ying qi flows within the vessels, circulating fifty times day and night according to water clocks and breaths; Wei qi travels through Yang meridians by day and Yin meridians by night. Hand-Yang meridians go from hand to head; Foot-Yang meridians from head to foot; Hand-Yin from chest/abdomen to hand; Foot-Yin from foot to abdomen. Slip's commentary treating these two phrases as one meaning is too simplistic. "Following or opposing the flow": For example, Foot-Yang meridians descend from head to foot. To reduce, direct the needle tip against the flow upward (Ying); to tonify, follow the flow downward (Sui). For Hand-Yang meridians ascending from hand to head, to reduce, direct against the flow downward (Ying); to tonify, follow the flow upward (Sui). The rest can be inferred. This chapter describes this reverse/forward Ying-Sui method. Regulating qi lies in Yin and Yang, referring to the previous discussion on male/female interior/exterior and concepts from *Su Wen: Yin Yang Ying Xiang Da Lun* such as "knowing the interior through the exterior, drawing from Yang to Yin, treating left via right." These are all methods of regulating qi, specifically "knowing interior/exterior and shallow/deep, regulating according to Yin/Yang." *Su Wen* states: "The method of regulating qi must distinguish Yin and Yang, determine interior and exterior, each keeping to its place. Interior is treated internally, exterior externally." Xie Fangde's citation by Slip is correct and should be referenced.
(Chapter 76, Old Chapter 79) Question: The Classic (*Ling Shu* Ch. 1) says, "Ying and draining it, how can it not become deficient? Sui and supporting it, how can it not become replete? Deficiency and repletion, if obtaining [righteous qi], if losing [pathogenic qi]; repletion and deficiency, seeming to have [pathogen] yet seeming to not have [righteous qi]." What does this mean? Answer: "Ying and draining" means reducing the Child element (taking from the anterior point); "Sui and supporting" means tonifying the Mother element (taking from the posterior point). For instance, in Heart disease, draining the Shu point of the Pericardium (Tailing, Earth) is Ying and draining; tonifying the Jing-Well point of the Pericardium (Zhongchong, Wood) is Sui and supporting. "Repletion and deficiency" refers to both righteous and pathogenic states, implying the pulse qualities of Firm (Lao) and Soft (Ru). (This refers to the repletion/deficiency of meridian qi, not just pulse quality). If the qi arriving under the needle is Firm and solid (if righteous qi was deficient, tonification makes it firm), this is "Obtaining" (successful tonification). If it is Soft and weak (if pathogenic qi was firm, reduction makes it soft), this is "Losing" (successful reduction). Hence, "seeming to obtain, seeming to lose."
Commentary: *Ling Shu: Xiao Zhen Jie* states: "Speaking of repletion and deficiency, seeming to have and not having, means repletion has qi, deficiency lacks qi. Speaking of deficiency and repletion, seeming to obtain and lose, means tonification feels like gaining something, reduction feels like losing something." "Having/not having" refers to the location of the disease: pathogenic repletion is "having," righteous deficiency is "not having." "Obtaining/losing" refers to the needle manipulation: deficiency gathers qi (obtaining), repletion scatters pathogens (losing). This chapter discusses Mother-Child Ying-Sui, differing from the previous chapter's meaning, aligning with *Ling Shu*'s "observe posterior/anterior, seeming to exist and seem to vanish," discussing the sequence of tonification/reduction based on qi repletion/deficiency. The terms "repletion and deficiency" here carry deep meaning, akin to changing "three in the morning, four in the evening" to "four in the morning, three in the evening"; the fundamental contradiction remains unresolved arbitrarily. Thus, "repletion and deficiency" implies Firm and Soft. Firm indicates pathogenic repletion and righteous deficiency; Soft indicates pathogenic deficiency and righteous repletion. Read carefully, do not overlook.
(Chapter 77, Old Chapter 69) Question: The Classic (*Ling Shu* Ch. 10) says, "Tonify deficiency, reduce repletion, and for neither deficient nor replete, treat via the Meridian." What does this mean? Answer: Righteous deficiency: tonify the Mother point. Pathogenic repletion: reduce the Child point. First tonify, then reduce. "Neither deficient nor replete, treat via the Meridian" means the disease originates in the Primary Meridian itself, not affecting other meridians. One should directly select points from this meridian. Hence, "treat via the Meridian."
Commentary: This continues the previous chapter's Q&A to interpret "neither deficient nor replete, treat via the Meridian" from *Ling Shu* and *Su Wen*. The intent seems to question if there is a distinct "Meridian Needling" method beyond tonification/reduction. Tonification is Sui, reduction is Ying. "Treating via the Meridian" involves needling points belonging to the meridian itself, not Mother-Child points. If "Mother makes Child empty," tonifying the Mother treats the root (disease transmitting from Mother to Child). If "Child makes Mother full," reducing the Child treats the branch (disease adding from Child to Mother). These are caused by external pathogens. Primary Meridian self-disease arises from abnormal qi flow and disorder; thus, needling regulates the meridian qi. It is neither deficiency nor repletion, so Ying-Sui is not applied. I observe that in our country in recent times, acupuncture mostly uses this "Meridian Needling" method, rarely employing full Ying-Sui Mother-Child techniques. Even the Five Shu point selection mentioned earlier is scarcely used, nearly extinct. Tragic! Ancient sages taught earnestly for millennia, yet their teachings remain only in books, damaged by worms. Alas!
(Chapter 78, Old Chapter 75) Question: The Classic says, "East is Replete, West is Deficient; Drain South, Tonify North." What does this mean? Answer: Metal, Wood, Water, Fire, Earth should mutually balance. (Listing standard mutual restraint). East is Liver Wood, West is Lung Metal. If Wood becomes replete, Metal should restrain it (Metal overcomes Wood). If Fire becomes replete, Water should restrain it (Water overcomes Fire). If Earth becomes replete, Wood should restrain it (Wood overcomes Earth). If Metal becomes replete, Fire should restrain it (Fire overcomes Metal). If Water becomes replete, Earth should restrain it (Earth overcomes Water). East is Liver, so Liver is Replete (not ordinary repletion). West is Lung, so Lung is Deficient (not ordinary deficiency). Drain South (Heart Fire), Tonify North (Kidney Water). South Fire is the Child of Wood; North Water is the Mother of Wood. (These two sentences initiate the key discussion on etiology and treatment). Child (Heart) can make Mother (Liver) replete; Mother (Kidney) can make Child (Liver) deficient. Water overcomes Fire. Therefore, drain Heart Fire and Tonify Kidney Water, intending to prevent Lung Metal from restraining Liver Wood. The Classic says, "Cannot treat such deficiency... what need to ask about the rest?" This is the meaning.
Commentary: "East Replete, West Deficient" means Liver Wood Replete and Lung Metal Deficient, indicating the disease location. "Drain South, Tonify North" means draining Heart Fire and tonifying Kidney Water, indicating the treatment goal. This initiates the query. The answer first lists mutual restraint to show normal patterns. "Fire is Child of Wood, Water is Mother of Wood" is the key to analyzing etiology and treatment. Liver hyperactivity stems from Heart Fire excess; the Child does not consume Mother qi, causing Liver Wood to flourish. Kidney failure relates to Lung Metal deficiency; the Mother cannot assist the Child, causing Lung Metal to be severely deficient. By standard mutual restraint, treatment should tonify Lung and drain Liver. Instead, abandoning East/West to treat South/North is non-standard, like strategic flexibility in Confucianism or warfare. "Child makes Mother replete" refers to pathology: Child (Heart) causes Mother (Liver) repletion. "Mother makes Child deficient" refers to treatment: Mother (Kidney) makes Child (Liver) deficient. Question: If Heart excess makes Liver replete, shouldn't Liver excess make Kidney replete? Why is Kidney deficient? Answer: Heart making Liver replete involves rebellious Qi becoming pathogenic. Wood generating Fire is natural. Here, Heart excess fails to consume Mother qi, causing Wood qi to fail to reach and rebel, becoming pathogenic. Kidney deficiency loses Mother qi. Water generating Wood is natural, but insufficient Qi cannot transmit effectively, lacking rebellion. Transmission from Heart to Liver is pathogenic; transmission from Kidney to Liver is righteous. Like water flow: blockage at the end causes backflow and turbulence, churning the source—this is not water's nature, explaining Liver repletion. A thin source leads to short flow; even with dams downstream, the weak force dries up mid-course, depositing silt, lacking turbulence—explaining Kidney deficiency. Question: Are draining fire and tonifying water simultaneous or sequential? Answer: No. With needles, tonify Yin and drain Yang suffices. With herbs, it is not necessarily so; focus on tonifying Yin. "Water overcomes Fire" clarifies this. This is a crucial point. Analyzing the cause: Middle Qi deficiency prevents Spleen from distributing essence to Lung; Lung lacks governing Qi. Lung deficiency leads to Lung Qi stagnation, causing Kidney Yin insufficiency. Yin insufficiency triggers Yang within Yin, causing Liver Wood to rebel upward and merge with Heart. Liver repletion leads to extreme Heart excess, failing to consume Mother qi, blocking transmission, intensifying Liver pathogen. Liver repletion and Heart excess oppress Lung, causing severe Lung deficiency. Treatment ignores Lung deficiency (like ignoring a request for tribute to glorify a declining dynasty). Tonifying Kidney increases Yin, weakening Heart; relying on Mother reduces Liver repletion (like Jin borrowing passage from Yu to attack Guo; Jin targets Yu, not Guo). "Preventing Metal from restraining Wood" and "cannot treat such deficiency" refer to this. My interpretation synthesizes Chen Tingzhi, Wang Andao, and Sun Yikui. Wang gained insight recently but erred by deleting "not." Chen and Sun retained "not," capturing the true intent. This chapter discusses adaptive treatment, supplementing deficiencies to achieve dual benefits. Chapter 80 discusses standard tonifying Lung/draining Liver. Deleting "not" would confuse constant and variable methods, contrary to Bian Que's intent. Scholars should examine this carefully.
(Chapter 79, Old Chapter 77) Question: The Classic (*Ling Shu: Ni Shun*) says, "Superior doctors treat disease before it arises; average doctors treat disease after it arises." What does this mean? Answer: Treating before it arises means seeing Liver disease, knowing it will transmit to the Spleen, and thus first strengthening Spleen Qi to prevent receiving Liver pathogen (the overcoming relationship). Hence, "treating before it arises." Average doctors, seeing Liver disease, do not understand transmission and focus solely on treating the Liver (where the disease is). Hence, "treating after it arises."
Commentary: "Before arising" refers to areas not yet affected by pathogen; "after arising" refers to diseased areas. Visceral diseases often transmit to what they overcome. Superior doctors, treating before arising, inspect horizontal and vertical transmissions to prevent encroachment, preparing early. Average doctors lack foresight, addressing only immediate symptoms, being rigid. *Ling Shu* Ch. 55 states: "Superior doctors needle where disease has not yet arisen; inferior doctors needle where disease is attacking." This chapter follows this logic. *Su Wen* Ch. 2 defines "before/after arising" differently (healthy vs. sick), which should not be confused. Draining South/Tonifying North is superior treatment of "before arising." Thus, superior and average doctors have distinct levels.
(Chapter 80, Old Chapter 81) Question: The Classic says, "Do not replete repletion, do not vacate deficiency; do not damage insufficiency and benefit excess." Is this seen in Cun Kou pulse, or is it natural repletion/deficiency in symptoms? How does damaging insufficiency and benefiting excess occur? Answer: This disease (some note "two characters" as redundant, Sun Yikui argues it's ancient phrasing, accepted here) does not refer to Cun Kou pulse (which reveals true repletion/deficiency) but to false deficiency and false repletion in the disease presentation. For example, if Liver is truly Replete and Lung is truly Deficient, Wood and Metal should balance (standard). One should know Metal restrains Wood (standard treatment). But if Lung is truly Replete and Liver is truly Deficient (here Lung shows false deficiency, Liver shows false repletion), using needles without tonifying Liver (true deficiency) and instead heavily reinforcing Lung (true repletion), one says "replete repletion, vacate deficiency, damage insufficiency, benefit excess." This is the harm caused by average doctors.
Commentary: Diseases have repletion and deficiency, which have true and false aspects. True aspects are known via pulse, so they are excluded here. False aspects often lead to misdiagnosis by average doctors, hence the warning: do not "replete repletion, vacate deficiency," i.e., do not treat false as true. If replete repletion/vacate deficiency occurs with mixed true/false, insufficiency is further damaged, excess further benefited. Cun Kou pulse clearly shows true repletion/deficiency, minimizing error. Hence, "not referring to Cun Kou pulse," but to disease manifestations. "Repletion and deficiency" here refer to false repletion and false deficiency. If...