八十难曰∶经言有见如入,有见如出者,何谓也?
然∶所谓有见如入者,谓左手见气来至乃内
针,针入见气尽乃出针,是谓有见如入,有见如出也。
此论针之出入,必见其气之已至已尽,而后可出可入也。经言有见如入,有见如出者,谓凡
欲刺,先以左手按其穴,候其穴中之气来而内其针,针入候其气尽,乃出其针,非迎随补泻之
法也。滑氏曰∶所谓有见如入下,当欠“有见如出”四字。如读若(而),《孟子》书望道而未
之见,而读若“如”,盖通用也。
八十一难曰∶经言无实实虚虚,损不足而益有余,是寸口脉耶,将病自有虚实耶,其损益奈
何?
然∶是病非谓寸口脉也,谓病自有虚实也。假令肝实而肺虚,肝者,木也,肺者,金也,金
木当更相平,当知金平木。假令肺实而肝虚,微少气,用针不补其肝,而反重实其肺,故曰实实
虚虚,损不足而益有余,此者中工之所害也。
经言,《灵枢·九针十二原》也。夫治病之法,以平为期,虚者补之,实者泻之,不足者益
之,有余者损之。若实者宜泻,而反补之;虚者宜补,而反泻之,不足者反损之,有余者反益之;
此皆误治也?故曰∶无实实,无虚虚,损不足,益有余也。但此所谓之虚实者,不知其指脉言
也,抑指病言也,故曰∶是寸口脉耶,将病有虚实耶?其损益之法将如何以治之?故曰∶其损
益奈何,然此非脉之虚实,乃病自有之虚实也,故曰,是病非谓寸口脉也。假令肝实肺虚,则
金无平木之力,当知泻南方火,补北方水,作隔二隔三之治,其金木始得相平也。设或肺实肝
虚,盒饭抑金扶木。而粗工昧此,不知补肝,而反重实其肺,如此则肺益实而肝益虚,是不独
不明隔治之法,而虚实莫辨,反损其不足,益其有余,不惟不能治其病,而反害其人矣。故复
申之曰∶实实虚虚,损不足,益有余,此则中工之害也。此章虽言针法之补泻,实为总结全篇
纲领,盖医家于虚实之间,不容稍误,若或稍误,害如反掌,故越人不惮反复叮咛,谆谆垂
戒也。
或问《难经》问难《内经》之义者也,而《内经》当难之义,未必止此,而越人独问八十
一难,何所取义耶?曰∶ 于老子道生一,一生二,二生三,三之为九,故九而九之,为八十一
章。太玄以一元为三方,自是为九,而积之篇八十一首。《素问·离合真邪论》,九九八十一
篇,以起黄钟数焉。古书多以八十一篇为数者,实本乎此。然辞虽简而义该,于诊法、经络、
脏象、病能、 穴、针法、莫不咸备。如脉有根本,人有元气,男生于寅,女生于申,木所以
沉,金所以浮,金生于巳,水生于申,泻南方火,补北方水诸说,《灵》《素》未见,皆足以羽
翼经文。而诊法独取寸口以三部,其事约而易明,实为不磨之矜式也。详其设问之辞,称经言
者,出于《素问》《灵枢》二经固多,亦有二经无所见者,盖摭于古医经。是《难经》一书,实
与《内经》相表里,而不可岐视者也。若潜心研究,寻其指趣,虽不能洞见五脏症结,亦思过
半矣。
上第六卷,六十九难至八十一难,论针法。
第八十难说:医经中说“有见如入,有见如出”,这是什么意思呢?
回答说:所谓“有见如入”,是指左手感觉到经气到来时才进针;进针后感觉到经气已尽才出针,这就叫做“有见如入”和“有见如出”。
这是论述针刺的进出,必须看到经气已经到来、已经耗尽,然后才可以出针或进针。医经中说“有见如入,有见如出”,意思是凡是想要施刺,先用左手按压穴位,等待穴中的经气来至再内进针,针进入后等待经气尽,才拔出针,这并不是迎随补泻(一种根据经脉走向和虚实情况进行的补泻手法)的方法。滑寿(滑氏)说:在“所谓有见如入”下面,应当缺了“有见如出”这四个字。“如”字读作“而”(表示顺承),《孟子》书中“望道而未之见”,其中的“而”读作“如”,大概是通用的。
第八十一难说:医经中说不要使实证更实、虚证更虚,不要损害不足的正气而增加有余的邪气,这是指寸口脉而言呢,还是指疾病本身自有虚实呢?其损益的原则是怎样的呢?
回答说:这里说的病,不是指寸口脉,而是指疾病本身自有虚实。假如肝实而肺虚,肝属木,肺属金,金与木应当互相制约平衡,应当知道用金(肺/火/水等间接关系,此处原文逻辑为金克木,若肺虚则金弱不能制木,故需调整)来平抑木(肝)。假如肺实而肝虚,气息微弱,使用针刺时不补益肝脏,反而加重肺的实证,所以叫“实实虚虚”,损害不足而增加有余,这是中等水平医生造成的危害。
医经的话,出自《灵枢·九针十二原》。治疗疾病的法则,以平衡为标准,虚证用补法,实证用泻法,不足的加以增益,有余的加以削减。如果实证适宜用泻法,却反而用补法;虚证适宜用补法,却反而用泻法;不足的反而去损害它,有余的反而去增益它;这些都是误治。所以说:不要使实证更实,不要使虚证更虚,不要损害不足,不要增益有余。只是这里所说的虚实,不知道是指脉象来说,还是指病症来说,所以说:这是指寸口脉呢,还是疾病本身有虚实呢?其损益的治疗方法将如何施行呢?所以说:其损益原则是什么?然而这里说的不是脉象的虚实,而是疾病本身固有的虚实,所以说:这说的是疾病,不是指寸口脉。假如肝实肺虚,那么金就没有力量平抑木,应当知道泻南方(心/火),补北方(肾/水),采用隔二、隔三(间接治疗脏腑相关病变)的方法,这样金木才能重新达到平衡。假设肺实肝虚,就应当抑制金(肺)扶持木(肝)。而粗疏的医生不明白这一点,不知道补肝,反而加重肺的实证,像这样就会使肺更加实、肝更加虚,这不仅是不明白间接治疗的方法,而且分不清虚实,反而损害其不足,增益其有余,不仅不能治好病,反而害了病人。所以再次申明说:使实证更实、虚证更虚,损害不足、增益有余,这是中等水平医生的祸害。这一章虽然讲的是针刺的补泻,实际上是总结全篇的纲领,大概因为医家在虚实之间,不容许有一点错误,如果稍有错误,危害如同翻手掌一样快,所以扁鹊(越人)不怕反复叮咛,恳切地告诫后人。
有人问:《难经》是问难《内经》义理的著作,而《内经》中应当被问难的义理,未必只有这些,但扁鹊唯独问到第八十一难,有什么取义呢?回答说:老子说“道生一,一生二,二生三,三生万物”,三乘以二十七得八十一,所以九而九之,得到八十一章。扬雄的《太玄》以一元分为三方,由此成为九,累积起来也是八十一首。《素问·离合真邪论》中有九九八十一篇,以此起于黄钟律数。古书多以八十一篇为数,实际上都本源于此。然而文辞虽然简略,但义理完备,对于诊法、经络、脏象、病能、穴位、针法,无不具备。比如脉有根本,人有元气,男生于寅月,女生于申月,木性沉,金性浮,金生于巳,水生于申,泻南方火,补北方水等说法,《灵枢》《素问》中未见,都足以辅助经文。而诊法独取寸口分为三部,事情简约且容易明白,实在是不可磨灭的典范。详细考察其设问的文辞,称引“经言”的,大多出于《素问》《灵枢》二经,也有这两部经书中没有见到的,大概是摘取自古医经。因此《难经》这本书,确实与《内经》互为表里,不可以区别看待。如果潜心研究,探寻其旨趣,即使不能透彻看见五脏的症结所在,也能思过半矣(理解大部分内容)了。
以上是第六卷,从六十九难到八十一难,讨论针法。
Chapter 80 states: The classic texts mention "seeing as entering, seeing as exiting." What does this mean?
The response is: By "seeing as entering," it refers to inserting the needle only when the practitioner's left hand perceives the arrival of Qi (vital energy). By "seeing as exiting," it refers to withdrawing the needle only after perceiving that the Qi has dissipated. This is what is meant by "seeing as entering" and "seeing as exiting."
This discussion concerns the insertion and withdrawal of needles, emphasizing that one must observe whether the Qi has arrived or dissipated before proceeding with insertion or withdrawal. When the classics say "seeing as entering, seeing as exiting," they mean that whenever one intends to puncture, one should first press the acupoint with the left hand, wait for the Qi within the point to arrive, and then insert the needle. After insertion, one waits until the Qi is exhausted before withdrawing the needle. This is not the method of Ying-Sui Bu-Xie (a tonification and sedation technique based on the direction of meridian flow and deficiency/excess conditions). Hua Shou (Hua Shi) stated: Below the phrase "so-called seeing as entering," the four characters "seeing as exiting" are likely missing. The character "Ru" (如) is read as "Er" (而, indicating sequence), as seen in the *Mencius* where "looking at the Way but not yet seeing it" uses "Er" pronounced as "Ru"; thus, they were used interchangeably.
Chapter 81 states: The classic texts say, "Do not reinforce excess nor deplete deficiency; do not damage what is insufficient nor benefit what is already abundant." Does this refer to the Cun Kou pulse, or does it refer to the inherent deficiency and excess of the disease itself? How should these tonifications and sedations be applied?
The response is: This refers to the disease itself, not the Cun Kou pulse. For example, if the Liver is in a state of Excess and the Lungs are in a state of Deficiency: The Liver corresponds to Wood, and the Lungs correspond to Metal. Metal and Wood should mutually regulate each other. One should understand how Metal regulates Wood. If the Lungs are in Excess and the Liver is in Deficiency, manifesting as slightness of Qi, and the practitioner uses acupuncture without tonifying the Liver but instead further reinforcing the Lungs, this is called "reinforcing excess and depleting deficiency," damaging the insufficient and benefiting the abundant. This causes harm through the actions of average physicians.
These words from the classic texts originate from *Ling Shu: Nine Needles and Twelve Origins*. The principle of treating diseases aims for balance: tonify deficiency, sedate excess, augment what is lacking, and reduce what is abundant. If an excess condition is suitable for sedation but is treated with tonification; if a deficiency condition is suitable for tonification but is treated with sedation; if what is lacking is damaged rather than augmented, and what is abundant is benefited rather than reduced—all these constitute misdiagnosis and mistreatment. Therefore, it is said: "Do not reinforce excess, do not deplete deficiency, do not damage the insufficient, do not benefit the abundant." However, regarding the terms deficiency and excess mentioned here, it is unclear whether they refer to the pulse or the disease symptoms. Hence the question: "Does this refer to the Cun Kou pulse, or does the disease itself have deficiency and excess? How should the principles of reduction and augmentation be applied in treatment?" Thus it asks, "What are the principles of reduction and augmentation?" But this does not refer to the deficiency and excess of the pulse, but rather the inherent deficiency and excess of the disease itself. Hence it says: "This refers to the disease, not the Cun Kou pulse."
If the Liver is in Excess and the Lungs are in Deficiency, Metal lacks the strength to regulate Wood. One should understand to sedate the South (Heart/Fire) and tonify the North (Kidney/Water), employing indirect treatments such as "separating two" or "separating three" (treating related organs indirectly). Only then can Metal and Wood achieve balance again. Conversely, if the Lungs are in Excess and the Liver is in Deficiency, one should suppress Metal and support Wood. Crude practitioners fail to grasp this; knowing not to tonify the Liver, they instead further reinforce the Lungs. In doing so, the Lungs become more excessive and the Liver more deficient. This not only shows ignorance of indirect treatment methods but also an inability to distinguish between deficiency and excess, resulting in damaging the insufficient and benefiting the abundant. This not only fails to cure the disease but harms the patient. Therefore, it is reiterated: "Reinforcing excess and depleting deficiency, damaging the insufficient and benefiting the abundant—this is the harm caused by average physicians." Although this chapter discusses acupuncture tonification and sedation, it essentially serves as the summary and guideline for the entire volume. Physicians must not make even the slightest error regarding deficiency and excess; if they do, the harm occurs as quickly as flipping a hand. Therefore, Bian Que (Yue Ren) did not hesitate to repeat his admonitions earnestly.
Someone asked: *Nan Jing* questions the meanings of *Nei Jing*, yet the matters worthy of questioning in *Nei Jing* are not limited to these. Why did Yue Ren specifically address up to Chapter 81? The answer is: Laozi stated, "The Dao produced One, One produced Two, Two produced Three, Three produced All Things." Multiplying nine by nine yields eighty-one chapters. Yang Xiong’s *Tai Xuan* divides one Yuan into three Fangs, leading to nine, which accumulates to eighty-one sections. *Su Wen: Discussion on Separating True and Evil* contains eighty-one chapters derived from the Huang Zhong pitch-pipe number. Ancient texts often use eighty-one as a numerical standard, originating from this concept. Although the language is concise, the principles are comprehensive, covering diagnostic methods, meridians, zang-fu imagery, pathological capabilities, acupoints, and needling techniques. Concepts such as pulses having roots, humans possessing Yuan Qi, males originating in Yin month, females in Shen month, wood being heavy/sinking, metal being light/floating, metal originating in Si, water originating in Shen, sedating South Fire, and tonifying North Water—these theories are not found in *Ling Shu* or *Su Wen* but serve to supplement the canonical texts. Diagnostic methods focusing solely on the Cun Kou divided into three positions are concise and easy to understand, serving as an enduring model. Examining the rhetorical questions, most citations of "the classics" come from *Su Wen* and *Ling Shu*, though some appear nowhere in these two works, likely extracted from ancient medical texts. Thus, *Nan Jing* stands in intimate relation to *Nei Jing* and should not be viewed separately. With deep study and exploration of its intent, although one may not fully penetrate the complexities of the five zang organs, one will have grasped more than half of the knowledge.
This concludes Volume Six, Chapters 69 to 81, discussing needling techniques.