平按∶此篇自篇首至末，见《灵枢》卷二第六《寿夭刚柔》篇，又见《甲乙经》卷十第一。
黄帝问曰∶余闻刺有三变，何谓三变？伯高答曰∶有刺营者，有刺卫者，有刺寒痹之留经者。
黄帝问曰∶刺三者奈何？（平按∶《灵枢》三下有变字。）伯高曰∶刺营者出血，刺卫者出气，
刺寒痹者内热。（刺营见血，出恶血也；刺卫见气，出邪气也；刺痹见热，故曰三变。寒温之气
停留于经络，久留针使之内热，以去其痹也。平按∶注寒温，温字恐系湿字传写之误。）黄帝问
曰∶营卫寒痹之为病奈何？伯高答曰∶营之生病也，寒热少气，血上下行。卫之生病也，气痛时
来时去，怫忾贲响，风寒客于肠胃之中，寒痹之为病也，留而不去，时痛而皮不行。（怫忾，上
扶物反，下 气反，气盛满貌。贲响，腹胀貌也。平按∶气痛时来时去《灵枢》作气通时来时去，
《甲乙》作气血时来去。皮不行《灵枢》、《甲乙》作皮不仁。）黄帝问曰∶刺寒痹内热奈何？
伯高曰∶刺布衣者必火 ，刺大人者药熨之。
（平按∶《灵枢》、《甲乙》必火 作以火 之，药上有以字。）黄帝问曰∶药熨之奈何？
伯高曰∶用醇酒二十升，蜀椒四升，干姜一升，桂一升，（平按∶醇酒，二十升《灵枢》作二十
斤。蜀椒，四升《灵枢》、《甲乙》作一升。干姜，一升《灵枢》作一斤。桂一升《灵枢》作桂
心一斤。）凡四种，皆 咀，渍酒中。用绵絮一斤，细白布四丈，（平按∶《甲乙》皆 咀作各
细咀，渍酒中作着清酒中，四丈下有二尺二字。）皆并
内酒中。置酒马矢温中，盖封涂、勿使泄。（平按∶温《灵枢》、《甲乙》作 。盖《甲乙》作
善。《甲乙》泄上有气字。）五日五夜，出布绵絮，曝干复渍，以尽其汁。（平按∶《甲乙》絮
上无绵字。《灵枢》曝干下有之干二字。）每渍必 其日，乃出干。（平按∶乃出干，《灵枢》
干下重一干字，《甲乙》作乃出布絮干之。）并用滓与绵絮，复布为复巾，长六七尺，为六七巾。
（平按∶与绵絮复布为复巾长六七尺为六七巾《甲乙》作与絮布长六七尺为六巾。）即用之生桑
炭灸巾，以熨寒痹所刺之处，（平按∶《甲乙》所刺作所乘。）令热入于病所，（平按∶《灵枢》、
《甲乙》入下有至字。）寒复灸巾以熨之，三十遍而止。即汗出，灸巾以拭身，（平按∶《灵枢》
作汗出以巾拭身。）亦三十遍而止。起步内中，无见风。每刺必熨如此法，病已矣，此所谓内热
者也。（酒、椒、姜、桂四物，性热又泄气，故用之熨身，皮腠适而可刺也，此在冬日血气不流
之时，熨之令通也。 ，弗禹反。咀，才与反。 咀，谓调粗细分等也。 ，祖赖反，一日周时
也。平按∶如此法病已矣，《灵枢》、《甲乙》无法字。矣《甲乙》作失。）
平按：本篇从开头到结尾，见于《灵枢》卷二第六篇《寿夭刚柔》，又见于《甲乙经》卷十第一篇。
黄帝问道：我听说针刺有三种变化，什么是三种变化？伯高回答说：有刺营分的，有刺卫分的，有刺寒痹病邪留滞于经络的。
黄帝问道：对这三种情况如何施针？（平按：《灵枢》中“三”字下有“变”字。）伯高说：刺营分要使其出血，刺卫分要使其出气，刺寒痹要使其内部产生热感。（刺营分见到血，是排出恶血；刺卫分见到气，是排出邪气；刺寒痹见到热感，所以称为三种变化。寒湿之气停留于经络，长时间留针使其内部产生热感，以祛除痹症。平按：注文中“寒温”，“温”字恐怕是“湿”字在传抄中的错误。）黄帝问道：营、卫、寒痹所导致的疾病表现是怎样的？伯高回答说：营分生病时，表现为寒热、气短，血液上下妄行。卫分生病时，表现为气痛，时而发作时而消失，胸膈胀闷、肠鸣有声，风寒之邪客居于肠胃之中。寒痹生病时，病邪留滞不去，时常疼痛且皮肤麻木不仁。（怫忾，上音扶物反，下音气反，指气盛满的样子。贲响，指腹胀的声音。平按：“气痛时来时去”在《灵枢》中作“气通时来时去”，在《甲乙经》中作“气血时来去”。皮不行在《灵枢》、《甲乙经》中作“皮不仁”。）黄帝问道：刺寒痹使其内部产生热感的方法是怎样的？伯高说：对于平民百姓必须用火灸法，对于达官贵人要用药熨法。
（平按：《灵枢》、《甲乙经》中“必火”后作“以火焠之”，“药”字上有“以”字。）黄帝问道：药熨法是怎样的？
伯高说：用清酒二十升，蜀椒四升，干姜一升，桂心一升，（平按：清酒二十升，《灵枢》作二十斤。蜀椒四升，《灵枢》、《甲乙经》作一升。干姜一升，《灵枢》作一斤。桂心一升，《灵枢》作桂心一斤。）共四种药材，都切碎，浸泡在酒中。用绵絮一斤，细白布四丈，（平按：《甲乙经》中“皆咀”作“各细咀”，“渍酒中”作“着清酒中”，“四丈”下多“二尺”二字。）一起放入酒中。将容器置于马粪发酵产生的温热环境中，覆盖密封涂抹严实，不要使药气泄漏。（平按：“温”字在《灵枢》、《甲乙经》中作“煴”。盖，《甲乙经》作“善”。《甲乙经》中“泄”字上有“气”字。）经过五天五夜，取出布和绵絮，晒干后再浸入酒中，直到浸尽药汁。（平按：《甲乙经》中“絮”字上没有“绵”字。《灵枢》中“曝干”下有“之干”二字。）每次浸泡必须等到一天一夜的时间，然后拿出来晾干。（平按：“乃出干”，《灵枢》中“干”字下重一个“干”字，《甲乙经》作“乃出布絮干之”。）将剩下的药渣与绵絮混合，再用布包裹成双层巾帕，长六七尺，做成六七条巾帕。（平按：“与绵絮复布为复巾长六七尺为六七巾”在《甲乙经》中作“与絮布长六七尺为六巾”。）就用这些巾帕在生桑炭火上加热，用来熨烫寒痹针刺的部位，（平按：《甲乙经》中“所刺”作“所乘”。）使热力进入病灶部位，（平按：《灵枢》、《甲乙经》中“入”字下有“至”字。）寒气退了再用巾帕熨烫，重复三十次停止。如果出汗，就用加热的巾帕擦拭身体，（平按：《灵枢》作“汗出以巾拭身”。）也重复三十次停止。随后在室内缓步行走，不要吹风。每次针刺都必须这样熨烫，病就好了，这就叫做内热法。（酒、椒、姜、桂四味药，性热又能泄气，所以用来熨身，使皮肤腠理开泄适宜针刺，这是在冬日气血运行不畅的时候，通过熨烫使其通畅。 ，弗禹反。咀，才与反。 咀，指将药材调制成粗细均匀的碎块。 ，祖赖反，指一天一夜的时间。平按：“如此法病已矣”，《灵枢》、《甲乙经》中没有“法”字。“矣”在《甲乙经》中作“失”。）
Ping An: This chapter, from beginning to end, is found in *Ling Shu* (Spiritual Pivot), Volume 2, Chapter 6 "Shou Yao Gang Rou" (Longevity, Frailty, Rigidity, and Softness), and also in *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion), Volume 10, Chapter 1.
The Yellow Emperor asked, saying: I have heard that there are three variations in acupuncture. What are these three variations? Bo Gao answered, saying: There are needlings of the Ying (Nutrient) level, needlings of the Wei (Defensive) level, and needlings for Cold-Bi (Cold Obstruction Syndrome) where pathogenic factors remain lodged in the meridians.
The Yellow Emperor asked, saying: How should one needle these three types? (Ping An: In *Ling Shu*, the character "Bian" [variation] appears after "San" [three].) Bo Gao said: Needling the Ying level involves causing bleeding; needling the Wei level involves releasing Qi; needling Cold-Bi involves generating internal heat. (Needling the Ying level results in blood discharge, expelling evil blood; needling the Wei level results in Qi discharge, expelling pathogenic Qi; observing heat generation in Bi needling leads to the term "three variations." When cold and damp qi stagnates in the meridians, retaining the needle for an extended period generates internal heat to dispel the Bi syndrome. Ping An: In the commentary, "Han Wen" [cold and warm], the character "Wen" [warm] is likely a transcription error for "Shi" [damp].) The Yellow Emperor asked, saying: What are the pathological manifestations of diseases arising from Ying, Wei, and Cold-Bi? Bo Gao answered, saying: When the Ying level is diseased, symptoms include chills and fever, shortness of breath, and blood moving erratically upward and downward. When the Wei level is diseased, symptoms include Qi-related pain that comes and goes intermittently, chest and epigastric fullness with distension, and borborygmus (intestinal rumbling), as wind-cold pathogens lodge within the stomach and intestines. When Cold-Bi disease occurs, the pathogen remains lodged without departing, causing intermittent pain and skin numbness/insensitivity. ("Fu Kai," pronounced 'fu' (rising tone) and 'qi' (falling tone), refers to a sensation of Qi excess and fullness. "Ben Xiang" refers to abdominal distension and sound. Ping An: "Qi tong shi lai shi qu" [Qi flows, coming and going] in *Ling Shu* is written as "Qi tong shi lai shi qu"; in *Jia Yi Jing* it is "Qi xue shi lai qu" [Qi and blood come and go]. "Pi bu xing" [skin does not move/function] in *Ling Shu* and *Jia Yi Jing* is written as "Pi bu ren" [skin insensitivity].) The Yellow Emperor asked, saying: How is the method of generating internal heat for needling Cold-Bi performed? Bo Gao said: For commoners, fire therapy must be used; for nobles, medicated hot compresses (Yao Wan) should be applied.
(Ping An: In *Ling Shu* and *Jia Yi Jing*, "Bi Huo" [must use fire] is followed by "Yi Huo Cui Zhi" [use fire to cauterize], and the character "Yi" [with/by] precedes "Yao" [medicine].) The Yellow Emperor asked, saying: How is the medicated hot compress performed?
Bo Gao said: Use twenty sheng of pure wine, four sheng of Shu pepper (Sichuan peppercorn), one sheng of dried ginger, and one sheng of cinnamon bark. (Ping An: Twenty sheng of pure wine, *Ling Shu* records as twenty jin. Four sheng of Shu pepper, *Ling Shu* and *Jia Yi Jing* record as one sheng. One sheng of dried ginger, *Ling Shu* records as one jin. One sheng of cinnamon bark, *Ling Shu* records as one jin of cinnamon heart.) These four ingredients are all chopped into coarse pieces and soaked in the wine. Take one jin of cotton wadding and forty zhang of fine white cloth. (Ping An: In *Jia Yi Jing*, "Jie Ju" [all chopped] is written as "Ge Xi Ju" [each finely chopped], "Zi Jiu Zhong" [soak in wine] as "Zhe Qing Jiu Zhong" [place in clear wine], and two chi are added after "Si Zhang".) Place them together into the wine. Set the container in the warm environment generated by fermenting horse manure, cover and seal it tightly with paste, ensuring no medicinal vapor escapes. (Ping An: "Wen" [warm] in *Ling Shu* and *Jia Yi Jing* is written as "Yun" [smoldering heat]. "Gai" [cover] in *Jia Yi Jing* is written as "Shan" [carefully]. In *Jia Yi Jing*, the character "Qi" [vapor/gas] appears before "Xie" [escape].) After five days and nights, remove the cloth and cotton wadding, dry them in the sun, and soak them again until all the medicinal juice is extracted. (Ping An: In *Jia Yi Jing*, the character "Mian" [cotton] is absent before "Xu" [wadding]. In *Ling Shu*, the characters "Zhi Gan" [dry them] appear after "Pu Gan" [sun-dry].) Each soaking must last for one full day and night before removal and drying. (Ping An: "Nai Chu Gan" [then take out and dry], in *Ling Shu* the character "Gan" is repeated at the end; in *Jia Yi Jing* it is written as "Nai Chu Bu Xu Gan Zhi" [then take out the cloth and wadding and dry them].) Mix the remaining dregs with the cotton wadding, wrap them in cloth to form double-layered towels, each six or seven chi long, making six or seven towels. (Ping An: "Yu Mian Xu Fu Bu Wei Fu Jin Chang Liu Qi Chi Wei Liu Qi Jin" [mix with cotton wadding, wrap in cloth to make double towels, length six or seven chi, make six or seven towels] in *Jia Yi Jing* is written as "Yu Xu Bu Chang Liu Qi Chi Wei Liu Jin" [mix with wadding and cloth, length six or seven chi, make six towels].) Heat these towels over charcoal made from living mulberry wood, and apply the hot compress to the sites of the Cold-Bi needling. (Ping An: In *Jia Yi Jing*, "Suo Ci" [the needled site] is written as "Suo Cheng" [the affected site].) Allow the heat to penetrate into the lesion site. (Ping An: In *Ling Shu* and *Jia Yi Jing*, the character "Zhi" [to] appears after "Ru" [enter].) Once the cold recedes, continue applying the hot towel, repeating this process thirty times to stop. If sweating occurs, use the heated towel to wipe the body. (Ping An: *Ling Shu* reads "Han Chu Yi Jin Shi Shen" [after sweating, use towel to wipe body].) Repeat this wiping thirty times to stop. Then walk slowly indoors, avoiding exposure to wind. Every needling session must be accompanied by this moxibustion/compress method. Once the illness is cured, this is referred to as "Nei Re" (Internal Heat). (The four substances—wine, pepper, ginger, and cinnamon—are hot in nature and can disperse Qi; thus they are used for body compresses to open the skin and pores, making the area suitable for needling. This is performed when winter causes stagnant Qi and Blood flow, using compression to promote circulation. Pronunciation: , fu yu fan. Ju, cai yu fan. Ju, means adjusting ingredients to uniform coarse fragments. , zu lai fan, refers to a period of one day and night. Ping An: "Ru Ci Fa Bing Yi Yi" [thus the disease is cured], *Ling Shu* and *Jia Yi Jing* lack the character "Fa" [method]. "Yi" [particle indicating completion] in *Jia Yi Jing* is written as "Shi" [loss/error].)