平按∶此篇自形乐志苦至出气恶血，见《素问》卷七第二十四《血气形志篇》，又见《灵枢》
卷十二第七十八《九针论》，又见《甲乙经》卷六第二，又见日本《医心方》卷一《治病大体》第
一。自阳明多血气至末，《素问》《灵枢》见同前篇。又自阳明多血气至少阴少血多气，《灵枢》
卷十第六十五《五音五味》篇亦有此文。
形乐志苦，病生于脉，治之以灸刺；（形，身之貌也。志，心之志也。心以主脉，以其心劳，
邪气伤脉，心之应也，故以灸刺补泻脉病也。）形苦志乐，病生于筋，治之以熨引；（形苦筋劳，
邪气伤筋，肝之应也，筋之病也医而急，故以熨引调其筋病也。药布熨之引之，使其调也。平按∶
形苦志乐一段《素问》在形乐志乐一段下。）
形乐志乐，病生于肉，治之以针石；（形志俱逸，则邪气客肉，脾之应也，多发痈肿，故以
砭针及石熨调之也。 《山海经》曰∶高氏之山，其上多玉，有石可以为砭针。堪以破痈肿者也。平按∶注多发痈
肿，肿字袁刻误作脾。）
形苦志苦，病生于咽喝，治之以药；（形志俱苦劳气，客邪伤气，在于咽喝，肺之应也。喝，
肺喘声也。有本作渴。故疗之汤液丸散药之也。平按∶咽喝《素问》作咽嗌，《甲乙》作困竭。
药《素问》作百药，《灵枢》、《甲
乙》作甘药，《医心方》引《太素》仍作药。）形数惊恐，筋脉不通，病生于不仁，治之以按摩醪
药，是谓五形。（惊恐主肾，形多惊惧，邪客筋脉，筋脉不通，肾之应也，痛生筋脉皮肤之间，
为痹不仁，故以按摩醪醴。五形，言陈其所宜也。平按∶《素问》筋脉作经络，五形下有志也二字。
《医心方》无是谓五形四字。）故曰∶刺阳明出血气，（手阳明，大肠脉，足阳明，胃脉也，二脉
上下连注，其气最强，故此二脉盛者，刺之血气俱泻。平按∶故曰二字《素问》无，《甲乙》作
故志曰。）刺太阳出血恶气，（手太阳，小肠脉也，足太阳，膀胱脉也，二脉上下连注，津液最
多，故二脉盛者，刺之泻血，邪客之者，泻去恶气也。）刺少阳出气恶血，（手少阳，三焦脉也，
足少阳，胆脉也，二脉上下连注，其气最多，故此二脉盛者，刺之泻气，邪客之者，泻去恶血也。）
刺太阴出血气，（手太阴，肺脉也，足太阴，脾脉也，此二太阴与二阳明虽为表里，其气血俱盛，
故并泻血气也。平按∶《素问》出血气作出气恶血，《甲乙》同。《素问》新校正云∶“按《太素》
云∶刺阳明出血气，刺太阴出血气。杨上善云∶阳明太阴虽为表里，其血气俱盛，故并泻血气。
如是则太阴与阳明等俱为多血多气。前文太阴一云多血少气，二云多气少血，莫可的知。详《太
素》血气并泻之旨，则二说俱未为得，自与阳明同尔。”）刺厥阴出血恶气，（手厥阴，心包络
脉也，足厥阴，肝脉也，与二少阳以为表里，二阳气多血少，阴阳相反，故二阴血多气少，是以
二厥阴盛，以泻血也，邪客之者，泻去恶气。）刺少阴出气恶血。（手少阴，心脉也，足少阴，
肾脉也，与二太阳以为表里，二太阳既血多气少，亦阴阳相反，二阴气多血少，是以二少阴盛，
泻于气也，邪客之者，泻去恶血也。平按∶刺少阴句《素问》、《甲乙》在刺厥阴前。注阴阳上
袁刻脱亦字。）
阳明多血气，太阳多血少气，少阳多气少血，太阴多血气，厥阴多血少气，少阴少血多气。
（此言刺三阴三阳，出血出气差别所以也。平按∶太阴多血气《素问》作太阴常多气少血，《灵枢》
作多血少气，《甲乙》同。《素问》新校正云∶“按《甲乙经·十二经水篇》云太阳太阴血气多
少，与《素问》不同。又《阴阳二十五人形性血气不同》篇，与《素问》同。盖皇甫疑而两存之
也。”今考《甲乙经·阴阳二十五人形性血气不同》篇所云太阴常多血少气，仍与《素问》异，
或宋臣所见《甲乙经》与今本《甲乙经》不同，姑存之以备参考。）足阳明太阴为表里，少阳厥
阴为表里，太阳少阴为表里，是谓足之阴阳也；手阳明太阴为表里，少阳心主为表里，太阳少阴
为表里，是谓手之阴阳也。（今知手足阴阳所在。平按∶《素问》两太阳少阴为表里在两少阳上，
两阳明太阴为表里在两少阳下。注今知手足八字，《素问》将此注作经，惟所在作所苦。）凡治
病必先去其血，去其所苦，伺之所欲，然后泻有余，补不足。（凡疗病法，诸有痛苦由其血者，
血聚之处先刺去之，刺去血已，伺候其人情之所欲，得其虚实，然后行其补泻之法也。平按∶《素
问》血下有乃字，《灵枢》无此一段。注血聚，聚字袁刻误作刺。）
平按：本篇从“形乐志苦”到“出气恶血”，见于《素问》卷七第二十四《血气形志篇》，又见于《灵枢》卷十二第七十八《九针论》，又见于《甲乙经》卷六第二，又见于日本《医心方》卷一《治病大体》第一。从“阳明多血气”至末尾，《素问》和《灵枢》均见于前述篇章。另外，从“阳明多血气”到“少阴少血多气”，《灵枢》卷十第六十五《五音五味》篇也有此文。
形体安逸而精神困苦，疾病生于血脉，治疗用灸法和针刺；（形，指身体的形态。志，指心的情志。心主管血脉，因为心劳损，邪气伤害血脉，这是心的对应表现，所以用灸刺来补泻血脉的疾病。）形体劳累而精神安乐，疾病生于筋腱，治疗用热敷和导引；（形体劳累导致筋腱劳损，邪气伤害筋腱，这是肝的对应表现，筋腱的疾病如果治疗急迫，所以用热敷和导引来调和筋腱的疾病。用药布热敷并牵引，使其调和。平按：关于“形苦志乐”一段，《素问》将其放在“形乐志乐”一段之后。）
形体安逸且精神安乐，疾病生于肌肉，治疗用砭石和针刺；（形体和精神都安逸，则邪气客居肌肉，这是脾的对应表现，多发生痈肿，所以用砭针及石熨来调和它。《山海经》说：高氏之山，山上多玉，有石头可以做砭针。可以用来破开痈肿。平按：注文中“多发痈肿”，“肿”字袁刻误作“脾”。）
形体劳累且精神困苦，疾病生于咽喉闭塞（或口渴），治疗用药物；（形体和精神都辛苦劳气，客邪伤害气，在于咽喉闭塞，这是肺的对应表现。喝，是肺喘的声音。有的版本作“渴”。所以用汤液、丸散等药物治疗。平按：“咽喝”在《素问》中作“咽嗌”，在《甲乙》中作“困竭”。药，在《素问》中作“百药”，在《灵枢》、《甲乙》中作“甘药”，《医心方》引用《太素》仍作“药”。）
经常惊恐，筋脉不通，疾病表现为麻木不仁，治疗用按摩和酒剂，这称为五种形体（的治疗原则）。（惊恐主肾，形体经常惊惧，邪气客居筋脉，筋脉不通，这是肾的对应表现，疼痛产生在筋脉皮肤之间，成为痹症和不仁，所以用按摩和醪醴。五形，是说陈述其适宜的治疗方法。平按：《素问》中“筋脉”作“经络”，“五形”下有“志也”二字。《医心方》没有“是谓五形”四字。）所以说：刺阳明经放出血液和气，（手阳明是大肠脉，足阳明是胃脉，这两条经脉上下相连灌注，其气最强，所以这两条脉盛的时候，刺之可以气血俱泻。平按：“故曰”二字在《素问》中没有，《甲乙》作“故志曰”。）刺太阳经放出血液而厌恶排出气（即主要泻血，避免伤气），（手太阳是小肠脉，足太阳是膀胱脉，这两条经脉上下相连灌注，津液最多，所以这两条脉盛的时候，刺之泻血，如果有邪气客居，则泻去恶气。）刺少阳经排出气而厌恶放出血液（即主要泻气，避免伤血），（手少阳是三焦脉，足少阳是胆脉，这两条经脉上下相连灌注，其气最多，所以这两条脉盛的时候，刺之泻气，如果有邪气客居，则泻去恶血。）刺太阴经放出血液和气，（手太阴是肺脉，足太阴是脾脉，这两条太阴脉与两条阳明脉虽然互为表里，但它们的气血都旺盛，所以一并泻血和气。平按：《素问》中“出血气”作“出气恶血”，《甲乙》同。《素问》新校正说：“按《太素》说：刺阳明出血气，刺太阴出血气。杨上善说：阳明太阴虽为表里，其血气俱盛，故并泻血气。如果是这样，则太阴与阳明等同均为多血多气。前文太阴一说多血少气，二说多气少血，无法确切知晓。详细考察《太素》血气并泻的宗旨，则这两种说法都不恰当，自应与阳明相同。”）刺厥阴经放出血液而厌恶排出气，（手厥阴是心包络脉，足厥阴是肝脉，与两条少阳脉互为表里，两条少阳阳气多血少，阴阳相反，所以两条阴经血多气少，因此两条厥阴脉盛时，以泻血为主，如果有邪气客居，则泻去恶气。）刺少阴经排出气而厌恶放出血液。（手少阴是心脉，足少阴是肾脉，与两条太阳脉互为表里，两条太阳既血多气少，也是阴阳相反，两条阴经气多血少，因此两条少阴脉盛时，泻于气，如果有邪气客居，则泻去恶血。平按：刺少阴句在《素问》、《甲乙》中位于刺厥阴之前。注文中“阴阳”上袁刻脱漏“亦”字。）
阳明经多血多气，太阳经多血少气，少阳经多气少血，太阴经多血多气，厥阴经多血少气，少阴经少血多气。（这是说明刺三阴三阳时，出血出气差别的原因。平按：太阴多血气，《素问》作“太阴常多气少血”，《灵枢》作“多血少气”，《甲乙》同。《素问》新校正说：“按《甲乙经·十二经水篇》云太阳太阴血气多少，与《素问》不同。又《阴阳二十五人形性血气不同》篇，与《素问》同。大概是皇甫谧疑惑而两存之。现在考证《甲乙经·阴阳二十五人形性血气不同》篇所云太阴常多血少气，仍与《素问》异，或许宋臣所见的《甲乙经》与今本《甲乙经》不同，姑且保存以供参考。）足阳明与太阴互为表里，少阳与厥阴互为表里，太阳与少阴互为表里，这称为足的阴阳；手阳明与太阴互为表里，少阳与心主互为表里，太阳与少阴互为表里，这称为手的阴阳。（现在知道手足阴阳的位置。平按：《素问》中两个太阳少阴为表里在两个少阳之上，两个阳明太阴为表里在两个少阳之下。注文中“今知手足”八字，《素问》将此注作经文，惟“所在”作“所苦”。）凡是治病必须先去其瘀血，去除其所痛苦之处，观察患者的所欲，然后泻有余，补不足。（凡是疗病的方法，凡是有痛苦由血引起的，血聚结的地方先刺去之，刺去血后，伺候病人的情志所欲，得其虚实，然后施行补泻之法。平按：《素问》中“血”下有“乃”字，《灵枢》没有这一段。注文中“血聚”，“聚”字袁刻误作“刺”。）
Ping An (Editor's Note): This section, from "Xing Le Zhi Ku" to "Chu Qi E Xue", is found in *Su Wen* (Plain Questions), Volume 7, Chapter 24, "Blood and Qi Form and Will"; also in *Ling Shu* (Spiritual Pivot), Volume 12, Chapter 78, "Nine Needles Discussion"; also in *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion), Volume 6, Chapter 2; and also in the Japanese *Ishinpō* (Medical Center Formula), Volume 1, "General Principles of Treating Diseases," Part 1. From "Yangming has abundant blood and qi" to the end, both *Su Wen* and *Ling Shu* appear in the aforementioned chapter. Additionally, from "Yangming has abundant blood and qi" to "Shaoyin has little blood and abundant qi", this text also appears in *Ling Shu*, Volume 10, Chapter 65, "Five Tones and Five Flavors".
When the body is at ease but the mind is distressed, diseases arise in the vessels (Mai, channels/vessels). Treatment involves moxibustion and acupuncture. (Body refers to physical form. Mind refers to the heart's will. The Heart governs the vessels; due to heart strain, pathogenic factors damage the vessels, which corresponds to the Heart. Thus, moxibustion and acupuncture are used to tonify or sedate vessel diseases.) When the body is laborious but the mind is joyful, diseases arise in the sinews (Jin, tendons/ligaments). Treatment involves warming compresses and Daoyin (guiding and pulling exercises). (Physical labor causes sinew strain; pathogenic factors damage the sinews, corresponding to the Liver. Sinew diseases require prompt treatment; thus, warming compresses and Daoyin are used to regulate sinew diseases. Medicinal cloths are applied for warming and traction to achieve harmony. Ping An: In *Su Wen*, the section on "Xing Ku Zhi Le" follows the section on "Xing Le Zhi Le".)
When both body and mind are at ease, diseases arise in the flesh (Rou, muscles). Treatment involves Bian stones (Bian shi, stone knives for surgical incision) and acupuncture. (When both form and spirit are idle, pathogenic factors lodge in the muscles, corresponding to the Spleen. This often results in carbuncles and swellings; thus, Bian needles and hot stone compresses are used to regulate it. *Shan Hai Jing* states: On Mount Gao, there is much jade, and stones can be made into Bian needles. These can be used to lacerate carbuncles and swellings. Ping An: In the note "often develops carbuncles and swellings", the character "zhong" (swelling) is erroneously printed as "pi" (spleen) in Yuan edition.)
When both body and mind are laborious, diseases arise in the throat obstruction (Yan He, throat blockage/dyspnea) or thirst. Treatment involves herbal medicine. (Both form and spirit suffer from laborious qi consumption; exogenous pathogens damage the qi, affecting the throat obstruction, corresponding to the Lung. "He" refers to the sound of lung wheezing. Some versions read "ke" (thirst). Therefore, decoctions, pills, and powders are used for treatment. Ping An: "Yan He" is written as "Yan Yi" in *Su Wen* and "Kun Jie" in *Jia Yi Jing*. "Medicine" is written as "Bai Yao" in *Su Wen*, "Gan Yao" in *Ling Shu* and *Jia Yi Jing*, while *Ishinpō* quoting *Tai Su* retains "Yao".)
Frequent fright and alarm cause obstruction of sinews and vessels; diseases manifest as numbness and insensitivity (Bu Ren). Treatment involves massage and medicinal wine (Lao Yao). This is called the "Five Forms" (Wu Xing, referring to the five types of physical conditions). (Fright relates to the Kidney; frequent bodily fear leads to pathogenic factors lodging in sinews and vessels, causing obstruction, corresponding to the Kidney. Pain arises between sinews, vessels, and skin, resulting in Bi syndrome and numbness. Thus, massage and Lao Li (medicinal wine) are used. "Five Forms" describes stating the appropriate treatments. Ping An: In *Su Wen*, "sinews and vessels" is "jingluo"; "Wu Xing" is followed by "Zhi Ye". *Ishinpō* lacks the four characters "Shi Wei Wu Xing".)
Therefore it is said: Puncture Yangming to release blood and qi. (Hand Yangming is the Large Intestine channel; Foot Yangming is the Stomach channel. These two channels connect up and down with strong qi. When these two channels are full, puncturing them releases both blood and qi. Ping An: "Gu Yue" (Therefore it is said) is absent in *Su Wen*; *Jia Yi Jing* reads "Gu Zhi Yue".) Puncture Taiyang to release blood and avoid releasing qi. (Hand Taiyang is the Small Intestine channel; Foot Taiyang is the Bladder channel. These two channels connect up and down with abundant fluids. When these two channels are full, puncturing them releases blood; if pathogenic factors lodge, evil qi is released. Puncture Shaoyang to release qi and avoid releasing blood. (Hand Shaoyang is the Sanjiao channel; Foot Shaoyang is the Gallbladder channel. These two channels connect up and down with abundant qi. When these two channels are full, puncturing them releases qi; if pathogenic factors lodge, evil blood is released.) Puncture Taiyin to release blood and qi. (Hand Taiyin is the Lung channel; Foot Taiyin is the Spleen channel. Although these two Taiyin channels are interior-exterior pairs with the two Yangming channels, their blood and qi are both abundant, so both blood and qi are released. Ping An: In *Su Wen*, "chu xue qi" is "chu qi e xue"; *Jia Yi Jing* agrees. *Su Wen* Xin Zheng Xiao says: "According to *Tai Su*: 'Puncture Yangming to release blood and qi, puncture Taiyin to release blood and qi.' Yang Shangshan says: 'Although Yangming and Taiyin are interior-exterior pairs, their blood and qi are both abundant, so both are released. If so, Taiyin and Yangming are equally abundant in blood and qi. Previously, Taiyin was described once as having abundant blood and little qi, and twice as having abundant qi and little blood, making it impossible to know definitively. Examining the intent of simultaneous blood and qi release in *Tai Su*, neither previous description is accurate; it should align with Yangming.'") Puncture Jueyin to release blood and avoid releasing qi. (Hand Jueyin is the Pericardium channel; Foot Jueyin is the Liver channel. They are interior-exterior pairs with the two Shaoyang channels. The two Shaoyang have abundant qi and little blood; yin and yang are opposite, so the two Yin channels have abundant blood and little qi. Therefore, when the two Jueyin channels are full, blood is released; if pathogenic factors lodge, evil qi is released.) Puncture Shaoyin to release qi and avoid releasing blood. (Hand Shaoyin is the Heart channel; Foot Shaoyin is the Kidney channel. They are interior-exterior pairs with the two Taiyang channels. Since the two Taiyang have abundant blood and little qi, and yin and yang are opposite, the two Yin channels have abundant qi and little blood. Therefore, when the two Shaoyin channels are full, qi is released; if pathogenic factors lodge, evil blood is released. Ping An: The sentence on puncturing Shaoyin precedes Jueyin in *Su Wen* and *Jia Yi Jing*. The note misses the character "yi" before "yin yang" in Yuan edition.)
Yangming has abundant blood and qi; Taiyang has abundant blood and little qi; Shaoyang has abundant qi and little blood; Taiyin has abundant blood and qi; Jueyin has abundant blood and little qi; Shaoyin has little blood and abundant qi. (This explains the differences in releasing blood and qi when puncturing the three Yin and three Yang channels. Ping An: "Taiyin has abundant blood and qi" is written as "Taiyin usually has abundant qi and little blood" in *Su Wen*, and "abundant blood and little qi" in *Ling Shu* and *Jia Yi Jing*. *Su Wen* Xin Zheng Xiao says: "According to *Jia Yi Jing · Twelve Waters Chapter*, the abundance of blood and qi in Taiyang and Taiyin differs from *Su Wen*. Also, in the chapter *Yin-Yang Twenty-Five Persons: Form, Nature, Blood, and Qi Differences*, it matches *Su Wen*. Perhaps Huangfu Mi preserved both due to doubt. Now examining *Jia Yi Jing · Yin-Yang Twenty-Five Persons: Form, Nature, Blood, and Qi Differences Chapter*, Taiyin is stated as 'usually abundant blood and little qi', still differing from *Su Wen*. Perhaps the Song ministers' version of *Jia Yi Jing* differed from the current version; preserving this for reference.) Foot Yangming and Taiyin are interior-exterior pairs; Shaoyang and Jueyin are interior-exterior pairs; Taiyang and Shaoyin are interior-exterior pairs; this constitutes the Yin-Yang of the feet. Hand Yangming and Taiyin are interior-exterior pairs; Shaoyang and Heart Master (Pericardium) are interior-exterior pairs; Taiyang and Shaoyin are interior-exterior pairs; this constitutes the Yin-Yang of the hands. (Now we know the locations of hand and foot Yin-Yang. Ping An: In *Su Wen*, the Taiyang-Shaoyin pair is above the Shaoyang pair, and the Yangming-Taiyin pair is below the Shaoyang pair. The eight characters "Jin Zhi Shou Zu" in the note were part of the text in *Su Wen*, where "suo zai" was written as "suo ku".)
In all disease treatment, one must first remove the blood, eliminate the source of suffering, observe what the patient desires, then sedate excess and tonify deficiency. (The general method of treating diseases: for pains caused by blood, puncture and remove the area where blood gathers. After removing the blood, observe the patient's emotional desires to determine deficiency and excess, then apply tonification and sedation methods. Ping An: *Su Wen* adds "nai" after "xue"; *Ling Shu* lacks this paragraph. In the note, "xue ju" (blood gathering), the character "ju" is erroneously printed as "ci" (puncture) in Yuan edition.)