平按∶此篇自篇首至末，见《灵枢》卷十第六十八《上膈》篇，又见《甲乙经》卷十一第八。
黄帝问于岐伯曰∶气为上鬲，上鬲者，食饮入而还出，余已知之矣；虫为下鬲，下鬲者，食
时乃出，余未得其意，愿卒闻之。（ ，子内反。鬲，痈也。气之在于上管，痈而不通，食入
还即吐出；虫之在于下管，食 时而出，虫去下虚，聚为痈，故须问也。平按∶《灵枢》鬲作膈，
上鬲二字不重。《甲乙》入上无饮字。）岐伯曰∶喜怒不适，饮食不节，寒温不时，则寒汁流于
肠中，流于肠中即虫寒，虫寒则积聚守于下管，守于下管则下管充郭，卫气不营，邪气居之。人
食则虫上食，虫上食则下管虚，虚则邪气胜之，积聚以留，留则痈成，痈成则下管约。其痈在管
内者，则沉而痛深；其痈在外者，则痈外而痛浮，痈上皮热。（虫痈之病，所由有三∶一因喜怒
伤神，不得和适；二因纵欲，饮食不节；三因随情寒温，不以时受。此三因中随有一种乖和，则寒
邪汁下流于肠中，令肠内虫寒，聚满下管，致使卫气不得有营，邪气居之。又因于食，虫亦上食，
下管遂虚，邪气积以成痈。其痈若在管内，其痛则深；若管外，其痛则浮，当痈皮热，以为候也。
平按∶《甲乙》则寒汁流于肠中，流作留；流于肠中即虫寒作留则虫寒；管作脘；
则下管充郭卫气不营作守下脘则胃肠充郭胃气不营。《灵枢》则下管充郭作则肠胃充郭，虚则邪气
胜之作下管虚则邪气胜之。《甲乙》胜下无之字，有胜则二字。《灵枢》则沉二字作即。）黄帝
曰∶刺之奈何？岐伯曰∶微按其痈，视气所行，（以手轻按痈上以候其气，取知痈气所行有三∶
一欲知其痈气之盛衰，二欲知其痈之浅深，三欲知其刺处之要，故按以视也。平按∶《甲乙》无
微字。）先浅刺其旁，稍内益深，遂而刺之，毋过三行，（候其痈旁气之来处，先渐浅刺，后以
益深者，欲导气令行也。还，复也。如此更复刺，不得过于三行也。平按∶遂《灵枢》、《甲乙》
作还，据本注亦应作还，当系传写之误。）察其沉浮，以为深浅，（沉浮浅深也，察痈之浅深以行
针也。平按∶《甲乙》作浅深。）已刺必熨，令热入中，日使热内，邪气益衰，大痈乃溃。（寒汁
邪气聚以为痈，故痈塞也。令刺已熨之令热入中者，以寒，温使其日有内热，寒去痈溃也。）以
参伍禁，以除其内，（亦可含于豕膏，无冷食，三日其病已矣。参伍，揣量也。平按∶《甲乙》作
互以参禁，《灵枢》作伍以参禁。）恬 无为，乃能行气，（夫情有所在则气有所并，气有所并则
不能营卫，故忘情恬 无为，则气将自营也。平按∶《灵枢》、《甲乙》 作澹，袁刻作淡。）后
以酸苦，化谷乃下。（酸为少阳，苦为太阳，此二味为温，故食之化谷也。平按∶《灵枢》酸作咸。
《甲乙》此句作“后服酸苦，化谷乃下膈矣。”）
平按：本篇从开头到结尾，见于《灵枢》卷十第六十八篇《上膈》，又见于《甲乙经》卷十一第八篇。
黄帝问岐伯说：气逆导致上鬲（此处指痈肿阻塞），所谓上鬲，就是饮食入口后立即吐出，我已经知道了；虫积导致下鬲，所谓下鬲，就是进食后食物停留一段时间才吐出，我还不明白其中的道理，希望能听您详尽讲解。（注：“鬲”通“膈”，意为痈肿。气邪在上管引起痈肿而不通畅，食物进入随即吐出；虫邪在下管，进食时虫动而出，虫去则下部空虚，聚结形成痈肿，所以需要询问。平按：《灵枢》中“鬲”写作“膈”，“上鬲”二字不重复。《甲乙经》在“入”字前无“饮”字。）
岐伯回答说：喜怒情绪失调，饮食没有节制，寒温调节不当，那么寒湿汁液就会流注于肠中。流注于肠中就会导致寄生虫受寒，寄生虫受寒就会积聚停留在下管。停留在下管就会导致下管胀满，卫气不能正常循行，邪气占据其中。人进食时，寄生虫向上觅食，寄生虫向上觅食则下管变得空虚，空虚则邪气胜过正气，积聚之物停留下来，停留久了就形成痈肿，痈肿形成则下管约束不通。如果痈肿位于管内，触感深沉且疼痛位置深；如果痈肿位于管外，则体表可见痈肿且疼痛位置浅表，痈肿表面的皮肤发热。（虫痈这种病，成因有三：一是因喜怒伤神，不得调和适宜；二是因纵欲过度，饮食不节；三是因随情志变化感受寒温，不按时令调摄。这三种原因中只要有一种乖违不和，寒邪汁液就会下流于肠中，使肠内寄生虫受寒，聚满下管，致使卫气无法营运，邪气占据其中。又因为进食，寄生虫也随之向上觅食，下管遂成虚损，邪气积聚而成痈。其痈若在管内，疼痛则深；若在管外，疼痛则浮，当见痈处皮热，以此作为征候。平按：《甲乙经》中“则寒汁流于肠中”的“流”写作“留”；“流于肠中即虫寒”作“留则虫寒”；“管”写作“脘”；“则下管充郭卫气不营”作“守下脘则胃肠充郭胃气不营”。《灵枢》中“则下管充郭”的“则”作“则肠胃充郭”，“虚则邪气胜之”作“下管虚则邪气胜之”。《甲乙经》在“胜”字下无“之”字，有“胜则”二字。《灵枢》中“则沉”二字作“即”。）
黄帝说：如何针刺治疗？岐伯说：轻轻按压痈肿部位，观察气血运行的情况。（用手轻按痈处以候察其气，取知痈气所行的要点有三：一是想知道痈气的盛衰，二是想知道痈的浅深，三是想知道针刺的关键部位，所以通过按压来观察。平按：《甲乙经》无“微”字。）先在旁边浅刺，逐渐加深，顺势而刺，不要超过三次，（候察痈旁气来的地方，先逐渐浅刺，后来逐渐加深，是想引导气机运行。还，是反复的意思。这样反复针刺，不得超过三行。平按：“遂”在《灵枢》、《甲乙经》中作“还”，根据本注也应作“还”，可能是传写错误。）观察痈肿的沉浮，以确定针刺深浅，（沉浮即浅深，观察痈的浅深以决定行针深度。平按：《甲乙经》作“浅深”。）针刺完毕后必须熨烫，使热力进入内部，每天让热气内入，邪气日益衰减，大痈才能溃破。（寒湿汁液和邪气聚结形成痈，所以痈部闭塞。针刺后熨烫使热力进入内部，是因为寒邪所致，用温热使其每日产生内热，寒去则痈溃。）配合参伍诊法禁忌，以清除体内病邪，（也可以含服猪脂膏，不吃冷食，三天病就好了。参伍，是揣量判断的意思。平按：《甲乙经》作“互以参禁”，《灵枢》作“伍以参禁”。）心境恬淡无为，才能使气机运行，（情感有所执着则气机有所壅并，气机壅并则不能营运卫气，所以忘却情欲、恬淡无为，气机将自行营运。平按：《灵枢》、《甲乙经》中“澹”字作“澹”，袁刻本作“淡”。）随后服用酸味和苦味的药物，谷物得以消化下行。（酸味属少阳，苦味属太阳，这两种味道性温，所以食用后能助化谷气。平按：《灵枢》中“酸”作“咸”。《甲乙经》此句作“后服酸苦，化谷乃下膈矣。”）
Ping An: This chapter, from beginning to end, is found in *Ling Shu* (Spiritual Pivot), Volume 10, Chapter 68 "Shang Ge" (Upper Diaphragm), and also in *Jia Yi Jing* (Classified Classic of Jia Yi), Volume 11, Chapter 8.
Huang Di asked Qi Bo: "Qi reversal causes Shang Ge (upper diaphragmatic obstruction/abscess). Regarding Shang Ge, food and drink enter but are immediately regurgitated; I already understand this. Parasites cause Xia Ge (lower diaphragmatic obstruction/abscess). Regarding Xia Ge, food remains for a time before being expelled; I do not yet grasp the meaning behind it. I wish to hear you explain it thoroughly." (Note: 'Ge' is interchangeable with 'Zhi', meaning abscess. When qi pathogen resides in the upper tube causing an abscess and blockage, food enters and is vomited out immediately. When parasite pathogen resides in the lower tube, parasites move upon eating and exit; after they leave, the lower part becomes deficient, leading to accumulation and abscess formation, hence the inquiry. Ping An: In *Ling Shu*, 'Ge' is written as 'Ge' (diaphragm); the characters 'Shang Ge' are not repeated. In *Jia Yi Jing*, there is no character 'Yin' (drink) before 'Ru' (enter).)
Qi Bo replied: "If joy and anger are not regulated, if diet is not moderated, and if cold and warmth are not timed appropriately, then cold fluid will flow into the intestines. Once flowing into the intestines, the parasites become cold. When the parasites become cold, they accumulate and remain in the lower tube. Remaining in the lower tube causes the lower tube to become distended. Wei Qi (Defensive Qi) fails to circulate, and evil qi occupies the space. When a person eats, the parasites move upward to feed. As the parasites move upward, the lower tube becomes deficient. Deficiency allows evil qi to prevail. Accumulated pathogens remain; prolonged retention leads to abscess formation. Once the abscess forms, the lower tube becomes constricted. If the abscess is within the tube, the pulse feels deep and the pain is profound. If the abscess is outside the tube, the abscess is visible externally and the pain is superficial, with heat on the skin overlying the abscess." (The etiology of parasitic abscess involves three factors: first, emotional disturbance injuring the spirit, lacking harmony; second, indulgence in desires and unregulated diet; third, exposure to cold or heat according to mood, disregarding seasonal timing. If any one of these three factors lacks harmony, cold evil fluid flows down into the intestines, chilling the internal parasites, causing them to fill the lower tube, preventing Wei Qi from circulating, and allowing evil qi to occupy the area. Furthermore, due to eating, the parasites move upward, leaving the lower tube deficient. Evil qi accumulates to form an abscess. If the abscess is inside the tube, the pain is deep; if outside, the pain is superficial, accompanied by heat on the skin over the abscess, serving as a sign. Ping An: In *Jia Yi Jing*, 'Liu' (flow) in 'cold fluid flows into the intestines' is written as 'Liu' (remain); 'Liu yu chang zhong ji chong han' is written as 'Liu ze chong han'; 'Guan' (tube) is written as 'Wan' (stomach cavity); 'Ze xia guan chong guo wei qi bu ying' is written as 'Shou xia wan ze chang wei chong guo wei qi bu ying'. In *Ling Shu*, 'Ze xia guan chong guo' has 'ze' followed by 'chang wei chong guo'; 'Xu ze xie qi sheng zhi' is written as 'Xia guan xu ze xie qi sheng zhi'. In *Jia Yi Jing*, there is no 'Zhi' after 'Sheng', but there are 'Sheng Ze'. In *Ling Shu*, 'Ze Chen' is written as 'Ji'.)
Huang Di asked: "How should acupuncture be performed?" Qi Bo said: "Lightly press the abscess to observe the movement of qi." (Press lightly with the hand over the abscess to examine its qi, aiming to know three aspects of the abscess qi's movement: first, to determine the excess or deficiency of the abscess qi; second, to ascertain the depth or shallowness of the abscess; third, to identify the key point for needling. Thus, pressing is used for observation. Ping An: *Jia Yi Jing* omits the character 'Wei' (slightly/lightly).) "First, needle shallowly around the periphery, then gradually deepen the insertion, following the direction of the qi, without exceeding three passes. (Observe where the qi arrives near the abscess; start with shallow needling and gradually deepen it to guide the qi to move. 'Huan' means repetition. Repeat such needling, but do not exceed three passes. Ping An: 'Sui' is written as 'Huan' in *Ling Shu* and *Jia Yi Jing*. According to the commentary note, it should also be 'Huan', likely a transcription error.) Observe the floating or sunken nature [of the abscess] to determine the depth of insertion. (Floating and sunken refer to depth; observe the depth of the abscess to decide the needle depth. Ping An: *Jia Yi Jing* writes 'Qian Shen' [shallow and deep].)" "After needling, apply moxibustion or hot compresses to ensure heat penetrates inward. Daily application of internal heat will cause evil qi to decline further, allowing the large abscess to suppurate and drain." (Cold fluid and evil qi accumulate to form the abscess, causing blockage. Applying heat via needling and warming therapies ensures internal heat generation daily. As cold dissipates, the abscess drains.) "Adhere to the contraindications of the Can Wu diagnostic method to eliminate internal pathogens. (Alternatively, hold pig fat paste in the mouth, avoid cold food, and the disease will resolve in three days. 'Can Wu' refers to comparative assessment and judgment. Ping An: *Jia Yi Jing* writes 'Hu Yi Can Jin'; *Ling Shu* writes 'Wu Yi Can Jin'.)" "Maintain a tranquil and non-action-oriented state of mind to allow qi to circulate. (When emotions are attached, qi becomes congested. Congested qi cannot nourish Wei Qi. Therefore, by forgetting desires and maintaining tranquility and non-action, qi will self-nourish. Ping An: In *Ling Shu* and *Jia Yi Jing*, the character is 'Dan'; Yuan edition writes 'Dan'.)" "Subsequently, administer sour and bitter substances to facilitate the digestion and downward movement of grain." (Sour corresponds to Shaoyang, and bitter corresponds to Taiyang. These two flavors are warm in nature, thus aiding the transformation of food. Ping An: In *Ling Shu*, 'Suan' (sour) is written as 'Xian' (salty). In *Jia Yi Jing*, this sentence reads: 'Subsequently take sour and bitter substances, transforming grain so it descends through the diaphragm.')