黄帝曰。气为上膈者。饮食入而还出。余已知之矣。虫为下膈。下膈者。食 时乃出。余未得
其意。愿卒闻之。岐伯
曰。喜怒不适。食饮不节。寒温不时。则寒汁流于肠中。流于肠中。则虫寒。虫寒则积聚守于下
管。则肠胃充郭。卫气不营。邪气居之。人食则虫上食。虫上食则下管虚。下管虚则邪气胜之。
积聚已留。留则痈成。痈成则下管约。其痈在管内者。即而痛深。其痈在外者。则痈外而痛浮。
痈上皮热。（管脘同）
此言汁沫积于肠胃而成痈。膈者。内之膈肉。前连于胸之鸠尾。后连于脊之十一椎。旁连于
胁。膈上为膻中。名曰气海。上焦宗气之所居。上焦开发。宣五谷味。所以熏肤充身泽毛。膈下
胃腑之所居。名水谷之海。受中焦之气。泌糟粕。蒸津液。化其精微。随三焦出气。以温肌肉。充
皮肤。若因于喜怒不适。食饮不节。寒温不时。病在膈上者。食饮入而还出。因于膈下者。食入
时乃还。 时。周时也。夫胃者。水谷血气之海也。汁沫者。胃腑所生之津液。渗出于肠胃之外。
募原间之孙脉络脉。化赤为血。注于胃之大络。从脏腑之经隧。外出于皮肤。如因于外邪。以致汁
沫渗留于肠外。不得散。则日以成积矣。如因于内伤。汁沫留于肠内。渐积而成痈。此皆因于中上
二焦之气有伤。不能宣化输布。故帝曰气为上膈。虫为下膈。上膈者。上焦之气也。下膈者。中焦之
气也。盖虫为阴类。遇阳热则消。中焦之气虚寒。则阴类生聚而上食矣。寒汁流于肠中。则肠胃充
郭。而卫气不能营于外。则留积而成痈矣。其痈在脘内者。即痛而深。其痈在外者。则隐见于外而痛
浮。在痈上之腹皮则热。徐振公曰。此节亦承前数章而言。谓形中之肌肉血气。藉胃腑水谷之所
生养。若食饮入而还出。或朝食暮吐。暮食朝吐。则形气消索矣。此皆因于喜怒不节。若伤于五脏
之形。则成五脏之积。伤于肠胃。则成肠胃之痈。本经曰。五脏不和。则七窍不通。六腑不和。则留
而为痈。
黄帝曰。刺之奈何。岐伯曰。微按其痈。视其所行。先浅刺其旁。稍内益深。还而刺之。毋过
三行。察其沉浮。以为深浅。已刺必熨。令热入中。日使热内。邪气益衰。大痈乃溃。伍以参禁。
以除其内。恬 无为。乃能行气。后以咸苦化谷乃下矣。
视气所行者。视卫气之行于手足阳明而取之也。毋过三行者。先浅刺之。以逐阳邪而来血气。复
深刺之。以致阴气之邪。最后还而复深刺之。以下谷气。谷气者。水谷所生之正气也。若过取之。则
谷气出。故曰毋过三行。察其浮沉者。察痈之生于脘内脘外。而为浅深之刺也。已刺必熨者。温散其
寒汁沫也。伍以参禁者。参伍而禁忌之。以除其内积也。上古天真论曰。恬 虚无。真气从之。故宜
恬无为。乃能行气。咸苦化谷者。以咸苦之物。同谷食之。盖咸能软坚。苦能泄下。谷则卫其正
气者也。徐振公曰。此因喜怒不适。食饮不节。寒温不时之所致。故曰伍以参禁。谓禁其饮食之所
当忌者。恬 无为。是和其喜怒。适其寒温矣。倪仲玉曰。当忌者忌。不当忌者不忌。故曰参伍。
黄帝说：气逆导致上膈，表现为饮食进入后随即吐出，我已经知道了。寄生虫导致下膈，下膈的表现是进食一段时间后食物才吐出，我还没完全理解其中的道理，希望能听您详细讲解。
岐伯说：如果情绪喜怒失调，饮食没有节制，寒暖不适时，那么寒冷的津液就会流注于肠道中。寒冷津液流注于肠道中，会导致寄生虫受寒。寄生虫受寒后，就会积聚并停留在下脘（胃的下口）。这会导致肠胃胀满充实，卫气无法正常运行，邪气便占据其中。人进食时，寄生虫向上觅食；寄生虫向上觅食，下脘就会变得空虚。下脘空虚，邪气就会乘虚而入。邪气停留积聚，日久便会形成痈脓。痈脓形成后，下脘就会狭窄闭塞。如果痈脓位于管腔内部，按压时疼痛深沉；如果痈脓位于管腔外部，则体表可见肿胀且疼痛浮浅。痈脓上方的皮肤发热。（“管”与“脘”同义）
这段文字论述的是汁沫（津液代谢产物）积聚在肠胃中从而形成痈脓的情况。“膈”，指的是体内的膈膜，前方连接胸部的鸠尾穴，后方连接脊柱第十一椎，两侧连接胁肋。膈的上方为膻中，称为气海，是上焦宗气居住的地方。上焦开发宣发，布散五谷的精微气味，用来熏蒸肌肤、充盈身体、润泽毛发。膈的下方是胃腑所在，称为水谷之海，接受中焦之气，泌别糟粕，蒸发津液，化生精微物质，随着三焦的气机运行，用来温养肌肉，充实皮肤。如果因为喜怒失调、饮食不节、寒暖不适，病变发生在膈以上的，饮食入胃后即反吐出来；如果病变发生在膈以下的，食物入胃后过一段时间才吐出。“时”，指周时，即经过一定的时间。胃是水谷和血气的汇聚之处。“汁沫”，是胃腑所生的津液，渗出到肠胃之外，分布于募原之间的孙络和脉络，化为血液，注入胃的大络，通过脏腑的经络隧道，外达于皮肤。如果因为外邪侵袭，导致汁沫渗漏滞留于肠外，不能消散，就会日渐形成积块。如果因为内伤，汁沫留滞于肠内，逐渐积聚而形成痈脓。这都是因为中焦和上焦的气机受损，不能宣发、运化和输布所致。所以黄帝说：气逆导致上膈，虫积导致下膈。所谓上膈，是指上焦之气的问题；所谓下膈，是指中焦之气的问题。大概来说，虫属于阴类，遇到阳热就会消散，如果中焦之气虚寒，阴类的虫就会滋生聚集并向上觅食。寒冷的津液流注于肠道中，导致肠胃胀满，卫气不能在体表正常营行，就会留滞积聚而形成痈脓。如果痈脓在脘内，按压时疼痛深沉；如果痈脓在脘外，则在体表隐约可见且疼痛浮浅，痈脓上方的腹皮则发热。徐振公说：这一节也是承接前几章的内容而言，指出形体中的肌肉血气，依赖胃腑水谷的滋养。如果饮食入胃即吐出，或者朝食暮吐、暮食朝吐，那么形气就会消耗殆尽。这些都是因为喜怒没有节制造成的。如果损伤了五脏的形体，就会形成五脏的积证；如果损伤了肠胃，就会形成肠胃的痈脓。《本经》说：五脏不和，则七窍不通；六腑不和，则留滞而成痈脓。
黄帝问：应该如何针刺治疗？
岐伯说：轻轻按摸痈脓部位，观察其气血运行的走向。先在旁边浅刺，然后逐渐加深，来回多次针刺，不要超过三次。根据痈脓位置的深浅来调整针刺的深度。针刺完毕后必须用熨法热敷，使热力深入体内，每天让热气内入，邪气就会日益衰减，大的痈脓才能溃破。同时参考多种禁忌事项，以清除体内的积滞。保持心境恬淡虚无，才能使气机运行通畅。之后服用咸味和苦味的药物配合谷物，使食物得以顺利下行。
“视气所行者”，是指观察卫气在手足阳明经的运行情况而选取穴位。“毋过三行者”，意思是先浅刺以驱逐阳邪并引导血气到来，再深刺以引致阴分之邪，最后再次深刺以疏导谷气。谷气，是由水谷化生的正气。如果过度针刺，会导致谷气耗散，所以说不要超过三次。“察其浮沉者”，是指观察痈脓生于脘内还是脘外，从而决定针刺的深浅。“已刺必熨者”，是用温热的方法散除寒性的汁沫。“伍以参禁者”，是指综合参照各种禁忌，以清除体内的积滞。《上古天真论》说：“恬淡虚无，真气从之。”所以适宜保持恬淡虚无的状态，才能使气机运行。所谓“咸苦化谷”，是指用咸味和苦味的药物配合谷物食用。因为咸味能软坚散结，苦味能泄降通便，而谷物能护卫正气。徐振公说：这是由于喜怒失调、饮食不节、寒暖不适所导致的，所以说要参考多种禁忌。所谓禁忌，是指禁止食用那些应当忌口的食物。保持恬淡虚无，就是调和喜怒，适应寒温。倪仲玉说：应当忌口的就忌口，不应当忌口的就不忌口，所以称为“参伍”。
Huangdi said: Qi stagnation causing upper Jue (obstruction/regurgitation), characterized by food being vomited immediately after ingestion, I already understand this. Parasites causing lower Jue, where food is vomited only after a period of time has passed since eating, I have not yet fully grasped the meaning. I wish to hear the complete explanation.
Qibo said: If emotions such as joy and anger are unregulated, diet is irregular, and exposure to cold or heat is inappropriate, then cold fluids will flow into the intestines. When cold fluids flow into the intestines, parasites become cold. When parasites become cold, they accumulate and remain in the lower Wan (lower opening of the stomach). This causes the intestines and stomach to become distended and full, preventing Wei Qi (Defensive Qi) from circulating normally, allowing pathogenic factors to reside there. When a person eats, the parasites move upward to feed. When the parasites move upward to feed, the lower Wan becomes deficient. When the lower Wan is deficient, pathogenic factors prevail. The accumulation remains; if it remains, an abscess forms. Once the abscess forms, the lower Wan becomes constricted. If the abscess is inside the lumen, pressing it causes deep pain. If the abscess is outside the lumen, swelling is visible externally and the pain is superficial. The abdominal skin above the abscess becomes hot. ("Guan" and "Wan" are synonymous.)
This passage discusses how fluid residues accumulate in the intestines and stomach, leading to abscess formation. "Ge" (Diaphragm) refers to the internal diaphragmatic membrane, connecting anteriorly to the Jiwei point on the chest, posteriorly to the eleventh thoracic vertebra on the spine, and laterally to the hypochondrium. Above the diaphragm is the Shanzhong area, known as the Sea of Qi, which is the residence of Zong Qi (Pectoral Qi) of the Upper Jiao. The Upper Jiao opens and disseminates, spreading the flavors of the five grains, thereby steaming the skin, filling the body, and moistening the hair. Below the diaphragm resides the Stomach, known as the Sea of Water and Grain, receiving Qi from the Middle Jiao, separating dregs, evaporating fluids, transforming essence, and distributing them via the San Jiao (Triple Burner) to warm the muscles and fill the skin. If due to unregulated emotions, irregular diet, or inappropriate temperature exposure, the pathology is located above the diaphragm, food enters and is immediately regurgitated. If the pathology is below the diaphragm, food enters and is regurgitated after a certain period. "Shi" refers to a cycle of time. The Stomach is the sea of water, grain, blood, and Qi. "Fluid residues" refer to the body fluids generated by the Stomach, seeping out beyond the intestines and stomach, entering the collateral vessels of the Mu Yuan (Omenta), transforming into red blood, and injecting into the large collaterals of the Stomach, traveling through the meridians of the zang-fu organs to emerge at the skin surface. If external pathogens cause these fluids to leak and stagnate outside the intestines without dispersing, accumulations form daily. If internal injuries cause fluids to remain inside the intestines, they gradually accumulate and form abscesses. All these result from damage to the Qi of the Middle and Upper Jiao, impairing their ability to disseminate, transform, and distribute. Thus, Huangdi stated: Qi stagnation causes upper Jue; parasites cause lower Jue. Upper Jue pertains to the Qi of the Upper Jiao; lower Jue pertains to the Qi of the Middle Jiao. Generally, parasites belong to Yin types; they dissipate when encountering Yang-heat. If the Qi of the Middle Jiao is deficient and cold, Yin-type parasites proliferate and move upward to feed. Cold fluids flowing into the intestines cause distension of the intestines and stomach, preventing Wei Qi from circulating externally, leading to stagnation and abscess formation. If the abscess is within the Wan, pressing causes deep pain. If the abscess is outside the Wan, it is subtly visible externally with superficial pain, and the abdominal skin above the abscess is hot. Xu Zhen Gong commented: This section continues from previous chapters, stating that the muscles and blood/Qi of the form rely on the nourishment from the Stomach's water and grain. If food is regurgitated immediately upon entry, or if morning food is vomited in the evening and evening food in the morning, the form and Qi will be exhausted. These are all caused by unregulated emotions. If the form of the Five Zang Organs is injured, accumulations in the Five Zang Organs form; if the intestines and stomach are injured, abscesses in the intestines and stomach form. The Classic states: Disharmony of the Five Zang Organs leads to obstruction of the seven orifices; disharmony of the Six Fu Organs leads to stagnation and abscess formation.
Huangdi asked: How should acupuncture be applied?
Qibo replied: Gently palpate the abscess to observe its course of Qi circulation. First, prick shallowly around it, then gradually deepen the insertion. Repeat the needling but do not exceed three passes. Observe the floating and sinking nature of the condition to determine depth. After needling, apply moxibustion or warming therapy to ensure heat penetrates inward. Daily application of internal heat will cause pathogenic factors to decline, allowing large abscesses to rupture. Refer to multiple contraindications to eliminate internal accumulations. Maintain tranquility and non-action to allow Qi to flow smoothly. Subsequently, administer salty and bitter substances combined with grain food to facilitate downward movement.
"Observing where Qi travels" means observing the circulation of Wei Qi in the Hand and Foot Yangming meridians and selecting points accordingly. "Do not exceed three passes" means first pricking shallowly to drive out Yang pathogens and attract blood and Qi, then pricking deeply to draw out Yin pathogens, and finally pricking deeply again to descend Gu Qi (Grain Qi). Gu Qi is the righteous Qi generated from water and grain. If over-treated, Gu Qi will be depleted; hence, it is said not to exceed three passes. "Observing floating and sinking" means observing whether the abscess is inside or outside the Wan to determine the depth of needling. "Applying warmth after needling" is to disperse cold fluid residues using heat. "Referencing multiple contraindications" means comprehensively applying dietary and lifestyle restrictions to remove internal accumulations. The Treatise on the Heavenly Truth states: "Tranquility and emptiness allow True Qi to follow." Therefore, maintaining tranquility and non-action enables Qi circulation. "Salty and bitter transforming grain" refers to consuming salty and bitter substances together with grain food. Salty substances can soften hardness, bitter substances can purge downward, and grain food protects righteous Qi. Xu Zhen Gong commented: This results from unregulated emotions, irregular diet, and inappropriate temperature exposure, hence the reference to multiple contraindications regarding foods to avoid. Maintaining tranquility and non-action harmonizes emotions and adapts to temperature changes. Ni Zhong Yu stated: Avoid what should be avoided; do not avoid what should not be avoided; thus it is called "Can Wu" (interwoven examination/restriction).