自强也。善行水者。不能凿冰。善用针者。不能取四厥。谓气随天地之寒暑出入。非人力之所能强也。
治厥者必先熨。通其气也。调和其经。通其经也。谓所受于天之精气。行于经脉之外内者也。调之掌
与腋。肘与脚。项与脊。谓血气之行于上下四旁。无处不到也。淖泽者。行之太过。当刺而平之。紧
涩者。涩滞不通。当破而散之。此所谓以针而解结者也。
用针之类。在于调气。气积于胃。以通营卫。各行其道。宗气流于海。其下者注于气街。其上者
走于息道。故厥在
于足。宗气不下。脉中之血。凝而留止。弗之火调。弗能取之。
此言后天饮食之谷气。乃营卫宗气。各走其道。充于形身之上下者也。厥在足者。少阴之气厥也。
寒气厥逆于下。是以宗气不能不行。脉中之血。凝而留止。弗之火调。弗能通之。谓下焦之精气。乃
阴阳水火。得火热而后能温其水寒。夫所受于天者。少阴肾脏之精气也。冲脉与少阴之大络。起于肾。
出于气街。循阴股内廉。邪入 中。厥在于足。而宗气不下者。谓宗气下行。而与少阴之气相合也。
夫所谓合并而充身者。下焦先天之气。上与阳明之谷气相合。而出入于关节肌腠之间。然而后天所生
之宗气。亦下行而与少阴之精气相合。注于气街。入于 中。并行于经脉皮肤之外内者也。
用针者。必先察其经络之实虚。切而循之。按而弹之。视其应动者。乃后取之而下之。
此申明血气之行于脉中也。内经云。络满经虚。泻阳补阴。经满络虚。泻阴补阳。盖以里之经
脉为阴。外之络脉为阳。血气之行于脉中。从经而脉。脉而络。络而孙。故必先察其经络之虚实而
后取之。
六经调者。谓之不病。虽病谓之自已也。一经上实下虚而不通者。此必有横络盛加于大经。令之
不通。视而泻之。此所谓解结也。
此申明血气之行于脉外也。六经者。手足之十二经别也。大经者。经隧也。经隧者。五脏六腑
之大络也。胃腑所出之气血。充于皮肤分肉之间者。从脏腑之大经。而外出于皮肤。横络者。经脉之
支别也。如一经上实下虚而不通者。此必有经脉之横络。盛加于大经。而令之不通也。故视而泻之。
此所谓解结也。此二节。论水谷
所生之血气。营于脉中。充于肤腠。各有道路也。闵士先曰。以此二节列于节中者。分别合并。而
充身之真气各别也。当以自费之义参之。
上寒下热。先刺其项太阳。久留之。已刺则熨。项与肩胛。令热下合乃止。此所谓推而上之者也。
此言下焦所生之气。从下而上也。太阳为诸阳主气。而太阳之气。生于膀胱水中。上寒下热。此
太阳之气。留于下而不上。故先刺其项太阳久留之。以候气至。已刺则熨项与肩胛。令火热与下之阳
气交合乃止。此所谓推而上之者也。闵士先曰。本经凡曰项太阳。皆在气分上看。取表气。故不言
经穴。赵庭霞曰。少阴太阳。本水火之标本。故俱用火以温气。
上热下寒。视其虚脉而陷之于经络者取之。气下乃止。此所谓引而下之者也。
此言上焦所生之气。从上而下也。上焦开发。宣五谷味。熏肤充身泽毛。是谓气。此上焦之气。
从上而下。如上热下寒。当视其虚脉而陷之于经络者取之。此因脉虚而气陷于脉内。不能熏肤热肉。
故下寒也。故当取之于经。俟气下乃止。此所谓引而下之者也。
大热遍身。狂而妄见妄闻妄言。视足阳明及大络取之。虚者补之。血而实者泻之。因其偃卧。居
其头前。以两手四指挟按颈动脉。久持之。卷而切之。下至缺盆中而复止。如前热去乃止。此所谓推
而散之者也。
此言中焦所生之气。从中而出。散行于上下者也。中焦之气。阳明水谷之悍气也。大热遍身。狂
而妄见妄闻。
此阳明之气。逆而为热狂也。故当视足阳明之皮部。及大络取之。虚者补之。如逆于血脉之中而
血实者泻
之。盖中焦之气。从大络而出于皮肤者也。其悍气之上冲头者。循咽上走空窍。出 。下客主人。
循牙车。复与阳明之脉相合。并下人迎。从膺胸而下至足跗。故当因其偃卧。居其头前。以两手四
指。挟按颈中人迎之动脉。久持之。盖使悍热之散于脉外。勿使合于脉中。此所谓推而散之者也。
以上三节。申明肤表之气。又有从上中下之三道而出者。是所受于天与谷气并而充身者。又有二气也。
学人能明乎阴阳血气离合出入之道。全经大义。思过半矣。
黄帝曰。有一脉生数十病者。或痛或痈。或热或寒。或痒或痹。或不仁。变化无穷。其故何也。
岐伯曰。此皆邪气之所生也。
此下论邪气之伤人营卫宗气。则真气去。邪独留。邪气淫 。变化无穷。是以一脉而生数十病也。
黄帝曰。余闻气者。有真气。有正气。有邪气。何谓真气。岐伯曰。真气者。所受于天。与谷气
并而充身者也。正气者。正风也。从一方来。非实风。又非虚风也。邪气者。虚风之贼伤人也。其中
人也深。不能自去。正风者。其中人也浅。合而自去。其气来柔弱。不能胜真气。故自去。
所受于天者。先天之精气。谷气者。后天水谷之精气。合并而充身者也。正气者。大块噫气。其
名为风。从一方来。非实风。又非虚风。此天地之正气也。虚风者。从虚乡来之贼风。伤人正气。其
中人也深。不能自去。正风者。其中人也浅。与真气合而自去。盖其气来柔弱。不能胜真气。故自去。
闵士先曰。人秉天地之正气所生。故天之正气。与人之真气相合。不能胜真气者。合并之气盛也。
朱卫公曰。风出于地隧之中。故其气来柔弱。
实风者。天之怒气也。
虚邪之中人也。洒淅动形。起毫毛而发腠理。其入深。内搏于骨。则为骨痹。搏于筋。则为筋挛。
搏于脉中。则为血闭。不通则为痈。搏于肉。与卫气相搏。阳胜者则为热。阴胜者则为寒。寒则真气去。
去则虚。虚则寒搏于皮肤之间。其气外发腠理。开毫毛。淫气往来。行则为痒。留而不去为痹。卫气
不行。则为不仁。
此言虚邪之伤形也。洒淅动形。故搏于皮脉肉筋骨。而为痹为挛。为痈为痹。阴胜则为寒。寒则真
气去。有伤卫气。则为不仁。此皆邪气之所生也。
虚邪偏客于身半。其入深。内居营卫。营卫稍衰。则真气去。邪气独留。发为偏枯。其邪气浅者。
脉偏痛。
此邪气偏客于形。伤其营卫。则真气去。而为偏枯也。其邪气浅者脉偏痛。盖偏枯者。邪直伤于筋
骨也。闵士先曰。营卫衰则真气去。当知营卫真气。同本所生。而各走其道。可离而可合者也。
虚邪之入于身也深。寒与热相搏。久留而内着。寒胜其热。则骨疼肉枯。热胜其寒。则烂肉腐肌为脓。
内伤骨。内伤骨为骨蚀。有所疾前筋。筋屈不能伸。邪气居其间而不反。发为筋溜。有所结。气归之。
卫气留之。不得反。津液久留。合而为肠溜。久者数岁乃成。以手按之柔。已有所结。气归之。津液留
之。邪气中之。凝结日以易甚。连以聚居。为昔瘤。以手按之坚。有所结。深中骨。气因于骨。骨与气
并。日以益大。则为骨疽。有所结。中于肉。宗气归之。邪留而不去。有热则化而为脓。无热则为肉疽。
凡此数气者。其发无常处。而有常名也。
此虚邪伤气而病形也。寒与热搏者。形中之阴阳二气也。盖形舍气。气归形。形气之相合也。是以
伤形则病
气。伤气则病形。结气归之者。寒热相搏之气。归于邪留之形所也。凡此数气者。其发无定处。而
有肉枯骨蚀筋溜昔瘤之定名也。末章论邪气病形。则真气去而营卫伤。盖真气者。出入于节之交。游
行于皮肤肌腠之间者也。
自强也。善行水者。不能凿冰。善用针者。不能取四厥。谓气随天地之寒暑出入。非人力之所能强也。
这是指依靠人为力量强行干预是行不通的。善于治水的人，无法凿开坚冰；善于用针的人，无法强行解除四肢厥冷（四肢逆冷的病证）。这是因为人体的气机随着天地间的寒暑变化而进出流转，并非单凭人力可以强行改变的。
治厥者必先熨。通其气也。调和其经。通其经也。谓所受于天之精气。行于经脉之外内者也。调之掌与腋。肘与脚。项与脊。谓血气之行于上下四旁。无处不到也。淖泽者。行之太过。当刺而平之。紧涩者。涩滞不通。当破而散之。此所谓以针而解结者也。
治疗厥证（四肢逆冷）必须先使用温熨疗法，目的是疏通气机。调和经脉，是为了使经脉通畅。这里所说的“所受于天的精气”，是指运行在经脉内外的气血。调理手掌、腋下、肘部、足部、颈部和脊柱，是因为气血运行于身体的上下四方，无处不到。如果气血运行过于滑利过度（淖泽），应当通过针刺来使其平和；如果气血运行紧涩阻滞（紧涩），应当通过针刺破散郁结。这就是所谓的用针刺来解开气血的郁结。
用针之类。在于调气。气积于胃。以通营卫。各行其道。宗气流于海。其下者注于气街。其上者走于息道。故厥在于足。宗气不下。脉中之血。凝而留止。弗之火调。弗能取之。
运用针刺的方法，关键在于调节气机。谷气积聚于胃，用来通达营气（营养之气）和卫气（防御之气），它们各自沿着不同的路径运行。宗气（汇聚于胸中大气）流注于膻中（气海），向下注入气街穴（腹股沟动脉处），向上行走于息道（呼吸之道）。所以，当厥证发生在足部时，是因为宗气不能下行，导致脉中的血液凝滞停留。如果不采用火疗（如艾灸或温熨）进行调理，就无法治愈它。
此言后天饮食之谷气。乃营卫宗气。各走其道。充于形身之上下者也。厥在足者。少阴之气厥也。寒气厥逆于下。是以宗气不能不行。脉中之血。凝而留止。弗之火调。弗能通之。谓下焦之精气。乃阴阳水火。得火热而后能温其水寒。夫所受于天者。少阴肾脏之精气也。冲脉与少阴之大络。起于肾。出于气街。循阴股内廉。邪入 中。厥在于足。而宗气不下者。谓宗气下行。而与少阴之气相合也。夫所谓合并而充身者。下焦先天之气。上与阳明之谷气相合。而出入于关节肌腠之间。然而后天所生之宗气。亦下行而与少阴之精气相合。注于气街。入于 中。并行于经脉皮肤之外内者也。
这段话论述后天的饮食谷气，化生为营气、卫气和宗气，各自沿不同路径运行，充盈于身体的上下各部。足部的厥证，是少阴肾气发生厥逆。寒气在下方厥逆上冲，导致宗气无法正常下行，脉中的血液因此凝滞停留。若不借助火疗调理，就不能使之通畅。这里所说的下焦精气，即是阴阳水火，必须得到火热的温煦才能温暖寒冷的状态。所谓“所受于天”的，是少阴肾脏的先天精气。冲脉与足少阴肾经的大络，起始于肾，出于气街，沿着大腿内侧下行。若邪气侵入其中，导致足部厥冷且宗气不下行，是指宗气下行并与少阴之气相结合。所谓合并而充满全身的是：下焦的先天之气，与上焦阳明胃腑的后天谷气相结合，出入于关节和肌肉腠理之间。然而，后天生成的宗气，也下行与少阴的先天精气相结合，注入气街，进入体内，并行于经脉和皮肤的内外。
用针者。必先察其经络之实虚。切而循之。按而弹之。视其应动者。乃后取之而下之。
使用针刺的人，必须先诊察经络的实证或虚证。通过触摸、循按、按压并弹拨穴位，观察哪里出现反应性搏动，然后才选取该处进行针刺泻实。
此申明血气之行于脉中也。内经云。络满经虚。泻阳补阴。经满络虚。泻阴补阳。盖以里之经脉为阴。外之络脉为阳。血气之行于脉中。从经而脉。脉而络。络而孙。故必先察其经络之虚实而后取之。
这进一步阐明了气血在脉管中的运行情况。《内经》说：络脉充实而经脉空虚，应泻阳（络）补阴（经）；经脉充实而络脉空虚，应泻阴（经）补阳（络）。这是因为体内的经脉属阴，体表的络脉属阳。气血在脉中运行，由经脉流向络脉，再由络脉流向孙络（细小的分支脉络）。所以必须先诊察经络的虚实，然后再进行针刺治疗。
六经调者。谓之不病。虽病谓之自已也。一经上实下虚而不通者。此必有横络盛加于大经。令之不通。视而泻之。此所谓解结也。
如果六条主要经脉（手足三阴三阳经）气血调和，就称为没有疾病，即使生病也能自愈。如果某一条经脉出现上部实证、下部虚证且气血不通，这必定是有横向的络脉（横络）盛大压迫在大经脉上，导致气血不通。诊察到这一点后予以泻法，这就是所谓的“解结”。
此申明血气之行于脉外也。六经者。手足之十二经别也。大经者。经隧也。经隧者。五脏六腑之大络也。胃腑所出之气血。充于皮肤分肉之间者。从脏腑之大经。而外出于皮肤。横络者。经脉之支别也。如一经上实下虚而不通者。此必有经脉之横络。盛加于大经。而令之不通也。故视而泻之。此所谓解结也。此二节。论水谷所生之血气。营于脉中。充于肤腠。各有道路也。闵士先曰。以此二节列于节中者。分别合并。而充身之真气各别也。当以自费之义参之。
这部分阐明了气血在脉外的运行情况。六经指的是手足十二经别。大经就是经隧，也就是五脏六腑的大络。由胃腑化生的气血，充盈在皮肤和分肉之间，是从脏腑的大经向外输布到皮肤的。横络是经脉的分支。如果某一经脉出现上实下虚而不通，必定是经脉的横络盛大，压迫在大经上，导致不通。因此诊察后予以泻法，这就是所谓的“解结”。这两段文字，论述了由水谷化生的气血，在营行于脉中，充养于肤腠，各有其运行道路。闵士先说：将这两段列在章节中间，是为了区分和合并，说明充养全身的真气各有不同。应当结合自费的义理来参考理解。
上寒下热。先刺其项太阳。久留之。已刺则熨。项与肩胛。令热下合乃止。此所谓推而上之者也。
对于上部寒冷、下部发热的症状，先针刺颈部的太阳经穴位，长时间留针。针刺完毕后，对颈部和肩胛部进行温熨，使热气下行与下部的阳气交汇后才停止。这叫做“推而上之”（将下方的阳气推引向上）。
此言下焦所生之气。从下而上也。太阳为诸阳主气。而太阳之气。生于膀胱水中。上寒下热。此太阳之气。留于下而不上。故先刺其项太阳久留之。以候气至。已刺则熨项与肩胛。令火热与下之阳气交合乃止。此所谓推而上之者也。闵士先曰。本经凡曰项太阳。皆在气分上看。取表气。故不言经穴。赵庭霞曰。少阴太阳。本水火之标本。故俱用火以温气。
这是在论述下焦产生的气，从下向上运行。太阳经是诸阳经的主气，太阳之气生于膀胱之水。出现上寒下热，是因为太阳之气滞留于下而不能上行。所以先针刺颈部的太阳经穴位并长时间留针，以等待气至。针刺后用温熨法作用于颈部和肩胛部，使火热之气与下部的阳气相交合才停止。这就是所谓的“推而上之”。闵士先说：本经凡是提到“项太阳”，都是从气分的角度看待，旨在获取表气，所以不具体指明是哪一经穴。赵庭霞说：少阴和太阳，本是水和火的标本，所以都使用火法来温煦气机。
上热下寒。视其虚脉而陷之于经络者取之。气下乃止。此所谓引而下之者也。
对于上部发热、下部发冷的症状，观察那些虚弱且陷入经络的脉象，选取相应穴位进行治疗。待气机下行后才停止。这叫做“引而下之”（将上方的热气引导向下）。
此言上焦所生之气。从上而下也。上焦开发。宣五谷味。熏肤充身泽毛。是谓气。此上焦之气。从上而下。如上热下寒。当视其虚脉而陷之于经络者取之。此因脉虚而气陷于脉内。不能熏肤热肉。故下寒也。故当取之于经。俟气下乃止。此所谓引而下之者也。
这是在论述上焦产生的气，从上向下运行。上焦具有开发宣发的功能，散布五谷的精微气味，熏蒸皮肤，充盈身体，润泽毫毛，这就叫作气。这种上焦之气，本应从上向下布散。如果出现上热下寒，应当诊察那些虚弱且陷入经络的脉象并选取治疗。这是因为脉虚导致气陷于脉内，不能熏蒸皮肤、温暖肌肉，所以下部发冷。因此应当选取经脉穴位进行治疗，等到气机下行后才停止。这就是所谓的“引而下之”。
大热遍身。狂而妄见妄闻妄言。视足阳明及大络取之。虚者补之。血而实者泻之。因其偃卧。居其头前。以两手四指挟按颈动脉。久持之。卷而切之。下至缺盆中而复止。如前热去乃止。此所谓推而散之者也。
对于全身大发高热，伴有精神狂乱、胡言乱语、幻视幻听的症状，诊察足阳明胃经及其大络进行针刺。属于虚证的给予补法，属于血实证的给予泻法。让患者仰卧，医者坐在其头部前方，用双手的四指夹住并按压颈部的动脉（人迎脉），长时间保持不动，然后旋转并切压，向下至缺盆穴（锁骨上窝）再停止。直到前面的热症消退才结束。这叫做“推而散之”（推散郁结的热邪）。
此言中焦所生之气。从中而出。散行于上下者也。中焦之气。阳明水谷之悍气也。大热遍身。狂而妄见妄闻。此阳明之气。逆而为热狂也。故当视足阳明之皮部。及大络取之。虚者补之。如逆于血脉之中而血实者泻之。盖中焦之气。从大络而出于皮肤者也。其悍气之上冲头者。循咽上走空窍。出 。下客主人。循牙车。复与阳明之脉相合。并下人迎。从膺胸而下至足跗。故当因其偃卧。居其头前。以两手四指。挟按颈中人迎之动脉。久持之。盖使悍热之散于脉外。勿使合于脉中。此所谓推而散之者也。
这是在论述中焦产生的气，从中焦发出，散行于身体上下。中焦的气，是阳明水谷精微中慓悍滑疾的部分。全身高热、狂乱、幻视幻听，是阳明之气逆乱化为热狂所致。因此应当诊察足阳明经的皮肤部位和大络进行针刺。虚证用补法，如果气逆于血脉之中导致血实证，则用泻法。因为中焦之气是从大络输出到皮肤的。其中慓悍之气向上冲击头部，沿着咽喉上行至五官空窍，出于面部，下行至客主人穴（上关穴），沿着牙车穴（下颌角），再与阳明经脉汇合，向下经过人迎穴，从胸膺部下行至足背。所以要让患者仰卧，医者坐于其头前，用双手四指夹按颈部人迎处的动脉，长时间保持，目的是使慓悍的热邪散行于脉外，不要让它合入脉中。这就是所谓的“推而散之”。
以上三节。申明肤表之气。又有从上中下之三道而出者。是所受于天与谷气并而充身者。又有二气也。学人能明乎阴阳血气离合出入之道。全经大义。思过半矣。
以上三段文字，阐明了体表之气，又有从上、中、下三条通道发出的情况。这就是所受于天的先天之气与后天的谷气合并而充养全身的两类气。学习者如果能明白阴阳、血气离合出入的道理，那么对整部《灵枢》大义的领悟也就超过一半了。
黄帝曰。有一脉生数十病者。或痛或痈。或热或寒。或痒或痹。或不仁。变化无穷。其故何也。
黄帝问道：有一种经脉产生几十种疾病的情况，有的疼痛，有的生痈肿，有的发热，有的发冷，有的瘙痒，有的麻木不仁，变化无穷无尽，这是什么原因呢？
此下论邪气之伤人营卫宗气。则真气去。邪独留。邪气淫 。变化无穷。是以一脉而生数十病也。
下面论述邪气伤害人体的营气、卫气和宗气，导致真气离去，只有邪气独自留存。邪气淫溢蔓延，变化无穷，所以同一条经脉会产生几十种不同的疾病。
黄帝曰。余闻气者。有真气。有正气。有邪气。何谓真气。岐伯曰。真气者。所受于天。与谷气并而充身者也。正气者。正风也。从一方来。非实风。又非虚风也。邪气者。虚风之贼伤人也。其中人也深。不能自去。正风者。其中人也浅。合而自去。其气来柔弱。不能胜真气。故自去。
黄帝说：我听说气有真气、正气和邪气之分。什么是真气？岐伯说：真气，是禀受于天的先天精气，与后天的水谷精气合并而充养全身的气。正气，即正风，从单一方向吹来，不是实风，也不是虚风。邪气，即虚风，是贼害伤人的风气。它侵入人体较深，不能自行消散。正气侵入人体较浅，与人体正气相合后便自行消散。因为正风气来柔弱，不能胜过人体的真气，所以会自行消散。
所受于天者。先天之精气。谷气者。后天水谷之精气。合并而充身者也。正气者。大块噫气。其名为风。从一方来。非实风。又非虚风。此天地之正气也。虚风者。从虚乡来之贼风。伤人正气。其中人也深。不能自去。正风者。其中人也浅。与真气合而自去。盖其气来柔弱。不能胜真气。故自去。闵士先曰。人秉天地之正气所生。故天之正气。与人之真气相合。不能胜真气者。合并之气盛也。朱卫公曰。风出于地隧之中。故其气来柔弱。
禀受于天的，是先天精气；谷气，是后天水谷的精气，二者合并充养身体。正气，即自然界的大气，名为风，从一方而来，不是实风，也不是虚风，这是天地的正气。虚风，是从虚空之乡来的贼风，伤害人的正气，侵入人体深，不能自行去除。正气侵入人体浅，与人的真气相合后自行消散。因为其气来势柔弱，不能胜过人的真气，所以自行消散。闵士先说：人是秉承天地的正气而生存的，所以天的正气与人的真气相合。天的正气不能胜过人的真气，是因为合并后的气机旺盛。朱卫公说：风产生于地下的孔穴隧道中，所以它的气来势柔弱。
实风者。天之怒气也。
实风，是天之怒气的表现（指反常的强劲之风）。
虚邪之中人也。洒淅动形。起毫毛而发腠理。其入深。内搏于骨。则为骨痹。搏于筋。则为筋挛。搏于脉中。则为血闭。不通则为痈。搏于肉。与卫气相搏。阳胜者则为热。阴胜者则为寒。寒则真气去。去则虚。虚则寒搏于皮肤之间。其气外发腠理。开毫毛。淫气往来。行则为痒。留而不去为痹。卫气不行。则为不仁。
虚邪侵袭人体，使人战栗动摇，毫毛竖起，腠理开泄。如果邪气深入，向内搏击于骨，就会形成骨痹；搏击于筋，就会形成筋挛；搏击于脉中，就会导致血闭，不通畅就会形成痈肿；搏击于肉，与卫气相搏，阳气胜则发热，阴气胜则发冷。发冷会导致真气离去，真气离去则导致虚损，虚损则寒邪搏击于皮肤之间。邪气向外发散于腠理，张开毫毛，邪气在体内往来流动，运行则感到瘙痒，停留不去则形成痹证。卫气运行不畅，则形成不仁（感觉丧失）。
此言虚邪之伤形也。洒淅动形。故搏于皮脉肉筋骨。而为痹为挛。为痈为痹。阴胜则为寒。寒则真气去。有伤卫气。则为不仁。此皆邪气之所生也。
这是在论述虚邪对形体组织的伤害。使人战栗动摇，所以邪气搏击于皮、脉、肉、筋、骨，形成痹证、筋挛、痈肿等。阴气胜则发冷，冷则真气离去。如果有伤卫气，则形成不仁。这些都是邪气侵害所产生的病变。
虚邪偏客于身半。其入深。内居营卫。营卫稍衰。则真气去。邪气独留。发为偏枯。其邪气浅者。脉偏痛。
虚邪偏侧客居于身体的一半，侵入较深，内居于营卫之中。如果营卫稍微衰弱，真气就会离去，只有邪气独自留存，从而引发偏枯（半身不遂）。如果邪气较浅，则表现为一侧经脉疼痛。
此邪气偏客于形。伤其营卫。则真气去。而为偏枯也。其邪气浅者脉偏痛。盖偏枯者。邪直伤于筋骨也。闵士先曰。营卫衰则真气去。当知营卫真气。同本所生。而各走其道。可离而可合者也。
这是邪气偏侧客居于形体，损伤营卫，导致真气离去，从而形成偏枯。邪气较浅的则引起一侧脉痛。大概偏枯是邪气直接损伤筋骨所致。闵士先说：营卫衰弱则真气离去，应当知道营卫和真气同源于根本，但各自走不同的路径，是可以分离也可以聚合的。
虚邪之入于身也深。寒与热相搏。久留而内着。寒胜其热。则骨疼肉枯。热胜其寒。则烂肉腐肌为脓。内伤骨。内伤骨为骨蚀。有所疾前筋。筋屈不能伸。邪气居其间而不反。发为筋溜。有所结。气归之。卫气留之。不得反。津液久留。合而为肠溜。久者数岁乃成。以手按之柔。已有所结。气归之。津液留之。邪气中之。凝结日以易甚。连以聚居。为昔瘤。以手按之坚。有所结。深中骨。气因于骨。骨与气并。日以益大。则为骨疽。有所结。中于肉。宗气归之。邪留而不去。有热则化而为脓。无热则为肉疽。凡此数气者。其发无常处。而有常名也。
虚邪侵入人体很深，寒邪与热邪相互搏击，长久停留并附着于体内。如果寒邪胜过热邪，就会骨头疼痛、肌肉枯萎；如果热邪胜过寒邪，就会腐烂肌肉化为脓液。向内损伤骨骼，损伤骨骼称为骨蚀。如果疾病先前发生在筋，筋屈曲不能伸展，邪气停留在其间而不返回，形成筋溜（筋部的肿瘤）。如果有所结聚，气归向那里，卫气停留在那里，不能返回，津液长久停留，结合而形成肠溜（肠部的肿瘤），历时数年才形成，用手按压感觉柔软。已经有所结聚，气归向那里，津液停留，邪气侵入其中，凝结程度日益加重，连接聚集在一起，形成昔瘤（多年的肿瘤），用手按压感觉坚硬。如果结聚深入骨骼，气依附于骨，骨与气合并，日益增大，形成骨疽（骨的化脓性感染）。如果结聚在肌肉，宗气归向那里，邪气停留不去，有热则化为脓，无热则形成肉疽（肌肉的慢性脓肿）。所有这些气机病变，发作没有固定的位置，但有固定的名称。
此虚邪伤气而病形也。寒与热搏者。形中之阴阳二气也。盖形舍气。气归形。形气之相合也。是以伤形则病气。伤气则病形。结气归之者。寒热相搏之气。归于邪留之形所也。凡此数气者。其发无定处。而有肉枯骨蚀筋溜昔瘤之定名也。末章论邪气病形。则真气去而营卫伤。盖真气者。出入于节之交。游行于皮肤肌腠之间者也。
这是虚邪伤害气机进而影响形体的病变。寒与热搏击，是形体中的阴阳二气相互作用。形体容纳气，气归属于形体，这是形与气的结合。所以伤害形体就会影响气机，伤害气机就会影响形体。所谓结气归向那里，是指寒热相搏的气，归向于邪气停留的形体部位。所有这些气机病变，发作没有固定位置，但有肌肉枯萎、骨蚀、筋溜、昔瘤等确定的名称。最后一章论述邪气导致的形体病变，指出真气离去而营卫受损。因为真气，是在关节交会处出入，游走在皮肤和肌肉腠理之间的。
Self-effort is limited. One who is skilled in managing water cannot chisel through ice; one who is skilled in acupuncture cannot forcibly resolve Si Jue (Four Coldness, a condition characterized by cold extremities). This implies that Qi (vital energy) enters and exits following the seasonal changes of heaven and earth, which cannot be forced by human effort alone.
To treat Jue syndrome (cold extremities), one must first apply warming moxibustion or hot compresses to unblock the Qi. Harmonizing the meridians serves to unblock them. The Jing Qi (Essence Qi received from heaven) circulates inside and outside the meridians. Regulation involves the palms, axillae, elbows, feet, neck, and spine, indicating that Blood and Qi circulate throughout the upper, lower, and four sides, reaching every part of the body. If the flow is overly slippery and abundant (Nao Ze), it should be regulated via needling to bring it to balance. If the flow is tight and choppy (Jin Se), indicating stagnation and blockage, it should be broken and dispersed. This is referred to as using needles to untie knots.
The essence of needling lies in regulating Qi. Qi accumulates in the Stomach to facilitate the circulation of Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi), each following its own pathway. Zong Qi (Gathering Qi) flows into the Sea of Qi (Dan Zhong/Ren Zhong area); its descending branch pours into the Qi Street (Qi Jie), while its ascending branch travels through the respiratory tract (Xi Dao). Therefore, when Jue manifests in the feet, it is because Zong Qi fails to descend, causing the blood within the vessels to coagulate and stagnate. Without fire therapy (such as moxibustion or warming) for regulation, this condition cannot be resolved.
This passage discusses how postnatal grain Qi transforms into Ying Qi, Wei Qi, and Zong Qi, each traveling distinct pathways to fill the upper and lower parts of the body. Jue in the feet is due to the reversal of Shao Yin (Kidney) Qi. Cold Qi reverses upward from below, preventing Zong Qi from descending, leading to coagulation and stagnation of blood in the vessels. Without fire therapy, it cannot be unblocked. The Essence Qi of the Lower Jiao constitutes Yin and Yang, Water and Fire, which require heat to warm the cold water. What is "received from heaven" is the Essence Qi of the Shao Yin Kidney. The Chong Mai (Penetrating Vessel) and the large collaterals of the Shao Yin meridian originate in the Kidney, emerge at the Qi Street, and follow the medial aspect of the thigh. If pathogenic factors invade here, causing foot Jue and failure of Zong Qi to descend, it means Zong Qi descends to merge with Shao Yin Qi. The so-called "merging to fill the body" refers to the congenital Qi of the Lower Jiao merging with the Grain Qi of the Yang Ming (Stomach) to enter and exit between joints and muscle fissures. Meanwhile, the postnatal Zong Qi also descends to merge with the Essence Qi of Shao Yin, pouring into the Qi Street and entering the interior, circulating inside and outside the meridians and skin.
When using needles, one must first examine the excess or deficiency of the meridians. Palpate, trace, press, and flick the areas to observe where pulsations respond, then select these points for needling to drain excess.
This clarifies the circulation of Blood and Qi within the vessels. The *Nei Jing* states: If collaterals are full and meridians are deficient, drain the Yang (collaterals) and tonify the Yin (meridians); if meridians are full and collaterals are deficient, drain the Yin (meridians) and tonify the Yang (collaterals). This is because internal meridians are Yin and external collaterals are Yang. Blood and Qi flow from meridians to vessels, from vessels to collaterals, and from collaterals to sun-collaterals (fine branches). Thus, one must first assess the excess or deficiency of the meridians before needling.
If the Six Meridians (Six Channels) are harmonious, the person is considered disease-free; even if illness occurs, it will resolve spontaneously. If one channel exhibits excess above and deficiency below with obstruction, there must be an overabundance of transverse collaterals pressing upon the main meridians, causing blockage. Observing this and applying draining methods is called "untie the knot."
This clarifies the circulation of Blood and Qi outside the vessels. The Six Meridians refer to the twelve divergent channels of the hands and feet. The main meridians are the meridional tunnels, which are the large collaterals of the five zang and six fu organs. The Qi and Blood derived from the Stomach fill the space between skin and muscles, exiting from the large meridians of the zang-fu to the skin. Transverse collaterals are branches of the meridians. If one channel shows excess above and deficiency below with obstruction, it is due to transverse collaterals being excessive and pressing on the main meridians. Observing this and draining them is called "untie the knot." These two sections discuss how Blood and Qi generated from food and drink nourish the interior of the vessels and fill the skin and muscle fissures, each having its own pathway. Min Shixian stated that placing these two sections in the middle distinguishes and merges the true Qi filling the body, suggesting they be understood in the context of self-nourishment principles.
For symptoms of cold above and heat below, first needle the Tai Yang points at the neck and retain the needles for a long time. After needling, apply hot compresses to the neck and shoulder blades until the heat descends and merges with the Yang Qi below, then stop. This is called "pushing upward."
This discusses Qi generated in the Lower Jiao moving upward. Tai Yang governs the Qi of all Yang channels, and Tai Yang Qi is born from Bladder water. In cases of cold above and heat below, Tai Yang Qi is retained below and fails to ascend. Therefore, one needles the neck Tai Yang points and retains them to await Qi arrival. Post-needling, hot compresses are applied to the neck and shoulders to allow the fire heat to merge with the Yang Qi below. This is "pushing upward." Min Shixian noted that whenever "neck Tai Yang" is mentioned in this classic, it is viewed from the perspective of Qi distribution to capture surface Qi, hence specific acupoints are not named. Zhao Tingxia stated that Shao Yin and Tai Yang are the root and branch of Water and Fire, respectively, so fire methods are used to warm the Qi in both cases.
For symptoms of heat above and cold below, observe the deficient pulses sinking into the meridians and needle them. Stop when the Qi descends. This is called "drawing downward."
This discusses Qi generated in the Upper Jiao moving downward. The Upper Jiao opens and disseminates, spreading the flavors of grains to steam the skin, fill the body, and moisten hair; this is Qi. When Upper Jiao Qi moves downward, but symptoms present as heat above and cold below, one should observe the deficient pulses sinking into the meridians and needle them. This occurs because vessel deficiency causes Qi to sink within the vessels, unable to steam the skin and warm the flesh, resulting in cold below. Therefore, one needles the meridians and stops when the Qi descends. This is "drawing downward."
For widespread high fever accompanied by mania, hallucinations, and delirious speech, examine the Foot Yang Ming meridian and its large collaterals for needling. Tonify deficiency; drain blood excess. With the patient lying supine, position yourself at the head. Use four fingers of both hands to clamp and press the carotid artery in the neck, holding firmly for a long time. Then rotate and press downwards to the Supraclavicular Fossa (Que Pen) and stop again. Continue until the heat dissipates. This is called "pushing and dispersing."
This discusses Qi generated in the Middle Jiao emerging from the center and dispersing upward and downward. The Qi of the Middle Jiao is the fierce and rapid Qi from Yang Ming grain digestion. Widespread fever, mania, hallucinations, and delirium result from Yang Ming Qi reversing into heat and madness. Therefore, examine the skin regions of the Foot Yang Ming and its large collaterals. Tonify deficiency; if Qi reverses in the blood vessels causing blood excess, drain it. The Qi of the Middle Jiao emerges from large collaterals to the skin. Its fierce Qi rushing upward follows the throat to the orifices, exits the face, descends to the Guest Master point (Shang Guan), follows the jaw angle, re-joins the Yang Ming pulse, passes down through the Ren Ying point, and continues from the chest to the dorsum of the foot. Thus, with the patient supine, you sit at the head, clamping the Ren Ying pulse in the neck with four fingers for a long time. This ensures the fierce heat disperses outside the vessels rather than merging inside. This is "pushing and dispersing."
These three sections clarify that surface Qi emerges through three pathways: upper, middle, and lower. This represents the two types of Qi—congenital Qi received from heaven and postnatal Grain Qi—that merge to fill the body. If students can understand the principles of separation, union, entry, and exit of Yin-Yang, Blood, and Qi, they will have grasped more than half of the essential meaning of the entire classic.
Huang Di asked: Why does one meridian give rise to dozens of diseases, such as pain, abscesses, heat, cold, itching, numbness, or anesthesia, with infinite variations? What is the cause?
Qi Bo replied: These are all generated by pathogenic factors.
The following section discusses how pathogenic factors injure Ying Qi, Wei Qi, and Zong Qi, causing True Qi to depart while pathogens remain alone. Pathogens spread widely, causing infinite variations, hence one meridian produces dozens of diseases.
Huang Di asked: I have heard of True Qi, Regular Qi, and Pathogenic Qi. What is True Qi? Qi Bo said: True Qi is what is received from heaven and merged with Grain Qi to fill the body. Regular Qi is Zheng Feng (Regular Wind), coming from one direction, neither Shi Feng (Solid/Excess Wind) nor Xu Feng (Empty/Deficient Wind). Pathogenic Qi is Xu Feng, which贼ingly injures humans. It penetrates deeply and cannot expel itself. Regular Qi penetrates shallowly and expels itself upon merging with the body's Qi. Its approach is gentle and cannot overcome True Qi, so it dissipates naturally.
What is received from heaven is congenital Essence Qi; Grain Qi is postnatal Essence Qi from food and drink; they merge to fill the body. Regular Qi is the breath of the great earth, named wind, coming from one direction, neither solid nor empty wind; this is the Regular Qi of heaven and earth. Xu Feng is thief-wind coming from empty directions, injuring Regular Qi. It penetrates deeply and cannot expel itself. Regular Qi penetrates shallowly, merges with True Qi, and dissipates. Because its approach is gentle, it cannot overcome True Qi, so it dissipates. Min Shixian stated: Humans are born inheriting the Regular Qi of heaven and earth; thus, heavenly Regular Qi merges with human True Qi. Heavenly Regular Qi cannot overcome human True Qi because the merged Qi is vigorous. Zhu Weigong stated: Wind originates from underground tunnels, hence its approach is gentle.
Shi Feng is the anger of heaven.
When Xu Xie (Deficient Evil) invades, it causes shivering and bodily agitation, raising goosebumps and opening the cou li (skin and muscle interstices). If it penetrates deeply and internally clashes with bone, it becomes Gu Bi (Bone Bi); with sinew, Jin Luan (Sinew Spasm); within vessels, Xue Bi (Blood Blockage); obstruction leads to Yong (Abscess); with flesh, clashing with Wei Qi, Yang excess causes heat, Yin excess causes cold. Cold causes True Qi to depart; departure leads to deficiency; deficiency allows cold to clash in the skin. Qi erupts outward in the cou li, opening hair follicles. Errant Qi moving causes itching; staying without departing causes Bi syndrome. If Wei Qi does not move, it causes An Ren (loss of sensation).
This describes how Xu Xie damages form. Shivering agitates the body, so it clashes with skin, vessels, flesh, sinews, and bones, causing Bi, spasm, abscess, etc. Yin excess causes cold; cold causes True Qi to depart. Injury to Wei Qi causes loss of sensation. All these are produced by pathogenic factors.
If Xu Xie lodges偏侧ally in half the body, penetrating deeply and residing within Ying and Wei, slight decline of Ying and Wei causes True Qi to depart, leaving pathogens alone, resulting in Pian Ku (hemiplegia). If pathogens are shallow, it causes偏侧al vessel pain.
This describes pathogens lodging偏侧ally in form, injuring Ying and Wei, causing True Qi to depart and leading to hemiplegia. Shallow pathogens cause偏侧al vessel pain. Hemiplegia results from pathogens directly injuring sinews and bones. Min Shixian stated: When Ying and Wei decline, True Qi departs. One must know that Ying, Wei, and True Qi share the same origin but travel different paths; they can separate and merge.
When Xu Xie enters deeply, cold and heat clash, lingering internally. If cold exceeds heat, bones ache and flesh withers; if heat exceeds cold, flesh rots and muscles decay into pus. Internal injury to bone is called Gu Shi (Bone Erosion). If prior disease affects sinews, sinews contract and cannot extend; pathogens remain without returning, forming Jin Liu (Sinew Tumor). If结聚 occurs, Qi gathers there, Wei Qi stays and cannot return, fluids linger, forming Chang Liu (Intestinal Tumor), taking years to develop, soft to touch. If结聚 occurs, Qi gathers, fluids linger, pathogens invade, condensation worsens daily, clustering together, forming Xi Liu (Old Tumor), hard to touch. If结聚 reaches deep into bone, Qi attaches to bone, bone and Qi merge, enlarging daily, forming Gu Ju (Bone Abscess). If结聚 is in flesh, Zong Qi gathers there; pathogens stay without departing. With heat, it turns to pus; without heat, it forms Rou Ju (Flesh Abscess). All these qi disorders arise in no fixed location but have fixed names.
This describes Xu Xie injuring Qi and manifesting in form. Cold and heat clash represent Yin and Yang Qi in form. Form houses Qi; Qi returns to form; this is the union of form and Qi. Thus, injuring form affects Qi; injuring Qi affects form. "Qi gathering" refers to the clashing Qi of cold and heat returning to the form where pathogens linger. These disorders arise in no fixed place but have fixed names like flesh withering, bone erosion, sinew tumor, and old tumor. The final chapter discusses pathogenic diseases of form, noting True Qi departs and Ying/Wei are injured. True Qi enters and exits at joint intersections and wanders between skin and muscle fissures.