法。以治皮肉筋骨之浅深。盖天气有四时之出入。而人有阴阳之形层。故各以时为齐也。
五脏身有五部。伏兔一。腓二。腓者 也。背三。五脏之 四。项五。此五部有痈疽者死。
夫在外者。皮肤为阳。筋骨为阴。痈疽所发。在于皮肉筋骨之间。此言五脏各有五部。而一部之
阴阳不和。即留滞而为痈矣。伏兔。肾之街也。 者。脾之部也。背者。肺之俞也。五脏俞者。
谓五椎之心俞也。项者。肝之俞也。本经曰。痈疽之发。不从天下。不从地出。积微之所生也。故
五部之有痈疽者。乃五脏渐积之郁毒。外应于血气之不和而为痈疽。故五部有此者死。按上章论五
脏之邪。外应于皮肉筋骨。此言五脏各有五部。而一部之中。皆有阴阳血气之流行。所谓阴中有
阳。阳中有阴也。
余伯荣曰。痈疽之发。有因于风寒外袭者。有因于喜怒不测。食饮不节。营卫不和。逆于肉理。
乃发为痈。阴阳不通。两热相搏。乃化为脓。然有发于股臂而死者。有发于项背而生者。此又以邪
毒之重轻。正气之虚实。以别其死生。然病及五脏者必死。故因于外邪者。善治治皮毛。其次治肌
肉。因于内伤者。使五脏之郁气。四散于皮肤。弗使痈肿于一部。所谓始萌可救。脓成则死。此
上工之治未病也。
病始于臂者。先取手阳明太阴而汗出。病始头首者。先取项太阳而汗出。病始足胫者。先取足
阳明而汗出。
此分别形身上下。各有所主之阴阳也。夫身半以上。手太阴阳明皆主之。故病始于臂者。先取手
阳明太阴而汗出。太阳之气。生于膀胱。而上出于头项。故病始于头首者。先取项太阳而汗出。身
半以下。足太阴阳明皆主之。故病始足胫者。先取足阳明而汗出。曰始者。谓病始于下者。下行极
而上。始于上者。上行极而下。曰先者。谓手足之阴阳。虽各有所主。然三阴三阳之气。上下升降。
外内出入。又互相交通者也。
臂太阴可汗出。足阳明可汗出。故取阴而汗出甚者。止之于阳。取阳而汗出甚者。止之于阴。
汗乃阴液。生于阳明。太阴主气。行于肤表。水津四布。乃气化以通调。故臂太阴可汗出。水
谷之津液。从腠理发泄。汗出溱溱。故足阳明可汗出。然汗液必由气之宣发。气得液而后能充身泽
毛。故取阴而汗出甚者。止之于阳。取阳而汗出甚者。止之于阴。盖阳为阴之固。阴为阳之守也。
沈亮宸曰。此篇论阴阳之不调。而为寒热之证。宜从汗解。故总结汗法数条。
凡刺之害。中而不去则精泄。不中而去则致气。精泄则病甚而 。致气则生为痈疽也。
泄精者。谓阴阳血气生于精。过伤则并伤其根原矣。痈疡者。谓阴阳血气。营行于皮肉筋骨之
间。邪气留客。致正气不行。则生痈疡矣。本篇论阴阳寒热。缘邪正之实虚。故以此节重出于篇末。
盖以戒夫治病者。慎勿再实实而虚虚也。
针刺的法则。用于治疗皮、肉、筋、骨病变的深浅程度。因为天气有四季的出入变化，而人体有阴阳构成的形体层次。所以要根据时令来把握治疗的尺度。
五脏在体表各有五个对应部位：伏兔穴是一处，腓肠肌部位是二处，腓部（小腿肚）属脾；背部是三处，五脏的腧穴是四处，项部是五处。这五个部位如果发生痈疽，预后不良，多致死亡。
凡是在体表的病变，皮肤属阳，筋骨属阴。痈疽的发生，在于皮、肉、筋、骨之间。这里所说的五脏各有五个对应部位，如果其中某一部位的阴阳不和，就会留滞而形成痈疽。伏兔穴，是肾经气血通行的街道；腓部，是脾经所主的部位；背部，是肺脏的腧穴所在；五脏的腧穴，指的是第五胸椎旁的心俞穴；项部，是肝脏的腧穴所在。本经说：“痈疽的发生，不是从天上掉下来，也不是从地里长出来，而是由微小的积累逐渐形成的。”所以这五个部位发生的痈疽，乃是五脏逐渐积聚的郁毒，反映在外部就是血气不和而发为痈疽。因此，这五个部位出现此类病症的，预后凶险，多致死。按上一章论述五脏的邪气，反映在体外的皮肉筋骨上；这里说五脏各有五个对应部位，而在每一部位之中，都有阴阳血气的流行，这就是所谓“阴中有阳，阳中有阴”。
余伯荣说：痈疽的发生，有因风寒外袭引起的，有因喜怒无常、饮食不节制、营卫不和，逆乱于肌肉纹理之间引起的，从而发为痈疽。阴阳之气不通，两热相互搏结，就化为脓液。然而，有的发生在股臂部位而死亡，有的发生在项背部位而痊愈。这是根据邪毒的轻重、正气的虚实来辨别死生的。但是，病邪波及五脏的必然死亡。所以，因外邪引起的，善于治疗者治皮毛，其次治肌肉；因内伤引起的，要使五脏的郁散之气，散布于皮肤，不让痈肿局限在一个部位。这就是所谓“病初起时可救治，脓已成则难治”。这是高明医生“治未病”的方法。
疾病始于手臂的，先取手阳明大肠经和手太阴肺经的穴位，使患者出汗；疾病始于头部的，先取项部足太阳膀胱经的穴位，使患者出汗；疾病始于足胫部的，先取足阳明胃经的穴位，使患者出汗。
这是分别形体上下各有所主的阴阳经脉。身体半以上，手太阴肺经和手阳明大肠经都主管它，所以疾病始于手臂的，先取手阳明、手太阴经穴使患者出汗。太阳经的气，生于膀胱，而上行出于头项，所以疾病始于头部的，先取项部足太阳经穴使患者出汗。身体半以下，足太阴脾经和足阳明胃经都主管它，所以疾病始于足胫部的，先取足阳明经穴使患者出汗。“始”字，是说病始于下方的，下行至极点则向上行；病始于上方的，上行至极点则向下行。“先”字，是说手足的阴阳经脉，虽然各有所主，但三阴三阳之气，上下升降，内外出入，又是互相交通的。
手臂的太阴经可以导致出汗，足阳明经也可以导致出汗。所以，取阴经穴位而汗出过多的，应止之于阳经；取阳经穴位而汗出过多的，应止之于阴经。
汗是阴液，产生于阳明经。太阴经主管气，运行于肤表，水津四布，是通过气化作用通调的结果，所以手臂太阴经可以导致出汗。水谷的津液，从腠理发泄，汗出淋漓，所以足阳明经可以导致出汗。然而，汗液的排出必须依靠气的宣发，气得到阴液后才能充盈身体、润泽毫毛。所以，取阴经穴位而汗出过多的，应止之于阳经；取阳经穴位而汗出过多的，应止之于阴经。这是因为阳是阴的固护，阴是阳的守持。
沈亮宸说：本篇论述阴阳不调而产生的寒热证候，适宜通过发汗来解表。所以总结了数条关于汗法的论述。
凡是针刺的危害，如果刺中病所而不及时停止，就会耗泄精气；如果没有刺中病所就停止，就会导致邪气滞留。精气耗泄，病情就会加重并出现虚损症状；邪气滞留，就会产生痈疽。
所谓“泄精”，是指阴阳血气都源于精，过度损伤就会同时伤及根本。所谓“痈疡”，是指阴阳血气营行于皮肉筋骨之间，邪气留驻客居，导致正气不能正常运行，从而产生痈疡。本篇论述阴阳寒热，是由于邪气和正气的虚实变化，所以将此节内容重复放在篇末，大概是用来告诫治病的人，千万不要再犯“实其实、虚其虚”的错误了。
The principles of needling. These are used to treat lesions of varying depths in the skin, flesh, sinews, and bones. Since the weather undergoes changes with the four seasons, and the human body has layers of Yin and Yang constitution, treatment must be regulated according to the seasonal timing.
The five Zang organs correspond to five specific regions on the body: 1) Futu (ST32); 2) The calf region (associated with the Spleen); 3) The back; 4) The Shu points of the five Zang organs; 5) The neck. If carbuncles or sores develop in any of these five regions, the prognosis is poor and death may ensue.
In external diseases, the skin is considered Yang, while the sinews and bones are considered Yin. Carbuncles and sores arise within the layers of skin, flesh, sinews, and bones. This passage indicates that each of the five Zang organs has corresponding external regions; if Yin and Yang become disharmonious in any one of these regions, stagnation occurs, leading to the formation of a carbuncle. Futu (ST32) is the pathway for Kidney Qi; the calf region is the domain of the Spleen; the back is the location of the Lung's Shu points; the "Shu points of the five Zang" refers specifically to Xinshu (BL15) located beside the fifth thoracic vertebra; and the neck is the location of the Liver's Shu points. The Classic states: "Carbuncles and sores do not fall from the sky nor emerge from the earth; they arise from the gradual accumulation of minor factors." Therefore, carbuncles occurring in these five regions result from the gradual accumulation of toxic stagnation within the five Zang organs, manifesting externally as disharmony of Qi and Blood. Consequently, the appearance of such conditions in these five regions indicates a fatal prognosis. As discussed in the previous chapter, pathogenic factors of the Zang organs manifest externally in the skin, flesh, sinews, and bones. Here, it is stated that each Zang organ has five corresponding regions, within which the flow of Yin, Yang, Qi, and Blood circulates. This illustrates the principle that "Yin contains Yang, and Yang contains Yin."
Yu Borong stated: The onset of carbuncles and sores may be caused by external invasion of Wind-Cold, or by unregulated emotions (excessive anger or joy), irregular diet, and disharmony of Ying and Wei (Defensive and Nutritive Qi), causing rebellion within the muscle tissue. This leads to the formation of carbuncles. When Yin and Yang pathways are blocked, and two types of Heat contend with each other, pus is formed. However, some cases originating in the thighs or arms result in death, while those originating in the neck or back may result in recovery. This distinction depends on the severity of the pathogenic toxin and the deficiency or excess of the healthy Qi. Nevertheless, if the disease involves the five Zang organs, death is inevitable. Therefore, for diseases caused by external pathogens, skilled practitioners treat the skin and hair layer first, and the muscle layer secondarily. For diseases caused by internal injury, the goal is to disperse the stagnant Qi of the Zang organs into the skin, preventing the carbuncle from localizing in a single region. This embodies the principle that "early intervention can save the patient, but once pus has formed, it is difficult to cure." This represents the approach of master physicians in treating disease before it arises ("Zhi Wei Bing").
If the disease begins in the arm, first select points from the Hand-Yangming Large Intestine Meridian and the Hand-Taiyin Lung Meridian to induce sweating. If the disease begins in the head, first select points in the neck from the Foot-Taiyang Bladder Meridian to induce sweating. If the disease begins in the lower leg, first select points from the Foot-Yangming Stomach Meridian to induce sweating.
This differentiates the Yin and Yang meridians governing the upper and lower parts of the body. The upper half of the body is governed by the Hand-Taiyin Lung and Hand-Yangming Large Intestine meridians; thus, for diseases beginning in the arm, points from the Hand-Yangming and Hand-Taiyin meridians are selected to induce sweating. Taiyang Qi originates in the Bladder and ascends to the head and neck; therefore, for diseases beginning in the head, points in the neck from the Foot-Taiyang meridian are selected to induce sweating. The lower half of the body is governed by the Foot-Taiyin Spleen and Foot-Yangming Stomach meridians; thus, for diseases beginning in the lower leg, points from the Foot-Yangming meridian are selected to induce sweating. The term "beginning" implies that if a disease starts below, it descends to its extreme and then ascends; if it starts above, it ascends to its extreme and then descends. The term "first" implies that although the Yin and Yang meridians of the hands and feet have their respective dominions, the Qi of the Three Yin and Three Yang meridians ascends and descends, moves internally and externally, and communicates with one another.
The Taiyin Meridian of the arm can induce sweating, and the Yangming Meridian of the foot can also induce sweating. Therefore, if excessive sweating results from selecting points on Yin meridians, regulation should be sought in the Yang meridians; if excessive sweating results from selecting points on Yang meridians, regulation should be sought in the Yin meridians.
Sweat is a Yin fluid, generated from the Yangming stage. The Taiyin Meridian governs Qi, which circulates on the surface of the skin. Water fluids are distributed throughout, facilitated by the transformation and transportation of Qi; hence, the Taiyin Meridian of the arm can induce sweating. The fluids from food and drink are excreted through the interstices (couli), resulting in profuse sweating; hence, the Foot-Yangming Meridian can induce sweating. However, the discharge of sweat relies on the dissemination of Qi. Qi requires fluids to fill the body and nourish the hair and skin. Therefore, if excessive sweating results from selecting points on Yin meridians, regulation should be sought in the Yang meridians; if excessive sweating results from selecting points on Yang meridians, regulation should be sought in the Yin meridians. This is because Yang acts as the guardian of Yin, and Yin acts as the anchor of Yang.
Shen Liangchen stated: This chapter discusses cold-heat syndromes caused by the disharmony of Yin and Yang, which are appropriately resolved through diaphoresis (sweating). Thus, several principles regarding the sweating method are summarized.
The harm of needling lies in this: if the needle strikes the target but is retained too long, essence will be depleted; if the needle does not strike the target and is withdrawn immediately, pathogenic Qi will accumulate. Depletion of essence leads to worsening of the disease and debility. Accumulation of pathogenic Qi leads to the formation of carbuncles and sores.
"Depletion of essence" refers to the fact that Yin, Yang, Qi, and Blood all originate from Essence; excessive injury damages the root source. "Carbuncles and sores" refer to the condition where Yin, Yang, Qi, and Blood circulate nutritively between the skin, flesh, sinews, and bones. When pathogenic factors linger and lodge, causing healthy Qi to stagnate, carbuncles and sores arise. This chapter discusses Yin-Yang and cold-heat syndromes arising from the excess or deficiency of pathogenic and healthy Qi. Therefore, this section is repeated at the end of the chapter, serving as a warning to practitioners: beware of exacerbating an excess condition or further weakening a deficient one ("making the excess more excess and the deficiency more deficient").