涩甚为溢饮。涩微为 挛。筋痹。（ 音颓）
肝主语。在志为怒。肝苦急。故急甚为恶言。微急为肥气。在胁下。若覆杯。皆有余之气也。
食气入胃。散精于肝。缓主多热。热则肝气逆。故善呕。水瘕痹者。亦食饮之所积也。本经曰。喜
怒不测。饮食不节。阴气不足。阳气有余。荣气不行。乃发为痈。大主肝气盛。盛则郁怒而不得
疏达。故为内痈。呕衄。肝气逆于上也。阴缩。肝气逆于下也。肝脉抵少腹。上注肺。咳引小腹
者。经气逆于上下也。小者。血气皆少。少则木火盛。故多饮。及为消瘅也。滑主气盛而热。故为
疝。肝主疏泄。肝气盛而热。故遗溺也。溢饮者。饮留于四肢。则经脉阻滞。故脉涩。肝气
虚而有寒。故为 挛筋痹。肝主筋也。
脾脉急甚为 。微急为膈中。食饮入而还出。后沃沫。缓甚为痿厥。微缓为风痿。四肢不用。
心慧然若无病。大甚为击仆。微大为疝气。腹里大。脓血在肠胃之外。小甚为寒热。微小为消瘅。
滑甚为 癃。微滑为虫毒 蝎腹热。涩甚为肠 。微涩为内 。多下脓血（ 音回同 ）
者。急而收引。 者。纵而懈弛。脾主四肢。故急甚为 。脾有寒不能运化饮食。故为
膈中。食饮入而还出。
后沃沫。盖不能游溢津液。上归于肺。四布于皮毛。故涎沫之从口出也。痿厥风痿。皆四肢瘫痪而
不为所用。甚则从中而病见于外。微则病在外而不及于中。故心慧然若无病也。大乃太过之脉。脾为
孤脏。中央土以灌四旁。太过则令人四肢不举。故为击仆。若击之而仆地也。疝气腹里大。脓血在
肠胃之外。皆有余之积聚也。寒热者。血气虚也。脾虚而不能为胃行其津液。故为消瘅。脾为阴湿
之土。湿热则为疝 。为小便闭癃。湿热则生虫也。脾气虚而有寒。则为肠 。多血少气。故下脓
血也。
肾脉急甚为骨癫疾。微急为沉厥奔豚。足不收。不得前后缓甚为折脊。微缓为洞。洞者食不化。
下嗌还出。大甚为阴痿。微大为石水。起脐以下至小腹 然。上至胃脘。死不治。小甚为洞泄。微
小为消瘅。滑盛为癃 。微滑为骨痿。坐不能起。起则目无所见。涩甚为大痈。微涩为不月。沉痔。
肾为阴脏而主骨。阴寒太甚。故为骨癫疾。肾为生气之原。正气虚寒。则为沉厥。虚气反逆。
故为奔豚。阴寒在下。故足不收。肾开窍于二阴。气虚不化。故不得前后也。督脉属肾贯脊。缓则
督脉懈弛。故脊折也。戊癸合而化生火土。以消入胃之食饮。肾气缓。故食不化而还出也。阴痿者。
阴器痿而不举。石水。肾水也。上至胃脘。水泛而土败也。肾气虚则为洞泄。精血不足。则为消瘅。
肾有热。则为小便闭癃。为睾丸肿 。骨痿坐不能起。热伤肾气也。目无所见。热伤骨精也。血气
皆始于肾。涩则血气阻滞。故为大痈。气血不行。故为女子不月。为沉痔。
黄帝曰。病之六变者。刺之奈何。岐伯答曰。诸急者多寒。缓者多热。大者多气少血。小者血
气皆少。滑者阳气盛。
微有热。涩者多血少气。微有寒。是故刺急者。深内而久留之。刺缓者。浅内而疾发针。以去其
热。刺大者。微泻其气。无出其血。刺滑者。疾发针而浅内之。以泻其阳气而去其血。刺涩者。必
中其脉。随其逆顺而久留之。必先按而循之。已发针。疾按其 。无令其出血。以和其脉。诸小者。
阴阳形气俱不足。勿取以针。而调以甘药也。（内叶讷泻本作写去声 音委）
六变者。五脏之所生。变化之病形。有缓急大小滑涩之六脉。此缘阴阳血气寒热之不和。而
变见于脉也。寒气收劲。故脉急。热气散弛。故脉缓。宗气荣气行于脉中。卫气行于脉外。故大主
多气。如血气皆少。则脉小也。阳气盛而微有热。则脉行滑利。气少则脉行涩滞。血随气行者也。
深内而久留之者。俟阳气至而针下热也。浅内而疾发针者。去其热也。气盛者微泻其气。无出其血。
使阴阳血气之和调也。滑者。疾发针而浅内之。泻脉外之阳热也。针者。必中其脉。随其逆顺而久
留之。调经脉外内之血气也。必先按而循之。致脉外之气也。疾按其 。无令其出血。以和其脉。
无令皮肤之血出。使脉外之气以和于脉中也。夫针者。所以调阴阳血气之不和。若血气皆少者。必
须调以甘药。非针之可能资生也。按、刺涩者曰必中其脉。要知刺急刺缓。取脉外之气也。刺大刺
滑。泻脉外之阳。以和脉内之血也。刺涩者必中其血。随其逆顺。必先按而循之。调脉内之血。
以致脉外之气也。勿取以针。调以甘药者。血气之生于阳明也。当知血气乃胃腑水谷之精。有行于
皮肤之外者。有行于经脉之内者。外内贯通。环转不息。故善调尺者。不待于寸。善调脉者。不待
于色。能参合而行之。可为上工。上工者。知阴阳血气之终始出入者也。
黄帝曰。余闻五脏六腑之气。荥输所入为合。令何道从入。入安连过。愿闻其故。岐伯答曰。
此阳脉之别入于内。属于腑者也。
按、脏腑之十二经脉。出于指井者。受皮肤之气血。溜于荥。注于输。入于肘膝而为合。故
帝问五脏六腑之气。荥输所入为合。令何道从入。入安连过。谓从荥输所入为合之气血。从何道而
入。入安所连而为合。安所行过而相连。帝总问五脏六腑者。盖欲访明脏之五输。腑之六输。所出
所入之原流。然此已论于本输篇内。故伯只答六腑之合。皆在于足之原因。再按脉外之卫气。出于
足之阳明。上冲于头面。散行于三阳。脉外之气血。从手阳明之五里。布散于肤表。是手足诸阳之
气。皆从上而下。复从足趾井入于脉中。从足而交于手。故曰六腑之经脉。皆出于足之三阳。上合
于手也。此阳气之出于地中。营运于天表。复从下而贯于地脉经水之中。
黄帝曰。荥输与合。各有名乎。岐伯答曰。荥输治外经。合治内腑。黄帝曰。治内腑奈何。岐
伯曰。取之于合。黄帝曰。合各有名乎。岐伯答曰。胃合于三里。大肠合入于巨虚上廉。小肠合入
于巨虚下廉。三焦合入于委阳。膀胱合入于委中央。胆合入于阳陵泉。黄帝曰。取之奈何。岐伯答
曰。取之三里者。低跗取之。巨虚者。举足取之。委阳者。屈伸而索之。委中者。屈而取之。阳
陵泉者。正竖膝予之。脐下至委阳之阳取之。取诸外经者。揄申而从之。（揄音于引也抒也）
此申明三阳之气。外合于三阳之经。三阳之经。内合于六腑也。所谓太阳少阳阳明者。三阳
之气也。营运于脉外。与六腑之经脉相合。脉外之气与经脉合于荥输之间。是以荥输治外经。治在外之经脉也。
脉内之血气。与三阳之气。合于肘膝之间。是以合治内腑。盖脉中之血气。六腑之所出也。三里巨
虚。皆足阳明之经。巨虚上下廉。乃手太阳阳明之合。故取三里者。低跗取之。以足经之在下也。
巨虚者。举足取之。欲其伸舒于上也。委阳者。足太阳之经。三焦之合。屈伸而索之者。索三焦之
气。往来于上下也。膀胱主水。故屈而取之。少阳属木。故竖膝予之。使木气之条达也。脐下至
委阳之阳取之者。谓胆与三焦。总属少阳之气也。盖言在经脉。则有手足之分。合于三阴三阳之气。
又无分手与足也。取诸外经者。取五脏六腑之荥输也。揄申而取之者。伸舒其四体。使经脉之流
通也。帝始问五脏六腑之荥输。伯只答六腑之合。而未言取诸外经。君臣反复问答。盖以详明阴阳
血气之出入。经脉外内之贯通。
黄帝曰。愿闻六腑之病。岐伯答曰。面热者。足阳明病。鱼络血者。手阳明病。两跗之上脉
坚陷者。足阳明病。此胃脉也。
此复申明脉外之气血。从手足阳明之所出也。卫气者。乃阳明之悍气。上冲于头。循目 耳
前。散行于三阳。复循牙车。合阳明。并下人迎。合于颔脉。注足阳明。以下行至跗上。故曰面
热者足阳明病。盖以征卫气之悍热太过。而上行于面也。两跗之上。脉坚陷者。足阳明病。盖以
征阳明之气。合于颔脉。以下行至跗上也。阳明之气。下合于胃脉。故曰此胃脉也。夫五脏六腑之
经脉。外合于六气。则为阳明为太阳为太阴。内合于脏腑。则为胃脉为心脉肾脉也。盖脏腑之气。
内合五行。五行外合于六气者也。胃腑所出之血气。别走于脉外者。
注脏腑之大络。从大络而外渗于孙络皮肤。循手阳明之经。大会于尺肤以上鱼。犹脉内之血气。大
会于手太阴之尺寸也。故曰鱼络血者。手阳明病。盖以征脉外之气血。大会于手阳明也。是以帝问
六腑之病。而伯先答手足之阳明。然后论及六腑。盖以申明脉外之气血。出于手足之阳明也。本经
多因病假针。以明阴阳血气之生始出入。脏腑经脉之外内贯通。学人识之无忽。
大肠病者。肠中切痛。而鸣濯濯。冬日重感于寒即泄。当脐而痛。不能久立。与胃同候。取巨
虚上廉。
大肠者传道之官。故病则肠中切痛而鸣濯濯。阳明秉清金之气。故冬日重感于寒即泻。当脐而
痛。大肠主津液。津液者。淖泽注于骨。故病而不能久立也。大肠属胃。故与胃同候。取胃经之巨
虚上廉。
胃病者。腹 胀。胃脘当心而痛。上肢两足膈咽不通。食饮不下。取之三里也。
腹者肠胃之郛郭。胃脘在鸠尾内。正当心处。故病则腹 胀。胃脘当心而痛。上肢。心肺之
分。两胁。肝之分也。食饮入胃。散精于肝。浊气归心。输布于肺。胃病则气逆而不能转输。是以
上肢两胁膈咽不通。食饮不下。当取之三里也。
小肠病者。小腹痛。腰脊控睾而痛。时窘之后。当耳前热。若寒甚。若独肩上热。甚及手小
指次指之间热。若脉陷者。此其候也。手太阳病也。取之巨虚下廉。（睾音皋阴丸也）
小肠病者。谓病小肠之腑气也。小肠名赤肠。为受盛之府。上接于胃。下通大肠。从阑门济
泌别汁而渗入膀胱。其气与膀胱相通。是以小腹痛。腰脊控睾而痛。时窘之后。当耳前热者。病腑
气而痛窘之后。则入于手之
经脉矣。手太阳之脉。起于小指之端。循臂出肩解。上颊入耳中。至目 。脉陷者。此太阳之经
脉病也。故首提曰小肠病。末结曰手太阳病。是腑气之从下而上。合于手太阳之经。故当取之巨
虚下廉。
三焦病者。腹气满。小腹尤坚。不得小便。窘急。溢则水留即为胀。候在足太阳之外大络。大
络在太阳少阳之间。亦见于脉。取委阳。
三焦者。下约膀胱。为决渎之府。病则气不输化。是以膈气满而不得小便也。不得小便。则
窘急而水溢于上。留于腹中而为胀。候在足太阳经外之大络。大络在太阳少阳经脉之间。其脉亦见
于皮部。当取之委阳。此言六腑之气。皆从足三阳之别络。而通于经脉者也。开之曰。按足三阳之
脉。循于足者。亦皆系支别。
膀胱病者。小腹偏肿而痛。以手按之。即欲小便而不得。肩上热。若脉陷。及足小趾外廉。及
胫踝后皆热。若脉陷。取委中央。（踝叶瓦去声）
膀胱者。津液之府。气化则出。腑气病。故小腹肿痛。而不得小便也。肩上足小趾外廉。及
胫踝后。乃足太阳经脉之所循。若热而脉陷。此病腑而及于经矣。故当取委中之中央。
胆病者。善太息。口苦。呕宿汁。心下淡淡。恐人将捕之。嗌中 然。数唾。在足少阳之
本末。亦视其脉之陷下者灸之。其寒热者。取阳陵泉。
胆病。则胆气不升。故太息以伸出之。口苦呕宿汁者。胆汁也。心下淡淡。恐人将捕之者。胆
气虚也。嗌中 然数唾者。少阳之脉病也。足少阳经脉之本在下。其末在颈嗌之间。宜灸之以起
陷下之脉气。其寒热者。少阳之枢证也。当以经取之。少阳之经气。外内出入者也。
黄帝曰。刺之有道乎。岐伯答曰。刺此者。必中气穴。无中肉节。中气穴则针游于巷。中肉
节则皮肤痛。补泻反则病益笃。中筋则筋缓。邪气不出。与其真相搏。乱而不去。反还内着。用
针不审。以顺为逆也。（中去声着音着）
气穴者。腑气所注之经穴。故中气穴则针游于巷。即气穴论之。所谓游针之居。言针入有间。
恢恢乎有余地矣。此言腑邪之从经脉而出于气穴。即上章面热者足阳明病。鱼络血者手阳明病。谓
腑气之从经脉而出于皮肤也。皮肉筋骨。脉外之气分也。若中肉节。即皮肤痛。中筋则筋缓。邪气
不出。与其真气相乱而不去。反还内着。言刺皮肉筋骨。使腑邪不能从气穴而出。元真之气。反
内着而与邪相乱。盖言脉外之气血。合于经脉。而复通于内腑。即上章所谓两跗之上。脉坚陷者足
阳明病。余故曰。本经多因病假针。以明阴阳血气之生始出入。宜顺而不宜逆也。张开之曰。有
邪处泻邪。无邪处补正。邪在经脉而不在肉节。故当泻气穴以去之。反补其肌腠之元真。则真气入
而与邪相搏。故曰补泻反。则病益笃。
脉象涩而严重的是溢饮（水饮停聚于四肢肌肤）。脉象涩而轻微的是筋脉拘挛。这是筋痹。（“颓”音同“颓”，指筋脉松弛或萎软）
肝主管声音的表达。在情志上对应怒。肝气急迫时感到痛苦，所以肝气急甚时会说恶毒的话。肝气微急会产生“肥气”（一种积聚病），位于胁下，形状像倒扣的杯子，这都是有余之邪气所致。
饮食进入胃后，精微物质散布到肝。脉缓主多热，热则导致肝气上逆，所以容易呕吐。“水瘕痹”（水湿结聚而成的痹证），也是由饮食积滞引起的。《灵枢》本经说：“喜怒无常，饮食不节，阴气不足，阳气有余，营气运行不畅，于是发生痈肿。”脉大主肝气盛，盛则郁结愤怒而不能疏达，所以发生内痈。呕吐和鼻衄，是肝气上逆的表现。阴器收缩，是肝气下逆的表现。肝脉抵少腹，上行注入肺，咳嗽牵引小腹疼痛，是经气在上下逆乱的表现。脉小，说明血气都少，少则木火偏盛，所以容易口渴多饮，以及发生消瘅（类似糖尿病的症状）。脉滑主气盛而有热，所以发生疝气。肝主疏泄，肝气盛而有热，所以出现遗尿。溢饮，是水饮留滞于四肢，导致经脉阻滞，所以脉象涩。肝气虚而有寒，所以出现筋脉拘挛和筋痹，因为肝主筋。
脾脉急甚会出现“㾦”（皮肤肌肉萎缩无力）。脉微急会出现膈中（胸膈部位），饮食入胃后又吐出来，大便排出涎沫。脉缓甚会出现痿厥（肢体软弱无力且寒冷）。脉微缓会出现风痿，四肢不能活动。脉大甚会出现突然昏倒如被击打。脉微大会出现疝气，腹部胀大，脓血积聚在肠胃之外。脉小甚会出现寒热往来。脉微小会出现消瘅。脉滑甚会出现小便闭塞不通（癃闭）。脉微滑会出现虫毒引起的腹部发热。脉涩甚会出现肠风（便血）。脉微涩会出现内脏出血，经常排出脓血。（“回”音同“回”）
脉急是因为收敛引缩。脉缓是因为纵弛懈怠。脾主四肢，所以脉急甚会导致肢体痿废。脾有寒不能运化饮食，所以出现膈中症，饮食入胃又吐出，大便排出涎沫。这是因为脾不能游溢津液，使其上归于肺，布散于皮毛，所以涎沫从口而出。痿厥、风痿，都是四肢瘫痪而不能使用。病重则内部病变反映到外部；病轻则病变在外部而不波及内部，所以感觉心里清醒好像没有病一样。脉大是太过之脉。脾为孤脏，属中央土以灌溉四方。太过则让人四肢不能举动，所以出现被击打般昏仆的症状。疝气、腹部胀大、脓血在肠胃之外，都是有餘之邪的积聚。寒热往来，是血气虚弱。脾虚不能为胃传输津液，所以发生消瘅。脾为阴湿之土，湿热则形成疝气和闭癃，湿热则生虫。脾气虚而有寒，则形成肠风，因多血少气，所以排出脓血。
肾脉急甚会出现骨癫疾。脉微急会出现沉厥（下肢冰冷厥逆）和奔豚（气从少腹上冲心胸）。脚不能收持站立，大小便不通。脉缓甚会出现折脊（脊柱折断感）。脉微缓会出现洞泄（完谷不化的腹泻），洞泄就是食物不消化，咽下去又从口中吐出。脉大甚会出现阳痿。脉微大会出现石水（水肿起于脐下至小腹坚硬如石），向上延伸至胃脘，这种死症无法治疗。脉小甚会出现洞泄。脉微小会出现消瘅。脉滑盛会出现小便闭癃。脉微滑会出现骨痿，坐起困难，站起则眼睛看不见东西。脉涩甚会出现大痈。脉微涩会出现女子月经不来，以及痔疮。
肾为阴脏而主骨，阴寒太甚，所以出现骨癫疾。肾是生气之源，正气虚寒，所以出现沉厥。虚气反逆，所以出现奔豚。阴寒在下，所以脚不能收持。肾开窍于二阴，气虚不能气化，所以大小便不通。督脉属于肾贯穿脊柱，脉缓则督脉懈弛，所以出现脊折。戊癸合化火土，以消化进入胃的饮食。肾气缓，所以食物不消化而从口中吐出。阳痿，是指阴器痿软不能勃起。石水是肾水病。向上至胃脘，是水泛而土败。肾气虚则出现洞泄。精血不足则出现消瘅。肾有热，则出现小便闭癃、睾丸肿胀。骨痿坐起困难，是热伤了肾气。眼睛看不见，是热伤了骨精。血气都始于肾，脉涩则血气阻滞，所以出现大痈。气血不行，所以女子月经不来，出现痔疮。
黄帝说：疾病的六种变化（急、缓、大、小、滑、涩），针刺应当怎样处理？岐伯回答说：各种脉急的多为寒证，脉缓的多为热证，脉大的多为气盛血少，脉小的血气都少，脉滑的阳气盛，微有热，脉涩的多血少气，微有寒。因此，刺脉急者，要深进针并长时间留针。刺脉缓者，浅进针并快速出针，以去除其热。刺脉大者，轻微泻其气，不要放出血液。刺脉滑者，快速出针并浅进针，以泻去阳气和血液。刺脉涩者，必须准确刺中血脉，顺着气血运行的逆顺方向长时间留针。必须先按压并循按经脉，出针后迅速按压针孔，不让其出血，以调和经脉。凡是脉小的，阴阳形气都不足，不要用针刺，而要用甘味药物来调理。
六变脉象，是由五脏产生的，是变化的病形表现，有缓、急、大、小、滑、涩六种脉象，这是由于阴阳血气寒热不和，而表现在脉象上的变化。寒气收敛强劲，所以脉急；热气散漫弛缓，所以脉缓。宗气、营气行于脉中，卫气行于脉外，所以脉大主多气。如果血气都少，则脉小。阳气盛而微有热，则脉行滑利；气少则脉行涩滞，因为血随气而行。深进针并长时间留针，是等待阳气到来，使针下产生热感。浅进针并快速出针，是为了去除其热。气盛者轻微泻其气，不放血，以使阴阳血气调和。脉滑者，快速出针并浅进针，是为了泻去脉外的阳热。刺涩脉者，必须准确刺中血脉，顺着气血逆顺方向长时间留针，以调节能脉内外血气。必须先按压并循按，以引导脉外之气。出针后迅速按压针孔，不让其出血，以调和经脉，不让皮肤出血，使脉外之气与脉中之气相和。针刺的作用，是用来调和阴阳血气的不和。如果血气都少，必须用甘药调理，这不是针刺所能资助生发的。按：刺涩脉说必须中其脉，要知道刺急、刺缓，是取脉外之气；刺大、刺滑，是泻脉外之阳，以和脉内之血；刺涩者必中其血，顺着逆顺，必先按而循之，调脉内之血，以致脉外之气。勿用针刺，用甘药调理，是因为血气生于阳明。应当知道血气是胃腑水谷的精微，有行于皮肤之外的，有行于经脉之内的，内外贯通，环转不息。所以善于调尺肤的人，不需要看寸口脉；善于调脉的人，不需要看面色。能参合三者而行医的，可称为上工。上工，是懂得阴阳血气始终出入规律的人。
黄帝说：我听说五脏六腑之气，荥穴、输穴所入的地方叫合穴，请问它们从什么道路进入？进入后连接经过哪里？希望听您讲讲其中的道理。岐伯回答说：这是阳脉的别支进入体内，属于腑的经脉。
按：脏腑的十二经脉，出于手指足趾的井穴，接受皮肤的气血，流注于荥穴，灌注于输穴，进入肘膝部位成为合穴。所以黄帝问五脏六腑之气，荥输所入为合，是从什么道路进入？进入后连接在哪里成为合？经过哪里相连？黄帝总问五脏六腑，是想访明脏的五输穴、腑的六输穴，所出所入的源流。但这已经在《本输》篇论述过了，所以岐伯只回答六腑的合穴，都在足部。再按：脉外的卫气，出于足阳明胃经，上冲头面，散行于三阳经。脉外的气血，从手阳明经的五里穴，布散于肤表。所以手足诸阳之气，都是从上面向下，再从足趾井穴进入脉中，从足交于手。所以说六腑的经脉，都出于足之三阳，上行合于手经。这是阳气出于地中，营运于天表，再从下面贯穿于地脉经水之中。
黄帝说：荥穴、输穴和合穴，各有名称吗？岐伯回答说：荥穴、输穴治疗外经病，合穴治疗内腑病。黄帝说：治疗内腑病怎么样？岐伯说：取用合穴。黄帝说：合穴各有名称吗？岐伯说：胃的合穴在足三里，大肠的合穴在巨虚上廉，小肠的合穴在巨虚下廉，三焦的合穴在委阳，膀胱的合穴在委中，胆的合穴在阳陵泉。黄帝说：如何取穴？岐伯说：取足三里，要低跗（放下脚背）取穴。取巨虚，要举足取穴。取委阳，要屈伸寻找。取委中，要屈膝取穴。取阳陵泉，要正竖膝盖给予定位。从脐下到委阳的阳侧取穴。取各种外经穴位，要舒展肢体从而取得。（“揄”音同“于”，意为引、抒）
这是在申明三阳之气，外合于三阳之经，三阳之经，内合于六腑。所谓太阳、少阳、阳明，是三阳之气。营运于脉外，与六腑的经脉相合。脉外之气与经脉合于荥输之间，所以荥输治外经，治疗在外之经脉。脉内之血气，与三阳之气，合于肘膝之间，所以合穴治内腑。盖脉中之血气，是六腑所出的。三里、巨虚，都是足阳明经，巨虚上下廉，是手太阳、阳明的合穴。所以取三里，要低跗取穴，因为足经位置在下。取巨虚，要举足取穴，想要它伸展向上。委阳，是足太阳经，三焦的合穴，屈伸而索之，是索取三焦之气，往来于上下。膀胱主水，所以屈而取之。少阳属木，所以竖膝予之，使木气条达。从脐下到委阳的阳侧取穴，是说胆与三焦，总属少阳之气。大概说在经脉，则有手与足之分，合于三阴三阳之气，又没有分手与足。取诸外经，是取五脏六腑的荥输穴。揄申而取之，是舒展四肢，使经脉流通。黄帝起初问五脏六腑的荥输，岐伯只答六腑的合，而未说取诸外经，君臣反复问答，是为了详明阴阳血气的出入，经脉内外的贯通。
黄帝说：希望听您讲六腑的病。岐伯回答说：面部发热，是足阳明胃经的病。鱼际络脉充血，是手阳明大肠经的病。两足背上方脉象坚硬下陷，是足阳明胃经的病，这是胃脉。
这是在再次申明脉外气血，从手足阳明所出。卫气，是阳明之悍气，上冲头，循目外眦耳前，散行于三阳，再循牙车，合于阳明，并下行入迎，合于颔脉，注入手足阳明，以下行至足跗上。所以说面部发热是足阳明病，这是征验卫气之悍热太过，而上行于面。两足背上方，脉象坚硬下陷，是足阳明病，这是征验阳明之气，合于颔脉，以下行至足跗。阳明之气，下合于胃脉，所以说这是胃脉。五脏六腑的经脉，外合于六气，则为阳明、太阳、太阴；内合于脏腑，则为胃脉、心脉、肾脉。大概脏腑之气，内合五行，五行外合于六气。胃腑所出的血气，别走于脉外，注入脏腑的大络，从大络外渗于孙络皮肤，循手阳明经，大会于尺肤以上的鱼际，就像脉内血气大会于手太阴的尺寸脉一样。所以说鱼际络脉充血是手阳明病，这是征验脉外气血，大会于手阳明。所以黄帝问六腑的病，而岐伯先答手足之阳明，然后论及六腑，这是为了申明脉外气血，出于手足之阳明。本经多因病假借针刺，以明阴阳血气的生始出入，脏腑经脉的外内贯通，学者识之不可忽视。
大肠病，肠中剧烈疼痛，肠鸣濯濯，冬天再次感受寒邪就腹泻，肚脐周围疼痛，不能久立，与胃病脉候相同，取巨虚上廉。
大肠是传导之官，所以生病则肠中切痛而肠鸣。阳明秉受清金之气，所以冬天重感寒邪即泻。肚脐周围疼痛，大肠主津液，津液淖泽注于骨，所以生病不能久立。大肠属胃，所以与胃同候，取胃经的巨虚上廉。
胃病，腹部胀满，胃脘当心而痛，向上支撑两胁，膈咽不通，饮食不下，取足三里。
腹部是肠胃的外郭，胃脘在鸠尾内，正当心脏位置，所以生病则腹部胀满，胃脘当心而痛。上肢，是心肺的分野；两胁，是肝的分野。饮食入胃，精微散布于肝，浊气归心，输布于肺。胃病则气逆而不能转输，所以上肢、两胁、膈咽不通，饮食不下。应当取足三里。
小肠病，小腹痛，腰脊牵引睾丸疼痛，时常窘迫想大便，当耳前发热，或者很冷，或者单独肩上发热，甚至到手小指和次指之间发热，如果脉象下陷，这是它的征候，是手太阳小肠经的病，取巨虚下廉。（“睾”音同“皋”，指阴丸）
小肠病，是指小肠腑气生病。小肠名叫赤肠，是受盛之腑，上接于胃，下通大肠，从阑门济泌别汁渗入膀胱，其气与膀胱相通，所以小腹痛，腰脊牵引睾丸疼痛，时常窘迫想大便。当耳前发热，是病在腑气而痛，窘迫想大便时，病气进入手的经脉。手太阳经脉，起于小指端，循臂出肩解，上颊入耳中，至目内眦。脉陷，是此太阳经脉病。所以首提曰小肠病，末结曰手太阳病，是腑气从下而上，合于手太阳经，所以应当取巨虚下廉。
三焦病，腹部气满，小腹尤其坚硬，小便不通，窘急，水溢则停留体内即为胀满，征候在足太阳经外的大络，大络在太阳少阳之间，也见于脉象，取委阳。
三焦是下约膀胱，为决渎之腑，生病则气不输化，所以膈气满而小便不通。小便不通，则窘急而水溢于上，留于腹中而为胀。征候在足太阳经外的大络，大络在太阳少阳经脉之间，其脉也见于皮部，应当取委阳。这是说六腑之气，都从足三阳之别络，通于经脉。张开来说：按足三阳之脉，循行于足的，也都系支别。
膀胱病，小腹偏肿而痛，用手按压，就想小便却不得，肩上发热，或者脉象下陷，以及足小趾外侧，以及胫骨踝后都发热，或者脉象下陷，取委中。（“踝”叶音“瓦”，去声）
膀胱是津液之腑，气化则尿液排出。腑气生病，所以小腹肿痛而不得小便。肩上、足小趾外侧、以及胫踝后，是足太阳经脉所循行的部位。如果发热而脉陷，这是病在腑而波及于经，所以应当取委中的中央。
胆病，喜欢叹气，口苦，呕吐宿汁（胆汁），心中澹澹然（心慌不安），害怕别人像要抓捕自己一样，咽喉中干燥，频繁吐唾沫，病位在足少阳经的本末，也可以观察脉象下陷的部位进行艾灸。如果有寒热症状，取阳陵泉。
胆病，则胆气不升，所以叹气以伸出之。口苦、呕吐宿汁，是胆汁。心中澹澹然、害怕别人抓捕，是胆气虚。咽喉干燥、频繁吐唾沫，是少阳经脉病。足少阳经脉的根本在下，其末在颈喉之间，宜灸之以兴起下陷的脉气。如果有寒热，是少阳的枢机证，应当以经取之。少阳的经气，是外内出入的。
黄帝说：针刺有法则吗？岐伯回答说：刺这些病，必须中气穴，不要中肉节。中气穴则针在巷道中游走（指得气顺畅），中肉节则皮肤痛。补泻相反则病更重。中筋则筋缓，邪气不出，与其真相搏，混乱而不离去，反而还内附着。用针不审慎，把顺当作逆。（“着”音同“着”）
气穴，是腑气所注的经穴，所以中气穴则针游于巷，即《气穴论》所说的“游针之居”，意思是针入有空隙，宽绰有余地。这是说腑邪从经脉而出于气穴，即上一章说的“面热者足阳明病，鱼络血者手阳明病”，谓腑气从经脉而出于皮肤。皮肉筋骨，是脉外之气分。如果中肉节，即皮肤痛；中筋则筋缓，邪气不出，与其真气相乱而不离去，反而还内附着。是说刺皮肉筋骨，使腑邪不能从气穴而出，元真之气，反而内着而与邪相乱。大概是说脉外之气血，合于经脉，而复通于内腑，即上一章所说“两跗之上，脉坚陷者足阳明病”。所以我常说，本经多因病假借针刺，以明阴阳血气的生始出入，宜顺而不宜逆。张开来说：有邪处泻邪，无邪处补正。邪在经脉而不在肉节，所以当泻气穴以去之。反补其肌腠的元真，则真气入而与邪相搏，所以说补泻反，则病更重。
Severe *se* (choppy) pulse indicates *Yi Yin* (overflowing drink, fluid retention in the limbs and skin). A mild *se* pulse indicates tendon cramping. This is *Jin Bi* (tendon bi-syndrome, obstruction of tendons). The Liver governs speech. In emotions, it corresponds to anger. The Liver suffers from urgency; thus, severe urgency leads to speaking harsh words. Mild urgency leads to *Fei Qi* (a mass accumulation), located under the hypochondrium, resembling an inverted cup; this is all due to excess pathogenic qi.
When food and drink enter the stomach, their essence is dispersed to the Liver. A *huan* (relaxed/slow) pulse primarily indicates heat; heat causes Liver qi to rebel upward, leading to frequent vomiting. *Shui Jia Bi* (water mass bi-syndrome, obstruction caused by fluid accumulation) is also caused by dietary stagnation. The classic states: "Uncontrolled anger and joy, irregular diet, deficiency of yin qi, excess of yang qi, and failure of Ying qi to circulate lead to the development of abscesses." A *da* (large) pulse indicates盛 (excess) Liver qi; excess leads to depression and anger without smooth discharge, resulting in internal abscesses. Vomiting and epistaxis indicate Liver qi rebelling upward. Retraction of the genitalia indicates Liver qi rebelling downward. The Liver meridian reaches the lower abdomen and ascends to connect with the Lung; coughing that draws pain to the lower abdomen indicates rebellion of meridian qi in the upper and lower parts. A *xiao* (small) pulse indicates deficiency of both blood and qi; deficiency leads to flourishing Wood and Fire, causing excessive thirst and *Xiao Dan* (wasting-thirst syndrome). A *hua* (slippery) pulse indicates excess qi with heat, leading to *Shan* (hernia). The Liver governs free flow; excess Liver qi with heat leads to enuresis. *Yi Yin* occurs when fluids remain in the four limbs, blocking the meridians, hence the *se* pulse. Liver qi deficiency with cold leads to tendon cramping and *Jin Bi*, because the Liver governs the tendons.
A *ji* (tight/tense) pulse on the Spleen mer严重时 leads to *Pi* (skin/muscle wasting). Mild *ji* leads to *Ge Zhong* (obstruction in the chest/diaphragm), where food and drink are vomited back up after ingestion, and stool contains saliva. Severe *huan* leads to *Wei Jue* (flaccidity and coldness of limbs). Mild *huan* leads to *Feng Wei* (wind flaccidity), where the four limbs cannot be used. Severe *da* leads to sudden collapse as if struck. Mild *da* leads to hernia, abdominal distension, and pus/blood accumulation outside the intestines and stomach. Severe *xiao* leads to alternating chills and fever. Mild *xiao* leads to *Xiao Dan*. Severe *hua* leads to *Long* (difficulty urinating). Mild *hua* leads to insect toxin causing abdominal heat. Severe *se* leads to *Chang Feng* (intestinal wind, bleeding from the rectum). Mild *se* leads to internal bleeding, often passing pus and blood.
*Tight* pulses indicate contraction and drawing inward. *Relaxed* pulses indicate laxity and relaxation. The Spleen governs the four limbs; thus, severe tightness leads to limb paralysis. Spleen cold fails to transform and transport food, leading to *Ge Zhong*, where food is vomited back and stool contains saliva. This is because the Spleen cannot float and overflow fluids to ascend to the Lung and distribute them to the skin and hair, so saliva exits from the mouth. *Wei Jue* and *Feng Wei* are all cases of limb paralysis and non-use. Severe cases involve internal disease manifesting externally; mild cases involve external disease not affecting the interior, so the mind feels clear as if healthy. A *da* pulse indicates excess. The Spleen is the solitary organ, Earth in the center, irrigating the four directions. Excess causes the four limbs to be unable to move, leading to collapse as if struck. Hernia, abdominal distension, and pus/blood outside the intestines are accumulations of excess pathogens. Alternating chills and fever indicate deficiency of blood and qi. Spleen deficiency fails to transport fluids for the Stomach, leading to *Xiao Dan*. The Spleen is Yin-damp Earth; damp-heat leads to hernia and urinary retention (*Long*); damp-heat generates parasites. Spleen qi deficiency with cold leads to *Chang Feng*; due to abundant blood and deficient qi, pus and blood are passed.
Severe *ji* pulse on the Kidney meridian leads to *Gu Dian Ji* (bone mania/epilepsy). Mild *ji* leads to *Chen Jue* (deep cold reversal) and *Ben Tun* (running piglet/qi rushing upward from the lower abdomen). The feet cannot support the body, and there is inability to pass urine or stool. Severe *huan* leads to *Zhe Ji* (broken spine sensation). Mild *huan* leads to *Dong Xie* (hole diarrhea, undigested food). *Dong* means food is not digested and regurgitated after swallowing. Severe *da* leads to *Yin Wei* (impotence). Mild *da* leads to *Shi Shui* (stone water, edema starting below the navel to the lower abdomen, hard as stone), extending up to the epigastrium; this is fatal and untreatable. Severe *xiao* leads to *Dong Xie*. Mild *xiao* leads to *Xiao Dan*. Excessive *hua* leads to urinary retention. Mild *hua* leads to *Gu Wei* (bone flaccidity), difficulty sitting and rising, and blindness upon standing. Severe *se* leads to large abscesses. Mild *se* leads to amenorrhea in women and hemorrhoids.
The Kidney is a Yin organ governing bones; extreme Yin-cold leads to bone mania. The Kidney is the source of vital qi; deficiency and cold of true qi lead to deep cold reversal. Rebellious deficient qi leads to running piglet. Yin-cold in the lower jiao leads to inability to support the feet. The Kidney opens into the two yin orifices; qi deficiency fails to transform, leading to inability to pass urine or stool. The Du meridian belongs to the Kidney and penetrates the spine; laxity leads to spinal collapse. Wu and Gui combine to transform into Fire and Earth to digest food. Kidney qi laxity leads to undigested food regurgitation. Impotence refers to flaccid genitals. Stone water is Kidney water disease. Extension to the epigastrium indicates water flooding and Earth failure. Kidney qi deficiency leads to hole diarrhea. Essence and blood deficiency lead to wasting-thirst. Kidney heat leads to urinary retention and testicular swelling. Bone flaccidity with difficulty rising indicates heat injuring Kidney qi. Blindness indicates heat injuring bone essence. Blood and qi originate in the Kidney; *se* pulse indicates blood and qi stagnation, leading to large abscesses. Lack of blood and qi circulation leads to amenorrhea and hemorrhoids.
Huangdi said: Regarding the six changes of disease, how should acupuncture be applied? Qibo replied: Tight pulses mostly indicate cold; relaxed pulses mostly indicate heat; large pulses indicate excess qi and deficient blood; small pulses indicate deficient blood and qi; slippery pulses indicate excess yang qi with slight heat; choppy pulses indicate excess blood and deficient qi with slight cold. Therefore, for tight pulses, insert deeply and retain for a long time. For relaxed pulses, insert shallowly and withdraw quickly to dispel heat. For large pulses, slightly reduce qi without bleeding. For slippery pulses, withdraw quickly and insert shallowly to reduce yang qi and blood. For choppy pulses, must penetrate the vessel, follow the direction of flow, and retain for a long time. First press and massage the area. After withdrawing the needle, quickly press the acupoint to prevent bleeding and harmonize the vessel. For small pulses, where yin and yang, form and qi are all deficient, do not use needles but regulate with sweet medicines.
The six changes are generated by the five Zang organs and represent changing pathological forms. There are six pulse types: huan, ji, da, xiao, hua, se. These arise from disharmony of yin/yang, blood/qi, and cold/heat manifesting in the pulse. Cold qi contracts and stiffens, hence tight pulses. Heat qi scatters and relaxes, hence relaxed pulses. Zong qi and Ying qi circulate within the vessels; Wei qi circulates outside. Hence, large pulses indicate excess qi. If blood and qi are deficient, the pulse is small. Excess yang qi with slight heat makes the pulse slippery and rapid. Deficient qi makes the pulse choppy and sluggish, as blood follows qi. Deep insertion and long retention wait for yang qi arrival and warmth under the needle. Shallow insertion and quick withdrawal remove heat. Slightly reducing qi in excess cases without bleeding harmonizes yin/yang and blood/qi. For slippery pulses, quick shallow withdrawal disperses external yang-heat. For choppy pulses, penetrating the vessel and following flow direction regulates internal/external blood/qi. Pressing and massaging guides external qi. Quick pressing after withdrawal prevents skin bleeding and harmonizes internal/external qi. Acupuncture regulates disharmony of yin/yang and blood/qi. If blood/qi are deficient, sweet medicine is required, as needles cannot generate life. Note: Treating choppy pulses requires penetrating the vessel. Treating tight/relaxed pulses takes external qi. Treating large/slippery pulses reduces external yang to harmonize internal blood. Treating choppy pulses penetrates blood, follows flow, presses/massages first to regulate internal blood and guide external qi. Do not use needles for deficiencies; use sweet medicine because blood/qi are generated by Yangming. Blood/qi are essences of grain/water from the Stomach; some circulate outside the skin, some inside the vessels, connecting internally and externally in a continuous cycle. Thus, one skilled in regulating the chi (forearm) pulse does not need the cun (wrist) pulse; one skilled in regulating the pulse does not need the complexion. Integrating these three makes a superior physician (Shang Gong), who understands the beginning, end, entry, and exit of yin/yang and blood/qi.
Huangdi said: I have heard that the qi of the five Zang and six Fu organs enters at the He-sea points following the Ying and Shu points. From what pathway do they enter? Where do they connect and pass through? Please explain. Qibo replied: This is the branch of the Yang meridians entering internally, belonging to the Fu organs.
Note: The twelve meridians of the Zang and Fu organs emerge from the Jing-well points at the fingers/toes, receive qi/blood from the skin, flow into Ying points, pour into Shu points, and enter the elbows/knees as He-sea points. Thus, Huangdi asked about the pathway of entry for Ying/Shu/He points. This was already discussed in the Ben Shu chapter, so Qibo only answers regarding the He-sea points of the Fu organs, which are on the foot. Furthermore, Wei qi emerges from Foot Yangming, rushes to the head/face, and scatters through the Three Yang meridians. External blood/qi spreads from the Wuli point of Hand Yangming to the skin surface. Thus, qi of all hand and foot Yang meridians descends from above and re-enters the vessels at the Jing-well points of the toes, moving from foot to hand. Therefore, Fu organ meridians all emerge from the Three Yang meridians of the foot and ascend to connect with the hand meridians. This is yang qi emerging from the earth, circulating on the heavenly surface, and descending through the earthly meridians.
Huangdi said: Do Ying, Shu, and He points have specific names? Qibo replied: Ying and Shu points treat external meridians; He-sea points treat internal Fu organs. Huangdi said: How to treat internal Fu organs? Qibo said: Take the He-sea points. Huangdi said: Do He-sea points have specific names? Qibo said: The Stomach He-sea is Zusanli (ST36). The Large Intestine He-sea is Shangjuxu (ST37). The Small Intestine He-sea is Xiajuxu (ST39). The Sanjiao He-sea is Weiyang (BL39). The Bladder He-sea is Chengshan (BL57) [Note: Text says Wei Zhong/BL40, but standard is BL57 for Bladder He, though BL40 is major He. Context implies BL40/Weizhong based on text "Wei Zhong"]. The Gallbladder He-sea is Yanglingquan (GB34). Huangdi said: How to locate them? Qibo said: For Zusanli, lower the dorsum of the foot. For Juxu, raise the foot. For Weiyang, flex and extend to find it. For Weizhong, flex the knee to take it. For Yanglingquan, vertically extend the knee. Take the Yang side from below the navel to Weiyang. For external meridians, stretch and extend the limbs to access them.
This clarifies that Three Yang qi externally combines with Three Yang meridians, and internally with Six Fu organs. Taiyang, Shaoyang, and Yangming are Three Yang qi, circulating outside the vessels and combining with Fu organ meridians. External qi combines with vessels at Ying/Shu points, so Ying/Shu treat external meridians. Internal blood/qi combines with Three Yang qi at the elbows/knees, so He-sea points treat internal Fu organs. Blood/qi in vessels originates from Fu organs. Zusanli and Juxu are Foot Yangming. Shangjuxu and Xiajuxu are He-sea of Hand Taiyang and Yangming. To take Zusanli, lower the foot because the foot meridian is inferior. To take Juxu, raise the foot to extend it upward. Weiyang is Foot Taiyang, Sanjiao He-sea; flexing/extending seeks Sanjiao qi moving up and down. Bladder governs water, so flex to take it. Shaoyang belongs to Wood, so vertically extend the knee to allow Wood qi to flourish. Taking the Yang side from navel to Weiyang indicates Gallbladder and Sanjiao both belong to Shaoyang. In meridians, there is hand/foot distinction; in combining with Three Yin/Yang qi, there is no hand/foot distinction. Taking external meridians refers to Ying/Shu of Zang/Fu. Stretching limbs ensures smooth meridian flow. Huangdi initially asked about Ying/Shu of Zang/Fu; Qibo answered only Fu He-sea, omitting external meridians. The dialogue clarifies entry/exit of yin/yang and blood/qi, and internal/external connection of meridians.
Huangdi said: I wish to hear about diseases of the Six Fu organs. Qibo replied: Heat in the face indicates Foot Yangming disease. Blood in the collaterals of the thenar eminence (Yu) indicates Hand Yangming disease. Hard, depressed pulses on the dorsum of both feet indicate Foot Yangming disease; this is the Stomach meridian.
This reiterates that external blood/qi emerges from Hand and Foot Yangming. Wei qi is the fierce qi of Yangming, rushing to the head, circling the eyes and ears, scattering through Three Yang, returning to the jaw, combining with Yangming, descending to Renying, combining with Hanmai, pouring into Foot Yangming, and descending to the dorsum of the foot. Thus, facial heat indicates Foot Yangming disease, verifying excessive fierce heat of Wei qi ascending to the face. Hard, depressed pulses on the dorsum of the feet verify Yangming qi combining with Hanmai and descending to the foot. Yangming qi combines with the Stomach meridian below, hence "this is the Stomach meridian." Meridians of Zang/Fu externally combine with Six Qi (Yangming, Taiyang, Taiyin) and internally combine with Zang/Fu (Stomach, Heart, Kidney). Zang/Fu qi internally combines with Five Elements, which externally combine with Six Qi. Blood/qi exiting the Stomach Fu branches outside the vessels, pours into the great collaterals of Zang/Fu,渗es into sun-collaterals and skin, follows Hand Yangming, and converges at the Yu above the Chi-skin, just as internal blood/qi converges at Cun/Guan of Hand Taiyin. Thus, blood in Yu collaterals indicates Hand Yangming disease, verifying convergence of external blood/qi at Hand Yangming. Hence, when asked about Fu diseases, Qibo first answers Hand/Foot Yangming before discussing other Fu organs, to clarify that external blood/qi emerges from Hand/Foot Yangming. This classic often uses disease and acupuncture examples to illustrate generation, entry, exit, and internal/external connection of yin/yang, blood/qi, and Zang/Fu meridians. Scholars should not neglect this.
Large Intestine disease involves severe intestinal pain and gurgling sounds. Re-exposure to cold in winter causes diarrhea, pain around the umbilicus, and inability to stand for long periods. The pulse prognosis is similar to Stomach disease; take Shangjuxu (ST37).
The Large Intestine is the official of transmission; disease causes severe pain and gurgling. Yangming inherits Clear Metal qi; thus, winter cold causes diarrhea. Pain around the umbilicus occurs because the Large Intestine governs fluids, which moisten bones; disease prevents standing. The Large Intestine belongs to the Stomach, so pulse prognosis is shared; take ST37 of the Stomach meridian.
Stomach disease involves abdominal distension, pain in the epigastrium corresponding to the heart, upward support to the arms and legs, obstruction of the diaphragm and throat, and inability to swallow food/drink. Take Zusanli (ST36).
The abdomen is the outer wall of the intestines/stomach. The epigastrium is within Jiwei, directly over the heart; disease causes distension and heart-area pain. The upper limbs correspond to Heart/Lung; the hypochondrium corresponds to Liver. Food enters the Stomach, essence goes to Liver, turbid qi to Heart, distributed to Lung. Stomach disease causes qi rebellion and failure to transport, leading to obstruction in limbs/hypochondrium/diaphragm/throat and dysphagia. Take Zusanli.
Small Intestine disease involves lower abdominal pain, pain radiating from the waist/spine to the testes, frequent urgency to defecate, heat in front of the ears, coldness, isolated shoulder heat, or heat extending to the space between the little finger and ring finger. If the pulse is depressed, this is the sign of Hand Taiyang Small Intestine disease. Take Xiajuxu (ST39).
Small Intestine disease refers to Fu qi pathology. The Small Intestine is named Red Intestine, the official of reception. It connects above to the Stomach and below to the Large Intestine, separating clear/turbid at the Lanmen and渗ing into the Bladder. Its qi communicates with the Bladder, causing lower abdominal pain, radiating pain to testes, and urgency. Heat in front of the ears indicates Fu qi pain; urgency moves qi into the hand meridian. Hand Taiyang meridian starts at the little finger, goes up the arm, out of the shoulder joint, to the cheek, into the ear, to the inner canthus. Depressed pulse indicates Taiyang meridian disease. Thus, it starts as Small Intestine disease and ends as Hand Taiyang disease, showing Fu qi ascending to combine with the Hand Taiyang meridian. Take Xiajuxu.
Sanjiao disease involves abdominal fullness, especially hardness in the lower abdomen, inability to urinate, urgency, and if fluids overflow, retention causing distension. The sign is in the great collateral outside the Foot Taiyang meridian, between Taiyang and Shaoyang, visible in the pulse. Take Weiyang (BL39).
The Sanjiao binds the Bladder below and is the official of drainage. Disease causes failure of qi transformation, leading to fullness and urinary retention. Retention causes urgency and fluid overflow into the abdomen, causing distension. The sign is in the great collateral outside Foot Taiyang, between Taiyang and Shaoyang, visible in the skin region. Take Weiyang. This shows Fu qi connects to meridians via branches of Foot Three Yang. Note: Foot Three Yang meridians on the foot have branches.
Bladder disease involves unilateral lower abdominal swelling and pain. Pressure induces the urge to urinate but fails. Heat in the shoulder, depressed pulse, heat on the lateral aspect of the little toe, and heat behind the tibial malleolus with depressed pulse indicate this. Take Weizhong (BL40).
The Bladder is the official of fluids; qi transformation allows excretion. Fu disease causes swelling/pain and urinary retention. The shoulder, lateral little toe, and posterior malleolus are pathways of Foot Taiyang. Heat and depressed pulse indicate Fu disease affecting the meridian. Take the center of Weizhong.
Gallbladder disease involves frequent sighing, bitter taste, vomiting of old bile, palpitations (Dan Dan), fear of being caught, dryness in the throat, and frequent spitting. The disease is at the root and extremity of Foot Shaoyang. Moxibustion can be applied to depressed pulses. For chills and fever, take Yanglingquan (GB34).
Gallbladder disease causes stagnant qi, relieved by sighing. Bitter taste and vomiting old bile are gallbladder juice. Palpitations and fear indicate deficient Gallbladder qi. Throat dryness and spitting indicate Shaoyang meridian disease. Foot Shaoyang root is below, extremity is at the throat. Moxibustion raises depressed qi. Chills/fever are Shaoyang pivot symptoms; treat via the meridian. Shaoyang qi moves in/out.
Huangdi said: Is there a principle for acupuncture? Qibo replied: When treating these, must hit the Qi-acupoints (Qi-Xue), not flesh joints. Hitting Qi-acupoints allows the needle to roam freely in the alley; hitting flesh joints causes skin pain. Wrong tonification/reduction worsens the disease. Hitting tendons causes flaccidity; pathogenic qi does not exit, mixes with true qi, becomes chaotic, and returns internally. Unskilled acupuncture turns compliance into rebellion.
Qi-acupoints are where Fu qi pours into meridians. Hitting them allows free needle movement (as per Qi-Xue chapter). This shows Fu pathogenic qi exiting meridians via Qi-acupoints, i.e., from meridians to skin (as seen in facial heat/Yu blood signs). Skin/flesh/tendons/bones are external qi divisions. Hitting flesh joints causes pain; hitting tendons causes flaccidity. Pathogenic qi stays, mixes with true qi, and rebounds internally. This means needling skin/flesh/tendons/bones prevents Fu pathogenic qi from exiting via Qi-acupoints, causing true qi to mix internally with pathogens. It illustrates that external blood/qi combines with meridians and connects to internal Fu organs (e.g., depressed pulses on foot dorsum). Thus, this classic uses disease/acupuncture to illustrate yin/yang/blood/qi dynamics and internal/external connections. One should follow rather than oppose. Note: Dispel pathogenic qi where present; tonify righteous qi where absent. Pathogens are in meridians, not flesh joints; thus, reduce Qi-acupoints to expel them. Tonifying muscle/cutaneous true qi causes true qi to clash with pathogens, worsening the disease ("wrong tonification/reduction").