素问·调经论 Treatise on Regulating the Channels
黄帝问曰：余闻刺法言，有馀写之，不足补之，何谓有馀，何谓不足。歧伯对曰：有馀有五，不足亦有五，帝欲何问。帝曰；愿尽闻之。歧伯曰：神有馀有不足，气有馀有不足，血有馀有不足，形有馀有不足，志有馀有不足，凡此十者，其气不等也。帝曰：人有精气津液，四支九窍，五藏十六部，三百六十五节，乃生百病，百病之生，皆有虚实，今夫子乃言有馀有五，不足亦有五，何以生之乎。歧伯曰：皆生于五藏也。夫心藏神，肺藏气，肝藏血，脾藏肉，肾藏志，而此成形，志意通内连骨髓，而成身形五藏，五藏之道，皆出于经隧以行血气，血气不和，百病乃变化而生，是故守经隧焉。
帝曰：神有馀不足何如。歧伯曰：神有馀则笑不休，神不足则悲。血气未并，五藏安定，邪客于形，洒淅起于毫毛，未入于经络也，故命曰神之微。帝曰：补写柰何。歧伯曰：神有馀，则写其小络之血，出血勿之深斥，无中其大经，神气乃平。神不足者，视其虚络，按而致之，刺而利之，无出其血，无泄其气，以通其经，神气乃平。帝曰：刺微柰何。歧伯曰：按摩勿释，著针勿斥，移气于不足，神气乃得复。
帝曰：善。有馀不足柰何。歧伯曰：气有馀则喘咳，上气不足，则息利少气。血气未并，五藏安定，皮肤微病，命曰白气微泄。帝曰：补写柰何。歧伯曰：气有馀，则写其经隧，无伤其经，无出其血，无泄其气。不足，则补其经隧，无出其气。帝曰：刺微柰何。歧伯曰：按摩勿释，出针视之，曰我将深之，适人必革，精气自伏，邪气散乱，无所休息，气泄腠理，真气乃相得。
帝曰：善。血有馀不足，柰何。歧伯曰：血有馀则怒，不足则恐。血气未并，五藏安定，孙络水溢，则经有留血。帝曰：补写柰何。歧伯曰：血有馀，则写其盛经出其血。不足，则视其虚经内针其脉中，久留而视，脉大，疾出其针，无令血泄。帝曰：刺留血，柰何。歧伯曰：视其血络，刺出其血，无令恶血得入于经，以成其疾。
帝曰：善。形有馀不足柰何。歧伯曰：形有馀则腹胀泾溲不利，不足则四支不用。血气未并，五藏安定，肌肉蠕动，命曰微风。帝曰：补写柰何。歧伯曰：形有馀则写其阳经，不足则补其阳络。帝曰：刺微柰何。歧伯曰：取分肉间，无中其经，无伤其络，卫气得复，邪气乃索。
帝曰：善。志有馀不足柰何。歧伯曰：志有馀则腹胀飱泄，不足则厥。血气未并，五藏安定，骨节有动。帝曰：补写柰何。歧伯曰：志有馀则写然筋血者，不足则补其复溜。帝曰：刺未并柰何。歧伯曰：即取之，无中其经，邪所乃能立虚。
帝曰：善。余已闻虚实之形，不知其何以生。歧伯曰：气血以并，阴阳相倾，气乱于卫，血逆于经，血气离居，一实一虚。血并于阴，气并于阳，故为惊狂。血并于阳，气并于阴，乃为炅中。血并于上，气并于下，心烦惋善怒。血并于下，气并于上，乱而喜忘。帝曰：血并于阴，气并于阳，如是血气离居，何者为实，何者为虚。歧伯曰：血气者，喜温而恶寒，寒则泣不能流，温则消而去之。是故气之所并为血虚，血之所并为气虚。帝曰：人之所有者，血与气耳。今夫子乃言血并为虚，气并为虚，是无实乎。歧伯曰：有者为实，无者为虚，故气并则无血，血并则无气，今血与气相失，故为虚焉。络之与孙脉俱输于经，血与气并，则为实焉。血之与气并走于上，则为大厥，厥则暴死，气复反则生，不反则死。帝曰：实者何道从来，虚者何道从去，虚实之要，愿闻其故。歧伯曰：夫阴与阳，皆有俞会，阳注于阴，阴满之外，阴阳匀平，以充其形，九候若一，命曰平人。
夫邪之生也，或生于阴，或生于阳。其生于阳者，得之风雨寒暑。其生于阴者，得之饮食居处，阴阳喜怒。帝曰：风雨之伤人柰何。歧伯曰：风雨之伤人也，先客于皮肤，传入于孙脉，孙脉满则传入于络脉，络脉满则输于大经脉，血气与邪并客于分腠之闲，其脉坚大，故曰实。实者外坚充满，不可按之，按之则痛。帝曰：寒湿之伤人柰何。歧伯曰：寒湿之中人也，皮肤不收，肌肉坚紧，荣血泣，卫气去，故曰虚。虚者聂辟气不足，按之则气足以温之，故快然而不痛。帝曰：善。阴之生实柰何。歧伯曰：喜怒不节，则阴气上逆，上逆则下虚，下虚则阳气走之，故曰实矣。帝曰：阴之生虚柰何。歧伯曰：喜则气下，悲则气消，消则脉虚空，因寒饮食，寒气熏满，则血泣气去，故曰虚矣。
帝曰：经言阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒，余已闻之矣，不知其所由然也。歧伯曰：阳受气于上焦，以温皮肤分肉之闲。令寒气在外，则上焦不通，上焦不通，则寒气独留于外，故寒栗。帝曰：阴虚生内热柰何。歧伯曰：有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，胃气热，热气熏胸中，故内热。帝曰：阳盛生外热柰何。歧伯曰：上焦不通利，则皮肤致密腠理闭塞，玄府不通，卫气不得泄越，故外热。帝曰：阴盛生内寒柰何。歧伯曰：厥气上逆，寒气积于胸中而不写，不写则温气去，寒独留，则血凝泣，凝则脉不通，其脉盛大以涩，故中寒。
帝曰：阴与阳并，血气以并，病形以成，刺之柰何。歧伯曰：刺此者，取之经隧，取血于营，取气于卫，用形哉，因四时多少高下。帝曰：血气以并，病形以成，阴阳相倾，补写柰何。歧伯曰：写实者气盛乃内针，针与气俱内，以开其门如利其户，针与气俱出，精气不伤，邪气乃下，外门不闭，以出其疾，摇大其道，如利其路，是谓大写，必切而出，大气乃屈。帝曰：补虚柰何。歧伯曰：持针勿置，以定其意，候呼内针，气出针入，针空四塞，精无从去，方实而疾出针，气入针出，热不得还，闭塞其门，邪气布散，精气乃得存，动气候时，近气不失，远气乃来，是谓追之。
帝曰：夫子言虚实者有十，生于五藏，五藏五脉耳。夫十二经脉，皆生其病，今夫子独言五藏，夫十二经脉者，皆络三百六十五节，节有病，必被经脉，经脉之病，皆有虚实，何以合之。歧伯曰：五藏者，故得六府与为表里，经络支节，各生虚实，其病所居，随而调之。病在脉，调之血。病在血，调之络。病在气，调之卫。病在肉，调之分肉。病在筋，调之筋。病在骨，调之骨。燔针劫刺其下，及与急者。病在骨，焠针药熨。病不知所痛，两蹻为上。身形有痛，九候莫病，则缪刺之。痛在于左而右脉病者，巨刺之。必谨察其九候，针道备矣。
Huangdi asked: I have heard it said in the methods of needling that in cases of excess one should drain, and in cases of deficiency one should supplement. What is meant by excess, and what is meant by deficiency? Qibo replied: There are five kinds of excess, and likewise five kinds of deficiency. What does Your Majesty wish to ask? Huangdi said: I wish to hear of them all. Qibo said: Spirit may be in excess or deficient; qi may be in excess or deficient; blood may be in excess or deficient; form may be in excess or deficient; and will may be in excess or deficient. These ten conditions all involve qi that is unequal. Huangdi said: A person possesses essence, qi, and fluids, the four limbs and nine orifices, the five viscera and sixteen regions, and the three hundred sixty-five joints, from which the hundred diseases are born. And in the birth of the hundred diseases there is always deficiency or excess. Now Master, you speak of five kinds of excess and five kinds of deficiency—how do these arise? Qibo said: They all arise from the five viscera. The heart stores the spirit, the lung stores qi, the liver stores blood, the spleen stores the flesh, and the kidney stores the will; from these the bodily form is completed. Will and intention penetrate within and connect with the marrow and bones, thereby completing the body's form and the five viscera. The pathways of the five viscera all issue from the channel passages, through which blood and qi travel. When blood and qi are not harmonious, the hundred diseases arise through transformation—therefore one must guard the channel passages.
Huangdi asked: What of spirit in excess or deficiency? Qibo said: When spirit is in excess, one laughs without cease; when spirit is deficient, one grieves. Before blood and qi have combined with the pathogen and the five viscera remain settled, if a pathogen lodges in the body it produces a shivering that arises from the fine hairs, not yet having entered the channels and network vessels—this is called a subtle affection of the spirit. Huangdi asked: How does one supplement or drain in this case? Qibo said: When spirit is in excess, drain the blood of its small network vessels; let blood out, but do not press too deeply, and do not strike the great channel—then the spirit qi will be leveled. When spirit is deficient, observe its empty network vessels, press upon them to draw qi there, needle to free them, but do not let blood out, do not drain the qi—so as to open the channel, and the spirit qi will be leveled. Huangdi asked: How does one needle a subtle case? Qibo said: Massage without release, insert the needle without dislodging it, and move qi to where it is deficient—then the spirit qi can be restored.
Huangdi said: Good. What of qi in excess or deficiency? Qibo said: When qi is in excess there is panting and coughing with qi rising upward; when qi is deficient, breathing is uneven and qi is scant. Before blood and qi have combined and the five viscera remain settled, there is a slight affection of the skin, called a subtle leakage of white qi. Huangdi asked: How does one supplement or drain? Qibo said: When qi is in excess, drain its channel passage, but do not injure the channel, do not let blood out, do not drain the qi. When deficient, supplement its channel passage, but do not let the qi escape. Huangdi asked: How does one needle a subtle case? Qibo said: Massage without release; when withdrawing the needle, observe it, saying, 'I shall insert it deeply'; once it truly enters, the response will surely change—the essential qi will naturally settle, the pathogenic qi will scatter and disperse with nowhere to rest, the qi will leak out through the interstices, and the true qi will thereby find its proper place.
Huangdi said: Good. What of blood in excess or deficiency? Qibo said: When blood is in excess there is anger; when deficient there is fear. Before blood and qi have combined and the five viscera remain settled, if the grandchild network vessels overflow with fluid, then there is retained blood in the channel. Huangdi asked: How does one supplement or drain? Qibo said: When blood is in excess, drain its abundant channel and let out its blood. When deficient, observe its empty channel and insert the needle within its vessel, retaining it long while observing; when the vessel becomes full, withdraw the needle quickly, without letting blood escape. Huangdi asked: How does one needle retained blood? Qibo said: Observe its blood network vessels, needle to let out the blood, and do not let malign blood enter the channel, lest it become a chronic ailment.
Huangdi said: Good. What of form in excess or deficiency? Qibo said: When form is in excess there is abdominal distension and difficulty in urination and defecation; when deficient, the four limbs cannot be used. Before blood and qi have combined and the five viscera remain settled, the flesh twitches faintly—this is called subtle wind. Huangdi asked: How does one supplement or drain? Qibo said: When form is in excess, drain its yang channel; when deficient, supplement its yang network vessel. Huangdi asked: How does one needle a subtle case? Qibo said: Select the spaces between the flesh, without striking the channel and without injuring the network vessel—then the defensive qi can be restored and the pathogenic qi will disperse.
Huangdi said: Good. What of will in excess or deficiency? Qibo said: When will is in excess there is abdominal distension and undigested diarrhea; when deficient there is reversal cold. Before blood and qi have combined and the five viscera remain settled, there is stirring in the bones and joints. Huangdi asked: How does one supplement or drain? Qibo said: When will is in excess, drain the blood at Rangu; when deficient, supplement at Fuliu. Huangdi asked: How does one needle when blood and qi have not yet combined? Qibo said: Needle it at once, without striking the channel, and the place of the pathogen can immediately be made deficient.
Huangdi said: Good. I have now heard the forms of deficiency and excess, but do not know how they arise. Qibo said: When qi and blood have combined with a pathogen, yin and yang tip against each other; qi becomes disordered in the defensive level, blood rebels within the channels, and blood and qi become separated from their proper places—one becomes excess, the other deficient. When blood combines in the yin and qi combines in the yang, this produces fright and mania. When blood combines in the yang and qi combines in the yin, this produces a burning within. When blood combines above and qi combines below, there is vexation in the heart and a tendency to anger. When blood combines below and qi combines above, there is confusion and a tendency to forgetfulness. Huangdi asked: When blood combines in the yin and qi combines in the yang, and thus blood and qi are separated from their places, which is excess and which is deficient? Qibo said: Blood and qi delight in warmth and are averse to cold; when cold, they congeal and cannot flow; when warm, they dissolve and disperse. Therefore, wherever qi combines, blood becomes deficient there; wherever blood combines, qi becomes deficient there. Huangdi said: What a person possesses is only blood and qi. Now Master, you say that where blood combines there is deficiency, and where qi combines there is deficiency—is there then no excess at all? Qibo said: Where something is present, that is excess; where something is absent, that is deficiency. Thus where qi combines there is no blood, and where blood combines there is no qi. Now, since blood and qi have lost each other, this is called deficiency. The network vessels and grandchild vessels all convey into the channels; when blood and qi combine there, this becomes excess. When blood and qi together rush upward, this produces great reversal; in reversal there is sudden death—if the qi returns, the person lives; if it does not return, the person dies. Huangdi asked: By what path does excess arrive, and by what path does deficiency depart? I wish to hear the essentials of deficiency and excess. Qibo said: Yin and yang each have their transport points and meeting places. Yang pours into yin, and yin fills to the outside; when yin and yang are evenly balanced, the body is thereby nourished, and the nine indicators are as one—this is called a balanced person.
Now, in the generation of pathogens, some are generated in the yin, some in the yang. Those generated in the yang are contracted through wind, rain, cold, and summer heat. Those generated in the yin are contracted through diet, dwelling, and excesses of yin and yang or joy and anger. Huangdi asked: How does injury from wind and rain affect a person? Qibo said: When wind and rain injure a person, they first lodge in the skin, then are transmitted inward to the grandchild vessels; when the grandchild vessels are full, they are transmitted into the network vessels; when the network vessels are full, they pour into the great channel vessels. Blood and qi combine with the pathogen and lodge between the interstices of the flesh, so that the vessel becomes firm and large—hence it is called excess. In excess, the exterior is firm and full, and cannot bear pressing; pressing produces pain. Huangdi asked: How does injury from cold and dampness affect a person? Qibo said: When cold and dampness strike a person, the skin fails to contract, the flesh becomes tight and firm, the nutritive blood congeals, and the defensive qi departs—hence it is called deficiency. In deficiency, the flesh is wrinkled and sunken, the qi insufficient; pressing on it allows the qi to warm it, hence it feels pleasant and is not painful. Huangdi said: Good. How does excess arise in the yin? Qibo said: When joy and anger are not moderated, yin qi rebels upward; when it rebels upward, the lower part becomes deficient; when the lower part is deficient, yang qi rushes into it—hence it is called excess. Huangdi asked: How does deficiency arise in the yin? Qibo said: Joy causes qi to descend, grief causes qi to dissipate; when qi dissipates, the vessel becomes empty and hollow. When this is compounded by cold food and drink, cold qi steams and fills the interior, the blood congeals and the qi departs—hence it is called deficiency.
Huangdi asked: The classics say that when yang is deficient there is external cold, when yin is deficient there is internal heat, when yang is in excess there is external heat, and when yin is in excess there is internal cold. I have already heard this, but do not know why it is so. Qibo said: Yang receives its qi from the upper burner, which warms the skin and the space between the flesh. If cold qi lodges in the exterior, then the upper burner becomes obstructed; when the upper burner is obstructed, cold qi alone remains in the exterior—hence there is cold and shivering. Huangdi asked: How does deficiency of yin give rise to internal heat? Qibo said: When there has been overexertion and fatigue, the bodily form and qi decline and diminish, grain qi is not abundant, the upper burner fails to move, and the lower stomach-duct fails to open; the stomach qi becomes heated, and this heat steams the chest—hence there is internal heat. Huangdi asked: How does excess of yang give rise to external heat? Qibo said: When the upper burner is obstructed and fails to flow freely, the skin becomes dense and the interstices close up, the mysterious gateways fail to open, and the defensive qi cannot be released and dispersed—hence there is external heat. Huangdi asked: How does excess of yin give rise to internal cold? Qibo said: When reversal qi rebels upward, cold qi accumulates in the chest without being drained; if it is not drained, warm qi departs and cold alone remains; the blood then congeals, and once congealed the vessels fail to flow freely—the vessel becomes large and rough, hence there is internal cold.
Huangdi asked: When yin and yang combine with pathogens, when blood and qi combine, and the form of disease is thereby completed, how does one needle this? Qibo said: In needling such cases, select the channel passages; draw blood from the nutritive level, draw qi from the defensive level, and make use of the bodily form, according to the season, whether abundant or scant, high or low. Huangdi asked: When blood and qi have combined and the form of disease has been completed, and yin and yang tip against each other, how does one supplement and drain? Qibo said: To drain excess, insert the needle once the qi is abundant; let the needle enter together with the qi, opening its gate as though loosening its door; let the needle withdraw together with the qi, so that the essential qi is not injured and the pathogenic qi is thereby brought down. Do not close the outer gate, so as to let the ailment out; shake wide its passage, as though clearing its path—this is called great draining; one must press firmly as the needle is withdrawn, so that the great pathogenic qi is thereby subdued. Huangdi asked: How does one supplement deficiency? Qibo said: Hold the needle without placing it yet, to steady one's intent; await the exhalation and insert the needle; as the qi goes out, the needle goes in; let the needle's hollow be sealed on all four sides, so that the essential qi has nowhere to escape; when it becomes truly replete, withdraw the needle quickly; as the qi enters, the needle comes out, so that heat cannot return; close its gate, so that the pathogenic qi is dispersed and the essential qi may thereby be preserved. Move the qi and await the right moment, so that the near qi is not lost and the distant qi will then arrive—this is called pursuing it.
Huangdi asked: Master, you have spoken of ten kinds of deficiency and excess, arising from the five viscera—the five viscera having five vessels. Yet the twelve channel vessels all give rise to disease; now Master, you speak only of the five viscera. The twelve channel vessels all connect with the three hundred sixty-five joints; when a joint is diseased, it must affect the channel vessel, and the diseases of the channel vessels all involve deficiency or excess—how are these to be reconciled? Qibo said: The five viscera are paired in exterior-interior relation with the six bowels; the channels, network vessels, and joints each give rise to their own deficiency or excess, and one regulates according to where the disease resides. If the disease is in the vessel, regulate the blood. If the disease is in the blood, regulate the network vessels. If the disease is in the qi, regulate the defensive level. If the disease is in the flesh, regulate the spaces between the flesh. If the disease is in the sinews, regulate the sinews. If the disease is in the bone, regulate the bone. Use fire-heated needles for rapid piercing where the disease lies and where there is tension. If the disease is in the bone, use the tempered needle together with medicinal fomentation. If the disease's location of pain cannot be identified, the two springing vessels are best to treat. If the body has pain but the nine indicators show no disease, then apply crossed needling. If the pain is on the left but the affected vessel is diseased on the right, apply great needling. One must carefully examine the nine indicators, and the way of needling will then be complete.