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บทที่ 10 จาก 10
难经
Question: The medical classic says, "For deficiency syndrome use supplementation, for excess syndrome use drainage; when neither deficient nor excessive, treat the affected meridian itself." What does this mean?
Answer: For deficiency syndrome, one should supplement its mother organ/meridian; for excess syndrome, one should drain its child organ/meridian; for mixed deficiency and excess conditions, one should first supplement the mother, then drain the child. The so-called "not deficient, not excessive, treat the meridian itself" means this is a disease arising from the meridian itself, not an external pathogen invading another meridian, so one should treat it by selecting points on the affected meridian itself.
Question: In spring and summer needling should be shallow; in autumn and winter needling should be deep. Why?
Answer: In spring and summer yang qi is above, and the body's qi movement is also relatively upward, so needling should be shallow; in autumn and winter yang qi is below, and the body's qi movement is also relatively downward, so needling should be deep.
Question: In spring and summer one should cause one yin to be drawn out beneath the needle; in autumn and winter one should cause one yang to be pushed in beneath the needle. What does this mean?
Answer: In spring and summer the climate is warm; to draw in one yin, when inserting the needle first pierce deeply to the depth of the kidney and liver, and after obtaining qi, draw the yin qi upward. In autumn and winter the climate is cold; to conduct one yang, when inserting the needle first insert superficially floating to the depth of the heart and lung, and after obtaining qi, push the yang qi deep inward. This is why in spring and summer one must conduct one yin, and in autumn and winter one must conduct one yang.
Question: The medical classic says, "When needling nutritive qi, do not injure defensive qi; when needling defensive qi, do not injure nutritive qi." What does this mean?
Answer: When needling the yang aspect (defensive aspect), use a flat/lateral needling technique. When needling the yin aspect (nutritive aspect), first use the left hand to press the selected Ying-spring point or Shu-stream point and other areas, causing the local defensive qi to disperse before inserting the needle. This is needling the nutritive without injuring defensive, and needling defensive without injuring nutritive.
Question: The medical classic says, "One who can master the qi of ying and followed (ni-shun) can regulate qi mechanisms; the method of regulating qi has its key in yin and yang." What does this mean?
Answer: What is called "Ying-sui" is understanding the flow of nutritive and defensive qi (nutritive qi moving within the vessels and defensive qi moving outside the vessels) and the direction of meridian flow. Selecting points according to the adverse or favorable direction of the meridian is called Ying-sui. To regulate qi one must grasp yin and yang, that is, understand disease internally, externally, superficially, and deeply, adjusting according to yin-yang attributes. Thus it is said the key to regulating qi lies in yin and yang.
Question: Various Jing-well points are located in areas where the muscles are shallow and thin, with little qi, insufficient for applying needling techniques. What should be done when needing to needle the Jing-well point?
Answer: The Jing-well point belongs to Wood, and the Ying-spring point belongs to Fire. Fire is the child of Wood. When one should needle the Jing-well point, one may use draining the Ying-spring point instead. Thus the medical classic says, "Supplementation cannot be equated with drainage; drainage cannot be equated with supplementation." This is precisely what is being discussed.
Question: The medical classic says, "In spring needle the Jing-well points; in summer needle the Ying-spring points; in late summer needle the Shu-stream points; in autumn needle the Jing-river points; in winter needle the He-sea points." Why?
Answer: In spring one needles the Jing-well points because the pathogen resides in the liver. In summer one needles the Ying-spring points because the pathogen resides in the heart. In late summer one needles the Shu-stream points because the pathogen resides in the spleen. In autumn one needles the Jing-river points because the pathogen resides in the lung. In winter one needles the He-sea points because the pathogen resides in the kidney.
Question: The liver, heart, spleen, lung, and kidney respond to spring, summer, autumn, and winter. Why?
Answer: Once the five viscera become diseased, it is often manifested in multiple aspects such as the five colors, five smells, five tastes, five sounds, and five fluids. For example, for liver disease: a blue/blue-green complexion belongs to liver, fetid odor belongs to liver, preference for sour belongs to liver, preference for shouting belongs to liver, tendency to tears belongs to liver. There are many related manifestations, impossible to exhaust in detail. The four seasons have certain rhythms and correspond to the five viscera. The subtlety of acupuncture is in it delicate precision like an autumn hair.
Question: The medical classic says, "When the East is excessive and the West is deficient, use the method of draining the South and supplementing the North." What does this mean?
Answer: Metal, Wood, Water, Fire, and Earth should mutually control and balance each other. The East belongs to Wood, and the West belongs to Metal. If Wood is about to become excessive, Metal should control it. If Fire is about to become excessive, Water should control it. If Earth is about to become excessive, Wood should control it. If Metal is about to become excessive, Fire should control it. If Water is about to become excessive, Earth should control it. The East belongs to the liver, hence one knows the liver is excess. The West belongs to the lung, hence one knows the lung is deficient. Drain the South's Fire, supplement the North's Water. The South's Fire is the child of Wood; the North's Water is the mother of Wood. Water can overcome Fire. The child's replenishment can make the mother excess, and the mother's emptiness can make the child deficient. Therefore, draining Fire and supplementing Water is to avoid relying solely on Metal to control Wood. The medical classic says: "If one cannot treat the deficiency, why ask about the rest?" This is what it means.
Note: The phrase "desiring that Metal not be used to level Wood" (yin zhang Ling jin bu de ping mu ye) is one of the more difficult passages in the Difficult Classic. It broadly means that since the lung (Metal) is already deficient, one should not rely solely on lung Metal to restrain liver Wood; instead one should indirectly restore balance by draining heart Fire and supplementing kidney Water. This is presented here only as a traditional theoretical study point.
Question: What is called "supplementation and drainage"? When supplementing, from where is qi taken? When draining, to where is the qi placed?
Answer: When supplementing, qi is taken from the defensive aspect. When draining, qi is placed into the nutritive aspect. If yang qi is insufficient and yin qi is surplus, one should first supplement the yang, then drain the yin. If yin qi is insufficient and yang qi is surplus, one should first supplement the yin, then drain the yang. It is crucial to allow nutritive and defensive qi in particular to flow freely; this is the key.
Question: The medical classic says, "Advanced practitioners treat disease before it occurs; ordinary practitioners treat disease after it has already developed." What does this mean?
Answer: The so-called treating disease before it occurs means when one sees liver disease, one knows the liver disease will transmit to the spleen. Therefore one first strengthens/hardens the spleen qi to prevent the spleen from being harmed by the liver pathogen. This is called treating disease before it occurs. An ordinary practitioner, upon seeing liver disease, does not know about transmission; they only focus on treating the liver. This is called treating disease after it has already developed.
Question: In acupuncture, there are supplementation and drainage methods. What do they mean?
Answer: Supplementation/drainage needling techniques do not necessarily rely on coordinating with breathing during insertion and withdrawal. The true expert values the left hand; the inexperienced only trust the right hand. When needling, one first uses the left hand to press the selected Ying-spring and Shu-stream points, uses fingers to pluck/vibrate to fill the area, and uses the nail to press/cut the point. Wait for qi to arrive like the pulse of a moving artery, then along with that moment, insert properly. After obtaining qi, push the needle deeper for supplementation. After obtaining qi, shake the needle and withdraw it upward for drainage. If qi is not obtained, reposition 99: in men slightly outward/escape, women slightly inward. If qi is consistently not obtained per the ancients, the condition is grave and very difficult to treat.
Question: The medical classic says, "When needling against the flow of meridian qi and taking away from it, how is it not deficiency? Milking and drawing along with the flow of qi, when invigorating, does it truly supplement? Deficinility and excess of these two states is like grasping, then losing; excess and deficiency; / like being there vs absent that point/sequence." What does this mean?
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No fabrication keep reader cautious respectful high valued remains precisely.## 難經第69－81難
問：醫經說「虛證用補法，實證用瀉法，不實不虛就取本經治療」，是什麼意思？
答：虛證應當補它的母臟/母經，實證應當瀉它的子臟/子經；對虛實夾雜的情況，應當先補其母，然後再瀉其子。所謂「不實不虛，以經取之」，是說這是本經自身發生的病，不是外邪侵入他經，所以應當取本經的腧穴來治療。
問：春夏針刺宜淺，秋冬針刺宜深，為什麼？
答：春夏陽氣在上，人體的氣機也偏上，所以應當淺刺；秋冬陽氣在下，人體的氣機也偏下，所以應當深刺。
問：春夏要使針下引出一陰，秋冬要使針下推入一陽，是什麼意思？
答：春夏氣候溫暖，要引一陰，進針時先深刺到腎肝的深度，得氣後把陰氣引持平上來；秋冬氣候寒冷，要致一陽，進針時先淺刺浮至心肺的深度，得氣後把陽氣推入深處。這就是春夏必致一陰、秋冬必致一陽。
問：醫經說「刺營氣不要傷衛氣，刺衛氣不要傷營氣」，是什麼意思？
答：刺陽分（衛分）時，用臥針平刺；刺陰分（營分）時，先用左手按壓要刺的滎穴、俞穴等處，使局部衛氣散開後再進針。這就是刺營不傷衛、刺衛不傷營。
問：醫經說「能掌握迎隨之氣，就可以調理氣機；調氣的方法，關鍵在陰陽」，是什麼意思？
答：所謂「迎隨」，是了解營衛（營氣與衛氣，營行脈中、衛行脈外）的流行和經脈的往來方向。根據經脈的逆順方向來取穴，就叫迎隨。調氣必須把握陰陽，是了解病在內、外、表、裡，根據陰陽屬性來調整，所以說調氣的方法關鍵在於陰陽。
問：各井穴在肌肉淺薄處，氣少，不足以施行手法，那要刺井穴時怎麼辦？
答：井穴屬木，滎穴屬火。火是木之子。應當刺井穴時，可以用瀉滎穴來代替。所以醫經說「補法不能當作瀉法，瀉法不能當作補法」，就是說的就是這個道理。
問：醫經說春天刺井穴，夏天刺滎穴，季夏刺俞穴，秋天刺經穴，冬天刺合穴，為什麼？
答：春天刺井穴，是因為邪在肝；夏天刺滎穴，是因為邪在心；季夏刺俞穴，是因為邪在脾；秋天刺經穴，是因為邪在肺；冬天刺合穴，是因為邪在腎。
問：肝、心、脾、肺、腎，與春夏秋冬相應，為什麼？
答：五臟一旦生病，往往會正五色、五臭、五味、五聲、五液等多個方面表現出來。比如肝病，面色青屬肝，氣味臊屬肝，喜酸屬肝，喜呼叫屬肝，喜流淚屬肝。相關表現很多，不能一一說盡。四時有一定節律，與五臟相應。針刺的奧妙在於秋毫般精細。
問：醫經說「東方實，西方虛，用瀉南方、補北方的方法」，是什麼意思？
答：金、木、水、火、土應當相互制約平衡。東方屬木，西方屬金。木欲過實，金應當早制它；火欲過實，水應當早制它；土欲過實，木應當早制它；金欲過實，火應當早制它；水欲過實，土應當早制它。東方屬肝，所以知道肝實；西方屬肺，所以知道肺虛。瀉南方火，補北方水。南方火是木之子；北方水是木之母。水能勝火。子能令母實，母能令子虛，所以瀉火補水，是為了不單靠金去早木。醫經說：不能治療其虛，何必再問其他，就是說的這個。
註：此段「欲令金不得平木也」是《難經》較難理解處，大致指肺已虛，不能只靠肺金去制肝木，而應通過瀉心火、補腎水來間接恢復平衡。此處僅作傳統理法研讀。
問：什麼叫補瀉？當補的時候從哪裡取氣？當瀉的時候從哪裡置氣？
答：當補時，從衛分取氣；當瀉時，從營分置氣。如果陽氣不足、陰氣有餘，應當先補其陽，後瀉其陰；如果陰氣不足、陽氣有餘，應當先補其陰，後瀉其陽。讓營衛通行，這是關鍵。
問：醫經說「上工治未病，中工治已病」，是什麼意思？
答：所謂治未病，是見到肝病，就知道肝病會傳給脾，所以先充實脾氣，不讓脾受到肝邪的侵害，所以叫治未病。中工見到肝病，不知道它會傳變，只一心治肝，所以叫治已病。
問：針法有補有瀉，是什麼意思？
答：補瀉手法，不一定非要配合呼吸進出針。真正會針的人，重視左手；不會針的人，只信右手。針刺時，先用左手按壓要刺的滎穴、俞穴，用手指彈擊使局部充盈，用指甲切按，等氣來如動脈搏動狀，再順勢刺入。得氣後，把針推進深部，是補法；得氣後，搖動針體並向外提伸，是瀉法。如果沒有得氣，就應當調整針位，男子偏外、女子偏內；如果始終不得氣，古人認為病情危重，難以救治。
問：醫經說「迎著經脈之氣而奪之，怎麼不虛？隨著經脈之氣而濟之，怎麼不實？虛與實，若得若失；實與虛，若有若無」，是什麼意思？
答：迎而奪之，是瀉它的子穴；隨而濟之，是補它的母穴。例如心病，瀉手厥陰心包經的俞穴，就是迎而奪之；補手厥陰心包經的井穴，就是隨而濟之。所謂實與虛，是指針下氣感的堅牢與濡軟。氣來堅實為得，濡軟空虛為失，所以說若得若失。
問：醫經說「有見如入，有見如出」，是什麼意思？
答：所謂有見如入、有見如出，是指左手候到經氣來至才進針；針入後，候到氣盡就出針。這就是有見如入、有見如出。
問：醫經說「不要使實證更實、虛證更虛，不要損害不足而補益有餘」，這是指寸口脈嗎？還是疾病本身有虛實？怎樣損補？
答：這是指疾病，不是寸口脈。疾病本身有虛實。例如肝實而肺虛，肝屬木，肺屬金，金木應當相互制約，應知用金來平木。假如肺實而肝虛，病人稍有少氣，用針時不補肝，反而更實肺，這就是「實實虛虛」，損害不足而補益有餘。這是中等醫生造成的危害。
這十三難集中討論針刺治療的核心原則，可以歸納為幾條：
補母瀉子 💡
六十九難、七十三難、七十九難、七十五難反覆運用五行生剋關係。虛證補其母，實證瀉其子，是古代針灸補瀉的重要思路。例如井穴屬木，滎穴屬火，火為木之子，所以瀉井可用瀉滎代替。
四時刺法與人體陽氣位置 🍂
七十難、七十四難說明針刺深淺、五輸穴選擇要與季節相應。春夏陽氣在上在表，宜淺刺；秋冬陽氣在下在裡，宜深刺。這體現了「人與天地相應」的整體觀。
營衛深淺與刺法分寸 🩺
七十一難、七十六難強調針刺要分清營分和衛分，補法從衛取氣，瀉法從營置氣。刺衛用平刺，刺營先按壓散氣，避免相互損傷。
迎隨調氣與陰陽 💨
七十二難指出，調氣的根本在於辨陰陽、知內外表裡。迎隨不是簡單手法，而是要了解營衛流行、經脈往來方向。
治未病與臟腑傳變 🌿
七十七難是中醫「治未病」思想的經典表述。見肝之病，知肝傳脾，先實脾，防止疾病傳變。這體現了整體觀和預防思想。
得氣與補瀉操作 🔥
七十八難、八十難強調左手候氣、得氣後推內為補、動伸為瀉。得氣是判斷針刺效果的重要標誌。八十一難則警示不能「實實虛虛」，避免誤治加重病情。
這些內容屬於古代針灸理論體系，具有重要的歷史和文化價值。
關聯概念：
五輸穴（井、滎、俞、經、合）、母子補瀉、迎隨補瀉、營衛、得氣、治未病、五行生剋、四時刺法、實實虛虛
延伸閱讀：
《靈樞·九針十二原》《靈樞·本輸》《靈樞·終始》《素問·刺要論》《素問·四氣調神大論》《金匱要略·臟腑經絡先後病脈證》
本內容基於中醫經典古籍，僅供傳統文化學習與研讀，不構成任何醫療診斷、用藥或治療建議；如有不適請及時就醫。
——卜瓜