黄帝曰。余以小针为细物也。夫子乃言上合之于天。下合之于地。中合之于人。余以为过针之意矣。愿闻其故。岐
伯曰。何物大于天乎。夫大于针者。惟五兵者焉。五兵者死之备也。非生之具。且夫人者。天地之镇也。其不可不参乎。
夫治民者。亦唯针焉。夫针之与五兵。其孰小乎。黄帝曰。病之生时。有喜怒不测。饮食不节。阴气不足。阳气有余。
营气不行。乃发为痈疽。阴阳不通。两热相搏。乃化为脓。小针能取之乎。岐伯曰。圣人能不使化者。为知邪不可留也。
（言圣人能不使化脓者为知邪不可留而早治之也待脓已成岂小针之治乎）故两军相当。旗帜相望。白刃陈于中野者。此
非一日之谋也。能使其民。令行禁止。士卒无白刃之难者。非一日之教也。须臾之得也。夫至使身被痈疽之病。脓血之
聚者。不亦离道远乎。夫痈疽之生。脓血之成也。不从天下。不从地出。积微之所生也。故圣人自治于未有形也。愚者
遭其已成也。黄帝曰。其已形。不予遭。脓已成。不予见。为之奈何。岐伯曰。脓已成。十死一生。故圣人弗使已成。
而明为良方。着之竹帛。使能者踵而传之后世。无有终时者。为其不予遭也。黄帝曰。其已有脓血而后遭乎。不导之以
小针治乎。岐伯曰。以小治小者其功小。以大治大者多害。故其已成脓血者。其唯砭石铍锋之所取也。黄帝曰。多害者。
其不可全乎。岐伯曰。其在逆顺焉。黄帝曰。愿闻逆顺。岐伯曰。以为伤者。其白眼青。黑睛小。是一逆也。内药而呕
者。是二逆也。腹痛渴甚。是三逆也。肩项中不便。是四逆也。音嘶色脱。是五逆也。除此五者为顺矣。黄帝曰。诸病
皆有逆顺。可得闻乎。岐伯曰。腹胀。身热。脉大。是一逆也。腹鸣而满。四肢清泄。其脉大。是二逆也。衄而不止。
脉大。是三逆也。咳且溲血。脱形。其脉小劲。是四逆也。咳脱形。身热。脉小以疾。是五逆也。如是者。不过十五日
而死矣。其腹大胀。四末清。脱形。泄甚。是一逆也。腹胀。便血。其脉大。时绝。是二逆也。咳。溲血。形肉脱。脉
搏。是三逆也。呕血。胸满引背。脉小而疾。是四逆也。咳呕。腹胀且飧泄。其脉绝。是五逆也。如是者。不及一时而
死矣。工不察此者而刺之。是谓逆治。黄帝曰。夫子之言针甚骏。以配天地。上数天文。下度地纪。内别五脏。外次六
腑。经脉二十八会。尽有周纪。能杀生人。不能起死者。（二句承上启下在有意无意之间不能起死即暗指前诸逆也）夫子
能反之乎。岐伯曰。能杀生人。不能起死者也。黄帝曰。余闻之。则为不仁。然愿闻其道。弗行于人。岐伯曰。是明道
也。其必然也。如刀剑之可以杀人。如饮酒之使人醉也。虽勿诊犹可知矣。黄帝曰。愿卒闻之。岐伯曰。人之所受气者
谷也。谷之所注者胃也。胃者水谷气血之海也。海之所行云气者天下也。胃之所出气血者。经隧也。经隧者五脏六腑之
大络也。迎而夺之而已矣。黄帝曰。上下有数乎。岐伯曰。迎之五里。中道而止五至而已。五往而脏之气尽矣。故五五
二十五而竭其输矣。此所谓夺其天气者也。非能绝其命而倾其寿者也。（句义与上下不续非字疑当作是字）黄帝曰。愿卒
闻之。岐伯曰。 门而刺之者。死于家中。入门而刺之者。死于堂上。黄帝曰。善乎方。明哉道。请着之玉版。以为重
宝。传之后世。以为刺禁。令民勿敢犯也。
帝先疑小针之无大功也。而岐伯极称之下。乃接叙痈疽之重者。诸病之逆者。皆非小针所能治。以诘小针之果。无
大功也。末乃推论针害以结之通篇一气。贯注前后。尤笔致纡徐婉转关生深情 。
黄帝说：我认为小针是细微之物。先生却说它上合于天，下合于地，中合于人。我认为这超出了对小针本意的理解。希望能听听其中的缘故。
岐伯说：有什么东西比天更大呢？比针更大的，只有五种兵器（戈、殳、戟、弓矢、矛）。五种兵器是死亡的预备，不是生存的工具。况且人，是天地的主宰。人的身体怎能不与天地相参验呢？治理百姓，也仅靠针罢了。针与五兵相比，哪个更小呢？
黄帝说：疾病产生之时，往往有喜怒无常，饮食不节制，导致阴气不足，阳气有余，营气运行不畅，于是发为痈疽（皮肤及皮下组织的化脓性炎症）。阴阳之气不通，两热相互搏结，于是化为脓液。小针能治愈这种情况吗？
岐伯说：圣人能够防止病情发展到化脓阶段，是因为知道邪气不可留滞。（意思是圣人懂得防止化脓，是因为知道邪气不可留滞而及早治疗；如果等到脓已形成，岂是小针所能治疗的？）所以两军对垒，旗帜相望，白刃陈列在田野之中，这不是一天的谋划就能做到的。能使民众令行禁止，士兵免受白刃之害的，也不是一天的教导就能实现的，这是长期积累的结果。至于使身体遭受痈疽之病，脓血积聚，岂不是离大道太远了吗？痈疽的产生，脓血的形成，不是从天上掉下来，也不是从地里长出来，而是由微小因素逐渐积累而成的。所以圣人在疾病尚未显现时就加以调理，愚者则等到疾病已经形成才遭遇它。
黄帝说：如果疾病已经成形，我没有遇到；脓已经形成，我没有看见，该怎么办呢？
岐伯说：脓已经形成，十个人中有九个会死，只有一个能活。所以圣人防止疾病发展到已成脓的阶段，并明确制定良方，写在竹简丝帛上，让有能力的人继承并传给后世，使其没有终结的时候，就是为了应对那些未能提前预防的情况。
黄帝说：如果已经有脓血而后才遇到，不用小针来治疗吗？
岐伯说：用小针治疗大病，功效很小；用大方法治疗大患，往往造成很多危害。所以对于已经形成脓血的情况，唯有使用砭石（石针）和铍锋（一种手术刀）来取除脓血。
黄帝说：造成很多危害，难道就不能完全治愈吗？
岐伯说：这取决于是否违背了疾病的顺逆规律。
黄帝说：希望听听什么是顺证和逆证。
岐伯说：如果患者眼睛白眼多、黑眼珠小，这是一逆（预后不良）。服药后呕吐，是二逆。腹痛且极度口渴，是三逆。肩颈部位活动不便，是四逆。声音嘶哑、面色枯槁无华，是五逆。除了这五种情况外，其余为顺证。
黄帝说：各种疾病都有顺证和逆证，可以讲讲吗？
岐伯说：腹部胀满，身体发热，脉象洪大，是一逆。肠鸣且腹部胀满，四肢厥冷，腹泻，脉象洪大，是二逆。鼻出血不止，脉象洪大，是三逆。咳嗽且小便带血，形体消瘦，脉象小而劲急，是四逆。咳嗽、形体消瘦、身体发热，脉象小而快，是五逆。像这样的情况，不超过十五天就会死亡。
另外，腹部胀大，四肢清冷，形体消瘦，腹泻严重，是一逆。腹部胀满，大便出血，脉象洪大，时而断绝，是二逆。咳嗽，小便带血，肌肉脱失，脉搏躁动有力，是三逆。呕血，胸部胀满牵引背部疼痛，脉象小而快，是四逆。咳嗽、呕吐，腹部胀满且完谷不化（泄泻），脉象断绝，是五逆。像这样的情况，不到一个时辰就会死亡。医生如果不明察这些情况而进行针刺，这就叫做“逆治”（错误的治法）。
黄帝说：先生的话关于针道非常精妙，配合天地，上数天文，下度地理，内别五脏，外序六腑，经脉二十八会，周流全身。但针能杀生人（导致活人死亡），不能起死回生。（这两句承上启下，意在言外，不能起死即暗指前面提到的各种逆证）先生能改变这一点吗？
岐伯说：针确实能杀生人，但不能起死回生。
黄帝说：我听说这样的话，就觉得很不仁义。然而希望能听听其中的道理，不要施行于人身。
岐伯说：这是明确的道理，是必然的规律。就像刀剑可以杀人，就像饮酒使人醉酒一样。即使不进行诊断也可以知道。
黄帝说：希望详尽地听您讲解。
岐伯说：人所受纳的气来源于谷物。谷物所注入的是胃。胃是水谷气血的海洋。海洋所运行的云气就是天下（比喻气血运行遍布全身）。胃所输出的气血，通过经隧（经络通道）。经隧是五脏六腑的大络脉。迎而夺之（逆着经气方向针刺以泻实）就可以了。
黄帝说：上下有定数吗？
岐伯说：针刺五里穴，中途就要停止，刺五次就够了。刺五次后，脏气就耗尽了。所以五五二十五次，就会竭尽输穴中的气血。这就是所谓的“夺其天气”。这并不是直接断绝生命或折损寿命，而是过度泻实导致的后果。（此句义与前文不连贯，“非”字疑当作“是”字）
黄帝说：希望详尽地听您讲解。
岐伯说：在门内针刺（指误刺重要穴位），病人会死在家中；进入厅堂再针刺（指病情加重后误刺），病人会死在厅堂上。
黄帝说：这个方子真好，这个道理真明白。请把它刻在玉版上，作为重宝，传给后世，作为针刺禁忌，让百姓不敢违犯。
【按语】
黄帝起初怀疑小针没有大功，而岐伯极力推崇它。接着叙述痈疽重症、诸病逆证，都不是小针所能治疗的，以此诘问小针果真是无功用的吗？最后推论针害以总结全文，通篇一气贯注，笔致迂徐婉转，关涉生死之情深意切。
Huangdi said: I consider the small needle to be a minute object. Yet you say it corresponds to Heaven above, Earth below, and Humanity in between. I believe this exceeds the true meaning of the needle. I wish to hear the reason.
Qibo said: What is greater than Heaven? Among things greater than the needle, there are only the Five Weapons (spear, halberd, dagger-axe, bow, and arrow). The Five Weapons are instruments of death, not of life. Moreover, humanity is the anchor of Heaven and Earth. How can it not correspond with them? To govern the people, one relies solely on the needle. Comparing the needle with the Five Weapons, which is smaller?
Huangdi said: When diseases arise, they often stem from uncontrolled joy or anger, irregular diet, deficiency of Yin Qi, excess of Yang Qi, and stagnation of Ying Qi (Nutritive Qi), leading to carbuncles and sores (purulent inflammation of skin and subcutaneous tissue). When Yin and Yang fail to communicate and two heats clash, pus is formed. Can the small needle treat such conditions?
Qibo said: The Sage prevents progression to suppuration because he knows that pathogenic factors must not remain stagnant. (This means the Sage understands that preventing pus formation requires early treatment; once pus has formed, it is beyond the scope of small needle therapy.) Thus, when two armies face each other, banners visible, and white blades arrayed in the fields, this is not the result of a plan made in a single day. To enable the people to obey orders and prohibit actions, and for soldiers to avoid harm from blades, is not achieved in a single day's instruction but through long-term cultivation. If one allows the body to suffer from carbuncles and sores, with accumulation of pus and blood, is this not far from the Great Dao? The generation of carbuncles and sores, and the formation of pus and blood, do not fall from the sky nor emerge from the earth; they arise from the accumulation of minute factors. Therefore, the Sage regulates health before disease manifests, while the fool encounters disease after it has already formed.
Huangdi said: If the disease has already taken shape and I have not encountered it; if pus has already formed and I have not seen it, what should be done?
Qibo said: Once pus has formed, nine out of ten patients will die, with only one surviving. Therefore, the Sage prevents disease from reaching the stage of suppuration and clearly formulates effective prescriptions, inscribing them on bamboo slips and silk, so that capable successors may transmit them to future generations without end, thereby addressing cases where prevention was neglected.
Huangdi said: If pus and blood have already formed and then I encounter the case, should I not treat it with the small needle?
Qibo said: Using small methods to treat large diseases yields little effect; using major interventions for major ailments often causes significant harm. Therefore, for conditions where pus and blood have already formed, only bi stone (lithic needles) and pi feng (a type of surgical knife) should be used to drain them.
Huangdi said: Causing significant harm, does this mean complete cure is impossible?
Qibo said: It depends on whether one violates the patterns of Shun (favorable) and Ni (unfavorable) in disease progression.
Huangdi said: I wish to hear about Shun and Ni.
Qibo said: If the patient has excessive whites in the eyes and small pupils, this is the first unfavorable sign (poor prognosis). Vomiting after taking medicine is the second unfavorable sign. Abdominal pain with extreme thirst is the third unfavorable sign. Inability to move the shoulders and neck is the fourth unfavorable sign. Hoarseness and loss of luster in complexion is the fifth unfavorable sign. Apart from these five conditions, the rest are favorable signs.
Huangdi said: All diseases have favorable and unfavorable signs; may I ask about them?
Qibo said: Abdominal distension, fever, and a large pulse constitute the first unfavorable sign. Bowel sounds with abdominal fullness, cold extremities, diarrhea, and a large pulse constitute the second unfavorable sign. Unstopping epistaxis with a large pulse constitutes the third unfavorable sign. Coughing with hematuria, emaciation, and a small yet forceful pulse constitute the fourth unfavorable sign. Coughing, emaciation, fever, and a small rapid pulse constitute the fifth unfavorable sign. In such cases, death occurs within fifteen days.
Furthermore, massive abdominal distension, cold extremities, emaciation, and severe diarrhea constitute the first unfavorable sign. Abdominal distension, bloody stool, large pulse, and intermittent pulse cessation constitute the second unfavorable sign. Coughing, hematuria, muscle wasting, and a surging pulse constitute the third unfavorable sign. Hematemesis, chest fullness radiating to the back, and a small rapid pulse constitute the fourth unfavorable sign. Coughing, vomiting, abdominal distension with undigested food in stool, and an absent pulse constitute the fifth unfavorable sign. In such cases, death occurs within less than one shi (two hours). If physicians fail to observe these signs and proceed with acupuncture, it is called "Ni Zhi" (incorrect treatment).
Huangdi said: Your words regarding needle therapy are profound, aligning with Heaven and Earth, counting celestial phenomena above, measuring terrestrial boundaries below, distinguishing the Five Zang internally, and ordering the Six Fu externally, covering the twenty-eight meridians and their cycles completely. Yet, needles can kill living persons but cannot revive the dead. (These sentences serve as a transition, implying that inability to revive refers to the previously mentioned unfavorable signs.) Can you reverse this?
Qibo said: Needles can indeed kill living persons, but cannot revive the dead.
Huangdi said: Hearing this, I feel it is inhumane. However, I wish to understand the principle, provided it is not applied to human bodies.
Qibo said: This is a clear principle and an inevitable law. Just as swords and knives can kill, and just as alcohol intoxicates, this can be known even without diagnosis.
Huangdi said: I wish to hear this in detail.
Qibo said: The Qi received by humans comes from grain. Grain enters the Stomach. The Stomach is the sea of water and grain, generating Qi and Blood. As the sea distributes clouds and air throughout the world, the Qi and Blood output from the Stomach travel through Jing Sui (meridian channels). These Jing Sui are the great collaterals of the Five Zang and Six Fu. One simply needs to attack them by迎 (Ying -迎着经气方向, against the flow) and seize (夺 - draining excess).
Huangdi said: Are there fixed numbers above and below?
Qibo said: When needling the Wuli point, one must stop midway after five thrusts. After five thrusts, the Qi of the Zang is exhausted. Thus, five sets of five (twenty-five) thrusts will deplete the Qi at the Shu points. This is referred to as "stealing Heavenly Qi." It does not directly sever life or shorten lifespan, but results from excessive draining. (The meaning here seems disconnected; "Fei" [not] is suspected to be a typo for "Shi" [is].)
Huangdi said: I wish to hear this in detail.
Qibo said: If one needles inside the gate, the patient dies at home; if one needles after entering the hall, the patient dies in the hall.
Huangdi said: Excellent is this prescription, clear is this Dao. Please inscribe it on the Jade Tablet as a precious treasure, to be transmitted to posterity as acupuncture contraindications, so that the people dare not violate them.
[Commentary]
Huangdi initially doubted the efficacy of the small needle, while Qibo extolled its virtues. The text then discusses severe carbuncles and unfavorable signs of various diseases, none of which can be treated by the small needle, questioning its utility. Finally, it deduces the harms of needling to conclude the chapter. The entire passage flows as one continuous breath, with a narrative style that is leisurely and tactful, deeply concerned with matters of life and death.