灵枢经云。凡将用针。必先诊脉。脉法繁多。用针者以六字概括。曰缓急大小滑
涩（一）。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。
涩者多血而少气。微有寒。六脉主五脏诸病。详见经文。不繁赘。惟小脉不可针。诸小
者。阴阳形气俱不足。勿取以针
而调以甘药也。
盖阴阳虚实互有盛衰者。则补之泻之。人迎主三阳。寸口主三阴。人迎大寸口一倍
二倍三倍。则三阳气盛。当泻三阳而补三阴。寸口大人迎一倍二倍三倍。则三阴气盛。
当泻三阴而补三阳。盛则泻之。虚则补之。热则疾之。寒则留之。此补泻寒热之正法
也。不盛不虚。以经取之。此调和营卫之常法也。如久病阴阳血气皆不足。人迎寸口脉
皆小。只可用甘淡之药以调之。则慎用针。再者。藏气有绝于内外之分。绝于外者。则
脉去而不来。金匮云。不来或曲如蛇行者死。或来而无去。尺中无脉。此藏气将绝之脉
形。如不诊其脉而妄针之。下针即死。其死者有躁静之分。躁者五脏之气已先绝于外。
其脉去而不来。医者以手按尺脉。则寸关之脉全无。手足厥逆。四末本输诸井已无所
出。而十二原接受三百六十五节气味转注之道已绝。藏真之气。不得天气谷气入而合
之。则藏之气暴露于外。以致其脉去而不来。不用针亦将死之候。针之即死。其死也躁
动不安。盖因藏真之气尽量泄于外也。是谓逆厥。
静者五脏之气已先绝于内。其脉来而不去。医者以手按寸。则尺关之脉全无。张口
短气。吸而难入。盖藏真之气将绝。虽有天气谷气欲补充之。亦无能为力。不用针亦将
死之候。针之即死。盖藏真之气先竭而妄针之。重竭其外来之气。其死也静。是谓重
竭。
取五脉者死。其义有二。
（一）五里脉。尺动脉在五里。为五 之禁。盖五脏之真气。尝赖六腑水谷之气以养
之。五里乃手阳明之要穴。如藏气已损而妄针之。则六腑水谷之气补充五脏之要
道隔绝。得谷者昌。绝谷者亡。即此义也。
（二）五脏之气绝而各有脉形。春弦夏钩秋毛冬石四季脉代（二）。但弦无胃曰死。如
按琴瑟。但钩无胃曰死。前曲后居。如操带钩。但毛无胃曰死。按之萧索。如风
吹毛。但石无胃曰死。来如解索。去如弹石。但代无胃曰死。动而中止。不能自
还。以上五脉。不可用针。仲景云。脉结代。心动悸。炙甘草汤主之。本调以甘
药之正义。然次条释脉末语云。名曰代阴也。得此脉者。必难治。脉经定为死
脉。贤如仲师。对此脉之断语。难治之上。加一必字。与不可治之死证。相去几
希。恶可用针乎。
《灵枢经》说：凡是准备使用针刺治疗，必须先诊察脉象。脉法虽然繁多，但用针者可以用六个字来概括，即缓、急、大、小、滑、涩。（一）脉急的，多属寒证；脉缓的，多属热证；脉大的，多属气盛血少；脉小的，多属气血皆不足；脉滑的，阳气旺盛，微有热象；脉涩的，多血而少气，微有寒象。这六种脉象主要对应五脏的各种疾病，详细内容见经文，此处不再赘述。只有脉小的情况不可针刺。凡是脉小的，说明阴阳、形体、正气都不足，不要用针石治疗，而应用甘味药物进行调理。
因为阴阳虚实往往互相影响，出现盛衰变化，所以有的需要补法，有的需要泻法。人迎穴（位于颈部两侧颈动脉搏动处）主要反映三阳经的情况，寸口脉（位于手腕桡动脉处）主要反映三阴经的情况。如果人迎脉比寸口脉大一倍、两倍或三倍，说明三阳经气盛，应当泻三阳经之气而补三阴经之气；如果寸口脉比人迎脉大一倍、两倍或三倍，说明三阴经气盛，应当泻三阴经之气而补三阳经之气。气盛的用泻法，气虚的用补法，热证的用疾刺法（快速进针出针），寒证的用留针法（长时间留针）。这是处理补泻和寒热的正确法则。如果不盛不虚，则直接取本经穴位治疗，这是调和营卫的常规方法。如果是久病导致阴阳气血都不足，人迎和寸口脉都细小，只可用甘淡性质的药物来调理，此时应慎用针刺。
再者，脏腑之气的衰竭有在体内和在体外的区别。衰竭在体外的，脉象表现为去而不回。《金匮要略》说：“去而不回，或者脉形弯曲如蛇行，主死。”或者脉象有来无去，尺部没有脉搏，这是脏腑之气即将断绝的脉象表现。如果不诊察脉象就妄自针刺，下针后病人就会死亡。这类死亡的表现有躁动和安静两种区别。躁动的，是五脏真气先在体外断绝，脉象去而不回。医生用手按压尺部脉搏，发现寸部和关部的脉搏完全消失，手足厥冷，四肢末端的井穴以及十二原穴接受三百六十五节气味转注的通道已经断绝，脏腑的真气无法与天气、谷气相合，导致脏气暴露在体外，因此脉象去而不回。这种情况下，即使不针刺也是将死的征候，针刺了就会立即死亡，其死亡过程表现为躁动不安，这是因为脏腑真气尽量外泄所致，这叫做“逆厥”。
安静的，是五脏真气先在体内断绝，脉象有来但不去。医生用手按压寸部脉搏，发现尺部和关部的脉搏完全消失，张口短气，吸气困难。这是因为脏腑真气即将断绝，虽然有天气、谷气想要补充，但也无能为力。这种情况下，即使不针刺也是将死的征候，针刺了就会立即死亡。这是因为脏腑真气先已枯竭，再妄加针刺，会进一步耗竭外来之气，其死亡过程表现为安静，这叫做“重竭”。
取五里穴会导致死亡，其含义有二：
（一）五里穴处的脉象。尺部动脉在五里穴处，是针刺的五禁之一。因为五脏的真气，常常依赖六腑水谷之气来滋养。五里穴是手阳明大肠经的重要穴位，如果脏腑之气已经受损而妄加针刺，那么六腑水谷之气补充五脏的关键通道就会被隔绝。“得谷者昌，绝谷者亡”，就是这个道理。
（二）五脏之气断绝时各有其脉象特征：春季脉弦、夏季脉钩、秋季脉毛、冬季脉石、四季交替时脉代（二）。但是，如果只有弦脉而没有胃气，主死，脉象像按琴瑟一样僵硬；如果只有钩脉而没有胃气，主死，脉象前曲后居，像拿着带钩的东西；如果只有毛脉而没有胃气，主死，按之萧索，像风吹毛发；如果只有石脉而没有胃气，主死，脉来如解绳索，去如弹石；如果只有代脉而没有胃气，主死，脉动中止，不能自行恢复。以上五种脉象，不可用针刺。张仲景说：“脉结代，心动悸，炙甘草汤主之。”这正是遵循“调以甘药”的正义。然而，他在解释脉法的末尾又说：“名曰代阴也，得此脉者，必难治。”《脉经》将其定为死脉。即使是贤明的张仲景，对此脉的判断语中，在“难治”之上加了一个“必”字，这与不可救治的死证相差无几，怎么还能用针刺呢？
The *Ling Shu* (Spiritual Pivot) states: Whenever one is about to use acupuncture, one must first diagnose the pulse. Although pulse methods are numerous, acupuncturists can summarize them in six characters: slow (Huan), rapid/tense (Ji), large (Da), small (Xiao), slippery (Hua), and choppy (Se). (1) A tense pulse indicates mostly cold; a slow/relaxed pulse indicates mostly heat; a large pulse indicates excess Qi and deficient Blood; a small pulse indicates deficiency of both Qi and Blood; a slippery pulse indicates abundant Yang Qi with slight heat; a choppy pulse indicates abundant Blood but deficient Qi with slight cold. These six pulses primarily correspond to various diseases of the five Zang organs, as detailed in the classic texts, which will not be repeated here. Only when the pulse is small should needling be avoided. In cases of small pulses, both Yin and Yang, as well as form and Qi, are insufficient. One should not use needles for regulation but instead employ sweet (Gan) herbs.
Since Yin and Yang, deficiency and excess, often influence each other with fluctuations in abundance and decline, treatment may require tonification or sedation. The Renying point (located at the carotid artery on the neck) mainly reflects the three Yang meridians, while the Cunkou pulse (located at the radial artery of the wrist) mainly reflects the three Yin meridians. If the Renying pulse is one, two, or three times larger than the Cunkou pulse, it indicates excess Qi in the three Yang meridians; one should sedate the three Yang meridians and tonify the three Yin meridians. Conversely, if the Cunkou pulse is one, two, or three times larger than the Renying pulse, it indicates excess Qi in the three Yin meridians; one should sedate the three Yin meridians and tonify the three Yang meridians. Excess is treated by sedation, deficiency by tonification, heat by quick needling (rapid insertion and withdrawal), and cold by retention needling (long retention time). This is the correct method for handling tonification, sedation, heat, and cold. When there is neither excess nor deficiency, one should treat the affected meridian directly; this is the standard method for harmonizing Ying (Nutritive) and Wei (Defensive) Qi. In cases of chronic illness where both Yin and Yang, as well as Qi and Blood, are insufficient, and both Renying and Cunkou pulses are small, only sweet and bland herbs should be used for regulation, and acupuncture should be used with extreme caution.
Furthermore, the exhaustion of Zang organ Qi can occur internally or externally. Exhaustion occurring externally is characterized by a pulse that departs and does not return. The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: "If the pulse departs and does not return, or if it winds like a snake, death ensues." Or, if the pulse arrives but does not depart, and there is no pulse at the Chi position (distal part of the radial pulse), this is the pulse manifestation of impending exhaustion of Zang organ Qi. If one needles without diagnosing the pulse, the patient will die immediately upon needle insertion. Such deaths manifest as either restlessness or stillness. Restlessness indicates that the true Qi of the five Zang organs has first exhausted externally; the pulse departs and does not return. When the physician presses the Chi pulse, the Cun (proximal) and Guan (middle) pulses are completely absent. The limbs are cold (Jue Ni), and the Jing-Well points at the extremities, along with the Twelve Yuan-Source points which serve as pathways for the transmission of seasonal Qi and grain Qi from 365 acupoints, are cut off. The true Qi of the Zang organs cannot combine with Heaven's Qi and Grain Qi, causing Zang Qi to be exposed externally. Consequently, the pulse departs and does not return. Even without needling, this is a sign of impending death; needling causes immediate death. The death process is marked by restless agitation because the true Qi of the Zang organs is fully depleted externally. This is called "Nijue" (Rebellious Jue).
Stillness indicates that the true Qi of the five Zang organs has first exhausted internally; the pulse arrives but does not depart. When the physician presses the Cun pulse, the Chi and Guan pulses are completely absent. The patient opens their mouth and suffers from shortness of breath, finding inhalation difficult. This is because the true Qi of the Zang organs is about to exhaust; although Heaven's Qi and Grain Qi wish to replenish it, they are powerless to do so. Even without needling, this is a sign of impending death; needling causes immediate death. This is because the true Qi of the Zang organs was already exhausted, and reckless needling further depletes the incoming Qi. The death process is marked by stillness, which is called "Chongjie" (Double Exhaustion).
Puncturing the Wuli point leads to death, for two reasons:
(1) The pulse at the Wuli point. The Chi pulse at the Wuli point is one of the five prohibitions against needling. The true Qi of the five Zang organs relies on the water and grain Qi of the six Fu organs for nourishment. Wuli is an important point of the Hand-Yangming Large Intestine Meridian. If Zang Qi is already damaged and one recklessly needles it, the crucial pathway for the Fu organs' water and grain Qi to supplement the Zang organs is severed. "Those who obtain grain prosper; those deprived of grain perish"—this is the meaning behind this principle.
(2) The exhaustion of Qi in the five Zang organs presents with specific pulse forms: String-like (Xian) in Spring, Hook-like (Gou) in Summer, Hair-like (Mao) in Autumn, Stone-like (Shi) in Winter, and Intermitting (Dai) during the transition seasons (2). However, if there is only a String-like pulse without Stomach Qi (Wei Qi), death ensues; the pulse feels stiff like pressing a zither string. If there is only a Hook-like pulse without Stomach Qi, death ensues; the pulse bends forward and stays back, like holding a hooked belt. If there is only a Hair-like pulse without Stomach Qi, death ensues; it feels desolate when pressed, like wind blowing through hair. If there is only a Stone-like pulse without Stomach Qi, death ensues; it comes like untying a rope and goes like flicking a stone. If there is only an Intermitting pulse without Stomach Qi, death ensues; the pulse movement stops and cannot recover itself. None of these five pulses should be treated with acupuncture. Zhang Zhongjing stated: "Intermitting and knotted pulse, palpitations—Zhi Gancao Tang (Honey-Fried Licorice Decoction) governs this." This aligns with the righteous principle of regulating with sweet herbs. However, in his explanation of pulse methods, he added: "It is named Dai Yin (Intermitting Yin); those who obtain this pulse will certainly find it difficult to treat." The *Mai Jing* (Classic of Pulse Diagnosis) classifies this as a death pulse. Even the wise Master Zhang, in his judgment of this pulse, added the word "certainly" (Bi) to "difficult to treat," bringing it very close to untreatable death syndromes. How could one possibly use acupuncture?