用针大要。诊脉后先辨其表里虚实寒热。久病暴病。阳盛阴虚。阴盛阳虚。或病六
腑。或病五脏。五脏有疾。当取大渊大陵太冲太白太溪诸原穴（本名俞穴）。针以出
病。藉用谷气托邪外出。故灵枢法天篇称九针十二原也。五脏痼疾。有外来者。有内生
者。有相传者。有阻碍部分者。用针手法。各有不同。经云。五脏之有疾也。譬犹刺
也。犹污也。犹结也。犹 也。刺虽久。犹可拔。邪自外来者。泻之而已。污虽久。犹
可雪。邪自内生。纵横传播。或补母。或泻子。或取其胜者而泻之之谓。结虽久。犹可
解。 虽久。犹可决。此即刺法论中上升下降。升之者。均须待时。解结之谓。降之
者。折其所胜。勿须待时。决 之谓。详见升降手法篇。不再赘。
六腑有疾。六腑为阳。五脏为阴。背为阳。腹为阴。阴有阳疾者。取之下陵三里。
盖腹为阴部。有阳明胃肠之病者。正往勿殆。气下乃止。不下复始。盖阳明多气多血。
大泻之尽除其邪。日二刺之。亦无损于正也。
六淫之邪。病在三阴三阳。人迎脉大于寸口。寸口脉大于人迎。此即阳盛阴虚阴盛
阳虚之鉴别。再有一盛二盛三盛之分。详前用针脉法。
久病暴病。如中风历节之痼疾。须用子午捣臼（一）最繁难之手法。急痧卒然倒
仆。当刺指井见血。急则急之。缓则缓之。此迥然有别也。
新病在表者。当浅刺之。阳经取陷。针陷脉（二）则外邪立除。针中脉（二）则浊
气除。针太深则邪气反沉。气之在脉。邪气在上。浊气（二）在中。清气（二）在下。
清者为营。浊者为卫。浅病近于
卫。用针不必损其营。不可不辨。如病入里。则当深针之。停针候气。辨其寒热虚实。详补泻寒热各篇。排邪得宜。病
可立愈。经云。刺之要气至而有效。效之信。若风之吹云。明乎若见苍天。刺之道毕矣。
针刺的要领。诊察脉象后，首先要辨别病证的表里、虚实、寒热。无论是久病还是暴病，都涉及阳盛阴虚或阴盛阳虚的状态；或者是六腑受病，或者是五脏受病。五脏发生疾病时，应当取用太渊、大陵、太冲、太白、太溪等原穴（这些穴位原本也是俞穴）。通过针刺来祛除疾病，借助谷气（水谷精微化生的正气）托举邪气使其排出体外。所以《灵枢·九针十二原》篇中提到了九针和十二原穴。五脏的顽固性疾病，有的来自外部侵袭，有的是内部产生，有的是由其他脏腑传变而来，有的是因为局部阻滞不通。使用针刺的手法，各有不同。医经说：五脏的疾病，就像刺入异物一样，像沾染污垢一样，像打结一样，像堵塞一样。刺入虽久，仍可拔出；邪气从外来的，只需泻法即可。污垢虽久，仍可洗净；邪气从内产生的，纵横传播，或者补益母脏，或者泻泄子脏，或者选取克制它的脏腑而进行泻法，就是这个意思。结缔虽久，仍可解开；堵塞虽久，仍可疏通。这就是《素问·刺法论》中提到的上升与下降。所谓“升”，都必须等待时机，这是解开结缔的意思。所谓“降”，是折损其克我者之气，不需要等待时机，这是疏通堵塞的意思。详细内容见升降手法篇，不再赘述。
六腑发生疾病，六腑属阳，五脏属阴；背部属阳，腹部属阴。阴分部位出现阳分疾病时，取下陵（足三里）三里穴。因为腹部是阴部，如果有阳明胃肠的疾病，应当前往针刺不要懈怠，待气机下行后才停止针刺；如果气未下行，则重新开始针刺。因为阳明经多气多血，大力泻除以尽除邪气，每天针刺两次，也不会损伤正气。
六淫（风、寒、暑、湿、燥、火六种外感病邪）之邪，病变在三阴三阳经。人迎脉大于寸口脉，或寸口脉大于人迎脉，这就是阳盛阴虚与阴盛阳虚的鉴别方法。再有一盛、二盛、三盛的区别，详见前文用针脉法部分。
久病或暴病，如中风、历节等顽固性疾病，须用子午捣臼（注1）这种最为繁难的手法。急痧突然倒仆，应当针刺手指井穴见血。急症就用急治法，缓症就用缓治法，这两者截然不同。
新病在体表者，应当浅刺。阳经取穴在凹陷处，针刺陷脉（注2）则外邪立即消除，针刺中脉（注2）则浊气消除。针刺过深则邪气反而陷入体内。气在经脉中运行，邪气在上部，浊气（注2）在中部，清气（注2）在下部。清者为营气，浊者为卫气。浅层的病靠近卫气，用针不必损伤营气，这一点不可不辨明。如果病邪入里，则应当深刺。留针候气，辨别寒热虚实，详细参考补泻寒热各篇。排邪得当，病可立即痊愈。医经说：针刺的要领在于气至而有疗效，疗效的验证，就像风吹散云层一样，看得清清楚楚如同见到青天。针刺的道理也就完备了。
The essentials of acupuncture. After examining the pulse, one must first differentiate the exterior and interior, deficiency and excess, cold and heat. Whether it is a chronic disease or an acute disease, it involves states of Yang excess with Yin deficiency or Yin excess with Yang deficiency; or diseases affecting the Six Fu-organs, or diseases affecting the Five Zang-organs. When diseases occur in the Five Zang-organs, one should select the Yuan-source points (originally also Shu-stream points) such as Taiyuan (LU9), Daling (PC7), Taichong (LR3), Baihui (SP3 - *Note: Text says Taibai SP3*), and Taixi (KI3). By needling, one expels the disease, relying on Guqi (vital energy derived from grain/food) to support the righteous Qi and push the pathogenic factors outwards. Thus, the chapter "Fa Tian" in *Ling Shu* mentions the Nine Needles and Twelve Yuan-source points. Chronic diseases of the Five Zang-organs may originate externally, arise internally, be transmitted from other organs, or be caused by local obstruction. The manual techniques of needling vary accordingly. The classics state: Diseases of the Five Zang-organs are like removing a thorn, like washing away dirt, like untying a knot, or like clearing a blockage. Although the insertion has been long, it can still be withdrawn; for pathogens coming from outside, only the reducing method is needed. Although dirt is old, it can still be washed clean; for pathogens arising internally, spreading longitudinally and transversely, one may tonify the Mother organ, reduce the Child organ, or reduce the organ that controls it. This is the meaning. Although knots are old, they can still be untied; although blockages are old, they can still be cleared. This refers to the ascending and descending methods mentioned in the *Su Wen* chapter on Needling Techniques. "Ascending" requires waiting for the appropriate time, which refers to untying knots. "Descending" involves overcoming the controlling element's Qi and does not require waiting for time, which refers to clearing blockages. For details, see the chapter on Ascending and Descending Techniques; no further elaboration here.
When diseases occur in the Six Fu-organs, since the Six Fu-organs belong to Yang and the Five Zang-organs to Yin; the back belongs to Yang and the abdomen to Yin. When Yang-type diseases occur in Yin areas, one should select Xiaguling (Zusanli, ST36). Since the abdomen is a Yin region, if there are diseases of the Yangming Stomach and Intestines, one should proceed to needle without hesitation, stopping only when the Qi descends; if the Qi does not descend, restart the process. Because the Yangming meridians have abundant Qi and Blood, heavily reducing them eliminates all pathogens, and needling twice daily will not harm the Righteous Qi.
Pathogens of the Six Excesses (Six Evils) affect the Three Yin and Three Yang meridians. If the Renying pulse (carotid artery) is larger than the Cunkou pulse (radial artery), or vice versa, this is the differentiation between Yang excess/Yin deficiency and Yin excess/Yang deficiency. There are also distinctions of one-fold, two-fold, and three-fold magnitude, detailed in the preceding section on Pulse Methods for Needling.
For chronic or acute diseases, such as stubborn conditions like Wind-stroke or Bi-syndrome (Li-jie), one must use the Zi-Wu Dao-Jiu technique (Note 1), which is the most complex and difficult manual method. For sudden collapse due to acute Sha-syndrome, one should needle the Jing-well points on the fingers until bleeding occurs. Acute conditions require urgent treatment, while chronic/slow conditions require gentle treatment; these are distinctly different.
For new diseases located at the exterior, one should needle superficially. For Yang meridians, select points in depressions; needling the Xianmai (depression vessels) removes external pathogens immediately, and needling the Zhongmai (middle vessels) removes turbid Qi. Needling too deeply causes the pathogen to sink inward. Regarding Qi in the meridians, pathogens are in the upper part, turbid Qi (Note 2) is in the middle, and clear Qi (Note 2) is in the lower part. Clear Qi constitutes Ying-nutrient Qi, and turbid Qi constitutes Wei-defensive Qi. Superficial diseases are close to the Wei-Defensive Qi, so needling should not damage the Ying-Nutrient Qi; this distinction must not be overlooked. If the pathogen enters the interior, one should needle deeply. Retain the needle to await the arrival of Qi, differentiate cold, heat, deficiency, and excess, referring to the chapters on Tonification, Reduction, Cold, and Heat for details. If pathogens are expelled appropriately, the disease can be cured immediately. The classics state: The essence of needling lies in the arrival of Qi producing efficacy. The evidence of efficacy is like wind blowing away clouds, clearly revealing the blue sky. Thus, the way of needling is complete.