（《灵枢·根结篇》）
黄帝曰∶逆顺五体者，言人骨节之小大，肉之坚脆，皮之浓薄，血之清浊，气之滑涩，脉之长短，血之多少，经络
之数，余已知之矣，此皆布衣匹夫之士也。夫王公大人，血食之君，身体柔脆，肌肉软弱，血气 悍滑利，其刺之徐疾
浅深多少，可得同之乎？（五体者，五形之人也。故其骨节皮肉，血气经脉，禀有不齐，刺治亦异，所以有逆顺之变；
至于贵贱之间，尤有不同，故欲辨其详也。脆音翠。 音飘，急也。悍音旱。）岐伯答曰∶膏粱菽藿之味，何可同也？
（膏，
脂肥也。粱，粟类，谷之良者也。菽，豆也。藿，豆叶也。贵者之用膏粱，贱者之用菽藿，食味有浓薄，禀质所以不同
也。）气滑即出疾，气涩则出迟，气悍则针小而入浅，气涩则针大而入深，深则欲留，浅则欲疾。（气滑者易行，故出宜
疾。气涩者难致，故出宜迟。气悍者来必勇利，故针宜小而入宜浅。气涩者至必艰迟，故针宜大而入宜深。所以宜深者
则欲留，宜浅者则欲疾也。）以此观之，刺布衣者深以留之，刺大人者微以徐之，此皆因气 悍滑利也。（布衣气涩，故
宜深宜留。大人气滑，故宜微宜徐。盖贵人之气， 悍滑利，有异于布衣之士耳。）黄帝曰∶形气之逆顺奈何？岐伯曰∶
形气不足，病气有余，是邪胜也，急泻之。（貌虽不足，而神气病气皆有余，此外似虚而内则实，邪气胜也，当急泻之。）
形气有余，病气不足，急补之。（形虽壮伟，而病气神气则不足，此外似实而内则虚，正气衰也，当急补之。）形气不足，
病气不足，此阴阳气俱不足也，不可刺之，刺之则重不足，重不足则阴阳俱竭，血气皆尽，五脏空虚，筋骨髓枯，老者
绝灭，壮者不复矣。（阳主外，阴主内，若形气病气俱不足，此表里阴阳俱虚也，最不可刺。若再刺之，是重虚其虚，
而
血气尽，筋髓枯。老者益竭，故致绝灭。壮者必衰，故不能复其元矣。）形气有余，病气有余，此谓阴阳俱有余也，急
泻
其邪，调其虚实。（形气病气俱有余，邪之实也，故当急泻。既当急泻，其实无疑，何以又云调其虚实？盖未刺之前，
防
其假实，既刺之后，防其骤虚，故宜调之也。）故曰有余者泻之，不足者补之，此之谓也。（凡用针者，虚则实之，满则
泄之，故曰虚实之要，九针最妙，补泻之时，以针为之。又曰虚则实之者，气口虚而当补之也。满则泄之者，气口盛而
当泻之也。此用针之大法，似乎诸虚可补矣；何上文云形气不足，病气不足，此阴阳气俱不足也，不可刺之？《宝命全
形论》曰∶人有虚实，五虚勿近，五实勿远。《五阅五使篇》曰∶血气有余，肌肉坚致，故可苦以针。《奇病论》曰∶所
谓无损不足者，身羸瘦无用 石也。《本神篇》曰∶是故用针者，察观病患之态，以知精神魂魄之存亡得失之意，五者
以
伤，针不可以治之也。《小针解》曰∶取五脉者死，言病在中，气不足，但用针尽大泻其诸阴之脉也。《脉度篇》曰∶盛
者泻之，虚者饮药以补之。《邪气脏腑病形篇》曰∶诸小者阴阳形气俱不足，勿取以针而调以甘药也。诸如此者，又皆
言
虚不宜针也。及详考本经诸篇，凡所言应刺之疾，必皆邪留经络，或气逆脏腑，大抵皆治实证，此针之利于泻，不利于
补也明矣；然则诸言不足者补之，又何为其然也？盖人身血气之往来，经络之流贯，或补阴可以配阳，或固此可以攻彼，
不过欲和其阴阳，调其血气，使无偏胜，欲得其平，是即所谓补泻也。设有不明本末，未解补虚之意，而凡营卫之亏损，
形容之羸瘦，一切精虚气竭等证，概欲用针调补，反伤真元，未有不立败者也。故曰针有泻而无补，于此诸篇之论可知
矣。凡用针者，不可不明此针家大义。）故曰刺不知逆顺，真邪相搏。（补泻反施，乃为之逆，不知逆顺，则真气与邪气
相搏，病必甚也。）满而补之，则阴阳四溢，肠胃充郭，肝肺内 ，阴阳相错。（益其有余，故病如此。）虚而泻之，则
经
脉空虚，血气竭枯，肠胃HT 辟，皮肤薄着，毛腠夭 ，予之死期。（损其不足，故病如此。HT ，畏怯也。辟，邪僻
不正也。薄着，瘦而涩也。夭，短折也。予，与同。HT ，丑涉切。辟，僻同。 ，焦同。）故曰用针之要，在于知调
阴
与阳，调阴与阳，精气乃光，合形与气，使神内藏。故曰上工平气，中工乱脉，下工绝气危生。故曰下工不可不慎也。
（上
工知阴阳虚实，故能平不平之气。中工无的确之见，故每多淆乱经脉。下工以假作真，以非作是，故绝人之气，危人之
生也。）必审五脏变化之病，五脉之应，经络之实虚，皮之柔粗，而后取之也。（五脉，五脏之脉应也。）
（出自《灵枢·根结篇》）
黄帝问道：关于逆顺五体，是指人的骨节大小、肌肉坚脆、皮肤厚薄、血液清浊、气机滑涩、脉象长短、血量多少以及经络的分布情况，这些我都已经知道了，这些都是针对普通百姓而言的。然而王公大人、享有肉食特权的君主，他们身体柔嫩脆弱，肌肉软弱，气血运行悍急滑利，对他们进行针刺时，进针的快慢、深浅和用量的多少，能同普通人一样处理吗？（所谓五体，是指五种不同体质类型的人。因此他们的骨节皮肉、血气经脉，禀赋各有不齐，治疗刺法也各不相同，所以有逆顺的变化；至于贵贱之间，差异尤为明显，所以想要详细辨析。）岐伯回答说：吃肥肉精粮与吃豆麦粗食的味道，怎么能相同呢？（膏，指油脂肥肉。粱，是粟类，属于优质的谷物。菽，是豆类。藿，是豆叶。贵人食用膏粱，贱人食用菽藿，饮食味道有浓淡之分，禀赋体质自然不同。）气机滑利的出针要快，气机涩滞的出针要慢；气机悍猛的，选用小针且进针浅；气机涩滞的，选用大针且进针深，进针深则留针时间较长，进针浅则出针迅速。（气机滑利者易于运行，所以出针宜快。气机涩滞者难以激发经气，所以出针宜慢。气机悍猛者来势勇利，所以针具宜小且进针宜浅。气机涩滞者至气艰难迟缓，所以针具宜大且进针宜深。适宜深刺的就要留针，适宜浅刺的就要快速出针。）由此看来，刺普通百姓要深刺并留针，刺王公大人要微刺并徐缓出针，这都是因为王公大人的气血悍急滑利所致。（普通百姓气机涩滞，所以适宜深刺和留针。王公大人气机滑利，所以适宜微刺和徐缓。大概贵人的气，悍急滑利，与普通百姓不同罢了。）
黄帝又问：形气与病气的逆顺如何判断？岐伯说：形体正气不足，而病邪之气有余，这是邪气胜实，应当紧急泻之。（外表看似正气不足，但神气和病气都有余，这是外似虚而内实则邪气胜，应当紧急泻之。）形体正气有余，而病气不足，应当紧急补之。（外形虽然壮伟，但病气和神气却不足，这是外似实而内则虚，正气衰败，应当紧急补之。）形体正气不足，病气也不足，这是阴阳之气都虚弱，不可用针刺治疗，如果误刺，会导致双重虚弱，双重虚弱则阴阳俱竭，血气耗尽，五脏空虚，筋骨髓枯，老年人会死亡，强壮人也无法恢复。（阳主外，阴主内，如果形气和病气都不足，这是表里阴阳俱虚，最不可针刺。如果再刺，就是使虚者更虚，导致血气尽、筋髓枯。老年人更加衰竭，故致死亡。强壮人也必然衰败，故不能恢复元气。）形体正气有余，病气也有余，这叫做阴阳俱有余，应当紧急泻其邪气，调理虚实。（形气和病气都有余，是邪气实证，所以应当紧急泻。既然应当紧急泻，其实证无疑，为什么又说调理虚实？因为在针刺之前，要防止假实的情况；针刺之后，要防止正气骤然虚脱，所以适宜调理。）所以说，有余的用泻法，不足的用补法，就是这个道理。（凡是用针的原则，虚证用补法使其充实，实证用泻法使其泄去，所以说虚实的关键，九针最为巧妙，补泻的时机，通过针具来实现。又说虚证用补法，是因为气口脉虚而应当补。实证用泻法，是因为气口脉盛而应当泻。这是用针的大法，似乎各种虚证都可以补了；为什么前面说形气不足、病气不足，即阴阳气俱不足时，不可针刺？《宝命全形论》说：人有虚实，五虚证不要靠近（慎用针），五实证不要远离（及时治）。《五阅五使篇》说：血气有余，肌肉坚实细致，所以可以用苦寒的针石治疗。《奇病论》说：所谓不能损伤不足之人，身体羸瘦的人不能用砭石。《本神篇》说：所以用针的人，要观察病患的状态，以知道精神魂魄的存亡得失之意，如果五脏精气受伤，针不可以治疗它。《小针解》说：取五脉而死，是说病在中焦，气不足，如果只用针尽泻诸阴之脉，就会致死。《脉度篇》说：脉盛者泻之，脉虚者服药以补之。《邪气脏腑病形篇》说：凡是脉象细小的，阴阳形气都不足，不要用针，而要用甘药调理。诸如此类的论述，都说虚证不宜用针。等到详细考察本经各篇，凡是提到应该针刺的疾病，必定都是邪气留滞经络，或者气逆脏腑，大体上都是治疗实证，这说明针利于泻而不利于补是显而易见的；那么为什么说对于不足的要补呢？这是因为人身血气的往来，经络的流贯，有时补阴可以配阳，有时固护此处可以攻彼，不过是想调和阴阳，调畅血气，使其没有偏胜，达到平衡，这就是所谓的补泻。如果有不明白根本末梢，不理解补虚真意的人，对于一切营卫亏损、形容羸瘦、精虚气竭等证候，一概想用针来调补，反而损伤真元，没有不立即败亡的。所以说针只有泻的作用而没有补的作用，从这些篇章的论述中可以知道了。凡是用针的人，不可不明白这个针灸家的重大义理。）所以说，针刺不知道逆顺，真气与邪气就会相互搏结。（补泻反施，就称为逆，不知道逆顺，真气与邪气相搏，病情一定会加重。）实证用补法，则阴阳之气四溢，肠胃胀满，肝肺受压，阴阳错乱。（增加其有余的邪气，所以病变成这样。）虚证用泻法，则经脉空虚，血气枯竭，肠胃收缩拘急，皮肤消瘦紧贴骨骼，毛发枯槁折断，给予他死亡的期限。（损伤其不足的正气，所以病变成这样。HT，指畏怯。辟，指邪僻不正。薄着，指瘦而涩。夭，指短折。予，通“与”。HT，音丑涉切。辟，通“僻”。 ，通“焦”。）所以说，用针的要领，在于懂得调和阴与阳，调和阴与阳，精气才能光明，形体与气相合，使神气内藏。所以说，上工能平复气机，中工会扰乱经脉，下工会断绝气机危及生命。所以说下工不可不谨慎啊。（上工懂得阴阳虚实，所以能平复不平之气。中工没有确切的见解，所以常常多乱经脉。下工把假的当作真的，把非的当作是的，所以断绝人的气机，危害人的生命。）必须审察五脏变化的疾病，五脉的对应，经络的虚实，皮肤的柔粗，然后才选取穴位进行治疗。（五脉，指五脏之脉的相应表现。）
(Luoshu · Genjie Chapter)
Huangdi asked: Regarding the "reverse and smooth five bodies," this refers to the size of bone joints, the firmness or fragility of muscles, the thickness of skin, the clarity or turbidity of blood, the slipperiness or roughness of Qi, the length of pulses, the quantity of blood, and the number of meridians. I already know these; these all apply to commoners (Bu Yi, people of cloth clothing). However, kings, dukes, and great officials, who are rulers enjoying meat and grain, have bodies that are soft and fragile, with weak muscles. Their Qi and blood are fierce, rapid, and slippery. Can their acupuncture treatment—specifically the speed, depth, and amount of needle insertion—be handled in the same way as for commoners? (The "five bodies" refer to five types of physical constitutions. Therefore, their bones, joints, skin, flesh, Qi, blood, and meridians vary in endowment, and their acupuncture treatments differ accordingly, leading to variations in reverse and smooth conditions; the differences between nobles and commoners are even more pronounced, hence the need for detailed distinction.) Ciqi answered: How can the dietary tastes of rich fats and fine grains be compared to those of beans and coarse leaves? (Gao refers to animal fat. Liang refers to millet, a high-quality grain. Shu refers to beans. Huo refers to bean leaves. Nobles consume gao and liang, while commoners consume shu and huo; the richness of diet leads to different constitutions.) When Qi is slippery, withdrawal should be rapid; when Qi is rough/stagnant, withdrawal should be slow. When Qi is fierce, small needles should be used and inserted shallowly; when Qi is rough/stagnant, large needles should be used and inserted deeply. Deep insertion requires retention, while shallow insertion requires quick withdrawal. (Slippery Qi moves easily, so withdrawal should be fast. Rough Qi is difficult to stimulate, so withdrawal should be slow. Fierce Qi arrives vigorously, so small needles and shallow insertion are appropriate. Rough Qi arrives slowly and with difficulty, so large needles and deep insertion are appropriate. Thus, deep insertion requires retention, and shallow insertion requires quick withdrawal.) From this, we see that treating commoners requires deep insertion and retention, while treating nobles requires slight/mild insertion and slow withdrawal. This is due to the fierce, rapid, and slippery nature of the nobles' Qi and blood. (Commoners have rough Qi, suitable for deep insertion and retention. Nobles have slippery Qi, suitable for mild/slight and slow techniques. The Qi of nobles is fierce, rapid, and slippery, differing from that of commoners.)
Huangdi asked again: How can one judge the reverse and smooth conditions of Xing (Form/Structure) and Qi? Ciqi said: If Xing Qi is insufficient but Bing Qi (Pathogenic Qi) is excessive, this indicates an excess of pathogen, requiring urgent sedation (Xie). (Although the appearance suggests insufficiency, the Shen Qi and Bing Qi are excessive; this is exterior deficiency with interior excess caused by pathogens, requiring urgent sedation.) If Xing Qi is excessive but Bing Qi is insufficient, urgent tonification (Bu) is required. (Although the form appears robust, the Bing Qi and Shen Qi are insufficient; this is exterior excess with interior deficiency due to weakened Zheng Qi, requiring urgent tonification.) If both Xing Qi and Bing Qi are insufficient, this indicates a deficiency of both Yin and Yang Qi. Acupuncture should not be used; if needled, it causes double deficiency. Double deficiency leads to the exhaustion of Yin and Yang, depletion of blood and Qi, emptiness of the five Zang organs, and withering of sinews, marrow, and bones. The elderly will perish, and even the strong will not recover. (Yang governs the exterior, Yin governs the interior. If both Xing and Bing Qi are insufficient, there is deficiency in both exterior and interior, Yin and Yang. It is most inadvisable to needle. Further needling exacerbates the deficiency, leading to exhausted blood/Qi and withered sinews/marrow. The elderly become more depleted and die. The strong decline and cannot restore their Yuan Qi.) If both Xing Qi and Bing Qi are excessive, this is called dual excess of Yin and Yang. Urgently sedate the pathogen and regulate the deficiency and excess. (Both Xing and Bing Qi being excessive indicates pathogenic excess, requiring urgent sedation. Since urgent sedation is needed, the excess is certain. Why mention regulating deficiency/excess? Before needling, guard against false excess; after needling, guard against sudden collapse into deficiency; thus, regulation is appropriate.) Therefore, it is said: Excess is treated by sedation, insufficiency by tonification. This is the principle. (In acupuncture, deficiency is filled, and fullness is drained. Thus, the key to deficiency and excess lies in the nine needles. Tonification and sedation are performed via the needle. It is said that tonifying deficiency means the pulse at the Qi Kou is deficient and should be tonified. Draining fullness means the pulse at the Qi Kou is vigorous and should be drained. This is the major method of acupuncture, suggesting all deficiencies can be tonified. Yet, earlier it was stated that when Xing and Bing Qi are both insufficient (Yin/Yang dual deficiency), acupuncture is contraindicated. *Baoming Quanxing Lun* states: In cases of deficiency and excess, do not approach the Five Deficiencies, do not distance from the Five Excesses. *Wuyue Wushi Pian* states: When blood and Qi are sufficient and muscles are firm and delicate, bitter/cold needles may be used. *Qibing Lun* states: One must not harm the insufficient; a emaciated person does not benefit from bi-shi (stone lancets). *Benshen Pian* states: The acupuncturist must observe the patient's state to understand the survival or loss of spirit, soul, etc. If the five internal organs are injured, needles cannot treat them. *Xiaozhen Jie* states: Taking the five pulses leads to death; this means if the disease is in the middle jiao and Qi is insufficient, draining all Yin pulses with needles causes death. *Maidu Pian* states: Vigorous pulses are drained, deficient pulses are supplemented with medicine. *Xieqi Zangfu Binxing Pian* states: For small pulses where Yin/Yang, Form, and Qi are all insufficient, do not use needles; instead, regulate with sweet medicines. All such texts state that deficiency is unsuitable for needles. Upon detailed examination of the classic chapters, diseases indicated for needling generally involve pathogens lingering in meridians or Qi rebellion in organs, mostly treating excess syndromes. This clearly shows needles are beneficial for sedation but not for tonification. Then why do some texts say to tonify insufficiency? Because the flow of blood and Qi through meridians allows for tonifying Yin to balance Yang, or securing one area to attack another. The goal is to harmonize Yin and Yang, regulate blood and Qi, prevent imbalance, and achieve equilibrium. This is the essence of tonification and sedation. Those who do not understand the root and branch, or the true meaning of tonifying deficiency, and attempt to use needles to tonify all conditions of Ying-Wei depletion, emaciation, Jing-Qi exhaustion, etc., will damage the True Yuan and likely die immediately. Thus, it is said that needles only have a sedating effect, not a tonifying one, as evidenced by these chapters. Acupuncturists must understand this fundamental principle.) Therefore, it is said: If one does not know the reverse and smooth conditions during needling, Zhen Qi and Pathogenic Qi will clash. (Reversing tonification and sedation constitutes "reverse." Not knowing reverse and smooth leads to the clash of True Qi and Pathogenic Qi, worsening the disease.) Tonifying excess causes Yin and Yang to overflow, intestines and stomach to distend, and liver and lungs to be compressed, causing Yin-Yang disorder. (Adding to what is already excessive causes such pathology.) Sedating deficiency causes meridians to become empty, blood and Qi to dry up, intestines and stomach to contract abnormally, skin to become thin and adhere to bones, and hair/coarse follicles to wither and break, hastening death. (Damaging what is insufficient causes such pathology. HT: fear/timidness. Pi: abnormal/deviant. Bozhe: thin and adherent. Yao: short/broken. Yu: same as "give." HT: pronunciation chou-she. Pi: same as pi. : same as jiao.) Therefore, it is said: The essence of needling lies in knowing how to regulate Yin and Yang. Regulating Yin and Yang makes Jing Qi radiant, unites Form and Qi, and keeps Shen stored within. Therefore, it is said: Superior practitioners (Shanggong) level the Qi, intermediate practitioners (Zhonggong) disrupt the pulses, and inferior practitioners (Xiagong) sever the Qi and endanger life. Thus, inferior practitioners must be extremely cautious. (Shanggong understands Yin/Yang deficiency/excess and can level disordered Qi. Zhonggong lacks precise insight and often disrupts meridians. Xiagong mistakes false for true and wrong for right, severing Qi and endangering life.) One must carefully examine diseases of the five Zang changes, the correspondence of the five pulses, the excess/deficiency of meridians, and the roughness/smoothness of the skin before selecting points. (Five pulses refer to the pulse correspondences of the five Zang organs.)