夫针之要，易陈而难入。粗守形，上守神。神乎神，客在门。未睹其病，恶知其原。刺
之微，在速迟。粗守关，上守机。机之不动，不离其空，空中之机，清静以微。其来不可逢
，其往不可追。知机道者，不可挂以发。不知机者，叩之不发。知其往来，要与之期。粗之
暗乎，妙哉上独有之也。往者为逆，来者为顺。明知逆顺，正行无问。迎而夺之，恶得无
虚。追而济之，恶得无实。迎而随之，以意和之。针道毕矣。凡用针者，虚则实之，满则泄
之，菀陈则除之，邪胜则虚之。《大要》曰∶徐而疾则实，疾而徐则虚。言其实与虚，若有
若无。察后与先，若存若亡。为虚为实，若得若失。虚实之要，九针最妙。补泻之时，以针
为之。泻曰迎之。迎之意，必持而内之，放而出之。排扬出针，疾气得泄。按而引针，是谓
内温。血不得散，气不得出。补曰随之。随之意，若忘之。若行若按，如蚊虻止。如留如环
，去如绝弦。令左属右，其气故止。外门已闭，中气乃实。必无留血，急取诛之。持针之道
，坚者为实，（《素问》注作宝）。正指直刺，无针左右。神在秋毫，属意病者，审视血脉，刺
之
居。视之独满，切之独坚。夫气之在脉也，邪气在上，浊气在中，清气在下。故针陷脉则邪
气出，针中脉则浊气出，针太深则邪反沉，病益甚。故曰皮肉筋脉，各有所处。病各有所
舍，针各有所宜。各不同形，各以任其所宜。无实实虚虚，损不足，益有余，是为重病，病
益甚。取五脉者死，取三脉者 。夺阴者厥，夺阳者狂，针害毕矣。
知其所苦。鬲有上下，知其气之所。先得其道，布而涿之（《太素》作希而疏之），稍深
而留之，故能徐入之。大热在上者，推而下之，从下上者，引而去之，视前痛者，常先取之。
大寒在外，留而
从之。阴阳皆虚，火自当之，厥而寒甚，骨廉陷下，寒过于膝，下陵三里，阴络所过，得之
留止，寒入于中，推而行之，经陷下者，即火当之。结络坚紧，火之所治。不知其苦，两跷
之下，男阳女阴，良工所禁，针论毕矣。凡刺虚者实之，满者泄之，此皆众工之所共知也。
若夫法天则地，随应而动，和之若响，随之若影，道无鬼神，独来独往。凡刺之真，必先治
神。五脏已定，九候已明，后乃存针。众脉所（《素》作不）见，众凶所（《素》作弗）闻。外
内相得，无以形先。可玩往来，乃施于人。虚实之要，五虚勿近，五实勿远。至其当发，
间不容 。手动若务，针耀而匀。静意视义，观适之变，是谓冥冥，莫知其形。见其乌
乌，见其稷稷；从见其飞，不知其谁。伏如横弩，起若发机。刺虚者须其实，刺实者须
其虚。经气已至，慎守勿失。深浅在志，远近若一。如临深渊，手如握虎，神无营于众物。
黄帝问曰∶愿闻禁数？岐伯对曰∶脏有要害，不可不察。肝生于左，肺藏于右。心部于
表，肾治于里，脾为之使，胃为之市。膈肓之上，中有父母。七节之傍，中有志心（《素》
作小心）。顺之有福，逆之有咎。泻必用方（《太素》作员）。切而转之，其气乃行。疾入徐
出，邪气乃出。伸而迎之，摇大其穴，气出乃疾。补必用员（《太素》作方），外引其皮，令
当其门。左引其枢，右推其肤，微旋而徐推之。必端以正，安以静，坚心无解，欲微以留，
气下而疾出之。推其皮，盖其外门，真气乃存。用针之要，无忘养神。泻者以气方盛，以
月方满，以日方温，以身方定，以息方吸而内针，乃复候其方吸而转针，乃复候其方呼而徐
引针。补者行也。行者移也，刺必中其荥，复以吸排针也。必知形之肥瘦。营卫血气之衰
盛。血气者，人之神，不可不谨养。形乎形，目瞑瞑。扪其所痛（《素》作问其所痛），索之
于经，慧然在前，按之弗得，不知其情，故曰形。神乎神，耳不闻。目明心开而志光，慧然
独觉，口弗能言，俱视独见，象若昏，昭然独明，若风吹云，故曰神。三部九候为之原，九
针之论不必存。凡刺之而气不至，无问其数；刺之而气至乃去之，勿复针。针各有所宜，
各不同形，各任其所为。刺之要，气至而效，效之信，若风吹云，昭然于天，凡刺之道毕矣
。节之交，凡三百六十五会。知其要者，一言而终；不知其要者，流散无穷。所言节者，神
气之所游行出入也，非皮肉筋骨也。睹其色，察其目，知其散复。一其形，听其动静，知其
邪正。右主推之，左持而御之，气至而去之。凡将用针，必先视脉气之剧易，乃可以治病。
五脏之气已绝于内，而用针者反实其外，是谓重竭。重竭必死，其死也静，治之者辄反其
气，取腑与膺。五脏之气已绝于外，而用针者反实其内，是谓逆厥。逆厥则必死，其死也
躁，治之者反取四末。刺之害，中而不去则精泄；害中而去则致气；精泄则病甚而 ，
致气则生为痈疡。刺针必肃，刺肿摇针，经刺勿摇，此刺之道也。刺诸热者，如手探汤；刺
寒清者，如人不欲行。刺虚者，刺其去；刺实者，刺其来。刺上关者，KT 不能欠；刺下
关者，欠不能KT 。刺犊鼻者，屈不能伸；刺内关者，伸不能屈。病高而内者，取之阴
陵
始矣。
针刺的要领，道理容易陈述但难以深入掌握。技术粗疏的医生只关注形体表象，高明的医生则注重守护患者的神气。所谓“神”，微妙难测，邪气入侵必有门户可寻。尚未看清病症，怎能知道病源？针刺的精微之处，在于进针速度的快慢控制。粗疏的医生只拘泥于穴位部位（关），高明的医生则把握经气运行的时机（机）。当经气未至时，并不离开腧穴，穴中之机的变化，清静而细微。经气来时不可逆其势而强行补益，经气去时不可追其尾而妄加泻法。懂得把握经气运行规律的人，不会因丝毫差错而失误；不懂的人，即使叩击激发也不会产生感应。知晓经气的往来规律，关键在于把握恰当的时机。粗疏者对此昏暗不明，而精妙之道唯有高明者独得。经气离去为逆，经气到来为顺。明确辨别逆顺，施针便无需犹豫。迎其来势而夺之，怎会不导致虚证？随其去势而济之，怎会不导致实证？迎着经气方向刺入并随之调和，这就是针刺的道理了。
大凡使用针法，虚证用补法使其充实，实证用泻法使其泄出，瘀血陈积则予以清除，邪气盛实则予以削弱。《大要》说：缓慢进针、快速出针为补法（实）；快速进针、缓慢出针为泻法（虚）。所说的虚实变化，若有若无。观察治疗的先后顺序，若存若亡。判断虚实，如同得失之感。虚实的关键，九种针具最为奇妙。补泻的时机，通过针具操作来实现。泻法称为“迎”。迎的意思，必须持针稳固地刺入，然后放开让针退出。排出并扬起针体，使疾速的邪气得以宣泄。按压针孔并引导针退出，这叫“内温”（封闭针孔以固护正气）。这样血液不会散乱，正气不会外泄。补法称为“随”。随的意思，意念仿佛遗忘。动作若有若无，像蚊虻叮咬般轻微。像停留又像画圆，退针时像断弦般利落。使左手固定，右手推针，经气自然停止扰动。外门已闭，中气于是充实。必须不留瘀血，若有急症则迅速处理。持针的原则，坚实有力才算扎实。端正直刺，不要左右偏斜。精神专注在毫毛般的细微处，意念集中在患者身上，审视血脉，确定刺入位置。视诊发现某处独满，切诊发现某处独坚。气在脉中的情况是：邪气在上部，浊气在中部，清气在下部。所以针刺浅层脉络可使邪气排出，针刺中层脉络可使浊气排出，针刺过深则邪气反而陷入，病情加重。所以说皮、肉、筋、脉各有其适宜的位置。病邪各有归属，针法各有适宜。形态各不相同，各自顺应其适宜之法。不要犯“实实虚虚”的错误（即实证用补、虚证用泻），损伤不足的正气，增加有余的邪气，这会导致重病，病情加剧。误取五脉之气者死，误取三脉之气者……夺阴气者发生厥逆，夺阳气者发生狂躁，针刺的危害至此穷尽。
了解患者的痛苦所在。膈膜有上下之分，需知晓气机所在。先掌握治疗原则，布散并疏通经气（《太素》作希而疏之），稍深进针并留针，因此能缓慢进入。大热证在上部的，向下推引以导邪外出；病势从下向上的，向上牵引以祛除病邪；看之前痛之处，常先选取治疗。大寒证在体表的，留针以从阳引阴。阴阳皆虚的，用火灸法治疗。厥冷且寒甚，骨廉凹陷，寒冷超过膝盖，取足三里（下陵），这是阴络经过之处，寒气停留于此，推引以行气。经脉陷下的，用火灸法治疗。结聚的络脉坚硬紧束，用火灸法治疗。不知其苦处，在两跷脉之下，男子取阳跷，女子取阴跷，这是良工所禁忌的。针刺理论到此结束。大凡刺虚证用补法，刺实证用泻法，这都是众工匠所共知的。至于效法天地，随机应变，和谐如响，跟随如影，道中没有鬼神，独自往来。凡针刺的真谛，必先调治神气。五脏状况已定，三部九候脉象已明，之后才考虑用针。各种脉象未见异常，各种凶兆未闻。内外相合，不以形体为先。可以玩味经气的往来，然后施针于人。虚实的关键，五虚证勿近（勿轻易用补），五实证勿远（勿轻易用泻）。到了该发针的时候，间隙不容许迟疑。手部动作专一，针体光亮均匀。静心观察义理，观察适应性的变化，这叫冥冥之中，无形可见。看见乌乌聚集，看见稷稷众多；跟随看见飞翔，不知是谁。潜伏时如横置的弩弓，发起时如发射机关。刺虚证须使其充实，刺实证须使其虚衰。经气已至，谨慎守护勿失。深浅在意念中，远近感觉如一。如同面临深渊，手如握虎，精神不被众物干扰。
黄帝问道：希望听听针刺的禁忌有哪些？岐伯回答说：脏腑有要害，不可忽视。肝气生于左，肺气藏于右。心主表，肾治里，脾为之使，胃为之市。膈肓之上，中有父母（指心肺）。第七节脊椎旁边，中有志心（《素问》作小心）。顺应则福，违背则灾。泻法必用“方”（《太素》作员）。切按并旋转针体，经气才能运行。快速进针，缓慢出针，邪气才能排出。伸展针体迎其气，摇大针穴，气出才快。补法必用“圆”（《太素》作方），向外牵引皮肤，使其对应针孔。左手牵引枢机，右手推展皮肤，微微旋转并缓慢推进。必须端正庄重，安静安心，坚定心意不懈怠，欲微留针，待气下行后快速出针。推压皮肤，盖住外门，真气才能留存。用针的要领，不要忘记养神。泻法要在气方盛、月方满、日方温、身方定、息方吸时进针，再候其方吸时转针，再候其方呼时缓慢引针。补法是行气，行气就是移气，刺必中荥穴，再在吸气时排针。必须知晓形体的肥瘦，营卫血气的盛衰。血气是人的神，不可不谨慎调养。形之于形，目瞑瞑然。扪按疼痛处（《素问》作问其所痛），在经络中索求，慧然在前，按之不得，不知其情，故曰形。神乎神，耳不闻。目明心开而志光，慧然独觉，口不能言，俱视独见，象若昏，昭然独明，若风吹云，故曰神。三部九候是根本，九针的理论不必拘泥。凡针刺而经气未至，不问次数多少；针刺而经气已至就停止，不再重复针刺。针各有所宜，形态不同，各自任其所为。刺的关键，气至而有效，有效的确凿性，如风吹云散，昭然于天，凡针刺的道理到此结束。腧穴交会之处，共有三百六十五会。懂得要领的，一言而终；不懂要领的，流散无穷。所说的节，是神气游行出入的地方，不是皮肉筋骨。观察面色，察视眼睛，知其精气散复。统一身形，听其动静，知其邪正。右手主推，左手持御，气至而去针。凡将用针，必先视脉气的剧易，才可以治病。五脏之气已绝于内，而用针者反实其外，这叫重竭。重竭必死，死时安静，治者辄反其气，取腑与胸。五脏之气已绝于外，而用针者反实其内，这叫逆厥。逆厥则必死，死时躁动，治者反取四肢末端。针刺的危害，中病不去则精气泄漏；害中而去则致气滞留；精气泄漏则病甚而……致气则生为痈疡。刺针必须严肃，刺肿疡摇针，刺经脉勿摇，这是刺的方法。刺各种热证，如手探热水；刺寒凉证，如人不愿行走。刺虚证，刺其去路；刺实证，刺其来路。刺上关穴，口不能欠伸；刺下关穴，欠伸不能开口。刺犊鼻穴，屈不能伸；刺内关穴，伸不能屈。病位高而在内的，取阴陵泉始矣。
The essence of acupuncture is easy to state but difficult to master. The mediocre practitioner guards the form, while the superior practitioner guards the Shen (Spirit/Mind). Profound is the Shen; the pathogen enters through a gate. Without perceiving the disease, how can one know its origin? The subtlety of needling lies in the speed and slowness (timing). The mediocre guard the acupoints (Guan), while the superior guard the Ji (Opportunity/Key moment). When the Ji does not move, it does not leave the Kong (Acupoint); the Ji within the Kong is clear, quiet, and subtle. Its arrival cannot be met with forceful supplementation, its departure cannot be chased with draining. One who knows the Dao of Ji cannot be mistaken by even a hair's breadth. One who does not know Ji, though struck, will not respond. Knowing the coming and going, one must seize the appropriate time. The mediocre are dark to this; the profound Dao is possessed only by the superior. What goes is Ni (Reverse), what comes is Shun (Smooth). Clearly knowing reverse and smooth, one proceeds correctly without hesitation. Meeting and draining it, how could it not become Deficient? Following and assisting it, how could it not become Excess? Meeting and following it, harmonizing with intention—this completes the Dao of needling.
In general, when using needles: for Deficiency, use Tonification to make it solid; for Fullness, use Draining to empty it; for Stagnation and old accumulation, remove it; for Pathogenic Excess, weaken it. The *Da Yao* says: Slow insertion and rapid withdrawal constitute Tonification (Shi/Solid); rapid insertion and slow withdrawal constitute Draining (Xu/Empty). Speaking of Solid and Empty, it seems as if there were something or nothing. Observing the sequence, it seems as if present or absent. Creating Deficiency or Solidity, it feels like gaining or losing. The key to Deficiency and Solidity lies in the Nine Needles. The timing of Tonification and Draining is achieved through the needle. Draining is called "Ying" (Meeting). The intent of Ying is to hold firmly and insert, then release and withdraw. Discharging and raising the needle allows the rapid pathogenic Qi to escape. Pressing and guiding the needle out is called "Nei Wen" (Internal Warming/Closing). Blood does not scatter, Qi does not exit. Tonification is called "Sui" (Following). The intent of Sui is as if forgetting. Moving and pressing lightly, like a mosquito bite. Like staying, like a circle; withdrawing like a broken string. Letting the left hand secure and the right hand push, the Qi stops disturbing. The external gate is closed, the internal Qi becomes solid. There must be no retained blood; urgent cases require immediate treatment. The way of holding the needle: firmness makes it solid. Point straight and pierce vertically, do not deviate left or right. Focus your Shen on the finest detail, direct your attention to the patient, examine the blood vessels, and determine the piercing location. If inspection shows fullness alone, palpation shows hardness alone. Regarding Qi in the meridians: Pathogenic Qi is in the upper part, Turbid Qi is in the middle, Clear Qi is in the lower part. Therefore, needling the superficial vessels expels Pathogenic Qi; needling the middle vessels expels Turbid Qi; needling too deeply causes Pathogenic Qi to sink further, worsening the disease. Thus, skin, flesh, sinews, and vessels each have their proper places. Diseases have their abodes, needling has its appropriateness. Forms differ, each should follow its appropriate method. Do not tonify Excess or drain Deficiency, do not damage what is insufficient nor add to what is excessive; this leads to severe illness and worsening condition. Taking from the Five Pulses causes death; taking from the Three Pulses... Depriving Yin causes Jue (Fainting/Cold extremities); depriving Yang causes Kuang (Mania). The harms of needling are complete here.
Know the patient's suffering. The diaphragm has upper and lower parts; know where the Qi resides. First grasp the principle, spread and dredge the Qi (Tai Su reads "Xi and Shu"), penetrate slightly deeper and retain the needle, thus allowing slow entry. For great Heat in the upper part, push downwards to guide it out; for conditions rising from below, lead upwards to dispel them; for previous pain sites, often treat them first. For great Cold on the exterior, retain the needle to follow the Yang. If both Yin and Yang are deficient, apply Moxibustion. For Jue with severe cold, sunken bone margins, cold exceeding the knees, take Xia Ling (Zusanli, ST36), where the Yin collaterals pass, where cold stays and stops; push and move the Qi. For collapsed meridians, apply Moxibustion. For knotted and tight collaterals, apply Moxibustion. If unaware of the suffering, at the lower ends of the two Qiao vessels, Yang Qiao for men, Yin Qiao for women—this is forbidden by skilled practitioners. The discussion on needling concludes. Generally, tonifying deficiency and draining fullness is known by all craftsmen. But regarding emulating Heaven and Earth, responding flexibly, harmonizing like an echo, following like a shadow—the Dao has no ghosts or gods, it comes and goes alone. The true essence of needling requires first governing the Shen. Once the Five Zang organs are assessed and the Nine Pulse positions are understood, then consider the needle. When common pulses show no abnormality and common ominous signs are unheard, when internal and external accord, not relying solely on form, one may study the coming and going before applying it to the person. The key to Deficiency and Solidity: do not approach Five Xu patterns closely (avoid blind tonification), do not stay away from Five Shi patterns (avoid blind draining). When the time to needle arrives, allow no interval for hesitation. Hand movement must be focused, the needle bright and even. Quietly observe the meaning, watch for changes in adaptation; this is called "Ming Ming" (Obscure/Subtle), where the form is unknown. Seeing Wu Wu (gathering), seeing Ji Ji (abundant); following the sight of flying, not knowing who. Lying still like a crossbow, rising like releasing the trigger. To needle Deficiency, ensure it becomes Solid; to needle Excess, ensure it becomes Empty. Once Jing Qi arrives, guard it carefully and do not lose it. Depth is in the mind, distance feels uniform. Face the abyss like a deep pool, hold the hand like grasping a tiger, let the Shen not be distracted by many objects.
Yellow Emperor asked: I wish to hear about the number of contraindications? Qibo replied: The Zang organs have vital points that must be examined. Liver Qi arises on the left, Lung Qi stores on the right. Heart governs the exterior, Kidney manages the interior, Spleen acts as the envoy, Stomach acts as the market. Above the diaphragm and Huang, there are Parents (Heart and Lung). Beside the seventh vertebra, there is the Zhi Xin (Mind-Heart) (*Su Wen* reads Xiao Xin). Following brings fortune, opposing brings blame. Draining must use Fang (Square/Upright) (*Tai Su* reads Yuan). Palpate and rotate, then Qi flows. Rapid insertion, slow withdrawal, so Pathogenic Qi exits. Extend and meet the Qi, widen the aperture, so Qi escapes quickly. Tonification must use Yuan (Round/Circular) (*Tai Su* reads Fang). Draw the skin outward, aligning with the gate. Left hand draws the pivot, right hand pushes the skin, slight rotation and slow pushing. Must be upright and correct, calm and quiet, firm heart without relaxation. Desire slight retention, then after Qi descends, withdraw rapidly. Push the skin, cover the external gate, so True Qi remains. The essence of using needles is not to forget nourishing the Shen. Draining is done when Qi is flourishing, Moon is full, Day is warm, Body is stable, Breath is inhaling. Insert the needle, wait for inhalation to rotate, wait for exhalation to slowly withdraw. Tonification is Xing (Movement). Xing is Yi (Transference). Needle must hit the Ying-Spring point, then withdraw during inhalation. Must know the fatness and thinness of the body, the decline and abundance of Ying and Wei Qi and Blood Qi. Blood Qi is the Shen of man, must be carefully nourished. Form upon form, eyes dim. Palpate the pain (*Su Wen* reads ask the pain), search in the meridians, clearly visible before, but unobtainable by touch, not knowing the condition, thus called Xing (Form). Profound is the Shen, ears do not hear. Eyes bright, heart open, will shines, clearly aware alone, mouth cannot speak, seeing together but perceiving alone, image seems dim, yet clearly illuminates alone, like wind blowing clouds, thus called Shen. The Three Parts and Nine Positions are the source; the theory of Nine Needles need not be rigidly kept. If needling does not bring Qi, do not count the repetitions; if needling brings Qi, stop and do not repeat. Needles have their appropriateness, forms differ, each performs its function. The essence of needling is Qi arrival leading to effect; the certainty of effect is like wind clearing clouds, manifest in heaven. The Dao of needling is complete. Intersections of joints, three hundred and sixty-five Hui (Assemblies). One who knows the essence finishes in one word; one who does not knows endless dispersion. The "Jie" mentioned refers to the places where Shen Qi travels and enters/exits, not skin, flesh, sinew, or bone. Observe color, inspect eyes, know scattering and returning. Unify the form, listen to movement and stillness, know pathogenic and righteous Qi. Right hand pushes, left hand holds and defends; when Qi arrives, withdraw. Before using needles, first observe the severity and ease of Mai Qi, then one can treat diseases. If Qi of Five Zang is exhausted internally, but the practitioner tonifies externally, this is called Chong Jie (Double Exhaustion). Chong Jie leads to death, death is quiet; the practitioner reverses the Qi, taking from Fu organs and chest. If Qi of Five Zang is exhausted externally, but the practitioner tonifies internally, this is called Ni Jue (Reverse Jue). Ni Jue leads to death, death is restless; the practitioner takes from the four limbs. Harms of needling: hitting the target but not stopping causes Jing leakage; harming the target but stopping causes Qi stagnation; Jing leakage worsens the disease... Qi stagnation generates abscesses. Needling must be solemn; shaking the needle for swelling, not shaking for meridian needling—this is the way of needling. Needling various Heat conditions is like probing hot water; needling Cold conditions is like a person unwilling to walk. Needling Deficiency targets the departing Qi; needling Excess targets the arriving Qi. Needling Shang Guan prevents opening the mouth; needling Xia Guan prevents closing the mouth. Needling Dubi prevents bending; needling Neiguan prevents extending. For high disease located internally, start by taking Yin Ling Quan.