七十七难曰∶经言上工治未病，中工治已病，何谓也？然所谓治未病者，见肝之病，则
知肝
当传之于脾。故先实其脾气，无令得受肝之邪，故曰治未病焉。中工治已病者，见肝之病，
不晓相传，但一心治肝，故曰治已病也。
滑氏曰∶见肝之病，先实其脾，使邪无所入，治未病也，是为上工。见肝之病，一心治
肝，
治已病也，是为中工。《灵枢》五十五篇曰∶上工刺其未生也，其次刺未盛者也，其次刺已
衰者也。下工刺其方袭者也，与其形之盛者也，与其病之与脉相逆者也。故曰方其盛也，勿
敢必毁伤因其衰也，事乃大昌。故曰上工治未病不治已病，此之谓也。
帝曰∶医之治病也，一病而治各不同，何也？岐伯曰∶地气使然也。故东方之域，天地
之所
始生也，鱼盐之地，海滨傍水，其民食鱼而嗜碱，皆安其处美其食。鱼者使人热中，盐者胜
血，故其民黑色理疏，其病皆为痈疡，（音羊）其治宜砭石。故砭石者，亦从东方来。南方者
，天地所长养之盛处也。其地下，水土弱，雾露之所聚也，其民嗜酸而食 ，其民皆致理而
赤色，其病挛痹。其治宜微针，故九针亦从南方来。形乐志苦，病生于内，治之以针石。
帝曰∶针之长短有数乎？岐伯对曰∶一曰 针，取法巾针，头大末锐，去末寸半卒，锐
之长
一寸六分。二曰员针，取法于絮针， （音同）其身而卵其锋，针如卵形，员其末，长一寸六
分
。三曰 （音低）针，取法于黍粟之锐，长三寸半。四曰锋针，取法于絮针， 其身。锋其末
，刃三隅，长一寸六分。五曰铍（音彼）针，取法于剑锋，末如剑，广二寸半，长四寸。六曰
员利针，取法于 ，针大如 ，且员且锐，微大其末，反小其身，又曰中身微大，长一寸六
分。七曰毫针，取法于毫毛，尖如蚊虻喙，长一寸六分。八曰长针，取法于綦针，锋利身薄
，长七寸。九曰大针，取法于锋针，尖如挺，其锋微员，针形毕矣。此九针之长短也。
《难经》第七十七难说：医经中说“上工（高明的医生）治疗未发生的疾病，中工（一般的医生）治疗已发生的疾病”，这是什么意思呢？回答说：所谓治疗未发生的疾病，是指看到肝脏的疾病，就知道肝病会传变到脾脏。因此预先使脾气充实，不让脾脏受到肝邪的侵害，所以叫做治疗未发生的疾病。中工治疗已发生的疾病，是看到肝脏的疾病，不懂得脏腑相传的道理，只是专心治疗肝脏，所以叫做治疗已发生的疾病。
滑寿氏说：看到肝脏的疾病，预先充实脾脏，使病邪无处侵入，这是治疗未发生的疾病，属于上工。看到肝脏的疾病，只专心治疗肝脏，这是治疗已发生的疾病，属于中工。《灵枢经》第五十五篇说：上工在病邪尚未产生时进行针刺，其次是在病邪尚未强盛时进行针刺，其次是在病邪已经衰退时进行针刺。下工则在病邪正侵袭人体时进行针刺，或在患者形体正气强盛时进行针刺，或在病情与脉象相逆的情况下进行针刺。所以说，当病邪强盛时，不敢轻易攻伐以免损伤正气，必须等待其衰退时再施治，事情才能大吉大利。所以说上工治疗未发生的疾病，不治疗已发生的疾病，说的就是这个道理。
黄帝问：医生治疗疾病，同样的病却采用不同的治疗方法，为什么呢？岐伯回答：这是因为各地地理气候条件不同所致。所以东方地区，是天地阳气开始生发的地方，是出产鱼盐之地，靠近海边和水边，那里的百姓吃鱼而喜欢吃咸味食物，都安于当地的生活，喜爱当地的食物。吃鱼容易使人体内积热，吃盐过多会耗伤血液，所以那里的百姓皮肤颜色黑且纹理疏松，他们的疾病多为痈疡（音羊），治疗适宜用砭石。所以砭石疗法，也是从东方传来的。南方地区，是天地阳气生长旺盛的地方。那里地势低洼，水土柔弱，雾气露水聚集，那里的百姓喜欢吃酸味食物和发酵食品，他们的百姓皮肤纹理致密且面色红润，他们的疾病多为筋脉拘挛和痹证。治疗适宜用微针，所以九针也是从南方传来的。形体安逸但精神苦闷，疾病生于内脏，治疗用针石。
黄帝问：针具的长度有几种规格吗？岐伯回答说：第一种叫鑱（chán）针，取法于巾针，头大末端尖锐，去掉末端一寸半后突然变得尖锐，全长一寸六分。第二种叫员针，取法于絮针，针身圆直而针锋呈卵圆形，针体如卵形，末端圆润，全长一寸六分。第三种叫鍉（dī）针，取法于黍粟的尖端，长三寸半。第四种叫锋针，取法于絮针，针身圆直，针锋锋利，刃口有三个棱角，全长一寸六分。第五种叫铍（pí）针，取法于剑锋，末端像剑一样，宽二寸半，长四寸。第六种叫员利针，取法于牦牛尾毛，针体粗大如牦牛尾毛，既圆又锐，末端稍大，中间部分略小，又说中部微大，全长一寸六分。第七种叫毫针，取法于毫毛，尖细如蚊虻的嘴，全长一寸六分。第八种叫长针，取法于綦针，锋利且针身薄，长七寸。第九种叫大针，取法于锋针，尖头像挺直的棍棒，针锋微微圆润，九针的形制就完备了。这就是九针的长度规格。
The Seventy-Seventh Difficulty of the *Nan Jing* states: The medical classics say, "Superior physicians (Shang Gong) treat disease before it arises; average physicians (Zhong Gong) treat disease after it has arisen." What does this mean? The answer is: Treating disease before it arises means that upon observing a liver disease, one knows that the liver pathology will transmit to the spleen. Therefore, one first strengthens the Spleen Qi (vital energy of the Spleen) so that it is not susceptible to pathogenic factors from the Liver. This is called treating disease before it arises. Average physicians treating disease after it has arisen observe a liver disease but do not understand the principle of transmission between Zang organs; they focus solely on treating the Liver. This is called treating disease after it has arisen.
Master Hua Shou stated: Observing a liver disease and first strengthening the Spleen to prevent pathogens from entering constitutes treating disease before it arises, which characterizes a Superior Physician. Observing a liver disease and focusing solely on treating the Liver constitutes treating disease after it has arisen, which characterizes an Average Physician. Chapter 55 of the *Ling Shu* (Spiritual Pivot) states: "Superior physicians needle where disease has not yet generated; next best is to needle where disease has not yet become excessive; next best is to needle where disease has already declined. Inferior physicians needle when pathogens are just invading, or when the patient's constitution is still robust, or when the disease pattern contradicts the pulse." Thus it is said: When disease is in its exuberant phase, do not dare to attack recklessly and cause damage; wait for its decline, and success will be great. Hence, superior physicians treat disease before it arises and do not treat disease after it has fully manifested; this is what is meant.
The Yellow Emperor asked: "When physicians treat diseases, why is it that the same disease is treated with different methods?" Qibo replied: "This is caused by the influence of local geographical and climatic conditions. The Eastern region is where heaven and earth begin to generate Yang Qi. It is a land of fish and salt, near the sea and waters. Its people eat fish and crave salty flavors, being content with their location and food. Fish consumption tends to cause heat accumulation in the interior; excessive salt consumption depletes Blood. Consequently, the people have dark skin and loose tissue texture, and their diseases are mostly carbuncles and ulcers (yang). Treatment is suitable with Bian stones (lithic therapy). Thus, Bian stone therapy originated from the East. The Southern region is where heaven and earth nurture and grow with abundant vitality. The terrain is low, the water and soil are weak, and mist and dew gather there. Its people favor sour flavors and fermented foods. Their people have dense skin texture and reddish complexion, and their diseases are mainly spasms and Bi syndrome (obstruction syndrome). Treatment is suitable with fine needles (Wei Zhen). Thus, the Nine Needles also originated from the South. When the body is at ease but the mind suffers, disease arises internally; treatment employs needles and stones."
The Yellow Emperor asked: "Are there specific lengths for the needles?" Qibo answered: "The first is the Chan Needle (Chan Zhen), modeled after the pin used for headgear. It has a large head and sharp tip. Removing half an inch from the tip leaves a sharp point extending one cun and six fen. The second is the Yuan Needle (Round Needle), modeled after the quilting needle. Its shaft is cylindrical and its tip is ovoid. The needle body resembles an egg shape with a rounded end, one cun and six fen long. The third is the Di Needle (Di Zhen), modeled after the sharp tip of millet grains, three cun and half a cun long. The fourth is the Feng Needle (Sharp Needle), modeled after the quilting needle. Its shaft is cylindrical, its tip is sharp, and its blade has three edges, one cun and six fen long. The fifth is the Pi Needle (Pi Zhen), modeled after the edge of a sword. The end is like a sword blade, two cun and half a cun wide, four cun long. The sixth is the Yuanli Needle (Round-Sharp Needle), modeled after cattle tail hair. The needle is thick like cattle tail hair, both round and sharp, with a slightly larger end and a slightly smaller shaft, or described as having a slightly larger middle section, one cun and six fen long. The seventh is the Hao Needle (Hair Needle), modeled after body hair. The tip is sharp like the proboscis of a mosquito or horsefly, one cun and six fen long. The eighth is the Chang Needle (Long Needle), modeled after the Qi needle. It is sharp and thin, seven cun long. The ninth is the Da Needle (Large Needle), modeled after the Feng Needle. The tip is straight like a rod, and the edge is slightly rounded. These constitute the forms of the Nine Needles. These are the lengths of the Nine Needles."