黄帝曰。余以小针为细物也。夫子乃言上合之于天。下合之于地。中合之于人。余以为过针之意矣。愿闻其故。岐
伯曰。何物大于天乎。夫大于针者。惟五兵者焉。五兵者死之备也。非生之具。且夫人者。天地之镇也。其不可不参乎。
夫治民者。亦唯针焉。夫针之与五兵。其孰小乎。黄帝曰。病之生时。有喜怒不测。饮食不节。阴气不足。阳气有余。
营气不行。乃发为痈疽。阴阳不通。两热相搏。乃化为脓。小针能取之乎。岐伯曰。圣人能不使化者。为知邪不可留也。
（言圣人能不使化脓者为知邪不可留而早治之也待脓已成岂小针之治乎）故两军相当。旗帜相望。白刃陈于中野者。此
非一日之谋也。能使其民。令行禁止。士卒无白刃之难者。非一日之教也。须臾之得也。夫至使身被痈疽之病。脓血之
聚者。不亦离道远乎。夫痈疽之生。脓血之成也。不从天下。不从地出。积微之所生也。故圣人自治于未有形也。愚者
遭其已成也。黄帝曰。其已形。不予遭。脓已成。不予见。为之奈何。岐伯曰。脓已成。十死一生。故圣人弗使已成。
而明为良方。着之竹帛。使能者踵而传之后世。无有终时者。为其不予遭也。黄帝曰。其已有脓血而后遭乎。不导之以
小针治乎。岐伯曰。以小治小者其功小。以大治大者多害。故其已成脓血者。其唯砭石铍锋之所取也。黄帝曰。多害者。
其不可全乎。岐伯曰。其在逆顺焉。黄帝曰。愿闻逆顺。岐伯曰。以为伤者。其白眼青。黑睛小。是一逆也。内药而呕
者。是二逆也。腹痛渴甚。是三逆也。肩项中不便。是四逆也。音嘶色脱。是五逆也。除此五者为顺矣。黄帝曰。诸病
皆有逆顺。可得闻乎。岐伯曰。腹胀。身热。脉大。是一逆也。腹鸣而满。四肢清泄。其脉大。是二逆也。衄而不止。
脉大。是三逆也。咳且溲血。脱形。其脉小劲。是四逆也。咳脱形。身热。脉小以疾。是五逆也。如是者。不过十五日
而死矣。其腹大胀。四末清。脱形。泄甚。是一逆也。腹胀。便血。其脉大。时绝。是二逆也。咳。溲血。形肉脱。脉
搏。是三逆也。呕血。胸满引背。脉小而疾。是四逆也。咳呕。腹胀且飧泄。其脉绝。是五逆也。如是者。不及一时而
死矣。工不察此者而刺之。是谓逆治。黄帝曰。夫子之言针甚骏。以配天地。上数天文。下度地纪。内别五脏。外次六
腑。经脉二十八会。尽有周纪。能杀生人。不能起死者。（二句承上启下在有意无意之间不能起死即暗指前诸逆也）夫子
能反之乎。岐伯曰。能杀生人。不能起死者也。黄帝曰。余闻之。则为不仁。然愿闻其道。弗行于人。岐伯曰。是明道
也。其必然也。如刀剑之可以杀人。如饮酒之使人醉也。虽勿诊犹可知矣。黄帝曰。愿卒闻之。岐伯曰。人之所受气者
谷也。谷之所注者胃也。胃者水谷气血之海也。海之所行云气者天下也。胃之所出气血者。经隧也。经隧者五脏六腑之
大络也。迎而夺之而已矣。黄帝曰。上下有数乎。岐伯曰。迎之五里。中道而止五至而已。五往而脏之气尽矣。故五五
二十五而竭其输矣。此所谓夺其天气者也。非能绝其命而倾其寿者也。（句义与上下不续非字疑当作是字）黄帝曰。愿卒
闻之。岐伯曰。 门而刺之者。死于家中。入门而刺之者。死于堂上。黄帝曰。善乎方。明哉道。请着之玉版。以为重
宝。传之后世。以为刺禁。令民勿敢犯也。
帝先疑小针之无大功也。而岐伯极称之下。乃接叙痈疽之重者。诸病之逆者。皆非小针所能治。以诘小针之果。无
大功也。末乃推论针害以结之通篇一气。贯注前后。尤笔致纡徐婉转关生深情 。
Huangdi said: I consider the small needle to be a minute object. Yet you say it corresponds to Heaven above, Earth below, and Humanity in between. I believe this exceeds the true meaning of the needle. I wish to hear the reason.
Qibo said: What is greater than Heaven? Among things greater than the needle, there are only the Five Weapons (spear, halberd, dagger-axe, bow, and arrow). The Five Weapons are instruments of death, not of life. Moreover, humanity is the anchor of Heaven and Earth. How can it not correspond with them? To govern the people, one relies solely on the needle. Comparing the needle with the Five Weapons, which is smaller?
Huangdi said: When diseases arise, they often stem from uncontrolled joy or anger, irregular diet, deficiency of Yin Qi, excess of Yang Qi, and stagnation of Ying Qi (Nutritive Qi), leading to carbuncles and sores (purulent inflammation of skin and subcutaneous tissue). When Yin and Yang fail to communicate and two heats clash, pus is formed. Can the small needle treat such conditions?
Qibo said: The Sage prevents progression to suppuration because he knows that pathogenic factors must not remain stagnant. (This means the Sage understands that preventing pus formation requires early treatment; once pus has formed, it is beyond the scope of small needle therapy.) Thus, when two armies face each other, banners visible, and white blades arrayed in the fields, this is not the result of a plan made in a single day. To enable the people to obey orders and prohibit actions, and for soldiers to avoid harm from blades, is not achieved in a single day's instruction but through long-term cultivation. If one allows the body to suffer from carbuncles and sores, with accumulation of pus and blood, is this not far from the Great Dao? The generation of carbuncles and sores, and the formation of pus and blood, do not fall from the sky nor emerge from the earth; they arise from the accumulation of minute factors. Therefore, the Sage regulates health before disease manifests, while the fool encounters disease after it has already formed.
Huangdi said: If the disease has already taken shape and I have not encountered it; if pus has already formed and I have not seen it, what should be done?
Qibo said: Once pus has formed, nine out of ten patients will die, with only one surviving. Therefore, the Sage prevents disease from reaching the stage of suppuration and clearly formulates effective prescriptions, inscribing them on bamboo slips and silk, so that capable successors may transmit them to future generations without end, thereby addressing cases where prevention was neglected.
Huangdi said: If pus and blood have already formed and then I encounter the case, should I not treat it with the small needle?
Qibo said: Using small methods to treat large diseases yields little effect; using major interventions for major ailments often causes significant harm. Therefore, for conditions where pus and blood have already formed, only bi stone (lithic needles) and pi feng (a type of surgical knife) should be used to drain them.
Huangdi said: Causing significant harm, does this mean complete cure is impossible?
Qibo said: It depends on whether one violates the patterns of Shun (favorable) and Ni (unfavorable) in disease progression.
Huangdi said: I wish to hear about Shun and Ni.
Qibo said: If the patient has excessive whites in the eyes and small pupils, this is the first unfavorable sign (poor prognosis). Vomiting after taking medicine is the second unfavorable sign. Abdominal pain with extreme thirst is the third unfavorable sign. Inability to move the shoulders and neck is the fourth unfavorable sign. Hoarseness and loss of luster in complexion is the fifth unfavorable sign. Apart from these five conditions, the rest are favorable signs.
Huangdi said: All diseases have favorable and unfavorable signs; may I ask about them?
Qibo said: Abdominal distension, fever, and a large pulse constitute the first unfavorable sign. Bowel sounds with abdominal fullness, cold extremities, diarrhea, and a large pulse constitute the second unfavorable sign. Unstopping epistaxis with a large pulse constitutes the third unfavorable sign. Coughing with hematuria, emaciation, and a small yet forceful pulse constitute the fourth unfavorable sign. Coughing, emaciation, fever, and a small rapid pulse constitute the fifth unfavorable sign. In such cases, death occurs within fifteen days.
Furthermore, massive abdominal distension, cold extremities, emaciation, and severe diarrhea constitute the first unfavorable sign. Abdominal distension, bloody stool, large pulse, and intermittent pulse cessation constitute the second unfavorable sign. Coughing, hematuria, muscle wasting, and a surging pulse constitute the third unfavorable sign. Hematemesis, chest fullness radiating to the back, and a small rapid pulse constitute the fourth unfavorable sign. Coughing, vomiting, abdominal distension with undigested food in stool, and an absent pulse constitute the fifth unfavorable sign. In such cases, death occurs within less than one shi (two hours). If physicians fail to observe these signs and proceed with acupuncture, it is called "Ni Zhi" (incorrect treatment).
Huangdi said: Your words regarding needle therapy are profound, aligning with Heaven and Earth, counting celestial phenomena above, measuring terrestrial boundaries below, distinguishing the Five Zang internally, and ordering the Six Fu externally, covering the twenty-eight meridians and their cycles completely. Yet, needles can kill living persons but cannot revive the dead. (These sentences serve as a transition, implying that inability to revive refers to the previously mentioned unfavorable signs.) Can you reverse this?
Qibo said: Needles can indeed kill living persons, but cannot revive the dead.
Huangdi said: Hearing this, I feel it is inhumane. However, I wish to understand the principle, provided it is not applied to human bodies.
Qibo said: This is a clear principle and an inevitable law. Just as swords and knives can kill, and just as alcohol intoxicates, this can be known even without diagnosis.
Huangdi said: I wish to hear this in detail.
Qibo said: The Qi received by humans comes from grain. Grain enters the Stomach. The Stomach is the sea of water and grain, generating Qi and Blood. As the sea distributes clouds and air throughout the world, the Qi and Blood output from the Stomach travel through Jing Sui (meridian channels). These Jing Sui are the great collaterals of the Five Zang and Six Fu. One simply needs to attack them by迎 (Ying -迎着经气方向, against the flow) and seize (夺 - draining excess).
Huangdi said: Are there fixed numbers above and below?
Qibo said: When needling the Wuli point, one must stop midway after five thrusts. After five thrusts, the Qi of the Zang is exhausted. Thus, five sets of five (twenty-five) thrusts will deplete the Qi at the Shu points. This is referred to as "stealing Heavenly Qi." It does not directly sever life or shorten lifespan, but results from excessive draining. (The meaning here seems disconnected; "Fei" [not] is suspected to be a typo for "Shi" [is].)
Huangdi said: I wish to hear this in detail.
Qibo said: If one needles inside the gate, the patient dies at home; if one needles after entering the hall, the patient dies in the hall.
Huangdi said: Excellent is this prescription, clear is this Dao. Please inscribe it on the Jade Tablet as a precious treasure, to be transmitted to posterity as acupuncture contraindications, so that the people dare not violate them.
[Commentary]
Huangdi initially doubted the efficacy of the small needle, while Qibo extolled its virtues. The text then discusses severe carbuncles and unfavorable signs of various diseases, none of which can be treated by the small needle, questioning its utility. Finally, it deduces the harms of needling to conclude the chapter. The entire passage flows as one continuous breath, with a narrative style that is leisurely and tactful, deeply concerned with matters of life and death.