官针最妙 马云。官者任也。官针者。任九针之所宜也。张云。官、法也。公也。制有法而公于人。
故曰官针。
病弗能移 张云。用不得法。则不能去病。
皮肤为痈 张云。内伤良肉。则血流于内而溃于外。故皮肤为痈。
支为大脓 甲乙。支、作反。马云。支、当作皮。或作反。张云。病气不泻而伤其支络。故为大脓。
凡病有浮沉。刺分浅深。过之则内伤。不及则外壅。邪反从之。后生大病。简案、支字今从甲乙作反。
大者泻 小者不移 张云。当小而大则泻伤正气。当大而小则病不能移。皆失针之宜也。
病在皮肤（止）勿取 张云。病在皮肤无常处者。火之游行也。用 针者主泻阳气也。肤白则无火
可知。故不宜刺。
取之 针于井荥分输 张云。此针宜于用补。分输。言各经也。
病在中者 张云。中、言其远也。九针论。八曰长针。主取深邪远痹者也。
痹气暴发 九针论云。调阴阳四时。而合十二经脉。虚邪客于经络而为暴痹者也。故为之治。针必
令尖如 。且
圆且锐。中身微大。以取暴气。知痹气暴发。即所谓暴痹也。
大针 九针十二原云。尖如挺。其锋微圆。以泻机关之水也。九针论云。主取大气不出关节者。
固居 马本。居、作痹。注云。前云病在经络痼痹者。取以锋针。当同之也。但彼止取经取络。
而此则泻其井荥与俞。及照五脏以取四时耳。简案、居作痹。未见所据。
日应九变 日、诸本作以。是。当删改。
诸经荥输脏 张云。诸经荥输。凡井荥经合之类皆 也。脏 背间之脏腑 也。本经。输、 、
俞、三字皆通用。
远道刺 甲乙无远字。简案。道、导同。
腑 张云。谓足太阳膀胱经。足阳明胃经。足少阳胆经。十二经中。惟此三经最远。可以因下
取上。故曰远道刺。
大经 志云。五脏六腑之大络也。邪客于皮毛。入舍于孙络。留而不去。闭结不通。则流溢于大
经之分。而生奇病。故刺大经之结络以通之。
小络之血脉 张云。调经论曰。病在血。调之络。经脉篇曰。诸刺络脉者。必刺其结。上甚血者。
虽无结急。取之以泻其邪。而出其血。留之发为痹也。
分刺 志云。分肉之间。溪谷之会。亦有三百六十五穴。会邪在肌肉者取之。
大泻刺 甲乙注。一作大刺。
毛刺 志云。邪闭于皮毛之间。浮浅取之。所谓刺毫毛无伤皮。刺皮无伤肉也。
刺浮痹皮肤也 甲乙痹下有于字。
巨刺 马云。素问缪刺论。以刺经穴为巨刺。刺络穴为缪刺。皆左取右。右取左。
刺 马云。调经论曰。病在骨。 刺药熨。张云。即后世火针之属。取寒痹者用之。以上谓之九变。
十二节 志云。节、制也。言针有十二节制。以应十二经也。
偶刺 马云。前后各用一针。有阴阳配合之义。故曰偶刺。张云。偶、两也。前后各一。故曰偶刺也。
以手直心（止）傍针之也 张曰。直、当也。以手直心若背。谓前心后心。当其痛所。各用一针
治之。然须斜针以刺其傍。恐中心则死也。马云。傍、当作旁。古盖通用。
报刺 张云。重刺也。简案、犹报灸之报。
无常处也 甲乙无也字。
无拔针 甲乙无无字。
恢刺 史云。恢、苦回切。大也。一本作怪。道藏本。怪作悭。恐误。恢、大也。出说文。张云。
恢恢廓也。志云。恢、大之也。前后恢荡其筋之急。
恢刺直 诸本直作者。当改。
旁之举之前后 楼氏云。谓直刺入 。转针头从旁挑举其筋也。张云。不刺筋而刺其旁。必数举
其针。或前或后。以恢其气。则筋痹可舒也。
齐刺 张云。齐者。三针齐用也。故又曰三刺。甲乙作参刺。
以治寒气小深者 甲乙寒下有热字。
扬刺 张云。扬、散也。中外共五针。而用在浮泛。故能祛散博大之寒气。志云。从中而发扬于
四旁也。
治寒气之博大者 甲乙寒下有热字。无气字。
直针刺 张云。直入无避也。引起其皮而刺之。则所用不深。
输刺 张云。输、委输也。言能输泻其邪。非上荥文输之谓。直入直出。用其锐也。稀发针。留
之久也。久而且深。故可以去盛热之气。志云。直入直出。如转输也。
短刺 张云。短者。入之渐也。故稍摇针而深致骨。所以摩骨痹。摩、迫切也。志云。短刺者。
用短针深入而至骨。
浮刺 马云。似前扬刺。但彼有正纳旁纳。而此则止有旁入之针耳。张云。浮、轻浮也。旁入其
针而浮举之。故可治肌肤之寒。此与上文毛刺义大同。
阴刺 马云。以其刺阴经也。张云。刺阴寒也。志云。刺少阴之寒厥也。
率刺之 张云。率、统也。
中寒厥 足踝后少阴也 甲乙厥足作者取。似是。马云。中、去声。简案、上文言十二刺应十二
经。然特举足踝后少阴。不及他经。其义今无可考。
旁针刺 甲乙无针字。张云。一正一旁也。正者刺其经。旁者刺其络。故可以刺久居之留痹。
赞刺 张云。赞、助也。数发针而浅之。以后助前。故可使之出血而治痈肿。志云。助痈肿之外散也。
致其空脉气也 甲乙作致其脉空也。张云。盖恐太过。反伤正气。故但久留而引致之。使其空中
之脉气上行也。张兆璜云。致五脏之神机。非营卫血气。故曰空脉气。
脉浅者勿刺 甲乙脉下有气字。张云。脉浅者。最易泄气。
谷气出 马云。终始篇曰。凡刺之属。三刺至谷气。
故一刺则阳邪出。再刺则阴邪出。三刺则谷气至。正与此节同。张云。谷气即正气。亦曰神气。出、至也。终
始篇曰。所谓谷气至者。已补而实。已泻而虚。故以知谷气至也。志云。谷气者。通会于肌腠之元真。脾胃之
所主也。故曰谷气。
阴邪出 张云。绝皮及肌。邪气稍深。故曰阴邪。
未入分肉间也 甲乙无也字。间下有后刺深之一句。马云。肌肉分肉之辨。肌肉在皮内肉上。而分
肉则近于骨者也。分肉有二。各部在外之肉曰分肉。其在内近骨之肉与骨根分。亦曰分肉。张云。大肉深处。
各有分理。是谓分肉间也。
逐邪气而来血气 甲乙作逐阳邪之气。无而来血气四字。
致阴气之邪（止）此之谓也 甲乙作致阴邪之气。张云。凡刺之浅深。其法有三。先刺绝皮。取卫中
之阳邪也。再刺稍深。取营中之阴邪也。三刺最深。及于分肉之间。则谷气始下。下、言见也。按、终始篇之
义。与此互有发明。
年之所加（止）不可以为工也 张云。年之所加。如天元纪、至真要等论是也。气之盛衰。如八正神
明论、阴阳系日月等篇是也。知天地之气候。则人有五虚五实。皆可因而知矣。此数句。又见六节藏象论。简
案、此五句。疑后人所缺。
半刺 张云。此即前章毛刺之义。浅入而疾发。故可取皮分以应肺。
豹文刺 张云。豹文者。言其多也。主取血脉。所以应心。
关刺 张云。关、关节也。左右四肢也。尽筋、即关
节之处也。慎无出血。血以养筋也。肝主筋。刺筋所以应肝。
或曰渊刺一曰岂刺 甲乙此二句在四曰合谷刺下。
合谷刺 张云。言三四攒合。如鸡足也。邪在肉间。其气广大。非合刺不可。脾主肌肉。故取肌痹者。
所以应脾。简案、张戴人治郾城梁贾麻痹。针用鸡足法。向上卧针。三进三引。复向下卧针送入。见儒门事亲。
输刺 张云。义见前章。肾主骨。刺深至骨。所以应肾。
The use of official needles is most excellent. Ma Yun: "Guan" (Official) means to serve or assume responsibility. The term "Guan Zhen" (Official Needle) refers to the method that assumes the suitability for all nine types of needles. Zhang Yun: "Guan" means law, rule, and public justice. It establishes laws and makes them public; hence it is called "Guan Zhen".
Therefore, if the disease cannot be moved (removed), [it is because] the method was not applied correctly. Zhang Yun: If the method is not used properly, the disease cannot be eliminated.
If the skin becomes an abscess. Zhang Yun: Internal injury to healthy flesh causes blood to accumulate internally and ulcerate externally, thus forming an abscess on the skin.
"Zhi" (Branch/Support) implies producing large pus. *Jia Yi Jing* notes: "Zhi" sounds like "Fan" (Reverse). Ma Yun suggests: "Zhi" should be read as "Pi" (Skin) or "Fan". Zhang Yun: When pathogenic qi fails to vent and damages the collateral branches, large pus is formed.
Generally, diseases have superficial (floating) and deep (sinking) locations; needling depth must correspond accordingly. Over-penetrating causes internal injury, while under-penetrating leads to external stagnation, allowing pathogens to enter further and eventually cause severe illness later. (Commentary: The character "Zhi" is now corrected to "Fan" based on *Jia Yi Jing*).
For mild cases, apply draining methods; for severe cases where the disease does not move. Zhang Yun: Using a large needle when a small one is indicated drains healthy Qi; using a small needle when a large one is indicated fails to move the disease. Both represent a loss of appropriateness in needling.
When the disease is located in the skin without fixed location, do not use needle therapy. Zhang Yun: Diseases in the skin with no fixed location indicate wandering Fire-evil. Needling primarily aims to drain Yang Qi. If the skin color is pale, indicating absence of Fire, needling is contraindicated.
If treatment is required, needle the Jing-Well, Ying-Spring, and Shu-Stream points. Zhang Yun: This approach is suitable for tonification. "Fen Shu" refers to the various meridians.
For diseases located in the interior (deep). Zhang Yun: "Zhong" here refers to distance from the surface. *Jiu Zhen Lun* states: The eighth needle, the Long Needle, is mainly used to treat deep-seated pathogens and distant Bi-syndromes.
Sudden onset of Bi-Qi. *Jiu Zhen Lun* states: Harmonize Yin-Yang and the four seasons, aligning with the twelve meridians. When deficient pathogens invade the meridians causing sudden Bi, treatment involves needles with tips sharp like arrowheads, slightly thicker in the middle, to expel sudden pathogenic Qi. Recognizing sudden Bi-Qi is recognizing "Sudden Bi".
The Large Needle. *Jiu Zhen Shi Er Yuan* states: The tip resembles a rod, with a slightly rounded edge, used to drain fluid accumulation in joints. *Jiu Zhen Lun* states: It is mainly used to address atmospheric Qi trapped within joints.
Fixed, entrenched Bi-syndrome. Ma's edition reads "Ju" as "Bi". The annotation says: Previously, entrenched Bi in meridians and collaterals was treated with the Pricking Needle; this should be similar. However, the previous method only selected meridians and collaterals, whereas this method drains Jing-Well, Ying-Spring, and Shu points, and selects points according to the five Zang organs corresponding to the four seasons. (Commentary: Changing "Ju" to "Bi" lacks textual evidence.)
Daily corresponds to nine changes. The character "Ri" (Day) appears as "Yi" (Use/By) in various editions, which is correct; "Yi" should be deleted/corrected.
Ying-Spring and Shu points of various meridians, and the Back-Shu points of the Zang organs. Zhang Yun: Ying-Spring and Shu points of various meridians include Jing-Well, Ying-Spring, Jing-River, and He-Sea points. "Zang" refers to the Zang-Fu organs on the back. In this text, "Shu", "Yu", and "Shu" are used interchangeably.
Distant Pathway Needling. *Jia Yi Jing* omits the character "Yuan" (Distant). (Commentary: "Dao" is synonymous with "Dao" leading/guiding).
Fu organ diseases. Zhang Yun: Refers to the Foot-Taiyang Bladder Meridian, Foot-Yangming Stomach Meridian, and Foot-Shaoyang Gallbladder Meridian. Among the twelve meridians, these three are the furthest, allowing treatment from below to affect above, hence "Distant Pathway Needling".
Large Meridians. Zhi Yun: These are the great collaterals of the five Zang and six Fu organs. When pathogens invade the skin and hair follicles, entering the Sun-Luo (fine collaterals), and remain there without dispersing, they block circulation and overflow into the areas of the Large Meridians, causing strange diseases. Therefore, puncturing the knotted collaterals of the Large Meridians unblocks them.
Blood vessels in small collaterals. Zhang Yun: *Tiao Jing Lun* states: For diseases in the blood, regulate the collaterals. *Jing Mai Pian* states: When needling collateral vessels, one must puncture their knots. If blood is abundant at the upper part, even without visible knots, urgent needling is required to drain pathogens and release blood; otherwise, retention leads to Bi-syndrome.
Fen Needling (Muscle Separation Needling). Zhi Yun: Between muscle layers, at the convergence of valleys, there are 365 acupoints. When pathogens reside in the muscles, these points are selected.
Da Xie Ci (Great Draining Puncture). *Jia Yi Jing* note: Also written as "Da Ci" (Great Puncture).
Mao Ci (Hair Puncture). Zhi Yun: When pathogens are blocked between skin and hair follicles, shallow needling is used. As stated: "Needle the fine hairs without injuring the skin; needle the skin without injuring the flesh."
Puncturing floating Bi in the skin. *Jia Yi Jing* adds the character "Yu" (In) after "Bi".
Ju Ci (Great Puncture / Cross Puncture). Ma Yun: *Su Wen · Miao Ci Lun* states: Needling Jing points is called Ju Ci; needling Luo points is called Miao Ci. Both involve left-right cross-needling (left disease treated on right, right disease on left).
Fan Zhen Jie Ci (Cauterizing Needle Snatching Puncture). Ma Yun: *Tiao Jing Lun* states: For bone diseases, use cauterizing needle snatching plus herbal hot compress. Zhang Yun: This refers to later fire-needle techniques, used for cold Bi-syndromes. The above constitutes the "Nine Changes".
Twelve Joints (Regulations). Zhi Yun: "Jie" means regulation or limit. There are twelve regulatory needling techniques corresponding to the twelve meridians.
Ou Ci (Paired Puncture). Ma Yun: One needle anteriorly and one posteriorly, embodying the principle of Yin-Yang pairing, hence "Ou Ci" (Paired). Zhang Yun: "Ou" means two. One anteriorly and one posteriorly, hence "Ou Ci".
Using the hand to align with the heart/chest (and back) side-needling. Zhang said: "Zhi" means directly opposite. Aligning the hand with the heart and back refers to the anterior chest and posterior back. At the site of pain, use one needle each. However, the needle must be inserted obliquely towards the side to avoid piercing the heart directly, which could be fatal. Ma Yun: "Bang" should be read as "Pang" (Side); they were interchangeable in ancient times.
Bao Ci (Reporting/Repeating Puncture). Zhang Yun: Repeated needling. (Commentary: Similar to the "Bao" in Bao Moxibustion).
Without fixed location. *Jia Yi Jing* omits "Ye".
Without withdrawing the needle. *Jia Yi Jing* omits "Wu".
Hui Ci (Expansive Puncture). Shi Yun: "Hui" is pronounced 'ku hui qie', meaning large. Some editions write "Guai". Daozang edition writes "Qian", likely an error. "Hui" means large, from *Shuo Wen*. Zhang Yun: "Hui Hui" means vast/expansive. Zhi Yun: "Hui" means to enlarge. Expand and relax the tension of the tendons anteriorly and posteriorly.
Hui Ci Zhi. Various editions have "Zhi" as "Zuo Zhe"; this should be corrected.
Side lifting, anterior and posterior operations. Lou Shi said: Insert vertically, then rotate the needle head to lift the tendon from the side. Zhang Yun: Do not needle the tendon itself but the side; repeatedly lift the needle, anteriorly or posteriorly, to expand the Qi, thereby relieving tendon Bi.
Qi Ci (Three-Needle Puncture). Zhang Yun: "Qi" means using three needles simultaneously. Hence also called "San Ci" (Three Punctures). *Jia Yi Jing* writes "Can Ci".
To treat cold pathogens that are small and deep. *Jia Yi Jing* adds "Re" (Heat) after "Han" (Cold).
Yang Ci (Scattering Puncture). Zhang Yun: "Yang" means scatter. Five needles are used centrally and peripherally, applied superficially, thus able to disperse extensive cold pathogens. Zhi Yun: Scattering from the center to the four directions.
To treat extensive cold pathogens. *Jia Yi Jing* adds "Re" (Heat) after "Han" (Cold). Omits "Qi".
Zhi Zhen Ci (Straight Needle Puncture). Zhang Yun: Straight entry without avoidance. Lift the skin and needle; thus, the depth is shallow.
Shu Ci (Transporting Puncture). Zhang Yun: "Shu" means transport/drainage. It refers to draining pathogens, not the Shu points mentioned earlier. Straight in and straight out, utilizing the needle's sharpness. Sparse needling, long retention time. Deep and prolonged, thus eliminating excessive heat. Zhi Yun: Straight in and straight out, like transportation.
Duan Ci (Short Needle Puncture). Zhang Yun: "Duan" implies gradual insertion. Slightly shake the needle while inserting deeply to the bone. Used to rub/massage bone Bi. "Mo" means pressing closely. Zhi Yun: Duan Ci uses a short needle inserted deeply to the bone.
Fu Ci (Floating Puncture). Ma Yun: Similar to Yang Ci. But Yang Ci has central and lateral insertion, whereas this only has lateral insertion. Zhang Yun: "Fu" means light/floating. Insert the needle laterally and lift it lightly, treating cold in the skin and muscles. This shares much meaning with Mao Ci above.
Yin Ci (Yin Puncture). Ma Yun: Because it needles Yin meridians. Zhang Yun: Needling Yin-cold. Zhi Yun: Needling Shaoyin cold-jue.
Shuai Ci (General/Uniform Puncture). Zhang Yun: "Shuai" means general/unified.
Middle Cold-Jue, located behind the ankle at the Shaoyin meridian. *Jia Yi Jing* reads "Jue Zu" as "Qu" (Take), which seems plausible. Ma Yun: "Zhong" is pronounced with departing tone. (Commentary: The text mentions twelve punctures corresponding to twelve meridians, but here specifically cites only the Shaoyin behind the ankle, excluding others; its rationale is currently untraceable).
Pang Zi Ci (Side-Adjacent Puncture). *Jia Yi Jing* omits "Zi". Zhang Yun: One central, one lateral. Central needles the meridian; lateral needles the collateral. Thus, it treats chronic, lingering Bi.
Zan Ci (Assisting Puncture). Zhang Yun: "Zan" means assist. Frequent, shallow needling, assisting the previous insertions, promoting bleeding to treat abscesses. Zhi Yun: Assisting the external dispersion of abscesses.
Guiding the Qi of empty vessels. *Jia Yi Jing* reads "Zhi Qi Mai Kong Ye". Zhang Yun: Likely to prevent excess, which would damage healthy Qi. Thus, retain the needle for a long time to guide the Qi of the empty vessels upward. Zhang Zhaohuang said: Guiding the divine mechanism of the five Zang, not Ying-Wei or Blood-Qi, hence "Empty Vessel Qi".
Do not needle shallow vessels. *Jia Yi Jing* adds "Qi" after "Mai". Zhang Yun: Shallow vessels easily leak Qi.
Gu Qi emerges. Ma Yun: *Zhong Shi Pian* states: In all needling, after three stages, Gu Qi arrives.
Thus, the first puncture expels Yang pathogens, the second expels Yin pathogens, and the third brings Gu Qi. This aligns with this section. Zhang Yun: Gu Qi is Healthy Qi, also called Shen Qi. "Chu" and "Zhi" both mean arrival. *Zhong Shi Pian* states: Arrival of Gu Qi indicates successful tonification (making solid) or drainage (making empty), confirming its arrival. Zhi Yun: Gu Qi is the primordial truth communicating through muscle-coupling, governed by the Spleen and Stomach, hence named Gu Qi.
Yin pathogens exit. Zhang Yun: Penetrating skin and muscle, the pathogen is slightly deeper, hence called Yin pathogen.
Not yet entered the space between muscle layers. *Jia Yi Jing* omits "Ye". After "Jian" (Space), there is a sentence about subsequent deep needling. Ma Yun: Distinction between Muscle and Fen-Rou: Muscle is inside the skin and above the flesh; Fen-Rou is near the bone. There are two types of Fen-Rou: outer fleshy parts are called Fen-Rou; inner parts near the bone separating from the bone root are also called Fen-Rou. Zhang Yun: Deep within large muscles, there are distinct separations, called Fen-Rou Jian.
Drive out pathogenic Qi and attract Blood-Qi. *Jia Yi Jing* reads "Zhu Yang Xie Zhi Qi", omitting "Er Lai Xue Qi".
Guide Yin-pathogenic Qi (End of section). This is what is meant. *Jia Yi Jing* reads "Zhi Yin Xie Zhi Qi". Zhang Yun: There are three depths/methods for needling. First, penetrate skin to take Yang pathogens in Wei; second, go slightly deeper to take Yin pathogens in Ying; third, deepest, reaching Fen-Rou Jian, where Gu Qi begins to descend. "Xia" means appearance. Note: The meaning of *Zhong Shi Pian* complements this.
What is added by the year (End of section) cannot make one a skilled practitioner. Zhang Yun: "Nian Zhi Suo Jia" refers to theories like *Tian Yuan Ji Da Lun* and *Zhi Yao Yao Lun*. Fluctuations of Qi are discussed in *Ba Zheng Shen Ming Lun* and *Yin Yang Xi Ri Yue Pian*. Knowing heavenly and earthly climates allows understanding human Wu Xu (Five Deficiencies) and Wu Shi (Five Excesses). These sentences also appear in *Liu Jie Zang Xiang Lun*. (Commentary: These five lines are suspected to be missing from later transmission).
Ban Ci (Half Puncture). Zhang Yun: This is the same as Mao Ci in the previous chapter. Shallow insertion and rapid withdrawal, taking the skin layer to correspond to the Lung.
Bao Wen Ci (Leopard Pattern Puncture). Zhang Yun: "Bao Wen" implies multiplicity. Mainly targets blood vessels, corresponding to the Heart.
Guan Ci (Joint Puncture). Zhang Yun: "Guan" means joint. Left and right limbs. "Jin Jin" (End of tendons) refers to the joint area. Carefully avoid bleeding, as blood nourishes tendons. Liver governs tendons; needling tendons corresponds to the Liver.
It is said Yuan Ci is also called Qi Ci. *Jia Yi Jing* places these two sentences under "Si Yue He Gu Ci".
He Gu Ci (Valley/Gathering Puncture). Zhang Yun: Three or four needles gathered together, resembling a chicken's foot. When pathogens are in the meat spaces, the Qi is extensive, requiring combined needling. Spleen governs muscles; thus, treating Ji Bi corresponds to the Spleen. (Commentary: Zhang Dairen treated paralysis of Liang Jia in Yancheng using the chicken-foot method: inserting the needle horizontally upwards, advancing three times and pulling three times, then inserting downwards. See *Ru Men Shi Qin*).
Shu Ci (Transporting Puncture). Zhang Yun: Meaning seen in the previous chapter. Kidney governs bones; needling deeply to the bone corresponds to the Kidney.