（《灵枢·九针十二原篇》《小针解篇》）
凡将用针，必先诊脉，视气之剧易，乃可以治也。
（《灵枢·九针十二原篇》）。病之虚实，不易识也，必察于脉，乃可知之。故凡将用针，必先诊脉，察知重轻，方可
施治，否则未有不误而杀人者矣。）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，（脏气已
绝于内，阴虚也。反实其外，误益阳也。益阳则愈损其阴，是重竭也。阴竭必死，死则静也。）治之者辄反其气，取腋
与
膺。（腋与膺皆脏脉所出，气绝于内而复取之，则致气于外而阴愈竭矣。）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，（脏气已绝于外，阳虚也。反实其内，误补阴也。助阴则阳气愈竭，故致四逆而厥。逆
厥
必死，死必躁也。）治之者反取四末。（四末为诸阳之本，气绝于外而取其本，则阴气至而阳愈陷矣。）刺之害中而不去
则
精泄，害中而去则致气，精泄则病益甚而 ，致气则生为痈疡。（言中而不去，去针太迟也。不中而去，去针太早也。均
足为害。此节与寒热病篇文同，但彼云不中而去则致气者是，此云害中者误也。详见前五十四。）
《小针解》曰∶所谓五脏之气已绝于内者，脉口气内绝不至，（此释上文之义也。脉口浮虚，按之则无，是谓内绝
不
至，脏气之虚也。）反取其外之病处与阳经之合，有留针以致阳气，阳气至则内重竭，重竭则死矣，其死也无气以动，
故
静。（外者阳之分，阴气既虚，复留针于外以致阳气，则阴愈虚而气竭于内，无气以动，故其死也静。）所谓五脏之气已
绝于外者，脉口气外绝不至，（脉口沉微，轻取则无，是谓外绝不至，阳之虚也。）反取其四末之输，有留针以致其阴气，
阴气至则阳气反入，入则逆，逆则死矣，其死也阴气有余，故躁。（阳气既虚，复留针四末以致阴气，则阳气愈竭，必
病逆厥而死。阳并于阴，则阴气有余，故其死也躁。）
(Ling Shu: Jiu Zhen Er Shi Yuan Pian [Nine Needles and Twelve Original Points Chapter], Xiao Zhen Jie [Explanation of the Small Needle Chapter])
Whenever one is about to use acupuncture, one must first examine the pulse to observe the severity and ease or difficulty of the pathogenic Qi, before treatment can be administered.
(Ling Shu: Jiu Zen Er Shi Yuan Pian). The deficiency or excess nature of a disease is not easy to identify; it is necessary to inspect the pulse to know it. Therefore, whenever one is about to use acupuncture, one must first examine the pulse to discern the lightness or heaviness of the condition before applying treatment. Otherwise, there will inevitably be errors leading to death.
When the Qi of the Five Zang Organs (Five Zang Organs) has exhausted internally, but the acupuncturist instead tonifies externally, this is called "Double Exhaustion" (Zhong Jie). Double Exhaustion leads to certain death, and the manner of death is quiet. (The Qi of the Zang Organs is exhausted internally, indicating Yin Deficiency. Tonifying externally erroneously augments Yang. Augmenting Yang further depletes Yin, which is Double Exhaustion. When Yin is exhausted, death ensues; because there is no Qi to move, the state is quiet.) The practitioner, however, reverses the Qi by selecting points in the axilla and chest. (The axilla and chest are where the Zang pulses emerge. If Qi is exhausted internally yet these points are selected, Qi is drawn to the exterior, causing Yin to become even more depleted.)
When the Qi of the Five Zang Organs has exhausted externally, but the acupuncturist instead tonifies internally, this is called "Reverse Joule" (Ni Jue - Reversal Cold Syndrome). Reverse Joule leads to certain death, and the manner of death is restless. (The Qi of the Zang Organs is exhausted externally, indicating Yang Deficiency. Tonifying internally erroneously supplements Yin. Supplementing Yin causes Yang to become even more depleted, resulting in cold extremities and Joule. Reverse Joule leads to death; death involves restlessness.) The practitioner, however, incorrectly selects the four limbs. (The four limbs are the roots of all Yang channels. If Qi is exhausted externally yet the roots are selected, Yin Qi arrives while Yang Qi sinks further.)
The harm of needling lies in this: if the needle hits the target but is retained too long, essence (Jing) leaks out; if the needle misses the target and is withdrawn too early, pathogenic Qi accumulates. Essence leakage causes the disease to worsen and leads to emaciation; accumulated Qi generates carbuncles and sores. (To "hit and not remove" means the needle struck the target but was removed too late. To "miss and remove" means the needle missed the target and was removed too early. Both are harmful. This section corresponds to the text in the Han Re Bing Pian [Cold-Heat Disease Chapter], except that chapter states "missing and removing leads to accumulated Qi" is correct, whereas here stating "hitting" is erroneous. See Chapter 54 for details.)
Xiao Zhen Jie states: What is meant by "the Qi of the Five Zang Organs exhausted internally" is that the pulse at the Cun Kou (Radial Pulse) fails to reach internally. (This explains the meaning above. The Radial Pulse is floating and deficient; pressing reveals nothing, which is called internal exhaustion without arrival, indicating Zang Qi deficiency.) Instead, one selects diseased areas on the exterior and the He-Sea points of Yang channels, retaining the needle to draw Yang Qi. When Yang Qi arrives, internal Yin suffers double exhaustion, leading to death. Because there is no Qi to move, the death is quiet. (The exterior belongs to Yang. Since Yin is already deficient, retaining needles on the exterior to draw Yang makes Yin even more deficient, exhausting Qi internally. With no Qi to drive movement, death is quiet.)
What is meant by "the Qi of the Five Zang Organs exhausted externally" is that the pulse at the Cun Kou fails to reach externally. (The Radial Pulse is deep and minute; light palpation reveals nothing, which is called external exhaustion without arrival, indicating Yang deficiency.) Instead, one selects the Shu-Stream points of the four limbs, retaining the needle to draw Yin Qi. When Yin Qi arrives, Yang Qi reverses inward. Inward reversal leads to disorder, and disorder leads to death. Because Yin Qi is in excess, the death is restless. (Since Yang is already deficient, retaining needles on the four limbs to draw Yin causes Yang to exhaust further, inevitably leading to pathological reversal and Joule death. Yang merging into Yin results in excess Yin, hence the death is restless.)