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If the disease is superficial but the needle insertion is too deep, it will damage healthy flesh internally, leading to carbuncles on the skin. If the disease is deep but the needle insertion is too shallow, the pathogenic qi will not be discharged, instead resulting in large abscesses. If the pathology is minor but the needle is too large, the righteous qi will be excessively depleted, causing the illness to worsen and become harmful. If the pathology is major but the needle is too small, the righteous qi will not be discharged, also leading to treatment failure. Deviating from the appropriate principles of acupuncture—failing to apply reducing methods for major conditions or failing to adjust needle size for minor ones—results in error. Diseases vary in their depth (superficial vs. deep), and needle insertion must correspondingly vary in depth, reaching the proper level without exceeding the prescribed limits. Exceeding the limit damages muscle; falling short causes external stagnation, allowing pathogens to enter. Improper depth becomes a great disaster, internally disturbing the Zang organs and later generating severe diseases. Thus it is said: diseases may reside in the hair follicles and interstices, in muscles, in vessels, in sinews, in bones, or in marrow. Therefore, when needling the hair follicles and interstices, do not injure the skin; if the skin is injured, it internally disturbs the Lung, which manifests as warm malaria with chills in autumn. When needling the skin, do not injure the muscle; if the muscle is injured, it internally disturbs the Spleen, which manifests as abdominal distension, irritability, and anorexia during the last eighteen days of each season. When needling the muscle, do not injure the vessel; if the vessel is injured, it internally disturbs the Heart, which manifests as heart pain in summer. When needling the vessel, do not injure the sinew; if the sinew is injured, it internally disturbs the Liver, which manifests as heat syndromes with flaccid sinews in spring. When needling the sinew, do not injure the bone; if the bone is injured, it internally disturbs the Kidney, which manifests as abdominal distension and lower back pain in winter. When needling the bone, do not injure the marrow; if the marrow is injured, emaciation and wasting occur, accompanied by soreness and weakness that persist. "Needling the bone without injuring the sinew" means stopping at the sinew level without reaching the bone. "Needling the sinew without injuring the muscle" means stopping at the muscle level without reaching the sinew. "Needling the vessel without injuring the muscle" means stopping at the vessel level without reaching the muscle. "Needling the vessel without injuring the skin" means stopping at the skin level without reaching the vessel. "Needling the skin without injuring the muscle" refers to cases where the disease is in the skin; the needle enters only the skin, sparing the muscle. "Needling the muscle without injuring the sinew" implies passing through the muscle to reach the sinew. "Needling the sinew without injuring the bone" implies passing through the sinew to reach the bone. This is referred to as an error (the original text says "Jiu," suspected to be a typo for "Shi," meaning mistake).

Regarding the distribution of Qi within the vessels, pathogenic Qi tends to be in the upper part, turbid Qi in the middle, and clear Qi in the lower part. Therefore, needling points like Xian Gu expels pathogenic Qi, while needling the central vessels expels turbid Qi; however, if needling is too deep, pathogenic Qi sinks back into the body, worsening the condition. Thus, the skin, muscle, sinew, and vessel each have specific appropriate depths and forms, requiring adherence to their respective suitability. One must not tonify excess nor reduce deficiency; damaging insufficient righteous Qi while augmenting excessive pathogenic Qi leads to aggravated disease and worsening prognosis. Depriving the Five Vessels (excessive reduction of all five Zang organs) leads to death; depriving three vessels (excessive reduction of Yin) leads to death; depriving Yang leads to mania. The harm caused by improper acupuncture is indeed profound.