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The term "Yi Chen" (Easy to State) means that the principles are easy to articulate. The term "Nan Ru" (Difficult to Enter) means that they are difficult for ordinary people to comprehend.

A crude practitioner (Cù Gōng, a physician with inferior skills) only adheres to physical forms; this refers to their rigid adherence to needling techniques. An superior practitioner (Shàng Gōng, a highly skilled physician) observes Shen (Spirit/Mind); this refers to their attention to the excess or deficiency of Blood and Qi in the human body, thereby determining whether to apply tonification or sedation.

"Shen Ke" (Spirit Guest) refers to the convergence of Zheng Qi (Upright Qi/Healthy Energy) and Xie Qi (Evil Qi/Pathogenic Factor). "Shen" denotes Zheng Qi, while "Ke" denotes Xie Qi. "Zai Men" (At the Door) indicates that Xie Qi enters along the pathways where Zheng Qi exits and enters.

"Wei Du Qi Ji" (Not yet perceiving the disease) implies that before clearly identifying the pathology, one must first determine which meridians are affected by Zheng Qi and Xie Qi. "E Zhi Qi Yuan" (How to know its origin) implies that to understand the root of the disease, one must first identify which meridian is diseased and select the appropriate treatment points.

The subtlety of needling lies in the speed (Xu Chi), reflecting the intention of Xu (slow) and Ji (fast) manipulation for tonification and sedation.

Crude practitioners only guard the joints (Guan) of the limbs, unaware of the fluctuation of Zheng and Xie Qi within the blood vessels. Superior practitioners guard the Ji (Mechanism/Opportunity), understanding how to secure the Qi. The movement of the Ji does not depart from the Kong Zhong (Empty Space/Void within the tissue); this refers to knowing the emptiness or fullness of the Qi and applying slow or fast needle manipulation accordingly.

"The Ji in the Empty Space is clear, quiet, and subtle." This means that once De Qi (Arrival of Qi/Acquired Sensation) is achieved, the practitioner must maintain mental clarity and closely guard the Qi so as not to lose it.

"Its arrival cannot be met (with tonification)." This means when Qi is excessive, tonification should not be used. "Its departure cannot be pursued (with sedation)." This means when Qi is deficient, sedation should not be used.

"It cannot hang by a hair." This signifies that Qi is easily lost; even a slight error can lead to mistakes.

"Striking but not sounding." This means if one does not understand the intent of tonification and sedation, it is like striking an instrument without producing sound, failing to mobilize the Qi. At this point, Blood and Qi are exhausted, and Qi fails to descend.

"To know its coming and going" refers to understanding the direction (Ni/Shun) and strength (Sheng/Xu) of the Qi.

"To set a time with it" refers to knowing the opportune moment to treat based on the Qi's state.

Crude practitioners are obscure because they unknowingly fail to perceive the subtle and secret changes of Qi.

The skillful artisan possesses unique insight because they fully understand the art of needling.

"Wang Zhe Wei Ni" (Going away is Ni/Reverse) describes a state where Qi is deficient and weak; weakness constitutes a Reverse pattern. "Lai Zhe Wei Shun" (Coming is Shun/Smooth) describes a state where Form and Qi are balanced; balance constitutes a Smooth pattern.

"To clearly know Reverse and Smooth, and act correctly without interval" means knowing the correct points to select and executing them without error.

"Ying Er Duo Zhi" (Meeting and seizing) is Sedation (Xie Fa). "Zhui Er Ji Zhi" (Chasing and assisting) is Tonification (Bu Fa).

"As for 'Deficiency requires Repletion' (Xu Ze Shi Zhi)," it means when the Qi Kou (Pulse at the radial artery) is deficient, it should be tonified.

"As for 'Fullness requires Draining' (Man Ze Xie Zhi)," it means when the Qi Kou is excessive, it should be sedated.

"As for 'Removing Stasis and Oldness' (Wan Chen Ze Chu Zhi)," it refers to removing stagnant blood from the vessels.

"As for 'Excess Evil requires Emptiness' (Xie Sheng Ze Xu Zhi)," it means that if any meridian has excessive evil, one should sedate the evil.

"Slow insertion and fast withdrawal result in Repletion (Xu Er Ji Ze Shi)." This means slowly inserting the needle and quickly withdrawing it tonifies the Qi.

"Fast insertion and slow withdrawal result in Emptiness (Ji Er Xu Ze Xu)." This means quickly inserting the needle and slowly withdrawing it sedates the Qi.

Speaking of "Repletion" and "Emptiness," appearing as if present or absent: this means that in Repletion patterns, there is a sensation of Qi; in Emptiness patterns, there is no sensation of Qi.

"Observing sequence and priority, as if present or absent" refers to determining the order of tonification and sedation based on the emptiness or fullness of Qi, performing the manipulation with a subtle, almost imperceptible feel. One must also observe whether the Qi has descended or remains constant.

"Being empty or full, as if gained or lost": When tonifying, the patient feels as if they have gained something (comfort/fullness); when sedating, the patient feels as if they have lost something (relief/lightness).

Regarding Qi in the meridians: "Evil Qi affecting the Upper" means that pathogenic factors often attack the body from high points, hence the disease location is upper.

"Turbid Qi remaining in the Middle" means that food and drink enter the Stomach; their essence ascends to the Lung, while turbid residues remain in the intestines and stomach. If there is disharmony in cold/warmth or irregular diet, disease arises in the intestines and stomach, thus termed Turbid Qi in the Middle.

"Clear Qi stagnating in the Lower" means that cold and damp earthy pathogens attack the body, necessarily starting from the feet; thus, it is termed Clear Qi in the Lower.

Needling the Xian Mai (Sunken/Depressed Collaterals) to expel evil involves selecting points in the upper body. Needling the Zhong Mai (Middle/Deep Meridians) to expel evil involves selecting points on the Yangming He-Sea acupoints.

If deep needling causes the evil to sink further, it means that superficial floating diseases should not be treated with deep needling; deep needling allows the evil to follow the needle inward, hence termed "reverse sinking."

Skin, flesh, tendons, and vessels each have their specific locations, meaning that different meridians govern specific tissues.

Taking the Five Pulse groups (referring to the Yin meridians associated with the Five Zang organs) excessively leads to death. This occurs when internal Qi is insufficient, yet one uses strong sedation on all Yin meridians. Taking the Three Yang pulses excessively results only in draining all San Yang Qi, leaving the patient exhausted and listless.

Depriving the Yin leads to death; this refers to repeatedly taking Wu Li (ST36) near the Chi area. Depriving the Yang leads to mania; this is a definitive statement.

Observing the complexion and inspecting the eyes allows one to know the dispersion and recovery of Shen. Unifying observation of the form and listening to movements means that a superior doctor knows to correlate the five colors observed in the eyes with the pulse characteristics (size, speed, tension, smoothness) at Cun Kou to diagnose the disease. Knowing the nature of evil and upright qi means distinguishing between Xu Xie (Deficient Evil/External Pathogens) and Zheng Xie (Upright Evil/Internal Factors).

Pushing the needle forward with the right hand while holding and controlling with the left hand refers to the manipulation of needle insertion and withdrawal. Expelling the Qi after it has moved refers to stopping the operation once the Qi is regulated through tonification or sedation. Regulating Qi depends on maintaining a consistent mindset (Zhong Shi Yi Zhe, Chi Xin Ye).

The 365 junctions of the body are the sites where collaterals seep and irrigate Qi.

As for "The Qi of the Five Zang is already exhausted internally," this refers to the inner pulse at Qi Kou being faint or absent. If one then treats external symptoms or selects He-Sea points of Yang meridians and retains the needle to attract Yang Qi, the arrival of Yang Qi will cause further depletion of internal Yin, leading to double depletion and death. Such death is characterized by stillness due to the lack of Qi movement.

As for "The Qi of the Five Zang is already exhausted externally," this refers to the outer pulse at Qi Kou being faint or absent. If one mistakenly treats the extremities (Si Mo) and retains the needle to attract Yin Qi, the arrival of Yin Qi will cause Yang Qi to retreat and reverse, leading to reversal and death. Such death is characterized by restlessness due to excess Yin Qi.

Therefore, observing the eyes is crucial because the Five Zang make the five colors bright and clear; clarity leads to distinct voice. A distinct voice indicates that the speech differs from the person's normal state. (Zhang, "Zhang", sounds like "Bi", meaning manifest/clear).

Zhang Kaizhi explains: This passage interprets the meaning of "Small Needle" but does not involve the theory of the Nine Needles. "Hun" means confused/dark; "Huang" means vague/uncertain. The reason for observing the eyes follows the previous text. Eye color reflects the blood aspect of the Five Zang, while vocal clarity reflects the Qi aspect of the Five Zang. The correspondence of clear colors and clear voice demonstrates the interaction of Blood and Qi. Speaking of "voice differing from normal" refers to the voice of scattered and ruined Qi. In summary, when the Qi of the Five Zang is exhausted internally, one should not over-tonify Yang; when exhausted externally, one should not over-tonify Yin. Yin and Yang, internal and external, support each other and should be stored rather than fully exposed externally.