（《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。）
（《灵枢·九针十二原篇》《小针解篇》）
凡是准备使用针刺治疗时，必须先诊察脉象，观察病气的盛衰难易程度，然后才可以进行治疗。
（《灵枢·九针十二原篇》）。疾病的虚实性质，是不容易识别的，必须通过诊察脉象，才能知晓。所以凡是准备使用针刺，必须先诊察脉象，辨别病情的轻重，然后方可施治，否则没有不失误而致人死亡的。
五脏之气在内已经衰竭，如果用针的人反而在体表（阳分）进行补益，这叫做“重竭”，重竭必然导致死亡，其死亡时的状态是安静的。（脏气在内已经衰竭，属于阴虚。反而在体表补益，是错误地增益了阳气。增益阳气就会更加损耗阴气，这就是重竭。阴气竭尽必然死亡，死亡时因为无气以动，所以表现为安静。）治疗的人却反过来调取腋部和胸膺部（这些部位是脏脉所出之处，内气已绝却又去取这些穴位，就会使气汇聚于体表，导致阴气更加枯竭）。
五脏之气在外已经衰竭，如果用针的人反而在体内（阴分）进行补益，这叫做“逆厥”，逆厥必然导致死亡，其死亡时的状态是躁动的。（脏气在外已经衰竭，属于阳虚。反而在体内补益，是错误地补助了阴气。补助阴气就会使阳气更加枯竭，从而导致四肢逆冷而发生厥证。逆厥必然死亡，死亡时必然表现为躁动。）治疗的人却反而选取四肢末端（四末是诸阳经的根本，外气已绝却又去取根本，就会导致阴气至而阳气更加下陷）。
针刺的危害在于：如果刺中病所却留针时间过长，就会导致精气泄漏；如果未刺中病所就过早拔针，就会导致邪气滞留。精气泄漏则病情加重并出现消瘦，邪气滞留则会化生为痈疡。（所谓“中而不去”，是指刺中病所但去针太迟；“不中而去”，是指未刺中病所就去针太早。这两种情况都足以造成危害。这一节与《寒热病篇》的文字相同，只是那篇说“不中而去则致气”是正确的，这里说“害中”是错误的。详见前五十四篇。）
《小针解》说：所谓五脏之气在内已经衰竭，是指寸口脉（脉口）的内侧脉搏跳动微弱或消失。（这是解释上文的意思。脉口浮取虚弱，重按则无，这叫做内绝不至，是脏气虚弱的表现。）反而取其体表的病处和阳经的合穴，并且留针以引致阳气，阳气到来则内部阴气再次枯竭，重竭就会死亡，其死亡时因为没有气机活动，所以表现为安静。（体表属于阳的分野，阴气既然已经虚弱，又在体表留针以引致阳气，那么阴气会更加虚弱，气机在内枯竭，没有气机以驱动形体，所以其死亡时表现为安静。）
所谓五脏之气在外已经衰竭，是指寸口脉的外侧脉搏跳动微弱或消失。（脉口沉取微细，轻取则无，这叫做外绝不至，是阳虚的表现。）反而选取四肢末端的输穴，并且留针以引致阴气，阴气到来则阳气反而内入，内入则发生逆乱，逆乱就会死亡，其死亡时因为阴气有余，所以表现为躁动。（阳气既然已经虚弱，又在四肢末端留针以引致阴气，那么阳气会更加枯竭，必然发生病逆厥证而死。阳气并入阴分，则阴气有余，所以其死亡时表现为躁动。）
(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.)