（《灵枢·九针十二原篇》《小针解篇》《四时气篇》《终始篇》）
刺之而气不至，无问其数（《灵枢·九针十二原篇》）；无问其数者，必以气至为度也。即如待贵人，不知日暮之谓。）刺之而气至，乃去之，
勿复针。（气至勿复针，恐其真气脱也。候气详义，有按在前十四。）针各有所宜，各不同形，各任其所为。（皮肉筋骨，
病各有处，用针各有所宜也。）刺之要，气至而有效，效之信，若风之吹云，明乎若见苍天，刺之道毕矣。（刺以气为要，
以效为信，得其要则效，故如风之吹云。邪气去则正气见，故明手若见苍天也。）
睹其色，察其目，知其散复；一其形，听其动静，知其邪正。（详义具见下文。）右主推之，左持而御之，气至而去
之。（右主推之，所以入针也；左持而御之，所以护持也。邪气去而谷气至，然后可以出针。）
《小针解》曰∶睹其色、察其目、知其散复、一其形、听其动静者，言上工知相五色，于目有知，调尺寸小大缓急
滑涩，以言所病也。（察形色于外，可以知其散复。察脉于内，可以知其动静。）知其邪正者，知论虚邪与正邪之风也。
右主推之、左持而御之者，言持针而出入也。气至而去之者，言补泻气调而去之也。（补不足，泻有余，必得其平，是气
调也，方可去针。）调气在于终始。一者持心也。（终始，本经篇名，见下文。一者持心也，释前文一其形。听其动静、
知其邪正者，皆主持于心也。）节之交三百六十五会者，络脉之渗灌诸节者也。（此一句，详经络类十四。）所以察其目者，
五脏使五色循明，循明则声章，声章者，则言声与平生异也。（五脏六腑之精气，皆上注于目而为之精，故能使五色循明。
盖色明于外者，由气盛于内，故其声音亦必章大，与平生异矣。）
《四时气篇》曰∶睹其色、察其目、以知其散复者，视其目色，以知病之存亡也。（神完则气复，神失则气散，故察
其目色，即可知病之存亡也。）一其形、听其动静者，持气口人迎，以视其脉坚且盛且滑者病日进，脉软者病将下，（脉
坚而且盛且滑者，邪气之炽也，故病日进。脉软而和者，元气之来也，故病将下。下，退也。）诸经实者病三日已。（凡
邪气未解者，最忌脉弱无力，如《平人气象论》曰∶病在中脉虚。《玉机真藏论》曰∶病在外脉不实坚者，皆难治。《邪
客篇》曰∶虚而细者久以持。皆不实之谓也。若病在诸经而脉实有力者，邪将外达也，故可三日而已矣。）气口候阴，人
迎候阳也。（气口在手，太阴肺脉也，气口独为五脏主，故以候阴。人迎在头，阳明胃脉也，胃为六腑之大源，故以候阳。
人迎气口详议，见藏象类十一。）
凡刺之道，气调而止（《灵枢·终始篇》）。）补阴泻阳，音气益彰，耳目聪明，反此者血气不行。（此阴阳以表里言。凡正气在中，所当补
也，故曰补阴。邪自外入，所当泻也，故曰泻阳。阳邪去而真阴复，故音气益彰、耳目聪明也。）所谓气至而有效者，泻
则益虚，虚者脉大如其故而不坚也，坚如其故者，适虽言故，病未去也。（凡气至之效，泻者欲其虚也，既泻之后，虽其
脉大如旧，但得和软不坚，即其效也。若脉坚如旧者，虽欲文 其故，而病实未除也。）补则益实，实者脉大如其故而益
坚也，夫如其故而不坚者，适虽言快，病未去也。（补者欲其实，实则脉必坚，既补之后，而脉之大小不坚如旧者，不可
言快，病未除也。二节云大者，乃概指脉体进退而言也，非洪大之谓。）故补则实，泻则虚，痛虽不随针，病必衰去。（补
则实者，其脉必坚。泻则虚者，其脉必不坚。若或有痛，虽未随针即愈，亦必以渐而去矣。）必先通十二经脉之所生病，
而后可得传于终始矣。（十二经脉各有左右上下，其受病之处亦有先后，必治其病所从生，而后可得终始之义。终始，本
篇名，即本末之谓。）故阴阳不相移，虚实不相倾，取之其经。（移，移易也。倾，相伤也。或阴或阳，无所改易，不相
移也。虚者自虚，实者自实，不相倾也。此则无所从生而各病其病，但求其经而取之。）凡刺之属，三刺至谷气，邪辟妄
合，阴阳易居，逆顺相反，沉浮异处，四时不得，稽留淫 ，须针而去。（三刺义如下文。邪辟妄合等六句，详言病变也。
凡此者皆须用针，治以三刺之法，则诸病可去也。）故一刺则阳邪出，（初刺之，在于浅近，故可出阳分之邪。）再刺则阴
邪出，（再刺之，在于深远，故可出阴分之邪。）三刺则谷气至，谷气至而止。所谓谷气至者，已补而实，已泻而虚，故
以知谷气至也。（三刺之，在候谷气。谷气者，元气也。止，出针也。盖邪气来也紧而疾，谷气来也徐而和，必邪气去而
后谷气至。故已补而实则虚者坚，已泻而虚则坚者软，是以知谷气之至也。）邪气独去者，阴与阳未能调，而病知愈也。
故曰补则实，泻则虚，痛虽不随针，病必衰去矣。（谷气至者，知邪气之去也。虽阴阳经气未见即调，而病则已愈，故上
文曰补则实，泻则虚，病必衰去矣。）
（引用自《灵枢·九针十二原篇》《小针解篇》《四时气篇》《终始篇》）
针刺后若经气未至，不必拘泥于针刺的次数。（出自《灵枢·九针十二原篇》）所谓不必拘泥次数，必须以经气到来为标准。这就好比等待尊贵的客人，不知天色已晚一样。）当针刺后经气到来，即可起针，不要再继续针刺。（经气至则不再针刺，是担心真气耗脱。关于候气的详细义理，在前文第十四部分已有详述。）每种针具各有其适宜之处，形状各不相同，各自承担不同的治疗作用。（皮肤、肌肉、筋、骨等病变部位不同，使用针具也各有适宜的选择。）针刺的关键，在于经气到来才能见效；疗效的验证，就像风吹云散，清晰地看见蓝天一样，针刺的道理也就完备了。（针刺以经气为关键，以疗效为验证，得其要领则有效，所以像风吹云散。邪气去除则正气显现，所以清晰得如同看见苍天。）
观察患者的面色，审视其眼神，可以知道神气的涣散或恢复；统一其形体状态，倾听其动静表现，可以辨别邪正盛衰。（详细义理见下文。）右手主推针具，左手扶持控制，待经气到来后即可出针。（右手推针是为了进针；左手扶持是为了护持。邪气去而谷气（脾胃之气，此处指正常的经气）至，然后才可以出针。）
《小针解》说：观察面色、审视眼神、知晓神气的散复、统一形体、听其动静，是说高明的医生懂得观察五色，对眼睛的变化有认知，通过调节寸口和人迎脉的大小、缓急、滑涩，来判断病情。（在外观察形色，可以知道神气的散复；在内诊察脉象，可以知道气血的动静。）所谓知晓邪正，是指辨析虚邪与正邪之风。
右手推针、左手扶持，是说持针进出。经气至而出针，是说补虚泻实使经气调和后即可出针。（补不足，泻有余，必须达到平衡，这就是经气调和，才可以出针。）调气在于《终始》篇。所谓“一”，是指持守心神。（《终始》是本经的一篇名，见下文。“一”即持守心神，解释前文的“一其形”。倾听动静、知晓邪正，都是由心神主持。）
周身三百六十五个穴位交会处，是络脉渗透灌注各关节的地方。（这一句，在经络类第十四部分有详细说明。）之所以要观察眼睛，是因为五脏使五色循行明亮，循行明亮则声音彰显，声音彰显，则言语声音与平时不同。（五脏六腑的精气，都上注于眼睛而形成视觉，所以能使五色循行明亮。大概颜色明于外，是由于气盛于内，所以其声音也必然宏大，与平时不同了。）
《四时气篇》说：观察面色、审视眼睛，来知晓神气的散复，是通过观察眼目的色泽，来知道疾病的存亡。（神志完固则气机恢复，神志丧失则气机涣散，所以观察眼目色泽，就可以知道疾病的存亡。）统一形体、听其动静，是指持守气口和人迎脉，来观察脉象。如果脉象坚硬、盛大且滑利，说明病势日益进展；脉象软弱，说明病势将退。（脉象坚硬、盛大且滑利，是邪气炽盛的表现，所以病势日进。脉象软弱和缓，是元气来复的表现，所以病势将退。下，意为退却。）各经实证，三天可愈。（凡邪气未解者，最忌脉弱无力，如《平人气象论》说：病在中而脉虚。《玉机真藏论》说：病在外而脉不实坚者，都难治。《邪客篇》说：脉虚而细者久持。都是指脉不实的情况。如果病在各经而脉实有力，说明邪气将要外达，所以三天就可以痊愈。）气口脉候阴，人迎脉候阳。（气口在手腕部，属手太阴肺经，气口独为五脏之主，所以用来候阴。人迎在颈部，属足阳明胃经，胃为六腑的大源，所以用来候阳。人迎和气口的详细讨论，见藏象类第十一部分。）
大凡针刺之道，以经气调和为终止标准（出自《灵枢·终始篇》）。）补阴泻阳，声音气息更加彰显，耳目变得聪明，与此相反则血气运行不畅。（这里的阴阳是从表里角度说的。凡是正气在中焦，应当补益，所以说补阴。邪气从外侵入，应当泻除，所以说泻阳。阳邪去除而真阴恢复，所以声音气息更加彰显、耳目聪明。）所谓经气到来才有效的，是指泻法之后应使邪气更虚，虚证患者脉象虽大但像以前一样不坚硬；如果脉象依然坚硬，虽然表面看似旧状，但病邪并未去除。（凡经气到来的疗效，泻法希望其变虚，既泻之后，虽然脉象大小如旧，但只要变得和软不坚，就是有效。如果脉象坚硬如旧，虽然想掩饰旧状，但病实未除。）补法之后应使正气更实，实证患者脉象虽大但比以前更坚硬；如果脉象像以前一样不坚硬，虽然患者自称舒服，但病邪并未去除。（补法希望其实，实则脉必坚，既补之后，如果脉的大小不坚如旧，不可言快，病未除也。这两节说“大”，是泛指脉体的进退变化而言，并非指洪大之脉。）所以补则实，泻则虚，疼痛即使不随针立止，疾病也必定逐渐消退。（补则实，其脉必坚。泻则虚，其脉必不坚。如果有疼痛，虽然不随针立即痊愈，也必定逐渐消除。）必须先通晓十二经脉所生的疾病，然后才能掌握《终始》篇的要义。（十二经脉各有左右上下，其受病的部位也有先后顺序，必须治疗疾病产生的根源，然后才能理解终始的含义。终始，本篇名，即本末的意思。）所以阴阳不相移易，虚实不相倾轧，取穴就在其所属的经脉。（移，是移易的意思。倾，是相伤的意思。或阴或阳，没有改易，不相移易。虚者自虚，实者自实，不相倾轧。这种情况是没有从其他方面产生而是各自在其本经发病，只需寻求其经脉而取穴。）
凡属于针刺的范畴，经过三次针刺可达到谷气，邪气妄乱结合，阴阳位置互换，逆顺相反，浮沉异处，四时脉象失常，邪气稽留浸淫，都需要用针去除。（三刺的意义如下文所述。邪辟妄合等六句，详细论述病变。凡此情况都需要用针，采用三刺的方法，各种疾病都可以去除。）所以第一次针刺则阳分之邪外出，（初刺较浅，所以能排出阳分的邪气。）第二次针刺则阴分之邪外出，（再刺较深，所以能排出阴分的邪气。）第三次针刺则谷气到来，谷气到来就停止针刺。所谓谷气到来，是指已经补益而变得充实，已经泻除而变得虚弱，因此知道谷气已到。（第三次针刺是在等候谷气。谷气，就是元气。止，指出针。因为邪气来时紧促疾速，谷气来时徐缓和缓，必须邪气去而后谷气至。所以补后实者变坚，泻后虚者变软，以此知道谷气已到。）只有邪气单独去除，而阴与阳尚未调和，但疾病也知道要痊愈了。所以说补则实，泻则虚，疼痛即使不随针立止，疾病也必定逐渐消退了。（谷气到来，就知道邪气已去。虽然阴阳经气未见立即调和，但疾病已经痊愈，所以上文说补则实，泻则虚，病必衰去矣。）
(Quoted from *Ling Shu: Nine Needles and Twelve Origins Chapter*, *Small Needle Explanation Chapter*, *Four Seasons Qi Chapter*, and *Ends and Beginnings Chapter*)
If the Deqi sensation (arrival of Qi) does not occur after needling, do not be concerned with the number of insertions (*Ling Shu: Nine Needles and Twelve Origins Chapter*). The phrase "do not be concerned with the number" means that one must take the arrival of Qi as the standard. It is like waiting for a noble guest, unaware that evening has fallen.) When the Deqi sensation arrives, remove the needle; do not needle again. (Do not needle again once Deqi arrives, to avoid depleting the Zhen Qi (True Qi). For detailed meanings regarding waiting for Qi, see Part 14 earlier.) Each type of needle has its specific indications, different shapes, and respective functions. (Diseases in the skin, flesh, sinews, and bones have their specific locations, and the use of needles has specific appropriateness.) The essence of needling lies in the arrival of Qi for efficacy; the confirmation of efficacy is like wind blowing away clouds, clearly revealing the blue sky. Thus, the way of needling is complete. (Needling relies on Qi as the key and efficacy as proof; obtaining the essence leads to efficacy, hence like wind blowing clouds. When pathogenic Qi departs, healthy Qi appears, thus clear as seeing the blue sky.)
Observe the complexion, inspect the eyes, and know whether Shen (Spirit) is scattered or restored; unify the body posture, listen to movements and sounds, and know whether it is pathogenic or healthy. (Detailed meanings are seen below.) Push the needle forward with the right hand, hold and control it with the left hand, and remove it when Qi arrives. (Pushing with the right hand is for insertion; holding with the left hand is for protection. When pathogenic Qi departs and Gu Qi (Grain Qi, here referring to normal meridian Qi) arrives, then the needle can be removed.)
The *Small Needle Explanation* states: Observing complexion, inspecting eyes, knowing the scattering and restoration of Shen, unifying the form, and listening to movements and sounds means that an expert physician knows how to observe the five colors, has insight into the eyes, and regulates the Cun Kou (Radial Pulse) and Ren Ying (Carotid Pulse) sizes, speeds, and qualities (slippery/rough) to diagnose the disease. (Observing form and color externally reveals the scattering and restoration of Shen; observing pulses internally reveals the movement and stillness of Qi.) Knowing pathogenic versus healthy refers to discussing Wind of Deficient Pathogen and Wind of Healthy Pathogen.
Pushing with the right hand and holding with the left hand refers to the manipulation of inserting and withdrawing the needle. Removing the needle upon Qi arrival refers to tonifying deficiency and draining excess until Qi is harmonized. (Tonify insufficiency, drain excess, must achieve balance; this is Qi harmony, only then can the needle be removed.) Regulating Qi lies in the *Zhong Shi* (Ends and Beginnings) chapter. "One" refers to maintaining mental focus. (*Zhong Shi* is a chapter name in this classic, seen below. "One" refers to mental focus, explaining the previous text "unify the form." Listening to movements and knowing pathogenic/healthy states are all governed by the mind.)
The three hundred and sixty-five junction points of the meridians are where collateral vessels seep and irrigate various joints. (This sentence is detailed in Meridian Category 14.) The reason for observing the eyes is that the Five Zang organs cause the five colors to circulate brightly; when bright, the voice becomes prominent. A prominent voice means the speech sound differs from one's usual state. (The essence of the Five Zang and Six Fu organs all ascend to the eyes to form vision, thus causing the five colors to circulate brightly. Generally, if color is bright externally, it is due to Qi being abundant internally, so the voice must also be loud and distinct, differing from the usual state.)
The *Four Seasons Qi Chapter* states: Observing complexion and inspecting eyes to know the scattering and restoration of Shen involves viewing eye color to know the survival or demise of the disease. (When Shen is complete, Qi restores; when Shen is lost, Qi scatters. Thus, observing eye color allows one to know the disease's status.) Unifying form and listening to movements refer to holding the Cun Kou and Ren Ying pulses to observe them. If the pulse is firm, large, and slippery, the disease progresses daily; if the pulse is soft, the disease will recede. (A firm, large, and slippery pulse indicates blazing pathogenic Qi, so the disease progresses daily. A soft and harmonious pulse indicates the arrival of Yuan Qi (Original Qi), so the disease will recede. "Recede" means to retreat.) For excess conditions in the meridians, the disease will resolve in three days. (For unresolved pathogenic Qi, a weak and powerless pulse is most taboo. As stated in *Ping Ren Qi Xiang Lun*: Disease inside with a deficient pulse. *Yu Ji Zhen Zang Lun*: Disease outside with a pulse that is not solid and firm is difficult to treat. *Xie Ke Pian*: Deficient and fine pulses persisting for a long time. All refer to non-solid pulses. If the disease is in the meridians but the pulse is solid and forceful, pathogenic Qi is about to reach the exterior, so it can resolve in three days.) The Cun Kou pulse inspects Yin, and the Ren Ying pulse inspects Yang. (Cun Kou is at the wrist, belonging to the Hand Taiyin Lung Meridian; Cun Kou alone is the master of the Five Zang, thus used to inspect Yin. Ren Ying is at the neck, belonging to the Foot Yangming Stomach Meridian; the Stomach is the great source of the Six Fu, thus used to inspect Yang. Detailed discussion of Ren Ying and Cun Kou is in Zang Xiang Category 11.)
In general, the way of needling stops when Qi is harmonized (*Ling Shu: Ends and Beginnings Chapter*). Tonify Yin and drain Yang, and the voice and breath become more prominent, with ears and eyes becoming sharp; the opposite results in blocked Blood and Qi flow. (Here, Yin and Yang refer to interior and exterior. Since healthy Qi resides in the interior, it should be tonified, hence "Tonify Yin." Since pathogenic Qi enters from the exterior, it should be drained, hence "Drain Yang." When Yang pathogen departs and True Yin restores, voice and breath become prominent, and ears and eyes become sharp.) Regarding "efficacy upon Qi arrival," draining should further reduce excess; in a deficient patient, the pulse may be large but not firm as before; if it remains firm, although it appears unchanged, the disease has not departed. (The effect of Qi arrival via draining aims for emptiness; after draining, even if the pulse size is like before, if it becomes soft and not firm, it is effective. If the pulse remains firm like before, despite appearances, the disease is not removed.) Tonifying should further increase solidity; in an excess patient, the pulse may be large but firmer than before; if it is not firm as before, although the patient feels comfortable, the disease has not departed. ("Large" in these two sections generally refers to the advancement or retreat of the pulse body, not specifically to a洪大 (Surging/Large) pulse.) Therefore, tonification leads to solidity, drainage leads to emptiness; even if pain does not cease immediately with the needle, the disease will surely diminish. (Tonification leads to solidity, so the pulse must be firm. Drainage leads to emptiness, so the pulse must not be firm. If there is pain, although it may not heal immediately with the needle, it will gradually disappear.) One must first understand the diseases generated by the Twelve Primary Meridians, and only then can one transmit the meaning of *Zhong Shi*. (The Twelve Primary Meridians have left and right, upper and lower; the sites of disease have sequence. One must treat the origin of the disease to understand the meaning of ends and beginnings. *Zhong Shi* is the chapter name, meaning root and branch.) Therefore, when Yin and Yang do not shift, and deficiency and excess do not compromise each other, select points from their respective meridians. ("Shift" means change; "Compromise" means harm. Yin or Yang undergoes no change, they do not shift. Deficiency is self-deficient, excess is self-excess, they do not compromise. This implies the disease arises independently without cross-contamination, so one seeks the meridian and selects points.)
Regarding all types of needling, three insertions reach Gu Qi. When pathogenic factors combine recklessly, Yin and Yang exchange positions, reverse and contrary states occur, floating and sinking differ in location, and Four Seasons pulse patterns are lost, with pathogenic Qi lingering and overflowing, needles are required to remove them. (The meaning of "Three Insertions" is below. The six phrases regarding reckless combination etc. detail pathological changes. All such cases require needles, treating with the Three Insertion method, so various diseases can be removed.) Thus, the first insertion expels Yang pathogen, (The first insertion is shallow, thus expelling Yang branch pathogens.) the second insertion expels Yin pathogen, (The second insertion is deeper, thus expelling Yin branch pathogens.) and the third insertion brings Gu Qi. Stop when Gu Qi arrives. What is meant by Gu Qi arriving is that after tonification, the condition becomes solid; after drainage, it becomes empty. Thus, we know Gu Qi has arrived. (The third insertion waits for Gu Qi. Gu Qi is Yuan Qi. "Stop" means removing the needle. Pathogenic Qi comes tight and rapid; Gu Qi comes slow and harmonious. Only after pathogenic Qi departs does Gu Qi arrive. Thus, after tonification, the previously empty becomes firm; after drainage, the previously firm becomes soft. Hence, we know Gu Qi has arrived.) If only pathogenic Qi departs while Yin and Yang are not yet harmonized, the disease is known to be healing. Therefore, it is said: Tonification leads to solidity, drainage leads to emptiness; even if pain does not cease immediately with the needle, the disease will surely diminish. (The arrival of Gu Qi indicates the departure of pathogenic Qi. Although Yin and Yang meridian Qi may not be immediately harmonized, the disease is already healing. Hence the previous text says: Tonification leads to solidity, drainage leads to emptiness, and the disease will surely diminish.)