此篇以气血随谷脉为虚实，叮咛反复，以免误针。可见针灸家于虚实寒热补泻之道，亟应讲求，不
得笼统施治。
黄帝问曰∶愿闻虚实之要。岐伯对曰∶气实形实，气虚形虚，此其常也，反此者病。谷盛气盛，谷虚气
虚，此其常也，反此者病。脉实血实，脉虚血虚，此其常也，反此者病。帝曰∶如何而反？岐伯曰∶气虚
身热，此谓反也。谷入多而气少，此谓反也。谷不入而气多，此谓反也。脉盛血少，此谓反也。脉小血
多，此谓反也。气盛身寒，得之伤寒。气虚身热，得之伤暑。谷入多而气少者，得之有所脱血，湿居下也。
谷入少而气多者，邪在胃及与肺也。脉小血多者，饮中热也。脉大血少者，脉有风气，水浆不入，此之谓也。
夫实者，气入也。虚者，气出也。气实者，热也。气虚者，寒也。入实者，左手开针空也，入虚者，
左手闭针空也。
此篇与《灵枢·小针解》大同小异，后半所释，非《九针十二原》篇之文。疑另有九针一篇，或在外
经，今佚不传。篇末百二十四字，王冰已称义理残缺，莫可寻究，因上古之书，故且载之，以示一字千金之义。
黄帝问曰∶愿闻九针之解，虚实之道。岐伯对曰∶刺虚则实之者，针下热也，气实乃热也。满而泄之者，
针下寒也，气虚乃寒也。菀陈则除之者，出恶血也。邪胜则虚之者，出针勿按。徐而疾则实者，徐出针而疾
按之。疾而徐则虚者，疾出针而徐按之。言实与虚者，寒温气多少也。若无若有者，疾不可知也。察
后与先者，知病先后也。为虚与实者，工勿失其法。若得若失者，离其法也。虚实之要，九针最妙者，为其各
有所宜也。补泻之时者，与气开阖相合也。九针之名，各不同形者，针穷其所当补泻也。刺实须其虚者，留
针阴气隆至，乃去针也。刺虚须其实者，阳气隆至，针下热乃去针也。经气已至，慎守勿失者，勿变
更也。深浅在志者，知病之内外也。近远如一者，深浅其候等也。如临深渊者，不敢堕也。手如握虎者，欲其
壮也。神无营于众物者，静志观病患，无左右视也。义无邪下者，欲端以正也。必正其神者，欲瞻病患目制
其神，令气易行也。所谓三里者，下膝三寸也。所谓跗之者，举膝分易见也。巨虚者，跷足 独陷
者。下廉者，陷下者也。帝曰∶余闻九针，上应天地四时阴阳，愿闻其方，令可传于后世以为常也。岐伯
曰∶夫一天、二地、三人、四时、五音、六律、七星、八风、九野，身形亦应之，针各有所宜，故曰九针。人
皮应天，人肉应地，人脉应人，人筋应时，人声应音，人阴阳合气应律，人齿面目应星，人出入气应
风，人九窍三百六十五络应野。故一针皮，二针肉，三针脉，四
针筋，五针骨，六针调阴阳，七针益精，八针除风，九针通九窍，除三百六十五节气，此之谓各有所主也。
人心意应八风，人气应天，人发齿耳目五声应五音六律，人阴阳脉血气应地，人肝目应之九。九窍三百六十
五。人一以观动静，天二以候五色，七星应之，以候发毋泽。五音一以候宫、商、角、征、羽，六律有
余不足应之。二地一以候高下、有余。九野一节，俞应之，以候闭节。三人变一、分人候齿，泄多血少，十
分角之。变五分以候缓急，六分不足，三分寒关节。第九分四时，人寒温燥湿，四时
一应之，以候相反，一四方各作解。
这一篇通过气血随饮食水谷及脉象的虚实变化，反复叮咛告诫，以避免误用针刺。由此可见，针灸医家对于虚实、寒热以及补泻的原则，必须深入探究，不能笼统地进行治疗。
黄帝问道：我想了解虚实的要领。岐伯回答说：气盛则形体充实，气虚则形体虚弱，这是正常情况；与此相反的就是病态。饮食多则气盛，饮食少则气虚，这是正常情况；与此相反的就是病态。脉象实则血实，脉象虚则血虚，这是正常情况；与此相反的就是病态。黄帝说：怎样才算是相反呢？岐伯说：气虚而身体发热，这叫做反常。饮食摄入多但气却少，这叫做反常。不吃东西但气却多，这叫做反常。脉象盛大但血量少，这叫做反常。脉象细小但血量多，这叫做反常。气盛而身体发冷，这是由于感受了伤寒邪气。气虚而身体发热，这是由于感受了伤暑邪气。饮食摄入多但气少的，是由于失血或湿气积聚在下部所致。饮食摄入少但气多的，是由于邪气在胃和肺。脉象细小但血量多的，是由于体内有饮邪且伴有热。脉象大但血量少的，是由于脉中有风邪，且水浆不入，说的就是这种情况。
所谓实证，是邪气内入。所谓虚证，是正气外泄。气实的表现为热，气虚的表现为寒。治疗实证（使邪气外出），左手要张开针孔；治疗虚证（使正气留存），左手要闭合针孔。
这一篇与《灵枢·小针解》大同小异，后半部分所解释的内容，并非出自《九针十二原》篇。怀疑另有专门论述九针的一篇，或者在外经中，如今已经散佚不传了。篇末的一百二十四个字，王冰已经指出其义理残缺，无法寻究，因为这是上古之书，所以姑且收录，以显示一字千金的价值。
黄帝问道：我想了解九针的原理以及虚实的道理。岐伯回答说：针刺虚证使其充实的方法，是使针下产生热感，这是因为正气充实才会感到热。对满实证进行泻法，是使针下产生寒感，这是因为邪气虚衰才会感到寒。“菀陈则除之”的意思是排出恶血。邪气胜实需要泻除时，出针后不要按压针孔。徐缓出针而迅速按压（补法），是为了使正气充实。疾速出针而缓慢按压（泻法），是为了使邪气虚衰。所说的“实”与“虚”，是指寒温之气的多少。所说的“若无若有”，是指针下的感觉难以捉摸。观察治疗的先后顺序，是为了了解病情的先后发展。针对虚证和实证进行治疗，医生不可违背法则。如果感觉若得若失，说明偏离了法则。虚实的要领，九针最为奇妙，是因为它们各自有适宜的适应症。补泻的时机，是与经气的开阖相配合的。九针的名称不同，形状各异，是因为针具穷尽了应当补泻的部位。针刺实证需要等待邪气消退（留针候阴气隆至）才去针。针刺虚证需要等待正气恢复（阳气隆至，针下变热）才去针。经气已至，谨慎守护不要失误，意思是不要变更治法。深浅由意念决定，是为了了解病位的内外。远近如一，是指无论深浅，候气的标准是一样的。像面临深渊一样小心，是不敢懈怠。手像握着老虎一样有力，是希望手法稳健。精神不被众物干扰，是静心观察病患，不左右顾盼。进针端正无邪，是希望态度端正。必须端正患者的神志，是通过注视患者眼睛来制约其神志，使经气容易运行。所谓的“三里”，是在膝盖下三寸处。所谓的“跗”，是抬起膝盖容易看到的地方。所谓的“巨虚”，是踮起脚时单独凹陷的地方。所谓的“下廉”，是凹陷下去的地方。黄帝说：我听说九针上应天地四时阴阳，想听听它的方术，以便流传后世作为常规。岐伯说：一天、二地、三人、四时、五音、六律、七星、八风、九野，人的身形也与之相应，针各有适宜之处，所以称为九针。人的皮肤应天，人的肌肉应地，人的血脉应人，人的筋应时，人的声音应音，人的阴阳合气应律，人的牙齿面目应星，人的呼吸出入应风，人的九窍三百六十五络应野。所以一针刺皮，二针刺肉，三针刺脉，四针刺筋，五针刺骨，六针调和阴阳，七针益精，八针祛风，九针通九窍，除三百六十五节气，这就叫各有所主。人心意应八风，人气应天，人的头发牙齿耳目五声应五音六律，人的阴阳脉血气应地，人的肝脏眼睛对应九。九窍三百六十五。人一用来观察动静，天二用来候察五色，七星对应它，用来候察头发是否润泽。五音一用来候察宫、商、角、徵、羽，六律有余不足来对应它。二地一用来候察高下、有余。九野一节，腧穴对应它，用来候察闭节。三人变一、分人候察牙齿，泄多血少，十分对应角的变化。变五分用来候察缓急，六分不足，三分对应寒关节。第九分四时，人的寒温燥湿，四时一与之对应，用来候察相反的情况，一方四方各自作解释。
This chapter repeatedly emphasizes the deficiency and excess of Qi and Blood in relation to dietary intake and pulse conditions, to avoid erroneous acupuncture. Thus, it is evident that acupuncturists must diligently study the principles of deficiency/excess, cold/heat, and tonification/sedation, rather than treating indiscriminately.
The Yellow Emperor asked: "I wish to hear about the essentials of deficiency and excess." Qibo replied: "When Qi is excess, the body is full; when Qi is deficient, the body is weak. This is the normal state; the opposite indicates disease. When dietary intake is abundant, Qi is excess; when dietary intake is scant, Qi is deficient. This is the normal state; the opposite indicates disease. When the pulse is excess, Blood is excess; when the pulse is deficient, Blood is deficient. This is the normal state; the opposite indicates disease." The Emperor said: "How does one identify the opposite?" Qibo said: "Qi deficiency with body heat is called 'opposite'. Abundant food intake but scant Qi is called 'opposite'. No food intake but excessive Qi is called 'opposite'. Excessive pulse but scant Blood is called 'opposite'. Small pulse but abundant Blood is called 'opposite'."
"Qi excess with cold body results from Cold Injury (Shanghan). Qi deficiency with body heat results from Summer-heat Injury (Shangshu). Abundant food intake but scant Qi results from blood loss or dampness accumulating below. Scant food intake but excessive Qi results from pathogenic factors in the Stomach and Lung. Small pulse but abundant Blood results from fluid retention with internal heat. Large pulse but scant Blood results from wind pathogens in the vessels, where fluids are not ingested; this is what is meant."
Excess refers to the inward entry of pathogens. Deficiency refers to the outward leakage of Zheng Qi. Qi excess manifests as heat; Qi deficiency manifests as cold. To treat excess (expelling pathogens), the left hand should open the needle aperture. To treat deficiency (retaining Zheng Qi), the left hand should close the needle aperture.
This chapter is largely similar to *Ling Shu: Xiao Zhen Jie*. The latter half's explanation does not originate from *Jiu Zhen Shi Er Yuan*. It is suspected that there was another chapter dedicated to the Nine Needles, perhaps in the *Wai Jing*, which is now lost. Wang Bing noted that the last 124 characters have incomplete logic and are difficult to investigate. Since these are ancient texts, they are retained to demonstrate their immense value.
The Yellow Emperor asked: "I wish to understand the interpretation of the Nine Needles and the way of deficiency and excess." Qibo replied: "To tonify deficiency, one seeks warmth under the needle; this warmth arises when Zheng Qi becomes sufficient. To sedate fullness, one seeks coldness under the needle; this coldness arises when pathogenic Qi becomes deficient. 'Removing stasis and old blood' means evacuating bad blood. When pathogenic excess requires sedation, do not press the needle hole after withdrawal. Slow withdrawal and rapid pressing (Tonification) consolidates Qi. Rapid withdrawal and slow pressing (Sedation) disperses pathogens. 'Excess and Deficiency' refer to the degree of cold/warmth and Qi quantity. 'As if present, as if absent' refers to the elusive sensation of the needle. Observing order determines knowledge of the disease's progression. Treating deficiency and excess requires strict adherence to method. Deviation leads to a sense of loss. The Nine Needles are superior for managing deficiency/excess because each is suited to specific indications. Tonification and sedation timing aligns with the opening and closing of Qi. The different names and shapes of the Nine Needles correspond to the specific sites requiring tonification or sedation. For excess, retain the needle until Yin Qi arrives abundantly before removing it. For deficiency, retain the needle until Yang Qi arrives abundantly and warmth is felt before removing it. Once Jing Qi arrives, guard it carefully without changing the approach. Depth is determined by intent to know interior/exterior locations. Proximity and distance are treated equally regarding palpation. Approach with caution like standing at an abyss. Hold the needle firmly like grasping a tiger. Keep the mind undistracted, observing the patient quietly without looking around. Insert the needle upright and correctly. Stabilize the patient's Shen by gazing into their eyes to facilitate Qi flow."
"The point Sanli is three cun below the knee. 'Fu' refers to the area easily seen when lifting the knee. 'Juxu' is the depression visible when raising the foot. 'Xialian' is the depressed area."
The Emperor said: "I have heard the Nine Needles correspond to Heaven, Earth, Four Seasons, and Yin-Yang. I wish to learn the theory to pass it down." Qibo said: "One Heaven, Two Earth, Three Man, Four Seasons, Five Tones, Six Pitch-pipes, Seven Stars, Eight Winds, Nine Fields. The human body corresponds to these. Each needle has its suitability, hence 'Nine Needles'. Skin corresponds to Heaven. Flesh corresponds to Earth. Vessels correspond to Man. Tendons correspond to Seasons. Voice corresponds to Tones. Yin-Yang combined Qi corresponds to Pitch-pipes. Teeth and face correspond to Stars. Respiration corresponds to Winds. Nine Orifices and 365 collaterals correspond to Fields. Thus, Needle 1 treats skin, Needle 2 treats flesh, Needle 3 treats vessels, Needle 4 treats tendons, Needle 5 treats bone, Needle 6 regulates Yin-Yang, Needle 7 benefits Essence, Needle 8 dispels Wind, Needle 9 opens the nine orifices and removes 365 joint diseases. These are their respective dominions. Human intent corresponds to Eight Winds. Human Qi corresponds to Heaven. Hair, teeth, ears, eyes, and five sounds correspond to Five Tones and Six Pitch-pipes. Yin-Yang vessels and Blood/Qi correspond to Earth. Liver and eyes correspond to Nine. Nine orifices and 365 [collaterals]. 'One' observes movement/stillness. 'Two' observes five colors. 'Seven Stars' observe hair luster. 'Five Tones' observe Gong, Shang, Jue, Zhi, Yu. 'Six Pitch-pipes' respond to surplus/deficiency. 'Two Earth' observes height/depth and surplus. 'Nine Fields' one section, Shu points respond, observing joint closure. 'Three Man' changes to 'One', observing teeth, blood loss vs abundance, corresponding to Jue variations. Changes to 'Five Parts' observe slack/tightness. 'Six Parts' deficiency, 'Three Parts' cold joints. 'Ninth Part' Four Seasons, human cold/warmth/dryness/dampness correspond to seasons. Observe opposites. One direction, four directions, each explained."